ABSTRACT The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1907-1912

Serum Tumor Necrosis Factor- (TNF-) with Erectile
Dysfunction in Psoriatic Patients
1Tarek Mohamed Tawfik, 1Mohamed Saeed Mohamed Hasan, 2Mohamed Ibrahim Aref,
1Mohamed Samy Ibrahim Marie
1Department of Dermatology, Venereology and Andrology, 2Department of Clinical Pathology,
Faculty of Medicine - Al-Azhar University (Cairo)
Corresponding author: Mohamed Samy Ibrahim Marie, Mobile: 01156677886, email: drmsamy1@gmail.com

ABSTRACT
Background:
Erectile dysfunction (ED) is a common disorder leading to serious, negative impact on the quality of
the patient's life and self-esteem. Its occurrence rate increases with psoriatic patients, as it is a systemic disease
intervenes with endothelial dysfunction. A link is described among systemic inflammation and endothelial
dysfunction (Psoriasis), and ED.
Objective:
Estimate of the serum level of tumor necrosis factor- (TNF-) in erectile dysfunction patients with
psoriasis and patients with erectile dysfunction without psoriasis.
Subjects and Methods: This study was conducted over a period of one year starting from February 2018 until
February 2019. The study was consented by the Ethics Committee of Al-Azhar Faculty of Medicine. A sample of
90 men (30 men psoriatic patients with ED and 30 men with ED complaints and 30 healthy men of matched age as
controls) were conscripted from the Dermatology and Andrology Outpatient Clinics at Al-Hussien and Bab Al-
Shariah University Hospitals. ED presence and severity were tested by the five-item version of the International
Index of Erectile Function questionnaire (IIEF-5). Psoriatic patients were evaluated by PASI score. All subjects
had thorough medical history and full physical examination. The serum level of TNF- was measured for all cases
and healthy controls using specific enzyme-linked immunosorbent assay (ELISA) technique. All men volunteered
to partake in this study were married and have only one sexual partner.
Results: In this study, serum TNF- levels were indicatively elevated in psoriatic patients with ED compared to
ED patients only. In addition, the difference reached highly statistical significance between psoriatic patients with
ED and healthy controls. The elevation correlates with duration of the disease, and family history. Levels of TNF-
were further increased when ED was associated with psoriasis advocating a more severe course of ED in these
patients.
Keywords:
Erectile dysfunction, tumor necrosis factor-, psoriasis.

INTRODUCTION
Interleukins (ILs), various Colony Stimulating
Erectile dysfunction (ED) is defined as the
Factors and Interferons (IFNs) (4).
incompetency to attain and/or maintain penile
It is noticeable that diseases associated with
erection and it is a multifactorial condition that is
high levels of TNF- such as psoriasis, psoriatic
estimated to affect more than 150 million men
arthritis are associated with erectile dysfunction (5).
worldwide. It seriously affects the quality of life of
Endothelial dysfunction is a key event in the
patients and their partners. Erectile dysfunction
pathophysiology of erectile dysfunction and
becomes increasingly ubiquitous with age. The
endothelial function is impaired in the presence of
presence of chronic disease (e.g., CVD), as well as
increased oxidative stress and inflammatory
smoking, alcohol or drug abuse, and sedentary
conditions such as psoriasis (6). TNF- plays a key
lifestyle are major risk factors for erectile dysfunction
role in inducing endothelial dysfunction. Many
(1). Psoriasis is a common, chronic inflammatory
studies indicated that TNF- may be the causal agent
disease of the skin affecting 1­3% of the general
of endothelial dysfunction such as in erectile
population
and
characterized
by
complex
dysfunction and psoriasis (7).
amendments in epidermal growth and differentiation

with multiple biochemical, immunological, and
AIM OF THE WORK
vascular abnormalities (2).
The aim of this study was to estimate the
Although the accurate etiology of psoriasis
serum level of TNF- in erectile dysfunction patients
remains uncertain, current evidence indicates that it is
with psoriasis and patients with erectile dysfunction
T-cell driven. Individuals with active skin disease
without psoriasis.
have elevated levels of tumor necrosis factor alpha

(TNF-) in both blood and skin lesions (3).
SUBJECTS AND METHODS
Cytokines are protein molecules that
This study was conducted over a period of
comprise Tumor Necrosis Factor (TNFs),
one year starting from February 2018 until February

2019. The study was approved by the Ethics
1907

Received:1/3/2019
Accepted:20/3/2019

Full Paper (vol.751 paper# 1)


Introduction The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1913-1917

High Tibial Opening Wedge Osteotomy in
Osteoarthritis with Varus Knee
Ismael Ahmed Yassein, Ehab Abd El Maboud Elzehad, Yasser Mohamed Ali Mohamed*
Orthopedic Surgery Department, Faculty of Medicine, Al-Azhar University
* Corresponding author: Yasser Mohamed Ali Mohamed, E-mail: dr.yasor10@gmail.com

ABSTRACT
Background:
High tibial osteotomy was first described in 1958 as a successful treatment for moderate to severe
unicompartmental, degenerative arthritis of the knee associated with angular deformity. Malalignment is
frequently associated with knee arthrosis and can influence the mechanical load through either the medial or the
lateral compartment.
Aim of the work: Investigation of the clinical and radiographic results of opening-wedge high tibial osteotomy
and fixated by locked compression plate, when used to as surgical treatment of osteoarthritis and varus
deformity.
Patients and methods: The study took place at Al Azhar University Hospital {Elhussein and Bab EL Sharia}.
It was a prospective study on 20 consecutive patients who had knee osteoarthritis and varus knee deformity.
They were treated by surgical intervention by opening wedge high tibial osteotomy applied by T ­ locked plate,
between September 2016 to April 2019. The procedures are carried out under spinal anesthesia.
Results: There was a significant improvement in the pain level after surgery when compared to before surgery.
Postoperatively, 16 patients (80%) were found to have no pain. Pre-operatively 19 patients (95%) had full range
of knee motion, and only one patient had hyperextension. Post-operatively, all patients had maintained their full
knee extension. Postoperatively, 60% of the patients showed normal alignment, 10% valgus (mean: 1° valgus)
and 30% still varus (mean: 2.33° varus, range: 1-4°).
Conclusion: The patients in this study were satisfied with the results. Younger patients planning for HTO should
be advised about the benefits and risks of the procedure, specifically mentioning kneeling and scar formation.
Keywords: High Tibial Opening Wedge Osteotomy, Osteoarthritis, Varus Knee.

INTRODUCTION

AIM OF THE WORK
High tibial osteotomy was first described in
The aim of this study was to investigate the
1958 as a successful treatment of acute to severe
clinical and radiographic results of opening-wedge
acute to severe arthritis, and degenerative knee
high tibial osteotomy and fixated by locked
arthritis associated with angular deformity (1). Bad
compression plate, when used as surgical treatment
pigmentation is often associated with knee
of osteoarthritis and varus deformity.
arthroplasty and can affect mechanical load through

the median or lateral space. Increased pressure on the
PATIENTS AND METHODS
articular cartilage may lead to a higher risk of
The study took place at Al Azhar University
arthritis (2).
Hospital {Elhussein and Bab EL Sharia}. It is a
Several studies have analyzed the results of
prospective study on 20 consecutive patients who
this process with respect to age, activity, sex, degree
had knee osteoarthritis and varus knee deformity.
of neuropathy, weight, pre-treatment and pre-
They were treated by surgical intervention by
operative and post-operative treatment (3).
opening wedge high tibial osteotomy applied by T ­
The aim of bone, regardless of anatomical or
locked plate, between September 2016 to February
technical location, is to re-establish the weight line as
2019. The procedures are carried out under spinal
close as possible naturally to reduce pressure through
anesthesia.
the central and lateral compartments or ligament
The study was approved by the Ethics
structures (4). HTO is the reduction of load by turning
Board of Al-Azhar University and an informed
the mechanical axis towards the side chamber.
written consent was taken from each participant
It is an effective surgical procedure for
in the study.
young and middle-aged patients with osteoarthritis of

the knee. The results suggest that the factors
All patients underwent the same preoperative
predicting positive outcomes include relative weight
clinical, radiological examination and Lysholm score
loss, angular correction, and a general low level of
system.
disease (5).
1913

Received13/11/2018
Accepted:2/12/2018

Full Paper (vol.751 paper# 2)


c:\work\Jor\vol751_3 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1918-1922
Effect of Anise (Pimpinella Anisum L.) as Phytoestrogen on
Some Sex Hormones and Biochemical Parameters
Eman G.E. Helal1, Mohamed A. Abd-El-Aziz2, Shaimaa S. Ahmed1
Zoology Department, Faculty of Science, Al-Azhar University (Girls), Cairo, Egypt.1
Physiology Department, Faculty of Medicine, Al-Azhar University (Boys), Cairo, Egypt2
*Corresponding Author: Eman G.E. Helal, E-mail: emanhelal@hotmail.com, mobile: 00201001025364, Orchid.org/0000-
0003-0527-7028.

ABSTRACT
Background:
Phytoestrogen is a plant derived compound which have estrogenic effect similar to estrogen.
Aim of work: The present study was carried out to investigate some pharmacological and biochemical effects of
anise oil on male albino rats. Materials and methods: twelve animals were divided randomly into two groups.
Group A: Control. Group B: treated rats. The treated rats were given an oral dose of 1 ml/kg body weight/day anise
oil once daily for one month. At the end of the experiment, blood samples were collected for biochemical analysis.
Results: The anise oil induced highly significant decrease (p<0.01) in TC, TG, LDL, VLDL, LDL/HDL. In
addition, significant increase (p<0.05) in HDL and highly significantly decreased in FSH, LH, testosterone and
sperm count compared to normal control group. Conclusion: This study showed that high levels of anise intake
cause hormonal disturbance and decrease sperm count.
Keywords: Anise oil, Lipid profile, Albino rats, sperm count, Physiological parameters.

INTRODUCTION

Experimental animal
Anise (Pimpinellaanisum L.) is a flowering plant
The experiment was carried out on 12 male albino rats
in the Apiaceae family, also called aniseed (1). Anise is
of Rattus rattus strain weighting (130-140gm) obtained
a natural herbal plant that grows widely in Egypt and
from animal farm of El-Nile Company for
many Arab countries. Anise is commonly used in
Pharmaceutical Products (Cairo, Egypt). Animalswere
human nutrition to regulate the balance of physical and
housed in metallic cages and maintained under standard
sexual hormones. It contains essential oils and fatty
condition
of
temperature,
humidity
and
acids.The main component of essential oils is
naturallight/dark cycle along the experimental period.
anetholthat biologically inhibits bacteria (2) and
Food and water were available throughout the
stimulates the secretion of gastrointestinal enzyme and
experiment ad libitum. Rats were left to acclimatize for
appetite (3). The taste and smell of anise are mainly due
one week before starting the experiment.
to the essential oil, which is 80-90% trans-anethole,
Experimental design
with other components consisting of cis-anethole,
In current study, 12 male albino rats were divided into
safrole, estragole, p-anisaldehyde, anisketone,linalool
two equal groups (6 rats in each group) as the
and b-farnesene(4).
following:
The seeds of anise contain 1.5-6% essential oil, 10-
Group I: (control group) comprised of normal rats and
20% fixed oil and 18% protein. The main constituents
maintainedon standard pellet diet and tap water ad
of the essential oil are 90% anethole, 2-4%
libitum for 30 days.
gammahimachalene, <1% p-anisaldehyde, 0.9-1.5%
Group II: rats received orally anise oil (1 ml/kg body
methylchavicol,
3%
cis-pseudoisoeugenyl
2-
weight) for 30 days.
methylbutyrate and 1.3% trans-pseudoisoeugenyl2-
Body weight measurement
methylbutyrate (5). The main constituent of the anise
Body weight was recorded before and at the end of the
oil anethole, has been considered as the active
experiment.
estrogenic agent. Anethole causes premature larche,
Blood samples collection
which is a common disorder characterized by breast
At the end of the experimental period, the blood
development, usually younger than 2 years, with no
samples were collected from the retero-orbital sinus
other signs of puberty. It is usually associated with
after overnight fasting and rats being anesthetized by
adrenal or ovarian disorders and hypothyroidism(6).
ether. Serum was separated by centrifugation at 2500 g
Anise has also been shown to have anticancer(7),
for 15 minutes at room temperature to estimate
antioxidative, antihemolytic, anti-inflammatory(8),
biochemical parameters.
antihyperglycemic and hypolipidemic(9).


Biochemical analysis
MATERIALS AND METHODS
Assessment of biochemical parameters:
Anise oil extracts were purchased from Cap Pharm for
In the present study total protein (TP) and albumin
Extracting Natural Oils and Herbs, Cairo, Egypt.
concentration were estimated, then serum globulin
1918

Received://2018
Accepted://2018

Full Paper (vol.751 paper# 3)


c:\work\Jor\vol751_4 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1923-1931
Evaluation of Knowledge, Attitude and Practice of Epistaxis among the
General Population of Tabuk City, Saudi Arabia
Mohammed Ahmed Alhejaily1, Ahmad Awadh Alatawi1,
Meshal Saleh Alatawi2, Hyder Osman Mrighani3
1- Medical intern, Faculty of Medicine, University of Tabuk, 2- 3rd year Medical student,
Faculty of Medicine, University of Tabuk, 3- MD, Associate Professor of Internal Medicine and Endocrine,
Department of Medicine Faculty of Medicine, University of Tabuk, KSA
Corresponding author: Mohamed Ahmed Alhejaily, E-mail: alhejailymohammed@gmail.com,
Mobile: +966 56 666 9605
ABSTRACT
Background:
epistaxis is a fairly common problem, which has been reported to be occurring in about 60% of the
population. It defined as a bleeding from nose or nasal cavity and it is considered as one of the most common
emergencies presenting in Ear, Nose and Throat (ENT) Department and Accident and Emergency Department
worldwide. Objectives: this study aimed to assess the knowledge, awareness and practice of the general
population of Tabuk City, KSA towards epistaxis, its causes, and management.
Materials and Methods: a cross sectional study was conducted on 540 participants of age less than 20 years to
51 and older in Saudi Arabia. Data were collected by using a pre-designed online questionnaire, which was
distributed among the general population of Tabuk City, Saudi Arabia. Results: this study included 540
participants, 71.9% females and 28.1% males. Most of the participants (50.4%) were from 21 to 30 years.
Epistaxis was found in 45.2% of them. Among participants, 34.8% knew that chronic diseases cause epistaxis,
42.2% stated that drugs cause epistaxis and 68.9% knew that excess nose manipulation caused epistaxis. Tilting
the head forward was the best position to stop epistaxis which reported by 45.2% and 42.2% reported cartilage as
a part of nose should be pressed on to stop epistaxis. There were no significant correlations between educational
level and different knowledges of the causes and how to deal with epistaxis case (p>0.05). However, we found
that there was a significant correlation with the action should be done if the epistaxis continues (p=0.001), the
best position to stop epistaxis (p= 0.02) and nose manipulation as a cause of epistaxis (p=0.01).
Conclusion: our results showed that high percent of the participants were suffering from nasal bleeding
(Epistaxis) in Saudi Arabia. And there was good a knowledge about causes of epistaxis and how to deal with
epistaxis cases.
Keywords: epistaxis, bleeding, knowledge, awareness, Saudi Arabia

