c:\work\Jor\vol803_1 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 951-957

Evaluation of Serum Eosinophil-Derived Neurotoxin Level in Children with
Bronchial Asthma and its Relation to Disease Severity
Osama Taha Amer, Mohammed Sanad Naguib, Ayman Abdulrahman Allam, Essam Monir Ibraheem Fouad
Department of Pediatrics, Faculty of Medicine ­ Zagazig University
*Corresponding author: Essam Monir Ibraheem Fouad, Mobile: (+20)01024683929,
Email: mosad8rashed@gmail.com

ABSTRACT
Background:
Asthma is a chronic inflammatory disease of multifactorial etiologies. The eosinophil is a major player
in allergic disease. Therefore, direct measurement of eosinophilic inflammation is needed for diagnosis.
Objective: To assess Eosinophil-Derived Neurotoxin serum level in children with bronchial asthma. Also, to
determine the relation of these levels to severity of bronchial asthma in children.
Patients and methods:
This case control prospective study was conducted during the period from August 2018 to
August 2019. This study included 85 cases (17 in each group) divided into: control, intermittent, mild, moderate and
severe persistent asthma groups. This study was carried out at Pediatric Department of Zagazig University Hospitals.
Results: Eosinophil-Derived Neurotoxin (EDN) concentrations were significantly increased in asthmatic children
when compared to controls (p-value < 0.05). The current work revealed that EDN levels can be considered as a
possible biomarker for asthma diagnosis (PPV = 91.9%, NPV = 100%, sensitivity = 100%, specificity = 64.7%). The
level of serum EDN was statistically higher in moderate and severe 0.832.
Conclusion: EDN level was higher in asthmatic children than controls and correlated with asthma severity. Therefore,
serum EDN can be considered as a possible biomarker for diagnosis, grading of asthma severity and the degree of
airway inflammation. Serum EDN had a significant correlation with mean spirometric parameters in asthmatics.
Therefore, it can reflect airway resistance in asthmatic children.
Keywords: Serum Eosinophil-Derived Neurotoxin, Bronchial asthma, Evaluation, Severity.

INTRODUCTION

Asthma is a chronic inflammatory disease of
asthma and to determine the relation of these levels to
multifactorial etiologies that affects 300 million people
severity of bronchial asthma in children.
worldwide. Initially, asthma was considered typical

eosinophilic airway inflammation initiated by allergic
PATIENTS AND METHODS
sensitization,
which
results
in
airway
This case control prospective study was conducted
hyperresponsiveness
(AHR)
and
acute
during the period from August 2018 to August 2019.
bronchoconstriction. Among asthmatic patients, severe
This study included 85 cases divided into 5 groups:
asthma (SA) is responsible for more than 50% of the
control, intermittent, mild, moderate and severe
medical expense of asthma, even though it accounts for
persistent asthma (17 in each group). This study was
5%-10% of entire asthma patients. Severe asthmatics are
carried out at Pediatric Department of Zagazig
suffering from frequent exacerbations that contribute to
University Hospitals.
progressive lung function decline and increasing burden

of medical cost [1].
Design of the study: Case control prospective study.
The eosinophil is a major player in allergic disease.
Ethical approval:
Therefore, direct measurement of eosinophilic
This study was ethically approved from
inflammation is needed for diagnosis, treatment and
Institutional Reviewer Board (IRB), Faculty of
monitoring of asthma. However, management decisions
Medicine, Zagazig University Hospital. A written
have traditionally been based on symptoms (non-
consent was obtained from every case' parent or their
specific and subjective), airway function and rescue
caregivers.
medication use. The current feeling on eosinophilic

inflammation
monitoring
is
that
eosinophil
Sample size:
counts/percentages provide only a limited understanding
Assuming that mean + SD of Eosinophil-
of the activity of these cells, whereas, the secretory
Derived Neurotoxin in bronchial asthma group and in
activity of eosinophils (the product of the concentration
control group was 73.3 + 59.5 versus 31.9 + 22.5
of eosinophils and their propensity to release mediators)
respectively. So, sample size was calculated by Open
provides a more accurate and complete picture [2].
Epi program to be 85 cases (17 in each group):
This study aimed to assess Eosinophil-Derived
control, intermittent, mild, moderate and severe
Neurotoxin serum level in children with bronchial
persistent asthma with confidence level 95 % &

power of test 80%.

This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (

CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
951
Received:20 /5 /2020

Accepted:30 /6 /2020

Full Paper (vol.803 paper# 1)


c:\work\Jor\vol803_2 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 958-963

Role of Diffusion-Weighted Magnetic Resonance Imaging in the
Diagnosis of Hepatic Focal Lesions
Ahmed Okasha Mohammed1, Mohamed Mostafa Ali2, Hoda Rabea Hassan1, Wael Mohammed Wagdy*1
1Radiodiagnosis Department, 2Clinical Oncology Department,
Faculty of Medicine, South Valley University, Egypt
*Corresponding author: Wael Mohammed Wagdy, Mobile: (+20) 01005651501, Email: massa2000@yahoo.com

ABSTRACT
Background:
Diffusion-weighted imaging (DWI) is a novel imaging technique with a growing application in onco-
imaging. This modality evaluates the diffusion of water molecules in various tissues, which is restricted in
hypercellular regions such as malignant tissue. Apparent diffusion coefficient (ADC) is a method that can quantify
the degree of restriction in tissues and can have diagnostic roles in the characterization of hepatic lesions.
Aim of the Work: To study the role of diffusion-weighted MRI sequence with quantitative ADC measurements as
a useful tool in the differentiation between benign and malignant liver lesions.
Patients and Methods: The current study was carried out on thirty adult patients, 24 males (80%), and 6 females
(20%). They were presented to Qena University Hospitals at the Radiodiagnosis Department.
Results: Both, qualitative evaluation of high b-value DW-MR images and quantitative evaluation of ADC maps are
employed for lesion characterization. The ADC values of benign lesions are significantly higher than those of
malignant lesions, with variable degrees of overlap between the pathological entities.
Conclusion: DW MR imaging has the potential to be a reasonable alternative technique to contrast-enhanced
imaging.
Keywords:
DWI, Hepatic focal lesions, ADC.

INTRODUCTION

reported to be useful for the early detection of small
Liver diseases have been known liver size and
focal hepatic lesions. Moreover, DWI offers the
functions but the assessment of the exact pathology is
possibility to obtain criteria for lesion characterization
grossly inadequate. Focal liver disease is a common
without the need for contrast agent administration by
diagnostic problem referred to the radiologists for
quantifying diffusion effects via apparent diffusion
evaluation owing to its nonspecific clinical presentation
coefficient (ADC) measurements, with better results
and marked inter-observer variation on clinical
compared with those of conventional MR imaging(2).
examination (1).
DWI could characterize specific tissue
The liver is considered a common site for many
properties without any harm to patients, especially
benign, primary malignant and metastatic focal lesions.
beneficial for those who are at risk for complications of
Accurate detection and characterization of these tumors
a biopsy procedure(4).
are crucial before treatment to ensure correct staging, to

prevent tumors from being falsely rated as inoperable
AIM OF THE WORK
and patients with inoperable tumors from being
The present work aimed to study the role of
scheduled for surgical procedures(2).
Diffusion-Weighted Magnetic Resonance Imaging
Today, focal masses are diagnosed using
(DW MRI) & ADC in the detection of hepatic focal
ultrasonography (USG) and/or computed tomography
lesions and its ability to differentiate between benign
(CT). Additionally, magnetic resonance imaging (MRI)
and malignant hepatic focal lesions.
is preferred when further characterization of these

masses is needed(1).
PATIENTS AND METHODS
Ultrasound has a high sensitivity (Se) for FLLs
The current study was performed in Qena
detection but with low specificity (Sp) for
University Hospitals, where thirty patients with hepatic
discriminating between different entities. CT is
focal lesions were included in this study. All patients
recommended in patients with known malignancy for
underwent US before MR examination.
staging, and in patients with chronic liver disease or
Inclusion Criteria:
even in otherwise healthy persons for confirmation of a
1. Patients with hepatic focal lesions diagnosed by US
suspected liver tumor detected in the US. MRI is
or CT.
considered the imaging technique with the best Se and
2. Hepatic focal lesion more than 10 mm.
Sp for FLL diagnosis. Diffusion-weighted imaging
3. Age > 18 years.
(DWI) is a relatively recent non-contrast imaging tool
that has a high contrast resolution allowing accurate
Exclusion Criteria:
FLLs detection and characterization(3).
1. Patients who have a heart pacemaker.
Diffusion-weighted imaging (DWI) has been
2. Patients who have a metallic foreign body.

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/)
958
Received:20 /5 /2020

Accepted: 30/ 6/2020

Full Paper (vol.803 paper# 2)


c:\work\Jor\vol803_3 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 964-970

Adverse Effects of Fast Green, Sodium Nitrate and Glycine on Some
Physiological Parameters
Eman G.E. Helal*1, Aisha Almutairi2, Mohamed A. Abdelaziz3, Asmaa A. H. Mohamed1
1Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Egypt,
2Department of Pediatrics, College of Medicine, Qassim University, Saudi Arabia.
3Department of Physiology, Faculty of Medicine (Boys), Al-Azhar University, Egypt
*Corresponding Author: Eman Helal, Email: emanhelal@hotmail.com,
Mobile: 00201001025364, orcid.org/0000-0003-0527-7028

ABSTRACT
Background
: Food additives are a substance added to food to enhance its flavor or appearance or to preserve it. They
are widely used nowadays.
Objectives:
The aim of the current work was to determine the hazardous effects of sodium nitrate, fast green and glycine
on some physiological parameters such as liver enzymes, lipid profile , hormonal assays ...etc.
Materials and methods: This study has been done on forty male albino rats. The Animals were divided into four groups:
Group I (Control untreated group), Group II (fast green-treated group), Group III (glycine-treated group) and Group
IV
(sodium nitrate-treated group). Estimation of some biochemical parameters (liver enzymes, kidney function tests,
glucose, protein profile and lipid profile) and hormonal assays [testosterone, T3 (triiodothyronine), T4 (thyroxine) and
insulin were done.
Results: body weight was increased in fast green-treated group and decreased in sodium nitrate group. There was an
increase in the activities of AST and ALT as well as urea and creatinine, in both sodium nitrate and fast green groups.
There was a decrease in plasma proteins in both fast green and sodium nitrate groups. Lipid profile [total cholesterol
(TC), triglycerides (TG), very low-density lipoprotein-cholesterol (VLDL-chol) and low-density lipoprotein-cholesterol
(LDL-chol)] were decreased in fast green-treated groups while high-density lipoprotein-cholesterol (HDL-chol) was
increased. In sodium nitrate group, the lipid profile (TC, TG, VLDL and LDL) were increased while HDL was
decreased. Serum glucose, insulin, and HOMA-IR (insulin resistance) were decreased in fast green-treated group and
increased in sodium nitrate-treated group. There was a decrease in T3 and T4 in fast green-treated group while were
increased in sodium nitrate-treated group. Testosterone decreased in fast green-, glycine- and sodium nitrate-treated
groups. While glycine-treated group showed the same results as the control group.
Conclusion: It could be concluded that minimizing the use of food additives protects young children and mature people
from their destructive effects.
Keywords:
Food additives, Thyroid hormones, Glycine, Sodium nitrite, Fast green.

INTRODUCTION
minerals or they can be synthetic. They are added
Food-added substances are those added to food
deliberately to food to play out certain technological
to keep up or improve the safe, newness, taste, surface,
purposes which shoppers frequently underestimate.
or appearance of food. Some food-added substances
There are a few thousand food-added substances
have been utilized for quite a long time for conservation
utilized, which are all intended to make a particular
as salt (in meats, for example, bacon or dried fish), sugar
showing in making food more secure or additionally
(in jelly), or sulfur dioxide (in wine). A wide range of
engaging (2).
food-added substances have been created over time to
Fast green (FG) is a bluish green powder totally
address the issues of food creation, as making food for
disintegrated in water. Its chemical structure is C37H34
an enormous scope is totally different from making
N2Na2OlOS3 (1). Van Hooft mentioned that quick
them at home. Added substances are expected to
green is one of the manufactured natural food-added
guarantee handled food stays safe and in great condition
substances, utilized as a coloring operator for
all through its excursion from factories or industrial
nourishments, medications, and beautifying agents. It is
kitchens, during transportation to distribution centers
utilized in coloring drinks, dairy items, puddings, fruits,
and shops and lastly to customer (1).
sugary treats, ice cream, sherbet and baked goods (3).
The utilization of food-added substances is
As of late, the potential job of food-added
possibly advocated when their utilization has a
substances in food prejudice has gotten specific
technological need, does not mislead customers and
consideration. FG appeared to have harmfulness,
serves a very much technological function capacity (for
altering the quick unfavorably susceptible reaction
example, to protect the healthful nature of the food or to
when ingested orally in food (4), impairing hepatic
upgrade the soundness of the food). Food-added
functions and restraining synaptic action in rat
substances can be gotten from plants, creatures,
hippocampal interneurons(5).

This article is an open access article distribute
d under the terms and conditions of the
Creative Commons Attribution (CC BY-SA)

license
(http://creativecommons.org/licenses/
by469
/4.0/)
Received:10 /5 /2020

Accepted:19 /6 /2020

Full Paper (vol.803 paper# 3)


c:\work\Jor\vol803_4 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 971-976
Efficacy of Intensive Phototherapy as A Treatment Modality for Neonatal
Hyperbilirubinemia
Amira Mohammed Mohammed Hamed, Mohammed Mahmoud Sayed Younis,
Said Mostafa Al-Sayed Mohammed*
Departemnt of Pediatrics, Faculty of Medicine ­ Al-Azhar Universty (Assiut)
*Corresponding author: Said Mostafa Al-Sayed Mohammed, Mobile: (+20) 01116024807, (+20) 01119776144

ABSTRACT
Background:
Jaundice is the most common condition that requires medical attention in newborns. The yellow
coloration of the skin and sclera in newborns with jaundice is the result of accumulation of unconjugated bilirubin.
Objectives:
To assess the efficacy of intensive phototherapy as a treatment modality for neonatal hyperbilirubinemia.
Subjects and methods: This was A prospective, cohort, controlled study that was conducted on 100 babies with
neonatal jaundice. They were admitted to Luxor General Hospital NICU at the beginning of November 2018 to the
end of October 2019. Those 100 cases had been divided into 2 groups: the first group received intensive phototherapy
sessions as a treatment modality for neonatal jaundice and the second group received conventional phototherapy.
Results:
The results of the study revealed that intensive phototherapy had succeeded in decreasing the need for
exchange transfusion in 39 cases (78 %), whereas 11 cases (22%) remained for exchange transfusion (p value (0.001)
was highly significant).
Conclusion: The use of intensive phototherapy in the treatment of indirect pathological hyperbilirubinaemia is as
effective as exchange transfusion in lowering total serum bilirubin when its level is within 2-3 mg/dl (34-51 µmol/l)
of the exchange level and it is effective in reducing needs for exchange transfusion and duration of phototherapy.
Keywords: Exchange transfusion, Conventional phototherapy, Neonatal, Jaundice.

