c:\work\Jor\vol815_1 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1916-1923

Occupational Pesticides Intoxication among Agricultural Workers
Mahmoud Ali Saleh, Hassan El Sayed El far, Omyma Mahmoud Hassan, Marwa Salah El-DienAbdEl-
Raouf, Shaima Adel Elsayed Ali
Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Benha University
Corresponding author: Marwa Salah El-dienAbd-Elraouf, Mobile: (+20) 01065063533, E-Mail: marwad24@yahoo.com

Abstract
Background: Pesticide intoxication is a public health problem in many developing countries. Approximately 18.2
per 100000 agricultural workers worldwide have occupational-related pesticide acute and chronic toxicity
symptoms.
Objective: This study aimed to investigate the toxic symptoms in pesticide-exposed agricultural workers.
Patients and Method: A cross sectional study was conducted on 390 agricultural workers using an interview
questionnaire that consists of socio-demographic and exposure data, safety practices and self-reported toxicity
symptoms. Physical examination and investigations were done.
Results:
Among the self-reported toxicity symptoms, cough was the most common acute symptom (59%) while
skin problems were the most reported chronic symptoms (11.5%). There was a statistically significant difference
regarding age between those with & without blurring of vision [(median, 50 and 39 years respectively) P < .001],
muscle spasm [(median, 49 and 40 years respectively) P < .001] and skin problems [(median, 48 & 41 years
respectively) P < 0.007]. Regarding duration of exposure, there was a statistical significant difference between those
with & without blurring of vision [(median, 10 and 50 years respectively) P < .001], muscle spasm [(median, 10
and 6 years respectively) P < .001] and skin problems [(median, 12 and 6 years respectively) P < .001]. There was
statistical significant negative correlation between serum cholinesterase level and age, duration of pesticides
exposure and body mass index.
Conclusions: The most self-reported pesticides toxicity symptom was cough (59%) while walking problems were
the least reported one (5.9%). Age and duration of pesticides exposure are significant risk factors for pesticides
toxicity.
Keywords: Pesticides, Toxicity, Agricultural workers.

INTRODUCTION

Study setting: The Primary Health Care Units in 3
Agricultural sector has a central role in the
randomly chosen villages in Kafr-Shukr disrict,
Egyptian economy, as it accounts for more than 30%
Qalyubia governorate. Egypt (Kafr Ali Sharafuddin,
of the work force (1). Pesticide intoxication is a well-
Berqata and Alshuqur).
known public health problem in many developing
Study period: The field work of this study was carried
countries. It is estimated by the World Health
out from first of March 2020 to the end of May 2020.
Organization (WHO) that approximately 18.2 per
Target population of the study: Agricultural
100000 agricultural workers have occupational-
workers who are fulfilling the following inclusion
related pesticide poisonings worldwide (2). This can be
criteria.
attributed to inappropriate protective measures

including inadequate clothing, unsafe handling,
Inclusion criteria: Agricultural workers using
storage and disposal practices, drift of spray droplets,
pesticides of age group 18-60 years old and accepted
poor maintenance of spray equipment (3). Occupational
to participate in the study.
exposure to pesticides can cause acute and chronic

poisoning. Acute toxicological symptoms include
Exclusion Criteria: Alcoholics, drug abusers and or
dizziness, muscle ache, headache and seizures (4). In
workers with chronic diseases.
addition, long-term pesticides exposure has been

associated with a wide range of chronic
Sampling Design
manifestations, including impaired neurobehavioral
- Sample size:
function, respiratory problems, obesity, skin problems
The minimal calculated sample size was 384 by using
and thyroid problems (5).
free online program; Open Epi: Open Source
Objective: This study aimed to investigate the toxic
Epidemiologic Statistics for Public Health version
symptoms in pesticide-exposed agricultural workers.
3.01 (6). With Confidence Interval 95%, margin of error

5% and study power 80%. The annual incidence rate
SUBJECTS AND METHODS
of pesticides poisoning among agricultural workers
Study design: This is a cross-sectional study.
was 18.2 per 100000 workers according to Thundiyil
et al
(7).



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1916
Received:13 /7 /2020

Accepted:12 /9 /2020

Full Paper (vol.815 paper# 1)


c:\work\Jor\vol815_2 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1924-1930

Urinary Netrin-1 as an Early Marker for Diabetic Nephropathy
Ezzat M. Mohammed1, Fawzy A. El-Messallamy1, Ahmed M. Mazroue 2,
Islam A. Elsayed1, Amal A. Zidan3
Departments of 1 Internal Medicine and 3Clinical Pathology, Faculty of Medicine,
Zagazig University, Sharkia, Egypt
2 National Institute of Urology and Nephrology, Cairo, Egypt.
Corresponding author: Ahmed M. Mazroue, Mobile: (+20) 01226959412, E-Mail: eltaher2008@gmail.com

ABSTRACT:
Background:
Netrin-1, a laminin-related secreted protein, is a proximal tubular injury urinary marker. It is released
in the urine of both humans and mice and highly stimulated after acute and chronic renal diseases.
Objective: The current study aimed to assess the value of urinary netrin-1 level as an early marker for diabetic
nephropathy.
Patients and Methods: A total of 60 diabetic patients and 20 healthy controls were enrolled in this case-control
study. Diabetic patients were subdivided into normoalbuminuria, microalbuminuria, and macroalbuminuria.
Urinary netrin-1 levels were analyzed by enzyme-linked immunosorbent assay (ELISA).
Results: Urinary netrin-1 excretion was significantly higher in the diabetic group (1418.3±733.6 pg/mg creatinine)
compared to the control group (477.4±283.6 pg/mg creatinine) with the highest value in the macroalbuminuria
group (1919.4±573.4 pg/mg creatinine) and the lowest value in normoalbuminuria group (833.7±595.3 pg/mg
creatinine). ROC curve analysis showed that urinary netrin 1/creatinine at a cutoff point of >630.75 pg/mg with
AUC of 0.899 had 83.3% sensitivity and 85% specificity for prediction of diabetic nephropathy (P<0.001).
Conclusion: Our study is suggesting that urinary netrin-1 may be a useful biomarker for early detection of diabetic
nephropathy.
Keywords:
Diabetic nephropathy, Netrin-1, Albuminuria.

INTRODUCTION
Also, netrin-1 has an anti-angiogenic effect
Egypt is considered as the 9th leading country
that improves blood flow to hypoxic tissue and has a
in the world for the incidence of diabetes. The
promising cardioprotective value in the prevention of
prevalence of diabetes in 2019 was around 8.9 million
ischemia-reperfusion injury through the subsequent
which accounts for 17.2% among adults between 20
production of nitric oxide in animal models (8).
and 79 years of age, with an annual death of 76,262
The current study aimed to assess the value of
related to diabetes that accounts for 41.6% of deaths
urinary netrin-1 level as an early marker for diabetic
under 60 years (1).
nephropathy.

Diabetic nephropathy (DN) is a serious

microvascular complication of diabetes which may be
SUBJECTS AND METHODS
complicated with renal failure, cardiovascular disease,
Sixty patients with type 2 diabetes, at the diabetic
and premature mortality (2). Most diabetic nephropathy
outpatient clinic of Zagazig University Hospitals
patients will die from cardiovascular disease before
between February 2018 and February 2019, as well as
they reach end-stage renal disease (ESRD) and start on
20 healthy controls, were enrolled for this case-control
dialysis (3).
study. All laboratory investigations were done in the
Traditionally, microalbuminuria is considered
Clinical Pathology Department in Zagazig University
the hallmark of early diagnosis of DN. However, a
Hospitals. A total of 80 subjects had a mean age of 49.7
significant
renal
injury
arises
among
± 11.5 years with 40 males and 40 females. Diabetes
normoalbuminuric diabetic patients that are
mellitus was diagnosed according to The American
accompanied by more advanced glomerular lesions (4).
Diabetes Association criteria (9).
Although diabetic nephropathy is classically

believed to be a glomerular disease, tubulointerstitial
Ethical Considerations:
injury is suggested to precede obvious glomerulopathy
Informed consent was obtained from all
(5).
participants and the study protocol was approved by
Netrin-1 is a laminin-related protein of 50­75
the Internal Medicine Department and The
KD weight that has been stated as a neuronal guidance
Institutional Review Board (IRB) of the Faculty of
cue (6). It is principally expressed in the central nervous
Medicine at Zagazig University. The work has been
system (CNS), but also in non-neural tissues such as
carried out following The Code of Ethics of the World
kidneys, liver, pancreas, lungs, and vascular
Medical Association (Declaration of Helsinki) for
endothelium (7).
studies involving humans.



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1924
Received:12 /7 /2020

Accepted: 11/9 /2020

Full Paper (vol.815 paper# 2)


c:\work\Jor\vol815_3 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1931-1936

Role of Hysterolaparoscopy in The Evaluation and Management of Female Infertility
Wael Hussein Al-Bromboly, Hussein Mohammed Abdel-Dayem,
Amr Ahmed Abdel-Rahman and Bashaer Rashad Ali Gamal El-Din
Department, Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding Author: Bashaer Rashad Ali Gamal El-Din, Mobile: (+20)01096937052,
Email: bashaerrashad1995@gmail.com

ABSTRACT
Background:
The definition of infertility is one year of unprotected intercourse with no pregnancy among married
couples.
Objective: The aim of the study is to assess the efficacy and safeness of combined hysterolaproscopy on evaluation and
management of female infertility.
Patients and Methods: A prospective clinical triad study was carried on 416 patients infertile women aged between 18
and 42 years with either primary or secondary infertility with normal hormone profile and without male factor infertility
at the Cytogenetics and Endoscopy Unit, at Zagazig University. Those females underwent both hysteroscopy and
laparoscopy through the period from August 2017 to July 2018.
Results:
This study showed that 42.7% of primary infertility and 59.5% of secondary infertility cases did not have any
abnormality detected on laparoscopy. Endometriosis was the most common abnormality found in primary infertility
followed by peritoneal adhesions, which was (12.2%) the most common abnormality found in second infertility followed
by endometriosis. Abnormality in cases of primary infertility was intrauterine septum, and in secondary infertility was
intrauterine synechia.
Conclusions:
Diagnostic hysterolaparoscopy is a very safe and effective tool for the evaluation of infertility particularly
for detection of conditions like endometriosis, tubal adhesions, and intrauterine septum.
Key words: Female infertility, Infertility, Hysteroscopy, Laparoscopy.

INTRODUCTION
the case with conventional surgery, endoscopic surgery
Infertility is defined as failure to conceive during
relies heavily not only on the skill of the surgeon but
1 year of unprotected frequent intercourse. It affects
also on technology (6).
approximately 10­15% of couples. Leading cause of
Similarly, visualizing the uterine cavity and
infertility includes tuboperitoneal disease (40­50 %),
identifying the possible pathology made hysteroscopy
ovulatory disorders (30­40 %), uterine factor (15­20 %)
an equally important tool in infertility evaluation.
and
male
factor
infertility
(30­40
%).
Additionally, hysteroscopic guided biopsy and
Hysterolaparoscopy is an excellent diagnostic modality
therapeutic
procedures
like
polypectomy,
to detect hidden pathology in patients without any overt
myomectomy, septal resection, and adhesiolysis can be
clinical manifestations. Laparoscopy can reveal the
done in the same setting (8).
presence of peritubal adhesions, periadnexal adhesions,
The question of tubal morphology and patency,
tubal pathology and endometriosis in 35­68 % of cases
ovarian morphology, any unsuspected pelvic pathology,
even after normal HSG (1). Diagnostic hysteroscopy is
and uterine cavity abnormalities can all be resolved with
an equally important modality to detect uterine
accuracy at one session by hysterolaparoscopy (7).
anomalies and other intrauterine pathologies (2).
Hysterolaparscopy may appear to be invasive, but
The definition of infertility is one year of
it may become more beneficial, as diagnosis and
unprotected intercourse with no pregnancy among
therapeutic interventions can be done at the same
married couples (3). Couples with primary infertility
setting. Thus, the entire procedure becomes " prognostic
have never been able to conceive while, on the other
and therapeutic oriented rather than only diagnostic(7).
hand, secondary infertility is difficulty in conceiving
The aim of the study is to assess the efficacy and
after already having conceived (and either carried the
safeness of combined hysterolapascopy on evaluation
pregnancy to term or had a miscarriage) (4).
and management of female infertility
In gynecology, endoscopes are used most often to

diagnose conditions by direct visualization of the
PATIENTS AND METHODS
peritoneal cavity (laparoscopy) or the inside of the
A prospective clinical triad study was conducted at
uterus (hysteroscopy) (5). It has affected every area of
the Cytogenetics and Endoscopy Unit, at Zagazig
gynecology, from diagnosis to therapy, from
University from August 2017 to July 2018, on 416
reproductive medicine to urogynecology to oncology (6).
patients infertile women aged between 18 to 42 years.
It gives the surgeon an opportunity to have access
Inclusion criteria: Women aged 18­42 years. Primary
to patient's diseased organs, remove abnormal tissue
or secondary infertility with normal hormone profile
and reconstruct damaged organs (7). Much more than is
and without male factor infertility.


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1931
Received:20 /6 /2020

Accepted:21 /8 /2020

Full Paper (vol.815 paper# 3)


c:\work\Jor\vol815_4 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1937-1947

Role of Ultrasonography in Diagnosis of Pleuropulmonary Diseases in Adults
Tarek MA Elziat (1), Salah MA Maklad (1),
Shaimaa RM Ali (1), Sayed AE Mohammed (2),
(1) Department of Diagnostic Radiology, (2) Department of Chest Diseases
Faculty of Medicine, Aswan University
Corresponding author: Shaimaa RM Ali, Mobile: 01063416805; Email: shaimaaragab20@gmail.com

ABSTRACT
Introduction:
The advantage of transthoracic ultrasound (TUS) includes the absence of ionizing radiation, easy
performance, rapid, accurate, safe, short time of examination, lower cost, bedside availability and high sensitivity in
detecting pleural and pulmonary diseases. Aim of this study: Aim of the current study was to assess of the role of
transthoracic ultrasound in pleuropulmonary diseases in adults.
Patients and methods: The present study included 50 patients who fulfilled the selection criteria and formed the study
population. The present study was conducted in Radiology Department, Aswan University Hospital in the period from
December 2016 to November 2017. All patients were subjected basically to full history taking, full clinical examination,
chest x-ray, chest ultrasonography, CT chest and histopathological correlation for some cases. Results: In this study,
patients were classified into 2 groups based on the final diagnosis. The first group included 28 cases with pleural diseases
that the US reported sensitivity of 96.43%, specificity of 81.8%. The second group included 22 patients with pulmonary
diseases that the US reported sensitivity of 95.45%, specificity of 78.57%.
Recommendations: TUS has a valuable role at diagnosis of pleuropulmonary diseases.
Keywords: TUS, pleural diseases, pulmonary diseases, BLUE protocol, pleural effusion, pneumothorax, pneumonia,
pleural masses, pulmonary masses, TUS guided interventions.


INTRODUCTION
proper and the most efficient therapeutic management
Ultrasonography is currently underutilized as an
measures in many cases (2).
imaging method in the respiratory field despite the fact
Ultrasonic examination of the chest is a rapidly
that it is an easy-to-learn method with simple, straight
developing application and may be used to evaluate a
forward signs (1).
wide range of peripheral, parenchymal, pleural and chest
Thoracic ultrasound examination was considered
wall diseases. The technique is particularly suited to
less useful (2). This theory was mainly based on the less
bedside use in the intensive care unit, where suboptimal
capacity of the ultrasound in penetrating the air filled
radiography may mask or mimic clinically significant
structures, because the air is very low penetrated by the
abnormalities and where differentiation of pleural from
ultrasound beam (3).
parenchymal changes can be challenging (6).
The sonographic diagnostic impact of the chest is
Furthermore, US is increasingly used to guide
limited by its bony limitation (ribs, spinal column,
interventional procedures of the chest, such as biopsy and
sternum, and clavicle) and the gas content of the lung. So
placement of intercostal chest drains. Pathological
the normal lung cannot be judged (4).
modifications can be detected, if they are situated in the
As lung contains air and air is a poor medium for
chest wall, the diaphragm or the upper chest aperture (7,8).
sound transmission interface between chest wall and
Although ultrasound can be used to explore multiple
normal lung with different acoustic densities reflects
districts for different purposes (especially in emergency
most of the ultrasound waves, preventing a direct
and intensive care) in the respiratory setting, the routine
examination of an otherwise healthy lung. In pathological
use of ultrasound is as a tool at the patient's bedside to
conditions such as tumor invasion, consolidation or
aid and confirm the diagnosis of diseases suspected
atelectasis, the alveoli are replaced with denser tissue
following and integrating the objective examination; it
allowing better sound conduction. When the pleural
can be completed by the common techniques of chest
space is occupied with fluid or the consolidated lung
imaging; as well it can help guide eventual interventional
reaches the chest wall, it opens an acoustic window
procedures that the clinician may decide necessary (1).
permitting ultrasound examination of the lung (5).
Transthoracic ultrasonography could evaluate
The newest theories are sustaining and
abnormalities in the peripheral lung parenchyma, pleura
recommending this technique as the fastest and non-
and chest wall. Thoracic ultrasonography may also be
invasive method for the diagnosis of the affected
utilized as guidance in performing invasive procedures,
structures in the thoracic cavity. It is also easy for
such as pleural puncture, transthoracic biopsy and chest
learning and performing, without any complications and
tube insertion (9,10).
do not involve financial efforts. In addition, it can provide
Advantages of ultrasound in respiratory diseases
in real time diagnostic information and can establish the
(11,12).

