c:\work\Jor\vol763_1 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3618-3625

Epidemiology of End Stage Renal Disease Patients on Regular
Hemodialysis in El-Beheira Governorate, Egypt
Mostafa Abdel-Fattah El-Ballat, Mohamed Ahmed El-Sayed, Hossam Kamel Abdel-Raouf Emam*
Department of Internal Medicine, Faculty of Medicine, Al-Azhar University
*Corresponding author: Hossam Kamel Abdel-Raouf Emam, Mobile: (+20)01023650927, E-Mail: dr.hosamnephro@gmail.com

ABSTRACT
Background:
End Stage Renal Disease (ESRD) is associated with severe morbidity, mortality, high cost for
management and different impacts on general health and patient wellbeing. Total number of ESRD patients
requiring renal replacement therapy has been growing drastically.
Objective:
the aim of the present work was to study the epidemiology of End Stage Renal Disease in one of
the Egyptian areas in El Beheira Governorate, for getting some data about the distribution and most common
causes of this disease. Identifying major risk factors on the onset of ESRD is an important part in preventing
the development of ESRD. Patients and Methods: a cross-sectional study was conducted at dialysis centers in
El Beheira Governorate, Egypt, by using questionnaire and direct interviewing technique with ESRD patients,
in addition to using medical records for our data collections to identify major risk factors leading to ESRD.
Results: The prevalence of ESRD patients on regular hemodialysis in El Beheira Governorate, Egypt, was 571
pmp (0.057%). The causes of ESRD in the present study were hypertension (31.7%), diabetes mellitus (18.0%),
obstructive nephropathy (10.8%), glomerulonephritis (4.5%), urinary tract infection (3.9%), Autosomal
Dominant Polycystic Kidney Disease (ADPKD) (2.9%), unknown (21.6%) and other causes such interstitial
nephritis (1.9%) and Systemic lupus erythematous (1.5%).
Conclusion: It could be concluded that increase public awareness about kidney problems and also increase
awareness among primary health care physician about the early detection and prevention of Chronic Kidney
Disease (CKD) will help to identify a probable correctable cause and to prevent progression to CKD.
Keywords: Epidemiology of End Stage Renal Disease, Patients on Regular Hemodialysis, El Beheira
Governorate, Egypt.

INTRODUCTION

End-stage renal disease (ESRD) is increasing
studies suggest that tobacco use is positively
worldwide. Renal replacement therapy (RRT) and
associated with CKD(6). Also, obesity seems to be an
kidney transplantation are increasing the burden on
important and potentially preventable risk factor for
health systems. This condition is particularly serious
chronic renal failure (7).
in developing countries where health resources are
ESRD is one of the main health problems in
inadequate (1).
Egypt. Hemodialysis represents the main mode for
Chronic kidney disease (CKD) is a progressive
treatment of CKD stage 5 (8).
loss in renal function over a period of months or
According to 9th Annual Report of The Egyptian
years. All individuals with glomerular filtration rate
Renal Registry provided by Egyptian Society of
less than 60 mL/min/1.73 m2 for 3 months or more
Nephrology
and
Transplantation
(ESNT),
are classified as having chronic kidney disease(2).
prevalence of ESRD in Egypt raised to 483 patients
Worldwide, the number of patients receiving
per million. Mean age is about 49.8 ± 19 years.
RRT is estimated at more than 1.4 million, with the
Males represented 55.2 % while females were about
annual incident rate growing to 8% (3).
44.8 %. Only about 4 % of patients are HBV positive
ESRD has many causes that vary from one
while HCV positive patients are about 52.1%(9).
patient to another. The key risk factors for chronic
The aim of the present work was to study the
kidney disease (CKD) are the increasing age of the
epidemiology of End Stage Renal Disease in one of
population, diabetes mellitus and hypertension and
the Egyptian areas in El Beheira Governorate, and
medications, such as the use of analgesics regularly
from this study we can get some data about the
over long durations of time resulting in analgesic
distribution and most common causes of this
nephropathy and kidney damage. Polycystic kidney
disease. Identifying major risk factors on the onset
disease is an example of a hereditary cause of CKD
of ESRD is an important part in preventing the
(4). In many Arab countries, obstructive uropathy
development of ESRD.
constitutes a major cause of ESRD (40%). The two

most common underlying causes are renal calculi
PATIENTS AND METHODS
and schistosomiasis. In many developing countries,
This cross-sectional study was conducted at
chronic glomerulonephritis is often caused by
dialysis centers in El Beheira Governorate, Egypt,
infections and infestations, and is a leading cause of
by using questionnaire and direct interviewing
CKD (5).
technique with ESRD patients, in addition to using
The body of evidence for other modifiable risk
medical records for our data collections.
factors such as lifestyle factors is growing as some
3618
Received:15/4/2019
Accepted:14/5/2019

Full Paper (vol.763 paper# 1)


c:\work\Jor\vol763_2 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3626-3632

Percutaneous Medial Collateral Ligament Release in Arthroscopic
Medial Menisectomy in Knees with Tight Medial Compartment
Ismail Ahmad Hammouda, Mohamed Abdelrahman Elnahas, Mahmoud Sabry Mahrous Khodair
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mahmoud Sabry Mahrous Khodair,email:mahmoudkhodair655@gmail.com

ABSTRACT
Background:
In tight knee joints with a narrow medial joint space, there is a risk of iatrogenic articular cartilage
injury, even by an arthroscopy specialist which may predispose to osteoarthritis of the knee.
Objective: The aim of the study was to detect if there is any residual knee laxity after the Pie- crusting technique or
any other complications.
Patients and methods: This prospective randomized analytical clinical study included a total of thirty patients with
torn posterior horn of the medial meniscus with tight medial compartment of the knee attending at the Department
of Orthopedics and Traumatology, Al-Azhar University Hospitals. In this study percutaneous release of the medial
collateral ligament was done. Results: All the patients complained post-operative pain over the site of the release
(grade I MCL sprain) that has resolved within 1-2 weeks.
Conclusion: It could be concluded that in cases with tight knees, the Pie-crusting technique is safe and efficient for
visualization of the posterior horn of the medial meniscus. It allows the avoidance of causing iatrogenic chondral
damage or fracture of the medial femoral condyle.
Keywords: Medial collateral ligament.

INTRODUCTION

ligamentous structures with the use of needles. Also
The posterior horn of the medial meniscus is
we were concerned about studying the possible
a common site of meniscal tears. Unrestricted
complications especially residual medial laxity.
arthroscopic visualization of the posterior horn of the
The aim of the current study was to detect if
medial meniscus is crucial to perform adequate
there is any residual knee laxity after the Pie-
menisectomy. In patients with tight knees, the medial
crusting technique or any other complications. It also
femoral condyle makes the visualization of the
aimed to evaluate the effect of percutaneous release
posterior horn of the medial meniscus and the usage
of the superficial medial collateral ligament (pie-
of instruments is very difficult. So in tight knees, this
crusting technique) in patients with tight medial
area is reported to be one of the greatest sources of
compartment of the knee undergoing partial
diagnostic errors in knee arthroscopy (1,2).
menisectomy for torn posterior horn of the medial
Vigorous
manipulations
with
the
meniscus.
instruments in cases with tight knees may cause

iatrogenic chondral damage which may contribute to
PATIENTS AND METHODS
degeneration of the articular cartilage and
This prospective randomized analytical clinical
osteoarthritis (3,4). Also this inadequate visualization
study included a total of thirty patients with torn
may lead to insufficient menisectomy, with the left
posterior horn of the medial meniscus with tight
meniscal fragment might result in continued
medial compartment of the knee attending at the
symptoms and reoperation (5,6). Meniscal pathologies
Department of Orthopedics and Traumatology, Al-
may be missed as a result of this inadequate
Azhar University Hospitals. Approval of the ethical
visualization. Moreover this vigorous manipulation
committee and a written informed consent from
to open the medial compartment, may result in
all the subjects were obtained. This study was
rupture of the medial collateral ligament (MCL) or
conducted between February 2018 and April 2019.
even fracture of the femur (7,8) .

Agneskirchner
and
Lobenhoffer
(3),
All patients were selected according the
Agneskirchner et al (9), Bosch (10), Park et al (11) and
following criteria: Age: skeletally mature patients.
later Fakioglu et al (12) described a minimally
Both sexes were included. Torn posterior horn of the
invasive technique to open the medial compartment
medial meniscus in a patient with a tight medial
by puncturing the postero-medial capsulo-
compartment of the knee. Athletes and non- athletes.
ligamentous structures percutaneously with the use
No malalignment that needs corrective osteotomy.
of a needle. Although they reported that the injured
No other ligamentous injuries. No osteoarthritis. No
structures healed uneventfully, there were no data on
any other articular lesions.
the injury localization, healing patterns or

complications.
Preoperative evaluation
In this study, we used the same technique as
History: Gender, affected side and cause of
described by Fakioglu et al (12) to enlarge the medial
injury (Table 1). 26 male patients and 4 female
joint space in tight knees, which is, percutaneous
patients were included. Of the thirty patients, 20
puncturing of the postero-medial capsulo-
patients had torn PHMM of the right knee and 10
3626
Received:9/4/2019
Accepted:8/5/2019

Full Paper (vol.763 paper# 2)


c:\work\Jor\vol763_3 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3633-3640

Ultrasound Guided Platelet Rich Plasma Injection in
Patients with Primary Knee Osteoarthritis
Ali Eed El-Deeb, Amal Mohamad EL-Barbary, Radwa Mostafa El Khouly, Nevien Ibrahim Elfeky *
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University
*Correspondence author: Nevien Ibrahim Elfeky, Mobile: (+20)01126726758, E-mail: nova_elfeky87@yahoo.com

ABSTRACT
Background:
Osteoarthritis is a leading cause of pain, disability, and socioeconomic cost worldwide and the knee is
one of the most commonly affected joint.
Objective:
to evaluate clinical and functional therapeutic effect of ultrasound guided intraarticular or periarticular
platelet rich plasma (PRP) injection in treatment of patients with primary knee osteoarthritis.
Patients and Methods: eighty patients with primary knee osteoarthritis were divided into two groups: Group I: 50
knees, group II: 30 knees. Both groups were treated by PRP injection into the lateral recess of the knee group I or into
painful periarticular structure that have previously been identified on ultrasound group II.
Results: The VAS in group I (6.3±1.45) and II (6.57±1.30) significantly improved after injection (1.30±0.97 and
1.43±0.77; p<0.001). The range of movement (ROM) (flexion) significantly improved in both groups after injection.
The WOMAC significantly improved in both groups after injection (p<0.001); (group I: 14.04±7.73 vs group II:
15.20±7.12). The KOOS score significantly improved in group I (41.93±11.05 to 75.43±7.70; p<0.001) and group II
(39.83±12.46 to 76.08± 7.12; p<0.001) after injection. There was a significant improvement in the percentage of
different parameters in mild and moderate knee osteoarthritis in both groups.
Conclusion: Ultrasound guided single dose PRP injection is a safe and effective method for treating all grades of knee
OA mainly mild to moderate also injection in periarticular pain generator structures reduce pain and improve knee
function.
Keywords: Knee, Osteoarthritis, Ultrasound-guided injection, Platelet rich plasma.

INTRODUCTION
Ultrasound-guided PRP injections have become a quick
Osteoarthritis (OA) is a leading cause of pain,
and safe procedure (6).
disability, and socioeconomic cost worldwide and the
PRP is a whole blood fraction containing high platelet
knee is one of the most commonly affected joint. The
concentrations. Platelets are closely involved in
epidemiology of the disorder is multifactorial, with
hemostasis, inflammation, innate and adaptive
genetic, biological, etiological and biomechanical
immunity, tissue regeneration and other physiological
components(1).
and pathological processes. Platelets enclose dense
The clinical diagnosis of primary knee osteoarthritis
granules that release a wide range of bioactive
is based on patient history and physical examination and
substances in response to agonists. When activated,
radiological findings. Ultrasound has proven to be a non-
platelet
membranes
release
thrombotic
and
invasive, safe and is more sensitive than clinical
inflammatory agents, which may take an active part in
examination for diagnosing pathologic conditions of the
the
pathophysiology
of
autoimmune
and
knee joint, including the tendons, ligaments, muscles,
autoinflammatory disorders(9). In addition to various
synovial fluid, articular cartilage, nerves, and
growth factors which participate in tissue repair
surrounding soft tissues. In addition; color and power
processes to accelerate the healing response and to
Doppler techniques can be used to measure
enhance the regeneration of bones and soft tissues (10,11).
neovascularization of the synovial joints lining, tendons,
The aim of this study was to evaluate clinical and
and soft-tissue masses (2-4). Ultrasonic guidance injection
functional therapeutic effect of intraarticular or
can be a valid tool to select a proper injection site, to
periarticular PRP injection guided by ultrasound in
increase the efficacy and reduce complications of blind
treatment of patients with primary knee osteoarthritis.
injection (5). Ultrasound-guided injection was effective in

different lesions as plantar fasciitis (6) and rotator cuff
AIM OF THE WORK
tendinopathy (7).
To evaluate clinical and functional therapeutic effect
Treatment of primary knee OA aims to relieve pain
of ultrasound guided intraarticular or periarticular
and restore knee function. Conventional therapies
platelet rich plasma (PRP) injection in treatment of
include activity modification, oral medication, nutrition,
patients with primary knee osteoarthritis.
physical therapy and joint injection(8). The use of PRP as

a biological solution for pain relief and functional
PATIENTS AND METHODS:
improvements in patients with primary knee OA has
Inclusion criteria: This randomized control study was
gained popularity over the last several years.
carried out on 80 knees of 80 patients with primary knee
osteoarthritis selected from the Outpatient Clinic of
3633
Received:16/4/2019
Accepted:15/5/2019

Full Paper (vol.763 paper# 3)


c:\work\Jor\vol763_4 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3641-3646

Factors Predicting Male Satisfaction after Penile Prosthesis Implantation
Alsaeed Abd Elbadea Alsayed*, Magdy Mohamed Sabrh, Yaser Ali Badran
Department of Urology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Alsaeed Abd Elbadea Alsayed, Mobile: +201019965424, Email: saeedaldmoky@gmail.com

ABSTRACT
Background:
penile prosthetic surgery is associated with satisfaction rates> 90% for the general implant population.
However, it is suggested that satisfaction rates may be lower in certain populations.
Objective:
to analyze the factors affecting male satisfactionrates after penile prosthesis implantation (PPI).
Patients and Methods: this observational retrospective and prospective study included all patients who underwent PPI
surgery at Al-Azhar University Hospitals [Al-Hussein and Sayed Galal]; Cairo; Egypt during the period from January
2015 to May 2019. One hundred and three men were eligible for the study. The age of patients, body mass index (BMI),
associated medical co-morbidities, etiology of erectile dysfunction (ED), duration of ED before PPI, date of the surgery,
and intra- and post-operative complications were evaluated. Men`s satisfaction with PPI was evaluated at a time point at
least 6 months postoperatively by using the validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP)
questionnaire. Results: seventy-six (73.8%) subjects were highly satisfied while 27 (26.2%) were less satisfied. The BMI
of highly satisfied subjects was significantly lower than those less satisfied (21.3±2.2 kg/m2 vs. 27.5±1.4 kg/m2; p<0.001)
and a significant positive relationship was found between BMI and less satisfaction.
Conclusion: the increase in is male“s BMI has a negative impact on his satisfaction levels post PPI; with every unit
increase in male“s BMI > 24.5 kg/m2, there is increase in the risk of less satisfaction by 11.1 times.
Keywords: Penile prosthesis implantation (PPI), Satisfaction, Erectile dysfunction (ED), Quality of Life and Sexuality
with Penile Prosthesis (QoLSPP) questionnaire.

