c:\work\Jor\vol801_1 The Egyptian Journal of Hospital Medicine (July, 2020) Vol. 80, Page 553-595
2-Microglobulin Post Kidney Transplantation as A Predictor of
Subsequent Kidney Allograph Dysfunction
Amir Mohamed El Okely1, Mohamed Salah El Din Zaki2, Mahmoud Hosni Zahran1,
Mahmoud Maamoun Amin Maamoun*1
1Department of Internal Medicine, Faculty of Medicine, Zagazig University, Sharkia, 2Department of
Internal Medicine and Nephrology, National Institute of Nephrology and Urology, Cairo, Egypt
*Corresponding author: Mahmoud Maamoun Amin, Mobile: (+20)01097023526


ABSTRACT
Background
: Long-term outcome in renal transplantation is heterogeneous, and predicting success is
challenging. Serum 2-microglobulin (2MG), a novel marker of kidney function, predicts mortality and kidney
failure in the general population, and its elevation following transplantation is a marker of acute rejection.
Objective: To determine whether serum beta-2-micro-globulin one three-year post-transplant period could
predict the decline in GFR over a follow-up period of six months.
Patients and methods: This study was carried out at the National Institute of Nephrology and Urology, Cairo,
Egypt. The patients were subjected to different demographic, clinical, biochemical, ultrasonographic, and
endoscopic findings. In this study, 42 primary kidney transplant recipients were included.
Results: The results showed a significant increase in serum 2-microglobulin level between renal transplant
recipients with unstable kidney functions in comparison to renal transplant recipients with stable kidney
function. The results showed serum 2-microglobulin level could be a good predictor of renal graft outcomes.
Measurements of serum levels of beta 2 micro-globulin could be more sensitive and more specific than serum
creatinine as renal function tests for early prediction of graft dysfunction.
Conclusion
: In this study, we found an association between serum level of 2MG in the late post-transplant
period and a subsequent decline in kidney allograft function within a short time-frame. The overall results show
that a higher serum level of 2MG after a single measurement at different intervals of the late post-transplant
period independently predicts the lower eGFR. Thus, higher serum 2MG is a risk factor for graft function,
particularly with longer follow-up.
Keywords: 2-Microglobulin; Kidney Transplantation; GFR.

INTRODUCTION
allows 2MG to pass through it. Identification of
Kidney transplantation is the most effective
patients at risk for kidney graft failure beyond the
method of treatment for patients with end-stage
first post-transplant year is a prerequisite for
renal disease (1). At present, the rate of one-year
developing strategies for saving graft function and
kidney allograft survival exceeds 95%, and the
improving its survival (3).
preservation of allograft function in the late period
Several authors reported that measurement of
after transplantation has become the main challenge
the serum 2MG concentration in native kidney
(2).
diseases estimates GFR as serum creatinine does (5)
Identification of patients at risk for kidney
and even supersedes it (6).
graft failure beyond the first post-transplant year is
Astor et al. have recently demonstrated that
a prerequisite for developing strategies for saving
high serum 2MG at discharge predicted kidney
graft function and improving its survival (3). Many
graft loss (7), but detailed retrospective information
recent studies have focused on higher serum
might not be available for all patients. The
creatinine and lower glomerular filtration rate (GFR)
association between serum 2MG and the rate of
within the first post-transplant year as surrogate
decline in kidney allograft function remains
predictors of inferior graft survival (3, 4).
obscure (8).
2-microglobulin (2MG) is a membrane

protein
associated
with
class
I
major
AIM OF WORK
histocompatibility complex proteins and is,
This work aims to determine whether serum
therefore, found on the surface of all nucleated cells.
beta-2-micro-globulin one three post-transplant
Under physiological conditions, 2MG is produced
period could predict the decline in glomerular
at a constant rate and is eliminated through the
filtration rate (GFR) over a follow-up period of
kidney. The low molecular weight (11.800Da)
six months.



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553
Received:20 /1 /2020
Accepted:1 /3 /2020

Full Paper (vol.801 paper# 1)


c:\work\Jor\vol801_2 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 560-569

Knowledge of Gestational Diabetes Mellitus among Prenatal Women
Attending a Public Health Center in Al-Khobar, Saudi Arabia
Abdullah Alnaim
Family and Community Medicine Department, College of Medicine-Al Hassa,
King Faisal University, AI Hfouf, Kingdom of Saudi Arabia

ABSTRACT
Background
: Gestational diabetes mellitus (GDM) is a current health problem that affects pregnant women and
fetuses. Addressing GDM offers a window of opportunity for the prevention of DM in Saudi Arabia. Here, we
aimed to assess the current level of knowledge regarding GDM among prenatal women attending primary healthcare
centers (PHCs) in the city of Al-Khobar. We also aimed to increase the awareness of GDM and to determine the
significance of this study within the Saudi Arabian context.
Methods: After obtaining informed consent from the study subjects, a pre-validated, structured questionnaire was
used to assess GDM knowledge among prenatal women attending PHCs in the city of Al-Khobar.
Results: We included 471 prenatal women in the study (mean age: 29 years). Overall, 36.5% of the women had
good knowledge of GDM, while 50.5% had fair knowledge, and 13% had poor knowledge. Most women (> 99%)
were literate and identified themselves as housewives (75.4%). The knowledge score concerning how GDM is
diagnosed was 45.3%. Approximately 41.4% women had undergone tests for GDM. Furthermore, 65.8% of the
participants were aware of GDM treatment. However, only 39.5% were aware of the consequences of GDM. A
major source of GDM knowledge was reported to be from friends and relatives.
Conclusion: Although knowledge of GDM as a disease in Al-Khobar community was average, the depth of this
knowledge was poor. Thus, doctors and healthcare providers must play a greater role in improving health education
among prenatal women. Furthermore, suitable intervention programs should urgently be undertaken by the Ministry
of Health to improve GDM knowledge among this population.
Keywords: gestational diabetes, knowledge, level of knowledge, awareness.

INTRODUCTION

Gestational diabetes mellitus (GDM) is defined as
Cesarean section and higher risks of ketonemia,
any degree of glucose intolerance with onset or first
preeclampsia, and urinary tract infection. Neonatal
recognition occurring during pregnancy (1). According
risks include increased perinatal morbidity (e.g.,
to the World Health Organization (WHO), gestational
macrosomia, neonatal hypoglycemia, and neonatal
diabetes can be defined as hyperglycemia with onset or
jaundice) and an increased risk of mortality. Women
first identification occurring during pregnancy (2).
with a history of GDM have a higher risk of subsequent
Globally, the prevalence of GDM is approximately
type 2 diabetes. Therefore, diagnostic testing and
7%, but the prevalence ranges from 1% to 14% of all
prevention measures should be undertaken during
pregnancies in some countries depending on the
postnatal follow-up (1, 7). The prevalence of gestational
population studied and the diagnostic tests employed
diabetes has been steadily increasing in the Kingdom
(1). Some countries have higher prevalence rates (19%)
of Saudi Arabia. Therefore, we performed a cross-
than others (3). For example, recent studies have
sectional study to assess knowledge of GDM among
revealed higher prevalences of gestational diabetes in
prenatal women attending PHCs in hospitals located in
Norway and in the United Arab Emirates (UAE)
the city of Al-Khobar.
(37.7%) than in Mexico (30.1%) (4, 5). The prevalence

of GDM in the Kingdom of Saudi Arabia ranges from
Definition of Terms
8.9% to 12.5% based on a study reported in 2000 (6).
Gestational diabetes mellitus: any degree of
Risk assessment for GDM should be conducted
glucose intoler- ance with onset or first
upon the first prenatal visit. Clinical characteristics
recognition during pregnancy(1).
suggestive of a high risk of GDM include both
Knowledge: The fact or condition of being aware
modifiable factors, such as marked obesity and
of something (merriam-webster.com).
lifestyle factors, and non-modifiable factors, such as a
Awareness: The ability to directly know and
personal history of GDM, glycosuria, or a strong
perceive, feel, or be aware of events. More
family history of diabetes (1, 8, 9).
broadly, it is the state or quality of being conscious
GDM is associated with significant complications
of something.
for both the mother and the fetus or newborn. Maternal
Level of knowledge: A higher score indicated
risk includes an increased chance of requiring a
better GDM knowledge. The maximum score was


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560
Received:2 /3 /2020
Accepted:11 /4 /2020

Full Paper (vol.801 paper# 2)


c:\work\Jor\vol801_3 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 570-575
The Role of Surgery in Management of Primary Metatarsus Adductus
Adel Mohamed Salama, Amr Mohamed El-Adawy,
Ahmed Mashhour Gaber, Ahmed Abdelrhman Hafez*
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Abdelrhman Hafez, Email: hafezahmed864@gmail.com,
Telephone: 01117121526 ­ 01010909098

ABSTRACT
Background:
Metatarsus adductus is the most common congenital foot deformity in children. Different bone surgical
procedures were portrayed to treat severe cases of fixed metatarsus adduction.
Objective: To establish a protocol for diagnosis and treatment of forefoot adduction deformity in metatarsus adductus,
and to evaluate the results of double column osteotomy (closing wedge cuboid osteotomy and opening wedge medial
cuneiform osteotomy) (i.e. lateral column shortening with medial column lengthening) in correction of the foot
deformity. Patients and Methods: In this prospective study 16 patients with 17 feet with fixed metatarsus adductus
were operated upon for forefoot adduction deformity in Zagazig University Hospitals since 2018. 10 boys and 6 girls
from 4-12 years old. The right foot was operated upon in 7 patients and the left foot in 10 patients. All cases underwent
double column osteotomy; closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy.
Results: According to the grading system applied in this study, there were twelve cases with excellent results (nearly
70%). There was no pain throughout the foot. The forefoot adduction deformity was completely corrected. There was
no supination in all cases. All cases manifested no complaints of the footwear or braces. All cases were satisfied and
their parents revealed gratification of the foot shape and gait. There were 3 good results (18%), 2 fair results (12%), and
no poor result. Conclusion: Double column osteotomy (combined cuboid/cuneiform osteotomy) is a safe operation,
which allows satisfying correction of forefoot adduction deformity in severe rigid metatarsus adductus.
Keywords: Metatarsus Adductus, Surgery, Double Column Osteotomy.

INTRODUCTION
prominence at cuboid bone and the base of the fifth
Metatarsus adductus (MA) was first portrayed by
metatarsal) (2).
Henke in 1863, however until 1940 it was inconsistently
Moreover, the external side edge of the feet are
reported in the literature (1). Metatarsus adductus is a
convex, with a dorsal and lateral prominence at cuboid
relatively common congenital foot deformity, which
bone and the base of the fifth metatarsal. Though the
reportedly happens in 1:1000 alive childbirths and there
calcaneus is at a valgus position, there is not equines
is an expanded incidence with subsequent siblings of
deformity, rather than a clubfoot. The whole deformity
1:10 (2). In patients with MA, there is a disorder of the
is generally increased in weight-bearing and when the
arrangement of the forefoot, with shifting degrees of
peroneal muscles are stimulated by tactile stimulation,
supination and adduction (Figure 1).
the abduction of the forefoot fails to happen (2).
If the deformity is not managed, the patient will
have an abnormal gait (i.e., the child will walk with the
forefoot pointed toward the midline (in-toeing)) and
may cause recurrent stumbling, which could have an
unfavorable effect on both the parents and child. This
dysfunction results in an expanded number of trips due
to the child's consequent psychomotor retardation.
Moreover, in the long term, the pressure applied by the
shoe may be an inclining factor for the development of
hallux valgus (3).
Management of the foot with metatarsus adductus
differs depending on the degree of misalignment,

ranging from monitoring and observation in mild cases
Figure (1): Normal feet and MA (the external side
to the applying of serial casts, thermoplastic splints, and
edge of the feet are convex, with a dorsal and lateral
even surgery in severe cases. Many authors agree that
the optimum therapeutic choice will depend on the


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570
Received: /3 /2020
Accepted:10 /4 /2020

Full Paper (vol.801 paper# 3)


c:\work\Jor\vol801_4 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 576-580

Evaluation of High Sensitive Cardiac Troponin I as A Marker of
Myocardial Injury in Children with Congenital Heart Disease
Mohamed Mamdouh Gaafar1, Eman M. ElMoghazy1,
Nagwa Mohamed Shawky2, Mona Mohamed Abdelkhalek Elsayed1
1Department of Pediatrics, 2 Department of Clinical Pathology, Faculty of Medicine - Zagazig University

ABSTRACT
Background:
Congenital heart diseases are abnormalities of the heart and/or great vessels present at birth. 1% of
live births have a congenital heart defect. Cardiac Troponin, especially cardiac Troponin I (cTnI), are the preferred
biomarkers for the detection of cardiac injury. International cardiology and laboratory medicine guidelines
recommend highly sensitive Tn1 (hscTnI) that has excellent precision (<10%). hsTnI is a cheap way that is capable
of accurately and precisely detecting low levels of Troponin I enabling treatment and allowing earlier definitive
diagnosis of acute myocardial injury than is currently possible.
Objectives: Evaluation of the myocardial injury as detected by highly sensitive cardiac Troponin I (hscTnI) in
children with left to right shunt.
Patients and methods: This cross-sectional study was conducted on 48 patients with congenital heart diseases
(CHD) whether cyanotic or acyanotic diagnosed clinically and by echocardiography admitted to Cardiology Unit of
Pediatric Department, Zagazig University Hospitals from June 2017 to December 2017. Their ages ranged from 2
months to 4 years. hscTnI assay was performed for all patients.
Results:
The study revealed that patients' group with CHD with left to right shunt had high level of hscTnI with a
median range from 1.7-237.00 ng ml.
Conclusion:
Serum Troponin I levels were high in children with CHD with left to right shunt, which may indicated
underlying myocardial injury.
Keywords: Pediatrics, Heart, Troponin I.

INTRODUCTION
circulating troponin increased lately after onset of
Congenital heart disease represents a major
injury (9). Highly sensitive cardiac troponin assay
health problem and most common cause of congenital
allows detection of 10-fold lower concentration of
anomalies (1). The estimated prevalence reaches up to
cardiac troponin (10). We aimed to study the level of
10 per 1000 live births. Congenital heart defects are
HscTnI in children with CHD as a predictor of
divided into two main groups; cyanotic and acyanotic
myocardial injury.
heart disease (2).

Most CHD have specific hemodynamics,
PATIENTS AND METHODS
including volume and pressure overload as well as
This cross-sectional study included 48 infants
cyanosis & pulmonary hypertension (HPN), which
and children their ages ranged from two months to
cause myocardial Injury by activation of
four years and all cases with CHD were diagnosed
neurohormones & inflammatory cytokines (3).
clinically and by echocardiography and admitted to
Cardiac troponins (cTnI) are considered the
Cardiology Unit of Pediatric Department, Zagazig
preferred and gold standard biomarker for myocardial
University Hospitals during the period from June 2017
injury as it detects subclinical injury (4). Troponin is a
to December 2017.
complex of three regulatory proteins (troponin c,
Ethical approval:
troponin T, troponin I) that is integral to muscle
A signed written informed consent was taken
contraction in skeletal and cardiac muscle (5). Cardiac
from parents of each case. The study was approved
troponins are not expressed outside cardiac tissue (6).
by our Ethical Committee.
Ischemic and non-ischemic cardiac injury release cTnI
Inclusion Criteria:
in circulation which may be due to cardiomyocyte

death (7).
Children with congenital heart disease whether
Evaluation of hemodynamic load and
cyanotic or non-cyanotic.
myocardial injury can be done by cardiac troponin in
Age From 2 months to 4 years from both sexes.
children with CHD (8). Recently a second generation
Exclusion Criteria:
cTnI assay has become available. The accuracy of
Infant less than 2 months of age were excluded
diagnosis of myocardial injury increased by
from the overall analysis because serum cTnI
assessment of this group of sensitive troponin as the
level abruptly increase immediately after birth
first-generation troponin has some limitation as
followed by gradual decrease.


