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The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2130-2109
Assessment of Vitamin D Level in Patients with Recurrent Renal Calcium Stones
Mohamed Marzook Abd El-maksoud, Mohamed Adel Abozead*,
Mohamed Sayed ELgharbawy, Abd- Elalim Mohamed El-Doray
Urology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Mohamed Adel Abozead, Mobile: +20 100 722 5641, Email: mohamed.abozead.1985@gmail.com
ABSTRACT
Background: a higher concentration of the active vitamin D metabolite colic calciferol 1,25-dihydroxyvitamin D3
is associated with increased urinary calcium excretion, which could lead to increase the risk of stone formation.
Objectives: To assess vitamin D level in patients with recurrent renal calcium (Ca) stones.
Patients and methods: This study was conducted in Urology Department at Menoufia University Hospital during
the period from March 2018 to December 2019. 96 patients were included in this study divided into two groups. The
first group (group 1) consisted of 76 patients with renal Ca stone and the second group (group 2) consisted of 20
cases without renal stone. Patients who were included in this study seeking for treatment of recurrent renal stone that
proved to be Ca stone by CT KUB or stone analysis.
Results: there was no statistically significant difference between the two groups regarding vitamin D level, there was
no statistically significant difference between different types of calcium stone in relation to vitamin D levels (P=
0.981). There was no statistically significant correlation between vitamin D levels with age (P=0.300), Hounsfield
unites of stone (P=0.650) or serum creatinine (P=0.690).
Conclusion: There was no statistically significant difference between studied groups regarding vitamin D level.
Further studies are needed to determine whether there is any untoward consequence of a concomitant rise in intestinal
absorption and urinary excretion of calcium associated with vit D supplementation in idiopathic stone formers.
Keywords: Calcium stone, Vitamin D, Recurrent, Renal stone, Urinary excretion.
INTRODUCTION
Urinary stone disease is a common and recurrent
homeostasis (6). Epidemiological studies of patients
disorder with an estimated lifetime risk in the United
who developed renal stones showed that they have
States with incidence of 612%, and a recurrence rate
osteopenia, osteoporosis and hypovitaminosis D (7).
of up to 50%. The estimated prevalence of kidney stone
The aim of the present study was to assess vitamin D
disease is about 35 % in females and 1015 % in
level in patients with recurrent renal calcium stones.
males (1). The most common type (more than 80 %) is
the calcium-based renal stone, and high urine calcium
PATIENTS AND METHODS
excretion is a strong risk factor for stone formation (2).
This study was conducted in Urology
Both dietary pattern and genetic factors can influence
Department at Menoufia University Hospital during
urinary calcium (Ca) excretion and take a role in the
the period from March 2018 to December 2019. 96
pathogenesis of renal stones (3). Prior studies showed
patients were included in this study divided into two
that a higher concentration of the active vitamin D
groups.
metabolite colic calciferol 1, 25-dihydroxyvitamin D3
76 patients with recurrent Ca renal stone and 20
(1.25 (OH)2 D3), is associated with increased urinary
cases without renal stone (control group). Patients
calcium excretion, which could lead to increase the risk
included in this study were seeking for treatment of
of stone formation (4). Despite vitamin D played an
recurrent renal stone that proved to be Ca stone by CT
important role in maintaining bone health, as well as a
or stone analysis.
variety of other physiologic functions, many clinicians
are not going to treat vitamin D deficiency or
Ethical consideration:
insufficiency in renal stone formers because of the risk
All participants were volunteers. All of them
of increasing urinary calcium excretion. This likely
signed a written informed consent with explaining the
derives from the fact that vitamin D is often cited as a
aim of study before the study initiation. Protocol of the
risk factor for renal stones (5). The vitamin D endocrine
study was approved by Ethical Scientific
cycle helps to maintain extracellular Ca++ level through
Committee of Menoufia University Hospital.
its action in kidneys, bones, parathyroid (PTH) and
All of them were selected according to inclusion and
intestine. 1,25 (OH)2D3 produced in the kidney
exclusion criteria.
(proximal tubules) enhances intestinal calcium
absorption, controls bone remodeling and suppresses
Inclusion criteria: recurrent renal stones adult cases
of PTH function (hormone production and cell
(20-50) years and Ca stone proved by CT or stone
growth). These effects of vitamin D help in calcium
analysis.
This article is an open access article distributed under the terms and conditions of the Creative
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1203
Received:20 /7 /2020
Accepted:19 /9 /2020
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The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2110-2114
Surgical Treatment of Pediatric Proximal Humeral Fracture by
Percutaneous Pinning
Omar Abd-Wahab Kelany, Waleed Mohammed Nafea,
Mohamed Ismael AbdelRhman Kotb, Mohamed Abdusalam Omar Idrah*
Department of Orthopedic Surgery, Faculty of Medicine Zagazig University, Egypt.
*Corresponding Author: Mohamed Abdusalam Omar Idrah, Mobile: (+20)01021954504 , Email: edrahmoha@gmail.com
ABSTRACT
Background: Proximal humeral fracture pattern varies based on the mechanism of injury and the patient's age at
the time of the injury. The purpose of this study was to prove short-term clinical and radiographic results of closed
reduction and percutaneous pinning in displaced proximal humeral fractures in pediatric by K-wire. Subjects and
Methods: This was clinical trial study included 18 children with proximal humeral fracture; their age ranged from
8 to 15 years with mean age 11.88 ± 2.08 with closed proximal humeral fracture between November 2019 and June
2020 at Zagazig University Hospital by closed reduction and percutaneous pinning under image intensifier using
Kirschner-wires. Results: This study showed that 12 cases had no complication (66.7%), 3 cases had stiffness
(16.7%), 2 cases had superficial infection (11.1%) and 1 case had loss of reduction (5.6%) and treated by K-wire
removal, arm sling stabilizer. Two cases of superficial infection did not necessitate early removal of K-wires. All of
them were treated with oral antibiotics. Conclusions: Additional K-wires through the lateral cortex give more
stability for the severely displaced fractures with rotational or angular instability mainly type 4 fractures.
Keywords: Closed reduction, Kirschner-wires, Proximal Humeral Fracture, Percutaneous pinning,
INTRODUCTION
fragment (epiphysis) displacement in abduction and
Proximal humeral fracture pattern varies based
externally rotated due to rotated cuff muscles and distal
on the mechanism of injury and the patient's age at the
fragment (shaft) displacement anterior and adduction
time of the injury. Pediatric proximal humeral fractures
due to pectoralis major and deltoid muscles (5).
are not common. Studies estimate that these fractures
Regardless of the degree and severity of
constitute approximately 2% of all pediatric fractures
displacement, open treatment of proximal humeral
and 3% to 6.7% of all physical fractures (1).
fractures in children is rarely justified. This is in spite of
Treatment of proximal humeral fractures is
the fact that the majority of patients in grade IV
rarely debatable. The traditional teaching is that non-
(displacement greater than 2/3 of the humeral shaft)
operative treatment is expected to give satisfactory
group had persistent deformity and many had notable arm
results with return to full function and complete
shortening compared to the opposite side(6).
anatomic remodeling (2).
Several other published studies have attempted
Fractures of proximal humerus, including
to address the reasons for potential malunion in many
fracture of the epiphysis, and surgical neck, have huge
of these cases. These studies have alluded to the
remodeling potential because of longitudinal humeral
interposition of the periosteum or the long head of the
growth, which accounts for age dependency for 80%
biceps tendon within the fracture site as factors that
of humeral growth (3).
block satisfactory restoration of alignment and fracture
Proximal humeral fractures are classified by
reduction with closed techniques (7).
their anatomic location, displacement, and angulation.
Closed reduction and percutaneous pinning of
Proximal humeral fractures are commonly diagnosed
displaced proximal humeral fracture has its role if
according to the Salter Harris classification scheme.
obtaining accepted satisfied reduction of proximal
Most of these fractures are either non displaced Salter
humeral fracture is achieved. Although closed
Harris I fractures, or displaced Salter Harris II
reduction and percutaneous pinning give satisfactory
fractures. It is extremely rare to see a Salter Harris III
result in displaced proximal humeral fracture for
or IV proximal humeral fracture. Neer classified
pediatric. Yet it has complication as pin tract infection,
pediatric proximal humeral fractures based on the
migration of pin and osteomyelitis (8). The aim of this
amount of displacement. Grade I fracture has less than
study was to prove short-term clinical and radiographic
5 mm of displacement; grade II has between 5 mm and
results of closed reduction and percutaneous pinning in
one third the diameter of the humeral shaft; grade III
displaced proximal humeral fractures in pediatric by
has between one third and two thirds the diameter of
K-wire.
the humeral shaft; and grade III fractures has
displacement greater than two thirds the diameter of
SUBJECTS AND METHODS
the humeral shaft (4) .
This was clinical trial study included 18
Varus is the usual direction of proximal
children with proximal humeral fracture their age
humeral fracture displacement, with proximal
ranged from 8 to 15 years with mean age (11.88 ± 2.08)
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-
SA) license (http://creativecommons.org/licenses/by/4.0/)
1210
Received:7 /6 /2020
Accepted:18 /8 /2020
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The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2114-2119
Patterns of Pulmonary Hypertension in Patients with Chronic Kidney Disease
Mohammed Zain El-Din Hafiz1, Hala Abdallah Mahmoud2,
Ramadan Ghalib Mohammed3, Mohammed Mahmoud Abd Elwahab Mohammed*2
1Department of Internal Medicine, Faculty of Medicine, Assiut University, Departments of 2Internal Medicine and
3Cardiology, Faculty of Medicine, Aswan University, Egypt
*Corresponding author: Mohammed Mahmoud Abd Elwahab, Mobile: (+20)1159547006,
Email: mmawahab92@gmail.com
ABSTRACT
Background: Pulmonary hypertension (PH) is often associated with high morbidity and mortality and is recently
recognized as a common complication secondary to chronic kidney disease (CKD). Epidemiological data for this
disorder across the spectrum of CKD is poorly understood.
Objective: The aim of the work was to detect patterns of PH in patients with chronic kidney disease (CKD).
Patients and methods: This study was carried on 80 patients with CKD who were followed up at outpatient clinics,
Aswan University Hospital, Aswan, Egypt. This study was conducted between February 2019 and January 2020.
Results: There was highly statistically significant increase in PH (65 %) in dialytic group and (42.5%) in non-
dialytic group, with mean pulmonary artery systolic pressure (PASP) 41.22 ± 11.32 18 to 25 mm Hg in dialytic
group versus 33.37± 9.43 mm Hg in non-dialytic group. Also, positive relationship between PH and increase in
duration of CKD, but there is no significant relationship with duration of dialysis treatment, hemoglobin level,
calcium and phosphorus. Despite a positive correlation between arteriovenous fistula (AVF) flow and PASP,
multivariate analysis did not show a significant relation between them.
Conclusion: It could be concluded that pulmonary hypertension is a common finding in CKD patients; the
prevalence was highest among patients with end stage renal disease (ESRD) on regular haemodialysis (HD) than
those on conservative management. Early detection of PH is important in order to avoid the serious consequences of
the disease.
Keywords: Pulmonary Hypertension, Chronic Kidney Disease
INTRODUCTION
Chronic kidney disease is a common
thromboembolic PH, and PH due to unclear
condition, and its prevalence is increasing. It is a
multifactorial mechanisms, respectively (4).
functional or structural kidney abnormality, lasting for
There are two methods to measure PH, first of
at least three months which could be classified
them is right heart catheterization which considered the
according to etiology, glomerular filtration rate (GFR)
diagnostic gold standard, and second one is
and/or albuminuria. Staging of CKD was defined by
noninvasive transthoracic doppler echocardiography
accepted eGFR thresholds, CKD stage with GFR 90,
(TTDE) which is used to calculate estimated PASP (5).
and CKD stage I with GFR 6089mL/min/1.73 m2,
Using TTDE, measurement of PASP is based
with evidence of renal damage, CKD stage III with
on the tricuspid regurgitation jet, a phenomenon that
GFR 3059, stage IV with GFR 1529, and stage V
can be recorded in most physiologic and pathologic
with GFR<15 mL/min/1.73m2 (1).
conditions. In the absence of pulmonary stenosis,
Pulmonary hypertension is relatively common
PASP is estimated by the calculation of right
in patients with CKD and ESRD. There are many
ventricular systolic pressure by a modified Bernoulli
mechanisms can describe the influence of CKD on the
equation and is computed as 4 times the square of
pulmonary arteries as left ventricular disorders, volume
maximum tricuspid regurgitation jet velocity (TRV),
overload, hyperdynamic circulation due to severe
plus right atrial pressure (6).
anemia, AVF, sleep disorders, thromboembolism, and
The aim of this study was to detect patterns of
others (2, 3).
PH in patients with chronic kidney disease.
Pulmonary
hypertension
is
a
pathophysiological disorder complicating heart, lung,
PATIENTS AND METHODS
or systemic diseases, with increased morbidity and
This cross-sectional study included a total of 80
mortality regardless of its etiology. It is a syndrome
CKD patients who were followed up at outpatient
characterized by presence of mean pulmonary artery
clinics, Aswan university hospital, Aswan, Egypt.
pressure > 25 mm Hg at rest (3).
This study was conducted between February 2019 and
The World Health Organization categorizes
January 2020.
PH into 5 distinctive groups based on cause: pulmonary
arterial hypertension, PH due to left sided cardiac
Inclusion criteria: Patients from both sex, patients
disease, PH due to lung disease or hypoxia, chronic
above 18 years old and known CKD patients fulfilled
by laboratory and radiological assessment.
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-
SA) license (http://creativecommons.org/licenses/by/4.0/)
2115
Received:19 /7 /2020
Accepted:18 /9 /2020
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The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2121-2128
Role of Nailfold Capillaroscopy as A Method of Detection of Atherosclerosis in
Systemic Lupus Erythematosus Patients
Hanan M Farouk1, Fatma M Aboud1, Huda T Hussein 2, Rasha M Mohamed1.
1-Department of Internal Medicine and Rheumatology, Faculty of Medicine,
Ain Shams University,2-National research center, Cairo, Egypt.
Corresponding Author: Fatma Mohammed Aboud, Mobile: 01286451050, E mail: drfatmaaboud@gmail.com
ABSTRACT
Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with increased risk of atherosclerosis.
Despite the relative youth of lupus patients, they have risk for the development of premature cardiovascular atherosclerotic
diseases. Objective: This work aimed to study the detection of atherosclerosis and the cardiovascular risk in SLE patients
by nail fold capillaroscopy and the intima media thickness of the carotid artery.
Patients and methods: This was a cross sectional study included 60 SLE patients. Patients were collected from the
Outpatient Clinic and Inpatient of Internal Medicine and Rheumatology Departments within 6 months.
Results: 22 patients (36.7%) had atherosclerosis, with higher SLE disease activity index (SLEDAI) score (p 0.002). 45.5
% of them had severe disease activity and 54.5% had moderate disease activity. Atherosclerotic patients had statistically
significant lower capillary density (P 0.001), higher capillary length (P 0.008), capillary width (P < 0.001) and arterial limb
diameter (P< 0.001) with higher prevalence of tortuous (P= 0.022), meandering (p=0.014) and disorganized capillaries (P=
0.008). There was statistically significant positive correlation between Intima media thickness (IMT) and disease duration,
SLEDAI score, capillary width and arterial limb diameter, while there was statistically significant negative correlation with
capillary density. The Arterial limb diameter had highest diagnostic performance in diagnosing atherosclerosis.
Conclusion: Atherosclerosis is common in SLE & is associated with higher diseases activity. By capillaroscopy, lower
density, longer, wider and disorganized capillaries and tortuous & meandering capillaries were associated with the presence
of atherosclerosis.
Key words: Capillaroscopy, atherosclerosis, SLE.
