c:\work\Jor\vol817_1
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2300-2304
Laparoscopic Versus Open Pyeloplasty for Management of Secondary
Ureteropelvic Junction Obstruction
Hassaan A. Gad*1, M. Zaki Eldahshoury1, Mohammed M. Hussein1, Ahmed Hammady2
1Department of Urology, Faculty of Medicine, Aswan University, Aswan, Egypt
2Department of Urology, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Hassaan Ali Ahmed, Mobile: (+20) 01113730199, E-Mail: hassan.ali@aswu.edu.eg
ABSTRACT
Background: Ureteropelvic junction obstruction (UPJO) causes hydronephrosis and progressive renal impairment
may ensue if left uncorrected. Open pyeloplasty remains the standard against which new techniques must be
compared.
Objective: To evaluate the laparoscopic management of secondary pelvi-ureteric junction obstruction regarding the
operative time. Bleeding requiring blood transfusion intraoperative complication, hospital stays short- and long-
term complication, and the rate of success in comparison to open repair in literature.
Patients and methods: This study was conducted at the Urology Department of Aswan and Sohag University
Hospitals. In the period from April 2016 to April 2020, a total of forty-five patients with secondary PUJ obstruction
fulfilling the inclusion criteria were admitted for undergoing laparoscopic pyeloplasty.
Results: The median follow-up period was 24 months (6-36 months). The mean of operative time (LPP) was 154.9±
25.4 minutes, ranged from 80 to 185 minutes, and the mean of blood loss was 77.8±32.8 ml, ranged from 30 to 190
ml. The mean value of hospital stay of our patients was 3.8±1.2 days, ranging from 2 to 7 days, and the mean of
follow-up was 5.6±2.15 months, ranged from 3 to 24 months. During the follow up there were three patients who
experienced postoperative obstruction, our success rate was 93.3%.
Conclusion: Laparoscopic pyeloplasty regarding cost-effectiveness, success rate, complications, and outcome the
disadvantages of longer operative time of laparoscopi pyeloplasty, and the long learning curve, is more superior to
open pyeloplasty in shorter hospital stay, early convalescence, and low postoperative analgesic requirements.
Keywords: Open pyeloplasty, Laparoscopic pyeloplasty, Redo pyeloplasty, UPJO
INTRODUCTION
Open pyeloplasty has been the gold standard for
endopylotomy as it deals effectively with the crossing
surgical treatment of ureteropelvic junction (UPJ)
vessel (6).
obstruction, enjoying a long-term success rate
In cases of failed pyeloplasty open redo provides
exceeding 90% (1).
excellent results, with reported success rates of 77.8
Ureteropelvic junction obstruction. is the most
100% and have been suggested to be the first-choice
common congenital abnormality of the upper urinary
method for repair (7).
tract, open pyeloplasty has been the gold standard for
Laparoscopic pyeloplasty has recently been shown
UPJO repair Since the first successful reconstruction of
to have excellent success rates for persistent UPJO
an obstructed UPJO was accomplished in 1892 (2), and
after a previously failed procedure (8).
achieves success rates exceeding 90% (3).
This work aims to evaluate the laparoscopic
Open pyeloplasty originally described by
management of secondary pelviureteric junction
Andersen et al. (4) remains the gold standard against
obstruction regarding the operative time, bleeding
which new techniques must be compared. The
requiring
blood
transfusion
intraoperative
morbidity associated with flank incision, however, has
complication, hospital stays short and long term
led to the development of minimally invasive
complication and the rate of success.
approaches to UPJ repair. Over the last two decades,
the treatment approach to UPJ obstruction has evolved
PATIENTS AND METHOD
from open pyeloplasty to various minimally invasive
This study was conducted at the Urology Department
procedures like endopyelotomy, acucise catheter
of Aswan and Sohag University Hospitals. In the
incision, balloon dilatation, and laparoscopic
period from April 2016 to April 2020, a total of forty-
pyeloplasty. These minimally invasive options are
five patients with secondary PUJ obstruction fulfilling
reported to have been less successful than open
the inclusion criteria were admitted for undergoing
pyeloplasty (5).
laparoscopic pyeloplasty.
Laparoscopic
dismembered
pyeloplasty
Inclusion criteria: All adult patients with PUJ
represents a minimally invasive alternative of gold
obstruction after renal surgery (open, endoscopic, or
standard open Anderson- Hynes technique that has a
laparoscopic previously repaired).
comparable successful outcome with open pyeloplasty
Exclusion criteria:
while avoiding its comorbidity. It is also better than
1. Patient having poor ipsilateral renal function < 15%.
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/)
2300
Received:27 /7 /2020
Accepted:26 /9 /2020
c:\work\Jor\vol817_2
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2305-2309
Dissipation Kinetics of Pymetrozine in Tomato Field Ecosystem
Sherif H. Abd-Alrahman1 and Gamila, A. M. Kotb*2
1 - Pesticides Residue and Environmental Pollution Department, Central Agricultural Pesticides Laboratory,
Agricultural Research Center (ARC), Dokki, Giza ,2- Mammalian and Aquatic Toxicology Department, Central
Agricultural Pesticides Laboratory, Agricultural Research Center (ARC), Dokki, Giza 12618, Egypt
* Corresponding Author: Gamila, A. M. Kotb, e-mail: kotb_73@yahoo.com
ABSTRACT
Background: The food safety is one of the top priorities in the protection of public health. Pesticide residue has
environmental and human health impact so, studding the behavior and dissipation of pesticides on foods is necessary.
Objectives: This paper aimed to study the dissipation kinetics of pymetrozine to assess its effect in the ecosystem of
tomato field, to expose residual dissipation behavior.
Materials and methods: In a tomato-field ecosystem, tomato samples were collected after pymetrozine application in
different time intervals 0, 1, 3, 5, and 7 days. The dissipation kinetics and residual behavior of insecticide were analyzed
based on a QuEChERS method and quantified by high-performance liquid chromatography combined with photodiode
array detection (HPLC-DAD). Results: The average recovery from tomatoes was 90.75% (88.5 - 93%), and 85 - 87.5%
from soil. The coefficient variation of the method (CV %) was less than 7% in tomatoes, and less than 12%. in soil, ranged
from 1.27% to 4.77% for repeatability. The low detection limit (LOD) and limit of quantitation (LOQ) of pymetrozine
were determined to be 0.01 and 0.03 mg/kg, respectively. The dissipation kinetics of pymetrozine residue was C = 1.504
e-0.528t in tomato and C= 11.82 e-0.4082t in soil, in addition, residues half-lives were 1.31, and 2 days, respectively.
The pre-harvest interval (PHI) of pymetrozine on tomatoes was 3 days. The recommended dosage could be considered a
safe dosage for humans.
Conclusion: This study would contribute to provide information on safe and proper use of the pesticide.
Keywords Dissipation, Pymetrozine, Tomato, QuEChERS, HPLC-DAD.
INTRODUCTION
number of pesticides are applied in the tomato field to
Pymetrozine is a selectivity insecticide used for
control all these different diseases[18].
insects, such as aphids, whiteflies, and plant hoppers [1-
To our knowledge, few studies have examined the
4].It has a novel way by interfering in the neuro-regulation
dissipation of pymetrozine in agricultural products;
or nerve-muscle interaction and cause the death of insects
broccoli [19], rice field [20,21], red pepper [22], and lettuce
after a few days through the feeding behavior [5-
[23],and there are no published studies about its dissipation
7].Moreover, pymetrozine has been considered by the US-
on tomatoes. The main aim of this paper was to study the
EPA as a ``likely'' human carcinogen [8].Dissipation
dissipation kinetics of pymetrozine to assess the
studies are necessary to evaluate the pesticide residue
pymetrozine effect in the ecosystem of tomato field, to
behavior and the degradation kinetics under the open field
expose residual dissipation behavior of pymetrozine.
conditions to determine PHI is below the maximum
These findings may aid in the creation of regulations for
residue limit (MRL). QuEChERS is a well-known
the safe use of pymetrozine in tomato field pest
method that was applied in the multi-residues analysis of
management strategies.
pesticides in a variety of food[9], in tomato [10], in fruits
and vegetables [11]. penconazole in tomato [12],
MATERIALS and METHODS
propamocarb-hydrochloride in different matrices [12],
1 - Chemicals and reagents
QuEChERS method is easy and high throughput
Analytical standard (purity 98%), and the
compared to conventional analysis methods [14,15].
formulation (Chess 50% WG) were supplied by Syngenta
QuEChERS was recently considered to be the official
(Cairo, Egypt), general structure of pymetrozine (figure
multi-residues AOAC method for the study of pesticide
1).LC grade organic solvent(acetonitrile, methanol, and
residues in fruits and vegetables [16].
analysis grade acetic acid) was purchased from Merck
Tomato is one of Egypt's most important and
Millipore Ltd. Milli-Q water purification system for
common vegetables. Approximately 526 feddan;
ultrapure water. PSA, 40 µm was purchased from Supelco
representing 34% of Egypt's cultivation area were used for
(Supelco, USA). Magnesium sulfate anhydrous, and
tomato cultivation. Tomato can be eaten fresh as a salad,
Sodium chloride were purchased from Merck Millipore
or processed as a juice or paste[17]. Tomatoes at various
Ltd. An Agilent HPLC with a quaternary pump, column
growing stages are infested by several pests. A large
thermostat, and photodiode array detector was used.
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/)
2305
Received:28 /7 /2020
Accepted:27 /9 /2020
c:\work\Jor\vol817_3
The Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2310-2317
Study of CD4 and CD8 Subsets in Morbid Obese Population
Fawzia Hassan Abo Ali, Asmaa Saber Mostafa Abdel Rehim,
Hoda Mohamed El Sayed, Shaimaa Hani Fouad, Amira Ramadan Elmahdi*
Department of Internal Medicine, Allergy & Clinical Immunology,
Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding Author: Amira Ramadan El Mahdi, Internal medicine Department, Faculty of Medicine, Ain Shams
University, Abbasiyya, Cairo, Egypt, Mobile: +201121641520, E-mail: dr_ amiraramadan@yahoo.com
ABSTRACT
Background: Immune dysfunction is one of the co-morbidities that became well recognized several years ago in
people with obesity. Objective. To study the peripheral blood T-cell compartment, the absolute counts and relative
frequencies of T-cell subpopulations including CD8+T cells; CD4+Tcells in adults suffering morbid obesity
compared to lean subjects. Patients and methods: This case-control study included 30 adults with morbid obesity
and 20 lean healthy subjects who were age and sex-matched.CD4 and CD8 absolute and relative count together
with CD4/CD8 ratio were assessed and compared between the two groups. Results: Adults with morbid obesity
had higher total leucocyte count (TLC), CD4 percentage, CD4 absolute count, and CD4/CD8 ratio than that of
controls. On the other hand, the CD8 percentage was lower in people with morbid obesity. There were positive
correlations between CD4% and BMI, waist circumference, cholesterol, triglyceride, LDL, and TLC and
neutrophils count. There was a negative correlation between the percentage of CD8 and BMI. CD4/CD8 ratio
correlated positively with BMI but negatively with systolic blood pressure. Conclusion: CD4+ CD8+ T
lymphocytes assay could help assess the immune state and recognize obese at risk of immune dysfunction
complication as infection and metabolic diseases.
Keywords: CD4, CD8, morbid, obesity, lymphocytes
INTRODUCTION
CD8+T cells and CD4+Tcells in morbidly obese
Obesity is a metabolic disease that has increased
compared to lean subjects.
in prevalence lately. It is considered a major risk of
death in the West (1). Complications of obesity include
MATERIAL AND METHODS
type 2 diabetes mellitus and cardiovascular disease (2).
The present study was a case-control study that
Immune dysfunction is one of the co-
included 30 apparently healthy morbidly obese adults
morbidities that appeared several years ago in obese
(BMI 40) subjects. Patients were recruited from the
(3). Studies clarified the role of excess adiposity in
outpatient Obesity Clinic, Ain Shams University
increased susceptibility of infection and therefore
Hospital, Cairo, Egypt between October 2014 and
proved a negative impact on the immune system (4).
February 2016. Twenty lean healthy subjects of
Morbid obesity has been described as a chronic
matched age and sex were also included as controls
inflammatory disease that contributes to immune
(BMI 18.5-24.9).
dysfunction, as it participates in neutrophil and
monocyte dysfunction (5, 6). Although macrophages in
Ethical considerations
the adipose tissue are long known to be the primary
The study was approved by the ethical committee
cause of chronic inflammation, T cells appeared to
of Ain Shams University and written informed
accumulate in adipose tissue in an amount that
consent was obtained from all participants.
exceeded that of macrophages (7-10). Therefore, studies
Patients who smoked, pregnant females, patients with
postulated the importance of T cells in the
chronic illness such as advanced liver, pulmonary,
pathogenesis of adipose tissue inflammation (11).
renal diseases, or diabetes mellitus, known
T cells are the main contributors to the adaptive
malignancy,
or
on
current
medications
immune system. The main two arms of T cells are the
(antihypertensive, lipid-lowering, hormones, anti-
CD4+ T cells, which recognize MHC II-presented
inflammatory, and immunosuppressive drugs), acute
antigens, and the cytotoxic CD8+ T cells which are
or chronic inflammatory or infectious diseases, recent
responsible for the MHC I-presented antigens (12,13).
trauma, and positivity for hepatitis B and C were
Limited number of studies demonstrated the link
excluded from the study.
between obesity and the composition of the peripheral
Patient data and Anthropometric Measurement.:
immune system(14,15). Some studies reported an
For all subjects: age, weight, height, and blood
increase in the T-cell compartment proliferation while
pressure were recorded. Full history taking and
others demonstrated a decrease in the number(16-18).
clinical examination were done with special emphasis
This work aimed to study the peripheral blood
on the history of any chronic disease, current
T-cell compartment, the absolute counts and relative
infections, and any current medications. Measurement
frequencies of T-cell subpopulations including
of mean arterial blood pressure was done using
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) 2310
license (http://creativecommons.org/licenses/by/4.0/)
Received:22 /6 /2020
Accepted:21 / 8/2020
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Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2318-2324
Autogenous Bone Graft as a Surgical Method for Treatment of
Simple Bone Cyst in Calcaneus
Ahmed Mohammed Ibrahim Attia*, Mohsen Mohammed Mar'éi, Reda Hussein Elkady,
Mohammed Abd Elfattah Sebai
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
*Corresponding author: Ahmed Mohammed Ibrahim Attia, Mobile: (+20) 01147381381,
E-Mail: ahmed_abo33mra@yahoo.com
ABSTRACT
Background: Simple bone cysts are benign lesions with fluid content, commonly occur in the proximal
femur and humerus and rarely occur in the calcaneus. Calcaneal bone cysts are usually asymptomatic,
diagnosed incidentally on radiographs and rarely susceptible to pathological fractures, but it may present
with heel pain. The site of the cysts is usually the neutral triangle of the calcaneus. Plain radiograph, CT,
MRI and histopathology examinations are the diagnostic tools for simple bone cyst (SBC) in calcaneus.
Objective: To evaluate the results of using autogenous bone graft in surgical treatment of simple bone
cysts in calcaneus.
Patients and Method: A prospective study held between February 2019 and February 2020, where 12 patients
included with simple bone cyst in the calcaneus managed by curettage and autogenous bone graft were admitted to
Orthopedic Department at Zagazig University Hospitals and followed up for 6 to 12 months.
