c:\work\Jor\vol813_1 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1538-1545

Depression and Its Relation to Diabetes Control and Complications in
Type 2 Diabetic Patients in Police Authority Hospital
Mohannad Mahmoud Mohamed*1, Mohab Fawzy2, Fayrouz Selim1, Mohamed Sakr1
Departments of 1Internal Medicine and 2Psychiatry, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Mohannad Mahmoud Mohamed Hassan, Mobile: (+20)01004785050,
E-mail: drmohaned@hotmail.com
ABSTRACT
Background
: Type II diabetes mellitus (DM) is a progressive chronic disease with high prevalence all over the world.
Psychological complications, such as depression are common in older people with diabetes. Unlike in other chronic
conditions, good diabetes management relies heavily on a patient's self-care abilities. Although depression is common
in older people with diabetes, it remains underdiagnosed and therefore often untreated
Objective: To assess presence and severity of depression and its relation to diabetic control and complications in type
2 diabetic patients at police authority hospital, Cairo, Egypt.
Patients and methods: The study included 322 patients recruited from the Outpatient Clinics of Police Authority
Hospital-Nasr city. The studied patients were screened for the presence of depression with Hamilton depression rating
scale, and then they were further classified into two groups: Group A diabetic patient without depression which
included 172 patients and group B diabetic patients with depression which included 150 patients. All patients were
subjected to clinical examination including Michigan Neuropathy Screening Instrument (MNSI), fundus examination
and laboratory evaluation to assess diabetic control and the presence of macro and micro-vascular complications of
diabetes.
Results: The percentage of depression among the studied patients was 46.6%. No statistically significant difference
between the patients with and without depression in the laboratory data except for levels of fasting and postprandial
glucose. High statistically significant difference was detected by the MNSI regarding the severity of depression.
Conclusion: depression is a common finding in patients with type II DM and the severity of the depressive symptoms
were correlated to self-monitoring, diet regimen, type of anti-diabetic medications and adherence to medications.
Keywords: Depression, Diabetes mellitus, Hamilton, Michigan.

INTRODUCTION

complications in type 2 diabetic patients at police
Several studies report that depression is highly
authority hospital, Cairo, Egypt.
prevalent in patients with type 2 diabetes (1). The

prevalence has been reported to be about twice as likely
PATIENTS AND METHODS
as the general population (2). Depression is associated
This study is a cross-sectional descriptive study.
with poor glycemic control, suboptimal self-
The patients recruited from the Outpatient Clinics of the
management behavior, obesity, chronic complications
Police Authority Hospital, Nasr city, Cairo, Egypt in the
and mortality (3). Diabetes and depression appear to be
period from June 2018 to April 2019. This study aimed
interactively associated with each other in terms of the
to assess presence and severity of depression among
pathogenesis. Specifically, risk of diabetes is higher in
patients with type 2 diabetes mellitus and its relation to
patients with depression due to inappropriate eating
diabetic control and complications. The recruited
behavior (e.g., overeating) and a decrease in physical
patients were assessed for the presence of depression
activity is often found in patients with depression (4).
with Hamilton depression rating scale then they were
Meanwhile, for patients with diabetes, anxiety about
subdivided into two groups. Group A included 172
future diabetic serious complications and limitations of
diabetic patients without depression and group B that
physical function that accompany such complications
included 150 diabetic patients with depression.
may contribute to the development of depression (5).

Screening for depression may provide an
Ethical approval:
opportunity for identifying patients at risk of having
A written informed consent was obtained from all
more severe psychological symptoms and worse
patients before being included in the study. The study
outcomes, particularly if these patients do not present
was approved by the Institute Review Board (IRB) of
with current symptoms (6). Limited studies have indicated
Zagazig University.
that depression is also associated with a variety of
All patients were subjected to complete history
diabetic microvascular complications such as diabetic
taking and full physical examination. Routine laboratory
neuropathy, retinopathy and nephropathy (7).
investigations were done including urinary albumin
This study aimed to assess presence and severity
excretion (UAE) rate using albumin creatinine ratio
of depression and its relation to diabetic control and
(ACR) in a spot urine sample. Additional performed

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1538
Received:27 /6 /2020

Accepted:26 /8 /2020

Full Paper (vol.813 paper# 1)


c:\work\Jor\vol813_2 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1546-1551

Growth Differentiation Factor 15 in Patients with Acute Coronary Syndrome
and Its Relation to Type 2 Diabetes Mellitus
Mahmoud Abdelsabour Abdellah1, Hosney Ali Hassen2, Abdel-Rahim Mohammed Abdel-Hafiz2,
Doua Ahmed Fouad1, Aliaa Aly Youssef*2, Naglaa Kamal Idriss2
Departments of 1Cardiology and 2Medical Biochemistry, Faculty of Medicine, Assuit University
*Corresponding author: Aliaa Aly Youssef, Mobile: (+20)01060961596, E-Mail: aliaa.aly1610@gmail.com

ABSTRACT
Background:
Growth differentiation factor 15 (GDF15) gene expression level is a novel biomarker that reflects
inflammation and oxidative stress in patients with acute coronary syndrome and those complicated with type 2
diabetes mellitus (T2DM). Growth differentiation factor 15 high levels could be a reliable sensitive biomarker for
the prediction of acute coronary syndrome.
Patients and Methods: This Cross-sectional/case-control study was conducted at the Cardiology Department,
Assiut University during the period from January 2018 to December 2019, and patients were selected with the
exclusion of any inflammatory or autoimmune disease.
Results: Growth differentiation factor 15 gene expression was significantly higher in acute coronary syndrome
patients compared to the controls (p-value <0.001) and its expression was significantly higher in acute coronary
syndrome patients with type 2 diabetes mellitus group compared to acute coronary syndrome patient group (p-
value<0.05). Growth differentiation factor 15 had 92% sensitivity and 77% specificity in the prediction of acute
coronary syndrome which was statistically significant (p-value< 0.001), while yielded 73% sensitivity and 53%
specificity of no statistical significance (p-value=0.829) in the prediction of type 2 diabetes mellitus among patients
with acute coronary syndrome.
Conclusion: Growth differentiation factor 15 gene expression could be used as a reliable sensitive biomarker for
prediction of the acute coronary syndrome but more studies will be mandatory soon to clarify its role as a predictive
marker for type 2 diabetes mellitus development among patients with the acute coronary syndrome.
Keywords: Acute coronary syndrome, Type 2 Diabetes Mellitus, Gene Expression, Growth Differentiation Factor
15 prediction.

INTRODUCTION
complications. GDF15 is very important in the
Acute coronary syndrome (ACS) is the
regulation of glucose homeostasis and lipid
leading cause of death and disability worldwide
metabolism, also it improves insulin sensitivity and
especially in developing countries, the mortality rate
regulates food intake (7, 8).
in individuals over 35 years old from CAD
This study aimed to clarify the pattern of
compromise one-third of deaths worldwide (1). Growth
GDF15 gene expression in acute coronary syndrome
differentiation factor 15 (GDF15) is a stress-
patients with or without type 2 diabetes mellitus and
responsive cytokine, a member of the transforming
its role as a predictive biomarker for type 2 diabetes
growth factor-beta (TGF) superfamily. GDF15 is
mellitus among those patients.
expressed at low levels in all organs, whereas it is

expressed in high concentrations in the liver, kidney,
PATIENTS AND METHODS
heart, and lungs in response to ischemia, oxidative
This Cross-sectional /Case-control study was
stress, and mechanical stress (2).
conducted during the period from January 2018 to
GDF15 has been examined as a novel
December 2019. This study included three studied
emerging biomarker for CAD (3). Increased expression
groups; 23 patients with acute coronary syndrome
of GDF15 was identified in atherosclerotic lesions and
(ACS group), 22 ACS patients with type 2 diabetes
within the myocardium in acute myocardial infarction
mellitus group (ACS with T2DM), and 45 age-
(AMI) (4). GDF15 has been considered as a marker of
matched healthy control group. The sample size was
poor prognosis in patients with CAD (5), acute
calculated using EPi Info 2000, version 1.1.2 (Center
myocardial infarction, atrial fibrillation, and heart
for Disease Control and Prevention, Atlanta, Georgia,
failure (6).
USA).
Type 2 diabetes mellitus (T2DM) is an
This study had been performed at the coronary care
important risk factor for CAD and hyperglycemia
unit of the Cardiology Department, Assiut University
results in oxidative stress with reactive oxygen species
Hospital. Patients presented by clinical manifestations
(ROS) generation that affect the integrity of the
and ECG changes of acute coronary syndrome were
endothelial cells and predispose to cardiovascular
included in the study. All patients were subjected to

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1546
Received:25 /6 /2020

Accepted:24 /8 /2020

Full Paper (vol.813 paper# 2)


c:\work\Jor\vol813_3 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1552-1557

Association between Glycemic Control and Birth Weight with Glycated
Albumin in Women with Gestational Diabetes Mellitus
Mohammed Najib Azzam, Mohammed Sabry Mahdy,
Mustafa Taha Abdelfattah, Sarah Elsayyed Ibrahim Abdalrahman*
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Zagazig, Sharkia, Egypt
*Corresponding author: Sarah Elsayyed Ibrahim Abdalrahman, Mobile: (+20) 01095123762,
Email: Ramyammar2020@gmail.com

ABSTRACT
Background:
Gestational diabetes mellitus (GDM) is defined as glucose intolerance that is primarily detected during
pregnancy.
Objective: To determine the relationship between glycemic control and glycated albumin in women with GDM.
Patients and Methods:
This prospective study was carried out in the Department of Obstetrics and Gynecology,
Zagazig University Hospitals, Zagazig, Sharkia, Egypt from December 2018 to October 2019. The study included 30
patients suffering from GDM (study group) as well as another matching 30 women (control group). Maternal
screening for all cases at 24-28 wks using a 75-gm oral glucose tolerance test (OGTT) which is a fasting blood glucose
sample was done.
Results:
GA levels were significantly higher after 24 weeks of gestation in the GDM group compared with controls.
Elevated GA levels had a positive correlation with birth weight. In the present study, fetal weight was significantly
higher among the study group (3850.0±513.7) than controls (3396.6±334) (p<0.001). Glycated albumin, HbA1c only
showed association with large for date status. Also, GA24_28, more than 13.4 had a sensitivity of 82% and
specificity of 72% for GDM. ROC curve, as the cut off point for identifying poor glycemic control in GDM women,
and provided the optimal sensitivity (75.93%) and specificity (86.36%).
Conclusion:
GDM women, the risk of macrosomia significantly increases when the GA levels are 14.45% in the
third trimester. The results provide strong support for the use of GA measurements, as a complement to finger stick
glucose, for assessing short term glycemic control and predicting large birth weight in the GDM women.
Keywords:
Glycemic Control, Birth Weight, Glycated Albumin, Gestational Diabetes Mellitus.

INTRODUCTION

Gestational diabetes mellitus is defined as
Two types of indicators are monitored, the instant
glucose intolerance that is primarily detected during
blood glucose (such as fasting blood glucose) and the
pregnancy (1).
long-term blood glucose monitoring such as
According to the latest diagnostic criteria of the
glycosylated hemoglobin (HbAlc). However, the two
International Association of Diabetes and Pregnancy
indicators have their shortcomings. Fasting blood
Study Groups (IADPSG), the incidence of GDM has
glucose is greatly influenced by previous diet, mental
increased to 20% (2).
state, and other factors such as stress, and exhibits
Women with pre-gestational diabetes and their
great fluctuations, making it difficult to control.
fetuses are at increased risk of developing
HbA1c only reflects the blood glucose level during the
complications compared with the non-diabetic
previous 2­3 months and has a relatively shorter
pregnant women, including spontaneous abortion,
observation period for GDM, thus, it is not sensitive (6).
preterm labor, hypertensive disorders, and delivery by
Glycated hemoglobin (HbA1c), the current gold
cesarean section (3). Women with gestational diabetes
standard marker for glycemic control, reflects blood
mellitus (GDM), although have short disease durations
glucose level but it is affected by an abnormal
also develop similar complications, though not of the
erythrocyte life span, which may occur in iron
same magnitude. Gestational diabetes mellitus
deficiency anemia. Pregnant women with gestational
accounts for ~90% of cases where pregnancy is
diabetes mellitus (GDM) often develop iron deficiency
complicated by diabetes, with increasing the risk of
anemia; therefore, HbA1c may be insufficient for
subsequently developing type 2 diabetes for both the
assessing glycemic control in them (7).
mother and the child (4).
Recent reports have advocated the use of
Glycemic control is essential to minimize the
glycated albumin as a marker of glycemic control. (1).
maternal and fetal morbidity and mortality of
Glycated albumin is the product of non-enzymatic
pregnancies with GDM (5).
glycosylation of plasma albumin. GA measurement
At present, the treatment of GDM is mainly
reflects the blood glucose levels of diabetic patients in
focused on the monitoring and control of blood sugar.
the preceding 2­3 weeks (8).

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2551
Received:27 /6 /2020

Accepted:26 /8 /2020

Full Paper (vol.813 paper# 3)


c:\work\Jor\vol813_4 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1558-1564

Multi-detector Computed Tomography versus Digital Panoramic Radiography for
Preoperative Evaluation of Jaw Bones before Dental Implantation
Tarek Mohamed M. Mansour1*, Mohamad Hasan Tawfik 2,
Mohamed M. El-Barody 3, Ibrahim M. Mwafey 4, Ahmed Okasha5
1 Department of Radio-diagnosis, 4 Department of Oral Medicine and Periodontology Diagnosis and Oral
Radiology, Faculty of Medicine, Al-Azhar University, Assuit,2 Department of Radio-diagnosis, Faculty of
Medicine, Al-Azhar University, Cairo,3 Department of Radio-diagnosis, South Egypt Cancer Institute, Assuit
University, Assuit, 5 Department of Radio-Diagnosis, Faculty of Medicine, South Valley University, Qena, Egypt
*Correspondence author: Tarek Mohamed M. Mansour, E-mail: drtarekrad@gmail.com, Mobile: (+20)01006237731

ABSTRACT
Background:
To evaluate and compare preoperatively multi-detector computed tomography and digital panoramic
radiography of jaw bones in patients submitted to dental implant restoration.
Patients and methods: We conducted a diagnostic test accuracy study, Al-Azhar University Hospital Assuit.
Thirty patients, with partial edentulous areas, were enrolled in the study and they were 11 females and 19 males
with mean age of 37 years. Patients were included if they were systemically healthy, at least 18 years old, missing
a single or multiple teeth, and their crestal residual ridge width ranging from 3 to 5 mm.
Results: A higher Cronbach's alpha for the multi-detector computed tomography (MDCT) modality, as well as a
lower reliability of error were found. Moreover, unlike digital panorama radiography, MDCT obtained length and
width could predict the implant length and diameter. These results highlight the superiority of MDCT to digital
panorama radiography in the preoperative assessment before dental implantation.
Conclusion: Superiority of MDCT to digital panorama radiography in determining the implant site parameters
before dental implantation. Future studies should consider reducing the cost of MDCT and improving its
accessibility in low-resource settings.
Keywords:
MDCT, Radiography, Panorama.

