The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2112-2119
Impact of NGAL (Neutrophil Gelatinase Associated lipocalin) on
Outcome of Hepato-renal Syndrome
Mohammed Kamal Zahra, Kamal Mohamed Okasha,
Maha Mahmoud Hagras, Mai Samir Abd-Elhady Elzahaby*
Department of Clinical Pathology, Faculty of Medicine - Tanta University
*Corresponding author: Mai Samir Abd-Elhady Elzahaby, Mobile: (+20)01226620597, E-Mail: firstname.lastname@example.org
Background: Renal dysfunction is a severe complication of advanced cirrhosis as well as of acute-on-chronic liver
failure (ACLF). Hepato-renal syndrome (HRS) has been defined as a syndrome that occurs in patients with
advanced liver disease, characterised by impaired renal function and marked abnormalities in the arterial circulation
and over-activity of the endogenous vasoactive systems.
Objective: The aim of this work was to study the role of plasma NGAL level in patients with hepatorenal syndrome
in order to identify patients with high risk of renal dysfunction, correlate clinical outcome with therapeutic
management and provide a clue on better management to prevent renal deterioration.
Patients and methods: This study was carried out on 50 patients. They were divided into 3 groups in addition to
control group; group I of 25 patients with decompensated liver cirrhosis , group II of 25 patients with hepato-renal
syndrome , group III of 25 hepato-renal patients who followed up after treatment in addition to 25 healthy
individuals as a control group ( group IV) .
Results: of NGAL in different study groups were as follows: There was a significant increase of NGAL in Group
2 & 3 compared to Group 1& 2. There was a statistical significance between the four groups (p< 0.001).
Conclusions: NGAL could be used in conjuction with serum creatinine to assess the hepato-renal affection and
may aid in stratifying patients in need for liver transplant.
Keywords: NGFAL, HRS, MELD, ESLD.
Moreau et al. (1) stated that ascites, hepatic
SUBJECTS AND METHODS
encephalopathy and bacterial infection are frequently
This clinical study was carried out on 50
presented with acute decompensated liver cirrhosis.
patients admitted to Mahalla Hepatology Teaching
About 50% of patients with acute liver
Hospital and Tanta Internal Medicine Department in
decompensation develop several renal dysfunction.
the period of November 2017- November 2018 and
Patients with end-stage liver disease (ESLD) who
divided into three groups:
develop hepatorenal syndrome (HRS) have very high
Group 1: it consisted of 25 Patients suffered from
mortality rate (2). Hepatorenal syndrome (HRS) is a
decompensated liver cirrhosis.
multiorgan condition affecting the kidneys and the
Group 2: it consists of 25 Patients suffered from
liver as a natural course in 40 % of patients with
cirrhosis and ascites (3).
Group 3: it consists of 25 patients who were
Liver Transplantation is the best treatment for
diagnosed as hepato-renal syndrome and were
both type-1 and type-2 HRS (4). Also medical
followed up after treatment.
treatment in the form of administration of
Group 4: In addition to 25 apparently healthy
vasoconstrictors plus albumin can be effective (5).
individuals served as a control group.
Serum creatinine as a marker of renal function
Inclusion Criteria: Cirrhotic patients whose age
in patients with liver cirrhosis has several limitations
ranged from 4070 years were included in this study.
(6). Plasma NGAL is a very early & sensitive
biomarker in kidney injury because it is less affected
cadiomyopathy and pregnant women were excluded.
by high bilirubin levels, reduced protein diet and
Written informed consent was taken from all
muscle wasting as creatinine (7). Many studies showed
participants in this research. They were subjected to
that NGAL as valuable marker of GFR in cirrohosis
the following parameters:
and may predict renal dysfunction (8).
1. Full history taking included age, sex, complaints.
2. Clinical examination with special interest on ascites,
AIM OF THE WORK
vascular spiders, bacterial peritonitis, hepatic
The aim of this work was to study the role of
encephalopathy & variceal bleeding from portal
plasma NGAL level in patients with hepato-renal
syndrome in order to identify patients with high risk of 3. Abdominal U/S and triphasic CT was done when it
renal dysfunction, correlate clinical outcome with
therapeutic management and provide a clue on better
management to prevent renal deterioration.
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2120-2127
Serum Highly Sensitive Cardiac Troponin I (hs-cTnI) as a Diagnostic
Biomarker of Myocardial Injury after Pediatric Cardiac Catheterization
Ahmed Magdy Hegazy1, Raghda Ghonimy El-Sheikh2, Desoky Ezzat Abo Ammo3 and Amr Mohamed Zoair1*
Departments of 1Pediatric Medicine, 2Cardiology and 3Clinical Pathology,
Faculty of Medicine, Tanta University, Egypt
*Corresponding author: Ahmed Magdy Hegazy; Mobile: 01062196986; E-mail: email@example.com
Background: new Highly Sensitive Cardiac Troponin I assay (as hs-cTnI) represents an important advance with added
sensitivity for cardiac myocyte necrosis and could have several distinct roles in clinical practice.
Aim of the present study: it was to determine the serum level of highly sensitive cardiac troponin I (hs-cTnI) before
and after pediatric cardiac catheterization (diagnostic or interventional), as a diagnostic biomarker of myocardial injury
in these patients. Patients and Methods: a Prospective Cohort study was carried out during the period from January
2017 to June 2018 at Pediatric Cardiology Unit and Cardiology Department, Tanta University Hospital. It included 30
patients who were admitted and required pediatric cardiac catheterization. Doppler echo- cardiography and Estimation
of serum highly sensitive cardiac troponin I (hs-cTnI): using the ELFA technique (Enzyme Linked Fluorescent Assay)
was done. Results: there was highly significant increase of serum hs-cTnI levels immediately after and 12 hours after
therapeutic pediatric cardiac catheterization (p <0.001), whereas in diagnostic pediatric cardiac catheterization there
was no significant differences of serum hs-cTnI levels (p >0.05). There was significant negative correlation between
serum hscTnI levels and Fractional shortening (FS) %, and also there was significant negative correlation between
serum hs-cTnI levels and ejection fraction (EF) % (measured by echocardiography). Conclusion: serum highly
sensitive cardiac troponin I (hs-cTnI) was significantly increased immediately after pediatric cardiac catheterization,
with more significant increase after 12 hours, suggesting myocardial injury in these patients. Also, elevation of this
diagnostic biomarker of myocardial injury was more after therapeutic than diagnostic pediatric cardiac catheterization.
Keywords: Highly Sensitive Cardiac Troponin I, Myocardial Injury, Pediatric Cardiac Catheterization
Cardiac catheterization has long served as the
troponin I (hs-cTnI) before and after pediatric cardiac
"gold standard" for the anatomic and physiological
catheterization (diagnostic or interventional), as a
assessment of patients with CHD. Real-time fluoroscopy
diagnostic biomarker of myocardial injury in these
with contrast injection coupled with rapid digital
angiography has provided the high-resolution images of
the heart necessary for successful surgical management
PATIENTS AND METHODS
of these patients (1).
This Prospective Cohort study was carried out
It has been shown that after a myocardial infarction
during the period from January 2017 to June 2018 at
the heart initially releases free cTnT into the plasma.
Pediatric Cardiology Unit and Cardiology Department,
Later, it releases free cTnI, tertiary cTnT-cTnI-TnC
Tanta University Hospital. It included 30 patients who
complexes, and, occasionally, some fragments of cTnT.
were admitted and required pediatric cardiac
Tertiary complexes have a short half-life, since they are
catheterization. The study was approved by the Ethics
rapidly broken down into free cTnT and cTnI-TnC binary
Board of Tanta University and an informed written
consent was taken from each participant in the study.
With advances in technology, a new era in
troponin assays is approaching, previous-generation
Inclusion criteria: Infants and children aged from 6
troponin assays have been used as diagnostic and
months to 12 years with cardiac diseases admitted for
prognostic markers in acute coronary syndrome patients
cardiac catheterization for diagnostic or interventional
and for risk stratification to guide triage decisions and aid
purposes both sexes were included.
in treatment selection. New, high-sensitivity troponin
Exclusion criteria: Infants and children with heart
assays represent an important advance with added
failure, cardiomyopathy, myocarditis, acute or chronic
sensitivity for cardiac myocyte necrosis, but there
infection, chronic renal failure, muscle diseases,
remains a need for judicious interpretation with these
neoplastic diseases, or high troponin level before
The objective of the present study was to
Written Informed consent was obtained from the
determine the serum level of highly sensitive cardiac
parents or guardians of the child. The study was approved
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2128-2135
Comparative Study between Setting Position Versus Left Lateral Position Effects
During Spinal Anesthesia Block in Caesarean Section
Mohamed Mohamed Salah Shamlool1, Maamon Mohamed Ismail1 , Khaled Shehata Ali Elshaer2*
Department of 1Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University,
Cairo and 2Damanhour Teaching Hospital, Damanhour, Egypt
*Corresponding author: Khaled Shehata Ali Elshaer, Mobile: (+20)01008168750, E-Mail: firstname.lastname@example.org
Background: A caesarean section is recommended when vaginal delivery is a threat to the mother or child.
Aim of study: The aim of the study was to compare the effect of position (sitting versus left lateral) during spinal
anesthesia application in cesarean section. The sample of the study was 60 patients.
Patients and Methods: Half of the patients received spinal analgesia consisting of 2 ml (10 mg) of 0.5% hyperbaric
bupivacaine and 25g fentanyl in the sitting position, while the other half received spinal analgesia consisting of 2
ml (10 mg) of 0.5% hyperbaric bupivacaine and 25g fentanyl in the left lateral position.
Results: both Left lateral and sitting position in spinal anesthesia in cesarean section have the same effect on
hemodynamics, also satisfactory sensory and motor block can be achieved in both positions. So left lateral position
is safe and can be performed in parturient who are sedated, in pain or using entonox.
Conclusion: Satisfactory sensory and motor blockade were successfully achieved in both sitting and lateral
positions during intrathecal injection in cesarean section without significant difference in the hemodynamic changes
or motor blockade. With superiority of faster onset of sensory blockade in lateral position, while sitting position is
more comfortable for he parturient.
Keywords: Spinal Anesthesia, Sitting, Left Lateral, Cesarean Section.
indicator, urgency, partial desire, and anesthesiologist
A caesarean section is recommended when
and surgeon skills(4).
vaginal delivery is a threat to the mother or child. Not
There are many indications for general
all of these cases are mandatory, and in many cases the
anesthesia, some of which are failed regional
obstetrician must use the discretion to determine if a
anesthesia, conditions where regional anesthesia is
cesarean section is necessary. Some signs of cesarean
contraindicated, maternal request and life-threatening
delivery are: Prolonged labor or failure to progress
fetal compromisewhen there might not be adequate
(obstetrics), fetal distress, umbilical cord prolapse,
time to perform a regional technique. In the past,
uterine rupture, placental problems (placenta previa,
general anesthesia was considered to be the technique
placental abruption or placenta accreta), abnormal
of choice. However, the proportion of caesarean
presentation (posterior or transverse positions), failed
sections performed under general anesthesia has
labor induction, failed instrumental, overly large baby
dropped significantly. In the United States, general
(macrosomia), umbilical cord abnormalities (vasa
anesthesia is used for less than 5% of electivecaesarean
previa, multi-lobate including bi-lobate and
deliveries. For emergency deliveries, the rate varies
succenturiate-lobed placentas, velamentous insertion)
between 15 and 30% )5,6).
and contracted pelvis (1,2).
Regional anesthesia is the most popular form of
Other complications of pregnancy, preexisting
anesthesia for caesarean section due to avoiding risks
conditions and concomitant disease such as pre-
of general anesthesia, for better postoperative pain
eclampsia, hypertension, multiple births, precious
relief and also for keeping the woman awake to see her
(High Risk) fetus, HIV infection of the mother,
baby just after birth(7). Approximately 95% of
Sexually transmitted infections such as genital herpes
caesarean sections are performed under regional
(which can be passed on to the baby if the baby is born
analgesia in United States, nearly evenly split between
vaginally, but can usually be treated in with
spinal and epidural analgesia(8). Although this can be
medication and do not require a caesarean section)(2).
achieved by spinal or epidural anesthesia, spinal
Also, if we have problems with the healing of
anesthesia is a simple technique with low failure rate,
the perineum (from previous childbirth or Crohn's
rapid onset and low drug dose(9).
Disease) or lack of obstetric skill (obstetricians not
being skilled in performing breech births, multiple
anesthesia(1). It may be due in part to cephalad spread
births, etc). In most situations' women can birth under
of local anesthetic in the subarachnoid space and also
these circumstances naturally. However, obstetricians
to aortocaval compression by the gravid uterus. These
are not always trained in proper procedures(3).
factors are influenced by the parturient position during
The choice of anesthesia for caesarean delivery
and immediately after subarachnoid injection.
is determined by several factors, including the process
Prophylactic measures to reduce the incidence of
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2136-2141
Comparisons of Ranibizumab Injection and Dexamethasone Implant in
Macular Oedema Secondary to Central Retinal Vein Occlusion
Ahmed N Elsayed
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Background: central retinal vein occlusion (CRVO), a common retinal vascular disorder, is characterized by dilated
and tortuous retinal veins with hemorrhages in all four quadrants of the retina, CRVO can reduce vision severely, and
its prevalence is estimated at 0.80 per 1000 persons.
Purpose: Comparing the efficacy and safety of intravitreal ranibizumab versus dexamethasone implant (DEX) in
patients with macular oedema secondary to CRVO.
Patients and Methods: a prospective randomized comparative study was performed at Al-Azhar University hospitals
on forty eyes in thirty-four patients presented by macular oedema secondary to CRVO included in this study, divided
into two equal groups: Group (1) included 20 eyes with intravitreal ranibizumab for six months and group (2) included
20 eyes with dexamethasone implant for six months.
Results: in group (1) visual acuity improved and CMT decreased slightly but not significantly after 1 month to
0.25±0.12 and 335.3±75.5M, respectively. After 6 months of follow-up, the mean BCVA had significantly increased
to 0.73±0.4 (P=0.007) and retinal thickness had significantly decreased to 271.3±145M. In group (2) visual acuity
improved and CMT decreased slightly after 1 month to 0.25±0.13and 480.35±185.25M, respectively. After 6
months of follow-up, the mean BCVA had significantly increased to 0.63±0.3 (P=0.008) and retinal thickness had
significantly decreased to 290.3±155M
Conclusion: intraocular injections of 0.7mg ranibizumab provided rapid, effective treatment for macular edema
following CRVO, and patients who do not respond to consecutive anti-VEGF treatment may benefit from switching
the therapy to dexamethasone implant.
Keywords: Ranibizumab, Dexamethasone, Central retinal vein occlusion, Macular oedema.
