c:\work\Jor\vol811_1 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1151-1155

The Relation between Visual Motor Integration and
Cognitive Development in Full Term versus Preterm Infants
Hadeer Ahmed El-Sayed Mohammed El-Deeb1*, Elham Elsayed Salem1,
Kamilia Saad Abdelhamid2, Mona Nabil Mohamed1
1Department of Physical Therapy for Pediatrics - Faculty of Physical Therapy, Cairo University
2Department of Psychology - Faculty of Arts Cairo University, Cairo University
*Corresponding author: Hadeer Ahmed El-Sayed Mohammed El-Deeb,
Mobile: (+20) 01062282946, E-Mail: dr_dody_1993@yahoo.com

ABSTRACT
Background:
Preterm children present more often than children born at term with neurological problems that
include severe neurological handicaps, such as cerebral palsy or severe mental retardation, or more subtle cognitive
impairments.
Purpose of the study: To investigate the relation between visual motor integration and cognitive development in
full term versus preterm infants.
Subjects:
One hundred and twenty infants (full term & preterm infants) from both sexes, their ages ranged from 6 to
24 months. They were selected from Saray El-kobba Medical Center & Sawa Academy Nursery in Cairo (Ain
shams area). Methods: Children were divided into 2 groups of equal number, Group A: Included sixty full term
infants and Group B: Included sixty preterm infants (low risk preterm). Within the 2 groups children were
subdivided into 3 subgroups according to their chronological age for full term and corrected age for preterm. The
participants of both groups were assessed by the following tools to assess their visual motor integration and
cognition by The Peabody Developmental Motor Scales­Second Edition (PDMS-2) and the Portage Guide to early
childhood education: (Arabic version) respectively.
Results: The results revealed that there was a strong positive correlation between PDMS-2 and Portage scale in full
term sub groups (6-12months), (12-18 months) and (18-24 months) scores [( r= 0.48, p=0.03), (r=0.84, p=0.0001)
and (r=0.75, p=0.0001) respectively]. There was strong positive correlation between PDMS-2 and Portage scale in
preterm subgroups (6-12 months), (12-18 months) and (18-24 months) scores [(r=0.84, p=0.0001) ­ (r=0.63,
p=0,003) ­(r=0.88, p=0.0001) respectively].
Conclusion: Based on this study, it could be concluded that there is a relation between visual motor integration and
cognitive development in full term versus preterm infants.
Keywords: Visual motor integration and Cognitive development, Full term infants, preterm infants.

INTRODUCTION


Normal development in childhood consists of
The previous researches rarely focused on the
sequential changes in function that occurs as an
relationship between cognitive flexibility and the
individual matures. This is different to the concept of
visual motor integration (VMI) because of its
growth. Growth consists of physical maturation of the
complexity containing two subcomponents of
individual, while the development of an individual
executive function (working memory and inhibitory
focuses on stages or hierarchical changes, which
control) at the same time. However, children with
incorporate the skills basis necessary as a prerequisite
better cognitive flexibility probably integrated visual
for higher-level skills. The most critical part of a
and motor information automatically and could reduce
child's development occurs between birth and three
the occupation of cognitive resources so as to deal
years of age (1). This stage is most critical due to the
with other more complex information (4).
developmental sequence of the brain and the impact
The evidence from previous studies investigating
of neuroplasticity being at its greatest within these
the link between visual motor integration and
primitive years (2).
cognitive development in full term and preterm
Late preterm infants (LPIs) are physiologically
infants is still not sufficient to draw firm conclusions.
and metabolically immature at the time of birth, often
More research is needed investigating such specific
lacking the self-regulatory ability to respond
links at this stage of early development, so this study
appropriately to the extra-uterine environment.
was conducted to investigate the relation between
Despite their appearance as small but "normal"
visual motor integration and cognitive development in
babies, LPIs have higher rates of morbidity and
full term versus preterm infants.
mortality than their term counterparts do, not only

during birth hospitalization, but also throughout the

first year after birth and beyond (3).


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1151
Received:1 /7 /2020

Accepted:17 /8 /2020

Full Paper (vol.811 paper# 1)


c:\work\Jor\vol811_2 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1156-1164

Scavenger Receptor Class B Type 1 Gene rs5888 Single Nucleotide Polymorphism:
Association with Risk and Severity of Premature Coronary Artery Disease
Wessam El Sayed Saad 1, Manal Mohamed Abd Al Aziz 1, Marium El Sayed Ahmad Fathi*1, Adham
Ahmed Abdeltawab2, Hoda Ahmad Abdel Sattar 1
Departments of 1Clinical and Chemical Pathology and 2Cardiology, Faculty of Medicine, Ain Shams University.
*Corresponding author: Marium El Sayed Ahmad, Email: cutemar2@hotmail.com, Mobile: (+20)01003598014

ABSTRACT
Background:
Many different genetic associations with premature coronary artery disease (PCAD) have been
identified. One exonic single nucleotide polymorphism (SNP) rs5888 of Scavenger receptor class B type1 (SCARB
1) gene has been linked to lipid traits as well as subclinical atherosclerosis.
Objective: To investigate the association between SNP rs5888 of SCARB 1 gene and PCAD risk and severity.
Patients and Methods: This study was conducted on 50 Egyptian patients diagnosed as PCAD by coronary
angiograph (PCAD group) and (50) age- and sex-matched non-CAD subjects who showed no luminal stenosis in
coronary angiographic served as a control group (non-CAD group). Gensini score was calculated as an indication
for atherosclerosis severity for patients only. Detection of rs5888 polymorphism of SCARB 1 gene was done by real-
time polymerase chain reaction (PCR) and high resolution melting analysis (HRM).
Results: The mutant TT and CT genotypes were more frequently distributed in PCAD group compared to non-
PCAD group (34 % and 48 % vs. 26 % and 18 %, respectively). The (CT) genotype conferred a positive risk for
PCAD in males (OR: 6.117, 95% CI (1.744-21.452); p<0.01). T allele conferred a positive risk for PCAD (OR:
2.564, 95% CI (1.440-4.543); p<0.05). Highest Gensini score was found in PCAD patients with (TT) genotype
(p<0.01).
Conclusion: The mutant (CT) genotype and the T allele of SCARB 1 SNP rs5888 were associated with increased
risk of PCAD and the mutant (TT) genotype was associated with disease severity calculated by Gensini score.
Keywords: PCAD, SCARB 1, genotypes, Gensini.

INTRODUCTION

Coronary artery disease (CAD) is a leading
Scavenger receptor class B type1 (SCARB 1)
cause of morbidity and mortality all over the world,
is a multi-ligand cell surface receptor expressed both on
affecting millions of people in both developed and
macrophages and on liver cells, indicating a major role
developing countries (1). The institute of health metrics
for clearance of excess cholesterol from the body(7).
and evaluation in the year 2016 has declared that
This membrane protein facilitates the uptake of
ischemic heart disease was the leading cause of
cholesterol esters from high-density lipoprotein
premature mortality in Egypt reaching 27.7% of all
cholesterol (HDL-C) and drives cholesterol from
causes of premature mortality(2).
tissues to the liver in the various stages of reverse
Premature coronary artery disease (PCAD) is defined
cholesterol transport pathway (8).
as CAD which manifests for the first time under the
SCARB 1 receptor is encoded on SCARB 1
age of 55 years for males and under 65 years for
gene which is located on 12q24.31. Various SCARB
females (3). Risk factors for CAD are both
1 polymorphisms in humans have been shown to be
environmental and genetic; environmental factors
associated with altered serum lipid profile (9). One
contributing to the development of CAD includes
exonic single nucleotide polymorphism (SNP)
obesity, hypercholesterolemia, alcohol intake,
(rs5888) within SCARB 1 gene has been linked to
smoking,
diabetes
and
hypertension.
lower the receptor expression and function. This SNP
Hypercholesterolemia arising from abnormal lipid
is a "C" to "T" substitution at cDNA position 1050
metabolism has been considered to be one of the most
base position on exon 8 (10). Therefore, SCARB 1 gene
key risk factors for CAD pathogenesis (4).
is considered as an attractive marker for CAD (11).
In addition, apart from these modifiable

factors, accumulating evidences have shown close
PATIENTS AND METHODS
associations of genetic polymorphisms in candidate
This study was conducted on 50 patients with
genes with the risk of PCAD(5). Moreover, studying
premature coronary artery disease (PCAD) newly
the genetic predisposition associated with plaque
diagnosed by coronary angiography showing luminal
production showed that disease progression may be
stenosis as an evidence for atherosclerosis in at least
avoided by following the established preventive
one coronary artery or major branch segment in their
measures with altering patients' lifestyles (6).
epicardial coronaries (12) "Group 1", and a control

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1156
Received: 16 /5/2020

Accepted: 28/6/2020

Full Paper (vol.811 paper# 2)


c:\work\Jor\vol811_3 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1164-1172

Hypomagnesemia as a Predictor of Cardiovascular Morbidity in
Patients Undergoing Hemodialysis
Haitham Ezzat, Hesham Abo El Leil, Doaa Elwasly*
Department of Nephrology, Faculty of Medicine - Ain Shams University, Cairo, Egypt
*Corresponding author: Doaa Elwasly, Mobile: (+20)01005646480, Email: dr.dodoelwasly@hotmail.com

ABSTRACT
Background:
Dialysis patients may be particularly vulnerable to the effects of magnesium deficiency, yet scant if any
attention is being given to this cation in most dialysis centers, which should be rectified.
Objective: To find whether hypomagnesaemia represent an independent risk factor for increased cardiovascular
morbidity in hemodialysis patient (HD) either with or without residual renal function (RRF).
Patients and methods: 60 prevalent hemodialysis patients were included and subdivided into 15 each; group 1a with
normal serum magnesium and residual renal function, group 1b with low serum magnesium and residual renal
function, group 2a with normal serum magnesium and no residual renal function and group 2b with low serum
magnesium and no residual renal function. Patients were subjected to history taking, clinical examination, lab. tests,
echo and ECG.
Results: Among 60 hemodialysis patients divided into 30 with RRF and 30 without, hypomagnesemia was found in
30% of whole patients. HD patients with RRF had lower mean serum magnesium level than those without. There was
no statistical significant difference between the 2 groups regarding cardiovascular morbidities including diastolic
dysfunction, pulmonary hypertension, and others, suggesting that RRF has no effect on cardiovascular morbidities in
HD patients. There was no correlation between hypomagnesemia and diastolic dysfunction or pulmonary hypertension
or hypertensive heart and left ventricular hypertrophy (LVH) or arrhythmias but we found significant correlation
between hypomagnesemia and ischemic heart disease.
Conclusion: There is a close relationship between hypomagnesemia and risk factors for cardiovascular disease
morbidity in hemodialysis patients.
Keywords: Hypomagnesemia, Residual Renal Function, Hemodialysis, Cardiovascular Disease Morbidity, Echo.

INTRODUCTION

Cardiovascular mortality in dialysis patients is
effects on magnesium balance. It might appear that
10-20 times greater compared to the general population
hypermagnesemia is the only possible outcome in such
(1). There is increased prevalence of many traditional
patient. However, dialysis patients in the modern era
factors for cardiovascular risk. In addition, patients
are usually normomagnesemic and sometime even
with chronic kidney disease (CKD) stage 5 have related
hypomagnesemic (5).
risk factors such as anemia hyperhomocysteinemia,
Finally, increasing evidence points towards a
hyperparathyroidism, oxidative stress, prothrombotic
link between magnesium and cardiovascular disease.
factors, among others. Data suggest that uremic factor
The purpose of this work was to determine whether
or factors related to renal replacement therapy
hypomagnesaemia is an independent risk factor for
(RRT)/dialysis may be implicated in the pathogenesis
increased cardiovascular morbidity in end stage renal
of heart disease in patients treated by dialysis, because
disease patients undergoing hemodialysis.
cardiovascular survival improves after transplantation

even in high risk patients. Conversely, aspects of the
PATIENTS AND METHODS
dialysis treatment itself may contribute to
This study was conducted on 60 prevalent
cardiovascular disease (CVD) (2).
hemodialysis patients who dialyze 3 times weekly, 4
Dysregulation in mineral and bone metabolism
hours for each session with low flux dialyzer, dialysate
may contribute to the development of vascular
flow rate 500 mmHg, and blood flow rate 250 mmHg,
calcification, cardiovascular disease and adverse
for at least 6 months in El Sahel Teaching Hospital,
clinical outcomes in patients with end-stage renal
Cairo, Egypt, including stable hemodialysis patients for
disease (ESRD) (3).
6 months aged from 21 to 50, with hemoglobin (Hb)
Studies from the general population have linked
more than 10g/dl, excluding those with thyroid illness,
magnesium deficiency with endothelial dysfunction,
diabetes mellitus, active intercurrent infection,
insulin
resistance,
hyperaldosteronism
and
hyperkalemia or hypokalemia, hypercalcemia or
inflammation, all of which are associated with vascular
hypocalcemia and severe metabolic acidosis or
calcifications (4). In dialysis patients, losing the
alkalosis.
regulatory role of the kidneys can have significant

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1165
Received:15 /6 /2020

Accepted:14 /8 /2020

Full Paper (vol.811 paper# 3)


c:\work\Jor\vol811_4 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1173-1177

Association Between Serum Uric Acid and Metabolic Syndrome Components in
Prep Ubertal Obese Children (Tanner Stage I) At Zagazig University Hospital
Laila Raslan Abd El Aziz1, Saed Mohamed Morsy1, Hanan Samir Ahmed2,
Mustafa Mohammed Abd El Hameed Ahmed*1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University.
Corresponding Author: Mustafa Mohammed Abd El Hameed Ahmed, Mobile: (+20)01024683929,
Email: mosad8rashed@gmail.com

ABSTRACT

Background: Biomarkers are useful in the early detection and risk stratification of metabolic syndrome (MetS)
patients. Serum uric acid (SUA) is the end metabolite product of purine degradation and is the most abundant
antioxidant in human plasma, as it protects against free radical oxidative damage.
Objective: To investigate the potential association between serum uric acid (sUA) and MetS.
Patients and Methods: A prospective case-control study was conducted in Cardiac Unit, Zagazig University
Children's Hospital, during the period from February 2019 until August 2019. Our Study included 26 patients with
metabolic syndrome who were randomly selected from 129 random obese pediatric patients according to waist
circumference and BMI with percentage of 20.1%. We enrolled matched control with same number.
Results: Cases were significantly higher concerning uric acid. We found significantly positive correlation between
body mass index (BMI), waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP),
fasting blood glucose (FBG), triglycerides (TG), total cholesterol, low-density lipoproteins (LDL) and serum uric
acid (SUA), while significant negative correlation of serum uric acid and high density lipoprotein (HDL-C).
According to ROC curve analysis, the AUC of SUA for detection of metabolic patient with best cutoff value > 4.3
with sensitivity 70% and specificity 96.3%, and this was maximizing sensitivity and specificity to predict future
metabolic syndrome and their area under the curve was 0.79.
Conclusion: Serum uric acid showed a significant correlation with components of metabolic syndrome making it a
potent biomarker for diagnosing of metabolic syndrome patients in coming years.
Keywords: Serum uric acid - metabolic syndrome- obese Tanner Stage I.

INTRODUCTION

biomarkers could provide a relatively easy, minimally
Hypertension,
central
obesity,
increased
invasive means of identifying those who are at risk for
triglycerides, decreased high-density lipoprotein
developing metabolic syndrome and subsequent
cholesterol (HDL-C), increased blood glucose and
complications (4). Nowadays, biomarkers are useful in
insulin resistance are collectively defined as risk
the early detection and risk stratification of MetS
factors for cardiovascular disease triggered by
patients. Studies confirmed the implication of
metabolic syndrome (1). The pathogenesis of MetS is
adipokines, neuropeptides, inflammatory cytokines,
very complex and not yet clear. Several studies
prothrombotic factors, and others in MetS
support the concept that oxidant/antioxidant
pathogenesis (5). Increased biomarkers of oxidative
imbalance may play an important role in its
stress (OS) and decreased antioxidant defenses have
manifestations (2). In the last few years, in addition to
been measured in blood of patients with MetS
the clinical factors, new factors in the pathogenesis of
suggesting an in vivo overproduction of oxidizing
MetS have also been taken into consideration. These
species. In particular, it has been reported that patients
factors can be classified based on their function (e.g.,
with MetS have decreased antioxidant protection, in
marker of exposition, markers of effects, etc.) or in
the form of depressed serum vitamin C and -
their biochemical or biologic properties (e.g., proteins
tocopherol concentrations, decreased superoxide
metabolites, hormones, cytokines, etc.) (3).
dismutase (SOD) activity and increased protein and
For many pathological states, medicine relies on
lipid oxidation levels (6).
biomarkers to aid in diagnosis and management when
Serum uric acid (SUA) is the end metabolite
overt clinical signs or gross anatomic abnormalities
product of purine degradation and is the most
are absent or are not obvious. In addition to this,
abundant antioxidant in human plasma, as it protects
biomarkers can identify individuals within a
against free radical oxidative damage (7). Apart from
population susceptible to disease on the basis of a
the antioxidant property of uric acid, its abnormal
"genotype" rather than on a reported history.
raised levels crystallize in joints resulting in gouty
Biomarkers also afford the ability to quantify this
arthritis. Moreover, gout is also associated with
susceptibility, allowing for an estimation of disease
various cardiometabolic diseases like hypertension,
risk for a population. A panel of metabolic syndrome
diabetes, CV diseases and metabolic syndrome.

