c:\work\Jor\vol812_1
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1342-1346
Study of the Mean Platelet Volume in Children with Chronic Renal Diseases
Ali Mohamed Abu-Zeid1, Saed Mohamed Morsy2, Sherif Hassan Mohamed1
Departments of 1Pediatrics and 2Biochemistry, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Sherif Hassan Mohamed Fawzy, Mobile: (+20)01002327771,
E-Mail:sherif.hassan021@gmail.com
ABSTRACT
Background: The mean platelet volume (MPV), which is a readily available indicator of platelet activation and
function, is considered as a promising predictive and prognostic biomarker of cerebrovascular and cardiovascular
diseases in several studies. The larger platelets tend to aggregate and produce larger amounts of adhesion molecules
than small ones.
Objective: To investigate the relationship between MPV levels and the glomerular filtration rate (GFR) in pediatric
patients with Chronic Kidney Disease (CKD).
Patients and Methods: A prospective case-control study was carried out at the Nephrology Unit in the pediatric
department of Zagazig University Children Hospitals.40 children participated in study 20 of them having chronic
kidney disease as a case group and a similar number of control children comparable with case group. We reviewed
the medical records of patients between May 2018 and February 2019.
Results: In this study, there was a positive significant correlation between MPV with Red cell Distribution Width
(RDW) and creatinine and a negative correlation between MPV and eGFR in the CKD group. There was a statistically
significant difference between case and control groups as regard serum creatinine, urea, and eGFR. There was a highly
significant difference between the two groups regarding Hemoglobin, MPV, and RDW. There was a statistically
significant difference between the two groups regarding systolic blood pressure (SBP) and diastolic blood pressure
(DBP). There was a significant difference between the two studied groups as regard weight. MPV was significantly
increased with the progression of CKD. Thus the lower the results of eGFR reflecting poor stage and prognosis of
chronic kidney disease accompanied by higher values of MPV.
Conclusion: The useful estimation of MPV provides a promising Cheap Biomarker in the monitoring of the course
of progression in Chronic Kidney Diseased Children.
Keywords: CKD, MPV, eGFR, SBP, DBP, RDW.
INTRODUCTION
measured in labs by automated cell counters. More large
Chronic kidney disease (CKD) is a major
platelets are being activated than the smaller platelets (4).
worldwide health problem with increasing incidence and
High MPV is associated with a variety of many
prevalence. The prevalence of all stages of CKD varies
diseases in children and adults as Familial Mediterranean
between 712% in the different regions of the world.
Fever &Myocardial Infarction, Also it is considered as a
Chronic Kidney Disease in low and middle-income
useful biomarker in patients with cardiovascular diseases
countries is poorly characterized owing to the lack of
using Percutaneous Coronary Intervention (PCI) and in the
community-based studies (1). Little is known about CKD in
prognosis of many patients of acute cerebrovascular
children because children are not included in many clinical
disorders (5).
studies. It has a significant effect on the health status of a
Recent few studies of using MPV as a biomarker in
wide range population and affects the economic state of
patients with renal disease have been done revealed high
society considering the high cost of renal replacement and
values of MPV in CKD patients. This study aimed to
management (2).
determine the relationship between Mean Platelet Volume
The definition of chronic kidney disease is a
& estimated Glomerular Filtration Rate in Children with
decrease in kidney function estimated by Glomerular
Chronic Kidney Disease (6).
Filtration Rate (GFR) of less than 60 ml/min/1.73 m², or by
markers of kidney structure damage, or both of them for at
AIM OF THE WORK
least 3 months duration, whatever was the underlying
To determine the relationship between Mean
cause. The best indicator of kidney function is GFR, which
Platelet Volume & estimated Glomerular Filtration Rate in
is measured either by exogenous markers or estimated
Children with Chronic Kidney Disease.
using Creatinine-Based "Beside Schwartz" Equation in
children (3).
PATIENTS AND METHODS
Mean platelet volume (MPV) is the average
This study was a case-control study and had been
volume of a single platelet measured in femtolitres (fL) and
performed in the period from May 2018 to February 2019
is considered an inexpensive marker that routinely is
in the Nephrology Unit, Pediatric Department of Zagazig
University Hospitals. Total subjects included 40 patients in
This article is an open access article
distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license h
( ttp://creativecommons.org/licenses/by/4.0/)
1342
Received: 21 /6 /2020
Accepted:20 /8 /2020
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The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1347-1351
Hepatitis (C) Virus, Hepatitis (B) Virus and Human Immunodeficiency (HIV)
Virus Coinfection and Their Impact Outcome on the Liver
Said Abdelbaky Gad1, Ahmed I. Elagrody2
Department of Internal Medicine, Faculty of Medicine, Zagazig University
Corresponding author: Said Abd Elbaky Gad Shams El Deen, Mobile: (+20)01227517689,
Email: saidabdelbaky12345@gmail.com
ABSTRACT
Background: Hepatitis C virus (HCV), hepatitis B virus (HBV) and human immunodeficiency virus (HIV) are the
commonest chronic viral infections worldwide, they share most common routes of infections, they are hepatotropic
viruses and their combined infections had bad outcome on the liver.
Objective: To evaluate the risk of coinfection of the liver by both HCV, HBV and HIV on the liver outcome.
Patients and Methods: This is a retrospective study of 241 patients attending different fever hospitals coinfected by
HCV and or HBV with HIV but not HCV or HBV without HIV infections.
Result: There was significant difference between male 59.8% and female 40.2%, age of patients, also there was
significant difference as regard liver enzymes, cirrhosis, splenomegaly, international normalization ratio in triplet
coinfections.
Conclusion: There is high risk on liver outcome in the presence of coinfection between HCV or HBV and HIV.
INTRODUCTION
behavior of infected persons (7). It is unclear how many
Human immunodeficiency virus (HIV) is a
people have
lentivirus which target the immune system resulting in
HIV in the country so we decided to study in cross-
depression of cell mediated immunity with resulting
section of retrospective study the true triplet coinfection
serious opportunistic infection and rare malignances (1).
and its effect on the liver (6, 8).
Worldwide hepatitis (B) virus, hepatitis (C) virus
Aim of the work was to evaluate the risk of coinfection
and human immunodeficiency virus (HIV) are the
of the liver by both HCV, HBV and HIV and the liver
commonest chronic viral infections. They have
outcome.
common routes of transmissions as they are blood born
infectious diseases (blood and blood products), needle
PATIENTS AND METHODS
transmission, and sexual activity (2). HBV is
This study is a cross sectional study between
characterized by special route of transmission which is
Mayo 2018 and June 2019. It included 241 patients with
the vertical one (from mother to baby) which is rare in
no sex predilection aged between 20-75 years old
HCV. Coinfection between the three hepatotropic
attending Alexandria, Al Abasia and Al Ahrar fever
viruses are of great risk as the viruses may impact the
hospitals. This study depended on file records of
natural history of the other one, HIV accelerates the
patients attending these hospitals to follow up and
natural course of both HBV and HCV with consequent
treatment. Objectively this study measures the
destructive effect on the liver and progression to
prevalence of coinfection between HIV, HCV and HBV
cirrhosis and hepatocellular carcinoma (HCC).
but not HCV or HBV alone without HIV infection and
Worldwide among HIV infected patients about 2-4
its impact out come on the liver.
millions have chronic HBV coinfection and 4-5 million
coinfected with HCV (3).
Ethical approval:
In Egypt about 2-3 million are chronic carriers
An approval of the study was obtained from
for HBV and 6-8 million are HCV positive patients so
Zagazig University academic and ethical committee.
we decided to study the effect of coinfection between
Every patient signed an informed written consent for
HIV and HCV and HBV on the liver outcome in some
acceptance of the operation.
Egyptian fever hospitals in a retrospective study (4).
HBV and HCV coinfection with HIV in very
Inclusion criteria:
important as triplet infection increase the risk of
All patients included in the study had HIV
hepatological complications (5).
infection with work up to investigate other serological
As infection with the triplet viruses may hasten
markers of HCV and HBV but not HCV or HBV alone.
the scarring of the liver with consequent cirrhosis and
hepatocellular carcinoma (HCC) life expectancy with
Exclusion criteria:
these viruses are decreased (6). Infection by the three
Any patient have any liver disease weather acute
viruses is different according to geographic regions and
or chronic and patients with HCV or HBV without HIV.
All patients included in the study were subjected
to filling data records of age, sex, onset of disease,
This article is an open acc
ess article distributed under the terms and conditions of the Creative
Commons Attribution ( CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1347
Received:21 /6 /2020
Accepted: 20/8 /2020
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The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1352-1358
Prognostic Value of Interleukin-17 A Gene Polymorphism and Serum IL-17
Levels in Adult Acute Myeloid Leukaemia Patients
Ahmed A Alnagar1, Mohamed H Mourad2, Zainab A Farrag2, Lamiaa M Kamel2
Departments of 1Medical Oncology and 2Clinical Pathology , Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Zainab A Farrag, Mobile:(+20) , Email: drzainabfarrag@gmail.com
ABSTRACT
Background: T helper 17 (Th17) cells play a role in the pathogenesis and prognosis of acute myeloid leukemia (AML).
Th17 cells produce interleukin (IL)-17A and IL-17F, that share strong surface expression and homology of the IL-23
receptor (IL-23R).
Objective: To evaluate the expression of IL-17A gene polymorphism and IL-17 serum level in adult AML patients
and to clarify its prognostic significance.
Patients and methods: In this prospective study, 48 patients with de novo AML and 48 healthy matched controls were
enrolled. Cases were diagnosed at clinical pathology and managed in Medical Oncology Departments. We evaluated
both serum IL-17 levels, measured by ELISA, and IL-17A (rs2275913) gene polymorphism was assessed using real-
time polymerase chain reaction (PCR) in all patients and control. All patients received "3+7" as induction, responders
received 3-4 courses of high dose cytarabine as consolidation, while non-responders received salvage therapy.
Results: Serum levels of IL-17 were higher in AML patients (median 27 pg/ml) vs 17 pg/ml in the control group (P <
0.001). Also, serum IL 17 level was higher in non-responders with median 37.5 (pg/ml) vs 23 (pg/ml) in responders
(P < 0.001). while IL-17A mutant genotypes and alleles showed no significant relation between expression of IL-17
A gene polymorphism and response to treatment or outcome of studied AML cases.
Conclusion: Serum IL-17 levels can be considered a useful diagnostic and prognostic factor in AML patients, unlike
IL-17 A gene polymorphisms.
Keywords: IL-17, Prognostic, Polymorphisms, AML.
INTRODUCTION
between IL-17A gene polymorphisms, serum IL-17
Acute myeloid leukaemia (AML) is an aggressive
levels and the prognosis and response to therapy. We
haematological malignancy resulting from the clonal
enrolled in our study, De novo AML patients aged 18 to
expansion of abnormal myeloid progenitors (1).
60 years, with an ECOG performance status of two or
T helper lymphocytes produce pro-inflammatory
less. Liver and kidney function tests were within the
interleukin-17 (IL-17) that plays a critical role in many
normal range. Normal cardiac functions tests. Patients
types of cancers and inflammatory diseases (2). IL-17
with relapsed or secondary AML, promyelocytic
triggers proliferation of IL-17R (IL-17 receptor)-positive
leukaemia, prior history of exposure to radiation, or
AML cells by activating the PI3K/Akt and Jak/Stat3
chemotherapy, patients with other malignancies, history
signaling pathways. IL-17 increases in the bone marrow
of myelodysplastic or myeloproliferative neoplasm,
and blood in AML patients more than in healthy controls
patients with impaired renal, cardiac and liver function or
(3). IL-17 can activate MAPK, PI3K/Akt, NF-B, and
patient refusal were excluded.
STAT3 downstream signaling pathways to regulate AML
progression (4). IL-17A (rs2275913) polymorphisms
Ethical approval:
might be responsible for chronic inflammatory diseases,
The Institutional Review Board (IRB) approved
autoimmune diseases and malignancies as an inducer of
this study (IRB) (2465-15-12-2015) chaired by the
inflammatory chemokines secretion also release
Faculty of Medicine. Informed consent was obtained
cytokines stored in neutrophils and macrophages (5).
from all subjects.
We aimed to evaluate the expression of IL-17A
gene polymorphism and IL-17 serum level in adult AML
Methods of IL-17 detection:
patients and to clarify its prognostic significance.
Detection of Interleukin-17 A gene polymorphism
rs 2275913 by Real-Time PCR technique
PATIENTS AND METHODS
For DNA extraction, 2 ml samples of blood were
This prospective study was conducted in the
collected into a sterile tube containing EDTA. The
Clinical Pathology and Medical Oncology Departments,
samples were stored in the same vacutainer at -20°C
over two years from December 2015 to December 2017.
before processing. The GeneJET Genomic DNA
We assessed serum IL-17 levels and the expression of IL-
Purification Kit (California, USA) was used for DNA
17A in 48 de novo adult AML patients and 48 age and
isolation. Then DNA concentration was measured for
sex-matched controls. We studied the relationship
adjustment of the needed sample volume used in PCR
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/)
1351
Received:20 /6 /2020
Accepted:19 /8 /2020
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The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1365-1372
Transvaginal nUltrasound Measurement of Lower Uterine Segment Myometrial
Thickness for the Prediction of Preterm Labor in Twins Gestations.
Observational Study
Ibrahim Saif Elnasr, Mohamed Fahmy, Haitham Hamza, Hesham Ammar
Obstetrics and Gynecology Departments, Faculty of Medicine, Menoufia University Menoufia, Egypt
* Corresponding author: Ibrahim Saif Elnasr, Tel.: +201003086747, Email: Ibrahimalisaifelnasr @gmail.com
ABSTRACT
Background: Transvaginal ultrasound evaluation of cervical length considered a good predictor of PTL and
recently lower uterine segment myometrial thickness had been used for this purpose.
Objectives: Evaluating the efficacy and validity of transvaginal ultrasound measurement of lower uterine
segment myometrial thickness (LUS-MT) in prediction of preterm delivery (PTL) in twins pregnancies.
Patients and Methods: This is an observational prospective cohort study where ninety sex (96) twins pregnant
women were enrolled. LUS-MT and CL were measured by transvaginal ultrasound between 16-24 gestational
weeks. All patients were scheduled for routine antenatal care till delivery and divided in two groups: preterm
group and full-term group.
Results: 58 patients delivered at full term and 38 patients had preterm delivery. Among patients who had preterm
delivery, 25 patients (56.8%) had LUS-MT <4.26 and 2 patients (3.8%) only had LUS-MT 4. among patients
who delivered at full term, 50 patients (96.2%) had LUS-MT 4.26 and 19 patients (43.2%) had LUS-MT <4.26.
The best cutoff value for LUS was 4.26 mm with area under the ROC curve (AUC) 0.917, sensitivity 92.1 %,
specificity 86.2%, PPV 81.3%, NPV 94.3% and Accuracy 92.1 %.
Conclusion: Transvaginal ultrasound measurement of LUS-MT is an effective, precise, applicable and safe
procedure in predicting the preterm labor in twins gestation with high validity than cervical length. Use of lower
uterine wall as a substitution of CL measurement in order to predict population at risk of preterm labor needs to
be investigated.
Keywords: Cervical length, Lower Uterine Segment Myometrial Thickness, Preterm Labor, Transvaginal
Ultrasound.
INTRODUCTION
twins as in singletons (8). Most published studies
Twins pregnancy constitutes 2-4% of all births,
agreed on cervical length measurement between 16-24
and the rate of twining has increased by 76 % between
weeks (9).