Central retinal vein occlusion (CRVO), a
photocoagulation was available to treat macular oedema
common retinal vascular disorder, is characterized by
secondary to BRVO while there were no effective
dilated and tortuous retinal veins with hemorrhages in
treatments for macular oedema secondary to CRVO (4).
all four quadrants of the retina, CRVO can reduce
Recently, the introduction of ranibizumab and of
vision severely, and its prevalence is estimated at 0.80
dexamethasone implant has widened the therapeutic
per 1000 persons, indicating that approximately
choice. Both treatments have been shown to be effective
2.5million adults are affected by CRVO globally.
against the visual acuity loss that is associated with both
CRVO is caused by a combination of risk factors,
including advanced age, atherosclerosis, hypertension,
The treatment of macular edema due to RVO
diabetes mellitus, thrombophilia, hyperlipidemia,
has seen significant changes over the past decade, New
glaucoma and other vessel wall changes or
treatments and combination therapies continue to
hemodynamic abnormalities (1). Macular oedema (ME)
emerge with several showing positive results, As
is the most common complication in CRVO that can
directed by the Central and Branch Vein Occlusion
lead to impaired central vision, and ME secondary to
Study Groups, for many years macular edema in CRVO
CRVO is the second most common retinal vascular
was observed, while in BRVO grid laser
disease after diabetic retinopathy (2).
photocoagulation was applied (6). Corticosteroids, both
Macular oedema secondary to RVO is the
intra- and extraocular, have long been used to treat
second most frequent major retinal vascular disease after
edema with RVO, and the SCORE study results
diabetic retinopathy and is also one of the most common
validated this therapy for edema in CRVO while
causes of sudden visual loss. Branch retinal vein
confirming grid laser photocoagulation as superior
occlusion (BRVO) involving only a single retinal vein is
treatment for edema in BRVO. More recently, treatment
the most common (3), while CRVO is less common but is
with dexamethasone intravitreal implant has shown
more serious and carries a high risk of complications and
longer-lasting results in the treatment of this edema (7).
vision loss. Until recently, only grid laser
The use of intravitrealranibizumab has been
extensively studied and is very effective in the treatment
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2142-2148
Comparative Study between Dexmedetomidine, Magnesium Sulphate and
Meperidine as Anti-Shivering Agent Following Neuraxial Anesthesia
Osama A. Kasem, Mostafa M. El-Sayed, Mahmoud N. Abd Elasttar
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
Corresponding author: Mahmoud N. Abd Elasttar; Mobile: 01159443114; Email: email@example.com
Background: shivering is a protective phenomenon which occurs when there is a drop in the core body
temperature. As the patients plunge into anesthesia, shivering is always bound to happen, and its avoidance is of
prime importance. Aim of the Work: compare the efficacy of intravenous dexmedetomidine 0.5 g/kg body
weight (bw) versus magnesium sulphate 30 mg/kg bw and meperidine 0.5 mg/kg bw in the management of
shivering in patients undergoing elective surgery under neuraxial anesthesia in Al-Azhar University Hospitals.
Patients and Methods: a prospective, double-blinded and controlled randomization study was conducted on 120
ASA grade I and II patients, posted for orthopedic, general surgeries and gynecological surgeries undergoing
spinal and combined spinal-epidural anesthesia in Al-Azhar University Hospitals, following approval from the
Ethics Committee of the Al-Azhar University. Results: dexmedetomidine was effective in the prevention of
shivering throughout a period of 30 minutes. Bradycardia and hypotension were observed in 10 out of 40 patients
who received dexmedetomidine and also in 6 out of 40 patients in the magnesium group and with no hypotension
and bradycardia in the pethidine group. But of these how many occurred because of dexmedetomidine cannot be
commented upon, as spinal and epidural anesthesia itself causes hypotension. Whereas it was observed in 8 out
of 40 patients in the magnesium sulfate group. There was no nausea and/or vomiting in pethidine group. These
were treated with ondansetron 0.08 mg/kg by the intravenous route. Conclusion: Dexmedetomidine is an effective
drug in the prevention of shivering in patients undergoing neuraxial block.
Keywords: Dexmedetomidine, magnesium sulphate, Meperidine, anti-shivering agent, neuraxial anesthesia
overcome and prevent shivering from occurring.
The main temperature in the human body is
Nonpharmacological methods used are insulators,
controlled through the hypothalamus, which
cutaneous warmers placed beneath the patient,
regulates the body temperature between 36.5 to
covering the exposed areas using blankets, drapes,
37.5°C, this is known as the threshold range. It is
use of intravenous fluid warmers. Warm air blowers
important for the body to maintain this range of
are also used, but they fail to raise the core body
temperature. These methods are usually not sufficient
physiological performance and any changes that
and hence pharmacological treatment is almost
result in the disruption of these functions (1).
always clubbed with the above. The drugs used in the
During any form of anesthesia there is an imbalance
treatment of shivering are tramadol, pethidine
in the body's ability to generate heat as compared to the
nefopam, physostigmine, ketamine, ondansetron, and
heat loss. In general anesthesia use of inhalational
anesthetics, inhibition of autonomic system and
Pethidine in the dose of 0.5 mg/kg, but
behavioral responses make the patient suffer from
considering its opioid properties of respiratory
hypothermia, whereas in spinal anesthesia there is a
depression, this drug is being replaced by other newer
shift of heat to the periphery from the core.This shift
ones. The availability of pethidine is not hassled free
occurs because of loss of afferent impulses from the
and not every setup can procure this drug (4).
temperature sensing nerve fibers of the lower half of the
Dexmedetomidine is an 2A adrenergic receptor
body as the spinal nerve roots are blocked by the local
agonist. It causes hyperpolarization of the
anesthetic, which is injected into the subarachnoid
noradrenergic receptors leading to decreased firing
from the locus ceruleus. This causes analgesia,
The adverse effects of shivering can lead to
sedation and also is the possible mechanism in the
increased morbidity. In the process of shivering there
prevention of shivering (4).
is a continuous phase of muscle contractions similar
Intravenous magnesium has been shown to
to that of clonus, which leads to anaerobic
suppress postoperative shivering, suggesting that the
metabolism, increasing the oxygen consumption and
agent reduces the shivering threshold. Recently, the
generation of lactate, progressing to metabolic
addition of intravenous magnesium sulfate to a
acidosis. This can lead to dangerous consequences in
pharmacological anti-shivering regimen increased
coronary artery diseases, pregnancy and other
the cooling rate in unanesthetized volunteers. The
hemodynamically compromised states. Knowing its
drug not only exerts a central effect, but is also a mild
dangerous effects many non-pharmacological and
muscle relaxant and may thus simultaneously reduce
pharmacological methods have been tried to
the gain of shivering (incremental shivering intensity
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2149-2153
The Relation between Serum C-Reactive Protein Level and Gestational Diabetes
Mohammed Khaled Mostafa 1 , Tamer Fares Ouf 1,
Ahmed Fathy Abd AL- Aziz 2 , Hesham Ahmed Hegazy 1*
Departments of 1 Obstetrics & Gynecology and 2 Clinical pathology, Faculty of Medicine,
Al-Azhar University, Cairo, Egypt
*Corresponding author: Hesham Ahmed Hegazy, Mobile: 01008632367, Email: firstname.lastname@example.org
Background: Gestational diabetes is one of the most common medical condition during pregnancy and its early
detection is necessary to prevent prenatal and maternal complications. There is a link between raised CRP and
development of gestational diabetes, so early detection of raised CRP may avoid serious maternal and neonatal
hazards. Objective: The goal of this study was to detect the prevalence of raised high sensitivity C reactive protein
(hs CRP) in normal pregnancy and gestational diabetes mellitus (GDM) and to compare the prevalence in both
groups. Materials and methods: A casecontrol study was conducted between April 2018 and December 2018. A
number of 60 pregnant women who were investigated for oral glucose tolerance test at 2428 weeks of gestation
were enrolled in this study. They were divided into 30 women with GDM as cases and 30 normal pregnant as
control. They were investigated for the level of hs CRP. Results: The prevalence of elevated hs CRP in controls
was 60%, whereas in cases it was 83.3%, with a P = 0.045 which is significant in this study.
Conclusion: The study showed a raised level of hs CRP in GDM in comparison with normal pregnant subjects.
Keywords: C-reactive protein, gestational diabetes.
related with increasing insulin resistance beginning at
Inflammation is a basic component for a
midgestation (15). In GDM, an increased severity of
successful pregnancy (1). Without a doubt, inflammatory
insulin resistance can disturb the intrauterine milieu,
processes are associated with implantation and
prompting abnormal fetal growth (16). When increased
decidualization during early periods of gestation, yet
insulin release can't adjust for the pregnancy-initiated
additionally in the uterine activation during delivery (1-
insulin resistance then GDM results (17).
3). Nonetheless, during the mid-gestation a quiescence
The present study was conducted to examine the
of inflammation is needed to ensure maternal tolerance
prevalence of elevated hs-CRP, an oxidative stress
for fetal antigens (4). A growing body of evidence
biomarker and acute phase reactant in normal
assumes that a dysregulated maternal inflammation
pregnancy and GDM. In this study, IADPSG criteria
during gestation may be a conceivable risk factor for
were taken for diagnosis of GDM.
several neonatal complications (5, 6). In addition, a few
studies have showed a connection between
MATERIALS AND METHODS
inflammation and the advancement of gestational
complications (7, 8). The detection of an inflammatory
The study was a case control study to evaluate the
biomarker with low cost, easy to be measured and able
relation between gestational diabetes and C-reactive
to predict high risk pregnancy might allow a better
protein (CRP) at 24-28 weeks of gestation.
screening during gestation.
There is an insulin resistance during ordinary
April 2018 to December 2018.
pregnancy, which is further improved in pregnancy
complications. For example, GDM, disturbed placental
The study was conducted on sixty pregnant
function, preeclampsia and IUGR (9). There has been a
patients in Antenatal Unit in Al-Azhar University
relationship between hs-CRP and pregnancy related
Hospitals and Etay Al-Baroud general Hospital. After
complications (10). The significance of estimating
approval of the Medical Ethics Committee and
maternal circulating hs-CRP in diagnosing of
signing a written informed consent.
subclinical infection as well as inflammation in ladies
The patients were divided into two groups:
with preterm rupture of membrane (11) in anticipating the
Group (A): 30 pregnant females diagnosed
danger of preterm labor (12) and preeclampsia (13) has
with gestational diabetes.
been discussed by some researches. As most pregnancy
Group (B): 30 normal pregnant females.
complications show up in later period of pregnancy but
underlying pathophysiology begins early in pregnancy
1) Maternal age: 20-40 years old.
subsequently, an early hs-CRP determination may help
2) Singleton pregnancy.
in the detection of unfavorable pregnancy result. The
3) Gestational age: 24th-28th weeks.
level of hs-CRP gives a better sensitivity in establishing
inflammation than levels of C-reactive protein (CRP)
1) Diabetes mellitus.
(14). Pregnancy is a hyperglycemic interval of life and is
2) Chronic inflammatory diseases.
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2154-2165
Tissue Expression of Caspase-4 and-5 in Some Chronic Colorectal Diseases
1 Sumaya H. El-Shazly, 2Olfat A. Hammam, 1Wafaa M. El-Zefzafy, 1Moshira A. Ibrahim
1 Tropical Medicine - Faculty of Medicine for Girls -Al-Azhar University Cairo, Egypt,
2 Pathology -Theador Bilharz Research Institute, Cairo, Egypt
Corresponding author: Moshira A. Ibrahim,email: email@example.com
Background: Colonic lining epithelium is subject to variety of insults ranging from inflammatory, infectious to
neoplastic processes. One of the most common colon problems are inflammatory bowel disease, colorectal polyps,
cancerous growths. Caspases are involved in apoptosis, necrosis, and inflammation. Altered Caspase activity has
been associated with a variety of colonic diseases, including inflammatory bowel disease (IBD) and colorectal
cancer. Caspases-4 and -5 involvement during intestinal homeostasis and disease has not yet been established.
Aim: Detection of the tissue expression of Caspases-4 and -5 in some chronic colorectal diseases. Methods: 100
patients underwent colonoscopy divided into four groups: colorectal cancer (CRC) (35 patients), inflammatory bowel
disease (IBD) (25 patients), colorectal polyp (CRP) (20 patients) and irritable bowel syndrome (IBS) as control (20
patients). The diagnosis was established on the basis of clinical history, laboratory (CBC, ESR, liver function tests,
CEA), endoscopic and histological data. Immunohistochemistry (IHC) techniques were employed to examine the
cellular expression profile of Caspase-4 and -5.
Results: Tissue Caspase-4 and -5 were statistically highly significantly increased in the epithelium of CRC in
comparison to the other groups. On the other hand, stromal expression of Caspase -4 and -5 were statistically highly
significantly increased in IBD group in comparison to the other groups. Conclusions: This study identified epithelial-
expressed Caspases -4 and -5 as biomarkers with diagnostic potential in CRC. Also they were a potential marker of
dysplasia in IBD and colorectal polyps.
Keywords: Caspase-4 and-5, Colorectal cancer, inflammatory bowel diseases, colorectal polyp.
regulated during CRC and has been identified as a key
The colon is the primary target of many functional and
factor in tumour progression and metastasis (3, 4).
pathological disorders, which may have an acute or
Caspase 4 mRNA is found in most tissues
chronic presentation. The pattern of colorectal diseases
examined with the exception of the brain. Highest
differs in developed countries from developing
expression is found in spleen and lung, with moderate
countries especially in tropical and subtropical areas.
expression in heart, intestine and liver. Low expression
Chronic inflammation includes different lesions as
is observed with skeletal muscle, kidney, and testis
polyposis, schistosomiasis and IBD. IBD include
.The data suggest that in lung cancer cells, caspase-5
ulcerative colitis (UC) and Crohn's disease (CD),
might be a candidate for a tumor suppressor gene.
which are serious disorders of the GIT involving tissue
Frame-shift mutations in the caspase-5 gene have also
damage and inflammation leading to bowel
been revealed in endometrial, colon, and gastric
impairment. IBD patients have an associated risk of
cancers (5, 6). The aim of this study was to detect the
developing (CRC), with a cumulative 30-year risk of
tissue expression of Caspases-4 and -5 in some chronic
UC-associated CRC of approximatly 20% (1, 2).
CRC ranking the 6th cancer in Egypt,
representing 4% of the total cancer cases and 53% of
MATERIALS AND METHODS
GIT cancers. Its incidence rates are decreasing for most
The present study was conducted on 100 selected
of the past two decades, which has largely been
patients with chronic colonic lesions, referred to
attributed to development of potential biomarkers that
will facilitate the early detection of CRC. Caspases are
Department, Alzahraa university Hospital, Cairo,
a family of cysteine proteases with evident roles in
Egypt (from April 2016 to December 2018).
cellular homeostasis, apoptosis and inflammation. In
Inclusion criteria: adult and elderly patients
humans, Caspases-4 and -5 are the inflammatory
with symptoms suggestive of chronic colorectal
Caspases subfamily. They have altered activity in the
development of intestinal diseases. Excessive
Exclusion criteria: patients with local causes of
production of the inflammatory cytokines, interleukin
rectal bleeding as pile and fissures, patients with
(IL)-1b and IL-18, which are dependent upon
malignancy other than CRC, patients with suspected
inflammation-mediated Caspase activation, found in
toxic megacolon, colonic obstruction, colonic
inflammed colons. IL-1b expression is also up-
perforation, colectomy or proctocolectomy and
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2166-2172
Impact of Endometriosis on Pregnancy Outcome of Intracytoplasmic Sperm Injection
Yehia A. Wafa, Fahd A. Elomda, Ahmed T. Abdel Fattah, Hanan M. Abdel Rahman*
Department of Obstetrics and Gynecology, Faculty of Medicine, A-Azhar University
*Corresponding author: Hanan M Abdel Rahman, Mobile: (+20)01286007305, email: firstname.lastname@example.org
Background: endometriosis is one of the most challenging diseases that constitute 20%-40% of women searching for
their infertility diagnosis. The effects of endometriosis on assisted reproductive outcomes are the issues continuously
debated. Aim of the work: This study was undertaken to compare the outcome of intracytoplasmic sperm injection
(ICSI) in women with endometriosis and women with tubal factor infertility as controls. Patients and Methods: from
2016 to 2018 a retrospective study was carried out on patients with endometriosis (n=40) and tubal infertility (n=40) after
treatment with ICSI. The main outcome measures were implantation rate, chemical and clinical pregnancy rates while
secondary outcomes were COH, such as dosage and duration of gonadotropins, the number of oocytes retrieved,
endometrial thickness and E2 level on the day of hCG, fertilization rate and the number of transferred embryos.