Easy to learn

Fast, non-invasive and easily reproducible
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7391
Received:20 /3 /2018

Accepted:30 /3 /2018

Full Paper (vol.815 paper# 4)


c:\work\Jor\vol815_5 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1948-1952

Frequency of Inborn Errors of Metabolism among Infants with Non-Apparent
Causes of Failure to Thrive in Zagazig University Hospitals
Azza Ibrahim El-Desouky, Sherif Mohamed El-Gebally, Tarek Mahmoud Beyoumi*
Department of Pediatrics, Faculty of Medicine ­ Zagazig University
*Corresponding Author: Tarek Mahmoud Beyoumi, Email: tarekmahmoudbayoumi@gmail.com

ABSTRACT
Background:
Inborn errors of metabolism (IEM) are disorders in which there is a block at some point in the normal
metabolic pathway caused by a genetic defect of a specific enzyme. Diagnosis is important not only for treatment and
prognostication but also for genetic counseling and antenatal diagnosis in subsequent pregnancies.
Objective: The present study aimed to find out the relative frequency of inborn errors of metabolism among infants
with unapparent cause of failure to thrive (FTT).
Patients and Methods:
This study was cross-sectional prospective study, which was conducted during the period
from 2017 to August 2019. It included 58 cases with non-apparent cause of failure to thrive admitted at Pediatric
Department, Faculty of Medicine, Zagazig University. All studied cases were subjected to: EMS (extended metabolic
screen) using filter paper by Tandem Mass Spectrometry. Urinary organic acids analysis was performed.
Results: In this study, frequency of inborn errors of metabolism (IEM) among the studied unapparent causes of FTT
cases was 8.6%. Types of IEM diseases among the studied cases were one case for each of biotinidase enzyme
deficiency (1.7%), methyl malonic acidemia (1.7%), mitochondrial disease (1.7%), organic acidemia (1.7%) and
phenylketonuria (1.7%). There was statistically significant increase in complains of vomiting and diarrhea among
cases with inborn errors of metabolism than those without inborn errors of metabolism.
Conclusion:
There was high frequency of inborn errors of metabolism (IEM) among FTT without apparent cause.
Frequency of hypoglycemia, positive ketone in urine, high anion gap and high serum ammonia were significantly
more frequent among cases with inborn errors of metabolism than those without inborn errors of metabolism.
Keywords: Inborn errors of metabolism, Unapparent cause of failure to thrive, Frequency.

INTRODUCTION
PATIENTS AND METHODS
Inborn errors of metabolism (IEM) are a
Design of the study:
complex, heterogeneous group of genetic diseases.
This cross-sectional prospective study was
Most of them have severe neonatal onset and are a
conducted during the period from 2017 to August
primary cause of death in newborns and infants.
2019. It included 58 cases with non-apparent cause of
Unfortunately, newborns have a limited variety of
failure to thrive. This study was conducted at Pediatric
responses to illness, and early signs and symptoms of
Department, Faculty of Medicine, Zagazig University.
IEM are similar to the features of other, more common

neonatal illnesses (1).
Ethical approval:
Specific and effective treatments are available
This study was ethically approved from
for many IEM, and early therapeutic intervention can
Institutional Reviewer Board (IRB) in Faculty of
prevent the worsening of disease. Even if therapy is
Medicine, Zagazig University and a parental consent
unavailable, an accurate diagnosis is crucial for genetic
from every case caregiver that participates in this
counseling (2).
research was taken.
Failure to thrive (FTT) in a child is defined as

`lack of expected normal physical growth', `failure to
Sample size:
gain weight' or `lack of growth' (3).
Assuming that the total population size, of
This affects not only somatic development but
failure to thrive infant in Pediatric Department is 72
also psychosocial and motor maturation, subsequent
cases. The Positive Predictive Value (PPV) of
cognitive performance, immune function, and defenses
extended metabolic screen is 76.6%. The sample size
against infection. Because of the multiple ways in
is 58 cases using OPEN-EPI with CI 95% and Power
which childhood development is impaired, early
80%.
correction is needed (4).

The study aimed to find out the relative
Inclusion criteria:
frequency of inborn errors of metabolism among
Age from 1 month to 2 years
infants with unapparent cause of failure to thrive.
Patients with non-apparent cause of failure to

thrive

Weight: less than 3rd percentile for age and sex (5).

Exclusion criteria:
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8491
Received:23 /6 /2020

Accepted:24//8/2020

Full Paper (vol.815 paper# 5)


c:\work\Jor\vol815_6 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1953-1957

Different Treatment Modalities of Colo-Rectal Cancer (Retrospective Study)
Abbas Mahmoud Sarhan1, Mohammed Abdelgawad Soliman1,
Eman Ali El-Sebai1, Mahmoud Mohammed Ahmed El-Demery*2
1Department of Clinical Oncology, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
2Department of Clinical Oncology & Nuclear Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
*Corresponding Author: Mahmoud Mohammed Ahmed El-Demery, E-mail: mahmod.eldemery@gmail.com,
Mobile: (+20)01222922230

ABSTRACT
Background:
Colorectal Cancer (CRC) is the most common type affecting the gastrointestinal tract accounting for
about 13% of all malignancy diagnosed each year. Although Surgery stays the most effective treatment in managing
colorectal carcinoma, there is a rapid increase in the use of preoperative radiotherapy and chemotherapy.
Objective: So, the present study was conducted to identify the different therapeutic modalities used in the treatment.
Patients and Methods:
This study was a retrospective study that included CRC patients treated at the Clinical
Oncology Department, Zagazig University Hospital during the period from 2012 to 2017. Medical records of 385
patients, who were referred to the Clinical Oncology Department after being diagnosed with CRC were obtained
and used to collect data about different treatments and then analyzed.
Results: Chemotherapy regimen FOLFOX was received in (45.5%) of cases and partial response in 41 % of cases
was observed. Patients received at least one line of chemotherapy with either adjuvant or palliative intent. Rectal
cancer patients who received neoadjuvant concurrent chemo& radiotherapy showed a partial response in 45.5 % of
cases. Xeloda was the most common chemotherapy received in most cases who received either adjuvant or
neoadjuvant CCRT. Recurrence occurred in (81%) of cases.
Conclusion:
Chemotherapy regimen FOLFOX was received in most cases. Patients received at least one line of
chemotherapy with either adjuvant or palliative intent, FOLFOX was the most chosen protocol. Xeloda was the
most common chemotherapy received in most cases.
Keywords: treatment modalities, Colorectal Cancer, Retrospective.

INTRODUCTION


Colorectal Cancer (CRC) is the most common
has been proven to be the only potentially curative
cancer affecting the gastrointestinal tract. About two-
therapy (5).
thirds of all colorectal cancers were presented in the
Metastatic irresectable CRC patients usually
developed regions of the world. It also comes as the
receive either palliative chemotherapy, radiotherapy,
second leading cause of cancer-related deaths. It is the
or BSC (Best Supportive Care) according to their
third most diagnosed cancer in males and the second in
performance status, tolerance to treatment (6).
females, with 1.8 million new cases and almost
Chemotherapy is routinely added to long-course
861,000 deaths in 2018 according to the World Health
radiation treatment as chemo-radiation was associated
Organization (1).
with a lower risk of local recurrence and improved
In Egypt, the average number of colon cancer
disease-free survival, compared with radiation
patients (without rectal cancer) in 2015 was slightly
treatment alone (7). So, the present study was
more than three thousand (2). Evaluation of the entire
conducted to identify the different therapeutic
colon & rectum and accurate staging are essential for
modalities used in CRC and their impact on patients'
optimal treatment of colorectal cancers. The TNM
outcomes.
staging system is the main tool used for CRC staging

(3).
PATIENTS AND METHODS
Surgery stays the only curative and most effective
This was a retrospective study on CRC patients
treatment in managing colorectal carcinoma. But in the
treated at the Clinical Oncology Department, Zagazig
last decade, there is a rapid increase in the use of
University Hospital during the period from 2012 to
preoperative radiotherapy, neoadjuvant, and adjuvant
2017. The medical records of 385 patients, who were
chemotherapy (4).
referred to the department after a proven diagnosis
The liver is the most common site of distant
with CRC were enrolled in the study. A detailed
metastases from colorectal cancer with approximately
history and clinical examination were revised. The
25% of patients diagnosed with synchronous
intent of management: whether curative or palliative
colorectal liver metastases (CLM) at presentation.
was addressed.
Surgical resection is the current treatment of choice for
Chemo and Radiotherapy setting whether received
colorectal cancer metastases isolated to the liver and
in adjuvant or neoadjuvant setting data was collected

and each group had been subdivided into smaller


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1953
Received:13 /6 /2020

Accepted:12 /8 /2020

Full Paper (vol.815 paper# 6)


c:\work\Jor\vol815_7 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1958-1966

Studies on the Effect of Aqueous Green Tea Extract on Lipid Profile and
Vascular Reactivity in Hypercholesterolemic Albino Rats
Mohammed Hassan El-Bakry, Ramadan Hassan Ibrahim, El-Shazly Abdelaal Mohaseb*
Department of Pharmacology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: El-Shazly Abdelaal Mohaseb, Mobile: (+20) 01144881566, E-Mail: Shazly_1234@yahoo.com

ABSTRACT
Background:
Hypercholesterolemia is one of the most important risk factors for atherosclerosis and subsequent
cardiovascular disease (CVD). CVD is the leading cause of cardiovascular morbidity and mortality worldwide,
currently, there is a major trend to use herbal remedies for the treatment and prevention of hypercholesterolemia.
Objective: In the present work, we investigated the effect of aqueous green tea extract on lipid profile and vascular
reactivity & changes in body weight in hypercholesterolemic albino rats
Materials and methods: Adult male albino rats were chosen as an animal model for this study. Rats were brought
from animal house, Faculty of Medicine, Assiut University, Assiut, Egypt, and were maintained on a balanced diet
with water supply freely in clean containers. They were kept for two weeks to adapt to the laboratory conditions
before the start of the experiment. Forty age-matched male albino rats with initial body weights ranging from 200 to
220g were used.
Results: In group (III & IV), total cholesterol, LDL, and triglyceride levels were significantly decreased
respectively& HDL were significantly increased compared with the group II (p< 0.05). also in group (III & IV) the
aortic contractility is decreased and aortic relaxation were significantly increased compared with the group II (p<
0.05) & body weight was decreased significantly (p< 0.05) in group IV compared with the group II.
Conclusion: The results obtained by the present study showed that administration of aqueous green tea extract to the
hypercholsterolemic rats has a role in improvement of plasma lipids, vascular reactivity& body weight.
Keywords: Aqueous green tea, Lipid profile, Vascular reactivity, Hypercholesterolemic albino rats.


INTRODUCTION

Hypercholesterolemia is a condition characterized by
cardioprotective effect via multiple mechanisms (6).
very high levels of cholesterol in the blood (1).
Including the inhibition of oxidation, vascular
Hypercholesterolemia is a problem faced by many societies
inflammation, thrombogenesis, and improvement in
and is a cause of concern for health professionals (2).
blood lipid concentrations. Recent animal studies have
The continuous ingestion of high amounts of fat
revealed that green tea catechins could inhibit key
seems to be directly related to hyperlipidemia in
enzymes involved in lipid biosynthesis and reduce the
humans. Consequently, it has been tried to provoke
intestinal absorption of Total cholesterol, thereby
hyperlipidemia in laboratory animals, in order to
improving blood lipid profiles (7). Green tea catechins
understand better the relationship between disorders in
and EGCG have been reported to improve endothelial
cholesterol metabolism and atherogenesis and to test
function in the spontaneous hypertensive rat and the
possible treatments for the reduction of circulating
high fat-fed mouse (8).
cholesterol level (3).

\Treatment of hyperlipidemia may be with
AIM OF THE WORK
therapeutic medicines or through natural edible
In the present work, we investigated the effect of
materials which help to lower serum lipid levels.
aqueous green tea extract on lipid profile and
Natural edible materials have the advantage in that
vascular reactivity & changes in body weight in
they avoid side effects often associated with
hypercholesterolemic albino rats.
medications, while still improving or healing the

hyperlipidemia (4). Green tea is a widely consumed
beverage worldwide and is traditionally used in Asian
MATERIALS AND METHODS
countries as a medication. Green tea is produced from
1. Experimental animals:
fresh leaves of Camellia sinensis and is not
Forty adult male albino rats were chosen as an
traditionally fermented (5).
animal model for this study. Rats were brought from
Green tea contains antioxidants and other
animal house, Faculty of Medicine, Assiut University,
beneficial nutrients such as protein, carbohydrates,
Assiut, Egypt, and were maintained on a balanced diet
minerals, vitamins, and flavonoid-like polyphenols. In
with water supply freely in clean containers. They
vivo and in vitro studies have shown that green tea
were kept for two weeks to adapt to the laboratory
catechins (which belong to the family of flavonols and
conditions before the start of the experiment. Forty
serve as an essential component of green tea, exert a


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1958
Received:14 /7 /2020

Accepted:13 /9 /2020

Full Paper (vol.815 paper# 7)


c:\work\Jor\vol815_8 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1967-1969
Purine Nucleoside Phosphorylase (PNP) Deficiency: A Case Report
Rawia Albar1, Alaa Alesa2, Dina Saqa3, Jamanah Abdulaziz2, Mohammad Batouk4, Abdullah Alesa1
1King Abdulaziz Medical City, Jeddah, 2King Saud bin Abdulaziz University for Health Sciences College of
Medicine,3Ibn Sina National College for Medical Studies,4King Abdulaziz University.
Corresponding Author: Alaa Alesa, E-Mail: alaa.alesa@gmail.com, Phone : +966583399699

ABSTRACT
Background:
Purine nucleoside phosphorylase (PNP) deficiency is a rare genetic disease that results in combined
immunodeficiency. Its inheritance is autosomal recessive and affects the purine metabolic pathway. There is a profound
effect on T-cells and variable B-cell dysfunction. There is a strong association with neurological dysfunction in as many
as two thirds of cases and autoimmunity in one third. When PNP activity is absent or greatly diminished, deoxyguanosine
triphosphate (dGTP) is believed to accumulate in the mitochondria, which inhibits ribonucleotide reductase and
mitochondrial DNA repair. This is very harmful to T lymphocytes and leads to DNA damage and apoptosis during thymus
selection.
Case: A toddler girl diagnosed with PNP) deficiency that is currently being managed using different type of modalities
with good response.
Results: The patient was admitted in an outside hospital when she developed fever for 4 days along with a perianal
abscess. Septic shock was suspected, and she was initially started on gentamycin and tazocin then switched to vancomycin,
mereponem and metrodinazole. After resolution of fever, the patient was transferred to our tertiary care center to undergo
immunology work up. Upon finally receiving the patient she was stable and afebrile, however there was severe
neutropenia and leukopenia. A multidisciplinary team, which included general pediatrics, hematology, Infectious diseases
and immunology, handled her case. Furthermore, the patient was switched back to tazocin and gentamycin and completed
14 days with good response and full resolution of fever. Following the multidisciplinary team plan, an
immunology/hematology work up was initiated.
Conclusion: After 14 days of treatment, there was a good response and resolution of fever. Then, a multidisciplinary
team plan, an immunology/hematology work up was initiated.
Keywords: PNP, immune deficiency, immunity, pediatrics.

INTRODUCTION

Purine nucleoside phosphorylase (PNP) deficiency is
We presented a case of a thirty-three month old girl
a rare genetic disease that results in combined
diagnosed with PNP deficiency who had multiple
immunodeficiency. Its inheritance is autosomal recessive
infections requiring hospitalizations along with hypotonia
and affects the purine metabolic pathway. There is a
and global developmental delay.
profound effect on T-cells and variable B-cell dysfunction.

