The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3392-3396
Role of Pelvic and Para-Aortic Lymphadenectomy in
Advanced Ovarian Epithelial Cancer
Ahmed Mohamed Aydarous, Hamed Ahmed Al Azoony, Eid Rizk El Gammal,
Ibrahim Hassan Mohamed, Mohamed Foad Abd Elmoty and Mohamed Rashed Abdel Hamid
Surgical Oncology Unit, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Ahmed Mohamed Aydarous, E-mail: ahmedaydarous343 @gmail.com
Background: the role of detection and removal of retroperitoneal lymph nodes in patients with advanced ovarian
cancer disease is unclear. Aim of the work: this study was aimed to evaluate the therapeutic role of pelvic and para-
aortic lymphadenectomy in patients with advanced epithelial ovarian cancer.
Patients and Methods: this study was designed as a prospective randomized controlled trial. Thirty patients were
divided into two equal groups; 15 patients underwent optimum cytoreduction and in the other 15 patient retroperitoneal
lymphadenectomy was added.
Results: the mean number of nodes removed was 26, and the mean number of positive nodes was 6. There was
significant difference between the two groups of the study when considering operation time (Mean 122 min. Vs. 192
min.). Also there is significant difference between the two groups of the study when considering hospital stay in days
(Mean 8 days Vs. 13 days). There was significant difference between the two group of the study when considering the
blood loos and need for blood transfusion (26% Vs. 80%). There was no significant difference between the two groups
of the study when considering recurrence (73.3% Vs. 60%). Conclusion: Our results show improvement towards
decrease the recurrence in the lymphadenectomy group but with non-significant results.
Keywords: Advanced epithelial ovarian cancer, Prognostic factors, Survival, Therapeutic role pelvic and aortic
die within 5 years of diagnosis (6).The value of pelvic
Worldwide, ovarian cancer is the seventh most
and paraaortic lymphadenectomy in advanced ovarian
common cancer in women and the second most
tumors is still in debate. It needs more studies to be
common gynecologic cancer, after endometrial cancer.
established, understood, and best of all tailored to the
Ovarian cancer is usually seen in perimenopausal
population that would have the most benefits in relation
women with mean age being 63 years (1).Ovarian
to the cost (7).
epithelial carcinoma (OECs), the most common ovarian
malignancy, is a heterogeneous disease with several
AIM OF THE WORK
histologic subtypes that show characteristic cytogenetic
This study was aimed to evaluate the therapeutic role of
features, molecular signatures, oncologic signaling
pelvic and para-aortic lymphadenectomy in patients
pathways and clinical-biologic behavior(2). OECs are
with advanced epithelial ovarian cancer.
notoriously difficult to diagnose in the early stages.
Even patients with advanced disease may present with
PATIENTS AND METHODS
nonspecific abdominal and pelvic symptoms. Also,
This prospective study included thirty female
there are no reliable biomarkers that may aid in early
patients presented by pelvi-abdominal swelling and
elevated CA-125 suggesting ovarian cancer. All patients
The contribution of imaging includes surgery
underwent primary surgery in the Surgical Oncology
planning and selection of candidates for neoadjuvant
ward of Al-Azhar university hospitals from May 2016 to
chemotherapy by demonstration of non-optimally
January 2018. The study was approved by the Ethics
Board of Al-Azhar University and an informed
Surgery is the primary treatment of choice for all
written consent was taken from each participant in
ovarian cancers. Radical debulking includes bilateral
omentectomy, and peritoneal surface biopsy and
washing. In patients with extraovarian disease, extent of
Patients were only included in this study if they had all
surgery is individualized. Tumor resectability is of great
of the following criterion: Advanced ovarian epithelial
concern in stage III and IV disease(5).Due to nonspecific
cancer stage (III and IV).
symptoms, lack of reliable biomarkers, frequent
Exclusion criteria: Patients were excluded if they had
diagnosis of advanced disease and the presence of drug-
any of the following criteria: Synchronous abdominal
resistant histologic types, the long-term cure rates for
or pelvic pathology, medically unfit for surgery and
ovarian epithelial carcinoma is limited, for these reasons
residual tumor more than 1 cm after surgery.
OECs are the most lethal gynecologic malignancy.
Patient consent: Patients agreed to be included in the
Approximately 70% of women with OECs have
study and an informed consent was taken.
advanced disease at presentation, and 65% of women
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3397-3400
Estimation of Autophage Function for Clearance of Hyperlipidemia with
Concern of Anti-Rheumatoid Drugs
Mohamed Ibraheim Aref, Mahmoud Mohammed Mohammed Metwally,
Ahmed Ewas Abd El Wahab*
Department of Clinical Pathology, Faculty of Medicine Al-Azhar University
*Correspondence author: Ahmed Ewas Abd El Wahab, Mobile: (+20) 01016306691, E-mail: firstname.lastname@example.org
Background: Dyslipidemia is the common complication in rheumatoid arthritis (RA) patient, and subsequently
increased CVD risk. Dyslipidemia is the net result between positive intake of lipids and clearance by autophage.
Objective: The aim of this work is to evaluate the effect of autophages function as clearance of dyslipidemia in two
different lines of active RA treatment. Patients and methods: This study was carried out at Agouza Police Hospital.
It was analysis of data from one hundred and twenty individuals who were admitted to the hospital. Their age ranged
from 40-65 years. They were 84 females (70%) and 36 males (30%) healthy and patient with rheumatoid arthritis
attending the outpatient clinic and the inpatient of the Department of Rheumatology.
Results: There was significant increase of cholesterol in group 2, 3, and 4. There was significant increase of LDL in
group 2 and 4 while it decreased in group 3 which showed significant increase in HDL. There was significant increase
of disease activity (DAS-28) in group 2, 3, and 4. The autophage function showed significant increase in all groups and
this could be secondary increase of phagocytosis through the action of cytokines and defect of digestion secondary to
therapeutic drugs. Conclusion: Methotrexate is immunosuppressive drug could be the one of the famous
immunosuppressive drugs in RA that is completely responsible for dyslipidemia.
Keywords: Autophage Function, Clearance Hyperlipidemia, Concern of Anti-Rheumatoid Drugs.
SUBJECTS AND METHODS
Rheumatoid arthritis (RA) is a chronic
This study was carried out at Agouza Police
autoimmune disease with joint inflammation and
Hospital. It was analysis of data from one hundred and
autoantibody production as key elements of its
twenty individuals who were admitted to the hospital.
pathogenesis. RA remains a heterogeneous syndrome in
Their age ranged from 40-65 years. They were 84
terms of clinical expression and long-term course, and
females (70%) and 36 males (30%) healthy and patient
different pathogenic pathways are likely to be differently
with rheumatoid arthritis attending the outpatient clinic
activated in different patients or at least in different
and the inpatient of the Department of Rheumatology,
phases of the disease. In particular, the relative
Rehabilitation and Physical Medicine. They were
contribution of B lymphocytes appears greatly variable,
divided into 4 groups:
as inferred at least by the existence of a seropositive and
Group 1: 30 healthy volunteers considered as negative
a zero negative subtype of RA (1). The net effect on
atherosclerosis of the drugs used to treat RA is unclear.
Group 2: 30 patient discovered early without medication
Corticosteroids could increase the risk of atherosclerosis
had either moderate or high disease activity (DAS-28
via deleterious effects on lipids, glucose metabolism, and
>3.2) as a positive control.
blood pressure. However, corticosteroids could also
Group 3: 30 patient taking combined therapy (immune
decrease the risk of atherosclerosis by controlling
suppressive + immunestimulant) and were going in
inflammation. Equally, use of corticosteroids could just
remission or had low disease activity (DAS-28 <3.2).
be an indicator of more severe RA (2).
Group 4: 30 patient taking immune suppressive
In this context, novel biomarkers reflecting RA
medication (methotrexate) and were going in remission
pathogenesis could be tested for improving the
or had low disease activity (DAS-28 <3.2).
recognition and management of chronic arthritis since
All patients included in the study met the
the very early phases of the disease, before the
American College of Rheumatology (ACR) revised
fulfillment of any established classification criterion(3).
criteria for classification of rheumatoid arthritis (6).
RA is associated with an adverse lipid profile that - Exclusion criteria:
is conventionally accepted as a risk factor for
Patients and control were excluded from the study when
cardiovascular disease (4). Lipid profile can be improved
to an extent that is clinically meaningful by effectively Tobacco smoking.
treating RA without using a lipid lowering agent(5).
Chronic diseases including (hypertension, diabetes or
AIM OF THE WORK
The aim of this work is to evaluate the effect of
autophages function as clearance of dyslipidemia in two
An informed consent was taken from patients
different lines of active RA treatment.
included in the study and it was approved by Ethical
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3401-3406
Comparison of Intra-articular versus Intravenous Application of Tranexamic
Acid in Total Knee Arthroplasty: A Prospective Randomized Study
Bahaa Kornah, Galal Mohamed Mansour and Mohamed Tawfiq Ibrahim Mohamed *
Orthopedic Surgery Department, Faculty of Medicine, Al-Azhar University
*Corresponding Author: Mohamed Tawfiq Ibrahim Mohamed, Phone No.: (+2) 01000517724,
Background: Total knee arthroplasty (TKA) is commonly performed for the advanced knee joint disease. Considerable
postoperative blood loss, however, is an unavoidable occurrence because of extensive soft-tissue release, and the large
area of cancellous bone osteotomy associated with the procedure. In addition, knee flexion and extension activities that
begin the day after the operation adds to the problem. Aim of the Work: to compare between the intravenous the
intraarticular tranexamic acid (TXA) administration in total knee arthroplasty surgery. Patients and Methods: It is a
prospective double-blinded randomized controlled study. This prospective, two-arm, parallel-group study was conducted
at El-Hussein University Hospital and El-Agouza Hospital on 20 patients who underwent total knee arthroplasty and
fulfilled all assumed inclusion and exclusion criteria. Results: The average total blood loss amount in the drain after 48
hrs. in the 1st group was 365±74.722 while in the 2nd group it was 575±88.976. This indicates a significant decrease in
blood loss amount in the 1st group (intraarticular TXA group) than the 2nd group (intravenous TXA group). Also, it was
found that the decrease in hemoglobin (Hb) level is less in the 1st group than in the 2nd group which indicates less
postoperative anemia. Conclusion: Concerning intraarticular administration of TXA seemed to be effective much more
than intravenous injection in terms of blood loss amount and transfusion frequency.
Keywords: Blood Loss Tranexamic Acid Total Knee Arthroplasty.
Various measures have been tried to decrease
Total knee arthroplasty (TKA) is commonly
the bleeding and subsequently, the transfusion
performed for the advanced knee joint disease, which could
requirements, such as the usage of anti-fibrinolytic
lessen pain and greatly improved the knee joint function.
agents. Tranexamic acid (TXA) which is a synthetic
The number of total knee surgery increases in clinical
compound derived from amino acid lysine is acting as a
application as there is an improved newer surgical
competitive inhibitor of plasminogen activation [6,7]
techniques and implant used. Considerable postoperative
Tranexamic acid prevent fibrinolysis by
blood loss, however, is an unavoidable occurrence because
competing with the lysine molecule on fibrinogen
of extensive soft-tissue release, and the large area of
binding sites, and showed effectiveness in reducing
cancellous bone osteotomy associated with the operation.
blood loss amount, but still the controversy regarding the
Besides, knee flexion and extension activities that begin the
dosage and the type of administration exists. 
day following the operation adds to the problem.
Postoperative dominant blood loss after unilateral TKA can
AIM OF THE WORK
reach 1,2001,900 mL [1,2].
The objective of this randomized comparative study
A growing number of elderly patients undergo
was to compare between the administration route of both
TKA. This patients group can suffer from many
intraarticular and intravenous tranexamic acid (TXA)
underlying diseases, such as the inability of the
injection in total knee arthroplasty, regarding the blood loss
amount and the change in Hb levels preoperatively and 48
mechanisms and the CVS diseases. As such, hemorrhage
could be a serious consequence. Anemia is a key
impeding factor in patients' postoperative recovery.
PATIENTS AND METHODS
Homologous blood transfusion is often used to solve
It is a prospective double-blinded randomized
postoperative anemia, but this carries substantial risk of
controlled study. This prospective, two-arm, parallel-
immunologic reaction and disease transmission for the
group was performed at El-Hussein University Hospital
patients and also increases medical expenses. Therefore,
and El-Agouza Hospital from June 2018 till February
a reduction in operative blood loss, especially post TKA,
2019 on 20 patients who underwent total knee
is beneficial to recovery and decreases the transfusion
arthroplasty and fulfilled all inclusion and exclusion
risks. The usage of pneumatic tourniquets leads to an
criteria. The study design is shown in (Fig.1). The study
increase in the activity of blood fibrinolytic system (a
was approved by the Ethics Board of Al-Azhar
naturally existing enzymatic system that regulates clot
University and an informed written consent was
and thrombus formation in the body). [3,4,5]
taken from each participant in the study.
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3407-3413
Neuropsychiatric Manifestations of Multiple Sclerosis in Egyptian Patients
Mahmoud Mohamed Abdel Sayed, Ahmad Farag Ibrahim, Ahmed El said Hassan Mohamed*
Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
* Corresponding author: Ahmed El said Hassan Mohamed, E-mail: email@example.com
Background: Multiple sclerosis (MS) is a chronic inflammatory central nervous system (CNS) disease, arising from
a complex interaction of both environmental and genetic factors. MS affects individuals during the most productive
time of their lives, and directly limits their work capacity, leading to major social and economic consequences.
Objectives: The aim of the current work was to study neuropsychiatric manifestations in multiple sclerosis patients
and to understand their correlation with the degree of clinical disability.
Patients and Methods: A cross-sectional randomized study included a total of 40 consecutive M.S. patients (26 female
and 14 males with mean age ± SD 32.60 ± 10.01) attended at MS Outpatient Clinics of Al-Azhar University Hospitals
(Al Hussein and Bab Elshierya) and 20 controls during the period from January 2018 until February 2019.
Results: The present study showed that there was a highly significant difference between patients and controls groups
regarding Beck scale score for depression (p =0.005). There was 52.5% of MS patients had depression (while 25% of control
subjects had depression). The study showed that there was significant positive correlation between beck scale score and
EDSS scale score for disability a (p value =0.048 r=0.315). There was a highly significant difference between patients and
control group regarding Hamilton scale score for anxiety as (P-value = 0.002).
Conclusion: An understanding of neuropsychiatric disorders in MS is important for all professionals involved in the
care of people with MS. These disorders affect about half of patients.
Keywords: Neuropsychiatric Manifestations, Multiple Sclerosis
Multiple sclerosis (MS) is a chronic
`pathological laughing and crying,' occurs in
inflammatory central nervous system (CNS) disease,
approximately 10% of individuals with MS (11).
arising from a complex interaction of both
The aim of the current work was to study
environmental and genetic factors (1).
neuropsychiatric manifestations in multiple sclerosis
MS affects individuals during the most
patients and to understand their correlation with the
productive time of their lives, and directly limits their
degree of clinical disability.
work capacity, leading to major social and economic
consequences (2). While Middle Eastern and North
SUBJECTS AND METHODS
African (MENA) countries were previously considered
This cross-sectional randomized study included a
areas of low moderate risk of MS (3), there are
total of 40 consecutive M.S. patients attending at MS
evidences now that suggests a rising prevalence of MS
Outpatient Clinics of Al-Azhar University Hospitals
in this region (4, 5).