Results: Age of the patients ranged from 5 to 30 years with mean age of 15.8 years. 8 [66.7%] patients
were male and 4 [33.3%] patients were female. All of the patients had heel pain and two of them [16.7%]
had pathological fractures. 10 patients [83.3%] had complete healing of the cyst while 2 patients [16.7%]
of them healed with defect and all of the studied cases [100%] had complete clinical resolution. The
observed complications during the follow-up period were superficial infection on one [8.3%] patient and
delayed wound healing on another [8.3%] patient.
Conclusion: Curettage and autogenous bone graft is an effective successful method for treating SBC in
the calcaneus.
Keywords: Autogenous bone graft, Calcaneus, Curettage, Simple bone cyst.
INTRODUCTION
Simple bone cysts are benign lesions filled
tools to determine these cysts(5). SBC should be
with fluid. The frequent sites are the proximal
differentiated from other calcaneal lesions as
femur and humerus (7580%). They rarely occur
ABC, lipoma, Ewing's sarcoma, GCT, osteoid
in the calcaneus but calcaneus is the most
osteoma, osteomyelitis and metastasis(6).
common tarsal bone affected(1).
In
the
majority
of
cases,
conservative
Contrary to other bone cysts, the calcaneal
management is preferred due to the negligible
bone cysts are asymptomatic, rarely susceptible to
symptoms and the rare incidence of pathological
pathological fractures and incidentally diagnosed
fractures(7). The main indication for surgical
as a result of minor trauma to the foot or ankle.
treatment is pain or an impending pathological
However, pain is the major complain in many
fracture. According to Pogoda's criteria, calcaneal
patients and it may be severe to affect their daily
cysts that take up 100% of the cross-section in the
activities. The size of the cyst is generally less
coronal plane or at least 30% of the calcaneus in
than 1/31/2 of the calcaneal length(2).
the sagittal plane represent a potential risk for a
The etiology of simple bone cysts remains
pathological
fracture
and
should
receive
unclear and the most accepted pathogenesis is the
prophylactic surgical treatment even if the cyst is
venous
obstruction
of
the
interstitial
fluid
asymptomatic(8).
drainage in an area of rapidly growing cancellous
General treatment options include steroid
bone lead to development of simple bone cyst(3).
injection, curettage with autologous or allogenic
The site of the cysts is usually the neutral
grafting, bone substitutes, multiple drilling and
triangle of the calcaneus where stresses are
continuous decompressions through a cannulated
physiologically low(4). Plain X-ray, CT, MRI and
screw. The risk of recurrence can be reduced by
histopathology examination are the diagnostic
mechanical destruction of the inner cyst wall by
application of chemical or thermal intraoperative
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/)
2318
Received: 20/6 /2020
Accepted: 19/8/2020
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Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2325-2334
Patterns of Work-related Musculoskeletal Disorders among Health Care Workers
Hassan ElSayed El Far, Eman Abd El Fattah Albitar,
Eman Mohamed Araby, Nashwa Nabil, Omyma Mahmoud Hassan
Department of Community Medicine & Public Health, Faculty of Medicine, Benha University, Benha, Egypt
Corresponding author: Nashwa Nabil, Mobile: (+20) 01125923049, E-Mail nashwanabil2020@gmail.com
ABSTRACT
Background: Work related musculoskeletal disorders (WRMDs) is a high cost problem in the healthcare industry
and one of the leading causes of disability among health care workers (HCWs). It is an ongoing problem due to
frequent patients handling with limited resources, time constraints & repeated shifts.
Objective: To determine the prevalence & severity of WRMDs among HCWs at Benha University Hospitals
(BUHs), to identify the risk factors of WRMDs and finally, to recommend a program for prevention.
Patients and methods: It was a cross-sectional included 343 of HCWs at BUHs from 1st May 2019 to the end of
December 2019 using an interview questionnaire incorporating the Nordic Musculoskeletal Questionnaire.
Results: The majority of the studied group were females (81.9%) with a mean age of 35 ± 7.5 years old. Nurses
represented more than two thirds of the studied group (67.1%) while 25.9% were doctors and only (7%) were service
workers. The prevalence of chronic MSDs among studied group was 81%. Chronic lower back pain (LBP) was the
most prominent complaint in the last 12 months (81%), while only (14.3%) complained of chronic elbow pain.
(WRMDs) were significantly higher among those who keep prolonged static and awkward posture, those having
work shift, over-time work, those who felt hard to keep-up with work pace and those who did not have enough rest
time during working hours and did not have regular rest at work.
Conclusion: Workrelated musculoskeletal disorders have a great impact on the workers, the organization and the
society as a whole. So measures to prevent them are recommended.
Keywords: WRMDs, HCWs, BUH.
INTRODUCTION
Most of Egyptian studies on WRMDs among medical
Work-Related
Musculoskeletal
Disorders
workers were limited to one professional groups such
(WRMDs) are defined as " injuries or disorders of the
as nurses, physical therapists, dentists etc. In addition,
muscles, nerves, tendons, joints, cartilage and
there is lack of studies about WRMDs among all
disorders of the nerves, tendons, muscles and
groups of healthcare workers in Egypt generally and
supporting structures of the upper and lower limbs,
particularly in Benha. Therefore, this study aimed to
neck and lower back that are caused, precipitated or
explore the prevalence of WRMDs among different
exacerbated by sudden exertion or prolonged exposure
HCWs and its relation to the work environment &
to multiple risk factors (1). WRMDs may occur due to
psychological factors.
physical risk factors, psychosocial, workplace
organizational factors and personal risk factors.
SUBJECT AND METHODS
Physical risk factors for WRMDs include force,
Study design: This was a cross-sectional study
repetition, vibration, coldness and awkward postures.
conducted in Benha University Hospitals. Fieldwork
Psychosocial risk factors include, higher job demands,
started from 1st May 2019 to the end of December
taking fewer rest breaks, awkward postures,
2019. The target group was health care personnel
movements or exposure to forces (2). Organizational
(physicians, nurses and service workers) fulfilling the
factors are defined as the distribution of work tasks
inclusion criteria. They were working for at least 5
over time and between workers. The duration of work
years in BUHs. Exclusion criteria included pregnancy,
and rest periods has a profound effect on tissue fatigue
chronic diseases like D.M and hypertension and
and recovery (3).
finally, the participant must not have any
Globally, WRMDs are the highest contributor
musculoskeletal injuries due to neurological diseases,
to global disability (accounting for 16% of all years
metastatic disease or spinal surgery caused by causes
lived with disability) and lower back pain remained the
other than workplace.
single leading cause of disability globally. WRMDs
Sampling design: The sample size was calculated
result in a median of 8 missed work days compared to
according to the following equation with Confidence
non-fatal injuries/illnesses, which account for only 6
days of missed work (4). The prevalence of WRMDs
SS = Z2 *(P)* (1-P) / E 2
varies between 33%-88% among nurses all over the
world, while it was about 84% or higher in some
Interval 95%, margin of error 5% and study power
Egyptian hospitals (5).
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/)
2325
Received:27 /7 /2020
Accepted:26 /9 /2020
c:\work\Jor\vol817_6
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2335-2339
Value of Increased Serum Lactate in Critically Ill Children in
Pediatric Intensive Care Unit and Its Association with Worse Outcome
Mohamed Mahmoud Romih1, Dina Tawfeek Sarhan1,
Ahmed Mohamed Baraka2, Mohamed Abdelhalem Mohamed*1
Departments of 1Pediatrics and 2Clinical pathology - Faculty of Medicine, Zagazig University
*Corresponding author: Mohamed Abdelhalem Mohamed; Email: besideyoubimo@yahoo.com, Mobile: (+20) 01018129676
ABSTRACT
Background: There is increasing evidence that lactate and hyperlactatemia can be a marker for the outcome in
critically ill children. Objective: Our study aimed to describe the prognostic value of increased serum lactate in
critically ill children and its association with worse outcome.
Patients and methods: This prospective observational (cohort) study was carried out in Pediatric Intensive Care
Unit (PICU) and Clinical Pathology Department at Zagazig University Hospitals over a period of 6 months started
from august 2018 till January 2019, it included 86 critically ill children. The study was approved by Ethics
Committee, Faculty of Medicine, Zagazig University.
Results: Serum lactate was significantly higher among died cases than survived. Conclsuion: Hyperlactatemia in
critically ill children is associated with worse outcome in critically ill patient in PICU.
Keywords: Hyperlactatemia, outcome, children, PICU.
INTRODUCTION
Ethical approval
Critically ill children due to various underlying
This study was approved by the
disease processes often have diminished tissue
Institutional Review Board (IRB) and was done
perfusion. Delay in recognition of hypoperfusion leads
after ethical approval of the Ethical Committee of
to development of multi-organ dysfunction syndrome
Research Centre in Zagazig University Hospital and
(MODS). This result in morbidity and increased
informed written parental consent from every subject
mortality until it is timely recognized and promptly
that participated in this work.
reversed (1).
Inclusion Criteria: Patients admitted to PICU for
These patients need intensive monitoring of organs
more than 24 hours and aged from 1 month to 16 years
functions such as functions related to the
including both males and females.
cardiovascular, the respiratory, and the neurological
Exclusion Criteria: Patients whose parents refused
systems. Most critically ill patients are transferred to
participation in the study. Neonates aged < 28 days and
the intensive care unit (ICU) for close monitoring (2).
patients who stayed in the PICU for < 24 hours.
Albumin (3), lactic acid (4), procalcitonin (5),
glucose (6), PaO2 (7) and nutritional status (8) have been
All the participating patient were subjected to the
reported as indicators of the risk of mortality in patients
following:
who are severely ill.
-Full detailed history including:
Lactic acid (LA), a by-product of anaerobic
a- Personal history included age, sex.
metabolism has been used as a biomarker and indicator
b- History of present illness.
of tissue hypoxia. This tissue hypoxia may result from
c- Past history of previous hospitalization, PICU
respiratory or circulatory disorders (9).
admission, medications, blood or blood products
There is increasing evidence available that clinical
transfusion.
signs lag biomarkers like lactate and tissue
d- History of immunization.
hypoperfusion do not always show clinical signs,
e- Developmental and nutritional history.
hyperlactatemia can be the only marker for this
f- Family history.
disorder (1, 9).
We report the incidence of hyperlactatemia and its
-Full clinical examination:
relationship with outcome in critically ill children
1-General examination
admitted in PICU.
2-Chest examination.
3- Significant congenital anomalies.
SUBJECTS AND METHODS
4- Neurological examination: including reflexes,
This study was carried out in Pediatric Intensive
muscle tone, activity, cranial nerves and any abnormal
Care Unit (PICU) and Clinical Pathology Department
movements.
at Zagazig University Hospitals over a period of 6
5- Cardiac examination: for auscultation of the heart
months started from August 2018 till January 2019, it
sounds and detection of any congenital heart diseases
included 86 critically ill children.
or signs of heart failure or murmurs.
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/)
2335
Received:20 /6 /2020
Accepted:19 /8 /2020
Introduction
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2340-2351
Histopathological and Ultrastructural Alterations in The Renal Cortex of
Albino Mice Foetuses Induced by Beta-Lactam Antibiotic 'Amoxicillin'
Sahar A. Sabry, Heba I. Rashad, Mohamed A. Shahin
Department of Biological and Geological Sciences, Faculty of Education, Ain Shams University
Corresponding author: Sahar A. Sabry, Mobile: (+20) 01204427241, E-Mail: aharsabry84@yahoo.com
ABSTRACT
Background: The aim of this investigation was to evaluate the effect of a low and high doses (205 &
820mg/kg body weight, respectively) of the beta-lactam antibiotic amoxicillin on the kidney of maternally
treated mice foetuses.
Material and Methods: Pregnant mice were allocated into three groups; the first group served as control
(injected with the drug solvent) and those of the other two groups were injected intraperitoneally with two
doses (205 & 820 mg/kg body weight) of amoxicillin for 8 days from day 7 till day14 during gestation.
Results: The histological examination of the renal cortex of maternally treated foetuses showed erosion of
the parietal cells of Bowman's capsule, hypoplasia of the mesangial cells of the glomerulus, and erosion of
the epithelial cells lining the proximal and distal convoluted tubules. At the electron microscopical level, the
alternations of the renal cortex of foetuses maternally treated with amoxicillin were represented by, fusion of
the foot processes of the podocytes and partial destruction of the apical brush borders microvilli of the
proximal convoluted tubule cells. Also, degeneration of some mitochondria, and fragmentation of the rough
endoplasmic reticulum elements of the lining cells of some proximal and distal convoluted tubules were
observed.
Conclusions: The uses of amoxicillin should be under restricted precautions specially for the pregnant
women to avoid the hazardous impact.
Keywords: Amoxicillin -Kidney - Mice foetuses.
INTRODUCTION
prescribed during gestation in Egypt; therefore,
-Lactams are the oldest and the most class
the aim of the current investigation was to
of antibiotics used in the treatment of infections (1).
evaluate the histopathological changes of a low
The beta-lactam antibiotics are widely used in
and high doses (205&820mg/kg body weight,
Egypt for the treatment of many cases of acute
respectively) of amoxicillin on the renal cortex of
otitis media, respiratory and urinary tract
maternally treated mice foetuses.
infections, skin infections, salmonella infections,
and chlamydia infections. Antibiotics are used in
MATERIAL AND METHODS
pregnancy for treatment of infections, adding that
Dosages and route of administration of the
many pregnant women may administrate
drug
antibiotics without doctors' prescription (2). Like
Two doses of amoxicillin were used in the
most drugs, -lactam antibiotics cross the human
present investigation; 205 and 820mg /kg body
placenta and therefore the foetus is exposed to
weight and were considered as the low and high
these molecules (3). Amoxicillin is assigned to
doses, respectively, and were calculated based on
pregnancy category B by the U.S. Food and Drug
body surface area according to the conversion
Administration (FDA)(4).
table recommended by Reagan-Shaw et al. (7).
Despite the beneficial role of this drug, yet
The chosen dosages were nearly comparable to
large-scale study has shown an association
the human effective low and high therapeutic
between antibiotic use in the mother and
doses (8).
infections in their foetuses. It is quite evident that
the effects of such this drug on pregnant women
Experimental animals
and their foetuses have received diminutive
The present investigation is carried out on
attention(5).
mature albino mice of pure CD-1 strain with an
Otherwise, male albino rats supplemented
average body weight of 20-30g obtained from the
with amoxicillin (50mg/kg body weight) for five
breeding unit of Theodor Bilharz Research
consecutive days exhibited a significant increase
Institute (TBRI), Imbaba, Giza, A.R. Egypt. The
in serum AST, ALT, and creatinine levels. These
experiments were performed parallel to the ethical
biochemical data were supported by the adverse
standards and according to the International
histopathological observations on the liver and
Guides for the Care and Use of Laboratory
kidney (6).
