The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 705-720
Comparative Study between Treatment of Lumbar Disc Herniation with
Intra Discal Ozone and Transforaminal Steroid Injection versus Steroid
Abd El Shafy Ahmed Haseeb, Abd El Hameed Abd El Hares, Khaled Mohamed Abd El Moez,
Ashraf Ismail Mustafa, and Osama Eid Ahmed Ahmed*
Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Al-
*Corresponding author: Osama Eid Ahmed Ahmed, Mobile: (020)01274858137, E-Mail: firstname.lastname@example.org
Background: Oxygen-ozone therapy is a minimally invasive treatment for lumbar disc herniation that
exploits the biochemical properties of a gas mixture of oxygen and ozone.
Objective: The purpose of our study was to prospectively evaluate the clinical effectiveness of oxygen-
ozone therapy and compared the therapeutic outcome of injection of oxygen-ozone combined steroid
with injection of steroid alone at different follow-up period.
Patients and Methods: One hundred patients were included for this study from al-Agouza Physical
Medicine, Rheumatology and Rehabilitation center. From March 2014 to April 2016, we treated 100
patients (42 men, 58 women; age range, 2365 years) with lumbar disk herniation (L3-4, 23 patients;
L4-5, 61 patients; L5-S1, 75 patients) and radicular pain. The mean duration of radicular pain at the
time of treatment was 8 weeks.
Result: Satisfactory clinical outcomes were obtained in both groups after two weeks, three months and
at 6 months. Treatment was successful in patients in group I and patients in group II. The difference
between group I and group II was insignificant.
Conclusion: O2O3 seems to play a role in pain relief, and we suggest the administration of the O2
O3 mixture combined with transforaminal steroid injection as a first-choice treatment before recourse
to surgery or when surgery is not possible.
Keywords: Lumbar Disc Herniation, Intra Discal Ozone, Transforaminal Steroid, Steroid Injection
The lumbosacral region is a critical
immunomodulating, and analgesic and anti-
area in the spinal column subjected to forces
inflammatory characteristics (3).
greater than elsewhere in the body with an acute
Intradiscal ozone has a direct effect on
change in the direction of transmission of
proteolysis during the release of water
forces at this level. Low back pain (LBP) is one
molecules and cell degeneration of the matrix,
of the most common complaints that a patient
which is replaced by connective tissue and
presents with at a pain clinic. It has been an
blood cells (4). The resulting effect on the disk
important clinical, social, economic, and public
nucleus is mainly a result of the dehydration of
health problem affecting the human population
the fibrillary matrix of the nucleus pulposus,
revealing collagen fibers and signs of
Ozoneoxygen nucleolysis is one of
regression like vacuole formation and
the treatments for patients with subacute and
fragmentation. The reduction in herniated disk
chronic low back pain that needs careful
volume is one of the therapeutic aims of
evaluation with respect to its effectiveness in
intradiscal administration of medical ozone, as
short-and long-term pain relief. Ozone oxygen
disk shrinkage may reduce nerve root
nucleolysis is a minimally invasive therapy for
the treatment of disk herniations and is often
addressed the subject of volume changes in test
combined with periradicular administration of
animals such as pigs, dogs, and rabbits (5).
steroids and local anesthesia (2). The treatment
Previously published studies have
is based on various mechanisms of action.
shown an association between the reduction of
Ozone (i.e., O3) is an unstable, strongly
the herniated lumbar disk size and the
improvement in patient symptoms with
reduction in nerve root edema. It has been
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 721-725
Corneal Endothelial and Central Corneal Thickness Changes after non
Complicated Uneventful Phacoemulsification
Mohamed A. El Masry, Abdelghany I. Abdelghany, Mohamed R. Elrefaei
Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mohamed R. Elrefaei, Email: email@example.com
Aim of the work: this study aimed to evaluate the central corneal thickness and the corneal endothelium by
specular microscopy in torsional phacoemulsification versus longitudinal phacoemulsification. Methods: in our
study we did a comparative analysis of the changes in endothelial cells of the cornea (Central cell density and cell
loss) and central corneal thickness after cataract extraction surgeries by torsional phacoemulsification versus
longitudinal phacoemulsification. In our study thirty eyes of thirty patients were chosen from Ophthalmology clinic
at Bab Al-Shaariah University Hospital for uneventful phacoemulsification surgeries (15 eyes of 15 patiens for
torsional phaco and 15 eyes of 15 patients for longitudinal phaco). The types and densities of cataract were
determined as cortical, posterior supcapsular (PSC), nuclear I, nuclear II and nuclear III. Divide and Conquer
technique was used for phacoemulsification using (Infiniti, Ozil technology, Alcon) phaco machine. A noncontact
specular microscope Topcon SP-1P (Topcon Corporation, Japan) was used to evaluate the central endothelial cell
density (CD) and central corneal thickness (CCT). Results: The mean U/S time was lower in the torsional group
than in the longitudinal group (p< 0.05). On comparing between the torsional Phaco and longitudinal phaco groups,
the longitudinal phaco group had higher average central corneal thickness (p > 0.05) and higher average corneal
endothelial cell losses at 2 weeks postoperative (p > 0.05). Conclusions: our study suggested a better efficiency by
the torsional mode rather than the longitudinal mode.
Keywords: Corneal Endothelial ,Central Corneal Thickness .
Phacoemulsification and intraocular lens
phacoemulsification act by longitudinal stroke
implantation is the preferred method to treat cataract,
direction that produce cutting action during forward
however, the quality of surgery is a problem that
stroke. This longitudinal technique benefits from high
needs to be addressed (1). Phacoemulsification surgery
vacuum to reduce the repulsion with the generated
can be described based on its two components. The
heat being proportional to the phaco power that used
first, ultrasound energy is used to emulsify the
.Torsional phacoemulsification act by sideways
nucleus of the lens. The second, a fluidic circuit is
stroke direction that produce cutting action during
used to remove the nucleus through a small incision
either right or left directions, this lead to less power
while maintaining the anterior chamber. The circuit is
needed than longitudinal technique, better efficacy
supplied by an elevated irrigation bottle that supplies
and less phaco time. Also with the torsional technique
both the fluid volume and pressure to maintain the
there is better follow ability with less repulsion and
less dispersion of lens matter so we can decrease the
hydrostatically. The anterior chamber pressure was
vacuum, in addition to better anterior chamber
directly proportional to the height of the bottle. The
stability i.e. less surge (4).
fluid circuit was regulated by a pump that clears the
PATIENTS AND METHODS
chamber from emulsion and also provided significant
clinical utility. When the phaco tip was unoccluded,
30 patients with cataract were categorized into
the pump produced currents in the anterior chamber
two groups: the first group was consisted of 15
which attract nuclear fragments. When a fragment
patients, whose ages ranged from 55 to 70 years for
completely occlude the phaco tip, the pump provide
torsional phacoemulsification. The second group was
holding power or vacuum, which grip the fragment (2).
also consisted of 15 patients, their ages ranged from 55
Interrupted phaco mode, improved pump system and
to 70 years for longitudinal phacoemulsification. An
vacuum assisted phaco have reduced the amount of
ethical approval was obtained from the local ethical
ultrasound power needed to remove the cataract. The
committee and all patients signed informed consent for
ultrasound power continue to carry the risk for
the surgical procedure. All surgeries were performed
corneal endothelial cell loss and tissue damage. So,
using the Infiniti Vision System (Alcon Laboratories
reducing ultrasound power with improving its
Inc.). Patients were with nuclear, cortical and nuclear
cataract of grades I-IIIII. Exclusion criteria included
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 726-734
Evaluation of Psychological and Sexual Effects of Female Genital
Zakaria Mahran Obaid1, Ahmed Wahhed-Allah Amer1, Mohammed Abdel Fatah El
Mahdy2, Amira Elmaadawy Barakat Mohammed1*
Departments of 1Dermatology, Venereology & Andrology and 2Psychiatry, Faculty of
Medicine, Al-Azhar University, Damietta, Egypt
*Corresponding author: Amira Elmaadawy Barakat Mohammed, E-Mail: firstname.lastname@example.org, Mobile:
Background: female genital mutilation (FGM), also known as female circumcision (FC), but
more recently as female genital mutilation/cutting (FGM/C) according to the World Health
Organization (WHO), has occurred in many forms in all societies. The psychosocial
consequences include post-traumatic stress disorder (PTSD), anxiety disorders, panic
disorders, depression and suppression of feeling and thinking, and sometimes attempted
Objective: To evaluate sexual and psychological effects of female genital mutilation.
Patients and Methods: The two groups were compared as regard many demographic data
such as age, level of education, associated chronic diseases and previous gynecological
history. The results revealed no significant difference between the two groups in the
educational level. The females in the two groups also showed significant difference in their
agreement with the process and subsequently in their future decision in performing
circumcision for their daughters. Other demographic data included in this study revealed no
difference between the studied groups.
Results: The study used different questionnaires and scores to compare the sexual satisfaction
and psychological effects of the females in the study. For assessment of sexual satisfaction,
Female Sexual Function Index (FSFI) questionnaire translated into Arabic was used and
showed no significant difference between the two groups except for only a single domain"
Conclusion: Concerning the psychiatric analysis of the two groups, Anxiety Hamilton score
and Depression Beck score were used and showed no statistically significant difference
between the two groups in the two scores. Also 19% of the females in the group of FGM
showed positive symptoms for post-traumatic stress disorder (PTSD).
Keywords: Post-traumatic stress disorder, female genital mutilation, female circumcision
According to a 2013 UNICEF report
The psychosocial consequences of
covering 29 countries in Africa and the Middle
East, Egypt has the highest total number of
disorder (PTSD), anxiety disorders, panic
women that have undergone female genital
disorders, depression and suppression of
mutilation (FGM) (27.2 million) in the region,
feeling and thinking, and sometimes
while the highest percentage (prevalence) of
attempted suicide (4).
FGM was in Somalia (98%)(1). FGM harms
women's physical health throughout their lives
psychological trauma of the painful
(2). Circumcised women have reported several
procedure, sense of humiliation and being
sexual problems including a reduction in all
cheated by parents, use of physical force
her sexual cycle as sexual desire, arousal,
by those performing the procedure,
excitement, orgasm, and dyspareunia at
negative genital image, lack of sense of
varying levels (3).
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 735-743
Surgical Outcomes of Right Anterolateral Minithoracotomy versus Median
Sternotomy in Atrial Septal Defect
Hossam ElSayed Abd Al-Fattah, Mohammed Eldesoky Sharaa, Mohammed Abd Al-Fattah
Department of Cardiothoracic Surgery, Faculty of Medicine, Al-Azhar University
Corresponding author: Hossam Elsayed Abd Al Fattah, Mobile: 01060792731, Email:email@example.com
Background: the atrial septal defect repair has been traditionally approached through a median sternotomy.
However, significant advances in surgical optics, instrumentation, tissue tele manipulation and perfusion
technology have allowed for atrial septal defect repair to be performed by using progressively smaller
incisions including the minithoracotomy. Aim of the study: this study aimed to compare the surgical
outcome of right anterolateral minithoracotomy versus median sternotomy in atrial septal defect repair.
Methods: this study was done in Department of Cardiothoracic Surgery at Elhussen Hospital, Al-Azhar
University, after approval of the local ethical committee in the period between July 2017 till July 2018. 30
patients with ASD required ASD repair were included in this study for operative and short term
postoperative results to evaluate the impact of two approaches of repair on quality of life of patients who
survived the operation was studied. Results: The patients in both groups were similar in age preoperative
comorbidities and ejection fraction but more female s were in Right anterolateral mini -thoracotomy group.
There was a highly statistically significant prolonged pump-run time in the thoracotomy group than the
sternotomy group with p-value ¼ 0.0 0 4. Interestingly, in the thoracotomy group, mechanical ventilation
time (hours) was shorter with p-value ¼ 0.0 02. There were similar blood transfusion rate, chest tube
drainage, intensive care unit stay and hospital length of stay. However, more wound infection was found in
the sternotomy group which was statistically significant (p-value ¼ 0.035). There were no patients requiring
conversion to full sternotomy, no residual defect across the atrial septum and all patients were alive on a
month follow-up of the hospit al discharge. Conclusion: right antero-lateral mini-thoracotomy technique
for atrial septal defect anomaly closure was safe and reliable technique as sternotomy incision. Apart from
its restricted operating field and longer pump-run time, it kept the sternal integrity, it had better esthetic
incision, it reduced wound infection and the need for analgesia. Moreover, it is associated with an early
recovery and short ICU stay.