INTRODUCTION

Kernicterus
and
other
complications
of
Neonatal jaundice is defined as yellowish
hyperbilirubinemia, jaundice should be managed by
discoloration of skin, sclera of eyeball, and mucous
phototherapy or exchange transfusion (ECT) (5).
membranes caused by deposition of bile salts in these
Phototherapy is a useful method for treating
tissues. Depending upon the cause, jaundice may be
neonatal hyperbilirubinemia because it is easily
present at birth or any time during the neonatal period.
available and devoid of all complications of double
Jaundice due to either indirect (unconjugated) or direct
volume exchange transfusions. The efficacy of
(conjugated) bilirubin within the first 24 hours of life
phototherapy depends on the dose and wave length of
should be taken seriously (1).
light used and the surface area exposed (6). Intensive
Neonatal jaundice is estimated to occur in 60%
phototherapy in neonatal hyperbilirubinemia rapidly
of term newborns in the first week of life, and < 2%
decreases total serum bilirubin (TSB) below the
reach total serum bilirubin (TSB) levels of 20 mg/dL. In
threshold
for
treatment
(5).
rare instances, the TSB reaches levels that can cause

kernicterus, a condition characterized by bilirubin
AIM OF THE WORK
staining of neurons and neuronal necrosis involving
The aim of the work was to assess the
primarily the basal ganglia of the brain and manifested
effectiveness of intensive phototherapy in comparison
in athetoid cerebral palsy, hearing loss, dental dysplasia
with conventional phototherapy in reducing the need for
and paralysis of upward gaze (2).
exchange transfusion during the management of
The most common cause of jaundice in first 24
neonatal hyperbilirubinemia.
hours of life due to hemolytic disease of newborn

(HDN) is rhesus (Rh) hemolytic disease. As the mother
SUBJECTS AND METHODS
becomes sensitized due to feto-maternal previous
This was a prospective, cohort, controlled study that
pregnancies, anti-D IgM and IgG are produced. Anti-D
was conducted on 100 babies with neonatal jaundice.
IgG is responsible for rhesus disease in the neonate as
They were admitted to Luxor General Hospital NICU at
this antibody can cross placenta. Rhesus (Rh)
the beginning of November 2018 to the end of October
incompatibility develops between an Rh negative
2019.
mother (previously sensitized) and her Rh-positive fetus
Those 100 cases had been divided into 2 equal
(3). ABO incompatibility is common condition in a
groups:
newborn baby and causes minimal hemolysis. It may The first group: received intensive phototherapy
cause elevated levels of bilirubin and anemia but less
sessions as a treatment modality for neonatal jaundice.
severe than Rh hemolytic disease (4). For preventing the

This article is an open access article distributed under the terms and conditions of the

Creative Commons Attribution (CC BY-SA) license

(http://creativecommons.org/licenses/by/4.0/
971
)
Received:10 /5 /2020

Accepted:19 /6 /2020

Full Paper (vol.803 paper# 4)


c:\work\Jor\vol803_5 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 977-985
Role of Diffusion Weighted Magnetic Resonance Imaging in Evaluation of
Bone Marrow Edema of the Knee
Fathy Hussein Ali1, Abdullah Hussein Ahmed1, Khaled Aly Matarawy2,
Walid Mohamed Ahmed2, Marwa Fadl Elsayed Hashad1*
1Department of Radiodiagnosis - Faculty of Medicine, Azhar University for Girls
2Department of Radiodiagnosis - Medical Research Institute, Alexandria University
*Corresponding author: Marwa Fadl Elsayed Hashad, Mobile: (+20) 01005216383, E-Mail: marwafadlhashad@gmail.com

ABSTRACT
Background:
Bone marrow edema (BME) has not been recognized as a significant pain generator or as a primary
contributor to disease until recently. Bone marrow edema is characterized by a non-specific pattern of ill-defined
high signal intensity on short-tau inversion-recovery and T2-weighted magnetic resonance (MR) images and low
signal intensity on T1-weighted images.
Objective: To assess the value of diffusion weighted magnetic resonance imaging in the diagnosis and evaluation
of bone marrow edema at the knee region.
Patients and methods: This study was conducted on 130 patients referred with clinical suspicion of knee edema
with or without history of trauma. They were divided into group "A" with lesions less than 15 mm and group "B"
with lesions greater than 15 mm. Their ages ranged between 9 years and 75 years with mean age of 42 years old.
They were 43 females and 87 males.
Results: Between both groups A and B, we found that bone marrow lesions (BMLs) were approximately two times
larger on apparent diffusion coefficient (ADC) maps than on FS PD-weighted TSE images. The most important
value of adding the ADC-derived maps in routine MRI examination of the knee is to show additional bone marrow
lesions that only can be detected at the ADC maps and could not be detected at the FS-PD. About 27 more lesions
in 27 patients and one patient showed two more lesions. These non-concordant lesions accounted totally for 29 more
bone marrow lesions.
Conclusion: Magnetic resonance imaging (MRI) is the mainstay of diagnosis, staging and management plan of knee
traumatic and non-traumatic disorders. ADC maps are more sensitive than corresponding FS PD weighted TSE
images allowing for detection of significantly more and larger BMLs. In addition, they represent a valuable add-on
in knee imaging protocols.
Keywords: Bone marrow edema, Knee, Diffusion weighted magnetic resonance imaging, ADC, FS PD-weighted.

INTRODUCTION

Bone marrow edema (BME) is emerging as an
and short-tau inversion recovery (STIR), BME appears
important clinical issue because of its contribution to
hyperintense when compared to normal marrow. STIR
patient symptoms and its capacity to accelerate the
has been advised due to its lower cost and lack of risk
progression of certain diseases. Differential diagnosis
to the patient for a reaction to Gadolinium (4).
through appropriate imaging is vital for case
MRI findings often cannot determine the
management and may contribute in the prevention or
precise underlying condition. Therefore, correlation
decreased progression of certain pathologies. It is
with clinical history, biochemical markers, and other
important to understand the breadth of diseases
imaging modalities are required. Understanding of the
exhibiting BME, the risk factors for these diseases and
patterns of marrow abnormalities in the knee can help
the role of imaging in differential diagnosis (1). When
narrow the list of differential diagnoses and guide the
located adjacent to a joint, BME is often associated
radiologist toward
an
appropriate treatment
with pain or discomfort. While the appearance of
recommendation (5).
associated pathologies can vary and the appearance of
Unlike standard MR imaging sequences, in
BME itself is consistent (2).
diffusion-weighted imaging (DWI), the signal depends
MRI is ideal for localizing the increased
on the random movement of water molecules and
extracellular water of BME and for the differential
tissue susceptibility. These functional diffusion data
diagnosis of the associated disease (3).
can be displayed quantitatively on apparent diffusion
BME possesses an intermediate signal (higher
coefficient (ADC) maps. Intact bone marrow shows
than muscle or disc) on T1-weighted imaging and a
directional diffusion, whereas BML shows isotropic
high signal on T2-weighted imaging. On fat-
diffusion, which suggests that the osseous trabeculae
suppressed (FS) imaging, contrast-enhanced imaging,
impose a physiological diffusion barrier. While,

trabecular injury facilitates enhanced isotropic

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/
977
)
Received:10 /5 /2020

Accepted:19 /6 /2020

Full Paper (vol.803 paper# 5)


c:\work\Jor\vol803_6 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 986-989

Assessment of the Association between Neuropeptide Y and
Chronic Kidney Disease Progression
Haitham Ezzat¹, Saeed Abdel Wahab Saeed¹, Hend Ahmed Abouelsaad², Nahla Mohamed Teama*¹
1 Department of Internal Medicine and Nephrology, Faculty of Medicine-Ain Shams University
2 Internal Medicine - Ain Shams University
*Corresponding author: Dr. Nahla Mohamed Teama, Tel: (+20) 01090447009; ORCID: 0000-0003-0095-8721.
E-mail: nahlateama@med.asu.edu.eg
ABSTRACT
Background
: Neuropeptide Y (NPY) is a sympathetic neurotransmitter with wide-ranging effects in various organ
systems, from the central nervous system (CNS) to the cardiovascular system, the bone and the renal system. There is
a strong association between serum concentration of NPY and deterioration of eGFR and proteinuria as suggested by
recent studies, however, its real effect on chronic kidney disease (CKD) progression is uncertain.
Objective: This study was conducted to assess the relationship between serum NPY and CKD progression.
Materials and Methods: In this observational case-control study all participants were subjected to renal function tests
and calculation of estimated glomerular filtration rate, urinary protein/creatinine ratio, serum NPY and pelvi-
abdominal ultrasonography at baseline and repeated for the patients only after six months as follow up.
Results:
Serum NPY increased with a statistically significant difference in the patients group after six months follow
up, the same as serum creatinine which increased significantly after six months and eGFR decreased with statistically
significant difference. Also there was high statistically significant rise in the blood urea. There was no statistically
significant difference rise in protein creatinine ratio after six months. The ROC curve determined the sensitivity and
specificity of serum NPY as a marker of progression in CKD patients and the best cut off point to detect CKD status
was calculated with NPY greater than 110 ng/L with sensitivity 100% and specificity 93.33%.
Conclusion: Serum NPY could be a useful sensitive and specific marker that can be used as diagnostic and
progression predictor for CKD.
Keywords: Neuropeptide Y, Chronic kidney disease, Sympathetic neurotransmitter.

INTRODUCTION
damage to a normal functioning kidney (6). Moreover, it
Neuropeptide Y (NPY) is a sympathetic
is previously reported that albuminuria and podocyte
neurotransmitter with wide-extending impacts in
injury in the settings of high sympathetic activity and
different systems, from the central nervous system
renin-angiotensin system (RAS) activation could be
(CNS) to the cardiovascular system (CVS), the bone and
prevented by sympathetic denervation. GFR and with
the kidney. Increased sympathetic activity was
proteinuria in CKD patients are closely related with the
suspected to play a role in renal disease progression (1).
measured sympathetic activity (7). Some CKD patients
A sympathetic activity marker (e.g. pulse) predicts
based studies have also showed that sympathetic
movement to kidney failure autonomously of other
denervation was associated with hypertension control
factors in older chronic kidney disease (CKD) patients.
and GFR stabilization. Thus, there is emerging
Coursing NPY levels have just been related with left
experimental evidence that high sympathetic activity
ventricular hypertrophy (2) and incident CV occasions (3)
plays a role in CKD progression (8).
and bone illness (4) in advanced CKD.
It is like a vicious circle, NPY has a
Neuropeptide Y (NPY) is a vasoactive neuropeptide
vasoconstrictive effect on the renal vasculature causing
widely distributed in the central and peripheral nervous
decrease in renal blood flow and increase in renal
system. The gut and associated organs are likely to be
vascular resistance (3), and in the same time there is
the source of most circulating NPY, and the release of
increased serum NPY due to increased NPY gene
this substance is stimulated after feeding in a way that
expression, decreased NPY excretion and many other
does not correlate with norepinephrine (NE) (5). This
factors all associated with or caused by CKD. This study
neuropeptide is also co-released with NE during
was conducted to assess the relationship between serum
sympathetic nerve stimulation, and it is extensively
NPY and CKD progression.
involved in cardiovascular (CV) regulation because it

modulates heart rate, cardiac excitability, and ventricular
MATERIALS AND METHODS
function as well as coronary blood flow.
This was an observational case-control study
Sympathetic neural responses regulating the
conducted in Ain Shams University Hospital in Cairo,
systemic circulation can be measured by the level of
Egypt. The study included 60 subjects; 30 CKD subjects
circulating NPY (5). The increased sympathetic activity
(group I) stage 1 to 4 and 30 healthy subjects as a
has its drawbacks on the renal function. It can, not only,
control group (group II). Group I was called (a and b)
increase a pre-existing renal impairment, but also 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/lice
986
nses/
by/4.0/)
Received:10 /5 /2020

Accepted: 19/ 6/2020

Full Paper (vol.803 paper# 6)


c:\work\Jor\vol803_7 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 990-996

Evaluation of Serum Midkine as a Marker of Hepatocellular
Carcinoma in Cirrhotic Patients
Noha Elnakeeb, Ahmed El Saady Khayyal, Mohamed Ramadan Osman,
Ahmed Mohamed ElGhandour*
Division of Gastroenterology and Hepatology, Department of Internal Medicine,
Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding Author: Ahmed Mohamed ElGhandour, Mobile: (+20)1001973493,
E-mail: ghandour80@hotmail.com

ABSTRACT
Background:
Hepatocellular carcinoma (HCC) is the fifth most common malignancy. Midkine (MK) is a
cytokine or a growth factor belongs to the carbohydrate-binding proteins. MK is over expressed in hepatocellular
carcinoma. Furthermore, patients with high MK expression in the tumor frequently have a worse prognosis than
those with low MK expression.
Objectives:
The aim of the work was to evaluate serum midkine as a marker for Hepatocellular carcinoma in
cirrhotic patients.
Patients and
Methods: This study was conducted on 90 subjects who were divided into three groups: group I
included 40 patients with liver cirrhosis and hepatocellular carcinoma, group II included 40 patients with HCV
related liver cirrhosis without HCC and group III with 10 healthy subjects as controls. Plasma level of midkine
was measured for all subjects.
Results:
Serum levels of midkine were highest in patients of group I with HCC compared to those with liver
cirrhosis and the control groups (p value< 0.001). Also midkine values increased with tumor number and overall
size. According to the ROC curve, the best cutoff value for midkine differentiating HCC from liver cirrhosis
cases was 8500pg/mL, above which the sensitivity to discriminate HCC = 100% and below which the specificity
to discriminate liver cirrhosis = 87.5% with 94.5% accuracy.
Conclusion: Serum midkine level was significantly elevated in HCC patients, so it can be used as a diagnostic
marker for HCC. Also, it was directly correlated to the tumor number and overall size so it has a good prognostic
value.
Keywords: Hepatocellular carcinoma, Serum Midkine, Cirrhotic liver.

INTRODUCTION


Hepatocellular carcinoma (HCC) is the most
The ideal HCC biomarker is one that enables
frequent liver cancer (1). HCC is the fifth most
clinicians to diagnose asymptomatic patients and can
common cancer and the second leading cause of
be widely used in a screening process. In general, a
cancer-related deaths. HCC most often develops in
biomarker valuable for clinical use achieves a level
patients with a history of cirrhosis due to chronic
of sensitivity and specificity of 90%, and is non-
alcohol abuse, non-alcoholic fatty liver disease, or
invasive and cost-effective to allow widespread use.
hepatitis C virus (HCV) infection (2).
The most desirable biomarker is therefore tumor-
Biomarkers that distinguish HCC from
specific and easily detectable in bodily fluids, such
inflammation and cirrhosis are desperately needed in
as serum, plasma, and bile (7).
order to enhance prognosis of these patients.
Midkine (MDK) is a heparin-binding growth
Contributing to the poor prognosis of HCC is the
factor that has been associated with tumor migration
lack of specific symptoms in the early stages of the
and proliferation (8). Not surprisingly, MDK is often
disease. More than 60% of patients are diagnosed
over expressed in various human tumors, making it
with late-stage disease after metastasis has occurred
an attractive target in tumor detection and treatment
(3), resulting in an overall 5-year survival rate of <
(8). A clinical study on a cohort of 388 HCC patients
16% (4). In contrast, patients diagnosed with early
and 545 hospital enrollees diagnosed with other
stage disease have a relatively good prognosis, with
diseases identified MDK as a discriminating tissue
a 5-year survival rate of > 70% (5).
and serum biomarker with better sensitivity (86.9%,
The diagnosis of HCC without a pathological
serum MDK) than AFP (51.9%)(9).
diagnosis can be achieved by assessing serum -
The aim of the current work was to evaluate
fetoprotein (AFP) levels and diagnostic imaging,
serum midkine as a marker for Hepatocellular
such as computed tomography (CT) and magnetic
carcinoma in cirrhotic Patients.
resonance imaging (MRI)(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/li 990
ce
nses/by/4.0/)
Received:10 /5 /2020

Accepted: 19/ 6/2020

Full Paper (vol.803 paper# 7)


c:\work\Jor\vol803_8 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 997-1002

Effect of Change in Newborn's Position during Mechanical Ventilation on
Oxygenation
Abdel Razek Mohammed Hefny Elshiekh, Atef Ibrahim Nosair,
Enas Mohammed Mahmoud Radwan Elshazly*
Pediatric Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Enas Mohammed Mahmoud Radwan Elshazly, Pediatric ICU resident at
Zagazig General Hospital, Egypt, Telephone: (+20)01024683929, Email: mosad8rashed@gmail.com

ABSTRACT
Background:
Acute respiratory failure remains an important cause of morbidity and mortality in children. In the last
few years great attention was paid to the effect of changes in infant's position other than the supine position during
mechanicall ventilation.
Objective: To evaluate the effect of position change on oxygenation in newborn infants during mechanical ventilation
in neonatal intensive care unit (NICU).
Methods:
This study was across- section study, which was done on 74 obese children aged 6-18 years. This study
was done at Pediatrics Department, Zagazig University Hospitals, during the period from 2017 to 2018. The cases
were divided into two groups, group A included newborn infants using ventilators in supine position (supine group)
and group B included newborn infants in supine position alternating with prone position (alternate group). All children
were subjected to history talking and clinical examination. Anthropometric measurements were measured. In addition,
carotid intima-media thickness quantification was estimated.
Results:
There were statistically significant decrease in VT (ml) at (8 hr and 16 hr) among alternate group than supine
group. In addition, OI and PaO2, at 8 and 16 h in alternate position groups were higher than those in supine position
group were. There were statistically significant decrease in PEEP (cm H2O) at 8 hour among supine group than
alternate group. There was no statistically significant difference between supine group and alternate group regarding
PEEP (cm H2O) at 16 hour. This study showed that, There were statistically significant decrease in PaO2 (mm Hg) at
(8 hr and 1 hr drawl) among supine group than alternate group. There was no statistically significant difference
between supine group and alternate group regarding PaO2 (mm Hg) at 16 hr.
Conclusion:
Oxygenation and respiratory mechanics were significantly improved in prone position group than those
in supine position group. The physiological basis of prone positioning seems to act beneficially improving
hemodynamics, gas exchange and respiratory mechanics.
Keywords: Newborn's Position - Mechanical ventilation-Oxygenation.

INTRODUCTION


Acute respiratory failure remains an important
PATIENTS AND METHODS
cause of morbidity and mortality in children. Cardiac
Present study was an experimental study, which
arrests in children frequently result from respiratory
carried out on all neonates (in first 28 days of life)
failure. In 2014, data from the National Center for
admitted to neonatal intensive care unit (NICU) at
Health Statistics listed respiratory illnesses as one of
Zagazig University Hospital. The study was
the top 10 causes of pediatric mortality (1). The
comparative study between two groups where cases
introduction of mechanical ventilation in the 1960s
selected randomly. Group A included newborn infants
was one of the major new interventions in
using ventilators in supine position and group B
neonatology, which provided lifesaving support for
included newborn infants in supine position alternating
infants with respiratory failure (2).
with prone position.
In the last few years, great attention was paid to the

effect of changes in infant's position other than the
Inclusion criteria: Newborn infants with
supine position during mechanicall ventilation
confirmed respiratory failure.
(3). Prone positioning has been shown to improve
Exclusion criteria: Neonates with severe chest
oxygenation in extremely low-birth infants with
deformities, intolerance to prone position,
chronic lung disease and in neonates with respiratory
increased intracranial tension, acute haemorrhage
failure (4).
and pneumothorax or hemodynamically unstable.

