c:\work\Jor\vol773_1 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5081-5088
Serum Chemerin Level as Biomarker for Renal Dysfunction in Type II Diabetes
Ahmed Mohammed Abdel- Rahman Tahoun1, Ahmed Abdou El lawah 2, Magdy Abdel-kareim EL
dahshan2, Ahmed Mohammed El sayed Shalaby*1
1Department of Clinical Pathology, Faculty of Medicine, Al-Azhar University
2Department of Internal Medicine, Faculty of Medicine, Al-Azhar University
*Corresponding author: Ahmed Mohammed El sayed Shalaby; Mobile: (+20)0100 621 4169;
Email: drahmedshalaby1981@yahoo.com

ABSTRACT
Background:
Type 2 diabetes mellitus is the most common form of diabetes. Millions of patients worldwide have
been diagnosed as type 2 diabetes and many more are unaware they are at high risk. It represents a major public
health threat and constitutes an important contributor to the predicted decline in life expectancy.
Objective: The aim of the present work was to evaluate serum chemerin level and its association with kidney
functions in patients with type 2 diabetes mellitus.
Patients and methods: This case control study was conducted at Clinical Pathology Departments of Al-Azhar
University Hospitals. It was carried out on 80 subjects of matched age and sex divided as 60 type 2 diabetic patients
and 20 apparently healthy volunteers (hospital staff) serving as control group.
Results: In a correlation study between serum chemerin and other studied parameter in diabetic patients, a significant
positive correlation was found between serum levels of chemerin, FBS, ACR, serum creatinine, serum urea, fasting
insulin, HOMA-IR index and BMI. On the other hand, a highly significant negative correlation between serum chemerin
and eGFR was observed in patients' group. Furthermore, we evaluated the diagnostic performance of chemerin for
discriminating patients with macroalbuminuria from those without. The best diagnostic cutoff for chemerin was 100.1
ng/mL. This had a diagnostic sensitivity of 85%, specificity 75%, negative predictive value 63%, positive predictive
value 90.9%. The area under the curve (AUC) was 78.3%.
Conclusion: These findings suggested that serum chemerin can be used as a predictive marker for diabetic nephropathy.
Keywords: Serum chemerin, Renal dysfunction, Type 2 diabetes mellitus.

INTRODUCTION

The incidence of diabetes, particularly type 2
metabolic function of adipocytes, and glucose
diabetes is increasing at alarming rate. About 347
homeostasis (7). Chemerin expression was significantly
million people worldwide have diabetes (1). Diabetes is
elevated in adipose tissue of obese and type 2 diabetic
predicted to become the seventh leading cause of
compared to lean and normoglycemics (8). Chemerin
death in the world by the year 2030 (2).
has been shown to induce insulin resistance in skeletal
In Egypt, it is estimated that by the year 2030
muscle cells (9). Significant positive association was
Egypt will have at least 8.6 million adults with
found between circulating chemerin and BMI, waist-
diabetes, however little data are available on the
to-hip ratio, glucose and insulin homeostasis model
epidemiology of diabetes in Egypt (3).
assessment of insulin resistance (HOMA-IR). These
Diabetic nephropathy (DNP) is by far the most
studies suggest that chemerin may play a potential
common cause of end stage renal disease (ESRD).
role in obesity-induced insulin resistance and the
Approximately one third of individuals with diabetes
development of type 2 diabetes (10). Serum chemerin
develop DNP with a high likelihood of progression to
levels were found to be significantly higher in patients
ESRD. In addition, DNP is associated with
on chronic hemodialysis compared to controls,
considerably increased cardiovascular disease risk and
suggesting that determinants of renal function are
mortality. Thus, the public health burden from DNP is
independently related to circulating chemerin levels.
enormous. Current evidence suggests that both genetic
Therefore, serum chemerin concentration might be
and environmental factors determine susceptibility to
altered in patients with diabetic nephropathy (11).
develop DNP and the risk for and rate of progression

of DNP (4). The decrease in renal function in diabetic
AIM OF THE WORK
nephropathy
is
characterized
by
glomerular
The aim of the present work was to evaluate
dysfunction, which is closely related to elevated
serum chemerin level and its association with kidney
urinary albumin excretion. Increased urinary albumin
functions in patients with type 2 diabetes mellitus.
excretion has been demonstrated to be strongly

associated with insulin resistance in type 2 diabetes
SUBJECTS AND METHODS
patients (5).
I. Subjects:
Chemerin, a recently discovered adipocytokine (6), is a
This case control study was conducted at
multifunctional protein implicated in chemotaxis of
Clinical Pathology Departments of Al-Azhar
immune cells, regulation of differentiation and
University Hospitals. It was carried out on 80 subjects
5081
Received:17/07/2019
Accepted:17/08/2019

Full Paper (vol.773 paper# 1)


c:\work\Jor\vol773_2 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5089-5095

The Role of Midkine in Breast Cancer
Walaa M. Hadida (1), Dina A. Ali (1), Ayman A. ELnemr (2), Hanaa E. Nofal (1)
(1) Department of Clinical Pathology, (2) Department of Surgical Oncology
Faculty of Medicine ­ Tanta University
Corresponding author: Walaa M. Hadida; Mobile: 01069415772; Email: walaa.hadida@gmail.com

ABSTRACT
Background
: Breast cancer (BC) is the most frequently diagnosed life-threatening cancer in women and the second
leading cause of cancer death among women worldwide. The present conventional clinicopathological factors remain
insufficient to evaluate the substantial prognosis of this disease. Midkine is a heparin-binding growth factor. It is up-
regulated in many types of cancer.
Aim of the work:
The aim of this study was to through light on the role of serum midkine level in breast cancer patients
and its relation to the conventional tumor marker CA 15-3.
Subject and method: This study was conducted on 40 newly diagnosed breast cancer patients (Group I) and 20 apparently
healthy control subjects (Group II). Complete history, clinical examination, mammography and histopathological
examination of breast cancer with immunohistochemical study were performed. Serum midkine level was assessed by
double antibody sandwich assay technique(ELISA) by using human midkine ELISA kit also CA 15-3 level was assessed
by using an automatic immune assay analyzer (TOSOH AIA system).
Results: The present study revealed a statistically significant difference between breast cancer patients (Group I) and
healthy control (Group II) regarding serum midkine level. Serum midkine level showed a statistically significant
difference with stage of breast cancer, menopausal status and CA 15-3 serum level. There was no statistically significant
difference regarding age, family history of breast cancer, parity, breastfeeding and history of oral contraceptive pills
(OCPs) intake.
Conclusions:
This study showed that midkine might be a diagnostic and prognostic biomarker for breast cancer.
Keywords: Breast cancer, Midkine, ELISA, Immunoassay, CA 15-3.

INTRODUCTION

Breast cancer (BC) is the most widely spread
Midkine (MK) is a multifunctional growth factor
diagnosed cancer among women and the second principle
that can induce various effects in the targeted cells
cause of cancer mortality. Deaths due to BC generally
including nerve cells, neutrophils, macrophages, smooth
occur due to the growth of distant metastases that cannot
muscle cells, fibroblasts, mammary gland cells and tumor
be detected with the existing treatments. Approximately
cells. It plays a role in tumor development, growth,
69% of women who are diagnosed with advanced-stage
invasion, angiogenesis, and metastasis. For this reason,
breast cancer die within 5 years (1).
some researchers have focused on investigating the MK
BC is a quite complex and heterogeneous in its
expression as one of the growth factors and on the
development, progress, and response to treatment;
relationship of this expression with cancer types and its
therefore, researchers are encouraged to identify novel
serum values (1).
biomarkers for the optimization of breast carcinoma

management (2).
SUBJECTS AND METHODS
The key to clinical diagnosis and treatment of
Subjects:
breast cancer is early diagnosis of BC. Accurate
This study was conducted on 40 newly diagnosed
determination of the clinical condition, and the detection
breast cancer patients who were recruited from the
of related molecules in tumor tissue can provide accurate
Surgical Oncology Outpatient Clinic in Tanta University
evidence for the judgment of pathological stage and the
Hospitals. In addition, 20 apparently healthy subjects
degree of tumor malignancy. Tumor tissue obtained
serving as healthy control matched by age, and
through biopsy, on the other hand, may cause a certain
geographic origin with the patients group. Subjects
degree of trauma to patients (3).
included in this study were classified into the following
Growth factors contribute largely to tumor
groups:
formation. They stimulate cell proliferation and regulate
A. Group I: breast cancer patients (BC) = Cases
cell differentiation, migration, survival, and proliferation.
(n=40):
Many studies reported that high levels of growth factors
This group included 40 newly diagnosed breast
associated with malignant tumors and such factors play a
cancer patients classified according to findings into stage
role in tumor development, growth, invasion,
I, II, III and IV. Their age ranged from 40 to 70 years old
angiogenesis and metastasis (3).
with a mean of 54.50 ± 9.5 (Mean ± SD).
5089
Received:27/10/2019
Accepted:16/11/2019

Full Paper (vol.773 paper# 2)


c:\work\Jor\vol773_3 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5096-5100

Anti-Mullerian Hormone as A new Marker for Diagnosis of
Poly Cystic Ovary Syndrome
Abdel Monieum Mohamed Zakaria, Ahmed Osama, Ahmed Kamal Mohamed Abo Sheashea
Department of Obstetrics and Gynecology, Faculty of Medicine Al-Azhar University

ABSTRACT
Background:
Polycystic ovary syndrome (PCOS) is a complex disease characterized by various endocrine disorders
that are the potential cause of anovulation and hyperandrogenism. This heterogeneous syndrome affects about 5­
10% of reproductive-age female population and it can be considered the most common endocrine disorder affecting
women during reproductive life. PCOS is a multifactorial polygenic disease. Genes that regulate steroidogenesis and
folliculogenesis are interested. Hence, AMH measurement has been found to offer a relatively high specificity and
sensitivity as a diagnostic marker.
Objectives: The study aimed to assess the accuracy of AMH in the prediction of PCOS in patients admitted to
Elsayed Galal and El Hussein University Hospital.
Subjects and methods: This was a retrospective study that was done on 130 women, divided into two groups, group
I include 100 PCOS patients and group II, 30 control subject.
Results: The results of this study showed that there was no significant difference between the two groups regarding
age, while there was a significant increase in BMI in patients more than in control. The level of LH showed a
significant increase in patients more than in the control. The level of FSH showed a significant decrease in patients
less than in the control. The Testosterone showed a significant increase in patients more than in the control. The
androstenedione showed a significant increase in patients more than in the control group. The AMH showed a highly
significant increase in patients more than in the control and in turn the number of follicles in group II (patients) was
significantly higher than in the control. The sensitivity of AMH in diagnosis PCOS was 98.0, specificity was 80.0%
and the total accuracy was 93.0 at the cutoff of point 0.911.
Conclusion: Additional advantages of AMH as diagnostic tool are that it is biological, objective, quantitative marker
not affected by day of menses or OCP intake. So in future, more studies should be undertaken to validate its role as
diagnostic tool for PCOS.
Keywords: Anti Mullerian Hormone - Diagnosis - Poly Cystic Syndrome.

INTRODUCTION

Polycystic ovary syndrome (PCOS) is a
the perinatal period, it increases gradually until puberty,
complex disease characterized by various endocrine
remaining stable in the reproductive period and it
disorders that are the potential cause of anovulation and
becomes very low after the menopause (4).
hyperandrogenism. This heterogeneous syndrome
Women with PCOS have an increased number of
affects about 5­10% of reproductive- age females
small follicles in the pre-antral and antral stage, and
population and it can be considered the most common
therefore it is observed that their AMH serum
endocrine
disorder
affecting
women
during
concentrations are higher than their counterpart (5).
reproductive life. PCOS is a multifactorial polygenic
Females with PCO have higher levels of AMH whether
disease: genes involved in insulin-resistance, genes that
obese or lean as compared to a female with no PCOS.
encode inflammatory factors and genes that regulate
This has been reported in a study that recruited sample
steroidogenesis and folliculogenesis are interested (1).
from a community that included both lean and
Although PCOS is the most frequent endocrine disorder
overweight women. Elevated circulating AMH levels
in women of reproductive age, the diagnosis of the
were found among PCOS females versus non-PCOS
syndrome remains one of the most challenging issues in
women, regardless of Insulin resistance and adiposity
endocrinology, gynecology and reproductive medicine.
status (6). Furthermore, AMH levels are positively
PCOS is a diagnosis of exclusion and is defined by the
correlated with individual features of PCOS, including
Rotterdam classification from 2003 requiring at least 2
LH concentrations, testosterone, mean ovarian volume
out of 3 criteria: oligo and/or anovulation, clinical
and the number of ovarian follicles as reported by.
and/or biochemical hyperandrogenism (HA) and
Laven et al. (7). Hence as a diagnostic marker, AMH
polycystic ovaries on ultrasound (2).
measurement has been found to offer a relatively high
Anti-Meullerian hormone (AMH) is a
specificity and sensitivity (92 and 67% respectively) for
glycoprotein hormone with a molecular weight of 140
PCOS. Thus in situations where accurate ultrasound
kDa that belongs to the superfamily of the transforming
data are not available or where there is lack of adequate
growth factor beta (TGF-b) (3). AMH acts as a regulator
quality of equipment used for sinology (8), AMH could
of folliculogenesis, it is produced by the granulosa cells
be used instead of the follicle count as a diagnostic
of follicles from the stage of the primary follicle to the
criterion for PCOS (9).
initial formation of the antrum. Its production begins in

5096
Received:18/07/2019
Accepted:18/08/2019


Full Paper (vol.773 paper# 3)


c:\work\Jor\vol773_4 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5101-5108

Role of Speech-Language Pathologist in Pediatric Corrosive Ingestion in
Zagazig University Children Hospital
Hatem Mohammed Hussein1, Hossam Fathy El-saadany1, Elham Magdy Hafiz2,
Mahmoud Gamal-eldeen Mohamed Mohamed1*
1Department of Pediatrics, Faculty of Medicine, Zagazig University
2Department of Phoniatrics, Faculty of Medicine, Zagazig University
* Corresponding author: Mahmoud Gamal-eldeen Mohamed Mohamed, Mobile: (+20)01020430873,
E-mail: M.g.abasy@gmail.com
ABSTRACT
Background:
Pediatric corrosive ingestion injuries represent a significant proportion of total ingestion injury
annually. Medical and surgical advancements over the past five decades led to significant reductions in mortality.
Optimal treatment of children with ingestion injuries requires a multi-skilled team approach.
Objective: The aim of the work was to assess the effects of corrosive ingestion in children and to determine the role
of speech-language pathologist. Patients and methods: This cross section study was conducted on 52 patients with
corrosive ingestion. The patients were admitted at Zagazig University Children Hospitals from February 2018 to
February 2019. Results: Our results showed that there was high significant relation between impaired oral intake and
period of admission, PICU admission, days to initiate oral feeding and grade of mucosal injury. Also, there was high
significant relation between fluid, semisolid and solid dysphagia and oropharyngeal mucosal injury. Also, there was
a high significant relation between oesphageal mucosa grading of injury and oropharyngeal mucosal injury.
Conclusion: Children admitted to hospital with severe ingestion injury to the oral cavity, oropharynx and esophagus
had significant and sustained delay in the recovery of effective PO intake milestones, with many requiring ongoing
gavage feeding at hospital discharge.
Keywords: Speech-Language Pathologist, Pediatric Corrosive Ingestion.

INTRODUCTION

Children who ingest liquid chemical substances
The clinical history must emphasize the type and
sustain diffuse injuries to multiple sites across the oral
amount of caustic and if possible get the product
cavity, pharynx, larynx and eosophagus (1). The
package. Hemodynamic stabilization and adequacy of
pediatric population is the most affected. The highest
the patient's airway are priorities. The induction of
risk age groups are infants and pre-schoolers (2).
vomiting or gastric lavage is contraindicated following
Although, it is not a public health problem, caustic
caustic ingestion because a re exposure of the
ingestion is a significant issue worldwide, particuralry
oesophageal mucosa to the caustic agent with further
in developing countries in which an unsafe environment
injury may occur (8).
is a substantial risk factor for child injury (3).