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license (http://creativecommons.org/licenses/by/4.0/)
576
Received:3 /3 /2020
Accepted:12 /4 /2020

Full Paper (vol.801 paper# 4)


c:\work\Jor\vol801_5 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 581-586
Prognostic Value of Soluble HLA-G and CD38 Expression in Patients with
Chronic Lymphocytic Leukemia in Egypt
Omar Elhenawy Mohamed Thabet*1, Wafaa Salah Mohamed1, Magda Assem2,
Abdel Rahman Abdel Hamid3, Randa Amin Osman1
1Department of Clinical Pathology, Faculty of Medicine ­ Aswan University,
2Department of Clinical Pathology, National Cancer Institute ­ Cairo,
3Department of Clinical Pathology, Faculty of Medicine ­ Qena University
*Corresponding author: Omar Elhenawy Mohamed Thabet, Mobile: (+20) 01002398088,
E-mail: omarhenawy86@gmail.com

ABSTRACT
Background:
Chronic lymphatic leukemia (CLL) is the most common hematological malignancy in adults presenting
with varied clinical courses. There is an increased demand for establishing known prognostic factors for stratifying
CLL patients.
Aim of the work: To investigate the expression of soluble form of human leucocyte antigen-G (HLA-G) & CD 38 in
CLL and to correlate our findings with a variety of clinical and laboratory variables.
Patients and methods: The study included thirty newly diagnosed CLL patients. They were 18 males and 12 females
with age ranged from 49­65 (a mean of 57.5 years old). Diagnosis of CLL was confirmed by flow cytometric
immunophenotyping using standard lymphoma panel. CD38 expression was determined by flow cytometry. S. HLA-
G was measured by ELISA method.
Results: Positive CD38 expression was significantly associated with lower Hb and platelets (p = 0.008 and 0.025
respectively) also with higher Beta2 microglobulin (p = 0.012). Soluble HLA G was positively correlated with the
platelets count(r = 0.400, p = 0.02). Higher level of soluble form HLA-G was significantly more frequent in patients
of 60 years or older (p = 0.001). The cumulative overall survival was 83.3%. Positive CD 38 expression was associated
with significantly worse survival (p < 0.005). HB count < 10 gm/dl was associated with significantly worse survival (p
< 0.001).
Conclusion:
CD38 expressions are considered powerful prognostic markers in predicting overall survival for Egyptian
CLL patients and they should be assessed to decide the patient's therapy and to determine disease prognosis. Expression
of soluble form of HLA-G in CLL patients by ELISA get no extra prognostic importance.
Keywords: CLL, HLA-G, CD38, ELISA.

INTRODUCTION

CLL is the most public form of leukemia in the world
predictive factor, CD38 is a diphosphate-ribose
(1). In Egypt, CLL was the most common subtype of
hydrolase that acts as a simple ecto-enzyme with
leukemias and it was reported that over 80% of lymphoid
adenosine diphosphate-ribosyl cyclase and cyclic
leukemias are CLL (2).
adenosine (6). The raised CD38 expression is associated
CLL is a varied disease. The currently used clinical
with lower clinical outcomes of CLL (7).
staging system for CLL is simple but does not predict
Many laboratories now investigate CD38
disease advance and overall survival on an individual
expression as part of their expectable diagnostic flow
base. The well-recognized Rai and Binet staging systems
cytometric analysis of CLL patients. However, the
and the well-known other prognostic markers would be
proven use of CD38 data has been concerned by an
unsuccessful to find B-CLL patients with disease
observation that major suspicions remain in the works
progression who will advantage from early initiation of
concerning its prognostic value (4, 5, 6). Some studies have
therapy and are the target for novel therapy (3). Therefore
stated that CD38 expression changed over time or that
an increased request for finding known prognostic
only moderately high levels of CD38 positivity were
factors is of great significance. HLA-G is a HLA class I
prognostic (4, 5), but another studies have shown that
molecule expressed on trophoblast cells and thus
CD38 expression was steady over time and that the
guarding fetus from immunorecognition during
existence of even a lesser proportion of CD38-positive
pregnancy (4). HLA-G exerts multiple immunoregulatory
cells was accompanying considerably inferior clinical
functions. HLA-G expression on tumor cells may service
results.
their escape from antitumor immune responses, hence

allowing tumor progression (5).
Aim of the work: To investigate the expression of
The expression of HLA-G was described in CLL,
soluble form of HLA-G & CD 38 in Egyptian CLL
its use as prognostic factor is debatable however some
patients and to correlate our findings with a variety of
scientists suggested it could be used as a unique
clinical and laboratory variables.


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581
Received: 5 /3 /2020
Accepted:14 /4 /2020

Full Paper (vol.801 paper# 5)


c:\work\Jor\vol801_6 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 587-593

Expression of Tolerogenic HLA-G Confer Worse Outcome in
Patients with Chronic Lymphocytic Leukemia
Omar Elhenawy Mohamed Thabet*1, Wafaa Salah Mohamed1,
Magda Assem2, Abdel Rahman Abdel Hamid3, Randa Amin Osman1,
1Department of Clinical Pathology, Faculty of Medicine, Aswan University,
2Department of Clinical Pathology, National Cancer Institute, Cairo,
3Department of Clinical Pathology, Faculty of Medicine, Qena University, Egypt
*Corresponding author: Omar Elhenawy Mohamed Thabet, Mobile: (+20) 1002398088,
E-mail: omarhenawy86@gmail.com

ABSTRACT
Background:
Chronic lymphocytic leukemia (CLL) is the most common hematological malignancy in adults
presenting with varied clinical course. There is a higher request for founding known prognostic factors for stratifying
CLL patients. HLA-G is a non-classical major histocompatibility complex (MHC) molecule. It can be expressed in
membrane bound (m.HLA-G) and soluble forms (s.HLA-G).
Objective: The aim of work was to investigate the expression of membrane form of HLA-G in CLL and correlate
findings and a variety of clinical and laboratory variables.
Patients and methods: This prospective study included a total of thirty newly diagnosed B-CLL patients, attending
at Hematology Unit, Medical Oncology Department, national Cancer institute, Cairo. This study was conducted
between December 2017 to July 2019. Diagnosis of CLL was confirmed by flow cytometric immunophenenotyping
using standard lymphoma panel, membrane HLA-G was determined by flow cytometry.
Results: The expression of HLA-G by flowcytometry was negatively correlated with the platelet count (r = -0.516,
p = 0.004) and Hb (r = -0.479, p = 0.007). The expression of HLA-G was significantly higher in CD38 positive cells
(p = 0.006). The expression of HLA-G was significantly higher in Rai stage 4 compared to stage 1 & stage 2 (p =
0.001).
Conclusion:
It could be concluded that expression of HLA-G might represent signs of immunosuppression in CLL
patients which contribute to the immune escape of tumor cells. In addition, HLA-G expression by B-CLL cells
correlates significantly with the known prognostic markers of disease progression, mainly Rai clinical staging, CD38
expression and worse survival, making this parameter possibly an important prognostic factors of disease
progression.
Keywords: CLL, HLA-G.

INTRODUCTION

Therefore, increased request for founding known
Chronic lymphocytic leukemia (CLL) is the most
prognostic factors is of great importance. Classical
public form of leukemia in the world (1). In Egypt, CLL
major histocompatibility complex (MHC) class I
was the most common subtype of leukemias and
antigens are very much polymorphic molecules that
reported over 80% of lymphoid leukemias (2).
facilitate the presentation of peptides to T lymphocytes.
The recorded significant prognostic indicators in
They are universally expressed and show an significant
CLL are clinical staging systems developed by Rai et
role in the recognition of tumor cells and their products
al. (3) and Binet et al. (4). Other prognostic markers
by the immune system (7). Human leukocyte antigen G
include markers of tumor load such as (thymidine
(HLA-G) is a non-classical MHC class I antigen with
kinase and B2-microglobulin), and expression of
very slight sequence variability which is not expressed
specific proteins in CLL cells; CD38, CD49d & ZAP-
in normal tissues except in fetal trophoblasts (8).
70.
Both Membrane bound and soluble HLA-G are
People with CLL have varied clinical course.
involved in the development of malignancies in multiple
Some people never need medical treatment however
ways (9).
others have more aggressive course demanding early
HLA-G utilizes various immunoregulatory roles
beginning of therapy (5).
such as inhibition of natural killer (NK) cell or T-cell-
The well-known Rai and Binet staging systems and
mediated cytolysis, induction of T-cell apoptosis, or
the well-known prognostic markers be unsuccessful to
inhibition of transendothelial NK cell migration (8).
recognize B-CLL patients with disease progression who
Meanwhile the net outcome of these effects is
will benefit from early start of therapy and are the target
immunosuppression, HLA-G expression in tumor cells
for unique therapy (6).
could favor their escape from antitumor immune


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587
Received: 4 /3 /2020
Accepted:13 /4 /2020

Full Paper (vol.801 paper# 6)


c:\work\Jor\vol801_7 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 594-598

Prevalence of Thyroid Function Abnormalities in Patients with
Chronic Renal Failure under Regular Hemodialysis
Haitham Ezzat; Essam Khedr; Walid Bichari; Husein Sayed; Doaa Elwasly*
Nephrology Department, Faculty of Medicine - Ain Shams University, Cairo, Egypt
*Corresponding author: Doaa Mohamed Osama Elwasly; Email: dr.dodoelwasly@hotmail.com

ABSTRACT
Background:
There are various changes in the thyroid gland and its function in end stage renal disease (ESRD).
It is not surprising that impairment of kidney function leads to disturbed thyroid physiology.
Objective: Is to detect thyroid function abnormalities in hemodialysis patients.
Patients and Methods: 100 patients on maintenance hemodialysis (HD) were enrolled, they were excluded if they had
the following criteria: history of thyroid disease, thyroid and parathyroid surgery, under interferon therapy, exposed to
radiation, antithyroid drugs or thyroid replacement therapy, and those under 30 years. They were subjected to history
taking, clinical examination and laboratory investigations including hepatitis C virological state, renal functions and
thyroid functions.
Results: 92% of patients had normal thyroid-stimulating hormone (TSH) levels, 8% had abnormal TSH levels.
Regarding fT3 levels, 67 % had normal fT3 while 33 % had abnormal fT3, and only 11 patients had abnormal fT4. In
respect to the thyroid hormone status, only one was hyperthyroid, 92% were in euthyroid status, 2% were clinically
hypothyroid, 5% were subclinically hypothyroid, and 1% was hyperthyroid. There was significant negative correlation
between TSH levels and dialysis duration, 8 patients having abnormal thyroid functions ere females, and 60% had
HCV positive status. No significant associations were found between HCV infection and the thyroid hormones levels.
However, HCV positive patients experienced lower levels of T4 and TSH.
Conclusion: The average percentage of patients under regular hemodialysis with abnormal thyroid state is 8% with
females having abnormal fT4 and TSH levels compared to males. TSH levels were inversely correlated with dialysis
duration.
Keywords: Hepatitis C Virus, Free T3, Free T4, TSH, HD.

INTRODUCTION

Hypothyroidism has a more negative influence on
Aim of the work is to detect thyroid function
kidney function. Peripheral vascular resistance is
abnormalities in hemodialysis patients.
increased with intrarenal vasoconstriction, and cardiac

output is decreased, causing decreased renal blood flow
PATIENTS AND METHODS
(1).
Our study is a cross-sectional study. It was
Various abnormalities in thyroid function were well
conducted on 100 patients on maintenance HD at
documented, there is increase in prevalence of goiter and

incidence of primary hypothyroidism in chronic renal
Mahalla General Hospital, excluding those with the
failure. Diagnosis of primary hypothyroidism can only
following criteria: history of thyroid disease, thyroid and
be made with confidence if plasma TSH is unequivocally
parathyroid surgery, under interferon therapy, exposed to
elevated, measurement of free T4 may be helpful but can
radiation, antithyroid drugs or thyroid replacement
be unreliable. Diagnosis of hyperthyroidism in renal
therapy and those less than 30 years. They were
failure rests on the demonstration of elevated T4
subjected to careful history taking, clinical examination
concentration in the presence of suppressed TSH,
with special attention to the presence of symptoms and
although hyperthyroidism is extremely rare in patients
signs of hyperthyroidism, symptoms and signs of
with this condition (2).
hypothyroidism and local examination of the thyroid
Fortunately, most of the renal manifestations of
gland. Laboratory investigations including serum
thyroid disorders, which are clinically most significant
creatinine, blood ureanitrogen [BUN], hemoglobin [HB],
with hypothyroidism, are reversible with treatment (3).
hepatitis C virological state and thyroid function tests by
On the other hand, chronic kidney disease (CKD) is
means of measurement of fT3, fT4, TSH.
characterized by a low T3 syndrome which is now
Fasting blood samples were collected from patients
considered a part of an atypical nonthyroidal illness.
under aseptic precautions by venipuncture; 5.0 ml were
CKD patients also have increased incidence of primary
put in a vial. Two to three ml were left in test tube to clot
hypothyroidism and subclinical hypothyroidism (1). It
for 15 minutes. The samples were then centrifuged for 10
was also found that thyroid disorders are more common
minutes at 5000 rpm. The supernatant serum was
in patients on HD compared to general population (4).
separated then stored at -70 C till the time of analysis.


