c:\work\Jor\vol771_1 1The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4675-4680
Loop versus Divided Colostomy in Patients with High and Intermediate
Anorectal Malformations: Randomized Controlled Study
Ibrahim Mohamed Hagras*, Mohammed Awad Mansour, Mohamed Mahmoud Shalaby,
Ashraf Ahmed El-Attar and Ahmed Eissa Abdalla
General Surgery Department, Faculty of Medicine, Tanta University
* Corresponding Author: Ibrahim Mohamed Hagras,email: muslimone11111@gmail.com

ABSTRACT
Background:
Colostomy is performed as a step of staged management of high-type anorectal malformations in
pediatrics. Creating a colostomy, by itself, is a minor surgical procedure, but it has many complications.
Aim: The aim of the study was to compare the outcome results of loop versus divided colostomies in patients with
high and intermediate anorectal malformations.
Methods and Material: This randomized prospective study was performed on 34 patients with imperforate anus.
Patients were divided into 2 groups (17 patients each); group A were subjected to loop colostomy and group B were
subjected to divided colostomy. Results: There was no significant difference between both groups as regards to
demographic data (gestational age, sex and birth weight), age of first presentation, associated congenital anomalies
and types of fistula. The mean operative time was 42.05 ±6.19 min in group A and 51.76 ±8.21 min in group B. The
difference between both groups in this point was statistically significant (P value =0.04). The hospital stay and
postoperative complications showed insignificant difference between both groups. Patients with loop stomas were
significantly more likely to develop prolapse (P=0.033).
Conclusions: Both techniques of colostomy are easy to perform and safe in the anorectal malformation (ARM)
patients. Loop colostomy had a shorter operative time, but the complications rates, especially prolapse and urinary
tract infection (in cloaca patients), are significantly higher in the loop colostomy when compared to the divided
colostomy.
Keywords: Anorectal malformations - loop colostomy - divided colostomy.

INTRODUCTION
were obtained. There was a code number for every
Anorectal malformations (ARMs) are birth
patient`s file, this file included photos, videos (the
defects in which the anus is absent or malformed. Its
patient's face was not included) and investigations of
incidence is around 1 in 5000 births and affects both
the patient. Results of our research were only used for
genders equally (1). ARM usually requires immediate
academic interest.
surgery to open a passage for feces, unless a fistula can
This study was carried out on 34 patients with
be relied upon, or until corrective surgery is done (2).
imperforate anus, during the period from September
Colostomy is performed as a step of staged
2017 to September 2018. Patients included in this
management of high-type anorectal malformations in
study were: with high and intermediate ARM, fit for
pediatrics (3). The site and the type of the least
surgery, well-nourished infants and without other
troublesome stoma in the surgical management of
major life-threatening anomalies.
ARMs were major subjects for argument amongst
Patients were randomly divided into 2 groups;
pediatric surgeons (4).
group A: patients who were subjected to loop
Creating a colostomy, by itself, is a minor
colostomy and group B: included patients who were
surgical procedure, but has many complications (5-7).
subjected to divided colostomy. The randomization
Some of these complications are retraction, prolapse,
was done using the closed envelope method.
parastomal hernia, intestinal obstruction, skin
All Candidates were subjected to: preoperative
excoriation, revision, anastomotic leak and wound
workup (to rule out associated anomalies) and this
infections following stoma closure (8).
included:
The aim of the study was to compare the outcome
1- complete history taking from parents or
results of loop versus divided colostomies in patients
guardians with focusing on age, consanguinity, course
with high and intermediate anorectal malformations.
of pregnancy and delivery, similar family history and

passage of meconium 2- Clinical examination: General
SUBJECTS AND METHODS
physical examination, perineal inspection: for absence
This prospective randomized study was done at
of anal opening and condition of perineal musculature
the Pediatric Surgery Unit, General Surgery
and a nasogastric tube was inserted for decompression
Department, Tanta University Hospitals after protocol
and to exclude the presence of esophageal atresia. 3-
approval by the ethical Approval.
Investigations: routine laboratory investigations (CBC,
Ethical Approval:
INR... etc.), pelviabdominal US (to exclude other
The study was approved by the Ethics Board
anomalies e.g. single kidney, hydronephrosis,
of Tanta University .Full counseling of the
hydrocolpos...etc.), echocardiography (to exclude
candidate's parents for surgery and informed consents
cardiac anomalies), X-ray spine (to exclude sacral
4675
Received:20/5/2019
Accepted:19/6/2019

Full Paper (vol.771 paper# 1)


c:\work\Jor\vol771_2 The Egyptian Journal of Hospital Medicine (October, 2019) Vol. 77 (1), Page 4681-4687
Role of Plasma Amino Acids Profiles in Pathogenesis and Prediction of
Severity in Patients with Drug Resistant Epilepsy
Tahia Saleem1, Ahmed Y. Nassar 1, Hamdy N El-Tallawy 2, Marwa Dahpy1*, Sara A Atta 1
1Medical Biochemistry and Molecular biology Department, Faculty of Medicine, Assiut University,
2Neurology and Psychiatry Department, Faculty of Medicine, Assiut University, Assiut, Egypt.
Authors' E-mails : Tahia Saleem: tahia.saleem@yahoo.com, Ahmed Y. Nassar : aynassar41@yahoo.com ,
Hamdy N El-tallawy: Hamdy_el_tallawy@aun.eg , Sara A Atta: Saraatta2016@gmail.com.,
*Corresponding authors: Marwa Dahpy Email:marwadahpy@yahoo.com, marwadahpy@aun.edu.eg

ABSTRACT
Background:
Altered plasma levels of free amino acids may predict the development of patients with drug
resistant epilepsy and their therapeutic approach.
Objectives: To elucidate the effect of plasma free amino acids (PFAAs) profiles on the etiology of patients with
drug resistant epilepsy (PRE) and the pathogenesis of status epilepticus and their contribution on the frequencies
of epileptic fits, quantitative measurements of PFAAs profiles using Sykam
Patients and Methods: Automatic Amino Acid Analyzer S433, were performed for 90 subjects; 45 of them were
PRE patients, and the other 45 were healthy controls.
Results: The plasma levels of valine, leucine, ornithine, aspartate, arginine and alanine (p 0.05 each) were
significantly increased in PRE group when compared to controls. Glutamate, glycine and GABA were also
significantly increased in PRE group compared to controls (p 0.05 each). Their plasma levels also showed
significant increase with increase the frequency of fits. On the other hand, histidine levels were significantly
decreased with mild decease in taurine levels in PRE patients compared to control group.
Conclusion: These findings documented that the use of altered PFAAs profile in PRE patients may help explaining
pathogenesis of PRE, provide a road for new therapeutic approach for such patients, and for further researches
regarding normalization of the disturbed amino acid/s or its derivative/s in managing PRE patients.
Abbreviations: Anti-epileptic drugs (AEDs), Branched-chain amino acids (BCAAs), Plasma free amino acids
(PFAAs), Pharmaco-resistant epilepsy (PRE), Sudden unexpected death in epilepsy (SUDEP).
Keywords: Aminogram; Plasma free amino acid profile; Pharmacoresistant epilepsy.


INTRODUCTION

Epilepsy is the most common chronic and severe
of individual amino acids in the brain is regulated by
neurological disease. It affects over 70 million people
the concentration of amino acids in plasma so it can
worldwide (1) with increased risk of mortality,
affect the brain functions and mental health
psychological and socioeconomic consequences
(Fernstrom,1994).
impairing quality of life (2). It is diagnosed with either
Glutamate is the most abundant excitatory
recurrent unprovoked seizures (i.e., two or more
neurotransmitter in the brain, which increases the
unprovoked seizures occurring at least 24 hours
likelihood that the neuron will have an action
apart) or a tendency toward recurrent unprovoked
potential)8). Also, it was documented that glutamate
seizures (i.e., a single seizure, accompanied by
action mediated through activation of G protein
evidence from clinical, electroencephalographic, or
coupled metabotropic (mGlu) receptors and
neuroimaging tests that an increased risk [at least
ionotropic receptors so, altered glutamate amino acid
60%] exists for future seizures over the next 10 years)
transport or metabolism may be a contributory factor
, or when an epilepsy syndrome is diagnosed (3). Over
in some genetic and acquired forms of epilepsy (9).
the past two decades approximately 40% of patients
Inhibitory neurotransmission is mediated by
with
epilepsy
exhibit
resistance
to
several neurotransmitters, as GABA and glycine (10).
pharmacotherapy(4) . Pharmaco resistant epilepsy
Gamma amino butyric acid (GABA) increases the
(PRE) is defined as the failure of adequate trials of
permeability of membranes to specific ions in such a
two
tolerated
and
appropriately
chosen
way as to cause the membranes to resist
monotherapies singly or in combination to achieve
depolarization, regulates major neurodevelopmental
sustained seizure freedom for more than one year (5).
processes, so functional and structural alterations of
PRE patients have increased risk of mortality due to
GABAergic
circuits
contribute
to
the
sudden unexpected death in epilepsy (SUDEP) (6).
pathophysiology of various brain diseases including
The practice of altering the diet to treat epilepsy
epilepsy (11).
dates to c. 400 BC, and the classical ketogenic diet
The essential branched-chain amino acids
has been utilized since the 1920s (7).
(BCAAs; leucine, isoleucine, and valine) have
Many of the neurotransmitters in the brain are
recently used as a novel treatment for PRE. Blood-
synthesized from amino acids. The in vivo synthesis
derived BCAAs can readily enter the brain, where
4681
Received:20/5/2019
Accepted:19/6/2019

Full Paper (vol.771 paper# 2)


c:\work\Jor\vol771_3 The Egyptian Journal of Hospital Medicine (October2019) Vol. 77 (1), Page 4688-4691
Preoperative Assessment of Crystalline Lens by A-Scan Quantitative
Echography and Its Correlation with Phacoemulsification Parameters
Doaa A. Mahmoud, Hanan S. Hegazy
Department of Ophthalmology, Faculty of Medicine for Girls, Al-Azhar University, Cairo,
Corresponding author: Doaa A. Mahmoud, Tel: +20 122 610 0310; e-mail: doaamahmoud75@gmail.com

ABSTRACT
Purpose:
To evaluate the correlations between the total ultrasound energy consumed during phacoemulsification with
various preoperative parameters, including the best- corrected distant visual acuity (BCDVA) and quantified metrics
taken from A-scan ultrasound biometry. Patients and methods: A prospective observational interventional study
included 40 eyes of 40 consecutive patients scheduled for cataract surgery. We assessed the lens internal reflectivity in
the A-scan echograms within a range of 0% to 100%, and calculated the mean of all spikes. All eyes with cataract
underwent clear corneal phacoemulsification. At the end of the operation we recorded the phacoemulsification time and
mean percent power. The correlations of echographic and phacoemulsification data were assessed. Results: Quantitative
echography in the 40 studied eyes with different types of cataract revealed acoustic reflections having various
configurations according to the biomicroscopic type of cataract, i.e. cortical, nuclear and posterior subcapsular cataract.
The mean spikes were 31.027% ± 25.5908, the mean lens thickness was 4.291 ± 0.6166, the mean best corrected distant
visual acuity in decimal was 0.205±0.1435, the mean phaco power% was 6.400 ± 3.0701 and the mean phaco time is
84.225. There was statistically insignificant correlation between spikes% and phaco power% in the study group (p>0.05).
There was statistically insignificant correlation between mean spikes% and lens thickness in the study group
(p>0.05).There was statistically insignificant correlation between spikes% and phaco time (in seconds) in the study group
(p>0.05). Conclusion: With regards to the predictive value of lens hardness changes in the acoustic properties identified
by our method, it is not correlated with the ultrasound energy required intraoperatively. The A-scan is helpful for the
clinical prediction of lens opacity location, but not predictive of lens hardness quantification.
Keywords: crystalline lens, A-scan quantitative echography, phacoemulsification.

INTRODUCTION

PATIENTS AND METHODS
Cataract is clouding of the crystalline lens that
A prospective observational interventional study
reduces the amount of incoming light and impairs visual
included 40 eyes of 40 consecutive patients scheduled
perception. Phacoemulsification is the most common
for cataract surgery. It was carried out at Al-Azhar
surgical method for treating advanced cataracts. The
university hospital between (March 2018 to September
optimal phacoemulsification energy is determined by
2018). Ethical approval: The study was approved by
the lens hardness(1). A detailed evaluation of cataract
the Ethics Board of Al-Azhar University and
density is essential in surgery planning in order to
an informed written consent was taken from each
improve visual outcomes and to avoid possible
participant in the study.
intraoperative and postoperative complications(2). In the

past quantification of crystalline lens hardness before
Inclusion criteria:
cataract removal has been attempted by several
Clinical diagnosis of cataract by slit lamp.
researchers. These have been in humans and in animals,
Mental and physical capacity to undergo the test.
and have used a variety of imaging modalities(3).
Normal posterior segment.
Ultrasound is an effective approach to an objective
Exclusion criteria:
evaluation of the hardness of the cataractous lenses. The
Previous eye surgery.
frequently applied methods are based on measuring
Coexistence of ocular pathology other than cataract
ultrasonic attenuation and sound speed, which tend to
(eg. Vitreous hemorrhage, retinal detachment, and
increase with the increased hardness of the cataract
elevated choroidal lesion ).
lens(4). It is already known that A-scan examination of
The study protocol adhered to the tenets of the
cataract lens will show one or more spikes originating
declaration of Helsinki and was approved by the
from the lens, appearing between the highly reflective
ethical board of Al-Azhar University. Informed
anterior and posterior lens spikes(3). Brazitikos et al. (5)
written consent was taken from each participant in
have documented the importance of A-scan lens
the study.
echography in classifying the distinct category of white
Each subject was undergone:
senile cataracts and in preoperatively evaluating the
I. Full ophthalmic examination including : Visual
potential risks of performing phacoemulsification in
acuity using Snellen visual acuity chart which was
these eyes.
converted to decimal notation for statistical analysis,



4688
Received: 26/1/2019
Accepted: 26/2/2019

Full Paper (vol.771 paper# 3)


c:\work\Jor\vol771_4 The Egyptian Journal of Hospital Medicine (October2019) Vol. 77 (1), Page 4692-4699
Serum Anti-Mullerian Hormone, Follicle Stimulating Hormone and Antral Follicle
Count Measurement as a Prediction for Pregnancy Rates in IVF/ICSI cycle
Abd El Monem Mohamed Zakaria1, Ebrahim Hasan Mohamed Yosef2, Osama Mohamed Deif1,
Mohammed Mahmoud Ahmed Khalil1*
1Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University
2Department of Pathology, Faculty of Medicine, Al-Azhar University
* Corresponding author: Mohammed Mahmoud Ahmed Khalil, Mobile: (+20) 01067907910,
E-mail: drmohamedkhalil86@gmail.com
ABSTRACT
Background:
A successful in vitro fertilization treatment depends on the ability of the ovary to respond to
gonadotrophin stimulation. This response reflects the ovarian function or `ovarian reserve'. Poor ovarian response
may be associated with reduced number of oocytes and embryos and may lead to cycle cancellation in severe cases.
On the other hand, exaggerated response leads to increased risk of ovarian hyper-stimulation syndrome.
Objective: The aim of this study is to assess role of serum AMH, FSH and AFC measurement as a prediction of
pregnancy rates in IVF/intracytoplasmic sperm injection (ICSI) cycle.
Patients and Methods:
A prospective cross sectional study was conducted at Specialized Air Forced Hospital in
the period between January 2018 and December 2018. The study included 100 unexplained infertility patients
undergoing IVF/ICSI treatment cycles. They were 82 patients primary infertility and 18 patients secondary
infertility.
Results: Type of infertility showed insignificant difference between the 2 groups while menstrual history and
gonadotrophins type showed significant difference. Age and duration of infertility were significantly higher in non-
pregnant group than pregnant. The mean value of FSH, day 3 E2 levels did not have any significant difference
between the 2 group while the mean value of serum E2 the day of HCG injection, serum AMH day 3, AFC were
significantly higher in pregnant group than non-pregnant.
Conclusion: No test can predict pregnancy in high accuracy as it is multifactorial however, mean levels of FSH,
E2, a day HCG injection and AFC showed significant difference between pregnant and non-pregnant.
Keywords: Anti-Mullerian Hormone, Follicle Stimulating Hormone, Antral Follicle, Pregnancy Rates, IVF/ICSI
cycle.

