c:\work\Jor\vol841_1 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1638-1643

Comparative Study between Dexmedetomidine Versus Dexamethasone as
Adjuvants to Levobupivacaine for Cervical Plexus Block in Patients Undergoing
Thyroid Operation. Prospective-Randomized Clinical Trial
Ahmed Hamody Hassan1, Islam A. Amer2, Ayman Mohamed Abdelkareem1
Departments of 1Anesthesia and Intensive Care and Pain Management and 2Maxillofacial, Head and Neck Surgery
Unit, General Surgery, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Ayman Mohamed Abdelkareem, Mobile: (+20) 01021330778,
E-Mail: aymann8100@gmail.com

ABSTRACT
Background:
Thyroidectomy is the most common endocrine surgical procedure, and many challenges are
encountered during the preoperative, intraoperative, and postoperative periods. After thyroidectomy, bilateral
superficial cervical block is the most successful option reducing postoperative pain, analgesic needs and post-
operative complications such as vomiting.
Objective: Our study aimed to evaluate the analgesic effect, onset time of sensory block, duration time,
postoperative visual analogue score (VAS) and complications of adding dexmedetomidine versus dexamethasone
to levobupivacaine for cervical plexus block.
Patients and Methods: A prospective-randomized clinical trial study that was conducted at Sohag University
between April 2018 and March 2020. The study included fifty patients with (ASA) Class I or II, aged 30 to 60 years
were scheduled for euthyroid surgeries (including thyroid adenoma, Hashimoto's goiter, and nodosity thyroiditis)
Results: The addition of dexmedetomidine to levobupivacaine (group D) shortened the sensory block onset time
compared to dexamethasone added to the levobupivacaine group (group S) (p < 0.05). The duration of analgesia of
cervical plexus block in group (D) was significantly longer than that in group (S) (232.34 versus 303.55 min; p <
0.05). HR level in group (D) was significantly lower than that in group (S) (p < 0.05).
Conclusion: The addition of 1 g kg-1 dexmedetomidine to levobupivacaine for cervical plexus block (BSCPB)
shortened the sensory block onset time and extended the duration of analgesia and increased the quality of analgesia
more superior than the addition of dexamethasone.
Keywords: Cervical plexus block, Levobupivacaine, Dexamethasone; Dexmedetomidine.

sleep better than any other sedative while also
INTRODUCTION
producing analgesic1 and anxiolytic 2 impacts. It
Cervical plexus block is one regional anaesthetic
does, however, cause some respiratory depression.
technique, which often used in neck surgery,
Because of its pharmacological properties, it is now
especially in thyroid surgery (thyroid adenoma,
widely used in intensive care units as sedation and
Hashimoto's goiter, and nodular thyroiditis), but if it
anaesthesia, especially in regional anaesthesia. We
is used alone its problem that patients awake and
currently use dexmedetomidine for regional
arouse. Most surgeons prefer cervical plexus block to
anaesthesia, as Esmaoglu et al. (3) reported that adding
general anaesthesia (1). Patients who undergo this form
1 g kg1 dexmedetomidine to lidocaine for IVRA
of anaesthesia will experience stress, anxiety, or pain
improves the quality of anaesthesia and postoperative
when they are kept awake due to the minor failure of
analgesia. Dexmedetomidine was found to be safe
the cervical plexus block, although not all patients
when used in conjunction with a local anaesthetic for
will. Adjuvant medications such as midazolam,
plexus brachialis block in a study by Kaygusuz et al.
opioid, remifentanil, and clonidine were used to
(4) it may extend the time of anaesthesia and analgesia.
improve surgical outcomes and make it easier to
Also, Plunkett et al. (5) showed that an awake
patients. However, side effects such as oversedation,
thyroidectomy with dexmedetomidine (1 g kg1)
respiratory depression, hypoxemia, and hypotension
intravenous
infusion
and
local
anaesthesia
can occur due to using these medications. Some
administered by the surgeon was healthy and without
researchers have been testing new adjuvant
respiratory depression in a case study.
medications with various dosages in recent years to
Dexamethasone is a steroid that may relieve pain
find those that are better for patients (2).
and therefore the inflammatory response to tissue
Dexmedetomidine is a highly selective agonist for
damage following surgery (heat, pain, redness, and
the 2 adrenergic receptors. Its main site of action is
swelling). Dexamethasone may be administered with
the locus coeruleus in the brainstem. When used as a
the local anaesthetic around the nerve (perineural) or
sedative for patients, it has served as a central
into a vein (intravenous) to extend the pain relief from
antisympathetic, and it may maintain physiological
peripheral nerve block (4).

Our study aimed to evaluate the analgesic effect,

onset time of sensory block, duration time,

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/)
1638
Received:12 /1 /2021

Accepted:9 /3 /2021

Full Paper (vol.841 paper# 1)


c:\work\Jor\vol841_2 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1643-1649
Determinants of Quality of Life after Laparoscopic Cholecystectomy
Taghreed Mohamed Farahat1, Hatem Mohamed Soltan2,
Hala Mohamed El-Moselhy Shaheen1, Nagwa Nashaat Hegazy1, Heba Ali Rohiem Elghalban*1
Departments of 1Family Medicine and 2General Surgery, Faculty of Medicine - Menoufia University, Egypt
*Corresponding author: Heba Ali Rohiem Elghalban, Mobile: (+20)1023841668, E-Mail: Hebaelghalban@gmail.com

ABSTRACT
Background:
Laparoscopic Cholecystectomy is one of the most common surgical procedures. Quality of life (QOL)
is a concept reflecting physical, social, and emotional attitudes. Surgical operation, as a traumatic treatment procedure,
could affect QOL of the patients as well as treating them. Therefore, surgeons should try their best to improve patient's
QOL in addition to focus on the more traditional outcomes of mortality, morbidity, and laboratory findings.
Objectives: The aims of the current work were to determine risk factors for calcular cholecystitis and assess the
determinants of quality of life after laparoscopic cholecystectomy.
Patients and methods: This cross-sectional study included a total of 200 patients prepared for laparoscopic
cholecystectomy, attending at Department of Surgery, Menoufia University Hospital, Egypt. Patients were first
introduced and consented for the study at the surgery outpatients' clinics during the preoperative settings and guided
to fill out the chosen questionnaires and filling out other important information. Patients' understanding and readiness
to fill out the questionnaire without help were assessed. Assistance was offered accordingly.
Results: The demographic of the studied population shows predominant female distribution which was about three
times their fellow Males. Mean age was 43 years. Presence of comorbidity in 41.5% of patients. There was a statistically
significant difference between the preoperative scores and 3 months postoperative in all domains as the total score of
Gastrointestinal Quality of Life index (GIQLI) improved by about ten points.
Conclusion: It could be concluded that with no doubt laparoscopic cholecystectomy positively affected the Quality of
life. Patients subjectively had significant improvement of their symptoms. Some social determinants can predict
postoperative outcomes.
Keywords: Laparoscopic Cholecystectomy, Quality of Life.

INTRODUCTION


since the introduction of laparoscopic cholecystectomy
The gallbladder stones and cholecystitis
in 1989 further increased the cholecystectomy rate in the
prevalence are highly variable through the world with
United States and the United Kingdom, there was a 28%
different distribution among several ethnicities. In
increase in the numbers of cholecystectomies performed
general Gallstones are common in the adult affecting
in the late nineties (3).
more than 10 to 15% of the adult population (1).
The possible explanation for this increase is that
In the Middle East gallstones and subsequent
laparoscopy is less invasive, providing a lower surgical
cholecystectomy is one of the most common operation
risk and better patient acceptance compared with
performed in general surgical units. It represents up to
conventional (open) surgery, therefore leading to more
57% of major elective surgery and about 43% of
surgeries in patients previously thought too high a risk
emergency surgery this percentage is even higher in
or in those with minimal symptoms. Although there is
developed countries (2).
undoubtedly an element of overuse, cholecystectomy is
Although most gallstones are usually clinically
now the most common elective abdominal surgery
silent, 20% of people having stones experience true
performed in the United States, with more than 750,000
biliary symptoms at some time; 1% to 2% of patients
operations annually (3).
each year could experience complications and require
The rate of cholecystectomy has notably
surgical removal of the gallbladder. Yet the number of
increased in Egypt, probably owing to increased
operations for cholelithiasis has increased since 1950 in
awareness and improved governmental health services.
developed countries. Since the frequency of gallbladder
Given the Unique medical problems in Egypt the
surgeries was six times higher in the United States than
decision to either proceed with surgical intervention or
in Western Europe. Gallstone disease in Europe,
not is particularly important for Egyptians, where
however, is similar to that in the United States, with a
gallstones may be associated with liver fibrosis,
median prevalence in large population surveys ranging
cirrhosis,
and/or
viral
hepatitis,
rendering
from 5.9% to 21.9% (3).
cholecystectomy hazardous owing to vascular
The reason for this disparity could possible not
adhesions taking into consideration the impact on their
lie in the prevalence of cholelithiasis prese, but most
quality of life knowing that majority of Egyptian are
likely represent differences in surgical practice. Ever
suffering from compromised quality of life to begin with

(4).



Thi s 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/)

1644
Received:24 /1 /2021

Accepted:21 /3 /2021

Full Paper (vol.841 paper# 2)


c:\work\Jor\vol841_3 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1650-1654

Retrospective Statistical Study of Thoracic Trauma Patients in
Al-Hussein Hospital, Al-Azhar University
Shaban Ragab Ibrahim*, Ahmed Ezzat Abdelaziz**
* Forensic Medicine and Toxicology, Prince Sattam Ibn Abdelaziz University, Saudi Arabia
* Forensic Medicine and Clinical Toxicology, Al-Azhar Faculty of Medicine, Egypt
** Public health, Al-Azhar Faculty of Medicine, Egypt.
*Corresponding author: Shaban R. Ibrahim, Email: ssukkar444@gmail.com

ABSTRACT
Background:
Trauma is reported to be the leading cause of death. Thoracic trauma comprises 10-15% of all traumas.
Thoracic trauma directly accounts for approximately 25% of trauma related mortality and is a contributing factor in
another 25%. Eastern Mediterranean region had one of the highest rates of trauma mortalities around the world.
Objective: to determine chest trauma cases as regards the pattern, etiology, type of chest trauma, management and
outcome of chest trauma in Al-Hussein Hospital, Al-Azhar University.
Patients and methods:
A retrospective study was done on one hundred patients with traumatic chest injuries admitted
to Al-Hussein Hospital, Al-Azhar University and were randomly chosen. Data were collected from patient's files.
Results: The highest incidence of thoracic trauma was found in age groups of 3rd and 4th fourth decades. The cause of
trauma was work related; 42%, assault; 31%, road traffic accident; 20% respectively. Forty seven percent of cases had
open cardiothoracic injury, 26% had closed lung injury and hemothorax, and 18% had chest cage fracture while 9%
had pneumothorax only. Conclusion: Assault related injury was found to be the commonest cause of chest trauma
followed by road and motor car accident, which could be explained by characters of population activities in the area
surrounding Al-Hussein hospital.
Keywords: Al-Hussein Hospital, Thoracic trauma.

INTRODUCTION
PATIENTS AND METHODS
Trauma continues to be a major health problem
Our study included cases who were hospitalized due
worldwide because it is associated with high morbidity
to non-iatrogenic chest injuries and who were randomly
and mortality in both developed and developing
chosen. The hospitalization criteria were intrathoracic
countries. It is the leading cause of death,
injury, clinically significant rib cage injury (even one
hospitalization, and long-term disabilities in the first
rib fracture), or clinical suspicion of significant thoracic
four decades of life. Thoracic trauma comprises 10-
injury like subcutaneous emphysema.
15% of all traumas (1).
This study was based on analysis of data in medical
O'Connor and Adamski (2), reported that thoracic
files of 100 cases in Cardiothoracic Department in Al-
trauma directly accounts for approximately 25% of
Hussein Hospital, Al-Azhar University. Both,
trauma related mortality and is a contributing factor in
epidemiological and medicolegal analysis of the
another 25%. Fortunately, over 80% of injuries can be
collected data from the studied group were done. Data
managed utilizing tube thoracostomy, appropriate
were patients demographic profile, age, gender, cause
analgesia and aggressive respiratory therapy.
of trauma, various chest and other associated injuries,
The etiological pattern of chest trauma varies
underlying co-morbidities, interventional procedures
worldwide with many environmental and sociopolitical
undertaken, length of hospital stay, duration of tube
factors. Road traffic accidents (RTAs) remain the cause
thoracostomy, duration of ventilator support, length of
of most chest trauma in non-war zones. Mohta et al.,
hospital stay, complications, mortality and follow-up.
(3) stated that very few studies have been conducted to

assess its magnitude and management of thoracic
Ethical approval:
trauma.
Approval of the study was obtained from Al-Azhar
Pekka and Knight (4), found that injuries can be
University Academic Ethical Committee based on
inflicted on any part of the body. In forensic practice
analysis of data from medical files of patients.
certain areas are particularly vulnerable or have special

medicolegal significance, of these are especially the
Statistical analysis: The collected data were
chest in which damage can be sustained to either the
statistically studied, tabulated and analyzed and
chest wall or to the contents.
graphically represented. The data were analyzed
This study aimed to study chest trauma cases as
through SPSS for Windows version 10. Nominal
regards the pattern, etiology, type of chest trauma,
variables were reported as frequency and percentages
management and outcome of chest trauma.
and were compared by Chi2 test. P value less than 0.05

was considered significant.

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/)
1650
Received:27 /1 /2021

Accepted:24 /3 /2021


Full Paper (vol.841 paper# 3)


c:\work\Jor\vol841_4 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1655-1661

Diagnostic Performance of Shear Wave Elastography Ultrasound for
Identification of Esophageal Varices Needing Treatment in
Initially Diagnosed Patients of Compensated Cirrhotic Liver
Wael Abdelghany1, Mahmoud M. Higazi*2, Elham Mousa1, Mahmoud R. Mohamed3, Wafaa Abdelhamid1
Departments 1Tropical Medicine, 2Radiology and 3Internal Medicine, Faculty of Medicine, Minia University, Egypt
*Corresponding author: Mahmoud M. Higazi, E-Mail: mahmoud.higazi@minia.edu.eg

ABSTRACT
Background:
The presence of varices in liver cirrhosis patients is an important risk factor for death and
decompensation. Ultrasound elastography can be a noninvasive alternative to estimate portal hypertension severity
and to predict varices.
Objective: Our study was performed to evaluate the diagnostic performance of liver stiffness (LS) and splenic
stiffness (SS) measured by 2D shear wave elastography (SWE) and correlate it with endoscopic findings for the
accuracy of assessment of varices needing treatment (VNT) in compensated liver cirrhosis patients.
Patients and methods: This is a prospective study that included 150 patients who had compensated liver cirrhosis.
Two dimensional shear wave elastography measurements for liver and spleen stiffness were obtained and upper
gastrointestinal endoscopies for the presence and grade of varices were performed.
Results: We found that as liver or spleen stiffness increases, the more is the increase in the size of the varices with
significant positive linear correlation (p value < 0.001). We tried to identify the value of liver/spleen stiffness, which
could predict presence of significant varices. Multivariate analysis identified several factors that could be associated
with high risk varices, including liver and spleen elastography (p < 0.001).
Conclusion: Shear wave elastography is an effective and noninvasive tool not only for staging of fibrosis, but also
for predicting clinically significant portal hypertension.
Keywords: Shear Wave Elastography Ultrasound, Esophageal Varices, Compensated Cirrhotic Liver.

INTRODUCTION

Cirrhotic liver patients can be divided into
Our study was performed to evaluate the
compensated and decompensated disease, which have
diagnostic performance of liver stiffness (LS) and
substantially different prognoses. Although more
splenic stiffness (SS) measured by 2D shear wave
difficult to detect clinically, compensated cirrhosis has
elastography (SWE) and to correlate it with endoscopic
a better prognosis, and early treatment may prevent
findings for accuracy of non-invasive assessment of
progression
and
complications
(1).
Upper
varices needing treatment (VNT) in compensated liver
gastrointestinal (GI) bleeding from varices is a common
cirrhosis patients.
complication of portal hypertension due to chronic liver

disease and carries a high mortality rate of about 20-
PATIENTS AND METHODS:
35% (2).
This is a prospective study included 150
Patients with compensated cirrhosis and
patients who had chronic hepatitis, attended the
clinically significant PHT are at a higher risk of varices,
Outpatient Clinic of the Tropical Medicine Department,
decompensation, and hepato-cellular carcinoma (HCC).
Faculty of Medicine, Minia University Hospital. The
The presence of varices is an important risk factor for
patients were allocated into 2 groups according to the
death and decompensation. Therefore, being able to
upper GIT endoscopy findings. The 1st group included
detect varices as early as possible has the potential to
patients with no or minimal varices not needing
affect patient outcome(3).
treatment (VNNT). The 2nd group included patients with
The standard method for evaluating portal
varices needing treatment (VNT).
hypertension is hepatic venous pressure gradient

(HVPG) measurement and the stratification of variceal
Inclusion criteria:
bleeding is mainly based on endoscopy (4). However;
(1) Patients who are initially diagnosed as compensated
ultrasound elastography could be a noninvasive
liver cirrhosis due to HCV or HBV, (2) No beta blocker
alternative to estimate portal hypertension severity and
treatment and (3) Time interval between SWE and
to predict varices (5). Shear wave elastography is based
endoscopy < 30 days.
upon generation of shear waves induced by the force of
Exclusion criteria:
a focused ultrasound beam. They travel slowly (between
Patients were excluded if they had previous
1 and 10 m/s) and are attenuated by tissue. The
decompensation manifested by hepatic encephalopathy
propagation velocity of the shear waves correlates with
or moderate/marked ascites, or if they had
elasticity of examined tissue (6).
hepatocellular carcinoma.


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/)

1655
Received:28 /1 /2021

Accepted:25 /3 /2021


Full Paper (vol.841 paper# 4)


c:\work\Jor\vol841_5 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1662-1666

Prognostic Value of Neutrophil /Lymphocyte Ratio in Acute Ischemic
Stroke patients Either Received Reperfusion Therapy or Not
Mahmoud Ahmed Shahin1, Mostafa Saleh Melake2,
Saad Soliman Ibrahim1, Amira Mohiey El-deen Hamdey3
Departments 1General Surgery, 2Neurology and 3Emergency Medicine Unit,
General Surgery Department, Faculty of Medicine, Menoufia University, Egypt.
*Corresponding author: Amira Mohiey El-deen Hamdey, Mobile: 00201010740323 -00201225897293,
E-MAIL: DR_AMIRA9393@YAHOO.COM

ABSTRACT
Background:
Very few studies have investigated the specific relationship between neutrophil-lymphocyte ratio
(NLR) and the short-term prognosis of patients with acute ischemic stroke (AIS) and after receiving intravenous
thrombolysis.
Objectives:
To discuss if there is a relationship between neutrophil-lymphocyte ratio and stroke severity in the
emergency department and short-term prognosis whether the patient is treated by reperfusion therapy or not to use
it as a rapid prognostic marker in acute ischemic stroke patients.
Patients and Method:
A prospective comparative interventional study was done on 56 patients with acute
ischemic stroke at Menoufia University Hospitals. They were selected according to certain inclusion and exclusion
criteria. NLR was assessed from the patients' blood samples. Initial stroke severity was evaluated by Glasgow
Coma Score (GCS), National Institutes of Health Stroke Scale (NIHSS) score and modified ranking scale (mRS),
then was re-evaluated later after 24 hours of admission and after one month.
Results:
NLR among ischemic stroke patients with a bad prognosis was significantly higher than that of the
patients who had a good prognosis. The optimal cutoff value of NLR for the prediction of unfavorable outcomes
was 4.15 with a sensitivity of 100% and a specificity of 88.5%.
Conclusion:
Elevated NLR on the hospital admission is an easy and strong predictor of poor outcomes in AIS
patients either receiving reperfusion therapy or not.
Keywords: Acute ischemic stroke, Intravenous thrombolysis, Neutrophil-to-lymphocyte ratio, outcome.

INTRODUCTION
in patients with AIS (6). However, the problem is that
Cerebrovascular stroke is the second most
the effects of NLR on functional outcome in AIS are
common cause of death after ischemic heart disease
still uncertain. This study aimed to discuss if there is
and the third most common cause of disability in
a relationship between neutrophil-lymphocyte ratio
adults (1). The overall crude prevalence rate of stroke
and stroke severity in the emergency department and
in Egypt is 963/100,000 population (2). Using
short-term prognosis either the patient is treated by iv
intravenous reperfusion therapy is the most important
reperfusion therapy (r-tPA) or not. Using this ratio as
in
treating
patients
suffering
from
acute
a fast marker on arrival at the hospital can help in
ischemic stroke.
predicting the prognosis of the patients of acute
This treatment should be given as fast as
ischemic stroke in an easy manner.
possible, perfectly within 4:5 hours after the onset of
Therefore, a higher NLR should be taken into
the symptoms and within 60 minutes from the arrival
consideration in patients with AIS and these patients
of the patient to the emergency room (3). Acute
should be followed more closely in terms of poor
ischemic stroke is an inflammatory process in which
outcomes. This study aimed to investigate whether a
the diseased tissues releases chemokines and
high NLR is associated with a poor outcome in
cytokines, and recruits peripheral circulating
patients with AIS and after receiving r-tPA.
leukocytes. Among the leucocytes, neutrophils were

known to be an important mediator and early
PATIENTS AND METHODS
neutrophilia was demonstrated to be accompanied by
This study included 56 ischemic stroke patients
larger stroke volumes and bad outcome. Lymphocytes
who were admitted with history of neurologic
also infiltrate the ischemic tissues and cause
symptoms, signs, and neuroimaging of acute ischemic
inflammatory responses (4).
stroke into the Emergency Department at Menoufia
Admission Neutrophil-to-Lymphocyte Ratio
University Hospitals. Sample size was calculated
(NLR) is supposed to be a readily available and
using Epi-Info program.
inexpensive predictor for short-term prognosis in

acute ischemic stroke (AIS) patients (5). In recent
studies, NLR was shown to correlate with mortality

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/)


1662

Received: 27/1/2021

Accepted: 24/3/2021


Full Paper (vol.841 paper# 5)


c:\work\Jor\vol841_6 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1667-1671

Prevalence and Predictors of Aortic Valve Sclerosis in Chronic Hemodialysis Patients
Walid Ahmed Ragab Abdelhamid
Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Corresponding author: Walid Ahmed Ragab Abdelhamid, Email: WAAbdelHamid@medicine.zu.edu.eg,Tel. +201062904443

ABSTRACT
Background:
Aortic valve sclerosis (AVS) is a serious public health issue, particularly among the elderly. It is linked to
higher rates of acute cardiovascular events. In addition, cardiovascular diseases are common in chronic hemodialysis
patients. Objective: To find out the prevalence of AVS in chronic hemodialysis patients and assess risk factors for AVS in
these patients. Patients and Methods: The research involved 58 chronic hemodialysis patients from December 2019 to
December 2020. They were categorized into group 1 (22 subjects) who did not have AVS and group 2 (36 subjects) who
had AVS. Demographic data were gathered from all patients. Laboratory investigations and echocardiographic examinations
were done for all the subjects. Results: Group 2 was older than group 1 (p = 0.002). In addition, diastolic blood pressure
(DBP) was higher in group 1 than in group 2 (p < 0.003). Furthermore, group 2 exhibited greater serum alkaline phosphatase
(ALP) levels than group 1 (p = 0.011). In contrast, group 2 had lower serum creatinine, mean corpuscular volume (MCV),
mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) than group 1 (p= 0.049,
p = 0.038, p = 0.01, and p = 0.01, respectively). On multivariate regression analysis, greater age (p = 0.014), lower DBP (p
= 0.049), and lower MCH (p = 0.011) were significantly predictive of AVS. Conclusion: 37.9% of hemodialysis patients
had AVS in this study and the predictors for AVS included older age, lower DBP, and lower MCH.
Keywords: Aortic Valve Sclerosis, Chronic Kidney Disease, Hemodialysis, Mean Corpuscular Hemoglobin, Vascular
Calcification.

INTRODUCTION
weight, height, pulse, blood pressure, temperature, general
In older individuals, one of the most prevalent
examination, and local cardiac examination. Investigations
echocardiographic findings is aortic valve sclerosis (AVS).
included renal and hepatic function tests, bone profile, iron
AVS is related to a higher prevalence of myocardial
profile, fasting lipid profile, urea reduction ratio, complete
infarction leading to higher rates of mortality (1). Moreover,
blood count, serum vitamin B12, C-reactive protein, serum
the fatality rate from cardiovascular problems in chronic
folate, troponin T, and erythropoietin resistance index
dialysis patients is greater than in the general population (2).
(ERI). ERI was calculated as weekly erythropoietin
AVS has the same pathological features and risk factors
dosage/weight of the patient/hemoglobin level (5). All
as atherosclerosis (3). Furthermore, mechanical stresses,
patients underwent echocardiographic examination by a
including membrane stretching, blood pressure, and shear
skillful cardiologist and AVS was identified by the
force, enhance the calcification process of the aortic valve
detection of irregular thickening of the aortic leaflet with a
(4). Therefore, this study aimed to find out the prevalence of
peak velocity across the valve <2.5 m/s.
AVS in chronic hemodialysis patients and detect predictors
Ethical approval:
of AVS in these patients.
The research was authorized by the Institutional
PATIENTS AND METHODS
Review Board of the Ethical Committee of Zagazig
This cross-sectional study included 58 subjects from
University and according to the Helsinki declaration
December 2019 to December 2020. They were end-stage
ethical guidelines. Each participant signed informed
kidney disease (ESKD) patients who had been on regular
consent to share in the study.
hemodialysis for at least 6 months. All subjects with a past
Statistical analysis
history of parathyroidectomy, coronary artery bypass
SPSS (Statistical Package for the Social Sciences)
surgery, previous hospital admission for acute coronary
version 26 was used to execute data analysis. The normality
syndrome, and advanced heart failure were excluded.
of continuous data was examined using the Shapiro Wilk
The contributors were sorted into two groups depending
test. Continuous variables with skewed distributions were
on the identification of AVS on echocardiography. Group 1
presented as medians and interquartile ranges, while
consisted of 22 patients who did not have AVS. They were
continuous variables with normal distributions were
14 males and 8 females, and the ages varied from 27 to 82
presented as means and standard deviations. Categorical
years. Group 2 comprised 36 patients with a confirmed
data were expressed as numbers and percentages. The
diagnosis of AVS. They were 21 males and 15 females, and
Student's t-test and the Mann-Whitney U test were
the ages varied from 29 to 82 years. Medical histories were
employed to evaluate normally distributed and non-
collected from all subjects. Clinical examination included
normally distributed continuous data, respectively. While

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/)
1667
Received:27 /1 /2021

Accepted:24 /3 /2021


Full Paper (vol.841 paper# 6)


c:\work\Jor\vol841_7 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1672-1676

Prevalence of Stress Cardiomyopathy in Polytrauma Patients
Samir Mohamed Attia1, Nader El Shahat Awad2, Mohamed Elsaid Ahmed3, Amany Medhat Ezzat Youssef*4
Departments of 1Vascular Surgery, 2Cardiology, 3Critical Care Medicine and
4Emergency Medicine, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Amany Medhat Ezzat Youssef, Mobile: (+20) 01011271652,
E-Mail: mohamedsaeedahmed68@gmail.com

ABSTRACT
Background:
Polytrauma is a leading cause of death globally and usually involving young victims. Takotsubo
cardiomyopathy (TCM) is a serious clinical presentation of myocardial dysfunction characterized by acute, transient, and
reversible heart failure syndrome owing to regional wall abnormalities of the ventricular myocardium associated with
ECG changes and rising of myocardial biomarkers in the absence of cardiac condition causing the temporary ventricular
dysfunction. Objective: To detect the prevalence of stress cardiomyopathy among polytrauma patients attending to
Emergency Hospital Mansoura University. Patients and methods: The current study was a cross sectional study
conducted on 500 patients who attended to Emergency Department, Emergency Hospital Mansoura University, suffering
from polytrauma within the period from August 2019 to August 2020.
Results: Prevalence of cardiomyopathy among the studied trauma patients was 4.4%. Mode of trauma (either blunt or
penetrating) had no effect in the incidence of cardiomyopathy. Sequential organ failure assessment (SOFA) score and
revised trauma score (RTS) demonstrated positive correlation with incidence of cardiomyopathy among polytrauma cases
(P<0.001). Cardiomyopathy group was associated with marked affection of all echocardiographic parameters (Stroke
volume, end diastolic volume, ejection fraction and fractional shortening) except end systolic volume. Cardiomyopathy
group was associated with marked increase in ICU admission, ICU length of stay, total length of stay and mortality rate.
Conclusion: Presence of stress cardiomyopathy in trauma cases may be used as an indicator of poor outcomes. Both
SOFA and RTS scores were considered as reliable tools used to describe organ dysfunction/failure in polytrauma cases
and have a positive correlation with stress cardiomyopathy.
Keywords: ICU, Polytrauma, RTS, SOFA, Stress Cardiomyopathy.

INTRODUCTION
Although ITCM is a rare complication, it occurs
Polytrauma is a leading cause of death
more frequently in polytrauma patients. Moreover, it is
worldwide, often involving young victims. Stress
characterized by left ventricular wall motion
cardiomyopathy (inverted takotsubo cardiomyopathy) is a
abnormalities in the mediobasal segments and always by
rare but potentially lethal complication in this setting,
normal coronary arteries (8).
featuring transient myocardial contractile dysfunction.
The aim of the present study was to detect the
The sequelae of severe polytrauma may include
prevalence of stress cardiomyopathy among polytrauma
myocardial dysfunction followed by acute heart failure
patients attending to Emergency Hospital Mansoura
and death (1). Evidence is emerging that systemic
University.
inflammation after trauma drives structural and functional

impairment of cardiac function, thus worsening the
PATIENTS AND METHODS
outcome of poly-trauma patients (2).
The current research was a cross sectional study
Inverted takotsubo cardiomyopathy (ITCM)
conducted on 500 patients who attended to Emergency
usually has benign course, however, on rare instance, it
Department, Emergency Hospital Mansoura University,
can result in life-threatening and fatal complications
suffering from polytrauma within the period from
including
acute
cardiogenic
shock,
ventricular
August 2019 to August 2020.
arrhythmias and ventricular wall rupture (3).
Inclusion criteria: Polytrauma patients, injury severity
ITCM is a variation, first described by Dote et al.
score 16, admission to Emergency Hospital, all age
(4). It was so-named because of an unusual shape of the
group, and both genders.
left ventricle that is similar to that of a Japanese octopus's
Exclusion criteria: Previous cardiac disease, injury
trap,
`Takotsubo',
when
observed
on
left
severity score <16, and patients who refused the
ventriculography in the systolic phase.
participation in the study.
The inverted-type is more common in young
Methods:
people and maybe associated with specific clinical
1. Primary survey and resuscitation:
conditions (5), including trauma (6). It is characterized by
A = Airway opening and maintenance of
akinesia or dyskinesia of the basal left ventricular
airway.
segments and hypercontractility of the apex. Endogenous
B = Breathing and ventilation.
and exogenous catecholamine surges may be the
C = Circulation.
mediators (7).
D = Disability: neurological status and Glasgow
coma scale (GCS).

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/)

1672
Received:27 /1 /2021

Accepted:24 /3 /2021


Full Paper (vol.841 paper# 7)


c:\work\Jor\vol841_8 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1677-1683

Left Atrial Volume as A Parameter of The Ventricular Function in
Patient with Non-Valvular Atrial Fibrillation
Mohamed A. E. Mostafa, Ensaf Bassam Yousef, Sherif Abd Alsalm Sakr, Ayman Elsayed Elbadrany*
Department of Cardiology, Faculty of Medicine, Mansoura University, Egypt.
*Corresponding author: Ayman Elsayed Elbadrany, Mobile: (+20) 01010668806, E-Mail: aymanalbdrany@yahoo.com

ABSTRACT
Background:
Remodeling of the left atrium (LA) is a reflection of chronicity of the underlying, often occult
cardiovascular disease. The presence of left atrial enlargement indicates clinically significant risk of adverse
cardiovascular consequences for the patient. Left atrial volume provides a more sensitive assessment of left atrial
enlargement, which is an important predictor of AF, providing incremental information beyond that afforded by the
clinical risk factors and conventional M mode LA dimension.
Objective: Assessment of left atrial volume as a parameter of ventricular function in patients with non-valvular atrial
fibrillation.
Patients and methods:
The study was conducted on convenient sample of 50 patients with non-valvular AF and 50
normal control group who presented to Damietta Cardiology Center Outpatient Echocardiography Laboratory for a
resting transthoracic study. The eligible patients were adults aged from 26 to 67 years, who had no history of pacemaker
implantation, valvular heart disease (except mild degree), congenital heart disease and ischemic or dilated
cardiomyopathy.
Results:
our study revealed that there was a strong direct significant graded relationship between the severity of diastolic
dysfunction and left atrial volume index (LAVI) in patients of non-valvular AF. There was limited significance regarding
Tei index and global longitudinal strain (GLS). Therefore, LAVI can be considered a sensitive and specific
echocardiographic indicator for left ventricular diastolic dysfunction. We can consider LAVI the A1c of the heart.
Conclusion: Diastolic dysfunction in non-valvular AF patient can be assessed using LAVI with limited significance of
Tei index and GLS. Regarding systolic function in those patients, it can be assessed using GLS as it is considered
sensitive index of early systolic dysfunction.
Keywords: Left atrial volume index, GLS, Ventricular function, Non-valvular atrial fibrillation.

INTRODUCTION


LA is a reservoir for LV during systole and a
resting transthoracic study. The eligible patients were
conduit during early diastole and an active contractile
adults aged from 26 to 67 years old, who had no history
chamber in late diastole. It contributes up to 30% of LV
of pacemaker implantation, valvular heart disease
output during diastole. LA is directly exposed to LV
(except mild degree), congenital heart disease and
pressure that increases with worsening of diastolic
ischemic or dilated cardiomyopathy.
dysfunction. Consequently, LA wall pressure increases

to maintain adequate LV filling. This results in increase
Inclusion criteria: Adult male or female presented with
LA wall tension and LA dilatation (1).
non-valvular AF.
AF is one of the most common tachyarrhythmia
Exclusion criteria: moderate to severe mitral stenosis
associated with adverse outcome. Many studies have
or mitral valve replacement, ischemic or dilated
shown a strong relationship between AF and diastolic
cardiomyopathy, congenital heart disease, and history
dysfunction. Furthermore, the risk of heart failure
of pacemaker implantation.
progression is markedly increased once AF develops.

Left atrial volume provides a more sensitive assessment
Ethical Approval:
of left atrial enlargement, which is an important
An approval of the study was obtained from
predictor of AF, providing incremental information
Mansoura University academic and ethical
beyond that afforded by the clinical risk factors and
committee. Every patient signed an informed written
conventional M mode LA dimension (1).
consent for acceptance of the operation.
Aim of the present work was to assess left atrial

volume as a parameter of ventricular function in patients
All patients were subjected to the following:
with non-valvular atrial fibrillation.
1) Detailed history taking and clinical general and

cardiac examination.
PATIENTS AND METHODS
2) 12-leads electrocardiography (ECG).
The study was conducted on convenient sample
3) Two-dimensional
transthoracic
of 50 patients with non-valvular AF and 50 normal
echocardiography:
The
examination
was
control group who presented to Damietta Cardiology
performed by VIVID E 9, EKG leads using the 4D
Center Outpatient Echocardiography Laboratory for a
probe for all AF cases. Images were obtained from

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/)
1677
Received:29 /1 /2021

Accepted:26 /3 /2021


Full Paper (vol.841 paper# 8)


c:\work\Jor\vol841_9 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1684-1685

Leg Wound Complications During Hospital Stay When Using Conventional
Saphenous Vein Harvest Versus Endoscopic for Coronary Bypass Surgery
Ahmed S. Mahmoud*, Fouad M. Rasekh, Hesham Zayed Saleh
Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University
*Corresponding authors: Ahmed Sayed Hussein, Mobile: (+20)1090991111, E-mail: drahmed 755@gmail.com

ABSTRACT
Background:
Using the endoscope to harvest the saphenous vein as an alternative to conventional method helps in
decreasing leg wound related complications.
Objective: The aim of the current work was to detect the leg wound problems while using endoscopic vein harvesting
versus conventional method during hospital stay.
Patients and Methods: Fifty patients underwent coronary bypass surgery divided into two groups randomly,
conventional, and endoscopic. Data of the patients were collected perioperatively. Patients were followed up during
hospital stay which was 5-7 days in average regarding leg wound complications.
Results: Leg wound pain in the postoperative period during hospital stay was significantly higher in the conventional
group, leg swelling was lower in endoscopic group, occurrence of hematoma of the leg was higher in endoscopic group.
Conclusion: It could be concluded that harvesting the saphenous vein endoscopically is superior to conventional
method regarding leg wound complications in addition to its cosmetic advantage.
Keywords: Leg Wound Complications, Conventional Saphenous Harvest, Endoscopic, Coronary Bypass Surgery.

INTRODUCTION
using special harmonic diathermy and clips applied after
The saphenous vein graft is the commonest graft
harvesting.
used in coronary surgery (1). Conventional saphenous vein
Perioperative data were collected. Patients were
graft harvesting is accompanied by increased incidence
followed up after surgery during hospital stay which was
of leg wound complications (2-3). Endoscopic vein
(5-7) days in average as regards leg wound related
harvesting reduces the leg wound related problems in
complications. Severity of pain in the leg wound was
comparison to conventional method (4-5).
documented as the patient subjectively complained.
The aim of the current work was to detect the leg

wound problems while using endoscopic vein harvesting
Statistical analysis
versus conventional method during hospital stay.
Recorded data were analyzed using the statistical

package for social sciences, version 20.0 (SPSS Inc.,
PATIENTS AND METHODS
Chicago, Illinois, USA). Quantitative data were expressed as
This prospective randomized study included a total
mean± standard deviation (SD). Qualitative data were
of fifty patients underwent coronary bypass surgery and
expressed as frequency and percentage. Independent-
requiring 2 segments of saphenous vein plus internal
samples t-test of significance was used when comparing
mammary artery, attending at Department of
between two means. P<0.001 were considered
Cardiothoracic Surgery, Cairo University Hospitals.
statistically significant.

This study was conducted between January 2017 to
RESULTS
December 2019.
Patients' data listed in (Table 1). Most of patients

were diabetic males. Operative data regarding harvesting
Ethical consent:
of the saphenous vein are listed in (Table 2). The length
An approval of the study was obtained from Cairo
of skin incision is significantly lower in group 2. The
University academic and ethical committee. Every
mean length of the harvested saphenous vein was the
patient signed an informed written consent for acceptance
same in both groups. The harvesting time in both groups
of the operation.
was almost the same. The number of branches required
Patients were divided into two equal groups: 25
repair using 7-0 were significantly higher in the
patients each, conventional method of saphenous vein
endoscopic group. The length of skin incision was
harvesting in group one, and endoscopic harvesting in
significantly shorter in endoscopic group. Data showing
group two.
leg wound related complications during hospital stay
Duplex was used to map both saphenous veins
listed in (Table 3). Postoperative pain was significantly
prior to surgery. Saphenous vein should be at least 5.0
higher in group 1 during hospital stay. Incidence of
mm under the skin, wall thickness less than 1.6 mm,
hematoma was higher in group 2 but not statistically
lumen 2.0 to 4.0 mm and the deep venous system must be
significant. Swelling of the leg was higher in group 1.
patent. In both groups the operator was a senior surgeon.

In group one side branches were clipped and ligated, in
Table (1): Clinical data of the patients
group two MAQUET harvesting system was used with

carbon dioxide insufflation, the branches were divided

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/)
1684
Received: 28/2/2021

Accepted: 23/5/2021


Full Paper (vol.841 paper# 9)


c:\work\Jor\vol841_10 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1686-1689

The effect of Psoriasis on Female Sexual Function
Amany Abdelrahman Nassar, Al-shimaa Mohammed Ibrahim, Heba Mohammed Mohammed Salem*
Department of Dermatology, Venereology and Andrology, Faculty of Medicine ­ Zagazig University, Egypt.
*Corresponding Author: Heba Mohammed Mohammed Salem, Mobile: (+20)01111134983,
Email: mosad8rashed@gmail.com
ABSTRACT
Background:
Psoriasis is one of the most common immune-mediated chronic inflammatory skin disorders. Sexual
dysfunction in psoriasis is influenced by factors such as the severity of psoriasis, psoriasis body area and associated
physical and/ or psychic comorbidities.
Objective: The study aimed to assess female sexual dysfunction and their correlation with psoriasis severity.
Patients and Methods: The present study was conducted on two groups: patient group that included 30 female patients
with psoriasis, with age ranged from 20-60 years old and control group included 20 healthy females, with matched age.
The disease severity was graded according to the Psoriasis Area and Severity Index (PASI) score. Female sexual
function was assessed by female sexual function Index (FSFI).
Results:
The mean of all six FSFI domains were lower in psoriatic group than in control group except pain was increased
and with no statistically significant difference between both groups. Orgasm was found to be significantly decreased in
female patients with psoriasis than control group. There was a significant negative correlation between female sexual
function index (FSFI) and psoriasis severity (PASI). There was a significant negative correlation between age and FSFI
among control group. In contrast to psoriasis group, there was no correlation between FSFI and either age or duration
of disease.
Conclusion: There was a significant negative correlation between FSFI and PASI.
Keywords:
PASI, FSFI, Female sexual dysfunction.

INTRODUCTION


Psoriasis is one of the most common immune-
PATIENTS AND METHODS
mediated chronic inflammatory skin disorders (1).
This was a case-control study that included 30
Beside genetic factors, several environmental factors
female patients with a diagnosis of psoriasis (psoriasis
such as injuries, infections, stress, drugs, and immune
group), in addition to 20 female healthy volunteers of
defect take part in autoimmune pathogenesis of the
matched age and sex as a control group. All patients
disease. In addition, it has been reported that some
were selected from the Outpatient Clinic of
hormones may also have a role in the pathogenesis of
Dermatology,
Venereology
and
Andrology
psoriasis, due to their effects on keratinocytes
Department, Zagazig University Hospitals through the
proliferation (2). Studies revealed that sex hormones
period from March 2019 to January 2020.
manifest a variety of biological and immunological

effects in the skin which modulate the natural course of
Ethical considerations:
psoriasis (3).
An informed consent was obtained from all participants.
Psoriasis has a substantial emotional impact on an
The present study was approved by the Ethics
individual, which is not necessarily related to the extent
Committee on research involving human subjects of
of skin disease. One-fourth of patients with psoriasis
Faculty of Medicine, Zagazig University.
have sexually-affected lives after the onset of psoriasis,

regardless of gender. Sexual dysfunction is one of the
Inclusion criteria: Females with age ranging between
causal factors in reducing the quality of life in patients
18 to 60 years old and having active sexual life.
with psoriasis, along with low self-esteem, anxiety,
For psoriatic group: Clinically typical psoriatic
depression and suicidal ideation. Sexual dysfunction in
lesions with different clinical varieties of psoriasis, and
psoriasis is influenced by factors such as the severity of
different degrees of severity of psoriasis according to
psoriasis, psoriasis body area and associated physical
Psoriasis Area and Severity Index (PASI) score.
and/or psychic comorbidities (4).

According to the World Health Organization
Exclusion criteria: Age < 18 or > 60, receiving topical
(WHO), sexuality is a basic need and an aspect of
therapy for 2 weeks or systemic therapy for 1 month
human beings that cannot be separated from others,
before being enrolled in our study, receiving hormonal
extremely important in maintaining good mental health.
therapy as oral contraceptive pills, presence of
The impact of psoriasis on sexual functioning is
gynecological disorders potentially affecting sexual
significant, because the condition causes intense
function including (vaginitis, chronic pelvic pain,
interpersonal strain, hindering quality of life (4).
malignant neoplasm, vaginismus and alteration of
The study aimed to assess female sexual
Pelvic anatomy), pregnancy, breast-feeding, renal,
dysfunction and their correlation with psoriasis severity.
hepatic or endocrinopathic diseases, and patient

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/)
1686
Received:1 /4 /2021

Accepted:27 /5 /2021


Full Paper (vol.841 paper# 10)


c:\work\Jor\vol841_11 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1690-1695

Interrupted versus Continuous Suture Technique for Ventricular
Septal Defects Surgical Closure
Rafik F.B. Soliman*1, Sherif S. Salim2,3, Luna S. Baangood2,
Abdulhamid Alnajjar2, Ayman R. Abdelrehim1,4
1Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2Pediatric Cardiology Department, Madina Cardiac Center, Madina, Saudi Arabia
3Paediatric Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
4Cardiac Surgery Department, Madina Cardiac Center, Madina, Saudi Arabia
*Corresponding author: Rafik F.B. Soliman, Mobile: (+20) 01011102102, E-Mail: rafikfekry@hotmail.com

ABSTRACT
Background:
Ventricular septal defect (VSD) is the most frequent congenital cardiac defect. Conventionally, open-
heart surgical repair through cardiopulmonary bypass (CPB) is the primary approach for many years.
Objective: Given the absence of a reliable evidence on the optimal suture technique regarding the efficacy and
morbidity, this study aimed to compare the postoperative complication rates and the outcomes of the interrupted and
continuous suture techniques for the surgical VSD closure.
Patients and Methods: This retrospective cohort study included 140 consecutive children who underwent surgical
closure of congenital VSD of any type with or without associated congenital heart diseases. Patients with associated
major cardiac anomalies were excluded. Preoperative, operative, and long-term outcomes data including VSD
residual and heart block that needed permanent pacemaker (PPM) were collected from medical files. The closure
was performed using interrupted sutures in 76 (54.3%, group 1), and by continuous sutures in 74 (45.7%, group 2)
patients.
Results: Three (3.9%) patients in group 1 and four (6.3%) patients in group 2 developed heart block that needed
PPM, with no significant difference (p=0.702). Four (5.3%) patients in group 1 compared with two (3.1%) patients
in group 2 had clinically and sizable (by echocardiography) significant residual, with no significant differences
between both groups (p=0.688).
Conclusion: The present study indicates that interrupted and continuous VSD closure techniques have comparable
success and postoperative complication rates. Thus, the optimal suturing technique for VSD closure cannot be
standardized, and their predilection depends on the experience and the comfort of the surgeons.
Keywords: Heart block, Residual VSD, Surgical closure, Ventricular septal defect.

INTRODUCTION

through the right atrial approach in which the VSD is
Ventricular septal defect (VSD) is the most
reached through the tricuspid valve (8). The
frequent congenital cardiac defect. It commonly
interventricular septum is typically closed by using an
occurs as isolated defect in the interventricular septum,
autologous pericardium patch, which is fixed by either
and it also constitutes a fundamental part of complex
interrupted or continuous suturing techniques
congenital cardiovascular anomalies (1). The incidence
depending on the surgeon preference (9). However,
of VSD is 1.75­4.48 per million live births, while the
there may be differences in the postoperative outcomes
incidence of isolated VSD is about 0.3% of newborns
and complications of the two techniques.
(2).
Given the absence of a reliable evidence on the
Diagnosis
of
VSD
is
mainly
by
optimal suture technique regarding the efficacy, and
echocardiography, which plays a major role in
morbidity, this study aimed to compare the
detecting the VSD, the individual anatomy of the case,
postoperative complication rates, and the outcomes of
and the associated anomalies or complications (3). The
the interrupted and continuous suture techniques for
VSD defect commonly (80%) shrink and closes
the surgical VSD closure.
spontaneously within the first month of life (4),

especially the isolated defects (5). If not closed, large
PATIENTS AND METHODS
defects can lead to unfavorable complications such as
This retrospective cohort study was conducted at
pulmonary
arterial
hypertension,
ventricular
the Department of Pediatric Cardiac Surgery, Madina
dysfunction, with an increased risk of arrhythmias. In
Cardiac Center, KSA and El Aml Hospital, Egypt.
this case, surgical repair is the ultimate treatment (6).

Conventionally, open-heart surgical repair
Ethical approval:
through midline sternotomy and cardiopulmonary
The study was conducted according to the World
bypass (CPB) is the primary approach for many years
Medical Association Declaration of Helsinki, after the
(7). Surgical VSD closure commonly performed
approval of the Research Ethics Committee, Madina

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/)
1690
Received:27 /1 /2021

Accepted:24 /3 /2021


Full Paper (vol.841 paper# 11)


c:\work\Jor\vol841_12 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1698-1702

Identification of Circulating Tumor Cells and Chemokine Receptor CCR6 as
Noninvasive Biomarkers in Egyptian Patients with Hepatocellular Carcinoma
Mohammed F. Elshal1, Manal O. Elhamshary1, Morad M. Mahmoud1 and Neama M. Lotfy2
1Molecular Biology Department, Genetic Engineering and Biotechnology Institute, University of Sadat, Sadat City,
Egypt,2Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding Author: Neama Lotfy, Mobile: (+2) 01008334082, E-mail: neama_lotfy@yahoo.com

ABSTRACT
Background:
Circulating tumor cells (CTCs) are cancer cells in the circulation that are derived from the original
tumor or metastatic foci. Chemokines and their receptors have major roles in hepatocellular carcinoma (HCC)
metastasis. They also represent a very promising group of markers to detect CTCs in HCC patients. The CCL20-
CCR6 axis promotes cancer proliferation, migration, and tumor remodeling through immune cell control.
Objective: This study aimed to identify the role of CTC and CCR6 in hepatocellular carcinoma patients.
Patients and methods: The study included 91 subjects; 71 HCC patients and 20 normal individuals. Routine
laboratory investigations included CBC, PT and INR, ALT, AST, bilirubin, albumin, alpha fetoprotein, and creatinine
in addition to detection of chemokine receptor 6 (CCR6) RNA by real time PCR and CTCs by flow cytometry as
CD45¯CK19+ cells were performed for all subjects enrolled in this study.
Results: There was significant difference between the studied groups as regards liver function tests. Also, high
significant difference was recorded regarding CCR6 RNA expression, CTCs count and hepatic focal lesion detection
by ultra sound. No significant difference between both groups regarding kidney function tests. Correlation studies
between CTCs and other variables showed positive correlations with liver function tests (ALT, AST, BIL, Alb, AFP,
and INR) and negative correlations with albumin and platelets.
Conclusion:
CCR6 mRNA concentration was significantly increased in HCC patients and its elevation was correlated
with CTCs percentage. Therefore, it can be concluded that the combined assessment of CTCs and CCR6 could be
considered as noninvasive biomarkers for HCC patients.
Keywords: Hepatocellular carcinoma, Circulating tumor cells, Chemokine receptor 6, PCR, Flowcytomerter.

INTRODUCTION
albumin, heat shock protein and group of chemokine
Hepatocellular carcinoma (HCC) is the most
receptors, which represent a very promising group of
common primary malignancy of the liver and is a
markers to detect CTC such as CXCR4, CX3CR1, and
leading cause of cancer-related death worldwide. In
CCR6 express during HCC progression (4).
Egypt, it is the leading cause of cancer after hepatitis
Many studies have been conducted on
C infection, with male-to-female sex-linked infection
chemokines and their receptors (chemokines-receptors
{2: 1} (1).
axes) in HCC. Currently, the CCL20-CCR6 axis have
Circulating tumor cells (CTCs) are cancer
received much research attention. CCL19, CCL20,
cells derived from the original tumor or metastatic foci
CCL21, CXCL12 and the expression of their receptors
that are flowing freely in the blood circulation. These
were also studied in HCC, and found that all
calls are considered the drivers of recurrence and
chemokines are expressed in normal liver and HCC
metastasis following liver cancer surgery for primary
tissues. Yet, CCL20 was the only chemokine, which
HCC. Those CTCs can lead to a new fatal metastasis
showed significant upregulation along with its receptor
and can be vividly described as "seeds" of tumors (2).
CCR6 in HCC tissues (5). The CCL20-CCR6 axis plays
CTCs-positive rate was directly correlated with tumor
an important role in the growth and progression of
size and counts as a biomarker of poor prognosis. The
HCC, as there is a strong association between the
absolute numbers of CTCs detected have been
levels of their expression and the degrees of
associated with survival and treatment response and
differentiation of HCC, that is, with high
associated with increased recurrence risk after
differentiation, the expression was low and so there is
resection and shorter overall survival as the more
a distinct increase in CCL20 and CCR6 expression
advanced the cancer stage, the higher number of these
rates in HCC tissues of grade III tumors in comparison
cells in the peripheral blood (3).
to grade II (6).
Hepatocellular carcinomas can synthesize
Screening methods for HCC include
various tumor-related proteins, polypeptides, and
radiological tests such as ultra-sonography,
isoenzymes as well as the corresponding mRNAs. It is
computerized tomography, and magnetic resonance
important to have tumor-specific markers of HCC to
imaging. Serological methods such as liver function
detect CTCs in the blood stream or lymphatic system
tests (ALT, AST, Bilirubin, INR, Albumin, and AFP).
like some cytokines (IL8 and TGF-1), AFP, alpha
Percutaneous liver biopsy is yet used as diagnostic

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/)
1696
Received: 1/4 /2021

Accepted: 27/5/2021


Full Paper (vol.841 paper# 12)


c:\work\Jor\vol841_13 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1703-1710

Does Farnesoid X receptor (FXR) Have a Role in NAFLD Progression ?
Shereen Fathy Mahmoud1, Dina Sweed2, Esraa Karman*2, Nancy Youssef Asaad1, Nanis Shawky Holah1
1Pathology Department, Faculty of Medicine, 2Pathology Department,
National Liver Institute, Menofia University, Egypt
*Correspondence: Esraa Karman, Mobile: 02001098086080, E-mail: esraa.karman92@gmail.com

ABSTRACT
Background:
Non-alcoholic fatty liver disease (NAFLD) is the emerging cause of chronic liver disease. In addition,
steatosis may lead to failure of obtaining sustained virological response after hepatitis C virus eradication. Therefore,
there is a trend to identify effective strategies for managing hepatic steatosis. Farnesoid X receptor (FXR) agonists are
reported to play a role in NAFLD treatment.
Objective: This study aimed to explore the immunohistochemical expression of FXR in NAFLD spectrum in
association with the clinicopathological data.
Material and method: This was a retrospective study including 50 cases of NAFLD and 23 cases of normal liver. The
NAFLD group was subdivided into 11 cases of NAFL (simple steatosis) and 39 cases of non-alcoholic steatohepatitis
(NASH). Results: Hepatocyte FXR nuclear expression was significantly decreased in NASH group (P=0.001) with no
significant decrease in NAFL group compared to normal liver (P=0.149). Bile duct FXR expression was significantly
lower in NAFL group compared to normal liver (P= 0.009) to reach the lowest level in NASH group (P= 0.017). In
NAFLD group, there was an inverse correlation between hepatocyte FXR nuclear expression and the ALT/AST ratio
(r=-0.349 and P=0.013). However, hepatocyte FXR nuclear expression was significantly associated with moderate
grade of steatosis and severe fibrosis (P= 0.044 and P= 0.033, respectively).
Conclusion: Hepatocyte FXR nuclear expression showed a stepwise decrease in its expression from normal to NASH
passing with NAFL. Therefore, FXR has a protective role against NAFLD progression. Elevated liver enzymes could
be used as a non-invasive method for monitoring FXR agonists' efficacy.
Keywords:
ALT/AST ratio, FXR, NAFLD spectrum.


INTRODUCTION

Non-alcoholic fatty liver disease (NAFLD) is
Under physiological condition, bile acids (BAs)
considered an emerging issue worldwide with an
are endogenous ligands of FXR playing a crtitical role
alarming rising prevalence. The highest prevalence
in elimination of cholesterol, regulation of glucose and
rates (nearly 30%) has been reported from Middle East
lipid metabolism, and reduction of inflammation and
and South American countries with a much lower
fibrosis. FXR is located in cytoplasm of cholangiocytes
prevalence rate in Africa (13%) (1). NAFLD is a
and hepatocytes and aids in BA formation and
spectrum of liver disease including simple steatosis >
regulation through different pathways(8). Upon
5%, non-alcoholic steatohepatitis (NASH), fibrosis,
activation, FXR is translocated to the nucleus, forms a
cirrhosis, and hepatocellular carcinoma (HCC) (2). The
dimer and binds to hormone receptor element
fundamental criteria is the presence of steatosis in the
downregulating the expression of certain genes. In
absence of any other causes for liver diseases; such as
addition, the regulatory role of FXR in glucose and
alcohol consumption, chronic viral hepatitis and
lipid metabolism via activation of de novo lipogenesis
autoimmune hepatitis (3). NAFLD is considered the
pathway through induction of liver X receptor (LXR)
hepatic manifestation of metabolic syndrome and
and Sterol regulatory element binding protein 1c
commonly associated with obesity, insulin resistance,
(SREBP1c) (7, 9). Low hepatic FXR expression is
type 2 diabetes, dyslipidemia, hypertriglyceridemia,
reported as a risk factor in the development of NASH
and hypertension (4). Therefore, a global trend reached
(10, 11). Furthermore, FXR is involved in both the
a final consensus that NAFLD terminology should be
adaptive and innate immune response associated with
changed to metabolic associated fatty liver disease
chronic inflammation of NASH (11). Ongoing clinical
(MAFLD) (5). Because of the rising global concern
trials using FXR agonists might represent a promising
towards NAFLD as the coming leading cause of end-
therapeutic strategy in the future to prevent and treat
stage liver disease, HCC and liver transplantation, a
NASH (12). In view of limited previous studies
considerable effort has to be paid to its prevention and
exploring the expression of FXR protein on NAFLD
available treatment (6).
patients.
Farnesoid X receptor (FXR), also known as
Therefore,
we
aimed
to
study
the
NR1H4, is a member of the nuclear receptor
immunohistochemical (IHC) expression of FXR on
superfamily. It is highly expressed in the liver,
liver tissue from NAFLD cases with different dissease
intestine, kidney and adrenals (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/)


1703
Received: 27/1/2021


Accepted: 24/3/2021


Full Paper (vol.841 paper# 13)


c:\work\Jor\vol841_14 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1711-1718

Ultrasound Assessment of Fetal Adrenal Gland in Term and
Preterm Labor Cases
Heba Maged Abo Shady1, Mohamed Ahmed Samy Kandil1,
Ashraf Anas Zytoon2, Shaimaa Mahmoud Youssef1
Departments of 1Gynecology & Obstetrics and 2Radiodiagnosis, Faculty of Medicine - Menoufia University, Egypt
*Corresponding author: Shaimaa Mahmoud Youssef, Mobile: (+20)01063603679,
E-Mail: shaimaayoussef606@gmail.com

ABSTRACT
Background:
Preterm birth (PTB) remains a major cause of perinatal morbidity and mortality worldwide. Compared
with term deliveries, early PTB (< 34 weeks' gestation) carries a 7-fold increased risk of neonatal death.
Objective: To compare the Fetal Zone Depth (FZD) of fetal adrenal gland in term and preterm labor cases
Patients and Methods: Thirty-three preterm pregnant women at 29-36 weeks of gestation with single pregnancy and
clinical diagnosis of preterm labor and control group of 33 pregnant women at 37-40 weeks with term pregnancy were
included in this study. FZD and Total Gland Depth (TGD) of fetal adrenal gland were ultrasonographically measured
and FZD/TGD ratios were calculated and compared between the two groups.
Results: No difference was found between the two groups in respect of age and number of pregnancies (P > 0.05). Yet,
preterm birth history rupture of membrane, cervical dilatation and mode of delivery were higher in preterm group (P
<0.05). Fetal adrenal gland FZD/TGD ratio was statistically significantly higher in preterm group compared to the term
group (52% ± 5% vs. 29% ±9%; P <0.001).
Conclusion: The growth in FZ as a fetal adaptation mechanism in increased fetal stress in preterm labor cases was at a
significant level. Once supported by more comprehensive studies, we think that this result would be beneficial in the
prediction of preterm labor in clinical practice.
Keywords: Preterm labor, Adrenal gland, Fetal zone, Ultrasonography.

INTRODUCTION
fetal adrenal gland endocrine signaling pathways play an
Identification of women at risk for PTB is one of
important role in initiation of the normal parturition
the critical prerequisites for effective intervention and
process (8).
improvement in outcome. For the last several decades,
Biochemical
activation
causes
increased
significant effort has been focused toward discovery of
dehydroepinadrosterone-sulfate production in the central
an accurate method to predict PTB.
zone of the fetal adrenal gland (fetal zone). Accordingly
Traditional predictors such as obstetric risk
the whole fetal adrenal gland increases in size and this
factors and clinical presentation are helpful but seldom
increase is predominantly due to significant enlargement
completely define the population that will truly deliver
of the central fetal zone (9). Arguments in support of this
preterm (1). Approximately 20-30% of the preterm births
process have been provided by an autopsy study, which
(i.e. 1-4% of all births) are caused by medical and
demonstrated that neonates that delivered in the setting
obstetric reasons. While, 70-80% of these births may be
of idiopathic PTB had significantly higher adrenal gland
linked to spontaneous idiopathic reasons associated or
weight than those that delivered secondary to
not associated with premature rupture of membranes
fetal/maternal hemorrhage(1).
(PROM) (2). Preeclampsia, fetal distress, Fetal Growth
The recent studies conducted in this context
Retardation (FGR), abruption placenta and fetal death
revealed that the ultrasound-measured fetal adrenal
may be referred to as the medical and obstetric causes (3).
gland volume is highly predictive of preterm birth,
The prediction and prevention of preterm births
independent of expected birth weight and gestational
are among the major issues of obstetrics. Prediction and
week (1-10). Hence, this study aimed at comparing the fetal
prevention of preterm births by determining the risk
adrenal gland FZD/TGD ratios in preterm and term labor
factors would be the most appropriate approach with a
through ultrasonographic assessment.
view to reduce the preterm birth rates. Risk scoring

systems, digital examination of the cervix, biochemical
PATIENTS AND METHODS
markers, ultrasonographic cervical length measurement
The study was carried out on 66 patients attending
are the methods used in predicting preterm labor (4, 5).
Outpatients and Emergency Unit of Gynecology and
Currently,
ultrasonographic
cervical
length
Obstetrics Department, from December 2019 to
measurement is the most frequently used method in
December 2020. Thirty three preterm pregnant women
clinical practice for the prediction of preterm labor (6, 7).
at 29-36 weeks of gestation with single pregnancy were
There is evidence to support the view that
admitted to the hospital with the clinical diagnosis of
activation of the fetal hypothalamic-pituitary-adrenal
preterm labor. On the other hand, a control group of 33
axis, and the cross talk between a variety of placental and
pregnant women between 37 and 40 weeks with term
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/)




1711
Received: 2/4/2021

Accepted: 28/5/2021


Full Paper (vol.841 paper# 14)


c:\work\Jor\vol841_15 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1719-1723

Neonatal Sepsis: Single Center Experience
Mansour Alzahrani1*, Sami Alrashidi1, Abdulaziz Alnujaydi1,
Abdulqudos Aljenendil1, Omar Alomar1, Abdulaziz Alareefy1, Yazeed Alsubaie1,
Mohammed Alghoshimi1, Dayel Alshahrani2
Departments of 1Pediatric, and 2Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia
*Corresponding author: Mansour Alzahrani, Mobile: (+966)508776660, E-Mail: msgalzahrani@kfmc.med.sa

ABSTRACT
Background:
Neonatal sepsis is a major cause of morbidity and mortality worldwide, especially when an infant is
delivered preterm.
Objectives: The aim of the current work was to evaluate the clinical presentation, etiology, antibiotics use, and
mortality in neonatal sepsis cases at King Fahad Medical City. Duration of antibiotics and length of hospital stay
were also included.
Patients and Methods: This cross sectional retrospective descriptive, single-institute study included a total of 225
neonates suspected to have neonatal sepsis, attending at tertiary hospital, Department of General Pediatric, King
Fahad Medical City, Riyadh, Saudi Arabia. This study was conducted between January 2014 to July 2017. Subjects
were hospitalized through Emergency Department and included all neonates underage of 28 days.
Results: Among the included 225 neonates, 134 (59.6%) were male and 91 (40.4%) were female. Most of them Term
neonates 203 (90.2%). Fever found to be the most common symptoms 184 patients (81.8%) followed by decrease
feeding and activity in 124 (55%) and 101 (44.9%) respectively. Respiratory symptoms like cough, tachypnea, runny
nose and cyanosis found in 56 (25%). Empirical antibiotics frequently used were amipicillin 209 (92%) and
cefotaxime 185 (82%) with median duration of 4days (range 1-47 days). Blood cultures came positive in 8 patients
(3.6%). Coagulase negative staphylococci came in 3 (30%) patients and E.coli in 3 (30%) patients as well.
Conclusion: It could be concluded that large number of neonates admitted as suspected neonatal sepsis in our hospital
resolved their symptoms without find identifiable etiology. In those who had identifiable etiology urinary tract
infections (UTI) and viral infections were the common etiology. However, blood stream sepsis and meningitis were
quite rare.
Keywords: Neonatal, Sepsis, Antibiotics.