INTRODUCTION


PPI is a valuable surgical treatment for erectile
PATIENTS AND METHODS
dysfunction and is currently proposed as a third-line
This observational retrospective and prospective
treatment for patients who do not respond or reject other
study included all patients who underwent PPI surgery at
erectile dysfunction treatments (1).
Al-Azhar University Hospitals (Al-Hussein and Sayed
The satisfaction of the patient and the partner is
Galal), Cairo, Egypt, during the period from January
the most important end point of PPI(2). Men's satisfaction
2015 to May 2019.
with PPI revealed (1) psychological factors include
The Research Ethics Committee of our
positive emotions, self-esteem, confidence, the
institution approved the study protocol and all
promotion of male identity, direct living change, self-
participants provided an informed written consent
image;(2) improve the sexual function that indicates
before inclusion.
vaginal penetration, increase sexual desire, sexual
Patients with unstable sexual relationship,
satisfaction, penis size, and improve erectile function; (3)
genital anomalies and gonadal hormones disturbance
relationship factors that indicate improved relationship
were excluded. One hundred and three men were eligible
and partner satisfaction (3,4).
for inclusion.The age of patients, body mass index
Advances in penile prosthetic device design and
(BMI), associated medical co-morbidities, etiology of
refined surgical technique have resulted in improved
erectile dysfunction (ED), duration of ED before PPI,
postoperative outcomes with fewer problems such as
date of the surgery, and intra- and post-operative
mechanical failure or infection(5). Thus, patients report
complications were evaluated. Men`s satisfaction with
levels of general satisfaction as high as 90% (6,7).
PPI was evaluated at a time point at least 6 months
However, it is suggested that satisfaction rates may be
postoperatively by using the Quality of Life and
lower in certain populations(8).
Sexuality
with
Penile
Prosthesis
(QoLSPP)
Although there are several studies examining the
questionnaire, which was developed and validated in a
outcomes and satisfaction rates post PPI, as far as we
cohort of patients treated with PPI for ED(9).
know the factors affecting the satisfaction levels post PPI

have not been well studied.
Statistical Analysis

The collected data were organized, tabulated
AIM OF THE WORK
andstatistically analyzed using statistical package
It is to analyze the factors affecting male
forsocial science (SPSS) version 25 software.
satisfactionrates after PPI in Al-Azhar University
Data were explored for normality using
Hospitals (Al-Hussein and Sayed Galal), Cairo, Egypt.
Kolmogrov-Smirnov test and Shapiro-Wilk test.
3642
Received:17/4/2019
Accepted:16/5/2019

Full Paper (vol.763 paper# 4)


c:\work\Jor\vol763_5 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3647-3652

Management of Lumbar Disc Prolapse Associated with Retrolisthesis
Ibrahim G. Ewaiss, Mustafa M. Abo Elkheir, Adnan M. Albanna*
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University
*Corresponding author: Adnan M. Albanna, Mobile: 01111142290, Email: A_A5005@yahoo.com

ABSTRACT
Background:
retrolisthesis is the posterior displacement of one vertebral body in relation to the adjacent vertebrae
to a degree less than a dislocation. However, lots of neurosurgeons consider retrolisthesis as incidental finding a
rising prove that it is not a rare condition and a cause of many backaches.
Aim of work: to compare between discectomy with or without fixation as regards to pain, function and rate of
reoperation in patients with lumbar disc prolapse associated with retrolisthesis.
Patients and Methods: This study is prospective and retrospective study in fifty cases of patients with single level
of lumbar disc prolapse associated with retrolisthesis in Al-Azhar University hospitals and Health Insurance
hospitals in time between 2018 and 2019. Twenty-four patients were undergone discectomy alone and 26 patients
were undergone discectomy plus lumbar fusion surgery.
Results: the main level of retrolisthesis is L5-S1 with higher incidence than other high levels. Sixty six percent (33
cases of 50) and conservative treatment plays an important role in initiation of treatment but surgery by discectomy
and fixation according to case demand is the main convenient solution.
Conclusions: In this study we showed that patients with lumbar disc prolapse with retrolisthesis should be managed
by discectomy alone in cases presented with radicular pain more than low back pain with dynamic study shows no
instability. And should be managed by discectomy and fixation in cases presented with low back pain more than
radicular pain with dynamic study showing instability or MRI finding shows advancing facet arthritis.
Keywords:
Retrolisthesis, Lumbar disc prolapse, discectomy, fixation.

INTRODUCTION

Retrolisthesis is the posterior displacement of
Retrolisthesis is comparatively rare but when
one vertebral body in relation to the adjacent
present has been accompanied by increased back pain
vertebraeto a degree less than a dislocation(1).
and impaired back function. It is associated with
Complete Retrolisthesis - The body of one
increased by a degree and thus diminished function of
vertebra is posterior to both the vertebral body of the
the spine. It is correlated with a decline in lumbar
segment of the spine above as well as below.
lordosis, endplate, inclination and segmental height.
It's classified as:
Retrolisthesis hyper loads as a minimum one disc and
·Stair stepped Retrolisthesis - The body of one
puts shearing forces of the anterior longitudinal
vertebra is posterior to the body of the spinal segment
ligament, the annular rings, nucleus pulposus and
above, but is anterior to the segment below.
cartilage end plate ligament. A small number of
·Partial Retrolisthesis - The body of one vertebra
studies have been done to date and little is known
is posterior to the body of the spinal segment either
about retrolisthesis. There is a possible association
superior or inferior. Since the vertebral body in a
between retrolisthesis and increased back pain and
retrolisthesis moves in a backward direction, the
reduced back function ( 3).
grading used for retrolisthesis is of little use. It is on
Little is known about the effect of retrolisthesis
the other hand useful to divide the anterior to posterior
in patients with surgical conditions such as lumbar
dimension of the intervertebral foramina (IVF) into
disc herniation. Retrolisthesis has an impact of a
four equal units. A backward displacement of up to ¼
variable nature on nerve tissue and mechanical impact
of the IVF is graded as Grade 1, ¼ to ½ as Grade 2, ½
on the spinal joints themselves. Structural instability
to ¾ as Grade 3, ¾ to total occlusion of the IVF as
differs from the local discomfort to structural
Grade 4.
compensatory distortion involving the whole spine.
Otherwise, a measurement of the degree of
With joint involvement, there may be changes in
displacement can also done by calculating the bone
posture and range of motion which depend upon the
displacement in millimeters(1).
degree of vertebral displacement. The soft tissue of
Retrolisthesis may be found more commonly
the disc is often tend to bulge in retrolisthesis. The
than initially believed. Series have shown that
ability to move freely may also be limited.
retrolisthesis may be present in up to 30% of
Majority of retro positions are asymptomatic,
extension radiographs of patients complaining of
though such a subluxation tends to displace nerve
chronic low back pain. Retrolisthesis has been
roots cranially and leading to lateral entrapment from
brought into being associated with disc herniation,
the superior facet from the segment below.
decrease in lumbar lordosis, and reduction in
Retrolisthesis has sizable effect on a variable nature
vertebral endplate angle( 2).
on nerve tissue and mechanical impact on the spinal
3647
Received:14/4/2019
Accepted:13/5/2019

Full Paper (vol.763 paper# 5)


c:\work\Jor\vol763_6 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3653-3658

Serum Protein and Prolactin in Evaluation of Uterine Fibroids
Abd Al Azim Mohamed Ahmed1, Osama Mohamed Deif1, Salma Saad Abd Al-Latif2,
Ahmed Mohamed ELHussieny Mohamed1*
Departments of 1Obstetrics and Gynecology and 2Clinical Pathology, Faculty of Medicine ­ Al-Azhar University
*Correspondence author: Ahmed Mohamed ELHussieny Mohamed; Mobile: (+20) 01022556826

ABSTRACT
Background:
uterine fibroid (leiomyoma) is the most common benign uterine tumors in women of reproductive
age. The majority of leiomyomas are asymptomatic, however up to 20% cause menorrhagia, pelvic pain and
genitourinary symptoms.
Objective:
the aim of the study was to evaluate using of total protein or serum prolactin as a marker for evaluation
and follow up of uterine leiomyomas.
Patients and Methods:
a randomized, controlled clinical trial study design was utilized to prove the relation between
uterine fibroid and serum prolactin and serum protein. The study was performed at Obstetrics and Gynecology
Department in AL Hussein Hospital. 100 females have myoma of different sizes are included in this research.
Results: it was concluded that serum total protein and albumin levels in patients with elevated serum TNF levels
were significantly lower (p < 0.05) than the corresponding values in patients with undetectable serum TNF levels.
The study concluded that prolactin (PRL) levels are decreased following surgical therapy in patients with uterine
fibroids. In addition, a slight increase in serum total protein was detected after surgery in uterine patients.
Conclusion:
in conclusion, a highly significant correlation was found between serum PRL and its ratio with serum
total protein. This result ensured and supported the relation between the patient's serum PRL and serum total protein
with their fibroid number. This enables to suggest these variables as a simple biochemical marker supporting other
clinical findings.
Keywords: Serum protein, Prolactin, Uterine fibroids.

INTRODUCTION
signal transducers, and activators of transcription
Uterine leiomyomas are benign tumors affecting up
(JAK/STAT) pathways. Although, it is isolated as a
to 60% to 80% of reproductive aged women. The
pituitary hormone, prolactin is expressed in other
majority of leiomyomas are asymptomatic, however up
tissues including uterine leiomyomas (5).
to 20% cause menorrhagia, pelvic pain, and
Total Protein:
genitourinary symptoms (1). Leiomyomas grow in the
Serum total protein test measures the total amount of
presence of gonadal steroids, disproportionally affect
albumin and globulin in the blood. Values below the
women of African descent and are associated with 10%
normal threshold usually are associated with nutritional
of infertility cases. The diagnosis of uterine fibroids is
deficiency, liver and kidney disease or prolonged
usually achieved through radiographic modalities or
hemorrhage or anemia. Elevated total protein values
surgical procedures (2). The sensitivities and
can be a marker of chronic inflammation or
specificities of available diagnostic tools vary;
malignancies such as multiple myeloma. In a
currently, they range from 50% and 20% for
prospective trial examining total protein as a biomarker
hysterosalpingogram (HSG), 90% and 87% for
for uterine leiomyomas, the serum total protein level
transvaginal ultrasound, and approach 100% for
was lower in patients with uterine fibroids before they
magnetic resonance imaging (MRI)(3).
underwent
hysterectomy
for
leiomyomas
or
Biomarkers are biologic compounds that can be
myomectomy (6).
obtained from the serum or other easily accessible

tissue. They are a reflection of normal physiology or a
AIM OF THE WORK
pathologic process. They are useful in a variety of
The aim of the study was to evaluate using of total
clinical situations that involve detection of subclinical
protein or serum prolactin as a marker for evaluation
disease, risk stratification, preoperative planning,
and follow up of uterine leiomyomas.
treatment monitoring, and diagnosis. Serum biomarkers

for uterine leiomyomas that accurately diagnose,
PATIENTS and METHODS
differentiate, or monitor response to therapy are
Design of study: A randomized, controlled clinical trial
currently absent from the clinician's arsenal (4).
study design was utilized to prove the relation between

uterine fibroid and serum prolactin and serum protein.
Potential biomarkers
Setting of study: The study was performed at
Prolactin
Obstetrics and Gynecology Department in AL Hussein
Prolactin is a protein hormone involved in a variety of
University Hospital.
mammalian physiologic actions such as lactogenesis.
Population of study: 100 females have myomas of
Prolactin mediates its function by interacting with type-
different sizes are included in this research.
1 cytokine receptors and signals through Janus kinase,
2653
Received:18/4/2019
Accepted:17/5/2019

Full Paper (vol.763 paper# 6)


References The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3659-3664
Uterine Tamponade Using Condom Catheter Balloon in The Management of
Non-Traumatic Postpartum Hemorrhage
Mohammed Khaled Mostafa, Abd El-Samea Hassan Khalifa, and Mohammed Shaaban Hamid Rady*
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mohammed Shaaban Rady, Mobile: (+20)01272324339, E-Mail: mohammed rady480@gmail.com

ABSTRACT
Background:
uterine tamponade can be lifesaving in PPH associated with deranged coagulation; as such women
are at high risk for surgical intervention or angiographic embolisation. Successful tamponade with Rusch balloon
catheter, Sengstaken-Blakemore tube, rolled gauze and recently with condom catheter are reported.
Objective: the aim of this research was to study the efficacy and complications of uterine tamponade using
condom catheter balloon in non-traumatic postpartum hemorrhage.
Patients and Methods: this single-arm prospective study, that was conducted in Kafr Al-Dawar General Hospital
and Al-Hussein Hospital. Twenty patients with non-traumatic postpartum hemorrhage not responding to medical
treatment were included in this study.
Results: outcome measures were the success rate in controlling hemorrhage, time required to stop bleeding, need
for additional surgical measure, use of anesthesia, subsequent morbidity in terms of infection (measured by fever,
total leucocyte counts >12 000 mm3 over next 5 days) and technical difficulties. There was significant statistical
relation between volume of fluid in condom tamponade and pain in relation to the success in control of PPH in 15
min (P >0.05). There was no significant statistical relation between age, gestational age, Parity, fever and total
leucocytes count in relation to the success in control of PPH in 15 min (P <0.05).
Conclusion: condom catheters control PPH effectively and quickly. It is a simple, inexpensive and safe method of
conserving the reproductive capacity along with saving the life of women with primary PPH.
Keywords: Uterine tamponade, Condom catheter balloon, Non-traumatic postpartum hemorrhage

INTRODUCTION


Normal labor includes 4 stages: The 1st stage
Thrombin (< 1%): Coagulation abnormalities(3).
begins with the onset of labor and ends with full
A tony is by far the most common cause of
cervical dilation followed by the 2nd stage of labor
postpartum hemorrhage. Uterine contraction is
including the interval between full cervical dilation
essential for appropriate hemostasis, and disruption of
and the delivery of the infant, then the 3rd stage of
this process can lead to significant bleeding. Uterine
labor which is the duration from the birth of the infant
atony is the typical cause of postpartum hemorrhage
to the delivery of the placenta, umbilical cord and
that occurs in the first 4 hours after delivery.
fetal membranes, the 4th stage or puerperium follows
Guidelines for the management of postpartum
delivery and concludes with the resolution of the
hemorrhage (PPH) involve a stepwise approach
physiologic changes of pregnancy usually by 6 weeks
including the exclusion of retained products and
postpartum in which the reproductive tract returns to
genital tract trauma. Uterine atony, which is the most
the non-pregnant state and ovulation may resume (1).
common cause, is dealt with uterine rubbing and
During the third stage of labor complications
various uterotonic agents such as oxytocin,
are common and can threaten the mother's life. The
ergometrine, misoprostol and prostaglandin F2a
most
common
complication
is
postpartum
(PGF2a) (4).
hemorrhages (PPH), which remains a leading cause of
Recently, uterine balloon tamponade has been
maternal mortality, especially in developing countries
added to this armamentarium in the management of
(25.0%), with placental retention and uterine atony
PPH (5, 6, 7), the purpose of this research is to evaluate
are underlying causes of prolonged 3rd stage leading
the use of uterine balloon technique currently
to postpartum hemorrhage. Women who survive PPH
available for the management of PPH.
are likely to suffer from anemia and other
Uterine packing is the most basic method
complications (2).
described for tamponade(8) and recently, balloon
The common causes of PPH are referred to as
technology, using the principle of a fluid-filled
the `Four T's' and in order of most to least commonly
structure exerting a tamponade effect to stop bleeding
occurring are (3): 1-Tone (70 %): Atonic uterus, 2-
has been used in the management of atonic PPH.
Trauma (20%): Lacerations of the cervix, vagina and
Successful results have been shown by many
perineum, Extension lacerations at CS, Uterine
researchers using a Sengstaken-Blakemore tube,
rupture or inversion, 3-Tissue (10%): Retained
Rusch urologic balloon 5 or condom catheter balloon.
products, placenta (cotyledon or succenturiate lobe),
Bakri Surgical Obstetric Silicone (SOS) balloon is
membranes or clots, abnormal placenta and 4-
specially designed to control obstetric hemorrhage

using pressure and tamponade effect (4, 9).
3659
Received:18/4/2019
Accepted:17/5/2019

Full Paper (vol.763 paper# 7)


c:\work\Jor\vol763_8 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3665-3672

Arthroscopic Management of Meniscal Root Injury
Younus Akl, Emad Zayed, Mahmoud Maher
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mahmoud Maher,email: mahercordoba@gmail.com

ABSTRACT
Background:
Meniscal root tear s are becoming increasingly recognized. They can cause rapidly progressive arthritis.
Purpose: The purpose of this study was to document the radiological and functional outcome of arthroscopic
management of meniscal root tears injuries. Patients and Methods: This study was held on 20 patients suffered from
meniscal root tears at Al-Azhar University Hospitals. There were 11 males and 9 females with mean age 41.63 (23-
50) years old. All patients were evaluated preoperatively and postoperatively with mean follow up 6 months.
Results: Clinical outcome measures significantly improved after surgery. Preoperatively there were 13 patients (65%)
had poor score and 7 patients (35%) had fair score. Postoperatively there were 3 patients (15%) had poor score, 4
patients (20%) had fair score, 6 patients (30%) had good score and 7 patients (35%) had excellent score. The mean
IKDC score for meniscal repair increased, and the mean IKDC score for partial meniscectomy increased. Postoperative
MRI showed complete healing in 12 patients and failure in 8 patients.preoperative ME was 3 mm in 17 patients and
3 mm in 3 patients .postoperative ME was 3 mm in 11 patients and 3 mm in 9 patients. Conclusions: Meniscal
root repair has increased in popularity and when done in selected patients results in a high rate of healing and restoring
the ability of the meniscus to dissipate axial tibiofemoral loads, thereby slowing or halting arthritic progression.
Keywords: Root tear injury, partial menisectomy, pullout suture repair.

