c:\work\Jor\vol823_1 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 386-390

Missed Traumatic Diaphragmatic Hernia: Presentation and Outcome of Surgery
Khaled Mohamed Abdelaal1, Ayman Mohammad Abdelghaffar 1, Mohamed Abdel Bary 2, Abdelhady
Ahmad Helmy3, Islam Mokhtar Ahmad3, Essam Elbadry Hashim Mohamed1
Departments of 1Cardiothoracic Surgery and 3Anesthesia and Intensive Care,
Faculty of Medicine, Sohag University, Sohag, 2 Department of Cardiothoracic Surgery,
Faculty of Medicine, South Valley University, Qena, Egypt
*Correspondence author: Essam Elbadry Hashim Mohamed, Mobile: 00201093939202,
E-mail: essam_hashem@ med.sohag.edu.eg
ABSTRACT
Background:
Diaphragmatic insults are the most frequently overlooked injuries in trauma patients. Sometimes it is
difficult for trauma physicians to detect diaphragmatic injuries because they are clinically silent. Nevertheless, the
precise determination of this hernia is crucial, as missed traumatic diaphragmatic hernia (MTDH) may lead to serious
complications. Objective: To comprehend MTDH more readily regarding the presentation and evaluation of surgical
management outcomes. Methods: All patients diagnosed with MTDH admitted to the emergency department for
surgery at the period from January 2010 to March 2018 were included in the study. We evaluated our cases as regard
age, gender, clinical presentation, type of trauma, time since trauma, site of the hernia, surgical technique,
complications, and mortality.
Results: 25 patients with MTDH were included, 76% were males, mean age was 33.3 years. 92% were left-sided,
while 8% were right-sided. 56% of cases were detected within 20 to 40 years of age. Penetrating trauma was the
cause in 76 % of cases, blunt trauma in 16%. The stomach and colon were the commonest herniated organs in 64%
and 56 % respectively. Dyspnea, abdominal pain, and vomiting were the commonest presentation. Thoracotomy was
performed in all patients. Chest infection, pneumonia, ARDS, and empyema were the commonest complications. 3
(12%) cases of mortality in our study.
Conclusion: every effort should be done to detect diaphragmatic injury in trauma patients, and surgeons should have
a high index of suspicion, for early diagnosis, to prevent complications with subsequent high morbidity and mortality.
Keywords: Diaphragmatic hernia; Trauma; Missed diagnosis.

INTRODUCTION
descriptive statistics in SPSS (Version 23), and a P-
Despite being a rare entity, diaphragmatic insults
value of 0.05 was considered significant. This study
are the most frequently overlooked injuries in trauma
was approved by the ethical Institutional Review Board
(1). The traumatic diaphragmatic hernia was detected in
of Sohag University Hospital.
about 10% of thoracoabdominal injuries; either blunt,

penetrating, or iatrogenic trauma (2, 3). It is reported that
ETHICAL APPROVAL
missed diaphragmatic injuries in conservatively
The study was approved by the medical research
managed patients range from 12% to 66%, leading to
ethics committee of Sohag University, and informed
late complications and considerably increased mortality
patients' consent was fulfilled.
and morbidity among the patients (4,5). We aim to

RESULTS
comprehend
more
readily
missed
traumatic
25 patients with MTDH diagnosed at least 8 months
diaphragmatic hernia (MTDH) regarding the
after trauma (8 to 50 months, mean= 24.48 months)
presentation and evaluation of surgical management
were included, 19 of them were males, their mean age
outcomes.
was 33.3 years (5-55 years). 23 (92%,) cases were left-

PATIENTS AND METHODS
sided, and 2 (8%) cases were right-sided. 14 (56%)
This is a retrospective study that included 25 MTDH
cases were detected within the 20 to 40 years of age
patients who underwent surgical management at
group. 19 (76%) cases were due to penetrating trauma;
Cardiothoracic and General Surgery Departments,
other causes were blunt trauma (MCA and falling from
Sohag University, Egypt, from January 2010 to March
a height) in 4 cases (16%), iatrogenic in one case, and
2018. All patients diagnosed with MTDH admitted to
post-hernia repair in one case (4%) (Table 1). The
the emergency department for surgery at this period
stomach and colon were the herniated organs in 16
were included in the study. After reviewing the medical
(64%) and 14 (56%), respectively. Other organs (small
files, the required data were collected and recorded in a
intestine, spleen, and liver) were also observed in 24%,
prepared form. We evaluated our cases as regard age,
12%, and 8%, respectively (Table 2) (Figure 4).
gender, clinical presentation, type of trauma, time since
Dyspnea was detected in 11 (44%) patients,
trauma, site of the hernia, diagnostic modalities,
abdominal pain in 6 (24%) patients, and vomiting in 3
surgical technique, complications, mortality, and
(12%) patients. Three (12%) cases presented with an
hospital stay. Data analysis was performed using
emergency in the form of colonic obstruction 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/)
386
Received: 9/10 /2020

Accepted: 27/11/2020



Full Paper (vol.823 paper# 1)


c:\work\Jor\vol823_2 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 391-398

Evaluation of Angiopoietin 2 Serum Level in Lichen Planus and
Psoriasis Patients
Mohamed AbdElkader Teama1, Hagar Awad Bessar1,
Noha Mohamed El-Sayed2, Tawhed Mahmoud Ismail Mahmoud1
Departments of 1Dermatology, Venereology & Andrology and 2Medical Microbiology & Immunology,
Faculty of Medicine ­ Zagazig University.
*Corresponding Author: Tawhed Mahmoud Ismail Mahmoud, Mobile: (+20)01024683929,
Email: mosad8rashed@gmail.com

ABSTRACT
Background:
Psoriasis and lichen planus (LP) are common chronic inflammatory skin diseases. The exact
pathogenesis of these diseases until now is not fully determined. Angiogenesis is tightly regulated by a balance
between pro- and anti-angiogenic mediators.
Objective:
To assess the relation of Ang-2 serum level with angiogenesis and inflammation that occurs in
psoriasis and lichen planus.
Patients and Methods:
Thirty adult patients were included in this study. They were divided into 2 groups, 15
patients each, of psoriasis and lichen planus (8 patients with combined cutaneous and oral LP and 7 patients with
cutaneous LP only). In addition to fifteen healthy subjects taken as control. The activity of the diseases was
estimated at the time of examination using specific activity index for each disease. The serum level of angiopoietin
2 had been estimated by ELISA.
Results:
It was found that these diseases had significantly higher serum levels of angiopoietin 2 than the control
group. The serum levels of angiopoietin 2 were higher in psoriasis compared to lichen planus, but the difference
between psoriasis and lichen planus was not statistically significant. There was significant positive correlation
between serum levels of angiopoietin 2 and the clinical severity of psoriasis. On the other hand, there was no
correlation between serum level of angiopoietin 2 and the clinical severity of lichen planus.
Conclusion: An important evidence on the importance of angiopoietin 2 serum level in pathogenesis of lichen
planus as well as psoriasis. It elevated in serum of psoriasis and lichen planus patients that reflects its role in
angiogenesis and inflammation that are important events in the development of these diseases.
Keywords: Angiopoietin 2, Lichen planus, Psoriasis, Evaluation.

INTRODUCTION
angiogenic factor is VEGF, which has been
Psoriasis and lichen planus are chronic
characterized to have the role in proliferation,
relapsing inflammatory skin diseases. They may lead
survival and cell migration, as well as vascular
to marked disability affecting the physical and
permeability (4).
emotional wellbeing of patients. Both combined cost
In addition to the VEGF signaling, studies have
of long-term therapy and social burden of this disease
drawn much attention to the contribution of
have a major impact not only on the patient, but also
aberrantly activated Ang-2 signaling to angiogenesis
on health care systems. Recent studies indicate that
development. It has been identified to interact with
severe and long-standing psoriasis is associated with
VEGF to determine the fate of blood vessels during
co-morbidities, as well as a shorter life span due to
angiogenesis as it is very essential for controlling
cardiovascular mortality (1).
sprouting angiogenesis, vascular remodeling and the
These diseases are multifactorial, with complex
transition between the quiescent and the activated
interactions of innate and adaptive immune responses
status of ECs (5). Beside its role in angiogenesis, Ang-
based on a strong genetic predisposition and
2 has a positive association with chronic
triggered by environmental factors. The exact
inflammation and psoriasis. For instance, it induces
pathogenesis of these diseases now is not fully
vascular leakage and sensitizes endothelial cells for
determined (2).
signaling molecules like tumor necrosis factor-į
In addition, recent studies suggest that
(TNF-į). Furthermore, it has paracrine eff ects on
angiogenesis is essential for the triggering of
leukocytes, specifically myeloid cells, leading to
psoriatic pathology beside being the key mechanism
monocytes' migration and up/down regulation of
in psoriasis by marked increase in the
cytokines in neutrophilic granulocytes and
microvasculature and underlying marker of lichen
macrophages (6).
planus activity (3). So, the critical role of angiogenesis
The study aimed to o detect the role of
in psoriasis and lichen planus pathogenesis is
Angiopoietin 2 in the pathogenesis of psoriasis and
strongly suggested. In angiogenesis, the prime
lichen planus.

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

/lice nses/by/4.0/)
391
Received:7 /7 /2020

Accepted:22 /8 /2020

Full Paper (vol.823 paper# 2)


c:\work\Jor\vol823_3 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 399-403

Post Chemotherapy Balance Exercises in Children with
Acute Lymphoblastic Leukemia
Radwa Mohamed Mohamed Zakaria*1, Mohamed Maher Elkeblawy2, Abdelmoneim Ahmed
Abdelmoneim3, Hussein Gamal Hussein Mogahed4
1 Physical Therapist at Benha Fever Hospital, 2 National Center of Research,
3Department of Internal Medicine and Hematology, Faculty of Medicine, Benha University, 4Department of
Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Radwa Mohamed Mohamed Zakaria, Mobile: (+20) 01206711197,
E-Mail: radwa.Zakaria87@gmail.com
ABSTRACT
Background:
Acute lymphoblastic leukemia (ALL) is the most common type of childhood cancer; Children with
this type of leukemia have poor postural balance, which is one of the side effects of chemotherapy. Objective: To
evaluate the therapeutic effect of static and dynamic balance exercises using both sides up (BOSU) ball on balance
in children with acute lymphoblastic leukemia after completing their 6 months-chemotherapy treatment.
Patients and methods:
Thirty children patients of both sexes (18 boys and 12 girls) were participated in this study,
who were selected from Benha Children Hospital with acute lymphoblastic leukaemia and had chemotherapy
treatment for 6 months participated in this study. They were randomly assigned to 2 groups of an equal number,
control group, 15 child patients who were 5-8 years of age (6.53 ± 1.13) that underwent gait training therapy and
study groups, 15 child patients who were 5-8 years of age (6.67 ± 1.11), that underwent the same program in addition
to static and dynamic balance training program by using BOSU ball. Results: There was a significant improvement
of balance performance in study group more than control group. Conclusion: Balance exercises using BOSU ball
can be used effectively in treating balance defect post chemotherapy in children with acute lymphoblastic leukemia.
Keywords: Acute lymphoblastic leukemia; Balance exercises; Post chemotherapy side effect.


INTRODUCTION

Acute lymphocytic leukemia (ALL) is the
The advantages of physical exercise training
most common type of childhood cancer, and its
interventions that act on many disabilities in children
incidence is steadily increasing. The 5-year survival
such as the skeletal system, skeletal muscle,
rate has also risen up to more than 85% in high income
neuromuscular system, heart and lung, cardiovascular
countries, but treatment has adverse impacts. Because
system, fatigue, disturbances of postural balance, and
of this improvement in survival rate, attention has
metabolic changes were examined. These side effects
shifted toward understanding the adverse impacts of
can be prevented or significantly reduced by
cancer treatment such as chemotherapy-induced
introducing a physical exercise program during or
neuropathy and loss of bone mineral density. Poor
shortly after cancer treatment. Several interventions
balance is an adverse effect that is less investigated
are introduced to reduce the level of vulnerability
for cancer treatment (1).
caused by disease and thus suggest the importance of
Balance defects seen in children and
physical training activity in improving children's
adolescents having been through neurotoxic treatment
quality of life (5). Balance training is an effective
for cancer, despite balance impairments occurring
intervention to improve static postural sway and
during cancer treatment improve over time, their
dynamic balance. Both sides up (BOSU) ball is a tool
mean scores remain below population norms at 6
that helps enhance postural balance and adds extra
months post treatment for many forms of cancer (2).
intensity to many different types of training; upper
Motor skills in children grow fast and any
and lower body, core and cardio, challenging body
intermission of this development, e.g. during the
balance, improving core strength, stability, moreover
course of a cancer disease and its treatment, leads to
it adds fun to children (6).
a lateness in a number of these motor skills (3). This
Also, gait training can help in improve
can be accompanied by psychosocial effects in
postural balance as it helps in strengthening the
affected individuals when dealing with other
muscles of the body, improves balance and posture,
members of their same age group. A decrease of
builds up endurance, develops muscle memory,
balance ability is supposed to be one side effect of
retrains the legs for repetitive movement, and reduces
childhood cancer, according to the cancer type, the
the risk of falls, while increasing body movements (7).
treatment, and the time elapsed since treatment (4).

This article is an open access article distributed under the terms and conditions of the
Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
399

Received:9 /10 /2020

Accepted:27 /11 /2020



Full Paper (vol.823 paper# 3)


c:\work\Jor\vol823_4 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 404-409
Comparative Study between Ultrasound-Guided Serratus Anterior Plane
Block and Thoracic Epidural Analgesia for Breast Surgery
Ahmed Elsaied Abd-Elrahman Ali1, Sherif Kamal Hafez Arafa2,
Amir Abou Zkry Elsayed2, Mahmoud Fawzy Shehata El Sharkawy*4
1Department of Anesthesia and Intensive Care and Pain Medicine, Faculty of Medicine, Sohag University, Sohag,
2Department of Anesthesia and Intensive Care, Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh,
4Department of Anesthesia and Intensive Care, Faculty of Medicine, Aswan University, Aswan, Egypt
*Corresponding author: Mahmoud Fawzy Shehata, Mobile: (+20) 01011774192, E-Mail: mahmoud83me@gmail.com

ABSTRACT
Background:
Breast surgery is a common procedure and associated with an increased incidence of acute and chronic
pain. These procedures cause significant acute pain and may progress to chronic pain states in 25­60% of cases.
Regional anesthesia techniques may improve postoperative analgesia for patients undergoing breast surgery.
Objective: To compare the difference between the anesthetic effect of thoracic epidural versus serratus anterior plane
block in breast surgery.
Patients and methods: This study conducted on 60 adult patients scheduled for elective breast surgery divided into
three groups. Each group contains twenty patients. Group A (n. 20) received general anesthesia only, Group B (n. 20)
received combined general anesthesia and thoracic epidural analgesia, by receiving 6­8 ml of 0.25% bupivacaine and
0.05 mg fentanyl via the epidural catheter and Group C (n. 20) received serratus anterior plane block combined with
general anesthesia.
Results: The results of the present study demonstrated that SAP block caused hemodynamic stability, decreased the
intensity of postoperative pain, reduced postoperative analgesic requirement, prolonged the time needed for the first
request of analgesia, Therefore it can be considered as a safe procedure and effective for intraoperative and
postoperative pain control in breast surgeries. Also, this study demonstrated that there is no difference between the
groups according to nausea and vomiting.
Conclusion: SAP block can produce excellent pain relief during the first six postoperative hours. It has a great promise
due to its simplicity, easy-to-learn techniques, and relative lack of contraindications and complications.
Keywords: Ultrasound, Serratus Anterior Plane Block, Thoracic Epidural Analgesia, Breast Surgery