INTRODUCTION


Neonatal sepsis remains one of the leading causes
The aim of the current work was to evaluate the
of mortality and morbidity in neonate (1). Based on the
clinical presentation, etiology, antibiotics use, and
timing of infection neonatal sepsis has been classified
mortality in neonatal sepsis cases at King Fahad
into early and late onset sepsis. This classification helps
Medical City. Duration of antibiotics and length of
to guide antibiotic therapy according to predominant
hospital stay were also included.
organisms at onset. Early onset sepsis is defined as onset

of sepsis in the first week of life and mostly it is caused
PATIENTS AND METHODS
by vertical transmission from mother to infant (2).
This cross sectional retrospective descriptive,
Most common organisms are Group B
single-institute study included a total of 225 neonates
streptococcus (GBS) which is the most common leading
suspected to have neonatal sepsis, attending at tertiary
cause of neonatal sepsis and meningitis in united states.
hospital, Department of General Pediatric, King Fahad
E.Coli described to have emerged as 2nd most common
Medical City, Riyadh, Saudi Arabia. This study was
(3), Listeria monocytogens was also associated with
conducted between January 2014 to July 2017.
intensive disease in neonates. Late onset sepsis is

defined as onset of sepsis beyond the first week of life
Ethical approval:
until 28 days of life.
Approval of the ethical committee was obtained
Mostly it is caused by horizontal transmission of
from King Fahad Medical City.
pathogens acquired postnatally (2). Most common
Subjects were hospitalized through Emergency
organisms (70%) are gram positive cocci, being
Department and included all neonates underage of 28
coagulase negative staphylococcus.
days. Cases who showed clinical signs of neonatal
Other organisms associated with high rates of
sepsis such as fever, decreased activity or oral intake,
death are pseudomonas aeruginosa, Serratia marcescens
apnea, cyanosis, respiratory symptoms, abnormal
and E.coli (4).
movement, vomiting, diarrhea, or abdominal distension
However, Local results and outcome of neonatal
were included. Cases who known to have major
sepsis is sufficient.
comorbidities e.g., complex heart disease and neonates


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/)
1719
Received:2 /3 /2021

Accepted:28 /5 /2021


Full Paper (vol.841 paper# 15)


c:\work\Jor\vol841_16 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1724-1730

The Role of Multi-Slice Computed Tomography for the Assessment of Bronchiectasis
Zeinab Abd El Aziz Ali, Zinab Mostafa Shehata Bisar, Yasmin Hossney Hemeda
Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Zinab Mostafa Shehata Bisar, Mobile: (+20)1061437864, E-Mail: nodamecantabelle@gmail.com

ABSTRACT
Background:
Bronchiectasis is pathological, irreversible dilatation of the bronchi due to destruction of the bronchial
wall and the elastic connective tissue. Recurrent infection and inflammation and the resulting chemical and cellular
cascade lead to permanent architectural changes in the airways. Bronchiectasis can confer substantial potential
morbidity, usually secondary to recurrent infection.
Objective: The aim of the current work was to evaluate the role of Multi-Slice Computed Tomography (MSCT)
examination in detection and diagnosis of pulmonary bronchiectasis.
Patients and methods: This study included 60 patients with bronchiectasis detected in their MSCT of the chest referred
from the Chest Diseases Hospital to the Radiology Department, Mit Khalaf Hospital Complex, Al-Menoufia.
Results:
The most common etiology was post inflammatory bronchiectasis 26 patients (43.3%), followed by traction
bronchiectasis 21 patients (35%). The distribution of bronchiectasis in post inflammatory cases was mostly affecting the
lower lobes 16 (61.4%) of 26 patients. Regarding traction bronchiectasis, affection was mostly in the upper lobes
including 10 (47.4%) of 21 patients. In chronic obstructive pulmonary disease, distribution was mostly in lower lobes
with 4 (50%) of 8 patients. In aspiration, distribution was in bilateral lower lobes. In cystic fibrosis, it affected the
bilateral upper lobes and in Kartagener syndrome, the distribution was on bilateral lobes. The most common
morphological type of bronchiectasis was the cylindrical type which was detected in (25%) of cases followed by the
signet ring type with (23.3%) of the cases.
Conclusion: It could be concluded that the role of MSCT in the diagnosis of the pulmonary bronchiectasis is central,
accurate and non-invasive.
Keywords: Multi-slice computed tomography, Bronchiectasis.


INTRODUCTION

Bronchiectasis is a permanent irreversible
could occur from massive hemoptysis (4). Characteristic
diffuse or localized dilatation of the airways (1). Long-
computed tomography (CT) scan findings is the main
term architectural changes in the airways triggering
differentiating factor (2).
bronchial dilatation related to many etiologies mainly
Multi detector computed tomography (MDCT),
caused by recurrent infection and inflammation(2).
is the most sensitive imaging modality for the
Clinical diagnosis of bronchiectasis is
identification and diagnosis of bronchiectasis. MDCT
dependent on a history of daily viscid excessive sputum
findings in bronchiectasis include bronchial wall
production, so that it is generally misdiagnosed as
thickening with dilatation of the bronchi to a diameter
bronchial asthma or chronic obstructive pulmonary
greater than that of the accompanying artery (the signet-
disease (COPD) because of the similarities in clinical
ring sign); lack of normal tapering of bronchi (5).
findings (2). Bronchiectasis can be caused by different
The aim of this study was to evaluate the role of
pathological conditions. Acquired causes are more
MSCT examination in detection and diagnosis of
common, such as infection, pulmonary fibrosis,
pulmonary bronchiectasis.
recurrent or chronic aspiration, stenosis, or obstruction
PATIENTS AND METHODS
of airways by neoplasm, granulomatous disease,
This study included a total of 60 patients with
broncholithiasis, and asthma. Congenital conditions that
different age and residence, presented with productive
cause bronchiectasis include, cystic fibrosis, and
cough and dyspnea with bronchiectasis in their Multi-
cartilage development disorders (3). Bronchiectasis could
slice computed tomography referred from the Chest
be a part of numerous multi-systemic diseases, such as
Diseases Hospital to the Radiology Department, Mit
cystic fibrosis (CF), immunodeficiencies, alpha 1-
Khalaf Hospital Complex, Al-Menoufia for doing
antitrypsin deficiency, primary ciliary dyskinesia
MSCT of the chest. This study was conducted between
(PCD), rheumatoid arthritis and inflammatory bowel
July 2020 to February 2021.
diseases, especially ulcerative colitis (2).

It helps to identify the cause, as it is useful in
Ethical consent:
the management decision, minimizing further damage to
An approval of the study was obtained from
the airways through inflammation reduction, infection
Menoufia University academic and ethical
prevention,
and
bronchopulmonary
hygiene.
committee. Written informed consent of all the subjects
Bronchiectasis may cause potential morbidity secondary
was obtained.
to recurrent infections and in severe conditions, death

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/)
1724
Received:2 /4 /2021

Accepted:28 /5 /2021


Full Paper (vol.841 paper# 16)


c:\work\Jor\vol841_17 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1731-1738

Effects of Varicocele on Serum Testosterone Levels and Changes of Testosterone
Levels after Varicocelectomy among Infertile Men: A Prospective Controlled Study
Tamer Youssef Mohamed, Atef Mohamed Abdel Latif,
Ahmed Mohamed AbdElmodaber, Mohamed Ali Kamar*
Endocrine Surgery Unit, Faculty of Medicine, Mansoura University, Egypt
* Corresponding author: Mohammed Ali Talaat Kamar, Mobile: (+20) 01096723523, E-mail: m.ali9020@yahoo.com

ABSTRACT

Background: Varicocele repair has been advocated as an option to prevent and treat low serum testosterone, even in
men with normal semen quality. The association between clinical varicocele and impaired testosterone production is
less clearly understood. Although, the conceptions of the negative impact of clinical varicocele on Leydig cell functions
and the beneficial effect of varicocele repair on testosterone production have been proposed for decades.
Objective:
To examine the hypotheses that clinical varicoceles affect baseline serum total testosterone levels and to
study the effects of varicocelectomy on serum testosterone levels and semen quality in infertile men who suffer from
varicocele.
Patients and Methods: This study included 100 patients (50 control and 50 cases) presented to the General Surgery
and Endocrine Surgery Unit Outpatient Clinic at Mansoura University Hospitals with clinical varicocele for primary
infertility. The study was conducted during the period between 1st April 2020 and end of March 2021.
Results: Regarding preoperative and postoperative testosterone level among the intervention group, there were highly
statistically significant increases in total testosterone as well as significant improvement in gonadal functions
(significant increase in number of cases with euogonadism) after the operation among the intervention group (P <
0.001). however the percent of improvement was more than among hypogonadal compared to euogonadal.
Conclusion: Varicocelectomy was demonstrated to significantly improve both sperm quality (in terms of volume,
count, motility and morphology) as well as serum testosterone in infertile men, especially in cases with hypogonadism.
Keywords: Varicocele, Testosterone, Varicocelectomy, Semen analysis, Fertility.

INTRODUCTION
function of Leydig cells, reactivate this enzyme, and
Varicocele is an abnormal dilatation of the
increase testosterone production (6).
pampiniform plexus of the veins that drain the testis.
In men with idiopathic varicocele, testicular
Restoration of this abnormality has been shown to cause
biopsies demonstrated decreased tubular diameters,
positive effects on the spermatogenesis process (1).
hyperplasia and atrophy of Leydig cells with
Clinical varicocele is a prevalent condition affecting
cytoplasmic vacuolization, and decreased number of
15% of general male population, 35% of patients with
testosterone-positive Leydig cells (7).
primary infertility, and 81% of men presenting for the
Although a considerable difference between serum
management of secondary infertility. The associations
testosterone levels among infertile and fertile varicocele
between clinical varicocele, impaired spermatogenesis,
men might be anticipated that varicoceles might impair
and male infertility have long been recognized (2).
Leydig cell functions and decrease serum testosterone
Several studies documented improvements in
levels among fertile men with varicocele as well (8).
semen parameters, hormonal profiles, and pregnancy
Varicocele repair has been advocated as an option to
rates after varicocele repair (3).
prevent and treat low serum testosterone, even in men
On the other hand, the association between clinical
with normal semen quality (9).
varicocele and impaired testosterone production is less
The aim of the present study was to examine the
clearly understood. Although, the conceptions of the
hypotheses that clinical varicoceles affect baseline
negative impact of clinical varicocele on Leydig cell
serum total testosterone levels and to study the effects
functions and the beneficial effect of varicocele repair
of varicocelectomy on serum testosterone levels and
on testosterone production have been proposed for
semen quality in infertile men who suffer from
decades (4).
varicocele.
Many studies have reported that varicocelectomy

promotes Leydig cell function based on testosterone
PATIENTS AND METHODS
levels. In addition, research indicates that ageing in men
This study included 100 patients (50 control and
can induce a reduction in serum testosterone levels (5).
50 cases) presented to the General Surgery and
High temperatures can reduce the activity of the 17-a
Endocrine Surgery Unit Outpatient Clinic, Mansoura
hydroxyl progesterone aldolase enzyme, which results
University Hospitals with clinical varicocele for
in decreased testosterone production. Thus, it is
primary infertility. The study was conducted during the
believed that treatment of varicocele may improve the
period between 1st April 2020 and end of March 2021.
All patients were radiologically evaluated using duplex

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/)



1731
Received: 3/4/2021

Accepted: 29/5/2021


Full Paper (vol.841 paper# 17)


Introduction The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1739-1748

The Effects of Educational Interventions on Nurses' Knowledge and Practices in
Hemodialysis Unit Regarding Infection Control Practices
Fatma Korashy Osman*, Haneya Mohamed El Banna, Amany Youssef Sharaf, Yasmin Fathy Mohammed
Medical Surgical Nursing Department, Faculty of Nursing, Alexandria University, Egypt
*Corresponding author: Fatma Korashy Osman, Mobile: (+20) 01113532059, E-Mail: fatykorashy1234@gmail.com

ABSTRACT
Background:
Nurses are considered a key element to break the chain of the infection through their adherence to
standard precautions. Many factors may hinder nurses' adherence to these precautions as; shortage of nurses, high
number of patient ratio, turn-over of nursing staff, lack of staff training, inadequate supplies, patient urgency, time
limits and low patients education level regarding infection control.
Objective: This study aims to evaluate the effects of educational interventions on nurses' knowledge and practices
in Hemodialysis Unit regarding infection control practices.
Patients and methods: A quasi-experimental research design (pretest-posttest) was utilized to fulfill the aim of the
study. The study was conducted at the Hemodialysis Unit, Alexandria Fever Hospital. All nurses who were involved
in providing direct care throughout the three shifts (morning, evening, night), for patients, at the above-mentioned
setting, were included in the study (n=30 nurses).
Results:
No statistical significant relationships were detected between the studied nurses' knowledge levels and their
demographic characteristics after application of the educational interventions. Statistical significant relationships
were detected between the nurses' age, level of education, and their practices level after application of the
educational interventions. The results of the present study highlighted that nearly two thirds of the studied nurses
had "poor" overall knowledge and half of them had "poor" overall practices regarding infection prevention, and
control practices before application of the educational interventions.
Conclusion: Educational nursing interventions had significant positive effects on overall percent improvement of
nurses' knowledge, and practice related to infection control in Hemodialysis (HD) Unit Fever Hospital.
Keywords: Educational Interventions, Hemodialysis Unit, Infection Control Practices, Nurses' Knowledge and
Practices.

INTRODUCTION
precautions by the (HCP) is assumed to be a
End-stage renal disease (ESRS) is a health
noteworthy role in controlling such infection (5).
issue that extends worldwide as it requires long term
Nurses are the cornerstone of managing HD
care and in the same time, is very costly. Prevalence
patients safely in health care settings. They have an
of chronic renal failure increases in various countries
essential role in breaking the chain of infection
(1).
through compliance with infection prevention and
The annual incidence of ESRD in Egypt (2015)
control practices. Unfortunately, sometimes nurses
was about 74 per million populations (pmp), and the
utilize optional approaches of the infection prevention
prevalence of patients on dialysis was 264 per million
and control practices (6). Constant training programs
populations (pmp). ESRD of hospitalized patients was
must be made by the health care settings to apply
around 1.68% of all hospitalized Egyptian patients.
evidence based practices to prevent and control
Egypt is highlighted as the first country which has the
infection. These programs must consist of theoretical
highest rate of mortality of patients with renal failure,
and practical area to enhance nurses' adherence to
as 25% of ESRD patients die annually (2).
infection prevention and control practices (7).
Patients' quality of life has improved by
The Center of Disease Control (CDC)
hemodialysis (HD) therapy, but patients treated with
developed a staff training program in 2016 to
hemodialysis are at increased risk of infection firstly
maintain safe dialysis and zero infection in HD units.
due to the hemodialysis process itself, secondly
This program consisted of: hand hygiene, AV
hemodialysis patients are immunosuppressed, and
care, safe injection, use of personal protective
require
frequent
blood
transfusions
and
equipment (PPE), and cleaning, disinfection of
hospitalizations which expands their chances for
dialysis station. It also included the use of checklists,
hospital-acquired infections (3).
month to month reviews of hand hygiene practices
Infection is considered the main reason for
just for prescribing the adherence of nursing staff
hospitalization and the second cause for mortality in
related to infection prevention and control practices.
HD patients (4). Poor adherence to infection control
Later on the results of these checklists were used to
practices by healthcare personnel (HCP) is the
enhance staff adherence (8, 9).
primary reasons for incidence of infection, so

consistent and strict adherence to rules of standard

This article is an open access article distributed under the terms and conditions of the Creativ
e


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1739
Received: 1/4/2021

Accepted: 27/5/2021


Full Paper (vol.841 paper# 18)


c:\work\Jor\vol841_19 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1749-1756

Exercise-Induced ST Changes in aVR, V5 and V1 in Differentiation between
Single and Multi-Vessel Coronary Artery Disease
Ayman Elsayed Elbadrany*, Soliman M. Ayad, Mahmoud D. S. Elmenshawy, Tarek A. Naguib
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Ayman Elsayed Elbadrany, Mobile: (+20) 01010668806, E-Mail: aymanalbdrany@yahoo.com
ABSTRACT
Background:
Angina occurs when there is regional myocardial ischemia caused by inadequate coronary perfusion and
is usually but not always induced by increases in myocardial oxygen requirements.
Objective:
The aim of this work was to study the significance of ST changes in aVR, V5, V1 during exercise ECG for
diagnosis of single -or multi-vessel coronary artery disease.
Patients and methods: This study had been carried out in the cardiology department, Zagazig University and National
Hear Institute during the period from January 2005 to January 2007. This study included 56 patients (40 male +16
female) with chronic stable angina. Results: Comparison was done among groups regarding demographic data, resting
ECG data, echocardiographic findings and there were no statistical significant difference among groups. Single vessel
disease: LAD: - the ability of the test to detect left anterior descending (LAD) lesion as a single vessel disease has high
specificity 87.5%, high +ve predictive value 96%, but low sensitivity 50%. Left circumflex (LCx): the sensitivity of
the test to detect LCx lesion as a single vessel disease was 53.4%, specificity 60%, but with low +ve predictive value
44%. RCA: as regard RCA lesion the test has low sensitivity, specificity positive and negative predictive values.
Conclusion: The concomitant appearance of exercise-induced ST-segment elevation in lead V1 and in lead aVR with
simultaneous ST-segment depression in lead V5, or the isolated appearance of ST-segment elevation in lead V1 mostly
detects single-vessel disease and correlates strongly with significant narrowing of the LAD coronary artery as single-
vessel disease, or with significant stenosis of the LAD and LCx coronary arteries as double-vessel disease.
Keywords: Coronary Artery Disease, ST changes, aVR, V5 and V1, Single - and Multi-Vessel.

INTRODUCTION
aVR, V5, V1 during exercise ECG for diagnosis of
Exercise testing is an important diagnostic and
single- or multi-vessel coronary artery disease (ST
prognostic procedure in the assessment of patient with
segment elevation in V1 and simultaneous ST depression
ischemic heart disease. The test is now most frequently
in V5 and ST elevation in aVR "aVR­E +V5-D" and
used to estimate prognosis and to determine functional
each of them alone during exercise to detect either LAD
capacity, extent of coronary artery disease and the effect
stenosis as a single-vessel coronary artery disease or
of therapy (1). It is known that exercise-induced ST
multi-vessel coronary artery disease involving LAD.
segment elevation in lead V1 detects left anterior

descending (LAD) stenosis. It is also postulated that ST
PATIENTS AND METHODS
elevation in aVR and simultaneous ST depression in V5
This study was carried out in the Cardiology
is a marker of ischemia due to significant stenosis of
Department, Zagazig University and National Heart
LAD in patients with single vessel disease (2).
Institute during the period from January 2005 to January
The study of Michaelides et al. (2) aimed to
2007. The study included 56 patients with chronic stable
investigate the concomitant appearance of ST segment
angina who presented to Outpatient Clinic, Stress ECG
elevation in V1 and the simultaneous ST depression and
Lab, and Coronary Catheterization Laboratory, Zagazig
ST elevation in aVR and each of them alone during
University Hospital and National Heart Institute.
exercise ECG to detect either LAD stenosis as a single­
According to the result of exercise stress ECG,
vessel coronary artery disease or multi-vessel coronary
Patients included in this study were divided into three
artery disease involvement. The concomitant appearance
groups according to the ST changes in aVR, V1, and V5
of exercise-induced ST segment elevation in Lead V1,
as follow;
ST elevation in lead aVR and ST depression in lead V5,
Group A: 25 patients with ST elevation in aVR, V1
as well as the isolated appearance of ST elevation in lead
and, ST depression in V5.
V1 detect significant LAD stenosis as a single vessel
Group B: 19 patients with ST elevation in aVR and ST
disease, or significant stenosis of LAD and left
depression in V5).
circumflex (LCx) arteries in patient with double vessel
Group C: 12 patients with ST elevation in V1.
disease. Whereas, the appearance of ST segment
Exclusion criteria:
elevation in aVR and ST depression in V5 but without
All patients with ECG liable for ST and T wave changes
ST elevation in V1 correlates strongly with significant
like: Previous MI, bundle branch block (B.B.B.),
LAD and right circumflex artery (RCA) stenosis and
electrolyte imbalance, patients receiving digitalis,
usually indicate double-vessel disease (2). The aim of this
ventricular pre-excitation, left ventricular hypertrophy,
work was to study the significance of ST changes in
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/)
1749
Received:3 /4 /2021

Accepted:29 /5 /2021


Full Paper (vol.841 paper# 19)


c:\work\Jor\vol841_20 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1757-1764

Ultrasound Guided Foam Sclerotherapy of Lower Limb Varicose
Veins: Outcome and Patient Satisfaction
Waleed Araby Abd Elkhalek Elmadany1, Mohamed Tharwat Mahmoud Solyman1,
Mohammad Zaki Ali Mourad1, Khaled Mohammad Helmy El-Kaffas2
1Department of Radiology, Faculty of Medicine, Sohag University, Egypt.
2Department Interventional Radiology, Faculty of Medicine, Cairo University, Egypt.
*Corresponding author: Waleed Araby Abd Elkhalek Elmadany, Mobile: (+20) 01007588773,
E-Mail: elmadany99@gmail.com

ABSTRACT
Background
: Varicose veins are defined as dilated, tortuous, and elongated superficial veins of the lower limbs with
incompetent valves. Sclerotherapy could be a minimally invasive technique that uses an injection of a special
chemical (sclerosant) into a varicosity to wreck and scar the inside lining of the vein. Resulting in blockage of the
treated vein.
Objective: To explain the efficacy and safety of foam sclerotherapy within the treatment of varicose veins and to see
patient's satisfaction after ultrasound-guided foam sclerotherapy.
Patients and Methods: This study was conducted at Sohag University hospitals to evaluate the efficacy, safety, and
patient satisfaction following foam sclerotherapy for varicose veins. There was 60 cases with lower limb varicosities
whose mean age was 33.72 years (range 20 ­ 52). Females represented 62% of cases, while the remaining cases were
males.
Results: The cosmetic appearance showed a major improvement (p < 0.001) after our intervention. Pain sensation
was significantly decreased after the intervention. Only 25% of cases reported that sensation after 1 week, of
which percent decreased all the way down to 3, 3, and seven during the following visits respectively. Saphenofemoral
reflux was present in 48% of cases before the intervention, and it decreased all the way down to 7, 3, 3, and seven of
cases at the scheduled follow up visits respectively. Complications were reported by 28% of cases. Skin
hyperpigmentation was the most common complication (22%), followed by visual disturbances (8%), and
thrombophlebitis (7%).
Conclusion: Ultrasound-guided foam sclerotherapy seemed to be a safe and effective procedure for the treatment of
chronic venous insufficiency within the selected group of patients.
Keywords: Radiofrequency ablation, Superficial venous reflux, Ultrasound guided foam sclerotherapy.

INTRODUCTION

Varicose veins are elongated, tortuous, and
UGFS is widely employed in most countries to
dilated lower-limb superficial veins with faulty valves.
eradicate superficial venous reflux (SVR).
Varicose veins are described by the world Health
UGFS ends up in significant improvements in
Organization (WHO) as saccular dilatation of the veins,
symptoms and venous hemodynamics and is
which are sometimes tortuous (1). Varicose veins are
additionally related to high levels of patient satisfaction
divided into primary and secondary varicose
(6).
veins according to their etiology. Secondary varicose
Ultrasound is useful in guiding the injection of
veins nearly always occur as a result of a change within
foamed sclerosants. Foam is extremely visible with
the deep venous system's operation, whether it's an
ultrasound, allowing for a more accurate injection. It
outflow obstruction, pump failure, or a mixture of the
also enables immediate post-injection observation of
two. Primary varicose veins are caused by a variety of
vein compressibility as a predictor of treatment efficacy
things that are unknown (2).
(1). Foam sclerotherapy has potential benefits over other
Sclerotherapy may be a minimally invasive
standard treatments for varicose veins like surgery and
technique that uses an injection of a special chemical
endovascular interventions. Surgery carries a risk
(sclerosant) into a venous blood vessel to break and
of anesthesia and therefore the time of work off (2).
scar the within lining of the vein, resulting in blockage
Most complications from sclerotherapy are
of the treated venous blood vessel (3). The results with
minor and transient. They include hyperpigmentation,
foam sclerotherapy are excellent and this method of
pain, and urticaria (7,8).
treatment offers a good alternative to surgery (4).
This study was done to explain the efficacy and
Ultrasound-guided foam sclerotherapy (UGFS) is
safety of foam sclerotherapy within the treatment of
effective for every kind of pathological venous
varicose veins and to see patient's satisfaction after
dilatations from major truncal varicose veins to the
UGFS for varicose veins in terms of improvement in
smallest telangiectasias (5).
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/)
1757
Received:1 /4 /2021

Accepted:27 /5 /2021


Full Paper (vol.841 paper# 20)


c:\work\Jor\vol841_21 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1765-1771

Study of Red Blood Cell Indices and Biochemical Parameters of
Mineral Bone Disorders in Hemodialysis Patients
Alhoussein Alsayed AbdelAal*, Alshabrawy M. Abdelnabi
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
* Corresponding author: Alhoussein Alsayed AbdelAal, Mobile: (+2) 01022073791, E mail: alhala1982@gmail.com

ABSTRACT
Background:
Chronic kidney disease (CKD) is a worldwide public health problem and a major cause of suffering
and having a reduced quality of life for those affected.
Objective: We aimed to study the changes in red blood cell indices and mineral bone metabolism in hemodialysis
patients and to explore the correlation between these studied parameters.
Patients and Methods: This is a case control study included 55 adult patients with end stage renal disease on
maintenance hemodialysis as well as 55 healthy individuals as a control group. All participants were subjected to
laboratory investigations included complete blood count and serum levels of creatinine, urea, total calcium, albumin,
phosphate and intact parathyroid hormone (iPTH).
Results: Our study showed that hemoglobin (Hb), hematocrit and red blood cell count were significantly reduced in
the hemodialysis patients (P<0.001 for all). Regarding mean corpuscular volume, mean corpuscular hemoglobin and
mean corpuscular hemoglobin concentration, no significant differences were found between the hemodialysis patients
and the control group (P= 0.362, 0.116, 0.22, respectively). In the hemodialysis group, the albumin-corrected serum
calcium level was significantly lower while the serum phosphate and iPTH levels were significantly higher compared
to the control group (P<0.001 for all). Hb was inversely correlated with serum iPTH (r=-0.359, P=0.007) and serum
phosphate (r=-0.570, P<0.001) in the hemodialysis group and was inversely correlated with serum phosphate (r=-
0.495, P<0.001) in the control group.
Conclusion: Hemodialysis patients are at high risk of anemia, hypocalcemia, hyperphosphatemia and
hyperparathyroidism. In hemodialysis patients, an association was found between anemia and each of
hyperphosphatemia and hyperparathyroidism.
Keywords: Anemia, Chronic kidney disease, Hemodialysis, Mineral bone disorder.

INTRODUCTION

Chronic kidney disease (CKD) is recognized as
PATIENTS AND METHODS
a global public health problem inflicting huge medical
This study was a case control study that has
and economic burdens on societies and health care
conducted in Nephrology Unit, Internal Medicine
organizations with an estimated prevalence of 13.4%
Department, Faculty of Medicine, Zagazig University
universally
(1).
Although
healthcare
Hospitals between May 2019 and April 2020.
resources allocated for management of CKD have
The present study included 55 patients with end
significantly increased in past years, patients with CKD
stage renal disease (ESRD) on maintenance
continue to have a significant decrease of life
hemodialysis for more than 3 months. Patients were
expectancy (2). With the progression of CKD, a wide
selected randomly for study participation. The age
range of physiological processes are altered by the
range of patients was 18 to 70 years.
progressive decline in glomerular filtration rate.
The study excluded patients with other comorbid
Hematological parameters particularly red blood cell
conditions such as chronic liver disease, hypersplenism,
(RBC) indices are commonly affected giving rise to
autoimmune diseases, obstructive airway disease,
anemia (3). Another common complication of CKD is
thyroid gland dysfunctions, malignancy, recent
the deterioration in mineral homeostasis manifesting as
myocardial infarction or stroke, history of bleeding as
disturbance of serum concentrations of phosphate and
hematemesis or melena, primary known hematological
calcium as well as changes in the circulating levels of
disease, HIV infection and patients on medications such
parathyroid hormone (PTH) resulting in mineral bone
as bisphosphonates or warfarin. Pregnant or lactating
disorder (4). Several investigators have proposed a link
women, those who received iron, erythropoietin,
between anemia and mineral metabolism. Conversely,
calcium or vitamin D therapy in any form within the
other authors have failed to detect an association
last 3 months, patients who had blood transfusion in the
between anemia and PTH.
past 3 months, patients with active infection, and
The present study aimed to evaluate red blood
patients with known parathyroid disorder, metabolic
cell indices and mineral metabolism indicators in
bone diseases or anemia with definite etiology were
hemodialysis patients and to assess the association
also excluded from the study.
between these 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/)
1765
Received:2 /4 /2021

Accepted:28 /5 /2021


Full Paper (vol.841 paper# 21)


c:\work\Jor\vol841_22 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1772-1781

Psoas Compartment Block for Lower Limb Surgeries: A Comparative
Study among The Four Lumbar Plexus Localizing Methods
Ahmed Mohamed Mahmoud Awadalla*, Adel Rizk Botros, Howida Kamal Abd Ellatif
Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Ahmed Mohamed Mahmoud Awadalla, Mobile: (+20) 01204420302, E-Mail: audy1980.aa@gmail.com

ABSTRACT
Background:
Psoas compartment block (PCB) is a frequently used techniques providing anesthesia for proximal lower
limb surgeries. There are many methods of localization of peripheral nerves for regional anesthesia as loss of resistance
(LOR), electric nerve stimulation (ENS), ultrasound-guided (US) and combined ultrasound-guided and electric nerve
stimulation (US/ENS).
Objective:
To compare between these four techniques to find out the method of better outcome and least complications.
Patients and Methods: This study was a prospective randomized trial, conducted at Anesthesia and Intensive Care
Department, Zagazig University Hospitals during the period from January 2018 to January, 2020. 140 patients
undergoing unilateral elective proximal lower limb surgeries were included. Patients were categorized randomly,
according to the used method for lumbar plexus localization, into four equal groups (each 35 patients). All groups were
compared regarding efficacy and safety.
Results:
The success rates of PCB in ENS, US and US/ENS groups were higher than that in LOR group with combined
US/ENS group was the best group (97.14%). The onset of sensory and motor blocks in ENS, US and US/ENS groups
were shorter than that in LOR group. Times to ask for the 1st postoperative analgesia in ENS, US and US/ENS groups
were longer than those in LOR group with the consumed amount of morphine for pain relief during the 1st 24 hours
postoperatively in ENS, US and US/ENS groups were lower than that in LOR group.
Conclusion: Usage of combined ultrasound and electric nerve stimulation was better regarding the outcome and
complications.
Keywords:
Electric nerve stimulation, Localizing methods, Psoas compartment block.

INTRODUCTION
stimulation with either insulated or non-insulated needle,
Nowadays, the interest of peripheral nerve blocks
ultrasound-guided and combined ultrasound-guided and
(PNBs) to provide anesthesia/or analgesia for lower limb
electric nerve stimulation (7).
surgeries have increased as central neuraxial blocks
So, the current study was done to compare between
(CNBs) are associated with many complications as
loss of resistance (LOR), electrical nerve stimulation
transient neurologic symptoms with spinal block and
(ENS), ultrasound (US), and combined ultrasound and
epidural hematoma with epidural block (1). Psoas
electrical nerve stimulation (US/ENS) as aiding methods
compartment block (PCB) is one of the frequently used
for localizing lumbar plexus nerves during performance
techniques for providing anesthesia/or analgesia in cases
of a single-shot psoas compartment block to provide
of proximal lower limb surgical procedures. It blocks all
anesthesia for ipsilateral elective proximal lower limb
lumbar nerves' roots and potentially some sacral nerves'
surgical procedures in order to find out the method of
roots via posterior approach (2).
better outcome and least complications.
PCB has some advantages as providing efficient

intraoperative anesthesia, excellent postoperative
PATIENTS AND METHODS
analgesia and stable hemodynamics especially in elder
This study was a prospective randomized clinical
patients (3). If anesthesia or analgesia of the lower leg or
trial. It was conducted at Anesthesia and Surgical
posterior thigh is required for the lower limb surgical
Intensive Care Department, Zagazig University
procedure, a sciatic nerve block must be added to psoas
Hospitals during the period from January 2018 to
compartment block (4).
January, 2020.
Block of the various lumbar plexus nerve roots after

injection of the selected local anesthetic (LA) solution
Ethical approval:
within the psoas compartment (PC) is due to the
This study was approved by Zagazig
cephalad and caudate spread of the injected LA solution
University's Institutional Review Board. A written
(5). In 25% of cases, block of the first sacral nerve root
informed consent was obtained from all patients
also
occurs
and
in
70%
of
cases
an
participating in the study. Also, this study was carried
ilioinguinal/iliohypogastric block is found (6).
out according to the Code of Ethics of the World
The commonly used methods of localization of
Medical Association (Declaration of Helsinki) for
peripheral nerves for regional anesthesia involve
studies involving humans.
anatomical localization, eliciting of paresthesia, pops or
Inclusion criteria were cooperative both sexes patients,
clicks sensation and loss of resistance, electric nerve
their ages ranged from 21 to 60 years, their body mass

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/)
1772
Received:3 /4 /2021

Accepted:29 /5 /2021

Full Paper (vol.841 paper# 22)


c:\work\Jor\vol841_23 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1782-1785

Is Remnant Donor Volume Less Than 35 % Safe to the Donor in
Living Donor Liver Transplantation
Mahmoud Abd Al Hady Abd Al Aziz Abd Al Hady1, Khaled Amer2
1Department of Surgery, Faculty of Medicine, Al-Azhar University, Egypt
2Department Hepatobiliary and Liver Transplantation, International Medical Center, Egypt
*Corresponding author: Mahmoud Abd Al Hady, Mobile: (+20) 1008493950, E-mail: alnaggar82@yahoo.com

ABSTRACT
Background
: In adult (Living donor liver transplantation) LDLT, donor safety is of paramount importance, and ideally,
there should not be any donor deaths. Objectives: To assess the prognosis of donor laboratory and clinical data
according to the remnant liver volume. Patients and methods: The present study conducted on 200 consecutive cases
of living donor liver transplantation over a period of 7 years (2012 and 2018). Patients were divided to two groups
according to remnant liver volume (RLV): group (A) 60 patients with 30% to less than 35% RLV, while group (B) 140
patients with RLV more than or equal 35%. Results There were statistically significant difference between both studied
group among ALT, total bilirubin and serum albumin. Conclusion: Right lobe donor hepatectomy can be performed
with remnant liver volume of less than 35% with low risk on donor.
Keywords: Donor complications, Liver transplantation, Right lobe

INTRODUCTION

Patients were selected according to the protocol of
Living donor liver transplantation (LDLT) has
living donor liver transplantation of the Liver
become a possible solution for the growing difference
Transplantation Unit of the International Medical
between the number of patients listed for liver
Center, Armed Forces, Egypt.
transplantation and the availability of cadaveric organs.

The most important development is the extension of
Criteria for selection:
LDLT to adults (1).
A potential candidate for liver donation was
This development has been made possible by
required to meet the following selection criteria: A
progressively increasing the extent of resection in the
living liver donor must be a healthy adult with no
donor to overcome the barrier of size matching between
chronic diseases, having the ability to give consent. The
donor and recipient. Consequently, right lobe
donor must be at least 21 years old, not more than 40
transplantation was introduced and has been widely
years old in Egypt, compatible blood group, BMI
performed. The right lobe accounts for approximately
maximum 28, and steatosis not more than 10%.
2/3 of the entire liver volume and provides a graft

Absolute Contraindications:
capable of size for size donor-to-recipient weight ratio,
BMI > 30, Emotional / Psychological instability,
or even smaller donors to donate to larger recipients.
Substance abuse, Age > 50, Uncontrolled DM,
Moreover, it has been suggested that a graft-to-recipient
Uncontrolled hypertension, or increasing postoperative
weight ratio of 1.0% appears to be a safe limit for adult
complication
risk
concerning
cardiovascular,
recipients, regardless of the cause of disease (2).
respiratory, and metabolic systems.
The aim of the present study was to assess the

prognosis of donor laboratory and clinical data
Relative Contraindications (to be evaluated on an
according to the remnant liver volume.
individual basis):

BMI between 28-30, Age 41-50 years old, heavy
PATIENTS AND METHODS
smokers and/or addicts.
The present study conducted on 200 consecutive

cases of living donor liver transplantation over a period
2- Evaluation process:
of 7 years (2012 and 2018). All patients were admitted
The evaluation protocol is constructed in a step-
at the Department of Transplantation, International
by-step fashion and takes into account the type and the
Medical Center, Armed Forces, Egypt. Patients were
cost of the tests that need to be performed. The step by-
then divided into two groups according to remnant liver
step evaluation process starts with the simplest and
volume (RLV): group (A) 60 patients with 30% to less
most cost-effective blood workup.
than 35% RLV, while group (B) 140 patients with RLV

more than or equal to 35%. ALT, albumin, total
Ethical approval:
bilirubin and INR were measured preoperatively and 1,
The study was approved by the Ethics Board of Al-
3, 5, 6 and 9 postoperatively to compare the two groups.
Azhar University and an informed written consent

was taken from each participant in the study.
1. Donor selection:
Once a potential donor was determined to be
compatible with the intended recipient, he or she

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/)
1782
Received: 6/4/2021
Accepted: 2/6/2021

Full Paper (vol.841 paper# 23)


c:\work\Jor\vol841_24 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1786-1790

Chemerin As A Non-Invasive Serum Marker for Non-Alcoholic Fatty Liver Disease
Mohamed M Salama, Essam Byoumy, Azza Mohamed, Wesam Ibrahim,
Ahmed El-shafie, Mohamed Abdallah, Ghada A Mohamed*
Gastroenterology and Hepatology Unit, Department of Internal Medicine,
Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
*Corresponding author: Ghada Abdelrahman Mohamed, Gastroenterology and Hepatology Unit, Department of Internal
Medicine, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt.
E-mail ghadaabdelrahman@med.asu.edu.eg http://orcid.org/0000-0003-0320-1011
ABSTRACT
Background:
Attempts have been made to recognize noninvasive markers for the identification of non-alcoholic fatty
liver disease (NAFLD). Chemerin is a newly defined adipokine linked to insulin resistance and adipogenesis.
Objective: This study intended to evaluate the diagnostic ability of serum chemerin compared with NAFLD fibrosis
score as a noninvasive marker for the diagnosis and grading of NAFLD.
Patients and methods: We enrolled 60 NAFLD patients and categorized them into 3 subgroups based on the fatty liver
grade by ultrasound. Thirty healthy participants were recruited as a control group. ELISA method was used for serum
chemerin levels measurement. Results: Serum chemerin levels were significantly higher in NAFLD cases than controls
(p 0.001). Furthermore, these levels were positively correlated with the fatty liver grade (p 0.001). Serum chemerin
was comparable to NAFLD fibrosis score as regards NAFLD diagnosis (p 0.001). Patients within the gray zone of
NAFLD fibrosis score had a significantly higher serum chemerin levels in comparison to patients under the gray zone
(p 0.001).
Conclusion: Serum chemerin is a promising marker for diagnosing and grading of NAFLD. More research is required
to determine its definitive clinical benefit in patients with NAFLD.
Keywords: Non-alcoholic fatty liver disease, Chemerin, Adipokines, Obesity, NAFLD fibrosis score

INTRODUCTION

prochemerin (inactive form) then stimulated through C-
Non-alcoholic fatty liver disease (NAFLD) is a
terminal cleavage by coagulation and inflammatory
chronic liver disease that affect 30% of the population
serine proteases (12). Chemerin can activate the immune
and 40%-70% of overweight persons (1). The occurrence
inflammatory reaction by binding to chemerin-like
of NAFLD is growing due to the rising pandemic of
receptor 1 (CMKLR1), chemerin receptor (ChemR) 23,
obesity (2). NAFLD is described as the excess deposition
and chemokine (CCmotif) receptor-like (CCRL) 2 (13).
of lipid in the patients' liver in the absence of alcohol
The visceral adipose tissue and the hepatocytes are the
abuse and other reasons of hepatic steatosis. It includes
main sources of chemerin construction (14). Studies found
a broad scale of severity extending from simple steatosis
that obesity and insulin-resistance cause a stimulation of
to non-alcoholic steatohepatitis (NASH), in which
the chemerin/ CMKLR1 signalling path, which
steatosis is combined with inflammation and fibrosis (3)
subsequently trigger the inflammatory response (15, 16, 17).
with the risk of evolution to hepatic cirrhosis and
In the current study, we intended to evaluate the
hepatocellular carcinoma (4).
diagnostic ability of serum chemerin compared with
NAFLD is the hepatic component of metabolic
NAFLD fibrosis score as a noninvasive marker for the
syndrome (5). This syndrome is characterized by obesity-
diagnosis and grading of NAFLD.
linked insulin resistance and inflammation which are

known by increased inflammatory cytokines levels and
PATIENTS AND METHODS
pro-inflammatory pathway stimulation (6, 7). Currently,
This case-control study included 60 NAFLD cases
liver biopsy is still the gold method for the precise
in addition to 30 healthy controls. All participants were
NAFLD diagnosis. However, it is invasive, expensive,
enrolled from Ain Shams University Hospitals. NAFLD
and containing a risk of sampling errors and significant
patients were further equally categorized into three
complications (8). Hence, there is a serious need to
subgroups according to the grade of the disease.
recognize and validate a simple, noninvasive test that
Cases with other aetiologies of hepatic disease
precisely diagnose and determines the stage of NAFLD.
(e.g. alcohol consumption > 20 g/day, viral hepatitis,
The liver interacts with adipose tissue (9), which
primary biliary cholangitis, autoimmune hepatitis,
is not only an energy-storage organ but also considered
primary sclerosing cholangitis, Wilson's disease,
as an endocrine organ that secrete polypeptides named
hemochromatosis, 1-antitrypsin deficiency, drug-
adipokines (10). An increasing evidence from reports
induced liver disease), and those on total parenteral
shows that adipokines are linked to many physiological
nutrition or taking medications affecting carbohydrate or
processes, such as inflammation, immunity, insulin
lipid metabolism were excluded.
resistance, and NAFLD (11).
NAFLD Evaluation:
Chemerin is known as retinoic acid receptor
Ultrasonography was done to evaluate the grades of
response protein 2 (RARRES2). It is produced as
steatosis. Grading of NAFLD was done in line with 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/)
1786
Received: 5/4/2021

Accepted: 1/6/2021

Full Paper (vol.841 paper# 24)


c:\work\Jor\vol841_25 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1791-1794

Prevalence and Risk Factors of Helicobacter Pylori Recurrence in
Egyptian Patients with Liver Cirrhosis
Mohamed G. Hamed, Mohamed A.A. Bassiony, Ayman F. Elsayed Mohamed
Internal Medicine Department, Faculty of Medicine, Zagazig University,Egypt
Corresponding Author: Mohamed Bassiony, Mobile: 00201205664331, E-mail: dr_mbh13303@yahoo.com
ABSTRACT
Background:
Helicobacter pylori (H. pylori) is a worldwide gastrointestinal infection. It is a common risk factor for
peptic ulcer disease (PUD), chronic gastritis, and stomach cancer. In patients with cirrhosis, there is a significant
association between H. pylori infection and severity of gastropathy due to portal hypertension, chronic stomach upset,
frequent upper gastrointestinal bleeding as well as hepatic encephalopathy.
Objective: To assess the rate and risk factors of recurrence of H. pylori infection in Egyptian patients with liver cirrhosis
after successful eradication therapy. Patients and methods: This study included 500 liver cirrhosis patients who were
tested for H. pylori infection. Patients with positive H. pylori infection received proton pump inhibitors (PPI)-based
treatment regimen. Successful eradication therapy was assessed 4-8 weeks and repeated over one year after end of
treatment using urea breath test (UBT) and stool antigen test (SAT).
Results: The prevalence of H. pylori infection in cirrhotic patients was 58%. There were significantly higher serum
levels of ammonia and C-reactive protein (CRP) in H. pylori positive patients as well as significantly more gastritis in
endoscopy findings in comparison with H. pylori-negative patients. H. pylori recurrence after successful eradication
therapy was observed in 22.1% patients of H. pylori-positive cirrhotic patients. Multivariate analysis showed that higher
serum ammonia level & receiving multiple treatment courses to achieve H. pylori eradication were independent risk
factors for H. pylori recurrence in cirrhotic patients.
Conclusion:
H. pylori infection is prevalent in liver cirrhosis patients with a significant recurrence rate after eradication
therapy. High serum ammonia and the need for multiple treatment courses are risk factors for recurrence.
Keywords: Helicobacter pylori, Liver cirrhosis, Eradication therapy, Hepatitis C, Ammonia level, Bacterial resistance.

factors, education level, non-compliance to treatment,
INTRODUCTION
bacterial resistance & prolonged alcohol intake (4).
H. pylori is a gram-negative, microaerophilic,
Cirrhosis caused by chronic hepatitis C virus
highly-motile and spiral-shaped bacterium infecting
infection and its complications is one of the major health
more than 50% of the world population through oro-oral

or feco-oral transmission(1) . H. pylori infection is the

most prevalent risk factor for chronic gastritis, peptic
problems in Egypt. H. pylori infection is a common
ulcer disease (PUD), gastric carcinoma (which is the
cause of PUD in cirrhotic patients, and it is also
second leading cause of cancer-related death
correlated with the severity of portal hypertensive
worldwide), and mucosal associated lymphoid tissue
gastropathy (PHG) and frequent upper gastrointestinal
(MALT) lymphoma. H. pylori is also a probable risk
bleeding in those patients. However, there are
factor for multiple extra-gastric disorders, such as
insufficient data in the literature on the rate and risk
ischemic heart disease, diabetes, iron & vitamin B12
factors for recurrence of H. pylori infection after
deficiency and idiopathic thrombocytopenic purpura as
successful resection treatment in cirrhotic patients (5).
well as some liver disorders including nonalcoholic
The aim of our study was to assess the rate and risk
fatty liver disease, isolated hypertransaminasemia, and
factors of recurrence of H. pylori infection in Egyptian
portosystemic encephalopathy(2, 3).
patients with liver cirrhosis after successful eradication
H. pylori recurrence is negative detection of H.
therapy.
pylori at 4 weeks after eradication therapy but positive

detection at a later time. Despite the awareness of the
PATIENTS AND METHODS
risks of H. pylori infection & the multiple regimens
This prospective study was carried on in
offered for its eradication, there is still a high risk of H.
Gastroenterology and Hepatology Unit, Internal
pylori recurrence after successful eradication therapy
Medicine Department, Zagazig University Hospitals
with one-year recurrence rate 1-2% in developed
from January 2020 till March 2021. Inclusion criteria:
countries but 10-70% in developing countries. H. pylori
included age > 18 years, both sexes, and evidence of
recurrence can occur either by reconolization of the
liver cirrhosis. Exclusion criteria: included pregnant or
same H. pylori strain (recrudescence) or a new strain
lactating females, patients with gastric cancer, and
(reinfection) with most cases of H. pylori recurrence are
history of H. pylori treatment 4 weeks ago or after one
due to recrudescence. Many risk factors for H. pylori
year of end of therapy. The study enrolled 500 liver
infection have been reported, including socioeconomic
cirrhosis patients who were tested for H. pylori
infection. In accordance with American College of
This article is an open access article distributed under the terms and conditions of the Creativ
e


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1791
Received:5 /4 /2021

Accepted:1 /6 /2021

Full Paper (vol.841 paper# 25)


c:\work\Jor\vol841_26 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1795-1800

Immunohistochemical Detection of Tumor Necrosis Factor Alpha in
Ileocolonic Biopsies of Patients with Inflammatory Bowel Disease
Ehab Ahmed Abdelatti1, Alsaid Ibrahim Alshayeb1,
Asmaa Gaber Abdou2, Ezzat Mohamed Abdalla*1, Ezz El-Arab A.1
Departments of 1Internal Medicine (Gastroenterology and Hepatology Unit) and 2Pathology,
Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Ezzat Mohamed Abdalla, Mobile: (+20) 01001131318, Email: eabdalla89@yahoo.com

ABSTRACT
Background:
Tumor necrosis factor alpha (TNF-) is a major proinflammatory cytokine playing paramount role in the
pathophysiology of inflammatory bowel disease (IBD). The identification of predictive biomarkers to establish response
to treatment is intuitive and still unresolved need. A biomarker of TNF- sensitivity would avoid unnecessary exposure
of the patient to the drug and to its side effects.
Objective: To investigate the relationship between immunohistochemical expression of TNF- in the biopsies of
ileocolonic segments in patients with activity of both ulcerative colitis (UC) and Crohn's disease (CD) and the
clinicopathologic parameters and the response to treatment.
Patients and methods: The study was conducted on 41 naïve patients diagnosed as IBD (UC and CD) and 15 normal
subjects as a control group. All patients and control underwent full history taking (age, gender and clinical data as
weight loss, diarrhea, bleeding, and duration of the disease), complete physical examination, laboratory investigation
(Complete blood count (CBC), ESR, C-reactive protein (CRP), fecal calprotectin (FC)), colonoscopy disease
localization, upper endoscope with upper GIT symptoms. Biopsies from the terminal ileum and different colon segments
were taken for histopathological evaluation and immunohistochemistry was done according to published protocols to
all cases and control. Results: Percentage and H-score for TNF- significantly correlated with clinical severity and
need to give additional treatment besides conventional therapy as anti-TNF therapy. Increased TNF- expression is
significantly associated with better response to anti-TNF treatment.
Conclusion:
Increased expression of TNF- in the tissues is associated with the need to give additional treatment
besides conventional therapy as anti-TNF therapy and also increased TNF expression is associated with better response
to anti-TNF treatment.
Keywords: Anti-TNF treatment, Inflammatory bowel disease, Tumor necrosis factor alpha.

INTRODUCTION
Crohn's disease (CD) and the clinicopathologic
Tumor necrosis factor alpha (TNF-) is a major
parameters and the response to treatment.
proinflammatory cytokine playing important role in the

pathophysiology of IBD (1), and blocking its
PATIENTS AND METHODS
inflammatory pathway leads to effective control of the
The study was conducted on 41 naïve patients
disease (2). The identification of predictive biomarkers
diagnosed as inflammatory bowel disease (IBD) (UC
to establish response to treatment is intuitive and still
and CD) from the GI Endoscopy Unit of Internal
unresolved need. A biomarker of TNF- sensitivity
Medicine Department, Menoufia University Hospital.
would avoid unnecessary exposure of the patient to the
15 normal subjects were recruited as a control group.
drug and to its side effects (3).
All patients and control underwent full history taking
Unfortunately, apart from the demonstration
(age, gender and clinical data as weight loss, diarrhea,
that patients with high blood levels of CRP respond
bleeding, and duration of the disease), complete
better to anti-TNF agents, no other biomarkers are
physical examination, laboratory investigations
available in the daily routine (4). A study performed on
including (CBC, ESR, CRP, FC), colonoscopy disease
UC
patients
employing
immunohistochemical
localization and assessment, upper endoscope in cases
techniques showed that TNF expression correlates to
with upper GIT symptoms, and assessment of clinical
the degree of colonic inflammation, and that tissue
severity.
levels of TNF may predict response to infliximab
Biopsies from the terminal ileum and different
treatment (5). Moreover, in patients with CD, high
colon segments were taken for histopathological
expression of TNF- in the inflamed ileocolonic tissues
evaluation. The specimens were processed in Pathology
of patients may predict the response to biological agents
Department for embedding in paraffin. From each
(6).The aim of the present study was to investigate the
paraffin embedded block, 5 m-thick sections were cut
relationship between immunohistochemical expression
and stained by haematoxylin and eosin (H and E) to
of TNF- in the biopsies of ileocolonic segments in
confirm the diagnosis and to assess the histopathologic
patients with activity of both ulcerative colitis (UC) and
severity by original Geboes score in confirmed UC
cases (7). Immunohistochemistry was done according to

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/)
1795
Received:3 /4 /2021

Accepted:29 /5 /2021


Full Paper (vol.841 paper# 26)


c:\work\Jor\vol841_27 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1801-1809

Management of Pain and Related Disabilities in Primary Fibromyalgia Using
Neuromodulator Techniques, Repetitive Transcranial Magnetic
Stimulation and Transcranial Direct Current Stimulation
Sahar Y. Ragab, Mervat A. Reda, Dalia M Ezz-Eldin, Mohja A. EL-Badawy*
Department of Physical Medicine, Rheumatology and Rehabilitation,
Ain Shams University Hospitals, Cairo, Egypt.
*Corresponding author: Mohja Ahmed Elbadawy, Mobile: (+20) 01005048716, Email:mohjaelbadawy@gmail.com

ABSTRACT
Background:
Fibromyalgia syndrome (FMS) is a chronic condition that causes pain, stiffness, and tenderness in
muscles, tendons, and joints. It is also characterized by disturbed sleep, fatigue, anxiety, depression, and disturbances
in bowel function. Management of FMS is at present very challenging as it contains multiple etiological factors and
psychological tendencies; though, a patient-centered approach is essential to deal with this problem.
Objective: To compare the efficacy of repetitive transcranial magnetic stimulation (rTMS) and transcranial direct
current stimulation (tDCS) in improving pain and related disabilities in patients with primary (1ry) FM.
Patients and Methods: Thirty patients with 1ry FM, 18 to 50 years old were randomized into 2 groups. Group I
included 15 patients, who received 8 sessions (2/week for 4 consecutive weeks) of high frequency rTMS (10 Hz
frequency) and Group II included 15 patients received 8 daily sessions of anodal tDCS (2 mA for 20 minutes) applied
over the left primary motor cortex (M1).
Results: Pain visual analogue scale (VAS), the revised Fibromyalgia Impact Questionnaire (FIQR), tender point
scale, and Hospital Anxiety and Depression Scale (HADS) showed a significant decrease between baseline and
follow-up assessments for both groups. Moreover, a significant change in all assessment scales was observed post-
treatment when compared between both groups with more significant improvement in the group that received rTMS.
Conclusion: Both rTMS and anodal tDCS of the left primary motor cortex showed marked improvement in
symptoms of pain, functional disabilities and psychological status in patients with 1ry fibromyalgia. Both
neuromodulator techniques can be considered as promising alternatives therapeutic options in the management of
pain and related disabilities in FM.
Keywords: Chronic pain, Fibromyalgia, Neuromodulator techniques, Repetitive transcranial magnetic stimulation,
Transcranial direct current stimulation.

INTRODUCTION
frequencies (5 Hz) are associated with increased
Fibromyalgia (FM) is one of the most
cortical excitability (13). Repetitive stimulation to the
challenging chronic pain syndromes with regard to
left prefrontal cortex is frequently associated with
treatment, affecting 3% to 5% of the world's
antidepressant and mood stabilizer effects, while
population (1,2). It is characterized by widespread
repeated stimulation of the primary motor cortex
chronic musculoskeletal pain, accompanied by sleep
(M1), over contralateral side of the painful area, can
disturbances,
fatigue,
decreased
physical
produce analgesic effects through the activation of
performance, and psychological distress that affects
horizontal fibers in the superficial layers of the
quality of life (3, 4). Many studies indicated that FM
precentral gyrus (14,15).
could be considered as one of the central sensitivity
Another neuromodulator technique is the
syndromes (5-7).
transcranial direct current stimulation (tDCS). Its
Mhalla and colleagues, represented that FM is
work is based on weak electrical currents that are
associated with impairment of intra cortical
applied to the scalp through electrodes for a specific
modulation, which supports the hypothesis that it may
amount of time. Anodal stimulation produces
be associated with changes in cortical excitability (8).
membrane
depolarization,
and
consequently
Considering central pain-processing changes found in
increasing neuronal firing. While cathodal stimulation
FM and the effects of neuromodulatory techniques on
produces
membrane
hyperpolarization
and
neuroplasticity, several studies had examined the
consequently decreasing neuronal firing (16). The
effects of these techniques on chronic pain in FM (9-
effectiveness of both neuromodulator techniques in
12).
managing pain and related functional and psychiatric
Transcranial magnetic stimulation (TMS) is a
impairments in FM has been reported in several trials
non-invasive technique of brain stimulation that uses
(17-19). To the best of our knowledge, comparing the
changes in magnetic fields to increase or decrease
effects of both modalities in FM patients had not been
neuronal activity (13). Low frequencies (1 Hz) can
previously studied.
induce neuronal inhibitory function, whereas high

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/)
1801
Received: 4/4/2021

Accepted: 30/5/2021

Full Paper (vol.841 paper# 27)


c:\work\Jor\vol841_28 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1810-1813

Reliability of Optical Coherence Tomography Angiography in Detection of
Early Hydroxychloroquine Toxicity
Nesma Sayed Mohammed
Ophthalmology Department, Faculty of Medicine (For Girls), Al-Azhar University, Cairo, Egypt
Corresponding author: Nesma Sayed Mohammed, Mobile: (+20)1014852522, E-mail: nesma7@live.com

ABSTRACT
Background:
Chloroquine is an antimalarial drug, while hydroxychloroquine is an analogue of chloroquine.
Hydroxychloroquine (HCQ) is used to treat autoimmune diseases in addition to malaria. They have toxic effects on
retina. Different screening protocols were described to detect HCQ toxicity.
Objective
: The aim of the current work was to study the ability of optical coherence tomography angiography (OCTA)
to detect early retinal changes that may occur after HCQ treatment in patients with rheumatoid arthritis.
Patient and Methods: This prospective cross-sectional study included a total of 40 eyes of 20 patients who were
newly or previously prescribed HCQ for rheumatoid arthritis, recruiting from the Department of Ophthalmology, Al-
Zahraa University Hospital. This study was conducted between May 2018 to Dec 2019. OCTA imaging was
performed via Angiovue software.
Results: The superficial whole vascular density, superficial parafoveal vascular density, superficial perifoveal vascular
density, deep whole vascular density, deep parafoveal vascular density, and deep perifoveal vascular density were
thinner in treatment groups compared to the control group (p<0.05).
Conclusion: OCTA could be a beneficial tool for screening of HCQ retinal affection. It could detect the decrease in
the deep capillary plexus at the parafoveal and perifoveal regions in patients who were receiving HCQ treatment.
Keywords: Hydroxychloroquine toxicity, Optical coherence tomography angiography, Rheumatoid arthritis.

INTRODUCTION

Optical coherence tomography angiography
Chloroquines
(CQ)
and
its
analogue
(OCTA) is a new noninvasive tool which can assess the
hydroxychloroquine
(HCQ)
were
known
as
retinal vascular system quantitatively, and the efficacy
antimalarial drugs. They are now being widely used in
of OCTA in HCQ retinopathy was previously
the treatment of autoimmune diseases (1, 2). They are
evaluated by several authors (11, 12).
also used as emerging treatment options for skin,
The aim of this work was to study the efficacy of
oncologic, and pediatric inflammatory disorders (3).
OCTA in detecting the early changes in retinal
Surprisingly, they are now widely used as a first-line
vasculature by comparing the quantitative OCTA
drug in the treatment of new coronavirus infection
parameters in patients who were using HCQ for
COVID-19 (4). At first the Food and Drug
different durations.
Administration (FDA) granted an emergency use

authorization for use of oral formulations of CQ and
PATIENTS AND METHODS:

HCQ in the treatment of COVID-19 (5, 6).
This prospective cross-sectional study included a
Chloroquines have toxic effects on retina and
total of 40 eyes of 20 patients, recruiting from the
eventually lead to so-called bull's eye maculopathy.
Department of Ophthalmology, Al-Zahraa University
Both the actual body weight and the duration are two
Hospital. This study was conducted between May 2018
important factors for toxicity (7). The optimum safe
to Dec 2019.
dose of the drug is still debatable. The doses of < 5

mg/kg/day were considered safe (3).
Ethical Consideration:
The exact mechanism of retinal toxicity still
An informed written consent was obtained from
unclear. Toxic effects on retinal pigment epithelium
each participant after receiving a full explanation about
(RPE) cells, accumulation of HCQ in pigmented ocular
the study. Approval was obtained from the Ethics
tissues, and degeneration of rods and cones are among
Board of Al-Azhar University committee. All
the purposed mechanisms of HCQ toxicity (8).
procedures were conducted in accordance with the
Screening is recommended in the first year and
Helsinki Declaration guidelines.
annually thereafter. The 10-2 visual field testing,

spectral domain optical coherence tomography (OCT),
The included subjects were divided into three
and autoflu orescence (AF) imaging are accepted as the
groups: Group 1 (control) included 16 eyes of 8
main screening tools (3). In some special circumstances,
patients, who were not taking any medication, Group
multifocal electroretinography (mfERG) might be
(2) included 14 eyes of 7 patients,. who were under
essential also (9, 10).
HCQ treatment for 5 years, and Group (3) included
10 eyes of 5 patients, who were under HCQ treatment

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/)
1810
Received: 4/4/2021

Accepted: 30/5/2021

Full Paper (vol.841 paper# 28)


c:\work\Jor\vol841_29 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1814-1817

Correlation between Visual Field Changes and Peripapillary Vessel Density in
Primary Open Angle Glaucoma
Ahmed Fouad Ibrahim1, Zeinb Sayed Hassan2, Nesma Sayed Mohammed*2
1Department of Ophthalmology, Magrabi Eye Hospitals, and 2 Department of Ophthalmology, Faculty of
Medicine (For Girls), Al-Azhar University, Cairo, Egypt
*Corresponding author: Nesma Sayed Mohammed, Mobile: (+20)1014852522, E-mail: nesma7@live.com

ABSTRACT
Background: Glaucoma is a progressive optic neuropathy, which is characterized by degeneration of the retinal
ganglion cells. The role of optic nerve head (ONH) microvascular network and vascular dysfunction has been
investigated in the pathogenesis of glaucoma.
Objective:
The aim of the current work was to assess the correlation between visual field changes in primary open
angle glaucoma (POAG), and the density of the radial vessels around the optic disc.
Patients and Methods: One hundred eyes of fifty patients were enrolled in this prospective cross-sectional study.
Patients were recruited from the Department of Ophthalmology, Al-Zahraa University Hospital from December 2018
to March 2020. They were divided into two groups, control group with normal functional and structural data, and
glaucomatous group with POAG.
Results: There were significant differences in all measurements among both groups, including visual field indices,
optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) parameters. The
changes of peripapillary vessel density (PpVD) had strongly positive correlations with the mean deviation (MD),
ganglion cell complex (GCC) thickness and retinal nerve fiber layer (RNFL) thickness, while had negative correlation
with pattern standard deviation (PSD) and cup disc (C/D) ratio.
Conclusion:
Decreased PpVD was detected in the glaucomatous group. There were statistically significant correlations
between visual field changes (changes of both MD and PSD) and PpVD where there were strongly positive correlations
with the (MD), and negative correlation with PSD. This can add to the diagnosis of POAG. Also, it provided more
information about the microvascular changes in the ONH and peripapillary retina in cases of POAG.
Keywords
: Optical coherence tomography angiography, Ganglion cell complex, Retinal Nerve fiber layer.

INTRODUCTION

supporting a vascular role in the development of
Glaucoma is a group of progressive optic
glaucoma (5, 6).
neuropathies characterized by a degeneration of retinal
Optical coherence tomography angiography
ganglion cells and retinal nerve fiber layers that result
(OCTA) has several advantages over the other previous
in specific changes in the optical nerve head (ONH) (1).
devices since it is a non-invasive, reliable, depth-
It is well documented that early diagnosis, early
resolved, and user-friendly technique. Since our
treatment and monitoring of the disease progression are
knowledge has been started to expand about the role of
the key determinants to reduce the risk of irreversible
ocular blood flow in glaucoma, OCTA is expected to
vision loss (2). Although the pathogenesis of glaucoma
provide us with qualitative and quantitative
is not fully understood, it is well known that structural
information of the microvasculature in various retinal
damage occurs prior to functional damage (3).
regions including the optic nerve and peripapillary
It may be not appropriate to diagnose the earliest
retina (7). Also, we can easily get insight of the
stages of glaucoma with visual field (VF) testing
relationship between retinal blood flow and visual
because a significant amount of ganglion cell (GC) loss
functional damage (8).
is predicted to occur before the functional deficits start
The aim of this study was to correlate between
to appear (4). Peripapillary retinal nerve fiber layer
peripapillary vessel density and glaucomatous visual
(RNFL) thinning which is better detected using optical
field changes in primary open angle glaucoma
coherence tomography (OCT) system, ganglion cell
(POAG), and to evaluate the diagnostic abilities of
complex GCC thickness reduction and neuroretinal rim
measuring the peripapillary vessel density in the
narrowing are other available good parameters for
diagnosis of POAG.
diagnosing the early changes and monitoring the

progression of glaucoma, while detection of VF defects
PATIENTS AND METHOD
is indispensable for monitoring the functional decline.
This observational prospective, cross sectional
Some studies have suggested that reduced ocular blood
study included a total of one hundred eyes of fifty
flow is a primarily independent metric of visual
persons
attending
at
the
Department
of
function outside of other structural parameters,
Ophthalmology, Al-Zahraa University Hospital. 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/)
1814
Received:4 /4 /2021

Accepted:30 /5 /2021

Full Paper (vol.841 paper# 29)


c:\work\Jor\vol841_30 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1818-1826

The Therapeutic role of Thymoquinone Bioactive Compound as
Target Natural Product from Nigella sativa Loaded with
Chitosan Nanoparticles on Schistosomiasis
Hend M. El-Menyawy1*, Karima M. Metwally1, Ibrahim R. Aly1, Asmaa A. Abo Elqasem1, Alaa A. Youssef2
1Zoology Department, Faculty of Science, Al-Azhar University (Girls branch), Cairo, Egypt.
2Environmental Research and Medical Malacology Department, Theodor Bilharz Research Institute, Giza, Egypt.
*Corresponding author: Hend M. El-Menyawy, Mobile: (+20) 0201019232739, E-Mail: hendmetwally.2059@azher.edu.eg

ABSTRACT
Background
: Schistosoma mansoni is a trematode helminth responsible for liver fibrosis or cirrhosis.
Aim of the work:
In the present work natural products Thymoquinone loaded with chitosan nanoparticle (TQ/ChNP))
(TQ/ChNP) were used to determine their therapeutic effect on S. mansoni infection.
Materials and methods:
A total of 40 healthy Swiss albino mice, 20-25 g in weight, procured from Theodor Bilharz
Research Institute (TBRI) Imbaba, Egypt's Schistosome Biological Supply Center (SBSC).
Results:
The infected mice treated with TQ/ChNP showed a significant decrease in the total worm burden. Treatment
with TQ/ChNP had a highly significant effect on mature worm burden, TQ/ChNP in prophylactic and therapeutic
doses significantly increased the mean number of dead ova in comparison to control. TQ/ChNP had a high decrease
effect on ova count in intestinal tissue and a moderate reduction on ova count in hepatic tissue. Prophylactic dose gave
a high reduction effect on ova count in intestinal tissue. As regards the size of hepatic granuloma, TQ/ChNP had the
highest significant reduction on mean granuloma diameter with noticeable improvement of hepatic pathology.
TQ/ChNP treated group showed observable improvement of liver pathology with mild degeneration and slight-sized
fibrocellular. Conclusion: Based on the outcome of this study, TQ/ChNP proved to have potential bioactivity against
S. mansoni adult stages and its potentiality in improving hepatic pathology. Efficacy of TQ/ChNP to postpone
progression in chronic liver diseases must be considered as preventive medicine in patients with hepatic disorders.
Keywords: S. mansoni infection, Nigella sativa, (TQ/ChNP), Chitosan, Oogram, Granuloma formation.