Results: no statistically significant difference between the two groups in percentage of metaphase II oocyte, number of
embryo transferred, implantation rate and chemical and clinical pregnancy rates, suggesting that embryo quality and
uterine receptivity remains unaffected despite the number of oocyte retrieved and fertilization rate were significantly
lower in endometriosis group. Conclusion: our data suggest that the presence of endometriosis in patients undergoing
ICSI does not affect pregnancy outcome, although significantly fewer oocytes retrieved from patients with endometriosis,
and lower fertilization rate. .
Keywords: ICSI, COH, hCG, Endometriosis.
was to compare the pregnancy outcome of ICSI cycles
Endometriosis is a known cause of subfertility
characterized by the presence of ectopic endometrial
in women with endometriosis and tubal factor infertility
glands and stroma. As a disease entity, it affects around
10-15% of all women of reproductive-age but as many
as 20 to 40% of women who seek help with infertility.
PATIENTS AND METHODS
There are several theories in association with
A retrospective, database-searched, case-control
endometriosis, but the theory of retrograde remains
study was conducted. Data were extracted from the
dominant (1). Many patients with endometriosis and
database of a private IVF center from July 2016 to June
infertility will require some assistance to conceive. The
2018. The data collected included age, BMI, duration
assisted reproductive technologies and, more
and type of infertility, antral follicle count, basal serum
specifically, in vitro fertilization (IVF/ICSI) represent
E2, FSH, LH and AMH, ovarian stimulation protocol,
the most successful means of achieving conception in
dosage of gonadotropin, days of stimulation, endometrial
endometriosis patients struggling with infertility. This
thickness and number of follicles on day of HCG,
approach bypasses anatomic distortion, potential
oocytes retrieved number, M oocyte number, number
compromise in tubal function, and aberrations in the
of transferred embryo and implantation, chemical and
peritoneal environment associated with this disease (2).
clinical pregnancy outcome. The study was approved
The effect of endometriosis on the success rates
by the Ethics Board of Al-Azhar University and
of IVF treatment remains an issue of some debate. One
an informed written consent was taken from each
of the main problems has been a variety of conflicting
participant in the study.
studies either demonstrating a negative impact of
endometriosis or no impact at all. There have been two
The study group comprised of 40 women with
primary theories for the proposed poor outcome after
endometriosis having no other known infertility factor
IVF in patients with endometriosis. First, the oocyte
besides endometriosis while the control group
quality is poor, resulting in lower fertilization rates.
consisted of 40 women with tubal-factor infertility.
Second, implantation is impaired either as a result of
endometrial dysfunction or combined with poor oocyte
They were women were age < 40 years,
or embryo quality (3).
minimum 2 years of infertility, regular menstrual
Considering the presence of controversies in
cycle, normal concentrations of prolactin, free
data on the effect of endometriosis on the results of ICSI
thyroxin and thyroidstimulating hormone (TSH).
treatment, we decided to perform this study.
Diagnosis of the two groups had previously been
confirmed by laparoscopy. All patients in both groups
AIM OF THE WORK
underwent a routine infertility work-up.
The main objective of this retrospective study
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2173-2182
Role of Low Dose Sildenafil in Improvement of Implantation Rate
in Case of Recurrent ICSI failure
Yahia A. Wafa, Mohammed Moh. ALKhouly, Reham M. Salah Abdelsalam Mosalam
Department of Obstetrics and Gynecology, Al-Azhar University, Cairo, Egypt
Corresponding author: Reham M. Salah, Mobile: 00201150011938, Email: email@example.com
Background: Infertile couples to have healthy children are one of primary tasks of assisted reproductive
technologies. In order to fulfill these tasks, reproductive medicine constantly needs to obtain information on
physiology and pathophysiology of infertility and to develop efficient strategies for ovarian hyper-stimulation.
Objectives: Aim of the current Work was to evaluate the efficacy of oral sildenafil citrate 25 mg on pregnancy
outcome, endometrial thickness, pattern and uterine arteries Doppler blood flow in patients with 3 or more
concoctive unexplained recurrent IVF/ICSI implantation failure.
Patients and Methods: This prospective, randomized, double blinded study included a total of seventy patients
undergoing ICSI trial attending at the University Maternity Hospital IVF\ICSI unit. The included subjects were
randomly allocated into two groups: Group I (study group): included 35 women with recurrent ICSI implantation
failure with another trial of ICSI using the standard drugs and technique with the addition of sildenafil 25 mg orally
twice daily. Group II (control group): included 35 women with recurrent ICSI implantation failure with another
trial of ICSI using the standard drugs and technique (control group).
Results: The statistical comparison between group I (Sildenafil Citrate) and group II (control) regarding
endometrial thickness showed non significant differences before and significant differences after 21days of
administration of Sildenafil Citrate. The statistical comparison in patients in group I (Sildenafil Citrate) regarding
Pulsatility index, Resistance index and Systolic/ diastolic ratio showed significant differences of these parameters.
Conclusion: It could be concluded from this study that adding of sildenafil citrate 25 mg orally twice daily for 21
days to patients with unexplained recurrent ICSI implantation failure, increase in pregnancy rate.
Keywords: Sildenafil, Implantation Rate, Recurrent ICSI failure.
Assisted reproductive techniques (ART) are used
endometrium and found that a poor uterine receptivity in
widely to treat fertility problems, which affect
women with thin endometrium may be due to the
approximately 715% of women in reproductive age (1).
impairment of blood flow impedance through the
Although there have been several improvements in
techniques during the last three decades, clinical
Several treatment options were suggested to improve
pregnancy and live-birth rates remain at approximately
endometrial receptivity in IVF cycles. Using the available
3040% and 2030%, respectively (2) according to results
treatment modalities (extended estrogen administration,
from the Canadian ART Register in 2007. Increasing these
vaginal sildenafil, vitamin E, pentoxifylline, and luteal
rates is desirable for couples undergoing ART, as
phase GnRH-a supplementation) (10).
treatment failure is a source of psychological distress and
It has been reported that low-dose aspirin is
the most common cause of drop-out before achieving
effective in improving implantation and pregnancy rates in
the IVF program. We also reported that a nitric oxide
The success of in vitro fertilization and embryo
donor reduced the uterine arterial PI of a woman with a
transfer (IVF-ET) cycles depends mainly on embryo
history of repeated unexplained ICSI/IVF implantation
quality (4), uterine receptivity, and efficient crosstalk
failure. The transvaginal color Doppler technique makes it
between the embryo and the receptive endometrium. It is
possible to further the investigation on the influence of
thought that the impairment of any one of these factors or
various medications on uterine perfusion (11).
biological processes may result in implantation failure (5).
Sildenafil citrate enhances the effect of NO by
Implantation remains a major limiting step of assisted
inhibiting phosphodiesterase type 5(PDE5) which is
reproductive technology (ART) and the uterine receptivity
responsible for degradation of c GMP, So with the use of
is important for successful implantation (6).
sildenafil cGMP remain elevated, which leads to vascular
Endometrial receptivity is regulated by many factors
relaxation and increased blood flow to improve the
including endometrial perfusion (7). Several studies have
endometrial thickness (12).
demonstrated the existence of a correlation between
Uterine receptivity is likely to be regulated by a
endometrial characteristics and pregnancy rate in
number of factors including uterine perfusion and is of
IVF/ICSI patients (8).
great importance in achieving a normal pregnancy.
Factors affecting the growth of endometrium are still
Transvaginal pulsed Doppler ultrasonography allows
not well understood, but recently many researchers have
non-invasive evaluation of uterine circulation. In a
focused on the angiogenesis and vascularization within the
number of studies, pulsed Doppler ultrasonography
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2183-2192
Evaluation of Vascular Morphological Changes in The Superficial and
Deep Retinal Plexuses by Optical Coherence Tomography
Angiographyin Cases of Acute Phase Branch Retinal Vein Occlusion
Ahmad El-Sayed Hudieb
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Background: Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic
retinopathy and an important cause of visual morbidity and blindness
Aim of the work: was to detect if there are diagnostic signs in the two intra retinal layers superficial network layer
and deep network layer by Optical coherence tomography angiography (OCT-A) to diagnose branch retinal vein
Patients and Methods: an observational cross-sectional study included a total of ten patients with branch retinal
branch retinal vein occlusion of recent onset within three months attending at the Ophthalmology Department Al-
Azhar University Hospitals, Cairo. Demographic data such as age, gender, sex and hypertensive history were
obtained. A detailed evaluation of cases including complete anterior segment evaluation and posterior segment
evaluation was done. OCT-A and fluorescein angiography (FA) were used to study the vascular morphological
changes in the branch retinal vein occlusion (BRVO)area.
Results: As regarding 5 disc area of retinal ischemia FA detected ischemia in 2 cases (20%), detected no ischemia
in one case (10%) and was not able to evaluate ischemia in 7 cases (70%) compared to OCT-A, that detected the
ischemia in the superficial retinal plexus (SCP) in 4 cases (40%) and detected no ischemia in 6 cases (60%), but it
detected the ischemia in the deep retinal plexus (DCP) in 6 cases(60%) and detected no ischemia in 4 cases (40%).
Conclusion: It could be concluded that that OCT-A was superior to FA in detection of macular ischemia,
macular ischemia detected by OCT-A had stronger negative relation with V.A. than macular ischemia detected
by FA and retinal ischemia in the DCP was more evident than that of SCP by OCT-A.
Retinal vein occlusion (RVO) is the second
of this study was to detect the vascular morphological
most common retinal vascular disease after diabetic
changes in the branch retinal vein occlusion area in
retinopathy and an important cause of visual
both the superficial and the deep retinal network
morbidity and blindness(1). Retinal vein occlusion may
layers by OCT-A in cases of acute onset BRVO.
develop at different sitesand to varying extent.
Depending on the location of occlusion it can be
PATIENTS AND METHODS
classified into occlusions of central vein, hemi central
This observational cross-sectional study included
vein, major branch vein and macular branch vein (2).
a total of ten patients to detect the vascular
Fluorescein angiographic (FA) assessment is an
morphological changes in the branch retinal vein
important tool for an adequate evaluation of the
occlusion area of recent onset within three months, in
disease severity and for proper classification between
both the superficial and the deep retinal network
the two types of (RVO), ischemic and non-ischemic
layers by OCT-A in cases of acute onset BRVO.
(3). However, FA cannot separately visualize the intra-
Patients had attended at the Ophthalmology
retinal structures of major capillary networks; the
Department, Al-Azhar University Hospitals, Cairo,
images of superficial and deep capillaries overlap, so
2 of the 3 major capillary networks (superficial retinal,
Approval of the ethical committee and a
deep retinal and chorio capillaries) do not appear to be
written informed consent from all the subjects
imaged well despite the retina being a nearly
transparent structure (4).
This study was conducted between January 2016,
OCTA, in comparison, is a non-invasive
and December 2017.
technique that acquires volumetric angiographic
Each case was subjected to a detailed ocular
information without the use of dye. Each
examination. This assessment included uncorrected
three-dimensional scan set takes approximately six
visual acuity (UCVA), refraction (automated) and
seconds to obtain. The en-face images obtained can
then best corrected visual acuity (BCVA), Intraocular
then be scrolled to visualize individual vascular
pressure (IOP) measurement using applanation
plexuses and segment the inner retina, outer retina,
tonometer, Anterior segment slit-lamp examination,
choriocapillaris, or other areas of interest (5). The aim
Posterior segment slit-lamp examination by +78 lens
an, color photography fundus examination Fundus
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2193-2199
Lateral Rectus Recession Considering the Tendon Width in Intermittent Exotropia
Salwa A. Almabrouk*1, Wafaa A. Madbouly2, Hayam S. Kamel2.
Ophthalmology Department, Faculty of Medicine for Girl, 2Al- Azhar University,
1Omar Almukhtar University, Albaida, Libya
*Corresponding author: Tel.: 00201018255511, Email: firstname.lastname@example.org
Background: Intermittent exotropia (IXT) is a common form of childhood exotropia. Surgery is thought to be an
effective method for the treatment, recession of lateral rectus (LR) muscles most frequently used. The tendon width
of the LR which has been reported to be a useful indicator for estimation of the effect of LR recession in IXT.
Aim : It was to determine whether the tendon width of the LR would predict the effects of lateral rectus recession.
Patients and Methods: This was a prospective study included 30 patients had IXT, they were divided into two
groups: group 1 (age 10 y), group 2 (>10 y). All of them underwent unilateral or bilateral LR recessions according
to the preoperative angle of deviation, the tendon width of LR muscle was measured by surgical calipers. The
actual effect of lateral recession was calculated then compared it to hypothetical effect.
Results: there is statistically significant negative correlation between tendon width and actual effect in all group
(r= -0.7921, P.<0.05). The actual effect was 2.60, 2.51, and 1.76PD when ranges of tendon width were 8mm, 8.5-
9mm, and 9.5-10mm, respectively. Conclusion: In our study we found the tendon width of LR muscle significantly
affect surgical dose response, where the effects of LR recession were larger in cases in which the tendon width of
muscle was decreased, and the effect was smaller in cases in which the tendon width of muscle was increased.
Keywords: intermittent exotropia, lateral rectus recession, tendon width.
AIM OF THE WORK
Intermittent exotropia (IXT) is a common form of
Our aim was to determine whether the tendon width
childhood exotropia, comprise about 5090% of all
of the lateral rectus would predict the effects of lateral
the extropia and affecting about 1% of the general
rectus recession to facilitate the appropriate amount of
population(1). Nonsurgical treatment includes over-
correction as the surgeon desires in the early
minus prescription may be useful, part-time occlusion
of the non-deviating eye may improve control in
some patients, and orthoptic exercises may be helpful
PATIENTS AND METHODS
for near exotropia(2). It indicated in some situation
Thirty patients having IXT were included in this
such as convergence insufficiency, small angle
prospective study (28 patients were basic type IXT and
exophoria, interim treatment prior to surgery and high
2 patient were pseudodivergence type IXT) from
hypermetropia with exotropia(3).
October 2017 to April 2019 at Al-zahra University
Surgery is an effective method for the treatment of
Hospital, who met the inclusion criteria.
IXT. Several surgical approaches have been used
successfully to correct exotropia, but the most
The ethical clearance
frequently used is recession of both lateral rectus
All the parents of children and adult patients were
muscles(4). Generally, most studies define their success
given a detailed oral description about the study, and
rate in terms of ocular motor alignment of within 10
a written consent were obtained befor the surgical
prism diopters (PD) of orthotropia(5). Recurrence after
intervention. The study was approved by the Ethics
exotropia surgery is frequently observed and the low
Board of Al-Azhar University.
success rate often frustrates the operator. Exotropic
Cases were divided into two groups according to age:
drift is common after surgical management of IXT and
Group 1: Those who were 10 years, included 13
several studies have attempted to reduce the rate of
recurrence and reoperation by revealing the largest
Group 2: Those who were >10 years of age, included
angle of exodeviation preoperatively, or by
augmenting the amount of surgery(6).