INTRODUCTION
of the intercostal nerves, before dividing into anterior
Anesthesiologists are very concerned about
and posterior branches are blocked as they pass through
alleviating postoperative pain in general and especially

after breast surgery. Regional blocks guided by
this plane to supply sensation to the anterolateral chest
ultrasonography such as thoracic epidural block and
wall. This novel technique has become a popular
pectoral nerve block are recommended. That is because
analgesic alternative to multiple puncture intercostals
breast surgery, even relatively minor, can be associated
block, epidural and paravertebral block in breast surgery
with significant postoperative pain (1).
given decreased incidence of adverse events and has the
Postoperative pain for surgeries involving chest
advantage of the simultaneous blockade of multiple
wall is mostly managed using multimodal analgesia by
dermatomes, it is easy to do and decrease the rate of local
using a combination of non-steroidal anti-inflammatory
anesthetic absorption (5).
drugs (NSAIDs), paracetamol, opioids, and local
The great advances achieved in the pain
anesthetic infiltration. In extensive surgeries like radical
management of breast cancer surgery have made it
mastectomy and latissimus dorsi flaps, some anesthetists
essential for the anesthesiologist to have detailed
may employ the use of thoracic epidural analgesia or
knowledge of all anatomical features of the breast,
paravertebral blocks, or pectoral nerves block (2).
thoracic wall, and axillary region, especially with the
Epidural anesthesia represents one of the central
increasing use of ultrasonography to identify tissue
neuraxial block techniques. Improvements in
layers and particularly, fascial layers has led to the
equipment, drugs, and technique made it a popularity
development of several newer interfascial injection
and introduced it as a versatile anesthetic technique with
techniques for analgesia of the chest and abdominal wall
many applications in surgery and pain control (3).
(6).
Blanco et al. (4), first described a new block of
Over the past decade, the physical and clinical
the thoracic wall serratus plane block under Ultra Sound
understanding of anatomical sonography has evolved
guidance. Local Anesthesia was deposited in the
greatly. Ultrasound guidance enables the anesthetist to
Serratus Anterior Plane. The lateral cutaneous branches
secure an accurate needle position and to monitor the
distribution of the local anesthetic in real-time and this
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/)
404
Received:9 /10 /2020

Accepted:27 /11 /2020



Full Paper (vol.823 paper# 4)


c:\work\Jor\vol823_5 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 410-415

Role of Myxovirus Resistance Protein 1 (MXA) in Psoriatic Skin
Rehab Monir Samaka1, Mohamed Ahmed Basha2, Yara Mahmoud*2
Departments of 1Pathology and 2Dermatology, Faculty of Medicine, Menoufia University
*Corresponding author: Yara Mahmoud, Telephone: +2- 01005538249, Email: yaramahmoud_1267@gmail.com

ABSTRACT
Background:
Myxovirus-resistance protein 1 (MXA) is a key mediator of the interferon-induced antiviral
response and is tightly regulated by type I IFNs. The expression of type I IFN signaling components is markedly
increased in psoriasis skin lesions. The role of MXA in psoriasis pathogenesis is still poorly understood.
Objective: The aim was to investigate the role of MXA in psoriatic skin.
Material and Methods:
Medline databases (PubMed, and Medscape) and all materials available in the internet
were searched. The search was performed in December 2020.
Study selection: The initial search presented 120 articles. The number of studies that met the inclusion criteria
was 17. The articles included diagnosed patients with chronic plaque psoriasis of both genders.
Data synthesis: Significant data were collected. Then a structured review was performed.
Data extraction:
If the studies did not fulfill the inclusion criteria, they were excluded. Data from each eligible
study were independently abstracted in duplicate using a data collection form to capture information on study
characteristics, interventions, and quantitative results reported for each outcome of interest.
Finding:
In total 9 potentially relevant publications were included; it was found that cytoplasmic localization of
MXA in the keratinocytes of the psoriatic skin might play a private role in psoriasis pathogenesis.
Conclusion: Cytoplasmic localization of MXA in the keratinocytes of the psoriatic skin might play a private role
in psoriasis pathogenesis. This can open a new gate for a target therapy in psoriasis.
Keywords: Myxovirus resistance protein 1, Psoriasis, Skin.

INTRODUCTION
connective tissue diseases(2).
Psoriasis is a chronic, inflammatory skin
The etiology of psoriasis is multifactorial and
condition that affects between 2­4% of the general
recently, researches on psoriasis pathogenesis have
population, with recent estimates suggesting over
increased in a trial to get targeted and highly effective
one hundred twenty-five million patients worldwide.
therapies (3).
It is associated with a number of comorbidities as
Type
I
interferons
(IFNs)
are
an
well as a high socioeconomic burden. Psoriasis
immunomodulatory class of cytokines that serve to
patients also experience a decreased quality of life as
protect against viral and bacterial infection. In
a result of this disease. The pathogenesis of psoriasis
addition there is evidence suggests IFNs, particularly
is currently under active investigation, with studies
type I but also IFN, are important to the
aiming to identify genetic susceptibility loci for
pathogenesis of autoimmune and inflammatory skin
psoriasis in order to detect novel targets for systemic
diseases, such as cutaneous lupus erythematous
therapy. While the exact pathogenesis of psoriasis is
(CLE). Type I IFNs ( and ) are produced by
not fully understood, basic and translational
recruited inflammatory cells and by the epidermis
investigations have led to a renewed understanding
itself (IFN) and have important roles in autoimmune
of Th-17 and Th-1 pathways involved in the
and inflammatory skin disease such as psoriasis (4).
development of psoriasis (1).
Myxovirus resistant protein 1 (Mx1) is the main
Psoriasis is a chronic inflammatory also
IFN-induced intracellular restriction factor against
systemic disease with various co-morbidities, having
influenza and influenza-like viruses in mice, and the
been recently considered as a comprehensive disease
Mx homologs in human serve similar functions (5).
named psoriatic disease or psoriatic syndrome. The
Their expression is strictly controlled by type I and
autoimmune diseases are one form of its co-
III IFNs. In humans, MX1 (also known as MxA) and
morbidities. In addition to the genetic background,
MX2 (also known as MxB) are encoded by closely
shared pathogenesis including innate immunity,
linked genes on the long arm of chromosome 21
neutrophil extracellular trap (NETs), and type I
(map position 21q22.3) (6). Opposite to other IFN-
interferon, as well as acquitted immunity such as T
stimulated genes, mx genes generally are not induced
helper-17 (Th17) related cytokines are speculated to
directly by viruses and are not expressed
play a significant role in both psoriasis and
constitutively. In contrast, their expression is strictly
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/)
410
Received:9 /10 /2020

Accepted:27 /11 /2020



Full Paper (vol.823 paper# 5)


c:\work\Jor\vol823_6 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 416-425

Association of Circulatory Long Non-Coding RNA AFAP1-AS1 with
Risk and Progression of Hepatocellular Carcinoma in Egyptian Patients with
Chronic Hepatitis C Virus Infection
Nearmeen M. Rashad*1, Sherweet M. Ahmed2, Marwa H.S. Hussien3, Marwa G. Amer4, Neveen F. Ibrahim1
Departments of 1Internal Medicine, 2Tropical Medicine, 3Medical Biochemistry and
4Clinical Pathology, Faculty of Medicine, Zagazig University - Zagazig, Egypt
*Corresponding author: Nearmeen M. Rashad, Tel.: +20 1224248642, E-mail: nrashad78@yahoo.com & n.rashad@zu.edu.eg.

ABSTRACT
Background:
Hepatocellular carcinoma (HCC) is one of the most frequent malignant tumors worldwide. Long
noncoding RNA (lncRNA) contribute to extensive biological processes and play oncogene or tumor suppressor roles in
several diseases.
Objective: To evaluate the expression levels of lncRNA AFAP1-AS1 in Egyptian patients with chronic hepatitis c virus
infection (HCV) and to assess its relations with clinicopathological features of HCC.
Patients and Methods: 60 chronic hepatitis C (CHC) patients in addition to 40 healthy subjects as a control group were
enrolled in this study. CHC patients were divided into three groups, group I comprised 33 patients with chronic hepatitis
C (CHC); group II comprised 15 patients with cirrhosis and 12 patients with HCC. lncRNA AFAP1-AS1 relative
expression level was determined by RT-PCR.
Results: lncRNA AFAP1-AS1 relative expression level was upregulated in CHC groups (4.28 ± 2.69) compared to
controls [(2.56 ± 1.35), P < 0.001*]. Additionally, there was a significant difference between case groups as the highest
relative expression level was in HCC patients (5.3 ± 2.28) compared to cirrhosis (4.28 ± 3.69) and CHC (3.93 ± 0.652).
The lncRNA AFAP1-AS1 relative expression level was significantly positively correlated with clinicopathological
features of HCC.
Conclusions: lncRNA AFAP1-AS1 relative expression level was upregulated in CHC patients in particular patients with
cirrhosis and HCC. Thus, circulatory lncRNA AFAP1-AS1 may be able to serve as a promising non-invasive diagnostic
marker for cirrhosis and HCC.
Keywords: lncRNA, Chronic hepatitis C, Cirrhosis, AFAP1-AS1, HCC.

INTRODUCTION
pathogenesis and pathophysiology such as cancers,
Hepatocellular carcinoma (HCC) is one of the
cardiovascular disorders, and metabolic disorders. This
most frequent malignant tumors worldwide. Chronic

hepatitis C (HCV) infection is the third leading cause of

HCC and accounts for about one-third of total incidence
relation reveals that lncRNAs could be used for
rates and one-fifth of HCC-related deaths (1). HCV
therapeutic targets or biomarkers for diseases (6).
increases the risk of HCC development by nearly 17-fold
lncRNA actin filament associated protein 1-
compared to healthy individuals (2). The risk of developing
antisense RNA 1 (AFAP1-AS1) is associated with cellular
HCC in patients with HCV infection increases in
proliferation, invasion, and metastasis and increased
proportion to the degree of hepatic fibrosis. In fact, most
apoptosis in vivo (7).
cases of HCV-related HCC occur during established
Many global studies have focused on the
cirrhosis,
suggesting
that
cirrhosis-mediated
diagnosis and treatment of HCC. Nevertheless, its
carcinogenesis may play a primary role in the
prognosis is still poor owing to a series of reasons, such as
development of HCC (3).
growing incidence, late diagnosis, persistent drug
Long non-coding RNA (LncRNAs) account for a
resistance, and repeated recurrence. Thus, it is urgent to
large portion of the non-coding transcripts. They include
discover novel and valuable diagnostic and prognostic
more than 200 nucleotides and have no or restricted
biomarkers for HCC the present study aimed to evaluate
protein-coding potential (4). LncRNAs can regulate gene
the expression levels of lncRNA AFAP1-AS1 in Egyptian
expression and the synthesis of protein in different ways.
patients with HCV and to assess its relations with
Numerous previous studies concluded that long non-
clinicopathological features of HCC.
coding RNAs play an important role in regulating many

biological processes including gene expression, cell cycle
SUBJECTS AND METHODS
regulation, and cellular differentiation (5). Hence,
This case-control study was conducted on 60 adult
deregulated lncRNA Th
expr is
es a
si rticle is
on may a
n o
contpren a
ibut ccess
e to a
di rt
se icle di
ase strib
pat u
i ted u
ents n
of d
er
bot th
h e
s ter
exe m
s s a
witnd co
h chr nd
on itio
ic ns
he of
pat t
ith
i e
s Crea
C in tive
addition
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
416
Received:9 /10 /2020

Accepted:27 /11 /2020


Full Paper (vol.823 paper# 6)


c:\work\Jor\vol823_7 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 426-432

Assessment of Transcerebellar Diameter Accuracy in Detection of Gestational
Age in Third Trimester in Cases of Intrauterine Growth Restriction
Youssef Abo Elwan El-Sayed, Mohamed El Sayed Mohamed,
Walid Abdallah Abdel Salam, Rana Ramadan Ibrahim Soliman
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Rana Ramadan Ibrahim Soliman, Mobil: (+20)1117633096,
E-mail: ranaramadanibrahim88@gmail.com

ABSTRACT
Background:
Intrauterine Growth Restriction (IUGR) is defined as decreased fetal birth weight less than 10th
percentile as regard to gestational age also diagnosed when there is a delay more than 2 weeks in a serial ultrasound
monitoring of fetal gestational age.
Objective: The aim of the work was to evaluate accuracy of transcerebellar diameter (TCD) in detection of
gestational age in pregnancies with intrauterine growth restriction IUGR.
Patients and Methods: Case-Control study was carried out on 52 women with normally progressing pregnancies
during the third trimesters, with gestational ages between 27 and 37 weeks of gestation came to outpatient clinic of
department of Obstetrics and Gynecology, Zagazig General Hospital and Zagazig University Hospital from June
2019 to March 2020, of them, 26 subjects were normal pregnancies and 26 subjects diagnosed as IUGR in 3rd
trimester at gestational age (27week to 37 week). Trans-abdominal ultrasound was performed on all subjects; Fetal
TCD was measured using the widest diameter of the cerebellum, measurement of fetal Bi-Parietal Diameter (BPD),
Abdominal Circumference (AC), and Femur Length (FL).
Results:
There was statistically significant difference between gestational age (GA) by Last Menstrual Period
(LMP) and sonar parameters at normal group but highest was TCD with P value 0.000 but in IUGR group only
TCD, AC and FL were significantly positive correlated with GA; and TCD were highly significant.
Conclusions: It could be concluded that the TCD measurement appears to be an accurate predictor of gestational
age, even in the third trimester of pregnancy.
Keywords:
Transcerebellar Diameter, Intrauterine growth restriction, gestational age.