1980 and 2009. Preterm birth is the most common
Lower uterine wall lies closely to the
complication of twins pregnancy affecting 40-60% of
cervix so the changes that originated in the cervix
such gestations (1). There is a substantial long-term
could possibly involve the adjacent lower uterine
health impact from preterm birth due to increased risk
wall as well (10). There is inverse association
of death and of developing a wide range of chronic
between the thickness of the lower uterine segment
physical and neurological disabilities compared to full
and cervical length and advancing gestational age as
term births (2).
the lower segment becomes thinner (11).
In twins pregnancy, etiological factors for
So, we conducted this study to evaluate the
preterm birth include uterine over distention (3).
efficacy and validity of transvaginal ultrasound
Myometrial
distention
increases
myometrial
measurement of lower uterine segment myometrial
contractility, releases prostaglandins, and up regulates
thickness (LUS-MT) and its correlation with
oxytocin receptors, all of which are implicated in the
cervical length in prediction of preterm delivery in
cascade of events that occur in early labor (4).
twin pregnancies.
Obstetrical history, demographic factors and
symptoms were traditionally used for prediction of
PATIENTS AND METHODS
PTL (5). Also, numbers of biologic markers in serum,
This is an observational prospective cohort
amniotic fluid, and cervical secretions were evaluated
study carried out in the department of Obstetrics and
for this purpose like cervicovaginal fetal fibronectin
Gynecology at Menoufia University Hospital,
(fFN) and serum Ferritin (6, 7).
Menoufia governorate, Egypt.
Now it is established that cervical length
Ninety sex (96) twins pregnant women their
measurement using transvaginal ultrasound is the best
gestational age ranged from 16-24 weeks were
method for prediction of preterm birth in twin
enrolled in the period from December 2016 to
pregnancies and was demonstrated as sensitive in
October 2018.
This article is an o
pen access article distributed under the terms and conditions of the Creative
Commons Att
ribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1365
Received: 21/06 /2020
Accepted: 20/08/2020
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The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1373-1378
Flibanserin Versus Vardenafil in the Treatment of Female Sexual
Dysfunction, Randomized Controlled Clinical Trial
Abdalla Kandil, Amany Nassar, Rasha Sayed Ahmed Mahmoud Serag
Department of Dermatology, Venereology and Andrology, Faculty of Medicine Zagazig University.
*Corresponding Author: Rasha Sayed Ahmed Mahmoud Serag, Mobile: (+20)01001541538, Email: rashaserag61@gmail.com
ABSTRACT
Background: Female sexual dysfunction (FSD) defined as the persistent/recurring decrease in sexual desire or arousal,
the difficulty/inability to achieve an orgasm, and/or the feeling of pain during sexual intercourse. Therapeutic options
available are few pharmacological options in the treatment of FSD.
Objective: To study the efficacy of flibanserin and vardenafil on female sexual dysfunction and identify which is the
best. Methods: The study was conducted in Gynecology and Obstetrics Department and Dermatology and Venereology
Department, Faculty of Medicine, Zagazig University Hospitals during the period from February 2019 to December
2019. Thirty-two married female patients were included in this study. These patients were divided into two groups.
Group I included sixteen patients who were treated by vardenafil and group II included the sixteen patients who were
treated by flibanserin.
Results: The present study showed that there were no statistical significant differences between the studied groups in
any of demographic data. In addition, there were no statistical significant differences between the two studied groups in
all scores pre-treatment. However, there was statistical significant increase in desire, orgasm and total score among
Group II (flibanserin) compared to Group I (vardenafil) post-treatment.
Conclusion: Treatment of FSD is multi-factorial. Medications alone do not resolve FSD. Flibanserin is a controversial
drug approved for a controversial disorder amid huge controversy. While it may serve as the light in the long search for
female sexual problems, which still has a long way to go. Women taking this drug must well be educated about the
adverse events associated with this drug and the possible interactions.
Keywords: Flibanserin, Vardenafil, Female Sexual Dysfunction.
INTRODUCTION
Female sexual dysfunction defined as the
arousal. The ultrafiltration of plasma through capillary
persistent/recurring decrease in sexual desire or arousal,
vaginal vessels contributes to vaginal lubrication (5).
the difficulty/inability to achieve an orgasm, and/or the
Phosphodiesterase type 5 (PDE5) inhibitors
feeling of pain during sexual intercourse (1).
(eg, sildenafil, tadalafil, vardenafil) physiologically
Therapeutic options available are few
enhance the production of guanosine monophosphate
pharmacological options in the treatment of FSD.
from cyclic guanosine monophosphate. PDE5 is
Historically, FSD patients were treated through
expressed in vaginal, clitoral, and labial smooth
psychological therapy. More basic science research and
muscles. Thus, PDE5 inhibitors could be used as an
clinical recognition have been developed to address the
easily available medical treatment for genital FSADs (6).
problem. Several pharmacological initiatives are in
The study aimed to study the efficacy of
development aimed at increasing blood flow to the
flibanserin and vardenafil on female sexual dysfunction
genitals, improving androgen deficiencies and
and identify which is the best.
enhancing central nervous system stimulation (2).
Flibanserin is a non-hormonal, centrally acting
PATIENTS AND METHODS
molecule that acts as an agonist at postsynaptic 5-HT1A
The study was conducted in Gynecology and
receptors and as an antagonist at 5-HT2A receptor (3).
Obstetrics Department and Dermatology and
Flibanserin administration has been shown to lead to
Venereology Department, Faculty of Medicine,
brain region-specific decreases in serotonin (5-HT) and
Zagazig University Hospitals during the period from
increases in dopamine and norepinephrine (4).
Feb 2019 to December 2019.
Vardenafil, in smooth muscle cells, nitric oxide
activates the guanylate cyclase enzyme, which converts
1) Sample size:
guanosine triphosphate into cyclic guanosine
Thirty two married female patients were
monophosphate. This molecule promotes the relaxation
included in this study. These patients were divided into
of the smooth muscle cells, causes vasodilatation, and
two groups. Group 1 included sixteen patients who were
increases blood flow in genital organs. The
treated by vardenafil and group II, which included
engorgement of clitoris and labia minora in women are
sixteen patients who were treated by flibanserin.
the main modifications of genital organs during sexual
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/)
1373
Received:21 /6 /2020
Accepted:20 /8/2020
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The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1379-1388
Role of Metformin in Combination with Neoadjuvant Chemotherapy in
Treatment of Breast Cancer
Ahmed Said Ahmed Said*1, Hussein Ali Mustafa abd Al-Mutteleb2, Mohammed Ali Morsy Abdeen3,
Mohammed Abd Al Rahman Hassan3, Soha Abdelrazek Abbas Ahmed1
Departments of 1Clinical Oncology & Nuclear Medicine and
2General Surgery, Faculty of Medicine- Aswan University
Department of 3Clinical Oncology & Nuclear Medicine, Faculty of Medicine- Cairo University
*Corresponding author: Ahmed Said Ahmed Said, Mobile: (+20) 01125408705, E-Mail: ahmedsaidorman@yahoo.com
ABSTRACT
Backgound: Globally, breast cancer is the most frequently diagnosed malignancy and the leading cause of cancer
death in women. Improvements in chemotherapy, surgery, lymph node evaluation and hormone receptor blocking
therapy have successfully doubled the survival of breast cancer patients.
Objective: To determine whether metformin use was associated with improvement in pathologic complete response
(PCR) rate in patients with breast cancer receiving neoadjuvant chemotherapy.
Patients and Methods: This prospective study was conducted at the Clinical Oncology Department, Aswan
University and Upper Egypt Hospitals in the period between 1/7/2016 and 1/9/2019. This study included 50 patients
divided into 2 groups, test group (metformin group) and standard group (non-metformin group). Histopathology was
confirmed by tissue core biopsy.
Results: All patients in the two groups in our study achieved either pathological complete response or partial
response. No patients developed disease progression or were still stable disease. Among the patients in test group
(metformin group), 15 patients (60%) achieved pathological complete response (PCR) while 10 (40%) patients did
not achieve PCR. However, among the patients in standerd group (non-metformin group) 9 patients (36%) achieved
pathological complete response (PCR) while 16 (64%) patients did not achieve PCR. There was statistically
significant difference between the two groups regarding the response with better PCR in metformin group (p value
is 0.089).
Conclusion: The addition of metformin to neoadjuvant chemotherapy has a significant impact on pathological
complete response (PCR) in female patients with advanced breast cancer.
Keywords: Metformin, Neoadjuvant Chemotherapy, Breast Cancer
INTRODUCTION
cancer, was an evolving chance for more rapid
In general, patients with early-stage breast cancer
incorporation of new drugs (3).
undergo primary surgery (lumpectomy or mastectomy)
Metformin, the famous oral hypoglycemic agent,
to the breast and regional nodes with or without
has attracted attention recently for its possible
radiation therapy (RT). Over the years, surgery for
antineoplastic effect (4). A recent convergence of
breast cancer has become less invasive in both the
clinical and epidemiologic evidence has linked
breast and axilla. Surgical techniques have advanced to
hyperinsulinemia, insulin resistance and diabetes to
provide better cosmesis in breast conservation and also
poor breast cancer outcomes. This has been coupled
in breast reconstruction for woman who require
with enhanced understanding of molecular effects of
mastectomy (1).
metformin and its potential role in malignancy. It has
Following definitive local treatment, adjuvant
been revealed that metformin may influence cancer
systemic
therapy
may
be
offered.
cells through indirect (insulin-mediated) effects, or it
Immunohistochemistry (IHC) markers, together with
may directly affect cell proliferation and apoptosis of
clinicopathological variables such as tumor size, tumor
cancer cells (5). Metformin has shown anticancer
grade, nodal involvement, histologic type and surgical
properties, including activation of the AMP-activated
margins, have been widely used for prognosis,
protein 21 kinase (AMPK) pathway, antioxidant
prediction and treatment selection (2).
activity, induction of apoptosis and many others.
Preoperative systemic therapy (neoadjuvant) is
Patients with type 2 diabetes are hyperinsulinemic, and
becoming popular nowadays for early-stage or locally
there is evidence that this condition contributes to
advanced breast cancer. Neoadjuvant treatment also
tumorigenesis (6).
allows prompt tumor response evaluation and the
In this scenario, metformin reverses, at least
residual disease can be a prognostic factor of tumor
partially,
hyperinsulinemia
and
exhibits
recurrence and overall survival. In the last decade,
antiproliferative properties, which might increase the
pathological response for neoadjuvant chemotherapy,
effect of chemotherapy in a synergy. Preclinical
as an indicator for long term clinical benefit in breast
research has demonstrated that metformin can sensitize
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/)
1379
Received:21 /6 /2020
Accepted:20 /8/2020
c:\work\Jor\vol812_8
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1389-1395
Study Serum Level of Interleukin-17 in Pediatric Systemic Lupus Erythematosus
Doaa Mostafa Tawfik1, Mayy Abdel-Fattah Moahmed1, Naglaa Ali Khalifa2, Asmaa Ibrahim Mohamed Ged1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding Author: Asmaa Ibrahim Mohamed Ged, Mobile: (+20)01005416759, Email: dr.asmaagad2010@gmail.com
ABSTRACT
Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease of unknown etiology.
Objective: To assess serum levels of IL-17 in pediatric SLE (pSLE) and their association with clinical
manifestations, laboratory findings, SLE disease activity index score (SLEDAI), and therapy.
Patients and Methods: A case-control study was conducted at Pediatric Nephrology units, and Outpatient
Nephrology Clinic of Children Hospital, Zagazig University. It was carried out over two years from September 2017
to August 2019. This study was performed on 60 patients classified into two groups: thirty of them were children
with SLE and 30 apparently healthy children as a Control group of comparable age and gender. All patients were
subjected to complete history taking and clinical examination. Laboratory investigations were done. Renal biopsy
was done to 22 cases who were presented by renal symptoms.
Results: Frequency of manifestation were malar rash 86.7%, photosensitivity 80.0%, renal manifestations, and
anemia73.3% for each. SLEDAI score was 18 38. Class II lupus nephritis (LN) was the most common biopsies
result (40%). The range of IL-17 for cases was (89.3 359 pg/ml), a highly significant increase in the Il-17 level in
the case group than the control. A significant association between IL-17 level and renal manifestation, urea,
creatinine, 24-hour urinary protein, and SLEDAI.
Conclusions: Serum IL-17A is elevated more than 170 in pSLE patients with lupus nephritis, which correlates with
disease activity and renal biopsy. IL-17 seems to have a possible role in the pathogenesis of lupus nephritis.
Keywords: Systemic lupus erythematosus (SLE), interleukin-17 (IL-17), Lupus nephritis (LN), Systemic Lupus
Erythematosus Disease Activity Index (SLEDAI).
INTRODUCTION
Interleukin-17(IL-17) is a potent proinflammatory
Systemic lupus erythematosus (SLE) is a complex,
cytokine produced by the CD4+T-helper subset called
multi-system autoimmune disease of unknown etiology.
It is characterized by autoantibodies production,
Th17 cells (8). IL-17 promotes inflammation by inducing
immune complex formation and immune dysregulation
local chemokine and cytokine secretion (9) and is
result in damage to the multisystem include the kidney
essential for the clearance of certain pathogens such as
(1). SLE has a wide range of disease manifestations and
bacteria and fungi. Moreover, IL-17 has been linked to
can lead to significant morbidity and even mortality (2).
immune-mediated organ damage in the context of
Children are at higher risk for severe SLE, typically
several autoimmune diseases (10). The frequency of IL-
presenting with higher disease activity and continuing
17 producing T cells is increased in the peripheral blood
with higher activity over time than adults. Presentation
of adult SLE patients (11) and IL-17 production is
in childhood occurs in 1520% of all SLE patients, with
abnormal in SLE patients. IL-17 levels are increased in
median diagnosis age for pSLE at 12 years(3). Children
adult SLE sera (8).
are more likely to have serious renal, neurological, and
The balance of Th17 and Th1 cell responses is also
hematological involvement than their adult counterparts
dysregulated in SLE patients and correlated with
(4). Mortality rates are higher in pSLE patients than
disease activity. IL-17 serves as a prognostic marker in
adults, despite having less comorbidity (5).
SLE (8). Vincent and his colleagues reported an
Lupus nephritis (LN) is the most common severe
important role for IL-17 in the pathogenesis of lupus
manifestation of SLE. It is a serious complication of
nephritis (12).
SLE, influencing prognosis, and life expectancy more
The present study was conducted to determine the
than any other organ system involvement (6).
serum IL-17 levels in pSLE patients and control groups
Furthermore, LN is common in children. SLE in
and to evaluate the association between IL-17 and
children and adolescent has higher rates of renal damage
clinical manifestations, disease activity, laboratory
and proceed to ESRD more frequently than their adult
findings, SLEDAI, and therapy.
counterparts (4).
The balance between proinflammatory and anti-
PATIENTS AND METHODS
inflammatory cytokines influences the clinical
A case-control study was conducted at Pediatric
manifestations in many inflammatory diseases such as
Nephrology Units, and the Outpatient Nephrology
SLE and rheumatoid arthritis (RA). These cytokines are
Clinic of Children Hospital, Zagazig University. It was
mainly produced by helper T (Th) cells (7).
carried out over two years from September 2017 to
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Commons Attribution (
CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1389
Received:21 /6 /2020
Accepted:20 /8/2020
c:\work\Jor\vol812_9
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1396-1400
Corneal Topographic Changes After Two Different Grafting
Pterygium Surgery Techniques
Sabreen A Omar, Abdalla M Abdalla, Abdul Mongi E Ali, Ahmed F Gabr*
Department of Ophthalmology Faculty of Medicine, Aswan University, Aswan, Egypt
*Corresponding author: Ahmed Fathy Gabr, FRCSEd, MD, Mobile: +201223496297, E-mail: drafgabr@yahoo.com
ABSTRACT
Background: Surgical treatment of pterygium can result in corneal topographic changes. It is not clear that those
changes are universal or technique dependent.