INTRODUCTION
nasal allergies, the introduction of foreign bodies
Epistaxis is acute bleeding from the
into the nasal cavity, trauma and septal perforation
nasopharynx or the nose. It is one of the most
[5]. Other causes have been reported in children from
common ENT emergencies faced in the emergency
nose picking and idiopathic causes, to trauma,
departments worldwide [1]. Epistaxis is a common
medications, nasopharyngeal mass, bacterial nasal
problem and it ranges from mild to severe bleeding,
colonization and allergic rhinitis and to the less
also it is considers as life-threatening rhinological
common cause such as ectopic intranasal tooth [6,
emergency. It acts as a significant workload in
7].Epistaxis can be broadly divided as occurring
accident and emergency and Otolaryngology
from anterior or posterior sites. Anterior epistaxis is
Departments; it usually causes anxiety for both
more frequent at an early age. Its origin can be either
patients and clinicians [2]. Of population, 66.67%
arterial
(Keisselbach
area)
or
venous
experience epistaxis during their lifetime.
(Retrocolumellar vein). As the bleeding point is
It is common among school children as they
easily accessible, this type of epistaxis is rarely
are easily injured during different school activity.
serious. Posterior epistaxis, on the other hand, is
More than 50% of children between 6 and 10 years
more frequent in the elderly and they may be a major
have suffered from at least one episode of epistaxis
therapeutic problem [4].
[3]. Epistaxis reportedly occurs more frequently
In most of the cases, epistaxis usually occurs
during the dry, cold winter months. It is thought to
in an out of the hospital setting. Thus, it is very
occur more frequently in males than in females and
important for non- health professional people to
there is an increasing incidence with age [4].
understand
and k
now some first aid measures for
The nasal bleeding caused by either systemic or
epistaxis. First aid is important to reduce mortality
local factor, the systemic factors involved
and morbidity of the emergency case [8] especially
coagulopathy, blood disorders, the use of
in the persistent bleeding cases [9]. The management
anticoagulant and arterial high blood pressure, while
of epistaxis is complex and varied and it has
the local factors included upper airway infections,
undergone significant changes over the years from
1923

Received:2/1/2019
Accepted:21/1/2019

Full Paper (vol.751 paper# 4)


c:\work\Jor\vol751_5 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1932-1936
Patterns of Presentation of Lung Cancer in Aswan University Hospital
Suzan S. Sayed, Maha M.S. Elkholy, Eman M. Ismail, *Ebtsam S. Abdulkareem
Department of Chest Diseases & TB, Faculty of Medicine, Aswan University
Corresponding author: Ebtsam Sayed Abdulkareem, Phone number: +2 010162109,
E-mail: ebtsamsayed46@yahoo.com

ABSTRACT
Background:
globally, lung cancer is the most common cancer among males in terms of both incidence and
mortality and among females has the third highest incidence, and comes after breast cancer in mortality.
Aim of the Work: to recognize the lung cancer presentation pattern in Aswan University Hospital involving
different clinical, radiological and bronchoscopic pattern.
Patients and Methods: this retrospective study included 30 patients with lung cancer in Aswan University
Hospital, all these data were recorded; complete clinical examination, full laboratory investigations, imaging
modalities, bronchoscopy and histopathological analysis of tissue samples.
Results: the mean age in lung cancer patients was (59.33 ± 8.6) years, mass lesion and collapse were the main
radiological presentations and endobronchial mass lesion was the main presenting bronchoscopic finding.
Conclusion: endobronchial mass was the most frequent bronchoscopic finding in lung cancer patients in our study.
Keywords: lung cancer, smoking, bronchoscopy.

INTRODUCTION

Lung cancer is considered the principal cause
(diagnosis depending on clinical, radiological,
of cancer deaths worldwide, with over a million deaths
bronchoscopic and histopathological studies).
annually (1). In 2012, there were 1.82 million new cases

globally, and 1.56 million deaths due to lung cancer,
Inclusion criteria
representing 19.4% of all deaths caused by cancer (2).
All patients with lung cancer with age more than 18
According to the newest WHO data published in May
years.
2014, Deaths related to lung cancer in Egypt reached
Exclusion criteria
4,429 or 0.96% of total deaths, Egypt orders 111 in the
1. Metastatizing lung cancer.
world (3). Cigarette smoking is a substantial risk factor 2. Patients with any organ cancer other than lung cancer.
for lung cancer, especially squamous and small cell
All these data obtained from patients files included:
lung cancer, with more than 80 % of all lung cancer
1- Full history taking.
cases can be attributed to cigarette smoking (4). The
2- Full Clinical Examination.
most common presenting symptoms are coughing,
3- Imaging Modalities including Plain Chest x- ray
hemoptysis, weight loss, dyspnea, and chest pain (5).
P-A view and CT chest with contrast.
Lung carcinomas can besubdivided according to the
4- Invasive investigations including:
dimension and shape of the malignant cells into two
Fiberoptic bronchoscopy and sampling with
main classes: non-small cell lung carcinoma (NSCLC)
Endobronchial biopsy using forceps, Bronchial brush
and small-cell lung carcinoma (6).
for histopathological study and Bronchial wash for
Adenocarcinoma, squamous-cell carcinoma
cytological study.
and large-cell carcinoma are the three commonest
One patient had CT guided percutaneous true cut
subtypes of NSCLC. Although most cases of
needle biopsy from peripheral lung mass.
adenocarcinoma are linked with tobacco smoking,
5- Routine Laboratory investigations.
adenocarcinoma is also the most abundant subtype of 6-
lung cancer among the non-smokers. Squamous-cell
Ethical statement
carcinoma constitutes about 30% of all lung cancers
The
study
was
conducted
according
to
subtypes and nearly, 9% of lung cancer cases are large-
considerations of the ethical committee of Aswan
cell carcinoma (7).
university hospital and informed consent was taken

from the patients.
AIM OF THE WORK

To recognize the pattern of presentation of lung cancer
Statistical analysis
in Aswan University Hospital regarding symptoms,
Analysis was done by SPSS version 21.
signs, radiology and bronchoscopic Finding.
Means, standard deviations, medians and percentages

were calculated. Test of significances were used to
PATIENTS AND METHODS
compare the variation in distribution of frequencies
This retrospective study was done in Aswan
among the study population.
University Hospital. It included 30 patients with lung
Independent t-test analysis was carried out to
cancer during the period of October 2016 to June 2017
compare the means of normally distributed data.
1932
Received:3/11/2018
Accepted:22/11/2018

Full Paper (vol.751 paper# 5)


c:\work\Jor\vol751_6 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1937-1945
Evaluation of Role of Captopril and Erdosteine in Protection of
The Lung against Bleomycin-Induced Injury in Rats
Esam Omar Kamel1*, Alsayed Abdel Rahman Abdel Hady2,
Al-Sayed Al-Hady Abd-Elrahman3, Mahmoud Mohamed Diab4
1Department of Medical Histology and Cell Biology, 4Department of Human Anatomy and Embryology, Faculty
of Medicine, Al-Azhar University, Assuit Branch, 2Department of Human Anatomy and Embryology, Faculty of
Medicine, Helwan University,3Department of Human Anatomy and Embryology, Faculty of Medicine, Port Said
University
*Corresponding author:Esam Omar Kamel, Tel: +201143189339,EMail:dr_esamomar@yahoo.com

ABSTRACT
Background:
bleomycin (BLM) is a chemotherapeutic agent having a wide use in the clinical field. Its most serious
side effect is the life-threatening pulmonary toxicity.Objective:this study aimed to evaluate the role of captopril
and erdosteine (ERD) in lung protection against BLM-induced injury in rats. Material and Methods:thirty-two
rats were categorized into 4 equal groups. Group I: rats received distilled water. Group II: rats injected
intaperitonealy with 0.5 mg of BLM sulphate dissolved in 0.5 ml saline twice weekly for 4 weeks. Group III: rats
received BLM in a dose as in group II &ERD by a dose of 10 mg/kg/day orally, 2 days before BLM administration.
Group IV: rats received BLM in a dose as in group IIand captopril with a dose of 5 mgkg orally for 4 weeks, 2
days before BLM administration. Results: rats treated with BLM revealed disturbance of lung structure. There were
marked cellular infiltration and thickening in alveolar septa with wide variation in the diameter of alveoli. Blood
vesselswere congested. Extravasation of blood into interalveolar septa was observed. Large number of vacuolated
cuboidal cells was noticed. Large amounts of collagen fibers around the bronchioles and few collagen fibers in the
interalveolar septa were detected. Sections of rats treated with BLM and ERD showed apparently normal lung
structure but, some collapsed alveoli with thick septa were still noticed. Sections treated with BLM and captopril
showed lesser structural improvement than ERD-treated sections.Conclusion: administration of captopril and ERD
partially improved BLM-induced pulmonary fibrosis in rats.
Keywords:lung, alveoli, fibrosis, bleomycin, captopril, erdosteine.

INTRODUCTION


Idiopathic pulmonary fibrosis (IPF) is a
problems which can be correlated with the presence of
chronic and disabling interstitial lung disease poorly
a BLM hydrolase enzyme in these tissues(6).
responding to medical treatment and it has a high
Angiotensin-converting
enzyme
(ACE)
mortality rate because it usually causes respiratory
inhibitors are known to be effective in treatment of
failure (1).It has been claimed that inflammatory cells
many diseases including coronary artery diseases,
which accumulate in the lower respiratory passages
hypertension, diabetic nephropathy and congestive
resulting from repeated respiratory tract infections
heart failure. The therapeutic effect of these drugs is
release considerable amounts of reactive oxygen
mostly by modulation of the renin-angiotensin
species (ROS) leading to depletion in glutathione, the
system(7). It was found that ACE inhibitors,
major factor of the lung antioxidant defense system
mainlycaptopril are effective in improvement of
leading to lung injury and fibrosis(2).Bleomycin (BLM)
induced lung fibrosis in animal models(8).
is an antitumor agent isolated from a strain of
Erdosteine (ERD) is an antioxidant known to have a
Streptomyces verticillus. It has been widely used to
mucolytic effect, specifically it is a thiol derivative
treat a variety of tumors including squamous cell
developed for the treatment of chronic obstructive
carcinoma of the head, cervix and esophagus, as well
bronchitis, including acute infective exacerbation of
as, Hodgkin's and non-Hodgkin's lymphomas(3).
chronic bronchitis(9).
BLM is selectively affecting the lungs because they
Objective:
lack the enzymes that hydrolyze the L-aminoalanine
This study aimed to evaluate the role of
moiety of BLM, which prevent its metabolite from
captopril and erdosteine in lung protection against
binding metals such as iron(4).Using superoxide
BLM-induced injury in rats.
dismutase,
glutathione,
dimethylurea
and

metalloporphyrin aimed toreduce oxidative stress and
MATERIALS AND METHODS
to decrease BLM -induced lung injury and fibrosis
Animals, drugs used and dosage:
(5).Skin and lungs were found to be highly sensitive to
The present study was carried out on 32 adult
BLM-induced injuries.This was explained by low
male albino rats weighing 130-150 gm. They were
concentration of BLM hydrolase enzyme. But, still
obtained from the animal house of the Faculty of
there are some tissues can resist BLM-induced
Medicine, Al-Azhar University, Cairo, Egypt. The
1937
Received:6/1/2018
Accepted:25/1/2018

Full Paper (vol.751 paper# 6)


A COMPARISON BETWEEN VOLUME-CONTROLLED VENTILATION AND PRESSURE-CONTROLLED VENTILATION IN PROVIDING BETTER OXYGENATION IN OBESE PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1946-1952
A Comparison between Volume-Controlled Ventilation and Pressure-Controlled
Ventilation in Providing Better Oxygenation in Obese Patients Undergoing
Laparoscopic Cholecystectomy
Said Ahmed Ali, Said Mohamed Fayad, Nasr Abd Alaziz Mohamed Saad and
Mohammad Abd AlHady Abd Allatif
Department of Anesthesia and Intensive Care, Faculty of Medicine - Al-Azhar University
Corresponding author: Mohammad Abd AlHady Abd Allatif, Mobile: (+20)01063355972,
E-Mail: meinemeinung_schonheiten@yahoo.com
ABSTRACT
Background:
The main goal of mechanical ventilation is the maintenance of adequate oxygenation and
ventilation. There is no guidelines on the mechanical ventilation in obese patients. This study aims to compare
the effect of pressure controlled ventilation PCV vs. volume controlled ventilation VCV on oxygenation
parameters in obese patients undergoing laparoscopic cholecystectomy.
Methods: 70 obese patient of ASA physical status II, Body Mass Index of 30­40 kg/m2, scheduled for
laparoscopic cholecystectomy were included in this prospective randomized study. All patients received VCV.
Fifteen minutes after creation of pneumoperitoneum, they were randomized to receive either VCV (Group V) or
PCV (Group P). The ventilatory parameters were adjusted accordingly to maintain the end tidal CO2 between
30 and 40 mmHg.
Primary outcome variable was mean airway pressures. Secondary outcomes were PO2/FiO2 ratio, dead space to
tidal volume ratio and alveolar arterial oxygen tension gradient before and after creation of pneumoperitoneum.
Results: Patients in group P showed a statistically significant (P < 0.05) higher level of PaO2/FiO2 ratio and
mean airway pressure and lower value of PAO2­PaO2, dead space to tidal volume ratio and peak airway pressure
than those in group V.
Conclusion: PCV is a more efficient mode of ventilation in comparison with VCV mode regarding oxygenation
in obese patients undergoing laparoscopic cholecystectomy.
Keywords: Volume-Controlled Ventilation, Pressure-Controlled Ventilation, Obese Patients Undergoing,
Laparoscopic Cholecystectomy

INTRODUCTION
This mode uses a constant flow to deliver tidal
Obesity results in several pathophysiological
volume but can result in higher airway pressures
changes of the respiratory system mechanics that
especially during laparoscopic procedures due to
promote the development of intraoperative
decreased lung and chest wall compliance and
atelectasis and exaggerate the impairment of gas
reduced functional residual capacity which impairs
exchange (1- 3).
alveolar ventilation and leads to ventilator induced
As a consequence, arterial oxygenation is
lung injury(9).
inversely related to body mass index (BMI) (4)
Pressure-controlled ventilation (PCV) has been
Obesity also, is a well established risk factor
proposed as an alternative to VCV in ICU patients
for
cholelithiasis
for
which
laparoscopic
with adult respiratory distress syndrome, and in
cholecystectomy is the routinely performed
obese patients to achieve adequate oxygenation and
surgery(2). The cardiopulmonary and metabolic
normocapnia with minimum lung injury and
changes during pneumoperitoneum are complex and
hemodynamic impairment(10).
related to the level of intraabdominal pressure,
PCV uses a decelerating flow, which reaches the
duration of pneumoperitoneum, patient position and
highest possible value at the beginning of
the ventilation mode(5, 6).
inspiration. Flow diminishes throughout inspiration
Several studies have been performed to determine
according to the pressure target, and the resulting
the optimal ventilatory settings in obese patients(6).
tidal volume (Vt) depends on the pressure limitation
The primary goal of mechanical ventilation is the
and on the chest compliance(9).
maintenance of adequate gas exchange, which must
Although PCV potentially provides greater
be achieved with minimum lung injury and the
control over airway pressure by virtue of its
lowest
possible
degree
of
hemodynamic
decelerating inspiratory flow pattern, it remains a
impairment(7).
relatively less frequently used ventilation strategy in
The most frequently used ventilation mode in
the operating theatre. Furthermore, PCV may be
general anesthesia is volume-controlled ventilation
associated with increased mean airway pressure that
(VCV) as this has been the only available mode on
in turn may improve oxygenation(11).
ventilators for a long time(8).
1946
Received:3/1/2019
Accepted:22/1/2019

Full Paper (vol.751 paper# 7)


Full Paper (vol.751 paper# 8)


c:\work\Jor\vol751_9 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1963-1968
Ceruloplasmin as a Predictor for Responsiveness to Direct Antiviral
Drugs in Treatment of Chronic HCV Infection
Mohammed Salah Hussein1, Asem Ashraf Mahmoud4, Abdel Rahman Ibrahim5, Mohammed
Saied Bakeer1, Safaa Abd Elsalam Hussein6, Abdelhalim Assem Mahmoud2, Tarek Eldahshan3
1Department of Internal Medicine, 2Department of Tropical Medicine, 3Department of Clinical Pathology, Faculty
of Medicine, Al-Azhar University, 4Department ofGastroenterology and Hepatology, Military Medical Academy,
5Department of Internal Medicine,Algalaa Military Hospital, 6Department of Internal Medicine, Faculty of
Medicine, Ain Shams University
Corresponding author: Mohammed Salah Hussein, email: dr_msalahali@azhar.edu.eg

ABSTACT
Background:
Hepatitis C virus (HCV) is one of the major globally cause of death and morbidity.
The appearance of direct-acting antiviral agents (DAAs), which specifically target HCV proteins, has
provided insights into the current situation Ceruloplasmin (Cp), where its serum levels tend to be high in
myocardial infarction, neoplastic and inflammatory conditions.
Objective: The aim of the current work was to evaluate the prognostic value of serum ceruloplasmin in chronic
hepatitis C before and after treatment by direct-acting antiviral agents and possibility of using it as a marker for
hepatitis C virus treatment response.
Patients and methods: This intervention prospective study was conducted on one hundred subjects attending at
the Hepatology Clinic at the Hepatology Clinic at Algalaa Military Hospital and Kopri Elkopa Military Hospital
and Al-Hussein university Hospital, from December 2016 till June 2017. The associations between serum
Ceruloplasmin levels in chronic HCV patients before receiving DAAS and three months after was investigated.
Results: showed that serum Ceruloplasmin levels were slightly higher after receiving DAAS and so it can be
used as a marker for responsiveness to direct acting antiviral drugs.
Conclusion: It could be concluded that ceruloplasmin can be used as a marker for responsiveness to direct acting
antiviral drugs.
Keywords: Ceruloplasmin; Hepatitis C virus; Direct acting antiviral agents.