INTRODUCTION
in SLE patients by nail fold capillaroscopy and the intima
Systemic lupus erythematosus (SLE) is a chronic
media thickness of the carotid artery.
autoimmune disease usually affects women at
reproductive age1. Atherosclerosis is an inflammatory
PATIENTS AND METHODS
process, which affects intima of arteries 2. Inflammation is
This was a cross sectional study included 60 SLE
involved in the pathogenesis of both lupus and
patients. Patients were collected from the Outpatient
atherogenesis. Endothelial injury caused by several factors
Clinic and Inpatient of Internal Medicine and
including autoantibody production, impaired immune
Rheumatology departments within 6 months.
complex clearance and complement activation, which are
Inclusion criteria: SLE patients fulfilling the American
associated with the pathogenesis of both SLE and
College of Rheumatology and European League against
coronary artery disease 3. Quantification of the carotid
Rheumatism (ACR / EULAR) 2012 classification criteria
artery intima media thickness using ultrasonography has
for SLE 8.
been used to diagnose atherosclerosis 4. Nail fold
Exclusion criteria: Patients with diabetes mellitus,
capillaroscopy (NFC) is a simple technique, which is
hypertension, obese patients "BMI more than 30" and
useful to detect atherosclerosis and microcirculation 5.
patients with other connective tissue diseases were
Different abnormal NFC changes are quite common
excluded from the study.
among patients with SLE, and nail fold capillaroscopy is
an effective method to monitor such changes. Treatment
Ethical consideration: The study was approved by
strategies may change in the different patterns of nail fold
Local Research Ethical Committee of Ain Shams
capillaroscopy 6.
University and conforms to the provisions of the
NFC can be beneficial in the disease diagnostic
Declaration of Helsinki in 1995. Informed consent from
process, and the extent of microvascular involvement in
all patients was obtained after explaining the aim of the
SLE may be reflected by the abnormal changes in nail fold
work and study design.
capillaroscopy. Severe or moderate pathological changes
Demographic data including age, sex and disease
under NFC were found in all reported SLE patients with
duration,
clinical
manifestations
including
internal organ manifestations 7. This work aimed to study
musculoskeletal, constitutional, renal, neurological,
the detection of atherosclerosis and the cardiovascular risk
hematological,
mucocutanous,
cardiovascular,
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-
SA) license (http://creativecommons.org/licenses/by/4.0/)
1221
Received:20 /7 /2020
Accepted:19 /9 /2020
ABSTRACT
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2129-2132
Discrepancy between Stool Culture and Blood Culture in Acute Diarrheal Disease
Hosny Mohammed Ahmed Elmasry, Alaa Hashim, Amira Rifaat Ebrahim*
Pediatric Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: Amira Rifaat Ebrahim, Mobile: (+20) 01003011761, E-Mail: mdamehab411@gmail.com
ABSTRACT
Background: Acute diarrhea is defined as the passage of stools with abnormal consistency and frequency in a day
(e.g. more than three times) which lasts for less than two weeks. Diarrheal diseases are reported as the leading cause
of mortality among children aged five years and below. Stool or blood culture tests are very important to determine
proper management for diarrheal illness.
Objective: to investigate the difference between the role of stool and blood cultures in the diagnosis of acute
diarrheal disease and to determine the predictors of positive cultures in patients with diarrheal illness.
Subjects and Methods: This prospective cohort study included 77 children. Forty-one of them were males and 36
were females with acute diarrhea with ages between 6months to 5 years who attending Al-Azhar Assiut University
Hospital starting from May 2018 until May 2019. Results: The results of the present study demonstrated that Stool
culture was positive in 41 cases and blood culture was positive in 8 cases. All cases with positive blood culture were
also had a positive stool culture. Twenty-one cases were positive for campylobacter in stool culture and 2 cases of
them were pseudomonas positive in blood culture. Twelve cases were salmonella positive in stool culture and 2 cases
of them were pseudomonas positive in blood culture. Seven cases were E-coli positive in stool culture and 2 cases of
them were E-coli positive and 1cases was positive for pseudomonas in blood culture. Conclusion: The results of this
study revealed that stool or blood culture tests are very important to determine proper management for diarrheal
illness, Stool culture is more sensitive than blood culture and in severely ill patients, blood culture was required.
Keywords: Acute Diarrhea, Stool Culture, Blood Culture.
INTRODUCTION
Diarrheal disease is a major public health concern
diagnosis of acute diarrheal disease and to determine
for both developed and developing countries. The
the predictors of positive cultures among those patients.
diarrheal disease continues to be a significant cause of
morbidity and mortality worldwide. Acute diarrhea is a
SUBJECTS AND METHODS
leading cause of child mortality in developing
This is a prospective study (cohort study)
countries, accounting for 1.5-2 million deaths in
targeting all cases of acute bacterial diarrhea of either
children under five years (1).
sex with age between 6months to 5 years attending Al-
Acute diarrhea is defined as the production of
Azhar Assiut University Hospital, starting from May
three or more watery stools a day for less than 14 days.
2018 until May 2019. All patients underwent a detailed
The main cause of acute diarrhea in children is
history taking including Personal history present
infectious organisms, including viruses, bacteria, and
history in the form of :the duration of diarrhea
parasites (1, 2). Along with improvements in living
,description of stools (frequency, amount, presence of
standards and health conditions, the incidence of
blood or mucus),fever (duration, magnitude),vomiting
parasite infections has decreased, with viruses and
(onset, amount and frequency), the amount and type of
bacteria now being predominantly responsible for acute
solid and liquid oral intake, clinical symptoms of
diarrhea in children (1, 2). Human rotavirus is a major
dehydration should be evaluated: urine output (amount
causative agent of diarrhea in children, especially in
and color of urine), whether the child is active, whether
those <5 years of age. However, the etiology of
the child drinks vigorously, and the date and value of
bacteria causing diarrhea appears to differ depending
the most recent weight measurement , Past history to
on the geographical area(2). The most dangerous
identify comorbidities that might increase the risk or
symptom of infectious diarrhea is dehydration, which is
severity of acute gastroenteritis and Family history
the direct cause of much diarrheal death. The American
examination
was
done
either
general
College of Gastroenterology recommends a routine
examination for general appearance (activity, response
stool culture for a patient who presents with any of the
to stimulation) , respiratory pattern ,eye (sunken or
following symptoms: severe or persistent diarrhea, a
not),Skin turgor is assessed by pinching a small skin
temperature of 38.5°C, bloody diarrhea, or the presence
fold on the lateral abdominal wall at the level of the
of stool leukocytes, lactoferrin, or occult blood and
umbilicus, Mucous membrane moisture level, presence
recommends blood culture in severely ill patients,
of tears and extremity temperature should be assessed
immunocompromised patients, and diarrhea with
Investigations were done e.g.: Complete Blood
severe comorbidities.
Count, C- Reactive Protein, Electrolytes (Na, K& Ca),
This work aims to investigate the difference
Kidney function test (urea & creatinine) Stool
between the role of stool and blood cultures in the
specimens were examined for mucus, blood and blood
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e (http://creativecommons.org/licenses/by/4.0/)
9221
Received:21 /7 /2020
Accepted:20 /9 /2020
c:\work\Jor\vol816_6
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2133-2138
Prevalence of HCV, HBV and HIV in Institutionalized
Mental Illness Patients at Aswan Governorate
Atef Mohammed Mahmmoud*, Mohammed Bastawy, Sherif Ali Abdel-Aziz, Abd-Allha Mustafa Jafer
Department of Hepatogastroentrology and Infectious Diseases, Faculty of Medicine, Al-Azhar University, Egypt
*Corresponding author: Atef Mohammed Mahmmoud, Mobile: (+20) 01066302454, E-Mail: dratef @yahoo.com
ABSTRACT
Background: HIV, hepatitis B, and hepatitis C are serious infections, but can be treated. The prognosis is much
improved by earlier detection and treatment. Prevalence studies have shown that serious mental illness is a risk factor
for blood-borne virus infection.
Objective: To evaluate the prevalence of blood-borne viral infection in people with psychological disorders attending
Aswan Governate.
Patients and methods: This across sectional study included 180 patients (150 male, 30 female) with moderate to
severe mental illness from the attendants of the Outpatient Clinic of Psychiatric Department, Neuro-Psychiatric
Hospital, Aswan Governorate. The study was conducted in the period from May 2019 to November 2019. The
etiological diagnosis of the studied group were schizophrenia (males=64, females=9), depression (males=30,
females=9) and general anxiety disorder (males=16, females=6).
Results: As regard HCV Abs, 157 patients (87.2%) were negative and 23 patients (12.8%) were positive in the
studied patients. As regards HBs Ag, there were 162 negative patients (90%) and 18 positive patients (10%) in the
studied patients. As regards HIV Abs, there were 170 negative patients (94.4%) and 10 positive patients (5.6%) in
the studied patients. There was no statistical significant relation between sex and virology markers in all studied
patients (p-value > 0.05).
Conclusion: People with serious mental illness are at risk of blood-borne viral infections. Serious mental illness is
unlikely to be a sole risk factor and risk of blood-borne viral infection is probably multifactorial and is associated
with low socioeconomic status, drug and alcohol misuse, ethnic origin, and sex.
Keywords: Depression, general anxiety disorder, Hepatitis B, Hepatitis C, mental illness and schizophrenia.
INTRODUCTION
Hepatitis C virus (HCV) infection is a major
largely neglected sexual health. Failure to address this
public health burden in Egypt, which has the highest
deficiency can lead to increased morbidity and mortality
prevalence rate in the world. The prevalence of mental
from undetected and untreated infections (4). We aimed
illness in patients with hepatitis C virus infection is
to evaluate the prevalence of blood-borne viral infection
higher than those in the general population, and the
in people with psychological disorders attending Aswan
prevalence of viral hepatitis infection in patients with
Governate.
severe mental illness may reach nine times that of the
general population (1).
PATIENTS AND METHODS
Hepatitis C is the 10th leading cause of death
This across sectional study included 180
worldwide. However, viral hepatitis is a major public
patients (150 male, 30 female) with moderate to severe
health threat in Egypt, but little is known about the
mental illness from the attendants of the Outpatient
epidemiology of hepatitis B (HBV). The prevalence of
Clinic of Psychiatric Department, Neuro-Psychiatric
hepatitis B virus among adults between the ages of 15
Hospital, Aswan Governorate. The study was conducted
and 59 in Egypt is 1.4%, but despite the exceptionally
in the period from May 2019 to November 2019. The
high prevalence of hepatitis C virus, the rate of infection
etiological diagnosis of the studied group were
with hepatitis B-HCV is 0.06% and the geographical
schizophrenia (males=64, females=9), depression
distribution varies significantly (2).
(males=30, females=9) and general anxiety disorder
Psychological reactions among hepatitis B
(males=16, females=6).
patients differ widely and influence their decision about
treatment and follow-up of the disease. Moreover,
Our study was subjected to: Patients with
psychological problems are common among patients
psychological disorder were studied for their
with chronic hepatitis B virus infection, to the extent
association with HCV & HBV and HIV infection.
that anxiety and depression are much more among them
than among healthy people (3).
Inclusion criteria: · Age: more than 20 years old. · All
Although people with severe mental illness have
patients attending Outpatient Clinic should be
a high risk of contracting a blood-borne viral infection,
diagnosed with a lifetime diagnosis of a serious mental
mental health researchers and policymakers have
illness.
This article is an open access article distributed under the terms and conditions of the Creative
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2133
Received: 20/7/2020
Accepted: 19/9/2020
c:\work\Jor\vol816_7
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2139-2145
Assessment of Body Composition in Patients with Multiple Sclerosis:
Institutional-Based Cross-Sectional Study
Nearmeen M. Rashad1, Waleed M. Reda Ashour2, Azza H. Abd El-Fatah1
Departments 1Internal Medicine and 2Neurology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
* Corresponding author: Nearmeen M. Rashad, Mobile: (+20)1224248642
ABSTRACT
Background: Multiple sclerosis (MS) is the most common progressive neurologic disease all over the world. MS
is an immune-mediated disease and there is contradictory data regarding cardiovascular morbidity and mortality
risk factors in MS patients.
Objective: To assess the body composition in MS patients, and to explore the associations of anthropometric
indices and metabolic risk factors with the phenotypic features of MS.
Patients and Methods: a cross-sectional study included 150 patients fulfilling the diagnostic criteria for MS
according to the revised McDonald's criteria 2010, and 145 age and sex-matched healthy controls. Fat mass index
(FMI) and free fat mass index (FFMI) were assessed by dual-energy X-Ray absorptiometry (DEXA).
Results: This study was conducted on MS patients with phenotypes; RRMS (82%) and SPMS (18%). our results
revealed that the distribution of body composition among MS patients was 30 %, overweight was 48% and lean was
22%. Also, MS patients had significantly higher values of systolic and diastolic blood pressure as well as
dyslipidemia, obesity indices, and hs-CRP compared to the control group, P-value < 0.001. Interestingly, there were
significantly higher values of the expanded disability status scale (EDSS), dyslipidemia, obesity indices, and
hypertension in the obese group compared to other groups.
Conclusions: MS patients had higher values of dyslipidemia and obesity indices than control groups. Among MS,
the prevalence of overweight patients was higher than lean and obese MS patients.
Keywords: Multiple sclerosis, Body composition, EDSS, FMI
INTRODUCTION
Obesity contributes significantly to the development
Multiple sclerosis (MS) is a chronic central
and progression of MS which is believed to be
nervous system disease with inflammatory and
mediated by vitamin D deficiency, inflammation, and
neurodegenerative components. The course of MS is
metabolic syndrome (12). In MS and associated
variable and most MS patients initially present with a
disabilities, despite remarkable advances in the insight
relapsing-remitting course defined by the acute onset
into the responsible mechanisms, the etiology remains
of focal neurologic deficits and focal inflammatory
unknown, the current explorative study was designed
changes. The immunopathological changes include
to assess the body composition in MS patients, and to
inflammatory demyelinating lesions in the optic
explore the associations of anthropometric indices and
nerves, brain, and spinal cord (1), in addition to
metabolic risk factors with the phenotypic features of
neurodegeneration lesions (2). According to the patterns
MS.
of cognitive or physical impairment progression:
relapsing-remitting MS (RRMS), primary-progressive
PATIENTS AND METHODS
MS (PPMS), secondary-progressive MS (SPMS), or
One hundred apparent healthy control subjects
progressive-relapsing MS (PRMS) (3).
and 150 consecutive patients fulfilling the diagnostic
The prevalence of obesity is rapidly increasing
criteria for MS according to the revised McDonald's
worldwide, According to The World Health
criteria 2010 (13) were consecutively enrolled to
Organization (WHO) about 500 million adults are
participate in a cross-sectional study. Patients were
obese, and 1.5 billion adults are overweight, the
recruited from outpatient clinics of the Neurology and
majority of which in developing countries (4). Obesity
Internal Medicine Departments of Zagazig University.
also has been raised as a risk factor for MS. (5).
Both cases and controls were matched for age, gender,
Growing evidence highlights the link of systemic-
and BMI. The MS patients either with RRMS or
obesity inflammatory changes with the MS disease
SPMS. Expanded Disability Status Scale (EDSS) (14) of
process, particularly in obesity during childhood (6).
these patients is <5. Patients with RRMS were being in
Interesting studies reported that obesity was also
the remission period (at least 2 months after the last
associated with higher levels of C-reactive protein,
relapse). The enrolled MS were divided according to
interleukin-6, and leptin levels (7,8), thus they concluded
body mass index (BMI) to lean, overweight and obese
that a proinflammatory state may affect MS
subgroups.
pathogenesis. Interestingly, serum levels of several
All subjects were subjected to thorough
adipokines, including leptin, adiponectin, and resistin
history taking, complete general including an
(9), and gut microbiota. are associated with MS (10, 11).
anthropometric and neurological examination.