Objectives: Evaluation of corneal topographic changes following pterygium surgery using sutured conjunctival
autografting versus sutured amniotic membrane grafting.
Patients and methods: In this prospective randomized study, patients suffering from primary pterygia that extend
between two and four millimeters over the cornea were included. Patients were separated into group I; underwent
pterygium excision with sutured conjunctival autograft, and group II underwent pterygium excision with sutured
amniotic membrane graft after a comprehensive ophthalmic examination. The following topographic parameters were
noted: the axial curvature map, elevation posterior map, and corneal thickness map.
Results: Significant improvement of the mean visual acuity measured using the logMAR test was found in both groups
postoperatively. The improvement included UCVA and BCVA as well as anterior keratmetric and cylindrical power
of the cornea without significant dissimilarity between study groups. No statistically considerable changes in the
posterior corneal surface or the corneal thickness were found.
Conclusions: Pterygium excision can cause changes in the keratmetric and cylindrical power of the cornea without the
affection of the posterior corneal surface or the corneal thickness. The corneal topographic changes caused by the
pterygium were not varied with the type of surgical technique used.
Keywords: Amniotic membrane, conjunctival autograft, pterygium, corneal topography.
INTRODUCTION
a full explanation about the nature of the procedure used
Surgical excision remains the main treatment for
written consents were taken from the patients before
pterygium causing impaired vision, cosmetic deformity,
surgery.
restriction of ocular motility, and/or marked irritation
History of ocular trauma, ocular surgery,
unrelieved by medical management (1).
recurrent pterygium, and presence of corneal
To reduce the rate of recurrence following
abnormalities such as scarring was accepted as exclusion
surgical treatment of pterygium, various techniques have
criteria. Included patients were allocated into two
been applied which include pterygium resection
groups: group I; comprised 20 eyes that underwent
combined with conjunctival auto-graft, amniotic
pterygium excision with sutured conjunctival autograft,
membrane graft, or with stem cell transplantation (2).
and group II comprised 20 eyes that underwent
Refractive and topographic changes possibly
pterygium excision with sutured amniotic membrane
occur as a result of pterygium existence or due to surgical
graft.
interference for its management (3). Previous studies tried
After obtaining the required consent, complete
to correlate the degree of spherocylindrical changes to
medical and ocular history was taken from all patients.
the technique of surgical removal used keratometric
Then they were exposed to comprehensive ophthalmic
values only (4). Scheimpflug topographer imaging system
examination including visual acuity [uncorrected
was reported to accurately determine different corneal
(UCVA) and best-corrected (BCVA)], refraction,
characteristics as curvature and topography of anterior
tonometry, as well as slit-lamp examination.
and posterior corneal surface as well as its thickness (5).
Computerized video keratography (Scheimpflug
This study intended to evaluate the different
topographer TMS -5, Tomey Gmbh Technology, and
corneal topographic changes following pterygium
vision, Nurnberg, Germany) was obtained before the
excision using two grafting techniques and their
surgery.
refractive outcome.
The following topographic parameters were
noted: the axial curvature map [steep axis of curvature
PATIENTS AND METHODS
(Ks), the flat axis of curvature (Kf), average K and
In this perspective, controlled, randomized study
corneal astigmatism (Cyl)], elevation posterior map (Ks,
(randomization was achieved using a software computer
Kf, average K, Cyl), corneal thickness map (apex and
program); voluntary patients aged 20 - 60 years old and
thinnest location).
suffering from primary pterygia that extend between two
and four millimeters over the cornea were included. After
Intraoperative:
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Commons Attribution (
CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1396
Received:22 /6 /2020
Accepted:21 /8/2020
c:\work\Jor\vol812_10
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1401-1405
Ultrasonographic Evaluation of the Yolk Sac Diameter and Shape in the First
Trimester of Pregnancy and Its Relation to Pregnancy Outcome
Hanan Atef Ahmed Ghali, Amr Abd Almohsen Alnemr,
Mohamed Abd Al moniem Ibrahem, Ayat Ahmed Hassan Abou Elkhair*
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding Author: Ayat Ahmed Hassan Abou Elkhair, Mobile: (+20)01029293980,
Email: Ayatabouelkhair@gmail.com
ABSTRACT
Background: Transvaginal sonography is used to assess the viability of first-trimester pregnancy. Significant data
regarding normal and abnormal ultrasonographic measurements of the yolk sac (YS). The study aimed to know
pregnancy outcome by assessing the role of ultrasonographic evaluation of yolk sac diameter and its shape in the
first trimester.
Patients and Methods: This study was conducted at the Obstetrics and Gynecology Department, Zagazig
University Hospitals on 72 pregnant women in their first trimester of pregnancy. All pregnant women in their first
trimester of pregnancy referred by the Department of Obstetrics for transvaginal sonography. All pregnancies with
an abnormal appearing yolk sac were re-evaluated by sonography after two weeks.
Results: The mean age was 26.9±3.9 years. It was found that there was no significant relationship between
maternal age and pregnancy outcome. Regarding the absence of the yolk sac. It was not visualized in three cases,
and all of them aborted later. Total mean YSD ± S.D was 3.7±1.8 mm, seen in GA from 6-9th weeks and there
was no significant difference between the studied groups as regard YSD. Regarding normal YSD with the abnormal
outcome, three cases with a normal YSD and regular morphology aborted after the 8th week of gestation. Regarding
large-sized YSD, it was found in three cases; two cases ended in a missed miscarriage at 8th week with YSD 8.4
mm and 8.2 mm respectively. In contrast, the third one with YSD 6.8 mm finally continued beyond 20 weeks with
no demonstrable fetal anomalies. Regarding small-sized YSD; it was found in one case which ended in missed
abortion at 7th week. Regarding the shape of the YS, an echogenic YS was detected in one case.
Conclusion: The yolk sac diameter and shape as a sole parameter is a poor predictor for pregnancy outcome
beyond 20 weeks and may be related to early pregnancy loss only. If any abnormality is observed, close follow up
with ultrasonography is recommended for these pregnancies.
Keywords: Pregnancy outcome, Ultrasonographic evaluation, yolk sac, first trimester.
INTRODUCTION
Pregnancy is one of the most marvelous events
of predicting early pregnancy failure and establishing
which a woman experiences in her life and reality of
standardized parameters for each gestational age.
the whole life, the first trimester is a vital time as the
The secondary yolk sac (SYS) is the first
pregnancy gets established (1).
extraembryonic structure which can be detected by
It was concluded that ultrasonography (USG)
transvaginal sonography (TVS) in the chorionic
plays an important role in differentiating normal from
cavity and can be seen from the 5th to the 12th week of
abnormal pregnancies and therefore in the prediction
pregnancy and it can be detected in normal
of its wellness accurately. It gives an accurate
pregnancies, the primary yolk sac cannot be
diagnosis in the majority of pregnant women in the
visualized on ultrasound (5).
first trimester and also defines a reliable
The yolk sac plays an important role during the
differentiation between viable pregnancy and
period of organogenesis providing metabolic,
ongoing abnormal pregnancy (2).
immunological,
endocrinal,
nutritional,
and
Transvaginal sonography is used to assess the
hemopoietic functions, and its highest level of
viability of first-trimester pregnancy. The ultrasound
functional activity is reached between the 4th to 7th
cut offs for defining miscarriage have been
week of development (6).
prospectively validated. Also, the timing of
The study aimed to know pregnancy outcome by
subsequent ultrasound scans in women with an
assessing the role of ultrasonographic evaluation of
intrauterine pregnancy of uncertain viability (IPUV)
yolk sac diameter and its shape in the first trimester.
has been outlined (3).
Abdallah et al. (4) reported a significant data
PATIENTS AND METHODS
regarding normal and abnormal ultrasonographic
A-Technical design:
measurements of the gestational sac (GS), yolk sac
Setting: This study was conducted at the Obstetrics
(YS), crown-rump length (CRL) in early gestations.
and Gynecology Department, Zagazig University
These parameters have been studied for both purposes
Hospitals.
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Commons Attribution (
CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1401
Received:21 /6 /2020
Accepted:20 /8/2020
c:\work\Jor\vol812_11
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1406-1411
Comparative Study between Bupivacaine Alone and With Dexamethasone as An
Adjuvant in Ultrasound-Guided Popliteal Nerve Block in below Knee Surgeries
Ahmed Alsaied Abd Elrahman1, Ayman Mohamady Eldemrdash2,
Amir Abouzkry Elsayed2, Mohammed Hamdi Abolwafa Esmail*2
1Department of Anesthesiology, Intensive Care and Pain medicine, Faculty of Medicine, Sohag
University,2Department of Anesthesiology, Intensive Care and Pain medicine, Faculty of Medicine, Aswan University
*Corresponding author: Mohammed Hamdi Abolwafa Esmail, Mobile: (+20) 01003057949, E-Mail: hamdi.anaest@gmail.com
Abstract
Background: The popliteal nerve block is a form of regional anesthesia utilized for a variety of foot and ankle
conditions. This form of anesthesia has become a popular technique to decrease postoperative pain, decrease narcotic
use, and increase patient satisfaction.
Objective: To compare the effect of adding dexamethasone to bupivacaine on duration of sensory and motor blockade
of the popliteal sciatic nerve block in below knee surgeries.
Patients and Methods: This prospective, randomized, double blinded, control clinical trial was carried out in Aswan
University Hospitals for one year on 50 adult patients undergoing surgeries below knee from January 2019 to December
2019. Results: There was no statistically significant difference between the two study groups regarding onset of both
sensory and motor blocks, but the durations of both sensory and motor blocks were statistically significantly longer in
group A than group B (P=0.001, both). In group A , all the 25 patients (100%) requested their first analgesia through
the first 12 hrs postoperatively, While in group B 11 patients (44%) requested their first analgesia through the first 12
hrs postoperatively and 14 patients (56%) requested their first analgesia through the second 12 hrs postoperatively, with
statistically significant difference between the 2 study groups (P=0.001). As regard total rescue analgesic dose given
(Nalbuphine IV) it was statistically significantly lower in group A than in group B (P=0.001).
Conclusion: Addition of dexamethasone to bupivacaine in ultrasoundguided popliteal block significantly prolonged
the duration of postoperative sensory and motor block.
Keywords: Bupivacaine, Dexamethasone, Ultrasound-guided, Popliteal nerve block, Knee.
INTRODUCTION
postoperative time periods and the avoidance of
Anesthesia for below-knee surgeries can be
systemic complications such as nausea and vomiting are
provided by general or loco-regional anesthesia and
also potential benefits of the popliteal nerve block.
given the peripheral site of surgery, a combination of
Other advantages include earlier discharge from the
both is generally well-tolerated. Regional anesthesia
post-anesthesia care unit and decreased opioid
confers excellent analgesia postoperatively, reducing
consumption perioperatively (4).
the requirements for systemic analgesics. Anesthetic
However, solitary nerve block is limited by the
techniques are usefully divided into those appropriate
duration of effective analgesia coverage. The available
for surgery to the foot and those for surgery to the ankle
choice of local anesthetics (LA) and maximum toxic
(1). Peripheral nerve blocks (PNBs) have been delivered
dosage preclude the amount of local anesthetic that can
via either single injection or continuous catheter
be used with single injection. Finding adjuvants to the
infusion approaches. The single injection nerve block is
local anesthetic that could effectively and reliably
easier to perform and requires less resources in follow
extend the analgesia duration was the focus of
up management, which is more cost-effective in our
researchers' efforts (5).
clinical practice (2).
One promising adjuvant is dexamethasone.
The role of ultrasound in performing nerve
Dexamethasone is a synthetic glucocorticoid drug with
block is increasing over the more traditional technique
potent anti-inflammatory and immunosuppressant
of peripheral nerve stimulator. Compared to
effects. Several studies have reported that 810 mg of
neurostimulation, ultrasound has been shown to
perineural dexamethasone can significantly prolong the
improve the success rate and to reduce the block
analgesia duration of brachial plexus nerve block (6).
performance time (3).
Two recent publications reported comparable effects on
While the popliteal nerve block is principally
prolongation of analgesia duration between perineural
used as a form of postoperative analgesia, it can be
and intravenously administered dexamethasone (7, 8),
employed for fracture and dislocation reduction,
which lead to the assumption that the mechanism of
exploration of foreign bodies, bedside incision and
dexamethasone as adjuvant in peripheral nerve block
drainage procedures, and wound debridements. This can
might be systemic in nature.
be beneficial in medically compromised patients.
The objective of this study was to compare the
Profound analgesia during both the operative and
effect of adding dexamethasone to bupivacaine on
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/)
1406
Received: 22/6 /2020
Accepted:21 /8/2020
c:\work\Jor\vol812_12
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1412-1418
Specified Influence of Painful Diabetic Neuropathy on Quality of Life in
Egyptian Patients with Type 2 Diabetes Mellitus
Sally Sameh Ahmed Mohammed¹, Omnia Ibrahim Metwally State¹,
Ahmed Hassan Elsebaie², Mohammed Ali Gameil¹*
Departments of ¹Internal medicine and ²Clinical Pathology, Faculty of Medicine, Mansoura University.
Corresponding Author: Mohammed Ali Gameil, Mobile: 00201099975071 Email: drmaligameil1979@yahoo.com
ABSTRACT
Background: There is a lack of data in discrimination of different aspects of quality of life impairment in Egyptian
patients with painful diabetic neuropathy (PDN).
Objective: To assess the influence of PDN on different aspects of life quality in patients with type 2 diabetes mellitus
(T2D).
Patients and methods: A cross-sectional study that included 125 patients with T2D (100 with PDN and 25 without)
during the period from December 2018 to May 2019. All patients were subjected to history, examination with
modified Neuropathy Disability Score (NDS), neuropathy symptom score (NSS), visual analogue pain score (VAS),
nerve conduction study for (peroneal, sural and ulnar nerves) bilaterally and Norfolk Quality of Life Questionnaire-
Diabetic Neuropathy (Norfolk QOL-DN) and lab. Other neuropathy causes were excluded.
Results: PDN patients have longer duration of T2D. Norfolk QOL-DN showed a significant deterioration of the
activity of daily life (ADL) and general health status in PDN patients. We found a significant positive correlation
between the NSS, VAS, NDS, superficial pain sensation, and the duration of T2D with the effects on ADL and health
status in the case group. In addition, there was a significant positive correlation between insulin therapy, HbA1c,
electrical sensation, NSS, VAS, NDS and the duration of T2D with axonal neuropathy. The NDS was the only
independent predictor of ADL and health status impairment. Axonal neuropathy was independently determined by
NDS, electrical sensation and insulin therapy.
Conclusion: PDN impaired the activity of daily life and health status of patients with T2D. The NDS independently
could predict axonal neuropathy, ADL and health status impairment.
Keywords: Quality of life, Painful diabetic neuropathy, Norfolk Quality of Life Questionnaire-Diabetic Neuropathy
(Norfolk QOL-DN).