Animals. Pregnancy was achieved by housing one
Keeping in mind that amoxicillin is
adult virgin female with one well-marked fertile
among these drugs which are handled and
male overnight, from 5 pm until 9 am of the next
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY- 2340
SA)
license (http://creativecommons.org/licenses/by/4.0/)
Received:27 /7 /2020
Accepted:26 /8 /2020
c:\work\Jor\vol817_8
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2352-2360
Comparative Study Between Tubularized Incised Urethral Plate and
Tubularized Incised Plate with Preputial Graft in Hypospadias Repair
Sultan Mohamed Sultan1, Tarek Mohamed AbdelBaky1, Mohamed ElShazly,
Khaled Mohamed Magdy Zein Elabden Youssef*2, Atef Badawy1
1Department of Urology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2Department of Urology, Faculty of Medicine, Kafr El-Sheikh University, Kafr El-Sheikh, Egypt
*Corresponding author: Khaled M.Zein Elabden, Mobile: (+20)1025320013, E-mail: ddrkhaled@yahoo.com
ABSTRACT
Background: Hypospadias is a common congenital anomaly, affecting approximately 1 of 300 live male births making
hypospadias the second most common birth defect in boys after cryptorchidism. there are more than 100 techniques
for urethral reconstruction among these techniques the tubularized incised urethral plate (TIP) which was proposed by
Snodgrass in 1994 has been the most popular technique for the repair of primary hypospadias.
Objective: To study the difference between tubularized incised urethral plate and tubularized incised plate with
preputial graft in hypospadias repair.
Patient and methods: This prospective randomized study included sixty patients suffering from hypospadias who was
admitted to the urology department of Menoufia and Kafr El-Sheikh University Hospitals from December 2018 to June
2020 which were randomized into two groups; group I underwent the classic TIP repair and group II underwent TIP
repair with inlay preputial graft. Operative details, postoperative complications were reported also uroflowmetry was
done for all cases at the 3rd and 6th months postoperatively.
Results: There was no significant difference between both techniques regarding the postoperative complications and
overall success rate (P 0.718) which were 83.3% and 86.7% in A and B respectively. The uroflowmetry at 3rd month
postoperatively showed no significant groups difference in Q max between both groups (p >0.05) while there was a
significant improvement in Q max in the 6th month in the grafted group (p. 0.001)
Conclusion: despite both the classic TIP repair and TIP with preputial graft were comparable according to the overall
success rate and postoperative complications the grafted TIP was more superior to classic TIP in the functional
outcomes which were assessed by the uroflowmetry (Q max).
Keywords: Tubularized incised urethral plate, Tubularized incised plate, Hypospadias.
INTRODUCTION
Hypospadias is a congenital anomaly of the
epithelialization and to augment the narrow urethral
anterior urethra of males where the urethral opening
plate (8).
presents more proximal than its normal glanular
Later on; Kolon and Gonzales (9) reported inner
position. It is a common congenital anomaly, affecting
preputial graft allows the surface area of the healthy
approximately 1 of 250 live male births making
epithelium in neourethra rather than the raw area of
hypospadias the second most common birth defect in
traditional TIP (9).
boys after cryptorchidism (1). Hypospadias may be
This work aimed to study the difference between
associated with abnormal ventral curvature of the penile
tubularized incised urethral plate and TIP with preputial
shaft which is called chordee (2, 3).
graft in hypospadias repair.
The tubularized incised plate (TIP) repair is based
on an old principle of urethral plate tubularization which
PATIENTS AND METHODS
is known as the Thiersch-Duplay procedure (4). if the
A prospective randomized study included patients
urethral groove was not wide enough for tubularization
suffering from hypospadias who were admitted to the
in situ, alternative approaches such as the Mathieu
Urology Department of Menoufia and Kafr El-Sheikh
urethroplasty or a vascularized island flap were
University Hospitals during the period of study from
determined (5). In 1994, Snodgrass popularized the
December 2018 to June 2020.
concept of urethral plate incision with subsequent
tubularization and secondary dorsal healing for primary
The study design: It is a prospective randomized study
hypospadias repair. Not surprisingly, the principle of
which was conducted on Sixty patients who were
incising the urethral plate had been employed before, but
included and divided randomly into Group I: (30
for different purposes (6). In 1987 Ordeszewski incised
patients), underwent TIP repair and Group II: (30
the plate to achieve easier tubularization in redo cases
patients), who underwent TIP repair with inlay preputial
where the urethral plate is often scarred (7). In 1998
graft. (Grafted TIP)
Spagnoli had reported the use of a dorsal inlay graft for
The patients were randomized as follows; every odd
urethroplasty for primary hypospadias to initiate healing
number of the patients was given in group (A) for TIP
of the IP by
repair, and every even number was given in group (B)
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/)
2352
Received:27 /7 /2020
Accepted:26 /9 /2020
c:\work\Jor\vol817_9
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2361-2367
Cord Blood Alkaline Phosphatase and Albumin as Probable Predictors of
Significant Neonatal Jaundice in Healthy Full-Term Infants
Ahmed Thabet Mahmoud1, Seham Ahmed Khodeer2, Hanan Mostafa El-Sayed1, Youstina Isaac Zaki*1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine - Menoufia University
*Corresponding author: Youstina Isaac Zaki, Mobile: (+20) 1226454419, E-Mail: drminaezat@hotmail.com
ABSTRACT
Background: Hyperbilirubinemia in a neonate may occur in 60 -70 % of term and 80 % of preterm babies. It is
known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. The concept
of prediction of jaundice offers an attractive option to pick up babies at risk of neonatal hyperbilirubinemia.
Objective: To assess the predictive value of cord blood alkaline phosphatase (ALP) and cord albumin in development
of indirect neonatal hyperbilirubinemia in healthy term infants.
Patients and method: This prospective cohort study was conducted at Obstetrics Emergency Department, Menoufia
University Hospital and included (100) healthy full-term neonates over a period November 2019 to August 2020.
Result: The cord alkaline phosphatase in no jaundice group was (248.63±71.73 U/L) while in jaundice group it was
significantly higher (374.98±67.15 U/L, p <0.01). The cord albumin in no jaundice group was (3.72±0.18 g/dl) and
in jaundice group it was (2.81±0.31 g/dl) with a highly significant decrease in jaundice group than the no jaundice
group (p <0.01). The area under the curve was 0.965, at the cutoff value of alkaline phosphatase more than 315 (U/L),
with a sensitivity of diagnosis of jaundice 95.0%, and a specificity 100.0%. Also, the area under the curve was 0.983
at the cutoff value of cord albumin (g/dl) less than 2.82 (g/dl) with sensitivity of diagnosis of jaundice 96.0% and a
specificity of 100%.
Conclusion: It can be concluded that both cord albumin levels and cord blood alkaline phosphatase in a healthy term
neonate can predict the possibility of the neonate who will develop hyperbilirubinemia with a high sensitivity and
specificity, with cutoff value less than 2.8 gm/dl for cord albumin and more than 315 U/L for alkaline phosphatase.
Hence routine determination of cord albumin along with alkaline phosphatase can be implemented to keep track of
at-risk neonates.
Keywords: Cord Albumin, Cord Blood Alkaline Phosphatase, Neonatal Hyperbilirubinemia.
INTRODUCTION
Hyperbilirubinemia in a neonate may occur in
to implement early treatment and thereby minimize the
60 -70 % of term and 80 % of preterm babies. It is
risk of bilirubin dependent brain damage (5).
known to be associated with significant morbidity like
Early detection of risk factors is the first step
neonatal bilirubin encephalopathy and even death (1).
towards prevention of hyperbilirubinemia and a step
Early discharge of healthy term newborns after
ahead in protecting newborns from complications at
delivery has become a common practice because of
later age. There are few references which predict
medical and social reasons and economic constraints.
postnatal hyperbilirubinemia by estimating cord blood
It is significant that most common cause for
bilirubin levels but vary in opinions. Usually, albumin
readmission during the early neonatal period is
binds with unconjugated bilirubin and protects against
hyperbilirubinemia (2).
kernicterus. Blood albumin in neonates is mostly
American Academy of Pediatrics recommends
derived from maternal circulation till baby's liver
that neonate discharged within 48 hours should have a
starts synthesis. There is paucity of reports on cord
follow-up visit after 48 to 72 hours for any significant
blood
albumin
level
as
a
predictor
of
jaundice and any other problems (3). Kernicterus
hyperbilirubinemia (6).
occurs in more than 50% of infants with total bilirubin
Alkaline phosphatase (AP) level was used 6
levels>30 mg/dL but rarely occurs at levels <20
hours after birth as a marker for determining
mg/dL. Infants with total bilirubin levels >35 mg/dL,
hemolysis and hyperbilirubinemia (7).
regardless of etiology or rapidity of intervention, were
Measurement of cord blood AP may be a
observed to achieve some degree of irreversible
predicting marker for neonatal jaundice that
sequelae (4).
necessitates treatment in the first week of life either
The concept of prediction of jaundice offers an
with phototherapy or exchange transfusion (8).
attractive option to pick up babies at risk of neonatal
The aim of this study was to assess the
hyperbilirubinemia. Since physical examination is not
predictive value of cord blood alkaline phosphatase
a reliable measure of the estimation of serum bilirubin;
and cord albumin in development of indirect neonatal
under these circumstances it would be desirable to be
hyperbilirubinemia in healthy term infants.
able to predict the risk of significant jaundice, in order
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/)
2361
Received:27 /7 /2020
Accepted:26 /9 /2020
Untitled-1
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2368-2370
Braided Polyester versus Standard Wire in Sternal Closure in High Risk Patients
Fouad M. Rasekh, Ahmed S. Mahmoud M*
Cardiothoracic Surgery, Faculty of Medicine, Cairo University
*Corresponding author: Ahmed Sayed Hussein, E-mail: drahmed 755@gmail.com, Mobile: +20 01090991111
ABSTRACT
Objective: The aim of this study was to compare braided polyester sternal closure versus standard wire closure in
high-risk patients who are more susceptible to have deep sternal wound infections and mediastinitis after cardiac
surgeries. Patients and Methods: Between February 2017 and December 2019 risk factors for postoperative deep
wound infections and mediastinitis and mortality was collected for 100 adult patients undergoing open-heart
surgery under cardiopulmonary bypass. Patients were divided to two groups, those who underwent sternal closure
using either braided polyester or standard metal wire. Follow-up data on sternal wound healing and deep sternal
wound infections were assessed for up to two months after surgery in the Outpatient Clinics. Results: The
following risk factors were associated with a higher incidence of deep sternal wound infections and mediastinitis
in both groups. There was no mortality in both groups, the number of deep sternal infection and mediastinitis with
sternal dehiscence was 4 patients from group A (Ethibond) and 5 from group B (standard wire). Conclusion: This
study showed that braided polyester could be used safely in sternal closure the same as standard wire in high risk
patients.
Keywords: Braided polyester, Mediastinitis, High risk patients.
INTRODUCTION
impaired renal or liver functions, familial
Deep wound infections and mediastinitis are of
dyslipidemia, smoking and family history. All
the major complications after cardiac surgeries (1).
patients in both groups had routine preoperative
The incidence of deep sternal wound infection of
laboratory investigations, echocardiography, chest X-
course becomes much higher in high-risk patients as
ray PA, carotid duplex for patients above 60 years old
diabetic, obese, redo surgeries and other risk factors.
and coronary angiography in male patients more than
Over decades the stainless steel is the main
40 years old and female patients more than 45 years
material used in closure of the sternum in cardiac
old. All patients in both groups received intravenous
surgeries and although this material was effective to
broad-spectrum antibiotics after worm blood
maintain the sternal stability but it has some
cardioplegia. Group (A): The sternum was closed
drawbacks as development of sinuses related to the
using braided polyester number 5 by 6 figure of 8
wire in some patients (2,3,5). Different materials other
stitches. Group (B): The sternum was closed using
than standard wire were used to close the sternum
standard wire number 7 by 4 figure of 8 stitches. In
after cardiac surgeries to avoid the drawbacks of the
both groups the subcutaneous tissues was closed in 2
standard wire (4,6,7).
continuous layers using Vicryl 2/0 sutures and skin
was closed with Monocryl 4/0 in continuous and
PATIENTS AND METHODS
subcuticular manner.
Between February 2017 and December 2019 in
All patients were followed up daily during
Cairo University Hospital, 100 patients with high risk
hospital stay, one and two month postoperatively in
of postoperative mediastinitis and deep sternal wound
the Outpatient Clinic for sternal healing, deep sternal
infections who were going to open heart surgery using
wound infections and mediastinitis. Follow up of the
cardiopulmonary bypass were chosen to be involved
patients was done by clinical examination, chest X-
in this study. Patients were divided in 2 groups; Group
ray and C.T scan.
(A): 50 patients the sternum was closed using number
5 braided polyester and Group (B): 50 patients the
Ethical approval:
sternum was closed using standard wire number 7.
The study was approved by the Ethics Board
Proper history taking for all patients were obtained
of Cairo University and an informed written consent
including: age, sex, BMI, diabetes, previous surgery,
was taken from each participant in the study.
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2368
Received:27 /7 /2020
Accepted:26 /8 /2020
c:\work\Jor\vol817_11
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2371-2373
Subclavian Artery Versus Femoral Artery Cannulation as An Access for
Cardiopulmonary Bypass in Repair of Acute Type A Aortic Dissection
Fouad M. Rasekh, Ahmed S. Mahmoud*
*Cardiothoracic Surgery, Faculty of Medicine, Cairo University
Corresponding author: Ahmed Sayed Hussein, E-mail: drahmed 755@gmail.com, Telephone: 00201090991111
ABSTRACT
Background: Although many studies have reported the advantages and disadvantages between subclavian and femoral
and cannulation, however most of these studies reported results for all patients underwent deep hypothermic circulatory
arrest (DHCA) with ascending and aortic arch surgery with different pathologies. Objective: In our study we compared
femoral and subclavian artery cannulation and reported the results only for the ascending aorta with acute type A aortic
dissection (ATAAD). Patients and Methods: From January 2017 to January 2018 in Cairo University Hospitals, we
selected 100 patients presented with acute type A aortic dissection and underwent reconstruction of only the ascending
aorta. Patients were divided into two groups, Group (A): includes patients with subclavian artery cannulation to establish
cardiopulmonary bypass (CPB) and Group (B): includes patients with femoral artery cannulation to establish CPB. Early
postoperative results during hospital stay and mortality were reported and compared between the groups.
Results: The preoperative data in both groups showed no statistical difference in both groups, in postoperative data only
Subclavian cannulation had a better cerebral protection and lower hospital stay than femoral cannulation (2 vs 8%, p =
0.04) while other postoperative data as well as mortality showed no statistical differences in both groups. Conclusions:
From results of our study we concluded that subclavian cannulation is better than femoral cannulation in repair of type A
aortic dissection as it has better cerebral protection and lower postoperative hospital stay.
Keywords: Femoral artery cannulation, Subclavian artery cannulation, Type A acute aortic dissection.
INTRODUCTION
scan of chest with contrast. All patients underwent one
Surgical of acute aortic dissection type A (ATAAD) is
of 3 types of surgeries; Bentall, Tirone David or
considered a big challenge to all cardiac surgeons. One of
supracoronary replacement of ascending aorta with
the great difficulties involved in this procedure is how to
resuspension of the aortic valve. All patients were
establish adequate extracorporeal circulation, dealing with
assessed postoperatively by transesophageal echo
the friable aortic wall tissues, and to ensure adequate
(TEE).
cerebral protection especially during the deep hypothermic
Ethical approval:
total circulatory arrest.