INTRODUCTION
anti-Schistosoma effect (9,11). Based on the antiparasitic
Schistosomiasis is considered the second
activity of medicinal plants and natural products, Ali et
destructive tropical disease in the world (after malaria)
al. (10) test the anti-Schistosoma activity of Nigella sativa
and it is the main cause of morbidity and mortality in
oil and/or the terrestrial Chroococcus turgidus.
developing African countries, including Egypt
Nanoparticles can act as drug carriers that can
especially with distinct population groups (1). It affects
alleviate pharmacokinetics, increase bioavailability, and
more than 799 million patients who are children at risk
objective release with negligible toxic effects (12). The
of contracting contracture (2).
large numeral of free amine groups presents in the
The pathology associated with S. mansoni results
chitosan backbone when related with other
from the accumulation of eggs of the parasite in the
biodegradable polymers promotes binding of many
tissues, causing hepatomegaly, and followed by
bioactive agents to the polymer (13). For these reasons,
extensive cirrhosis (3). The granulomatous inflammatory
chitosan has been expansively investigated for its
reaction to trapped eggs in the liver has also been shown
potential as an absorption enhancer across intestinal
to cause oxidative tension. Chitosan's progressive
epithelium for bioactive agents such as TQ. Considering
nature aids in enhanced cellular contact, distribution,
above mentioned advantages of chitosan it was chosen
and
penetration
capability
in
heterogeneous
for encapsulating TQ powerfully. The high drug-
environments. benign tumor (4). Control programs
carrying capacity and longer shelf life of chitosan
depend mainly on praziquantel (PZQ) therapy (5).
compared with other biodegradable polymers (14), also
Nowadays, there is an increase in the use of anti-
serves as an important reason for using chitosan as a
parasitic drugs derived from natural plant sources (6) to
nanocarrier in this study. Elawamy et al. (15) estimated
overcome and control schistosomiasis (7). Abaza, (8)
the value of loading N. sativa on chitosan nanoparticles
reviewed all herbal treatments used for schistosomiasis,
(ChNPs) in the treatment of S. mansoni infection
including Chinese medicine, carvacrol (essential oil of
compared to praziquantel showed reduced in worm
Origanum vulgare obtained from pepperwort), myrrh
burden all groups concerning the control and N. sativa
(oleo-gum-resin
from
Commiphora
molmol),
groups while a significant decrease occurred in oogram
artemisinin derivatives insulated from Artemisia annua,
pattern and tissue egg loads reached reduction
curcumin (C. longa), quinine (Cinchona officinalis),
percentages more than 90% in NC and NCP groups. The
quinine-deficient garlic extract (Allium sativum) and
apparent role of ChNPs in the improvement of bilharzial
black seed (Nigella sativa). Nigella sativa is one of the
hepatic changes. Thus, ChNPs enhanced the effects of
hopeful alternative drugs of a plant origin that have an
N. sativa as a therapy for schistosomal infection.

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/)

1818
Received: 3/4 /2021

Accepted:29 /5 /2021

Full Paper (vol.841 paper# 30)


Immediate and long term results The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1827-1831

Value of Multislice Computerized Tomography in Evaluation of
Acute Abdomen with A Hidden Cause at Sonography
Mohammad T. Solyman1, Mohammed Z. Mourad1, Nehal G. Ahmed*1,
Ahmed E. Mohammed2, Sherif S. Abd Almonem1
Departments of 1Radiology and 2Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt.
*Corresponding Author: Nehal G. Ahmed, Mobile: +201099487660, Email: nehal.ngg81@gmail.com

ABSTRACT
Background
: Our focus is acute abdominal pain in general, but we also discuss a number of frequently encountered
urgent diagnoses in patients with acute abdominal pain: appendicitis, diverticulitis, cholecystitis, and bowel
obstruction. Although perforated viscus and mesenteric ischemia are less frequently encountered, these are also
addressed because imaging is of paramount importance for the timely diagnosis of these abnormalities.
Objective: Evaluation of the diagnostic accuracy of multislice Computerized Tomography (CT) examination in the
diagnosis of patients presented with acute abdominal pain with a hidden cause at abdominal Ultrasonography (US)
examination.
Patients and methods; the study is a prospective study which included 70 patients referred to the Radiology
Department at Sohag University Hospital from the surgical emergency room with Inclusion criteria is a Patient
presented with acute abdominal pain and Exclusion criteria is patient with a definite diagnosis of the cause of acute
abdominal pain at the abdominal US, medical or traumatic causes of acute abdominal pain.
Results: CT imaging may be called the main method for diagnosing severe abdominal pain. When expense and
ionizing radiation toxicity are key considerations, one approach is to conduct US first in all patients with severe
abdominal pain, followed by CT in all instances with the non-diagnostic US. CT is much more precise and descriptive
in this environment.
Conclusion: At present, CT can be considered the primary imaging technique for patients with acute abdominal pain,
with the exception of patients, suspected of having acute cholecystitis. The US is preferable in these patients, but CT
is an acceptable alternative.
Keywords: Multislice computerized tomography, acute abdomen, sonography.

INTRODUCTION
people presenting to emergency rooms in the United
Acute abdomen is a surgical emergency in
States with stomach discomfort underwent CT. By
which there is acute and intense discomfort in the
2005, that number increased to more than 22% of
abdomen with recent onset, accompanied by
patients. Concerns over patient exposure to ionizing
abdominal-specific signs and symptoms. It refers to a
radiation accompany the extensive usage of CT. In the
broad range of diseases, from a mild and self-limiting
interest of minimizing radiation exposure, abdominal
illness to a medical emergency. Nonetheless, only
CT subjects a patient to an appropriate radiation dose
around a quarter of patients historically diagnosed as
of about 10 mSv, relative to the annual background
having an acute abdomen undergo surgical care;
radiation dose of 3 mSv in the United States; attempts
therefore, the therapeutic question is determining if the
have been made to utilize CT more prudently (4).
patients need surgical treatment or not and,
A major disadvantage of the US is that it is
additionally, in which situations the surgical
an operator-dependent modality. CT was shown to be
alternative should be pursued expeditiously. As a
slightly more responsive than the US in identifying
result, a rigorous and rational approach to abdominal
appendicitis and diverticulitis. For acute cholecystitis
pain diagnosis is needed (1).
and bowel obstruction, there were no significant
Rapid, reliable diagnosis is critical for reducing
differences in accuracy between US and CT. The
morbidity and mortality dramatically. Clinical
etiology of the obstruction is better evaluated with CT
evaluation is often challenging, and experimental and
than with the US. Another study did not show any
traditional radiologic results are frequently unspecific.
significant difference in accuracy between US and CT
Cross-sectional imaging's progress has had a
in detecting diverticulitis, but CT is more likely to
significant effect on the detection and care of acute
detect
complications
of
acute
diverticulitis.
abdomen (2). While ultrasound (US) is used in the
Diverticulitis-associated abscesses are found at CT in
evaluation of the biliary disease and gynecologic
approximately 15% of patients (5).
conditions as the initial imaging study, CT has emerged
The study aims to evaluate the diagnostic
as the primary imaging modality for the evaluation of
accuracy of multislice CT examination in diagnosing
the acute abdomen (3).
patients presented with acute abdominal pain with a
CT has been more common for evaluating
hidden cause at abdominal Ultrasonography
abdominal pain in recent years. In 2001, nearly 10% of
examination.

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/)
1827

Received:5 /4 /2021

Accepted:1 /6 /2021

Full Paper (vol.841 paper# 31)


c:\work\Jor\vol841_32 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1832-1838

Comparative Study between Corneal Topographic Changes Following
Phacoemulsification and Small Incision Cataract Surgery
Tag-Eldin Mohammed Othman, Asmaa Abu Alhassan Abd Elrasol*,
Abdalla Mohamed El Amin Abdalla, Ahmed Fathy Gabr
Department of Ophthalmology, Faculty of Medicine - Aswan University, Egypt
*Corresponding author: Asmaa Abu Alhassan Abd Elrasol, Mobile: (+20) 01000503197, E-Mail: asmaaabualhasan2@gmail.com

ABSTRACT
Background:
Phacoemulsification has become the routine procedure for cataract extraction for most of the
surgeons because of its smaller incision and rapid visual rehabilitation. Also, manual small incision cataract surgery
(MSICS) with its sutureless relatively smaller incision, compared to conventional extracapsular cataract extraction,
has similar advantages to phacoemulsification in addition to its lower risk to corneal endothelium especially in hard
cataracts and elder patients.
Objective: To compare the effect of phacoemulsification and small incision cataract surgery on corneal topography
in a prospective randomized study.
Patients and methods: 80 eyes were included in this study. Patients were divided into two groups: Group A (40
eyes) underwent phacoemulsification and Group B (40 eyes) underwent MSICS. Both groups were studied
preoperatively and postoperatively regarding uncorrected visual acuity (UCVA), best corrected visual acuity
(BCVA), keratometry, and corneal topography.
Results: There was a significant difference between preoperative and postoperative uncorrected visual acuity
(UCVA) during the follow up period (p value < 0.001) among both study groups. There was no significant difference
in preoperative as well as postoperative intraocular pressure (IOP) or between preoperative and postoperative IOP
values in both study groups. There was significant increase in the mean central corneal thickness during first
postoperative week in both studied groups (p value <0.001). In MSICS group there was minimal significant increase
in astigmatism within the first weak and first month of follow up (p value 0.041).
Conclusion: Cataract surgery using phacoemulsification or small incision cataract surgery was found to yield
excellent visual results with no significant difference as regards to central corneal thickness, keratometric readings,
and postoperative astigmatism or perioperative complications.
Keywords: Corneal topographic, Phacoemulsification, Small incision cataract surgery.

INTRODUCTION
the operated cataracts because of the advanced
As it is accounted for 50% of global burden of
maturity and hardness of the lens nucleus (7).
blindness, cataract is considered as the leading cause
Although phacoemulsification is the preferred
of preventable visual impairment worldwide (1). In
technique for cataract surgery, for most surgeons,
developing nations, where cataract represents a
MSICS has gained popularity as it yields comparable
socioeconomic burden, phacoemulsification remains
surgical outcomes as phacoemulsification (8).
an expensive modality of its management and the
The aim of the work was to compare the effect
main bulk of the population find it unaffordable (2).
of phacoemulsification and small incision cataract
The delivery of high-quality low cost cataract
surgery on corneal topography in a prospective
surgery has the priority in the Vision 2020 programs
randomized study.
in Africa (3), whilst phacoemulsification cataract

surgery has become the standard surgery in high
PATIENTS AND METHODS
income countries (4). Financial limitations have
Patients who were eligible to the study had been
precluded the introduction of phacoemulsification as
recruited from the outpatient clinic of Ophthalmology
a routine procedure in middle and low income
Department at Aswan University Hospital. The study
countries (5).
was conducted as a prospective randomized
Manual small incision cataract surgery (MSICS)
controlled study, where 80 eyes of 77 patients were
is the term reserved for non-phacoemulsification
included.
cataract surgery done through small self-sealing

corneoscleral tunnel (6-7mm), through which the
Ethical approval:
nucleus is delivered intact or after division into two or
An approval of the study was obtained from
three pieces. It has been shown to have many of the
Aswan
University
academic
and
ethical
advantages of phacoemulsification surgery (6)
committee.
particularly when there is a concern that
Every patient signed an informed written
phacoemulsification may be unsuitable for some of
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/)
1832
Received: 17/01 /2021

Accepted: 04/03/2021

Full Paper (vol.841 paper# 32)


c:\work\Jor\vol841_33 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1839-1845

Suprascapular Nerve Radiofrequency versus Intraarticular
Steroid Injection in Chronic Shoulder Pain
Hamdy A. Youssef1, Ossama H. Salman2, Ahmed Y. Ahmed2,
Hesham H. Refae3, Ghada Mahmoud Morsy*2
1Department of Anesthesiology, Faculty of Medicine, Assuit University, Assuit, Egypt.
2Department of Anesthesiology, Qena Faculty of Medicine, South Valley University, Qena, Egypt.
3Department of Orthopedics, Aswan Faculty of Medicine, Aswan University, Aswan, Egypt.
*Corresponding author: Ghada Mahmoud Morsy, Mobile: (+20)01007544554, E-Mail: gmm_06@yahoo.com

ABSTRACT
Background:
Chronic shoulder pain is a frequent clinical condition that often reduces patient's function and
rehabilitation. Objectives: We aimed to compare efficacy of pulsed radiofrequency (PRF) to intra-articular steroid
(triamcinolone acetonide) injection in controlling chronic shoulder pain as regard improvement of pain and function in
six-month duration.
Patients and Methods: We carried out a prospective, randomized, controlled, single-blinded study enrolled 60 patients
with shoulder pain randomly divided into 2 groups. Group I: PRF group enrolled 30 patients who were treated by PRF
neuromodulation to the suprascapular nerve under fluoroscopy and Group II: steroid group enrolled 30 patients who
were treated with intra-articular injection of 5 ml of 2% lidocaine with triamcinolone acetonide 40 mg.
Results: In Group 1 (PRF group) we reported statistically significant improvement of VAS, these positive effects lasted
at least 6 months and the VAS decreased through 6 months from 6.5 to 3.5. In Group 2 VAS decreased through 6 months
from 7 to 3.5. Both groups showed significant Oxford Shoulder Scale (OSS) improvement.
Conclusion: Intra articular injection of triamcinolone acetonide is more effective in improvement of chronic shoulder
pain and function than PRF.
Keywords: Intra-articular steroid injection, PRF, OSS, Shoulder pain, VAS.

INTRODUCTION
was recommended in many studies as treatment of
Shoulder pain, which is one of the most
chronic shoulder pain )5).
common musculoskeletal maladies, may arise from
We aimed to compare efficacy of pulsed
diverse causes. Accurate diagnosis of shoulder pain is
radiofrequency (PRF) to intra-articular steroid
made difficult by the unique anatomy and position of the
(triamcinolone acetonide) injection in controlling
shoulder, which serves as a link between the upper
chronic shoulder pain as regard improvement of pain
extremity and the thorax (1).
and function in six-month duration.
Determining the source of shoulder pain is

essential in order to recommend the proper method of
PATIENTS AND METHODS
treatment. The examining physician must be able to
prospective, randomized, controlled, single-
differentiate the occurrence of shoulder pain caused by
blinded study was carried on 60 patients suffered from
intrinsic or local factors, extrinsic or remote factors, or
shoulder pain for 6 months or more with or without
a combination of the two. Intrinsic factors originate from
limitation of movements; not responding to conservative
the shoulder girdle and include glenohumeral and
treatment and requiring regular analgesia according to
periarticular disorders, whereas extrinsic factors occur
the following inclusion criteria, which consisted of (1)
outside of the shoulder girdle with secondary referral of
age: 30-80 years old, (2) shoulder MRI showing
pain to the shoulder. An example of an extrinsic factor
inflammatory or degenerative changes, (3) American
is left shoulder pain as the initial presentation of
Society of Anaesthetists (ASA) physical status was I or
coronary artery disease. Hepatic, gallbladder, and
II, and exclusion criteria consisted of (1) shoulder pain
splenic disease also may manifest initially as shoulder
less than 6 months' duration, (2) any previous surgical
pain (2). Accurate evaluation, diagnosis, and treatment
intervention to the shoulder, (3) morbid obesity (body
require a thorough understanding of shoulder anatomy,
mass index of more than 35), (4) infection at the site of
including pain referral patterns. A complete and
application, (5) severe psychiatric illness, (6) cardiac,
systematic physical examination is crucial for an
hepatic or renal compromised function, (7) allergy to
accurate diagnosis (2, 3).
local anesthetics, steroids or contrast materials, (8)
Nonetheless, most patients with a chronic
general inflammatory disease.
shoulder disorder can initially be treated conservatively

with some combination of activity modification,
Study Protocol:
physical therapy, medications, and corticosteroid
Ethical approval:
injections, if necessary (4). Also using of radiofrequency
Our study was conducted, after obtaining
approval from Ethical Committee (committee no. 48,

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/)
1839
Received: 09/01/2021

Accepted: 06/03/2021

Full Paper (vol.841 paper# 33)


c:\work\Jor\vol841_34 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1846-1851
New Insights in Role of Cart-T Cell Therapy in Hematological
Malignancy: A Systematic Review
Mohamed A. Abdel Hafez1, Ali M. El-khouly1, Essam A. Abd Elmohsen2, Dina Ragab Mahmoud Sharaf*1
1Internal Medicine and Hematology Department, Faculty of Medicine, Menoufia University, Egypt.
2Hematology Department, Maadi Hospitals, Cairo, Egypt.
*Corresponding Author: Dina Ragab Mahmoud Sharaf, Mobile: (+20)01024777826, E-mail dinasharf85@yahoo.com

ABSTRACT
Background:
The Chimeric antigen receptor T cell (CAR-T cell) is a kind of effector T cell that detects and kills
cancer cells without the need for major histocompatibility complex components. The entire process of creating CAR-
T cells is not well known. Acute lymphoblastic leukemia, chronic lymphocytic leukaemia, lymphoma, and multiple
myeloma are among the haematological cancers for which the CAR-T cell has been employed.
Objectives: Chimeric antigen receptor T cell (CAR-T cell) therapy is a novel adoptive immunotherapy where T
lymphocytes are engineered with synthetic receptors known as chimeric antigen receptors (CAR).
Data Sources: Electronic articles and Journal articles about role of Cart-T Cell therapy in hematological malignancy.
Study Selection: This essay was containing data from many resources such as Google scholar, Elsevier, PMC,
PubMed, England Journal, and Blood Journal to facilitate achieving the aim.
Data Extraction:
If the studies did not fulfil the inclusion criteria, they were excluded. Study quality assessment
included ethical approval was gained, eligibility criteria specified, adequate information and defined assessment
measures.
Recent Findings: Fourth-generation CARs include the combination of second-generation CARs with an additional
element, such as the tumor-killing cytokine IL-12. This type of CAR has improved tumor eradication by releasing
cytokines into the tumor microenvironment and recruiting immune cells without prior conditioning. In addition, it has
been used to treat virus infections, metabolic disorders and autoimmune diseases in addition to cancers.
Conclusion: CAR T cell therapy has brought a new hope for the treatment of malignant hematological diseases such
as acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL), acute myeloid leukemia (AML), non-
Hodgkin's lymphoma (NHL), Hodgkin's lymphoma (HL) and multiple myeloma (MM).
Keywords: CART-T cell therapy, Clinical applications, Hematological malignancy.

INTRODUCTION

T lymphocyte cells (T cells) are important
CAR-T cell generations are represented by
components of the cell-mediated immune system.
different intracellular regions. In first generation CARs
These cells are responsible for monitoring and
(lack of costimulatory signal), the signaling endo-
destroying tumour cells or cells that have the potential
domains of costimulatory molecules like CD28, CD134
to become cancerous. Many treatments that cultivate,
(OX40), or CD137 (4-1BB) are fused with CD3z. In the
redirect, and/or boost T lymphocytes towards
second and third generation CARs, the signaling endo-
malignancies have been developed in recent years. T
domains of costimulatory molecules like CD28, CD134
cell-based adoptive immunotherapy is one of them that
(OX40), or CD137 (4-1BB) are fused with CD3z (Fig.
is discovering novel ways to treat tumours, particularly
1). When TCR joins with antigen-presenting cells to
hematologic tumours. Tissue-infiltrating lymphocytes,
complete the activation process, this structure mimics
TCR-modified T cells, and chimeric antigen receptor T
the costimulation signal (3, 4).
cells (CAR-T cells) are three forms of this new
All of these factors combine to make CAR-T
treatment (1).
cells specialized for a certain type of cancer cell,
In comparison to CAR-T treatment, the first two
allowing them to be eradicated. Because a monoclonal
procedures do not create a significant alteration of the T
antibody against a tumour antigen provides novel T cell
cell per se, and hence the effectiveness is not
specificity for certain types of cancer cells while
significant. Their advancement is further hampered by
bypassing the established antigen-presenting process,
the manufacturing process, low success rates, and
one of the method's key advantages is that it is not
reliance on immunization. CAR-T cell therapy has been
dependent on the major histocompatibility complex for
around for over 25 years as a potential treatment
recognition (5, 6).
regimen. CAR, which has two domains: an extracellular
However, a new generation of CARs has piqued
and an intracellular domain, replaces the TCR. The
scientists' interest. This so-called "fourth generation of
extracellular domain is usually a single-chain fragment
CARs" is additionally equipped with a "nuclear factor
(scFv) of an antibody directed toward a cell surface
of activated T cell responsive expression" element for
antigen, while the intracellular domain includes fused
an inducible transgenic product like IL-12 or another
signaling domains from a natural TCR complex and
cytokine in addition to costimulatory signal(s) like
costimulatory molecules (2).
CD28 and (or) CD137 (Fig. 1).

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/)

1846
Received:4 /4 /2021

Accepted:30 /5 /2021

Full Paper (vol.841 paper# 34)


c:\work\Jor\vol841_35 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1852-1857

Screening of High-Risk Patient by Uterine Artery Doppler Analysis in
The 1st Trimester to Predict Early Onset Pre-Eclampsia
Hasnaa Mohamed Elfouly Mohamed, Ahmed Mahmoud Moustafa Badawy,
Ashraf Ghanem, Khaled Samir Ismail
Department of Obstetrics and Gynecology, Faculty of Medicine - Mansoura University, Egypt
*Corresponding Author: Hasnaa Mohamed Elfouly Mohamed, Mobile: (+20)01068360579,
Email: elawadyabdalla88@gmail.com

ABSTRACT
Background:
Preeclampsia (PE) is still a major obstetrical problem world-wide. First trimester prediction of PE is
of great clinical importance, as it would allow clinicians to focus on high-risk groups and initiate prophylactic medical
treatment. The first stage of pre-eclampsia begins in the first trimester by impaired placentation. High-resistant spiral
arteries can be detected from the 11th week of gestation by uterine artery (UtA) Doppler examination.
Objective: To assess the relationship between 1st trimester uterine artery pulsatility index (UtA PI) and the
development of early onset PE. Patients and Methods: Prospective observational study was performed at Mansoura
University Hospital. This study was conducted on 109 pregnant women who attended their routine antenatal care
visits at the Outpatient Obstetrics and Gynecology Clinic of Mansoura University Hospital.
Results:
There were statistically high significant difference between both groups in the BMI (p = 0.003), and no
statistically significant difference as regards the age, gravidity and gestational age (p > 0.05). Statistically significant
difference was evident between two groups in the mean values of UtA PI (p = 0.028). The best cutoff value of UtA
PI for the prediction of early onset preeclampsia was 2.03 with accuracy of 0.79, and that of BMI was 35 with
accuracy of 0.93.
Conclusion: This study revealed that first trimester uterine artery Doppler can be used as a reliable screening test for
prediction of preeclampsia in high risk women. It is a reliable, noninvasive method of examining uteroplacental
perfusion. Abnormal UA Doppler ultrasonography (elevated PI) in 11­14 weeks' gestation can predict pre-eclampsia.
Keywords: Early onset pre-eclampsia, High risk patient, Screening, Uterine Artery Doppler.

INTRODUCTION
circulation. This is reflected in abnormal waveform
Preeclampsia (PE) is still a major obstetrical
patterns of the uterine arteries on sonograghic Doppler
problem world-wide. It is one of three major factors
velocimetry evaluation with increase pulsatility and
causing maternal and fetal morbidity and mortality, and
resistance indices seen (5).
at the same time being one of the most important factors
High-resistant spiral arteries can be detected from
responsible for preterm birth (1).
the 11th week of gestation by uterine artery (UtA)
Currently, there is no treatment for PE other than
Doppler examination (6). Therefore, first trimester UtA
delivery. Furthermore, the lack of specific predictive
Doppler examination may be a good noninvasive
and diagnostic tools makes clinical handling of the
method for predicting PE that reflects abnormal
disease a global maternal health problem with many
trophoblast invasion (7,8).
unmet clinical needs. PE is a syndrome of pregnancy
The aim of this study was to assess the
defined by its clinical manifestations, proteinuria, and
relationship between 1st trimester uterine artery
hypertension (2).
pulsatility index (UtA PI) and the development of early
First trimester prediction of PE is of great clinical
onset PE through prospective observational study.
importance, as it would allow clinicians to focus on

high-risk groups and initiate prophylactic medical
PATIENTS AND METHODS
treatment. Health economists have calculated that it
Prospective observational study was conducted on
would be economically beneficial to screen for PE as
109 pregnant women who attended their routine
long as there is an effective intervention method
antenatal care visits at the Outpatient Obstetrics and
available (3).
Gynecology Clinic of Mansoura University Hospital.
The first stage of pre-eclampsia begins in the first

trimester by impaired placentation that leads to shallow
Ethical consent:
trophoblast invasion of the maternal decidua and spiral
An approval of the study was obtained from
arteries, resulting in insufficient remodeling of the
Mansoura University Academic and Ethical
smooth muscle wall of the arteries and consequently,
Committee. Every patient signed an informed written
inadequate perfusion of the placenta (4). Impaired
consent for acceptance of participation in this research.
developments of the placenta translate into persistently
Inclusion criteria: Nulliparous pregnant women, a
elevated resistance to blood flow in the uteroplacental
singleton pregnancy, gestational age of 11 to 13 weeks,

This article is an open access article distributed under the terms and conditions of the Creative



Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1852
Received: 21/ 01/2021

Accepted: 18/ 03/2021

Full Paper (vol.841 paper# 35)


c:\work\Jor\vol841_36 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1858-1862

Evaluating the Impact of Fractional Flow Reserve (FFR) on
Decision-Making for Treatment of Borderline Coronary Artery Lesions:
MUST University Experience, Egypt
Ahmed Elbarbary1, Ghada Kazamel2, Ahmed Tamara3
1Cardiology Department, Misr University for Science and Technology, Egypt
2Cardiology Department, National Heart Institute, Egypt
3Cardiology Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Ahmed Elbarbary, Mobile: (+20) 01222333615, E-Mail: dr.barbary_ai@yahoo.com

ABSTRACT
Background:
The primary reference criterion for evaluating coronary artery stenosis functional significance is
fractional flow reserve (FFR). It helps the interventionist to define appropriate angiographic borderline coronary lesions
that should or should not be treated with a stent.
Objective: To evaluate the experience of the cardiology department, MUST University, on the use of FFR and its
impact on patients with a borderline coronary lesion as regard revascularization decision-making.
Patients and methods: A retrospective study were done on 86 patients with borderline lesions undergoing coronary
angiograms for whom FFR was performed. Three experienced cardiac interventionists re-analyzed their coronary
angiography and whether to delay or conduct revascularization with borderline stenotic lesions (40-70 %). A distinction
was made between the findings of quantitative coronary angiography (QCA), visual and functional assessment of
coronary stenosis severity. Result: Eighty-six patients (51 males and 35 females) with a mean age of 58.60 ± 9.20 were
enrolled in the current study. FFR was < 0.80 in 26.74% (23/86) of the patients, and they had coronary angioplasty.
Between quantitative evaluation of lesion diameter by FFR and visual measurement, the correlation was -0.645 (P <
0.001). Seven patients (8.139%) had FFR > 0.8 left main (LM) lesion and for the other vessels with severe coronary
lesions, stenting was performed.
Conclusion: In patients having borderline coronary artery stenosis, FFR is an important tool for clinical decisions
making about procedures of revascularization. FFR results in alteration in the coronary intervention judgment.
Keywords: Coronary Angiography, Coronary Stenosis, Fractional Flow Reserve.

INTRODUCTION
severity. Myocardial FFR is defined as an invasive index
The definition of a borderline coronary artery lesion
of the coronary stenosis functional severity in borderline
is a diameter that narrows from about 40 to about 70 %.
lesions, according to pressure flow study of the coronary
It can be identified in approximately one-third to half of
lesion in the maximum flow reserve (8-9).
the coronary angiograms. Visual assessment of the
Fractional flow reserve (FFR) is one of the best
severity of coronary lesions during routine coronary
diagnostic methods used for determining the functional
angiography is not always reliable due to the two-
value of borderline coronary lesion. This can be
dimensional views and inter/intra-observer variability (1,
achieved through intracoronary pressure guide wires.
2). The hemodynamic influence of coronary artery stenosis
FFR can also be calculated as the ratio of the maximum
can be determined by fractional flow reserve (FFR)
coronary blood flow in the stenotic area to the maximum
measurements. In the absence of non-invasive evidence of
blood flow in the normal part of the same artery. FFR =
ischemia, current guidance suggests their use. The
Pd (the distal coronary artery mean pressure) /Pa (aortic
prognostic effect of FFR has been tested, and it has been
pressure) during maximal hyperemia. The index of FFR
shown that revascularization can be safely postponed if
is independent of heart rate, systemic blood pressure,
FFR is > 0.80, whereas stenosis revascularization with FFR
and systolic function of the left ventricle. It is also not
values of 0.80 results in substantially lower rates of events
affected by situations known to improve baseline
compared to medical therapy. In patients with borderline
myocardial blood flow. Regardless of the patient or
severity of coronary artery stenosis and angina pectoris,
particular vessel examined, the normal index value is
decision-making for choosing treatment options,
one. It has been shown that the FFR corresponds well
revascularization, or medical follow-up is a challenge,
with other non-invasive ischemia detection tests. FFR
as determined by visual estimation for a coronary
has clear clinical importance, unlike most other invasive
angiogram. Coronary artery revascularization is done in
indices (3, 4, 8, 10-12). FFR was first used as part of a clinical
a significant number of patients with no definite
trial in Egypt in 2013 and was used in clinical practice
evidence that symptoms are caused by coronary stenosis
in 2015. It was first used in our catheter lab at Misr
(3-7).
University for Science and Technology (MUST)
Technical developments in recent years have
hospital in 2016.
equipped catheterization laboratories with innovative
Borderline coronary artery lesions may be stented
testing instruments to assess the coronary artery lesions
incorrectly without using FFR. Using FFR improves

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/)
1858
Received:5 /4 /2021

Accepted:1 /6 /2021


Full Paper (vol.841 paper# 36)


c:\work\Jor\vol841_37 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1863-1867

Locked Dynamic Hip Screw Plate for Elderly Patients with
Trochanteric Femur Fracture
Mohamed Abdelfattah Sebaei1, Khaled Edris Abdelrahman1,
Raouf Elmahdi Omar Muftah2, Mahmoud Elsayed Elbadawy Thabet1
1Orthopedic Department, Faculty of Medicine, Zagazig University, Egypt.
2Orthopedic Department, Faculty of Medicine, Tripoli University, Libya.
*Corresponding Author: Raouf Elmahdi Omar Muftah, Mobile: 00218913353235,
E-mail: raoufelmahdi_86@yahoo.com
ABSTRACT
Background:
Proximal Femoral fractures are common in elderly. Their incidence had increased due to the increased
life expectancy and osteoporosis.
Objective: The aim of this study was to evaluate the use of locked dynamic hip screw plate (LDHS) as a treatment
of intertrochanteric femoral fracture in elderly patients.
Patients and Methods:
This study was a non-randomized clinical trial including eighteen patients with
intertrochanteric femoral fracture fixed with locked dynamic hip screw plate. They came to Orthopedic Department
in Zagazig University Hospital and Orthopedic Department in Tripoli Central Hospital over 3 months from July 2020
until September 2020. Patients with sub-trochanteric extension were excluded. There was 10 cases group A1 and
eight cases group A2 according to AO Orthopedic Trauma Association (OTA).
Results:
Clinical and radiological outcome assessments showed that 77.8% were excellent clinically, 11.1% were
good and 11.1% were fair. Regard radiological assessment, 83.3% were excellent, 11.1% were good and 5.6% were
fair. As regards complications, 4 cases had groin pain and 1 case had lag screw cut-out and overall complications
were in 22.2%.
Conclusion
: Locking DHS plate for trochanteric femur fractures is a good option in elderly patients.
Keywords: Locked Dynamic hip screw (DHS), Elderly patients, Femur fracture..

INTRODUCTION

operative cut out ranges from 1% to 6% (5). To
Hip fractures are a leading cause of disability
overcome these problems a locking plate and screw
among the elderly. Treatment goals for this patient
system has been developed. The locking compression
population include early mobilization with restoration
plate is the combination of two completely different
of the anatomic alignment of the proximal part of the
anchorage technologies in one implant (6). Locked side
femur and maintenance of the fracture reduction (1).
plate for DHS is better than standard DHS plate in
Trochanteric femur fractures account for nearly 50%
treating intertrochanteric fractures in terms of lowering
of all fractures of proximal femur from which 50 ­ 60
of complications rate and maintenance of reduction (7).
% are classified as unstable. Unstable fracture patterns
The aim of this study was to assess the use of (LDHS)
occur more commonly with increased age and low
as an efficient treatment of inter trochanteric femoral
bone mineral density. Patients who suffer
fracture in elderly patients.
intertrochanteric fractures tend to be more limited

ambulators and more dependent in their care (2).
PATIENTS AND METHODS
The care of the patients with trochanteric femur
This study was a non-randomized clinical
fractures has advanced dramatically since the advent
trial including eighteen patients aged above 50 years
of internal fixation. However, the differences in failure
old with intertrochanteric femoral fracture fixed with
rates between stable and unstable intertrochanteric hip
locked dynamic hip screw plate; 12 patients came to
fracture patterns have recently been emphasized (3).
Orthopedic Department, Zagazig university hospital
Restoring mobility in patients with unstable
and 6 patients came to Orthopedic Department, Tripoli
intertrochanteric fracture ultimately depends on the
Central Hospital over 3 months from July 2020 until
strength of the surgical construct. Dynamic hip screw
September 2020 and followed up for 6 months.
(DHS) is commonly used for treating stable
Patients with sub-trochanteric extension, unstable
intertrochanteric fractures. DHS complications include
pattern of fracture and patients with severe debilitating
shortening, medicalization of the distal fragment,
disease were excluded.

implant cut-outs, uncontrolled lateralization of the
Ethical approval: Institutional Review Board (IRB)
proximal fragment, and varus collapse (4).
approval was taken from Zagazig University and
The most common mode of failure is for the lag
also informed written consent was taken from patients
screw to cut out of the femoral head, the second is for
and/or their caregivers. This Work was performed
the plate to be forced off the femur with the screws
according to the code of Ethics of the World
being pulled out of the osteoporotic bone. The post-

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/)
1863
Received:7 /4 /2021

Accepted:3 /6 /2021


Full Paper (vol.841 paper# 37)


c:\work\Jor\vol841_38 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1868-1874

Value of Serum Galectin-3 Levels as A Predictor of
Thromboembolism in Nonvalvular AF
Saud M. Elsaughier*1, Mohamed Yassin Abdelradi1, Mohamed Kamal Slama1,
Naggeh M. Mahmoud1, Amr Salah Amin2, Amr Hanafy1
1Cardiology Department, Faculty of Medicine, Aswan University, Aswan, Egypt.
2Cardiology Department, Faculty of Medicine, Minia University, Minia, Egypt
*Corresponding author: Saud M. Elsaughier, Mobile: (+20)01157166779, E-mail: soud_elsoughier_66@yahoo.com.

ABSTRACT
Background:
Galactin is involved in process of cardiac fibrosis. It is not clear if there is an association between
serum galactin level and thromboembolism events in atrial fibrillation (AF).
Objective: To investigate whether serum galactin levels can be used as a predictor for thromboembolism in patients
with non-valvular AF or not.
Patients and Methods: We conducted a case-control study on 200 participants (100 individuals as a control, 50
patients with AF and thromboembolism and 50 patients with AF but without thromboembolism). We recruited
patients from Cardiology Department, Aswan University Hospital who had non valvular AF. Participants were
subjected to detailed medical history, clinical examination, electrocardiography, and ELISA test to evaluate serum
galactin level. Results: Serum galactin was only predictor for thromboembolic event (OR=2.4, 95% CI = {1.3: 4.3},
P value=0.005) with a sensitivity of 73% and specificity of 65% for the thrombus detection (AUC= 0.80, 95%CI=
{0.69-0.89}). Serum galactin has a sensitivity of 81% and specificity of 77% to detect AF incidence (AUC= 0.84,
95%CI= {0.73-0.99}). Serum galactin was correlated to CHADS-VASc score (r= 0.75, p value < 0.001) and LVEF
(r= - 0.586, p value <0.001).
Conclusion: Galactin-3 level is a possible predictor for thromboembolism in patients with non-valvular AF.
Nevertheless, further studies are still needed to confirm our findings.
Keywords: Non-valvular AF, Thromboembolism, Galactin-3.

INTRODUCTION
Studies have supported an association between serum
Despite good progress in the management of
galectin-3 levels and atrial fibrosis demonstrated with
patients with atrial fibrillation (AF), this arrhythmia
delayed-enhancement of magnetic resonance imaging
remains one of the major causes of stroke, heart
in AF patients (7, 8). In this study, we investigated the
failure, sudden death, and cardiovascular morbidity in
possibility of using galactine-3 as a predictor of
the world. Furthermore, the number of patients with
thromboembolism in non-valvular AF patients.
AF is predicted to rise steeply in the coming years (1).

Traditionally, patients with AF have been
PATIENTS AND METHODS
dichotomized into valvular and non-valvular AF.
Our study is a case-control study that was
Although slightly different definitions have been used,
conducted from January 2018 to October 2019 at
valvular AF generally refers to AF patients with
Cardiology Department, Aswan University Hospital
moderate to severe mitral stenosis or prosthetic heart
and included 100 patients with non-valvular AF and
valves (and valve repair in North American
100 healthy control group. Then patients were divided
guidelines) (2).
into two subgroups: subgroup (A) 50 patients with
In AF patients, reduced LAA flow velocity
nonvalvular AF with thromboembolic events and
(LAAFV) and the presence of spontaneous echo
subgroup (B) 50 patients with non-valvular AF
contrast (SEC), an echogenic swirling pattern of blood
without thromboembolic events. Patients with
flow, which indicates a low-flow state in the left
Moderate to severe mitral stenosis and prosthetic
atrium (LA). These have been shown to be markers of
valve, pregnant women, abnormal thyroid function,
thromboembolic risk (3). Studies have suggested a
recent infection, Alcohol consumption, renal failure,
possible association between inflammation, AF, and
and all patients with non-valvular AF on oral
thrombosis. Levels of inflammatory makers, such as
anticoagulant (warfarin and NOAC) were excluded
C-reactive protein (CRP) have been found to be
from the study.
related to LA/LAA-located SEC and thrombus

Ethical approval:
observed on trans-esophageal echocardiography
An approval of the study was obtained from
(TEE) (4, 5).
Aswan University academic and ethical committee.
Galectin-3 is -galactoside-binding lectin that
All patients were informed about the purpose of the
has been shown to mediate cell-to- cell and cell-to-
research, and written consent was obtained from each
extracellular matrix interactions and act as a novel
patient.
chemo-attractant for monocytes and macrophages (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/)
1868
Received: 17/ 01/2021

Accepted: 13/ 03/2021


Full Paper (vol.841 paper# 38)


c:\work\Jor\vol841_39 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1875-1879

Study of PTCH1 Gene as a Prognostic Marker to Predict Imatinib Response in
CML Patients: a Single Egyptian Center Experience
Mohamed Mahmoud Moussa1, Mohamed Tarif Hamza2,
Omnia Shoukry Abdel Fattah1, Mary Gamal Naguib*1
Departments of 1Internal Medicine-Clinical Hematology and 2Clinical Pathology,
Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Mary Gamal, Mobile: (+20) 01224440277, E-mail: m.s.wilson.mg@gmail.com

ABSTRACT

Background: Chronic myeloid leukemia (CML) is a myeloproliferative illness marked by a reciprocal translocation
between chromosomes 9 and 22 [t (9;22) (q34; q11)], forming the Philadelphia chromosome and bringing together
the Breakpoint Cluster Region (BCR) and Abelson (ABL1) genes. The protein expressed by this fusion gene is a
dysregulated tyrosine kinase that causes alterations in cell proliferation, DNA repair, differentiation, and cell cycle
by phosphorylating many downstream proteins. Objectives: To assess PTCH1 gene expression and response of adult
patients with chronic myeloid leukemia to imatinib treatment.
Patients and Methods: This is a prospective case-control study that included 55 subjects; 45 patients with chronic
phase chronic myeloid leukemia and 10 healthy age and sex-matched controls. The control group presented from the
same geographic origin of the patients in the study group. The study was done between June 2015 and July 2017 at
the hematology clinic, Ain Shams University Hospital.
Results: PTCH1 gene was more in cases than control with a statistical significance (P-value=0.024). On following
up our cases after 6 months treatment with imatinib, patients with desired response to imatinib treatment had a mean
of PTCH1 gene expression of 2.41, compared to 3.58 in patients who did not achieve desired response with a statistical
significance with p-value = 0.017. Incidence of imatinib failure after 6 months of treatment in patients with high
PTCH1 expression is 27.8 % while in those with low expression is 44.4 %.
Conclusion: The study demonstrates that level of PTCH 1 did not affect imatinib response. Therefore, PTCH1 is not
a valid biomarker for imatinib resistance in CML patients.
Keywords: Chronic Phase, Egyptian CML Patients, Predict Imatinib Response, Prognostic Marker, PTCH1 Gene.

INTRODUCTION
progressive anemia, thrombocytopenia, and increasing
Chronic myeloid leukemia (CML) is a
splenomegaly. The median life expectancy is around 3
myeloproliferative condition characterised by increased
to 5 years (2).
granulocytic cell proliferation without loss of
A complete blood count, which reveals an
differentiation potential. It is responsible for 20% of all
increase in granulocytes of all sorts, including mature
adult leukemia cases. CML's clinical symptoms are
myeloid cells, is frequently used to diagnose CML. The
subtle, evolving as the illness develops through its three
presence of basophils and eosinophils is practically
stages (chronic, accelerated, and blastic). Fatigue,
ubiquitous, which may help distinguish CML from a
weight loss, low-grade fever, and splenomegaly are
leukemoid response. CML is characterized by genetic
signs and symptoms of the chronic phase (1).
aberration resulted in the formation of Philadelphia
CML was the first human malignancy
chromosome, which is formed by the fusion of 2 genes,
associated with a specific genetic lesion, the
ABL gene and BCR gene together, they are found on
Philadelphia chromosome, which harbors the BCR-
chromosome 9 and chromosome 22 respectively. The
ABL oncogene. In the realm of hematologic neoplasias,
BCR-ABL1 fusion gene produces the BCR-ABL1
it has now become a paradigm for finding molecular
fusion protein, which is a unique gene product. This
pathways and designing targeted therapeutic strategies
protein product has an enzyme domain with tyrosine
(2).
kinase catalytic activity from normal ABL1. This
CML strikes at a median age of 50 years, with
unregulated tyrosine kinase has been linked to CML
the highest incidence occurring between the ages of 50
pathogenesis (3).
and 60. There is no preference for one gender over
The drugs used to treat CML patients are
another. The chronic phase of the disease is followed by
designed to postpone the start of the accelerated or
the blastic phase, which is a second, more acute or
blastic phase of the disease. To achieve hematologic
sudden phase of the disease. The accelerated phase,
remission,
this
has
typically
included
a
which occurs occasionally between the chronic and
myelosuppressive medication, but more effective drugs
blast phases and is characterised by a more gradual
-most recently, interferon alfa and targeted treatment
increase in blast cells in the peripheral blood,
with tyrosine kinase inhibitors like imatinib mesylate-
progressive anemia, thrombocytopenia, and increasing
have gained prominence. Chemotherapy is sometimes
splenomegaly, is characterised by a more gradual
used to prepare for bone marrow or hematopoietic stem
increase in blast cells in the peripheral blood,
cell transplantation. At 3, 6, 12, and 18 months,

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/)
1875

Received:6 /4 /2021

Accepted: 2/6 /2021


Full Paper (vol.841 paper# 39)


c:\work\Jor\vol841_40 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1880-1885

Metabolic Changes in Women Using Levonorgestrel Releasing Intrauterine System
Mohamed Abdallah Rezk1, Alaa Masoud AbdElgayed1, Shimaa Adel Abdelsalam Allam2,
Dalia Ibrahim Mohamed Morsi1, Heba Maged Abo shady1
1Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Egypt
2Resident of Family planning department, Sadat City Hospital, Menoufia, Egypt
*Corresponding author: Shimaa Adel Abdelsalam Allam, Mobile: (+20) 0106 420 0726, Email: i_wz_u89@yahoo.com

ABSTRACT
Background:
The effect of levonorgestrel-releasing intrauterine system (LNG IUS) on metabolic parameters like body
mass index, body weight, blood pressure, blood sugar, lipid profile and liver function test is still unclear.
Objective: To assess the possible metabolic effects of the levonorgestrel intrauterine system on serum lipids, body
weight and fasting blood glucose level after a period of six months.
Subjects and Methods: A prospective study comprised 50 women attended to the Department of Family Planning in
Sadat city Hospital and request intrauterine hormonal contraception during the period from December 2018 to August
2019. Full history, routine, physical examination and special investigations were taking.
Results: There were no statistically significant differences between the studied patients regarding Socio-demographic
characteristics before and after 6 months follow up. Menstrual change was the most adverse effects among the studied
patients (15 cases, 32.61%), followed by spotting in 6 cases (13.04%) then lower abdominal pain in 5 cases (10.87%).
While, weight gain recorded the lowest frequent (2.17%). Regarding overall satisfaction with the method, most of the
studied patients had very or somewhat satisfied (32 cases, 69.57%) and 14 cases (30.43%) had neutral or somewhat
not satisfied.
Conclusions: Among the Egyptian the LNG-IUS does not have any adverse effects on metabolic parameters, TGs,
LDL and blood sugar levels. Most of the studied patients had very or somewhat satisfied with methods and 30.43%
had neutral or somewhat not satisfied.
Keywords:
Body mass index, Intrauterine system, Levonorgestrel, Lipid profile, Metabolic changes.

INTRODUCTION

Development of progestogen-medicated IUDs
declining slowly over the labeled lifetime of the device.
started in the 1970s and approved first in Finland in
Release of the hormone decreases to 11 g per 24 hours
1990 of an IUD with a 52-mg levonorgestrel load
by the end of 5 years, with an average release rate of 14
initially releasing 20 microg daily (Levonova®) with a
g per day over the life of the device (5). Maximum
5-year effective lifespan. The US FDA approved the 5-
plasma levels are reached within a few hours after
year 52-mg LNG-medicated IUD (Mirena®) in 2000.
LNG-IUS insertion and plateau at 150 to 200 pg/mL
In 2013, FDA approved an IUD with 13.5-mg LNG
(0.4 to 0.6 nmol/L) within the first few weeks. This is
(Skyla® or Jaydess®) and, in 2015, a new 52-mg LNG-
in contrast to the much higher plasma hormone levels
IUD (Liletta®). At present, these two new 13.5- and
of combined oral contraceptives, progesterone only
52-mg LNG-IUDs both have an approved lifespan of 3
pills and Norplant. Plasma LNG levels from the LNG-
years (1). The levonorgestrel-releasing intrauterine
IUS remain quite stable over time, but there is marked
system (LNG IUS) provides a long-acting, highly
variation between individuals (4).
effective, and reversible form of contraception, with a
The side effects, which can lead to treatment
pearl index of 0.18 per 100 women-years. The locally
discontinuation, are mainly due to the progesterone in
released hormone leads to endometrial concentrations
the LNG IUS. Include unscheduled breakthrough
that are 200­800 times those found after daily oral use
bleeding/spotting during the initial 3 to 6 months,
and a plasma level that is lower than that with other
amenorrhea, steroidal side effects, acne, chloasma,
forms of levonorgestrel-containing contraception (2).
weight change, and depression (6).
Apart from being a reliable contraception,
The gross cumulative termination rate at 5 years
Mirena is now widely indicated for its non-
because of change of weight was 1.5 in users of the
contraceptive benefits which include treatment of
LNG IUS and 0 for copper-IUD. The higher gross rate
menorrhagia, dysmenorrhea, premenstrual symptoms,
of removals for weight change in users of LNG IUS
fibroids, adenomyosis, endometriosis etc... (3).
most probably reflects the suspicion that the hormone
Although the mechanism of action of the LNG-IUS is
was responsible for the weight gain (7).
primarily local, the levonorgestrel that is released
Therefore, the aim of this study was to assess the
within the uterus is swiftly absorbed into the systemic
possible metabolic effects of the levonorgestrel
circulation (4). During the first year of use, the LNG IUS
intrauterine system on serum lipids, body weight, and
releases 20 g of levonorgestrel every 24 hours,
fasting blood glucose level after a period of six months.

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/)
1880
Received:8 /4 /2021

Accepted:4 /6 /2021


Full Paper (vol.841 paper# 40)


c:\work\Jor\vol841_41 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1886-1892

Acquired Left Ventricular to Right Atrial Shunt (Gerbodes Defect) after
Aortic Valve Replacement: Case Report
Ayman Elsayed Albadrany
Department of Cardiology, Damietta Cardiac and Gastroenterology Center, Egypt.
*Corresponding author: Ayman Elsayed Elbadrany, Mobile: (+20)1010668806, E-Mail: aymanalbdrany@yahoo.com

ABSTRACT
Background: Left ventricular to right atrial (LV--RA) shunt is an unusual type of ventricular septal defect (VSD).
Acquired LV--RA shunts may be due to complications of cardiac operation, endocarditis, trauma or myocardial
infarction. A previous cardiac operation is the most common cause. The diagnosis of LV--RA communication is
not easy, and it should be remembered in patients who do not recover normally. Diagnosis can be confirmed with
ultrasound or magnetic resonance image (MRI) or multi-slice CT. Surgical correction is usually the treatment of
choice, but closing the communication percutaneously should be considered as an option.
Objective: Aim of this case presentation was to show the clinical scenario of a rare post-operative complication
(after aortic valve replacement).
Patient and methods: Male patient aged 35 years, during hospital admission in the CCU post-operative after aortic
valve replacement was complaining of dyspnea, orthopnea, paroxysmal nocturnal dyspnea and by echocardiographic
examination revealed Gerbode defect, not improved by modification of medical treatment necessitating cardio-
thoracic surgery consultation who recommend conservative treatment and follow up if the patient still symptomatic
surgical repair versus percutaneous closure could be done.
Conclusion: Acquired left ventricular to right atrium shunt (Gerbodes defect) can result from septal trauma after
valve replacement, infective endocarditis, or myocardial infarction. In addition to the usual causes of cardiac
decompensation following aortic valve surgery, one should consider the possibility of a left-to-right shunt secondary
to an iatrogenic left ventricular-right atrial communication, particularly if either septal trauma or extensive valvular
calcification was encountered during the surgical procedure.
Keywords: Acquired left ventricular, Right atrial shunt, Gerbodes defect, Aortic valve replacement.

INTRODUCTION
(after aortic valve replacement), which is acquired left
Communication between left ventricular (LV)
ventricular to right atrium shunt (Gerbode s defect).
and right atrial (RA) is rare hazardous complication
Also, to know when to suspect this complication
for the patient after valve replacement as symptoms
during early postoperative period and how to confirm
may be ignored or may mislead the diagnosis. This is
the diagnosis by trans-thoracic and trans-esophageal
a rare type of acquired form of ventricular septal
echocardiography.
defect (VSD), that may result from complications of

cardiac surgery such as valve replacements (1) or
Anatomy:
closure of VSD (2), endocarditis (3), trauma (4), or
The tricuspid valve is located approximately
myocardial infarction (5). Diagnosis of this rare defect
15 mm below the mitral valve. A thin part of the
is challenging, but can be confirmed with ultrasound
septum between them may be ruptured in case of
or magnetic resonance imaging (MRI) (6). The
injury and create a direct shunt from LV into RA. Such
treatment of choice is surgical correction of the defect
a complication can result from cardiac surgery (1),
however successful trans-catheter closures have been
endocarditis (3), trauma (4), or myocardial infarction (5).
reported (1).
Anatomically, the defect may be above (type I), below
Lack of improvement following aortic valve
the tricuspid valve (type II) or a combination of these
surgery is usually attributed to one of the following:
two (type III) (7) (Fig. 1).
perivalvular
leaks,
prosthetic
dysfunction,
In the two latter cases, a perimembranous
uncorrected associated valve disease, or myocardial
septal defect accompanies a second defect located in
disease. Lack of improvement may be as a result of an
the tricuspid valve, usually in its septal leaflet. The
iatrogenic left ventricular-right atrial shunt
tricuspid valve may have a cleft, widened
inadvertently
produced
during
aortic
valve
commissural
space,
perforation
or
other
replacement or other aortic valve surgery(1).
malformations (7). A case of abnormal chordae, which
Aim of this case presentation was to show the
cause a regurgitation of the tricuspid valve, has also
clinical scenario of a rare post-operative complication
been described (8).

This article is an open access article distributed under the terms and conditions of the Creative



Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1886
Received: 6/4/2021

Accepted: 2/6/2021


Full Paper (vol.841 paper# 41)


c:\work\Jor\vol841_42 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1893-1900

Diagnostic Value of Mean Platelet Volume in Prediction of
Acute Myocardial Infarction
Samir Mohamed Attia1, Ahmed Wafa Soliman2,
Mohamed El Saeed Ahmed3, Ahmed Mohamed Ahmed Lasheen4
Departments of 1Vascular Surgery, 2Cardiology, 3Critical Care Medicine and
Emergency Medicine and 4Traumatology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Mohamed Ahmed Lasheen, Mobile: (+20)1096909403,
E-Mail: drahmedmaged55@gmail.com

ABSTRACT
Background:
Acute myocardial infarction (AMI) is one of the main etiologies of death globally. In AMI, platelets
were demonstrated to play a main role in thrombotic processes that limit the patency of the recanalized, infarct-
related coronary artery and contribute to reperfusion injury. Platelet volume is an important indicator for platelet
function and activation.
Objective:
The aim of the present study was to evaluate mean platelet volume (MPV) as an early and independent
predictor for AMI in patients with acute chest pain.
Patients and methods: This retrospective observational analytical study included a total of 107 patients presenting
with acute chest pain presenting to Mansoura Emergency Hospital within the period from January 2019 to January
2020. Of them, 36 cases were diagnosed as stable coronary artery disease and 71 cases were diagnosed as AMI.
Results: There were statistically significant differences among both groups regarding age, female sex and BMI
being increased in AMI group. Hypertension, DM and dyslipidemia were significantly increased among AMI cases
compared to stable coronary artery disease ones. Stable coronary artery disease cases demonstrated significant
increase in platelet count and significant decrease in MPV compared to AMI ones. Hypertension, DM, dyslipidemia,
family history of CAD, prior MI, prior PCI and MPV could be used as significant predictors for AMI.
Conclusion: The current study concluded that larger platelet volumes may be used as predictor for AMI as well as
ischemic complications.
Keywords:
Diagnostic Value of Mean Platelet Volume, Acute Myocardial Infarction

INTRODUCTION

regarding this issue, and one of the main suspected
Acute myocardial infarction (AMI) is
factors is platelet circulating in the blood flow.
becoming the leading cause of morbidity and

mortality in developing countries. The spectrum of
Platelets are a source of inflammatory mediators, and
presentation is wide from unstable angina to acute
they are being influenced in contact with artery
myocardial infarction. Despite advances in the acute
surface (2).
coronary syndrome (ACS) diagnosing and therapies,
The activated platelets release the mediators,
physicians hospitalize more numbers of low-risk
and then, platelet adhesion and its athero-thrombotic
patients with suspected myocardial ischemia (1).
potential can lead to the release of mediators, the
Troponin and creatine kinase-MB (CK-MB)
progression of inflammatory process, and the
are the routine biochemical markers, which are used
propagation of intracoronary thrombus predisposing
to detect AMI. Troponin, as the most sensitive and
to thrombotic events (2).
tissue-specific cardiac marker, is now considered as
Mean platelet volume (MPV), which is a
the gold-standard biochemical tool for AMI risk
component of complete blood count, is the most
stratification; however, it is undetectable in about 40-
common and reliable index to identifying the platelet
60% of patients suffering from an ACS. Therefore,
size and its activation status.
using a multimarker approach may be of benefit to
An increased MPV is associated with known
diagnose ACS (1).
cardiovascular risk factors, including diabetes
It has been previously demonstrated that the
mellitus
(DM),
hypertension
(HTN),
atherosclerosis is a chronic inflammatory disease.
hypercholesterolemia,
and
obesity.
Some
Atherosclerotic lesions in large and medium-sized
investigations have demonstrated the correlation
arteries can contribute to the ischemia of the heart,
between elevated MPV and AMI, and also the
brain or extremities leading to infarction. Plaque
association
between
increased
MPV
and
rupture and thrombosis are the important
percutaneous coronary intervention outcomes,
complications of the atherosclerotic lesions resulting
including mortality and stent restenosis.
in ischemia. Some factors have been investigated

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/)


1893
Received: 6/4/2021

Accepted: 2/6/2021


Full Paper (vol.841 paper# 42)


c:\work\Jor\vol841_43 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1901-1907

Comparison between Caudal Dexmedetomidine and Morphine for
Postoperative Analgesia in Pediatric Infraumbilical Surgeries
Hamza Aboalm Mahmoud, Ahmed Elsaeed Abd Elrahman Ali,
Mohamed Kamal Mahmoud*, Khaled Abdelfattah Mohamed Abdelfattah
Department of Anesthesia, Intensive Care and Pain Management,
Faculty of Medicine, Sohag University, Egypt
*Corresponding Author: Mohamed Kamal Mahmoud, Mobile: (+20) 01016753206, Email: mohkamalhegazy@gmail.com

ABSTRACT
Background:
The usage of caudal opioids extends the length of analgesia substantially, but it often comes with a
slew of adverse side effects, including fatigue, vomiting, pruritus, urinary retention, and a chance of respiratory
distress later on.
Objective: The aim of this analysis was to compare the effects of caudal dexmedetomidine versus morphine in
conjunction with bupivacaine in pediatric infraumbilical surgeries.
Patients and Methods: This randomized controlled sample involved 90 pediatric patients aged 1 to 7 years old, of
American Society of Anesthesiologists (ASA) physical status I-II, of both sexes, who were scheduled for lower
abdominal surgeries. Patients were allocated to three equal groups. Group D got a 0.25% bupivacaine + 1 g/kg
dexmedetomidine. Group M obtained a 0.25% bupivacaine + 30 g/kg morphine mixture. Group MD:
dexmedetomidine 1 g/kg and morphine 30 g/kg with bupivacaine were used in a single dose caudal epidural
analgesia.
Results: Intraoperative heart rate, mean arterial blood pressure at 20, 25, 30 and 45 min was significantly decreased
in group MD than group D and group M while in postoperative period were insignificantly among the three groups at
all times of measurement. FLACC was significantly lower in MD group at discharge, 1, 2, 3, 6, 12 and 18 hours.
Ramsey sedation score (RSS) at 30 min was significantly decreased in group M than group D and in group MD than
group M. Time for 1st analgesia and paracetamol dosage was significantly earlier in group M than group D and group
MD. Pruritus and vomiting were significantly lower in group D than other groups.
Conclusions: The addition of dexmedetomidine to caudal morphine in pediatric patients produced longer
postoperative analgesia, more sedation and with better emergence from anesthesia and hemodynamic stability, with
fewer side effects than morphine.
Keywords: Caudal, Dexmedetomidine, Morphine, Pediatrics.

INTRODUCTION

One of the most widely employed regional
PATIENTS AND METHODS:
anesthetic approaches of pediatric surgery is the
This randomized controlled prospective analysis
caudal epidural block (1). The biggest drawback with
was performed at Sohag University Hospital from
caudal anesthesia is that it only lasts a brief time
June 2019 to June 2020.
following a single injection of local anesthetic

solution, which is partly attributable to infection fears.
Ethical approval:
As a result, supplementary drugs have been used to
An approval of the study was obtained from
induce elongation of caudal analgesia using a "one
Sohag University academic and ethical committee.
shot" process (epinephrine, opioids, ketamine,
The parents of all patients who were candidates for
midazolam, tramadol, neostigmine, dexmedetomidine)
clinical testing were asked to sign a consent form.
(2). Adding morphine as a second agent aids in
The research involved 90 pediatric patients aged
ensuring successful and long-lasting analgesia whilst
1 to 7 years old of American Society of
still allowing a lower dosage of local anesthetic to be
Anesthesiologists (ASA) physical status I and II of
used, increasing protection and lowering the risk of
both sexes who were scheduled for lower abdominal
undesirable motor blockade (3).
surgeries, such as hernia, and perineal surgeries, such
However, there are a variety of side effects,
as undescended testis and hypospadias.
such as nausea and vomiting, urinary leakage,
Patient's
family
rejection,
overweight
pruritus, and hypoventilation, the most dangerous of
participants, coagulation problems, preexisting
which is respiratory distress in adults and infants (4).
neurological or spinal conditions, congenital
The aim of this research is to compare the
malformations of the spine, allergy to any medication
intraoperative
hemodynamics,
postoperative
included in the research, inflammation and skin
analgesia, and complications of caudal morphine and
lesions at the puncture site were all exclusion
dexmedetomidine alone or in combination for
requirements.
pediatric patients undergoing infraumbilical surgeries.

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/)
1901

Received:7 /4 /2021


Accepted:3 /6 /2021


Full Paper (vol.841 paper# 43)


c:\work\Jor\vol841_44 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1908-1913

Elastic Stable Intramedullary Nailing Femoral Shaft Fractures in
Children from Six to Ten Years Age
Ahmed Hashim Amin1, Ahmed Mohamed Nahla1, Ahmed Mashhour Gaber1,
Millad Mohammed Allafi Kamsawi*2
1Orthopedic Department, Faculty of Medicine, Zagazig University, Egypt.
2Orthopedic Department, Faculty of Medicine, Sabha University, Libya.
*Corresponding Author: Millad Mohammed Allafi Kamsawi, Mobile: 00218925139669, E-mail: kamsawimillad@gmail.com

ABSTRACT
Background:
Diaphyseal fractures of the femur (DFF) are common long-bone injuries in children and adolescents. DFF
represent 1.5% of fractures in childhood.
Objective: This study aimed to evaluate the clinical, functional and radiological outcome of femoral shaft fractures,
which are managed by elastic stable intramedullary nailing (ESIN) in pediatric age 6-10 years.
Patients and Methods: A prospective clinical randomized trial study was conducted on18 children underwent elastic
stable intramedullary nailing (ESIN) for treating femoral shaft fractures at Orthopedic department, Zagazig University
Hospitals during the period from April to December 2020. Plain X- rays of the femur Antero-posterior (AP) & Lateral
(Lat.) views (from hip to the knee joint) was taken. Results: The time to surgery was 1.39 ± 1.12 days ranging from 1
to 6 days, the time till full union was 9.4 ± 1.76 weeks ranging from 7 to 12 weeks, more than half of the studied group
(55.5%) ranged from 7 to 9 weeks and the time of full weight bearing was 9.6 ± 1.7 weeks ranging from 7 to 12 weeks,
half of the studied group (50.0%) ranged from 7 to 9 weeks. So, the final outcome was 83.3% had excellent functional
outcome, 11.1% of them had satisfactory functional outcome and 5.6% had poor functional outcome. 88.8% didn't have
any complications, 5.6% of them had irritation and 5.6% had superficial infection.
Conclusion
: ESIN is the choice treatment for transverse and short oblique shaft fractures in patients aging from 6 to 10
years old.
Keywords: Femoral shaft fractures, Femur, ESIN, Intramedullary nail.

INTRODUCTION


Femoral shaft fractures are a frequent pediatric
approaches [4, 5]. ESIN fits all of the minimally invasive
orthopedic injury that account for fewer than 2% of all
bone surgery requirements, including a shorter operating
pediatric fractures. 90 percent of femoral shaft fractures
time, little soft tissue dissection, fewer incisions and
in children are caused by motor vehicle accidents. The
consequently fewer scars, less discomfort, quicker
yearly incidence of femoral shaft fractures from road
mobilisation, and relatively simple implant removal [6].
traffic accidents is estimated to be between 1.0 and 2.9
Implantation of flexible nails is performed through
million [1]. Pediatric femur shaft fractures tend to unite
very small incisions and does not endanger the physes or
rapidly and have a tremendous remodeling potential.
the blood supply to the femoral head. The implant is
Consequently, a wide range of deformity of the initial
sufficiently elastic to respect normal bony curvature and
healed bone is considered acceptable. The acceptable
acts as a load sharing (internal splint) that maintains
angulation in the coronal and sagittal planes varies from
reduction until callus formation appears. It aims at rapid
30º at birth to 15º at 10 years. Rotational malalignment
restoration of bone continuity and no joint stiffness, and
does not remodel and deformity more than 10 in the axial
early rehabilitation [7].
plane is not acceptable. Limb shortening of up to 15 mm
This study was performed to evaluate the clinical,
can be compensated in children up to 12 years of age by
functional and radiological outcomes of femoral shaft
growth acceleration [1, 2].
fractures, which are managed by elastic stable
A variety of factors influence whether a femoral
intramedullary nailing (ESIN) in pediatric age from 6 to
shaft fracture should be treated conservatively or
10 years old.
surgically, including the patient's age and weight, the

kind of fracture, accompanying injuries/polytrauma, and
PATIENTS AND METHODS
the family's socioeconomic status [3].
A prospective clinical randomized trial
Elastic stable intramedullary nails (ESINs) have
study was conducted on18 patients (13 males, 5 females)
become the standard treatment of femur shaft fractures
aged from 6 to 10 years old and the mean age was 7.7
in children between 5 and 15 years because of favorable
years with fracture shaft of femur (11 suffered from right
results and lack of major complications. It is a closed
side fracture and 7 had left side fracture). The study was
surgical procedure that allows early weight bearing and
conducted in the Orthopedic Department, Zagazig
walking. The technique of ESIN was developed by the
University Hospital and treated surgically by elastic
team from Nancy in 1982 and represents a compromise
intramedullary nailing. There were 16 cases with closed
between conservative and surgical therapeutic
fracture and 2 cases with open fracture Gustilo's type I.