The tendon width of the lateral rectus has been
Cases were divided into three groups according to
reported to be a useful indicator for estimation of the
tendon width of lateral rectus muscle into:
effect of LR recession in IXT. The mean effect of 1mm
Group A: Those with tendon width 8mm.
lateral rectus recession has been shown to range from
Group B: Those with tendon width 8.5-9mm.
2.7 to 3.5 preoperative deviation (PD) according to
Group C: Those with tendon width 9.5-10mm.
tendon width and the effect of recession has been
Cases were divided into three groups according to
shown to be larger in cases in which the LR tendon
alignment on second post operative:
width is narrower (7).
o Those within 10PD Esodeviation.
o Those within 10PD Exodeviation.
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2200-2204
Functional, Radiological and Sagittal Balance Outcomes in
Surgically Treated Degenerative Cervical Disc Diseases
Mohamed Abd El Gawad, Hassan El Behairy, Hesham Farhoud
Department of Orthopedics, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mohamed Abd El Gawad, Mobile: (+20)01005442400, E-Mail: email@example.com
Background: The treatment of degenerative spinal diseases remains focused on dealing with symptoms, using both
conservative and surgical methods. Though surgery is considered an effective treatment for many cervical disorders, at
times it leads to significant problems including adjacent level disease.
Objectives: The aim of this study was to correlate the functional, radiographic and sagittal balance outcome in surgically
treated patients for the degenerative cervical disc diseases, outline the advantages, disadvantages and the effect of the sagittal
balance on the patient function and activities.
Patients and Methods: This study included a total of thirty patients who had degenerative disc disease of the cervical
spine at multiple levels treated by microscopic anterior cervical decompression. The average age of participants was
43.267 ± 10.780 years (26 64). 18 patients (60%) were females and 12 patients (40%) were males. All patients were
assessed and classified before and after surgery using the neck disability index and visual analogue scale. This
assessment was done for both neck and arm disability.
Results: The average neck disability index at the last follow-up was 17.74 ± 2.135, which was statistically significant (P
< 0.05) among groups and visual analogue scale improved from 7.4 ± 0.926 to reach 3.6 ± 0.35 six months postoperatively.
Full recovery was obtained between three and six months. All patients underwent a rehabilitation protocol and found no
postoperative neurological deficit in this series.
Conclusions: It could be concluded that cervical sagittal imbalance arising from regional and/or global spinal
sagittal malalignment plays an independent role in exacerbating adjacent segment pathomechanics after multilevel
fusion and should be considered during cervical fusion surgical planning. Also, it concludes that surgery
significantly led to improvement of symptoms three months post operatively.
Keywords: Cervical spine, Degenerative diseases, Sagittal balance, PEEK cage, Plate & screw.
In the last 50 years, advancements in the treatment of
the mechanisms responsible for cervical sagittal
cervical spine degenerative disorders have been many.
malalignment and how malalignment may influence
There have been concerted efforts to halt or reverse the
changes in muscle lengths, neuro- foraminal and canal
degenerative process by means of various biological
spaces, and load sharing between disc and facets, so as to
therapies, although these are still in experimental stages(1).
optimize both manual and surgical treatments. In the
Currently, the treatment of degenerative spinal diseases
current study, and as a first step towards this goal, we
remains focused on dealing with symptoms, using both
developed a novel laboratory model, which allowed us to
conservative and surgical methods (2).
examine the effects of selective variations in parameters
Though surgery is considered an effective treatment
of CSA, including C2-C7 SVA and T1-tilt, on postural
for many cervical disorders, at times it leads to significant
compensation in lordosis angles that are necessary to
problems including adjacent level disease.
maintain horizontal gaze.
To minimize the "footprints" arising from surgical
interventions on the cervical spine, it is crucial not only to
PATIENTS AND METHODS
treat the present disorder but also avoid sowing the seeds
This study included a total of 30 patients who had
of future problems. A milieu should also be created that
degenerative disc disease of the cervical spine at multiple
can easily address these problems should they arise (3).
levels attending at Al-Azhar University Hospitals.
A physiologic sagittal alignment of the head and neck,
including the ability to maintain horizontal gaze, is
Approval of the ethical committee and a
essential to maintaining functionality during activities of
written informed consent from all the subjects
daily living. Cervical sagittal malalignment has been
linked to poor health-related quality of life and is an area
This study was conducted between October 2015
of increasing clinical research interest(3-7).
to May 2018.
The long-term goal of our research was to understand
All patients were fully evaluated and diagnosed
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2205-2209
Comparative Study between Intralesional Injection versus Intradermal Injection of
Candida Albicans Antigen as An Effective Treatment of Common Warts
Abd El-Shakour Abd El- Hafiz Al Mohammady, Hassan Mamdoh Abd El-Aziz, Loay Hazem Aamer
Department of Dermatology, Venerology and Andrology; Faculty of Medicine, Al-Azhar University
*Corresponding author: Loay Hazem Aamer; Mobile: (+20)01099226613; E-mail: firstname.lastname@example.org
Background: Warts, or verrucae, are benign epithelial proliferations of skin and mucosa caused by
infection with human papilloma virus (HPV). They are common skin condition that can range in severity
from a minor nuisance that resolves spontaneously to troublesome, chronic condition.
Objective: The aim of the present study is to compare between intralesional injection of candida albicans
antigen versus intradermal injection as an effective treatment of common warts.
Patients and methods: This study included 60 (sixty) patients (adult males and females) were suffering from
common warts. The patients were divided into two equal groups of 30 patients each: Group A treated by
intradermal injection of candida albicans antigen. Group B treated by intralesional injection of candida albicans
antigen in one of their warts (mother wart) which was chosen and marked. The patients were collected from
the outpatient's clinics of Dermatology and Venereology Department of Al- Hossein University Hospital.
Results: As we compared the response to candida albicans antigen injection, we found a highly significant
cure response in intralesional injections over intradermal injections. After 6 months follow up in patients who
responded by complete cure (29 patients), there was no recurrence in 26 patients (89.6%) and only 3 cases
(10.4%) developed partially recurrence. As regard to side effects there were no side effects in 43 cases (71.7%).
Conclusion: candida albicans antigen injection seems to be promising effective and safe remedy for cutaneous
warts with good cure rates and excellent safety profile.
Keyword: Intralesional injection, Intradermal injection of candida albicans antigen, Warts
delayed-type hypersensitivity (DTH) reaction is
Warts are benign lesions that occur in the
characterized by an infiltration of lymphocytes and
mucosa and skin (1). These are a common medical
macrophages at the site of antigen deposition.
problem, especially in Whites (2).
Specific cell types that appear to play a major role
Warts are common dermatological skin
in the DTH response include CD4 and CD8 T
disease that affects 7 - 10% of the general
lymphocytes (5). Intralesional immunotherapy
population. Warts constitute the commonest
utilizes the ability of the immune system to mount
cutaneous manifestation of human papilloma virus
a delayed type hypersensitivity response to various
(HPV) that infects epithelial tissues of skin and
antigens and also the wart tissue. This therapy was
mucous membranes. There are over 150 distinct
found to be associated with the production of Th1
HPV subtypes; some tend to infect specific body
cytokines which activate cytotoxic and natural
sites and produce characteristic proliferative
killer cells to eradicate HPV infection. This clears
lesions at those sites. Many types of warts have
not only the local warts but also distant warts
been identified: common wart, flat warts, plantar
unlike traditional wart therapies (6).
warts and genital warts (3).
Different modalities for treatment of
AIM OF THE WORK
cutaneous warts are available. Local treatments
The aim of the present study is to compare
include salicylic acid, intralesional interferons
between intralesional injection of candida albicans
(alpha, beta, and gamma), dinitrochlorobenzene,
antigen versus intradermal injection as an effective
intralesional bleomycin and intralesional 5-
treatment of common warts.
PATIENTS AND METHODS
immunotherapy and cryotherapy (3). Antigens used
This study included 60 (sixty) patients (adult
for intralesional immunotherapy include tuberculin
males and females) who were suffering from
(PPD), candida, trichophyton; and mumps,
measles, and rubella (MMR) (4).
The patients were divided into two equal groups
Candida antigen is made from the culture
of 30 patients each :
filtrate and cells of two strains of Candida albicans.
1. Group A treated by intradermal injection of
It's indicated in origin for use as a recall antigen for
candida albicans antigen.
detecting delayed-type hypersensitivity by
2. Group B treated by intralesional injection of
candida albicans antigen in one of their warts
inflammatory response associated with the
(mother wart), which was chosen and marked.
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2210-2217
Gamma Knife Radiosurgery for Post-Operative Vestibulocochlear Schwannomas
Ibrahem G. Ewaiss, Hedaya M. Hendam and Ahmed E. Elhoufi
Department of Neurosurgery, Al-Azhar University, New Damietta, Egypt
Corresponding author: Ahmed E. Elhoufi, Mobile: (+20) 01060209890, E-Mail: email@example.com
Background: The discovery of Schwann cells as the oncologic cells led to the recommendation by a consensus
meeting in 1992 to use the term vestibular schwannoma. In the literature, the terms acoustic neurinoma, acoustic
neuroma, and vestibular schwannoma are used interchangeably.
Objective: Evaluation of the outcome of the management of post-operative recurrent or residual vestibular
schwannomas by using gamma knife radiosurgery (GKRS).
Patients and Methods: In this retrospective descriptive case series study during the year of 2018 on twenty (20)
consecutive cases at the International Medical Center (IMC) with residual or recurrent post-operative
vestibulocochlear schwannomas (VS) whom underwent gamma knife stereotactic radiosurgery (SRS). Clinical &
radiological follow up done for a period of 6 months minimum up to 3 years.
Results: After GKRS, it was shown that the cerebellar ataxia improved in 7 cases (100%). 5th cranial nerve
affection improved in 6 cases (100%). 7th cranial nerve affection improved in 5 cases (100%). Hearing affection
deterioration occurred in 4 cases (20%), 16 cases had stationary course (80%), Local tumor control in 90% of
patients & Regrowth of tumor in 10% of patients.
Conclusion: GKRS is the best choice in small size VSs less than 3 cm in maximum diameter X, Y, Z either prior
surgery was done or not due to its advantageous preservation of all cranial nerves as they can withstand the
prescribed SRS dose for VSs.
Keywords: Gamma Knife Radiosurgery, Vestibulocochlear Schwannomas.
Vestibular schwannomas (VS) are benign
oriented outcomes including preserving hearing and
tumors that arise from Schwann cells of the inferior
facial nerve function, therefore the impact of the
division of the vestibular portion of the
treatment on quality of life over complete tumor
Vestibulocochlear nerve (VIII) inside the internal
resection will lead to the progressive validation and
auditory canal. As they grow, they fill and extend
diffusion of combined strategies (such as a planned
beyond the internal auditory canal into the
subtotal resection followed by radiosurgery) (5).
cerebellopontine angle (CPA) (1). VSs account for
approximately 8% of intracranial tumors and have an
PATIENTS AND METHODS
incidence approaches 20 per million per year (2).
Typical presentation of VSs occurs in the 5th
In this retrospective descriptive case series study
or 6th decade of life. Its presentation is closely
during the year of 2018 on twenty (20) consecutive
correlated with tumor size; progressive unilateral
cases at the International Medical Center (IMC) with
hearing decline is the most common. Early symptoms
residual or recurrent post-operative vestibulocochlear
include triad: ipsilateral sensorineural hearing loss
schwannomas whom underwent gamma knife
(insidious and progressive) (90%), tinnitus (high
stereotactic radiosurgery (SRS). Clinical &
pitched) (>60%) and disequilibrium (true vertigo is
radiological follow up was done for a period of
uncommon). Imbalance, dizziness, vertigo and
minimum 6 months up to 3 years.
headache secondary to hydrocephalus can occur with
The study was approved by the Ethics Board of Al-
larger VS due to brainstem and trigeminal nerve
Azhar University and an informed written
compression. Up to 12% of patients can present with
consent was taken from each participant in the
facial paresthesia due to involvement of the
trigeminal nerve, and up to 6% can present with facial
nerve palsy. Rarely, intratumoral bleeding may lead
to rapid enlargement of the mass (3).
Post- operative recurrent or residual vestibular
Many patients prefer radiosurgery to surgical
resection, rendering the gamma knife radiosurgery
(GKRS) to be, currently, the most common primary
treatment for small- to medium-sized VS. According
· De novo vestibular schwannomas.
to some studies, between 7 and 37% of the patients
· Vestibular schwannomas size > 3 cm.
treated with GKRS for VS underwent previous
· Disturbed level of consciousness.
surgery (4). Since the tumor control and patient-
· Bilateral vestibulocochlear schwannoma (NF).
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2218-2223
Cyanoacrylate Glue Versus Suture Fixation of Mesh in Adult Inguinal Hernioplasty
Hazem A. Megahed
Department of General Surgery, Faculty of Medicine for Boys, Al-AzharUniversity, Damietta, Egypt.
E-Mail: firstname.lastname@example.org, mobile: 00201068687477
Background: Tissue glues have been present for over twenty years and are used in surgery for a variety of
indications. Use of N butyl- 2-cyanoacrylate based in inguinal hernia surgery were practiced for the first time in the
mid-nineties. These non-suture techniques was aimed to decrease the chronic groin pain after hernioplasty without
adversely affecting the outcomes
Aim of the work: this study was designed to compare the operative outcomes of mesh fixation with glue versus that
with suture. The primary objective was to compare pain in the immediate postoperative period and also to compare
chronic postoperative pain.
Patients and Methods: This prospective randomized study was performed Between January 2018 and January 2019
on 40 patients with unilateral inguinal hernia for whom open hernioplasty was done in the Department of surgery,
Al-Azhar University Hospital, Damietta.
Results: in the present study, there was significant difference in postoperative pain perception at 24 hours, at one
week and at one month (p < 0.05) between glue group and suture group with lesser pain perception in the glue group.
After the first month the difference between the two groups was non-significant. The mean operative time which
was 44.35 min in the glue group and 57.33 min in suture group showed significant difference. As regard to the
postoperative complications, the postoperative hematoma, infection and seroma were lesser in glue group but the
difference was not significant. There was no recurrence in both groups.