The study was approved by the Ethics Board of
Over many years cardiac surgeons used to use femoral
Cairo University and an informed written consent was
artery in this type of surgery as an access to establish
taken from each participant in the study.
cardiopulmonary bypass whether to cannulate it directly by
a femoral cannula or by using synthetic tube graft. Over the
Table (1): Preoperative risk factors
last 2 decades they started to find other surgical access
Group (A) Group (B) P value
during this type of surgery to maintain adequate perfusion
N=50
N=50
to different body organs especially the brain during
Age
60±13
59±11
NS
cardiopulmonary bypass (CPB) (1, .2).
Male gender
38 (76%)
37 (74%)
NS
PATIENTS AND METHODS
Hypertension
15 (30%)
12 (24%)
NS
In our study 100 patients presented by ATAAD were
Marfan
3 (6%)
2 (4%)
NS
selected in the period between January 2017 and January
syndrome
2018 in Cairo University Hospitals. Patients were
Prenancy
4 (8%)
2 (4%)
NS
divided into 2 groups; group (A): 50 patients underwent
Smoking
22 (44%)
20 (40%)
NS
CPB by subclavian cannulation and group (B): 50
Family history 6 (12%)
5 (10%)
NS
patients underwent CBP by femoral cannulation. All
of AADA
patients preoperatively were subjected to proper history
COPD
11 (22%)
13 (26%)
NS
taking age, sex, risk factors and past history, routine
laboratory
investigations,
chest
X-ray,
echocardiography and computerized tomography (C.T)
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/)
2371
Received:27 /7 /2020
Accepted:26 /8 /2020
c:\work\Jor\vol817_13
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2379-2382
Acute Kidney Injury in Mechanically Ventilated Patients in Pediatric
Intensive Care Unit in Children Hospital, Zagazig University
Alaa Zidan Ibrahim1, Mohamed Abdel-Salam Gomaa1, Hanaa Hosni El-Sayed2,
Omar Abdel Badeea Abdel Monem Ali*1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine Zagazig University.
*Corresponding Author: Omar Abdel Badeea Abdel Monem Ali, Mobile: +20 01226914424,
Email: Omar.2020.@gmail.com
ABSTRACT
Background: Over the last decade, the nephrology and critical care communities have repeatedly shown that acute
kidney injury (AKI) in children and adults portends poor short-term and long-term outcomes independent of severity
of illness. Objective: This study aimed to assess the incidence of acute kidney injury in mechanically ventilated
patients in pediatric intensive care unit.
Patients and Methods: This study was prospective cohort study, which conducted on 120 mechanically ventilated
patients admitted to Pediatric Intensive Care Unit, Zagazig University Hospital. We described acute kidney injury by
using PRIFLF criteria and Neutrophil Gelatinase Associated Lipocalin (NGAL) was measured.
Results: About 54 % of patients developed AKI. Mean value of length of hospital stay (days) was significantly higher
among AKI than in non-AKI. Mean value of NGAL was significantly higher between AKI and No AKI.
Conclusion: About half patients developed AKI. Creatinin was significantly higher among AKI. Urine output was
significantly lower among AKI. Length of hospital stay and NGAL was significantly higher among AKI and No AKI.
Keywords: Pediatric Intensive Care Unit- AKI- incidence.
INTRODUCTION
The study aimed to assess the incidence of
Acute kidney injury (AKI) is one of the most
acute kidney injury in mechanically ventilated patients
common conditions seen in the Pediatric Intensive Care
in Pediatric Intensive Care Unit and to identify risk
Unit (PICU) setup. Studies show that AKI is
factors for AKI.
independently associated with poor outcome. 0 by 25, a
global initiative with a strong emphasis on developing
PATIENTS AND METHODS
countries in Africa, Asia, aims to eliminate preventable
This study was prospective cohort study, which
deaths from AKI worldwide by 2025. To achieve this
conducted on 120 mechanically ventilated patients
ambitious goal, the mission is to call for globally
admitted to Pediatric Intensive Care Unit, Zagazig
applicable strategies that permit timely diagnosis and
University Hospital in the period from 2018 to March
treatment of AKI for patients with potentially reversible
2019.
diseases. AKI is often preventable and treatable with
Site of study: Pediatric Intensive Care Unit at Zagazig
few, if any, long-term health consequences. However,
University Hospital.
the lack of early identification and treatment in many
Sample size and method of selection: By assuming
countries means that patients often do not receive
that target population is 300 and incidence of acute
essential care before it is too late. We need to identify
kidney injury is 30% (5). So, the sample size was 120
people who are at risk, monitor them appropriately,
using EPI-INFO program at power 80% and CI 95%.
diagnose the problem early, and provide reliable and
consistent treatment to everyone (1).
Ethical considerations: Approval from Zagazig
While investigators have begun to focus on
Institational Review Board (IRP) and informed
AKI in the Adult Intensive Care Units, there is a paucity
written consents were obtained from the patients
of data in the area of pediatric AKI, in which the
participating in this study after informing them about
population is heterogeneous at varying ages and AKI
the steps of study, the complications and the capability
etiology is often multifactorial (2).
to withdraw at any time.
The urine represents a rich, noninvasive source
Inclusion criteria: Patients admitted to pediatric
of potential biomarkers. This is particularly relevant in
intensive care unit from age 1 month to 18 years old.
the neonatal population where blood-sparing studies are
Time of stay 48 hours. Mechanically ventilated patients.
paramount to standard clinical care. To determine
Exclusion criteria: Patients with previous renal disease
whether there is an association between candidate
or renal transplantation.
urinary biomarkers and AKI in this vulnerable
Data Timing: Data were collected at (Day 0, 3, 7)
population (3).
from mechanically ventilated PICU admission
NGAL is one of most robustly induced proteins
patients.
by the kidney after experimental ischemic or
Study design: We described acute kidney injury by
nephrotoxic injury (4).
using PRIFLF criteria
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/)
2379
Received:29 /6 /2020
Accepted:28 /8 /2020
c:\work\Jor\vol817_14
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2383-2388
Study of the Role of Adiponectin Gene Polymorphism in
Patients with Thyroid Disorders
Mohammed Almhdy Gamal Aldein Kamar, Mohammed Mohammed Awad,
Mayada Mohammed Mousa, Shimaa Mohammed Ragab *
Department of Internal Medicine, Faculty of Medicine Zagazig University.
*Corresponding Author: Shimaa Mohammed Ragab, Mobile: +20 01017489651, Email: dr.shimaa1984@yahoo.com
ABSTRACT
Background: Both hypo & hyperthyroidism are associated with some morbidity & mortality. Adiponectin is a fat
cell-derived hormone that protect against atherosclerotic cardiovascular diseases through its enhancing effect on
insulin sensitivity. Clinical studies investigating serum adiponectin levels in patients with hypothyroidism and
hyperthyroidism have reported conflicting results.
Objective: The study aimed to study the role of adiponectin gene polymorphism in patients with thyroid disorders
either hypothyroidism or hyperthyroidism. Also, the relation of adiponectin gene polymorphism with obesity and
DM.
Patients and Methods: Cross sectional study was conducted on one hundred and fifty cases that were classified
into hypothyroid group and hyperthyroid group. History, examination and investigation (adiponectin gene) was
done.
Results: In current study within hypothyroid & hyperthyroid group, there was non-significant relation between gene
polymorphism and either total T3, free T3, free T4 or TSH. There was statistically non-significant relation between
associated diabetes and either gene or allele polymorphism among patients within hypothyroid group and
hyperthyroid group. There was statistically non-significant relation between patient BMI and either gene or allele
polymorphism among patients within hypothyroid group and hyperthyroid group.
Conclusion: There was no role of adiponectin gene polymorphism and either total T3, free T3, free T4 or TSH. In
addition, there was no role of adiponectin gene polymorphism and either obesity and DM.
Keywords: Total T3, free T3, T4, TSH, Adiponectin, Polymorphism.
INTRODUCTION
reported to be associated with the risk of obesity,
Both hypo & hyperthyroidism are associated with
insulin resistance, T2D, and high levels of low-density
cardiovascular morbidity & mortality. Adiponectin is a
lipoprotein cholesterol (5). In contrast, Menzaghi et al.
fat cell-derived hormone that protect against
(6) found no association with obesity or type 2 diabetes.
atherosclerotic cardiovascular diseases through its
Genetic association studies of ACDC gene in T2D and
enhancing effect on insulin sensitivity. Adiponectin is
/or obesity have been well reported. Two SNPs,
a peptide produced exclusively in adipose tissue. It
45G15G (T/G) and +276G/T, respectively, in exon 2
plays an important role in the regulation of a variety of
and intron 2 of the ACDC gene are found to be
processes, ranging from energy homeostasis, lipid
significantly associated with T2D patients (7).
metabolism and insulin sensitivity to inflammation and
This is the first study to assess adiponectin gene
atherosclerosis (1).
polymorphism in patients with thyroid disorder either
Clinical studies investigating serum adiponectin
hypo
or
hyperthyroidism.
Adiponectin
gene
levels in patients with hypothyroidism and
polymorphism was reported as non-significant marker
hyperthyroidism have reported conflicting results.
in detecting thyroid dysfunctions. Adiponectin gene
While, various studies have demonstrated higher
polymorphism G 276T was reported to be not
adiponectin levels in hyperthyroid or hypothyroid
increased or decreased in patients with hypothyroidism
patients (2). Other reports found no differences in the
and hyperthyroidism.
adiponectin levels in individuals with thyroid
The study aimed to study the role of adiponectin
dysfunction (3).
gene polymorphism in patients with thyroid disorders
The adiponectin is expressed in adipose tissue
either hypothyroidism or hyperthyroidism. Also, the
exclusively. The encoded protein circulates in the
relation of adiponectin gene polymorphism with
plasma and is involved with metabolic and hormonal
obesity and DM.
processes. Gene sequence analysis of human
This cross sectional study was conducted in
adiponectin discovered numerous allele single-
Outpatient Endocrine Clinic and Internal Medicine
nucleotide polymorphisms (SNPs) of adiponectin in
Department in association with the Medical
the general population. In addition, there are many
Biochemistry
Department,
Zagazig
University
SNP polymorphism types, which are related to
Hospital. It included 150 patients, 75 patients of
coronary heart diseases (CHD) (4). Genetic variations
hypothyroidism (group 1) and 75 patients of
in the human adiponectin gene have recently been
hyperthyroidism (group 2) during period from August
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/)
2383
Received: 4/7/2020
Accepted:29 /8/2020
Microbial
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2389-2394
Determinants of Anticoagulation Control in Patients Receiving Warfarin Therapy
Mohammad Hossam Eldeen Al-Shaer, Mohammad Gouda Mohammad,
Islam Galal Sayed Ahmed, Ahmed Mohammed Badawy Ibrahim
Cardiovascular Medicine Department, Faculty of Medicine, Zagazig University.
Corresponding Author: Ahmed Mohammed Badawy Ibrahim, Mobile: +20 01128528577,
E-mail: ahmedbadawy.md89@gmail.com
ABSTRACT
Background: Warfarin, nowadays is considered one of the most prescribed anticoagulant medications. In
England for example, there is at least 1% of the whole population being prescribed warfarin. Despite the
emergence of new agents of anticoagulants like NOACS, warfarin still prevail in most prescriptions knowing
that it can't be substituted in certain indications. Objectives: To assess different factors associated with
International Normalized Ratio (INR) control in patients who are on warfarin therapy for different indications.
Methods: A retrospective cohort study conducted in National Heart Institute Outpatient Anticoagulation Clinic
over six-month period. It included 250 patients on warfarin therapy for different indications. Results: After
calculating Time in Therapeutic Range (TTR) of each patient the level of anticoagulation control was determined
using the following cut off values: a) Good control: TTR>70%, b) Intermediate control: TTR 50 -70 %, c) Poor
control: TTR <50%. Majority of patients in our study 62% had poor control with TTR less than 50%.
Conclusion: Majority of patients have poor anticoagulation control by means of TTR. Male gender, higher
education and employment status are associated with higher mean TTR and better anticoagulation control. Male
gender and employment were significant predictors for good INR control.
Keywords: Anticoagulation, INR control, Warfarin
INTRODUCTION
In our paper we try to evaluate the degree of
The therapeutic range for warfarin therapy is
anticoagulation by warfarin among Egyptian patients
determined by the International Normalized Ratio
by means of TTR calculations and to find different
(INR) which is calculated as the prothrombin time
factors
associated
with
each
degree
of
ratio (patient prothrombin time/mean of normal
anticoagulation like the effects of other co-morbid
prothrombin time for laboratory). The International
conditions, medications and other socioeconomic
Sensitivity Index (ISI) usually is close to 1, and this
conditions.
makes the INR calculation the ratio of the patient's
prothrombin time to the mean normal prothrombin
PATIENTS AND METHODS
time (1-3).
A retrospective cohort study conducted in
Determining the degree of anticoagulation in
National Heart Institute Outpatient Anticoagulation
each patient becomes of paramount importance
Clinic. It included 250 patients on warfarin therapy
especially for those with mechanical valves in whom
for different indications.
not achieving a desirable goal would lead to
Inclusions criteria of the study:
unavoidable consequences. From here many
This study includes all patients receiving
statistical methods emerged to help in solving this
warfarin therapy for more than one month.
issue. The Time in Therapeutic Range (TTR) is
Exclusion criteria of the study:
defined as the percentage of time a patient's INR is
All patients who were hospitalized at the moment of
within the desired treatment range. TTR is not only
conducting the study in order to include the most
used in determining the quality of warfarin treatment
stable INR measurements, which are reached usually
but also is considered for weighing the risks and
after 2 weeks from drug initiation during
benefits of oral anticoagulation. Multiple methods
hospitalization, or if they were participating in a
used for calculating TTR involve: 1) Calculating the
clinical trial.
proportion of INR values that are within range 2)
Patients unwilling or unable to provide written
Evaluating a cross-section of the patient's Files and
informed consent are also excluded.
3) using the Rosendaal method(4).
By using this method we can calculate the
Data collection:
percentage of the total patient's time that lies within
The data collection includes:
the target ranges. The TTR will allow us to estimate
1 Demographic data:
the success of warfarin therapy, because it is very
Age and sex, socio-economic status like
important in assessing warfarin's effectiveness and
employment, educational degree and awareness on
safety, with the maximum benefits when TTR is
anticoagulation.
>70%(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/)
2389
Received:29 /6 /2020
Accepted:28 /8 /2020
c:\work\Jor\vol817_16
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2395-2399
Acute Kidney Injury in Patients of Emergency and
Surgical Intensive Care Units: Incidence and Risk Factors
Samia Abdelrahman El Wakeel, Khaled Mohamed El Sayed,
Olfat Abdelmoniem Ibrahem, Sherif Omar Hasan Ali
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine Zagazig University
*Corresponding Author: Sherif Omar Hasan Ali, Mobile: +20 01113103492, Email: sherif.omar9291@gmail.com
ABSTRACT
Background: Acute kidney injury is an abrupt or rapid decline in renal filtration function.
Objective: The study aimed to identify the incidence and analyze the risk factors (age and sex) for acute kidney injury
development in patients of emergency and surgical intensive care units.
Patients and Methods: This study was carried out at emergency and surgical intensive care units of Zagazig
University Hospitals over a period of 6 months. Data collection were1: Peak of serum creatinine level. 2: Peak of
decreased urine output. 3: At the peak of AKI: AKIN (Acute Kidney Injury Network) score.