Sample Size:
AIM OF THE WORK
Assuming that PaO2 in supine group after 8 hours
This study aimed to evaluate the effect of position
was 60.13 ± 8.95 in supine group and 65.29 ± 7.62 in
change on oxygenation in newborn infants during
alternate group at confidence level 95% , power 80%
mechanical ventilation in NICU.
so, total sample size is 82 (41 in each group).

This article is an open access art
icle distributed under the terms and conditions of the
Creative Commons Attributio n (CC BY-SA) license
(http://creativecommons.org/l 997
ice
nses/by/4.0/)
Received:11 /5 /2020

Accepted:20 /6 /2020

Full Paper (vol.803 paper# 8)


Tittle: The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1003-1007

Renal Impairment and Nonalcoholic Fatty Liver Disease.
Disease ­ Disease Relationship
Said Abd Elbaky Gad Shams El Deen
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Sharkia, Egypt
Corresponding author: Said Abd Elbaky Gad Shams El Deen, Mobile: 01227517689, Email: saidabdelbaky12345@gmail.com

ABSTRACT
Background:
Nonalcoholic fatty liver disease (NAFLD) has emerged as serious growing global health problem
worldwide and its association with the progression of renal impairment (RI). Accumulating evidence suggests that
NAFLD and RI are sharing the same cardio metabolic risk factors.
Objective: to evaluate and investigate the confounding factors sharing in the relation between NAFLD and renal
impairment (RI).
Patients and Methods: 250 Egyptian patients with NAFLD were investigated for creatinine, ALT, AST, lipid
profile, fasting blood sugar. Questionnaire and physical examination were done to explore the relationship
between NAFLD and RI.
Result: HA1C was 6.0±0.31, cholesterol 210.05±36.67, triglyceride 162.59±35.06, LDL 146.02±16.7 and HDL
43.23±6.15. AST and ALT were 34.12±4.28 and 35.34±4.8 respectively. ALP was 72.49±6.56, Cr 0.99±0.11, urea
29.16±9.41 and e-GFR 89.67±9.95. 39.2% were smokers 39.6% were Hypertensive, 60.8% had dyslipidemia and
27.6% had metabolic syndrome. 22.4% were cardiac patients and asthma represented 17.2% of the studied group.
Renal impairment group was significantly associated with higher age and higher HA1C and also with higher Cr
and urea but with lower GFR. We found also significant association between RI and males, hypertension,
dyslipidemia, metabolic syndrome and asthma, with no other significant relation found.
Conclusion: There is strong and close association between NAFLD and RI as they share the same metabolic risk
factors and precipitating factors.
Keywords: Renal impairment, Nonalcoholic fatty liver.

INTRODUCTION

kidney troubles. Mild kidney damages occur early
Nonalcoholic fatty liver disease (NAFLD) is
before chronic renal failure according to a study by
growing worldwide global health problem represents
the National Kidney Foundation Practice Guidelines
about 20-30% of world population. It encompass wide
(8).
varieties of liver injury range from simple steatosis to
It is important to explore the risk factors
progressive inflammation (steatohepatitis), liver
affecting kidney function early to prevent progression
fibrosis and cirrhosis with consequent hepatocellular
to chronic renal failure. For these causes we decided
carcinoma (1).
to study the effect of confounding factors sharing
Chronic kidney disease (CKD) or renal impairment
NAFLD and RI as age, gender, lifestyle factors,
(RI) is worldwide health problem that results is high
diabetes, lipids, hypertension and liver biochemistry
morbidity, mortality and socio-economic problems (1,
on the relationship between NAFLD and RI from
2). RI is defined as gradually progressive decline in
volunteers and doing questionnaire as was done in
renal function represented by decreased glomerular
other studies (9, 10).
filtration rate (GFR) with consequent changes in renal
Aim of the work was to evaluate and investigate
mass (3, 4) and this abnormalities are diagnosed based
the confounding factors sharing in the relation
on urine analysis, kidney biopsy and imaging studies
between NAFLD and renal impairment (RI).
(4).

RI is frequently associated with patients of old
MATERIALS AND PATIENTS
age, hypertension, diabetes, obesity and dyslipidemia
This study was carried out at Internal Medicine
(4). Nonalcoholic liver disease in Western countries is
Department, Faculty of Medicine Zagazig University
also associated with obesity(5), diabetes, hypertension
in the period from April 2017 to June 2018.
and dyslipidemia. In some studies there is strong

evidence linking between NAFLD and kidney
Ethical approval:
function. Some cross-sectional studies shows that
The study was approved by the Institutional
NAFLD diagnosed by ultrasonography(6), enzymes or
Review Board of Ethical Committee. Written
biopsy is highly associated with renal impairment (7).
informed consent was obtained from all patients.
Another study had showed that NAFLD with
250 Egyptian patients with NAFLD were investigated
markedly increased transaminases is associated with
for creatinine, ALT, AST, lipid profile, fasting blood

This article is an open access article distributed under the terms and conditions of the

Creative Commons Attribution (CC BY-SA) license

1003
(http://creativecommons.org/licenses/by/4.0/)
Received:11 /5 /2020

Accepted: 20/1 /2020

Full Paper (vol.803 paper# 9)


c:\work\Jor\vol803_10 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1008-1013

Galectin-3 as a Biomarker of Heart Failure in Children with
Congenital Heart Disease
Ahmed Abdel Samed Elhewala1, Magdey Mohammed Ibrahem2, Eslam Samir Abdel Hafez*1
Departments of 1Pediatrics and 2Medical Biochemistry, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Eslam Samir Abdel Hafez, E-mail: mosad8rashed@gmail.com, Mobile: (+20)01024683929

ABSTRACT
Background:
Heart failure is defined as a clinical and pathophysiologic syndrome results from ventricular
dysfunction, volume, or pressure overload, alone or both. Galectin-3 is a novel biomarker that mediates fibrosis in
many organs like the heart that interest in galactin3 as a potential heart failure biomarker that reflects ongoing
ventricular remodeling.
Objective: To see if galectin-3 acts as a biomarker of heart failure in congenital heart disease and evaluate if there
is a correlation between galectin-3 and severity of HF detected by Ross classification and echocardiogram.
Patients and Methods:
The present study included 38 cases with HF due to CHD admitted to PICU and pediatric
department at Zagazig University Hospital from July 2018 to July 2019. Patients were selected to exclude heart
failure other than congenital heart disease.
Results:
Galectin-3 level was significantly higher in children with CHD than age and sex-matched healthy children.
There were statistically significant positive correlations between Galectin 3 and ROSS so higher Galectin-3 levels
were associated with measures of HF severity. The level was significantly elevated in children with HF in comparison
to those without HF, with a significant correlation with the disease severity. Galectin 3 had sensitivity 80%,
specificity 100%, PPV 100% and PPN 71.4%.
Conclusion:
Galectin-3 has short term prognosis and can be used as a tool to help in HF diagnosis in children as a
marker of disease severity (positive correlation between Ross classification and galectin-3 serum level was proved)
and staging patients with acute HF due to congenital heart diseases.
Keywords: Heart Failure, Congenital Heart Disease, Galectin-3.


INTRODUCTION
failure biomarker that could reflect ongoing ventricular
Heart failure is clinical and pathophysiologic
remodeling (5).
syndrome results from ventricular dysfunction, volume,
This work aimed to see if galectin-3 acts as a
or pressure overload, alone or both. In children, it is
biomarker of heart failure due to congenital heart
characterized by signs and symptoms, as poor growth,

feeding difficulties, respiratory distress, exercise
disease in children and to evaluate if there is any
intolerance, and fatigue and is associated with
correlation between galectin-3 and severity of HF as
circulatory,
neurohormonal,
and
molecular
detected by Ross classification and echocardiogram.
abnormalities (1).

There are two primary causes of heart failure in

children which are over circulation failure occurs when
SUBJECTS AND METHODS
blood mix inside the heart due to a congenital heart
1. Type of the study: Case-control.
defect and pump failure occurs due to damaged heart
2. Study setting: The study was conducted in the
muscle and can't contracts normally (2).
Pediatric Cardiology Unit, Pediatric Department,
Diagnosis, risk assessment, and treatment of
Zagazig University Hospitals, Sharkia, Egypt
heart failure are difficult and so need additional tools to
3. Study period: From July 2018 to July 2019.
improve clinical signs (3).
4. Sample Size: Total Sample Size included 60
The classification (ROSS classification) can
infants, 20 of them were control group, 20 had
predict risk from the disease so that management can be
congenital heart disease without heart failure and
tailored to HF class. Children classified as "no risk" not
the last 20 had congenital heart disease with heart
need treatment. "Mild risk" needs close observation,
failure.
early intervention while "Moderate risk" needs more
5. Sample collection and grouping: The target
intensive treatment, and "severe risk" requires maximal
sample comprised 60 randomly chosen infants of
therapy and may transplantation referral (4).
age ranged from (6 months - 36 months) selected
Galectin-3 is a novel biomarker that mediates
from those admitted to the Pediatric Cardiology
fibrosis in a variety of organs including the heart that had
Unit and well diagnosed as having acute heart
led to the interest of galactin3 as a potential heart
failure due to congenital heart diseases.




This article is an open access article distributed under the terms and conditions of the

Creative Commons Attrib ution (CC BY-SA) license
(http://creativecommons.or 1008
g/lice nses/by/4.0/)
Received:11 /5 /2020

Accepted:20 /6 /2020

Full Paper (vol.803 paper# 10)


c:\work\Jor\vol803_11 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1014-1018

Association of Single-Nucleotide Polymorphism (rs833061) of Vascular
Endothelial Growth Factor with Breast Cancer Risk
Wessam El Sayed Saad, Mona Mostafa Osman, Manal Abdel Baky Mahmoud,
Safeya Hamdy Zakaria Hassan, Heba M. Adel Abou Zaghla*
Clinical Pathology Department - Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Heba M. Adel Abou Zaghla, Mobile: (+20)01227191589, Email: hebazaghla@hotmail.com

ABSTRACT
Background:
Breast cancer is the most common cancer among women and one of the most important causes of death
among them. Angiogenesis is an important step for primary tumor growth, invasiveness, and metastases. Vascular
endothelial growth factor (VEGF) is involved in angiogenesis associated with tumors.
Objective:
To investigate the association of single nucleotide polymorphisms (SNPs) of VEGF gene located in the
promoter region at position 460T/C (rs833061) with the risk of breast cancer.
Patients and Methods:
This study was conducted on (40) Egyptian female patients who were diagnosed as breast cancer
according to histopathological examination of breast biopsy (Group 1, Patients), in addition to (40) age-matched
apparently healthy females serving as controls (Group II, Controls). Detection of SNP of VEGF gene located in the
promoter region 460T/C (rs833061) was done by real-time polymerase chain reaction technique.
Results:
There was no significant difference in frequency of the (C/C, T/C and T/T) genotypes of VEGF 460T/C
(rs833061) in group I compared with group II (p>0.05). None of the studied VEGF genotypes had shown significant
difference in distribution related to clinico-pathological parameters as tumor size, histological grade, hormone receptors,
HER2/new status, regional lymph node and distant metastasis (p>0.05).
Conclusion:
This study revealed that there was no significant association of the (C/C, T/C and T/T) genotypes of VEGF
460T/C (rs833061) and breast cancer risk. Moreover, VEGF polymorphism 460T/C (rs833061) was not associated with
breast cancer patients' clinico-pathological characteristics and tumor markers levels.
Keywords: Breast cancer, SNP, VEGF polymorphism 460T/C

INTRODUCTION

Breast cancer is the most common cancer in
permeability, while VEGFR-2 plays a role in
women and accounts for 29% of all cancers diagnosed
angiogenesis (5).
worldwide (1). It is the fifth leading cause of cancer death
The human VEGF gene is located on the short arm
in women. The incidence of breast cancer has increased
of chromosome 6 (6p12­p21) and consists of eight exons
steadily over the past few decades, but breast cancer
separated by seven introns that exhibit alternative
mortality appears to be declining (2). This suggests a
splicing to form a family of proteins. This gene is highly
benefit from early detection and more effective
polymorphic with multiple polymorphisms in the
treatment. In Egypt, breast cancer is the most common
promoter 5 untranslated region (5-UTR) and 3 UTR (6).
type of cancer in females as it accounts for approximately
The single-nucleotide polymorphisms (SNPs) in the
32 % of total reported malignancies(3).
promoter and 5 UTR have been reported to regulate
In general, carcinoma of the breast is a
VEGF expression via alternative initiation of
heterogeneous disease with a variety of pathological
transcription and internal initiation of translation (7).
entities, clinical behaviour and molecular alterations
Several SNPs in the promoter and 5' UTR of
involved in tumor growth, survival of individuals and
VEGFA have been reported to be associated with
response to treatment (2).
variation in VEGF protein production. The common sites
Angiogenesis is an important step in the
of SNPs are at position 2578, 46o, 1154, and 634. The
development of cancer and is necessary for primary
detection of VEGF SNPs and the validation of their
tumor growth, invasiveness, and metastases. Breast
associated risk in different studies are crucial to
cancer is among the well-known malignancies
understand the effect of these polymorphisms in breast
involving lymphangiogenesis, which is the recruitment
cancer susceptibility (7), with subsequent developing of
of blood and lymphatic vessels, to a growing tumor (4).
anti-angiogenetic drugs targeting the VEGF pathway that
Vascular endothelial growth factor (VEGF), also
could be used in tumour therapy (8).
known as VEGFA, specifically stimulates endothelial
A number of molecular epidemiological studies
cell proliferation, promotes endothelial cell migration,
have been conducted to examine the association between
and participates in the formation of new blood vessels.
VEGF 460T/C polymorphism (rs833061) and cancer
VEGF promotes mitotic activity mainly through its
susceptibility as lung, ovarian, cervical and endometrial,
interactions with 2 receptors: VEGF receptor-1
colon, prostate, pancreatic, renal cell carcinoma and
(VEGFR-1) and VEGF receptor-2 (VEGFR-2). In
breast cancer with disparate results (9).
particular, VEGFR-1 plays a role in vascular

This article is an open access article distributed under the terms and conditions of the

Creative Commons Attrib ution (CC BY-SA) license
(http://creativecommons.org/licens1014
es/b y/4.0/)
Received:11 /5 /2020

Accepted:20 /6 /2020

Full Paper (vol.803 paper# 11)


c:\work\Jor\vol803_12 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1019-1026

Incidence, Clinical Characteristics and Outcome of Acute Kidney Injury among
Critically Ill patients in Zagazig University Hospitals
Amir Mohamed AL Okaly, Islam Ali EL Sayed, Ahmed Mohamed Salah, Mohamed Ahmed EL Maghawry*
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed Ahmed EL Maghawry, Mobile: (+20)1221190600, E-Mail: tantawy_wael@yahoo.com


ABSTRACT
Background:
There is marked variety in Acute Kidney Injury (AKI) incidence and clinical characteristics as regards
independent developmental risk factors and independent risk factors that could affect the outcome especially in critical
care setting.
Objectives: The aim of the work was to identify incidence and the clinical features of AKI in critical care situation and
its impression on outcomes.
Patients and Methods: A prospective cohort study in which patients were screened for AKI during the period from
October 2018 to September 2019 using the AKIN criteria.
Results: Incidence of AKI in critical care setting was 20.3% (63/310). The most independent risk factors for the
development of AKI based on multivariate Logistic analysis were sepsis (p value: 0.000, estimated odds ratio: 4.492
and confidence intervals between 2.037 and 9.906) and chronic kidney disease (CKD) (p<0.001, estimated odds
ratio: 8,982 and confidence intervals between 3,852 and 20,945). The most independent risk factor for poor AKI
outcome was the need for renal replacement therapy (RRT) based on a multivariate logistic analysis (p<0.001,
estimated odds Ratio: 3.649 and confidence interval between 1.145 and 4.050). Late nephrologist consultation comes
in second place (p=0.002, estimated odds ratio: 4.902 and confidence interval between.463 and 9.316). Mortality in
AKI group was 31% (3 patients in stage 2 and 17 patients in stage 3) compared to 42/247 (17%) in patients without
AKI.
Conclusion: The incidence of AKI in Zagazig University Internal Medicine ICU was 20.3 %. Sepsis was the most
independent risk factor for the occurrence of AKI in ICU. The most independent risk factors for poor outcome
following AKI development were the need for RRT, Late nephrologist consultation, longer duration of AKI and a high
APACHE score.
Keywords: Acute Kidney Injury, CKD, AKIN criteria, APACHE score, Outcome.

