The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 220-226
Evaluation of Minimally Invasive Percutaneous Plate Osteosynthesis in
Treatment of Distal Tibial Fractures
Mohsen Mohammed Mar'éi, Reda Hussien El-Kady, Sherif Mohammed El-Aidy and
Kareem Mohammed Mohammed Al-Banna*
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Kareem Mohammed Mohammed Al-Banna,
Telephone: (+20) 1060647656; Email: Kareemalbanna20@gmail.com
Background: Distal tibial fractures are usually the result of high-energy axial compression and rotation forces.
They are usually associated with severe soft tissue compromise. The limited soft tissue, subcutaneous location and
poor vascularity make these fractures very challenging.
Objectives: The aim of the current work was to evaluate clinically and radiologically the results of the minimally
invasive percutaneous plate osteosynthesis (MIPPO) technique in fixation of distal tibial fractures.
Patients and methods: This prospective study included a total of 18 cases of type A distal tibial fractures treated
by locked distal tibial plate, attending at ZAGAZIG University Hospitals. The fractures were classified using the
method of AO classification. This study was conducted between February 2018 and April 2019.
Results: A comprehensive sample will be taken including cases that need minimally invasive percutaneous plate
osteosynthesis in treatment of distal tibial fractures, 3 cases / month, sample equal 18 / 6 months who have
traumatic fracture distal tibia on Orthopedic Surgery Department, Zagazig University Hospitals.
Conclusion: MIPO is simple, safe and effective method of treatment for diaphyseal & metaphyseal fractures. It
does not require direct visualization of the fracture at the cost of extensive soft tissue dissection. We are confident
in suggesting this alternative approach of plating. MIPPO through the deltoid-pectoralis approach seems superior
to conventional ORIF through the deltoid-pectoralis approach in the treatment of PHF in elderly patients in terms
of Constant-Murley score, NEER score, intraoperative blood loss, length of operation and SF36 score.
Keywords: Distal tibial fractures, Radiologically, MIPPO.
The management of displaced distal tibial
Gao et al. (5) have reported the use of locking
fractures is a controversial and debatable topic. The
plates in treating fractures of the distal tibial shaft and
classic technique of open anatomic reduction and
metaphysis. They have reported good clinical
internal fixation of distal tibial fractures requires
outcomes in distal tibial fractures treated with locking
extensive soft-tissue dissection and often leads to
compression plates. They maintain a better periosteal
subsequent periosteal injury. High rates of
blood flow by minimizing the contact of the plate
complications, including postoperative infection,
with bone; however, the implants may be more
delayed union, and nonunion (1).
Biological fixation principles advocate realigning
The aim of the current work was to evaluate
by manipulation at a distance to fracture site, leaving
clinically and radiologically the results of the
comminuted fragments out of the mechanical
minimally invasive percutaneous plate osteosynthesis
construct, preserving soft tissues with limited
(MIPPO) technique in fixation of distal tibial
operative exposure. Minimally Invasive Percutaneous
Plate Osteosynthesis (MIPPO) is one such method in
which percutaneously inserted plate is fixed at a
SUBJECTS AND METHODS
distance proximal and distal to the fracture site
This prospective study included a total of 18
through minimal exposure. Indirect reduction and
cases of type A distal tibial fractures treated by
biologic percutaneous plating without direct
locked distal tibial plate, attending at Zagazig
manipulation of the fracture fragments result in good
University Hospitals. The fractures were classified
clinical outcomes (2).
using the method of AO classification. Written
The main goal of biologic plating techniques is to
informed consent of all the subjects was obtained.
maintain the soft- tissue attachments and vascularity
This study was conducted between February 2018
of the cortical bone fragments, thereby reducing the
and April 2019.
risk of postoperative infection and nonunion (3).
Conventional plates such as narrow tibial
dynamic compression plates or buttress T plates have
Approval of the ethical committee of Zagazig
been inserted via minimally invasive methods for
University was obtained.
treating distal tibial fractures, with encouraging
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 227-233
Ultrasound-Guided Transversus Abdominis Plane block versus
Ultrasound-Guided Caudal Block for Pain Relief in
Children Undergoing Lower Abdominal Surgeries
Osama Helal Ahmed 1, Waheed Mohamed Ali 1, Ibrahim Elabd Hassan*2
Departments of Anesthesiology & Intensive Care Faculty of Medicine, Al Azhar (Assuit)1 and Aswan2
*Corresponding author: Ibrahim Elabd Hassan, Mobile: (+20)01001313392, E-mail: email@example.com
Background: Transversus abdominis plane (TAP) block has been described as an effective technique to reduce
postoperative pain intensity. Also, Caudal analgesia with local analgesics is effective but is often short-lived and
associated with an undesired motor blockade and other complications.
Objective: This prospective, randomized, controlled clinical study aimed to compare the effectiveness of analgesia
by using ultrasound guidance for TAP block and caudal analgesia in children undergoing lower abdominal surgery.
Patients and Methods: This prospective, randomized, controlled study included 60 children aged between 2 to 6
years, scheduled for elective lower abdominal surgery. Group A (n=20) received an ultrasound TAB block. Group
B (n=20) received ultrasound-guided caudal block Group C (n=20) who was the controlled group received
conventional analgesia. The intraoperative assessment included HR, systolic, diastolic and mean BP, need for rescue
analgesia postoperative pain scores and parent satisfaction
Results: No significant difference between all groups regarding demographic data, type and duration of surgery and
intraoperative hemodynamic values. The control group had the highest number of patients and doses needed for
rescue analgesia while TAB showed the lowest. The TAB group patient showed the highest degree of parent
satisfaction than the other two groups.
Conclusions: The study showed that TAB and Caudal block effective in postoperative pain-relieving in lower
abdominal surgery in children however patients who received TAB block required less postoperative rescue
analgesia with a better impact on pain scores than caudal block TAB show better parent satisfaction and earlier home
Keywords: Transversus abdominals plane block, Caudal block, Lower abdominal surgery.
The well-known side effects of painful
Caudal analgesia with local analgesics is
experience on the young nervous system are so
effective but is often short-lived and associated with
significant that long-term effects can occur, including
an undesired motor blockade and other complications
a lowered pain tolerance for months after a pain-
(7). Recently, the transversus abdominis plane (TAP)
producing event (1, 2).
block has been described as an effective technique to
The abdominal wall is a significant source of
reduce postoperative pain intensity and morphine
pain after abdominal surgery. Even a relatively small
consumption after lower abdominal surgery (6).
operation such as inguinal herniorrhaphy may be
followed by a risk of a chronic pain state in about 12%
AIM OF THE WORK
of patients, with clinically significant effects on daily
This prospective, randomized, controlled
activities if postoperative pain is not taken care of.
clinical study aimed to compare the effectiveness of
Regional analgesic techniques have gained
analgesia by using ultrasound guidance for TAP
widespread popularity as an important component of
block and caudal analgesia in children undergoing
postoperative analgesia regimens (3). During the last
lower abdominal surgery.
decade, the use of ultrasound-guided regional
anesthesia has increased, and developments in
PATIENTS AND METHODS
ultrasound technology have enabled direct
After approval of medical ethics committee in the
visualization of peripheral nerves (4). In pediatric
Department of Anesthesia and Intensive Care, Al-
patients, ultrasound-guided blocks have been
Azhar faculty of medicine (Assuit) and obtaining an
associated with a higher success rate and a lower
informed written consent from the child parents /
volume of local anesthetic needed, compared with the
guardians this prospective, randomized, controlled
conventional landmark-based techniques (5).
clinical study included 60 children from both genders,
The abdominal wall has three muscle layers:
aged between 2 to 6 years, with an ASA physical
external and internal obliques, and transversus
status of I and II, who were scheduled for elective
abdominis. They are innervated by mixed somatic
lower abdominal surgery.
nerves that course between the transversus abdominis
and the internal oblique muscles (6).
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 234-239
Outcome of Percutaneous Iliosacral Screw Fixation of
Sacroiliac Joint Disruptions
Mohamed El-sayed El-badawy*, El-sayed Abdel Moaty Mohamed, Ali Tawfik Alalfy,
Sherif Mohamed El-aidy
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University
*Corresponding author: Mohamed El-sayed El-badawy, Telephone: +201285203869, E-mail: firstname.lastname@example.org
Background: Closed reduction and percutaneous fixation of sacroiliac joint disruptions has the advantage of
minimal invasion of compromised soft tissue, limited blood loss, decreased operation time, and decreased infection
rates. The objectives of this study was to evaluate the functional and radiological outcome after percutaneous
fixation of sacroiliac joint (SIJ) disruptions by cannulated screw.
Objectives: Management of sacroiliac joint disruptions by closed reduction and percutaneous fixation by iliosacral
Patients and Methods: This study was carried out in Orthopedic Surgery Department, Zagazig University
Hospitals, during the period from May 2018 to September 2019. The study included 12 patients with age ranged
from 19-59 years, 7 males and 5 females. Mode of injury was road traffic accident in 58.3% of cases and fall from
height in 41.7%, right side was affected in 6 patients, left side was affected in 5 patient and one patient was affected
Results: All patients were evaluated clinically according to Majeed scoring system. The overall Majeed score was
satisfactory in 75%, while unsatisfactory results were in 25% of cases. Postoperative radiological evaluation was
done according to Matta and tornetta. 25% patients had excellent results, 50% had good results and 25% had fair
results. Postoperative complication were superficial infection in 6 patients and one patient had chronic posterior
Conclusion: Percutaneous method of fixation of the SIJ disruptions is effective and favourable method ensuring
low operative time, high chance of obtaining stable pelvic ring with minimal blood loss, low incidence of
complications and good rehabilitation results especially early mobilization.
Keywords: Pelvic Ring Injuries, Sacroiliac Joint Disruption, Iliosacral screw.
are Tile classification depending on pelvic stability in
The sacroiliac joint (SIJ) is formed by
vertical and horizontal planes and Young and Burgess
articulation between the auricular surface on the
classification depending on the mechanism of injury
medial aspect of the ilium and lateral aspect of the
(4). The poly-traumatized patient represent a
sacrum supported by strong ligamentous complex
therapeutic challenge to the treating surgeon
anteriorly and posteriorly. The SIJ allowing transfer
especially unstable pelvic injury due to high rate of
of forces from the upper body to lower part of the
mortality. The patient must have special care from the
body and has two types of movement nutation and
time of injury until stabilization. The treatment
counter nutation (1). Sacroiliac joint disruptions
protocol of the American College of Surgeons in the
usually is associated with pelvic ring injury. Pelvic
Advanced Trauma Life Support (ATLS) Program is
ring injuries result from multiple forces either APC
recommended for general assessment and evaluation
forces or LC forces or shearing forces or combined
of the patient (2, 4).
forces. Unstable pelvic injuries are usually associated
Evaluation of the patient with a pelvic injury
with high rate of morbidity and mortality(2).
begins with an accurate history of the incident. A full
The posterior SI complex is responsible for
and detailed history should be taken from the patient
pelvic stability preventing anterior or posterior
or his accompanying persons whenever possible.
displacement of the axial skeleton over the pelvis. So,
Clinical evaluation of the patient either general or
adequate assessment of polytraumatized patients with
local evaluation, radiological assessment and
pelvic ring injuries and analysing pelvic stability
neurovascular examination should be done for
should be done. Pain and limitation of function may
appropriate evaluation of patient with pelvic ring
follow SIJ instability (2, 3).