KEYWORDS atrial septal defect, right anterolateral thoracotomy
a reduction in surgical trauma with limited access
techniques, resulting in reduced hospital stays,
Atrial septal defect (ASD) is one of the most
reduced hospital costs, improved cosmosis and
common congenital heart defects. ASD was
increased patient satisfaction (3).Currently,
among the first anomalies to be corrected by
different trans-catheter closure procedures have
surgical treatment (1).
been introduced with outstanding long-term
outcomes, but they are still limited to apply for all
Sternotomy technique had been the gold standard
patients to avoid serious complications (4).
in cardiac surgery and generally provides an
Moreover, RALT for ASD repair gives an
unobstructed view of the heart. This is the
excellent exposure and the cannulation can be
currently used method in which all surgeons are
achieved either centrally or femorally in addition
trained and perform cardiac surgery across the
to the cardioplegia delivery to myocardium (5).
Built on the premise that less invasive surgery
could expedite postoperative recovery aiming to
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 744-751
Toxic effects of chronic exposure to dyes among workers of synthetic textile
Ahmed F.M. Mohammed*, Magdy M. Sherif*, Ashraf I. Hasan*, Bahyeldein E. Makrahy**, Nabil E.
Forensic Medicine and Clinical Toxicology, Internal Medicine (*) and Clinical Pathology (**) Departments,
Faculty of Medicine, Al-Azhar University
Corresponding author: Ahmed F.M. Mohammed, mobile: 01009612291, email:firstname.lastname@example.org
Background: textile industry is one of the major industries in Egypt. However, the working environment is
associated with potential health hazards. Aim of the work: to study the toxic effects of different types of dyes
among workers in textile industries and its effect on their respiratory, renal, and immunological systems.
Subjects and methods: this study was conducted on 50 male workers exposed to textile dyeing of different
ages, selected from all textile plants with dyeing industry at Borg Al-Arab City compared with 50 males, who
were not exposed to textile dye as a control group. Results: both groups were comparable as patient age, while
smoking was significantly increased in exposed group (38.0% vs 14.0%). Reported symptoms such as itching,
abdominal pain, etc. and respiratory symptoms were significantly increased in exposed group. There was
significant increase of AST, ALT, total bilirubin and alkaline phosphatase, urea and serum creatinine in study
when compared to control group. Furthermore, there was statistically significant decrease of respiratory function
percentage of predicted in study group, and there was statistically significant increase of serum lead
concentration in study when compared to the control group (17.18±2.35 vs 6.74±2.29 respectively). In addition,
there was significant increase of IgM and IgG in study group. Conclusion: workers in textile industry were
significantly exposed to health hazards especially on respiratory system. However, multi-organ affection is the
role with increased oxidative stress.
Keywords: textile, reactive oxygen species, respiratory, dyes, oxidative stress.
Textile is one of the leading industries in the
textile industries cause a range of environmental
world. Approximately 60 million workers are
problems, mostly the pollution of water resources
employed in the textile industry globally (1). The
(4).Textile wastewater contains various chemicals
textile industry workers are exposed to a number of
such as oil, grease, caustic soda, Glauber salt
chemicals including dyes, solvents, optical
(Na2SO4), ammonia, sulfide, lead, heavy metals
brighteners, finishing agents and numerous types of
and other toxic substances (5).
natural and synthetic fibre dusts which affect their
Typical characteristics of wastewater produced by
health. In addition, workers in the textile industry
the textile industry include high temperature, a wide
are exposed to airborne dust containing infectious,
range of pH values, biochemical oxygen demand
allergic and toxic substances (2). Furthermore,
(BOD), chemical oxygen demand (COD), total
working conditions in the developing world are
dissolved solids (TDS), heavy metals and strong
often very poor and the textile industry is not an
exception to this rule. Increasing awareness of
Aim of the work
consumers through civil society campaigns has
The aim of this work was to study the toxic effects
contributed to some relevant improvements,
of different types of dyes among workers in textile
especially in large factories delivering directly to
industries and its effect on their respiratory, renal,
the European and American markets. However,
and immunological systems.
working conditions in smaller factories that either
Subjects and methods
produce for the local market or are employed by the
This study was conducted on 50 male workers
large factories in case of higher demand are not well
exposed to textile dyeing of different ages, selected
known, although a high proportion of the workers
from all textile plants with dyeing industry at Borg
are employed in these small enterprises (3).The
Al-Arab City compared to 50 males, who were not
textile manufacturing is the major industrial water
exposed to textile dye as the control group. Before
user. Despite significant economic contributions,
inclusion in this study, an informed consent was
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 752-763
Adherence of surgeons to surgical prophylaxis guidelines
Alshehri Ibrahim M.1, Albishry Ibraheem M.2, Alharthi Khuwailid R.3, Al Qarni Bader A.4*
1 Inpatient Pharmacy Supervisor, Rabigh General Hospital, Jeddah,2 Rabigh General Hospital,
Pharm.,D 3 King Abdullah Hospital, Bishah, BPharm, Pharm.,4 Al-Thagar General Hospital, Jeddah,
Corresponding author: Al Qarni, Bader Ayed, Training and Education Section Supervisor, Al-Thagar General Hospital,
Jeddah, BPharm, PharmD, MClinPharm. Be.email@example.com.
Background: surgical site infections (SSIs) are microbial contamination of the surgical wound during
a period of one month that could result in major post-operative morbidity and mortality rates.
Objectives: this study aimed to identify the adhesion of surgeons to antibiotics prophylaxis guidelines
at Kingdom of Saudi Arabia (KSA). Methods: this study included 180 adult subjects who were
scheduled to undergo major surgeries in the hospital. The data of the patients were collected from the
surgical wards and day care unit. Results: most of the included surgeons showed no error during pre,
intra and post operative duration as give the required antibiotics and didn't give the non-require
antibiotics. The preoperative adherence of surgeons as most of the surgeons (73.9%) followed the
prophylactic measures that included correct choice, indications, dosage and duration. Most of the
surgeons (76.1%) followed the prophylactic measures including correct choice, indications, dosage and
duration during intra-operative period. The majority of the surgeons (75%) followed the prophylactic
measures including correct choice, indications, dosage and duration during post-surgical duration.
Conclusion: The level of surgeon's adherence to antibiotic prophylactic guidelines was efficient among
most of surgeons regarding the proper choice of antibiotic, duration, timing and indication. However,
these results differ from other available studies, this study showed a good sign for application of
antibiotic prophylactic measures in KSA hospitals. Further studies should be conducted to increase the
knowledge and adherence of surgeons all over KSA.
Keywords: adherence, prophylactic measures, antibiotic prophylaxis guidelines, surgeons, KSA,
Surgical site infections (SSIs) are
of infection and its consequences (11, 12). They
microbial contamination of the surgical wound
were recommended for clean, contaminated as
during a period of one month. SSIs could result
well as dirty procedures to avoid specific
in major post-operative morbidity and mortality
criteria of risk factors for infection (12-15).At
rates that increases the costs of treatment on
first, the type of surgery must be determined
populations and health authorities (1, 2). The SSI
then implanting a protocol for proper
annual prevalence in the United States was
prophylactic program. Also, popper time,
about 1.07% resulting in 8000 deaths every year
efficiency, advantages and complications must
with more than10 billion dollars for treatment
be taken into consideration before, during and
(3). Also, in the United Kingdom, SSI was
after the surgery. The greater the adhesion to
responsible for increasing the length of the
the surgical antibiotic prophylaxis would
hospital stay from 5-17 days and extra cost for
significantly decrease the rates of anaphylactic
each case by about 3394 dollars (4, 5). About
shock and diarrhea induced by antibiotic usage.
40% of surgical infections were found to be
Another aspect that necessitates adhesion of
SSIs (6) thus prevention and implementing of
surgeons to antibiotic prophylaxis programs is
antibiotic prophylaxis projects could reduce the
to reduce the resistance pattern of microbes to
rates of SSIs which in turn would decrease
antimicrobial agents. This study aimed to
hospital stay, ICU admission and costs for
identify the adhesion of surgeons to antibiotics
further treatment (7-10). The antibiotic
prophylaxis programs are defined as the
administration of antibiotic medications before,
during or after the surgery to decrease the risk
Rational and hypothesis:
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 764-770
Double Guidewire Technique versus Transpancreatic
Sphincterotomy for Difficult Biliary Cannulation
Mohie Eldin Mohamed Amer, Mohamed Abdel Rasheed Abdel Khalik Allam and Mohamed
Department of Tropical Medicine, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mohamed Hamza Al-Sisi, Mobile: (020)1095667072, E-Mail: firstname.lastname@example.org
Background: The standard biliary cannulation technique has been reported to fail in approximately 5
20% of cases so, several supplementary techniques have been recommended to facilitate access to the
common bile duct (CBD); Double-guidewire technique (DGT) and transpancreaticsphincterotomy
(TPS) are effective method in cases of standard biliary cannulation failure.
Objective: To compare the outcomes between DGT and TPS in patients with difficult biliary cannulation
regarding the procedure duration, success rate and complications.
Patients and Methods: This was a randomized study conducted in Al-Hussein University Hospital,
Endoscopy Unit in the period between May, 2016 to October, 2017. A total of 40 patients, who bile duct
cannulation was not possible and selective pancreatic duct cannulation was achieved were randomized into
DGT (n = 19) and TPS (n = 21) groups. DGT or TPS was done for selective biliary cannulation. We
measured the technical success rates of biliary cannulation, median cannulation time, and procedure related
Results: The distribution of patients after randomization was balanced, and both groups were
comparable in baseline characteristics. There was no significant difference between both groups
regarding age and sex distribution, clinical presentation, laboratory findings and sonographic findings.
Successful cannulation rate and mean cannulation times in DGT and TPS groups were 94.7% vs 95.2%
and 20.1 ± 8.7min vs 21.5 ± 7.8min, P = 0.602, respectively. There was no significant difference
between the two groups.
Conclusion: When free bile duct cannulation was difficult and selective pancreatic duct cannulation
was achieved, DGT and TPS facilitated biliary cannulation and showed similar success rates. However,
post-procedure pancreatitis and Cholangitis were significantly higher in the DGT group.
Selective biliary cannulation is a
have been made to develop alternative
crucial step for therapeutic endoscopic
endoscopic techniques, with the goal of
increasing the rate of successful biliary
(ERCP) (1). In the hands of experienced
endoscopists, successful biliary cannulation
rates are higher than 90%(2).
The use of a guidewire to physically
occupy the pancreatic duct (PD), also known
However, in some cases, bile duct
as the double-guidewire technique (DGT).
(BD) cannulation can be difficult because of
Sinceits first description, this method has
special anatomical features, inflammatory
been used with promising results in cases of
processes, and adenomas of the papilla or
complex biliary cannulation, especially in
patients with a distorted BD anatomy caused
In the past few years, various efforts
by neoplasia or atypical morphology of the
Predictive Factors for Failed Endoscopic Retrograde Cholangiopancreatography
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 771-774
Predictive Factors for Failed Endoscopic Retrograde
Hassan Abd El-Hafiez, Mohamed Abdel Rasheed, Mohamed Ismail Fadel*
Tropical Medicine Department, Al Azhar University
Background: failure during cannulation renders the endoscopic retrograde cholangiopancreatography
(ERCP) unsuccessful and gives rise to various consequences, including cholangitis and pancreatitis, which
may require interventions, such as percutaneous transhepatic cholangiography (PTC) and surgery, with
Aim of the Work: we aimed to establish predictive factors for ERCP failure.
Patients and Methods: a total of 103 ERCP procedures were done from October 2016 to October 2017 in
the endoscopy unit at AL Hussein university hospital. Patients were divided according to ERCP results into 2
groups; group I consists of 93 cases of successful ERCP procedure (90.2%) and group II consists of 10 cases
of failed ERCP procedure (9.7%). After clear written consent, full clinical, sonographic and laboratory
evaluation were done for all patients.
Results: patients with history of previous abdominal surgery and\or CBD stricture had a significant higher
rate of ERCP failure. Duodenal diverticula, papillary mass and gastric outlet obstruction were significantly
higher in failed ERCP group.
Conclusion: any patient with history of previous abdominal surgery, CBD stricture and benign or malignant
tumors should be investigated before ERCP with non-invasive image as magnetic resonant
cholangiopancreatography (MRCP) or Endoscopic ultrasound (EUS).