(Al Hussein and Bab Elshierya). Approval of the
MS comprises manifestations of acute, as well
ethical committee and a written informed consent
as chronically accumulating symptoms, including
from all the subjects were obtained. This study was
numbness, weakness, optic neuritis, incoordination,
conducted between January 2018 until February 2019.
diplopia, vertigo and neuropsychiatric manifestations.
Neuropsychiatric abnormalities are diverse, are
The included subjects were divided into two groups:
reported in up to 60% of patients with multiple sclerosis
I- Patient group: Included 40 consecutive M.S.
(MS) and are among the main contributors to the
patients (26 female and 14 male with mean age ± SD
morbidity and mortality associated with MS (6).
32.60 ± 10.01) fulfilling the following inclusion
Major depressive disorder is the most common
psychiatric disorder associated with MS with
1- Clinically definite M.S. patients diagnosed according
approximately five times the rate observed in the
to MacDonald Criteria of MS(2010).
general population (7).
2- The patients age between 15-55 years.
The coexistence of depressive and anxiety
3- Sex: both sexes.
symptoms has been found to be associated with
4- Patients were in clinical remission or after 3 weeks
increased rates of physical symptoms, social
of acute relapse, to avoid the effect of steroids given
dysfunction and suicidal ideation (8). Suicide is a
for treatment of acute relapse, on mood.
significant cause of mortality with a 3% rate of
completed suicide in individuals with MS (9).
1- Patients with history of head trauma or C.N.S
Bipolar affective disorder prevalence in MS is
disorder other than MS, to avoid overlapping of
approximately twice that in the general population (10).
these disorders with the effect of MS lesion.
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3414-3418
Comparative study between Sustained Low Efficiency Hemodialysis and Online
Hemodiafiltration in Critically Ill patients with Acute Kidney Injury
Mostafa Abdel Fattah El-Ballat 1, Mohamed Saeed El-Shorbagy 2,
Mohamed Ahmed El-Sayed1, and Abdel Aziz Refaat Abdel Aziz1*
Department of 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine,
Al-Azhar University, Cairo, Egypt
*Corresponding author: Abdel Aziz Refaat Abdel Aziz, Mobile: (+20)01116686028, E-Mail: firstname.lastname@example.org
Background: acute kidney injury (AKI) has arisen as a global public health problem and associated with high
morbidity and mortality where the AKI mortality is more than 50%. It is a serious complication frequently
occurred in ICU In hospitalized patients, 15% of them developed AKI and around 40% of AKI patients were
referred to ICU.
Objective: The aim of this study was to compare between effect of Sustained Low Efficiency Hemodialysis and
Online Hemodiafiltration in Critically Ill patients with Acute Kidney Injury.
Patients and Methods: This prospective study included a total of forty (age and sex matched) patients with Acute
Kidney Injury (AKI) who were critically ill, attending at Nephrology Unit, Bab El-Shaareya, Al-Azhar University
Hospitals. The patients were divided into 2 groups; Group (A): 20 patients on Sustained Low Efficiency
Hemodialysis (SLED) and Group (B): 20 patients on Online Hemodiafiltration (OLHDF)
Results: there was no significant difference between the two groups as regard Intradialytic hypotension (2 patients
(10 %) in group 1 and 5 patients in group 2 (25%) p-value = 0.2). There was no significant difference between
the two groups as regard weaning from ventilator (4 patients (40%) in group 1 and 3 patients in group 2 (42.8%)
p-value = 0.5).
Conclusion: Online haemodiafiltration (OL-HDF) showed to be better than IHD-LI in many aspects but there
was no statistically significant difference in mortality, allowing us to recommend as first choice OL-HDF of
treatment proposed for critically ill patients with acute kidney injury.
Keywords: Sustained Low Efficiency Hemodialysis, Online Hemodiafiltration, Acute Kidney Injury .
Acute kidney injury is a common occurrence in
Renal replacement therapy (RRT) is
critically ill patients, with incidence rates of
necessary in about 6% of critically ill patients,
occurrence varying from 5 to 60% and a trend towards
according to a large multinational, multicenter survey,
higher rates (30 to 60%) when using the risk, injury,
and it is provided as supportive treatment to AKI
failure, loss of kidney function, end stage renal failure
(Risk, Injury, Failure, Loss of kidney function,
(hypervolemia, metabolic acidosis, progressive
RIFLE) or Acute Kidney Injury (AKI) Network
uremia, and hyperkalemia) (5).
(AKIN) classification (1).
There is a long debate about the time to start,
Acute kidney injury is an independent risk
and the ideal treatment for RRT in critically ill patients
factor for increased morbidity and mortality (2). The
with sepsis, considering that the majority have
term `acute kidney injury' (AKI) is currently
multiorgan dysfunction and hemodynamic instability
recognized as the preferred nomenclature for the
complex clinical syndrome formerly known as acute
Controversies begin since the time of
renal failure (ARF). This transition in terminology
treatment´s onset, dose prescription, mode and
also serves to emphasize that the spectrum of disease
mechanism for solute´s remotion? (convection,
is much broader than the subset of patients who
diffusion, adsorption, or mixed), and about convection
experience renal failure requiring dialysis treatment
therapies there are discussion regarding the
replacement volume, although some studies
AKI occurs in a variety of settings, and has
recommend larger volumes of replacement as
clinical manifestations ranging from a minimal
beneficial, these results are not conclusive in other
elevation in serum creatinine levels to anuric renal
failure. In fact, AKI exists along a continuum of
Online hemodiafiltration (OL-HDF) is a
disease: the acute decline in kidney function is often
mixed technique that combines a standard
secondary to an injury that causes functional or
haemodialysis diffusive transport with a significant
structural changes in the kidneys. As the severity of
amount of convective transport, thus provides a
the underlying renal injury increases, the risk of
greater clearance of medium and large molecular-size,
unfavorable outcome rises (4).
which are difficult to remove by diffusion alone (1).
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3419-3424
Effect of Ligation of Inferior Thyroid Artery Main Trunk vs. its Branches on
Post Thyroidectomy Hypocalcaemia
Mohamed A. Rahman Al Kordy, Emad Ads El Ewesy, and Ahmed Jamal Nasr Hassan*
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Ahmed Jamal Hassan, Mobile: (+20)01000088747, E-Mail: email@example.com
Background: more than a century ago, thyroid surgery was a somewhat frightening operation, with a reported
mortality rate of 40%. Nowadays, thyroidectomy is one of the most commonly performed surgical procedures.
Hypocalcaemia is well recognized phenomenon following thyroidectomy; it has been a matter of interest in the past
100 years. Objective: to compare the effect of ligation of inferior thyroid artery main trunk versus its individual
branches on postoperative hypocalcaemia. Patients and Methods: thirty patients with indication for thyroidectomy
were randomly allocated into two groups; 15 patients each. Group A (15 patients) where the main trunk of inferior
thyroid artery was ligated, while in group B (15 patients) the individual branches were ligated.
Results: the results of this work showed that the incidence of post thyroidectomy hypocalcaemia, although was
statistically significant in some comparisons of calcium and PTH, yet most of the levels were within the normal range,
either pre or postoperatively with no clinical effects.
Conclusion: ligation of the main trunk of inferior thyroid artery, although have a statistical significant on the
parathyroid function and hypocalcaemia postoperatively, good surgical technique to identify and preserve the
parathyroids, is the most important factor which may affect the postoperative hypocalcaemia.
Keywords: Inferior Thyroid Artery, Ligation, Thyroidectomy, Hypocalcaemia
Care of the blood supply of the parathyroid
Thyroidectomy is one of the most commonly
gland during thyroid surgery may reduce the post
performed surgical procedures done nowadays. The
complications following thyroidectomy are well known,
some of them are fatal, others are quite disturbing
AIM OF THE WORK
particularly in their permanent form (1). The most
It is to compare the effect of ligation of inferior
common immediate surgical complication following
thyroid artery main trunk versus its individual branches
thyroidectomy is hypocalcaemia with more than 6% of
on postoperative hypocalcaemia and PTH levels.
patients experiencing this problem (2).
Post thyroidectomy hypocalcaemia may be
PATIENTS AND METHODS
transient or permanent. There is a great difference in the
In this prospective study conducted on Sayed
literatures in reporting the incidence of both. Transient
Galal University hospital and Police hospital during the
hypocalcaemia ranges from 5.4 to 26%. Such
period from Dec 2018 to May 2019, where 30 patients
discrepancies are due to differences in the definition of
with different indications for total thyroidectomy were
randomly divided to two groups each was 15 patients.
Group A, submitted for total thyroidectomy
The pathogenesis of transient hypocalcaemia is
with ligation of main trunk of inferior thyroid artery.
Group B, submitted for total thyroidectomy with
hypocalcaemia in the first post-operative day may be
sparing of the main trunk of inferior thyroid artery.
due to perioperative haemodilution. Common causes of
temporary hypocalcaemia include: parathyroid vascular
event such as ischaemia, oedema or rise of serum
All the patients were submitted to:
calcitonin level as a result of thyroid manipulation (4).
thyroidectomy I. Preoperative assessment:
hypocalcaemia include the extent, exposure of recurrent A. Clinical:
laryngeal nerves, parathyroid gland identification, 1. Detailed history: focusing on any history of manifest or
reoperation and lack of surgical experience (1).
Transient hypocalcaemia may be due to reactive
2. Physical examination: General and Local
hypoparathyroidism due to reactive hypocalcaemia in
thyrotoxic patients and hungry bone syndrome (5),
B. Radiological assessment:
release of endothelin 1 which suppress PTH, or
1. Chest x-ray: postero-anterior view.
2. Neck ultrasound.
Permanent hypocalcaemia is usually due to
C. Laboratory assessment:
devascularisation or surgical ablation of the parathyroid
Blood samples were collected using conventional
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3425-3431
Three-column Internal Fixation System for Comminuted
Fracture of the Tibial Plateau
Ali Mohammed El Gioushy, Galal Mansour Hegazy, and Ahmed Ashour El Sherief*
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Egypt
*Corresponding author: Ahmed Ashour El Sherief, Mobile: (+20) 01007627623
Background: the tibia is the major weight-bearing bone of the lower leg. The proximal portion of the bone, the tibial
plateau, forms the lower surface of the knee joint and it consists of two condyles medial and lateral separated by the
tibial spines, The articular surface of the medial plateau is concave, whereas that of the lateral plateau is convex. The
knee is a complex dynamic joint that is subjected to many forces during normal activities, so intact articular surface of
tibial plateau is one of important factors to keep the geometry and alignment of the knee joint to act in harmony to
perform its crucial function as a flexible weight bearing joint.
Objective: the aim was to describe the operative procedures and clinical outcomes of internal fixation of tibial plateau
to treat comminuted fractures of the tibial plateau according a new three-column classification.
Conclusion: using anatomical locking plates on tibial plateau is an effective and safe tool to treat complex three-column
fractures of tibial plateau and is more convenient than common plate.
Keywords: Internal Fixation System, Comminuted, Tibial Plateau
AIM OF THE WORK
Tibial plateau fractures are among the most
The aim of this work is to describe the operative
challenging intra-articular fractures to treat, fracture
procedures and clinical outcomes of internal fixation of
characteristics range from simple to complex(1).
tibial plateau to treat comminuted fractures of the tibial
Complex fractures of tibial plateau are considered a
plateau according a new three-column classification.
difficult aspect of trauma orthopedics, because these
kinds of fractures are mostly smashed to pieces,
Classifications of the tibial plateau fracture
accompanied by severe injuries of soft tissue and
There are numerous classification systems that
have been proposed to describe tibial plateau fractures.
The comminuted fractures of the tibial plateau
It is about six anatomical classification schemes are
are usually seen in pedestrians struck by vehicles and
established in clinical practice(13). The classical ones are
also in work related accidents. These fractures are
the OTA/AO and the Schatzker classification systems(14).
described by Luo et al.(3) as "Three- column fracture"
Recently, a new three-column classification approach
which is fracture' is defined as at least one independent
was proposed by Luo et al.(3) based on multiplanar CT
articular fragment in each column. The most common
three-column fracture is a traditional `bicondylar
a) Hohl classification
fracture' (Schatzker Type V or Type VI) combined with
The Hohl classification was the first widely
a separate posterolateral articular fragment(4).
accepted description of tibial plateau fractures,
In these type of fracture and according three-column
classifying these fractures into displaced and
concept, open reductionand internal fixation of each
undisplaced types. Under the displaced category, he
column separately is the gold standard(4). Osteosynthesis
recognized local compression, split compression, total
is performed from standard anterolateral and
condyle depression, and comminuted fractures (15).
posteromedial surgical approaches(2).
b) Moore classification:
Many shapes of plates are used in fixation such
Moore expanded upon Hohl's concepts, taking
as straight plate, T-shaped plate, L-shaped plate, clover-
into account higher-energy injuries and resultant knee
shaped plate, and angular stable locking plates(5-8). But
instability. His classification of fracture-subluxation of
these plates could not match the special bony structure
the knee is divided into five types. Type I is a split
of the posterior column which had irregular anatomic
fracture of the medial tibial plateau in the coronal plane;
form, and had obvious curvature at metaphysis,so, many
Type II is an entire condyle fracture in which the fracture
difficulties appeared, such as spending more time to
line begins in the opposite compartment and extends
mold plates, cutting soft tissue by up-warping plates,
across the tibial eminence; Type III is a rim avulsion
fracture displacement after compression through
fracture (these fractures are associated with a high rate
mismatching plates(2, 9, 10).
of associated neurovascular injury); Type IV is another
To solve these problems, three-column internal
type of rim fracture, a rim compression injury that is
fixation system has designed with anatomical locking
usually associated with some type of contralateral
plates on tibial plateau and it could shorten the internal
ligamentous injury; and Type V is a four-part fracture in
fixation process, reduce operation time, reduce operation
which the tibial eminence is separated from the tibial
injury and improve operation efficiency(2, 11,12).
condyles and the tibial shaft(15).
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3432-3436
Estimation of Serum Zinc Levels in Children with Short Stature
Hosny Mohammed Ahmed Elmasry, Abd El-Monem Mohammed Hassan,
Mohammed Ahmed Besher and Mostafa Mahmoud Abd El-Moiz *
Department of Pediatrics, Faculty of Medicine - Al-Azhar University
*Corresponding author: Mostafa Mahmoud Abd El-Moiz; Mobile: (+20)01002014714
Background: Factors affecting malnutrition in toddlers include genetics, hormones, gender, infectious diseases, and
chronic diseases. Nutritional factors that cause stunting include low intake of energy, protein, and micronutrients
such as iron, vitamin A, and zinc.
Objective: the aim of this study was to estimate the relation between serum zinc levels and short stature among
children. Patients and methods: our study included 50 children with short stature (Group I), and 30 children with
normal stature as a control group (Group II). Any children with possible genetic, endocrinological cause of short
stature, severe nutritional insufficiency, age beyond the 2-10 years range or having any chronic illness or infections
were excluded from the study. Results: we found non-significant relations between serum zinc and demographic
characteristics among group I cases. Also, we found non-significant relations between serum zinc and anthropometric
measures (weight, BMI and head circumference) among group I cases. On the other hand, we found a positive and
significant relation between serum zinc level and both of height and height percentile. Also, pallor was associated
with significantly lower levels of serum zinc. We found non-significant relations between serum zinc and laboratory
investigations among group I cases. The only exception was the moderate positive highly significant correlation
between HB and serum zinc level. Conclusion: our study concluded that lower serum zinc level is associated with
short stature among preschool children, and is also associated with more anemia, and lower WBCs count.