Results: Incidence of AKI in patients with normal kidney functions at admission and without history of any previous
renal problems equal 7.015% according to AKIN score.
Conclusion: our results reported that incidence rate of developing AKI in patients of emergency and postoperative
critical care units along the period of 6 months according to the inclusion criteria and AKIN score is 7.015 %. Age
and sex weren't risk factors for AKI.
Keywords: Acute kidney injury, Incidence, Risk factors.
INTRODUCTION
Acute kidney injury (AKI)--or acute renal failure
Risk factors for AKI in patients with severe illnesses
(ARF), as it was previously termed--is defined as an
are often multiple rather than single. These features can
abrupt or rapid decline in renal filtration function. This
be grouped into several categories: certain underlying
condition is usually marked by a rise in serum creatinine
background predisposes patients to the development of
concentration or by azotemia (a rise in blood urea
AKI. Aged patients tend to acquire AKI more frequently
nitrogen [BUN] concentration) (1).
than their younger counterparts, owing to the
However, immediately after a kidney injury, BUN
physiologic ageing of kidneys, multiple morbidities, and
or creatinine levels may be normal, and the only sign of
impaired renal recoverability (7).
a kidney injury may be decreased urine production (2).
Comorbidities include those with underlying
The disorder is generally characterized by an abrupt
diabetes mellitus (DM), hypertension, chronic kidney
deterioration in kidney function that disrupts metabolic,
disease (CKD), and heart failure all reportedly set the
electrolyte and fluid homeostasis over a period of hours
backstage of subsequent renal injury, through the
to days. The spectrum of AKI is broad, ranging from
interplay of disrupted renal auto-regulation, preexisting
small changes in the levels of biochemical markers of
renal damage, and concomitant use of nephrotoxic
kidney function to overt kidney failure requiring
medications (8, 9). Sepsis or systemic inflammatory
initiation of renal replacement therapy (RRT) (3).
response syndrome (SIRS) contributes to AKI
AKI is a common and devastating condition
development (10).
associated with significant morbidity and mortality.
Hypotension, shock at presentation, and use of
Efforts to identify biomarkers to assist with the early
vasopressors/inotropes, also account for part of the
diagnosis of AKI have yielded many promising
clinical settings that subsequently spawn AKI (8, 9).
candidates, such as kidney injury molecule-1 (KIM-1),
Several high-risk procedures or operations, such as
neutrophil gelatinase associated lipocalin (NGAL),
cardiac surgeries (with cardio-pulmonary bypass),
interleukin-18 (IL-18), cystatin C, clusterin, fatty acid
emergent surgeries, or lengthy surgery period, serve as a
binding protein (FABP), and osteopontin (4).
predisposing factor for AKI after operations (10).
In 2013, the World Kidney Day Steering Committee
Transfusion with packed red blood cells or use of
focused on AKI, directing awareness to its impact and
furosemide perioperatively could also be associated with
calling for campaigns to promote the prevention and
AKI (11). Medications are often the one neglected
prompt identification of AKI in patients at risk as well
component of the preludes for AKI. Angiotensin-
as the implementation of evidence-informed protocols
converting enzyme inhibitors or angiotensin receptor
and policies to mitigate its impact (5).
blockers constitute one important example. Their use
Incidence of AKI in intensive care unit (ICU)
during coronary angiography is reported to increase risk
patients ranges between 20-70% according to settings,
of subsequent contrast induced nephropathy by nearly
and, among these, patients who undergo RRT portend
50% (12).
even worse outcome (6).
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/)
2395
Received:25 /6 /2020
Accepted: 24/ 8/2020
Introduction
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2400-2404
The Connection between Serum Level of Paraoxonase (PON 1) and
Atherogenesis in Egyptian Patients with Type II Diabetes Mellitus
EL-Saeed Mostafa El-Saeed Elbawab, Sameh Salah-El-din El-Saed Mohamed, Ahmed Essa Fahmy*
Department of Medical Biochemistry, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: Ahmed Essa Fahmy, Mobile: (+20) 01013767213, E-Mail: ahmedessaaldiry@gmail.com
ABSTRACT
Background: Diabetes is considered a health problem all around the world that affects people at different age levels
with increasing incidence and spread of disease leading to many complications. Paraoxonase is known as an anti-
oxidant enzyme, it was originally found to stimulate the hydrolysis of paraoxonase and has a wide range of important
analytical activities.
Objective: To evaluate the serum level of paraoxonase1 (PON 1) in patients with type 2 diabetes mellitus with or
without hypertension as a predictor marker of atherogenesis.
Patients and methods: This study was a case-control study and carried out on 90 persons (45 males, 45 females) they
were selected from the outpatient and inpatient clinic of Qena University Hospital. The study was conducted during
the period between October 2019 and March 2020.
Results: There was an increase in the level of blood glucose, serum cholesterol, serum triglycerides, serum LDL,
serum Hs CRP, decreased serum PON 1, and serum HDL in (diabetic group) as compared to (healthy individuals
group). The study also showed a positive correlation between the decreased level of serum PON 1 in patients and
decreased serum HDL. The study also showed a negative correlation between the decreased level of serum PON 1 and
increased serum glucose serum cholesterol, serum triglycerides, serum LDL, and serum Hs CRP. Also, measurement
of serum PON 1 may become a useful, expanding tool for evaluating atherogenesis diabetes and hypertension.
Conclusion: Therefore, measurement of the proportion of serum PON 1 as a biomarker of atherogenesis in Egyptian
patients with type 2 diabetes mellitus.
Keywords: Paraoxonase (PON 1), Atherogenesis, Type II Diabetes Mellitus.
INTRODUCTION
Diabetes mellitus is a group of metabolic diseases
Progression from pre-diabetes to type 2 DM can be
characterized by chronic hyperglycemia resulting from
prevented or delayed in some patients through lifestyle
defects in insulin secretion, insulin action, and or both.
interventions and/or metformin (5).
The chronic hyperglycemia of diabetes is associated
Paraoxonase 1 (PON 1) is a protein of 354 amino
with long-term damage, failure of different organs,
acids with a molecular mass of 43 kDa. The amino acid
especially the eyes, kidneys, nerves, heart, and blood
arginine at position 192 of the protein specifies high
vessels. The basis of the abnormalities in carbohydrate,
activity whereas glutamine at that position specifies
fat, and protein metabolism in diabetes is the deficient
low-activity against paraoxon, the former has been also
action of insulin on target tissues (1).
termed band the latter A (the currently recommended
Diabetes mellitus (DM) and essential hypertension
nomenclature is R and Q respectively). The B enzyme
are common conditions that are frequently present
is stimulated by one mol L-1 NaCl to a greater extent
together. Both are considered risk factors for
than the A enzyme (6).
cardiovascular disease, microvascular complications,
Human paraoxonase (PON) is a Ca++-dependent
and therefore treatment of both conditions is essential
esterase synthesized in the liver. PON is related to high-
(2). It is well known that there is an increased prevalence
density lipoprotein (HDL) (7). PON 1 has two main
of hypertension among patients with type II DM, and
roles: detoxifying organophosphate compounds such as
hypertension is often present at the time of diagnosis (3).
paraoxon and protecting low-density lipoprotein (LDL)
Diabetes mellitus is classified into two types:
by hydrolysis of lipid peroxides (8). This study aimed to
(1) Insulin-dependent diabetes mellitus: Type 1
evaluate the serum level of paraoxonase1 (PON 1) in
diabetes mellitus (T1DM) is characterized by an
patients with type 2 diabetes mellitus with or without
absolute deficiency of insulin, is seen most often in
hypertension as a predictor marker of atherogenesis.
children and adolescents.
Lower paraoxonase 1 (PON 1) levels had been
(2) Non-insulin-dependent diabetes mellitus: Type
recognized as a risk factor for atherogenesis in patients
2 diabetes mellitus (T2DM) is caused by insulin
with diabetes mellitus and hypertension.
resistance, inadequate secretion of insulin, is generally
The connection between the serum level of
associated with overweight and obesity (4).
paraoxonase 1 (PON 1) and atherogenesis in Egyptian
patients with type II diabetes mellitus.
This article is an open access article distributed unde
r the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2400
Received:28 /7 /2020
Accepted:27 /9 /2020
c:\work\Jor\vol817_18
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2405-2409
Comparative study of Adenoidectomy by Endoscopic Transoral Suction
Coagulation Versus the Traditional Method
Abdelaziz Elsherif, Ahmed Mohamed Nagy Abdul Raaof*, Sabry Habashy Issa
Department of Otorhinolaryngology, Faculty of Medicine - Al Azhar University-Asyut
*Corresponding author: Ahmed Mohamed Nagy Abdul Raaof, Mobile: (+20) 01020726697,
E-Mail: dr_ahmednagy95@yahoo.com
ABSTRACT
Background: Adenoidectomy is one of the most common procedures performed by otorhinolaryngologists.
Previously, suction cautery was used for haemostasis following curettage adenoidectomy. Whereas more recently, the
entire procedure has been performed using this technique, and it has now been accepted as a suitable technique,
especially in the pediatric population.
Objective: To compare two different techniques for adenoidectomy, one is traditional adenoidectomy and the other
is the endoscopic transoral adenoidectomy by suction diathermy.
Patients and methods: This study included 100 patients (62 males and 38 females) attended to the
Otorhinolaryngology Outpatient Clinic of Al-Azhar University Hospital in Assiut and diagnosed as adenoid
hypertrophy through the period from November 2019 to March 2020.
Results: The average operative time of traditional method was 9.9 minutes (range: 7 to 12 minutes), which is longer
than that of adenoidectomy by suction diathermy where it was7.2 minutes (range: 4 to 10 minutes) also the intra
operative blood loss was markedly lower in adenoidectomy by suction diathermy. It was 5.7 ml (range: 3 to 7 ml)
while it was 27.3 ml (range: 21 to 32 ml) in the traditional method. Post-operative complications in our study include
post-operative hemorrhage, velopharyngeal insufficiency and recurrence, which was higher in the traditional method.
Post adenoidectomy healing time was 14 days for the traditional method (range: 13 to15 days), which is shorter than
that of suction diathermy where it was 18 days (range: 17 to 20 days).
Conclusion: Adenoidectomy by endoscopic transoral suction diathermy is more safe and effective than
adenoidectomy by traditional curatte in treatment of patients with hypertrophied adenoid with less complication.
Keywords: Adenoidectomy, Endoscopic Transoral Suction Coagulation, Versus the Traditional Method.
INTRODUCTION
Adenoidectomy alone or in association with
Subsequently, six patients with active bleeding
tonsillectomy is one of the oldest and most commonly
gastric lesions underwent endoscopic mucosal
performed ENT surgical procedures. It is typically
coagulation (5).
carried out in children for conditions such as
It was not utilized in adenoid surgery for a further 10
adentonsillar hypertrophy, obstructive sleep apnea,
years. Initially the instrument was used for hemostasis
otitis media with effusion, recurrent otitis media and
following curettage of the adenoids (6). More recently,
nasal
obstruction.
Historically
recommended
the whole procedure has been performed using suction
instrumentation for performing adenoidectomy has
diathermy (7). This approach provides a direct-targeted
varied from the surgeon's fingernail, a steel nail,
route to the nasopharynx, improved visualization, a
cutting or biting forceps, adenotomes and adenoid
bloodless surgical field and improved evaluation of the
curettes (1).
adenoids, the Eustachian tube and the posterior nasal
Complete removal of the adenoids is difficult
choanae. The improved visualization enables the
to determine when performing curette adenoidectomy.
surgeon to remove choanal adenoids, which are present
The importance of removing laterally based adenoidal
in 10% of patients (8). It also allows the surgeon to avoid
tissue when performing adenoidectomy for otitis media
adjacent structures such as the Eustachian tube orifices.
with effusion has been well described in earlier reports
Adenoidal tissue encroaching on the Eustachian
(2). The search for an instrument to perform bloodless
cushions can be suctioned medially and then ablated,
adenoidectomy successfully under direct vision has
thus avoiding trauma to the Eustachian tube openings.
been the topic of numerous clinical trials. A number of
The benefit of suction diathermy in reducing
instruments have been implemented to perform
intraoperative blood loss and post-operative bleeding
adenoidectomies, including radio frequency, suction
has been well documented (9). Therefore, it is essential
diathermy, microdebrider and laser (3, 41).
to compare this relatively new method with the
One method that seems to be gaining
established conventional method. This work aimed to
popularity
is
transoral
suction
diathermy
compare two different techniques for adenoidectomy,
adenoidectomy while using 70-degree endoscope. The
one is traditional adenoidectomy and the other is the
suction coagulator was developed in the 1970s. The
endoscopic transoral adenoidectomy by suction
first experimental use described in the literature was in
diathermy.
control of upper gastrointestinal hemorrhage in dogs.
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/)
2405
Received:28 /7 /2020
Accepted:27 /9 /2020
c:\work\Jor\vol817_19
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2410-2415
PCR Genetic Expression of Interleukin 37 in the Eutopic and
Ectopic Endometrium of Women with Endometriosis
Ahmed Mohamed Abbas1, Sayeda Ibrahim EL-Desouky2, Ihab Fouad Serag Eldin Allam1,
Deena A Mohamed3, Amgad Alsaid Abou Gamrah1
Departments of 1Obstetrics & Gynecology and Clinical & Chemical Pathology3, Faculty of Medicine,
Ain Shams University
2Banha Teaching Hospital
*Corresponding author: Sayeda Ibrahim EL-Desouky, Mobile: (+20)01005414292, E-mail: noonnoun@hotmail.com
ABSTRACT
Background: In endometriosis, there is a chronic immune and inflammatory reaction.
Objective: To study the PCR genetic expression of interleukin 37 in the eutopic and ectopic endometrium of
women with endometriosis in comparison with controls.
Patient and Methods: Forty-six patients were included in the study. Twenty-three women diagnosed as
endometriosis and twenty-three women diagnosed as free of endometriosis were subjected to laparoscopy for any
other gynecological cause. Interleukin 37 gene expression was studied in ectopic and eutopic endometrium using
polymerase chain reaction.
Results: Ectopic endometrium expressed high levels of mRNA compared to eutopic endometrium in endometriosis
patients. Eutopic endometrium of endometriosis patients expressed high levels of mRNA compared to eutopic
endometrium of controls.
Conclusion: The finding of high mRNA produced in endometrial tissue suggests that interleukin 37 may be
important in the chronic inflammation occurring during endometriosis.
Keywords: Endometriosis, PCR Genetic Expression, Interleukin 37
INTRODUCTION
Interleukin- 37 (IL-37) (previously called IL-
Endometriosis is defined as the presence of
1F7) is a recently discovered member of the IL-1
endometrial-like tissue outside the uterine cavity. It is
family. It is located both in the cytoplasm and in the
a common, chronic, progressive and inflammatory
nucleus. The key role of IL-37 is that it inhibits both
disease, associated with local and systemic altered
innate and adaptive immunity by decreasing
immune system. It is an estrogen-dependent pelvic
expression of pro-inflammatory cytokines (4).
inflammatory disease affecting about 1015% of
Interleukin-37, located within the IL-1 gene cluster on
women in reproductive age (1). More than 180 million
2q12, has recently been identified as a regulatory
women worldwide are affected by the disease. The
cytokine that dampens the immune response in
definition of endometriosis is histological so it requires
humans (5). A previous study reported that the
the identification of the presence of endometrial gland
immunostaining score of IL-37 was significantly
and stroma-like tissue outside (ectopic) the uterus.
higher in the eutopic endometrium (4.79 ± 1.91) and
These ectopic lesions are commonly located on the
ectopic endometrium (7.71 ± 1.78) of women with
pelvic organs and peritoneum. Most common affected
ovarian endometriosis compared to that of controls
sites are the ovaries, fallopian tubes and tissues around
without endometriosis (3.27 ± 1.62) (6).
the uterus (2).