INTRODUCTION

Acute kidney injury is a common medical problem
for recovery. (4). Patients with history of diabetes
especially in critical care setting that has negative
mellitus (DM), hypertension or underlying chronic
impact as regard patients outcome and health care
kidney disease , have high susceptibility for renal injury
resources. It has multiple risk factors and causes (1). AKI
that could result from presence of renal damage from
has incidence ranges from 20 to 70 percent in critical
underlying co-morbidity, use of nephrotoxic drugs or
care setting (2). High rate of hospital mortality ranges
defect in regenerating capacity of kidneys (5).
between 50-70% occur in patients with AKI undergoing
Interestingly, CKD is an important risk factor for
RRT and about 25-50% of patients develop chronic
occurrence of AKI, many patients with AKI develop
renal disease (3). As a consequence, identification of the
CKD (6).
precipitating factors for occurrence of AKI among

thosecategory of patients has great beneficial effect in
The aim of the work was to identify incidence and
reduction of the incidence of AKI among that category
the clinical features of AKI in critical care situation and
of patients (2).
its impression on outcomes therefore we could improve
Several risk factors for occurrence of AKI in critical
the consequence of occurrence of AKI among that high-
care setting has been identified, these factors are more
risk category of patients.
nuanced rather than being single risk. Elderly patients

appear to experience AKI more often than younger
PATIENTS AND METHODS
patients due to physiological ageing of the kidneys,
This prospective cohort study included a total of 310
presence of co-morbidities and impaired renal capacity
patients for potential occurrence of AKI, admitted to the

This article is an open a
ccess article distributed under the terms and conditions of the Creative
Commons Attribution (CC B Y-SA) license (http://creativecommons.org/licenses/by/4.0/)

1019
Received:12 /5 /2020

Accepted:21 /6 /2020

Full Paper (vol.803 paper# 12)


c:\work\Jor\vol803_13 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1027-1034

Musculoskeletal Ultrasound Assessment of Enthesopathy in Fibromyalgia Patients
Mohamed Ismail Mohamed AbdelKareem, Ahmed Mosallam Ibrahim, Mostafa Mahmoud Abdelkareem*
Department of Rheumatology & Rehabilitation, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
*Corresponding author: Mostafa Mahmoud Abdelkareem, Mobile: (+20) 01023869085,
E-Mail: dr.rheuma90@gmail.com

ABSTRACT
Background: Fibromyalgia (FM) is a syndrome of persistent widespread pain, stiffness, fatigue, disrupted and
unrefreshing sleep, and cognitive difficulties, often accompanied by multiple other unexplained symptoms, anxiety
and/or depression, and functional impairment of activities of daily living
Objectives:
To assess the frequency and pattern of enthesopathy in primary FM using musculoskeletal ultrasound
with Glasgow Ultrasound Enthesitis Scoring System (GUESS) and Correlate these findings with clinical and
laboratory parameters of FM.
Patients and Methods: A cross-sectional study includes 100 persons divided into two groups as follows: Group
(1): 50 patients with primary fibromyalgia syndrome (FM) were diagnosed. Group (2): 50 apparently healthy
controls with comparable age and sex. Patients were selected from those attending the outpatient clinic of the
Rheumatology & Rehabilitation Department of Al-Azhar University Hospital, Assiut.
Results: There is no statistically significant difference between cases and control groups regarding age, gender, and
BMI (P>0.05 for each), there were no statistically significant correlations between the GUESS scores and any of
the clinical characteristics of FM patients. Although non-significant, these correlations were negative between the
GUESS score and the tender point number, the Widespread Pain Index as well as the Fibromyalgia Impact
Questionnaire. The total GUESS score of the FM group ranged between 0-12 with a mean ±SD of 5.3 ± 2.8. The
total GUESS score of control group ranged between 0-6 with a mean ±SD of 0.97± 1.58, with a significant difference
between the two groups (P<0.05)
Conclusion: There were significant enthesopathic changes detected among FM patients especially affecting the
Achilles, quadriceps, and proximal patellar tendons.
Keywords: Fibromyalgia, Enthesopathy, Ultrasound, GUESS score.


INTRODUCTION

Fibromyalgia is a disorder of chronic, widespread
upregulate pain inhibitory neuropeptides such as
pain, and tenderness. Chronic indicates the pain and
norepinephrine and serotonin, that is, reduce CS (2).
tenderness have been present continuously for at least
Enthesitis is the term used to describe
3 months. Widespread means the pain and tenderness
inflammation at tendon, ligament, or joint capsule
are on both sides of the body, above and below the
insertions. It thus applies to disease associated with
waist, including the axial spine (usually the paraspinal,
spondylarthritis
(SpA)
including
ankylosing
scapular, and trapezius muscles). While the
spondylitis, psoriatic arthritis, reactive arthritis, and
identification of fibromyalgia patients by the original
undifferentiated SpA. The term `enthesopathy',
1990 American College of Rheumatology (ACR)
however, has a wider meaning and designates all
classification criteria required a specialized physical
pathological abnormalities of insertions including
examination to quantify tender-point count that many
inflammatory changes and degenerative problems (3).
providers have not been trained to perform, the 2010
Conventional radiography, ultrasonography, and
ACR diagnostic criteria allow for diagnosis by history
magnetic resonance imaging are used to diagnose
without specialized training (1).
tendinopathies, bursitis, and other morphologic
In addition to chronic, widespread pain and
pathologies
of
the
musculoskeletal
system.
tenderness, the 2010 diagnostic criteria require that
Musculoskeletal ultrasonography is a widely available
fibromyalgia patients have significant symptoms of
and inexpensive imaging tool and demonstrates fluid
fatigue, unrefreshed sleep, and cognitive dysfunction
collections, soft tissue lesions, and bone surface lesions
(difficulties with thinking and remembering), along
with sensitivity comparable with magnetic resonance
with numerous somatic symptoms (1). Optimal
imaging. The sonographic examination is more
treatment
approaches
are
multidisciplinary,
sensitive and specific than clinical examination for the
nonpharmacologic including education, exercise, and
detection of enthesitis and tendon involvement (4).
cognitive behavioral therapy, and pharmacotherapy
Developments of high-resolution transducers of
including non-narcotic analgesics which downregulate
ultrasonography (US) have made it possible to assess
nociceptive neuropeptides such as glutamate and
enthesitis more accurately than clinical examination.

This article is an open a
ccess article distributed under the terms and conditions of the
Creative Commons Attribut
ion (CC BY-SA) license
(http://creativecommons.org /licenses/by/4.0/)
1027
Received:12 /5 /2020

Accepted:21 /6 /2020

Full Paper (vol.803 paper# 13)


c:\work\Jor\vol803_14 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1035-1043

The Possible Protective Effect of Selenium on Pancreas of Adult Male Albino Rats
Treated with Bleomycin Sulfate
Shadia A. Abd Elshafy, Sayeda M. Abd Elhameed and Hala H.M. Mossalam
Department of Anatomy and Embryology, Faculty of Medicine for Girls, Al-Azhar University
Address for *Correspondence: Hala Hamed Mohamed Mossalam, MD, Department of Anatomy and Embryology,
Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt. E-mail: halahamed1000@gmail.com Mobile:
01020212116, Orcid.org/0000-0002-8723-9393

ABSTRACT
Background:
Pancreas is one of the most vital complex organs in the body. Bleomycin sulfate is a cytotoxic drug
that may injure the pancreas. Objective: To detect the effect of bleomycin sulfate on pancreas of adult male Albino
rats and to assess the possible pancreatic protection by selenium use. Materials and methods: This study continued
10 days and included 20 adult male Albino rats that were categorized into three groups: group I served as the control
group. Group II: bleomycin sulfate treated group. Group III: bleomycin sulfate and selenium treated group.
Pancreatic specimens were excised and processed for light and electron microscopic examination. Furthermore,
Anti-insulin immunohistochemical staini was assessed and statistically analyzed. Results: Treatment with
bleomycin sulfate induced distortion and damage of pancreatic architecture with areas of hemorrhage and necrosis.
The acinar cells showed vacuolation of cytoplasm with either euchromatic or pyknotic nuclei. Islets of Langerhans
appeared distorted, shrunken with difficult differentiation between beta cells and alpha cells. Most of these changes
were improved by selenium administration. Conclusion: Selenium has significantly ameliorated bleomycin-
induced alterations in the pancreas of adult male Albino rats.
Keywords: Bleomycin sulfate, Selenium, Oxidative stress, Pancreas.

INTRODUCTION
Ethical approval: this study was conducted in
Bleomycin sulfate is a chemotherapeutic
accordance with ethical procedures and policies
antibiotic that attracted interest because it's
approved by Animal Care Committee of Faculty of
antineoplastic activity either as a single agent or in
Medicine, Al-Azhar University, Cairo, Egypt.
combination (1). Bleomycin acts by chelation of metal
The "Principles of laboratory animal care" were
ions forming single and double strand DNA breaks in
followed, as well as specific national laws where
tumor cells and hindering the cell cycle with
applicable.
consequent formation of superoxide and hydroxide free

radicals (2).Antioxidant is a molecule capable of abating
Drugs:
or anticipating oxidation of other molecules. Oxygen is
Selenium was purchased as a powder with a trade
a highly reactive atom that is capable of becoming part
name (Sodium selenate) from Sigma Chemical
of possibly harmful molecules called free radicals
Company, Cairo, Egypt. It was dissolved in distilled
(3).Selenium is a dietary trace element and an
water and given at a dose of 55 microgram/kg/day
antioxidant. It is a constituent glutathione peroxidase
orally by gastric gavage for 10 days. The selenium dose
(GSH-PX), an enzyme that uses hydroperoxides(4).
was equivalent to the average human therapeutic dose
Selenium exists naturally in a very small concentration
(6). The rat dose was adjusted according to Paget and
and both its deficiency and toxicity are closer than any
Barnes(7). Bleomycin sulfate was purchased as vial
other trace element (5).
with a trade name (Blenoxane) from Bristol-Myers
This study aimed to detect the effect of bleomycin
Squibb Company. It was given as a single daily dose of
sulfate on pancreas of adult male Albino rats and to
2.7mg/kg /day by intramuscular injection for 10 days.
assess the possible pancreatic protection by selenium
This dose was equivalent to the average human
use.
therapeutic dose (8). The rat dose was adjusted

according to Paget and Barnes(7).
MATERIALS and METHODS

The experimental animals:
3-Experimental Design:
The present study was carried out on 20 adult male
Animals were categorized into 3 groups:
Albino rats (average weight 200 -230 g). The animals
Group 1: the control group contained 10 rats which
were kept in a separate cage under standard laboratory
were subdivided into two equal subgroups. Subgroup
and environmental conditions. They were allowed free
1a: (- ve control group) were kept without medication
access food and water.
during the whole experimental period (10 days).

Subgroup 1b: (Selenium group): each rat received only
a single daily dose of selenium for 10 days.

This article is an open access article distributed under the terms and conditions of the Creative

Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)

1035
Received:12 /5 /2020

Accepted:21 /6 /2020

Full Paper (vol.803 paper# 14)


c:\work\Jor\vol803_15 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1044-1045

Metabolic Acidosis ­ Not Always the Medication to Blame
Mohammed Yousef Al Mulhim
Department of Medicine, Faculty of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
Email: mohd.ym@gmail.com. Mobile: 00966554921113


ABSTRACT
Background:
Metabolic acidosis is a clinical disturbance characterized by an increase in acidity of plasma.
Metabolic acidosis is considered a sign of an underlying disease. Identification of this underlying condition is the
cornerstone to initiate appropriate management. Metabolic acidosis is typically classified as having a normal anion
gap (AG) (i.e. non-AG) or a high AG. An increase in the AG can result from either a decrease in unmeasured cations
(e.g. hypokalemia, hypocalcemia, hypomagnesemia) or an increase in unmeasured anions (e.g. hyperphosphatemia,
high albumin levels).
Case: A 46-year-old male with a history of type 2 diabetes mellitus, recently started on liraglutide. He was presented
to the emergency department with 4 days of nausea, vomiting, and diarrhea and one day of lethargy. He appeared
to be dyspneic upon presentation, and he was initially placed on noninvasive positive pressure ventilation. The
arterial blood gases (ABG), however, showed metabolic acidosis. After admission and resolution of diabetic
ketoacidosis, his bicarbonate was still low, and a sodium bicarbonate drip was begun. Correction only had occurred
after stopping liraglutide.
Conclusion: Vehicle solvent such as propylene glycol should be considered in the differential diagnosis of high
anion gap metabolic acidosis, and its level should be measured in intractable cases.

INTRODUCTION

History of diabetes mellitus, alcoholism, or
Metabolic acidosis is a clinical disturbance that is
prolonged starvation - Accumulation of
characterized by an increase in acidity of plasma.
ketoacids
Metabolic acidosis is considered a sign of an

underlying disease. Identification of this underlying

Polyuria, increased thirst, epigastric pain,
condition is the cornerstone to initiate appropriate
vomiting -Diabetic ketoacidosis (DKA)
management. Plasma, like any other body fluid

Nocturia, polyuria, pruritus, and anorexia -
compartment, is neutral; total anions match total
Renal failure (3)
cations (1).

Ingestion of drugs or toxins - Salicylates,
Metabolic acidosis is typically classified as having
acetazolamide, cyclosporine, ethylene glycol,
a normal AG (i.e. non-AG) or a high AG. Non-AG
methanol, metformin, topiramate
metabolic acidosis is also characterized by

Visual
symptoms,
including
dimming,
hyperchloremia and is sometimes referred to as
photophobia, scotomata - Methanol ingestion
hyperchloremic acidosis. Calculation of the AG is thus

Renal stones ­ Renal tubular acidosis (RTA) or
helpful in the differential diagnosis of metabolic
chronic diarrhea
acidosis (2).

Tinnitus, blurred vision, and vertigo - Salicylate
An increase in the AG can result from either a
overdose(1).
decrease in unmeasured cations (e.g. hypokalemia,

hypocalcemia, hypomagnesemia) or an increase in
CASE
unmeasured anions (e.g. hyperphosphatemia, high
A 46-year-old male with a history of type 2
albumin levels). In certain forms of metabolic acidosis,
diabetes mellitus, recently started on liraglutide, was
other anions accumulate; by recognizing the increasing
presented to the emergency department with 4 days of
AG, the clinician can formulate a differential diagnosis
nausea, vomiting, and diarrhea and one day of lethargy.
for the cause of that acidosis (1).
He appeared to be dyspneic upon presentation, and he
The clinical history in metabolic acidosis is helpful
was initially placed on noninvasive positive pressure
in establishing the etiology when symptoms relate to
ventilation. The ABG, however showed metabolic
the underlying disorder. The age of onset and a family
acidosis with a pH of 7.08 and bicarbonate of 10
history of acidosis may point to inherited disorders,
mEq/L. The blood glucose was 740 mg/dL with
which usually start during childhood. Important points
diabetic ketoacidosis. He was admitted to the intensive
in the history include the following:
care and was started on an insulin drip and aggressive

Diarrhea - GI losses of HCO-3
fluid resuscitation. Although the diabetic ketoacidosis
resolved, his bicarbonate was still low, and a sodium
bicarbonate drip was begun. After 3 days of a

This article is an open access art icle distributed under the terms and conditions of the Creative
Commons Attribution (CC B Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1044
Received:13 /5 /2020

Accepted:22 /6 /2020

Full Paper (vol.803 paper# 15)


c:\work\Jor\vol803_16 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1046-1053

Transperitoneal Laparoscopic Pyeloplasty versus Laparoscopic Assisted
Pyeloplasty for the Treatment of Ureteropelvic Junction Obstruction in Children
1Ahmed Abdelmohsen, 1Rafik Shalaby, 2Hussein Galal, and 1Samir Gouda
1Department of Pediatric Surgery and 2Department of Urology, Faculty of Medicine, Al-Azhar University
Corresponding author: Ahmed Abdelmohsen Said, email: a.abdelmohsen@azhar.edu.eg, mobile: 00201011252126

ABSTRACT
Background:
Laparoscopy-assisted pyeloplasty [LAP] has been introduced to shorten the operative time and
make the traditional transperitoneal laparoscopic pyeloplasty [LP] much easier while maintaining comparable
functional and cosmetic results to the LP. Purpose: Comparing the outcomes of LP to LAP in terms of operative
time and cosmetic appearance. Patients and Methods: This is a randomized controlled study where twenty
patients presented with ureteropelvic junction obstruction [UPJO] were divided into two equal groups. The first
was subjected to LP while the second was subjected to LAP. The outcome measurements included the operative
time, the hospital stay, intraoperative complications, and the success rates. Postoperative data were collected with
special emphasis on pain and analgesia requirements.
Results: The mean age of the patients was 4.95 ±3.7 years [range=9 months to 12 years], the preoperative SFU
grade was 3.7 and the renal relative function was 25.5%. The mean operative time was 154±21 minutes [range
=126 to 185 minutes] for LP compared to just 114±12 minutes [range =98 to 130 minutes] in LAP (p<0.001). The
success rate was 90% in both groups and the postoperative split function rose to around 40%. Although the
leakage was slightly higher in the LP, the wound complications were higher in the LAP group. The cosmetic
results and patients' satisfaction were in favor of LP.
Conclusion: The success and recurrence rates are almost equal in both techniques. The main advantages of LAP
over LP are the marked operative time reduction and its reproducibility by the less experienced laparoscopic
surgeons.
Keywords: Laparoscopy, laparoscopy-assisted, pyeloplasty, extracorporeal, UPJO.