INTRODUCTION

Intrauterine growth restriction (IUGR) is
especially early gestation 6. The fetal cerebellum
characterized as a decreased fetal birth weight of less
displays progressive growth over the entire gestation
than 10th percentile in terms of gestational age.
period of 5, 7; thus, it is an organ capable of providing
It is diagnosed when the fetal gestational age
information on the prediction of GA during pregnancy.
measured by transabdominal ultrasound less than
TCD is well known in ultrasound literature as a valid
estimated gestational age measured using first day of
parameter for the estimation of GA. This parameter can
last menstrual period by more than 2 weeks. It is also
be especially useful for accurate pregnancy dates in the
diagnosed when there is a delay more than 2 weeks in
third trimester (5).
a serial ultrasound monitoring of fetal gestational age
The TCD is a reliable indicator of GA in the fetus
(1).
and is a normal to which aberrations in other fetal
IUGR has a prevalence of 5­8% in the general
parameters can be compared, particularly when GA
population. It is the second cause of perinatal mortality
cannot be determined by routine methods of early
after prematurity (2).
pregnancy scanning or the date of the last menstrual
IUGR mostly associated with maternal, fetal and
cycle (6).
placental problems. Maternal as: hypertension,
Nomograms have been developed for TCD and
diabetes mellitus and malnutrition; fetal as: stillbirth,
gestational age during pregnancy, and several studies
oligohydramnios, fetal anomalies, perinatal morbidity
have reported a better relationship between TCD and
and mortality. Placental abnormalities as: placenta
gestational age in the second and third trimesters, and
previa, true knot of the cord (3).
even in IUGR patients, its utility as a growth
The cerebellum, the largest portion of the hind
assessment parameter compared to other routine
brain, consists of a midline part called the vermis and
ultrasound parameters (4,7).
two lateral hemispheres. It is approximately spherical,
This study was aimed to evaluate accuracy of
but somewhat constricted in its median region and
transcerebellar diameter (TCD) in detection of
flattened, with the largest diameter being transverse (4).
gestational age in pregnancies with intrauterine growth
The transverse cerebellar diameter (TCD) is one of
restriction IUGR.
the most reliable growth ultrasound parameters,

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/)
426
Received:8 /7 /2020

Accepted:21 /8 /2020



Full Paper (vol.823 paper# 7)


Evaluation Of QT Interval In Diabetic Ketoacidosis In Medical Intensive Care Unit The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 433-439

Spontaneous Separation Versus Manual Removal of Placenta During
Elective Cesarean Section Regarding Blood Loss
Tarek Mohamed Abd El hamid El-behiedy, Badeea Seliem Soliman,
Fatma El Zahraa El Sayed Ali*, Mohamed Ramadan Ali
Obstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Egypt*
Corresponding author: Fatma El Zahraa El Sayed Ali, Mobile: (+20)1207966674, E-mail: frisky_cat89@yahoo.com

ABSTRACT
Background
: Cesarean section (CS) rates have increased; this is especially concerning in developing countries.
The mode of placental delivery contributes to morbidity associated with CS, and determines blood loss during CS.
Objective:
The aim of the work was to compare spontaneous placental delivery with cord traction and manual
removal of placenta as regards amount of blood loss during elective cesarean section.
Patients and Methods
: This prospective Cohort study included a total of 48 Women prepared for elective cesarean
section, attending at Zagazig University Hospitals and Zagazig General Hospital. This study was conducted between
April 2019 to October 2019. The included subjects were divided into two groups (24 each) regarding methods of
placental delivery. Group A; placenta was allowed to be separated spontaneously and removed by gentle cord
traction. Group B; placenta was removed manually by the surgeon's hand introduced into the uterine cavity and
cleavage plane was created between the placenta and decidua basalis following which the placenta was grasped
and removed. With the use of oxytocin by intravenous infusion 20 units after delivery of the baby in both groups.
Results
: Blood loss in spontaneous placental separation group was (881.67 ± 74.54) ml, but in manual placental
separation group was (962.79 ± 116.11) ml, (p<0.01). The preoperative hemoglobin (g/dl) in spontaneous
separation group was (11.3 ± 1.07) and in manual separation group was (11.63 ± 1.11), postoperative hemoglobin
in spontaneous separation group was (10.3 ± 0.83) and in manual separation group was (9.42 ± 0.74).
Conclusion
: Manual removal of placenta only seems to be superior in saving the time taken to extract out placenta.
Manual removal of placenta adds to the post-operative complications in form of greater blood loss and infections.
Keywords; Cesarean section, Manual placental removal, Blood loss

INTRODUCTION

A cesarean section is a surgical intervention in
So the degree of blood loss depends on timing of
which incisions are made through woman's abdomen
the placental separation from the uterine wall and the
then uterus to give birth. This procedure is done when
time of uterine muscle contraction (5).
vaginal delivery is considered dangerous to the baby or
The method of placental removal is one of the
the mother, so it is a life-saving operation (1).
factors that may increase or decrease in the morbidity
The rate of cesarean section has increased from
of cesarean section (6).
5% to more than 20% over the last 3 decades as a belief
The aim of this study was to compare
that cesarean section will reduce perinatal mortality.
spontaneous placental delivery with cord traction and
This rate has been increasing and continue in future to
manual removal of placenta as regards amount of blood
the extent that cesarean section can be done as an
loss during elective cesarean section.
elective as well as emergency procedure (2,3).

Cesarean section may be associated with
PATIENTS AND METHODS
complications like hemorrhage, fever and endometritis,
This prospective Cohort study included a total
venous thromboembolism, and abnormal placentation
of 48 Women prepared for elective cesarean section,
in the following pregnancies. Women undergoing
attending at Zagazig University Hospitals and Zagazig
cesarean delivery have higher risk of hemorrhage
General Hospital. This study was conducted between
compared to those undergoing normal delivery (4).
April 2019 to October 2019.
The process of placental separation starts

immediately after delivery of the baby by contraction
Ethical approval:
and retraction of uterine muscle which result in
Written informed consent was obtained from all
reduction in the size of the uterus consequently, the
participants and the study was accepted by the
placental bed to which the placenta is attached become
Research Ethics Committee of the Faculty of
smaller than the incompressible placenta. The placenta
Medicine, Zagazig University. Study has been
sheared off and blood vessels supplying the naked
carried out on experiments involving human
placental bed are compressed by continued contraction
subjects in compliance with the Code of Ethics of the
and retraction of uterine muscle to reduce the bleeding.
World Medical Association (Declaration Helsinki).




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/)
433

Received:6 /7 /2020

Accepted: 20/ 8/2020



Full Paper (vol.823 paper# 8)


List of Abbreviations The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 440-444

Impact of Arterial Blood Pressure Management in
Acute Ischemic Stroke on Short Term Outcome and Prognosis
Mohammed Abdelrahman Abdelrahman Osman1,
Samir Mohamed Attia2, Mohamed Said Gomaa3, Hisham Khairy Ismael4
Departments of 1Emergency Medicine, 2Vascular Surgery,
3Neurology and 4Critical Care Medicine - Faculty of Medicine ­ Mansoura University
*Corresponding author: Mohammed Abdelrahman Abdelrahman, Mobile: (+20) 01028572236,
Email: mohammed_3sman@yahoo.com
ABSTRACT
Background:
Blood pressure (BP) is elevated in 75% or more of patients with acute stroke and is associated with poor
outcomes. Whether to modulate BP in acute stroke has long been debated. With the loss of normal cerebral
autoregulation, theoretical concerns are twofold: high BP can lead to cerebral edema, hematoma expansion or
hemorrhagic transformation; and low BP can lead to increased cerebral infarction or perihematomal ischemia.
Objective: To determine the impact of arterial blood pressure management in acute ischemic stroke on short term
outcome and prognosis. Patients and methods: This study included 200 patients diagnosed with ischemic stroke and
arrived to Emergency Hospital, Mansoura University over a year from June 2019 to June 2020. The cases were classified
into 4 groups according to the systolic BP (SBP) of the cases; control group (SBP < 140 mmHg), group 2 (SBP 140-
160 mmHg) group 3 (SBP 160-180 mmHg) and group 4 (SBP 180-200 mmHg).
Results: The stroke score (follow up) according to blood pressure groups showed no statistically significant difference
between the groups. Regarding the initial CT findings of the cases according to blood pressure groups, fourth group has
more changes in CT brain, with a highly statistical significant difference observed between the groups.
Conclusion: Elevated blood pressure in patients with stroke were associated with worse outcomes including ICU
admission, mortality and duration of hospital admission. CT findings supported these findings as the percent of cases
presented with initial infarction and cases who showed hemorrhagic transformation increased with elevation of BP.
Keywords: Arterial Blood Pressure, Acute Ischemic Stroke, CT, ICU.

INTRODUCTION
approx. 127/79 mmHg in men and 122/77 mmHg in
Stroke is a non-traumatic vascular insult of the
women (4). Blood pressure could be an important
brain in which poor blood flow to the brain results in cell
modifiable factor associated with functional outcomes,
death. It is a major public health problem and the second
especially when considering acute stroke management.
leading cause of death and long-term disability all over
Elevated BP in acute periods is associated with worse
the world (1).
outcomes in acute ischemic stroke (AIS) and could also
Number of potential causes have been
influence the clinical outcome of patients after
hypothesized, including preexisting hypertension;
reperfusion therapy (5). Mean arterial pressure is the
infection; pain; stress associated with hospitalization;
strongest predictor of stroke and is important for
activation of neuro-endocrine hormones (cortisol,
maintaining cerebral perfusion and cerebral blood flow
natriuretic peptide and renin-angiotensin-aldosterone)
velocity (6). High blood pressure during the acute phase
and sympathetic neuroendocrine systems; reduced
of ischemic stroke might be advantageous, as it may
cardiac baroreceptor sensitivity; and Cushing's reflex (a
improve cerebral perfusion of the ischemic tissue.
vasopressor response in response to increased
Conversely, elevated blood pressure might also be
intracranial pressure) (2). Large vessel occlusion (LVO)
detrimental, as it can exacerbate edema and hemorrhagic
leading to severe acute ischemic stroke and vessel
transformation of the ischemic tissue (7).
rupture leading to acute hemorrhagic stroke and
The aim of our study was to determine the
intracerebral hemorrhage (ICH) are immediately
impact of arterial blood pressure monitoring in acute
threatening the patient with severe disability or even
ischemic stroke on short term outcome and prognosis.
death. The emergency and critical care management of

these patient naturally involves controlling circulation
PATIENTS AND METHODS
including BP. Physicians may have tended to raise BP
This is a prospective observational study, which
(or leave high BP alone) in acute ischemic stroke and
was carried out on 200 patients that diagnosed with
lower BP in ICH (3). Blood pressure is one of the vital
ischemic stroke and arrived to Emergency Hospital,
signs, along with respiratory rate, heart rate, oxygen
Mansoura University over a year from June 2019 to June
saturation and body temperature. Normal resting blood
2020.
pressure in an adult aged (18-60) is approximately 120
Inclusion criteria: The study included 200 patients
millimeters of mercury systolic, and 80 millimeters of
arrived to Emergency Department (ED) and treated by
mercury diastolic, abbreviated "120/80 mmHg".
members of ED: Aged 18 or older, first-ever ischemic
Globally, the average age standardized blood pressure
stroke confirmed by a CT and both gender.
has remained about the same since1975 to present, at
This article is an open access article distributed under the terms and conditions of the Crea t
ive
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
440
Received:12 /10 /2020

Accepted:30 /11 /2020



Full Paper (vol.823 paper# 9)


To, The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 445-454

Efficacy of Dexamethasone as A Prophylaxis for Radiation-Induced Pain
Flare after Palliative Radiotherapy for Symptomatic Bone Metastases
Mai Y. Zaki, Soheir E. Abdelmohsen, Maha L. Zamzam, Marwa A. Suliman*
Clinical Oncology Department, Faculty of Medicine - Suez Canal University, Ismailia, Egypt
*Corresponding Author: Marwa A. Suliman, Mobile: +201007585156, E-mail: marwa_awad2008@yahoo.com

ABSTRACT
Background:
Bone is the most common site for metastases in cancer and may complicate a wide range of
malignancies. Radiotherapy is a successful and efficient method for pain palliation and it can prevent the morbidity
of bone metastases. Pain flare is a common event, occurring in almost 40% of the patients that receive palliative
radiotherapy. Dexamethasone has shown possibility for prevention of such flare.
Objective: This study aimed to investigate the efficacy of dexamethasone as prophylaxis for radiotherapy-induced
pain flare in cases of painful bone metastases.
Patients and Methods: Prospective randomized control trial was conducted at the Oncology and Nuclear Therapy
Unit, Suez Canal University Hospital. The study involved 129 patients. Patients with painful bone metastases were
divided into two groups, Study group received 8 mg dexamethasone first day of radiotherapy then for three days
after finishing treatment, while control group received radiotherapy only.
Results: The mean age in study group was 60.59 ± 7.64 years in comparison to 59.85 ± 7.02 years in control group.
The most common primary sites were breast and prostate cancer. Incidence of pain flare was 8.8% of patients
among study group while 19.7% of patients among control group. The difference between both groups was
statistically non-significant. Conclusion: Dexamethasone does not play a significant role in reducing pain flare
after palliative radiotherapy on painful bone metastases.
Keywords: Dexamethasone, Pain flare, Radiotherapy, Bone metastases

INTRODUCTION


Bone is the most common site for
therapy or location of area receiving radiotherapy (3).
metastases. It is a complication of a wide range of
Pain flare is defined as a two-point increase from
malignancies, resulting in significant morbidity and
baseline pain in the pain scale of 0-10 with no
complex demands on healthcare resources. Bone
decrease in analgesic intake or increase in analgesic
metastases are the most common cause of
intake by 25% employing daily oral morphine
cancer-related pain (1).
equivalent with no decrease in pain score (4).
Radiation therapy is a successful way to
Dexamethasone can be used for prevention
relieve pain and prevent the spread of bone metastases.
of such flare as dexamethasone might decrease this
Depending on the criteria used, a complete pain
edema and thereby reduce the incidence of pain flare.
response can be achieved from 10% to 35% of
Multiple studies were conducted both globally and
patients, with overall pain response rates approaching
locally including study showing that 26% of patients
70% (2). Pains flare usually occurring in almost 40% of
enrolled to dexamethasone experienced pain flare
the patients who receive palliative radiotherapy for
versus 35% of patients who did not receive
symptomatic bone metastases. Radiotherapy is a very
dexamethasone (5). Besides, a study done in south
effective palliative treatment; however, pain flare has a
Egypt cancer institute, Assiut University showed that
negative impact on daily functioning and mood of
16.2% of patients who received dexamethasone
patients. No significant difference was found between
developed pain flare while 38% of patients who did
patients who experienced pain flare versus who did not
not receive dexamethasone developed pain flare (6). As
in terms of sex, radiation dose, previous systemic
well as other ongoing studies (7).
This article is an open access article distributed under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
445

Received:10 /10 /2020


Accepted:28 /11 /2020



Full Paper (vol.823 paper# 10)


c:\work\Jor\vol823_11 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 455-460

Role of Administration of Beta Receptor Blockers in the Management of
Traumatic Brain Injury
Samir Mohamed Attia1, Mostafa Mahmoud Nabeeh2,
Mohamed El-Said Ahmed3, Mohammed El-Atabani Abdel-Khalek Mohammed4
Departments of 1Vascular Surgery, 2Neurosurgery, 3Critical Care Medicine and
4Emergency Medicine - Faculty of Medicine ­ Mansoura University
*Corresponding author: Mohammed El-Atabani Abdel-Khalek, Mobile: (+20) 0101 161 3243,
E-Mail: moh3tbani1991@gmail.com


ABSTRACT
Background:
Severe traumatic brain injury (TBI) is associated with paroxysmal sympathetic hyperactivity (PSH),
which is characterized by catecholamine surge. -blockers can break this cycle by protecting -receptor rich brain
cells to decrease the cerebral oxygen demand, which may attenuate cerebral ischemia and secondary brain injury. In
addition, -blockers are beneficial to decrease hypermetabolism, lighten cardiac workload and ischemia, and lessen
cerebral oxygen demand in head injury.
Objective: The purpose of the study was to evaluate the effect of beta blockers (propranolol) on patients with acute
TBI.
Patients and methods: A total of 400 patients who were presented and admitted to Mansoura University Emergency
Hospital (MUEH) surgical ICU with TBI were enrolled in this study. The enrolled patients were divided equally and
randomly into 2 groups: Propranolol group (200 patients) who received IV propranolol and control group (200
patients) who received the standard medical and surgical care without propranolol.
Results: The clinical outcome of the studied cases were obviously better in propranolol group (P <0.05). The
neurologic examination; according to GCS; was improved in 34% vs. 27.5%. The cardiac examination; according to
ECG showed changes in 12% vs. 26.5% in propranolol and control groups respectively. Also, the secondary outcome
assessment parameters including ICU length of stay (LOS), ward LOS, mechanical ventilation, ventilation periods,
survival rate and unfavorable GOS were better in propranolol group (P <0.05).
Conclusion: Early propranolol administration is associated with post-head injury cardioprotective and
neuroprotective effects, lower hospital resources use and better functional outcome.
Keywords: Beta Receptor Blockers, ICU, Traumatic Brain Injury.