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1173
Received:15 /6 /2020

Accepted:14 /8 /2020

Full Paper (vol.811 paper# 4)


c:\work\Jor\vol811_5 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1178-1185

Thoracolumbar Fractures in Adolescent Patients: Epidemiological, Clinical,
Radiological Characteristics and Recent Methods of Management
Magdy Elsayed Hassan Rashed, Atif Kelany Abdel Wanes, Mohammed Mohammed Salem Selim*
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding Author: Mohammed Mohammed Salem Selim, Mobile: (+20) 01024683929,
Email: mosad8rashed@gmail.com

ABSTRACT
Background:
Spine fractures account for a large portion of musculoskeletal injuries worldwide; approximately
54.9% of the patients had fractures in the thoracolumbar spine; with most of these occurring at the thoracolumbar
junction (T10-L2).
Objective: To assess the epidemiologic characteristics of spinal injuries in adolescents, their unique anatomic, and
radiographic characteristics.
Patients and Methods:
18 selected patients presented with traumatic thoracolumbar fractures admitted to the
Neurotrauma Unit of Neurosurgery Department, Zagazig University Hospitals, and Al-Ahrar Teaching Hospital,
Sharkia, Egypt with our study prospective study and post-resuscitation they were of both sexes and their age range
starts from 12:17 years adolescent group.
Results:
the number of patients (18 patients) was 20.2% from 189 cases of all spine fractures in adolescent patients.
Sex were 11 males (61.1%) falling from height is the most common cause of thoracolumbar fractures (50%),
followed by road traffic accidents (33.3%). the most common type of fracture in both groups was a wedge and burst
where it constituted more than 80%. Orthopedics fractures were the most common associated injuries which were
found in 6 patients (33%). According to motor power, 14 patients had full motor power (77.7%). the most common
level of injury was L1 vertebrae 11patients (61.1%). The mean height of the vertebral body in the conservative
treated group was 26.11±4.85, but in the surgically treated group is 25.55 ±4.63.
Conclusion: The most common cause of trauma was fall from a height (50%). The most affected vertebra was L1
(61.1%). Over 80% of patients were neurologically intact. The angle of kyphosis in the surgically treated group
improved and decreased from 23 degrees to18.22 degrees.
Keywords: Serum Eosinophil Derived Neurotoxin, Bronchial Asthma, Evaluation, Severity.

INTRODUCTION
and the clinical and radiographic evaluation of these
Spine fractures account for a large portion of
injuries regarding the principles of non-operative and
musculoskeletal injuries worldwide; approximately
operative management of injuries to the adolescent
54.9% of the patients had fractures in the
thoracolumbar fractures.
thoracolumbar spine (1); with most of these occurring

PATIENTS AND METHODS
at the thoracolumbar junction (T10-L2)(2).
Patients:
In other literature, the incidence of
Between April 2018 and April 2019, 18 selected
thoracolumbar injuries in children and adolescents is
patients presented with traumatic thoracolumbar
quite variable and ranges between 5.4 and 34%(3).
fractures admitted to Neurotrauma Unit of
The Thoracolumbar Junction (TLJ) (T10-L2)
Neurosurgery Department, Zagazig university
represents a transitional zone with a straight spinal
hospitals and Al-Ahrar Teaching Hospital, Sharkia,
segment between the long stiff kyphotic thoracic
Egypt with our study prospective study and post-
spine and the mobile lordotic lumbar spine, and
resuscitation they were of both sexes and their age
transition of facet orientation from the coronal facet
range starts from 12:17 years adolescent group. All
joints of the thoracic spine to the sagittal facet joints
patients were admitted after first aid measures.
of the proximal lumbar spine (4, 5). Adolescence is a

Inclusion criteria:
transitional stage of physical and psychological
(1) All thoracolumbar fractures coming to the ER
development that generally occurs during the period
including different types and grades according to AO
from puberty to legal adulthood (age of majority)
spine classification of thoracolumbar fractures.
mostly from12-17 (6).
(2) Age: 12-17 years.
Injuries of the spine are rare in young children
(3) Sex: Both sexes are included.
but increase significantly in adolescents from 12 to17
Exclusion criteria:
years of age (7).
- Age above 18 years.
The study aimed: To assess the
- Completely healed fractures (no edema on MRI or
epidemiologic characteristics of spinal injuries in
normal bone scan).
adolescents, their unique anatomic, and radiographic
- Active infections: sepsis, osteomyelitis, discitis,
characteristics. To evaluate the mechanisms of injury
and epidural abscess.

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1178
Received:15 /6 /2020

Accepted:14 /8 /2020

Full Paper (vol.811 paper# 5)


ACKNOWLEDGEMENT The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1186-1192
Comparative Study between Pressure Controlled Ventilation and Volume
Controlled Ventilation and Their Effects on Respiratory Mechanics for
Posterior Lumbar Spine Surgery Patients in Prone Position
Ahmed Mohamed Reda Ragheb*1, Ahmed ELSaied Abdul Rahman2,
Ayman Mohamady Aldemrdash1, Sherif Kamal Hafez Arafa1
1Department of Anesthesiology and Intensive Care, Faculty of Medicine, Aswan University,
2Department of Anesthesiology and Intensive Care, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Ahmed Mohamed Reda Ragheb, Mobile: (+20)1006228286, E-Mail: dr_ahmedmorsi@yahoo.com

ABSTRACT
Background:
Prone position is one of the challenging and widely used surgical positions with high rates of
complications. The applied position and selected ventilation parameters during the operation are known to
influence the pulmonary mechanics.
Objective: This study was conducted to compare two modes of ventilation; volume controlled and pressure-
controlled ventilation and their effect on improvement of respiratory dynamics.
Patients and Methods: This prospective randomized controlled study included a total of 60 patients who had
posterior lumbar spine surgery in prone position, attending at Department of Anesthesiology and Surgical ICU,
Aswan University Hospital, Egypt. This study was conducted between June 1, 2017 to December 13, 2018.
Patients were randomly divided between two groups, 30 patients each; Group (I): were received VCV mode and
Group (II): were received PCV mode. Then study parameters were recorded intraoperative and postoperative in
the two groups of ventilation modes. The study parameters which were recorded: Peak inspiratory pressure (Ppeak),
Plateau pressure (Pplateau), dynamic compliance (Cdyn), ETCO2, Tidal volume (VT), respiratory rate (RR).
Results: As regarding Ppeak and Pplat, they were statistically significant lower in PCV group than VCV group at
both supine and prone positions. As regarding Cdyn, it was statistically significant higher in PCV group than VCV
group at both supine and prone positions. Arterial oxygen tension (PaO2) was significantly higher in PCV group
intraoperative in prone position and postoperative.
Conclusions: Compared with VCV, PCV is better regarding the respiratory dynamics including lower Ppeak and
Pplat. It has also higher Cdyn and oxygenation. PCV it is more suitable for general anesthesia of posterior lumbar
spine surgery patients in prone position.
Keywords: pressure-controlled ventilation, volume controlled ventilation, respiratory mechanics, lumbar spine
surgery.

INTRODUCTION

The number of lumbar spine surgical
ventilation and cardiac dysfunction during prone
procedures has been obviously increasing (1). The
position. The prone position alters respiratory
most important indications for spine surgery include
dynamics by increasing airway pressure and
intervertebral disc prolapse, degenerative disc
decreasing respiratory compliance. The applied
disease, scoliosis and spondylolisthesis. This type of
positioning and selected ventilation parameters
patients are a prominent group among hospitalized
during the operation are known to influence the
patients especially most of them present with acute
pulmonary mechanics and so oxygenation (5).
surgical condition. In these surgeries, perioperative
In volume controlled ventilation (VCV) mode,
complications mostly occur in about 22% of patients.
tidal volume, respiratory rate and Inspiration/
Among complications, those affecting the respiratory
expiration (I/E) are under control of the anaesthetist.
system which have been of high morbidity rates (2).
The aim of this mode is to perform fixed minute
During posterior lumbar spine surgery, the
ventilation for the patient. The airway pressure in
prone position is commonly used to expose the dorsal
VCV mode may change depending to resistance and
surface of the body for specific surgical indications
compliance therefore there is a risk of increased
(3). During general anaesthesia, changing from the
airway pressures. For this reason, pulmonary
supine to prone position may have adverse effects on
compliance and airway resistance should be
epidural venous pressure and respiratory mechanics
monitored (6).
(4). For surgeons, the major problems encountered in
In pressure controlled ventilation (PCV), the
performing spine surgery are exposure of the surgical
parameters that are under anaesthetist control are
field and bleeding from it. For anaesthetist, the major
peak airway inspiration pressure, respiratory rate and
problems noted in those patients are difficulties in the
Inspiration / expiration (I/E) ratio. Peak flow rate is

This article is an open access a rticle distributed under the terms and conditions of the Creative
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CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1186
Received:15 /6 /2020

Accepted:14 /8 /2020

Full Paper (vol.811 paper# 6)


INTRODUCTION The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1193-1203

Serum Neopterin Level in Early Onset Neonatal Sepsis
Hanan Mohammed Abd El-Moneim Awad, Mohammed Bahaa El-amir Hawary,
Emad Farah Mohammed Kholef, Manal Abdel Rahim Ahmed Ali*
Departemnt of Pediatrics - Faculty of Medicine, Aswan University
*Corresponding author: Manal Abdel Rahim Ahmed Ali, Mobile: (+20) 01007480982, E-Mail: drmanal.abdelrahim@gmail.com

ABSTRACT
Backgound:
Neonatal sepsis is defined as a clinical syndrome of bacteremia with signs and symptoms of
infection in the first four weeks of life. A better understanding of the neonatal inflammatory response to sepsis
and identification of sensitive and specific markers of inflammation or rapid microbe-specific diagnostic tests
would assist in the early detection of neonatal sepsis.
Objective: Evaluate of serum neopterin level as an early diagnostic marker in neonatal sepsis for early detection
of neonatal sepsis and early implementation of the appropriate therapeutic strategies.
Patients and Methods: The current study included 90 newborns admitted into NICU with 30 of them septic, 30
suspected neonatal sepsis and 30 control at Aswan University Hospital during the study period after obtaining
consent from the parents.
Results: Neopterin level was significantly higher in cases than control (p < 0.001). A highly significant positive
correlations was found between serum neopterin with TLC, T. neutrophils, immature/total neutrophil (I/T) ratio,
serum C-reactive protein (CRP) level, ESR 1st hour, ESR 2nd hour and sepsis score. On the other hands, negative
correlation was found between serum neopterin level and gestational age, with poor Moro reflex & apnoea.
Moreover, no significant relation was found between serums level of neopterin and socio-demographic data.
Conclusion: Combined use of one or more laboratory marker as Haematological scoring system (HSS) and CRP
with neopterin will enhance the diagnostic accuracy, early detection and consequently prevention of
complications of infected cases.
Keywords: Neopterin, Neonatal Sepsis, HSS, CRP.

INTRODUCTION
markers such as immature/total neutrophil ratio,
Neonatal sepsis is a clinical syndrome of
platelet count, CRP, various cytokines have been
systemic illness accompanied by bacteremia
proposed as being useful indicators for identification
occurring in the first month of life. Sepsis in
of septic infants (4).
newborn is a major health-care burden worldwide
The unnecessary exposure to antibiotics, with
accounting for approximately 1.4 million neonatal
emergence of bacterial resistance will lead to
deaths annually (1). Premature infants are particularly
potential poor outcomes in this vulnerable population
susceptible to sepsis and have a higher risk of long-
of neonates. Resistance to antibiotics is a global
term complications and mortality. There is an inverse
problem.
correlation between gestational age, birth weight and
Reports of multiresistant bacteria causing
sepsis (2).
neonatal sepsis in developing countries are increasing

There are two clinical types of sepsis: Early
and this may be explained by wide availability of
onset sepsis (EOS) presents within the first 72 hours
over the counter antibiotics and the inappropriate use
of life. In severe cases, the neonate may be
of broad-spectrum antibiotics in the community (5).
symptomatic at birth. Infants with EOS usually
Moreover, despite extensive investigations, no single
presents with respiratory distress and pneumonia.
test meets the criteria that would make it an ideal
Late onset sepsis (LOS) usually presents after 72
marker for early diagnosis of sepsis in the newborn.
hours of age. The source of infection in LOS is either
Generally, complete blood count with differential
nosocomial (hospital-acquired) or community-
count that may be accompanied by other adjuvant
acquired and neonates usually present with
tests such as C-reactive protein (CRP) may be
septicemia, pneumonia or meningitis (2).
useful(6).
Neonatal sepsis is clinically diagnosed by a
Neopterin is a catabolic product of guanosine
combination of clinical signs, nonspecific laboratory
triphosphate (GTP). It serves as a marker of cellular
tests and microbiologically confirmed by detection of
immune system activation. Measurement of
bacteria in blood by culture (3). Warning signs and
neopterin concentrations in body fluids like blood
symptoms are often subtle and can easily be confused
serum, cerebrospinal fluid or urine provides
with non-infective causes such as apnea,
information about activation of cellular immune
hypothermia, and acute exacerbation of chronic lung
system (7). There is a close relationship between high
disease. So that hematological and biochemical
neopterin levels and septicemia. High neopterin

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1193
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Accepted:15 /8 /2020

Full Paper (vol.811 paper# 7)


c:\work\Jor\vol811_8 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1204-1208
Local Experience on Clinical Characteristics of COVID-19: Single
Center Experience
Nezar Refat 1, Ahmed H Kasem 1, Fatma MM Kamel*2, Ahmed F Mady 1
Departments of 1Chest Diseases and 2Internal Medicine, Faculty of Medicine, Minia University, Egypt
*Corresponding author: Fatma MM Kamel, Internal Medicine Department, Faculty of Medicine, Minia University, Egypt,
Mobile: (+20) 01007407599, Email: fatma.kamel@mu.edu.eg
ABSTRACT
Background:
Coronavirus disease 2019 (COVID-19) emerged in December 2019 in Wuhan, the capital of Hubei
province, China. COVID-19 is an acute respiratory disease caused by a newly emerged zoonotic coronavirus. The
virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is
called coronavirus disease 2019 (COVID-19). In March 2020, the World Health Organization (WHO) declared the
COVID-19 outbreak a pandemic.
Aim of the work: Clinical description of COVID-19 patients presented to El-Minia University Hospital Screening
Triage. Identification of different varieties of COVID-19 clinical manifestations and complications.
Patients and Methods:
A retrospective study on the clinical manifestation and complications of 76 patients of
COVID-19.
Results: Average age 50 years old 43 male and 33 female. 29% with previous history of smoking, 26% with
hypertension, 15% diabetic patient and 9% chronic kidney disease. The most common presentation is fever 80%, dry
cough 81.6% and shortness of breath 75%, productive cough 9%, anosmia 18.4%, myalgia and bone aches in 60.5%,
easy fatigability 61.8% and persistent headache in 34%. GIT manifestations including diarrhea 22% and vomiting
14.5%. Another 3 cases diagnosed as mesenteric vascular occlusion and 2 cases presented with eye involvement. The
acute kidney injury (AKI) occurred in 5.3% of the patients.
Conclusion: SARS COV-2 can present with different clinical manifestation affecting multiple body systems.
Key words:
COVID-19, Comorbidity, GIT manifestations, Acute kidney injury.