Dysphagia and difficulty with oral intake are
AIM OF THE WORK
common initial symptoms following ingestion injury in
The aim of the work was to assess the effects of
children. More than one third of children have difficulty
corrosive ingestion in children and to determine the
with oral intake within 48 hours following injury, so
role of speech-language pathologist.
swallowing assessment is needed to detect which stage

of swallowing is affected (4). Endoscopic grading of
PATIENTS AND METHODS
mucosal injury: 0 = normal examination, I = edema and
Study design and setting:
hyperemia of the mucosa, IIa = superficial ulceration,
This cross section study was conducted on 52
erosions, friability, blisters, exudates, hemorrhages, and
patients with corrosive ingestion. The patients were
whitish membranes, IIb = grade IIa plus deep discrete or
admitted at Zagazig University Children Hospitals from
circumferential ulcerations, IIIa = small scattered areas
February 2018 to February 2019.
of multiple ulceration and areas of necrosis with brown-

black or grayish discoloration, and IIIb = extensive
Ethical approval and written informed consent: An
necrosis (5). Severe injuries and associated
approval of the study was obtained from Zagazig
complications that often involve children or health
University Academic and EthicalCommittee. Every
professionals are initiated by cessation of oral intake, as
patient signed an informed written consent for
well as long-term nonoral feeding, with gavage feeding
acceptance of the treatment.
often used to avoid further damage to tissues in the short

term (6).
Patients were subjected to the following:
There is no standard treatment of caustic ingestion
A) Full history taking including: Name, age, sex,
during the acute phase. Several treatment strategies are
length of admission, need for and duration of pediatric
described in pediatric surgery books (7).
intensive care unit (PICU) admission, need for
All patients who suffered a caustic ingestion
intubation/ventilation, substance ingested (nature,
should be hospitalized and evaluated comprehensively.
5101
Received:18/07/2019
Accepted:18/08/2019

Full Paper (vol.773 paper# 4)


c:\work\Jor\vol773_5 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5109-5113

Pregnancy Outcome in Women with Previous One Cesarean Section,
Experience from Kingdom of Saudi Arabia
Fatimah Alkhamis
Department of Obstetrics and Gynecology, Faculty of Medicine, King Faisal University, Saudi Arabia
Corresponding Author: Fatimah Alkhamis , Drfatimah7070@hotmail.com
Maternity and Children Hospital Al-HASA, Kingdom of Saudi Arabia

ABSTRACT
Objectives:
The aim of this study is to determine the outcome of pregnancy in women with previous one cesarean section
as successful trial of scar and vaginal delivery, and repeated caesarian section.
Methodology: This is a retrospective cohort hospital-based study was conducted in Maternity and Children Hospital Al-
HASA. Included booked women and non-booked pregnant women and had previous one cesarean section. Data were
collected from delivery room log book and medical files when more details were required. Those who were eligible for
the study were 299 women who underwent comprehensive analysis.
Main results: The successful vaginal delivery was (73.9%). No reported cases of maternal mortality or morbidity.
However, there were tender scar with no dehiscence or rupture uterus (4 %). No neonatal mortality, however, 6% of the
CS were indicated by fetal distress. There was statistically significant association between gestational age and fetal weight
(P < 0.01) and between the gestational age and Apgar score (P < 0.01). Significant results was found between outcome
and previous successful vaginal birth after cesarean (VBAC) (P < 0.001) and with spontaneous vaginal deliveries (P Value
0.004) and between previous cause of C-Section and the outcome was highly significant (P < 0.001).
Conclusion:
In this study the maternal and fetal outcome of VBAC were quite satisfactory. Policy maker can use the
findings of this study to develop strategy to decrease the cesarean section rate. Safe practice that enhances VBAC success
rate without increasing mortality and morbidity should be evaluated.
Keywords: VBAC, maternal, fetal, outcome, Saudi Arabia.

INTRODUCTION
a decreased likelihood of planned VBAC success:
World Health Organization (WHO) recommended
VBAC at or after 41 weeks of gestation, birth weight
the expected rate of cesarean to be as low as 15%
greater than 4000 g; no epidural anaesthesia, previous
however, it's documented as 13% (1). The probability that
preterm caesarean birth, cervical dilatation at admission
a woman undergoes a cesarean is 3 times more than that
less than 4 cm, less than 2 years from previous caesarean
of 20 years ago (2). There were increased in caesarean
birth, advanced maternal age, non-white ethnicity, short
section (C-section) rate with different variation in
stature and a male infant (14).
countries (3). The caesarean rate in Brazil, Chile and
Women with previous cesarean sections constitute
China increased up to 40-42 % (4, 5), in Iran 26- 66.5%
a high risk group in obstetrics. Vaginal birth after
and it's as high as 87% in private centers (6,7). Cesarean
cesarean (VBAC) or trial of scar (TOS)represents a
delivery is carried out due to such various reasons as
significant change in modern obstetric practice.
pregnancy at higher ages, lower number of a woman
However, the concern that a scarred uterus might end up
previous pregnancies, obesity, fetal distress, etc. (8,9). The
in rupturing the uterus, leading to severe maternal and
single best predictor for successful VBAC is previous
perinatal morbidity that still prevents a large number of
vaginal birth, particularly previous VBAC which is
obstetricians and pregnant women worldwide from
associated with an approximately 87­90% planned
adopting a TOS after previous one cesarean section (15).
VBAC success rate (10,11).
In Saudi Arabia, where having a big family is the
In Kingdom of Saudi Arabia (KSA) there was
social normal, VBAC after a prior cesarean is important
increase in the overall cesarean delivery rate by 80.2%
issue with special consideration in Saudi population. The
from 10.6% in 1997 to 19.1% in 2006 in different regions
aim of this study is to determine the outcome of
(12). Recent study showed a high rate of cesarean delivery
pregnancy in women with previous one cesarean section
(55.4 %.), and obese women were at higher risk to
as successful trial of scar and vaginal delivery, and
deliver by cesarean (13). A number of factors are
repeated caesarian section.
associated with successful VBAC. Risk factors for

unsuccessful VBAC are: induced labour, no previous
METHODOLOGY
vaginal birth, high body mass index and previous
This is a retrospective cohort hospital based study,
caesarean section for dystocia. When all these factors are
which was carried out in a tertiary care hospital that
present, successful VBAC is achieved in only 40% of
serves a steady population of the civilians and their
cases. There are numerous other factors associated with
dependents, the Maternity and Children Hospital Al-
HASA. This hospital offer elective service as well as
5109
Received:06/07/2019
Accepted:06/08/2019

Full Paper (vol.773 paper# 5)


c:\work\Jor\vol773_6 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5114-5120

The Relationship between Childhood Trauma and Schizophrenia
Symptoms Severity at Zagazig University Hospitals
Asaad AbdElrahman Shalanda, Amira Mohamed Youssef, Rehab Saeed Mahdy,
Alaa Elsayed Mohamed Zayed
Department of Psychiatry, Faculty of Medicine, Zagazig University, Egypt
Corresponding Author: Alaa Elsayed Mohamed Zayed,email: alaaelsayedzayed@gmail.com.
ABSTRACT
Background: Childhood trauma is an environmental and risk modifying factor for schizophrenia.
Aim of the work: The objective of the present work is to evaluate the incidence of childhood trauma among
schizophrenic patients and how this impacts the clinical features of the disorder. Subjects and Methods: It is a cross-
sectional study conducted from January 2019 to June 2019 at the Psychiatry Department, Zagazig University hospitals
where the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Arabic version was used to verify the
diagnosis of randomly chosen 104 schizophrenic patients meeting the inclusion criteria. Positive and Negative
Syndrome Scale (PANSS) for the assessment of positive, negative and general psychopathology connected with
schizophrenia. Adverse Childhood Experiences International Questionnaire (ACE-IQ) Arabic version to assess
adverse childhood experience. The study was approved by the medical ethics committee of Zagazig University
Hospitals and a written informed consent is obtained from all patients.
Results
: The prevalence of childhood trauma in schizophrenic patients is (85.6 %), (42.3%) of them had 3 types of
trauma. Childhood trauma was associated with low education level and rural residence. There was a statistically
significant positive correlation between childhood trauma and positive symptoms of schizophrenia in which (ACE
total score 3 traumas) were associated with severe positive symptoms.
Conclusion: Childhood trauma is prevalent in patients with schizophrenia. Childhood trauma patients are associated
with more severe positive symptoms, especially in patients with 3 or more traumas. Patients with childhood trauma
were associated with early schizophrenia onset.
Keywords: Childhood trauma, Schizophrenia, Symptom severity.


INTRODUCTION

The study was approved by the medical ethics
Schizophrenia is a severe, complex psychiatric
committee of Zagazig University Hospitals and a
disorder characterized by lack of feeling or emotion,
written informed consent is obtained from all patients.
lack of initiative and changes in thought, perception,

and behavior. Delusions and hallucinations are present
All patients were subjected to the following
in many patients as well as misinterpretation of reality
assessment procedures:
(1). Childhood trauma is one of the environmental risk
1- Simi-structured psychiatric interview to collect
factors most studied for schizophrenia and is considered
sociodemographic data.
a risk-modifying factor (2)
2- Structured Clinical Interview for DSM-IV Axis I
Recent studies have verified an elevated incidence
Disorders (SCID-I) Arabic version:
of adverse childhood experiences (ACE) in
SCID-I was implemented to verify the diagnosis and
schizophrenia patients (3,4). Further findings suggest
substance use disorder as a conventional gold semi-
relationships between adverse experiences in childhood
structured clinical disorder evaluation tool. SCID-I
(ACE) and increased general psychopathology, positive
utilizes conventional sequence of questions to
symptoms or cognitive deficits (5,6)
determine whether there are symptoms that make it
Previous studies also indicated a relationship
possible to diagnose according to DSM-IV criteria. The
between childhood trauma and an earlier age of
primary uses of SCID are for diagnostic assessment,
psychosis (7), general malfunctioning (8), and higher
study and training of mental health professionals. It
number of hospitalizations (9)
evaluates 33 of the psychiatric disorders mentioned in

the fourth edition of the American Psychiatric
SUBJECTS AND METHODS
Association's Diagnostic and Statistical Manual (DSM-
This study is a cross-sectional study which was
IV) Disorders (10(
conducted from January 2019 to June 2019 at the
The Arabic version of the SCIDI used in this study was
Psychiatry Department, Zagazig University Hospital.
converted and validated by prior studies undertaken at
A total of 104schizophrenic patients of both sexes
the Institute of Psychiatry, Ain Shams University (11(
(age 18-65) diagnosed by the Structured Clinical
3- Positive and Negative Syndrome Scale (PANSS(
Interview for DSM-IV Axis I Disorders (SCID-I) were
The PANSS is a standardized clinical interview
chosen by simple random sampling from both the
assessing the presence and severity of positive and
hospital ward and the outpatient clinic.
negative symptoms and general psychopathology for

schizophrenic people over the past week. Out of the 30
Ethical approval:
items, 7 are positive symptoms (range of scores 7­49),
5114
Received:17/07/2019
Accepted:17/08/2019

Full Paper (vol.773 paper# 6)


c:\work\Jor\vol773_7 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5121-5127

Endoscopic Endonasal Approach for Craniopharyngiomas
Hamdy M. Behairy a, Adel R. Almelesy b and Mohamed M. Daoush c
a Neurosurgery Department, Faculty of Medicine, Al-Azhar University, Cairo, b Neurosurgery Department,
Faculty of Medicine, Al-Azhar University, Cairo, c Neurosurgery Department, Shebin El Kom Teaching
Hospital, Egypt
*Corresponding author: Mohamed M. Daoush, E-mail: address: drdaoush2015@gmail.com, Mobile: (+20)01154430504

ABSTRACT

Background: Craniopharyngiomas are challenging tumors that most frequently occur in the sellar or suprasellar
regions. The endoscopic endonasal transsphenoidal approach is a minimal-invasive technique for managing
craniopharyngiomas.
Objective: The aim of this study was to evaluate endoscopic endonasal trans-sphenoidal approach in management
of craniopharyngioma as regard the indications, operative difficulties, post-operative complications and outcomes.
Patients and methods: An analytical prospective study conducted on 10 Craniopharyngioma patients treated via
endoscopic endonasal, trans-sphenoid approach in Al-Azhar University Hospitals. Follow up of patients done
clinically and radiologically over 6 months.
Results: The study included 10 patients, 2 (20%) males and 8 (80%) females. Ages ranged from 19 to 60 years
(mean age 39.5 years). Gross total resection was achieved in 7 patients (70%). The most common surgical
complications in our series were diabetes insipidus (DI) and cerebrospinal fluid (CSF) leakage in 5 patients (50%)
and 3 patients (30%) respectively. None of our patients suffered from worsening of endocrinological or visual
outcome postoperatively.
Conclusion: To conclude that endoscopic endonasal approach (EEA) is an effective surgical treatment for removal
of craniopharyngiomas in terms of surgical outcome and tumor control.
Keywords:
Craniopharyngioma, Endoscopy, Skull base surgery, Endoscopic Endonasal Approach,
Transsphenoidal surgery.

INTRODUCTION

compared to transcranial approaches, which managed
Craniopharyngiomas are benign tumors that arise
by nasoseptal flaps and multilayer repairs (4).
from squamous epithelial remnants of Rathke's pouch.

These account for approximately 2­5% of all

intracranial tumors and approximately 5.6­13% in
Radiation therapy is often advocated for residual or
children. The overall incidence of craniopharyngiomas
recurrent craniopharyngioma following surgical
1.3 per million person/year. A bimodal age distribution
resection to prevent local recurrence. However,
has been noted with peak incidence rates in childhood
radiation therapy is not always effective and may
at 5­14 years and in adulthood at 50­74 years.
render tumors more difficult to remove (5).
Craniopharyngiomas are rare in newborns and infants

with only 5% arising in patients between birth and 5
AIM OF THE STUDY
years old (1).
Evaluation of endoscopic endonasal trans-sphenoidal
According
to
a
histologic
finding,
approach in management of craniopharyngioma as
adamantinomatous and papillary subtypes have been
regard the indications, operative difficulties, post-
defined. From a histopathological perspective,
operative complications and outcomes.
craniopharyngiomas are considered to have benign

pathologies. Local adhesiveness, tendency to create a
PATIENTS AND METHODS
mass effect, high surgical failure rates, and increased
Patents:
mortality/morbidity risks of repetitive surgeries may
An analytical prospective study conducted on 10
lead these potentially aggressive tumors to be
Craniopharyngioma patients that were treated via
considered ``malignant'' from surgical and clinical
endoscopic endonasal, trans-sphenoidal approach in
points of view (2).
Al-Azhar University Hospitals. Follow up of patients
Intrasellar and infra-diaphragmatic lesions could
done clinically and radiologically over 6 months.
be resected through an endonasal approach. With the
Inclusion criteria: Sellar, Suprasellar, Infra-
advent of endoscopic endonasal surgery (EES),
diaphragmatic and sub-chiasmatic Craniopharyngioma
suprasellar and select intraventricular tumors, which
in adult patients and de novo cases (not operated
were accessible only using craniotomy, can now be
before).
resected using endoscopic endonasal surgery often with
Exclusion criteria: Pediatric patients below 18 years,
improved clinical outcomes compared to transcranial
recurrent cases, other sites of craniopharyngioma as
resection (3). CSF leak remains the most pronounced
intraventricular, sub-frontal, posterior fossa etc...
disadvantage of endoscopic endonasal surgery when
Contraindications of endoscopic endonasal approach as
5121
Received:18/07/2019
Accepted:18/08/2019

Full Paper (vol.773 paper# 7)


Full Paper (vol.773 paper# 8)


ABSTRACT The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5132-5137

To Evert or not to Evert Tunica Vaginalis during
Low Inguinal Approach Varicocelectomy
Shawky Mohammed Deabes, Mohamed Abdel-all Nafea, Ahmed Soliman Ibrahim*
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Correspondence author: ahmed soliman Ibrahim ahmed, Mobile: (+20) 01227993674,
E-mail: ahmed.sol.ib.88@gmail.com
ABSTRACT
Background:
Varicocele is the most common correctable etiology found in infertile men. The aim of all surgical
methods that treating varicocele is to increase the potential for future fertility.
Objective:
The aim of work was to evaluate the outcome of varicocelectomy through the low inguinal approach as a
compare of eversion or non-eversion of the tunica vaginalis.
Patients and methods: This prospective study included a total of 40 patients with a diagnosis of primary testicular
varicocele and underwent low approach varicocelectomy, attending at Department of General Surgery, El-Hussein
University Hospital. The patients were divided into two groups: group I included 20 patients with everted tunica and
group II included 20 patients without everted tunica.
Results: show that eversion of tunica vaginalis proved statistically to be effective in avoidance of hydrocele
formation after varicocelectomy as there is no case developed hydrocele during the follow up period and as effective
as microsurgical varicocelectomy. Conclusion: It could be concluded that for reduction of the incidence of
hydrocele after varicocelectomy, eversion of tunica vaginalis can be afforded as adjunctive in operation theatre
performing sub inguinal varicocelectomy without the aid of an operating microscope.
Keywords: varicocelectomy, hydrocele.