INTRODUCTION

predict reproductive lifespan and it is useful as
The reproductive capacity of a woman depends
baseline assessment preceding ovarian stimulation for
on many factors. Prediction of ovarian reserve has
individualizing the therapeutic strategy. Through
long been the golden key of reproductive
paracrine mediation, AMH contributes to control
endocrinology. Various endocrine follicle stimulating
follicle development from a reserve of primordial
hormone (FSH), inhibin B, estradiol (E2) and
follicles constituted early in life AMH has been
ultrasound tests ovarian volume, antral follicle counts
considered an ovarian reserve marker that can be
(AFC) have been suggested to improve prediction of
measured independently of the cycle phase with
oocyte yield and pregnancy outcome following
minimal fluctuations in the menstrual cycle (2).
assisted reproductive technologies (ART). Currently,
The AFC may reflect the size of the remaining
most in vitro fertilization (IVF) clinicians determine
primordial pool in women with proven natural fertility
starting doses of gonadotropin in the first cycle of IVF
and is highly correlated to the number of oocytes
based principally on the patient's age and basal FSH
retrieved. Otherwise, AFC can be used in the
levels. Ovarian reserve is determined by the size of the
prediction of ovarian response but not of
ovarian follicle pool and the quality of the produced
oocyte/embryo quality or IVF outcome (3).
oocytes. Its declines resulting in a decrease in a

woman's reproductive ability with time. Assessing
AIM OF THE WORK
ovarian reserve is a useful but challenging process in
The aim of this study is to assess role of serum
the field of IVF. Various hormonal tests have been
AMH, FSH and AFC measurement as a prediction of
used, such as basal (day 3) FSH levels, anti-Mullerian
pregnancy rates in IVF/intracytoplasmic sperm
hormone levels (AMH), and inhibin B levels. The
injection (ICSI) cycle.
most commonly used is basal FSH, which is reversely

correlated with ovarian reserve. Ultrasonography is
SUBJECTS AND METHODS
also used to assess the quantitative aspect of ovarian
Study design: A prospective cross sectional study
reserve (1).
was conducted at Specialized Air Forced Hospital in
During the last few years, AMH has emerged as
the period between January 2018 and December 2018.
one of the most important clinical markers for ovarian
Patients' characteristics: The study included 100
reserve in ART. It has a strong correlation with the
unexplained infertility (UEI) patients undergoing
number of follicles, it is operator independent, can
IVF/ICSI.
4692
Received:1/7/2019
Accepted:1/8/2019

Full Paper (vol.771 paper# 4)


c:\work\Jor\vol771_5 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4700-4704
Early Versus Delayed Umbilical Cord Clamping in Preterm Births
Tarek Ramadan Abbas, Adel Aly Elboghdady, Mohammed Elnady Abdel Samea Mohammed *
Department of Obstetrics and Gynecology, Faculty of Medicine ­ Al-Azhar University
*Correspondence author: Mohammed Elnady Abdel Samea Mohammed,
Mobile: (+20) 01146211085, E-mail: m.elnady65@yahoo.com

ABSTRACT0020
Background:
Preterm infants are at a great risk for both cognitive and motor delay. Hypovolemia secondary to
immediate cord clamping, may be disruptive to the developing brain resulting in subsequent motor delay.
Objective: The aim of this work is to compare early versus delayed cord clamping in cases of preterm birth.
Patients and Methods: This is a prospective randomized controlled study which was performed at Al-Azhar
University Maternity Hospital from July 2018 to February 2019. It included 100 pregnant patients. They were divided
into two equal groups: Group I with early cord clamping (ECC). Group II with delayed cord clamping (DCC).
Results: In our study the hematocrit on day 1 was also significantly higher in the DCC group (5.2%+50.8 ±vs. 58.5
±5.1 %, p value 0.00). The DCC group required significantly longer duration of phototherapy (55.3±40.0 h vs.
36.7±32.6 h, p value 0.016) and had a trend towards higher risk of polycythemia probably due to the higher
hemoglobin and bilirubin pool in those babies, however the incidence of significant jaundice was not different. In
this study, there was no statistically significant difference in blood pressure between neonates of both groups of ECC
and DCC. Our study found that 24% of the group underwent delayed cord clamping needed blood transfusion versus
70% of infants of the group of the immediate cord clamping.
Conclusion: Delayed cord clamping (DCC) (more than 30 seconds) in preterm births is associated with higher Hb,
hematocrit and less need for blood transfusion compared to immediate cord clamping.
Keywords: Umbilical cord, DCC, ECC, Preterm Births.

INTRODUCTION
In preterm infants, delayed umbilical cord
Although the mortality rate for preterm infants
clamping is associated with significant neonatal
and the gestational age-specific mortality rate have
benefits, including improved transitional circulation,
dramatically improved over the last 3 to 4 decades,
better establishment of red blood cell volume, decreased
infants born preterm remain vulnerable to many
need for blood transfusion, and lower incidence of
complications (1). Anemia of prematurity is a common
necrotizing
enterocolitis
and
intraventricular
problem seen in almost all preterm neonates. The
hemorrhage. Delayed umbilical cord clamping was not
placenta is a reservoir of fetal blood, which could be
associated with an increased risk of postpartum
useful to the neonate (2).
hemorrhage or increased blood loss at delivery, nor was
The development of anemia of prematurity is
it associated with a difference in postpartum hemoglobin
due to inadequate RBC production, shortened RBC life
levels or the need for blood transfusion (5).
span and blood loss due to frequent samples of blood that

obtained for various tests. These losses are often 5-10%
AIM OF THE WORK
of the total blood volume esp. premature babies who are
The aim of this work is to compare early versus
liable to NICU admission and more frequent visits for
delayed cord clamping in cases of preterm birth.
follow up. Studies on harvesting of placental blood

indicate that the placenta can contain up to 40% of the
PATIENTS AND METHODS
total circulating fetal blood volume, with perhaps 15 to
This is a prospective randomized controlled study
20 mL being situated in the cord vein (3). Consequently,
which was performed at Al-Azhar University Maternity
the timing of the clamping of the cord {more
Hospital from July 2018 to February 2019. It included
specifically, early cord clamping (ECC) versus delayed
100 pregnant patients.
cord clamping (DCC)} has been the subject of much
The study population was divided into two equal
debate (2).
groups: Group I with early cord clamping (50 patients).
Delayed umbilical cord clamping appears to be
Group II with delayed cord clamping (50 patients).
beneficial for term and preterm infants. In term infants,
Inclusion criteria:
delayed umbilical cord clamping increases hemoglobin
Patients delivered before 37 completed weeks of
levels at birth and improves iron stores in the first several
gestation either vaginally or by cesarean section.
months of life, which may have a favorable effect on
Exclusion criteria:
developmental outcomes. There is a small increase in
· Antepartum hemorrhage.
jaundice that requires phototherapy in this group of
· Multiple pregnancies (twins and more).
infants. Consequently, health care providers adopting
· Fetal hydrops.
delayed umbilical cord clamping in term infants should
· Rhesus isoimmunization.
ensure that mechanisms are in place to monitor for and
· Major congenital anomalies.
treat neonatal jaundice (4).
· Early neonatal sepsis.
4700
Received:1/7/2019
Accepted:1/8/2019

Full Paper (vol.771 paper# 5)


ABSTRACT The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4705-4713
Assessment of Curve Correction in Cases of Adolescent Idiopathic Scoliosis
Operated Through Posterior Approach by Ordinary Pedicle Screws
Ibrahim Ahmed Mustafa, Mohammad Abdelmenem Negm, Mohammad Nagah Elnoemany Ashour
Department of Orthopedic Surgery Faculty of Medicine, Al-Azhar University
Corresponding author: Mohammad Nagah Elnoemany Ashour, Mobile: 01017344226, email: m.nagah10391@gmail.com

ABSTRACT
Background:
Curve correction is the main aim in treatment of adolescent idiopathic scoliosis (AIS). Many methods
were published for correction and the most common method now is curve correction through posterior approach.
Objective: This study was conducted to assess curve correction in cases of adolescent idiopathic scoliosis that were
operated through posterior approach by ordinary pedicle screws.
Patients and methods: This was a retrospective study carried out at Al-Azhar University Hospitals between November
2018 and August 2019. Twenty (20) patients with AIS were treated through posterior approach by ordinary pedicle screw.
The patients were cooperative and reliable. The sample was comprised of 17 female and 3 male patients with a mean age
of 15.3 ± 2.9 years (range 10 - 20 years).
Results: The results were analyzed and compared with the results published by other authors which revealed that
SRS 24 questionnaire with an average of 100.2 (of total score 120 representing good outcome). All patients gained
height ranged from 3 cm to 8 cm with an average of 4.6 cm. Correction of rib hump ranged from 2.2 cm to 7.4 cm
with an average of 4.5 cm (about 77%).
Conclusion:
Finally, we concluded that all pedicle screw constructs are reliable in the treatment of AIS, while
longer follow up period is needed.
Keywords:
Adolescent idiopathic scoliosis, scoliosis research society.

INTRODUCTION

radiographs and clinical assessments ought to be gotten
Scoliosis is a three dimensional deformation of the
at regular intervals until skeletal development and after
spine characterized as a sidelong shape of the spine in
that at regular intervals a short time later to screen for
the coronal plane of more than 10° (1). It tends to be
bend movement into adulthood (4).
ordered into three noteworthy sorts: innate, syndromic,
Medical procedure is demonstrated for AIS when
and idiopathic. Inherent scoliosis alludes to spinal
the Cobb edge is more prominent than 45 degrees or the
distortion brought about by unusually framed vertebrae.
bend is quickly advancing. The pillar of treatment is
Syndromic scoliosis is related with a turmoil of the
spinal combination by means of back (PSF), foremost
neuromuscular,
skeletal,
or
connective
tissue
(ASF), or infrequently consolidated front/back
frameworks, neurofibromatosis or other significant
methodology (APSF). The objective is to settle the
ailment. Idiopathic scoliosis has no known reason and
bend while likewise amending the disfigurement. The
can be subdivided dependent on the period of
most well-known strategy is PSF with pedicle screw
beginning: childish idiopathic scoliosis incorporates
and bar obsession, which can be utilized for a wide
patients matured 0-3 years. Adolescent idiopathic
range of AIS, particularly thoracic and twofold real
scoliosis incorporates patients matured 4-10 years, and
bends. Back combination was first depicted by Hibbs in
youthful idiopathic scoliosis influences individuals
1911 as a method for restricting spinal deformation in
matured >10 years. Youthful idiopathic scoliosis (AIS)
the setting of tuberculosis (5).
is an auxiliary, parallel, pivoted ebb and flow of the
The target of this investigation was to survey the
spine that emerges in generally solid kids at or around
bend rectification in instances of AIS that was corrected
adolescence. Adolescent idiopathic scoliosis (AIS) is
through back methodology utilizing normal pedicle
the most widely recognized spinal distortion seen by
screws.
essential consideration doctors, pediatricians and spinal

surgeons (2).
AIM OF THE WORK
The analysis of AIS is one of prohibition and is
The aim of this work was to assess curve correction
made just when different reasons for scoliosis, for
in cases of adolescent idiopathic scoliosis that was
example, vertebral distortions, neuromuscular clutters
operated through posterior approach by ordinary
and different disorders have been discounted. As per
pedicle screws.
epidemiological investigations, 1-3% of kids matured

10-16 years will have some level of spinal ebb and
PATIENTS AND METHODS
flow, albeit most bends won't require careful
This was a review study done at Al-Azhar
intercession (3).
University Hospitals between November 2018 and
The Scoliosis inquire about society (SRS)
August 2019.
prescribes perception in patients who have not arrived
Ethical approval:
at skeletal development and have bends under 25
After obtaining approval of ethics committee,
degrees and in the individuals who are skeletally full
orthopedic departmental scientific committee and a
grown with bends of under 45 degrees. Sequential
4705
Received:1/7/2019
Accepted:1/8/2019

Full Paper (vol.771 paper# 6)


INTRODUCTION The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4714-4719
Accuracy of Fetal Transcerebellar Diameter in the Prediction of Gestational
Age in Singleton Pregnancy at the Second and the Third Trimesters
Hanna Abd-Elhammed El-Ebeisy, Hanan Abd-Elmonem Mohammed, Basma Osman Mohammed*
Department of Obstetrics and Gynecology, Faculty of Medicine (for Girls),
Al-Azhar University, Cairo, Egypt
* Corresponding author: Basma Osman Mohammed, Mobile: (+20) 01277696068, E-mail: dr.m.nasr88@gmail.com

ABSTRACT
Background:
Gestational age (GA) is an important parameter in obstetrics for management of pregnancy and
evaluating fetal development. High incidence of perinatal mortality has been noted in patients whose accurate
gestational age is not known.
Objective: The aim of this study was to evaluate whether trans-cerebellar diameter (TCD) in singleton
gestations can serve as a reliable predictor of gestational age (GA) in fetuses in the second and third trimester
between 14-40 weeks of pregnancy in women attending the clinic for routine ultrasound examination.
Patients and methods: This prospective study was carried out at the antenatal outpatient clinic at Al-Zahraa
university Hospital and El-Sahel Teaching Hospital. This study was hold one thousand of pregnant women
attending the outpatient clinic for routine ultrasound examination during second and third trimester between
14-40 weeks of pregnancy in a period from 1 December 2016 to March 2019.
Patients and methods: This prospective study included a total of one thousand of pregnant women, attending
at Antenatal Outpatient Clinic, Al-Zahraa University Hospital and El-Sahel Teaching Hospital. The accuracy
of the transverse Cerebellar Diameter (TCD) in the prediction of gestational age (GA) in fetuses in the second
and third trimester between 14-40 weeks of pregnancy was assessed. This study was conducted between
December 2016 to March 2019
Results: According to accuracy of measured gestational age according to measured parameters in relation to
actual gestational age (accuracy within 2 weeks), TCD had the highest accuracy (98.7%) than other parameters
in early second trimester. Accuracy of TCD in late second trimester was 91.6% and 82% in early third trimester
while in late third trimester TCD had the lowest accuracy (68.1%).
Conclusion: TCD is an accurate parameter in estimation of gestational age as its values are in close relation
with that of GA by LMP. TCD is a better predictor of the gestational age when compared to other parameters
especially between (14-22) weeks.
Keywords: Transcerebellar Diameter, Prediction of Gestational Age, Singleton Pregnancy at the Second and
the Third Trimesters

INTRODUCTION
biparietal diameter (BPD), femur length (FL) and
Gestational age estimation is one of the
abdominal circumference (AC) (1).
important decisions which guide care during
A less commonly used parameter is the
pregnancy. It is the basis for the appropriate timing
Transcerebellar Diameter (TCD), which was
of deliveries and management of complications.
fortuitously found to be a useful parameter for
Studies have shown that decisions based on
determination of GA, while it was being evaluated
inaccurate gestational ages result in higher fetal
for the assessment of fetal cerebellar growth and its
and maternal morbidity and mortality (1).
disorders. The fetal cerebellum in the embryo
The traditional method of estimating
appears at the end of 5th week of pregnancy and
gestational age, which is based on the last
can be reliably measured using ultrasonography
menstrual period, could be influenced by the
from the 12th to14th week of gestation till delivery
regularity of menstrual cycles, especially in the
(4).
immediate three months pre-conception and also
The anatomical location of the cerebellum in
by prior exposure to hormonal contraception. In
the posterior cranial fossa makes the organ less
women from developing countries, late ``antenatal
vulnerable to external pressures on the fetal
booking, the absence of accurate menstruation
cranium (5). Studies of TCD shows that the
records and menstrual cycle irregularities are
cerebellum is the least organ affected by fetal
additional challenges (2).
growth abnormalities and also revealed its
Sonographic estimation of gestational age
potential for reliable estimation of gestational age
is the `gold standard' in antenatal care,with the
(5).
first-trimester measurement of crown-rump-length
Ultrasonographically, the cerebellum, in
(CRL) which is considered the most reliable index
the second trimester, can be easily viewed as a
(3).
central rectangular echogenic structure (vermix)
The most frequently used fetal biometric
connecting two oval echoluscent structures
parameters after the first trimester include the
(hemispheres) after the 14th week of gestation (6).
4714
Received:1/7/2019
Accepted:1/8/2019

Full Paper (vol.771 paper# 7)


c:\work\Jor\vol771_8 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4720-4726

Assessment of Left Ventricular Function and Contractile Reserve in
Patients with Hypertension
Kamal Ahmed Marghany, Abd-Elhamid Ismail Abu Rahhal, Abd-Elrahman Atef Shawkat
Department of Cardiology - Faculty of Medicine, Al-Azhar University
* Corresponding author: Abd-Elrahman Atef Shawkat, Mobile: (+20)01003152977, E-mail: abdou_shawkat@hotmail.com

ABSTRACT
Background: Hypertension is a prevalent and well-recognized cardiovascular risk factor, which may lead to left
ventricular (LV) systolic impairment through chronic pressure overload.
Aim of the work: An impaired contractile reserve (CR) may be an early manifestation of left ventricular (LV) systolic
dysfunction in hypertensive patients. Using normotensive patients as controls, we examined LV CR and its correlates
in hypertensive patients. Material and methods: The study was conducted prospectively on fifty cases. 30 cases (24
males and 6 females aged 55.57 ± 10.07) had hypertension. All patients were subjected to complete history taking
including comorbidities, risk factors and full clinical examination. Patients with significant coronary or valvular disease,
previous myocardial infarction or revascularization and diabetes were excluded. LV ejection fraction (LVEF) & global
longitudinal strain (GLS) were measured at rest and at low-dose dobutamine.
Results: Hypertensive patients, compared to control had significantly impaired GLS at rest (-19.00 ± 2.34% vs. -20.50
± 1.52%, P <0.015) and at low dobutamine dose (-19.90 ± 2.33% vs. -22.60 ± 1.88 %, P <0.001). Absolute and relative
GLS CR were significantly lower in hypertensive patients (-0.88 ± 0.45% vs.-2.12 ± 0.77% and 4.70 ± 2.76% vs. 10.33
± 3.78 %, respectively, both P < 0.001). Absolute and relative LVEF CR were significantly lower in hypertensive
patients (3.31 ± 0.97 % vs. 7.09 ± 1.67% and 5.37 ± 1.64% vs. 11.61 ± 3.19%, respectively, both P < 0.001).
Conclusion: Compared to control, hypertensive patients with no other co-morbidities had impaired LV GLS at rest and
impaired CR despite normal LVEF.
Keywords: Hypertension, Ventricular function, Contractile reserve, Echocardiography, Speckle tracking strain.