INTRODUCTION

Since December 2019, coronavirus disease 2019
University Hospital Screening Triage were included in
(COVID-19) has become a global pandemic health
this study. The data were obtained from their medical
problem caused by the highly transmissible severe
reports.
acute respiratory syndrome coronavirus 2 (SARS-CoV-
The severity of COVID was defined based on the
2) (1). SARS-CoV-2 is an enveloped, positively charged
criteria established by China's National Health
and single-stranded RNA belonging to the beta
Commission (5): 1- Mild: minor symptoms only,
coronavirus genus. It enters cells via the angiotensin-
without evidence for pneumonia by chest X-ray. 2-
converting enzyme 2 (ACE2) receptor (2).
Moderate: Fever and respiratory symptoms are present,
Current studies revealed that respiratory
and there is evidence for pneumonia by chest X-ray,
symptoms of COVID-19 such as fever, dry cough, and
(both groups classified also as non-severe cases). 3-
even dyspnea represent the most common
Severe: Defined by any of the following conditions. 1)
manifestations. Most patients exhibited mild symptoms
Dyspnoea, respiratory rate 30/min, 2) resting hypoxia
and partial patients exhibited worse prognosis and
SaO2 93%, 3) PaO2/FiO2 300 mmHg. 4. Critical.
developed severe pneumonia, acute respiratory distress
The presence of any of the following conditions. 1)
syndrome (ARDS), multi-organ failure (MOF) and
Respiratory failure, require mechanical ventilation, 2)
death (3).
shock, 3) other acute organ failure. (Both groups
COVID-19 reported to be presented with other
classified also as a severe cases).
gastrointestinal manifestations by Zhang et al. (4) who

reported that ACE2 was highly expressed in
Ethical approval and written informed consent:
oesophageal epithelial cells and the absorptive
An approval of the study was obtained from
enterocytes from ileum and colon, suggesting possible
Minia University academic and ethical committee.
faecal transmission.
Every patient signed an informed written consent for

acceptance of the operation.
PATIENTS AND METHODS

We performed a retrospective study on the
Statistical analysis
demographic,
clinical
symptoms,
patients'
The analysis of the data was carried out using the
comorbidities and their outcome and complications of
IBM SPSS 20.0 statistical package software. Data were
a laboratory confirmed cases with COVID-19. 76
expressed as median, interquartile range (IQR), mean
confirmed cases with COVID-19 from El-Minia
and standard deviation (SD) for quantitative data in

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1204
Received:16 /6 /2020

Accepted:15 /8 /2020

Full Paper (vol.811 paper# 8)


Application of Ultrasound in Sports Injury The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1209-1216

The Diagnostic Value of High-Resolution Ultrasound in Evaluation of
Ankle Sports Injuries: A Comparative Study with MRI
Mohamed Abdel-Moneim Ismail Mokbel*, Khaled Mohamed Shawky,
Maged Abd El-Galel Hamed, Hossam A. Al-Kenawy
Professor of Radiodiagnosis - Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Mohamed Abdel-Moneim Ismail Mokbel, Mobile: (+20) 01005030205,
E-Mail: toti_2008@hotmail.com

ABSTRACT
Background:
Usually, the ankle joint's lesions are due to trauma, inflammatory disorders, or overuse syndrome.
Different imaging modalities are used to evaluate the ankle joint including plain radiography, CT, US, and MRI.
Objective: The aim of the current study had to assess the value of high-resolution ultrasonography in sports injuries
compared to high field MRI.
Patients and methods: High-frequency (7­15 MHz) ultrasound and MRI were performed in 30 patients with an
acute ankle injury (traumatic ankle pain) in the age range between 18 and 55 years, complaining of unilateral ankle
sports injuries.
Results: Sensitivity of US in the detection of sprain comparing to MRI as the gold standard was 75%, specificity
was 100% and accuracy was 92.2% and there was statistical significance agreement between two tests. Regarding,
the sensitivity of the US in the detection of tears comparing to MRI as gold slandered was 90%, specificity was
100% and accuracy was 96.7% and there was statistical significance agreement between two tests (P-value <
0.001). The sensitivity of the US in the detection of joint effusion comparing to MRI as gold slandered was 75%,
specificity was 95.5% and accuracy was 90% and there was statistical significance agreement between the two
tests.
Conclusion: Ultrasonography and MRI are two complementary tools of investigation with formers being used as a
primary tool of investigation and the latter is done to confirm the diagnosis and the extent of the lesion especially
when surgical interference is planned.
Keywords: Ankle Sports Injuries, CT, US, MRI.

INTRODUCTION
as in CT and plain radiography or the contraindications
The ankle joint is the most frequently injured
of cardiac pacemakers and metallic implants as in MRI.
major joint in the body, where ankle sprains are

frequently encountered in individuals playing sports, in
Colour and power Doppler (PD) add essential data
addition to occurring in the general population (1).
about the related vascular structures (4).
Ankle pain is often due to an ankle sprain but
The musculoskeletal US could be a helpful
can also be caused by ankle instability, arthritis, gout,
imaging modality for the evaluation of joint lesions. It
tendonitis, fracture, nerve compression (tarsal tunnel
is a fact that MRI is more critically performed for
syndrome), infection, and poor structural alignment
joint lesions than the US, yet both of them could be
of the leg or foot. Ankle pain can be associated with
considered as complementary to each other. As for
swelling, stiffness, redness, and warmth in the
the US, there has been a marked improvement in its
involved zone (2).
capability to detect multiple joint lesions with
Ankle joint injury could result in critical short
increased resolution (3).
term morbidity, recurrent injuries, functional instability;
Ligaments on each side of the ankle also provide
appropriate initial evaluation, and treatment could
stability by tightly strapping the outside of the ankle
decrease the occurrence of these complications (1).
(lateral malleolus) with the lateral collateral ligaments
Imaging plays a crucial role in the evaluation of
and the inner portion of the ankle (medial malleolus)
ankle ligaments. The ankle joint's lesions are due to
with the medial collateral ligaments. The ankle joint is
trauma, inflammatory disorders, or overuse syndrome.
surrounded by a fibrous joint capsule. The tendons that
Different imaging modalities are used to evaluate the
attach the large muscles of the leg to the foot, wrap
ankle joint including plain radiography, Computed
around the ankle both from the front and behind (5).
Tomography (CT), Ultrasound (US), and Magnetic
The advantage of sonography over MRI is the
Resonance Imaging (MRI) (3).
ability to focus the examination precisely in the
The US is a rapid, available, safe, and
region of symptoms. Ultrasound examination is also
noninvasive tool. It has a lowcost in comparison to CT
valuable in assessing ankle disorders when metallic
and MRI. It doesn't have the risk of ionization radiation
artifacts would limit imaging with MRI or CT (6).

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1209
Received:16 /6 /2020

Accepted:15 /8 /2020

Full Paper (vol.811 paper# 9)


c:\work\Jor\vol811_10 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1217-1225

Cord Blood Albumin as a Predictor of Neonatal Jaundice
Hanan Mohamed Abd El-Moneim Awad, Mohamed Nashat Moawed Hasan,
Ghadeer Sayed Mostafa Khaleil*
Department of Pediatrics, Faculty of Medicine - Aswan University
*Corresponding author: Ghadeer Sayed Mostafa Khaleil, Mobile: (+20) 01150174149, E-Mail: dr.ghadeersayed@yahoo.com

ABSTRACT
Background:
Neonatal jaundice is a very common condition worldwide occurring in up to 60% of term and 80% of
preterm newborns in the first week of life. Even though extreme hyperbilirubinemia is rare in developed countries it
is still quite rife in developing countries often resulting in kernicterus with its attendant medical, economic and social
burden on the patient, family and society.
Objective: The present study was conducted to evaluate the predictive value of umbilical cord blood albumin level
for subsequent neonatal jaundice in healthy full-term neonates.
Patients and Methods: The current study was carried out in the Pediatric Department, Faculty of Medicine, Aswan
University Hospital. The study was conducted on 100 healthy full-term newborn after obtaining consent from parents.
Cord blood was collected at birth and cord blood albumin estimation was done.
Results: The incidence of neonatal hyperbilirubinemia in our study (64%). In terms of demographic data: males
represented (32.5 %) of the jaundiced cases in the study and females represented (62.5 %); the difference was
statistically insignificant (P value 0.325). Cord serum albumin level of (> 3.3) g/dl has a sensitivity of (86%) and
specificity of (80%), PPV (81%), NPV of (85%) and the accuracy rate was (83 %) in predicting neonatal
hyperbilirubinemia.
Conclusion: There is significant correlation between cord serum albumin level and neonatal hyperbilirubinemia in
healthy full-term neonates 2.5 kg birth weight and that serum albumin level taken from the blood of the umbilical
cord is an effective way to predict neonatal hyperbilirubinemia in term healthy infants.
Keywords: Cord Blood Albumin, Predictor of Neonatal Jaundice, Hyperbilirubinemia.

INTRODUCTION
upper abdomen 8-10 mg/dl, Lower abdomen and thighs
Bilirubin is a yellow colored pigment which is
12-14 mg/dl, Arms and lower legs 15-18 mg/dl, Palms
produced from hemoglobin during destruction of
and soles 15-20 mg/dl) (2).
erythrocyte. So increased production, impaired uptake
In term babies physiological jaundice is seen to
of bilirubin by liver and ineffective conjugation causes
appear between 36 to 72 hours of age, maximum
increase level of unconjugated bilirubin leading to
intensity of jaundice is seen on 4th day of life.
hyperbilirubinemia (1).
Physiological jaundice never appears before 24 hours
Bilirubin is non-polar, insoluble in water and is
of life. In certain conditions, the bilirubin levels may
transported to the liver bound to serum albumin.
exceed this duration and may cause complications like
Bilirubin that is bound to albumin does not usually
brain injury which can be prevented if detected and
enter the central nervous system. Hence it is thought to
treated early with simple treatments like phototherapy
be non-toxic. Free bilirubin circulates in the body when
(2).
the level of albumin is low and this is toxic to the body
The American Academy of Pediatrics (AAP)
(2).
recommends that newborns discharged within 48 hours
Liver is the site of synthesis of albumin. It
should have a follow-up visit after 48-72 hours to detect
binds to unconjugated bilirubin and helps in the
significant jaundice and other problems (4).
transport. This in turn reduces the bilirubin toxicity on
In developing countries, this recommendation
the tissues and thereby competing with tissues for
is not practical due to limited follow up facilities.
bilirubin binding (3).
Severe jaundice and kernicterus has been found in some
Clinical guide to the level of jaundice which
healthy full term newborns discharged early with no
was originally described by Kramer as the dermal
apparent hemolysis. It is difficult to predict which of
staining of bilirubin may be used and confirmation can
these newborns are at risk for developing significant
be done by measuring the levels of bilirubin. Dermal
hyperbilirubinemia (Total serum bilirubin 15 mg/dl)
staining in an infant advance in a cephalo-caudal
(5).
direction. The skin should be blanched with digital
Thus, the concept of prediction of jaundice offers
pressure and the underlying color of the skin should be
an attractive option to pick up babies at risk of neonatal
analyzed. It gives a rough guide for the level of
hyperbilirubinemia in order to implement early
bilirubin dermal staining (Face 4-6 mg/dl, Chest and

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1
217
Received:16 /6 /2020

Accepted:15 /8 /2020

Full Paper (vol.811 paper# 10)


c:\work\Jor\vol811_11 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1226-1230

Necrotizing Pneumonia Complicated by Pulmonary Artery and Middle Cerebral
Artery Pseudoaneurysms in A Healthy Young Child in Saudi Arabia
Ayed Alenazi , Dana Albassam, Khaled Baqais , Abdullah Al-Shamrani
Department of Pediatric, Prince Sultan Medical Military City.
Corresponding author:Ayed Alenazi,Tel: +966-1-4777714, Email: ayed1425@yahoo.com

ABSTRACT
Background:
Necrotizing pneumonia (NP) is a common complication of community-acquired pneumonia.
However, pulmonary artery pseudoaneurysm (PAP) is a rare but serious complication that could follow the
infection including NP even in previously healthy children. The usual presentation of PAP are fever, cough with
hemoptysis, which is commonly encountered in significant numbers of bronchopneumonia.
Objective: Prompt diagnosis and early intervention to prevent a fatality, identification of the underlying cause,
prognosis and outcome.
Material and Methods: A case report of PAP and cerebral pseudoaneurysm complicating NP with residual central
nervous system sequelae.
Results: The patient stayed in the hospital for 6 weeks, received vancomycin and meropenem, antifungal therapy,
levetiracetam for seizure and prophylactic enoxaparin. His level of consciousness was gradually improving.
However, he had left hemiparesis. His speech and swallowing was markedly improved. His follow up chest x-ray
6 months after the vent was normal.
Conclusion: Many causes for PAP exist including lung infection. PAP need to be considered in patients with
pneumonia who develop hemoptysis. Cerebral artery pseudoaneurysm can rarely complicate NP with PAP,
especially in patients with neurological manifestations.
Keywords
: Necrotizing pneumonia (NP), Pulmonary artery pseudoaneurysm (PAP), cerebral artery
pseudoaneurysm, endovascular embolization.

INTRODUCTION
improvement. His family denied a history of a similar
Necrotizing pneumonia (NP) is increasingly
condition or chronic illness in the family.
common complication of chest infection in children

for different reasons. Such infection could be serious
Clinical examination:
and leads to significant morbidity and mortality (1).
The patient was tachypneic with a respiratory
Pulmonary artery pseudoaneurysm (PAP) is a
rate of 40/m, tachycardic with a heart rate of 150/m,
rare, potentially life-threatening condition. It might
febrile 38.8 C with normal
occur secondary to trauma, pulmonary artery
oxygen saturation 98% in room air and normal blood
interventions, or infections (2).
pressure. Chest auscultation revealed decreased
Here, we reported PAP secondary to NP where
breath sounds on the right lower region with no added
we passed through multiple challenges:
sounds. Otherwise, he had a normal growth
1- Intubating a coded patient while doing the CT
parameter and a normal systemic examination. He
scan of the brain.
was diagnosed with right-sided bronchopneumonia,
2- Unexpected CT scan finding with massive
for this admitted to our institute (Prince Sultan
intraparenchymal hemorrhage.
Military Medical City) and started on IV ceftriaxone
3- Arranging un-urgent CNS intervention to
and IV fluid.
control the massive CNS bleeding.

4- Knowing what is the underline cause.
Diagnostic assessment:
5- What is the prognosis and the outcome for such
The initial blood workup showed marked
case?
leukocytosis of 27,000 x 109/L (normal 4-10 x 109/l)
6- Talking to a very anxious parent.
with high neutrophils level 23,000, Hb was low 10.3

g/dl, platelet count was 591 x 109/L normal (150-
CASE REPORT
450x 109/L), elevated inflammatory markers (CRP
Patient information:
147 mg/l, ESR 61 mm/hr) and normal coagulation
Our patient is a 5 years old previously healthy
profile. Viral screening for respiratory syncytial virus
boy presented to our emergency department with
and Influenza A and B were negative. Blood and
high-grade fever, wet cough, progressive dyspnea
nasopharyngeal cultures showed no growth.
and post-tussive vomiting containing fresh blood for
Chest X-ray (Figure-1) showed patchy opacity in
the last 10 days. He received oral antibiotics without
the right middle and lower lung zones with rounded

lucencies represent a cavitary lung lesion. Chest

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1226
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Accepted:15 /8 /2020

Full Paper (vol.811 paper# 11)


c:\work\Jor\vol811_12 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1231-1233

Steroid-Responsive Encephalopathy Associated with
Autoimmune Thyroiditis (SREAT): A Case Report
Hessah Abdulaziz Al Hussaini
Department of Internal Medicine, College of Medicine, King Faisal University,
Al Ahsa, Kingdom of Saudi Arabia

ABSTRACT
Background:
Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT), also known as
Hashimoto's encephalopathy, is a disorder characterized by an encephalopathy associated with anti-thyroid antibodies
in the absence of alternative causes. It has a wide range of clinical, laboratory and radiological features.
Objective: Cases of steroid-responsive encephalopathy associated with autoimmune thyroiditis are difficult to
diagnose and requires a high index of suspicion, as this will determine the early timing of management and disease
outcome.
Patient and Methods: Here we present a case report of twenty-year-old woman presenting with neurological and
psychological symptoms. She was found to have high anti-thyroid peroxidase antibodies (Anti-TPO) with normal
thyroid function and negative screening for other etiologies of encephalopathy. Based on her presentation, she was
diagnosed with steroid-responsive encephalopathy associated with autoimmune thyroiditis.
Results: Patient was started on high dose steroids upon which she responded partially. Then she required the addition
of immunotherapy in the form of Rituximab to improve her symptoms.
Conclusion: After exclusion of other causes of encephalopathy, the presence of thyroid antibodies prompts the
suspicion of SREAT and therefore the early initiation of steroids to improve patients' outcome.
Keywords:
Steroid-Responsive Encephalopathy Associated with Autoimmune Thyroiditis, SREAT, Hashimoto's
encephalopathy, Encephalopathy, Autoimmune thyroiditis.