Different classifications were described for
Generally the objectives of treating patients
pelvic ring injuries depending on either the anatomic
with pelvic ring injury is to achieve union in
site of injury or the mechanism of injury or affection
satisfactory position, prevention of deformity and
of weight bearing mechanism or pelvic stability. The
rehabilitation as soon as possible to ensure early
most common and useful classifications for the
return of mobility and function. Operative treatment
diagnosis and management of the pelvic ring injuries
of sacroiliac joint disruptions and pelvic injury is
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 240-246
Pregnancy Outcomes in Cases of Preterm Prelabor Rupture of
Membranes at Aswan University Hospital
Alhoussain Mohamed Fahmy*1, Abdou Saeed Ait-Allah2, Laila Ezzat Abdel Fattah1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Aswan University, 2Department of Obstetrics
and Gynecology, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Alhoussain Mohamed Fahmy, Mobile: (+20) 1015712838
Background: Preterm premature rupture of the membranes (PPROM) is a pregnancy complication. In this
condition, the sac (amniotic membrane) surrounding baby breaks (ruptures) before week 37 of pregnancy.
Once the sac breaks, there will be an increased risk for infection. There will be also a higher chance of having
baby born early.
Objectives: The aim of the work was to determine the maternal and fetal outcomes of preterm prelabor rupture
of membranes at Aswan University Hospital.
Patients and methods: This observational descriptive study included 100 women with preterm prelabor
rupture of the membranes, attending at Department of Obstetrics and Gynecology, Aswan University
Hospital. This study was conducted between October 2017 to October 2018.
Results: Fetal outcomes observed as : The mean of NICU stay was 5.67±8.3 SD while prematurity was the
most common neonatal complication by 16% then RDS by 52% while the overall neonatal mortality was 8%;
45% of neonates did not need NICU while the maximum NICU stay was 40 days by 2%. Correlations between
the latency period and fetal outcomes showed that: shorter latency period <2 weeks increase prevalence of
preterm delivery and increase prevalence of RDS while longer latency period >2 weeks increase prevalence of
neonatal sepsis and NEC, while perinatal mortality are nearly equal in both group.
Conclusion: Perinatal morbidities and mortality also affected by the preference of conservation as this study
found high incidence of perinatal morbidities like: prematurity by 53% then RDS by 52 % then Neonatal sepsis
by 16 %.
Keywords: Maternal, Fetal outcomes, Preterm Prelabor Rupture of Membranes, Aswan University Hospital.
Preterm premature rupture of membranes
multiple pregnancy and procedures such as
(PPROM) is the spontaneous rupture of the fetal
cerclage and amniocentesis (1, 2).
membranes during pregnancy before 37 weeks
Clinical diagnosis may be easy when
gestation in the absence of regular painful uterine
patients are presenting with heavy watery vaginal
contractions. Preterm premature rupture of
discharge or when clear fluid can be seen leaking
membranes (PPROM) complicates 3-8% of
from the cervical os. However, recent data suggest
pregnancies and leads to one third of preterm
that in 47% of the cases, clinicians are uncertain
deliveries. It can lead to significant fetal perinatal
regarding the diagnosis of PPROM based on
morbidity such as respiratory distress syndrome,
clinical examination by sterile speculum
neonatal sepsis, umbilical cord prolapse, placental
examination and patient history alone (3).
abruption and fetal death (1).
Diagnosis is indeed difficult when leakage
It can also lead to maternal morbidity such
of fluid is tiny and/or intermittent and/or ultrasound
examination shows a normal to low index of
intravascular coagulopathy, maternal sepsis,
amniotic fluid. In these cases, noninvasive
delayed menses and Asherman syndrome. PPROM
biochemical tests can help in diagnosing PPROM
is an important cause of perinatal morbidity and
mortality because it is associated with brief latency
`Classic' tests are represented by an
from membrane rupture to delivery, perinatal
alkaline pH of the cervicovaginal discharge, which
infection and umbilical cord compression due to
is typically demonstrated by seeing whether
Oligohydramnios (1, 2).
discharge turns yellow nitrazine paper to blue
The etiology is multifactorial, numerous
(nitrazine test); and/or microscopic ferning of the
risk factors are associated with PPROM such as
cervicovaginal discharge on drying. Evidence of
black race, lower socioeconomic status, smokers,
diminished amniotic fluid volume alone cannot
past history of sexually transmitted infections,
confirm the diagnosis but may help to suggest it in
previous preterm delivery, polyhydraminos,
the appropriate clinical setting (5).
The effects of cervicitis, vaginitis
(bacterial vaginosis), and contamination with
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 247-252
Color Doppler Ultrasound Assessment of the Uterine and Intraovarian
Arteries Blood Flow in Cases of Menorrhagia
Abdou Saeed Ait-Allah1, Mohamed Salah-Eldeen Fahmy2,
Mohamed Diaa-Eldeen Mohamed Abd-Elaal*2
1Department of Obstetrics and Gynecology - Faculty of Medicine, Sohag University,
2Department of Obstetrics and Gynecology - Faculty of Medicine, Aswan University
*Corresponding author: Mohamed Diaa-Eldeen Mohamed Abd-Elaal, Mobile: (+20) 01008685577,
Background: Menorrhagia (menstrual bleeding >80 ml per period) is one of the most common problems in
gynecology. Menorrhagia is a menstrual period with excessively heavy flow and falls under the larger category
of abnormal uterine bleeding (AUB).
Objectives: To use the transvaginal color Doppler to study the blood flow in the uterine and intraovarian
arteries in patients with menorrhagia. To add more to the service of Doppler ultrasound in Aswan University
Patients and methods: This is a cross sectional observational study which was done in the Department of
Obstetrics and Gynecology, Aswan University Hospital. The study included 100 ladies. Fifty women came
complaining of menorrhagia and another 50 women were regularly menstruating with normal cycles.
Results: There was a highly statistically significant difference in the Doppler indices of both the right and left
uterine arteries between the cases of menorrhagia and the control group. There was no statistically significant
difference in the Doppler indices of the right and left intraovarian arteries between the cases of menorrhagia
and the control group. There was a strong positive correlation between the uterine volume and Doppler indices
of the uterine arteries in cases of menorrhagia while only positive correlation with pulsatility index in regularly
Conclusion: Vascular changes may play an important role, in the occurrence of menorrhagia, so the use of the
transvaginal color Doppler to study the blood flow in the uterine and intraovarian arteries is a useful adjuvant
Keywords: Menorrhagia, Color Doppler Ultrasound, Uterine and Intraovarian Arteries Blood Flow.
values than those without menorrhagia, with or
Abnormal uterine bleeding can be caused by
without IUD (6). These data imply a possible
structural abnormalities in the reproductive
association between uterine blood flow and
tract, anovulation, bleeding disorders, hormone
menstrual blood loss (MBL).
issues (such as hypothyroidism) or cancer of
Treatment depends on the cause, severity, and
the reproductive tract. Initial evaluation aims at
interference with quality of life. (7). Initial treatment
figuring out pregnancy status, menopausal status,
often involves contraceptive pills. Surgery can be
and the source of bleeding (1). Approximately 53 in
an effective second line treatment for those women
1000 women are affected by AUB (2).
whose symptoms are not well-controlled (8).
Although new diagnostic methods improved
the clinical triage of menorrhagia, approximately
AIM OF THE WORK
half of the cases show no underlying pathology (3).
1. To use the transvaginal color Doppler to study
Vascular changes may play an important role, but
the blood flow in the uterine and intraovarian
remain poorly studied.
arteries in patients with menorrhagia.
Transvaginal Doppler is a non-invasive
2. To find if Doppler can differentiate between
method for studying changes of blood flow which
dysfunctional and organic causes.
may highlight the underlying pathology in cases
3. To add more to the service of Doppler
with menorrhagia. Studies with transvaginal
ultrasound in Aswan University Hospital.
sonography (TVS) coupled with color Doppler
4. To find the relation between the endometrial
have shown that the uterine artery pulsatility index
thickness, uterine volume and uterine and
(PI), measuring arterial flow impedance (4), is
Intraovarian blood flow in cases of
higher in amenorrhoeic and climacteric than in
menstruating women (5). On the other hand, PI is
reduced by hormone replacement therapy and the
PATIENTS AND METHODS
restoration of cyclic withdrawal bleeding (5).
Sitting: Department of Obstetrics and Gynecology,
Moreover, women with menorrhagia induced
Aswan University Hospital.
by an intrauterine device (IUD) have lower PI
Device Used: GE Voluson S8 Ultrasound.
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 253-256
Mandibular Canine Index: A Reliable Predictor for Gender Identification
Using Study Cast in North Saudi Sakaka Population
1 Shilpa S Magar, 2Shaliputra P. Magar, 3Omar Hadi, 4Faries Al Turqik,
4 Nawaf S. Alanazi ,4 Rakan M. Albilasi
1. Department of Operative Dentistry and Endodontic, 2. Department of Oral and Maxillofacial Surgery,
4. Oral Medicine & Radiology, Jouf University, College of Dentistry Sakaka, KSA
Corresponding Author: Dr Shaliputra P. Magar, Mobile:+966568522659, Email: shaliomdr@gmail. com
Background: Various methods are used for gender identification in anthropologic and forensic investigations. The
canine tooth are widely used for gender determination because of its sexual dimorphism and durability in oral cavity.
Mandibular canine index is one of the most reliable and valid predictor for gender identification.
Aim: To assess the reliability of Mandibular Canine Index in gender determination in North Saudi Sakaka populations.
Settings and Design: This was an experimental study involving the preparation of plaster cast models on 100
individuals residing in North Saudi Sakaka populations. Out of these 55 were males and 45 were females. Both sexes
were in the age group of 20- 40 years old. Study casts were prepared for all individuals and the measurements of
mandibular canine teeth were taken. The Mandibular canine index was calculated using standardized equation. In
addition, the percentage of sexual dimorphism was calculated. Independent sample t test was used. P value < 0.05 was
considered statistically significant. Results: There was a significant difference (p value < 0.05) observed between
intercanine distance, right and left canine width and right and left mandibular canine index between males and females.