The present work aimed to study the PCR
Further insights into the pathogenesis of
genetic expression of interleukin 37 in the eutopic and
endometriosis could be valuable, possibly leading to
ectopic endometrium of women with endometriosis in
new therapeutic approaches. Mechanisms underlying
comparison with controls.
the chronicity of this disease are not understood, but
are of major importance in its pathogenesis. There has
PATIENTS AND METHODS
been much speculation about the role of immune
This case-control study was conducted in Ain
mediators in the pathogenesis of endometriosis,
Shams University Maternity Hospital in Laparoscopy
especially cytokines. This was based on the presence
Department in the period from October 2016 to
of different cytokines in both endometriosis tissue,
October 2018. Forty-six patients were included in the
peritoneal fluid and high levels of cytokines in serum
study where twenty-three women were diagnosed as
of
endometriosis
patients.
Cytokines
have
endometriosis and twenty-three women were free of
proinflammatory actions on the surrounding tissue,
endometriosis and were subjected to laparoscopy for
stimulating inflammation and angiogenesis (3).
any other gynecological cause.
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/)
2410
Received: 28/7/2020
Accepted: 27/9/2020
c:\work\Jor\vol817_20
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2416-2421
Study of The Role of Human Papilloma Virus and Laryngopharyngeal
Reflux in Adult Vocal Fold Polyps
Abdelhakim Fouad Ghallaba, Ahmed Farag Allama, Salwa Ahmed Abdelhayb,
Mohamed Gamal Abdelwahabc, Rasha Abdelhamid Elsayedd, Abdelrahman Ahmed Abdelalima,*
a Department of Otorhinolaryngology, b Unit of Phoniatrics, Department of Otorhinolaryngology, d Department of
Medical Microbiology and Immunology, Benha Faculty of Medicine, Benha University, c Department of
Otorhinolaryngology, Al-Ahrar Teaching Hospital, Ministry of Health and Population, Egypt.
Corresponding author: Mohamed Gamal Abdelwahab, Mobile: (+20) 01127123062, E-Mail: anashamza812@gmail.com
ABSTRACT
Background: There are several possible causes of vocal fold polyps in adults. The mechanical damage is the main cause
for polyp formation. Laryngopharyngeal reflux and human papilloma virus are possible co-factors.
Objective: The aim of this study was to find out the associated roles of laryngopharyngeal reflux and human papilloma
virus in the development of adult vocal fold polyps.
Patients and Methods: This cross-sectional observational study included 50 adult patients presented with vocal fold
polyps. Patients were preoperatively assessed for the presence of laryngopharyngeal reflux using the validated nine-item
reflux symptom index and eight-item reflux finding score. All patients were subjected to excision of the laryngeal polyp
by microlaryngoscopic surgery. The excised samples were sent for human papilloma virus (HPV) detection by PCR.
Results: Laryngopharyngeal reflux (LPR) was presented in 34 patients (68%). Reflux symptom index ranged from 6 to
25 (mean 13.06 ± 4.95). Reflux finding score ranged from 3 to 18 (mean 10.08 ± 4.32). Seventeen patients (34%) had
positive HPV-6. Fifteen patients had positive HPV-6 out of 34 patients diagnosed with LPR (44.11%), compared to only
two patients had positive HPV-6 among 16 patients without LPR (12.5%) (P = 0.027). There were significant relations
between presence of HPV-6 and both reflux symptom index and reflux finding score; both were significantly higher
among patients with positive HPV-6 (P = 0.028) and (P < 0.001) respectively. Conclusion: Both laryngopharyngeal reflux
and human papilloma virus play important associated roles in the development of vocal fold polyps in adults.
Keywords: Human papilloma virus; Laryngopharyngeal reflux; Vocal fold polyp.
INTRODUCTION
Adult vocal fold polyps are generally unilateral
the concept of a direct damaging effect of acidic gastric
benign lesions affecting larynx, usually causing
juice on the true vocal cords (7).
hoarseness of voice, breathiness and/or voice fatigue (1).
Human papilloma viruses are species-specific
However, rare cases have been reported with large or
viruses, which show strict tropism for the stratified
giant polyps causing airway obstruction (2).
squamous epithelium. Over 170 types have been
The mechanical damage is the main cause for
identified so far that can infect the skin or the mucosal
polyp formation either vocal over-and misuse or strong
surface of the aerodigestive tract, those viruses can be
coughing.
Smoking,
gastroesophageal
reflux,
classified as low-risk and high-risk types (8). Laryngeal
chronic/recurrent upper respiratory infections, and
papilloma can be developed and caused by the human
allergy are considered as co-factors (3).
papilloma virus (HPV), most commonly of low-risk
There are several possible causes of vocal fold
subtypes 6 and 11, which infiltrates and proliferates
polyps which can lead to increased vocal fold blood
within epithelial tissue. This condition can manifest in
vessel permeability, local edema, hypoxia, degeneration,
either childhood or adulthood (9). The genotype HPV-11
and fibrosis (4). Laryngopharyngeal reflux (LPR) is an
appears to be associated with more severe forms, with an
inflammatory condition of the upper aerodigestive tract
increased risk of airway obstruction (10). However, only
related to effect of gastric or duodenal content reflux,
20% of patients with laryngeal papilloma have
which induces morphological changes in the upper
measurable levels of human papilloma viral DNA (11).
aerodigestive tract (5). The laryngopharynx is more
Also, human papilloma virus can be latent in vocal folds
susceptible than the esophagus to epithelial damage
without laryngeal papillomas and viral DNA can be
caused by reflux, since the laryngopharynx has a thin
detected by polymerase chain reaction (PCR) in the
epithelium compared to the esophagus (6). The higher
epithelium of the vocal cords in patients suffering from
prevalence of laryngopharyngeal reflux episodes in
chronic laryngitis, nodules, or polyps reflecting the
patients with benign true vocal fold lesions supporting
possible prevalence of latent HPV infections in the vocal
cord mucosa (12).
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/)
2416
Received:28 /7 /2020
Accepted:27 /9 /2020
c:\work\Jor\vol817_21
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2422-2428
Non-Invasive Ventilation in Preventing Intubation and Reintubation in The
Intensive Care Unit of Pediatrics Zagazig University Hospital
Mohamed Mohamed Abdel-Rahim*1, Tarek Abdel-Rahman Mohamed Attia2,
Dalia Abdel-Latif Abdel-Rahman2
1 Resident of Pediatrics, Maghagha General Hospital, Minya, Egypt.
2 Pediatric Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
*Corresponding Author: Mohamed Mohamed Abdel-Rahim, Mobile: +20 1068161730,
Email: mohamedrahiem22@gmail.com
ABSTRACT
Background: Non-invasive ventilation (NIV) refers to methods of respiratory assistance without an indwelling
endotracheal tube. Objectives: To evaluate the efficacy, identify possible predictors for the success of NIV in
preventing intubation and re-intubation, and to determine the characteristics, and outcomes associated with NIV
therapy in Pediatric intensive care units (PICUs) settings.
Patients and Methods: A clinical trial study was conducted at the Pediatric Intensive Care Units, Children Hospital,
Zagazig University and Al-Ahrar Educational Hospital on 60 patients divided equally into two groups; group A with
NIV as the first line and group B with NIV after extubation. Patients were followed up till weaning.
Results: Male constituted a larger percentage with both groups. One-sixth and 20% of patients within group A and
B respectively had failed to wean. There is a statistically significant difference between the outcome of weaning
among group A and all of PIM-2 score, PIM-2 percent, and NIV duration. While the relation is significant between
the outcome of weaning among group B and patients' age, body weight, and NIV duration. Increasing NIV duration
significantly predicts weaning success in group A while increasing body weight predicts it in group B.
Conclusion: Non-invasive ventilation as the first line of treatment in acute respiratory failure provides significant
avoidance of intubation and lowers the incidence and risk of complications. Non-invasive ventilation if considered
after weaning of invasive mechanical ventilation it helps to avoid re-intubation and failure of weaning. The most
important significant predictors of NIV outcome are NIV duration and body weight.
Keywords: Weaning, Intubation, Ventilation.
INTRODUCTION
Respiratory failure is one of the main reasons for
forth), this therapy slightly decreased the rate of
admission to the pediatric intensive care unit (PICU).
intubation and improved survival(4).
Children require invasive mechanical ventilation
NIV has gained impetus as a ventilatory support
(IMV) as part of a therapeutic approach, which, despite
therapy for pediatric patients. Its administration
allowing to modify the prognosis, involves life-
reduces the use of accessory muscles, heart rate, and
threatening complications that extend the length of stay
respiratory rate. The main advantage of NIV is that it
in the hospital(1).Post-extubation respiratory failure is
prevents invasive mechanical ventilation (IMV) and,
also a common complication that remarkably increases
therefore, any associated risk(5).
morbidity and mortality. The rate of extubation failure
The use of non-invasive ventilation as the first-
among children ranges from 3% to 22%(2).
line mode of mechanical ventilation in critically ill
The ability to avoid endotracheal intubation by
children admitted to PICUs may be associated with
using Non-invasive ventilation (NIV) means that the
significant clinical benefits. Further high-quality
upper airway remains intact and both physiological
evidence regarding optimal patient selection and
functions and airway defense mechanisms are
timing of initiation of non-invasive ventilation could
preserved. Some controlled studies and meta-analysis
lead to less variability in clinical care between
have shown its efficiency in adults, but experience in
institutions and improved patient outcomes(6). Hence
the pediatric population is limited. Despite this, NIV is
this study aimed at evaluating the efficacy, identifying
frequently used in pediatric intensive care units
possible predictors for the success of NIV in preventing
(PICUs) to avoid intubation and prevent re-
intubation and re-intubation, and also determining the
intubation(3).
characteristics, and outcomes associated with NIV
NIV is a safe and effective means of improving gas
therapy in PICUs settings.
exchange in patients with many types of acute
respiratory failure. In patients with various forms of
SUBJECTS AND METHODS
acute hypoxemic respiratory failure (pneumonia,
The present Clinical Trial study was conducted at
congestive heart failure, chest-wall impairment, and so
the Pediatric Intensive Care Units, Children Hospital,
Zagazig, and Al-Ahrar University Hospitals. The study
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2422
Received:2 /7 /2020
Accepted:28 /8 /2020
c:\work\Jor\vol817_23
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2433-2438
Magnesium Sulfate Versus Lidocaine for Attenuating Hemodynamic
Response to Tracheal Intubation
Zeinab Hamed Sawan, Kamelia Ahmed Abaza, Ahmad Zyada, Ahmad Ezz El Din
Department of Anesthesia and Surgical Intensive care, Faculty of Medicine-Zagazig University.
*Corresponding Author: Ahmad Ezz El Din Muhammad, Mobile: +20 01014353330, Email:ahmedezz188@gmail.com
ABSTRACT
Background: It is well recognized that the occurrence of hemodynamic responses in the form of rise in heart rate and
blood pressure during and after laryngoscopy and endotracheal intubation mediated by sympathetic response, is a well-
known treat. Objective: The aim of the study was to evaluate effects of magnesium sulfate and lidocaine in attenuating
hemodynamic response at a certain doses based on previous studies.
Patients and Methods: 76 patients were randomly divided into two groups (group M and group L) using computer
generated randomization table, and induced by magnesium sulphate (30 mgkg-1) or 2% lidocaine (2 mgkg-1),
infused in 3 minutes using syringe pump, after 3 minutes of pre-oxygenation, we proceeded for anesthetic induction by
2 mg/kg propofol and after loss of consciousness, 0.5 mg/kg atracurium (a muscle relaxant). All patients in both groups
were intubated by the same anesthetist (the researcher) with direct laryngoscopy 3 minutes after administration of
magnesium sulfate or lidocaine.
Results: There was statistically non-significant difference between the studied groups regarding age, gender, weight,
height, body mass index, ASA, presence of diabetes or hypertension, systolic or diastolic blood pressure values
baseline, mean arterial blood pressure and heart rate values baseline at a time range of 1 to 5 minutes, while, there was
statistically significant difference between the studied groups regarding the same measurements at a time range of 5 to
15 minutes.
Conclusion: we conclude that magnesium sulphate is better alternative to lignocaine for attenuation of stress responses
of laryngoscopy and intubation
Keywords: Hemodynamic response, Lidocaine, Magnesium sulfate
INTRODUCTION
glycinergic action, which decreases the airway reactivity
It is well recognized that the occurrence of
(5).
hemodynamic responses in the form of rise in heart rate
The aim of the study was to evaluate effects of
and blood pressure during and after laryngoscopy and
magnesium sulfate and lidocaine in attenuating
endotracheal intubation mediated by sympathetic
hemodynamic response at a certain doses based on
response, is a well-known treat (1).
previous studies.
The mechanism of the responses to laryngoscopy
and orotracheal intubation are proposed to be by
PATIENTS AND METHODS
somatovisceral reflexes starts from proprioceptors at the
Site of study: This study was carried out in operating
base of the tongue, the epiglottis, hypopharynx,
rooms of Zagazig University Hospitals.
peritracheal area, and vocal cords. The efferent
Sample size: the sample size was calculated to be 76 (38
sympathetic outflow to the heart originates from the
in each group).
spinal cord between T1 and T4, and that to the adrenal
medulla from between T3 and L3 (2).
Inclusion criteria:
The magnesium sulfate mechanism of action for
1. ASA I or II.
hemodynamic response attenuation appears to result
2. Age: between 21- 65 years.
from the inhibition of catecholamine release from the
3. Gender: both male and female
adrenal medulla, maintains the plasma concentration of
4. Patients who are scheduled for elective surgery with
epinephrine practically unchanged, and also reduces the
orotracheal intubation.
increased circulating norepinephrine when compared to
5. BMI < 35 kg/m2
that of a control group. It also has a systemic and
Exclusion criteria:
coronary vasodilation effect by antagonizing calcium ion
1. Patient refusal.
in vascular smooth muscle (3).
2. Patients with contraindications or history of
Due to its inhibiting effects on release of
hypersensitivity to the study drugs.
catecholamines from adrenergic nerve endings and
3. Expected difficult intubation
adrenal medulla, magnesium has been an option for
minimizing adverse cardiovascular responses during
Type of study: Randomized prospective comparative
laryngoscopy and intubation (4).
clinical study. All Patients were randomly divided into
As for lidocaine, when used systemically, it has an
two groups (group M and group L) Using computer
antagonistic action on sodium channels and NMDA
generated randomization table, each group consists of 38
receptors, reduces the release of substance P, and has
patients.