There is a strong association with neurological
Case description:
dysfunction in as many as two thirds of cases and
This is a Thirty-three month old, full term female child
autoimmunity in one third (1, 2).
from Saudi Arabia. She was delivered by spontaneous
Giblett et al. (3) was the first to describe PNP
vaginal delivery with no perinatal complications to report.
deficiency in 1975 shortly after discovering a deficiency
The parents are 1st degree relatives and the mother is a
of another enzyme of the purine metabolic pathway,
primigravida with no history of abortions.
adenosine deaminase (ADA). When PNP activity is absent
However, the child was known to have autosomal
or greatly diminished, deoxyguanosine triphosphate
recessive immunodeficiency due to purine nucleoside
(dGTP) is believed to accumulate in the mitochondria,
phosphorylase deficiency.
which inhibits ribonucleotide reductase and mitochondrial
There were central hypotonia and a history of
DNA repair. This is very harmful to T lymphocytes and
recurrent oral thrush. Moreover, there was a history of one
leads to DNA damage and apoptosis during thymus
previous hospitalization before at the age of 9 months due
selection. There are many disease-causing mutations in the
to a respiratory infection. Recently she was admitted in an
PNP gene and approximately 17 have been reported to
outside hospital when she developed fever for 4 days
date, coupled with the somewhat variable course of the
along with a perianal abscess. Septic shock was suspected,
disease associated with PNP deficiency that may be
and she was initially started on gentamycin and tazocin
related to this genetic heterogeneity (4).
then switched to vancomycin, mereponem and


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Commons Attribution (CC BY-

SA) license (http://creativecommons.org/licenses/by/4.0/)
1967
Received:15 /7 /2020

Accepted:14 /9 /2020

Full Paper (vol.815 paper# 8)


c:\work\Jor\vol815_9 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1970-1976

Anandamide Level in Men with Oligoasthenoteratozoospermia
Moustafa A El Taieb1*, Abdallah Mahmoud A Ali2, Mona H Sedeek3, Aya AA Hussein1
Departments of 1Dermatology, Venereology & Andrology, 2Biochemistry and 3Physiology ­
Faculty of Medicine, Aswan University
*Corresponding author: Moustafa A. El Taieb, Mobile: (+20) 01092991101, Email: moustafa.eltaib@aswu.edu.eg

ABSTRACT
Background:
Male infertility is a relatively common medical condition. Male partners are found to be solely
responsible for 20­30% of infertility cases. Oligoasthenoteratozoospermia (OAT) is the most common laboratory
finding in infertile men. Endocannabinoids are endogenously produced substances, that primarily act at cannabinoid
receptors (CBRs), thus reproducing some of the biological actions of the natural cannabis sativa components (the
"cannabinoids"). The endocannabinoid system is involved in several physiological processes, including fertility and
body weight control.
Objective: The aim of this study was to detect the level of anandamide (AEA) in patients with OAT and its relation
to BMI.
Patients and methods: This study was a case control study. It was hold between June 2018 to April 2019 in the
Dermatology, Venereology and Andrology Department at Aswan University Hospital. The study included 20
patients with OAT and 9 as controls. Semen analysis using CASA was done. AEA level in seminal plasma was
measured using ELISA kits. BMI was calculated.
Results: AEA level in seminal plasma significantly decreased in men with ligoasthenoterat- ozoospermia than
control (P < 0.009). AEA concentration on seminal fluid was significantly increased with an increase in BMI (P=
0.023). On the other hand, a significant negative relationship was present between BMI and semen volume (P= 0.03).
Conclusion: AEA concentration in seminal plasma was significantly decreased in patients with OAT. AEA
concentration in seminal fluid was significantly increased with an increase in BMI. On the other hand, a significant
negative relationship was present between BMI and semen volume.
Keywords: Anadamide, Oligoasthenoteratozoospermia, BMI.

INTRODUCTION
Cannabinoid signalling is mediated via two well-
Infertility is the inability of a sexually active,
characterized
G-protein-coupled
cannabinoid
non-contracepting couple to achieve spontaneous
receptors, CB1and CB2, which are the molecular
pregnancy in one year (1). Fertility rates have been
targets of the endocannabinoids (ECS), a group of
declined over the last century in many developed
endogenous bioactive lipid mediators (8). The most
countries (2). Male infertility is a relatively common
studied
endocannabinoid
is
N-
medical condition affecting up to 12% of men globally.
arachidonoylethanolamine (anandamide, AEA), which
Male partners are found to be solely responsible for 20­
is found in tissues and biological fluids at nanomolar
30% of infertility cases and contribute to roughly 50%
concentrations. Human spermatozoa have been shown
of cases overall (3). It affects approximately one in six
to express functional cannabinoid receptors CB1 and
couples (15­20%) (4).
CB2 and mRNA and proteins for CB1 and CB2
It is considered a male factor when an alteration
receptors have been reported in mature human
in sperm concentration and/or motility and/or
spermatozoa (9, 10). Significant levels of AEA are
morphology could be found in at least one sample of
present in human seminal plasma mid-cycle fallopian
two sperm analyses, which comply with World Health
tubal fluid and follicular fluid. This suggests that
Organization (WHO) 2010 guidelines, collected
human spermatozoa are sequentially exposed to AEA
between1­4 weeks apart (5). However, causes of
during storage in the epididymis and also during their
approximately 50 % of male factor infertility cases are
journey through the female reproductive tract,
still unexplained (6).
suggesting a potential modulatory role of the
Oligoasthenoteratozoospermia (OAT) is the
endocannabinoid system on human sperm functions
most common finding in the era of evaluation of male
(11).
infertility. In most cases the etiology of OAT can be
Studies on the relationship between body mass
detected by common investigative and radiological
index (BMI) and sperm motility have shown
methods.
When
the
etiology
of
conflicting data. Comparing obese fertile to obese
oligoasthenoteratozoospermia could not be detected,
infertile oligozoospermic males found a significant
the
syndrome
is
termed
idiopathic
negative correlation with sperm motility (12).
oligoasthenoteratozoospermia (iOAT) (7).
There is an increasing data on endocannabinoid

control of energy homeostasis and recent evidence for


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1970
Received: 15/7 /2020

Accepted: 14/9/2020

Full Paper (vol.815 paper# 9)


c:\work\Jor\vol815_10 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1977-1984

Femoral Cartilage Thickness and Vitamin D Level in
Systemic Sclerosis Patients and Relation to Disease Severity
Mohammed Abd El Monem Teama*, Hanan Mohamed Farouk, Safaa A. Hussein, Fatma Mohammed Badr
Internal Medicine Department, Division of Rheumatology and Immunology, Faculty of Medicine,
Ain Shams University, Cairo, Egypt
*Corresponding author: Mohammed Abd El Monem Teama, Email: mohteama2009@yahoo.com

ABSTRACT
Background:
Systemic sclerosis (SSc) is a heterogeneous autoimmune disorder associated with vascular dysfunction
and fibrotic changes. Low vitamin D levels and decreased femoral cartilage thickness (FCT) have been observed in
SSc.
Objectives:
This study aimed to evaluate the relation between serum level of vitamin D and FCT among SSc patients
and to correlate both with clinical features and disease severity score.
Patients and Methods:
This study included 40 SSc patients, divided into 2 groups; group 1: sufficient vitamin D
(level > 30 ng/ml), group 2: insufficient vitamin D (level < 30 ng/ml). All patients were subjected to history taking,
clinical examination, and assessment of disease severity by Medsger Disease Severity Index (MDSI), laboratory
investigations, 25 (OH) vitamin D level and musculoskeletal ultrasound of both knees to assess FCT. Three midpoint
measurements of FCT were taken from each knee: lateral femoral condyle (LFC), femoral intercondylar area (ICA)
and medial femoral condyle (MFC).
Results:
Thin FCT was found in 60% of patients. There was insufficient vitamin D level in 65% of patients. Age
was negatively correlated with FCT at right MFC area and female parity was also negatively correlated with right
ICA and MFC areas. FCT was significantly lower in group 1 at areas of left MFC and LFC areas, but no relation
between femoral cartilage thickness and vitamin D level with disease severity.
Conclusion:
There is significant relation between femoral cartilage thickness and vitamin D level in scleroderma
patients, both decline in SSc patients but not related to disease severity score.
Keywords:
Scleroderma, Vitamin D, Femoral cartilage thickness, Disease severity score, Musculoskeletal
ultrasound.

INTRODUCTION


Systemic sclerosis (SSc) is a connective tissue
synthesis of proteoglycan and/or increasing the
disease characterized by different degrees of skin
metalloproteinase activity, leading to cartilage loss (4).
fibrosis and visceral organ involvement. The etiology
Patients with SSc had thinner femoral cartilage.
of SSc remains obscure; the disease appears to be the
The underlying possible mechanisms of thin femoral
result of a multistep and multifactorial process,
cartilage may be multifactorial, and there may be
including immune system alterations, under the
many influencing factors like immune activation,
influence of genetic and exogenous (toxic or
vasculopathy, oxidative stress and synovial fibrosis or
infectious) factors (1).
markers of cartilage degradation. The possible factors
Vitamin D had been the focus of a growing
influencing the change in cartilage thickness or
number of studies in the past years, demonstrating its
metabolism in patients with SSc require further
function not only in calcium metabolism and bone
research (5).
formation, but also the interaction with the immune
This study was performed to evaluate the
system since vitamin D receptors are expressed in
relationship between serum levels of vitamin D and
different tissues. Numerous studies have been
femoral cartilage thickness (FCT) among the studied
conducted to study whether vitamin D is associated
SSc patients and to correlate with both disease severity
with SSc. However, they produced varying results (2).
score and clinical features.
Vitamin D deficiency was identified to be frequent in

SSc patients and associated with disease activity or
PATIENTS AND METHODS
phenotype characteristics such as pulmonary
The present cross-sectional study enrolled forty
hypertension, lung involvement, and extensive
SSc patients aged >18 years based on 2013 European
cutaneous forms (3). Vitamin D deficiency may change
League against Rheumatism/American College of
the balance of cartilage metabolism via reducing the
Rheumatology (EULAR/ACR) classification criteria


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1977
Received:14 /7 /2020

Accepted:13 /9 /2020

Full Paper (vol.815 paper# 10)


c:\work\Jor\vol815_11 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1985-1992

Factors Affecting Employment in Maintenance Hemodialysis Patients in Egypt
Magdy El-Sharkawy, Yahya Makkeyah, Doaa Elwasly*
Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Doaa Elwasly, Email: dr.dodoelwalsy@hotmail.com

ABSTRACT
Background:
Most of hemodialysis patients are unemployed and the few who are working are at risk of losing their
jobs. Therefore, factors affecting employment need to be studied.
Objective: Our aim was to access factors affecting employment among working-age patients on hemodialysis all over
Egypt as it was not assessed before.
Patients and Methods: This study was conducted between October 2012 and April 2015 in multiple hemodialysis
centers by direct interview of the patients and collecting the data from the medical record in a special data collection
sheet. Results: The study was conducted on 16280 hemodialysis patients in 19 Egyptian governorates. 21.2% of the
patients were employed, 81.6% of the employed patients were men, and their mean age was 47.25+11.31. Hypertension
was the most common etiology of end-stage renal disease (ESRD) and was the commonest comorbidity in employed
patients. Employment was affected by age, gender, ESRD etiology and most comorbid conditions apart from comorbid
chronic liver disease and chronic obstructive pulmonary disease. Factors affecting employment was dialysis frequency,
duration, complications, dialyzer type, material, and surface area, dialysate type, dialysate Na, K and vascular access,
haemoglobin (Hb) level, Ca/PO4 ratio, parathormone (PTH), iron injection, blood transfusion, erythropoietin intake,
vitamin B complex intake, L carnitine intake, phosphate binders, cinacalcet and folic acid intake while Kt/v and urea
reduction ratio and vitamin D supplements did not affect employment.
Conclusion: Similar to the other studies we found that employment was not common among hemodialysis patients,
which was affected by age, gender, ESRD etiology and comorbidities apart from chronic obstructive pulmonary disease
(COPD) and chronic liver disease (CLD) which differed from other studies.
Keywords: Employment, ESRD, hemodialysis, hypertension.

INTRODUCTION

Dialysis is a life-changing event for patients at
There are several different types of interventions
multiple levels. Employment is one of several challenges
that may assist an adult on dialysis to retain employment.
faced by individuals with progressive chronic kidney
These can include 1)vocational interventions such as
disease (CKD) transitioning to ESRD. Such patients face
flexible working hours, working from home
multiple disincentives to employment, including
arrangements, 2) workplace adjustments such as a
medical, logistical, and financial disincentives (1).
private room for peritoneal dialysis exchanges, 3)
A prospective study investigating 659 patients
government policies such as paid caregiver-assisted
undergoing dialysis in The Netherlands reported that at
home dialysis, 4) skills training after extended time away
the start of hemodialysis treatment, 31% of the patients
from work due to hospitalisation, 5) psycho-social
were employed, but that the proportion decreased to 25%
interventions to assist with re-adjustment to new roles,
within 1 year after dialysis initiation (2). Another study of
6)drug interventions to reduce uremic symptoms, 7)
4026 patients undergoing dialysis in the US Renal Data
provision of nocturnal dialysis therapies such as
System (USRDS) reported that 41.9% of the patients
automated peritoneal dialysis or nocturnal home
were employed before starting hemodialysis treatment,
hemodialysis may also be considered, as well as 8)
but the proportion decreased to 21.1% after hemodialysis
dialysis machine adjustments to facilitate work-based
treatment and decreased even further to 6.6% a year later
tasks (4).
(3).
The aim of this study was to investigate the
The factors associated with job loss after starting
factors affecting employment in maintenance
dialysis are older age (i.e. over 49 years), female gender,
hemodialysis in Egypt.
concurrent chronic diseases, hemodialysis rather than

peritoneal dialysis as first treatment modality, poor
PATIENTS AND METHODS
health insurance coverage, and low or no erythropoietin
This study is a cross sectional study that was
usage before ESRD (4).
conducted in multiple hemodialysis centers from 19
The factors associated with increased
different governorates across Egypt between October
employment after initiation of dialysis were studied
2012 and April 2015 by direct interview of the patients
before (5), but the data on employment rates of the ESRD
and collecting the data from the medical record in a
on hemodialysis patients from Egypt and the factors
specialized data collection sheet.
affecting their employment were not investigated before.



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1985
Received:14 /7 /2020

Accepted:13 /9 /2020


Full Paper (vol.815 paper# 11)


c:\work\Jor\vol815_12 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 1993-2000

Serum Golgi Protein 73 as a Biomarker for Liver Fibrosis in
Chronic Hepatitis C Patients
Hala A Abdel-Azeez1, Samar M Sharaf1, Eman A Elshamy2, Abeer A Fikry1
Departments of 1Clinical Pathology and 2 Tropical Medicine, Faculty of Medicine, Zagazig University
*Corresponding author: Abeer A Fikry, Mobile: 00201029153181, Email: abfikry@gmail.com

ABSTRACT
Background:
Serum Golgi protein 73 (GP73) is a promising biomarker of liver fibrosis, but most data are from
hepatitis B virus-related liver diseases rather than hepatitis C virus (HCV).
Objective:
To evaluate the use of GP73 as a marker for liver fibrosis in chronic HCV patients and to correlate it with
fibrosis staging of liver biopsy and other laboratory findings.
Subjects and Methods: The study included 37 chronic HCV patients who were subdivided according to liver biopsy
results into chronic HCV patients without fibrosis (10) and chronic HCV patients with fibrosis (27). 37 healthy
individuals were taken as control. All participants were subjected to determination of liver function tests with
calculation of AST-to-Platelet Ratio Index (APRI) and serum GP73 by ELISA.
Results: GP73 was significantly increased in chronic HCV patients with fibrosis when compared to patients without
fibrosis and healthy control. A significant positive correlation was observed between GP73 and advanced liver function
tests, increased fibrosis stage and APRI in chronic HCV patients with fibrosis. Based on receiver operating
characteristic (ROC) curve analysis, GP73 had an area under curve (AUC) of 0.909 with 81.8% sensitivity and 93.3%
specificity for prediction of significant fibrosis. On combination with APRI, the sensitivity was increased to 90.9%.
Conclusion: GP73 can be used as serum marker for prediction of significant liver fibrosis in chronic HCV patients
either alone or in combination with APRI. It can be also useful in monitoring fibrosis progression.
Keywords:
Hepatitis C, Golgi protein 73, APRI, Liver fibrosis.