INTRODUCTION
relationship between impaired CR and resting LV
Hypertension is a prevalent and well-
systolic function as assessed by LV deformation. A
recognized cardiovascular risk, which may lead to left
group of normotensive patients was recruited as
ventricular (LV) systolic impairment through chronic
controls.
pressure overload. LV hypertrophy (LVH) is a

compensatory process in response to increase wall
PATIENT AND METHODS
stress. However, this initially useful adaptive
This was a prospective observational study that
mechanism later becomes `a pathological change' in
was conducted from July 2018 to June 2019 and
the myocardium. Whilst, LVH has been shown to be a
included 50 cases who presented to stress
powerful independent predictor for cardiovascular
echocardiography test. 30 patients with hypertension
morbidity and mortality (1).
as study group and twenty normotensive as control
Multiple recent studies have shown that LV
group. Complete history was taken (personal, past,
ejection fraction (LVEF) lacks accuracy and
present & family) and complete physical examination
sensitivity in detecting early subclinical impairment. In
(SBP, DBP, HR, RR, Temp & BMI).
contrast, LV strain analysis has been proven to be more

sensitive in the detection of early subclinical LV
Exclusion criteria:
systolic dysfunction, when the LVEF is still within
- Diabetes mellitus and moderate to severe left sided
`normal' limits (2).
valvular diseases.
LV systolic dysfunction in the early stage can
- Conduction abnormalities as well as pacemaker and
be subtle and sub-clinical where resting systolic
ongoing arrhythmias.
function may remain preserved, but contractile reserve
- Congenital heart disease, poor echocardiographic
(CR) to inotropic stimulation may be blunted. A
window, previous myocardial infarction or coronary
depressed CR has been documented in patients with
revascularisation.
aortic stenosis (3), mitral regurge (4), aortic regurge (5)
The study protocol was approved by Al-Azhar
and in the diabetic cardiomyopathy (6) and is thought to
University, Faculty of Medicine. A chart review was
represent an early manifestation of LV dysfunction.
performed, and data were collected including patient
Similarly, impaired CR may be an early manifestation
demographics, medical history and physical
of LV systolic impairment in hypertensive patients.
examination.


AIM OF THE WORK
Ethical consideration and written informed
The aim of this study was to examine CR and its
consent:
correlates in hypertensive patients and to examine the
An approval of the study was obtained from Al-
Azhar

University
Academic
and
Ethical
4720
Received:2/7/2019
Accepted:2/8/2019

Full Paper (vol.771 paper# 8)


c:\work\Jor\vol771_9 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4727-4732

Prediction of The Functional Outcome in A Group of
Egyptian Patients with Posterior Circulation Stroke
Fathi M. Afifi Nasra 1, Ahmad H. Ali 2, Abdelmonem M. Hassan 1, Yasser A. Alzainy*1
1, Department of Neurology and 2 Department of Radiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Yasser A. Alzainy; Mobile: 01016620230; Email: yasser.alzainy@gmail.com

ABSTRACT
Background:
Stroke is the third most common cause of disability and second most common cause of death
worldwide. Brainstem is involved in almost all the important functions of the central nervous system, and brainstem
infarction is relatively dangerous with high mortality. Early prediction of the severity and degree of disability and
identification of high-risk patients are critical for the treatment of patients with brain stem infarction and might
contribute to reduce death rates and comorbidities after stroke.
Objective:
To assess the usefulness of Posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS)
for predicting functional outcome in posterior circulation stroke patients.
Subjects and Methods:
A cohort study on 61 patients with first-ever acute ischemic stroke who were admitted
within 24 h from onset. Results: We observed a statistically significant correlation between poor outcome and high
NIHSS score on initial assessment, as well as low pc-ASPECTS score, in contrast to other factors involved in the
study such as, age, sex, hypertension, atrial fibrillation, diabetes mellitus, high lipid profile, smoking, time from
onset to presentation, ESR, initial blood glucose measurement, HbA1C, leukoaraiosis, silent infarction or type of
stroke. Conclusion: both the pc-ASPECTS and NIHSS help clinicians predict functional outcomes. The pc-ASPECTS
is more reliable than the NIHSS in minor stroke prediction. Moreover, the combination of the pc-ASPECTS and NIHSS
has an additive effect in predicting the functional outcomes of patients with posterior circulation stroke.
Keywords: Posterior Circulation, Stroke, pc-ASPECTS, Outcome.


INTRODUCTION

Stroke can be classified into 2 major categories:
indicator (6). Following the development of diffusion-
ischemic (80%-85%) and hemorrhagic (15%-20%) (1).
weighted MRI (DWI), regional extent on DWI has
Of the ischemic strokes, 25% involve the posterior
been studied as another predictor of functional
circulation ischemic infarcts (POCI), and of these 60%
outcome, although the results remain controversial.
and 40% occur in the brainstem and cerebellum,
Previous examinations have focused on anterior
respectively (2).
circulation infarction (AC) with few studies
Medullary infarctions account for 7% of all
examining DWI data and functional outcome in
ischemic brainstem strokes and are 3:1 male
posterior circulation infarction (PC). Because the
predominance. Lateral Medullary infarctions are 3-4
anatomical architecture of the posterior circulation has
times more common than medial medullary
a high density of motor and sensory pathways and
infarctions. Isolated pontine strokes are relatively
nuclei compared to the supratentorial hemisphere,
frequent, but they can occur as part of a larger
lesion location rather than lesion volume may be
infarction in the posterior circulation. Atherosclerotic
critical for functional outcome in PC (7).
disease of perforating arteries and occlusion or
The Alberta Stroke Program Early CT Score
stenosis of the basilar artery (BA) are the most
(ASPECTS) is a 10-point scoring system of middle
common causes of pontine infarct. Infarcts of
cerebral artery (MCA) early ischemic change in which
midbrain are usually accompanied by involvement of
a score of 10 indicates normal CT and a score of 0
other structures -such as the cerebellum, thalamus, and
indicates diffuse ischemia throughout the MCA
pons- due to its complex blood supply (3, 4).
territory. ASPECTS has advantages over methods that
Risk factors associated with brainstem stroke
assess lesion volume alone because lesion volume is
include hypertension, diabetes mellitus, cardiac
only weakly correlated with neurological outcome.
disease, hyperlipidemia, smoking, obesity, and use of
ASPECTS has been shown to be reproducible at
oral contraceptives (5). Prediction of acute ischemic
varying levels of observer expertise and to enable
stroke outcome is essential for treatment planning,
prediction of functional outcome and symptomatic
guidance of patient and relatives, and in the search for
intracerebral hemorrhage after thrombolysis (8).
new therapeutic strategies. Multiple studies have
DWI ASPECTS also has been used as a reliable
identified many important factors helpful for
marker of functional outcome in patients with AC who
predicting outcome, even within the early period after
received t-PA therapy. Puetz et al. (9) proposed a new
onset of ischemic stroke. Among them, stroke severity
grading system for posterior circulation ischemia:
and age have been regarded as the most powerful
posterior circulation ASPECTS (pc-ASPECTS). Pc-

ASPECTS utilizes a 10-point scoring system to assess
4727
Received:2/7/2019
Accepted:2/8/2019

Full Paper (vol.771 paper# 9)


c:\work\Jor\vol771_10 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4733-4741

Effect of Adding Dexmedetomidine as Adjuvant to Different Regional Anesthetic
Techniques after Inguinal Herniorrhaphy
Ezzat Mahmoud Ali El-Saudi, Waheed Mohamed Ali, Esraa Mohamed Mohamed Abd-elsalam*
Department of Anesthesiology and Intensive Care, Faculty of Medicine - Al-Azhar University
*Corresponding author: Esraa Mohamed Mohamed Abd-elsalam, Mobile: (+20)1096399632,
E-Mail: esr.m.ab@gmail.com
ABSTRACT
Background:
Inguinal herniorrhaphy is one of the most commonly performed surgeries, often performed on a
fast-track basis. However, inguinal herniorrhaphy is frequently associated with persistent postoperative discomfort
and pain, which can lead to patient distress, delayed discharge, and subsequent complication.
Objective: Aim of this work is to compare TAP block technique versus local infiltration with or without
dexmedetomidine regarding analgesic effect and endogenous stress response.
Patients and Methods: This randomized prospective study included 120 patients of both genders scheduled for
non-complicated inguinal hernioplasty. Their age ranged between 18 and 60 years, with ASA physical status I and
II, and body mass index 35 kg /m². The study was approved by the medical ethics committee of Al-Azhar
University Hospital in Assiut and a written informed consent is obtained from all patients.
Results: The major finding in this study was that the pain scores were statistically significantly lower when we
added dexmedetomidine than when we did not add it and in the surgical site infiltration groups than TAP block
groups at postoperative 2nd, 6th, and12th hours. 1st request for analgesia in this study among all groups was similar.
Frequency of analgesic doses was statistically significant among all groups, and group T used the most frequent
doses. In this study, local wound infiltration and TAP block with dexmedetomidine showed decrease number of
analgesic doses and attenuated the stress response indicators (norepinephrine and glucose levels) without side
effects.
Conclusion: Dexmedetomidine added to bupivacaine in both local infiltration and TAP block had better visual
analogue scale, decreased number of analgesic doses and attenuated postoperative stress response indicators.
Norepinephrine is the most accurate stress response indicator while blood glucose is accurate and the cheapest one.
Keywords: Dexmedetomidine, Regional anesthetic techniques, Inguinal herniorrhaphy

INTRODUCTION

Post-herniorrhaphy pain is conventionally
sedative or adjuvant anesthetic. The results of a recent
treated with non-steroidal anti-inflammatory drugs
study demonstrated that synergistic interactions exist
(NSAIDS) or opioids. However, these drugs can induce
between dexmedetomidine and LA.
certain side effects, such as gastrointestinal adverse
Systemic administration of dexmedetomidine
events, postoperative bleeding, vomiting, respiratory
enhanced spinal and epidural anesthesia (7), intravenous
depression and sedation (1).
regional anesthesia (8), and its addition to LA prolonged
They eventually lead to delayed discharge from
the duration of blockade and enhanced the analgesic
hospital, thus attenuating the advantage of fast-track
and anesthetic property in a caudal and sciatic nerve
basis surgery for which early postoperative pain relief
block (9).
is imperative. Therefore, a continuous search is
Various animal studies have been conducted
underway to reduce the use of post-operative
using intrathecal dexmedetomidine at a dose range of
analgesics, such as ilioinguinal nerve blockade (2),
2.5 to 100 g without any neurological complications
caudal blockade (3), systemic administration or
(10). Antinociceptive effect of dexmedetomidine, a
infiltration of local anesthetics (LA) directly into the
highly selective alpha 2 adrenergic agonist was
wound (4), and transversus abdominis plane block
evaluated in animal studies. Dexmedetomidine was
(TAP) (5).
used to enhance the analgesic property of local
Local and/or regional analgesia techniques are
anesthetics like lidocaine, bupivacaine and ropivacaine.
critical components of an optimal multimodal analgesia
In vivo and in vitro studies indicated that these local
techniques, as they have been shown to improve pain
anesthetics had significant neurotoxicity (11).
relief, as well as reduce opioid requirement. Surgical
Dexmedetomidine showed protective or growth
site local anesthetic infiltration has been shown to
promoting properties in tissues, including nerve cells
provide excellent analgesia and is recommended, when
from cortex and has a neuroprotective effect similar to
appropriate. Transversus abdominis plane blocks have
methylprednisolone in spinal cord injury when used
been increasingly used in patient undergoing lower
intrathecally (12).
abdominal surgical procedures because of improved

pain relief and reduced opioid requirement (6).
AIM OF THE WORK
Dexmedetomidine is a newly developed
To compare local infiltration versus
selective alpha 2-adrenoceptor (AR) agonist used as a
transversus abdominal plane block (TAP) with or
4733
Received:3/7/2019
Accepted:3/8/2019

Full Paper (vol.771 paper# 10)


c:\work\Jor\vol771_11 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4742-4747

Interleukin 28B Polymorphism as a Predictor of Response to Treatment of
Egyptian HCV Patients Working in Nuclear Material Authority
Hisham E Zidan 1*, Randa M Talaat 2, Amal A A Ammar 1, Moustafa A Sakr 2
1 Department of Medical Researches, Nuclear Material Authority, Cairo, 2 Department of Molecular Diagnostics and
Theraputics, Genetic Engineering and Biotechnology Research Institute (GEBRI), University of Sadat City,
Menoufia, Egypt
Corresponding author: Hisham E Zidan, email: hz1616@yahoo.com

ABSTRACT
Background:
A Single nucleotide polymorphism upstream of the interferon-3 gene (IFNL3; formerly referred to
IL28B), strongly linked to unprompted and treatment-induced HCV infection clearance. Interleukin 28B genotype
predictive value over the outcome interferon-/ribavirin treatment was assessed carefully and contrasted with virological
predictors
Objective: The study aimed to evaluate IL-28B rs12979860 polymorphism in the reaction of HCV patients with direct-
acting antiviral (DAA) regimens (sovosbuvir) and ribavirin therapy and the allele frequencies of this gene in Egyptian
HCV patients working in the Egyptian Nuclear Materials Authority contrasted to healthy control.
Subjects and Methods: The study was conducted on randomly chosen fifty Egyptian patients infected with genotype 4
HCV aged 30 or more and received antiviral therapy (sovosbuvir and ribavirin) before six months or more. Another Fifty
age and gender matched apparantely healthy individuals were also selected as a control group. The study was carried out
in accordance with the ethical principles and guidelines of the Declaration of Helsinki and a written informed consent
was obtained from all subjects.
Results:IL-28B genotype CC was found in 34.6% of patients, while CT and TT genotypes were identified in 42.3 and
23.1% of patients, respectively. Forty (40%) patients achieved an SVR, whereas ten (20%) did not. Of the 40 patients
with an SVR, 12 had genotype CC, 25 had genotype CT, and 3 had genotype TT. CT genotype patients has achieved
considerably higher SVR rates (62.5%) compared with CC (30%) and TT patients (7.5%).
Conclusion:
Polymorphism Il-28B is an autonomous predictor of SVR to Peg IFN / RBV in patients with genotype 4 in
Egyptian HCV favorable.
Keywords: Interleukin 28B, Hepatitis C, Sofosbuvir.

INTRODUCTION
et al. (7) reported that there is no enhanced risk of
According to the WHO There are about 150
cirrhosis for bomb irradiation in the 11fold rise in
million HCV-infected people who make up 3% of the
cirrhosis in Danish individuals subjected to thorotrast.
population of the world. About 3:4 million fresh HCV
Thus, while chronical exposure to elevated doses of
patients are diagnosed each year (1). Approximately 90
radiation can trigger both genetic alteration and
percent of all HCV patients are genotype 4 (HCV g4) (2).
hepatocyte cell proliferation leading to severe HCC,
Hepatitis C virus is one of main causes for liver
acute exposure to radiation at concentrations
cirrhosis and subsequent growth of hepatocellular
encountered by survivors of a bomb can only trigger the
carcinoma (HCC). This often leads to failure of the liver
first of these occurrences. Thus, acute, unlike chronic,
and therefore transplantation of liver (3).
radiation exposure may require an additional factor of
The pathogenesis continues uncertain, but it is
risk for developing of HCC (8). Treatment with
possible that not only the virus but also the virus'
pegylated interferon plus ribavirin PEG IFN / RBV is
interaction with immune system of the host is important
the norm for chronic HCV infection). However, this
in determining the infection course and treatment
therapy results in continuous SVR reaction in only
reaction (4). Cytokines have recently recognized
about 40% of genotype 1 HCV patients and in 60% of
functional gene polymorphisms such as IFN which
those with genotype 4, whereas over 80% of genotypes
shows possible relations among these genotypes and the
2 or 3 achieve SVR (9).
clinical results of liver disease linked to HCV (5).
Recently, many antiviral effectors drugs have
Exposure to radiation was related to enhanced
been developed for the treatment of HCV infection. One
HCC risk, specially among those affected by HBV or
of the approved direct acting antiviral drugs (DAA) is
HCV infection, alcohol consumption, and smoking
daclatasvir (DCV) in combined with sofosbuvir (SOF)
habit, even for non-predisposing variables (6).
with or without ribavirin for treatment of genotype 3
However, chronic and acute radiation exposure seems to
HCV infection. DCV is a potent, pan genotypic
have a distinct connection with cirrhosis of the liver, a
inhibitor of the HCV NS5A protein and SOF is a pan
frequent cause of proliferation of liver cells. Andersson
4742
Received:4/7/2019
Accepted:4/8/2019

Full Paper (vol.771 paper# 11)


c:\work\Jor\vol771_12 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4748-4753
Interferon-Lambda 4 Gene Polymorphisms Predict Treatment Response in
Egyptian HCV Genotype 4 Patients Exposed to Radiation
Hisham E Zidan 1*, Randa M Talaat 2, Amal A A Ammar 1, Moustafa A Sakr 2
1 Department of Medical Researches, Nuclear Material Authority, Cairo, 2 Department of Molecular
Diagnostics and Theraputics, Genetic Engineering and Biotechnology Research Institute (GEBRI),
University of Sadat City, Menoufia, Egypt.
Corresponding author: Hisham E Zidan, email: hz1616@yahoo.com

ABSTRACT
Background:
Direct-acting antivirals (DAAs) has seen a significant increase of the count of patients with hepatitis C
virus (HCV) clearing their infection. Interferon Lambda Four (IFNL4) polymorphism plays a distinguished role in
spontaneous and treatment-output clearance of HCV infection.
Aim of this Work: This study aimed to assess IFNL4 polymorphism among hepatitis C Egyptian patients who were
exposed to radiation, compared to normal by a polymerase chain reaction with restriction of fragment length
polymorphism (PCR-RFLP) technique.
Materials and Method: This study included 50 HCV-positive Egyptian patients working in Egyptian Nuclear
materials Authority treated with DAAs therapy. According to treatment, they were split into two groups. Group I
included 40 patients with sustained viral response (SVR). Group II included 10 patients with no response (nSVR).
Fifty healthy people served as controls. Liver function tests, complete blood count, evaluation of viral markers, HCV-
RNA by PCR, and evaluation for IFNL4 single nucleotide polymorphisms for rs368234815 were performed by PCR-
RFLP in all patients. Results: Of the 50 patients, 40 (80%) achieved sustained virological response (SVR). Of the 23
patients with rs368234815 TT/TT genotype, 21 (91.3%) achieved SVR, while in 27 patients with non TT/TT
genotypes, 19 (70.4%) achieved SVR. The rs368234815 was a powerful predictor of SVR. However, in the present
research individuals, the predictive power of this SNP was the same as that of rs12979860 SNP.
Conclusion: In Egyptian HCV-positive patients with genotype 4, IFNL4 rs368234815 SNP is an autonomous
predictor of SVR to DAAs treatment.
Keywords: Interferon Lambda Four, hepatitis C, Polymerase Chain Reaction.