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/)
1908
Received:8 /4 /2021

Accepted:4 /6 /2021



Full Paper (vol.841 paper# 44)


c:\work\Jor\vol841_45 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1914-1919

Intravenous Magnesium Sulfate versus Tramadol in Prevention of Post Spinal
Shivering in Geriatric Patients Undergoing Transurethral Resection of Prostate
Fatma Mahmoud Ahmed1, Ashraf Said Sayed1, Hala Ibrahim Zanfaly1, Jamaah Husayn Qareen*2
1Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Zagazig University, Egypt
2Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Sirte University, Libya
*Corresponding Author: Jamaah Husayn Qareen, Mobile: 00218917811001, E-mail: khaledgrain69@gmail.com

ABSTRACT
Background:
Postanesthetic shivering is a frequent complication of anesthesia, perhaps even aggravating pain
especially during transurethral rsection of prostate (TURP) surgery.
Objective: To compare the efficacy of I.V MgSO4 and tramadol to placebo normal saline on incidence and severity of
postspinal shivering in geriatric patients undergoing TURP surgery, when used as prophylaxis.
Patients and methods: This was a comparative prospective study that included 39 geriatric male patients who
scheduled for performing an elective TURP surgery under subarachnoid blockade (SAB) at Zagazig University
Hospitals. Patients were divided equally into 3 groups: Group C received isotonic saline after spinal anesthesia, group
Mg: received I.V MgSO4 in isotonic saline and group T: received I.V tramadol in isotonic saline after spinal anesthesia.
All patients were enrolled for examination before and after surgery.
Results:
There was no significant difference among the studied groups as regards HR, MAP and Spo2 between the
three studied groups. Regarding changes in temperature between the studied groups, C group showed a significant
lower temperature time followed by Mg group then T group at different times. There was a significant higher rate of
shivering in C group then Mg group and the lowest was T group. Onset of shivering was significantly faster in control
then Mg group and longer significantly in Group T.
Conclusions: Prophylactic administration of I.V tramadol in a dose of 0.5 mg/kg immediately after SAB could
significantly reduce the incidence and severity of postspinal shivering more than I.V MgSO4 in a dose of 15 mg/kg in
geriatric patients undergoing TURP surgery.
Keywords: Tramadol, MgSO4, Post Spinal Shivering, TURP.

INTRODUCTION
problems. Hypothermia can complicate TURP surgery.
Spinal anesthesia is known to significantly
Geriatric patients are predisposed to the risk of
impair thermoregulation and predispose patients to
hypothermia, which induces shivering after spinal
hypothermia (1). General and epidural anesthesia alter
anesthesia (6).
the function of the autonomic nervous system, which
Magnesium sulfate (MgSO4) has anti-shivering
plays a significant role in thermoregulation and
effects. But it may enhance the rate of cooling because
interferes primarily with peripheral vasoconstriction
of its vasodilatory properties. Furthermore, it has a
below the level of the sympathetic blockade (2).
potential neuroprotective effects, and experimental
Shivering associated with spinal and epidural
data suggest that the neuroprotective effect of
anesthesia is common, occurring in up to 56.7% of
hypothermia may be increased with the addition of
patients (3). Shivering may interferes with monitoring of
MgSO (7, 8)
4
.
the electrocardiogram, blood pressure, and oxygen
Tramadol is a centrally acting weak -opioid
saturation. Furthermore, shivering increases oxygen
receptor analgesic. Administration of tramadol is the
consumption, lactic acidosis, carbon dioxide
universally available cost-effective drug with the
production, and metabolic rate by up to 400%. Thus, it
minimal side-effects. It is a cyclohexanol derivative,
may cause problems in patients with low cardiac and
which has agonist activity as well as acts as an
pulmonary reserves (4). Shivering is an important
inhibitor of serotonin and norepinephrine uptake. It is
problem for urologists, especially during transurethral
metabolized in the liver and is mainly consumed as an
resection of the prostate (TURP) surgery. Shivering
analgesic (9). Intravenous tramadol has been used for
may interfere with the surgeon's ability to visualize a
treatment of shivering. The use of oral tramadol 50 mg
resectable prostate tissue. Injury to the urethra, bladder,
is effective as a prophylactic agent to reduce the
and rectum may occur during the procedure. As a
incidence, severity and duration of perioperative
result, shivering not only prolongs the operation time,
shivering in patients undergoing TURP surgery under
it may also cause severe complications (5).
subarachnoid blockade (SAB) (10). The analgesic
Geriatric patients have a higher incidence of
potency of tramadol is found to be a ten times lesser
morbidity and mortality during surgery than young age.
than morphine but is preferred being safe than the later.
Also, geriatric patients who are undergoing TURP
Tramadol is considered safe, as it does not cause
surgery have a cardiac risk because of medical
respiratory depression and addiction when compared to

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/)
1914
Received:9 /4 /2021

Accepted: 5/6 /2021


Full Paper (vol.841 paper# 45)


c:\work\Jor\vol841_46 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1920-1931

Effect of Bisphenol A on the Testis of Offspring of White Albino Rats during
Pregnancy and Lactation: (Light and Electron Microscopic Study)
Al Sayed A. Abd Elhady*1, Mohamed A. Autifi2, Moustafa E. El Gizawy2, Moaaz M. Yousef2
1Department of Human Anatomy and Embryology, Faculty of Medicine, Helwan University, Egypt.
2Department of Human Anatomy and Embryology, Faculty of Medicine, Al-Azhar University, Egypt.
*Corresponding author: Al Sayed A. Abd Elhady, Mobile: (+20) 01001951390, E-Mail: abdrahmankellany@yahoo.com

ABSTRACT
Introduction
: The synthetic industrial and biomedical chemicals suspected to threat the health of the living
organisms by disrupting their endocrine systems, referred to as endocrine disrupting chemicals (EDCs).
Objective:
To study the effects of Bisphenol A (BPA) on the natal and postnatal testis by the light and electron
microscope to make sure if it is harmful or not on the development of male reproductive organs in albino rats.
Matrial and Methods: Chemical used:
Bisphenol A. The daily single oral dose was (0.3 mg/kg BW./day).
Experimental animals: Adult female rats in proestrus cycle were caged overnight with adult males of proven
fertility (1 male / 2 females / cage) and produced neonatal male rats.The offspring rats were divided into five main
groups: Group I (Control offspring group), Group II (Experimental low dose treated offspring group with Bisphenol
A (0.3 mg/kg BW./day) for two weeks, Group III (Experimental high dose treated offspring group; 12 mg/kg
b.w/day
), Group IV (First recovery group ), Group V (Second recovery group),
Results:
Chronic Bisphenol A administration produced testicular toxicity leading to marked serious histological
changes of the testis including the spermatogenic cells, spermatids, Sertoli cells and Leydig cells. These testicular
changes increased with the high dose intake of BPA indicating its cumulative toxic effects that caused
hypospermatogenesis, leading to infertility.
Conclusion: Bisphenol A administration causes testicular toxicity. So, these serious complications on testicular
structure should be considered when buying any canned foods or drinks, because it is used nowadays on a large scale
allover the world.
Keywards: Albino Rats, BPA, Testis. Histology.

INTRODUCTION
suggested that BPA affects male reproductive system,
The Endocrine Society defines an endocrine-
leading to lower sperm counts and alterations in
disrupting chemical (EDC) as "an exogenous chemical,
testicular histology (6).
or mixture of chemicals, that interferes with any aspect
But, the effects and mechanism of BPA toxicity
of hormone action"(1). Bisphenol A (BPA) is an EDCs
on reproductive system still remain unclear. So, the
that is widely present in the environment. It is widely
majority of population in the developing countries may
used in production of polycarbonate plastics which are
not be aware of the harmful effects of BPA on the
introduced into the environment by the pharmaceutical,
human body (7). Hence, this study was designed to
food, cosmetics, agricultural, and chemical industries
observe and analyze the effects of prenatal and post
(2). A key concept in the study of EDCs is that their
natal exposure of BPA on the testes of adult male
mechanism of action cannot be easily demonstrated in
albino rats and the possibility of recovery.
vivo,
as
their
effects
can
appear
after

prolonged/continuous exposure to a low dose and, even
MATRIALS AND METHODS
worse, these effects are often the result of the
A-Materials:
simultaneous interaction of several substances (mixture
1- Chemical used:
effect) and the hormone balance of the individual
Bisphenol A (BPA, CAS 80-05-7, > 99% pure) was
concerned(3).
Spermatogenesis
is
a
complex
purchased from Sigma Aldrich Company (USA)
differentiation process involving the production of
Tocopherol-stripped corn oil (ICN Biomedicals Inc.,
spermatozoa
which
requires
the
functional
Aurora, OH) served as the vehicle and control
coordination of numerous endocrine and paracrine
substance. The daily single oral dose was 0.3 mg/kg
factors. For this reason, EDCs have been repeatedly
b.w/day. while the high dose was 12 mg/kg b.w/day.
linked to its disruption(4).
The doses were selected as lowest observed adverse
Several researches on EDCs have shown that
effect levels (LOAEL) on the male reproductive
their effects in critical periods of development,
system and toxic daily doses of BPA according to
including prenatal life and early childhood, may lead to
(8,9).
serious consequences. However, the studies that
2- Experimental animals:
examine the effects of prenatal and lactational
Adult male and female albino rats (weight 200-250 gm
exposures are extremely limited(5). Some studies
male and 160-200gm female ) were selected in Animal




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/)
1920
Received: 7/4 /2021


Accepted:3 /6 /2021



Full Paper (vol.841 paper# 46)


c:\work\Jor\vol841_47 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1932-1938

New Modification of Koyanagi Technique Using Dartos Muscle Flap in
Management of Proximal Hypospadias
Tarek Abd El Hamed Keshk, Yasser Mohamed Omar El Sheikh, Mahmoud Abd El Rahman, Haytham
Shaker Ahmed Rezq, Hanan Ali Ali Dawod
Plastic Surgery Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding Author: Haytham Shaker Ahmed Rezq, Mobile: +965 6003 9355,
E-mail: drhaythamshaker@yahoo.com

ABSTRACT
Background:
One stage urethroplasty through parameatal foreskin flap (OUPF) available for all types of hypospadias
was first described by Tomohiko Koyanagi (1983). High complication rates were reported.
Objective:
To evaluate the outcome of Koyanagi technique modification using dartos muscle as a 2nd layer because it
has a high vascularity, very thin, easily elevated, and leaves no complications.
Patient and methods: This study was conducted in the Plastic Surgery Department at Menoufia University, during
the period of April 2017 to April 2019. Thirty cases for proximal hypospadias were included during this study. After
chordee release, urethra was constructed using Koyanagi technique and adding scrotal dartos muscle flap as a 2nd layer.
Results: Patient's age ranged from 1 to 4 years with mean age of 2.83 ± 1.17. All of the 30 cases were with proximal
hypospadias and had severe chordee. Early complications were detected as bleeding in 2 patients (6.6%). One patient
(3.3%) reported for retention due to obstruction of the inserted catheter. Another case (3.3%) showed wound infection.
The reported late complications were fistula in 6 patients (20%), meatal recession in 5 patients (16.6%), meatal stenosis
in 3 patients (10%), and diverticulum in one patient (3.3%).
Conclusion: The modified Koyanagi one stage repair of proximal hypospadias is an innovative technique and realize
many criteria for expected effective operating results. The use of dartos muscle flap as a cover for the urethroplasty
improves the results and minimize complications.
Keywords: Dartos muscle flap, Management, Modification of Koyanagi, Proximal hypospadias.

INTRODUCTION

of April 2017 to April 2019. Thirty cases of proximal
Hypospadias is one of the commonest congenital
hypospadias were included in this study. The single-
anomalies, through the incidence about 1 in 300 live
phase repair, modified Koyanagi technique by using
births. Proximal hypospadias may be mi penile (20­
scrotal dartos muscle flap as a 2nd layer was performed
30% of cases), or posterior penile, penoscrotal, scrotal,
for all of them.
or perineal (10­15% of cases) all of them have chordee

(1, 2). Proximal hypospadias shows the most challenging
Ethical considerations:
and complex manifestations and might be treated
All procedures were carried out according to
successfully using one of several one- or multiple-stage
the ethical standards of the institutional committee
techniques (3). All evolved different surgical techniques
and with the 1964 Declaration of Helsinki. The study
of repair target the same purpose, to give the child a
received the contest of Ethical Committee of Faculty
straight penis with a terminal meatus with least
Medicine, Menoufia University. The aim and steps of
morbidity. No technique has gained widespread
the study were explained to the parents and written au
popularity, as each technique has its advantage and
courant consent were acquired from them.
drawbacks. The Koyanagi technique combines the

release of chordee and construction of urethra using two
Inclusion
criteria:
Children
with
proximal
meatal-based flaps into a single procedure. Many
hypospadias, presence of chordee, intact prepuce and
modifications applied to this technique aiming to
healthy penile skin.
improve the blood supply of the neourethral flaps to

achieve good healing for minimizing postoperative
Exclusion
criteria:
Children
with
anterior
complications (4, 5).
hypospadias, previously operated using preputial flap
Therefore, the purpose of this study was to
and circumcised patients or severely scared penile skin.
evaluate the outcome of Koyanagi technique

modification using dartos muscle as a 2nd layer because
Methods
it is a highly vascular tissue, very thin, easily elevated,
Patient Preparation: All patients were subjected to
and leaves no complications.
thorough clinical evaluation, routine laboratory

investigations, and abdominopelvic ultrasonography to
PATIENT AND METHODS
exclude other associated anomalies. All patients, after
This study was conducted in the Plastic Surgery
complete release of chordee, had modified Koyanagi
Department at Menoufia University, within the period
technique. All operations were completely performed




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/)
1932
Received:8 /4 /2021

Accepted: 4/6 /2021


Full Paper (vol.841 paper# 47)


c:\work\Jor\vol841_48 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1939-1944
Evaluation of Percutaneous Tendoachilles Tenotomy as an
Outpatient Procedure in Clubfoot Treatment by Ponseti Method
Adel Abdelazim Ahmad Salem1, Khaled Edris Abdelrahman1,
Fahmi Subhi Alghazawi*2, Mahmoud Elsayed Elbadawy Thabet1
1Orthopedic Department, Faculty of medicine, Zagazeg University, Sharkia, Egypt.
2Orthopedic Department, Faculty of medicine, Gharyan University, Gharyan, Libya.
*Corresponding Author: Fahmi Subhi Alghazawi, Mobile: 00218944629813, E-mail: algezawy2018@gmail.com

ABSTRACT
Background:
Clubfoot is a relatively common congenital foot deformity. Ponseti demonstrated correction of clubfoot
in infants using manipulation followed by application of well-molded, long-leg plaster casts. Objective: In the current
study, we evaluated the efficacy and safety of percutaneous Achilles tenotomy as an office procedure during the
Ponseti technique in the correction of CTEV deformity of the foot. Patients and Methods: This randomized clinical
trial study was conducted in the Orthopedic Outpatient Clinic of Zagazig University Hospitals on 12 patients with
idiopathic clubfoot managed with the Ponseti technique during the period from April 2020 to September 2020.
Results
: This study showed, 13 feet had a favorable outcome (8 cases (53.3%) excellent and 5 cases good 33.3%) and
2 feet had fair outcome (13.3); these 2 feet had a relapse (13.3%), one foot relapsed equinus deformity and one adducts
foot deformity, The equinus deformity patient responded to repeated tendo-Achilles tenotomy and further Ponseti
casting and adductus foot deformity responded to adductor tenotomy and cast. Both two cases obtained satisfactory
outcomes after the completion of treatment. Conclusion: Achilles tenotomy as an out-patient procedure using topical
and/or local anesthesia is a safe procedure and is an important step in the successful treatment of congenital clubfoot.
Keywords: Clubfoot, Ponseti method, Achilles tenotomy.

INTRODUCTION


Clubfoot, also termed congenital talipes
procedure during the Ponseti technique in the
equinovarus (CTEV), is a common foot abnormality,
correction of CTEV deformity of the foot.
in which the foot points downward (equinus) and

forefoot inward (metatarsus adductus) hindfoot in
PATIENTS AND METHODS
(varus) midfoot in (cavus). The condition is present at
This randomized clinical trial study was conducted
birth. It is occurring in about one in every 1000 live
in the Orthopedic Outpatient Clinic of Zagazig
births(1).
University Hospitals on 12 patients with idiopathic
Clubfoot deformity may be associated with
clubfoot managed with the Ponseti technique during
myelodysplasia, arthrogryposis, or multiple congenital
the period from April 2020 to September 2020. We
abnormalities, but is most commonly an isolated birth
performed the procedure on 12 patients with idiopathic
defect and considered idiopathic(2). The prevalence of
(15 feet) who were included in this prospective study,
additional congenital anomalies or chromosomal
syndromic cases, recurrent or residual cases were
abnormalities in patients with clubfoot varies
excluded.
substantially across studies, depending on the

population, and ranges from 24% to 50%(3).
Inclusion criteria: Idiopathic clubfoot managed with
Clubfoot is an embryonic malformation. A
the Ponseti technique. Age: below 1 year. Exclusion
normally developing foot turns into a clubfoot during
criteria: Syndromic cases such as arthrogryposis
the second trimester of pregnancy. As regards the
multiplex congenita, Spina Bifida, cerebral palsy, and
pathology, according to Turco, the talus is forced into
poliomyelitis. Residual talipes equinovarus after
the equinus by the underlying calcaneus and navicular,
Ponseti technique. Recurrent cases after surgical
whereas the head and neck of the talus have deviated
correction.
medially. The calcaneus is inverted under the talus,
Written informed consent was obtained from all
with the posterior end displaced upward and laterally,
participants' parents and the study was approved by the
and the anterior end displaced downward and
research ethics committee of the Faculty of Medicine,
medially(4).
Zagazig University. The work has been carried out
The management of clubfoot deformity has
following The Code of Ethics of the World Medical
been transformed in the last two decades from surgical
Association (Declaration of Helsinki) for studies
correction (posterior medial release) to the non-
involving humans.
surgical Ponseti method(5).

This study aimed to evaluate the efficacy and
Ethical consent:
safety of percutaneous Achilles tenotomy as an office
Approval of the study was obtained from Zagazeg

University academic and ethical committee. Every

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/)
1939
Received:10 /4 /2021

Accepted: 6/6 /2021


Full Paper (vol.841 paper# 48)


c:\work\Jor\vol841_49 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1945-1954

Mental Health Outcomes Among Health Care Workers Exposed to
Covid-19 Pandemic, Qalyoubia Governorate: Cross-Sectional Survey
Mai Abdullah Elmahdy*, Eman Mahmoud Shebl
Department of Public Health and Community Medicine, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mai Abdullah Elmahdy, Mobile: (+20) 01201882742, E-Mail: maielmahdy24@yahoo.com

ABSTRACT
Background:
The pandemic caused by novel coronavirus disease 2019 (COVID-19) is considered the worst health crisis
facing the entire world today. At the topmost of this crisis are the healthcare workers (HCWs) who are working to
maintain well-being of all people. COVID-19 pandemic added more and more stress to healthcare workers in particular,
depending on their work position. Objective: To assess mental health outcomes among HCWs dealing with confirmed
or suspected COVID-19 patients. Methods: This is cross-sectional, hospital-based survey study conducted between Feb
6 and April 28, 2021. A total of 548 HCWs participated in the study. Mental health impact was assessed by using the 9-
item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder (GAD-7) and the 7-item Insomnia
Severity Index (ISI) questionnaires. Multivariable logistic regression analysis was done to determine the risk factors of
mental health outcomes. Results: Among the 548 HCWs surveyed; 64.8% were nurses and 50.0% aged from 26-30 years
old. About 52.0% worked in Benha University Hospital, 21.2% worked in Toukh Fever Hospital, and 26.8% worked in
Qaha Central Hospital. A considerable proportion of HCWs had symptoms of anxiety, depression and insomnia. Nurses,
workers aged from 26-30, those working in Qaha Central Hospital and those who had shift hours from 7­10 experienced
more severe symptom levels of depression, anxiety, and insomnia. Nurses were associated with severe symptoms of
anxiety, depression and insomnia.
Conclusion:
The COVID-19 pandemic represents a new working challenge for HCWs and intervention strategies to
prevent depression and anxiety to reduce the risk of adverse mental health outcomes are needed.
Keywords: Anxiety, COVID-19, Depression, (HCWs) Health Care Workers, Mental Health, Insomnia.

INTRODUCTION
treatment and care of COVID-19 patients were at risk of
The pandemic of the severe acute respiratory
developing psychological stress and other mental health
coronavirus 2 (SARS-COV-2) and its associated disease,
symptoms. The increasing number of suspected and
named coronavirus disease 19 (COVID-19), was
confirmed cases, awesome workload, and reduction of
emerged at the end of December 2019 in Wuhan, China,
personal protection equipment, extensive media
then spread to the entire country, and then attracted large
coverage, lack of proper treatment or specific drugs, and
concern from around the world (1). As COVID-19 is
feelings of being inadequately supported may all lead to
rapidly spreading worldwide, on May 29, 2021, there
the mental burden of healthcare workers (9). Adding to all
have been 169,118,995 confirmed cases of COVID-19
these previous factors, most health professionals working
worldwide, including 3,519,175 deaths. On 29th of May
in quarantine units and hospitals very often do not receive
2021, Egypt reported 259,540 confirmed cases of
any training for providing care of mental health (10).
COVID-19 and 14,950 deaths (2). The situation in Egypt
Furthermore, the mental health problems of
is becoming more and more critical and serious with the
HCWs would affect their clinical decision-making,
increasing number of cases and the large numbers of
attention and cognitive functioning, leading to a
deaths caused by the disease (3, 4). Adding to this the
subsequent increase in the incidence of medical errors
governmental health expenditure in Egypt is only 5.3%
and medical problems, and thus putting patients at more
of gross domestic product (GDP), such limited resources
risks (11, 12). It was also well known that acute stress in
combined with the continuous increasing number of
disasters can lead to a long-term effect on the overall
cases place a huge burden on healthcare workers during
health (13). So, the mental health problems of HCWs
the COVID-19 pandemic (5).
during the COVID-19 pandemic became an important
Infectious disease outbreaks such as COVID-19
and crucial public health concern and addressing mental
can cause depression, anxiety and emotional distress.
health issues of HCWs is important for improving
These feelings of distress and anxiety can occur even in
pandemic prevention and control as well (14).
people that are not at high risk of getting sick (6, 7, and 8).
This study aimed to assess mental health
Hence, facing this growing pandemic, HCWs especially
outcomes among Egyptian healthcare workers dealing
the frontline who are directly involved in the diagnosis,
with confirmed or suspected COVID-19 patients to be as
an important indicator for the promotion of mental health

This article is an open a

ccess article distributed under the terms and conditions of the Creative



Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
1945
Received:9 /4 /2021

Accepted:5 /6 /2021


Full Paper (vol.841 paper# 49)


c:\work\Jor\vol841_50 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1955-1960

Ferrous Sulphate Alone Versus Combination of Ferrous Sulphate and
Lactoferrin for The Treatment of Iron Deficiency Anemia during
Pregnancy and Their Effect on Neonatal Iron Store: A Randomized Clinical Trial
Ibrahim Ali Seif El-Nasr*, Sayed Abdmoneim Mahmoud, Eman Mahmoud Elnaddar, Hesham Ali Ammar
Obstetrics and Gynecology Departments, Faculty of Medicine, Menoufia University Menoufia, Egypt.
*Corresponding author: Ibrahim Seif El-Nasr, Mobile: (+20)01003086747, Email: ibrahimaliseifelnasr@gmail.com

ABSTRACT

Background: Iron deficiency anemia (IDA) is a frequent medical condition that causes disturbing pregnancies,
especially in low-resource nations, and it contributes considerably to morbidity and mortality. As a result, early
detection and treatment of IDA are strongly advised.
Objective: This study was conducted to evaluate the effectiveness, safety and acceptability of ferrous sulphate alone
in comparison to combination of ferrous sulphate and lactoferrin for the treatment of iron deficiency anemia during
pregnancy and their effect on neonatal iron store.
Patients and methods: This randomized prospective cohort study was conducted on 300 pregnant women from the
second trimester with IDA who were enrolled and randomly separated on 2 groups; ferrous sulphate group: 150
pregnant women received 150 mg of dried ferrous sulphate capsules. Combined ferrous sulphate and lactoferrin group:
150 pregnant women received combined 200 mg lactoferrin and 30 mg iron once daily for eight consecutive weeks.
Results: Total increase in CBC with combined ferrous sulphate and lactoferrin was higher compared to ferrous sulfate
alone (p value < 0.05). Gastrointestinal adverse effects occurred more frequently with ferrous sulphate than the
combined ferrous sulphate and lactoferrin (p< 0.05). Neonatal iron store significantly increased in combined ferrous
sulphate and lactoferrin than in ferrous sulphate alone (p value < 0.001).
Conclusion: Combined ferrous sulphate and lactoferrin was more effective than ferrous sulfate in pregnant women
with IDA, with fewer gastrointestinal adverse effects and better effect on neonatal iron store.
Keywords: Combined ferrous sulphate and lactoferrin, Ferrous sulphate, Iron deficiency anemia.


INTRODUCTION


IDA is the most common type of anemia, it is
This study was conducted to evaluate the
more prevalent during pregnancy due to high iron
efficacy and safety of combined ferrous sulphate and
requirements during gestation due to the increase in
lactoferrin in comparison to ferrous sulphate for the
maternal red cell mass, and for development of the
treatment of IDA during pregnancy and their effect on
fetus and placenta (1).
neonatal iron store.
Anemia affects maternal and fetal health. It

affects the general wellbeing of the mother (i.e. fatigue,
PATIENTS AND METHODS
dyspnea, palpitations, headaches and irritability) and
This randomized prospective cohort study included
increases the risk of maternal morbidity and mortality,
300 pregnant women suffering from iron deficiency
preterm birth, fetal growth retardation, low birthweight
anemia, conducted in the Department of Obstetrics and
and perinatal death and decrease neonatal iron store (2).
Gynecology at Menoufia University Hospital and
There are different routes in treatment of IDA in
General Menouf Hospital from October 2019 to April
pregnancy (3).
2020.
The oral route as ferrous iron preparations are

the first choice to replace iron stores as this allows the
Ethical approval:
normal mechanism of absorption to be used, in addition
The study protocol was approved by Hospital
to being an inexpensive and effective treatment (4).
Local Medical Ethical Committee, Faculty of
Unfortunately, gastrointestinal side effects such as
medicine, Menoufia University.
epigastric discomfort, nausea, vomiting, diarrhea,
An informed consent was obtained from all study
constipation, abdominal colicky pain and dark stools
participants after explanation nature and scope of the
are frequently associated with ferrous iron supplements
study.
and up to 30% of patients' experience dose limiting
Pregnant women with single fetus, in the second
side effects (5).
trimester, with IDA (hemoglobin level< 10.5 g/dL and
Oral bovine lactoferrin is an alternative to
ferritin level< 12 ng/mL) were enrolled.
ferrous sulphate for treatment of IDA in pregnancy

with minimal gasterointestinal side effects (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/)
1955
Received: 9/4 /2021

Accepted:5 /6 /2021


Full Paper (vol.841 paper# 50)


c:\work\Jor\vol841_51 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1961-1971

The Integrative Role of Magnetic Resonance Cholangiopancreatography and
Percutaneous Transhepatic Cholangiography in Malignant Obstructive Jaundice
Hayam A. Abdellatif1, Omar A. Hamada2, Mohamed S. Elzawawi1, Mohamed A. Deif2
1Department of Radio-diagnosis, Faculty of Medicine, Menoufia University, Egypt.
2Department of Radiology, National Liver Institute, Menoufia University, Egypt.
*Correspondence author: Hayam Abdelmonsif Abdellatif, Mobile: (+20) 01098057324, Email: hayam_drar@yahoo.com

ABSTRACT
Background:
Magnetic resonance cholangiopancreatography (MRCP) and percutaneous trans-hepatic
cholangiography (PTC) are established techniques for the evaluation of intra-hepatic and extra-hepatic bile ducts in
patients with malignant hepato-biliary diseases. PTC has procedure-related complications. MRCP is accurate, non-
invasive and safe.
Objective: To evaluate the role of magnetic resonance cholangiopancreatography (MRCP) and percutaneous
transhepatic cholangiography (PTC) in the diagnosis of malignant biliary obstruction.
Patients and Methods:
This study was conducted on 30 patients (18 males and 12 females) with malignant
obstructive jaundice. Their ages ranged between 36 and 85 years with a mean age of 59.9 years. All the 30 examined
cases in our study were subjected to MRCP and PTC to detect the diagnosis, the level of obstruction and the degree
of obstruction.
Results:
Both MRCP and PTC were accurate in the detection of the malignant biliary dilatation and the level of
obstruction. MRCP provided adequate information in the diagnosis of the malignant lesions with sensitivity of 86.6%
with low sensitivity to detect the degree of obstruction weather complete or partial 12.5% compared to PTC. MRCP
detected other related malignant features in 40% of cases. PTC-related complications in 6 out of 30 cases (20%). In
6 patients more than one puncture had to be performed during PTC to delineate the whole biliary system.
Conclusion: MRCP is accurate and non-invasive procedure for the diagnosis of the malignant obstructive jaundice
and the level of biliary obstruction reserving PTC for therapeutic procedures and pre-surgical assessment of the degree
of obstruction.
Keywords: Magnetic resonance, Cholangiopancreatography, Percutaneous trans-hepatic, cholangiography,
Malignant obstructive jaundice.

INTRODUCTION
signals from the background tissue are hypo-intense,
Malignant obstructive jaundice is a frequent
allowing excellent description of the biliary
clinical condition caused by malignancies of the
anatomical structures (5).
pancreas, biliary tree, liver, or subsequent metastases
PTC studies show the level, extent and
in the liver or lymph nodes of the porta-hepatis (1). The
characteristics of lesions which obstruct bile ducts.
majority of the time, radiographic imaging is used to
Biliary obstruction is caused by many conditions,
diagnose bile duct cancer. Imaging gives crucial
including benign and malignant diseases. Malignant
information for assessing operability and the most
biliary obstruction (MBO) is usually caused by
appropriate surgical approach (2). Elevated serum
cholangiocarcinoma, gall bladder and pancreatic
enzymes may be the sole identifiable abnormality in
malignancies, metastatic lymphadenopathy and
the early stages of bile duct cancer, but after the tumour
infrequently by hepatic and advanced gastric and
has grown large enough to cause stenosis along the
duodenal malignancies. Frequently the tumors are
biliary channel, serum bilirubin begins to rise. The
unresectable at diagnosis and only palliative treatment
major goal is to distinguish between intra- and extra-
is possible to improve patients' quality of life (6).
hepatic causes. Imaging must next be used to establish
The management of obstructive jaundice is often a
the location and type of the obstructive lesion (3).
difficult problem for the surgeon. Many affected
MRCP is a completely non-invasive technique
patients are elderly, and are poor surgical risks.
that provides projectional images similar to those of
Accurate information regarding the level, extent and
ERCP without administration of any contrast agents,
nature of the obstructing lesion enables an early and
without radiation, requires no anesthesia and less
precise decision on the type of surgical intervention,
operator dependent (4). The signal of static or slow-
and greatly improves the progress of these patients.
moving fluid-filled structures like the bile and
Tumors situated distally in the common bile duct or
pancreatic ducts is greatly increased by using heavily
ampulla of Vater are often amenable to surgical
T2-weighted sequences, resulting in increased duct-to-
resection. Detailed information on more proximal,
background contrast, so signals from the biliary system
unresectable tumors may allow the surgeon to arrange
and pancreatic duct fluids are hyper-intense whereas
a bypass treatment for beneficial palliation, or it may

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/)
1961
Received:9 /4 /2021

Accepted:5 /6 /2021


Full Paper (vol.841 paper# 51)


c:\work\Jor\vol841_52 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1971-1978

Histopathological Changes in Lesional and Perilesional Vitiligo Skin
Ola A Bakry1, Rehab M Samaka2, Wafaa Shehata1, Basma F Elsawah1, Iman Seleit1
1Department of Dermatology and Andrology and STDs, 2Department of Pathology,
Faculty of Medicine, Faculty of Medicine, Menoufiya University, Egypt.
*Corresponding Author: Ola Bakry, Mobile: (+20)00201065190509, Email: olabakry8@gmail.com

ABSTRACT
Background
: Vitiligo is a skin disease with complex, multifactorial pathogenesis. Abnormalities in surrounding
keratinocytes may cause melanocyte death due to deprivation of growth factors.
Objective: To evaluate Haematoxylin and Eosin (H&E) histopathological findings in lesional and perilesional
vitiliginous skin.
Patients Methods: Lesional skin biopsies were taken from 18 vitiligo patients. Perilesional biopsies were taken from 5
patients. All biopsies were stained with Hematoxylin and Eosin for histopathological assessment.
Results: Detected changes in lesional skin included increased epidermal thickness, epidermal atrophy, focal disruption
of dermoepidermal junction and vacuolar degeneration with focal degree. All examined sections showed congested
blood vessels and scanty melanin pigment. Dermal perivascular lymphocytic infiltration was present in all cases.
Detected changes in perilesional skin included increased epidermal thickness, epidermal atrophy, plenty of melanin
pigment and focal vacuolar alteration. All examined sections showed congested blood vessels and focally disrupted
dermoepidermal junction. Dermal perivascular lymphocytic infiltration was present in all sections.
Conclusion: Histopathological changes occur in perilesional as well as lesional vitiligo skin. Therefore, topical or
physical treatment for vitiligo should be extended to the surrounding apparently normal skin. This may help in arresting
disease course by preventing subclinical or silent lesions from progression to clinically visible lesions.
Keywords: Hematoxylin and eosin, Lesional, Perilesional, Vitiligo.

INTRODUCTION
an informed written consent was taken from each
Vitiligo is an acquired pigmentary disorder of the
participant in the study prior to study initiation.
skin presenting as depigmented or hypopigmented
The studied cases were either newly diagnosed or
macules or patches. It affects 0.1-2% of population
old patients with completely depigmented lesions. The
worldwide (1). The prevalence of disease in Egypt's
diagnosis of vitiligo was based on the patient's history
general population was estimated to be 1.22 percent (2).
and the typical clinical features of discrete, well
It can begin at any age with almost half of the patients
circumscribed, milky white macules and patches.
presenting before the age of 20 years (3).
Inclusion criteria: Newly diagnosed patients with
Vitiligo is divided into two types; segmental and
different clinical varieties of nonsegmental vitiligo
nonsegmental. Generalized vitiligo, focal vitiligo, acral
irrespective of age and gender who agreed to join the
vitiligo, acrofacial vitiligo, and vitiligo universalis are
study and signed written consent.
examples of nonsegmental vitiligo (4). Vitiligo's
Exclusion criteria: Dermatologic disease other than
pathophysiology is poorly known. The presence of
nonsegmental vitiligo, systemic autoimmune or
several pathogenic factors for the disease, which
inflammatory disease, cases having leukoderma
progress as a result of the interaction of numerous genes
secondary to other diseases and patients with vitiligo
and the environment, is the fundamental explanation (5).
under treatment.
Although epidermal melanocytes form a

functional and structural unit with surrounding
Every patient was subjected to:
keratinocytes, most investigations on vitiligo have
1- History taking:
focused on the abnormalities of melanocytes rather than
A) Personal history: Name, age and sex.
the abnormalities of keratinocytes (6).
B) Present history: Onset, course and duration of
The current work aimed to study histopathological
disease.
changes in lesional and perilesional vitiligo skin.
C) Family history of vitiligo.

2-Examination: Full general and dermatological
PATIENTS AND METHOD
examination.
This study was carried out on 18 patients with
3-Skin biopsies:
vitiligo. Patients were selected from the Dermatology
Three millimeter punch biopsies were taken
Outpatient Clinic, Menoufia University Hospital in the
under 2% lignocaine local anesthesia from vitiliginous
period between October 2015 and October 2017.
skin of patients. Biopsies from perilesional area were
Ethical approval:
taken from 5 patients. Biopsies were fixed in neutral
The study was approved by the Ethics Board of
formalin 10% and submitted to routine tissue
Menoufia Faculty of Medicine University and
processing ending with paraffin embedded blocks

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/)
1971
Received: 9/4/2021

Accepted: 5/6/2021


Full Paper (vol.841 paper# 52)


c:\work\Jor\vol841_53 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1980-1983

Tracheoesophageal Voice Rehabilitation after Total laryngectomy:
Primary Versus Secondary Tracheoesophageal Puncture
Ibrahim Ahmed Khaled*, Alaa El-Din Mohammed El-Feky, Tarek Abd-Elmoaty Omran,
Khaled Abd-Elshakour Mohammed, Amal Said Quriba, Ali Mohammed Awad
Department Otorhinolaryngology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding Author: Ibrahim Ahmed Khaled, Mobile: (+20)01025825570, E-mail:dr.5aled444@Gmail.com


ASTRACT
Background:
Voice prosthesis is the current standard for post laryngectomy rehabilitation. Several clinical factors
can affect the functional outcomes of voice prosthesis. Various complications are recorded with voice prosthesis.
Objective: This study aimed to compare the results of primary and secondary provox insertion in patients with
advanced laryngeal carcinoma undergoing total laryngectomy.
Patients and Methods:
Randomized-controlled clinical study included 24 patients with provox voice prosthesis
rehabilitation 12 had primary tracheoesophageal puncture and 12 had secondary tracheoesophageal puncture. All
patients were evaluated for successful voice restoration and complications rates.
Results:
Short-term success rate was 92% in the primary group and 83% in the secondary group. Long-term success
rate was 83% in the primary group and 75% in the secondary group. Success rates were higher in the primary group
but without statistically significant difference. Complications rate in the primary group was 58.3% and in the
secondary group 66.6%. Complications rate was higher in the secondary group but without statistically significant
difference. Conclusion: Provox voice prosthesis provides consistent and good voice results, which improve with
time. Primary provox insertion had better success rates and fewer complications. Periprosthetic leak is the most
common complication.
Keywords: Total laryngectomy, Voice rehabilitation, Tracheoesophageal puncture, Provox prosthesis.

INTRODUCTION
TEP) or late afterwards (secondary TEP). Primary TEP
Laryngeal cancer represents the second most tumor
has the advantages of avoiding a second operation with
of the region of head and neck and upper aerodigestive
immediate postoperative voice acquisition but it is
tract following carcinoma of the oral cavity with a
associated with increased risk of surgical complications
predominant histological type of squamous cell
such as pharyngocutaneous fistula (PCF), stomal
carcinoma (1, 2).
stenosis, and local infection around prosthesis.
Total laryngectomy (TL) is the best surgical
Secondary TEP ensure proper wound and tracheostomal
approach in advanced laryngeal cancer. It is an
healing with better patient satisfaction after being
aggressive surgery compromising many vital functions
aphonic for certain duration (6). This study aimed to
of the patients including speech communication with an
compare the results of primary and secondary provox
adverse impact on patients' physical, functional and
insertion in patients with advanced laryngeal carcinoma
psychological health resulting in a decreased quality of
undergoing total laryngectomy.
life. Restoration of speech is an integral part of

rehabilitation of laryngectomees and can be achieved by
PATIENTS AND METHODS
esophageal speech, artificial larynx, or surgical creation
This randomized-controlled clinical study was
of tracheoesophageal fistula to insert voice prosthesis
carried out in ORL-HNS Department, Zagazig
(3). Tracheoesophageal puncture (TEP) and voice
University from 2017 to 2020. Sample size was
prosthesis insertion allows the patient to speak through
designed to be 24 cases, (Group A) or primary group:
tracheoesophageal speech. When the stoma is occluded
(12) cases with advanced laryngeal carcinoma operated
it causes shunting of the expired air through the one way
by total laryngectomy and provox insertion at the same
valve into the esophagus. The expired air causes
operation. (Group B) or secondary group: (12) cases
vibrations of the upper esophageal and neopharyngeal
actually operated by total laryngectomy and provox
segment with production of voice (4).
insertion is made as a separate operation.
Prosthetic voice rehabilitation has numerous

advantages including immediate voice production,
Inclusion criteria in the primary group: Patients with
higher success rate, and the ability to produce fluent,
advanced laryngeal carcinoma T3 & T4 laryngeal
intelligible and natural sounding voice in contrast to
lesions, fit for surgery, and intact (T0) party
other speech rehabilitation methods so that TEP with
tracheoesophageal wall.
prosthetic voice rehabilitation is considered the gold

standard for post TL voice rehabilitation (5). TEP) can
Inclusion criteria in the secondary group: Patients
be made at the time of total laryngectomy (primary
motivated for TEP, patent stoma, adequate pulmonary

support, good visual acuity and good manual dexterity.

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/)
1980
Received:11 /4 /2021

Accepted:7 /6 /2021


Full Paper (vol.841 paper# 53)


c:\work\Jor\vol841_54 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1984-1988

Management of Open Tibial Shaft Fractures in Children with
Intramedullary Elastic Nail
Amr Mohamed Eladawy1, Riad Mansour Megahed1,
Abobaker Emrehil Mohamed Yosef*2, Mohamed Ibrahim Salama1
1Orthopedic Department, Faculty of Medicine, Zagazeg University, Egypt.
2Orthopedic Department, Faculty of Medicine, Tripoli University, Libya.
*Corresponding Author: Abobaker Emrehil Mohamed, Mobile: (+20)01013506461, E-mail: abobaker.m.yosef@gmail.com

ABSTRACT
Background:
Elastic intramedullary nailing is a method of diaphyseal fracture osteosynthesis in children. This
technique has many advantages. Namely, there is primary bone union with avoidance of growth plate injury, early
weight bearing, and minimally invasive surgery with a short duration of hospitalization. Objective: In this study, we
evaluated radiological and functional results of treatment of open tibial shaft fractures in children using intramedullary
elastic nail. Patients and Methods: This study was a prospective clinical study that included 24 cases with open tibial
fractures treated with intramedullary elastic nail at Zagazig University Hospital (ZUH), Egypt and in Tripoli Central
Hospital in Libya from June 2020 until September 2020 with six months follow-up. All patients were assessed
radiologically by anteroposterior and lateral plain radiographs of the tibia that included the knee and ankle to limit
unnecessary radiation. Results: The majority of studied group were excellent in 19 cases clinically according to
Ketenjian and Shelton Criteria and 23 cases were united using radiological assessment. Only two cases had superficial
skin infection and just one case had delayed union. Conclusion: Flexible intramedullary nailing is an effective
treatment option in patients with open fracture (gustilo type I, II), four to fifteen years age group.
Keywords: Elastic Nail, Fracture, Open Tibial

INTRODUCTION

Pediatric tibial fractures are the most common
Elastic intramedullary nailing is a method of
fractures in children, which account for 25­43% of all
diaphyseal fracture osteosynthesis in children(5). This
childhood fractures. The annual incidence of childhood
technique has many advantages. Namely, there is
fracture varies greatly across studies from about 12
primary bone union with avoidance of growth plate
fractures per 1000 children to 36.1 fractures per 1000
injury, early weight bearing, and minimally invasive
children with different factors suggested to impact the
surgery with a short duration of hospitalization(6).
incidence including geographic location, age, and
This study aimed to evaluate management of
gender of the patient(1).
open tibial shaft fractures in children with
Most of the tibial shaft fractures are managed
intramedullary elastic nail.
conservatively. The indications for the operative

treatment include open fractures, neurovascular
PATIENTS AND METHODS
deficits, polytrauma, unstable fracture patterns, and
A prospective clinical study was conducted on 24
fractures that fail to meet acceptable reduction
patients (18 males and 6 females) age varied from 4
parameters (roughly 10 degrees of sagittal angulation,
years to 15 years with a mean age±SD of (9.63 ± 1.88)
10 degrees of varus/valgus, >50% translation(2).
years with fracture shaft of open tibial fractures treated
Pediatric patients with high-energy tibial shaft
with intramedullary elastic nail at Zagazig University
fractures represent a challenging subset of injuries for
Hospital (ZUH), Egypt and in Tripoli Central Hospital
the orthopedic surgeon. Preservation of the proximal
in Libya from June 2020 until September 2020 with six
tibial physis precludes the use of reamed, locked
months follow-up.
intramedullary nails as in the skeletally mature

population, necessitating the use of other modalities.
Ethical approval:
External fixation has been used to stabilize these
An approval of the study was obtained from
injuries but has been shown to have increased time to
Zagazeg
University academic and
ethical
union, malunion, leg-length discrepancy, pin-tract
committee. Every patient signed an informed
infection, and decreased functional outcome(3).
written consent for acceptance of the operation.
Other fixation techniques like plate have

limited utilization due to more extended dissection
Inclusion criteria:
which leads to soft-tissue damage. Moreover, some
Displaced open tibial fractures, Gustilo Anderson
authors suggested that applying plate under the age of
classification grade 1 and 2. The fracture pattern was
twelve stimulates growth which may result in leg
classified using the classification of the AO/ASIF
length discrepancy(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/)
1984
Received:10 /4 /2021

Accepted:6 /6 /2021


Full Paper (vol.841 paper# 54)


c:\work\Jor\vol841_55 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1989-1993

Assessment of Interleukin-34 Serum level In Children with
Systemic lupus Erythematosus
Hossam Mostafa Kamal1, Mohammed Mohammed Abd El salam1,
Ahmad Mokhtar Ahmad2, Hany Suliman Selem Awadallah1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University, Egypt.
*Corresponding Author: Hany Suliman Selem Awadallah, Mobile: (+20) 01027034970,
Email: hanyawadallah1119@gmail.com


ABSTRACT
Background:
Pediatric-onset systemic lupus erythematosus (pSLE) is an autoimmune disease with multiorgan
involvement and accounts for 15% to 20% of all systemic lupus erythematosus (SLE) cases. Systemic lupus
erythematosus (SLE) is a multifactorial autoimmune disease characterized by variable immune dysregulation,
disabling symptoms, and progressive organ damage. Interleukin (IL) -34 is a newly discovered cytokine that has no
significant amino acid sequence homology to other cytokines.
Objective:
This study aimed to assess interleukin-34 serum level in children with systemic lupus erythematosus.
Patients and Methods:
This was a case-control study performed on 39 individuals divided into control group
containing 13 healthy children and diseased group containing 26 children, which further subdivided into two diseased
groups (one group classified as active SLE group and another group classified as inactive SLE group each group
contained 13 children).
Results: In our study the age of the participant children were distributed as 9.46 ± 2.93, 9.07 ± 2.9 and 10.0 ± 3.22 for
the control group, inactive and active SLE groups respectively with no significant difference among the studied groups
regarding age. But regarding sex, females were majority among all the studied groups with no significant difference
between all groups. Our study showed that malar rash was significantly associated with the active lupus nephritis (LN)
group. In the current study, we found that serum Interleukin 34 was significantly higher among the active LN group
followed by the inactive LN group and the control group was significantly lower.
Conclusion:

The serum IL-34 level was significantly elevated in the SLE patients. IL-34 could be a potential
disease activity marker, and this study might have revealed new insight for the study of SLE disease activity.
Keywords: Metabolic syndrome, Uric acid, Evaluation.

INTRODUCTION

Pediatric-onset systemic lupus erythematosus
therapeutic strategy and predicting treatment outcome
(pSLE) is an autoimmune disease with multiorgan
(2).
involvement and accounts for 15% to 20% of all
Interleukin (IL) -34 is a newly discovered
systemic lupus erythematosus (SLE) cases (1, 2). SLE is
cytokine that has no significant amino acid sequence
a multifactorial autoimmune disease characterized by
homology to other cytokines. (8) Currently, knowledge
variable immune dysregulation, disabling symptoms,
regarding this cytokine is limited. IL-34 shares a
and progressive organ damage (3).
common receptor with macrophage-colony stimulating
Although many of the clinical manifestations
factor (M-CSF) (9). Because IL-34 is an alternative
were similar with the adult onset form, lupus nephritis
ligand of the colony-stimulating factor-1 receptor
(LN) among the pediatric population has been
(CSF-1R), IL-34 binds to CSF-1R and promotes the
suggested to differ from the adult onset cases for its
differentiation and proliferation of lymphocytes and
abrupt onset, high prevalence, and relative poor
the expression of cytokines, leading to inflammatory
response to current treatment regimen (4).
lesions and autoimmunity (8). The study aimed to assess
According to previous studies, as high as 50% to
interleukin-34 serum level in children with systemic
78% of pediatric-onset systemic lupus erythematosus
lupus erythematosus.
(pSLE) cases suffered renal damages (5) and 18% to

50% of these cases subsequently progressed to end-
PATIENTS AND METHODS
stage renal disease (ESRD) (6). Additionally, WHO
This study was a case-control study that included
class IV diffuse proliferative glomerulonephritis, the
39 individuals. This study was conducted at Pediatric
subgroup known with the worst outcome, is the most
Department (Nephrology Unit), Zagazig University
common histopathological findings of LN among
Hospitals.
pSLE patients accounting for half (40%­55%) of the

cases (7).
Selected children were divided into two groups:
To date, invasive renal biopsy remains the gold
Group A: healthy controls, and Group B: diseased
standard in determining LN classification, directing
children with SLE.

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/)
1989
Received:11 /4 /2021

Accepted:7 /6 /2021


Full Paper (vol.841 paper# 55)


Evaluation Of QT Interval In Diabetic Ketoacidosis In Medical Intensive Care Unit The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 1994-1999

Validity of Computed Tomography Scoring Model for Prediction of Cervical
Nodal Metastasis in Patients with Head and Neck Squamous Cell Carcinoma

Amira Abdelnaby Abdallah*, Dalia Nabil Khalifa,
Mohammad Abd Alkhalak Basha, Ahmed Mohamed Alsowey
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Amira Abdelnaby Abdallah, Mobile: (+20)1285429547, E-mail: amiraelazony11@gmail.com

ABSTRACT
Background
: Squamous cell carcinoma of the head and neck is a common and often fatal cancer that can emerge
from a variety of anatomic locations. An accurate and comprehensive assessment of lymph node metastasis in
patients with head and neck squamous cell carcinoma (HNSCC) is necessary in daily practice.
Objective: This study aimed to predict cervical nodal metastasis by using multidetector computed tomography
(MDCT) scoring model in patients with HNSCCC.
Patients and Methods
: A cross sectional study in Zagazig University Hospital during the period from November
2019 to April 2020, included 76 lymph nodes from thirty patients with HNSCC. We analyzed preoperative CT
images of lymph nodes including diameter, ratio of long to short axis diameter, necrosis and T stage of the
primary tumor. The reference standard comprised pathologic results. Multivariable logistic regression analysis
was performed to evaluate the risk scoring system.
Results
: A 9-point risk scoring system (shortest axial diameter, L/S ratio, necrosis and T stage). The most common
site was RT buccal region (5 cases), followed by base of tongue (3 cases), followed by RT sided of tongue (cases 5),
followed by LT sided of tongue (1 case), followed by tip of nose (1 case), followed by lower lip (4 cases), followed
by RT mandibular ramus (3 cases), followed by Epiglottis, true, false vocal cord, aryepiglottic fold (4 cases),
followed by LT sided floor of mouth (2 cases), followed by LT external auditory meatus (1 case) and swelling in
posterior scalp.
Conclusion: A simple 9 point risk scoring system using CT characteristic of lymph nodes and tumors for HNSCC
could be feasible to stratify the risk of cervical lymph node metastasis with high diagnostic accuracy.
Keywords: Area under curve (AUC), HNSCC, Long-to-short.

INTRODUCTION
prediction of cervical lymph node metastasis and
Squamous cell carcinoma of the head and neck is
decision-making in daily practice as the existence and
a common, nasty, and sometimes fatal cancer that can
extent of lymph node metastasis change the extent of
emerge from a variety of anatomic locations. Tobacco
lymph node dissection and therapeutic plans in
use, alcoholism, and infection with a cancer-causing
patients with HNSCC (12-14) .
virus are all risk factors (1).
This study aimed to predict cervical nodal
In patients with head and neck squamous cell
metastasis by using MDCT scoring model in
carcinoma (HNSCC), the occurrence of lymph node
patients with HNSCCC
metastases has a significant influence on therapy and

prognosis (2).
PATIENTS AND METHODS
The presence of a metastatic node must be
This study included 30 patients; they were 17
correctly diagnosed before head and neck cancer may
males and 13 females with their ages ranged from 25
be treated. The prospect of early identification and
to 81 years and their mean age was 54.32 (± 13.38
treatment of head and neck cancer has a lot of
SD) years. Our patients were referred from Oncology
promise for improving the quality of life and
Department, Zagazig University Hospitals as well as
prognosis for these cancer patients (3).
the outpatient clinic for Neck MDCT examination
Contrast-enhanced multidetector CT is the
with intravenous contrast media during the period
preferred imaging modality for staging of the neck
from November 2019 to April 2020.
and detection of lymph node metastasis in HNSCC(4-

7). A simple 9-point scoring model using preoperative
Ethical approval:
CT characteristic of lymph nodes (including
Written informed consent was obtained from all
diameters, ratio of long to short axis diameter, and
participants and the study was accepted by the
presence of necrosis or cystic change) combined with,
Research Ethics Committee of the Faculty of
characteristics of primary tumor (such as T-stage )
Medicine, Zagazig University. Study has been
were selected as predictor s for lymph node
carried out on experiments involving human
metastasis (2, 8-11).
subjects in compliance with the Code of Ethics of
This proper diagnostic model based on those CT
the World Medical Association (Declaration
features maximize the role of enhanced MDCT in
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/)
1994

Received:10 /4 /2021


Accepted:6 /6 /2021


Full Paper (vol.841 paper# 56)


c:\work\Jor\vol841_57 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2000-2003

Corpus Callosum Tractography and its Correlation with Cognitive and
Behavioural Changes in Children with Attention-Deficit/Hyperactivity Disorder
Ayman Abdelfattah El-Hadad1, Afaf Zein El-Abedien Ragab1, Mohamed Mohamed Houseni2,
Ahmed Nabil Ramadan1, Esraa Mohiey Eldeen Hamdy*1
Departments 1Neuropsychiatry and 2Radiology - National Liver Institute,
Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Esraa Mohiey Eldeen Hamdy, Mobile: 00201018910476, E-mail: dr.esraa.mohiey@gmail.com

ABSTRACT
Background:
Very few studies have investigated the changes in white mater, corpus callosum (CC) specifically,
in attention-deficit/hyperactivity disorder (ADHD) patients and its relation to cognitive and behavioral changes in
ADHD patients. This study aimed to investigate the correlation between tractography of CC, behavioral and
cognitive changes in ADHD patients. Objectives: To detect any morphological changes in corpus callosum in
patients with attention-deficit/hyperactivity disorder through diffusion tensor image (tractography) and to elucidate
its relation with cognitive and behavioral changes of patients with ADHD.
Patients and Methods: A case-control study was done on 100 children divided into two groups; cases and
controls at Menoufia University Hospitals. They were selected according to certain inclusion and exclusion
criteria. Diffusion tensor imaging (DTI) of CC was done to both groups. Both behavioral and cognitive functions
were assessed in correlation with radiological data.
Results:
There were no significant differences between the groups regarding demographic data that included age
and sex, while statistically significant difference (p value <0.001*) was detected in IQ in ADHD (mean IQ was
89.62) compared to control (mean IQ: 96.08). The mean FA value (a measure of white matter consistency in DTI)
was higher in control group than in ADHD group in all subdivisions of corpus callosum with no significant
difference between the two groups except for the isthmus part (p value 0.034) whose fibers were originating from
sensory motor cortex denoting defective functioning in mentioned areas.
Conclusion:
Diffusion tensor image study of corpus callosum in attention deficit hyperactivity disorder reflected
defective inter-hemispheric connectivity mainly sensory motor cortices through isthmus part of corpus callosum.
Keywords: Corpus callosum tractography, Cognitive and behavioural changes, Children, Attention-
deficit/hyperactivity disorder.

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD)
brain volume with abnormally small caudate nuclei in
is a neurodevelopmental disorder used to be named as
ADHD patients (6).
hyperkinetic disorder (HKD) (1). It is characterized by
Indeed, not all patients of ADHD had cerebellar
three main characteristics which are hyperactivity,
or fronto-parietal atrophy as declared. Other areas of
impulsivity and inattention (2).
the brain must be searched carefully according to the
Its prevalence is estimated about 5-7% of
specific clinical presentation. This study aimed to
children and adolescents' population. According to
investigate whether there is a correlation between
DSM5, There are three subtypes of ADHD namely,
tractography of corpus callosum, behavioral and
predominantly
inattentive,
predominantly
cognitive functional changes in ADHD patients.
hyperactive/ impulsive and combined type (3).

According to DSM5, clinical diagnosis of ADHD
PATIENTS AND METHODS
necessitates the presence of at least 6 symptoms of
This study included 100 children that were
hyperactivity /impulsivity and at least 6 symptoms of
grouped into cases and controls at Menoufia
inattention. The high degree of heterogeneity in
University Pediatric and Child Psychiatry Outpatient
ADHD drags attention to the possibility of different
Clinic.
underlying theories explaining the condition (4).

With
evolution
of
Neuro-radiological
Inclusion Criteria: Diagnosis with attention deficit
interventions, studying ADHD using structural and
and hyperactivity disorder according to the criteria of
functional magnetic resonance imaging (MRI) started
DSM 5, age from 3 up to 14 years, both male and
to develop recently. Imaging of the brain anatomy of
female, IQ of 80.
ADHD has become the main stay for diagnosis (5).

For a decade, most studies have focused only on
Exclusion Criteria: Patients with co-morbid major
frontal-striatal regions and detected smaller volume
psychiatric disorder other than ADHD e.g. mental
of the brain in the affected patients. As many studies
sub-normality and schizophrenia, children with other
approved, there is a 3% to 4% global reduction in
neurological disorders as cerebral palsy, epilepsy or

organic brain lesions, children with chronic physical

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/)
2000

Received:12 /4 /2021


Accepted:8 /6 /2021



Full Paper (vol.841 paper# 57)


c:\work\Jor\vol841_58 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2004-2007
Early Outcomes of Cardiac Surgery in Patients with Liver Cirrhosis
Mohamed Azzam*, Hussein Derbala, Hesham Zayed Saleh
Cardiothoracic Surgery Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Egypt.
*Corresponding author: Mohamed Azzam, Mobile: (+20)01001427368, E-mail: dr.mohamed.ezzazzam@gmail.com

ABSTRACT
Background:
Liver cirrhosis is known to be associated with increased morbidity and mortality in patients
undergoing cardiac surgery.
Objective: The purpose of this study was to evaluate the early outcomes of cardiac surgery in patients with liver
cirrhosis in our settings, and to assess the performance of the Child-Pugh classification as a predictor of early
mortality.
Patients and Methods: A retrospective observational study included 58 patients operated between March 2012 and
October 2019. Among these 52 patients required open-heart procedures and 6 were operated without the use of
cardiopulmonary bypass. The primary endpoint being examined was early mortality.
Results: The overall mortality was 20.7%. Higher Child-Pugh (CP) class was associated with marked rise in
mortality. The mortality rate increased from 10.8% patients in class A of the Child-Pugh, to 25% in class B patients
to 80% in class C patients. The need for urgent or emergent procedures was also found to be associated with an
increased risk of mortality.
Conclusion: Early results of cardiac surgery in Child-Pugh class A patients although apparently higher than the
general population, remain acceptable. The mortality in patients with CP class C is extremely high and almost
prohibitive. Non-elective procedures also seemed to be associated with a significant increase in early mortality. This
should be borne in mind while assessing surgical risk in cirrhotic patients.
Keywords: Cardiac surgery, Liver cirrhosis, Child-Pugh score.

INTRODUCTION
Three patients were excluded due to deficient
Chronic liver disease constitutes a major health
files and lack of necessary laboratory results. The
problem in Egypt. Despite a recent decline, Egypt has
remaining 58 patients were included in the study and
the highest age-standardized rate of death due to liver
their individual files were reviewed to extract clinical
cirrhosis in the region, with hepatitis B and hepatitis C
data.
being the main etiologic factors (1). Although cardiac
Diagnosis of liver cirrhosis was founded on
surgery in cirrhotic patients is known to carry a higher
clinical history and physical findings consistent with
mortality and morbidity risk (2-5), the impact of the
cirrhosis, along with findings of abdominal
severity of hepatic dysfunction on surgical outcomes
ultrasonography or other imaging studies, which were
remains difficult to quantify.
characterized by a coarsened heterogeneous
The severity of liver cirrhosis has commonly been
echogenic pattern along with nodularity of the liver
evaluated by CP classification (6, 7).
surface and increased echogenicity of hepatic
Although this classification has been developed
parenchyma. The severity of liver cirrhosis was
for different clinical applications, many authors have
graded according to the CP classification.
used it to predict the cardiac surgical outcomes in
In-hospital mortality was defined as death
cirrhotic patients (3, 8, and 9).
within the same hospital admission regardless of cause.
The purpose of the current study was to evaluate
The occurrence of hepatic decompensation, evidenced
the early outcomes of cardiac surgery in patients with
by the new appearance of portosystemic
liver cirrhosis in our settings, and to assess the
encephalopathy, ascites, jaundice, coagulopathy,
performance of the CP class as a predictor of early
variceal bleed, and hepatorenal syndrome, was noted.
mortality.
The diagnosis of hepatic encephalopathy was made

after ruling out hypoxemia, pharmacological factors
PATIENTS AND METHODS
or other metabolic factors. Re-exploration for
This retrospective observational study included
bleeding was defined as bleeding that required
all patients diagnosed with liver cirrhosis and operated
surgical re-operation after initial departure from the
in the Cardiothoracic Surgery Department, Kasr Al
operating theatre. Renal failure was defined as patients
Ainy University Hospitals during the period spanning
with a post-operative kidney dysfunction requiring
from March 2012 to October 2019 where 61 cirrhotic
dialysis. Prolonged mechanical ventilation was
patients were offered a cardiac surgical procedure.
defined as the need for intubation and mechanical

ventilation for more than 72 hours, after completion 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/)
2004
Received: 12/4/2021

Accepted: 8/6/2021


Full Paper (vol.841 paper# 58)


c:\work\Jor\vol841_59 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2008-2013

Impact of Vitamin D Supplementation on Dry Eye in People with
Low Serum Vitamin D
Saber Hamed El Said1, Ahmed Ibrahim Basiony1,
Manar Mohammed Amin*1, Shaimaa Kamal El-deen2
Departments 1Ophthalmology and 2Internal Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Manar M. Amin, E-mail: manar.amin.sobih@gmail.com, Mobile (+20) 0155 844 6656

ABSTRACT
Background:
Dry eye is a disease (DED) of the tear film and ocular surface, leading to ocular discomforts and pain.
The pathophysiology of DED includes tear film instability and ocular surface inflammation. Vitamin D refers to a
group of fat-soluble secosteroids responsible for enhancing intestinal absorption of calcium, iron, magnesium,
phosphate, and zinc. It is not strictly a vitamin, and may be considered a hormone as its synthesis and activity occur
in different locations.
Objective: This study aimed to investigate tear film function in patients with vitamin D deficiency.
Patient and methods: A case-control study included 75 eyes of 39 patients who were referred to the Ophthalmologic
Clinic, Menoufia University during the period from March 2020 to December 2020. Patients of dry eye underwent
tear break up time, Schirmer I test without anesthesia and special tests as well as measurement of serum vitamin D
level were assessed.
Results: 25-hydroxy vitamin D level of the studied group ranged from 6-18.50 ng/ml with mean value of 8.22 ± 4.814
ng/ml. Also, majority of studied sample (92.3%) had bilateral affected eyes, followed by Gelinya (30%). Schirmer's
test, tear film breakup time (TFBUT) and ocular surface disease index (OSDI) were increased significantly when
compared the values at baseline and after treatment to be after 10 weeks (P < 0.001).
Conclusion: Vitamin D replacement appears to improve ocular surface health in patients with vitamin D deficiency.
However, further clinical trials with a large sample size and control group are warranted to define the role of vitamin
D. Vitamin D supplementation is an effective and useful treatment for patients with dry eye syndrome (DES) that is
refractory to conventional treatment.
Keywords: Dry Eye, Schirmer I test, TFBUT, OSDI, Vitamin D.