INTRODUCTION

Hepatitis C virus (HCV) represents a significant
proposed as the alternatives to liver biopsy, such as
global public health burden, and long-term infection
fibrosis index based on four factors (FIB-4), the AST-
can lead to many serious liver-related outcomes
to-
including liver cirrhosis, hepatocellular carcinoma and
platelet ratio index (APRI), and transient elastography,
liver-related mortality (1). The event with the greatest
which are based on blood indices and imaging
impact on the natural history of chronic HCV is the
modalities, respectively (5). Non-invasive assessment of
progressive formation and accumulation of liver
liver fibrosis is a focus of continuing interest to find a
fibrosis. This accumulation of fibrillar extracellular
marker that is cost-effective, easy to perform with
matrix components is the hallmark of the natural history
standard laboratory tests, accurately reflective of the
of the disease and significantly influences prognosis (2).
stage of hepatic fibrosis and valid over a wide patient
Liver fibrosis may progress to cirrhosis and eventually
population (6).
death. However, increasing evidence suggests that even
In normal livers, Golgi protein 73 (GP73) is a 73
advanced fibrosis is reversible, although end-stage
kDa transmembrane glycoprotein constitutively
cirrhosis is irreversible and affected patients can only
expressed by biliary epithelial cells, but only minimally
survive with a liver transplant. Estimating the current
by hepatocytes. Hepatocellular expression of GP73
degree of fibrosis is crucial for determining whether the
mRNA and protein is dramatically upregulated in acute
fibrosis could be reversed with treatment (3).
or chronic hepatitis, regardless of the etiology, and
Liver biopsy is an invasive method that has long
accompanies the advanced fibrogenesis stage. With the
been regarded as the `gold standard' for staging liver
recovery of acute hepatitis, GP73 expression reverses,
fibrosis. However, several issues prevent the routine use
whereas biliary epithelial cell expression remains
of liver biopsy as a clinical tool, including risk of injury
unchanged. GP73 overexpression also occurs in
to the patient, variable accessibility of the damaged
activated hepatic stellate cells, which are the major
section of the liver, high cost, sampling errors and
feature of liver fibrosis. GP73 has been considered a
inaccuracy due to inter- and intra-observer variability of
useful indicator in evaluating liver impairment or
pathologic interpretations (4). Instead, several
fibrosis (7).
noninvasive methods for fibrosis assessment have been




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1993
Received:16 /7 /2020

Accepted:15 /9 /2020

Full Paper (vol.815 paper# 12)


c:\work\Jor\vol815_13 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2001-2005

Clinical Outcomes of Upper Gastrointestinal Bleeding in Egyptian Patients with
Decompensated Liver Cirrhosis, Does the Bleeding Source Matter?
Mohamed S Mohamed, Mohamed G Hamed, Amr S Hanafy, Mohamed AA Bassiony
Internal Medicine Department, Faculty of Medicine, Zagazig University
Corresponding author: Mohamed Bassiony, Telephone: 01006680215, E-mail: dr_mbh13303@yahoo.com

ABSTRACT
Background:
Upper gastrointestinal bleeding (UGIB) is a prevalent emergency and mortality cause in cirrhotic
patients. It prolongs the hospital length of stay (LOS) and increases hospital readmission.
Objectives: We investigated the clinical outcomes of acute variceal bleeding (AVB) and non-variceal bleeding
(NVB) in patients with decompensated cirrhosis and the possible risk factors for prolonged hospital LOS.
Patients and Methods: All patients with decompensated liver cirrhosis and UGIB (AVB & NVB) hospitalized from
August 2018 to March 2019 were enrolled in this study. We assessed mortality rate, the hospital LOS and hospital
readmission rate along with the probable risk factors associated with prolonged hospital LOS.
Results:
Our study included 582 patients with decompensated liver cirrhosis, 367 patients had AVB and 215 patients
had NVB. There was no significant difference in mortality rate between both groups (11.4% vs. 9.3%, P= 0.43). The
hospital LOS in AVB patients was longer than that in NVB group (5.8 ± 2.2 vs. 4.3 ± 1.8, p=0.001). Rate of hospital
re-admission within 30 days was significantly higher in the AVB group (27%) compared to NVB group (18%). In-
hospital re-bleeding and the need for repeated endoscopy were also higher in AVB patients (20%) than in NVB
patients (12%). Risk factors for prolonged hospital LOS were development of hepatic encephalopathy, spontaneous
bacterial peritonitis (SBP), in-hospital re-bleeding, Child C score and higher Model for end-stage liver disease
(MELD) score.
Conclusion:
Patients with decompensated cirrhosis and AVB have longer hospital LOS and re-hospitalization rate
than those with NVB with no significant difference in mortality rate between both groups.
Keywords:
Decompensated cirrhosis, Variceal bleeding, Non-variceal bleeding, Peptic ulcer, Length of hospital stay,
In-hospital re-bleeding.

INTRODUCTION

Liver cirrhosis and its complications are major
a significantly higher mortality rate in patients with
health burdens in Egypt and worldwide.
liver cirrhosis than in those without liver disease, most
Acute UGIB is the most common medical
probably due to altered coagulation in hepatic patients
emergency in cirrhotic patients with significant
with a 6-week mortality up to 13% (7).
morbidity and mortality. AVB, from esophageal or
UGIB in decompensated cirrhosis increases the
gastric varices, is the most prevalent type of UGIB in
hospital LOS, 30-days hospital readmission and
liver cirrhosis patients accounting for up to 70% of all
augments the spending on healthcare programs (8).
cases, while NVB is responsible for the remaining

percentage of UGIB. Despite the sophisticated
PATIENTS AND METHODS
advancements in endoscopic procedures, hemostatic
This was a prospective study, included 582
therapies and medical management in the previous few
patients with decompensated cirrhosis, who were
years, high mortality rate from UGIB in patients with
admitted with UGIB to Internal Medicine Department
decompensated liver cirrhosis still represents a
at Zagazig University Hospitals from August 2018 to
significant health problem (1, 2).
March 2019.
Following AVB, patients with decompensated

cirrhosis may develop spontaneous bacterial
Inclusion criteria included age > 18 years old, both
peritonitis, aspiration pneumonia and respiratory
sexes, clinical, laboratory and ultrasound data
failure, renal failure due to hypovolemia or
supporting decompensated liver cirrhosis (Child score
hepatorenal syndrome, worsening of liver function,
B & C), clinical evidence of UGIB including
and hepatic encephalopathy, with a 6-week mortality
hematemesis and/or melena and upper GI endoscopy
rate up to 20% (3, 4).
done within 24 hours of onset of bleeding.
NVB refers to any other causes of UGIB other

than AVB. Peptic ulcer disease (PUD) represents the
Exclusion criteria: Patients were excluded from the
most common cause. It also includes bleeding from
study if they had one or more of the following criteria:
other sources such as esophagitis, gastritis, portal-
Child score A, advanced hepatic encephalopathy on
hypertensive gastropathy and gastric vascular ectasia
admission, death or discharge before endoscopy, if
and Mallory-Weiss tear (5, 6). Bleeding peptic ulcer has
patients refused to be enrolled in the study and patients


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2001
Received:16 /7 /2020

Accepted:15 /9 /2020

Full Paper (vol.815 paper# 13)


c:\work\Jor\vol815_14 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2006-2011

Immunohistochemical Nucleocytoplasmic Localization of
Light Chain3 in the Keratinocytes of Psoriatic Skin
Rehab Monir Samaka1, Alaa Hasan Marae2, Manar Ali Faried*3
Departments of 1Pathology and 2Dermatology, Andrology & STDs, Faculty of Medicine,
Menoufia University, Menoufia, Egypt, 3Dermatologists, Menoufia Governorate, Egypt
*Corresponding author: Manar Ali Faried, Mobile: (+20) 01281060901, E-Mail: manarfaried@yahoo.com

ABSTRACT
Background:
Light chain3 is a sensitive autophagy-related protein distributed within the mammalian tissues. The
role of LC3 localization in psoriasis pathogenesis is still poorly understood.
Objective: This study aimed to investigate, for the first time up to our knowledge, the localization of Light chain3
(LC3) in the keratinocytes of psoriatic skin by immunohistochemical study.
Materials and methods: This prospective case case-control study was carried out on 30 patients presented with
chronic plaque psoriasis versus 30 age and gender-matched apparently healthy volunteers. Clinical data were collected
and Psoriasis Area and Severity Index (PASI) was assessed. From all controls and cases (lesional and perilesional),
skin biopsies were taken and the epidermis was assessed for histopathological changes and LC3 immunoreaction.
Results: There was a highly significant difference (P<0.001) between the control skin and psoriatic skin (lesional and
perilesional) regarding the epidermal LC3 localization. Nucleocytoplasmic LC3 localization was dominant in lesional
skin specimens. Conclusion: Nucleocytoplasmic localization of LC3 in the keratinocytes of the psoriatic skin might
play a pivotal role in psoriasis pathogenesis. This can open a new gate for target therapy in psoriasis.
Keywords:
Psoriasis, Autophagy, LC3, Immunohistochemistry.

INTRODUCTION
Hospital in the period between December 2018 and
Psoriasis is a chronic, inflammatory immune-
December 2019. Control subjects were selected from
mediated skin disease characterized by epidermal
apparently healthy persons attending the Plastic Surgery
hyperplasia, defective keratinization, and infiltration of
Department, Menoufia University Hospital.
immune cells within the skin (1). Psoriasis prevalence is

now in increase. It is a serious dermatological disease
Ethical Considerations
extending beyond the physical symptoms as it exerts a
A written consent form, approved by the Local
significant, negative impact on patients' quality of life (2).
Ethical Research Committee in the Faculty of Medicine,
The pathogenesis of psoriasis is not completely
Menoufia University, was obtained from every
understood (3). Autophagy, an intracellular catabolic
participant before study initiation.
process associated with the maintenance of cellular
Exclusion criteria include: a) Cases of other types of
homeostasis, plays a critical role in inflammation,
psoriasis b) Treated patients with any topical or systemic
autoimmunity, and cellular differentiation (4).
therapy for at least four months before the study c) Any
Many autophagy-related proteins (Atgs) have
dermatological diseases except chronic plaque psoriasis
been identified in autophagosome formation. Some of
d) Any associated inflammatory or autoimmune disease
the Atgs such as beclin 1, p62, and light chain 3 (LC3)
e) Refusal of patients.
are more sensitive and stable during autophagosome
Every patient was subjected to complete history
formation and therefore can act as markers for
taking and physical examination. The data collected
autophagosomes (5). Microtubule-associated protein LC3
included the age, gender, onset, course, duration of the
is a soluble protein with a molecular mass of
disease, site of affection, and presence of itching. Full
approximately 17 kDa that is distributed ubiquitously in
general and dermatological examinations were done. The
mammalian tissues and cultured cells (6). The exact
severity of the disease was assessed by the Psoriasis Area
localization of LC3 is essential for investigating the role
and Severity Index (PASI) score (7). Mild psoriasis means
of autophagy in psoriasis. Therefore, this study aimed to
a PASI score of 10 while moderate to severe psoriasis
assess the nucleocytoplasmic localization of LC3 within
PASI score of >10 (8).
the keratinocytes of the psoriatic skin.


Skin biopsies:
PATIENTS AND METHODS
Skin biopsies were taken under 2% lignocaine local
This prospective case-control study was carried
anesthesia. For each patient, a skin biopsy from lesional
out on a total number of 60 subjects, they included 30
skin and another biopsy from perilesional skin was taken.
patients with chronic plaque psoriasis and 30 age and
The biopsies from the lesional skin were taken within the
gender-matched apparently normal subjects as a control
lesion, 1 cm from the edge of the plaque border (9),
group. Patients were selected randomly from
whereas the biopsies from the perilesional skin were
Dermatology Outpatient Clinic, Menoufia University
taken 2 cm beyond the plaque border (10). Skin biopsies


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SA) license (http://creativecommons.org/licenses/by/4.0/)
2006
Received:15 /7 /2020

Accepted:14 /9 /2020

Full Paper (vol.815 paper# 14)


Results The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2012-2015

Outcome of Direct Acting Antiviral Drugs (DAADs) for Hepatitis C Virus
(HCV) in the Setting of Chronic Kidney Disease (CKD) in Upper Egypt
Iman Ibrahim Sarhan, Mohamed Mostafa Ali, Ahmed Abd Elmonem Hassan,
Mostafa Abd Elnasier Abd Elgawad*
Department of Nephrology, Faculty of Medicine-Ain Shams University
Corresponding author: Mostafa Abd Elnasier Abd Elgawad, Mobile: (+20) 01120602323, E-Mail: mostafaabdelnasier@gmail.com

ABSTRACT
Background
: The frequency of hepatitis C virus (HCV) infection remains high in patients with CKD and plays a
detrimental role in mortality in this population, and patients undergoing maintenance dialysis are still at risk of
developing HCV infection and HCV disease prevalence of anti-hepatitis C virus (HCV) patients who undergo long-
term dialysis are significantly greater than those with normal kidney function. Objectives: The aim of the study was
to assess outcomes (efficacy, side effects, and possible complications) of DAADs for HCV in presence of CKD.
Subjects and methods: this was retrospective cohort study that was conducted at Aswan Fever Hospital and Luxor
Fever Hospital for anti HCV therapy between Jan 2018 and July 2018 including 60 patients recruited from both
hospitals with all stages of CKD and were receiving DAADs. Results: the results revealed that PC (%) in patients
from Aswan ranged between 61-100 with mean ±S.D. 83.09±9.258 while in patients from Luxor it ranged between
66-100 with mean ±S.D. 84.95±6.764. There was no statistically significant difference between groups (P=0.458).
HCV PCR in all patients from Aswan at baseline were positive while after 3 months 27 (90%) were negative and 3
(10%) were positive and after 6 months all patients were negative while in patients from Luxor they all were positive
while after 3 months 28 (93.3%) were negative and 2 (6.7%) were positive and after 6 months all patients were
negative. There was no statistically significant difference between groups.
Conclusion: Treatment with newer DAAs is effective and safe for the treatment of HCV-infected chronic kidney
disease patients.
Keywords: DAAs, Kidney, Treatment, CKD, HCV.


INTRODUCTION

Globally, an estimated 170-180 million people are
disease, as protease inhibitors and non-structural
infected with the hepatitis C virus (HCV), resulting in
protein 5A (NS5A) inhibitors are cleared by the liver
500,000 deaths annually (1). Egypt has the highest
with minimal renal excretion, and thus they are
prevalence of hepatitis C virus worldwide, with a
currently the most common option. It is a safe
prevalence rate (14.7%). If left untreated, CHC can
treatment for patients with ESRD with genotype 4
progress to cause fibrosis, cirrhosis, liver
infection (7).
compensation, or hepatocellular carcinoma (HCC) (2).
In addition, patients with advanced renal disease
Additionally, there
are
several extrahepatic
and severe hepatic impairment (Child-Pugh-Turcotte
manifestations of CHC, including kidney disease (3).
Class B or C) are largely left untreated, as the benefits
Kidney disease is common with chronic hepatitis
of treating these patients with multiple organ failure
C virus (HCV) infection. Kidney diseases associated
remain uncertain. At this time, the DAAD regimens
with hepatitis C virus are mainly complex immune
used in renal impairment are not in patients with severe
disorders such as mixed blood globulin and MPGN (4).
hepatic impairment resulting from recommended
In patients with end-stage kidney disease (ESRD),
hepatotoxicity, impaired hepatic clearance of drugs,
there is also a higher prevalence of viral hepatitis
and lack of data in decompensated cirrhosis (8).
infection due to the increased risk of transmission
The aim of the study was to assess outcomes
associated with dialysis (5).
(efficacy, side effects, and possible complications) of
Hepatitis C infection has significant risks of
DAADs for HCV in presence of CKD.
morbidity and mortality in this population and thus,

creates a mandate for screening and treatment of
SUBJECTS AND METHODS
hepatitis C in patients with CKD (6). In the era of
This study is retrospective cohort study, which
direct-acting antiviral drugs (DAADs), HCV infection
was conducted at Aswan Fever Hospital and Luxor
can be successfully treated in patients with advanced
Fever Hospital for anti HCV therapy between Jan 2018
kidney disease. The development of systems based on
and July 2018. About 60 patients with all stages of
DAADs that are not renally filtered has created new
CKD who were receiving DAADs were recruited from
options for treating hepatitis C in advanced kidney
both hospitals.


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2012
Received:15 /7 /2020

Accepted:14 /8 /2020

Full Paper (vol.815 paper# 15)


a The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2016-2025

Assessment of Right Liver Lobe Size / Serum Albumin Ratio as a
New Non-Invasive Predictor for the Presence of Oesophageal Varices in
Egyptian Patients with HCV Related Liver Cirrhosis
Emad Ahmad Awad, Wael Ahmed Yousry, Hasan Mokhtar Hasan, Ahmed Mohamed ElGhandour*
Department of Internal Medicine, Gastroenterology and Hepatology, Faculty of Medicine,
Ain Shams University, Cairo, Egypt
*Correspondence to Dr. Ahmed Mohamed ElGhandour, E-mail: ghandour80@hotmail.com,
Telephone number: 002 01001973493

ABSTRACT
Background:
Oesophageal varices are the most critical porto-systemic shunts that develop secondary to portal
hypertension, which is considered the main complication of liver cirrhosis. Many studies recommend the screening
of all cirrhotic patients by endoscopy, but repeated endoscopic examinations are unpleasant for patients and have a high-
cost impact and burden on endoscopic units. Objective: This study aimed to evaluate the accuracy of using the right liver
lobe size/serum albumin ratio as a non-invasive predictor of esophageal varices in patients with HCV-related liver cirrhosis.
Patients Methods:
This prospective study included 30 patients with liver cirrhosis and 30 patients who underwent upper
gastrointestinal endoscopy for any causes other than liver cirrhosis. All studied subjects underwent a detailed history and
clinical examination, biochemical workup, upper gastrointestinal endoscopy, and abdominal ultrasound. The right liver
lobe/serum albumin ratio was calculated for all patients.
Results:
There was a statistically significant difference between the control and the study subgroups as regards the
Right lobe of the Liver/Albumin ratio (p-value 0.007). The diagnostic accuracy of the Right lobe of the
Liver/Albumin ratio was assessed using the ROC curve which revealed a sensitivity of 86.67% and specificity of
73.33% at cut-off value >3.88, with an acceptable discriminative accuracy of 79.9%.
Conclusion: The use of Right liver lobe/serum albumin ratio can help physicians by restricting the use of endoscopic
screening only to patients presenting a high probability of esophageal varices. This is especially useful in clinical settings
where resources are limited, and endoscopic facilities are not present in all areas.
Keywords: Non-invasive diagnosis of oesophageal varices, Right liver lobe size/serum albumin ratio, Oesophageal
varices, HCV.