INTRODUCTION

Traumatic brain injury (TBI) is defined as an

alteration in brain function caused by an external force.
Cerebral edema is related to the structural
It varies from mild (including concussion) to moderate
damage or water and osmotic imbalance induced by the
to severe TBI. It constitutes a major health and
primary or secondary injury. Thus, effective treatment
socioeconomic problem worldwide. It is prevalent in
of brain edema would include reduction of hydrostatic
both low- and high-income countries and affects all age
capillary pressure and preservation of normal colloid
groups. It is called the `silent epidemic' because its
osmotic pressure (4).
consequences are often not immediately visible, and
Propranolol may have beneficial effects over
TBI patients are not very vociferous (1).
other beta blockers in patients with TBI as it has excellent
TBI is a complex process that is composed of
penetration into central nervous system owing to its
overlapping phases, including primary injury,
lipophilic properties. Also, it is found to be associated
secondary injury and recovery. Primary injury
with improvement in cerebral perfusion and reduction in
represents a large category of insults at the time of insult
cerebral hypoxia. In addition, it decreases catabolism and
and is directly proportional to the magnitude of the force
oxygen consumption in hyperadrenergic states (5).
applied to the brain. As a result, primary injury cannot
The purpose of the study was to evaluate the
be modified and is not amenable to treatment (2).
effect of beta blockers (propranolol) on patients with
The mechanisms contributing to the secondary
acute TBI regarding their roles in management of
events after TBI are adrenergic-mediated cerebral
paroxysmal sympathetic hyperactivity during first week
vasospasm and cerebral edema. Cerebral vasospasm
in moderate and severe traumatic brain injury (TBI) in
occurs in more than one third of TBI and denotes severe
emergency department and regarding their adverse
injury. The onset varies from 2 to 15 posttraumatic days;
effects.
with hemodynamically significant vasospasm occurs in

50% of all patients developing vasospasm (3).



This article is an open access article distributed under the terms and conditions of the
Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
455
Received:10 /10 /2020

Accepted:28 /11 /2020



Full Paper (vol.823 paper# 11)


c:\work\Jor\vol823_12 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 461-470

Environmental Risk Factors Associated with Children Autism Spectrum
Disorders in, Menoufia Governorate
Nagwa Nashat Hegazy1, Seham Mohammed Ragab2, Walaa Zaki El Hofey*1
Departments 1Family Medicine and 2Pediatric, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Walaa Zaki El Hofey, Mobile: (+20) 01000502830, E-Mail: walaazaki2211@hotmail.com

ABSTRACT
Background:
Although no official statistics are available, some medical studies suggest that there are over 800,000
children with autism in Egypt. While, there is no cure for autism spectrum disorder, intensive, early treatment can
make a big difference in the lives of many children.
Objective:
To explore environmental risk factors for autism spectrum disorders by using participants identified
through broad ascertainment and reliable classification in Shebin El Kom city.
Subjects and Methods: Our study was conducted at Psychiatric and Neurology Clinic, Pediatric Department,
Menoufia University Hospital and centers for children with special needs in Shebin El Kom City. A case control study
enrolled 80 children, 40 of them diagnosed with autistic spectrum disorders by DSM-V-TR criteria with no another
medical disease and another 40 apparently healthy children, from their brothers as a control group. All children
attended to Psychiatric and Neurology Clinic, Pediatric Department, Menoufia University Hospital in Shebin El Kom
City, Menoufia Governorate, Egypt during the period from April 2017 to January 2019.
Results: There were significant differences between cases and control groups regarding gender, history of
hypertension, diabetes mellitus, folic­iron, fever, bleeding, induced labor and precipitous labor, dental fillings,
silver/mercury fillings in pregnancy and taking antibiotics during pregnancy or breast fed, born healthy > 4.5 kg,
neonatal unit, breast fed, Jaundice, delayed sitting, delayed crawling, delayed walking and delayed speaking.
Conclusions: From the current study, it was concluded that boys, high and moderate socioeconomic states and positive
family history represented conditions associated with an increased risk for autism and ASDs in Egyptian population.
Keywords: Autism, Fetal Factors, Maternal Factors, Risk Factors.

INTRODUCTION

syndrome (3). Although no official statistics are
Autism spectrum disorder (ASD) is a serious
available, some medical studies suggest that there are
neurodevelopmental disorder that impairs child's
over 800,000 children with autism in Egypt. While,
ability to communicate and interact with others. It also
there is no cure for autism spectrum disorder, intensive,
includes restricted repetitive behaviors, interests and
early treatment can make a big difference in the lives
activities. These issues cause significant impairment in
of many children (4). Early identification of autism
social, occupational and other areas of functioning (1).
spectrum disorder (ASD) is essential to ensure that
The term (spectrum) in autism spectrum disorder refers
children can access specialized evidence-based
to the wide range of symptoms and severity. The
interventions that can help to optimize long-term
number of children diagnosed with autism spectrum
outcomes. Early identification can be done through the
disorder is rising. It is not clear whether this is due to
Antenatal Primary health care settings through
better detection and reporting or areal increase in the
screening. It also helps shorten the stressful "diagnostic
number of cases or both (2). Autism spectrum disorder
odyssey" that many families experience before
affects children of all races and nationalities, but certain
diagnosis
factors increase a child's risk. Environmental risk
Therefore, the aim of this study was to determine
factors for autism may be broadly defined as any
the possible risk factors for autistic spectrum disorders
nongenetic contributor to the risk of autism and include
and assessment of the quality of life for their parents.
reproductive-, dietary-, chemical-, and demographic-

related exposures. They include the child sex where
SUBJECTS AND METHODS
boys are about four times more likely to develop ASD
Our study was conducted at Psychiatric and
than girls do. Family history: families have one child
Neurology Clinic, Pediatric Department, Menoufia
with ASD have increased risk of having another child
University Hospital and centers for children with
with the disorder. Extremely preterm babies. Parent's
special needs in Shebin El Kom city.
age: There may also be a connection between children
A case control study was conducted on 80 children, 40
boom to older parents and ASD. Other disorders:
of them diagnosed with autistic spectrum disorders by
Fragile X syndrome, Tuberous sclerosis and Rett
DSM-V-TR criteria with no another medical disease
This article is an open access article distributed under the terms and conditions of the

Creat ive
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
461
Received:10 /10 /2020

Accepted:28 /11 /2020



Full Paper (vol.823 paper# 12)


c:\work\Jor\vol823_13 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 471-478

Arterial Blood Gases as an Indicator of Early ICU Admission in Chest Trauma Patients
Ola Abd elsamie Abd elsamie Rotab*1, Nour Eldin Noaman Gwely2,
Samir Mohammed Atia3, Hisham Khairy Ismael4
Departments of 1Emergency Medicine, 2Cardiothoracic Surgery,
3Vascular Surgery and Critical 4Care Medicine - Faculty of Medicine ­ Mansoura University
*Corresponding author: Ola Abd elsamie Abd elsamie, Mobile: (+20) 01069386951, E-Mail: olarotab1991@gmail.com

ABSTRACT

Background: Trauma is injury to living tissue caused by an extrinsic agent. Trauma is a Greek word which means body
injury. Blunt chest trauma causes 25% of traumatic deaths. It is commonly associated with multiple organ damage which
leads to catastrophic patient outcome. Blunt chest trauma is more common than penetrating chest trauma. Arterial blood
gas (ABG) studies report the degrees of acidemia, hypercarbia, and hypoxemia, which depend on cardiopulmonary status
at the time of collection. Objective: To determine the value of ABG measurements in patients with blunt chest trauma
and its role in prognosis of different outcomes.
Patients and Methods: This study included 100 patients arrived to Emergency Department (ED) in Emergency Hospital-
Mansoura University during the period from 1-8-2019 to 1-8-2020. Patients were divided to subtypes according to ward
or ICU admissions and presence or absence of lung injury. Length of hospital stay as outcome was also reported.
Results: ABG and combined ABG measurements are strongly reflecting the clinical situation of chest trauma patients. It
can predict longer length of hospital stay. PCO2 is more sensitive than HCO3- in prediction of ICU admission in chest
trauma patients. SaO2, combined ABG analysis had higher sensitivity in prediction of ICU admission in chest trauma
patients. HCO3- level and combined ABG were statistically significant in prediction of lung injury among studied patients
with high specificity.
Conclusion: ABG values and combined ABG values seemed to have a promising role in determination of patients
admitted to ward versus others admitted in ICU.
Keywords: Advanced Trauma Life Support, Emergency medical system, Focused assessment with sonography for
trauma.

INTRODUCTION
The need for a universal system for thoracic
Trauma-related mortality accounts for 9% of
trauma is justified to identify critical factors, to predict
deaths in all age groups and most cases involve blunt
patient outcomes, urgent need for intervention,
injuries. Multiple traumas are the main cause of
requirement of intensive care, and to communicate with
emergency admission, accounting for approximately 16%
the family (6). The available thoracic trauma scores are
of global medical expense (1). Chest trauma is one of the
Wagner score, Abbreviated Injury Scale chest (AIS), Lung
most common injuries suffered by poly trauma patients,
Injury Scale, Pulmonary Contusion score (PCS), or Rib-
with an incidence of 45%­65%. This type of trauma,
Score, Thoracic Trauma Severity Score (TTSS) and
which is usually caused by a high-energy blunt force, is
modified early warning signs (MEWS) scoring system(7).
associated with mortality rates as high as 60% (2). Chest
Due to difficult applicability of some scores, lack of
injury was found to cause death in 20%­25% of multiple
significance for predicting outcome or resource limitation,
trauma patients. Thoracic trauma is, therefore, important
there is no universal scoring system (8).
in the overall management of multiple injured patients and
There is evidence to support routine blood gas
may require a longer stay in the Intensive Care Unit (ICU)
analysis for base deficit and metabolic acidosis evaluation
and use of mechanical ventilation (3). In addition, trained
in trauma patients suspected on initial history and physical
multidisciplinary teams and well-equipped facilities play
examination as being at risk of serious injury. However,
critical roles in reducing the rate of mortality within a few
the decision as to whether to obtain a venous or arterial
hours of trauma injury (4).
blood gas is best determined by the needs of the individual
Though multiple studies have been done to
patient with consideration of arterial oxygen saturation and
evaluate factors that predict morbidity and mortality in
tissue perfusion status (9).
thoracic trauma, few have developed into scoring systems.
The aim of this study was to determine the value
A prognostic scoring system makes it easier to manage by
of ABG measurements in patients with blunt chest trauma
directing resources. Improved outcomes and decreased
and its role in prognosis of different outcomes as length of
hospital stay were reported following score and protocol-
hospital stay, ward or ICU admissions and lung contusion.
based interventions in trauma victims (5).

This article is an open access article distributed under the terms and conditions of the Crea t ive
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
471
Received:10 /10 /2020

Accepted:28 /11 /2020



Full Paper (vol.823 paper# 13)


c:\work\Jor\vol823_14 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 479-486

Clinical Predictors of mortality in Acute Mesenteric Ischemia
Nagat Moaz Hamza Youssef Elsharkawy1, Mostafa Mohamed Abu Zeid2,
Mohamed El Said Ahmed3, Samir Mohamed Attia4
Departments of 1Emergency Medicine, 2 Gastroenterology Surgery, 3 Critical Care Medicine Emergency Hospital
and 4Vascular Surgery - Faculty of Medicine ­ Mansoura University
*Corresponding author: Nagat Moaz Hamza Youssef Elsharkawy, Mobile: (+20) 01010899747,
Email noogayoussef@yahoo.com

ABSTRACT
Background:
Acute mesenteric ischemia (AMI) is an emergency condition, which is accompanied by fatal
complications. Clinical signs and symptoms are often unspecific. In addition, there is no single laboratory test to
diagnose acute mesenteric ischemia. Early and accurate diagnosis of intestinal ischemia is important to provide rapid
and correct treatment and reduce morbidity and mortality rates.
Objective: To determine the clinical predictors of outcome in patients with acute mesenteric ischemia at Emergency
Hospital, Mansoura University. Materials and Methods: This was a prospective study, which was conducted on
patients that were admitted to Emergency Hospital, Mansoura University over a year from December 2019 to
December 2020. All patients above 18 years old with acute mesenteric ischemia were included while whom less than
18 years old were excluded. Results: this study had 50 patients (21 males and 29 females) with average age of 66
years old. The results showed that majority of the studied cases died, while only 42% (21 cases) of AMI cases survived.
Hypercholesterolemia was considered the most frequently reported Co-morbidity followed by HTN, AF and lastly
DM and cardiomegaly. There were statistically significant differences as regards co-morbidities (presence of 2 or
more co-morbidities). Conclusion: Acute Mesenteric Ischemia is a serious condition with high mortality rate
especially in advanced age and in cases associated with comorbidities, presence of 2 or more co-morbidities,
hypertension, hypercholesterolemia, past surgical history increase the incidence of death.
Keywords: Acute Mesenteric Ischemia, Hypercholesterolemia, Transmural necrosis, Peritonitis.

INTRODUCTION
Incidence increases from the sixth to eighth decade
Intestinal ischemia refers to insufficient blood flow
of life, with a slight prevalence in males. The risk of
within the mesenteric circulation to meet the metabolic
developing bowel infarction is significantly higher in
demands in the bowel (1). Acute mesenteric ischemia
patients with a history of atrial fibrillation and/or
(AMI) remains a dreaded surgical emergency that
myocardial infarction, in smokers, and in patients
continues to be fraught with elevated morbidity and
suffering from hypertension. Abdominal aortic
mortality rates (2). It is a potentially catastrophic entity
aneurysm is another important risk factor (8).
leading to ischemia, cellular damage, intestinal necrosis
The general factors that are affecting the prognosis
and eventually patient death if untreated and may require
include older age, those with delayed presentation,
emergent intervention (3).
peritonitis at presentation, those who present with organ
The mortality rate in AMI remains high due to
failure, extent of necrosis, and recent major
challenges in early diagnosis, the lack of specific
cardiovascular surgery (9).
markers, and irreversible intestinal ischemia secondary
The basis of treatment in cases of acute mesenteric
to delay in diagnosis. Although significant advances in
ischemia is composed of early diagnosis, resection of the
its diagnosis and treatment have been made over the last
intestinal sections with infarction, regulation of
decade, mortality rates are still reported to be around 40-
intestinal blood flow, second look laparotomy when
70% for acute mesenteric ischemia mainly due to a low
required and intensive care support (10). The aim of this
index of suspicion (4).
study was to determine the clinical predictors of
The etiologic cause in 70-80% of cases with AMI
outcome in patients with acute mesenteric ischemia at
is intestinal ischemia that occurs as a result of occlusion
Emergency Hospital Mansoura University.
of the mesenteric artery due to an embolus or thrombus.