INTRODUCTION

low rate of recurrence, hydrocele formation, no nerve
Primary varicocele is the most common pre-
damage or any other potential complications (6).
pubertal andrological condition. it has first been
Despite the well-established natural history of
described as early as 1st century B.C. Armelius
the varicocele disease process, the optimal method for
Cornelius Celsus wrote "when the disease has spread
ligation of the varicocele is still a matter of debate as
over the testicle and its cord, the testicle sinks a little
more interventional radiology as well as minimal
lower, and becomes smaller than its fellow, in as much
invasive surgical procedures is ever emerging (7).
as its nutrition has become defective" (1).
The aim of the study was to evaluate the outcome of
Early description of varicocele in the modern
varicocelectomy through the low inguinal approach as
literature was in 1885 when a conventional description
a compare between eversion and non-eversion of the
of surgical treatment was given by Barwell (2).
tunica vaginalis.
However, it has only been in the last two

decades those adolescent varicoceles have been proven
PATIENTS AND METHODS
to affect the growth and function of the testis (3).
This prospective study included a total of 40
Varicocele in pediatric and adolescent was
patients with a diagnosis of primary testicular
thought to be clinically ineffective as early as 1970s.
varicocele
and
underwent
low
approach
This belief then changed when Kogan et al. (4).
varicocelectomy, attending at Department of General
Some clinical studies confirmed that there was
Surgery, El-Hussein University Hospital. Written
a reduction in ipsilateral testicular volume of the
informed consent from all the subjects were obtained
varicocele, which leads to change of the way of
after complete explanation of the procedure and any
treatment of varicocele. It is now proven that there is an
possible complications they may suffer. This study was
increase in both ipsilateral and contralateral testicular
conducted between December 2018 to June 2019.
growth in children and adolescents who have

undergone varicocele treatment compared with those
Ethical approval:
who had not (4).
The study was approved by the Ethics Board of Al-
Varicocele is the most common correctable
Azhar University and an informed written consent
etiology found in infertile men. The aim of all surgical
was taken from each participant in the study.
methods that treating varicocele is to increase the
The included subjects were randomly divided into
potential for future fertility (5).
two groups; Group I (with eversion of tunica) consisted
The main goal of treatment in children is to
of 20 patients whose ages ranged from 17 to 52 years,
prevent testicular injury and maintain testicular normal
with a mean age of 30.75±10.67 years, and who
function, which can be achieved by surgical treatment of
underwent varicocelectomy with eversion of tunica,,
varicoceles (4).
Group II (with non-everted tunica) consisted of 20
The ideal surgical treatment for varicocele
patients, with ages ranging from 16 to 48 years and a
would be one where the varicocele is completely
mean age of 29.35±8.93 years, who underwent low
eliminated, while testicular function is preserved with a
approach varicocelectomy only.

5132
Received:19/0/2019
Accepted:19/08/2019

Full Paper (vol.773 paper# 9)


c:\work\Jor\vol773_10 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5138-5142

Management of Abdominal Complications of Ventriculoperitoneal and
Thecoperitoneal Shunts
Megahed Mohamed Ali El-Shafei 1, Abd El Kafi Sharaf El Din2,
Abd El Fattah Morsi Saied Mohammed1, Islam Abd Elhaleem Matter *1
Departments of 1General Surgery and 2Neurosurgery, Faculty of Medicine, Al-Azhar University
*Corresponding author: Islam Abd Elhaleem Matter; Mobile: (+20)01004059051; Email: Islammatter221183@gmail.com

ABSTRACT
Background:
The overall incidence of hydrocephalus in the general population is not known since the condition occurs
in association with a large number of childhood and adult intracranial diseases. It is obvious that the reported incidence
of infantile hydrocephalus, namely 3 to 4 per 1000 live birth is grossly understated.
Objective: The aim of this study was to study various complications of the ventriculoperitoneal shunt and their
management. Patients and methods: This a prospective study, a total of assessed 20 patients of complicated shunt
operations for hydrocephalus in single group, the age of the patients varied from two months to seventeen years?; there
were ten males and ten female patients, at Al-Azhar University Hospitals between March 2017 and June 2018.
Results: Treatment of shunt obstruction was done by shunt revision using a new catheter which was easy with excellent
results in absence of infections. 65% of the cases with shunt infection occurred during the first six months after initial
shunt insertion. Treatment of patients with shunt infection was done by shunt removal, CSF drainage and combined
intravenous and intraventricular antibiotics according to culture and sensitivity. Shunt insertion was done after negative
three successive CSF cultures and lower CSF protein level. The cure rate was 62.5% in cases of shunt infections using
the above-mentioned regimen. Conclusion: The complication due to non-infective causes is easy to manage and usually
requires a short stay of the patient in the hospital.
Keywords: Abdominal Complications of Ventriculoperitoneal, Thecoperitoneal Shunts.

INTRODUCTION

The aim of this study was to study various
Placement of ventriculoperitoneal (VP) shunt is
complications of the ventriculoperitoneal shunt and
the most common operation performed in the treatment
their management.
of hydrocephalus (HC) (1). The use of the peritoneal

cavity for CSF absorption in ventriculoperitoneal
PATIENTS AND METHODS
shunting was first introduced in 1908 by Kausch (2).
This Prospective study included a total of 20 patients of
Other shunting has since been used include a
complicated shunt operations for hydrocephalus in
ventriculoatrial shunt (VA), a lumboperitoneal shunt,
single group, attending at Al-Azhar University
and a third ventriculostomy (3).
Hospitals. This study was conducted between March
The peritoneal cavity is preferable to the pleural
2017 and June 2018.
cavity for insertion and reinsertion of the shunt (4).

Intraabdominal
complications
after
Ethical approval:
ventriculoperitoneal shunt placement are most
The study was approved by the Ethics Board of Al-
commonly located near the peritoneal end of the shunt
Azhar University.All the procedures were in
catheter, more than 50% of patients require shunt
accordance with the ethical standards of the responsible
revision (5). The most common complications have been
committee on human experimentation. All parents were
reported to be; the infection of the shunt, malfunction
adequately informed and signed a consent form before
due to blockage, disconnection, migration, and
surgery after they had received an explanation about the
equipment failure, which are related to extraperitoneal
nature of the study and its potential complications.
retraction of the catheter (6). Shunt infection remains a
The age of the patients varied from two months to
frequent and potentially fatal complication of CSF
seventeen years; there were ten males and ten female
diversion (7).
patients.
Development of an incisional hernia,

subcutaneous collection of CSF, and peritoneal
Inclusion criteria: Patient fit for surgery, managed by
pseudocyst formation due to low-grade infection
VP shunt and Thecoperitoneal shunt.
followed by wrapping by the omentum, other

complications include intestinal perforation, CSF
Exclusion criteria: Patients unfit for surgery,
ascites, inguinal hernia and intestinal volvulus (6). These
managed by other types of CSF diversion.
complications may manifest as either local abdominal
Demographic characteristics including: Age, gender,
signs or increased intracranial pressure (8). Therefore, a
past history, family history, antenatal history.
key issue in the treatment of these complications is early

and correct diagnosis of intraabdominal complications
All cases were subjected to the following
by CT, MRI, sonography or abdominal radiography (6).
procedures:
5138
Received:20/07/2019
Accepted:20/08/2019

Full Paper (vol.773 paper# 10)


c:\work\Jor\vol773_11 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5143-5147

Curcumin Phytosome Ameliorates Aluminum Chloride-Induced
Nephrotoxicity in Rats
Mohammed A. Al Kahtani
Biology Department, Science College, King Khalid University, Abha, Saudi Arabia
Research Centre for Advanced Materials Science (RCAMS), King Khalid University,
Corresponding author email: dr.malkahtani@gmail.com

ABSTRACT
Aim of the work
: aluminum chloride (AlCl3) toxicity to animals and human increased in the last decade. Thereby, this
study evaluated the potential ameliorative role of curcumin phytosome (CP) on AlCl3-induced nephrotoxicity.
Material and methods: rats were allocated into four groups (n=6), Control group; CP group: rats orally administered
with CP (200 mg/kg b.wt.) for 21 days; AlCl3 group, intraperitoneally injected with three doses of AlCl3 (30 mg/kg/b.wt.)
every five days; group AlCl3 and CP, rats received CP for 7 days prior to AlCl3 and then received CP concurrently with
AlCl3 for another 14 days.
Results: AlCl3 acquaintance significantly increased levels of creatinine, urea, uric acid, LPO and NO as well as reduced
renal GSH, SOD and GPx activity in comparison with the control group. These biochemical variations linked with
histological renal atrophy and morphological lesions in the glomeruli and the different renal tubules. All these
biomarkers in addition to the histopathological changes of injured kidneys were distinctly reversed after treatment with
CP. CP is effective in mitigating the nephrotoxicity evoked by AlCl3 through restoring the oxidant/antioxidant
equilibrium. The pathway of renal ameliorative effect of curcumin phytosome may be related to its ability to decrease
MDA and other ROS and increase of antioxidants activity.
Keywords: aluminum chloride, nephrotoxicity, curcumin phytosome, antioxidants.

INTRODUCTION

Aluminum is plentiful element in the earth's
longa. Curcumin has many therapeutic characters due to
layer and is broadly distributed all over the environment.
its phenolic property as it can be considered as
Aluminum recorded in the priority list of risky
antidiabetic,
anti-inflammatory,
hepatoprotective,
substances by the Agency for Toxic Substances and
anticarcinogenic, antioxidant and cardioprotective
Disease Registry (1).The huge hazard effects of
role(3,7,8). Regardless of these therapeutic roles, curcumin
aluminum have resulted from its entrance in many
is restricted in clinical application. Curcumin is a poorly
applications including food processing such as its
water-soluble, thereby its bioavailability is very low
addition to yellow cheese as well as packaging,
when
administered
orally(9,10).
The
universal
hemodialysis procedures, antiperspirants, phosphate
bioavailability of curcumin is only 1.8 ng/mL from the
binders hyperparathyroidism controlling, and using cans
inventive of 500 mg administered to rats(11). Thereby,
bottle(2).Unfortunately, aluminum eradication from the
inserting lipids to the poor soluble promising agents
body is inadequate and occurs through urine; therefore
enrich their bioavailability(7).
kidney is susceptible to a failure after aluminum
Phytosome is a novel technology, in which
exposure(3).
phospholipids assimilated to a natural compound to
Renal function is contributing to elimination
produce lipid compatible complex boosts the absorption
of aluminum such as aluminum chloride (AlCl3) via
of the candidate(12). The newly formed curcumin
glomerular filtration, reabsorption of filtrated AlCl3 in
phytosome heighten the absorption of curcumin to five-
tubules, secretion and excretion in distal tubules(4).
fold further than the free curcumin in rats(13). Therefore,
The extreme exposure of aluminum due to dissimilar
curcumin phytosome was anticipated to exhibit superior
human daily lifestyle raised the threat of renal aluminum
antioxidant and renal protective role due to its amended
withholding due to accumulation of aluminum to renal
bioavailability. Accordingly, the present study aimed to
tubules resulted in renal dysfunction(2,5).In this context,
probe the ameliorative effect of curcumin in
the kidney is a vigorous organ that is more liable to toxic
contradiction of the toxicity of AlCl3.
insults of AlCl3.

AlCl3 impairs the prooxidant/antioxidant
MATERIALS AND METHODS
stability which motivates the pro-oxidant properties of
Administrative agents and dosing
iron or copper (6).This augments lipid peroxidation
Aluminum chloride/anhydrous (AlCl3) was
(LPO) process and diminishes the activities of the
obtained from LOBA Chemie (India). It was injected
antioxidants accordingly over generates oxidative stress
three intraperitoneally doses (30 mg/kg b.wt) every five
leading to renal toxicity.Therefore, antioxidant
days for 21 days(14). Curcumin phytosome (CP) was an
compounds that can mitigate the oxidative insult may be
aptitude sample from Meriva® (Indena Spa, Milan,
a nominee to relieve AlCl3 toxicity(2).
Italy). CP administered orally as a suspension to rats
Recently, phytotherapeutics curcumin is one
with a dosage of 200 mg/kg b.wt for 21 days(10).
of the best famous spices extracted from Curcuma

5143
Received:15/07/2019
Accepted:15/08/2019

Full Paper (vol.773 paper# 11)


c:\work\Jor\vol773_12 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5148-5154
Ocular Manifestations of Rheumatoid Arthritis and Complications of
Hydroxychloroquine Treatment
Zeinab Sayed Hasan, Sanaa Ahmed Mohamed, Fatma Essam Abdelmohsen*
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Fatma Essam Abdelmohsen, Mobile: (+20)01127521596, E-mail:dr.fatma.esam@gmail.com

ABSTRACT
Background:
Rheumatoid arthritis (RA) is the most common autoimmune disease. Ocular manifestations of RA
vary and are mainly keratoconjunctivitis sicca, episcleritis, scleritis and keratitis. Antimalarial drugs
[hydroxychloroquine (HCQ) and chloroquine (CQ)] have been used for the treatment of RA.
Objective: The aim of this study was to study the ocular manifestations of rheumatoid arthritis and the
complications of the use of hydroxychloroquine in treatment.
Patients and methods: A prospective study that was conducted at Al-Zahraa University Hospital. The study
included a total of 80 eyes of 40 patients. Patients were divided into two groups: Group (1) 20 RA patients not using
HCQ treatment and group (2) 20 RA patients using HCQ treatment. All patients underwent complete ophthalmic
examination including SD-OCT. Results: the most ocular manifestations found in patients were keratoconjunctivitis
sicca (KCS) 93.8%, scleritis and episcleritis 2.5%, acute anterior uveitis (AAU) and sclerosing keratitis 1.3%.
Regarding SD-OCT finding comparing between the two groups, we found signs of early HCQ retinopathy in patients
of group 2 in the form of parafoveal and perifoveal thining compared to group 1.
Conclusion: RA is associated with many extra-articular manifestations, HCQ and CQ used in treatment of RA have
significant efficacy and safety, but with long duration of using can cause retinopathy, and follow up of patients is
necessary to detect early retinopathy.
Keywords: Rheumatoid arthritis, ocular manifestations, hydroxychloroquine, retinopathy.

INTRODUCTION
field testing, which make local screening possible. Such
Rheumatoid arthritis (RA) is one of the common
tests are generally acceptable to patients (6).
autoimmune
disease,
which
causes
chronic

inflammation of the joints and other areas of the body,
AIM OF THE WORK
the exact etiopathogenesis of RA is yet unknown (1).
The aim of this study was to study the ocular
The prevalence of RA worldwide is around 0.8%,
manifestations of rheumatoid arthritis and the
extra-articular manifestation in RA are present in 10-
complications of hydroxychloroquine treatment.
20% of patients, which are more frequent in

seropositive patients (2). Ocular manifestations of RA
PATIENTS AND METHODS
include KCS, episcleritis, scleritis, keratitis, glaucoma
A total of 80 eyes of 40 patients were enrolled in our
and retinal vasculitis. Ocular manifestations occur
study, which was conducted in Ophthalmology
independently or in association with a disease
Department, Al-Zahraa University Hospital from
exacerbation. They occur in 25% of patients with RA
December 2018 till June 2019. Patients were selected
(3).
from Al-Zahraa Rheumatology Outpatient Clinics.
HCQ is a drug increasingly used in the treatment of
Patients were divided into two equal groups: group (1)
systemic lupus erythematosus, rheumatoid arthritis and
that included 20 RA patients not using HCQ drug and
other autoimmune disorders. Long-term use of HCQ
group (2) that included 20 RA patients using HCQ
can cause retinopathy, a condition in which harmful
drug.
effects on the retina can lead to permanent loss of vision

affecting both eyes (4). Specialised retinal tests are able
Ethical consideration and written informed
to detect early evidence of retinopathy before a patient
consent:
notices visual changes. Looking for a particular
An approval of the study was obtained from Al-
condition in a person thought to be at risk, in order to
Azhar University Academic and Ethical Committee.
detect it before symptoms develop to minimise the risk
All patients signed an informed written consent for
of harm is a process called "screening". The aim of
acceptance of the examinations.
screening for HCQ retinopathy is to detect the earliest

definite signs of the condition (5).
Methods:
Although most patients taking HCQ will not
All patients will be subjected to the following:
develop retinopathy, around 7.5% of individuals taking 1. Detailed history taking (age, gender, treatment, etc...)
HCQ for more than 5 years may have signs of retinal 2. Complete ocular examination including uncorrected
damage detected on specialised tests. It is recognised
visual acuity (UCVA) and best corrected visual acuity
that most hospital eye services have modern retinal
(BCVA) using Snellen chart.
imaging technology (optical coherence tomography 3. Slit-lamp examination for the anterior segment.
and fundus autofluorescence) and automated visual
4148
Received:20/07/2019
Accepted:20/08/2019

Full Paper (vol.773 paper# 12)


c:\work\Jor\vol773_13 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5155-5160

A Two Years Follow Up of a Surgical Treatment and Reconstruction Using Platelet
Rich Fibrin for Central Giant Cell Granuloma of The Mandible _ A Case Report
Tarek kasem1, Salma Albati2, Jihad Alokaily3, Ali Alsalim4
Dental Department, AlRass general hospital, Qassim, Kingdom of Saudi Arabia.