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594
Received:1 /4 /2020
Accepted:10 /5 /2020

Full Paper (vol.801 paper# 7)


c:\work\Jor\vol801_8 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 599-706

Evaluation of Bone Mineral Density among type 2 Diabetes Mellitus
Patients in Zagazig University Hospitals
Abdelmonem Fathy Zeid 1, Amira Shoukry Ahmed 1,
Mina Talaat Shohdy*1, Mostafa Mohamed Hamdy Asssy2
1 Internal Medicine Department, 2 Radiology Department, Faculty of Medicine, Zagazig University
*Corresponding Author: Mina Talaat Shohdy, Phone No.: (+2) 01210329498, E-mail: minatalaatmed@gmil.com

ABSTRACT


Background: Diabetes is one of the biggest health problems worldwide where the disease affects almost all organ
systems. The relationship between type 2 diabetes mellitus (T2DM) and bone mineral density (BMD) has been
controversial. Some show increased, decreased and others show no change in BMD among type 2 diabetics.
Objective:
The aim of the study was to assess the effect of T2DM on BMD among diabetic patients in Zagazig
University Hospitals. Also, evaluation of the effect of other factors like menopause, age and gender that may
interfere with DM on BMD.
Materials and methods: A case control study that was conducted on 90 individuals. Their ages ranged between 40
and 70 years and consisted of 60 diabetic and 30 nondiabetic subjects. BMD was measured using DEXA scan and
the data were compared among age-matched subjects of both groups.
Results:
BMD was significantly decreased among diabetic patients matched to those who are non-diabetics. Also,
the incidence of osteopenia and osteoporosis was higher among diabetic patients. On further analysis of date the
highest percent of abnormal BMD (osteopenia and osteoporosis) was among diabetic postmenopausal female cases.
Conclusion: Type 2 DM negatively affect the bone strength through affection of BMD. Hence, all type 2 diabetics
should be evaluated for the risk of osteoporosis and should be offered appropriate preventive measures.
Key words: Bone Mineral Density, Osteoporosis, DEXA scan, Type 2 diabetes, Menopause

INTRODUCTION
which may have positive, others have negative effect
Diabetes has evolved as one of the biggest health
on bone density. Higher levels of advanced glycation
problems worldwide and the disease affects almost all
end-products (AGEs) in collagen fibers of diabetic
organ systems. Diabetes mellitus is a metabolic
patient interact with bone reducing bone strength. Also,
disorder resulting from a defect in insulin secretion,
may stimulate apoptosis of osteoblasts leading to
insulin action, or both. Osteoporosis is a silent disease
defective bone formation and so osteoporotic bone (6).
with a harmful impact on bone health. Endocrine and
Glycosuria in diabetic patients indirectly
metabolic alterations in diabetes mellitus can trigger
decreasing BMD through hypercalciuric effect and so
disorders of calcium homeostasis, skeletal metabolism
decreased levels of serum calcium in the body thus
and bone mass. Most studies indicate that type 1 DM is
hastening bone loss (7). Some studies have shown low
associated with decreased bone mineral density (BMD)
levels of vitamin D with altered vitamin D metabolism
(1) and more than 50% of them are osteoporotic what is
in patients with diabetic osteopenia (8). Microvascular
called diabetic osteoporosis (2), but with type 2 DM the
complications of diabetes lead to reduced blood flow to
situation is different, some authors report increased,
bone contributing to bone loss and fragility (9).
some report decreased and some others report no
However, obesity, widespread in type 2 diabetic
change in BMD (3). Early identification of reduction in
patients, is associated with higher BMD, probably
bone mass in a diabetic patient may be helpful in
through mechanical loading effect and hormonal
preventing the bone loss and future fracture risk. BMD
factors
like
insulin,
estrogen,
and
leptin.
has been identified as a key determinant of future
Hyperinsulinemia may promote bone formation.
fracture risks (4).
However, with progression of the T2DM disease, low
Diabetic osteopathy may need attention as one of
levels of insulin will be that may cause reduction of
the common disease complications. Recently,
BMD (10).
osteoporosis is the most significant metabolic bone

disease in patients with diabetes mellitus (5). Even
AIM OF THE WORK
diabetic patients who have higher BMD, are also at
To measure and assess the bone mass density in type
increased risk of fracture due to higher risk of falling
2 diabetic patients either males or females. Also,
related to diabetic complications as retinopathy and
studying other factors that may affect BMD like
vasculpathy and not to diabetes itself. Diabetes could
menopause and gender using DEXA scan densitometer.
influence bone through several mechanisms, some of


PATIENTS AND METHODS


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599
Received:2 /4 /2020
Accepted:11 /5 /2020

Full Paper (vol.801 paper# 8)


c:\work\Jor\vol801_9 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 608-614
Nail Fold Capillaroscopy Abnormality in Behcet's Disease and
Relation to Disease Activity among Egyptian Patients
Shafica Ibrahim, Magdeldin N Ibrahim, Rasha Mahmoud Hammoda*
Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding Author: Rasha Mahmoud Hammoda, E-Mail: rasha.hammoda80@gmail.com, Mobile: (+20)01148904211

ABSTRACT
Background:
Behcet's disease is a systemic autoimmune disease. Treatment mainly is immunosuppression.
It has no sure diagnostic tests and relies mainly on clinical diagnosis. There are few scores to assess Behcet's disease
activity (Behcet's Disease Current Activity Form) BDCAF score. Nailfold Capillaroscopy is a technique to visualize
capillaries in nailfold area. It can correlate many diseases with the abnormalities in shape of blood capillaries.
Objectives: The aim of the work was to find out Nail Fold Capillaroscopy abnormality in Behcet's Disease and its
relation to the disease activity.
Patients and Methods:
A cross sectional-case control study which was done on 50 Behcet's patients and 30 healthy
controls. We assessed nailfold capillaroscopic changes in Behcet's patients in comparison to controls and the
correlation of BDCAF score with nailfold capillary abnormalities.
Results: we found that 70% of Behcet's Disease patients had nailfold capillaroscopy abnormalities , a highly
statistically significant changes in the capillaries in the form of capillary dilatation (24%), hemorrhage (54%),
tortuosity (64%) in comparison to the control group (P<0.001). However, pattern was not specific as BDCAF Score
wasn't related to the capillary changes.
Conclusion: Nailfold capillaroscopy showed nonspecific pattern in 70% Behcet's disease patients. Tortuosity,
hemorrhages, dilation were not related to disease activity. Capillaroscopy is a good primary test for Bechet's disease
and can reflect the presence and extent of microvascular involvement and thereby might have diagnostic and
prognostic value.
Keywords: Nail Fold Capillaroscopy Abnormality, Behcet's Disease.

INTRODUCTION


Behcet's disease is a systemic variable sized
disease entity, which, by 1947, had gained widespread
vasculitis of uncertain etiology with specific affection
international recognition. Due to the absence of a
of venules. Onset is typically in young adults with
diagnostic laboratory test, Behçet's disease still
recurrent oral and genital ulceration, uveitis, skin
remains a clinical diagnosis, and for the purposes of
manifestations, arthritis, neurological manifestation,
international research the diagnostic criteria proposed
and increased risk of thrombosis. International
by the International Study Group in 1990 and revised
diagnostic criteria have been proposed; however,
in 2010, is now widely accepted (3).
diagnosis can be difficult, particularly if the typical
Capillaroscopy is a non-invasive diagnostic
ulcers are not clear at presentation. Treatment is
technique designed to evaluate small vessels of the
challenging and must be tailored to the pattern of organ
microcirculation. Nailfold capillaries were first
affection for each patient and often requires
observed in the 17th century with primitive magnifying
combination therapies (1).
equipment, and in the early 19th century the first
Behçet's disease name goes to the Turkish
associations between inflammation and capillary
physician professor Huluci Behçet, who in 1937,
alterations were made. A direct link between capillary
described the classic tri-symptom complex of
abnormalities and certain medical conditions was
hypopyon, iritis, and orogenital ulcers. In his
made. With the advent of modern digital equipment
Epidemion, book 3, case 7, Hippocrates of Kos (460­
and evidence-based methodology, we can witness a
377 BC) describes an endemic disease in Asia Minor
renaissance of the capillaroscopic technique and
characterized by "aphthous ulcerations," "defluxions
widespread recognition of its significance (4).
about the genital parts," "watery inflammation of the
The aim of the current work was to find out Nail
eyes of a chronic character which cause loss of the
Fold Capillaroscopy abnormality in Behcet's Disease
sight of many persons (2). No further reference to the
and its relation to the disease activity.
disease is encountered in the medical literature until

the early 1900s, when the classic tris-symptoms
PATIENTS AND METHODS
complex was again described in Europe. At first, this
This cross sectional-case control study included a
complex was considered to be a manifestation of
total of 50 Behcet's disease patients and 30 healthy
syphilis, but in 1937 Behçet proposed a separate
controls, attending at Ain Shams University


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608
Received:3 /4 /2020
Accepted:12 /5 /2020

Full Paper (vol.801 paper# 9)


c:\work\Jor\vol801_10 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 615-618

Value of Chest Radiography and Electrocardiography in Diagnosis of
Congenital Heart Diseases in Pediatrics in Comparison with Echocardiography
Azza Ali Khalil, Eman Mahmoud El-Moghazy, Ghada Mohammed Hussein Mohammed*
Department of Pediatrics, Faculty of Medicine - Zagazig University
*Corresponding author: Ghada Mohammed Hussein Mohammed;
Email: drghadaelbahrawy8@gmail.com; Mobile: (+20) 01003495911

ABSTRACT
Background:
Advances in echocardiographic technology have made a revolution in the quality of image and
acquisition of data; however, it has also increased the cost of this diagnostic test.
Objective: To determine if chest x ray (CXR) and electrocardiography (ECG) are still valuable in evaluation of new
patients with heart murmurs in presence of echocardiography (ECHO).
Patients and Methods: This was a six month, prospective clinical study undertaken in the Outpatient Pediatric
Cardiology Unit, Zagazig University Children Hospital, between April 2018 and October 2018. The study included
44 patients (boys and girls) between the ages of 1 month and 14 years. All cases were subjected to detailed history,
full clinical examination and imaging modalities as CXR, ECG and ECHO.
Results: The highest accuracy of CXR was detection of right atrium (96.9%) followed by left ventricle (95.1%). The
highest accuracy of ECG was detection of right atrium (98.5%) and left ventricle (95.5%). The agreement between
CXR and ECHO in detection of pulmonary hypertension was 0.4 while that for ECG was 0.6. The agreement between
CXR and ECHO in diagnosis of congenital heart diseases was 0.6 and that for ECG was 0.9. The accuracy of ECG
in diagnosis of congenital heart disease was 95.4% while that for CXR was 70.4%.
Conclusion: ECG is more accurate than CXR in detection of cardiac chamber enlargement and heart diseases in
general but echocardiography still the most accurate method in this regard. The chest radiograph and
electrocardiogram had limited values in the diagnosis of pulmonary pressure changes and echocardiography is the
method to be used in this regard.
Keywords: Congenital heart diseases (CHD), chest x ray (CXR), electrocardiography (ECG), echocardiography
(ECHO).

INTRODUCTION
diseases in children. The most effective tool in
Referral for evaluation of heart murmurs
diagnosis of cardiac diseases in children is clinical
accounts for the largest group of new patients seen by
assessment while CXR and ECG can add an important
the pediatric cardiologist (1). It was determined that
value in diagnosis (3).
clinical diagnosis of heart disease cannot be changed
Aim of the work was to determine if CXR and
by diagnostic tests such as ECG, CXR, and M-mode
ECG are still valuable in evaluation of new patients
echocardiography if it was based on accurate history
with heart murmurs in presence of echocardiography.
taking and physical examination (2). It was proved that

CXR and ECG are effective in assessment of pediatric
PATIENTS AND METHODS
patients with heart murmur or chest pain referred to
This prospective clinical study was carried out
pediatric cardiologist for evaluation. In days of cost
between April and October, 2018 in the Outpatient
containment, routine ECG and CXR are still valuable
Pediatric Cardiology Unit, Zagazig University
tools for evaluation of patients with heart murmurs by
Children Hospital. The study included 44 patients
the pediatric cardiologist (3). Inaccurate diagnosis may
(boys and girls) between the ages of 1 month and 14
result in unnecessary anxiety and psychological
years. Written informed consents were obtained from
trauma when incorrectly identifying a child with an
parents of each child contributing in this study after
innocent murmur as having heart disease. On the other
telling them about the stages of study.
hand, false-negative assessment may expose children

with undiagnosed minor and major cardiac lesions to
Ethical approval:
dangerous
complications.
Advances
in
Approval from Ethical Committee, Faculty
echocardiographic technology made a revolution in
of Medicine, Zagazig University was also obtained.
the quality of image and acquisition of data; however,
Inclusion criteria: Patients referred for the evaluation
it has also increased the cost of this diagnostic test (2).
of heart murmur aged from one month through 14
The diagnostic accuracy of clinical assessment, CXR
years. Exclusion criteria include new patients referred
and ECG were determined in the complete evaluation
for other reasons and patients with previously
of new patients with heart murmur to diagnose cardiac
diagnosed cardiac lesions. All subjects included in this


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distributed under the terms and conditions of the Creative
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Y SA) license (http://creativecommons.org/licenses/by/4.0/)
615
Received:5 /4 /2020
Accepted:14 /5 /2020

Full Paper (vol.801 paper# 10)


c:\work\Jor\vol801_11 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 619-626

Infection Control: Hand Hygiene Practices among Nurses in the
Neonatal Intensive Care Unit at Benha University Hospital
Neveen T. Abedaand Rasha Sh. Eldesoukyb*
aDepartment of pediatrics, bDepartment of Community Medicine,
Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Rasha Shaker Eldesouky, Mobile: (+20) 1146184334,
E-mail:dr.rashashaker@gmail.com,rasha.alsayed@fmed.bu.edu.eg

ABSTRACT
Background
: Hand hygiene is abasic strategy in all infection control programs. Poor hand-hygiene practices are the
cause of 40% of hospital-acquired infections; however,the implementation of proper practical nursing skills can help
prevent these infections.Objectives:The aim of the work wasto investigate the availability of hand-hygiene equipment
and suppliesat the neonatal intensive care unit (NICU) at Benha University Hospital, to assessthe hand-washing
practices among nurses working on this unit, and to determine the factors underlying improper hand-hygiene practices.
Subjects and methods:This observational cross-sectional study included 28 nurses working at the NICU, Department
of Pediatrics,Benha University Hospital.Data were collected using a questionnaire sheet consisting of two parts; the
first included socio-demographic data and the second included the observational checklist of hand-hygiene equipment,
supplies, and practices according to the infection control assessment tool (ICAT).
Results:The results showed that 7.1% of the studied nurses fell under class A, in which the recommended hand-hygiene
practices are followed accurately, whereas 75% fell under class B, where standard practices are usually followed, and
17.9% fell under class C, in which training, close observation, and follow-up on standard practices are recommended.A
significant associations (P<0.05) were found between proper hand-hygiene practices of nurses and both the institute
from which they graduated and the completion of previous training courses on infection control.
Conclusion:It could be concluded thathand hygiene compliance among health care providers in our local environment
was poor. Further educational and training courses are needed.
Keywords: Infection Control; Hand hygiene; Nurses; NICU.

INTRODUCTION
Hospital-acquired infections are a common
[7],and is recommended by the Centers for Disease
problem worldwide. Up-to-date knowledge and refined
Control and Prevention (CDC) [8].
practical nursing skills can play important roles in
Hospital-acquired infections are a problem in
preventing infection [1,2]. Hand hygiene is the most
intensive care units (ICUs)due to heavy workload, low
effective strategy in the prevention of nosocomial
compliance withprevention and control measures of
infections [3]and transmission of infection has been
infection,
impaired
patient
immunity,
shown to decrease as hand-hygiene adherence increases
prolongedadmission and invasive procedures such as
[4]. A review of the relevant literature reveals that if
mechanical
ventilation
and
central
venous
adequate hand hygiene protocols are strictly followed
catheterization [9,10].
by healthcare personnel, it could lead to a
This study aimed to investigate the availability
significant,15­30% reduction in hospital-acquired
of hand-hygiene equipment and supplies in the neonatal
infections; however, observational studies show that
intensive care unit (NICU) of Benha University
current compliance rates of hand-hygiene in hospitals
Hospital to assess hand-washing practices among its
are approximately 50% [5].
nurses, and to detect the factors underlying improper
The World Health Organization (WHO)
practices.
describes key situations when proper hand hygiene

should be applied: before and after contact with a
SUBJECTS AND METHODS
patient, after contact with a contaminated material or
This
observational
cross-sectional
the patient's environment, and before performing an
studywasconducted on 28 nurse, working at the NICU,
aseptic procedure[6]. Though hand-washing with plain
Department of Pediatrics, Benha University Hospital.
soap has been a time-honored practice, hand rubbing
The field work was conducted between January 1, to
with alcohol-based solutions ensures greater safety
April 30, 2019.