INTRODUCTION
also plays important roles in immune regulation,
The tear film is a thin fluid layer providing a
proliferation,
differentiation,
apoptosis,
and
smooth surface over the cornea (1). It is composed of 3
angiogenesis. Vitamin D deficiency and genetic
layers: the innermost mucin layer, an aqueous layer,
variations may cause a wide range of ocular
and the outermost lipid layer (2). Furthermore, the tear
pathologies, such as myopia, age-related macular
film is a complex mix of electrolytes, proteins
degeneration, diabetic retinopathy, uveitis, and dry eye
(lipocalins, lactoferrin, transferrin, defensin, and
(5). Vitamin D deficiency may also cause dry eye, as
lysozyme),
phospholipids,
oligopeptides,
studies have reported dry eye syndrome (DES) to be a
glycopeptides, and immunoglobulins. The tear film
localized autoimmune disease, and researchers
also includes a variety of surfactants, including
recently hypothesized that vitamin D plays a role in the
surfactant proteins A and D. It is essential for the
disorder because of its anti-inflammatory properties (6).
health of the eye that tears film components work in
Dry eye, described by increased osmolarity of the tear
harmony (3). Tears film stability is therefore, the result
film and inflammation of the ocular surface that cause
of the harmonious balance between tear components.
ocular discomfort, visual disturbance, and tear film
A disturbance in one or more of the tear layers leads to
instability with potential damage to the ocular surface
the occurrence of dry eye disease (DED). DED is a
(7). Hyperosmolarity provides proinflammatory stress
disease of the tear film and ocular surface, leading to
to the ocular surface (8). The current study aimed to
ocular discomforts and pain (4). The pathophysiology
investigate tear film function in patients with vitamin
of DED includes tear film instability and ocular
D deficiency.
surface inflammation (3).

Vitamin D refers to a group of fat-soluble
PATIENTS AND METHODS
ketosteroids responsible for enhancing intestinal
A case-control study included 75 eyes of 39 patients
absorption of calcium, iron, magnesium, phosphate,
who were referred to the Ophthalmologic Clinic,
and zinc. It is not strictly a vitamin, and may be
Menoufia University after exclusion of 4 cases who
considered a hormone as its synthesis and activity
had sufficient 25-hydroxy vitamin D. The study started
occur in different locations. Although commonly
from March 2020 to December 2020.
known for its role in calcium homeostasis, vitamin D

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/)
2008
Received:13 /4 /2021

Accepted:9 /6 /2021


Full Paper (vol.841 paper# 59)


c:\work\Jor\vol841_60 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2014-2019

Serum Adiponectin Level in Patients with Psoriasis and its
Correlation with the Clinical Severity
Mahmoud Yousry Abdel-Mawla1, Naglaa Ali Khalifa2,
Aisha Hamza Gamil*1, Mohamed Mahmoud Nasr1
Departments of 1 Dermatology, Venereology and Andrology and 2 Clinical Pathology,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Aisha Hamza Gamil, Mobile: (+20)1004072373, E-mail: aishahamzawy2014@gmail.com

ABSTRACT
Background
: Psoriasis is a common chronic immune mediated papulosquamous disease that affects 2-3% of the
population. The exact cause of psoriasis is still unclear, but it is considered a disease of dysregulated inflammation
which is driven and maintained by interaction among multiple components of immune system in genetically
predisposed individuals. Adipose tissue is an active endocrine organ contributing to the regulation of multiple
metabolic pathways via self-produced bioactive products called adipokine. Adiponectin of adipose origin has the
highest circulating concentration among the known adipokines. Adiponectin regulates skin inflammation especially
IL-17-related psoriasiform dermatitis. Objective: This study was aimed to estimate the serum level of Adiponectin
and detect its correlation with activity of psoriatic patients.
Patients and Methods
: This case control study included a total of 50 patients with psoriasis and 50 healthy
individuals, attending at Outpatient Clinic, Department of Dermatology, Venereology and Andrology in collaboration
with Department of Clinical Pathology, Faculty of Medicine, Zagazig University Hospitals. This study was conducted
between November 2019 to November 2020. Psoriasis severity was classified according to psoriatic area and severity
index (PASI) score. Serum level of adiponectin was determined by ELISA for both groups.
Results: The results revealed that control group had significantly higher level of adiponectin than psoriasis patients.
There was a negative significant correlation between adiponectin and Psoriasis Area and Severity Index (PASI score)
(p <0.001**). Sensitivity of adiponectin in diagnosis of psoriasis was 94%, specificity was 90% and accuracy was
92%. Conclusion: Adiponectin measurement in serum of patients with psoriasis provides a tool for monitoring disease
activity.
Keywords: Psoriasis, Adiponectin, PASI, Markers, Adipokines

INTRODUCTION

origin has the highest circulating concentration among
Psoriasis is a common chronic inflammatory skin
the known adipokines (4).
condition. Crosstalk between epidermal keratinocytes,
A small amount of a processed globular form of
dermal vascular cells, and immunocytes such as
adiponectin was reported to be present in human
antigen presentation cells (APCs) and T cells causes the
plasma (5). Plasma concentrations reveal a sexual
distinctive epidermal and vascular hyperplasia seen in
dimorphism, with females having higher levels than
lesional psoriatic skin (1). The cause of psoriasis is
males. Levels of adiponectin are reduced in diabetics
unclear; however, it is thought to be multifaceted, with
compared to non-diabetics; also weight reduction
many essential components such as genetic
significantly increases circulating levels of adiponectin
vulnerability, environmental triggers, skin barrier
(6). It is also varied according to age as it has been
disturbance, and immunological dysfunction (2).
decreased in males at the puberty (7). Adiponectin has
There have been strong claims in years supporting
anti-inflammatory effects by inhibiting the activity and
the systemic involvement of adipose tissue in the
secretion of proinflammatory cytokines, including IL-
pathogenesis of psoriasis. The physiologic condition of
2, IL-6, TNF- and IFN-. It enhances the production
systemic white adipose tissue (WAT), particularly the
of anti-inflammatory cytokines, including IL-10.
intensity and variety of released adipokines, has been
Upregulation of anti-inflammatory cytokines can help
linked to the pathophysiology and inflammatory
restore the imbalance between Th1/Th17 and Th2
character of psoriasis, resulting in imbalanced
responses that affect patients with psoriasis (8). In
production of pro- and anti-inflammatory signalling
patients with psoriasis, circulating adiponectin level
proteins. This research backs up the theory that WAT
has been shown to be decreased as compared to healthy
has a role in the development of several skin diseases,
controls (9). A negative correlation between adiponectin
including psoriasis (3).
and extent of the skin disease evaluated by psoriasis
Adiponectin (GBP28, adipoQ, ACRP30) is a
severity index (PASI) or pro-inflammatory cytokines,
collagen-like plasma protein with a molecular weight
such as IL-6 and TNF was found in these studies (10).
of 28 kDa in human. It has a plasma concentration
From these studies, adiponectin plays a crucial role
ranging from 5 to 30 µg/mL. This protein of adipose
to regulate psoriasis inflammation by directly
suppressing IL-17 production from T cells.

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/)
2014
Received:10 /4 /2021

Accepted: 6/6 /2021


Full Paper (vol.841 paper# 60)


c:\work\Jor\vol841_61 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2021-2027
Comparison between Tran abdominal and trans anal one stage pull
through in Hirschsprung disease
Mansour Mohammed Kabbash1, Mohammed Abd-Alkader Osman2, Mohammed
Youssef Ahmed3, Mohamed Rabie1, Mohammed Kandil Ibrahim*1
1Department of General Surgery, Faculty of Medicine, Aswan University
2Department of Pediatric Surgery, Faculty of Medicine, Assiut University
3Department of General Surgery, Faculty of Medicine, South Valley University
*Corresponding author: Mohammed Kandil Ibrahim, Mobile: (+20)1009193937, E-Mail: kandil9595@gmail.com

ABSTRACT
Background:
Hirschsprung's disease (HD) is one of the commonly studied diseases among pediatric surgeons and
researchers. It is also known as intestinal aganglionosis, which is a kind of birth defects mainly expressed as partial or
complete absence of ganglion cells of the intestinal tract.
Objective: The aim of the current work was to evaluate the management of children with Hirschsprung's disease by
one stage pull-through Soave procedures (transanal and trans-abdominal one stage pull-through) concerning
perioperative, short term outcomes and complications.
Patients and methods: This randomized controlled trial study included a total of 32 patients subjected to transanal
and transabdominal one stage pull-through procedures for management of Hirschsprung's disease. Patients were
recruited from the Inpatient Clinic, Pediatrics Surgical Department, Assiut University Hospitals. This study was
conducted between April 2015 to March 2019 and followed up at our clinics.
Results: Comparison of the rates of late post-operative complications among the studied groups revealed that regarding
post-operative incontinence, group A had statistically insignificant (p = 0.723) lower rates (50%) compared with group
B (56%). Likewise, rates of adhesive intestinal obstruction were insignificantly (p = 0.310) higher (6.2%) in
comparison with group B (0%). There was statistically significant (p = 0.001) longer duration of hospital stay among
patients in group A (11.1 ± 6.4days) compared with patients in group B (5.0 ± 1.4 days).
Conclusion: It could be concluded that the advantages of TERPT include a good cosmetic effect, short hospital stays,
safe, and less surgical site infection compared to transabdominal procedures.
Keywords: Hirschsprung Disease, One stage pull-through transanal and trans-abdominal.

INTRODUCTION

end to side anastomosis. Soave (9( described the details
Hirschsprung's disease is one of the commonly
of endorectal approach for pull through. The endorectal
analyzed diseases among researchers in pediatric
pull-through was originally described through
surgery. This condition was first described by Harald
transabdominal approach.
Hirschsprung as a congenital megacolon in 1888. Since
In 1998, De la Torre-Mondragon proposed a
then, various methods for diagnosis and treatment of
new treatment called single-stage TERPT, which is
Hirschsprung's disease have been introduced (1, 2).
more suitable for infants. This minimally invasive
The disease incidence is about 1 per 5000 live
surgery with an anal approach has become an
births, males are more likely to be affected than
increasingly popular method for the treatment of HD,
females. Although Hirschsprung disease usually occurs
eliminating the risk of complications such as
in infancy, some people will present with persistent,
abdominal adhesions and pelvic nerve injury (10).
severe constipation in the later life (3(. The basic
The advantages of TERPT include a good
principle for the definitive surgical therapy is resection
cosmetic effect and a short hospitalization time, and its
of the aganglionic bowel followed by anastomosis (4).
safety has been proved by many studies (11, 12, 13).
The surgical management of Hirschsprung's
However, there are a variety of ways to choose surgery
disease (HD) is rapidly changing from the multi-staged
in clinical practice, and no consensus has been reached.
procedure to a single-stage one. This evolution aims at
The current study was aimed to evaluate the
reducing the cost, hospital stay, and the morbidity
management of children with Hirschsprung's disease
associated with the staged procedures (5).
by one stage pull-through Soave procedures (transanal
Swenson and Bill (6) performed the first
and trans-abdominal one stage pull-through)
successful corrective surgery. The procedure, soon
concerning perioperative, short term outcomes and
became popular as Swenson's procedure, brought a
complications.
realistic hope that children with HD can be cured (7).
PATIENTS AND METHODS
Duhamel (8) described another technique
This randomized controlled trial study included
different from Swenson. The principle of the procedure
a total of 32 patients subjected to transanal and
is partially bypassing the rectum and performance of
transabdominal one stage pull-through procedures for

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/)
2020
Received: 20/1/2021

Accepted: 15/3/2021


Full Paper (vol.841 paper# 61)


c:\work\Jor\vol841_62 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2027-2032
Serum Neutrophil Gelatinase-Associated Lipocalin and Iron Status in
Predialysis Chronic Kidney Disease at Zagazig University
Halla Mohamed Allam1, Haidy Essam Eldin Ahmed Zidan2,
Mohamed Gomaa Abdelrehim1, Amira Mohamed Hamed Hassan*1
Departments of 1Internal Medicine & Nephrology and Medical Biochemistry & Molecular Biology, Faculty of
Medicine ­ Zagazig University, Egypt.
*Corresponding Author: Amira Mohamed Hamed Hassan, Mobile: (+20)01275668494,
Email: Omarwahmed2015@gmail.com

ABSTRACT
Background:
The burden of chronic kidney disease (CKD) is substantial. Anemia is a common feature of CKD.
Objective: The aim was to predict about iron status by serum neutrophil gelatinase-associated lipocalin (NGAL) levels
and role of serum NGAL as biomarker of iron deficiency in CKD patients.
Patients and Methods: A prospective, case-control comparative study that was conducted at Nephrology Outpatient
Clinic and Internal Medicine Department, Zagazig University Hospitals. Seventy two participants were divided into
two groups: Group I included 36 participants with no chronic kidney disease and group II that included 36 chronic
kidney disease patients. Laboratory investigations included iron parameters and serum NGAL levels were measured
Results: S. Iron, TIBC, S. Ferritin and calculated T. sat" were statistically analyzed and showed that there was a
statistical significant difference between the two studied groups. NGAL level was higher in CKD group than in the non-
CKD group. A significant positive correlation between serum NGAL and T sat & serum ferritin and there was a
significant negative correlation between NGAL and eGFR, HB and serum iron.
Conclusion: Patients had significantly higher NGAL levels when compared to controls and this means that it had an
important role in iron metabolism in those patients. There was statistically significant direct correlation between serum
NGAL levels and serum ferritin levels and T. sat and inverse correlation with iron. Serum NGAL could be a good
biomarker for iron status in CKD patients but not better than the ordinary used methods "serum ferritin and T. sat".
Keywords: Neutrophil Gelatinase, Associated Lipocalin, Iron status, Predialysis, CKD.

INTRODUCTION
folic acid deficiency or blood loss. Most patients with
Chronic kidney disease (CKD) is a global health
CKD can be effectively treated with erythropoiesis
burden affecting a large proportion of the population
stimulating agents (ESA) (5).
worldwide (1). The burden of CKD is substantial.
Iron deficiency is a frequent cause of EPO
According to WHO global health estimates 864,226
resistance. An accurate assessment of iron status is
deaths (or 1.5% of deaths worldwide) were attributed to
important because both anemia and overtreatment with
this condition in 2012 (2).
erythropoiesis stimulating agents (ESA) are associated
The Kidney Disease Improving Global
with poor clinical outcomes (6).
Outcomes (KDIGO) organization classified CKD by
Human NGAL was originally isolated from the
the degree of renal dysfunction, as measured by the
supernatant of activated neutrophils and identified as a
estimated glomerular filtration rate (eGFR) and by the
polypeptide covalently bound to gelatinase. (7). NGAL
presence or absence of structural kidney abnormality or
can primarily bind siderophores, small hydrophobic
by other evidence of chronic kidney damage,
molecules containing iron, transporting them into the
particularly albuminuria. This classification gives five
cells to activate cytoplasmic iron-dependent pathways
levels of dysfunction defined by eGFR (G1­G5) and
in order to protect the same cell from oxidative stress (8).
three by albuminuria (A1­A3) (3).
It is produced by injured nephron epithelia.
Only a small proportion of people with CKD
Circulating NGAL is normally reabsorbed at the level
progress to end-stage kidney disease (ESRD) and renal
of the proximal tubule, and after ischemia, NGAL is
replacement therapy (dialysis or transplantation), which
secreted in the thick ascending limb and found in the
represents major costs for health care systems and
urine (9). So, NGAL is considered as a novel biomarker
burden for patients (3).
of acute kidney injury (AKI) and a predictor of the
ESRD is included under stage 5 of the KDIGO
progression of CKD (10). The aim of the study was to
classification of CKD, where it refers to individuals
predict about iron status by serum NGAL levels and role
with an estimated glomerular filtration rate less than 15
of serum NGAL as biomarker of iron deficiency in
mL/min/1.73 m2 or those requiring dialysis (4).
CKD patients.
Anemia in CKD & ESRD is mostly due to

erythropoietin (EPO) deficiency, inhibition of
PATIENTS AND METHODS
erythropoiesis by uremic solutes and reduction in red
This is a prospective case-control comparative
blood cell life span. Other causes include iron, B12 or
study and was conducted at Nephrology Outpatient

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/)
2027
Received:14 /4 /2021


Accepted:10 /6 /2021


Full Paper (vol.841 paper# 62)


c:\work\Jor\vol841_63 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2033-2039

Predictors of Outcome for Non-Operative Management of Localized
Intra-Abdominal Infection ''Abscess'': A Prospective Study
Alaa El-Din Hassan Mohamed, Ahmed Gaber Mahmoud,
Wael Barakat Ahmed, Sherif Galal Abdel-Aal Kopesy*
Department of General Surgery, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Sherif Galal Abdel-Aal Kopesy, Mobile: (+20) 01095921177, E-Mail: sherifgall@yahoo.com
ABSTRACT
Background:
Interventional (percutaneous) drainage of abdominal abscesses is a safe and successful method of treatment
that avoids many of the disadvantages of traditional surgical drainage.
Objective: This study aimed to evaluate factors associated with success or failure for non-operative management of
localized intra-abdominal infection ' abscess' . Patients and Methods: This is a prospective single arm descriptive study
that has been conducted at Sohag University Hospital from June 2017 to August 2018. This study included 100 patients
presented with intra-abdominal localized collection during the period of the study, from June 2017 to August 2018, and
presented to Sohag University Hospital, with any sex, age, previous abdominal surgery or clinical presentation.
Results: In our studied population, 85 cases of total 100 cases had spontaneous abscesses without any previous abdominal
surgeries. 52 cases of them responded successfully to non-operative management while 33 failed. 64 cases of total 100
cases responded successfully to non-operative management, 25 % of them were appendicular/post appendectomy
abscesses, 21.88% were liver abscesses, 21.88% were iliopsoas/ iliopsoas and perinephric abscesses. To be noticed that
all 14 cases (11 iliopsoas and 3 iliopsoas and perinephric abscesses) responded successfully to non-operative management
by 100%. Out of 29 diabetic patients with intra-abdominal abscess, 26 cases of them responded to non-operative
management while only 3 cases of them needed surgical intervention. Conclusion: Diabetes mellitus and positive culture
of aspirate are predictors for success of non-operative management while high grade fever is predictor for failure.
Keywords: Intra-abdominal abscess, Localized intra-abdominal collection, Percutaneous drainage, Pig tail.

INTRODUCTION
PATIENTS AND METHODS
The management of sepsis remains a significant
This is a prospective single arm descriptive study
challenge for health professionals. The Surviving Sepsis
that was conducted at Sohag University Hospital from
campaign, an effort to improve outcomes from sepsis
June 2017 to August 2018. This study includes 100
launched in 2004 and sponsored by major critical care
patients presented with intra-abdominal localized
societies across the world, estimates that severe sepsis
collection during the period of the study, from June 2017
and septic shock affects millions every year (1). Statistics
to August 2018, and presented to Sohag University
from England support this, showing that over 120 000
Hospital, with any sex, age, previous abdominal surgery
patients develop sepsis each year and more than 37 000
or clinical presentation.
of these die, making sepsis the second most common

cause of death after cardiovascular disease (2). Some 22
Inclusion criteria: All patients with intra-abdominal
percent of all patients with severe sepsis or septic shock
localized collection presented to Sohag University
in the International Multicentre Prevalence Study on
Hospital pre or post any abdominal surgery.
Sepsis (IMPreSS), a recent international point
Exclusion criteria: Patients with generalized intra-
prevalence audit of sepsis care, had an abdominal source
abdominal peritoneal infection "free intraperitoneal
(3).
Percutaneous
drainage
' as
non-operative
collection" was excluded from the study.
management' is a well-accepted procedure for the

treatment of intra-abdominal and intrapelvic abscesses.
Ethical consideration:
The use of this technique may help obviate more costly
The study protocol was approved by Ethical
and time-consuming surgical procedures. In addition,
Committee of Sohag Faculty of Medicine. All official
results in lower mortality rates in comparison with those
permission letters were taken from director of the
obtained with surgical drainage (4, 5). Surgeons have a
Surgery Department before start in the data collection.
significant contribution to make with regard to sepsis,
The study purpose and treatment were carefully
because they play a central role in the management of
explained to the patients individually. Then they were
patients in whom a decision whether for surgical
consented to participate in the study. They were allowed
procedure or non-operative management may be needed
to ask questions freely to ensure that they had
for source control (6, 7). The aim of the present study was
understood.
to evaluate factors associated with success or failure for

non-operative management of localized intra-abdominal
All patients were subjected to:
infection ' abscess' and clarify different modalities of
A full history data were taken from all patients
this management.
including items of the personal history as name, age,

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/)
2033
Received:12 /4 /2021

Accepted:8 /6 /2021


Full Paper (vol.841 paper# 63)


c:\work\Jor\vol841_64 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2040-2045

Vitamin D Sufficiency Status in a Sample of
Egyptian Patients with Different Rheumatological Diseases
Raef Malak Botros 1, Amr Hassan Mostafa2, Nagwa Roshdy Mohamed1
1Department of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
2Department of Internal Medicine, Mabarret El-Maadi Hospital, Cairo, Egypt
*Corresponding author: Nagwa Roshdy Mohamed, Mobile: (+20) 01065958431, E-Mail: dr_pharos2000@yahoo.com

ABSTRACT
Background:
Vitamin D is a key hormone in the metabolism of calcium and phosphorus, as well as the creation and
maintenance of the mineralized skeleton. It has also been linked to the etiology of autoimmune disorders such as
diabetes mellitus type 1 and multiple sclerosis. Vitamin D has been the topic of several difficult investigations in
recent years, including its function in the pathophysiology and development of many rheumatological disorders such
as rheumatoid arthritis and systemic lupus erythematosus (SLE).
Objective: To investigate Vit D sufficiency status in different rheumatological diseases.
Patients and methods:
The current study included 80 patients, divided into 20 patients with rheumatoid arthritis, 20
patients with SLE, 20 patients with osteoarthritis and 20 patients with other miscellaneous rheumatological diseases.
The following investigations have been done. 25(OH) vit D, CRP, ESR, ANA, Ca, Po4, rheumatoid factor , C3,C4
Results: 60% of the studied patients had vitamin D deficiency, 33.75 % had vitamin D insufficiency, 6.25% had
sufficient vitamin D. Vitamin D was significantly deficient in patients with rheumatoid arthritis compared to other
studied rheumatological diseases, Also vitamin D level was significantly deficient with increasing age and Longer
duration of the disease (P value < 0.001). Vitamin D was significantly deficient in patients on corticosteroid therapy
and smoker patients.
Conclusion: 25(OH) vitamin D was significantly low in Egyptian patients with different rheumatological disease
especially rheumatoid arthritis, explaining its role in development of inflammation and autoimmunity. So, 25(OH)
vitamin D should be put in consideration in diagnosis and treatment of such patients.
Keywords:
Vitamin D, Autoimmune disease, Rheumatoid arthritis, SLE, Osteoarthritis.

INTRODUCTION
as well as multiple sclerosis, type I diabetes, and
Vitamin D is a steroid hormone that has a role in
inflammatory bowel illnesses (5). Rheumatoid arthritis
calcium and phosphorus balance. Calcium and bone
(RA) is an autoimmune condition with no recognised
metabolism are also involved (1). UV exposure
cause (6) Vitamin D insufficiency has been linked to an
stimulates the production of this hormone in the skin (2).
increased risk of developing RA (7).
Vitamin D has an extra-skeletal impact, and
The increased disease symptoms present in SLE
insufficiency has been linked to the onset of
patients with very low levels of vitamin D suggest a role
autoimmune disorders such as type 1 diabetes and
for supplementation with exogenous vitamin D to
multiple sclerosis (3). However, 1,25-dihydroxyvitamin
optimize therapeutic outcomes. However, the
D3 [1,25(OH)2D3] the biologically active metabolite of
possibility that such treatment could lead to increased
Vitamin D3, not only regulates bone and calcium
autoantibody levels requires further study.
metabolism but also exerts immunomodulation via the

nuclear vitamin D receptors (VDR) expressed in
PATIENTS AND METHODS
antigen-presenting cells and activated T/B cells. In
A cross sectional study was done at
particular, this regulation is mediated through
Rheumatology clinic of Mabarret El-Maadi Hospital,
interference with nuclear transcription factors such as
Cairo, which is a tertiary hospital, belongs to
NF-AT and NF-B or by direct interaction with vitamin
Therapeutic Foundation hospitals, Ministry of Health,
D responsive elements in the promoter regions of
Egypt. It was conducted on 80 patients during the
cytokine genes (4).
period from September 2016 to March 2017. Patients
Epidemiological evidence suggests a link
were subdivided into 20 patients with rheumatoid
between vitamin D deficiency and an increased risk of
arthritis diagnosed according to EULAR criteria 2016
autoimmune diseases, and a better understanding of the
(8), 20 patients with SLE according to Systemic Lupus
physiological role of endogenous VDR agonists in
International Collaborating Clinics (SLICC) criteria
autoimmune response regulation will help justify the
2016 (9), 20 patients with osteoarthritis, and 20 patients
use of pharmacological VDR agonists in the clinic.
with other miscellaneous rheumatological diseases.
Synthetic VDR agonists' anti-proliferative, pro-
Patients with any end organ disease (Chronic
differentiative,
immunomodulatory,
and
anti-
Liver Disease, Heart Failure or Chronic Kidney
inflammatory qualities might be used to treat a number
Disease), pregnant ladies and patients on vitamin D
of autoimmune rheumatic disorders, from RA to SLE,
supplementation were excluded from our study.

This article is an open access article distributed under the terms and conditions of the Creative



Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2040

Received:13 /4 /2021

Accepted:9 /6 /2021


Full Paper (vol.841 paper# 64)


c:\work\Jor\vol841_65 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2046-2051

Cystatin C and Acute Kidney Injury in Acute Heart Failure;
Impact on Hospital Course
1Ahmed Elbarbary, 2Lobna Refaat, 3Mohamed Awadein, 4Ahmed Tamara
1Cardiology Department, 2Clinical Pathology, 3Internal Medicine, Faculty of Medicine,Misr University for Science
and Technology, MUST University,4Cardiology Department, Faculty of Medicine, Ain Shams University
*Corresponding author: Ahmed Elbarbary, Mobile: (+20)01222333615

ABSTRACT
Introduction
: Acute heart failure (AHF) is a life-threatening disease with a high mortality rate. Cardio-renal syndrome
(CRS) has received much attention because of its relation to the poor prognosis of hospitalized patients. In both acute
and chronic cardiac disease, kidney impairment is a significant predictor of outcome. Finding a more sensitive renal
damage marker is a top priority due to the disadvantage of the existing marker creatinine. Several new acute kidney
injury (AKI) biomarkers are being studied. Cystatin Cis a kidney function biomarker that has also been investigated
for its use in acute kidney injury early detection.
Aim: was to assess the outcome of using cystatin C as a new AKI biomarker in patients diagnosed with AHF and its
effect on hospital stay and in-hospital mortality.
Methods: Cystatin C levels were measured on admission and 48 hours later in 200 hospitalized AHF patients. The
amount of increase in cystatin C after 48 hours was measured, as well as the impact of a cystatin C increase on the
hospital course.
Results: The mean population age was 66.4 years old, while 49% of the population were females. AKI was detected
in 16% of patients with >0.3 mg/L rise in cystatin C within two days of hospital admission, and this led to 3 days (P =
0.01) significant more extended hospital stay while in-hospital mortality was more but could not reach statistical
significance (P = 0.239).
Conclusion: In patients with acute heart failure, elevation in Cystatin C within 48 hours of hospital admission is a
good detector of early acute kidney injury and has a detrimental impact on their hospital course.
Keywords:Acute heart failure, Cystatin C, Acute renal injury.

INTRODUCTION

Acute heart failure (AHF) is a life-threatening
has a comparatively significant amount change (For
disease with accelerated worsening of heart failure,
example, a 50% increase in serum creatinine from 0.5
leading to a high death rate. (1, 2) Renal impairment is
mg/dL to 2.0 mg/dL result in 1.0 mg/dL and 3.0 mg/dL,
one of the most common and most crucial predictors of
respectively)(11).
chronic
heart
disease
outcomes
and
AHF
Deteriorating kidney function might be described by a
hospitalization. (3, 4)The acute cardio-renal syndrome
rise of more than 25%, or the absolute level increased
(CRS) known as (Type 1) is characterized by worsening
by 0.3 mg/dL from baseline in the initial stages of acute
of kidney functionfollowing acute heart failure patients
kidney injury (24-48 hours). Due to the slow kinetics of
(5, 6). Renal function declines often following AHF
serum creatinine, a significant reduction in eGFR can
hospitalization, and it has been linked to poor prognosis
result in only minor differences in serum creatinine
and higher mortality rates (7, 8).
levels (12).
Serum creatinine is used to evaluate kidney
Cystatin C, a protein consisting of a 13.3 kDa,
function. However, using serum creatinine as a measure
belongs to the cysteine protease inhibitors group. It is
of renal impairment has several drawbacks. Age has a
produced by all nucleated cells and filtered through the
significant impact on serum creatinine, and it is also
glomerulus, and neither secreted nor absorbed into the
affected by other factors like sex and muscle mass(9, 10).
renal tubules bloodstream. However, tubular epithelial
Furthermore, serum creatinine is not a perfect
cells partially metabolize it (1, 4).
biomarker of renal damage. It has been shown that renal
Cystatin C may identify the variations in
injury can happen without an increase in the GFR as
glomerular filtration rate (GFR) more easily and quickly
measured by serum creatinine. The baseline renal
than creatinine, which suggested that it may be used as
function is a primary determining factor for kidney
a valuable biomarker of acute renal damage in
injury staging by detecting the change in serum
hospitalized patients in the intensive care unit. Unlike
creatinine, so when baseline renal function is normal,
serum creatinine, cystatin C is unaffected by the age,
serum creatinine levels begin to rise at a late stage of
sex, race, or body mass of the patient. It can be a more
renal injury, but when the patient has already a renal
sensitive renal failure indicator than serum creatinine
failure, the creatinine level changes are exaggerated
since it is only affected by thyroid dysfunction and
because creatinine level change is magnified because it
steroid consumption(12, 13).



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/)
2046
Received:11 /4 /2021

Accepted:7 /6 /2021


Full Paper (vol.841 paper# 65)


c:\work\Jor\vol841_66 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2052-2056

Albuminuria Independently Determines Intact Parathyroid
Hormone in Diabetic Nephropathy with Micro-albuminuria
Mohammed Ali Gameil*1, Rehab Elsayed Marzouk 2,
Ahmed Hassan Elsebaie³, Ahmed Ahmed Ahmed Eldeeb1
Departments of 1Internal Medicine, ² Medical Biochemistry,
³ Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Mohammed Ali Gameil, Mobile: 00201099975071, Email: drmaligameil1979@yahoo.com

ABSTRACT
Background
: Diabetes mellitus (DM) is a well-recognised cause of end-stage renal disease (ESRD) through diabetic
nephropathy (DN). Elevated intact parathyroid hormone (intact PTH) in DN represents a serious metabolic threat.
Objective:
We aimed to detect determinants of intact PTH changes during micro-albuminuria stage of DN.
Patients and Methods: An observational study included 294 patients with type 2 diabetes mellitus (T2D) divided
into 2 groups. Case group; 220 patients of DN with micro-albuminuria versus control group; 74 patients without
albuminuria. Participants were subjected to history taking, clinical examination and laboratory assessment of
glycosylated haemoglobin (HBA1c), serum creatinine, blood urea nitrogen (BUN), urine albumin creatinine ratio
(urine ACR), estimated glomerular filtration rate (eGFR), 25(OH) vitamin D, intact PTH, serum ionized calcium,
phosphorus and magnesium.
Results: Among 220 patients of mean age 48.7 years and 57.7% male, albuminuria was significantly higher
(P<0.001). We found non-significant difference between the study groups in estimated glomerular filtration rate
(eGFR) and serum creatinine (P=0.375 and 0.294) respectively. Meanwhile, intact PTH was significantly elevated
(P<0.001) in case group. Intact PTH was positively correlated with urine ACR, HBA1c, BUN, and serum creatinine
and inversely correlated with eGFR. However, urine ACR was the only independent determinant of intact PTH in
diabetic patients with micro-albuminuria (OR: 1.177; 95% CI: 1.074-1.290, P= 0.001).
Conclusion:
Interestingly, urine albumin creatinine ratio was the only independent determinant of intact PTH in
diabetic patients with micro-albuminuria.
Keywords: Diabetic nephropathy, Intact PTH, Micro-albuminuria.

INTRODUCTION

Diabetic nephropathy (DN) is a prevalent cause
is still unclear (7). Management of metabolic bone
of end-stage renal disease (ESRD). Hyperglycaemia
disorder (MBD) is an integral component of CKD
causes structural and functional disruption of the
treatment. Serum intact parathyroid hormone (intact
glomerular capillaries and renal tubules, resulting in a
PTH) is the key target for the management of CKD-
progressive illness (1).
MBD (8).
Early detection of diabetic nephropathy (DN)
In the current study, we aimed to address the
represents a serious clinical challenge to reduce the
clinical and biochemical alterations in diabetic patients
burden of chronic kidney disease (CKD) (2). Despite
with micro-albuminuria. We tried to clarify the
the contradictory data concerning sensitivity and
relationship between intact PTH and other metabolic
specificity of the urine albumin creatinine ratio (urine
parameters in this early stage of DN.
ACR), it is often used to assess the severity of DN.

Persistent micro-albuminuria (urine ACR =30-300
PATIENTS AND METHODS
mg/g) is considered an important marker and predictor
An observational case-control study conducted
of DN and its progression to ESRD (3,4). To date, the
at the outpatient department of our institutional
pathogenesis of DN is not fully understood. The
hospital, during the period from July 2019 to
increased urinary albumin excretion in DN may be
December 2019.
attributed to defects in the glomerular membrane
Our study included 294 participants of two
filtration
and
endothelial
damage
due
to
groups of patients with type 2 diabetes mellitus (T2D)
hyperglycaemia, oxidative stress, ischemia, and
of matched age and sex: Case group; 220 patients with
inflammation (5,6).
micro-albuminuria (urine ACR=30-300mg/g) and
Mineral and metabolic bone disorders (MBD)
control group; 74 patients without albuminuria.
associating chronic kidney disease (CKD) start early
Egyptian patients aged (40-60) years with glycosylated
and worsen with the progression of CKD particularly
haemoglobin (HBA1c) 7.0-9.5% and estimated
among patients with DN.
glomerular filtration rate (eGFR) 50 mL/min/1.73 m²
In incipient CKD, the precise metabolic
were enrolled in this study. After signing written
alterations that lead to secondary hyperparathyroidism
informed consent, all participants were subjected to




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/)
2052
Received: 8/4/2021

Accepted:4/6/2021


Full Paper (vol.841 paper# 66)


c:\work\Jor\vol841_67 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2057-2059
Serum Malondialdehyde and Vitamin C in Children with Epilepsy
Seham Fathy Abdelhamid Azab1, Safaa Hamdy Ahmad Saleh2,
Noha Abdelhalim Mohamed Rezk1, Abdalmalek Milad Ahmed Abudhir3
Departments of 1Pediatrics and Medical 2Biochemistry, Faculty of Medicine, Zagazig University, Sharkia, Egypt
Department of 3Pediatrics, Faculty of Medicine, Tripoli University, Tripoli, Libya.
*Corresponding Author: Abdalmalek Milad Ahmed Abudhir, Mobile: (+20) 01060784193,
Email: malek.milad86@gmail.com

ABSTRACT
Background:
Epilepsy is one of the most common neurological disorders. The prevalence of active epilepsy was
estimated to be 6.38 per 1000 persons. Serum malondialdehyde (MDA) is used as a marker to investigate the
oxidative damage of lipids in many degenerative human diseases. Vitamin C is important for the proper functioning
of the central nervous system.
Objective: To evaluate the association of serum MDA and vitamin C with epilepsy in children.
Methods:
This case-control study was carried out in the Pediatric Department at Zagazig University Hospitals during
the period from December 2019 to July 2020. This study included 46 children who were divided into 2 groups: Cases
group: which included 23 epileptic children. Control group: which included 23 healthy children with age and sex-
matched to cases. All the participants were subjected to measuring serum malondialdehyde MDA and Vitamin C.
Results:
This study showed that there was a statistically significant increase in serum malondialdehyde (MDA)
among the case group than the control group. Also, there was a statistically significant decrease in serum Vitamin
C among the case group than the control group.
Conclusion: This study has correlated the increase of lipid peroxidation and defective antioxidant defense and the
pathogenesis of epilepsy and we found a significantly elevated level of MDA and a depleted level of vitamin C in
epileptic patients than in the healthy control subjects
Keywords: Serum Malondialdehyde, Vitamin C, Epilepsy.

INTRODUCTION
PATIENTS AND METHODS
Epilepsy is considered one of the most common
This case-control study was carried out in the
neurological disorders. The prevalence of active
Pediatric Department at Zagazig University Hospitals
epilepsy was estimated to be 6.38 per 1000 persons (1).
during the period from December 2019 to July 2020.
It is associated with heterogeneous nature that affecting
It included 46 children who were divided into 2
50 million people worldwide, with more than 85%
groups:
living in the developing world, and it begins in

childhood in more than half of the cases. An estimated
Cases group: which included 23 epileptic children.
4.7 million people with epilepsy live in the Eastern
Control group: which included 23 healthy children
Mediterranean Region (2). The prevalence of epilepsy in
with age and sex-matched to cases.
Egypt is not accurately determined, although some

studies reported that the lifetime prevalence rate of
Inclusion criteria:
epilepsy is 12.67/1000 (3).
1. All patients who are newly diagnosed with epilepsy,
Serum
malondialdehyde
(MDA)
is
an
having abnormal EEG, and have been experiencing
endogenous genotoxic product, generated by oxidation
at least one seizure in the past 6 months.
of arachidonic acid and larger polyunsaturated fatty
2. Both sexes are included.
acids (PUFAs). It is used as a marker to investigate the
3. Patient with no previous history of antiepileptic and
oxidative damage of lipids in many degenerative human
antioxidant drug administration.
diseases (4). Vitamin C is important for the proper
4. Age (1-12 years).
functioning of the central nervous system. Reduction of

optimum concentration causes structural and functional
Exclusion criteria:
damage to the cells and imbalance in the
1. Absence of informed consent.
neurotransmission system. Microminerals and trace
2. Age group out of range (1- 12 years).
elements act as crucial components for the development
3. Patient with a previous history of antiepileptic and
of immunity and provide antioxidant defense in the
antioxidant drug administration.
human body (5).
4. Patient who had a severe general medical condition
The objective of this study was to evaluate the
(diabetes mellitus, renal, cardiovascular, liver
association of serum MDA and vitamin C with epilepsy
disease, endocrine disorder).
in children.



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/)
2057
Received:13 /4 /2021

Accepted:9 /6 /2021


Full Paper (vol.841 paper# 67)


c:\work\Jor\vol841_68 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2060-2064

Preprocedure Ultrasound-Guided Midline Spinal Anaesthesia versus
Conventional Landmarks Technique: Efficacy and Safety
Mohamed Anwer Rifky1, Mohamed Mowafy Khattab1, Ayman Fathy Zeid2,
Ahmed Sobhy Hegab1, Basmah Ahmed Abdelrahman Alrobaa*1
Departments and 1Anaesthesia and Surgical Intensive Care and 2Radiodiagnosis,
Faculty of Medicine, Zagazig University, Egypt.
*Corresponding Author: Basmah Ahmed Abdelrahman, Mobile: (+20) 01060640084, E-mail: basma.robaa@gmail.com

ABSTRACT
Background:
Comparison between spinal anaesthesia with conventional land mark (blind) technique and with
preprocedural ultrasonographic guidance technique. Ultrasound (US) can be used effectively and accurately to
identify the anatomical landmarks of neuraxial blockade, in order to improve the safety and efficacy of spinal
anaesthesia.
Objective:
To assess the effectiveness and safety of US to improve the technique of spinal anaesthesia, and decrease
it's complications in comparison to the conventional landmarks technique.
Patients and Methods: The study was performed in Zagazig University Hospital. Hundred and four ASA classes I
and II adult cooperative patients of both sexes were scheduled for surgery in the lower part of the body under neuraxial
blockade. They were randomly allocated into two equal groups, preprocedure ultrasonography guided spinal
anaesthesia (PS) group, and conventional landmark group (CL).
Results:
It was found that there was a statistically significant difference between PS and CL groups regarding the
number of attempts, number of needle pass (bone hitting), successful dural puncture after the first attempt, and total
time for technique performance.
Conclusion:
ultrasound guidance improves the success rate of midline spinal anaesthesia. It reduces the number of
attempts required, improves the success rate of a single needle pass, and shortens the time to dural puncture. Further
trials can be done to establish the role of ultrasound-guided neuraxial block among high-risk groups, such as obese,
elderly, and patients with spinal deformity.
Keywords: Spinal anaesthesia landmark technique, Ultrasound.

INTRODUCTION

Spinal anaesthesia is widely performed using a
surgery and spinal deformity (5,6). US is a useful
surface landmark-based technique ' blind technique''.
preoperative assessment tool for assessing the
Thus, multiple passes and attempts while
feasibility of central neuraxial blockade when
administering spinal anaesthesia are associated with
technical difficulty is anticipated (7).The aim of this
many complications (1). Failure of spinal anaesthesia,
study was to assess the effectiveness and safety of US
cardiovascular side effects like hypotension and
to improve the technique of spinal anaesthesia, and
bradycardia, nausea and vomiting are often associated
decrease it's complications in comparison to the
with hypotension, disturbances of micturition,
conventional landmarks technique.
transient neurologic symptoms, dysesthesia, and

lastly, postdural puncture headache (PDPH) can be
PATIENTS AND METHODS
considered as the most common side effects (2).
This comparative prospective study was
The use of preprocedural ultrasound (US) has
performed in surgical operation rooms of Zagazig
been shown to increase the first pass success rate for
University Hospitals, in Egypt. Sample size was taken
spinal anaesthesia compared with a conventional
as number of attempts in patients who assessed with
landmark based midline approach (3,4). It provides
conventional landmarks (group CL); 1.98 (1.66), and
preprocedure scanning of anatomical structures as
in patients who assessed with preprocedure ultrasound
location of neuraxial midline, interlaminar space,
(group PS); 1.28 (0.7). At 80 % power and 95 %
ligamentum flavum (FL), dura mater (D), and
confidence interval (CI), the estimated sample size will
posterior vertebral body (PVB). Ultrasound can
be 52 patients in each group (Open EPI programs).
estimate the depth from the skin to intrathecal space,
In this study, 104 patients were allocated
allowing selection of needle length. Also, it may
randomly into two groups: preprocedural US guided
prevent a lot of side effects.
technique (PS) (n=52), and conventional landmark
In addition, it can identify the intervertebral
group (CL) (n=52). Two patients from PS group
levels by counting spinous processes or laminae. It will
refused to participate, and two other patients from CL
be most helpful in patients with poor or abnormal
group had failed spinal anaesthesia.
anatomical landmarks, as in obesity, previous spinal


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/)
2060
Received:12 /4 /2021

Accepted:8 /6 /2021


Full Paper (vol.841 paper# 68)


c:\work\Jor\vol841_69 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2065-2070

Evaluating the Role of Autologous Platelet-Rich-Plasma in
The Treatment of Dry Eye Disease
Doaa Hatem Farhan Emam*, Gamal Youssef El Mashad,
Ayman Ahmed Alkawas, Sherif Mohammed Sharaf El Deen
Ophthalmology Department, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding Author: Doaa Hatem Farhan Emam, Mobile: 01004229389, E-mail: dodohatemfarhan@gmail.com

ABSTRACT
Background:
Platelets are irregularly shaped, non-nucleated cytoplasmic bodies derived from fragmentation of
megakaryocyte precursors. Objective: This study aimed to evaluate the role of autologous platelet-rich-plasma
(PRP) as a monotherapy versus artificial tears (Hyaluronic acid) use for better management of dry eye disease.
Patients and Methods: A prospective clinical randomized trial study was conducted on 62 patients with moderate
to severe dry eye disease (Schirmer`s test outcomes of 5.5 mm or lower). Patients had been recruited from the
Outpatient Clinics of Ophthalmology Department in Zagazig University Hospital during the period from February
2020 to January 2021. They were divided into two equal groups; group A was treated with PRP and group B was
treated with artificial tears. Results: There was a significant decrease regarding ocular surface disease index (OSDI)
in both groups after treatment, but the improvement was more significantly in PRP group compared to artificial tears
group. There was a significant increase in tear break-up time (TBUT) in PRP group only after treatment; although,
there was an increase in TBUT in artificial tears group but without statistical significance. There was a significant
increase in BCVA in both groups after treatment, but the improvement was more significantly in PRP group
compared to artificial tears group. Conclusion: PRP is an interesting alternative therapy in symptomatic dry eye.
Keywords: Dry Eye Disease (DED), Platelet-Rich-Plasma (PRP), Tear Break-up Time (TBUT).

INTRODUCTION
The use of platelet-rich plasma (PRP) has become
Dry eye disease (DED) is a multifactorial disease
a strategy in the management of several disorders of the
of the ocular surface characterized by loss of homeostasis
ocular surface, including corneal ulcers (5) and persistent
of the tear film, and accompanied by ocular symptoms, in
ocular epithelial defects(6). Platelet rich plasma (PRP) and
which tear film instability and hyperosmolarity, ocular
plasma rich in growth factors (PRGF) have also been
surface inflammation and damage, and neurosensory
reported as successful therapies for moderate to severe
abnormalities play etiological roles(1).
dry eye, with advantages over AS due to its higher
DED is classified into aqueous-deficient dry eye
concentration of anti-inflammatory, cytokines, growth
and evaporative dry eye. Aqueous-deficient dry eye has
factors and other platelet derivatives, that can stimulate
two major subtypes: Sjögren syndrome and non-Sjögren
the proliferation and regeneration of stem cells which
DED as lacrimal deficiency, lacrimal gland duct
could be with high benefit for the required ocular surface
obstruction, reflex block and systemic drugs. Evaporative
restoration in cases of moderate and severe dry eye(7).
dry eye is subdivided into intrinsic causes as (meibomian
PRP has an antiapoptotic effect on corneal stromal cells(8)
oil deficiency, disorders of lid aperture and low blink
and autologous platelets have been used for the
rate) and extrinsic as (vitamin A deficiency, contact lens
management of macular holes(9). Autologous platelets in
wear). Activities like watching television, extended
the form of eye-drops have also been used in the
computer use, and reading can trigger and/or aggravate
management of several eye conditions as corneal ulcer
dry eye symptoms(2).
depending on the desired effect and the purpose of the
Lacrimal gland dysfunction is the most common
clinical intervention. In this way, PRP has great utility in
cause of severe dry eye and is secondary to several
the management of several ocular diseases(10).
factors, including acinar atrophy, lacrimal gland fibrosis
The aim of the present study was to evaluate the
and ductal obstruction, as well as lymphocyte infiltration
role of autologous PRP as a monotherapy versus artificial
with upregulation of proinflammatory cytokines leading
tears (hyaluronic acid) use for better management of dry
to a severe reduction in lacrimal gland secretion(3).
eye disease.
The standard treatment for dry eye is topical use

of artificial tears, although the expected results are not
PATIENTS AND METHODS
satisfying and often ineffective. This has led to the use of
A prospective clinical randomized trial study was
other therapeutic methods based on blood derivatives.
conducted on 62 patients with moderate to severe dry eye
Autologous serum (AS) has been suggested to be a more
disease (Schirmer`s test outcomes of 5.5 mm or lower).
efficient treatment for severe dry eye disease (DED)
Patients had been recruited from the Outpatient Clinics of
rather than preservative-free artificial molecules, with
Ophthalmology Department in Zagazig University
varying success rates(4).
Hospital during the period from February 2020 to January
2021.

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/)
2065
Received:11 /4 /2021

Accepted:7 /6 /2021


Full Paper (vol.841 paper# 69)


c:\work\Jor\vol841_70 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2071-2077
Efficacy of Albendazole Mass Treatment Alone Compared to
Combined Albendazole ­ Flubendazole Regimen for Treatment of
Resistant Enterobius vermicularis Infection in Children Enterobius
Khaled A. Temsah*1, Doaa Abdel Fattah2, Amal A. El Kholy3, Mohamed Ibrahim Elsamanoudy4
Departments of 1Parasitology and 4Pediatrics, Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
2Department of Parasitology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
3Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
*Corresponding author: Khaled Aly Temsah, Mobile: (+20)01063282834; Email: drkhaled2008@yahoo.com

ABSTRACT
Background:
Enterobius vermicularis is one of the most common parasitic helminths causing infection in children
worldwide causing distressing lifestyle and health problems. The empirical use of anthelminthic drugs without medical
supervision and low compliance to treatment protocols lead to resistance to therapy.
Objective: To assess the efficacy of albendazole mass treatment alone compared to the combined albendazole-
flubendazole regimen for treatment of recurrent and resistant Enterobius vermicularis infection in children and their
families.
Subject and Methods:
It was a clinical trial that included 130 children 3-12 years old with resistant Enterobius
vermicularis
infection determined by the following inclusion criteria for treatment resistance. This study was carried
out at the Pediatrics outpatient Clinic at Al-Azhar University Hospitals, and the Medical Parasitology Department at
Damietta Faculty of Medicine, Al-Azhar University at New Damietta city, Egypt.
Results: 36 out of 65 (55.4%) children in the albendazole treated group and 54 out of 65(83.1%) in the albendazole-
flubendazole treated group was cured with significantly higher efficacy for the albendazole-flubendazole regimen. The
laboratory data showed improvement in post-treatment phase especially for albendazole- flubendazole treated groups
for hemoglobin%, total leukocytic counts, neutrophil and lymphocyte counts that improved by time and a decline in the
reported eosinophilia. The clinical data were significantly warning the presence of infection however they did not define
the significance of treatment efficacy or resistance.
Conclusion: Enterobiasis is a childhood health problem with potential resistance to regular therapeutic protocols. Using
albendazole- flubendazole combined regimen showed promising results in the treated groups superior to albendazole
alone against resistant Enterobius vermicularis infection in children. This gives promising results encouraging further
evaluation studies.
Keywords: Pinworm, Enterobius vermicularis, Flubendazole, Albendazole, Resistance.

INTRODUCTION
infection due to direct transmission of infection and low
Enterobiasis is the most common parasitic
compliance to treatment guidelines(6).
helminth prevailing among children with estimated
Most cases of enterobiasis are reported to be
affection of one billion population worldwide. It has a
asymptomatic however the nocturnal perianal activity
prevalence rate of 4% to 28% among children
and laying off their sticky eggs lead to sleep
worldwide causing distressing lifestyle and health
disturbances and psychological distress(7,8).
problems (1,2).
Pruritis ani or perianal itching is the cardinal
The life cycle from swallowing of eggs to adult
symptom of infection while abdominal pain, diarrhea,
worm maturity and passage of eggs again takes an
and urinary manifestations especially in females are
average duration of 2 months(3). The hosts' and food
also present with associated vulvovaginal inflammation
handlers' hands play important roles in transmitting the
and scratching. Some cases are complicated with
eggs and causing autoinfection(4) and transmission of
appendicitis due to invasion by adult worms of the
eggs to new hosts through contamination of food or
lumen or peri- appendicular space(8), with about 4%, 7%
drinks or shared towels and personal utensils. Also, the
(7,8), and 9.8% of children proved to have Enterobius
larvae can re-enter the anus and cause retrograde
worms in appendicular lumen among all pediatric
infection(5).
appendectomies from Egypt, Ireland, Iran, and the USA
. Socioeconomic factors including overcrowding
respectively(9,10), also reports about extra-intestinal
and low personal hygiene and shared beds and utensils
involvement of internal organs are reported(11,12,13).
lead to increased infection rates among children and
Also, Bayoumy et al.(14) reported that the presence of E.
adults. The overcrowded families and communities with
vermicularis worms was observed in 4/200 (2%) of
low health education increase the prevalence of
appendectomy among Egyptian patients attending Al-

Azhar University Hospitals.


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/)
2071
Received:14/4/2021

Accepted: 10/6/2021


Full Paper (vol.841 paper# 70)


c:\work\Jor\vol841_71 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2078-2083

Clinical Manifestations and Comorbidities of SARS-Cov-2 Infection:
A Descriptive Study
Nearmeen M. Rashad1*, Nevin F. Ibrahim1
Department 1 Internal Medicine, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Nearmeen M. Rashad, Mobile: (+20) 01224248642,
E-mail: nrashad78@yahoo.com and n.rashad@zu.edu.eg.

ABSTRACT
Background:
Coronavirus disease 2019 (COVID-19) is a clinical syndrome caused by infection with severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with severe illness have an overactive immune system,
which can damage organs other than the lungs.
Objective: The aim of this study was to assess the prevalence of clinical manifestations and comorbidities in SARS-
CoV-2 infected patients.
Patients and methods: This retrospective single-center observational study was conducted in the Tertiary Hospital,
Internal Medicine Department, Faculty of Medicine, Zagazig University. This retrospective observational study was
conducted on consecutive 370 patients with confirmed SARS-CoV-2 infection from May to September 2020.The
diagnosis of the cases was confirmed using RT-PCR for detection of the viral RNA. Demographic characteristics,
including underlying comorbidities, symptoms, signs, laboratory findings, chest CT scan and treatment measures
were reported.
Results: According to this retrospective, single-center observational study, which was conducted on consecutive
370 patients with confirmed SARS-CoV-2 infection? The study involved 193 Egyptian males (52.1%) and 177
Egyptian females (47.9%) with COVID-19. The mean age was 40. 2 ±14.74 years. The common symptoms of the
COVID-19 patients at the onset of sickness were myalgia [355 (95.9%)], fatigue [291 (78.6%)], headache [235
(63.5%)], fever [247 (66.8%)], cough [213 (57.6.%)], sputum production [201 (54.3%)] and dyspnea [189
(51.1%)].The most prevalent comorbidity were hypertension [142(38.4%)] followed by diabetes [132 (35.6%)].
Conclusion: The commonest clinical manifestations of confirmed cases of COVID-19 were myalgia, fatigue,
headache, fever, and cough and the most prevalent comorbidities associated with COVID 19 patients were
hypertension and diabetes.
Keywords: SARS-CoV-2, Diabetes, Comorbidity, Coronavirus.

INTRODUCTION

Coronavirus disease (COVID-19), which is
and management of COVID-19. According to this
caused by the severe acute respiratory syndrome
protocol, patients with COVID-19 infection are
coronavirus 2 (SARS-CoV-2), is a global pandemic
classified on clinical bases into mild, moderate, severe,
disease that began in Wuhan, China, and swiftly spread
and critical cases [6].
to over 180 nations [1]. COVID-19 is a novel and
Finally, critical patients are those who fulfill one
understudied illness, with little information available.
or more of the following criteria: (a) respiratory failure
However, comorbidities were found to enhance the
needing mechanical ventilation, (b) shock, or other
risk of infection in the instances that were found [2].
organ failures needing ICU surveillance and treatment
Coronaviruses can cause multiple system infections in
[7].
various animals and mainly respiratory tract infections
COVID-19 can affect anyone, and the disease
in humans, such as severe acute respiratory syndrome
can cause symptoms ranging from mild to very severe.
(SARS) and Middle East respiratory syndrome [3].
Recent interesting study reported the clinical features
The majority of individuals have little symptoms
of 41 confirmed patients with COVID 19 and
and a favourable prognosis. Few patients infected with
established that 13 (32%) of them had underlying
2019-nCoV have suffered severe pneumonia,
diseases, including cardiovascular disease, diabetes,
pulmonary oedema, ARDS, or multiple organ failure
hypertension, and chronic obstructive pulmonary
thus far [4]. COVID-19 is more likely to cause severe
disease [8].
sickness in People who have chronic obstructive
Another recent research by Wang et al. [4] stated
pulmonary disease (COPD) or other respiratory
that at 138 patients of COVID-19, they found that 64
diseases. In individuals with COPD, the probability of
(46.4%) of them had comorbidities.
acquiring COVID-19 is reported to be 4-fold greater
Importantly, patients admitted to the intensive
than in those without COPD [5].
care unit (ICU) had a greater rate of comorbidities
Egyptian Ministry of Health and Population
(72.2%) than patients who were not sent to the ICU
(MOH) issued a standardized guide for the diagnosis
(37.3%). In this regard, comorbidities maybe risk

factors for adverse outcomes. Assessing 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/)
2078
Received:16 /4 /2021

Accepted:12 /6 /2021


Full Paper (vol.841 paper# 71)


c:\work\Jor\vol841_72 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2084-2089

Correlation between Severity of Coronary Artery Disease and
Insulin Resistance in Diabetic Patients
Rehab I. Yaseen1, Mohammad Y. Beda*2, Fatma A. Ibrahim1
1Department of Cardiology, Faculty of Medicine, Menoufia University, Egypt
2Department of Cardiology, Dar El-Shefaa Hospital, Cairo, Egypt
*Corresponding author: Mohammad Y. Beda, Mobile (+20) 0109 767 7504, E-mail: mohammed.yahya84@yahoo.com

ABSTRACT
Background:
Diabetes mellitus is a well-established risk factor for the development of coronary artery disease
(CAD), which is the major cause of premature death in diabetic patients, both in type 1 or type 2 diabetes.
Objective: To examine the relationship between insulin resistance determined by fasting insulin level and
complexity of coronary artery lesion in diabetic patients.
Patient and methods: This study enrolled 84 diabetic patients who were presented to the catheter Lab for elective
coronary angiography in the period from October 2019 to April 2020. All patients were subjected to full history
taking, thorough clinical examination, laboratory investigations (fasting insulin level, HbA1c level, lipid profile and
serum creatinine), 12-lead surface ECG, echocardiography examination and coronary angiography. The complexity
of the coronary artery lesions was evaluated using Gensini score. Statistical tests were used to analyze the association
between the measured fasting insulin levels and Gensini score.
Results:
there was a statistically highly significant positive linear correlation between insulin level and Gensini score
(P<0.05). The accuracy of for insulin level as a predictor for coronary artery disease equals 96,6% by 96.7%
sensitivity and 75% specificity at cut off predictive value <25.8 mIU/L.
Conclusion: Fasting insulin level is a simple test for insulin resistance and significantly correlated with severe CAD
so it may have a value as a predictor of severity of CAD and risk stratification of diabetic patients.
Keywords: Coronary artery disease, Diabetic patients, Insulin resistance.


INTRODUCTION

Coronary artery disease is the major cause of
1975 by Goffedo G. Gensini. The Gensini score has
death worldwide, and more than 60% of the global
been developed to characterize the complexity of
burden of disease occurs in developing countries.
coronary artery disease taking into consideration three
GBD 2010 study showed that death from coronary
main parameters for each coronary lesion: severity
artery disease increased by 87.8% between 1990 and
score, region multiplying factor and collateral
2010, and a further rise by 50% is expected by 2030
adjustment factor (7, 8). Therefore aim of this work was
(1). The prevalence of coronary artery disease in
to examine the relationship between insulin resistance
diabetes is not only high, but also characterized by
determined by fasting insulin level and complexity of
increasing the severity and when the diabetic patients
coronary artery lesion in diabetic patients.
have the coronary artery disease, typically they have

more severe disease, with a greater number of arteries
PATIENTS AND METHODS
involved (2). Diabetes is a fast-growing health problem
A total number of eighty four diabetic patients
in Egypt with a significant impact on morbidity,
diagnosed according to the American Diabetes
mortality, and health care resources. Currently, the
Association (ADA) were referred to elective coronary
prevalence of type 2 diabetes (T2D) in Egypt is around
angiography at Dar El-Shefaa Hospital within the time
15.6% of all adults aged 20 to 79 (3).
period from October 2019 to April 2020, and patients
Insulin resistance (IR) is a pathological
with sepsis, pregnancy, acute or chronic renal failure,
condition in which cells fail to respond normally to
active bleeding, severe anemia, decompensated heart
insulin. IR known to be a pathogenic cause that can
failure were excluded from the study.
predict the occurrence of coronary artery disease (4).
All patients were subjected to history
The evolution of insulin resistance is unique in type 2
taking, full clinical examination, venous samples were
diabetes mellitus because it precedes the onset of
withdrawn for fasting insulin level, glycated
diabetes and remains fairly constant throughout the
hemoglobin, serum creatinine and lipid profile.
disease process from the time of diagnosis and even
Electrocardiogram was done, and coronary
after the conventional treatment for type 2 diabetes
angiography was recorded, and Gensini scores were
mellitus (5, 6).
calculated then patients were divided into four groups
Gensini score is a widely used angiographic
according to Gensini: Group (1): Normal coronary
scoring system for quantifying the severity of
arteries (0 score), Group (2): Mild CAD (0-15
coronary artery disease, and was first described in

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/)
2084
Received:13 /4 /2021

Accepted:9 /6 /2021


Full Paper (vol.841 paper# 72)


c:\work\Jor\vol841_73 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2090-2096

The Relationship between Serum Sclerostin Levels and
Carotid Intima Media Thickness in Predialysis Chronic Kidney Disease
Recep Demirci*1, Can Sevinc2
1Department of Nephrology, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
2Department of Internal Medicine and Nephrology, Ataturk University Faculty of Medicine, Erzurum, Turkey
*Corresponding author: Recep Demirci, E-Mail: rcpdemirci@windowslive.com, ORCID: 0000-0001-5609-9634

ABSTRACT
Background:
The most common cause of increased morbidity and death throughout the chronic kidney disease
(CKD) process is atherosclerosis, which advances quickly and is linked to cardiovascular diseases (CVDs).
Sclerostin levels in CKD and CVDs have a complicated connection.
Objective: We examined the relationship between serum sclerostin levels and atherosclerosis in patients with stage
3, 4, or 5 CKD who were not receiving hemodialysis treatment.
Patients and Methods: A total of 125 patients aged >18 years with CKD stage 3, stage 4 and non-dialysis stage 5
were enrolled in the study. Patients with obesity, uncontrolled hypertension, coronary artery disease, with active
cancer or liver disease, malignant hematologic disorders, acute renal failure, acute or chronic infections, were
excluded. As for the control group; healthy volunteers without any known illness, regular drug use, smoking, alcohol
use, and obesity were recruited.
Results:
Study population was diagnosed as 39.2% with diabetes mellitus and 91.2% of patients with arterial
hypertension. 54% of the patients were female. There was a positive correlation between serum sclerostin levels and
carotid intima media thickness (CIMT). A negative correlation was found between serum sclerostin levels and GFR
and 25-OH vitamin D levels. Sclerostin levels were found to be significantly higher in the group with high CIMT
levels. There was no difference in terms of other parameters.
Conclusion:
Sclerostin levels were significantly higher in patients with abnormal CIMT independent of GFR,
calcium, phosphorus and PTH values. This finding suggests that the serum sclerotin level can be used as a CVD
marker in patients with CKD.
Keywords: Carotid Intima Media Thickness, Predialysis Chronic Kidney Disease, Serum Sclerostin Levels.

INTRODUCTION

Chronic kidney disease (CKD) has become a
these individuals than in the general population (4).
serious public health concern with a global prevalence.
Medial and intimal calcification of the arteries appears
CKD has a negative influence on one's quality of life
as a sign of accelerated atherosclerosis in uremic
and comes at a significant financial expense.
patients. Coronary artery lesions in young adults first
Atherosclerosis, which progresses swiftly and is
appear as calcium crystals in the lipid core of
connected to cardiovascular diseases (CVDs), is the
atherosclerotic plaques (5).
leading cause of increased morbidity and mortality
Vascular calcification was originally thought to be
throughout the CKD process (1). Although the
a passive, degenerative process that occurred in the
extensive use of renal replacement therapy, the
vascular intima and media layer, but it has recently
cardiovascular risk remains, and the vast majority of
been shown to be an active, planned process (6).
patients die before reaching end-stage renal failure or
Mineral diseases such as hyperphosphatemia and
starting treatment (2).
hypercalcemia promote gradual calcification, which
In addition to traditional risk factors that accelerate
results in passive precipitation and the conversion of
atherosclerosis in patients with CKD, the presence of
vascular smooth muscle cells (VSMCs) to an
non-traditional risk factors promotes the development
osteoblast-like phenotype (7). Several proteins that are
of early rapid atherosclerosis in people with CKD.
useful in this process have been discovered. The Wnt-
Calcium and phosphorus metabolic problems,
-catenin pathway is critical for the development of
oxidative stress, inflammation, activation of the renin-
skeletal and bone mass. Furthermore, this route is
angiotensin
system,
albuminuria,
anemia,
involved in the progression of arterial calcification and
malnutrition, extracellular volume overload, and
atherosclerosis (8-10).
disturbance of nitric oxide and endothelial balance are
Sclerostin is a 22-kDa molecule and a SOST gene
the key factors that accelerate atherosclerosis (3).
product. Sclerostin is released from osteocytes,
Abnormal blood phosphate levels, calcium
inhibits the Wnt--catenin pathway. Sclerostin also
phosphate products, and parathyroid hormone levels
inhibits bone formation by suppressing differentiation
have all been associated to mortality in CKD patients.
and proliferation of osteoblasts and stimulating
Vascular calcification occurs 10­20 years earlier in
osteoblast apoptosis (11). Studies have shown that

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/)
2090
Received:15 /4 /2021

Accepted:11 /6 /2021


Full Paper (vol.841 paper# 73)


c:\work\Jor\vol841_74 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2097-2102

Relationship between Plasma Levels of Vitamin D in Pregnant Women and
Development of Gestational Diabetes Mellitus
Ali El Shabrawy Ali1, Wael Sabry Noseir 1,
Mohammed El-Hussiny El-Kadosi 1, Nawras Mohammad Ramadan Alshibani*2
1Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
2Department of Obstetrics and Gynecology, Faculty of Medicine, Tripoli University, Tripoli, Libya
*Corresponding Author: Nawras Mohammad Ramadan Alshibani, Mobil: 00218918931211,
E-mail: raoufelmahdi_86@yahoo.com
ABSTRACT
Background:
Gestational diabetes mellitus (GDM) is the leading cause of complications associated with childbirth
for both mothers and offspring, and it is considered to be caused by the imbalance between insulin resistance and
insulin secretion and contributed maternal hyperglycemia.
This study aimed to assess the relationship between plasma levels of vitamin D in pregnant women and the
development of gestational diabetes mellitus.
Patients and Methods: A case-control study was conducted at Gynecology and Obstetrics Department, Zagazig
University during the period from August 2020 until April 2021. It included a total of 104 pregnant women. Clinical
and obstetrical data were gathered, 25(OH) vitamin D3 total level in ng/ml at week gestation (10-12), (24-26), and
(34-36). The blood samples were performed by a Cobas 6000.
Results:
There is a strong correlation between vitamin D deficiency with the occurrence of gestational diabetes with
a cut-off value of 14.1 at (10-12) weeks gestation, sensitivity 100%, specificity 97.83%, NPV 100%, and PPV 93.3%.
Conclusions: There is an inverse association of vitamin D status with gestational diabetes risk.
Keywords: Plasma, Vitamin D, Gestational diabetes mellitus (GDM).