ABSTRACT
Background:
Central giant cell granuloma (CGCG) is a benign aggressive destructive osteolytic lesion of osteoclastic
origin. The central giant cell granuloma is often found in the mandible, anterior to the first molars. It most commonly
occurs in patients under the age of 30, with a clear female prevalence.
Objectives: The aim of this report was to present a case of CGCG of the mandible and to describe the effect of platelet
rich fibrin along with the surgical treatment on such aggressive lesions.
Patients and methods:
A 29 years old man referred from Hafer Albaten General Hospital to our Department of Oral
and Maxillofacial Surgery with a chief complaint of painless swelling on the left lower back jaw region for 6 months.
An unusual treatment modality had been carried out in Department of Oral and Maxillofacial Surgery at Alrass
General Hospital. Aggressive curettage along with peripheral osteotomy has been done followed by reconstruction
with Platelet rich fibrin (PRF) as an autologous grafting material.
Results: A Three months, six months, One year and Two years follow up revealed a good healing of the osseous
lesion with no signs of recurrence.
Conclusion: Curettage of the tumor mass, followed by the removal of the peripheral bony margins results in a low
recurrence rate and good prognosis.
Keywords: Central Giant Cell Granuloma, Platelet rich fibrin, Autologous graft, Reconstructive surgery.

INTRODUCTION
along the lower border of the mandible (figure 1A &
Central giant cell granuloma (CGCG) is described
1B). Intra oral examination revealed a solitary swelling
as a benign lesion affecting the mandible and maxilla
in the left lower buccal vestibule in the third molar
that consists of a massive fibrohistiocytic proliferation
region extending posteriorly to the posterior border of
with numerous heavily hemosidrinladen multinucleated
mandible.
giant cells. CGCG was first described by Jaffe in 1953.
Radiographically Panoramic X-ray showed a
It is an uncommon, benign and proliferative non-
multilocular, radiolucent destructive lesion in the
neoplastic process. Jaffe considered it as a locally
mandibular left third molar region (Figure 2). 3D CT-
reparative reaction of bone, which can be possibly due
Scan showed a multiloculated lesion with areas of bone
to either an inflammatory response, hemorrhage or local
destruction and erosion extending to mandibular ramus
trauma. Females are affected more frequently than
(Figure 3).
males. Most lesions occur in the molar and premolar
Based on the clinical and radiographic
area, some of these extending up to the ascending ramus
examination, a provisional diagnosis of Ameloblastoma,
(1).
True giant cell lesion, Odontogenic keratocyst,

Hemangioma, Aneurysmal bone cyst, Traumatic bone
AIM OF THE STUDY
cyst was made.
The purpose of this clinical report was to describe
Fine-needle aspiration cytology was performed
the effect of platelet rich fibrin along with the surgical
which came out to be negative to confirm the diagnosis.
treatment on such aggressive lesions.
An incisional biopsy was planned. Biopsied specimen

revealed connective tissue made up of mature collagen
CASE REPORT
fibers, fibroblasts and numerous multinucleate giant
A 29 year ­ old man referred from Hafer
cells with foci of osseous structures. On the basis of
Albaten General Hospital to our Department of Oral and
histopathologic and radiological findings, a diagnosis of
Maxillofacial Surgery with a chief complaint of painless
aggressive CGCG was established (Figure 4).
swelling on the left lower back jaw region since 6
Pre-operative evaluation was performed before
months.
approaching the patient under local anesthesia. Routine
On examination, a swelling on the left side was
hemogram was done, which turned out to be normal.
revealed on posterior mandibular region, which was

firm and painless. The patient had difficulty in speech
Procedure:
and chewing, as there was a limited mouth opening.
The tumor mass was removed through an
Examination revealed large swelling, focal, non tender,
intraoral approach and curettage with peripheral
non-fluctuant and non compressible, restricting the
ostectomy with preservation of the continuity of the
mandibular movements. On extra-oral examination, a
mandible was performed (Figures 5A & 5B). Tooth #38
single, focal, swelling was seen on the left side of the
was extracted. The inferior alveolar nerve was
mandible. The swelling measured about 4 cm × 4 cm.
preserved. Immediate reconstruction with platelet rich
The surface of the swelling was smooth and extended
5155
Received:19/07/2019
Accepted:19/08/2019

Full Paper (vol.773 paper# 13)


c:\work\Jor\vol773_14 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5161-5166
The Relationship between Vitamin D Deficiency and NAFLD in
Sample of Egyptian Type 2 Diabetic Patients
Hanaa Taha Kandeel, Doaa Mohammed Sayed, Esraa Hatem Ahmed
Department of Endocrinology and Metabolism, Faculty of Medicine for Girls, AL-Azhar University

ABSTRACT
Background
: vitamin D deficiency has a strong association with insulin resistance and NAFLD.
Objective: to assess vitamin D levels in patients having type2 diabetes with NAFLD and to study its relationship with
insulin resistance. Patients and methods: a case­control study conducted on 50 subjects who were divided into 2
groups
: 35 patients having T2DM and NAFLD (group 1) and 15 healthy subjects served as control (group 2). Fasting
plasma glucose (FBG), 2 hour post prandial (2hrpp), and fasting plasma insulin (FPI) were measured with calculation
of HOMA-IR. Fasting lipids, Hb A1c, calcium, phosphorus, urea, creatinine, serum alanine aminotranseferase (ALT),
aspartate aminotransaminase (AST) were also measured. BMI was calculated, serum 25 (OH)D was measured with
ELISA and abdominal ultrasonography was done for all participant.
Results: the study showed lower level of vitamin D in patients with T2DM and NAFLD 10.6 (5.5-21.3) as compared
to control group 31 (27-39.7). While non-significant difference was found between male and female regarding 25(OH)
D level and HOMA-IR. There was significant negative correlation between vitamin D level and HOMA-IR.
Conclusion:
Vitamin D level was associated with presence of NAFLD. There was strong relation between vitamin D
level and insulin resistance as vitamin D deficiency was associated with higher levels of HOMA-IR. Obesity may be
related to low vitamin D level, but no difference in VD level between males and females was found.
Keywords: Vitamin D, NAFLD, T2DM.

INTRODUCTION

Type 2 diabetes (T2DM) is a chronic endocrine
AIM OF THE WORK
disease characterized by poor pancreatic cells and
To assess vitamin D levels in patients having type 2
insulin resistance. It represents one of the major health
diabetes with NAFLD and to study its relationship with
problems worldwide due to its chronic disrupted
insulin resistance.
complications which require special medical care for

prevention and early treatment (1). Several genetic and
PATIENTS AND METHODS
environmental factors have linked to T2DM
The study was conducted on 50 subjects; age and sex
development (2).
matched, their age ranged from 30 to 50 years.
NAFLD is the most common liver disease in western

countries and Mediterranean region, the exact
Ethical approval:
mechanism of NAFLD development is unknown.
All subjects were selected after taking their verbal and
However, NAFLD has the potentiality of progression to
written consent and after taking approval from the
nonalcoholic steatohepatitis (NASH), cirrhosis and
ethical committee consent of Al-Azhar University.
hepatocellular carcinoma (HCC). It is commonly
They were divided into two groups, Group 1:
associated with insulin resistance and metabolic
included thirty five patients having type 2 diabetes with
syndrome (3).
NAFLD on oral antidiabetic treatment. Patients were
Vitamin D deficiency has been identified as one of
selected from diabetes outpatients' clinic of Al-Zahraa
the risk factors for type 2 diabetes development and
University Hospital. Group 2: included fifteen
NAFLD (4). Several evidence based studies have
clinically normal subjects (not having diabetes) served
documented the relation between vitamin D deficiency
as control group. They were recruited from the
and development of T2DM (5). Where vitamin D
employee and patients attending (orthopedic, general
supplementation found to be associated with the
surgery, ENT) outpatient clinics of Al-Zahraa
decreased risk in predisposed patients (6).
University Hospital.
The biological effects of vitamin D mediated after its
The clinical part of the study was performed from
binding to cytosolic / nuclear vitamin D receptors
October 2018 to June 2019.
(VDRs) which belong to steroid hormone receptor
Diagnosis of T2DM was based on American
family. These receptors spread in many tissues
Diabetes Association criteria (2018). FPG 126
including hepatocytes and pancreatic cell (7).
mg/dL. Fasting is defined as no caloric intake for at least
VDR upregulation occurs secondary to a pathologic
8 h, or 2-h PG200 mg/dL or HbA1C6.5%, or in a
stimulus. This would be consistent with the observations
patient with classic symptoms of hyperglycemia or
of VDR expression/activity in transformed hepatocytes
hyperglycemic crisis and a random plasma glucose
and the inverse correlations between VDR levels and
200 mg/dL
severity of non-alcoholic fatty liver disease described by
For defining NAFLD, the hepatic steatosis index
studies (8).
(HSI) was calculated as follows: (8 × ALT/AST ratio
5161
Received:21/07/2019
Accepted:21/08/2019

Full Paper (vol.773 paper# 14)


INTRODUCTION The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5167-5172

A Novel Three Drug Rigemen (Moxifloxacin ­Omeprazole - Nitazoxanide) in
Comparison to Traditional Triple Therapy for Treatment and Eradication of
Naïve and Resistant H. Pylori Infection in Dyspeptic Patients
Ahmed Abd El Aleem Ahmed, Mohammed Zakaria Abu Amer, Mahmoud Mostafa Abd El Hamid*
Department of Tropical Medicine, Faculty of Medicine, El-Azhar University
* Corresponding author: Mahmoud Mostafa Abd El Hamid, Mobile: (+20)01000962976, E-mail: dr7oodasamar@gmail.com

ABSTRACT
Background:
Helicobacter pylori is one of the most common, medically prominent infection worldwide and one of the
major causative factor of peptic ulcer disease. So, eradication of H. pylori is effective in healing ulcers, reducing the ulcer
recurrence and eliminating the need for maintenance therapy.
Objective:
The aim of the work was to compare between the efficacy of traditional triple therapy and Moxifloxacin-based
triple therapy in treatment of H. pylori infection and to evaluate the efficacy of moxifloxacin-based regimens as a rescue
regimen for H. pylori eradication in resistant patients.
Patients and methods:
This study was carried out on 100 Helicobacter pylori (H. pylori)-infected patients (within the
period between septemper, 2018 to May, 2019) who were enrolled from Hepatology, Gastroenterology & Tropical
Medicine Department, Al Azhar University Hospitals (El-Hussein and BAB El-Shaarea).
Results: Helicobacter pylori eradication results in group III as evaluated by monoclonal H. Pylori stool Ag, 6 weeks
post therapeutic regimens reported that eradication rate was 76.9% (20 patients). Regarding post treatment clinical
data in group III, 42.3% of patients remained having symptoms and 57.7% had acheived symptomatic improvement.
Also, the best results were recorded for H.pylori eradication (90%) in group II who received moxifloxacin based triple
therapy compared to group I (with eradication rate 62.9%) who received traditional triple therapy regimen. Thus the
better results (76.9%) were achieved in group III (resistant patients from group I).
Conclusion: The present results could state that moxifloxacin can overcome traditional triple therapy resistance.
Keywords: H.Pylori, Moxifloxacin, Omeprazole, Nitazoxanide, Traditional triple therapy.

INTRODUCTION


Helicobacter pylori (H. pylori) is a small gram-
~30% of patients on an intention-to-treat (ITT) basis
negative spirochete that inhabits the mucous layer
and treatment with PPI, bismuth, metronidazole, and
overlying the gastric epithelial cells in humans. It is the
tetracycline as second-line therapy failed in another
most common prevalent chronic human bacterial
30%, leaving ~10% of the total patient population in
infection estimated in 50% of the global population (1)
need of an alternative regimen.
and the most common cause of gastritis worldwide (2).
Moxifloxacin, a bactericidal fluoroquinolone
Gastric mucus colonization with H. pylori
antibiotic, has activity against HP due primarily to the
induces chronic gastric inflammation in all infected
drug's activity on bacterial DNA gyrase. Moxifloxacin
individuals, but only induces clinical diseases in 10-
has been advocated for use in second- and third-line
20% of infected individuals. These include peptic
"rescue" regimens. Unfortunately, fluoroquinolone
ulcers, acute and atrophic gastritis, intestinal meta-
resistance, especially in patients who had routinely
plasia, gastric adeno-carcinoma and gastric B-cell
received a fluoroquinolone for other indications, is of
lymphoma (3). The preferred treatment for H. pylori
particular concern (6). A lower dose of moxifloxacin
infection involves; proton pump inhibitor (PPI)-based
was used to aid in the tolerability of this three-drug
triple or quadruple regimens (4). PPI, amoxicillin &
regimen, how-ever, as moxifloxacin is a concentration-
clarithromycin is one of a global standard care for
dependent agent, higher doses may increase
confirmed H. pylori infection (2). Metronidazole
eradication rates. Although the optimal dose of
(MNZ) is used instead of amoxicillin or clarithromycin
moxifloxacin is yet to be determined, our study
in cases of allergy or resistance (5).
demonstrated efficacy using the lower dose of 400 mg
Current guidelines from the American College
once daily. Considering the regimen, it was well
of Gastroenterology and the European Helicobacter
tolerated overall. An increase in moxifloxacin dosage
Study Group recommend either a clarithromycin-based
may be warranted (7).
triple therapy (a proton pump inhibitor (PPI) plus
Nitazoxanide is a thiazolide antibiotic
amoxicillin and clarithromycin) or a bis-muth
indicated for use in adults and children for the
quadriple therapy (a PPI plus bismuth, metronidazole,
treatment of Cryptosporidium and Giardia infections.
and tetracycline) as a standard of care in the treatment
Unlike metronidazole, nitazoxanide has been shown to
of confirmed HP infections (2). However, a study by
be non-mutagenic for HP and to possess anti-
Rokkas et al. (2) based on the Maastricht III guidelines,
vacuolating toxin activity. In vitro studies indicated
indicated that treatment with a PPI, amoxicillin, and
that nitazoxanide is a potent agent against HP and
clarithromycin regimen as first-line therapy failed in
other anaerobes and having activity against
5167
Received:21/07/2019
Accepted:21/08/2019

Full Paper (vol.773 paper# 15)


c:\work\Jor\vol773_16 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5173-5182


Assessment of Myocardial Viability After Acute ST- Elevated Myocardial Infarction
Using Stress Speckle Tracking Echocardiography and Cardiac MRI
Ahmed Saleh *, Ali El-Amin**, Mohamed El-Baz**, Hany Negm*
*Cardiology unit, Research Institute of Ophthalmology, Ministry of Scientific Research and Technology,
**Cardiology department,
Al-Azhar University, Cairo, Egypt
* Corresponding author: A. Saleh, salehcardio@hotmail.com

ABSTRACT
Background:
Speckle-tracking echocardiography has emerged as a unique technique for accurately evaluating
myocardial function by analyzing the motion of speckles identified. Speckle-tracking measured under stress may offer
an opportunity to improve the detection of dynamic regional abnormalities and myocardial viability.
Objective: The aim of the current study was to evaluate stress speckle tracking to detect myocardial viability in
comparison to cardiac MRI in post-STEMI patients.
Patients and methods: 74 patients were prospectively enrolled in 18-month's study. Dobutamine stress
echocardiography was performed 4 days post-infarction accompanied with automated functional imaging analysis of
left ventricle during rest and then during low dose stress. All patients underwent a follow up stress echocardiography
at 3 months with speckle tracking analysis. Cardiac MRI took place concomitantly at 4 days post-infarction and 3
months.
Results: Investigating strain rate obtained with stress speckle tracking after revascularization predicted the extent of
myocardial scar, determined by contrast-enhanced magnetic resonance imaging. A good correlation was found
between the global strain and total infarct size (R 0.75, p< 0.001). Furthermore, a clear inverse relationship was found
between the segmental strain and the transmural extent of infarction in each segment. Meanwhile it provided 81.82%
sensitivity and 82.6% specificity to detect transmural from non-transmural infarction at a cut-off value of -10.15.
Conclusion: Strain rate obtained from speckle tracking during stress is a novel method of detecting myocardial
viability after STEMI. Moreover, it carries a promising role in post-myocardial infarction risk stratification with a
reasonable prediction of reversible cardiac-related hospital re-admission.
Keywords: STEMI, stress echocardiography, speckle tracking, Cardio-MRI.