INTRODUCTION

Esophageal varices are submucosal, expanding
lateral and perforate veins makes it an excellent
esophageal veins connecting the portal and systemic
choice in monitoring treatment response to
circuits (1). This is caused by portal hypertension most
endoscopic varicose ligation (EVL) and predicting
commonly due to cirrhosis, resistance to portal blood
their recurrence (8, 9). Currently, EUS is not considered
flow, and increased inward portal venous blood flow
a primary diagnostic method due to the Limited
(2). The most common fatal complication of cirrhosis
availability of local expertise. A recent meta-analysis
is the rupture of varicose veins. The severity of the
reviewed the use of capsule endoscopy for the
liver disease is associated with the presence of
diagnosis and classification of esophageal varices and
varicose veins and the risk of bleeding (3, 4). Variceal
noted a diagnostic accuracy of 90% with a combined
bleeding occurs in 20-40% of cirrhotic patients with
sensitivity and specificity of 83% and 85%,
esophageal varices and is associated with high
respectively (10).
morbidity and mortality (5). Mortality associated with
The inability of capsule endoscopy to detect
each episode of varicose veins ranges from 17% to
GVs is a major drawback. Although capsule
57% (6).
endoscopy is relatively less invasive and does not
Gastroesophageal endoscopy (EGD) is the gold
require anesthesia, diagnostic sensitivity is not
standard procedure used in the diagnosis of
enough to call for index monitoring. There may be a
esophageal varices (GOVs). Based on the endoscopic
consideration for a select subset of high-risk patients
evaluation, GOVs are classified into small (<5 mm)
who do not wish to undergo further conventional
and large (> 5 mm) varicose veins for clinical
endoscopic evaluation (11, 12). For these reasons,
management. The disadvantages of endoscopy
several studies have examined how to identify
include the risks of anesthesia, high cost, bleeding,
patients with varicose veins using non-invasive or
and risk of aspiration (7). Endoscopic ultrasound
minimally invasive methods to avoid endoscopy in
(EUS) has also been evaluated as a diagnostic tool in
patients with low risk of varicose veins. However, it
the evaluation of GOVs. Endoscopic ultrasound
is not accurate enough to diagnose or exclude
imaging is better than EGD at detecting gastric varices
clinically significant portal hypertension (CSPH)
(GVs), and its ability to evaluate the anatomy of the
(HVPG> 12 mm Hg). Specifically, transient
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2016
Received:6 /7 /2020

Accepted: 15/ 9/2020

Full Paper (vol.815 paper# 16)


c:\work\Jor\vol815_17 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2026-2029

The Stress Hormone Copeptin as a Prognostic Biomarker in Acute Illness
Raef Malak Botros, Maram Mohamed Maher, Rahma Khaled El Shaer, Hanan Mahmoud Ali*
Department of Internal Medicine & Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Hanan Mahmoud Ali, Mobile: (+20)1222521314, Email: hanan.mahmoud29@yahoo.com

ABSTRACT
Background:
Copeptin has been evaluated as biomarker for several illnesses such as cerebrovascular stroke, heart
failure, showing a promising role mainly as a prognostic biomarker. Copeptin levels seem to be strongly related to
short, mid, and long-term mortality in patients admitted to hospital showing that copeptin could be a valuable
prognostic tool in the most frequent disease entities.
Objective: The aim of the current study was to study the level of copeptin as a prognostic biomarker in acute illness.
Patients and Methods: This study included a total of 64 patients with acute deterioration of their chronic illness as
chronic liver diseases (most of them were child C on Child-Pugh score), COPD (admitted with infective exacerbation),
cerebrovascular stroke and Decompensate heart failure and 20 controls, attending at emergency room, Ain Shames
University Hospital.
Results: Serum copeptin levels have positive correlation with longer duration of hospitalization, the higher the
copeptin level the more length of hospital stay (r= 0.264* p= 0.035). There was highly statistically significant
difference between copeptin level and survival rate, copeptin concentrations were significantly higher in non-
survivors than in survivors (p=0.000).The mean of copeptin level among patient who died was 500 ) pmol/L with
range of 70 to 750 pmol/L, while the mean of copeptin level among survivors was 60 pmol/L with range of 20-600
pmol/L.
Conclusion: It could be concluded that copeptin has a role in prognosis of mortality and morbidity of hospitalized
patients and high copeptin level significantly associated with a longer hospital stay and a poor outcome of hospital
admission.
Keywords: Copeptin, Acute illness, Prognostic biomarker.

INTRODUCTION

`Stress' may be defined as any situation which
Different studies have suggested that a higher
tends to disturb the equilibrium between a living
copeptin level is an independent prognostic marker for
organism and its environment. In day-to-day life there
unfavorable outcome and mortality in patients with
are many stressful situations such as stress of work
acute ischemic stroke and intracranial hemorrhage (5).
pressure, examinations, psychosocial stress, and
The aim of the current study was to study the level
physical stresses due to trauma, surgery and various
of copeptin as a prognostic biomarker in acute illness.
medical diseases. Copeptin is located in the C-terminal

section of the arginine vasopressin (AVP) precursor
PATIENTS AND METHODS
(pro-AVP) and consists of 39 amino acid
This study included a total of 64 patients with
glycopeptides. Evidence demonstrated that copeptin is
chronic illness and 20 controls of both sexes and their
released from pro-AVP together and equivalent with
age ranging between 18- 60 years, attending at
AVP (1). Why is copeptin a good prognostic tool in a
emergency room, Ain Shames University Hospital.
variety of diseases? Vasopressin, together with
The included subjects were divided into two
corticotropin-releasing hormone, is the main
groups; Group I (admitted to ward) consisted of 64
secretagogue of the Hypothalamic­pituitary­adrenal
patients with chronic illness as chronic liver diseases,
axis to produce adrenocorticotropic hormone and
chest infection, cerebrovascular stroke, and heart
cortisol. Serum cortisol levels have been reported to be
failure. Group II (control) consisted of 20 apparently
proportionate to the degree of stress and, by mirroring
healthy individuals served as control.
the individual stress level, to predict outcome in sepsis
The patients were followed up till their discharge,
and pneumonia (2). Importantly, copeptin levels seem to
or transfer, or death. For patients who transferred to
mirror even more subtly moderate levels of stress than
ICU, their progress was also monitored till their
cortisol levels (3).
discharge or death.
The prognostic role of copeptin has been

reported in various types of acute illness, including
All participants were subjected to the following:
hemorrhagic/septic shock, lower respiratory tract
Full history taking, full clinical examination,
infection, heart failure, and acute myocardial infarction
investigations including: serum copeptin level, serum
(4); a higher copeptin level has been associated with all
random free cortisol level, complete blood picture
of these conditions and also predicts outcomes
(CBC), erythrocyte sedimentation rate (ESR), C-
following heart failure and acute myocardial infarction.
reactive protein (CRP), kidney function tests, serum
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2026
Received:16 /7 /2020

Accepted:15 /9 /2020

Full Paper (vol.815 paper# 17)


STUDY of 1, 25 Dihydroxy Vitamin D Level in Term Neonates with Indirect Hyperbilirubinemia The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2030-2035
Vitamin D Levels in Full-Term Neonates with Indirect Hyperbilirubinemia
Neveen T. Abed1, Farida F. Negm1, Enas S. Ahmad2, Heba A. Mohammed*1
Departments of 1Pediatric and 2 Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Heba A. Mohammed, Mobile: (+20)01122803949, E-Mail: heba.anwar.soliman@gmail.com
ABSTRACT
Background: Jaundice is a common clinical sign in neonatal medicine. Considering the different roles of vitamin D,
its lower level may be correlated with neonatal jaundice. Objectives: This study aimed to demonstrate the relationship
between serum vitamin D level and neonatal hyperbilirubinemia and to measure its level in their mothers. Subjects
and methods:
This case-control study was conducted on 90 neonates and their mothers, 60 neonates with
hyperbilirubinemia in patients group and 30 healthy neonates age and sex matched in control group. Blood samples
from neonates and their mothers were obtained and sent for laboratory estimation of 25-hydroxy vitamin D, calcium,
magnesium, phosphorus, alkaline phosphatase and parathyroid hormone. Results: There is highly significant decrease
of vitamin D levels among patients than controls, significant negative correlation between vitamin D levels and serum
bilirubin in neonates and no significant difference regarding different laboratory parameters among their mothers.
Conclusion: Decreased levels of vitamin D were significantly correlated with neonatal indirect hyperbilirubinemia so,
low vitamin D can be included among risk factors for neonatal jaundice.
Keywords: Jaundice, Mothers, Neonatal, Vitamin D.


INTRODUCTION
SUBJECTS AND METHODS
Hyperbilirubinemia is one of the most common
This case-control study was conducted on 90
conditions in neonatal period. Discharge of healthy
neonates, recruited from Neonatal Intensive Care Units
neonates early after birth, especially if breastfeeding is
(NICU) of Benha University Hospital and their mothers
not well established, may lead to delayed diagnosis of
in the period from October, 2018 till October, 2019.
pathological hyperbilirubinemia that has the ability for
Ethical approval: Approval of the Research Ethics
causing neurological complications (1). Overall, up to
Committee at Benha University Hospital, Faculty of
60% of term neonates have significant jaundice in the
Medicine was obtained. A written consent was
1st week of life (2). Any problem which increases
collected from parents to agree to participate in the
bilirubin production and decreases conjugation can
study.
cause neonatal jaundice (3).
Inclusion criteria: Full-term neonates with gestational
It is necessary to know different risk factors for
age > 37 weeks, exclusive breast feeding, with indirect
increased incidence of neonatal jaundice because its
hyperbilirubinemia that was needed phototherapy
incidence can be reduced by modifying them. Vitamin
according to American Academy of pediatrics (8).
D is fat-soluble vitamin technically considered a
Exclusion Criteria: Neonates with pathological causes
hormone. Different functions of vitamin D were
for their hyperbilirubinemia such as: ABO and Rh
reported in medical research (4).
incompatibility,
sepsis,
glucose-6
phosphate
Vitamin D in the body comes from dietary
dehydrogenase deficiency, cephalhematoma, Jaundice
sources and from synthesis in the skin exposed to sun
necessitating exchange transfusion, perinatal asphyxia
light. Ultraviolet irradiation stimulates skin synthesis of
and congenital anomalies. Also newborns whose
cholecalciferol, then hydroxylation in the liver to 25-
mothers had a history of chronic disorders such as:
hydroxyl vitamin D (25-(OH) D) and lastly
hepatic disorders, kidney disorders, gestational
hydroxylation in the kidney to the active form, 1, 25
diabetes,
hypertension,
anticonvulsant
therapy,
dihydroxy vitamin D (5).
malignancy, cardiovascular diseases, diabetes mellitus,
Vitamin D deficiency is a worldwide problem.
respiratory diseases, autoimmune diseases and
Insufficiency and deficiency of vitamin D has been
musculoskeletal diseases were excluded.
related to multiple diseases, ranging from neurological

disorders to chronic inflammatory conditions (6).
They were divided in two groups:
Decreased vitamin D causes marked damages to the
Patients group: included 60 term neonates with
growth and development of fetal bones (7).
indirect hyperbilirubinemia needing phototherapy.
Although vitamin D metabolism and bilirubin
Control group: included 30 healthy neonates with
metabolism occurs on two separated pathways, both of
similar age and sex.
them have a common pathway in the liver. So, changes
Each neonate in this study was subjected to
in synthesis or metabolism of each of them might have
complete history taking, full clinical examination, also
an effect on the other product (2), so this study aimed to
their mothers were asked about their age, educational
demonstrate the relationship between serum vitamin D
state, calcium and vitamin D use during pregnancy and
level and neonatal hyperbilirubinemia and to measure
any disease or drug intake that might affect vitamin D
its level in their mothers.

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2030
Received:16 /7 /2020

Accepted:15 /9 /2020

Full Paper (vol.815 paper# 18)


c:\work\Jor\vol815_19 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2036-2045

Short-Term Results of Patient Specific Instruments (PSI) ­
Total Knee Replacement (TKR)
Mohamed Mosa Mohamed Mahmoud*1, Amr Abdelhalem Amr1, MA Hafez2
1Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, Al Azhar University, Assiut
Branch,2Department of Orthopaedic and Trauma Surgery, Faculty of Medicine, 6 October University
*Corresponding author: Mohamed Mosa Mohamed Mahmoud, Mobile: (+20) 01009092327,
E-Mail drmohamedmosa@yahoo.com
ABSTRACT
Background:
TKR is an effective treatment for severely arthritic knees. PSI TKR is a recent technique, which relies
on preoperative formulation of specific instruments for every patient preoperatively, aiming at decreasing surgical
time and instruments and increasing accuracy and functional outcome. Objective: Assessment of functional and
radiological outcome of PSI TKR after a period of 3 years duration. Patients and Methods: 40 TKRs in 24 patients
were done using CT-based PSI technique. Pre-and postoperative knee society score (KSS) were measured and digital
long-leg X-rays were obtained for all patients. Hip-knee-ankle, proximal tibia land lateral distal femoral angles
together with mechanical axis deviation were measured for all patients to assess the mechanical axis alignment after
TKR. Results: HKA (hip knee ankle) has decreased from 4.70 varus preoperatively to 1.27 varus. The mean knee
society score had markedly increased from 31.2 preoperatively to 85.3 with fair to excellent KSS was 95% after 3
years duration. Conclusion: PSI TKR is an effective technique in knee replacement as conventional method. With
the advantages of reduction of the operative steps and concurrent potential complications.
Keywords: PSI, TKR.
INTRODUCTION
CT scan was done under a special protocol (it was
Total knee replacement (TKR) is considered as an
done in 1 mm cuts and scanogram from hip to ankle
effective treatment for severely arthritic knees (1).
was done in two planes coronal and sagittal planes.
Patient specific instrumentation (PSI) TKR is a recent
Then printed in a computer disc (C.D.).
technique that relies on preoperative CT (computed
Preoperative planning:
tomography) scan or MRI of the arthritic knee (2). Then
Planning began by importing the CD to a
three-dimensional printing technology used to produce
special software in the computer. Firstly, measuring
two patient-tailored templates (one tibial and one
mechanical axis in both coronal and sagittal plane was
femoral) (3, 2). These templates act as bone cutting
done (figures 1 and 2). After that, the software
guides (for direct bone cutting through the templates)
reconstructed the knee in three-dimensional images
or as pin locator (pin-placement guides) (4).
without patella. Then the tibial image was removed and
PSI aims at simplifying the operative technique
distal femur cut and sizing were done (figure 3), then
for TKR through decreasing surgical steps, shortening
removal of femur image, and tibial image were brought
operative time, avoiding invasion of femoral medullary
back for cut and sizing (figure 4). In the virtual cuts,
canal by intramedullary guide, minimizing blood loss
distal femoral cut perpendicular to the mechanical axis
and obviating fat embolism, bone injury and possibly
of the femur in the coronal plane, and in 3 degrees
the rate of infection (3, 5). The aim of this study was to
flexion in the sagittal and in three degrees of external
assess short-term functional and radiological outcome
rotation was done. The proximal tibial cut was adjusted
of TKR on patients indicated for primary TKR done by
perpendicular to the mechanical axis of the tibia and
PSI using cutting guides templates.
tibial slope was adjusted according to anatomy of the

patient or company guidelines. The amount of cut was
PATIENTS AND METHODS
about 10 mm of the healthy side but also we could
During the period from January to October 2017,
change level of cut as we needed in special
circumstances (e.g. flexion deformity). After
40 TKRs in 24 patients were done using CT-based PSI
alignments, cuts and sizing had been done, we had 3-D
technique in 6 October University Hospital. Average
view of the virtual postoperative knee (figure53).
age of patients was 58.9 ± 9.9 year (30-70). The
patients were divided to 21 females and 3 males.
The surgeon revised the planning at all steps
and he could change the planning according to clinical
The
preoperative
diagnosis
was
severe
and radiological conditions of the patient (e.g. he could
osteoarthritis in all patients except 4 patients had
change size, femoral rotation, tibial slope and level of
rheumatoid arthritis. Preoperative KSS, x-rays and CT
bone cuts). After that, the software produced two 3-D
scans of the knees had been done.