Cholangiopancreatography and Endoscopic Ultrasound
Since its introduction in 1968, endoscopic
times, or hook-nose-shaped papilla (difficult type
retrograde cholangiopancreatography (ERCP) has
of cannulation) (2).
become a commonly performed endoscopic
PATIENTS AND METHODS:
procedure. The diagnostic and therapeutic utility
of ERCP has been well demonstrated for a variety
This prospective study was carried out at
of disorders, including the management of biliary
AL Hussein University Hospital Endoscopy unit
malignancies, and the evaluation and treatment of
from October 2016 to October 2017. The
benign and malignant disease of the pancreas (1).
examined patients were divided according to
ERCP results into 2 groups; group I successful
ERCP cases; and group II of failed ERCP cases.
endoscopic retrograde cholangio-pancreatography
(ERCP) requires selective cannulation of the bile
All patients signed an informed written
duct. Despite advances and new developments in
consent before the procedures, after receiving an
endoscopic accessories such as catheters, guide-
explanation on the risks, benefits and alternatives
wires and sphincterotomes, selective biliary
of ERCP and associated therapeutic procedures.
cannulation fails in 5%-15% of cases, even in
The study was approved by the Ethics Board of
expert high-volume centers (2).
Difficult biliary cannulation was defined
All patients were subjected to full history
as failure to achieve selective biliary access by
taking, full laboratory evaluation included;
wire-guided cannulation despite 5 min of
complete blood picture, prothrombin time and
attempted cannulation (cannultion time > 5 min),
partial thromboplastin time, liver functions, renal
papillary contacts > 5 times, attempted
functions and serum amylase, as well as
unintentional pancreatic duct cannulation > 3
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 775-781
The Role of Ultrasound versus Hysteroscopy in Assessment of Cesarean Section
Scar in Non Pregnant Females
Islam Ibrahim Abdel-Aziz El-Ewiny*, Farid Ahmed Kassab, Kamel Nour el-Dean Abdul-Jaleel
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-azhar University, Cairo, Egypt
*Corresponding author: Islam Ibrahim Abdel-Aziz El-Ewiny, Email: email@example.com
Background: cesarean section is one of the most commonly performed surgical procedures in obstetric practice.
It has become increasingly important to study the sequelae of this procedure on the future reproductive capacity.
Special investigations are required for assessment of CS scar integrity to avoid its dehiscence or rupture during
pregnancy or labor.
Objectives: to compare between the accuracy of ultrasound and hysteroscopy in visualization of the site of
Cesarean section scar in non-pregnant females and also to determine and comment on thickness, vascularity,
continuity and ballooning of the scar.
Patients and Methods: in a comparative cross-sectional study, 50 women with previous cesarean section
attending the Ob/Gyne outpatient clinic complaining of infertility or recurrent pregnancy loss. They had been
examined by transvaginal ultrasound (TVS), then by hysteroscopy to evaluate and compare their accuracy in
assessment of the scar.
Results: it was found that hysteroscopy can't comment on scar thickness but transvaginal ultrasound can do it
in all patients of the study with a mean value 1.57 mm. There is a statistically significant correlation between
the use of ultrasound and hysteroscopy in determination of the site, continuity and vascularity of scar, while
there is a statistically insignificant correlation between ultrasound and hysteroscopy in determination of the
balloning of the scar.
Conclusion: ultrasound is more accurate than hysteroscopy in evaluating scar thickness and detection of scar
Keywords: Cesarean section scar, ultrasonography, hysteroscopy.
Cesarean section (CS) is one of the most
assessment of scar integrity to avoid its dehiscence
commonly performed surgical procedures in
or rupture during pregnancy or labor (4).
obstetric practice, as large number of women are
undergoing this vital operation each year, it has
For women who have had previous
become increasingly important to study the
Caesarean section, choices for mode of birth in their
sequelae of this procedure on the future
next pregnancy are either trial of Vaginal Birth after
reproductive capacity (1).
Cesarean (VBAC) or an Elective Repeat Cesarean
Cesarean section is associated with
complications in subsequent pregnancies, such as
In the recent years, VBAC was found to be
placenta previa, placenta accreta, increta or
less safe than was thought previously. This fact led
percreta, dehiscence or uterine rupture. Also the
to less obstetricians offering and less patients
surgical maternal morbidity including risk of bowel
accepting VBAC. Decreased utilization of VBAC
and bladder injury is significantly increased (2).
and increased rates of ERC is one of the major
factors behind global increase in Cesarean section
Cesarean sections are usually performed by
incision of the lower uterine segment. Women with
previous Cesarean section may develop intrauterine
Uterine rupture due to dehiscence of the
adhesions with subsequent infertility, recurrent
previous CS scar is one of the most morbid and
pregnancy loss or menstrual disorders (3). Moreover,
catastrophic complications that may happen during
women with previous Cesarean section are
delivery either by VBAC or ERC. The risk of
considered a high risk patient when she gets
uterine rupture during VBAC trial is estimated to be
pregnant and requires special investigations for
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 782-788
Evaluation of the Effect of Diabetes Mellitus on Corneal Biomechanics
Abd Elmagid Mohamed Tag Eldin, Abdulmoez Haddad Ahmed, Amr Khalil Abdelmonem*
Ophthalmology department, Faculty of Medicine, Al-Azhar University
*Corresponding author: Amr Khalil Abdelmonem, E-Mail: AmrKhalilAbdelmonem@gmail.com, Mobile: 01002877071
Background: the cornea exhibits viscoelastic properties, which give it the quality of hysteresis. Corneal
hysteresis is an important indicator of the biomechanical properties of the cornea.
Aim: to compare the biomechanical properties of the cornea in patients having diabetes mellitus and age
matched normal individuals as regards to corneal hysteresis (CH), corneal resistance factor (CRF), Corneal
compensated IOP (IOPcc) and Goldman- correlated IOP (IOPg).
Patients and Methods: A total of 200 eyes of 100 patients were enrolled in our study. Patients were
selected from Ophthalmology outpatient clinics in Minia Health Insurance Hospital Ophthalmology
department. The type of our study is a case-control one. Patients were divided into two equal groups:
Group A: included 50 patients (100 eyes) of age matched normal individuals.
Group B: included 50 patients (100 eyes) having type 2 diabetes mellitus.
Results: mean CH in control group was 9.8±1.3 mm Hg in comparison to mean CH in diabetic group which
was 11.9±1.4 mm Hg, which was statistically significantly higher in diabetic patients when compared to
control group, (P value = 0.<001).
Conclusion: the corneal biomechanics in diabetic group are significantly higher compared with those of
the control group.
Keywords: Cornea, corneal hysteresis, corneal resistance factor, intra-ocular pressure, diabetes mellitus,
corneal compensated intra-ocular pressure, Goldman correlated intra-ocular pressue.
Biomechanics of the cornea affect its
corneal resistance to intraocular pressure (IOP)
functional responses and greatly impact vision.
measurements than central corneal thickness
The physical composition of the cornea gives it a
viscoelastic property which means that it exhibits
The ORA uses a puff of air to deflect the
elements of both elasticity and viscosity (1, 2).
cornea while an infrared beam tracks changes in
Elasticity refers to the ability of a
the shape of the anterior cornea during inward
substance to deform reversibly under stress.
and outward deviation. Analysis of the
Viscous materials, on the other hand, flow when
parameters produced by the infrared waveform
an external shear force is applied and do not
signal allows the calculation of several useful
regain their original shape when the force is
values. Corneal hysteresis (CH) is calculated as
the difference in air pressures between force-in
characteristics of both viscosity and elasticity,
applanation (P1) and force-out applanation (P2),
resulting in energy dissipation when stress is
or (P1 P2). However, corneal hysteresis values
applied. The energy lost in this dissipation
can be produced by various combinations of
process is called hysteresis (CH) (3).
corneal thickness, rigidity, intraocular pressure,
The Ocular Response Analyzer (ORA)
and hydration. Corneal resistance factor is
(Reichert Inc., Depew, New York), described by
another measurement provided by ORA (4).
Luce (4) , is the only commercially available
Diabetes leads to complications in almost
medical device capable of measuring corneal
all ocular structures, diabetes significantly
biomechanics. In vivo Studies have shown that
CH is altered in various disease states.
physiological and clinical properties of the cornea
Measurement of CH also provides a more
complete characterization of the contribution of
Aim of the Work:
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 797-801
The Incidence and Predictors of Renal artery Stenosis in Patients Referred for
Mohamed Osama Fathy Kayed1, Haytham Mahmoud Hassan 2, Mostafa Elsayed Abd ElGhany1, Adham Mohamed Abd
1Department of Cardiology and 2Department of Community and occupational medicine, Faculty of Medicine. Al-Azhar
University, 3Department of Cardiology, Matrouh Specialized Cardiothoracic and Interventional Catheterization Center,
Corresponding author: Adham Mohamed Abd Elkader, Tel: 002-01099452447, firstname.lastname@example.org
Background: Renal artery stenosis (RAS) and coronary artery disease (CAD) are two manifestations of a same pathogenesis
which is atherosclerosis.. RAS is a leading factor of secondary hypertension, ischemic nephropathy and end stage renal disease
(ESRD). Aim of work: This study was aimed to detect the incidence and predictors of renal artery stenosis in patients referred
for elective coronary angiography. Patients and Methods: In this study we included 100 patients who underwent coronary
and renal angiography. The mean age was 56.6 + 7.9 years, 60 males (60%), 40 females (40%), 60 diabetic (60%), 58
hypertensive (58%), 41 smokers (41%), 62 dyslipidemic (62%), 27 patients with family history of ischemic heart disease
(27%), and patient with normal coronaries 12 (12 %). Our study consisted of 2 groups; 87 (87%) patients with normal renal
arteries (group 1) and 13 (13%) patients with renal artery stenosis (group 2). Results: The incidence of RAS was 13% and the
incidence of significant RAS (>50% stenosis) was 7%. The significant difference between the two groups was in the terms of
hypertension (p-value 0.014), female gender (p-value 0.021), multivessel (> 2 vessels) coronary artery disease (p-value 0.046),
normal coronaries had a significant negative association with RAS (p-value 0.027) and there was a significant relationship
between atherosclerotic involvement of Left anterior descending artery (LAD), Diagonal, and right coronary artery (RCA) with
RAS (p-value 0.037, 0.041 and 0.042). Conclusion: It could be concluded that predictors of RAS were hypertension,
multivessel coronary artery disease (> 2 vessels) and female gender.
Keywords: Coronary angiography; renal artery stenosis; renal angiography; atherosclerosis.
Atherosclerosis accounts for about 90% of cases with
Cardiovascular disease is the principal cause of death
RAS and mostly involves the origin and the proximal third of
worldwide. Significantly, it remains the chief cause of
the main renal artery. Actually, ostial RAS can be considered
preventable death globally. Public health efforts to improve
as a combined disease of the aorta and the renal artery,
lifestyle and control lifestyle related major cardiovascular
instead of an isolated problem of the renal arteries. 
risk factors, will definitely contribute to cardiovascular
Definitely, atherosclerotic RAS is a progressive disease, as
disease prevention .
more than half of the patients show an increasing degree of
Renal artery stenosis (RAS) generally refers to a disease
stenosis within 5 years after diagnosis , and one out of five
of the large extra-renal arterial vessels and is mostly caused
patients with a critical stenosis undergoes renal atrophy and
by atherosclerotic obstructions. Atherosclerotic RAS causes
renal failure throughout this period .
cardiorenal problems. Thus it is a matter of concern for both
nephrologists and cardiologists. Yet, the kidney does not
Aim of the work:
present organ-specific signs or symptoms of ischemia, unlike
This study was aimed to determine the incidence and
the heart, brain or lower limbs. Successful detection of RAS
predictors of renal artery stenosis in patients suspected
can thereby be very difficult in clinical practice .
with coronary artery disease who are referred for coronary
Arterial hypertension (HTN), progressive renal failure,
angiography. The study was approved by the Ethics
flash pulmonary edema, and multivessel coronary disease are
Board of Al-Azhar University.
clinical manifestations of RAS demanding intervention and
treatment and could be resolved by revascularization therapy.
PATIENTS and METHODS
In the past, RAS was under recognized, underdiagnosed, and
undertreated. With enhanced noninvasive imaging
This prospective study included a total of 100 patients who
techniques such as magnetic resonance imaging angiography,
were subjected to catheterization using the femoral
computed tomography angiography, and high-resolution
renal duplex sonography, the diagnosis is now more
Cardiothoracic and Interventional Catheterization Center
frequently established .
and Al-Azhar (Sayed Galal) University Hospitals.