INTRODUCTION
PATIENTS AND METHODS
The meniscus roots are responsible for meniscal
This prospective cohort study was approved by the
stability, which is necessary for proper meniscal
Ethical Committee of Al-Azhar University. A total of
function. Without the meniscus root attachments, the
20 patients with root tears were treated in Al-Azhar
meniscus would be unstable (1).
University Hospitals using arthroscope. All patient were
A meniscus root tear is described as a radial tear
signed an informed consent form.
or avulsion at the posterior horn attachment to bone for
We include patients with meniscal root tears either
medial or lateral meniscus (2).
traumatic or degenerative.
Medial meniscal tears are common in patients
Exclusion criteria were: a) elder patients, b) poor
with chronic ACL insufficiency, while lateral meniscal
surgical candidates, c) initial bone marrow edema
tears is found in acute ACL injuries (3). Specifically,
because of change loading in the compartment greater
meniscal root tears result in a loss of hoop stress, as well
varus mechanical axis deviation.
as functional load distribution, exposing the articular
There were 11 males and 9 females with mean
cartilage to abnormal forces that are comparable to those
age 41.63 ± 9.7 and range 23 to 50 years old.
following total meniscectomy (4).
All patients had preoperative clinical assessment in the
MRI diagnosis of root tear is based on the
form of general and local examination and special tests
presence of radial tears on the axial plane, signs of
as Payr's test and McMurray test.
truncation and extrusion on the coronal plane, and the

ghost sign from the sagittal plane (5).

Figure (1): Images - MRI with knee coil. A - Ghost

sign- sagittal plane. B - Radial linear defect in axial
Fig (2): Mcmurrays test. The tibia rotated on the femur
plane. C- Vertical linear defect in coronal plane.
in to full internal rotation and (fig b) rotated in to full
Treatment of root tear is partial meniscectomy
external rotation (10).
for degenerative tear (6). In comparison, root tear repair
MRI was done as routine preoperative
focuses on restoring hoop tension and preventing
investigation to assess meniscal root tear.
progression to degenerative arthritic changes. The repair
All patients were assessed preoperative by
methods can be divided into pull-out suture (7) or suture
Lysholm and IKCD score.
anchor techniques (8).
Operative technique:
Arthroscopic partial meniscectomy is normally
Surgical technique:
effective in eliminating mechanical and irritative
All the patients were anaesthetized by spinal
symptoms associated with a damaged meniscus (9).
anesthesia. Patients were placed in the supine position.

3665
Received:14/4/2019
Accepted:13/5/2019

Full Paper (vol.763 paper# 8)


Evaluation Of Different Techniques In Management Of Hypospadias Cripples The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3673-3677
Comparative Study between Oral Zinc Sulphate versus Electrocautery in
Treatment of Patients with Recurrent Warts
Mohamed Abdel Moneim Abdel Aal1, Hamed Mohamed Abdo1,
Mohamed Abdel Latif Hasheesh2, Mohamed Masoud Abdel Gayed1*
Departments of 1Venereology and Anrology and 2Clinical Pathology, Faculty of Medicine,
Al-Azhar University, Cairo, Egypt
*Correspondence author: Mohamed Masoud Abdel Gayed, Mobile: (+20)01156808000, E-mail: ebn.masoud2020@gmail.com

ABSTRACT
Background:
viral warts are benign proliferations of the skin and mucosa that are caused by HPV infection. They
consider common and major health problem. Zinc can be a therapeutic option by medulating the immune system in
patients with viral warts.
Objective: the aim of this work was to compare the effect of oral zinc sulfate versus electrocautery in treatment of
patients with recurrent warts.
Patients and Methods: this study was carried on 90 patients with common warts. The patients were divided into
three groups (A, B, C) of 30 patients. Group A consisted of 30 patients treated with oral zinc sulfate, 30 patients in
group B treated by electrocautery while group C was given placebo in the form of starch capsules.
Results: our results showed more improvement in group of electrocautery than in the group of zinc sulphate, and
showed increase in complications in electrocautery group with statistically significant difference. In this study there
was a positive correlation between percentage of improvement and serum level of zinc with a significance increase
in the serum zinc level before and after treatment in zinc sulphate group.
Conclusion: this study showed that the role of oral zinc sulphate as a systemic treatment modality for common
warts could have the advantage of being non-invasive, non scarring and with minimal side effects, but it was not
very effective so it can be taken with other modalities of treatment and not as monotherapy.
Keywords: Oral Zinc Sulphate versus Electrocautery, HPV, Warts

INTRODUCTION
pathogen. The options range from surgical excision,
Warts are benign proliferations of skin and
cautery, curettage, cryotherapy to laser application (8).
mucosa that results from infection with human
An electric current can deliver quite a lot of heat
papilloma viruses (HPVs) (1). HPVs are members of
energy and it is this heat which used to remove warts in
genus family papovaviruses, which are small double
electrosurgery. A metal probe with a current is applied
stranded DNA viruses that replicate inside the nucleus
to the warts with effectively burns it off , heat has
(2).
powerful effect on living tissues, drying them out and
Warts are one of the most common diseases
denaturing important proteins and other structures to
seen in the dermatology clinics. The role of immune
kill of unwanted cells. Because of this mechanism, it is
system in determining the outcome of HPV infection is
an extremely effective method with warts (9).
well documented(3).

Adequate intake of zinc is required for any
AIM OF THE WORK
rapidly dividing cell particularly those of the immune
The aim of this work is to compare the effect of
system to function efficiently, and its deficiency
oral zinc sulfate versus electrocautery in treatment of
compromises the function of immune cells, especially
patients with recurrent warts.
T cell function. Zinc deficiency leads to a decreased

number of T cells and disruption of their function,
PATIENTS AND METHODS
including a shift of the T-helper (Th1) cell response to
This study was conducted on 90 patients with
Th2 predominance (4).
common warts. The patients were collected from the
Zinc also results in reduced killing activity in
Out-patient Clinics of Dermatology and Venereology
natural killer (NK) cells (5). Neutrophil count is reduced
Department, Kafr El-Dawar Hospital.
and their recruitment is diminished during zinc

deficiency (6).
Inclusion criteria
Zinc sulphate has been used orally and
Patients suitable for participation were:
topically and also intralesionally for the treatment of
1. Individuals with common warts with a history of
warts in some clinical trials with favorable results
recurrence.
considering the role of zinc in immune function and the
2. Individuals of both sexes.
efficacy of zinc sulphate in wart resolution, estimation

of zinc level in patients with warts might be of value (7).
Exclusion criteria
Destructive therapy targets to damage or
1 . Subjects with acute infections or systemic diseases.
remove lesion, rather than aiming to eradicate the
2. Patients on any immunomodulutatony medications
or with immunosuppressive disease.
3673
Received:19/4/2019
Accepted:18/5/2019

Full Paper (vol.763 paper# 9)


c:\work\Jor\vol763_10 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3678-3683
Assessment of Serum Level of 25-Hydroxy Vitamin D in
Patients with Acne Vulgaris
Abd El-Raouf Mohamed Elmohsen1, Hassan Mamdouh Abd El-Aziz1,
Nagah Mohamed Abo Mohamed2, Amr Farag Ibrahim Dabash1*
Departments of 1Dermatology, Venerology and Andrology and 2Clinical Pathology,
Faculty of Medicine ­ Al-Azhar University
*Correspondence author: Amr Farag Ibrahim Dabash, Mobile: (+20) 01221897857, E-mail: amrafandy8@gmail.com

ABSTRACT
Background:
acne vulgaris is a common chronic inflammatory disease of the pilosebaceous unit, characterized by
the formation of non-inflammatory comedones and inflammatory papules, pustules, nodules and cysts.
Objective: the aim of this study was to evaluate serum levels of vitamin D in a group of Egyptian patients with acne
vulgaris in comparison to controls, in order to shed more light on its possible role in the pathogenesis and detect any
relation between vitamin D and acne severity.
Patients and Methods: the study recruited 90 subjects, 60 acne vulgaris patients and 30 age and sex matched healthy
controls. All patients were subjected to detailed history taking and examination to detect extent and severity of acne
vulgaris. Blood samples were taken from all participants to assess serum 25 OH D level.
Results: revealed lower serum vitamin D levels in acne patients in comparison to controls, with statistically significant
p value (0.009). Serum 25 OH D level showed no significant difference in females than in males in both patients (p =
0.726) and controls in comparison to patients (p = 0.794). There was no significant difference in level of 25 OH D
between participants reporting adequate sun exposure and those reporting inadequate sun exposure in patients (p =
0.804) but it was statistically significant p value in controls in comparison to patients (p < 0.001).
Conclusion:
the present study revealed lower, statistically significant, serum vitamin D levels in acne patients, suggesting
a possible role for vitamin D supplementation in acne treatment.
Keywords: 25-Hydroxy Vitamin D, Acne Vulgaris

INTRODUCTION
dendritic cells, all of which express vitamin D receptors
Acne vulgaris is a common chronic
(VDR)(6).
inflammatory disease of the pilosebaceous unit,

characterized by the formation of non-inflammatory
AIM OF THE WORK
comedones, inflammatory papules, pustules, nodules or
The aim of this study is to evaluate serum levels
cysts (1).
of 25(OH)D in a group of Egyptian patients with acne
Acne vulgaris is a multifactorial disease
vulgaris in comparison to controls, in order to shed more
involving androgen-induced increased production of
light on its possible role in the pathogenesis and detect
sebum,
together
with
altered
keratinization,
any relation between 25(OH)D and acne severity.
inflammation and bacterial colonization of hair follicles

by propionibacterium (P.) acnes (1). In addition,
PATIENTS AND METHODS
nutritional factors such as vitamins and minerals may be
Patients:
involved in the pathogenesis of acne (2).
This study was conducted on 90 adult individuals.
Specific dietary agents and supplements are
The subjects were recruited from Dermatology
known to enhance the health and appearance of the skin,
Outpatient Clinics in Al-Azhar University Hospitals.
by improving immune function at the skin level and
The 90 adult individuals were divided into 4 groups:
providing therapeutic bioactive agents that assist in the
Group (1): included 30 apparently healthy not
treatment of many skin conditions, such as psoriasis,
suffering from any manifestations of acne.
eczema and acne (3).
Group (2): included 20 patients with mild acne
Vitamin D is a fat-soluble steroid hormone,
vulgaris.
which plays an important role in calcium homeostasis,
Group (3): included 20 patients with moderate acne
immune system regulation as well as cell growth and
vulgaris.
differentiation. The main source of vitamin D is the skin
Group (4): included 20 patients with severe acne
upon sun exposure and a small proportion is obtained
vulgaris.
from dietary sources (4).

Sebocytes are identified as bioactive vitamin D-
Ethical consideration:
responsive target cells, suggesting a possible role for
An informed consent was taken from all subjects
vitamin D in acne (5). In addition, vitamin D has multiple
before enrollment in the study after approval of the
effects on innate and adaptive immune responses through
Medical Research Ethics Committee.
its actions on T and B lymphocytes, macrophages and

3678
Received:17/4/2019
Accepted:16/5/2019

Full Paper (vol.763 paper# 10)


c:\work\Jor\vol763_11 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3684-3691
Strain Bull's Eye Plot Derived from 3D Speckle Tracking Imaging in
Children with Dilated Cardiomyopathy
Enas Talaat Mansor Madkor*, Osama Abd Rab El-Rassoul Tolba,
Waleed Ahmed El-Shehaby and Shaymaa Basuny El-Nemr
Department of Pediatric Medicine1, Faculty of Medicine, Tanta University, Egypt
*Corresponding author: Enas Talaat Mansor Madkor, Mobile: 01110219350; Email: enas_madkoor@yahoo.com

ABSTRACT
Background:
Cardiomyopathies (CMPs) are a group of myocardial diseases with adverse outcomes.
Aim of the study: Was to evaluate the global and segmental 3­dimensional strain using speckle tracking
echocardiography in children with dilated cardiomyopathy and correlate this parameter with other echocardiographic
findings especially 2-dimensional strain (2DS bull's eye).
Patients and Methods: 100 subjects were categorized into 2 groups: Group 1; 50 patients with dilated
cardiomyopathy. Group 2; 50 healthy controls matched with the patient group. Echocardiographic studies were
performed by the following: Routine echocardiographic examination, tissue Doppler examination (TDE): [systolic and
diastolic mitral annulus velocities - LV myocardial performance Index (MPI)], speckling tracking technique [2D LV
longitudinal strain (2DS bull's eye) - Auto EF for LV systolic function - sphericity index] and transthoracic 3DE
examination (3DRTE) [3D longitudinal strain (3DS bull's eye)].
Results: There was a significant reduction in left ventricular ejection fraction (LVEF), sphericity index (SI), mitral
annulus systolic velocity (S), early diastolic mitral annulus tissue velocity and late diastolic mitral annulus tissue
velocity (E'/A') and LV GLS (global longitudinal strain) in patients when compared with controls but there was a
significant increase in myocardial performance index (MPI) and 2 dimensional (2DS) than 3 dimensional (3DS) in
patients when compared with controls. There was significant positive correlation between 2DS and 3DS GLS among
patients also, there was good agreement between all items in 2DS and 3DS in patients group. Conclusion: The bull's
eye plot offers an intuitive visual overview of LV myocardial function status in cardiomyopathies.
Keywords: Strain Bull's Eye Plot, 3D Speckle Tracking imaging, Dilated Cardiomyopathy.

INTRODUCTION

Cardiomyopathy (CMP) is defined as a disease
AIM OF THE STUDY
of the myocardium linked to cardiac dysfunction.
It was to evaluate the global and segmental 3­
Understanding of CMP is very important, because it is
dimensional
strain
using
speckle
tracking
related to heart failure in children and is the most
echocardiography
in
children
with
dilated
common indicator for heart transplantation in children
cardiomyopathy and correlate this parameter with other
over one year old (1).
echocardiographic findings especially 2-dimensional
Dilated Cardiomyopathy (DCM) is a myocardial
strain (2DS bull's eye).
disorder characterized by a dilated left ventricular (LV)

chamber and systolic dysfunction which usually leads
PATIENTS AND METHODS
to congestive heart failure (CHF). In some patients,
This observational case-control study was
right ventricular dysfunction (RVD) is also noted and
carried out during the period from April 2018 to
observed and may increase the severity of the clinical
January 2019 at Pediatric Cardiology Unit, Tanta
disease (2).
University Hospital. It included 100 subjects who were
The newly developed 3D speckle tracking in
classified into 2 groups. Group 1: 50 patients with
real time 3D echocardiographic (RT3DE) datasets has
primary dilated cardiomyopathy aged from 6 months
the potential to circumvent these limitations because:
up to 8 years, those patients attended the Cardiology
(i) it does not depend on2D views that can be
Unit Pediatric department, Tanta University Hospital.
foreshortened, and (ii) it tracks motion of speckles
Group 2: 50 healthy children matched for age and sex.
within the scan volume, irrespective of its direction.