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2139
Received:18 /6 /2020
Accepted:19 /8 /2020
c:\work\Jor\vol816_8
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2146-2151
Correlation between Site of Placenta and Umbilical Cord Hematocrit Value
Anwar Ezzat Ismail, Amal Mohamed El-Anwar,
Waleed Mohammed Etman, Amany Mohamed Taha Emara*
Department of Obstetrics and Gynecology, Faculty of Medicine Zagazig University,
Faculty of Medicine, Egypt
*Corresponding Author: Amany Mohamed Taha Emara, Tel : +201210901265, Email: dr.amany_emara@yahoo.com
ABSTRACT
Background: Placenta Previa (PP) is characterized as the unusual implantation of placental tissue over or adjoining the
inside cervical os. The commonness of PP is at around 5 for every 1000 pregnancies. It represents roughly 20% of all
antepartum drain, front PP was seen as related with unfavorable maternal results including over the top blood
misfortune, gigantic transfusion, placenta accreta and hysterectomy. Objective: The purpose of our study was to decide
the connection between the site of placenta in pregnant women and the hematocrit (Hct) estimation of umbilical cord
blood (CB) of the newborn. Patient and method: This case-control study was carried out at Obstetrics and Gynecology
Department, Zagazig University Hospitals and El-Menshawy General Hospital in Tanta during the period from May
2018 to May 2019. The study included 32 pregnant women with various placental site. They were classified into two
groups; group 1: women determined to have placenta previa as front or back placenta previa. Group II: women without
placenta previa at a similar gestational age as (bunch II). Placenta position was classified as foremost, back and fundal
placenta. Results: there was high huge distinction between hemoglobin levels when activity in the placenta previa
gathering. Additionally, there was high distinction between the placenta previa gathering and the control group in
respect to fetal haematocrit esteem, which was higher among placenta previa gathering. Regarding fetal hematocrit and
placenta site, our examination demonstrated that there was high solid critical connection between the placental site and
haematocrit esteem. Conclusion: Placental area can decide pregnancy outcome.
Keywords: Placenta, Placenta Previa (PP), hematocrit, neonate.
INTRODUCTION
sickliness (3). Together with pre-term birth, neonatal iron
The placenta is a mateno-fetal organ, which starts
deficiency is a central point of the 48% danger of
creating at implantation of the blastocyte and is conveyed
perinatal mortality in placenta previa patients (3).
with the baby during childbirth. As the baby depends on
The newborns hematological parameters are not
the placenta for sustenance. Yet numerous other
quite the same as those of newborn children or grown-ups,
formatively basic capacities, the right advancement of the
including contrasts as indicated by the course of birth,
placenta is imperative to address embryonic and fetal
rope cinching time, blood tests (umbilical CB, venous
improvement. To help support and keep up the pregnancy,
blood, slim blood) withdrawn at 2, 12 or 24 hours after
the placenta should quickly grow at the same time with
birth, healthful fetal conditions, and Hct estimation
the fetus. The placenta is a transient organ which creates
technique. Critical changes occur in the hematocrit from
from the trophectoderm of the embedding blastocyst.
birth through the principal long stretches of postnatal life.
Maternal blood streams into the placental intervillous
It rises not long after birth, topping at 2 hours of age, and
space, where solutes (supplements, oxygen) diffuse over
diminishes bit by bit after that. An expanded hematocrit
the shipping epithelium to the fetal flow, while fetal
(Hct) is related with hyper-thickness of blood and
metabolic waste items are expelled through the partition
diminished blood stream to crucial tissues, particularly
of courses controls solute transport and shield the baby
when the hematocrit increments to over 60% (4). This
from poisons. However, it shields the embryo from the
study aimed to decide the connection between the site of
maternal insusceptible framework. The placenta controls
placenta in pregnant ladies and the hematocrit (Hct)
maternal physiology through the generation of hormones:
estimation of umbilical rope blood (CB) of the hatchling.
human chorionic gonadotropin (hCG), human placental
lactogen (hPL), estrogen and progesterone (1).
PATIENT AND METHODS
Placenta previa (PP) is characterized as the unusual
This case-control study was carried out at Obstetrics
implantation of placental tissue over or adjoining the
and Gynecology Department, Zagazig University
inside cervical os. The commonness of PP is at around 5
Hospitals and El-Menshawy General Hospital in Tanta
for every 1000 pregnancies and it represents roughly 20%
during the period from May 2018 to May 2019. Including
of all antepartum drain. Front PP was seen as related with
32 pregnant women with various placental site.
unfavorable maternal results including over the top blood
Ethical approval: The study was approved by the
misfortune, gigantic transfusion, placenta accreta and
Research Ethics Committee of the Faculty of
hysterectomy (2). 10% of all newborn children brought into
Medicine, Zagazig University. Written informed consent
the world after placenta previa are presented with extreme
was obtained from each patient. The work was conducted
pallor. Furthermore, placenta previa is the most widely
for research involving humans according to the Code of
recognized placental irregularity causing neonatal
This article is an open access article distributed under the terms and conditions of th
e
Creative
Commons Attribution (CC BY-SA)
license (http://creativecommons.org/licenses/by/4.0/)
6412
Received:19 /6 /2020
Accepted:20 /8 /2020
c:\work\Jor\vol816_9
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2152-2159
Prevalence of Polycystic Ovarian Syndrome in Young Adult Unmarried Females
Attending Zagazig University Hospital Outpatient Clinic
Soha Galal Siam, Badeea Seliem Soliman, Mohammed Ramadan Ali, Omnia Abdallah Mohamed Abdallah*
Department Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
*Corresponding Author: Omnia Abdallah Mohamed Abdallah, Mobile: 01095967944, Email: abdallahomnia37@gmail.com
ABSTRACT
Background: Polycystic ovary syndrome (PCOS) is one of the most prevalent endocrine and metabolic disorders in
women of childbearing age.
Objective: To determine the frequency of Polycystic ovarian syndrome (PCOS) among young unmarried females to
increase awareness of PCOS and to promote effective early medical interventions and healthy lives for women.
Methods: This was a prospective cross-sectional study in which 180 unmarried females between 16 to 24 years old
attending gynecology and dermatology outpatient clinic suffering from menstrual abnormalities or symptoms of
hyperandrogenism to estimate the prevalence rate of polycystic ovarian syndrome from May to November 2018.
According to diagnostic criteria of the NIH, Rotterdam, and the AE-PCOS. Menstrual irregularities (MI) were identified,
and clinical hyperandrogenism was evaluated by self-assessment of hirsutism using the modified FerrimanGallwey
score. Blood analysis was done for measurement of prolactin, thyroid-stimulating hormone, and androgen hormones.
Results: This study revealed Prevalence rate of PCOS is 55.6% among all presented cases, oligomenorrhea, acne, and
hirsutism were the most common complaint in this study. Also, this study showed that there is an association between
PCOS and sedentary life, and unhealthy food habits. There was a significant difference between PCOS and non-PCOS
in LH and prolactin levels. There is a disturbed LH \FSH ratio (2:1 or more). It also shows that there was a significant
difference between PCOS and non-PCOS in ovarian volume.
Conclusions: Lifestyle modification as healthy food and exercise play important role in the prevention of PCOS.
Keywords: Polycystic Ovary Syndrome (PCOS), Hyperandrogenism (HA), Hirsutism, Menstrual Irregularities (MI).
INTRODUCTION
Polycystic ovarian syndrome (PCOS), also
PCOS is a heterogeneous disorder. There is a
known as Stein-Leventhal syndrome, is a frequently
wide range in the age of manifestation and
occurring metabolic and reproductive endocrinopathy.
symptomatology. Recent trends of sedentary lifestyle,
Prevalence in the reproductive age group is reported in
carbohydrate, and fat-rich foods predispose adolescent
various studies as 5-20% (1). Young women with PCOS
girls to weight gain and high BMI.
mainly present with reproductive problems such as
As a consequence, of these lifestyle changes,
hyperandrogenism, menstrual irregularities, infertility,
there is an increased risk of PCOS, including hormonal
and chronic anovulation. Infertility increases 10 folds in
imbalance, menstrual problems, infertility, and altered
women with PCOS and affects up to 40% (2).
pregnancy outcome in these women.
PCOS reduces fertility due to associated
PCOS has a high prevalence in infertile women.
endocrine, metabolic and gynecological abnormalities
Apart from its impact on reproductive outcome, PCOS
that impact the quality and function of the ovary.
also presents with delayed manifestations which have
Derangements in factors involved in normal follicular
many potential metabolic and cardiovascular risks if not
development lead to the arrest of follicular growth as the
managed appropriately. Lifestyle modification at early
follicles reach a diameter of 4-8 mm, the dominant
age, counseling of the parents, better knowledge and
follicle does not develop, and ovulation does not ensue.
attitude of women towards PCOS are crucial in
Increased insulin resistance which causes an increased
improving the quality of life in women with PCOS (6).
LH/FSH ratio and decreased SHBG leads to
PCOS women present with a constellation of
hyperandrogenism. Studies have also reported poor
symptoms which significantly impacts the quality of
pregnancy outcomes in these women (3).
life. These women are at higher risk for various
There is no single definitive test to diagnose
morbidities such as obesity, insulin resistance, type II
PCOS, however, three different guidelines, National
diabetes mellitus, cardiovascular disease (CVD),
institute of health criteria (NIH), Androgen excess-
infertility, malignancy, and psychological disorders (7).
PCOS society of India criteria (AE-PCOS), or
This study aimed to determine the frequency of
Rotterdam criteria can be followed (4). Insulin resistance
Polycystic ovarian syndrome (PCOS) among young
and obesity are considered intrinsic to PCOS but neither
unmarried females to increase awareness of PCOS and
of them is included in the guidelines and should
to promote effective early medical interventions and
therefore be used for diagnostic purposes (5).
healthy lives for women.
Despite its high prevalence and implications on
reproductive health, PCOS is underdiagnosed (6).
This article is an open access article distributed under the terms and conditions of the Creative
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2152
Received:19 /6 /2020
Accepted:20 /8 /2020
c:\work\Jor\vol816_10
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2160-2164
The role of Therapeutic Repetitive Transcranial Magnetic Stimulation in
Treatment of Sleep Disorders in Parkinson's disease Patients
Eman Mohamed Khedr1, Suzan Salama Sayed2, Abeer Abd El Hady Tony3, Rana Gamal Abd El Shakour*3
Departments of 1Neurology and 2Chest Diseases, Faculty of Medicine - Assuit University
Departments of 3Neurology, Faculty of Medicine - Aswan University
*Corresponding author: Rana Gamal Abd El Shakour, Mobile: (+20) 01127427819, E-Mail: ranasholok2020.rg@gmail.com
Abstract
Background: Parkinson's disease (PD) is the most common movement disorder and represents the second most
common degenerative disease of the central nervous system.
Objective: To measure the effect of repetitive transcranial magnetic stimulation (rTMS) as therapeutic treatment on
sleep disorders in patients with Parkinson's disease (PD).
Patients and methods: This double-blinded study included 20 PD patients (10 received real rTMs and 10 received
sham rTMs) patients recruited from Inpatient and Outpatient Clinic of Neuropsychiatric Department of Aswan
University Hospital. Our patients were divided into 2 groups (10 patients each). Results: As regards the effect of
rTMs on PDSS and sleep latency, our study results found no significant change in Parkinson disease sleep scale
between both groups but there was significant change in sleep latency that it decreased in the group received real
rTMS in comparison with the SHAM group. In addition, there were significant changes in wake stage and rapid eye
movement stage that both decreased in response to rTMS while there was no significant changes in non-rapid eye
movement stage. Awakening after being asleep on both studied groups showing significant decrease in wake after
sleep onset and wake after persistent sleep as both of them decrease wit rTMS. Conclusion: The main finding of
this study was that 10 sessions of 20Hz rTMS applied over both parietal area improved the subjective as well as the
objective sleep quality as reflected by a decrease of frequency in arousal from sleep and in Non-REM1 stage sleep.
Keywords: Parkinson's disease, Transcranial Magnetic Stimulation, Sleep Disorders.
INTRODUCTION
improvement of sleep quality after the stimulation over
Complaints of disordered sleep are reported in 60
parietal cortex was explained by documented
to 98% of Parkinson's disease (PD) patients, being one
involvement of this area in sleep regulating processes.
of the most frequent non-motor symptoms and
The stimulation of PMC may improve sleep as an
contributing significantly to the decreased quality of
outcome of the alleviation of motor symptoms (7).
life in PD. PD patients suffer mostly from impaired
Transcranial magnetic stimulation (TMS), a tool
sleep maintenance and increased sleep fragmentation
for noninvasive magnetic stimulation of the cerebral
(1).
cortex (4), is used as an experimental non
The pathophysiology of sleep disorders in PD
pharmacological therapy in PD with variable effects on
patients has not been fully elucidated. A primary factor
motor symptoms in PD patients (8). In healthy
is degeneration of central sleep regulation centres in the
participants, rTMS can affect sleep structure both when
brainstem (2). Sleep disorders in PD may also be
applied during sleep and prior to sleep (9). In spite of the
secondary to dopaminergic medication, nocturnal
high prevalence of sleep disorders in PD patients, the
akinesia and non-motor symptoms such as depression
effect of rTMS on sleep in PD patients has not
and restless legs syndrome (3). Recent evidence
previously been studied objectively.
suggests that also dopaminergic dysfunction in the
In the recent years, there is an increasing interest
hypothalamus, whether disease or medication-related,
in application of rTMS in the treatment of patients with
contributes to sleep disorders in PD (4).
insomnia, and it seems that rTMS might have the
The effect on sleep was investigated with a self-
potential to improve sleep (10), but negative results were
assessment scale by Khedr et al. (5) who found
also reported (11).
improvement after the stimulation applied over primary
The aim of the work was to measure the effect of
motor cortex (PMC). Another study reported objective
rTMS as therapeutic treatment on sleep disorders in
improvement of patients' sleep profile after the
patients with PD.
stimulation over parietal cortex but not over PMC (6).
However in that study sleep was recorded with
PATIENTS AND METHODS
actigraphy, a diagnostic tool considered to be less
This double-blinded study included 20 PD patients
sensitive than nocturnal polysomnography (PSG),
started and the 20 PD (10 real, 10 sham) patients that
especially in determining the percentage of particular
were recruited from Inpatient and Outpatient Clinic of
sleep stages, occurrence of EEG arousals and the
Neuropsychiatric Department of Aswan University
presence of sleep-related breathing disorders. The
Hospital completed the study.
This article is an open access article distributed under the terms and conditions of th
e Creative
Commons Attribution (CC BY-SA)
license (http://creativecommons.org/licenses/by/4.0/)
0612
Received:22 /7 /2020
Accepted:21 /9 /2020
c:\work\Jor\vol816_11
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2165-2172
A Study of Vitamin D Supplementation to Patients with Chronic Diseases
Admitted to Ain Shams University Hospital
Ahmed Mohamed Bahaa El Din, Raef Malak Botros, Mariam Michel Ayad Grace, Hany Khairy Mansour*
Department of Internal Medicine and Endocrinology, Faculty of Medicine Ain Shams University
*Corresponding author: Hany Khairy Mansour, Mobile: (+20) 01221167449, Email: hanyemad@med.asu.edu.eg
ABSTRACT
Background: Vitamin D deficiency and insufficiency have become a common problem worldwide. Vitamin D has
been associated with all causes of mortality in chronic diseases which are significantly associated with a longer
hospital stay and poor outcome.
Objectives: We aimed to investigate the role of empirical vitamin D supplementation in hospitalized patients and
its relation to the length of stay and outcome of hospitalization.
Study design: Case control study performed on eighty patients admitted to Internal Medicine Department at Ain
Shams University Hospital, with acute deterioration of their chronic illness. Two groups of diseases were included,
chronic liver diseases (CLD) and congestive heart failure (CHF).
Methods: Twenty patients of each group were given vitamin D 200,000 IU IM within 3 days of admission
(Intervention group) and 20 patients of each group (control group) did not receive vitamin D. Patients were sampled
for their vitamin D, calcium and phosphorus levels on admission prior to intervention.
Results: CLD and CHF Intervention groups had a non-significant correlation between vitamin D supplementation
with length of hospital stay and mortality in comparison with control groups (P =1.000) (p=0.823) respectively. On
the other hand, we found baseline vitamin D deficiency was an independent predictor of mortality (P value .018).
Conclusions: Vitamin D deficiency is significantly associated with longer hospital stay and poor outcome of
hospital admission. Beneficial effect of empirical vitamin D supplementation can't be achieved with single dose
vitamin D (200,000 IU) on CHF and CLD hospitalized patients.
Keywords: CHF, CLD, Vitamin D supplementation.
INTRODUCTION
short and long term all cause patient mortality and
Vitamin D is the sunshine vitamin. During
blood culture positivity in a critically ill patient
exposure to sunlight 7-dehydrocholesterol in the skin
population(5).
absorbs ultraviolet B radiation converting it to
previtamin
D3.