Keywords: Zinc, Children, Short stature.
PATIENTS AND METHODS
Zinc is a metal with great nutritional
Study design: A cross sectional controlled study.
importance and is particularly necessary in cellular
Subjects: A total of 80 children aged 2-10 years were
replication and the development of the immune
included in this study, and divided according to stature
response (1). Zinc plays an important role in growth; it
into two groups:
has a recognized action on more than 300 enzymes by 50 children with short stature were included as the
participating in their structure or in their catalytic and
"case" group (Group I).
regulatory action (2). Zinc also enhances vitamin D 30 age and sex matched children with normal stature
effects on bone metabolism through the stimulation of
were included as the "control" group (Group II).
DNA synthesis in bone cells (2). Also zinc plays a
All of the cases and controls were recruited
critical role in many biochemical pathways and
from the pediatric outpatient clinic of Al-Azhar
physiological processes in the body including cell
University Hospitals, Assiut during the period from
growth, cell differentiation and metabolism and
June 2018 to April 2019.
Zinc deficiency is characterized by growth For sampling procedure, we used special software "PS
retardation, loss of appetite, and impaired immune
Power and Sample Size Calculation" version 3.1.2.
function. In severe cases, zinc deficiency can result in Based on previous studies' data, the PS software
hair loss, diarrhea and eye and skin lesions (4).
calculated the sample size to be 50 cases and at least 25
Short stature is a condition in which the height
of the individual is more than 2 standard deviations
(SD) below the corresponding mean height for a given
All of the participants were subjected to the following:
age, sex and population, in whom no identifiable
o Full history.
disorder is present. It can be subcategorized into
Personal history (age, sex, residence).
familial and non-familial short stature, and according to
Complaint and its duration.
pubertal delay. It should be differentiated from
History suggesting of zinc deficiency
dysmorphic syndromes, skeletal dysplasias, short
stature secondary to small birth size (small for
gestational age, SGA), and systemic and endocrine
o Examination including:
Vital signs and general look
AIM OF THE WORK
The aim of this study was to estimate the relation
between serum zinc levels and short stature among
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3437-3445
Evaluation of Transforaminal Lumbar Interbody Fusion and Posterolateral Lumbar
Fusion In Treatment Of Degenerative Lumbar Disorders With Instrumentation
El- Sayd Abd El-Rahman El-Mor1, Mamoun Mohammed Abo Shosha1, Mokhtar Ragab2,
Mohammed Saad El-Din Radwan3, and Ashraf Abbas Abd Al Karim1*
Departments of 1Neurosurgery,2Radiology and 3Clinical Pathology,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding Author: Ashraf Abbas Abd Al Karim, E-mail: firstname.lastname@example.org
Background: degenerative lumbar disorders affect millions of people causing low back pain, which can restrict
mobility and daily activities. Lumbar fusion operations are used as a treatment of degenerative lumbar disorders.
However, the better choice among fusion techniques is still controversial.
Objective: to compare the clinical and radiological outcome of Transforaminal Lumbar Interbody Fusion (TLIF) and
Posterolateral fusion (PLF) in the treatment of degenerative lumbar spine stenosis and degenerative spondylolisthesis.
Patients and Methods: a prospective study was conducted on 40 patients with degenerative lumbar spondylolisthesis
and degenerative lumbar spine stenosis. Twenty patients underwent transforaminal lumbar interbody fusion and 20
patients underwent posterolateral fusion. Patients were followed up using the visual analogue scale (VAS) for back and
leg pain and Oswestry Disability Index (ODI). Final fusion assessment was done according to Bridwell criteria.
Results: ODI and VAS of leg and back pain improved in the two groups with no significant differences between the
two groups whether after six or twelve months of follow up. TLIF group shows a high grade of fusion according to
Bridwell grading criteria for spinal fusion and significantly better than the PLF group of patients either in six-month
follow up (p=0.045) or twelve-month follow up (p=0.04).
Conclusion: both TLIF and PLF provide improvement of disability and pain in patients with degenerative lumbar
disorders. TLIF is superior to PLF with regard to achieving radiographic fusion. There is no significant clinical or
functional outcome to support the use of TLIF over PLF in the treatment of degenerative lumbar disorders.
Keywords: TLIF, PLF, Spinal Fusion, Degenerative lumbar disorders.
Degenerative lumbar disorders are relatively
AIM OF THE STUDY
common cases of people over the age of 50 and are more
It is to compare the clinical and radiological
common in females. Patients with constellation of
outcome of Transforaminal Lumbar Interbody Fusion
symptoms include back pain, radiology, and/or
(TLIF) and Posterolateral fusion (PLF) in the treatment of
degenerative lumbar spine stenosis and degenerative
In the absence of progressive neurological deficit
spondylolisthesis with instrumentation.
and/or symptoms of cauda equina syndrome, treatment
begins with a series of nonoperative interventions that
PATIENTS AND METHODS
include physical therapy, nonsteroidal anti-inflammatory Study design:
medications, and epidural injections(1).
This is a prospective study that was conducted on
patients with degenerative lumbar spondylolisthesis and
retrospective studies in the literature that maintain
degenerative lumbar spine stenosis who were admitted to
positive results can be achieved following decompression
Neurosurgical departments of Al-Hussein University
alone (without arthrodesis) in the setting of low-grade
hospital and Arab Contractors' Medical Center and
degenerative spondylolisthesis. For an elderly patient
underwent lumbar spine fixation with either
with multiple comorbidities and low functional activity,
transforaminal interbody fusion or posterolateral fusion
decompression alone may be a viable option(2).
from February 2017 to February 2019.
However, higher-quality data demonstrates
The patients were divided into two groups
superior and more durable results which can be achieved
according to the operative procedure done for each group:
when arthrodesis is performed in addition to
decompression in the setting of degenerative lumbar
Group A (20 patients): included patients who
disorders. This is reflected in the North American Spine
underwent transforaminal lumbar interbody fusion
Society (NASS) clinical guideline for degenerative
with transpedicular screws instrumentation.
spondylolisthesis and canal stenosis, where a stronger
Group B (20 patients): included patients who
recommendation is made for both decompression and
underwent posterolateral fusion with transpedicular
arthrodesis as compared to decompression alone(3).
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3446-3453
Role of Magnetic Resonance Imaging in Assessment of Anterior Cruciate
Ligament Post-Grafting Cases in Terms of Graft Integrity and Complications
Eisha Ramadan Mohammed, Nadia Abd El Sater Metwally, Anne Abdelaziz Saeed Elaidy*
Department of Diagnostic Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Anne Abdelaziz Elaidy, Mobile: (+20)01124200108, Email: email@example.com
Background: because of the high incidence of anterior cruciate ligament (ACL) injuries among the
population, these have been the subject of many recent studies. It is the most commonly reconstructed
ligament in the knee. Its clinical evaluation is difficult. MRI is reliably and accurately used to assess
Objective: this work is an attempt to spot light the diagnostic value of MR imaging in assessment of
anterior cruciate ligament reconstruction graft for distinction of its various common complications.
Patients and methods: this prospective study was conducted on 50 patients with postoperative
knee reconstruction of ACL. The study was done between the duration of (April 2014 to February 2019)
in an MRI unit of a private radiology center. All cases were referred from the orthopedic department of
New Cairo Hospital. Results: according to our results, 33 (66%) cases showed osteoarthritic changes,
suggesting that the development of osteoarthritis is one of the common complications of ACL
reconstruction, however it can't be considered the commonest complication as it can be explained by the
associated risk factor as meniscal or chondral lesion. Thus osteoarthritic changes can be considered is
one of the most common associated findings of ACL reconstruction and ACL reconstruction can be a
risk factor for development of osteoarthritis.
Conclusion: MRI of the knee is indispensable and the preferred modality in evaluating the integrity of the ACL
graft and can be reliably and accurately used in diagnosing complications associated with ACL reconstruction.
Keywords: MRI, ACL, CT.
There has been an increase in the number
ACL-R complications may be broadly
characterized as those resulting in decreased
reconstructions (ACL-R) over the past 25 years,
range of motion (ROM), e.g., arthrofibrosis and
likely attributed to the overall availability of
impingement, and those resulting in increased
surgeons capable of performing the procedure
laxity, i.e., graft disruption (5).
and the increased participation in sporting
activities, which are prone to ACL injuries(1).
Although most patients treated with ACL
stretching/elongation and graft malplacement.
reconstruction achieve excellent results, up to
Causes of decreased range of motion include
15% of patients experience persistent instability
roof impingement, arthrofibrosis and cyclops
and pain. Radiographs, computed tomography
(CT), and magnetic resonance imaging (MRI)
are all modalities used to evaluate ACL
complications include hard-ware complications
and osteoarthritis (2).
reconstruction and common causes of failure is
AIM OF THE WORK
This work is an attempt to spot light on
the diagnostic value of MR imaging in
Multiple surgical procedures exist for ACL
reconstruction graft for distinction of its various
arthroscopically assisted technique is one of the most
common surgical procedures performed to reconstruct
PATIENTS AND METHODS
Autografts are considered the gold standard.
This prospective study was conducted on 50
Allograft constructs are occasionally used, but they are
patients with post operative knee reconstruction of
comparatively more prone to mechanical failure and
ACL. The study was done between the duration of
are associated with increased synovitis and osteolysis.
April 2014 and February 2019 in an MRI unit of a
The two autografts commonly used for ACL
private radiology center in New Cairo Hospital. All
reconstruction are patellar tendon and hamstring grafts
cases were referred from the Orthopedic department of
New Cairo Hospital.
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3454-3459
Role of Laparoscopy in Management of Non-Palpable
Undescended Testis in Children
Mohamed M. AbdElsalam, Khalid M. Elshimy, Akram M. Elbatarny, Mahmoud A. Elafifi
Pediatric Surgery Department. Faculty of Medicine. Tanta University
Corresponding author: Mohamed M. AbdElsalam, email: firstname.lastname@example.org
Background: Several techniques have been described for treatment of intra-abdominal testis including microsurgical
autotransplantation, primary laparoscopic orchiopexy (VILO), one- and two-stage laparoscopic FowlerStephens
procedures, and staged laparoscopic traction orchiopexy (Shehata technique).
Aim of the work: To evaluate the role of laparoscopy in the treatment of non-palpable undescended testis.
Patients and methods: This study was carried out in the Pediatric Surgery Unit, Tanta University Hospitals, during the
period from April 2017 to October 2018, on 37 cryptorchid boys with 40 non-palpable testes. The mean age of the
patients was 3.46 ± SD 3.1 years. Laparoscopic exploration was done for all cases, and if testes were found intra-
abdominally, with rough measurement of the length oftesticular vessels (TV), decision was taken either to do VILO or
Results: Out of 40 testes, 17 testes (42.5%) were vanishing, 3 intra-abdominal testes (7.5%) with long TV enough to
undergo VILO, and 20 intra-abdominal testes (50%) with short testicular vessels underwent Shehata technique. Follow
up for 3 -12 months postoperatively showed that all 3 testes underwent VILO were normal in size and vascularity. While
the 20 testes underwentShehata technique, 19/20 (95%) testes were normal in size, while small testis was detected in
1/20 testis (5%).
Conclusion: VILO has excellent results in management ofintra-abdominal testes with sufficient TV length while
Shehata technique has excellent results in management ofintra-abdominal testis with short TV.
Keywords: laparoscopy, intra abdominalt estis, primary laparoscopic orchiopexy, FowlerStephens procedures,
stage laparoscopicorchidopexy has been practiced and
Cryptorchidism or undescended testis (UDT) is
achieving good results. On the other hand, the high-lying
one of the most common genital anomalies in childhood.
testis is more controversial as regards the ideal
Itsincidence is 3-5 % in full term newborn, and affect
more than one third of premature newborn. The
laparoscopic orchidopexy has dominated the surgical
incidence decrease to 1 % at age of 3months. About 20%
techniques for decades but with only suboptimal results.
of UDT are impalpable, and about 50% of these
impalpable testes are either vanished or atrophic [1-3].
transplantation is tedious, time consuming and requires
Many diagnostic methods have been used for the
special experience and equipment making it less feasible
evaluation and management of the undescended testis,
and far from becoming a worldwide standard[5, 6].
including imaging studies and multiple surgical
Traction to achieve organ growth or stretch has
procedures. Laparoscopy has become the most common
been a charming surgical concept employed by general
way to identify the position of intra-abdominal testis and
surgeons to lengthen esophagus after resections. Kimura
exclusion of vanished testes.
and Foker described two different techniques depending
Surgical management of UDT is performed to preserve
on traction to lengthen the esophagus in treatment of
testicular function (spermatogenesis) and to prevent the
pure long gab esophageal atresia . Keetley and Torek
potential complications of undescended testis.
in 1909 have separately proposed techniques to lengthen
Regarding the optimal age of orchiopexy many
the short spermatic vessels for abdominal testes based on
recent findings suggest that early intervention (6 -12 ms
traction by fixation to the thigh. However, those
of age) is most beneficial. Other findings suggest that
techniques and many others were quickly abandoned
there is high rate of spontaneous descent during the first
after achieving disappointing results losing many testes
3 months of life, so observation of undescendedtestes is
probably because of the sudden and uncontrolled tension
advocated till 3 months of age, if the testis remains non-
on the testicular vessels . In 2008Shehata reintroduced
palpable at 3 months of age, it is unlikely to become
the concept of traction in the management of high intra-
palpable by waiting another 3 months. Therefore,
abdominal testes. In his landmark paper, he proposed a
diagnostic laparoscopy and orchidopexy could be
new staged laparoscopic-assisted technique for bringing
performed from 3 months of age.
down the abdominal testis with minimal complications
Intra-abdominal testes have been traditionally
while maintaining their viability.
divided into low-lying (within 2 cm from IIR) and high-
The aim of this study was to evaluate the role of
lying (over 2 cm from IIR). For the low-lying testes, one-
laparoscopy in the treatment of non-palpable
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3460-3467
A Study of CT Versus MR Arthrography in Detection of
Acetabular Cartilage Defects and Labral Tears
Eman Gaber Mohamed Al-Saadawy, Ashraf Mohammed Enite, Ahmed Mahmoud Sayed*
Radiodiagnosis Department, Faculty of Medicine, Al-Azhar University for Girls, Cairo, Egypt
*Corresponding author: Ahmed Mahmoud Sayed, Mobile: (+20) 01113751521, E-Mail: email@example.com
Background: the most important role of imaging in the preoperative period is to reveal labro-cartilaginous lesions
in patients with chronic hip pain and suggested FAI. MRI particularly 3T MRI has a good ability to detect labral and
chondral pathologies in FAI.
Objective: to evaluate CT hip arthrography in the detection of acetabularlabral lesions and articular cartilage defects
in comparison with MR arthrography in patients with chronic intractable hip pain.
Patients and Methods: this is a cross sectional study in Cairo Scan Radiology center and Al-Azhar University
hospital over 5 years period. The study included 61 patients who were referred for identification of source of chronic
hip pain or assessing previous hip arthroscopic intervention. All cases were subjected to evaluation by both MDCT
and MR arthrography. Confirmation of diagnosis was primarily based upon MR arthrography findings.
Result: sixty-one patients were included in this study. Of them, 51 patients have been proved to have intra articular
pathology; 31 males (61%) and 20 females (39%). Femoro-acetabular deformities were readily detectable via CT
arthrography. Compared to MRA, CT arthrography had a sensitivity and specificity of 90.7% and 100% in detection
of acetbularlabral lesions, 95% and 100% specificity in detection of femoral and acetabularchondral lesions, and
86% and 100% specificity in the detection of other intra articular pathologies, respectively.