INTRODUCTION


Stress echocardiography has emerged as an
tested in various clinical settings although its
important modality for the assessment of patients with
applicability
for
DSE
(Dobutamine
stress
coronary artery disease (CAD) and left ventricular (LV)
echocardiography) is still poorly documented (5).
systolic dysfunction. Multicenter studies have shown
In the acute setting, the extent of late gadolinium
worse outcome when viable myocardium was identified
enhancement in cardiac MRI is related to the magnitude
by stress echocardiography but the patient was not
of cardiac enzyme release and the functional outcome
revascularized (1).
after recovery. Late gadolinium enhancement CMR
Most stress echocardiography protocols are
reveals a permanent record of MI (both acute and
centered on the detection of contractile reserve and have
chronic) and is proving very useful clinically for the
used inotropic stimulation with dobutamine (1).
diagnosis of MI in cases of doubt (6,7).
Speckle-tracking echocardiography (STE) has
Further work has shown that CMR can
recently emerged as a quantitative ultrasound technique
differentiate between the densely bright infarct core and
for accurately evaluating myocardial function by
the adjacent peri-infarct zone, which appears with lower
analyzing the motion of speckles identified on routine
signal intensity because of the admixture of infarct and
2-dimensional sonograms (2, 3, 4).
viable tissue. The greater the extent of the peri-infarct
Thus a new based on Speckle tracking imaging
zone, the greater the likelihood of future cardiac death
technique, automated function imaging (AFI) allowing
and events (8).
a faster assessment of regional longitudinal strain of the
The aim of the current study was to evaluate the
left ventricle and clear results presentation as a polar
stress speckle tracking in detection of functional
map has recently gained wide interest and has been
recovery and viability of global and regional
5173
Received:20/07/2019
Accepted:20/08/2019

Full Paper (vol.773 paper# 16)


Statistics The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5183-5186

Study of Thyroid Dysfunction in Postpartum Psychosis
Eman M., Khedr1, Ehab S. Ramadan2, Emad Farah M3, Mostafa A. Bastawy4 and M. Nemr Osman4.
1Department of Neuropsychiatry, Faculty of Medicine, Asuit University,
2 Department of Neuropsychiatry, Faculty of Medicine, Tanta University,3Department of Clinical Pathology, 4
Department of Neuropsychiatry, Faculty of Medicine, Aswan University
Corresponding author: M. Nemr Osman, Mobile: 01223341551, Email: nemrmohamed@yahoo.co.uk

ABSTRACT
Background Becoming a mother of newborn involves adaptation to may changes socially and physiologically. Some risk
factors are responsible for the development of postpartum psychosis including postpartum hormonal changes.
Objectives: was to study the role of thyroid dysfunction in development of early postpartum psychosis among a sample of
Egyptian women.
Subjects and Methods: A total of 60 female patients with postpartum psychosis during the first four weeks after delivery
not suffering from any previous psychiatric disorders (Case Group) and 30 female patients within the first four weeks after
delivery not suffering any psychiatric disorders (Control Group) were subjected to clinical psychiatric assessment using
structured psychiatric interview of DSM -V, BPRS, HDRS and measuring plasma level of thyroid hormones e.g., free tri-
iodothyronine, free tetra-iodothyronine and thyroid stimulating hormone.
Results: There were higher significant difference regarding thyroid dysfunction in patients with postpartum
psychosis than in controls. Patients with postpartum psychosis with thyroid dysfunction have a higher significant
score on BPRS and HDRS than patients with postpartum psychosis without thyroid dysfunction.
Conclusion: There is significant association between thyroid dysfunction in first four weeks after delivery and postpartum
psychosis.
Keywords: Thyroid Dysfunction, Postpartum psychosis.

INTRODUCTION


Becoming a mother of newborn involves
inflammation and elevated thyroid antibody titers,
adaptation
to
great
changes
socially
and
occurring within the first year after delivery. After
physiologically. The normal postpartum period
delivery prevalence of 5­7% in the general population,
consists of sleep deprivation, physical exhaustion, and
autoimmune thyroid disease has been identified as a
dramatic hormonal and electrolytes changes. These
risk factor for postpartum psychosis and mood
changes can induce variety of psychiatric disorders, of
disorders5 .
which postpartum psychosis is the most severe one1 .
In spite of evidence of emerging consensus
Postpartum psychosis occurs in 1 to 2 of every
regarding the link between autoimmune thyroid
1000 new mothers. When undiagnosed and untreated,
disorder and postpartum depression, the lower
it presents a danger to both the life of the infant and
incidence of postpartum psychosis has thus far
mother.
precluded analogous studies. Although case reports
Infanticide is rare but does occur in 1 of
have documented the link of postpartum psychosis and
250,000 women with postpartum psychosis2.
postpartum AITD6.
The early symptoms of postpartum psychosis
Stewart 7 in his only previous systematic study
is often a combination of clouding consciousness and
found no evidence for an increase of AITD in patients
mood symptoms. Perplexity, hallucinations, confusion,
with a late onset of postpartum psychosis. However, no
and sleepiness are common. All these psychotic
previous study has demonstrated prospective thyroid
symptoms have been described among women with
dysfunction screening in patients with early onset of
puerperal psychosis in the literature: suspiciousness
postpartum psychosis (28 days postpartum) before the
concerning the identity of the child, verbal
start of medication.
hallucinations, delusions about the child being a

changeling, paranoia, thought broadcasting, echo
AIM OF THIS WORK
phenomena, catatonia and mania. Some risk factors are
Was to study the role of thyroid dysfunction in
responsible for the development of postpartum
occurrence of postpartum psychosis within four weeks
psychosis including hormonal, obstetric variables,
after delivery in a sample of Egyptian females
psychological stressors as well as sociodemographic,
suffering from postpartum psychosis.
genetic, and immunological factors. Some literatures

have proposed that the sudden postpartum hormonal
SUBJECTS AND METHODS
changes after childbirth trigger the onset of postpartum
This study was carried out at the out-patient clinic
psychosis.
of Neuropsychiatry Department, the outpatient and
Postpartum rapid change in serum levels of
inpatient of Gynecological and Obstetric Department
many hormones occurs4 . Postpartum autoimmune
and Clinical Pathology Department of Aswan
thyroid dysfunction (AITD) is defined by autoimmune
University Hospital.
5183
Received:21/07/2019
Accepted:21/08/2019

Full Paper (vol.773 paper# 17)


Statistics The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5187-5190
Phenomenology of Postpartum Psychosis
1Eman M. Khedr, 2Ehab S. Ramadan, 3Mostafa A. Bastawy and 3M. Nemr Osman
1Department of Neuropsychiatry Faculty of Medicine, Asuit University,2 Department of neuropsychiatry,
Faculty of Medicine, Tanta University,3 Department of neuropsychiatry, Faculty of Medicine, Aswan University
Corresponding author: M. Nemr Osman, Mobile 01223341551, Email: nemrmohamed@yahoo.co.uk

ABSTRACT
Background For centuries, physicians have observed a temporal relation between the occurrence of female-specific
reproductive events and the symptoms of illness that traditionally have been classified as "mental". Objectives: study
of phenomenology of postpartum psychosis. Methods: 60 female patients with postpartum psychosis during the first four
weeks after delivery (patients group) and 30 female patents within the first four weeks after delivery not suffering any
psychiatric disorders (Control group). The two groups were subjected to clinical psychiatric assessment using structured
psychiatric interview of DSM -V, BPRS, HDRS and EPDS. Results: Postpartum psychosis was more in younger females
than older and in primipara than multipara. The onset of symptoms of postpartum psychosis was more common in first week
after delivery (mean 6.11 days), sleep disturbance, irritability and hypomanic symptoms are the most early symptoms
of postpartum psychosis followed by anxiety, confusion and somatic complain. Mood congruent psychotic feature
significantly more than mood non-congruent psychotic feature. Conclusion: postpartum psychosis is more common in
younger and primipara females with onset of symptoms in first in first week after delivery. Sleep disturbance, irritability
and hypomanic symptoms are the earliest symptoms of postpartum psychosis.
Keywords: Phenomenology of postpartum psychosis.

INTRODUCTION
AIM OF THIS WORK
For centuries, physicians have observed a
Study of phenomenology and clinical variables of
temporal relation between the occurrence of female-
postpartum psychosis within four weeks after delivery
specific reproductive events and the symptoms of
which help in early diagnosis of this disorder
illness that traditionally have been classified as

"mental". Obviously, psychiatric disorders occurred
SUBJECTS AND METHODS
during maternity leave still occupies a territory and a
This study was carried out at the out-patient clinic of
period of time unrecognized in their entirety mean
Neuropsychiatry Department, the out-patient and
some, others controversial, the plan nosologic,
inpatient of Gynecological and Obstetric Department of
etiopathogenetic and psychopathology1 . The normal
Aswan University Hospital. The study was carried out
postpartum period consists of physical exhaustion,
from January 2016 to January 2017. The subjects of this
sleep deprivation and dramatic changes in hormones
study were females in postpartum period within four
and electrolytes balance. This challenge can provoke a
weeks after delivery with age ranged from 16 years to
wide variety of psychiatric disorders, of which
32 years.
postpartum psychosis is the most severe 2.

Postpartum psychosis occurs in 1 to 2 of every
Ethical approval:
1000 new mothers. If undetected and untreated,
The study was approved by the Ethics Board of
postpartum psychosis presents a danger to both the life
Aswan University and an informed written consent
of the mother and her infant. Infanticide is rare but
was taken from each participant in the study.
does occur in 1 of 250,000 women with postpartum

psychosis 3. The clinical picture of postpartum
The subjects were grouped into:
psychosis is often a combination of clouding
Group I (Patients group): Included 60 females
consciousness and affective symptoms, hallucinations,
with first-onset psychiatric illness developed in the first
confusion, perplexity and sleepiness are common.
four weeks after delivery.
Characteristic is the rapid change from normality to
Exclusion
criteria:
Patients
with
established
fully developed syndrome. All most all psychotic
neurological disorders and severe physical illness,
symptoms have been described among women with
patients with past history of reported psychiatric illness,
puerperal psychosis in the literature: megalomania
patients on hormonal preparations for endocrinal
concerning the identity of the child, delusions about
disturbance or any causes, patients with chronic medical
the child being a changeling, paranoia, verbal
illness as renal or hepatic illness, and patients with
hallucinations, though insertion, thought broadcasting,
history of head trauma and epilepsy.
echo phenomena, mania and catatonia 4. It appears
Group II (Control group): Included 30 females in
that postpartum psychosis is most likely to be a variant
the first four weeks after delivery.
of bipolar disorder rather than a discrete subtype of
Exclusion criteria: Females suffering from any
psychotic illness 5.
psychiatric illness in addition to the same exclusion
5187
Received:21/07/2019
Accepted:21/08/2019

Full Paper (vol.773 paper# 18)


c:\work\Jor\vol773_19 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5191-5198
Study of The Effect of Bisphenol A and Anise Oil on
Some Sexual Hormones in Male Albino Rats and Illustration of
The Effects of Aphanizomenon Flos-Aquae on Their Actions
Eman G.E. Helal1, Mohamed A. Abdelaziz 2, Hewaida A.E. Fadel3, Abeer Zakaria1
1Zoology Department, Faculty of Science (Girls), Al-Azhar University, 2Physiology Department,
Faculty of Medicine, Al-Azhar university, 3Department of Nutritional Chemistry& Metabolism,
National Nutrition Institute, Cairo, Egypt
*Corresponding Author: Eman G.E. Helal, E-mail: emanhelal@hotmail.com,
Mobile: 00201001025364, Orchid.org/0000-0003-0527-7028

ABSTRACT
Background: Xenoestrogens are compounds like estrogens in effect but not in structure which are mimicking the
action of endogenous estrogen and activate estrogen receptor. Phytoestrogens are naturally occurring non-steroidal
plant chemicals that can act like the female hormone estrogen. Aphanizomenon Flos-aquae (AFA) is a blue-green
microalgal species which has antioxidant properties.
Objective
: The aim of the study was to clarify the effects of both Bisphenol A (BPA) and anise oil (phytoestrogen)
together on some sexual hormonal pattern in male albino rats and illustration of the adverse effects of AFA on their
actions.
Materials and methods:
Thirty male albino rats were used. They were divided into three groups: Group I: control
(untreated group), Group II: rats treated with BPA and Anise oil and Group III: rats treated with BPA and Anise oil
in addition to AFA. Blood samples were collected for different biochemical investigations.
Results:
The biochemical results showed highly significant increase (p<0.01) in the activities of ALT, AST, urea,
creatinine, FSH, prolactin and lipid profile (total cholesterol, triglycerides, HDL-C, VLDL, LDL/HDL & TC/HDL).
While, there was a highly significant decrease (p < 0.01) in LDL-C, total protein, albumin, Globulin, testosterone
and LH. These results returned back to the normal values after receiving the AFA as compared to normal group.
Conclusion:
It could be concluded that phytoestrogen and xenoestrogen have undesirable effects and it is
recommended to minimize the utilization of these compounds to protect people from its hazardous effects.
Keywords
: BPA, Anise oil, AFA, Hormonal assay, Biochemical parameters.