Three-dimensional (3D) STE has been shown to enable
Inclusion criteria: Children less than 15 years with
analysis of deformities in myocardium in its
primary dilated cardiomyopathy.
longitudinal, circumferential and radial direction in a
Exclusion criteria: Children with congenital or
single 3D volume set (3). Three-dimensional strain-
acquired heart diseases other than dilated
relay on sequences provides both quantitative and
cardiomyopathy. Also; children with dilated
qualitative information regarding tissue motion and
cardiomyopathy secondary to systemic diseases were
deformation (4).
excluded. Written informed consent was obtained from
3684
Received:10/4/2019
Accepted:9/5/2019

Full Paper (vol.763 paper# 11)


c:\work\Jor\vol763_12 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3692-3700
Studying the Auditory Effect of Maternal Iron Deficiency Anemia on
Neonates Using Otoacoustic Emissions (Oaes)
Islam Gamal Ali El-Diasty1, Hamed Mohamed El-Sharkawy1,
Trandil Hassan Elmehalawi 2 and Mona Khaled Abo Almaaty Omar 3
Department of Pediatric Medicine1, Department of Audio-Vestibular Medicine 2, and Department of Obstetrics and
Gynecology3, Faculty of Medicine, Tanta University, Egypt.
*Corresponding author: Islam Gamal Ali El-Diasty; Mobile: 01015214194; Email: islam_gamal@yahoo.com

ABSTRACT
Background:
The adverse effects of iron deficiency anemia on auditory nerve (AN) development have been showed a
significant functional consequence on auditory brainstem response (ABR). Aim of the work was to study the effect of
maternal iron deficiency anemia on auditory system of newborn infant using otoacoustic emissions (OAEs). Subjects
and Methods:
60 full term neonates were divided into 2 groups: Group 1: 30 newborn infants as a control group with
maternal blood Hb >10.5 g/dL. Group 2: study group: 30 newborn infants with maternal blood Hb 10.5 g/dL and
diagnosed as maternal iron deficiency anemia (IDA). Results: In transient-evoked otoacoustic emissions (TEOAE) there
was significant difference between the studied groups at frequency of 4000 Hz in both right and left ears. There was also
significant difference between right and left ears as regard signal to noise ratio (SNR) and overall amplitude TEOAE at
frequency of 2000Hz in control group and at 4000 Hz in study group. There was significant difference in study group
between right and left ears as regard signal to noise ratio (SNR) distortion-product otoacoustic emissions (DPOAE) at
frequencies 1409 with right ears showing a higher mean SNR than left ears. Conclusion: The peripheral auditory
function, as tested by TEOAEs test, is affected in high frequency region of the cochlea in low ferritin babies while
DPOAEs test was less sensitive in these patients for assessment of their cochlear function.
Keywords: Maternal iron deficiency anemia, Neonates, Otoacoustic emissions.

INTRODUCTION

Anemia in pregnancy affects nearly half of all
and Neonatology Unit, Tanta University Hospitals. It
pregnant women worldwide and spreads in developing
included 60 full term neonates who were divided into 2
countries. The incidence of anemia in pregnancy in
groups: Group 1; control group: 30 newborn infants
developing countries ranges from 53 to 61% for Africa,
with maternal blood Hb >10.5 g/dL as control infants
from 44 to 53% for South-East Asia, and from 17 to 31%
and matched with age and sex for patient group. Group
for Europe and North America (1). The prevalence of
2: study group: 30 newborn infants with maternal IDA
anemia among pregnant women in Egypt was 22.6 % in
with maternal blood Hb 10.5 g/dL (5) and diagnosed as
2016, according to the World Bank collection of
IDA according to WHO (6).
development indicators (2).
Inclusion criteria: Full term neonates of iron
Previous reports indicate that hearing system is
deficiency anemia mothers without any other pregnancy
affected by iron deficiency, which may provide a
associated diseases.
pathological basis for deafness; on the other hand, iron
The birth weight of babies was appropriate for
deficiency may lead to functional and structural changes
gestational age.
in the cochlea because some of the cochlear enzymes
Maternal age between 19 and 40 years.
contain iron (3).
Normal APGAR score of neonate at 1st or 5th minutes
Otoacoustic emissions (OAE) are low-intensity
(>7/10).
sounds emitted from the functioning outer hair cells of
The babies with normal middle ear function test by
the cochlea. They can be measured even when the eighth
high frequency tympanometry were assessed by
nerve has been severed or blocked chemically (4).
(OAEs).

Exclusion criteria:
Aim of the work was to study the effect of
Post term neonates (gestational age 42 weeks).
maternal iron deficiency anemia on auditory system of
Neonates less than 37 weeks GA.
newborn infant using otoacoustic emissions (OAEs).
Neonates small or large for gestational age.

Low APGAR score (less than (7/10) at 1st and 5th

minutes).
PATIENTS AND METHODS

This case control study was carried out during the
Neonatal sepsis.
period from January 2017 to June 2018. Cases were
Neonates with cephalohematoma or subgaleal
selected from Obstetrics and Gynecology Department
bleeding.
Neonates with respiratory distress.
3692
Received:10/4/2019
Accepted:9/5/2019

Full Paper (vol.763 paper# 12)


c:\work\Jor\vol763_13 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3702-3708
Effects Of CANDEREL® and The Ameliorative Role of Stem Cell
Enhancer on Some Physiological Parameters in Male Albino Rats
Eman G.E. Helal1*, Mohamed A. Abdelaziz2, Mariam S. El-Gamal1
1Department of Zoology, Faculty of Science (Girls), Al-Azhar University
2Medical Physiology, Faculty of Medicine, Al-Azhar University
*Corresponding author: Eman Helal, email: emanhelal@hotmail.com,
mobile: 00201001025364, orcid.org/0000-0003-0527-7028
ABSTRACT
Background:
CANDEREL® is non-nutritive artificial sweetener, which is mainly composed of aspartame and
acesulfame potassium. Materials and Methods: thirty male albino rats weighing from 100 to 120 gm. The period
of the experiment was 30 days. The animals were divided into three groups; group 1: control, group 2: rats received
CANDEREL® (1 tablet/kg b.w./day) and group 3: rats received CANDEREL® (1 tablet/kg b.w./day) + SCE (9
mg/kg b.w./day). The following parameters were measured: serum glucose, ASAT, ALAT, serum creatinine, serum
urea, protein and lipid profiles and hormonal levels (insulin, testosterone, serum T3 and serum T4). Results: there
were many disturbances that occurred in the previous parameters, and SCE ameliorated most of these hazardous
effects. Conclusion: artificial sweeteners are not safe in use; their disadvantages are more than their advantages. So,
we recommended replacing non-nutritive sweeteners with nutritive ones to be away from any hazardous effects that
may result from the use of artificial sweeteners. Also, SCE made a great job in fighting the impairments that occur
during the experiment.
Keywords: CANDEREL®, aspartame, acesulfame potassium, stem cell enhancer, ASAT, ALAT, T3, T4,
testosterone, insulin.

INTRODUCTION
metabolites of methanol but also methanol itself are
Artificial sweeteners (ASs) have been
toxic to the brain. The primary metabolic fate of
introduced for more than a century as a way to provide
methanol is direct oxidation to formaldehyde, then into
a sweet taste of foods without the high energy content
formate. The toxic effects of methanol in humans are
of thermal sugars. The consumption of artificial
due to the accumulation of its metabolite formate and
sweeteners has gained popularity largely because of
correlated with formate levels (3).
low costs, low calorie and perceived health benefits to
Acesulfame Potassium (acesulfame-K or
reduce weight and normalize blood sugar levels. For
ACK), is a non-nutritive artificial sweeteners, which is
these reasons, artificial sweeteners are increasingly
discovered in 1967. It is approximately 200 times
being introduced into commonly consumed foods such
sweeter than table sugar and codified as E950.
as diet soda, cereals and sugar-free sweets, and are
Acesulfame potassium has been approved for use in a
recommended for weight loss and for individuals
variety of food products including carbonated drinks,
suffering from glucose intolerance and type 2 diabetes
baking products, baby food and frozen food. Besides
(1).
initiation of lingual sweet sensation, some studies have
Aspartame
(L-aspartyl-L-phenylalanine
shown potential ACK-related genotoxicity effects and
methyl ester) is a low calorie sweetener, which was
other cellular actions. Also, acesulfame potassium has
discovered in 1965 and codified as E951. It is two
been shown to induce insulin-secretion (5). Swithers et
hundred times sweeter than sucrose and readily
al.(6) reported that male rats given an ACK yogurt diet
dissolves in water (2). Approximately 50% of the
gained more weight than rats fed with a glucose-
aspartame molecule is phenylalanine, 40% is aspartic
sweetened yogurt diet. The potential link between the
acid, and 10% is methanol. Aspartic acid, a metabolite
dietary use of artificial sweeteners and the generation
of aspartame, is an excitatory amino acid normally
of generic metabolic syndrome has not been
found in high levels in the brain. These levels are
convincingly investigated and thus still remains highly
controlled by the blood-brain barrier, which protects
controversial (5).
the brain from large fluctuations in plasma aspartate (3).
CANDEREL® is made and used in Czech
Phenylalanine is an amino acid essential to the
Republic. It contains aspartame and acesulfame
production of monoamine in the brain and is found in
potassium.
nearly all foods that contain protein. Due to high levels
Stem cell enhancer (StemEnhance®) is a novel
of phenylalanine in the blood, the consumption of
mobilizer of bone marrow adult stem cells that was
aspartame may cause brain damage (4). Among the
shown to increase the number of circulating stem cells.
metabolites, methanol, which is released during
One gram of StemEnhance® has shown to support an
aspartame digestion, is a toxicant that causes systemic
increased release in the number of circulating stem
toxicity. Large doses of aspartame and its individual
cells in the body by 25% to 30% that greatly increased
metabolites have been tested in humans and other
the potential of the body's active repair and system
animals. It has been reported that not only the
renewal (7). StemEnhance® is a blend of 4 compounds:
2702
Received:20/4/2019
Accepted:19/5/2019

Full Paper (vol.763 paper# 13)


c:\work\Jor\vol763_14 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3709-3717

Role of Multidetector Computed Tomography in Gastric Cancers
Eisha Ramadan Mohamed, Alsiagy A. Abdel-Aziz, Eman Mohammed Mohammed Lofty*
Departments of Radiodiagnosis, Faculty of Medicine ­ Alazhar University
*Correspondence author: Eman Mohammed Mohammed Lofty, Mobile: (+20) 01006287509,
E-mail: emanlotfy1000@gmail.com

ABSTRACT
Background:
Gastric cancer is the third most common cause of cancer-related death in the world. Currently,
multislice computed tomography (MSCT) is a valuable tool for detection, staging, surveillance, and post-treatment
evaluation of gastric neoplasm. Objective: The aim of this work is to clarify the role of multidetector CT in
diagnosis and preoperative staging of gastric carcinoma. Patients and methods: The present study was conducted
between October 2017 and June 2019 on 60 patients (26 males and 34 females) with age ranged from 28 to 73
years with mean age of 53 years. The patients were complaining of symptoms of gastric cancer or as a follow-up
study for gastric cancer, referred to the CT Unit in Tanta University Hospital, Tanta Oncology Center and Health
Insurance Hospital from the Oncology Department. Results: In our study we found that there was a significant
relationship between pathological and CT staging by using MPR. CT with MPR was specific and accurate in
diagnosis of all stages of gastric cancer with specificity ranged between (95-100%) and accuracy ranged between
(94.5-97.5%). However, it showed lowest sensitivity in diagnosis of stage 1 of gastric cancer. On the other hand,
it showed highest sensitivity (97.5%) in diagnosis of stage IV. Conclusion: MSCT is a valuable tool for detection,
staging, surveillance, and post-treatment evaluation of gastric neoplasm.
Keywords: Multi-detector Computed Tomography, Gastric Cancers.

INTRODUCTION
gastric neoplasm and determine the stage and gastric
Although diagnostic advancements in performing
spread of gastric carcinoma, which is vital in choosing
endoscopy and double-contrast barium study currently
between palliative or radical surgical treatment. In
allows the detection of small lesions early in the course
addition, MDCT is used to monitor response to treatment.
of the disease, the depth of tumor invasion and the
Furthermore, it was shown to be a very important
presence or absence of metastases could not be
prognostic factor in patients with gastric cancer by
determined with either modality. In a routine clinical
evaluation and estimation of tumor invasion depth after
setting, patients with esophageal and gastric carcinoma
multiplaner reconstruction (MPR) (4).
most commonly undergo diagnosis and staging with

computed tomography (1).
AIM OF THE WORK
Multidetector-row
computed
tomography,
The aim of this work is to clarify the role of
particularly those apparatuses with 16 or more channels,
multidetector CT in diagnosis and preoperative staging of
offers rapid acquisition of submillimetric sections,
gastric carcinoma.
isotropic multiplanar reconstruction and post processing

options such as virtual endoscopy, which increases the
PATIENTS AND METHODS
method accuracy in the local staging (2). Additionally,
The present study was conducted between October 2017
computed tomography can evaluate lymph nodes and
and June 2019 on 60 patients (26 males and 34 females)
other organs (3).
with age ranged from 28 to 73 years with mean age of 53
MSCT can provide valuable additional information
years. The patients were complaining of symptoms of
and improve the detection and staging of both early and
gastric cancer or as a follow-up study for gastric cancer,
advanced gastric neoplasm. MSCT offers high diagnostic
referred to the CT Unit in Tanta University Hospital,
accuracy in tumor detection and staging of lymph node
Tanta Oncology Center and Health Insurance Hospital
metastasis, and high reliable information as regards
from the Oncology Department.
secondary tumors. MSCT is a valuable tool for
Written informed consent:
monitoring response to treatment and post-treatment
An approval of the study was obtained from
evaluation of gastric neoplasm(4).
Al- Azhar University academic and ethical committee.
The most recent international consensus
Every patient signed an informed written consent for
corroborated the necessity of preoperative TNM staging
and pointed out multidetector-row computed tomography
acceptance of the operation.
as the best staging method, which demonstrated similar
All patients were subjected to the following:
or superior accuracy as compared with endoscopic Detailed history taking including: history of smoking,
ultrasonography for T-staging and a clear advantage in
family history of gastric carcinoma and past history of
relation to other methods for N- and M-staging (5).
previous gastric surgery or radiation exposure (Data were
The role of multidetector computed tomography
taken from patients' files).
(MDCT) is to differentiate between benign and malignant Clinical examination and laboratory investigations.
3709
Received:18/4/2019
Accepted:17/5/2019

Full Paper (vol.763 paper# 14)


c:\work\Jor\vol763_15 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3718-3723
Evaluation of Flanged Haptics Intrascleral Sutureless Intraocular Lens Fixation
Younis Alsaeid Abd-Elhafez, Ali Ahmed Ali Ghali, Ahmed El Sayed Hodib, Ahmed Anwer Sadat Ali*
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University
*Correspondence author: Ahmed Anwer Sadat Ali, Mobile: (+20) 01022131987, E-mail: ahmedophth89@gmail.com

ABSTRACT
Background:
successful intraocular lens (IOL) placement in patients undergoing cataract surgery has become
synonymous with the IOL being placed in the capsular bag.
Purpose: to evaluate the flanged haptic sutureless intrascleral intraocular lens fixation with double needle technique
as a method of scleral fixation of posterior chamber IOL (PCIOL) as regard to its stability and safety as well as its
complications. Patients and Methods: this is a prospective study, which included 20 eyes of 20 patients with aphakia
with no adequate capsular support. Results: post-operatively the best corrected visual acuity (BCVA) was improved
to reach up to 0.8 decimal unit. Intra-operatively, haptic breakage was reported in 3 cases where the IOLs were
explanted and new IOLs were implanted and sclerally fixated. The post-operative complications included iris capture
in 2 cases (10%), haptic deformation in 2 cases (10%), exposure in 5 cases (25%) and slippage in 2 cases (10%),
corneal edema in 6 cases (30%), IOL decentration in 4 cases (20%) one of them was significantly decentered and
needed for reoperation where one point fixation by a stitch of the slipped haptic , spontaneous IOL dislocation in 2
cases (10%) 1 month and 3 months post-operatively, both required re operation where the slipped IOL was explanted
and new one is re implanted and sclerally fixated. There were no incidents of post-operative ciliary body injury,
retinal tear or detachment or endophthalmitis.
Conclusions: the flanged haptics intrascleral sutureless IOL fixation with double needle technique can be done for
aphakic cases with no adequate capsular support.
Keywords: Aphakia, Flanged haptics, Sutureless, Scleral fixation.