INTRODUCTION

dimensions, bone quality and determine the location
Partial or total edentulism is a major health
of significant adjacent structures like dental inferior
problem that affects health related quality of life like
nerve, mental foramen, mandibular canal, maxillary
self-esteem, dietary intake, speech and alters food
sinus and incisive foramen (11-13).
taste, and preference. Poor dietary intake will

increase the risk of cardiovascular disease and cancer
The present study was designed to evaluate and
(1-3). The WHO declared that total or partial absence
compare preoperatively multi-detector computed
of natural teeth is a public health concern and recent
tomography and digital panoramic radiography of
data indicated possible increases in prevalence in the
jaw bones in patients submitted to dental implant
next decades (4). In addition, loss of teeth is frequent
restoration.
in 30% of adults and the percentage increased in low

socioeconomic class (1-3). In Egypt, edentulism affects
PATIENTS AND METHODS
a large proportion of the population (5, 6).
1. Study design and patients selection: We
Osseointegrated implants are an alternative method to
conducted a diagnostic test accuracy study, Al-Azhar
healthy and comfortable denture that acts by
University Hospital Assuit. Thirty patients, with
mechanical propagation and helps in charges
partial edentulous areas, were enrolled in the study
distribution (7, 8). Radiographic methods play a major
and they were 11 females and 19 males with mean
role in assessing the bony support for endosseous
age of 37 years. Patients were included if they were
dental implants. However, they are often inaccurate
systemically healthy, at least 18 years old, missing a
and have disadvantages like bad visualization for
single or multiple teeth, and their crestal residual
anatomic structures, superimposition, and distortion
ridge width ranging from 3 to 5 mm. Patients were
(9,10). Volumetric techniques (as Multi-detector
excluded from the study if they had any of the
computed tomography (MDCT) and cone beam
following: alcoholic, smoking, drug abused,
computed tomography (CBCT)) are more accurate
currently or from three months ago on certain
than conventional radiography, especially if the field
medications like bisphosphonates or steroids,
is less than 15 mm high (11). These techniques are
pregnant or receiving contraceptive pills, had obvious
effective in assessing the bone quantity in three
undercut on the labial cortical plate or perforated

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1558
Received:28 /6 /2020

Accepted:27 /8 /2020

Full Paper (vol.813 paper# 4)


c:\work\Jor\vol813_5 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1565-1570

Serum Survivin Level as A Novel Biomarker in Acne Vulgaris Patients
Sahar Mohammed Abd Elfatah El Mokadem1, Shrook Abd Elshafy Khashaba1,
Nora Mohammed Said2, Aya Mostafa Soliman Mostafa1
Departments of 1Dermatology, Venereology and Andrology and Clinical Pathology,
Faculty of Medicine ­ Zagazig University.
*Corresponding Author: Aya Mostafa Soliman Mostafa, Mobile: 01112915316, Email: ayanmostafa88@gmail.com

ABSTRACT
Background:
Acne vulgaris is a common skin disease characterized by sebum overproduction, which is hormonally
mediated, follicular hyper-keratinization and chronic inflammation of the pilosebaceous unit. Survivin is a member
of inhibitors of the apoptosis (IAP) gene family. It is a 16.5 kDa protein that inhibits apoptosis and regulates cell
division, proliferation, and survival.
Objective:
To determine the survivin level in acne vulgaris patients and detect the relation of its levels with acne
severity and presence of acne scarring.
Patients and Methods:
Forty acne vulgaris patients were included in this case control study along with forty age and
sex matched healthy controls. The patients were recruited from Dermatology, Venereology and Andrology
Department, Faculty of Medicine, Zagazig University Hospitals in the period from October 2017 to May 2018.
Results:
Results showed that there were statistical significant difference in survivin level among the three groups
showing highest levels in scar group followed by active acne group then control group (P < 0.001). These findings
support that there is a relationship between survivin and developing acne and acne scars. Moreover we found that
there was statistical significant increase in survivin level among cases of active acne with progressive course
compared to stationary cases (P=0.001). There was also statistical significant positive relation between survivin level
and acne severity.
Conclusion:
The findings of this study showed a significant association between survivin level and both active acne
and acne scars, in addition to positive relation between survivin level and severity of acne. All these findings prove
that survivin protein has a potential important role in acne pathogenesis and mechanism of acne scarring.
Keywords: surviving, acne vulgaris, acne severity.

INTRODUCTION
including increased sebum production, increased
Acne vulgaris is a common skin disease
keratinization of the follicular epithelium, inflammation
characterized by sebum overproduction, which is
and overgrowth of normal skin microflora, particularly
hormonally mediated, follicular hyper-keratinization
Gram-positive Propionibacterium acnes (7).
and chronic inflammation of the pilosebaceous unit (1).
Survivin is a member of inhibitors of the
Acne vulgaris is the eighth most prevalent disease
apoptosis (IAP) gene family. It is a 16.5 kDa protein that
worldwide. Almost every individual between 15 and 17
inhibits apoptosis and regulates cell division,
years of age is affected (2). Acne may persist into
proliferation, and survival (8). The expression of survivin
adulthood in approximately 12%­14% of cases causing
is undetectable or is found at very low levels in normal
psychological and social implications due to
tissues, whereas it is found at relatively higher levels in
disfigurement and permanent scarring (3). Acne may be
various malignant tissues, embryonic and fetal tissues,
associated with lasting side effects, including facial
and uncommonly in normal adult tissues, including
scars, feelings of low self-esteem and withdrawal from
skin (9). Interestingly, survivin was not previously
society and depression (4).
evaluated, studied, described, or investigated in the
Acne vulgaris is characterized by non-
fibrosis progression of the cutaneous tissues but its
inflammatory open and closed comedo, and by
upregulation has already been described in certain liver
inflammatory papules, pustules, nodules and sometimes
diseases and during hepatic stellate cell activation. This
purulent sacs. In some cases, acne is accompanied by
proves to large extent the potential role of survivin in
scarring, a consequence of abnormal resolution or
fibrogenesis process, most likely through regulation of
wound healing following the damage that occurs in the
apoptosis (10). Survivin has been found to be increased in
sebaceous follicle during acne inflammation. The
keratinocyte proliferative and inflammatory states,
scarring process can occur at any stage of acne (5). It
which are deeply involved in the pathogenesis of the
affects the area of the body, which contains hormonally
acne lesions (11). This may affect both the sebaceous
sensitive sebaceous glands, including the face, neck,
gland (sebocyte survival) and the perifollicular dermal
chest and upper arms (6). Several independent,
tissue (scar formation). Moreover, nuclear survivin
interacting factors contribute to acne pathogenesis,

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1565
Received:28 /6 /2020

Accepted:27 /8 /2020

Full Paper (vol.813 paper# 5)


c:\work\Jor\vol813_6 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1571-1575

Efficacy of Low-Level Laser on Renal Pruritus in Hemodialysis Patients
Zakaria Mowafy Emam1, Sami Ahmed Abbas², Ahmed Hassan El-Thakaby2,
Marwa Mahdy Abd EL-Hameed 1, Amany Ibrahim Marae Farek1
1Department of Physical Therapy for Surgery, 2National Institute of Urology and Nephrology,
Faculty of Physical Therapy, Cairo University, Giza, Egypt
*Corresponding author: Amany Ibrahim Marae Farek, Mobile: (+20)1012783532,
E-Mail: amanyibrahim1234@icould.com

ABSTRACT
Background:
Renal pruritus is a distressing disease, often overlooked condition in patients with chronic kidney
disease and end-stage renal disease that adversely affect the quality of life (QOL) and medical outcomes of patients
and therapy with antihistamines has been unsuccessful.
Objective: The purpose of the study was to evaluate the efficacy of low-level laser on renal pruritus in hemodialysis
patients.
Patients and methods: Thirty patients who established diagnosis of chronic renal failure with age ranged 35-60
years were selected randomly from Hemodialysis Unit of Al-Galaa military Hospital. Patients were randomized into
two groups of equal number, 15 each. Group (A) received low level laser therapy 3times/week for 8 consecutive
weeks and antihistamine and their conventional medical care. Group (B) who only received antihistamine and their
conventional medical care.
Parameters: Itching visual analogue scale (VAS) and 5-D Pruritus scale.
Results: Compared to the results before and after low level laser (LLLT) treatment. Our study showed that there
was a statistically significant decrease in the results of VAS and 5-D pruritus; but the results of group (A) were
superior to that of group (B) when comparing the group results together.
Conclusion: It can be concluded that low level laser therapy (LLLT) relieves itching pain and lowers progression
of renal pruritus in patients undergoing hemodialysis.
Keywords: Hemodialysis, Renal Pruritus, low level laser therapy, Antihistamine, Itching Visual analogue scale.

INTRODUCTION


Chronic kidney disease (CKD) is defined as either
tissues and nerves and preventing tissue damage in
kidney damage or decreased kidney function (decreased
situations where it is likely to occur (5). Laser treatment
GFR) for 3 or more months (1). Renal pruritus, also
inhibits the release of cyclooxygenase, prostaglandins,
known as uremic pruritus (UP), afflicts from 25% to
and cytokine levels, and it accelerates collagen
86% of patients with CKD (2). Currently, antihistamines
synthesis and cell proliferation. It also decreases pain
are prescribed as a standard routine therapy for pruritus,
levels, improves tissue repair, and inhibits A and C
but they never provide full relief on their own for
fiber transmission due to its effect on nerve structures
patients with moderate to severe itch. Such patients
and functional disability (6).
produce excessive histamine, and antihistamines do not
The aim of this work was to evaluate the efficacy of
act by desensitizing or inhibiting the itch receptors, so
low-level laser on renal pruritus in hemodialysis
sufficient relief from itching is not attained (3).
patients.
It has been suggested that phototherapy is a safe and

efficacious management modality which decreases
PATIENTS AND METHODS
pruritus and can be used across age groups that provide
Thirty men patients who established diagnosis of
relief for UP patients without many of the risks and
chronic renal failure (CRF) with age ranged 30-60 years
adverse effects of systemic medications and probably
were selected randomly from Hemodialysis Unit of Al-
lowers inflammation and improve quality of life (4).
Galaa military Hospital, Cairo, Egypt.
Low level laser therapy (LLLT), phototherapy or photo
The included subjects were randomly distributed
biomodulation refers to the use of photons at a
into two equal groups; Group A (Study group)
nonthermal irradiance to alter biological activity. LLLT
consisted of 15 men patients on hemodialysis treatment
uses coherent light sources, non-coherent light sources
and received low level laser therapy (LLLT), for 10-15
consisting of filtered lamps or LED, or, on occasion, a
minutes, 2 times/week, for 2 months in addition to
combination of both. LLLT is a safe and cost-effective
conventional medical treatment (antihistamine), and
treatment modality. The main medical applications of
Group B (Control group) consisted of 15 men patients
LLLT are reducing pain and inflammation, augmenting
who only received antihistamine and their conventional
tissue repair and promoting regeneration of different
medical care.

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1571
Received:28 /6 /2020

Accepted:27 /8 /2020

Full Paper (vol.813 paper# 6)


c:\work\Jor\vol813_7 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1576-1582

Prediction of Maturation of The Fetal Lung by Lamellar
Bodies' Count of Amniotic Fluid in PPROM
Yossef Abu Elwan Elsayed, Walid Abdallah Abd Elsalam, Mostafa Abdou Ahmed,
Ahmed Mohamed Mahmoud El-Sayyad
Department of Obstetrics and Gynecology, Faculty of Medicine ­ Zagazig University
*Corresponding Author: Ahmed Mohamed Mahmoud El-Sayyad, Mobile: 01148376114,
Email: Ahmedhunter2020@gmail.com



ABSTRACT
Background: There are many risk factors for Preterm Premature Rupture of Membranes (PPROM). Infection
is the main one (15-25%), especially at earlier gestational ages. Neonatal respiratory distress syndrome of the
neonate is an important obstacle in cure of preterm infants.
Objective: To assess the efficacy of the amniotic fluid lamellar body counting (LBC) from vaginal pool in
predicting fetal lung maturity in women with preterm premature rupture of membranes.
Patients and Methods:
This study was conducted on 92 cases. Prediction of fetal lung maturity and the
presence of respiratory distress syndrome (RDS) were estimated. LBC was measured for all cases.
Results: There were a significant negative correlation between respiratory distress syndrome and gestational
age. Also a significant correlation between level of LBC and fetal lung maturity using 38.0 (x103/L) as a cut-
off point for LBC; as it is can be considered a good predictor for fetal lung maturity with sensitivity 92.9% and
specificity 90.6%, positive predictive value of 81.3% and negative predictive value of 96.7%.
Conclusion:
There is a significant correlation between level of LBC and fetal lung maturity. LBC could be
considered a good predictor for fetal lung maturity.
Keywords: Lamellar body counting- Fetal lung maturity-Preterm premature rupture of membranes.

INTRODUCTION

tests estimate components of the surfactant which
Preterm Premature Rupture of Membranes
are the lecithin/sphingomyelin
ratio
and
(PPROM) is defined as spontaneous rupture of the
phosphatidylglycerol. The physical tests estimate
amniotic membranes before 37 weeks gestation and
the physical characteristics of the phospholipid
before the time of labor. There are many risk factors
surfactants which are the surfactant/albumin (S/A)
for PPROM. Infection is the main one (15-25%),
ratio and lamellar body counts. These tests depend
especially at earlier gestational ages. Previous
on the amniotic fluid which reflects the fetal lung
history of PPROM, shortness of cervical length,
fluid components (4).
second-trimester and third-trimester hemorrhage,
Lamellar bodies are found in intracellular
decreased body mass index, bad socioeconomic
storage granules in lung cells or pneumocytes. The
status, smoking, and drugs intake are also major
lamellar bodies are discharged to become a
risk factors for PPROM (1).
surfactant monolayer in the alveolar space.
Respiratory distress syndrome is a main
Surfactant and lamellar bodies are secreted into
reason of fetal morbidity and mortality that is
amniotic fluid due to fetal breath movements
caused by a decreased level of lung surfactant in
starting around 28 to 32 weeks of fetal
premature
fetus.
Therefore,
laboratory
development. The risk of respiratory distress
investigations were developed to measure the
syndrome
due
to
decreased
surfactant
presence and/or level of pulmonary surfactant and
concentrations is appeared during gestational
lamellar bodies in amniotic fluid to evaluate
weeks 32 to 36, and more accurate evaluation of
maturity of the fetal lung (2).
that risk is facilitated by estimation of surfactant
Neonatal respiratory distress syndrome of the
phospholipid levels or, as was shown, by lamellar
neonate is still an important obstacle in cure of
body counts (LBC) (5).
preterm infants. It is associated by inflammatory
Lamellar body count is a direct assessment of
occurrence with free radical generation and
surfactant releasing by type II pneumocyte cells
oxidative stress (3).
within the pneumocytes in fetal alveolus and
Fetal lung maturity testing can give us
released to amniotic fluid during respiratory
information to prevent a preterm delivery or to start
movement that have the same size of the platelets
maternal drug therapy to support lung maturity. The
(6).
fetal lung maturity tests can be divided into 2
The diameter of intact lamellar body is about 1 to 5
groups, biochemical and biophysical. Biochemical
microns and its volume is about 1.7 to 7.3 fl (7).

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1576
Received:29 /6 /2020

Accepted:28 /8 /2020

Full Paper (vol.813 paper# 7)


c:\work\Jor\vol813_8 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1583-1589

Assessment of Vitamin D Level and Osteoporosis in
Children with Sickle Cell Anemia
Mohamed Ahmed Badr1, Amal Mohamed Abdel-Latef1,
Nermin Raafat Abdel Fattah2, Asmaa Hassan Soliman Attia*1
Departments of 1Pediatrics and 2Medical Biochemistry, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding Author: Asmaa Hassan Soliman Attia, Mobile: (+20) 01007388138,
Email: eslamawahab@yahoo.com

ABSTRACT
Background
: Calcium and vitamin D are important for bone metabolism. The low calcium intake leads to a reduction
in the ideal bone mass peak in children with sickle-cell anemia, which determines growth failure. There is little
information on BMD in children with SCD and its association with 25(OH)D levels.
Objective: To evaluate the relation between Vitamin D level and bone mineral density in children with sickle cell
disease.
Patients and Methods:
This cross-sectional study was conducted over 6 months from February to August 2018. It
included 30 patients (14 males and 16 females) with SCD who were following up regularly, at Pediatric Hematology
outpatient clinics of Zagazig University Hospitals, their ages ranged from 6-18 years (mean ±SD=12.3+3.84).
Results:
more than ¾ of the studied group has a deficient level of vitamin D (83.3%). BMD of L1-L4 is normal in
only 13.3% of the studied patients and BMD of total body is normal in the fifth of the studied patients (20%).
Correlation is non-significant between bone markers and Z-score of BMD, Z-score of BMD L1-L4, and vitamin D
level among the studied sickle cell disease cases.
Conclusion:
Vitamin D deficiency is a major nutritional health problem in patients with sickle cell disease.
Emphasizes the need for vitamin D level screening for all SCD patients. Children with SCD have low BMD. There
was no statistically significant correlation between vitamin D and (Z-score of BMD L1-L4, Z-score of BMD total
body, Osteocalcin, and Beta cross lab) among the studied sickle cell disease cases.
Keywords:
Sickle Cell Anemia, Vitamin D, Osteoporosis.