INTRODUCTION
It was noticed that she had irritability,
Steroid-responsive encephalopathy associated
restlessness and severe sleep disturbance for two weeks.
with autoimmune thyroiditis (SREAT) was first
In addition, she had shock-like movements in all over
reported in 1966 by Brain et al. (1).
her body and involuntary eye movements for the same
It is also called Hashimoto's encephalopathy
duration. Two days before presenting to emergency
and, to a lesser extent, non-vasculitic autoimmune
department, she was confused and not communicating,
meningoencephalitis. It is defined as an encephalopathy
with poor oral intake and urinary incontinence.
with positive thyroid antibodies after exclusion of other
On physical examination, she was conscious but
alternative causes and responding to steroid therapy (2-4).
not following commands nor having verbal input. She
It has wide variety of clinical, laboratory and
was vitally stable. She had irregular ocular movements
radiological features, making it difficult to diagnose and
and continuous myoclonic jerks of head, trunk and
leading to delay in management (5). Many authors have
extremities.
some concerns regarding the actual diagnosis of SREAT
Patient was admitted to intensive care unit,
as there is no evidence of thyroid autoimmunity
intubated, mechanically ventilated and was kept on
affecting the central nervous system (CNS), especially
general anaesthesia and muscle relaxants. She was
with the presence of thyroid antibodies in general
worked up for the possibilities of CNS infection,
population (6).
Rhombo encephalitis, paraneoplastic syndrome,
But, the presence of encephalopathy, high
autoimmune syndrome or toxin-related encephalitis.
thyroid antibodies titre and the response to steroids
Her workup showed negative septic screen, negative
together can make SREAT diagnosis possible (7, 8).
toxicology screen, negative paraneoplastic workup,
Here, we present a patient diagnosed with
normal brain magnetic resonance imaging (MRI) and
SREAT after exclusion of all possible causes of
single-photon
emission
computed
tomography
encephalopathy.
(SPECT), normal whole body computed tomography

(CT) and positron emission tomography (PET) and
CASE PRESENTATION
normal electroencephalogram (EEG).
A twenty-year-old lady, who was adopted and
Upon workup for autoimmune causes of her
separated, smoker but otherwise not known to have any
presentation, she was found to have significantly
medical illness, presented to emergency department
elevated anti-thyroid peroxidase antibodies (Anti-TPO)
with multiple neurological complaints.
with normal thyroid function (Table 1).





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1231
Received:15 /6 /2020

Accepted:14/8 /2020

Full Paper (vol.811 paper# 12)


c:\work\Jor\vol811_13 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1234-1239

Analysis of the Variables Affecting the Outcome of Management of Distal
Radius Fractures with a Variable-Angle Volar Locking Plate
Ahmed Mohamed Abdel Wahed*, Mohamed Safwat Mostafa Shalaby,
Mohamed Elsadek Attia, Reda Hussien Elkady
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
*Correspondence: Ahmed Mohamed Abdel Wahed, Mobile: (+20) 01097888228
Email: ahmedabdelwahed126@gmail.com

ABSTRACT
Background:
The new low-profile plates and locking systems have popularized surgical options. Treatment
modalities exist for surgical management of distal radius fractures, including open reduction and internal fixation
(ORIF) with volar or dorsal plates and screws.
Objectives: This study aimed to find a possible correlation between various parameters, either patient-related (age,
bone quality) or fracture-related (type, reduction), and to analyze the impact of these factors on the radiological
and clinical outcome of distal radius fractures treated by a variable-angle volar locking plate.
Patients and Methods: The study included 18 patients suffering from fractures of the distal radius admitted to the
Orthopedic Department in Zagazig University Hospital. All patients were operated from January 2019 to June
2019. A total of 18 patients complete at least 6 months follow up period.
Results: The results were assessed according to the disabilities of arm, shoulder, and hand scoring system (DASH
score), eight patients had excellent results with average 3.54 ±1.23, eight patients had good results with average
9.71 ±1.97.
Conclusions: There was a negative correlation between patients' age, sex, type of fracture, or presence of an
associated ulnar styloid fracture and the final score. This correlation was statistically insignificant. A correlation
was found between the affected dominant hand or number of rows of distal screws and the final functional score.
this was found to be statistically significant.
Keyword: Distal Radius, variable angle, locking plates


INTRODUCTION

The distal radius fractures commonly occur and
January 2019 to June 2019. A total of eighteen
represent 10 % of all broken bones (1). A fracture of
patients who fulfilled the inclusion criteria complete
the distal radius is considered unstable by the inability
at least 6 months follow up period.
to resist displacement following anatomic reduction.

Some of the more redundant factors of instability in
Ethical Approval:
the literature include fracture prereduction with the
Approval for performing the study was
following radiographic features: Dorsal tilt greater
obtained from Orthopedic Surgery Departments,
than 20°, radial inclination less than 15°, radial
Zagazig University Hospitals after taking
shortening greater than 5 mm (or resultant ulnar
Institutional Review Board (IRB) approval.
positive variance). Extension into the radiocarpal
The work has been carried out following the code
joint. Concomitant fracture of the ulna. Patients more
of ethics of the world medical association
than 60 years old or the presence of osteoporosis (4, 5).
(Declaration of Helsinki) for studies involving
Whereas a large number of these fractures are
humans.
managed non-operatively, the number of patients who
The inclusion criteria for the study were as follows:
undergo surgical management is considerable (2, 3).

A few randomized control trials have shown that
Age: Skeletally mature patients' group (>18)
open reduction and internal fixation with locking
years old.
implants were usually superior to both external
Unstable extra-articular fractures.
fixation and percutaneous pinning, concerning
Intra-articular fractures.
radiological results, early functional results, and
The exclusion criteria for the study were:
complication rates (6).
Open fractures Gustilo and Anderson type II and III.

Pathological fractures.
PATIENTS AND METHODS
Patients who are unfit for surgery.
A prospective cohort study on eighteen
patients with unstable distal end radius fractures
There were twelve males and six females. There
admitted to Orthopedic Department in Zagazig
were eleven patients with dominant hand fractures and
University Hospital. All patients were operated from
seven with non-dominant hands fracture.

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1234
Received:17 /6 /2020

Accepted:16 /8 /2020

Full Paper (vol.811 paper# 13)


c:\work\Jor\vol811_14 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1240-1250

The Possible Protective Effect of Platelet Rich Plasma on Aspirin Induced
Gastric Ulcer in Adult Male Albino Rat
Fatma Fawzy Nada*, Fatma El-Nabawia A. El-Safty, Abeer E. El ­mehi, Noha M. Issa
Department of Anatomy, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Fatma Fawzy Nada, E-mail: dr_fatmanada@yahoo.com,
Mobile: (+20)1029971784 - (+20)1117480910
ABSTRACT
Background:
High morbidity and mortality due to gastric ulcer made its management is a medical challenge. Platelet
rich plasma (PRP) had been used for treatment of skin ulcers, some hair and bone problems as PRP contains many
growth factors which make it suitable for management of gastric ulcer.Objectives: The current work was aimed to study
the protective role of PRP on gastric ulcer induced by aspirin. Materials and Methods: Forty adult male albino rats
were divided into four groups. Group I; sham control, group II received PRP, group III received aspirin for induction of
gastric ulcer and group IV was provided with PRP then received aspirin. All rats were sacrificed then the fundic mucosa
was processed for light and scanning electron microscopic study. Paraffin sections were stained by hematoxylin and
eosin, mallory trichrome and combined periodic acid Schiff (PAS) and alcian blue (AB) stains. Immunohistochemical
staining for iNOS and EGFR were also performed. Results: Aspirin had induced mucosal destruction in the form of
ulceration, epithelial surface desquamation, hemorrhage, vacuolation and inflammatory cellular infiltration. Scanning
electron microscopic examination of aspirin group showed decreased mucus, widening of gastric pits and cavitation of
mucosal folds. PRP produced a great preservation of gastric structure in protected group (IV). Conclusion: It could be
concluded that aspirin caused ulcerating changes in gastric mucosa and PRP had ameliorating effects on these changes.
Keywords: Aspirin, Gastric ulcer, PRP, Scanning electron microscopy.

INTRODUCTION

for animal research, Faculty of medicine Menoufia
Gastric ulcer has the most prevalence of
University.
gastrointestinal disorder ever known. Gastric ulcer is a
Experimental substances:
major health hazard in terms of mortality and morbidity
A. Acetyl salicylic acid powder: was provided from
(1). Jafer et al.(2) mentioned that complicated gastric
Sigma-Aldrich chemical Co., St. Louis. Mo. (USA).
ulcer may induce upper gastrointestinal bleeding.
B. Inducible Nitric Oxide synthase (iNOS) (5): a
Around 15mortality from gastric ulcer has been reported
rabbit polyclonal antibody (Medico trade company,
out of the world's 15,000 complications annually.
Giza, Egypt) 1:100.
Gastric ulcer is caused by imbalance between
C. Epidermal growth factor receptor (EGFR)
defensive and destructive factors of the mucosa.
antibody: a rabbit polyclonal antibody (Santa Cruz
Destructive factors against gastric mucosa include
Biotechnology, Santa Cruz, California, USA).
pepsin, hydrochloric acid, Helicobacter Pylori and
Preparation of platelet rich plasma:
consumption of non-steroidal anti-inflammatory drugs
Selected ten rats (170­200 g) were fed on normal
(NSAIDs). The local defensive factors include mucus
chaw and tap water. They were held for one week before
secretion, bicarbonate, maintenance of normal blood
the start of the experiments for 12 hours of light/12hours
flow, cellular regeneration which is maintained by
of dark conditions. The research procedure followed the
growth factors especially prostaglandins (PG) and
Faculty of Medicine, Menoufia University, Egypt's
epidermal growth factor (2, 3). Although various methods
recommendations for animal care.
which suppress one or more processes of gastric ulcer
We anesthetized the rats with ether. Under aseptic
pathogenesis are under evaluation, a perfect curative
technique, 2 ml of blood was collected from the retro-
method for this disease isn't established (2).
orbital plexus via capillary tube that was initially dipped
Platelet-rich plasma (PRP) has a great concern
in 3.2% sodium citrate, then the blood was collected into
to doctors who are involved in wound healing and
tubes containing 0.5 mL of acid citrate dextrose. The
regenerative medicine. Growth factors of PRP are
blood was subjected to double centrifugation process,
available, cost-effective and stable (4). The aim of the
firstly the tubes were centrifuged at 1600 revolutions per
current work was to study the protective role of PRP on
minute (rpm) for ten minutes.
aspirin induced gastric ulcer in adult male rats.
Three different density layers were formed: the
MATERIALS AND METHODS
inferior one layer containing red blood cells, the middle
Forty male albino rats of average body weight 200-
containing buffy coat of white blood cells, and the
250 g were used in this study. They were housed at room
superior one containing plasma. We pipetted the plasma
temperature and had free access of diet and tap water.
and the portion just above buffy coat without disturbance
Rats were fasted 8 hours before ulcer induction.
of the buffy coat. In the second centrifugation, the
Ethical approval: Strict care and hygiene were
plasma was centrifuged again for ten minutes but at 2000
provided to keep them in normal and healthy conditions
rpm. This resulted in 2 compartments: the superior
under the guidelines recommended by ethical committee

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1240
Received:17 /6 /2020

Accepted:16 /8 /2020

Full Paper (vol.811 paper# 14)


c:\work\Jor\vol811_15 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1251-1254

Assessment of Serum Concentrations of Omentin-1 in Children with
Type 1 Diabetes as Indicator of Insulin Resistance
Mahmoud Mohamed El-Adly*1, Mohamed Nagiub Abu-Elfotoh1,
Hesham Samy Abd-Elhamed2, Ahmed Mohamed Gaballah1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University
*Corresponding Author: Mahmoud Mohamed El-Adly, Mobile: (+20)01024683929, Email: mosad8rashed@gmail.com

ABSTRACT
Background:
Omentin-1, a protein produced mainly in visceral adipose tissue. Its function is most likely to increase
insulin sensitivity and stimulate glucose metabolism. This effect can be both local and systemic.
Objective: To evaluate the concentrations of selected gastric peptide omentin-1 in serum of children with type 1
diabetes, relevant to the disease duration.
Patients and Methods:
This case control prospective study was conducted during the period from 2018 to 2020. This
study was carried out in Endocrinology Unit and Outpatient Clinic at Pediatric Department, Zagazig University
Hospital. The sample size was 85 (17 in every group). Serum omentin-1 level was measured.
Results:
Cases were significantly higher than control regarding FBS, PPBS and HA1c. Cases were significantly higher
than control as it was distributed as 426.04 ± 137.6 and 103.21 ± 32.5 respectively. Significant AUC with cutoff >
191.7 and 100.0% sensitivity and specificity. Regarding FBS & PPBS, control group were significantly lower than
other groups but group 4 was significantly higher than other groups regarding PPBS. Regarding HA1c, control group
was significantly lower than other groups but groups 1 & 4 were significantly higher than other groups. Concerning
omentin, control group was significantly lower than other groups and group 4 was significantly higher than other
groups also groups 2 & 3 were significantly higher than group 1.
Conclusion:
T1DM is a common health problem in the pediatric age group. Omentin-1 level was significantly high
in T1DM and its level is strongly correlated to duration and insulin resistance.
Keywords: Type 1 Diabetes, Omentin-1, Insulin Resistance.

INTRODUCTION
The increasing knowledge on the functions of
Type 1 diabetes is autoimmune disease with
intestinal peptides and adipokines in the body allows
multiple factors that may accelerate the start and the
the assumption of their major role linking the process
course on the disease. It has also strong genetic
of food intake, nutritional status and body growth,
predisposition (1). The disease can start in any age, but
largely through the regulation of glucose metabolism
usually it starts more in childhood with the maximum

incidence at the time of puberty, so it was called
and insulin resistance. The alimentary tract and human
juvenile diabetes (2).
adipose tissue constitute an important part of the
The incidence of type 1 diabetes mellitus is
endocrine system producing the greatest amounts of
increasing rapidly worldwide with the incidence rate in
regulatory peptides.
children below 5 years in Europe is increasing to the
Food intake control is substantially regulated by
double in the last 20 years. Type 1 diabetes makes up
the hypothalamic neurons that receive various signals
an estimated 5­10% of all diabetes cases. The number
from the so-called circuit-adipose tissue, stomach,
of people affected globally is unknown, although it is
intestines, thyroid or pancreas (4).
estimated that about 80,000 children develop the
One of the adipokines is omentin-1, a protein
disease each year. Rates of disease vary widely with
produced mainly in visceral adipose tissue. Its function
approximately 1 new case per 100,000 per year in East
is most likely to increase insulin sensitivity and
Asia and Latin America and around 30 new cases per
stimulate glucose metabolism and this effect can be
100,000 per year in Scandinavia and Kuwait (3).
both local and systemic. In vitro studies have
Despite the usage of insulin in the treatment of
demonstrated that omentin-1 increases insulin
type 1 diabetes mellitus. This disease is still associated
sensitivity by stimulating insulin-dependent glucose
with increased morbidity due to the disease
uptake in both subcutaneous and visceral adipocytes so
complications affecting the cardiovascular, renal and
levels of these adipokines can reflect the tissue
nervous systems, which is affecting the quality of life
resistance to insulin therapy (5).
and life expectancy of the children suffering from it.
The study aimed to evaluate the concentrations of
Arise of insulin resistance incidence makes it
selected gastric peptides omentin-1 in serum of
important to search for resistance reliable markers that
children with type 1 diabetes relevant to the disease
gives idea on insulin resistance (1).
duration.
PATIENTS AND METHODS

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1251
Received:17 /6 /2020

Accepted: 16/8 /2020

Full Paper (vol.811 paper# 15)


c:\work\Jor\vol811_16 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1255-1261