Conclusions: Cyanoacrylate glue for mesh fixation in Lichtenstein repair of adult inguinal hernia shows advantages
over mesh fixation by sutures in terms of immediate and chronic post-operative pain, operative time, and
Keywords: Cyanoacrylate Glue, mesh fixation, hernioplasty, inguinal hernia repair
Repair of inguinal hernia is still one of the most
severe groin pain and as a persisting dragging pain in
commonly performed procedures allover the world
the inguinal region several months after the surgery and
(1).Many techniques are used for repair of inguinal
has been attributed to the traumatic mesh fixation (6).
hernia, a Lichtenstein's tension free hernioplasty firstly
The incidence of long-standing groin
described in 1989 (2) and is the most widely practiced
pain after inguinal hernioplasty is estimated to be 0.7%
surgical technique due to its superiority to the other
(4) to 62.9% (5) and it can be categorized into two types,
open techniques in many ways as better postoperative
neuropathic and non-neuropathic. Neuropathic pain is
comfort than before and lower incidence of recurrence
due to involvement of ilioinguinal, iliohypogastric or
which has been decreased due to the usage of prosthetic
genitofemoral nerves during surgery (6) and can be very
mesh.Many studies reported that the incidence of
well prevented by careful identification and
recurrence after tension-free repair was as low as 25%
preservation of the nerves during surgery and
recently (3,4). In spite of the success of this method in
lateralization of the nerve to prevent injury. use of
inguinal hernia repair,the long-standing groin pain after
lightweight meshes induce a thinner fibrotic reaction
hernioplasty represented a great challenge to surgeons
thus preventing entrapment of the nerves , also the
(5).The surgeons continue to search for the ideal repair
usage of atraumatic methods for mesh fixation like
method with the best outcome and parameters other
tissue glues prevent the incorporation of the nerves
than recurrence rate were taken into consideration to
within sutures (7)
determine the effects of hernioplasty (e.g.
Non-neurogenic pain is a constant dull
postoperative long-standing groin pain and discomfort)
aching pain in the inguinal region which could be due
(1). Several small scale modifications have been made
to excessive posterior wall scarring due to heavy weight
to the classical Lichtenstein's hernioplasty technique
mesh usage. First bite for mesh fixation is taken at the
over the years. These modifications aimed to decrease
pubic tubercle. This may induce osteitis of the tubercle
the chronic groin pain after hernioplasty without
and a source for pain. The presence of mesh and fibrosis
adversely affecting the outcomes. Chronic groin pain
could be perceived as a foreign body sensation and
was observed in the immediate postoperative period as
stiffness in the inguinal region.this type of pain can be
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2224-2230
Study of Oncoprotein 24p3 as Diagnostic Marker for Hepatocellular
Carcinoma on Top of Hepatitis C Virus
Sara M. Abd Elaziz(1) , Amany M. Abo Elenein(1), Dina H. Ziadh(2), Sara A. Hamam(1), Sara M. A
(1) Department of Clinical Pathology and (2) Department of Tropical Medicine,
Faculty of Medicine, Tanta University, Egypt
Corresponding author: Sara M. Abd Elaziz; Email: email@example.com
Background: Hepatitis C virus is one of the main causes of chronic liver disease worldwide. Egypt has the
highest prevalence of HCV in the world, estimated nationally at 14.7% and is therefore confronted with a
disease burden of historical proportions that distinguishes this nation from others. In HCC, 24P3 is
overexpressed in tissues and closely associated with the proliferation and invasion of HCC cells.24P3 is mainly
expressed in myeloid cells and later assigned to a cluster of at least three lipocalins on the long arm of human
Aim of the Work: was to shed the light on the role of oncoprotein 24p3 as a diagnostic marker in patients with
hepatocellular carcinoma complicating hepatitis C virus.
Subjects and Methods: This case control clinical study was carried out on 60 subjects who were divided into
three groups: Group I: Twenty Patients diagnosed with HCC on top of HCV. Group II: Twenty Patients diagnosed
with HCV without HCC. Group III: Twenty normal subjects with matched age and sex as a control group. Studied
groups were subjected to abdominal ultrasonography, triphasic CT for patients with focal lesions, laboratory
investigations including; liver function tests included hepatitis markers and serum 24P3, detected by enzyme
linked immunosorbent assay (ELISA).
Results: The study revealed a significant increase in AFP in Group I compared to Group II and in Group II
compared to Group III. A significant difference P=0.001 was found among the three different groups. The cutoff
for AFP was >20ng/mL, sensitivity was 70%, specificity was 85%, PPV 90%, NPV 65% and accuracy 78%.
There was a significant increase of 24P3 in Group I compared to Group II and in Group II compared to Group
III. A statistical significance p=0.001 was found among the three different groups. The cutoff for 24P3 was
>250ng/mL and its sensitivity, specificity, PPV, NPV, and accuracy were all 100%. Based on the present study,
24P3 has a higher sensitivity, specificity and accuracy as compared to AFP, a famously used biomarker in HCC.
Conclusion: Serum 24P3 levels in patients with HCV may be used as a guide for progression and prognosis of
HCC. In these patients, if 24P3 levels were found to be high, serum alpha feto protein and ultrasonographic
examination could be repeated at more frequent intervals. This may also be used as a guide in terms of the
treatment plan. Measurement of 24P3 in sera of large number of patients and follow up may pave the way to pick
up early stage of HCC and showed its prognostic effect.
Keywords: oncoprotein 24P3, hepatocellular carcinoma, hepatitis C virus.
Cancer is among the leading causes of
procedure, a blood test can be used to measure
morbidity and mortality worldwide, accounting for 14
million cases and 8.2 million deaths in 2012.
Among serological biomarkers, AFP is the
Globally, liver cancer is the fifth most common type
approved marker for screening HCC, but it is not
of cancer and third most common cause of cancer
used routinely by clinicians, due to its insufficient
mortality. In the United States (US), according to the
sensitivity and specificity. To improve the
Surveillance, Epidemiology, and End Results
diagnosis and prognosis of HCC, additional
Program (SEER) estimates in 2015, liver cancer
reliable markers must be identified that can be used
accounted for 2.2% of all new cancer cases and 4.2%
for its early and accurate detection(2).
of all cancer deaths; hepatocellular carcinoma (HCC)
24P3, belongs to the lipocalin family that were
is the most common primary liver cancer, accounting
first proposed to have unifying functions in the
for nearly 80% of all primary liver cancers(1).
transport of hydrophobic substances. It was initially
Although HCC has been examined
isolated and purified as 25-kD a neutrophil protein
extensively and although its symptoms are well
that is inpart associated with gelatinase from human
known, its early diagnosis remains difficult; thus,
the survival rate after diagnosis is low (<10%). The
24P3 is mainly expressed in myeloid cells and
conventional diagnostic tools include alpha feto
later assigned to a cluster of at least three lipocalins
protein (AFP), liver biopsy, and radiographic
on the long arm of human chromosome 9(3). It starts
imaging. As aless invasive and cost-effective
being expressed in the embryonic stage and it has
been shown to be activated strongly in inflamed
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2231-2235
Comparative Study between Outcomes of Abdominoplasty with or without
Use of Diuretics in Postoperative Treatment
Abd El Fattah Morsi
Department of General Surgery, Faculty of Medicine, Al-Azhar University
Correspondence: Abd El Fattah Morsi, E-Mail: firstname.lastname@example.org, Mobile: (+20)01061031228
Background: Seroma formation is a common complication after abdominoplasty and is associated with delayed
wound healing, infection, skin flap necrosis, patient discomfort and repeated visits to the outpatient clinic to deal
with seroma and its sequelae. Closing the dead space after abdominoplasty seems to be key in reducing seroma and
Objective: The aim of this study was to compare outcome amount of serous fluid in the drain and incidence of
seroma post abdominoplasty with and without use of spironolactone in medical treatment in postoperative period.
Patients and Methods: This study was conducted on 40 patients who underwent classical abdominoplasty without
use of mesh, all laboratory and radiological investigations were done. Patients were divided into two groups group
A involved 20 patients who didn't take spironolactone and group B included 20 patients that had taken
spironolactone for 15 days postoperative.
Results: In group A, there were 3 males and 17 females and mean age was 34 ± 8.6 years. Group B consisted of
5males and 15 females, their mean age was 40 ± 10.8. BMI was 13 patients >25 in group A and in group B was 6
cases >25. There is small paraumbilical hernia in 4 patients in group A and in 3 patients in group B. Group B who
took spironolactone showed significant improvement in outcome including volume of fluid in the drain, time of
removal of drain and no occurrence of flap edema.
Conclusion: There was statistically significant decrease in the incidence of seroma formation after
abdominoplasty with the use of spironolactone postoperative.
Keywords: abdominoplasty, seroma, diuretics, spironolactone.
Abdominoplasty is a comprehensive surgery,
many other areas of medicine, this uncertain pathology
often followed by a large number of local and general
led to a lack of consensus or a common approach for
complications. The formation of serums or
preventing and treating these complications.
accumulation of non-infected fluids under the skin is
Various preventive measures have been
one of the most common complications after tummy
described, such as reducing the amount of flap
tuck. The most important factors that prepare patients
undermining, reducing the use of electrolysis and
for seroma formation are body mass index, amount of
liposuction, and using tissue adhesives and abdominal
undermining flap, and combination of liposuction or
binders. Use of diuretics was also described to
other procedures (1).
decrease incidence of seroma formation especially
Incident estimates vary from 1% to 57%, with
spironolactone in the morning (5).
an acceptable standard of 10%(2). It is usually a self-
limiting phenomenon, but it can sometimes cause
OBJECTIVE OF THE STUDY
major problems. The accumulation of excessive serous
This study was conducted to evaluate the
fluid increases the pressure, which can be transmitted
value of use of diuretics (spironolactone) in treatment
to the flap, causing gapping in the wound and necrosis
of post abdominoplasty surgery and its effect on
of the flap. May also become contaminated and
seroma formation and to compare that with patients
predispose to infection. Minor secondary effects such
didn't use the diuretics postoperatively.
as chronic fluid accumulation with false wall
formation and systemic inflammatory response
PATIENTS AND METHODS
syndrome (3). As reported. Although they are benign in
This study was conducted on 40 patients who
nature, the seroma always cause discomfort and
underwent abdominoplasty in Al-Azhar University
anxiety in the patient, resulting in frequent office
Hospitals. They were divided into two groups:
Group A 20 patients who did not take diuretics
The supposed mechanisms of seroma
Group B 20 patients who took diuretics postoperative
formation are disorders of vascular channels and
lymphatic vessels, creation of dead space, and shear
Patients with pendulous abdomen.
forces between flap and muscles of ant abdominal
Patients with small paraumbilica hernia and pendulous
wall, and release of inflammatory mediators (4). As in
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2236-2240
Correlation between Subjective and Linear Measurements of The
Palatal Airway on Lateral Cephalometric Radiography
Mohamed Abd El Aziz El Dab1, Mohamed Abd El Mon'm Younis1,
Mohamed Ahmed El Sharkawy1, Mohamed Abd El Razek Abd El Aziz2,
Ahmed Mohamed Anwar*3
1Otolaryngology, 2Radiology, Faculty of Medicine Al-Azhar University,3 Alexandria Faculty of Medicine
* Corresponding Author: Ahmed Mohamed Anwar, email: email@example.com
Introduction: hypertrophied adenoid tissue is one of the most common health problems that occurs in childhood
that results in many symptoms including 1. Nasal obstruction. 2. Mucoid, mucopurulent nasal discharge and
postnasal discharge 3. Snoring and obstructive sleep apnea. 4. Recurrent acute otitis media (A.O.M).
Objective: to evaluate the correlation between subjective and linear measurements of palatal airway on lateral
cephalographs. Patients and Methods: Diagnostic lateral cephalometric imaging study that took place from March
2017, to July 2018. 200 Children with chronic mouth breathing (116 boys and 84 girls), with age range from 2 to
14 years, were enrolled in this study. Patients were grouped into three groups according to age: a- 2 - <6 years were
84 patients (42%). b- 6 - <10 years were 76 patients (38%). c- 10 14 years were 40 patients (20 %).
Results: The age was inversely correlated with the grade of airway obstruction. The correlations between the
palatal airway grading with the shortest adenoid distance (SAD) and the most convex adenoid distance (CAD) were
r= -0.826 and r= -0.424, respectively, which is statistically significant. The relation between SAD and CAD was
directly proportional to each other accounting for correspondence of evaluation in more than 50% of the population
which is statistically significant. Conclusion: subjective grading of palatal airway obstruction correlates with the
objective measurements of SAD and CAD. Although both methods are reliable in measurement particularly the
more severe obstructions, SAD is a more favorable objective tool.
Keywords: hypertrophied adenoid, CAD, SAD.
The pharynx forms the common upper pathway
breathe at the same time (5). The soft palate
of the respiratory and alimentary tracts. It extends
overlapping the epiglottis contributes significantly to
from the skull base to the lower border of the cricoid
the preferential nasal breather status that characterizes
cartilage. It communicates with the nasal cavity as
infancy. These anatomic features of the larynx
nasopharynx, the mouth as oropharynx and the larynx
predispose the infant for rapid aggravation of upper
as hypopharynx (1). Waldeyer's ring is a ring of
airway obstruction. With growth of the neck, the
lymphoid tissues surrounding the pharynx, where
larynx gradually descends to the adult position, at or
nasal and oral passages unite. It consists of four main
near the fourth or fifth cervical vertebrae(1, 2).
masses of lymphoid tissue, namely the palatine tonsils,
Compared with the nasopharynx and oropharynx
the lingual tonsils, the pharyngeal tonsils (more
in adults, these structures in children normally have
commonly referred to as adenoids), and the tubal
more lymphoid tissues within the mucosa, extending
tonsils, forming a ring of lymphoid tissue) (2). The
into the airway (6).
pharyngeal (tonsils) adenoid is the lobulated masses of
Clinical picture of adenoid hypertrophy:
lymphoid tissues in the roof of nasopharynx. It
The clinical symptoms of adenoid enlargement
represents primary immunologic tissues, which
vary with the age of the patient and can be associated
represents the first line of defense against foreign-
with the patient's general condition as well as with the
based pathogens whose principal port of entry is
size of the nasopharynx. Thus in a small nasopharynx,
through the respiratory tract. Adenoid captures and
the adenoid tissue may prove to be clinically
entraps foreign materials that are inhaled, resulting in
significant whereas a larger adenoid mass may be
exposure of antigenic material that leads to activation
relatively asymptomatic in an anatomically larger
of immune responses and subsequent hyperplasia of
nasopharynx. In normal children the size and shape of
these tissues. The lymphatic tissue is similar to that of
the adenoid tissue varies from year to year and the
the palatine tonsils (3).
anterior convexity changes to a concavity with
In newborns, the neck is relatively short, and the
maturity. The adenoid appears to grow more rapidly
infant larynx is positioned high, approximating the
between 3 and 5 years of age. Therefore, it's important
third or fourth cervical vertebrae at rest, while rising
to perform further assessment of the size of the
to the height of the first or second cervical
adenoid in different age groups. The most common
vertebrae with swallowing (4). The higher located
symptoms attributed to adenoid enlargement are: 1.
larynx allows potential overlap of the soft palate and
Nasal obstruction which results into: a. Mouth
the epiglottis, establishing a secure airway during oral
breathing b. Adenoid facies c. Hypo-nasality of
nutritive sucking, thus permitting the infant to eat and
voice. 2. Mucoid, mucopurulent nasal discharge and
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2241-2244
Comparison of Temporalis Fascia Graft Medial and Lateral to
Handle of Malleus in Dry Central Tympanic Membrane Perforation
Wael Hassan Abo El-Wafa and Ibrahim Ibrahim El-Dsoky
Otorhinolaryngology Department, Faculty of Medicine, AL-Azhar University, Egypt
Corresponding author: Ahmed Yehia Yehia Fouda, Mobile: 01021511120
Background: Tympanoplasty is a surgical method, to eradicate middle ear infection and improve its function. The
two most common techniques for positioning the graft relative to the remnant of both the tympanic membrane and the
tympanic annulus are the `overlay' and the `underlay' techniques.