Sexual dimorphism was more on left permanent mandibular canine teeth than right permanent mandibular canine teeth.
The overall percentage of accuracy observed was 85.5 %.
Conclusions: Study findings revealed that mandibular canine index can be used as a reliable predictor for gender
determination in Sakaka population and can form the basis of anthropologic and forensic investigations.
Keywords: Mandibular canine index, Sexual dimorphism, Inter canine distance.
invaluable for identification on fragmentary adult
In cases of mass disasters or major catastrophes,
where the bodies are mutilated beyond recognition, the
Sex determination using dental features is mainly
dimorphism in mandibular canines play a significant role
based upon the comparison of tooth dimensions in males
in gender identification. The only method that can give a
and females 2. The 4 Mandibular canines are found to
totally accurate result is the DNA technique, but in many
exhibit the greatest sexual dimorphism among all teeth
cases for several reasons it cannot be used. Teeth used in
because of the following reasons:
odontometric analysis, are an excellent material in living
1. Canines are less exposed to plaque and calculus.
and non-living populations for anthropological, genetic,
2. Less severely affected by periodontal disease.
odonatological and forensic investigations. Their
3. Lesser pathological migration of mandibular canines
durability in the face of fire and bacterial decomposition
than other teeth.
makes them invaluable for identification. Mandibular
4. Canines are the last teeth to be extracted with respect
canines exhibit the greatest sexual dimorphism amongst
all teeth 1.
5. Canines are more likely to survive in conditions such
Sexual dimorphism refers to those differences in
as air disasters and hurricanes 1.
size, stature and appearance between male and female
that can be applied to dental identification because no two
The present study establishes the impact of the 'sex
mouths are alike 2. However, differences in tooth
factor' on the morphometry of the mandibular canines.
size, variations in root length and crown diameter, dental
The dimorphism in maxillary canines can be of immense
index, odontometric differences, barr bodies and using
medico-legal use in gender identification. The study
enamel protein have also been tried for sex
defines the morphometric criteria for mandibular canines
determination. Human teeth are the hardest and
in North Saudi Sakaka population.
chemically the most stable tissues in the body, and are
extremely durable even at higher temperatures. Teeth can
SUBJECTS AND METHOD
be identified even when the rest of the body has
This study was carried out on 100 individuals
undergone decomposition as in case of using soft tissue
residing in North Saudi Sakaka population. Out of these
structures for gender identification. They are therefore
55 were males and 45 were females. Both sexes belong
to age group between 20- 40 years old.
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 257-264
Comparative Study between Perforator Based Island Flaps and
Fasciocutaneous Flaps in Reconstruction of Lower Extremities
Wael Mohammad Sakr, Wael Mohammad El Shaer, Adel Mayhoub Mahmoud,
Gamal Mohammad Ali El Ziady, Omar Mahmoud Nasser*
Department of Plastic and Reconstructive Surgery, Faculty of Medicine - Beni-Suef University
* Corresponding author: Omar Mahmoud Nasser, Mobile: (+20) 01226664107, E-mail: email@example.com
Background: Open wound of the lower limb is one of the common health problems that have a significant
economic and social burden. It has a risk of osteomyelitis of the underlying bone and even necrosis can occur.
Objective: To evaluate the difference between the perforator-based island flaps and fasciocutaneous flaps in
reconstruction of lower extremities regarding; functional, aesthetic outcome, size of the flap, degree of rotation,
technical difficulties, percentage of flaps survival, flap loss, operative time and donor site morbidity.
Patients and Methods: The study was conducted on 40 patients with soft tissue defects in lower extremities
which were equally distributed into two groups. Group 1 consisted of 20 patients that were treated by perforator
based island flap and group 2 that consisted of 20 patients treated by fasciocutaneous flap.
Results: The two techniques had similar results when evaluated by the Likert scale. The results of both procedures
had no significant statistical differences as regards any of the Likert score components namely, color, texture,
appearance, and shape. The main finding of the current study was the comparable postoperative outcome for both
techniques. The number of patients that had necrosis was 7 in perforate based island flap and 4 in fasciocutaneous
flap which represented 35% and 20% respectively of each studied group and this was statistically insignificant.
Conclusion: Any flap can be used as a perforator-based island flap in which the source vessel is completely
preserved. Perforator flaps have multiple advantages over Fasciocutaneous flaps as allowing increased diversity
and versatility in the design and composition of flaps.
Keywords: Perforator Based Island Flaps; Fasciocutaneous Flaps in Reconstruction; Lower Extremities.
Lower extremity reconstruction is an
Fasciocutaneous flaps are tissue flaps that
essential part of plastic surgery and focuses on the
include skin, subcutaneous tissue, and the underlying
treatment of wounds and defects secondary to
fascia. Including the deep fascia with its prefascial
trauma, cancer, or chronic disease processes. During
and subfascial plexus enhances the circulation of
the last 25 years, advances in plastic surgical
these flaps (5).
techniques and improved wound care technologies
Perforator flap surgery is a technique used in
have revolutionized this field, allowing the salvage
of limbs that would have otherwise been
subcutaneous fat are removed from a distant or
adjacent part of the body to reconstruct the excised
The goal of lower extremity reconstruction is
part. The vessels that supply blood to the flap are
the coverage of defects and open wounds of the
isolated perforator derived from a deep vascular
lower extremity to give patients a healed wound and
system through the underlying muscle or
to let them resume their life, ambulate, and go back
intermuscular septa. Some perforators can have a
to work while preventing amputation (2). The
mixed septal and intramuscular course before
reconstructive ladder guides our efforts in lower
reaching the skin (6).
extremity reconstruction and describes levels of
Microvascular free tissue transfer has
increasingly complex management of wounds (3).
revolutionized the treatment of high energy lower
Closure by secondary intention is the simplest
extremity injuries with associated bone, soft tissue,
method of reconstruction and focuses on allowing
and muscle loss and with exposure of bone and vital
the wound to naturally granulate and contract by the
use of good local wound care (4).
The concept of perforator-based island flaps
Many wounds can be closed by directly
becomes simple, providing more options in the
opposing the skin edges as long as there is minimal
selection of an appropriate design and resolves the
tension on the wound and the skin edges are non-
problems that previously required a free flap as by
traumatized and have good blood supply (1).
using perforator-based island flaps, the source
Full-thickness or split-thickness skin grafts
vessels can be preserved and the donor site can be
can be used for lower extremity reconstruction. Skin
closed without the need of a skin graft (6).
grafts best used to cover exposed muscle or soft
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 265-270
Epidemiology of acute kidney injury in Intensive Care Units in
Aswan University Hospital
Mohammed Zein Eldeen Hafez, Soumaia Ahmed Kassem, Saleh Ahmed Saleh*
Department of Internal Medicine - Faculty of Medicine - Aswan University
* Corresponding author: Saleh Ahmed Saleh, Mobile: (+20) 01024304560, E-mail: ibnelqiem1@gmail .com
Background: Acute kidney injury (AKI) is a frequent complication in patients admitted to the intensive care unit
(ICU) and is associated with adverse outcomes including increased length of ICU and hospital stay, development
of chronic kidney disease (CKD) and increased short- and long-term mortality risk.
Objective: To screen critically ill patient admitted to ICU in Aswan University Hospital for acute kidney injury
from September 2017 up to September 2018. Patients and methods: In this study 538 patients were admitted to the
ICU in Aswan University Hospital in Egypt, from August 1st, 2017 to August 1st 2018. This study was a
prospective, randomized; hospital based clinical study on critically ill patients in Intensive Care Unit. With
inclusion criteria patients who were 18 years or older and admitted to the Intensive Care Unit (ICU).
Results: Out of 583 patients admitted to ICU, there were 97 patients had AKI, 64.9% of them already had AKI on
the admission while the rest of them (35.1%) developed AKI after admission. There is more than one third of
mortality among ICU patients related to AKI (35.1%), while (64.9%) were related to other causes.
Conclusion: AKI is associated with high mortality in our ICU setting. Further studies are needed to estimate the
burden of AKI among patients before ICU admission.
Keywords: Epidemiology, AKI, ICU, Aswan University Hospital.
inpatients means that it has a major impact on
Establishing an accurate event rate for AKI
patients and a major economic impact. According
is important for health policy, quality initiatives,
to NHS Kidney Care, the cost of AKI to the NHS
and for design of clinical trials. However, analyzing
(excluding AKI in the community) is estimated to
AKI in the ICU setting from existing databases is
be between £434 million - £620 million per year.
often limited by missing data elements needed for
This is more than the expenditure on breast cancer,
application of these definitions (e.g., inclusion of
lung cancer and skin cancer combined (6).
urine output, selection of baseline serum creatinine,
Therefore any steps to prevent or treat AKI
etc.). Administrative databases are limited, as
should have a positive outcome, at an individual
billing codes do not capture many cases of AKI (1).
patient level and at the health care system level.
Together with differences in patients' baseline
AKI also carries increased short and long term
characteristics, this may explain the wide variation
morbidity and mortality and a significant risk of
in the occurrence of AKI reported in ICU patients,
with an average reported occurrence of 3040 % (2).
Since the publication of the RIFLE
AIM OF THE WORK
consensus classification for AKI, and the
The aim of the present study was to screen
modifications by the Acute Kidney Injury Network
critically ill patient admitted to ICU in Aswan
(AKIN), and Kidney Disease: Improving Global
University Hospital for acute kidney injury from
Outcomes (KDIGO), these definitions have been
September 2017 up to September 2018.
used in the majority of studies reporting on AKI (3).
RIFLE Classification in 2002, the Acute
PATIENTS AND METHODS
Dialysis Quality Initiative (ADQI) was created with
This study was a prospective, randomized,
the primary goal of developing consensus and
hospital based clinical study on critically ill patients
evidence-based guidelines for the treatment and
in Intensive Care Unit (ICU).
prevention of AKI. The first order of business was
Inclusion criteria: Patients who were 18 years or
to create a uniform, accepted definition of AKI.
older and admitted to the Intensive Care Unit
Hence, the RIFLE criteria were born. RIFLE is an
acronym of Risk, Injury, Failure, Loss and End-
stage kidney disease (4). Studies have used different
1- Chronic renal replacement therapy (RRT).
classification systems to study the epidemiology of
2- Kidney transplantation within 3 months before
AKI. Not surprisingly, incidence and prevalence
rates vary depending on the classification system
All Patients enrolled in this study were subjected
used, associated comorbid factors and subset of
to the following:
population studied. The same patient may be
1. Full medical history taking from the patient or
classified differently - or may even not fulfil the
the relatives on admission and include:
AKI criteria - depending on the classification
Previous medical and surgical history and
system (5). The high frequency of AKI amongst
previous drug history.