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2036
Received: 17/7/2020

Accepted: 16/9/2020

Full Paper (vol.815 paper# 19)


c:\work\Jor\vol815_20 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2046-2053

Changes in Fetal and Uteroplacental Doppler Waveforms After Antenatal
Dexamethasone Administration in Women at Risk of Spontaneous Preterm Birth
Mohamed Elsibai Anter1, Ayman Abd Elkader Shabana1,
Sally Mohamed Ali Badr2, Nehad Mahmoud Hoseny1
1Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2Obstetrics and gynecology department, El-Bagour general Hospital, Menoufia, Egypt
*Corresponding author: Mohamed E. Anter, Mobile: +20 1224462910, Email: Mohamedsibai681@yahoo.com

ABSTRACT
Background:
Early detection of fetal risk is one of the main issues in today's obstetrics. Ultrasound diagnosis plays a
significant role, as the introduction of the Doppler imaging method in the evaluation of blood flow has enabled non-
invasive assessment of uteroplacental circulation.
Objective: To assess the impact of maternal dexamethasone on doppler waveforms velocity flow of the fetal umbilical
and middle cerebral arteries and maternal uterine arteries in pregnant women at risk of preterm labor with normal fetal
vascular resistance.
Patients and methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology at
Menoufia University hospital on 36 patients who were diagnosed as having threatened preterm birth. All the patients
were enrolled in the study with routine follow up according to local protocols in the period between January 2019 and
November 2019. Full history taking, full general, obstetric examination, and Ultrasound examination was performed.
Results: After dexamethasone administration, Umbilical A resistive and Pulsatility indexes were significantly
decreased to (1.084 ± 0.118 and 0.66 ± 0.054) in comparison to before dexamethasone (1.121±0.124 and 0.70±0.058).
Regarding the Uterine Doppler values, mean Pulsatility index before dexamethasone was 0.79±0.049 (right) and 0.78
±0.038 (left) decreased significantly to 0.78±0.044 (right) and 0.77±0.036 (left) after dexamethasone. Similarly, the
mean Resistive index before dexamethasone was 0.55±0.027 (right) and 0.54±0.026 (left) decreased significantly to
0.53±0.023 (for right and left) after dexamethasone.
Conclusions: dexamethasone administration for the pregnant mothers at risk of preterm labor enhance the flow of blood
to the fetal umbilical, middle cerebral arteries and maternal uterine arteries 24 hrs. after its administration.
Keywords: Antenatal, Dexamethasone, Doppler waveforms, Fetal Health, Preterm Birth, Uteroplacental.

INTRODUCTION

Artificial corticosteroids have been successfully
fetus in the following day (6). Conversely, another trial
used for more than 20 years to promote the maturity of
described a transient decrease in fluctuations of the
the fetal lung in situations where early birth is expected
fetal heart rate, fetal body, and respiratory movements
(1). Maternal administration of artificial corticosteroids
after betamethasone, while still noting. On the first day
(betamethasone or dexamethasone), decreases newborn
after dexamethasone fetal heart rate fluctuations were
deaths,
syndrome
of
respiratory
distress,
increased (7). These effects were more pronounced with
intraventricular
hemorrhage,
and
necrotizing
betamethasone than dexamethasone (8).
enterocolitis in preterm infants (2). Serious side-effects
Alteration of fetal heart rate characteristics was
on the neonate have not been described when prenatal
first recognized in 1995 (9). It has been determined that,
treatment has been administered during the second half
in more than a third of the examined fetuses,
of pregnancy (3). However, a transient decrease in fetal
computerized fetal heart rate variation fell below the
heart rate, fetal body movements, and Respiratory
normal range, and this may indicate fetal hypoxemia
movements
was
confirmed
after
maternal
(10). Fetal health assessment with doppler waveform
betamethasone administration (4). Biophysical activities
studies after maternal corticosteroid administration
monitoring is a powerful tool known for assessing fetal
could therefore be considered important (2). However,
health. Studies presented initial evidence that antenatal
knowledge of the different fetal hemodynamic effects
steroids to improve the maturity of the fetal lung may
after exogenous corticosteroids is limited (11).
lead to transient depression of biophysical activities of
Another way to assess a fetus's condition is to
the fetus (5). Indeed, conflicting results have been
measure the Doppler flow velocity of the umbilical
reported regarding the effects of betamethasone and
artery and MCA of the fetus. This technique may be
dexamethasone on the fetal heart pattern (2). Lately,
useful in specifying a fetus at risk and can be of clinical
Miller found that betamethasone and dexamethasone
value in the differential diagnosis between changes
were accompanied by an increase in the long term and
caused by therapy in the biophysical behavior of the
short-term variability and a decrease in the movements
fetus and that of the fetal compromise (12). Moreover
of the fetus on the first day after steroid administration
antenatal administration of corticosteroids, given to
followed by a decrease in heart rate variability of the
accelerate the maturity of fetal lung and improve


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Full Paper (vol.815 paper# 20)


c:\work\Jor\vol815_21 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2054-2056

Physiotherapy is A New Line in Management of
Chronic Pelvic Inflammatory Diseases
Dalia Ibrahim Morsi, Ahmed Mohammed Nofal*
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Ahmed Mohammed Nofal, Mobile: (+20)01092678240,
E-mail: nofal3030@gmail.com
ABSTRACT
Background:
Pelvic inflammatory disease (PID) is an inflammatory condition of the upper female genital tract. Chronic
PID include both residue of acute and subacute attack of infection. Generally shortwave diathermy (SWD) is used to
decrease pain and edema, thus improves the inflammatory reaction and accelerates the healing of the chronically
inflamed tissues. Objective: To evaluate the therapeutic efficacy of shortwave diathermy in the management of chronic
PID. Materials and methods: 80 patients with chronic PID for more than 6 months diagnosed by thorough history,
clinical examination and cervical swabs. Patients were divided into two groups: First group (group 1): patients received
both medical treatment and shortwave diathermy. Second group (group 2): patients received only medical treatment.
Results There was a statistically highly significant improvement of clinical and laboratory manifestations in the first
group of patients compared to the baseline and compared to the second group.
Conclusion shortwave diathermy has a fair therapeutic efficacy in the treatment of chronic PID.
Keywords:
Pain, Pelvic Inflammatory Disease, Shortwave Diathermy.

INTRODUCTION
Inclusion criteria: Patients diagnosed as PID according
Pelvic inflammatory disease (PID) is defined as
to Centers for Disease Control and Prevention (CDC)
inflammation of the female upper genital tract. The most
diagnostic criteria for PID for more than 6 months by
prominent manifestation of PID are fever, dyspareunia,
thorough history, clinical, and microbiological
pelvic pain, cervical discharge, and abnormal uterine
examination.
bleeding (1). About 25%-50% of patients with acute PID
Exclusion criteria: Acute PID, severely ill patients,
will develop chronic pelvic pain, ectopic pregnancy and
pregnancy,
skin
sensation
defect,
intrauterine
impaired fertility, usually due to scarring and adhesions
device/implants, cardiac pacemaker, intolerance to
(2,3). The cornerstone of PID management is symptomatic
electromagnetic
therapy.
to relieve pain and systemic malaise. Management
Methods:
should be also aimed at microbiological cure, prevention
Full History taking: concentrating on symptoms of PID.
of the occurrence of permanent tubal damage and spread
Full clinical examination:
of infection to the surrounding tissues (4). The shortwave
General examination: blood pressure, pulse,
diathermy is a form of radiofrequency radiation, with a
temperature, respiratory rate, chest, abdomen.
frequency of 27.12MHz, which is a high-frequency
Local examination: Bimanual examination to confirm
electromagnetic waves that improves pelvic circulation,
the criteria of PID. Cusco speculum was used to visualize
thus leads to reduce edema and relieve of pain (5).
the cervix, cervical discharge and cervical swabs
Vascular improvement leads to relieve the inflammatory
obtained, placed in tubes of normal saline and sent for
processes by increasing oxygen supply, and removing
microbiological examination. Specimens were examined
waste products to enforce natural resistance to infection
for presence of chlamydia and gonorrhea.
and accelerate healing of inflamed tissues (6).
Chlamydia detection: by usage of Pap smear examination
Aim of the present work was to assess the role of short
and Chlamydial antigen detection using Vidas
wave diathermy in the management of chronic pelvic
Chlamydia Kit. The assay principle combined an
inflammatory diseases through comparing the
immunoassay method with a final fluorescent detection
therapeutic efficacy of combined (medical and short
enzyme linked fluorescent assay (ELFA). The
wave diathermy) therapy with medical treatment only.
Chlamydia trachomatis were seen as characteristic

intracellular inclusion bodies in Pap cervical smears.
PATIENTS AND METHODS
Gonorrhea detection: A direct smear for Gram staining
This was a prospective observational study that was
was performed after collecting the swab specimen from
conducted at Obstetrics and Gynecology Department in
the cervix. The Gram stain of a smear of endocervical
Menoufia University Hospitals from September 2018 till
secretions shows typical Gram-negative, non-motile,
January 2020. 80 patients were included in this study, the
intracellular diplococci. The identification of N.
patients were divided randomly into two groups (40
gonorrhea rests on the isolation of an oxidase-positive,
patients in each group).
catalase-positive, Gram-negative diplococcus recovered
-First group (group 1): patients received both medical
from urogenital sites that grow on selective media,
treatment and physical treatment. (Combined therapy).
Modified Thayer Martin Medium was used. Pelvic pain
-Second group (group 2): patients received only medical
assessment by the visual analogue scale (VAS).
treatment.

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Full Paper (vol.815 paper# 21)


RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2057-2062

Incidence of Atrial Fibrillation in Hemodialysis Patients
Mohamed El-Tayeb Nasser 1, Adham Ahmed Abdel Tawab 2,
Raafat Boshra Mehany*1, Mostafa Abd El-Nassier Abd El-Gawad 1
Departments of 1 Nephrology and 2Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding Author: Raafat Boshra Mehany, Phone: (+20) 1201846643, E-mail: raffatboshra2010@yahoo.com

ABSTRACT
Background:
Chronic kidney disease patients usually experience several comorbid conditions including
cardiovascular disorders and at final end-stage renal disease (ESRD) stage, cardiovascular mortality accounts for about
50% of total mortality. End-stage renal disease (ESRD) patients commonly have a higher risk of developing
cardiovascular diseases than general population.
Objective: The aim of the work was to detect the incidence of atrial fibrillation (AF) in hemodialysis patients for
six months.
Patients and Methods: The study was a prospective cohort study for six months included 250 adult patients with
end stage renal diseases on regular hemodialysis sessions in National Institute of Urology and Nephrology in
Cairo, Egypt for at least six months with no past history suggestive of any arrhythmias and normal holter ECG at
the start of the study.
Results: The study included 250 patients, of them 37 patients refuse follow up after 6 months and 18 patients
were died before our follow up holter ECG so mortality rate 14.4%. For the current study population, there were
102 male patients (52.3%) and 93 female patients (47.7%) with mean age 54.39 ± 9.98 (19:73) and BMI
29.01±1.28 (24.5:34). In study population 96 patients were diabetic (49.2%), 84 patients were hypertensive
(43.1%), 100 patients were with ischemic heart diseases (51.3%) with median renal replacement duration 4 (3 ­
6) with range (1 ­ 13). The main etiological causes of dialysis were diabetes mellitus, hypertension and analgesic
nephropathy and other different causes of dialysis 35 patients (45%).The study showed association between
incidence of AF in hemodialysis patients and different factors as increased BMI (0.006), prolonged duration of
renal replacement therapy (0.017), diabetes mellitus (0.005), hypertension (0.000), ischemic heart diseases (0.02)
and left atrium dilation (0.000).
Conclusion: It could be concluded that the incidence of AF in patients with ESRD is 16.4% .The risk factors
for increased incidence of AF in hemodialysis are; increased BMI, increased duration of renal replacement
therapy, hypertension, diabetes mellitus, ischemic heart diseases and left atrium dilation by echocardiography.
Keywords: Chronic kidney disease, End-stage renal disease, Arrhythmias, Atrial fibrillation.

INTRODUCTION


Chronic kidney disease patients usually
Factors contributing to the occurrence of AF
experienced several comorbid conditions including
in patients undergoing dialysis include: age, presence
cardiovascular disorders and at final end-stage renal
of coronary heart disease, echocardiographic
disease (ESRD) stage, cardiovascular mortality
abnormalities
(low
ejection
fraction,
atrial
accounts for about 50% of total mortality. End-stage
enlargement, valvular calcification, left ventricular
renal disease (ESRD) patients commonly have a
hypertrophy), heart failure, chronic obstructive
higher risk of developing cardiovascular diseases
pulmonary disease, hypertension, stroke, malnutrition
than general population. Chronic kidney disease is an
(low levels of albumin, total cholesterol and high-
independent risk factor for atrial fibrillation (AF);
density
lipoprotein
(HDL),
secondary
however, little is known about the AF risk among
hyperparathyroidism, low pre dialysis systolic blood
ESRD patients with various modalities of renal
pressure, duration of renal replacement therapy as
replacement therapy (1).
well as the method of renal replacement therapy
Atrial fibrillation (AF), the most common
(more frequent in Hemodialysis patients) (5).
sustained arrhythmia in clinical practice (2). Atrial
Patients who have both atrial fibrillation
fibrillation is a serious problem, especially in patients
(AF) and renal failure have an increased risk of
on dialysis. The prevalence of AF in this group of
thrombo-embolism. Renal failure is also a risk factor
patients is higher than in general population and
for bleeding, which makes decisions regarding
associated with increased mortality (3).
thromboprophylaxis complicated (6).
Hemodialysis (HD) is associated with
Clinical trial data support the use of
cardiovascular structural modifications; moreover,
anticoagulant agents to prevent stroke in AF patients.
during HD, rapid electrolytic changes occur. Both
Although
several
guidelines
recommend
factors may favor the onset of atrial fibrillation (4).
anticoagulant use for stroke prevention as the



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Full Paper (vol.815 paper# 22)


c:\work\Jor\vol815_23 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2063-2068

The Effect of Adding Kinesio Tape to Mulligan's Mobilization in
Patients with A Cervicogenic Headache
Lamyaa Ahmed Neyazi1, Nadia Abdelzim Fayaz2,
Samah Saad Almoogy Zahran2, Ahmed Hamdi Azzam3
2Department of Physical Therapy, International Institute of Cancer, Cairo University, 2Department of
Physical Therapy for Musculoskeletal Disorders and its Surgeries, Faculty of Physical Therapy, Cairo
University, 3Department of Orthopedic Surgeries, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Lamya Ahmed Neyazi Farghali, Mobile: (+20) 01093435582, Email: dr.lamya3@gmail.com

ABSTRACT
Background:
Cervicogenic headache is a major problem in many people suffering from upper cervical
dysfunction with a great conflict in its physical therapy management.
Objective:
The aim of the work was to determine the effect of Adding Kinesio Tape To Mulligan's Mobilization
in patients with a cervicogenic headache.
Patients and methods:
Fifty four patients with cervicogenic headache included in the study; from outpatient
clinic, Faculty of physical therapy, Cairo University Hospital (Kasr El Ainy), were randomly assigned into two
equal groups ; group A (Kinesiotaping and mulligan techniques), Group B (mulligan techniques). Their mean ±
SD age, weight, height and BMI were 37.74±5.55 years, 80.62±6.27 kg, 170.11±5.5 cm and 27.48±2.73 kg/m²
respectively. The visual analogue scale (VAS) is used for measuring intensity of cervicogenic headache.
Frequency and duration of cervicogenic headache are collected from subjective data of patients. Correlations
between the examined parameters were also measured. Kinesiotaping application with mulligan SNAGs were
companied in group A and mulligan SNAGs done only in group B.
Results: There was significant improvement of VAS outcome scores and frequency and duration of cervicogenic
headache in Group (A) more than Group (B).
Conclusion:
It could be concluded that adding kinesio tape to mulligan's mobilization in patients with a
cervicogenic headache is found to be an effective in treatment of cervicogenic headache.
Keywords: Cervicogenic headache, Kinesiotaping, SNAGs.