INTRODUCTION


Xenoestrogens are small lipophilic molecules that

mimic physiological estrogens (1) and linked to a variety
20% fixed oil and 18% protein. The main constituents
of disease states even when present at concentrations
of the essential oil are 90% anethole, 2-4%
far below those currently allowed by federal regulations
gammahimachalene, < 1% p-anisaldehyde, 0.9-1.5%
(2). Bisphenol A (BPA) is an estrogenic chemical able
methylchavicol,
3%
cis-pseudoisoeugenyl
2-
to interact with human estrogen receptors (ER). Many
methylbutyrate and 1.3% trans-pseudoisoeugenyl 2-
lines of evidence reveal that BPA has an impact as an
methylbutyrate (5).
endocrine disruptor even at low doses. Bisphenol- A
The main constituent of the anise oil anethole, has
(BPA) is a chemical used for lining metal cans and in
been considered as Anise has been reputed to increase
polycarbonate plastics, such as baby bottles. In rodents,
milk secretion, promote menstruation, facilitate birth,
BPA is associated with early sexual maturation, altered
alleviate symptoms of the male climacteric and increase
behavior and effects on prostate and mammary glands.
libido (6). The main constituents of aniseed are
In humans, BPA is associated with cardiovascular
coumarins, flavonoid (flavonol and flavone),
disease, diabetes and male sexual dysfunction in
glycosides, volatile oils (trans-anethole, estrgole and
exposed workers. Food is a major exposure source.
aniseketone), carbohydrate and lipids (saturated and
BPA can contaminate the environment in
unsaturated).
significant amounts by leaching from products (plastic
The
most
common
blue
green
algae,
food containers and water containers, dental sealants
Aphanizomenonflos-aquae (AFA) is commercially
and some cash register receipts) and as byproducts of
distributed as organic algae dietary supplements. They
manufacturing (3). The herbs chosen for this study,
have significant amounts of lipid, protein, chlorophyll,
contain phytoestrogens as shown from their chemical
carotenoids, vitamins, minerals and unique pigments.
constituents. Anise or Aniseed is a flowering plant in
They may also have potent probiotic compounds that
the family Apiaceae. It is used extensively as a spiceand
enhance health (7). AFA is a fresh water unicellular
is listed by the Council of Europe as a natural source of
blue­green algae that spontaneously grows in Upper
food flavoring. It is stated to possess expectorant,
Klamath Lake (Germany) and that is consumed as a
antispasmodic, carminative, and parasiticide properties
nutrient-dense food source and for its health enhancing
(4). The seeds of anise contain 1.5-6% essential oil, 10-
properties (8). AFA is an important source of the blue
5191
Received:22/07/2019
Accepted:22/08/2019

Full Paper (vol.773 paper# 19)


c:\work\Jor\vol773_20 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5199-5206
Assessment of Extent and Severity of Coronary Artery Stenosis Using
CT Coronary Angiography Among Prediabetic Patients
Eman Elkholy1*, Layla Ahmed 2, Rehab M. Hamdy2, Ahmed Magdy3
1Mahalla Cardiac Center, 2 Department of Cardiology, Faculty of Medicine (for Girls),
Al-Azhar University, Cairo, Egypt, 3Kobry El-Kobba Military Hospital
*Corresponding author: Eman Elkholy, Mobile: (+20)01068343683, E-mail: emanelkholy23@gmail.com


ABSTRACT
Background and aims:
Prediabetes is associated with an increased risk of developing diabetes and
cardiovascular disease. Our objective was to assess the extent and severity of coronary artery diseases (CAD)
among prediabetic patients using multi-slice computed tomography (MSCT) coronary angiography.
Subjects and methods: Our population included 60 patients with mean age 56.2 ±10.5 years presented by
typical chest pain with fasting blood glucose (FPG) < 126 mg/dL and HbA1c 6.4% and at least one CV risk
factor. Any patients with prior history of CV disease or clinical evidence of advanced renal disease were
excluded from this study. The extent and severity of coronary artery stenosis were assessed using MSCT
coronary angiography. The patients were divided into two groups, prediabetic group (GI) and non-diabetic
group (GII). Prediabetes was defined as an HbA1c value of 5.7-6.4%.
Results: Prediabetic group had significantly higher number of diseased vessels with higher number of patients
having MVD compared to non-diabetic group. HbA1C and FPG were found as independent predictors for both
extent and severity of diseased coronary arteries.
Conclusion:
CAD was more advanced in prediabetic patients compared to non-diabetic patients. Moreover,
non-diabetic levels of glucose metabolism evidenced by impaired FBG and increased levels of HbA1C were
helpful to predict increased risk for the extent and severity of CAD among our study population.
Keywords:
Prediabetes, HbA1c, coronary artery disease, MSCT coronary angiography.

INTRODUCTION

MSCT is a non-invasive technology to visualize
Prediabetes is a metabolic stage intermediate
the coronary arteries and found to be safe and reliable
between normal glucose homeostasis and diabetes (1)
to detect or exclude coronary artery disease (CAD).
and is associated with an increased risk of developing
MSCT appears to be useful as a first-line imaging
diabetes and cardiovascular disease (2).
technique in carefully selected patients to evaluate the
The American Diabetes Association (ADA)
need of an invasive coronary angiography (9).
proposed that glycated hemoglobin A1c (HbA1c)

could be used as a diagnostic test for diabetes and
AIM OF THE WORK
prediabetes as an alternative to impaired fasting
Our objective was to assess the extent and
glucose (IFG), or impaired glucose tolerance (IGT) (3).
severity of coronary artery diseases among prediabetic
An HbA1c value of (5.7-6.4%) was
patients using multi-slice computed tomography
recommended for the diagnosis of prediabetes.
(MSCT) coronary angiography.
Increasing levels of HbA1c in individuals without DM

are associated with the presence and burden of
PATIENTS AND METHODS
coronary atherosclerosis and mixed coronary arterial
Study population:
plaques (4).
This study was conducted on 60 patients having
There are several methods of screening for
typical chest pain. The patients were selected from
cardiovascular disease, among these, coronary artery
those attending cardiology outpatient clinic at Kobri
calcium (CAC) score by coronary computed
El-Kobba Military Hospital and referred for multi-
tomography (CCT) (5).
slice CT angiography (MS-CT), for diagnosis of
Coronary angiography is the gold standard for
coronary artery disease. The study was conducted
diagnosis of coronary artery disease, but its
during the period from June 2018 to December 2018.
invasiveness nature prevents its regular use in
Inclusion criteria were; patients with typical chest pain
asymptomatic patients.
and having: FBG < 126 mg/dL, HbA1c 6.4% and at
Coronary artery calcium (CAC) score is a strong
least one cardiovascular (CV) risk factor among the
predictor of incident coronary heart disease (6) and is
following: hypertension, dyslipidemia, family history
considered as one of the best subclinical coronary
of IHD or premature sudden cardiac death or current
atherosclerosis markers(7), especially in asymptomatic
smoking.
individuals at intermediate cardiovascular risk (8).
Arterial hypertension was considered present
when measurement of brachial blood pressure (BP)
5199
Received:22/07/2019
Accepted:22/08/2019


Full Paper (vol.773 paper# 20)


c:\work\Jor\vol773_21 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5207-5209

Factors Correlated with Post Endoscopic Retrograde Cholangiopancreatography
Hyperamylasemia: A Single Center Study
Bilal O Al-Jiffry
Department of surgery, Taif University Saudi Arabia

ABSTRACT
Background and aim of the work:
Identifying patient at risk for post ERCP hyperamylasemia which may progress
to pancreatitis is essential to minimize morbidity and mortality by suitable procedural or pharmacological intervention.
In this study hyperamylasemia following ERCP were recorded and correlated with different patient or procedure
related risk factors.
Patients and methods: The data of all patients who met the inclusion criteria of the study and underwent endoscopic
retrograde cholangiopancreatography (ERCP) in Al-Hada Armed Force Hospital, Taif, Saudi Arabia from January
2015 to March 2016, were collected through a review of their hospital and data base records.
Results: There were 138 patients (86 females and 52 males) with mean age of 63.7±15.3 years. Hyperamylasemia
was developed in 29.7% of them; 16.8% were recorded as asymptomatic hyperamylasemia and post ERCP pancreatitis
in the remaining 13%. Multivariate analysis confirmed that, the gender, precut sphincterotomy and pancreatic duct
cannulation were significant risk factors for development of non symptomatic hyperamylasemia and confirmed also
the significance of precut sphincterotomy and pancreatic duct cannulation for post ERCP pancreatitis.
Conclusion: This study confirmed the correlation of precut sphincterotomy and pancreatic duct cannulation with post
ERCP hyperamylasemia and pancreatitis and in such conditions preventive measures are recommended.
Keywords: post ERCP, Hyperamylasemia, pancreatitis, Risk Factors.

INTRODUCTION
and this level increased following performance of ERCP
Hyperamylasemia following ERCP is recorded in
with or without associated clinical, laboratory or
more than seventy percent of patients following the
imaging evidence of development of post ERCP
procedure, however, only 3.5-15% would be
pancreatitis. Exclusion criteria included; patients with
symptomatic with evident post ERCP pancreatitis (PEP)
elevated serum amylase or evident pancreatitis at time
[1-5]. This wide variation in the incidence of post ERCP
of admission, incomplete and unclear files.
pancreatitis would be attributed to the associated risk

factors [2, 6]. These risk factors vary from one study to
Ethical approval:
another and may be patient related risk factors as; female
After approval of the ethics committee; the
sex, young age, history of PEP, and absence of
records were reviewed for the patient specific risk
hyperbilirubinemia [3, 5, 7].
factors at time of admission as; gender, age group,
Most of the procedure related risk factors are related
bilirubin level, diameter of the common bile duct,
to difficult endoscopic intubation that lead to injury of
presence of choledocholithiasis, in addition to factors
pancreatic tissues or edema with duct obstruction and
related to the procedure as; precut sphincterotomy,
consecutive pancreatitis [1, 2, 8-10]. Risky measures used
pancreatic duct cannulation, depth of cannulation and
during intubation include; difficult cannulation with
procedure time.
repeated or deep wiring, precut sphincterotomy, and
The collected data were analysed using SPSS
prolonged cannulation of the pancreatic duct [1-5, 9]. Few
version 22 (IBM SPSS Statistics for Windows, Version
studies considered dysfunction of sphincter of Oddi as a
22.0. Armonk, NY: IBM Corp). The data was expressed
risk factor; however, synergistic cofactors are usually
as means ±SD and percentage. A univariate and
found [3, 4, 9, 10].
multivariate logistic regression analyses of patient
The objective of this study and similar studies is to
specific and procedure related factors were performed to
identify patients at risk and reduce morbidity and
identify factors associated with development of post
mortality of PEP if suitable preventive measures are
ERCP hyperamylasemia with or without evident
used [1, 12-15]. In this study hyperamylasemia following
pancreatitis. P<0.05 was considered as statistically
ERCP were recorded and correlated with different
significant.
patient or procedure related risk factors.

Method:
RESULTS
In this retrospective study the patients who
There were 138 patients (86 females and 52 males)
underwent
endoscopic
retrograde
with mean age of 63.7±15.3 years. Hyperamylasemia
cholangiopancreatography (ERCP) in Al-Hada Armed
was developed in 41 patients (29.7%). Twenty three/138
Force Hospital, Taif, Saudi Arabia from January 2015 to
patients were asymptomatic (16.7%) and in 18/138
march 2016 were identified in the computerized hospital
(13%) pancreatitis were confirmed. Table 1, shows the
database registration system. One hundred thirty eight
relation of assumed risk factors and non symptomatic
patients met the inclusion criteria which included; the
hyperamylasemia. Table 2, shows the relation of these
patients who were admitted with normal amylase level
factors and post ERCP pancreatitis.
5207
Received:24/07/2019
Accepted:24/08/2019

Full Paper (vol.773 paper# 21)


c:\work\Jor\vol773_22 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5219-5227

Infant Weaning Knowledge and Practice among Mothers Attending
Maternal and Child Healthcare Center in Tor-Sinai City
Doaa Mohammed Saeed ¹*, Soad Abd Elsalm Shedeed ², Amira E. Abdelsalam 3,
Rasha Mohamed Bahaa Eldien ¹
Departments of ¹Family Medicine, ² Pediatrics and 3Community Medicine,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Doaa Mohammed Saied, Mobile: 01032646878, Email: dr.dms.online@gmail.com

ABSTRACT
Background
: Weaning has been one of the most wrongly practiced processes in the developmental stages of the
children. Objective: The aim of the work was improving knowledge and practice of mothers regarding weaning diet.
Subjects and methods: Across sectional study was performed on 323 mothers attended maternal and childcare center
in Tour Sinai City. Structured questionnaire was used included sociodemographic data, knowledge and practice
regarding infant weaning. Results: revealed that the mothers belonging to the age group 20-35 (84.8%), secondary
education (39.6%), with current occupation (60.1%), and with enough income (79.9%) were classified as medium social
class. Level of mothers' knowledge and practice was moderate (50-70%) and there was highly statistical significance
association (P<0.001**) between social class and level of mothers' knowledge and practice. Social class was the only
significant factor affecting knowledge and practice where moderate knowledge was noticed in medium social class,
moderate practice was associated with high social class. There was statistically significant positive correlation between
total score of knowledge and total score of practice. Conclusion: Knowledge and practice among the participants were
of moderate level and social class was the only factor affecting it.
Keywords: Weaning, Knowledge, Practice, Assessment.

INTRODUCTION


Weaning is a process by which foods other than
Institutional Review Board (IRB). An Official
breast milk is introduced gradually into baby's diet after
permission was obtained from the Family Medicine
the first six months of life to initially complement the
department at Faculty of Medicine, Zagazig University.
breast milk and then to wean totally off breast milk (1).
The necessary official permissions to carry out the study
Correct infant weaning confers both short-term and
were obtained from the manager of the health center the
long-term benefits to a child such as reduction in rate of
objective of this study was explained to them to ensure
infections and mortality among infants, improvement in
their cooperation.
mental and motor development (2).
Sample size: Assuming that total number of female
Adequate nutrition during infancy and early
attending maternal and childhood center is 5000
childhood is essential for growth, health and
female per year and prevalence of women had low
development of children to their full potential (3).
practice concerning infant weaning was 66% (1), so
Infants should be exclusively breastfed for the first
sample size will be 323 using open Epi, CI 95% .
six months followed by breastfeeding along with
Sampling technique: systematic Random sample
complementary foods for up to two years of age or
was taken "one every three" from average
beyond(4). The first two years of life are critical stages
attendance 25 case per day, eight mothers were
for a child's growth and development. Any damage
interviewed by face-to-face discussion to fill the
caused by nutritional deficiencies during this period
questionnaire.
could lead to impaired cognitive development,
Inclusion criteria: Mothers of the infant aged from
compromised educational achievement and low
6-24 months.
economic productivity (2).
Exclusion criteria: Mothers of twins and of infants
The aim of the current study was improving the
with syndromic diseases were excluded.
knowledge and practices level among mothers attending
Sample size: Assuming that total number of female
maternal and child health care center in tour Sinai city
attending maternal and childhood center is 5000
through assessment of both knowledge and practice.
female per year and prevalence of women had low

practice concerning infant weaning was 66% (1), so
SUBJECTS AND METHODS
sample size will be 323 using open Epi, CI 95% .
This cross-sectional study included a total of 323
Sampling technique: systematic Random sample
mothers, attending at Maternal and Child Health Care
was taken "one every three" from average
Center in Tour Sinai city. Written informed consent
attendance 25 case per day, eight mothers were
from all the participants were obtained. This study was
interviewed by face-to-face discussion to fill the
conducted between March 2019 to September 2019.
questionnaire.
Administrative and Ethical consideration: The study
Study tools: A standardized questionnaire was used for
protocol was approved by the Ethical Committee at
assessment of socio -demographic status using the
Faculty of Medicine, Zagazig University and
socioeconomic scale developed and validated by
5219
Received:23/07/2019
Accepted:23/08/2019

Full Paper (vol.773 paper# 22)


c:\work\Jor\vol773_23 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5228-5234

Management of Lumbar Spondylolysis
Ibrahem Gameel Ewaiss, Mostafa Abo-El kheir, Ibrahim Mohammed Ibrahim Al-Abd*
Department of Neurosurgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Ibrahim Mohammed Ibrahim Al-Abd, Mobile: (+20) 01002057271, email: tantawy_wael@yahoo.com


ABSTRACT
Background:
Spondylolysis is a fatigue fracture which occur in the pars interarticularis due to repetitive mechanical
stresses on the lumbar spine.
Objective: This work was aimed to discuss the different methods in management of spondylolysis, regarding the
conservative treatment and surgical procedures.
Patients and methods:
This study included 30 cases with spondylolysis at Al-Azhar University Hospitals. 13 cases
were operated upon in El-Sayed Galal Hospital of Al-Azhar University and 12 cases were operated upon in El-Hussin
Hospital of Al-Azhar University with 5 cases were managed by conservative treatment between August 2017 and
July 2019. Follow up was done for average one year.
Results: The improvement of radiculopathy in our study was ranging into 3 category: Fair improvement (2 cases,
20%) with conservative treatment, Good improvement (2 cases, 20%) with decompression and fixation, and Excellent
improvement (6 cases, 60%) also with decompression and fixation, so there was a statistical significant relation
between both strategy (p-value=0.007), which indicate that the spondylolysis with radicular pain is better managed
by decompression and fixation. In our study, we used the Visual Analogue Scale (VAS) in the all cases pre
management and post management to assess the outcome. In our study, there was a significant change in Mean VAS
score with mean VAS pre-management 7.1, mean VAS post management 2.6 and mean difference in VAS 4.5.
Indicating a significant improvement of pain intensity (P<0.001).
Conclusion: Spondylolysis is common in young females at L5 pars and presented with LBP in most cases. Different
surgical procedure is safe and effective in management than conservative treatment.
Keywords: Management, Lumbar Spondylolysis.