INTRODUCTION

Sickle cell disease is caused by a mutation
lesions (3). Recent studies show that children with SCD
resulting from an exchange of nitrogenous bases in the
frequently have severe vitamin D deficiency. Children
sixth codon of the beta-globulin hemoglobin gene,
with sickle cell disease (SCD) often develop bone
generating abnormal hemoglobin called hemoglobin S
complications manifested as vaso-occlusive bone pain
(HbS) (1). The manifestations of the sickle-cell disease
crises, dactylitis, osteomyelitis, avascular necrosis, or
are due to the presence of HbS, of which molecules are
vertebral deformity. In this population, the literature
organized into polymeric beams when deoxygenated
describes a decrease in BMD secondary to chronic
and give the RBC an elongated and rigid conformation,
anemia and bone marrow hyperplasia and associated
called a "sickle-shaped red blood cell.
with a higher risk of osteopenia and osteoporosis (4).
After the sickling process, the red blood cells
Despite the higher risk of bone disease in this
begin to show changes in membrane proteins and
population, there is little information on BMD in
increased expression of adhesion molecules that,
children with SCD and its association with 25(OH)D
consequently, lead to red blood cell adhesion to the
levels and the risk of fractures (3).
endothelium. This process triggers an inflammatory
This work aimed to evaluate Vitamin D level and
phenomenon, activation of coagulation, hypoxia,
its relation to bone mineral density in children with
ischemia, and local infarction, in addition to reduced
sickle cell disease.
RBC survival (2).

Calcium and vitamin D are important for bone
PATIENTS AND METHODS
metabolism, and the low calcium intake leads to a
This cross-sectional study was conducted over 6
reduction in the ideal bone mass peak in children and
months from February to August 2018. It Included 30
adolescents with sickle-cell anemia, which determines
patients (14 males and 16 females) with SCD who were
growth failure. Vitamin D deficiency, in turn, is
following up regularly, at Pediatric Hematology
associated with increased respiratory infections,
outpatient clinics of Zagazig University Hospitals,
muscle weakness, and increased risk of falls and micro
their ages ranged from 6-18 years (mean

±SD=12.3+3.84).

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1583
Received:28 /6 /2020

Accepted:27 /8 /2020

Full Paper (vol.813 paper# 8)


c:\work\Jor\vol813_9 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1590-1596

Role of the Pediatric Early Warning Score in Identification of Patients in
Need to Pediatric Intensive Care Units Admission
Mohamed Mamdouh Gaafar, Mohamed Mahmoud Shehab, Mohab Saad Mansour
Department of Pediatrics, Faculty of Medicine ­ Zagazig University
Corresponding Author: Mohab Saad Mansour, Mobile: (+20)01000847013, Email: mohab4414@gmail.com

ABSTRACT
Background:
Pediatric Early Warning Scores (PEWS) are physiologically-based scoring systems developed to
identify patients admitted to inpatients pediatric wards and emergency departments.
Objective: Our study objective was to explore if the PEWS assigned in the ED or ward predicts the need for ICU
admission from the ED or clinical deterioration in admitted patients.
Patients and Methods:
This retrospective study was carried out at the Pediatric Intensive Care Units of Zagazig
University Hospitals on 53 children admitted to Pediatric Intensive Care Units (PICUs) in the period from June 2017
to June 2018. PEWS scores were measured at initial assessment (H0) and time of admission (H1).
Results:
We evaluated 12 different PEWS and the ability to predict early deterioration and the need to ICU admission.
We also reported that ward has the highest percentage in admission by 60.4% to ICU, then emergency room by 39.6%.
The patients included 32 (60%) males and 21 (40%) females with mean age 17.42 ± 28.002 months. Pneumonia had
the highest percentage by 32.1%, and then fulminant hepatic failure comes in second place by 22.6%, followed by
sepsis 13.2%. Mean duration length of staying in hospital before admission to PICU was 2.05 ± 2.89 days, and the
mean after admission to PICU was 5.16 ± 6.69 days. Patients admitted from ward were statistically higher in hospital
stay before admission to PICU. Conclusion: pediatric early warning score can be helpful in predicting patient
disposition in pediatric emergency department (ED) with acceptable validity and can serve as a potentially excellent
screening tool for prediction of ICU admission.
Keywords: Pediatric Early Warning Scores- Pediatric Intensive Care Units ­ Prediction.

INTRODUCTION


The early identification of patients at risk of
and persistent postsurgical vomiting. Monaghan's
clinical deterioration and matching the severity of
PEWS has been validated in retrospective studies of
illness to the appropriate level of care are integral
the inpatient floor setting of pediatric hospitals (3).
components of high-quality medical care, as is
Despite the extensive literature discussing
appropriate resource allocation in the hospital setting.
PEWS in the inpatient setting, there are limited
The establishment and implementation of inpatient
published studies evaluating the utility of PEWS
medical emergency teams address the deterioration of
systems in the pediatric emergency department (ED).
hospitalized patients. Prior studies in adults and
To date, there are two studies evaluating the ability of
children have demonstrated that physiologic changes
PEWS systems to predict which patients in the
in patient status can be identified in the hours
pediatric ED need admission to the intensive care unit
preceding cardiac arrest (1).
(ICU). A recent study from a pediatric hospital in
The medical emergency teams (MET) concept
Netherlands evaluated the validity of multiple PEWS
was designed as a direct response to the impending
scores. The authors tested the performance of ten
deterioration of a patient admitted to the hospital, but
different established PEWS in the ED, with the
ideally such patients should be identified as early and
discriminative ability of each PEWS determined to be
accurately as possible. Recent studies have been
poor to moderate for predicting hospitalization and
geared toward early warning scores and their ability to
moderate to good for predicting ICU admission (4).
identify at risk patients. For children, the original
A second study by Breslin et al. (5) sought to
concept of a Pediatric Early Warning Score (PEWS)
determine the association between PEWS at time of
system was developed to provide a reproducible
ED disposition and level of care and included both
assessment of the pediatric patient's status based on
admitted and discharged patients in the cohort. They
physiologic parameters (2).
concluded that PEWS is associated with the level of
Multiple pediatric scoring systems have been
care at ED disposition, but cannot accurately be used
developed worldwide, and Monaghan's PEWS is one
in isolation. Most earlier studies investigating the
of the most simple and flexible systems. It is quickly
various uses of PEWS in hospitalized patients had
performed, not age specific and has five domains:
positive findings, implying that a PEWS will help
behavior, cardiovascular status, respiratory status,
identify those patients who will go on to need intensive
nebulizer use
care therapies.

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1590
Received:229 /6 /2020

Accepted:28/8 /2020

Full Paper (vol.813 paper# 9)


c:\work\Jor\vol813_10 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1597-1602

Association between Helicobacter pylori and Iron Deficiency Anemia in
Preschool Children
Amr Megahed Abo El-Naga1, Amal Mohamed Abd El-laatef1,
Naglaa Ali Khalifa2, Mohamed El-Tabey Awad*1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University
*Corresponding Author: Mohamed El-Tabey Awad, Mobile: 01097508127, Email: mohamed.eltab3y@gmail.com

ABSTRACT
Background:
Helicobacter pylori is a gram-negative helical microaerophilic flagellated bacterium contained by a
majority of the world's population in the sterile gastric mucosa. It is considered as a significant pediatric
gastroenterology pathogen that is acquired in early infancy.
Objective: This study aimed to detect Helicobacter pylori infection in preschool children with iron deficiency anemia
and compare them to a control healthy group.
Patients and Methods:
The present study was a single blinded randomized controlled interventional trail that was
conducted in Pediatric and Clinical Pathology Departments, Zagazig University Children Hospital during the period
from August 2017 to May 2018. 44 patients that were randomly divided into 2 groups. Group 1 included 22 diagnosed
as iron deficiency anemia with Hb less than 11g/d. Group 2 included 22 apparently healthy children.
Results: In the present study, we used H. pylori stool Ab test to detect Helicobacter pylori infection in the children of
the study and it is found that there was increased incidence of H. pylori infection in group I (77.3% vs 4.5% in group
II).
Conclusions: There was significant increased incidence of Helicobacter pylori infection in children with iron
deficiency anemia and children with refractory iron deficiency anemia compared to healthy ones. This indicates that
Helicobacter pylori may be one of the significant causes of iron deficiency anemia and refractory iron deficiency
anemia.
Keywords:
Helicobacter pylori, Iron Deficiency Anemia , Preschool children.

INTRODUCTION
children in the developing world. Across industrialized
Anemia is characterized by a decline in total
nations, IDA remains is a common cause of anemia
hemoglobin, or red blood cell count. Iron deficiency
across young children following a demonstrable
anemia is a type of anemia due to lack of enough iron to
decrease in prevalence. However, the suggestion that
shape normal red blood cells. Iron deficiency anemia is
the more common ID without anemia may also
usually caused by inadequate iron intake, chronic blood
adversely affect long-term neurodevelopment and
loss or a combination of both. Iron deficiency anemia is
behavior, which is perhaps more significant than
the world's most common cause of anemia (1).
anemia itself, and that some of these effects may be
Pediatric Nutrition Surveillance System Report
irreversible (4).
indicated a rise in the incidence of anemia in children
Helicobacter
pylori
is
a
gram-negative
with low incomes. Anemia should not be treated as a
microaerophilic flagellated bacterium found in majority
diagnosis but as a finding that needs further
of the world's population's gastric mucosa. The presence
investigation. It is usually caused in children by
of bacteria in the stomach was already established as in
decreased RBCs development or increased RBCs
the late 19th century (5). Helicobacter pylori (H. pylori)
turnover. Most children suffering from moderate
is a major pediatric gastroenterologic pathogen that is
anemia have no signs or symptoms. Some may show
acquired in early childhood, and are more common in
shortness of breath with pallor, irritability, or
developing countries. These bacteria infect more than
palpitations. Physical exams can show tachypnea,
half of the world's population. Infection rates in both
tachycardia, and heart failure, especially in children
sexes are similar, although some studies reported a
with severe or acute anemia (2).
slight increase in male predominance. Prevalence
Iron deficiency anemia is characterized as a
increases with age and is more frequent in Asians and
hemoglobin below the fifth percentile for age normal
Africans. The clinical effects of this infection are still
caused by iron deficiency. Most studies showed that
in the evolution stage in children (5).
the cut-off point was about 11g/dL (-2 SD lower than
Helicobacter pylori is associated with a number of
mean) (3). Iron deficiency (ID) and iron-deficiency
extra-gastric disorders including iron deficiency
anemia (IDA) remain of concern worldwide. Iron is
anemia, chronic idiopathic purpura, growth retardation
the most common single nutrient deficiency among
and diabetes mellitus (6). Several reports indicated a

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1597
Received:29 /6 /2020

Accepted:28 /8 /2020

Full Paper (vol.813 paper# 10)


c:\work\Jor\vol813_11 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1603-1608

Candidemia in Preterm Infants in Neonatal Intensive Care Unit at Zagazig
University Hospitals
Omima Ahmed Fatooh Abdelhameed Eissa 1, Hanaa Abdelfatah Mohammed 1,
Tarek Hamed Attya 1, Ghada Elsayed Amr 2
Departments of Pediatrics and Neonatology and Clinical Pathology, Faculty of Medicine - Zagazig University
Corresponding Author: Omima Ahmed Fattoh Abdelhameed Eissa,
Mobile: 01123324227, Email: Omima.a.eissa@gmail.com

ABSTRACT
Background:
Candidiasis is a leading cause of blood stream infections in neonatal intensive care units (NICUs) and
associated with high mortality and morbidity. Preterm infants are more vulnerable to be affected with candida
infections.
Patients and Methods:
The study is cross-sectional analytical study aimed to evaluate the magnitude of candidemia
and evaluate risk factors, proper management, and clinical outcome of candidemia in preterms in NICU in Zagazig
University Hospital. It included (103) preterms, their gestational ages of 30 to 37 weeks with weights of 1 to 3 kg.
They were admitted to (NICU) of Pediatric Department and Obstetric and Gynecology Department. Investigations
were conducted at the Department of Clinical Pathology and Microbiology at Zagazig University Hospitals during the
period of 6 months from November 2018 to April 2019.
Results
: 12.6% of the studied group gave positive fungal culture, Candida albicans was the commonest type of fungi
found (among 61.5% of the candidemia positive group). 30.8% of candidemia group had taken empirical diflucan as a
regimen versus 95.6% of the other group had taken it and the difference between groups was highly statistically
significant.
Conclusion
: Preterms are more vulnerable to candida infection. Candida albicans is the commonest type and the use of
empirical antifungal therapy to preterms at risk reduces the prevalence of candidemia in the NICU.
Keywords:
Preterm, Candidemia, NICU, Empirical, Antifungals.

INTRODUCTION

In patients at risk for invasive candidiasis,
We can find candida normally inside the body
empirical antifungal therapy with the administration of
causing no harm but if they grow out of control or
antifungals prior to the availability of culture is known
affect deep organs of the body (brain, kidney or the
to improve survival (2). In infants with blood cultures
heart), candidiasis occur (1).
positive for Candida, an appropriate dose of
When candida infection occurs in the blood
antifungals given. If the patient is receiving
stream it is called candidemia (2) which is associated
fluconazole prophylaxis or if Candida glabrata is
with high mortality and morbidity (3) especially in
isolated, then an amphotericin product or micafungin
preterms as they are considered immunocompromised
should be given (10).
with early gestational ages and low birth weight.
The present study aimed to evaluate the
Under some circumstances as (catheterization,
magnitude of candidemia and evaluate risk factors,
mechanical ventilation (MV), parenteral nutrition,
proper management, and clinical outcome of
broad spectrum antibiotics and corticosteroids)
candidemia in preterms in NICU in Zagazig University
systemic candidiasis commonly occur (4).
Hospital.
Candida pathogenicity involves: adherence,

colonization, infection, dissemination (5). Candidemia
SUBJECTS AND METHODS
in neonates could be presented with signs and
The study is cross-sectional analytical study
symptoms that are indistinguishable from bacterial
included (103) preterms, their gestational ages of 30 to
sepsis and newborns who survive frequently have
37 weeks with weights of 1 to 3 kg. They were
long-term neurological impairment (6, 7, 8).
admitted to (NICU) of Pediatric Department and
Workup and evaluation for fungal infections in
Obstetric and Gynecology Department. Investigations
preterm infants includes: CBC, blood culture, urine,
were conducted at the Department of Clinical
and cerebrospinal fluid (CSF) cultures, and liver and
Pathology and Microbiology at Zagazig University
renal function (2). Fungal PCR in very low birth weight
Hospitals during the period of 6 months from
(VLBW) infants has yielded promising results but
November 2018 to April 2019.
requires additional study to be used with every
Ethical approval:
infection evaluation (9).