INTRODUCTION
To date, some reports including meta-analysis
The growing experience with ablative and
have demonstrated the efficacy and safety of
reconstructive urologic laparoscopic procedures has
minimally invasive pyeloplasty in the pediatric
encouraged pediatric surgeons to attempt the
population(6-8). However, there have been few studies,
laparoscopic approach to repair UPJO. Since it was
directly comparing recent surgical techniques(5). In
first introduced in 1993, LP has achieved comparable
the present study, we described the clinical
results to that of open surgery, while achieving the
characteristics and compared the surgical outcomes of
added goals of low morbidity, shorter hospital stay
LP and LAP for the treatment of UPJO in children.
and shorter convalescence. Excellent results have

been reported no matter which method has been used
PATIENTS AND METHODS
even in difficult cases with atypical anatomical
This is a randomized controlled study
anomalies(1). For these reasons, LP was considered
conducted at Al-Azhar University Hospitals,
the treatment of choice for primary UPJO; however,
combined with some private hospitals under
the technical challenges associated with laparoscopy
supervision of Al-Azhar's Pediatric Surgery and
and intracorporeal suturing have limited its
Urology Departments' staff between May 2017 and
widespread use(2, 3).
December 2019. A total of 20 patients with UPJO's
Nevertheless, since the first application of LP in
were divided into two equal groups [No=10]. Method
pediatrics by Peters et al.(4), the laparoscopic
of randomization used was the closed envelop
approach has not been as popular in pediatric urology
method.
as in the adult population, possibly due to its
Group A was subjected to LP in which a total
technical difficulty and long learning curve. During
transperitoneal laparoscopic pyeloplasty was done.
the last two decades various minimally invasive
Group B was subjected to LAP in which the UPJ was
surgical techniques such as laparoscopy-assisted
exteriorized out the abdominal cavity through a 2-cm.
extracorporeal pyeloplasty (LAP), and robot-assisted
flank incision, after UPJ was completely exposed
laparoscopic pyeloplasty have been developed and
laparoscopically, and subsequently the obstructed
popularized in clinical practice. LAP is a hybrid
UPJ segment was excised, the proximal ureter was
technique of conventional laparoscopic surgery and
spatulated and then the anastomosis was done
extracorporeal hand sewing anastomosis(5).
extracorporeally identical to the open technique using
5/0 Vicryl sutures (Figs. 1-3). All the patients' data

This article is an open access art icle distributed under the terms and conditions of the Creative
Commons Attribution (CC B Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1046
Received:14 /12 /2019

Accepted: 16/01 /2020

Full Paper (vol.803 paper# 16)


c:\work\Jor\vol803_17 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1054-1059

Prevalence of Psychiatric Disorders in Children with Chronic Kidney
Disease in Zagazig University Hospitals
Ehab Mahmmoud Rasheed1, Sabry Abdel Rahman Tolba1, Yasser Mohamed Raya2,
Shahenda Hassan Mohamed El-Nabarawy1*
Departments of 1Pediatrics and 2Psychiatry, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding Author: Shahenda Hassan Mohamed El-Nabarawy, Mobile: (+20) 1024683929,
Email: mosad8rashed@gmail.com
ABSTRACT
Background:
Psychiatric manifestations as depression, periods of adjustment, low self-Esteem, cognitive dysfunction,
anxiety, and attention deficit disorders occur with chronic kidney disease (CKD).
Objective: The aim of the work was to assess the association between psychiatric disorders and chronic kidney disease
in Pediatric Nephrology Unit, Zagazig University Children's Hospital.
Patients and Methods: This cross-sectional study included a total of 156 patients with Chronic Kidney Disease,
attending at Pediatric Nephrology Unit, Zagazig University Children's Hospital. All patients were subjected to
complete history taking and psychiatric assessment of children that was based on the Semi Structured Clinical Interview
for Children and Adolescents AGES 6-18 PROTOCOL FORM (SCICA) and the diagnostic and statistical manual of
mental disorders 5th edition (DSM-5). Results: Among CKD children the prevalence of anxiety was 37.2%, prevalence
of eating disorder was 15.4%, prevalence of elimination disorder was 19.2% and prevalence of attention deficit was
43.6%. Prevalence of depression among CKD children was 30.8%. CKD patients on dialysis were more likely to be
depressed than the pre-dialysis patients. Prevalence of psychiatric disorders among CKD children was 64.7 %. This
study showed that, CKD patients on dialysis were more likely to had psychiatric disorders than the pre-dialysis patients.
Conclusion: Psychiatric disorders were significantly higher in CKD patients. The most common psychiatric
comorbidity in CKD patients was attention deficit (43.6%), followed by disruptive disorder (40.4%) and depression
(30.8%). Patients with dialysis are significantly more prone to develop psychiatric disorders.
Keywords: Psychiatric Disorders; Children; Chronic Kidney Disease.

INTRODUCTION

loss of lean body mass, and muscles weakness. Altered
Chronic kidney disease (CKD) is defined as an
salt and water handling by the kidney in CKD can cause
abnormality of kidney function, as determined by
peripheral edema and pulmonary edema (5).
laboratory tests, urine analysis, or imaging tests, which
Psychiatric morbidity is defined as the presence
have been present for at least 3 months. CKD is under
of handicapping abnormalities of emotions, behavior,
diagnosed and underreported worldwide, partly due to
and relationships that impede personal and social
the asymptomatic nature of the disease (1).
functioning (6). Psychiatric manifestations as depression,
A value called glomerular filtration rate (GFR) is
periods of adjustment, low self-Esteem, cognitive
determined to help estimate kidney function. Note that
dysfunction, anxiety, and attention deficit disorders
GFR values for CKD staging are for children older than
occur with CKD (7).
2 years of age, because the GFR values for children
Any chronic illness is a potential life crisis for
under two are low due to ongoing kidney growth (2).
patients and their family. Chronic kidney disease (CKD)
CKD is the new term defined by the national
is emerging as an important chronic disease globally (8).
kidney foundation Kidney Disease and Outcome Quality
Advances
in
medical
care,
including
Initiative KDOQI group to classify any patient who has
improvements in dialysis and transplantation, have
kidney damage lasting for at least 3 months with or
increased the survival rates for children with chronic
without a decreased GFR or any patient who has a GFR
renal failure (CRF). This long survival increases the
less than 60 ml/min per 1.73 m² lasting for 3 months with
opportunities for the development of psychiatric
or without kidney damage (3).
morbidity among these children (9).
Generally, these disturbances become clinically
The aim of this work was to assess the association
manifest with CKD stages 4-5 (GFR > 30 ml/min per
between psychiatric disorders and chronic kidney
1.73 m²), patients with tubulointerstitial disease, cystic
disease in Pediatric Nephrology Unit Zagazig University
diseases, nephritic syndrome and other conditions
Children's Hospital.
associated with "positive" symptoms e.g. polyuria,

hematuria, edema) are more likely to developp signs of
PATIENTS AND METHODS
disease at earlier stages (4).
This cross-sectional study included a total of 156
Uremic manifestations in patients with CKD
patients with Chronic Kidney Disease, attending at
stage 5 are believed to be primarily secondary to an
Pediatric Nephrology Unit, Zagazig University
accumulation of multiple toxins. Metabolic acidosis in
Children's Hospital. Written informed parental consent
stage 5 may manifest as Protein-energy malnutrition,

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/)

1054
Received:13 /5 /2020

Accepted:22 /6 /2020

Full Paper (vol.803 paper# 17)


c:\work\Jor\vol803_18 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1060-1066

Aortic Valve Sclerosis Severity Index is a Predictor of Coronary Artery
Disease Severity in Diabetic Patients with Ischemic Heart Disease
Ayman Ibrahim1, Saud M. Elsaughier1, Bahaa Eldin Shamandy*1, Ahmed Abdel-Galeel2
1Department of Cardiology, Faculty of Medicine - Aswan University, Aswan, Egypt
2Department of Cardiovascular, Faculty of Medicine - Assiut University Heart Hospital,
Assiut University, Assiut, Egypt
*Corresponding author: Bahaa Eldin Shamandy, Mobile: (+20)01115657375, E-mail bahaa.shamandy@gmail.com

ABSTRACT
Background:
The degree of aortic valve sclerosis can play a major role as an independent risk factor for coronary
artery disease as in conditions like diabetes mellitus, hypertension and hyperlipidemia. Therefore, it can be directly
linked to coronary artery diseases (CAD) severity making its assessment and measurement an important step before
the costly or invasive investigations to diagnose CAD. The link between diabetes mellitus and CAD is firmly
confirmed. DM in general confers a two-fold excess risk of vascular outcomes (coronary heart disease, ischaemic
stroke, and vascular deaths) independent of other risk factors.
Objective: To assess the association between aortic valve sclerosis severity index and severity of coronary artery
disease and hence if it could be also used as a bedside predictor of severity of CAD.
Patients and Methods: The study enrolled 100 diabetic patients with ischemic heart disease who were indicated for
coronary angiography. Echocardiography was done for all patients to assess the aortic sclerosis severity index.
Assessment of severity of CAD was done for all patients using SYNTAX score, number of affected vessels and
degree of stenosis were also assessed.
Results: There was statistically significant positive strong correlation between average aortic valve sclerosis score
index with both SYNTAX score and number of affected vessels (r = 0.944, P value < 0.001 and r = 0.611, P value <
0.001 respectively).
Conclusion:
Aortic valve sclerosis severity index can be used as a predictor of severity of coronary artery disease in
diabetic ischemic patients.
Keywords:
CAD, AVSSI, SNTAX score.

INTRODUCTION
asymptomatic people with diabetes for silent myocardial
Atherosclerosis is a major health problem
ischaemia is an appealing concept. However, many
affecting cardiovascular system, which makes coronary
factors argue against implementing a broad-based
artery diseases (CAD) the leading cause of death in
screening program In addition, aortic valve diseases
developed countries and one of major health problems in
became a major health problem with increasing
developing countries. It is a degenerative disease
prevalence of aging and senility rate and advancement of
affecting blood vessels and leads to catastrophic
medical facilities (6-8).
cardiovascular events. It is characterized by basement
Aortic valve sclerosis (AVS) is defined as
membrane disruption, inflammation, cell infiltration,
increased thickness and progressive calcification of
lipid deposition and calcification (1).
aortic valves that causes no obstruction to ventricular
The Emerging risk factor collaboration, a meta-
output (antegrade velocity across the valve of less than
analysis of 102 prospective studies, showed that diabetes
2.5 m/s) (9).
mellitus (DM) involves a two-fold excess risk of
The initial lesions in both AVS and CAD involve
vascular outcomes (coronary heart disease, ischaemic
lipid deposition and focal sclerosis, so atherosclerosis
stroke, and vascular deaths) independent of other risk
affection of coronary artery is akin to its effect on aortic
factors (2). Both relative and absolute risk levels are
valve endothelium (10). Being the site of frequent
higher in long-standing DM and microvascular
turbulence and mechanical stress from blood flow, the
complications, including renal disease or proteinuria (3).
aortic valve serves as a focus for the deposition of lipids
In the 2016, European Guidelines on
involved in the process of atherosclerosis. Recently
cardiovascular disease prevention in clinical practice
many studies focused on aortic valve sclerosis as a
reported that individuals with DM and cardiovascular
degenerative disease sharing common histopathological
disease (CVD), or DM with target organ damage, such
mechanisms with coronary artery atherosclerosis (11). It
as proteinuria or kidney failure, are at very high risk (10-
has the advantage of being proceeding in its nature so it
year risk of CVD death >10%). Patients with DM with
can be a mirror of what is happening inside coronary
three or more major risk factors or with a DM duration >
arteries. Moreover, it has a predictive value of coronary
20 years are also at very high risk (4).
angiography in patients with ischemic heart disease.
Moreover, coronary artery disease is mostly silent
Therefore, it can be directly linked to CAD severity
in people with diabetes (5). Because of that, screening
making its assessment and measurement an important

This article is an open access art icle distributed under the terms and conditions of the Creative
Commons Attribution (CC B Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1060
Received:13 /5 /2020

Accepted:22 /6 /2020

Full Paper (vol.803 paper# 18)


c:\work\Jor\vol803_19 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1067-1073

Interlocking Medullary Nail Versus Plate Fixation in Management of
Diaphyseal Humeral Fracture
Omar Ab-Wahab Kelany1, Waleed Mohammad Nafae1, Sameh Mohammad Holeil1, Aymen Faraj Saleh2
1Department of Orthopedic Surgery, Faculty of Medicine ­ Zagazig University, Sharkia, Egypt
2Department of Orthopedic Surgery, Faculty of Medicine - Tripoli University, Tripoli, Libya
*Corresponding Author: Aymen Faraj Saleh, Email: abokalishaymenfarajyahoo@gmail.com, Mobile: (+20)01030499288

ABSTRACT
Background
: Humeral shaft fractures represent 3% of all fractures, a significant number of these fractures require
operative intervention. Objective: To compare the results of plate osteosynthesis and interlocking nailing in the
treatment of diaphyseal humeral fracture concerning rate healing, functional outcome, and complications. Patients
and
Methods: This study is a prospective comparative study that included 18 patients in the period from December
2018 to July 2019 with follow up 8 months were operated up on at the Orthopedic Surgery Department of Zagazig
University Hospitals. All patients had closed fractures in both groups. The commonest mechanism of injury was road
traffic accidents (RTA) in 7 patients were in group I, 4 patients in group II. Falling from height in 3 patients were in
group I and 4 patients were in group II. 9 cases of them were fixed by plates (group 1) and the other 9 by IM nails
(group 2). Results: The results obtained were excellent in 15 patients (83.3%) 6 patient fixed with a plate (66.6%)
and 9 patient fixed with nail (100%), good in 2 patients (11.1%) fixed with plate and Fair in one patient (5.5%) fixed
with a plate. The excellent and good results were considered satisfactory while fair and poor results were considered
unsatisfactory. Conclusions: Plate fixation offered a higher likelihood of anatomic reduction of the fractures and
predictable healing results, provided AO principles were followed. Although not quantifiable, it was our impression
that antegrade nails were advantageous in comminuted AO Type C fractures.
Keywords: Shaft fractures, IM nails, Plate fixation.

INTRODUCTION

Humeral shaft fractures make up approximately
invasive plate osteosynthesis (MIPO). The use of the
3% of all fractures. Typically, they are the result of
relative stability principle in diaphyseal fractures with
direct trauma but also occur in sports where rotational
minimally invasive techniques has gained interest for
forces are greater, for example, baseball or arm
its potential advantage in causing few soft-tissue
wrestling, Fractures of the middle or distal third of the
complications. Although the infection and nonunion
shaft put the radial nerve at risk. In a small percentage
rates do not differ for IMN and ORPO, there are other
of cases, humeral shaft fractures are associated with a
potential benefits of using minimally invasive
vascular injury. Open fractures are uncommon but can
techniques for humeral fractures: there is less need for
represent serious injuries particularly if associated
bone grafts, there is a smaller incidence of radial nerve
with crushing in industrial injuries (1).
lesions, and there are less demanding techniques for
AO/ASIF classification humerus fractures are
complex or comminuted fractures. However, IMN has
divided into three types with further subdivisions, A -
been how two cause more complications than ORPO,
simple fracture, A1 - spiral fracture, A2 - oblique
with a higher risk of shoulder pain and reoperation.
fracture, A3 - transverse fracture, B - wedge fractures,
The MIPO technique for humeral fractures has
B1 - spiral wedge, B2 ­ bending wedge, B3 ­
recently been described and was developed to allow
fragmented wedge, C- complex fractures, C1 ­
the theoretical benefits of less soft tissue disruption
complex spiral, C2 complex segmental fractures, C3 ­
without the complications of IMN (4).
complex irregular fractures (2).
The present both of these surgical approaches are
Operative treatment for humerus fractures has
used to treat humeral shaft fractures. Both techniques
usually been reserved for the treatment of non-union,
have certain mechanical and anatomical advantages
unacceptable reduction of fractures, compound
and disadvantages. Plating with stable fixation and
fractures, associated with forearm fractures, for
direct visualization, which is known to provide an
polytrauma patients, fractures with neurovascular
accurate anatomic reduction and protection of the
complications and patients with obesity who are at risk
radial nerve, can reduce the risk of malunion but
of developing varus angulations (3).
requires wide intraoperative exposure associated with
There are currently three main operative
soft-tissue stripping. Continuous innovation in the
techniques for definitively treating displaced humeral
design of IMN has ensured the clinical application of
shaft fractures, open reduction with plate
intramedullary fixation in treating humeral shaft
osteosynthesis (ORPO), intramedullary nailing
fractures. Several studies recommended IMN as a
(IMN), and the more recently described minimally
standard surgical method through antegrade or

This article is an open access art icle distributed under the terms and conditions of the Creative
Commons Attribution (CC B
Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1067
Received:13 /5 /2020

Accepted:22 /6 /2020

Full Paper (vol.803 paper# 19)


c:\work\Jor\vol803_20 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1074-1078

TNF And Glycemic Control in T2D: A Single Center Study
Fatima Al Taher*1, Adel Abd El Mohsen Ghorab1, Ali Mostafa Shendi1,
Asmaa Mohamed Hosny Esh2, Ahmed Embaby1
Departments of 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Faima Al Taher, Mobile: (+20)01156200818, E-mail fatima.tahir21@gmail.com

ABSTRACT
Background
: Type 2 diabetes mellitus (T2D) is a global heath burden that is recently viewed as a state of chronic
low-grade inflammation involving activation of immunological and inflammatory responses. Tumor necrosis factor
alpha (TNF ) is a well-known pro inflammatory cytokine produced mainly by adipose tissues that plays a
predominant role in development of insulin resistance in obese population. Thus, several researchers have
hypothesized that circulating TNF levels in diabetic patients can influence diabetic control
Objectives: The aim of the study was to analyse the relationship between the pro-
inflammatory cytokine TNF, C-reactive protein (CRP), ESR and HbA1c in patients with type2 diabetes mellitus to
evaluate the impact of these inflammatory markers on glycemic control.
Subjects and methods: This study included eighty-four Type 2 DM patients from patients admitted to internal
medicine department in Zagazig University Hospitals. Routine laboratory investigations, TNF -, ESR, CRP and
HbA1c were collected and analyzed in all studied population.
Results: We found significant association between serum TNF- and serum HbA1c. These results supports the impact
of TNF- on glycemic control in T2D patients.
Conclusion: Serum TNF- and CRP levels are elevated in type-2 diabetic patients and their levels correlate with level
of HBA1c. This supports the impact of inflammation on glycemic control.
Keywords: HbA1c, C-reactive protein, Tumor necrosis factor-, Type 2 diabetes mellitus.