Embolic occlusion results in earlier ischemia and
PATIENTS AND METHODS
transmural necrosis as compared with other causes, due
This was a prospective study conducted on
to the absence of a well-developed collateral circulation
patients who were admitted to Emergency Hospital
(5). Strangulated hernia, venous thrombosis and non-
Mansoura University over a year from December 2019
occlusive causes are rare reasons of AMI (6).
to December 2020.
Because early diagnosis is critical for improving
Inclusion criteria: All patients above 18 years old with
morbidity and mortality, the emergency medicine
acute mesenteric ischemia
provider must maintain a high level of clinical suspicion,
Exclusion criteria: Age < 18 years old and pregnant
particularly in high-risk patient populations (7).
women.
This article is an open access article distribute

d under the terms and conditions of the Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
479

Received:11 /10 /2020

Accepted:29 /11 /2020



Full Paper (vol.823 paper# 14)


c:\work\Jor\vol823_15 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 487-490

Epidemiology of Vascular Neck Injury in Polytrauma Patients in
Emergency Hospital Mansoura University, Egypt
Ahmed Magdy Saleh1, Hosam Roshdy Zaher2, Mohamed El-Said Ibrahim3, Samir Mohamed Attia2
Departments of 1Emergency Medicine, 2Vascular Surgery, 3Critical Care Medicine,
Faculty of Medicine, Mansoura University, Dakahlia, Egypt
*Corresponding author: Ahmed Magdy Saleh, Mobile: (+20) 01024240079, Email: ahmed.mg.sa@hotmail.com

ABSTRACT
Background:
Trauma is considered to be the second most common cause of disability. Injuries to the neck can have
significant morbidity and mortality that demand immediate attention and intervention. The most common clinical
presentations for patients who reach trauma centers alive are shock, active bleeding, hematoma, and neurologic
deficit.
Objective: To determine the epidemiology of vascular neck injuries to patients admitted to Emergency Hospital,
Mansoura University.
Materials and Methods: This study was conducted on 96 cases admitted to Emergency Hospital, Mansoura
University suffering from Neck Vascular Injuries. Assessment includes ABCDE approach, AMPLE history taking,
full clinical examination, and radiological investigations that involve FAS, multislice CT brain, Duplex U/S, and
CTA (computed tomographic angiography) in selective cases.
Results: shock was the main presenting symptom. Neck zone II was the most commonly affected in 41 (42.7%) of
cases. Operative treatment was performed in 68 (70.8%) cases while Conservative treatment was performed in 28
(29.2%) cases. AS regards Incidence of mortality, 44 (45.8%) of cases died compared with 52 (54.2%) of cases who
were Survived.
Conclusion: Neck injuries were relatively uncommon, found in 2.5% of all TQIP observations. Penetrating trauma
was the predominant mode of trauma among the studied cases. Shock was considered the commonest presenting
symptom followed by airway compromise. The main management was operative treatment.
Keywords: Trauma, Neck, Operative, Shock, Penetrating.

INTRODUCTION

Trauma itself is a pandemic that is projected
The management of neck injuries has changed
to be the second most common cause of disability-
dramatically over the last 30 years with modern
adjusted life years lost within the next thirteen years
imaging techniques, from a mandatory exploration of
(1). Trauma accounts for about 16000 deaths a day
all wounds that penetrated the platysma to an
worldwide (2). The neck is a complex anatomical
increasingly selective approach (8). Technological
region because, in a small space, there are numerous
advances in interventional radiology and endovascular
critical aerodigestive, neurological, and vascular
procedures allow the identification and management
structures (3).
of potentially life-threatening injuries while saving
Injuries to the neck can have significant
many patients from surgery (3).
morbidity and mortality that demand immediate
The current study aimed to determine the
attention and intervention (4). This is related not only
epidemiology of vascular neck injuries to patients
to massive bleeding and cerebral ischemia due to
admitted to the Emergency Hospital, Mansoura
embolization or thrombotic occlusion associated with
University.
the vascular injury but also to secondary damage to the

aerodigestive tract (e.g., airway compression from a
PATIENTS AND METHODS
large expanding hematoma). The most common
This was retrospective (from Jan 2015 to Jan
mechanism is penetrating injuries, but the incidence of
2020) and prospective (from Feb 2020 to Jan 2021) to
blunt vascular trauma is probably underestimated
traumatic patients admitted to Emergency Hospital,
because related symptoms are often vague and not
Mansoura University suffering from Neck Vascular
recognized or absent(5).
Injuries. Emergency Hospital Mansoura University is
A quick diagnosis and prompt treatment are
a level one trauma center with about 250,000 visits and
mandatory to reduce the mortality and morbidity of
25,000 trauma cases per year.
these complex injuries (6). The most common clinical
Ethical Considerations:
presentations for patients who reach trauma centers
An approval of the study was obtained
alive are shock, active bleeding, hematoma,
from Mansoura University academic and ethical
neurologic deficit, and bruit. Once diagnosed, the
committee. Every patient signed an informed written
patient's clinical condition guides treatment (7).
consent for acceptance of the operation.



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 /
)
487

Received: 11/10/2020

Accepted: 29/11/2020



Full Paper (vol.823 paper# 15)


Full Paper (vol.823 paper# 16)


c:\work\Jor\vol823_17 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 497-501

Are Diabetes Mellitus and Diabetic Nephropathy Good Predictors of Osteoporosis
Said Abdelbaky Gad, Ahmed I. Elagrody
Department of Internal Medicine, Faculty of Medicine, Zagazig University
Corresponding author: Ahmed I Elagrody, Mobile: (+20) 1145514358, Email: agrody666@yahoo.com

ABSTRACT
Background:
Osteoporosis is a metabolic bone disorder with a tendency for fracture and diabetes mellitus (DM) has
a close relation to osteoporosis.
Objective: Is to study the role of diabetes mellitus (DM) and diabetic nephropathy in the acceleration and production
of osteoporosis.
Patient and Methods: This study included 88 cases which were divided into 2 groups; 44 patients with DM and 44
patients as a control group with no sex predilection. Both groups were exposed to full history taking, bone mineral
density (BMD) measurement, fasting blood sugar, urinary albumin, postprandial blood sugar, HA1C, creatinine, urea,
HOMA- IR.
Result: There is a strong and positive correlation between DM, diabetic nephropathy, and incidence of osteoporosis
as BMD was -0.59 (-5.0:1.0) and -0.08 (-3.0:1) for cases and control respectively and 36.4% of diabetic cases had
osteoporosis and only 11.4% of control had osteoporosis.
Conclusions: Osteoporosis (OP) is a more complication in patients with DM. Increased risk of OP present in older
age group, and female sex. Diabetic patients on long-term insulin therapy are at high risk of OP. due to high bone
turnover and low bone formation.
Keywords: DM, Diabetic nephropathy, Osteoporosis.

INTRODUCTION

Osteoporosis is a progressive bone disorder
associated diabetic nephropathy and to evaluate other
characterized by decreased bone mass, bone mineral
risk factors on the development of osteoporosis.
density, and destruction of the microarchitecture of the

bone, which can progress and increased the risk of
PATIENTS AND METHODS
fracture. Osteoporosis is defined by the world health of
This study was carried out at internal medicine
organization (WHO) by the limitation of the active lives
and outpatient clinic of Endocrinology and Diabetes
of half of the osteoporotic patients older than 50 years
Units of Zagazig University Hospital in the period
and most patients over 70 years. There are several
between August 2017 and August 2020.
methods to diagnose osteoporosis; measuring bone

mineral density (BMD) is the best and most accurate
Ethical approval:
method(1).
This study was done after the consent from all
The bone density of the lumbar spine and femur
participants in the study and approval of the search
length of postmenopausal women is the best to measure
Ethics Committee of Zagazig University.
by dual x-ray absorptiometry (DXA) and interpreted as

follows: if lowest T score higher than -1.0; it is normal,
The study included 88 patients 44 as a control
osteopenia between -1.0 and -2.5 and osteoporosis if less
group and 44 as a diseased group with mean age of 62.0
than -2.5 (2).
5.02 for cases and mean age of 51.06 3.83 for the
DM is a metabolic disorder characterized by
control group with no sex predilection.
increased fasting blood sugar 126 mg/dl. The number
- All enrolled persons in the study were submitted for
of diabetic patients expected to be approximately 300
the following.
million in 2025. Type II DM represents more than 90%
- Clinical assessment including history taking with
of that expected range. DM is often associated with
special attention to the drugs associated with
comorbid conditions. The most important top chronic
osteoporosis; such as drugs that interfere with bone
complication are peripheral vascular, cardiac, renal, and
metabolism as anti-thyroid drugs, steroids,
neurological complications. The endocrinal and
anticonvulsants, benzodiazepines, and vitamin D or
metabolic changes that DM produces can alter calcium
Ca++ supplementation.
(Ca++) homeostasis, skeletal metabolic function, and
- All participants (cases and control) were free from
bone cell mass (3).
any illness that may interfere with bone metabolic
Most of the cross-sectional studies have shown that
changes as chronic chest diseases, rheumatoid
increased bone fracture and osteoporosis are associated
arthritis, thyroid disorders, liver disease cardiac or
with DM owing to reduced bone formation and
renal disease, SLE, chronic pancreatitis, or history
increased bone resorption. So we decided to study the
of gastric surgery.
relationship between osteoporosis and DM with
This article is an open access article distributed under the terms and conditions of t he Creative
Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
497
Received:12 /10 /2020

Accepted:30 /11 /2020



Full Paper (vol.823 paper# 17)


c:\work\Jor\vol823_18 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 502-505

Different Timing of Intrauterine Insemination and Pregnancy Outcome in
Patients with Unexplained Infertility: A Randomized Controlled Study
Salwa Sabry Ahmed*, Allam Mohamed Abdelmonem, Mohamed Sabry Ibrahim, Eman Hassan Ali
Obstetrics and Gynecology Department, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Salwa Sabry Ahmed, E-mail: Salwa011111@gmil.com

ABSTRACT
Background:
In this era of rapid advancements in assisted reproductive technologies, intrauterine insemination (IUI) is
still widely offered to subfertile couples, as a cheaper and less invasive treatment option before proceeding to IVF.
Objective: To determine the most suitable timing of hCG administration prior to intrauterine insemination for optimizing
pregnancy outcome and success rate.
Patients and methods: A randomized controlled study conducted in Obstetrics and Gynecology Department, Sohag
University from 30 June 2018 to 30 June 2019 and included couples with unexplained infertility. A total of 110 patients
were recruited in our study, 30 patients dropped out; where 20 patients were due to inadequate stimulation, bad
endometrium or more than 3 follicles were present, 6 patients did not show up for folliculometry after being given
treatment and 4 patients did not show up for the procedure after being given the hCG trigger.
Results:
This study showed an improved pregnancy rate when IUI was performed with a time interval of 24­36 h (13
case with positive pregnancy test).
Conclusion:
IUI after ovulation induction can be done any time between 24 and 48 h after hCG injection without
significant differences in pregnancy rates.
Keywords: Intrauterine Insemination, Ovarian induction, Unexplained Infertility.

INTRODUCTION

In this era of rapid advancements in assisted
found no difference in clinical pregnancy rate between
reproductive technologies, intrauterine insemination
the two groups. There is no consensus on the optimal
(IUI) is still widely offered to subfertile couples, as a
timing of IUI. In the large majority of published studies,
cheaper and less invasive treatment option before
insemination is performed 32-36 hours following human
proceeding to IVF (1). IUI is superior to timed intercourse
chorionic gonadotropin hCG administration (7). There is
because in IUI, motile spermatozoa, which are
insufficient evidence to determine whether there is any
morphologically normal, are concentrated in small
difference in safety and effectiveness between different
volumes and placed directly into the uterus, close to the
methods of synchronization of ovulation and
released oocyte (2).
insemination, more researches are needed (8).
There are various factors affect the success rate of
We aimed in this study to determine the most
IUI including female age, types of ovarian stimulation,
suitable timing of hCG administration prior to
the optimal procedures for sperm preparation,
intrauterine insemination for optimizing pregnancy
insemination method, and timing of insemination in
outcome and success rate.
regards to (hCG) injection to yield the best pregnancy

outcome (3). One of the most debated issues is the timing
SUBJECTS AND METHODS
of insemination in relation to (hCG) injection to yield the
A randomized controlled study conducted in
best pregnancy outcome. Although insemination at 34-
Obstetrics and Gynecology Department, Sohag
38h after (hCG) injection is most prevalently used, the
University from 30 June 2018 to 30 June 2019 and
clinical evidence for this time is scarce, there is no
included couples with unexplained infertility.
difference in simultaneous use of (hCG) injection
A total of 110 patients were recruited in our study,
compared to cycles in which IUI is performed after 34-
30 patients dropped out; where 20 patients were due to
36 hours following hCG injection (4).
inadequate stimulation, bad endometrium or more than 3
Järvelä et al. (5) reported that pregnancy rate was
follicles were present, 6 patients did not show up for
higher when hCG was administrated after the IUI than
folliculometry after being given treatment and 4 patients
when hCG was administrated at 24-32 hours before
did not show up for the procedure after being given the
insemination. On the other hand, in a randomized study
hCG trigger.
by Aydin et al. (6) they compared the clinical pregnancy
Patients were divided randomly according to the
rate between IUIs with simultaneous hCG injection and
time intervals between hCG injection and IUI into four
IUIs performed at 34-36 h after hCG injection; they
groups, each group 20 patient: group (1); 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/)
502

Received:13 /10 /2020

Accepted:1 /12 /2020



Full Paper (vol.823 paper# 18)


c:\work\Jor\vol823_19 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 506-513

Fixation of Distal Ulna Fractures by Distal Ulnar Locked Hook Plate
Mohammed Abobaker Mohammed Bakouri*, Mohamed Abd Allah El-Soufy,
Tarek Abd ELSamad El-Hewala, Fahmy Samir Fahmy
Department of Orthopedic Surgery, Faculty of Medicine - Zagazig University
*Corresponding author: Mohammed Abobaker Mohammed, Mobile: (+20)01097476072, E-Mail: anmd2006@gmail.com

ABSTRACT
Background:
Distal ulna fractures are often found in conjunction with distal radius fractures, and the complexity
of the interaction of the distal ulna with the radio-ulnar joint and triangular fibrocartilage complex makes
understanding and treatment of distal ulna fractures challenging.
Objective: To determine the efficacy and analyze the results of Locking Compression Distal Ulna Hook Plate (LC-
DUP) in patients suffering from distal ulnar fracture (either isolated or associated with distal radius fractures).
Patients and methods: This prospective clinical trial study included 18 patients. The age of the studied group
ranged from 22 to 58 years; half of the group had age ranged from 30 to 40 years. They were suffering from distal
ulna fractures and were treated by locked compression distal ulnar hook plates during the period from November
2019 to July 2020.
Results: All patients eventually achieved full union. Only two of them had delayed union. The radiological and
clinical assessment of fracture site and DRUJ was promising. More than three quarters of patients had excellent
outcome, while the rest quarter; half of them had good, and the other half had satisfactory outcome according to the
Modified MAYO Score, which had mean of 90.5 ± 14.6. While, the mean of the Quick DASH score was 9.8 ± 5.8.
Conclusion:
The good outcomes achieved in this study suggest that the use of the distal ulna hook plate could be
an alternative treatment method for intra-articular ulna neck or head fractures, as well as basal oblique ulnar styloid
fractures.
Keywords: Distal Ulna Fractures, Distal Ulnar Locked Hook Plate.