INTRODUCTION
tension to ensure good centration of the scleral-fixated
Optimal placement of an intraocular lens
IOL (5).
(IOL) is within an intact posterior lens capsule with
Yamane et al.(5) described a new technique for
good zonular support. However, ophthalmic surgeons
sutureless intrascleral fixation of a PCIOL using 27-
are faced with situations during cataract surgery in
gauge needles. This technique requires no special
which an occasional inadvertent, extensive lens
instruments for the IOL fixation and provides good
capsular tear may remove the option of placing the lens
IOL fixation with good wound closure without
in the capsular bag, requiring a different location to
leakage.
make the eye pseudophakic(1).
Two lamellar scleral incisions 1.5 mm in
Alternatively, a patient who has been aphakic
length and about 50% scleral thickness were made 1.7
with an aphakic contact lens may elect to have a
mm from the limbus at 180° from each other. A 3-piece
secondary IOL placement due to a recent inability to
IOL was inserted into the anterior chamber with an
wear the contact lens, or there may be situations in
injector and the trailing haptic was kept outside. An
which an IOL exchange may be required when dealing
angled sclerotomy was made at the end of lamellar
with a subluxated IOL(2).
scleral dissection with a 27-gauge needle. The leading
In these situations, and others, the choices for
haptic was threaded into the lumen of the needle using
a secondary IOL placement include the anterior
forceps. The IOL was rotated and the trailing haptic
chamber, iris-fixation and scleral-fixation using
was inserted into the anterior chamber. A second
transscleral sutures. Based on a literature review,
sclerotomy was then made, the trailing haptic was
Wagoner et al.(3) suggested that all three IOL location
passed into the lumen of the second needle and both
options are safe and effective choices in the absence of
haptics were externalized onto the sclera with the
lens capsular support for IOL implantation.
double needle technique(6).
When the surgeon elects to place an IOL in the

ciliary sulcus, away from the corneal endothelium, the
AIM OF THE WORK
options include fixating the IOL to the sclera using
To evaluate the flanged haptics sutureless
sutures or tucking the haptics within scleral pockets
intrascleral intraocular lens fixation with double
without the use of sutures (4).
needle technique as a method of scleral fixation of
Surgical expertise, prolonged surgical time,
posterior chamber IOL (PCIOL) as regard to its
suture-induced inflammation, suture degradation, and
stability and safety as well as its complications.
delayed IOL subluxation or dislocation due to broken

suture are some of the limitations in sutured scleral-
PATIENTS AND METHODS
fixated IOL. It is also difficult and time-consuming,
This is a prospective study in which 20 eyes of
requiring perfect adjustment of suture length and
20 patient with aphakia without adequate capsular
support due to complicated cataract surgery,
3718
Received:19/4/2019
Accepted:18/5/2019

Full Paper (vol.763 paper# 15)


Introduction The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3724-3735
Role of CT Gastric Volumetric Study in Sleeve Gastrectomy
Abd Ellah Nazzer Yassin Mohamed, Mohamed Salah Elfeshawy,
Emad Abdelsalam Abdelkader Sokker*
Department of Radio-diagnosis, Faculty of Medicine, Al-Azhar University
*Correspondence author: Emad Abdelsalam Sokker, Mobile: (+20) 01099914306, E-mail: emad.sokkar@yahoo.com

ABSTRACT
Background:
obesity continues to be a major public health problem, as defined by a body mass index (BMI) 30
kg/m2. Obesity has been associated with an increased hazard ratio for all-cause mortality, as well as significant
medical co-morbidity. Indeed, obesity is not only a chronic medical condition but should be regarded as a bona fide
disease state. Objective: the study aimed at correlation between the operative gastric volume reduction and body
weight reduction after surgery. Patients and Methods: our study included 30 cases; all were overweight/obese
individuals. There were 20 females and 10 males. All patients underwent MSCT abdomen with oral contrast. Post
processing in form of multi-planner reformatting and 3D reconstruction was performed to all cases before and 3
months after sleeve gastrectomy.
Results: collection and correlation of preoperative and postoperative data, revealed that the percentage of operative
gastric volume reduction ranged between 76% and 98% with mean value of about 84%, while the percentage of
body weight reduction ranged between 7% and 24% with a mean value of about 15%. The correlation between the
body weight and gastric volume measured preoperative in the studied patients was found to be insignificant, which
means that the stomach volume doesn't have a direct impact on body weight.
Conclusion: MSCT volumetric study of the stomach is the gold standard imaging technique for evaluation of the
gastric size in the preoperative and postoperative states in the context of bariatric sleeve gastric surgery.
Keywords: CT Gastric Volumetric, Obese, Sleeve Gastrectomy

INTRODUCTION

attention-deficit hyperactivity disorder in children. The
Obese individuals are highly stigmatized and face
complications of obesity are profound and potentiate
multiple forms of prejudice and discrimination because
decreased physical activity (PA) and sedentary
of their weight. Weight bias translates into inequities
behaviours contributing to a never-ending spiral of
in employment settings, health-care facilities, and
obesityhealth
consequenceshealth-limiting
educational institutions, often due to widespread
behavioursincreasing or maintained obesity (2).
negative stereotypes that overweight and obese persons
The safety and effectiveness of bariatric surgery
are lazy, unmotivated, lacking in self-discipline, less
have improved. Bariatric surgery is often an option for
competent, noncompliant, and sloppy. These
individuals with a BMI over 40 or those with BMI's at
stereotypes are prevalent and are rarely challenged,
35 or above with medical comorbidities. However,
leaving overweight and obese persons vulnerable to
surgery is often not recommended for adults with a
social injustice, unfair treatment, and impaired quality
BMI over 70 or for children. Identified benefits include
of life as a result of substantial disadvantages and
improvement in mental health and physical, sexual
stigma (1). Many contributing factors for obesity are
functioning, reduction in mortality 5 to 10 years
existing, genetic and physiologic factors, there has
following surgery, weight loss (4).
been an increasing focus on contextual elements that
The role of radiology in gastric bariatric surgery is
impact weight-related behaviours and ultimately
no longer limited for detection of postoperative
weight status. Those factors include, but are not limited
complications, but also it extends to evaluate the role
to, geography, food preferences, physical and social
of surgical reduction of gastric size in body weight
environment, gender, age, cultural identity, and family
reduction after surgery. MSCT gastric volumetric
composition (2).
study is the only method for accurate assessment of
Bariatric surgery procedures are indicated for
volumes of stomach and gastric sleeve after surgery. It
patients with clinically severe obesity. Currently, these
ensures exact data concerning gastric volumes and
procedures are the most successful and durable
diameters of anastomoses.
treatment for obesity. Furthermore, although overall

obesity rates and bariatric surgery procedures have
AIM OF THE WORK
plateaued, rates of severe obesity are still increasing (3).
The study aims at correlation between the
Obesity is associated with cardiovascular disease,
operative gastric volume reduction and body weight
hypertension,
type
2
diabetes
mellitus,
reduction after surgery.
hyperlipidaemia, stroke, sleep apnoea, liver and gall

bladder disease, osteoarthritis, gynaecological
PATIENTS AND METHODS
problems,
periodontal
disease,
poor
school
Patients: The study included 30 cases as pathological
performance, altered pre-pubertal hormones, and
obesity cases. No age limits were considered.
3724
Received:20/4/2019
Accepted:19/5/2019

Full Paper (vol.763 paper# 16)


Introduction The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3736-3740

Use of Fecal Calprotectin as A Predictor of Spontaneous Bacterial
Peritonitis in Post Hepatitis C Cirrhotic Egyptian Patients
Atef Abou Elfotouh Ibrahim, Mohammed Salah Ali Hussein, Zakarya Mohamed Zakarya Shady,
Mahmoud Mohammed Mohammed Metwally, Abdelrahman Saad Mohamed Amer
Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Abdelrahman Saad Amer; Mobile: (+20)01008677734; Email: abdosaad123@gmail.com

ABSTRACT
Background:
patients with liver cirrhosis have an increased risk of infections mainly spontaneous bacterial
peritonitis, which is present in about 15% of patients with cirrhosis and ascites. This is believed to be mainly due to
bacterial translocation (BT) although accurate mechanisms of BT are unknown, SIBO, gut dysmotility, increased
intestinal permeability and impaired defense mechanisms are regarded as major risk factors for BT.
Objective: to assess the value of fecal calprotectin (FC) as a predictor of SBP in cirrhotic Egyptian patients.
Patients and Methods: this study included 75 subjects; they were divided into two groups: 25 cirrhotic subjects with
ascites and no SBP as control group and 50 with liver cirrhosis and ascites and an evident SBP, all patients were
subjected to full history taking, complete clinical examination and routine laboratory investigations and
microbiological analysis of ascitic fluid, stool samples were collected for measuring FC by ELISA.
Results: FC showed a highly significant difference (p<0.001) with the median FC in SBP case group higher than
median FC of cirrhotic control group and both groups above average normal range, also a colleration emerged
between elevated FC and previous history of hepatic encephalopathy in case group.
Conclusion: FC was significantly elevated in cirrhotic patients dependant on the severity of liver disease as assessed
by Child pugh score and a significant colleration emerged between elevated FC and complications of liver cirrhosis
as SBP; So FCC can be used as a useful marker for early prediction and diagnosis of SBP in patient with liver
cirrhosis.
Keywords: Fecal calprotectin, Spontaneous bacterial peritonitis, Hepatitis C cirrhotic.

INTRODUCTION
Calprotectin measurements in fecal samples
Patients with liver cirrhosis have an increased
not only correlate with the degree of neutrophil
risk of infections mainly spontaneous bacterial
migration in the gastrointestinal mucosa, but also serve
peritonitis (SBP) which is present in approximately
as
reliable
surrogate
marker
of
intestinal
15% of patients with cirrhosis and ascites. This is
inflammation(5).
believed to be mainly due to bacterial translocation
Gundling study is considered one of the most
(BT)(1).
important studies regarding the role of fecal
BT refers to the entry of viable bacteria or their
calprotectin in the diagnosis of BT, They confirmed
products into the regional lymph nodes, the systemic
that patients with cirrhosis had significantly elevated
circulation, and possibly extra intestinal organs. The
fecal calprotectin levels when compared to healthy
origin of such microorganisms is the enteric flora and
controls. Moreover, this increase correlated with the
translocation occurs via a defective mucosal barrier(2).
severity of liver. Even more significantly, higher
Over 70% of these cases are caused by intestinal
calprotectin values were associated with advanced
bacteria and can be prevented by selective bacterial
stages of HE, the presence of SBP, as well as
decontamination with non absorbed or absorbed
extraintestinalinfections(6).
antibiotics, which confirms that, the gut is the main
In all, calprotectin remains a promising
source of microorganisms. Although accurate
surrogate marker for BT in cirrhosis. It demonstrates
mechanisms of BT are unknown, small intestinal
many advantages, especially in its fecal measurement,
bacterial overgrowth (SIBO), gut dysmotility,
as it is a non-invasive, quick and relatively easy to
increased intestinal permeability and impaired defense
perform assay, with proven clinical value in other
mechanisms are regarded as major risk factors for BT
disease states(7).
(3).

Calprotectin is calcium and zinc binding
AIM OF THE WORK
protein that belongs to the S-100 protein group and it
It is to assess the value of fecal calprotectin
has been estimated that it may account for more than
(FC) as a predictor of spontaneous bacterial peritonitis
60% of the soluble cytosolic proteins in human
in cirrhotic Egyptian patients.
neutrophil granulocytes, it increases under conditions

such as inflammation, infection and malignancy.
PATIENTS AND METHODS
Calprotectin can be measured in stool, plasma, synovial
The study data: A prospective, case control study,
fluid, cerebrospinal fluid, oral fluids and urine(4).
which have been conducted in association with the G.I.
Unit of Elhussein University Hospital in Cairo, Egypt.
3736
Received:20/4/2019
Accepted:19/5/2019

Full Paper (vol.763 paper# 17)


ž’'D9D'B) The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3741-3748

Preconditioning Risk Factors Affecting Survival and Remission of
Adult Egyptian Patients with Hematological Malignancies
Undergoing Hematopoietic Stem Cell Transplantation
Fathy Ghamry Abd El-Razek, Ezzat Abd El-Rahman El-Etraby, Essam Abd El-Wahed Hassan,
Amro Mohamed Sedky El Ghammaz, Mohammed Abd El-Akher Mohammed *
Department of Internal Medicine, Faculty of Medicine, Al-Azhar University
*Correspondence author: Mohammed Abd El-Akher Mohammed, Mobile: (+20) (+20)01119998995

ABSTRACT
Background: Hematopoietic stem cell transplantation (
HSCT) was used for many years to treat various
malignant and non-malignant hematologic conditions and in the treatment of various solid tumors. Since the 1970s,
steady progress has been made and HSCT is now regarded as a routine, rather than an experimental, approach in the
treatment of a number of conditions, which would have proven fatal earlier on.
Objective:
Our study aimed to determine the most important preconditioning prognostic factors affecting the overall
survival (OS), disease free survival (DFS) and relapse rate (RR) of adult Egyptians with hematological neoplasms who
are treated with HSCT, whether autologous or allogeneic, and in turn minimizing the morbidity and mortality of those
patients and improving their quality of life. Patients and methods: The study evaluated 98 adult patients with
different hematological malignancies who underwent HSCT (whether autologous or allogeneic) at Stem Cell
Transplantation Unit of Ain-Shams University from January 2014 to December 2018.
Results:
In our study, in the group of allogenic transplantation, There was a statistically significance at overall survival
with number of chemotherapy cycles with P =0.028. Regarding post HSCT relapse and post HSCT mortality 11 patients
(37.9%) died in the group that received 4 cycles of chemotherapy and 16 patients (55.2%) died in the group that
received > 4 cycles of chemotherapy. Conclusion: Five-year overall and progression-free survival rose for allogeneic
and autologous HSCT after the decade of their introduction.
Keywords:
Hematological Malignancies, Hematopoietic Stem Cell Transplantation.