INTRODUCTION

Gestational diabetes mellitus (GDM) is the
population has not been definitively determined. Finally,
leading cause of complications associated with
several questions remain unanswered, including the
childbirth for both mothers and offspring, and it is
additional confounding factors that may affect the
considered to be caused by an imbalance between insulin
association between serum 25-hydroxyvitamin D and
resistance and insulin secretion and contributed to
the risk of GDM(5).Vitamin D deficiency during
maternal hyperglycemia(1). Among all obstetric
pregnancy has been associated with adverse outcomes in
complications, a rising prevalence of gestational
pregnant women, such as GDM, urinary tract infection,
diabetes mellitus (GDM), a disorder characterized by
preeclampsia, and cesarean delivery. Furthermore,
variable severity of glucose intolerance with onset or
infants born to mothers with lower vitamin D levels have
first recognition in pregnancy, has been reported over the
been found to have elevated risk of small for gestational
years, reaching 10­15% in the world(2).
age, low birth weight, cardiovascular disease, respiratory
Physiologically, pregnancy is a diabetogenic
illnesses, and type 2 diabetes mellitus(6).
condition since the steroid hormones increase and
Another
potential
effect
of
1,25
insulin resistance occurs in peripheral tissues, as well as
dihydroxyvitamin D on insulin sensitivity might be
inflammatory cytokines secreted from both adipose
exerted via its regulatory role in extracellular calcium
tissue and placenta, can contribute to insulin resistance
concentration and flux through cell membranes. Calcium
and pathogens of GDM(3).
is essential for insulin-mediated intracellular processes
Despite a delayed discovery, vitamin D (VD)
in insulin-responsive tissues such as muscle and fat with
has emerged as one of the most controversial nutrients
a narrow range of intracellular calcium needed for
and prohormones of the twenty-first century. If its role
optimal insulin-mediated functions(7).
in calcium metabolism and bone health is undisputed, its
Changes in intracellular calcium in insulin target
influence on other diseases and, more in general, long-
tissues may contribute to peripheral insulin resistance
term health is debated. Predominantly, VD appears as an
via an impaired insulin signal transduction leading to a
intriguing research topic for perinatal investigators
decreased glucose transporter activity(8). So we designed
dedicated to GDM because its status is easily modified
this study to assess the relationship between plasma
by supplementation(4).
levels of vitamin D in pregnant women and the
In a meta-analysis of 10 observational studies, it
development of gestational diabetes mellitus.
was found that 25-hydroxyvitamin D insufficiency was

associated with increased GDM risk in several
PATIENTS AND METHODS
subpopulations; however, the effect of serum vitamin D
A case-control study was conducted at the
levels and subsequent GDM outcomes in the general
Gynecology and Obstetrics Department, Zagazig

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/)
2097
Received:16 /4 /2021

Accepted:12 /6 /2021


Full Paper (vol.841 paper# 74)


c:\work\Jor\vol841_75 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2103-2107

Evaluation of Serum Testosterone Level in Patients with Psoriasis and Its
Correlation to Severity of the Disease
Amira Mohamed Abdelmonem*, Enayat Mohamed Atwa, Ayman El Sayed Ahmed Yosef.
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Amira Mohamed Abdelmonem, Mobile: (+20)1012306261, Email:dramiramohamed360@gmail.com

ABSTRACT
Background:
Psoriasis is a chronic inflammatory, immune-mediated systemic disease with skin manifestations that
typically follow a relapsing and remitting course. The most common form, plaque psoriasis, occurs in 80­90% of
psoriatic patients. Objective: The aim of the current work was to evaluate level of serum testosterone in psoriasis
male patients and its relation to severity of the disease.
Patients and methods: This cohort study included a total of 35 psoriatic patients, attending At Outpatient Clinic,
Dermatology and Venereology Department, Zagazig University Hospital, Egypt. This study was conducted between
January 2020 to October 2020. Serum free and total testosterone and total cholesterol were measured.
Result:
About two thirds of the studied group (71.4 %) had normal testosterone level and (28.6 %) had low
testosterone level.
Conclusion: Low serum total and free testosterone levels in male psoriasis patients are present and they correlate
with disease severity.
Keywords: psoriasis, testosterone, PASI score.

INTRODUCTION

biological and immunological impact on skin. The
Psoriasis is a chronic inflammatory disease of
lower levels of total testosterone, free testosterone, and
the skin that affects about 2­3% of the population and
sex hormone-binding globulin were found to be
greatly impairs the quality of life of affected individuals
associated with the metabolic syndrome. The latter is
(1). Psoriasis affects mainly skin, nails and joint and is
considered a sensitive biomarker for insulin resistance
characterized by the presence of sharply demarcated,
and systemic inflammation in psoriatic patients (9).
red plaques with adherent silvery white scales and a
This study was aimed to evaluate level of serum
tendency for symmetrical distribution over the body (2).
testosterone in psoriasis male patients and its relation to
The etiology of psoriasis is not fully understood, but it
severity of the disease.
may be the net result of the interaction among genetic,

environmental and immunological factors (3).
PATIENTS AND METHODS
The pathogenesis of psoriasis seems to be
This cohort study included a total of 35 psoriatic
driven by the interaction between innate immune cells,
patients and 15 apparently healthy males, attending At
adaptive immune cells and keratinocytes, in a process
Outpatient Clinic, Dermatology and Venereology
mediated by cytokines (including interleukins (IL)-6,
Department, Zagazig University Hospital, Egypt. This
IL-17 and IL-22, interferon- and tumor necrosis factor-
study was conducted between January 2020 to October
) and other signaling molecules (4). This leads to an
2020.
inflammatory process with increased proliferation of

epidermal cells, neo-angiogenesis and infiltration of
Ethical Consideration:
dendritic cells in the skin (4). Chiricozzi et al. (5) pointed
This study was ethically approved by the
at the cytokines of the IL-23/IL-17 axis as the important
Research Ethics Committee of Zagazig University
players in the pathogenesis of psoriasis. Psoriasis
Hospital. All included participants gave a written
lesions reveal significant expression of IL-23 and its
informed consent before being in the study.
receptor in psoriatic lesional skin and in blood
This work has been carried out in accordance
circulation (6). As IL-23 stimulates TNF- and IL-22,
with The Code of Ethics of the World Medical
its high expression has been proposed as a causative
Association (Declaration of Helsinki) for studies
factor in the onset of psoriasis (7(.
involving humans.
Interleukin-22, cytokine of the IL-10 family, it

stimulates proliferation of keratinocytes. The
Inclusion criteria: Male patients, age 18 years or
interaction between IL-22 and IL-17 results in
older, and suffering from psoriasis for longer than one
activation
of
proinflmmatory
cytokines
and
year.
chemokines and increases vascular endothelial growth
Exclusion criteria: Age less than 18 years, and disease
factor (VEGF) production from keratinocytes (8).
duration less than one year.
Hormones, especially sex steroid hormones, have

a major role in psoriasis pathogenesis due to their effect
Clinical assessment of the patients:
on keratinocyte proliferation along with their variable

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/)
2103
Received: 14/4/2021

Accepted: 10/6/2021


Full Paper (vol.841 paper# 75)


c:\work\Jor\vol841_76 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2108-2114

Supraclavicular Versus Infraclavicular Brachial Plexus Block Using
Two Different Techniques: Comparative Study
Areej Rashad Mohammad Abdalziz*, Samia Mohammad Masoud,
Ahmad Abd Elhakem Balata, Mona Abd Elhamed El Harrisi
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Areej Rashad Mohammad Abdalziz, Mobile: (+20)1200989822, Email: arig3000@yahoo.com

ABSTRACT
Background:
A perfectly conducted regional anesthetic guided by ultrasound offers much to anesthesiologists.
Objective: This study was aimed to compare supraclavicular block with infraclavicular brachial plexus block for
anesthesia in the forearm, hand surgery using two different methods: ultrasound alone or ultrasound together with a nerve
stimulator. Patients and Methods: This prospective randomized study was performed on 80 adult patients, aged from
20 to 60 years, with ASA (American Society of Anesthesiology) physical status I and II. Patients were randomized in one
of four groups: Supraclavicular block used Ultrasound (n =20), Supraclavicular block used ultrasound with nerve
stimulator (n =20), Infraclavicular block used Ultrasound (n =20), Infraclavicular block used ultrasound with nerve
stimulator (n =20). The local anesthetic solution used consisted of a 1:1 volume of 0.5 % bupivacaine and 2% lidocaine
with 1:200.000 adrenaline. This solution was injected in a dose of 0.5 ml/kg to maximal 40 ml.
The Measured parameters
were: Demographic values, the scanning time, the block performance time, the onset time,
the degree of pain during block performance, evaluation of sensory and motor block, and complications.
Result: There were no significant differences between groups as regards all measured parameters. Conclusion: It could
be concluded that the supraclavicular nerve block showed no significant difference from infraclavicular ultrasound-
guided with or without nerve stimulator. It remains controversial whether the adding of the nerve stimulation to the
ultrasound is more beneficial in ensuring rapid onset, longer duration of action, and avoiding complications.
Keywords: Supraclavicular, Infraclavicular, Brachial Plexus, Ultrasound-guided, Nerve stimulator with Ultrasound.

INTRODUCTION

Indications for a supraclavicular block are operations
The Code of Ethics of the World Medical
on the elbow, forearm, and hand (1). General
Association (Declaration of Helsinki) for studies
contraindications to supraclavicular block are those to
involving humans.
whichever regional block, such as injection site's local
Patients were enrolled and randomized into one of four
infection, coagulopathy (2). Due to the risk of
groups, 20 each:
pneumothorax, or phrenic nerve block, bilateral
Group (I): Supraclavicular block (SC BPB) performed
supraclavicular block is avoided in patients with
using Ultrasound.
respiratory compromise (1). Infraclavicular approaches to
Group (II): Supraclavicular block (SC BPB) performed
the brachial plexus provides reliable anesthesia for the
using ultrasound together with nerve stimulator.
forearm and the hand (3). Probable complications may
Group (III): Infraclavicular block (IC BPB) performed
include: Infection, Vascular puncture, paresthesia, Nerve
using Ultrasound.
injury, Local Anesthetic Systemic Toxicity (LAST),
Group (IV): Infraclavicular block (IC BPB) performed
Horner syndrome, Hemi diaphragmatic paralysis, and
using ultrasound together with nerve stimulator.
Pneumothorax (3). The aim of the current work was to

compare supraclavicular block with infraclavicular
Inclusion Criteria: The study involved 80 adult patients
brachial plexus block for anesthesia in the forearm, hand
of both sexes, aged between 20 and 60 years, and with
surgery using two different methods: ultrasound alone or
ASA I and II physical status.
ultrasound together with a nerve stimulator.
Exclusion Criteria: Patients under the age of 20 or above

the age of 60, severe form of chronic restrictive or
PATIENTS AND METHODS
obstructive lung diseases, skin infection in injection's site,
This prospective randomized study included a total
local anesthetics's allergy, sensory or motor deficit in the
of 80 adult patients planned for hand, and distal arm
operated upper limb, Or patient's refusal.
surgery, attending at Zagazig University Hospital,

Egypt.
Withdrawal cases:
Six patients were discounted due to the block's
Ethical Consideration:
failure. Block failure was stated as a partial or absent nerve
This study was ethically approved by the
block in more than one nerve territory, the block was not
Research Ethics Committee of Zagazig University
repeated, and these patients received GA.
Hospital. All included participants gave a written
Three patients were not sticking to inclusive criteria
well-informed consent before being in the study.
due to a local skin infection, and below 20 years. Seven
This work has been carried out in accordance with

This article is an open access article distributed under the terms and conditions of the Creative



Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2108
Received:15 /4 /2021

Accepted:11 /6 /2021


Full Paper (vol.841 paper# 76)


c:\work\Jor\vol841_77 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2115-2123

Prevalence, risk factors and Impact of Post-transplant Tuberculosis on
Live Donor Kidney Transplant Recipients: A Retrospective Study
Said M. Al-Barshomy1, Samar Elshahat2, Essam Elden Mahmoud Lotfy1, Salwa Mahmoud El Wasif2
1Department of Internal Medicine and Nephrology, Faculty of medicine, Zagazig University, Egypt
2Department of Nephrology, Urology and Nephrology Center, Mansoura University, Egypt.
*Corresponding author: Said M. Al-Barshomy, Mobile: (+20)1008559101, Email: saidbarshomy@yahoo.com

ABSTRACT
Background:
TB is encountered worldwide more frequently among renal transplant recipients than in the general
population. It is reported to be nearly 50 times higher in the renal transplant population because of immunosuppression.
TB may arise from unrecognized infection in the allograft or acquisition of new infection after transplantation.
Objective: The aim of the current work was to determine prevalence and risk factors for development post-transplant
TB, and the impact of post-transplant TB in live donor renal transplantation on both patient and graft survival. Patients
and methods:
This retrospective cohort study carried out in the Nephrology Unit, Mansoura Urology and Nephrology
Centre in Association with Nephrology Unit, Zagazig University Hospitals in the period between January 2020 to
December 2020. Included 210 patients out of 3200 kidney transplant recipients (KTRs) who underwent renal
transplantation in the period between March 1976 and December 2019, divided into 2 main groups according to
development of post-transplant tuberculosis, a group of 70 (KTRs) who developed tuberculosis after transplantation
served as a study group and a matched group of 140 (KTRs) who did not develop tuberculosis after transplantation
served as control group and evaluation of two groups through risk factor to develop TB, demographical data, clinical,
laboratory and radiological evaluation. After that TB group was subdivided into 2 groups according to the site of
infection: pulmonary and urinary TB. Results: Body mass index was higher among control group with statistically
significant difference. Associated medical disorders as post-transplant diabetes, post-transplant bacterial and CMV
infection had higher incidence among TB group. Liver enzymes and calcineurin (CNI) levels showed statistically
significant difference among TB group before and during anti tuberculous treatment, in which liver enzymes were
elevated while CNI levels were significantly reduced during antituberculous treatment. Post- transplant CMV infection
was higher in patients who developed pulmonary TB. Graft and patient survival were comparable among both groups
with no significant difference. Conclusions: It could be concluded that post-transplant diabetes, bacterial and CMV
infections increase risk of development of post-transplant TB. There was no effect of post-transplant tuberculosis on
both patient and graft survival.
Keywords:
Post transplant tuberculosis, Live donor, Kidney transplantation.

INTRODUCTION

1.2 to 6.4 percent but has been as high as 10 to 15
For the majority of patients with end-stage kidney
percent in endemic regions (4).
disease, kidney transplantation is the treatment of
TB is most transmitted from the donor allograft to
choice. Patients and health-care providers benefit from
the recipient as a result of reactivation of latent infection
long-term transplantation because mortality is lower
in the recipient, but it can also occur as a result of
than with maintenance dialysis and quality of life is
unrecognized infection in the allograft or acquisition of
improved also the annual cost of transplantation is
new infection after transplantation. There have been
substantially less than that of dialysis (1).
numerous reports of TB transmission from the donor
TB is encountered worldwide more frequently
allograft to the recipient, particularly when the donor
among renal transplant recipients than in the general
country of origin is endemic for TB (5).
population. It is reported to be nearly 50 times higher in
TB can also emerge as a result of a higher risk of
the renal transplant population because of
contracting a new Mycobacterium tuberculosis
immunosuppression (2).
infection, which can quickly proceed to miliary TB due
The total TB incidence rate in Egypt was 12 (11­14)
to immunosuppressive therapy. Because the symptoms
per 100,000 people according to the World Health
and indicators of latent and active TB in donors and
Organization estimates of TB burden, 2018. Screening,
transplant recipients are ambiguous, the diagnosis is
diagnosis, notification, and registration of TB cases
readily disregarded unless there is a high degree of
were implemented all over Egypt according to the
suspicion of TB. Transplant patients' tuberculosis
National TB Strategy of the National Tuberculosis
clinical picture is claimed to differ from that of the
Control Program (NTP) (3).
normal population, with an increased prevalence of
In developed countries, the prevalence of active
extrapulmonary tuberculosis (6).
tuberculosis among transplant patients has ranged from
Antituberculosis drugs act as a double-edged
weapon despite treating tuberculosis, they cause

This article is an open access article distributed under the terms and conditions of the Creative



Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2115
Received:15 /4 /2021

Accepted:11 /6 /2021


Full Paper (vol.841 paper# 77)


c:\work\Jor\vol841_78 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2124-2129

Plasma Concentrations of the Trace Elements Copper, Zinc, Lead and Selenium
in Children with Autistic Spectrum Disorder at Zagazig University Hospitals
Mohamed Mamdouh Abdelhamed Gaafar1, Hatem Mohamed Elsayed Hussein1,
Seham Mahrous Zaki Nasr2, Mohamed Talaat Mohamed Mohamed Amer*1
Department of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Mohamed Talaat Mohamed, Mobile: (+20)01149339130,
E-mail: mohamedtalat544@g.mail.com

ABSTRACT
Background:
Autistic spectrum disorder (ASD) has a multifactorial etiology involving interactions between genes,
environment, and diet. Among the environmental factors that have received significant attention related to ASD are
toxic metals, such as lead (Pb). Given the importance of zinc (Zn) and copper (Cu) metabolism for healthy
neurological functioning and detoxification of heavy metals. Selenium (Se) is an essential trace element having a very
narrow range between deficient, essential, and toxic doses.
Objective: To evaluate the association between the level of serum Cu, Zn, Pb, and Se in children with ASD.
Patients and Methods:
Our case-control study was carried out in the psychiatric and neurology clinic, Pediatric
Department, Zagazig University Hospital, during the period 2018 - 2019. It enrolled 42 children, (13 males and 8
females) with autism diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text
Revision (DSM-IV-TR) and the Childhood Autism Rating Scales (CARS) (with no other medical disease). The
control group enrolled 21 apparently healthy children.
Results: There was a statistically significant difference between the studied groups regarding the presence of plasma
zinc and selenium (lower in the autistic group). There was a statistically significant difference between the studied
groups regarding the presence of copper and plasma lead (higher in the autistic group). There was a statistically
significant negative correlation between plasma selenium and lead level.
Conclusion: Our results suggested an association between serum Cu, Zn, Pb, and Se in children with ASD.
Keywords:
Trace Elements, Copper, Zinc, Lead, Selenium, Autistic Spectrum Disorder.

INTRODUCTION

Autism spectrum disorder (ASD) is a complex
The role of other essential trace elements in ASD
neurodevelopment disorder that is present from early
is less studied. In particular, certain studies have
childhood and affects daily functioning. The condition
demonstrated altered cobalt (Co)(8), selenium (Se)(9),
is characterized by social-interaction difficulties,
manganese (Mn)(10), and iron (Fe)(11), metabolism in
communication challenges, and restricted, repetitive
ASD.
patterns of behavior, interests, or activities(1).
This study aimed to evaluate the association between
The number of children with ASD has during the
the level of serum Cu, Zn, Pb, and Se in children with
last decades increased at an alarming rate. Currently, it
ASD.
is estimated that 1 in 45 children in the US has ASD

diagnosis(2). ASD is influenced by both genetic and
PATIENTS AND METHODS
non-genetical factors(3). Non-genetical factors include
This study was carried out in the psychiatric and
immunological,
nutritional,
metabolic,
and
neurology clinic, Pediatric Department, Zagazig
environmental factors(4).
University Hospital, during the period 2018 - 2019.
A significant impact of the interaction between
The present study was designed to be a case-
genetic and environmental factors in the etiology of
control type. It enrolled 42 children, (13 males and 8
ASD has been demonstrated(5).
females) with autism diagnosed by the Diagnostic and
Essential trace elements are also known to play a
Statistical Manual of Mental Disorders, Fourth Edition,
significant role in ASD. In particular, zinc (Zn) playing
Text Revision (DSM-IV-TR) and the Childhood
an important physiological role in the modulation of
Autism Rating Scales (CARS) (with no other medical
immunity, antioxidant system, was shown to be
disease). Their ages ranged between 3 to 11 years with
essential for brain function. Zinc deficiency was found
a mean of 6.6±2.9 years.
to be frequent in ASD children(6). At the same time,
The control group enrolled 21 apparently healthy
copper (Cu) also being an essential micronutrient may
children, matched to the patients' age and sex. All
have a negative impact on ASD in the case of
controls were also clinically examined by the
overexposure.
Moreover,
certain
antagonistic
pediatricians to exclude the possibility to have any
interactions between Zn and Cu are proposed to be
subclinical autistic features.
involved in ASD pathogenesis(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/)
2124
Received:16 /4 /2021

Accepted:12 /6 /2021


Full Paper (vol.841 paper# 78)


c:\work\Jor\vol841_79 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2130-2136

A Persistent left Superior Vena Cava: Case report
Ayman Elsayed Albadrany
Department of Cardiology, Damietta Cardiac and Gastroenterology Center, Egypt.
*Corresponding author: Ayman Elsayed Elbadrany, Mobile: (+20)1010668806, E-Mail: aymanalbdrany@yahoo.com

ABSTRACT

Background: Persistent left superior vena cava (PLSVC) is rare but important congenital vascular anomaly. It results
when the left superior cardinal vein caudal to the innominate vein fails to regress. It is most commonly observed in
isolation but can be associated with other cardiovascular abnormalities including atrial septal defect, bicuspid aortic
valve, coarctation of aorta, coronary sinus ostial atresia, and cortriatriatum.
Objective: Aim of this case presentation was to describe a rare case of persistent left superior vena cava that is
associated with atrial septal defect and partial anomalous pulmonary venous drainage. Also, how to suspect and then
confirm the presence of PLSVC by echocardiographic examination, and to know the role of multi-slice CT and cardiac
MRI for detection of other cardiac and extra-cardiac anomalies.
Patients and methods: Male patient aged 32 year complaining of shortness of breath for about 1 year,
echocardiographic examination revealed dilated coronary sinus and injection of agitated saline indicated the presence
of persistent left superior vena cava. PLSVC may be associated with other anomalies so further evaluation by multi-
slice CT was done to confirm the diagnosis of PLSVC as well as sinus venosus ASD and partial anomalous pulmonary
venous drainage so surgical consultation was done for surgical correction.
Conclusion: Diagnosis of PLSVC is important, as it is often associated with other anomalies as atrial septal defect
and partial anomalous pulmonary venous drainage, which lead to pulmonary hypertension and need surgical
correction before the occurrence of pulmonary hypertension.
Keywords: PLSVC, CT MRI.

INTRODUCTION
suspect and then confirm the presence of PLSVC by
Persistent left superior vena cava (PLSVC) is the
echocardiographic examination, and to know the role
most common systemic venous return anomaly, with
of multi-slice CT and cardiac MRI for detection of
an estimated prevalence of 0.3-0.5% in the general
other cardiac and extra-cardiac anomalies.
population, of 4-8% in patients with congenital heart

disease (1), and 0.9% in the fetal population (2). The
CASE PRESENTATION
origin of the PLSVC is not yet completely clear. It is
Male patient aged 32 year, work as a driver with
believed to be the result of an intrauterine failure of the
average normal weight and height complaining of
development of the left anterior cardinal vein, resulting
shortness of breath for about one year, he asked for
in the bilateral presence of superior vena cava (3).
medical advice. By clinical examination, normal blood
However, in the last years the prenatal diagnosis of
pressure, heart rate, also cardiac and chest examination
PLSVC has been done based on an abnormal view of
was unremarkable. Lab investigations were done
three vessels in the upper mediastinum, showing a
including CBC, liver functions test, renal functions
supernumerary vessel to the left of the pulmonary
tests, and thyroid function tests. All lab investigation
trunk and arterial duct (4).
were normal. ECG showed right bundle branch block
Although there are many divergences regarding
pattern. Therefore, echocardiographic examination to
the true prevalence, the PLSVC does not have major
assess ventricular function, valves and pulmonary
clinical impacts, as systemic venous blood continues
artery pressure was necessary. Echocardiographic data
to return to the right atrium through the coronary sinus,
included dilated coronary sinus (Figure 1 and 2) and
and there is usually a normal right superior vena cava
low probability pulmonary hypertension with TR
(5).
velocity 2.8 m/sec, and dilated RA, RV.
The recognition of PLSVC is of great
Causes of dilated coronary sinus includes:
importance for anatomists, clinicians and surgeons,
LSVC (left superior vena cava), isolated atresia or
especially in the implantation of long-term central
stenosis of the coronary sinus (CS) partial anomalous
venous catheter as well as pacemaker insertion. Thus,
hepatic venous connection to CS, partially unroofed
the present article aimed to report a finding of a
CS, anomalous pulmonary venous return to CS,
persistent left superior vena cava in adult 32 years male
coronary arterio-venous fistula and aneurysm of the
who was complaining of shortness of breath for a year
CS (7, 8).
before diagnosis (6).
To exclude LSVC, agitated saline was injected
Aim of the study: to describe a rare case of PLSVC
through the left arm vein if reached the CS before the
that was associated with atrial septal defect and partial
right atrium and right ventricle suggest the presence of
anomalous pulmonary venous drainage. Also, to
PLSVC (Figure 3, 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/)
2130
Received:6 /4 /2021

Accepted:12 /6 /2021


Full Paper (vol.841 paper# 79)


c:\work\Jor\vol841_80 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2137-2143

Fixation of Displaced Midshaft Clavicular Fracture in Adult by
Intramedullary Elastic Rod
Abdelrhman Ebrahem Kenan*1, Mahmoud Seddik Hasan2, Mohamed Mosa Mohamed Mahmoud1
1Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Al-Azhar University (Assiut), Egypt.
2Department of Orthopedic Surgery and Traumatology, Faculty of Medicine, Al-Azhar University (Cairo), Egypt.
*Corresponding Author: Abdelrhman Ebrahem Kenan, Mobile: 01000716898, Email: dr_kenan47@gemail.com

ABSTRACT
Background:
Intramedullary elastic rod fixation of midshaft clavicular fracture results in rapid free movement of the
shoulder and an earlier return to daily activities than the conservative treatment. In comparison with plate fixation,
the procedure is less invasive, with no loss of fracture haematoma, rapid union, and less infection. No major surgery
for removal with less injury to surrounded neurovascular structures. A smaller incision is required with superior
cosmesis. Objective: To study the short-term results of treatment of displaced fractures of the middle third of the
clavicle using percutaneous elastic intramedullary nails
Patient and Methods: This prospective study was carried out on twenty patients with displaced fractures of the
middle third of the clavicle presented to the Hospital and treated by percutaneous elastic intramedullary rod between
November 2019 and May 2020.
Results: At the end of the follow-up period, the mean score was 89.70 ± 13.55 ranging from 48 to 100 according to
the modified Constant and Murley shoulder score. Fourteen patients (70%) had excellent results, four patients (20%)
had good results, one patient (5%) had a fair result, and one patient (5%) had a poor result.
Conclusion: Elastic stable intramedullary nailing (ESIN) is an image dependant procedure indicated best for young
medically free patients with acute simple 2 part middle third clavicle fracture. Delay in surgery may necessitate open
reduction. Hammering is not recommended to avoid dorsolateral cortex perforation.
Keywords:
Midshaft clavicular fracture, Elastic rod, Minimally invasive fixation.

INTRODUCTION
In this study, we analyzed the clinical and
Fracture of the clavicle is considered as one
radiological results of fixation of displaced midshaft
of the most common fractures in adults constituting
clavicular fractures in 20 patients, by elastic stable
about 5-10% of all fractures in adults, and 35% to 45%
intramedullary nailing (ESIN) used by a minimally
of shoulder girdle injuries. These injuries are most
invasive procedure. This work aimed to study the short
common in younger patients, often associated with
term results of treatment of displaced fractures of the
direct or indirect trauma to the clavicle (1, 2).
middle third of the clavicle using percutaneous elastic
Midshaft clavicular fractures constituting
intramedullary nails.
(80%) of all clavicular fractures, followed by lateral

PATIENTS AND METHODS
third fractures (12% to 15%) and lastly medial third
This prospective case series study was done in
fractures (5% to 6%) (3).
Al-Azhar University Hospital (Assiut) between
Midshaft clavicular fractures have been
November 2019 and May 2020 on 20 patients. The
treated conservatively, but high-quality randomized
patients had isolated displaced midshaft clavicular
studies have recently begun to change the evidence-
fractures. The mean age of patients was 26.4 (18 to 65
based management of these fractures toward operative
years) about 3 females and 17 males who came with a
fixation (4).
history of trauma of less than 2 weeks duration.
Although healing and functional outcomes

are generally good with conservative treatment for
Inclusion criteria: Age above 18 and below 65 years.
midshaft clavicular fractures, bad cosmetic results due
The duration was less than 2 weeks, and displaced or
to shortening and angulation are not uncommon (1, 5).
angulated mid-shaft fracture with shortening and axial
Nonunion rate about 5% with conservative treatment
malalignment.

(5, 6). Moreover, with clavicular shortening of 1-2 cm
Exclusion criteria: Duration of trauma more than 2
after conservative treatment, there is a decrease in
weeks, presence of medical comorbidity, pre-existent
shoulder function (5, 7). Although the mild functional
morbidity of the ipsilateral arm, shoulder or hand,
decrease is well tolerated by most patients, restoration
presence of neurovascular injury, and pathological
of clavicular length and full functional recovery of the
fractures.
shoulder is of great importance for athletic patients (5).
Ethical consent:
Plate osteosynthesis is the standard operative treatment
An approval of the study was obtained from Al-
for a midshaft clavicular fracture, but higher
Azhar University academic and ethical committee.
complication rates have been described with this
Every patient signed an informed written consent
technique like hematoma, infection, nonunion, and
for acceptance of the operation. This work has been
implant failure (8).
carried out in accordance with The Code of Ethics

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/)
2137
Received:17 /4 /2021

Accepted:13 /6 /2021


Full Paper (vol.841 paper# 80)


c:\work\Jor\vol841_81 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2144-2148

Effect of Following Guidelines on Pharmacological Managements in
Adult Patients with Type 2 Diabetes on Glycemic Outcomes
Hamed Abdelaziz Deraz1, Nagwa Mohamed Shawky1, Ahmed Salah Al Allam1, and Reem Saad Abujnah*2
1Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt.
2Department of Internal Medicine, Faculty of Medicine, El Mergeb University, Libya.
*Corresponding Author: Reem Saad Abujnah, Mobil: +218 91-4948816, E-mail: reem18634@gmail.com

ABSTRACT
Background:
The prevalence of diabetes among hospitalized patients is high. One out of 4 hospitalized patients has
diabetes; thus, treating hyper- or hypoglycemia represents an everyday challenge in hospitals worldwide.
Objective: This study aimed to assess the level of adherence to current American practice guidelines for inpatient
pharmacologic management of type 2 diabetes and its effect on glycemic outcomes.
Patients and Methods: A prospective study was conducted in Internal Medicine Department, Faculty of Medicine,
Zagazig University in the period from April 2020 to April 2021. It included 50 patients with type 2 diabetes who were
treated with insulin and/or other antihyperglycemic drugs. They were followed up during their hospital stay for
hyperglycemic and hypoglycemic episodes. Results: Mean capillary blood glucose measurement (CBGM) throughout
three days were higher among Guideline adherence group than Guideline non-adherence group (12.6±1.04 vs. 5.2±1.3)
with statistically significant difference p<0.0001. In addition, 88.0% of Guideline adherence group CBGM was
measured four times or more per day. The incidence of hyperglycemic reading (12.0% in Guideline adherence group
and 36.0% in Guideline non- adherence group) showed statistically significant difference p= 0.047. Conclusions: There
is a good level of adherence to the current American guidelines for inpatient management of type 2 diabetes. The level
of adherence is greater with more training and clinical seniority.
Key words: Diabetes mellitus, Glycemic, Guidelines, Type 2 Diabetes.

INTRODUCTION
as a chronic progressive disease. However, both clinical
Diabetes mellitus (DM) is a complex chronic illness
experience and scientific studies have shown that
associated with a state of high blood glucose level, or
bringing progression to a standstill and even reversing
hyperglycemia, occurring from deficiencies in insulin
the clinical manifestations of T2DM should be
secretion, action, or both. The chronic metabolic
considered an achievable clinical outcome(3).
imbalance associated with this disease puts patients at
The prevalence of hyperglycemia in noncritically ill
high risk for long-term macro- and microvascular
patients with diabetes is estimated to be about 25%. One
complications, which if not provided with high quality
out of 4 hospitalized patients has diabetes; reasons for
care,
lead
to
frequent
hospitalization
and
this high rate, in addition to the physiologic state, are
complications(1). The clinical diagnosis of diabetes is
related primarily to inadequate prescribing, monitoring
reliant on either one of the four plasma glucose (PG)
and communication practices; thus, treating hyper- or
criteria: elevated (i) fasting plasma glucose (FPG) (>126
hypoglycemia represents an everyday challenge in
mg/dL), (ii) 2 h PG during a 75-g oral glucose tolerance
hospitals
worldwide(4,5).
Hyperglycemia
during
test (OGTT) (>200 mg/dL), (iii) random PG (>200
admission is associated with increased rate of
mg/dL) with classic signs and symptoms of
complications and longer hospitals stays; hence, the
hyperglycemia, or (iv) hemoglobin A1C level >6.5%.
inpatient care of diabetes patients accounts for a
Recent American Diabetes Association (ADA)
substantial proportion of total health costs(6,7) .
guidelines have advocated that no one test may be
The role of glucose control during hospitalization
preferred
over
another
for
diagnosis.
The
has been a subject of debate recently, as has the choice
recommendation is to test all adults beginning at age 45
of insulin regimens. The first landmark trials on
years, regardless of body weight, and to test
glycemic targets were performed in intensive care units.
asymptomatic adults of any age who are overweight or
van den Berge et al. (8) reported that intensive insulin
obese, present with a diagnostic symptom, and have at
treatment with a glycemic goal of 110 mg/dl (6.2
least an additional risk factor for development of
mmol/L) reduced inhospital morbidity and mortality;
diabetes(2).
however, subsequent trials failed to confirm this finding
T2DM is a leading cause of morbidity and mortality
of reduced mortality with intensive glycemic control in
and is a significant factor in increasing healthcare costs
critically ill patients(9).
due to its extensive complications. The American
So we designed this study to assess the level of
Diabetes Association estimates the annual costs
adherence to current American practice guidelines for
associated with T2DM to be over $300 billion in 2017.
inpatient pharmacologic management of type 2 diabetes
In January 2017, the American Diabetes Association and
and its effect on glycemic outcomes.
American Academy of Family Physicians labeled T2DM


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/)
2144
Received:16 /4 /2021

Accepted:12 /6 /2021


Full Paper (vol.841 paper# 81)


c:\work\Jor\vol841_82 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2149-2152

Olecranon Apophyseal Fracture and Radial Neck Fracture in a
Patient without Osteogenesis Imperfecta: A Case Report
Abdullah A. Alshamrani
Department of Orthopedic Surgery, King Abdulaziz Hospital, Makkah, Saudi Arabia
Corresponding Author: Abdullah A. Alshamrani, E-Mail: dr.a.alshamrani2016@gmail.com

ABSTRACT
Background:
Olecranon apophyseal fractures in children are uncommon. The bulk of these injuries are nondisplaced
and therefore can be treated nonoperatively.
Objective:
To study the outcome of open reduction and internal fixation of olecranon fracture.
Patients and methods: Our case report of a 9 years old girl who sustained left elbow trauma after falling directly over
the elbow. Attended the outpatient clinic of the Department of Orthopedic Surgery, Alnoor Specialist Hospital, Makkah,
Saudi Arabia, radiographs showed olecranon and radial neck fractures, olecranon fracture was displaced so we fix it
with K-wire and tension band, while the radial neck fracture was treated conservatively.
Results: At the 12 weeks follow-up, she achieved a complete range of motion of the left elbow with good functional
outcomes and with no complications. The goal in such complex fractures is to achieve a stable congruent joint with
gradual rehabilitation to reach a good functional outcome.
Conclusion: open reduction and internal fixation of the olecranon fracture is the optimal treatment to achieve a complete
range of motion and good functional outcome.
Keywords: Olecranon, Radial neck, Elbow injury.


INTRODUCTION
complaining of left elbow pain after she falls
Olecranon apophyseal fractures in children are
while playing 1 hour before her presentation. The pain
uncommon. The bulk of these injuries are
was severe mainly at the elbow and radiated to the
nondisplaced and therefore can be treated
mid-forearm. Associated with swelling and
nonoperatively.
ecchymosis around the elbow. She could not move the
Few published reports of children with displaced
elbow passively and actively due to pain. No signs of
fractures of the olecranon apophysis exist, and the
compartment syndrome.
large majority of reports describe children with
No open wounds. The wrist and shoulder were
osteogenesis imperfecta. Our report is about a 9-years
free from injuries and have a full range of motion.
old, healthy, girl patient without osteogenesis
Distal neurovascularity was normal. Anteroposterior,
imperfecta who sustained a displaced olecranon
lateral, and oblique radiographs showed olecranon
apophyseal fracture during a fall.
apophyseal fracture and radial neck fracture (Figure

1).
Ethical approval:
Then above elbow posterior splint applied. And
The patient signed informed written
the patient was admitted to the ward for surgical
consent for the acceptance of the operation and
fixation. The patient underwent open reduction and
publication of this case report. An approval of the
internal fixation of olecranon fracture using K-wire
study was obtained from Alnoor Specialist
and tension band. Using a direct posterior approach to
Hospital, Makkah, Saudi Arabia, academic and
the elbow. The ulnar nerve was dissected and
ethical committee. This work has been carried out
protected with a vessel loop. Olecranon fracture was
in accordance with The Code of Ethics of the
identified and the hematoma was evacuated and
World Medical Association (Declaration of
irrigation with normal saline done. Fracture reduced
Helsinki) for studies involving humans.
and fixed with two K-wire and tension band under the

guidance of fluoroscopy (Figure 2,3).
CASE REPORT
After closure and dressing, a posterior splint
A 9 years old girl not known to have any medical
was applied. Distal neurovascularity was intact.
illnesses came to the Emergency Department
Radial neck fracture was treated conservatively.






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/)
2149
Received:14 /4 /2021

Accepted:10 /6 /2021


Full Paper (vol.841 paper# 82)


c:\work\Jor\vol841_83 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2153-2164

Minimizing Myocardial Ischemic Injury by Cool Dialysate in
Maintenance Hemodialysis Patients: A Randomized Controlled Trial
Mohamed E. Ibrahim1, El-Metwally L. El-Shahawy1, Hassan G. Abdelsalam1,
Heba Ahmed M. Mokhtar1, Reda Biomy2, Saddam A.A. Hassan*1
1Internal Medicine and Nephrology Department, Faculty of Medicine, Benha University, Egypt
2Cardiology Department, Faculty of Medicine, Kafr El-Sheikh University, Egypt
*Corresponding author: Saddam A.A. Hassan, Mobile: (+20) 01008950489, E-mail: saddam.ahmed@fmed.bu.edu.eg

ABSTRACT
Background:
Emerging evidence supports a cardiovascular protective role of Cooled Dialysis (CD) in incident
Hemodialysis (HD) patients. Whether this benefit can be extended to maintenance HD patients remains to be established.
Objective: The aim of the present study was to assess the impact of CD by lowering Dialysate temperature (dt) 0.5oC below
Core Body Temperature (CBT), on minimizing myocardial ischemia in maintenance HD patients (>1 year on HD).
Patients and Methods: from March 2019 to January 2021, we randomized one hundred maintenance HD patients to receive
either Cooled Dialysis (dt - 0.5oC below CBT, intervention) or Standard Dialysis (dt= CBT, control) for 12 months. Over
the study period, serial measurements of ECG, echocardiography, and myocardial enzymes (CK-MB and Troponin-T) were
performed for the whole study population as surrogates for myocardial ischemic injury.
Results:
By the end of 12-months, compared to Standard Dialysis (ST) patients, Cooled Dialysis (CD) patients had overall
less incidence of new myocardial ischemia (composite surrogate outcomes: ECG, Echo and CK-MB) (p=0.032). In logistic
regression analysis, CD was found to be independently protective against myocardial ischemia (OR 0.54, p-value 0.033,
CI: 0.3-0.95). Conclusion: In maintenance HD patients, Cooled Dialysis might help decrease myocardial ischemia with a
reasonable safety profile. Further studies are warranted to explore these findings.
Keywords: Core Body Temperature (CBT), Cooled dialysate (CD), Dialysate Temperature (dt), Hemodialysis (HD),
Ischemia-Reperfusion Injury (IRI).

INTRODUCTION


Cardiovascular disease (CVD) is the leading cause of
kidney, Gut and liver. The cumulative HD-induced IRI
morbidity and mortality among End-Stage Renal Disease
ends
in
myocardial
stunning,
HD-induced
(ESRD) patients on Hemodialysis (HD) (1). Early in the
cardiomyopathy, brain white matter ischemia, cognitive
course of Chronic Kidney Disease (CKD) with 75% of
dysfunction, decreased renal perfusion and endotoxemia
patients having preexisting CVD, patients are more likely
due to disruption of Gut barrier (3-9).
to experience Major Adverse Cardiovascular Events
Another overlooked factor in the unique profile of
(MACE) than to progress to ESRD. As CKD progresses to
CVD in HD patients is the HD-induced "thermal stress"
ESRD, transition from traditional atherosclerotic to
due to the thermal imbalance encountered during HD
nontraditional non-atherosclerotic MACE is noted in HD
procedure that further adds to the impaired
patients accounting for up to 50% of mortality (2).
thermoregulatory mechanisms when they are most needed
Emerging evidence has shed light on the dark side of
to combat the "circulatory stress" superimposed by HD (10).
conventional HD which acts as a major "circulatory
Up to 40% of HD patients have dysregulated baseline
stressor" in ESKD patients prone to Intradialytic
Core Body Temperature (CBT) at low levels of 36.5oC,
Hypotension (IDH). Left untreated, repetitive episodes of
hence dialyzing patients against an arbitrarily set 37oC
IDH further trigger and accelerate CVD by inducing
"standard" dialysate temperature (dt) results in passive
cumulative HD- mediated Ischemia-Reperfusion Injury
transfer of heat energy from dialysate to the patient. The
(IRI) (3). Therefore, on its own, conventional HD acts as a
end result of this "supraphysiological" heating during HD
cardiovascular "disease modifier" by superimposing
would be excessive vasodilatation of vasculature which
ischemic multiorgan injury on preexisting complex
further compromises the hemodynamic responses to IDH.
comorbidities in this population. Thus, HD, in and of itself,
Conversely, Dialysate Cooling (CD) has been traditionally
accelerates and augments (CVD) morbidity and mortality
employed in HD patients who cannot tolerate
(1-3).
ultrafiltration- induced hypovolemia to offset (IDH) based
Over the past decade, HD-induced circulatory stress
on its favorable hemodynamic stabilizing effect attributed
has been the focus of a series of imaging, and biomarker
to enhanced cardiac inotropy, improved peripheral
studies addressing the subclinical insults of (IDH)
vascular resistance, and catecholamine surge induced by
affecting the vulnerable vascular beds in the heart, brain,
lowering dialysate temperature (11-15).

This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2153
Received:19/04/2021

Accepted:15/06/2021


Full Paper (vol.841 paper# 83)


Full Paper (vol.841 paper# 84)


c:\work\Jor\vol841_85 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2168-2172


Spinal Hemangioma in Pregnancy: A Case Report
Ibrahim Abdullah Masoudi*, Fared Nicholas Kassab
Department of Orthopedic Surgery, International Medical Center Hospital, Jeddah, Saudi Arabia
*Corresponding Author: Ibrahim Abdullah Masoudi, E-Mail: dr.imsoudy@gmail.com

ABSTRACT

Background: Hemangiomas of bone are localized benign tumors composed of fully developed adult blood vessels.
Vertebral hemangiomas are present without symptoms in approximately 10% of the population and more common
in females. It is usually located in the lower thoracic and lumbar vertebra and are often multifocal. Infrequently
these benign lesions may cause local or radicular pain and neurological deficits ranging from myeloradiculopathy
to paralysis.
The physiological vascular, hemodynamic and hormonal changes in pregnancy act to enlarge a preexisting
hemangioma and most of these changes peak in the third trimester. The most important contributing factor is the
increase in venous pressure resulting from mechanical obstruction of blood flow from the paravertebral veins into
the inferior vena cava by the gravid uterus.
Objective: To study the outcome of management of a case of spinal hemangioma during pregnancy.
Case report: A 26-years-old pregnant female patient attended the Department of Orthopedic Surgery at the
International Medical Center Hospital, Jeddah, Saudi Arabia, suffering from a severe lower limb paresis and loss
of sphincteric control and diagnosed with spinal hemangioma. An intervention was done during pregnancy to
prevent further complications by decompressing the spinal cord. Post-delivery, the main surgery was performed to
prevent the recurrence.
Conclusion: The management of spinal hemangiomas in pregnant women can be done in the following two steps.
The First step is short-timed, less bloody intervention to decompress the mass to prevent further damage and
complications. The second step is to perform the main surgery post-delivery when the condition permits.
Keywords: Hemangiomas, Spinal, Vertebroplasty.

INTRODUCTION

Spinal hemangiomas are one of the most frequent
also be a presenting symptom (6).
primary tumors of the spine. This tumor is of vascular
In cases associated with neurogenic pain,
origin and like hemangiomas in other parts of the
hemangiomas usually extend into the spinal canal or
body is usually associated with proliferation of
neural foramina (7).
normal capillary and venous structures (1, 2).

In a previous study it was, identified in about 11%
CASE REPORT

of patients at general autopsy. These lesions are
A 26-years-old pregnant patient at the 31st week
usually an incidentally discovered on CT and MR
of gestation was presented to the Department of
imaging of the body and spine, and frequently in
Orthopedic Surgery at the International Medical
radiographs of the thoracolumbar spine (3, 4).
Center Hospital, Jeddah, Saudi Arabia, complaining
A minority of these lesions can be associated with
of inability to move her lower extremity with loss of
symptoms, primarily involving back pain and
sphincter control.
neurologic complaints with some estimates of 0.9%
Following history taking, medical examination
to 1.2% becoming symptomatic (5). Symptoms can
and investigations, she was found to have spinal
involve severe backaches that is worsened by
hemangioma that was compressing the spinal cord at
movement. However, mild to moderate pain might
the level of T3 to T5 started to bleed and calcified

inside the epidural space compressing the cord.














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/)
2168
Received:18 /4 /2021

Accepted:14 /6 /2021


Full Paper (vol.841 paper# 85)


c:\work\Jor\vol841_86 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2173-2175

Huge Post-Partum Intra-Myometrial Hematoma (Couvelaire Uterus) in
A Preserved Uterus in A Case of Placenta Accreta: Case Report
Ahmed A. Khalifa*1, Elsemary M.A1, Mahmoud Mousa Ahmed1, Mariam M. Elshamandy2
Departments of 1Obstetrics & Gynecology and 2Public Health, Faculty of Medicine - Sohag University, Egypt
*Corresponding author: Ahmed A. Khalifa, Mobile: (+20) 01065337768, E-Mail: ahmed.khalifa@med.sohag.edu.eg

ABSTRACT
Background:
Couvelaire uterus, also known as uteroplacental apoplexy, is a rare but nonfatal condition resulting from
extravasation of blood into the uterine musculature and surrounding tissues.
Objective: presentation of a case of huge intramyometrial hematoma (Couvelaire uterus) developed postpartum in a
preserved uterus in a case of placenta previa accreta, which is atypical presentation in such cases.
Case Report: 29 years old female patient 38 weeks pregnancy. Pregnancy was terminated by CS due to placenta previa
cenralis accreta. During CS, preservation of the uterus was done by application of multiple haphazard haemostatic sutures
and bilateral uterine artery ligation. The patient presented by post-partum collapse. Ultrasonographic examination
revealed huge intramyometrial hematoma (Cauvlair uterus). Exploration was done with confirmation of the
ultrasonographic picture. Subtotal abdominal hysterectomy was done with preservation of both ovaries with uneventful
post portative period. Examination revealed huge intramyometrial hematoma (Cauvlair uterus).
Conclusion: Post-partum intramyometrial hematoma (Couvelaire uterus) is atypical presentation in cases of preserved
uterus in patients with placenta accreta and it may result from multiple haphazard unorganized haemostatic sutures.
Therefore, the obstetricians should be aware of such rare complication for early diagnosis and management.
Keywords: Huge post-partum intramyometrial hematoma, Couvelaire uterus, Preserved uterus, Placenta accrete.

INTRODUCTION
placenta previa major degree, accreta with no other
Morbidly adherent placenta (MAP) is considered
remarkable risk factors. The patient have four off
one of the most life-threatening obstetric complications
springs, two males and two female, all of them have
and may cause severe intra-operative bleeding requiring
been delivered by caesarean section. On admission, the
massive blood transfusion with its related consequences,
vital data were within normal pulse: 94beat /minute, Bp:
increased incidence of peripartum hysterectomy and
120/70 mmHg and hemoglobin level: 12 gm/dl.
high maternal mortality (1, 2).
Obstetric ultrasonography revealed single living fetus
MAP is the greatest challenge in obstetric (3). Good
about 38 weeks gestational age with placenta previa
results and outcomes of MAP depend on early diagnosis
centralis accreta with no other abnormal sonographic
and multidisciplinary planning for delivery (4). MAP is
findings.
classified into three important degrees according to the
No history of vaginal bleeding or labour pain,
attachment of chorionic villi to the uterine wall and
which was confirmed by obstetric assessment. The
adjacent organs. It could be placenta accreta (chorionic
patient was counseled about the termination of
villi are in contact with the myometrium), placenta
pregnancy by caesarean section and the possible risks of
increta (chorionic villi invade the myometrium) or
this operation as regard peripartum hysterectomy and
placenta percreta (chorionic villi penetrate the uterine
related consequences. Consent for hysterectomy was
serosa). The increased rate of cesarean delivery over the
obtained from the patient and her husband.
past 50 years is the leading cause of MAP (5). In the last
The patient was transferred to the operative
decades, the rate of cesarean section has increased
theatre after availability of all measures in such cases;
dramatically worldwide (6, 7).
cross-matched blood, fresh frozen plasma, platelet,
Many methods were reported to control bleeding in
anesthesia team and availability of ICU place. Under
cases of MAP. Postpartum bleeding or postpartum
general anesthesia lower segment caesarean section was
hemorrhage is often defined as the loss of more than 500
done resulted in single living male fetus with massive
ml or 1000 ml of blood within the first 24 h following
bleeding at the placental bed which was managed by
childbirth. Couvelaire uterus is considered atypical
multiple unorganized haphazard haemostatic sutures
presentation in post-partum patient with no clinical
and bilateral uterine artery ligation. Intra-operatively,
evidence of ante-partum placental separation.
patient received three units of backed RBCs and two

units of fresh frozen plasma, abdomen closed after
CASE REPORT
insurance of homeostasis and contracted uterus with
29 years old, female patient was admitted to the
intraperitoneal drain insertion. The vital signs of the
emergency unit of obstetrics and gynecology
patient were within normal ranges at the time of
department of Sohag University hospital for elective
termination of the surgery and there was no need for
caesarean section. The obstetric history of the patient
ICU admission.
demonstrated that she was pregnant at 38 weeks with

This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2173
Received: 18/4/2021

Accepted: 14/6/2021


Full Paper (vol.841 paper# 86)


c:\work\Jor\vol841_87 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2176-2179

Split Tibialis Anterior Transfer for Correction of Residual Dynamic Metatarsus
Adductus Following Ponseti Management of Idiopathic Clubfoot
Hosam Mohammed Khairy Tawfik Omar, Mohammed AbdElAziz Gaith,
Yamen Safwat AbdElDayem, Emhemmed Faraj Emmhemed Aboubreeg
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Emhemmed Faraj Emmhemed, E-Mail: emhemmed.faraj@gmail.com

ABSTRACT
Background:
Clubfoot represents one of the most common congenital orthopedic deformities. It affects 1-2/1000 live
births all over the world. Cases of dynamic and severe deformity represent a challenging problem. This is because the
conservative management is not effective as well as the surgical options are little.
Objective: Aim of the present study was to evaluate the better management of split tibialis anterior tendon transfer in
the treatment of residual clubfoot.
Patients and methods: Eighteen cases (22 feet) with residual dynamic supination deformity following previous
Ponseti management underwent split transfer of the anterior tibial tendon. This was a prospective study between March
2020 and February 2021, the cases were collected and the study was carried out at Zagazig University Hospitals.
Results: In our study, the mean age was 41.05 months (ranged from 30 to 59 months). Out of the 18 patients, there
were 12 males and 6 females. Four cases (22.2%) were bilaterally affected. While 14 patients (77.8%) were one-side
affected (5 left foot affected and 9 right foot affected). Our results showed marked improvement of patients according
to Garceau and Palmer's criteria as the mean pre-operative assessment was 2.5 reaching 3.28 post-operatively. 14
patients (88.9%) were either poor or fair and no single patient was excellent pre-operatively, while postoperatively all
patients became either excellent mostly or good.
Conclusion: Anterior tibial tendon transfer is a reasonable method of achieving the objective, either fully or split
transfer because both operations have excellent results with low rate of major complications. It's very simple but yet
very effective soft-tissue procedure to correct the muscle imbalance of the foot.
Keywords: Split tibialis anterior transfer, Residual dynamic metatarsus adductus, Ponseti management, Idiopathic
clubfoot.

INTRODUCTION

Clubfoot is the most common congenital
supination as well as prevention of clubfoot relapse in
musculoskeletal disease with an average frequency of 1
children. The transferred tibialis anterior tendon is
to 4/1000 per birth. The deformity consists of the cavus,
anchored in the center of the foot using different
adductus, varus, and equinus of the foot. It is also one
methods, each of which has its drawbacks. The
of the most common and challenging orthopedic
traditional method of anchoring the tendon through the
deformities in children. Many studies, particularly in
pullout sutures on the plantar surface of the foot has its
short-term studies, demonstrate good clubfoot treatment
known skin complication (6).
outcomes, reaching up to 97% (1).
Aim of the present study was to evaluate the
Idiopathic clubfoot is characterized by an
better management of split tibialis anterior tendon
alteration of the morphology of the foot and its position
transfer in the treatment of residual clubfoot.
with the leg, so the foot cannot physiologically move on

the ground. For these reasons, the treatment should aim
PATIENTS AND METHODS
to correct the four components of the deformity in such
Eighteen cases (22 feet) with residual dynamic
a way as to restore as much as possible of the anatomic
supination deformity following previous Ponseti
shape and function of the foot to allow plantigrade
management underwent split transfer of the anterior
stance and proper gait (2).
tibial tendon. This was a prospective study between
Timely Ponseti treatment starts with gentle
March 2020 and February 2021, the cases were
manipulative and plaster cast treatment, gives excellent
collected and the study was carried out at Zagazig
and very good results in 92-95% of cases and the only
University hospitals. Patients' age ranged from 2.5
surgical intervention in this primary stage is
years to 5 years old at the time of the operation with
percutaneous tendon Achilles tenotomy. This is applied
mean age was (3.42). 12 were male and 6 female. 9 with
in 85% of all treated feet. The essential element in
right foot affection, 5 with left foot deformity while 4
treatment is followed by Denis Brown splint, which
patients (8 feet) were bilateral.
continues at least 24 months and after an individual

estimation, probably one more year after that (3, 4, 5).
Ethical consent:
Tibialis anterior tendon transfer was described
An approval of the study was obtained from
as an effective method in the management of dynamic
Zagazig
University Academic
and
Ethical

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/)
2176
Received:17 /4 /2021

Accepted:13 /6 /2021


Full Paper (vol.841 paper# 87)


c:\work\Jor\vol841_88 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2180-2183

Blunt Chest Trauma; Differences Between Children and Adult in
Menoufia University Emergency Hospital
Yahia Mohammed Al khateep1, Mahmoud Magdy AL Abassy1,
Heba Magdy Ahmed Ghanima1, Mohammed Ahmed El-Hag-Aly2
Departments of 1General Surgery and Cardiothoracic Surgery,
Faculty of Medicine, Menoufia University, Egypt.
*Corresponding author: Heba Magdy Ahmed Ghanima, Mobile: (+20)01224643341, E- mail: dhebamagdy@gmail.com

ABSTRACT

Background: Trauma is a leading cause of mortality globally. Thoracic trauma is a significant cause of morbidity
and mortality in both children and adult.
Objective: To compare between children and adult after exposure to a blunt chest trauma according to incidence,
mechanism of injury, effect of trauma on lung, pleura and ribs and in hospital mortality rate.
Patients and methods: A prospective, comparative study included patients with blunt chest trauma attending to the
Emergency Department, Menoufia University during the period from November 2019 to April 2020.
Results: The outcomes of the study were in the form of incidence, mechanisms of injury, effect of trauma on lung,
pleura and ribs and hospital mortality rate in adult and children. There was difference in incidence in studied groups
as adult has higher incidence, according to mechanism of injury, motor traffic accident was the main cause of trauma
in both groups. Pulmonary contusion was the most common chest injury in both groups but more in children (71%)
than in adult (66.7%), chest wall fracture was more in adult (33.3%) than in children (7.1%) and pneumothorax was
more in adult (27.3%) than in children (7.1%) exactly as hemothorax. Mortality was observed mainly in adult group
(36.4%), while it was (21.4%) in pediatric group.
Conclusion: There were differences between children and adult exposed to blunt chest trauma in incidence, effect of
trauma on lung, pleura and ribs, and in mortality
Keywords: Chest trauma, Emergency department, Outcomes, Blunt, Adult, Children.

INTRODUCTION

Trauma is a leading cause of mortality globally;
survey by (ABCD) approach, laboratory tests that
chest traumas account for 10% to 15% of all traumas
include arterial blood gas analysis, CBC and ABO
and are the cause of death in 25% of all fatalities
cross-matching. Imaging studies: Upright chest x-ray
resulting from trauma (1). It's the leading cause of death
film, abdominal FAST or Extended FAST. Secondary
from trauma after head and spinal cord injury (2). Traffic
survey, which include head to toe examination and
related injuries present in 63% of blunt trauma patients
AMPLE history.
(3).

The aim of this study was to compare between
Ethical approval:
children and adult after exposure to a blunt chest trauma
An approval of the study was obtained from
according to incidence, mechanism of injury, effect of
Menoufia University Academic and Ethical
trauma on lung, pleura and ribs, thoracic trauma
Committee. Every patient signed an informed
severity score and hospital mortality rate at Emergency
written consent for acceptance of the study. This
Department, Menoufia University.
work has been carried out in accordance with the

Code of Ethics of the World Medical Association
PATIENTS AND METHODS
(Declaration of Helsinki) for studies involving
A prospective, comparative study that included
humans.
patients with blunt chest trauma attending to the

Emergency Department, Menoufia University during
Statistical analysis:
the period from November 2019 to April 2020.
Data were collected, tabulated and statistically
Inclusion criteria: 1 ­ Blunt chest trauma. 2-
analyzed using an IBM compatible personal computer
Children from 1 year to 18 years old. 3- Adult above 18
with Statistical Package for the Social Sciences (SPSS)
years. 4- Both sex.
version 23 (SPSS Inc. Released 2015. IBM SPSS
Exclusion criteria: 1- Penetrating trauma. 2- Need for
statistics for windows, version 23.0, Armnok, NY: IBM
immediate surgical or neurosurgical interventions. 3-
Corp.). Chi-square test (2) was used to study
Infant > 1 year. 4- Lack of required information. 5-
association between qualitative variables. Student t-
Pregnancy.
test: is a test of significance used for comparison
All patients were examined according to
between two independent groups of normally
advanced trauma life support guidelines with primary
distributed quantitative variables. Mann-Whitney test

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/)
2180
Received:18 /4 /2021

Accepted:14 /6 /2021


Full Paper (vol.841 paper# 88)


c:\work\Jor\vol841_89 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2184-2191

Outcomes of Complete Atrioventricular Septal Defect
Surgical Repair in Down Patients
Ayman R. Abdelrehim1,2, Abdulhamid Alnajjar3, Syed Aitizaz FRCS2,
Mostafa Ashry4, Rafik F.B. Soliman*1
1Department of Cardiothoracic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
2Department of Pediatric Cardiac Surgery, Madina Cardiac Center, Madina, Kingdom of Saudia Arabia, Khalid
Bin Al Waleed Road, PO Box 6167, Post Code 41442
3Department of Pediatric Cardiology, Madina Cardiac Center, Madina, Kingdom of Saudia Arabia, Khalid Bin Al
Waleed Road, PO Box 6167, Post Code 41442
4Department of Pediatric, Sohag University, Faculty of Medicine, Sohag, Egypt.
*Corresponding author: Rafik F.B. Soliman, Mobile: (+20) 01011102102, E-Mail: rafikfekry@hotmail.com

ABSTRACT
Background:
Atrioventricular septal defect (AVSD) is commonly associated with chromosomal abnormalities,
especially trisomy 21 or Down syndrome (DS). Surgical repair of complete AVSD (CAVSD) is a complex procedure
that carries risks of postoperative morbidity and mortality.
Objective: To evaluate the surgical outcomes and to identify the risk factors for hospital mortality and reoperation
after repair of CAVSD in DS patients.
Patients and Methods: This retrospective cohort study included 65 consecutive DS patients who underwent surgical
correction for the complete form of AVSD with or without associated congenital heart diseases during the period
from 1st January 2014 to the end of June 2020. Patients with associated other major cardiac anomalies were excluded.
Results: In-hospital mortality was documented in 3 (4.6%) patients, whereas 4 (6.2%) patients needed second
unplanned operation for valve/shunt correction. Heart block that needed permanent pacemaker insertion was
recorded in 3 (4.6%) patients. In-hospital mortality was significantly associated with prolonged cardiopulmonary
bypass (CPB) time (p = 0.008) and the development of renal dysfunction that required dialysis or sepsis (p = 0.004).
We found a significant association between the need for second unplanned operation and type A CAVSD (p = 0.041)
and the presence of preoperative moderate/severe atrioventricular (AV) valve regurgitation as detected in the
transesophageal echocardiography (TEE) (p=0.035).
Conclusions: In view of the incidence of the hospital mortality, reoperation, and other postoperative morbidities, we
suggest that our outcomes are accepted for surgical repair of CAVSD in DS patients. The CPB time and the
development of renal dysfunction that required dialysis and sepsis during the ICU care significantly contributed to
the hospital mortality.
Keywords: Atrioventricular septal defect, Down syndrome, Hospital mortality, Outcomes, Reoperation.

INTRODUCTION
Atrioventricular septal defects are very
Atrioventricular septal defect (AVSD) is a severe
commonly diagnosed in utero or after birth by
congenital heart disease characterized by a spectrum of
echocardiography. Three-dimensional echocardiography
cardiac anomalies, mainly deficient atrioventricular
is very useful in the diagnosis, further delineating
septation and variability in atrioventricular valve
treatment options, and in the follow up after surgical
morphology. The complete form of AVSD (CAVSD)
correction (5, 6).
includes a premium interatrial septal defect, common
A diverse and challenging group of defects that
atrioventricular
(AV)
valve
orifice,
and
an
require surgical correction characterizes atrioventricular
interventricular septal defectof inlet type (1). The CAVSD
septal defect. Early surgical repair of complete AVSD is
is an uncommon malformation, and it accounts for 3% of
the ultimate treatment option to reduce the pulmonary
all congenital heart diseases (2).
vascular disease (7). Surgical repair of complete AVSD is
Atrioventricular septal defect arises from
a complex procedure that carries risks of postoperative
defective development of endocardial cushions during
morbidity and mortality due to various complications
the prenatal period due to genetic mutations. It is
such as residual intracardiac shunts, atrioventricular
commonly associated with chromosomal abnormalities,
valve regurgitation, left ventricular outflow tract
especially trisomy 21 or Down syndrome (DS) (3). Every
obstruction, and arrhythmias (8).
six patients with DS have associated AVSD.
Postoperative outcomes depend on various
Further, Down syndrome cell adhesion molecule gene
preoperative and operative risk factors. Further, there is
has been described to be associated with AVSD and other
no conclusive evidence in the literature on the outcomes
congenital heart diseases in these patients (4).
of CAVSD repair in DS patients (9).

Therefore, this study aimed to evaluate the
surgical outcomes and to identify the risk factors for

This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2184
Received: 20/4/2021

Accepted: 16/6/2021


Full Paper (vol.841 paper# 89)


c:\work\Jor\vol841_90 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2192-2197

Early Results of Surgical Treatment of Intra-Articular
Calcaneal Fractures Using T-Shaped Plates
Ahmed Abdulmunem Husayn Layyas*, Mohsen Mohamed Abdo Mar'e'i, Reda Hussien Elkady,
Mohamed Abd Elaziz Mohamed Ghieth
Department of Orthopedic, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding Author: Ahmed Abdulmunem Husayn Layyas, Mobile: 00218925430873,
E-mail: layas.ahmed87@gmail.com

ABSTRACT
Background:
Displaced intra-articular calcaneus fractures are still now a controversial topic among orthopedic
surgeons. There is no single treatment option to manage all different fractures. Objective: The aim of this study was
the assessment and evaluation of providing and maintaining stable fixation by the use of a T-shaped plate for displaced
intra-articular calcaneal fractures. Patients and Methods: A randomized controlled study was conducted on18
patients were conducted between the ages of 18 to 50 years in the Orthopedic and Traumatology Department of
Zagazig University Hospital from August 2020 to April 2021 including 6 months follow-up periods, all patients with
closed D.I.A.C.F with no morbidity. T plates were the method of fixation for all patients.
Results
: Mean A.O.F.A.S. hindfoot scale result was 86.61, 88.8% of patients their results were satisfying (excellent
and good), and 11.1% of patients their results were unsatisfying (fair). Complications were seen in 27.7% (wound
complication, subtalar arthritis, symptomatic hardware, and delayed union).
Conclusion
: T-shaped plates can provide stable support and rigid fixation as they maintain proper reduction and
alignment to displaced intra-articular calcaneus fractures.
Keywords: Surgical, Calcaneus fracture, T-Shaped Plates.