INTRODUCTION

direct-acting antivirals (DAAs) have been developed
Hepatitis c virus (HCV) infects more than 170
and introduced for treatment of HCV infection.
million people globally, 70% of whom become long-
Although DAAs are more effective than PEG-IFN/RBV
term carriers. Only a minority of infected people
combination therapy given, these new treatments of
spontaneously clear the virus, while 30 to 60% develop
HCV are not affordable and available in many countries.
chronic liver illness and a significant proportion develop
PEG-IFN and RBV still known to remain the alternative
chronic liver disease and a substantial percentage
HCV treatment regimen (3).
develops cirrhosis or even hepatocellular carcinoma
Egypt Demographic and Health Surveys
(HCC). Egypt has the largest hepatitis C incidence in
(EDHS) assessed the incidence of antibodies among
the world (1). Ionizing radiation and hcv infection
adults aged 15­59 at 14.7% in 2009 and 10.0% in 2015
communicate
to
boost
the
risk
of
HCC
substantially greater than worldwide rates. To address
supermultiplicatively. Ionizing radiation at elevated
this challenge, Egypt created a domestic HCV control
concentrations of exposure considerably improves HCC
strategy and established programs for HCV prevention
hazards when hcv is not identified at the same time.
and therapy. Following effective 99% discounted DAA
This fits into a pattern with other studies of interaction
pricing negotiations, Egypt introduced an ambitious
in hepatocarcinogenesis. Synergistic or greater than
domestic HCV therapy program aimed at treating more
multiplicative interactions in HCC being reported when
than 250,000 chronically infected people per year with
subjects are subjected to agents such as radiation that
the objective of attaining a domestic chronic infection
cause mainly genetic alteration, as well as agents such
incidence of < 2% by 2025. Despite this advancement,
as hcv and heavy drinking that trigger liver cell
current proof indicates that HCV transmission in Egypt
regeneration. People with HCV may therefore be
continues, with greater rates of incidence compared to
particularly susceptible to exposure to radiation and vice
other nations (4).
versa (2).
Diagnostic instruments, such as genotyping
HCV treatment was tied to combination therapy
IFNL3 andIFNL4, can predict those most likely to
consisting of pegylated interferon and ribavirin (PEG-
spontaneously clear HCV that could be postponed in
IFN and RBV). Recently, new antiviral agents known as
therapy. These instruments may also stratify people and
4748
Received:4/7/2019
Accepted:4/8/2019


Full Paper (vol.771 paper# 12)


c:\work\Jor\vol771_13 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4754-4759
Pattern of Eye Diseases in Ophthalmic Outpatient Clinic of Al-Zahraa
University Hospital: An Observational Descriptive Study
1Afaf Hassan Rashwan, 2Omaima I. Abo-Elkheir, 3Aya Alsayed I. Metwally
Departments of 1Ophthalmology and 2Community and Occupational Medicine, Faculty of Medicine (for Girls),
Al-Azhar University, Cairo, Egypt, 3Department of Ophthalmology, 15 May Hospital, Helwan, Egypt
Corresponding author: Aya Alsayed I. Metwally. Email: dr.ayametwally@gmail.com

ABSTRACT
Background:
A study of the pattern of the eye diseases is very essential because while some eye conditions are only
causing of ocular morbidity, others invariably lead to blindness. However, some conditions are curable, others are largely
preventable. Objective: The aim of this study was to determine the pattern of different eye diseases among patients
attending the Ophthalmic Outpatient Clinic of Al-Zahraa University Hospital.
Subjects and methods: This study was carried out on 500 patients recruited from the Outpatient Clinic of the
Ophthalmology Department, AL-Zahraa University Hospital. The study was performed from December 2018 to August
2019. All participants were subjected to fulfilling a pre designed questionnaire including questions about demographic
data, a detailed ophthalmological history and a complete Ophthalmological Examination.
Results: Retinal diseases (20.2%) were the most common eye diseases among the studied group followed by errors of
refraction (19.6%), cataract (19.4%), dry eye (12.8%) and intravitreal injection (6.4%). There was a significant difference
between male and female population regarding ocular trauma and different eye diseases. Also, there was a significant
difference between occupation groups regarding diagnosis of different eye diseases and between age groups regarding
diagnosis of different eye diseases. Conclusion: It could be concluded that due to the presence of a variety of ocular
disorders that affect different anatomical parts of the eye, routine clinical examination and screening programs to
decrease the incidence and prevalence of ocular morbidity are required.
Keywords: Pattern of eye diseases, ophthalmology clinic, Cairo, Al-Azhar University, Egypt.

INTRODUCTION
above 18 years of age; where 82% of patients were

A study of the pattern of the eye diseases is very
unaware of the dangers of diabetes on the eyes [7].
essential because while some eye conditions are only
Hypertension is considered also a major risk factor for
causing of ocular morbidity, others invariably lead to
the development of hypertensive retinopathy and other
blindness. However, some conditions such as refractive
retinal vascular diseases, such as retinal vein and artery
errors and cataract are curable, others like measles and
occlusion, and ischemic optic neuropathy. Moreover,
vitamin A deficiency are largely preventable [1].
high blood pressure increases the risk of both
Prevalence of eye diseases vary in different communities
development of diabetic retinopathy and its progression.
according to several factors, which include social and
The etiology and disease mechanisms of both diabetes
environmental characters of the community, health
and hypertension are overlapped. They share many
habits of the community, personnel hygiene and
common risk factors e.g. dyslipidemia, proteinuria [8].
technical procedures used in the diagnosis of eye
Early diagnosis and treatment can prevent all diabetic
diseases [2], [3].
ocular complications. However, the cornerstone for
Trachoma is still the chief cause of infectious
prevention of these complications are through Good
blindness in the world [4]. Visual impairment and
control of blood glucose and other systemic risk factors
blindness remain a major problem in the world
such as hypertension and hyperlipidemia [9]. A clear
nowadays. There are an estimated 161 million suffering
awareness of the pattern of eye diseases will form a
from visual disability and 37 million people worldwide
framework which will utilize to effectively prevent or
suffering from blindness; around 80% of these are
treat diseases that may cause blindness. This in turn will
preventable. Cataract, which can be simply operated
decrease needless blindness and visual impairment, and
upon and cured, is responsible for more than half of the
eventually, it will help to get their full potential in life
blindness in the world. Glaucoma, diabetic retinopathy,
[10]. This type of study is helpful to get an idea about the
trachoma, uncorrected refractive error and childhood
epidemiology of any ocular disorder. It is necessary to
blindness make up the rest [4]. Globally, cataract is
organize community education and ensure early
considered the principal cause of blindness. Smoking,
treatment to reduce the prevalence of these diseases in
diabetes, and exposure to UVB light have been
the general population [11].
recognized as risk factors for cataract development [5].
The aim of this work was to determine the pattern
Deficient protective measures in workplaces appear to
of different eye diseases among patients attending the
be the main cause of ocular injury, especially in young
ophthalmic outpatient clinic of Al-Zahraa University
males. It can be assumed that health education, as well
Hospital.
as application of safety measures and protocols, will

significantly reduce the incidence of ocular injuries in
SUBJECTS AND METHODS
the target population [6]. Diabetic retinopathy (DR) was
This observational Descriptive Cross-Sectional
20.5% among Egyptian diabetic patients who were
study included a total of 500 patients attending at
4754
Received:01/07/2019
Accepted: 01/08/2019

Full Paper (vol.771 paper# 13)


c:\work\Jor\vol771_14 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4760-4767

Diagnostic Value of Combined Diffusion Weighted MRI and
Conventional MRI in The Diagnosis of Non-Palpable Undescended Testes
Elsayed Ahmed Ibrahim Awad*, Abd Ellah Nazeer Yassin, Maged Mohamad AbdlAziz
Department of Radiodiagnosis, Faculty of Medicine, Al-Azhar University
*Corresponding author: Elsayed Ahmed Ibrahim, E-mail: saidegypt15@gmail.com, Mobile: (+20)01008792985

ABSTRACT
Background:
Additional MRI assessments, as DWI are useful methods to improve the accuracy and sensitivity of
diagnosis of non-palpable testes. Objective: The aim of this work was to assess diagnostic value of combined diffusion
weighted MRI and conventional MRI in the diagnosis of non-palpable undescended testes before laparoscopy.
Patients and Methods: This was a prospective study during a period of 12 months duration from January 2018 to
December 2018 including 30 male patients with 33 non-palpable undescended testes (unilateral in 27 cases and bilateral
in three cases). They were prospectively enrolled in this study. Their ages ranged from 6 months to 21 years old (mean
age = 4.04 ± 4.004 years, mood=1 years). The research was carried on the Radiology Department, Al Azhar University
Hospital and AlAhrar Teaching Hospital. All patients underwent ultrasound then underwent magnetic resonance
imaging included different pulse sequences and scanning planes.
Results: Conventional MRI showed sensitivity of 79.31%, specificity of 100% and overall accuracy of 81.82%; DWI
had higher sensitivity (82.76%) but lower specificity (75%) and similar overall accuracy (81.82%) compared to
conventional MRI; combined assessment had the highest sensitivity (86.21%), specificity (100%) and accuracy
(87.88%). Conclusion: DWI findings complement the information on the location and viability of undescended testes
obtained with conventional MRI before laparoscopy.
Keywords: Conventional MRI, DWI, UDT.

it had been shown to have low sensitivity in identifying
INTRODUCTION
non-palpable testicles preoperatively (5). CT is
Cryptorchidism is the absence of one or both
noninvasive but is unreliable and carries the risk of
testes in the scrotum and is generally synonymous with
radiation (6). Conventional MRI has low sensitivity for
undescended testes (1).
Undescended testis is the
localization of non-palpable UDT. It has apparently low
most common genital disorder identified at
efficiency in the detection of intra-abdominal
birth. Undescended testes occur in 1­3% of full-term
functioning testes. Moreover, it fails to locate most of
and up to 45% of preterm male neonates (2).
the atrophied testes, thus, rendering the utilization of
The term `non-palpable testes' implies that the
conventional MRI less reliable in distinguishing
testes cannot be detected on physical examination; they
children needing surgery from those who do not (2).
are intra-abdominal, absent, vanishing or atrophic. In
In DWI technique, information is extracted on the
Kato (3) study, 18% of these testes could be palpated
diffusion of water molecules, which reflects the degree
during physical examination under anaesthesia, and
of cellularity of tissue. Use of DWI therefore facilitates
12.6% of viable testes discovered on exploration were
characterization of tissue at the microscopic level in a
distal to the inguinal canal and simply missed on
mechanism different from T1 and T2 relaxation (6). The
physical examination (3).
degree of restriction of water diffusion in biologic tissue
The cardinal reasons for treatment of undescended
is inversely related to tissue cellularity and the integrity
testis (UDT) include increased potential risks of
of cell membranes. The motion of water molecules is
testicular malignancy, infertility, together with testicular
more restricted in tissues with the high cellularity
torsion and associated inguinal hernia (2, 3).
associated with numerous intact cell membranes (e.g.
Preoperative identification and location of
tumor tissue). Concordantly, intra-abdominal testes are
testicles can help to determine the optimal type of
considerably more cellular than the adjacent organs and
procedure and allow for appropriate advance planning.
tissues and can be detected easily on DW images owing
On the basis of the imaging findings, the surgeon can
to their increased signal intensity (6).
appropriately counsel the patient and alter the operative

approaches needed. In the case of absent or vanishing
AIM OF THE WORK
testicles, imaging findings could obviate the need for
The aim of this work was to assess diagnostic
surgical exploration (4).
value of combined diffusion weighted MRI and
Different imaging techniques have been implied in
conventional MRI in the diagnosis of non-palpable
localizing non-palpable UDTs preoperatively, with
undescended testes before laparoscopy.
varying limitations. Imaging techniques include

ultrasonography (US), computed tomography (CT),
PATIENTS AND METHODS
conventional magnetic resonance imaging (MRI),
Patients:
magnetic resonance angiography (MRA) and magnetic
This was a prospective study conducted during
resonance venography (MRV) (2). Ultrasound is the least
a period of 12 months duration from January 2018 to
expensive, does not involve ionizing radiation and
December 2018 including 30 male patients with 33 non-
frequently used technique of all imaging tools. However
palpable undescended testes (unilateral in 27 cases and
4760
Received:03/07/2019
Accepted:03/08/2019

Full Paper (vol.771 paper# 14)


ABSTRACT The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4768-4776
Assessment of Degree of Fibrosis in Chronic Hepatitis C Virus Patients
Treated with Direct Acting Antiviral Agents
Fathy Ghamry Abd-Elrazik1, Magdy Abd-Elkarim Aldahshan1, Arafat Abd-Elazim Kasim1, Haitham
Ahmed Ali Gabr2, Mohamed Nasr Mohamed1
1Department of Internal Medicine, Faculty of Medicine - Al-Azhar University
2Researcher of Internal Medicine, National research center ­ Cairo
Corresponding author: Mohamed Nasr Mohamed, Mobile: 01270949812;
Email: dr.m.nasr88@gmail.com
ABSTRACT
Background:
Weighing in at around 3 pounds, the liver is the body's second largest organ; only the skin is larger
and heavier. The liver performs many essential functions related to digestion, metabolism, immunity, and the storage
of nutrients within the body. These functions make the liver a vital organ without which the tissues of the body would
quickly die from lack of energy and nutrients. Fortunately, the liver has an incredible capacity for regeneration of
dead or damaged tissues; it can grow as quickly as a cancerous tumor to restore its normal size and function.
Objective:
to evaluate the levels of fibrosis regression by ARFI in the patients with successful eradication of chronic
hepatitis C virus after 12 weeks and 24 weeks after completion of treatment with direct acting antiviral drugs
(sustained virological response, SVR 12 and SVR 24).
Patients and Methods: This prospective and observational cohort study was conducted during the period between
June 2016 and February 2019 in total of 60 individuals at Al-Azhar (Al-Hussein) Hospital and National Search
Institute in Cairo divided into three groups.
Results:
Results show that the median fibrosis degree measured by ARFI in all patients was significantly decreased
after HCV eradication with 100 % success in cure rate and 16.5% of patients failed to regress fibrosis.
Conclusion: A disappointing percentage (16.5%) failure in fibrosis regression although reaching a sustained
virological response.
Keywords:
Hepatitis C virus, Sustained virological response, Liver cirrhosis.