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1603
Received:29 /6 /2020

Accepted:28 /8 /2020

Full Paper (vol.813 paper# 11)


c:\work\Jor\vol813_12 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1609-1613

Evaluation of Serum RANTES as a Biomarker in the Diagnosis of
Early-Onset Neonatal Infections
Mahmoud Mohammed Abd-Elsamea*1, Azza I. El-dousoky1,
Hadeel M. Abd El-Rahman1, Randa Hussiny Mohammad2
Departments of 1Pediatrics and 2 Medical Biochemistry, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Mahmoud Mohammed Abd-Elsamea. Contact: +201550903974
Email: mahmod.mohmed222@gmail.com
ABSTRACT
Background:
Globally, sepsis is still one of the major causes of morbidity and mortality in neonates, despite recent
advances in health care units.
Objective: To assess the accuracy of serum chemokine RANTES as a biomarker for early-onset neonatal infection
as early diagnosis and to assess its relationship with gestational age, birth weight, sex, mode of delivery, and value of
some hematological and biochemical parameters facilitating early good treatment.
Patients and Methods
: This case-control study was carried out on neonates with early-onset neonatal infections that
were admitted to the Neonatal Intensive Care Unit of Zagazig General Hospital. This study included 45 matched age
and sex neonates divided into three groups.
Results:
Significantly higher levels of RANTES were found in neonates with EONS compared with non-infected
cases. RANTES levels were significantly higher in infected term &preterm neonates compared to healthy controls.
Infected full-term neonates had higher RANTES levels than in infected preterm neonates without a statistically
significant difference. A positive correlation between serum RANTES concentration and CRP value was found in
both infected neonates groups. On the other hand, no correlation between RANTES and the number of white blood
cells, platelets, or hemoglobin was noted.
Conclusion:
The significant increase of serum RANTES concentration in early-onset infections in neonates,
regardless of their gestational age, birth weight, and Apgar score, not only proves the presence of an active
immunological process but also may be a useful biomarker for diagnosis of early-onset severe neonatal infections.
Keywords: RANTES, Biomarker, Early, Onset Neonatal Infections.

INTRODUCTION

Globally, sepsis is still one of the major causes of
A particular subject of interest of researchers is
morbidity and mortality in neonates, despite recent
chemotactic cytokines, one of whose representatives is
advances in health care units (1).
RANTES (regulation on activation normal T-cell
The mortality rate as a consequence of irreversible
expressed and secreted). It is produced by
septic shock ranges from 20 to 50%. The most frequent
macrophages,
epithelial
cells,
platelets,
clinical forms of severe early-onset infections are sepsis,
megakaryoblasts, T lymphocytes, and eosinophils. It
pneumonia, meningitis, and urinary tract infections (2).
acts through CCR1, CCR3, and CCR5 receptors. It has
On the other hand, the survivors of neonatal sepsis
an effect on chemotaxis of monocytes, T lymphocytes
are
vulnerable
to
short-
and
long-term
(including memory cells), NK cells, eosinophils,
neurodevelopmental morbidity (3).
dendritic cells, and mast cells including adhesion
Diagnosis of sepsis is a formidable challenge
molecules VCAM-1 and ICAM-1. Moreover, it
for NICU because clinical signs of sepsis are
activates histamine secretion by mast cells, stimulates
nonspecific, subtle, and are observed in other non-
lymphocyte proliferation and IgE and IgG production,
infectious conditions. Furthermore, bacterial cultures
increases the expression of CD80 on antigen-
are time-consuming, frequently false negative,
presenting cells, and activates the cytotoxicity of T
especially in neonates, due to low or intermittent
lymphocytes and NK cells (6).
bacteremia, small blood inoculation volumes, or
This study aimed to assess the accuracy of
intrapartum antibiotics use. Despite its limitations,
serum chemokine RANTES as a biomarker for early-
blood cultures remain a gold standard (4).
onset neonatal infection as early diagnosis and to
The early diagnosis of neonatal infection,
assess its relationship with gestational age, birth
especially sepsis in preterm neonates, before clinical
weight, sex , mode of delivery, and value of some
signs, is important to start antimicrobial therapy and
hematological
and
biochemical
parameters
prevent
unfavorable
complications,
such
as
facilitating early good treatment.
intraventricular
hemorrhage,
periventricular

leukomalacia, bronchopulmonary dysplasia, and long-
MATERIALS AND METHODS
term consequences, mainly cerebral palsy (5).
This Case-control study carried out on neonates
with early-onset neonatal infections that were

This article is an open access article distributed under the terms and conditions of the Creative
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http://creativecommons.org/licenses/by/4.0/)
1609
Received:30 /6 /2020

Accepted:29 /8 /2020

Full Paper (vol.813 paper# 12)


INTRODUCTION The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1614-1620

Effect of Phototherapy on Serum Zinc Level in Neonatal Jaundice
Abdulmagid Mohammed Baiomi1, Khaled Hassaan Hassan1,
Mohammed Ahmed Besher2, Mahmoud Hussein Mahmoud*1
Departments of 1Pediatrics & Neonatology and 2Clinical Pathology, Faculty of Medicine,
Al- Azhar University, Assiut
*Corresponding author: Mahmoud Hussein Mahmoud, Mobile: (+20) 01065272779,
E-Mail: Drmahmoudhussein777@gmail.com

ABSTRACT
Background:
Zinc salts can reduce phototherapy duration by precipitating unconjugated bilirubin in the intestine
however, zinc toxicity is an issue that must be considered. Theoretically, bilirubin reduction by phototherapy may
increase serum zinc levels, making additional zinc supplementation, which cause zinc toxicity.
Objectives: To evaluate serum zinc level alterations before and after phototherapy in hyperbilirubinemic
newborns.
Materials and Methods: A prospective cross sectional case-control study was performed at Neonatal Intensive
Care Unit (NICU), Al-Azhar University Hospital, Assiut. 150 newborns aged between 2-7 days divided into 50
healthy neonates without hyperbilirubinemia (control group) and 100 neonates with physiological jaundice who
required phototherapy (case group). Participants were treated according to American Academy of Pediatrics (AAP)
criteria. Serum zinc level was measured before and after phototherapy.
Results: The mean age of onset was approximately 2 days, while the majority of patients were females and
delivered with cesarean section. The age at admission was 3.09 ± 0.57 days. In regard to our primary outcomes,
serum bilirubin level was decreased significantly after phototherapy to reach 8.47 ± 1.36 mg/dl (p < 0.001). Serum
zinc level was increased significantly after phototherapy to reach 75.45 ± 14.94 mcg/mL (p < 0.001). The
comparison between control and study groups regarding serum zinc level showed that there was highly statistically
significant difference being higher in case group compared to control group (p < 0.001). Phototherapy was associated
with a significant increase in serum zinc level in neonates.
Conclusions: Phototherapy increases serum zinc level by reducing bilirubin level so additional supplementation of
this element can lead potentially zinc toxicity.
Keywords: Hyperbilirubinemia, Zinc, Phototherapy, Neonatal Jaundice.

INTRODUCTION
pathogenesis of neonatal jaundice (5). Moreover, it has
Bilirubin is produced by the catabolism of heme
been recently postulated that increased enterohepatic
in the reticuloendothelial system. This bilirubin is in an
circulation (EHC) of bilirubin may occur with ileal
unconjugated form and is released into the circulation
inflammation, resection or bypass resulting in biliary
and transported to hepatocytes where it combines
hypersecretion of bilirubin with enhanced black
enzymatically with glucuronic acid, producing bilirubin
pigment gallstone formation (6).
mono- and diglucuronides. The conjugation reaction is
The existence of EHC bilirubin was first
catalyzed by uridine diphosphate glucuronosyl
described in early 1960s when radiolabeled bilirubin
transferase (1).
became available. Based on the data, it was suggested
Jaundice, or yellowish discoloration of the
that bilirubin must be deconjugated before
skin, can occur due to an increased amount of
reabsorption from the intestine. As no active transport
bilirubin pigment in the blood (2). Neonates with
for UCB has been proved in the intestine, bilirubin
severe hyperbilirubinemia are endangered because of
may cycle enterohepatically only by passive diffusion
possible accumulation of bilirubin in tissues,
under specific conditions that occur, for instance,
particularly in the brain causing acute bilirubin
during the neonatal period or in patients with
encephalopathy and its chronic sequelae such as
pathology of the distal ileum. Interestingly, only one
cerebral palsy, sensorineural hearing loss, intellectual
third of bilirubin reabsorbed from the intestine is
difficulties or gross developmental delays (3).
cleared by the liver during the first pass; the remainder
Phototherapy is the single most common
may enter the systemic circulation (6).
intervention used for the treatment of neonatal
Enterohepatic Circulation (EHC) may be
jaundice. The greater the surface area exposed, the
exaggerated in the neonatal period, in part because
greater the effectiveness of phototherapy (4). Several
the newborn intestinal tract is not yet colonised with
lines of evidence suggest the importance of intestinal
bacteria that convert unconjugated bilirubin (UCB) to
metabolism of unconjugated bilirubin (UCB) in the
urobilinogen
and
because
intestinal
beta
glucuronidase activity is high (7).

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1614
Received:30 /6 /2020

Accepted: 29/8 /2020

Full Paper (vol.813 paper# 13)


c:\work\Jor\vol813_14 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1621-1627

The Assessment of Infection Control Measures in
Dental Clinics Primary Health Care , Bilqas, Dakahlia
Taghreed M. Farahat, Nagwa Hegazy, Mohammed A. Mohammed*
Family Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Mohammed Abdallah Mohammed, Mobile: (+20) 0155 788 8875,
E-mail address: mohamed.a.elattar022@gmail.com

ABSTRACT
Background:
The emergence of life-threatening infectious diseases demands the implementation of efficient
infection control practices in health care facilities. Failure to adhere to such infection control measures may lead
to the spread of pathogens and microorganisms which damage the health of both the healthcare personnel and the
community in general.
Objectives: This study aimed to assess the practices of infection control procedures among dental staff through
the application of a health education program.
Subjects and methods:
It was an intervention study conducted at a dental clinic at Bilqas District in Dakahlia
Governorate to assess the knowledge and attitude of staff concerning infection control practice. The study included
the doctors and nurses (20 dentists and five nurses) working in the clinic.
Results: The results of the study revealed that there was a highly significant increase in infection control measures
score and the total score; also, there was a significant increase in occupational safety measures score and waste
disposal score after the intervention.
Conclusion: The infection control measures implemented by health care providers in their dental practice were
effective. Hence, it is necessary to educate, raise awareness of professionals, and promote constant updating
courses on procedures aiming at improving safety in the dentistry practices.
Keywords: Cross-infection, Infection control, Practices, Medical Waste, Dentist Role

INTRODUCTION


Patient safety is a vital medical discipline that
Primary health care centers (PHC) at Bilqas
targets improving the quality of patient care,
District. Lists of all dental clinics in the PHC in Bilqas
minimizing treatment errors, and ensuring safety.
District were identified (20 clinics). All Dental staff
Infectious diseases represent a public health concern
were invited to participate in the study. The total
that challenges health care systems in many countries.
number of dentists was 20, all of whom agreed to
Dental care is not free from risk (1).
participate; there were only five nurses specialized in
The role of infection control is to eliminate
dental care and they consented to participate in the
the transfer of microorganisms which may be
study. The participants were asked to fill in a
accomplished in several methods. These methods
questionnaire. The pre-structured questionnaire
include the use of personal protective equipment,
included:
immunization of dental healthcare workers against

the infectious disease of concern, correct cleaning,
1. Personal and occupational data of the dentists:
and disinfection of surfaces and instruments, and
These data comprised age, sex, residence, marital
proper technique for handling sharp instruments (2).
status, qualification, and the number of years of
Bacterial, fungal and some viral infections
dental practice.
can be completely avoided if strict infection control
measures are followed. About 36% of these infections
2. Pattern of practice: This item was concerned with
are preventable through the adherence to strict
the medical practice of dentists like the number of
guidelines by healthcare workers when providing
working hours per day, the number of patients seen
dental services to patients (3). Thus, this study aimed
daily.
to assess the practices of infection control among
The second tool was a valid and reliable
dental staff after the application of a health education
observation checklist for practice assessment adopted
program.
from The United States Department of Labor's

Occupational Safety and Health Administration
METHODOLOGY
(OSHA) regulations and recommendations of the
An intervention study was carried out between
Egyptian Central Dentistry Administration. The
August and December 2019. The participants were
occupational checklist was formed of three main
doctors and nurses who work at dental Clinics in the

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icle distributed under the terms and conditions of the Creative
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1621
Received:30 /6 /2020

Accepted:29 /8 /2020

Full Paper (vol.813 paper# 14)


c:\work\Jor\vol813_15 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1628-1633

Evaluation of the Association between Acne Vulgaris and Metabolic Syndrome in
Adolescents at Zagazig University Hospitals
Ghada Ibrahim Ahmed, Ayman Elsayed Yousef, Eman Salah El-Din
Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
Corresponding author: Ghada Ibrahim Ahmed, Mobile: +201202033360,
Email: Ghada.ibrahim1987@gmail.com

ABSTRACT
Background:
Acne vulgaris is an epidemic inflammatory disease of the human sebaceous follicle and represents the
most common skin disease affecting about 85% of adolescents. Until recently, very little was known about the link
between metabolic syndrome (MetS) and skin diseases. Over the past several years, it has been reported that MetS is
potentially associated with numerous dermatological conditions, of which acne vulgaris.
Objective: To determine the relation between acne vulgaris and metabolic syndrome in adolescent males and females
with different severities of acne vulgaris.
Material and Methods:
A cross-sectional study on acne vulgaris patients, carried out in the outpatient clinic of
Dermatology, Venereology and Andrology Department, Faculty of Medicine of Zagazig University Hospitals in the
period from October 2017 to August 2018. This study included 60 patients of acne vulgaris of both sexes aged 10-19
years old.
Results:
We found no statistically significant difference in age and sex between different patients with different disease
severity. Also, no significant difference in fasting blood glucose, waist circumference, triglycerides, HDL, and blood
pressure between different patients with different disease severity. There was a statistically significant difference in waist
circumference and diastolic blood pressure only. There was no significant correlation between disease severity and
metabolic syndrome criteria in the studied group.
Conclusion:
Face is the commonest site affected. No association was found between acne vulgaris and metabolic
syndrome in our study. No significant difference between different patients with different disease severity and (laboratory
data, blood pressure).
Keywords: Acne vulgaris, Metabolic syndrome, adolescents.