INTRODUCTION
non-locking screws to be inserted into the ulnar shaft.
Most fractures of the distal ulna, which are
One of these holes is oval in shape to allow minor
associated with fracture distal radius, are well aligned
adjustments during initial positioning of the plate.
and stable once the distal radius has been realigned and
These holes also allow screw placement in an eccentric
secured. At that time, there is no benefit from the
fashion to apply axial compression when indicated by
internal fixation of the ulnar fracture. Unstable and
the fracture pattern (5).
displaced fractures require open reduction and surgical
Although designed for distal ulna fractures, the
stabilization, usually with a mini-fragment plate to
indications for the plate have now been extended to the
avoid derangement of the load-bearing surface (1).
treatment of distal ulna nonunion, including ulnar
Locking Compression Distal Ulnar Plate (LC-
styloid nonunion, providing improved security in
DUP), recently designed for use in distal ulna fractures.
osteopenic bone (6). A publication further extends its
Its anatomically precontoured design reduces soft-
use for a novel ulnar shortening osteotomy technique
tissue dissection and the need for hardware removal (2).
performed at the metaphysis for the treatment of
The section of the implant applied to the ulnar head
ulnocarpal abutment syndrome (UCAS), offering
accepts fixed-angle locking screws for angular
benefits over diaphyseal osteotomy (7). However, the
stability, while the shaft component accepts both
major benefit of the plate brings is angularly stable
locking and non-locking cortical screws for dynamic
fixation of unstable and/ or displaced distal ulna
compression and improved length adjustment (3).
fractures including comminuted head fractures, which
Distally, an undercut allows plate bending for further
frequently present a challenge to the surgeon (2).
adjustment. Distally the plate has two pointed hooks
The aim of this study was to determine the
designed to hold the styloid securely and to provide a
efficacy and analyze the results of Locking
reference point for plate application (4). The gap
Compression Distal Ulna Hook Plate (LC-DUP) in
between the hook arms can be used to house a lag
patients suffering from distal ulnar fracture (either
screw, which is necessary to stabilize the ulnar styloid.
isolated or associated with distal radius fractures).
In total, the plate has seven holes: (a) three 2.0-mm

locking coaxial screw holes for ulnar head fixation,
PATIENTS AND METHODS
which are divergent in direction to enhance stability
This prospective clinical trial study included
and pullout strength in cancellous bone and to prevent
18 patients. The age of the studied group ranged from
screws interfering with each other. (b) Four or more
22 to 58 years, half of the group had age ranged from
proximal Combi holes, which allow both locking and
30 to 40 years. They were suffering from distal ulna
fractures and were treated by Locked compression


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/)
506
Received:18 /7 /2020

Accepted:27 /8 /2020

Full Paper (vol.823 paper# 19)


c:\work\Jor\vol823_20 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 514-518

Pediatric COVID-19 Infection: Do Clinical Features and Hematological
Parameters Predict the Need for ICU Admission?
Shaimaa Reda Abdelmaksoud1*, Rana Atef Khashaba2, Rasha Shaker Eldesouky3, Effat Assar1
Departments of 1Pediatrics, 2Clinical Pathology and Chemistry and
3Community Medicine, Benha Faculty of Medicine, Benha University, Egypt.
Corresponding author: Shaimaa Reda Abdelmaksoud, Mobile: (+20) 01001814411, E-Mail: shaimaareda82@gmail.com

ABSTRACT
Background:
The world is facing the new pandemic caused by SARS-COV2. The confrontation of this new pandemic
necessitates study and analysis of the clinical and laboratory finding in such entity.
Objectives: To discuss the clinical and hematological findings in pediatric patients with SARS-CoV-2 infection and
to correlate these characters with the need for ICU admission.
Patients and methods: This was a hospital record-based study, in which the clinical features and laboratory findings
of 29 pediatric patients with confirmed COVID-19 infection were obtained from the medical records of admitted
pediatric patients.
Results: This study included 29 pediatric patients with confirmed COVID-19 infection. Six cases (20.7%) were
admitted to pediatric ICU. The most common presenting symptoms were cough in 23 cases (79.3%) and fever in 19
cases (65.5%). There was a significant association between tachypnea and ICU admission; as 5 out of 6 ICU cases
(83.3%) had tachypnea compared to none 0/23 (0.0%) of the non ICU patients (P < 0.001). The frequencies of
lymphopenia and thrombocytopenia were higher among ICU patients (100.0% and 50.0% respectively) than the non
ICU ones (39.1% and 8.7% respectively) (P < 0.05 for both). The median values of lymphocytes and platelets counts
were significantly lower in ICU patients than those of non ICU patients (P=0.002 and 0.007 respectively). CRP values
were higher in ICU patients compared to non ICU patients (P=0.011).
Conclusion: Decreased lymphocyte count, thrombocytopenia and elevated CRP can be stood out as discriminative
laboratory indices for early ICU admission.
Keywords: Clinical features, Hematological, Lymphopenia, Pediatric COVID-19.
Registry: The study was registered as an observational study at ClinicalTrials.gov ID: NCT04487119.

INTRODUCTION

and chest computed tomography tests showed that,
In December 2019, a new infectious disease
compared with adults, children with COVID-19 were
broke out in Wuhan, Hubei Province, China. The cause
less ill and exhibited less obvious symptoms, and were
of this outbreak was a new corona virus called severe
not typical.
acute respiratory syndrome coronavirus 2 (SARS-
Fever and cough are the most common clinical
CoV-2), which was accountable for Corona Virus
manifestations in children with COVID-19, with some
Disease 2019 (COVID-19) (1).
being accompanied by fatigue, muscle pain, nasal
Corona Virus disease 2019 (COVID-19) was
congestion, runny nose, sneezing, sore throat,
more prevalent among adults in the early stages of the
headache, dizziness, vomiting and/or abdominal pain.
outbreak, and the proportion of confirmed cases
A small number of children can be presented without
among children was relatively small. Since then,
a fever, but only a cough or diarrhea is apparent, and
however, given that younger children cannot wear
even a smaller number can be asymptomatic. Some
masks and have not taken other special preventive and
babies and newborns can develop atypical symptoms,
control measures, the number of cases of infection in
such as vomiting, diarrhea and other digestive
children has increased dramatically, particularly in
symptoms, or only asthma and shortness of breath (6).
younger age groups, and therefore great attention
Fan et al. (7), studied the hematologic parameters
should be paid (2).
in adult patients with COVID-19 infection and stated
The
novel
virus
genome
and
early
that 29.2% of patients showed leukopenia and 36.9%
epidemiological and clinical features of infection in
of patients showed lymphopenia. Most patients had
adults have been reported (3,4). It has been estimated
normal platelet counts, with 20.0% having mild
that the infection has an incubation period of 5.2 days
thrombocytopenia.
and usually causes fever, cough, muscle pain, and
Little is known about the effect of COVID-19
pneumonia in patients (3).
disease on pediatric hematology (8). Furthermore;
Xu et al.(5), conducted nucleic acid tests on 745
children exhibit certain particularities and cannot
children and 3174 adults with a history of close contact
clearly describe their own health status or contact
with COVID-19 patients, they found that 1.3% and
history, which has contributed to the severe challenge
3.5% tested positive in children and adults
of protecting, diagnosing, and treating this
respectively. Body temperature, routine blood tests,
population(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/)
514
Received: 13/10 /2020

Accepted: 1/12/2020

Full Paper (vol.823 paper# 20)


c:\work\Jor\vol823_21 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 519-530

Evaluation of Hypertension and Pre-Hypertension among
Obese Children Living in Saudi Arabia by National and
International Guidelines of Hypertension
Reham Wagdy 1, 2*, Sameer Al-Ostaz2, Omar Al-ghamdi 2, Ahmad Kanaa 2 Saleh Al-Shareef 2,
Mohammad Al-Mazidii 2, Ensaf Albokhari 2 & Maha Al-Attas 2.
1Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt,
2Medicine Program, Batterjee Medical College for Science and Technology, 6231 Jeddah 21442, Saudi Arabia.
*Corresponding author: Reham Wagdy, Mobile: (+20)1005088297 Email:

ABSTRACT
Background:
Pediatrics hypertension is a major public health concern. The burden of hypertension among children
has increased especially in high-income countries due to the surge in obesity prevalence.
Objective:
The current study aimed to evaluate the differences and similarities in the prevalence of hypertension and
prehypertension among obese students living in Jeddah estimated by the updated Saudi guidelines and the guidelines
of American Academy of Pediatrics for hypertension.
Patients and Methods
: This cross-sectional study included a total of 107 students having BMI >18.5 and 192
students having BMI <18.5, served as a control, matched in age and gender. They were collected from national and
international schools and from out-patient clinics of Hospitals of Ministry of Health . This study was done between
October 2019 and March 2020. The participants were subjected to blood pressure measurements, classified based on
updated Saudi & American guidelines of hypertension 2017.
Results: Among overweight/obese students' systolic hypertension was significantly higher and was 2.344 more
likely to occur than among normal students (95% CI:1.283 ­ 4.285. <0.001), the prevalence of systolic hypertension
grade I was significantly higher by Saudi guidelines compared to that recorded by American among
overweight/obese group (21.5% versus 12.1, P=0.004). The prevalence of elevated systolic blood pressure by
American guidelines was significantly higher among overweight/obese group above 13 year when compared to its
similar by Saudi guidelines (37.4% versus 25.2%, P=0.004).
Conclusion
: It could be concluded that overweight/obese students are at least two times more susceptible for
hypertension than normal body weight students. A fixed threshold for hypertension of the updated American
guidelines for teenager could be the cause of a down-estimation of prevalence of hypertension to prehypertension
state.
Keywords: Hypertension; Pre-hypertension; Obesity; Saudi guidelines of hypertension

INTRODUCTION

The epidemiological changes of hypertension
Hypertension is a major public health
might be attributed to the growing rates of overweight
problem. It is a leading cause of death globally,
and obesity among population (6, 7).
accounting for about 10.4 million deaths per year (1). In
Childhood obesity is considered by World
2010, an estimated 1.39 billion people had
Health Organization (WHO) a public-health threats for
hypertension worldwide with adverse impact on
children over the world. Particularly in Saudi Arabia,
cardiovascular and renal morbidity (2). The importance
the prevalence of overweight and obesity is rising
of hypertension among children has not been well
alarmingly among children and adolescents over the
appreciated as in adults although presence of
past decade. The overall prevalence of obesity rate has
hypertension in children usually leads to hypertension
been doubled over a 10-year period from (9.3%) as
in adulthood. In the past, primary hypertension in
reported in 2004 by the WHO-based national
children was considered a non-common disease.
prevalence rate to 18.2% at 2015 with significant
Currently, the incidence of hypertension in children
predominance among adolescents (>11 years) (8).
has been increased and widely ranged from 0.3% up to
Obese children often, become obese adolescents and
21% among diversity of population (3). Different risk
eventually obese adults (9).
factors for pediatrics hypertension have been studied;
Strong initiatives had been implemented for
genetic factors, ethnic groups, gender, body mass
obesity prevention/intervention programs in Saudi
index, physical activity and stress, however, obesity is
Arabia for Saudi community. Thus, studying
a main risk (3, 4). Evidence showed strong relation of
prehypertension and hypertension among obese
blood pressure (BP) to dyslipidemia, vascular
children was challenging (8).
dysfunction, increased left ventricular mass and type 2
Systemic hypertension, although easy to be
Diabetes in obese population (5).
clinically measured and assessed, is a silent disease,

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/)

519
Received:13 /10/2020

Accepted: 1/12 /2020

Full Paper (vol.823 paper# 21)


Full Paper (vol.823 paper# 22)


c:\work\Jor\vol823_23 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 536-541

Prevalence of Obesity in A Cohort of Egyptian Rheumatoid Arthritis
Patients and Its Implication on Disease Activity
Rasha M. Hammoda*1, Salwa G. Moussa2, Rasha M. Hassan1
Departments of 1Internal Medicine, Division of Rheumatology and
2Physical Medicine, Rheumatology & Rehabilitation, Ain Shams University, Cairo, Egypt
*Corresponding author: Rasha M. Hammoda, Mobile: (+20)01148904211, E-Mail: rasha.hammoda80@gmail.com

ABSTRACT
Background:
Rheumatoid arthritis (RA) is a systemic autoimmune disease with articular and extra-articular
manifestations, several factors can affect disease outcome.
Objective: To assess the prevalence of obesity in a cohort of Egyptian rheumatoid arthritis patients and study its
relation to disease activity and extra-articular manifestations.
Patients and methods:
The study included 200 RA patients. Detailed medical history, disease activity score
(DAS28), VAS, HAQ, were carefully recorded. High-resolution computed tomography (HRCT) was done and to
detect lung affection. BMI was calculated and patients were sub-grouped accordingly into underweight, normal BMI,
over-weight and obese patients.
Results:
Patients were 172 females and 28 males with a mean age of 45.1±14.2 years. According to BMI, 32% of
patients were overweight, 35% were obese, 20% with normal BMI and 13% were underweight. Overweight and
obese patients were significantly older (p 0.001), had longer disease duration (p 0.001), had higher ESR, CRP,
DAS, HAQ, VAS (p 0.001), had more frequent arthritis (p0.001), had joint deformity, had rheumatoid nodules (p
= 0.007) and ILD (p 0.001).
Conclusion: overweight and obesity were frequent among Egyptian RA patients. It was associated with high disease
activity and extra-articular manifestations. In turn, patients' weight reduction can help in improvement of patients'
outcome and disease activity control.
Keywords: Obesity, Rheumatoid arthritis, Extra-articular.

INTRODUCTION

to classify RA as in remission or in a low, moderate, or
Rheumatoid arthritis (RA) is a common
high activity state (4).
multisystem connective tissue disease of autoimmune
Overweight and obesity with a state of
nature (1). Approximately It affects 0.5- 1% of the
increased white adipose tissue are characterized by a
general population, with high female predominance.
state of low-grade inflammation. Adipose tissues
Usually it is characterized by the presence of additive
secrete a wide range of several inflammatory mediators
polyarthritis affecting large and small joints with
such as leptin, tumor necrosis factor alpha (TNF-
specific predilection of small joint of the hands with
alpha), IL-6 and monocyte chemotactic proteins (7).
high tendency of joint destruction. Approximately 50%
Several studies in the literature reported that obesity
of
rheumatoid
patients
have
extra-articular
could be considered a documented risk factor for
manifestations with lung affection, infection and
development of RA (8). Some researchers reported that
accelerated atherosclerosis being significant causes of
obese or overweight RA patients are less likely to
morbidity and mortality in these patient (2). Symptoms
achieve disease remission. Moreover, obesity can
of RA can vary from, such as pain, stiffness and
reduce the probability of patients' response to anti ­
swelling up to sever joint disabilities. Extra­articular
TNF drugs (9).
manifestations may be life threatening (1). Importantly,
Current study aimed to assess prevalence of
persistently high disease activity without proper control
obesity in a cohort of Egyptian rheumatoid arthritis
is associated with irreversible joint destruction and
patients and its relation to disease activity and extra-
reduction of life expectancy (1).
articular manifestations.
Treatment of RA patients should be started

as early as possible to avoid joint deformities and
PATIENTS AND METHODS
severe disabilities. Management of RA requires
This cross sectional study included 200 RA
repeated assessment of disease activity using different
patients fulfilling the American College of
activity measures (3). Several disease activity scores are
Rheumatology and European League against
available to asses RA disease activity; Disease Activity
Rheumatism (ACR/EULAR) 2010 classification
Score in 28 joints (DAS28-ESR) (4), the Simplified
criteria (10). Patients were recruited from Outpatient
Disease Activity Index (SDAI) (5) and the Clinical
Rheumatology Clinic and Inpatient Department of
Disease Activity Index (CDAI) (6). These are the
Rheumatology Ain Shams University Hospital during
disease activity indices that are most frequently used in
the period from March 2018 to May 2020. Patients with
RA, which generate specific cut-off values that are used
other connective tissue diseases, malignancy, diabetes


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/)
536
Received:14 /10 /2020

Accepted: 2/ 12/2020

Full Paper (vol.823 paper# 23)


INTRODUCTION The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 542-550

Recent Advances of TIRADS Classification of Thyroid Nodules by Ultrasound
Ayman Mohammed Ibrahim, Wessam Sherin Shokry, Hanan Ebrahim Mousa Ebrahim*
Radiodiagnosis Department, Faculty of Medicine, Ain Shams University
*Corresponding author: Hanan Ebrahim Mousa Ebrahim, Mobile: (+20) 01111134983,
E-Mail: hananibrahim.010@gmail.com

ABSTRACT
Background:
Thyroid nodules are abnormal growths of thyroid tissue which commonly arise within an
otherwise normal thyroid gland. They may be hyperplasia or a thyroid neoplasm, but only a small percentage of
the latter are thyroid cancers.
Objectives: To improve the management of the patients and to reduce cost-effectiveness by decreasing number
of unnecessary fine needle aspiration cytology (FNAC).
Patients and Methods:
This study was conducted on 50 patients known or clinically suspected to have solitary
thyroid nodule or multiple nodules, referred to Radiodiagnosis Department, Ain Shams University Hospitals.
The cases included 33 females and 17 males (age between 41-50 years).
Results:
All the nodules with TIRADS 1 were benign. In TIRADS 2 there were 10 benign and 1 malignant
nodules. In TIRADS 3 there were 4 benign and 1 malignant nodules. In TIRADS 4 there were 2 benign nodules
and 4 benign nodules while in TIRADS 5 there were 2 benign and 4 malignant nodules. There was a
statistically significant difference between the two groups. There was a statistically significant difference
between the two groups with benign and malignant nodules regarding the texture of the nodules. Solid texture
was higher in the malignant nodules and spongiform texture was common in the benign nodules while the
cystic and mixed texture were comparable between the two groups.
Conclusion:
The major ultrasound features seen associated with malignancy were microcalcifications, taller
than wider shape of the nodule, hypoechoic and marked hypoechoic echopattern of the nodule, irregular
borders and presence of suspicious cervical lymph nodes.
Keywords:
Thyroid Nodules, TIRADS Classification, Ultrasound.