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/)
2433
Received:6 /7 /2020
Accepted:28 /8 /2020
c:\work\Jor\vol817_24
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2439-2444
Osteopontin As A Marker of Diabetic Nephropathy in Patients With
Type 2 Diabetes Mellitus
Mohammed Hamdy Assy, Hazem Mohamed El Ashmawy, Jehan Saeed Abdo Soliman, Alaa Badr
Abd El Hamed
Department of Internal Medicine, Faculty of Medicine Zagazig University
*Corresponding Author: Alaa Badr Abd El Hamed, Mobile: +20 01008641310, Email:
2439asneem_2015@yahoo.com
ABSTRACT
Background: Diabetic nephropathy is the most common cause of end stage renal disease (ESRD) that is
associated with high rates of morbidity and mortality. osteopontin (OPN) is a secreted phosphorylated
glycoprotein that mediates diverse biological functions.
Objective: The study aimed to determine the relation between serum OPN and the progression of diabetic
nephropathy in patients with type 2 DM. That may open a door for early prediction of diabetic nephropathy.
Patients and Methods: This case-control study was conducted in Internal Medicine, Endocrinology Unit and
Biochemistry Departments, Zagazig University Hospital. This study was carried out on 96 patients devided
into: Group 1: 20 age and sex matched healthy volunteers (control group). Group 2: 38 patients with type 2
DM without nephropathy (DWN group). Group3: 38 patients with type 2 DM with nephropathy (DN group).
Serum osteopontin concentrations was measured for all cases.
Results: HOMA-IR increased significantly in DN group (8.59 ± 1.34) compared to DWN group (4. 73 ± 0.59)
and control group (0.90 ± 0.18). Serum osteopontin level (ng/ml) increased significantly in the DN group
(258.52 ± 46.93 ng/ml) compared to DWN group (159.12 ± 19.56 ng/ml) and control group (70.90 (± 20.47
ng/ml)(p value =0.000). There was a high significant correlation between S. OPN and HOMA-IR.
Conclusion:
Type 2 diabetic patients with or without nephropathy showed increased osteopontin levels
than control group. Serum osteopontin may be considered as an early prognostic marker for the risk of
nephropathy in patients with type 2 diabetes mellitus.
Keywords: Osteopontin, Diabetic nephropathy, Prediction.
INTRODUCTION
Diabetic nephropathy is the most common
tissue, OPN is strikingly upregulated at sites of
cause of end stage renal disease (ESRD) that is
inflammation and tissue remodeling (3).
associated with high rates of morbidity and
The study aimed to determine the relation
mortality. It is of utmost importance to emphasize
between serum OPN and the progression of
the early identification and treatment of this
diabetic nephropathy in patients with type 2 DM.
chronic complication, which would reduce the
That may open a door for early prediction of
medical and economic burden associated with it (1).
diabetic nephropathy.
Although microalbuminuria remains the
gold standard marker for early detection of DN, it
PATIENTS AND METHODS
is not a sufficiently accurate predictor of DN risk
This case-control study was conducted in
given some limitations. For example, not all
Internal Medicine, Endocrinology Unit and
diabetics with microalbuminuria will end up with
Biochemistry Department, Zagazig University
ESKD and 30% of them may actually have
Hospitals during the period from October 2018 to
normoalbuminuria, while several biomarkers of
April 2019.
glomerular or tubular dysfunction can precede
microalbuminuria,
suggesting
that
Patients:
microalbuminuria is present once significant renal
This study was carried out on 96 patients
injury has already occurred (2).
divided into:
OPN is a secreted phosphorylated
Group 1: 20 age and sex matched healthy
glycoprotein that mediates diverse biological
volunteers (control group)
functions originally isolated from bone. OPN was
Group 2: 38 patients with type 2 DM
later shown to have a wider distribution. In adults,
without nephropathy (DWN group).
OPN expression is normally limited to the bone,
Group 3: 38 patients with type 2 DM with
kidney, and epithelial linings, and is secreted in
nephropathy (DN group).
body fluids including milk, blood and urine. In
contrast to its restricted distribution in normal
Inclusion Criteria:
Age: 35-70 years old and diabetic patients with
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/)
2439
Received:29 /6 /2020
Accepted:27 /8 /2020
c:\work\Jor\vol817_25
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2445-2450
Hepato-nephro-toxicity Induced by Premium Fungicide and
Protective Effect of Sesame Oil in Male Rats
Reem M. Ziada, Sanaa M. Abdulrhman, Nahas, A.A.
Mammalian and Aquatic Toxicology Department, Central Agricultural Pesticides Lab. (CAPL), Agricultural
Research Center, Ministry of Agriculture, Dokki, Giza 12618, Egypt
ABSTRACT
Background: Fungicides impact on agriculture is reflected by the wide spread use of Azoxystrobin (AZX) and metalxyl
M, the active ingredients of premium fungicide used on more than 80 different crops.
Objective: The present study aimed to investigate the hepato-renal-toxicity of premium fungicide on adult albino rats and
focused on benefits of sesame oil in detoxification of toxicological effects of fungicides.
Materials and methods: Thirty male albino rats allocated into five groups, -ve, +ve control and sesame oil groups. While
the two other groups were treated with sesame oil before and after fungicide exposure daily by gavage for (28 days).
Results: Exposure of male albino rats to Azoxystrobin fungicide resulted in liver and kidney injury as evidenced by
increased liver and renal function bioindicator (ALT, AST, ALP, urea and creatinine)..Also, glutathione (GSH) was
significantly decreases and malondialdhyde (MDA) was increased as oxidative stress biomarkers. In addition,
degeneration of some tubular epithelial cells and hemorrhage in kidney and severe inflammatory cell infiltration in liver.
Conclusion: The present study concluded that premium had induced functional and histological changes in liver and
kidney male rats. Sesame oil successfully ameliorated the oxidative stress, hepatotoxicity and nephrotoxicity of fungicide.
Keywords: Liver function, Renal function, Oxidative stress, Sesame oil, Azoxystrobin, Metalxyl.
INTRODUCTION
where most of metabolism takes place. Due to its role in
To avoid crop losses, pesticides are widely used to
the biotransformation of xenobiotics, the liver is at great
sustain yields of economically valuable crops, to satisfy
risk of injury, when the pollutant can be reached at high
the growing demands of world food supply (1). The
intracellular concentrations (9).
commercialization of pesticides is subject to stringent
It is well recognized that through the rapid
regulatory limits because of improper disposal and
generation of reactive oxygen species (ROS), biotic and
inappropriate usage, accidental leaks and leakages pose
abiotic stresses contributes to oxidative stress (10). ROS
a great danger to the atmosphere and human health (2).
induces imbalance, leading to membrane oxidation and
Pesticides are a very significant group of environmental
DNA protein damage (11).
contaminants used to guard against pathogens and pests
It will be logical to maximize the quantity of
in intensive agriculture but nearly 1-2% of used
exogenous antioxidants (mainly by ingestion) to
pesticides reach the targeted pests (3).
improve the protective properties of individuals against
Azoxystrobin (AZX) belongs to strobilurin
environmental oxidative stress, since we have no impact
fungicide which generated fungicidal activity by
on the amounts of endogenous antioxidants (12).
binding site of cytochrome b blocking the electron
Apparently due to their protective properties against
transfer (4). Strobilurins are known an extraordinary new
both the toxicity of different toxins and pathogenic
class of fungicides since they are broad-spectrum
factors, more attention is being paid to bioactive
systemic fungicides after emergence, avoiding and/or
compounds, especially where reactive oxygen species
curing foliar diseases caused by the main classes of
(ROS) are involved. (13). A clear link between essential
pathogenic plant fungi. AZX residues equal to or below
oil of some vegetables and plant products and the
maximum residue levels (MRLs) were detected in fruit
mitigation of harmful effects of different toxicants and
and vegetable samples (5). AZX bioaccumulation
environmental pollutants has been identified. Through
potential or biomagnifications values have been scarce
scavenging free radicals and modulating the antioxidant
(5). The other component of premium fungicide,
protection mechanism, plant products are known to
Metalaxyl has a high water solubility that raises the
perform their defensive impact. (14). Sesame oil is
likelihood of land and surface water reaching by
particularly useful for the treatment of liver and kidney
agricultural run-offs and spillage, mild hydrolysis
toxicity caused by lead and iron and has no harmful
stability under physiological pH, and metalaxyl is also
effects by inhibiting xanthine oxidase, nitric oxide,
not highly biodegradable (6).
superoxide anion, and hydroxyl radical generation.
Several experiments in laboratory animals have
Sesame oil inhibits lipid peroxidation induced by iron
shown the nephrotoxic and hepatotoxic effects of agro-
and inhibits proinflammatory mediator's reactions (15).
pesticides (7). A strong correlation between agro-
The present study was therefore undertaken to
pesticide toxicity and indicators of liver and kidney
investigate the effects of premium fungicide exposure on
impairment (8). Liver is the main detoxification organ,
the liver and kidney function of male albino rats and
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/)
2445
Received: 28/7 /2020
Accepted:27 9 /2020
c:\work\Jor\vol817_26
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2451-2455
Recoverability of Renal Function after Treatment of Adult Patients with
Unilateral Obstructive Uropathy: A Prospective Study
Atef Badawy, Osama A. Abdel Gawad, Mohammed A. El-Shazly, Mahmoud H. Hewaidy*
Urology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
*Corresponding Author: Mahmoud H. Hewaidy, Mobile: +20 01009150509, E-mail: drmhh8383@yahoo.com
ABSTRACT
Background: Obstructive uropathy refers to any blockage of urine drainage at any level of the urinary tract. It may
be chronic or acute and may occur unilateral or bilateral. The prediction of the recoverability of kidney function
after treatment of unilateral obstructive uropathy is of great clinical value to the urologists and nephrologists as it
may affect the decision of treatment.
Objectives: To detect changes in split renal function of unilaterally obstructed kidney after a period of 6 weeks of
drainage.
Patients and methods: This prospective observational study included 66 adult patients divided into 2 groups;
Group A included patients with split function less than 10 % (36 patients) and Group B included patients with
split function of 10 % or more (30 patients).
Results: The study showed that there were an insignificant difference between the two groups in age, sex, cause of
obstruction, laterality of obstruction, method of drainage and patient's presentation. Also, there was an insignificant
difference between pre- and post-drainage for group A (P-value 0.142). While there was a highly significance
difference between pre- and post-drainage for group B (P-value < 0.001).
Conclusion: the preoperative split function of the obstructed kidney is the independent factor affecting the
recoverability of renal function. Where kidneys with split function less than 10% are irreversibly damaged and the
decision of treatment can be taken with no need to do drainage followed by repeating renal scan. While stabilization
or improvement of renal function is expected after relief of obstruction in kidneys with split function of 10% or
greater.
Keywords: Adult, Isotope renography, Obstructive uropathy, Recoverability, Split function, Unilateral.
INTRODUCTION
Obstructive uropathy refers to any blockage of
Qa1
after drainage? In other words, does it have
urine drainage at any level of the urinary tract.
an impact on the decision? We aimed in this study to
Obstructive uropathy may be long-term disease
answer that question.
(chronic) or occur suddenly (acute). As well, it can
The aim of this study is to detect changes in split
occur unilateral or bilateral (1).
renal function of unilaterally obstructed kidney with
Unilateral obstruction may be caused by many
normal contralateral kidney after a period of 6 weeks
urologic disorders either intrinsic or extrinsic.
of drainage.
Intrinsic causes may be intraluminal such as stones,
blood clots, papillary necrosis and fungus balls or
PATIENTS AND METHODS
intramural causes e.g., ureteropelvic junction
This prospective study was carried out in the
obstruction (UPJO), tumors and ureteric stricture.
Urology Department of Menoufia University
Extrinsic causes such as aberrant vessel in UPJO,
Hospitals. It included 66 patients divided into 2
accidental ligation of ureter, pregnant uterus, tumours,
groups; Group A included patients with split function
retroperitoneal fibrosis or hematoma (2).
less than 10 % (36 patients) and Group B included
The prediction of the recoverability of kidney
patients with split function of 10 % or more (30
function after treatment of unilateral obstructive
patients). All cases were evaluated in the period from
uropathy is of great clinical value to the urologists and
April 2018 to April 2020.
nephrologists as it may affect the decision of treatment
Inclusion criteria included adult patients (more than
(3).
16 years old) with unilateral obstructive uropathy
There is an agreement that in obstructed kidney,
(radiologically grade 3 and 4 hydronephrosis) and
if the radioisotope estimated split function of less than
normal contralateral kidney (normal morphology and
10%, this warrants nephrectomy. In practice, this
no backpressure or nephropathy in ultrasound and
critical decision is verified by some urologists through
GFR is greater than 40 mL/min/1.73 m2 in renal scan).
isotope scanning 6 weeks after drainage of the
Exclusion criteria included patients with
obstructed kidney for possible recoverability and
bilateral obstruction, infants and children with
assessment of the renal split function (4, 5).
ureteropelvic junction obstruction (UPJO), cases with
Does it really matter to do isotope scanning and
radiological grade 1 and 2 hydronephrosis and cases
take the decision to repair or to remove only 6 weeks
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/)
2451
Received:27 /7 /2020
Accepted:26 /8 /2020
c:\work\Jor\vol817_27
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2456-2461
Letrozole Therapy versus Extended Clomiphene Citrate Therapy for
Induction of Ovulation in Resistant Patients with Polycystic Ovarian
Syndrome in Low Resource Communities
Mohamed A. Emara 1, Dalia I. Mohamed 1, Mohamed A. M. Hassanein*2, Amira A. Fathey1
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Obstetrics and Gynecology at Sohag General Hospital, Sohag, Egypt
* Corresponding Author: Mohamed Ahmed Mohamed Hassanein, Mobile: 01100121090,
E-Mail: mamhassanein@yahoo.com
ABSTRACT
Background: many drugs can be used in ovulation induction in patients with clomiphene-resistant polycystic
ovarian syndrome (PCOs).
Objective: to evaluate the effect of letrozole therapy versus extended clomiphene citrate therapy for ovulation
induction in clomiphene-resistant polycystic ovarian syndrome patients
Patients and Methods: The study included 100 infertile patients who had failed induction by clomiphene for three
cycles. They were randomly allocated to receive either letrozole or extended clomiphene therapy. The effects of
these drugs on follicular volume, ovulation, endometrium thickness and occurrence of pregnancy were evaluated.
Results: No significant difference was found between both groups regarding age, body mass index, basal FSH
level, LH level, prolactin level, thyroid function and semen analysis of the husband. Use of letrozole or extended
clomiphene led to improvement of number of growing follicles, ovulation rate and pregnancy rate after 3 cycles of
ovulation induction.
Conclusion: The results of this study revealed that use of letrozole or extended treatment with clomiphene did not
show better outcomes over each other in number of growing follicles, ovulation rates, occurrence of pregnancy and
pregnancy outcomes. Letrozole group showed a significant increase in the endometrium thickness than extended
clomiphene group but this did not affect pregnancy rate.
Keywords: Letrozole, extend clomiphene therapy, PCOs, clomiphene resistance.