Insulin-Like Growth Factor Binding Protein-1 versus Cervical Length in Prediction of
Successful Induction of Labor after 37 Week. Observational Study
Ibrahim Saif Elnasr*1, Dalia Sabry Mohamed Said1, Thoria Ahmed Omar2, Hesham Ammar1
Departments of 1Obstetrics and Gynecology and 2Clinical Pathology,
Faculty of Medicine, Menoufia University Menoufia Governorate,
Egypt.
*Corresponding author: Ibrahim Saif Elnasr, Mobile: (+20) 01003086747, E-Mail: ibrahimalisaifelnasr@gmail.com
ABSTRACT
Background:
Bishop Score is still the usual method to expect the results of labor induction. Transvaginal
ultrasonographic measurement of cervical length (TVUS-CL) is more objective and insulin like growth factor binding
protein-1(IGFBP-1) has been recently used for this aim.
Objective: This study was conducted to compare between TVUS-CL and detection of cervical (IGFBP-1) for
prediction of results of induction of labor after 37 week of pregnancy.
Patients and Methods: A prospective cohort study on 140 pregnant women underwent induction of labor. All patients
were subjected to TVUS-CL and detection of cervical (IGFBP-1) and Bishop Score. The primary outcome measure
was induction success. The secondary outcome measure was induction to delivery interval.
Results: In our study (97) females delivered by simple vaginal delivery (SVD), (79) females delivered within 24 hour
of induction, (18) females delivered after 24 hour, and (43) females delivered by caesarian section. The mean cervical
length measured by TVUS in females who delivered by SVD was 24.89 ±5.48 mm and was 26.79±3.06 mm in those
who delivered by CS. IGFBP-1 was positive in 71 females who delivered by SVD and in 17 females who delivered
by CS and it was negative in 26 females who delivered by SVD and 26 females who delivered by CS.
Conclusion:
Success of labor induction correlated significantly with detection of cervical IGFBP-1 and measurement
of cervical length by TVUS.
Keywords: Induction of labor, Bishop Score, Transvaginal ultrasonographic measurement, cervical length,
IGFBP-1.
INTRODUCTION
University (May 2019).
Induction of labor is used in about 20% of all
An informed consent was obtained from all study
deliveries and success of induction is thought to be
participants after explanation the nature and scope of
dependent on cervical conditions, or ripeness (1). To
the study.
date, Bishop Score is still the standard method to
After exclusion of women with multifetal
predict the duration and outcome of induced labor.
pregnancies, mal presentations, intrauterine fetal
However, the pre induction favorability of the cervix
death (IUFD), placenta previa , major degree of
as measured by the Bishop score is very subjective
cephalopelvic
disproportion,
non-reassuring
and many researches hade shown a low predictive
cardiotocography (CTG), active genital herpes or
value for the induction outcome especially in women
invasive cervical cancer which contraindicate vaginal
with a small Bishop score (2). TVUS-CL is a more
delivery, extreme low birth weight defined as less than
objective tool for knowing cervical status (3). Recently
1500 g, previous surgeries on the cervix (e.g. cautery,
a bedside test for phosphorylated isoforms of IGFBP-
cervical amputation or conization), premature rupture
1 has been used to expect successful labor induction
of membranes (PROM), antepartum hemorrhage and
(4).The aim of our study was to do comparison between
patients in active labor on admission.
Our study included patients with singleton
TVUS-CL and detection of IGFBP-1 by Actim Partus
pregnancies after 37 weeks, women bearing a living
test in cervical secretions for prediction of successful
fetus, fetuses with a cephalic presentation, no history of
induction of labor after 37 weeks of pregnancy.
previous CS or myomectomy and intact membrane.

PATIENTS AND METHODS
All women were subjected to complete history
This is prospective cohort study conducted on 140
taking, general examination, routine laboratory
pregnant women underwent induction of labor for
investigations, ultrasound examination and specific
various indications. The cases were recruited from
laboratory investigations.
Obstetric Department of Menoufia University
Detection of cervical IGFBP-1:
Hospital,
Shibin
El-Kom
City,
Menoufia
The test was used: IGFBP-1 was detected using
Governorate, Egypt in the period from March to
Actim Partus test (Actim Noljakantie 13. FI-80130
December 2019.
Joensuu, Finland).
Ethical approval: The study protocol was
approved by Hospital Local Medical Ethics
Committee, Faculty of Medicine, Menoufia


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1255
Received: 18 /6 /2020

Accepted: 17 /8 /2020

Full Paper (vol.811 paper# 16)


ACKNOWLEDGEMENT The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1226-1268

Pressure Controlled Ventilation versus Volume-Controlled Ventilation
Regarding Hemodynamics and Stress Response for
Posterior Lumbar Spine Surgeries in The Prone Position
Ahmed Mohamed Reda Ragheb*1, Ahmed ELSaied Abdul Rahman2,
Ayman Mohamady Aldemrdash1, Sherif Kamal Hafez Arafa1
1Department of Anaesthesiology and Intensive care, Faculty of Medicine ­ Aswan University, Aswan,
2Department of Anesthesiology and Intensive care, Faculty of Medicine ­ Sohag University, Sohag, Egypt
*Corresponding author: Ahmed Mohamed Reda Ragheb,
Mobile: (+20)01006228286, E-Mail: dr_ahmedmorsi@yahoo.com

ABSTRACT
Background:
Prone positioning may induce alterations of airway pressures and hemodynamic that may affect
intraoperative blood loss. Ventilation mode may modify these alterations.
Objective: Our study aimed to differences between pressure-controlled ventilation (PCV) and volume-controlled
ventilation (VCV) in their effects on hemodynamic changes during posterior lumbar surgeries performed in the prone
position.
Patients and Methods: This is a prospective randomized controlled study, which was performed in the Department
of Anaesthesiology and Surgical ICU, Aswan university, Egypt at the duration from 1-6-2017 to 13-12-2018 for 60
patients who had posterior lumbar spine surgery in prone position who were eligible to inclusion/exclusion criteria
divided into two groups; Group (I) were received VCV mode (n = 30) and Group (II) were received PCV mode (n =
30) then study parameters were recorded intraoperatively and postoperatively in the two groups of ventilation modes.
Results: As regarding heart rate, mean arterial blood pressure, serum glucose level, and serum cortisol level, they
were statistically significantly lower in PCV group than VCV group both intraoperative and postoperative which
reflects that stress response is lower with PCV more than VCV and that may have also a rule in decreasing
intraoperative blood loss and improving the surgical field in these surgeries.
Conclusions: for lumbar spine surgeries in the prone position, PCV was associated with decreased HR, blood
pressure, cortisol, glucose levels compared with VCV. The stress response is lesser with PCV which is better for this
type of patients.
Keywords: Pressure-controlled ventilation, Volume-controlled ventilation, Hemodynamic changes, Lumbar spine
surgery.

INTRODUCTION

during surgery and ventilation mode parameters that are
In lumbar spine surgery of the posterior approach,
selected during general anaesthesia here are affecting the
the prone position is a common position to be used. It is
pulmonary mechanics, hemodynamic changes, and
one of the excellent positions for exposing the back of
stress response. Hemodynamic stability is important for
the patient and gives a clear angle view for vertebral
both intraoperative and postoperative stages. The stress
column spines especially lumbar spines (1). Changing the
response is one of the factors which is reflecting on the
patient's position from supine to prone during general
hemodynamic stability of the patient. Among parameters
anaesthesia for this kind of surgery has complications on
of the stress response are heart rate, mean arterial blood
venous pressure of the epidural veins and mechanics of
pressure, serum glucose level, serum cortisol level, and
respiration which is reflected in intraoperative stress
PH in arterial blood gases (5).
response and hemodynamic changes (2).
From the above, the prone position is one of the
The lumbar spine surgical procedures are widely
difficult managed and challenging surgical positions
increasing nowadays especially after rapidly developing
with a high incidence of complications (6). Prone
surgical techniques in this field and the advancement in
positioning may induce alterations of hemodynamic that
medical engineering concerning its equipment. This type
may affect the outcome (7). Thus, the current study was
of surgery acts as a wide section through hospital
conducted to test the effects of ventilation modes
admitted patients and most of these patients are
pressure-controlled
ventilation
versus
volume-
presenting with acute surgical indications as in cases of
controlled ventilation on hemodynamics during
trauma and acute pain of lumbar disc prolapse (3).
anaesthesia of this type of patients, and if the type of
During
anaesthesia
of
these
surgeries,
ventilation may modify these alterations.
perioperative complications are common. Among

complications, those which are affecting the
AIM OF THE WORK
hemodynamic which may induce high morbidity rates
Clarification of the relation between ventilation
among these patients (4). The position which is applied
mode and stress response and its resulted in

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1262
Received:17 /6 /2020

Accepted:16 /8 /2020

Full Paper (vol.811 paper# 17)


c:\work\Jor\vol811_18 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1269-1274

Evaluation of Lipoxin A4 as A Marker of Severity of Bronchial Asthma in
Pediatrics in Zagazig University Hospital
Kossay Usama Mohamed1, Saad Ahmed Mansour1, Sanaa Mahmoud Abdelsalam2, Seham Mahrous Zaki1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University
*Corresponding Author: Kossay Usama Mohamed, Mobile: (+20)01024683929,
Email: mosad8rashed@gmail.com

ABSTRACT
Background:
Asthma is a common, chronic respiratory disease affecting 1-18% of the population in different
countries. Lipoxins were the first agents to be identified as anti-inflammatory endogenous lipid mediators involved
in the resolution of inflammation.
Objective:
The study aimed to test this hypothesis via investigating the serum levels of lipoxin A4 in a group of
pediatric patients comparing to controls. Also to examine potential differences in lipox in A4 levels in relation to the
severity of asthma.
Patients and Methods: A case-control study was conducted at Zagazig University. Sample size was 22 children in
cases group and 22 children in controls group. Twenty two patients were classified as mild, moderate and severe
persistent asthma. All children were subjected to lipoxin levels assay.
Results:
Serum lipoxin A4 levels were significantly higher in all asthmatic patients compared to controls group with
P value (<0.05). There was statistically significant difference between degree of severity and lipoxin level. On
pairwise comparison, the difference was significant between mild and severe group (P=0.01). Our study shows that
there was significant increase of serum LXA4 levels in patients with severe asthma compared to those with moderate
and mild asthma.
Conclusion:
Serum lipoxin was significantly elevated in asthma patients when compared to controls (P <0.05).
Serum lipoxin levels in severe asthmatics were significantly higher than in moderate and mild asthmatics (P <0.01).
Keywords: Lipoxin A4, Bronchial asthma, Severity of asthma.

INTRODUCTION
:
The study aimed to test this hypothesis via
Asthma is a common, chronic respiratory disease
investigating the serum levels of lipoxin A4 in a group
affecting 1-18% of the population in different
of pediatric patients with persistent asthma attack,
countries. It is characterized by variable symptoms of
comparing results to a matched healthy group of
wheeze, shortness of breath, chest tightness and/or
controls. The study also examined potential differences
cough, and by variable expiratory airflow limitation.
in lipox in A4 levels in relation to the severity of
Both
symptoms
and
airflow
limitation
asthma.
characteristically vary over time and in intensity. These
PATIENTS AND METHODS
variations are often triggered by factors such as
A case-control study was conducted at University
exercise, allergen or irritant exposure, change in
Hospital, Faculty of Medicine, Zagazig University,
weather, or viral respiratory infections. Symptoms and
Egypt. It was held from November 2017 to November
airflow limitation may resolve spontaneously or in
2018. Sample size was 22 children in cases group and
response to medication, and may sometimes be absent
22 children in controls group. Candidates were
for weeks or months at a time (1).
recruited from the allergy and pulmonology clinic.
Lipoxins were the first agents to be identified as
Cases group:
anti-inflammatory
endogenous
lipid
mediators
Twenty-two patients were included in this group.
involved in the resolution of inflammation (2). The
They were classified as mild, moderate and severe
activation of inflammatory cascades is accompanied by
persistent asthma (the cases were newly diagnosed
the generation of pro-resolving mediators which
before starting asthma control therapy) (diagnosis and
restore tissue homeostasis by antagonism of
classification of asthma according to GINA guidelines
inflammation and promotion of immune defense
2016 (1).
mechanisms. Among these moieties are lipoxins­
Inclusion criteria:
lipoxygenase interaction products of arachidonic acid
Age from 3-12 years. Cases with mild, moderate and
metabolism (3).
severe persistent asthma. No associated chest infection or
Lipoxin A4 (LXA4) suppresses air way
diseases causing respiratory distress other than asthma. No
hyperresponsiveness and pulmonary inflammation
intake of systemic corticosteroids 2 weeks before study
through
anti-inflammatory
receptors,
namely
enrollment. Approval to participate in the study.
ALX/FBR2 receptors, expressed on both leucocytes

and air way epithelial cells (4).

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1269
Received:17 /6 /2020

Accepted: 6/8 /2020

Full Paper (vol.811 paper# 18)


c:\work\Jor\vol811_19 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1275-1280

Regulation of Liver Fibrosis during Murine Schistosomiasis Mansoni
Tarek K Zaalouk*1, Gamal A Abo-Sheishaa1
And Ibrahim R Shalash2
Department of Medical Parasitology, Faculty of Medicine, Al-Azhar University1, Cairo,
Theodor Bilharz Research Institute2, Giza, Egypt.
*Correspondence: Tarek K Zaalouk, email: tkzaalouk@gmail.com

ABSTRACT
Background
: The main pathology of Schistosoma mansoni (S. mansoni) infection is induced by a granulomatous
tissue reaction against the parasite eggs. Unfortunately, no therapy has been proven to prevent the progression of
hepatic fibrosis associated with granulomatous hypersensitivity to parasite eggs. Accumulating evidence has
demonstrated a critical pathogenic role for both interleukin 17 (IL-17) and interleukin 13 (IL-13) in organ fibrosis.
Objective: The present study investigated the role of IL-17 and IL-13 in the pathogenesis of liver fibrosis during S.
mansoni
infection.
Material and Methods: Thirty female C57BL/6 mice were divided into three groups, normal, infected, and anti-
mouse IL-17 treated groups. The infected and anti-mouse IL-17 groups were infected with 40±5 cercariae of S.
mansoni
per mouse. Neutralizing rat anti-mouse IL-17 mAb or an isotype-matched rat IgG mAb was first
administered intraperitoneally 3 weeks after S. mansoni infection (62.5µg per mouse) then at the same dose every
third day until 2 days before killing. Serum IL-17, IL-13, and proinflammatory cytokines levels were determined by
ELISA. Liver granulomas were measured by an ocular micrometer.
Results: Serum level of IL-17 was significantly higher in infected mice compared with non-infected animals.
Reducing IL-17 activity using anti-IL-17 monoclonal antibodies improves liver functions and reduces the size of the
liver granulomas. Meanwhile, Th-2 profibrogenic cytokine IL-13 was also decreased in infected/anti-IL-17 mAB-
treated mice. IL-17-induced proinflammatory mediators (IL-1Land TNF-that involved in liver fibrosis were
markedly reduced in anti-IL-17 mAB-treated mice.
Conclusion: IL-17 and IL-13 contribute to granulomatous inflammatory and fibrosing reactions in murine
schistosomiasis.
Keywords: Schistosoma mansoni, Liver fibrosis, Mice, IL-17, IL-13.