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619
Received:6/4/2020
Accepted:15/5/2020

Full Paper (vol.801 paper# 11)


Results The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 627-632

Study of Urinary Podocalyxin As an Early Biomarker in Diabetic Nephropathy
Adel Abd ElMohsen Ghorab1, Magda Elsayed Diab2,
Nermin Raafat Abdelfattah3, Walaa Refaat Elmenshawy*2
1Department of Internal Medicine & Nephrology, 2Department of Internal Medicine,
3Department of Medical Biochemistry, Faculty of Medicine, Zagazig University
*Corresponding author: Walaa Refaat Elmenshawy; Email: habiba.yaseen22@gmail.com; Mobile: (+20)01228529994

ABSTRACT
Background:
Diabetic nephropathy is one of the major complications of diabetes and the leading cause of
end-stage renal disease.
Objectives:
The main aim of the study was evaluation of urinary podocalyxin as a non-invasive marker for
early detection of diabetic nephropathy, through assessing the level of urinary podocalyxin in patients with
diabetic nephropathy and assessment of the correlation between urinary podocalyxin levels and severity &
grades of diabetic nephropathy.
Patient and methods:
A prospective cohort study that was conducted in Internal Medicine Department in
Zefta General Hospital and Zagazig University Hospital on 42 cases of diabetic nephropathy. Urinary
podocalyxin was estimated by using commercially available podocalyxin ELISA test according to the
manufacturer's instructions.
Results:
The study showed that the area under the curve for validity of podocalyxin was measured to be
0.996. Also, there was significant association and agreement with sensitivity 97.6% and specificity 100%.
Conclusion: Podocalyxin is a sensitive and valid marker in diabetic nephropathy that can be used for early
detection of diabetic nephropathy in its early stages and can predict the prognosis of nephropathy.
Keywords: Diabetic Nephropathy, Prospective Cohort, Podocalyxin.

INTRODUCTION
the most severe lesion of podocytes (6).
Diabetes mellitus (DM) is a group of
As the result of the proximity of the apical
metabolic diseases in which there are high blood
region of Pods to the urinary space, pathological
sugar levels over a prolonged period. Diabetes is a
events occurring in this region are expected to be
complex chronic disease that requiring continuous
more easily detectable in urine than those
medical care with multifactorial risk-reduction
occurring in the basal or slit diaphragm regions of
strategies about glycemic control. For patients with
Pods (7). The number of podocytes per glomerulus
DM, self-management education and care are
is
reduced
in
diabetic
patients
with
critical to prevent acute complications and long-
microalbuminuria
and/or
macroalbuminuria.
term complications (1). Diabetic nephropathy is one
Moreover, urinary podocytes have been detected in
of the major complications of diabetes and the
those two stages of diabetes patients (8). Recent
leading cause of end-stage renal disease (2). It is
studies demonstrated that podocytes detachment
clinically characterised by proteinuria and
presented
in
diabetic
patients
with
progressive renal insufficiency (3).
normoalbuminuria by electron microscopic
Human Podocytes (glomerular visceral
morphometric analysis based on kidney biopsy (9).
epithelial cells) are highly specialized and
These findings suggest that detached
terminally differentiated cells, which cover the
podocytes
and
their
fragments
(marked
outline of glomerular basement membrane (GBM)
podocalyxin) might appear in urine of diabetic
to contribute the final size and charge barrier of
patients with normoalbuminuria, and that
glomerular filter to completely limit the leakage of
podocalyxin-positive element (PCX + EL) might
proteins into urinary space (4).
be a possible marker of early stage of nephropathy,
Also, it has been demonstrated to be
but the role of it remained obscure. Several
functionally and structurally injured in the natural
markers of podocyte injury are available and
history of diabetic nephropathy (5). Injuries to
include nephrin, sinaptopodin, podocalyxin and
podocytes are accompanied by characteristic
podocin (10). Podocalyxin (PCX) is the major
morphologic changes, as observed in the electron
surface antigen of human podocytes and the
microscopy, including vacuolization, loss of slit
expression of PCX on podocytes remains
diaphragms, effacement of foot process, and
unchanged in various kinds of glomerular nephritis
detachment from GBM into urine space which is
(11).


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627
Received:7 /4 /2020
Accepted:16 /5 /2020

Full Paper (vol.801 paper# 12)


c:\work\Jor\vol801_13 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 633-637

Optic Disc Swelling as The First Presentation of
Systemic Lupus Erythematosus: A Case Report
Abdulrhman Al Abdulqader, Mbbs(1,3),Manal Hasan, Mbbs(1,2)
(1) King Fahad University Hospital ,AL Khobar, (2) Imam Abdulrahman Bin Faisal
University, Dammam, (3) King Faisal University, Alhassa, Saudi Arabia
Corresponding author: Abdulrhman Al Abdulqader,email: doctorakq@hotmail.com


ABSTRACT
Background:
Systemic lupus erythematosus (SLE) is an autoimmune disease that affects multiple systems. Systemic lupus
erythematosus is a disease of 1000 faces and can present with ocular manifestations. Early recognition and treatment are
essential to prevent morbidities which can reach up to blindness. Ocular involvement occurs in around 30% of SLE patient.

Materials and methods: A case of 40-years-old female complained of an acute periorbital edema with visual involvement
concurrent with arthralgia.

Results: Ophthalmology evaluation showed ulcerative keratitis. Laboratory investigation showed leukopenia and anemia.
Immunological screening showed high positive Anti-nuclear antibody (ANA), anti-double-stranded DNA and low
complements level. Magnetic resonance imaging (MRI) of the brain with contrast showed left optic disc swelling and
bilateral periorbital edema. The patient was diagnosed as SLE with ocular manifestations and started on pulse steroid
therapy with immunoglobulin intravenous infusion. Her ocular manifestation improved and follow up MRI showed
improvement of the Left optic disc swelling.

Conclusion: Optic nerve disease is a rare ocular manifestation of SLE. It is important to recognize it early to avoid serious
complication and blindness.

Keywords: Systemic lupus erythematosus, optic disc swelling, ocular manifestations.

INTRODUCTION


Systemic lupus erythematosus is an autoimmune
scleritis, anterior uveitis and exudative retinal detachment.
disease
with
multisystem
involvement.
Ocular
About one percent of patient with SLE will develop optic
manifestations can be the first clinical picture of SLE.
nerve involvement, which can be due to vasculitis or
Keratoconjunctivitis sicca is the most common ocular
thrombosis if SLE associated with antiphospholipid
manifestation (1). Other manifestations include episcleritis,
antibody syndrome (2).


















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633
Received:4 /4 /2020
Accepted:13 /5 /2020

Full Paper (vol.801 paper# 13)


c:\work\Jor\vol801_14 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 638-646
Comparison between High and Low Binding of the Inferior Mesenteric
Artery in Mesorectal Excision of Rectal Tumor
Ahmed Elsayed Mohamed1*, Alsayed Basiony Moghazy2
1 Department of Surgical Oncology, 2 Department of General Surgery,
Faculty of Medicine, Al-Azhar University, Cairo Egypt
*Corresponding author: Ahmed Elsayed, Mobile: (+20)0114661061, email: dr.ahmed.elsayed.surg2020@gmail.com

ABSTRACT
Background:
Colorectal tumor is one of the most common tumors in both men and women worldwide. However, whether
high or low inferior mesenteric artery (IMA) ligation should be performed in the laparoscopic resection of resectable
rectal tumor remains controversial.
Objectives: The aim of the work was to compare low vs high IMA binding in patients undergoing laparoscopic mesorectal
excision for rectal tumor.
Patients and methods: This retrospective archived-based data study included a total of 161 patients with rectal tumor
who were eligible for total mesorectal excision, attending at Al-Azhar University Hospitals. This study was conducted
between 2010, and 2017. The high IMA binding (HIMAB) was conducted for 87 patients and low IMA binding
(LIMAB) was conducted for 74 patients. Baseline data were retrospectively analyzed for patients in both groups.
Results: The LIMAB group showed more high anus retention ratio (P = 0.022), more brief hospital stay (P = 0.025), less
medical costs (P = 0.032), lower anastomotic leakage (P = 0.023), and lower frequency of postoperative genitourinary
dysfunction (P = 0.003) when compared with HIMAB group. Analysis of the Cox regression showed local recurrence,
distant metastases, tumor differentials.
Conclusion: It could be concluded that laparoscopic radical rectal cancer resection with low IMA binding tends to be
correlated with reduced anastomotic leakage risk, anastomotic stringency risk, the risk of instability of the genitourinary
system, less time of hospitalization, and decreased costs. By comparison, it was found that the rate of excised lymph node,
tumor recurrence, metastasis, or mortality was not associated with the level of IMA binding.
Keyword: Binding of inferior mesenteric artery; Rectal tumor; Mesorectal excision.

INTRODUCTION

Colorectal tumor is one of the most common tumors
hypogastric plexus in addition to the sympathetic nerves
in both men and women worldwide and the third to fourth
is increased. This may cause genitourinary dysfunction
cause that lead to tumor-associated mortality1. 1.4 million
and adversely affect distal rectal arterial perfusion12,13.
cases were reported annually with high mortality up to 0.7
Furthermore, inappropriate stump of the rectal arterial
million per year 1. Moreover, around 30 % of patients with
perfusion and the anastomotic tension could lead to the
colorectal tumor develop complications2,3. Despite the
development of anastomotic leakage or anastomotic
positive results of neoadjuvant chemoradiotherapy, total
stricture14­16.
mesorectal excision (TME), is considered the best choice
However, few studies have discussed the
for management of rectal tumor4.
association between the IMA binding level and the
In comparison with open colectomy, laparoscopic
anastomotic leakage, lymph node affection, or 5-year
colectomy, that was implemented since the early 1990s,
survival.
showed many advantages5-7. Moreover, the bowel
The aim of the current work was to compare low vs
function of patients, for them laparoscopic colectomy was
high IMA binding in patients undergoing laparoscopic
conducted, was returned early, with the time of ileus
mesorectal excision for rectal tumor.
return 24 hours prior patients underwent open surgery8,9.

Therefore, the laparoscopic TME was considered the best
PATIENTS AND METHODS
choice for treatment of rectal tumor. However, there are
This retrospective archived-based data study
debates regarding the site of inferior mesenteric artery
included a total of 161 patients with rectal tumor who
(IMA) binding (whether on the origin or not) 10,11. Despite
were eligible for total mesorectal excision, attending at
high IMA binding is simpler and could increase the extent
Al-Azhar University Hospitals. This study was conducted
of lymphadenectomy, the risk of injury of the superior
between 2010, and 2017.


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638
Received:9 /4 /2020
Accepted:18/5 /2020

Full Paper (vol.801 paper# 14)


c:\work\Jor\vol801_15 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 647-653

Serum Adiponectin Level in Patients with Systemic Lupus Erythematosus and its
Correlation with Disease Activity
Mohammed Hassan Ali1, George Emad Shaker1, Ghada Elsayed Amr2, Manar Albendary Altanahy*1
1Department of Internal Medicine, 2Department of Clinical Pathology,
Faculty of Medicine, Zagazig University
*Corresponding author: Manar Albendary Altanahy; Email: manar.albndary30@gmail.com,
Mobile: (+20)01062521232

ABSTRACT
Background:
Systemic lupus erythematosus (SLE) is a chronic, multisystem, autoimmune disorder characterised by
widespread inflammation of connective tissues affecting the skin, joints, kidneys, heart, lungs, and nervous system.
SLE is associated with significant morbidity, thus requiring prompt evaluation, appropriate therapy and long-term
follow-up.
Objective: This study was performed to measure serum adiponectin in SLE patients and to correlate it with SLEDAI
and to evaluate its role as a biomarker of activity in SLE patients specially renal in the hope of preventing or at least
postponing renal damage.
Patients and methods:
This study included 72 subjects, 36 patients and 36 volunteers. The patients were divided into
three groups. Group I (active renal) 12 patients having renal disease activity, group II (active non-renal) 12 patients
having non-renal disease activity and group III (inactive SLE). 36 apparently healthy volunteers were included (group
IV) as a control group.
Results: A highly significant difference in serum adiponectin between SLE groups and control group. A highly
significant positive correlation between serum adiponectin and 24 h protein in urine. Negative correlation between
serum adiponectin and C3 & C4. A significant difference between SLE groups as regards serum anti-double stranded
DNA titres, which were higher in renal group patients, also C3 & C4 levels which were lower in the renal group.
Serum adiponectin level was not correlated with SLE Disease Activity Index (DAI).
Conclusion: Adiponectin level was strongly associated with active SLE with renal disease. Adiponectin level in SLE
patients was not correlated with SLEDAI. It may be a promising biomarker for prediction of renal activity of SLE.
Keywords: Adiponectin Level, SLE, SLEDAI.

INTRODUCTION

The laboratory tools used to measure kidney
may play a role as an enhancer of the inflammatory
damage are crude and relatively imprecise in their
response in the process of immune response and
ability to indicate a flare of lupus nephritis. Proteinuria,
inflammation (4).
hematuria, pyuria, presence of urinary casts and serum
The anti-inflammatory properties of adiponectin
creatinine levels are all non-specific renal markers.
may be a major component of its beneficial effects on
They may correlate with kidney damage, but they
metabolic disorders including systemic lupus
unfortunately cannot predict a renal flare (1).
erythematosus. Higher circulating adiponectin levels in
Adipose tissues form an endocrine organ that
SLE patients may positively correlate with
regulates immune processes and inflammation by
inflammatory markers (3). High levels of adiponectin
secreting bioactive mediators called adipokines.
have been found in patients with SLE in comparison
Adipokines, including adiponectin, visfatin, leptin and
with healthy controls. Some studies reported that
ghrelin (2).
plasma adiponectin levels are increased in patients with
Adiponectin is a 30-kDa plasma protein produced
renal SLE compared to healthy controls and patients
mainly by adipocytes macrophages. It is structurally
with non-renal SLE (5).
similar to complement component C1q and function as

an anti-inflammatory and pro-inflammatory factor (3).
AIM OF THE WORK
Adiponectin inhibits pro-inflammatory cytokines such
This study aimed to measure serum adiponectin in
as tumor necrosis factor (TNF)- and interleukin (IL)-6
SLE patients and to correlate it with SLEDAI and to
and adhesion molecules. Also, it is involved in the
evaluate its role as a biomarker of activity in SLE
modulation of inflammatory responses. Adiponectin
patients specially those having renal affection in the
also has pro-inflammatory effects on various cells in the
hope of preventing or at least postponing renal damage.
immune system. Adiponectin can increase the

production of IL-6 and metalloproteinases (MMPs)
Ethical approval and patient consent:
from endothelial cells and monocytic cells. Adiponectin
This study was carried out after review and


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647
Received:8 /4 /2020
Accepted:17 /5 /2020

Full Paper (vol.801 paper# 15)


c:\work\Jor\vol801_16 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 654-661

Interferential Electrical Stimulation Versus Pulsed Electro-Magnetic Field in
Management of Intermittent Claudication
Mona Mahmoud Mohamed*1, Nesreen Gharib El-Nahas1, Mohamed Hamza Hamed2, Nagy Nassif Louis1
1Physical Therapy Department for Cardiovascular/Respiratory Disorder and Geriatrics,
Faculty of Physical Therapy, Cairo University, Giza, Egypt.
2Department of Vascular Surgery, Faculty of Medicine, Al Azhar University, Egypt.
*Corresponding Author: Mona Mahmoud Mohamed, Mobile: (+20)01127744248, E-Mail:dmonamahmoud925@gmail.com

ABSTRACT
Background: Intermittent claudication is the occurrence of leg pain, aching, cramping, or fatigue triggered by
walking and relieved by rest. It's a chronic disabling condition and the first symptom of peripheral arterial disease
(PAD).
Objective: This study was designed to compare between the therapeutic efficacy of Interferential electrical
stimulation and pulsed electromagnetic field (PEMF) in management of intermittent claudication (IC).
Subjects and methods: Forty five patients suffering from intermittent claudication due to atherosclerosis (Fontain
stage II PAD) and randomly were assigned into three equal groups. Group "A" included 15 patients received 30 min
of pulsed electromagnetic field in addition to heel raise exercise and calf stretch exercise and their medical treatment,
group "B" included 15 patients received 20 min of interferential electrical stimulation in addition to heel raise
exercise and calf stretch exercise and group "C" (control group) that included 15 patients received their medical
treatment only. Ankle brachial pressure index, graded treadmill exercise testing to determine absolute claudication
distance (ACD), Peak walking time (PWT) and walking impairment questionnaire (distance score, speed score,
symptoms impairment score) were recorded pre and post the two months period for all groups.
Results: All measured parameters were significantly improved in all groups with the greatest improvement was in
group (A) and the least improvement was in group (C) except for ankle brachial index that was changed significantly
in group (A) only.
Conclusion: PEMF could be an effective vascular rehabilitation modality for improving walking efficiency and
functional capacity in patients with intermittent claudication. It significantly increases the blood flow in peripheral
arteries and so on can delay the complications of intermittent claudication.
Keywords: Pulsed electromagnetic field, Interferential electrical stimulation, Intermittent claudication, Peripheral
artery disease.