INTRODUCTION

Hepatitis C virus (HCV) is one of the leading
HCV genotype 1 who have relapsed post-
causes of death and morbidity in the world. It is
treatment(5).
estimated that about 3% of the world's population and
Ceruloplasmin acts as a ferroxidase and increases
about 130-170 million people, are infected with this
during inflammation, and other conditions, and these
virus. Of them, 30% will get liver cirrhosis and 2%
observations seem to suggest that ceruloplasmin is
will develop liver cancer (1).
likely to act as an antioxidant and an acute reactive
Hepatitis C virus (HCV) still affects a large
agent (6).
proportion of the Egyptian population. It is estimated
Serum ceruloplasmin is typically decreased in
that in the 1-59 age group, 5.3 million people are
patients with Wilson's disease and other conditions
infected with the virus. Approximately 3.7 million
characterized by marked renal or enteric protein loss,
HCV RNA is positive (2).
including severe end-stage liver disease of any
Peginterferon Alfa plus ribavirin (pegIFN /
etiology and in some rare neurologic diseases (7).
RBV) is traditionally used to treat the hepatitis C
Patients with severe hepatitis were shown to have
virus (HCV). However, this system has limited viral
significantly lower levels of Ceruloplasmin
response rates of 40% -50% and is associated with a
compared to patients with other liver diseases, except
high frequency of adverse events (3).
for Wilson's disease (8).
The use of direct acting agents has revolutionized
The aim of the current work was to evaluate the
the treatment of chronic hepatitis C (HCV). Oral
prognostic value of serum ceruloplasmin in chronic
therapy is not only effective, but safe and tolerable (4).
hepatitis C before and after treatment by direct-acting
The appearance of direct-acting antiviral agents
antiviral agents and possibility of using it as a marker
(DAAs), which specifically target HCV proteins, has
for hepatitis C virus treatment response.
provided insights into the current situation, The use

of protease inhibitors, such as Telaprevir,
SUBJECTS AND METHODS
Boceprevir, Simeprevir, Faldaprevir and Vaniprevir,
This intervention prospective study included a
in combination with Peginterferon and Ribavirin has
total of one hundred subjects recently discovered
improved treatment efficacy in treatment-naïve
hepatitis C virus (HCV) attending at the Hepatology
patients (70% to 80%) and in patients infected with
Clinic at Algalaa Military Hospital and Kopri
Elkopa Military Hospital and Al-Hussein university
1963
Received:3/1/2019
Accepted:22/1/2019

Full Paper (vol.751 paper# 9)


ABSTRACT The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1969-1975

Correlation Between Role of Preoperative Computerized Tomography
and Intraoperative Findings in Revision Myringoplasty
1Mohammed Abd Elmoneim Ahmed, 2Abd Ellah Nazeer Yassin,
1Yahia Mohammed Dawood, 1Ahmed Ragab Abd Elwahab
1Department of Otorhinolaryngology, 2Department of Diagnostic Radiology,
Faculty of Medicine, Al-Azhar University
Corresponding author: Ahmed Ragab Abd Elwahab, Mobile: 01060123441, email: ragaboly90@gmail.com

ABSTRACT
Background:
The goals of tympanic membrane repair in tubotympanic chronic suppurative otitis media are to
close the perforation, remove the disease, and improve hearing of the patient. Myringoplasty is an operation used
to repair a perforation of the tympanic membrane and this improves the patient hearing and decreases susceptibility
of infection. Objective: To correlate the radiological findings of preoperative CT with intra-operative findings in
revision myringoplasty.
Patients and Methods: This study included 30 patients suffering from safe type of chronic suppurative otitis
media with central tympanic membrane perforations. 23 patients were subjected to underlay revision
myringoplasty and 7 patients were subjected to cortical mastoidectomy based on the preoperative CT findings.
Diagnosis of the disease was established by clinical, otoscopic, microscopic and endoscopic examination. All
patients were studied prospectively. Preoperative history taking, ENT examination, general examination, and
assessment of hearing were performed for all cases. All patients complained of history of ear discharge and
deterioration of hearing. Surgery was done; operative details were recorded and postoperative follow up was done.
Results: This study showed that CT scan temporal bone is 100% accurate in assessment of ossicular chain, aditus
ad antrum patency and mastoid pneumatization. While, CT accuracy in assessment of middle ear spaces, middle
ear mucosa and fibrous adhesions is 76.7%.
Conclusion:
Comparing these results with those of other researches using similar techniques, revealed that they
are almost similar regarding the accuracy of CT scanning and success rate.
Keywords:
Chronic otitis media, tympanic membrane, chronic suppurative otitis media.

INTRODUCTION
Other etiologies include traumatic or neoplastic
The prevalence of chronic otitis media
defects of the tympanic membrane (5).
(COM) is estimated at 0.5-30% in various
Various factors have been implicated to affect
populations, with approximately 120 million patients
the results of myringoplasty; ventilation of middle ear
with COM worldwide. The primary treatment for
is an essential predictor of the functional results
COM is by surgery to eliminate the disease, prevent
following middle ear reconstruction. It is a complex
recurrence and maintain or improve hearing (1). The
and dynamic process depending on a number of
objective of repairing the TMS in chronic tubular
factors including: the functional status of the
otitis media (CSOM) is to close the hole, remove the
Eustachian tube (ET), the degree of pneumatization of
disease, and improve patient hearing (2).
mastoid air cells, and the condition of middle ear
The term myringoplasty was firstly used in
mucosa. The role of mastoid pneumatization in the
1953 by Horst Wullstein when reporting his
middle ear aeration is not exactly known. However, it
reconstruction technique of the tympano-ossicular
forms an air reservoir and acts as a surge tank to
system in cases of chronic otitis media. Regarding the
minimize pressure fluctuation (6).
technique, the targets of surgery are, the eradication
Possible complications of myringoplasty
of the pathological condition, resulting dry middle ear
include failure of the graft to heal, causing recurrent
and restoration of the mechanisms that transmit
eardrum perforation, narrowing (stenosis) of the ear
sounds (3).
canal, scarring or adhesions in the middle ear,
Myringoplasty is a surgical method, to
perilymph fistula, hearing loss, erosion or extrusion of
eradicate middle ear infection and improve its
the prosthesis, dislocation of the prosthesis and facial
function. Type 1 tympanoplasty is the commonest
nerve injury. Other problems such as recurrence of
otological procedure performed in any otological
cholesteatoma, may or may not result from the
clinics for patients with COM. Different graft
surgery (7).
materials have been tried for reconstruction of the
Failed tympanoplastic reconstruction still
defect in the tympanic membrane with temporalis
remains problematic. A number of causes have been
fascia being the most common autograft used (4).
recognized, including infection, poor wound healing,
A main part of myringoplasty is repair of
ET dysfunction, retained aural disease and poor
perforated TM which results mainly from COM.
surgical technique. Besides that, other studies
consider material used for the graft, technique of the
1969
Received:4/1/2018
Accepted:23/1/2018

Full Paper (vol.751 paper# 10)


c:\work\Jor\vol751_11 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1976-1981
The Influence of Acesulfame-K and Aspartame on Some
Physiological Parameters in Male Albino Rats
Eman G.E. Helal1, Mohamed A. Abdelaziz2, Neama M. Taha3 Mariam S. El-Gamal1
1Department of Zoology, Faculty of Science (Girls), Al-Azhar University,2Medical Physiology,
Faculty of Medicine, Al-Azhar University,3Physiology Department, College of Medicine,
Umm Al-Qura University, KSA
*Corresponding author: Eman Helal, emanhelal@hotmail.com, mobile 00201001025364,
orcid.org/0000-0003-0527-7028

ABSTRACT
Background:
the easiest method of reducing calories is to replace the high caloric food products with sweetened
ones. Aim of the work: this study aimed to determine the effects of acesulfame-k or aspartame on some
physiological parameters in male albino rats. Materials and methods: we used thirty male albino rats of local strain
weighing from 100 to120 gm. The period of the experiment was 30 days. The animals were divided into three
groups; Group 1: control, Group 2: rats received acesulfame-k (15 mg/kg/day) and group 3: rats received
aspartame (50 mg/kg/day). Results: there was an increase in serum glucose, insulin level, T3 and T4 in rats that
received aspartame. In addition, there was increase in ASAT and ALAT activities, serum creatinine, serum urea
and lipid profile except HDL-C in both treated groups as compared to the control group. Meanwhile, there was a
drop in percentage of body weight and serum testosterone level in aspartame group as well as in total protein,
albumin and albumin/globulin ratio in both treated groups as compared to control group. Conclusion: aspartame
has more dangerous effects than acesulfame-k.
Keywords: acesulfame-k, aspartame, ASAT, ALAT, T3, T4, testosterone, insulin.

INTRODUCTION

Most people prefer to eat sweet-tasting foods.
breakdown in the body is acetoacetamide, which is
Preloading experiences show that sweet taste, whether
toxic at high doses. Centre for Science in the Public
delivered with sugar or artificial sweeteners, enhances
Interest (CSPI) noted that acetoacetamide has been
human appetite. Because of the concern that eating
shown to cause tumor growth in the thyroid gland in
high sugars can increase the risk of obesity, diabetes,
rats, rabbits, and dogs after administration of only 1%
and cardiovascular disease, non-food sweeteners
acetoacetamide in the diet for three months (3).
(NNSs) are increasingly being used to replace sugars.
Aspartame (ASP) is one of the most widely
NNSs are marketed as dieting tools, and consumers
used artificial sweeteners. It consists of substances
can intuitively select NNS on sugar to maintain or lose
normally found in the diet and body, i.e. amino acids
weight. Most drinks, chewing gum, chocolates, jams
aspartic acid, phenylalanine and methane alcohol.
and various NNS power authorities are used. There is
After oral administration to human and experimental
emerging evidence indicating that NNSs have
animals, ASP is metabolized quickly and fully into its
unanticipated effects on human health (1).
three components. Consumption of ASP has been
Acesulfame potassium (also known as
reported to be responsible for neurological and
acesulfame K, or K-Ice) is an industrial plant,
behavioral disturbances in sensitive individuals. The
sometimes referred to in Europe as the E950. It is a
adverse neurological effects such as headaches,
high density, non-nutritive analyzer 200 times better
insomnia and seizures may be attributed to the
than sucrose. It is stable under high temperatures and
alterations in regional brain concentrations of
has an excellent default life. Potassium acesulfame is
catecholamines (4). In addition, Humphries et al. (5)
used to give food and drink a taste that is soluble
proposed that excessive aspartame ingestion might be
without adding calories. It is used as a sweetener in
involved in the pathogenesis of certain mental
many foods, including chewing gum, baked foods,
disorders and also in compromised learning and
canned foods and desserts. Acesulfame potassium is
emotional functioning. Small amounts of ASP can
not metabolized or stored in the body. It is quickly
significantly increase methanol (MeOh) concentration
absorbed and then excreted without undergoing
in the bloodstream. MeOH has a relatively low
modifications. Acesulfame potassium contains the
toxicity, but its metabolites are very toxic. It is
chemical methylene chloride, a known carcinogen.
increasingly recognized as a substance that damages
Long-term exposure to methylene chloride can cause
the liver cells, where it is oxidized to formaldehyde
headaches, depression, nausea, mental confusion, liver
which is a factor that cause significant increase in lipid
and kidney effects and cancer in humans (2). Another
peroxidation (6).
one of the byproducts of acesulfame potassium's

1976
Received7:1//2018
Accepted:26/1/2018

Full Paper (vol.751 paper# 11)


c:\work\Jor\vol751_12 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1982-1986
Assessment and Management of Asymptomatic Bacteriuria in Pregnancy
Amany A. Soliman1, Adel S. Hussein1, Ahmed G. Ahmed2
*Urology Department of Urology, 1Al-Azhar Faculty of Medicine and 2Cairo Fatemic Hospital, Cairo, Egypt
Corresponding author: Amany A. Soliman, Mobile: (+20)01006200471, E-Mail: damanyahmed@gmail.com

ABSTRACT
Background:
Asymptomatic bacteriuria in pregnancy is defined as the presence of a significant amount of bacterial
growth in a urine culture taken from a urine sample and the absence of symptoms of urinary infection such as pain or
urgency.Asymptomatic urinary tract infection is an important risk factor for developing acute symptomatic infection
later in pregnancy, and it was also associated with a preterm labor, intra-uterine growth retardation and low birth
weight infants.
Objective:
This prospective study was aimed to assess the incidence, causative organisms, response to medication
and follow-up for recurrence of asymptomatic bacteriuria in pregnant and non-pregnant women in a randomized
pattern with maximum safety procedures to both mother and fetus.
Patient and Methods: This study included 100 pregnant and 50 non-pregnant women were screened for the
prevalence of asymptomatic bacteriuria from March 2016 to May 2017 at AL-Zahraa University Hospital and Cairo
Fatemic Hospital. All the subjects were clinically identified to have no signs and symptoms of urinary tract infection.
The age ranges of the study and control groups were between 18-30 years. All were subjected to bacteriological
screening of mid-stream (MSU).
Results: Revealed that 4/100(14%) and 6/50(12%) were positive for asymptomatic bacteriuria in the study and control
groups respectively. The most prevalent organism was the E. coli (71.4%,83.3%) in both groups respectively.
Conclusion: All pregnant women should be screened for bacteriuria and subsequently treated with appropriate
antibiotic therapy. Acute cystitis and pyelonephritis should be aggressively treated during pregnancy.
Keywords: Asymptomatic bacteriuria- culture and sensitivity- urinary tract infection.