INTRODUCTION
has demonstrated profibrogenic effects in different
Studies of schistosomiasis showed that 700
experimental models of hepatic, pulmonary, and
million at risk of infection with almost 200 million
myocardial fibrosis (6, 7). The IL-17 family is
infected in Africa alone (1). Infection begins with skin
composed of six members, including IL-17A, IL-
penetration by cercariae (infectious stages of
17B, IL-17C, IL-17D, IL-17E, and IL-17F. Among
schistosomes), and following maturation into sexual
them, IL-17A (generally called IL-17), the founding
pairs, adult parasites of S. mansoni migrate to the
member was predominantly produced by Th 17 cells
mesenteric veins where they live up to 10 years or
(8). These cytokines exert their biological effects
more, laying hundreds of eggs/ day. Some of the eggs
through binding to their cognate IL-17 receptors (IL-
were trapped in the liver microvasculature and
17R). The IL-17 receptor family consists of five
induced a vigorous granulomatous response (2).
members, IL-17RA­IL-17RE. IL-17A signals
Subsequently, fibrosis, portal hypertension, and
through binding to IL-17RA (also referred to as IL-
collateral vessels may develop which were the
17R) and IL-17RC that are expressed on various cell
primary causes of morbidity in infected individuals
types (9, 10). A crucial role for IL-17 in S. japonicum
and some cases would ultimately be lethal. So, much
induced pathology, with severe morbidity correlating
of the symptomatology of schistosomiasis is
with high levels of IL-17 were identified in C57BL/6
attributed to the egg-induced granulomatous
mice. C57BL/6 mice display a vigorous IL-17
inflammatory response and associated fibrosis (3).
response following infection with S. japonicum,
Mechanisms underlying the development of
leading to severe liver pathology. Neutralization with
pathology were not well-defined. Animal studies
anti-IL-17 mAb or using IL-17RA-/- mice markedly
identified a moderate type 1 helper (Th1) response to
reduced granuloma size(11).
parasite antigens; but, a robust Th2 response to egg-
Also, IL-13 plays an important part in liver
derived
antigens
dominates
and
propagates
pathology during schistosomiasis (12). IL-13 is bound
fibrogenesis within the liver (4).
by two distinct receptors; IL-13Ra1 (which forms a
The unique subset of new T-cell lineage
complex with the signaling IL-4Ra chain) and IL-
characterized by IL-17 secretion was defined (5) and
13Ra2. IL-13Ra2 was first described as a soluble,

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1275
Received: 19/6/2020

Accepted: 18/8/2020

Full Paper (vol.811 paper# 19)


c:\work\Jor\vol811_20 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1281-1284

Clinical Utility of Enzyme-Linked Immunosorbent Assay for Hepatitis C Core
Antigen Quantification in Diagnosis and Monitoring Patients Treated with
Direct-Acting Antivirals in A Resource Limited Setting
Ahmed ElMetwally Ahmed, Wael Ahmed Yousry,
Ghada Kamal Mohamed Abdel-Halim, Walaa Mohammad Hashem*
Gastroenterology and Hepatology Unit, Internal Medicine Department, Faculty of Medicine,
Ain Shams University
*Corresponding author: Walaa Mohammad Hashem, Email: walaa.hashem@med.asu.edu.eg, Mobile: (+2) 01001597662

ABSTRACT
Background:
Hepatitis C virus core antigen (HCV-cAg) assay has been proposed as a more economical
alternative to HCV RNA detection. Aim of the work: To evaluate the clinical utility of ELISA for HCV-cAg
quantification in diagnosis and monitoring treatment outcomes in patients treated with direct acting antivirals
(DAAs) for chronic hepatitis C. Patients and Methods: A prospective study on 40 subjects recruited from
hepatology department and outpatient clinic in Ain Shams University Hospitals. Group I included 20 patients
with positive anti-HCV antibody. Group II included 20 healthy subjects. The patient group received a combination
of sofosbuvir 400 mg and daclatasvir 60 mg once daily for 12 weeks. The levels for both HCV-cAg and HCV
RNA were evaluated at baseline and 12 weeks after completion of therapy. Results: Baseline HCV-cAg levels
showed good correlation with HCV viral load (r=0.808, p<0.001). A sustained virological response 12 weeks off
therapy (SVR12) was achieved in all patients with HCV-cAg levels decreasing significantly at the end of
treatment (EOT) (21.5±8.5 vs 5.4±3.63 IU/ml respectively, p<0.001). The sensitivity and specificity of HCV-cAg
in predicting HCV RNA was 100% and 90% respectively at cut-off value >8 IU/ml. Conclusion: ELISA for
HCV-cAg can replace the high sensitivity HCV RNA molecular assay to confirm the presence of HCV infection
and to monitor treatment outcome.
Keywords: Hepatitis C virus; HCV-core antigen; HCV RNA, Direct acting antiviral agents.

INTRODUCTION

Currently the diagnosis of HCV infection
Hepatitis C virus (HCV) infection is one of the
involves a time consuming and cost ineffective two-
major public health problems. The global prevalence
step approach. Antibody screening is performed first
of people with HCV antibodies (anti-HCV-positive)
(anti-HCV), followed by determination of the viral
are estimated to be 115 million, 80 million of them
load by real time polymerase chain reaction (RT-PCR)
have active infection (HCV RNA positive) (1). Most of
which helps to differentiate between active and past
the HCV-infected individuals remain asymptomatic
infection (6). Despite its high sensitivity and reliability,
for decades and 75% of them develop chronic
HCV RNA molecular assay requires skilled laboratory
infection. Around 10-20% of chronically infected
personnel, long detection time and high cost which
patients develop cirrhosis and hepatocellular
make it impractical for low-income countries to
carcinoma (HCC) (2), leading to an estimated 7.2
routinely administer this test (7). Thus, a cheaper, rapid
million deaths between 2015 and 2030 in absence of
and simplified alternative is needed for screening and
treatment (3).
monitoring of treatment especially in resource-limited
In 2016, the World Health Organization (WHO)
settings, where HCV is more prevalent.
adopted its first Global Health Sector Strategy on Viral
HCV core antigen (HCV-cAg) is a highly
Hepatitis. The strategy defines time-bound targets for
conserved and antigenic protein of the internal capsid
eliminating HCV as a public health threat by 2030.
which is released into the blood stream during HCV
One key target is to reduce new HCV cases by 80%
assembly. It can be detected in the plasma earlier than
and another key target is to reduce HCV-related deaths
antibodies and throughout the course of infection.
by 65% (4).
Enzyme-linked immunosorbent assays (ELISAs) have
In the recent years, the availability of the direct
been introduced to test HCV-cAg since 1999. In recent
acting antivirals (DAAs) which are potent and highly
years; assays for HCV-cAg have been developed such
effective with cure rates above 90-95% will make the
as
enzyme
immunoassays
(EIAs)
and
achievement of this goal feasible (5). In this new
chemiluminescent immunoassays (CMIA) (8).
scenario, priorities arise for the detection of active
Several studies showed that the limit of detection
HCV infection, treatment monitoring and detection of
of core antigen by CMIA is 3 fmol/L which
therapeutic failures.
corresponds to a viral load range of 428-2700 IU/ml.

Moreover; there is an excellent correlation between

core antigen concentrations and HCV RNA levels.

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1281
Received:18 /6 /2020

Accepted:17 /8 /2020

Full Paper (vol.811 paper# 20)


c:\work\Jor\vol811_21 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1285-1291

Effect of High Flux Hemodialysis versus Hemodiafiltration on
Metabolic Status in Hemodialysis Patients
Sara Tito Ibrahem 1, Adela Mahmoud Gad Salama 2,
Hanaa Mohammed Eid Elsayed 2 , Mahmoud Ahmed Ali 3
1 Kobry El Kobba Military Nephrology Hospital,2 Internal Medicine Department,
Faculty of Medicine for Girls, Al Azhar University,3 Armed Forces College of Medicine
Corresponding author: Hanaa Mohammed Eid Elsayed, email: Hana_sozy@yahoo.com, Mobile: 01006566308

ABSTRACT
Background
: Hemodiafiltration (HDF) is a newly developed renal replacement therapy blood purification
technology with more advantageous effects on hemodynamic stability and better removal of B2 microglobulin and
phosphorous
Objective: The aim of this study is to compare effect of high flux (HF), low flux (LF) dialysis membranes and
hemodiafiltration (HDF) on the metabolic status in hemodialysis patients and quality of life of those patients.
Patients and Methods: This study included 60 patients more than18 years old, clinically stable with end stage renal
disease on regular HD for at least three years (3 yrs), selected from HD unit in (Kobry El Kobba Military Nephrology
Hospital) in the period from March 2018 to September 2018. The patients were divided into three groups equally.
Group I: 20 patients on low flux dialyzer, Group II: 20 patients on high flux dialyzer, Group III: 20 patients on
hemodiafiltration.
Results: There was a highly significant decrease in iPTH, B2 microglobulin and Phosphorous in patients received
HDF (363.80±149.04, 8.79±7.22 and 4.31±0.74 respectively in comparison with patients received HF hemodialysis
(540.10±242.55, 20.47±3.97and 4.58±1.07 respectively) and patients received LF hemodialysis (725.95±270.01,
36.60±7.22 and 5.73±1.34 respectively).Also, there were a highly significant increase in urea reduction ratio in HDF
group compared to HF and LF groups (80.43±7.46, 76.03±9.55 and 65.81±7.42 respectively.
Conclusion: Hemodiafiltration is the most effective dialysis technique than high flux and low flux dialysis
membrane in removal of medium sized molecule and improvement of quality of life.
Key Words: Online hemodiafiltration, high flux hemodialysis, B2 microglobulin, quality of life.


INTRODUCTION
disease undergoing hemodialysis (HD) and its
Chronic kidney disease (CKD) originates
aggregation accelerates dialysis related amyloidosis
from several heterogeneous disease mechanisms that
(DRA) (4). The theory of hemodialysis is by the removal
irreversibly alter the function and structure of the
of solutes across a semi-permeable membrane by
kidneys over months or years. The diagnosis of CKD
diffusion and ultrafiltration processes. The membranes
relies on a chronic decrease in kidney function and
used are divided into two main groups: low-flux
structural damage of the kidney (1).
membrane, which is based on using dialyzers with low
End-stage renal disease (ESRD) is a
permeability for water, and high-flux membrane with
dangerous disorder. The universal prevalence is
increased permeability, which is capable of removing
proven to be 260 million people annually. Renal
medium-sized molecules including many of the
diseases lead to morbidity and mortality as a major
inflammatory
proteins,
ß2-microglobulin
and
part, and have become global issue requiring early
lipoproteins (5).
identification,
assessment
and
preventive
Hemodiafiltration (HDF) is a recently
management (2).
evolved renal replacement treatment, blood
Chronic kidney disease (CKD) is associated
purification technique, for scavenging medium and
with many forms of metabolic changes induced by the
large molecules with more beneficial effects on
kidney failure and often due dialysis treatment. The
hemodynamic stability (6).
metabolic waste products, normally eliminated with the
The study goal was to compare the impact of
urine, accumulate and the body is overexposed to these
low flux, high flux dialysis membranes and
uremic toxins and waste products such as increased urea
hemodiafiltration on the metabolic status with the
and other electrolytes causing hyperkalaemia and
intention of improving the quality of life with
hyponatremia (3). ß2 microglobulin is the most
hemodialysis.
commonly uremic toxins as a guide for preservation and

removal of medium sized molecules by hemodialysis.
PATIENTS AND METHODS
Serum levels of 2-microglobulin (ß2M) are
This was a comparative study that was conducted at
substantially higher in patients with end stage renal
the Hemodialysis Unit in (Kobry El Kobba Military

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1285
Received:18 /6 /2020

Accepted:17 /8 /2020

Full Paper (vol.811 paper# 21)


c:\work\Jor\vol811_22 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1292-1298

Nailfold Capillaroscopic Changes in Dermatomyositis and
Polymyositis Egyptian Patients: Relation to Disease Activity
Shafica Ibrahim Ibrahim, Howaida Elsayed Mansour, Gamer Abdelrahman Azrag,
Safaa Abd Elsalam Hussein*
Internal Medicine Department, Division of Rheumatology, Faculty of Medicine,
Ain Shams University, Cairo, Egypt

*Corresponding author: Safaa Abd Elsalam Hussein, Email: safaa.abdelsalam@gmail.com


ABSTRACT
Background:
Nailfold capillaroscopy (NFC) has been described to be a valuable instrument used in diagnosis of
systemic sclerosis (SSc) and juvenile dermatomyositis (JDM) patients. Though, NFC has been infrequently assessed
in adult dermatomyositis (DM) patients.
Objectives:
Our aim was to visualize nailfold capillary changes in dermatomyositis (DM) and polymyositis (PM)
Egyptian patients and to identify a specific diagnostic capillary pattern and to assess its relevance to disease activity,
clinical and laboratory findings.
Patients and Methods:
This study included 20 patients (12 DM, 5 PM, and 3 overlap syndrome). Routine laboratory
assessment was done, disease and skin activity scores were evaluated. Assessment of the nailfold capillary circulation
using the videocapillaroscope was done and capillary density score was assessed.
Results:
The mean age was 39±12 years and their mean disease duration was 24±19 months. The mean muscle
disease activity score was 3.8±3.3, and global disease activity score (DAS) 3.92±3.09. The mean skin activity score
was 2±3. The global DAS was significantly higher in patients with branched capillaries (p=0.041). Skin activity score
was significantly higher in patients with capillary hemorrhage (p=0.024). More severe capillaroscopic findings were
prominent in DM patients rather than PM or overlap patients.
Conclusion:
Capillary branching is more common in patients with higher global DAS and capillary hemorrhage is
more frequent in patients with higher skin activity score. Capillaroscopic changes are evident in DM patients rather
than PM or overlap patients.
Keywords:
Nailfold capillaroscopy, Dermatomyositis, Polymyositis, Disease activity.

INTRODUCTION
neck, heliotrope rash, Gottron papules, with or without
Nailfold capillaroscopy (NFC) is a highly
muscle weakness. On the other hand, polymyositis is
sensitive, low-cost, simple, harmless, and noninvasive
believed to occur clinically as a sub-acute myopathy, with
imaging tool used in the morphological examination of
different degrees of muscle weakness, which is mediated
nutritious nailfold capillaries (1). It is an important
by cytotoxic T cells. Extra-muscular clinical features are
vascular imaging method that allows for in vivo direct

visualization of the microcirculation, with a definite
designated in both DM and PM, like cardiac involvement,
expecting
role
in
distinguishing
Raynaud's
arthralgias, interstitial pulmonary disease, and the
phenomenon patients who are at risk of developing
relationship
to
malignancies
associated
with
into the spectrum of scleroderma disorder, specially
dermatomyositis (2).
systemic
sclerosis
(SSc),
systemic
lupus
The blood vessels destruction and profound
erythematosus (SLE), dermatomyositis (DM) and
internal organ dysfunctions occur as a result of chronic
small vessels vasculitis (2).
systemic inflammation associated with injury of the
Idiopathic inflammatory myositis (IIM) is an
vascular endothelium. Thus, earlier recognition of
acquired muscle disorder, with diverse manifestations,
vascular affection has an important value in the
which occurs in different age groups. A common feature
diagnosis of different connective tissue diseases
of IIM is immune mediated muscular inflammatory
(CTDs) (3).
changes leading to weakness. Though, variabilities in
The frequency of NFC microvascular changes in
clinical
picture,
prognosis,
histology,
and
DM and PM patients, typical features and the
immunopathology enable distinguishing main three
relationship to disease activity, as well as the
diseases: dermatomyositis (DM), polymyositis (PM), and
possibility of its association with clinical and
inclusion body myositis (IBM). Dermatomyositis is
laboratory parameters are not well recognized (2). This
recognized as a type of microangiopathies which is
study was performed to visualize nailfold capillary
complement mediated, that has multiple clinical
changes in DM and PM Egyptian patients and to
consequences, clinically the disease is marked by skin
identify a specific capillary pattern and to assess its
manifestations: an erythematous rash on the face and

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CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1292
Received:19 /6 /2020

Accepted: 18/8 /2020

Full Paper (vol.811 paper# 22)


Evaluation Of QT Interval In Diabetic Ketoacidosis In Medical Intensive Care Unit The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1299-1302

Relation between Substitution of Threonine for Isoleucine at 2 Adrenergic
Receptor on Bronchial Asthma in Children
Samir Zamzam1, Khalid Mohamed Salah1, Rania Mohammed Mohammed Amer2, Rana Ahmed Waheed*1
Departments of 1Pediatrics, 2Microbiology and Immunolgy, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding Author: Rana Ahmed Waheed, Mobile: (+20)01024683929, E-mail mosad8rashed@gmail.com
ABSTRACT
Introduction:
Pediatric asthma is a complex disorder involving immunologic, genetic, environmental and other
factors. Objective: To evaluate the role of substitution of threonine for isoleucine at codon 164 on bronchial asthma
susceptibility, severity and response to short- and long- term acting 2-adrenergic receptor agonists in children.
Patients and Methods:
This study was a prospective case control study, which was done in Pediatric Department of
Zagazig University Hospital from Pulmonology Clinic in the period from February 2016 to February 2018. 100
children were included, 50 of them had asthma with bronchodilator and their ages ranged from 5 to 12 years (25
males and 25 females) with the mean age of 6.8 ± 2.5 years. In addition, 50 healthy age and sex matched worked as
control children. All studied groups were subjected to full history taking, clinical examination, pulmonary function
tests, total serum IgE and identification of adrenergic 2 receptor (ADR2) substitution of threonine for isoleucine at
codon 164 polymorphism. Results: In this study, there was a significant association between homozygous
isoleucine and increase incidence of asthma, this mean that the gene gives harmful effect when it is in a homozygous
form. However, there was no statistically significant difference between asthma severity and gene polymorphism
(CC, CT and TT). Conclusion: In the present study ADR Thr164Ile polymorphism is reported as an important
variant at salbutamol refractoriness in sever asthmatics. In addition, the polymorphism form is susceptible variant to
develop asthma risk.
Keywords: Threonine for Isoleucine, Adrenergic Receptor and bronchial, asthma, ADR2.