Previtamin
D3
being
AIM OF STUDY
thermodynamically unstable isomerizes within a few
To study the effect of vitamin D supplementation
hours to form vitamin D3(1). Humans get vitamin D
on the outcome of hospitalization for patient with CLD
from exposure to sunlight, from their diet, and from
patients with CHF, admitted to Ain Shams University
dietary supplementation(2). Research carried out during
Hospitals with acute deterioration of their illness.
the past two-decades extended the understanding of
actions of vitamin D, from regulating calcium and
PATIENTS AND METHODS
phosphate absorption and bone metabolism to many
pleiotropic actions in organs and tissues in the body.
Patients:
Most observational and ecological studies report
This case control study included 80 patients with
association of higher serum 25-hydroxyvitamin D
acute deterioration of their illness namely CLD and
(25(OH)D) concentrations with improved outcomes
CHF and sub-grouped as follows:
for several chronic, communicable and non-
Group 1: 40 patients suffering from chronic liver
communicable diseases(3).
diseases (most of them were child C on Child-
Vitamin D deficiency is a common problem
Pugh score).
among Egyptian adolescent girls, for whom
Group 1a: intervention group (20 patients of
contributing factors include inadequate sun exposure
CLD).
due to social/cultural factors and insufficient dietary
Group1b: control group 20 patients of CLD
calcium(4). Vitamin D deficiency is rarely considered
(control group).
or treated in critically ill patients, however, recently
Group 2: 40 patients suffering from
reported three cases of life-threatening hypocalcemia
decompensated heart failure (most of patients with
secondary to vitamin D deficiency, highlighting
ejection
fraction
<40%
diagnosed
by
potential acute complications. Deficiency of 25(OH) D
echocardiogram).
prior to hospital admission is a significant predictor of
Group 2a: intervention group 20 patients of CHD.
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Commons Attribution (CC BY-SA)
license (http://creativecommons.org/licenses/by/4.0/)
5612
Received:21 /7 /2020
Accepted:20 /9 /2020
c:\work\Jor\vol816_12
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2173-2178
Laparoscopy Versus Laparotomy in The Surgical Treatment of
Perforated Duodenal Ulcers
Mohamed Tag El-Din
General Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
ABSTRACT
Background: There is no clear consensus about whether laparoscopy or laparotomy is more beneficial in
managing perforations of duodenal ulcers.
Objective: The study was performed to compare between laparotomy and laparoscopic approaches in managing
perforations of duodenal ulcers regarding operative time and early operative outcomes.
Patient and methods: This randomized comparative prospective study included 84 cases diagnosed with
perforated duodenal ulcer, they were divided into two equal groups: laparotomy and laparoscopic groups (42 cases
for each). All cases were clinically and radiologically assessed. Operative time was our primary outcome, while
secondary outcomes included post-operative pain, analgesic consumption, hospitalization time, and complications
of both techniques.
Results: No significance in differences were reported between the two groups regarding patient demography. Both
smoking history and analgesic use were reported by most cases in both groups. The operative time (p = 0.082) was
not significantly different between the two groups. The laparoscopic group showed less pain scores, less morphine
needs, earlier oral fluid intake, and short hospitalization time in comparison to the laparotomy group. Also, the
wound infection incidence was significantly higher in the laparotomy group.
Conclusion: The laparoscopic approach appears to be more safe and efficacious in the surgical treatment of
perforations of duodenal ulcers, as it is associated with less peri-operative complications and shorter hospitalization
time with a comparable operation time in comparison to laparotomy.
Keywords: Perforated duodenal ulcer; Laparoscopy, Laparotomy.
INTRODUCTION
Although the modern development in the
associated with worse outcomes and prolonged
medications for peptic ulcer disease have resulted in
operative time 6, 7. Despite the previously mentioned
a great decrease in the number of elective surgeries
advantages, laparoscopy should not be used on the
for such cases 1, the number of cases requiring urgent
expense of morbidity and mortality. Hence, this study
surgery for peptic ulcer complications including
perforation and obstruction remains relatively
was conducted to compare between laparotomy and
unchanged 2. These emergency operations have a
laparoscopic approaches in the treatment of
mortality risk ranging between 6 and 30% 3.
perforations of duodenal ulcers regarding operative
Perforation can complicate up to 2 10% of cases
time and early operative outcomes.
with peptic ulcer disease 4. It should be suspected in
cases with sudden onset of severe diffuse abdominal
PATIENTS AND METHODS
pain. Duodenal ulcer perforation is characterized by a
This is a randomized comparative prospective
classic triad consisting of sudden abdominal pain,
study that was completed during the period of three
tachycardia, and abdominal rigidity 5. Multiple
years, from July 2017 till July 2020. The study
options are existing for the management of perforated
included cases diagnosed with perforated duodenal
duodenal ulcer including repair by interrupted sutures
ulcers who were admitted and operated during that
only, interrupted sutures followed by a pedicled
period in three hospitals; Al-Hussein University
omentum coverage (Cellan-Jones repair), or
Hospital, Al-Rahma, and Dar Al-Hekma Private
perforation plugging with an omental patch (Graham
Hospitals.
patch) 5.
Sample size was calculated using the IBMª SPSSª
Laparoscopy has been introduced in treating
SamplePowerª version 3.0.1 (IBMª Corp., Armonk,
peptic ulcer disease since 1990 1. The application of
NY, USA). According to the literature review, the
laparoscopy is associated with documented benefits
mean operative time in the laparoscopic group
including smaller incisions, less post-operative pain,
reported by Lunevicius and Morkevicius 8 was 76.2
better cosmesis, and better post-operative recovery
min. (S.D 35.5) versus 57.3 min. (S.D. 26.1) in the
compared to the laparotomy approach 4. However,
laparotomy group. The difference between these two
other authors have denied the superiority of
groups was used to calculate the sample size. At 95%
laparoscopy over laparotomy in managing such cases.
level of significance and power of 80%, the sample
in addition, they reported that laparoscopy was
size calculated was 42 in each group.
This article is an open access article distributed under the terms and conditions of the Creative
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2173
Received:22 /7 /2020
Accepted:21 /9 /2020
c:\work\Jor\vol816_13
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2179-2183
A Randomized-Trial Study of Corneal Collagen Cross-Linking (CXL) in
Progressive-Keratoconus (PK)
Hassan Shamselden Yousef
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
Corresponding Author: Hassan Shamselden Yousef, Phone: +201144090050; E-Mail: hassanetal@yahoo.com
ABSTRACT
Background: Keratoconus is a frequent, familiar, bilateral, non inflammatory, and gradually progressive corneal ectasia,
which leads to corneal protrusion, irregular astigmatism, and decrease vision. Currently, the corneal cross-linking (CXL)
treatment could attain vision improvement.
Aim: To investigate the topographic, refractive, and clinical-out-comes after six months CXL in gradually progressing
keratoconic eyes.
Patients & Methods: A follow-up, randomized, controlled-trial study was used. In this study, 30eyes with progressive-
keratoconus (PK) were recruited in the study. Cross-linking was done and achieved by a solution of 0.1% riboflavin
mixture with 20% dextran for 15minutes before and during 30minutes time-period of ultraviolet A (UV-A) irradiation
(3Mw\cm2). The obtained data were analysed using IBM SPSS software.
Results: Statistically significant improvements were noticed in Sim k (at 6months), Kmin (at 6months), spherical power
(at 6momths), cylinder power (at 6momths), spherical equivalent [SE] (at 6months), uncorrected visual acuity (UCVA)
(at 6months) and best corrected visual acuity [BCVA] (at 6months) in trial group (15patients) when compared with the
controls.
Conclusions: At 6months, hopeful, promising improvements were reported in Kmax, UCVA, and BCVA. So, long term
studies are requested to survey the efficiency of CXL as well as the safety of the repeated procedures.
Keywords: Corneal collagen cross-linking; Riboflavin; Epithelium-off procedure; Topographics changes; Keratoconus.
INTRODUCTION
Keratoconus
is
a
common,
bilateral,
(UV-A) radiation (370nm). Absorption of the topically
noninflammatory, and gradually progressive corneal
applied riboflavin is generaly
ectasia; leads to corneal protrusion, irregular
obstructed because of the corneal epithelial tight
astigmatism, and lowering vision(1,2). Change in the
junctions. Accordingly, the up-to-date gold-standard
collagen fibrils structural organization in the cornea is
treatment protocols use the de-epithelialization to
deemed as its fundamental features(3). In the advanced
optimize the riboflavin permeation and improve its
phases, the stroma could break leading to acute hydrops,
absorption(8). However, reaction to riboflavin
resulting in considerabe visual deteruations(4). Diagnosis
experience pharmacogenomic variation(7), and variation
of keratoconus relies on the presence of two of the three
in its efficiency is noticed in various settings(9).
standard criteria, which consists of the anterior or
Over the past-decades, the CXL treatment could
posterior surface of the corneal steeping, progressively
attain vision improvement(10-12), apical keratometry
rising of corneal stromal thinning, and corneal thickness
improvement, lowering the corneal curvature, SE
alteration in the thinnest site(1-3,5). Keratoconus is a
refraction and refractive cylinder(13,14) with boosting the
popular indication for corneal transplantation surgery(6).
contrast sensitivity (CS)(15,16).
However, corneal cross-linking (CXL) is the process,
AIM OF THE STUDY
which could abstain the keratoconus progression and as
To investigate the topographic, refractive, and
well the other corneal ectasia(7,8).
clinical-outcomes after six months CXL in gradually
In theory, CXL implentation in strengthing the
progressing keratoconic eyes.
corneal tissue is based on the concept that a proportional
pacuity of covalent bonds in and between the collagen
PATIENTS AND METHODS
matrix that leads to a weakned biomechanical firmness
Study design and setting:
of keratoconic cornea.
The present work was done using a prospective
Therefore, it's supposed that the CXL treatment
randomized-trial design, at a private eye center (the
could encourage photochemically triggered cross-links
Future Eye Center, Sohag, Upper Egypt) on 30eyes of
in the collagen-network by using a mixture of vitamin
15 patients with bilateral progressive-keratoconus (PK)
B2 (riboflavin) and a long wave-length ultraviolet A
as a study group and another 30 eyes of 15patients with
bilateral PK as a control group.
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY- SA) license (http://creativecommons.org/licenses/by/4.0/)
2179
Received:23 /7 /2020
Accepted:22 /9 /2020
c:\work\Jor\vol816_14
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2184-2194
Effect of Chronic Stress on The Testis of The Adult Male Albino Rat and
The Role of Ginger
Hadeer Abd El-Mohsen El-Naggar, Fatma El-Nabawia A. El-Safty,
Abeer E. El-mehi, Ayman Abdallah Reafie
Department of Anatomy and Embryology, Anatomy Department, Menoufia University, Menoufia, Egypt
*Corresponding author: Hadeer Abd El-Mohsen El-Naggar, Mobile: 01005537800, E-mail: hadderelnaggar@yahoo.com
ABSTRACT
Background: Infertility and its problems are one of the most vital problems that ranges from 10% to 15% among
couples. Chronic variable stress (CVS) disrupts normal homeostasis of a variety of body systems and is a major cause
of male infertility. Ginger is known to have anti-inflammatory and antioxidant properties via its free radical
scavenging activity so it can be used in various experimental models as a protective agent against various toxicants.
Objectives: The current work aimed to study the effect of chronic variable stress on the testis and the possible
protective and therapeutic roles of the ginger on this effect. Materials and Methods: thirty-five adult male albino rats
were divided into five groups. Group I; control, group II received ginger only, group III subjected to CVS, group IV
CVS + pretreated with ginger and group V CVS + post-treated with ginger. All rats were weighted, sacrificed, blood
samples collected to asses testosterone hormone, the testis was weighted to calculate gonadosomatic index and
processed for light microscopic study. Paraffin sections were stained by hematoxylin and eosin stain.
Immunohistochemical staining for PCNA, caspase-3 and androgen receptor were also performed. Results: CVS
induced decreased gonadosomatic index, testosterone hormone level, destructive effects on the testis as decreased
spermatogenic cells and sperm count, detachment of the cells, vacuolations and apoptosis. Ginger produced great
improvement of these effects which was pronounced in the protected group (IV) than the treated one (V). Conclusion:
CVS caused apoptotic changes in testis and ginger had ameliorating effects on these changes.
Keywords: CVS, testicular apoptosis, Ginger.
INTRODUCTION
of chronic variable stress on the testis of the adult male
Stress is defined as a basic or perceived threat to
albino rats and the possible protective and therapeutic
the homeostasis of an organism (1). Chronic variable
roles of the ginger on this effect.
stress (CVS) is a major problem of the modern life,
MATERIALS AND METHODS
which led to changes in endocrine and reproductive
Animals: male rats (35 animals, 200±20
functions along with the central and peripheral nervous
grams B. wt.)
obtained from... Theodor bilharz animal house, Cairo,
systems (2). Male fertility depends on the production of
Egypt and housed at room temperature and had free
a large number of spermatozoa by spermatogenesis (3).
access of diet and tap water. Strict care and hygiene
Spermatogenesis is essential for sexual reproduction.
were provided to keep them in normal and healthy
This process depends on pituitary gonadotropins,
conditions under the guidelines recommended by
follicle stimulant hormone (FSH) and luteinizing
ethical committee for animal research, Faculty of
hormone (LH) (4) as well as adequate testosterone
medicine Menoufia University.
concentrations (5). Both acute and chronic stress (6) are
able to cause disruption of male reproduction. Aside to
Experimental substances:
the increase in adrenal corticosteroids (7), chronic stress
Ginger (zingiber officinal): was obtained from Arab
induces suppression of testosterone secretion, libido
Co. for Pharmaceuticals and Medicinal Plants
and spermatogenesis in males (8), thus lowering
"MEPACO-MEDIFOOD", Egypt. It was available as
fecundity in men (9). Ginger (zingiber officinale) is one
tablets (each tablet contained 400 mg ginger extract)
of the most popular food spices known among Asian
stored at temperature not exceeding 30 Cº
and African people for long periods (10). It includes
versatile range of active constituents such as volatile
Stress method:
oils, proteolytic enzymes, vitamins, and trace elements
The cages of stressed rats were transferred to
(11). These constituents gave ginger the priority to be
another room for stress. The order of the cages being
used in many diseases as anti-inflammatory and
taken to the stressor area was random and balanced
antioxidant modulator (12). The strong antioxidant and
from day to day. The stressors were applied at the onset
protection abilities of ginger to biological tissues and
of the dark phase of the cycle to avoid circadian
cell membrane lipids against toxicity occur via free
variations of corticosterone.
radical scavenging activity in a dose dependent manner
Stress by immersion in cold water (ICW): Rats
(13). So, this increases its tendency to be used in various
were placed individually in a covered tank of cold
experimental models as a protective agent against
water (depth = 15.5 cm; temperature = 15°C), where
various toxicants (14). So, we decide to study the effect
they were either swimming or remaining in an upright
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2184
Received:20/8 /2020
Accepted: 19/9 /2020
c:\work\Jor\vol816_15
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2195-2198
Resistance Index of Uterine and Spiral Arteries as a Predictor of
Threatened Miscarriage Outcome
AlaaEdeen F. Al Halaby1, Mohamed M. Fahmy1, Hany M Khallaf2,
Mohamed S Abdullah3, Ahmed M Nofal*1
1Obstetrics and Gynecology Department, 3Radiology Department, Faculty of Medicine, Menoufia University,
Menoufia, 2Obstetrics and Gynecology Department, Al-Bajour Hospital, Menoufia
*Corresponding author: Ahmed Mohammed Nofal, Mobile: +201092678240, E-Mail: nofal3030@gmail.com
ABSTRACT
Background: Miscarriage is a common event in the first half of pregnancy. Improvements in
Ultrasound and Doppler technology, have led to a better understanding of early pregnancy development.
Such a facility may be used in turn to predict pregnancy outcome in threatened miscarriage.