INTRODUCTION

Peripheral arterial disease (PAD) is chronic
in the mid-frequency range of 1-100 KHz. It is an
arterial occlusive disease of lower extremities caused
amplitude-modulated alternative current produced by
by atherosclerosis leading to an inadequate blood
cross-interference of different currents within the body,
supply due to narrowing or hardening of the arteries (1).
thereby transmitting a burst frequency in the biological
About half of the patients with PAD are asymptomatic.
range into a continual flow of electric potential.
From the other half, about 40-45% present with
Interferential stimulation stimulate arterial and
intermittent claudication (2). Muscle ischemia during
capillary dilatation, improve tissue oxygenation and
exercise and reperfusion after claudication limit
metabolism and decrease blood viscosity in the region
exercise, which is associated with an increase in
applied. The frequency rhythmic electrical modulation
oxidant stress. The production of oxygen-free radicals
system (FREMS) has been recently reported to improve
may be a unifying mechanism of vascular and skeletal
the claudication distance (CD) and micro-circulation
muscle injury in PAD (3). Cigarette smoking is by far
thus mimicking the effects of exercise (5).
the most potent risk factor for development of
On the other hand the Pulsed low frequency
peripheral
atherosclerosis
and
intermittent
electromagnetic field (PLFEM) is an interesting
claudication. Other major risk factors are increasing
therapeutic procedure. It achieved significant
age, diabetes, hypertension, hyperlipidemia and
improvements when utilized in multiple peripheral
hyperhomocysteinaenmia.
In
younger
patients
vascular and musculoskeletal disorders treatment (5).
intermittent claudication may be caused by conditions
The therapy of PEMF is achieved by altering biological
such as popliteal artery entrapment, cystic adventitial
and physiological systems via low energy and non-
disease, fibromuscular dysplasia and external
ionizing electromagnetic fields. PEMF therapy was
compression syndromes (4).
originally used clinically to manage osteoarthritis-
Interferential electrical stimulation uses a current
related pain and stiffness and to augment bone healing.


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654
Received:10 /4 /2020
Accepted:19 /5 /2020

Full Paper (vol.801 paper# 16)


c:\work\Jor\vol801_17 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 662-665

Screening for Hepatitis C Virus (HCV) Infection in Acute Lymphoblastic
Leukemia (ALL) Survivors in The Hematology and Oncology Department of
Children Hospital Zagazig University
Laila Metwaly Sherief1, Mohamed AbdelKader Elmalky1, Sameh Saber Bayoumi2, Sherif Mamdoh Talat*1
Departments of 1Pediatrics and 2Radiology - Faculty of Medicine, Zagazig University
*Corresponding author: Sherif Mamdoh Talat; Email: dr-s@windowslive.com; Mobile: (+20)01111422050


ABSTRACT

Background: Acute lymphoblastic leukemia (ALL) survivors received blood transfusions for multiple times during
treatment are at great risk for HCV infection. Rapid progression to cirrhosis in those patients is a concern for cancer
survivors because of the immunosuppression from cancer-related treatment.
Objective: Our study aimed to screen for (HCV) infection in acute lymphoblastic leukemia (ALL) survivors.
Patients and methods: This cross-sectional study was conducted in the Hematology and Oncology Department of
Children Hospital-Zagazig University on 80 cancer survivors collected over a period of 6 months from September
2018 to February 2019.
Results: 70% of ALL survivors were HCV positive.
Conclsuion: ALL survivors are at great risk for acquiring HCV infection from the repeated blood and blood
products transfusions with supsequent development of liver comorbitidites later on.
Keywords: HCV, ALL Childhood cancer.

INTRODUCTION


Hepatitis C virus (HCV) is a small single-
Our study aimed to screen for hepatitis C virus
stranded RNA virus. It is considered as the leading
(HCV) infection in acute lymphoblastic leukemia
cause of chronic infectious hepatitis in children. It is
(ALL) survivors.
also considered as a major health and economic burden
SUBJECTS AND METHODS
in children in both developed and developing
This cross-sectional study was conducted in the
countries. Egypt is one of the countries with the highest
Hematology and Oncology Department of Children
prevalence of HCV infection in the world (1).
Hospital-Zagazig University on 80 cancer survivors as
ALL
survivors
who
received
blood
cases collected over a period of 6 months from
transfusions were potentially exposed to hepatitis C
September 2018 to February 2019.
virus (HCV) prior to second-generation screening of
Ethical approval:
blood products in July 1992. Alternatively, this
This study was approved by the Institutional
population may have been exposed to HCV through
Review Board (IRB) and was done after ethical
other mechanisms, such as intravenous drug use (2).
approval of the ethical committee of research centre
Symptoms
of
HCV
infection
are
often
in Zagazig University Hospital and informed written
indistinguishable from other chronic diseases, but
parental consent from every subject that participated in
adverse outcomes of chronic HCV infection are
this work.
common. Rapid progression to cirrhosis is a concern
Inclusion criteria:
for ALL survivors because of immunosuppression
1. Children with acute lymphoblastic leukemia
from cancer-related treatment. Nevertheless, limited
(ALL) who had finished their treatment for at
evidence is available about long-term incidence of
least 2 years.
cirrhosis in this population (3).
2. Their age was less than 18 years.
Diagnosis of HCV infection in children with
3. Both sexes were involved.
cancer especially with hematological malignancies is
Exclusion criteria:
more challenging than diagnosis in normal children as
1. Newly diagnosed cancer cases.
the former can have false negative results of
2. Cancer cases on chemotherapy.
serological tests using antibodies against HCV due to
3. Cases of chronic hepatic problems.
immunosuppression.
In
some
of
severly
All subjects were subjected to the following:
immunocompromised patients, conventional detection
Full clinical assessment:
of anti-HCV antibodes is not sufficient for diagnosis,
Full history taking:
necessitating polymerase chain reaction (PCR)
Age, sex and residency.
analysis for HCV RNA quantification in blood to
Time of start of chemotherapy.
identify patients with occult infection (4).
Protocol of therapy.

Duration of follow up.


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662
Received:14 /4 /2020
Accepted:23 /5 /2020

Full Paper (vol.801 paper# 17)


Evaluation Of QT Interval In Diabetic Ketoacidosis In Medical Intensive Care Unit The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 666-671

Cerebrospinal Fluid (CSF) Presepsin as a Diagnostic Marker for Bacterial
Meningitis in Pediatric Intensive Care Units
Tarek Abd-Elrahman Attia1, Alaa Zedan Ibrahem1, Lamiaa Abd-Elwahab Mohamed2,
Ahmed Mohamed Attia El-Bayed*1
Departments of 1Pediatrics, 2Clinical Pathology, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding Author: Ahmed Mohamed Attia El-Bayed, E-mail: free_soul90@yahoo.com, Mobil: (+20) 01112336650

ABSTRACT
Background:
Meningitis is an inflammation of the leptomeninges. The inflammation may be caused by infection
with viruses, bacteria, other micro-organisms, or non-infective causes.
Objective: The aim of this study was to evaluate the role of CSF-Presepsin in diagnosis of bacterial meningitis and
in differentiation between bacterial and viral meningitis or aseptic meningitis.
Patients and methods:
The present study was a cross sectional study conducted in Intensive Care Unit and
Pediatric Departments of El-Hommyat Hospital in Zagazig in the period from January 2017 to November 2017. The
study included 50 patient of children with age from 6 months to 14 years with symptoms of CNS infection. Among
the studied subjects there were 30 cases already diagnosed as bacterial meningitis and 20 cases already diagnosed to
have viral meningitis (controls). Full history, clinical examination, and full laboratory tests were taken (Complete
blood count (CBC) with differential leukocytic count, random blood sugar, serum CRP, and CSF analysis, CSF
presepsin (psp) and CRP).
Results:
There was a significant increase in Presepsin and CRP in the CSF of cases of bacterial when compared to
viral group. Additionally, there were significant direct correlation between CSF presepsin and CSF CRP to blood
CRP, CSF total leucocytic count (TLC) and CSF protein and indirect correlation between CSF presepsin and
hemoglobin level, platelet count and CSF glucose.
Conclusion:
CSF-Presepsin and CSF-CRP can be used in diagnosis of bacterial meningitis and can differentiate
between them in bacterial and viral patients.
Keywords: Meningitis, Cerebrospinal Fluid, Bacterial meningitis.

INTRODUCTION


Bacterial meningitis is a serious type of meningo-
mechanisms of presepsin are related to the
encephalitis that causes inflammation of meninges of
phagocytosis process and cleavage of membrane
the brain, particularly the arachnoid and piamater.
CD14 with lysosomal enzymes of granulocytes in
Apart from meningeal inflammation, it has also been
response to bacterial infection (8).
shown to affect other regions of the central nervous
Determination of presepsin in CSF could
system (CNS). It has serious complications for
overcome problems with time-consuming procedures
producing
detrimental
long-term
clinical
in diagnosis and manegement of bacterial meningitis.
manifestations and life threatening consequences in
This study aimed to evaluate the role of
comparison to aseptic meningitis (1, 2).
CSF-Presepsin in diagnosis of bacterial and in
Brain macrophage play an important role during
differentiation between bacterial and viral
inflammatory reactions of the central nervous system
meningitis.
parenchyma, ventricles and meninges and are involved

in the release of soluble CD14 (3).
PATIENTS AND METHODS
CD14 is a glycosylphosphatidylinositol(GPI)-
The present study was a cross sectional study
anchored glycoprotein expressed on the surface of
conducted in Intensive Care Unit and Pediatric
monocytes/macrophages (mCD14) and serves as a
Departments of El-Hommyat Hospital in Zagazig in
receptor for complexes of lipopolysaccharides(LPS)
the period from January 2017 to November 2017. The
and LPS-binding protein (LPBP) (4). This activates a
study included 50 patients of children with age from 6
toll-like receptor 4 (TLR4) (specific proinflammtory
months to 14 years with symptoms of CNS infection.
signaling cascade) upon contact with infectious agent
Among the studied subjects there were 30 cases
(5). CD14 is shed from the cell membrane into the
already diagnosed as bacterial meningitis and 20 cases
circulation, forming sCD14 (6).
already diagnosed to have viral meningitis (controls).
Presepsin is a 13-KDa protein, a truncated N-
Full history, clinical examination, and full laboratory
terminal fragment of CD14 (7). The production
tests were taken such as CSF samples, C-reactive


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666
Received:16 /4 /2020
Accepted:25 /5 /2020

Full Paper (vol.801 paper# 18)


c:\work\Jor\vol801_19 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 672-677

Carotid Intima Media Thickness in Obese Egyptian Children and Adolescent
Zainab Al-Drawny1, Safaa Hamdy Ahmad Saleh1,
Ahmad Abdel Aziz El-Sammak2, Hisham Mahmoud Attia*1
Departments of 1Pediatric and 2Diagnostic Radiology, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Hesham Mahmoud Attia, Telephone: +201024683929, E mail: mosad8rashed@gmail.com

ABSTRACT
Background:
Obesity is a significant public health crisis. Carotid artery Intima-Media Thickness (CIMT) is a new
noninvasive ultrasound test that is being recommended to screen for heart disease in apparently healthy individuals.
Objective: To determine the relationship between CIMT and obesity in children and adolescents.
Patients and Methods:
This study was a cross-sectional study, which was done on 74 obese children aged 6-18
years. This study was done at the Pediatrics Department, Zagazig University Hospitals., during the period from 2017
to 2019. All children were subjected to history taking and clinical examination. Anthropometric measurements were
measured. Carotid intima-media thickness quantification was estimated.
Results:
The study resulted in 36 females (48.6%) and 38 males (51.4%). Children lived in rural areas 38(51.4%)
and urban areas were 36 (48.6%). There was a significant increase in CIMT in obese children. Statistically significant
positive correlations were observed between CIMT and BMI. Statistically significant positive correlations between
CIMT and total cholesterol, triglycerides, while no statistically significant correlations were observed between CIMT
and LDL, and HDL.
Conclusion:
There is a relationship between CIMT and obesity in children of the target population of the study and,
at the same time, there also exist statistically significant positive correlations between CIMT and total cholesterol,
triglycerides, and no statistically significant correlations between CIMT and LDL, and HDL. Regarding the
prevalence of insulin resistance (IR) among our studied children, we found that 31 patients were IR (41.9%), while
43 were not (58.1%). Insulin resistance (IR) was statistically higher in children with CIMT > 0.5 millimeters.
Key words:
Carotid Intimamemdia Thickness, Obese, Children, Adolescents

INTRODUCTION

Obesity is an important public health crisis all
Borda et al. (8) determined the relationship
over the world (1). The prevalence of obesity is more
between CIMT and obesity in children. They found a
than doubled between adults (rising from 15% to 34%),
relationship between CIMT and obesity in children and
and also more than three times as in children and
a direct relation between CIMT and abdominal
adolescents (rising from 5% to 17%) (2). Childhood
perimeter.
obesity is always associated with many diseases,

especially cardiovascular diseases, diabetes mellitus
AIM OF THE WORK
type 2, obstructive sleep apnea, some types of cancer,
This work aimed to determine the relationship
and osteoarthritis. For that, obesity has been found to
between CIMT and obesity in children and adolescents.
reduce life expectancy (3).