INTRODUCTION
According to the Essex-Lopresti classification,
Calcaneal fractures correspond to 2% of skeletal
intra-articular fractures can be tongue-type or joint
fractures and about 60% of fractures of the tarsal
depression types. In most series, joint depression is the
bones(1).

Calcaneal fractures are divided into two types
most frequent type of fracture, accounting for 43%­
extra-articular and intra-articular, about 60% to 75% of
61% of intra-articular fractures(12, 13).
calcaneal fractures are displaced intra-articular
The most suitable treatment for displaced intra-
calcaneal fracture (D.I.A.C.F)(2,3).
articular calcaneal fractures is still controversial. Since
The most common cause of injury is axial loading
the mid-1990s, open reduction and internal fixation
by fall from height leading to calcaneal fractures.
(ORIF) via the extensile lateral approach has been
Other modes of injury like the brake pedal and high-
considered the standard treatment for displaced intra-
velocity trauma causing open fractures are also
articular fractures of the calcaneus, as it generally
common. Associated fractures like spinal and pelvic
restores the subtalar joint anatomically and has good
fractures must be excluded(4,5).
functional outcomes(14, 15). However, there are multiple
The complex anatomy of the hindfoot raises the
complications of open surgery including peroneal
difficulty of dealing with this calcaneal fracture(6). The
tendonitis (18%), sural nerve injury (9%),
calcaneus bone is irregular in shape with numerous
vascularization injury (6-33%), infections (8-18%),
articular facets with very challenging soft-tissue cover,
and amputation (0-2%)(16, 17).
making proper surgical intervention time-sensitive(7,8).
Attempts to limit these complications many
Despite the great development of orthopedic
surgical techniques have been developed including:
traumatology in the last century, treatment of these
(limited lateral, plantar, combined lateral and medial,
fractures is still controversial and results are often
u-incision, Kocher, and limited posterior approach).
unsatisfactory, due to the complex anatomical shape of
Limited lateral approaches include: (plantar, Ollier,
the calcaneus, and the fact that it is subjected to
and sinus tarsi). The sinus tarsi approach is using a
constant weight load(9). Thus, this injury causes major
smaller incision hence limiting soft tissue dissection
socioeconomic and functional impairment to patients
and provides a good visualization of the articular
and represents a burden to public and private
reduction(18-20).
compensation policies(10).
Intra-articular
fractures
require
anatomic
Tomographic classifications help to assess the
reduction and stable fixation to improve the chances of
severity and prognosis of the injury. Sander,s
a good outcome(21). This study was performed to
classification is the most commonly used(11).
evaluated providing and maintaining stable fixation by



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/)
2192
Received:18 /4 /2021

Accepted:14 /6 /2021


Full Paper (vol.841 paper# 90)


c:\work\Jor\vol841_91 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2198-2202
Study of Latent Tuberculosis among Type 1 Diabetic Children in
Zagazig University Pediatric Hospital
Saad Ahmed Mansour1, Ehab Abd Elhamid Abd Elsalam1,
Rehab Ahmed Rabie2, Naglaa Fathy Abd Elrazik Ibrahim*1
Departments of 1Pediatrics and 2Medical Microbiology and Immunology,
Faculty of Medicine, Zagazig University, Egypt.
*Corresponding Author: Naglaa Fathy Abd Elrazik Ibrahim, Mobile: (+20)01066610307,
Email: doc.naglaafathy33@gmail.com
ABSTRACT
Background:
In certain places, tuberculosis (TB) and diabetes mellitus (DM) are strongly linked as frequent
comorbidities and might be termed epidemics combined. Objective: The present work aimed to detect relationship
between type 1 DM (T1DM) and latent TB. Patients and Methods: This comparative cross-sectional study was
conducted over the period from October 2019 to October 2020. It included 81 cases had type 1 DM and 81 healthy
children as control group. This study was conducted at Zagazig University Pediatric Hospital. All patients were
subjected to the following: Full history taking, full general examination, and investigation (Tuberculin test and chest X
ray). Results: In the current study, 42% were male and (58%) were female. In the present work, there was no statistically
significant difference between cases group and controls group regarding anthropometric measurements. This study
showed that, the percentage of positive tuberculin test was higher among cases group than controls group (32.1%, 7.4%)
p value< 0.001. OR estimate for DM on risk of TB was 5.9 (95% CI 2.27 to 15.33). Conclusion: There
was
no
statistically significant difference between diabetic group and control group regarding sex, age, weight, and height.
There was no statistically significant difference between diabetic and control group regarding contact with patient with
TB and passive smoking. The percentage of positive tuberculin test was higher among diabetic group than control group.
Keywords: Diabetes mellitus, Tuberculosis, Type 1 Diabetic Children.

INTRODUCTION
claimed 35 million diabetes people in this region (10). In
In certain places, tuberculosis (TB) and diabetes
Egypt, the prevalence of tuberculosis ranged from 14 to
mellitus (DM) are strongly linked as frequent
44 cases per 100,000, whereas diabetes incidence was
comorbidities and might be termed epidemics
16.8%. The proportion of DM in TB patients ranged
combined. When compared to nondiabetic individuals,
from 16.4% to 29.3%. (11, 12).
diabetes doubles the chance of developing active
In spite of the fact that there are numerous
tuberculosis after infection. DM can make TB therapy
techniques for screening latent pulmonary tuberculosis,
more difficult and/or hasten the progression of the
there is no consensus on the standard screening test. For
illness (1).
a long time, tuberculin skin test (TST) alone was used
The pathophysiological basis for this association
as a screening technique (1).
is thought to be mediated through alterations in the
The present work aimed to detect relationship
immune
response
against Mycobacterium
between type 1 DM and latent TB.
tuberculosis (2). This occurs through affection of both

innate and adaptive immunity (3). Affection of innate
PATIENTS AND METHODS
immunity occurs through accumulation of the advanced
This comparative cross sectional study was
end-products of glycation that impair functions of
conducted over the period from October 2019 to
phagocytes (4, 5). Regarding adaptive immunity, higher
October 2020. It included 81 cases who had type 1 DM
levels of interleukin 2 and T-cell helper 1 (interferon )
and 81 healthy children as control group. This study was
and T-cell helper 17 cytokines and a lower frequency of
conducted at Zagazig University Pediatric Hospital.
natural T-regulatory cells (CD4+, CD25+, and CD127-)

are found in diabetic patients and increase the likelihood
Ethical approval:
for TB coexistence (6).
This study was ethically approved from
Because of the significant link between diabetes
Institutional Reviewer Board (IRB) in Faculty of
and tuberculosis, bidirectional screening is required to
Medicine, Zagazig University Hospital and parental
detect newly diagnosed diabetes in patients with active
or caregivers' written consent from every case that
TB or latent TB infection in individuals with DM (7).
participates in this research was taken. This work
Indeed, in areas with a high prevalence of diabetes, the
has been carried out in accordance with The Code of
risk of developing tuberculosis due to the illness
Ethics of the World Medical Association
outweighs that of the human immunodeficiency virus
(Declaration of Helsinki) for studies involving
(8). The WHO recorded 1 000 000 cases of tuberculosis
humans.
in the Middle East (880 000­1 200 000) (9). In
Sample size: Two sided significance level 95(1-alpha)
comparison, the International Diabetes Foundation
power (1-beta) % chance 80 of detecting ratio of sample

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/)
2198
Received:17 /4 /2021

Accepted:13 /6 /2021


Full Paper (vol.841 paper# 91)


Measurement of Serum Lipid Level in Children with Congenital Heart Diseases The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2203-2207

Measurement of Serum Lipid Level in Children with Congenital Heart Diseases
Abdulmonam Almokhtar Embark Omar1, Amr Megahed Abouelnaga1,
Amal Mohamed Abd El Latef1, Samar Mahmoud Abdelhalim Sharaf2
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding author: Abdulmonam Almokhtar Embark Omar, Mobile: (+20) 01094884925,
E-mail: abdalmoname1983@gmail.com
ABSTRACT
Background:
The lipid profile is an important and independent predictor of coronary heart disease is. This process
relates to cholesterol concentration, accumulation and deposition of lipids on the arterial wall.
Objective: The aim of this study was the measurement of serum lipid profile (cholesterol, triglycerides, high-density
lipoprotein (HDL) and low-density lipoprotein (LDL) in children with congenital heart diseases and to compare the
results with those of healthy children. Patients and methods: This case-control study was carried out from July 2020 to
December 2020 in Cardiology Unit of Pediatric Department Outpatient Clinic, Zagazig University Hospital on 44 children.
Patients were divided into: Group (I): (Case group) included 22 children with congenital heart diseases, and Group (II)
(control group) included 22 healthy children. All patients were subjected to dimensional transthoracic echocardiography
with color flow Doppler (Vivid 7 dimension apparatus) and Laboratory investigations (total cholesterol, triglycerides, low-
density lipoprotein (LDL), high-density lipoprotein (HDL). Results: The most frequent cardiac defect was ASD (22.7%)
followed by VSD (13.6%), common A-V canal (9.1%), mitral regurgitation (9.1%), pulmonary regurgitation (9.1%), and PDA
(9.1%). 18.2% of the studied patients had cyanotic congenital heart disease (CHD) and 81.8% had non-cyanotic CHD. There
was statistically significant differences between the studied groups in lipid profile as case group had higher cholesterol,
triglyceride, LDL and lower HDL than control group. Conclusion: We concluded in this study that patients had
significantly higher serum lipid levels than age and sex-matched controls in light of these findings.
Keywords:
Congenital Heart disease, Lipids, Dyslipidemia.

INTRODUCTION

children with CHD. Accordingly, control of lipid levels
Congenital heart diseases (CHD) are structural
and other risk factors has gained considerable
problems that arise from abnormal formation of the heart
significance (5). So it is suggested to screen and treat
or major blood vessels. It is the commonest of all
dyslipidemia to prevent atherosclerosis since childhood
congenital lesions and is the most common type of heart
and is important to evaluate prevalence of dyslipidemia
diseases among children (1). The global incidence rate of
in children with congenital heart disease (4). The aim of
CHD is 6.8 to 9.0 per 1000 live births. Its most common
this study was the measurement of serum lipid profile
subtypes are atrial septal defect, ventricular septal defect,
(cholesterol, triglycerides, high-density lipoprotein
patent ductus arteriosus, pulmonary stenosis, and
(HDL) and low-density lipoprotein (LDL) in children
tetralogy of Fallot. Depending on the presence of a right
with congenital heart diseases and to compare the results
to left shunt, congenital heart disease patients can be
with those of healthy children.
divided into two groups; acyanotic and cyanotic (2).

Dyslipidemia is an important etiological factor in
PATIENTS AND METHODS
the development of cardiovascular disease (CVD),
This case-control study was carried out from July 2020
which is a leading cause of death worldwide as CVD
to December 2020 in Cardiology Unit of Pediatric
begins in childhood (3). An important and independent
Department Outpatient Clinic, Zagazig University Hospital
predictor of coronary heart disease is the lipid profile.
on 44 children. Their ages ranged from 2 to 10 years old. The
This process relates to cholesterol concentration,
study groups were divided into: Group (I): (Case group):
accumulation and deposition of lipids on the arterial
Which include 22 children (11 males and 11 females) with
wall. The most important consequences of dyslipidemia
congenital heart diseases, and Group (II): (control group):
are atherosclerosis and coronary artery disease due to the
Which include 22 healthy children (11 males and 11
occlusion of the coronary arteries, ischemic heart disease
females).
(IHD) and myocardial infarction (MI). Many factors

such as overweight, hypertension (HTN), diabetes
Ethical approval:
mellitus (DM), smoking and low physical activity lead
Written informed consent was obtained from all
to increased serum lipid levels and consequently
participants' parents and the study was approved by
atherosclerosis (4).With advances in pediatric cardiology,
the Research Ethical Committee, Faculty of
early physical examination and diagnosis, medical
Medicine, Zagazig University. The work hasd been
treatment, surgical methods, and postoperative care
carried out in accordance with The Code of Ethics of
made the prevalence of CHD in adults has risen in
the World Medical Association (Declaration of
relation to children, and the number of adults living with
Helsinki) for studies involving humans.
CHD is expected to continue its upsurge. It is presumed

that there are more adults with CHD living than there are

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/)

2203
Received:21 /4 /2021

Accepted:17 /6 /2021


Full Paper (vol.841 paper# 92)


Evaluation Of QT Interval In Diabetic Ketoacidosis In Medical Intensive Care Unit The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2208-2212

Effect of Diclofenac Versus Misoprostol on Pain Perception during
Intrauterine Contraceptive Device Insertion
Manal Mohamed Mahmoud Beheiry, Hala Elsayed Mohamed Mowafy,
Alaa Ibrahim Mohamed Nugud*, Safaa Abdelsalam Ibrahim Khalil
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Alaa Ibrahim Mohamed Nugud, Mobile: (+20)1156900409,
E-mail: alaaibrahim11690@gmail.com

ABSTRACT
Background
: The intrauterine device (IUD) is one of the most contraceptive methods with highly effective and
safe use. However, insertion through a narrow cervix may be technically difficult and painful.
Objective:
This study was performed to compare the effect of vaginal misoprostol and intramuscular diclofenac
sodium in decreasing pain and facilitating IUCD insertion.
Patients and Methods: A randomized double-blind controlled trial in Zagazig University Hospital during the
period from December 2019 to November 2020. It included sixty-four women who want to insert an IUD. They
were classified into four groups on a randomized basis, the first group received two tablets (400 mcg) of
misoprostol in the posterior fornix of the vagina 2 hours before IUD insertion and the second group received
diclofenac sodium 75 mg ampule intramuscular 2 hours before IUD insertion. The third group received two
tablets (400 mcg) of misoprostol in the posterior fornix of the vagina and diclofenac sodium 75 mg ampule
intramuscular 2 hours before IUD insertion while the fourth group received placebo. Pain during insertion and
difficulty in IUCD insertion were evaluated.
Results: Misoprostol significantly facilitated the insertion of IUD insertion whereas diclofenac sodium lowered
the average pain score for all steps of IUD insertion. Side effects were higher in the misoprostol group.
Conclusion
: 400 mcg of vaginal misoprostol 2 hours before IUD insertion facilitates the introduction and IM
injection of 75 mg diclofenac sodium 2 hours before IUD insertion reduced the pain perception.
Keywords: IUD, Cervical stenosis, Misoprostol, Diclofenac sodium.


INTRODUCTION

The intrauterine device (IUD) is one of the most
misoprostol as a cervical ripening agent in
effective contraceptive methods available in addition
nonpregnant women (8).
to one of the safest long-acting reversible
Diclofenac sodium is a nonsteroidal agent with
contraception (LARC) (1). Its effectiveness refers to its
marked analgesic, anti-inflammatory properties. It is
low rate of unintended pregnancy that is expected due
an inhibitor of prostaglandin synthetase. It has been
to independent use of adult females (2). Despite that,
used in obstetrics and gynecology to control acute and
the incidence of its exercise is only 7.6% of adult
chronic postoperative and menstrual pain as well as
females in developed countries and 14.5% in
pain related to medical abortions, menorrhagia and it
developing nations. This can be attributed to worry for
is administrated as tocolytics in preterm labor (9).
the difficulty of insertion, pain for the woman during
This study aimed to compare the effect of
insertion, and an increased risk of infection (3).
vaginal misoprostol and intramuscular diclofenac
Cervical stenosis is the narrowing of the
sodium in decreasing pain and facilitating IUCD
passageway through the cervix or even its complete
insertion.
closure (4). It considers as a factor associated with the

difficulty sounding of the cervical canal or even
PATIENTS & METHODS
failure to insert IUD (5). The mechanical means to
The current study was a randomized double-
overcome anatomic cervical stenosis and scarring
blind controlled trial. It included sixty-four women
during insertion of IUD by grasping the cervix with a
undergoing Cu T 380A IUCD insertion who came to
tenaculum and the additional use of a dilator. These
the family planning clinic in Obstetrics and
techniques are usually associated with increased
Gynecology Department in Zagazig University
anxiety, pain, or even failure (6).
Hospitals during the period from December 2019 to
Misoprostol is an inexpensive prostaglandin E1
November 2020.
analog, which is associated with few side effects. It is

an effective method for treatment of incomplete and
Ethical approval:
missed abortion as well as prevention, and treatment
Written informed consent was obtained from all
of postpartum hemorrhage. It is also used in the
participants and the study was accepted by the
induction of provocative abortion as well as for labor
Research Ethics Committee of the Faculty of
induction (7). Several studies have shown the benefit of
Medicine, Zagazig University.

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/)

2208
Received:17 /4 /202 1

Accepted:13 /6 /2021


Full Paper (vol.841 paper# 93)


c:\work\Jor\vol841_94 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2213-2218

Surgical Treatment of Giant Cell Tumor in Proximal End of Tibia by
Curettage and Bone Cement
Elsayed Eletawy Soudy, Mohsen Fawzy Omar,
Mohamed Ismael Abd-Elrhman Kotb, Mohammed Basheer Tahir Wail
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohammed Basheer Tahir Wali, E-Mail: mohammedwali2886@gmail.com


ABSTRACT
Background:
A giant cell tumor of bone (GCTB) is a primary bone tumor with potential invasion, local recurrence,
and low probability of distant metastasis. Surgical treatment stills the most effective treatment for this kind of tumor.
The surgery often involves defect reconstruction following tumor removal.
Objective: Aim of the current work was to evaluate the results of surgical treatment of giant cell tumor in proximal end
of tibia by curettage and bone cement.
Patients and methods: This study included a total of eighteen adult patients with giant cell tumor of proximal end of
tibia, attending at Department of Orthopedic, Zagazig University Hospitals. Patients were treated by curettage and
bone cement. This study was conducted between January 2020 to March 2021.
Results: In this study the age was (30.39±6.4) years ranged from 22 to 41 years, half of the group (50.0%) had age less
than 28 years and the other half were equal or more than 28 years. Two thirds (66.7%) of the studied group were females
and one third (33.3%) of them were males (2:1). Concerning campanacci radiological grading of lesion; most of the
studied group (83.3%) had campanacci grade I and grade II (16.7%). The functional outcome by the musculoskeletal
tumor society functional scoring system (MSTS) in the present study revealed that two thirds (66.7%) of the studied
group didn't have pain and only (33.3%) of them had intermediate pain.
Conclusion: It could be concluded that patients with GCT of the bone at the proximal end of tibia can be treated
satisfactorily with curettage and bone cement packing with lower recurrence rate. Better MSTS functional results
were also observed after extended curettage and bone cement.
Keywords: Surgical Treatment, Giant Cell Tumor, Tibia by Curettage and Bone Cement.

INTRODUCTION

appearance. MRI is useful to assess extra-cortical
Giant cell tumors (GCTs) represent 5% of
spread and intramedullary extension (4).
primary bone tumors. GCT of the bone is a benign but
Surgical removal of the lesion remains the only
locally aggressive tumor with a relatively high
curative intent treatment for GCT of the bone. The most
recurrence rate after primary treatment. GCTs mainly
common form of surgical treatment for GCT of the bone
occur between the age of 20 and 40years. Epiphyseal
is aggressive local curettage with or without packing of
regions of the long bones are the most commonly
the defect with bone cement or bone graft and internal
affected, especially the distal femur and proximal tibia
fixation. More aggressive surgical approaches
(1).
employing wide resection of the involved bone may be
Pain is the leading symptom relating to the
chosen to achieve tumor removal and potentially
mechanical insufficiency resulting from the bone
decrease the risk of local recurrence, at the cost of
destruction. A soft tissue mass or bump can
greater functional compromise (5).
occasionally be seen and results from the cortical
The aim of the current work was to evaluate the
destruction and tumor progression outside bone. GCT is
results of surgical treatment of giant cell tumor in
often found close to the joint thus limited range of
proximal end of tibia by curettage and bone cement.
motion is common, joint effusion and synovitis are also

possible. At diagnosis, approximately 12% of patients
PATIENTS AND METHODS
with GCT present with pathologic fracture (2).
This clinical trial study included a total of
Radiologically, GCT of bone has characteristic
eighteen adult patients with giant cell tumor of
radiolucent, geographic appearance with a narrow zone
proximal end of tibia, attending at Department of
of transition found at the margin of the lesion. This
Orthopedic, Zagazig University Hospitals. This study
margin, contrary to that of many other benign lesions,
was conducted between January 2020 to March 2021.
lacks a complete sclerotic rim. Typically, there is no

visible mineralization within the tumor matrix. The
Ethical consent:
lesion is eccentrically located in the metaphysis of long
An approval of the study was obtained from Zagazig
bones usually about the subchondral bone. Moreover, it
University academic and ethical committee. Every
commonly breaks through the cortex (2,3).
patient signed an informed written consent for
GCT of bone typically shows as an epiphyseal,
acceptance of the operation. This work has been
eccentric, expansive lytic lesion with a `soap-bubble
carried out in accordance with The Code of Ethics of

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/)

2213
Received:17 /4 /2021

Accepted:13 /6 /2021


Full Paper (vol.841 paper# 94)


c:\work\Jor\vol841_95 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2219-2225

Effect of Muscle Energy Technique Versus Aerobic Exercise on
Chronic Cyclic Pelvic Pain
Khadyga Sayed Abdul Aziz1, Hala EL Sayed Mohammad Mowafy2,
Marwa Esmael Hasanin1, Noran Hany Hassan Mahmoud Ghazal1
1Department of Physical Therapy for Women's Health, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
2Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
*Corresponding Author: Noran Hany Hassan Mahmoud Ghazal, Mobile: 01011269218, Email:noranghazalrr@gmail.com

ABSTRACT
Background:
Chronic cyclic pelvic pain is cyclic pain located in the pelvis and the lower abdominal area, persisting
for 6 months or more with no obvious pathological cause for their pain and severe enough to interfere with daily
activities. Objective: This study was conducted to compare the effect of aerobic exercise versus the effect of muscle
energy technique on chronic cyclic pelvic pain.
Patients and Methods:
30 women complaining of increased pelvic pain of unknown cause lasts more than 6 months
diagnosed and referred by their gynecologist. They were divided into two equal groups, Group (A) received muscle
energy technique; and Group (B) received aerobic exercise. Both groups were assessed before and after the treatment
period (8 weeks) for pain degree by visual analog scale (VAS) and assessment of premenstrual, menstrual, and
intermenstrual symptoms by menstrual distress questionnaire scale (MDQ).
Results: The results of this study revealed that there was a significant decrease in VAS and MDQ values post-
treatment in both groups (A and B) compared with that pretreatment values, when comparing both groups there was a
more significant decrease in the post-treatment values of VAS and MDQ of the group (A) compared with that of the
group (B). Conclusion: It can be concluded that both muscle energy technique and aerobic exercise will improve
chronic cyclic pelvic pain but muscle energy technique resulted in better improvement as compared to aerobic exercise
on chronic cyclic pelvic pain.
Keywords: Muscle energy technique, Aerobic exercises, Pelvic pain.

INTRODUCTION
is a safe and efficient treatment option for lumbopelvic
Chronic pelvic pain (CPP) is described as intermi
discomfort MET is one of the most widely used therapy
ttent or persistent discomfort that affects the anatomic
techniques for improving elasticity in contractile and
pelvis, anterior abdominal wall at or below the umbilic
non-contractile tissues. MET is a manual treatment that
us, lumbosacral back, or buttocks for six
is becoming increasingly popular since it looks to be
months or more and is severe enough to interfere with
safe and mild, and it is thought to be beneficial in a wide
everyday activities (1). Endometriosis, adenomyosis,
range of patients. The muscular energy approach has
pelvic adhesions, pelvic inflammatory disease, tubo-
been recommended for treating muscle imbalances in
ovarian abscess, ovarian cysts, ovarian neoplasms,
the lumbopelvic region, such as pelvic asymmetry, for
polyps, fibroids, and pelvic venous congestion should
many years. MET is an effective technique for treating
all be considered, as should nongynecologic causes such
pain in various parts of the body ranging from the pelvis
as gastrointestinal, urologic, and psychological issues
to the neck and even the elbow (5).
such as depression. (2).
The study aimed to compare the effect of aerobic
For many years, the concept that exercise can help
exercise versus the effect of muscle energy technique on
prevent and treat symptoms has prevailed, leading to the
Chronic cyclic pelvic pain.
promotion of the concept that exercise is helpful.

Exercise and other behavioral therapies may not only
PATIENTS AND METHODS
relieve pain but may also remove or reduce the need for
This study was conducted on thirty women aged
medication to regulate menstrual cramps and other
between 25 to 35 years. They were selected randomly
symptoms. (3).
from the outpatient clinic of Obstetrics and Gynecology
Physical activity, which improves blood flow at
at Zagazig University Hospitals according to the
the pelvic level while also increasing the production of
following criteria:
endorphins, may help to relieve pelvic pain caused by
Inclusive criteria: Thirty women complaining of
excessive prostaglandins release; in fact, it operates as a
increased pelvic pain of unknown cause lasts more than
non-specific analgesic. Aerobic exercises including
6 months diagnosed and referred by their gynecologist.
pelvic tilting, walking, bicycling, and swimming can
All women had a regular menstrual period and their BMI
help treat pelvic pain by improving blood flow, relaxing
ranged between 20 to 25. Their age ranged between 25-
abdominal muscles, reducing pelvic discomfort, and
35 years old.
relieving pressure on nerve centers, pelvic organs, and

the alimentary canal (4). Muscle energy technique (MET)
Exclusion criteria:

This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2219
Received: 19/4/2021

Accepted: 15/6/2021


Full Paper (vol.841 paper# 95)


c:\work\Jor\vol841_96 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2226-2230

Urinary Neutrophil Gelatinase-associated Lipocalin:
As an Early Marker for Diabetic Nephropathy
Hoda Gouda Bakr1, Khaled Ahmed Elbana2, Abeer Abd Alla Fekry2, Mahmoud Samir Elkot1
Departments of 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Mahmoud Samir Elkot, Mobile: (+20)01063667588, Email: Doctorelkot1988@gmail.com

ABSTRACT
Background:
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects
in insulin secretion, insulin action, or both. Diagnostic marker to detect diabetic nephropathy at early stage is important
as early intervention can slow the loss of kidney function and reduce adverse outcomes. Neutrophil gelatinase-
associated lipocalin (NGAL) is a small (25-kd) protein that belongs to the lipocalin protein family. Urinary NGAL (u-
NGAL) levels have been demonstrated to be a very promising marker especially in acute kidney disease.
Objective: To measure urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker for diagnosis of
diabetic nephropathy in type 2 diabetes mellitus (T2DM) patients.
Patients and Methods:
The study was conducted on 84 subjects, from (18- 80 years old), 45 (53.5%) were males and
39 (46.4%) were females, with mean age (58.18 ± 13.98). They were collected from Endocrinology and Nephrology
Clinic after a written consent was taken from the patients at Zagazig University Hospital.
Results:
Urinary NGAL is higher in diabetic patients compared with non-diabetic controls with high significant
difference (p < 0.0001). In our result we found a positive correlation between NGAL and the duration of DM (r =0.279,
p=0.027). There was a positive correlation between NGAL level and HbA1C, with significant difference (r =0.778, p
=0.000) in patients groups. Our results showed a positive correlation between NGAL and FPG (r= 0.562) (p< 0.001)
and 2hPPPG (r=0.687) (p< 0.001). There was a positive correlation between NGAL level and albumin-creatinine ratio
(Alb/Cr) with significant difference (r =0.888, p< 0.001) in patients groups.
Conclusion:

There was a high significant difference in the level of urinary NGAL in diabetic patients than control
subjects. Urine NGAL had a positive correlation with albumin-creatinine ratio, duration of DM, HbA1c.
Keywords: Associated lipocalin, Neutrophil gelatinase, T2DM, Diagnosis.

INTRODUCTION
(ESRD), requiring costly renal replacement therapy in
Diabetes mellitus is a group of metabolic diseases
the form of dialysis or transplantation. Diagnostic
characterized by hyperglycemia resulting from defects
marker to detect diabetic nephropathy at early stage is
in insulin secretion, insulin action or both. The chronic
important as early intervention can slow the loss of
hyperglycemia of diabetes is associated with long-term
kidney function and reduce adverse outcomes. The
damage, dysfunction and failure of various organs
appearance of small amount of protein albumin in urine,
especially the eyes, kidneys, nerves, heart and blood
called microalbuminuria has been accepted as the
vessels (1).
earliest marker for development of diabetic
Several pathogenic processes are involved in the
nephropathy. However, it has been reported that a large
development of diabetes. These range from
proportion of renal impairment occurs even before
autoimmune destruction of the 13-cells of the pancreas
appearance of microalbuminuria (4).
with consequent insulin deficiency to abnormalities that
It is necessary to implement different strategies
result in resistance to insulin action. The basis of the
for detecting early diabetic nephropathy in patients with
abnormalities in carbohydrate, fat, and protein
T2DM aiming to delay its progression and improve
metabolism in diabetes is due to deficient action of
outcomes. Increased levels of urinary biomarkers can be
insulin on target tissues, which results from inadequate
detected in T2DM patients before the onset of
insulin secretion and/or diminished tissue responses to
significant albuminuria. There are several glomerular
insulin at one or more points in the complex pathways
and tubular biomarkers predicting onset or progression
of hormone action (2).
of nephropathy in patient with diabetes and may be used
Diabetes has become the primary cause of end-
as an early marker of renal injury in diabetic
stage renal disease (ESRD). Early diagnosis of diabetes
nephropathy, this would play a significant role in
and early intervention are critical in preventing the
clinical diagnosis and treatment approaches in diabetic
normal progression to renal failure seen in many
care (5).
patients with type 1 and a significant percentage of
Neutrophil
gelatinase-associated
lipocalin
T2DM (3).
(NGAL) is a small (25-kd) protein that belongs to the
Diabetic nephropathy is associated with an
lipocalin protein family. NGAL is produced in
increased risk of all-cause mortality, cardiovascular
epithelial cells and neutrophils in most tissues. It was
disease and progression to end stage renal disease
found in activated neutrophils, in accordance with its

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/)
2226
Received:19/3 /2021

Accepted: 15/5/2021


Full Paper (vol.841 paper# 96)


c:\work\Jor\vol841_97 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2231-2236

Association between Neutrophil-To-Lymphocyte and Platelet-To-Lymphocyte
Ratios with Chronic Allograft Nephropathy
Walid Ahmed Ragab Abdelhamid
Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Corresponding author: Walid Ahmed Ragab Abdelhamid, Email: WAAbdelHamid@medicine.zu.edu.eg, Tel. +201062904443

ABSTRACT
Background:
In several diseases, both neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are
reliable indicators of chronic inflammation. Endothelial dysfunction is widely distributed in renal transplant patients and is
caused by inflammation and can lead to the malfunction of the graft. Objective: To detect the correlations of NLR and PLR
with chronic allograft nephropathy (CAN) in recipients of kidney transplants and determine the cutoff values for the
prediction of CAN. Patients and Methods: 68 kidney transplant recipients shared in the study between January 2017 and
December 2019. They were two groups. Group 1 (44 subjects) had estimated glomerular filtration rate (eGFR) 60
ml/m/1.73 m2 and group 2 (24 subjects) had eGFR less than 60 ml/m/1.73 m2. Results: The two groups had similar age and
sex distributions. eGFR was shown to be adversely linked to NLR and PLR. The optimal cutoff level of NLR for predicting
chronic allograft nephropathy was 1.58 and the optimal cutoff level of PLR was 109.13. Conclusion: Significant
correlations were detected between kidney function tests and each of NLR and PLR. PLR is a more sensitive inflammatory
marker to predict chronic allograft nephropathy than NLR with a sensitivity of 83.33 % versus 66.67 %.
Keywords: Glomerular Filtration Rate, Graft Rejection, Inflammation, Kidney Transplantation

INTRODUCTION
At present, transplantation of the kidney is the ideal

choice for treating end stage kidney disease (ESKD). The
were recorded. Investigations included complete blood
main benefits are better survival estimates and better
count, kidney function test, urinary protein creatinine ratio
quality of life than long term dialysis (1). However
(PCR), fasting lipid profile, bone profile, and other routine
endothelial dysfunction is widely distributed in recipients
metabolic screening tests. The eGFR was assessed using
of renal transplants. Additionally, it is related to the higher
the Modification of Diet in Renal Disease Study formula
(4)
prevalence of inflammation. Inflammation enhances the
.
stiffness of the blood vessel wall. Chronic inflammation
Ethical approval:
leads to atherosclerosis in individuals with end-stage
The protocol of the research was authorized by the
kidney disease (ESKD) (2). In several diseases, such as
Institutional Review Board of the Ethical Committee of
ischemic heart disease, heart failure, atrial arrhythmia,
Zagazig University and followed the Helsinki ethical
malignancy, and ESKD, the neutrophil-to-lymphocyte
guidelines.
ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are
Statistical analysis
reliable indicators of chronic inflammation and poorer
Analysis of data was conducted using the MedCalc
outcomes (3). Thus, the objectives of this work were to
20 for windows and the Statistical Package for the Social
detect the correlations of NLR and PLR with chronic
Sciences version 26. The Shapiro Wilk test was utilized to
allograft nephropathy (CAN) and determine the cutoff
assess the distribution of continuous variables. Means and
values for the prediction of CAN.
standard deviations for normally distributed continuous

variables and medians and interquartile ranges (25th
percentile to 75th percentile) for skewed continuous
PATIENTS AND METHODS
68 kidney transplant recipients between January 2017
variables were calculated. Categorical data are presented
and December 2019 were recruited for this retrospective
as numbers and relative frequencies. Normally distributed
cross-sectional research. Exclusion criteria included active
continuous variables were compared using the Student's t-
infection, acute kidney injury, active malignancy,
test, while the Mann-Whitney U test was employed for
hematological
disorders, and
patients requiring
skewed continuous data. Ordinal data were compared
maintenance dialysis. The research was composed of two
utilizing the Chi-square test. Correlations between NLR
groups. Group 1 consisted of 44 subjects who had eGFR
and PLR and selected study parameters were calculated
60 ml/m/1.73 m2. They were 22 men and 22 women
using Spearman's rank correlation test. Receiver operating
with a median age of 45.5 years. Group 2 contained 24
characteristic (ROC) curves were plotted to calculate the
subjects who had eGFR less than 60 ml/m/1.73 m2. They
sensitivity and specificity of NLR and PLR in the
were 12 men and 12 women with a median age of 42.5
prediction of CAN. P-value below 0.05 was deemed
years. Demographic and clinical features of each patient
significant.

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/)
2231
Received:17 /4 /2021

Accepted:13 /6 /2021


Full Paper (vol.841 paper# 97)


c:\work\Jor\vol841_98 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2237-2241

Effect of Pulmonary Artery Venting in Patients Having Elevated Pulmonary
Artery Pressure Undergoing Mitral Valve Surgery, Comparative Study
Ahmed M. Elwakeel*1, Sherif Nasr2, Mahmoud El-wakeel3, Ahmed Asfour4, Ihab Elsharkawy1
Departments of 1Cardiothoracic Surgery, 3Anesthesia & Critical Care and 4Cardiovascular Medicine,
Faculty of Medicine, Cairo University, Egypt
Department of 2Cardiothoracic Surgery, Faculty of Medicine, Fayoum University, Egypt
*Corresponding Author: Ahmed M. Elwakeel, Mobile: +201005236454
Email: aelwakeel@kasralainy.edu.eg, ORCID: https://orcid.org/0000-0003-2877-3446

ABSTRACT
Background:
Despite being controversial, left ventricular venting is still used to facilitate valvular heart surgeries and
prevent distention. The classic way to vent the left ventricle is via the right superior pulmonary vein, which has many
reported complications.
Objective: We aimed to evaluate the effectiveness of pulmonary artery venting in patients undergoing mitral valve
surgery who have elevated pulmonary artery pressure.
Patients and Methods: 100 patients undergoing isolated mitral valve replacement, and having elevated pulmonary
artery pressure were recruited in Cairo University Hospitals. They were divided into 2 groups; group 1 had pulmonary
artery venting, and group 2 had no plmonary artery venting. Both groups were compared for preoperative, operative and
postoperative variables.
Results: Patients were divided into 2 groups; group 1 comprised 51 patients and had pulmonary artery venting, and
group 2 comprised 49 patients and had no pulmonary artery venting. Both groups had similar preoperative characteristics,
with group 1 having 14 minutes shorter cross clamping time (p value = 0.001), and 0.6 days shorter ICU stay (p value
= 0.002), mean hospital stay was 6.4 ± 1.7 in group 1 and 8.7 ± 2.2 in group 2 (p value = 0.001).
Conclusion: Using pulmonary artery venting during open heart surgery for mitral valve replacement, in patients with
elevated pulmonary artery pressure is beneficial, facilitates the surgical procedure, and is associated with shorter ICU
and hospital stay.
Keywords: Mitral valve replacement, Left ventricular venting, ICU stay, Surgical outcome, Elevated pulmonary artery
pressure.

INTRODUCTION
weaning off bypass, in patients undergoing mitral valve
Routine use of left ventricular vent is controversial
replacement.
in patients undergoing open heart surgery. However,

surgeons use it during valvular surgery to maintain a dry
PATIENTS AND METHODS

field to make the operation easier. In addition, it helps
This is a randomized prospective study including
to prevent left ventricular distention during the critical
100 consecutive patients, who were operated in Kasr
period of rewarming and reperfusion if ventricular
Alainy hospitals, in the period between January 2017
function does not return immediately following the
and December 2019. Only patients with isolated mitral
release of aortic cross clamp(1).
valve disease were studied. The study aimed to assess
Many mitral valve disease patients present for
the effectiveness of PA venting in patients with PH
valvular surgery at a late stage and often have severe
undergoing mitral valve surgery regarding impact on
left atrial dilatation, pulmonary hypertension, and
cross clamp time, bypass time, need for inotropic
impaired right ventricular function. Improper drainage
support, time to extubation, ICU stay and total hospital
of the blood returning to left atrium during surgery may
stay. Inotropic support was defined as "requiring one or
cause RV distension and increase the inotropic
more of norepinephrine/ epinephrine/ amrinone/
requirement to wean off bypass. The most commonly
dobutamine/ >2.5 mug/kg/min dopamine, for at least 45
used technique to drain the LA is venting via RSPV,
minutes intraoperatively"(2) while those requiring small
however technique of insertion of the vent catheter is
doses of inotropes, which was weaned before transfer
not easy (2), and many complications are reported with
from OR are not counted.
the use of this technique. Most of the studies focused on

the value of LV vent for the reduction of myocardial
Inclusion criteria: All adult patients with PH
oxygen consumption (3).
undergoing isolated MVR surgery.
We aimed to assess whether the use of pulmonary

artery (PA) vent will yield better clinical results such as
Exclusion criteria: Severe LV dysfunction with
shorter cross clamp time, bypass time; and to determine
EF< 35%, combined procedures as DVR, ischemic MR,
whether it is beneficial for the heart as indicated by less
mitral repair, as operative time is variable depending on
need for inotropics, shorter ICU stay, and easier
the complexity of the repair, those with a previous
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/)



2237
Received:21 /4 /2021

Accepted:17 /6 /2021


Full Paper (vol.841 paper# 98)


c:\work\Jor\vol841_99 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2242-2248

Value of Serum Copeptin Estimation for the Diagnosis of Diabetic
Nephropathy in Type 2 Diabetes Mellitus Patients
Said M Al-Barshomy¹, Adel A. Ghorab¹, Osama A. Mahmoud²,
Mohamed Shahein1, Amira A. Mahmoud¹, Niveen S.S. Sakla¹.
Departments of 1 Internal Medicine and Nephrology and ²Biochemistry,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Said M. Al-Barshomy, Mobile: (+20) 01008559101, Email: saidbarshomy@yahoo.com

ABSTRACT:
Background:
Serum copeptin, the terminal part of the arginine vasopressin (AVP), is stable in plasma. The AVP is
increased in diabetic patients and may play a role in the development of diabetic kidney disease.
Objective: To evaluate the role of serum copeptin in the diagnosis of diabetic nephropathy in type-2 diabetes mellitus.
Patients and Methods: 40 type-2 diabetes mellitus (T2DM) patients; divided into two groups, (20 with poor glycemic
control, and 20 with good glycemic control), in addition to 20 non-diabetic healthy control subjects. The following
investigations had been made; HbA1C, FBS, blood urea, serum creatinine and sodium, creatinine clearance (Ccr),
glomerular filtration rate (eGFR), urinary protein, and urinary sodium. Serum copeptin levels were measured using an
enzyme-linked immunoassay (ELISA).
Results:
Serum copeptin levels were significantly higher in (T2DM) patients with poor glycemic control than in
(T2DM) patients with good glycemic control compared to the healthy control group. There was a significant positive
correlation between serum copeptin and FBS, HbA1C, blood urea, serum creatinine, urinary Na, and 24-hour urinary
protein, and a significant negative correlation with serum Na, eGFR, and creatinine clearance. The receiver operating
characteristic (ROC) curve for the validity of serum copeptin, as a marker for diabetic nephropathy, at cutoff point 3452
pg/ml, showed 90% sensitivity, and 95% specificity.
Conclusion: Serum copeptin is independently related to markers of kidney injury in T2DM and may be used as a marker
for diabetic nephropathy.
Keywords:
Serum copeptin, Arginine vasopressin (AVP), Diabetic kidney disease.

INTRODUCTION
dehydration and hyperosmolarity may lead to chronic
The arginine vasopressin (AVP), also known as
kidney injury, through its effect on AVP, and serum
the antidiuretic hormone (ADH), is important in
copeptin secretion (13).
maintaining fluid balance and vascular tone (1). Copeptin
This study was conducted to evaluate the role of
is a glycopeptide co-secreted with the AVP, and its
serum copeptin in the diagnosis of diabetic kidney
function is unknown. It is used as a marker for the AVP
disease, in type-2 diabetes mellitus.
secretion, as it is stable in the serum, unlike the AVP (2).

Copeptin is used as a marker for the AVP secretion in
PATIENTS AND METHODS
some
infections,
cardiovascular,
respiratory,
This case-control study was carried out, during
cerebrovascular, and stressful conditions (3). AVP level
the period from January 2019 to March 2020, at the
is increased in diabetes mellitus (DM) and may play a
inpatient wards, and the outpatient clinics, of the Internal
role in the albuminuria and the changes in glomerular
Medicine Department, Nephrology Unit, and the
filtration rate (GFR) in chronic kidney disease (CKD) or
Biochemistry Department, Faculty of Medicine, Zagazig
diabetic kidney disease (4). The ADH secretion is
University Hospitals, Egypt.
stimulated by hyperosmolarity, hypotension, hypoxia,
A total of 40 age-matched patients with type-2
insulin-induced hypoglycemia, and stress (5, 6). It binds to
diabetes mellitus (DM) were divided into; 20 diabetics
3 types of receptors; V1a, V1b, and V2 receptors (7); V1a
with poor glycemic control (glycosylated hemoglobin
mediates vasoconstriction (5), V1b mediates the
(HbA1C) more than 7%) and 20 diabetics with good
secretion of adrenocorticotrophic hormone (ACTH), and
glycemic control (HbA1C) less than 7%. Diabetic
insulin (8), and V2 mediates its antidiuretic effect,
patients had criteria for diagnosis as type 2 DM on
through the aquaporin-2 channels in the distal nephrons
regular oral hypoglycemic treatment, for 5 years or more
(1). Elevated serum copeptin levels are related to
(14), in addition to 20 age-matched healthy non-diabetic
increased mortality in hemodialysis (HD) patients with
subjects served as the control group.
type-2 diabetes mellitus (DM) (9) and are correlated to the
In our work, we excluded patients with other
progression of chronic kidney disease (CKD) (10). Serum
conditions affecting serum copeptin including sepsis,
copeptin is correlated to albuminuria, and renal decline
malignancy, chronic obstructive pulmonary disease, S-T
in kidney transplant recipients (11) and can be used as a
elevation-myocardial infarction, or cerebrovascular
marker for kidney injury in preeclampsia, with high
stroke.
sensitivity and specificity (12). Also, recurrent
Ethical approval:

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/)
2242
Received:19 /4 /2021

Accepted:15 /6 /2021


Full Paper (vol.841 paper# 99)


c:\work\Jor\vol841_100 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2249-2255

Clinical and Laboratory Characteristics of Children with
Autism Spectrum Disorder at Sohag University Hospital
Abdelrahim Abdrabou Sadek, Amr Ahmed Osman, Marina Naseralla Samy*
Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Marina Naseralla Samy, Mobile: (+20) 01069411092, E-Mail: marinaatef_2020@yahoo.com

ABSTRACT
Background:
Autism Spectrum Disorder (ASD), sometimes referred to as "autism", is "a chronic disorder whose
symptoms include failure to develop normal social relations with other people, impaired development of communicative
ability, lack of imaginative ability, and repetitive, stereotyped movements".
Objective: To assess the clinical and laboratory characteristics as well as risk factors of ASD.
Patients and methods: The study was a retrospective descriptive cohort study and included 1650 autistic patients with
AD/ASD referred to the Pediatric Department and Psychiatry Outpatient Clinic at Sohag University Hospital, Egypt,
and followed up during the period from June 2019 to May 2020.
Results: Age at presentation ranged from one month to 252 months with a mean ± SD of 44.496 ± 28.435. The results
of IQ of the studied patients were available in 241 patients with a range from 25 to 100 with a mean IQ of 62.98. Our
CARS data were available in 920 of the studied patients (n=920) and showed a mean of 30.064 with a range from 20 to
60. In our study, the associated risk factors of autism were reported in 332 patients. Hearing problems were found in
25.9%, neonatal asphyxia in 15.9%, phenylketonuria was found in 11.8% of those patients. Epilepsy was found in 7.8%,
hyperammonemia in5.3%, cerebral malformation in 5.1%, down syndrome in 3.3%, and tuberous sclerosis in2.8%.
Conclusion: Our study confirmed diagnosis of ASD in children affects patients, family, and the community at large.
Knowledge of ASD is crucial for health professionals as its prevalence is increasing globally.
Keywords: Clinical and laboratory characteristic, Autism Spectrum Disorder.

INTRODUCTION

The most significant risk factor is having one or

Autism Spectrum Disorder (ASD), sometimes
more relatives with ASD. Hence the risk of having a
referred to as "autism", is a chronic disorder whose
second child with ASD is around 2-6%. And this
symptoms include failure to develop normal social
possibility increases even further up to 50% if more than
relations with other people, impaired development of
one sibling is already affected by ASD. In the case of
communicative ability, lack of imaginative ability, and
identical (monozygotic) twins who share the same
repetitive, stereotyped movements" (1).
genetic material, there is a 60% possibility that they

Individuals with autism disorder have markedly
would both have ASD, but this increases to 90% in the
different social and emotional actions and reactions than
presence of a significantly impaired capacity for social
non-autistic individuals. For example, many autistic
interaction (4).
children do not seem to care whether or not they get

Environmental factors may play a role before
attention from their parents. ASD also affects IQ. While
and during childbirth.
30% of individuals with autism have an average or
Those with the greatest evidence of an increased risk of
gifted IQ, 70% are considered mentally retarded (2).
autism are, Advanced age of parents at the time of

For an individual to be diagnosed with ASD, he
conception (both the mother and the father), illnesses
or she must be several qualifications as stated in the
suffered by the mother during pregnancy that trigger
Diagnostic and Statistical Manual of Mental Disorders
important immune responses, Extreme prematurity,
(DSM-V). These include a qualitative impairment in
with very low birth weight, complications during
social interaction and communication, restricted
childbirth, particularly any that involve a reduction in
repetitive and stereotyped patterns of behaviors,
the oxygen supply reaching the baby's brain, Treatment
interests, and activities, and delays in functioning.
for epilepsy (treatment with valproic acid during
Diagnosis also requires that Rett's Disorder and
pregnancy), Exposure to high levels of pesticides or air
Childhood Disintegrative Disorder ­ which have similar
pollution in pregnant women (5).
symptoms ­ do not better account for the behaviors (3).

Among the environmental factors, vaccines

There is no single cause of autism. Genetic
have been ruled out as a risk factor for autism. It is
factor, In the last five years, scientists have identified a
important to remember that these factors alone do not
series of rare genetic changes or mutations associated
cause autism. Only when they are combined with
with autism. They have already identified over 100
genetic risk factors may they produce a modest increase
genes connected to the risk of autism. However, there is
in risk. Although the causes of autism are complex and
not just one mutation in the majority of cases but rather
have yet to be fully elucidated, there is no doubt
a complex and variable combination of environmental
whatsoever that it is not caused by bad parenting and the
and genetic risk factors that influence early brain
medical community considers it to be a biological
development (3).
disorder (5).

This article is an open access article distributed under the terms and conditions of the Creative


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

2249
Received:19 /4 /2021

Accepted:15 /6 /2021


Full Paper (vol.841 paper# 100)


c:\work\Jor\vol841_101 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2256-2261

The Impact of Smoking on Semen Quality and ICSI Outcome in the Obese Men
Salha Abd El Fatah Saad*1, Nehal Ali Abu-Elnaga1,
Amira Badereldin Abdel Ghany2, Ahmed Fathy Alsherbiny Hassan3
1Department of Embryology, Zoology Department, Faculty of Science, Al-Azhar University, Egypt.
2Department of Embryology, International Islamic Center for Population Studies and Research, Al-Azhar University.
3Department of Fertility, International Islamic Center for Population Studies and Research, Assisted Reproductive
Unit, Al-Azhar University
*Corresponding author: Salha Abd El Fatah Saad, Mobile: (+20) 01015317144, E-Mail: dr.salhamansoura@gmail.com

ABSTRACT

Background: Male obesity with or without smoking and raised male BMI can markedly harm quality embryo blastocyst
development, clinical pregnancy rate, and live birth rate in couples who underwent in vitro fertilization (IVF) or
intracytoplasmic sperm injection (ICSI). Male BMI could be an essential factor influencing IVF­ICSI outcome.
Objective: This study aimed to investigate the effect of smoking on semen quality, fertilization, embryo quality, and
their impact on pregnancy after ICSI in overweight men. Material and methods: The study was performed on 150
cases in the assisted reproductive unit in International Islamic Center for Population Studies and Research, Al-Azhar
University. The recruited males were divided into three groups (50/group): Normal control (C), Overweight (OW), and
overweight with a smoking (OW&S). Their physiological, biochemical, and semen parameters were investigated for all
cases. The fertilization rate, cleavage rate, embryo quality, and pregnancy rate were examined and recorded during and
after the ICSI process. Results: Percent of abnormal sperm morphology in the OW&S group showed a very highly
significant increase (P<0.01) than the control group. However, for the overweight with smoking (OW&S) and
overweight groups (OW), the percentage of the fertilization rate and the high-quality embryos were significantly lower
than the values of the control group (P<0.01). The percentage of the low-quality embryo was higher in OW&S and OW
groups than in the control group. The lowest rate of positive pregnancy test recorded in overweight with smoking (46%)
followed by overweight (60%). Conclusion: the semen parameters and hormonal profile, fertilization rate, embryo
quality, and pregnancy rate were significantly lower in smoker men suffering from overweight.
Keywords: ICSI; Overweight; Semen quality; Smoking.

INTRODUCTION
Obesity, defined by the World Health
Sperm participation in embryogenesis is done
Organization (WHO) as a body mass index (BMI) 30
through the haploid genome. Sperms are involved in a
kg/m2, is a medical condition of excess body fat
variety of processes, including syngamy, cleavage, and
negatively influencing morbidity and mortality via non-
epigenetic control, in addition to their genetic content.
communicable disease risks (7, 8). Although the effect of
Infertility affects around 15% of reproductive-age
paternal BMI on sperm function has been studied (9, 10),
couples. Twenty-five percent of them can be described
there are few studies on the effects on the paternal health
by male factors alone and up to 50% by the combination
of the fetus and live birth outcomes (11, 12).
of female and male factors. Along with genetic and
Attention to human reproduction is how
epigenetic abnormalities, other influential factors may
lifestyle factors such as cigarette smoking impacts IVF
contribute to idiopathic male infertility and affect in
outcome (13). Cigarette smoke contains cotinine,
vitro fertilization (IVF) outcomes (1). Many infertile
cadmium, metabolites of nicotine that are toxic,
men have an abnormal semen analysis, whose etiology
mutagenic chemicals and carcinogens. These chemicals
is often poorly described. These may include
cross the blood-testis barrier. The proof of this
environmental, diet, medical, genetic and physiological
correlation is the concentration of toxic materials in
factors (2).
seminal plasma as those in the serum; this provides an
Throughout fertilization, sperms that have
abnormal environment during spermatogenesis(14).
high quality and have healthy chromatin are naturally
This unnatural environment causes oxidative
selected. In assisted reproductive techniques (ART),
DNA damage in spermatozoa due to its high content of
especially in intracytoplasmic sperm injection (ICSI),
oxidants (15). This study aimed to investigate the effect
sperm that have a DNA breakage are naturally excluded
of male overweight with or without smoking on semen
and not selected, and this can affect the fertilization
quality, fertilization, embryo quality and their impact on
ratio, embryo quality, and implantation rate (3-5).
pregnancy after intracytoplasmic sperm injection (ICSI)
The impact of paternal obesity on prenatal
outcome.
development was neglected until recently. More than

half of males of reproductive age are overweight,
PATIENTS AND METHODS
according to recent research, and this has a variety of
The study population consisted of 150
consequences for their children's health (6).
couples; the men were divided into three groups:

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/)
2256
Received:20 /4 /2021

Accepted:16 /6 /2021


Full Paper (vol.841 paper# 101)


c:\work\Jor\vol841_102 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2262-2269

Partial Nephrectomy Versus Radical Nephrectomy for Localized Renal Masses: Critical Analysis of
Oncological Outcome and Impact on the Renal Function
Mohamed Selim, Mahmoud Amer*, Mohamed Elshazly, Sultan Sultan
Urology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding Author: Mahmoud Abdelaziz Amer, Mobile: 00201014627286, E-Mail: mahmoud.mousa@med.menofia.edu.eg

ABSTRACT
Background:
Management of renal tumors remains a controversial issue especially in small size tumors or special
situations as bilateral disease, single kidney, or compromised renal function, nephron-sparing surgery is the case in such
situations.
Objective: Comparing oncological outcome and impact on renal function of open radical nephrectomy and open partial
nephrectomy for management of renal tumors.
Patients and methods: Our study was conducted as a non-randomized prospective observational study at the Urology
Department, Menoufia University Hospital between December 2018 and June 2020. Forty-eight patients with organ-
confined renal masses were included in the study. They were divided into two equal groups; (group 1) 24 patients and
was treated by PN, and (group 2) 24 patients and was treated by RN.
Results: The mean age of our study is 56.6±13.2. Thirty-two patients were males (66.7%), while females represented
16 (33.3%). Hot ischemia was done for all partial nephrectomy cases with a mean time of ischemia 13.2±4.1. We used
different techniques included simple enucleation in 17 patients (70.8%), polar nephrectomy in 4 patients (16.7%), and
wedge resection in 3 patients (12.5%). Regarding surgical margin, it was free in 21 patients (87.5%) of PN and positive
in 3 patients (12.5%) 2 of them missed follow up and 1 showed no recurrence till now. Our patients showed a smooth
postoperative course.
Conclusion: Both techniques (RN&PN) were comparable in terms of oncological outcomes. Patients tolerated both
techniques with no major complications, however partial nephrectomy is advised in the localized renal tumors when
technically feasible with less probability of complications and good follow-up data regarding the renal function, the
oncological outcome is the same as radical surgery.
Keywords: Partial Nephrectomy, Radical Nephrectomy, Renal masses.

INTRODUCTION
standard, but recent data suggest a potential role for
Renal cell carcinoma (RCC) represents about 2­
partial nephrectomy in selected cases (5, 6).
3% of all cancers and about 85­93% of malignant
Comparing partial nephrectomy with radical
tumors of the kidney (1).
nephrectomy; both have the same surgical outcomes in
RCC is more common in men than in women as
immediate and long-term follow-up, but radical
2:1, the average age of presentation is fifty to sixty years
nephrectomy is associated with more cardiac and
of life. Smoking, hypertension, and obesity have also
metabolic events. Partial nephrectomy is associated
been strongly associated with RCC.
with more complications as hemorrhage, urinary leak,
Patients with RCC can present with local or
long-term follow-up, and recurrence. The most valuable
systemic symptoms. Local signs and symptoms include
feature of partial nephrectomy over radical is better
hematuria, flank pain, or a palpable abdominal mass.
renal function preservation (7-9).
Systemic symptoms can be due to metastases or
The present study aimed to compare oncological
paraneoplastic syndromes such as hypertension,
outcomes and impact on renal function of open radical
erythrocytosis, fever, and wasting syndromes (2, 3).
nephrectomy and open partial nephrectomy for
RCC is referred nowadays as the radiologist's
management of renal tumors.
tumor as most cases are diagnosed incidentally by

ultrasonography and contrast-enhanced urinary CT
PATIENTS AND METHODS
without any complaint (4).
Our study was conducted as a non-randomized
Treatment options for renal masses include partial
prospective observational study at the Urology
nephrectomy (PN), radical nephrectomy (RN), and
Department, Menoufia University Hospital between
others (minimal invasive thermal ablative therapies,
December 2018 and June 2020. Forty-eight patients
active surveillance).
with organ-confined renal masses were included in the
Partial nephrectomy is considered a standard
study.
surgical treatment for localized renal tumors T1a and is
Patients were divided into two groups: Group A:
preferred over radical nephrectomy for T1b tumors
open radical nephrectomy 24 patient. Group B: open
when technically can be done. For larger T2 tumors
partial nephrectomy 24 patients. All patients were
radical nephrectomy is still considered the gold
subjected to detailed medical history and general &
local examination.

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/)
2262
Received:20 /4 /2021

Accepted:16 /6 /2021


Full Paper (vol.841 paper# 102)


List of Abbreviations The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2270-2278

Dexmedetomidine versus Dexamethasone as Adjuvants to Bupivacaine for
Ultrasound Guided Rectus Sheath Block in Pediatric Abdominal Surgery
Ahmed Adel Ahmed Oriba*, Mohamed Younis Makharita,
Medhat Mikhail Messeha, Amer Abd Allah Atia
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University,Egypt
*Corresponding author: Ahmed Adel Ahmed Oriba, Mobile: (+20)01000010217, E-Mail: adolabashaa@yahoo.com

ABSTRACT
Background:
The use of ultrasound as a guide for regional anesthesia has become common practice and a new
challenge to anesthesiologists. Besides its benefits of reduced complications, it also helps in reducing the total anesthetic
dose required with higher block success rates. There is also the advantage of direct observation of the pattern of
anesthetic spread.
Objective: To compare between dexamethasone and dexmedetomidine as adjuvants to bupivacaine in rectus sheath
block applied during pediatric abdominal surgeries.
Patients and methods: This prospective randomized study was conducted at Mansoura University Children Hospital.
We included a total of 60 pediatric patients undergoing elective abdominal surgery. The study was conducted over the
period of two years, starting from January 2019 till December 2020.
Results:
The mean age of the included patients was 4.7, 4.7, and 4.6 in groups C, D, and Z respectively. Operative time
and duration of anesthesia did not show any significant difference between the three groups. The duration of analgesia
showed a highly significant difference between the three groups. Group Z showed its superiority as it had a mean
analgesic duration of 15.3 hours, followed by Group D which had mean value of 13.02 hours.
Conclusion: Both dexamethasone and dexmedetomidine were efficient adjuvants to local anesthetics as they were
associated with significant prolongation of the duration of analgesia, decrease in postoperative analgesia, and better
patient satisfaction compared to bupivacaine alone.
Keywords:
Bupivacaine, Dexamethasone, Dexmedetomidine, Pediatric Abdominal Surgery, Ultrasound.

INTRODUCTION
and vomiting (8). Another useful use for dexamethasone

Effective perioperative pain management for
is the synergistic analgesic effect when added to local
the pediatric patient continues to be challenging.
anesthetics epidurally that reduce postoperative
Avoiding the undertreatment of pediatric pain is critical,
analgesic needs. Different theories attempt to explain its
because inadequate analgesia may lead to longer
analgesic effects. One theory stated that dexamethasone
hospital stays, patient dissatisfaction and an increased
might have a direct local anesthetic effect on the nerve
risk of morbidity and mortality (1).
(9).
In an effort to reduce postoperative pain and
While dexmedetomidine is an alpha 2 agonist
opioid use, rectus sheath blocks (RSB) have become
which has sedative, analgesic, and opioid-sparing effect
increasingly popular in the pediatric population, and
(10). It prolongs the duration of analgesia by its local
have been used to provide analgesia after umbilical and
vasoconstrictive effect and by increasing the potassium
epigastric hernia repair, laparoscopic surgery, and
conductance in A-delta and C-fibers (11). It also exerts its
pyloromyotomy (2).
analgesic action centrally via systemic absorption or by
The rectus sheath block aims to anesthetize the
diffusion into the cerebrospinal fluid and reaches alpha
anterior rami of nerves T9­11(3). Initial RSBs were
2 receptors in the superficial laminae of the spinal cord
performed without the aid of ultrasound (US); however,
and brainstem or indirectly activating spinal cholinergic
the use of ultrasound to provide image-guided
neurons (12,13). The sedative effects of dexmedetomidine
placement of regional blocks has been increasing (4).
are mostly due to stimulation of the alpha 2

Studies in adults and children have compared
adrenoceptor in the locus coeruleus (14).
the rectus sheath block with opioids alone for analgesia
The aim of the current study was to compare
after laparoscopic surgery, showing favorable results (5).
between dexamethasone and dexmedetomidine as
It was successfully used in chronic pain management of
adjuvants to bupivacaine in rectus sheath block applied
pediatric abdominal wall pain (6).
during pediatric abdominal surgeries.
Various adjuncts have been added to local

anesthetics to extend its postoperative analgesic time,
PATIENTS AND METHODS
for example, fentanyl, neostigmine, clonidine, and most
This prospective randomized study was
recently dexamethasone and dexmedetomidine (7).
conducted at Mansoura University Children Hospital
Dexamethasone has various perioperative uses,
aiming to compare between dexamethasone and
mainly to reduce inflammation and to prevent nausea
dexmedetomidine as adjuvants to bupivacaine in rectus

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/)
2270
Received:20 /4 /2021

Accepted:16 /6 /2021


Full Paper (vol.841 paper# 103)


c:\work\Jor\vol841_104 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2279-2284

Effect of Genital Tract Infection on Citric Acid in Semen of Infertile Male Patients
Doaa Abdel Rahman Sonbol, Ahmed Fathy State, Samir Mohammad Elhanbly
Department of Dermatology, Andrology and STDs - Faculty of Medicine -Mansoura University, Egypt
*Corresponding author: Ahmed Fathy State, Mobile: (+20) 01001409323, E-Mail: ahmedelkordys4@gmail.com

ABSTRACT
Background:
Infertility means the failure to achieve a clinical pregnancy after 12 months of regular unprotected sexual
intercourse. It affects approximately 15% of couples. The male factor is the main cause of infertility in 20% of cases and
contributes in about 50%. There are many etiologies for male factor infertility. Infectious processes contribute to about 15%
of such cases. Citric acid has antioxidant and anti-inflammatory functions in tissues damaged by environmental factors. In
addition, it favors the synthesis of glycosaminoglycans in various tissues. Citric acid levels are regulated by testosterone,
and like fructose can be elevated in oligozoospermic and azoospermic subjects without a convincing clinical explanation.
Objective:
To evaluate effect of genital tract infection on level of citric acid in semen of infertile men.
Patients and methods: This study was carried out on 30 infertile male patients. Patients were recruited from the Outpatient
Clinic of Andrology Unit in Dermatology & Andrology and STDs Departments, Mansoura University Hospital for one year.
Results
: The mean age of the studied group was 29.57 ± 4.22 years. All studied samples were subjected to antimicrobial
sensitivity tests. The most sensitive antibiotics were rifampicin, cefoprazone/sulbactam, amoxicillin/clavulanic acid and
piperacillin/tazobactam. While the most resistant antibiotics were ciprofloxacin, cephalexin and levofloxacin. The mean of
citric acid was significantly increased after receiving antibiotic (16.64 ± 2.24 versus 3.32 ± 1.40 mg/ejaculate before
treatment).
Conclusion:
Citric acid was significantly increased after receiving antibiotic versus before male genital infection treatment.
Keywords: Sexually transmitted diseases, Genital tract infection, Infertility, spermatogenesis.