INTRODUCTION
The Norfolk Quality of Life Questionnaire-
Diabetic neuropathy is identified by the
Diabetic Neuropathy (Norfolk QOL-DN) is
presence of peripheral nerve dysfunction in diabetic
considered as an integrated model that covers the
patients with exclusion of other causes (1). The
whole spectrum of diabetic neuropathy (10). Our aim
mechanisms involved in the development of
was to get a delicate discrimination of various aspects
neurological manifestations of diabetes are complex
of QOL impairment induced by PDN in Egyptian
and poorly understood (2, 3). Metabolic abnormalities in
patients with type 2 diabetes mellitus (T2D).
diabetic patients have a principal role in painful
diabetic neuropathy (PDN) development. Oxidative
PATIENTS AND METHODS
stress, advanced glycation end product, activation of
An observational cross sectional study that
the polyol pathway, increased sorbitol and fructose
included 125 patients with T2D (100 with diabetic
deposition, myo-inositol depletion, Na /ATPase
neuropathy and 25 without neuropathy) and was
inhibition, neurotropism deficiency with depletion of
conducted at the Outpatient Clinics of our hospital
neurotrophic factors and deranged axonal transport are
during the period from December 2018 to May 2019.
the main pathological features of diabetic peripheral
Detailed medical history (age, sex, duration of
neuropathy (4, 5, 6). Worldwide, PDN represents a
diabetes, therapeutic history, smoking and presence of
clinical challenge. Diabetic patients may have
hypertension or diabetic foot lesion). Clinical
hyperalgesia, allodynia, hypothesis and spontaneous
examination with anthropometric measures (height,
pain (7, 8).
body weight and BMI). Laboratory assessment
PDN has a substantial effect on the diabetic
(fasting and postprandial plasma glucose, HBA1c,
patients' life. It interferes with the patient's self-
lipid profile, TSH, electrolytes, hepatic and renal
management through decreased activity and loss of
functions and vitamins (25 (OH) vitamin D and B12)
motivation with increased risk of fall down and
were done for each participant
fractures due to movement incoordination and
Exclusion criteria: We excluded patients with
weakness (9).
endocrine disorders (Thyroid disease, acromegaly,
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Commons Attribution (
CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1412
Received:23 /6 /2020
Accepted:22 /8/2020
c:\work\Jor\vol812_13
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1419-1425
Results of Percutaneous Fixation of Acute Scaphoid
Fractures by Herbert Screw
Mohamed Ahmed Saleh Gad*, El-Sayed Abd Elmoaty AL-sherbiny,
Hossam Fathi Mahmoud, Mohamed Ismail Abd El-Rahman Kotb
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Mohamed Ahmed Saleh Gad, Mobile: (+20) 01026455885, E-Mail: mohsaleh20@yahoo.com
ABSTRACT
Background: The Scaphoid bone is the tmost commonly fractured carpal bone. Proper clinical examination and
radiological imaging is essential for early diagnosis and management. The management of scaphoid fractures varies
from cast immobilization to open reduction and internal fixation. This paper explores the outcome of using headless
cannulated screws in minimally displaced scaphoid fractures.
Objective: Aim of this study is to assess the functional and clinical outcome of using cannulated headless screws in
management of acute scaphoid fractures. Methods: A prospective study held between February 2019 and January
2020, where eighteen patients included with acute scaphoid fractures of Herbert B1, B2 and B3 classification.
Fixation was done using both volar and dorsal percutaneous technique. Patients were evaluated postoperatively
clinically using modified Mayo wrist score (MMWS). Results: Of mean age 34.5±8.37 years, the majority were with
excellent final outcome (83.3%), good (5.6%), fair one case (5.6%) and only one poor (5.6%) and mean time of union
was 9.66±1.9 months. Conclusion: All active young individuals with acute non-displaced or minimally displaced
scaphoid fractures should be offered percutaneous internal fixation, for the sake of earlier gain of motion of the
wrist, earlier time to union, quicker return to activity of daily living, and a lower complication rate.
Keywords; Scaphoid, Acute fractures, Percutaneous fixation.
INTRODUCTION
Hence there is a recent orthopedic trend
The scaphoid is a boat shaped bone, crosses
toward percutaneous fixation of an acute nondisplaced
both proximal and distal carpal rows (1). The main blood
scaphoid that have traditionally been treated
supply to the scaphoid enters through the dorsal ridge at
conservatively
to
shorten
the
postoperative
the waist via a dorsal branch of the radial artery that
immobilization period resulting in early functional
accounts for 80% of its blood supply, also a volar branch
recovery and early return to work (5).
enters through the volar tubercle that accounts for 20
Aim of this study is to assess the functional
30% of the scaphoid's blood supply, mainly to the distal
and clinical outcome of using cannulated headless
portion. The proximal pole of the scaphoid relies entirely
screws in management of acute scaphoid fractures.
on intramedullary blood flow in a retrograde manner
renders it susceptible to avascular necrosis after a
PATIENTS AND METHODS
fracture through waist (2).
Research design:
The scaphoid bone is the most commonly
A prospective clinical trial conducted during the
fractured carpal bone, accounting for over 60% of carpal
period of February 2019 to January 2020.
fractures. Treatment of scaphoid fractures continue to be
Sample size:
a great challenge due to the different types and methods
18 patients with recent scaphoid fractures were
of fixation (3).
admitted and operated upon in the Casualty Unit of the
Although there are several treatment
Orthopedic Department of Zagazig University
modalities
for
scaphoid
fractures
like
cast
Hospitals. According to the Herbert classification of
immobilization and surgical either open or percutaneous
scaphoid fractures, 11 patients had complete waist
fixation, displaced fractures and proximal pole fractures
fractures, 5 patients had distal pole fractures, while 2
are clear indications for surgical intervention (4).
patients had proximal pole fractures. The follow up
However, controversy exists in the treatment of
period of the cases ranged from 6 -12 months.
undisplaced or minimally displaced scaphoid waist
Study population:
fractures due to good union rate reported using either
Inclusion criteria:
nonsurgical management or percutaneous screw fixation
1) Patients of skeletal maturity.
(5).
2) Patients with acute scaphoid fractures less than 3
Conservative management is not free of
weeks duration.
complication as the majority of the cases are young men
3) Surgically fit patients
and immobilization in this group has a significant
Exclusion criteria:
economic burden due to the time off work (4).
1) Scaphoid fractures more than 3 weeks.
2) Proximal fifth fractures not amenable for screw fixation.
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/)
1419
Received:22 /6 /2020
Accepted:21 /8/2020
c:\work\Jor\vol812_14
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1426-1431
Umbilical and Middle Cerebral Artery Doppler Indices at Late Third Trimester in
the Prediction of Perinatal Outcome in Growth Restricted Fetuses
Hossam Hassan Mahmoud El Ktatny, Khaled Mohamed Ahmed Mohamed,
Mostafa Amman Ahmed Mohamed*
Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, Egypt
*Corresponding author: Mostafa Amman Ahmed Mohamed, Mobile: (+20) 01099870783,
E-Mail: mostafa_aman2015@yahoo.com
ABSTRACT
Background: Intrauterine growth restriction (IUGR) is implied to those fetuses who do not achieve their genetically
determined potential size. IUGR being a major complication of pregnancy may result in significant morbidity and
mortality. Objective: To evaluate the potential value of (CPR) measured at 34-37 weeks' gestation in predicting the
perinatal outcome of pregnancies with FGR.
Patients and Methods: A prospective observational study was conducted in Al-Helal Health Insurance Hospital from
October 2018 to September 2019. The target population for this study were pregnant females with gestational age
between 34- 37 weeks and with biometrically suspected intrauterine growth-restricted fetuses attending the hospital
for antenatal care, and are fulfilling the inclusion and exclusion criteria. Doppler ultrasound evaluation of Umbilical
and Middle cerebral arteries was performed and CPR was calculated. At 34-37 weeks' gestation. Patients
characteristics, intrapartum, and neonatal outcomes were recorded. The main outcomes required urgent Cesarean
section (CS) due to intrapartum fetal compromise (IFC), 5-minute Apgar score below 7, neonatal death, and admission
at neonatal intensive care unit (NICU).
Results: A total of 40 women participated in this study with an unfavorable outcome in 20% of newborns. Abnormal
CRP was present in 11 cases and was associated with a higher risk of adverse outcomes in terms of the need for urgent
CS, lower fetal weight, 5-minute Apgar score under 7, and neonatal death and NICU admission > 10 days., and the
diagnostic accuracy of CRP was superior to either umbilical artery pulsitivity index (UA-PI) or middle cerebral artery
pulsitivity index (MCA-PI) alone.
Conclusion: CPR was more effective, with higher specificity and diagnostic accuracy, in predicting perinatal outcomes
compared with the individual Doppler parameters of MCA and UA.
Keywords: Cerebroplacental ratio, fetal growth restriction, Doppler indices, perinatal outcome.
INTRODUCTION
above the 10th percentile (2). Antenatal diagnosis of fetal
Intrauterine growth restriction (IUGR) is
growth restriction (FGR) depends on the sonographic
implied to those fetuses who do not achieve their
estimation of certain anthropometric measures (3).
genetically determined potential size. IUGR being a
The use of doppler velocimetry of umbilical
major complication of pregnancy may result in
artery (UA) and middle cerebral artery (MCA) in high-
significant morbidity and mortality, hence timely
risk pregnancies, including FGR, has been reported to
diagnosis is of utmost importance. The widely accepted
decrease
perinatal
morbidity
and
mortality.
definition of IUGR is a fetus whose estimated fetal
Cerebroplacental ratio (CPR) is another Doppler index
weight is below the 10th percentile for its gestational
that represents cerebral centralization of fetal blood
age. The growth of the fetus is multifactorial depending
flow. CPR is calculated by dividing the doppler index
upon the mother. Both fetal and maternal blood flow has
(pulsatility index [PI], resistance index, or
to be adequate for normal placental function and
systolic/diastolic ratio) of the MCA by that of the UA(4).
subsequently fetal growth. Any compromise in the
The present work aimed to: Evaluate the potential
fetoplacental
circulation
results
in
placental
value of CPR measured at 34-37 weeks' gestation in
insufficiency which further promotes compensatory
predicting the perinatal outcome of pregnancies with
changes in fetal circulation (1).
FGR.
For assessment of fetal oxygenation, we use
Doppler assessment of impedance to flow in the UA,
PATIENTS AND METHODS
fetal MCA, and the ratio of PI in these vessels, or CPR.
Patients: This was a prospective observational study
The incidence of impaired placentation and adverse
conducted at Al-Helal Health Insurance Hospital in
perinatal events is higher in SGA than in appropriate-
Sohag Governorate (Egypt) from October 2018 to the
for-gestational-age (AGA) fetuses with a birth weight
end of September 2019. The target population for this
study was pregnant females with gestational age
between 34- 37 weeks and with biometrically suspected
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1426
Received:22 /6 /2020
Accepted:21 /8/2020
c:\work\Jor\vol812_15
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1432-1437
Effect of Modified Ultrafiltration on Acute Kidney Injury Biomarkers and
Clinical Outcome in Adult Patients Undergoing Valvular Heart Surgery
Hani Mohammed Ahmed Raslan*1, Ahmed Al-Saied Abdul Rahman2, Huda Fahmy Mahmoud1
1Department of Anaesthesia and Intensive Care, Faculty of Medicine, Sohag University, Sohag, 2Department
of Anaesthesia and Intensive care, Faculty of Medicine, Aswan University, Aswan, Egypt
*Corresponding author: Hani Mohammed Ahmed Raslan, Mobile: (+20) 01014734266,
E-Mail: hani.raslan@ymail
ABSTRACT
Background: Cardiac surgery associated with acute kidney injury (CSA-AKI) is a common and serious
postoperative complication of cardiac surgery requiring cardiopulmonary bypass (CPB). CSA-AKI varies between
7% and 40% in large cohorts undergoing a variety of cardiac surgical procedures and is associated independently
with increased morbidity and mortality.
Objective: Our study aimed to investigate the effect of using modified ultrafiltration on acute kidney injury by using
the levels of AKI biomarkers (serum creatinine and NGAL) in adult patients with no previous chronic renal disease
undergoing valvular heart surgery using cardiopulmonary bypass.
Patients and Methods: This prospective observational study was conducted at the cardiothoracic surgery unit, Kasr
AL-Ainy hospital from February 2017 to July 2017 on 40 patients who underwent valve replacement surgery using
cardiopulmonary bypass. The patients were randomly allocated into two groups: Group 1: Non-MUF group. Group
2: MUF group.
Results: Regarding serum creatinine, the preoperative and 2h postoperative levels were not statistically different
between the two studied groups (P>0.05), while in the non-MUF group, there was a significant increase (P<0.001)
in the 2h. post-operative creatinine level compared with the pre-operative level. In the MUF group, there was no
significant difference (P>0.05) between AKI and non-AKI patients in preoperative levels while the postoperative
creatinine levels were significantly higher (P<0.04) in AKI than non-AKI patients.
Conclusion: AKI after cardiac surgery is independently associated with a significant increase in morbidity,
mortality, and health-care costs.
Keywords: Modified ultrafiltration, Acute kidney injury biomarkers, Valvular heart surgery
INTRODUCTION
Acute kidney injury (AKI) after cardiac
renal insult (cardiopulmonary bypass). For this reason,
surgery occurs from a rapid deterioration in renal
several blood, and urinary proteins have been
function following cardiac surgery expressed as a
investigated in this setting, and found to serve as
significant decrease in glomerular filtration rate
biomarkers of AKI after cardiac surgery, including
(GFR). The reported prevalence of cardiac surgery-
neutrophil gelatinase-associated lipocalin (NGAL),
associated acute kidney injury (CSA-AKI) is up to
IL-18, cystatin C (CysC), kidney injury molecule-1
3o% and is independently associated with an increase
(KIM-1), and liver fatty acid-binding protein (4).
of morbidity and mortality (1).
For over a century, the measurement of serum
Patients with AKI who receive renal
creatinine, a biomarker of glomerular filtration, has
replacement therapy (RRT) are >3 times more likely
been a mainstay of clinical laboratory testing and
to develop ESRD than those who do not. This rise in
served as the primary method for quantifying renal
the number of patients who receive treatment for
function. These creatinine-based estimates of renal
ESRD is a global phenomenon associated with
function are focused on glomerular filtration and do
considerable patient costs, effects on quality of life,
not adequately account for structural renal tubular
and economic impact on society as a whole. In
injury, which may be extensive in the setting of AKI.
developing countries, most people with kidney failure
The past several years have seen a large number of
have insufficient access to dialysis and/or kidney
investigations seeking novel biomarkers of AKI (5).
transplantation (2).
Consequently, the development of effective
AIM OF THE STUDY
approaches to the prevention, early recognition, and
Our study aimed to investigate the effect of
management of AKI is necessary to reduce the burden
using modified ultrafiltration on acute kidney injury by
of CKD and ESRD (3).
using the levels of AKI biomarkers (serum creatinine
Cardiac surgery has long been used to study
and NGAL) in adult patients with no previous chronic
AKI because of the opportunity to prospectively
renal disease undergoing valvular heart surgery using
follow patients before and after a well-timed ischemic
cardiopulmonary bypass.
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/)
1432
Received:24 /6 /2020
Accepted:23 /8/2020
c:\work\Jor\vol812_16
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1438-1443
Subclinical Enthesitis in Rheumatoid Arthritis Patients and its Relation to
Disease Parameters and Disease Activity
Mohamed Ismail Mohamed AbdelKareem, Tarek Mohamed AbdelAziz, Asmaa Abd ELraheem Borai*
Departement of Rheumatology, Physical Medicine & Rehabilitation,
Faculty of Medicine - Al-Azhar University (Assiut)
*Corresponding author: Asmaa Abd ELraheem Borai, Mobile: (+20) 01014874897, E-Mail: Asmaa.123alborai@gmail.com
ABSTRACT
Background: Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disorder of unknown etiology
characterized by symmetrical joint synovitis and pain. RA has a wide clinical spectrum and may vary from mild
nonerosive disease to severe inflammation and joint damage with extra articular manifestations. To detect
enthesopathy, the European League Against Rheumatism (EULAR) recommends magnetic resonance imaging (MRI)
or ultrasonography (US).