Approval of the ethical committee and a written informed
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 802-808
Awareness of heat-related illnesses in population of Saudi Arabia
Mohammad Aljumaan, Faisal Alhawaj, Saleh Alkhalifa, Najebah Alhussain, Ali Alhashim,
Layan Alahmadi, Fatimah Alkhunaizi, Saleh Aljarudi
Emergency Department, Imam Abdulrahman Bin Faisal University, Eastern Provence, Saudi Arabia
Correspondin author: Saleh Alkhalifa, E-mail: email@example.com, Mobile number: +966567101389
Background: heat stroke is a preventable severe condition of heat-related illnesses; it is an emergency
condition affecting millions of people around the world. Heat related illnesses ranged from mild heat
exhaustion to life-threatening heat stroke. Early detection and treatment of heat-related illnesses crucial to
avoid mortality and morbidity. The aim of this study was to evaluate awareness of heat illnesses, its
symptoms, treatment and prevention among the population of Saudi Arabia.
Methodology: a cross-sectional study carried out an online survey, Saudi Arabia, between, 1 November 2017
and 23 June 2018. Data were collected by using a valid multiple-choice question (MCQ). Survey questions
included the possible thought causes and risk factors of both heat stroke and heat exhaustion.
Result: a total of 865 participants, the majority were Saudi citizens (806). Age and gender were almost equal.
281 were involved in the medical fields. Conclusion: this study assessed the awareness of heat stroke and heat
exhaustion among the health staff and medical students in different aspect of heat-related illness (Mainly heat
stroke and heat exhaustion) and compared it to the level of awareness of general population in some aspect of
heat-related illnesses. Almost, two third of medical personnel differentiate heat stroke definition when it was
listed among other heat-related illnesses.in the other hand, knowledge of heat exhaustion definition was
markedly lower among both health staff and non-health staff.44.6% of the participants chose all cooling
methods as appropriate treatment of heat stroke. 71.1% knows that heat stroke had more devastating outcomes
if not managed properly and rapidly than heat exhaustion.34% of the medical personnel thought avoiding hot
spots was the best way to prevent heat-related illnesses; a similar number of the non-medical (31%) also
thought the same. Awareness of heat-related illnesses and differentiation between them in relation to the
definition, sign, symptoms, diagnosis, and treatment is not satisfactory.
Keywords: heat stroke, heat exhaustion, heat-related illness, awareness of heat-related illness.
Heat stroke is a life threating emergency under
the category of heat related-illness which affect
vomiting, nausea, headache, diarrhea, goose flesh,
millions of people in the world (1,2). Heat-related
headache and lose of coordination (1), Immediate
illnesses (HRIs) are common and preventable
management of Heat exhaustion includes
conditions that range from minor form (e.g. heat
hydration, move to a shaded and cool location, rest
cramps) to life-threatening heat stroke (3).
and monitor for resolution. If not treated heat
exhaustion can complicate to a more sever
condition called Heatstroke (2,5).
characterized by mild dehydration with or without
sodium disturbance after excessive exercise,
dysfunction. Heat stroke manifested by confusion,
exposure to extremely high environmental
temperature, chronic loss of volume, low fluid
intake, and failure to adapt to surrounding
dysfunction, which is the most serious
temperature (3,4). Symptoms of heat exhaustion
complication that can lead to death (1,6), an early
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 809-819
Comparative Study between Submucosal Diathermy and Endoscopic
Partial Turbinectomy in Hypertrophied Inferior Turbinate
*Wael Hassan Aboulwafa *, Abd Elaziz Kamal Saad *, Ayman Yehia Abbas*, Mohammed Abed
Elewa, **Tarek Abd Elkarem Eldahshan
* Otolaryngology dept., ** Clinical Pathology dept., Faculty of Medicine, AL-Azhar University
Corresponding author: Mohammed Abed Elewa, email:firstname.lastname@example.org, +201063475773
Background: Chronic nasal obstruction is a common subjective complaint seen by otolaryngologists;
turbinate hypertrophy is one of its causes. There are various treatment options for enlarged turbinates,
the method of treatment depends on the size of the enlarged turbinates.
Objective: To evaluate the effectiveness of submucosal diathermy of inferior turbinate versus
endoscopic partial turbinectomy in patients with inferior turbinate hypertrophy.
Patients and methods: A total of sixty patients of different age groups and both sexes were involved in
the study. Patients were divided in two groups; group (I), which included 30 patients, had submucosal
diathermy of both inferior turbinates and group (II); which included 30 patients had surgical endoscopic
partial turbinectomy of both inferior turbinates. Patients were followed up for 6 months postoperatively
and nasal obstruction was analyzed according to (NOSE) scale.
Results: there were no significant differences between both groups in nasal score mean at pre-operative,
1 week and 1 month (post-operative), however, group (II) had significantly (p<0.01) lower nasal score
mean at 6 months compared to group (I),. In addition, there were a significant post-operative
improvement in nasal obstruction in both used techniques at 1 week and 1 month. However, this
significant improvement continued to 6 months in group II While, a type of recurrence was happened
in group I at 6 months.
Conclusion: both of the used surgical techniques were found to be effective in reducing nasal
obstruction but endoscopic partial turbinectomy was more effective in reducing nasal obstruction for
KEYWORDS: Submucosal Diathermy, Endoscopic Turbinectomy,HypertrophyInferior Turbinate
The inferior turbinates are bony and soft tissue
nasal cavity and contribute significantly to
projections that protrude into the nasal passages
nasal airway obstruction (4). Hypertrophy of the
and play an important role in normal respiratory
inferior turbinate is the most frequent cause of
function, as the main regulator of nasal airflow
chronic nasal obstruction and may be related to
in which the mucosa of the turbinates is
allergy, pseudo allergy, non allergic rhinitis
essential for maintaining normal defense,
with eosinophilia syndrome and iatrogenic
humidification, warming and filtering of
rhinopathy (5). Mucosal swelling of the inferior
inspired air (1). Chronic nasal obstruction is one
turbinates is a part of the physiologic vascular
of the most common human problems and a
changes which take place during the nasal
cycle. Hyper-reactivity, infection and allergy
otorhinolaryngology field (2). It is commonly
may enhance these changes (6). Enlargement of
defined as patient discomfort manifested as a
the inferior turbinate can be due to either an
sensation of insufficient airflow through the
enlargement of the osseous or mucosal
nose. The etiology of nasal obstruction is
component of the turbinate (7).
generally divided into mucosal and anatomical
Medical treatment including antihistamines,
topical and systemic steroids, desensitization,
In some patients, the nasal turbinate remains
and allergen avoidance is used but if these
persistently enlarged or swollen and obstructs
measures fail, surgery is advised (8). There are
the airway to cause a congested feeling and
numerous available surgical techniques in use
these enlarged inferior turbinates narrow the
to address inferior turbinate hypertrophy,
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 820-826
The outcome of Antegrade Cerebral Perfusion during Deep Hypothermic
Circulatory Arrest in Pediatric Arch Surgery
Hyam Refaat Tantawi 1; Mohamed Abdel Hafez2
1.Pediatric department , Ain Shams University, 2.Cardiothoracic department, Faculty of Medicine
Background: Techniques for the surgical correction of aortic aneurysms have steadily improved since
the first described successful repair, Despite these improvements, postoperative neurological
complications remain a major factor in determining an adverse outcome. Complex aortic arch
reconstruction in neonates and children is performed typically under deep hypothermic circulatory
arrest. Aim: The study aimed at examining the effect of clinical impact, particularly neurologic
complications, of deep hypothermic circulatory arrest in pediatric arch surgery and to summarize the
early outcomes. Patients and method: One-handed and fourteen underwent full-term babies were
enrolled in the present study .The maximum age was 20 weeks, arch surgery included Norwood, arch
reconstruction for hypoplastic arch and interrupted aortic arch. Healthy neurological status preoperative
was included between January 2011 and October 2015. The medical records were reviewed for
preoperative diagnosis of patients which included age at the time of operation, sex and diagnosis of the
patients. Operative details including type of the operation, duration of cross-clamp and deep
hypothermic circulatory arrest timing were documented. The deep hypothermic circulatory arrest was
conducted at 20 . Postoperative outcomes, neurological complications including seizers, cerebral
infarct, and duration of hospital stay were recorded. Results: The study noted that the incidence of
postoperative complications such as seizure & bleeding was markedly 5.3%& 1.8% of the studied
pediatric patients. Conclusion: The results concluded that the aortic arch reconstruction with Antegrade
cerebral perfusion during the deep hypothermic circulatory arrest was accompanied by a lower risk of
neurological complications. Recommendations: Long-term neurodevelopmental follow-up of these
children is required to evaluate the late outcomes of Antegrade cerebral perfusion.
Keywords: Aortic Arch Surgery, Antegrade Cerebral Perfusion, Deep Hypothermic Circulatory Arrest,
Aortic arch surgery represents a technically
Various strategies, including antegrade and
demanding and high-risk cardiovascular
retrograde cerebral perfusion, are used for
operation 1,2 . Although neurologic injury in
preventing neurological problems and allowing
children with congenital heart disease is
the surgeons more time for optimal repair and
recognized as having a multifactorial origin,
hemostasis has been developed 18,19,20,22.
considerable effort is being made to limit any
Hypothermia has been proven to decrease
aggravating factors occurring at the time of
cellular metabolism by lowering oxygen
repair(3,4,5) 19,33. Therefore, the Surgery on the
consumption, thus reducing the adverse impact
aortic arch is challenging because of the need to
of ischemia 10,23,24,25 . Hypothermia, usually by
ensure a bloodless surgical field and adequate
way of deep hypothermic circulatory arrest
cerebral protection6,7,8 . Protection of cerebrum,
(DHCA), has been used to minimize cerebral
which is the most vulnerable target at the aortic
metabolic demand and protect cerebral tissue
arch surgery, is crucial because deterioration of
from ischemia and provide adequate neurologic
neurological status has a direct impact on
protection during arch surgery 2326,27.
quality-of-life of these patients 5,9,10,11.
Since the introduction of DHCA in the early
1960s; it has been increasingly used in centers
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 827-841
Health Needs of Patients with Cholelithiasis Undergoing Laparoscopic
Sanaa Mohamed Alaa Eldin, Amna Yehia saad and Samira Saad Ali Abo El baka
Medical -Surgical Nursing Department, Faculty of Nursing, Alexandria University.
Background: Laparoscopic cholecystectomy is standard procedure for management of gallbladder stone.
Gallstones (cholelithiasis) are the most common cause of biliary tract disease in adults. The educative role
of nurse is integral part of the care that is essential to patient satisfaction and positive outcomes.
Objective: Identify health needs of patients with cholelithiasis who were undergoing laparoscopic
Patients and Methods: A convenient sample of 100 adult patients with cholelithiasis who were
undergoing laparoscopic cholecystectomy. Health needs of patients with cholelithiasis who were
undergoing laparoscopic cholecystectomy included structured interview schedule was used to collect the
data for the present study. It included two parts about socio-demographic and clinical data, knowledge
related to nature of the disease, pre- operative preparation, post-operative care and self- care following
Results: the present study revealed that the majority of the studied patients had poor level of knowledge.
There was statistically significant positive correlation between patients' level of knowledge and age,
educational level, nurses as a source of knowledge and advices as well as physician and the nurse as a
preferred source of knowledge.
Conclusion: It was concluded that the studied patients had poor level of knowledge regarding disease
nature, pre-operative care, post-operative care and complications and self-care following discharge.
Keywords: Health Needs, Cholelithiasis, Laparoscopic Cholecystectomy
Laparoscopic cholecystectomy (LC) is the
operative period and prevent post-operative
removal of the gallbladder using a laparoscopic
complications. In addition, provision of
technique. It is considered the Gold standard
information related to postoperative period
treatment for symptomatic gallstone disease. It is
includes post-operative pain management,
considered one of the most common surgical
exercise, nutrition, activity and follow up for
procedures in western world. It has many
evaluation of the care. This post-operative care
advantages over open cholecystectomy in terms
is very important to prevent post-operative
of minimal postoperative pain, shorter hospital
complications that lead to post-operative
stay, early recovery, a rapid return to work, less
mortality and prolonged hospital stay, decrease
intra-abdominal adhesion, a better cosmetic
functional and cognitive status and has a huge
outcome and decrease in perioperative septic
impact effect in hospital costs(3).
complications (1). The educative role of nurses
The aim of this study was to identify health
facilitate emancipation and empowerment as
needs of patients with cholelithiasis undergoing
patient gain confidence with self-care and
provision of information by nurses, a s s i s t
Patients and Methods
patient and families to cope with surgical
procedure, promoting participation and creating
This study was conducted at the Hepato-biliary
supportive and educative environment (2).