INTRODUCTION
Acne vulgaris affects approximately 85% of the
who had no acne. Enhanced mTORC1 signaling is a
adolescent population. It affects over 90% of males and
known characteristic of insulin resistance, obesity, and
80% of females in all ethnic groups (1). In Egypt, El-hamd
T2DM (4). Metformin, a commonly used drug for diabetes
et al. (2) reported the prevalence of acne in 60% of female
treatment that was identified as an mTORC1 inhibitor, is
secondary school students.
currently being considered as a candidate for treating
Acne vulgaris is a sebaceous gland disease related to
insulin-resistant skin diseases, including acne vulgaris. A
inflammation and metabolism. The sebum secretion of
reduction of acne was observed in young males who
sebaceous glands is mainly influenced by hormones,
adopted a hypoglycemic diet in conjunction with
especially
dihydrotestosterone.
Although
the
metformin therapy (5).
composition of sebum is roughly the same in people with
Overall, young patients with acne have a higher
or without acne, acne populations are always
tendency to develop insulin resistance, which may be a
accompanied by varying degrees of excessive secretion
stage of prediabetes, and these patients may eventually go
and seborrhea. (3)
on to develop T2DM. Thus, close observation of insulin-
Experimental evidence has indicated that the
resistant acne patients is clinically significant for
mechanistic target of rapamycin (mTOR) expression
controlling disease progression (6).
levels in the skin lesions of acne patients is positively
The present study was aimed to determine the
correlated with the magnitude of insulin resistance. The
relation between acne vulgaris and metabolic syndrome
activity of the mechanistic target of rapamycin complex
in adolescent males and females with different severities
1 (mTORC1) was found to be elevated in the glands and
of acne vulgaris.
injured skin of patients with acne compared with those


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

1628
Received:1 /7 /2020

Accepted:30 /8 /2020

Full Paper (vol.813 paper# 15)


c:\work\Jor\vol813_16 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1634-1638

Serum Hepcidin Level in Different Stages of Hepatitis C
Induced Chronic Liver Disease
Samy Eissa Abdel Wahab1, Ibrahim M Ibrahim1, Ahmed M. El-Gebaly1,
Amany M Sediq2, Amr Mohammed Fathy Youssef*3
1Tropical Medicine Department, 2Clinical Pathology Department, Faculty of Medicine,
Zagazig University, 3Al-Ahrar Teaching Hospital, Zagazig, Egypt
*Corresponding author: Amr Mohammed Fathy Youssef, E-mail: amrfathyyy987@gmail.com,
Phone: 01095159650, 01201274609

ABSTRACT
Background:
Patients with chronic hepatitis C (CHC) often have increased liver iron, a condition associated with
more rapid progression to cirrhosis. Hepcidin decrease is a possible pathophysiological mechanism of iron overload
in these patients.
Objective: The aim of the present work was to assess serum hepcidin in patients with chronic hepatitis C as an iron-
regulating hormone.
Patients and Methods: This study included 45 patients with CHC as patients group and 15 healthy individuals who
served as a control group. All were subjected to full history taking, clinical examination, pelvi-abdominal ultrasound,
laboratory investigations such as liver function tests, kidney function tests, complete blood count, prothrombin time,
INR, C-reactive protein, serum iron, ferritin, transferring saturation and serum hepcidin level by ELISA.
Results: Serum hepcidin (ng/ml) was highly significantly lower in CHC patients than in controls. Serum iron (µg/dl),
serum ferritin (µg/l) and serum transferrin saturation (%) were significantly higher in CHC patients than in controls.
Conclusion: Hepcidin levels in patients with CHC were significantly lower than that in HCV negative individuals.
It is an important factor in iron abnormalities and is detected in such cases in which serum iron levels, serum ferritin
and transferrin saturation were significantly high in CHC patients compared to HCV negative healthy individuals.
The suppression of this hormone by hepatitis C virus is likely an important factor in liver iron accumulation.
Keywords: Chronic hepatitis C, Serum hepcidin, Serum iron, Serum ferritin, Transferrin saturation.

INTRODUCTION

Globally, an estimated 71 million people have
both hepatocytes and reticuloendothelial cells although
chronic hepatitis C virus infection. Hepatitis C virus
the mechanism is not fully clarified (6). Iron is toxic to
causes both acute and chronic infection. New HCV
liver leading to ROS (reactive oxygen species)
infections are usually asymptomatic. Around 30% (15­
production and progression of liver disease (7). Some
45%) of infected persons spontaneously clear the virus
previous studies aimed to detect serum hepcidin level in
within 6 months of infection without any treatment. The
different causes of liver diseases and their results need
remaining 70% (55­85%) of persons will develop

chronic HCV infection. Of those with chronic HCV
further validation (8). In our study, we tried to detect
infection, the risk of cirrhosis ranges between 15% and
serum hepcidin level using ELISA technique in
30% within 20 years (1). CHC patients frequently
different stages of chronic HCV-induced liver disease.
develop mild to moderate iron overload. Many

experimental and clinical studies suggested that
PATIENTS AND METHODS:
excessive iron in CHC is a cofactor promoting the
This study was conducted on 60 participants.
progression of liver damage (2). With the discovery of
These participants were classified into two main
hepcidin, the liver has emerged as the central organ in
groups; control group of healthy individuals and
the regulation of systemic iron homeostasis (3). Hepcidin
patients group .Control group included 15 healthy
is 25-amino acid peptide hormone primarily
individuals of matched age and sex. In control group, 8
synthesized by hepatocytes. Hepcidin expression is
(53.3%) were males & 7 (46.7%) were females. Their
modulated by iron stores. Hepcidin expression is also
ages ranged from 18 to 57 years, with a mean age of
induced by inflammation, infection and suppressed by
36.20 ± 11.68 years old. Patients group was subdivided
hypoxia and anaemia (4, 5). Each part of iron metabolism
into 3 subgroups according to modified Child Pugh
including absorption, restoration, recycling and
classification. These subgroups were A, B and C and
utilization is regulated by hepcidin and any
included 45 patients with CHC. In patients group, 21
abnormalities in the process of iron metabolism may
(48.9%) were males & 24 (51.1%) were females. Their
lead to excessive iron burden. In chronic hepatitis C
ages ranged from 19 to 57 years, with a mean age of
patients, excessive iron deposition has been found in
40.77 ± 10.91 years old.

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1634
Received:30 /6 /2020

Accepted:29 /8 /2020

Full Paper (vol.813 paper# 16)


Full Paper (vol.813 paper# 17)


c:\work\Jor\vol813_18 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1644-1647

Short Term Outcome of Laparoscopic Trans-Abdominal Preperitoneal (TAPP)
Inguinal Hernia Repair Without Mesh Fixation, a Comparative Study
Hatem Mohammad*, Alaa A. FIAD, Hazem Nour, Abdelwahab M. Hamed
Department of General Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Hatem Mohammad, Mobile: (+20) 01142899902,
E-Mail: dr.hatem.2009@gmail. Com
ABSTRACT
Background:
Laparoscopic repair of groin hernia is gaining popularity, most surgeons follow up the consensus of
mesh fixation especially by tissue penetrating methods, as mesh fixation helps prevent recurrence it also, may cause
nerve injuries leading to acute and/or chronic postoperative pain, many alternatives for mesh fixation do exists as use
of self-gripping mesh, use of absorbable tacks, use of fibrin glue and the mesh placement in the extra-peritoneal space
without fixation as we tried to investigate in this study.
Patient and method: 46 patients undergoing laparoscopic trans-abdominal preperitoneal repair of groin hernia were
randomly allocated into two equal groups, A (group of mesh fixation with absorbable tacks) and B (group of mesh
no fixation). Preoperative, operative, and postoperative data in both groups, namely recurrence rate, acute and chronic
pain, and local complications were statistically analyzed in comparison to each other.
Results: Throughout the analysis of the data there were no statistically significant differences between both groups
regarding demographic data, hernia side, and hernia type. the operative time, acute pain score, and incidence of
chronic pain were longer in the fixation group without statistical significance, we recorded one case of recurrence in
the non-fixation group but without statistical significance.
Conclusion: Mesh placement in the preperitoneal space during laparoscopic trans-abdominal pre-peritoneal repair
of inguinal hernia is a safe efficient method as it is not associated with increased recurrence rate or postoperative
pain.
Keywords: Groin hernia, Mesh fixation, Laparoscopic repair.

INTRODUCTION

Inguinal hernia is a common surgical condition
by nerve injury may need surgical intervention , some
especially in males (1,2). Throughout the history of
studies reported colonic and small intestinal fistula due
inguinal hernia surgery, tension-free repair with the use
to adherence between the viscera and the used tacks
of mesh prosthesis was proved to have the least
(12,13,14,15), non-tissue penetrating fixation techniques
recurrence rate (3). The implication of endoscopic
like fibrin glue use or using self-gripping mesh can
technique in groin hernia surgery either total extra-
avoid these complications, in some localities those safe
peritoneal repair (TEP) or trans-abdominal pre-
techniques may exceed the financial capabilities of the
peritoneal repair (TAPP) maintained the principle of
health systems (16), so in our study we aimed at
tension-free repair and provides the benefits of
evaluation of the short term results of no mesh fixation
laparoscopic surgery as early ambulation (4, 5, 6),
in laparoscopic trans-abdominal preperitoneal groin
resumption of normal activity, less hospital stay time
hernia repair.
and better post-operative pain control. The mesh

prosthesis used in laparoscopic repair has a wide
PATIENTS AND METHODS
dimension supporting a vast area of the lower part of
This comparative study was performed in
the anterior abdominal wall as it extends beyond the
Zagazig University Hospitals, General Surgery
defected margins covering the deep ring, Hassel Bach's
Department, and Private Hospitals in Jeddah, Saudi
triangle, femoral ring and extends down to cover the
Arabia, in the period between July 2018 and May 2020,
obturator foramen (7, 8, 9).
on 46 patients undergoing laparoscopic trans-
Fixation of mesh prosthesis using tissue
abdominal
preperitoneal
(TAPP)
repair
for
penetrating techniques (tacks) either titanium or
uncomplicated unilateral inguinal hernia.
absorbable tacks guarantee mesh stability and

incorporation in surrounding tissues, but complications
Patient selection:
of these methods were not uncommon as many studies
In this study, we enrolled patients above 18 years
reported different complications (10, 11), the most
old suffering unilateral, non­recurrent, uncomplicated
reported complications were injuries to; inferior
inguinal hernia.
epigastric vessels, femoral nerve, genito-femoral

nerve, lateral cutaneous nerve of the thigh and even
We excluded patients with
injury to the operating surgeon hands, the pain caused
Previous abdominal or pelvic surgery,

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1644
Received:1 /7 /2020

Accepted:30 /8 /2020

Full Paper (vol.813 paper# 18)


c:\work\Jor\vol813_19 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1648-1653

Occult Hepatitis B Virus Infection Among Hemodialysis
Patients in Fakous General Hospital
Asmaa Sobhy Mohamed, Nermien Raaft abdel Fattah, Waleed Abdulfattah Ismail, Emad Abdel-Latif
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Sharkia, Egypt
* Corresponding author: Asmaa Sobhy Mohamed, Mobile: (+20)01067194692 Email: asmaasobhy@gmail.com

ABSTRACT
Background:
Occult HBV infection (OBI) is defined as the presence of a small amount of HBV in patients with negative
serum for hepatitis B surface antigen (HBs Ag). The serum HBV DNA level in these patients is generally lower than
104 copies/mL, there is a high prevalence of OBI in patients with chronic hepatitis C, HCC cryptogenic liver disease,
and HIV. Objectives: Assessment of prevalence of Occult Hepatitis B Virus infection among hemodialysis patients in
Fakous General Hospital.
Patients and Methods: A total of 40 patients with end-stage renal disease undergoing regular HD (for at least 6 months
underwent a complete physical examination. Serum samples were collected between before hemodialysis and then
stored at -80C° until tested. Serological markers of HBV infection (HBsAg, anti-HBs, anti-HBc) were determined using
standard third generation commercially available enzyme immunoassays).
Results: The 40 patients who have been included in this study had a minimum age of 25 years and a maximum age of
78 years. The number of females was 25 with a percentage of 62.5% and the percentage of males was about 37.5% (15
males). 22 patients (55%) had negative sera for anti-HCV antibody and a percentage of 37% and 63% for the distribution
of females and males, respectively. 18 patients (45%) had positive sera for anti-HCV antibody and 37% of them were
females and 63% of them were males.
Conclusions:
OBI infection is a relatively common infection (37.5%) among chronic hemodialysis patients in the
dialysis unit of Fakous general hospital.
Keywords:
Occult Hepatitis B Virus Infection, Haemodialysis Patients, Fakous General Hospital.

INTRODUCTION

The hepatitis B virus (HBV) is a well-known
the prevalence of anti-HBc and HBV DNA in the HD
blood-borne virus because it is transmitted through
patients with undetectable HBs Ag.
exposure to infective blood, semen, and other body
We also correlated the clinical, epidemiologic, and
fluids, peripheral blood mononuclear cells (PBMCs),
laboratory test characteristics of patients with OBI and
and sharing needles (1).
with or without HCV co-infection.
Acute HBV can be a self-limiting or it can be a

chronic infection and increases the risk of developing
SUBJECTS AND METHODS
liver failure, hepatocellular carcinoma (HCC), or
This comparative cross-sectional study included
cirrhosis (2). Occult hepatitis B infection (OHBI) is a
40 patients of ESRD on long-term hemodialysis in the
new clinical form of hepatitis B that is characterized by
dialysis unit of Fakous Hospital after they agreed to
the presence of HBV DNA in the liver with detectable
screen the prevalence of occult hepatitis B virus among
(<200 UI/mL) or undetectable HBV DNA in the serum
them and to study its possible effects.
in HBsAg negative patients and can be classified into

seropositive (anti-HBc and/or anti-HBs positive) and
Inclusion criteria:
seronegative (absence of anti-HBc and anti-HBs) (3).
This study aimed to include all patients, who are
The prevalence of OHBI varies from 1% to 87%
known to have an end-stage renal disease on long-term
in different regions of the world. The frequency of
hemodialysis in the dialysis unit of Fakous Hospital if
OHBI in patients with liver cirrhosis and cryptogenic
they agree and do not have any of the exclusion criteria.
chronic liver ranged from 2.7% to 60% and 1.9% to
Patients have different ages, genders, occupations, past-
55.6% respectively (4).
history of blood transfusions, past-history of previous
Patients with chronic renal failure (CRF) on
surgeries, and durations on hemodialysis. They live in
hemodialysis are at higher risk for acquiring Hepatitis B
Fakous city or the rural areas around it. Patients also
Virus (5).
have different causes of end-stage renal disease and
HD patients, compared to patients without renal
have different co-morbidities as diabetes, hypertension,
failure are more to become chronic HBV carriers (6).
or both.
This study aimed to investigate the prevalence of
The 40 patients were all candidate for the
OBI in HD patients. We used a highly sensitive and
following after written agreement signed by them:
specific PCR method to test for OBI and we determined


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1648
Received:2 /7 /2020

Accepted:1 /9 /2020

Full Paper (vol.813 paper# 19)


c:\work\Jor\vol813_20 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1654-1658

Influence of Overweight and Obesity on Bone Mineral Density in
Egyptian Premenopausal Women
Mohammed Ali Gameil¹* Ahmed Hassan Elsebaie², Rehab Elsayed Marzouk³, Nesma Alaa Elmenebawy4
Departments of ¹ Internal Medicine (Endocrinology Unite), ² Clinical Pathology, ³ Medical Biochemistry, Faculty of
Medicine, Mansoura University. 4Department of Internal Medicine, Mansoura General Hospital, Ministry of Health.
Corresponding Author: Mohammed Ali Gameil. Mobile: 00201099975071, Email: drmaligameil1979@yahoo.com

ABSTRACT

Background and objective: Can overweight and obesity exert a detrimental or a protective effect on bone density in
premenopausal women? We studied the correlation between obesity and bone mineral density (BMD) in
premenopausal women in Egypt. Patients and methods: a Case-control study included 50 overweight and obese
premenopausal women compared to 50 normal weight women of matched age. Clinical history, examination,
laboratory tests and DEXA scan were done. Results: T­score and Z-score at the forearm, hip, and lumbar vertebrae
were significantly lower in the case group than the control group. In all participants, we found a significant negative
correlation between body mass index (BMI) with Z-score ( forearm), BMI and bodyweight with Z-score (hip) and
BMI, waist circumference (WC) and bodyweight with Z-score (lumbar vertebrae). We found a significant negative
correlation between waist/ hip ratio (WHR) and T-score (hip) and between BMI, waist/hip ratio and bodyweight with
T-score (lumbar vertebrae). In the overweight and obese participants, BMI was inversely correlated with Z-score
(forearm, hip, and lumbar vertebrae) as well as waist circumference with Z-score (lumbar vertebrae). With post-hoc
analysis, T-score at the lumbar vertebrae was significantly lower in the obese group. With adjustment of the age, (age
and WC) and (age and WHR), we found a significant negative association in the obese group versus the lean group
with Z-score (forearm, hip and lumbar vertebrae).
Conclusion:
Overweight and obese Egyptian premenopausal women were more vulnerable to lower bone density.
Keywords: Bone mineral density, Obesity, Premenopausal women.