Objective: To detect subclinical enthesitis in rheumatoid arthritis patients and its relation to disease parameters and
disease activity. Patients and Methods: This prospective observational study included 50 adult patients diagnosed as
rheumatoid arthritis according to the 2010 ACR-EULAR classification criteria for rheumatoid arthritis. The study was
carried out in the Musculoskeletal Ultrasonography Unit of the Rheumatology, Physical Medicine and Rehabilitation
Department, Al-Azhar University Hospitals Assiut.
Results: We found that the mean age in case group was 46.3 ± 8.4 years. Females accounted for 62% (31 patients) of
all patients. The disease duration ranged from one year to 15 years with a mean of 6.2 ± 1.9 years. The BMI was 19.5
± 42 kg/m2. Mean of disease activity evaluated by the disease activity score in 28 joints was 4.7 ± 1.5. Our findings
demonstrated that prevalence of subclinical enthesitis in patients with rheumatoid arthritis was 32%. There was a
statistically significant relation between 28-joint Disease Activity Score (DAS28) score and ultrasound detected
enthesitis (p. value < 0.05).
Conclusion: BMI, old age and long disease duration were suggested as the risk factors for subclinical enthesitis.
Keywords: Subclinical enthesitis, Rheumatoid Arthritis Patients, MRI, US, BMI.
INTRODUCTION
challenging because of low sensitivity and specific
Rheumatoid arthritis (RA) is a chronic systemic
clinical testing. To detect enthesopathy, the European
autoimmune
disorder
of
unknown
etiology
League against Rheumatism (EULAR) recommends
characterized by symmetrical joint synovitis and pain.
magnetic
resonance
imaging
(MRI)
or
RA has a wide clinical spectrum and may vary from
ultrasonography (US) (4).
mild non-erosive disease to severe inflammation and
MRI had excellent results in evaluation of early
joint damage with extra-articular manifestations. The
RA. MRI wrist demonstrated bone erosions, synovial
wrist and hand joints were affected early in the disease
hypertrophy, synovitis and tenosynovitis. Other signs
process, with some deformities occurring in the first
include tendinitis, enthesitis, ligament and tendon
two years of the disease (1).
tears, bone marrow edema and joint effusions (5).
Rheumatoid arthritis is characterized by
Ultrasonography is an imaging technique that
proliferative, hypervascularized synovitis, resulting in
has attracted much interest in the field of
bone erosion, cartilage damage, joint destruction and
rheumatology in recent years. Because of
long-term disability. The absence of effective
technological improvements and wide availability,
treatment to prevent joint destruction has limited the
ultrasonography has the potential to facilitate
need for more sensitive imaging techniques.
diagnosis of RA and improve the assessment of
Availability of these powerful and expensive drugs has
disease activity (6). Imaging studies are more sensitive
created new demands on radiologists to identify
and specific than clinical examination in the diagnosis
patients with aggressive rheumatoid arthritis at an
of enthesitis, and even ultrasonography might be
early stage to affect the therapeutic management of
superior to MRI in detection of early signs of
these patients (2).
enthesopathy (7). Ultrasonography (US) is the best tool
Enthesis is the zones where tendon, ligament, or
to evaluate periarticular soft tissue as it is sufficient for
joint capsule are attached at a bone to facilitate easy
discovering both early (edema and thickening) and late
joint motion and assist in transmission of tensile load
changes (erosion and enterophytosis). Further, it's a
from soft tissues to bone (3).
safe, and easily ready, inexpensive and reproducible
Enthesopathy is characterized by inflammation
manoeuvre (8).
of insertions of tendons, ligaments or capsules into the
bone. However, recognizing enthesopathy could be
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC B
Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1438
Received:23 /6 /2020
Accepted:22 /8 /2020
INTRODUCTION
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1444-1448
Prevalence of Spontaneous Bacterial Peritonitis in Cirrhotic Patients with
Ascites and Its Pattern in Aswan University Hospital
Mohammed Zain-Eldeen Hafez*1, Hala Abdallah Mahmoud Abdallah2, Khalid Khairy Khalafalla Abdellatif2
1Department of Internal Medicine, Faculty of Medicine, Assiut University,
2Department of Internal Medicine, Faculty of Medicine, Aswan University
*Corresponding author: Khalid Khairy Khalafalla Abdellatif, Mobile: (+20)01000065925
ABSTRACT
Background: Spontaneous bacterial peritonitis (SBP) is the most common infection and a lethal complication in
patients with liver cirrhosis and ascites. It has high mortality and recurrence rates and poor long-term prognosis.
Objective: This study was done to determine the prevalence of spontaneous bacterial peritonitis and its variants in
patients of liver cirrhosis with ascites.
Patients and Methods: This was a prospective, randomized, cross-sectional clinical study, included 100 adult
patients of decompensated liver cirrhosis with ascites in Aswan University Hospital during the period from January
2019 to December 2019.
Results: Diagnosis of SBP is based on ascitic fluid analysis as well as culture and sensitivity. The diagnostic criteria
are PMNL > 250/mm³ and or positive culture. Mean of age of patients was 63.06 ± 9.67 years old. Majority of
patients were males (63%) and 37 % were females. In Our study, 62% of patients were diagnosed SBP. Classic SBP
in 30.6%, Culture Negative Neutrocytic Ascites (CNNA) in 59.7% and MNB in 9.7% of patients. Of 25 patients who
have positive culture ascetic fluid, 60% were positive for gram-negative bacteria predominantly E. coli.
Conclusion: Spontaneous Bacteria Peritonitis is the most common and life-threatening infection in patients who have liver
cirrhosis and ascites. It is diagnosed by a) Ascitic fluid PMNL > 250/mm³. b) Positive ascetic fluid culture. c) Both a and
b. It is found that SBP has recently increased in prevalence with predominantly causative organism gram negative E Coli.
Keywords: Spontaneous Bacterial Peritonitis, Liver cirrhosis, Ascites.
INTRODUCTION
bacterial peritonitis without evidence of source of
Liver cirrhosis is a significant cause of health
infection, a form of infection which has been termed
burden. It is the 14th most common cause of death
spontaneous bacterial peritonitis (SBP) in 1963 (8).
worldwide (1). In 2010, Egypt had the highest age-
SBP is the most common and life-threatening
standardized cirrhosis mortality rates and almost one-
infection in patients with advanced liver cirrhosis. Its
fifth (18.1%) of all deaths occurred in males (45 to 54
prevalence is as high as 12% in hospitalized patients
years old) were due to liver cirrhosis (2). Liver
while it develops in up to 3.5% of patients that are
cirrhosis also leads to liver dysfunction (impaired
treated as outpatients (9). Hospital mortality in patients
synthetic and metabolic functions of the liver) up to
with SBP reaches 10-20 % with high recurrence rate
liver cell failure. Both portal hypertension and liver
and so that it has poor long-term prognosis, one-year
cell failure contribute to serious complications e.g.
survival after an episode of SBP is 30-40 % and 20 %
hepatic encephalopathy (3).
at two years (10). SBP is recognized as an important
The disease can be compensated or
marker of liver disease progression, which might be
decompensated. Significant morbidity and mortality
the decisive watershed in the management of
are associated with decompensation. Complications
advanced liver disease (11). So it is necessary to
include variceal hemorrhage, ascites, increased risk of
consider
this
diagnosis
in
every
clinical
bacterial infection, spontaneous bacterial peritonitis
decompensation of a cirrhotic patient, diagnose it
(SBP),
hepatic
encephalopathy,
hepatorenal
early and treat it effectively (12).
syndrome, hepatopulmonary syndrome, umbilical
SBP is defined as the presence of an infection
hernia and hepatic hydrothorax (4). Management
in a previously sterile ascites in the absence of an
should be focused on the prevention of recurrence of
intra-abdominal source of infection or malignancy (13).
complications. Ascites is the most common
The clinical manifestation is nonspecific and variable,
complication of cirrhosis and is often the first sign of
up to one third of patients might be asymptomatic
decompensation to appear (5). It occurs within 10 years
(bacterascites) or it can quickly emerge as a fatal
of diagnosis in half of patients with 5-year mortality
sepsis syndrome (10). Presenting signs and symptoms
of 44% (6).
can include fever, changes in mental status, abdominal
Cirrhosis is an immunocompromised state,
tenderness, gastrointestinal (GI) bleeding, chills,
which predisposes patients to various infections
nausea, or vomiting. Because of the tremendous
resulting from alterations in defense mechanisms and
variability in presentations, and also because such
translocation of gut flora (7). In advanced stages of
presentations may overlap with other conditions often
liver cirrhosis with ascites, patients tend to develop
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icle distributed under the terms and conditions of the Creative
Commons Attribution (CC B
Y-SA) license (http://creativecommons.org/licenses/by/4.0/)
1444
Received:24 /6 /2020
Accepted:23 /8 /2020
c:\work\Jor\vol812_18
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1449-1456
Evaluation of Various Risk Factors in Neonatal Sepsis
Amira Mohammed Mohammed Hamed, Mohamed Fahmey Ibrahim, Maha Ali Abdel-Alim*
Department of Pediatrics, Faculty of Medicine-Al-Azhar University Assiut
*Corresponding author: Maha Ali Abdel-Alim, Mobile: (+20) 01060066348, E-Mail: maha811990@gmail.com
ABSTRACT
Background: Neonatal sepsis (NS) is a clinical syndrome characterized by signs and symptoms of infection in
neonatal period of life. It covers various systemic infections of newborn such as septicemia, meningitis, pneumonia,
arthritis, osteomyelitis and urinary tract infections (UTIs).
Objective: This study aims to evaluate the risk factors of neonatal sepsis and early detection of neonatal sepsis with
easily accessible, inexpensive, and widely used laboratory tests.
Patients and methods: This cross section study was conducted during a period of 6 months, on cases admitted to
Atfal Misr Neonatal Intensive Care Unit (NICU) on 80 newborns who were divided into 3 groups: group A (n = 22):
proven NS, group B (n = 18): clinical NS and Group C (n = 40): apparently healthy control.
Results: In current study, there was significant positive correlation between MPV with age (r= 0.22 and p= 0.04),
WBC (r= 0.66 and p= 0.0001) and CRP (r= 0.77 and p= 0.0001). On the other hand, there was significant negative
correlation between MPV with HB (r= -0.74 and p=0.0001), platelet (r= -0.62 and p=0.0001) and uric acid (r= -0.37
and p= 0.001). In current study, there was significant positive correlation between uric acid with HB (r= 0.31 and p=
0.005), and platelet (r= 0.46 and p= 0.0001). On the other hand, there was significant negative correlation between
uric acid with age (r=-0.11 and p=0.3), WBC (r= -0.42 and p=0.0001) and CRP (r= -0.42 and p= 0.0001).
Conclusion: The presence of the particular set of risk factors can help in deciding the empirical antibiotic and thereby
prevent delay in starting appropriate treatment. The combined use of CRP and MPV should be considered in the early
diagnosis of NS; however uric acid levels may only be utilized as an additional tool to support diagnosis.
Keywords: Sepsis, Neonatal, Risk Factors, CRP, MPV.
INTRODUCTION
such as mean platelet volume (MPV), platelet volume
Sepsis is a life-threatening condition that occurs
distribution width (PDW) and plateletcrit (PCT) (5).
when the body's response to an infection injures its
MPV is an important predictor for many
own tissues and organs. The pathogenesis of sepsis
diseases, high MPV in the first hours of life may
involves a series of complex regulatory interactions,
reflect the presence of a risk factor for the
with concomitant and often antagonistic processes,
development of necrotizing enterocolitis (NEC),
resulting in a dysregulated host response with both
bronchopulmonary dysplasia (BPD), intraventricular
exaggerated inflammation and immune suppression.
hemorrhage (IVH) and neonatal sepsis (6).
The pro-inflammatory response to sepsis leads to
The negative predictive value of various sepsis
activation of the coagulation system with concurrent
screen parameters is too low to confidently rule out
inhibition of anticoagulant mechanisms and
sepsis. There is no ideal test or combination of tests
fibrinolysis. Consequently, fibrinolytic and fibrinogen
which are bench markers of an excellent test (7).
products are consumed, clot forms, and bleeding
This study aims to evaluate the risk factors of
shows itself in the form of disseminated intravascular
neonatal sepsis and early detection of neonatal sepsis
coagulation (DIC) (1).
with easily accessible, inexpensive, and widely used
Neonatal sepsis represents an important cause
laboratory tests.
of morbidity and mortality especially in low-resource
PATIENTS AND METHODS
settings. Early diagnosis and prompt treatment of
This cross section study was conducted during
neonatal sepsis improves outcome (2). It is estimated
a period of 6 months, on cases admitted to Atfal Misr
that 20% of neonates develop sepsis and approximately
NICU.
1% deaths are related to sepsis (3).
Study populations were divided into three groups:
Though blood culture is gold standard for Group A: Cases with ( proven sepsis): 22 full-terms
diagnosis but it is not always positive even in presence
neonates who had clinical picture of sepsis (lethargy,
of clinical features of sepsis in a neonate. A high index
body temperature changes, poor neonatal reflexes,
of suspicion and its confirmation are necessary for early
poor feeding, vasomotor instability, low/high blood
diagnosis of sepsis. Various tests are traditionally
sugar, seizures, signs of CNS infections, jaundice,
applied (4).
etc.) and laboratory signs of sepsis (positive blood
Neonatal sepsis is usually accompanied by
culture high titre of CRP, increase MPV,
thrombocytopenia, so platelet indices have gained
thrombocytopenia, etc.) .
more importance in the recent studies; amongst, the Group B: Cases with (Clinical sepsis): 18 full term
indices related to morphology and platelet kinetics
neonates who had clinical picture of sepsis or
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icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY -SA) license (http://creativecommons.org/licenses/by/4.0/)
1449
Received:23 /6 /2020
Accepted:22 /8 /2020
c:\work\Jor\vol812_19
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1457-1461
Factors Affecting Glycemic Control in Type II Diabetic Patients
Marwa Salah El-Dien Abd-Elraouf
Public Health Department, Faculty of Medicine, Benha University, Benha, Egypt
Corresponding author: Marwa Salah El-Dien Abd-Elraouf, Mobile: (+20) 01065063533, E-Mail: marwad24@yahoo.com
ABSTRACT
Background: Diabetes is a major public health problem that affects morbidity, fatality and health care resources. Many
factors can influence diabetic control. Diabetic control remains the main goal in management of diabetes mellitus and
the major therapeutic target for prevention of complications due to diabetes Objective: Is to assess factors affecting
glycemic control among type 2 diabetic patients. Patients and Method: a cross sectional study was conducted on 200
diabetics at the Internal Medicine Department, Benha University hospital. A case record form was used including socio-
demographic features, anthropometric measurements and metabolic disease profile. Results: Participants were
classified according to their glycosylated hemoglobin level into good (7%) and poor (93%) diabetic control. There was
a statistically significant association between diabetic control and diabetes duration (p < 0.001), exercise (p = 0.001)
(OR (95% CI): 5.59 (1.77-17.62)), body mass index (p < 0.001). There was a statistically significant difference between
those with poor and good diabetic control as regard LDL level (OR (95%CI): 50 (6.41-333.3)) (p < 0.001), total
cholesterol level (p < 0.001), (median (range): (237 (178-320) and 100 (100-300)) respectively and the mean value of
fasting blood sugar ((mean ± SD): 298.52± 55.97 and 170±37.41 respectively, p < 0.001)). Conclusions: Majority of
participants had poor diabetic control. Diabetes duration, regular exercise, BMI, LDL and total cholesterol levels
significantly affected glycemic control
Keywords: Type 2 diabetes Glycemic control - Glycosylated haemoglobin.