INTRODUCTION

givers testing positive for the lethal ailment. As per
The liver is a basic organ for numerous
HCV advocate, the fundamental driver of presentation
physiological
procedures
which
incorporates
in Egypt has all the earmarks of being because of
supplement digestion, blood volume guideline,
deficient contamination control practices and infusion
resistant framework backing, lipid and cholesterol
treatment, for example, blood transfusions. Ailing in
homeostasis, and the breakdown of mixes, including
foundation to manage the infection, Egypt experiences
numerous present medications (1).
an especially high dreariness and death rate, with
Handling, parceling, and digestion of
40,000 biting the dust from the illness every year. It is
supplements give the vitality expected to the recently
evaluated that around 15 million Egyptians at present
referenced procedures and are thusly among the liver's
experience the ill effects of Hepatitis C. Consistently
most basic capacities. In addition, the liver store
there are 170,000 to 200,000 new HCV cases. Hepatitis
glucose as glycogen, with nourishing, and collect
C infection (HCV) is a hepatotropic infection and a
glucose by means of the gluconeogenesis pathway,
noteworthy reason for constant hepatitis and liver
considering fasting. The liver oxidizes lipids yet can
malady around the world. Introductory connections
likewise process abundance lipid for discharge to and
between HCV virions and hepatocytes are required for
capacity in different tissues, for example, fat tissues (2).
gainful viral disease and commencement of the viral
At long last, the liver is a noteworthy handler
life cycle. The accessibility of the immediate acting
of protein and amino corrosive digestion as it is in
antivirals which are basic and middle of the road
charge of most of proteins discharged in the blood, the
treatments for hepatitis C infection (HCV)
preparing of amino acids for vitality, and transfer of
contamination with reactions >95% is one of the best
nitrogenous waste from protein debasement as urea
medicinal advances in decades, offering a chance to
digestion (3).
turn around the rising weight due to HCV and endeavor
Liver disappointment from any number of
towards HCV disposal. A key test pushing ahead will
sources (for example viral disease, over sustenance, or
be to guarantee that the individuals who are
oncologic weight) is a worldwide medical issue.
undiscovered
are
caused
mindful
of
their
Emphasize that knowledge into hepatic pathologies and
contamination, to get HCV treatment and accomplish
potential helpful roads to treat these conditions requires
viral fix (4).
a comprehension of the advancement and physiology
Liver fibrosis is the last basic pathway of
of hepatic capacities (2).
ceaseless or iterative liver harm. Progressed perpetual
The World Health Organization (WHO) has
fibrosis is portrayed as cirrhosis with lost design and
discovered that Egypt has the most elevated
utilitarian disappointment and the advancement of
commonness of the Hepatitis C infection (HCV) on the
dangerous difficulties. In any case, convincing
planet, with roughly 22 percent of Egyptian blood
investigations demonstrates that if the damage is
4768
Received:04/07/2019
Accepted:04/08/2019

Full Paper (vol.771 paper# 15)


c:\work\Jor\vol771_16 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4777-4784
Detection of Some Genetic Polymorphism and Serological Factors
Associated with Rheumatoid Arthritis in Egyptian Patients
Kareman M. Bakr1, Maha M. Abd Al-Rahman1, Aml E. Abdou2, Hegazy M. Al-Tamimy3
1Department of Microbiology& Immunology, Faculty of Pharmacy (Girls), AL-Azhar University, 2Department of
Microbiology, Faculty of Medicine (Girls), AL-Azhar University, 3Department of Rheumatology, Physical Medicine &
Rehabilitation, Faculty of Medicine (boys), AL-Azhar University, Cairo, Egypt
Corresponding author: Kareman M.Bakr,email: karemanmohammed54@gmail.com
ABSTRACT
Background: Rheumatoid arthritis is a chronic inflammatory autoimmune disease thatis characterized by destruction of
cartilage and bone. PADI4 gene encoding the peptidyl arginine deiminase 4 citrullinating enzyme that has been found to be
over expressed in rheumatoid arthritis patients.
Objective: To investigate relation between PADI4 gene polymorphisms and anti­cyclic citrullinated peptide (Anti-CCP)
autoantibody levels in sera of Egyptian rheumatoid arthritis patients, and to find its relevance to the disease activity(DAS28
score) and other inflammatory markers as Rheumatoid factor (RF).
Methods: PADI4-89 andPADI4 -92 single nucleotide polymorphisms (SNPs) were analyzed in thirty RA patients and
twenty healthy controls by polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) method.
Serum anti-CCP levels were measured by enzyme-linked immunosorbent assay (ELISA).
Results: PADI4-89 genotype A/G was present in RA patients at higher frequency compared to controls (P = 0.024). (G)
allele frequency was significantly higher in RA patients than in controls (P= 0.047). Level of Anti ­ CCP was significantly
higher in RA patients serum than in controls (P= 0.000).PADI4-89 A/G + G/G genotype and PADI4-92 C/G+GG genotype
were associated with higher DAS28 score, Rheumatoid factor (RF), and anti-cyclic citrullinated protein (Anti ­ CCP).
Significant positive correlation was found between serum level of Anti­ CCP and DAS28 score (P= 0.023).
Conclusion: The SNPs A/G and G/G of PADI4-89 were associated with RA susceptibility. Relation was found between
both PADI4 polymorphism and anti-CCP levels.
Keywords: Rheumatoid arthritis, PADI4, Single nucleotide polymorphism, Anti­ CCP.

INTRODUCTION

and RA not only in the Japanese population but also in
Rheumatoid arthritis (RA) is the most common
European Caucasian populations. However, a recent
inflammatory arthropathy. The majority of evidence from
genome-wide association studies found a weak association
genetics, tissue analysis models and clinical studies showed
of PADI4 polymorphisms and RA in most Caucasian
that an immune-mediated etiology and stromal tissue
European studies (9).
dysregulation together lead to chronic inflammation and
Objectives: The aim of this study was to investigate
articular destruction. A pre-RA phase lasting months to
the association between PADI4 gene polymorphisms and
years may be characterized by the presence of circulating
anti­cyclic citrullinated peptide (Anti-CCP) autoantibody
auto antibodies, increasing range and concentration of
levels in sera of Egyptian patients with rheumatoid arthritis
inflammatory cytokines, chemokines and altered
and to find out its relevance to the disease severity (DAS28
metabolism (1). Different evidences have shown that genetic
score) and other inflammatory markers such as rheumatoid
alterations mainly of the single nucleotide polymorphisms
factor (RF), C-reactive protein (CRP) and erythrocyte
(SNPs) type that located in genes that regulate the innate
sedimentation rate ( ESR).
and adaptive immune response are the main genetic risk

factor in RA (2). The PADI4gene located at the 1p36 region
SUBJECTS AND METHODS
was recently found as one in association with RA(3). This
Study population
gene encoding peptidyl arginine deiminase 4 enzyme that
The study included thirty Egyptian patients with RA,
catalyzes the protein conversion of arginine residues into
all fulfilled the American College of Rheumatology (ACR)
citrulline, producing citrullinated proteins (4). This process
2010 criteria for diagnosis of RA (10) and ACR criteria for
can cause loss of immune tolerance and anti-CCP
classification of rheumatoid arthritis (1987) (11). They were
development. Anti-CCP identification provides accurate
26 (86.7%) Female and 4(13.3%) males, with the age
prognosis and diagnosis of RA (5,6). The protein peptidyl
between (23-70) years old at the time of diagnosis and they
arginine deiminase (PADI4) consists of 663 amino acid
were recruited from Physical Medicine, Rheumatology and
residues with a 74 kDa molecular weight (7). A candidate
Rehabilitation Department at Sayed Galal University
gene study identified several PADI4 SNPs (PADI4-89,
Hospital during the time period from January 2018 to May
PADI4-90, PADI4-92 and PADI4-104) involved with risk
2018.All patients were subjected to full history taking,
for RA (3). The first positive association between PADI4
musculoskeletal examination including signs of
and RA was shown in a Japanese population (3). A meta-
rheumatoid arthritis, plain X-ray of both hands AP view.
analysis showed that positive association between PADI4
Disease activity score was performed for each patient
4777
Received:05/07/2019
Accepted:05/08/2019

Full Paper (vol.771 paper# 16)


c:\work\Jor\vol771_17 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4785-4796
Evaluation of Right Ventricle Diastolic and Systolic Function in Patients with
Intracardiac Shunts by Strain Echocardiography and Tissue Doppler
Raghda Ghonimy El Sheikh, Suzan Bayoumy Elhefnawy, Ayman Ahmed Gaafar,
Tarek Hanafy Mahmoud Mahdy *
Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University
* Corresponding author: Tarek Hanafy Mahmoud Mahdy, Mobile: (+20)01027666748, E-mail: tarek.mahdy@ymail.com

ABSTRACT
Background:
The right ventricle performance is very important in the prognosis of the patients with intracardiac
shunts. Development of RV failure is associated with higher mortality. It can be directly related to the shunt itself or
indirectly associated with elevated pulmonary artery pressure.
Objective: The aim of this work was to assess the diastolic and the systolic performance of the right ventricle in patients
with different types of intracardiac shunts by the Echocardiography in comparison with the normal population.
Patients and methods:
Our study included 132 patients undergoing echocardiography in the Outpatient Clinic of
Tanta University Hospital. The study was conducted starting from 1st of February 2018 to 28th of February 2019. The
study included 63 female and 69 male patients. Their age ranged from 1 month to 49 years old. RV diastolic and
systolic function were assessed in the four groups using MPI, Stroke work, longitudinal RV strain rate.
Results: Our results showed higher values of the parameters measured in the atrial septal defects (ASD) patients' group
compared to the normal subjects and the other intracardiac shunt's patients. Also, ASD's patients were associated with
higher pulmonary artery pressure values and worse RV function parameters in general.
Conclusion: We concluded that the new echocardiographic measures are good and reliable tool to assess the right
ventricle function in the patients with intracardiac shunts. Additionally, ASD' patients are associated with worse
outcome especially if they develop elevated pulmonary artery pressure.
Keywords: Right Ventricle Diastolic and Systolic, Echocardiography, Tissue Doppler.


INTRODUCTION

Intracardiac shunting means abnormal flow of the
can remain asymptomatic until Eisenmenger syndrome
blood in the heart because of a defect in the structure of
and pulmonary vasculopathy develop (5).
either the ventricles or the atria. These alternative
Transthoracic echocardiography (TTE) is a useful
pathways cause blood flow to bypass the normal
method for initial evaluation of RV structure and function
circulation, resulting in the mixing of arterial and venous
in these type of patients. In our study, we discussed the
blood (1).
measures of normal RV function and the impact of the
Intracardiac shunts is classified into right-left, left-
most common intracardiac shunts in RV function (6).
right or bidirectional. It also may be congenital or

acquired (as VSD complicating acute myocardial
AIM OF THE STUDY
infarction) (2). The most common congenital intracardiac
The aim of this work was to assess the diastolic and
shunting are atrial septal defects (ASD), ventricular
the systolic performance of the right ventricle in patients
septal defects (VSD), and patent foramen ovale (PFO).
with different types of intracardiac shunts by the
These defects may be asymptomatic, or they may
echocardiography in comparison to the normal population.
produce symptoms, which can range from mild to severe

(3). Each type of shunt carries different hemodynamic
PATIENTS AND METHODS
stress and physiologic demands. The long-term capacity
Patients:
of the right ventricle (RV) to withstand the stresses and
Study Population
meet those demands has become recognized as a key
Our study included 132 patients undergoing
contributor to late clinical outcomes (4).
echocardiography in the Outpatient Clinic of Tanta
Right ventricle (RV) function is one of the most
University Hospital. The study was starting from 1st of
important predictors of morbidity and mortality in
February 2018 to 28th of February 2019.
congenital heart diseases. RV failure is a progressive
Patients were divided into four groups as follows:
process that begins with myocardial injury, stress, The first group consisted of 27 healthy subjects with
neurohumoral activation, cytokine activation, altered
normal echocardiography and totally asymptomatic.
gene expression and ventricular remodeling (1). RV The second group consisted of 51 patients diagnosed with
failure may be due to pressure or volume overload. When
atrial septal defect (ASD).
the RV is exposed to pressure overload, it corresponds The Third group included 21 patients diagnosed as patent
first with hypertrophy leading to dilatation and loss of
foramen ovale (PFO).
contractile force that may be complicated with right The Fourth group consisted of patients diagnosed with
ventricular ischemia worsening the ventricular
ventricular septal defect (VSD).
dysfunction. RV can adapt to high volume overload for
The study included 63 female and 69 male patients.
a long time without significant dysfunction and patients
Their ages ranged from 1 month to 49 years old.
4785
Received:05/07/2019
Accepted:05/08/2019

Full Paper (vol.771 paper# 17)


c:\work\Jor\vol771_18 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4797-4801
Outcome of Patient with Moderate Functional Tricuspid Regurgitation
Underwent Mitral Valve Replacement without Tricuspid Valve Repair
Abd-Allah Abd-Alhamid Sallam, Mohammed Eldesoky Sharaa, Bahaa Abd-El Gawad Hassan El
Khonezy, Mahmoud Hamed Al-Emam Zidan*, Mohammed Abd Elhameed Mohammed
Cardiothoracic surgery Department, Faculty of Medicine, Al-Azhar University
*Corresponding author: Mahmoud Hamed Al-Emam Zidan,
Email: zizooo9492@gmail.com
ABSTRACT
Background:
The tricuspid valve is often called the "forgotten valve" or "lost valve," because it is relatively
understudied relative to the other cardiac valves. Left-sided valvular heart diseases represent the most common cause
of functional tricuspid regurgitation (FTR) and the reported prevalence reached 25% to 30%.
Objective:
The aim of the work is to give an attention to the problem of moderate functional tricuspid valve
regurgitation with mitral valve replacement and includes revision of anatomy of tricuspid valve, pathophysiology,
diagnosis and management of functional tricuspid valve regurgitation.
Patients and Methods:
In the present retrospective study, 30 randomly selected patients with moderate functional
tricuspid valve regurgitation (grade 2) underwent mitral valve replacement for the first time at Al-Hussein University
Hospital without repair of their moderate functional tricuspid regurgitation. The study was approved by the medical
ethics committee of Al-Azhar University Hospitals and a written informed consent is obtained from all patients.
Results: In the present study and according to the sex, the females (9) represent (30%) while males (21) were (70%).
Their age ranged between 40-60 years with mean 48.40 ± 6.92. The Degree of TR was mild 15 (50.0%), moderate 6
(20.0%), severe 3 (10.0%) and Trivial 6 (20.0%) of Echo data after 6 months.
Conclusion: Functional tricuspid regurgitation (TR) is commonly associated with mitral valve (MV) diseases and the
presence of significant TR is reported to be an indicator of poor prognosis after the surgical correction of MV diseases.
Keywords: Moderate functional tricuspid regurgitation, Mitral valve replacement, Tricuspid valve repair.

INTRODUCTION
45% in patients undergoing MV surgery for mitral
The tricuspid valve is often called the "forgotten
regurgitation (MR) (3).
valve" or "lost valve," because it is relatively
Right ventricular (RV) dilatation and annular
understudied relative to the other cardiac valves (1).
dilatation result in coaptation deficiency and tethering
Tricuspid valve regurgitation which can be
of leaflets of the tricuspid valve. Historically,
divided into functional (secondary) disease and
conservative strategies have been recommended for
organic (primary) disease. Functional disease typically
FTR in patients undergoing left-sided heart valve
occurs in the setting of an anatomically normal valve
operations (4).
and results from pulmonary artery hypertension and
Guidelines have classified FTR based on
right ventricular (RV) dilatation. This condition most
anatomy, valve hemodynamics, hemodynamic
often is secondary to left-sided valvular disease but
consequences, and clinical symptom (5, 6). Concomitant
also may result from Eisenmenger's syndrome, RV
tricuspid valve repair or replacement at the time of the
infarction, or primary pulmonary hypertension (PPH).
left-sided valvular operation has been recommended,
These types of disease typically manifest in the clinical
with class I indication in patients with severe FTR to
presentation of tricuspid regurgitation (TR). Organic
improve long-term clinical outcomes (7). Nonetheless,
disease (in which there is a structural abnormality of
the optimal management of mild to moderate FTR
the valve) is associated most frequently with rheumatic
remains controversial. We therefore performed a meta-
fever but also may occur in the setting of congenital
analysis to examine the outcome of strategies used for
anomalies, infective endocarditis, radiation therapy,
the treatment of mild to moderate FTR in patients
trauma (from endomyocardial biop-sies or pacemaker
undergoing mitral valve operations.
lead insertion), carcinoid syndrome, Libman-Sacks

endocarditis, eosinophilic leukemia, and diffuse
AIM OF THE WORK
collagen disorders. Left sided valvular heart diseases
The aim of the work is to give an attention to the
represent the most common cause of functional
problem of moderate functional tricuspid valve
tricuspid regurgitation (FTR) (2).
regurgitation with mitral valve replacement and
The reported prevalence of FTR in patient's
includes revision of anatomy of tricuspid valve,
undergoing operations for left-sided heart valve
pathophysiology, diagnosis and management of
disease is 25%to 30% (5). Other study reported a
functional tricuspid valve regurgitation.
prevalence of moderate to severe FTR of up to 63% of

patients with mitral stenosis. The prevalence of
PATIENT AND METHODS
moderate or severe FTR ranges largely from 8% to
Ethical approval: This is retrospective study which
was approved by the medical ethics committee of Al-
4797
Received:05/07/2019
Accepted:05/08/2019

Full Paper (vol.771 paper# 18)


ž˙ The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4802-4809
Risk Factors of Anemia in Pre-end-Stage Renal Disease
Mohammed M. Nussier1, Hosni A. Younis1 and Mohammed S. Allam2
1Internal Medicine, and 2Clinical Pathology Departments
Faculty of Medicine, Al-Azhar Assiut University, Egypt
Corresponding author: Mohammed M. Nussier,
Internal Medicine Department, Faculty of Medicine, Al-Azhar Assiut University, Egypt

ABSTRACT
Background:
Anemia is a common complication of chronic kidney disease (CKD). Observational studies indicate
that low Hb levels in such patients may increase risk for progression of kidney disease and cardiovascular morbidity
and mortality. Objective: The aim of the work is to study the different risk factors contributing to anemia in pre-
end stage renal disease patients (stage 3 and 4 CKD).
Subjects and methods: The study involved 50 patients with history of CKD, not receiving any treatment or dialysis,
29 men and 21 women, 22-72 years old. In addition to 20 healthy persons as a control group. They were randomly
selected from the outpatient clinics and inpatient department of Internal Medicine Departments, Al-Azhar Assiut
University Hospitals over a period of two years.
Results:
There were different risk factors causing anemia among patients group; 1-Anorexia was present in (44%)
of patients, 2-Fecal occult blood test was positive in (6%) of patients, 3-The indicators of inflammation including
high levels of CRP, ESR (were high in 100%) and serum ferritin was high in (80%) of patients, 4-The indicators of
"uremic milieu" including increased level of blood urea and S. creatinine and moderate to severe albuminuria in
addition to decreased level of GFR, all were present in (100%) of patients, and 5-erythropoietin deficiency also was
present in (54%) of patients. Conclusion: Our study concluded that anemia in pre end stage renal disease (ESRD) is
multifactorial and the prevalence of different risk factors is inversely correlated with hemoglobin level.
Keywords: Risk Factors, Anemia, Pre-end Stage Renal Disease.