INTRODUCTION

women. Therefore, we tried to get a delicate assessment
Obesity and osteoporosis threaten human health and
of the relationship between obesity and BMD in
are strictly related to growing incidence of morbidity
premenopausal women in Egypt.
and mortality worldwide (1). Obesity is a complex

disorder with abnormal excessive fat deposition (2).
PATIENTS AND METHODS
Osteoporosis is a disorder of deranged bone strength
This is an observational case-control study
with a higher fracture risk. Integration of bone density
conducted at the outpatient department at our institution
and quality is essential for bone strength which is
during the period from December 2018 to May 2019.
identified through Bone Mineral Density (BMD)
The study included 50 obese premenopausal women
assessment. Osteoporosis is often overlooked and
compared with 50 normal-weight women of matched
undertreated due to its silent course before fracture
age as a control group. The case group comprised 50
occurs (3). The gold standard method to assess bone
women of age (31-39 years old) with BMI (25 ­ 40
mineral density (BMD) is Dual-energy X-ray
kg/m²).
absorptiometry (DEXA) (4).
Exclusion criteria: we excluded patients with
WHO defined osteoporosis of BMD 2.5 standard
chronic diseases (diabetes, hypertension, ischemic heart
deviations or more lower than the average value for
diseases, chronic obstructive pulmonary disease, renal,
young healthy women (T-score -2.5 SD) (5). Both
hepatic diseases, or endocrinal disorders), nutritional
adipocyte and osteocyte originate from the same stem
disorders or autoimmune diseases, patients on
cell representing unexplained close interrelation
medications affecting bone metabolism like diuretics,
between adipose tissue and bone (6). The correlation
steroid, calcium, or hormones and patients with prior
between obesity and osteoporosis is still controversial;
bariatric surgery.
some researchers found a protective effect of obesity
All participants were subjected to detailed clinical
against osteoporosis "obesity paradox" (7, 8). However
history and examination with anthropometric
others considered obesity as a risk factor for
measurements; body weight, height, body mass index
osteoporosis (9, 10). Different associations may be
(BMI) waist circumference and waist/hip ratio (WHR)
expected in premenopausal women as they have a
(11). Laboratory tests for assessment of fasting blood
different pattern of fat distribution, lifestyle and bone
glucose (FBS), postprandial blood sugar (PPBS) (12),
density than others. In Egypt, there is a lack of data
lipid profile (13), serum calcium, phosphorus, vitamin
about the effect of obesity on BMD in premenopausal
D3, intact parathyroid hormone, renal, hepatic function

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1654
Received:1 /7 /2020

Accepted:30 /8 /2020

Full Paper (vol.813 paper# 20)


In the name of Allah The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1659-1665

Comparison between Adductor Canal Nerve Block and Femoral Nerve Block in
Postoperative Pain Management after Arthroscopic Knee Surgeries
Fawzy Abbas Badawy, Mohsen Mohammed El Sayed*, Khaled Abdelfattah Mohamed Abdelfattah
Department of Anesthesia, ICU & Pain Management, Faculty of Medicine, Sohag University
*Corresponding author: Mohsen Mohammed El Sayed, Mobile: (+20)01144336881,
E-Mail: mohsentakhder@gmail.com

ABSTRACT
Background: Knee arthroscopy is one of the surgeries of lower limbs, which are associated with postoperative
pain and the patients generally require a significant amount of opioid-based analgesics after such procedures.
Treatment of the postoperative pains after surgical operations of lower limbs is of special importance. Inadequate
treatment of these pains results in the reduction of patient's activities and related complications.
Objective: To evaluate and compare the efficacy, duration of sensory block, duration of postoperative analgesia
and complication between adductor canal block (ACB) and femoral nerve block (FNB).
Patients and methods: This randomized controlled study was conducted at Sohag University Hospital. Fourty
patients undergoing elective arthroscopic knee surgeries under general anesthesia were included in the study after
giving written and informed consents.
Results: In our study, there was a statistically significant difference between the studied groups regarding onset
and duration of sensory block peak (both were higher in ACB group). Regarding VAS, there was a statistically
non-significant difference between the studied groups preoperatively and at 3, 6 and 12 hours postoperatively,
while significant difference was detected between them at 24 hours postoperatively (higher VAS score in ACB
group at 24 hours). On assessing change overtime in each group, the difference was statistically significant
(significant fluctuation over time). But, there was statistically non significant difference between the studied
groups regarding modified Ramsey before or one hour after nerve block.
Conclusion: ACB provided comparable analgesic efficacy and facilitated earlier mobilization by sparing
quadriceps strength compared to FNB.
Keywords: Adductor canal nerve block, Femoral nerve block, Pain management, Knee surgeries.

INTRODUCTION
considered the standard PNB in patients undergoing
Knee arthroscopy is a common orthopedic
knee arthroscopy. However, FNB is followed by a
procedure worldwide. Despite its minimally invasive
significant decrease in quadriceps muscle strength,
nature compared to the traditional knee surgery, post
resulting in delayed mobilization, which is associated
arthroscopic pain may be severe and the patients
with the potential risk of falling (6).
generally require a significant amount of opioid-based
Adductor canal block (ACB) is a relatively an
analgesics after such procedure (1).
alternative for post-knee surgeries pain management.
Peripheral nerve blocks offer effective analgesia
Regional anesthesia is deposited within an adductor
and decrease the need for opioids, thereby reducing the
canal that can be easily visualized at the middle third
complications associated with the use of this class of
of the thigh with use of ultrasonography (7). As the
drugs (2). Moreover, postoperative pain relief is an
length of stay in hospital has been shortened by the
important factor in the early ambulation and
performance of knee arthroscopy on an outpatient
rehabilitation of patients after knee surgery (3).
basis, a potent analgesia that preserves motor strength
The lumbar plexus consists of sensory and
during early rehabilitation is becoming increasingly
motor nerves, which innervates visceral organs in the
accepted as an essential part of the current
pelvis, anterior, anterolateral dermatomes of the thigh
perioperative protocol following knee arthroscopy. A
and the medial dermatome of the lower leg, as well as
growing body of evidence supports the use of an
provides motor control for the quadriceps femoris
adductor canal block (ACB) that offers almost pure
muscle (4).
sensory block with minimal motor involvement as part
The femoral nerve is one of the most
of a multimodal approach to pain control after knee
important nerves of the anterior division group of
arthroscopy (8).
nerves in the lumbar plexus, which mainly supplies the
As the emphasis has been on faster recovery
sensation for the anterior and medial parts of the lower
during the early postoperative period, recent trends in
extremities (5). Given excellent pain relief and the
pain
management
protocols
following
knee
opioid sparing effect, femoral nerve block (FNB) is
arthroscopy have shifted toward effective analgesia
commonly used as an analgesic modality and is
with limited motor involvement. FNB is a commonly

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1659
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Accepted:1 /9 /2020

Full Paper (vol.813 paper# 21)


c:\work\Jor\vol813_22 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1666-1671

Vitamin D and Linear Growth in a Sample of Egyptian Adolescents
Laila M Hendawy*, Raef M Botros, Inas M Sabry, Maram M Abromia, Heba A Marzouk, Rania A Radwan
Department of Internal medicine - Ain Shams University, Cairo, Egypt
*Corresponding author: Laila M Hendawy, Mobile: (+20) 01003842942, E-Mail: dr_lma@yahoo.com
ABSTRACT
Background: Vitamin D deficiency is a common health problem worldwide. Decreased appreciation of the importance
of sun exposure to provide children and adults with vitamin D requirement led to a pandemic of vitamin D deficiency.
Vitamin D deficiency may exert a negative influence on bone development causing not only rickets, but also interfering
with achieving genetically programmed height. Objective: To assess vitamin D status among healthy Egyptian
adolescents and its relation to height percentile. Patients and Methods: Our study was conducted on 180 healthy
adolescent males and females aged 10-19 years. Exclusion criteria included subjects with chronic systemic diseases and
those with height that is 2 standard deviation (SD) below the mean age. All participants were subjected to detailed history
including sun exposure, dietary pattern, socioeconomic status, physical and anthropometric evaluation, laboratory
investigations including: hemoglobin concentration, serum creatinine, serum albumin, corrected serum total calcium,
serum phosphorus and serum 25 hydroxy-vitamin D level. Results: The prevalence of vitamin D deficiency was 142 out
of 180 (78.9 %) which was significantly higher among females. On comparing vitamin D status groups as regard stature
for age percentile we found non-significant statistical difference (p=0.394), however there was a positive significant
correlation between vitamin D level and stature for age percentile (p=0.019).
Conclusion: Subclinical vitamin D insufficiency and deficiency are common problems in apparently healthy Egyptian
adolescents with negative impact on height percentile.
Keywords: Vitamin D, Linear Growth, Egyptian Adolescents.
in not only rickets, but also affecting attainment of
INTRODUCTION
Vitamin D deficiency is a common health problem
genetically programmed height (7). So, we aim in our study
among the world (1) which is present in many continents
to assess the status of vitamin D among healthy adolescents
and affecting all ages, sexes and races (2). It is estimated
(age 10-19 years) in Egypt and its relation to height
that more than billion people are vitamin D deficient or
percentile in both genders.
insufficient all over the world (3).

High percent of vitamin D insufficiency in healthy
MATERIALS AND METHODS
adolescents and children was reported worldwide in the
A cross-sectional study was conducted during winter
past few years. Studies in India found that 95% of
and spring in the period from January 2017 to May 2017
apparently healthy adolescents were vitamin D deficient.
in Cairo, Egypt. The average UV index during January is
Other studies reported different prevalence of vitamin D
about 4 and during May is about 12. It included 180 healthy
deficiency as 59.4% in Turkey, 42.5% in Beijing, 47% in
adolescent males (n=84) and females (n=96) aged 10-19
Greece and 78% in France (4).
years, randomly selected from Ain Shams University
In spite of the abundance of sunshine in the Middle
Hospital outpatients with minor intercurrent illness or
East allowing vitamin D synthesis all the year, the region
companions of inpatients were invited to participate in the
shows some of the lowest levels of vitamin D and the
study after explaining the objective of the study.
highest levels of hypovitaminosis D all over the world.
Ethical approval:
Several studies in Jordan, Lebanon, Iran, Saudi Arabia,
The study was accepted by the local Ethical
United Arab Emirates and Qatar showed that 30-75% of
Committee of Ain Shams Faculty of Medicine and a
healthy children and adolescents have vitamin D
written consent was taken from all subjects or their parents.
deficiency (5).
Subjects with chronic diseases like: Diabetes mellitus,
In a recent study conducted on 90 healthy Egyptian adults
chronic liver or kidney diseases, congenital or rheumatic
aged 20-60 years, the prevalence of vitamin D deficiency with
heart disease, malabsorption syndrome, thyroid diseases
level of 25 hydroxy (OH) vitamin D <20 ng/ml was 77%,
and juvenile rheumatic diseases were excluded from our
while prevalence of vitamin D insufficiency with level of
study. Also, participants with height that is 2 SD below the
25(OH) vitamin D between 20-29 ng/ml was 20% (6).
mean of their age and sex were excluded to rule out
However the status of vitamin D among adolescents in
diseases causing short stature.
Egypt and its relation to growth has not been addressed yet.
All Participants were subjected to detailed history
Vitamin D deficiency during stages of growth may
emphasizing on:
exert a negative influence on bone development, resulting
1-Sun exposure Assessment:

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1666
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Accepted:1 /9 /2020

Full Paper (vol.813 paper# 22)


c:\work\Jor\vol813_23 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1672-1677

Role of Suction Pipelle in Diagnosis of Endometrial Lesions in
Patients with Abnormal Uterine Bleeding
Ali El-shabrawy Ali1, Mai Mohammed Abd Elwahab2,
Basem Mohammed Hamed1, Heba Fathy Helmy Mohamed1
Departments of 1Obstetrics & Gynecology and 2Pathology, Faculty of Medicine ­ Zagazig University.
Corresponding Author: Heba Fathy Helmy Mohamed, Mobile: (+20)01000672180, Email: dr.heba 1987@gmail.com

ABSTRACT
Background:
Abnormal uterine bleeding (AUB) is a major clinical problem among women in the reproductive,
perimenopausal and postmenopausal age groups. It may have a significant impact on woman physical, social,
emotional and material quality of life. Along with the direct impact on the woman and her family, there are significant
costs to both economy and health service. The AUB in women aged 40 and older, especially in peri and post-
menopausal age group requires exclusive assessment, to exclude atypical endometrial hyperplasia and carcinoma.
Objective: This study aimed to determine the efficacy of suction pipelle in diagnosis of endometrial lesions in cases
of abnormal uterine bleeding. Patients and Methods: The current study was designed as cross-sectional study
conducted in Zagazig University Maternity Hospitals, Al-Ahrar Teaching Hospital and the Department of Pathology,
Zagazig University during the period from April 2018 to July 2019. The study was conducted on 92 patients
presented with abnormal uterine bleeding. Results: The 2 methods were 100% matched in diagnosis of secretory
endometrium, hormone-dependent endometrium, atypical hyperplasia and EEC grade 1. The pipelle succeeded to
diagnose some cases of proliferative endometrial and simple hyperplasia, which were missed by D & C (18.5% and
17.4% by pipelle versus 16.3% and 13% by D & C respectively for proliferative endometrial hyperplasia and 8.7%
and 17.4% by pipelle versus 16.3% and 19.6% by D&C for simple hyperplasia respectively). Conclusion: Pipelle
had high sensitivity and specificity for diagnosis of proliferative endometrial, secretory endometrium, hormone-
dependent endometrium, simple endometrial hyperplasia, atypical hyperplasia and EEC grade 1.
Keywords: Suction Pipelle, Endometrial lesions, Abnormal uterine bleeding.

INTRODUCTION
submucous myomas endometrial hyperplasia, and
Abnormal uterine bleeding (AUB) is a
endometrial carcinoma) should always be suspected,
significant clinical entity and it is one of the most
and evaluation appears to be mandatory (3).
common complaint among women in reproductive age
There are numerous methods for endometrial
attending to physicians. It may have a significant
assessment among women with abnormal uterine
impact on woman physical, social, emotional and
bleeding including ultrasonography, endometrial
material quality of life. Along with the direct impact
curettage D & C and office-based methods including
on the woman and her family, there are significant
biopsy by hysteroscopy or endometrial samplers such
costs to both economy and health service (1).
as pipelle. The main reason for performing
AUB [formerly, dysfunctional uterine bleeding
endometrial biopsy in women with abnormal uterine
(DUB)] is irregular uterine bleeding that occurs in the
bleeding is to confirm the benign nature of the
absence of recognizable pelvic pathology, general
problem, by ruling out endometrial carcinoma, so that
medical disease, or pregnancy. It reflects a disruption
medical treatment or conservative surgery can be
in the normal cyclic pattern of ovulatory hormonal
offered, and unnecessary radical surgery can be
stimulation to the endometrial lining. The bleeding is
avoided (1).
unpredictable in many ways. It may be excessively
The endometrial curettage is gold standard
heavy or light and may be prolonged, frequent, or
method of endometrial sampling. However, it may
random (2).
lead to less than fifty percent. Curettage of
The International Federation of Gynecology and
endometrium in sixty percent of cases is also
Obstetrics working group on menstrual disorders has
accompanied with risk of infection, and perforation. It
recently developed a classification system for causes
also needs hospital admission and local or general
of the AUB in non-gravid women of reproductive age.
anesthesia (1). While pipelle is an ambulatory,
There are nine main categories, which are arranged
outpatient, cost-effective method, does not require a
according to the acronym PALM-COEIN: Polyp;
syringe or pump nor require general anesthesia or
adenomyosis;
leiomyoma;
malignancy
and
cervical dilatation and permits almost painless
hyperplasia; coagulopathy; ovulatory dysfunction;
endometrial sampling (4).
endometrial; iatrogenic; and not yet classified.
The study aimed to determine the efficacy of suction
Besides, systemic, iatrogenic or hormonal age-related
pipelle in diagnosis of endometrial lesions in patients
causes and an endometrial pathology (polyps,
with abnormal uterine bleeding. So, presenting a

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2761
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Accepted:1 /9 /2020

Full Paper (vol.813 paper# 23)


c:\work\Jor\vol813_24 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1678-1682

Efficacy of Surgical Treatment of Unstable Sacral Fractures
Omar Abd El-Whab Kelany, Waleed Mohamed Nafae, Ahmed Mostafa EL-Naggar,
Ahmed Hamdy Mohamed Rashad
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
Corresponding Author: Ahmed Hamdy Mohamed Rashad, Mobile: (+20)01002284762
Email: ahmed2020Hamdy@gmail.com

ABSTRACT
Background:
Complications of sacral fractures include hemorrhage, shock and neurological complications, sensory,
motor. Objective: To evaluate the clinical and radiographical results of surgical treatment of unstable sacral fractures.
Patients and Methods:
This study was carried out as an interventional prospective study on 24 patients with unstable
sacral fracture. Clinical evaluation was assessed, and Radiological assessment was done.
Results: 17 patients underwent iliosacral screw, 4 spino pelvic, 2 patients underwent plate, and one plate with
spinopelvic. Satisfactory outcome group significantly younger in age and shorter in operation days. In this study 7
cases of infection 6 superficial 1 deep. In this study, 1 pt had deep venous thrombosis, 3 chest infection. There were
2 cases with postoperative neurological deficits improved within 4 months and one case didn't improve during follow
up. Post-operatively all patients were clinically assessed according to Majeed score. Excellent cases were 10 (41.7%),
good results were 12(50%) and fair were 2 (8.3%). Conclusion: Patients were found to have a good outcome;
therefore, surgical treatment is effective in unstable sacral fractures. Iliosacral screw fixation is indicated in minimally
displaced fractures, usually performed percutaneously, consequently, blood loss is minimal. Sacral fractures are rare
and detection of these potentially complicating fractures is very important.
Keywords: Clinical, Radiographical, Surgical treatment, Sacral fractures.