INTRODUCTION
specimen of urine from pregnant women without signs
Urinary tract infections (UTI) affects all age
or symptoms of UTI.Thus urine culture is the gold
groups, but women are more likely than men because
standard screening technique for asymptomatic
of due to short urethra, pregnancy, easy urinary tract
bacteriuria during pregnancy (4-5).
infections with fecal plants and many other reasons.
The current study was aimed to assess the
Urinary tract infection is a common problem in
incidence, causative organisms, response to medication
pregnancy due to the morphological and physiological
and follow-up for recurrence of asymptomatic
changes that occur in the genitourinary tract during
bacteriuria in pregnant and non-pregnant women in a
pregnancy. It is of two types, symptomatic or
randomized pattern with maximum safety procedures
asymptomatic (1). Asymptomatic bacteriuria (ASB) is
to both mother and fetus.
define as the "presence of actively multiplying bacteria

within the urinary tract excluding the distal urethra", at
PATIENTS AND METHODS
a time when the patient has no urinary symptoms (2).
This prospective study included a total of 150
There are a number of conditions associated with an
asymptomatic patients attending the AL-Zahraa
increased prevalence of asymptomatic bacteriuria in
University Hospital and Cairo Fatemic Hospital
pregnancy: low socioeconomic status, sickle cell traits,
seeking medication for complaints other than urinary
diabetes mellitus and grand multiparity have been
disease. Of them 100 primipara pregnant women at any
reported; each is associated with two-fold increase in
trimester attending the ante-natal clinic and 50 age-
the rate of bacteriuria (1). Asymptomatic bacteriuria are
matched non-pregnant women attending medical
found in 2% to 10% of pregnant women and are likely
outpatient department. Approval of the ethical
to develop acute pyelonephritis, postpartum UTI,
committee and a written informed consent from all
hypertensive disease, anemia, prematurity, low birth
the subjects were obtained. This study was conducted
weight babies if untreated(2-3). 40% of asymptomatic
between March 2016 to May 2017. The age of the study
bacteriuria cases develop into acute symptomatic UTI.
and control groups ranged from 18-30 years.
Hence early detection and treatment is of considerable
Exclusion criteria included history of severe UTI
importance not only to forestall acute pyelonephritis
symptoms (dysuria and urgency), Pregnancy induced
and chronic renal failure in the mother, but also to
Diabetes Mellitus & Hypertension, Hypertension,
reduce prematurity and fetal mortality in the
Diabetes mellitus, History of antibiotic therapy in the
offspring(4). Asymptomatic bacteriuria is a microbial
previous two weeks, Pyrexia, Vulvovaginitis and
diagnosis based on the isolation of a specified
Known congenital anomalies of the urinary tract.
quantitative count of bacteria in a properly collected
1982
Received:14/11/2018
Accepted:3/12/2018

Full Paper (vol.751 paper# 12)


c:\work\Jor\vol751_13 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1987-1995

Internal Fixation of Proximal Humerus Fracture by PHILOS Plate
Hesham Mohamed Safwat, Mohamed Ebrahim Abulsoud, Abdelazim Elsayed Abdelazim
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Abdelazim Elsayed Abdelazim, Mobile: 00201064498822, email: g01065949954@gmail.com

ABSTRACT
Background:
Fractures of the proximal humerus are relatively common, accounting for about 5% to 9% of all
fractions. Majority of undisplaced proximal humeral fractures can be treated with a sling immobilization and
physical therapy. However, approximately 20% of displaced proximal humeral fractures require surgery.
Objective:
The aim of the current study was to assess the expected outcomes and complication rate of proximal
humerus fractures treated with Proximal Humerus Internal Locking System (PHILOS) plating.
Patients and Methods: This prospective study included a total of 15 patients with fracture of the proximal
humerus attending at Department of Orthopedic Surgery, Al-Azhar University Hospitals. This study was
conducted between January 2018 to October 2018. All cases were surgically managed by fracture fixation
procedures (PHILOS). The follow up period of the cases is 6 months.
Results: From analysis of the literature concerning the use of PHILOS plates, our results were satisfying in terms of
functional recovery, with Constant Scores 73.67 that range between (48%­94%). Data from our survey show that
most of patients were satisfied. We have noticed that limited functional recovery was usually caused by incorrect or
delayed rehabilitation. The complication rate in our study (26.66%) is comparable to the literature, where the most
recent studies report complication rates between 32 and 50%.
Conclusion: More accurate length measurement and shorter screw selection should prevent primary screw
perforation.
Keywords:
Range of motion, PHILOS.

INTRODUCTION


Fractures of the proximal humerus are
a functionally acceptable range of motion (ROM).
relatively common, accounting for about 5% to 9%
For the 15% to 20% of displaced proximal humerus
of all fractions (1).
fractures that may benefit from surgery (5).
These fractures can be a challenge for
Surgeons should be familiar with the various
orthopedic surgeons in bone therapy because of the
treatment options available, including recent
nature of osteoporosis generally in the elderly and
advances in complex fracture management and lock
the relative deformed forces of the surrounding
pad technology, which are particularly important for
muscles. Fractions are classified according to Neer
the care of fractures(7).
standards, and treatment is often directed through the
Lock pad technology and the use of
relative displacement of anatomical fragments.
osteobiologics may become increasingly important
Historically undeveloped fractures have been treated
in the management of displaced adrenal fractures,
conservatively, with generally good results (2).
making it easier to maintain the humerus head in
Displaced fractures with angulation of the
appropriately selected patients (8).
articular surface >45° and displacement of the major
The aim of the current study was to assess the
segments >1 cm have been treated surgically, as
expected outcomes and complication rate of
have fractures with substantial valgus impaction, all
proximal humerus fractures treated with Proximal
with mixed results (3, 4).
Humerus Internal Locking System (PHILOS )
Surgical
techniques
have
included
plating.
percutaneous fixation, standard plate-and-screw
.
fixation, intramedullary fixation with rods or pins,
PATIENTS AND METHODS
the use of tension bands with and without plates or
This prospective study included a total of 15 patients
rods, standard plate modification into blade plate
with fracture of the proximal humerus attending at
constructs, and hemiarthroplasty(2, 4, 5).
Department of Orthopedic Surgery, Al-Azhar
Proximal humerus fractures are increasingly
University Hospitals.
common in societies with maturing populations.

These fractures are not simple to treat. A variety of
Approval of the ethical committee and a written
options exists; however, outcomes are less than ideal
informed consent from all the subjects were
in many patients (6).
obtained.
Most proximal humerus fractures are either
This study was conducted between January 2018 to
non displaced or minimally displaced and can be
October 2018.
treated non surgically. Nonsurgical options focus on
early functional exercises with the goal of achieving
1987
Received:4/11/2018
Accepted:23/11/2018

Full Paper (vol.751 paper# 13)


c:\work\Jor\vol751_14 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 1996-2006
Risk Factors for Neonatal Mortality in Neonatal Intensive Care Units in Tanta City
Hadeer Fahmy Ramadan El-Ganainy1, Abd El-Rahman Mohamed El-Mashad1,
Nihal Salah Shihab2 and Ashraf Mohamed Abu-Hamama1.
Department of Pediatric Medicine1 and Department of Public Health and Community medicine2,
Faculty of Medicine, Tanta University, Egypt.
Corresponding author: Hadeer Fahmy Ramadan El-Ganainy; Mobile: 01007492816; Email: dodyramy2@gmail.com

ABSTRACT
Background:
Neonatal period is the weakest period of life as it causes high rates of morbidity and mortality due to
various diseases, especially in preterm infants and those with low birth weight. Aim of the present study: assessment
of the risk factors and incidence of neonatal mortality in neonatal intensive care units in Tanta city.
Subjects and Methods: Multi-centric prospective Cohort study that was conduct in Neonatal Intensive Care Units in
Tanta city (5 public centers and 10 private centers). The duration was 6 months from August 2017 to January 2018.
Results: Incidence of neonatal mortality among the studied sample during a period of six months was 27.7%. The most
common cause of neonatal deaths was prematurity (39.4%). Cesarean section was the highest maternal risk factors
(64.3%) among the study sample. Positive consanguinity was found in 52% and had statistically significant on neonatal
mortality. There was no statistically significant difference between survived and expired neonates, while gestational age
and birth weight were statistically significant. Neonatal mortality was higher between lower gestational age and lower
birth weight. Conclusion: Neonatal mortality rates were found to be significantly high in prematurity, low gestational
age, low birth weight, cesarean section and positive consanguinity. Improvement of health care qualities is needed to
control the preventable risk factors and decrease neonatal morality.
Keywords: Neonatal mortality, Neonatal intensive care units.

INTRODUCTION

of the membrane and postpartum complications).
The first four weeks of newborns carry the highest
History of antenatal care routine ( antenatal care visits,
risk of death than any four-week period in a person's
regular ultra sound, regular measuring blood
lifetime. Neonatal mortality is a reflection of the
pressure, taking routine vaccine, screening for
effectiveness of obstetrics and neonatal services in any
TORCH infection and blood tests for blood group and
given community. It contributes to about two-thirds of
rhesus factor ).
infant deaths worldwide and most of these occur in the
Parity, health status of the other siblings and family
first week of life (1). Infants with long-term central
history.
catheterization and TPN, those who suffer from delayed 2. Review of neonatal records which included the
initiation of enteral feeding and who have a prolonged
following:
period to reach full enteral feedings or to regain their birth
Childbirth complications: pallor, cyanosis and
weight are all at high risk of late-onset sepsis (LOS) (2).
jaundice.

Newborn care: neonatal resuscitation and vital signs,
PATIENTS AND METHODS
neonatal parameters (appearance, anthropometric
This Prospective Cohort study was carried out at
measurements and breast feeding).
Pediatric Department, Tanta University Hospital over 6
Neonatal sex, place, mode of delivery and gestational
months [August 2017 to January 2018]. A total of 238
age.
neonates (The least sample size needed was calculated by
Neonatal complications: hyperthermia, hypothermia,
epi-info statistical program (version 7.2.1.0), using 90%
hypoglycemia, and anemia and their management.
estimated power and 95% confidence level.) were
Presence of congenital anomalies.
included in this study and were followed up till their death
Initial diagnosis (respiratory, cardiac, hematological,
or discharge.
infectious, surgical, metabolic, neurological and
Collection of data: Data were obtained from:
miscellaneous), and final diagnosis (the same as
1. Review of maternal records which included the
primary diagnosis).
following:

Any investigation done during incubation.
Maternal age.

Any operation or procedure done during incubation.
Level of education, occupation of the parents, marital
All newborns were followed up for 28 days or until
status,
urban/rural
residence,
address
and
time of death if before 28 days. All deaths which occurred
consanguinity.

up to 28 days of life were considered as neonatal deaths.
Medical history (diabetes, hypertensive disease,
All details regarding dates of admission, length of stay,
hemorrhage, genito-urinary infection, preterm rupture
management, provided examination and investigation and
1996
Received:6/1/2019
Accepted:25/1/2019

Full Paper (vol.751 paper# 14)


c:\work\Jor\vol751_15 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2007-2012
Serum Vascular Endothelial Growth Factor Levels in Asthmatic Children
Shimaa Moawad Hamed Elkholy1, Ahmed Mohamed Abd-ElRazek1,
Amal Said ElBendary2 and Ahmed Ibrahim Harkan3.
Department of Pediatric Medicine1 and Department of Clinical Pathology 2, Faculty of Medicine,
Department of Applied Statistics, Faculty of Commerce3 - Tanta University, Egypt
Corresponding author: Shimaa Moawad Hamed Elkholy; Mobile: 01122211709; Email: shimaakholy@yahoo.com

ABSTRACT
Background:
Bronchial asthma is a heterogeneous disease, which is usually characterized by chronic airway
inflammation. Asthma is a global problem with 300 million affected individuals. Angiogenesis has been recognized
as an essential step in the development and maintenance of airway inflammation and tissue remodeling. Vascular
endothelial growth factor plays a key role in both the physiological and pathophysiological forms of angiogenesis.
Aim of the present study was
to measure serum levels of vascular endothelial growth factor in asthmatic children to
assess its relation with asthma severity. Subjects and Methods: This study was conducted on two groups, group A:
30 asthmatic children and group B: 20 healthy children of matched age and sex. Serum vascular endothelial growth
factor (VEGF) levels were measured by ELISA. Results: There was no significant difference between asthmatic and
control groups as regard age, sex and weight. There was significant increase in serum VEGF levels in asthmatic group
than control group. There was negative correlation between VEGF serum levels and pulmonary function tests. There
was positive correlation between serum VEGF levels and asthma severity. Conclusion: There were higher levels of
serum VEGF in asthmatic patients than healthy control. Serum VEGF was higher in those with moderate and severe
asthma than those with mild disease.
Keywords: Vascular Endothelial Growth Factor, Asthmatic Children.

INTRODUCTION
compartments for circulating VEGF (5).
Bronchial asthma is a global problem with about
The aim of this study was to measure serum
300 million people with asthma. It is considered as the
levels of vascular endothelial growth factor in
most common chronic disease in children. Asthma is
asthmatic children in comparison with healthy children
one of the top 20 chronic conditions in terms of the
to
detect
the
role
of
VEGF
global ranking of disability in children (5­14 years of
in the pathogenesis of bronchial asthma in pediatric age
age). Death rates from asthma in children range from
and to assess its relation with asthma severity.
0.0 to 0.7 per 100,000. There are significant global
.
differences in the prevalence of asthma in children,
PATIENTS AND METHODS
with up to 13-fold differences between countries (1).
This prospective case control study was
Vascular endothelial growth factor (VEGF) is a
performed in the Pediatric Intensive Care Unit (PICU)
pluripotent growth factor that has a broad effect on
at Tanta University Hospital including patients
endothelial cell function. VEGF is also one of the most
attending the unit from October 2016 to September
potent angiogenic factors that stimulates endothelial
2017. The study was approved by the Ethics Board
cell proliferation and induces angiogenesis. VEGF is
of Tanta and an informed written consent was taken
widely expressed in different vascularized organs,
from each participant in the study.
including the lung (2).
A total of 50 subjects were included in this study
VEGF is a major regulator of blood vessels
and were categorized into 2 groups: Group A: 30
growth in the airways of patients with bronchial
asthmatic children aged 3-12 years diagnosed
asthma, by promoting proliferation and differentiation
according to GINA guidelines 2017 (6) in chest unit of
of endothelial cells and also inducing vascular leakage
pediatric department of Tanta University Hospital (16
and increased permeability. VEGF expression and its
males and 14 female). Group B: 20 apparently healthy
receptors are closely related to new blood vessels
children of matched age and sex coming for routine
formation, suggesting that VEGF may also be involved
health care serving as a control group. Children with
in the remodeling of the airways (3). The main sources
malignancy, thyroid dysfunction, rheumatoid arthritis,
of VEGF in the airways are alveolar epithelial cells,
sepsis or treated with immunosuppressive drugs during
smooth muscle cells, bronchial epithelial cells,
the last 4 weeks were excluded.
fibroblasts, and alveolar macrophages (4). It has been
Asthmatic children in the current study were
suggested that eosinophils are the main sources of
classified into 4 groups according to the severity, as
peripheral VEGF, but also other cellular components
follows:
including platelets and neutrophils may be important
1- Intermittent asthma: They were 10 children (6 males,
2007
Received:6/1/2019
Accepted:25/1/2019

Full Paper (vol.751 paper# 15)


c:\work\Jor\vol751_16 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2013-2019

Evaluation of Vitreoretinal Changes after Nd: YAG Laser Posterior Capsulotomy
Mohamed El-Moddather Ahmed Dardyr, Emad Abdel Aal Saliem, Hossam Ahmed Sabra
Ophthalmology Department, Faculty of Medicine, AL-Azhar University (Assuit), Egypt

ABSTRACT
Objective: To evaluate the vitreoretinal changes after Neodymium-Yttrium-Aluminum-Garnet (Nd: YAG) laser
posterior capsulotomy in patients with posterior capsular opacification after cataract extraction.
Patients and Methods: 60 pseudophakic eyes of 50 patients with opacified posterior capsule after uncomplicated
cataract surgery treated by Nd: YAG laser posterior capsulotomy. Patients were divided according to the
preoperative refractive state of the eye into three groups (Myopic, Hypermetropic, and Emmetropic). Vitreoretinal
assessment was done pre and post YAG capsulotomy.
Results: The mean best corrected visual acuity (BCVA) had improved after YAG laser posterior capsulotomy in
all groups (p < 0.001). Although there was no significant correlation between the refractive state of the eye and
changes in CMT measured by optical coherence tomography (OCT) (p <
0.096), however, there was a statistically
significant increase in CMT before and one week after YAG posterior capsulotomy (p < 0.001) without any
detectable clinical effect on the BCVA.
Conclusion: Nd: YAG laser posterior capsulotomy is the standard treatment for posterior capsular opacification
[PCO] and gives rise to rapid improvement in visual acuity relieving the symptoms of blurring, photophobia, and
glare.
Keywords: Capsular Opacification, Vitreoretinal changes, Nd: YAG laser posterior Capsulotomy.