INTRODUCTION

by skilled and experienced transplant teams working in
Hematopoietic stem cell transplantation
specialized centre. Allogeneic HSCT carries a
(HSCT) was used for many years to treat various
relatively high mortality and morbidity. However,
malignant and non-malignant hematologic conditions
advances in supportive care and modifications made to
and in the treatment of various solid tumors. Since the
the conditioning regimens played a central role in
1970s, steady progress was made and HSCT is now
decreasing the morbidity and mortality of HSCT over
regarded as a routine, rather than an experimental,
the past years (4).
approach in the treatment of a number of conditions

which would have proven fatal earlier on (1).
AIM OF THE WORK
Although stem cells can be collected by direct
To determine the most important preconditioning
aspiration from the bone marrow, with the patient
prognostic factors affecting the overall survival (OS), disease
under general or spinal anesthetic, they are more
free survival (DFS) and relapse rate (RR) of adult Egyptians
commonly harvested from the peripheral blood. HSCT
with hematological neoplasms who are treated with HSCT
can be performed with cells from a family member or
whether autologous or allogeneic and in turn minimizing the
an unrelated volunteer (allogeneic transplantation),
morbidity and mortality of those patients and improving their
with stem cells previously collected from the patient
quality of life.
(autologous transplantation) or with cells harvested

from umbilical cord blood at time of delivery (2).
PATIENTS AND METHODS
It is well established that the cure of malignant
Patients:
disease by HSCT relies on both the conditioning
The study evaluated 98 adult patients with
regimen, which can provide an antitumor effect from
different hematological malignancies who underwent
myeloablative doses of chemotherapy or radiotherapy,
HSCT (whether autologous or allogeneic) at Stem Cell
and the graft-versus-leukemia (GvL) effect provided
Transplantation Unit of Ain-Shams University from
by donor T-cells and NK cells. Malignant diseases
January 2014 to December 2018.
have been found to have different susceptibilities to

eradication by GvL effects, with decreasing
Methods:
susceptibility in diseases with rapid proliferation rates
GROUP I: Patients underwent autologous HSCT:
and advanced or chemorefractory disease (3).
peripheral blood mobilization of their stem cells was
HSCT, particularly allogeneic transplantation, is a
transfused to them after receiving conditioning.
high cost and highly specialized procedure, performed
3741
Received:19/4/2019
Accepted:18/5/2019

Full Paper (vol.763 paper# 18)


c:\work\Jor\vol763_19 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3749-3757

Effect of YAG Laser Posterior Capsulotomy on Central Macular
Thickness in Pseudophakic Patients
Younis E. Abd-Elhafez, Mohamed Mohamed-Aly Ibrahim, Mahmoud A. Elsherbiny*
Ophthalmology Department, Faculty of Medicine, Al-Azhar University, Egypt
*Correspondence author: Mahmoud A. Elsherbiny, Mobile: (+20) 01069818162, E-mail: Elsherbinymahmoud2@gmail.com

ABSTRACT
Background:
posterior capsular opacification (PCO), also known as `secondary cataract' or `after cataract', develops
a few months to a few years over the clear posterior capsule after an uncomplicated cataract surgery.
Purpose: evaluation the impact of Neodymium-doped Yttrium Aluminum-Garnet (Nd: YAG) laser capsulotomy on
central macular thickness (CMT) by optical coherence tomography (OCT).
Patients and Methods: the present study examined 50 eyes (24 males, 26 females) with an average age of 63.58±7.7
which was pseudophakic and had PCO, preoperative evaluation included history taking, ophthalmological examination
and OCT was done. All patients underwent YAG laser posterior capsulotomy and CMT assessed at 3 days, 1 week, 1
month and 3 months by OCT.
Results: there was significant improvement of BCVA (LogMAR) post laser capsulotomy (P< 0.001), IOP statistically
significant increased (P< 0.001) at the first postoperative 3 days, 1 week, 1 month with mean ±SD of 16.46±2.54 mmHg
17.50±2.67 mmHg ,15.50±2.39 mmHg respectively when compared to preoperative values 13.0±1.67 mmHg. At 3
months there was minimal change (P=0.02). As regard CMT values at 1 week post laser (mean ±SD of 270.92±24.88)
was highly significant increased (P< 0.001) and values at 3 months (mean ±SD of 248.70±21.66) showed non-
significant difference (P=0.285) when compared to pre laser values (mean ±SD of 245.58±23.30).
Conclusion:
typical treatment of the PCO is YAG laser capsulotomy, IOP elevation is the most prevalent complication
so antiglaucoma drugs is recommended and IOP return to normal values in the follow up period.
Keywords: Posterior Capsule Opacification (PCO), Nd: YAG laser, Central Macular Thickness (CMT)

INTRODUCTION

resulting from increasing the permeability of the
Posterior capsular opacification (PCO), also
perifoveal capillaries due to releasing of inflammatory
known as `secondary cataract' or `after cataract', develops
mediators as YAG laser capsulotomy causing damage of
a few months to a few years over the clear posterior
the vitreous (9). OCT is a noncontact diagnostic tool that
capsule after an uncomplicated cataract surgery (1). PCO
can perform cross-sectional imaging of the retina. The
is the most prevalent complication of uneventful cataract
spectral domain (SD)-OCT system measures retinal
surgery that appears lately (2). There are known two types
thickness from the retinal pigment epithelium to the
of PCO, pearl and fibrous, or combination of both. PCO
internal limiting membrane, thereby giving the correct
developed by abnormal proliferation, migration and
thickness of the retinal layers, OCT images allow
differentiation of LECs (lens epithelial cells)(1,3). PCO
investigation of retinal pathology and visualization of
incidence is at a rate of between 3% and 50% in the first
internal retinal architecture(10).
5 postoperative years in eyes undergoing uncomplicated

cataract surgery (4). Pseudophakic patients with PCO
AIM OF THE WORK
complaining of decreasing visual acuity as well a slight
This work aims to evaluate the impact of YAG
scatter and affects contrast sensitivity(5,6). PCO typical
laser capsulotomy on the central macular thickness
treatment is Neodymium-doped Yttrium Aluminum-
(CMT) by optical coherence tomography (OCT).
Garnet (labeled as Nd : YAG) laser capsulotomy, which

is valuable, quick, noninvasive, relatively secure
PATIENTS AND METHODS
technique and outpatient procedure(7,8).
This study included 50 eyes (24 males, 26
The method is credible but some complications
females) with an average age of 63.58±7.7 which was
may occure as IOP elevation, IOL pitting, iritis, vitreous
pseudophakic and had PCO.
prolapse, retinal detachment, macular edema and change

in refraction (9). IOP elevation is the most prevalent
Inclusion criteria: The patients had PCO which graded
complication of YAG laser posterior capsulotomy despite
as Grade 1: Minimal PCO: red reflex is not reduced, no
using anti- glaucoma as a prophylactic treatment(3).
pearls at all, slight opacity at the periphery. Grade 2: Mild
The rise of IOP was mostly due to blocking of the
PCO: reduced red reflex, Elsching pearls to the IOL edge.
trabecular meshworkby cells and flare released after
Grade 3: Moderate: Elschnig pearls or fibrosis within IOL
capsulotomy in the anterior chamber(8). Macular edema
edge but with clear the visual axis .with slit lamp grading
3749
Received:19/4/2019
Accepted:18/5/2019

Full Paper (vol.763 paper# 19)


c:\work\Jor\vol763_20 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3758-3763

Evaluation of Pedicled Medial Thigh Perforator Flap and Its
Application in Loco-Regional Soft Tissue Reconstruction
Wael M. Ayad, Mohamed A. Autifi, Abdel-Nasser M. Khallaf, Ahmed A. Aborawash
The Departments of Plastic & Reconstructive Surgery, Al-Azhar University Hospitals and
El-Sahel Teaching Hospital
*Correspondence author: Ahmed A. Aborawash, Mobile: (+20) 01066802600, E-mail: ahmedfyounes143@yahoo.com
ABSTRACT
Introduction:
perineoscrotal defects represent a challenging problem in reconstructive surgery. Scrotal skin loss can
occur following trauma, Fournier's gangrene, post tumor excision, burns, etc. There are many techniques described
in the literature for reconstruction of defects of scrotal skin. The pedicled medial thigh (PMT) perforator flap is a
valuable reconstructive option. In its pedicled form, the experience is currently limited to a few case reports.
Objective: the purpose of this study was to describe clinical applications of the pedicled medial thigh (PMT)
perforator flap for reconstruction of loco-regional soft tissue defects.
Patients and Methods: between June 2018 and June 2019, an experimental cadaveric study including two cadavers
with four lower limbs was done in Al-Azhar University, Faculty of Medicine, Department of Anatomy and
Embryology. A prospective cross-sectional study in which ten male patients with soft tissue defects or lesions that
requires excision and reconstruction in perineum and scrotum received MTP flaps. All flaps were unilateral and the
flap sizes ranged from 9-12 cm to 12-26 cm. Results: all flaps survived well, with the exception of partial wound
dehiscence in two patients that was managed conservatively by frequent dressings and healed by 2ry intention.
Conclusion: the medial thigh fasciocutaneous perforator flap offers a good option for Perineoscrotal defects. The flap
provides a single stage, stable, well vascularized soft tissue coverage with no significant major complications, short
hospital stay, appropriate range of motion, faster return to normal lifestyle and accepted aesthetic appearance.
Keywords: Pedicled Medial Thigh Perforator Flap, Application in Loco-Regional Soft Tissue Reconstruction.

INTRODUCTION

Perineoscrotal defects represent a challenging
PATIENTS AND METHODS
problem in reconstructive surgery. Etiologies include
A prospective cross sectional study involving 10
traumatic avulsion of scrotal skin, burn injury, tumor
patients with soft tissue defects or lesions that requires
ablation, and infection. Fournier's gangrene is an acute
excision and reconstruction in the proximal and distal
and potentially lethal necrotizing fasciitis that involves
medial thigh, groin, perineum and genitalia (scrotum &
the skin and soft tissues of the scrotum, perineum, and
vulva). The study was carried on Plastic Surgery
lower abdomen, resulting in tissue defect, and possibly
Departments, Al-Hussien & Bab Elshaaria Hospitals,
death. After adequate surgical debridement and
Faculty of Medicine, Al-Azhar University (Cairo) in the
infection control, the remaining skin and soft tissue-
period between June 2018 and June 2019. Medial thigh
defects need to be covered (1).
perforator flap was performed for ten male adult
There are many techniques described in the
patients. Their mean age was 48.8 (36 ­ 63 years) years
literature including residual scrotal skin mobilization
old. All patients presented with soft tissue defects of the
for defects of scrotal skin up to 50%, split skin graft,
scrotal and perineal areas after extensive multiple
thigh flaps with pouch, tissue expansion, gracilis
debridement sessions for Fournier's gangrene (8
myocutaneous advancement flap, groin fasciocutaneous
patients) and two patients with raw area in the scrotum
island flap, flaps based on inferior epigastric vessels,
after excision of a huge condyloma accuminata lesion.
superomedial thigh flaps, pedicled omental flap and
Inclusion criteria:
even microvascular free greater omentum flap (1).
Male and female patients
The pedicled medial thigh (PMT) perforator flap is
All patients older than 5 years old
a valuable reconstructive option. In its pedicled form.
Patients with soft tissue defects in the thigh, groin,
The experience is currently limited to a few case
perineum
reports. The purpose of this study was to describe
Scrotal reconstruction after debridement of
clinical applications of the pedicled medial thigh (MTP)
Fournier's gangrene
perforator flap for reconstruction of loco-regional soft
Scrotal, penile or vulvar lesions that require
tissue defects (1).
reconstruction after excision

Chronic resistant groin Hidradenitis Suppurativa
AIM OF THE WORK
Local post burn contracture
Aim of this study is to evaluate the validity and
Local unstable scar.
application of pedicled medial thigh perforator flap for
Exclusion criteria:
loco-regional soft tissue reconstruction of the groin and Patients not fit for surgery

Diseased donor site
perineum region and assessment of aesthetic and Psychologically unstable patients
functional outcome of using this flap.
Bleeding tendency
3758
Received:19/4/2019
Accepted:18/5/2019

Full Paper (vol.763 paper# 20)


c:\work\Jor\vol763_21 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3764-3773
Endoscopic Management of Supratentorial Ventricular Tumors
Osama El Ghannam, Ahmed El Narsh, Hamdy Beheiry, Mohamed Fathy Kamel Ziady*
Department of Neurosurgery, Faculty of Medicine ­ Al-Azhar University
*Correspondence author: Mohamed Fathy Kamel Ziady, Mobile: (+20)01007077748, E-mail: ahmedyounes143@yahoo.com

ABSTRACT
Background:
Intraventricular tumors are ideal indications for neuroendoscopic surgery. Because intraventricular
tumors often cause cerebrospinal fluid (CSF) pathway obstruction, resulting in ventricular dilation and sufficient
space for maneuvering with the endoscopes is available.
Objective: The aim of this study was retrospectively and antrospectively evaluation of the role and outcome of use
of endoscope in intraventricular tumors in term of: 1-Diagnostic of the deep lesions. 2- Management of increased
intra-cranial pressure (ICP). 3-Excision of tumor depends on the type.
Patients and Methods: This prospective and retrospective study was carried on 30 patients who sought medical
advice for intra ventricular tumor from 2015 to 2019 in Al-Hussein University Hospital. Tumors are removed or
biopsied with or without ETV and septum pellucidostomy.
Results: According to our study, we found that endoscopic removal of intraventricular tumors has low rate of
complications. There were 25 cases with no complications (83.3%) and better outcome. There were 15 cases (50%)
very good outcome and 10 cases (33.3%) were good outcome, as there was minimal dissection and brain retraction.
Conclusion: Regarding endoscopic treatment of intra ventricular tumors, there are many advantages of the
endoscopic approach as low rate of complications, minimal dissection, better outcome, brain retraction, rapid
access to the target and excellent visualization of the lesion and surrounding structures. Endoscopic approach also
has the ability of treatment of the associated hydrocephalus at the same session with low rate of failure or
recurrence.
Keywords: Endoscopic Management, Supratentorial ventricular tumors, ETV, SCF.

INTRODUCTION
ventricle and (CSF) drainage. It never contributes to
Intraventricular tumors are ideal indications for
treat obstructed hydrocephalus. Symptoms and sign
neuroendoscopic surgery. These lesions can easily be
are related to non-communicated hydrocephalus in
approached with the endoscope through the
majority of patients with these tumors. For instance
ventricular
system.
Moreover,
because
90% of the patient's with pineal region tumors
intraventricular tumors often cause cerebrospinal
clinically
present
with
hydrocephalus
(5).
fluid (CSF) pathway obstruction resulting in
Hydrocephalus should be treated beside tumor. One
ventricular dilation, sufficient space for maneuvering
of treatment options is ventriculoperitoneal shunting
with the endoscopes is available. However, even in
(VP shunting). But it contributes to dissemination of
patients with narrow ventricles, the lesions may be
some tumors such as pineoblastoma and germ cell
approached accurately and safely with the aid of
tumors in to peritoneal cavity (6).
neuronavigation (1, 2).
The deep location of intraventricular tumors
The aims of endoscopy in intraventricular
makes the microsurgical approach difficult. In these
tumors are usually the restoration of CSF pathway
tumors, endoscopic procedures are continually
obstruction, clarification of the histology, and if
gaining importance in neurosurgery, especially
possible, a complete tumor removal (3). Advantages of
because many of these intraventricular tumors do not
the
endoscopic
approach
compared
with
require aggressive removal (7).
microsurgical resection are an improved visualization

and illumination in the depth of the ventricles as well
AIM OF THE WORK
as less brain tissue dissection and retraction (3).
The aim of this study was retrospectively and
Craniotomies can be avoided because
antrospectively evaluation of the role and outcome of
endoscopes are inserted through simple burr holes.
the use of endoscope in intraventricular tumors in
Working through an operative sheath protects the
term of: 1-Diagnostic of the deep lesions, 2-
surrounding structures such as fornix, hypothalamus
Management of increased ICP and 3-Excision of
and vessels. Initially, endoscopic tumor surgery was
tumor depend on type.
limited to tumor biopsy, mostly performed after an

endoscopic third ventriculostomy (ETV) in patients
PATIENTS AND METHODS
presenting
with
tumor-related
obstructive
Study participants:
hydrocephalus (4).
This prospective and retrospective study was
Another alternative procedure in management
carried on 30 successive patients who sought medical
of ventricular tumors is stereotactic biopsy procedure.
advice for intra ventricular tumor from 2015 to 2019
But it has high risk of sampling error because
in Al-Hussein University Hospital. Tumors are
migration of tumor from target after puncture of
3764
Received:19/4/2019
Accepted:18/5/2019

Full Paper (vol.763 paper# 21)


c:\work\Jor\vol763_22 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3774-3778

Risk Factors of Post PCNL Systemic Inflamatory Response Syndrome (SIRS)
Mohamed Kamal*, Atef Ahmed Hamdy, and Abdullah Mohamed
Urology Department, Al-Azhar University, Cairo, Egypt
*Corresponding author: Mohamed Kamal, Mobile: 01147653356; Email: mhmd645kamal@gmail.com

ABSTRACT
Background: urolithiasis is one of the most common benign urologic diseases, with a nearly 10% of lifetime
incidence. In addition, the prevalence of urolithiasis has been rising through the decade worldwide.
Objective:
To determine the parameters and contributing factors that are associated with SIRS following PCNL.
Materials and Methods: an observational retrospective case control study, the medical records of all patients who
underwent PCNL for renal stones in-between 10/2017 and 4/2019 (320 patients) at Al-Hussein and Sayed Galal, Al-
Azhar University Hospitals had been reviewed. The demographic and perioperative data of these patients had been
collected.
Results: the study comprised 307 patients, the mean age of the studied patients was 40.9±15.8 years (range: 2.5 to 70
years). The mean BMI was 26±3 (range: 18 to 35). There were 193(62.9%) males and 114(37.1%) females. Twenty
two patients had bilateral renal stone. In 170(55%) cases the targeted stone was in left side and the rest was in the
right one. Forty eight (15.6%) cases developed SIRS post-operative. The age, gender, residual stones, hepatitis and
diabetes were found to be independent risk factors for SIRS.
Conclusions: good preoperative assessment and strict control of DM and haptic diseases before the procedure, try to
render the patient stone free intraoperative as much we can and strict follow up to these categories of patients
postoperatively to detect inflammatory response and infectious complications as early as possible.
Keywords: SIRS, infectious complications, percutaneous nephrolithotomy.