Objectives: To compare two methods of tympanic membrane (TM) grafting when graft materials medial (group A)
or lateral (group B) to malleus.
Materials and Methods: This prospective study was carried out on thirty patients (30) from May 2017 to August
2018. All operations were done at Hearing and Speech Institute. They were divided into two groups; the first one
(group A): included 15 patients treated by grafting with temporalis fascia medial to handle of malleus. The second
one (group B): included 15 patients treated by grafting with temporalis fascia lateral to it. Patients with obvious
ossicular dysfunction or external ear pathology were excluded from the study. Patients with ear discharge were initially
treated conservatively and were included in the study when their ear became dry for at least 3monthes. Any patient
requiring ossiculoplasty was subsequently excluded from the study. Diagnosis of the disease was established by
clinical, otoscopic, endoscopic and microscopic examination. All patients examined and tested by audiometry 3 month
after surgery. Success of surgery is defined as complete repair of TM, without lateralization, atelectasis or retraction
Results: 83.33 % was total graft success. 86.7% with (group A) underlay technique comparing this with 80.0% with
(group B) over-underlay technique. Differences of air-bone gap in each group before and after surgery was 33.42
±3.71 dB in Group A, and 22.30 ± 5.56 dB in Group B. Improvement of hearing level was not significant between the
two surgical methods.
Conclusions: Both techniques (medial and lateral to malleus handle) of TM grafting are effective with success rates
86.7% and 80.0% respectively.
Keywords: Chronic otitis media, Tympanoplasty, Tympanic membrane perforation.
Tympanoplasty is a surgical method, to eradicate
Evaluation of hearing outcome and healing of
middle ear infection and improve its function (1). The two
temporalis fascia graft in underlay procedure
most common techniques for positioning the graft
tymanoplasty by placing the graft medial (underlay
relative to the remnant of both the tympanic membrane
technique) or lateral to the handle of malleus (over-
and the tympanic annulus are the `overlay' and the
underlay technique) in patients with dry central
`underlay' techniques (2).
The underlay technique is perhaps more commonly
used worldwide. This technique is easier to perform and
MATERIALS AND METHODS
less time consuming. In this technique, the graft is placed
A randomised prospective study was conducted for
medial to the entire TM remnant and also to the malleus
thirty patients (30) from May 2017 to August 2018. All
handle and is more suitable for posterior perforations (3).
operations were done at Hearing and Speech Institute.
In the overlay technique, after the elevation of squamous
They were divided into two groups; the first (group A)
tissue, the graft is positioned lateral to the annulus and
included 15 patients treated by grafting with temporalis
fibrotic layer of the TM residue (4).
fascia medial to handle of malleus. The second (group B)
A new technique that has evolved from the two
included 15 patients treated by grafting with temporalis
classical techniques of overlay and underlay and aimed
fascia lateral to it. The two groups were followed up for
at eliminating the disadvantages of these techniques is
3 months post operatively. The preoperative and
over-underlay myringoplasty. In this technique, graft is
postoperative air bone (AB) gaps in both groups were
placed lateral (over) the handle of maleus but medial
compared. The success of surgery was defined as
(under) the tympanic membrane remnant and annulus (5).
complete repair of tympanic membrane perforation
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2245-2253
Early Detection of Gestational Diabetes Mellitus (GDM) by Measuring
Maternal Serum Uric Acid in the First Trimester of Pregnancy
Ali El- Shabrawy Ali, Hend Salah Abdo, Ahmed El- Sayed Mansour and Marwah Fathy Abdalla
Department of Obstetrics and Gynecology, Faculty of Medicine - Zagazig University
*Corresponding author: Marwah Fathy Abdalla; Mobile: 01003967044; E-mail: firstname.lastname@example.org
Background: Gestational diabetes mellitus (GDM) is a common condition with risks for mother and baby.
Type 2 diabetes mellitus (T2DM) and obesity are occurring with increasing frequency, and the incidence of
GDM reflects this trend.
Objective: The aim of the study was to determine the relationship between first trimester elevated uric acid levels
and subsequent development of gestational diabetes mellitus during pregnancy.
Patients and Methods: The study included 78 pregnant women in the first trimester attending the outpatient
clinic of Zagazig University Hospitals, Zagazig for antenatal care. In this study, patients were classified according
to their serum uric acid level into 3 groups.
Results: Women's GDM in group (I) showed that 3 (11.5%) were normal, 16 (61.5%) their fasting blood sugar
levels (FBS) were high in 2nd trimester and 7 (26.9%) their FBS were high in both 2nd and 3rd trimesters while in
group (II) 1 (3.8%) were normal, 9 (34.6%) their FBS were high in 2nd trimester and 16 (61.5%) their FBS were
high in both 2nd and 3rd trimesters and in group (III) 1 (3.8%) was normal, 5 (19.2%) their FBS were high in 2nd
trimester and 20 (76.9%) their FBS were high in both 2nd and 3rd trimesters. There was statistically significant
differences between groups where P=0.007.
Conclusion: First trimester serum uric acid levels are associated with subsequent development of IGT and GDM.
The test has good predictive value for the diagnosis of GDM and it can be used in a risk assessment model.
Keywords: Gestational Diabetes Mellitus, Uric Acid, First Trimester of Pregnancy
After birth, the infant is no longer exposed
Gestational diabetes mellitus (GDM) is a
to the maternal source of glucose yet still has
common condition with risks for mother and baby.
elevated circulating insulin levels, leading to
Type 2 diabetes mellitus (T2DM) and obesity are
hypoglycemia in the early neonatal period. Neonatal
occurring with increasing frequency, and the
hypoglycemia must be addressed rapidly to
incidence of GDM reflects this trend. Further, new
minimize the risk of serious adverse consequences
diagnostic criteria have greatly increased the
such as seizures, brain injury, and long-term
prevalence of GDM. Potential lifelong consequences
neurodevelopmental impairment. Other adverse
exist for mother and baby if the condition goes
hypocalcemia, both of which may require close
management can ameliorate adverse maternal and
monitoring in the NICU (5).
fetal effects (1).
Additionally, the hyperglycemic intrauterine
Pregnancies affected by GDM pose a risk
environment predisposes the fetus to early onset
for adversities such as the need for Caesarean
diabetes, in adolescence or early adulthood, even in
sections due to fetal macrosomia. Macrosomia
populations with a relatively low incidence of
occurs because of accelerated fetal growth fueled by
T2DM. T2DM is a metabolic disease that is
maternal hyperglycemia. In approximately 95% of
characterized by dysfunction in insulin secretion,
GDM cases, maternal glucose metabolism returns to
insulin action, or both. This dysfunction leads to
normal after delivery of the baby, however, an
chronic insulin resistance and resulting chronic
association between GDM and the development of
hyperglycemia. Typically, T2DM has an onset in
diabetes mellitus in the mother later in life exists. In
adulthood however, with increasing prevalence of
addition, research into the long-term effects of poor
risk factors; early onset T2DM is becoming more
maternal glucose metabolism on the fetus has
revealed that offspring born to mothers with GDM
The maternal consequences of GDM include
are susceptible to impaired glucose tolerance (IGT)
preeclampsia and cesarean section in the short term
and obesity. With these associations in mind, it
and increased risk of T2DM in the long term. If
would be important to identify pregnant women at
GDM remains untreated, mothers are at a higher risk
risk for GDM so that prevention management such
of preeclampsia and cesarean section. While GDM
as lifestyle modifications can be implemented (2-4).
itself is not an indication for cesarean section, the
Hypoglycemia in the neonatal period is
complications associated with GDM, such as
another adverse effect of fetal hyperinsulinemia.
preeclampsia and macrosomia, may be an indication
for cesarean section (C-section). If the mother is
diagnosed with preeclampsia that necessitates early
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2254-2260
Histological and Histochemical Alterations Induced in Rats Fetal
Esophageal Tissue Intoxicated Maternally with Carisoprodol
Mervat Ahmed Abd Rabou
Biology Department, College of Science, Jouf University, P.O. Box 2014, Sakaka, Saudi Arabia
Background: skeletal muscle relaxants are a varied set of drugs which treat pain of muscles or shudders from
marginal musculoskeletal circumstances. Aim of the work: this work targeted to detect the histopathological and
histochemical alternations in the rats fetal esophageal treated maternally with Carisoprodol (Soma). Material and
methods: thirty gravid rats were branded into three sets: 1-Rats of the 1st group served as the control group and
they were administered oral doses of distilled water, 2- Group of 10 pregnant rats served as the 2nd group and they
were treated daily with 10.8 mg/100g/day b.wt. of Carisoprodol, 3-In group 3 pregnant rats were treated with 21.6
mg/100g body weight/day of Carisoprodol (treatment started from the 6th till the 20th day of gestation). Pregnant
mothers were sacrificed and small sections of fetal rat esophagus were taken for the histopathological and
histochemical purposes. Results: numerous histopathlogical and histochemical changes were detected in the fetal
esophageal tissue of the two treated groups compared to the control group and the alternations were amplified with
raising the doses of carisoprodol. Conclusion: treatment of the pregnant rats with carisoprodol caused dystrophic
variations in the fetal esophageal tissue, so the usage of this medicine during gestation should be under strict
Keywords: Carisoprodol, fetuses, pregnant rats, esophagus, histopathology and histochemistry.
belongings of alcohol, avoid unease during cocaine
Skeletal muscle relaxants contain a diverse
feeding and assistance quiet persons) . The cruelty
mixture of proxies with different buildings and
of carisoprodol has amplified intensely in previous
instrument of achievement. These proxies are
years. In certain patients who shortly stop
categorized as antispasticity or antispasmodic proxies;
carisoprodol consumption, a withdrawal disease
one of them is carisoprodol drug . Carisoprodol is
happens. It appeared as seen with meprobamate
considered well than palliative and the dose which
withdrawal, signifying that they outcome from
correspondence in efficiency actions is 350 mg and
withdrawal from meprobamate collected with
250 mg. About less than one percent of patients who
consumption of extreme carisoprodol and it is
were treated with 250 mg dose of Soma informed
accomplished of moderating GABAA purpose, which
sleepiness and no patient finished the medicine due to
may give to its abuse potential . In addition,
sleepiness . It is essentially acts as skeletal muscle
relaxant and it is thought to slab interneuron action by
cardiovascular functios (postural hypotension
stimulating GABA-A receptors in descendent
tachycardia and facial flushing) and gastrointestinal
reticular creation and spinal rope . This medicine has
tract (vomiting, nausea, hiccup and epigastric distress)
been increasingly harmed
because of its
. Esophagus is the first part of the alimentary
meprobamate, exact substance that products
canal that connects the laryngeal portion of the
tranquility through GABAA receptors .
pharynx and the stomach. It lies ventral to the ventral
In Norway, Carisoprodol was detached from
cervical muscles and dorsal to the trachea. It is a
shops in one May 2008, but it might still use by certain
highly specialized organ designed for transporting the
patients. It was branded from organized matter in
food from the mouth to the stomach. Because of its
numerous US states, then it energetic on 11 January
position in the gastrointestinal tract it may be exposed
2012 . It is extensively recycled in main care
to a variety of noxious stimuli . Skeletal muscle
locations. The drug is found in markets by a diversity
relaxants characterize a varied pharmacotherapeutic
names (Soma, Sodol, Somalgit, Vanadam, Sonoma,
group of drugs across several chemical modules that
Scutamil, Carisoma, Somacid, Mio Relax, Relacton-
are physically dissimilar and these effective for
C, Relaxibys, Rela and Soridol) . Soma is a neutral
spasticity and skeletal muscle contractions. This work
crystalline powder with white color and it is a
aimed to determine the toxicity belongings of the oral
chemical derivative of meprobamate with an aliphatic
treatment of Somadril (Carisoprodol) on the fetal rat
dicarbamate. It is soluble in many organic diluents,
esophageal tissue of albino rats.
insoluble in vegetable oils, but soluble in water . In
the United States, carisoprodol is considered as the
MATERIAL and METHODS
second greatest commonly set of muscle relaxant in
2000 . Carisoprodol is used to increase or change
Albino rats, male and female were used in the
belongings of other drugs (e.g. to rise pain killing
present work (150- 200 g). Before experiment animals
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2261-2271
Hepato-Renal Toxicity of Titanium Dioxide Nanoparticles and The Protective
Effects of Moringa Oleifera Leaves Extract and Vitamin E in Male Albino Rats
Doaa S. A. El-behairy1, Nayera H. Diaa Eldin1, Entsar E. Elbadry1,
Amira A. Mohamed2 and Islam M. Farrag1
1 Forensic Medicine and Clinical Toxicology, Faculty of Medicine for Girls, Al-Azhar University,
Egypt,2Genetic and Cell Biology, National Research Centre, Dokki, Egypt
Corresponding Author: Doaa S. A. El-behairy, Tel.:01028330856, E-mail: email@example.com
Background: Titanium dioxide nanoparticles (TDN) one of the most common nanomaterial used in a wide range
of applications. Moringa oleifera leaves extract (MOLE) has hepato- and nephron-protective effects amongst
other medicinal and nutritional benefits. Vitamin E (Vit. E) is an important lipid soluble vitamin.
Aim: The present work aimed to study hepato-renal toxicity of TDN in adult male albino rats through
biochemical and histopathological study and protective effects of either MOLE or Vit. E or both.
Materials and Methods: 49 adult male albino rats were divided randomly into 7 groups (7 rats each). Group 1:
served as control, Group 2: Rats received (MOLE) once daily by oral gavage Group 3: Rats received (Vit. E)
once daily by oral gavage Group 4: Rats received TDN subcutaneous on alternate days Group 5: Rats co-
administrated TDN and MOLE Group 6: Rats co-administrated TDN and (Vit. E), Group 7: Rats co-
administrated TDN, (MOLE) and vitamin E. All groups received the treatment for four weeks, then blood
samples were collected for assessment of liver function markers and kidney function markers. Also, Liver and
kidney were excised for histopathological examination.
Results and Conclusion: TDN treated animals recorded a significant increase in ALT, AST. ALP, total
bilirubin, urea and creatinine and a significant decrease in total protein. Significant improvement occurred on
co-administration of either (MOLE) or (Vit.E) or both. Histopathological lesion in both liver and kidney which
were observed in TDN treated animals improved on co-administration of either (MOLE) or (Vit. E) or both.
Keywords: TDN, Moringa oleifera leaves extract, vitamin E, hepatotoxicity and nephrotoxicity.