Objective: To assess the ability of the Uterine artery RI and Spiral artery RI to predict outcome in cases
of Threatened miscarriage
Patients and methods: Prospective observational study was conducted in the Department of Obstetrics and
Gynecology at Menoufia University Hospital. The study included 90 women with gestational age between 5 13 w.
divided into three groups; Group (A): involved (30) women diagnosed with threatened miscarriage and was followed
up and got aborted before pregnancy completed 24weeks. Group (B): (30) women diagnosed with threatened
miscarriage and were followed up and the pregnancy continued till 24weeks. Group (C): 30 women having singleton
normal ongoing pregnancy till 24 weeks of gestation as a control group.
Results: In this study, the Doppler study of uterine arteries the subchorionic blood flow revealed that (RI) was
significantly higher in the miscarried group than both continued and control groups.
Conclusion: Uterine artery RI and Subchorionic blood flow RI can predict the fate of pregnancy in cases with
threatened miscarriage with high accuracy.
Keywords: Threatened miscarriage, Doppler, Uterine artery, Spiral artery.
INTRODUCTION
Obstetrics and Gynecology at Menoufia University
Threatened miscarriage is extremely common
Hospital after obtaining approval from the Ethics
as one fourth or fifth of women experiencing vaginal
spotting or bleeding during early pregnancy (1).
Committee for Human Research of the Faculty of
Some parameters are considered as prognostic
Medicine and obtaining written informed consent from
factors such as the morphological characteristics of the
the participating women.
yolk sac, adequate visualization of the embryo by
The study was conducted from April 2018 till
transvaginal ultrasound, and changes in fetal heart rate
July 2019. The study included three groups of women
(2). The introduction of Doppler in obstetrics allowed
(A): involved (30) women diagnosed with threatened
the evaluation of hemodynamic characteristics at the
miscarriage and was followed up and got aborted
first trimester of pregnancy (3).
before pregnancy completed 24weeks.
The
measures
obtained
by
Doppler
Group (B): involved (30) women diagnosed
ultrasonography that may have prognostic value to the
with threatened miscarriage and were followed up their
evolution of pregnancy include uteroplacental blood
pregnancy completed 24weeks.
flow also known as trophoblastic flow. Jaffe et al.
Group (C): involved 30 women having a
reported that abnormal Doppler findings were
singleton normal ongoing pregnancy till 24 weeks of
associated with a significantly higher prevalence of
gestation as a control group. Criteria of selected cases
complicated pregnancies (4).
are including women with a singleton pregnancy
Recently it has been reported that the abnormal
between the 5th to 13th week of gestation and having
resistance of the uterine artery could be useful in the
normal ongoing pregnancy (Group c) or diagnosed with
prediction of recurrent fetal loss (5).
threatened miscarriage (Group B and A) after
Objective: The study aimed to assess the ability of the
documentation of embryonic cardiac pulsation. While
uterine artery RI and spiral artery RI to predict outcome
patients excluded from the study with any of the
in cases of Threatened miscarriage.
following criteria: women with multiple pregnancies,
recurrent miscarriage (2 or more) ectopic pregnancy,
PATIENTS AND METHODS
molar pregnancy, maternal history of systemic diseases
This prospective observational study was
(Diabetes Mellitus, Hypertension, vasculopathy) or
conducted on 90 women in the Department of
uterine anatomical abnormalities and women receiving
medications such as aspirin and heparin. as well as
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2195
Received:23 /7 /2020
Accepted:22 /8 /2020
c:\work\Jor\vol816_16
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2199-2204
The Omentopexy Role in The Prevention of Post-Operative Gastric
Sleeve Surgery Complications
Mohamed Fathy Labib
General Surgery Department, Faculty of Medicine, Al-Azhar university, Cairo, Egypt.
ABSTRACT
Background: Currently, there is still a debate about the omentopexy preventive mechanism of sleeve gastrectomy
complications. The current study was conducted to evaluate the omentopexy role on the early outcomes after
laparoscopic gastric sleeve surgery.
Patients and methods: This prospective randomized study included a total number 172 cases, divided equally into
two groups (86 cases for each); the omentopexy (sleeve gastrectomy with omentopexy) and control groups (sleeve
gastrectomy only). All cases were subjected for complete pre-operative assessment. Post-operative complications
including leakage, bleeding, vomiting, reflux symptoms, and gastric volvulus were recorded.
Results: patient characteristics including age, sex or comorbidities did not significantly differ between both groups.
However, the duration of operation showed significant prolongation in the omentopexy group (78.33 vs. 62.47
minutes in controls). No difference was significantly noted between both groups regarding posto-perative
complications, apart from gastric twist that was not encountered in our study. Despite that, these complications
showed a slight increase in controls. The duration of hospitalization did not differ significantly between the study
groups (median = 1 day).
Conclusion: Omentopexy did not have a significant different impact on the prevention of post-sleeve gastrectomy
complications although it is associated with longer operative time. However, it may serve as an extra guard against
leakage, bleeding, vomiting, and GERD, manifested by the decreased incidence of these complications with that
technique.
Keywords: Sleeve gastrectomy; Omentopexy; Leakage; Bleeding.
INTRODUCTION
line after creating the gastric tube 8. Multiple studies
Morbid obesity represents a growing health problem
have reported the positive impact of omentopexy in
for both developed and developing countries, as it has
decreasing post-operative volvulus 12, leakage 13,
serious social, financial, and health consequences. That
bleeding 14, and reflux symptoms 15. However, it was
makes obesity one of the major priorities of the World
associated with minimal prolongation of the operative
Health Organization (WHO) 1. In Egypt, the prevalence
time 14.
of obesity has been increased significantly, as more
In the current literature, there is a paucity of
than one third of the whole Egyptian population are
prospective trials evaluating the role of omentopexy in
obese 2. Nowadays, obesity surgery is the proven and
sleeve gastrectomy procedure. Therefore, this current
effective long-term method for achieving weight loss
study was conducted aiming to evaluate the
in such cases 3. Laparoscopic gastric sleeve surgery has
omentopexy role on the early outcomes after
gained a great popularity as a safe and efficacious
laparoscopic sleeve gastrectomy.
bariatric procedure that could achieve satisfactory post-
operative outcomes 4. Moreover, sleeve gastrectomy
PATIENTS AND METHODS
has a relatively easier learning curve compared to other
This is a prospective randomized study that
obesity
surgeries
like
gastric
bypass
and
was completed between June 2018 and June 2020 for
biliopancreatic diversion 5. Nevertheless, gastric sleeve
patients diagnosed with obesity and prepared for
surgery has its own dreadful complications including
laparoscopic gastric sleeve surgery. The current study
staple line leakage, bleeding, and stenosis 6, 7.
included cases who presented to the outpatient clinic of
Multiple options are existing for staple line
Al-Hussein University Hospital, Bedaiat and Al Gabry
enforcement including oversewing, buttressing, and
private hospitals.
glue-type hemostatic agents 8. Although some surgeons
The required sample size was calculated
believe that reinforcement does not add any significant
using the IBMª SPSSª Sample Powerª version 3.0.1
advantages to the procedure 9, previous meta-analyses
(IBMª Corp., Armonk, NY, USA). Based on literature
reported that reinforcement decrease efficiently the
review, the incidence of postoperative leakage in the
incidence of posto-perative complications like bleeding
group of cases with no omentopexy in the study
and others 10, 11.
conducted by Sabry and Qassem 16 was 0.9% versus
Omentopexy is still a controversial technique, that
0% of cases in the omentopexy group. A total number
involves fixation of the greater omentum to the stable
of 172 patients (86 in each group) was required with
95% level of significance and power of 80%.
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2199
Received:22 /7 /2020
Accepted:21 /8 /2020
c:\work\Jor\vol816_17
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2205-2210
Endoscopic Verses Conventional Septoplasty in the Treatment of
Deviated Nasal Septum
Mohamed O.A. Gad1, Mostafa Othman Ramadan Salama1, Mostafa Mahrous Mahmoud*1,
Reham AE Ibrahim2
Department of 1Otolaryngology and 2Phoniatrics, Faculty of Medicine - Assiut University
*Corresponding author: Mostafa Mahrous Mahmoud, Mobile: (+20) 01061877662,
E-Mail: mostafamahrouss@gmail.com
ABSTRACT
Background: Septum deviation is the major cause of nasal obstruction, which is the most common symptom in ENT
practice. Surgical correction of the deviated nasal septum has been advanced over the years, from the radical removal
of both mucosa and cartilage to submucous cartilage resection with preservation of the mucosa.
Objective: To compare the efficacy of the conventional and the endoscopic septoplasty in the management of patients
with symptomatic nasal deviation.
Patients and methods: This study included 40 patients presented to the Otorhinolaryngology outpatient clinic at Assiut
University Hospitals between May 2018 and December 2019, suffering from nasal obstruction due to a significant
septal deviation, randomly divided into two groups: Group A: 20 patients underwent endoscopic septoplasty and Group
B: 20 patients underwent conventional septoplasty.
Results: In this study, no significant difference was detected in the preoperative results of both groups regarding the
age, sex and types of septal deformities. So, the preoperative circumstances were similar between both groups. Hence,
results of this study showed that these two procedures were suitable to correct septal deformities but the endoscopic
septoplasty was superior to the traditional septoplasty in cases with isolated septal spur. Also, it was associated with
the minimal re-occurrence rate.
Conclusion: Endoscopic septoplasty is a valuable teaching tool, which is efficient in the management of different types
of septal deformities.
Keywords: Endoscopic, Conventional septoplasty, Deviated nasal septum.
INTRODUCTION
Endoscopic septoplasty has been commonly performed
A straight septum is found to be the exception
since the development of endonasal surgery and as an
rather than the rule (1). Only 15% of females and 7.5%
alternative to the traditional technique(4).
of males worldwide have a non-deviated septum (2).
The aim of this work was to compare the
A deviated septum can be asymptomatic or can
efficacy of the conventional and the endoscopic
cause functional and cosmetic abnormality .it can
septoplasty in the management of patients with
become symptomatic at any age. Deviated nasal
symptomatic nasal deviation.
septum (DNS) not only causes breathing difficulties
PATIENTS AND METHOD
but also causes improper aeration of para nasal sinuses
This study included 40 patients presented to
leading to infection. So any functional or cosmetic
the Otorhinolaryngology outpatient clinic at Assiut
disturbance caused by a deviated septum should be
University Hospitals between May 2018 and
treated (3).
December 2019, suffering from nasal obstruction due
Septoplasty is a well-established procedure in
to a significant septal deviation.
nasal obstruction caused by nasal septum deviation
Ethical approval: An approval of the study was
resistant to medical management. It also improves
obtained from Assiut University Academic and
access to the medial meatus in sinus surgery and other
Ethical Committee. Every patient signed an informed
nasal and sinus procedures, such as cosmetic
written consent for acceptance of the operation.
rhinoplasty and functional endoscopic sinus surgery
(FESS) (4). It is conventionally performed under direct
Inclusion criteria: Male and female patients older
visualization using a headlight and nasal speculum.
than 16 years with severe symptomatic deviated nasal
However, this method has the drawbacks of relatively
septum (complaining mainly of nasal obstruction,
poor illumination and accessibility and no
headache, post-nasal discharge and/or hyposmia).
magnification, calling for a larger incision and
Exclusion criteria: Patients aged less than 16 years or
elevation of larger flaps often on both sides of the
more than 60 years. Patients with nasal polyposis or
septum. As a result, there are higher chances of over-
nasal tumors. Patients with sinusitis not responding to
resection and over manipulation (5).
medical treatment. Patients with craniofacial
Modern septoplasty techniques were in the
alterations or congenital malformation. Patients with
first place described by Killian and Freer (6).
associated co-morbidity (diabetes mellitus, hepatitis,
renal disorders, hypertension, cardiac diseases,
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2205
Received: 23/7 /2020
Accepted: 22/9/2020
Evaluation Of QT Interval In Diabetic Ketoacidosis In Medical Intensive Care Unit
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2211-2216
Role of D-Dimer in Assessment of the Severity of Community Acquired
Pneumonia in Children
Hasan El-Banna Khedr1, Dina Mohamed Shokry1,
Eman Mohamed El Behedy2, Zeinab El-Sayed Kotb El-Sayed1
Departments of 1Pediatrics and 2Medical Microbiology & Immunology,
Faculty of Medicine Zagazig University, Zagazig, Sharkia, Egypt.
Corresponding Author: Zeinab El-Sayed Kotb El-Sayed, Mobile:(+20) 1062198220, Email: zeinab_kotb12@yahoo.com
ABSTRACT
Background: Pneumonia remains the leading cause of death in children under five worldwide. It accounts for about 1.6
million deaths a year in this age group - 18% of all deaths among children under five. More than 99% of all pneumonia
deaths occur in low- and middle-income countries.
Objective: To detecting the role of D-dimer in assessment of the severity and prognosis of community acquired
pneumonia (CAP) in children.
Patients and Methods: This was a cross sectional study carried out in Zagazig University Hospital, Pediatric,
Microbiology and Immunology Departments. 143 children with pneumonia aged 6 months to 12 years old were
included in the study that was conducted in the period from January 2019 to June 2019. Blood samples were taken
from the antecubital vein with an injector and placed into citrated tubes. After they were centrifuged, the samples were
evaluated with the quantitative ELISA method.
Results: The study showed that plasma D-dimer levels were higher in patients with lobar or multi-lobar pneumonia
than in patients with segmental pneumonia. Additionally, the present study revealed a significant area under curve
with cutoff > 0.85 and with sensitivity 97% and specificity 95% of D-dimer.
Conclusion: Pneumonia severity (CAP) patients showed increased plasma D-dimer levels in absence of an
accompanying disease that could increase D-dimer levels.
Keywords: Pneumonia severity, D-dimer, Community-acquired pneumonia.
INTRODUCTION
Intrahospital mortality in patients with community-
acquired pneumonia (CAP) is still high. Severity
Some studies suggest that an increase in D-dimer is
assessment is a crucial component in the management of
directly related to the intra- and extra-vascular
patients with CAP to guide physicians in clinical decisions.
coagulation that occurs in acute and chronic lung
Routine clinical judgments alone have shown to be a poor
damage in CAP cases. During pneumonia, vascular
predictor of disease severity (1). More than 40 indicators of
congestion develops and the alveolar cavity fills with
poor prognosis in patients with CAP have been identified,
fibrin. Due to enzymatic degradation of this fibrin by the
and complex scoring systems have been developed (2). The
fibrinolytic system, fibrin degradation products can be
existing severity tool, Pneumonia Severity Index (PSI)
released into the circulation (9). Alveolar fibrin
incorporates
various
combinations
(demographic
deposition is the characteristic of diverse forms of acute
characteristics, co-morbidities, clinical and laboratory
lung injury. Intravascular thrombosis can also occur in
variables) that are felt to be important in determining the
an acutely injured lung (9).
clinical course of CAP. Pneumonia Severity Index
Therefore, being one of the fibrin degradation products,
analyzed 20 parameters (3). However, PSI score model is
D-dimer levels can be increased in pneumonia. Idelle (9)
not practical in many clinical settings and it is not widely
and Quick et al. (10) proposed scoring systems helped to
used (4, 5).
distinguish patients with CAP who can be managed at
Plasma D-dimer represents an endogen thrombolytic
home and those with high mortality risk who need
process. The potential use of plasma D-dimer levels has
intensive care treatment (2). Recommended score systems
been assessed as a screening test for venous
are accurate, but not always easy to apply in clinical
thromboembolism (6). It is a non-specific test, influenced by
practice on admission (4).This study aimed to detect the
many factors (patient's age, background illnesses and any
role of D-dimer in assessment of the severity and
inflammatory state) (7). Its role in other disorders has not
prognosis of community acquired pneumonia in
been defined as well. D -dimer results from the fibrin
children.
breakdown after fibrinolytic system activation by plasmin.
Pro-inflammatory states in critically ill hospitalized
PATIENT AND METHODS
patients lead to elevated D-dimer levels via cytokine
This cross-sectional study was carried out from
activation of the coagulation cascade and corresponding
January 2019 to June 2019 in Zagazig University
inhibition of fibrinolysis (8).