INTRODUCTION

Urolithiasis is one of the most common benign
based on risk factors. There have been numerous studies
urologic diseases, with a nearly 10% of lifetime
investigating potential risk factors for the development
incidence (1). In addition, the prevalence of urolithiasis
of postoperative infectious complications in PCNL
has been rising through the decade worldwide (2). In the
patients(10).
United States, the prevalence rate increased from 3.8%
The following terms were identified according
in the 1970s to 8.8% in the 2000s (3).
to the census statement published by the American
Percutaneous nephrolithotomy (PCNL) is the
College of Chest Physicians (ACCP) and the Society of
standard treatment for large renal stones >2cm and
Critical Care Medicine (SCCM) in 2001(11):
staghorn calculi. It is less traumatic and quicker
SIRS Criteria of two or more of the following:
recovery compared with open surgery. In addition,
(1) Body temperature >38°C or < 36C;
PCNL has a higher rate of stone clearance than
(2) Heart rate >90 bpm;
extracorporeal shock wave lithotripsy (4). However,
(3) Respiratory rate >20 breaths/min or PaCO2
relatively higher perioperative complication rates were
<32mmHg;
also reported; including fever (10.8%), blood
(4) White blood cell count >12,000 cells/L or <4,000
transfusion (7%), thoracic complications (1.5%), sepsis
cells/.
(0.5%), embolization (0.4%), organ injury (0.4%), and
SIRS describe the inflammatory process,
urinoma (0.2%) (5).
independent of cause based on a combination of vital
The rate of complications in PCNL can vary
signs and blood work(12).
according to the complexity of stone disease as well as
(1) Infection: Pathological process caused by invasion
patient and procedure-related factors. Complication
of normally sterile tissue or fluid or body cavity by
rates reported by various studies ranged from 3% to
pathogenic or potentially pathogenic micro-organisms.
83% (6). Postoperative fever is a frequent occurrence
(2) Sepsis: Clinical syndrome defined by the presence
with reported rates between 15% and 30% (7). While
of both SIRS and infection.
urosepsis has been reported to occur in 0.9­4.7% of
Historically, clinicians assume that blood
PCNL procedures (8).
cultures are required for the diagnosis of sepsis. In
There are predictive tables and scoring systems
theory, sepsis may occur in the absence of bacteremia,
to predict stone clearance, but there is limited literature
and therefore blood cultures are not included in the
on the prediction of complications during PCNL.
definition of sepsis. Further, bacteremia is a poor
Duration of procedure, bacterial load in the urine,
indicator for sepsis because blood cultures are negative
severity of obstruction, and presence of infected stone
in up to 30% of cases of septic shock (12).
directly affect the incidence of febrile urinary tract
Hence, there is intense need to evaluate patient,
infection (UTI) and/or urosepsis (9).
stone and procedure-related factors in details as there
Infection remains a serious event as sepsis is the
are limited studies on this issue in literature. Current
leading cause of perioperative mortality(10). With sepsis
study was aimed to determine predictors of systemic
established as an important complication of PCNL,
inflammatory response syndrome following PCNL.
focus has shifted to trying to predict its occurrence

3774
Received:21/4/2019
Accepted:20/5/2019

Full Paper (vol.763 paper# 22)


c:\work\Jor\vol763_23 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3779-3790


Aesthetic External Dacryocystorhinostomy
Sayed Abbas Sayed Mahfouz1, Ahmed Mahmoud Ahmed Mahmoud Amin1, Kareem Bakr Elessawy2,
Mohammed Mahmoud Hamed Mahmoud1*
1Department of Ophthalmology, Faculty of Medicine ­ Al-Azhar University
2Department of Ophthalmology, Faculty of Medicine ­ Cairo University
*Correspondence author: Mohammed Mahmoud Hamed Mahmoud; Mobile: (+20) 01018506185;
E-mail: m.m.hamed2013@gmail.com

ABSTRACT
Background:
acquired obstruction of the lacrimal excretory outflow system whether functional, structural or both
will produce the symptoms of epiphora, mucopurulent discharge, pain, dacryocystitis and even cellulitis, promoting
the patient to seek the ophthalmologist for evaluation and treatment.
Objective: comparative study between conventional external DCR with postoperative scar modulating treatment,
external DCR via subciliary incision and DCR via transconjunctival approach evaluating their functional outcome
and final cosmetic scar.
Patients and Methods: study cases were non-randomized 30 eyes in patients who inclusion and exclusion criteria
are applied for them and dacryocystorhinostomy operation was done. Transconjunctival approach was done for 10
eyes, subciliary approach was done for 10 eyes while conventional approach with scar modulating treatment was
done for last 10 eyes.
Results: Aesthetic outcome of our study showed improvement in postoperative conventional approach scar with
using scar modulatory treatment postoperatively and the results were 30% invisible, 50% minimally visible and 20%
moderately visible after three months follow up. Also, subciliary approach study showed a significant improvement
in scar outcome which was 60% invisible and 40% minimally visible.
Conclusion: in spite of all the new innovations and competition, external DCR remains the gold standard and the
most successful surgery in the management of complete NLDO.
Keywords: Ex-DCR, Eye.

INTRODUCTION
as a therapeutic agent only (6). Topical silicone gel
External dacryocystorhinostomy (Ex-DCR)
sheeting is cumbersome to keep on the scar and the
initially described by Toti has been the gold standard
patient compliance often is low for lesions in visible
procedure for many decades to treat nasolacrimal duct
areas (4).
obstruction (1). Despite superior success rate, the
Tapes or bandaging frequently is not accepted.
inevitable downside of Ex-DCR had an external skin
It may also lead to skin irritation, which may require
scar, which has led to evolution of endonasal and
discontinuation of treatment, especially in hot climates.
several other techniques (2). Scarring following external
Gel sheeting is effective for scar control, but patient
DCR surgery is difficult to predict. Both physicians and
compliance with the method is not always satisfactory.
their patients are highly concerned with minimizing
Steroid injections are painful and may lead to skin
scar appearance. Existing prophylactic and therapeutic
atrophy and dyschromia. They usually are
strategies included planning incision site according to
contraindicated for large areas and for children. Topical
relaxed skin tension lines and use of postoperative
silicone gel application can overcome some of these
topical preparations (scar modulating treatment) that
limitations (7).
have been used and proved their efficacy in reducing

postoperative possible scar. Since the early 1980s,
AIM OF THE WORK
silicone gel sheeting has been widely used in the
Comparative study between conventional external
treatment of hypertrophic scars and keloids. Several
DCR with postoperative scar modulating treatment,
clinical studies and reviews have confirmed its efficacy
external DCR via subciliary incision and DCR via
(3).
transconjunctival approach evaluating their functional
While many treatments have been suggested in
outcome and final cosmetic scar.
the past for scars, only a few of them have been

supported by prospective studies with adequate control
PATIENTS AND METHODS
group. Treatments can be said to have sufficient
The study is prospective study which was carried out
evidence for scar management as topical application of
on patients attending at "Ophthalmology Department at Al-
silicone gel sheeting and the intra-lesional injection of
Azhar University Hospitals and Mataria Teaching Hospital
corticosteroids (5). The former generally is indicated as
". All participants were hidden & replaced by code
both a preventive and therapeutic device while the latter
numbers to maintain privacy of the patients. Study
3779
Received:21/4/2019
Accepted:20/5/2019

Full Paper (vol.763 paper# 23)


Single stage decompression The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3791-3796

Transpedicular Screw Fixation for Degenerative Lumbar Spine
Stenosis with Segmental Instability
El-Sayed El-Mor, Adel Ragab, Mohammed Elsayed Mansour
Neurosurgery Faculty of Medicine-Al-Azhar University
Corresponding author: Mohammed Elsayed Mansour, email: neurosugery151988@gmail.com

ABSTRACT
Objectives:
Evaluation of the Transpedicular Screw Fixation as a surgical treatment for the degenerative lumber spin
stenosis with segmental instability. Methods: A prospective, uncontrolled and interventional study conducted on
thirty patients with low back pain and associated sciatica and claudication due to degenerative spinal stenosis and
instability between March 2017-August 2018. Pain assessment, dynamic x rays and MRI was done perioperatively.
Results: By comparison of pre- and post-operative translational motion, it has been found that more cases tend to be
"fixed in plane" with high statistically significant testing (p=0.00677) by using Wilcoxon signed rank. In the same
line, angular motion was compared perioperatively with the same test above, it has been found that vertebral line is
more fixed as regard angular motion with high statistically significant result (p=0.0074). By comparing both variables
to test the existence of good operative results with presence of "changed" vertebral alignment from instable to stable.
It has been found that good results were statistically significant associated with changed alignment from moving to
unmovable spinal segment (p < 0.0001). Conclusion: Posterolateral pedicle screws insertion for degenerative lumbar
spine is a good option for restoration of sagittal balance, decompression of canal stenosis and needs no demanding
experience or learning curve to serve patients with lumbar spine stenosis and instability.
Keywords: degenerative lumbar, segmental instability, screw fixation.

INTRODUCTION

Multilevel degeneration with lumbar canal
low back pain with associated sciatica and
stenosis is a common issue worldwide (1). The
claudication due to degenerative spinal stenosis and
pathological changes involve osteophyte formation at
instability.
the disk level, facet hypertrophy and ligamentum
The study has been approved by the ethical board
flavum hypertrophy (2). The condition is manifested
of university hospital.
as buttock pains and neurogenic claudication.

Wide decompressive laminectomy, nerve root
Inclusion criteria
release and discectomy (if necessary) had remained
1. Above 40 years old
the gold standard to operate patients with lumbar
2. Both genders
canal stenosis (3). When there was instability,
3. Degenerative spondylolisthesis only
posterolateral interpedicular fusion was carried out in
4. Multi-level spinal instability
the past (4). However, there was confusion in the
Exclusion criteria
literature concerning the role of fusion even in the
1. Recurrent canal stenosis
presence of instability in degenerative lumbar canal
2. Traumatic cases or pathological fractures.
stenosis due to absence of prospective reserches.
3. Osteoporosis
The hypothesis tested by the Spinal

Laminectomy versus Instrumented Pedicle Screw
Preoperative record
(SLIP) trial was that lumbar laminectomy with
1. Full history taking, general and neurological
instrumented (rigid pedicle screws affixed to titanium
examination and full labs
alloy rods) fusion would result in greater
2. MRI LSS.
improvement than that with laminectomy alone. In
3. Dynamic LSS x-ray.
the primary outcome measure, the change in the
4. Pain assessment score (visual scale).
physical-component summary score of the Medical
After induction of general anesthesia and putting
Outcomes Study 36-Item Short-Form Health Survey
patient on prone position, sub-periosteal muscle
(SF-36; range, 0 to 100, with higher scores indicating
separation was done. The exposure of laminae by
better physical health­related quality of life) -- at 2
spinous process splitting, neural decompression
years (5, 6) . This study is designed for evaluation of the
with bilateral total facetectomy was done to
interpedicular arthrodesis as a surgical treatment for
achieve wide exposure of the disc space and the
the degenerative lumber spine stenosis with
neural elements to prevent possible nerve root
segmental instability.
impingements, while preserving the area PS
PATIENTS AND METHODS
entry. Ps were placed under fluoroscopy guidance
This study was prospective, uncontrolled and
by CBT as described previously (2, 4) with slight
interventional study conducted on thirty patients with
modifications.
3791
Received:22/4/2019
Accepted:21/5/2019

Full Paper (vol.763 paper# 24)


ABSTRACT The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3797-3800

Effect of Low Temperature Dialysis on The Functional Activity of Complement Activation
Pathways during Hemodialysis Procedure
Mohammed Nabil Raafat Farhat1, Mohammed Elsaed Alshorbagy2, Ahmed Mohamed abd-Elfattah Al Ashkar1,
Mahmoud El-Sayed Lotfy Hassan1
Departments of 1Internal Medicine and 2Clinical Pathology
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Mahmoud El-Sayed Lotfy Hassan, Mobile: +201097870479, E-Mail: dr.lot64@gmail.com

ABSTRACT
Background:
low dialysate temperature dialysis has been used successfully in treatment of intradyalytic hypotension
and resistant pruritus. In both conditions complement activation was proposed as one pathological mechanisms for
their development. to our knowledge, no study has been done to assess the effect of low dialysate temperature on the
individual complement activation pathway. Objective: to assess the effect of low dialysate temperature on
complement activation pathways. Patients and Methods: this case control study included 20 patients, on regular
hemodialysis at Alhusein University Hospital.
Results: the mean age of our patients was 48.8±10 years, 11 males and 9 females, their mean BMI was 22±4 kg/m2,
their mean blood pressure 120/80± 20/20, all patients received hemodialysis via arterio-venous fistula. The main
cause of hemodialysis is chronic renal failure due to hypertension in 8 patients, glomerulonephritis in 4 patients,
polycystic kidney in 2 patients, hyperurecemic nephropathy in 2 patients, analgesic abuser in 1 patient, and chronic
pyelonephritis in 1 patient.
Conclusion: cold hemodialysis is associated with activation of complement system.
Keywords: hemodialysis, lactin pathway.