Carotid artery Intimamedia Thickness (CIMT) is
PATIENTS AND METHODS
considered a new noninvasive ultrasound test which is
This study was a cross-sectional study, which
recommended by the American Heart Association and
was done on 74 obese children aged 6-18 years. This
the American College of Cardiology as has a role in
study was done at the Pediatrics Department, Zagazig
screening for heart disease in all individuals (4).
University Hospitals., during the period from 2017 to
Touboul et al. (5) demonstrated that obese
2019.
children present higher values in the CIMT and, at the

same time, have more cardiovascular complications
Inclusion criteria: Obese children aged 6-18 years
throughout their lives.
were chosen (their body mass index which exceeds the
Schiel et al. (6) found a significant association
age- gender-specific 95th percentile.
between carotid IMT and weight, BMI, BMI-SDS,

blood pressure, as well as various other metabolic
Exclusion criteria: Obese children with genetic
parameters.
syndromes, Children receiving any medications like
Abdel-Wahab et al. (7) concluded that obesity in
hormonal or corticosteroids, Children with endocrinal
childhood and adolescents is associated with subclinical
disorders as diabetes mellitus. Children with
atherosclerosis.
hypertension and Children with chronic illness and


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672
Received:12 /4 /2020
Accepted:21 /5 /2020

Full Paper (vol.801 paper# 19)


c:\work\Jor\vol801_20 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 678-682
The Role of Mean Platelet Volume in Pediatric Chronic Kidney Disease
Mohamed A. Talat1, Naglaa Ali Khalifa 2, Lamiaa Mahmoud Kamel2,
Eman Morsy Mohammed 3 and Hassan Shehata 1
Departments of Pediatrics1 and Clinical Pathology 2, Zagazig University, Ministry of Health3, Egypt
Corresponding Author: Mohamed Ahmed Talat Kamal, email: Abo.talat@yahoo.com, Tel. No.: +201110455548

ABSTRACT
Background:
Platelets are heterogeneous in size, density, metabolic, functional, and biochemical properties. Mean
platelet volume (MPV) is a measure of the average size of platelet in a blood sample.
Objectives: The aim of the work was to study the relationship between MPV levels and the glomerular filtration rate
(GFR) in pediatric patients with chronic kidney disease (CKD) and its role to be a marker for the disease progression.
Patients and methods: Seventy-five children with chronic kidney disease subdivided into four subgroups according
to GFR were included in this study. Seventy-five healthy subjects were enrolled as a control group. All subjects were
subjected to detailed history taking, physical examination and Laboratory investigations. Pelvi- abdominal ultrasound
used for diagnosis of chronic kidney disease, Tc-99m DTPA (diethylenetriaminepentaacetic acid) scan used for
measurement of GFR.
Results: MPV levels in the whole patient group were significantly higher than in controls (9.1±0.57fL versus
6.95±0.63fL). There were no significant differences between subgroups of patients with CKD as regard sex, age,
weight, systolic, diastolic blood pressure, MPC and PDW while significant differences in disease duration and MPV
levels were found among them. In patients with CKD, we have found a significant negative correlation between MPV
and GFR. Also, we have found a significant negative correlation between MPV and Mean platelet count per thousand
(MPC).
Conclusion: It could be concluded that MPV value can be an easy, rapid, inexpensive, and simple marker for disease
progression in pediatric patients with CKD.
Keywords: Mean platelet volume, glomerular filtration rate, Tc-99m DTPA (diethylenetriaminepentaacetic acid)
scan.

INTRODUCTION

Mean platelet volume (MPV) is a measure of the
The aim of the current work was to study the
average size of platelet in a blood sample. A high MPV
relationship between MPV levels and the GFR in
indicates the presence of generally larger platelets and
pediatric patients with CKD and its role to be a marker
when the MPV is low, platelets are generally smaller.
for the disease progression.
MPV, a readily accessible indicator of platelet

activation and function. It is linked with a variety of
PATIENTS and METHODS
proinflammatory and prothrombotic conditions. Larger
This case control study included a total of 150
platelets are more possible to aggregate and discharge
children with age range 2 to 17 year, attending at
greater quantities of adhesive particles (1).
pediatric nephrology unit and general pediatric
Chronic kidney disease (CKD) is identified by
outpatient clinic, Zagazig University Hospitals. This
the occurrence of kidney damage; either structural or
study was conducted between July 2018 and December
functional and characterized by progressive and
2019.
irreversible deterioration of the renal excretory function

and/or glomerular filtration rate (GFR) below 60
Ethical approval: Approval of the Ethical
mL/min/1.73 m2 of body surface area for more than
Committee of Zagazig University was obtained. It is
three months (2).
consistent with the principles of the Declaration of
CKD is associated with a variety of
Helsinki. Written informed consent of all the parents of
proinflammatory and prothrombotic conditions.
subjects was obtained; included the required
Elevated MPV in patients with CKD may reveal the
information about this study.
chronic inflammatory status of CKD (3).

One study has been investigated MPV in
The included subjects were divided into two groups;
pediatric patients with CKD but the authors involved a
Group A (chronic kidney disease) consisted of 75
disease control with upper respiratory tract (URT)
children. They were further subdivided into four
inflammatory signs due to difficulty to recruit normal
subgroups according to GFR calculated by DTPA scan
pediatric patients and they did not investigate the role
(5): Subgroup (1): Mild CKD (GFR = 60-89
of MPV in reflection of disease progression (4).


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678
Received:15 /4 /2020
Accepted:24 /5 /2020

Full Paper (vol.801 paper# 20)


c:\work\Jor\vol801_21 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 683-687

Comparison of Decompression and Decompression plus Fusion, for
Degenerative Spondylolisthesis Management: Randomized Controlled Trial
Ali Ahmed Abdel Salam Hussanin
Egyptian Fellowship and Arab Board Trainee, Neurosurgery Department, Nasser Institute Hospital
Corresponding author: Ali Ahmed Abdel Salam Hussanin; Email: drloyoo@hotmail.com; Mobile: (+20)01069903794

ABSTRACT
Background:
Degenerative spondylolisthesis is defined as forward slippage of a vertebra with respect to the
underlying vertebra, without rupture of the posterior arc, distinguishing it from lytic spondylolisthesis. It thus
usually induces lumbar canal stenosis. There is, however, no strong consensus regarding the various medical and
surgical treatments available.
Objective: To assess the long-term clinical results of decompression alone and decompression plus fusion, for
degenerative spondylolisthesis.
Patients and methods: We randomly assigned 63 patients who had lumbar spinal stenosis due to degenerative
spondylolisthesis at the L4/5 level to undergo either decompression alone (decompression group), decompression
plus fusion (fusion group). Three patients refused to undergo randomization; therefore, the remaining 60 patients
were randomly assigned.
Results: In total, 60 patients underwent randomization. The follow-up rate at 3 years was 85%. The fusion group
showed higher blood loss, longer postoperative hospital stay and a longer operative time than the decompression
group. As regard clinical outcomes, all scores significantly improved in the postoperative period and these
outcomes were maintained at 3 years postoperatively in each group. There were no significant differences found
among the two groups at 1 and 3 years postoperatively.
Conclusion:
Decompression plus fusion does not have better results than decompression only in the management
of patients with lumber spinal stenosis with low grade degenerative listhesis.
Keywords: Decompression, Decompression plus fusion, Degenerative Spondylolisthesis.

INTRODUCTION

Degenerative
spondylolisthesis
(DS)
is
plus fusion (6). The aim of lumbar decompression is to
pathological disease referred to forward slippage of the
decompress the neural elements while preserving
vertebral body that result in symptoms of neurogenic
stability (7).
claudication and backache (1).
Aim of the work was to assess the long-term
It mostly occurs in patients older than 50 years
clinical results of decompression alone and
being more common in females than in males (2). A
decompression plus fusion, for degenerative
large number of symptomatic patients with
spondylolisthesis.
spondylolisthesis
have
Meyerding
grade
I

spondylolisthesis, the classification system is based on
PATIENTS AND METHODS
the degree of slippage (3).
Study Design: This was a prospective, randomized
Conservative management consists of physical
controlled trial.
therapy, epidural injections, anti-inflammatory agents,

and opioid analgesic agents (2). However, indications
Ethical and patient approval:
to proceed from conservative treatment to operative
Patient selection followed approval and
intervention depends on progressive neurological
registration of this randomized trial from Nasser
deficit, persistent severe backache and/or leg pain, and
Institute Hospital. A signed written informed consent
bladder or bowel symptoms three months following
was taken from all involved patients. 63 patients who
trial of nonoperative interventions (1).
underwent spinal operation for lumbar spinal stenosis
The first line in management of this condition
with degenerative spondylolisthesis at the L4/5 level
involves conservative management. Approximately
from Neurosurgery Department, Nasser Institute
10%-15% of patients develop an incapacitating
Hospital. Those patients who had lumbar spinal
backaches and/or leg pain (BP and/or LP), which
operation, multilevel stenosis, or foramenal stenosis
requires surgery (4).
were excluded from the beginning. Doctors explained
The aim of surgical treatment is decompression of
to every patient the clinical condition and the
the spinal canal and dural sac from degenerative bony
indication of operative intervention and after patient
and ligamentous overgrowth (5). Conventional surgical
approval of surgical intervention, every patient was
options include decompression and decompression
invited to participate in the study. Of 63 patients, three


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icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
683
Received:11 /4 /2020
Accepted:20 /5 /2020

Full Paper (vol.801 paper# 21)


c:\work\Jor\vol801_22 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 688-695

Fistula Excision with Sphincter Repair and/ or Approximation Leaving
Long Braided Sutures for Drainage of Intersphencteric Space for
Management of Fistula in Ano
Mahmoud S. Ahmad*
Lecturer of MRCS Eng, Faculty of Medicine, Aswan University, Aswan, Egypt
*Corresponding author: Mahmoud S. Ahmad, Mobile: (+20) 01005651501, E-mail: Mahmoud.znaty@yahoo.com

ABSTRACT
Background:
Fistula-in-ano is the most common form of perineal sepsis. Typically, a fistula includes an internal
opening, a track, and an external opening. The external opening might acutely appear following infection and/or
an abscess, or more insidiously in a chronic manner.
Objective: To analyze the results of surgical excision of intersphencteric, transsphencteric or suprasphencteric
perianal fistula by fistula excision with sphincter repair and / or approximation leaving braided sutures for
drainage
Patients and method: In this prospective study a group consisted of 124 patients with intersphencteric,
transsphencteric or suprasphencteric perianal fistulae were treated with fistula excision followed by sphincter
repair and / or approximation leaving the ends of the threads long for drainage of intersphencteric space. All
patients were observed along one year after surgery for complications, recurrence and / or incontinence
Results: The technique was done under spinal anesthesia for 92 patients (74 %) and under general anesthesia for
the other 32 patients (26 %). The median operative time was 30 minutes; ranging from 25 to 40 min. there were
no postoperative deaths. Hospital stay was less than 24 hrs for all patients. The overall recurrence rate was 4.8
%, with no permanent incontinence.
Conclusion: This technique has shown to be highly effective and applicable for management of intersphencteric,
transsphencteric or suprasphencteric perianal fistula with low recurrence rate (4.8%), no permanent incontinence
and good patient satisfaction.
Keywords: Fistula in ano, Sphincter repair, Fistulectomy.

INTRODUCTION
closure of fistula tract by primary closure, endorectal
Fistula-in-ano (FIA) is one of the most common
advancement flap, fibrin glue injection and fistula plug
benign anal conditions in daily surgical practice. It is
has been extensively investigated in the prevention of
defined as an epithelized abnormal tract connecting two
recurrence.
surfaces, usually the rectal mucosa and perianal skin (1).
The results regarding reduction of recurrence are
Anal fistula is a devastating problem that most
not impressive. Either recurrence is due to the natural
commonly occurs in healthy subjects with crypto
history of the disease itself, or the choice of surgery has
glandular infection being the most widely accepted
not been clearly identified in past literature (15-18).
etiological factor (2).
In this prospective study aimed to investigate
Successful surgical management of anal fistulae
surgical outcomes of this technique, which is
depends upon accurate knowledge of anal sphincter
considered as a modification or a combination of
anatomy and fistulas course through it. The most
more than one techniques aiming mainly at
comprehensive and practical classification is Park's
decreasing the recurrence rate and maintaining
classification. Four main groups exist: intersphencteric,
continence with proper patient satisfaction.
transsphencteric, suprasphencteric and extrasphencteric

(3). Most fistulas have been surgically treated by
Ethical Consideration: The Institutional Ethics
fistulotomy or fistulectomy which have both proven to
Committee of the Faculty of Medicine, Aswan
be effective however these techniques even for simple
University, Egypt approved this study.
fistulas result in some form of incontinence in
All patients gave informed consent before
approximately 12 - 39% of patients (4-6).
participation in this study. The study conducted in
Despite the advancement in preoperative road
accordance with the ethical guidelines of the 1975
mapping of fistula tracts by magnetic resonance imaging
Declaration of Helsinki and International
(MRI) and endo anal ultrasound (EAUS) (7-8), there is a
Conference on Harmonization Guidelines for Good
significant recurrence rate of 4% up to 45% (9-14).
Clinical Practice.
Modification of conventional surgical treatment for


PATIENTS AND METHODS


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688
Received:18 /4 /2020
Accepted:27 /5 /2020

Full Paper (vol.801 paper# 22)


c:\work\Jor\vol801_23 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 696-703

Comparative Anatomical Studies on the Skull of Three Mammals in
Egypt Having Different Diets
Fatma M.A. Taki-El-Deen1,2
1-Department of Biological and Geological Sciences, Faculty of Education, Ain Shams University, Egypt.
2- Department of Biology, College of Science, Qassim University, Buraidah, Al-Qassim, Kingdom of Saudi Arabia.
ABSTRACT
Aim of the work:
the present work was designed to study the anatomical structure of the skull of three mammalian
animals live in Egypt. These animals were Guinea Pig (Cavia porcellus), Hedgehog (Hemiechinus auritus) and Least
Weasel (Mustela nivalis vulgaris). It is worth mentioning that these animals are having different diets since, Cavia
porcellus
is herbivorous, Hemiechinus auritus is insectivorousand Mustela nivalis vulgaris is carnivorous.
Materials and methods: heads of the three animals (Cavia porcellus, Hemiechinus auritus and Mustela nivalis vulgaris)
were used to study the anatomical structure of the skull and mandible in each animal.
Results: after preparation of each skull of the animals under investigation, it was photographed and described according
to the different views; dorsal, ventral, lateral and occipital in addition to the lower jaw. It is worth mentioned that these
animals had different diets. So, some differences were observed in the facial and cranial regions of the skulls in the three
animals. The parietals and frontals in the skull of Cavia porcellus were slightly convex and the skull had a broad zygomatic
arch. The skull of Hemiechinus auritus had a long facial region and the tympanic bulla was not well developed. The skull
of Mustela nivalis had short facial region and long cranial region which had an obvious prominent sagittal crest. The
lower jaw had two mandibles which were connected firmly by bony mandibular symphysis. Also, heterodont teeth were
arranged on the upper and lower jaws.
Keywords: anatomy, skull, Guinea Pig, Hedgehog, Least Weasel, lower jaw

INTRODUCTION
the basal part of the nasal septum(9). The orbital cavity
The mammalian's skull encloses and protects the
contains the eye ball during the life of the animal. It may
brain and sense organs. Also, it gives the special shape of
be bordered superiorly by supraorbital process or not.
the head (1). The skull consists of many bones that are
Also, the supra-orbital foramen is absent in some
separated from each other by sutures. These bones are
mammals (10).
grouped in two main regions which are the facial and
The nasal cavities are covered by the nasal bones. These
cranial (2). The occipital bones represent the caudal part of
cavities have scroll-shaped turbinal bones(11). Both upper
the skull (3). There are two occipital condyles enclose the
and lower jaws bear heterodont teeth. The lower jaw is
foramen magnum (4). The dorsal surface of the cranial
formed of two mandibles which articulated anteriorly by
region comprisesthe parietal and frontal bones(5). There is
bony mandibular symphysis(12).
a nuchal crest at the line that connects the posterior border

of the parietal and squamosal with the superior border of
MATERIALS AND METHODS
occipital bones (6). Also, there is a prominent sagittal crest
The heads of the three animals (Cavia porcellus,
in the dorsal surface of the skull. The parietal bones are
Hemiechinus auritus and Mustela nivalis vulgaris) were
separated by the sagittal crest (7).
used to study the anatomical structure of the skull and
In the bear's skull, the sagittal crest is not eminent
mandible in each animal. Preparation of the skulls was
(8). The squamosal is placed on the lateral side of the
done by using boiling water to get rid of thesoft tissues.
cranium. It articulates dorsally with the parietal bone.
Then they were placed in 3% hydrogen peroxide for two
Squamosal bone participates in the formation of
weeks. After that, the skulls were left in sunlight to bleach
zygomatic arch by giving a zygomatic process of
(13).
squamosal. The cheek region of the animal's head is

supported internally by the zygomatic arch (9).
RESULTS
The tympanic bullae are located on each side of
Dorsal View of the Guinea Pig's skull:
the basioccipital bone. The pterygoids form the superior
The skull of Guinea Pig is composed of the facial region
and lateral walls of the naso-pharyngeal passage. The
and the cranial region. The cranial bones are: occipital,
vomer articulates caudally with the presphenoid. It forms
parietal, squamosal, sphenoid and ethmoid.