Conclusion: multidetector CT arthrography is an efficient alternative to MR arthrography in the evaluation of internal
derangements of the hip.
Keywords: Labral tear, Cartilage loss, Para-labral cysts and ossification, CTA and MRA
AIM OF THE WORK
Acetabular labral tears are a recently recognized
To evaluate CT hip arthrography in the detection
cause of hip pain in the absence of plain radiographic
of acetabularlabral lesions and articular cartilage
abnormalities. Typical presenting signs and symptoms
defects in comparison with MR arthrography in
in patients with labral tears include persistent pain,
patients with chronic intractable hip pain.
clicking, locking, and decreased range of motion(1).
Improvements in surgical techniques have meant
PATIENTS AND METHODS
that chondral lesions and labral tears are amenable to
We conducted a randomized cross sectional study
surgical intervention. As orthopedic surgeons become
in Cairo Scan Radiology center and Sayed Galal
more comfortable performing arthroscopic surgery on
University hospital over 5 year-period. The study
the hip joint, labral abnormalities are more frequently
included 61 patients who were referred for
being addressed by means of minimally invasive
identification of the source of chronic hip pain or
surgery. Accurate preoperative identification of labral
assessing previous hip arthroscopy.
tears by the radiologist has therefore become an area
of increasing interest(2). As with other joints in the
The study was approved by the Ethics Board of
body, magnetic resonance (MR) arthrography of the
Al-Azhar University and an informed written
hip has emerged as a technique of choice for diagnosis
consent was taken from each participant in the
of internal derangement of the hip(3).
Both non-contrast MRI and MR arthrography
have limitations in terms of spatial resolution, which
All cases were subjected to both CT and MR
can make the detection of subtle labral and cartilage
Arthrography (CTA and MRA), confirmation of
diagnosis was primarily based upon MRA findings.
3D-CT play an important role in the evaluation of
osseous anatomy and paralabral ossifications in
Those patients who had previous intervention or
MDCT arthrography, with its exquisite spatial
those who have metallic prosthesis degrading MRI
resolution and high intra-articular contrast resolution,
is a viable alternative (widely available, rapid, robust,
Failed or inconclusive MRI studies.
and well tolerated) to MRI and MR arthrography in the
Preoperative planning of osseous and cartilage
evaluation of internal derangements of the hip(6).
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3468-3474
Role of Assessment of The Diaphragm by Ultrasound During Weaning from
Mechanical Ventilation in Patients with Chronic Obstructive Pulmonary Disease
Hussien Ahmed Abo-Alyzeid, Ibrahim Hassan Elbana Ibrahim, Waheed Gouda Ibrahim Yousif*
Department of Chest Diseases, Faculty of Medicine, Al Azhar University
*Correspondence author: Waheed Gouda Ibrahim Yousif, Mobile: (+20) 01224396747, E-mail: firstname.lastname@example.org
Background: Diaphragmatic Rapid Shallow Breathing Index (D-RSBI) is a new promising tool to predict weaning
outcome. The D-RSB), which is the ratio between respiratory rate (RR) and the ultrasonographic evaluation of
diaphragmatic displacement. Its accuracy in predicting weaning failure, in ready-to-wean mechanically ventilated
chronic obstructive pulmonary disease (COPD) patients, needs to be evaluated.
Objective: Assessment of diaphragm using ultrasound during weaning from mechanical ventilation in COPD
patients and to compare the new (D-RSBI) with traditional rapid shallow breathing index (RSBI).
Patients and Methods: A prospective observational study was carried out on mechanically ventilated COPD patients
who were ready-to-wean. During spontaneous breathing trial (SBT), evaluation of the right hemi-diaphragmatic
displacement and diaphragmatic thickness by using M-mode ultrasonography. Then calculation of D-RSBI (RR/DD)
and RSBI (RR/tidal volume [VT]) were carried out simultaneously. Outcome of the weaning trials were recorded.
Receiver operating characteristic curves were used to evaluate the diagnostic accuracy of D-RSBI and RSBI.
Results: A total of 104 patients with acute excerptions chronic obstructive pulmonary disease AECOPD who were
ready to perform a SBT from mechanical ventilation. 86 (82.7%) were successfully liberated from mechanical
ventilation and 18 patients (17.3%) had failure of weaning. The sensitivity and specificity of diaphragmatic
displacement were 72.2% and 93.0% respectively. The sensitivity and specificity of RSBI were 77.8% and 70.9%.
While the sensitivity and specificity of D-RSBI were 83.3% and 90.7% respectively.
Conclusion: D-RSBI (RR/DD) is superior than the traditional RSBI (RR/VT) in predicting weaning outcome patients
Keywords: Diaphragmatic rapid shallow breathing, diaphragmatic displacement, COPD, spontaneous
breathing trial, weaning.
COPD is a major cause of chronic morbidity
and mortality worldwide; many people have suffered
preventing extubation failure is, therefore an
from this disease for years and die prematurely
important task. Various
because of it or its complications (1).
weaning parameters have been suggested to be
The diaphragm is the main respiratory muscle and
useful, e.g., minute ventilation (VE), respiratory
contributes to 75% of the comfortable lung ventilation,
rate (RR), tidal volume (VT), rapid shallow
with a journey of 1-2 cm. During forced breathing, the
breathing index (respiratory rate divided by tidal
length of the trip is 7-11 cm, and is variable with
volume, f/VT), maximum inspiratory pressure (PI
individual characteristics and methods (2).
max) and trans-diaphragmatic pressure (Pdi).
The evaluation of diaphragmatic mobility has been
However, the prediction rate of these parameters
traditionally performed using fluoroscopy. In recent
may not be satisfactory.
years, ultrasound has also become used to evaluate
Evaluating the strength of the respiratory
diaphragmatic mobility. It offers some advantages over
muscles becomes important, since the imbalance
fluoroscopy including the lack of ionizing radiation and
between respiratory demand and supply will lead
the possibility of using at bedside of the patient. So
to weaning failure through the development of
ultrasonography has been shown to be a promising tool
respiratory muscles fatigue (5).
in the evaluation of the diaphragm function (3).
The rapid shallow breathing index (RSBI)
Mechanical ventilation (MV) is a life
(defined as the ratio of respiratory rate to tidal
volume [RR/VT]) is one of the most widely used
maintain adequate alveolar ventilation including
patients (4). Discontinuing
unfortunately it has variable sensitivity and
ventilation is a rapid and uneventful process for
most patients, but for one of every four or five
diaphragmatic RSBI (D-RSBI) by substituting
patients, the transition to spontaneous breathing
VT with DD in the RSBI (ie, D-RSBI = RR/DD).
is a prolonged process that can consume almost
half of the total time on a ventilator (4).
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3475-3482
Fixation of Fractures of Ulnar Styloid Associated with Distal Radius
Fractures by K wires "Tension Band"
Adnan Abd-aleem El sebaey, Galal Mohamed Mansour, Sobhy Taher Sobhy Daoud*
Department of Orthopaedic Surgery, Faculty of Medicine, Al-Azhar University
*Correspondence author: Sobhy Taher Sobhy Daoud, Mobile: (+20) 01225274402, E-mail: email@example.com
Background: fracture of the distal radius is the most common type of fracture in the upper extremity. Because the
radius plays a fundamental role in the stability of the wrist joint, preservation of ligamentous function of the wrist
and the biomechanics of radiocarpal and radioulnar joints, anatomical reduction and correction of articular surface
incongruity decreases the potential of degeneration and accelerates post-injury rehabilitation.
Objective: the aim of this study is targeting fixation of ulnar styloid fracture associated with distal radius fracture by
" Tension Band" and detecting the effect of these fractures on final wrist outcome.
Patients and Methods: ten cases with fracture of ulnar styloid were managed over the last year from July 2017 to
march 2018. Case selection was according to: 1- Base fracture of ulnar styloid (Type 2). 2- Involvement more than
50% of the height of ulnar styloid.
Results: our study showed that one patient developed non-union, one patient developed infection, two patients with
injury to dorsal cutaneous branch of ulnar nerve and one patient developed DRUJ instability. According to Mayo
Clinic Wrist Score; one patient achieved excellent Mayo Score, two with good score, five with satisfactory score and
two with poor score.
Conclusion: although Open reduction and internal fixation is recommended in case of base fracture if there is
displacement more than 2mm or if there is associated DRUJ instability as it is associated with high union rate and
less rate of DRUJ instability.
Keywords: Ulnar Styloid, DRUJ, K wires.
Ulnar styloid fractures are often associated with
radioulnar (DRU) joint. The relationship of
fractures of the distal radius, and are present in up to 50
theulnar styloid to the stabilizing ligaments
to 65% of these fractures (1). The effects of ulnar styloid
determines whethera specific fracture type is
fractures in the setting of distal radius fractures are
likely to result in DRU joint instability(6).
unclear. Although some studies suggest that ulnar
styloid fractures have little effect on radiographic or
AIM OF THE WORK
clinical outcomes. Other studies showed that these
The aim of this study is targeting fixation of
fractures can contribute to poor results, including distal
ulnar styloid fracture associated with distal radius
radioulnar joint (DRUJ) instability, ulnar sided wrist
fracture by K wires" Tension Band" and detecting the
pain, stiffness, and weakness (2).
effect of these fractures on final wrist outcome.
The ulnar styloid plays a crucial role in wrist
biomechanics; the ulnar styloid base and the fovea are
PATIENTS AND METHODS
the insertion points for the primary stabilizers of the
DRUJ, the superficial and deep portions of the palmar
Ten cases with fracture of ulnar styloid were
and dorsal radioulnar ligaments. In addition, the ulnar
managed over the last year from July 2017 to march
styloid functions as a strut, helping to stabilize the
extensor carpi ulnaris (ECU), its sub-sheath, and the
Case selection was according to:
1- Base fracture of ulnar styloid (Type2).
Because of its anatomic importance, the 2- Involvement more than 50% of the height of ulnar
potential exists for ulnar styloid fractures to cause ulnar-
sided wrist symptoms. However, the clinical
Cases with neglected fracture or open fracture
significance of ulnar styloid fractures in association
with distal radius fractures is not clear. Although some
investigators have found no correlation between
outcomes and the presence of ulnar styloid fractures(4);
Patients were evaluated by history taking,
others have noted that ulnar styloid fractures can have a
physical examination, investigation, consent taking and
negative impact on outcomes after distal radius
The treatment was by open reduction and
The management of acute ulnar styloid
internal fixation using K-wire and tension band.
fractures is based on the long-term effect that
Follow up was done using Mayo (wrist performance
they may have on the stabilityof the distal
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3483-3493
Retrospective Evaluation of The Result of Fixation of Lateral Humeral
Condyle Fractures by K-Wires versus Cannulated Screws in Children
Adnan A. Alim Alsebaie, Mohamed A. Monam Negm, Mostafa Mahmoud Mohamed Kudaih *
Department of Orthopedic Surgery, Faculty of Medicine Al-Azhar University
*Correspondence author: Mostafa Mahmoud Mohamed Kudaih, Mobile: (+20) 01064044555,
Background: fractures of the lateral condyle of the humerus represent the second most common type of fracture of
the elbow in children. Although this injury is seen at all ages, it is predominately observed in children aged
between 5 and 10 years.
Objective: the purpose of this study is retrospective evaluation of the results of fixation of lateral humeral condyle
by K-wires versus cannulated screws in children by assessment of: 1-Time to full union. 2-Range of motion.3-
Percentage of complications. 4-According to Hardacre criteria.
Patients and methods: a retrospective study for evaluation of the result of fixation of lateral humeral condyle
fractures in children by K-wires vs cannulated screws. Our series was conducted in Al-Azher University Hospitals.
20 patients with humeral condyle fractures were treated by K-wires and cannulated screws.
Results: in group A patients presented by complications as following: extension lag 1 (10%), delayed union
(healing at 36 months) 1 (10%), revision 1 (loss of reduction at the 3rd day of operation and required revision
using pin fixation) (10%), fish tail deformity 0 (0%) and 7 (70%) had no complications. While in group B:
extension lag 1 (10%), delayed union 2 (20%), nonunion 1 (10%) (Not healed at greater than 6 months and re-
operated using bone graft and pin fixation), revision 0 (0%), fish tail deformity 1 (10%), pin tract infection 1 (10%)
and 4 (40%) had no complications.
Conclusion: our study supports that screw fixation may be a viable option, with no nonunions and fewer
complications than pin fixation.
Keywords: Fixation of lateral humeral condyle fractures, K-wires, Cannulated screws in children
Fractures of the lateral condyle of the
with decreased duration of casting (possibly leading to
humerus represent the second most common type of
an improved range of motion)(3).
fracture of the elbow in children. Although this injury
is seen at all ages, it is predominately observed in
AIM OF THE WORK
children aged between 5 and 10 years (1). These
The purpose of this study is retrospective
injuries are typically the result of an avulsion of a
evaluation of the results of fixation of lateral humeral
portion of the lateral humeral condyle by pull of the
condyle by K-wires versus cannulated screws in
extensor musculature due to a varus force on a
children by assessment of
supinated forearm (Milch type II) or by the direct
1- Time to full union.
force of the radial head onto the lateral condyle in the
2- Range of motion.
setting of a fall and axial load through an extended
3- Percentage of complications.
elbow (Milch type I) (2).
4- According to Hardacre criteria(4).
Multiple treatment options are available for
these fractures, ranging from simple immobilization
PATIENTS AND METHODS
for nondisplaced or minimally displaced fracture
A. Study design:
patterns, to operative reduction and fixation with
A retrospective study for evaluation of the
Kirschner wires (K-wires) or screws for displaced
result of fixation of lateral humeral condyle fractures
fractures. Although some controversy exists with
in children by K-wires vs cannulated screws. Our
regard to the acceptable amount of displacement,
series was conducted in Al-Azher University
fractures with displacement greater than 2 mm or 3
Hospitals. 20 patients with humeral condyle fractures
mm are generally thought to require open reduction
were treated by K-wires and cannulated screws.
and fixation to facilitate union and prevent deformity
and articular incongruity. Because of concerns about
B. Patients selection:
the possibility of loss of fixation with brief use of K-
wires or occurrence of infection with their prolonged
1. Children aged from 2 to 14 years old.
use, authors have explored the use of screw fixation
2. Displaced fracture lateral humeral condyle > 2 mm.
for lateral condyle fractures. In theory, screws should
3. Closed fracture lateral humeral condyle.
be better suited for resisting load in tension, provide
4. Recent fracture lateral humeral condyle.
more stable fixation, resulting in a higher union rate,
5. Any joint incongruity.
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3494-3499
Phytoestrogens Soymilk and Fenugreek Oil Perturb Lipid and
Hormonal Profile and Other Physiological Parameters of Male Albino Rats
Eman G.E. Helal1, Hewaida, A.E. Fadal2, Gavin C. Ikechukwu3,
Mohamed A. Abd-El-Aziz4, Shaimaa S. Ahmed1
1Zoology Department, Faculty of Science, Al-Azhar University (Girls), 2Physiology and Nutritional Chemistry,
National Nutrition Institute, Cairo, Egypt3Biochemistry Department, College of Natural Sciences, Michael Okpara
University of Agriculture, Umudike, Nigeria,4Physiology Department, Faculty of Medicine, Al-Azhar University
(Boys), Cairo, Egypt
*Corresponding Author: Eman G.E. Helal, E-mail: firstname.lastname@example.org, Mobile: 00201001025364, Orchid.org/0000-0003-
Background: phytoestrogens are a diverse group of plant-derived compounds that structurally or functionally mimic
mammalian estrogens. They have been investigated at the epidemiological, clinical and molecular levels to determine
their potential health benefits.