INTRODUCTION
without complications, some of which can be sight-
Cataract is the main cause of avoidable blindness
threatening. Several studies have described damages
in the world. Extracapsular cataract extraction [ECCE]
in the intraocular lens [IOL], increased intraocular
and phacoemulsification [PHACO], with posterior
pressure [IOP], iritis, corneal injury, hyphema,
chamber intraocular lens implantation [PC-IOL] are
vitreous prolapse, vitritis, cystoid macular edema,
the surgical techniques mostly used to remove the
retinal tear, retinal detachment [RD] and reactivation
cataract. Posterior capsular opacification [PCO] is one
of dormant microorganism in the posterior capsule
of the most common postoperative complication
that may induce intraocular infection [5].
which results in decreased visual performance of the

patient. It develops in approximately 20% of patients
Evaluation of vitreoretinal changes after Nd-
who have undergone cataract surgery. PCO is
YAG laser posterior capsulotomy is carried out
characterized by proliferation, transformation, and
through a variety of measures including detailed
migration of lens epithelial cells remaining on the
fundus examination, B-scan and optical coherence
margin of anterior capsule which form plaques on the
tomography [OCT] which is one of the most helpful
central portion of the posterior capsule. Over time, the
tool in vitreoretinal assessment [6]. The present study
capsule becomes opacified by various proteins within
aimed to focus on vitreoretinal changes or
the eye and this will reduce the visual acuity of the
complications that may occur after Nd: YAG laser
patient [1]. Time from cataract surgery to visually
posterior capsulotomy.
significant posterior capsular opacification varies from

months to years in adults. Almost 100% opacification
PATIENTS AND METHODS
occurs within 2 years after surgery in younger age
This prospective study was performed in the
groups. Rate of opacification declines with
Department of Ophthalmology at Al-Azhar University
increasing age
Hospital-Assuit between April 2018 and November
The Neodymium-Yttrium-Aluminum-Garnet [Nd:
2018 and included 60 pseudophakic eyes of 50
YAG] laser is a solid state laser with a wavelength of
patients with a significant visual loss due to posterior
1064 nm that can disrupt ocular tissues by achieving
capsular opacification treated by Nd-YAG laser
optical breakdown with a short, high-power pulse.
posterior capsulotomy. All of these patients had
Optical breakdown results in ionization and plasma
undergone
non-complicated
cataract
surgery
formation in the ocular tissue. This plasma formation
(phacoemulsification "46 eyes", extracapsular cataract
then causes acoustic and shock waves that disrupt
extraction "8 eyes" and manual small incision cataract
tissues [3]. The Nd: YAG posterior capsulotomy is an
surgery [MSICS] "6 eyes". An informed written
outpatient effective, and relatively safe technique for
consent was obtained from each patient before the
opening the opacified posterior capsule [4].
enrollment in the study. Al-Azhar University
Although Nd:YAG laser capsulotomy
Institutional Ethics Committee approval was
is accepted as a standard treatment for PCO and has
obtained. The age ranged between 26-84 years with
been found to be safe and effective, however it is not
the main age of 58.68±12.37 years.
2013
Received:9/11/2018
Accepted:28/11/2018

Full Paper (vol.751 paper# 16)


Introduction The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2020-2025

Doppler Characteristics of Subendometrium and Uterine Hemodynamic
Changes in Patients with Copper Intrauterine Device-induced Bleeding
Mohamed Hesham Hassan Anwar, Yousef Abu Shady,
Bassem Ragab Abdel-Aziz, AbdelHalim Esmail Esmail Ashour *
Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University
* Corresponding author: AbdelHalim Esmail Esmail Ashour, Mobile:01001647041, email: drhalimashour@yahoo.com

ABSTRACT
Background:
The intrauterine contraceptive device is one of the most frequently used method of contraception
allover the world. The most important adverse effects related to copper intrauterine contraceptive device
use are excessive uterine bleeding and menstrual pain which are responsible for 5-15% removal rate of IUD
during the first year of its insertion.
Objectives: The aim of the present study is to evaluate subendometrial blood flow in cases of menorrhagia after
copper IUCD insertion in comparison to cases using IUCD and not complaining of abnormal uterine bleeding.
Patients and Methods: This study included 200 women; divided into two groups. Group I; included 100 women
using copper intrauterine device and complaining of menorrhagia, Group II; included 100 women using copper
IUD and not complaining of abnormal uterine bleeding.
Results: As regard to Doppler findings, it was noted that PI, RI of uterine arteries were significantly lower in
group I in comparison to group II (p value <0.001), and by power Doppler energy women in group I with
menorrhagia had a significant increase in subendometrial blood flow according to the subendometrial signal area
percentage in comparison with women in group II using copper IUD and not complaining of abnormal
uterine bleeding (control group). Conclusion: The results of our study revealed that uterine artery and
subendometrial blood flow were increased in women with copper IUD induced menorrhagia in comparison
to women with copper IUD and not complaining of abnormal uterine bleeding.
Keywords: Doppler, Subendometrium, Uterine Hemodynamic, Copper Intrauterine Device-induced Bleeding.

INTRODUCTION

The intrauterine copper devices are the most
It has been suggested that menorrhagia, may
widely used method of long-acting reversible
be caused by an increased uterine secretion of
contraception with a very low failure of 0.2-1.0% (1).
prostanoids leading to impaired hemostasis (6).
Side effects associated with IUD are mainly
Temporary post-insertion rise in prostaglandin
used for pelvic cramping, dysmenorrhea, heavy
concentrations coincided with the phase of increased
menstrual periods, and the discovery of uterine device
bleeding and pain. There is over expression of mRNA
expulsion may cause a stopover. Heavy menstrual
and protein of Cyclo-Oxygenase-2 (COX-2) enzyme
periods are the most common cause of device removal
leading to overproduction of prostaglandins in the
(2). There are many possible mechanisms that explain
endometrium after the insertion of copper intrauterine
the cause of menstruation in patients who use
device (CIUD) (7).
intrauterine contraception. Several studies have
Other vasoactive substances may also be
reported that intrauterine contraceptive inputs increase
involved, including nitric oxide (NO) which is a potent
the production of prostaglandins in the lining of the
vasodilator produced the vascular endothelium. Nitric
uterus, which causes an increase in blood vessels,
oxide (NO) is present in the human endometrium and
vascular permeability, inhibits platelet activity, and
myometrium (8).
thus increases menstrual bleeding (3).
There is evidence that nitric oxide (NO) may
Probably there is relation between intrauterine
play a part in acute and chronic inflammation (9). The
device adverse effects and uterine vascularization.
introduction of intrauterine device into the uterine
However, this association is neither well-known nor
cavity induces a foreign body reaction in the
well-studied (4). Only a few studies have demonstrated
surrounding endometrium (10). Nitric oxide (NO) is
an increase in subendometrial vascularization in
present in the foreign body inflammatory reaction
patients with intrauterine device-induced menorrhagia
around loosened joint replacement implants. Thus, it is
(5). There are several mechanisms explaining the
possible that Intrauterine device also induces nitric
association of the pulsatility index (PI) and resistance
oxide (NO) synthesis in the surrounding tissue. There
index (RI) of uterine artery with menstrual blood loss.
is also a connection between nitric oxide (NO)
2020
Received:17/11/2018
Accepted:6/12/2018

Full Paper (vol.751 paper# 17)


c:\work\Jor\vol751_18 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2026-2035
One Year Randomized Study of L-Thyroxin Treatment in
Women with Subclinical Hypothyroidism
Olfat A. Fawzy1, Eman Mahmoud1, leaW M. Attia2, Ahmed M. Ibrahim3
1Department of Endocrinology, Faculty of Medicine for Girls, Al-Azhar University,
2Department of Cardiology, Faculty of Medicine for Boys, Al-Azhar University,
3Police Authority Hospital, Ministry of Interior, Cairo, Egypt
*Corresponding author: Ahmed Morsy Ibrahim, E-mail: drahmedmorsy@yahoo.com, Mobile: (+20)01223955647

ABSTRACT
Introduction:
Subclinical hypothyroidism (SCH) is a laboratory finding which may be asymptomatic or
associated with signs and symptoms of hypothyroidism. However, benefits of L-Thyroxin (LT4) treatment are
not well established.
Aim of the Work: The aim of the study was to evaluate the impact of treatment of SCH on thyroid clinical
scores, bone mineral density (BMD), cardiac function and health related quality of life (HR-QOL).
Subjects and Methods: a total number of 65 women, who were diagnosed with SCH, constituted the study
subjects. They were within the age range of 40-70 years. They were randomly divided into two groups (group I,
included 25 patients who were treated with L Thyroxin (L-T4), and group II included 40 women with SCH who
were not treated and kept under follow up for one year. Effects of L-T4 treatment on BMI, cardiac function,
BMD, lipid profile, thyroid clinical score and HR-QOL were assessed.
Results: After one year; regarding body mass index (BMI), Group II had significantly higher BMI (p=0.006)
though the percentage change of BMI after one year was comparable in the two groups. Total thyroid clinical
score and the total HR-QOL score were significantly lower in Group I compared to group II (p < 0.001).
Regarding thyroid hormone profile; free T4 was significantly higher and thyroid stimulating hormone (TSH)
was significantly lower in-group I compared to group II (p=0.033 & p < 0.001 respectively).
Conclusion: LT4 treatment for women with SCH was found to improve total clinical thyroid score, HR-QOL,
systolic and diastolic dysfunction besides lowering TC, LDL and TG levels. However, there was evidence of
bone loss in patients with SCH treated with L-T4. Thus, decision to treat or not should be individualized
according to the patient's risk benefit ratio assessment.
Keywords: Subclinical Hypothyroidism, Thyroid Clinical Score, Diastolic Dysfunction, Health Related Quality
of Life.

INTRODUCTION

Subclinical hypothyroidism (SCH), also called
has other risk factors for developing overt
mild thyroid failure, is diagnosed when peripheral
hypothyroidism (6).
thyroid hormone levels (FT4) are within normal
Several studies have reported a link between
reference laboratory range but serum thyroid-
SCH and conditions that increase morbidity and
stimulating hormone (TSH) levels are mildly
mortality rates, such as weight gain, quality of life,
elevated corrected by age, as suggested by the
diastolic hypertension, low-grade inflammation, low
American and European thyroid associations and the
fat lipid level, insulin resistance, and metabolic
American Association of Clinical Endocrinology (1,
syndrome and heart dysfunction. L-T4 may have
2).
positive effects on many of these associated diseases
The incidence of SCH is 4­10% and is higher in
(1, 3­9). The aim of the current work was to evaluate
women. The prevalence of SCH significantly
the
impact
of
treatment
of
subclinical
increases in people over the age of 60 when it
hypothyroidism on thyroid clinical scores, bone
reaches 15% of females and 8% of males (3). The
mineral density, cardiac function and health related
commonest leading cause of increased TSH is chronic
quality of life.
autoimmune thyroiditis (4). Among the patients with

the TSH values of 5.0­9.9 mIU/L, SCH progresses
PATIENTS AND METHODS
to overt hypothyroidism in 5.6% of cases. Patients
This prospective follow up study included a
with TSH values between 15.0 and 19.9 mIU/L have
total of 65 women, who were diagnosed with
a higher percentage of progression (85.7%) (1, 5).
subclinical hypothyroidism (SCH). They were
According to current guidelines, a decision
recruited from the outpatient clinics of Al-Agouza
for treatment is based on the presence of mild
Hospital in Giza. Approval of the ethical committee
symptoms suggestive of hypothyroidism as goiter
and a written informed consent from all the subjects
and any other comorbidity. Many authors advise L-
were obtained. This study was conducted between
Thyroxine (LT4) treatment only if TSH elevation
January 2014, and December 2018.
still persists for more than 3 months and the patient
2026
Received:15/9/2018
Accepted:30/9/2018

Full Paper (vol.751 paper# 18)


ABSTRACT The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2036-2042

Evaluation of Choroidal Changes During Pregnancy
Asmaa A. Mohammed, Heba M. Abdelrahman, Mona M. Aly
Department of Ophthalmology, Faculty of Medicine (For Girls), Al-Azhar University, Cairo, Egypt
Corresponding author: Asmaa Abdullah Mohammed, Mobile: 01288569553; Email: first220dr@gmail.com

ABSTRACT
Background:
During pregnancy, various physiological changes occur in almost all organs of the body including the eyes.
Increased blood volume and cardiac output results in ocular blood flow increase. Consequently, the choroid is a highly
vascular tissue; any local or systemic pathology affecting the vasculature could also affect the choroid.
Objective: The aim of the study was to report and evaluate choroidal changes in healthy pregnant women, pregnant women
with gestational diabetes mellitus (GDM), and pregnant women with gestational hypertension (GH) and to compare the
measured parameters with those of healthy non-pregnant women.
Patients and Methods: This prospective comparative study comprised 180 eyes of 90 women divided into 4 groups;
Group 1(control): 30 healthy non-pregnant females, Group 2 (Low risk pregnancy): 30 healthy pregnant females 24
weeks of gestation, Group 3 and 4 (high risk pregnancy): each consisted of 15 pregnant females 24 weeks of gestation
with GDM or GH. All four groups were age-matched. Choroidal thickness (CT) was measured using enhanced depth imaging
spectral domain optical coherence tomography at seven different locations.
Results: CT increased significantly in healthy pregnant females (third trimester) compared to control group and decreased
significantly in high risk pregnant females compared to healthy pregnant and non-pregnant females.
Conclusion: Reporting changes in CT during pregnancy may give valuable data to interpret pregnancy-related ocular
pathologies.
Keywords: Choroidal thickness, pregnancy, enhanced depth imaging optical coherence tomography

INTRODUCTION


Pregnancy is a natural state of physiological stress
than 70% of the blood flow in the eye. So, any changes
to the whole body. Each system of the body in a
of the choroid may lead to ocular problems (1, 2, 4).
pregnant lady behaves in a different way from a non-
The development of the enhanced depth imaging
pregnant state (1). One of the most important organs
optical coherence tomography (EDI-OCT) has
affected by pregnancy-induced physiological changes
enabled the visualization and measurement of the
is the eye such as temporary variation in refractive
anatomical features of the choroid. It decreases signal
error, decrease in intraocular pressure (IOP) and
strength posterior to the RPE, hence increasing image
reactive changes in the retinal vessels (2).
resolution of the choroid dramatically. This method of
Pregnancy may worsen pre-existing conditions
imaging is performed with Spectral Domain (SD) -
such as diabetic retinopathy and result in the
OCT instruments focused on deeper ocular structures,
manifestation of major complications. Pathological
such as the choroid (2, 5).
changes during pregnancy that did not exist before
The aim of the current study was to evaluate
have also been reported such as eclampsia-associated
choroidal changes in healthy pregnant women,
retinopathy and central serous chorioretinopathy (2).
pregnant women with gestational diabetes mellitus
A variety of important changes in the
(GDM), and pregnant women with gestational
cardiovascular system occurs starting early in
hypertension (GH) and to compare the measured
pregnancy. These changes include increase in the
parameters with those of healthy non-pregnant
cardiac output and heart rate. As early as the first
women.
trimester of pregnancy; progressive increase in the

blood volume occurs mediated by an increase in the
PATIENTS AND METHODS
renin-angiotensin-aldosterone system. Hormonal
This prospective comparative study included a
changes lead to dilatation of the blood vessels.
total of 120 eyes of 60 pregnant women and 60 eyes of
Peripheral vasodilatation leads to fall in systemic
30 age-matched healthy non-pregnant females
vascular resistance, which is accompanied by an
attending at the Ophthalmology and Obstetrics and
increase in vascular capacity; as a result, the blood
Gynecology Departments and Clinics of Al-Zahraa,
flow to many organs increases (3).
Al-Azhar University Hospital. This study was
The choroid is a vascular tissue that has an
conducted between July 2018 and January 2019. A
important role in providing oxygen and nutrients to the
written informed consent from all the subjects and
retinal pigment epithelium (RPE), outer retinal layers,
approval of the Ethics Board of Al-Azhar University
avascular fovea and part of the optic nerve. The blood
were obtained. This study was conducted in
flow per unit weight of choroid is higher than that of
accordance with the Declaration of Helsinki
any other tissue in the body (about 20 to 30 times
guidelines.
greater than that of the retina) accounting for more
6302
Received:7/1/2019
Accepted:26/1/2019

Full Paper (vol.751 paper# 19)


Abstract The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2043-2047
Closed Reduction and Percutaneous Pinning in Management of
Epiphyseal Injury of Distal Radius in Children
Ismail Hammouda, Mahmoud Sedeek, Ahmed Ali Fadel*
Orthopedic Surgery Department, Faculty of Medicine, AlAzhar University
* Corresponding author: Ahmed Ali Fadel, E-mail: ahmed_ali_fadel@yahoo.com

ABSTRACT
Background:
The goals of management of a displaced epiphyseal fracture of distal radius are to recover full
function in a cosmetically normal wrist and elbow and avoidance of complication. The commonly accepted
treatment in children is fracture reduction and percutaneous pin fixation.
Objectives: Study of the results of treatment of displaced epiphyseal fractures of distal radius in children by closed
reduction and percutaneous fixation by K-wires.
Materials and Methods: Twenty-five children were treated by this method. Most of them were displaced dorsal
and the others were displaced volar according to the directional displacement. The cases were examined clinically
and radiologically at first. Twenty cases were operated in the same day and five cases were delayed because of
sever edema. Results: the results were assessed both functionally and cosmetically according to evaluation of
elbow, wrist function, pronation and supination and residual deformity. The overall results obtained were
satisfactory with treatment by closed reduction and percutaneous pinning.
Conclusion: we suggest that children who initially have a completely displaced fracture of the distal radius should
be manipulated under general anesthesia and recommend that percutaneous K-wire fixation be used to ensure
stabilization and avoid redisplacement, even when a perfect closed reduction has been achieved.
Keywords: Percutaneous Pinning, Epiphyseal Injury, Distal Radius.