INTRODUCTION
ligand-receptor interactions and decline of coupling of
Asthma is a complex inflammatory disorder that
2AR to adenylyl cyclase are often observed.
has multifactorial inheritance mediated by a variety of
The aim of this work was to evaluate the role of
environmental triggers. According to WHO, it affects
substitution of threonine for isoleucine at codon 164
about 300 million people worldwide and approximately

250000 patients die from asthma annually (1). Several
on bronchial asthma susceptibility, severity and
factors influence development of asthma including
response to short- and long-term acting 2 adrenergic
gene (that predispose individual to atopy and airway
receptor agonists in children.
hyper-responsiveness), obesity, sex and environmental

causes like house dust mites, animal fur and fungi.
PATIENT AND METHODS
There is also viral infections, tobacco smoke, air
This study was a prospective case control study,
pollution and eating habits. Additionally some
which was done in Pediatric Department of Zagazig
immunological characteristics, such as immune system
University Hospital from Pulmonology Clinic in the
maturation and the number of exposure to infectious
period from Feb 2016 to Feb 2018. It was done on 100
agents at first year of life. These factors affect the risk
children, 50 of them had asthma with bronchodilator
of developing asthma (2). A number of single nucleotide
and their ages ranged from 5 to 12 years (25 males and
polymorphism have been reported in ADR2. Four of
25 females) with the mean age of 6.8 ±2.5 years and 50
these results in amino acid substitutions at amino
healthy age and sex matched control children.
acids16, 27, 34 and164, whereas the silent mutations
Inclusion criteria: Children having asthma according
are located at amino acids 84, 175, 351 and 43. Inhaled
to Global Initiative for Asthma Management and
2 agonists have been established as first line in
Prevention, 2016. Ensure that the child could
treatment of asthma as it has excellent bronchodilator
understand and perform the pulmonary function
effect, low side effects and wide range therapeutic
maneuvers efficiently.
range (3).
Exclusion criteria: Other allergic disorders. Children
2 agonist form an effective and well tolerated
with any chronic disease other than asthma that may
bronchodilator in patients with asthma (4, 5). In studies
affect pulmonary function. Children with restrictive
using site-directed mutagenesis and recombinant
pattern in spirometry.
expression, the amino acid substitution in the receptor
Ethical and Patients' approval: Written Informed
alter function of receptor leading to pathology in body.
consent was taken from the patients' parents to
The replacement of threonine with isoleucine at 164th
participate in the study. Approval for performing the
position in 2 adrenergic receptor leads to decrease of
study was obtained from Pediatrics, Microbiology

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1299
Received:19 /6 /2020

Accepted:18 /8 /2020

Full Paper (vol.811 paper# 23)


c:\work\Jor\vol811_24 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1303-1306

Value of Screening for Osteoporosis among Children with
Juvenile Idiopathic Arthritis
Alaa-Eldin A. Hassan*1, Mohammed M M Rayan2,Tarek M. Abdel-Aziz2, Awad Saad Abbas2, Mohamed Z.
Shoaeir2
Departments of 1 Pediatric and 2Rheumatology and Rehabilitation,
Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: Alaa-Eldin A. Hassan, Mobile: (+20)01005781753, E-Mail: tahawyalaa1971@yahoo.com

ABSTRACT
Background:
Juvenile idiopathic arthritis (JIA) is one of the most common rheumatic diseases in children. In all
subtypes of JIA, a low bone mass has been detected in a high percentage of children due to failure to develop adequate
bone mineralization.
Objective: To determine the extent of osteoporosis among children with JIA.
Patients and Methods: A cross sectional study on thirty patients diagnosed with JIA. In addition, age and sex matched
thirty healthy children worked as control. Bone mineral density (BMD) and Z score of lumbar spine, neck of the femur
and distal radius were analysed and adjusted for age and sex among patients and controls. Lunar DPX-NT 2013 made
in USA by General Electric did dual energy X-ray absorptiometry (DEXA) scan.
Results: 60% of patients were males with a male to female ratio of 3:2. Our patients' age ranged between 6-15 years.
The disease duration ranged between 6 months and 10 years. We found that 24 patients (80%) had osteoporosis (age-
matched Z score was below normal), while among the control group only 4 children (13.3%) had osteoporosis. There
was a significant difference between patients and controls regarding DEXA scan findings. Patients with longer
duration of JIA at diagnosis had more osteopenia and osteoporosis than those with short duration of disease. The mean
± SD of disease duration in patients with JIA who were suffering from osteoporosis was 5.1 ± 2.76 years. In
oligoarticular type, majority of the cases had osteoporosis 40% (12 patients). In systemic onset JIA 8 cases (26.7%),
six of them were osteoporotic. The psoriatic type was diagnosed in four patients (13.3%), all of them were
osteoporotic. The polyarticular RF +ve type was diagnosed in four patients (13.3%), half of them were osteoporotic
and the polyarticular RF -ve type was diagnosed only in 2 patients (6.7%), all of them were within normal bone
density.
Conclusion: Results obtained from this study suggest that osteoporosis was a frequent complication of JIA. JIA
patients are likely to have low BMD. Children with JIA who have oligoarticular and systemic onset of JIA patients
were more susceptible to low BMD.
Keywords: JIA, Osteoporosis, DEXA.

INTRODUCTION


Osteoporosis is a major health problem

worldwide characterized by low bone mass and micro-
considered to prevent its complications. DEXA scan is a
architectural deterioration, which increase bone fragility
diagnostic tool used for measuring BMD (5, 7).
and increase risk of fracture (1, 2). Children with
In adults, osteoporosis is defined as a bone
symptomatic osteoporosis present with a history of
density of 2.5 standard deviations (SD) below the mean
recurrent low impact fractures or moderate to severe
in dual emission x-ray absorptiometry while osteopenia
backache (3).
is defined as BMD between 1.0 and 2.5 SD below the
Increasing awareness among paediatricians to
young adult mean (8). As bone density varies with age,
identify risk factors and the clinical conditions or
Z-score is used in the pediatric population and not the T-
diseases that could lead to development of osteoporosis
score, which is usually used in adults and the Z scores of
made them screen for possibility of asymptomatic
-2 SD define as osteoporosis (9).
osteoporosis in children with rheumatological disease.

JIA is the most common rheumatological disease in
SUBJECTS AND METHODS
children (4) and the prevalence of JIA varies between
This cross-section study was conducted on 60
3.83 to 400 cases/100,000 children (5). Low BMD is
children to determine the extent of osteoporosis in JIA.
expected in children with chronic connective tissue
30 patients diagnosed with JIA according to ILAR
diseases, as JIA, systemic vasculitides, juvenile
classification of JIA (10) and 30 crossed matched normal
dermatomyositis and juvenile systemic lupus
child as control.
erythematosus (SLE) (6).
They were attending the Outpatient Clinics of
As osteoporosis in children has a considerable
Pediatric and Rheumatology Departments, Al-Azhar
burden of morbidity, so special effort should be

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1303
Received:19 /6 /2020

Accepted:18 /8 /2020

Full Paper (vol.811 paper# 24)


c:\work\Jor\vol811_25 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1307-1313

Prevalence and Risk Factors of Intellectual Disabilities in Children
Hosny Mohamed Ahmed Elmasry, Mohamed Abo-elwafa Aladawy, Mamdouh Mahmoud Abd-elhamid*
Department of Pediatrics, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: Mamdouh Mahmoud Abd-elhamid, Mobile: (+20) 01026888270,
E-Mail: mamdouh0abdallah2014@gmail.com

ABSTRACT
Background:
Intellectual disabilities in childhood constitutes a major health problem throughout the world and a
handicapping illness with long term costly treatment and bad impact on the family. It constitutes a major problem in
Egypt affecting the quality of life of children and the welfare of their families.
Objective: To identify the prevalence and risk factors of intellectual disabilities in children aged 2-16 years in the
Pediatric Neurology Out-patient Clinic, Al-Azhar University Hospital, Assiut.
Patients and Methods: The present study included one thousand (1000) children randomly selected and examined
for the presence of intellectual disabilities from patient attending the clinic, ninety of them (9%) (63 males - 27
females) had intellectual disabilities. The present study has been conducted at the pediatric neurology out-patient
clinic of Al-Azhar University in Assiut from 1/11/2018 to 30/6/2019.
Results:
There was a significant statistical attachment between intellectual disabilities and family's socioeconomic
profile in terms of residence, maternal and paternal education, and Father's job and parent's consanguinity. In the
present study the total number of cases was 90, 63 males 27 females, 76% of cases were coming from rural areas
while 24% of cases were coming from urban areas. As regards the investigation, neuro-imaging (CT-MRI) was not
done in (41.1 %) while normal in (38.9 %), (11.1%) with brain atrophy, (6.7%) with focal lesion and congenital brain
malformation represent (2.2 %).
Conclusion: Mentally retarded cases are more common in rural areas and male sex. Socioeconomic factors like
education of parents and parental consanguinity play a role in the occurrence of MR.
Keywords: Intellectual Disabilities, Risk Factors, Children

INTRODUCTION
developmental disabilities, or failure to meet age-
Intellectual disability refers to a group of
appropriate developmental milestones. There are no
disorders that have in common deficits of adaptive and
specific physical characteristics of intellectual
intellectual function and an age of onset before maturity
disability, but dysmorphisms may be the earliest signs
is reached (1).
that bring children to the attention of the pediatrician.
The prevalence of intellectual disability depends
They might fall within a genetic syndrome such as
on the definition, the method of ascertainment, and the
Down syndrome or be isolated, as in microcephaly or
population. According to statistics, 2.5% of the
failure to thrive. Associated developmental disabilities
population should have intellectual disability, and 75%
include seizure disorders, cerebral palsy, hypotonia,
of these individuals should fall into the mild to
and autism; these conditions are seen more commonly
moderate range. Rates vary across populations.
in conjunction with intellectual disability than in the
Globally, the prevalence of intellectual disability has
general population (3).
been estimated to be approximately 16.41/1,000
Children with intellectual disability have higher
persons in low-income countries, approximately
rates of vision, hearing, neurologic, orthopedic, and
15.94/1,000 for middle-income countries, and
behavioral or emotional disorders than do typically
approximately 9.21/1,000 in high-income countries.
developing children. These other problems are often
Overall, intellectual disability occurs more in boys than
detected later in children with intellectual disabilities.
in girls: 2: 1 in mild intellectual disability and 1.5: 1 in
If untreated, the associated impairments can potentially
severe intellectual disability. In part, this may be a
adversely affect the individual's outcome more than the
consequence of the many X-linked disorders associated
intellectual disability itself (4).
with intellectual disability, the most prominent being
Prevention of intellectual disabilities includes:
fragile X syndrome (2).
Increasing the public's awareness of the adverse effects
Early diagnosis of intellectual disability
of alcohol and other drugs of abuse on the fetus,
facilitates earlier intervention, identification of
Preventing teen pregnancy and promoting early
abilities, realistic goal setting, easing of parental
prenatal care, Preventing poisonings by teaching
anxiety, and greater acceptance of the child in the
parents about locking up medications and potential
community. Most children with an intellectual
poisons, Encouraging safe sexual practices to prevent
disability first come to the pediatrician's attention in
the transmission of diseases and Implementing
infancy because of dysmorphisms, associated
immunization programs to reduce the risk of

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1307
Received:19 /6 /2020

Accepted:18 /8 /2020

Full Paper (vol.811 paper# 25)


Lower Limb Muscles Activity and Inclined Squat Position in Normal Children (cross sectional study) The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1314-1319

Lower Limb Muscles Activity and Inclined Squat Position in
Normal Children (Cross Sectional Study)
Ahmed A. Allam*1, Emam H. Elnegmy2, Mahmoud S. El Fakharany2
1Captain Physiotherapist at Al Agouza Police Hospital.
2Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University
*Corresponding author: Ahmed A. Allam, Mobile: (+20) 01094660443, E-Mail: Ahmadallam92@gmail.com

ABSTRACT
Background:
Benefits associated with squat performance are not limited to the athletic population. Given that most
activities of daily living necessitate the simultaneous coordinated interaction of numerous muscle groups, the squat is
considered one of the best exercises for improving quality of life because of its ability to recruit multiple muscle
groups in a single maneuver.
Objective: To determine the effect of inclined squat position on the vastus medialis oblique (VMO) and gluteus
maximus (GM) at the different ankle angles 5°-10° degrees of inclination in normal children.
Subjects and methods: thirty non-athletic children of both genders, age ranged from 14 to 18 years, were selected
from the Egyptian governmental schools at Sixth of October City and Sixth of October Sporting Club. The maximum
voluntary isometric contraction (MVIC) was measured after the electrodes were attached to the GM and the VMO of
the subject during squat postures which applied on two inclined borders 5 and 10 degree of inclination; the feet are
spread out shoulder width, hip 70° flexion, knee 75° flexion and in the erect posture.
Results:
There was a significant increase in the VMO activity in 5° ankle angle compared with that of 10° ankle angle
(p = 0.0001). There was a significant decrease in the GM activity in 5° ankle angle compared with that of 10° ankle
angle (p = 0.0001).
Conclusion:
modification of ankle dorsiflexion during squat position should be integrated in the rehabilitation
programs of the different injuries.
Keywords:
Squat Position, Muscles Activity, Isometric contraction, Electromyography.


INTRODUCTION

Squat exercise is the most commonly used
Isometrically, the lower back, the upper back,
exercise among various weight training methods
the abdominals, the trunk muscles, the costal muscles,
because it is easily accessible without using tools (1).
and the shoulders and arms are all essential to the
Squat exercises strengthen the gluteal, quadriceps, and
exercise and thus are trained when squatting with the
trunk muscles that are important for running, jumping,
proper form (5).
and lifting (2).
The electromyography (EMG) signal is
Squat movements are more advantageous than
electrical indication of the neuromuscular actuation
non-weight bearing exercises by moving many joints,
connected with a contracting muscle. It is an
mobilizing
more
muscles,
and
stimulating
exceedingly complicated sign which is influenced by
proprioceptive more strongly (3).
the anatomical and physiological properties of muscles,
The squat is a well-known exercise for the knee
the control plan of the fringe sensory system, and also
and hip muscles and is commonly used in rehab
the attributes of the instrumentation that is utilized to
programs. Biomechanically, the squat is a close-chain
identify and watch it (6).
movement, requiring simultaneous extension patterns
EMG is measuring the electrical sign connected
of the ankle, knee and hip joints. The squat can be
with the enactment of the muscle. This may be willful
performed in many different ways, including variations
or automatic muscle compression. The EMG action of
in foot width (sumo squats), foot position (single leg
willful muscle withdrawals is identified with pressure
squats, Bulgarian squats), load position (front squats,
(7). This study aimed to determine the effect of inclined
sissy squats) and depth (full range squats, shallow
squat position on the vastus medialis oblique (VMO)
squats). However, it is important to keep in mind that
and gluteus maximus (GM) at the different ankle angles
each one of these variations will influence knee joint
5° ­ 10° degrees of inclination in normal children.
forces and muscle recruitment patterns.

For example, there was much debate about the
SUBJECTS AND METHODS
safety of deep (full range) squats. Coaches often define
The subjects included 30 non-athletic children
a full range squat by amount knee range of motion (120-
of both genders, age ranged from 14 to 18 years, were
140 degrees), or by observation of the thigh angle
selected from the Egyptian governmental schools at
(below parallel to the floor) (4).
Sixth of October City and Sixth of October Sporting

Club, the subjects were selected with inclusion criteria

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

1314
Received:20 /6 /2020

Accepted:19 /8 /2020


Full Paper (vol.811 paper# 26)


c:\work\Jor\vol811_27 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1320-1325

The Peripheral Blood Expression of Lipoic Acid Synthetase
Gene as an Early Marker for Diabetic Nephropathy
Marwa M. Esawy1*, Mahmoud M. Magdy2
1. Clinical Pathology Department, 2. Internal Medicine Department,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Marwa M. Esawy, Telephone Number: 00201066343326,
Email: dr.marwaesawy@ymail.com,ORCID: 0000-0002-2198-258X

ABSTRACT
Introduction:
Diabetic nephropathy (DN) is one of the diabetic complications, which leads to end-stage renal disease.
This study aimed to assess the expression of the lipoic acid synthetase (LIAS) gene in type 2 diabetic patients and DN
patients.
Subjects and Methods: A case-control study conducted on 60 patients who had type 2 diabetes, 60 patients who had
DN, and 60 healthy matched individuals. The peripheral blood expression of the LIAS gene was assessed by real-time
qRT-PCR.
Results: In diabetic and DN patients, the expressions of LIAS were significantly lower than controls (p<0.001). The
LIAS expression showed a reducing trend with the progress of DN (p<0.001). The LIAS expression showed a
sensitivity of 95 % and specificity of 88.3% in the differentiating between diabetic and DN patients and it can detect
early DN with a sensitivity of 93.5 % and specificity of 90%. LIAS expression in DN patients had significant negative
correlations with disease duration and albuminuria. LIAS gene expression can protect significantly from the DN. It
had an odds ratio of 0.01 [95% confidence interval (CI): 0.001-0.03] (p<0.001). LIAS gene expression can significantly
predict disease severity.
Conclusion: Peripheral blood expression of the LIAS gene was significantly lower in diabetic and DN patients in
comparison to controls. The LIAS expression negatively correlated with the progress of DN. LIAS gene expression
seems to be a promising marker for prediction and early detection of DN in type 2 diabetic patients.
Keywords:
Diabetic nephropathy; Gene Expression; Lipoic acid synthetase.