INTRODUCTION

Spondylolysis occurs in 6 % of general
extension or rotation. Children under 13 years old show
population and approximately 75 % of these will
tenderness or pain on extension and Children can
develop spondylolisthesis. Spondylolysis is more
present a postural deformity or abnormal gait pattern
common in children and teens participating in sports
(4).
(athletic population 23-63 %) that place a lot of stress
The golden standard for the diagnosis of
on the lower back or cause a constant over-stretching
spondylolysis is the combination of Dynamic X-ray
(hyperextending) of the spine, such as gymnastics,
and CT. MRI shows promising results in detecting
weightlifting, and football (1).
spondylolysis but can also be used to determine the
Vertebrae consist of the vertebral body and a
state of the disc above and below the affected vertebra
bony ring or arcus which protects the spinal cord. The
(5).
arcus is formed by two pedicles which attach to the
Many lines of treatment have been used to treat
dorsal side of the vertebral body and two laminae,
pars defect including conservative treatment. While
which complete the arch. The area between the pedicle
recent surgical trends are directed towards surgical
and the lamina is called the pars interarticularis and is
repair of the defect rather than segmental fusion to
in fact the weakest part of the arcus. It is the pars
preserve motion segments (6).
interarticularis that is affected in spondylolysis (2).
Many surgical techniques for direct repair of
The cause of spondylolysis is unknown, but is
pars defect have been described since Kimura
likely multifactorial. One theory points to genetics
described his technique in 1968. In 1970, Buck used a
(heredity) as a factor, suggesting that some people are
screw across the pars interarticularis defect. In 1998
born with thin vertebrae, which places them at higher
Songer et al reported the use of a hook screw construct.
risk for fractures. Many authors feel that repetitive
The most recent technique is repairing the pars defect
mechanical stress specifically with hyperextension and
using a cable-screw constructand percutaneous
trunk rotation plays a primary role (3).
placement of pedicle screws (7).
In most cases, spondylolysis is asymptomatic. If
This work was aimed to discuss the different
there are any symptoms, they often have following
methods in management of spondylolysis, regarding
characteristics: Focal low back pain with radiation
the conservative treatment and surgical procedures.
into the buttock or proximal lower limb. Symptoms can

increase with movement specifically lumbar

5228
Received:23/7/2019
Accepted:23/8/2019

Full Paper (vol.773 paper# 23)


c:\work\Jor\vol773_24 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5235-5241
Mobility Safety in Chronic Elderly Stroke: Evaluation and Assessment
A Narrative Review of the Current Literature and Future Directions
Bani Ahmed Ali A.
Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk
Mobile: (00966) 533933971, email: ali.baniahmed@gmail.com

ABSTRACT
Purpose: Safe ambulation is a multidisciplinary approach of combined skills of medical, nursing, and physical
therapy staff to achieve safe outcomes within in- and outpatient settings. The purpose of this literature review is an
in-depth evaluation of the available research on factors contribute to mobility falls in chronic ambulatory stroke
survivors as a vascular brain pathology with senseromotor consequences especially in geriatric population. Most
importantly, the review proposes guidelines for a comprehensive assessment tool combining the major threats
assessed of mobility safety in integrated approach.
Material and Methods: This narrative review searched in PubMed/MEDLINE was presented in four sections:
(Section one) represents the gait motor impairment, (section two) represents the gait motor recovery (section three)
addresses walking speed and how it relate to community ambulation and (section four) represents the major threats
to mobility safety in chronic stroke survivors.
Results: The three major factors that are related to mobility-related fall risk are vision, fast walking and cognitive
functions. The literature point to no conclusions regarding the mobility safety benchmarks assessment in an
integrated approach.
Conclusion: Our literature review shows a complete lack of a comprehensive well-tested clinical assessment tool
for measuring mobility safety in stroke. The review propose future research using Dynamic Visual Acuity test as
an integrated assessment methodology to assess mobility safety in chronic ambulatory stroke survivors.
Keywords: Stroke mobility, safety; Dynamic visual acuity.

INTRODUCTION
assessment battery combining the major threats
Following
a
stroke,
independent
assessed of mobility safety in integrated approach.
ambulation is a major long-term goal after
We hope such effort will provide guidance for future
rehabilitation. Although 60% to 80% of stroke
scholars in the research area to enable the optimal
survivors achieve this goal. However, a typical course
recovery and maintenance of mobility safety
of physical therapy to increase walking speed does
especially after gait-oriented interventions in chronic
not guarantee that a person is "safe" in terms of their
ambulatory stroke survivors.
mobility. Therefore, a thorough understanding of

performance benchmarks is critical to maximize
MATERIAL AND METHODS
safety and ensure quality performance. There is a
In order to meet the objective of this narrative
debate over which types of performance benchmarks
review,
an
electronic
database
search
in
are the most useful for monitoring patients safety and
PubMed/MEDLINE was performed to identify the
remains a question of international concern especially
available literature. This database was accessed
after a stroke (1). Presumably cognitive, visual and
online by one researcher through the local
motor ability would have to be assessed (1). The lack
university's library system through January 2019 and
of such knowledge represents an important problem
was limited to articles written in English.
considering the high prevalence of mobility-related
Specific key words and their combinations using
falls in this population. As 40% of all stroke survivors
the "AND" operator were used for the purpose of the
suffer serious falls within a year after their stroke,
literature search. These key words included: "Chronic
clinicians should be cautious when treating stroke
stroke", "Gait," "Safety," "Mobility," "Fall risk".
patient to increase walking speed. The purpose of this
Based on inclusion criteria, studies were
literature review is to analyze and detail the available
accepted when: (1) they investigated the gait motor
research what factors contribute to mobility falls in
impairment/recovery and the mobility-related safety
chronic
ambulatory
stroke
survivors.
Most
and falls (2) they included adult subjects who are
importantly, the review proposes guidelines for an
clinically diagnosed with stroke (3) subjects were in
5235
Received:8/6/2019
Accepted:26/8/2019

Full Paper (vol.773 paper# 24)


c:\work\Jor\vol773_25 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5242-5248

Selective Intraoperative Transcystic Cholangiogaraphy in
Laparoscopic Cholecystectomy, 3 Years' Experience
Ayman Helmy Ibrahim 1*, Mohamed A. Abdellatif 2
Departments of 1 General Surgery and 2 Diagnostic Radiology and Medical Imaging,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Ayman Helmy Ibrahim, email: aymanmohamedmed.b@azhar.edu.eg

ABSTRACT
Background:
Use of intraoperative cholangiography (IOC), a contrast-based examination of the biliary system
during laparoscopic cholecystectomy (LC) still represents a valuable approach to illustrate biliary duct anatomy,
diagnose obstruction and avoid complications.
Objective: The aim of work was to detect the advantages of IOC when used in selected cases during LC in diagnosis
of biliary obstruction and prevention of biliary injuries.
Patients and methods:
29 patients with specific criteria were included in the study to perform LC and IOC after
preoperative magnetic resonance cholangio pancreatogaraphy (MRCP). Follow-up was done by clinical examination,
serum bilirubin and U/S for one year. Collected data had been statistically analyzed.
Results: IOC resulted in significant increase in mean surgical time with longer time in cases with pericholecystic
fluid and mucocele. IOC still has a higher specificity, sensitivity and positive predictive value (PPV) (100,
87.5&100% respectively) over MRCP (65, 77.8&50% respectively) in prediction of choledocholithiasis. U/S, MRCP
& IOC had high negative predictive values (NPV), good negative tests. History of obstructive jaundice had a low
sensitivity, specificity and PPV (71.5, 63.6&38.5) but had a high NPV (87.5%) in detection of choledocholithiasis.
Normal IOC saved 8 patients with history of obstructive jaundice from unnecessary endoscopic retrograde
cholangiopancreatography (ERCP). No biliary injuries had been reported.
Conclusion:
selective IOC in high risk patients is useful in detection of choledocholithiasis, avoidance of ERCP in
patients with non-specific common bile duct (CBD) dilatation and prevention of biliary injuries in cases with high
risk for injury.
Keywords: Laparoscopic cholecystectomy, MRCP, selective intraoperative cholangiogram, biliary injuries.

INTRODUCTION

Studies were held to use a safer, more cost effective,
Gall stone disease is one of the most prevalent
less invasive procedures with less
clinical problems all around the world. The incidence

of gallstones is three folds more common in females

than in males (1­3). 12% of patients with symptomatic
complication which have a high sensitivity and
gall stones have stones in the common bile duct (CBD)
specificity in prediction of choledocholithiasis to
that may be asymptomatic, but it may cause serious
replace IOC (9-11). This study present an experience on
complications as obstructive jaundice, cholangitis and
suspicious patients for choledocholithiasis and/or
pancreatitis. Investigations should be done to rule out
difficult surgery with use of preoperative MRCP
choledocholithiasis prior to surgery to diagnose
followed by selective use of IOC to detect additional
choledocholithiasis if present and avoid future
benefits from use and reliability of different risk factors
complications of missed stones (4). Specificity and
for prediction choledocholithiasis and also to try to
sensitivity and of laboratory tests are low,
answer the question: Can MRCP eliminate the use of
ultrasonography (U/S) is a durable, low cost, non-
IOC?
invasive bed-side test, with no use of ionizing radiation
The aim of this study was to evaluate the
and can measure the diameters bile ducts, however,
protective effect of selective use of IOC during
approximately 65% of bile duct calculi are not detected
laparoscopic cholecystectomy (LC).
by U/S due to interference with bowel gases and also

because of being a highly operator dependent procedure
PATIENTS AND METHODS
(3-5). Magnetic resonance cholangiopancreatography
This study included a total of twenty-nine patients
(MRCP) also has an important well-established role in
with symptomatic gall bladder stones and suspicion of
identifying uncertain anatomy and visualizing the bile
CBD stones, attending at General Surgery Department
duct stones (6, 7). IOC is the gold standard procedure in
of Al-Azhar University Hospitals; Al-Hussein and Bab
the diagnosis of choledocholithiasis as it maps the
El-Sharia Hospitals, Cairo, Egypt. This study was
anatomy of biliary tree and detect pathological
conducted between October 2015 to September 2018.
conditions (8, 9). Being an invasive and contrast-based

procedure, routine versus selective use of IOC is a
Ethical approval:
matter of controversy in many literature as it may
Approval of the ethical committee of the university
increase intra and post-operative complications.
hospitals was obtained. Written informed consent
from all the subjects were obtained.
5242
Received:23/7/2019
Accepted:23/8/2019

Full Paper (vol.773 paper# 25)


Introduction and aim of work The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5249-5257

The Efficacy of Ultrasonography in Prediction of the Degree of Placental
Accretion among Cases of Placenta Previa
Esmail Mohamed Talaat El Garhy, Abd El Fatah Mohamed El Senity, Ahmed Gaber Ahmed Rizk*
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
* Corresponding author: Ahmed Gaber Ahmed Rizk, Mobile: (+20) 1285663854, email: prosso_2000@yahoo.com

ABSTRACT
Background:
Placenta previa and previous cesarean section are the two most important known risk factors for
abnormally invasive placenta (AIP). AIP can be predicted as early as in the first trimester, and almost always
confirmed in the second and third trimesters via Grayscale ultrasonography, with or without color Doppler has
been used widely for antenatal screening and diagnosis of AIP.
Objectives: To evaluate the accuracy of ultrasound in the diagnosis of placenta accreta and its variants, and to
assess the impact of prenatal diagnosis in our population.
Patients and Methods: A total of 60 women with placenta previa were enrolled prospectively. All those patients
presented during the period of December 2017 till December 2018 to Ghamra Military and Sayed Galal
Obstetrics outpatient clinic during their follow up visits in the 2nd and 3rd trimesters and underwent ultrasound
examinations.
Results: A number of ultrasound criteria can be used for in diagnosis of placenta accreta, as this study showing
their high accuracy, they include loss of retroplacental clear zone, presence of abnormal placental lacunae,
myometrial thinning, bladder wall interruption and uterovesical hypervascularity. On the other hand, both loss
of retroplacental clear zone and abnormal placental lacunae could predict which patient will mostly have CS
hysterectomy.
Conclusion:
It could be concluded that gray scale and color Doppler ultrasound have good performance in the
diagnosis of AIP and that prenatal diagnosis improves maternal outcome.
Keywords: Cesarean section ­ Co-morbidities ­ Efficacy­ Operative findings ­ Placenta accreta ­ Ultrasound.

INTRODUCTION


Abnormally invasive placentas are a life-
Women at greatest risk of placenta accreta are
threatening condition characterized by placental
those who have myometrial damage caused by a
villi being abnormally adherent to the myometrium
previous cesarean delivery with either anterior or
as a result of the absence of, or defects in, the normal
posterior placenta previa overlying the uterine scar.
decidual basalis and the fibrinous Nitabuch's layer
Many literature reviews have shown that in the
(1).
presence of a placenta previa, the risk of placenta
They are commonly classified into three distinct
accreta was 3%, 11%, 40%, 61%, and 67% for the
grades according to the degree of the placental villi
first, second, third, fourth, and fifth or greater repeat
invasion into the myometrium: placenta accreta
cesarean deliveries, respectively(4).
(placental villi are attached to the decidual surface
Transvaginal
and
transabdominal
of the myometrium), placenta increta (placental villi
ultrasonography are complementary diagnostic
more deeply invading into the myometrium) and
techniques and should be used as needed.
placenta percreta (placental villi invade through the
Transvaginal ultrasound is safe for patients with
myometrium and the uterine serosa and sometimes
placenta previa and allows a more complete
into adjacent organs, such as the bladder. However,
examination of the lower uterine segment.
in a clinical setting and daily practice, these
Sonographic findings that have been associated with
histopathological
differences
are
probably
placenta accrete: (1) Loss of normal hypoechoic
nonexistent. Therefore, the term "placenta accreta"
retroplacental zone ; (2) Multiple vascular lacunae
is used as a general term to describe all of these three
(irregular vascular spaces) within placenta, giving
conditions whereas the term percreta refers to
"Swiss cheese" appearance; (3) Blood vessels or
placenta percreta (2).
placental tissue bridging uterine-placental margin,
The incidence of placenta accreta has increased
myometrial-bladder interface, or crossing uterine
and seems to parallel the increasing cesarean
serosa1; (4) Retroplacental myometrial thickness of
delivery rate. Researchers have reported the
1 mm and/or (5) Numerous coherent vessels
incidence of placenta accreta as 1 in 533 pregnancies
visualized with 3-dimensional power Doppler in
for the period of 1982­2002. This contrasts sharply
basal view (5).
with previous reports, which ranged from 1 in 4,027
Overall, grayscale ultrasonography is sufficient
pregnancies in the 1970s, increasing to 1 in 2,510
to diagnose placenta accreta, with a sensitivity of
pregnancies in the 1980s (3).
77­87%, specificity of 96­98%, a positive

predictive value of 65­93%, and a negative
5249
Received:24/07/2019
Accepted:24/08/2019

Full Paper (vol.773 paper# 26)


c:\work\Jor\vol773_27 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5258-5275

Hypolipidemic Effects of Aphanizomenon flos-aquae and Slimquick on Cardiac Muscle
Fibers of the Adult Male Albino Rats
Hemmat M. Abdelhafez, Amira M. Salah EL-Din Ahmed El-Wahsh
Department of Zoology, Faculty of Science (for Girls), Al-Azhar University, Cairo, Egypt
Corresponding author: Hemmat M. Abdelhafez,email: dr.hematmansour@yahoo.com

ABSTRACT
Background: hyperlipidemia is a group of heterogeneous disorders characterized by an elevation of lipids in the blood
stream. It accounts for the high danger of coronary heart disease and atherosclerosis which is known as a silent killer.
Objectives: The aim of work was to evaluate the possible protective effects of Aphanizomenon flos-aquae (AFA) as a
natural hypolipidemic product on the cardiac muscle of adult male albino rats, in comparison with Slimquick as a
synthetic hypolipidemic drug and their ability to treat hyperlipidemia or to prevent it.
Material and methods: fifty six male albino rats (Rattus albinus) were used and categorized into eight groups
(7rats/group) .The 1st group (C) rats were used as a control, the 2nd group (H) rats were treated with high fat diet (HFD)
(2% cholesterol) to induce hyperlipidemia for 4 weeks only then scarified, the 3rd group (A) rats were orally
administrated with AFA only for 4 weeks(94.5 mg/kg body weight /day), the 4th group (H+A1) rats were treated with
HFD enriched with 2% cholesterol for 2 weeks to induce hyperlipidemia and the other 2 weeks were fed on the same
HFD plus AFA extract administration, the 5th group (H+A2) rats were treated with HFD diet enriched with 2%
cholesterol for 4 weeks to induce hyperlipidemia and then they were fed on normal basal diet (BD) plus AFA extract
administration for another 2 weeks, the 6th group (S) rats were orally administrated with Slimquick only for 4 weeks (5
mg orlistat/rat/day), the 7th group (H+S1) rats were treated with HFD diet enriched with 2% cholesterol for 2 weeks to
induce hyperlipidemia and the other 2 weeks rats were fed on the same HFD plus Slimquick extract administration, the
8th group (H+S2) rats were treated with HFD diet enriched with 2% cholesterol for 4 weeks to induce hyperlipidemia
and then they were fed on normal basal diet (BD) plus Slimquick extract administration for another 2 weeks.
Results: the biochemical parameters showed a highly significant increase in the mean value of LDH and CK in the
cardiac muscle fibers of the high fat diet group. Many histopathological and histochemical changes were detected in the
cardiac muscles of the high fat diet group. Meanwhile, treatment with AFA or Slimquick ameliorated the biochemical
parameters, histological and histochemical results; but using AFA extract arrived to decrease the strong changes which
were observed in the cardiac muscle fibers of the high fat diet group more than that observed with Slimquick.
Conclusion: Aphanizomenon flos-aquae extract as a natural product and Slimquick as a synthetic drug ameliorated the
biochemical, histopathological and histochemical changes in the cardiac muscle of the hyperlipidemic rats.
Aphanizomenon flos-aquae
extract proved to be a better hypolipidemic agent than Slimquick.
Keywords: Aphanizomenon flos-aquae (AFA), Slimquick, Orlistat, male albino rats, hyperlipidemia, LDH, CK.