INTRODUCTION
tissue-specific inflammation through increasing the
Type 2 diabetes (T2D) is a multifactorial
generation of ROS and activation of numerous
disorder that represents a growing worldwide
transcriptional mediated pathways. Additionally,
pandemic
with
underlying
complex
experimental animal studies have demonstrated that
pathophysiological mechanisms with new aspects of
TNF gene expression is increased in diabetic rats
these mechanisms still being discovered until today.
compared to control rats. In addition, results from
The nature of T2D had changed from being a
knockout mice deficient in TNF- or its receptors
metabolic disorder characterized by altered
have suggested that TNF- has a role in regulating in
metabolism of glucose, fat and proteins secondary to
vivo insulin sensitivity (4).
insulin resistance and pancreatic -cell dysfunction to
Several mechanisms have been suggested to
a mixed disorder involving both immune and
explain the metabolic effects of TNF- such as the
inflammatory aspects (1).
ability of TNF- to down regulate expression of genes
There is growing evidence that DM is an
involved in normal insulin action, causing elevation
autoinflammatory disease resulting from a state of
of free fatty acids production through stimulation of
chronic low-grade inflammation involving activation
lipolysis. In addition, the direct effects of TNF- on
of innate immunity and participation of several
insulin signaling and down regulation of PPAR, an
inflammatory cytokines as TNF- and CRP. In
important insulin-sensitizing nuclear receptor (5).
addition, alteration of specific cytokines and
Interestingly, a study by Moriwaki et al. (6), found
chemokines levels, changes in the number and
that inhibition of TNF- is a potential therapeutic
activation of various leukocyte populations and
strategy in experimental diabetic rats.
increased apoptosis and tissue fibrosis (2). Together,
The aim of this study was to investigate the
these changes suggest that inflammation participates
correlation between HbA1c and TNF-alpha in
in the pathogenesis of T2D and open the door for
patients with type2 diabetes mellitus to evaluate the
developing immunomodulatory strategies for the
impact of TNF-alpha on glycemic control.
treatment of T2D aiming at simultaneous lowering of

blood glucose levels and potentially decrease the
SUBJECTS AND METHODS
severity and prevalence of diabetic complications (3).
In this retrospective case control study, we
Tumor necrosis factor-alpha (TNF-) is a
recruited 84 subjects with T2DM from inpatients in
pleiotropic cytokine that is produced mainly by
Internal
Medicine
and
Clinical
Pathology
monocytes, macrophages, B and T lymphocytes as
Departments, Faculty of Medicine, Zagazig
well as glomerular mesangial cells. It can induce
University Hospitals between January and December

This article is an open access art icle distributed under the terms and conditions of the Creative
Commons Attribution (CC B
Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1074
Received:14 /5 /2020

Accepted:25 /6 /2020

Full Paper (vol.803 paper# 20)


c:\work\Jor\vol803_21 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1079-1085
Detection of Subclinical Crystal Arthropathy in Primary
Knee Osteoarthritis Patients
Mohamed Hesham Mohamed Shehata*, Mohamed Moneer Rayan, Mohamed Elwan Said
Department of Rheumatology & Rehabilitation, Faculty of Medicine, Al-Azhar University (Assiut), Egypt
*Corresponding author: Mohamed Hesham Mohamed Shehata, Mobile: (+20) 1000694420,
E-Mail: mohamedhesham0911@gmail.com

ABSTRACT
Background:
Crystal deposition is one of the most common arthropathies among the elderly. Similarly, osteoarthritis
(OA) considers the most common joint pathology amongst the elderly; it is usually associated with significant pain,
disability, and even synovitis.
Objective: The aim of the work was to detect Crystals in Non-symptomatized crystal arthropathy in cases of primary
knee Osteoarthritis.
Patients and Methods: 50 patients with primary knee osteoarthritis who diagnosed according to the American College
of Rheumatology classification criteria for osteoarthritis. Patients underwent to history taking, clinical examination,
laboratory examination, knee US, plain radiography and synovial fluid analysis.
Results:
Fifty patients (35 females, 15 males) were enrolled. Mean values were 65.4 years ± 13.5 SD for age and 50.7
months ± 35.5 SD for disease duration. Plain radiography revealed chondrocalcinosis in 4 patients (8%). Crystals were
detected by US in 36 knees (72%), 24 patients had calcification characteristic of CPPD and 12 patients had
calcifications characteristic of MSU crystals deposition. synovial fluid examination revealed crystal deposition in 38
knees (76%), it was MSU in 12 patients and CPPD in 26 patients. The sensitivity of US for the detection of calcification
was (83.3%) while that of plain X-ray was (22.2%), and the specificity was (93.8%) and (90.2%) respectively. There
is statistically significant difference between patients with crystal deposition and patients without crystal deposition as
regard WOMAC stiffness score.
Conclusion: Subclinical crystals were detected in a significant number of Primary Knee Osteoarthritis Patients. US
showed high specificity and acceptable sensitivity for the diagnosis of Crystal Arthropathy.
Keywords: Subclinical Crystal Arthropathy, Knee Osteoarthritis.

INTRODUCTION


Osteoarthritis (OA) is a chronic degenerative
The interpretation of such findings, the
synovial joints disease that usually affects elderly people.
underlying pathogenic theories, and their contribution to
The exact causes of (OA) are still unclear and there is
the existence/severity of the inflammatory degenerative
much controversy in the literature as to the specific
process in OA awaits in-depth understanding and
sequence of events that provoke the onset of the
evidence-based clarifications. A number of explanations
heterogeneous disease we know as OA (1). In spite of
have been postulated. Most commonly accepted is the
being a degenerative process, an inflammatory
one about infammasomes and crystals (4).
component of variable intensity had been reported
MSU and CPP crystals can directly stimulate the
significantly (2).
innate inflammatory cells like macrophages promoting
Calcium pyrophosphate crystal deposition
infammasomes activation leading to the subsequent
(CPPD) associates with ageing, osteoarthritis (OA),
downstream production and secretion of active
uncommon metabolic diseases, mutations and
inflammatory cytokines such as IL-18 and IL-1, a
polymorphisms in the ankylosis human gene (ANKH).
finding that strongly correlated with OA severity (5, 6).
CPPD is frequently polyarticular, occurs due to a
Intraarticular calcific crystal deposits frequently
generalized articular predisposition, and the association
go underdiagnosed, being largely dependent on
between CPPD and OA is joint specific, for example,
physician's knowledge and judgment, compounded by
CPPD associates with knee OA, but not with hip OA.
the lack of reproducibility of plain radiography in CDD,
Other recently identified associations include knee
another shortcoming of radiographic diagnosis. Diverse
malalignment (knee CC), low cortical BMD and soft
reports revealed a high discordance between clinical
tissue calcification. CPPD is generally asymptomatic. A
criteria of pain, stiffness, and functional disability and
recent study reported that knees with OA plus CC at the
radiographic changes in knee OA (7).
index joint, or at distant joints (in absence of index joint
While magnetic resonance imaging stood out as
CC), were more likely to have attrition. CPPD can cause
an accurate yet an expensive and time-consuming
acute CPP crystal arthritis, chronic CPP crystal
alternative (8). Joint aspiration and polarized microscopic
inflammatory arthritis, and is frequently present in joints
examination are considered the gold standard measure
with OA (3).
for diagnosis of crystal arthropathies.

This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-

SA) license (http://creativecommons.org/licenses/by/4.0/)

1079
Received: 14 /5 /2020

Accepted:23 /6 /2020

Full Paper (vol.803 paper# 21)


c:\work\Jor\vol803_22 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1086-1091
Metabolic Syndrome and Cardiovascular Diseases in Seronegative
Spondyloarthropathy and Rheumatoid Arthritis Patients: A Comparative Study
Mohamed Abdelazeem Mahmoud Ali*, Mohamed Ismail Mohamed AbdelKareem,
Mostafa Abd Elaal Doma, Ahmed Mosalem Ibrahim
Department of Rheumatology and Rehabilitation, Faculty of Medicine - Al-Azhar University (Assiut)
*Corresponding author: Mohamed Abdelazeem Mahmoud Ali, Mobile: (+20) 01063117010,
E-Mail: mojhad87@gmail.com

ABSTRACT
Background:
Spondyloarthritis (SpA) and rheumatoid arthritis (RA) are ones of the most rheumatic diseases with
chronic inflammatory damaging processes that have a great risk for metabolic syndrome (MS) and cardiovascular
diseases. Several studies have indicated higher cardiovascular disease (CVD) risk and mortality rates among these
patients compared to the general population.
Objective: To identify the prevalence and early detection of metabolic syndrome and cardiovascular disease in
seronegative spondyloarthropathy and rheumatoid arthritis patients and their relation to disease activity.
Patients and Methods: Our study was carried out on sixty rheumatoid arthritis patients (54 female and 6 males
with mean age 46.7 ± 5.5 years) and sixty spondyloarthroapathy patients (27 female and 33 males with mean age
44.9 ± 5.9 years).
Results: In RA group, there were 23 patients (38.3%) with metabolic syndrome and 37 patients (61.7%) without
metabolic syndrome. In SPA group, there were 21 patients (35%) with metabolic syndrome and 39 patients (65%)
without metabolic syndrome. There was no statistical significant difference (p-value > 0.05) between studied groups
as regards metabolic syndrome prevalence. There was high statistical significant difference (p-value < 0.001)
between patients with MS and patients without MS in RA group regarding age, duration, BMI, FBS, ESR, CRP and
DAS28. High statistical significant difference (p-value < 0.001) was detected between patients with MS and patients
without MS in SPA group as regards duration, BMI, FBS and BASDI. There was increase in cIMT in RA (0.8 ±
0.2) and SPA groups (0.7 ± 0.1) with high statistical significant difference (p-value < 0.001).
Conclusion: MS prevalence increased in patients with RA and SPA, whereas the cardiovascular risks increased in
RA patients. The disease activity of both were associated with metabolic syndrome, implicating the role of chronic
inflammation in metabolic syndrome development.
Keywords: Metabolic Syndrome, Cardiovascular Diseases, Seronegative Spondyloarthropathy, Rheumatoid
Arthritis.

INTRODUCTION

Rheumatoid arthritis (RA) is a chronic
The
spondyloarthropathies
form
a
inflammatory autoimmune disease characterized by
heterogeneous group includes ankylosing spondylitis,
progressive joint destruction, associated with extra-
psoriatic arthritis, inflammatory bowel disease
articular manifestations, affecting different internal
associated arthritis, and the `reactive' arthritis, which
organs (1). Interestingly, these patients showed an
follows a very specific set of infectious diseases (7).
increased risk of mortality when compared to general
The axial skeleton is a dominant site of pathology in
population and recent evidence clearly confirmed that
these conditions, with inflammation of the ligamentous
this risk is large due to cerebro-cardiovascular events
attachments in the affected spine, which results in pain,
(CVEs) (2). In addition, several studies showed the
stiffness and poor mobility. In contrast to other
close relationship between RA and specific
articular diseases such as rheumatoid arthritis where
cardiovascular (CV) events, including myocardial
inflammation is accompanied by bony erosion and
infarction (MI), cerebrovascular accident (CVA) and
destruction (8), spondyloarthropathy is not only
congestive heart failure (3).
characterized by such destruction, but by new bone
It is now well-known that increased subclinical
formation (9). Psoriatic arthritis (PsA) one of the most
atherosclerosis, mainly carotid artery plaques, may be
common spondyloarthropathies in which systemic
observed in RA patients, which may be easily
inflammation extends beyond the skin and joints.
recognized by ultrasound, thus identifying those
Recent research highlighted the increased risk of major
patients with higher CVEs risk (4). Rheumatoid arthritis
adverse cardiovascular events (combined end-point of
and metabolic syndrome are considered diseases with
myocardial infarction, stroke, and cardiovascular
common traits that can increase the risk of
death) in patients with PsA (10).
cardiovascular disease (5) with previous research
Cardiovascular
involvement
has
been
showing an association between the two (6).
demonstrated as the most important cause of mortality

This article is an open access article distributed under the terms and conditions of the Creative

Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)

1086
Received:15 /5 /2020

Accepted:24 /6 /2020

Full Paper (vol.803 paper# 22)


c:\work\Jor\vol803_23 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1092-1096

Short Term Result of Revision Total Hip Replacement after
Failed Hemiarthroplasty
Khaled Mohamed Hassan1, Mohamed Mansour Elzohairy 1,
Fahmy Samir Fahmy1, Abdulsalam Esmaeil Alkadoushi*2
1Department of Orthopedic Surgery, Faculty of Medicine ­ Zagazig University, Sharkia, Egypt
2Department of Orthopedic Surgery, Faculty of Medicine ­ Tripoli University, Tripoli, Libya
*Corresponding Author: Abdulsalam Esmaeil Alkadoushi, Mobile: (+20) 01023634549, Email: alkadoshi85@gmail.com

ABSTRACT
Background:
Total hip arthroplasty is the most common surgery performed for complications of hip
hemiarthroplasty. Hemiarthroplasty has been a good method of treating displaced fracture neck of femur. With the
increased demands placed on the prosthesis by highly active patients, the failure rate increased following
hemiarthroplasty. Pain is the most reliable complaint that indicates failure. Pain may be due to many complications
related to hemiarthroplasty as loosening, sepsis, protrusio, dislocation, and periprosthetic and prosthetic fractures.
Conversion to total hip replacement is a good method for treating patients with painful hemiarthroplasties.
Objective: This study aimed to evaluate the result of revision total hip replacement after failed hemiarthroplasty.
Patients and Methods:
This is a retrospective study included 62 patients with ages ranged from 38 years to 75 years
with a mean (62.7±11.38), with the conversion of failed hip hemiarthroplasty to total hip arthroplasty between 2000
and 2015 with a minimum follow up 5 years and maximum follow up 10 years at Zagazig University Hospital. Males
represented 54.8% (34 cases) and females were 45.2% (28 cases).
Results
: Our study that the mean Harris hip score significantly increased from 21.87±8.31 preoperative to 74.21±18.3
postoperative P=0.00** and postoperative radiologically we find that 58 patients (93.5%) has fixed implants and 4
patients (6.5%) has loose implants.
Conclusions:
This present study showed that the conversion of failed hemiarthroplasty to THR is a good way of
treatment for painful hemiarthroplasties. Conversion is a complicated surgery with a higher rate of complications both
intra and postoperatively.
Keywords:
Total hip replacement, Failed hemiarthroplasty, Hip arthroplasty.