Aim: the present study was carried out to investigate some biochemical effects of fenugreek oil and soymilk on male
Materials and Methods: eighteen (18) animals were divided randomly into three groups with 6 animals per group.
Group "1" received normal saline 1 mL/kg body weight orally for four weeks. Group "2" rats were treated with oral dose
of soymilk 1 ml/kg body weight/day once daily for four weeks, while rats in group "3" were treated with oral dose of
fenugreek 1 ml/kg body weight/day once daily for four weeks. Blood samples were collected on the last day of the
experiment for biochemical analysis.
Results: the fenugreek oil and soymilk induced highly significant decrease (p<0.01) in total cholesterol, triacylglycerol,
low-density lipoprotein, very low-density lipoprotein, low-density lipoprotein high-density lipoprotein ratio (LDL/HDL)
and a significant increase (p<0.05) in high-density lipoprotein. The results also showed highly significant decrease in
follicle stimulating hormone, luteinizing hormone, testosterone and sperm count compared to normal control group.
Conclusion: the results of this study suggest that high levels of fenugreek and soymilk intake can cause hormonal
disturbance and decrease sperm count.
Keywords: Fenugreek oil, Soymilk, Lipid profile, Phytoestrogen, Hormonal profile.
phytoestrogens, inhibit the action of estrogens which in
Phytoestrogen are plant-derived compounds
turn prevent the proliferation of breast cancer cells and
which have estrogenic effect and have been investigated
have been linked to selective estrogen receptor
for their health benefits(1).
modulators (SERM). Ingestion of isoflavone exerts
Milk is a naturally valuable source of vitamins
biological effect in pre-and postmenopausal women.
and minerals such as vitamin A, vitamin B6, vitamin B12,
Hence, the risk of breast cancer can be reduced to a great
thiamin, riboflavin, niacin, calcium, phosphorus,
extent by the use of soy-based products(3). Isoflavones are
magnesium, zinc and potassium(1). Soymilk is also
also antioxidants which protect our cells and DNA
consumed as an alternative drink to cow's milk. In
addition to the essential proteins it contains, other health
The fenugreek (Trigonella foenum-graecum L.)
benefits of consuming milk are widely recognized such
belongs to the family Fabaceae and is a multiuse and
as improvement of bone health blood cholesterol,
commercially important spice crop grown for its seeds,
protection against cardiovascular disease, reduced colon
tender shoots, and fresh leaves. Fenugreek has economic
cancer risk, reduced blood pressure, body weight
value as food, medicine and in cosmetics(4). Ethiopia,
regulation, protection of tooth enamel and reduced risk of
Egypt, and Turkey are the major countries for seed
type 2 diabetes. Soymilk is rich in isoflavones. The
production. Fenugreek is known to have several
presence of isoflavones is the most important and unique
pharmacological effects such as: hypoglycemic(5) and
benefit of soymilk. Each cup of soymilk contains about
20 mg isoflavones (mainly genistein anddaidzein).
Furthermore, this plant has shown antioxidant action(7),
Isoflavones have many health benefits including
gastroprotective activity(8), appetite stimulation (9) and
reduction of cholesterol, easing of menopause symptoms,
antirheumatic action(10). Fenugreek is used as herbal
prevention of osteoporosis and reducing the risk of breast
medicine for treating metabolic and nutritive
cancer. Estrogen stimulates the multiplication and growth
dysfunctions. Some studies indicate that fenugreek seed
of cancer cells in the breast(2). Isoflavones as
extract supplementation reduces the body and adipose
Comparative Histological and Immunohistochemical Study on the Effect of Curcumin and Atorvastatin in Induced Atherosclerosis in Aorta and
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3500-3515
Comparative Histological and Immunohistochemical Study on
The Effect of Curcumin and Atorvastatin in Induced Atherosclerosis in
Aorta and Cardiac Muscle of Male Rabbits
Sheriff Aly Saleh1, Gamal Soliman Algharabawy1 and Mohamed Ghazy Attia Hablas2*
Department of Histology, Faculty of Medicine, Al-Azhar University, 1Cairo and2Assiut, Egypt
*Correspondence author: Mohamed Ghazy Attia Hablas, Mobile: (+20) 01225958706, E-mail: email@example.com
Background: curcumin has many pharmacological effects including antioxidant, anti-inflammation, eliminating
free radicals, anti-tumor, lipid regulation and anti-coagulation.
Objectives: to compare the histological effects of curcumin and atorvastatin in experimental induced atherosclerosis
in the rabbit's aorta and heart.
Subjects and Methodology: thoracic aorta sections were prepared and stained by Hx&E, orcein, Masson's
trichrome and immuonohistochemical staning using CD34. Cardiac sections were prepared and stained by Hx&E,
Masson's trichrome stain and immuonohistochemical staning using troponin T. Morphometrical study included, the
thickness of both tunica intima and media of thoracic aorta , area % of the elastic fibers contents of both tunica
intima and media in thorathic aorta, and the area %of the immune reaction of CD34 in thoracic aorta .
Results: the atherosclerotic group showed a significant increase in the thickness of both tunicae intima& media
when compared with the control group. There was a significant decrease in elastic fibers content and significant
increase in the mean area % of the immune reaction of CD34 versus control. In atorvastatin treated group: there was
a significant increase in comparison to control group, while there was a significant decrease in comparison to
atherosclerotic group. There was significant decrease in elastic fibers content and significant increase in the mean
area % of the immune reaction of CD34 in comparison to control group. In curcumin treated group: the thickness of
both tunica intima and media showed a significant increase in comparison to control group.
Conclusion: curcumin has potential role in treatment of atherosclerosis and myocardial infarction.
Keywords: Atherosclerosis, Atorvastatin, Curcumin, Aorta, Cardiac muscle.
cardiovascular event is reduced. Controversial results
Atherosclerosis is potentially a life threatening
have been observed in animal and human studies on
disease develop characteristic atherosclerotic arterial
lipid profile improvement by curcumin(8).
Oxidative effect of curcumin results in preventive
In atherosclerosis, fatty material accumulates in the
effect of curcumin on atherosclerotic development
intima with additional fibrosis(2,3). This material is
which can decrease lipid peroxidation and cholesterol
covered by dense fibrous tissue, which gives the plaque
levels of sera and tissues in mice and human stress and
a white, pearly appearance(4). These features result in
massive lipid deposition in the aorta(9).
the hardening of the arterial wall due to thickening and
loss of elasticity. Hemorrhage, thrombosis, ulceration
MATERIALS AND METHODS
and calcification are advanced and late complicated
lesions of atherosclerosis(5).
Atorvastatin, is a member of the drug class known
1- Cholesterol powder 1% was purchased from Merck
as statins, used for lowering blood cholesterol(5). It also
Company mixed with ordinary diet for a period of 8
stabilizes plaque and prevents strokes through anti-
inflammatory and other mechanisms. Like all statins,
2- Atorvastatin trade name is Ator was purchased from
atorvastatin works by inhibiting HMG-CoA reductase
EPICO pharmaceutical company in the form of
tablets10mg.Each tablet was dissolved in 6ml saline.
Curcumin is a polyphenolic compound and active
The rabbits of this group were given 5mg\kg
constituent of the rhizomes of Curcuma longa plant
dissolved in 3 ml saline solution orally by special
from Zingiberaceae family(6).
oral syringe daily for 8 weeks.
Curcumin is found to have many pharmacological
3- Curcumin was purchased from spice dealer the
effects including antioxidant, anti-inflammation,
recommended daily dose of curcumin is 100 mg/
eliminating free radicals, anti-tumor, lipid regulation
(kg·d) dissolved in 3 ml saline solution daily for 8
and anti-coagulation. Curcumin has extensive
(II) The animal: The study was conducted at the
antimicrobial and cancer-preventive properties(7).
animal house of Al-Azher University. The rabbit was
It also has hypolipidemic and hypoglycemic
the animal of choice because it is the most sensitive
properties. It is also reported that after application of
species for induction of atherosclerosis. New Zealand
curcumin in coronary heart disease, the lipid level is
rabbit was the animal of choice in our study because its
effectively controlled and the incidence of
maximum life span is relatively short and well
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3516-3522
A Comparison between Both Mineralocorticoid Receptor Antagonist
Agents (Eplerenone and Spironolactone) in Prognosis of Heart Failure
with Reduced Ejection Fraction (HFrEF)
Mohamed Ayman Mostafa Saleh, Ramadan Ghaleb Mohammed,
Ayman Maher Asham Ibrahim, Mena Mekhail Solhy*
Department of Cardiology, Faculty of Medicine, Aswan University
*Corresponding author: Mena Mekhail Solhy, Email: firstname.lastname@example.org
Background: heart is the target organ for Aldosterone, spironolactone and eplerenone (mineralocorticoid receptor
antagonists) inhibits the aldosterone extraction through the heart in patients with congestive heart failure (CHF).
Objective: to evaluate prognostic impact of both MRA (spironolactone and eplerenone) on heart failure and
compare between both agents in incidence of side effect (gynecomastia and hyperkalemia).
Patients and Methods: the study was conducted from March 2016 to September 2016 at Aswan University hospital.
Our study population consisted of 100 adult patients, who were proved to have heart failure symptoms, with reduced
ejection fraction heart failure divided in two groups. Group A contains 50 patients on spironolactone in addition to
other anti-failure treatments according to ESC guidelines. Group B is 50 patients on eplerenone in addition to other
anti-failure treatments according to ESC guidelines.
Results: follow up had been done after one month for patient clinical status and serum potassium level and
development of gynecomastia. Another Follow up was done after 3 months for BNP level, gynecomastia, NYHA
classification and body weight.
Conclusion: MRA are important line of treatment in HF patients, eplerenone and spironolactone are both have good
result in improving BNP level and improving NYHA classifications and patients weight loss.
Keywords: Mineralocorticoid receptor, atrial fibrillation, congestive heart failure.
of the clinical benefits of blocking aldosterone at the
Until recently, our understanding of
aldosterone focused on its effects on sodium, water
AIM OF THE WORK
retention and potassium excretion, which are mediated
To investigate the safety, relative efficacy and
by the binding of aldosterone to the mineralocorticoid
side effects of different oral doses of spironolactone
receptor (MR) in epithelial tissues, such as the kidney
&eplerenone in prognosis of heart failure patients.
and non-epithelial tissues, such as the heart, brain, and
PATIENTS AND METHODS
These actions are associated with adverse
I. Study Design: This study is an observational study
effects, including impaired synthesis of the vasodilator
that was recruited patients diagnosed as heart failure
nitric oxide; promotion of vasoconstriction, endothelial
with low ejection fraction.
dysfunction, inflammation, and fibrosis in vasculature
II. Setting: Recruitment was in Cardiology
which reflect as ventricular hypertrophy, collagen
department, Aswan University, Aswan, Egypt.
deposition and remodeling in the heart(1).
III. Sample size: One hundred patients as (50 patients
Currently, two agents are available that
in spironolactone group & 50 patients for eplerenone
competitively inhibit aldosterone at the MR:
spironolactone and eplerenone. Spironolactone is
IV. The inclusion criteria: The Patients with HF
associated with progestogenic and antiandrogenic
according to Framingham criteria with EF equal or less
adverse effects. Eplerenone is a spironolactone
than 40 %(4).
derivative designed to enhance selective binding to the
MR while minimizing binding to progesterone and
Major criterion: Paroxysmal nocturnal dyspnea. Neck
RALES and EPHESUS studies have shown
vein distention. Pulmonary Rales. Radiologic
that this "aldosterone breakthrough" is an important
cardiomegaly. S3 gallop. Increased central venous
factor because it is a determinant of outcome in heart
pressure. Hepatojugular reflux. Weight loss > 4.5 Kg
failure patients. Therefore, it may be beneficial if the
in5 days in response to treatment.
therapies employed were downstream of this system
Minor criterion: Bilateral ankle edema. Dyspnea on
specifically at the MR(3).
ordinary exertion. Hepatomegaly. Pleural effusion.
Understanding of the adverse pharmacological
Decrease in vital capacity by one third of maximum
properties of aldosterone has prompted investigation
recorded. Tachycardia (heart rate >120 b/min).
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3523-3529
Metabolic Profile as A Predictor of Coronary Artery Disease Detected by
Multislice Computed Tomography in Asymptomatic Type II Diabetic Patients
Islam Shawky Abdel Aziz, Mohamed Abou Mandour Mousa, Mohamed Saleh Rizk Elwaseef*
Department of Cardiology, Faculty of Medicine Al-Azhar University
*Correspondence author: Mohamed Saleh Elwaseef, Mobile: (+20) 01007864300, E-mail: email@example.com
Background: previous studies have demonstrated that coronary artery calcium score (CACS) assessment combined
with risk factors among asymptomatic adults provides prognostic information superior to either method alone, and the
combined approach can more accurately guide primary preventive strategies for patients with coronary artery disease
(CAD) risk factors.
Objective: the purpose of this study was to assess the presence and extent of coronary calcium in symptomatic type
2 diabetic patients with metabolic syndrome by MSCT.
Patients and Methods: this was a prospective observational study that was done between January 2018 and December
2018. The study included 150 patients referred to the MSCT Coronary Angiography unite in Mustafa Kamel Military
hospital (Alexandria, Egypt) with metabolic syndrome according to IDF.
Results: in our study 51 cases (86.4%) of those with serum parathyroid hormone level less than 65 pg/dl had a
coronary calcium score (CCS) less than 10 compared to 8 cases (18. 6%) among those with more than 65 pg/dl (p
value 0.001), while 0% out of those with normal serum parathyroid hormone less than 65 pg/dl had a CCS more than
200 (p value= 0.001) while 100% cases with CCS more than 200 had serum parathyroid level more than 65 pg/dl. So,
the trend toward a high CCS is linked to increasing serum parathyroid hormone level.
Conclusion: CAC screening is accurate and valuable modality as a completely non-invasive and relatively time-
efficient screening way when avoiding high radiation burden to patients with metabolic syndrome criteria even when
Keywords: CACS, MetS, CVD, HDL, DMT2, CCS.
score has been shown to be a reliable non invasive
Metabolic syndrome (MetS) is a complex
technique for screening risk of future cardiac events (5, 6)
disorder that is considered a worldwide epidemic. MetS
and can be quantified by using the Agatston score (7) or
is defined by a cluster of interconnected factors that
scores such as the volume score (8) or calcium mass(9).
directly increase the risk of coronary artery diseases
AIM OF THE WORK
(CHD), other forms of cardiovascular atherosclerotic
The purpose of this study is to assess the presence
diseases (CVD), and diabetic mellitus type 2 (DMT2), is
and extent of coronary calcium in symptomatic type 2
main component s are dyslipidaemia (elevated
diabetic patients with metabolic syndrome by MSCT.
triglycerides and apolipoprotein B (apo)-containing
lipoprotein, and low high-denisty lipoproteins (HDL),
PATIENTS AND METHODS
elevated arterial blood pressure (BP) and dysregulated
This was a prospective observational study that
glucose hemostasis, while abdominal obesity and/or
was done between January 2018 and December 2018. The
insulin resistance (IR) have gained increasing attention as
study included 150 patients referred to the MSCT
the core manifestation of the syndrome (1-3).
coronary angiography unite in Mustafa Kamel Military
The three components of atherogenic lipidemia
hospital (Alexandria, Egypt) with metabolic syndrome
(increase low density lipoprotein (LDL), decrease high
according to IDF. The study was approved by the
density lipoprotein (HDL) and high blood triglyceride
Ethics Board of Al-Azhar University.
concentration) are individually associated with a
cardiovascular risk can contribute to the buildup of
plaques in arteries(4).