INTRODUCTION
between malignant and benign lesions. A fine
Thyroid nodules are abnormal growths of
needle aspiration biopsy may be taken concurrently
thyroid tissue which commonly arise within an
of thyroid tissue to determine the nature of a lesion.
otherwise normal thyroid gland. They may be
This can determine the size and shape of lesions,
hyperplasia or a thyroid neoplasm, but only a small
reveal whether nodules or goitres are metabolically
percentage of the latter are thyroid cancers. Small,
active, and reveal and monitor sites of thyroid
asymptomatic nodules are common, and many
disease or cancer deposits outside the thyroid (3).
people who have them are unaware of them.
Ultrasound imaging is useful as the first-
Thyroid nodules can be felt as a lump in the throat.
line, non-invasive investigation in determining the
When they are large, they can sometimes be seen as
size, texture, position, and vascularity of a nodule,
a lump in the front of the neck. Sometimes a
accessing lymph nodes metastasis in the neck, and
thyroid nodule presents as a fluid-filled cavity
for guiding fine needle aspiration cytology (FNAC)
called a thyroid cyst. Often, solid components are
or biopsy. Ultrasonographic findings will also
mixed with the fluid (1).
guide the indication to biopsy and the long term
Inflammation of the thyroid is called
follow-up (4).
thyroiditis. Inflamed thyroids may cause symptoms of
After a nodule is found during a physical
hyperthyroidism or hypothyroidism. Two types
examination, most commonly an ultrasound is
thyroiditis initially present with hyperthyroidism and
performed to confirm the presence of a nodule, and
are sometimes followed by a period of
assess the status of the whole gland. Measurement
hypothyroidism;
Hashimoto's
thyroiditis
and
of thyroid stimulating hormone and anti-thyroid
postpartum thyroiditis. There are other disorders that
antibodies will help decide if there is a functional
cause inflammation of the thyroid, and these include
thyroid disease such as Hashimoto's thyroiditis
subacute thyroiditis, acute thyroiditis, silent thyroiditis,
present, a known cause of a benign nodular goitre.
Riedel's thyroiditis and traumatic injury, including
Fine needle biopsy for histopathology is also used
palpation thyroiditis (2).
(5).
Ultrasound of the thyroid may be used to
There is a high prevalence of thyroid
reveal whether structures are solid or filled with
nodules on ultrasonographic (US) examination.
fluid, helping to differentiate between nodules and
However, most of them are benign. US criteria may
goitres and cysts. It may also help differentiate
help to decide cost-effective management. The
This article is an open access article distributed under the terms and conditions of the Creative


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

542
Received:13 /10 /2 020

Accepted: 1/12 /202
0

Full Paper (vol.823 paper# 24)


c:\work\Jor\vol823_25 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 551-557

Comparison between the Foveal Avascular Zone and Macular Capillary
Network Density in Diabetic Retinopathy and Normal Retina
Khaled El-ghoneimy Said Ahmed, Asmaa Mohamed Ibraheem, Nahla Saad Mohamed Sayed*
Department of Ophthalmology, Faculty of Medicine - Menoufia University
*Corresponding author: Nahla Saad Mohamed Sayed, Mobile: (+20) 01007447468, E-Mail: drnahola@gmail.com

ABSTRACT
Background:
Diabetic retinopathy (DR) is mostly a vascular disease where the development of macular oedema and
proliferative retinopathy are major causes of visual impairment. Enlargement of the foveal avascular zone (FAZ) is
associated with visual deterioration in patients with diabetic retinopathy.
Objective: To evaluate the foveal avascular zone (FAZ) and perifoveal capillary network density in the superficial
retinal layer (SRL) and deep retinal layer (DRL) in patients with varying severities of diabetic retinopathy (DR).
Patients and methods: This is a prospective comparative randomized case-control study consisting of 77 eyes divided
into two groups, each group underwent imaging using OCT-A device. Group one: 37 healthy control eyes, and group
two: 40 eyes with DM of different degrees of diabetic retinopathy. Subjects were imaged between September 2019 and
February 2020 at Kasr El-Ainy Teaching Hospital.
Results: The FAZ area at the levels of the superficial and deep vascular networks of eyes with DR were found to be
larger compared with those of age-matched healthy controls, and as would be expected, control eyes had higher
vascular density in both networks compared with the diabetic eyes. Furthermore, eyes with worse DR stage showed
larger FAZ area and lower vascular density values. This study also showed that angiographic parameters, namely FAZ
area and vessel density (VD) correlated with best corrected visual acuity.
Conclusion: Our study revealed that vascular density and FAZ area can be quantified in DR eyes in a rapid, automated,
and noninvasive manner with OCTA. Also foveal avascular zone area and vascular density as measures of DMI
correlate with visual acuity in patients with DR.
Keywords: Diabetic Retinopathy, FAZ, Macular Capillary Network Density, OCTA

INTRODUCTION
screening or frequent longitudinal assessments. In
Diabetic retinopathy is the most common
addition, leakage of fluorescein dye and the
microvascular complication of diabetes, and remains a
superimposition of capillaries from different retinal
leading cause of blindness worldwide (1). Diabetic
layers onto a single two dimensional FA image have
retinopathy (DR) is mostly a vascular disease where the
hindered a more detailed investigation of the
development of macular oedema and proliferative
microvasculature by FA(4).
retinopathy are major causes of visual impairment. Over
Introduction of optical coherence tomography
the last years a lot of work has been done on early
angiography (OCTA) has allowed the opportunity both
diagnosis of DR and on looking for new ocular
to study retinal vasculature without the need for dye
diagnostic tools useful in evaluating patients affected by
injection and to image both the superficial and deep
diabetes (2).
capillary plexuses. Moreover, OCTA is able to image
The foveal avascular zone (FAZ) is extremely
and evaluate both the presence of retinal vascular
sensitive to biological events and tracking the
abnormalities and neovascularizations associated to
morphology of this region can provide insights into
diabetes (5).
possible pathologic processes, specifically FAZ
OCT-A images are mainly based on the detection
enlargement in DR. Therefore, exploring the
of blood movement without the need of injecting
relationship between the FAZ characteristics and onset
intravenous contrast. It combines a suitable visualization
and progression of disease may offer an early diagnostic
for the analysis of the retinal vasculature, as
tool that might allow for early detection before
angiographies,
but
non-invasively,
using
the
irreversible changes occur (3). Enlargement of the FAZ
tomography capture characteristics, which constitutes a
due to progressive capillary nonperfusion is associated
more comfortable scenario for the patients. OCT-A
with visual deterioration in patients with diabetic
images are typically taken at superficial and deep views
retinopathy. The FAZ area has long been considered an
of the eye fundus, which facilitates the subsequent
important clinical marker of advancing retinopathy (1).
vascular analysis; in addition, these images can be
In-vivo, the gold standard to screen for DR is
obtained at different levels of zoom, being 3 and 6
dilated biomicroscopic fundus examination. Fluorescein
millimetres-wide (greater and smaller zooms) the most
angiography (FA) is more sensitive than examination to
used configurations (6).
detect early microvascular changes. Since FA takes
Swept-source OCT technology uses longer-
several minutes and requires the administration of an
wavelength infrared light with less sensitivity roll-off
intravenous dye; the technique is not optimal for
with depth compared to conventional spectral-domain


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/)
551
Received14: 10/ /2020

Accepted:2 /12 /2020

Full Paper (vol.823 paper# 25)


c:\work\Jor\vol823_26 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 558-564

Effects of Metformin on Pregnancy Outcomes in Women with
Polycystic Ovary Syndrome during First Trimester
Azza Abdel Mageid Abdelhameid, Khaled Fathy Helal, Mohamed Fathy Abohashem,
Mohamed Abdel-Moneim Al Minshawy*
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.
*Correspondence to: Mohamed Abdel-Moneim Al Minshawy, E-mail: M.almeshawy@gmail.com,
Mobile: +20 0122057212

ABSTRACT
Background:
Polycystic ovary syndrome is a hormonal disorder commonly found in women of reproductive age
affecting about 15% of them and is considered the most common cause of anovulatory infertility. Administration
of metformin to these anovulatory women increase ovulation rate and continuing in first trimester improves the
pregnancy outcome.
Objective: To assess pregnancy outcome in women with polycystic ovary syndrome who continue metformin
during first trimester with its co-morbidity and mortality.
Patients and Methods: This prospective intervention study was conducted on 44 pregnant polycystic ovary
syndrome women who were attending for antenatal care at Outpatient Clinic, Obstetric and Gynaecological
Department, Zagazig University Hospital. These 44 women took metformin before pregnancy and was followed up
by indication of ovulation and metformin (1000-1500 mg/day) until they got pregnant. Then they were divided into
two group: group 1 (22) continuous metformin dose during first trimester and group 2 (22) who discontinued
metformin therapy once pregnancy diagnosed. The 2 groups followed up by fasting blood glucose and fasting serum
insulin at their first visit and at 28 weeks of gestation.
Results:
group 1 who continued (1000_1500mg /day) metformin in first trimester had good pregnancy outcomes
(significantly lower weight gain, lower gastrointestinal diabetes mellitus and lower spontaneous miscarriage) than
group 2 who discontinued metformin (p value: 0.001).
Conclusions:
good maternal outcomes in women with polycystic ovary syndrome who continued metformin during
first trimester including decrease incidence of spontaneous miscarriage and gastrointestinal diabetes mellitus.
Key words: Polycystic ovary syndrome (PCOS), Metformin, spontaneous abortion.

INTRODUCTION
adverse pregnancy outcomes. The most commonly
Polycystic ovary syndrome (PCOS) is a
identified of those are gestational diabetes mellitus
heterogeneous disorder affecting 6-15% of women of
(GDM),
early
pregnancy
loss,
gestational
reproductive age and it is considered as the most
hypertension, pre-eclampsia and preterm delivery (4).
common cause of chronic anovulation and
Although the mechanism of early pregnancy loss
anovulatory infertility (1). The Rotterdam (2003) PCO
is unclear. Several interrelated factors appear to
diagnostic criteria in adults considered that two of
increase the risk of spontaneous miscarriages
clinical or biochemical hyperandrogenism, ovulatory
including higher lutenizing hormone levels, obesity,
dysfunction, or polycystic ovaries on ultrasound are
hyperandrogenism and insulin resistance (5). PCOs
diagnostic (2).
women are believed to be strongly associated with
The threshold for poly cystic ovarian
insulin
resistance
and
compensatory
morphology (PCOM) should be on either ovary, a
hyperinsulinemia (6). Hyperinsulinemic insulin
follicle number per ovary of 20 and/or an ovarian
resistance is implicated as independent risk factor for
volume 10 ml, ensuring no corpora lutea, cysts or
early pregnancy loss as it plays a key role in the
dominant follicles are present. In patients with
disorder by increasing androgen concentration and
irregular menstrual cycles and hyperandrogenism, an
impeding ovulation leading to adverse effect on
ovarian ultrasound is not necessary for PCOS
endometrial function and implantation environment.
diagnosis. However, ultrasound will identify the
Therefore, the abnormal endocrine environment
complete PCOS phenotype in addition to poor
might exert an influence on the endometrium. The
conception rate. Early pregnancy loss rates are
ultimate cause of miscarriage could be secondary to
significantly higher (20-40%) than in general
endometrial non-receptivity (3).
population (3).
Administration of various insulin sensitizing
Many of these women require assisted
drugs such as metformin has been shown to decrease
reproductive techniques to conceive. In one meta-
serum androgen concentrations and to increase
analysis and one controlled clinical study, the PCOS-
ovulation rates in affected women (7). Continued
induced effects on reproduction were shown to be
metformin during pregnancy in women with PCOS
limited not only to infertility, but also to include
improves pregnancy outcomes by decreasing
spontaneous miscarriage rate and prevention of GDM


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/)
558
Received: / /2020

Accepted: / /2020

Full Paper (vol.823 paper# 26)


c:\work\Jor\vol823_27 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 562-566

Effect of Vinica Alkaloids Iontophoresis on Post-Mastectomy Shoulder Pain
Nermin Maher Mansour*1, Nancy Hassan Aboelnour1, Fady Samy Faltaous2, Mohamed Maher Elkabalawy1.
1Physical Therapy Department for Surgery, Faculty of Physical therapy, Cairo University, Giza, Egypt.
2Department of Anaesthesia and Pain Management, National Cancer Institute, Cairo, Egypt.
*Corresponding author: Nermin Maher Mansour, Mobile: (+20) 01012444513, E-Mail: nermoseif2313@gmail.com

ABSTRACT
Background:
Iontophoresis is a non-invasive technique used to increase the penetration of substances through the
skin through the dermal layer (epidermis, dermis and parenchyma) in a controlled manner. Technological advances
in recent decades have lowered the cost of equipment for implementation, which allowed for the expansion of this
technique.
Objective: To evaluate effect of vinica alkaloids iontophoresis on post-mastectomy shoulder pain.
Patients and Methods:
A randomized controlled study that was carried out on thirty females with age ranging from
35 to 50 years and suffering from post-mastectomy shoulder pain. The patients were randomly divided into two equal
groups, each one included 15 patients. Patients in group A (Study group) received 45-60 minutes of vincristine
iontophoresis (20 ml vincristine) 3 times/week in addition to conventional medical care, for eight weeks. While,
patients in group B (Control group) received placebo 45-60 minutes of only 20 ml saline iontophoresis (3
times/week), in addition to conventional medical care, for eight weeks.
Results:
Significant improvements in VAS and shoulder range of motion (ROM) were reported in the study group
compared to the control group (p > 0.001). In the study group, the percents of improvement of shoulder flexion,
abduction, internal and external rotation were 22.9%, 24.62%, 35.85%, and 39.97% respectively. While, in the
control group, they were 0.5%, 0.67%, 2.8%, and 3.35% respectively. VAS scores achieved higher percentage of
improvement (54.05%) compared to control group (10.15%).
Conclusion:
Vinica alkaloids iontophoresis achieved significant improvements in shoulder pain and ROM following
mastectomy.
Keywords: Vinica alkaloids, Iontophoresis, Mastectomy, ROM, VAS.