INTRODUCTION

Total hip arthroplasty is the most common surgery
implant. (4) Preexisting osteoporosis and thin femoral
performed for complications of hip hemiarthroplasty
cortices. (5) Periprosthetic femoral fractures (5, 6, 7).
(1). Pain is the most common indication for conversion
This study aimed to evaluate the result of revision
from a hemiarthroplasty to total hip replacement. Pain
total hip replacement after failed hemiarthroplasty.
following aseptic, undislocated hemiarthroplasty is

usually due to one of two pathological processes,
PATIENTS AND METHODS
articular cartilage erosion of the acetabulum and/or
This is a retrospective study that included 62
loosening of the femoral stem (2). Other indications of
patients with ages ranged from 38years to 75 years
conversion include periprosthetic fractures, prosthetic
with a mean (62.7±11.38), with the conversion of
fracture, dislocation, and infection (3).
failed hip hemiarthroplasty to total hip arthroplasty
Conversion of a hip hemiarthroplasty to total hip
between 2000 and 2015 with a minimum follow up 5
replacement (incidence 5% to 24%) is considered by
years and maximum follow up 10 years at Zagazig
many authors a revision arthroplasty because it is
University Hospital. Males represented 54.8% (34
associated with a high rate of intra-operative
cases) and females were 45.2% (28 cases). Thirty-four
difficulties if compared to the primary total hip
cases (54.8%) were right and twenty-eight cases
replacement (1, 4).
(45.2%) were left.
Reconstruction of the proximal femur is

considered as one of the major problems in Revision
Ethical approval
hip arthroplasty. Several causes are leading to
Approval for performing the study was
deficiencies in the proximal femur as follows: (1)
obtained from Orthopedic Surgery Departments,
Osteolysis caused by wear or infection. (2) Perforation
Zagazig
University Hospitals after taking
or creation of windows during removal of previous
Institutional Review Board (IRB) approval.
stems or another implant. (3) Stress shielding from the
The work has been carried out following the code
excessively stiff or extensively porous-coated
of ethics of the world medical association (Declaration

of Helsinki) for studies involving humans.

This article is an open access art icle distributed under the terms and conditions of the Creative
Commons Attribution (CC B
Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1092
Received:14 /5 /2020

Accepted:23 /6 /2020

Full Paper (vol.803 paper# 23)


ž’,'E9) The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1097-1201

Cardiac Myosin Binding Protein C Plasma Level as a Diagnostic and
Prognostic Biomarker in Heart Failure in Children
Eman M. El-Moghazy1, Saed Mohamed Morsy1, Somia Hassan Abdallah2, Mona Ahmed Ali1*
Departments of 1Pediatrics and 2Medical Biochemistry - Faculty of Medicine - Zagazig University
*Corresponding author: Mona Ahmed Ali, Mobile: (+20)01061402617, E-Mail: dr_monaali82@yahoo.com

ABSTRACT
Background:
Heart failure is one of the cardiovascular diseases that have high morbidity and mortality especially among
children. It accounts for 2% of all pediatric inpatient admission. Cardiac Myosin Binding Protein-C (cMyBP-C) is
cardiomyocyte specific sarcomeric protein that regulates sarcomeric structure and its function where it is released in
circulation in response to cardiac injury.
Objective: To explore the role of cMyBP-C as a biomarker in heart failure in children.
Patients and Methods: This prospective cohort study was carried out during the period from October 2017 to October
2018 in Pediatric Cardiology Unit, Zagazig University Hospital. It included 26 selected patients with heart failure
diagnosed clinically and by echocardiography.
Results: The study revealed that the most common cause pf heart failure in our patients was VSD (30.8%) then
DCM (26.9%). 57.7% of studied patients were grade III of ROSS classification while 30.8% were grade IV and
11.5% were grade II. In ECHO findings, mean EF% was 52.3% while mean FS% was 33 % with negative
correlation between plasma level of cMyBP-C and EF% and FS%. There was high statistical significant
difference in cMyBP-C plasma level at time of admission and after treatment (123.5 ng/ml and 78.8 ng/ml
respectively). There was high statistical significant difference in level of cMyBP-C among improved cases
before and after treatment. There was no statistical significant difference in level of cMyBP-C before and after
treatment among cases with bad prognosis.
Conclusion: cMyBP-C could be a prognostic biomarker in children with HF and may be used as a tool to help in
HF diagnosis in children as a marker of disease severity.
Keywords: Heart failure, cMyBP-C, Children.

INTRODUCTION

Heart failure was defined by American Heart
and the response to adrenergic stimulation
Association (AHA) as a complex clinical syndrome
decreases (6).
that results from any structural or functional
It is confirmed that cardiac stress is associated
impairment of ventricular filling or ejection of blood
with decreased level of cMyBP-C phosphorylation,
(1). It also can be defined as failure of the heart to
activate cleavage of intact cMyBP-C and release of
supply the blood essential for the metabolic demands
40-KDa. 40-KDa is a truncated fragment, which is
of body and it has high morbidity and mortality in
increased in diseased heart and compete for the
children (2).
normal cMyBP-C binding site to actin and myosin.
As 87% of new onset case of heart failure
Thus, interfering with cardiac contractility that
reach the diagnosis when the patient reaches the
causes heart failure. This finding suggests that
state of sever decompensation (3). It is important to
plasma level of cMyBP-C could be used for early
have simple biomarker that can help in early
diagnosis of heart failure and predicting its severity
diagnosis and prognosis of adverse outcome to
(7). This work aimed to explore the role of cMyBP-C as
change treatment plan . There are many HF
a biomarker in heart failure in children.
biomarkers that help in assessing the severity of HF

and predicting the course of the disease. The release
PATIENTS AND METHODS
of these biomarkers has different sources; from
This prospective cohort study was carried out
myocyte injury, ventricular remodeling and reduced
during the period from October 2017 to October 2018
coronary reserve (4).
in Pediatric Cardiology Unit, Zagazig University
cMyBP-C is a thick filament-associated
Hospital. The study includes 26 selected patients
protein and is a specific cardiomyocyte determinant
with heart failure diagnosed clinically and by
of integrity and function of structure of cardiac
echocardiography.
sarcomere (5). It regulates cardiac contractility and its

phosphorylation by protein kinase contributes to
Ethical approval:
increased cardiac output in response to adrenergic
The study was approved by the Ethical
stimulation. In heart failure, this phosphorylation
Committee of the Faculty of Medicine, Zagazig
decreases which leads to contractility dysfunction
University.

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/)

1097
Received:16 /5 /2020

Accepted:28 /6 /2020

Full Paper (vol.803 paper# 24)


c:\work\Jor\vol803_25 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1103-1019

The Prognostic Value of Circulatory Cancer Cells after
Debulking of Advanced Ovarian Tumor
Attia Mohamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Attia Mohamed, Email: elbalkinyattia@gmail.com

ABSTRACT
Background:
There is a recent focus on circulatory cancer cells (CCCs) as a prognostic biomarker for many malignant
cancers. We aimed to investigate the association between the presence of CCCs before the surgery in patients with advanced
ovarian cancer (AOC) and the survival of these patients. Methods: We included in this study 30 women with AOC and
eligible for debulking. Blood samples were obtained before and after the surgery and the CCCs were counted using the
optimized tapered-slit filter technique. The association between these cells and the survival of these patient was analyzed.
Results: The median age of the included women was 57 years, while the median follow-up period was 29.3 months. There
was no difference between the counts of CCCs before and after the debulking (P>0.05). There was no association between
the post-debulking CCCs and the 3-year progression-free survival (PFS) (P>0.05) or the overall survival (OS) (P>0.05).
There was an association between frequent presence of lymph node involvement and the presence of post-debulking CCCs
(P<0.01). However not significant, there was an association between the post-debulking CCCs and the PFS in women with
very advanced cancers (P>0.05).
Conclusion: The presence of post-debulking CCCs was proven to be associated with bad prognosis as it showed to be
associated with poor PFS. Further studies are required to enforce these findings.
Keywords: Ovarian cancer; Circulatory cancer cells; Prognosis.

INTRODUCTION

As
compared
with
other
gynecological
cancers and revealed that the CCCs is associated with bad
malignancies, ovarian tumor was proven to be the most
prognosis; as they were reported to be associated with
gynecological tumor associated with poor prognosis (1).
shorter progression-free survival (PFS) and overall
Due to the lack of presence of early biomarkers or
survival (OS) in these cancers. However, there were a
presence of clinical symptoms, ovarian cancer mostly
contradiction regarding these cells whether associated or
reaches the advanced stages. Around 80 % of patients
not with bad prognosis of ovarian cancer8-14.
with ovarian cancer relapse after the debulking and the
Therefore, if CCCs could predict the tumor activity
chemotherapy (2). The follow-up of such patient is
or metastasis occurrence, we could develop more optimal
conducted via both cancer antigen-125 (CA-125) and CT
treatment options to enhance the survival of patients with
scan; however, its sensitivity in diagnosis of recurrence
ovarian cancer. Therefore, we aimed to investigate the
do not exceed 70% (3,4). This is due to the inappropriate
association between the presence of CCCs before the
immune response associated with recurrence due to the
surgery in patients with advanced ovarian cancer (AOC)
small amount of antigen secreted from the small recurrent
and the survival of these patients.
tumor cells. Therefore, these biomarkers are not well-

effective in diagnosis of cancer recurrence after the
Methods
surgery in patients with ovarian cancer, and the search for
Throughout the inclusion period, we included 30
effective biomarker is an urgent need.
women with ovarian cancer and eligible for staging
There is a recent focus on circulatory cancer cells
operation who were admitted in Bab-Elshaarya
(CCCs) as a prognostic biomarker for many malignant
University Hospital, Cairo, Egypt. The recruitment period
cancers including the ovarian cancer. They are individual
was conducted throughout the entire year of 2018.
malignant cells or nests that originate from the main
Patients with any malignant tumor in the last 5 years were
cancer and enter the blood through the vascular invasion
excluded from the study.
and they could reach the distant cells to form metastasis5-

7. Occurrence of metastasis is the most critical outcome
Ethical approval:
that survivors fear from; therefore, catching these cells in
A written informed consent was obtained from each
the blood and the early prediction of metastasis has gain
participant and the institutional review board of Al-
the attention of many researchers. There are many studies
Azhar university approved the study. This study was
that were performed on breast colorectal, and prostatic
conducted under the declaration of Helsinki.

This article is an open access arti
cle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-S A) license (http://creativecommons.org/licenses/by/4.0/)
1103
Received:14 /5 /2020

Accepted:23 /6 /2020

Full Paper (vol.803 paper# 25)


c:\work\Jor\vol803_26 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1110-1115

Transforming Growth Factor-, Reverse IFN- Activation of
Intestinal Epithelial Cells during Cryptosporidium parvum Infection
Tarek K Zaalouk
Medical Parasitology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
Corresponding Author: Tarek K Zaalouk, Mobile: (+20) 01123900070, E-mail: tkzaalouk@gmail.com

ABSTRACT
Background:
The intracellular parasite Cryptosporidium parvum (C. parvum) is a causative agent of diarrhea in
humans and potentially fatal in AIDS patients. The parasites develop in enterocytes and are transmitted mainly by the
fecal-oral route. In developing countries, infections are more common in children and may be associated with
malabsorption and malnutrition. Enterocytes are an active component of intestinal mucosal immunity and their
resistance to infection can be mediated by more than one mechanism including responding to cytokine signals. IFN-
activates various mechanisms in infected enterocytes to kill invading pathogens. In contrast, transforming growth
factor (TGF-) is crucial in downregulating inflammation caused by the Th1 response.
Aim of Study: This study aims to investigate the role of IFN- and TGF- in host immunity against C. parvum
infection.
Methods: To determine the role of IFN- on the development of C. parvum in vitro, HT-29 monolayers were
incubated for 24h with varying concentrations of IFN-. Following infection with C. parvum oocyst, the cells were
re-incubated with cytokines for a further 24h before being fixed and stained with Giemsa. The parasites were then
counted using a Zeiss Axioplan microscope at x1000 magnification with oil-immersion in 20 random fields across the
diameter of the coverslip.
Results: IFN- was found to have a marked inhibitory effect on C. parvum infection. The effect of IFN- was partially
reversed by TGF-, which produces a significant dose-dependent antagonist of IFN- activity. IFN- mediated its
action by modification of intracellular Fe2+ concentration.
Keywords: Cryptosporidium, HT-29 cells, IFN-,TGF-.

INTRODUCTION
vitro. Infection with C. parvum induced expression of a
C.
parvum
is
an
intracellular,
-defensin- 2 in the intestinal epithelium(7).
extracytoplasmatic protozoan parasite that colonizes
IFN-, the crucial cytokine produced during the
the mucosal epithelium of the gastrointestinal (GI) tract
early phase of infection with intracellular pathogens,
causing a mild to severe, cholera-like diarrhea (1).
activate various mechanisms in infected IEC to kill
Cryptosporidiosis may be fatal in AIDS patients(2) and
invading pathogens. The major source of IFN- in
may also be a serious complication among
innate immunity is NK cells, that activated by
malnourished children in developing countries(3). Six
cytokines, including IL-12, IFN-/, IL-15, TNF-
percent of all diarrhoeal disease in immunocompetent
and IL-18 produced by ancillary cells such as dendritic
individuals and up to 24 percent of diarrheas in
cells and macrophages(8). The essential requirement for
immunosuppressed patients worldwide were attributed
IFN- in controlling intracellular infection has been
to cryptosporidiosis(4).
demonstrated by antibody-mediated neutralization of
IEC plays a key role in the protection of the
IFN- in vivo. In addition, gene knockout (KO) mice
underlying biological compartments from both
with deletion of either IFN- receptor chain or the
microflora and invading organisms. In response to
IFN- gene itself showed enhanced susceptibility to C.
infection, the epithelium activates mechanisms that
parvum infection(8). IFN- activity is mediated by two
help to maintain structural integrity, establish an
heterologous receptor subunits. A ligand-binding
inflammatory response, and contribute to parasite
subunit IFNGR-1 and an accessory subunit IFNGR-2(9).
killing. Human or murine intestinal epithelial cell lines
Heterodimerization of IFN- receptors leads to
infected with C. parvum demonstrate an inflammatory
activation of tyrosine kinases, jak-1 and jak-2(10), and
response characterized in particular by the production
subsequent phosphorylation of Stat-1 (signal
of numerous chemokines(5, 6). Also, epithelial cells
transducer and activator of transcription). Stat-1
exhibit antimicrobial killing mechanisms that could
phosphorylation form gamma activation factor (GAF)
affect the viability of Cryptosporidium. The
homodimers which translocated to the nucleus and bind
antimicrobial peptides expressed by human epithelial
to gamma activation site (GAS) present in IFN-
cells, -defensin-1 and -2, have been shown to induce
responsive gene(10).
lysis of C. parvum sporozoites and inhibit infection in

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/)

1110
Received:15 /5 /2020

Accepted:24 /6 /2020

Full Paper (vol.803 paper# 26)


c:\work\Jor\vol803_27 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1116-1125
Effect of Local Injection of 1, 25 Dihydroxycholecalciferol on
Bone Remodeling in Uremic Rabbit Model
Marwa K. Khairallah* 1, Nessren M. Abd El-Rady2, Yasmine S. Makarem3, Marwa A. Dahpy 4,
Hamdy M. Ibrahim 5, Mostafa K. Abdo6, Wael M. Refai7, Mohamed E. Ibrahim 7, Mohamed G. Elshal7
1Department of Internal Medicine, Nephrology & Renal Transplantation Division,
2Department of Medical Physiology, 3Department of Rheumatology & Rehabilitation,
4Department of Medical Biochemistry & Molecular Biology, 5Department of Diagnostic Radiology,
Faculty of Medicine, Assiut University, 6 Department of Orthodontics, Faculty of Dentistry, Aswan University,
Egypt.7 Department of Orthodontics, Faculty of Dentistry, Minia University, Egypt
*Correspondence to Marwa Kamal Abdo Khairallah, Fax: 71515, Mobile: 002/01097878113, E-mail: marwa.kamal82@hotmail.com
ABSTRACT
Purpose:
Uremia influences bone remodeling. This study aimed to evaluate the impact of treatment with local injection
of Vitamin D3 (Vit.D3) on bone remodeling associated with orthodontic treatment in uremic rabbits.
Patients and Methods: rabbits were split into four groups: a healthy control, a sham second group, where antibiotic was
given in therapeutic dose, uremic third group, uremia induced by a nephrotoxic dose of antibiotic, and the fourth uremic
group treated with locally injected Vit.D3. All groups experienced orthodontic procedures. Bone density before and after
tooth movement was determined using quantitative computed tomography. Analysis of serum parathyroid hormone was
done by Elisa while serum calcium, urea, and creatinine were done by enzymatic colorimetric assay. Maxillary bone
underwent histological analyses. Results: A statistically significant reduction in bone density in uremic models (P< 0.05)
versus healthy models. Improvement in bone density in the treated uremic group after treatment with locally injected
Vit.D3, which led to increase osteoblastic activity in comparison to the non-treated uremic group. A significant negative
correlation was detected between serum calcium and bone density in the non-treated uremic group, this correlation was
lost in the treated uremic group. Conclusions: Treatment of uremic models with locally injected Vit.D3, had significantly
improved bone density by increasing osteoblastic and decreasing osteoclastic activity regardless of calcium and
parathyroid levels. Local Vit.D3 could be used to improve bone remodeling in uremia.
Keywords: Uremia, bone remodeling, Dihydroxycholecalciferol, Osteoblastic chronic kidney disease.