Lipid Profile in Women with Polycystic Ovary Syndrome
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 272-277
Lipid Profile in Women with Polycystic Ovary Syndrome
Tharwat Ahmed E -
li E -
l Sharbrawy Ali , Mohamed E -
l Husseiny Radwan
1 Obstetrics & Gynecology, El-Ahrar Hospital, 2 Obstetrics & Gynecology,
Faculty of Medicine - Zagazig University, Egypt.
Corresponding author: Name: Tharwat Ahmed El-Sayed Ibrahim, Tel:+201147490014, Email: firstname.lastname@example.org
Background: Polycystic ovarian syndrome and obesity contribute to the metabolic problems that reproductive-
age women experience.
Objective: This research aimed to examine the effect of abdominal obesity using BMI and the waist/hip ratio
[WHR] on metabolic parameters in patients with polycystic ovary syndrome.
Patients and Methods: This prospective study was carried out on eighty  women, aged 20- 35 years-old
attending the Gynecology Clinic of Zagazig and Al-Ahrar Educational Hospital. The selected cases were divided
into four groups after taking a written or verbal consent to be included in the study: Group I: Twenty cases of
obese PCOS, Group II: Twenty cases of non-obese PCOS, Group III: Twenty cases of obese non-PCOS and
Group IV: Twenty cases of non-obese non- PCOS.
Results: Lipid profile in obese PCOS and non obese PCOS demonstrated statistically highly significant difference
between both groups regarding serum total cholesterol, serum triglycerides and serum low density lipoprotein [LDL].
There was a statistically insignificant differences between both groups as regard serum very low density lipoprotein
Conclusions: This study showed that women with PCOS had atherogenic lipoprotein profile characterized by increased
cholesterol, LDL and triglycerides especially in obese group, which might be a risk factor for developing cardiovascular
Keywords: Lipid Profile, Polycystic Ovary Syndrome, Obesity.
The new system also could avoid undesirable
diagnosis and intervention. Classification of women
testosterone and lower concentrations of globulin
with PCOS as below can prevent ambiguity in care
binding sex hormones [SHBG] are common findings
and to some extent avoid follow-up:
and hence the free androgen index [FAI] is often
Asymptomatic form: individuals with PCO
increased. Roles of hormonal derangements on
lipoprotein defects remain unclear. However, both
Mild form: PCO morphology + anovulation.
androgen and estrogens are known to have opposing
Classical form: hyperandogenicity + ovarian
effects on lipoprotein metabolism. These effects can
dysfunction (Anovulation and/or PCO).
be mediated by hepatic control of the lipoprotein
Metabolic form: a combination of mild and
metabolism, insulin sensitivity and body fat
traditional types of obesity and/or resistance to
insulin (abdominal obesity, insulin resistance, high
In obese patients with PCOS, the lipoprotein
waist/hip ratio, etc) .
profile is characterized by elevated plasma
The Polycystic Ovary Syndrome [PCOS] is
triglycerides and decreased lipoprotein cholesterol
the most common endocrine syndrome affecting
[HDL-C] concentrations, which mimic those seen in
women of reproductive age. The presence of
subjects with type 2 diabetes . Low-density
persistent ovaries with several [2-8 mm] small cysts
lipoprotein cholesterol [LDL-C] in PCOS is often
and hypervascularized androgen secreting stroma
only slightly elevated. Nevertheless, because LDL
has long been recognized as synonymous with
does not exist as homogeneous particles, a simple
symptoms of excess androgen [hirsutism, alopecia,
quantitative LDL concentration calculation may be
acne], obesity and menstrual cycle disturbance
misleading. Alternatively, LDL contains several
[oligomenorrhea or amenorrhea] . In general, the
European view is that the disease includes any of the
composition, density, size and atherogenic potential.
above described signs, symptoms or endocrine
Small and compact LDL particles [LDL-III] are
disorders [high serum androgen and/or luteinizing
known to be more atherogenic than larger LDL
hormone concentrations [LH] . In North America,
species [LDL-1 and LDL-II] and are associated with
there is agreement that the disorder is denoted by the
a higher prevalence of coronary heart disease [CHD]
combination of hyperandrogenism and ovulatory
and type 2 diabetes in circulation [even in normal
dysfunction in the absence of non-classical adrenal
LDL-cholesterol concentration] . Topics with
hyperplasia without the need to assess the existence
PCOS currently lack information on LDL
of polycystic ovaries by ultrasonic scanning .
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 278-285
Assessment of Infraorbital Nerve Parasthesia after
ZMC Fracture and Its Surgical Repair
Samy Saeed El Naas Farag Allah*, Mahmoud Ahmad Abdallah,
Wael Abd Almagid Almohandis, Bahaa Eldin Abdrabo Tawfik
Department of Oral and Maxillofacial Surgery Faculty of Dental Medicine, Al-Azhar University, Cairo
* Corresponding author: Samy Saeed El Naas Farag Allah,
Mobile: (+20)1069007128, E-mail: email@example.com
Background: Infraorbital nerve parasthesia is a very common finding after maxillofacial trauma involving
zygomaticomaxillary complex (ZMC) region. The use of computer assisted surgical protocols for managing
these fractures could improve the surgical outcome and maximize the functional and esthetic reconstruction of
traumatized bones with possible effect on infraorbital nerve recovery.
Objective: The aim of the present study was to assess infraorbital nerve parasthesia after ZMC fracture and
its surgical repair.
Patients and Methods: A total of 10 patients with unilateral ZMC fractures were selected from those having
maxillofacial injuries at the Emergency Room of Sayed Galal University Hospital, Al-Azhar University, Cairo.
Patients were divided randomly into two groups (five patients each); Group I: patients were treated with mirror
imaging technique and fabrication of a steriolithographic (STL) model. Group II: patients were treated through
the traditional technique without fabrication of an STL model.
Results: Infraorbital nerve affection occurred in 7 patients (70%), 4 in group I and 3 in group II. Recovery of
the nerve occurred at 3 months postoperatively except for only one patient from group II. Statistically, no
significant difference was found between both groups.
Conclusion: Although computer assisted surgery is impressive and has a remarkable role in facilitating the
precise contouring and adaptation of the titanium plates / mesh needed for fracture repair, it has no evident
advantages over the traditional techniques regarding infraorbital nerve recovery.
Keywords: Zygomaticomaxillary complex fracture, infraorbital nerve, computer aided surgery.
only mandibular fractures being more frequent (70
The zygomaticomaxillary (ZMC) complex
%) (3, 4). In 40 % of cases, the fractures affecting the
is a quadripod composed of the lateral and inferior
zygomatic bone are accompanied by injuries to the
orbital rims, the zygomatic arch and the
maxilla, orbit, and nose as well as limb traumas (5).
zygomaticomaxillary buttress. Several buttresses
Acute loss of sensory function of the
infraorbital nerve following ZMC fractures is often
seen because of their close proximity as the nerve
passes through the infraorbital sulcus in the floor of
zygomaticofrontal buttress. These are points of
the orbit to exit through the infraorbital foramen.
articulation between facial bones that are common
Traumatic injury to the infraorbital nerve may be
sites of fracture. These articulation points, or
due to compression, edema, ischemia, or laceration
sutures, are inherently weak, resulting in an
(6). The incidence of this complication in the long-
increased likelihood of fracture at these sites (1).
term period varies from 15 to 50
% . Such a
The zygomatic bone forms the orbital floor
significant variance largely depends on study
and the lateral orbital wall and has two points
design and different patient selection criteria.
where it contacts the maxilla and the cranium.
Long-term persistence of neuropathy is determined
Fractures of the body of the zygomatic bone are
both by the features of the fracture and the
extremely rare and are usually caused by gunshot
approaches used to manage it. Single-stage
wounds. As for peacetime traumas, the term
comprehensive surgical treatment involving open
zygomatic bone fracture usually applies to trauma
repositioning and rigid fixation of fragments with
when the bone has been fractured at the sutures
titanium plates plays a crucial role (7-10).
connecting the zygoma to the maxilla and cranium.
However, even successful repositioning of
Because of the complex anatomy and sutures of the
the zygomatic bone is accompanied by dysesthesia
zygoma, the pattern of fractures involving this
in two-thirds of patients which may last up to 6
bone is rather diverse (2).
months. Temporary dysfunction of the infraorbital
Fractures of the ZMC rank third in
nerve was observed in 100 % of cases after single-
incidence among all bone injuries occurring in
stage orbital floor reconstruction. There was no
humans. The share of zygomaticoorbital fractures
long-term difference in infraorbital nerve
in children and adolescents is 60 % of all facial
neuropathy occurring in patients with a minimally
fractures; in adults, this figure is 2433 %, with
dislocated zygomatic bone whether or not they
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 286-293
Reconstruction of Orbital Fracture with the Aid of
Mirror Imaged 3D Printed Models
Samy Saeed El Naas Farag Allah*, Mahmoud Ahmad Abdallah, Wael Abd Almagid Almohandis
Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Al-Azhar University, Cairo, Egypt
* Corresponding author: Samy Saeed El Naas Farag Allah, Mobile: (+20)1069007128,
Background: The use of mirror-imaging techniques with the aid of three-dimensional computed tomographic
(3DCT) scanning and 3D printing for reconstruction of orbital fractures could improve the outcome and maximize
the functional and esthetic reconstruction of traumatized orbit.
Objective: The aim of the present study was to evaluate reconstruction of orbital fracture with the aid of mirror
imaged 3D printed models. Patients and Methods: A total of 10 patients with unilateral orbital fractures were
selected from those having maxillofacial injuries at the emergency room of Sayed Galal University Hospital, Al-
Azhar University, Cairo. Patients were divided randomly into two groups (five patients each); Group I: patients
were treated with mirror imaging technique and fabrication of a rapid prototype skull model. Group II: patients
were treated through the traditional technique without fabrication of a rapid prototype skull model.
Results: At one, three and six months postoperatively, all patients affected with diplopia within both groups have
a total recovery. The difference was statistically significant. The traumatized orbits were reduced and fixed in both
groups through either technique and there was a statistically insignificant difference in mean orbital volume in
unaffected side and the affected side (immediately postoperatively).
Conclusion: It could be concluded that the use of mirror image rapid prototype skull model for treatment of
orbital fractures has no advantage over the traditional method.