INTRODUCTION
Controlling blood glucose will improve the quality of life
Diabetes mellitus is one of the most challenging
of the patients. The relationship between hemoglobin
public health problems worldwide. More than 366
A1c (HbA1c) level and quality of life for diabetics
million people worldwide are diabetics and this number
became evidenced by several studies as every 1%
may duplicate by 2030. The greatest burden of this health
reduction will improve 5% of life quality (4).
problem is present mainly in low and middle-income
Measurement of glycosylated hemoglobin (HbA1c) is
countries, representing about 80% of all cases of diabetes
accepted nowadays as the most reliable indicator for
(1). In Egypt diabetes is a major health problem which can
long-term glycemic control because it accurately reflects
affect morbidity, mortality, and health care resources.
patient's blood glucose levels over the previous 2-3
The prevalence of type 2 diabetes (T2D) among
months and the quality of diabetes care available to the
Egyptians is 15.6% of all adults from 20 to 79 years old.
population (5).
Diabetes is still a public health challenge with an
Hypothesis: This study aims at evaluating the following
influence on the Egyptian economy. Type 2 diabetic
hypothesis: There is a real effect of many factors
patients (T2D) represent about 90%-95% of all diabetic
(independent) on the degree of diabetic control among
patients worldwide and this presents a growing epidemic
diabetic patients at Benha University Hospital
(2). Multiple factors like age, gender, educational level,
(dependent).
marital status, body mass index (BMI), smoking,
Specific objectives of this study are to assess factors
diabetes duration, and schedule of medications have an
affecting glycemic control among type 2 diabetic
influence on diabetes control (3).
patients.
The increased spread of diabetes may be due to
aging, changes in life style, diet, and lack of exercises (4).
PATIENTS AND METHODS
Obesity remains a major risk factor for diabetes mellitus
It is a cross sectional study, was conducted from
among Egyptians (2).
July 2019 to December 2019 on type II diabetes mellitus
The risk factors associated with diabetes are either
patients who were admitted to the Internal Medicine
controllable, including obesity and inactive lifestyle or
Department at Benha University Hospital according to
uncontrollable like ethnicity and genetics that also play
specific inclusion criteria.
a dramatic role (1).
Inclusion Criteria: All adult diabetic patients (type II
Glycemic control remains the primary goal in
DM), with age 18 years and above, agreed to sign the
management of diabetes mellitus and the major
written consent. They were diagnosed as being diabetic
therapeutic target for preventing diabetic complications.
according to the following criteria (HbA1c 6.5% or
In addition, identifying determinants of poor glycemic
fasting plasma glucose 126 mg/dl).
control may help for better diabetic control and patient
Exclusion criteria: Patients less than 18 years of age,
outcomes (5). World Health Organization reported that,
impaired mental capacity, impaired level of
only 37% of diabetic patients have controlled disease.
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1457
Received:24 /6 /2020
Accepted:23 /8 /2020
c:\work\Jor\vol812_20
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1462-1469
A Clinico-Epidemiological Study of Pediatric Hair and Scalp Disorders
Mohammed M.S. Younis*1, Waleed Ahmed Mahmoud2
Departments of 1Pediatrics and 2Dermatology and Andrology, Al-Azhar University (Assiut), Assiut, Egypt
*Corresponding author: Mohammed M.S. Younis, Mobile: (+20)01117259456,
E-Mail: mmsyonis@yahoo.com
ABSTRACT
Background: Hair and scalp disorders are a common complaint in dermatology clinics and can be caused by
several conditions, reflected in a specific diagnosis. Also, this problem is of prime concern in the pediatric
population as it is associated with more significant psychological consequences in this growing age group.
Objective: To evaluate the clinical and epidemiological profile of hair and scalp disorders in children attending to
the Pediatrics and Dermatology Outpatient Clinics.
Patients and methods: The current study included 1000 children attending the outpatient pediatric and
Dermatology clinics in Alazher University Assiut within the period from June 2019 to April 2020, from them 200
children were diagnosed with hair disorder. All children were subjected to; thorough history taking, general and
local examination, and dermoscopic examination.
Results: In the present study we noticed that; male to female ratio was 0.8:1. The age groups with the largest and
smallest numbers of children were those of children aged 10-12 and 1-3 years, respectively. Alopecia areata
represented 15% of the studied patients. 10% of the included patients had seborrheic dermatitis. Pediculosis capitis
was evident in 14% of the studied population. Tinea capitis was evident in 15% of the study population. Infectious
causes were the most common causes of hair disorders in our study. Alopecia areata represented 15% of the
studied patients.there is a significant difference value in tinea capitis and pediculosis capitis in urban than rural
areas and there is a significant difference value in seborrheic dermatitis and alopecia areata in rural than urban
areas. In the current study, malnutrition was evident in 30% of children with scalp diseases.
Conclusion: Hair and scalp disorder in children is a common complaint in pediatrics clinics, and it is considered a
challenge for pediatricians for reaching a proper diagnosis and therapy. Early management is needed, as it affects
the normal physical and mental growth of children.
Keywords: Clinical and epidemiological profile of hair, Scalp disorders, Children.
INTRODUCTION
Hair and scalp disorders in infants and
common causes of hair loss can be seen including
children are a common occurrence and may constitute
thyroid disorders, illnesses, such as systemic lupus
a complex clinical problem, and they are also a source
erythematosus, diabetes mellitus, or iron deficiency
of anxiety and concern for patients and families (1).
anemia, malnutrition, structural abnormalities of the
Hair disorders in children can be congenital
hair shaft that usually results in easy breakage and dry
or acquired and may be associated or not with defects
brittle hair, scalp infection by various etiological
in hair structure. In some cases, they may be a part of
agents staphylococcus aureus and streptococcus
serious hereditary syndromes (2).
pyogens are the most common (6).
Common causes of hair disorders in children
This study was aiming to evaluate the clinical
include folliculitis and furunculosis, pediculosis,
and epidemiological profile of hair and scalp
alopecia areata, and tinea capitis (TC). In addition to
disorders in children attending the pediatric outpatient
the above-mentioned causes, other less common
clinic.
causes include pityriasis capitis, telogen effluvium,
folliculitis decalvans, premature graying of hair,
PATIENTS AND METHODS
piebaldism, trichotillomania, and congenital atrichia
This study was carried out as a cross-sectional
(3). No extensive report exists regarding the
study which included 1000 children attending the
epidemiology of these disorders in children (4).
outpatient in pediatric and Dermatology clinics in
Hair loss is not an uncommon problem in the
Alazher University Assiut within the period from
pediatric group but has patterns that are different from
June 2019 to April 2020, from
ht
mm
200 children
those seen in adults. In addition, this problem is of
emem diagnosed as hair and scalp disorder.
particular concern in the pediatric group, as it is
associated with more significant psychological
All children's were subjected to:
consequences in this growing age group (5).
(A) Thorough history taking:
Common causes of hair loss in children
1- The data collected: age, sex, and clinical
include telogen effluvium, tinea capitis, bacterial
presentations (patchy or diffuse hair loss,
infections,
traction
alopecia,
trichotillomania,
presence of itching or scales, affected site, and
alopecia areata. In addition to the previous, other less
This article is an open access art
icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY- SA) license (http://creativecommons.org/licenses/by/4.0/)
1462
Received:23 /6 /2020
Accepted:22 /8 /2020
c:\work\Jor\vol812_21
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1470-1475
Epidemiological and Clinical Characteristics of Children Suffering from
Inflammatory Bowel Diseases Attending Zagazig University Children Hospital
Hatem Mohammed Hussein, Hossam Fathi Elsaadany, Eman Nabil Ebrahim Zein Elabedeen*
Department of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Eman Nabil Ebrahim Zein Elabedeen, Mobile: (+20)01002231933,
Email: eman.nabil929@gmail.com
ABSTRACT
Background: Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn's disease (CD). It is a
chronic inflammatory disease that involves the gastrointestinal tract and results from a combination of genetic
susceptibility, environmental exposure, and dysregulated responses to the intestinal microbiota.
Objective: To study the natural history, patterns, and clinical characteristics of inflammatory bowel diseases (IBD)
in Sharkia Governorate.
Patients and Methods: The study was carried out in the Pediatric Hepatology and Gastroenterology Unit, at Zagazig
University Hospital on a comprehensive sample of all children suffering from inflammatory bowel diseases that were
included in the study (18 patients). We do retrospectively study all patients in whom the diagnosis of UC or CD was
confirmed by clinical, laboratory, endoscopic, and histological examination in Zagazig university children hospital.
Results: There is a predominance of UC among IBD cases. positive consanguinity was more evident in children with
IBD (44.4%). According to sex the percentage of females (55.6%), male (44.4%). Percentage chance of
gastrointestinal symptoms among the studied cases is diarrhea (83.3 %), mucus or blood in the stool (83.3%),
Abdominal pain (66.7%), vomiting (44.4%), loss of appetite (38.9%), Nausea (38.9 %), Rectal bleeding (27.8%) and
anoperineal lesion (22.2%). The Endoscopic finding of Crohn's disease showed a percentage of L1 (distal 1/3 ileum
± limited cecal disease) in (33.3 %) and L2 (Colonic) in (66.7%).
Conclusion: UC was more common than the CD. IBD was more common in females. We believe that the present
moment is critical in assessing the pattern of IBD spreading in Egypt, and the current status should be further studied
by more exhaustive database and registry documentation of IBD patients and their characteristics.
Keywords: Inflammatory bowel diseases- Epidemiology-Clinical characteristics.
INTRODUCTION
Inflammatory bowel disease (IBD) includes UC
Inflammatory bowel disease occurs with a
and CD. It is a chronic inflammatory disease that
variable frequency in different parts of the world. It is a
involves the gastrointestinal tract and results from a
common observation that IBD is prevalent in
combination of genetic susceptibility, environmental
industrialized countries as it is seen in Europe and the
exposure, and dysregulated responses to intestinal
USA but much less common in the southern part of the
microbiota (1). IBD is a chronic disease that involves
globe. Twenty to twenty-five percent of CD and UC
young patients. Also, its rapidly increasing incidence
cases, respectively, present during childhood (5).
together with the better access and delivery of
The current study was conducted to study the
healthcare is resulting in an exponential growth in the
natural history, patterns, and clinical characteristics of
prevalence of IBD (2).
inflammatory bowel diseases (IBD) in Sharkia
Emerging data have suggested that the incidence
Governorate.
of IBD is increasing globally in both developed and
.
developing countries (3).
PATIENTS AND METHODS
Crohn's disease and Ulcerative Colitis are both
(1) Technical design:
chronic inflammatory diseases of the gastrointestinal
A) Site of the study: The study was carried out in
tract with periods of remission and exacerbation. CD is
the Pediatric Hepatology and Gastroenterology Unit, at
characterized by transmural inflammation and can be
Zagazig University Hospital.
found anywhere in the gastrointestinal tract from mouth
B) Sample Size: A comprehensive sample of all
to anus, with a patchy inflammation process. Ulcerative
children suffering from inflammatory bowel diseases
colitis is an inflammatory disease limited to the colonic
that were included in the study (18 patients).
and rectal mucosa. The characteristic histology is
Inclusion criteria: Children aged less than 18 years
mucosal and submucosal inflammation with goblet cell
with a confirmed diagnosis of IBD.
depletion, cryptitis, and crypt abscesses but no
Exclusion criteria: Children with colitis other than
granulomas (4).
IBD.
This article is an open access art
icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY- SA) license (http://creativecommons.org/licenses/by/4.0/)
1470
Received:25 /6 /2020
Accepted: 24/8/2020
c:\work\Jor\vol812_22
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1476-1482
Impact of modified ultrafiltration on Cardiac Surgery-Associated Acute Kidney Injury
Hani Mohammed Ahmed Raslan*1, Ahmed Al-saied Abdul Rahman2, Huda Fahmy Mahmoud1
1Department of Anaesthesia and Intensive Care - Faculty of Medicine Sohag University,2Department of
Anaesthesia and Intensive care- Faculty of Medicine - Aswan University
*Corresponding author: Hani Mohammed Ahmed Raslan, Mobile: (+20) 01014734266, E-Mail: hani.raslan@ymail
ABSTRACT
Background: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a frequent happening affecting nearly
40% of the cases undergoing cardiac surgery. This is associated with increased hospital length of stay and mortality.
Objective: The aim of our study was to investigate the relationship impact of modified ultrafiltration on cardiac
surgery-associated acute kidney injury (CSA-AKI).
Patients and Methods: This prospective observational study was conducted over a 6-month period (February to
July 2017) at Cardiothoracic Surgery Unit, Kasr AL-Ainy Hospitals. The study included 40 patients undergoing
routine valve replacement surgery using cardiopulmonary bypass.
Results: There was no significant difference (P > 0.05) between AKI and non-AKI patients in pre-operative levels
while the postoperative serum creatinine levels were significantly higher (P < 0.04) in AKI than non-AKI patients
in the modified ultrafiltration (MUF) group. The pre-operative and 2h post-operative S. NGAL was significantly
higher in AKI than non-AKI patients in the MUF group were. Duration of CPB was significantly (P < 0.001)
prolonged in the AKI than the non-AKI patients. While, there was no significant difference regarding aortic cross-
clamp time. There was a significant longer ICU stay and duration of mechanical ventilation in AKI than non-AKI
patients.
Conclusion: Modified ultrafiltration after cardiac surgery is associated with a lower prevalence of morbidity and
mortality. Serum Neutrophil Gelatinase-Associated Lipocalin (NGAL) can be used as an early plasma biomarker
predictor for AKI in patients undergoing heart surgery.
Keywords: Modified ultrafiltration, Acute kidney injury biomarkers, Valvular heart surgery.
INTRODUCTION
modified ultrafiltration, and have assessed kidney
Cardiac surgery-associated acute kidney
injury in a number of ways, including renal
injury (CSA-AKI) is a common and serious
insufficiency, creatinine clearance (CrCl), and
postoperative complication of cardiac surgery that
elevated postoperative creatinine (5).
employs cardiopulmonary bypass (CPB), and it is the
Modified ultrafiltration has been used to treat
second most common cause of AKI in the intensive
the hemodilutional effects of cardiopulmonary bypass
care unit (ICU) (1). CSA-AKI is characterized by an
circuits. The impact of modified ultrafiltration on risk
abrupt deterioration in kidney function following
of acute kidney injury (AKI) remains uncertain.
cardiac surgery as evidenced by a reduction in the
Failure to perform modified ultrafiltration with
glomerular filtration rate. Importantly, this
resultant hemodilution or fluid overload can
deterioration may not be detected in the first 2448 h
potentially result in kidney injury through tissue
using conventional monitoring by serum creatinine
edema, as the kidneys are encapsulated organs (6).
(s.cr) levels because of the dilutional effects of the
Modified ultrafiltration has recently increasingly
CPB pump prime (2).
come into favor. The technique entails removal of
CSA-AKI is caused by a variety of factors,
water and low-molecular-weight substances under a
including exogenous and endogenous toxins,
hydrostatic pressure gradient after separation from
metabolic abnormalities, ischemia and reperfusion
cardiopulmonary bypass.
injury, neurohormones activation, inflammation and
This method has been demonstrated to induce
oxidative stress (2). Postoperative kidney function
hemoconcentration and reduce bleeding and total
deterioration has been shown to be an important
body water accumulation (7).
predictor of morbidity and mortality (3).