Medicinal plants are known to exhibit their
Nanoparticles can be defined as objects
antioxidative effects by scavenging the reactive
ranging in size from one to one hundred nanometers
oxygen species (ROS) and modulating the
and used for many purposes such as in medicine,
antioxidant defence mechanisms, which are capable
various branches of industry production such as
to generating reactive oxygen species (ROS)
solar and oxide fuel batteries for energy storage, to
including oxidative stress and DNA damage (3).
wide incorporation into diverse materials of
Medicinal plants are known to exhibit their
everyday use such as cosmetics(1).
antioxidative effects by scavenging the reactive
Titanium dioxide nanoparticles (TDN)
oxygen species (ROS) and modulating the
one of the most widely manufactured nanoparticles
antioxidant defence mechanisms. The world market
on a global scale, depending on its excellent
for alternative medicine is being increased. The
physicochemical properties. They are one of
global market for plant derived medicine alone has
nanoparticles used in industry as well as in
reached $5 trillion and is increasing at a rate of
consumer products, account for over 70% of the
about 11% per annum. This rapid growth in the
total production volume of nanoparticles
market of the herbal/alternative medicines indicates
worldwide. They are white pigment and used for
its acceptance and popularity worldwide (4).
its brightness and very high refractive index. It has
Moringa oleifera is plant, known in the
unique characters such as small size, large surface
tropical and subtropical countries(5). A variety of
area and high reactivity that allow themto enter
benefits have been attributed to the leaf extract of
quickly to the human body and produce potential
Moringa including anticancer, anti-inflammatory,
health risk on human (2). TDN have two major forms
of crystal structures, named rutile and anatase. Both
are toxic but the anatase form may produce much
more toxic than rutile nanoparticles because of the
Vitamins are good antioxidants protect the
photo catalytic properties of anatase and these
tissue from oxidative stress. vitamin E consists of
particles are usually associated with oxidizing
eight natural fat soluble compounds, including 4
mechanisms of an organism, which is capable to
tocopherols [alpha, beta, gamma and delta
generating reactive oxygen species (ROS)
tocopherol] and 4 tocotrienols [alpha, beta, gamma
including oxidative stress and DNA damage (3).
and delta tocotrienol](7).
RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2276-2284
Role of Kidney Injury Molecule-1 and 2-Microglobulin in Early
Diagnosis of Diabetic Nephropathy
Glonar Otiefy Ahmed, Amal Abdel Aleem Morsy and Samah Roshdy Abo El Eneen Abo El Eneen *
Clinical and Chemical Pathology Department, Faculty of Medicine, Al-Azhar University
*Corresponding Author: Samah Roshdy Abo El Eneen Abo El Eneen, Phone No.: (+2) : 01090600157
Background: Diabetes mellitus has been described as a metabolic disorder of multiple etiology characterized by chronic
hyperglycemia with disturbances of carbohydrate metabolism. Diabetic nephropathy is typically characterized by a
gradual increase in urinary albumin excretion. Albuminuria, a marker of glomerular involvement in early renal damage,
cannot always detect early diabetic nephropathy (DN).
Aim of the Work: Is to determine the suggested promising diagnostic role of kidney injury molecule-1 (KIM-1)
level and 2 microglobulin and how could improve the early diagnosis, predict disease progression and deliver new
insights in pathogenic of diabetic nephropathy.
Subjects and Methods: this study included 80 subjects. Group I: sixty (60) patients with T2DM classified into 3
subgroups according to the level of albumin/creatinine ratio (ACR). Thirty (30) diabetic patients with
normoalbuminuria (1a), 20 diabetic patients with microalbuminuria (1b) and 10 diabetic patient with
macroalbuminuria (1c). Group II: Twenty, age and sex matched, apparently healthy individuals serving as a control
group. Results: Our results revealed a statistical significant increase in FBS, blood urea, as well as
microalbuminuria with GFR decline in patients group when compared to control group. However, serum levels of
creatinine were only significantly elevated in diabetic patients with ACR 300 mg/g when compared to control
group. The results revealed a highly statistically significant increase in urinary KIM and 2 microglobulin levels in
micro than normo and in macro than micro albuminuric group.
Conclusion: Our data revealed that tubular biomarkers were increased in T2DM patients with normoalbuminuria
when compared with controls.
Keywords: Kidney Injury Molecule-1 - 2-Microglobulin - Diabetic Nephropathy.
damage, cannot always detect early DN. Thus, more
Diabetes mellitus (DM) has been described as
sensitive and specific markers in addition to
a metabolic disorder of multiple pathogens
albuminuria are needed to predict the early onset and
characterized by chronic hypoglycemia with metabolic
progression of DN (5).
disorders of carbohydrates caused by insulin secretion
Significant efforts have been made to identify
defects, insulin action or both. Type 2 diabetes
serum or urine biomarkers which can be clinically
includes individuals with insulin resistance (IR) and
detected in early stages of DN and progressive kidney
usually insulin (and not absolute) deficiency (1).
function decline in diabetic patients. The research
Diabetic nephropathy is a chronic condition that
community is focusing on a different strategy to
develops over many years and is characterized by a
enhance the sensitivity of biomarkers to predict
gradual increase in urinary albumin secretion. DN is
patients who will develop DN or are at risk of
one of the severe complications that occur in diabetics
progressing to ESRD (6).
and is associated with an increased risk of death from
Kidney injury molecule-1 (KIM-1), a
all causes, cardiovascular disease and progression to
discovered transmembrane tubular protein, is markedly
end stage renal disease (ESRD), requiring costly renal
induced in renal injury including acute kidney injury
replacement therapy in the form of dialysis or
(AKI) and chronic kidney disease (CKD). There are
many characteristics of KIM-1 making it an ideal
There is a preclinical stage of diabetic
biomarker for kidney injury. For example, KIM-1 is
nephropathy, characterized by urinary albumin
not expressed in normal kidney but specifically
excretion rate that are not detectable by standard
expressed in injured proximal tubular cells, and such
laboratory methods unless it is in excess of 300
an expression can persist until the damaged cells have
mg/day; that is distinctly abnormal. The range (30-
completely recovered (7).
300) mg/day has been referred to as microalbuminuria
Beta 2 microglobulin is a low molecular
and is the first laboratory evidence of diabetic renal
weight protein that is released at a constant rate and is
filtered by the glomerulus, absorbed and hardened by
In clinical practice, most commonly used
ductile tubes. Therefore, it is theoretically considered
markers of renal disease and progression of DN are
an appropriate biomarker for kidney weakness. In fact,
serum creatinine, estimated glomerular filtration rate,
tubular involvement may precede glomerular
and proteinuria or albuminuria(4). Albuminuria, a
involvement because many of these proteins and
marker of glomerular involvement in early renal
tubular enzymes can be detected even before the
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2285-2289
Common Errors in Diagnosis and Treatment of Pediatric Epilepsy
Hosny Mohammad Ahmed El-Masry, Mohammad Abo AlWafa Al-Adawy,
Mohammad Sayed Ali Mohammad*
Pediatrics Department, Faculty of Medicine, Al-Azhar University, Assiut
* Corresponding author: Mohammad Sayed Ali Mohammad; Mobile: (+20) 01007628090
Background: epilepsy affects people in all nations and of all races. Its incidence is greater in African
American and socially disadvantaged populations. Epilepsy is the most commonly encountered neurologic
conditions in children.
Aim of the Work: learning from one's mistakes is the best learning tool in medicine and this applies as well to
epilepsy, so the aim of our work is to review some of the most frequently identified mistakes and errors in the
diagnosis and treatment of pediatric epilepsy and how to avoid their occurrence.
Patients and Methods: the study included fifty children with epilepsy and condition mimic epilepsy, aged less
than fifteen years (35 males and 15 females). The children participating in the present study were selected
randomly from patients attending the pediatric neurology outpatient clinic of Al-Azhar University Hospital.
The present work was conducted from January 2018 till the end of September 2018.
Results: in the present study it was found that 70 % of the studied patients are males and 30 % females. 76%
of our patients were coming from rural areas, and only 24% living in urban. In this study we found that 34 %
of our patients are wrongly diagnosed as Epilepsy. The study showed that 27% of epileptic cases are not
controlled mostly due to improper selection of drug in 55.6 % and 44.4 % due to improper dose.
Conclusion: In fact, in patients with epilepsy, a detailed history is likely to lead to an accurate diagnosis in up
to 90% of patients.
Keywords: Diagnosis, Treatment of Pediatric Epilepsy.
mean time lapse between the first attack and the
Epilepsy affects people in all nations and all
correct diagnosis of non-epileptic seizures was over
races. The incidence rate is greater in African
9 years (7).
Americans and socially disadvantaged populations
NEPEs are common and are numerous
episodic clinical manifestations of diverse
Epilepsy is the most common neurological
etiologies that mimic or look like, but are not,
condition in children. Incidence rates among
epileptic seizures (8).
children under the age of 11 years are about seven
Failure to get a good and detailed history is
to eight cases per 1000 cases per year (2). The
the most frequent cause of diagnostic errors in any
prevalence rate in childhood is estimated at 0.05-
of the medical fields, and epilepsy is not an
exception. In fact, in patients with epilepsy, a
Shawki in the study reported a prevalence
detailed history is likely to lead to an accurate
rate of 3.5/1000 among primary school children
diagnosis in up to 90% of patients. In such cases,
while Shawki (4) reported a prevalence of 20/1000
auxiliary studies help to confirm the clinically
in the age group 6-12 years in Assiut Governorate.
based diagnostic formulation. In the evaluation of
The prevalence of epilepsy in primary school
patients with a presumed diagnosis of epilepsy, the
children in El-Minia City in Egypt was 7.2/1000 in
first task is to establish whether the paroxysmal
conventional schools and 133.3/1000 in school for
episode under investigation is, in fact, epileptic or
subnormal. Male: Female ratio was 2:1. Prevalence
nonepileptic. If the clinical characteristics of the
event are suggestive of an epileptic seizure, the next
socioeconomic class. Neonatal insult, febrile
step is to establish the type of seizure and epileptic
convulsions, consanguineous marriage in parents
syndrome, and whether the seizure in question was
and family history of epilepsy were the commonest
the first epileptic seizure ever, including seizures of
perinatal risk factors (5). Nonepileptic paroxysmal
other types that have gone unrecognized by the
events (NEPEs) that have been misdiagnosed as
patient or family (9).
epileptic seizures affect as many as 2030% of
If the event is suspected to be nonepileptic,
patients diagnosed with epilepsy; these patients
it is necessary to establish if it may be organic (i.e.,
have often received treatment for epilepsy for many
syncope, sleep disorder, movement disorder, etc.)
years or have been admitted to tertiary care epilepsy
or psychogenic. The misdiagnosis of nonepileptic
units (6). The problem is complicated by the fact that
events as epileptic seizures is a relatively frequent
approximately 30% of patients with genuine
occurrence. Indeed, 1 of 4 to 5 patients admitted to
epileptic seizures also suffer from non-epileptic,
a video-electroencephalogram (EEG) monitoring
mainly psychogenic seizures. In one study, the
unit with a diagnosis of pharmacoresistant epilepsy
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2290-2297
Comparative Study between Conventional and Custom Lasik
Ablation in The Treatment of Myopic Astigmatism
Mohamed El Moddather Ahmed Dardyr*, Ibrahim Mohammed Ahmed, Mohamed Abd Elaal Mohamed
Ophthalmology Department, Faculty of Medicine, Al-Azhar University (Assuit), Egypt
*Corresponding author: Mohamed El Moddather Ahmed Dardyr, E-Mail: firstname.lastname@example.org
Background: The popularity of laser-assisted in situ keratomileusis (LASIK) stems from its ability to treat a wide
range of refractive errors with rapid visual recovery and minimal patient discomfort. The conventional treatment is a
Munnerlyn based spherocylindrical ablation, Customized Ablation is a topography and wavefront guided ablation
treating corneal high-order aberrations
Objective: to evaluate the visual and refractive outcomes of customized ablation and conventional ablation in the
treatment of myopic astigmatism.
Patients and Methods: This randomized prospective comparative study was carried out on 60 eyes of 34 patients with
compound myopic astigmatism (myopic sphere -10.0 D and myopic cylinder - 4.0D) with age range between 18
and 50 years at Al-Azhar University Hospital, Assuit and Al-Nahar Eye Centre, Assuit, between April 2018 and October
2018. These patients were divided into two groups: Group (1) included 30 eyes of 18 patients who had Standard LASIK
ablation. Group (2) included 30 eyes of 16 patients who had WFG (Custom) LASIK ablation.
Results: Regarding the refractive safety, both procedures were highly safe (all the patients maintained the preoperative
BSCVA in the 6th month). It was obvious that the WFG LASIK was superior to the conventional LASIK in the visual
outcome and this can be approved by applying the efficacy index for the procedures (mean postoperative UCVA/mean
preoperative BSCVA), and it was 1.14 in the custom group and 0.97 in the conventional group in the 1st month.
Improving the visual acuity after custom LASIK, in spite of similar refractive results (predictability) indicates that not
only the defocus, but also the high order aberrations affect the final visual acuity level.
Conclusion: the two procedures have high degree of safety, refractive stability and predictability but the custom LASIK
is superior to the conventional LASIK.
Keywords: Myopic astigmatism, Custom LASIK, Conventional LASIK, Visual quality, High order aberrations.
Corneal refractive surgery is based on the
of vision deteriorated, especially under mesopic and low-
change in corneal curvature to compensate for refractive
contrast conditions secondary to induced high-order
errors of the eye. After many mechanical approaches,
such as radial keratotomy, keratomileusis, and
astigmatic keratotomies, ablative procedures using the
PATIENTS AND METHODS
excimer laser have become the most successful
This study is randomized prospective comparative study.
technique. It was mainly the submicron precision and the
Ethical considerations: The study protocol and all
high repeatability of the ablation of the cornea
procedures performed involving human participants
accompanied by minimal side effects that guaranteed
were in accordance with the ethical standards of the
this success (1).
Faculty of Medicine, Al-Azhar University, Assuit,
More than 20 years have passed since the first
Egypt. Informed consent was obtained from each patient
excimer laser treatment for the correction of a refractive
before the enrollment in the study and Al-Azhar
error was performed. The procedure was done in a
University, Assiut Institutional Ethics Committee
myopic patient. Today, although demographic data show
approval was obtained.
there are more hyperopes than myopes, most treatments
The current study was randomized prospective
are myopic or myopic-astigmatic corrections. The
comparative study carried on 60 eyes of 34 patients with
classic laser algorithms are based on Munnerlyn's
compound myopic astigmatism (myopic sphere -10.0
formula for calculating a laser profile and removing a
D and myopic cylinder -4.0D) of 34 patients with age
convexconcave tissue lenticules with spherocylindrical
range between 18 and 50 years presented to Al-Azhar
surfaces (2). Although these algorithms proved to be
University Hospital, Assiut and Al-Nahar Eye Centre,
effective to compensate for refractive error, the quality
Assuit, between April 2018 and October 2018. The
patients were divided into two groups: Group (1) patients
in this group had Standard LASIK ablation and Group
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2298-2304
Recent Trends in Management of Perianal Fistula
Ismaeil Abd- Almaguid Alkhawaga, Mohamed Hasan Elkaseer,
Ahmed Abdul Hameid Abozeid and Mostafa Sayed Mohamed
Department of General Surgery, Faculty of Medicine - Al Azhar University
*Corresponding author: Mostafa Sayed Mohamed, E-mail: mostafasayeddiab, Mobile: (+20)01203711361
Background: Perianal fistula is a tract lined by infected granulation tissue that connects anal canal or rectum to the
skin around anus. Its wall is made of inflammatory granulation as well as fibrous tissue. Perianal fistulae occur in
approximately 10 out of 10,000 persons. Objective: The aim was to discuss the classification, diagnosis and
management of perianal fistula with special emphasis on most recent trends.
Patients and methods: The study was carried out on 50 Egyptian patients suffering from perianal fistula. Patients
were managed in Sayed Galal University Hospital. The study was controlled prospectively. Ethical approval from
the local Ethics Committee of Surgery Department was obtained. The patients were divided into two groups group
A diagnosed by endoanal U\S and B by MRI fistulogram.
Results: The current results on difference between Seton operation and other types. Regarding surgical data, there
was localization of the internal opening occurred in 60% of patients operated with Seton technique. Among those
operated with Seton technique, 80% had no complications, while recurrence occurred in 13.3%.