Central obesity based on waist circumference 94cm
Metabolic syndrome has been associated with
for males and 80 cm for females and/or BMI >30.
atherosclerosis in some epidemiological studies. It is
important to investigate the prevalence of metabolic
Plus two of the followings:
syndrome and its components, and study the association
a- Raised fasting triglycerides 150 mg/dl
of metabolic syndrome with subclinical atherosclerosis.
The presence and extent of coronary artery calcium
b- Reduced high density lipoprotein cholesterol <
(CAC) are strongly correlated with the magnitude of
40mg/dl (1.03mmol/l) for males or <50 mg/dl
coronary atherosclerosis plaque burden and subsequent
(1.29 mmol/l) for females.
coronary events(4). Coronary artery disease is one of the
leading causes of death. Quantification the amount of
coronary artery calcium with unenhanced CT calcium
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3530-3541
Evaluation Study of Different Methods of Refraction in Hyperopic Lasik
Abd El Rahman Fathy Sayed Ahmed*, Hassan Abd El Wahab, Mahmoud Mohammed Saleh
Department of Ophthalmology, Faculty of Medicine-Al Azhar University.
*Corresponding Author: Abd El Rahman Fathy Sayed Ahmed, Email: firstname.lastname@example.org,
Background: hyperopia, also known as far-sightedness, is a common type of refractive error in which light is focused
behind, instead of on, the retina. This causes close objects to be blurry, while far objects may appear normal.
Aim: this was evaluation study between different methods of preoperative refraction detection in hyperopic lasik
including cycloplegic, manifest and wave front refraction for all patients and according to best-corrected visual acuity
we do refractive surgery and analyze postoperative refraction outcome. Patients and Methods: the current study was
carried out on thirty-four eyes of eighteen patients. All patients had primary hyperopia with or without hyperopic
astigmatism. All patients were informed about the limitations and risks of the procedure. All patients signed an
informed consent. Results: In hyperopic spherical group, the mean preoperative spherical equivalent regarding wave-
front refraction was + 3.36 ± 1.26 (range + 1.70 to + 5.39 D). 6 months post operatively, it became + 0.35 ± 0.36 (rang
+ 0.12 to +0.90 D). In hyperopic astigmatic group, the mean preoperative spherical equivalent regarding wave-front
refraction was + 3.13 ± 2.08 (range + 1.0 to +5.63D). 6 months post operatively, it became + 0.74 ± 0.43 (range + 0.12
to + 1.63D) and for Cycloplegic auto-refraction, it became + 0.92 ± 0.46 (range + 0.25 to + 1.74D).
Conclusion: laser in situ keratomileusis for hyperopia, hyperopic astigmatism is a safe, effective and predictable
technique. However, modification in the nomogram is needed in order to achieve good results.
Keywords: Wavefront, hyperopia and manifest refraction.
used to modify the shape of the cornea and correct a
Hyperopia, also known as far-sightedness, is a
refractive error, thereby restoring the focus plane of
common type of refractive error in which light is
parallel light on the retina. The safety, efficacy, and
focused behind, instead of on, the retina. This causes
predictability of the surgical outcomes have greatly
close objects to be blurry, while far objects may appear
improved since the introduction of the excimer laser.
normal. As the disease worsens, objects at all distances
Despite these advances however, certain limitations
may be blurred (1). Other symptoms may include
and complications (infection, ectasia, diffuse lamellar
headaches and eyestrain. People with hyperopia can
keratitis, sub-epithelial haze, dry eye, epithelial
also experience accommodative dysfunction, binocular
ingrowth, buttonholed flap, free cap etc.) still exist (8).
dysfunction, amblyopia, and strabismus (2). Depending
In hyperopia, there are difficulties in preoperative
on whether the magnitude of physiological hyperopia
evaluation of refraction so we must take in our
is moderate or severe, it can lead to additional visual
consideration not only the manifest refraction, but also
impairments such as strabismus, amblyopia or other
cycloplegic refraction to uncover any latent hyperopia
ocular complications that constitute a significant health
(9) and also wave front refraction is needed. Comparison
problem (3). The prevalence of hyperopia decreases as
between these three parameters may lead to proper
age increases, with a summary prevalence measure of
estimation of preoperative refraction.
5% at age 7, 2-3% between age 9 and 14 and around
Wavefront refraction has been recognized as an
1% at age 15 (4). Moreover, refractive errors like
optical science by Scheiner's and Newton's
hyperopia are conditions with high economic costs
observations of aberrated light in the 17th and 18th
associated with their correction (5).
centuries (10). The modern wavefront aberrometer
Astigmatism is a type of refractive error in which
applies a form of high-resolution autorefraction across
the eye does not focus light evenly on the retina; this
the entire area of the patient's pupil, giving the
results in distorted or blurred vision at all distances (6).
wavefront error (WFE) in terms of micrometers of
In Europe and Asia astigmatism affects between 30 and
deviation (root-mean-square [RMS]) from the ideal
60% of adults (7). People of all ages can be affected.
wavefront plane (11). The irregular portion of the WFE
Hyperopic astigmatism is a type of astigmatism in
is termed higher-order wavefront error (HO-WFE) that
which one or both principal meridians are farsighted; it
is not correctable with traditional sphero-cylindrical
is further classified to simple, compound and mixed
spectacles. Wavefront testing is used to detect higher
astigmatism. Eyeglasses, contact lenses, and refractive
order aberrations that may degrade vision. Standard
surgery are the primary options to treat the visual
LASIK procedures cannot treat patients with
symptoms of those with hyperopia or hyperopic
significant amounts of wavefront abnormalities, which
astigmatism. Lens implants are now available offering
may leave them with unwanted visual symptoms after
an alternative to glasses or contact lenses for hyperopic
surgery. Wavefront guided LASIK may be the better
for whom laser surgery is not an option. Several laser
choice to reduce higher order aberrations, subsequently
and non-laser refractive surgical procedures have been
giving the patient a better visual outcome (12).
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3542-3549
Role of Nucleic Acid Test (NAT) in Detection of Transfusion
Transmitted Viruses in Comparison to Other Methods
Ekram Yassin Ebeid, Hoda Abd Ellateif Kholeif, Nancy Hassan Hussein*
Department of Clinical Pathology, Faculty of Medicine - Al-Azhar University
*Corresponding author: Nancy Hassan Hussein, Mobile: (+20)01115258990, E-Mail: email@example.com
Background: over the two last decades, much attention has been given to the prevention of transfusion-transmitted
viral infections. Given the potential transmission of viruses during the window period, novel non-serology based
approaches such as viral nucleic acid testing (NAT) have been established.
Objective: a comparative study of different methods to detect transfusion transmitted viral infections.
Materials and methods: this cross-sectional study was conducted at the Egyptian National Blood Transfusion Center
(NBTC), Giza. The duration of the research was 2 months from June 2018 to august 2018. In our study 1000 donor
samples were tested by ELISA and NAT tests for HBV, HCV and HIV.
Results: regarding ELISA tests of the three viruses, only 14 (1.4%) samples were finally HBsAg reactive.
Finally, reactive HCVAb were 22 (2.2%) samples, while only 4 (0.4%) samples were HIV Ag-Ab finally reactive.
We found highly statistical significant difference between initial and final results of ELISA (p<0.001).
Regarding NAT testing of the three viruses. HBV: 5 (0.5%) samples were NAT and ELISA reactive, 1 was NAT yield.
HCV: 9 (0.9%) samples were NAT and ELISA reactive. HIV one sample (0.1%) was NAT and ELISA reactive, one
(0.1%) was NAT yield. Statistical significant difference was found in comparison between NAT and ELISA in HBV,
HCV, and HIV p values <0.001, <0.001, and = 0,008 respectively.
Conclusion: we concluded that NAT and ELISA are complementary to each other. NAT is an effective method for
safeguarding the blood supply.
Keywords: NAT, Transfusion transmitted viruses, HIV, HCV, HBV.
transfusion transmission of HTV, HCV, and HBV
The goal of any transfusion service is to provide
continues, primarily due to release of serology negative
adequate and safe blood and blood products that meet the
units that are infectious because of the window period
needs of patients. Transfusion transmitted infections
(TTIS) is a recognized complication of blood transfusion
Nucleic acid testing (NAT) is a molecular
and blood products. Many of these infectious agents may
technique for screening blood donations to reduce the risk
cause lifetime morbidity and/or mortality. The three
of TTIs in the recipients, thus providing an additional
major viral TTIs associated with blood transfusion are
layer of blood safety. It was introduced in the developed
human immunodeficiency (HIV), hepatitis C virus
countries in the late 1990s and early 2000s and presently
(HCV) and hepatitis B virus (HBV) viruses (1).
around 33 countries in the world have implemented NAT
Whole blood may be processed into various
for HIV and around 27 countries for HBV (5).
components. Each component can then be stored under
NAT technique is highly sensitive and specific
ideal storage conditions (i.e. temperature and movement)
for viral nucleic acids. It is based on amplification of
to ensure that the product is most effective when it is
targeted regions of viral ribonucleic acid (RNA) or
used. Special preservative solutions and blood bags are
deoxyribonucleic acid (DNA) and detects them earlier
used to lengthen the expiry time and improve product
than the other screening methods thus, narrowing the
quality; the storage conditions of the products can be
window period of HIV, HBV and HCV infections. NAT
optimized by the correct choice of additive, temperature,
also adds the benefit of resolving false reactive donations
bag type and other parameters to ensure effectiveness of
on serological methods which is very important for donor
each component for the longest possible time (2).
notification and counseling (6).
Blood safety and transfusion transmitted
NAT is a highly sensitive and advanced
infections (TTIs) are a major concern in low resource
technique which has reduced the window period of HBV,
areas. Laboratory screening of donors, a key contributor
HCV, HIV but it is highly technically demanding,
to blood safety, high performance serologic testing and
involving issues of high costs, dedicated infrastructure
NAT are the cornerstone of TTI screening. Unlike
facility, equipment, consumables and technical expertise.
serology, NAT has the ability to detect occult HBV
The need for NAT depends on the prevalence and
infection as well as preseroconversion "window" phase
incidence rate of infections in blood donor population,
available resources and the evidence of benefit added
In the last few decades through an awareness of
when combined with serology tests. Hence the decision
TTIs, a majority of countries have mandated serology
of starting NAT should be considered when basic quality
based blood screening assays for HIV, HCV, and HBV.
assured blood transfusion system is already in place such
However, despite improved serological assays, the
as volunteer base for blood donation, provision of donor
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3556-3563
Comparative Study between Heavy-Weight Mesh and Light-Weight
Mesh in Ventral Hernia Repair
Mahmoud Mohamed Ibrahim, Waleed Raafat Abd Alaaty, Osama Ibrahim Abd Alkader*
Department of General Surgery, Faculty of Medicine, Al-Azhar University
*Correspondence author: Osama Ibrahim Abd Alkader, Mobile: (+20) 01027640928
Background: Ventral hernia may be spontaneously (primary ventral hernia) or at the site of a previous surgical
incision (incisional hernia). Ventral hernias are classified according to their location and etiology, a primary
ventral hernia is classified as a (para-) umbilical, epigastric or Spigelian hernia (between the muscles of the
Objective: This work aims to study and compare the use of the heavy-weight mesh and light-weight mesh in
ventral hernia repair.
Patients and Methods: This study was conducted on patients (male and females) suffering from ventral hernia
"primary or incisional" admitted to the General Surgery Department, at Nasser Institute Hospital and Al-Azhar
University Hospital during the period from June 2018 to May 2019.
Results: Quality of life (QOL) values in the 3rd postoperative month were not statistically significant higher in
the LW group than that of the HW group. QOL values of the both groups in the 3rd postoperative month were
significantly higher when compared to the baseline (preoperative values). Foreign body sensation was
significantly less frequent in the LW group than that of the HW group.
Conclusion: The lightweight mesh offers benefits over heavyweight mesh for ventral hernia repair by reducing
the incidence of chronic pain and foreign body sensation.
Keywords: Heavy-Weight Mesh, Light-Weight Mesh, Ventral Hernia Repair.
two LW meshes, differing in the spatial arrangement
Ventral hernias may cause a varying degree
of their filaments and their porosity. Its aim was to
of discomfort and cosmetic concern. Symptoms such
establish whether the interfilament distance and
as pain and the size of the protruding bulge may be
structure of LW prostheses are determining factors
aggravated by daily living activities and especially by
for recipient tissue incorporation during the repair
coughing and straining. Hernias have the potential for
process and to examine effects on tensile strength.
incarceration (constriction of intestine), which is a
This will allow the abdominal wall to act as the
threat. Therefore, surgical repair is recommended for
dynamic structure, maintaining its flexibility and
most ventral hernia and mesh can be used to
avoiding the abdominal stiffness sometimes observed
strengthen the repair. The relatively high recurrence
in patients operated on using a conventional HW type
rate after open suture repair - up to 54% - has been
of PP mesh (4).
significantly lowered by the use of mesh (1).
It is important to use an appropriate-sized
One of the biomaterials most widely used to
mesh that overlaps the hernia gap by at least four to
repair an abdominal wall defect is polypropylene
five centimeters. Different techniques can be used for
(PP) in the form of a reticular, macroporous mesh.
fixing the mesh to the abdominal wall. These
The classic PP meshes have been modified in an
techniques may lead to different rates of recurrence,
effort to create a prosthesis containing less material
intensity of pain or health-related quality of life
by enlarging pore size and reducing the spatial
(HRQOL) in general (5).
reorganization of the filaments (2).
The mesh can be placed using the onlay,
Light-weight composite mesh is the result of
sublay or inlay technique. In the onlay technique, the
incorporating an absorbable component into a
mesh is positioned between the subcutaneous tissues
reduced polypropylene mass. The objectives of LW
of the abdominal wall and the anterior rectus sheath.
prostheses are essential to try to reduce the amount of
In the sublay technique the mesh is positioned below
foreign material that remains in the recipient after
the rectus muscle, either between the posterior rectus
their implant and thus generate the least fibrosis
sheath and the rectus muscle (subfascial), or above
possible. Although the post implant repair process
the peritoneum between the peritoneum and posterior
induced by LW varies from one recipient to the next,
rectus sheath or muscle (preperitoneal). Both the
it is clear that reducing the extent of fibrosis will
onlay and sublay positioning of the mesh are
prevent the formation of a very compact scar tissue
techniques that reinforce the abdominal wall and also
close the defect surgically. In the inlay technique the
One study was designed to compare the
mesh is placed between the edges of the fascia (the
behavior of three types of PP prostheses, a HW and
layer of abdominal fibrous tissue in which the defect
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3564-3571
Eating Red meat and Symptomatic Lower Urinary Tract Infection among
female students at King Abdul-Aziz University in Rabigh, Saudi Arabia
Iman Mohmad Wahby Salem (1), Soad Shaker Ali (2), Fatma Ibrahim Al Bllady (3),
Ebtihal Mohammed Saleh Albeshri (4)
(1) Family and Community Medicine Department, Faculty of Medicine, Rabigh, KAU and Al-Azhar University,
(2) Anatomy Department, Faculty of Medicine, Rabigh, KAU, (3) Internal Medicine Department, Faculty of
Medicine, Rabigh, KAU, (4) Undergraduate student, Faculty of Medicine, Rabigh, KAU.