Because of the properties of counteracting
Modified ultrafiltration has been explored as
tissue edema and eliminating inflammatory
a potential intervention to mitigate AKI risk in cardiac
mediators, further observations have attributed to
surgery (4). Conversely, modified ultrafiltration may
modified ultrafiltration the ability to improve acute
have an adverse consequence on kidney injury,
kidney injury (AKI) function and to attenuate
mechanistically related to fluid shift imbalances and
morbidity after cardiac surgery (7, 8).
renal hypoperfusion. A few relatively small studies
have explored the short-term risks associated with
AIM OF THE WORK
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icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY- SA) license (http://creativecommons.org/licenses/by/4.0/)
1476
Received:26 /6 /2020
Accepted:25 /8 /2020
c:\work\Jor\vol812_23
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1483-1488
Relation of Uridine Diphosphate Glucuronosyltransferase 1A1 Promoter Gene
Polymorphism (211G>A) With Risk of Hyperbilirubinemia in Neonates
Lotfy Mohamed Elsayed1, Laila Rasslan Abd El-Aziz1,
Amal Fawzy Abdel-Mageed2, Mohamed Mohamed Youssef*1
Departments of 1Pediatrics and 2Biochemistry, Faculty of Medicine Zagazig University
*Corresponding author: Mohamed Mohamed Youssef, Mobile: (+20)01007972627, Email:
mohboghdadi2012@gmail.com
ABSTRACT
Background: The gene 211G>A variants, that underlie complex disorders, are characteristically common in the
neonatal hyperbilirubinemia. However, it is the contribution of multiple different co-expressed susceptibility genes
that individually confer a small increase in risk coupled with environmental factors that generate complex disorder
phenotypes.
Objective: This study aimed to understand the relation of 211G>A promoter polymorphism in UGT1A1 gene and
the risk of hyperbilirubinemia in newborns.
Patients and Methods: The study included 50 newborns with hyperbilirubinemia with gestation age of 37weeks
and postnatal age of 2 weeks with normal birth weight. 34 were males and 16 were females. They were divided
into two groups; case group consisting of 30 neonates with the peak of total serum bilirubin (TSB) levels 16 mg
/dl and control group consisting of 20 neonates with the peak total serum bilirubin (TSB) levels <12 mg/dl.
Variation status of UGT1A1 genes in our study was determined by direct sequencing or genotype assays.
Results: This study showed that UGT1A1 promoter gene polymorphism 211G>A genotype can be used as a novel
method to detect susceptibility to indirect hyperbilirubinemia in neonates.
Conclusion: Our findings added to the understanding of the significance of UGT1A1 in association with neonatal
hyperbilirubinemia in East Delta of Egyptian population. Additionally we are in need for other studies to
investigate the protective mechanisms.
Keywords: Neonatal hyperbilirubinemia, UGT1A1 gene. 211G>A promoter polymorphism.
INTRODUCTION
resulting in hyperbilirubinemia known as Gilbert's
Neonatal hyperbilirubinemia is caused by
syndrome (GS) and Crigler-Najjar syndrome (CNS).
abnormal metabolism of bilirubin, and is characterized
Numerous polymorphisms of UGT1A1 have been
by a syndrome of skin, mucous membrane, and sclera
reported in patients with GS and CNS, including
jaundice (1). While most cases are physiological, when
GlycineArginine and 211G>A promoter (7).
serum bilirubin concentrations are higher than 12.9
The Gly71Arg (G71R) of the UGT1A1 gene has
mg/dl in full-term infants and for a prolonged period of
been reported as a genetic risk factor for GS, which
time, jaundice is no longer considered physiologic (2).In
might reduce the activity of the enzyme, and then cause
pathological
unconjugated
hyperbilirubinemia,
mild unconjugated hyperbilirubinemia (8).
increased production of bilirubin, deficiency in hepatic
In Japanese population, the allele frequency of
uptake, impaired conjugation of bilirubin, and/or
211G>A in infants with neonatal jaundice was
increased enterohepatic circulation of bilirubin are
significantly higher than in control infants (9). The
observed (3). However, there is no identifiable factor in
interaction among genetic polymorphisms and clinical
almost half of cases. It has been suggested that genetic
risk factors may modulate the hyperbilirubinemia risk.
variation could enhance the risk of neonatal
Better knowledge on geneenvironment interaction
hyperbilirubinemia when coexpressed with other
may advance our understanding of this complex
icterogenic conditions (4). Among these, uridine
disorder (4).
diphosphate glucuronosyltransferase 1A1 (UGT1A1)
Previous data have also shown that the effects of
was identified to be associated with neonatal
variants in UGT1A1 gene appear to be variable across
hyperbilirubinemia (5). It is the key rate-limiting
populations (10).
enzyme in the liver for bilirubin glucuronidation,
The study aimed to study the contribution of
which is a clearance mechanism for numerous dietary
211G>A promoter polymorphism in UGT1A1 gene
and environmental chemicals, including bilirubin (6).
and the risk of hyperbilirubinemia in newborns.
The polymorphisms of the UGT1A1 coding
region or the promoter may produce structural or
PATIENTS AND METHODS
functional enzymatic deficiencies, leading to
This study was carried out in Neonatal
intermittent elevation of unconjugated serum bilirubin,
Intensive Care Unit, Pediatrics Department, and
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icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY- SA) license (http://creativecommons.org/licenses/by/4.0/)
1483
Received:25 /6 /2020
Accepted:24 /8 /2020
ABSTRACT
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1489-1498
Correlation Between Helicobacter Pylori Infection and
Iron Deficiency Anemia in School-Aged Children
Mostafa Abd El-Azeem Hassan, Ismael Abd El-Razek Kasem,
Ahmed Salah Mohammed Ali
Department of Pediatrics and Neonatology, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, Egypt
Corresponding author: Ahmed Salah Mohammed Ali, Mobile: (+20) 01149371351,
Email: ahmedmet3eb1810@gmail.com
ABSTRACT
Background: Iron deficiency anemia (IDA) is recognized as a common nutritional problem in infants and young
children in developing countries mainly due to poor nutrition in most cases.
Objective: To evaluate the association between H. pylori infection and iron deficiency anemia in school-aged
children.
Patients and Methods: This study was conducted on 60 participants divided into two groups. Group I: formed of 30
patients suffering from iron deficiency anemia with hemoglobin (Hb) less than l1g/dL. Group II: formed of 30
healthy children (control Group)
Results: In the current study we found that there was a significant decrease in weight and BMI among cases group
p-value <0.001. In the current study, we found that there was a significant decrease in all CBC parameters among
cases versus control. In the current study we found that there were significant differences between the two groups
regarding nutritional status as in cases there was a higher percentage of low iron sources in the diet, there was a
significant decrease in serum iron, ferritin, and TIBC in cases versus control. In the current study, we found that
there was a significant increase in the number of positive samples for H pylori antigen in stool among cases versus
control 63.3% versus 23.3% p-value 0.002.
Conclusion: The results of this study demonstrate a significant association between children with iron deficiency
anemia and positive H. pylori infection in school-age children. Moreover, H. pylori infection may be one of the
significant causes of iron deficiency anemia.
Keywords: Iron deficiency anemia, Helicobacter Pylori, School-aged children.
INTRODUCTION
Iron deficiency (ID), the most common
to gastric lesions as a consequence of H. pylori
nutritional disorder among infants and young
infection (4). Reduced iron absorption due to an
children particularly in developing countries (1, 2).
elevated pH of the gastric juice has also been
Iron deficiency anemia (IDA) is defined as
attributed to H. pylori (5).
hemoglobin below the 5th percentile of normal for
As H. Pylori infection is primarily acquired
the age that is caused by the lack of iron. Most
in childhood, and iron stores are lower in children
studies showed that cut off point to be around (-2 SD
than in adults, children are thought to be at
below the mean) (2).
particularly increased risk for iron deficiency(6).
Based on the WHO estimation, iron
deficiency is responsible for 50 percent of all types of
AIM OF THE WORK
anemia. The prevalence of IDA during infancy and
Correlate between H. pylori infection and
early childhood is high because of high iron
iron deficiency anemia in school-aged children.
requirements in this age group, dietary iron
bioavailability, and gastrointestinal infections which
PATIENTS AND METHODS
are frequent in developing countries (2).
The present study was carried out in the
Helicobacter pylori (H. pylori) infection is
pediatric clinic and pediatric department in Sohag
one of the most common bacterial infections in
general hospital in the period from March to
developing countries which usually affects children
December 2018.
and if not treated, usually continues to exist in the
body for a long time. This bacterium can cause
The present study was carried out on 60
gastrointestinal disorders such as chronic active
participants divided into two groups:
gastritis, stomach cancer, and peptic ulcer (3).
Group I: Formed of 30 patients diagnosed as
The high prevalence of combined H. pylori
iron deficiency anemia with hemoglobin (Hb) less
infection and IDA in developing countries suggests
than l1g/dL according to WHO description (2). They
that infection with this bacterium may be a cause of
were 21 males and 9 females, and their age ranged
IDA. Possible mechanisms include increased iron
between 4-10 years.
uptake by the H. pylori bacterium and blood loss due
This article is an open access art
icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY- SA) license (http://creativecommons.org/licenses/by/4.0/)
1489
Received:26 /6 /2020
Accepted: 25/8 /2020
c:\work\Jor\vol812_25
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1499-1505
Correlation between Uric Acid and Thyroid Hormones in Patients with
Thyroid Disorders. A Case Control Study
Mona Youssry Helmy
Department of Internal Medicine, Faculty of Medicine, Cairo University, Egypt
*Corresponding Author: Mona Yousry Helmy, Tel: (+20)1004389020, Email: mona55508@yahoo.com
ABSTRACT
Background: Thyroid disease influences the purine metabolism, which may increase serum uric acid (UA) level.
Previous studies showed a high incidence of hyperuricemia in patients with thyroid disorders but with low thyroid
stimulating hormone (TSH)-to-serum uric acid association.
Objective: Aim of this work was to investigate the serum uric acid relationship to thyroid hormones in patients with
primary thyroid disorder.
Subjects and Methods: This case-control study included a total of 105 patients, 35 healthy participants as a control
group and 70 patients with primary thyroid disorders, attending at the Endocrinology Outpatient Clinic, Kasr El Ainy,
Cairo University. The included subjects were divided into three groups; (Group I) consisted of 35 patients with
primary hypothyroidism, (Group II) consisted of 35 patients with primary hyperthyroidism and (group III) consisted
of 35 subjects representing the control group. Waist circumference and the BMI have been calculated. TSH, free T4
(FT4; thyroxine) and free T3 (FT3; triiodothyronine), fasting lipids, creatinine, urea, eGFR and uric acid were
evaluated.
Results: On comparing the three studied groups a statistical significant difference in UA level was found (p < 0.05),
being highest in group I followed by group II then group III (6.59± 1.32mg/ dl, 6.38± 0.88mg/ dl and 5.48± 0.47mg/
dl respectively). Among hyperthyroid patients, there was a statistical negative significant correlation between UA and
TSH (r -0.733-) and a positive significant correlation between Uric acid and FT3 (r 0.541) and FT4 (r 0.482).
Conclusion: A significant negative correlation between uric acid and TSH and significant positive correlation
between it and FT3 and FT4 among hyperthyroid patients were found. Focusing more on the possible correlation of
uric acid and primary thyroid diseases.
Keywords: Uric acid; Thyroid hormones; Primary thyroid disorders.
INTRODUCTION
renal perfusion and glomerular filtration (GFR) in
Uric acid (UA) is water soluble and antioxidant
primary hypothyroid patients. The elevated uric acid
which is mainly produced by the liver (1). It inhibits the
(UA) levels is thought to be an intermediate factor in
harm done by the free radicals and also protect cell
adipose tissue. Also, it regulates endocrine disorders that
membranes and DNA (2). Among important biochemical
promote inflammation which can be an important factor
parameters, uric acid is functioning as antioxidant agents
leading to dyslipidemia and atherosclerosis (13).
which affected by thyroid function (3) and also, thyroid
Previous research has attempted to discover the
dysfunction affects the purine metabolism that may
link between these two conditions because thyroid
increase uric acid concentration (4).
dysfunction also alters UA concentration together with
There are few reports about the association of
other metabolic deranges (7, 14). Because the competition
thyroid dysfunction and metabolism of UA, with a
of deranged rates of SUA in primary thyroid diseases
contradictory evidence. There was a poor relationship
patients can not only elevate the risk of all-cause
between TSH and serum uric acid (SUA) levels (5, 6).
mortality, but can also impact disease management and
Previous research, however, documented a high
prognosis (12). However, the results of such studies were
prevalence of elevated levels of UA in hypothyroidism
inconsistent and the association between thyroid disease
(7) and hyperthyroidism (7, 8). This may be attributed to
and SUA concentrations is still unclear.
elevated rate of purine metabolism in primary
So, this study was aimed at evaluating the
hyperthyroidism and reduced renal perfusion and
connexion between uric acid and thyroid hormones in
glomerular filtration rate (GFR) in primary hypothyroid
patients with primary thyroid disorders in order to close
patients (9, 10).
this gap in the literature.
As to thyroid dysfunction, the elevated levels of
SUA are also accompanied with other co-morbid
SUBJECTS AND METHODS
conditions including hypertension, metabolic syndrome,
This case-control study included a total of 105
chronic kidney disease and type 2 diabetes mellitus (11,
patients aged 20 to 60 years, 35 healthy participants as a
12). This may be attributed to increased purine
control group and 70 patients with primary thyroid
metabolism in primary hyperthyroidism and reduced
disorders, attending at the Endocrinology Outpatient
This article is an open access art
icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY- SA) license (http://creativecommons.org/licenses/by/4.0/)
1499
Received:1 /8 /2020
Accepted:20 /9 /2020
ABSTRACT
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1506-1511
Evaluation of Role of Ambroxol in Treatment of Bronchiolitis
Ahmed Tawfik Mohammed Mohammed, Mostafa Abd Elazeem Hassan, Mohammed M. S. Younis
Department of Pediatrics and Neonatology, Faculty of Medicine (Assiut), Al-Azhar University, Egypt
Corresponding author: Ahmed Tawfik Mohammed Mohammed,
Mobile: (+20) 1099979868; Email: tawfikahmed706@gmail.com
ABSTRACT
Background: Bronchiolitis is the most common reason for hospital admission in infants, accounting for 20% of
hospitalization at < 1 year of age. The recently discovered human meta pneumo-virus and other viruses like
adenovirus, parainfluenza virus type-3, influenza virus and rhinovirus also cause bronchiolitis that is
indistinguishable from respiratory syncytial virus (RSV) disease. It is more common in males, those who are not
breast fed and living in crowded conditions.
Objective: The aim of the work was to assess role of Ambroxol inhalation in treatment of Bronchiolitis.
Patients and Methods: This randomized controlled clinical trial included a total of included 40 children with
bronchiolitis, attending at Department of Pediatrics, Sohag General Hospital. They were randomly divided into two
groups, the control group consisted of 20 cases who were given bronchodilators, inhaled or systemic steroids,
antibiotics if needed, or supportive measures and oxygen supplementation if needed. The intervention group
consisted of 20 cases who were treated with Ambroxol inhalation in addition to supportive measures mentioned
above.
Results: There was insignificant differences between two groups regarding the need of oxygen and duration of
oxygen therapy (p-value 0.337, 0.536 respectively). In the current study, we found that there was insignificant
differences between two groups regarding degree of RD on admission but after treatment there was significant
improvement in interventional group with p-value <0.001. In the current study, we found that there was significant
difference between two groups regarding length of hospital stay as in interventional group was lower than control
(p-value 0.002).