INTRODUCTION

Chronic kidney disease (CKD) is an important,
clinics and inpatient department of Internal Medicine
chronic disease that affects humans all over the world.
Departments, Al-Azhar Assiut University Hospitals
It is characterized by irreversible impairment of
over a period of two years.
excretory, metabolic and endocrine functions of the

kidney leads to the development of clinical syndrome
Inclusion criteria: Patients with documented chronic
of uremia (1). Anemia is a common complication of
kidney disease of: serum creatinine 2 mg/dl , GFR <
CKD. The prevalence of anemia varies with the degree
60 and >15 mL/ minute/1.73 m2 ( i.e. CKD stage III
of renal impairment in pre-dialysis patients with CKD,
and IV(pre ESRD).
but once end-stage kidney failure occurs, all patients
Exclusion criteria; for patients group: patients with
are eventually affected (2). Anemia develops once renal
ESRD or those on dialysis.
function decreases to 50% because of a deficiency in
For both patients and control groups:
endogenous erythropoietin production by the kidney,
· Recent severe hemorrhagic episode.
decreased red cell survival, blood losses, and increased
· Recent blood transfusion
red blood cell destruction once the patients begin
· patients receiving iron or erythropoietin therapy
dialysis treatment, particularly hemodialysis (3).
· Malignancy or known hematological disorder
Observational studies indicate that low Hb levels in

such patients may increase risk for progression of
Methods:
kidney disease and cardiovascular morbidity and
Ethical consideration and Written informed
mortality (4).
consent:

An approval of the study was obtained from Al-
AIM OF THE WORK
Azhar University academic and ethical committee.
The aim of the work is to study the different risk
Every patient signed an informed written consent for
factors contributing to anemia in pre-end- stage renal
acceptance of the operation.
disease patients (stage 3 and 4 CKD).


After providing informed consent, all subjects were
SUBJECTS AND METHODS
subjected to:
Subjects: The study involved 50 patients with history
1-Full history taking with stress on nutritional history
of (CKD), not receiving any treatment or dialysis, 29
and anorexia, history of chronic diseases, any drug
men and 21 women, 22-72 years old. In addition to 20
use, stigmata of CKD.
healthy persons as a control group. They were
2- Complete physical examination and assessment of
randomly selected from the outpatient
body mass index.

3-Abdominal US.
4802
Received:03/07/2019
Accepted:03/08/2019


Full Paper (vol.771 paper# 19)


c:\work\Jor\vol771_20 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4810-4814

Prevalence of Hepatitis C virus (HCV) and Hepatitis B Virus (HBV)
Co-infection among Human Immunodeficiency Virus (HIV/AIDS)
Mohamed Abdel-Basset gumie, Saeed Abdel-Baki Gad, Ahmed Alaa-Eldin Abdelrahman Ahmed Elgayar
Department of Internal Medicine, Faculty of Medicine - Zagazig University
*Corresponding author: Ahmed Alaa-Eldin Abdelrahman Ahmed Elgayar, Mobile: (+20)01095448831,
E-Mail: dr.ahmalaa89@gmail.com

ABSTRACT
Background:
HIV, HBV and HCV are still major public health concerns. Infections with these viruses rank among
ten leading causes of death attributable to infectious diseases. The variability in the prevalence of HIV/hepatitis
coinfection worldwide is multifactorial, and depends on geographic regions, infections' risk factors and type of
exposure. Objective: To investigate HBV and HCV prevalence in HIV patients.
Patients and Methods:
This study was conducted on HIV infected, and AIDS patients attending Alexandria Fever
Hospital during the period from August 2018 to July 2019, assuming prevalence of HCV in HIV patients is 15%
sample was calculated to be 141 patients using epi info version 7 program with test power 80%, CI 95%.
Results: The incidence of infection with hepatitis C virus was 45 patients (31.9%), all the 45 tested positive for PCR
for HCV RNA as HIV accelerated progression of the disease making it almost impossible for HCV spontaneous
clearance. This percentage is much higher than that of ordinary people, and the incidence of hepatitis B infection is 9
patients (6.4%). The Prevalence of co-infection between hepatitis C virus and HBV among immunodeficiency patients
was 2.8%, with the combined infection among the three viruses in only 4 patients out of 141 patients.
Conclusion: the results of the present work underline the importance of continued screening of HIV positive for HBV
as well as HCV markers before initiation of highly active antiretroviral therapy (HAART) as this practice would guide
correct choice of drug combination.
Keywords: HCV, HBV, HIV, AIDS

INTRODUCTION
HBV and HCV co-infections in HIV positive
Human immunodeficiency virus (HIV) is a
individuals is of outmost importance due to the
lentivirus (a member of the retrovirus family) which
underlying consequences such as the hepatological
targets the immune system, resulting in a defect in cell-
complications associated with these viruses, which
mediated immunity that is demonstrated by increased
have been shown to decrease the life expectancy in the
vulnerability to opportunistic infections and to certain
HIV-infected individuals (3). As chronic infection can
rare cancers. The most progressive stage of HIV
lead to scarring of the liver and ultimately to cirrhosis,
infection is acquired immunodeficiency syndrome
which is generally apparent after many years. In some
(AIDS) (1).
cases, those with cirrhosis will develop liver failure or
HIV infects vital cells in the human immune
other complications, including liver cancer or life-
system such as helper T cells (specifically CD4+ T
threatening esophageal varices and gastric varices (5).
cells), macrophages, and dendritic cells. HIV infection
In coinfection, the presence of one virus influences the
leads to low levels of CD4+ T cells through three main
natural history of the other virus. HIV hastens the
mechanisms; first; direct viral killing of infected cells,
natural course of HBV and HCV infection and
second; increased rates of apoptosis in infected cells,
facilitates faster progression of liver disease to
third; elimination of infected CD4+ T cells by CD8
cirrhosis and hepatocellular carcinoma (6). Disease
cytotoxic lymphocytes that recognize infected cells,
progression in HIV positive patients is nearly three
when CD4+ T cells numbers decline below a serious
times faster as compared to HIV negative patients (7).
level, cell mediated immunity is lost, and the body
So, in Egypt nearly 2 - 3 million Egyptians are
becomes progressively vulnerable to opportunistic
chronic carriers of HBV (8). And it was estimated that
infection. Most untreated people infected with HIV-1
more than 6.8 million persons aged 15­59 years had
eventually develop AIDS (2).
HCV antibodies, of which more than 4.5 million
Human immunodeficiency virus (HIV) and
individuals had active HCV infection, having the
hepatitis B and C viruses (HBV and HCV) are the three
highest HCV prevalence worldwide (9). This unusually
most common chronic viral infections documented
high incidence is attributable to the history of unsterile
world-wide. These viruses have similar ways of
injection equipment use for mass treatment of the
transmission, namely through blood and blood
general population with parenteral anti schistosomal
products, sharing of needles to inject drugs and sexual
therapy (PAT) from the 1920s to the 1980s, the
activity, enabling co-infection with these viruses is a
prevalence of HCV increases with age with the highest
common event (3). Vertical transmission of hepatitis B
rate reported in the age group older than 40 years (10).
virus (HBV) from mother to a child is frequent while
It is unclear how many people have HIV in the
rare in case of HCV (4).
country. UNAIDS estimates more than 22,000 by end
of 2018 (11).
4810
Received:06/07/2019
Accepted:06/08/2019

Full Paper (vol.771 paper# 20)


c:\work\Jor\vol771_21 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4815-4819
Evaluation of The Effect of Combined Intra-Vitreal Ranibizumab
Injection and Sub-Tenon Tri-Amcinolone Acetonide Injection in The
Management of Diabetic Macular Edema
AbdelKader Sayed Abdelkader, Nour eldin abdelhamid, Mohamed Mustafa Bahnassy*
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mohamed Mustafa Bahnassy,email: drmhmdmustafa@yahoo.com

ABSTRACT
Background:
to monitor and compare the effect of intravitreal ranibizumab injection alone or with sub-tenon
triamcinolone acetonide injection on patients with diabetic macular edema.
Aim of the Work:
To assess the effect of combined intravitreal ranibizumab injection, and sub-tenon triamcinolone
acetonide injection in the management of diabetic macular edema.
Patients and Methods: Patients with non-proliferative diabetic retinopathy associated with DME (Central macular
thickness over 300 um) which are aimlessly divided into two groups. In group 1, three monthly doses (0.5 mg) of
intravitreal ranibizumab are received. In group 2, the anti-VEGF injection was performed 10 days after the sub-tenon
steroid injection [triamcinolone acetonide]. All patients' visual acuity, IOP and CMT were followed up for 3 months.
Results: The combined treatment showed improved best corrected visual acuity from baseline 0.24 ± 0.32 log MAR to
0.56 ± 0.18 log MAR (p = 0.023) which was statistically significant. In addition, there was decreased CMT from
baseline 420.1 ± 112.84 to 275.73 ± 90.81 which was highly statistically significant (p > 0.001). When comparing the
combination treatment with the anti-VEGF treatment alone, recovery of BCVA and CMT was statistically significant
(p = 0.041 and p = 0.001, respectively).
Conclusion: Steroid addition to the routine anti-VEGF therapy is an effective method of treatment of diabetic macular
edema.
Keywords: macular edema · Steroid · Ranibizumab · Diabetic · Combined treatment.

INTRODUCTION

persistent DME causes severe disturbance for the retinal
Diabetic retinopathy (DR), is the commonest
architecture that can lead to permanent drop of vision
reason for drop of vision in the 20­74 aged-population
due to unending tissue stress and photoreceptor
in the developed countries [1]. Diabetic macular edema,
disruption [11]. Accordingly, its treatment is significant
is the significant reason for vision impairment in
and different combination therapies have been gone
patients determined to have diabetic retinopathy [1]. In
after for this purpose.
Wisconsin Epidemiologic Study of Diabetic
OCT gives more information about the retinal
Retinopathy there are over 20% of type 1 diabetic
microstructure and measures the retinal thickness with
patients and over 25% of type 2 insulin-dependent
high exactness and reproducibility [12]. OCT
diabetic patients had a degree of vision disability
morphology patterns in DME may foresee any
within ten years [2­4].
progression came from the effect of intravitreal anti-
Despite the pathogenesis of diabetic macular
VEGF injection as a tool in management of DME [13].
edema (DME) still not clear, it might be caused by

some pathological changes as leakages related to retinal
MATERIALS AND METHODS
vascular abnormalities, localized ischemia, chronic
This prospective study included 30 eyes of patients
inflammatory processes, and vascular cell degeneration
with non-proliferative diabetic retinopathy related
and necrosis [5]
with DME done at Kafr El-Sheikh Ophthalmology
The corticosteroids, anti- VEGF and anti-TNF-
Center that were examined and prepared for injection
alpha treatments have been appeared to decrease the
in the operation room under complete aseptic
release of mediators that lead to leukocyte migration
conditions between 01 Decemberr 2018 and 15 May
and inflammation [6]. Studies have tested these anti-
2019.
VEGF medications and demonstrated that the
Ethical approval:
inhibition of vascular endothelial growth factor
The study was accepted by the Ethics Board of Al-
(VEGF) release have a significant outcome in DME.
Azhar University. An informed written consent was
Therefore, anti-VEGF has become the main factor for
obtained from every patient before being included in
the treatment of DME [7­9]. However, it is not sufficient
the study.
for optimal edema control in some cases, which are
Study design
called persistent macular edema. Some studies
The study will categorize the cases of DME into 2
demonstrated that the prevalence is over 50% [10]. The
groups according to method of injection. Group "I"
4815
Received: 05/06/2019
Accepted: 01/07/2019

Full Paper (vol.771 paper# 21)


c:\work\Jor\vol771_22 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4821-4823

Incidence of Solid Organ Injury after Isolated Blunt Abdominal Trauma in
Pediatric Patients in Tanta University Hospital
Nahla El-Sebaie Mostafa 1, Khalid Ahmed Ismail 2,
Akram Mohammed Elbatarny 2 and Khalid Mohammed ElShimy 2.
1Emergency Medicine &Traumatology Department, Faculty of Medicine, Tanta University, Tanta 35127, Egypt.
2General surgery Department, Faculty of Medicine, Tanta University, Tanta 35127, Egypt.
Corresponding author: Nahla El-Sebaie Mostafa, Email: edr.nahla@gmail.com ,Tel: +2 01068720398

ABSTRACT
Background:
Trauma is considered the leading cause of children death worldwide. The most common cause of death
in pediatric trauma is abdominal trauma.
Aim of the study: This study aimed to evaluate incidence of solid organ injury after blunt abdominal trauma (BAT)
in pediatric patients.
Patients and Methods: The study was conducted on pediatric patients admitted to Emergency Department, Tanta
University Hospital with suspected solid organ injury after isolated blunt abdominal trauma.
Results: In this study, we had 119 patients with blunt abdominal trauma presented to emergency department. FAST
(Focused Assessment with Sonography for Trauma) showed that intra-peritoneal free fluid (IPFF) only with no solid
organ injury was found in 39.5%. Splenic injury was found in about 38.7% of patients while hepatic injury was present
in about 18.5%. Renal injury was found in about 1.7%. Both renal and splenic injury were present in about 0.8%.
Conclusion: Splenic injury was the most common solid organ to be injured in blunt abdominal trauma in pediatrics.
Keywords: Pediatric, blunt trauma, abdominal, intra-abdominal injury.

INTRODUCTION

Trauma in children is still a considerable cause of
was a code number for every patient file that included
disability and death in spite of injury prevention
all investigations.
successes and attention to child safety improvement [1,

2].
PATIENTS AND METHODS
Intra-abdominal injury (IAI) remains the
This study was carried out on 119 patients who
significant cause of morbidity in children. Early
were presented to Tanta University Emergency
recognition of IAI is important to decrease both
Hospital from October 2017 till October 2018.
morbidity and mortality [3, 4].
Patients younger than 18 years with isolated blunt
Mechanisms of trauma hinge upon the age of the
abdominal trauma within 24 hours were included
children. In young infants, non-accidental injury is
while patients older than 18 years old, patients with
most common while in toddlers, falls are the
history of trauma more than 24 hours and patients with
predominant [5]. Whereas for older children, road
associated chronic diseases were excluded.
traffic accidents predominate [5, 6].
All patients were subjected to full history taking
The Advanced Trauma Life Support (ATLS)
from the patient or his/her relatives or a witness.
protocol of the American College of Surgeons'
According to ATLS, management consisted of rapid
Committee remains the standard algorithm for the
primary survey, resuscitation of vital functions, more
evaluation and management of traumatized patients [7].
detailed secondary survey and finally the initiation of
Liver and spleen are considered the most common
definitive care.
solid organs to be injured in blunt abdominal trauma
Routine laboratory investigations including CBC,
in children, then kidneys. Hollow viscus injuries are
ABO Rh cross-matching, coagulation profile (PT,
the next most common form of injury, followed by
PTT, and INR) and renal and liver function test have
injuries to the abdominal vasculature [8].
been done to all patients. Radiological investigations
The study aimed to evaluate incidence of solid
including FAST, Plain chest x-ray, Plain pelvis x-ray
organ injury after blunt abdominal trauma in pediatric
and Plain erect abdominal x-ray have been done to our
patients in Emergency Department.
patients.

Abnormal FAST findings were defined as: free
Ethics of the Study:
fluids or injuries to solid organs. The views of
An approval from the Ethical Committee was
Morrison's pouch, the peri-splenic region, pelvis, and
obtained. An informed written consent was taken
pericardium are evaluated for the presence of free
from each patient after explanation of benefits and
intra-peritoneal fluid.
risks. Privacy of all patient's data was secured. There

4821
Received:07/05/2019
Accepted:06/06/2019

Full Paper (vol.771 paper# 22)


c:\work\Jor\vol771_23 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4824-4831
Citric Acid Inhibits Clonogenic Power and Anchorage-Independent
Growth of Glioma Cells
Mongi Ayat
Division of Hematology, Department of Clinical Biochemistry and Molecular Medicine,
Taibah College of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
Corresponding author: Mongi Ayat , Tel . 00966501731119, Email: mongi_64@yahoo.com

ABSTRACT
Background:
Glioblastoma multiforme (GBM) is the most fatal glioma with poor prognosis. C6 glioma is an
experimental model to simulate GBM growth and biology. GBM benefits from Warburg effect (aerobic glycolysis ending
in lactate formation even in the presence of oxygen) in tumor growth, invasion and metastasis. Citric acid is an antioxidant
and inhibitor of glycolysis pathway (phosphofructokinase inhibitor) that constitutes the major source of energy supply to
aggressive cancer cells. Citrate is a promising inhibitor of Warburg effect through blocking glycolysis upstreatm of lactate
formation step. Methods: Ability of citric acid to inhibit experimental GBM colony formation and anchorage-independent
growth were investigated.
Results: Citrate induced a dose-dependent inhibition of growth and proliferation of glioma colonies (attached to
substratum). High citrate dose (9 mM) inhibited initial formation of glioma colonies. A similar picture was observed
where citrate induced a dose-dependent inhibition of growth of glioma colonies in soft agar (i.e. not attached to a
substratum). High citrate dose (9 mM) inhibited initial formation of glioma colonies. In
conclusion, citrate inhibited 3D tumor models of GBM. Citric acid inhibited clonogenic power of glioma cells.
Conclusion: Citric acid may be a promising therapeutic modality for glioma and glioblastoma. That is quite promising in
treating GBM tumors and can be generalized for research in different tumors.