Hospital, Pediatric, Microbiology and Immunology
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-
SA) license (http://creativecommons.org/licenses/by/4.0/)
2211
Received:14 /6 /2020
Accepted:13 /8 /2020
Serum Fibroblast growth factor 19 as a novel biomarker predictor and follow up hepatocellular carcinoma
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2217-2221
Serum Fibroblast Growth Factor 19 As A Predictor and Follow Up of
Hepatocellular Carcinoma
Said Abdelbaky Gad, Ahmed I. Elagrody
Internal Medicine Department Faculty of Medicine, Zagazig University
Corresponding author: Said Abd Elbaky Gad Shams El Deen, Mobile: (+20)01227517689,
Email saidabdelbaky12345@gmail.com
ABSTRACT
Background: Abnormal autocrine fibroblast growth factor 19 (FGF19) productions have been observed in several
types of cancers, including hepatocellular carcinoma (HCC), which is considered 3rd cause of cancer deaths
worldwide with gradually increased incidence. Objective: To investigate the role of FGF 19 in prediction, diagnosis
and follow up of HCC together with alpha feto protein (FP). Patients and methods: This study was carried in
Internal Medicine Department and Clinical Pathology Department, Faculty of Medicine Zagazig University Egypt in
the period from October 2017 to October 2020. The study included 150 patients (111 males and 39 females) classified
into 3 groups: 50 healthy volunteers as a control, 50 patients with liver cirrhosis documented by examination and
investigation and 50 Patients with HCC with variable sizes. All participants in the study were subjected for the
following after written consent and approval by their search ethics committee of Zagazig University.
Result: The median of FGF19 level between control, liver cirrhosis and HCC was 4, 6 and 10 87 pg/ml respectively
with higher sensitivity for detection of small HCC with high significance of Fp between HCC > cirrhosis > control.
Conclusion: FGF19 can be used successfully as a novel biomarker for HCC diagnosis and follow up after treatment
together with already existing biomarker FP.
Keywords: FP, HCC, FGF 19.
INTRODUCTION
sensitivity and specificity together with F protein in
Liver cirrhosis represents the end stage of several
diagnosis, follow up after treatment of HCC (3).
chronic liver injuries. It is characterized by
Fibroblast growth factor 19 (FGF19) is a circulating
degeneration, regeneration by nodules with loss of
hormone that actively participates in governing bile
lobular architecture, which results in decrease of liver
acid synthesis, glycogenesis, and lipid metabolism (4).
cell mass, portal hypertension and porto-systemic
In human, there is a negative correlation between
shunt opening. Hepatocellular carcinoma (HCC)
FGF19 and cardiovascular risk factors (5) and FGF19
represent the 5th common cancer worldwide and 3rd
as an independent factor of the development of
cause of death between cancers, which represent the
coronary artery disease (6).
most serious complication following chronic infection
Aim of the work was to investigate the role of FGF 19
by hepatitis (C) virus and hepatitis (B) virus (1). Inspite
in prediction, diagnosis and follow up of HCC
of the advances in imaging diagnosis and therapeutic
together with alpha feto protein (FP).
advances in treatment modalities, the 5th year survival
rate of HCC still about 20 % (2).
PATIENTS AND METHODS
Tumor makers are widely used as a diagnostic
This study was conducted in Internal Medicine
follow up after treatment and prognosis. In HCC
Department and Clinical Pathology Department,
fetoprotein ( FP) is used for diagnosis, follow up of
Faculty of Medicine Zagazig University Egypt in the
HCC but with different variable changes so it cannot
period from October 2017 to October 2020. The study
used alone as a biomarker of HCC serum fibroblast
included 150 patients (111 males and 39 females)
growth factor 19 (FGF19) is autocrine factor signals
classified into 3 groups:
through FGF receptor tyrosine kinase to regulate wide
- 50 healthy volunteers as a control.
range of biological processes. Dysregulation between
- 50 patients with liver cirrhosis documented by
FGF and FGFR promote developmental of some
examination and investigation.
diseases including cancers. FGF19 secreted from
- 50 patients with HCC with variable sizes.
ileum negatively regulate bile duct acid synthesis in
All participants in the study were subjected for
the liver. It has been also demonstrated that over
the following:
expression of FGF19 and FGFR4 is associated with
1- Full history taking.
unfavorable prognosis of HCC. In this study, we
2- General & local examination.
aimed to investigate serum level of FGF19 by
3- Routine laboratory investigates as CBC, PT, INR,
sandwich enzyme linked immunosorbent assay
Liver function tests, kidney function tests.
(ELIZA) in HCC patients and to evaluate its
4- Specific laboratory investigations as FGF19, AFP (6,
7).
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2217
Received:24 /7 /2020
Accepted:23 /9 /2020
c:\work\Jor\vol816_20
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2222-2226
Plasma and Urinary Calprotectin Levels in Type 2 Diabetic
Patients with Peripheral Arterial Disease
Halawa M, Abushady MM, Abdelsalam Besibes MM, Basabbea AS, Mohamed NR
Department of Internal Medicine and Endocrinology, Faculty of Medicine Ain Shams University, Cairo, Egypt
ABSTRACT
Background: Plasma calprotectin is a persistent biomarker of insulin resistance (IR), gastroenteritis, and
cardiovascular disease (CVD). We assessed the role of plasma and urinary calprotectin in type 2 diabetes patients with
peripheral arterial disease (PAD), to assess whether calprotectin is a risk factor for developing PAD in type 2 diabetes
patients.
Aim of the work: To study the association of plasma and urinary calprotectin levels with peripheral arterial disease in
type 2 diabetic patients
Methods: The current study was conducted on 90 subjects. They were subdivided into 3 groups. Group I: 30 type 2
diabetics with PAD, group II: 30 type 2 diabetics without PAD and group III: 30 healthy control subjects of comparable
age and sex. They were subjected to history taking, full clinical examination, anthropometric measurement, plasma
and urinary calprotectin levels that were measured by ELISA and ankle brachial index. In addition, HbA1c, fasting
serum lipid profile, highly sensitive CRP and CBC were measured.
Results: plasma calprotectin level was significantly higher in patients with T2DM with lower extremity peripheral
arterial disease (LEPAD) compared to the other 2 groups, urinary calprotectin was significantly higher in all type 2
diabetic subjects compared to healthy control group. Age, current smoking status, duration of diabetes, glycated hemoglobin
and plasma calprotectin were independent determinant of peripheral arterial disease in T2DM patients
Conclusion: Elevated plasma and urinary calprotectin levels in diabetic patients compared to healthy control suggest
the possible role of calprotectin in development of atherosclerosis and peripheral arterial disease and the possibility of
its use as a biomarker for diabetic vasculopathy.
Keywords: Plasma and urinary calprotectin, Type 2 diabetes mellitus, Peripheral arterial disease.
INTRODUCTION
The widespread prevalence of diabetes in many
conditions, including rheumatoid arthritis, allograft
countries of the Middle East has made this region one of
rejection, inflammatory bowel disease, cancer and lung
the incidence of diabetes in the world. Due to rapid
disease. It is excreted during phagocytic stress. Elevated
socio-economic growth, changes in lifestyle, and
calprotectin levels have been reported to predict
increasing prevalence of obesity, the number of
microvascular changes in patients with type diabetes 2
diabetics is expected to double by 2045 in this region (1).
(T2DM). It was found to be an early and sensitive
Unfortunately, lower extremity peripheral arterial
marker of acute coronary syndrome and non-fatal
disease (LEPAD) is found asymptomatic in most people
myocardial infarction. In an examination approach
with diabetes and only 20% of them have symptoms
among healthy individuals, increased plasma
associated with LEPAD (2).
concentrations of calprotectin were found to predict the
Diabetes significantly increases the risk of lower
risk of future cardiovascular events (5).
limb amputations, 10-20 times more than those without
Aim of the work was to study the association of
diabetes (3). PAD causes significant long-term disability
plasma and urinary calprotectin levels with peripheral
in patients with diabetes. Therefore, the treatment of
arterial disease in type 2 diabetic patients.
patients with PAD may be costly due to the need for a
variety of diagnostic tests, treatment procedures, and
PATIENTS AND METHODS
hospitalization (4).
A case control study conducted on 90 subjects
Calprotectin has been recognized as an endogenous
divided into 60 type 2 diabetics recrurited from
Toll-like receptor activator and as a glycation end-
Endocrinology Clinic and Diabetic Foot Research Unit,
product (RAGE) receptor. Calprotectin is thought to act
Ain Shams University Hospital and 30 healthy control
as an intracellular differentiation marker for
subjects. The 60 diabetic patients were subdivided into
macrophages and as an extracellular protein complex
2 groups.
(DAMP). Elevated plasma levels of calprotectin have
Group I: 30 type 2 diabetics with peripheral
been reported in a variety of chronic inflammatory
arterial disease (15 females and 15 males) that was
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY- SA) license (http://creativecommons.org/licenses/by/4.0/)
2222
Received:24 /7 /2020
Accepted:23 /9 /2020
Image quality and attenuation values of multidetector CT coronary angiography using high iodine-concentration contrast material: A comparison of the use of iopromide 300 and iopromide 370
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2227-2234
Does the Gender Imply A Certain Predilection as Regards the Morphology of
Left Atrial Appendage in Egyptians?
Hazem Mansour*, Ahmed Mohamed Hassan, Ahmed Mohamed Onsy,
Azza Alaa Omran, Mona Rayan, Mohamed Ghazy
Department of Cardiology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Hazem Mansour, Mobile: (+20) 01000540100, E-Mail: hazemmansour79@gmail.com
ABSTRACT
Background: Left atrial appendage (LAA) has different shapes, sizes, and relations to different adjacent structures,
all of these may be extremely important when interventional procedures related to left atrium are done. There is a
growing data about variations in LAA morphology in relation to gender and in different populations.
Objective: So in our study we evaluated LAA morphologies and identified the proportion of its different subtypes in
Egyptians. Patients and methods: We analyzed retrospectively the data of 101 consecutive Egyptian patients who
underwent multidetector computed tomography (MDCT) in our university specialized hospital from August 2019 to
February 2020. Results: All images were evaluated for LAA morphology and volume. Windsock morphology existed
in 32% of patients followed by chicken wing in 25% of patients. Cauliflower morphology was reported in 23% of
patients whereas 20% of patients had cactus morphology. There was a significant gender difference, as female patients
had predominantly cauliflower and cactus morphologies (P<0.05). Left atrial appendage volume showed a statistically
significant positive correlation with advanced age and significant negative correlation with left ventricular ejection
fraction.
Conclusion: Egyptians had LAA predominantly windsock morphology in males and cactus morphology in females.
Keywords: Egyptians, Left atrial appendage, MDCT, Morphology.
INTRODUCTION
irrelevant portion of the cardiac anatomy but recently it
The left atrial appendage is identified anatomically
may have a significant correlation with the pathogenesis
from the left atrium by the narrowest part of the
of LAA thrombus formation. The pathogenesis for LAA
appendage which separates and also connects it into the
thrombus formation is probably linked to blood
left atrium (1). It has structural, and biological features
stagnation within a long, blind-ended trabeculated
discrete from the left atrium proper (2). LAA has
pouch(2). In a study using multidetector computed
dissimilar shapes, sizes, and relations to different
tomography (MDCT) and cardiac magnetic resonance
adjacent structures, all of these may be extremely
(CMR), the shapes of the LAA were classified into 4
important when interventional procedures related to the
morphological
types:
"chicken-wing"
"cactus",
left atrium are done (3).In the past, the left atrial
"windsock", and "cauliflower" (4) (Fig. 1).
appendage (LAA) has been conveyed to be a rather
(A) (B)
(C)
(D)
Figure (1): LAA morphology types based on Wang's classification with Kimura's quantitative limit, (A) Cactus (B)
Chicken wing (C) Windsock (D) Cauliflower(4).
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-
SA) license (http://creativecommons.org/licenses/by/4.0/)
2227
Received:23 /7 /2020
Accepted:22 /9 /2020
c:\work\Jor\vol816_22
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2235-2245
Long Noncoding RNA MALAT-1 and Mirna-9 Expression Profile Levels in
Patients with Diabetic Polyneuropathy (DPN) and Their Correlations with
The Severity of Painful DPN
Nearmeen M. Rashad1, Hala A. Fathy2, Rehab M. Atef3, Neveen F. Ibrahim1
Departments of 1Internal Medicine,2Neurology and 3Clinical Pathology,
Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Nearmeen M. Rashad, Mobile (+20) 1224248642
ABSTRACT
Background: Diabetic polyneuropathy (DPN) is the major microvascular complication of type 2 diabetes mellitus
(T2DM). Painful-DPN is a major cause of mortality as well as morbidity. Long non-coding RNAs (lncRNAs) and
microRNAs (miRNA) have emerged as critical regulators of many diseases, however, little is known about their
expression patterns and functions in T2DM and its complications.
Objective: To investigate the expression profile levels of lncRNA MALAT-1 and miRNA-9 in Egyptian patients
with T2DM and to explore their associations with clinical and electrophysiological tests of both painful and
painless DPN. Patients and Methods: This cross-sectional controlled study enrolled 55 patients with DPN and 40
controls. All participants were subjected to a complete neurological examination and electrophysiological tests
involving nerve conduction studies. The expression levels of lncRNA MALAT-1 and miRNA-9 were measured by
quantitative real-time polymerase chain reaction (qRT-PCR).
Results: The relative expression levels of MALAT-1 and miRNA-9 were significantly upregulated in patients with
DPN (0.219±0.061, 0.006454±0.0018, respectively) compared to controls (0.111±0.013, 0.0033±0.004,
respectively). Interestingly, the relative expression levels of MALAT-1 and miRNA-9 were significantly
upregulated in patients with painful DPN (0.206±0.037, 0.0045±0.0008, respectively) compared to patients with
painless DPN 0.219±0.083, 0.0058±0.0017, respectively). Patients with DPN had sensory-motor axonal
polyneuropathy which was affecting both lower limbs more than upper limbs. P<0.001*.
Conclusions: The relative expression levels of MALAT-1 and miRNA-9 were significantly upregulated in patients
with DPN more specifically in patients with painful DPN groups, hence, MALAT-1 and miRNA-9 could be used as
useful and reliable diagnostic biomarkers of DPN.
Keywords: DPN, LNC RNA, MALAT-1, miRNA-9, Nerve conduction studies.
INTRODUCTION
debilitating and can cause sleep disturbances, anxiety,
The prevalence of diabetes continues to
and interference with physical functioning(5).
increase and is reaching epidemic proportions,
There have been tremendous advances over
according to an estimation by the International
the last 2 decades in understanding the processes that
Diabetes Federation (IDF), the global population
regulate the epigenetic mechanisms and their potential
affected by diabetes will reach 552 million by the year
implication on diabetes and its complications.
2030(1). Type 2 diabetes mellitus (T2DM) results from
Epigenetics or epigenomics refer to all the alterations
ineffective
insulin
response.
The
clinical
and ensuing phenotypes such as changes in DNA
manifestations of DM restrict its timely diagnosis,
conformation, transcription, or translation, that do not
which may be delayed by several years. This delayed
involve changes to the underlying DNA sequence.
prediction often results in chronic complications
There are multiple stages of epigenetic regulation
including diabetic polyneuropathies (DPN)(2).
including DNA cytosine methylation, histones post-
DPN is characterized by diffuse damage to the
translational modifications in chromatin, and lately
peripheral nerve fibers. Despite the limited knowledge
noncoding RNAs (ncRNAs) such as long noncoding
on the molecular mechanisms underlying the
RNAs (lncRNAs), microRNAs (miRNAs), and
pathogenesis of DPN, emerging scientific evidence
circular RNAs (circRNAs) (6).
has disclosed that 3090% of patients with diabetes
Given the recognized differences in the
have peripheral neuropathy (3). Additionally, diabetic
epigenetic regulators, long noncoding RNAs
sensory-motor polyneuropathy (DSPN) which is the
(lncRNAs) family (>200nucleotides) could participate
most common form of neuropathy in T2DM is
in various biological processes, such as X-
associated with impaired quality of life, significant
chromosome inactivation, genomic imprinting,
morbidity,
and
increased
healthcare
costs.
quiescence, immune response as well as cellular and
Furthermore, 1634% of patients with diabetes report
metabolic processes (7). MALAT1 (metastasis-
painful neuropathic symptoms(4). It has been widely
associated lung adenocarcinoma transcript 1),
described that the symptoms of DPN can be
programmed by the MALAT1 gene on chromosome
11q13.1 with two exons is in many cells all over the
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (
CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2235
Received: 24/7/2020
Accepted: 23/9/2020
c:\work\Jor\vol816_23
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2246-2251
Comparative Study of Multimodal Analgesia and Morphine Analgesia
Concerning the Adverse Effects Following Open-Heart Surgeries
Wesam Abd El Galil Abu Elwafa, Ahmed El Saied Abd Ell Rahman,
Samar Thabet Abu Bakre*, Khaled Abdelfattah Mohamed Abdelfattah
Department of Anesthesia, Intensive Care and Pain Management,
Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Samar Thabet Abu Bakre, Mobile: (+20) 01067449485, E-Mail: samarthabet@med.sohag.edu.eg
ABSTRACT
Background: Historically, pain management has been based on opioid analgesics after cardiac surgeries. Opiates,
however, have adverse dose-related side effects that have an impact on the recovery of patients. So, evidence-based
opioids that spare multimodal analgesia are progressively being used.