Keywords: orbital fracture, diplopia, orbital volume, rapid prototyping
traumatized, facial region and superimposing its
Orbital floor injuries, alone or in
skeleton onto the fractured, displaced region (11, 12).
combination with other facial fractures, are one of the
The use of mirror-imaging techniques with
most encountered midfacial fractures. Having an
the aid of three-dimensional computed tomographic
incidence of 10-25% from the total facial fractures
(3DCT) scanning and 3D printing for reconstruction
and the most common age group is the third decade
of orbital fractures could improve the outcome and
of life. Significant complications can occur as a result
maximize the functional and esthetic reconstruction
of these injuries, including enophthalmos, persistent
of traumatized orbit (13, 14).
diplopia, vertical dystopia, restriction of gaze and
Changes of the orbital volume may affect the
even blindness (1- 4).
final treatment outcomes. Precise alignment of the
The majority of cases of orbital fractures
broken orbital bones indicates proper reconstruction.
require reconstruction of the orbital floor to support
This study has examined the volumetric changes of
the globe position and restore the shape of the orbit.
orbit associated with orbital fractures before and after
The most important factor in minimizing
reconstruction with the aid of mirror imaged rapid
postoperative complications related to globe position
prototype skull model.
is restoration of the orbital bones to their correct
The aim of the present study was to evaluate
anatomic position. The unique and complex anatomy
reconstruction of orbital fracture with the aid of
of the orbit requires significant contouring of the
mirror imaged 3D printed models.
implants to restore the proper anatomy (5, 6).
Technological advancements in imaging and
PATIENTS AND METHODS
surgical computer planning may assist the surgeon in
This study included a total of 10 patients
this task (7-10). One of the most promising emerging
with unilateral orbital fractures who were selected
technologies is the ability to use computer planning
from those having maxillofacial injuries, attending at
software to create a mirror image overlay (MIO) on
emergency room of Sayed Galal University Hospital,
a craniofacial computed tomographic CT scan. This
Al-Azhar University, Cairo. All patients were
involves duplicating the contralateral, non-
informed about the scope of the study and signed an
informed written consent form.
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 294-297
Quality of Life in Patients with Continent Urinary Diversion after
Radical Cystectomy in Upper Egypt
Emad Eldeen Salah Ali Saleh, Alaa Refaat Mahmoud Ali, Mohammed Abdelazez Elkhateb*
Department of Urology, Faculty of Medicine, Al-Azhar University, Egypt
*Corresponding author: Mohammed Abdelazez Elkhateb, Mobile: (+20): 01093917686,
Background: Quality of life (QOL) assessment after radical cystectomy (RC) and urinary diversion (UD) is
a crucial element of a fully evaluated patient-reported outcomes and gauging the impact and success of the
diversion surgery. There has been long-standing interest in health-related quality of life (HRQOL) evaluation
and research among patients who receive UD.
Objective: To compare ureterocolic versus orthotopic neobladder (ONB) urinary diversions in terms of their
Patient and method: This retrospective, multicenter study included 128 patients with muscle invasive bladder
cancer (MIBC) who underwent RC and UD through the period from January 2011 to June 2016. The patients
were divided into two groups: (ONB) 78 patients and uretrosigmoidostomy group 50 patients. HRQOL was
evaluated with Functional Assessment of Cancer TherapyBladder Cancer (FACT-BL) Questionnaire, while
Sexual Health Inventory for Men (SHIM) Questionnaire was used to assess the erectile function of males.
Results: The mean patients' age was 54.0 ± 7.9 years old in the ONB group and 57 ± 8.5 years old in
ureterosigmoidostomy group. Patients in the ONB group were younger than those in the ureterosigmoidostomy
group. There were diff erences in the physical, social and functional well-being that were significantly higher
in patients in the ONB. Regarding the sexual function, there were significant differences between patients who
underwent nerve sparing RC and non-nerve sparing RC.
Conclusions: Findings suggest that patients with an ONB have marginal QOL advantages over
Keywords: Radical cystectomy, urinary diversion, QOL.
In 2018, there were about 550,000 new cases
Questionnaire (EORTC-QLQ)-30 and Bladder
of bladder cancer (BC) worldwide, and bladder
Cancer Index (BCI) questionnaires (7).
cancer accounted about 200,000 deaths (1). In
Egypt, BC has the highest incidence rate in the
AIM OF THE WORK
world. An incidence of 37.1 per 100,000 males is
To compare ureterocolic versus orthotopic
almost two times higher than that in western
neobladder (ONB) urinary diversions in terms of
communities (2). The National Cancer Institute
(NCI) reported that, it constitutes 30.3% of all
cancers, 16% of male cancers, and 14.3% of female
PATIENT AND METHODS
cancers (3). The choice of UD technique depends on
This is retrospective study included 128
multiple factors as patient's age, co-morbidity,
patients (90 men (70%) and 38 women (30%)) with
continence status, renal function, surgical margin
MIBC who underwent RC and UD through the
and surgical experience (4).
period from January 2011 to June 2016 and came
Radical cystectomy (RC) with pelvic lymph
for routine follow up. The patients had been
node dissection represents the gold standard
followed up for an average period of 3 years. The
treatment of muscle invasive bladder cancer
study sample was not limited by gender, age,
(MIBC) (5). Whereas alternative treatments are
disease stage, or previous treatments. Institutional
reserved for patients with earlier stage non muscle
ethical approval for the study was obtained in
invasive bladder cancer (NMIBC), extensive co-
accordance to the Declaration of ethical committee
morbid conditions or poor performance status (6).
in the Faculty of Medicine, Al-Azhar University.
There are multiple questionnaires available to
The patients were divided into two groups:
measure QOL. These questionnaires can be general
orthotopic ileal neobladder group (ONB) 78 (61%)
or disease-specific. Bladder specific questionnaires
patients and uretrosigmoidostomy group 50 (39%)
include Functional Assessment of Cancer Therapy
for patients with Bladder Cancer (FACT-BL),
Data were retrospectively collected from the
European Organization for Research and
clinical records regarding the demographic profile,
Treatment of Cancer Core Quality of Life
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 298-302
Effect of Weight Bearing Exercises on Osteoporosis in Prostate Cancer Patients
Undergoing Androgen Deprivation Therapy
Amr El Sayed El Azizy1, Emad Tawfik Ahmed1, Naser Abd Elbary2, Hussein Gamal Hussein Mogahed1
1 Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
2Clinical Oncology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Amr El Sayed El Azizy, Mobile: (+20) 01007710603
Background: Most men diagnosed with prostate cancer (PCa) are aged 50 years old or more treated by androgen
deprivation therapy (ADT) treatment has been associated with interconnected adverse effects as decreased bone mineral
density (BMD) and a loss in the structure and strength of bone leading to osteoporosis. Exercise has been proposed as a
treatment to mitigate side effects of ADT.
Objective: This study was conducted to evaluate the effect of weight bearing exercises on osteoporosis in prostate
cancer patients undergoing androgen deprivation therapy.
Patients and methods: The current study was conducted during a period of 3 months starting from 1st October 2019 till
31st December 2019.Thirty PCa patients who had osteoporosis induced by ADT were participated in this study, their
ages were over 50 years old. They were selected from the Oncology Hospital Menoufia University and randomly
distributed into two equal groups, group A: included 15 patients who received 30 minutes of weight bearing exercises
through walking on treadmill, in addition to conventional medical care 3 days /week and group B: included 15 patients
who on their conventional medical care.
Results: Our study showed that there was a statistically significant improvement in BMD and T-score mean of spine,
femoral neck and total femur post treatment compared to that pre-treatment in the group A and B.
Conclusion: It can be concluded that weight bearing exercises had fruitful effects in cases of osteoporosis in prostate
cancer patients undergoing androgen deprivation therapy as evidenced by the significant increase in BMD and T-score
Keywords: Prostate Cancer, Osteoporosis, Androgen Deprivation Therapy, Weight Bearing Exercises, Bone Mineral
weight bearing exercise is walking, an exercise
Prostate cancer (PCa) is the most commonly
delicately very well and accepted by the older, as it is
diagnosed male cancer. Treatment for PCa includes
harmless, self-managed and effortlessly practicable.
surgery, radiotherapy, androgen deprivation therapy
The impacts of walking on BMD have been widely
(ADT) and chemotherapy, which is influenced by the
stage and aggressiveness of the cancer (1). The vast
Treadmill exercise fortifies bone formation what's
majority men diagnosed for PCa were 50 years old or
more suppresses bone resorption, increase serum 1,25-
more seasoned. And, as men get older, their risk for
dihydroxyvitamin D3 level, what's more declines the
osteoporosis likewise increases (2). Those pervasiveness
serum parathyroid hormone level, leading to an increase
for osteoporosis over men with PCa on ADT may be
in bone mass with incitement for longitudinal bone
great documented, with dependent upon 53 %
growth, particularly during weight-bearing sites (7).
influenced by this bone condition (3).
In spite of the fact that ADT has been shown to
AIM OF THE STUDY
The aim of this work was to evaluate the effect of
hypogonadism with multiple interconnected side
weight bearing exercises on osteoporosis in prostate
effects such as reduction in bone mineral density
cancer patients undergoing androgen deprivation
(BMD) and a loss in the structure and strength of bone.
What's more an expanded hazard about falls and What's
more resulting fractures in this clinical population
PATIENTS AND METHODS
The current study was a prospective case-control
Weight bearing exercise is more adapted to
study which was conducted during a period of 3
improve bone mass over whatever viable physical
months, starting from Oct 1st, 2019 till Dec 31st, 2019.
activity, they assume a double part over stressing the
Thirty PCa who had osteoporosis induced by ADT
bones as they set both gravitational and muscular stress
participated in this study, their ages were over 50 years
on bones (5). One of the most well-known types of
old. They were selected from the Oncology Hospital
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 303-310
Efficacy of Total Thyroidectomy for Treatment of Benign Thyroid Lesions
YASSER ALI ELSAYED, Atef Mohamed Abd-Elatif, Ahmed Elsayed Lotfy, Ahmed Abd-Elghany
General Surgery Department, Faculty of Medicine, Mansoura University, Egypt.
*Corresponding author: Ahmed Abd-Elghany Mohamed Seada; E-mail: firstname.lastname@example.org
Background: Total thyroidectomy is currently the preferred treatment for thyroid cancer, multinodular goitre
(MNG) and Graves' disease. However, many surgeons choose not to perform total thyroidectomy to treat
benign thyroid diseases owing to the associated risk of postoperative hypoparathyroidism, recurrent laryngeal
nerve damage and bleeding. We reviewed 100 total thyroidectomies performed for benign thyroid diseases,
when surgery was indicated.
Objective: Assessment whether total thyroidectomy is safe and can be considered as the optimal surgical
approach for treating benign thyroid diseases.