Conclusion: It could be concluded that Ambroxol gives a good improvement in cases with bronchiolitis and decreases
hospital stay. Furthermore, Ambroxol is safe, cheap and easy to administer.
Keywords: Coronary artery bypass graft, chronic obstructive pulmonary disease, positive end expiratory pressure
INTRODUCTION
Bronchiolitis is a disorder most commonly
improve the respiratory system symptoms of
caused in infants by viral lower respiratory tract infection
bronchiofitis and reduce the time of hospital
(LRTI). It is the most common lower respiratory infection
stay.Ambroxol has remarkable and predictable effect
in this age group. It is characterized by acute
(6).
inflammation, edema and necrosis of epithelial cells lining
The aim of this study was to assess role of
small airways, increased mucus production, and
Ambroxol inhalation in treatment of Bronchiolitis.
bronchospasm. Signs and symptoms are typically rhinitis,
tachypnea, wheezing, cough, crackles, use of accessory
PATIENTS AND METHODS
muscles, and/or nasal flaring (1).
This randomized controlled clinical trial included
Many viruses cause the same constellation of
a total of included 40 children with bronchiolitis,
symptoms and signs. The most common etiology is the
attending at Department of Pediatrics, Sohag General
respiratory syncytial virus (RSV), with the highest
Hospital.
incidence of RSV infection occurring between
December and March (2). Ninety percent of children are
Ethical approval:
infected with RSV in the first 2 years of life and up to
Written informed consent of all the subjects was
40% of them will have lower respiratory infection (3).
obtained. Approval of the ethical committee of Al-
The cost of hospitalization for bronchiolitis in
Azhar university was obtained.
children less than 1 year old is estimated to be more
than 700 million dollars per year. Several studies have
The included subjects were randomly divided into two
shown a wide variation in how bronchiolitis is
groups; the control group consisted of 20 cases who
diagnosed and treated (4).
were given bronchodilators, inhaled or systemic
Ambroxol is a secretolytic, mucokinetic and
steroids, antibiotics if needed, or supportive measures
stimulator for synthesis and release of surfactant by
and oxygen supplementation if needed and the
type II pneumocytes via modulation of surfactant
intervention group consisted of 20 cases who were
protein expression (5) and it is shown that it can
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icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY- SA) license (http://creativecommons.org/licenses/by/4.0/)
1506
Received:26 /6 /2020
Accepted:25 /8 /2020
Norhan Ahmed Elsayed Aliwa
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1512-1519
Quality of Health Medical Services at Pediatric Cardiology Unit,
Zagazig University Inpatient
Norhan Ahmed Elsayed Elewa*1, Amr Megahed Abu ElNaga1,
Ahmed AbdElSamad Elhewala1, Mona Hamed Ibrahim Mohamed2
Departments of 1Pediatrics and 2Community, Environmental and
Occupational Medicine - Faculty of Medicine, Zagazig University
*Corresponding author: Norhan Ahmed Elsayed Elewa, Mobile: (+20)01060319679, E-Mail: noraelewa8@gmail.com
ABSTRACT
Background: Patients' satisfaction represents an important indicator for the quality of health care delivery, and it is a
widely accepted factor, which needs to be studied repeatedly for better functioning of health care systems. Patient is
the best judge for the quality of health care so the factors affecting patients' satisfaction must be taken in consideration.
Objective: The aim of this study was improvement of quality of the health care services provided to children in
Pediatric Zagazig University Hospital.
Patients and methods: This study was a cross sectional study that was held a sample of Cardiology Unit at Pediatric
Department of Zagazig University Hospitals. It was carried out during the period from July 2018 to April 2019 on a
total sample of 106 patients attending Zagazig University Hospital Cardiology Unit at Pediatric Department.
Results: Among 106 participants 100% were females, 70.8% were secondary educated, 73.5% were non-workers,
55.7% were of low social class, 69.8% were from rural resident and 76.4% had not enough income with mean age of
24.48 ± 4.5 years. It was concluded that most of the studied patients (89.6%) were satisfied about the studied
cardiology unit at pediatric department. It was found that patient satisfaction is affected by sociodemographic factors as
age, sex, occupation, education, and social class. In addition, it was affected by satisfaction about environment,
facilities, treatment, doctors, nurses, administrative personnel and information given for them.
Conclusion: It was concluded that most of the studied patients are loyal to Zagazig University Hospital, as they will
definitely intend to reuse and recommend Zagazig University Hospital Outpatient Clinics to others. Patient loyalty was
found to be significantly affected by level of their satisfaction where satisfied patients tend to re-use and recommend
the hospital Cardiology Unit at Pediatric Department more than dissatisfied ones.
Keywords: Quality of health medical services, Pediatric Cardiology Unit, Patients' satisfaction.
INTRODUCTION
Patients' health care outcomes are determined by
Quality of care must be defined in the light of the
the structural attributes of the settings in which care
providers' technical standards and patients' expectation
occurs and the processes of care (6). According to the
(1). While there is no single definition of health service
model by Avedis Donabedian, measurement of health
quality applies in all situations, the most comprehensive
care quality is based on the structures, processes of care,
and perhaps the simplest definition of quality is that
and outcome (7). By interviewing the patients,
used by advocates of total quality management: Doing
information about the structures and processes and their
the right thing right, by right way (2).
influence on care outcome can be obtained (6). The
Quality of health care is an important part of an
structures include the physical ward environment and
efficient system, continuous evaluation of patients'
the resources required for pediatric treatment. Patient
perceptions of various dimensions of received services
care processes include interactions between caregivers
is necessary for raising the quality of health care.
and patients. These rely on the structures to provide
Patients' experiences are a useful basis for improving
resources and mechanism for those involved to be able
the quality of health services (3). Patients can play an
to carry out patient care activities that aim at outcomes
active role in the way health care is implemented, and
such as promotion of recovery, functional restoration,
they contribute to defining quality of care, not only on a
survival, and patient satisfaction. Care processes
technical level, but also on a cultural one.
involving the way care is delivered include the technical
Understanding and satisfying their needs are essential
and interpersonal aspects (8).Technical aspects involve
for achievement of adequate quality of car (4).
timeliness and accuracy of diagnosis, coordination of
Evaluating patients' experiences provides vital
care as well as appropriateness of therapy. Whereas
information on their perception of the quality of care
interpersonal
aspects
involve
clinician-patient
and treatment provided by the health care providers and
relationship, information, and involvement in decision-
the hospital as a whole. Factors affecting the provision
making (6). One of the outcomes of the care according to
of quality pediatric care cannot be adequately addressed
Donabedian includes client satisfaction. This is of great
without establishing the parents' perspectives on the
importance when measuring the quality of care. It provides
quality of care that their children receive (5).
information about the success of the health care provided
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-
SA) license (http://creativecommons.org/licenses/by/4.0/)
1512
Received: 26/6 /2020
Accepted:25 /8 /2020
c:\work\Jor\vol812_28
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1520-1524
Cumulative Radiation Exposure from Diagnostic Imaging in
Zagazig University Pediatric Intensive Care and Chest Units
Tarek Abd El-Rahman Atiyyah1, Mohammed Sanad Naguib Nasr1,
Talaat Salahdin Ahmed2, Marwa Mohamed Sabri Abdelmonem Mostafa*1
Departments of 1Pediatrics and 2Radiation Physics Atomic Energy Commission,
Faculty of Medicine Zagazig University
*Corresponding author: Marwa Mohamed Sabri Abdelmonem Mostafa,
Mobile: (+20) 01008455951, Email: tgems_18@yahoo.com
ABSTRACT
Background: The medical use of ionizing radiation has expanded worldwide. The use of radiation in pediatric
imaging (e.g. radiographs and computed tomography) saves lives and has a great clinical value for the diagnosis of
pediatric illness and injury. However, inappropriate or unskilled use of such technologies may result in unnecessary
exposure that may increase risk of malignancy occurrence.
Objective: To detect the effect of multi exposure and its application on reaching to risk threshold of radiation through
quantification of the cumulative effective dose (CED) of ionizing radiation attributable to diagnostic imaging in
Pediatric Intensive Care Unit (PICU) and Chest Unit, Zagazig University Hospitals. Also, to examine the patterns of
use of diagnostic X-ray imaging in these units.
Patients and Methods: This study was conducted in Pediatric ICU and Chest Unit at Zagazig University Hospital
from October 2018 to March 2019. 72 cases were included. Selected cases were observed and followed up in each
time they were asked to perform x-ray radiography or CT film during their whole stay period in the hospital.
Results: The median of x-ray + ct group was 3 7.9 msv in our study. Also, in our study, there was dose variation
among units. The median of exposure of patients of Chest Unit was 6.51. While the median of patients of ICU was
1.9. Dose of CT in our study formed 53.8%. Our study revealed that CT chest equaled about 30 chest X-ray in our
hospital. 74% of patients had very low and low risks.
Conclusion: Cumulative exposure dose (CED) of ionizing radiation due to frequent X-ray films and CT scans in our
study aren't likely to cause acute toxicity as they were relatively low but they may cause chronic toxicity and increases
the long-term risk for developing malignancy.
Keywords: Cumulative Radiation Exposure, Diagnostic Imaging, Pediatric Intensive Care, Chest Units.
INTRODUCTION
when cells are modified but not killed (e.g. cancer if
The medical use of ionizing radiation has
the transformation occurred in a somatic cell &
expanded worldwide. The use of radiation in pediatric
hereditary disease if the transformation occurred in a
imaging (e.g. radiographs and computed tomography)
germ cell). There is no definite threshold, above which,
saves lives and has a great clinical value for the
these effects can occur, as it depends on organ
diagnosis of pediatric illness and injury. However,
sensitivity, mitotic cycle and other factors (4).
inappropriate or unskilled use of such technologies
The study aimed to detect the effect of multi
may result in unnecessary exposure that may increase
exposure and its application on reaching to risk
risk of malignancy occurrence (1). High amounts of
threshold of radiation through quantification of the
exposure (e.g. cancer radiation therapy) are known to
cumulative effective dose (CED) of ionizing radiation
cause pulmonary toxicity (2).
attributable to diagnostic imaging in PICU and Chest
Although one chest radiograph has a similar
Unit, Zagazig University Hospitals. Also, to examine
amount of ionizing radiation equal that of 3 days of
the patterns of use of diagnostic X-ray imaging in these
environmental exposure, which is a minimal amount,
units.
the cumulative dose of repeated studies can be serious
(3). The biological effects of ionizing radiation target
PATIENTS AND METHODS
the DNA molecule principally.
I- Technical Design
Two kinds of effects are observed on tissues: 1 -
a) Setting: this study was conducted in Pediatric
Deterministic effects; occur when damage occur to a
ICU and Chest Unit, Zagazig University Hospital
large number of cells leading to affection of tissue
from October 2018 to Mars 2019.
structure or function, which are considered as tissue
b) Population or subjects: admitted patients in ICU
reactions e.g. erythema, hair loss, nausea, diarrhea,
and Chest Unit, whose age ranged from 1 month
sterility. There is a certain threshold, above which,
to 15 years at Zagazig University Hospital.
these effects can occur. 2- Stochastic effects that occur
c) Type of study: cohort study.
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-
SA) license (http://creativecommons.org/licenses/by/4.0/)
1520
Received:27 /6 /2020
Accepted:26 /8 /2020
c:\work\Jor\vol812_30
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (2), Page 1531-1537
Comparison between Levobupivacaine Alone and Levobupivacaine with Fentanyl in
Extending the Duration and Postoperative Analgesia of Supraclavicular
Brachial Plexus Block for Elective Upper Limb Orthopedic Surgeries
Hala Mahmoud, Fawzy Abbas, Mahmoud Gamal El-Din Youssef*, Ghada Abdelgaber
Department of Anesthesia and I.C.U and Pain Management, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Mahmoud Gamal El-Din, Mobile: (+20)1066117686, E-Mail: damong255@gmail.com
ABSTRACT
Background: Brachial plexus Block is widely utilized nowadays in high risk patients with high safety margins
providing hemodynamic stability and optimal muscle relaxation.
Objectives: The aim of the work was to evaluate the efficacy of fentanyl as an adjuvant on hemodynamic stability,
onset and duration of the block and postoperative analgesia.
Patients and methods: This double blinded randomized study included a total of 100 patients subjected for upper limb
orthopedic surgeries using supraclavicular brachial plexus block using levobupivacaine, attending at Sohag University
Hospital. Patients were divided randomly into two groups, group L (control group) and group LF (study group). Regular
hemodynamics monitoring were done.
Results: there was no significant difference between both groups as regard hemodynamics, although there was
significant faster onset of the block and prolongation of its duration in group LF. Also, the VRS pain score was
significantly lower in the postoperative period in group LF and less analgesic requirement.
Conclusion: It could be concluded that using fentanyl as an adjuvant to levobupivacaine is effective in enhancing the
onset of the brachial plexus block and prolonging the duration of motor and sensory blocks with no hemodynamic
changes. It effectively prolongs postoperative analgesia and lowers the analgesic requirements.
INTRODUCTION
account for the prolonged analgesia (5). However,
Brachial plexus blocks provide a useful alternative
fentanyl is reported to have a local anesthetic action (6).
to general anesthesia as they achieve near-ideal
The aim of the current work was to study the effect
operating conditions by producing complete muscular
of adding fentanyl to levobupivacaine as regard
relaxation,
maintaining
stable
intra-operative
hemodynamics stability, onset and duration of the
hemodynamics and the risk associated with general
block, postoperative analgesia, and complications.
anesthesia are avoided (1).
Of various local anesthetics, Levobupivacaine is
PATIENTS AND METHODS
used most frequently, as it has a long duration of action
This double blinded randomized study included a
varying from 3 to 8 hours and less cardiotoxic effect
total of 100 patients aged between 18 and 60 years with
with intravascular spread which is the major risk factor
ASA I and II score and posted for elbow, forearm, and
for brachial plexus block (2).
hand orthopedic surgeries, attending at Sohag
Various drugs were added to local anesthetics like
University Hospital. This study was conducted
neostigmine, opioids, dexamethasone, hyaluronidase,
between.
and clonidine to modify the block regarding producing
quick onset of action, good quality of anesthesia,
Ethical approval:
prolonged duration and effective post-operative
Written informed consent of all the subjects was
analgesia (3). The addition of opioids in brachial plexus
obtained.
block is reported to improve success rate and
Approval of the ethical committee of Sohag
postoperative analgesia, by some authors whereas
university was obtained.
others have found no effect (4).
All patients received anesthesia by supraclavicular
Fentanyl is an opioid analgesic is known to
brachial plexus block using levobupivacaine.
produce antinociception and to enhance the effect of
The included subjects were randomly divided into
local anesthetics when given epidurally or intrathecally,
two groups; Group L (control group) consisted of 50
studies showed that it could act directly on the
patients received 22.5ml levobupivacaine 0.5 % + 7.5ml
peripheral nervous system. Primary afferent tissues
normal saline and Group LF (study group) consisted
(dorsal roots) have been found to contain opioid-
of 50 patients received 22.5ml levobupivacaine 0.5 % +
binding sites. Due to the presence of bidirectional
1ml Fentanyl (50µg) + 6.5ml normal saline. Routine
axonal transport of opioid-binding protein, fentanyl can
preoperative investigations as complete blood picture,
penetrate the nerve membranes and act on the dorsal
renal function tests, liver function tests, and coagulation
horn. This could also
profile were done.
This article is an open access art
icle distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1531
Received:27 /6 /2020
Accepted:25 /8 /2020