INTRODUCTION
evaluate the peripheral blood LIAS gene expression and
Lipoic acid synthetase (LIAS) gene was identified at
its potential role as a new biomarker for DN.
human chromosome 4 in the p14 band (1). The LIAS gene

product is one of the mitochondrial proteins that is
SUBJECTS AND METHODS
capable of alpha-lipoic acid synthesis (2). Alpha-lipoic
Study design:
acid shows an obvious antioxidant activity (3). Besides, it
A case-control design was utilized. This study was
has a metal-chelating activity and reactive oxygen
taken place in the Internal Medicine Department and the
species-quenching activity that share in other natural
Clinical Pathology Department, Faculty of Medicine,
antioxidants reduction (4).
Zagazig University. Over a 1 year period, between
Diabetic nephropathy (DN) is a classic kidney
November 2017 and November 2018, this study was
abnormality in diabetic patients (5). The oxidative stress is
conducted.
the main suspected cause of its development (6,7). So,

many studies directed toward the impact of
Ethical approval:
supplementary antioxidant drugs in diabetes (8-10).
This study protocol was approved by the Faculty of
Especial attention was given to the roles of alpha-lipoic
Medicine Institutional Review Board (Zagazig
acid in diabetes; it shares in the glycemic control and
University). Before subjects' enrollment, all patients
complications management (11).
agreed and signed this study consent form.
Alpha-lipoic acid can prevent DN by reducing

malondialdehyde levels and restoring glutathione. These
Subjects:
changes prevent basement membrane thickening,
The sample size was calculated based on a statistical
mesangial expansion, glomerulosclerosis, and fibrosis
power of 0.8 and a 95% confidence interval (CI) to detect
(12). Also, alpha-lipoic acid attenuates the DN
an assumed 0.7­fold difference in the gene expression.
manifestation either in animal models (13-20) or humans (21,
The equal allocation ratio for the study groups was
22). So, studies were directed toward the LIAS gene and
utilized. This calculation was performed by the Epi Info
its expression in DN induced animal models (23, 24).
program 6 (Atlanta, Georgia, USA). This study was
This study hypothesizes that LIAS gene expressions is
conducted on 60 diabetic patients, 60 DN patients, and 60
reduced in diabetes and DN patients. This study aimed to
healthy matched individuals.

This article is an open access article dis tributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)

1320
Received:20 /6 /2020

Accepted:19 /8 /2020

Full Paper (vol.811 paper# 27)


c:\work\Jor\vol811_28 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1326-1329

The Role of Anti-ovarian Autoantibodies in Polycystic Ovary Syndrome
Mary M. Shoukry, Hanaa A. Amer, Rania H. El-Kabarity, Nancy S. Wahba*
Department of Clinical Pathology, Faculty of Medicine, Ain Shams University
*Corresponding author: Nancy S. Wahba, Mobile: (+20)01224340560, Email: nancy_samir@live.com

ABSTRACT
Background:
Autoimmunity has been proposed in the pathogenesis of polycystic ovary syndrome (PCOS) since early
1990s. Studies of anti-ovarian antibodies (AOA) that were performed so far yielded conflicting results.
Objective: This study aimed at evaluating the association between PCOS and AOA.
Patients and method: The study was conducted on 80 Egyptian women who were divided into two groups: cases
group of 40 women with PCOS, and a control group of 40 healthy age-matched normally cycling fertile women. For
both cases and control groups, serum level of AOA was measured using ELISA.
Results: Serum AOA level was significantly higher among cases than controls (p value < 0.05). No significant
difference was found between cases and controls regarding their hormonal profile (estrogen, FSH, LH, and
testosterone) except for the level of mid luteal progesterone which was significantly lower among cases (p value
<0.05). No significant correlation was found between AOA and age, body mass index (BMI), FSH, LH, E2, mid luteal
progesterone and testosterone in control group. However, a significant negative correlation between AOA and serum
testosterone level was found in PCOS group.
Conclusion: Our results suggest that autoimmune ovaritis may be frequently associated with PCOS. Circulating AOA
may represent a practical and suitable marker for diagnosis of PCOS.
Keywords: Autoimmunity, Anti-ovarian antibody, Polycystic ovarian syndrome, Pregnancy.

INTRODUCTION
(2003) criteria (5). All subjects with congenital adrenal
Polycystic ovary syndrome (PCOS) is a complex
hyperplasia, androgen-secreting tumors, Cushing's
disorder characterized by hyperandrogenism and
syndrome, hyperprolactinemia, virilizing ovarian or
chronic anovulation, leading to infertility in young
adrenal tumors and those taking any hormonal
women. Worldwide, PCOS affects 6­10% of women (1,
treatment during the previous three months before the
2). Autoimmunity has been proposed in the pathogenesis
study were excluded.
of PCOS since early 1990s and many studies have
Group 2 (control group): This group was
reported combination between PCOS and many
composed of 40 healthy age-matched normally cycling
autoimmune disorders such as autoimmune thyroiditis,
fertile women visiting the outpatient clinics because of
autoimmune oophoritis and premature ovarian failure.
problems not related to PCOS, with no history of
Many reviews have documented presence of many
autoimmune diseases or hormonal therapy during the
autoantibodies in PCOS patients such as: anti-nuclear
previous 3 months. Absence of PCOS was confirmed
(ANA), anti-histone, anti-thyroid, anti-spermatic and
by measuring serum level of sex hormones (estrogen,
anti-islet cell antibodies (3).
progesterone, FSH, LH, and testosterone).
The relation between ovarian autoimmunity and

PCOS was previously evaluated and the detection of
Methodology:
autoantibodies directed against various ovarian targets
Both groups were subjected to the following:
strongly supports the hypothesis of an autoimmune
(1) Detailed questionnaire, full medical history taking and
etiology of PCOS. In addition, it was shown by many
clinical examination.
studies that anti-ovarian antibody (AOA) could reduce
(2) Transvaginal ultrasound to evaluate the ovaries and
fertilization rates, generate a poor response to
uterus.
gonadotropin stimulation, and could be responsible for
(3) Laboratory investigations including the following:
implantation failures (4).
a. Serum level of sex hormones (estrogen, progesterone,
The aim of this study was to assess the association
FSH, LH, and testosterone) were measured by an
between PCOS and AOA in a sample of Egyptian
automated electrochemiluminescence immunoassay
women with PCOS compared to healthy controls.
system (Cobas e411 analyzer, Roche, Germany).

SUBJECTS AND METHODS
b. The presence of serum AOA was determined using a
Study participants:
commercially
available
solid-phase
enzyme
This case-control study was conducted at Ain
immunoassay kit (anti-Ovarian Abs ELISA, EIA-293,
Shams University Obstetrics and Gynecology Hospital,
DRG International, Inc. U.S.A.). Whole blood
Cairo, Egypt. It was composed of 80 patients who were
specimens were collected and allowed to clot, and the
divided into two groups: Group 1 (patient group):
serum was separated by centrifugation and stored at -
This group was composed of 40 women with PCOS
20°C. Sera were diluted 1:100 with dilution buffer (5
diagnosed and identified according to the Rotterdam
L of serum + 495 L of dilution buffer).

This article is an open access a rticle distributed under the terms and conditions of the Creative
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1326
Received:20 /6 /2020

Accepted:19 /8 /2020

Full Paper (vol.811 paper# 28)


c:\work\Jor\vol811_29 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1330-1337

Oral Gabapentin versus Pregabalin for Postoperative Pain Relief in
Elective Cesarean Section Patients under Spinal Anesthesia
Neveen Mahmoud Alaasar, Dalal El-sayed Mohammed soud, Asmaa Mohammed Galal El-Deen, Ahmad
Ibraheem Ahmad Abd Elfattah
1 Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Zagazig University
*Corresponding author: Ahmad Ibraheem Ahmad Abd Elfattah,
Mobile: (+20) 01092695118, Email: ahmad_201599@yahoo.com
ABSTRACT
Background: Pain after Cesarean delivery is the main postoperative complain in parturients, pregabalin and gabapentin
have been shown to decrease acute postoperative pain in parturient. Objective: The aim of the study was to compare
gabapentin and pregabalin as oral premedication in patients for elective cesarean section under spinal anesthesia for
postoperative pain relief and the need to rescue analgesia.
Methods: This study was carried out at Obstetric Operating Rooms, Zagazig University Surgical Hospitals. The study
included 54 consenting women aging 20­40 yrs old with uncomplicated pregnancies that were scheduled to undergo
elective Cesarean section delivery under spinal anesthesia. They were randomly allocated into three equal groups. Group
(P) received 300 mg pregabalin, group (G) received 900 mg gabapentin, and control group (C). The study medication
given orally one hour before the anticipated time of the surgical incision, and data measured included visual analogue
scale (VAS), the total doses of analgesia, the incidence of post-operative nausea and vomiting (PONV) and the level of
sedation. Results: The VAS was comparatively low in patients of group P as compared to G and C groups (P value <
0.05). Total analgesic requirement of pethidine in first 24 h was significantly lower in groups P as compared to groups
G & C (P value < 0.001). We found that there was statistically significant increase in the sedation scores of the patients
in P group as compared to G & C groups.
Conclusion: Pregabalin 300 mg was more effective than gabapentin300 mg in reducing post Cesarean section pain,
opioid consumption, nausea, and vomiting.
Keywords: Cesarean section, Postoperative pain, Pregabalin, Gabapentin.

INTRODUCTION


The relief of postoperative pain is a subject, which has

been receiving an increasing amount of attention in the
section under spinal anesthesia regarding postoperative
past few years specifically obstetric surgeries (1). Pain
pain relief and the need to rescue analgesia.
relief of good quality after cesarean section (CS) results

in early mobilization and good early mother­child
Ethical approval and written informed consent :
interaction (2). Patient-controlled analgesia (PCA), with
An approval of the study was obtained from
systemic opioids, gives a very high level of patient
Zagazig University academic and ethical committee.
satisfaction. However, opioids have well documented
Every patient signed an informed written consent for
side-effects i.e. sedation, nausea and respiratory
acceptance of the operation.
depression (3).
PATIENTS AND METHODS
Gabapentin and pregabalin are structural analogues of I. Technical Design:
gamma amino butyric acid that were introduced as a. Site of study:
antiepileptic drugs and have been extensively used to treat
This study was carried out in Obstetric Operating
painful neuropathies. Their mechanism of action is likely
Rooms, Zagazig University Surgical Hospitals.
mediated by binding to the presynaptic voltage-gated

calcium channels, inhibiting calcium influx via these b. Sample size
channels, and subsequently inhibiting the release of
Assuming that percent of three doses of
excitatory neurotransmitters from the primary afferent
postoperative analgesic requirements in gabapentin group
nerve fibers in the pain pathway (4).
is 20% verse 65% in control group so total sample size
Several clinical trials studying perioperative use of
will be 54 (18 in each group) using open EPI, power 80%
gabapentin and pregabalin, with a variety of surgical
,CI 95%(6).
procedures producing visceral and somatic injury, have
found significant reduction in postoperative analgesic
*Inclusion criteria:
requirements and others a reduction in early and late
1. Age: 21-40 years old.
postoperative pain (5).
2. Gender: females

3. Physical status: ASA II.
AIM OF THE WORK
4. BMI < 35&>20 kg/m2.
To compare gabapentin and pregabalin when given as
5. Written informed consent from the patient.
oral premedication in patients for elective cesarean

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/by/4.0/)

0331
Received:21 /6 /2020

Accepted:20 /8 /2020

Full Paper (vol.811 paper# 29)


ž’'DED.5 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (1), Page 1338-1341
Neurological Manifestations of Renal Diseases in Children at
Zagazig University Hospital
Ahmed Galal Siam1, Mohammed Mohammed Abdel Salam1, Hatim Saed Haweej*2
1 Department of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, Egypt
2 Department of Pediatrics, Faculty of Medicine, Almergib University, Libya
*Corresponding author: Hatim Saed Haweej, Mobile: (+20)01032168688, E-mail: hatemhoeg84@gmail.com

ABSTRACT
Background:
Chronic renal failure (CRF) may have many effects on the nervous system and manifest as headache,
seizure, dialysis disequilibrium syndrome, cerebral hemorrhage, hypertensive encephalopathy, uremic neuropathy.
Objectives
: This study aimed to identify the neurological manifestations in children with renal diseases at Zagazig
University hospital.
Subjects and methods
: This is cross-sectional was carried out in the Pediatrics Department, Zagazig University
Hospitals, on 270 Children with renal diseases during the period from January 2019 till June 2019. All patients
included in the study were subjected to history taking, detailed data about renal diseases.
Results
: our results revealed that Frequency of neurological manifestations in renal disease patients was (3%),
Common presentations of renal diseases was (7.4%) had dysuria, (70.37%) had edema, (3,7 %) had hematuria,
(18.51%) had hypertension and 8 cases (3%) had neurological presentations, of whom, 5 had febrile seizures, 2 had
cerebral thromboembolism, and 1 encephalopathy.
Conclusion: Neurological manifestations of pediatric renal diseases still are common and the neurological
presentations in 3 % of children with renal diseases, and febrile seizures were the most common presentation.
Keywords: Renal disease, Children, Neurological manifestations.


INTRODUCTION
PATIENTS AND METHODS
Renal diseases are one of the most common
This Cross-sectional prospective study was carried
causes of referrals and admissions of children. Common
out in the Nephrology Unit of Pediatrics Department,
renal diseases include Urinary Tract Infection (UTI),
Zagazig University Hospitals (from January 2019 till
nephrotic syndrome, and glomerulonephritis such as
June 2019). On 270 Children with a confirmed
Post-Streptococcal
Glomerulonephritis
(PSGN).
diagnosis of renal disease by pediatric nephrologists.
Urinary tract infection is one of the most common
Ethical consideration:
diseases in children. Delayed diagnosis and treatment
Written informed consent was obtained from all
can cause permanent complications such as renal
children's parents, the study was approved by the
scarring, hypertension, and renal failure (1).
research ethics committee of the Faculty of
Nephrotic syndrome is another disease that can be
Medicine, Zagazig University. The study was done
associated with neurological complications. The
according to The Code of Ethics of the World
prevalence of the nephrotic syndrome is about
Medical Association (Declaration of Helsinki) for
16/100,000 children per year (2).
studies involving humans.
It is identified with a triad of proteinuria, edema,

and hypoalbuminemia. One of the major complications
Inclusion criteria:
of nephrotic syndrome is a thromboembolic event.
The inclusion criteria were the age between one
PSGN is the most common form of glomerulonephritis
month to 15 years old and the existence of a renal
in children characterized by the sudden onset of gross
disease.
hematuria, edema, and hypertension following

streptococcal infection (3). Common presentations of
Exclusion criteria for cases: patients with diseases
renal diseases are frequency, dysuria, edema, hematuria,
other than renal diseases were excluded.
and hypertension (4).
Sampling:
Neurological symptoms are an important
The participants were chosen by systematic
presentation in children with renal diseases, which
random sampling from Patients admitted in the
include febrile seizures, encephalopathy, and cerebral
Nephrology Unit of Pediatrics Department, Zagazig
thromboembolism. Some children with UTI present
University Hospitals.
with febrile seizures (5).
All patients included in the study were subjected to
Given the importance of recognizing uncommon
the following:
symptoms of renal diseases, this study aimed to identify

the neurological manifestations in children with renal
History taking:
diseases at Zagazig University hospital.
Personal history: name, age, and gender,
residence, and consanguinity.

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

(http://creativecommons.org/licenses/by/4.0/)
1338
Received:21 /6 /2020

Accepted:20 /8 /2020


Full Paper (vol.811 paper# 30)