INTRODUCTION

appeared on the market. AFA is a fresh water
Hyperlipidemia has been graded as one of
unicellular blue-green alga that is consumed as a
the greatest peril factors lead to the pervasiveness and
nutrient-dense food source and for its health-enhancing
sharpness of coronary heart diseases (1). Medicinal
properties(6). AFA as a species have both nontoxic and
plants are used for various research causes. More than
toxic forms. Most sources global are toxic.
thirteen thousand plants have been studied for different
AFA from Klamath Lake is a non-toxic type of
pharmacological properties (2).
algae of the cyanobacteria phylum (7) and it has gained
Caro et al. (3) showed that blue-green algae
vogue in USA, Germany, Korea, Canada, Austria and
(BGA) (cyanobacteria) are among the most primal life
Japan. It contains 68 minerals, 20 antioxidants, 70 trace
forms on the earth and have been swill as food or
elements, B vitamins, all amino acids and important
medicine by humans for centuries. Edible blue-green
enzymes (8).
algae, as well as Spirulina, Nostoc and Aphanizomenon
This alga is rich in protein (63-69% dry weight),
species, are used for food for thousands of years. Singh
carotene, vitamin B12 and other biologically-active
et al. (4) and El-Depsi (5) reported that BGA have
compounds. AFA contains a high concentration of -
antiviral, antioxidant, antitumor, anti-inflammatory,
linolenic acid (18:3n3), which at a concentration of 10-
anti-allergic, antibacterial and anti-diabetic properties
15% in the rat diet consider an excellent source of n-3
as well as lipid-lowering effects. In the early 1980s, a
polyunsaturated fatty acids (9). It is an exceptional
new BGA species Aphanizomenon flos-aquae (AFA)
source of carotenoids (more than 240 retinol
5258
Received:25/07/2019
Accepted:25/08/2019

Full Paper (vol.773 paper# 27)


ABSTRACT The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5276-5278
Evaluation of Serum Interleukin-6 Level in Vitiligo
Patients before and after Phototherapy
1Amr Mohamed Zaki, 1Hassan Mamdouh Abd El Aziz, 2Mamdouh Atiah Mohamed,
1Ahmed Ayman Mohamed Abd El Hamed
1Department of Dermatology and Venereology, Faculty of Medicine - Al Azhar University
2Department of Clinical Pathology, Faculty of Medicine - Al Azhar University
Corresponding author: Ahmed Ayman Mohamed Abd El Hamed, Mobile: 01015896163
, email: ahmed.ayman4391190@gmail.com

ABSTRACT
Background:
Vitiligo is an acquired pigmentary disorder of the skin, resulting from a loss of functioning epidermal
melanocytes. Multiple pathogenetic factors have been proposed, including the neural theory, genetic predisposition and
impaired anti-oxidative defense. Objective: To evaluate the role of interleukin-6 in pathogenesis of vitiligo and the
effect Narrow band-UVB on IL-6 serum levels. Patients and Methods: The study included 30 patients with vitiligo and
30 healthy controls. Each was submitted to thorough history taking, complete general, dermatological examinations
including VASI score, and assessment of serum interleukin-6 before and after 16 sessions of NB-UVB.
Results: Results of this study showed no statistical significant difference between patients and control as regard age
and gender. Our study revealed a statistically significant difference between levels of IL-6 in patients group before
and after therapy. Conclusion: Knowing exactly the role of IL-6 is important not only to clarify the pathogenesis of
this disease, but also to improve the clinical course of vitiligo (i.e., disease stabilization and/or repigmentation) and the
quality-of-life of patients.
Keywords:
Broadband (narowband)UVB, systemic corticosteroids, erythrocyte sedimentation rate.

INTRODUCTION

Vitiligo is an inflammatory autoimmune skin
Ethical Approval:
disorder characterized by the progressive appearance
Approval was obtained from Research Ethics
of depigmented skin lesions caused by the loss of
Committee of faculty of Medicine, Al-Azhar
melanocytes at the cutaneous level (1).
University.
There is evidence suggestive that cytokines
Patients
play a major role in autoimmune pathogenesis and
Inclusion criteria: Patients with any type of
promotion of disease activity. Many cytokines have
vitiligo. Older than 8 years. Patients had to stop topical
been investigated in vitiligo, including IL-2, IL-4, IL-
therapy for vitiligo for at least 2 weeks before the
17, IL-6 TNF-, IFN- (2,3,4,5,6). Phototherapy has been
study. And the systemic therapy at least 4 weeks before
the pillar of vitiligo treatment whether for stabilization
the study. Patients who can come regularly two times
or stimulation of repigmentation. Despite the
per week to have their phototherapy sessions.
emergence of different therapeutic tools, phototherapy
Exclusion criteria: The patients had immune-
remains significant. Limitations, related to absence of
mediated comorbidities such as Graves' disease,
melanocyte reservoir, anatomic distribution, and
insulin-dependent diabetes, atopic dermatitis or
duration of the lesions, might make this exceptional
psoriasis or any other dermatological disease causing
tool sometimes less effective. Phototherapy is still
abnormal pigmentation. Pregnancy or lactation.
required with or resumed after surgical or medical
Patients with phototoxic reactions related to
correction in cases having such limitations (7).
phototherapy or photosensitivity or photomediated

disorders as lupus erythematosus, albinism, or
AIM OF THE WORK
dermatomyositis, also patients with previous skin
The aim of the present study was to evaluate
cancer or pre malignant skin lesions or taking
serum interleukin-6 in vitiligo patients before and after
immunosuppressive drugs such as methotrexate.
treatment with phototherapy.
Controls: Healthy individuals with no

symptoms or signs of vitiligo and with apparently
PATIENTS AND METHODS
healthy first degree relatives were selected as control
This case control study included 30 patients
group.
presented with vitiligo (active-stable), diagnosed on

the basis of typical clinical features, were selected as
Statistical analysis
patient group. Thirty age and sex matched apparently
Data were analyzed using Statistical Program
healthy individuals were also included representing the
for Social Science (SPSS) version 15.0. Quantitative
control group. All patients were collected from the
data were expressed as mean± standard deviation
Outpatient Clinics of Dermatology and Venereology
(SD). Qualitative data were expressed as frequency
of Al-Azhar University Hospitals. An informed written
and percentage.
consent was obtained from participant or their

guardians before their participation in this study.
5276
Received:10/10/2018
Accepted:29/10/2018

Full Paper (vol.773 paper# 28)


ABSTRACT The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5279-5286

Surgical Approach to Hysterectomy for Benign Gynecological Diseases
Samir Abdalla Ali, Mohamed Mohamed Farahat, Mahmoud Ahmed Mohamed ElShafei
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mahmoud Ahmed Mohamed ElShafei, Mobile: (+20) 1009448644,
email: dr_mahmoudelshafei@yahoo.com

ABSTRACT
Background:
Hysterectomy is one of the most commonly performed surgeries worldwide. Indication for
hysterectomy is most often benign, which includes conditions such as prolapse, abnormal uterine bleeding, fibroids
and pelvic pain. Hysterectomy can be performed vaginally, abdominally or laparoscopically.
Objective: The aim of work was to determine the frequency of use, evaluate and compare the most appropriate
surgical method and assess the effectiveness and safety of the three approaches for hysterectomy: Abdominal
hysterectomy (AH), vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH) for women with benign
gynecological conditions.
Patients and Methods: This Prospective case control study was conducted on 75 women with benign disease of
uterus with failed medical management or not amenable to medical management attending at Obstetrics and
Gynecology Department, Al-Azhar University Hospitals. Patients were divided into three groups (25 cases each) for
either technique of hysterectomy depending on the gynecological lesion that indicated the surgical procedure.
Results: In the present study there was no statistically significant difference between the abdominal and laparoscopic
groups as regard patients age, parity, BMI, previous CS, and previous pelvic surgeries. In our study fibroid
represented the most common indication for abdominal hysterectomy (40%), vaginal hysterectomy (36 %) and
Laparoscopic hysterectomy (48%).
Conclusion: It could be concluded that laparoscopic hysterectomy has minimally invasive and is related to a low
intra and postoperative complication rate, and even when there is a history of abdomino-pelvic surgery.
Keywords: Abdominal hysterectomy, laparoscopic hysterectomy, vaginal hysterectomy.

INTRODUCTION


Hysterectomy is one of the most commonly
hysterectomy is not indicated or feasible. Although
performed surgeries worldwide. Indication for
minimally invasive approaches to hysterectomy are
hysterectomy is most often benign, which includes
the preferred route, open abdominal hysterectomy
conditions such as prolapse, abnormal uterine
remains an important surgical option for some
bleeding, fibroids and pelvic pain. Hysterectomy can
patients. The obstetrician-gynecologist should discuss
be
performed
vaginally,
abdominally
or
the options with patients and make clear
laparoscopically. Hysterectomy can also be
recommendations on which route of hysterectomy
performed by combining two of these three routes,
will maximize benefits and minimize risks given the
such as in laparoscopically assisted vaginal
specific clinical situation. The relative advantages and
hysterectomy or laparoscopic hysterectomy combined
disadvantages of the approaches to hysterectomy
with a mini-laparotomy to remove the uterine
should be discussed in the context of the patient's
specimen from the peritoneal cavity (1).
values and preferences, and the patient and health
Based on the patient's problem, in addition to
care provider should together determine the best
the uterus, removal of the fallopian tubes, ovaries, or
course of action after this discussion (3).
cervix may be necessary (2).
All evidence suggests that the vaginal route is
Selection of the route of hysterectomy for
the safest, most cost-effective approach to
benign causes can be influenced by the size and shape
hysterectomy, affording rapid recovery, yet the
of the vagina and uterus; accessibility to the uterus;
majority of hysterectomies are still performed by the
extent of extrauterine disease; the need for concurrent
abdominal route(3).
procedures; surgeon training and experience; average
Surgical planning is a complex process,
case volume; available hospital technology, devices,
which requires an in depth and informed conversation
and support; whether the case is emergent or
between a patient and her physician. Patient
scheduled; and preference of the informed patient. (3).
preferences, surgeon skill and indication for surgery
Minimally
invasive
approaches
to
all should be taken into consideration when
hysterectomy should be performed, whenever
determining the most appropriate surgical approach.
feasible, based on their well-documented advantages
Hysterectomy has been associated with
over abdominal hysterectomy. The vaginal approach
improvements in physical and mental quality-of-life
is preferred among the minimally invasive
measures, body image, and aspects of sexual activity,
approaches. Laparoscopic hysterectomy is a
with few differences among surgical routes (1).
preferable
alternative
to
open
abdominal

hysterectomy for those patients in whom a vaginal
5279
Received:24/07/2019
Accepted:24/08/2019

Full Paper (vol.773 paper# 29)


c:\work\Jor\vol773_30 The Egyptian Journal of Hospital Medicine (October 2019) Vol. 77 (3), Page 5287-5292
Incidental Thyroid Carcinoma Diagnosed after Total Thyroidectomy for
Benign Thyroid Diseases: A Prospective Observational Study
Ahmed Fayez Othman 1, Bosat Elwany Bosat2, Hamed Ahmad Elbadawy2
1 General Surgery, Faculty of Medicine for Boys, Al-Azhar University,
2Department of General Surgery, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
Correspondence to: Ahmed Fayez Othman, Telephone number: (+20)01002932334, Email: ahmedfayez_666@yahoo.com

ABSTRACT

Background: The term "incidental" denotes malignant tumors of the thyroid gland detected postoperative in surgical
specimens resected for benign disease. As cancer, thyroid is the commonest endocrine malignancy and their
incidence increases over the past 15-20 years. In Egypt, it represents 2.2% of total cancers. It constitutes 30% of
endocrine malignancies and 12-49% of head and neck tumors.
Objective: The aim of this study was to determine the incidence and histological features of incidental cancers in
patients who had total thyroidectomy for benign thyroid diseases.
Patients and Methods: This Study is a prospective, empirical study carried out at Al-Zahraa University Hospital
during the period from April, 2016 to April, 2018. The study included 100 cases had total thyroidectomy of
previously diagnosed benign thyroid diseases and fulfilled the inclusion criteria.
Results: In this study, 100 patients underwent total thyroidectomy. The female (n=86) to male (n=14) ratio was 6.14:
1 and the age ranged from 19 to 69 years. The incidental carcinoma in this study found in 12 (12%) patients. The
frequency of papillary carcinoma was 9 % of all thyroid diseases and 75% of the incidental thyroid cancer (ITC)
(9/12). Also, frequency of follicular carcinoma was 1.4% of all thyroid diseases (three cases) and 16.66% of the ITC.
Conclusion: The non-irrelevant incidence of ITC, the eventuality of multifocal and bilaterality and the possible
occurrence of relapse support that total thyroidectomy without residuum is a valuable option for treating benign
thyroid conditions.
Keywords: Fine-needle aspiration cytology, Occult, Thyroid swelling, Incidental, Total thyroidectomy.

INTRODUCTION
PATIENTS AND METHODS
Thyroid cancer is the most common endocrine
Prospective, observational study carried out
malignancy and there has been a steady increase in its
at Al-Zahraa University Hospital during the period
incidence over the past 15-20 years (1). It accounts for
from April 2016 to April 2018. The study included
approximately about 1% of all malignancies in
100 cases subjected to total thyroidectomy for benign
developed countries with an estimated annual
thyroid disease. All cases proved to be malignant were
incidence of 122,000 cases worldwide (2).
excluded from the study.
In Egypt, it represents 2.2% of total cancers. It
All patients were subjected to
constitutes 30% of endocrine malignancies and 12-
I. Demographic and Historical Data.
49% of head and neck tumors. Most cases occur
II. Clinical Data.
between 25 to 65 years of age, but it can also occur in
III. Lab: TSH and Total T4 and T3, Free T4 and T3.
very young and in elderly patients (3, 4).
IV. Imaging: Neck ultrasound, Chest x ray and
Incidental thyroid cancer (ITC) is a malignancy
Computed Tomography (CT) neck.
undetected by preoperative imaging studies, but
V. FNA: performed only in cases with a suspicious
identified by pathological examination of surgical
nodule, which was detected during the clinical
specimens in patients treated for benign thyroid
examination and on USG.
diseases (5). The incidence of ITC ranges between 3
VI. Indirect laryngoscopy to check the vocal cord
and 16% (6). The mean false-positive and false-
movements.
negative rates of the fine-needle aspiration cytology
VII. Postoperative histopathologic reports.
(FNAC) are reported as less than 5%.
Ethical consideration and written informed
The main limitations of FNAC are the inability of
consent:
cytology to distinguish follicular and Hürthle cell
An approval of the study was obtained from Al-
carcinomas from the respective benign adenomas, the
Azhar University academic and ethical committee.
requirement of an experienced prober to avoid non
Every patient signed an informed written consent for
diagnostic punctures and the presence of multiple
acceptance of the operation.
nodules in a goiter (7).


AIM OF THE WORK
The aim of this study was to determine the
incidence and histological features of incidental
cancers in patients who had total thyroidectomy for
benign thyroid diseases.
5287
Received:25/07/2019
Accepted:25/08/2019

Full Paper (vol.773 paper# 30)