Surgical Department of Alexandria Main
Health needs of patients undergoing laparoscopic
University Hospital. A Convenient sample of 100
adult patients with cholelithiasis who underwent
information related to preoperative education,
laparoscopic cholecystectomy and meeting the
which is an important part to improve post-
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 842-852
Transcranial Ultrasound in Comparison to MRI in Evaluation of Hypoxic Ischemic
Injury in Neonates
Abd El-Aziz Kamal Aun*, Hassan Ali Hassan*, Wafik Ibrahim Ali*, Maged Mohamed Ali Ataky *
*Department of Radiodiagnosis, Al-Azhar University
Corresponding author: Maged Mohamed Ali Ataky, Mobile: (020)01010384245, E-Mail:email@example.com
Background: Hypoxic-ischemic injury is the most common cause of encephalopathy in newborns.
Objectives: The goal of our study was to demonstrate the role of transcranial ultrasound (TCUS) compared to MRI
in assessment of neonatal encephalopathy.
Patients and methods: Consecutive thirty sex neonates with hypoxic-ischemic encephalopathy (HIE) were
included. All cases had undergone MR imaging as well as transcranial ultrasound study of the brain. The study was
conducted between May 2015 and September 2017. They were collected from the Neonatology Intensive Care Unit
at Elsayed Galal and El-Demerdash University Hospitals.
Results: Our study found that stages I and II showed mild to moderate HIE presented with peripheral pattern and
white matter injuries while stage III revealed severe HIE presented with central pattern of injury (BGT). In
addition, our study reported that all patients with stage III of HIE showed severe central pattern on MRI.
Conclusion: MRI imaging is considered a sensitive technique in detecting different MR patterns of encephalopathy
in newborns. MRI placed other imaging modalities in diagnostic assessment and early predictor of future
development of neurological abnormalities in neonates with encephalopathy.
Keywords: HII, TCUS, MRI, WD, Neonates
Neonatal encephalopathy continues to be an
ticularly MR spectroscopy and diffusion-weighted
important cause of neonatal mortality and morbidity
(DW) imaging may provide further insight into HIE,
in the United States. Hypoxic-ischemic injury (HII),
the potential for possible therapeutic intervention and
which is also known as hypoxic-ischemic
increase specificity (2). However, normal imaging
encephalopathy, refers to the subset of neonatal
findings in term neonates are substantially different
encephalopathy that result from a hypoxic or
from those in preterm infants, term infants and older
ischemic event, often in the setting of perinatal
children. An understanding of the normal
asphyxia, which leads to hypoxemia and
development and anatomy of neonates is essential to
hypercapnia. Hypotension and the resulting
recognize pathologic processes (3).
decreased cerebral blood flow are thought to lead to
HII in preterm Infants, in the setting of mild to
acidosis, release of inflammatory mediators and
moderate hypotension, the most common location for
excitatory neurotransmitters, and formation of free
injury to the premature brain is the periventricular
radicals. HII is estimated to affect one to four infants
white matter, with ischemic parenchyma manifesting
per 1000 live births, depending on the criteria used to
as PVL. In the setting of severe hypotension, because
define infant encephalopathy. Between 20% and 50%
the thalami, brainstem, and cerebellum in the
of newborn infants with HII expire during the
immature brain have high metabolic activity, they are
newborn period. Among the survivors, as many as
more susceptible to injury and the insult manifests
25% exhibit permanent neurologic damage, which
variable T2 signal at MR imaging and restricted
typically manifests as cerebral palsy, mental re-
diffusion on DWI. Coexisting periventricular white
tardation, or seizures(1).
matter injury and germinal matrix hemorrhage may
Multiple modalities have been assessed for
be present (3).
their sensitivity in depicting HII, including,
Among the routine pulse sequences, diffusion-
Transcranial Ultrasonography (TCUS), Computed
weighted (DW) imaging is useful in the early days
Tomography (CT) and Magnetic Resonance (MR)
following a hypoxic-ischemic event and often depicts
Imaging. Newer diagnostic techniques such as
restricted diffusion within the first 24 hours that
gradually increases over the next several days. DW
spectroscopy of the available imaging modalities.
MR imaging is the most sensitive and is widely
approximately 1 week after the hypoxic or ischemic
available. The addition of advanced modalities, par-
event, a phenomenon known as pseudonormalization.
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 853-857
Conservative Treatment versus Elective Repair of Umbilical Hernia in
Patients with Liver Cirrhosis and Ascites
Ashraf Abdel El-hamid Abd El-monem, Mohammed Abbas, Mahmoud Ramadan Abdelaziz
Department of General Surgery, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mahmoud R.A. El-halawany, E-Mail: firstname.lastname@example.org
Background: management of umbilical hernia in patients with liver cirrhosis remains controversial.
The general surgical opinion is that umbilical hernia in patients with liver cirrhosis and ascites has
high operative risks and high recurrence rates after elective repair. Conservative treatment, however,
can also have severe complications resulting in emergency repair. In these patients such operations
carry an even greater risk of complications than compared to elective operations.
Objective: Aiming at comparing between conservative treatment and elective repair of umbilical
hernia in patients with liver cirrhosis and ascites.
Patients and Methods: a randomized prospective interventional study Our series was carried out
on 40 consecutive patients at General Surgery department, Al-Azhar University hospital; Bab
Elshaeria, Cairo, Egypt in the period from June 2017 till September 2018. The patients were
divided into 20 patients (group A) undergo surgical repair and 20 patients (group B) undergo
conservative treatment. Mean follow up was 6 months.
Results: elective repair of umbilical hernia in patients with liver cirrhosis and ascites had fewer
complications than conservative treatment.
Conclusion: Our study showed that elective repair of umbilical hernia in cirrhotic and ascetic patients
had less complication than conservative treatment.
Keywords: Conservative Treatment, Elective Repair, Umbilical Hernia, Liver Cirrhosis, Ascites.
high as 30% have been reported. Skin ulceration
An umbilical hernia (UH) occurs
and subsequent rupture of the hernia sac and
through the umbilical fibro-muscular ring, which
leakage is common, which can result in bacterial
is usually obliterated by age 2 years. They are
peritonitis and serious morbidity (5,6).
congenital in origin and are repaired if they
persist in children older than 2-4 years (1). It
herniorrhaphy in cirrhotic patients unfortunately
presents as a central, mid-abdominal bulge.
remain controversial, as there are no high-quality
Altered sensorium and obesity enhance
prospective studies to address this question.
incarceration. Hypertrophic, hyperpigmented,
Because of this, hernia repair in the presence of
papyraceous skin testifies to high pressure
advanced cirrhosis and ascites traditionally
being placed on the skin. The size of the
resulted in high rates of morbidity and mortality,
fascial defect and whether it is circular provide
prompting many to avoid elective repair and to
management clues (2).
operate only when complications develop (5).
Cirrhosis of the liver is a consequence of
Non-operative management of ruptured
chronic hepatic injury, with healing by
hernias with antibiotics and dressing changes
regeneration and fibrosis. Fibrosis leads to
may result in mortality rates in the range 60-
further cell damage and destruction of hepatic
88%. Thus, complicated umbilical hernias in
architecture, progressing to liver failure and
cirrhotics should be repaired urgently (7).
portal hypertension (3).
Ammar (7) identified wound infections in 6.8 %
Umbilical hernia is the most frequent
of their open repairs, while Cassie et al. (8)
abdominal wall complication of ascites in
reported a wound complication rate of 23.3 %,
cirrhotic patients (4). Umbilical hernias are
with half of those being superficial dehiscence
common among patients with cirrhosis and
and the other half having wound infections (8).
uncontrolled ascites. Complications of these
hernias can be serious, and mortality rates as
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 858-866
Comparative study between fixed and flexible GnRH antagonist protocol versus GnRH
agonist long protocol in polycystic ovarian disease patients treated with IVF
Hany Maged Abd-Elaala, Farid Ahmed Kassaba, Osama Deifa, Ismael Abd-Elazeem Miraa,
Mohamed Mohamed Mohamed Essawyb
a Obstetrics and Gynecology department, Faculty of Medicine, Al-Azhar University, b Obstetrics and
Gynecology Department, Beni-Suef General Hospital, Ministry of Health, Egypt.
The objective of the present study was to compare and evaluate the effectiveness and safety of GnRH
agonist long protocol compared with the GnRH antagonist (fixed and flexible) protocols in polycystic
ovary syndrome (PCOS) patients undergoing in vitro fertilization (IVF)/ intracytoplasmic sperm injection
(ICSI) cycles. This study was carried out on 60 patients with polycystic ovarian disease undergoing ICSI,
their age ranged from (20 to 40 years). The cases were selected from The International Center for
Population Study and Research (ICPS), Al-Azhar University. Eligible patients who accepted to take part
in the study were randomized into 3 study group: Group A: 20 patients were included in agonist protocol,
Group B: 20 patients were included in fixed antagonist protocol and Group C: 20 patients were included
in flexible antagonist protocol. The results obtained from this study indicated no statistically significant
differences regarding the pregnancy rates or regarding the developing of ovarian hyperstimulation
syndrome (OHSS) complication in the studied population; so larger studies with larger sample size and
longer duration are needed to clarify the roles of different IVF protocols.
Gonadotropin-releasing hormone agonist, gonadotropin-releasing hormone antagonist, in vitro
fertilization, polycystic ovarian syndrome
more follicles measuring 29 mm in diameter
and/or increased ovarian volume (> 10 cm3)(3).
Polycystic ovary syndrome (PCOS) is a common
endocrinal disorder affecting 6.6-8% of women
The pathophysiology of PCOS is likely to
in childbearing period (1). It is associated with
be multifactorial and polygenic. There is a
75% of the causes of anovulatory infertility (2).
significant body of evidence suggesting that
excess ovarian androgen production is central in
The polycystic ovary syndrome (PCOS) is a
the pathogenesis of PCOS (4).
heterogeneous collection of signs and symptoms
that, gathered together, form a spectrum of a
One of the main problems occurring in
disorder with a mild presentation in some and in
patients with PCOS undergoing IVF / ICSI is
others a severe disturbance of reproductive,
developing ovarian hyperstimulation syndrome
endocrine and metabolic function.The definition
(OHSS); a serious iatrogenic complication of
of the syndrome has been much debated. Key
ovarian stimulation induced and triggered by
features include menstrual cycle disturbance,
exogenous and/or endogenous HCG which
hyperandrogenism and obesity.There are many
varies from mild to severe and critical forms (5).
extra-ovarian aspects to the pathophysiology of
PCOS, yet ovarian dysfunction is central. At a
The long GnRH agonist protocol has been
joint consensus meeting of the American Society
used for pituitary desensitization in patients with
for Reproductive Medicine and the European
PCOS undergoing IVF / ICSI with the benefit of
significant reduction in the occurring of
premature LH surges and the frequency of cycle
definition of the PCOS was agreed,namely the
presence of two out of the following three
GnRH antagonist down-regulation protocol
in IVF / ICSI has gained much popularity over
hyperandrogenism (clinical and/or biochemical),
the last few years (7). It acts by competitive
polycystic ovaries with the exclusion of other
inhibition of GnRH receptors in pituitary, and
etiologies. The morphology of the polycystic
produce an immediate and rapid reduction in LH
ovary has been redefined as an ovary with 12 or
and FSH levels without GnRH receptor
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 867-872
Comparative Study between Single-Level Anterior Cervical Discectomy
and Fusion using Cage and Plate or Cage Alone
Youssef Barakat1, Alaa Rashad1, Mokhtar Ragab2, Mohamed Ibrahim Abd Elrahman1*
Departments of 1Neurosurgery and 2Radiology, Faculty of Medicine, Al-Azhar University
*Corresponding Author: Mohamed Ibrahim Abd Elrahman, E-mail: email@example.com
Background: anterior cervical discectomy and interbody fusion (ACDF) is a well-accepted
management option for the treatment of persistent cervical radiculopathy or myelopathy due to cervical
disc prolapse. Typically a fusion is performed to stabilize the segment, maintain foraminal height.
Objective: to prospectively analyze the effect of one-level ACDF, comparing stand-alone cages and
cage-with-plate fixation constructs with respect to clinical outcomes and radiologic changes.
Patients and Methods: a total of 20 patients who underwent one-level for cervical disc disease and
who completed 6 months of follow-up were included in this study. The patients were grouped into
ACDF-Cage-only and ACDF-Cage-with-plate groups. The following parameters were assessed using
radiographs: subsidence, adjacent disc space narrowing, clinical outcomes were assessed using the
Results: in the comparison of one-level ACDF-cage-only and ACDF-cage-with-plate groups, at the 3-
and 6-months follow-up: Regarding the functional outcome in the plate group 6 (60%) patients had
excellent outcome, 2 (20%) patients had good outcome, 1 (10%) had satisfactory and 1 (10%) had poor
outcome, while in the cage group 7 (70%) patients had excellent outcome, 110%) had good outcome,
1 (10%) had satisfactory and 1 (10%) had poor outcome.