INTRODUCTION
of neurologic injury (<10%) with the most common
The sacrum is composed of five vertebral
neurologic deficit being L5 radiculopathy. Zone 2
segments referred to as S1 to S5. These vertebrae are
injuries carry an intermediate (20­30%) risk of
fused, making the sacrum a solitary block of bone,
neurologic injury. Zone 3 injuries carry the highest
although, anywhere from 4 to 30% of people can have
(>50%) risk for neurologic injury with the most
variations in vertebral segmentation at the lumbosacral
common neurologic deficit being cauda equina
junction with segmentation anomalies ranging from the
syndrome (5).
complete fusion of L5-S1 to segmentation of S1
Plain x-ray is done first AP, lateral, inlet, and
resulting in six lumbar-type vertebrae (1).
outlet views. CT has become the mainstay for
Sacral fractures rarely occur in isolation, only 5%
diagnosing sacral fractures due to the low sensitivity of
isolated and 45% with pelvic ring injuries, 25%
radiographs, Noncontract CT imaging in the axial,
associated with neurologic injury, frequently missed in
coronal, and sagittal planes is generally adequate for
75% in neurologically intact patients, and 50% in
diagnosing sacral fractures, For complex sacral
patients with the neurological deficit (2).
fractures or sacral fractures that are part of a pelvic ring
Sacral stability is mainly dependent on the strong
injury pattern, additional three dimensional reformatted
ligamentous structures of the pelvic ring, The soft tissue
images are often helpful for surgeons to conceptualize
around the sacrum is relatively thin, consisting of the
fracture patterns and morphology for preoperative
multifidus muscle and the lumbosacral fascia, making
planning. Sacral morphology can preclude safe
this region particularly susceptible to infection, skin
placement of transacral screws, particularly at the S1
breakdown, and hardware related complications (3).
level and preoperative CT can be assessed for sacral
Complications of sacral fractures include
dysmorphism and adequate osseous pathway for sacral
hemorrhage, shock and neurological complications,
screw placement (6).
sensory, motor (4).
The goals of surgical treatment of unstable sacral
The Denis classification for sacral fractures was
fractures are to restore spine and pelvis stability and to
first described in 1988 and has become the most used
relieve nerve root compression both percutaneous and
classification system for sacral fractures. The Denis
open techniques for sacral fracture fixation have been
classification divides the sacrum into three zones: Zone
described. Most unstable sacral fractures are amenable
1 is lateral to the neuroforamina, zone 2 is through the
to percutaneous fixation, with sacroiliac or transacral
neuroforamina, and zone 3 is medial to the
screws being the most common method of stabilization
neuroforamina. Fractures are classified based on the
(7).
highest zone of involvement. The Denis classification
The study aimed to evaluate the clinical and
mainly has utility in predicting risk and type of
radiographical results of surgical treatment of unstable
neurologic injury. Zone 1 injuries carry the lowest risk
sacral fractures.

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8761
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Accepted:2 /9 /2020

Full Paper (vol.813 paper# 24)


c:\work\Jor\vol813_25 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1683-1689

Relation Between Carotid Artery Plaque Score and Severity of
Coronary Artery Disease in Patients with Metabolic Syndrome
Mahmoud Ahmed Abd Elbaset, Mohamed Ali Mahmoud Tawfeek*
Department of Cardiology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: Mohamed Ali Mahmoud Taweek, Mobile: (+20) 01007620476,
E-Mail mohamed_tawfeek@azhar.edu.eg

ABSTRACT
Background: Metabolic syndrome is a multiplex risk factor that arises from insulin resistance accompanying
abnormal adipose deposition and function. It is a risk factor for coronary heart disease, as well as diabetes, fatty liver
and several cancers.
Objectives: To assess the relationship between carotid plaque score by carotid ultrasonography and severity of
coronary artery disease (CAD) by SYNTAX score in metabolic syndrome patients undergoing coronary angiography.
Patients and Methods: A cross sectional case-control study included 100 persons divided into two groups: Group
(1) included 50 patients with metabolic syndrome and group (2) that included 50 patients did not fulfill the criteria
for metabolic syndrome. They were selected from those attending the Catheterization Unit of the Cardiology
Department, Al-Azhar University Hospital, Assiut.
Results: There was no statistically significant difference between the two groups regarding age and gender (P > 0.05).
There were a highly statistically significant difference between the two groups regarding hypertension, diabetes
mellitus and waist circumference (P < 0.0001). Regarding HDL level, there was a statistically significant difference
(P- 0.030), while there was no statistically significant difference regarding triglycerides level (P- 0.159). There was
highly statistically significant difference between the two groups regarding plaque score and SYNTAX score (P <
0.0001) with strong correlation (r=0.907). There was a moderate positive correlation between plaque score and
number of risk factors for metabolic syndrome (r=0.5) with a very high statistically significant level (P < 0.0001).
Conclusion: There was a moderate correlation between carotid artery plaque score and Syntax score in metabolic
syndrome patients.
Keywords: Metabolic syndrome, Carotid artery Plaque score, SYNTAX score, Atherosclerosis.

INTRODUCTION

Metabolic syndrome (MetS) is the commonly used
glucose and blood pressure (4). The cut-off limits of
term for a cluster of clinical and metabolic factors that
waist circumference are specific to the gender and
increase the risk for type 2 diabetes mellitus (T2DM),
ethnic groups in the IDF criteria (3).
coronary artery disease (CAD) and stroke. The
The term "atherosclerosis" describes the association
interrelated risk factors include central obesity,
of fatty degeneration and vessel stiffening. This process
dyslipidemias, hypertension, hypercoagulable state and
affects medium and large-sized arteries and is
insulin resistance (1).
characterized by patchy intramural thickening of the
Over years, several groups and organizations tried
subintima that encroaches on the arterial lumen. Each
to find accepted diagnostic criteria of metabolic
vascular bed may be affected by this process. The
syndrome. The World Health Organization (WHO)
etiology,
treatment
and
clinical
impact
of
created the first internationally recognized definition of
atherosclerosis varies from one vascular bed to another.
MetS in 1998, which was modified by the European
The earliest visible lesion of atherosclerosis is the fatty
Group for the Study of Insulin Resistance (EGSIR) in
streak, which is due to an accumulation of lipid-laden
1999. In 2001, the National Cholesterol Education
foam cells in the intimal layer of the artery. With time,
Program Adult Treatment Panel (NCEP/ATP111)
the fatty streak evolves into a fibrous plaque, the
updated the guidelines for MetS, and in 2003, the
hallmark of established atherosclerosis. Ultimately the
American Association of Clinical Endocrinologists
lesion may evolve to contain large amounts of lipid; if
(AACE) proposed their definition (2).
it becomes unstable, denudation of overlying
In 2005, the International Diabetes Federation (IDF)
endothelium or plaque rupture may result in thrombotic
provided the consensus worldwide definition of MetS
occlusion of the overlying artery (5).
(3). This definition includes waist circumference as a
Carotid artery intima-media thickness (CIMT) has
prerequisite for the identification of MetS while also
been reported as representative of subclinical and
comprising a number of the common features of the
asymptomatic atherosclerotic vascular diseases, shown
AACE, WHO, and EGSIR definitions, namely,
in several large ultrasonographic measurement of IMT,
measurement of triglycerides (TG) and of high-density
and therefore a procedure to detect primordial
lipoprotein (HDL)-cholesterol and evaluation of fasting
atherosclerosis. The amount of lesion in the common

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1683
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Accepted:2 /9 /2020


Full Paper (vol.813 paper# 25)


c:\work\Jor\vol813_26 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1690-1698

Serum Microrna155 Expression Level in Systemic Lupus Erythematosus
Related Peripheral Neuropathy
Nearmeen M. Rashad1, Hanan S. Ahmed*2, Mona M.Amer 3,
Rehab S. Abdul-Maksoud4, Amany M. Ebaid5, Magda M. Sherif1
Departments of 1 Internal Medicine, 2Clinical Pathology, 3Neurology, 4Medical Biochemistry and 5Rheumatology
and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
* Corresponding author: Hanan S. Ahmed, Mobile:(+20): 01128885180, Email: Hananclpath@yahoo.com

ABSTRACT

Background: miRNA-155 (miR-155) became a focus in several studies because of its essential functions in
autoimmune diseases and inflammatory responses such as multiple sclerosis (MS) and rheumatoid arthritis (RA).
Objective: We aimed in the current study to explore the expression profile of micro RNA-155 in SLE and evaluate
its association with the clinical, immunological, and electrophysiological tests of patients with peripheral neuropathy
(PN). Patients and methods: Ninety-five recently diagnosed systemic lupus erythematosus (SLE) patients according
to 2012 Systemic Lupus International Collaborating Clinics classification criteria were enrolled in addition to 100
controls. Peripheral nerve conduction was evaluated by performing nerve conduction studies (NCSs). The serum
miRNA-155 expression profiles were measured using a quantitative real time-polymerase chain reaction (qRT-PCR).
Results: Of the 95 SLE patients, PN was present in 35 patients (36.8%). The serum miR-155 expression levels were
upregulated the in serum of SLE patients (1.17±0.21) compared to controls (0.826±0.169), P < 0.001. Among SLE
groups, patients with PN had a higher level of miR-155 expression (1.24±0.1781) than patients without PN
(0.913±0.046), P < 0.001. There was a significantly positive correlation of miR-155 expression levels with The
Toronto Clinical Scoring System (TCSS), immunological markers, and electrophysiological tests of median and ulnar
nerve.
Conclusion: This is the first Egyptian study report that miR-155 expression profile is upregulated in SLE patients
especially patients with PN indicating miRNA-155 might be a potential biomarker for the diagnosis and treatment of
SLE related PN.
Keywords: Polyneuropathy, Nerve conduction studies, miR-155, SLE, Expression.

INTRODUCTION
post-transcriptional level by degrading or blocking
Systemic lupus erythematosus (SLE) is a
translation of messenger RNA (mRNA) (8). Mirna-155
multisystem autoimmune disease. Genetic and
(miR-155) is located at 21q21.3, the B cell integration
environmental hypothesis are closely linked with the
cluster, originally considered to be a proto-oncogene
pathogenesis of the SLE (1). Accumulating studies
associated with lymphoma. Moreover, miR-155 was
suggest that SLE affects the whole brain. Interestingly,
implicated in the innate immune function, and silencing
peripheral neuropathy (PN) is an apparent manifestation
miR-155 could ameliorate the disease severity and delay
of SLE (2). The most common forms of PN in SLE,
the
onset
of
experimental
autoimmune
including
symmetrical
polyneuropathy,
encephalomyelitis (9).
mononeuropathy, and cranial neuropathy (3,4). A
MiRNAs-based diagnosis and therapy are
preponderance of evidence suggests that the
highly likely to be the future of treatment and
pathogenesis of SLE-related neuropathy is obscure, and
prevention, especially in multifactorial disease
the few pathological studies of the peripheral nerves in
processes. The pathogenesis of SLE-related neuropathy
SLE have revealed axonal degeneration, inflammatory
is obscure, therefore, the aim in the current study is to
changes, and vacuities (5).
explore the expression profile of micro RNA-155 in
Increasing evidence supports the hypothesis of
SLE and evaluate its association with the clinical,
immune system dysregulation in pathogenesis of SLE.
immunological and electrophysiological tests of PN
Epigenetic modulation by DNA methylation, histone
patients.
post-translational modifications and microRNAs

(miRNAs) allows regulation of B cell mechanisms and
SUBJECTS AND METHODS

plasma cell differentiation (6,7). Dysregulation of
This
cross-sectional
controlled
study
epigenetic elements or mediators, including miRNAs,
comprised 95 SLE patients recently diagnosed
can result in aberrant immune responses, including
according to 2012 Systemic Lupus International
dysregulated antibody production, and compound
Collaborating Clinics classification criteria (10) and
genetic susceptibility to mediate autoimmunity (8).
recruited from the Rheumatology, Neurology and
MiRNAs are small non-coding, single-stranded
Internal Medicine outpatient clinics, Zagazig University
RNA molecules that regulate gene expression at the

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1690
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Accepted:2 /9 /2020

Full Paper (vol.813 paper# 26)


c:\work\Jor\vol813_27 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1699-1703

Outcome of An Educational Program on Bronchial Asthma Self-Management
Hanaa shawky Mohamed Eissa1, Taghreed Mohammed Farahat2,
Nagwa Nashaat Hegazy2, Ayah Mustafa Ali Barakat 2
1amily Physician at Batanoun Health Care Cente , Ministry of Health, Egypt.
2Family Medicine Department, Faculty of Medicine, Menofia University, Egypt.
Corresponding Author: Hanaa shawky Mohamed Eissa, Mobile: 01026996818, Email:eisahanaa59@gmail.com

ABSTRACT
Background:
Bronchial asthma is a highly prevalent chronic respiratory disease that affects over 300 million persons
worldwide with a mortality rate of approximately 250,000 annually. Instructing asthma patients about their illness is
significant and the principle accentuation is to build patients' information and to elevate patients' adherence to
medication plans. The absence of data about self-management had prompted reluctance of asthmatic patients to
disease management activities. Objective: To improve bronchial asthma control in asthmatic patients. This study
arranged and executed the bronchial asthma instructive program and assessed and elevated the level of information
about asthma self-management strategy of inhaler use and asthma control after training program among adult
asthmatic patients. Patients and Methods: An intervention study was conducted on 97 asthmatic patients attended
Chest Hospital at Menoufia Governorate. All studied patients were evaluated through four questionnaires titled socio-
demographic characteristics, Asthma Self-Management Questionnaire (ASMQ), GINA-2017 criteria of asthma
control and a checklist to assess technique of inhaler use. All participants were subjected to health education program.
Results: The results revealed that there was a statistically significant difference between patients' knowledge of
asthma self-management, accuracy of inhaler use technique and asthma control before and after the educational
program where P < 0.001. Conclusion: Based upon the results of this study, it could be concluded that implementation
of educational program had a positive effect on improvement of the patients' knowledge, practices and self-care
strategies post program implementation compared to pre-program implementation.
Keywords: ASMQ, Educating, GINA, Inhaler.