INTRODUCTION


A cervicogenic headache (CGH) is a
scapulae, and sternocleidomastoid muscles. Kinesio
syndrome characterized by chronic hemicranial
taping (KT) method is a somewhat new type of
pain that is referred to the head from either bony
taping technique. It was originally created by a
structures or soft tissues of the neck (1). It was first
Japanese chiropractor, Kenzo Kase in 1980 and has
described by Sjaastad et al. (2), as unilateral
gained popularity in the clinical setting. KT is an
frontotemporal
headaches
with
clinical
effective method for decreasing tightness and pain
symptomatology similar to a migraine. CGH is
intensity in soft tissues (12).
often unilateral, but it can be bilateral. It affects
Kilinç et al.(13) found that KT application
mostly the occipital region, the frontal region, or the
had the same effect of the mobilization techniques
retro-orbital region. It is commonly associated with
on decreasing the neck pain, headache intensity and
suboccipital neck pain and can be combined with
enhancing the activation of deep cervical neck
ipsilateral arm discomfort (3). The prevalence of
flexor muscles in mechanical neck problems. Falla
CGH in the general population is estimated from
et al. (14) found that KT improved the muscular
2,5% to 4,1% (4; 5). CGHs are thought to arise from
endurance of deep neck flexors. KT increased the
musculoskeletal impairment(s) in the neck (6).
muscle activation of back extensor muscles (15).
Dysfunction of the atlantoaxial (C1-2) and
One of the techniques that has been used in
atlantooccipital (C0-1) joints have been found in
managing CGH is Sustained Natural Apophyseal
CGH (7). The relative importance of C1-C2 as a
Glides (SNAGS) which involve a combination of a
primary cause of cervicogenic headache is also sup-
sustained facet glide with active motion, which is
ported by Aprill et al. (8). Zito et al. (9) have
then followed by overpressure (16). The efficacy of
confirmed the importance of examination of the C1-
the Mulligan concept was demonstrated in reducing
C2 segment in CGH diagnosis. Limitations in
of CGH symptoms and improving cervical range of
cervical muscle strength, endurance, and control
movement. The explanation of reducing headache
have been associated with CGH (10).
symptoms is neuromodulation effect of joint
On manual examination of a patient with
mobilization (17).
CGH, Moore (11) found a weakness of deep neck
The purpose of this randomized controlled
flexors and tightness of upper trapezius, levator
study was to investigate the effectiveness of adding
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2063
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Full Paper (vol.815 paper# 23)


c:\work\Jor\vol815_24 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2069-2070

A Case Report of Cesarean Scar Site Endometriosis: Diagnosis and Management
Medhat Monir K Fadel1, Mariam Sherif S Zaki2
1 Department of Reproductive Health and Family Planning, National Research Institute,2 Department of
Occupational and Environmental health, Benha University, Qalyubia, Egypt.
Corresponding author: Medhat Monir K Fadel, Email: medhat.fadel@nhs.net

ABSTRACT
Endometriosis is a frequent clinical problem in women of reproductive age, which means the presence and
proliferation of endometrial glands and stroma outside the uterus, the most common site of endometriosis is in the
pelvic cavity, extra pelvic endometriosis as on the surgical scar (as caesarean section, laparoscopic incision,
episiotomy, and hysterectomy scars) which is relatively rare, it is clinically presented by chronic pelvic pain,
dysmenorrhea, dyspareunia, subfertility, infertility, and poor both maternal & fetal outcomes and even stillbirth.
Caesarean section endometriosis is presented with cyclic pain and bleeding from the scar site. Our 33- year case
presented with a scar site endometriosis after the third Cesarean section. MRI was done to exclude uterine fistula
and a definite diagnosis has been made by histopathology. Management involved different modalities of treatment
including medical management, Mirena coil insertion. However, the definite treatment was surgical excision of the
endometriotic lesion and reclosure of the skin incision.
Keywords: Endometriosis, Caesarean section, scar, management.

INTRODUCTION
6 months post-delivery she started to have
Endometriosis, which means the presence and
menses, menses were very painful not as usual
proliferation of endometrial glands and stroma outside
before, and in the first two months, she observed
the uterus, the most common site is the pelvic cavity,
pain in the uterine scar and a change in color of the
extra pelvic endometriosis which is relatively rare,
scar to blue. In the third month, she started to
endometriosis on the surgical scar tissue is the common
develop bleeding from the scar site. The bleeding
example which can occur after hysterectomies,
was only during the time of menses and it was
episiotomy, laparoscopic procedure and after Caesarean
associated with pain in the scar site and painful
sections. 1,2. Endometriosis is a frequent clinical
menses. the pain was so severe that it required twice
problem in women of reproductive age which affects 5­
admission to the hospital to control pain. The
15 % of them 3. Abdominal wall endometriosis (which
bleeding from the wound was dealt with as wound
is commonly on the Cesarean scar) is the most common
infection,
broad-spectrum
antibiotics
were
type of extra pelvic endometriosis, with a reported
administrated three times: two during the hospital
incidence of 0.03­3.5 % 4-6 .it is characterized by the
admissions and one with the local GP. Many wound
presence of endometrial tissue in the subcutaneous
swabs have been done with no significant growth.
muscles-fascia layer following cesarean sections 7.
The characteristic feature was the dramatic
endometriosis is usually clinically manifested with
improvement of symptoms after stopping menses.
chronic pelvic pain, dysmenorrhea, dyspareunia,
This raised suspicion about the nature of the lesion.
subfertility as about 30%- 50% of patients have
The primary impression was the presence of uterine
difficulty in getting pregnant, poor maternal and
fistula: connection of the endometrium with the skin,
maternal outcomes, and even stillbirth 8,9.
U/S scan and MRI have been requested, no
As the diagnosis of endometriosis is difficult, it is
abnormality could be detected apart from a chocolate
only confirmed by pathology, the gold standard
cyst in the right ovary suspecting endometrioma.
diagnostic tests are laparoscopy and biopsy; however,
Hysteroscopy and laparoscopy have been
most accurate noninvasive diagnoses are magnetic
arranged: Hysteroscopy does not show any
resonance imaging (MRI) and transvaginal ultrasound
abnormality in the uterine cavity. The laparoscopic
for the detection of deep endometriosis with 83%-91%
examination was very limited because of extensive
sensitivity and 98% specificity, respectively 10,11.
adhesion around the lower uterine segment.

IUS: Mirena coil has been inserted, it
CASE REPORT
controlled the painful menses, however it causes
33 years old, 6 months post-delivery by Cs. It
unexpected spotting which was not acceptable by the
was her third delivery and she had two previous Cs. The
patient. Therefore, it has been removed. A trial of
last Cs was technically difficult, and it was complicated
using GnRH analogs was made to control the
by extensive adhesions. postoperatively on day 4 there
symptoms. It has been tried for six months, during
was wound infection and gapping of the wound which
which it causes dramatic relief in her symptoms,
has been treated successfully by broad-spectrum
complete stopping of menses and pain.
antibiotics: Co-Amoxiclav for 1 week.

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2069
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Accepted:17 /9 /2020

Full Paper (vol.815 paper# 24)


c:\work\Jor\vol815_25 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2071-2077

Assessment of Serum (YKL-40) As an Early Diagnostic Marker of Diabetic
Nephropathy in Patients with Type 2 Diabetes Mellitus
Mohamad Ahmed Shaaban1, Mohamad Abd El-raoof Korany1,
Rania Mohamad Azmy El-Shazly2, Mohammad Ali Nasr Ibrahem*3
Departments of 1Internal Medicine and 2Medical Biochemistry,
Faculty of Medicine, Menoufia University, Egypt, 3Kfr Elshiekh Liver Centre, Kfr Elshiekh-Egypt.
*Correspondence author: Mohammad Ali Nasr Ibrahem, Mobile: (+20)01009414389, E-mail: drmohamed183@gmail.com

ABSTRACT
Background:
YKL-40 is an inflammatory marker, a positive association between elevated circulating YKL-40 levels
and increasing levels of albuminuria, which have been described in patients with type 1 and type 2 diabetes indicating
a role of YKL-40 in the progressing vascular damage resulting in microvascular disease.
Objectives:
To assess serum YKL-40 as an early diagnostic marker of diabetic nephropathy in type 2 diabetes
mellitus. Patients and Methods: 70 patients with type 2 diabetes mellitus (46 males and 24 females) were included
in this study, another 19 healthy volunteers (12 males and 7 females) were chosen as a control group (group I). Patients
were further classified according to their Albumin/creatinine ratio into three groups: group II; Diabetic
normoalbuminuric, group III; Diabetic microalbuminuric and group IV; Diabetic macroalbuminuric. All subjects
(patients and controls) participating in the study were subjected to full history and clinical examination and routine
laboratory investigations and also specific laboratory investigations include glycated hemoglobin (HbA1c), urine
creatinine, microalbumin, albumin creatinine ratio, and serum YKL 40.
Results: The present study showed that serum YKL-40 significantly increased in diabetic patients than in the control
group. In addition, there was a significant increase of YKL-40 in the macroalbuminuric group compared to the
normoalbuminuric group and microalbuminuric group and a significant increase of YKL-40 in a microalbuminuric
group compared to the normoalbuminuric group.
Conclusion: The serum levels of YKL-40 in type 2 DM were significantly higher than in normal patients, and its
level increased with increasing urinary albumin excretion rate.
Keywords:
Albumin/Creatinine Ratio, Albuminuria, Diabetes mellitus, Diabetic nephropathy, YKL-40.

INTRODUCTION

Diabetes mellitus is a metabolic disease
albuminuria (15 males and 11 females), the
characterized by defective insulin secretion, insulin
albumin/creatinine ratio in these patients was less than
action, or both (1). Diabetic nephropathy is the most
30 mg albumin/g creatinine, Group III: Diabetic
common cause of end-stage renal disease.
microalbuminuric. It included 22 patients with type 2
Microalbuminuria is a widely used indicator for
diabetes with microalbuminuria (15 males and 7
diabetic nephropathy; its diagnostic accuracy is limited
females), the albumin/creatinine ratio in these patients
because structural damage might precede albumin
was 30 - 300 mg albumin/g creatinine, and Group IV:
excretion. Therefore, sensitive and specific biomarkers
Diabetic macroalbuminuric. It included 22 patients
for early detection of diabetic nephropathy are needed
with type 2 diabetes with macroalbuminuria (16 males
(2). YKL-40 serum levels are elevated in both patients
and 6 females). The albumin/creatinine ratio in this
with type 1 and type 2 diabetes (3).
group was more than 300 mg albumin/g creatinine.
The aim of this work was to assess serum YKL-40
Patients were recruited from the Internal Medicine
as an early diagnostic marker of diabetic nephropathy
Department and Endocrinology Outpatient Clinic of
in type 2 diabetes mellitus.
Menoufya University Hospital through the period from

March to December 2019.
PATIENTS AND METHODS

70 patients with type 2 diabetes mellitus (46
Ethical and patients' approval: Before starting the
males and 24 females) were included in this study, and
study, signed informed written consents were obtained
19 healthy volunteers (12 males and 7 females) were
from all subjects enrolled in the study as well as
chosen as control (Group I) without a history of arterial
approval of the Ethics Committee of Menoufya
hypertension, diabetes, neoplastic, cardiovascular,
University Hospitals was obtained.
inflammatory, renal, lung, endocrine or central nervous

system disorders. None of these subjects was under
Inclusion criteria: Patients were included in the study
medical treatment. Patients were further classified
if their fasting plasma glucose (FPG) was > 126 mg/dl,
according to their Albumin/creatinine ratio into three
PPPG > 200 mg/dl or HbA1c > 6.5% according to
groups: Group II: Diabetic normoalbuminuric. It
American Diabetic Association (ADA) guidelines (4).
included 26 patients with type 2 diabetes with normal
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Commons Attribution (CC BY-
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2071
Received:18 /7 /2020

Accepted:17 /9 /2020

Full Paper (vol.815 paper# 25)


c:\work\Jor\vol815_26 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2078-2083

Mirabegrone versus Solifenacine in Treatment of Overactive Bladder in
Female Patients in Zagazig University Hospitals
Abd Allah Mohammed Salem1, Osama Mostafa Kamhawy2, Emad Abd Elhamid Salem2, Ibrahim Ismail Elsayed2
1Department of Urology, Faculty of Medicine - Sert University, Libya,
2Department of Urology, Faculty of Medicine ­ Zagazig University, Egypt
Corresponding Author: Abd Allah Mohammed Salem, Mobile: (+20)0109589627,
ABSTRACT
Background:
Overactive bladder (OAB) syndrome, consisting of urgency, with or without urgency incontinence,
often with frequency (voiding more than eight times in a 24- h period) and nocturia (need to wake up one or more
times per night for urination), is a highly prevalent disorder with a significant impact on quality of life (QoL).
Objective: To evaluate the safety and efficacy of mirabegron 50 mg in comparison to solifenacin 5 mg in the
treatment of female patients suffering from overactive bladder symptoms.
Patients and Methods: This prospective randomized study was conducted in Zagazig University Hospitals during
the period From November 2018 to April 2019. Thirty consecutive female patients aged from 18 to 65 years old
were included in this study. Results: Mirabegrone significantly was associated with hypertension only in one
case, and Solifenacine significantly was associated with blurred vision, constipation and dry mouth. Comparison
between mirabegron and solifenacin group according to day and night frequency, urge and urge incontinence
pretreatment showed that there was no significant difference between both groups. Comparison between
mirabegron and solifenacin groups according to day and night frequency, urge and urge incontinence after taking
mirabegrone or solifenacin showed that mirabegron group was significantly lower as regards day and night
frequency also in urgency and urgency incontinence post treatment.
Conclusions: Solifenacin and mirabegron were effective in improving over active bladder symptoms. Mirabegron
showed greater tolerability with fewer patients discontinuing therapy because of side effects. mirabegron can be
considered as the drug with the better balance between efficacy and tolerability in the treatment of OAB.
Keywords:
Mirabegrone versus Solifenacine, Overactive bladder (OAB), Urgency incontinence.

INTRODUCTION
(AEs) such as dry mouth, which along with lack of
Overactive bladder (OAB) syndrome is a
efficacy, is the most frequently cited reason for
symptom complex defined as urinary urgency, usually
discontinuation of antimuscarinic treatment (5).
accompanied by increased daytime frequency and
The 3-adrenoceptor agonist, mirabegron, which
nocturia, with or without urgency incontinence, in the
acts via a different mechanism of action to
absence of urinary tract infection or other obvious
antimuscarinic, could potentially improve the efficacy
pathology (1). Urgency incontinence is present in
and tolerability balance over current standard of care in
approximately one-third of OAB cases. Compared to
the management of OAB. Mirabegron (25­100 mg)
other OAB symptoms, it has the greatest impact on
consistently demonstrated superiority over placebo with
quality of life (QoL), with higher rates of depression,
respect to reductions in incontinence episodes and
psychological and emotional distress, and social
micturition frequency, with a similar incidence of (AEs)
isolation (2). Urgency Incontinence is associated with
as placebo (6).
significantly higher health care resource utilization
In current clinical practice, patients were often
and lower productivity; consequently, incontinence
initiated on antimuscarinics however; symptom
has a major socioeconomic impact (3). OAB with
improvement was often insufficient, leading to
16.9% of women and 16.0% of men affected and
dissatisfaction, particularly if incontinence persists.
prevalence among patients of both sexes increasing
Increasing the antimuscarinic dose often exacerbates
with age. The prevalence of OAB wet was 6.1%, while
anticholinergic adverse events (AEs) that can lead to
10.4% of responders exhibited OAB dry. The
treatment discontinuation (7). If oral therapy fails,
prevalences of OAB wet and OAB dry were similar in
intravesical on abotulinumtoxin A can be used to treat
women (9.3% and 7.6%). However, in men the
OAB symptoms (8), but it is associated with urinary tract
prevalence of OAB dry was considerably higher than
infections, fluctuating response, and may require
that of OAB wet (13.4% and 2.6%, respectively) (4).
intermittent self-catheterization (9). Other invasive
Antimuscarinics are still the mainstay of oral
alternatives include percutaneous tibial nerve
pharmacological treatment for OAB, relaxing the
stimulation and sacral nerve stimulation, but their
detrusor muscle and reducing sensory symptoms during
penetrance in clinical practice is limited (10).
the storage phase of the micturition cycle by inhibiting
This work aimed to evaluate the safety and efficacy of
muscarinic receptor subtypes, M2 and M3. Both
mirabegron 50 mg in comparison with solifenacin 5
subtypes are expressed in multiple tissues, increasing
mg in the treatment of female patients suffering from
the risk of bothersome, anticholinergic adverse events
overactive bladder symptoms.


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2078
Received:17 /6 /2020

Accepted:18 /8 /2020

Full Paper (vol.815 paper# 26)


c:\work\Jor\vol815_27 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2084-2087

Study of The Effect of Nutrition and Glycemic Control and on IGF-1 and Growth
in Pre-pubertal Egyptian Children with T1DM
Raef Malak Botros1, Aliaa Ahmed Abdo El-Sherbeeny1, Nancy Samir El Barbary2,
Ala Muhammed Muhammed1, Hanan Mahmoud Ali*1
Departments of 1Internal Medicine, Endocrinology & Metabolism and 2Pediatrics,
Faculty of Medicine - Ain Shams University
*Corresponding author: Hanan Mahmoud Ali, Mobile: (+20)1222521314, Email: hanan.mahmoud29@yahoo.com

ABSTRACT
Background:
Pre-Pubertal children who have T1DM are shorter than their non-diabetic peers.
Objective: In the current study we aimed to evaluate the role of HbA1c and IGF-1 in these cases.
Patients and Methods:
The present study was a cross-sectional study conducted on 80 pre-pubertal Egyptian
children: 30 males, 30 females with T1DM and 20 age-matched controls (10 males and 10 females), the participants
were recruited from the Outpatient Clinic of the Pediatric Department of Ain Shams University Hospitals and the
National Institute of Diabetes and Endocrinology in Cairo, Egypt during the period from July 2018 to January
2019.
Results:
The height and weight percentiles were found to be lower in type 1 diabetic children when compared to
the controls with median values of 14.50 (IQR 27.98) in male patients, 17.95 (IQR 29.18) in female patients, and
87 (IQR 20.58) in the controls. A negative correlation between serum IGF-1 and HbA1c as well as the height and
weight percentiles were found with (P = 0.014, 0.009, and 0.05 respectively). Serum IGF-1 levels were also found
to be significantly lower in patients (P <0.001) with a mean value of (77.60 ± 69.377) in male patients and (64.0 ±
29.402) in female patients and (201.0 ± 102.798) in the controls. HbA1c was also found to be negatively correlated
with height percentile (P = 0.012).
Conclusion:
The glycemic control tested by HbA1c is an important indicator of linear growth in pre-pubertal
children, Height, and weight percentiles were found to be lower in type 1 diabetic patients when compared to the
healthy controls (P < 0.001) in both cases.
Keywords: T1DM, IGF-1, Growth.