Conclusion: our results showed that for single-level cases, plate fixation had no additional benefit
versus cage-only, although the cage-with-plate fixation group had a lower incidence of cage sinking
than did the cage-only group. We conclude that physicians should be aware of these possible advantages
and disadvantages associated with using cervical plates in one-level ACDF.
Keywords: Diskectomy, Cervical Vertebrae, Spinal Fusion, Bone Plate.
Anterior cervical discectomy and
fusion (ACDF) have become a standard
A comparative study of a clinical series of 20
surgical procedure for treating degenerative
patients with degenerative cervical disc treated
disk disease associated with radiculopathy or
by an anterior cervical discectomy procedure
myelopathy (1, 2).
and fusion (ACDF) using either cage alone
Although stand-alone ACDF using
(ACDF-CA) or cages and plating construction
cages can provide favorable outcomes, many
(ACDF-CPC) in Al-Hussein university hospital
and Al-Mataria teaching hospital during the
development of cage subsidence which may
period between December 2017 and June 2018.
cause segmental kyphosis, acceleration of
Patients were classified into 2 groups; group 1
adjacent segment disease, and a decreased rate
(N=10) in whom interbody fusion was done
of fusion (3).
using stand-alone cage, and group 2 (N=10) in
Therefore some surgeons prefer to add
whom interbody fusion was done by cage
an anterior plate to enhance stabilizing
augmented by anterior cervical plating.
- Inclusion criteria:
AIM OF THE STUDY
1- Degenerative disc disease single level within
It is to compare interbody fusion with
levels between C3-C7 causing:
stand-alone cage and interbody fusion with
Neck pain and/or brachial neuralgia.
cage and plate for degenerative single-level
cervical spine disorders.
2- Age between 18-70 years.
Patients and Methods
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 873-884
The possible protective effect of vitamin E on adult albino rat's testes exposed to
electromagnetic field emitted from a conventional cellular phone
Mahmoud Ibrahim EL-Naggar, Alaa EL-Din Sayed EL-Sagheer, Ashraf El- Sayed Ebaid.
Anatomy and Embryology department, Faculty of Medicine, Al- Azhar University
Aim of the work: i to discuss the possible protective effect of vitamin E as a model of powerful
antioxidant on the testes of adult albino rates exposed for electromagnetic field (EMF) emitted from
cellular phone. This study also detected and described signs of morphological and behavior changes
that can appear on the rats. Materials and Methods: The present study was carried out on 120 healthy
adult albino rats. The rats were divided into 3 main groups. Group I (control group): consisted of 40
rats. These rats were kept in the animal house away from any source of EMF. Group II (radiation group):
consisted of 40 rats that were exposed to EMF emitted from mobile phone for 60 days. Group III
(radiation and vitamin group): consisted of 40 rats, those were exposed to EMF emitted from mobile
phone for 60 days and simultaneously they received vitamin E, orally. Results: Electromagnetic field
exposed rats showed testicular alterations, which were ameliorated by using vitamin E.
Keywords: Mobile phones, electromagnetic field, vitamin E, testis.
When the biological systems are exposed to an
germ cells and in general subfertility and or
external magnetic field with a very large
strength relative to the bio-magnetic field of the
Vitamin E is one of the major antioxidants; it
cells, a disturbance in their metabolic function
plays an important role in reducing oxidative
is expected and may lead to death of the cells or
stress (10). Vitamin E suppresses lipid
increase their cell division (1). Exposure of mice
peroxidation in testicular microsomes and
to 900-1800 MHz microwaves affected the
mitochondria. It reverses the detrimental effects
histological structure of testis particularly
of oxidative stress on the testicular function (11).
Leydig cells and showed an apoptosis inducing
Vitamin E is associated with normal function of
effect on the spermatogenic cells (2). Free
the male reproductive system. Supplementation
radical formation and their interaction with
with vitamin E has also been shown to increase
biological system is a matter of major concern.
sperm concentration, improve sperm motility,
There is evidence of free radical generation
enhances sperm and semen quality (1,13).
after exposure to microwave radiation field (3).
ROS generated by mobile phones exposure if
MATERIALS AND METHODS
not scavenged may lead to widespread lipid,
protein and DNA damage (4). Electronic
household items and cell phones are reported to
The present study was carried out on 120
decrease fertility potential in men by decreasing
healthy adult male albino rats weighing from
sperm count, motility, viability, and inducing
200 to 300 grams each, obtained from the
pathological changes in sperm and testes
Egyptian Holding Company for Biological
morphology (5). Spermatogenesis is a complex
Products and Vaccines (Cairo, Egypt). All rats
process takes place in the testis, which may be
were kept in clean properly ventilated cages
exposed to various microwave frequencies,
under similar conditions and had free access to
which are currently in use (6). Among various
laboratory food and water throughout the
factors of infertility, oxidative stress has
experiment. The rats were divide into 3 main
become the factor of interest as a potential
cause of male infertility (7).The effect of EMF
Group I (control group): consisted of 40 rats.
on human health varies widely depending on
These rats were kept in the animal house away
the frequency and intensity of the fields (8).
from any source of EMF.
There are numerous studies showing that EMF
Group II (radiation group): consisted of 40
exposure of male rat/mice affects testicular
rats that exposed to EMF emitted from mobile
structure, spermatogenesis, sperm motility,
phone for 60 days.
Leydig cell reduction, increased apoptosis of
Group III (radiation and vitamin group):
consisted of 40 rats, those were exposed to
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 885-889
Assessment of Impact of Insight on Medication Adherence in Schizophrenic Patients
Abd Elhady E. Hassan, Ali Abd E. Elnabawy, Mohamed M. A. Eldeeb, Ahmed S. M. Essa
Departments of Psychiatry and Neurology Faculty of Medicine Al-Azhar University.
BACKGROUND: Many patients with schizophrenia have impaired insight and low medication adherence. Poor
adherence is one of the leading problems affecting the effectiveness of treatment in schizophrenia. It is an
identified factor for relapse and hospitalizations with major social and economic consequences.
OBJECTIVE: The aim of this study was to study the relation between insight and medication adherence and
other factors that may affect both of them.
SUBJECT AND METHODS: A total number of 50 schizophrenic outpatients "DSM 5" aged > 18 years old
who were attending the hospital for regular follow up were included in this study. From the selected patients full
medical history was obtained including: name, age, gender, occupation, educational status, history of the
psychiatric disease, duration, medical treatment and times of hospitalization. Cultural and social standard and
degree of family support was also collected. Patients' insight was measured by the Schedule for Assessment of
Insight-Expanded Version (SAIE) translated into Arabic by Marwa Abdelgawad. The degree of medication
adherence was measured by using Medication Adherence Rating Scale (MARS).
RESULTS: There was no significant correlation between patients' insight and patients' ages, duration of illness
and hospitalization times with p-value: 0.69, 0.61 and 0.07 respectively. In addition, there was no significant
association between medication adherence and age, duration of illness, number of hospitalization, gender, social
level and family support with p-value: 0.575, 0.678, 0.566, 0.945, 0.091 and 0.360 respectively. Our results
showed a strong positive correlation between insight and medication adherence with p-value: < 0.0001.
CONCLUSION: Insight and adherence were found to be closely related, low insight was associated with poor
adherence in patients with schizophrenia. Moreover, these results should be used to establish a strategy for
improving the prognosis of chronic schizophrenia.
Keywords: Medication adherence, Insight, Neurocognition, Schizophrenia.
targets for improving adherence. Factors that
contribute to medication non-adherence include a
Adherence to medication is a subject of
lack of insight or the inability to understand one's
increasing interest for clinicians studying diseases
illness, persistent psychotic symptoms, co-occurring
with chronic conditions such as schizophrenia. Non-
of a substance abuse and comorbid conditions (3).
adherence or poor adherence is a major concern in
the effectiveness of antipsychotic treatment in
Lack of insight has also been related to various
schizophrenic patients. It represents a poor
outcomes of schizophrenia, including increased
prognostic factor for schizophrenia, according to the
number of hospitalizations, poor functioning, and
increasing risk of relapse and hospitalization (1).
poor quality of life (2).
Medication nonadherence of patients with
schizophrenia was found to be associated with poor
The aim of the work was to estimate the impact
outcomes including rate of relapse, re-
of insight on adherence to medication based on a
hospitalization, and poor long-term functional
population of patients in Abbassia Hospital who had
outcomes. Many studies have particularly pointed
the diagnosis of schizophrenia.
out that medication nonadherence during the early
SUBJECTS AND METHODS
stage of schizophrenia increases the risk for relapse
and re-hospitalization (2).
This is a cross-sectional non-interventional study
It has been well established that the causes of
that had been carried out in Psychiatry Department,
non-adherence are multifactorial. Many studies have
Al Azhar University. The study was approved by
attempted to identify factors that can predict
the Ethics Board of Al-Azhar University.
medication non-adherence, which could be possible
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 890-898
Reproductive outcomes following Hysteroscopic Removal of endometrial polyps
of different location, number, and size in patients with infertility
Ismaeel Mohammed Adb EL Azim Mira, Abdelmonsef Abdelhamed Sedek,
Hazem Shaban Eldesoky
Department of Obstetrics and Gynecology, Faculty of Medicine - Al-Azhar University
Corresponding author: Hazem Shaban Eldesoky, Mobile: 01000434937;
Bkgroud: ystrosopi rstio is rltivly sf d simpl produr wi fftivly rmovs
polyps; owvr, domtril polyps rur. Studis v suggstd rurr rts of up to 46%, d
trfor it is importt to idtify risk ftors ssoitd wit rurr.
Objtiv: To ssss t prgy rt ftr ystrosopi polyptomy i ifrtility ptits wit
domtril polyps to ompr prgy rt mog subgroups wit polyps of diffrt lotios, umbr
Ptits d Mtods: These Prosptiv oort Study o 60 ss were odutd t t dprtmt of
obsttris & gyology Syd Gll Uivrity ospitl btw My 2017 d pril 2018. Ptits wit
uxplid ifrtility. two groups.
Rsults: I our study w ompr t prgy rt ordig to polyp rtristis su s lotio,
siz d umbr. lso w study t rprodutiv outom of ystrosopy i two groups: 1st group witout
itrutri lsio. 2 - 2d group wit domtril polyps. d w foud tt: tr is o sttistilly
dfr btw t two groups t p-vlu is 0.40654. W foud o sigifit positiv orrltios
btw Prgy outom d umbr of polyps wit p-vlu 0.71, o sigifit positiv orrltios
btw Prgy outom d siz of polyps wit p-vlu 0.456 d o sigifit gtiv
orrltios btw Prgy outom d sit of polyps.
Conclusion: W foud tt tr is o sttisticlly dfrc btw t two groups. W foud o
sigifict positiv corrltios btw Prgcy outcom d umbr of polyps, , siz of polyps d ,sit of
Kywords: ifirtility, domtril polyp, ystrosopy
domtril polyps r fol growts of t
bormlitis d itrutri dsios my
utri muos d osist of domtril glds,
itrfr wit tis rltiosip d otribut to
strom d blood vssls. It is stimtd tt
implttio filur, wi s b osidrd
utri polyps r foud i 10% of grl fml
to ostitut sigifit proportio of i vitro
popultio (1) wil ty my b symptomti;
frtilistio (IVF) filurs. domtril polyps
r t ommost struturl bormlitis of t
ivstigtios for borml utri bldig d
utri vity, wit prvl vryig btw
ifrtility. aborml utri bldig is t most
7.8% d 34.9% (5). Tis frquy is v igr
ommo symptom of domtril polyps, d i
i frtile popultio d rportd to b 32% i
wom wit su bldig, t prvl of
lrg prosptiv tril (6).
domtril polyps is tougt to b btw 20
Prvl of domtril Polyps i Ifrtil
d 30% (2,3). I 80% of t ss, su polyps
ppr i isoltd form, ltoug tr lso
xmitio (TVUS) s bom stdrd prt
b multipl polyps. I post-mopusl
of t gyologil ssssmt, d sli
ptits, t polyp glds r tropi pitlil
ifusio soogrpy or ystrosopy r oft
tissu d surroudd by fibrous strom (4).
prformd if itrutri mss lsios r
Struturl utri bormlitis su s
susptd, polyps r mor frqutly dttd.
domtril polyps, utri fibroids, Mullri
Tis ppro s ld to irs i t
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 899-904
Does Dopamine Agonist Hormonal Therapy for Macro-Prolactinoma Affect
Mohamed Raafat Kandeel, Magdy A. Elhawary, Osama Elghannam
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Correspondence author: Mohamed Raafat Kandeel, Phone: +20 01001129203 Email:firstname.lastname@example.org
Background: Controversy regarding first line therapy for macro-prolactinoma patients had been of debate for
many decades. Several reports suggested that dopaminergic agents (DAs) medications are accused for
prolactinoma fibrosis. Whether fibrosis has positive or negative influence on the management of prolactinomas is
Aim of the work: was to compare the intraoperative tumor consistency, intraoperative difficulties and
complications both pre- and post-operative between macro-prolactinoma patients who received DA medications
and who did not receive prior to surgery.