INTRODUCTION
its regulatory bone formation and mineralization effect (6).
Recently orthodontic treatment is universally
Also, it is well known that chronic kidney disease patients
practiced in patients with uremia as a result of
have Vit.D deficiency (7). Accordingly, bone remodeling
advancement in medical services resulting in reduced
evaluated by the rate of bone formation concerning
mortality in chronic kidney disease (CKD) patients.
orthodontic tooth movement (OTM) in CKD patients with
Clinical findings of CKD influence multiple organs. Bone
and without a combination of Vit.D3 seemed to be a point
disease is a universal feature of CKD (1). Calcium
worthy investigation. So, this study is conducted to
metabolism is compromised by an elevated parathyroid
highlight this aim.
hormone and by the disruption in Vit.D metabolism that
MATERIALS AND METHODS
results in secondary hyperparathyroidism (2). Besides,
Animals: The flow diagram (Fig. 1) is showing the steps
persistent inflammatory processes are prevalent in CKD
in our study. The study included 45 New Zealand healthy
patients. This is associated with the presence of several
male rabbits, ranged from 10-12 months in age, and 2.5-3
factors, as uremic mediators, high levels of oxidative
kg in weight at the start of the experiment. They were
stress,
protein-energy
wasting,
circulating
pro-
housed in clean cages in the animal house, Faculty of
inflammatory cytokines, enhanced infections, and chronic
Medicine, Assiut University. They were maintained on a
inflammation evaluated by high levels of C-reactive
natural 12:12-h light-dark cycle in an aerated room,
protein (3).Uremia acts as a bone metabolic disorder
temperature (25 ± 5°C), standard rabbit meals and water
affecting bone manipulative proceedings such as
were available. Animals were habituated for handling and
orthodontic treatment. Still, experimental researches that
acclimatized to laboratory conditions for one week before
examine the effect of uremia in CKD on orthodontics as
the start of the experiment. At the start of the experiment
representative of bone remodeling are scanty. Previous
they were randomly assigned into four groups: Healthy
experimental studies on orthodontic treatment have proven
control group (n =10), in which only OTM was conducted.
that injection of 1, 25(OH)2 dihydroxycholecalciferol
Sham group: (n=11), in which only gentamycin injections
(Vit.D3) and implementation of mechanical force stimulate
were given in regular therapeutic doses (3-5 mg/kg/day
formalization of several osteoclasts and increase bone
IM). Non-treated uremic group (CKD group) (n=12), in
resorption (4), bringing about higher rates of teeth
which nephropathy was induced by gentamycin, and
movements than those produced only by mechanical force
treated uremic group (CKD Treated group) (n=12), which
(5). Knowing that Vit.D3 affects bone metabolism in an
were treated by local injection of Vit. D3 after induction of
anabolic manner, osteoblastic cells have high-affinity
nephropathy and then orthodontic treatment was done in
receptors for Vit.D3, a finding that strengthens the idea of
all the four groups.
This article is an open access article distribu ted under the terms and conditions of the Creative Commons
Attribution (CC BY-SA) license (
http://creativecomm ons.org/licenses/by/4.0/)
1116
Received:14 /5 /2020

Accepted: 23/ 6/2020

Full Paper (vol.803 paper# 27)


c:\work\Jor\vol803_28 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1126-1137

Comparison between Dexmedetomidine or Magnesium Sulfate as
Adjuvants to Bupivacaine for Caudal Anesthesia in
Pediatric Patients Undergoing Infraumbilical Surgeries
Ahmed El-Saeed Abd El-Rahman Ali, Wesam Abd El-Galil Abu-Elwafa,
Ghada Abdel-Gaber Rezk, Mariam Helal Rasmy*
Department of Anesthesia, ICU& Pain management, Faculty of Medicine, Sohag University, Egypt
Corresponding author: Mariam Helal Rasmy, Mobile: (+20)1202616877, E-Mail: mariamhelalrasmy@gmail.com

ABSTRACT
Background:
Caudal epidural anesthesia is a common technique providing intra and postoperative analgesia in
pediatric infraumbilical surgical procedures.
Objectives: The aim of this study was to compare the effect of adding Dexmedetomidine or Magnesium Sulfate as
an adjuvant to Bupivacaine for caudal anesthesia in pediatric infraumbilical surgeries.
Patients and Methods: This randomized controlled prospective study was done at Sohag University Hospital on
sixty pediatric patients with American Society of Anesthesiologists (ASA) Classes I or II or III, weighted up to 20
kg scheduled for infraumbilical surgeries using caudal block in the period between January 2019 and January 2020.
The included subjects were divided into three groups, twenty patients each: Group C (control), Group D
(Dexmedetomidine group) and Group M (Magnesium group).
Results: In our study, the caudal block mainly used to relieve pain after Sevoflurane anesthesia with less incidence
of emergence agitation. On comparing (Group D) and (Group M), Face, Legs, Activity, Cry, Consolability scale
(FLACC) score was lower in (Group D: 0,1,1,2) than (Group M: 1,1,2,2) without significant difference at
postoperative set times (30 minutes,1,2,3 hours), respectively. At the 6th hour postoperatively, (Group M) patients
achieved higher FLACC scores (3) compared with (Group D) patients (2.5) with statistically significant difference
with P value of 0.05. During the first 3 hours post-operative, there were higher sedation scores in (Group D: 4,4,3,3)
and (Group M: 4,4,3,2.5) more than (Control group: 3,2.5,2,2) with highly statistical significant difference with (P
value < 0.001) at (30 minutes,1h, 2h, 3 hours), respectively. At the 6th hour postoperatively, there were higher
sedation scores with (Group D) (3) more than (Group M) (2) with highly statistical significant difference with (P
value < 0.001).
Conclusion: Administration of Dexmedetomidine as adjuvant with Bupivacaine enhances caudal block, prolongs
duration of postoperative analgesia, reduces postoperative EA and provides preferred postoperative sedation in
pediatric patient undergoing infraumbilical surgeries with minimum adverse effects compared to Magnesium Sulfate
as adjuvant.
Keywords: Dexmedetomidine, Magnesium Sulfate, Bupivacaine, Caudal anesthesia, Infraumbilical surgeries,
postoperative agitation.

INTRODUCTION

been achieved by the addition of various adjuvant such
Various multimodal techniques have been used
as opioids, ketamine, clonidine (5).
for postoperative pain relief in children undergoing
The use of adjuvants, such as opioids, such as
surgical procedures. These include both systemic and
fentanyl and morphine, which have traditionally been
regional analgesia. Of the regional blocks, Caudal
used as adjuvants to epidural local anesthetics, are
epidural analgesia is one of the most commonly
associated with side effects of pruritus, urinary
performed technique in the pediatric anesthesia. It is a
retention, nausea and vomiting, and respiratory
reliable and safe method that can be used in patients
depression(6).
undergoing lower abdominal and lower limb surgeries(1).
There is an increasing interest to study magnesium
Many anesthetic agents have been used for caudal
and dexmedetomidine analgesic effects. Many studies
analgesia in pediatric patients, examples: Lignocaine
suggested that epidurally administered magnesium as an
and Bupivacaine being most common (2). Bupivacaine
adjuvant to local anesthetics could reduce the
has been in clinical use for more than 25 years and is
postoperative pain in adults. But few studies are
widely used for pediatric caudal epidural analgesia
available about its use as an adjuvant in caudal block for
because of its preferential sensory than motor blocks (3).
such purpose(7).
Unfortunately, the main disadvantage of caudal
Dexmedetomidine, which is a highly selective -
anesthesia depending on local anesthetics only is its
2 adrenergic agonist with sedative and analgesic
relatively short duration of analgesia (4). Prolongation of
properties, has recently been used as an adjuvant to
caudal analgesia using a "single-shot" technique has
general and regional anesthesia in both adults and
children(8,9). As of yet, dexmedetomidine has not been

This article is an open access art icle distributed under the terms and conditions of the Creative
Commons Attribution (CC B
Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1126
Received:16 /5 /2020

Accepted:28 /6 /2020


Full Paper (vol.803 paper# 28)


c:\work\Jor\vol803_29 The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1138-1143

Assessment of Erythropoietin Efficacy in Treatment of Anemia in
Pre-dialysis Chronic Kidney Disease Patients
Mostafa Fawzy Mohamed Selim*, 1Essam Eldin Mahmoud Lotfy1,
Lamiaa Abd Elwahab Mohamed2, Mahmoud Hosny Zahran1
Departments 1Internal Medicine & 2Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
*Corresponding author: Mostafa Fawzy Mohamed Selim, Mobile : (+20)01558527334, Email: mostafaselim945@yahoo.com

ABSTRACT
Background:
Anemia is the most frequent condition in patients suffering from chronic renal disease. Iron supplements
are commonly prescribed for these patients using oral and intravenous iron with or without erythropoietin therapy.
Objectives: This study aimed at comparing the efficacy of IV iron versus oral iron in raising hemoglobin levels in pre-
dialysis chronic kidney disease (CKD) patients.
Patients and Methods:
A prospective cohort study that was conducted in Met-Ghamr Hospital of Nephrology and
Urology from February 2019 to July 2019. The study included 50 CKD patients with anemia in the pre-dialysis stage.
Group 1 consisted of 25 patients that were given IV iron while the 25 patients of group 2 were given oral iron. Both groups
were monitored for 4 months for changes in hemoglobin levels and side effects. After the initial 4 months, patients in both
groups who did not have a sufficient hemoglobin response to iron supplementation were prescribed an additional
erythropoiesis-stimulating agent (ESA) with monitoring of hemoglobin response for the consequent 2 months.
Results:
We found a significant difference in the hemoglobin response between the two sets of patients in favor of the IV
route after 4 months. We also found the safety profile of both routes to be comparable. After 4 months, the patients that
received additional dose of Epoetin alfa (4000 IU/week for 2 months) showed a significant rise in hemoglobin level over
the next 2 months compared to patients who did not receive the additional dose.
Conclusion:
We concluded that intravenous iron supplement is better than oral iron supplement in correction of anemia
in pre-dialysis patients.
Keywords: Erythropoietin, Chronic Kidney Disease, Glomerular Filtration Rate, Anemia, Iron.

INTRODUCTION

and nutritional deficiencies and various pro-inflammatory
Chronic
kidney
disease
(CKD)
is
mediators commonly elevated in CKD that may affect the
defined as kidney damage or an estimated glomerular
erythropoiesis (4). Iron deficiency is a common reversible
filtration rate (eGFR) less than 60 ml/min/1.73 m
factor contributing to the development of anemia in CKD
persisting for three months or more irrespective of the
patients and can be easily treated. Guidelines have a
cause.Kidney damage can be demonstrated through urine
consensus about iron deficiency anemic hemodialysis
analysis, imaging or renal biopsy (1).
patients to be supplied with iron supplementation through
CKD is classified based on the GFR into 5 stages from
the IV route. However, there is no recommendation yet on
one to five. Causes of CKD vary from diabetes mellitus,
the most appropriate for patients not yet on dialysis (5).
hypertension (the two most common causes), recurrent
Three routes of administration for iron are available:
renal stones and glomerular diseases (2). The presentation
oral, intramuscular, and intravenous. Moreover, iron
of CKD can vary from being asymptomatic to producing
deficiency is the most common cause of resistance to
symptoms such as nausea, vomiting, hiccough,
erythropoietin therapy, contributing to ineffective
hypertension, pruritus and uremic encephalopathy (2).
erythropoiesis and hematocrit/haemoglobin values below
CKD has various complications such as cardiovascular
the recommended target range of g/dL-12 g/dL (33% -
complications (the most common cause of mortality),
36%). Iron supplementation improves iron indices and
chronic kidney disease­mineral bone disease (CKD-
haemoglobin concentration and reduces the required ESA
MBD), dyslipidemia and malnutrition. However, anemia
dose (6).
is the most common complication of CKD. Anemia is
Most of the randomized controlled trials have
associated with progression of CKD, poor quality of life
compared intravenous (IV) iron to oral iron in non-
and increased morbidity and mortality (3).
dialysis-dependent CKD patients. Transferrin saturation
Anemia is defined as hemoglobin (Hb) < 13 g/dl in
(TSAT), serum ferritin and haemoglobin levels are useful
adult male and < 12 g/dl in adult female. The mechanism
markers of iron deficiency. In our population, most of the
of anemia in CKD is multifactorial: relative
people had nutritional anemia adding to the anemia of
erythropoietin deficiency from reduced renal mass, iron

This article is an open access art icle distributed under the terms and conditions of the Creative
Commons Attribution (CC B
Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1138
Received:16 /5 /2020

Accepted:28 /6 /2020

Full Paper (vol.803 paper# 29)


Introduction The Egyptian Journal of Hospital Medicine (July 2020) Vol. 80 (3), Page 1144-1150

Evaluation of Different Modalities in Prevention of Seroma Formation Post
Modified Radical Mastectomy
Mansour Mohamad Kabbash1, Abdel-Aal Ali Selem1, Anwar A. Elshenawy2, Ahmed Raafat Mohamed1*
Departments of 1General Surgery and 2Onco Surgery, Faculty of Medicine, Aswan University, Aswan, Egypt
*Corresponding author: Ahmed Raafat Mohamed, Mobile: (+20) 01002416594, E-Mail: hitmancode@ymail.com

ABSTRACT
Background:
Seroma is an abnormal collection of serous fluid in the dead space of post-mastectomy skin flaps and
axilla or following breast-conserving surgery. Seroma is one of the most common early post-operative
complications following surgery for breast cancer. Various studies report an incidence ranging from 10% to 85%
following modified radical mastectomy (MRM) or axillary lymph node dissection (ALND).
Objective: Evaluation of different modalities in the prevention of seroma formation post modified radical
mastectomy.
Patients and methods: This was a prospective comparative study carried out in the General Surgery Department,
Faculty of Medicine, Aswan University, Aswan, Egypt. in the period between December 2017 and June 2018.
Patients scheduled for modified radical mastectomy during the period of study were randomly divided into three
groups, mastectomy flap fixation group (10 cases), ipsilateral shoulder immobilization group (10 cases) & (pre &
post) operative tranexamic acid usage group (10 cases).
Results: Hypertension, obesity, blood transfusion, and bloody field are at high risk of developing seroma after
MRM; while DM, cancer stage, number of LN infiltrated and removed don't affect on seroma formation after
MRM. Flap fixation was found to be the best modality in the prevention of seroma formation with a low incidence
in developed seroma and other complications. On the other hand, tranexamic acid usage pre- and post-operative
found that no role in the prevention of seroma formation after MRM.
Conclusion: The mastectomy flap fixation technique is a valuable procedure that significantly decreases the
incidence of seroma formation, and reduces the duration and amount of drained fluid.
Keywords: Seroma, Modified Radical Mastectomy.

INTRODUCTION
dissection (ALND) advocate suturing of axillary or
Seroma is one of the noisiest events that
mastectomy flaps to underlying muscle using
disturb both the patient and surgeon with multiple
interrupted polyglactin or dexon sutures placed
visits that delay starting the adjuvant therapy and
approximately every 2.5­3 cm apart followed by
cause great patients' discomfort with the possibility of
placement of drains. These techniques add an
increased surgical site infection. Seroma is graded 1 if
estimated 10­20 min to operating time. Techniques of
asymptomatic (only diagnosed by ultrasound), graded
suturing mastectomy and axillary flaps to underlying
2 if symptomatic but can be managed either medically
tissue have been well described and seem to be an
or by simple aspiration, and graded 3 if symptomatic
efficacious option for the reduction of seroma (5).
and requires surgical or radiologic intervention (1).
Immobilization of the affected arm in the
The incidence of seroma has been shown to
early post-operative period remains controversial.
correlate with certain factors such as obesity, patient's
Several authors have been able to show reduced
age, breast size, hypertension, presence of malignant
volumes and duration of drainage in patients who
nodes in the axilla, number of dissected nodes, early
immobilize the ipsilateral limb, but this may be
shoulder exercise, and the use of some drugs, i.e.
associated with shoulder dysfunction (6).
tamoxifen and heparin (2).
Antifibrinolytic agents such as tranexamic
Seroma formation increases the risk of post-
acid stops the degradation of the fibrin complexes,
operative complications; delays wound healing,
thus reducing fluid leakage. Many studies indicated
increases susceptibility to infection, skin flap necrosis,
that this mechanism would make more sense in
persistent pain, wound dehiscence, and prolonged
dealing with breast wounds where fluid shows high
convalescence (3). There are various methods for
levels of fibrinogen, while axillary seromas contain
preventing seroma, such as prolonged suction
lymph-like fluid and thus contain no fibrinogen (3).
drainage, flap fixation, shoulder immobilization, pre

& postoperative use of tranexamic acid, ocreotide
AIM OF THE WORK
usage, dressing compression, tissue sealers (4).
Evaluation of different modalities in the prevention
More recent techniques following modified
of seroma formation post modified radical
radical mastectomy (MRM) or axillary lymph node
mastectomy.

This article is an open access art icle distributed under the terms and conditions of the Creative
Commons Attribution (CC B
Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1144
Received:16 /5 /2020

Accepted:28 /6 /2020

Full Paper (vol.803 paper# 30)