Objective: To determine if the multimodal opioid-sparing treatment of dexamethasone, gabapentin, ibuprofen,
ketorolac, and paracetamol had fewer side effects and was safe following open-heart surgeries compared to morphine.
Patients and Methods: This prospective, double-blinded randomized, and controlled clinical study was performed
on 60 patients scheduled for elective open-heart surgeries with sternotomy at Sohag University Hospital they were be
randomly allocated into two equal groups, 30 patients each in the Cardiothoracic Department, Sohag University.
Results: Fewer side effects occurred in patients in the multimodal group than in the morphine group. There was
nausea and constipation in patients on the morphine versus multimodal group (21versus 0) with a ratio of 70% (p-
value 0.001). Vomiting occurred in patients in the morphine group (12 versus 4) relative to the multimodal group with
a ratio of 40% (pvalue 0.020). Postoperative creatinine value showed no statistically significant difference in values
between the two groups in all days, with the exception of day zero, showing lower values in the multimodal group
creatinine level (0.82 ± 0.25 versus 1.02 ± 0.28 in morphine group (p-value 0.006).
Conclusions: The multimodal regimen offered lower side effects than morphine group in patients undergoing cardiac
surgery. There dramatically decreased complaint of nausea, vomiting, constipation, and respiratory depression. In
terms of renal complication, no safety issues were found with the multimodal regimen.
Keywords: Multimodal analgesia, Open-heart surgeries, NSAIDS, Gabapentin, Morphine.
INTRODUCTION
Heart and/or the proximate large vessels surgery is
A multimodal opiate sparing regimen composed of
known as a cardiac surgery. It is also a procedure
dexamethasone, gabapentin, NSAIDs such as
intended to enhance the quality of life. It is performed
ibuprofen, ketorolac, and paracetamol is the
under anesthesia and can be performed either
justification for the administration of various
laparoscopically or as open-heart surgery (1).
analgesics, not only the opioid sparing effect, but also
The best method for direct visualization of the heart
the achievement of more efficient pain relief to
and the related viscera is median sternotomy. Median
minimize opioid side effects and enhance pain ratings
sternotomy involving cardiac surgery requires coronary
(6). Nonsteroidal anti-inflammatory agents (NSAIDs)
artery bypass grafting, replacement of valves and
are effective in decreasing the amount of opiates
reconstruction of a number of congenital cardiac
requested and offered to patients, thus reducing side
diseases (2).
effects of opioids. They act by blocking the
Sternotomy causes important postoperative pain in
development of prostaglandins by inhibiting the
cardiac surgery, which has both major short-term and
enzyme cyclooxygenase (COX), resulting in an anti-
long-term effects. Acute postoperative pain that is
inflammatory response (7).
poorly controlled can complicate the immediate
Gabapentin is an analogue of gamma-
postoperative period and can cause chronic pain as well
aminobutyric acid (GABA), and is primarily used for
(3). Many unfavorable problems may result from
the treatment of epilepsy and neuropathic pain, but
inadequate analgesia in the postoperative period,
recently it has been used as part of multimodal regimens
hemodynamic instability (hypertension, tachycardia,
following non- cardiac surgery in recent years. By
and
vasoconstriction),
immunological
disorder
binding to the second subunit of voltage-sensitive
(impaired immune response), metabolic disorder
calcium channels (alpha2 delta subunit), as well as
(extensive catabolism) and hemostatic disorder
having a central antiallodynic effect. Gabapentin exerts
(platelet activation) (4). Consequently, adequate
an anti-nociceptive effect (8). Sedation and dizziness,
analgesia during the postoperative period will
headache, and ataxia were the main side effects
potentially minimize morbidity, and improve the
reported with gabapentin (9).
quality of life (5).
This article is an open access article distributed under the terms and conditions of the
Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2246
Received:25 /7 /2020
Accepted:24 /9 /2020
c:\work\Jor\vol816_24
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2252-2258
Association between Hypocapnea and Febrile Seizures
Hanan Mohammed Abd El-Moneim1, Bahaa Hawary1, Emad Farah Mohammed Kholef2,
Yahia Mohammed Hassan El Tayeb*1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine - Aswan University
*Corresponding author: Yahia Mohammed Hassan El Tayeb, Mobile: (+20) 01111509409, E-Mail: yahiaeltayeb77@gmail.com
ABSTRACT
Background: Although a number of susceptibility genes and environmental factors have been identified, precise
mechanism that triggers febrile seizures (FS) is still unclear. However, it is known that pH changes have central role in
the control of electrical activity in brain, leading to seizures. Brain alkalosis is known to enhance neuronal excitability and
promote epileptiform activity.
Objective: The aim of this study was to assess the association between febrile seizure and hypocapnea and the role of
hypocapnea in the development of febrile seizures.
Patients and Methods: The present study was an observational, case-control, study that was conducted on 100 patients
who were recruited form Aswan University Hospitals. The patients were divided into the following groups: Group I: 50
children with febrile seizure (defined as: seizures in children in association with fever of 38.0 C or more without definitive
evidence of neurological disorders, central nervous system infection, or metabolic abnormalities). Group II: 50 age- and
gender-matched children with febrile illness, but without convulsions working as a control group.
Results: We found that there was statistically significant difference between patients and control groups in terms of
hypocapnea (p < 0.001). Patients were more likely to have hypocapnea at admission. In addition, there were statistically
significant differences between patients and control groups in terms of acidosis at admission (p < 0.001) and alkalosis at
admission (p < 0.001). Patients were more likely to have acidosis or alkalosis.
Conclusion: Hypocapnea is significantly associated with febrile seizures. In our study, we found that children with febrile
convulsion had significantly higher rate of hypocapnea than normal controls. In addition, it is apparent that presence of
hypocapnea is associated with the type of seizure, but not with the duration of the attack.
Keywords: Hypocapnea, Febrile Seizures, Children.
INTRODUCTION
Fever is an elevation of body temperature induced
FS is one of the most common types of seizures in
by the thermoregulatory center of the hypothalamus in
children aged between 5 months and 5 years and accounts
response to certain situations. This sign is believed to be
for 30% of all childhood seizures (1). the American
an adaptive mechanism, developed with the purpose of
Academy of Pediatrics (AAP) has announced a standard
stimulating the immune system and preserving cell
definition of febrile seizures as a seizure occurring in
membrane integrity in the presence of threats. Although
febrile children between the ages of 6 and 60 months who
there is broad disagreement in the literature concerning
do not have an intracranial infection, metabolic
normal body temperature in children, normal axillary
disturbance, or history of afebrile seizures (2). FS can be
temperature is generally considered to range between
separated into two categories, simple and complex. A
36.0°C in the morning to 37.7º.C in the afternoon. Any
simple FS is isolated, brief and generalized. Complex FS
values above this range should be regarded as abnormal
is one with focal onset, one that occurs more than once
(5). pH changes have a central role in the control of seizure
during a febrile illness, or one that lasts more than 10 to
activity in the brain. Alkalosis is known to enhance
15 minutes (3). Simple FS have an age range classically
neuronal excitability and to promote epileptiform activity,
described as 6 to 60 months. The peak incidence is usually
both in vitro and in vivo. in line with this, hyperventilation
in the second year of life. FS are prevalent in up to 5% of
(which by definition leads to a net loss of CO2 and to
children, with the overall incidence estimated to be
consequent respiratory alkalosis) is a standard method to
460/100,000 in the age group of 04years. Most FS are
provoke absence seizures, complex partial seizures, and
simple; however, up to 30% might have some complex
other epileptiform manifestations in human patients (6).
features (4).
The pathophysiological link between fever and
Genetic and environmental factors are thought to
increased seizures susceptibility had been researched in
contribute to febrile epileptogenesis. Although a number
rats. In mouse modules, hyperthermia cause
of susceptibility genes associated with fever-induced
hyperventilation
with
intracerebral
hypocapnea
convulsions have been identified, the precise
(alkalosis) and seizures (7).
epileptogenic mechanisms have not been determined (4).
Kilicaslan et al. (8) measured both blood pH and
PCO2 within 1 hour after the FS and 1 hour of febrile
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-
SA) license (http://creativecommons.org/licenses/by/4.0/)
2252
Received: 26/7/2020
Accepted: 25/9/2020
Type of article: Original
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2259-2264
Diagnostic Value of Lung Ultrasound Versus Chest X-Ray in Surgical ICU Patients
Alrefaey K Alrefaey ,Ahmed S Marwa, Yassen M Amr, Zaghloul A Amgad
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
Correspondind author:Alrefaey K. Alrefaey, Email: refa3ey2@yahoo.com,Mobile: 00201064203475
ABSTRACT
Introduction: Facing the recognized obstacles of chest computerized tomography (CT) and chest x-ray (CXR), lung
ultrasound (LUS) is a promising alternative imaging tool gathering the benefits of real-time diagnosis with lower
difficulties. This study aims to evaluate the effectiveness of LUS as a diagnostic modality in surgical critical care in
contrast to chest x-ray.
Patients and Methods: In this study, for each of the 92 included patients, when chest CT is indicated, CXR was
requested and the BLUE protocol for LUS examination was initiated simultaneously. LUS data were recorded while
analysis of CXR finding was performed by independent radiologist who was unaware of CT or LUS findings.
Results: For each patient, 4 lung areas were examined with LUS and compared to CXR. LUS showed higher
specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA)
of LUS in contrast to chest x-ray. A significantly lower time was required for LUS to reach the diagnosis compared to
CXR (10.2± 4 minutes vs. 33±17 minutes respectively, p less than 0.01).
Conclusion: LUS is a useful tool in screening and diagnosis detection of various pulmonary problems in surgical ICU;
it can be used as daily bedside diagnostic tool for the critically ill patients adding the use of other chest imaging
modalities.
Key words: lung, ultrasound, complications, atelectasis.
INTRODUCTION
The study included a cohort of 154 patients,
Postoperative pulmonary complications (POPC)
admitted to surgical intensive care, Mansoura
are a major contributor to morbidity and mortality in
University Hospitals, and developed clinical data
the surgical patient with a high incidence reaching
suggestive of POPC, including one or more of the
40% of high-risk population(1,2). Early detection of
following; fever, cough, sputum production, dyspnea,
POPC is warranted to trigger early preventive and
respiratory distress, and/or hypoxia. When chest CT
therapeutic interventions (3). Diagnosis of POPC is
is indicated for the patient, CXR and LUS assessment
clinically suggested by findings like fever, cough and
were simultaneously requested. Patients with chest
crepitation, and confirmed by thoracic imaging. For
wall deformities, thoracotomy patients and pregnant
decades, thoracic imaging relied on routine bedside
females were excluded from the study. 92 patients
chest radiography (CXR), plus lung computed
only could be examined by CT for difficulty to
tomography (CT) when its indication is justified (3).
transfer or non-availability of CT.
Chest CT is generally accepted as the gold
standard for the assessment of pulmonary structure
Ethical approval
and morphology. However, the risk of patient transfer
This study was conducted after approval of the
and high radiation dosage restricts its use in critically
Institutional
Research
Board,
Mansoura
ill patients to certain indications. On the other hand,
University, Egypt (number: MS/15.12.42).
CXR is a simple widely available modality, it carries
An informed consent was taken from the included
a considerable technical defects that result in poor
patients or their guardians.
correlation between its findings and those of CT(4, 5).
A portable ultrasound device (Siemens Acuson
Facing the previously mentioned barriers of
p300 , Germany) was used for LUS examination (the
both non contrast CT chest and CXR, LUS is
BLUE protocol) (7, 8). While the patient was in supine
proposed as a promising alternative imaging tool,
position, the linear high-frequency transducer LA523
gathering the benefits of real-time diagnosis and the
(5-12MHz) was used to examine lung sliding and
availability as a bedside examination(6).
subpleural consolidation. The convex transducer
The aim of this study is to evaluate the
CA123 (1-8MHz) was applied for the rest of
effectiveness of LUS as a diagnostic modality in
examination or from the start in case of obese patient.
surgical critical care sitting in contrast to chest x-ray.
Scans were longitudinal with the probe orientation
We hypotheses that LUS is more sensitive and
towards patient's head where the pleural line sought
specific than chest x-ray with less radiation exposure
between two ribs (upper and lower).
and more time-saving.
Depth was adjusted according to patient size. Four
clinical regions were assessed on each lung side
PATIENTS AND METHODS
(Figure 1). The Lung sliding sign, A-profile, B-
profile, pleural effusion and consolidations were
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC
BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2259
Received:25 /7 /2020
Accepted:24 /9 /2020
c:\work\Jor\vol816_26
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2265-2273
Risk Factors of Type 1 Diabetes Mellitus in Children Attending
Aswan University Hospital
Asmaa Mohammed Ismail, Ahmed El-Meshwady Ahmed Mohammed*, Hanan Mohammed Abd El-Moneim
Department of Pediatrics, Faculty of Medicine, Aswan University
*Corresponding author: Ahmed El-Meshwady Ahmed Mohammed, Mobile: (+20) 01000507267,
E-Mail: ahmed.elmeshwady1992@gmail.com
Abstract
Background: Type 1 diabetes (T1DM) is a chronic disease caused by immune-mediated destruction of insulin
producing beta cells in the pancreas. The destruction of beta cells results in insulin insufficiency, and patients
develop life-threatening hyperglycemia that clinically manifests with weight loss, polyuria, and polydipsia.
Objective: This study aimed to search for disease prediction and disease prevention.
Patients and methods: The present cross-sectional study was conducted at Aswan University Hospital. One
hundred children with T1DM were included during the period from April to November 2018. The mean age of the
included patients was 7.2 ± 4.3 years and the age at onset of the disease was 4.56 ± 2.9 years. 56% of the patients
were males.
Results: In our cohort, we found that, in terms of obstetric history, 76% of the mothers delivered by CS and 12% of
them had history of preeclampsia. 13% had a history of gestational diabetes. On the other hand, 13% and 29% of
the mothers had a history of infectious diseases and use of antibiotics, respectively. There were no statistically
significant associations between age group and preeclampsia (p =0.33), gestational diabetes and use of insulin (p
=0.67), infectious diseases (p =0.91), use of antibiotic (p =0.26), use of antihypertensives (p =0.22), and mode of
delivery (p =0.067).
Conclusion: In conclusion, Egyptian children with T1DM had wide range of genetics, environmental, maternal,
and neonatal risk factors that may have contributed to the development of T1DM.
Keywords: Type 1 Diabetes Mellitus, Children, Aswan University Hospital.