INTRODUCTION
been used successfully in treatment of intradyalytic
under
normal
physiological
conditions,
hypotension and resistant pruritus. In both conditions
complement activation leads to a proteolytic cascade
complement activation was proposed as one
resulting in immune cell activation, rapid opsonization
pathological mechanisms for their development (5).
and the elimination of microorganisms. however,
to our knowledge, no study has been done to
excessive complement activation, especially in the
assess the effect of low dialysate temperature on the
generation of the c3a, c5a and c5b-complexes, are life-
individual complement activation pathway.
threatening for patients on hemodialysis(HD)(1).

the c3a, c5a and c5b-9 complexes are
AIM OF THE WORK
generated from the activation of c3 and c5 via three
It is to assess the effect of low dialysate
complement activation pathways, the classical pathway
temperature on complement activation pathways.
(cp), alternative pathway (Ap) and lactin pathway

(LP)(1).
PATIENTS AND METHODS
all over the last ten years complement
This case control study included 20 patients, on
activation have been linked to various clinical
regular hemodialysis at Alhusein University Hospital,
outcomes in hemodialysis patients such as
from 1/7 to 5/7 2018.
malnutrition, muscle wasting, oxidative stress,
Inclusion criteria: being on dialysis for more than
endothelial and immune dysfunction, leukopenia,
6 months, cold hemodialysis was prescribed to prevent
anaphylactoid
reactions,
amyloidosis,
hypo-
intradialytic hypotension or alleviate uremic pruritus.
/hypertension, headache, fever, sleep disturbances, and
Exclusion criteria: being age less than 18 years or
increase risk for atherosclerosis and myocardial
more than 60, patients with active sepsis, patients with
infarction(2, 3).
malignancy, organ failure rather than renal failure,
Despite reduced induction of complement
diabetes, dialysis via catheter, fistula malfunction.
activity by newer modified cellulose or synthetic
Institutional Ethics approval: the Ethical Committee
membranes, hemodialysis patients are still consistently
of the Alhussein University Hospital had approved
exposed to low-level complement activity during their
this study. An informed consent was taken from the
frequent treatment sessions, which likely contributes to
patients.
their chronically acute inflammatory state as described
All the subjects underwent the following:
above. As complement acts upstream of many
in all selected patients the followings were done
inflammatory pathways, modalities designed to reduce
on admission:
complement activity, and in turn beneficially regulate
. demographic data: age and sex. cause of chronic
related cytokine and coagulation networks, would be
renal failure: hypertension, glomerulonephritis, analgesic
expected to improve the overall condition of
abuser, chronic pyelonephritis, and obstructive uropathy.
hemodialysis patients and reduce inflammation-related
past history of: acute renal failure, autoimmune disease,
complications (4). low dialysate temperature dialysis has
diabetes mellitus. vital signs: heart rate, respiratory rate,
3797
Received:12/10/2018
Accepted:1/11/2018

Full Paper (vol.763 paper# 25)


c:\work\Jor\vol763_26 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3801-3806

Hydrocelectomy through Inguinal Approach in Adults
Adel Mohamed Abdel Halim Lashen, Mohamed Abdel-all Nafea, Mohamed Ahmed Mohamed Elsayed*
Department of General Surgery, Faculty of Medicine, Al-Azhar University
*Correspondence author: Mohamed Ahmed Mohamed Elsayed, Mobile: (+20) 01062566333,
E-mail: Drmbasiony1989surg@gmail.com

ABSTRACT
Background:
hydrocele is the most common cause of painless scrotal swelling. The incidence in adult males is
approximately 1%, although prevalence varies according to country.
Objective: to compare between the two groups? as regards the volume of the hydrocele sac, operative time,
postoperative morbidity, length of hospital stay, and time of return to daily life.
Patients and Methods: this prospective study was conducted on 40 patients with a diagnosis of unilateral
(idiopathic) primary vaginal hydrocele during the period from October 2010 to October 2011. All patients were
admitted to the Department of General Surgery, El-Hussein University Hospital, and underwent hydrocelectomy.
Results: the age of the patients in the inguinal approach group ranged from 17 to 52 years (mean 30.75±10.67),
whereas the patients included in the scrotal approach group had an age range of 16­48 years (mean 29.35±8.93).
The difference in mean age between the two groups was statistically insignificant. The mean volume of the
hydrocele sac was 196± 30.28 ml (range, 155­250 ml) in the inguinal approach group and 197.75±26.72 ml (range,
150­260 ml) in the scrotal approach group. The difference in mean volume of hydrocele between the two groups
was statistically not significant.
Conclusion: hydrocelectomy using the inguinal approach in adults is associated with low or no postoperative
morbidity, no discomfort, short hospital stay, and early return to normal life. It is easily applied and allows
management of any associated lesions in the inguinal canal.
Keywords: Hydrocelectomy, Vaginalis, Adults.

INTRODUCTION
This prospective study was conducted on 40
A hydrocele testis is a pathological
patients who presented to the El-Hussein University
accumulation of serous fluid between the layers of
Hospital with idiopathic hydrocele and underwent
the tunica vaginalis that occurs when production of
hydrocelectomy. These patients were divided into
fluid by the vaginal tunic increased or resorption is
two groups: group I (inguinal approach group)
decreased. Hydroceles are described in several
included 20 patients with a mean age of 30.75±10.76
domestic mammals and also in humans, appearing
years and who underwent hydrocelectomy through
unilaterally or bilaterally as variable degrees of fluid
the inguinal approach, group II (scrotal approach
enlargement of the scrotum without pain (1).
group) included 20 patients with a mean age of
Etiologically, this entity is categorized as
29.35±8.93
years
and
who
underwent
congenital or acquired. Congenital hydrocele which
hydrocelectomy through the scrotal approach. A
results from a communication between the tunical
comparison was made between the two groups as
and peritoneal cavities due to a patent processus
regards the volume of the hydrocele sac, operative
vaginalis usually resolves by 18­24 months (2).
time, postoperative morbidity, length of hospital
While acquired hydrocele is usually
stay, and time of return to daily life.
idiopathic in origin and it can occur at any time in
All patients subjected to the following:
adult life. The exact mechanism of idiopathic
1- History taking.
hydrocele formation is not known. Factors such as
2- Clinical examination:
increased serous fluid secretion, lack of efferent
Each patient of the 40 hydrocele cases was
lymphatics, and inadequate reabsorption of fluid
clinically examined by a general physical
secreted by the mesothelium are possible
examination for pulse, temperature, blood pressure.
explanations (3).
This was followed by proper examination of the
Origins other than idiopathic causes are
genitalia including: examination of the penis;
infection, infarction, torsion, tumors, radiotherapy,
including the location of the urethral meatus;
tuberculosis, or filariasis (4).
palpation of the testes and measurement of their size;

presence and consistency of both the vasa and
AIM OF THE WORK
epididymis; presence of a varicocele.
A comparison was made between the two
3- Scrotal ultrasonography:
groups as regards the volume of the hydrocele sac,
Testicular blood flow dynamics evaluated
operative time, postoperative morbidity, length of
using color Doppler ultrasonography to assess blood
hospital stay, and time of return to daily life.
flow before and after surgical excision of hydrocele.

Images with B mode ultrasound were
PATIENTS AND METHODS:
acquired in the longitudinal and transverse planes.
3801
Received:22/4/2019
Accepted:21/5/2019

Full Paper (vol.763 paper# 26)


Full Paper (vol.763 paper# 27)


Full Paper (vol.763 paper# 28)


Acknowledgement The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3824-3827
Cardiopulmonary Affection in Patients with Systemic Lupus Erythematosus
Mohammed Mahmoud Nussier1, Mohamed Elwan Sayed2, Hosni Abd-Elkareem Younus1
Departments of 1Internal Medicine, 2Rheumatology and Rehabilitation, Assuit Faculty of Medicine, Al-Azhar
University, Egypt
*Correspondence author: Mohammed Mahmoud Nussier, Mobile: (+20) 01016873338

ABSTRACT
Background;
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that can affect any part of the
body. Early detection and quantification of pathological changes are important for assessing the benefits of
cardiopulmonary prevention in SLE management.
Objective: The aim was to study the effect of SLE on cardiopulmonary system, and its early detection.
Patients and Methods: Fifty patients were selected from those attending the outpatient clinics and inpatients who were
admitted to Internal Medicine Department of Al-Azhar Assuit University Hospital, from May 2017 to May 2018, and
fulfilled the American College of Rheumatology (ACR) 1982 revised criteria for classification of SLE. All patients were
subjected to complete history taking, clinical examination, routine investigations, transthoracic echocardiography (Echo)
and computed tomography (CT) of the chest.
Results: The most common echo finding was pericardial effusion seen in 20 patients (40%), followed by mitral
regurgitation in 14 patients (28%), mitral valve prolapse was seen in 13 patients (26%).The most common CT chest
findings was ground glass opacity seen in 15 patients (30%) followed by pleural effusion seen in 14 patients (28%) and
pleural thickening in 10 patients (20%). There was non- significant correlation between EF% and SLE Disease Activity
Index (SLEDAI), but a negative significant correlation between disease duration and EF% (p=0.02).
Conclusion: All SLE patients even who have clinically inactive disease should be screened for the presence of structural
cardiac and chest abnormalities. Echocardiography and CT chest can be helpful as a noninvasive diagnostic tool for early
detection of such abnormalities
Keywords: Cardiac changes, pulmonary changes, Systemic Lupus Erythematosus.

INTRODUCTION
heart and lung inflammation, central nervous
SLE is a systemic autoimmune disease that can affect
abnormalities and blood disorders (5).
any part of the body. As occurs in other autoimmune
The aim was to study the effect of SLE on
diseases, the immune system attacks the body`s cells and
cardiopulmonary system, and its early detection.
tissue, resulting in inflammation and tissue damage (1).
The course of the disease is unpredictable, with periods
PATIENTS AND METHODS
of activity alternating with remissions. The disease occurs
This study was carried out on 50 patients (44 females
nine times more often in women that in men, especially
and 6 males), aged 16­56 years, and the mean age was
in women in child-bearing years ages 15 to 35 (2). Patients
31.12± 10.32 years. The mean disease duration was
with SLE have a high risk of cardiovascular disease.
(11.50±7.054). The study was approved by local
Coronary artery disease, myocarditis, endocarditis,
Ethical Committee of Assuit Faculty of medicine, Al-
valvular disease and pericarditis are major manifestations
Azhar University.
of cardiac involvement in SLE patients. Multiple SLE-
All patients fulfilled the American college of
specific mechanisms, such as autoimmune responses,
rheumatology (ACR) 1982 revised criteria for
altered autoantibody and cytokine levels, and lipid
classification of SLE. These patients were selected from
dysfunctions can accelerate the progression of overall
those attending outpatient clinics and inpatients who were
atherosclerotic burden. Therefore, early detection and
admitted to the Internal Medicine Department of Al-
quantification of pathological changes are important for
Azhar Assuit University Hospital, from May 2017 to May
assessing the benefits of cardiovascular prevention in
2018. Informed and written consent was taken from all
SLE management (3). The respiratory system is more
patients.
commonly affected in SLE than in any other systemic
Exclusion criteria: Diabetic patients, patients with
autoimmune disease and that all its components may be
associated rheumatic diseases and pregnant women.
affected. Pleuropulmonary involvement was defined as

the presence of one or more of the following
All patients were subjected to the following:
manifestations: pleuritis, pneumonitis, pulmonary arterial
A- History taking and Clinical examination:
hypertension, shrinking lung syndrome, pulmonary
Socio-demographic data including age, sex,
fibrosis, pulmonary hemorrhage, pulmonary thrombosis
occupation, residence, marital status and special habits.
and lung infarction (4). Disease activity varies over time
and, at onset, symptoms are nonspecific and may include
History of fever, skin
unexplained fever, extreme fatigue, muscle and joint pain
rash, purpuric eruption, ecchymotic patches, oral
and skin rash. SLE can presented by arthritis, nephritis,
ulceration, photosensitivity, hair loss, arthralgia or
arthritis and myalgia.
3824
Received:22/4/2019
Accepted:21/5/2019

Full Paper (vol.763 paper# 29)


c:\work\Jor\vol763_30 The Egyptian Journal of Hospital Medicine (July 2019) Vol. 76 (3), Page 3828-3834

Assessment of The Level of Protein C in Children with Nephrotic Syndrome
Magdy Zaky El Ghannam1, Ahmed Abd El Moez Ali 1, Mohamed Ibrahim El Samanoudy2,
Ayman Ramadan Kamel1*
Departments of 1Clinical Pathology, 2Pediatric and Neonates, Faculty of Medicine, Al-Azhar University
*Correspondence author: Ayman Ramadan Kamel, Mobile: (+20) 01021647385, E-mail: kamelayman896@gmail.com

ABSTRACT
Background:
thromboembolic events remain one of the most serious complications in patients with nephrotic
syndrome and this thrombotic tendency could be related to deficiency in natural coagulation inhibitors.
Objective: the aim of our study was to estimate P-C quantity &quality in the blood of nephrotic patients for the
possible role that it might play in the pathogenesis of thromboembolic complications in these patients & trial to find
correlations between P-C & some hemostatic parameters.
Patient and Methods: this study was carried out on 60 children (age: 3-13years) were diagnosed as nephrotic
patients. They were classified as follow: G1- comprised of 20 cases in relapse, G2- comprised of 20 cases in remission
(the same cases of relapse), G3- comprised of 20 healthy children as control group.
Results: Our study showed very high significant increase in P-C, both in activity and concentration in relapse but in
remission its level decreased towards the normal level but still slightly increased and this increase is statistically non-
significant. As regard serum albumin and serum total protein, the both were very highly significantly increased in
relapse and remission as compared to the control. As regard PT and PTT were found to be highly significant decreased
in relapse as compared to the control group. Conclusion: from the foregoing we can concluded that, Increase level of
P-C in N.S. denoted that it has no role in thromboembolic complications and Increase level of P-C in N.S may afford
some protection against the thrombotic diathesis by counteracting hypercoagulability state.
Keywords: Protein C, Children, Nephrotic syndrome.

INTRODUCTION

The activity of protein C may be down-
The haemostatic mechanism comprises a series
regulated by reducing the amount either of available
of integrated reactions of the vessel wall, platelets,

plasma coagulation and fibrinolytic factors directed
thrombomodulin or of EPCR. This may be done by
towards prevention of blood loss from intact vessels &
inflammatory cytokines, such as interleukin-1 (IL-1 )
to arrest bleeding from injured vessels. Variation in any
and tumor necrosis factor- (TNF-), Protein C may
of these factors may lead to either excessive bleeding or
be up-regulated by platelet factor 4. This cytokine is
thrombosis(1).
conjectured to improve activation of protein C by
Protein c is a vitamin K-dependent protein of
forming an electrostatic bridge from protein C's Gla
62 kDa that circulates in blood as a zymogen in a
domain to the glycosaminoglycan (GAG) domain of
concentration of about 4 µg/ml. The protein is
thrombomodulin, reducing the Michaelis constant (KM)
synthesized in the liver. The mature protein C molecule
for their reaction(4).
is composed of a light and a heavy chain .The two chains
Nephrotic syndrome is a common renal disorder
being disulfide-linked. The light chain consists of a Gla
seen in childhood. In African & Indian children, the
domain and two epidermal growth factors (EGF)-like
incidence appears to be higher, ranging from 11 to 16
domains. The heavy chain contains a short activation
per 100.000. The nephrotic syndrome is characterized
peptide and a serine protease domain. Similar to the
by Oedema, massive proteinuria, hypoalbuminaemia,
procoagulant co-factors, protein C circulates as an
and hyperlipidaemia. The serum albumin is usually 2.5
inactive proenzyme and needs to be activated to gain
gm/dL or less. There is elevation of the plasma
anticoagulant activity(2).
cholesterol early, with increase in the triglycerides when
Protein C is activated by thrombin bound to
the serum albumin falls to about lgm/dL(5).
thrombomodulin on the surface of endothelial
Once the diagnosis of N.S has been established,
cells. Activation is more efficient when protein C binds
the next step is to determine its etiology. In children,
to the endothelial cell protein C receptor (EPCR) via its
approximately 90 per cent result from a primary
Gla domain. Activated protein C (APC) is a physiologic
glomerulopathy, with only 10 per cent being secondary
anticoagulant that down-regulates thrombin generation
to a systemic disease. Renal biopsy is indicated in those
by cleaving and inactivating factor Va and factor VIIIa,
children who present with atypical features of the N.S.
the cofactors of the prothrombinase and intrinsic Xase
& in those with frequent relapses and severe steroid
complexes, respectively; protein S acts as a cofactor for
toxicity where cytotoxic therapy is considered(6).
APC-mediated inactivation of factor Va and factor
The underlying pathogenetic abnormality in
VIIIa by helping target APC to the negatively charged
nephrosis is proteinuria, which results from an increase
surface of activated platelets(3).
in glomerular capillary wall permeability(7). Infection is
the major complication of nephrosis; it results from
3828
Received:24/4/2019
Accepted:23/5/2019

Full Paper (vol.763 paper# 30)