The facial bones are: frontal, nasal, lacrimal,

zygomatic, vomer, palatine, maxilla and premaxilla. The


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696
Received:13/4/2020
Accepted:22 /5/2020

Full Paper (vol.801 paper# 23)


c:\work\Jor\vol801_24 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 704-714

Overview of COVID 19 in Children with the Current Situation in Saudi Arabia
Aisha Almutairi1, Abdullah Al-Shamrani2
1Department of Pediatrics, College of Medicine, Qassim University, 2Prince Sultan Medical Military City
(PSMMC), Department of Pediatric, Riyadh, Saudi Arabia
*Corresponding author: Aisha Thwayb Almutairi, Mobile: 00966503142618, Email: aishaalmutairi@qumed.edu.sa

ABSTRACT
Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), first identified in Wuhan, China, has
resulted within the coronavirus disease 19 (COVID-19) pandemic that has spread to 210 countries worldwide. At the
time of scripting this review, 76,726 people had been infected with and 411 died from SARS-CoV-2 in Kingdom of
Saudi Arabia. COVID-19 has deeply impacted the lives of millions globally, either directly or as a results of the
preventive measures instituted to regulate the spread of the disease. Research groups worldwide are working hard to
develop sensitive and specific diagnostic tools and effective vaccines. This review aimed to supply relevant COVID-
19 research data obtained from a literature review. Conclusion: We believe that our study makes significant
contributions to the literature because it provides a condensed, authoritative presentation of the numerous clinical
presentations, diagnoses, treatments, and patient management strategies for COVID-19. It also as reports
on this COVID-19 situation in Kingdom of Saudi Arabia.
Keywords: COVID 19, COVID 19 diagnostic testing, severe acute respiratory syndrome, coronavirus 2.

INTRODUCTION
clearer. Moreover, the management of neonates born to
In December 2019 in Wuhan, China, some
mothers with COVID 19 has become a further concern;
patients complained of fever and dry cough, and their
there are few neonates born to mothers with COVID 19
laboratory test results indicated either normal or
who had positive SARS COV-2 PCR on screening. Due
decreased leukocyte counts. These patients were initially
to their developing immune system, children and infants
diagnosed with "fever of unknown origin with
are susceptible to upper respiratory tract infection;
pneumonia", and their numbers continued to extend [1].
however, the reasons for fewer reported cases of
The causative organism of this infected pneumonia was
COVID-19 among the pediatric population remain
identified as severe acute respiratory syndrome
unclear. Overall, pediatric patients have been reported to
coronavirus 2 (SARS CoV 2). The World Health
have a good prognosis generally, with an average
Organization named the disease associated with SARS-
hospital stay of 12.9 days [5]. To help facilitate the most
CoV-2 infections as coronavirus disease 2019 (COVID-
effective management for patients with COVID-19, we
19). Coronaviruses (CoVs) are an oversized family of
sought to proceed with a narrative review of all original
RNA viruses that cause illnesses ranging from a common
research related to COVID 19, making it available to
cold to severe diseases such as Middle East Respiratory
everyone. Speed has been important, and to stay pace
Syndrome (MERS) and Severe Acute Respiratory
with the rapid production of new evidence, we have
Syndrome (SARS) [2]. SARS-CoV 2 is extremely
proceeded with informal, rapid, evidence synthesis.
infectious, and this virus has spread rapidly to other
Our review provides a condensed, authoritative
countries. As of May 5, 2020, the globally confirmed
presentation of the varied clinical presentations,
cases with COVID-19 were 3,600,106 and 251,898
diagnoses, and management strategies for patients with
COVID-19-related deaths. The World Health
COVID-19. It also describes the current situation
Organization declared the COVID-19 epidemic as a
regarding COVID-19 in Saudi Arabia.
pandemic on March 12, 2020 [3]. Currently, COVID-19

has spread across 210 countries worldwide. As of May
Etiology and pathogeneses of COVID 19
26th, 2020, 76, 726 individuals in Saudi Arabia had been
SARS CoV 2, a single stranded RNA virus, is
infected with SARS-CoV-2 and 411 individuals had
a member of the genus Beta coronavirus and belongs to
died. Till now no specific therapeutic agents or vaccines
the subgenus Sarbecovirus. SARS CoV 2 particles
for COVID-19 are available. Clinical trials evaluating
contain spikes and envelopes, and the virions are round,
the efficacy of remdesivir and favipiravir on COVID-19
oval, or pleomorphic with breadths of around 60­140
are currently underway [4]. The number of children who
nm. The structural proteins are encoded with four
reported having COVID 19 has gradually become
structural genes, namely, spike (S), envelope (E),


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704
Received:27 /5 /2020
Accepted:30 /6 /2020

Full Paper (vol.801 paper# 24)


c:\work\Jor\vol801_25 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 715-724

Effect of Adding Nalbuphine Hydrochloride Versus Fentanyl on The Characteristic
of Hyperbaric Bupivacaine Spinal Block for Lower Limb Orthopedic Surgery
Wafaa Zaki AL- Morsy, Gihan Eissa Eliwa Zahran, Doha Mohamed Saad AL- Metwaly Salem*
Department of Anesthesia, Intensive Care, and Pain Management. Faculty of Medicine for Girls, Al-Azhar University
*Corresponding author: Doha Mohamed Saad AL- Metwaly Salem, Mobile: (+20)01009969627,
E-Mail: doha.salem1228@gmail.com

ABSTRACT
Background:
The effective relief of pain is of paramount importance for patients undergoing surgery.
Patient and methods: Sixty patients, aged 35 - 45 years, ASA I and II, scheduled for elective lower limb orthopedic
surgery under spinal anesthesia were randomly divided into three equal groups, Control group: were given intrathecal
20 mg (4 mL) of 0.5% hyperbaric bupivacaine. Fentanyl group: were given 17.5 mg (3.5 mL) of 0.5% hyperbaric
bupivacaine with 25 g intrathecal fentanyl. Nalbuphine group: were given 17.5 mg (3.5 mL) of 0.5% hyperbaric
bupivacaine with 0.8 mg intrathecal preservative-free nalbuphine hydrochloride.
Results: There were no statistically significant differences between the three groups regarding the demographic data
or HR. The decrease in MAP was significantly lower in the nalbuphine group when compared with fentanyl and
control groups. The onset of complete motor and the sensory block was statistically significant rapid in the fentanyl
group when compared with other groups. The duration of the motor and the sensory block was highly statistically
significantly prolonged in the nalbuphine group when compared with other groups. Postoperative VAS showed a
highly statistically significant difference between the three groups.
Conclusion: Nalbuphine (0.8 mg) as intrathecal adjuvants to 0.5% hyperbaric bupivacaine increases the duration of
sensory block, motor block, and effective analgesia, and decreases the incidence of intraoperative complication more
efficiently than fentanyl in patients scheduled for elective lower limb orthopedic surgery under spinal anesthesia.
Keywords: Spinal anesthesia, bupivacaine hydrochloride, nalbuphine, fentanyl.

INTRODUCTION
synthetic opioid acts as a partial kappa receptor agonist
The sub-arachnoid block has several advantages
and µ receptor antagonist (4).
over general anesthesia as it is easy to perform, reduces
This mixed agonist-antagonist effect produces
stress response to surgery, and provides effective
analgesia and sedation through agonism at the kappa
postoperative analgesia (1).
receptors and lesser side effects when compared to
Various local anesthetics are available with
intrathecal fentanyl through antagonism at the mu
different durations of action and different degrees of
receptors (5, 6).
safety. Spinal anesthesia with only local anesthetics
AIM OF THE WORK
provides analgesia of short duration. For this
This study was conducted to compare the
reason, many intrathecal adjuvants are added to
effect of adding intrathecal nalbuphine hydrochloride
local anesthetics to prolong the effect of spinal
versus intrathecal fentanyl on the characteristics of
anesthesia(2).
hyperbaric bupivacaine spinal block for lower limb
Intrathecal administration of opioids as an
orthopedic surgery.
adjuvant to local anesthetics was found to prolong the
PATIENTS AND METHODS
duration of postoperative analgesia, reduces local
This prospective randomized double-blinded
anesthetic requirements, and provides better analgesia,
and placebo-controlled study was conducted at Al-
better hemodynamic stability and lesser side effects
Zahraa University hospital on sixty (60) adult patients
than the administration of an individual drug alone,
scheduled for elective lower limb orthopedic surgery
because both drugs have different sites of action, as the
under spinal anesthesia, which started from January
local anesthetics produce its effects by acting at nerve
2020 to April 2020.After obtaining approval of Al-
axon while opioids act on opioid receptors at the spinal
Azhar University medical research ethics committee
cord (3).
and written informed consent from all patients in the
Fentanyl is highly lipid-soluble µ (mu) opioid
study. Age group between 35 to 45 years of both
receptor agonist, that improves the quality of sensory
genders, with weight 50-90kg, and height >150cm
anesthesia and extends the duration of postoperative
belonging to American Society of Anesthesiologists
analgesia, this pure agonist effect is principally
physical status I and II (ASA I and II) were enrolled in
responsible for supraspinal and spinal analgesia along
this study.
with the side effects like nausea, vomiting, pruritus,
While patients with a history of an allergic
sedation, and respiratory depression. Nalbuphine, a
reaction to local anesthetic drugs, contraindication for


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icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
715
Received:15 /5 /2020
Accepted:27 /6 /2020

Full Paper (vol.801 paper# 25)


c:\work\Jor\vol801_26 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 725-729

Vitreous and Serum Levels of Apelin in Type 2 Diabetic Patients with
Diabetic Retinopathy
Nagwa Roshdy Mohamed*1, Ahmed Abdel Monsef Abdel Hamid 2,
Mohamed Hanafy Hashem 2, Nesrine Aly Mohamed 3
1 Department of Internal Medicine and Endocrinology, 2 Department of Ophthalmology, and
3 Department of Clinical Pathology and Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Nagwa Roshdy Mohamed, Mobile: (+20)01065958431, E-Mail: dr_pharos2000@yahoo.com

ABSTRACT
Background:
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes, and is the
leading cause of blindness and visual impairment in the working-age population. Retinal neovascularization is the
most important clinical features of proliferative DR (PDR). Apelin is an endogenous ligand of the G protein-
coupled receptor, which has been shown to be involved in retinal angiogenesis.
Objective
: To study vitreous and serum levels of apelin in type 2 diabetic patients with diabetic retinopathy.
Patients and methods: Case control study was conducted on total 60 subjects, 40 type 2 diabetic patients and 20
non diabetic subjects as control group. Diabetic patients were divided into 2 groups.
Results: Serum and vitreous levels of apelin were significantly higher in patients with PDR compared to NPDR
and control group (P< 0.001). There was non-significant correlation between serum and vitreous apelin. Serum
apelin showed lower cut off value (>4.45 ng/ml (P<0.001) with 96.7% sensitivity and 96.7 specificity) for detection
of PDR compared to control group than vitreous apelin. Also serum apelin showed lower cut off value >3.55 ng/ml
for detection of NPDR compared to control group.
Conclusion: Elevation of serum apelin in patients with PDR compared to NPDR and control group suggesting the
role of apelin in development of retinal neovascularization and diabetic retinopathy. So antagonizing effect of
apelin can be used as targeted therapy for treatment of diabetic retinopathy. We can rely on serum apelin for early
detection of diabetic retinopathy than vitreous apelin.
Keywords: Type 2 diabetes mellitus, proliferative diabetic retinopathy (PDR), non-proliferative diabetic
retinopathy (NPDR), Serum and vitreous apelin.

INTRODUCTION

Diabetic retinopathy (DR) is one of the most
Animal studies demonstrated that inhibition of
serious microvascular complication of diabetes
apelin-APJ system facilitated retinal vessel
mellitus and is one of the leading causes of blindness
maturation in ischemic retinopathy model, and
in working-age population. There are many
inhibition of apelin expression switched endothelial
angiogenic factors including cytokines, inflammatory
cells from proliferative to mature state in pathological
cells, growth factors, have been identified to play
retinal angiogenesis (4). So in our study we assessed
important roles in the pathogenesis of retinal
serum and vitreous level of apelin in diabetic
neovascularization including vascular endothelial
retinopathy to detect possible role of apelin in
growth factor (VEGF) and apelin which is a newly
development of diabetic retinopathy and its use as a
discovered adipokines involved in many metabolic
serum marker in early detection of diabetic
disorders (1).
retinopathy and as a targeted therapy of retinopathy.
Apelin is produced and secreted by both human
Aim of the work to study serum and vitreous level of
and mouse white adipose tissue. Studies have shown
apelin in type 2 diabetics with diabetic retinopathy.
that apelin was involved in vascular pathophysiology

and act as an angiogenic factor stimulating retinal
PATIENTS AND METHODS
endothelial cells' proliferation, migration and vascular
Study design:
tube formation (2).
Case control study was conducted on total 60
Furthermore, studies found that inhibition of
subjects, 40 type 2 diabetic patients and 20 non-
apelin/apelin receptor (APJ) system prevented rapid
diabetic subjects suffering from other conditions
abnormal vessel growth. Deficiency of apelin
necessitating vitrectomy such as retinal detachment as
successfully inhibited hypoxia-induced retinal
control group. Diabetic patients were divided into 2
angiogenesis in mice despite upregulation of VEGF.
groups. Group1: 20 type 2 diabetic patients with
Apelin was shown to affect many biological functions
proliferative retinopathy (PDR); group 2: 20 type 2
in mammals, such as adjusting the neuroendocrine,
diabetic with non-proliferative retinopathy. They were
cardiovascular, and immune systems by autocrine,
collected from endocrinology and ophthalmology
paracrine, endocrine and exocrine signaling (3).
outpatient clinics of Ain Shams University Hospitals


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725
Received:17 /4 /2020
Accepted:26 /5 /2020

Full Paper (vol.801 paper# 26)


c:\work\Jor\vol801_27 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 730-736
Prevalence of Urinary Tract Infection in Nephrotic Syndrome at
Zagazig University Children Hospital
Ali Mohammed Abo Zeid1, Mayy Abdel-Fattah Mohammed1, Rehab Hosny El-Sokary2,
Hosny Hussien Hosny Ahmed*1
Departments of 1Pediatrics and 2Microbiology and Immunology, Faculty of Medicine, Zagazig University
*Corresponding author: Hosny Hussien Hosny Ahmed, Mobile: (+20) 01006714949, E-Mail: dr.hosnyaser@gmail.com

ABSTRACT
Background:
Nephrotic syndrome (NS) is the most common chronic glomerular diseases in children. Nephrotic
syndrome increases a child's susceptibility to infection. Urinary tract infection (UTI) is the second most common
bacterial disease in children after upper respiratory tract infection.
Aim of this work: To find out the prevalence of UTI (either community acquired or hospital acquired) in NS children
and to uncover the bacterial spectrum and their sensitivity pattern for selecting the empirical antibiotic therapy till the
results of culture are awaited.
Subjects and methods: This study was descriptive cross sectional. 33 nephrotic syndrome cases were included in study.
All patients were subjected to full history taking, complete clinical examination and investigations as urine analysis and
urine culture. Results: The percentage of community acquired urinary tract infection (CA-UTI) was 57.6 % and hospital
acquired urinary tract infection (HA-UTI) was 42.4 %. E. coli is the commonest organism causing UTI followed by
klebsiella and proteus mirabilis. The isolated organisms showed resistance to many oral and parenteral antibiotics.
Amikacin gentamycin may be the first option of empiric therapy while waiting for culture reports. Conclusion: Children
with nephrotic syndrome are frequently predisposed to UTI and in most cases it is asymptomatic often undiagnosed.
Identifying bacterial causes and their susceptibility pattern of UTI will help in selecting the empirical antibiotic therapy
till the results of culture are awaited. Although dipstick and microscopic urinalysis can support the diagnosis of UTI,
growth of a single type of bacteria on urine culture is the gold standard.
Key words: Urinary Tract Infection- Nephrotic Syndrome- Prevalence.