INTRODUCTION
recruitment of antigen-presenting cells. Antigen-
Among Eastern Mediterranean and Middle
presenting cells sequester self-antigens released by
Eastern countries, the largest contribution to the total
injured -cells, followed by their transport to
number of estimated childhood type 1 diabetes
pancreatic lymph nodes where they are subsequently
mellitus (T1DM) cases comes from Egypt which
presented to auto reactive T cells (5).
accounts for about a quarter of the region's total. The
Type 1 diabetes may be diagnosed at nearly
incidence varies between 1/100 000 per year
any age, though peaks in presentation occur between
(Pakistan) and 8/100 000 per year (Egypt) in children
ages of 5 to 7 and around puberty. There appears to be
under the age of 15 years (1).
seasonal variation with more cases diagnosed in
Type 1 diabetes (T1D) is an autoimmune
winter. Unlike most autoimmune disorders, type 1
disorder which affects millions around the world. The
diabetes is slightly more common in boys and men.
incidence of T1D in children is increasing worldwide
Insufficient
endogenous
insulin
leads
to
at a rate that cannot be explained by genetics alone (2).
hyperglycemia, hyperglucagonemia, glycosuria, and
Type 1 diabetes mellitus (T1DM) is a chronic
without treatment, eventually ketosis, acidosis,
autoimmune disease resulting in the designated
dehydration, and death. About one-third of patients
immune destruction of insulin producing -cells,
with newly-diagnosed type 1 diabetes present with
usually diagnosed in youth, and associated with
diabetic ketoacidosis (DKA) which has a mortality
important psychological, familial, and social disorders
rate of around 0.5%, despite aggressive treatment (6).
(3).
There is a growing evidence that the
Environmental triggers such as certain dietary
underlying mechanisms in the pathogenesis of diabetic
factors and viruses are thought to initiate the
complications include certain genetic and epigenetic
autoimmune process, leading to the destruction of
modifications, nutritional factors, and sedentary
pancreatic B-cell and consequent T1DM. A genetic
lifestyle (7). Maternal age > 35 years at delivery, the
predisposition is another pre-requisite, allowing the
presence of gestational diabetes, pre-eclampsia and
autoimmune process to progress (4).
taking
medications
during
pregnancy
were
Persons destined to develop type 1 diabetes
significantly associated with the occurrence of T1DM.
are assumed to begin life with a full capacity of -
In addition, low birth weight children (< 2500 grams)
cells. However, a "triggering" insult, likely
and those who suffered from neonatal diseases
environmental, initiates a process involving the
(respiratory distress, jaundice, and infection) were at
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA)
license (http://creativecommons.org/licenses/by/4.0/)
2265
Received: 25/7/2020
Accepted: 24/9/2020
c:\work\Jor\vol816_27
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2274-2284
Assessment of Health-Related Quality of Life in Children with
Rheumatic Heart Disease at Upper Egypt
Asmaa Mohammed Ismail, Hanan Mohammed Abd El-Moneim, Asmaa Ashraf Mohammed*
Department of Pediatrics, Faculty of Medicine, Aswan University, Aswan, Egypt
*Corresponding author: Asmaa Ashraf Mohammed, Mobile: (+20) 01127427797, E-Mail: simsma_24@yahoo.com
ABSTRACT
Background: Many published literatures suggested that RHD can cause stress and anxiety in patients, with increased
risks of evolving physical and psychosocial impairments. These include not only pain and fatigue but also difficulties
with activities of daily living.
Objective: The study aimed to evaluate the HRQOL in children with RHD and delineate the HRQOL domains in
various clinical subtypes of RHD.
Patients and methods: The present study was a cross-sectional, comparative, study that was conducted on 120 RHD
patients who were recruited from Upper Egypt University Hospitals (Aswan, Assiut, and Qena hospitals) for six
months. Also, 120 age and sex-matched healthy volunteers were included as the control group.
Results: In our cohort, the most common presentation of the included patients was pancarditis with arthritis (33.3%),
followed by polyarthritis (31.7%), and fever with pan carditis (20%). One-third of the patients had a history of one
hospital admission, and 26.7% had a history of two or more admission. Besides, 65% had swollen, redness, hotness,
limitation of movement in the lower limb. All patients were on long-acting penicillin and 10.8% had a history of cardiac
surgery. In the present study, the mean serum CRP level was notably high in patients with RHD (mean 114.63
±113.5mg/dL).
Conclusion: Rheumatic heart disease imposed a considerable burden on the quality of life of the Egyptian pediatric
population. In our study, we found that Egyptian patients with rheumatic heart disease had significant impairments on
the physical, emotional, social, and school functioning, as compared to their counterpart healthy population.
Keywords: Health-related Quality of Life, Children, Rheumatic Heart Diseases, Upper Egypt.
INTRODUCTION
The US Food and Drug Administration (FDA)
Acute Rheumatic Fever (ARF) is a post-
released specific guidance for the development and
infectious, non-suppurative sequel of pharyngeal
validation of QOL measures that could be suitable for
infection with streptococcal pyogens, or group a beta-
regulatory purposes. Further developed by FDA authors
hemolytic streptococcus. Rheumatic fever occurs in 3-
in 2016, the recommended QOL components for drug
4% of the untreated group a streptococcal pharyngitis.
labeling purposes include disease-related symptoms,
Devastating complications of Rheumatic Heart Disease
physical function, and patient-reported adverse events
(RHD) include severe valve regurgitation, heart failure,
(6).
strokes, and infective endocarditis, usually affecting
Rheumatic Heart Disease accounting for the
both younger schools going and economically active,
greatest cardiovascular-related loss of disability-
childbearing members of society (1).
adjusted
life-years
among
1014-year
old
Many echocardiographic screening studies put
(516.6/100,000 individuals) and the second-highest
the prevalence of RHD at 857 out of 1000 children
number among children aged 59 years old
meaning that the true prevalence may rest closer to 62
(362/100,000 individuals) (7).
78 million individuals worldwide with up to 1.4 million
Quality of life in patients with chronic diseases
deaths each year. RHD has a high prevalence in Egypt.
is multifactorial conditioned. To some degree, quality
Although a high proportion of the abnormalities
of life is dependent upon the intensity and duration of
originally detected persisted at follow-up, both
its symptoms. Symptoms are influenced by activity,
progression and regression of valve lesions were
form location, and extent of disease. Psychological and
demonstrated (2).
social factors play a significant role, too (8).
Quality of life (QoL) has received increased
A recent study of children in Gulu, Uganda
attention within medical and psychological research
showed that being diagnosed with latent RHD was
and practice Traditionally, psychological well-being
associated with the reduced physical and emotional
has often been conceptualized in the negative sense as
quality of life scores even when patients were clinically
the absence of mental illness (3).
asymptomatic (9).
The American Heart Association (AHA)
Also, Scheel et al. (10) said that as early RHD
included health-related Quality of life (HRQoL)
detection efforts expand, it is critically important to
evaluation as a strategic treatment-impact goal for
diminish the negative psychological impact associated
cardiovascular health (4) AHA defined HRQoL as the
with a positive screening result. To our knowledge, this
"discrepancy between actual and desired functional
is the first time a support group was studied amongst
status and overall impact of health on well-being" (5).
pediatric patients with RHD. Here, we examine the
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-
SA) license (http://creativecommons.org/licenses/by/4.0/)
2274
Received:25 /7 /2020
Accepted:24 /9 /2020
c:\work\Jor\vol816_29
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2291-2294
Laparoscopic Treatment for Secondary Ureteropelvic Junction Obstruction
Hassaan A. Gad*1, M. Zaki Eldahshoury1, Mohammed M. Hussein1, Ahmed Hammady2
1Department of Urology, Faculty of Medicine - Aswan University,2Department of Urology,
Faculty of Medicine - Sohag University
*Corresponding author: Hassaan Ali Ahmed, Mobile: (+20) 01113730199, E-Mail: hassan.ali@aswu.edu.eg
ABSTRACT
Background: Pelviureteric junction obstruction (PUJO) is one of the most frequent congenital anomalies of the
urinary tract system. It is associated with pain, hydronephrosis, urinary tract infections, and eventually loss of renal
function.
Objective: To evaluate our institution in laparoscopic management of pelviureteric junction obstruction after failed
open or laparoscopic surgery for pyeloplasty.
Patients and methods: This study was conducted on 45 patients in two centers, Aswan Urology Department, and
Sohage Urology Department. All of them have secondary pelviureteric junction obstruction.
Results: This study included 24 females and 21 males, with the mean age of 30.2 ± 7.5 years (range 21 to 45 years),
failed previous repair on the left side was in 29 cases while it was in 16 cases on the right side. Regarding BMI, it
ranged from 21 to 30 with mean of 24.9 ± 3.1 kg/m2. The mean time after failure of primary pyeloplasty in both
genders was 21.3 ± 8.2 months with a range of 10-38 months. The preoperative total renal function by DTPA was
80.7 ± 26.5. All cases were done laparoscopically without conversion to open surgery with a mean operative time of
154.9 ± 25.4 minutes (range from 80 to 185 minutes). The intra operative etiological finding of previous failure were
peripelvic fibrosis and scarring in 34 cases, proximal ureteric stricture in 4, missed lower pole crossing vessels at
initial surgery in 5 and a kink at the PUJ associated with redundant pelvis in two patients.
Conclusion: Laparoscopic pyeloplasty is an effective minimal invasive alternative to open surgery in treatment of
secondary pelviureteric junction obstruction.
Keywords: Laparoscopic treatment, Pyeloplasty, Repyeloplasty, Secondary, UPJO.
INTRODUCTION
Definitions of treatment success and failure vary
Pelviureteric junction obstruction (PUJO) of the
within the literature. Failure can be considered as the
kidney can cause pain, recurrent urinary tract infections,
inability to improve symptoms, dynamic renographic
hydronephrosis and loss of renal unit function. Surgical
parameters, renal unit function or hydronephrosis (7).
intervention is often required and numerous treatment
Other success criteria have included symptomatic
strategies have been employed. These modalities have
resolution (i.e. more than 80% pain relief) associated
changed with time.
with stable or improved renal function and improved
PUJO can be considered congenital or acquired
washout from the renal pelvis (i.e. T1/2 < 20 min). On
and recent algorithms for the management of PUJO
renal scan a combination of reduction of symptoms and
have highlighted the importance of establishing
an improvement in renogram or intravenous urogram
intrinsic (e.g. atreteic or stenosed ureteral segment) or
has also been used (8).
extrinsic (e.g. lower pole crossing vessel) compression
Failure of primary treatment can be considered
in deciding optimal primary management (1).
as early or late, both scenarios will be termed
Following the description in 1949 by Anderson
"secondary PUJO." The causes of failed treatment
and Hynes (2), open dismembered pyeloplasty became
include poor surgical technique, an "irreparable pelvi-
the gold standard. Endoscopic management in the form
caliceal system," PUJ ischemia with re-stenosis,
of endopyelotomy was introduced in 1990's and success
anastomotic leak with urinoma and fibrosis, a missed
rates up to 70-90% was achieved (3). Laparoscopic
crossing vessel, which can occur in 18% - 50% of cases,
pyeloplasty was first described in 1993 (4), and success
ureteric stent malfunction and diabetes (7).
rates comparable to open pyeloplasty of 84-98% are
Most treatment failures present within the first
quoted (5).
18 months following the procedure. However,
Some now believe that laparoscopic pyeloplasty
secondary PUJO has been identified in patients up to 5
is the new gold standard, having superior outcomes
years after primary treatment. This suggests that a
compared to endopyelotomy and less morbidity
prolonged follow-up may be necessary in these patients
compared to open pyeloplasty.
(9).
Other modalities for primary intervention include
The aim of this study was to evaluate our
robotic pyeloplasty, which may have equivalent results
institution in laparoscopic management of pelviureteric
to laparoscopy, but is not as widely available and has
junction obstruction after failed open or laparoscopic
less follow-up to date (6).
surgery for pyeloplasty.
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2291
Received:26 /7 /2020
Accepted:25 /9 /2020
c:\work\Jor\vol816_30
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (6), Page 2295-2299
Serum leptin level in diabetic patients with erectile dysfunction
Moustafa A. El Taieb*1, Eisa M. Hegazy2, Ahmed I. Ebeed3,Mostafa A. Maher1
Departments of 1Dermatology, Venereology & Andrology and 3Radiodiagnosis, Aswan Faculty of medicine, Aswan
University, Egypt.
2Department of Dermatology, Venereology and Andrology, Qena Faculty of medicine, South Valley University,
Egypt.
*Corresponding author: Moustafa A. El Taieb, Mobile: +201092991101,
Email: moustafa.eltaib@aswu.edu.eg musmus22@yahoo.co.uk
ABSTRACT
Background: Erectile dysfunction (ED) is a common sexual problem affecting men. Diabetes mellitus (DM) is one
of the most common comorbidities of ED. Leptin is a 167-amino-acid peptide that is mainly expressed in white
adipose tissue but is also found in a variety of tissues. Objective: To estimate serum level of leptin in diabetic
patients with ED and correlate level of serum leptin in diabetic patients with severity and origin of ED. Patients and
methods: Cross-sectional descriptive study was conducted on 64 individual male; 34 diabetic patients of both types
of DM with ED and 30 non diabetic normal erectile function as control. All patients were evaluated clinically by
history included IIEF-5 score and examination. Assessment of serum leptin level, HbA1c, cholesterol, triglycerides
was done and penile duplex study was done only for diseased patients. Results: Serum leptin significantly increased
in cases than control (P <0.001). Also, there was increased in diabetic men vasculogenic ED either arterial, venous
or mixed (P =0.047). Serum leptin was correlated with the severity of ED (P =0.046). Conclusion: Leptin may play
an important biomarker as a cost-effective method for diagnosis and assessment of severity of vasculogenic ED in
DM and as a good predictor for ED occurrence.
Keywords: Diabetes mellitus, Erectile dysfunction, Serum leptin.
INTRODUCTION
PATIENTS AND METHODS
Erectile dysfunction (ED) is the failure to attain
This is a cross-sectional descriptive study, which
or maintain a satisfactory penile erection for sexual
was performed between August 2018 and May 2019 at
intercourse (1). It is a common problem affecting 15%
the Department of Dermatology, Venereology and
of men in the age range of 40 to 50 years, 45% of men
Andrology at Aswan University Hospital.
in their 60s, and 70% of men older than 70 years (2). ED
is classified into organic and psychogenic subtypes, of
Ethical approval: An informed consent was taken
which the organic subdivision is often caused by a
from all patients. The study was approved from
variety of factors including diabetes mellitus (DM),
Ethics Committee, Faculty of Medicine, Aswan
hypertension,
cardiovascular
diseases,
and
University.
hyperlipidemia (3).
Patients with other causes of ED including pelvic
ED is known to be one of the pressing problems
trauma, pelvic surgical intervention, hypogonadism,
faced by people with diabetes. About 75% of men who
hyperprolactinemia, smoking and old age more than 60
live with diabetes are exposed to ED in their earlier
years were excluded from our study.
ages as compared to non-diabetic men (4). DM was able
The study involved 64 individual male enrolled by
to produce oxidative stress damage in cavernosal
Diabetic Outpatient Clinic and Andrology Outpatient
tissues, usually resulting in the loss of the physiological
Clinic complaining of ED. It included 34 diabetic
properties of endothelium and shifting to a
patients. The patients were of both type of DM and
vasoconstrictor, pro-thrombotic and pro-inflammatory
their age ranged from 28-60 years. It also included 30
state (5).
non diabetic normal erectile function as control, their
Leptin was discovered as the product of obese
age ranged from 21-45 years. Each patient was assessed
(ob) gene, which is located on the long arm of 7th
by complete history, general, and genital examination.
chromosome (6). The peripheral actions of leptin include
In IIEF-5 score (International Index of Erectile
stimulation of inflammatory reaction, oxidative stress,
Function-5 items) (9) each item is scored from 0 to 5 on
atherogenesis and thrombosis, thus promoting
four items and 1 to 5 in one item. Disease grades of ED
endothelial dysfunction, arterial stiffness, development
on IIEF-5 scores were categorized as follows: severe
and vulnerability of atherosclerotic plaques (7, 8).
ED (IIEF-5 score: 1-7), moderate ED (IIEF-5 score: 8-
Aim of this study was to estimate serum level of
11), mild to moderate ED (IIEF-5 score: 12-16), mild
leptin in diabetic patients with ED and correlate level of
ED (IIEF-5 score: 17-21), and no ED (IIEF-5 score: 22-
serum leptin in diabetic patients with severity and
25). Investigations done for both diseased and control
origin of ED.
were as follows: serum leptin measured by enzyme
immunoassay method, triglycerides, cholesterol level,
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2295
Received: 26/7/2020
Accepted: 25/9/2020