Background: Chronic diseases, such as diabetes, hypertension associated-heart disease; and several different cancers
were reported to be linked to high meat consumption. Assessment of urinary nutria-metabolomics was also considered
and reported as a novel tool for dietary styles. Increased consumption of red meat was associated with increased risk of
bladder diseases and infection. Method: This is a cross-sectional study conducted among the Rabigh colleges' female
students throughout 10 months, for measuring the prevalence of symptomatic lower urinary tract infection (LUTI) at
King Abdul-Aziz University, Rabigh, Saudi Arabia, 2019. The questionnaire was distributed among 200 students
through their mobile via WhatsApp. It was calculated by the sample size equation, using a mean prevalence of LUTI
among teenage female. Result: Among the 230 students who received the questionnaire, the response rate was 66%, so
the total current studied sample was 152 female students from different colleges in Rabigh. 75.66% of them in age (15-
24 years), and 24.34% of them were in age (25-30 years), 23.68% of them were married, and 78.29% were eating red
meat. UTI prevalence was 25.66%. There was a high percentage (66.7%) of UTI among the young female (15-24 years),
the married women (35.9%), the group who don't drink enough water (69.2%), and 59.0% with a high rate of eating
meat (2 times/ week). All these differences were found to be statistically significant (P 0.05). Conclusion: LUTI
symptoms seemed to be related to increased trend towards red meat eating besides other factors e.g. water drinking and
Keywords: Eating Red meat, Symptomatic Lower Urinary Tract Infection, female students.
Essential amino acids and micronutrients needed
factors can predispose to cystitis such as mild infections
for body health were well known to be obtained via
(14), chemical irritation and neurogenic over active
consumption of red meat (1). However, chronic
bladder conditions (15). Acute simple cystitis is referred
diseases, such as diabetes (2), hypertension associated-
to conditions involving the bladder mucosal lining
heart disease (3) and several different cancers were
with symptomatic urgency, frequency and suprapubic
reported to be linked to high meat consumption (4,5)
pain (13, 16).
Biomarkers for meat intake could be detected in urine
Acute simple cystitis could be easily self-diagnosed
(6,7). Assessment of urinary nutrimetabolomics as a
and treated by appropriate increase water intake and
novel tool for dietary styles was also reported (8).
simple antibiotic course but if neglected and untreated
Reviewing literature showed that increased
it may be complicated and ending in precancerous
consumption of red meat was associated with increased
bladder changes (17) and in some cases upper tract
risk of bladder cancer e.g. Crippa, et al. (2018) (9) who
involvement with subsequent kidney damage (5)
reported that five cohort studies done on considerable
Decreased quality of life in persons suffering
number of cases pointed to a link between increased red
cystitis via disrupting normal daily activities were
meat consumption and cancer bladder.
reported in conditions associated with lower urinary
Values of urine pH in normal persons ranged
tract disorders (18) and this encouraged the design of
between 4.5 and 8.0. Acidic urine with pH < 6 was
the present study.
known to cause bladder urothelial irritation that is
The main objective of this study was to carry out a
evoking cystitis symptoms (10-12). Cystitis as a symptom
across sectional study to evaluate the prevalence of
of UTI is characterized by bladder pain or discomfort
symptomatic lower tract infection (dysuria, frequency,
and is clinically confused with what was known as
and hematuria) among teenage female students in
bladder pain syndrome (BPS). Some cases with
Rabigh university collages, King Abdul-Aziz
unknown understood etiology are challenging clinical
University and to define its link to their dietary style
problems and so difficult to be diagnosed (13). Many
especially consuming diet rich in red meat.
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3572-3580
Increased Risk of Rheumatoid Arthritis-Related Pulmonary Disease as a
Results of Serum Anticitrullinated Protein Antibody Positivity
Samia Abdel-Hamid Abdel-Mageed1, Eldesoky E. Foda2,
Emam Mohamed Abdel-Azeez3, Seham Abdallah Elazab1*
1Department of rheumatology and Rehabilitation, 2Department of Internal Medicine and Immunology and
Allergy Center, 3Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Correspondence author: Seham Abdallah Elazab, Mobile: (+20)01000263048, E-mail: firstname.lastname@example.org
Background: there is increasing evidence to indicate that autoimmunity as well as inflammatory reactions occur
systemically before development of any clinical sign of joint disease in patients with anticitrullinated protein
antibody (ACPA)positive rheumatoid arthritis (RA).
Objective: The aim of the work was to investigate the potential predictive value of anti-ccp3 for interstitial lung
disease association with RA and to discriminate RA patient who are at potential risk to develop methotrexate (MTX)
induced pulmonary toxicity.
Patients and methods: This cross-sectional study included a total of 50 RA patients who were diagnosed according
to the 2010 American College of Rheumatology / the European League Against Rheumatism classification criteria
for Rheumatoid Arthritis (ACR/EULAR 2010 criteria) for detection of pulmonary manifestations attending at
Physical medicine, Rheumatology and Rehabilitation Outpatient Clinics of Al-Azhar University Hospitals.
Results: there was statistically significant difference between patients with and without interstitial lung disease
(ILD), in high-resolution computed tomography (HRCT) as regards to Tiffeneau-Pinelli index (FEV1/FVC ratio),
except for FEV1/FVC between patients with and without ILD in HRCT, forced expiratory volume in first second
(FEV1), and forced vital capacity (FVC) are often decreased because of the reduction in lung volume, but the FEV1-
to-FVC ratio is maintained or increased in ILD.
Conclusion: RA patients without chest symptoms should not be neglected, pulmonary function testing and HRCT
should be done routinely to pick up early ILD cases.
Keywords: Rheumatoid arthritis, pulmonary disease, PCPA.
(vasculitis and pulmonary hypertension). These changes
Rheumatoid arthritis (RA) is a chronic, systemic,
may reflect chronic immune activation, increased
inflammatory disease that involves synovial joints and
susceptibility to infection (often related to
other organs and extra-articular involvements
immunomodulatory medications) or direct toxicity from
associated with impairment in physical function, higher
disease modifying or biological therapy. Prognosis
morbidity, and premature mortality (1).
varies depending on the type and severity of
Rheumatoid arthritis affects 1% of the population
in developed countries. The incidence and prevalence of
While the rate of some extra-articular manifestations
rheumatoid arthritis in developing countries is thought
of rheumatoid arthritis have decreased with
to be lower, but is difficult to quantify. Although joint
improvements in therapy, the incidence of ILD has
disease is the main presentation, there are a number of
remained fairly stable if not increased ,Whether this
extra-articular manifestations including subcutaneous
reflects an increase in detection or is the result of drug-
nodule formation, vasculitis, inflammatory eye disease
induced lung disease with more aggressive use of anti-
and lung disease (2).
rheumatic agents is not entirely clear (4).
Of these manifestations, lung disease is a major
Methotrexate (MTX) is the most frequently used
contributor to morbidity and mortality. interstitial lung
therapy in rheumatoid arthritis (RA) and is used widely
disease is the only complication of RA increasing in
in many other autoimmune disorders. Pulmonary
prevalence and accounts for approximately 6% of all
toxicity has been reported in patients receiving low
RA deaths (3).
dose MTX, and acute hypersensitivity pneumonitis is
It is critical for the pulmonologist to assess for
the most feared complication.
systemic and articular signs and symptoms of
It has also been suggested that chronic pulmonary
connective tissue disease when evaluating a patient with
fibrosis can be caused by MTX, but specific risk factors
pulmonary disease of unknown etiology as patients may
for the development of pulmonary toxicity in patients
initially present with pulmonary symptoms (2).
treated with low dose MTX have never been
There are a variety of pulmonary manifestations of
rheumatoid arthritis, including pulmonary parenchymal
pathogenesis suggest that One of the consequences of
disease (interstitial lung disease (ILD)) and
the formation of anti-cyclic citrullinated peptide
inflammation of the pleura (pleural thickening and
antibodies(anti-CCP),which are observed in around 55
effusions), airways and pulmonary vasculature
Anatomy and physiology of conductive system
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3581-3588
Subclinical Systolic Myocardial Dysfunction in
Diabetic Patients by 2-Dimensional Speckle Tracking
Muhammad Adel Attia, Muhammad Saad Reihan, Abu Bakr Muhammad Bakr*
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
* Corresponding author: Abu Bakr Muhammad Bakr, Mobile: (+20)01016069202, E-mail: email@example.com
Background: Diabetic cardiomyopathy became a subject of great interest and the evidence for this entity is rapidly
emerging as the incidence of heart failure is increasing in those patients even with no hypertension or coronary artery
disease (CAD). Objective: The current study was aimed at early detection of subtle left ventricular systolic
dysfunction by speckle tracking echocardiography in patients with Diabetes Mellitus with and without hypertension.
Patients and methods: This study included a total of 100 asymptomatic poorly controlled diabetic patients with or
without hypertension and no structural heart disease and 25 age-matched apparently healthy control subjects
attending at Cardiology department, Al-Azhar University Hospital in Damietta. The included subjects were divided
into three groups; Group I (control) consisted of 25 apparently healthy subjects, Group II (diabetic normotensive
group) consisted of 64 patients and Group III (diabetic hypertensive) consisted of 36 patients. The following were
done for all: resting ECG, HbA1c, conventional echo assessment and finally strain imaging with measurement of
LV-GLS and LV-GCS. Results: There was a significant inverse correlation between the duration diabetes, BMI and
LV-GLS. On the other hand, there was no significant correlation between hypertension or HbA1c and
echocardiographic parameters including conventional and strain methods. Patients with higher BMI had more
decrease in LV circumferential strain while patients with longer periods of DM and higher values of BMI had a
decrease on both global LV longitudinal and circumferential strains.
Conclusion: It could be concluded that assessment of left ventricular (LV) systolic function in patients with diabetes
mellitus by speckle tracking echocardiographic modalities can detect subtle LV dysfunction earlier than
conventional echocardiographic measures.
Keywords: DM, CAD, LV.
the speckles during the cardiac cycle, strain and the
The incidence and mortality of diabetes mellitus
strain rate can be rapidly measured offline after
(DM) in and of itself may be increased in patients with
adequate image acquisition (7).
congestive heart failure, irrespective of their
hypertensive or ischemic heart disease status (1).
independent evaluation of multidirectional LV strain in
In an analysis of heart failure with preserved
radial (RS), circumferential (CS) and longitudinal (LS)
ejection fraction (EF), type 2 DM was associated with
directions, and RV longitudinal strain (6).
a significantly increased risk of developing adverse
The study was aimed at early detection of subtle left
outcomes of heart failure (2). To prevent the progression
ventricular systolic dysfunction by speckle tracking
of heart failure in diabetic patients, a sensitive method
echocardiography in patients with Diabetes Mellitus
of diagnosing the presence of diabetic cardiomyopathy
with and without hypertension.
is important (3). However, clinical diagnostic surrogates
to monitor myocardial disease progression in diabetic
PATIENTS AND METHODS
patients are not well established (4).
This study included a total of 100 asymptomatic
Myocardial strain echocardiography can detect
poorly controlled diabetic patients with or without
myocardial damage beyond that indicated by EF by
hypertension and no structural heart disease and 25
assessing myocardial deformation in any direction (5).
age-matched apparently healthy control subjects
Assessment of LV systolic function may be carried
attending at Cardiology department, Al-Azhar
out by either conventional echocardiogram or by
University Hospital in Damietta. Approval of the
speckle tracking strain imaging and several studies
ethical committee and a written informed consent
emerged over last few years reporting the use of speckle
from all the subjects were obtained.
tracking strain imaging to detect subtle changes in the
This study was conducted between August 2018 to
ventricles (6). Speckle-tracking echocardiography has
recently emerged as a quantitative ultrasound technique
The included subjects were divided into three
for accurately evaluating myocardial function by
groups; Group I (control) consisted of 25 apparently
analyzing the motion of speckles identified on routine
healthy subjects, Group II (diabetic normotensive
2-dimensional sonograms. It provides non-Doppler,
group) consisted of 64 patients and Group III (diabetic
angle-independent, and objective quantification of
hypertensive) consisted of 36 patients.
myocardial deformation and left ventricular systolic
and diastolic dynamics. By tracking the displacement of 1) Patients with coronary artery disease.
2) ECG abnormalities.
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3589-3594
Intralesional Vitamin D3 versus Purified Protein Derivatives in
The Treatment of Multiple Cutaneous Warts: Comparative Study
Essam Elden M Mohameda, Moustafa A El Taiebb, Gehad A Abd El- sabourb
a. Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Assuit,
b. Dermatology, Venereology and Andrology, Faculty of Medicine, Aswan University
Corresponding author: Gehad A Abd El- sabour,email: firstname.lastname@example.org
Background: Viral warts are caused by human papillomavirus. Many therapeutic options are available for treating
warts. Newer and effective treatments include intralesional immunotherapy, has been tried in the recent times with
variable success rates. Objective: The aim of this study was to compare the effect of intralesional vitamin D3 versus
purified protein derivative (PPD) in the treatment of multiple cutaneous warts.
Methods: A total of 62 patients were included in the study, each patient had at least 3 common warts, one or more of
them injected with 0.1 of intralesional PPD, one or more injected with 0.5 of vitamin D3 and one or more were control
according to number of warts of each patient and up to 4 sessions. The clinical assessment was done by photographic
measurements at baseline, before each treatment session, and after the completion of treatment.
Results: In PPD-injected lesions. 43 patients (69.4%) showed complete clearance (100%) and 13 patients (20.9%)
showed partial response (25% - 99%). While, in vitamin D3-injected lesions, 22 patients (35.5%) showed complete
clearance while 21 patients (33.9%) showed partial response. On comparing between PPD, vitamin D3 and control,
both PPD and vit D3 were statistically significant compared to control and PPD was more statistically significant than
vit D3 (P3 = 0.019) in effectiveness and less in recurrence rate. Conclusions: PPD and vitamin D3 were found to be
effective, well-tolerated modalities of treatment of multiple common warts. Intralesional PPD was more statistically
significant in effectiveness and less in recurrence rate than intralesional vitamin D3.
Keywords: Intralesional, PPD, cutaneous wart, vitamin D3.
intralesional immunotherapy using PPD and vitamin D3
Warts are common, benign and self-limiting
in the treatment of multiple viral warts.
epidermal proliferations or tumors of the skin and
mucosa caused by HPVs (1). The prevalence of HPV
infection was estimated to be 7-12% (2) .About two thirds
A total 62 patients (28 males and 34 female), aged
of warts regress spontaneously within 2 years (3). Many
6 to 56 years, from Outpatient Clinic of Dermatology,
therapeutic options are available for treating warts, with
Venereology and Andrology, Aswan University
none is uniformly effective (4, 5) .The warts were treated
Hospital, Aswan University, Egypt were included in this
by variable methods, such as topical agents,
study in the period between October 2017 and March
cryosurgery, electrocautery and laser ablation (6, 7).