Patients and methods: This study was conducted on 100 patients presented by thyroid swellings and admitted
to Mansoura University Hospitals, Endocrine Surgery Unit over one year during the period between
November, 2017 and October, 2018. All patients were submitted to careful history taking, clinical examination
and radiological and laboratory investigations. Total thyroidectomy was done to all patients. Patients were
evaluated early postoperative at 1, 6 and 12 months by sr. TSH, total & ionized calcium, PTH and vocal cord
Results: Preoperative diagnoses in our patients revealed that there were 74 cases MNG (74%), 2ry toxic 19
cases (19%) and 1ry toxic 7cases (7%). The incidence of permanent bilateral recurrent laryngeal nerve palsy
was 0% and that of permanent unilateral recurrent laryngeal nerve palsy was 1%. Whereas the incidence of
temporary unilateral recurrent laryngeal nerve palsy was 5%. Permanent hypocalcaemia occurred in 2% and
overall temporary hypocalcaemia occurred in 8% of patients. Hemorrhage requiring repeat surgery occurred
in 1% of patients.
Conclusion: In our study, total thyroidectomy showed no significant operative and/or postoperative
complications. Also, it was noticed that total thyroidectomy operation gave very good results in patients with
benign thyroid diseases provided that they were done in qualified center and by experienced endocrine
Keywords: Total Thyroidectomy,Treatment ,Benign Thyroid Lesions.
primary procedure (3).
Historically, the risks associated with
major surgery for treating thyroid diseases and the
considered extremely effective in halting the
problems of adequate hormonal replacement have
progress of ophthalmopathy in Graves' disease,
deterred surgeons from performing total
while it practically eliminates the risks arising from
thyroidectomies. In fact, thyroid surgery was rarely
the incidental finding of carcinoma in surgical
performed until the late 19th century. Total
specimens resected for benign indications (4).
thyroidectomies were only performed occasionally
for indications other than cancer until the last
AIM OF THE WORK
quarter of the twentieth century (1).
Assessment whether the results support the
Total thyroidectomy (TT) is defined as
hypothesis that total thyroidectomy is safe and can
both total lobectomy and isthmectomy. Total
be considered as the optimal surgical approach for
thyroidectomy is the treatment of choice for
treating benign thyroid diseases.
patients with malignant thyroid disease. However,
the efficacy and safety of this procedure for
PATIENTS AND METHODS
patients with benign disease is still a matter of
This study was conducted on 100
debate due to the possible detrimental complication
patients presented by thyroid swellings and
of total thyroidectomy such as permanent recurrent
admitted to Mansoura University Hospitals,
Endocrine Surgery Unit over one year during
hypoparathyroidism (2). On the other hand, a
the period between November, 2017 and
considerable number of patients undergoing
function-preserving thyroidectomy will require
reoperation for recurrent disease and this
All patients undergoing total thyroidectomy for:
completion thyroidectomy has been shown to carry
Simple multi-nodular goiter
a higher rate of complications compared to the
Toxic nodular goiter
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 311-316
Low Vitamin D as A Risk Factor for Gestational Diabetes in
Egyptian Pregnant Women
Gehan Abdelkader Ibrahim1, Ihab Mohammed Ahmed Salem1, Hoda Goda Bakr1,
Amina Mohammed Talaat Al Naggar2, Rasha Elsayed Hussien Omar1
1Department of Internal Medicine, 2Department of Clinical Pathology, Faculty of Medicine, Zagazig University
Background: Gestational diabetes mellitus (GDM) is a worldwide problem affecting about 16.5% of
pregnancies all over the world, with serious maternal and fetal complications. Vitamin D (Vit D) deficiency
during gestation is widespread and during the last 10 years. A lot of studies found an association between
decreased Vit D and impaired glycaemia concluding that deficient Vit D might be a modifiable risk factor for
GDM. Objective: The aim was to detect whether maternal Vit D insufficiency during pregnancy is a risk
factor for GDM.
Materials and Methods: Case-control study done in Outpatient Clinics at Zagazig University Hospitals to
assess relation between GDM and low Vit D. 96 pregnant women were studied, 48 had GDM (diagnosed by
OGTT according to ADA criteria) and the other 48 had normal pregnancy. 25-Hydroxyvitamin D (S.25 OHD)
Results: Increased prevalence (68.75%) of Vit D insufficiency was found in both groups. S.25 (OH) D was
significantly lower in ladies with GDM in comparison with controls (26.8 ± 32.2 ng/ml vs 42.6 ± 4.2 ng/ml).
Fasting blood sugar in early gestation has insignificant negative correlation with 25 (OH) D level (r = -0.06)
Conclusion: There is statistically significant difference between case and control groups in 25 (OH) VIT D
level with higher occurrence of Vit D deficiency/insufficiency in the GDM group
Keywords: GDM, S. 25 (OH) D concentrations, Vit D deficiency, Insulin resistance.
Gestation is normally accompanied by
Vit D whatever synthesized de novo in the
insulin resistance like that occurs in type 2 diabetes
skin from cholesterol (cholecalciferol) or taken
(T2DM). This physiological resistance to insulin
orally from the diet as a precursor (cholecalciferol
function in gestation becomes more evident in the
and ergocalciferol), is hydroxylated to 25-
2nd trimester, and insulin resistance progressively
hydroxyvitamin D (25(OH) D) in the liver.
increases till delivery. If this maternal resistance to
Assessing the circulating serum level of 25(OH) D
insulin becomes more pronounced, maternal
is accepted to be the most reliable detector of one's
hyperglycemia exists and GDM might be
Vit D status. Then, 25(OH) D undergoes another
diagnosed (1). GDM is defined as any degree of
renal hydroxylation to the active 1, 25-
glucose intolerance leading to a state of
dihydroxyvitamin D (1, 25(OH) 2D) under control
hyperglycemia of variable severity, first found in
by parathyroid hormone (PTH) (6).
pregnancy, whatever the needed treatment or
Vit D deficiency is a common problem
postpartum evolution of diabetes or not (2).
nowadays, due to living indoors and sunscreens use
GDM almost complicates 4% of all
(7). Vit D plays a vital role in the regulation of
pregnancies and females with GDM have an
bone metabolism and has a great effect on muscle
estimated 7-fold risk of occurrence of future
strength and effects on cellular differentiation,
T2DM, as well as their children and subsequent
proliferation, immune regulation, apoptosis,
generations. The total prevalence of GDM has been
neurogenesis and genome stability. New studies
approximately supposed to reach 15%20% (3).
have also supposed that Vit D is closely associated
Screening of GDM is advised at 24-28th weeks of
with cardiovascular diseases, diabetes, cancers,
gestation in pregnant females who were not
autoimmune diseases, infectious diseases and
previously diagnosed as having overt diabetes
either by 1 or 2 step method of diagnosis (4).
Vitamin D regulates glucose metabolism by
Risk factors for GDM include increased
influencing insulin sensitivity, though the definite
parity, high maternal age, pre-gestation obesity,
mechanisms are still not completely understood.
family history of DM and obstetric history of
The pancreatic cells express both Vit D receptor
GDM, delivery of a macrosomic infant, or infant
and enzyme 1-hydroxylase that allows them to
with congenital malformation, but is not obvious
produce 1, 25(OH) 2D locally (9).
whether a decreased Vit D level is associated with
Vit D deficiency might also increase
the risk of GDM (5).
systemic inflammation which also has a vital role
in T2DM pathogenesis (10).
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 317-321
Total Versus Near Total Thyroidectomy in Treatment of Toxic Goiter
Atef Mohamed Abdel-Latif, Yasser Ali Elsayed, Waleed Ahmed Elsayed Gado,
Mohamed Elsayed Ibrahim Elmahdy*
Endocrine Surgery Unit, Faculty of Medicine, Mansoura University, Egypt
* Corresponding author: Mohamed Elsayed Ibrahim Elmahdy, E-mail: email@example.com
Background: The most common cause of hyperthyroidism and the most common autoimmune disorder in Toxic
goiter is Grave's disease. Antithyroid medications, radioiodine therapy, and surgery have all been employed in the
treatment of this disease. Nevertheless, thyroidectomy remains an important option for correcting
hyperthyroidism. Objective: The aim of the study was to compare both total and Near total thyroidectomy as
regard "Outcome, Complications and Curability" in patients with controlled Toxic Goiter.
Patients and Methods: This prospective randomized controlled study included a total of 84 patients with toxic
goiter, attending at Endocrine Surgery Unit, General Surgery Department, Mansoura University Hospitals. This
study was conducted between February 2018 and January 2019. The included subjects were randomly divided
into two groups; Group 1 (TT) consisted of 42 patients underwent total thyroidectomy, Group 2 (NTT) consisted
of 42 patients underwent near total thyroidectomy. Results: Compared to Near total thyroidectomy, total
thyroidectomy gave better results regarding the recurrence of toxic manifestations which occurred in 7% of cases
1 year later. Conclusion: It could be concluded that total thyroidectomy (TT) gives good results in management
of patients with toxic goiter compared to near total thyroidectomy (NTT). Total thyroidectomy (TT) is advised to
be done in patients with toxic goiter due to less liability for postoperative recurrence, provided to be done by
experienced endocrine surgeon in a qualified center.
Key Words: Total Thyroidectomy Near Total Toxic Goiter.
toxic goiter. Moreover, TT and NTT are increasingly
Over the years, subtotal thyroidectomy
being accepted as the procedure of choice for toxic
(STT) has become the mainstay of treatment for
toxic goiter; however, total and near total
particularly those with significant compression
thyroidectomy (TT & NTT) is increasingly being
symptoms (4, 5).
considered (1). Near-total (NTT) thyroidectomy in
The aim of the current study was to compare both
which less than 1 g of thyroid tissue remains and
total and near total thyroidectomy as regard
Total thyroidectomy (TT) have been utilized in the
"Outcome, Complications and Curability "in patients
treatment of Graves' disease for long time (1). There
with controlled Toxic Goiter.
remains controversy in the literature as to which
procedure is superior. In determining which surgical
PATIENTS AND METHODS
procedure to perform, a surgeon must balance the
This prospective randomized controlled study
risk of disease recurrence if too little thyroid tissue is
included a total of 84 patients with toxic goiter,
removed with the obvious need for lifelong thyroid
attending at Endocrine Surgery Unit, General
hormone replacement in all patients who undergo TT
Surgery Department, Mansoura University Hospitals
and NTT (2). Subtotal thyroidectomy has been the
(MUH). All patients were informed about the
standard procedure as it was thought to avoid long-
surgical procedure and written informed consent of
term thyroxin replacement therapy and presumed to
all the subjects was obtained. This study was
be a safer operation with low complication rates
conducted between February 2018 and January
compared to (TT) and (NTT).But on the contrary, the
long-term results of STT are not without their
consequences. This is evidenced by the progressive
Approval of the ethical committee was obtained.
increase in the incidence of hypothyroidism or
Sample size was calculated using G- Power with
recurrent hyperthyroidism from remnant thyroid
effect size 0.8 and power of 0.8 and it was 84 patients
tissue left behind (3).