INTRODUCTION

Glioma tumors are driven by glycolysis[1] and
with time in progressing brain stem glioma[11]. 52Fe-citrate
exhibits Warburg effect (increased glycolysis to produce
and positron emission tomography can measure iron
ATP with metabolic shift from oxidative phosphorylation
uptake in brain tumors[12]. Moreover, citrate was reported
to glycolysis even in the presence of oxygen).
to show a specific, dose-dependent lympholytic activity
Glioblastoma multiforme (GBM) is the most fatal type of
in neoplastic cell lines [13].
glioma with poor prognosis. C6 glioma is an experimental
Citrate was reported to have a lot of therapeutic uses as
model to simulate GBM growth and biology. Ability of
well e.g. in pediatrics, citrate is efficient in the correction
GBM cells to form colonies can be investigated versus
of diarrhea-induced metabolic acidosis as sodium citrate
anticancer treatments using in vitro models. GBM
equals sodium bicarbonate in oral rehydration therapy for
benefits from Warburg effect in tumor growth, invasion
treating childhood diarrhea[14].
and metastasis[2-3] .
In nephrology, citrate inhibits formation and retention
Citrate is safe, available in citrus fruits, and proved to
of crystals in the kidneys making citrate commonly
be effective in many therapeutic uses. Recently, high dose
prescribed for treating kidney stone disease[15], urinary
of citrate (4-6 grams/day) was reported in the treatment of
calculi [16] in addition to treatment of hyperuricosuric
medullary thyroid carcinoma in a child with no report of
calcium oxalate nephrolithiasis[17].
metabolic acidosis[4]. Also, citrate was reported to have
Interestingly, citrate helps the treatment of antibiotic-
anticancer effects in treating mesothelioma[5] and gastric
resistant postoperative wounds in cancer patients[18] and
cancer[6]. Low citrate (citric acid) level (< 1 mM) was
facilitates sperm motility[19].
reported to be inhibitory of phosphofructokinase-1(PFK-
Little research is done regarding the role of citrate as
1), a key glycolytic enzyme[7]. Inhibition of PFK by
an anticancer agent. Citric acid is not suspected of being a
citrate disturbs Warburg effect (metabolic alteration of
carcinogen or a teratogenic agent. This may make citrate
cancer cells in which glycolysis ends with formation of
a suitable anti-neoplastic drug targeting glycolysis and
lactate even in the presence of oxygen) (Figure 1).
Warburg effect, a common metabolic alteration in most
Citrate was reported to have many diagnostic uses in
cancer cells in which cancer cells use glycolysis as a
oncology e.g. citrate is an in vivo marker to discriminate
major energy source even in the presence of oxygen
prostate cancer from benign prostatic hyperplasia[8] to
(Figure 1)[20].
facilitate diagnosis of prostate cancer[9]. Citrate
In this study, dose-dependent citrate-induced
concentrations in human seminal fluid outperforms
inhibition of glioma colonies was investigated using both
prostate specific antigen in prostate cancer detection[10].
the clonogenic power and the anchorage-independent
Citrate level is further reduced in metastatic prostate
growth assay.
disease[8]. Citrate concentrations declined significantly

Received:8/1/2018 accepted:18/1/2018

4824


Full Paper (vol.771 paper# 23)


c:\work\Jor\vol771_24 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4832-4839

Clinical Outcomes in Diabetic Patients with Stable Coronary Artery Disease
Treated with Second- Generation Drug Eluting Stents
(Short and Mid-Term Follow Up)
Ehab Abdelwahab Hamdy, Mohamed Naseem Hussien, Ayman Ahmed El Sheikh,
Mohamed Abdel Moatty Emam*
Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University
* Corresponding author: Mohamed Abdel Moatty Emam, Mobile: (+20) 01144556670, E-mail:
dr.emamclinic@gmail.com


ABSTRACT
Buckhound:
The increased prevalence of type 2 diabetes mellitus (DM) is an important public health problem.
The number of patients with DM worldwide is estimated to rise to 366 million by the year 2030. In general,
individuals with DM have more severe and diffuse atherosclerotic disease, which accounts for the significantly
higher incidence of cardiovascular events in their native coronary, cerebrovascular, and peripheral arteries.
Objective: The aim of this study was to assess the short and mid-term clinical outcomes in type 2 diabetic
patients with stable coronary artery disease treated with 2nd generation drug eluting stents.
Patients and Methods: This prospective observational study included a total of 100 type 2 DM-CAD patients,
attending at Department of Cardiology, Tanta University Hospitals. This study was conducted between January
2018 till January 2019. Assessment of the mid and short-term clinical outcomes in patients was done.
Results: Non-significant difference as regards age, sex and family history (p > 0.05) was found. Non-significant
difference as regards height, weight, BMI, HTN and smoking (p > 0.05) was found. Significant increase in
inverted T wave in Major Adverse Cardiovascular Events
(MACE) group; compared to normal group;
with significant statistical difference (p = 0.015). Non-significant difference as regards creatinine, ST elevation,
ST depression, pathological Q, LBBB and RBBB (p > 0.05) were found. Highly significant decrease in EF in
MACE group; compared to normal group; with highly significant statistical difference (p < 0.01) were found.
Conclusion: Diabetes mellitus is a condition in which the use of 2nd generation zotarolimus-eluting stents is
preferable, in order to reduce the incidence of MACE adverse events.
Keywords: Diabetic, Coronary artery disease treated, Second- Generation drug eluting stents.


INTRODUCTION

The increased prevalence of type 2 diabetes
particular relevance in the setting of diabetic
mellitus (DM) is an important public health
patients with high atherothrombotic risk (7).
problem. The number of patients with DM
The aim of this study was to assess the short
worldwide is estimated to rise to 366 million by the
and mid-term clinical outcomes in diabetic patients
year 2030. In general, individuals with DM have
with stable coronary artery disease treated with
more severe and diffuse atherosclerotic disease,
2nd generation drug eluting stents.
which accounts for the significantly higher

incidence of cardiovascular events in their native
PATIENTS AND METHODS
coronary, cerebrovascular, and peripheral arteries.
This prospective observational study included
In addition to aggravated atherosclerosis in native
a total of 100 DM-CAD patients (64 male and 36
coronary arteries, DM is a well-known independent
female with average age 57.9 years), attending at
risk factor for worse outcomes after coronary stent
Department Of Cardiology, Tanta University
implantation, such as angiographic restenosis,
Hospitals. This study was conducted between
target lesion revascularization (TLR), late and very
January 2018 till January 2019.
late stent thrombosis, and even all-cause death (1, 2).

Second-generation durable polymer drug-
Ethical consideration and Written informed
eluting stents (DES), including a durable polymer
consent:
zotarolimus eluting stent, have demonstrated good
An approval of the study was obtained from
efficacy in the treatment of coronary artery disease
Tanta University academic and ethical
in diabetic patients (3, 4). However, persistent
committee. Every patient signed an informed
inflammatory response to durable polymer coatings
written consent for acceptance of the operation.
of DES is recognized as a leading cause of delayed

arterial healing and one of the key factors
Inclusion criteria: Diabetic patients with type 2
underlying late stent failure in patients who undergo
DM, with chronic stable angina treated with 2nd
DES implantation (5, 6). Indeed, this issue is of
generation DES.
4832
Received:07/07/2019
Accepted:07/08/2019

Full Paper (vol.771 paper# 24)


c:\work\Jor\vol771_25 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4840-4846

Prediction of Admission to Delivery Time by Transvaginal Ultrasonographic
Assessment of the Cervix in Cases of Preterm Prelabour Rupture of Membranes
Omar S. Ayad 1, Mohammad R. Abd El Zaher2 , Mohammad T. Ismaeil 2
1 Department of Obstetrics and Gynecology, Kafr EL-Sheikh General Hospital, 2 Department of Obstetrics and
Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Omar S. Ayad, Email: dr.omar_ayad135@yahoo.com. ,Tele: 0201018316781

ABSTRACT
Background
: Preterm Premature Rupture of Membranes (PPROM) heralds about 30% of cases with spontaneous
preterm births. Latency in PPROM is delineated as the time interval between PROM and delivery. It might be
beneficial to predict this latency period as it may help to make a decision concerning in-utero transfer of fetus to better
neonatal centers with advanced facilities and to administer corticosteroids in favor of fetal lung maturity.
Objective: The aim of the current study was to assess the usefulness of measuring the cervical parameters by
transvaginal sonography mainly cervical length and posterior cervical angle, in predicting the interval from admission
to delivery in women with (PPROM). Subjects and methods: This study was conducted at Kafr El- Shiekh General
Hospital and Al-Azhar University Hospitals and included 100 pregnant women with a singleton pregnancy of
gestational age between 28-34 weeks and PPROM presenting within 24 hours and not in labour.
Results
: showed non-significant differences between the mean of PCA among different groups (P>0.05).
Nevertheless, the results indicated that amniotic fluid index (AFI) increased significantly in patients with latency
period >7days group (P<0.001). Furthermore, the mean Cervical length (CL) was observed to increase in PPROM
patients' group with high latency period. The latency period had significant positive correlation with AFI and cervical
length (p<0.05). Also, it had significant negative correlation with birth weight, gestational age at hospitalization, CRP,
and TLC, and neonatal sepsis (p<0.05).
Conclusion:
It could be concluded that assessment of Cervical length via transvaginal sonography is a valuable tool
in the evaluating the interval between rupture of membranes and delivery in women with PPROM.
Keywords: PPROM, TVS, Cervical length, posterior cervical angle, latency period.

INTRODUCTION

for administration of corticosteroids for the fetus lung
Preterm Prelabour rupture of membranes
maturation (4).
(PPROM) is delineated as fetal membranes rupture
Transvaginal sonographic imaging of cervix
prior to 37 weeks of gestation. It has an incidence of
is assumed to be safe. Hence, its use for the prediction
2.7-7% in China and 5 -15% in America. Moreover, it
of period to delivery in PPROM women may be
precedes 30% of cases with spontaneous preterm
valuable (5). It is considered the "gold standard" for the
births (1). Statistics propose that PPROM birth costs
diagnosis of a short cervix throughout pregnancy as its
are eight folds more than that of uncomplicated births
accuracy was reported (6). Moreover, cervical length as
(2).
Serious
sequels
of
PPROM
include
determined by transvaginal ultrasound has emerged as
Chorioamnionitis, postpartum infection, and maternal
a powerful means of predicting spontaneous preterm
mortality owing to sepsis. Furthermore, placental
delivery in both women with intact membranes, and
abruption is frequent in PPROM cases especially if
in women with PPROM (6). Furthermore, Posterior
infection is present. As regard neonatal complications,
cervical angle (PCA) which defined as the angle
most of them are allied to prematurity, including
between the posterior uterine wall and cervical canal
respiratory distress syndrome (RDS), hazards of
(8), may reflect more accurate position of the cervix (4).
oligohydraminos, sepsis, intraventricular hemorrhage
The aim of the current study was to assess the
(IVH), necrotizing enterocolitis (NEC), cerebral palsy
usefulness of measuring the cervical parameters by
(CP), and perinatal death. Also, behavioral and
transvaginal sonography mainly cervical length and
educational problems may persist to the school age
posterior cervical angle, in predicting the interval
and adulthood for those who survive (2).
from admission to delivery in women with (PPROM).
Clinical consequences and management of

PPROM remains an area of controversy (3). Digital
SUBJECTS AND METHODS
vaginal examination should be evaded as it upsurges
This prospective study included a total of 100
the infection risk and reduce the latency period of
pregnant women, attending at Kafr El-Shiekh General
entering into labour (4).
Hospital and Al-Azhar University Hospitals. This
Latency in PPROM is outlined as the interval
study was conducted between February 2018 to
between PROM and delivery (5). It is worth noting that
December 2018.
prediction of the time interval between the occurrence
Ethical approval:
of PPROM to delivery may assist for better decision
Approval of the research was taken from quality
concerning in-utero transfer of neonates to better
education assurance unit, Al-Azhar university
neonatal centers with advanced neonatal facilities and
faculty of medicine, Egypt (approval code:
4840
Received:07/07/2019
Accepted:07/08/2019

Full Paper (vol.771 paper# 25)


Results The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4847-4854
Serum Calcium, Magnesium, Uric Acid and C-Reactive Protein in
Preeclampsia and Normal Pregnant Women
Mostafa A. Abdel-Hamid 1*, Abd El Moneim m. Zakaria 1, Fahd A. Alomda1 and Mekky Abd El Moneim2
Obstetrics & Gynecology1,, Clinical and Chemical Pathology 2 Departments,
Faculty of Medicine, Al-Azhar University, Egypt
* Corresponding Author: Mostafa A. Abdel-Hamid, email: Mostafakaseb1@yahoo.com

ABSTRACT
Objective:
To assess and to look at serum levels of calcium, magnesium, uric acid and C-reactive protein in mild,
extreme preeclamptic ladies and ordinary pregnant ladies and to connect these levels with seriousness of the
ailment. Methods: This investigation was a planned observational case-control study that was led at the division of
Obstetrics and Gynecology, Al-Azhar University, Maternity Hospital on 90 pregnant ladies in the third trimester of
pregnancy (gestational age from 28 to 40 weeks of pregnancy) chosen from the individuals who had gone to the
antenatal facility and the banquet hall in the period from January 2018 to June 2019. They were divided into 3
groups: 30 patients with serious preeclampsia, 30 patients with gentle preeclampsia and 30 normotensive ladies
free of any medicinal issue (control group). The study was approved by the medical ethics committee of Al-Azhar
University Hospitals and a written informed consent is obtained from all participants. Results: The mean
estimations of CRP and serum uric acid were fundamentally higher in the pregnant ladies with preeclampsia than
in the sound control ladies (p<0.05), while the mean estimations of serum calcium were altogether lower in the
pregnant ladies with preeclampsia than in the solid control ladies (p<0.05). The mean serum magnesium didn't
demonstrate critical contrasts among preeclampsia and solid ladies (p>0.05). Conclusion: These discoveries
bolster the speculation that hypocalcaemia, hyperuricemia and expanded C-reactive protein could be potential
etiologies of preeclampsia and that they relate to the seriousness of the illness.
Keywords
: Serum calcium, Serum magnesium, Serum uric acid, C-reactive protein, Preeclampsia, Normal
pregnancy.

INTRODUCTION

Hypertensive issue of pregnancy influence about
Preeclampsia starts with lacking trophoblastic
10% of every single pregnant lady (1) and record for in
intrusion right off the bat in pregnancy, which delivers
excess of 50000 maternal passing for each year (2) and
an expansion in oxidative pressure adding to the
together they structure one individual from the fatal set
advancement of foundational endothelial brokenness in
of three, alongside discharge and contamination, that
the later periods of the ailment, prompting the
contribute significantly to maternal sickness and death
trademark clinical sign of preeclampsia (9).
rates (3).
Raised serum uric acid levels because of
With hypertension, the preeclampsia disorder,
diminished renal urate discharge are every now and
either alone or superimposed on interminable
again found in ladies with preeclampsia (6).
hypertension, is the most hazardous(3). Preeclampsia is
Hyperuricemia because of oxidative pressure is known
a multisystem issue that entangles 3%­8% of
to be related with malicious consequences for
pregnancies in Western nations and establishes a
endothelial brokenness, oxidative digestion, platelet
noteworthy wellspring of dreariness and mortality
adhesiveness and conglomeration (10). Subsequently
around the world (4,5).
raised serum uric acid is profoundly prescient of
Preeclampsia (PE) is a disorder, all around
expanded danger of unfriendly maternal and fetal
characterized by the beginning of hypertension
result (11).
(140/90 mmHg) and proteinuria (0.3 g/24 h)
On the physiological premise, calcium assumes a
following 20 weeks of development in a formerly
significant job in muscle compression and guideline of
normotensive lady that likewise might be related with
water balance in cells. Change of plasma calcium
bunch, different signs and indications, and frequently
fixation prompts the adjustment of circulatory strain.
with subnormal fetal development (6,7).
The bringing down of serum calcium and the
Preeclampsia is best depicted as a pregnancy
expansion of intracellular calcium can cause a rise of
explicit disorder of decreased organ perfusion optional
circulatory strain in preeclamptic moms (12,13(.
to vasospasm and endothelial actuation, described by
In perspective on the above realities this
hypertension and proteinuria that may prompt
examination targets assessing serum levels of calcium,
multisystem inclusion including renal, hematological,
magnesium, uric acid and C-reactive protein in patients
hepatic and cerebral debilitation (8).
with clinical profiles of preeclampsia and in

4847
Received:06/07/2019
Accepted:06/08/2019

Full Paper (vol.771 paper# 26)


Study of thyroid dysfunction in patients with non-alcoholic fatty liver disease The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4855-4860
A Study of Helicobacter Pylori Infection in Patients with
Non-Alcoholic Fatty Liver Disease
Abd El-Hamid E. Khalil1, Hesham E. lashin1, Mahmoud M. Metwally2, Mohamed Rady *1
Departments of Internal Medicine1and Clinical Pathology2, Faculty of Medicine,
Al-Azhar University, Cairo, Egypt.
*Corresponding author: Mohamed Rady, E-mail: drrady18@gmail.com

ABSTRACT
Background:
Helicobacter pylori (H. Pylori) infection has been notified to enhance the progression of distinct
extra-digestive manifestations, embraced type 2 diabetes, liver, and cardiovascular diseases. Currently, the
association between H. pylori infection and nonalcoholic fatty liver disease (NAFLD) was suggested. Conversely,
evidence from various studies was doubtful.
Aim of the study:
This study was performed to assess the prevalence of H. Pylori infection and the possible
predictors of H. Pylori infection among NAFLD patients.
Patients and Methods: This prospective observational case-control study included a total of 60 patients with
NAFLD and 20 apparently healthy subjects served as control, attending at the Outpatient Clinic and Internal
Medicine Department, Sayed Galal; Al-Azhar University Hospitals. This study was conducted between February
2018 to March 2019. All participants were submitted to full history taking, complete physical examination, and
routine laboratory investigations. H. pylori Ag in stool test was tested to reveal the existence of infection along
with abdominal ultrasonography using Hamaguchi scoring system for assessment of NAFLD.
Results: An overall 80 participants were included in the current investigation. Based on the presence of NAFLD,
participants were assorted into healthy control group (20 candidates) and NAFLD group (60 patients) with a mean
age of 35.65±10.73 and 39.72±11.14, respectively. An overall 48 patients were infected with H. Pylori. Of them, 6
(30%) were among the healthy control group, whereby 42 (70%) were among NAFLD group (P<0.001). Based on
the multivariate logistic regression model, the male gender and the levels of high density lipo-proteins (HDL-C)
were statistically significant predictors of H. Pylori infection among NAFLD patients.
Conclusions: The burden of H. Pylori infection among NAFLD patients was noticeably high. Additionally, obese
males with decreased levels of HDL-C were more expected to be H. Pylori positive infection.
Keywords: H. Pylori, Nonalcoholic fatty-liver disease, High density lipoprotein cholesterol.