2018. The study was approved by the Local
Classical treatment lines are limited to local application
Institutional Ethics Committee of Faculty of
and do not act systemically (5). Immunotherapy depends
Medicine, Aswan University. All participants were
on the ability of the immune system to recognize
informed about the nature of the study, and written
bacterial, viral and fungal antigen that induce a delayed-
informed consent was obtained.
type hypersensitivity response to different antigens and
Patients with multiple common cutaneous warts
also the wart tissue, which induce the ability of the
and with a past history of BCG vaccination were
immune system to recognize and eradicate HPVs (8).
included in this study. Immunocompromised patients as
Immunotherapy is indicated in recalcitrant warts,
cancer and HIV patients, pregnant and lactating females,
recurrent warts and extensive warts and difficult to treat
patients with history of hypersensitivity to vitamin D3,
areas as periungual and palmoplantar sites (9). Many
patients with past history of tuberculosis or negative
agent of immunotherapy that have been tried include
tuberculin test and patients received any warts treatment
cimetidine, imiquimod, interferons, Candida albicans
1 month before the start of the study, were excluded
antigens, measles, mumps, rubella (MMR) vaccine,
from this study.
purified protein derivative (PPD) and intralesional
Each patient was assessed by detailed history,
vitamin D3 (10,11) .
Intralesional PPD and vitamin D3 are effective and
photographing the patient at baseline and every 2 weeks
recent modalities for the treatment of warts. So we
after the procedure was performed and follow up of the
undertook a study to compare the safety and efficacy of
patient for 3 months to detect recurrence. All patients
participated in the study had at least three warts. One or
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3595-3599
Arthroscopic Release of Resistant Tennis Elbow
Faisal Hassan Zayed Ismael Ahmed Yassin Waleed A -
bd Allah Salama A -
Department of Orthopedic Surgery, Al-
Azhar Faculty of Medicine
Department of Orthopedic Surgery, Al A
- zhar university hospital, Cairo
Corresponding Author: Waleed Abd-Allah Salama Al-Attar, Mob: 01090745436 E-mail: email@example.com
Background: Lateral epicondylitis is a common cause of lateral elbow pain; characterized as an overuse injury of the
forearm and the wrist extensors. The elbow arthroscopy has an important role for diagnosing and treating many elbow
disorders. Objective: The aim of this study was to evaluate the effectiveness of the arthroscopic intervention as a
minimally invasive procedure in management of resistant cases with tennis elbow after failure of conservative
treatment. Material and methods: A prospective study included 30 patients with resistant lateral epicondylitis
treated with arthroscopic debridement of extensor carpi radialis brevis tendon. This study was carried out in the period
between January 2017 and February 2019 at Al Azhar University Hospitals. The patients were evaluated pre-, intra-
and post-operatively for their elbow function and pain using the following scores: Mayo Elbow Performance Index
(MEPI), Disability of the Arm, Shoulder and Hand (DASH), The Nirschl staging score and visual analog scale (VAS)
for pain. Result: A total of 30 patients (12 male and 18 female) were included. The mean of MEPI score improved
from 71.33 to 92.55, DASH score from 28.53 to 3.18, Nirschl scale improved from 4.13 to 1.47 and pain VAS
improved from 5.27 to 1.47. There was a significant difference between from before to after surgery for the four
functional scores. 2 patients complicated with ulnar nerve injury.
Conclusion: The arthroscopic treatment of tennis elbow was shown to be an effective therapeutic option when
appropriately indicated and performed in refractory cases. It also allowed excellent viewing of joint space for
diagnosis and treatment of any associated pathological conditions with a minimally invasive procedure.
Keywords: lateral epicondylitis, elbow pain, arthroscopic release.
Conservative treatment presents with excellent
Lateral epicondylitis occurs as a result of
results, although surgical treatment becomes an option
repetitive motions involving the forearm and elbow,
when it fails (3-6 months) and in refractory chronic
such as the serving, forehand and backhand motions in
cases (approximately12%). The Arthroscopic treatment
tennis and other racquet sports. It is a common sports
has recently been described as having the advantages of
injury, occurring in up to 50% of athletes whose sports
allowing viewing of the associated intra-articular
involve frequent overarm motions (1).
lesions, not violating the aponeurosis of the extensors
However, the name "tennis elbow" can be
and having shorter rehabilitation period and lower
misleading, because most people who develop it do not
complications rate (10). In this study, 30 patients with
play tennis. The condition can affect anyone who
resistant tennis elbow underwent an arthroscopic
engages in the repetitive motion of one or both
management and evaluated pre-, intra- and post-
forearms, either in sports or during daily activities. The
operatively for elbow function and pain using the
non-inflammatory nature of tendinopathy has been
stressed (2, 3) and it has become clear that tennis elbow
1) Mayo Elbow Performance Index (MEPI).
does not involve an inflammatory process of the
2) Disability of the Arm, Shoulder, Hand (DASH).
common extensor origin. It was proposed that the
3) The Nirschl staging score.
pathology is angiofibroblastic hyperplasia of the
4) Visual analogue scale (VAS) for pain (11).
common extensor origin, especially of the tendon of the
extensor capiradialis brevis (ECRB) (4) in line with the
PATIENTS AND METHODS
other overuse tendinopathies (5).
From January 2017 to February 2019, 30
The diagnosis is mainly clinical, with image
patients with resistant tennis elbow were treated with
modalities such as ultrasound and MRI, to be used only
elbow arthroscopy at Orthopedic Department at Al-
for confirmatory, not diagnostic, purposes (6).
Azhar University Hospitals (Bab El Sharia Hospitals).
The literature is vast regarding types of treatment,
The follow up schedule occurred immediately, 2 weeks,
from rest to surgical intervention. However,
6 weeks and 6 months after the operation.
controversy still exists regarding the best option of
Inclusion criteria: Resistant cases after the failure of
treatment. The initial management of lateral
conservative treatments over a period of more than 6
epicondylitis is conservative, with the use of rest,
months. Exclusion criteria: Presence of concomitant
lifestyle modification, non-steroidal anti-inflammatory
disorders, such as lateral compartment, arthrosis,
drugs, forearm bracing, (7) physiotherapy and local
posterior interosseous syndrome, osteochondritis
steroid injection (8). These measures result in at least a
dissecans of the capitellum and Instability and previous
transient improvement in up to 90% of patients, and 3-
surgery or fracture on the ipsilateral elbow.
8% of patients who are resistant to conservative
treatment, may be surgical candidates (9).
Aim of the work
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3589-3606
Comparison between Fetal Echocardiography and Neonatal
Echocardiography in Diagnosing Congenital Heart Diseases
1Ahmed H. Khorshid*, 1Mohammad Ismail Abd El-KhalekAldeftar, 1Ahmed Al-Habbaa,
1Hassan Abd Elaziz Gaber, 2Ahmed Abd El-Samad Elhewala, 1Mohamed Hesham H. Ezzt
1Department of Cardiology, Faculty of Medicine Al-Azhar University,2Department of Cardiology,
Faculty of Medicine Zagazig University
*Corresponding Author: Ahmed Hesham Khorshid, Mobile: (+20) 01112250557, e-Mail: firstname.lastname@example.org
Backgound: Congenital heart defects (CHD) are the most common congenital malformations. It is six times more
common than chromosomal abnormalities and four times more common than neural tube defects. Congenital heart
disease accounts for approximately 40% of perinatal deaths due to congenital anomalies and more than 20% of
deaths in the first month. Objective: This study aimed to compare the accuracy between fetal and neonatal
echocardiography in diagnosing congenital heart disease.
Patient and methods: This is a retrograde comparative study that included neonates who underwent
echocardiography examination and the results were compared with fetal echocardiographic results available in
historical records from prenatal care. 60 pregnant women were referred for fetal echocardiography. The included
fetuses in the study were 60 fetuses. It was conducted at the Neonatal Echocardiography Unit, Pediatric Department
at Zagazig University Hospitals, from July 2016 to March 2018.
Results: Our study showed that out of the 60 cases, fetal echocardiography detected 8 cases out of 24 cases
diagnosed with CHD (33.3%), while Neonatal echocardiography detected 24 cases out of 24 cases diagnosed with
Conclusion: The present study demonstrated that fetal cardiovascular diseases, either functional or structural, can
be accurately identified by prenatal echocardiography.
Keywords: Fetal echocardiography, Neonatal echocardiography, Congenital heart diseas.
general examination of the heart and the
CHDs occur in nearly 1% of live births. Being
atrioventricular junctions. (4)
six times more common than chromosomal
In addition, there is "basic" and "extended basic"
abnormalities and four times more common than
fetal echocardiography which allows adequate
neural tube defects. The incidence of CHD with
evaluation of the outflow tracts. The overall sensitivity
intrauterine diagnosis ranges from 2.4% to 54%.
of fetal echocardiography ranges from 60% to 100%.
Some countries have high incidence of CHD because
Against this background, a prospective observational
they have instituted an organized policy to perform
study was conducted between two groups of fetuses
heart screening by ultrasound systematically (1).
having antenatal fetal cardiac screening at multiple
Prenatal diagnosis of heart defects can lead to changes
gestational ages for each one, comparing each result
in medical management that may improve clinical
with antenatal and postnatal detailed echocardiography
outcomes. For example, decisions to deliver at tertiary
done by cardiologists to allow calculating its accuracy
care centers with ready access to paediatric medical
and value. (4)
and surgical specialties are associated with decreased
neonatal morbidity and mortality. Prenatal diagnosis
AIM OF THE WORK
can be particularly important in the case of critical
The hypothesis of this study was that
CHDs (those that require surgery or catheterization
echocardiography is a reliable method to diagnose
within the first year of life) that may cause hypoxia and
congenital heart disease in fetuses and neonates.
lead to severe organ damage or death in the absence of
Therefore, the purpose of this work was:
timely intervention (2).
To compare the accuracy between fetal and
Although several risk factors for CHDs have been
neonatal echocardiography in diagnosing CHD.
identified, such as family history, exposure to
teratogenic medications, lack of prenatal vitamin and
SUBJECTS AND METHODS
folic acid use, parenteral CHDs and pregestational
diabetes, the causes of the majority of CHDs remain
This is a retrograde comparative study that included
unexplained. However, the routine use of fetal
(60) neonates who underwent echocardiography exam
screening echocardiography in all obstetric population
and the results were compared with fetal echo results
is still controversial (3). Various gestational ages and
available in historical records from prenatal care. It
various methods of antenatal ultrasound assessment of
was conducted in the Neonatal Echocardiography
fetal heart are currently available. The four-chamber
Unit, Pediatric Department, Zagazig University
view is the most basic assessment. This allows a
Hospitals, from July 2016 to March 2018.
The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (2), Page 3607-3617
Hepatotoxicity of Bare and Polyethylene Glycol Coated Iron Oxide
Nanoparticles and The Protective Role of Virgin Olive Oil in Male Albino Rats
Marwa El-Soudy Abd El-Maqsood Shakra1, Rawya Mohammed Salah El-Din1, Somaya Youssef
Mostafa Hamouda1, Amira Abdel Raouf Mohammed 2 and Rehab Abd Allah Abd Al-Rahman 3.
1 Forensic Medicine and Clinical Toxicology Department, Faculty of Medicine for Girls,
Al-Azhar University, Egypt, 2 Cell Biology Department, National Research Centre in Dokki, Egypt,
3 Histology Department, Faculty of Medicine for Girls, AL-Azhar University, Egypt.
Corresponding Author: Marwa El-Soudy Abd El-Maqsood Shakra, Tel.:01062265656, E-mail: email@example.com
Background: Iron oxide nanoparticles (IONPs) are widely used in various biomedical applications. Polyethylene
glycol (PEG) is most popular coating option, reduce the aggregation problem of uncoated IONPs and lower toxicity.
Liver is a target organ to identify adverse effects of IONPs. Virgin olive oil (VOO) has potent antioxidants and
hepatoprotective effects. Aim: The present work aimed to study hepatotoxicity of bare and PEG coated IONPs in male
albino rats through biochemical and histopathological study and protective effect of VOO.
Materials and Methods: Seventy seven adult male albino rats were divided randomly into 11 groups: control; PEG;
VOO; bare IONPs (15 mg/kg b.wt. and 30 mg/kg b.wt.) with and without VOO and PEG coated IONPs (15 mg/kg
b.wt. and 30 mg/kg b.wt.) with and without VOO. All groups received the treatment by oral gavage daily for four
weeks and then blood samples and livers were collected for biochemical and histopathological examination.
Results and Conclusion: Bare and PEG coated IONPs significantly increase AST, ALT, ALP and total bilirubin and
significantly decrease total protein. Also, all IONPs treated groups showed significant increase in malondialdehyde
(MDA) marker of oxidative stress and significant decrease in SOD and CAT activities (antioxidant markers). All these
biochemical changes significantly improved in PEG coated IONPs compared to bare IONPs. Histopathological
adverse effects were observed in livers of IONPs treated animals. Significant improvement occurred on co-
administration of VOO in these disrupted parameters and improved hepatic tissues damage and function.
Keywords: Iron oxide nanoparticles, polyethylene glycol, virgin olive oil, hepatotoxicity.
and oxygen produced by the mitochondria and creates
Standardization defines nanoparticles (NPs) as
highly reactive hydroxyl radicals and ferric ions (Fe3+)
structures with dimensions of one, two or three
via the Fenton reaction. Hydroxyl radicals generated
dimensions that are within 1 to 100 nanometers.
by the free iron could damage DNA, proteins, lipids,
Because of their small size, the properties of
and polysaccharides in the cellular structure (4).
nanomaterials may differ from the properties of bulk
More attentions have been paid to the natural
materials, which exhibit unique chemical, physical,
antioxidants owing to its protective effects against
optical and electrical properties(1).
metals-induced toxicities, especially whenever
Currently, the most commercially important
reactive oxygen species are involved. Among these
nanomaterial's (NMs) are simple metal oxides, such as
natural antioxidants is virgin olive oil (VOO) which is
iron oxide (Fe3O4, Fe2O3), aluminum oxide (Al2O3),
the main source of fat in the Mediterranean diet (5).
silica dioxide (SiO2), titanium dioxide (TiO2) and zinc
Virgin olive oil is well recognized for its
oxide (ZnO) (2).
antioxidant properties, hypotensive, hypoglycemic,
Iron oxide nanoparticles (IONPs) are applied
cardiovascular, hepatoprotective, antimicrobial and
due to their unique characteristics, such as their small
anti-inflammatory effects. Phenols present in the olive
size, surface chemistry and magnetic properties. Iron
oil are potent antioxidants and scavenge free radicals
oxide nanoparticles have been extensively used during
and inhibit low density lipoprotein (LDL) oxidation.
the last two decades, due to a variety of applications
Olive oil contains a wide variety of antioxidants such
such as contrast agent in magnetic resonance imaging
as vitamin E, oleocanthal and carotenoids (6).
(MRI) or as carriers of biomolecules for controlled
In comparison with other organs, the liver is
drug delivery and induced hyperthermia for cancer
able to accumulate more than 90% nanoparticles.
treatments. Polyethylene glycol has been the most
Activation of Kupffer cells elicits the release of
popular coating polymer. It stabilizes IONPs by
inflammatory mediators and reactive oxygen species
resisting interaction with blood proteins and therefore,
and modulates hepatocyte injury (7).
reduces opsonization, macrophage uptake and
Based on these facts our study was designed to
subsequent monophagocytic system clearance of the
investigate the toxic effects of bare and PEG coated
IONPS on the liver of rats and to study the protective
One of the most important toxic effects
effect of VOO on bare and PEG coated IONPS toxicity
induced by iron oxide nanoparticles is their ability to
in adult male Albino rats through biochemical and
cause oxidative stress. The free iron in the form of
ferrous ions (Fe2+) can react with hydrogen peroxide