Patients and Methods: Twenty-five macro-prolactinoma patients who underwent primary pituitary surgery, sub-
labial trans-sphenoidal microscopic removal, of macro-prolactinoma grouped into two groups. Group 1 included
patients who were treated by DA medication, combined therapy with Bromocreptine and Cabergoline, prior to
surgery for at least 3 months. Group 2 included patients who didn't receive any preoperative DA medications. We
compared the intra-operative texture of the tumor, intraoperative and post-operative complications together with
the extent of surgical excision and hormonal remission achieved.
Results: No significant statistical difference as regards intra-operative tumor consistency in relation to
preoperative hormonal treatment. The rate of intra-operative and post-operative complications has no relation to
the pre-operative hormonal therapy by DAs nor to the intraoperative tumor consistency. The only factor that affect
the extent of surgical excision is the pre-operative tumor size graded by KNOSP classification and this extent of
surgical excision has direct implication on the post-operative hormonal remission rate.
Conclusion: It could be concluded that there is no risk of more tumor fibrosis nor increase in the complication
rate due to DA medication prior to surgery. So, using dopamine agonist as the primary treatment for prolactinoma
while Surgical excision is deferred for cases of failure or intolerance of side effects of the the hormonal therapy.
Key words: Pituitary adenoma, Macroprolactinoma, Dopamine agonists, Bromocreptine, Cabergoline.
Controversy regarding first line therapy for
prolactinomas is still of debate. as studied by Molitch
macro-prolactinoma patients had been of debate for
and others (11-14).
many decades. Prior to the discovery of
We hypothesized that there is no correlation
dopaminergic agents (DAs), these tumors were
between the intraoperative tumor consistency,
treated surgically (1). DAs, due to their clinical
occurrence of intraoperative and post-operative
effectiveness and low toxicity profile, have become
complications in relation to DA medication use
the first line treatment, reserving surgery for patients
who failed medical therapy or for neurosurgical
The objective of the current study was to compare
emergencies such as apoplexy or neurologic deficit
the intraoperative tumor consistency, intraoperative
involving the visual pathways (2,3).
difficulties and complications both pre- and post-
It has been reported that prolactinomas exposed
operative between macro-prolactinoma patients who
to BROM may develop tumor fibrosis (2- 10), which
received DA medications and who did not receive
has generated a renewed interest in surgical
prior to surgery.
treatment of prolactinomas, and has promoted some
Patients and Methods:
controversy regarding first line therapy (11-14).
This retrospective comparative study included a
Several reports suggested that DA medications
total of 25 patients (17 males, 8 females) who
are accused for prolactinoma fibrosis. Bevan and
underwent primary pituitary surgery, sub-labial
others(2, 5, 10) have reported that bromocreptine is
trans-sphenoidal microscopic removal, of macro-
associated with histological perivascular tumor
prolactinoma, attending at Department of
fibrosis, but whether fibrosis has positive or
Neurosurgery "Neurosurgery Gama and Cobalt
negative influence on the management of
center". Approval of the ethical committee and a
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 905-913
Comparative study of total dose infusion of iron and intramuscular iron
administration in treatment of severe iron deficiency anemia during
1Fahd Abd El Aal Al Omda, 2Abd El Raaof Abd El Raaof Abo Nar, 1Waleed El Sayed Al
Naggar, 1Mohamed Abdullah Al Sayed Al-Morsi
1Department of Obstetrics and Gynecology, 2Department of Clinical Pathology, Faculty of Medicine-
Corresponding author: Mohamed Abdullah Al Sayed Al-Morsi, Mobile: 01013354222, email:
Background: Iron deficiency anemia is the most common type of anemia among pregnant women,
especially in developing countries. Indeed, a majority of women in the reproductive age group in the
developing countries are anemic even before conception; pregnancy only tends to intensify it further.
Objective: to compare the effectiveness and safety of intramuscular and intravenous iron therapy in
pregnant women with severe iron deficiency anemia.
Patients and Methods: This study is an interventional randomized study, comparing the effect of
intravenous and intramuscular iron therapy on pregnant women with severe anemia. Allocation of
patients in either group (I.V & I.M) was sealed and enveloped. The study was conducted at the
Department of Obstetrics and Gynecology of General Helwan Hospital.
Results: The results of our study proved that the intravenous iron, showed high effectiveness in the
treatment of iron deficiency anemia during pregnancy. Nearly no side effects were detected and thus,
it can be considered as a useful and alternative formulation for the treatment of iron deficiency.
Conclusion: The present study proved that the severity of iron deficiency anemia affects the maternal
outcome by increasing the risk of postpartum hemorrhage and also affects the fetal outcome by increasing
the risk of preterm delivery and low birth weight.
Keywords: Adenosine triphosphate, Complete blood count, Hemoglobin
Anemia is a very common condition in
and tinnitus. Chronic iron deficiency anemia
pregnancy affecting up to 32 % of all pregnant
lowers work tolerance, productivity, and the
women worldwide (1).
quality of life. This leads to further socio-
Hemoglobin levels of less than 11 g/dL
economic difficulties. Dysfunction in the
at any time during pregnancy are considered
immune system results in increased risks for
Anemia is defined as hemoglobin (Hb)
Anemia during pregnancy is associated
less than 11 g/dl in the first trimester, as well as
with a number of maternal and fetal disorders
10.5 g/dl in the second and third trimesters,
including the risks of preterm births, low birth
according to current UK guidelines (3).
weight babies, perinatal mortality and
Anemic pregnant women may present
intrauterine growth retardation (6).
with fatigue, weakness, pallor, tachycardia, and
They also have an elevated risk of
shortness of breath, and are at higher risk of
developing perinatal infection, pre-eclampsia,
adverse perinatal outcomes such as low birth
weight and preterm birth (4).
impairment and behavioral difficulties were
Typical features of iron deficiency
also reported (7).
anemia are caused by lowered oxygen delivery
Iron deficiency during the first trimester,
to the tissues, and include pallor, fatigue,
has a more negative impact on fetal growth than
apathy, fainting, and breathlessness. Additional
anemia developing later in pregnancy. This is also
features include headache, palpitation, hair loss,
true for risk of preterm labor (8).
Posterior subtenons versus intravitreal injection of triamcinolone acetonide in management of diabetic macular oedema
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 914-923
Diabetic macular edema: posterior subtenons versus intravitreal injection of
Ashraf Mohammed Gad Elkareem
Ophthalmology department, Faculty of medicine, Al-Azhar University, Asyut Branch, Egypt.
Corresponding author: Ashraf Mohammed Gad Elkareem, Email: email@example.com ,
m Tel: +2 01060293796
Background: Diabetic retinopathy (DR) with diabetic macular edema (DME) is one of the most common
complications of diabetes and can lead to visual loss in young individuals.
Purpose: to evaluate the efficacy of posterior subtenon versus intravitreal triamcinolone injection for
treatment of diffuse diabetic macular edema.
Patients and methods: seventy six eyes of 64 patients having diffuse diabetic macular edema were included
and divided into two groups; Intravitreal triamcinolon acetonide group (IVTA group) included 40 eyes of 30
diabetic individuals, injected with 4 mg (0.1ml) IVTA. Posterior subtenon triamcinolon acetonide group
(STTA group) consists of 36 eyes of 34 diabetic persons injected with 40 mg (1ml) in the posterior subtenon
The central subfield macular thickness (CMT) measured with optical coherence tomography (OCT) before
injection, 3 and 6 months post-injection was evaluated. Visual acuity as Log MAR, intraocular pressure (IOP)
and any complications associated with both techniques ware assessed.
Results: the baseline log MAR VA was significantly improved in both groups at one, three, and six months
post-injection .The IVTA and STTA groups had significant reduction in CMT three and six months after
steroid injection. The mean IOP was 16.6±1.3 mmHg and 15.4±1.1mmHg at the end of follow up in IVTA and
STTA groups respectively.
Conclusion: both intavitreal and subtenons routes of steroid injection are good alternatives for the treatment
of diabetic macular edema, but the intravitreal route has a more pronounced effect while the subtenons route is
Keywords: diabetes mellitus; diabetic macular edema; diabetic retinopathy, posterior subtenon.
The World Health Organization (1) and
As severity of DR increases the incidence of
International Diabetes Fedration (2) reported that
macular edema increases as well; approximately
more than 180 million persons all over the world
3%, 38%, and 71% of patients with mild non-
have diabetes, and this number is going to increase
to epidemic percentage within the next 2 decades,
moderate to severe NPDR and, proliferative
12.1 million of them are in Africa.
diabetic retinopathy (PDR) have macular edema
Diabetic retinopathy (DR) with diabetic macular
edema (DME), one of the most frequent adverse
The prevalence of diabetic macular edema is
effects of diabetes, stills a big public health
directly related to the duration of the diabetes. It is
problem with significant perdition on the
0% at 5 years and 29% at 20 years or more in type
socioeconomic state. It affects about 50% of
I diabetes; however it is 3% at 5 years and 28% at
diabetic persons and is the leading cause of visual
20 years in adult onset diabetes(4).
loss in working-age individuals(1).
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 924-933
Orthotopic ileal and sigmoid neobladder after radical cystectomy:
functional results: A prospective study and retrospective study
Saied A.A. Mostafa1, Ismail M. Khalaf1, Ali M.H. Farag1, Hassan A. Abdel-Baky1, Mostafa
M.M. Shakweer2, Tarek M. Omran3
Departments of 1Urology, Radiology2 and Clinical Pathology3, Faculty of Medicine, Al-Azhar
Background: bladder cancer is common among genitourinary tract. Radical cystectomy with urinary
diversion is the widely accepted treatment. However, no consensus exists regarding the best orthotopic
neobladder creation intestinal segment.
Aim of the work: to evaluate functional and oncological outcome of ileal and sigmoid orthotopic
Patients and methods: The study included two groups of 40 patients in each group (ileal and sigmoid
groups). Each group was further divided in two twenty subgroups; prospective and retrospective. Ileal
group operated in Urology and Nephrology centre (UNC) and Al-Azhar University hospital (Damietta),
while patients in sigmoid group were operated in Al-Azhar University hospital (Cairo). All underwent
full history taking, clinical examination, and laboratory investigations. Then, postoperatively, all were
followed up for 6 months. In each postoperative follow up visit, patients were assessed clinical,
radiological, urodynamic study and by laboratory investigations and patients' quality of life were
Results: In ileal orthotopic diversion, early postoperative complications were bleeding (2.5%), urine
leakage (2.5%) and wound infection (25%). Diurnal continence was achieved in 90%, while nocturnal
continence was achieved in 70%. The early postoperative complications were urine leakage (2.5%),
obstruction (2.5%), and ileus (12.5%). The late complications were DVT (2.5%) and intestinal
obstruction (5.0%). In addition, 2.5% were died from disease. Tumor recurrence was pelvic in 7.5%,
distant (hepatic) in 2.5%. Only 25% of patients were potent and urine culture revealed E-coli in 40.0%.
In the sigmoid orthotopic diversion group, the early postoperative complications were urine leakage
(17.5%), obstruction (2.5%), ileus (7.5%), bleeding (2.5%), DVT (2.5%) and faecal leak (2.5%). Late
complications were pouch stones (10.0%), stricture urethra (12.5%), ureterocolic stricture (7.5%), pouch
stones plus stricture urethra in 5.0%, DVT (2.5%), intestinal obstruction (10.0%) and hematemesis in
2.5%. In addition, 12.5% were died. Tumor recurrence was pelvic in 25.0%. Only 7.5% of patients were
potent and urine culture revealed E-coli in 35.0%. Diurnal continence was reported in 92.5%, while
nocturnal continence was reported in 60%.