INTRODUCTION
Polycystic ovarian syndrome (PCOs) is a
can be increased up to 250 mg/day with most effective
common endocrinal problem, which estimated that
dose that is between 100-150 mg/day, as ovulation
PCOs affects 5 % to 10 % of females between 18 and
occurs in more than 75% of cycles treated with these
44 years old (1). Moreover, PCOs is the commonest
doses. After six to nine cycles of CC therapy, the
cause of anovulation-induced infertility (around 75%
cumulative pregnancy rates are 70-75 % (9).
of the cases) (2). The Rotterdam consensus workshop
Letrozole is a specific aromatase inhibitor that
concluded that PCOS is a syndrome of ovarian
was used to treat patients with breast cancer (10).
dysfunction along with the cardinal features of
Letrozole blocks estrogen production from androgen
hyperandrogenism and polycystic ovary morphology
by inhibiting aromatization. By decreasing circulating
on ultrasonography (3). PCO patients present with
E2, the secretion of FSH and luteinizing (LH)
variety of manifestations (4) and many affected patients
hormone increases (11). Letrozole is considered better
have decreased fertility due to chronic anovulation (5).
drug than CC because of its lesser antiestrogenic effect
Infertility can have direct psychological and social
on endometrium (12).
burdens among infertile women, which decreases the
There is no specific starting dose for letrozole,
life quality for these patients (6).
however, it is better to start letrozole in low dose (2.5
Clomiphene citrate (CC) is considered to be
mg daily), and the dose is successively increased
traditional drug for ovulation induction in PCOs
according to the patient' response (13).
because of its low cost and oral route of administration
About 15 to 40 % of PCOs patients are not
with limited side effects (7). CC induces ovulation by
responding to ovulation induction by clomiphene
competing with estrogen (E2) on its receptor in the
therapy. Clomiphene resistant PCOs is defined by
hypothalamus which prevents the negative feedback
ovulation failure after receiving 150 mg/day for 5 days
effect of estrogen and stimulates the production of
for at least 3 cycles (14).
follicular stimulating hormone from the pituitary
Patients with obesity, insulin resistance and
gland that induces ovulation (8). The CC starting dose
hyperandrogenism are more susceptible for failure of
should be around 50 mg/ day for 5 days, starting on
induction by clomiphene; however, presence of
day 2 to 5 of menstrual cycle following spontaneous
clomiphene
resistance
is
unexplainable
or
or progestin- induced withdrawal bleeding. The dose
unpredictable in most of the cases (8).
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/)
2456
Received:28 /7 /2020
Accepted:27 /8 /2020
c:\work\Jor\vol817_28
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2462-2467
Role of TRIM Proteins in Inflammatory Skin Diseases
Rehab Monir Samaka1, Mohamed Ahmed Basha2, Dalia El Beih*2
1Department of Pathology, 2Department of Dermatology, Faculty of Medicine,
Menoufia University, Shebin Elkom, Menoufia Governate
*Corresponding author: Dalia El Beih, Mobile: +20 01096269900, Email: daliamedhatelbeih@gmail.com
ABSTRACT
Background: Despite the advance in treatment modalities of wide range inflammatory skin diseases, tripartite motif-
containing (TRIM) proteins are expected to become a potential therapeutic target for prevention and treatment of
dermatological disorders.
Objective: Studying the role of TRIM proteins in inflammatory skin diseases.
Material and Methods: We searched the PubMed and Google scholar databases for relevant studies that evaluated
the expression of TRIM proteins in inflammatory skin diseases.
Study Selection: All the studies were independently assessed for inclusion. They were included if they fulfilled the
following criteria: published in English language, published in peer-reviewed journals, focused on the role of TRIM
proteins in inflammatory skin diseases. The initial search presented 30 articles of which 8 met the inclusion criteria.
The articles studied the effect of role of TRIM proteins in inflammatory skin diseases.
Data Synthesis: Comparisons were made by structured review with the results tabulated.
Conclusion: We concluded that TRIM proteins play an important role in inflammatory skin diseases development,
prognosis and treatment.
Keywords: Tripartite motif proteins, TRIM proteins, Inflammatory Skin diseases, Psoriasis, Atopic dermatitis.
INTRODUCTION
Data Extraction:
The skin is the largest organ of the human body and
builds a barrier to protect from the harmful
If the studies did not fulfill the inclusion criteria,
environment and from loss of water. Disturbed barrier
they were excluded such as studies on TRIM protiens
allows the entry of substances into the skin that are
in systemic diseases or skin diseases other than
immunologically reactive, which lead to inflammatory
inflammatory, report without peer-review, not within
processes in the skin. In many common inflammatory
national
research
program
or
skin diseases, a defect in the formation of the skin
letters/comments/editorials/news.
barrier is observed, and cytokine composition within
The analyzed publications were evaluated according to
the skin is different compared to normal human skin (1).
evidence-based medicine (EBM) criteria using the
Inflammatory skin diseases are frequently chronic skin
classification of the U.S. Preventive services Task
conditions affecting many people at all stages of life (2).
Force & UK National Health Service protocol for EBM
Due to their impact and complexity, they represent
in addition to the Evidence Pyramid.
a major challenge of modern medicine. Dermatology
textbooks describe more than 100 different
U.S. Preventive services Task Force:
inflammatory skin diseases based on clinical
Level I: Evidence obtained from at least one
phenotype and histological architecture. Combining
properly designed randomized controlled trial.
the enormous advances made in lymphocyte
Level II-1: Evidence obtained from well-designed
immunology and molecular genetics with clinical and
controlled trails without randomization.
histological phenotyping reveals six immune response
Level II-2: Evidence obtained from well-designed
patterns of the skin, which are the lichenoid pattern, the
cohort or case-control analytic studies preferably
eczematous, the bullous pattern, the psoriatic pattern,
from more than one center or research group.
fibrogenic pattern and the granulomatous pattern (3).
Level II-3: Evidence obtained from multiple time
Multiple studies showed that TRIM family proteins
series with or without the intervention. Dramatic
play a significant role in a variety of cellular processes,
results in uncontrolled trials might also be
including immunity, transcriptional regulation,
regarded as this type of evidence.
inflammation, cell cycle progression, and apoptosis (4).
Level III: Opinions of respected authorities, based
This study aimed to evaluate the role of TRIM
on clinical experiences, descriptive studies, or
proteins in inflammatory skin diseases.
reports of expert committees.
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/)
2462
Received:28 /7 /2020
Accepted:27 /8 /2020
c:\work\Jor\vol817_29
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2468-2475
Clinical and Ultrasound Estimation of Fetal Weight at Term and
Its accuracy with Birth Weight
Magdi Ragab El-Sayed, Badeea Seliem Soliman, Mohamed Mustafa Zaitoun,
Rehab Jamal Mohammed El Shorbaji*
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Rehab Jamal Mohammed El Shorbaji, Mobile: +20 01204547416,
E-mail:dr.rehabjamal89@gmail.com
ABSTRACT
Background: Accurate estimation of fetal weight is of paramount importance in the management of labor and
delivery. Objective: To evaluate fetal weight by clinical and ultrasound methods and its correlation to actual birth
weight. Patients and Methods: This comparative cross sectional study was conducted at maternity hospital Zagazig
University Hospitals and Zagazig General Hospital, in the period from September 2018 to March 2019. 84 women
with singleton pregnancy, full term, no medical disorders with pregnancy were selected from Antenatal Clinics and
Maternity Wards. They were prepared for elective caesarean section within 24 hours. Full history was taken then
general and abdominal examination was done, followed by obstetric palpation (Leopold's manoeuver) to evaluate
fundal level, fundal and umbilical grip and first pelvic grip by the right hand to grasp the presenting part (head). Local
examination was done to evaluate cervical dilatation if present, degree of descent of the fetal head into pelvis and the
fetal station.
Results: The Hadlocks formula is more accurate than Johnson's formula. The sensitivity of ultrasound was 82.0%
higher than clinical (76.7%).
Conclusions: Antenatal fetal weight can be estimated with reasonable accuracy, by ultrasounography using Hadlocks
formula and clinically using Johnson's formula.
Keywords: Foetal Birth-Weight, Pregnancy, Ultrasonography.
INTRODUCTION
are then inserted into regression equations to derive
Birth weight is a single most important factor that
estimated fetal weight (7). Evaluation of uterine size
determines the neonatal outcome and survival (1). Fetal
externally with use of a physician's hands is
and Neonatal life are affected by many factors
characterized by being simple, easy and cheap. In
including genetic, socio economic and environmental
addition, it is characterized by being standard clinical
factor (2). Both low birth weight and excessive fetal
method as an alternative to ultrasonography (USG),
weight at time of delivery are associated with increased
which is expensive and not always easy to access,
risk of newborn complications during labor and the
especially in countries with limited financial resources
puerperium (3).
for health. However, the clinical method has many
The perinatal complications associated with low
drawbacks such as it is the oldest method and there
birth weight are attributed to either preterm delivery or
have been doubts about its use because it is not
intrauterine growth restriction (IUGR). For excessively
objective (8). The aim of this study was to evaluate fetal
large fetuses, the potential complications associated
weight by clinical and ultrasound methods and its
with delivery include shoulder dystocia, brachial
correlation to actual birth weight.
plexus injuries, intrapartum asphyxia, hypoglycemia,
electrolyte imbalance and neonatal jaundice (4).
PATIENTS AND METHODS
In preterm deliveries and intrauterine growth
A cross-sectional study was carried out at
restriction, perinatal counseling on the likelihood of
Maternity Hospital, Zagazig University Hospitals and
survival, the intervention taken to postpone delivery,
Zagazig General Hospital, in the period from
optimal route of delivery or the level of hospital where
September 2018 to march 2019. The study included 84
delivery should occur is completely based on the
pregnant women, 40 of them were delivered in
estimated fetal weight (5).
Maternity Hospital, Zagazig University Hospitals and
It has been suggested that accurate estimation of
44 were delivered in Zagazig General Hospital. All
fetal weight would help in successful management of
were delivered by elective caesarean section. The mean
labor and care of the newborn in the neonatal period
maternal age was 28.2 years, with minimum age being
and help in avoidance of complications associated with
20 years and maximum being 37 years. The mean
fetal macrosomia, thereby decreasing perinatal
gestational age was 38.1, with a minimum gestational
morbidity and mortality (6). Two main methods for
age being 37 weeks and maximum being 42 weeks.
predicting birth-weight in current obstetrics were used:
Inclusion criteria: Full term 37-42 weeks of gestation,
(a) Clinical techniques based on abdominal palpation of
singleton pregnancy, cephalic presentation and women
fetal parts and calculations based on fundal height and
with reliable date.
(b) Sonographic measures of skeletal fetal parts, which
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/)
2468
Received:26 /6 /2020
Accepted:24 /8 /2020
c:\work\Jor\vol817_30
Egyptian Journal of Hospital Medicine (October 2020) Vol. 81 (7), Page 2476-2480
Diagnostic Accuracy of Transthoracic Ultrasound Guided Biopsy Versus
Medical Thoracoscopic Pleural Biopsies in Unexplained Exudative Pleural
Effusions in El-Minia University Hospital (Single Center Experience)
Bahaa Ibrahim Mohamed*1, Mostafa Ibrahim Ali Elshazly2,
Hala Abd-Elhameed Mohammad1, Ali Abdelazeem Hasan3, Ahmed Fathy Mady1
1 Department of Chest Diseases, Faculty of Medicine Minia, University, 2Department of Chest Diseases, Faculty of
Medicine, Cairo University, 3Department of Chest Diseases, Faculty of Medicine, Assiut University, Egypt
*Corresponding Author: Bahaa Ibrahim Mohamed, Mobile: +20 01142741126, Email: Mahmoud.znaty@yahoo.com
ABSTRACT
Background: Transthoracic ultrasound (TUS) has been established to be important in chest diseases including pleural
diseases. Interventional pulmonology showed rapid growth and flexrigid thoracoscopy development, which brought
medical thoracoscopy to the forefront.
Objective: To compare the diagnostic accuracy, advantages and complications of TUS pleural biopsies versus medical
thoracoscopic pleural biopsies in patients with idiopathic and exudative pleural effusion (PE) in El-Minia University
Hospital.
Patients and methods: Seventy patients with idiopathic and exudative PE were divided randomly into two groups;
group I included 45 patients underwent sonar guided pleural biopsy and group II involved 25 patients underwent
thoracoscopic pleural biopsy.
Results: TUS-guided biopsy was diagnostic in 40 of 45 (88.8%) compared to 24 of 25 cases (96%) were diagnosed
by thoracoscopy. Forty-two patients had malignant cause of effusion; 23 patients (51%) in TUS group and 19 (76%)
patients in thoracoscopy group. Twenty-two patients had nonmalignant pleural effusion; 17 in group I and 5 in group
II. The diagnosis was unclear in 6 patients, 5 of them in group I. Thoracoscopic group displayed greater percentages
of post-procedural complications especially pain in site of puncture.
Conclusion: TUS examination has close sensitivity and specificity to medical thoracoscopy and allows better
assessment of effusion with fewer complications.
Keywords: Sonar-guided biopsies, Medical thoracoscopy, Pleural diseases, Pleural effusion, Thoracic ultrasound.
INTRODUCTION
Recently, interventional pulmonology shows
Pleural effusions (PE) are encountered
rapid growth along with the sedation techniques
conditions commonly seen in pulmonary medicine.
evolution and flexrigid thoracoscopy development,
Approximately 1.5 million new cases of pleural
which brought medical thoracoscopy (MT) to the
effusions are identified and around 180.000
forefront. Broadly, thoracoscopy is classified into
thoracentesis are annually carried out in the United
minimally invasive MT and surgical thoracoscopy,
States alone (1, 2). Definitive or more accurate diagnosis
which is called VATS (4, 16). Relatively, MT is a safe
in 59% to 73% of cases is provided by thoracocentesis
procedure with a very low mortality rate. Empyema,
and additional diagnostic methods are often needed (3,
bleeding, local metastasis, pneumothorax, broncho-
4). Sometimes, it is difficult to find pleural effusion
pleural fistula as well as pneumonia are major
cause, particularly malignant PE, via thoracocentesis
complications have been occurred in about 1.8%.
alone due to relatively low the diagnostic accuracy (5-
Whereas subcutaneous emphysema, minor bleeding,
7). The important step when identifying PE is
skin site infection, hypotension, atrial fibrillation, and
exanimation of pleural biopsy. Different techniques are
fever are minor complications have been occurred in
used to obtain diagnostic tissues for histological
7.3% according to the recent BTS guideline of Pleural
examination such as local anesthetic thoracoscopy
Disease (9).
(LAT), image-guided biopsy and video-assisted
Our study aimed to compare the diagnostic
thoracic surgery (VATS) (8-10).
accuracy, advantages and complications of TUS
Ultrasound (US) examination has been found to
pleural biopsies versus medical thoracoscopic pleural
be important in a wide range of chest diseases,
biopsies in patients with idiopathic and exudative
especially when the pleural space is affected (3). The
pleural effusion in El-Minia University Hospital.
benefits of ultrasound-guided biopsy are specifically
rapid and cheap and is linked with a low incidence of
PATIENTS AND METHODS
pneumothorax (11). The diagnostic exactness and
Seventy patients with idiopathic exudative pleural
accuracy of US-guided needle biopsy (PCNB) in many
effusion who attendant to Chest and Tuberculosis
literatures is 62.8% to 94% (12-15).
Department, El-Minia University Hospital.
Ethical and patients' approval: The protocol of this
This article is an open access article distributed u
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Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
6742
Received:28 /7 /2020
Accepted:27 /8 /2020
/center>