INTRODUCTION

subsequent nonadaptive changes within the supporting
Mastectomy could be a general expression
muscles (5, 6).
for eradication of the breast, typically to get rid of
Iontophoresis is a strategy for bringing
cancerous tissue (1, 2). Following mastectomy, some
ionized substances inside the body tissues, which has
patients complain from pain, numbness, edema,
demonstrated to be valuable in various clinical
weakness, or prickling within the arm and shoulder
applications. The strategy frequently uses direct
region in the affected side where surgery was applied
electrical flow to drive ionic substances for example,
(3). Combination of shoulder pain and muscle strength
synthetics or medications put on the skin over the intact
diminution can contribute to shoulder dysfunction. It
skin or other body surface to the body interior. Drug
was reported that about 60% of females with
transmission
via
iontophoresis
has
many
mastectomy suffer from shoulder pain, while 67% have
characteristics, as it is considered a safe, nonpainful and
a decrease in upper limb strength. Mastectomy with
noninvasive modality.
lymph node dissection or extensive radiotherapy can
It eliminates systemic drug adverse effects
predispose more to shoulder dysfunction comparing to
and increases the therapeutic efficacy of the drug by
patients with breast conserving surgeries or limited
bypassing hepatic first-pass metabolism. It introduces
radiotherapy. Additionally, age, weight, previous
few amounts of drug in comparison with other drug
shoulder complications, surgical procedures, using of
delivery modalities and also reduces the dosage
aromatase inhibitor, and cervical dysfunction also
frequencies and improves patient compliance (7-9).
contribute to shoulder limitations (4). Several studies
Use of iontophoresis for electrically
demonstrated that the muscles usually are directly
encouraged particle transport across natural films has
influenced by surgical procedures or radiation, the
been fruitful in management of neurological pain
pectoral muscles and the serratus, do not seem to be
conditions. Such pain conditions incorporate
those that have long dysfunction. Rather, muscles like
postherpetic neuralgia, diabetic neuropathy, constant
the trapezius muscle and rhomboids that do not act
regional pain disorders and phantom pain (10, 11). The
properly as they do not contract in a synchronous
fundamental agents utilized are the vinca alkaloids
pattern throughout shoulder ROM. This dysfunction
involving vincristine and vinblastine. It has been
may be attributed to biomechanical changes starting
recommended that vinca alkaloids can cause settlement
with pectoral muscles and serratus shortening and
of neurogenic pain through blockade of microtubules in
the neuron. The valuable impact of this treatment is


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/)
562
Received: / /2020


Accepted: / /2020

Full Paper (vol.823 paper# 27)


c:\work\Jor\vol823_28 The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 567-573

Extended Use of Clomiphene Citrate in Induction of Ovulation in
Polycystic Ovary Syndrome with Clomiphene Citrate Resistance
Mohammed Abd El Ghany Omara1, Nabih Ibrahim El Khouly1, Hend Talaat Salama2,
Ayman El-Sayed Solyman1
1Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2Obstetrics and Gynecology Department, Albagour General Hospital, Menoufia, Egypt
*Corresponding author: Hend Talaat Salama, Mobile: (+20) 0101 247 5850, Email: drhendsalama2020@gmail.com

ABSTRACT
Background
: Clomiphene citrate (CC) is still holding its place as the first-line treatment for induction of ovulation
in polycystic ovary syndrome (PCOS) patients.
Objective: to assess the effect of extended clomiphene citrate on pregnancy outcomes of clomiphene resistant
PCOS.
Patients and methods: this study was conducted on 48 PCO patients with CC resistance attended to the Obstetrics
and Gynecology Outpatient Clinic at Menoufia University and Al-Bajour General Hospitals, from April 2018 to
February 2020. Patients were treated with an extended CC administration (150 mg for 10 days) to overcome
anovulation.
Result: There was highly significant change in follicle-stimulating hormone (FSH), luteinizing hormone (LH) and
FSH/LH after extended CC treatment (p<0.001). Also, serum progesterone and number of follicles were
significantly increased after treatment compared to before treatment.
Conclusion:
CC extended is a safe, effective with minimal side effect, but low pregnancy rate was observed.
Therefore, further studies with large number of PCO patients with CC resistant with addition of other drugs are
required to investigate the improvement of the pregnancy rate.
Keywords: Clomiphene citrate resistance, Extended use, Rotterdam criteria


defined as failure of ovulation after receiving 150 mg
INTRODUCTION
of CC/day for 5 days per cycle, for at least three cycles,
PCOS is the cause of anovulatory infertility; in
is common and occurs in 15-40% in PCOS patients
approximately 75% of the cases (1). It occurs in
(11).
approximately 4% or 18% of females on childbearing-
Failure of CC to induce ovulation is unpredicted.
aged around worldwide (2). So, WHO type II ovulation
This result showed, above all, an inexplicable event.
occurs in 85% of anovulatory patients (3). Women with
Some studies showed that it is more likely in patients
PCOS should also be evaluated for reproductive
who are obese, insulin resistant and hyperandrogenic
function, hirsutism, alopecia, and acne. CC is still
to have a genetic predisposition (12). Nevertheless, it is
holding its place as the first-line of treatment for
virtually impossible to predict who will respond to
induction of ovulation in these patients (4-7). CC is able
which dose of CC, if at all. Also, there was no general
to induce a secretion of follicle stimulating hormone
agreement on standard CC resistant management.
(FSH) from the anterior pituitary and is often enough
However, these may be costly and sometimes risky.
to reset the cycle of events leading to ovulation. This
Addition of adjuvants to CC such as N-acetyl cysteine,
is achieved through CC action, a non-steroidal
metformin and glucocorticoids may give a hope for
compound very similar to estrogen in blocking
better ovarian response (13, 14).
hypothalamic receptors of estrogen, indication of
The aim of our study was to assess the effect of
circulating estrogen deficiency in the hypothalamus
extended clomiphene citrate on pregnancy outcomes
and inducing in pulsatile pattern changes release of
of clomiphene resistant PCOS.
gonadotropin hormone-releasing hormone (GnRH) (8).

Standard practice is to administer CC for 5 days
PATIENTS AND METHODS
from the second or third day of the menstrual cycle,
A prospective study was conducted on 48 PCOS
starting with 50 mg/day and increasing up to 250 mg.
patients with CC resistance and diagnosed according
However, other studies found the most dosage
Rotterdam criteria 2003. They received clomiphene
affective was 100­150 mg/day. After 6 to 9 cycles of
citrate (CC) with maximum dose (150 mg) for 5 days
treatment with CC cumulative reach 70­75% (9).
starting from 2nd day of cycle with no evidence of
Another study found that extended of CC is safe,
ovulation in the next 3 months preceding recruitment.
effective with minimal side effect (10). CC resistance
Patients took 150 mg of CC (Clomiphene Citrate®;

Hoechst Marion Russel, Cairo, Egypt) for ten days


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/)

567
Received: 13/7 /2020

Accepted: 12/9/2020

Full Paper (vol.823 paper# 28)


Objectives of the study The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 574-580

Unilateral Fenestration versus Open Laminectomy in Treatment of
Degenerative Stenosis of Lumbar Spine
Samy Hassanin Mohamed, Waleed Mohamed El-Hady Essa, Sherif Abdel-Raouf Abd El-Azeem,
Mohamed Ramadan Ibrahim Belassy
Department of Neurosurgery - Faculty of Medicine Zagazig University
Corresponding author: Mohamed Ramadan Ibrahim Belassy, Mobile: (+20) 01090933977,
E-Mail: dr.mohammed.ramadan.ns@gmail.com

ABSTRACT
Background:
The syndrome of degenerative lumbar canal stenosis accounts for a large percentage of causes of low
back pain in the elderly worldwide. Surgical management has demonstrated better clinical and radiological results
than conservative treatment. It allows for adequate decompression of the thecal sac and the compressed nerve roots.
However, aggressive laminectomy with facetectomy has been linked with many postoperative complications
including instability. Hence, new less invasive modalities have been introduced such as fenestration and endoscopic
laminotomy.
Objective: This study aimed at comparing the safety and outcome of conventional laminectomy to unilateral
fenestration in cases of lumbar canal stenosis.
Patients and methods: It took place at the Neurosurgery Department at Zagazig University and included thirty six
patients with lumbar canal stenosis; eighteen patients were treated by conventional laminectomy and eighteen
patients were treated by unilateral fenestration.
Results: Decompression led to an intense decrease of total pain in both groups. Matched with that experience in
group I, but, with more remaining back and leg pain was found in group II, 6.58±0.99 and 6.75±0.96, respectively,
compared with 2.16±0.57 and 2.75±0.86 , respectively, at the 12 weeks follow-up assessment (p < 0.001). The
most obvious symptom of lumbar stenosis, neurogenic claudication improved in 91% of patients in group I
compared to 83% in Group II. Patient satisfaction was higher in Group I, as the patients who underwent unilateral
fenestration showed more decrease in total pain with 12 weeks postoperatively.
Conclusion: Unilateral fenestration allows acceptable and safe decompression of the spinal canal in patients with
degenerative lumbar stenosis.
Keywords: Degenerative Stenosis, Lumbar Spine, Open Laminectomy, Unilateral Fenestration.

INTRODUCTION
Typically, patient symptoms comprise unilateral
The term lumbar spinal stenosis (LSS) refers to
or bilateral buttock and leg pain, which slowly
the anatomical narrowing of the lumbar spinal canal
develops and persists over several months, or even
with diminished space available for the neural and
years with or without back pain. The back pain is
vascular elements in the lumbar spine resulting in
localized to the lumbar spine and can radiate towards
buttock or lower extremity pain, which may occur with
the gluteal region, groin and legs, frequently displaying
or without low back pain (1).
a pseudoradicular pattern. Neurogenic claudication is
Lumbar spinal stenosis can be classified
the most specific symptom of LSS (4).
according to etiology (primary and secondary stenosis)
CT allows precise evaluation of the spinal canal
and to anatomy (central, lateral or foraminal stenosis).
and differentiation between spinal canal stenosis
Primary stenosis is caused by congenital narrowing of
caused by discs, ligaments and bony structures (5). MR
the spinal canal, whereas secondary stenosis can result
imaging brought on clearer information regarding the
from a wide range of conditions, most often chronic
morphology of the spinal canal and revealed its
degeneration. Other causes of secondary stenosis
stenosis, which can be central or lateral (of the lateral
include rheumatoid diseases, osteomyelitis, trauma and
recess or foramina). MRI is the preferred imaging
tumors (2).
modality for the assessment of LSS (6).
The amount of space available for nerve roots in
Conservative treatment for LSS should be
the lumbar spinal canal and foramina is determined
applied for 3­6 months, with the aim of achieving
both by spinal developmental variations and by
satisfactory improvement of the symptoms. In patients
articular degenerative responses. Stenotic lesions can
in whom severe symptoms persist and functional
occur in any of three anatomic sites: the central canal,
impairment develops, surgery is the recommended
bordered by the vertebral bodies, discs and articular
option. All surgical procedures used in LSS aim to
processes; the subarticular canal or lateral recess,
decompress the entrapped neural elements, without
which extends from the thecal sac to the pedicle and
disrupting the stability of the segment. Laminectomy
the intervertebral foramen or nerve root canal lying
has been the gold standard of surgical treatment for
below the pedicle (3).
lumbar spinal stenosis. Subsequently, less invasive


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/)
574
Received:25 /7 /2020

Accepted:24 /8/2020

Full Paper (vol.823 paper# 29)


Objectives of the study The Egyptian Journal of Hospital Medicine (January 2021) Vol. 82 (3), Page 581-586

Correlation between Refractive Errors and Intraocular Pressure after
Adjusting by Central Corneal Thickness
Rabeea Mifath Mohammed Juwayli*, Adel Abdel Razik Farag, Adel Abd El-Azim Shalaby, Sherif
Mohammed Sharf El-Deen
Department of Ophthalmology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Rabeea Mifath Mohammed Juwayli, Mobile: (+20)01060330596, Email: rabeeaj1986@gmail.com

ABSTRACT
Background:
There is a significant correlation between myopia and intraocular pressure as an increase in the
intraocular pressure (IOP) was on a higher side in high and moderate myopias in comparison to emmetropic and low
myopic patients indicating higher degrees of myopia as an important risk factor for ocular hypertension.
Objective: To investigate the correlation between refractive status and intraocular pressure after adjusting for central
corneal thickness.
Patients and Methods:
This study was conducted in the Ophthalmology Department at Zagazig University Hospitals
on patients with refractive errors within 20-40 years with no detectable systemic or ocular pathologies that could
affect the outcome of the study. The spherical equivalent of refractive errors ranges in myopia from -1 to -6 and in
hypermetropia from +1 to +6. The sample was (50) eyes to be divided into two groups. It was calculated using Open
Epi Program with a Confidence level of 95% and power of 80%
Results: The mean CCT of the studied myopic group was 544.68 ± 29.62, while among the studied hypermetropic
group it was 548.9 ± 32.5, there was no statistically significant difference between both groups regarding central
corneal thickness. The mean IOP of the studied myopic group was 17.44 ± 2.41. While among the studied
hypermetropic group it was 13.92 ± 1.8, there was a highly statistically significant difference between both groups
regarding IOP.
Conclusion: There was a statistically significant correlation between intraocular pressure and myopia with
intraocular pressure being higher in the moderate myopic patient than in low myopia, thereby increasing the risk of
glaucoma in these patients.
Keywords: Central corneal thickness, Intraocular pressure, Spherical equivalent refractive error.

INTRODUCTION
hypertension. Considering this variability in IOP in
Accurate measurement of intraocular pressure is
different populations and the inconsistencies in
an important parameter in ophthalmic examinations,
relation to IOP with age, gender, and refractive error
for the diagnosis and the follow-up of glaucoma.
(3).
Goldmann applanation tonometer (GAT) is considered
The myopic refractive error and the intra-ocular
the standard for measurement of IOP. However,
pressure seem to have a significant correlation as such
measurement with GAT depends on many factors,
that with the increase of myopic refractive error there
such as curvature and central corneal thickness. Higher
was an increase of the IOP. The myopic refractive
IOP values were detected by Rebound tonometry
error and the CCT seem to have a significant
(RT). The IOP readings exceed the GAT values
correlation as such that with the increase of myopic
usually in a range of less than 1 mmHg generally in
refractive error there was a decrease of the central
the myopic eye. The (RT­GAT) discrepancy is related
corneal thickness (4).
to the refractive error, but not to central corneal
Fern et al. (5), confirmed the relationship
thickness (CCT) (1).
between central corneal thickness manifest refractive
Han et al. (2), reported that IOP is positively
errors and intraocular pressure. The cornea of myopic
correlated with refractive errors. Myopes have higher
eyes was significantly thinner than that of control and
IOP than the Emmetropes and the IOP of hyperopes is
hyperopic eyes.
less compared to Emmetropes. Also raised IOP is the
Central corneal thickness plays an important role
modifiable major risk factor for the development of
in understanding the risk of glaucoma. The corneal
glaucoma is influenced by other systemic parameters
thickness of less than 555m provides false results of
such as blood pressure and pulse pressure. Glaucoma
low intraocular pressure, whereas, the corneal
is the second commonest cause of irreversible
thickness of more than 555m provides a false result
blindness and visual impairment.
of raised intraocular pressure when measured with
The relationship between refractive error and
GAT where IOP measurement is altered by the corneal
IOP is an area of a discrepancy. myopia may be
thickness (6).
associated with the risk of primary open-angle
Central corneal thickness and IOP have an
glaucoma and hyperopia with a possible risk of ocular
independent effect on the risk of developing POAG.


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/)
581
Received:23 /7 /2020

Accepted:22 /8/2020

Full Paper (vol.823 paper# 30)