The included subjects were randomly divided into
On the other hand, the advantages of TT are
two groups; Group 1 (TT) consisted of 42 patients
that it avoids recurrent disease and future repeat
underwent total thyroidectomy, Group 2 (NTT)
thyroidectomy which is known to be associated with
consisted of 42 patients underwent near total
higher morbidity even if performed with great care
and skill (4). If the risk of complications from TT is
no higher than that from STT, and coupled with
significant advantages in the prevention of
Patients with Grave's disease with controlled toxic
recurrence and avoidance of repeat surgery, perhaps
manifestations, both genders and age was between
TT should be considered as a treatment option for
25 and 75.
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 322-325
Prevalence of Astigmatism and Keratoconus in Egyptian Patients Evaluated by
Schleimpflug Tomography: A Retrospective Cohort Study
Cherine F. Osman1, Heba M. Fouad2
1Ophthalmic Diagnostic and Laser Unit (ODLU), Kasr El Einy, Cairo University
,2Ophthalmology Department, Faculty of Medicine, Cairo University, Egypt.
*Corresponding author: Heba M. Fouad, MD, Ophthalmology Department,
Kasr El-Ainy Hospital, Elsaraya Street, Manial, Cairo, Egypt 11451, Phone: (210) 0512-9360; E-mail: firstname.lastname@example.org
Background: Scheimpflug camera uses various indices such as corneal thickness, detection of early and
subclinical cases of keratoconus is challenging for the most refractive surgeon. However, corneal tomographic
imaging is of great value in detecting such early changes.
Purpose: To assess the pattern of refractive conditions implying corneal astigmatism, and KC, in an Egyptian
population attending a major referral diagnostic eye center, ODLU, as assessed by Schleimpflug Imaging.
Study Design: A retrospective, non-randomized, single-center, observational study.
Patients and Methods: 501 recorded files for patients who were referred to ODLU for corneal tomography
assessed by Scheimpflug imaging were retrieved by the serial selection, from January 2014 to June 2016
Results: 501 eyes, of 276 patients were analyzed, 50.7% males and 49.3% females, ranged from 5 to 80 years
old, number of normal corneas was 39 eyes (7.8%), astigmatism 0.5D-1.5D was 120 eyes (24%), astigmatism
>1.5D: 342 eyes (68.3%). The number of trauma/operated corneas( keratoplasty or LASIK) was 77 eyes(15.4%).
The number of eyes with KC was 144 eyes (28.74%), The KC suspect corneas were 32 eyes (6.77%)
Conclusion: The largest number of patients who were referred for corneal tomography had astigmatism more
than 1.5 D, the number of keratoconus suspects was higher in females in the 20 to 40 years age group, however,
the severity of keratoconus was more in males at the same age group.
Keywords; Astigmatism, Keratoconus, Corneal refractive conditions, Schleimpflug Imaging, Corneal
tomography, Corneal topography, Pentacam. Egyptian Population.
AIM OF THE WORK
Astigmatism is a common refractive error which
To determine the pattern of refractive
is a common cause of visual impairment worldwide.
conditions implying corneal astigmatism, and KC, in
However, it can be treated (1). Uncorrected refractive
an Egyptian population attending a major referral
errors have been associated with loss of independence
diagnostic eye center, ODLU, as assessed by
and reduced quality of life (2).
Keratoconus (KC) is a chronic, bilateral, non-
inflammatory disorder characterized by progressive
PATIENTS AND METHODS
steepening, thinning, irregular astigmatism and apical
A total of 501 recorded files were retrieved by
scarring of the cornea. (2,3). New computer-based
the serial selection, to generate a sample of the
technologies and imaging methods have increased the
population, representative of the study. From January
ability to diagnose KC and determine the incidence of
2014 to June 2016, according to the serial numbers,
astigmatism and KC in different age groups.
were collected in excel sheets, retrospectively from
The incidence of KC varies depending on factors
the Scheimpflug imaging (Sirius system), for corneal
such as ethnicity and the criteria used to establish the
diagnosis. Most estimates place the incidence in the
Inclusion criteria: All patients who were
general population between 50 and 230 per 100,000,
referred to ODLU, to perform Scheimpflug
though rates vary greatly in different geographic
regions (4). Screening for clinical KC is not difficult.
Exclusion criteria: Patients referred to perform
However, detection of the ectasia is difficult at the
preclinical stages. The identification of corneas at
higher risk represents a major challenge for most
Scheimpflug imaging data and eyes were collected
The Scheimpflug camera uses various indices
grouped and classified as follows:
derived from tomographic thickness evaluation
According to astigmatism shape;
parameters, such as the corneal thickness spatial
With the rule astigmatism (vertical bow tie)
profile, the percentage of thickness increase and
Against the rule astigmatism (horizontal bow tie)
utilizes anterior and posterior elevation data, and
According to Astigmatism grades (our Unit
pachymetric data to screen for ectatic changes (6).
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 326-331
Efficacy of Topical Use of Autologous Platelet Rich Plasma in Myringoplasty
Sayed Mahmoud Mekhemar, Soad Yehia Moustafa, Tawfik A.El Aaty EL Kholy,
Yasmeen Salah Ahmed*
Department of Otorhinolaryngology, Faculty of Medicine (for Girls), Al-Azhar University
*Corresponding author: Yasmeen Salah Ahmed, Mobile: (+20) 01274420972, Email: email@example.com
Background: Platelet-rich plasma (PRP) is an autologous product derived from whole blood through the
process of gradient density centrifugation. Autologous PRP, with growth factors up to 8 times that of normal
serum, has been shown to be safe and effective in promoting natural processes of wound healing.
Objective: Assessment of the efficacy and advantage in using autologous platelet-rich plasma during
myringoplasty in closure of tympanic membrane perforation improving overall outcome.
Method: Platelet-rich plasma (PRP) is an autologous platelet-rich concentrate prepared from patients' own
blood with growth factors up to 8 times that of normal serum. The efficacy of PRP when used during
myringoplasty is studied. 40 patients with chronic otitis media inactive mucosal disease were randomly chosen
and 20 of them was the study group and other 20 were the control group. Both group patients underwent
myringoplasty and PRP was used in the study group and the results were evaluated. Myringoplasty was done
and after placement of the cartilage graft, platelet-rich plasma was placed over the myringoplasty site.
Results: In our study among cases that underwent myringoplasty with use of platelet-rich plasma, 90% had
complete tympanic membrane closure and only 10% failure has been noticed. In controls 60% out of cases had
failure. The graft take up rate in our study is comparable with the reference studies. Use of PRP accelerated
Conclusion: Platelet-rich plasma is a cheap and cost effective platelet concentrate with enriched growth
factors. It accelerated the tympanic membrane closure following myringoplasty.
Keywords: Myringoplasty, Tympanic Membrane, Platelet-Rich Plasma, Graft Uptake.
Chronic suppurative otitis media is defined as
The aim of the current study was to assess the
chronic inflammation of the mucoperiosteal lining
efficacy and advantage in using autologous
of the middle ear cleft. It is associated with
platelet-rich plasma during myringoplasty in
persistent or intermittent discharge through a non-
closure of tympanic membrane perforation.
intact tympanic membrane (1).
Tympanic membrane perforation may result
PATIENTS AND METHODS
from acute otitis media (AOM), chronic otitis
The present study was carried out on 40 patients,
media, or trauma (injury or surgery). In some
25 female and 15 male aged 15-40 years suffering
instances, a dry, simple perforation results from a
from chronic suppurative otitis media with
single episode of AOM (i.e., necrotizing otitis
tympanic membrane perforation with preserved
middle ear anatomy and function.
Myringoplasty is the closure of the
perforation of pars tense of the tympanic
The study protocol and consent forms were
membrane. When myringoplasty is combined with
approved by the Research Review Committee.
ossicular reconstruction, it is called tympanoplasty.
Patients were selected from the Outpatient Clinics
The graft material most commonly used for the
of ENT department at Al Zahraa University
surgery is temporalis fascia. The tragal cartilage
hospital, Cairo, during the period from January,
and tragal perichondrium are also used as the graft
2017 to January 2019, all the patients under the
by some surgeons. Myringoplasty restores hearing
study were followed up at the same hospital for a
loss in certain cases of tinnitus (3).
period of 6 to 12 months post-operative.
Platelet-rich plasma (PRP) is a concentrate
Patients were classified into two groups: (A) Case
of platelet-rich plasma protein derived from whole
group included 20 patients who had undergone
blood. It has a greater concentration of growth
myringoplasty with use of autologous PRP and (B)
factors than whole blood. Platelet-rich plasma is a
Control group included 20 patients who had
novel material that is being used more and more
undergone myringoplasty without use of
frequently in many surgical specialties. Its
numerous advantages include safety (because it is
Exclusion criteria include: Children below 12
an autologous material), increased deposition of
years of age, active ear disease, patients with
platelets and growth factors in the healing area and
known systemic disorders like uncontrolled
a short preparation time (4).
diabetes and hypertension, other systemic illness
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 332-336
Short-Term Outcome of Perforated Peptic Ulcer; Relation with
Estimated Time from the Onset of the Abdominal Pain to Surgical Intervention
Owaid M. Almalki
Surgery Department, College of Medicine, Taif University
Corresponding author: Owaid M. Almalki,email: firstname.lastname@example.org
Background and aim of the work: perforated peptic ulcer still remains as one of the most common surgical
emergencies and the high incidence of postoperative complications necessitates the identification of the factors
associated with this morbidity. The aim of this study is to evaluate the various perioperative factors in patients
operated for PPU and how these factors may affect the operative outcome.
Methodology: Between January 2011 and Novermber 2019, 68 patients who were operated emergently for PPU in
our hospital were included in this study. Demographic and clinical data, surgical procedures, intraoperative findings,
postoperative complications were collected and analyzed retrospectively.
Results: The mean age was 46.75 ± 14.05 years. Out of 68 cases there were 49 (72%) male patients and 19 (28%)
female patients. The mean operation time was 81.32±12.18 minutes. The mean hospital stay period was 8.5±2.2. Most
of the cases (94%) presented without a warning of previous history of PUD, predominantly in older males. 50% of
cases presented within first 24 hours and therefore favors the better outcome. The commonest sites of perforation
encountered in our set up are the 1st part of duodenum (72%), followed by prepyloric region perforations (25%). The
size of perforations in most of the cases ranged from 0.5 cm to 3cmwith only two cases with size more than 3cm and
they are treated with simple Graham's omental patch. Common complications encountered were abdominal collection
(11.8%), followed by pleural effusion/pneumonia (10.2%) with a mortality rate of 7%. Half of the patients were
discharged home within the first week after surgery. Comparing estimated time from the onset of the perforation
symptoms to time of surgical intervention against the length of stays has shown that there was a statistically significant
correlation. Conclusion: the earlier the presentation of PPU to the emergency department resulted in betteroutcome.