INTRODUCTION
is not investigated enough (9). We performed this study
Educating the patient is a necessary part of his
to assess results on adult asthma patients from the
service. With the increase in numbers of population
bronchial asthma education program.
with the chronic diseases, the application of educational

programs has become even more necessary than before
SUBJECTS AND METHODS
because these patients need follow up continuously (1).
This study was an interventional study carried out
Asthma is one of chronic respiratory diseases
in Chest Hospital at Meit Khalaf Village, Shebin El-
worldwide. According to World Health Organization
Kom District, Menoufia Governorate. Meit Khalaf
(WHO), asthma prevalence is nearly 300 million
Chest Hospital is under the supervision of Directorate
patients all over the world. It is expected in 2025 to be
of Health Affairs in Shebin El-kom, Ministry of Health.
400 million by (2, 3), with mortality about 250,000
The hospital is distinguished by containing intensive
annually (4). In Egypt, asthma is estimated to be 8.2%
care units, Bronchoscopy and pulmonary function tests.
and 6.7% among children and adults respectively, being
The asthma clinics are three, one for men, second for
more predominant in males than females (1.2:1) (2, 3).
women and the last one for children. The study
Most patients still experience a high rate of
population included adults with asthma who were
morbidity. Most of the morbidity from asthma is
registered and attended the Outpatient Clinic at the
assumed to be attributed to causes such as denying a
place of study.
chronic disease, inadequate knowledge on the disease
Ethical approval:
process and medication use, insufficient awareness of
The study was certified by the Faculty of
inhaler use and inadequate self-management (5).
Medicine's Research Ethics Committee, Menoufia
Many studies worldwide have evaluated the effect
University and the included participants signed a
of patient education and indicated that each of the above
written informed consent.
components is amenable to asthma education (6, 7). Thus,
The target populations were:
the task of patient education has become a key
Target population were asthmatic patient having
component of asthma management for asthma patients
mild to moderate bronchial asthma, over 18 years old,
at all age groups (8). The efficacy and importance of
without significant co-morbidity and being non-
educational and behavioural approaches to asthma have
smokers.The sample size was estimated based on the
strengthened because of increased commonness of
bronchial asthma prevalence among Egyptian adults
asthma, improved knowledge of self-management and
that was 6.7% (3). Considering the confidence interval
growing interest in learning theories. However, the
95% and the power of the study 80%, the calculated
effectiveness of patient education for asthma in Egypt

This article is an open access article distributed under the terms and conditions of the Creative
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SA) license (http://creativecommons.org/licenses/by/4.0/)
1699
Received:4 /7 /2020

Accepted:3 /9 /2020

Full Paper (vol.813 paper# 27)


c:\work\Jor\vol813_28 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1704-1709
Combined Topo-Guided laser Vision Correction (LASIK) with Concurrent
Prophylactic High-Fluence Corneal Collagen Crosslinking (CXL) in
Myopic Patients with Normal Cornea
Khaled EL-Ghonemy Said Ahmed, Hany Ahmed Khiry,
Ahmed Ibrahim Basiony, Rana Mohamed Amer Elwakiel*
Department of Ophthalmology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Rana Mohamed Amer Elwakiel, Mobile: (+20) 01110518599, E-Mail: ronielwakiel@gmail.com

ABSTRACT
Background:
Corneal ectasia is a serious vision-threatening complication of laser-assisted in-situ keratomileusis
(LASIK). LASIK in combination with corneal collagen cross-linking (CXL) is an alternative to traditional LASIK
aimed at restoring strength to the cornea.
Objective:
The aim of the work was to evaluate the efficacy and safety of ultraviolet A (UVA) irradiation crosslinking
in concurrent with LASIK in myopic patient with normal cornea to avoid post LASIK ectasia.
Patients and Methods:
This Prospective randomized interventional study included 60 eyes of 30 consecutive patient
who were scheduled for LASIK surgery, all of them were myopic with normal cornea with no pervious refractive
surgery. They were candidate for Combined Topo-Guided LASIK with accelerated CXL. This was done in a private
eye hospital between Jun 2018 and Jun 2019.
Results: The preoperative uncorrected visual acuity (UCVA) ranged from 0.05- 0.1 with mean 0.075±0.02 and
preoperative best corrected visual acuity (BCVA) ranged 0.2- 1.0 with mean 0.58±0.13 and post-operative UCVA at
6 months showed ranged 0.2-1.0 with mean 0.55±0.16, and postoperative UCVA at 1 year showed ranged 0.2-1.0
with mean 0.56±0.13,. The improvement in visual acuity from 0.075±0.02 UCVA preoperatively show statistically
significant difference (P > 0.05) because we compared the results with the preoperative BCVA 0.58±0.13
postoperatively at 6 months. However, t-Paired Sample t-test; p-value < 0.05 S.
Conclusion: It could be concluded that LASIK combined with a prophylactic CXL intervention appears to provide
predictability as well as refractive and keratometric stability. The data reported in this study provide evidence of the
safety and efficacy of this approach.
Keywords: LASIK, CXL, Myopic Patients, Normal Cornea

INTRODUCTION

Laser assisted in situ keratomileusis (LASIK) is
LASIK in combination with CXL (Lasik Xtra
a widely accepted method to correct refractive
Avedro, Massachusetts, USA) is an alternative to
errors and offers predictable and stable refractive and
traditional LASIK aimed at restoring strength to the
visual outcomes, specifically in the correction of
cornea, increasing stability in visual outcomes,
moderate to high myopia (equal to or greater than
increasing the accuracy of the refractive correction, and
-6.00 diopters).The principle of LASIK is to ablate
the structural integrity of the cornea. It is logical to
corneal stroma by laser technique, altering central
anticipate that stiffening a cornea, which has been
corneal curvature to correct refractive error and focus
structurally weakened by LASIK through the addition
incident light on the retina (1).
of CXL may minimize the negative effects associated
Postoperative ectasia is a result of corneal
with this biomechanical compromise, so the aim of
alteration by severing of stromal lamellae through the
Lasik Xtra is to further reduce the rare incidence of
creation of the LASIK flap, combined with stromal
iatrogenic ectasia, as well as to reduce the rate of
ablation, which together can weaken corneal
hypermetric treatment regression and enhancements (4).
biomechanical properties and affect the corneal
The objective of this study was to evaluate the
stability. The application aims to enhance corneal
efficacy and safety of UVA irradiation crosslinking in
rigidity and thus reduce the likelihood of a long-term
concurrent with LASIK in myopic patient with normal
myopic shift (2).
cornea to avoid post LASIK ectasia.
The corneal collagen cross-linking (CXL)

procedure increases covalent bonding between or
PATIENTS AND METHODS
within collagen fibers in the corneal stroma, thus
This prospective randomized interventional study
increasing corneal stiffness and improving corneal
included a total of 60 eyes of 30 consecutive patient
biomechanical stability. The long-term efficacy of
who were scheduled for LASIK surgery, attending at
CXL has already been demonstrated in the treatment of
private Eye Hospital. This study was conducted
primary and secondary (post-LASIK and post-pRK)
between Jun 2018 and Jun 2019.
corneal ectasia (3).




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/)
1704
Received:3 /7 /2020

Accepted:2 /9 /2020

Full Paper (vol.813 paper# 28)


c:\work\Jor\vol813_29 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1710-1717

Fibrates in Chronic Kidney Disease Patients: A Controversial Issue
Aber H. Baki 1, John K Zarif 2
Departments of 1Internal Medicine and Nephrology and 2Cardiology, Faculty of Medicine,
Ain Shams University, Cairo, Egypt
Corresponding author: Aber H. Baki, Mobile: (+20) 01224037210, E-Mail: aberhalim@hotmail.com

ABSTRACT
Background:
Fenofibrates were not previously known to affect renal function tests until some reports indicated that
these drugs may lead to a decrease in renal function. Likewise, the nephrotoxic effect of fibrates remains to be vague
and unclear. Guidelines regarding fenofibrate dosing in renal impairment vary internationally.
Patients and methods
: A prospective cohort study over 6 months with a total of 80 patients on fibrates divided into
2 groups, 40 of which received statins, and the other 40 continued on fibrates. All patients were subjected to full
history, clinical examination, and complete baseline labs. The KFTs including serum creatinine and eGFR were
measured at 0, 1, 2, and 6-months intervals and lipid profile at 0,3,6 months serially in both groups.
Results: Out of the baseline values of KFTs, the statin group showed a significant decrease in all kidney function
values including mean serum creatinine by (0.9mg/dL, P=0.001) and an increase in eGFR (8.9 mL/min/1.73 m2,
P<0.001). Whilst in patients who continued to receive fibrates the KFTs continued to rise as serum creatinine showed
a significant increase in their mean serum Cr levels (by 0.9 mg/dL or 20%, P=0.001), and a significant decrease in
their mean eGFR values (by 8.2 mL/min/1.73 m2 or 20.55%, P<0.001). On the other hand, total and LDL Cholesterol
were significantly lower in the statin group at all follow-up intervals. Also, triglycerides were significantly higher in
the Statin group at the end of month-6 from baseline.
Conclusion: In our study fibrates administration showed a short-term state of renal insufficiency. The long-term
effects of fibrates versus variable renal derangement are yet to be identified.
Keywords:
Chronic kidney disease, fibrates, Lipid profile.

INTRODUCTION

Fenofibrates are used to cure dyslipidemia, they are
Shams University Hospitals and Ain Shams Specialized
often administered regardless of the chronic
Hospitals to follow up their kidney function tests.
nephropathies, as well as in transplanted patients (1, 2).

Fibrates were not previously known to affect renal
Inclusion Criteria:
function tests. Updated research pointed towards renal
1. All CKD patients with ischemic heart disease.
function derangement (1). The underlying mechanism is
2. All stages of CKD following in nephrology and
still, however, unclear. Changes in GFR, creatinine
cardiology clinics.
excretion within the kidney tubules, altered renal 3.
hemodynamics, and changes in the production of
Exclusion Criteria:
creatinine by skeletal muscle have all been hypothesized
1. Other causes of impaired kidney functions like
(3-5).
contrast nephropathy,
Fenofibrate's safety in patients with renal
2. Recent intake of diuretics or evidence of
insufficiency is an issue because it may increase plasma
hypovolemia.
creatinine. Furthermore, guidelines regarding fenofibrate
3. Recent intake of ACEIs or ARBs, NSAIDs, UTI.
dosing in renal impairment vary internationally. We 4.
investigated fenofibrate's effects on cardiovascular and
Then patients were randomized into two groups:
on advanced CKD, according to eGFR (6).
Group I: Shifted to statins instead of fenofibrate.

Group II: Maintained on the same dose of fenofibrate.
AIM OF THE WORK
All patients were subjected to full history,
To evaluate the potential benefits of fenofibrate versus
clinical examination, and Kidney function tests,
renal injury.
including serum creatinine, urea, K+, uric acid,

eGFRwith Cockcroft Gold formula at 0 (baseline) 1, 2,
PATIENTS AND METHODS
and 6 months. Complete lipid profile at 0 (baseline) 3 and
Our prospective cohort study over 6 months was
6 months.
conducted on 98 patients, 14 of them did not meet the

inclusion criteria and 4 refused to participate in the study
Ethical approval:
which left a total of 80 patients on which the randomized
All procedures performed in the study were
control study was performed. All of them were
following the ethical standards of the Ain-Shams
maintained on fenofibrate by their cardiologists and came
University hospital research committee (Ethics
to our nephrology out-patient clinics (OPC) at Ain
committee reference number 000017585) and with the

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

)
1710
Received:4 /7 /2020

Accepted:3 /9 /2020

Full Paper (vol.813 paper# 29)


c:\work\Jor\vol813_30 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (3), Page 1718-1721

Assessment of Precipitating Factors and Outcomes of
Hepatic Encephalopathy in Cirrhotic Patients
Mohamed Zain Eldeen Hafez 1, Hala Abdallah Mahmoud Abdallah2, Mohamed Anwar Mohamed Hamad*2
1Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
2Department of Internal Medicine, Faculty of Medicine, Aswan University, Aswan, Egypt
*Corresponding Author: Mohamed Anwar Mohamed Hamad, Phone: 00201066050428, E-mail:
mohamedanwar19911991@gmail.com
ABSTRACT
Background
: Hepatic encephalopathy (HE) is one of the major complications of liver cirrhosis (LC). It's defined as a
reversible neuropsychiatric event of liver cirrhosis. Up to fifty percent of cirrhotic patients will suffer from at least one
attack of HE. Studies examining the prognostic significance of HE are limited despite the high prevalence in cirrhosis.
The current study aimed to assess outcome of hepatic encephalopathy.
Patients and methods: Over one year duration, 100 patients with HE were enrolled. All patients were subjected to
full history taking and full examination. Patient with central nervous system lesion, metabolic disorders or post-ictal
state was excluded. Abdominal ultrasound and ascitic fluid examination were performed in all patients. Patients were
followed and their outcome was recorded.
Results: Mean age of patients was 53.19 ±3.6 years and the majority of patients were males. Hepatitis C infection was
the most frequent cause of LC. The main precipitating factor for HE was infection (29%) followed by hematemesis
(24%) and constipation (19%). In 19 (19%) patients, there was evidence of ascitic fluid infection. Out of studied
patients; 81 (81%) patients were alive. It was noticed that hematemesis and infection were significantly higher in dead
patients. Conclusion: hepatic encephalopathy is a serious event in patients with LC. Major precipitating factors were
infection, hematemesis and constipation. Infection and hematemesis are usually associated with poor outcome.
Keyword: Hepatic encephalopathy, Hepatitis C infection, Liver cirrhosis.

INTRODUCTION

absorption. There are many available therapeutic trials
Patients with liver cirrhosis (LC) usually have
but need further trials (3).
unpredictable prognosis. State of patient either with
Many published studies extensively clarified
compensated or decompensated LC greatly affects the
prognosis and natural history of patients with variceal
prognosis. The main features of decompensated
bleeding and ascites but there is paucity in literature
cirrhosis include ascites, hepatic encephalopathy (HE)
about natural history and prognosis of hepatic
and/or variceal bleeding. Median survival in
encephalopathy. It was reported that one year survival
compensated LC usually exceeds 12 years while it
is 42% after the first attack of HE (4,5).
doesn't exceed more than two years or even less in
To our knowledge there is lacking in studying
patients with decompensated cirrhosis (1).
and investigating the prognosis of cirrhotic patients
HE is known a reversible neuropsycahtric state
following episode of HE particularly in the era of
in patients with decompensated LC. In 30-45% of
rifaximin in our locality. This work was conducted to
cirrhotic patients, attack(s) of HE will occur during their
clarify risk factors and outcome of hepatic
life. HE and ascites are considered the commonest
encephalopathy.
decompensating signs in LC. HE had wide range of

PATIENTS AND METHODS
presentation varies from mild impairment of cognitive
Ethical approval:
function till coma and even death (2).
This work was conducted in accordance with
The most commonly used system for grading of
Code of Good Practice and the guidelines of
HE is West Haven criteria. Although ammonia level is
Declaration of Helsinki, 7th revision, 2013 and after
high in many cases with HE, but it isn't reliable for the
being approved by the Medical Ethics Committee
diagnosis. The predisposing factors for HE include
of the Faculty of Medicine at Aswan University.
infection, variceal bleeding, certain types of
Also, a written informed consent was obtained from all
medications as benzodiazepines, opiates and diuretics,
participants. The current study was prospectively
and constipation. The main line of therapy is to identify
conducted over one year duration.
the predisposing factor and its removal (3).

One hundred patients diagnosed as hepatic
Many lines of therapy are used to decrease level
encephalopathy were enrolled. Any patient with central
of ammonia in those patients. Lactulose is considered
nervous lesions (brain abscess, meningitis, intracranial
the mainstay of therapy for many years. It is able to
hemorrhage.....etc),
metabolic
disorders
reduce colonic pH and ammonia level. In addition to
(hypoglycaemia, electrolytes imbalance), other causes
lactulose, rifampicin was recently added to regimens of
of hyperammonemia (ureterosigmoidostomy), toxic
therapy. It had the advantage of poor systemic

This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (
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1718
Received:4 /7 /2020

Accepted:3 /9 /2020

Full Paper (vol.813 paper# 30)