INTRODUCTION
Possible complications postoperatively are;
Epiphyseal injuries of the distal radius are
edema, pin tract infection and pin migration. The
common in children, and they account for 75% to 84%
major problem I faced was the difficult closed
of pediatric forearm fractures (1).
reduction in the cases presented late because of the
Fortunately, most epiphyseal-plate injuries are
presence of edema. The second problem was difficult
not associated with any disturbance of growth. After
insertion of the pin from dorsal to volar in these cases.
separation of an epiphysis through its epiphyseal plate,
Iatrogenic neurovascular injuries and other intra-
there may be a slight and transient acceleration of
operative complications are possible but rare (10). The
growth, in which case no significant deformity ensues
most commonly used treatment modality is closed
(2). The radius is connected to the ulna via the proximal
reduction and immobilization in plaster. Conservative
radioulnar articulation, the interosseous membrane,
treatment is gold standard in long-term follow up of
and the distal radioulnar articulation. The distal and
children with epiphyseal fracture of distal radius. The
proximal radioulnar joints are interdependent for
most important problem in this treatment is to
stability. With pronation and supination, movement
maintain the reduction in a plaster brace. Loss of
occurs at each of these joints (3). Bado (4) noted that
reduction and malunions are frequently seen (11).
with pronation, the radius shortens and, with
Fixation with percutaneous Kirschner wire (K-
supination, it lengthens relative to the ulna. This
wire) is recommended in patients who carry high risk
interdependence may be the reason for late dislocation
of reduction loss after closed treatment in order to
of the radial head in children who had significant
prevent forearm rotational loss (12).
shortening of the ulna after an injury to its distal end.
In my study I aimed to determine the effect of
Caine classification of epiphysial injuries is
percutaneous K-wire fixation after the first reduction
based on the mechanism of injury and the relationship
maneuver in the patients with epiphyseal distal radius
of the fracture line to the growing cells of the
fractures who had risk of reduction loss in the plaster
epiphyseal plate and is correlated with the prognosis
brace.
for growth disturbance (5). Epiphyseal injuries have

also been classified by Poland, Aitken and Magill, and
AIM OF THE WORK
more recently by Ogden (2). The goal of treatment is to
Proper assessment and management of
prevent proximal migration of the distal radial
epiphyseal injury of distal radius through
fragment and to stabilize the radioulnar joint (7).
satisfactory reduction and proper fixation by K-wires
Displaced fractures of the distal radius physis
without effect on bone growth or length.
with median neuropathy and significant volar soft

tissue swelling can be managed with closed reduction
MATERIALS AND METHODS
and percutaneous pinning (8). The perfect anatomical
This prospective study was carried out from
reduction was the most important prognostic factor,
May 2017 to January 2019.Twenty five patients of
but not for initially completely displaced fractures (9).
recent displaced epiphyseal fractures of distal radius in
2043
Received:28/10/2018
Accepted:17/11/2018

Full Paper (vol.751 paper# 20)


c:\work\Jor\vol751_21 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2048-2053

Fragmented QRS and Ventricular Arrhythmias in Coroary Artery Disease Patients
Tamer Sayed Mohamed Abdel Mawla1, Asmaa Mizar Abdel Hameed1,
Sherif Hamed Zaky2, Khaled Ahmed El Khashab3
1Critical Care Department, Fayoum University,2Critical Care Department, Cairo University,
3Cardiology Department, Fayoum University
Corresponding author: Asmaa Mizar Abdel Hameed, Mobile:01127266629, email: asmaasaady44@yahoo.com

ABSTRACT
Background:
Fragmented QRS represents myocardial scar and will be associated with ventricular dysfunction and
occurrence of congestive heart failure. In CAD, fQRS represents prior occurrence of myocardial infarction and will
have a risk of subsequent occurrence of ischemic events.
Objective: in our study we aimed to determine whether fragmented QRS (fQRS) is associated with increased
incidence of ventricular arrhythmias in patients with coronary artery disease (CAD) or not .
Patients and Methods: one hundred patients with CAD were included. Patients were divided into two groups
according to presence or absence of fQRS on admission ECG. Group 1 (n=50) was defined as a fQRS (+ve) and group
2 (n=50) was defined as a fQRS (-ve). All patients were subjected to full history taking, complete physical
examination, ECG, echocardiography and laboratory investigations.
Results: There was higher incidence of fQRS in hypertensive patients (72%). FQRS was found to be associated with
increased incidence of ventricular arrhythmias, 52% in group 1 versus 24% in group II. EF % was significantly lower
in group I than in group 2 with p value 0.03. Fragmented QRS was an independent predictor of all-cause mortality
with p value 0.02. Conclusion: fQRS on the resting surface electrocardiogram is a simple, fast and inexpensive
modality of noninvasive investigation for evaluation of CAD patients. Patients who have known CAD present with a
fQRS have an increased rate of ventricular tachyarrhythmias, death risk, and low ejection fraction.
Keywords
: Fragmented QRS, Coronary Artery Disease, Ventricular arrhythmia, Mortality.

INTRODUCTION


Fragmented QRS complex in patients with CAD
PATIENTS AND METHODS
was associated with myocardial conduction block due
Prospectively we enrolled 100 consecutive
to myocardial scar detected by myocardial single
patients with CAD patients (with acute or old MI)
photon emission tomography (SPECT) (1).
admitted to intensive care unit in Fayoum University
Fragmented QRS was defined by an additional
hospital in the period from June 2016 to June 2017.
R wave (R') or notching within the QRS complex.
The study was approved by the Ethics Board of
FQRS improved identification of prior myocardial
Fayom and an informed written consent was taken
infarction in patients who are being evaluated for
from each participant in the study.
CAD (2). Fragmented QRS can be caused by zigzag

conduction around the scarred myocardium, resulting
Patients were divided into two groups
in multiple spikes within the QRS complex (2).
according to presence or absence of fQRS on
Fragmented QRS represents myocardial scar
admission ECG to:
and will be associated with ventricular dysfunction
- group1 (n=50) was defined as an fQRS (+ve).
and occurrence of congestive heart failure. In CAD,
- group 2 (n=50) was defined an fQRS (-ve).
fQRS represents prior occurrence of myocardial
We excluded from our study patients with
infarction and will have a risk of subsequent
electrolytes disturbance and patients with FQRS not
occurrence of ischemic events (3).
complaining of CAD.
FQRS also can reflect intracardiac conduction
After full history taking, complete clinical
abnormality and will represent a substrate for
examination, and routine laboratory investigations;
ventricular arrhythmia (4).The usefulness of fQRS for
all patients were subjected to the following:
detecting myocardial scar and for identifying high
Electrocardiography (ECG)
risk patients has been expanded to various cardiac
Twenty-lead surface ECG was obtained at
diseases, such as cardiac sarcoidosis, arrhythmogenic
admission. (25mm/s, 10 mm/mV). fQRS was defined
right
ventricular
cardiomyopathy,
Brugada
as the presence of different RSR' patterns which
syndrome, and acquired long QT syndrome (5).
included an additional R wave or notching of the R

wave or S wave, or the presence of more than one R'
AIM OF THE WORK
prime without typical bundle branch block in two
Determine whether fQRS is associated with
contiguous leads corresponding to a major coronary
increased incidence of ventricular arrhythmias in
artery territory.
CAD patients or not.

2048
Received:7/1/2019
Accepted:26/1/2019

Full Paper (vol.751 paper# 21)


c:\work\Jor\vol751_22 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2054-2058

Comparison of ICSI Outcomes in Patients with Hydrosalpinx Pretreated with
Either Laparoscopic Tubal Disconnection or Hysteroscopic Tubal Occlusion
Ismael Mohammed Elgarhy1, Ahmed Mohammed Rammah2, Mohammed Mohammed Saber Bakry3*
Department of Obstetrics and Gynecology, 1Faculty of Medicine, Al-Azhar University, Cairo 2International Islamic
Center for Population Studies and Research, Al-Azhar University, Cairo 3Shebein Elkom Teaching Hospital
*Corresponding author: Mohammed Mohammed Saber Bakry, E-mail: mustafatolba@yahoo.com

ABSTRACT
The aim of the study was to compare the efficacy of hysteroscopic tubal electrocoagulation versus laparoscopic tubal
disconnection for management of hydrosalpinx related infertility among patients undergoing ICSI. The sample of the
study was 100 patients. Half of the patients underwent hysteroscopic tubal electocoagulation who have laparoscopic
contraindications, while the other half underwent laparoscopic tubal disconnection. After tubal occlusion was done, an
ICSI cycle was startedwith assessment of chemical pregnancy rate. The rate of positive chemical pregnancy was 50 %
in hysteroscopic group and 58% in laparoscopic group, so hysteroscopic tubal electrocoagulation was found to be a
successful treatment for hydrosalpinges before ICSI when laparoscopy is contraindicated with chemical pregnancy rate
comparable to laparoscopic tubal disconnection.
Keywords: Hydrosalpinx; Hysteroscopy; Infertility; Invitrofertilization; Laparoscopy.

INTRODUCTION

Tubal factor of infertility resulting from various
followed by open salpingectomy, salpingostomy,
forms of tuboperitoneal damage remains an extremely
proximal
tubal
occlusion
and
transvaginal
common cause of female infertility, accounting for more
ultrasonographic guided hydrosalpinx aspiration either
than 35% of all cases of female infertility. Probably the
beforeor during oocyte retrieval. The latest treatment
most severe form of tubal pathology is hydrosalpinx.
option introduced was proximal occlusion of the
Hydrosalpinx is a Greek word that means a Fallopian
hydrosalpinx
by
hysteroscopic
placement
of
tube filled with water or fluid. Patients with
microinserts.
Clinicians
would
still
perform
hydrosalpinges have been identified as a subgroup with
opensalpingectomy. The possible explanation for this
significantly lower implantation and pregnancy rates
could be thelack of training in endoscopic surgery and/or
than patients with other tubal pathologies. An increased
that patientswith tubal disease may have significant
risk for early pregnancy loss and increased risk for
pelvic adhesions necessitating open surgery (7).
ectopic pregnancies was reported, and many studies
Laparoscopic salpingectomy or tubal ligation
confirmed that the presence of hydrosalpinx
has been shown to improve IVF outcomes for patients
significantly impairs IVF outcome as well(1).
with a hydrosalpinx (8).
Patients with a hydrosalpinx have been found to
However, this procedure has many drawbacks,
have significantly poorer outcomes of IVF than do
including its invasiveness, the possibility of surgical
patients with tubal factor infertility but no
injury (e.g. visceral injury, vascular damage, or
hydrosalpinx (2). Hydrosalpinges in infertile women
unintended laparotomy), the potential risks from general
reduce the success of IVF by 50% (3). The harmful effect
anesthesia, and technical difficulty if there are pelvic
of a hydrosalpinx on pregnancy rates after IVF has been
adhesions. The proximal occlusion of a hydrosalpinx by
attributed to mechanical washout of the transferred
hysteroscopy might offer a feasible therapeutic
embryos by tubal­uterine reflux of the hydrosalpinx
alternative when laparoscopy is technically difficult or
fluid (4). Additionally, a hydrosalpinx might disturb
contraindicated, with the advantage of hysteroscopic
endometrial receptivity: integrins, the best endometrial
procedures of faster recovery, less hospitalization and
markers, show decreased expression in cases of
rapid return to work, and in the future it might be done
hydrosalpinx (5). Altered endometrial blood flow has also
in the outpatient clinic as an office procedure(9).
been proposed as a possible factor causing decreased

rates of implantation (5).
AIM OF THE WORK
Any surgical interventions that disrupt tubal­
The aim of the study was to compare the efficacy
uterine communication in affected tubes might improve
of hysteroscopic tubal electrocoagulation versus
pregnancy rates (6).
laparoscopic tubal disconnection for management of
Laparoscopic salpingectomy was the most
hydrosalpinx related infertility among patients
popular treatmentoption offered by the clinicians,
undergoing ICSI.
2054
Received:8/1/2019
Accepted:27/1/2019

Full Paper (vol.751 paper# 22)


c:\work\Jor\vol751_23 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2059-2063

Role of CT and MRI in Assessment of Temporal Bone
Pre and Post Cochlear Implantation
Tarek Mohamed El-Zayat, Mohamed Salah Elfeshawy,
Ahmed Hassan Khashaba, Mohamed Ezzat Abd El-Raouf
Department of Radiology, Faculty of Medicine, Al-Azhar University.
*Corresponding author: Mohamed Ezzat Abd El-Raouf, Mobile: (+20)01113066065, E-Mail: ezzatmohamed15@gmail.com

ABSTRACT
Background: MDCT and MRI plays a critical role in evaluation and management of different causes of hearing loss
which require many therapeutic techniques including cochlear implantation. MDCT has proven its efficacy in the
postoperative imaging of cochlear implant patients. CT confirms the intracochlear position of the implant. It has also
been shown that malpositioning and kinking can be detected by CT imaging.
Aim of the Work: To evaluate the role of various imaging modalities (CT and MRI) in pre and postoperative evaluation
of cochlear implant candidates.
Patients and Methods:
The study included a total of 20 patients referred to the Radiodiagnosis Department from the
E.N.T Department in EL-Galaa Military Hospital. The patients had bilateral severe to profound sensorineural hearing
loss (SNHL). CT and MRI were done for assessment of the cochlear state prior to the cochlear implantation operation.
Postoperative CT was done to underline the position of implanted electrode.
Results: The study was performed on 8 males (40%) and 12 females (60%). Only 17 patients (85%) underwent cochlear
implantation, the other 3 cases (15%) were diagnosed as Michel deformity, Cochlear hypoplasia and Labyrinthine
ossificans. Full electrode array insertion was reported in all cases underwent of cochlear implantation.
Conclusion: Preoperative CT and MRI assessment is critical for determining implant candidacy. Postoperative CT
confirms the intracochlear position of the implant.
Keywords:
CT, MRI, temporal bone, petrous, cochlear implantation, preoperative, postoperative.