INTRODUCTION
these are more common especially in those with poor
T1DM is considered one of the most common
glycemic control and longer duration of the disease (3).
chronic endocrine disorders of childhood (1). The
Growth hormone (GH) secreted in a pulsatile
incidence of T1DM in Egypt is found to be 8-10 per
manner with age-dependent concentrations. Most of
100,000 population per year in children aged less than
the GH promoting growth effects are mediated through
15 (2).
the actions of peptides, like insulin-like growth factor
In children and adolescents diagnosed with
I (IGF-1).
T1DM, the most frequent complications in
IGF-1 is a hormone, structurally similar to
hypoglycemia, hyperglycemia, diabetic ketoacidosis
insulin. It has an important role in childhood growth.
(DKA), and psychiatric disorders. The pathogenesis of
Subjects with T1DM may have low IGF-1 levels,
long-term vascular sequelae including retinopathy,
related to insulinopenia and insulin resistance (4).
nephropathy, neuropathy, and cardiovascular disease
There is one study that suggested that IGF-1
usually starts in childhood, however, the clinical
increased with insulin therapy and better glycemic
manifestations of these complications are not common
control (5).
before adulthood.
Others concluded that an insulinopenic state has
Inadequate growth is also a well-known
effects on the regulation of IGF-1 similar to those of
complication of diabetes. As long as diabetes is known
nutritional deprivation (6).
to adversely affect linear growth and pubertal
To evaluate the effect of glycemic control on IGF-
development, so maintenance of good glycemic
1 and growth, represented by height and weight
control in the pre-pubertal diabetic patient is a must to
percentiles for age in a sample of pre-pubertal Egyptian
ensure normal physical and psychological growth.
children diagnosed with T1DM.
Several Studies revealed that growth velocity is

affected following the patient's age, also with the age
PATIENTS AND METHODS
at diagnosis of diabetes mellitus (DM). There is
This is a cross-sectional that has been performed
evidence to suggest that growth disorder occurs
during the period from July 2018 to January 2019,
secondary to abnormalities in the hypothalamic-
conducted on 80 pre-pubertal Egyptian children, 60 of
pituitary-growth hormone axis in diabetic patients and
those children were diagnosed with T1DM with


This article is an open access article distributed under the terms and conditions of the Creative
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2084
Received:19 /7 /2020

Accepted:18 /9 /2020

Full Paper (vol.815 paper# 27)


c:\work\Jor\vol815_28 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2088-2092

Optical Biometry Versus Ultrasound Biometry
Abd Elkhalek I. Elsaadani, Nermeen M. Badawi, Asmaa Z.A. Elterawy
Department of Ophthalmology, Faculty of Medicine Menoufia University, Menoufia, Egypt
Corresponding author: Asmaa Z.A. Elterawy, Moblie: (+20)01272412287, E-mail: asmaazakaria987@gmail.com

ABSTRACT
Background:
Implantation of an intraocular lens (IOL) is the gold standard in modern-day cataract surgery. Over
the last decade, IOL power calculations have become a focal point of cataract surgery.
Objective:
To compare the sensitivity and specification of optical biometry and applanation ultrasound biometry in
the measurement of intraocular lens.
Patient and methods: This prospective cohort study was done on 100 eyes from one hundred patients undergoing
phacoemulsification with primary intraocular lens implantation. and scheduled for cataract surgery in the
Ophthalmology Department of Menoufia University Hospitals and El-Mahalla Ophthalmology Hospital. Fifty eyes
of patients were measured by ultrasound measurement (by A-Scan, Group 1) and the other 50 eyes by optical
biometry (by IOL Master, Group 2).
Result:
in Group 1There were 22 eyes of 22males (44%), and 28 eyes of 28 females (56%) with a mean age was
58.4 ±10.13years. While, in Group 2, there were 16 eyes of 16 males (32%), and 34 eyes of thirty-fourth females
(68%) and the mean age of the patients in this group was 61.2±9.25 years. The mean IOL of the patient in Group I
was (18.86±2.57) with minimum IOL power (16.29) and maximum IOL power (21.43). Whereas, the mean IOL
potent ion of the patient in group II was (20.5±1.98) with minimum IOL power (18.52) and maximum IOL power
(+22.48).
Conclusion: We can conclude that IOL measurements performed by using the Zeiss IOL Master, using partial
coherence interferometry, resulted that a significantly better IOL power forecast and therefore the refractive result in
cataract surgery than Applanation US biometry.
Keywords:
Optical Biometry, Ultrasound Biometry, Intraocular lens.

INTRODUCTION
easy to use, and contact-free method. Optical
Intraocular lens (IOL) calculation is an essential
biometrics use a780nm laser diode infrared light to
step in obtaining the exact target that includes the
transmit the signal (5). Interface phenomena between
refractive result and is a critical goal in modern cataract
the reflected signal and the reference signal and used to
surgery. Several devices and formulas are currently
determine distances between interfaces.
available, allowing the precise IOL precision needed to
Previous comparisons between ultrasound and
reach target refraction (1, 2).
optical biometrics showed equal or better results with
To achieve targeted refraction, the axial length
ophthalmometric biometrics (6). A recent study
(AL), anterior chamber depth (ACD), and corneal
concluded that ultrasound biometrics and optical
radius (K1 and K2) must be completely accurate (3).
biometrics can be applied interchangeably for IOL
Axial length measurement (AL) uses the principle of
calculations (4).
signal reflection to calculate the difference between the

numerous ocular structures and the overall length of the
AIM OF THE STUDY
eye. The reflection time of the signal from an interface
This study aimed to compare the sensitivity and
is measured, divided into two, and multiplied by the
specification of optical biometry and applanation
speed of the signal in the corresponding medium (4).
ultrasound biometry in the measurement of intraocular
Distance is measured using the rules: distance = speed
lens.
* time / 2 the transmitting signal can be ultrasonic.

Ultrasound biometrics have been the gold standard for
PATIENT AND METHODS
decades. A specific crystal embedded in the probe
Study Design: This prospective cohort study was done
oscillates to create a high-frequency sound wave to the
on patients scheduled for cataract surgery in the
eye. There are two types of ultrasound biometrics
Ophthalmology Department of Menoufia University
Biometrics of contact type made by applying an
hospitals and El-Mahalla Ophthalmology Hospital.
ultrasound probe to the cornea; It carries the risk of
The study was conducted on 100 eyes of one hundred
infection.
Immersion-type
biometrics
require
patients undergoing phacoemulsification with primary
immersion of the probe in a saline-filled shell. A
IOL implantation after the purpose of the study was
decade ago, optical biometry was established in clinical
explained to them. 50 eyes of patients will be measured
practice, and over time optical biometry replaced
by ultrasound measurement (by A-Scan, Group 1) and
ultrasound biometry as the standard calculation for
the other 50 eyes by optical biometry (by IOL Master,
measuring the axial length of the eye because it is a fast,
Group 2).


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2088
Received:19 /7 /2020

Accepted:18 /9 /2020

Full Paper (vol.815 paper# 28)


c:\work\Jor\vol815_29 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2093-2098

Relationship between Hepatic Artery Resistive Index and
Liver Fibrosis Score in Non-Alcoholic Fatty Liver Disease Patient
Ashraf Mohammed Mohammed Alkabeer1, Tarek Mohamed Mohamed Mansour2,
Mohammed Atef Mohammed Abd El Kader*1, Mohammed Mahmoud Abd El Naser1
Departments of 1Internal Medicine and 2Diagnostic Radiology,
Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: Mohammed Atef Mohammed Abd El Kader, Mobile: (+20) 01062435257,
E-Mail: tantawy_wael@yahoo.com

ABSTRACT:
Background: Nonalcoholic fatty liver disease (NAFLD) is one of the most important precursors of chronic liver
disease all over the world. Doppler ultrasonography is an essential part of evaluating the vascular haemodynamic
variation seen within NAFLD.
Objective: Assessment of the role of Hepatic Artery Resistive Index (HARI) in NAFLD patient and the relation
between HARI and grading of fatty liver by ultrasound.
Patients and methods: One hundred Egyptian patients diagnosed to have NAFLD based on ultrasound abdomen
35, 35, and 30 patients in grade1, grade 2, and grade3 NAFLD, respectively and 20 healthy subjects as control
group were subjected to hepatic artery Doppler study. The study was carried out in the Outpatient Clinic of Internal
Medicine Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt.
Results: Our study results showed high statistical significant difference (p-value < 0.001) between studied groups
as regards hepatic artery resistance index. There was an inverse relationship between HARI and different grades
of fatty liver in patients (p < 0.001). Hepatic artery resistance index (RI) decreased as the severity of diffuse fatty
infiltration increases.
Conclusion: Hepatic artery resistance index (RI) decreases as the severity of diffuse fatty infiltration increases.
Keywords: Hepatic artery resistive index, Non-alcoholic fatty liver disease, NAFLD fibrosis score.

INTRODUCTION

Non-Alcoholic
Fatty Liver
Disease
vessels and diaphragm could be visualized. Grade 2
(NAFLD), affects around one fourth of the general
(moderate): moderately increased diffuse liver
population worldwide. Nonalcoholic steatohepatitis
echogenicity; intrahepatic vessels and the diaphragm
(NASH), the active form of NAFLD, characterized by
could be visualized slightly. Grade 3 (severe):
histological lobular inflammation and hepatocyte
markedly increased diffuse liver echogenicity, weak
ballooning, is associated with faster fibrosis
penetration through the liver by the gray-scale US
progression and affects around 1.5% to 6.5% of the
evaluation (5). Doppler ultrasonography of the liver is
general population (1). NAFLD is frequently
a useful test to evaluate arterial perfusion via
associated with metabolic comorbidities such as
calculation of resistance and plasticity indices (6). And
obesity,
type
2
diabetes,
hyperlipidemia,
the resistance Index (RI) is the commonest Doppler
hypertension, and metabolic syndrome (2).
parameter used for hepatic arterial evaluation (7).
Although the most common cause of death in
NAFLD fibrosis score (NFS) is one of the most
patients with NAFLD is cardiovascular disease,
commonly employed noninvasive tests to assess
independent of other metabolic comorbidities,
severity of hepatic fibrosis by using six commonly
NAFLD is becoming a major cause of liver disease-
measured
parameters.
These
include
age,
related morbidity (cirrhosis, end-stage liver disease,
hyperglycemia, body mass index (BMI), platelet
hepatocellular
carcinoma
(HCC)
and liver
count, albumin level, and AST/ALT ratio (8).
transplantation) as well as mortality (3).
This study aimed to evaluate the role of HARI in
As a non-invasive, extremely safe, widely
NAFLD patient and the relation between HARI and
available and inexpensive modality, ultrasonogram is
grading of fatty liver by ultrasound.
the common method used for detecting fatty liver and

assessing the stages of NAFLD. The bright liver,
PATIENTS AND METHODS
consisting of hyperechogenic liver tissue with fine,
The study was carried out in the Outpatient Clinic
tightly packed echoes on US examination,
of Internal Medicine Department, Faculty of Medicine,
ultrasonogram considered characteristics for fatty
Al-Azhar University. One hundred Egyptian patients
liver (4). The degree of fatty infiltration was graded
with hepatic steatosis (mild, moderate or severe)
by gray-scale US as follows: Grade 0 (none): Normal
detected by ultrasound and twenty healthy volunteers
liver echogenicity. Grade 1(mild): minimally
(subjects without fatty infiltration) as control group
increased diffuse liver echogenicity, intrahepatic
were enrolled.

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2093
Received:20 /7 /2020

Accepted:19 /9 /2020

Full Paper (vol.815 paper# 29)


c:\work\Jor\vol815_30 The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (5), Page 2099-2102

Study of The Podocalyxin as An Early Marker for
Diabetic Nephropathy and Its Correlation with Stages of
Diabetic Nephropathy in A Sample of Egyptian Patients with T2DM
Salah El-Din Ahmed Shelbaya, Rana Hashem Ibrahim, Nourhan Safwat Sawirs, Hanan Mahmoud Ali*
Department of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Hanan Mahmoud Ali, Mobile: (+20)1222521314, Email: hanan.mahmoud29@yahoo.com

ABSTRACT
Background:
Nephropathy is a major complication of diabetes, and is the main cause of end-stage kidney disease.
Early recognition of nephropathy in diabetic patients is critical because it creates an opportunity to prevent the
occurrence of diabetic nephropathy and/or even slow down the process of end-stage kidney disease attributable to
diabetes. Human cells; podocytes (pods) have been shown to be functionally and structurally affected in the natural
history of diabetic nephropathy.
Objective: Study of the podocalyxin as an early marker for diabetic nephropathy and its correlation with stages of
diabetic nephropathy in a sample of Egyptian patients with type 2 diabetes mellitus (T2DM).
Patients and Methods:This study was a cross sectional study conducted on 80 subjects divided into four groups:
Group 1: 20 diabetic patients with normalbuminuria. Group 2: 20 diabetic patients with nephropathy and
microalbuminuria stages. Group 3: 20 diabetic patients with nephropathy and macroalbuminuria stages, Group
4:20 apparently healthy volunteers were included as a control group.
Results: Urinary podocalyxin (PCX) was significantly higher in patients group compared to control group. Urinary
PCX was significantly higher in macroalbuminuric group followed by microalbuminuric group then
normoalbuminuric group. There was a positive significant correlation between urinary PCX and glycemic profile
[Fasting blood sugar (FBS), 2hrPP, Glycosylated Hemoglobin (HbA1C)], serum creatinine and albumin creatinine
ratio (ACR).
Conclusion: Urinary podocalyxin is a beneficial as an early marker for early stages of diabetic nephropathy in type
2 DM patients.
Keywords: Diabetic nephropathy, Podocalyxin, T2DM.

INTRODUCTION


Diabetes is a group of metabolic diseases
sugar in matrix proteins. Second, a thickening of the
characterized by high blood sugar caused by defects in
glomerular basement membrane (GBM) occurs.
insulin secretion, insulin action, or both. Chronic
Third, glomerular sclerosis is caused by high blood
hyperglycemia with diabetes is associated with long-
pressure within the glomeruli (caused by dilatation of
term damage, dysfunction, and failure of various
the incoming renal artery or from ischemic damage
organs, especially the eyes, kidneys, nerves, and heart
caused by stenosis of hyaline in the vessels supplying
and blood vessels (1).
the glomeruli) (5).
Nephropathy is a major complication of
Podocalyxin, the sialomucin most closely
diabetes and the main cause of end-stage kidney
related to cluster of differentiation 34 (CD34) and
disease. Diabetic kidney disease in diabetes mellitus
endoglycan, is expressed by kidney podocytes,
occurs in 20-40% of diabetic patients, and is clinically
hematopoietic progenitors, and vascular endothelium.
characterized by proteinuria and progressive renal
The function of PCX is to maintain the shape of a
insufficiency (2).
podocyte. PCX is usually found on the apical cell
Human cells (pods) have been shown to be
membrane of podocytes and is shed into urine from
functionally and structurally affected in the natural
infected PADS cells (6).
history of diabetic nephropathy. Podocytes cover the

glomerular basement membrane (GBM) schema to
AIM OF THE WORK
contribute to the final volume and shipping barrier of
Study of the podocalyxin as an early marker for
the glomerular filter to completely reduce the leakage
diabetic nephropathy and its correlation with stages of
of proteins into the urinary space (3).
diabetic nephropathy in a sample of Egyptian patients
Injuries of podocytes are associated with a
with T2DM.
hiatus, loss of incision membranes, erasure of the foot

process, and detachment from GBM (4).
PATIENTS AND METHOD
Three noteworthy tissue changes occur in the
This is a cross-sectional study that was performed
glomeruli in people with diabetic nephropathy. Firstly,
during the period between April and December 2018;
mesangial expansion induced by hyperglycemia,
conducted on patients attending the diabetes outpatient
which is likely by increased production of matrix or
clinics in Ain Shams University hospitals.


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/)
2099
Received:19 /7 /2020

Accepted:18 /9 /2020

Full Paper (vol.815 paper# 30)