Conclusion: both sigmoid and ileal orthotopic neobladder provided a satisfactory outcome. Sigmoid
neobladder was associated with lower rate of complications and better functional outcome. However,
there were many late-term complications detected in this group.
Keywords: bladder cancer, urinary diversion, orthotopic neobladder, sigmoid, ileum.
Bladder cancer is a common type of
ON reconstruction. Ileumand sigmoid, the most
genitourinary cancer. Radical cystectomy with
common substitutesfor an ON, and ileal
urinary diversion is the most effective local
neobladder (IN) and sigmoid neobladder (SN)
surgical intervention for invasive bladder
were seen to be suitable alternativesto ON with
cancer. However, radical cystectomy is
IN providing better continence and sigmoid
associated with frequent complications (19-
neobladder confer better voiding. However,
these neobladders are often created by the
After radical cystectomy (RC), the
detubularization technique, occasionally with
complex reconfiguration, and they are time-
chosentechnique of urinary diversion(2).
consuming(3). However, urinary diversion had
many complications (e.g., metabolic acidosis,
andtechniques have been explored andused for
electrolyte imbalance, bacterial growth,
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 934-941
Gestational Trophoblastic Neoplasia
Mahmoud Ibrahim M. Shahin*, Wael Helmy El Sheshtawy, Mohsen Salah El-Din Zikri
Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Al-Azhar University
* Corresponding author: Mahmoud Ibrahim M. Shahin, E-mail: Mahmoudshahin.firstname.lastname@example.org
Background: gestational trophoblastic neoplasia forms a wide variety of rare conditions arising from abnormal
proliferation of the trophoblastic cells in the placental microvilli. They consist of vesicular mole "partial and
complete", invasive mole, placental site trophoblastic tumor (PSTT), epithelioid trophoblastic tumor (ETT) and
choriocarcinoma. They can be classified into premalignant forms which include vesicular mole and malignant
forms which include the rest. Aim of the Work: this study aimed to study the epidemiological and clinical data,
as well as treatment regimes and their outcome included response and related toxicity among patients with
gestational trophoblastic neoplasia treated in this study.Patients and Methods: in this retrospective study,
medical records of all patients with GTN presented to Oncology Department, Al-Hussein University Hospital
in the period from January 2007 to June 2017 was retrieved from the archives and medical data was reviewed
and analyzed. Results: median age of patient was 37.5 (Range 20-55), molar pregnancy was the most common
pathological type (40%), followed by invasive mole (31.4%), while choriocarcinoma was diagnosed in 25.7%
and only 2.9% of patients had placental site trophoblastic disease. According to FIGO score; 26 patients (74.3%)
showed low risk and 9 patients (25.7%) showed high risk. In low risk patients, 30.8% of patients were kept
under follow up while, (69.2%) received chemotherapy, 61.1% of them achieved complete remission on
methotrexate as first line chemotherapy, while the rest 38.9% achieved complete response on EMA-CO or
dactinomycin as 2nd line chemotherapy. Methotrexate wasn't effective in high risk patients, while EMA-CO had
much better response achieving (66.7%) complete response rate, with 2 cases of early death in those patients.
Conclusion: this retrospective study represented a single center experience and had relatively small number of
cases. A large multicenter prospective trial is recommended.
Keywords: trophoblastic, neoplasia, microvilli, epithelioid trophoblastic.
Gestational trophoblastic neoplasia forms a
account for only less than 1% of all gynecological
wide variety of rare conditions that arising due to
tumors accounting for about 1 pregnancy out of
abnormal proliferation of the trophoblastic cells in
1,000 in which vesicular mole was the most
placental microvilli. They consist of vesicular mole
common while, choriocarcinoma were far less
"partial and complete", invasive mole, placental site
common affecting around 2 to 7 of every 100,000
pregnancies (4). While, the Far East accounts for the
trophoblastic tumor (ETT) and choriocarcinoma (1).
highest incidence up to 40.2 per 1000 births for
They can be classified into premalignant forms
vesicular mole and 5 per 1,000 for choriocarcinoma.
which include vesicular mole and malignant forms
However more recent studies reported that
which include the rest (2). During the 2000
incidence has fallen to 2 per 1000 and 0.5 per 1,000
Fédération Internationale de Gynéologie et
(5).After molar pregnancy evacuation there's no need
d'Obstétrique (FIGO) Oncology Committee
for prophylactic chemotherapy just a regular follow
meeting held in Washington, it was recommended
up with B-hCG every 2 weeks can provide an
that gestational trophoblastic neoplasia (GTN)
accurate observational tool (6). Where a plateaued or
should replace terms like gestational trophoblastic
rising hCG, was an indication for starting
tumor, persistent gestational trophoblastic disease
chemotherapy. Also, a tissue diagnosis of
choriocarcinoma or spread to other organs was
GTD.Internationally incidence varies from country
indications for chemotherapy (7). A sustained
to another. In a recent cross-sectional study
elevated HCG after 6 months even if decreasing is a
conducted during 2014 at Al-Azhar University
controversial indication for chemotherapy (8).
hospital the overall incidence was 6.6 per 1,000
Despite the rarity of these diseases they're highly
deliveries (150/22727) which were relatively higher
curable due to high sensitivity to chemotherapy with
than reports from different countries (3). In USA they
cure rates reaching up to 100% even with historical
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 942-948
Immunohistochemical expression of ERG and P63 in some prostatic lesions
Al-Sayed Mohamed Ibrahim, Hussein Abdel-Moneim Hasan, Al-Moatazbellah Mahmoud El-
*Department of Pathology, Faculty of Medicine, Al-Azhar University
Corresponding author: Al-Moatazbellah Mahmoud El-Sayed, Phone Number: 01114705706,
Background: prostate cancer (PCa) ranks second among the most common types of solid tumors and
the sixth among the leading causes of cancer deaths in men worldwide. In Egypt, prostatic cancer
formed the majority of male genital cancer (60.7%) at the NCI in the last 10 years. Aim of the work:
the present study aimed to detect the immunohistochemical expression of ERG and p63 (as abasal cell
marker) in benign prostatic lesions and prostatic carcinoma and to investigate the potential use of ERG
and p63 expression levels to discriminate prostatic carcinoma from other lesions and to investigate the
association of immunohistochemical expression of ERG with the other prognostic parameters of
prostatic carcinoma such as age, plasma PSA level and pathological Gleason score. Methods: fifty
prostate lesions, which were collected from the surgical files of the Pathology Department of Al-Azhar
University Hospital and from a private lab. Clinicopathological and histological features were taken
from patients files and confirmed by H&E examination. Immunohistochemical study was done by using
two markers ERG and P63.Results: expression of ERG was restricted to malignant tissue (Prostatic
carcinoma) and was negative in BPH and PIN specimens (P. < 0.001) ERG is highly specific but less
sensitive marker (40 % of PCa were negative). Expression of ERG revealed inverted significant
correlation with Gleason grade and plasma PSA level (P < 0.05). P63 is highly specific and sensitive
marker for non-carcinomatous prostatic lesions.Conclusion: ERG showed strong nuclear endothelial
expression in all lesions.
Keywords: ERG, P63, PSA, prostate cancer
Prostatic carcinoma is the sixth most common
1. To study the immunohistochemical
type of neoplasm in the world and the second in
expression of ERG and p63 (as a basal cell
prevalence among men (10% of all cases).
marker) in non- cancerous prostatic lesions and
Statistics worldwide indicated that prostate
cancer (PCa) has high prevalence and lethality,
2. To investigate the potential use of ERG and
with three-quarters of cases among 65-year-
p63 expression levels to discriminate prostatic
oldsters (1). Prostatic intraepithelial neoplasia
carcinoma from benign lesions.
(PIN) is considered a morphological equivalent
3. To investigate the association of
of prostate pre-cancer. It develops as a result of
immunohistochemical expression of ERG with
proliferative changes of ductal epithelium and
the other prognostic parameters of prostatic
acini of the prostate. Many researchers
carcinoma such as age, plasma PSA level and
distinguish two forms of PIN: low-grade PIN
pathological Gleason score.
(Low-grade prostatic intraepithelial neoplasia)
MATERIALS and METHODS:
and high-grade PIN (high-grade prostatic
The current study comprised 50 prostate
lesions, (17 were benign prostatic hyperplasia,
pronouncement of cytological and structural
3 were PIN, while the remaining 30 lesions
changes of epithelium lining the prostate (2).The
were prostatic carcinoma), which were
present study was an attempt to determine the
collected from the surgical files of the
expression of ERG and P63 as a (Basal
Pathology Department of Al-Azhar University
Hospital and from private lab during the period
from March 2016 to March 2018. The study
prostatic lesions, by immunohistochemical
was approved by the Ethics Board of Al-
study of both markers upon different Gleason of
The clinical data were retrieved from the
AIMS of the WORK
accompanying clinical sheets. Each case was
The aims of this study were:
subjected to histologic typing and grading. The
The Egyptian Journal of Hospital Medicine (January 2019) Vol. 74 (4), Page 949-956
The Role of Nuclear Factor Kappa B Rs28362491 Single Nucleotide Gene
Polymorphism in Recurrent Embryo Implantation Failure
Khalid Tahseen Ahmed Gabr1, Abd EL-Mohsen Mousa Shaheen1, Ashraf Taha Abd-Elmouttaleb2 and Adel
1Department of Medical Biochemistry, 2Assisted Reproductive Unit, International Islamic Center for Population
Studies and Research, Faculty of Medicine, Al-Azhar University
Corresponding author: Khalid Tahseen Ahmed Gabr; Phone: 01128518984; Email: email@example.com
Background: Embryo implantation is a very intricate process, which is controlled by a number of complex
molecules like hormones, cytokines, growth factors and their cross talk at feto-maternal interface. The transcription
factor nuclear factor kappa B (NF-B) induces the expression of various pro-inflammatory genes, including those
encoding cytokines and chemokines, and also participates in inflammasome regulation. Aim of the present study:
was to investigate the possible associations between NF-B rs28362491 single nucleotide gene polymorphism and
susceptibility to repeated implantation failure (RIF). Subjects and Methods: This study was conducted on 120
subjects subdivided into 2 groups: 60 women with successful implantation as a control group (Group I), and 60
women diagnosed with RIF (Group II). They were subjected to full history taking, clinical examination and
investigated for molecular testing of the NF-B -94 ins/del ATTG (rs28362491) polymorphism by lymphocyte
separation and extraction of DNA for polymerase chain reaction (PCR) together with determination of serum
concentration of day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol II (E2), prolactin
and thyroid stimulating hormone (TSH) concentrations by an automated quantitative enzyme-linked fluorescent
immunoassay (ELFA). Results: A significant difference in the genotype distribution of the NF-B rs28362491
between those with RIF and controls. Specifically, subjects with RIF had a significantly higher frequency of the NF-
B rs28362491 del allele than that of controls. Conclusion: This study showed a significant association between
rs28362491 in the promoter region of the NF-B gene and RIF. NF-B appears to be a triggering factor of
orchestrated gene regulation during embryo implantation.
Key words: Recurrent embryo Implantation Failure; Nuclear Factor Kappa B; single nucleotide gene polymorphism.
Repeated implantation failure (RIF) is defined
However, the results suggest that Th1 inflammatory
as three or more failed assisted reproductive technique
response is also necessary to acquire uterine
(ART) attempts or pregnancy failure after 10 or more
receptivity . Human embryo implantation may occur
embryo transfers in multiple transports. It is often
only during a regulated "implantation window" on
attributed to uterine failure to gain receptivity. For
days 6-10 post ovulation and surrounded by refractory
successful implantation a coordinated interaction
endometrial status .
between the receptive endometrium and developing
In 1986, David Biltmore and Coworkers
blastocyst is required, this coordination is mediated by
identified the nuclear factor kappa B (NF-B) as a
hormones, adhesive molecules, cytokines and growth
factor in the nucleus of B cells that binds to the
factors at the feto-maternal interface. Cytokines such
enhancer of the kappa light chain of immunoglobulin.
as leukemia inhibitory factor (LIF), interleukin 6 (IL-
It has been shown to be present in the cytoplasm of
6), interleukin 11 (IL-11) and transforming growth
every cell in its inactive state and is conserved in all
factor (TGF-) have been determined as key
animals from Drosophila to man. It translocate to the
cytokines for embryo implantation .
nucleus only when it is activated, regulating the
Embryo implantation is associated with an
expression of more than 300 immune, growth and
effective inflammatory response from T helper type 1
inflammatory genes .
(Th1) while T helper type 2 (Th2)-humoral
NF-B is a major regulator for transcription of
inflammation is required to maintain pregnancy.
genes responsible for immune responses, apoptosis,