INTRODUCTION

The cochlea implant is a high-tech device that is
females) with severe to profound bilateral sensorineural
inserted into the cochlea of patients with acute and
hearing loss (SNHL). All patients were referred from
severe bronchial hearing loss who have not benefited
ENT Department of El Galaa Military Hospital. CT
from conventional hearing amplification devices (1).
and MRI were performed as a part of preoperative
Candidates for the cochlear implant undergo
assessment in Radiodiagnosis Department.
preoperative assessment involving clinical, speech
The study was approved by the Ethics Board of
therapeutic, psychological, social criteria and imaging
Al-Azhar University and an informed written
of the cochlear region to identify the etiology of hearing
consent was taken from each participant in the
loss, findings that may contraindicate surgery and
study.
helping to select the ear to be implanted (2). Cochlear
CT was done after cochlear implantation to ensure
implants aim to provide complex sound analysis by
intracochlear position of inserted electrode. An approval
stimulating auditory cortex over a wide range of
of the study was obtained from El Galaa Military
frequencies. To achieve this goal, the implant must be
Hospital academic and ethical committee. Written
placed well within the cochlear lumen.
consent was taken from patients to participate in this
Therefore a detailed preoperative and postoperative
study. Imaging for the pediatric population was
radiological assessment of the temporal bone has
performed under sedation or short acting general
become vital for cochlear implantation (3). MDCT and
anesthesia. Low-dose pediatric HRCT protocols are
MRI plays a critical role in evaluation and management
used to keep radiation doses to a minimum.
of different causes of hearing loss which require many

therapeutic techniques including cochlear implantation
Patient selection (Inclusion criteria):
(4). Multi-slice CT has proven its efficacy in the
Cochlear implants are intended for patients with
postoperative imaging of cochlear implant patients. CT
bilateral severe to profound, pre or post-linguistic SNHL
confirms the intracochlear position of the implant. It has
and who demonstrate limited benefit from amplification
also been shown that malpositioning and kinking can be
(6). The goal of clinical and imaging evaluation is to
detected by CT imaging (5).
select
those
patients

who will benefit the most from implantation (7). The
PATIENT AND METHODS
decision to operate is made after a thorough evaluation
This study included 20 patients (8 males and 12
by a multidisciplinary team (8).
2059
Received:17/1/2019
Accepted:17/2/2019

Full Paper (vol.751 paper# 23)


c:\work\Jor\vol751_24 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2064-2070
Highly-Sensitive C-reactive Protein Level and its Association with
Intermediate and High Syntax Score in cases of Acute Coronary Syndrome
Abdelaziz Rezk , Mohamed Sarhan, Ahmed Elmoghl
Cardiology Department, Faculty of Medicine, Al-Azhar University

ABSTRACT
Background:
Highly-Sensitive C-reactive Protein (hs-CRP) levels are associated with short- and long-term
mortality in patients with acute coronary syndrome (ACS). Aim: We investigated if baseline hs-CRP levels are
correlated with burden of coronary atherosclerosis assessed by SYNTAX score (SXScore).
Subjects and methods: We investigated 200 patients with ACS who underwent coronary angiography. The
patients were divided into groups based on their SXScore: low SXScore ( 22), and intermediate-high SXScore (
23). Results: Patients in the intermediate-high SXScore group had higher serum hs-CRP levels in comparison to
low SXScore group (4.61 ±1.54 mg/dL versus 2.37 ± 0.66 mg/dL, P < 0.001). The mean age of patients and
prevalence of diabetes in the intermediate-high SXScore group were statistically insignificantly than in the low
SXScore group. Left ventricular ejection fraction (LVEF) was significantly lower in the patients with an
intermediate-high SXScore (41±9 %) compared to low SXScore tertiles (50±8 %) (P< 0.001).
There was significant correlation between the hs-crp levels and the syntax score. The correlation coefficient (r) =
0.567, also p value was significant p=0.0001. Consecutively hs-CRP at a cut-off point of 2.5mg/L was highly
sensitive (97%) and specific (41%) and was a strongly independent predictor of a high SXScore in patients with
ACS. Where accuracy of test was (acc= 0.94). Conclusion: It is believed that serum levels of hs-CRP on
admission in patients with ACS thought to be a strong predictor of the severity and complexity of coronary
atherosclerosis together with multivessel disease, and LVEF.
Keywords: Inflammation, Severity of atherosclerosis, Coronary artery disease.

INTRODUCTION

The SYNTAX score (SXScore) is a useful
syndromes [NST-ACS, including non ST elevation
angiographic grading tool and it can be used to
myocardial infarction (NSTEMI) or unstable angina
accurately quantify the extent, severity, and complexity
pectoris (USAP), n = 83, 41.5%], which diagnosed
of coronary artery disease (CAD) (1-3).
using electrocardiography (ECG) changes and the
The SXScore is an independent predictor of long-
development of myocardial necrosis. Patients with
term mortality and morbidity in several patient types
ACS, an SXScore of zero, history of prior coronary
including acute coronary syndrome (ACS) (4-8).
artery
bypass
grafting
surgery
(CABG),
It is known that important role in the
cardiopulmonary resuscitation before admission,
atherosclerotic
process
performed
through
presence of advanced valve disease and advanced
inflammation where, it begins as endothelial
renal/ hepatic disease, known malignancy, a history of
dysfunction then continues through all stages of plaque
congestive heart failure, and/or the presence of
formation until its detrimental clinical ischemic
congestive heart failure ( Killip class III) on
complications (9, 10). High sensitivity C-reactive protein
admission were excluded from the study.
(hs-CRP), is a well-known acute phase protein that

when elevated is considered an extremely sensitive
Diagnostic criteria for STEMI and NSTE-ACS:
marker of systemic inflammation, is also an important
The main symptom of ACS is typical ischemic
risk factor for atherosclerosis and CAD (6, 7).
chest pain. Subjects with ST segment elevation in 2
Many studies showed that hs-CRP levels were a
consecutive leads (with the cut-off point being > 0.2
useful marker to predict further cardiovascular events
mV in leads V1, V2, or V3, and > 0.1 mV in the other
in patients with CAD (11, 12). In this study, we aimed to
leads) were diagnosed as STEMI. On other side the
investigate whether hs-CRP was associated with the
diagnosis of NSTE-ACS was a rule-out diagnosis
SXScore in patients with ACS.
based on the ECG, i.e., lack of persistent ST elevation.

Biomarkers (troponins) further distinguish NSTEMI
METHODS
and USAP. Imaging modalities were used to rule out or
Study population:
rule in differential diagnoses. The clinical presentation
We selected 200 patients with ACS who underwent
of NSTE-ACS includes variety of symptoms. Most
coronary angiography between September 2017 and
commonly clinical presentations were described as:
June 2018. The clinical spectrum of ACS consisted of
Prolonged (> 20 minutes) angina pain at rest; new
ST elevation myocardial infarction (STEMI, n =117,
onset (de novo) angina (Class II or III of the
58.5%) and non-ST elevation acute coronary
Classification of the Canadian Cardiovascular Society);

recent destabilization of previously stable angina with
2064
Received:9/1/2019
Accepted:9/2/2019

Full Paper (vol.751 paper# 24)


c:\work\Jor\vol751_25 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2071-2080

Comparative Study between Effect of Sleeve Gastrectomy and
Mini-Gastric Bypass on Weight Loss and Improvement of Co-Morbidities
Mostafa M. Mostafa, Magdy M. Mostafa, Wael R. Hablas and Mohammed A. El-Kordy
* Department of General Surgery, Faculty of Medicine ­ Al Azhar University
Corresponding author: Mostafa M. Mostafa, Mobile: (+20)01110004842, E-Mail: dr.mostafamosbeh@gmail.com

ABSTRACT
Background: sleeve gastrectomy (SG) is one of the most popular procedures in the world. SG is a technically less
complex procedure with short learning curve and effective weight loss, but it suffers from two outstanding
disadvantages including high risk of weight regain and gastro- esophageal reflux disease (GERD). Mini-gastric
bypass (MGB), also known as single anastomosis gastric bypass or omega gastric bypass, is a newly emerged
procedure. Due to safe and simple process as well as effective outcomes, MGB has quickly become one of the
most popular procedures in many countries.
Patients & Methods: the study included 60morbidly obese patients that were assigned to two equal groups as
regards to the operation they underwent either Laparoscopic MGB or Laparoscopic SG. The primary outcome
measured was change in weight and BMI. The secondary outcome was improvement of other co-morbidities like
DM and lipid profile. Patients were followed up to 12 months after operation.
Results & Conclusion: after prospectively comparing the two procedures for a year, almost both procedures have
near same effect on loss of weight and resolving or better control on co-morbidities as DM, and HTN. However,
MGB patients in need for multi-vitamins and minerals costing more than 1500 Egyptian pounds per month. The
statistical differences observed as regards to BMI, LDL and HDL are still clinically insignificant. So, the
recommendation for Egyptian patient whatever their morbid obesity scale is Sleeve Gastrectomy except for patient
complaining of GERD, they should undergo MGB, as the results showed better resolution for their complain post-
operatively.

INTRODUCTION


Obesity became an epidemic disease. Physical,
bypass, is a newly emerged procedure originated from
psychological, and economic complications are
Rutledge and Walsh(6). Due to safe and simple process
associated with obesity which leads to difficulty in
as well as effective outcomes, MGB has quickly
caring of obese patients by physicians(1).
become one of the most popular procedures in many
Globally, Type 2 DM spreads also in parallel to
countries. Despite of popular status, the extension of
obesity as more than 171 million people are affected
MGB is still limited by some concerns such as gastric
worldwide, causing 3 million deaths per year(2). Obesity
and esophageal bile reflux, marginal ulcer, and remnant
and metabolic syndrome are associated with multiple
gastric cancer(7,8).
complications among them type 2 DM, HTN and

dyslipidemia, and there is a great evidence that this can
AIM OF THE WORK
be managed with bariatric surgery.Indications for
The aims of the current study are to determine
bariatric surgery include a BMI of 40 kg/m2 or higher,
and evaluate the impact of sleeve gastrectomy and mini-
or a BMI between 35 and 40 kg/m2 with at least two
gastric bypass procedure on weight loss, cure of co-
obesity-related comorbidities, According to National
morbidities and postoperative complications rate 3
Institutes of Health guidelines.
months, 6 months and 1 year postoperative.
DM is the most important comorbidity that

determines the risk of surgery, so bariatric surgery can
PATIENTS AND METHODS
be done for any obese patient with BMI 35
This is a prospective controlled clinical study
kg/m2withtype 2 DM who failed to lose weight with
was done in Al-Azhar University hospitals and Ahmed
other weight-control approaches (3).
Maher Teaching hospital, which included 60 morbidly
Roux-en-Y gastric bypass (RYGBP) and sleeve
obese patients, and they were divided into two groups:
gastrectomy (SG) are two most popular procedures(3).
Group 1: 30 patients who underwent sleeve
SG is one of the most popular procedures (37%) in the
gastrectomy (laparoscopically).
world(4). SG is a technically less complex procedure
Group 2: 30 patients who underwent Mini-Gastric
with short learning curve and effective weight loss,but
Bypass (laparoscopically).
it suffers from two outstanding disadvantages including
Inclusion Criteria:
high risk of weight regain and gastro- esophageal reflux
Age ranging between 20-50 years.
disease (GERD)(5).
Body Mass Index >40 or > 35 with co-morbidities as
Mini-gastric bypass (MGB), also known as
diabetes mellitus or hypertension.
single anastomosis gastric bypass or omega gastric
2071
Received:8/1/2019
Accepted:27/1/2019

Full Paper (vol.751 paper# 25)


c:\work\Jor\vol751_26 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2081-2088

The Effects of Vitamin D Supplement on Prevention of Recurrence of
Preeclampsia in Pregnant Women with a History of Preeclampsia
Abd-Alsameea Hassan Khalifa, Mohamed Mohamed Ibrahim Farahat,
Ahmed Fadel Abdel Hameed Mohamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Ahmed Fadel Abdel Hameed Mohamed, Phone: 01096680893, Email: Noor_dodo2007@hotmail.com

ABSTRACT
Background: Many studies hypothesized a strong relation between vitamin D level during pregnancy and the
frequency of recurrent preeclampsia (PE).
Objectives: The aim of the current study was to determine the effect of vitamin D supplement on reducing the
probability of recurrent preeclampsia in pregnant women with history of preeclampsia.
Patients and Methods: The study population included 50 women having a history of preeclampsia in previous
pregnancies. They were referred to the obstetrical clinic in Diarb Negm Centeral Hospital in Diarb Negm City, for
prenatal care. Women were classified into two groups, the first one (I) received 25-hydroxy vitamin D supplements
and the other (II) received placebo. Results: Eight patients had pre-eclampsia in group II (34.8%) while in group
I only 4 patients had preeclampsia (16%) (p=0.133). There were no significant statistical differences between the
two groups according to pre-eclampsia incidence. The mean vitamin D level was 25.72 ± 7.69 and 28.33 ± 7.40
among patients without and with preeclampsia respectively. (p=0.309) there were no significant relation between
the preeclampsia incidence and vitamin D level.
Conclusion: vitamin D supplement may not have a role in prevention of preeclampsia recurrence.
Keywords: Preeclampsia, Vitamin D, Eclampsia.

INTRODUCTION
probability of recurrent preeclampsia in pregnant
Hypertensive disorders of pregnancy are among
women with history of preeclampsia.
the major complications that account for

approximately 14% of maternal mortality (1,2) and
PATIENTS AND METHODS
these include gestational hypertension, preeclampsia
This randomized controlled clinical trial study
(PE), and eclampsia. Blood pressure greater than
included a total of 50 women having a history of
140/90 mmHg on two consecutive occasions 6 h
preeclampsia in previous pregnancies. They were
apart occurring after 20 weeks of pregnancy is defined
referred to the obstetrical clinic in Diarb Negm
as pregnancy induced hypertension with an incidence
Centeral Hospital in Diarb Negm City, for prenatal
of approximately 10% of all pregnancies worldwide
care. Approval of the ethical committee of Al-
(2). Hypertension and proteinuria (protein in urine
Azhar University and a written informed consent
0.3 g/24 h (1+ dipstick) on two occasions 6 h apart)
from all the subjects were obtained. This study was
or edema is considered to be Pre-eclampsia (PE) (3,4).
conducted between January 2018, and January 2019.
It is a significant contributor for morbidity and
25-hydroxy vitamin D plasma level was measured
mortality and complicates 2% to 8% of pregnancies
and the concentration equal or higher than 25ng/ml
(5). If the disorder is diagnosed between 20 to 34 weeks
(i.e., normal range) was the inclusion criterion. The
gestation it is named early onset severe PE (EOSPE)
exclusion criteria were chronic hypertension before
which is usually associated with a 20-fold increased
pregnancy, immunologic diseases such as lupus,
risk for maternal mortality compared to PE after
concurrent renal, pulmonary and cardiac diseases,
34 weeks gestation (6) called late onset severe PE
immigration or leaving location of study, and lack of
(LOSPE). Eclampsia, which is the occurrence of
confidence in patient's cooperation to complete study.
unexplained seizures (7) can affect pregnant women
The pockets of placebo and drug were assigned
who show signs of pregnancy induced hypertension or
randomly and neither physician nor patients knew
PE. Vitamin D deficiency has been associated with PE
about administration of drug or placebo.
(8). The mechanism by which vitamin D deficiency
Blood samples of all patients were taken after 12 hours
affect preeclampsia is not clearly understood,
of fasting to analyze level of vitamin D according to
nevertheless, some theories have been developed. Pro-
Liebermann­Burchard method.
inflammatory responses modulation and decreasing
The patients in the intervention group received a
oxidative stress in PE, promoting angiogenesis
50000IU pearl vitamin D3 once every two weeks
through VEGF and gene modulation, and decreasing
while subjects in the control group was administered
blood pressure through the renin-angiotensin system
placebo.
(RAS) are among these theories (9,10).
Statistics
The aim of the current study was to determine the
Through SPSS software (version 16), independent t-
effect of vitamin D supplement on reducing the
test of normal quantitative variables was conducted
for both independent groups. In addition, chi-square
2081
Received:2/1/2019
Accepted:21/1/2019

Full Paper (vol.751 paper# 26)


c:\work\Jor\vol751_27 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2089-2091

Short Term Outcomes of Non-Surfacing Patelloplasty in
Primary Total Knee Arthroplasty
Bahaa Ali Kornah, Mohamed Abd Elmoneam Negm, Mohamed Ahmed Mustafa Megahed
Department of Orthopedic, Al-azhr University, Cairo, Egypt
Corresponding author: Mohamed Ahmed Mustafa Megahed,email:dr.mmegahed89@gmail.com

ABSTRACT
Background:
The management of the patella during primary total knee arthroplasty (TKA) is controversial. The most
common methods of treating the patella in TKA are patellar resurfacing and non-surfacing patelloplasty.
Objectives: The aim of this study was to assess short term outcomes of non-surfacing patelloplasty in primary
total knee arthroplasty.
Patient and methods: This study included a total of twenty patients who had primary total knee arthroplasty for
degenerative or inflammatory arthritis accompanied with moderate to severe patellofemoral arthritis attending at
Al-Azhar University Hospitals. Patelloplasty was done in the form of excision of peripatellar synovial tissues,
osteophytectomy and denervation of patellar rim using electro-cautery and smoothing of the articular surface by
oscillating saw. Results: All patients were examined using a new patellofemoral scoring system,after one year
follow up after total knee arthroplasty (TKA) the end result was: 14 patients were very satisfied, while 5 patients
had mild to moderate anterior knee pain, tolerated by analgesics on demand and physiotherapy. Only one case
had severe pain and secondary resurfacing was done about 6 months postoperatively, the patient was satisfied,
and the pain became mild.
Discussion: Total knee arthroplasty (TKA) is one of the most commonly performed operations in adult
reconstructive surgery. The management of the patella in primary TKA remains controversial. The approaches
available for patellar management in TKA are non-resurfacing patelloplasty, and selective resurfacing.
Conclusion: It is recommended to do patelloplasty without resurfacing of the patella as this technique has fewer
hazards and complications.
Keywords: anterior knee pain, patellar denervation, patelloplasty, total knee arthroplasty.