INTRODUCTION
huge clinical and economic burdens (12). Therefore,
Helicobacter pylori (H. pylori) infection attributes
identifying the potential predictors along with
to a various array of gastric diseases, principally
therapeutic implications is a crucial factor in the
peptic ulcer, chronic gastritis, and gastric carcinoma
management of NAFLD. The occurrence of NAFLD
(1). Throughout the recent era, the evidence has
is a sophisticated process which comprises genetic
implicated H. pylori infection in extra-gastrointestinal
susceptibility along with environmental factors (13). H.
disorders
likewise
neurological
disorders,
pylori infection may be the cornerstone in the
cardiovascular diseases, and metabolic disturbances
development of NAFLD or even it may be a possible
(1). H. pylori colonize the stomach of approximately
cause for NAFLD.
half the world's population and are pivotal
The present study was conducted to reveal the
components of the human microbiome (2). Infection is
burden of H. Pylori infection and the possible
usually acquired early in life and persists throughout
predictors of H. Pylori infection among NAFLD
the host's life if untreated (3). H. pylori infection is not
patients.
only affecting the stomach, but also is linked to a

numerous extra-gastric disease, indicating that H.
PATIENTS AND METHODS
pylori may cause disease by a different biologic
This prospective observational case-control study
process far from the initial site of infection (4). Some
included a total of 60 patients with NAFLD, which
studies showed the relationship between H. pylori
established clinically and confirmed radiologically,
infection and T2DM and metabolic syndrome (5,6,7,8,9).
and 20 apparently healthy subjects served as control,
Non-alcoholic fatty liver disease (NAFLD) is the
attending at the Outpatient Clinic and Internal
condition, whereby excessive fat infiltrate liver in the
Medicine Department, Sayed Galal; Al-Azhar
obscurity of considerable alcohol intake or secondary
University Hospitals. This study was conducted
causes for steatosis (10). The clinical consequence of
between February 2018 to March 2019.
NAFLD is not limited to liver related mortality and
Ethical approval
morbidity but is also related to cardiovascular
The current investigation was executed with
impairment, T2DM and metabolic syndrome (11). The
respecting the guidelines of the Ethical Research
epidemics of NAFLD are rapidly increasing, with
Board of the Faculty of Medicine, Al-Azhar
4855
Received:08/07/2019
Accepted:08/08/2019


Full Paper (vol.771 paper# 27)


Introduction The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4861-4865
Botulinum Toxin-A, Fexofenadine Hydrochloride, and Nasal Corticosteroid
(Triamcinolone) Spray in Treatment of Allergic Rhinitis
Ahmed Abdelfattah1* and Essam A. El-Moselhy2
Departments of 1Otorhinolaryngology and 2Community Medicine, Faculty of Medicine,
Al-Azhar University, Egypt
*Corresponding author: Ahmed Abdelfattah, E-Mail: ahmedfatah10@hotmail.com

ABSTRACT
Background:
allergic rhinitis (AR) is a common health challenge and its prevalence is rising. Many medications were
used for treatment.
Aim of the work: to compare the effects of monotherapy with topical steroid, Botulinum Toxin-A (BTX-A) or
Fexofenadine hydrochloride in treatment of AR.
Patients and Methods: one hundred and fifty patients with AR were included. They were divided into three equal
groups; the first treated with a single dose intranasal injection of BTX-A, the second treated with Fexofenadine
(once/day), and the third treated with intranasal steroid spray (Triamcinolone, once/day). All patients were evaluated
before treatment for nasal symptoms and each symptom was scored by severity. In addition, patients were administered
the rhinoconjunctivitis quality of life (RQoL) questionnaire. All patients were followed-up each two weeks till the end
of the third month and data was evaluated in each visit.
Results: at baseline, groups were comparable regarding symptom severity and quality of life (QoL). At 2 weeks, all
groups showed improvement in symptom severity and QoL. Regarding symptom severity, the lower was Triamcinolone
followed by Fexofenadine and then BTX-A group, but QoL was significantly improvement in BTX-A, Fexofenadine
and Triamcinolone respectively. At the end, there was significant reduction of symptom severity scores for obstruction,
rhinorrhea, sneezing, itching, eye irritation, total nasal symptoms' score (TNSS) and QoL scores.
Conclusion: BTX-A may be a suitable alternative therapy for AR treatment. Otherwise, the treatment with second
generation antihistamine or corticosteroids is effective.
Keywords: Allergic rhinitis, Botulinum toxin-A, Fexofenadine, Triamcinolone, Severity, Quality of life.

INTRODUCTION
vasodilatation and mucosal inflammatory edema is the
Allergic rhinitis (AR) affects up to 20% of the
major symptom of AR and nasal airway resistance is
population with increasing prevalence. It is a disease
increased in these patients compared to that in non-
triggered by IgE-dependent chronic allergic inflamm-
allergic patients(6). The main treatment of AR includes
ation of nasal mucous membranes in response to
nasal topical corticosteroids. The efficacy of topical
environmental allergens(1).
nasal corticosteroids depends on patient compliance.
The nasal triad symptoms of allergic rhinitis are
Maximum efficacy is usually apparent after 1­2 weeks.
paroxysmal and repetitive sneezing, rhinorrhea, and
Oral antihistamines, although accepted as standard
obstructed nose. AR could be divided into continuous or
therapy for AR, have a lesser impact on nasal congestion
intermittent (according to duration of symptoms) and
and inflammation(7).
perennial or seasonal (according to the difference of
In addition to "designer" antihistamines and
allergens)(2). The number of patients with AR is
topical nasal corticosteroids, attention has been directed
estimated to be more than 500 million all over the world
to modulating the allergic reaction by inhibiting the
and 150 million in the Asia-Pacific region(3).
formation of leukotrienes or blocking their effects. The
The most common perennial allergens are dust
original role of leukotrienes modifiers was in the
mites(4). These allergens leading to release of mediators
treatment of asthma and polyposis, but recently they
from immune cells of allergic inflammation including
have been investigated as adjuncts to antihistaminic
mast cells and eosinophils causing vasodilatation,
and/or corticosteroid therapy or as stand alone treatment
hypersecretion, and inflammatory edema in the nasal
for allergic rhinitis(8).
mucosa. Symptoms include rhinorrhea, sneezing,

itching, and nasal obstruction. It leads to significant
AIM OF THE WORK
impact in quality of life (QoL), mental, and psychomotor
This study is aiming to compare the effects of
performance compared to the healthy people and also
monotherapy with topical steroid (Triamcinolone),
affects school learning achievement especially in
Botulinum Toxin-A, and Fexofenadine hydrochloride in
adolescent age group (5). Nasal obstruction secondary to
treatment of allergic rhinitis.
4861
Received:07/07/2019
Accepted:07/08/2019

Full Paper (vol.771 paper# 28)


c:\work\Jor\vol771_29 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4866-4873
Intranasal Oxidized Cellulose (Surgicel®) Sheet Application after
Partial Inferior Turbinectomy, Can It Make A Difference?
Ahmed Abdelfattah
Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Ahmed Abdelfattah, E-Mail: ahmedfatah10@hotmail.com

ABSTRACT
Background:
hemostasis, throughout and after endonasal surgery, still raise loads of debates as regarding the foremost
optimal technique as regard the efficacy, patient comfort, risks and costs.
Objective: assessment of the worth of applying the intranasal surgicel® sheet after partial inferior turbinectomy (PIT)
surgery
Patients and Methods: a prospective, randomized comparative study was conducted from July 2015 to July 2018 at
Al-Azhar University hospitals. A total of hundred and twenty patients underwent bilateral PIT. They were randomly
divided into a pair of groups; group A enclosed sixty patients had PIT with intranasal surgicel® sheet application and
group B enclosed sixty patients had PIT without surgicel® sheet. A comparison was made between the two groups at
three time points; forty eight hours, one week, and four weeks postoperatively.
Results: at forty eight hours after surgery, number of patients reported milder pain before and after pack removal in
group A were significantly higher than patients within the group B. Patients in Group A bled less with shorter
hemostasis time than those in group B. At one week postoperatively; visual analogue score (VAS) for pain was
significantly less in group A with a better healing. At four weeks postoperatively; healing was significantly better in
group A.
Conclusion: the utilization of intranasal surgicel® sheet after PIT can decrease pain and bleeding and lessen
hemostasis duration during pack removal and decreased postoperative pain with decreasing rates of intranasal
adhesions.
Keywords: Partial inferior turbinectomy, Intranasal pack, Nasal obstruction, Surgicel®.

INTRODUCTION
surface surgery. A recently added is endoscopic shaver
The nasal turbinate is an organ that regulates
turbinectomy and coblation(2). However, the surgery
the airflow in the nasal cavity and plays a crucial role in
ordinarily practiced in our setup is "bilateral partial
respiration. It is part of the nasal valve and plays the
inferior turbinectomy". Any surgical procedures
foremost important role in the biological activity of the
performed upon the nasal turbinates are absolute to
nasal cavity(1). It additionally encompasses a wide
disrupt with their physiological function. This
mucus membrane for external antigens to access, and it
disruption in addition to postoperative complications
is very vulnerable to inflammation and hyperemia. The
are main reasons for the arguable attitudes toward this
turbinate thickens chiefly because of its body structure
operation(3, 4).
and additionally due to nasal septal deviation or
Nowadays, nasal packing is employed as a step
rhinitis(2). Turbinate hypertrophy result in chronic nasal
of the nasal surgery so as to forestall hemorrhage and to
obstruction, pain and sleep disorder (3). These symptoms
ensure a normal wound healing process. The vary of
in individuals with turbinate hypertrophy impair their
materials used for these procedures are wide, including
quality of life and induce functional disorders(4). Thus,
removable and absorbable materials. Because there is
they need to be correctly managed.
no standardization in this matter, the selection is within
When conservative management is not enough
the surgeon's hand, according to his capabilities, beliefs
to permit a good nasal permeability, surgical
or technical possibilities(5).
management ought to be indicated. Whereas turbinate
Hemostasis, throughout and after nasal surgery,
surgery is frequently practiced, there has been a
still raise loads of debates regarding the foremost
protracted disagreement over its clinical efficacy and
appropriate technique as regard the efficacy, patient
long-term benefit(1).
comfort, risks, benefits and costs. Each endonasal
Many of surgical procedures are performed for
surgical procedure such as septoplasty, rhinoplasty, as
management of hypertrophic inferior turbinates such as
well as endoscopic sinus surgery, specifically when
total, partial or submucous turbinectomies, and
combined with turbinectomy and/or submucous
turbinoplasties, besides alternative procedures like
resection of the septum, could cause bleeding and/or
electrocautery, chemocautery, cryosurgery, and laser
postoperative hematoma requiring postoperative
4866
Received:08/07/2019
Accepted:08/08/2019

Full Paper (vol.771 paper# 29)


c:\work\Jor\vol771_30 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (1), Page 4874-4880

Comparison between Intravenous Magnesium and Lidocaine Administration on
Postoperative Pain during Spinal Anesthesia for Anal Surgery
Ezzat Mahmoud Ali El-Soudy, Waheed Mohamed Ali, Hoda Moneer Hassan Ahmed*
Department of Anesthesiology and Intensive Care, Faculty of Medicine, Al-Azhar University
* Corresponding author: Hoda Moneer Hassan Ahmed, Mobile: (+20)01122305855, E-mail: drhoda26@Yahoo.com

ABSTRACT

Background: Perioperative analgesia has been administered traditionally as opioid analgesics, but routine use
of opioids for postoperative analgesia has recently been critically challenged. Excessive use of potent opioids
may actually increase postoperative pain as a result of rapid elimination and development of acute tolerance
and decrease patient satisfaction.
Objective: The aim of this study was to assess and compare the effect of IV infusion of lidocaine and
magnesium sulphate (Mg) as adjuvant for postoperative pain in anal surgery after spinal anesthesia regarding
duration, potency of analgesia, analgesic consumption and hemodynamics.
Patients and methods: In this prospective, observational, randomized, double blinded (nurse and junior
doctor) placebo study, 150 patients of ASA (American Society of Anesthesiologists) physical status I and II
with the age between 18-40 year, undergoing anal surgery under spinal anesthesia were included. The study
was conducted in Al-Azhar University Hospital, Assiut during the period from June 2018 to Oct 2018.
Results: The results showed that there were significant differences between the three groups according to BP
and HR. The patients in Mg group showed more hypotension and bradycardia than the patients in lidocaine
and placebo groups. Patients in Mg group showed lower VAS score than lidocaine and placebo groups. The
amount of analgesic consumption was lower in Mg group than lidocaine and placebo groups.
Conclusion: Usage of IV MgSO4 at 50 mg/kg followed by continuous infusion of 10 mg/kg/h leading to
decrease in postoperative pain and analgesic consumption in patients undergoing anal surgery under spinal
anesthesia.
Keywords: Intravenous magnesium, lidocaine, Postoperative pain, Spinal anesthesia, Anal surgery.

INTRODUCTION

aspartic acid (NMDA) plays a principle role in
Surgical pain is due to inflammation from
central excitability. Increased central excitability
tissue trauma (surgical incision, dissection, burns)
during surgery is more pronounced, so the idea that
or direct nerve injury (nerve transaction, stretching,
the addition of NMDA antagonists can reduce pain
or compression). The postoperative pain can have
sensitivity seems innovative (6).
a significant effect on patient recovery and
Another drug is lidocaine that is an amide-
increases hospital stay and costs of care. In the long
type of local anesthetic. The anti-nociceptive and
term, acute surgical pain is followed by chronic
analgesic effect are thought to be attributable to the
pain in 10%­50% of patients who undergo
blockade of neuronal sodium channels, blockade of
common surgical procedures (1). Management of
potassium currents, interaction with nociceptive
postoperative pain relief suffering and leads to
pathways,
muscarinic
receptor
antagonist,
earlier mobilization, shortened hospital stay,
blockade of dopamine receptors, glycine inhibitor,
reduced hospital costs, increased patient
reduction in excitatory amino acids, reduction in
satisfaction and improve quality of life (2).
thromboxane and release of endogenous opioid
In order to reduce postoperative pain, opioids
peptides (7).
and NSAIDs are used on a routine basis; but the use

of these drugs is associated with some side effects
AIM OF THE WORK
and risks (3). The major goal in the management of
The aim of this study was to assess and
postoperative pain is minimizing the dose of
compare the effect of IV infusion of lidocaine to
medications to lessen side effects while still
the effect of IV infusion of magnesium sulphate as
providing adequate analgesia. This goal is best
adjuvant for postoperative pain in anal surgery
accomplished with multimodal and preemptive
after spinal anesthesia regarding duration, potency
analgesia (4).
of analgesia, analgesic consumption and
One IV adjuvant medication that has shown
hemodynamics.
potential in preemptive analgesia is magnesium (5).

It can antagonize N-Methyl-D-aspartic acid
PATIENTS AND METHODS
receptor and it also inhibits the release of
In
this
prospective,
observational,
acetylcholine in the neuromuscular junction. It has
randomized, double blinded (nurse and junior
been demonstrated that the receptor N-Methyl-D-
doctor) placebo study, 150 patients of ASA

(American Society of Anesthesiologists) physical
4874
Received:08/07/2019
Accepted:08/08/2019

Full Paper (vol.771 paper# 30)