INTRODUCTION

The aim of this work was to find out the prevalence
Nephrotic syndrome is most prevalent in children
of UTI (either community acquired or hospital
with chronic glomerular diseases. In children the
acquired) in NS children and to uncover the bacterial
incidence of this syndrome is 2-7 cases per 100.0000 (1).
spectrum and their sensitivity pattern for selecting the
Most (90 per cent) cases of nephrotic syndrome are
empirical antibiotic therapy till the results of culture are
idiopathic. The other 10 % have a secondary idiopathic
awaited.
nephrotic syndrome to glomerular or systemic diseases

(2). Nephrotic syndrome patients suffer from various
SUBJECTS AND METHODS
complications such as infection, effusion, hypovolemia,
Technical design:
hyperlipidemia and hypercoagulability (3). When
Study design: A descriptive cross-sectional study,
children suffering from nephrotic syndrome reach the
carried out at a Pediatric Nephrology Unit of Children
pediatric ward in the hospital, it is essential to examine
Hospital and Medical Microbiology and Immunology
them first in order to avoid possible complications or
Department, Faculty of Medicine, Zagazig University.
immediate discovery of infections and to initiate
It was carried out over a period of twelve months from
appropriate therapy (4).
February 2018 to January 2019.
Nephrotic syndrome makes the child more
Subjects: Thirty-three nephrotic syndrome cases were
susceptible to infection. Urinary tract infection is the
included in study. This study was designed to assess the
2nd most common bacterial disease in children
prevalence of urinary tract infections (either community
following infection of the upper respiratory tract and is
acquired or hospital acquired) and bacterial spectrum
the most prevalent bacterial infection that affects
and their sensitivity pattern in children with nephrotic
humans throughout their lives (5).
syndrome either newly diagnosed (1st attack) or
Symptoms of the urinary tract infection differ in
relapsed cases of nephrotic syndrome attending at
age and the younger the child the much more non-
children hospital.
specific these symptoms are (6).


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Commons Attribution (CC BY-SA) li

cense (http://creativecommons.org/licenses/by/4.0/)
730
Received:20 /4 /2020
Accepted:29 /5 /2020

Full Paper (vol.801 paper# 27)


c:\work\Jor\vol801_28 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 737-742

Incidence of Acute Kidney Injury Among Cases with Suicidal Attempts of
Paraphenylenediamine Poisoning in Aswan University Hospital
Omaima Mohamed Ali 1, Lalaa Abd Elrahem Othman1,
Wafaa Salah Mohammed 2, Wael Abd Elgwad Elsewify 1*
Departments of 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine,
Aswan University, Aswan, Egypt
*Corresponding author: Wael Abd Elgwad Elsewify, Department of Internal Medicine, Faculty of Medicine, Aswan
University, Aswan, Egypt, Tel: +201001657295, Email: waelelsewify@yahoo.com

ABSTRACT
Background
: The rate of suicidal attempts with paraphenylenediamine (PPD) poisoning has raised steadily in
the past few decades. Recently, a growing body of evidence demonstrated that PPD can lead to acute kidney
injury (AKI).
Objectives
: To assess the incidence of AKI among cases with suicidal attempts of PPD poisoning in Aswan
University hospital.
Patients and Methods
: Our study was a cross-sectional study that included 94 patients presented with suicidal
attempts of paraphenylenediamine (dark hair dye) at Aswan University Hospital during the period from January to
December 2019. All of the participants were subjected to history taking as age, sex, route of administration, suicidal
or accidental intake of dye, type and amount of dye used, and duration of intake. Examination and investigations
were as follows, vital data: BP, temperature, pulse, respiratory rate, electrocardiogram (ECG ), urine analysis,
blood urea, serum creatinine, serum sodium, serum potassium, creatine phosphokinase (CPK), alkaline
phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum uric acid, arterial blood
gases (ABG) and follow up for the development of any complications or any interventions as tracheostomy,
intubation, and hemodialysis.
Results: The mean age of the included patients was 26.1 ±12.9 years and the majority of them were females
(66%). In terms of the primary outcome of the present study, we found that the incidence of AKI was 29.7%.
There were statistically significant differences between AKI and non-AKI patients in terms of serum ALT (p
=0.001), serum AST (p =0.001), serum urea (p =0.001), serum creatinine (p =0.001), and serum CPK (p =0.001).
Additionally, patients with AKI had a significantly higher mortality rate than non-AKI patients (p =0.023).
Serum CPK was a major predictor of AKI in the univariate analysis.
Conclusion: In conclusion, AKI is considered one of the most common problems in patients with suicidal
attempts of PDD ingestion. AKI is one of the leading causes of mortality in patients with PPD ingestion.
Keywords: AKI, Paraphenylenediamine, Suicidal attempt.

INTRODUCTION

patients present with PPD poisoning is 93% (5). The
Suicide is a main public health concern in
systematic administration of PDD can lead to a
both developing and developed countries, which
variable degree of edema in various body parts that
contribute to at least 2% of global health issues (1).
can extend to larynx leading to suffocation and
According to the World Health Organization (WHO)
respiratory distress. Besides, PPD ingestion can be
report, it is estimated that suicide will kill one and a
complicated by rhabdomyolysis, acute hepatitis,
half million people worldwide by the end of 2020 (2).
acute renal failure, myocarditis, arrhythmias,
Over the past two decades, the rate of suicidal
metabolic abnormalities, seizures, shock, and
attempts has increased exponentially in developing
eventually death (6). Moreover, survivors can suffer
countries, recent reports estimated that more than
from long-term sequelae such as chronic kidney
two-thirds of the global suicidal attempts occur in
disease requiring maintenance hemodialysis(7).
developing countries alone (3).
The direct toxic effects of PPD can lead to
Oral ingestion of paraphenylenediamine
many pathological problems. Therefore, patients
(PPD) is a common suicidal method, especially in the
with PPD poisoning can present with some
Middle East and East Africa. PPD is an aniline
hematological and biochemical abnormalities (8).
derivative commonly present in commercial hair dye
Hair dye ingestion is a medical emergency.
formulations, it presents in henna (Lawsonia alba) to
Emergency measures should include gastric lavage.
darken its color, as well as in many-body tattooing
Patients should be monitored for respiratory distress
materials (4). According to a recently updated meta-
and endotracheal intubation has to be performed
analysis study, the prevalence of suicidal attempts in
early if laryngeal edema develops. Metabolic


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ses /by/4.0/)
Received:19 /4 /2020
Accepted:28 /5 /2020

Full Paper (vol.801 paper# 28)


c:\work\Jor\vol801_29 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 743-747

Effect of Phototherapy on Serum Level of Calcium and Magnesium in Term and
Preterm Neonates with Hyperbilirubinemia
Mohamed Mamdouh Gaafar1, Ehab Mahmoud Rasheed1,
Samar Mahmoud Abdel Halim2, Mousbah Mohamed Abdullah Mohamed El Gendi1
Departments of 1Pediatrics, 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mousbah Mohamed Abdullah Mohamed El Gendi, Mobile: (+20) 1018213213,
E-Mail: mousbahelgendi77@gmail.com

ABSTRACT
Background: Hyperbilirubinemia is one of the most prevalent problems in neonates. Jaundice is observed during
first week of life in approximately 60% of term neonates and 80 % of preterm neonates. Phototherapy is one of the
routine methods for management of hyperbilirubinemia. Many studies reported that serum levels of calcium and
magnesium are significantly affected after 48 hours of exposure to phototherapy.
Objectives: The aim of the work was to study the effects of phototherapy on serum calcium and serum magnesium in
full term and preterm neonates with hyperbiliurbinemia.
Patients and Methods: The current study was prospective cohort that was conducted in neonatal intensive care unit
(NICU), Zagazig University children hospital in period between August 2018 to July 2019. 60 jaundiced infants
admitted to (NICU) in the study. They were divided into 2 groups; Group I: 43 patients (full terms), Group II: 17
patients (preterms). Patients were examined for the effect of phototherapy on serum level of calcium and magnesium.
Results: There was a statistically significant difference between serum calcium and serum magnesium before and
after 48 hours of exposure to phototherapy (P <0.001). Calcium was distributed pre and post phototherapy as
9.63±0.79 and 9.04±0.78 respectively and Magnesium was distributed pre and post phototherapy as 2.17±0.23 and
1.91±0.18. Total bilirubin was distributed pre and post phototherapy as 16.76±2.99 and 11.0±2.45 respectively and
direct bilirubin pre and post as 1.05±0.33 and 1.05±0.32 respectively. Preterm were 28.3% (17 in number) and full-
term were 71.7 % (43 in number).
Conclusion:
Based on the findings of our study, phototherapy can significantly decrease the levels of calcium and
magnesium in jaundiced term and preterm infants undergoing phototherapy.
Keywords: Hyperbilirubinemia, Neonates, Phototherapy, Calcium, Magnesium.

INTRODUCTION

the effect of phototherapy on the decrease of melatonin
Neonatal jaundice or hyperbilirubinemia is an
leading to decrease in melatonin, spatter of reduced
unpreventable condition in 60% -80% of newborns
glucocorticoid, and increase in calcium resorption from
worldwide. In a proportion of infants, jaundice may
bone that causes hypocalcemia (4).
become severe progressing to acute bilirubin
Magnesium is the fourth most abundant cation in
encephalopathy or kernicterus with a significant risk of
the body and its vast majority is stored intracellularly.
neonatal mortality. Surviving infants may acquire
It is, however, the extracellular concentrations of the
long-term neurodevelopmental sequelae such as
mineral that is of interest to the clinician due to its
cerebral palsy, sensorineural hearing loss, intellectual
association with symptoms and signs. The major organs
difficulties or gross developmental delay (1).
involved in magnesium homeostasis are the gut, bone,
Phototherapy plays a significant role in the
and kidney, but the regulators affecting these organs at
treatment and prevention of hyperbilirubinemia in
the cellular level are not yet fully understood.
neonates. This relatively common therapy lowers the
Hypermagnesemia is rare and is seen mostly in those
serum bilirubin level by transforming bilirubin into
with renal failure and in the elderly. It is suggested that
water-soluble isomers that can be eliminated without
there is a positive correlation between plasma ionized
conjugation in the liver (2).
Mg levels and severity of hyperbilirubinemia in
The effectiveness of phototherapy depends upon
newborn (5).
the type of light source used (i.e. dose, spectral emission
Calcium, magnesium, are important elements in
curve, depth of penetration), the distance between the
the body and phototherapy can lead to the decrease of
light and the infant, the surface area treated, the etiology
serum calcium and magnesium in the blood. On the
of the jaundice, and total serum bilirubin level at the
other hand, decrease in calcium and magnesium can
onset of phototherapy (3).
cause certain complications such as apnea, muscular
In the recent years, limited research showed that
tick convulsion, and decrease in absorption of vitamin
phototherapy should be considered as a risk factor for
D, which causes a decrease in the absorption of calcium.
hypocalcemia and its mechanism is probably based on
Therefore, any changes in the blood level cause


This article is an open access art

icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
743
Received:21 /4 /2020
Accepted:30 /5 /2020

Full Paper (vol.801 paper# 29)


c:\work\Jor\vol801_30 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80, Page 748-753

Efficacy of Cd40l As an Early Marker in Diagnosis of
Hcv-Related Hepatocelluler Carcinoma
Amany Mohamed Ibrahim1, Ayman Fathy El Sayed1, Emad Abd Elhamid Morad2,
Reem Ahmed Nour Eldein Khalifa*1
1Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
2Microbiology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Reem Ahmed Nour Eldein Khalifa; Email: drreemkhalifa177@gmail.com;
Mobile: (+20) 01033301241

ABSTRACT
Background:
Hepatocellular Carcinoma (HCC) is the commonest primary cancer of the liver. Incidence of
HCC is increasing to be the fifth most common cancer and the second most frequent cause of cancer-related
death globally. Kupffer cells and hepatocytes can express elevated levels of CD40 in hepatitis C virus-
associated chronic liver disease. The CD40 CD40ligand co stimulatory pathway is associated with liver injury
and hepatocyte apoptosis.
Objective: This study aimed to evaluate efficacy of soluble CD40 ligand as an early marker in diagnosis of
HCV- related HCC.
Subjects and methods: This is a case control study. It was conducted in Internal Medicine and Microbiology
Departments, Faculty of Medicine, Zagazig University Hospitals along six months. Ninety subjects were
included in this study. They were classified into three groups as follows: Group 1 that included 30 (18 males
and 12 females) apparently healthy subjects aged between 44 to 67 years old. Group 2 that included 30 patients
(20 males and 10 females) aged between 41 to 65 years old with chronic HCV infection without HCC. Group
3 that composed of 30 patients (22 males and 8 females) aged between 44 to 65 years old with chronic HCV
infection with HCC.
Results: There was statistical significance increase in CD40 level in group 3 compared to the other two groups
(1 and 2). There was significant negative correlation between serum CD40L with both Hb and PLT, while
there was significant positive correlation between CD40 level with T.bilirubin, D.bilirubin, ALP, INR and
AFP.
Conclusion: Serum CD40L is significantly increased in patients with chronic HCV-related HCC. So, CD40L
can be used as a non-invasive pro inflammatory marker for diagnosis of HCC.
Keywords: HCV infection, HCC, CD40l..


INTRODUCTION

Hepatitis C is an infectious disease caused
cells and is expressed on APCs, such as B cells,
by the hepatitis C virus (HCV) that primarily
dendritic cells (DCs), macrophages, and
invades the liver (1). The virus persists in the liver
monocytes, as well as on non-immune cells such as
in about 75% to 85% of those initially infected.
epithelial,
endothelial,
and
mesenchymal
Over many years however, it often leads to chronic
(fibroblasts, myofibroblasts, synoviocytes, stellate
liver disease and cirrhosis (2). In some cases, those
cells, etc.) cells, platelets and tumors (4).
with cirrhosis will develop complications such as
CD40L is produced as a type II
liver failure, liver cancer, or dilated blood vessels
transmembrane protein, CD40L may be expressed
in the esophagus and stomach (1).
on the cell surface as a heteromultimeric complex.
There has been a remarkable increase of the
Apart from its 33-kDa form, the molecule is
proportion of HCC among Chronic liver disease
associated with two shorter versions of the protein
(CLD) patients in Egypt from 4.0% to 7.2% over a
of 31 and/or 18 kDa. These shorter soluble forms
decade. This rising proportion may be explained by
of CD40L retain their ability to form trimers, to
the increasing risk factors such as the emergence of
bind CD40, and to deliver biological signals, thus
HCV over the same period of time, the contribution
indicating that CD40L might also act as a bona fide
of HBV infection, improvement of the screening
cytokine (5).
programs and diagnostic tools of HCC (3).
In cancer patients, sCD40L is more likely
CD40 is a 40- to 45-kD type I membrane
derived from activated platelets than from T cells,
protein and a member of the TNFR superfamily
a notion supported by evidence that cancer patients
that exists as a constitutional trimer complex on the
have significant platelet activation, as well as
cell surface. CD40 was initially characterized on B
inadequate T-cell activation (6).


This article is an open access art

icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
748
Received:23 /4 /2020
Accepted:2 /6 /2020

Full Paper (vol.801 paper# 30)