INTRODUCTION

Total knee arthroplasty (TKA) is the efficient surgical
attending at Al-Azhar University Hospitals.
way for functional betterment and pain comfort in
Approval of the ethical committee of Al-Azhar
osteoarthritis (OA) and rheumatoid arthritis (RA)
University and a written informed consent from
patients. It is a very common surgical operation for
all the subjects were obtained. This study was
relieving pain and improving function, with a very high
conducted between 2016-2018.
patient satisfaction rating (1).
There were 8 men and 12 women with a mean age
The management of the patella during primary
at the time of the operation was about 62 years. Pre-
total knee arthroplasty (TKA) is controversial (2).
operatively and according to sex type, the included
When a decision is made not to resurface the patella, the
subjects were divided into two groups; I and II.The
patella may be left alone or undergo a "tidy up"
two groups had the same indications for surgery. All
procedure
(patelloplasty).
Numerous
different
the operations of enrolled cases were performed by
combinations of surgical steps include a patelloplasty (3).
same team of surgeons. Patelloplasty was done in the
Proponents of patellar non-resurfacing suggest that to
form of excision of peripatellar synovial tissues,
the post-resurfacing complications such as patellar
osteophytectomy and denervation of patellar rim
fracture, avascular necrosis (AVN), patellar tendon
using electro-cautery and smoothing of the articular
injury, extensor mechanism rupture, patellar clunk
surface by oscillating saw.
syndrome and instability requiring reoperation after
The inclusion criteria were patients with
resurfacing (4). The aim of this clinical study was to
tibiofemoral osteoarthritis (OA) or rheumatoid
evaluate the effects of patelloplasty in total knee
arthritis (RA) who have symptoms consistent with
arthroplasty as regards new patellofemoral scoring
patellofemoral arthritis such as anterior knee pain, or
system (clinical and radiological) and possible
who have moderate to severe patellofemoral arthritis
complications.
exhibiting radiographic changes consistent with

patellofemoral arthrosis, such as loss of joint interval.
PATIENT AND METHODS
Exclusion criteria were patients who previously had
This study included a total of twenty patients
a patellar operation such as patellectomy, patellar
who had primary total knee arthroplasty for
realignment operation or a high tibial osteotomy,
degenerative or inflammatory arthritis accompanied
patients who previously had a patellar dislocation and
with moderate to severe patellofemoral arthritis
revision knee arthroplasty.
2089
Received:11/1/2019
Accepted:11/2/2019

Full Paper (vol.751 paper# 27)


c:\work\Jor\vol751_28 The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2092-2097

The Effect of Shock Wave Therapy as a New Modality for
Treatment of Primary Knee Osteoarthritis
Safaa Shebl El-Sakka*, Mervat Ismail Hussein, Amal Mohamad El-Barbary, Fahema Saad Rehan
Department of Physical Medicine, Rheumatology and Rehabilitation
Faculty of Medicine, Tanta University
*Corresponding author: Safaa Shebl El-Sakka, Mobile: (+20)01098697188, E-Mail: safaaelsakka@yahoo.com

ABSTRACT
Background:
osteoarthritis, the most common form of arthritis, is a chronic disease characterized by slow degradation
of cartilage, pain, and increasing disability.
Objective: to study the effect of shock wave therapy in treatment of primary knee osteoarthritis.
Patients and Methods: thirty patients with primary knee osteoarthritis were classified equally into 2 groups according
to the line of treatment; Group I received extra-corporeal shock wave therapy and Group II received continuous
ultrasonic waves. Patients were evaluated for pain using visual analogue scale, active range of motion, and physical
and functional assessment. Bilateral anteroposterior weight bearing radiographs were done for all patients before
treatment and degree of osteoarthritis was assessed by Kallgren and Lawrence Radiographic criteria.
Results: there was significant improvement in group I more than group II (as regard to pain assessed by visual analogue
scale (VAS) after treatment (p=0.039) and in follow up (p <0.001). There was significant improvement in morning
stiffness in both groups with insignificant difference between both them. Regarding active range of motion (ROM),
there was significant improvement in flexion in both groups with significant difference between both groups before
and after treatment (p =0.001) and in follow up (p <0.001). Regarding chair stand test, there was significant
improvement in both groups with in significant difference between them. Regarding stair climb test (SCT), there was
significant improvement in both groups with insignificant difference between them.
Conclusions:
shock wave had an effect in treatment of primary knee OA as a new modality for improving clinical and
functional performance.
Keywords: Primary knee osteoarthritis; shock wave therapy; therapeutic ultrasound.

INTRODUCTION

Osteoarthritis (OA), the most common form of
primary knee osteoarthritis and its effect on clinical and
arthritis, is a chronic disease characterized by slow
functional outcome.
deterioration of cartilage, pain and increased disability

(1). The aim in treatment of OA is to reduce pain and other
PATIENTS AND METHODS
symptoms, increase health related quality of life and
This study included 30 patients with
normalize patient's limited daily activity(2).
symptomatic primary knee osteoarthritis. They were
There are several options for treating
collected from the outpatient clinic of Physical
osteoarthritis of the knee, including simple analgesics,
Medicine, Rheumatology & Rehabilitation Department,
non-steroidal anti-inflammatory drugs (NSAIDS), intra-
Tanta University Hospitals. The patients were diagnosed
articular injection of glucocorticoids, physiotherapy, and
according to American College of Rheumatology(7)
total knee replacement(3).
criteria for classification and diagnosis of osteoarthritis.
Extracorporeal shock wave therapy (ESWT)
The study was approved by the Ethics Board of Tanta
was first used to break kidney stones. Its use was
University and an informed written consent was
proposed for musculoskeletal disorders as the result of
taken from each participant in the study.
an incidental observation of an osteoblastic response

pattern, during animal studies, in the late 1980s(4).
Patients were classified equally into 2 groups
In recent years, ESWT has been widely used for
according to the line of treatment; Group I: The patients
pain relief and the treatment of musculoskeletal
received extra-corporeal shock wave therapy, once
disorders, such as epicondylitis, plantar fasciitis, calcific
weekly for three weeks, every session used radial and
tendinitis, and osteoarthritis (5,6).
focus heads. Radial head 1000 shocks per session, 2.5-

4mJ/mm2, frequency of pulses 8 Hz, and focus head
AIM OF THE WORK
1000 shocks persession, 0.15 MJ/mm2 and frequency of
The aim of this work is to study the effect of
pulses 6Hz(8). Site of application of radial head:
shock wave therapy as a new modality in treatment of
Around knee joint line. Site of application of focus head:
2092
Received:16/1/2019
Accepted:16/2/2019

Full Paper (vol.751 paper# 28)


Chapter (4) The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2098-2104
Comparative Study of Positron Emission Tomography /Computed
Tomography and Whole-Body Bone Scanning for
Detecting Bone Metastasis in Patients with Breast Cancer
Mohamed Ahmed Youssef, Mohamed Fathy Dawoud,
Lamiss Mohamed Abdelaziz, Mostafa Hussein Elsheikh*
Radiodiagnosis Department, Faculty of Medicine, Tanta University
*Corresponding author: Mostafa Hussein Elsheikh, Mobile: (+20)01278011228, E-Mail: mo2006st@gmail.com

ABSTRACT
Objective:
the aim of this study was to compare the role of PET/CT & bone scintigraphy in detection of bone
metastasis in patients with breast cancer.
Patients and methods: The present study included 30 patients with breast cancer. Their ages ranged between
25years and 65 years with mean age of 45 years old. All patients were subjected to full history taking, clinical
breast examination, histopathology investigation, 99mTc-MDP Whole body bone scan, whole body positron
emission tomography / computed tomography (FDG- PET/CT).
Results: on patient-based analysis in this study thirty patients were examined with bone scintigraphy and FDG-
PET/CT. only 24 (80%) were detected by FDG-PET/CT had metastasis compared by only 18 (60%) patients
detected by bone scintigraphy. On lesion-based analysis in this study 71 lesions detected by FDG-PET/CT
(positive 50 lesions (70.42%) - negative 21 lesions (29.58%), compared by 62 lesions detected by bone
scintigraphy (positive 43 lesions (69.35%) ­ negative 19 lesions (30.65%).
Conclusion: whole-body FDG-PET/CT is more sensitive and equally specific for the detection of bone
metastases compared with bone scintigraphy. Both bone scintigraphy and FDG-PET/CT give false-positive
results due to various common benign bone processes which are the most disadvantages of both modalities.
Keywords: PET/CT, Bone scintigraphy, bone metastasis, breast cancer.

INTRODUCTION

Bone is a common site for deposits in breast
PATIENTS AND METHODS
cancer patients, and most patients with advanced
Thirty patients were included in this study
stages have osteoarthritis. Bone pain, fracture, spinal
with histopathologically proven cancer breast
cord compression and bone marrow failure are
referred from Oncology clinic to our institution with
common complications (1).
age ranging from 25 to 65 years and the mean age
The spine is a common site of metastasis due
was 45 years + 2. The study was approved by the
to its high content of red marrow and is highly
Ethics Committee of our institution; all patients
vascularized. Peripheral lesions are commonly seen
signed an informed consent. The duration of the
in young patients due to extensively distributed red
study extended from May 2016 to April 2018.
marrow. Osseous metastases in cancer breast are

mainly osteolytic and small percent are sclerotic or
Inclusion criteria
mixed lesions (2, 3).
Patients diagnosed to have breast cancer with
For detection and evaluation of bone
suspected bone metastasis.
metastasis, 99mTc labeled phosphate compound bone

scintigraphy has been widely used because of its high
Exclusion criteria
sensitivity and easy evaluation of the whole skeletal
Pregnant women.
system (4).
Patients with chronic renal impairment if
Metabolic evaluation with positron emission
contrast media is used.
tomography (PET) or fused PET and CT (PET/CT)
Patients with previous allergy to contrast
has been recommended. 18 fluoro-deoxy-D-glucose
media.
(FDG) is the most commonly used PET tracer, FDG

accumulation can therefore be detected in highly
Patients were subjected to the following:
metabolic tissues, such as malignancies (5).
a) Full history taking:
PET can be used to investigate bone lesions,
Personal history.
however, PET alone may lack anatomic detail; the
Complaint.
fusion of PET/CT images improve its diagnostic
Present history.
ability for the metastatic disease (6).
Family history.
AIM OF THE WORK
b) Clinical local breast examination.
The aim of this study is to compare the role of
c) Histopathology investigation.
PET/CT & bone scintigraphy in detection of bone
d) 99mTc-MDP Whole body bones scan.
metastasis in patients with breast cancer.
2098
Received:16/1/2019
Accepted:16/2/2019

Full Paper (vol.751 paper# 29)


Assessment of Hypocalcemia Post Total Thyroidectomy for Benign Thyroid Lesions; to Continue or Not The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (1), Page 2105-2111
Assessment of Hypocalcemia Following Total Thyroidectomy for
Benign Thyroid Lesions: To Be Continued or Not?
Selim El Nemr1, Mahmoud Reda1, Mahmoud Hashish2, Hossam Amir
Departments of 1General Surgery and 2 Clinical Pathology, Faculty of Medicine,
Al-Azhar University, Cairo, Egypt
*Corresponding author: Hossam Amir, E-mail: hosamamir500@yahoo.com, Mobile: (+20)01005332422

ABSTRACT
Background: Thyroidectomy is one of the most common operations performed worldwide by various surgeons
whether general or endocrine surgeons. The rate of complications following thyroidectomy has been progressively
decreasing yet it still carries significant morbidity if preoperative preparation and patient as well as procedure
selection were not optimized.
Objective: This study was designed to evaluate the problem of hypoparathyroidism following thyroid surgery and
to assess the use of parathyroid hormone (PTH) level to predict patients with risk of postoperative hypocalcemia.
Through this study, it was sought that we could reach a recommendation to rely on the routine technique of total
thyroidectomy and utilization of PTH assay to allow for a safe and timely discharge of patients with normocalcemia
and for the early identification of patients requiring treatment of post thyroidectomy hypocalcemia.
Patients and Methods: This prospective study included 50 patients from two different hospitals undergoing total
thyroidectomy to evaluate the efficacy of postoperative serum PTH and calcium (Ca) levels as an early and accurate
predictor of post-thyroidectomy hypocalcemia. Ionized serum calcium as well as PTH were measured for each
patient preoperatively, intraoperatively (just after skin closure), at every day postoperative when patient admitted
and after one month in patients with hypocalcemia.
Results: Our results showed an overall incidence of 18% of hypocalcemia after total thyroidectomy. Of them, only
6% developed symptomatic hypocalcemia. Transient hypocalcemia occurred in 4% of patients while permanent
hypocalcemia affected 2%.
Conclusion: Serum calcium concentrations have been the basis of identification of post-operative hypocalcemia,
however this has been replaced by PTH levels being more sensitive and specific to the early prediction of transient
as well as permanent hypocalcemia. Postoperative PTH; also known as quick PTH assay, level of < 12 pg/ml was
found to have an overall accuracy of 98% in early prediction of permanent hypocalcemia in our study.
Keywords: Hypocalcemia Post Total Thyroidectomy, Benign Thyroid Lesions.

INTRODUCTION
recurrent laryngeal nerves (RLN), an accurate hemostasis

During the 1800s, the mortality rate from
and an excellent cosmesis (4).
thyroid surgery was approximately 40%. Most deaths
Hypoparathyroidism
is
another
feared
were caused by infection and hemorrhage. Sterile
complication of thyroid surgery. The parathyroid
surgical areas, general anesthesia, and improved
glands produce parathyroid hormone (PTH), which is
surgical techniques have made death from thyroid
intimately involved in the regulation of serum calcium.
surgery extremely rare today (1).
PTH increases serum calcium levels by causing bone
An important disadvantage of total thyroidectomy is
resorption, increasing renal absorption of calcium.
the high incidence of hypocalcemia due to parathyroid
PTH also increases renal excretion of phosphorus.
gland devascularization. A low complication rate is the
Therefore, low PTH levels result in high serum
advantage of subtotal thyroidectomy, but secondary
phosphorus levels (5).
thyroidectomy may be necessary because of recurrence
Inadequate production of PTH leads to
after subtotal thyroidectomy and is associated with
hypocalcemia. Hypoparathyroidism, and the resulting
increased morbidity and related to recurrent laryngeal
hypocalcemia, may be permanent or transient. The rate
nerve injury and hypoparathyroidism resulting from
of permanent hypoparathyroidism is 0.4-13.8%. The
parathyroid gland devascularization (2).
condition may be due to direct trauma to the
By developing a thorough understanding of the
parathyroid glands, devascularization of the glands, or
anatomy and of the ways to prevent each complication,
removal of the glands during surgery (6).
the surgeon can minimize each patient's risk. The
The rate of temporary hypocalcemia is reportedly
surgeon's experience is a significant contributor to
2-53%. The cause of transient hypocalcemia after
various complications during thyroid surgery (3).
surgery is not clearly understood. It may be
In general, the essential objectives for thyroidectomy
attributable to temporary hypoparathyroidism caused
are sparing the parathyroid glands, avoidance of injury to
by reversible ischemia to the parathyroid glands,
hypothermia to the glands, or release of endothelin-1.
2105
Received:9/1/2019
Accepted:9/2/2019

Full Paper (vol.751 paper# 30)