Conclusion: In this study, seton technique was the best surgical technique in management of perianal fistula with
less post-operative complication than other techniques.
Keywords: Management, Perianal Fistula, Seton, MRI.
Fistula in ano is defined as abnormal
location of the internal and external openings and the
communication, lined granulation tissue between the
course of the fistula (5). The treatment of fistula has
anal canal and the exterior i.e. the skin, which causes a
remained a challenging job for the surgeons. Different
chronic inflammatory response. Most commonly these
surgical techniques have been described in the
fistulae develop following an anal abscess, due to
literature. These included fistulectomy, fistulotomy,
inadequate drainage or a spontaneous rupture of the
insertion of seton, two staged fistulectomy,
abscess. Tuberculosis, inflammatory bowel diseases
advancement mucosal flaps, repair of fistula using fibrin
such as Crohn's disease and ulcerative colitis, and
adhesive glue and rerouting the fistula (6).
chronic anal fissure can also lead to development of anal
AIM OF THE WORK
Parks (2) developed a classification system in
The aim was to discuss the classification, diagnosis
which fistulae are divided into intersphincteric fistula,
and management of perianal fistula with special
transsphincteric fistula, suprasphincteric fistula and
emphasis on most recent trends.
extrasphincteric fistula. However, the type of treatment
depends not on the location of fistula tract but on the
PATIENTS AND METHODS
level of the internal opening in the anal canal (2).
Patients: The study was carried out on 50 Egyptian
The role of pre-operative imaging is to
patients suffering from perianal fistula. Patients were
demonstrate clinically undetected sepsis, to serve as a
managed in Sayed Galal University Hospital. The study
guide at the time of the initial surgery, to determine the
was controlled prospectively. Ethical approval from
relationship of the fistula tract to the sphincter
the local Ethics Committee of Surgery Department
mechanism and to reveal the site of sepsis in a recurrent
fistula, all serving to decrease recurrence rates
associated with fistula surgery. Imaging may take the
form of fistulography, endoanal ultrasound, and Patients aged 18 years to 60 years old males and
magnetic resonance imaging (MRI) (3). Magnetic
females. Diagnosis of intersphincteric, transsphincteric,
resonance imaging (MRI) describes infectious foci in
suprasphincteric and extrasphincteric fistula.
the perianal region better than any other investigation Patients sable to comply with the study protocol.
modality and allowing the characterization and Signed and dated informed consent by the patient.
classification of the fistula based on its relation with the Absence of any exclusive criteria.
pelvic diaphragm and the anal sphincter (4).
The goal of treatment of fistula in ano is
eradication of sepsis without sacrificing continence
because fistulous tracks encircle variable amounts of the
Patients below age 18 years old and above 60 years old.
sphincter complex. Surgical treatment is dictated by the Patients with known abdominal malignancies.
SOME OF OCCUPATIONAL HEALTH PROBLEMS
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2305-2311
Placental Thickness in First Trimester (11-14) Weeks and Correlation with
Preeclampsia and Intrauterine Growth Retardation
Samir Abdalla, Tamer Fares & Mohamed Ali Eisa Mohamed
Department of Obstetrics & Gynecology, Faculty of Medicine - Al Azhar University
*Corresponding author: Mohamed Ali Eisa Mohamed, E-mail: email@example.com, Mobile: (+20)01212119605
Background: First trimester trophoblastic invasion has far-reaching consequences for the fetus; failure at this
stage may result in fetal growth restriction with morbidity both in the immediate perinatal period, as well as
throughout development into adulthood.
Objective: The aim of this study was to estimate the placental thickness in first trimester (11-14) weeks and
investigating the correlation with preeclampsia and intrauterine growth retardation. Patients and methods: This
prospective cross-sectional study was conducted at Al-Azhar University Hospital. The study included 50 patients.
Results: There was a significant increase in the maximal placental thickness (PT) to placental volume ratio in
growth restricted fetuses in our study. This may be a reflection of reduction in placental surface area. Further work
is required to confirm this finding using more accurate stereological analysis of the placenta in utero. In this study,
the MRI appearance of suspected retroplacental haemorrhage, placental infarct, and subchorionic haemorrhage
was confirmed by placental histology in 100%, 100%, and 33% of cases respectively.
Conclusion: From our study, it can be concluded that PT can be used as a predictor of the GA, in the women in
whom the LMP is unreliable or is not known.
Keywords: Placental thickness, first trimester, preeclampsia, intrauterine growth retardation.
Fetal MRI is now established as an adjunct to
First trimester trophoblastic invasion has far-
ultrasonography in the diagnosis of fetal
reaching consequences for the fetus. Failure at this
abnormalities. MRI assessment of the placenta was
stage may result in fetal growth restriction with
first used in cases of suspected placenta praevia. Its
morbidity both in the immediate perinatal period, as
role has expanded and now ranges from the
well as throughout development into adulthood.
assessment of placental invasion in cases of
Pregnancies complicated by fetal growth restriction
suspected placenta accreta/increta/percreta in the
are characterised by shallow invasion of the
clinical setting to studies on spectroscopy and
trophoblast into maternal tissue, and inadequate
perfusion of the placenta in the research setting (5).
conversion of the spiral arterioles, leading to
placental ischemia (1).
AIM OF THE WORK
The aim of this study was to estimate the
malperfused placentae demonstrated a thickened,
placental thickness in first trimester (11-14) weeks
globular placenta with gross areas of infarct and
and investigating the correlation with preeclampsia
abruption, as well as microscopic evidence of
and intrauterine growth retardation.
chronic inflammation and villitis (2).
This increases uteroplacental impedance in
PATIENTS AND METHODS
both the fetal and maternal compartment was
This study was conducted at Al-Azhar
evidenced by an increase in the Doppler
University Hospital. The study included 50 patients.
velocimetry of the umbilical and the uterine arteries
respectively on ultrasonography (1).
1. Primary gravida "Para 0 +0 PG".
Growth restricted fetuses are at increased risk
2. Singleton pregnancies, 11-14 weeks.
of perinatal demise and neonatal complications such
3. Known last menstrual period.
as intraventricular haemorrhage, periventricular
4. A history of regular menstruation.
leucomalacia, respiratory distress syndrome, and
necrotising enterocolitis (3).
1. Maternal Disease
Ultrasound assessment of the placenta
a. Gestational Diabetes.
typically includes an assessment of placental
b. Hypertension (Systemic hypertension and
location and maturity, and the presence of placental
Pregnancy induced hypertension).
haemorrhage or intervillous lakes. Although
volumetric assessment of the placenta may be
performed using 3D ultrasound in the first trimester,
3. The presence of in utero infection.
it becomes increasingly difficult to perform as
4. The presence of additional structural
gestation progresses due to limitations in the field of
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2312-2318
Comparison Between Intravitreal Ranibizumab Injection, Corticosteroid
Implants and Intravitreal Triamcinolone Acetonide injection In
Treatment of Noninfectious Uveitic Macular Edema
Ahmed N. Elsayed
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Background: Uveitis is a broad term for inflammation involving the eye. It is classified according to the location of
the inflammatory process either anterior, intermediate, posterior or panuveitis. Uveitis can be secondary to an
infectious etiology, such as tuberculosis, toxocara canis, toxoplasmosis, herpes virus, Lyme, and syphilis.
Purpose: comparing the efficacy and safety of intravitreal ranibizumab injection, corticosteroid implants and
Intravitreal triamcinolone acetonide (IVTA) injection in treatment of noninfectious uveitic macular edema.
Patients and Methods: A prospective study was conducted in Al-Azhar University Hospitals (El-Hussein and Bab-
Elsheryia Hospitals). A total of 60 eyes of 45 uveitic patients were recruited in this study. First group; 20 eyes
undergo intravitreally injection with ranibizumab 0.5 mg (0.05 ml), one dose per month (six doses). Second group;
20 eyes undergo corticosteroid implants. Third group 20 eyes undergo IVTA injection.
Results: All patients included in this study completed the period of follow up (six months) in group 1 Visual acuity
(VA) improved and central macular thickness (CMT) decreased slightly but not significantly after 1 month to 1.35
± 0.25 and 365.3 ±185.5M, respectively. In group 2; VA improved and CMT decreased after 1 month to 1.75 ± 0.2
and 470.45 ± 175.20M, respectively. In group 3; VA improved and CMT decreased slightly after 1 month to 2.15
± 0.22 and 460.45 ± 185.45M, respectively, an increase of intra ocular pressure (IOP) between 6 mmHg and 15
mmHg was maintained in 16 of 20 eyes (80%) at 1 months and was maintained in 4 of 20 eyes at 3 months (20%).
Conclusion: Intravitreal injection can be used as a single therapy to treat uveitic ME secondary to noninfectious
uveitis. With a variety of intravitreal therapeutic agents available for treatment of uveitic ME in this study
(Intravitreal ranibizumab injection, corticosteroid implants and IVTA) and each drug having its own advantages and
disadvantages, the final treatment should be individualized based on the severity of disease, risk /benefit ratio of
each therapy and choice of the patient.
Keywords: Ranibizumab, Dexamethasone, IVTA, uveitic macular oedema.
Uveitis is a broad term for inflammation
Cystoid ME (CME) may progressively damage
involving the eye. It is classified according to the location
the macular photoreceptors and may lead to
of the inflammatory process either anterior, intermediate,
complications such as macular ischemia, macular cyst, or
posterior or panuveitis (1). Uveitis can be secondary to an
hole formation resulting in nonreversible visual acuity
infectious etiology, such as tuberculosis, toxocara canis,
loss. Development of an epiretinal membrane is also a
toxoplasmosis, herpes virus, Lyme, and syphilis. Ocular
consequence of chronic macular edema. Thus it is
inflammation can also be associated with an underlying
important to treat macular edema early. Further chronic
systemic condition, including juvenile idiopathic arthritis
macular edema may become more difficult to treat.
(JIA), sarcoidosis, tubulointerstitial nephritis and uveitis
Refractory macular edema usually occurs in patients with
(TINU), inflammatory bowel disease, Vogt-Koyonagi-
chronic or recurrent uveitis (4).
Harada (VKH) and Bechet's disease frequently;
Corticosteroid remains the first-line therapy for
however, uveitis is not associated with an underlying
the management of uveitis. Corticosteroids are effective
condition and is termed "idiopathic" (2).
in treating ME due to its potent anti-inflammatory
Uveitis is one of the major causes of visual
properties by preventing leukocyte migration, stabilizing
morbidity, with a reported prevalence of 38714 cases
endothelial cell tight junctions which reduces cellular and
per 100,000. It is responsible for 10%15% blindness in
fluid extravasation, and also inhibiting synthesis of
the developed world. It predominantly affects the
younger population, and the consequent economic
prostaglandins, and proinflammatory cytokines (5).
blindness imposes a greater burden on society and
Triamcinolone acetonide (TA) is the most widely
used corticosteroid for the treatment of uveitic CME.
When TA injected intravitreally, it has a mean half-life
The Egyptian Journal of Hospital Medicine (April 2019) Vol. 75 (2), Page 2319-2324
Early results of Ceramic on Ceramic versus Ceramic on highly cross linked
polyethylene Total Hip Arthroplasty
Ahmed Mohamed Khairy, Adnan Abd El-Aleem El Sebaie, and Mohamed Abd El Monem Negm
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University
Corresponding author: Ahmed Mohamed Khairy, email: firstname.lastname@example.org, mobile: 00201119906630
Background: Nowadays, other bearing surfaces such as ceramic on highly cross-linked polyethylene (HXLPE)
and ceramic on ceramic have been proposed as an alternative to metal on polyethylene as a solution to osteolysis
and loosening. Purpose: it was to spot light on a comparison of early results of use two different bearing surfaces,
ceramic on ceramic versus ceramic on HXLPE in primary total hip replacement
Materials and Methods: this is a prospective comparative study which was conducted during the period from June
2016 to April 2019 with mean follow up two years. It included 38 patients (42 hips) which were undergone for total
hip replacement (THR) due to end stage arthritis. Of these, there were 22 ceramic on ceramic and 20 ceramic on
HXLPE implants. These cases were operated upon Al-Azhar University Hospitals (Al-Hussein & Bab El-Shaeria).
Results: No statistically significant difference in clinical and radiological outcomes scores between the two studied
groups with higher rate of implant related fracture and squeaking in ceramic on ceramic group.
Conclusions: there was no statistically significant difference in the clinical and radiological outcome between the
two studied groups at the time of last clinical follow-up. Long-term follow-up is required for further evaluation.
Keywords: ceramic on ceramic, total hip replacement, HXLPE.
The aim of new hip-bearing materials is to
HXLPE implants. The patients were operated upon Al-
extend implant life by markedly decreasing the amount
Azhar University Hospital. The mean age of ceramic
of wear debris generated, thus considerably reducing
on ceramic group was 39.74 while the mean age in
or even eliminating the incidence of osteolysis and
ceramic on HXLPE group was 44.1.Demographic data
of patients are shown in table (1).
The polyethylene wear is directly linked to
In all cases, cementless, both femoral and
rate of osteolysis. In an attempt to decrease wear rates,
acetabular, components were used. The patients were
various combinations of materials in THA such as
evaluated preoperatively. Evaluation included an
ceramic-on-ceramic, metal-on-metal, and ceramic-on-
assessment of complete history, physical examination,
metal have been employed, with the most recent being
and scoring of the patients' condition according to the
Harris Hip Score (HHS), laboratory evaluation, and a
Replacing the polyethylene liner with ceramic
complete radiological evaluation.
seems to be an ideal option, especially in young, active
The procedure was performed under spinal
patients. They have the mechanical advantages of wear
anesthesia in all cases. The direct lateral approach was
debris reduction and reduction of subsequent debris-
utilized in all patients. Regular follow-up visits were
induced osteolysis. In contrast to lower wear rate,
made and re-evaluation was carried out at 6 weeks, 3,
concerns exist regarding the cost and adverse events,
6, and 12 months and then yearly.
such as ceramic fractures and audible squeaking (3).
The HHS is a comprehensive, widely accepted
Newer bearing surfaces in current clinical
scoring system that is used for the clinical evaluation
practice (Ceramic on ceramic, ceramic on HXLPE)
of patients, preoperatively and postoperatively at 6
showed promise in decreasing the wear rates (4).
weeks, 6 and 12 months, and yearly thereafter until the
Some randomized, controlled trials (RCTs)
last follow-up. The score is considered excellent if it is
have been conducted comparing ceramic on ceramic
between 90 and 100, good between 80 and 90, and fair
(COC) and C/HXLPE THAs to determine the optimal
between 70 and 80, whereas scores below 70 are
bearing surface, but different studies reached different
considered poor. Standard radiographs were obtained
for all patients immediately postoperatively and at
subsequent follow up assessments. Acetabular
MATERIALS AND METHODS
component inclination and position of screws.
This is a prospective comparative study which was
Acetabular inclination was determined in relation to
conducted during the period from June 2016 to April
the interteardrop line.
2019 with mean follow up two years. It included 38
Femoral stem alignment if the tip of the
patients with 42 hips who underwent primary total hip
stem is central, it is in neutral alignment. If the tip is
replacement (THA) due to end stage arthritis, of these,
pointed or resting on the lateral cortex, it is in varus
there were 22 ceramic on ceramic and 20 ceramic on