Those patients with high risk of perforation need to be identifiedto be diagnosed and managed immediately as they
reach the hospital.
Keywords: Perforated Peptic Ulcer (PPU), Duodenal ulcer, Perforation, Intraoperative findings, Outcome.
The incidence of peptic ulcer disease (PUD)has
Nowadays surgery for PPUconsists of
decreased over the past decades.Although surgery for
laparotomy/laparoscopy with peritoneal lavage and
intractable ulcer disease is rarely needed due to
closure of perforation which can be accomplished by
effective treatmentof proton pump inhibitors and H.
primary closure with interrupted sutures; occluding the
pylori eradication therapy, the epidemiological pattern
perforation with a pedicled omentoplasty (Cellan-
of the complications has changed little . In
Jones repair) ; placing a free omental patch (Graham
emergency situation, perforated peptic ulcer (PPU)
patch) ; and performing a sutureless repair .
repair and its consequence still remains one of the most
PPU presents with acute abdomen in a vague
common surgical operations, especially in developing
picture, leading to delay of intervention. In fact, time
countries, in spite of the good achievement in medical
of intervention is one of the known prognostic values,
therapy for PUD . Morbidity associated with PUD
known as the Boey score . Bas et al.stated that a
reported between 10 to 20% including bleeding,
delay of more than 24 h in diagnosis and management
perforation,and obstruction. Perforation is associated
greatly worsened predicted outcomes and increased
with increased mortality, comparing to other
post-operative complications . However, other
complications of PUD, accounting for more than 35%
factors, such as concomitant diseases, shock on
of all peptic ulcer-related deaths .
admission, delayed surgery, resection surgery, and
It has been well established that the main
postoperative abdominal and wound infections, have
predisposing factors for peptic ulcer perforation are
been associated with increased morbidity and
smoking, use of nonsteroidal anti-inflammatory drugs,
mortality in perforated ulcer patients . Many
chronic stress, Helicobacter pylori infection, and
patients with PPU have more than one postoperative
advanced age (>60 years) .
complication and each of these vary in its magnitude.
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 337-347
Predictors of Premenstrual Syndrome among Female Students at Governmental
Secondary Schools in Jeddah, Saudi Arabia: A Cross-sectional Study
Iman Mohmad Wahby Salem1,2, Mashael Yahya Alsamti3, Manal Abdulaziz Murad4
1Community Medicine, Saudi Arabia-King Abdulaziz University Rabigh,2Community Medicine Department,
Egypt- Al Azhar University, 3The Joint Program of Family Medicine, Jeddah, 4Family Medicine Department,
Faculty of Medicine,King Abdulaziz University, Jeddah,Saudi Arabia
Corresponding author: Mashael Yahya Alsamti, email:email@example.com
Background: The disorders related to menstruation are the greatest common gynecologic diseases. Premenstrual
syndrome (PMS) represents a common problem among females from all age groups due to several factors. It can
deteriorate their quality of life and social life. Objective: Assessment of the prevalence and predictors of
premenstrual syndrome among female students at governmental secondary schools in Jeddah, Saudi Arabia, 2018.
Materials and methods: The governmental female secondary students were the population for this study which
included 64926 students. The sample size is calculated using Rao soft calculator. The schools and students were
chosen by a multistage probability sampling method. Slight modification and validation by three consultants to
construct the questionnaire.
Results: Four hundred female students were included with mean age of 16.7 ± 1.16 years old. The prevalence of
PMS was 37.0% (95% CI=32.3% - 41.9%). There were more participants in the 3rd year (35.8% versus 24.6%,
p=0.00) and more Saudis (55.4% versus 44.4%, p=0.00) in the PMS group. In Saudi Arabia, other studies showed
variable prevalence figures compared to those reported in our study. 35.6% of medical students at King Faisal
University had a family history of dysmenorrhea as a risk factor of PMS.
Conclusion: PMS is prevalent among one-third of secondary school students, Jeddah. Menstrual pain was the most
common symptom, passive or active smoking and family history of dysmenorrhea were the predictors of PMS.
Keywords: Premenstrual syndrome, Female secondary schools students, Dysmenorrhea.
after that (1-8). Also, PMS characterized by somatic and
The disorders related to menstruation are the
psychological symptoms. Somatic symptoms include
greatest common gynecologic diseases (1). PMS disturbs
abdominal bloating, headache, edema, breast
the daily lives of women and can deteriorate their
tenderness, joint or muscle pain, and weight gain.
quality of life and social life (1-3]). In some women, these
While, psychological symptoms include anxiety, social
manifestations may be excessive and become a cause of
withdrawal, anger, irritability, confusion, and
misery, absenteeism and family disharmony(2). The
severity of premenstrual syndrome symptoms is
Known risk factors for PMS are hormonal
associated with its duration and how it ruins the daily
imbalance, genetic factors, lifestyle, diet, drugs, stress
lives of women (4). Premenstrual syndrome (PMS) is
and psychological factors (2, 3, 6, 8).
characterized by a varied range of emotional & physical
In 2015, in India, Badkur and his colleagues (7)
symptoms and behavioral changes, occurring during the
conducted an observational follow-up study, to estimate
luteal phase of the menstrual cycle and resolve at or
the prevalence of PMS and its association with
within a few days after the onset of menstruation (1-6).
menstrual profiles among female students of colleges
The PMS was defined by the American College
situated in Ujjain city, India. They found that the
of Obstetricians and Gynecologists (ACOG) as "a
prevalence of PMS was 39.6% with negative history of
clinical condition characterized by the cyclic presence
mothers having any menstrual problems (P= 0.04). In
of at least one of the physical and emotional symptoms
2016, in Ethiopia, Abeje and Berhanu (3) conducted a
unrelated to any organic disease that appear during the
cross-sectional study, to assess the prominence of
5 days before menses in each of the three prior
premenstrual syndrome and its associated factors
menstrual cycles and disappear within 4 days of the
between the secondary school students. They found that
onset of menses, without recurrence until at least cycle
the prevalence of PMS was 81.3% of the participants.
day 13(5). More than 90% of women of childbearing
There were statistically significant associations
have premenstrual symptoms but a minimal proportion
between the occurrence of PMS and age AOR (CI) 1.20
of female meet characters for PMS ranging from 35.6%
(1.01, 1.44). Also, with early age of menarche (< 12
to 96.6% worldwide (1-8). The prevalence varied, due to
years), AOR (95% CI) 2.68 (1.32, 5.47). Another study
cultural characteristics, sample differences and
in 2017, in Ethiopia, Tsegaye, and Getachew (2)
diagnostic methods. The highest rate is among the 20 to
conducted a cross-sectional study, to assess
24-year old age group then it decreases increasingly
premenstrual dysphoric disorder and associated risk
The Egyptian Journal of Hospital Medicine (January 2020) Vol. 78 (2), Page 348-355
Total Hip Arthroplasty in Femoral Neck Fractures in Zagazig University Hospitals
Mohamed Mohamed Ibrahim Ashour, El-Sayed El-Etewy Ahmed Soudy,
Mohamed El-Sadek Attia, Mohamed Ismail Abd-Elrhman Kotb
Orthopaedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Mohamed Mohamed Ibrahim Ashour; Mobile: (+20)01011010560.
Background: Femoral neck fractures are common in the geriatric population and are associated with high morbidity
and mortality. The worldwide incidence of hip fractures is expected to approach 6.26 million by 2050. Studies showed
that the functional outcome and pain scoring were improved in cases of femoral neck fracture treated by total hip
arthroplasty than any other methods.
Objective: Assessment of functional and radiological outcomes of treatment of femoral neck fractures by total hip
Materials and Methods: This study was performed on 18 patients presented with history of fracture neck femur
who were admitted to Orthopedic Department, Zagazig University Hospital in the period from January 2019 to
December 2019. All cases in this prospective study were treated by total hip arthroplasty (THA). All the patients
were operated through Harding's approach. Both cemented and un-cemented types of arthroplasty were performed.
Functional outcomes of hip were evaluated at 3 months and 6 months after surgery.
Results: 66.7 % of studied group had history of previous fixation. Previous operative fixation for neck femur (NF)
fracture were 50 % cannulated screw, 25 % DHS and 25% IMN. Regarding cause of lesion most frequent were
failure of other fixation for NF (66.7%) then acute NF associated with OA (22.2%) and neglected N F fracture
Conclusion: Total hip arthroplasty is one of the most successful orthopedic surgical procedures and has regained
popularity during the last few decades with minimal pain.
Keywords: Total hip arthroplasty; neck Femur fracture.
Femoral neck fractures are common in the geriatric
AIM OF THE WORK
population and are associated with high morbidity and
Assessment of functional and radiological
mortality. The worldwide incidence of hip fractures is
outcomes of treatment of femoral neck fractures by
expected to approach 6.26 million by 2050 (1). The
total hip arthroplasty.
optimal treatment for femoral neck fracture is a matter
of debate for many years (2). In the past it was assumed
MATERIAL AND METHODS
that internal fixation was gold standard treatment for
This study was performed on 18 patients presented
femoral neck fracture arguing that retaining the
with history of fracture neck femur who were admitted
femoral head always gives the good results than the
to Orthopedic Department, Zagazig University Hospital
prosthetic replacement (3).
in the period from January 2019 to December 2019. All
Treatment options for femoral neck fracture
cases in this prospective study were treated by total hip
include closed reduction and internal fixation, hemi-
arthroplasty including unipolar or bipolar arthroplasty
Prior to commencing the study.
and total hip arthroplasty (4). Treatment by closed
reduction and internal fixation is influenced by many
factors like age of patient, displacement of fracture,
Ethical approval was taken from Zagazig
quality of bone, delay in treatment, quality of fracture
University Hospitals and signed informed consent
reduction, type of fixation devices and final position
was obtained from all patients and their guardians
of the fracture. This method of treatment however
before participation in the study.
gives high rate of non-union and avascular necrosis so
that patients are ultimately landed into the revision
surgery (3). The majority of patients treated with hemi-
Management of fractures neck femur in older
arthroplasty developed the degeneration of acetabular
cartilage by erosion of the prosthesis, which may
Both genders will be included.
sooner require the revision surgery. The incidence is
even higher in young patients and overall revision rate
Fracture neck femur accompanied by other hip
is 7 to 12% within a few years (5). Studies showed that
diseases as systemic lupus erythematosus,
the functional outcome and pain scoring improved in
rheumatoid diseases and ankylosing spondylitis
cases of femoral neck fracture treated by total hip
due to hip osteoarthritis.
arthroplasty than any other methods (6).