INTRODUCTION
acrosome reaction, altered morphology, formation of
Infertility means the failure to achieve a clinical
reactive oxygen species leading to increased DNA
pregnancy after 12 months of regular unprotected sexual
fragmentation index, formation of antisperm antibodies
intercourse. It affects approximately 15% of couples (1).
due to breach in the blood-testes barrier, and genital tract
The male factor is the main cause of infertility in 20% of
obstruction due to inflammation and fibrosis (8). The
cases and contributes in about 50% (2). There are many
Polymorphnuclear leukocytes (PMN) count is considered
etiologies for male factor infertility. Infectious processes
the best known marker of inflammation in the
contribute to about 15% of such cases (3). Male genital
genitourinary tract and are a routine diagnostic parameter
tract infections are difficult to detect as they are
(9). Other inflammation marker includes citric acid (a
asymptomatic in many cases (4). A number of patients
prostate gland function parameter) (10). Citric acid has
seeking treatment for impaired fertility are increasing so
antioxidant and anti-inflammatory functions in tissues
the diagnosis of "silent" genital tract infections should
damaged by environmental factors. In addition, it favors
receive attention as the infection may be linked to
the synthesis of glycosaminoglycans in various tissues.
asthenozoospermia (5). Infections are potentially treatable
Citric acid levels are regulated by testosterone, and like
causes of male infertility, but the resistance to common
fructose can be elevated in oligozoospermic and
antibiotics and the poor compliance may impede the
azoospermic subjects without a convincing clinical
efficacy of antibiotics in resolving complicated GTI or
explanation (11).
restoring fertility (6).
The importance of citric acid in altering sperm
In a study on 140 patients with pyospermia, 92 of
attributes during abstinence has been underrated.
them
(65.7%)
yielded
bacterial
growth
Inspecting the levels of citric acid in seminal plasma thus
with Staphylococcus
aureus,
Streptococcus
may benefit to find the probable causes of male infertility.
saprophyticus and Escherichia coli with the highest
A proper counseling (brief medical history, physical
incidence rate by 28.3%, 19.6% and 13.0% respectively.
inspection and imaging), simple semen analysis beside
Then, there were Proteus mirablis, Klebsiella pneumonia
biochemical evaluation of seminal plasma is the
and Proteus vulgaris with 10.8% for each. Pseudomonas
prerequisite step to identify potential cause affecting
aeruginosa was 5% (7).
viability, motility and morphology of spermatozoa (12).
Bacteriospermia affects the normal fertility process
The aim of this study was to evaluate effect of
by any of the following mechanisms: deterioration of
genital tract infection on the level of citric acid in semen
spermatogenesis, decreased sperm motility, altered
of infertile men.

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/)
2279
Received:23 /4 /2021

Accepted:19 /6 /2021


Full Paper (vol.841 paper# 104)


c:\work\Jor\vol841_105 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2285-2296

Effect of Alpinia Officinarum Rhizome Extract on Fertility and
Sexual Behavior of Adult Male Albino Rats Treated with Sotalol
Nourhan Mahmoud Abd El-Zaher Bebars*, Mostafa M. El Habeby,
Noha M. Issa, Nermeen M. Noor El-Dien
Department Anatomy and Embryology, Anatomy, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
*Corresponding author: Nourhan Mahmoud Abd El-Zaher Bebars, Mobile: (+20)01009214420,
E-Mail: norabebars48@gmail.com

ABSTRACT
Background:
Infertility in cardiovascular patients is not only attributed to pathogenesis of the disease but, also to the
used therapeutic drugs. Beta blockers which are corner stone in treatment of these patients are reported to affect
fertility and sexual behavior in patients using them. Alpinia officinarum (A. officinarum) rhizome extracts are widely
used for their antioxidant and anti-inflammatory effects to improve oxidative stress which affects organs due to using
different drugs or pathogenesis of different diseases.
Objective:
The current work aimed to study effect of Alpinia officinarum rhizome extract on improving the
reproductive function and sexual behavior of adult male Albino rat treated with Sotalol.
Materials and Methods: Fifty adult male Albino rats were categorized into five groups. Group I control, group II
(A. officinarum group) received A. officinarum extract at a dose of 200mg/kg/day in olive oil orally by gastric tube
for 21 days, group III (Sotalol group) received Sotalol at a dose of 3mg/kg/day orally by gastric tube for 21 days,
group IV (protected group) received the extract then Sotalol and group V (treated group) received Sotalol then the
extract. Then fifty adult female rats were used for assessment of sexual behavior through observing mount latency
and frequency.
Results:
Sotalol induced testicular destruction in the form of shedding of germinal epithelium, hyaline deposition,
decreased sperm count with decreased testosterone level, increased oxidative stress in the form of decreased Serum
superoxide dismutase (SOD) level and increased Serum malondialdehyde (MDA) level. Deterioration of sexual
behavior in the form of increased mount latency and decreased mount frequency was noticed in the Sotalol group. A.
officinarum
extract produced a great preservation of testicular structure and sexual behavior in the protected group
(IV) together with improvement in the treated group (V).
Conclusion:
Sotalol induced destructive effects on the testicular structure, function and sexual behavior which were
greatly improved by using A. officinarum extract.
Keywords: Sotalol, Testis, Sexual behavior, A. officinarum extract.


INTRODUCTION
Alpinia officinarum Hance (lesser galangal), an
Infertility is a worldwide health problem
important member of family Zingiberaceae is widely
affecting about 8­12% of couples all over the world,
present in the tropical and subtropical regions of
the male factor accounts for about 40­50% of its cases.
Southeast Asia. Its rhizomes are used as an anti-
Male infertility may be attributed to testicular
inflammatory, analgesic, and antioxidant agent in
dysfunction or sexual dysfunction (impaired sexual
conventional medicine (6).
behavior) (1). Male sexual behavior consists of a
Alpinia officinarum extract was reported to
complex pattern of genital responses including pre-
improve sperm parameters and histological damage in
mating and mating behaviors (2). Medications are a
testis of the diabetic rats (7).
common exogenous factor that must be evaluated in
Alpinia officinarum has been also used for
infertile men, due to their impact on the different
treatment of sexual dysfunction in the traditional
reproductive parameters including spermatogenesis,
Persian medicine (8).
sperm parameters and sexual behavior (3). Sotalol, a

non-selective beta blocker is also classified as class III
MATERIAL AND METHODS
antiarrhythmic drug (4).
Chemicals:
It is used for treatment of atrial fibrillation,
a. Sotalol Hydrochloride-Sotalol hydrochloride
ventricular tachycardia, premature
ventricular
(Betacor 80mg®) was obtained as tablets
contractions, and supraventricular tachycardia (5).
manufactured by Amoun Pharmaceutical Company,
Sexual dysfunction is a distressing problem for many
Cairo, Egypt. Each tablet contained 80 mg Sotalol
people. The available drugs for management of this
hydrochloride. Each tablet was dissolved in 100 ml
problem have many side effects. Herbal medications
distilled water to obtain a concentration of 0.8mg/ml
recently provided the clue for safe management of the
then it was given orally by modified plastic syringe to
sexual dysfunction as they have no side effects (2).
animals in a dose of 3mg/kg body weight (9).


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/)
2285
Received: 22/4/2021

Accepted: 18/6/2021


Full Paper (vol.841 paper# 105)


c:\work\Jor\vol841_106 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2297-2300

Fetal Heart Rate Variability Before and After Antenatal Corticosteroids in
Patients at High Risk of Preterm Labor
Walid Abd Allah Abd Elsalam, Amr Kamel El Fayomy,
Basma Mohamed Safwat Ahmed Shalaby, Ahmed Ismail Mohamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Basma Mohamed Safwat Ahmed Shalaby,
Mobile: (+20)01063173152, Email: drbosy.m92@gmail.com

ABSTRACT
Background:
Premature birth (PTB) occurs in one in ten pregnancies. There are about 13 million PTBs annually
worldwide. Antenatal corticosteroids are administered to enhance fetal lung maturation in cases of threatened
preterm delivery between 24- and 34-weeks' gestational age (GA).
Objective: This study aimed to study the cardiotocograp (CTG) before and after antenatal corticosteroids
administration in patients at high risk of preterm labor to reduce preterm risks.
Patients and Methods
: A prospective cohort study included 52 women who were at risk of premature birth. Each
woman received the recommended course of corticosteroids consists of 4 doses of dexamethasone 6 mg for 48
hours (Dexamethasone 8 ml intramuscularly, 12 h apart). CTG examination: Fetal heart rate was monitored with
fetal monitor cardiotocogram machine. Cardiotocography strips were interpreted visually.
Results:
In our study we recorded decrease in baseline fetal heart rate and increase in fetal heart rate variability
(LTV, STV) after dexamethasone course by 24 hours, which were statistically significant. The number of
accelerations showed a slight increase, which was significant. Decelerations were not present at all before or after
the course. The STV showed a significant change before the course, all participants had moderate STV, but after
the course, 8 (15.4%) showed marked variability, which was significant. We found that most of participants (90.4%)
had decreased fetal kicks after injection relying on maternal perception.
Conclusion:
There was a decrease in baseline fetal heart rate and increase in fetal heart rate variability (LTV,
STV) after dexamethasone course by 24 hours, which were statistically significant. The number of accelerations
showed a slight increase, which was significant.
Keywords:
Antenatal Corticosteroids, Cardiotocograph, Fetal heart rate, Preterm labor.

INTRODUCTION

Premature birth (PTB) occurs in one in ten
decreasing gestational age and infants born below 30
pregnancies. There are about 13 million PTBs
weeks gestation are at the greatest risk for RDS (4).
annually worldwide. In 2011, 9% of all children born
Early detection of fetal risk is one of the main
in Germany were born before the end of GA 37 (1).
issues in today obstetrics. CTG is used both antenatally
Antenatal corticosteroids are administered to enhance
(before birth) and during labor to monitor the baby for
fetal lung maturation in cases of threatened preterm
any signs of distress. By looking at various aspects of the
delivery between 24- and 34- weeks' gestational age
baby's heart rate, doctors and midwives can see how the
(GA) (2).
baby is coping (5).
Since Liggins and Howie first described
Cardiotocography records changes in the fetal
improved survival and reduced morbidity among
heart rate and their temporal relationship to uterine
preterm infants treated with antenatal corticosteroids
contractions. The aim is to identify babies who may be
in 1972, their use has become internationally
short of oxygen (hypoxic), so additional assessments of
recommended practice (3).
fetal well-being may be used, or the baby delivered by
Respiratory distress syndrome (RDS), formerly
caesarean section or instrumental vaginal birth (6).
known as hyaline membrane disease, is a result of
It is therefore important to understand shortterm
surfactant deficiency, which causes increased surface
effects of corticosteroids on the fetus in utero, and
tension in the air-liquid interface of the terminal
whether there are correlations between these effects
respiratory units leading to atelectasis, increased
and neonatal outcomes and/or later outcomes. Also, of
ventilation-perfusion mismatch, and potential lung
importance is whether different steroid preparations
injury due to a marked pulmonary inflammatory
display different effects on fetal hemodynamics.
response. RDS is the most common cause of respiratory
This study aimed to study the CTG before and
distress in preterm infants because lung immaturity is
after antenatal corticosteroids administration in
associated with inadequate production of pulmonary
patients at high risk of preterm labor to reduce preterm
surfactant. The incidence of RDS increases with
risks.



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/)
2297
Received:22 /4 /2021

Accepted:18 /6 /2021


Full Paper (vol.841 paper# 106)


RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2301-2307

Indoor Air Quality Assessment in Critical Care Department in One Hospital of
The General Organization of Teaching Hospitals and Institutes in Cairo
Mohamed Mostafa Abdelghaffar1, Sahar Abdelfattah2, Neveen Mahmoud3, Hoda Shoman3
1Department of Gastoenterology and Infectious Disease, Faculty of Medicine, Cairo University, Egypt
2Department of Infection Control Specialist in General Organization for Teaching Hospital and Institutes (GOTHI),
Egypt, 3Department of Experimiental Zoology, Faculty of Science, Al-Azhar University, Egypt
*Corresponding Author: Sahar Abdelfattah Hassan, Phone No.: (+2) 01018020572, E-mail: Saherabdelfatah55@gmail.com

ABSTRACT

Background: Among hospitals-related health risks, environmental factors play a key-role; this accounting for different
rooms' specific use, patients' vulnerability and risk of overcrowding. For these reasons, air control in hospitals and in
healthcare facilities in general deserves scientific attention.
Objective: Assessing of the quality of indoor air ventilation in critical care department hospitals and its effect on the
incidence of hospital acquired infections in order to optimize the ventilation methods in hospitals.
Patients and methods: Our study was performed in Egypt by correlating the examined 70 air samples, from the
Intensive Care Unit (ICU), Cardiac Care Unit (CCU) and Neonatal Intensive Care Unit (NICU) in one of the General
Organization of Teaching Hospitals and Institute, for presence of bacterial and fungal contamination with the
concomitant infection of 70 patients admitted in these units during the period from November 2019 to January 2020.
Results: We had 59 (84.2%) positive air samples in comparison to 21 (30%) positive endotracheal tube (ETT) fluid
culture and 19 (27.1%) positive blood cultures in the completely selected air sampling areas and in the selected patients
during the included sampling period. This suggested a strong relation between the contamination between the indoor
airs either by bacterial or fungal organisms, and between the concomitant presence of the same organism in the ETT
fluid samples and to lesser extent in the blood cultures.
Conclusion: This study has fortified the hypothesis that achieving an optimal level of indoor air quality is related to
applying the infection control rules, application of approved air filters and strict adherence to hand hygiene.
Keywords: Air Quality, Critical Care Unit.

INTRODUCTION
temperature. Individuals potentially exposed to this risk
The indoor air quality is an issue of growing scientific
including all age groups, in particular the most
interest both because the risks due to exposure to air
vulnerable ones, such as children and elderly. The
pollution in indoor environments became more evident
biological risk in healthcare facilities can be controlled
and stated by WHO of improving public health and
and reduced through interventions of both structural and
quality of life (1). Indoor pollution levels are affected by
engineering plans' actions and in respect of basic
air quality, materials, room ventilation, type of
hygienic and behavioral knowledge by facility
furniture, equipment and products, occupants' habits
managers, workers, and users (3). When this risk is not
(including passive smoking), and overall building
well managed and monitored, infectious risks can arise,
management, according to the European Union and
affecting several categories of people involved in the
specifically the European Environmental Agency
hospital, which are contaminated directly, through the
(EEA) in the reports of Environment and Human Health
respiration of biological agents (bacteria, viruses, fungi,
and Environmental Signals 2013 (2).
endotoxins, spores, etc.) and their physique (4, 5).
The air quality criteria in healthcare facilities
In this descriptive study, we aimed at assessing
vary by health function and, in certain cases, even by
the quality of indoor air ventilation in critical care
room in relation to its utilisation. Some areas, such as
department hospitals and its effect on the incidence of
operating rooms, intensive care units, and isolation
hospital acquired infections in order to optimize the
rooms, require high-efficiency filtration to protect
ventilation methods in hospitals.
patients, staff, and visitors, while others require the

removal
of
gaseous
contaminants,
chemical
MATERIALS AND METHODS
contaminants, and odours to create a safer and more
Type of Study: A Descriptive Study.
pleasant working environment (2).
Study Setting: Our study was performed in Egypt by
Regarding biological risks, they are related to
correlating the examined 70 samples of air, from the
the presence of microorganisms (fungi, bacteria,
ICU, CCU and NICU in one of the General
viruses, parasites, protozoa, etc.), dust mites, animal-
Organization of Teaching Hospitals and Institute, for
and plant-derived allergens found in the air, in the dust,
presence of bacterial and fungal contamination with the
in construction materials and furniture, in engineering
concomitant infection of 70 patients admitted in these
plants' water, and in air conditioning. It is mainly
units.
influenced by physical factors, such as humidity and
Study Period: from November 2019 to January 2020.

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/)
2301
Received:24 /4 /2021

Accepted:20 /6 /2021


Full Paper (vol.841 paper# 107)


c:\work\Jor\vol841_108 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2308-2312

Evaluating the Role of Calprotectin in Pathogenesis of Acne Vulgaris
in Zagazig University Hospital
Mohamed M. Nasr1, Sharar Al Mokadem1, Samar A Ahmed1, Heba E AbdElrahman2
1-Dermatology, Venereology and Andrology Department, 2-Department of Clinical Pathology,
Faculty of Medicine, Zagazig University, Egypt.
ABSTRACT
Background:
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. The cardinal pathogenic factors
include increased sebum secretion, follicular hyperkeratinization and microbial colonization by Cutibacterium acnes.
Calprotectin is released from activated neutrophils, and can be detected in serum or other body fluids.
Aim: The aim of the present study was to clarify if calprotectin plays a role in acne vulgaris pathogenesis.
Subject and Methods: This study is a case control study included 42 patients complaining of acne vulgaris compared
with42 apparent healthy individuals matching in age and sex with control group. Human calprotectin level in the serum was
measured using enzyme linked immunosorbent assay (ELISA).
Results: The results showed that serum calprotectin level was higher in patients than controls but the difference was
statistically insignificant(P=0.12). However, there was statistically significant correlation between serum calprotectin level
in severe acne subtype and mild to moderate subtypes (P=0.026). The patients with acute onset had a higher serum
calprotectin level than the patients with gradual onset (P=0.42), the difference was statistically insignificant. The male acne
patients had higher statistically significant serum calprotectin level than female patients (P=0.03)
Conclusion: Serum calprotectin level was higher in patients with acne vulgaris than controls, and is positively correlated
with disease severity, therefore, might help in the evaluation of acne vulgaris severity and can help to evaluate the response
to treatment.
Keywords: Acne vulgaris, Calprotectin

plays a role in various inflammatory processes. Previously,
INTRODUCTION
calprotectin was also called calgranulin (due to its calcium
Acne vulgaris is a cutaneous chronic inflammatory
binding property and it is mostly found in granulocytes),
disease of the pilosebaceous unit affecting adolescents and
leukocyte-derived protein, cystic fibrosis antigen, and
is among the most common dermatological conditions
migration inhibitory factor-related proteins 8 and 14 (6)
worldwide. Acne is considered a chronic disease owing to
Calprotectin can be detected in many body fluids, including
its prolonged course, pattern of recurrence, relapse, and
serum, saliva, synovial fluid and feces. Serum calprotectin
manifestations such as acute outbreaks or slow onset (1).
levels increase in various cancers, inflammatory and
Acne vulgaris has a complex pathogenesis. There
autoimmune diseases (7). It plays a role in infections,
were four factors that play a vital roles in acne
leukocyte migration, and cytoskeleton regulation. In
pathophysiology,
such
as:
hyperseborrhea
and
addition, calprotectin binds to Zn2+ and Mn2+, which are
dysseborrhea, altered keratinization of the pilosebaceous
metal nutrients for bacteria, and this binding produces a
duct, Cutibacterium acnes (C. acnes) and inflammation.
direct antimicrobial effect(8).
The main hormones responsible for the development of
Calprotectin has been found to be more accurate
acne vulgaris include androgens, insulin and insulin-like
than other inflammatory markers, such as C-reactive
growth factor-1(2). The sequence in which these events
protein (CRP) and erythrocyte sedimentation rate (ESR).
occur is still not certain; inflammation has been suggested
Since calprotectin can be detected with minimal
as the initial factor. The mechanisms behind the beginning
inflammation and it normalizes prior to CRP and ESR, it
and maintenance of the inflammatory response are not fully
can be used to follow up of disease activity through the
known, but Propionibacterium (Cutibacterium) acnes plays
evaluation of treatment response or disease relapse,
an important role in these mechanisms(3). Cutibacterium
especially with autoimmune disorders (7,9).
acnes activates the innate immunity via the expression of
The aim of this study was to determine the calprotectin
protease activated receptors (PARs), tumor necrosis
serum level in acne vulgaris patients and detect the
factor (TNF)- and tolllike receptors (TLRs), which
correlation of its level with acne severity.
leads to production of interferon (INF)-, interleukins (IL

8, IL12, IL1), TNF, and matrix metalloproteinases
SUBJECTS AND METHODS
(MMPs)
by
keratinocytes,
resulting
in
the
Subjects
hyperkeratinization of the pilosebaceous unit(4,5).
Forty-two acne vulgaris patients were included in this
Calprotectin is the heterodimer form of S100A8 and
comparative case control study. All patients were
S100A9, which are members of the S100 protein family. It
collected
from
Dermatology,
Andrology
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/)
2308
Received:21 /4 /2021

Accepted:17 /6 /2021


Full Paper (vol.841 paper# 108)


c:\work\Jor\vol841_109 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2313-2322

The Role of Color Doppler Ultrasonography and Magnetic Resonance in the
Prenatal Diagnosis of Placenta Accrete
Hayam A. Abdellatif, Mona K. Alashwah, Mohamed S. Elzawawi
Department of Radio-diagnosis, Faculty of Medicine, Menoufia University, Egypt
*Correspondence author: Hayam Abdelmonsif Abdellatif, Mobile: (+20)1098057324, E-mail: hayam_drar@yahoo.com

ABSTRACT
Background:
Placenta accrete is a clinical and diagnostic challenge that is being with increasing frequency and may
lead to catastrophic blood loss and related complications. Color doppler ultrasonography and magnetic resonance
imaging are considered as specific imaging modalities and have very important role in the prenatal diagnosis of placenta
accreta. Objectives: The aim of the current work was to evaluate the diagnostic value of color doppler ultrasonography
and magnetic resonance imaging in the prenatal assessment of placenta accreta.
Patients and Methods: This study was conducted on 40 pregnant women (from 32 to 40 weeks of pregnancy) with
placenta previa and presented with manifestations of suspected placenta accreta. Their age ranged from 19 to 40 years
with mean age of 31.8 years. All cases were subjected to ultrasound examination, but MRI was done in 33 cases prior
to elective delivery. Results: Cases diagnosed of having placenta accreta were 18 out of 40 cases (45 %). Among those
18 cases; placenta found to be accreta in 6 patients, increta in 7 patients and percreta in 5 patients. Our study showed
high statistical significance between occurrence of Placenta accrete & prior uterine surgeries as a risk factor. Overall
accuracy of ultrasound was 88%, while that of MRI was 85%. Ultrasound showed better specificity (86%) than that of
MRI (81%), but MRI showed better sensitivity (92%) than that of ultrasound (89%).
Conclusion: It could be concluded that both ultrasound and magnetic resonance have fairly good sensitivity and
specificity for prenatal diagnosis of placenta accreta. Color doppler ultrasound remains the first primary screening
imaging modality used to evaluate suspected placenta accreta and MRI is suggested as an alternative complementary
tool to ultrasound in cases with inconclusive criteria.
Keywords: Accreta, Color Doppler, Placenta, Ultrasonography, Magnetic resonance.

INTRODUCTION

instrumentation, or injury involving the posterior
Placenta accreta is abnormal placental adherence
myometrium, sonographic visualization may be limited
or invasion of the myometrium or extra-uterine
by fetal position or other factors. In such cases in which
structures. It is one of the main causes of excessive
concern for possible placental invasion is raised,
postpartum hemorrhage. Placenta Accreta account for
targeted magnetic resonance imaging might be of
33­50% of all emergency peri-partum hysterectomies
benefit (5). The exact process is still unknown but is
(1). It is classified based on the depth of myometrial
probably more complicated than just abnormal
invasion. In placenta accreta vera, the mildest form, villi
decidualization of a scarred area or lack of decidua in
are attached to the myometrium but do not invade the
the lower uterine segment near the cervix. The
muscle. In placenta increta, villi partially invade the
consequences are often caesarean hysterectomy and the
myometrium. The most severe form is the placenta
end of fertility, as well as increased rates of blood loss
percreta, in which villi penetrate through the entire
and transfusion, injury to surrounding organs, and
myometrial thickness or beyond the serosa (2).
increased rates of intensive care admission when
The most common risk factors are placenta
compared with women who undergo caesarean section
previa, previous caesarean section and old maternal age.
for placenta previa alone. Forewarning and preparation,
Placenta previa has increased nowadays parallel to the
including a multidisciplinary approach, do help to
increasing cesarean delivery (3). There is an increase has
reduce morbidity (6). The aim of the present study was
also been seen in vitro fertilization pregnancies. The
to evaluate the diagnostic value of color doppler
two major diagnostic modalities used nowadays in
ultrasonography and magnetic resonance imaging in the
prenatal diagnosis are ultrasound and magnetic
prenatal assessment of placenta accreta.
resonance imaging. Ultrasound is always the first

imaging modality used to evaluate suspected placenta
PATIENTS AND METHODS
accreta. This modality has a great popularity because it
This study included a total of 40 pregnant women
is widely available, patient friendly, non-invasive, and
(from 32 to 40 weeks of pregnancy) with placenta pre-
relatively inexpensive (4). Although ultrasound remains
via and presented with manifestations of suspected pla-
the primary screening modality for the detection of
centa accreta, attending at Menoufia University Hospi-
abnormal placentation, MRI is a complementary
tals. Subject's age ranged from 19 to 40 years (mean
technique that should be considered when ultrasound is
age: 31.8 years). All cases were subjected to ultrasound
equivocal or additional information is needed for
examination. MRI was done in 33 cases prior to elective
example, in a patient with prior uterine surgery,
delivery.

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/)
2313
Received:23 /4 /2021

Accepted:19 /6 /2021


Full Paper (vol.841 paper# 109)


c:\work\Jor\vol841_110 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2323-2328

Serum Level of Calprotectin as a Potential Marker of Inflammation in
Acne Vulgaris Diagnosis and Severity Estimation
Mohammed A. Basha1, Rana G. Abdelmageed2, Noha Rabie Bayomy*1
Departments of 1Dermatology & Andrology Department and 2Medical Biochemistry & Molecular Biology,
Faculty of Medicine, Menoufia University, Shebin El Kom, Egypt.
*Corresponding author: Rana G. Abdelmageed, Mobile: (+20) 01099522518, E-Mail: ranaagaamal@gmail.com

ABSTRACT
Background:
Acne vulgaris (AV) is a common inflammatory skin disease involving dysfunction of the pilosebaceous
unit. Many mechanisms for the pathogenesis of acne have been postulated. However, the precise pathogenesis is still
uncertain.
Objective: This study aimed to measure serum calprotectin levels in AV and to correlate its level with the activity and
severity of the disease.
Patients and methods: A total of 80 subjects were subdivided into two groups; group I included 40 patients complaining
of AV with different severity levels, and group II had 40 healthy age and sexmatched participants as a control group.
Serum calprotectin level was measured in both groups by the enzymelinked immunosorbent assay (ELISA) method.
Results: Serum calprotectin concentration was statistically significantly (p=0.0001) higher in the patient group when
compared to the controls. There was a statistically significant (p = 0.001) difference among subgroups of patients
according to disease severity regarding serum calprotectin concentration. There was a high-significant positive
correlation between serum calprotectin concentration and disease severity. Calprotectin concentration could be used to
diagnose AV with cutoff points higher than 1.03 ng/ml (with 77.5% sensitivity, 80% specificity) and also can detect its
severity with cutoff points higher than 1.1 ng/ml with 96.3% sensitivity, 100% specificity to differentiate the mild cases
from moderate and severe ones.
Conclusion: Serum calprotectin concentration represents a valuable tool for diagnosing the inflammatory nature and
monitoring the disease activity in AV patients.
Keywords: Acne vulgaris, Calprotectin.

INTRODUCTION
inflammatory marker in many disorders (5). Calprotectin
Acne vulgaris is a common cutaneous chronic
subunits genes are encoded on chromosome 1q21,
inflammatory disorder with complex pathogenesis.
containing a cassette of genes known as the epidermal
Four factors play vital roles in acne pathophysiology:
differentiation complex (EDC). This complex is
androgen-induced hyper seborrhea and dysseborrhea,
involved in various biological processes, including the
altered keratinization of the pilosebaceous duct,
regulation of terminal cellular differentiation through a
cutibacterium acnes (P. acnes), and inflammation (1).
series of coordinated and interdependent signaling
The development of acne is mainly driven by increased
pathways. Moreover, it is a very sensitive diagnostic
sebum production, increased proliferation, and reduced
biomarker for many inflammatory diseases and may
desquamation of keratinocytes in the pilosebaceous
also be represented as a target of many therapies, which
unit. As sebum and keratinocytes hold together, the
may give S100A8/ A9 clinical significance in many
keratotic plug gradually forms and obstructs the
diseases (6).
pilosebaceous ducts, finally creating micro comedones
S100A8/A9 complex has a broad range of
(2). Bacterial colonization by Cutibacterium acnes
intracellular and extracellular biological functions.
aggravates the course of the disease in various manners,
Intracellular functions through the participation in
but its role as a prerequisite of the induction of acne is
cytoskeleton modulation, antibacterial activities when
disputable (3). Acne rates of prevalence in the range of
released to the extracellular space, S100A8/A9 can play
41.7% to 93.3% were reported in different countries
a crucial role in stimulating leukocyte recruitment and
with populations aged 12 to 18. Acne prevalence can
secretion of cytokines responsible for sustainment
vary from report to other because of methodological
exacerbation
of
inflammation (7).
Furthermore,
differences such as definition grading of acne and
S100A8/A9 has been demonstrated as an endogenous
population characteristics (4).
agonist of tolllike receptor 4 (TLR4). On binding to
Calprotectin is one of the family members of
TLR4 and the receptor for advanced glycation end
S100 proteins with two subunits (S100A8 and S100A9),
products (RAGE), it can mediate the extracellular
isolated primarily from granulocytes and monocytes.
functions of S100A8/A9 (8). Calprotectin is strongly
Calprotectin is released from activated neutrophils, and
expressed in infiltrating inflammatory cells, and it can
it can be identified in serum or other body fluids like
be found in almost all dermatoses associated with the
urine, feces, cerebrospinal fluid, synovial fluid, or
hyperproliferation of epithelial cells (9).
saliva. Therefore, it has been suggested to serve as an

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/)
2323
Received:24 /4 /2021

Accepted:20 /6 /2021


Full Paper (vol.841 paper# 110)


c:\work\Jor\vol841_111 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2329-2336

Relationship of Serum Total Bilirubin with Acute Coronary
Syndromes at Sohag University Hospitals
Hassan Ahmad Hassanien, Yasser Mohamed Kamal, Mohamed Hussein Ahmed, Safaa Ali Ismail
Departments of Internal Medicine, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Safaa Ali Ismail, Mobile: (+20)1124304491, E-Mail: shmb49@yahoo.com

ABSTRACT
Background:
Many evidence has documented that the development of coronary artery disease involves lipid oxidation
and formation of oxygen radicals as atherosclerosis and inflammation are associated with formation of oxygen and
peroxyl radicals. Bilirubin has proven to be a potent antioxidant under physiological conditions by inhibiting both lipid
and protein oxidation.
Objective: This study was aimed to show the relationship between serum total bilirubin and different types of acute
coronary syndromes (STEMI, Non-STEMI, unstable angina) in patients admitted at Coronary Care Unit, Sohag
University Hospital.
Patients and methods: This cross-sectional study included a total of 100 patients, 64 of them were men presented
with acute coronary syndrome, admitted at Coronary Care Unit, Sohag University Hospital. This study was conducted
between January 2020 to June 2020.
Results:
The mean age was 55.4 years; 64 (64%) were males, 44 (44%) were current smokers, 37 (37%) were HTN, 39
(39%) were DM, 71 (71%) had family history of IHD, 17 (17%) were obese. When the patients were divided into 3
groups (group A, n = 28 "28%", group B, n = 13 "13%", and group C, n = 59 "59%"). Serum total bilirubin was
significantly different (group A; Mean ± SD = 0.627 ± 0.241), (group B; Mean ± SD = 0.527 ± 0.173), (group C; Mean
± SD = 0.795 ± 0.367). "P-value = 0.007; highly significant".
Conclusions: It could be concluded that there is an inverse relation of bilirubin with acute coronary syndromes (ACS).
These strengths the fact that bilirubin acts as an antioxidant and has cardioprotective action and patients with ACS have
lower levels of bilirubin.

INTRODUCTION
lipid and protein oxidation leading to major antioxidant
It is considered that more than half of
action. As little as small level of bilirubin (10 nM), by
cardiovascular disease (CVD) will be the largest cause
rapid generation of bilirubin by biliverdin reductase, is
of death and disability by 2020. Acute coronary
found to be enough to protect cells against higher
syndrome, a common complication of coronary artery
concentration of oxidants. In addition to anti-
disease (CAD), considered the greatest proportion of
inflammatory effects of bilirubin on vasculature by
CVD (1, 2).
inhibition of vascular smooth muscle cells proliferation.
Rupture of an atherosclerotic plaque in coronary
So it is proved that bilirubin act against formation of the
artery is accused to be the cause of most cases of acute
plaque and subsequent atherosclerosis (8).
coronary syndromes (ACS), leading to formation of
Bilirubin show anti-inflammatory effects on
thrombus (3).
vasculature and inhibits proliferation of vascular
Atherosclerosis which is resulting from over
smooth muscle cells. This has led to suggestions that
balance among radical generating, compared with
mildly increased circulatory bilirubin may have a
radical scavenging systems, is called oxidative stress.
physiologic function to protect against disease
Endothelial cells could be damaged directly or
processes that involve oxygen and peroxyl radicals or
indirectly by many ways, which leads to accelerate the
vice versa and many studies have shown relation with
accumulation of atherogenic factors like LDL, leading
CAD (9, 10).
to increase the permeability of the cell (4, 5).
Reduced levels of bilirubin were noted to be
Bilirubin is the end product of heme catabolism,
associated with higher prevalence of coronary artery
which has 2 forms: indirect bilirubin (IDB) and direct
disease considered as potential risk factor marker (11).
bilirubin (DB). IDB is converted to DB in hepatic cells
This study was aimed to show the relationship
and excreted into bile (6). It was considered that bilirubin
between serum total bilirubin and different types of
is a waste product at first, bilirubin now has been known
acute coronary syndromes (STEMI, Non STEMI,
to have antioxidant and anti-inflammatory properties
unstable angina) in patients admitted at Coronary Care
based on the inhibition of endothelial adhesion
Unit of Sohag University Hospital.
molecules and antithrombotic effects (7).

As bilirubin is a waste product of the heme
PATIENT AND METHODS
oxygenase action, now considered to have strong
This cross-sectional study included a total of 100
relation with coronary artery lesion as it inhibit both
patients presented with acute coronary syndrome,

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/)
2329
Received:25 /4 /2021

Accepted:21 /6 /2021


Full Paper (vol.841 paper# 111)


Measurement of Serum Lipid Level in Children with Congenital Heart Diseases The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2337-2343

Assessment of SerumYkl-40 and High Sensitivity C-Reactive Protein as
Biomarkers of Renal Affection of Children with Type 1 Diabetes
Sabry Abdel Rahman Tolba (1) Hadeel Mohammad Abd-Elrahman(1),
Randa Hussiny Mohamed(2), and Khaled Abdulhafid Moftah Hendi(1)
Departments of 1Pediatrics and 2Medical Biochemistry, Faculty of Medicine, Zagazig University
*Corresponding author: Khaled Abdulhafid Moftah Hendi, Mobile: (+20)01013302392, E-mail: khaledhendi86@gmail.com

ABSTRACT
Background:
Diabetes describes a group of metabolic disorders characterized and identified by the presence of
hyperglycemia in the absence of treatment.
Objective: The aim of this study was early detection of renal affection in children with type 1 diabetes (T1DM) by
using serumYkl-40 and high sensitivity C-reactive protein (Hs-CRP) as biomarker.
Patients and methods: This study was a case control study carried out at Pediatric Department, in pediatric endocrine
inpatient and outpatient clinic, Zagazig University Hospitals from October 2019 to October 2020. It included 57
participants collected from Pediatric Department in Zagazig University Hospital who were divided into 3 groups; each
group included (19) patients.1st group was diabetic group with normoalbuminuria (<30 mg/g creatinine), 2nd group was
diabetic group with microalbuminuria (30-299 mg/g creatinine), and the 3rd group was healthy children.
Results :
The serumYkl-40 and Hs-CRP were good predictor markers for prediction of renal affection among children
with T1DM with (86.8% and 94.7%) ability truly diagnose renal affection, (72.0% and 84.2%) ability to exclude truly
negative ones and total (80.7% and 91.2%) accuracy for serumYkl-40 and Hs-CRP respectively.
Conclusion: YKL-40 and Hs-CRP levels could be used as tools to assess the risk of diabetic microangiopathy in the
very early stage in T1DM patients.
Keywords:
Diabetes mellitus, Diabetic nephropathy (DN), High sensitivity C-reactive protein, SerumYkl-40.

INTRODUCTION


Diabetic nephropathy (DN) is one of the most
significant positive association between YKI-40 and
important complications in patients with diabetes and
urinary albumin excretion(5,6).
most common cause of end stage renal disease (ESRD)
C-reactive protein (CRP) is acute phase
that is associated with high rates morbidity and
protein, whose production in the liver is stimulated by
mortality. Although microalbuminuria is widely used as
IL-6. These molecules are easy to detect in serum and
an early clinical marker for the detection of diabetic
are secreted in large amounts during infections. In the
nephropathy, it's limited by the fact that structural
behavioral literature, IL-6 and CRP are unanimously
damage might precede albumin excretion, this
regarded as inflammatory biomarkers, and both are
necessitates identifying better biomarkers that diagnose
commonly used to assess the presence and severity of
or predict diabetic nephropathy(1,2).
low-grade inflammation(7).
The chitinase-like protein family YKL-40, also
High sensitivity C-reactive protein (hs-CRP),
called cartilage glycoprotein-39 (HC-gp39) and chitinase
which is more sensitive than CRP, gives the
3-like-(CHI3L1). It's an inflammatory glycoprotein, its
opportunity to detect levels of 3 mg/L and less. Several
abbreviation is derived from the one letter code for the
studies demonstrated that hs-CRP was a marker
first three N-terminal amino acids, tyrosine (Y), lysine
showing low grade chronical inflammation(8).
(K), and leucine (L) and the apparent molecular weight
This study aimed to early detection of renal
of YKL-40 (40 kD) (3). It is expressed in a variety of cells
affection in children with type 1 diabetes through using
including macrophage, neutrophils and endothelial cells,
serumYkl-40
and
high
sensitivity
C-reactive
and its expression is regulated by various cytokines and
protein (Hs-CRP) as biomarker.
hormones(4).

YKL-40 has been implicated in diverse
PATIENTS AND METHODS
biological processes such as extracellular matrix
This case control study carried out from October 2019
remodeling, fibrosis, angiogenesis and inflammation,
to October 2020 in pediatric endocrine inpatient and
and elevated circulating or local tissue levels of YKL-
outpatient clinic, at Zagazig University Hospital.
40 have been observed in patients with cancers,
It included 57 children divided into 3 groups; each
cardiovascular diseases, infectious diseases, and some
group included (19) patients; 1st group was diabetic group
autoimmune diseases(3).
with normoalbuminuria (<30 mg/g creatinine) with their
Several studies reported the associations of
age ranged from (3-13), years, 2nd group was diabetic group
YKL-40 and renal diseases. Plasma YKL-40 levels
with microalbuminuria (30-299 mg/g creatinine) with their
were elevated in patients with adult type 1 or 2 diabetes
age ranged from (3-14) years and the 3rd group was control
compared with normal controls and there was a
group with their age ranged from (3.5-13) years.

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/)


2337
Received: 22/4/2021

Accepted: 18/6/2021


Full Paper (vol.841 paper# 112)


c:\work\Jor\vol841_113 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2344-2349

Endoscopic Versus Microscopic Canal Wall Up Surgery for Cholesteatoma:
A Diffusion-Weighted Magnetic Resonance Imaging Post-Operative Study
Mohamed Kamal Mobashir1, Atef Hamed Ali1, Mostafa Hasan Hassan1,
Inas Mohamed Abdel-Aziz El Fiki2, Ahmed Nagy Hadhoud*1, Mohammed Elsayed Elmaghawry3
Departments of 1Otorhinolaryngology, 2Radiology, Faculty of Medicine Zagazig University, Egypt
3 Fellow of Otorhinolaryngology, Zagazig University Hospitals, Egypt
*Corresponding Author: Ahmed Nagy Hadhoud, Mobile: (+20)1006708797, E-mail: A7me_ed@hotmail.com

ABSTRACT
Background:
Cholesteatoma is a surgical disease for which the primary universally accepted goal is total eradication
of cholesteatoma to obtain a safe and dry ear. The second objective is restoration or maintaining the hearing.
Objective: This study was aimed to solve the problem of residual cholesteatoma and decrease the problem of large
mastoid cavities and to increase the learning curve of endoscopic ear surgery.
Patients and Methods: non-randomized controlled trial study performed in Otolaryngology, Head and Neck Surgery
Departments, Zagazig University Hospitals in the period from February 2018 to February 2021 on 30 patients suffering
from middle ear cholesteatoma. Otoendoscopic evaluation were used for detection of the presence of attic perforation,
posterosuperior perforation, aural polyps and, whitish shadow behind intact tympanic membrane. All patients were
operated under general anesthesia with controlled hypotensive technique.
Results: After 1 year of follow-up in 15 patients using endoscopic approach and 15 patients using microscopic
approach, the recidivistic cholesteatoma was found in 6.7% in endoscopic group while it was 20% in microscopic group.
Conclusions: It could be concluded that the use of an endoscope provided important benefits to patients with middle
ear cholesteatoma and offer superior visualization than microscope.
Keywords: Endoscopic, Cholesteatoma, Microscopic, Ear surgery

INTRODUCTION

asgranulation tissue and mucosal reactions in the middle
Residual cholesteatoma, in which uncleared
ear and mastoid. One of the greatest challenges in the
remnants of keratinizing squamous epithelium survive
past decade has been the question whether MRI could
after incomplete surgical clearance occurs in as many as
replace second look surgery (7,8).
35% of patients(1). Canal wall down surgery exenterates
The aim of the current work was to solve the problem of
potential hidden places for matrix remnants, but residual
residual cholesteatoma and decrease the problem of large
disease still occur, in several reputable series as
mastoid cavities and to increase the learning curve of
frequently as with intact canal wall surgery. Removal of
endoscopic ear surgery.
the canal wall therefore does not seem justifiable for the

PATIENTS AND METHODS

prevention of residual disease, pose a life-long burden
This non-randomized controlled trial study
and poor hearing outcomes. Intact canal wall can lead to
included a total of 30 patients suffering from middle ear
conditions favorable to the introduction of the water into
cholesteatoma, unilateral or bilateral disease, attending
the external auditory meatus, and primary ossicular chain
at Otolaryngology, Head and Neck Surgery
reconstruction (2,3).Since the introduction operative
Departments, Zagazig University Hospitals. This study
endoscopy in the 1990s, the concept of a minimally
was conducted between February 2018 to February
invasive approach in middle ear surgery is changing.
2021.
Endoscopic middle ear surgery can offer some
Ethical Consideration:
advantages compared to the traditional microscopic
Written Informed consent was taken from the
technique, guaranteeing excellent visualization of
patient to participate in the study. Approval for
mesotympanic structures, direct visual control of hidden
performing the study was obtained from
areas
such
as
anterior
epitympanic
spaces,
Otorhinolaryngology
Departments,
Zagazig
retrotympanum, protympanum (4).
University Hospitals after taking Institutional Review
Use of endoscope during cholesteatoma surgery
Board (IRB) approval. The work has been carried out
should allow for more frequent preservation of the
in accordance with the code of ethics of the world
posterior canal wall, as well as lower rates of residual
medical association (Decleration of Helsinki) for
cholesteatoma and thus less need for second-look
studies involving humans.
operations for residual (5).
. Patients were 18 male and 12 female, their ages
Non-echo planar (non-EPI) diffusion-weighted
ranged from 11 to 56 years with mean age (30.9 ± 9.7).
(DW) magnetic resonance imaging (MRI) can accurately
They underwent endoscopic ear surgery (Group A) 15
predict the presence and extent of cholesteatoma in both
cases and microscopic ear surgery (Group B) 15 cases.
primary and residual cases (6). Non-EPI DW MRI can
distinguish
cholesteatoma
from
other
tissues

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/)
2344
Received: 24/4/2021

Accepted: 20/6/2021


Full Paper (vol.841 paper# 113)


c:\work\Jor\vol841_114 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2350-2356
Role of CD319 Expression as A Diagnostic and Prognostic Marker in
Plasma Cell Myeloma Patients
Saad Sabry El-Osh1, Ayman Fathy Abd El-Halim2,
Shaimaa Saeed Ibrahim*1, Heba Allah Elsayed Abd El-Rhman1
Departments of 1Clinical and Chemical Pathology and 2Internal Medicine,
Hematology Unit, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Shaimaa Saeed Ibrahim, Mobile: (+20)01006205976, Email: shaimaa.saeed39@yahoo.com

ABSTRACT
Background:
The surface antigen CD319 (SLAMF7) is a marker of normal and malignant plasma cells in plasma
cell myeloma. In view of the potential therapeutic use of SLAMF7targeting antibodies, such as elotuzumab, the
detection of SLAMF7 expression levels on abnormal plasma cells might play an important role in the evaluation of
therapy responses. Objective: This study aimed to evaluate role of CD319 marker in diagnosis and prognosis of
plasma cell myeloma patients. Patients and Methods: The study was Cohort study conducted on newly diagnosed
plasma cell myeloma patients in Clinical Pathology Department and Internal Medicine Department-Hematology Unit
at Zagazig University Hospitals in period between February 2019 and February 2021. It included 18 cases diagnosed
according to clinical, pathological, morphological and immunophenotypic criteria. Follow up of patients was carried
out after 3 months of initiation of treatment to assess response to therapy. Results: This study showed that CD319
(SLAMF7, CRACC, CS1) is a stable marker with high expression mean fluorescence intensity (MFI) on normal and
malignant plasma cells. In this study, CD319 is found positive in all plasma cell myeloma (PCM) patients. Low
expression of CD319 (if MFI below 128.3) was associated with a significant better response to treatment and good
prognosis but high expression of CD319 was accompanied by bad response to treatment. It can be effectively used
as a diagnostic and prognostic marker for PCM.
Conclusion: CD319 is found positive in all PCM patients. It can be effectively used as a diagnostic marker for PCM.
Low expression of CD319 is associated with a significant better response to treatment and good prognosis. This
indicates importance of CD319 as a prognostic marker of PCM.
Keywords:
Bone marrow aspiration, CD319, Flow cytometry, Plasma cell myeloma.

INTRODUCTION


Plasma cell myeloma (PCM) is a bone marrow-
addition to PCs, SLAMF7 expression is found on other
based multifocal neoplastic proliferation of plasma
immune cells such as NK cells, NKlike Tcells, and
cells, usually associated with an M protein in serum
CD8+ Tcells. In contrast to CD138 (the traditional
with evidence of organ damage related to the plasma
plasma cell marker), CD319/SLAMF7 is much more
cell neoplasm. It is associated with significant
stable and allows proper isolation of malignant plasma
morbidity due to its end-organ destruction. The disease
cells from delayed or even cryopreserved samples(3). So
spans a clinical spectrum from asymptomatic to
CD319 expression (SLAMF7) plays an important role
aggressive forms due to deposition of abnormal
in diagnosis of plasma cell myeloma. In view of the
immunoglobulin chain in the tissues. The diagnosis of
potential therapeutic use of SLAMF7targeting
plasma cell myeloma is based on a combination of
antibodies, such as elotuzumab, the detection of
pathological, radiological and clinical features(1).
SLAMF7 expression levels on abnormal plasma cells
PCM comprise about 1% of malignant tumors, 10-
might play an important role in the evaluation of
15 % of hematopoietic neoplasms, and 20 % of deaths
therapy responses.
from hematological malignancies. It is more common
This study aimed to evaluate role of CD319
in men than in women, with a male to female ratio of
marker in diagnosis and prognosis of plasma cell
1.1: 1. The incidence of plasma cell myeloma increases
myeloma patients and to correlate between CD319
progressively with patient age thereafter, with about
marker and response to therapy.
90% of cases occurring in patient aged more than 50

years, with the median age at diagnosis is 70 years(2).
PATIENTS AND METHODS
CD319 marker, known as SLAM (Signaling
This study was carried out at Clinical Pathology
lymphocytic activation molecule) family member 7, is
Department and Internal Medicine Department-
a protein that found in humans encoded by
Hematology Unit at Zagazig University Hospitals.
the SLAMF7 gene. It is located on chromosome 1 on
It included 18 cases (11 males and 7 females)
long arm (1q23.3). It is a marker of normal and
with a male to female ratio of 1.5:1. Mean age of cases
malignant plasma cells in plasma cell myeloma. In
was 53 ± 9.8 years.


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/)
2350
Received:23 /4 /2021

Accepted:18 /6 /2021


Full Paper (vol.841 paper# 114)


c:\work\Jor\vol841_115 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2357-2360

Serological Study of Infection with the Chlamydia - Like Microorganism
'Simkania Negevensis' in Patients Undergoing Hemodialysis
George Emad Shaker1, Rehab Ahmed Rabie2, Ahmed Abo El-Makarem Hosny1,
Heba Shafeak Abd El Khalik1
Departments of 1Internal Medicine and 2Medical Microbiology and Immunology,
Faculty of Medicine, Zagazig University, Egypt.
*Corresponding Author: Ahmed Abo El-Makarem Hosny, Mobile: (+20)01064448323,
Email: Ak6457113@gmail.com

ABSTRACT
Background:
Infection is a common complication of hemodialytic treatment. Many of these infections are due to
sepsis, primarily arising from the vascular access site. Simkania negevensis (S. negevensis) is an obligate
intracellular bacterium belonging to the family Simkaniaceae in the Chlamydial order, which is able to survive and
grow as an amoeba resisting microorganism in trophozoites and cysts of Acanthamoeba and other free-living
protozoa, which probably represent its natural reservoirs.
Objective: The study aimed to early diagnose and minimize the risks of Simkania negevensis infection in
hemodialysis patients.
Patients and Methods:
This cross-sectional study was performed on 78 hemodialysis patients, and they were treated
with regular hemodialysis. Patients were subjected to the following: complete history taking, full clinical assessment,
laboratory investigation (complete blood count, measurement of serum IgG antibody against S. negevensis in
hemodialysis patients and water samples were collected from hemodialysis circuits for detection of the occurrence
of S. negevensis infection).
Results:
There was no significant difference in the age and gender between the patients undergoing hemodialysis
with negative water samples for Simkania compared to hemodialysis with positive water for S. negevensis.
Regarding hypertension (HTN) and diabetes mellitus (DM), there was no significant difference between the patients
undergoing hemodialysis with negative water samples for Simkania compared to hemodialysis with positive water
for S. negevensis. IgG levels are significantly higher in patients during hemodialysis when the water samples were
positive for Simkania.
Conclusion: Our study detected the occurrence of S. negevensis in hemodialysis patients. When the patients were
undergoing hemodialysis with positive water for Simkania, we detected significant rise of IgG antibodies against S.
negevensis. Significant area under curve with significant cutoff >6.1 for IgG with sensitivity 73.3% and specificity
80.0%.
Keywords: Hemodialysis, Serological Study, Simkania Negevensis.

INTRODUCTION

free-living amoebae such as Acanthamoeba is found
Chronic kidney disease (CKD) has been
in many water sources, it may be the natural source of
recognized as a worldwide public health problem, and
transmission of S. negevensis to man.
the associated morbidity and mortality in patients
Widespread human exposure to S. negevensis has
reaching end-stage renal disease (ESRD) is constantly
been reported in healthy subjects and in association
increasing. Infection is a common complication of
with bronchiolitis in infants, both as community-
hemodialytic treatment. It has been identified as the
acquired pneumonia and as an acute exacerbation of
second cause of death among hemodialysis (HD)
chronic obstructive pulmonary disease in adults. As
patients. Hospitalization for infection in the HD
suggested, it is possible that S. negevensis infection
population has increased in the last decades (1).
may persist for a prolonged time in infected cells.
Many of these infections are due to sepsis,
Such persistence in respiratory or genital tracts could
primarily arising from the vascular access site.
be associated with chronic inflammation, which may
Simkania negevensis (S. negevensis) is an obligate
lead to scarring as described for C. Trachomatis (3).
intracellular bacterium belonging to the family
The seropositivity to S. negevensis in healthy
Simkaniaceae in the Chlamydial order, able to survive
population groups suggest that the organism is a
and grow as an amoeba resisting microorganism in
simple colonizer (4).
trophozoites and cysts of Acanthamoeba and other
Angeletti et al. (5) examined the occurrence of S.
free-living protozoa, which probably represent its
negevensis in two HD population, characterized by
natural reservoirs. S. negevensis was first defined in
high susceptibility to infectious complications. They
1993 (2). It was found that not only the organism was
detected for the first time the occurrence of S.
able to replicate in Acanthamoeba, but it was also able
negevensis in hemodialysis and suggested that water
to survive over long periods in amoeba cysts. Since
used in hemodialysis could be one of the possible

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/)
2357
Received:22 /4 /2021

Accepted:18 /6 /2021


Full Paper (vol.841 paper# 115)


c:\work\Jor\vol841_116 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2361-2365

Using Ultrasound for Pregnancy Failure in Patients with
1st Trimester Recurrent Pregnancy Loss
Abdelhaseib salah Saad1, Zakaria Fouad Sanad1, Ahmed Hammouda Hossameldin2, Dalia Ibrahim1
1Obstetrics and Gynecology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2Obstetrics and Gynecology Department, Rashid General Hospital, Al Behera, Egypt
*Corresponding author: Ahmed H. Hossameldin, Mobile: +201005440517, E-mail: docahmedhamoda@gmail.com

ABSTRACT
Background:
Pregnancy loss is the interruption and/or termination of pregnancy, either spontaneously or intentionally,
before the fetus develops sufficiently to survive. About 80% of abortions occur in the first 12 weeks of pregnancy.
Objective: To determine the accuracy of U/S parameters in predicting early pregnancy failure in pregnant with history
of 1st trimesteric recurrent pregnancy loss.
Patients and methods: This was a prospective study that included 120 pregnant females with history of first trimesteric
recurrent pregnancy loss. It was conducted in Obstetrics and Gynecology Department, Menoufia University Hospitals,
and Rashid General Hospital, Al-Bahira, Egypt during the period from April 2019 until August 2020.
Results: There is no significant difference between miscarriage group and ongoing pregnancy group regarding risk
factors and demographic data (p > 0.05). In addition, crown-rump length (CRL) below 5th percentile for gestational age
(GA) category more significantly prevalent in the miscarriage group compared to the ongoing pregnancy group. While,
mean gestational sac diameter (MGSD) below 5th percentile for GA, caudal displacement of gestational sac (GS) or
irregular GS could predict subsequent miscarriage. Embryonic heart rate/Fetal heart rate (EHR/FHR) below 5th
percentile for GA was statistically significantly more prevalent in the miscarriage group than in ongoing pregnancy
group. Abnormally large YSD (> 95th percentile for GA), absent yolk sac (YS), floating YS, deformed, irregular or
hypo-echoic YS could predict subsequent miscarriage. Uterine artery resistance index (RI), pulsatile index (PI) and
systolic/diastolic (S/D) ratio did not differ significantly between the miscarriage group compared to the ongoing
pregnancy group across the various gestational ages.
Conclusion: 1st trimester U/S parameters are useful diagnostic tool to prognosis pregnancy outcome among patients
with history of recurrent 1st trimester pregnancy loss.
Keywords: aborted cases, miscarriage, ongoing pregnancy, pregnancy outcome, ultrasonographic predictor, 1st
trimesteric pregnancy.

INTRODUCTION

woman with 2 consecutive or 3 non-consecutive
Recurrent pregnancy loss (RPL) also known as
miscarriages. For an aneuploidy fetus, no further
recurrent miscarriage or habitual abortion is defined as
evaluation of couple is required and pre-implantation
three or more consecutive pregnancy losses prior to 24
genetic diagnosis may be attempted in future
weeks gestational age from the last menstrual period (1).
pregnancies (4). Empirical treatment in women with
American Society of Reproductive Medicine and
unexplained recurrent miscarriage is superfluous and
European Society for Human Reproduction and
should be avoided. Rather, there is a need of focus on
Embryology defined RPL as two or more clinical and
pre-conceptional prophylactic folic acid, correction of
consecutive pregnancy losses, ectopic and molar
hormonal imbalance, any preexisting genital infection
pregnancies being excluded. However, RPL is to be
and correctable structural defect in the reproductive
considered after two or more failed pregnancies, which
tract (5). Stress reduction and lifestyle modification like
have a radiological or histopathological documentation.
curtailing use of tobacco, alcohol, and illicit drugs must
Some investigation must be done after each pregnancy
be emphasized as these factors may also contribute and
loss with a comprehensive evaluation to be done after
hamper a successful pregnancy outcome (6).
three or more losses. 80.0% of miscarriages occurs early
Ultrasound has its profound influence on the
in pregnancy (in the first trimester) and the rate
practice of medicine, either in obstetrics or in
decreases with advancement of gestational age (2).
gynecology. The invention of transvaginal ultrasound
Fetal chromosomal aberrations are the most
(TVUS) has markedly enhanced the assessment of early
frequent cause of first trimester abortion, but possibility
pregnancy in cases of threatened abortion. The rate of
of abortion due to fetal aneuploidy decreases with
fetal loss is about 15% in females with threatened
subsequent pregnancy losses. A structural chromosomal
abortion and a living baby in first trimester. The use of
defect, usually a balanced translocation is found in
color Doppler is beneficial in assessing abnormalities.
either of the spouse in 2­5% couples with RPL (3).
Ultrasound checkup has become the "gold standard" in
American College of Obstetrics and Gynecology
assessment and follow-up of pregnancy and the
recommends karyotyping of products of conception in
development of complications in early pregnancy.
Ultrasonographic findings such as irregular wall of

This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2361
Received: 25/4/2021

Accepted:21/6/2021


Full Paper (vol.841 paper# 116)


c:\work\Jor\vol841_117 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2366-2371

Transcranial Doppler Assessment of Cerebrovascular Reactivity in
Migraine Patients
Sawsan Abdel Aziz Yousef, Magdy Abdel Hameed Aidaros,
Muhammad Salah El Sayed, Abdelrahman Ahmed Fahmy
Neurology Department, Faculty of Medicine, Zagazeg University, Zagazeg, Egypt.
Corresponding Author: Muhammad Salah El Sayed, Mobile: (+20)01118613036, E-mail: m.s.ngu@hotmail.com

ABSTRACT
Background:
Migraine is considered as a neurovascular coupling disorder where the cerebral vascular reactivity is
malfunctioning and measuring hemodynamic changes during migraine without causing more disturbances has
always been a challenge. Objective: This study aimed to detect the role of transcranial Doppler ultrasound in
assessing the vasomotor reactivity of cerebral blood vessels in migraine patients. Patients and Methods: This case
control study included thirty-two migraine patients and thirty-two healthy individuals that were recruited from
Neurology Department at Zagazig University Hospital and Neuropsychiatry Department at El-Sahel Teaching
Hospital Outpatient Clinics during the period from April to December 2020. We performed Transcranial Doppler
(TCD) on all participants and Breath Holding Index (BHI) was measured on both sides from the middle cerebral
artery (MCA). Results: There was a significant decrease in breath holding index in patients of migraine. There was
a statistical significance decrease in BHI and Maximum flow velocity in the left MCA (Max. FV Lt MCA) among
severe patients compared to moderate patients. Conclusion: Migraineurs have significantly lower BHI compared to
control group. The noninvasiveness of TCD and the possibility it provides for obtaining instantaneous information
about cerebral blood flow changes indicates its usefulness in the study of vascular changes in different types of
migraine.
Keywords: Cerebrovascular Reactivity, Migraine, Transcranial Doppler, Ultrasound.


INTRODUCTION

Migraine is a common, chronic, multifactorial
response to cerebral blood flow changes is used to
neurovascular disorder typically characterized by
calculate the breath holding index, and the
recurrent attacks of disabling headache and autonomic
cerebrovascular response capacity is then estimated.
nervous system dysfunction. Migraine is a painful and
Physiological changes in systemic perfusion pressure
disabling disorder that imposes substantial burden on
are compensated by cerebrovascular autoregulation.
individual sufferers and society as a whole(1).
Vasomotor reactivity indicates the dilatation potential
Multiple hypotheses have been suggested to
of a vessel, and it is closely related to autoregulation.
explain the pathogenesis of migraine, yet it remains
In some conditions, vasomotor reactivity has the
not well understood. Substantial data support the
potential to keep cerebral blood flow stable, lower, or
vascular hypothesis of migraine pathogenesis. The
increase it(3).
aura phase of the migraine is caused by
This study was performed to the role of
vasoconstriction in the intracranial vessels, while
transcranial Doppler ultrasound in assessing the
vasodilatation is likely the cause of the headache
vasomotor reactivity of cerebral blood vessels in
phase(2). Impulses originating from neural structures,
migraine patients.
such as the trigeminal nucleus, might lead to vascular

phenomena by modifying the excitability potential of
PATIENTS AND METHODS
the vascular structures(3).
This case-control study was carried out in
The evolution of the pulsed Doppler technique
Neurology Department at Zagazig University Hospital
has resulted in TCD device which offers a non-
and Neuropsychiatry Department at El-Sahel
invasive and relatively easy tool for the determination
Teaching Hospital Outpatient Clinics during the
of blood flow velocities as a representation of flow in
period from April to December 2020. The patients
intracranial
vessels(4).
Transcranial
Doppler
studied were 32 migraine patients diagnosed
ultrasound is a sensitive real-time tool that is used for
according to International Classification of Headache
monitoring cerebral blood flow velocity. Immediate
Disorders diagnostic criteria for migraine; 9 males
responses can be tracked using this tool, and, thus,
(28.1%) and 23 females (71.8%), with ages ranging
hemodynamic changes are evaluated accordingly.
from 18- 45 years and mean age of 29.4 years. Of
Cerebrovascular reactivity can be evaluated using the
those 26 patients were diagnosed with migraine
breath holding test. Human brain has the ability to
without aura (81.25%) and 6 patients (18.75%) were
regulate blood flow by changing the size of its small
diagnosed with migraine with aura. The control group
arteries and capillaries to meet its regional oxygen and
contains 32 healthy individuals matched for age and
glucose needs. The amount of CO2 accumulated as a
gender; 12 males (37.5%) and 20 females (62.5%),

This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2366
Received:24 /4 /2021

Accepted:20 /6 /2021


Full Paper (vol.841 paper# 117)


Measurement of Serum Lipid Level in Children with Congenital Heart Diseases The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2372-2377

Evaluation of Platelet Indices as Early Markers for
Diagnosis of Neonatal Sepsis
Wafaa Fathy Elsaaed1, Asmaa Mohamed Hosny Esh2,
Abdulfatah Faraj Bin Aeshah1, Mohamed Ahmed Arafa1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University, Zagazig, Egypt
*Corresponding author: Abdulfatah Faraj Bin Aeshah, Mobile: (+20)01554929859, E-mail: fattahbenaisha@gmail.com

ABSTRACT
Background:
Neonatal septicemia is a clinical syndrome characterized by signs and symptoms of infection with or
without accompanying bacteremia in the first month of life. Sepsis is a common complication in the neonatal
intensive care unit. It is caused by various organisms invading the blood stream, which may be by bacterial, viral,
fungal and protozoal infections.
Objective: The aim of this study was to diagnose neonatal sepsis early in order to reduce morbidity and mortality
of newborn.
Patients and methods: This study was a case-control study that included 132 participants divided into two groups,
each group included 66 patients. 1st group included neonatal sepsis and 2nd group was control group without sepsis.
They were admitted at Neonatal Unit of Pediatric Department at Zagazig University Hospitals during the period
from 11/2019 to 11/2020. Investigations done for all these neonates, and included complete blood count [PLT, PDW,
MPV and Platelet-large cell ratio (P-LCR)], CRP, ESR, blood culture, urine culture and chest x-ray.
Results:
There was statistically significant difference between the septic cases and control group regarding platelets
distribution width (PDW) where 87.9% of the septic cases had elevated PDW while 45.5% of control group had elevated
PDW. There was statistically significant negative correlation between platelets count with CRP, platelets distribution width,
mean platelet volume and P-LCR (increased platelets count is associated with decrease in CRP, platelets distribution width,
mean platelet volume and P-LCR) among the control group.
Conclusion: Platelet indices, as part of a routine automated cell count, are cheap and readily available tests that can
be used as valuable clues in the diagnosis of neonatal sepsis.
Keywords:
Mean platelets volume (MPW), Neonatal sepsis, Platelet distribution width (PDW).

INTRODUCTION


Neonatal sepsis is an important cause of neonatal
Thrombosis takes place at later stages and
morbidity and mortality worldwide. However, it is a
stimulation of plasminogen and activation of
diagnostic challenge as there is overlapping signs and
antithrombin occurs in fibrinolytic system (5).
symptoms which preclude a specific diagnosis of
Moreover, bacteria or its products may cause damage
sepsis. So, we have to rely on investigations to guide
to endothelial leading to platelet adhesion and
us. Blood culture has always been the gold standard
aggregation or may bind directly to platelets leading
for the diagnosis of neonatal sepsis. It has been noted
to aggregation and expedited elimination from blood
that only 20% of symptomatic neonates with
circulation (6). Group B Streptococcus, Escherichia
suspected early-onset sepsis (EOS) have a positive
coli,
coagulase-negative
Staphylococcus,
blood culture, and only 30% neonates clinically
Staphylococcus aureus, Klebsiella, Pseudomonas and
suspected to have late-onset sepsis (LOS) in neonatal
Enterobacter are the most common cause of neonatal
intensive care unit (NICU) setting have a positive
sepsis(7).
blood culture (1).
Platelet distribution width (PDW) is an indicator
According to the age, neonatal sepsis is divided
of variation in platelet size. Normal ranges of PDW
into early-onset sepsis ( 3 days of birth) and late
are between 10% and 17%. The PDW levels increases
onset sepsis (After 3 days). The early-onset sepsis
in platelet consumption when turnover is increased,
usually results from organisms acquired intrapartum,
and behavior similar to MPV during acute severe
but late-onset sepsis is usually acquired from the
infections. Platelet-large cell ratio (P-LCR) indicates
environment (3). Neonatal sepsis occurs in one to four
the proportion of platelets greater than 12 fL and the
cases per 1000 live births in the developed countries,
normal range is below 30 percent in the total platelet
while it has been 10 times greater in many developing
count.
countries(4).
These indices can be measured by an
Almost all body systems and organs including
inexpensive and readily available routine blood count
haemostatic system can be affected by sepsis. In this
(8). This study aimed to early diagnose neonatal sepsis
situation, clotting cascades do not function. Many
to reduce morbidity and mortality of newborn.
inflammatory cytokines are released from endothelial

and mononuclear cells.

This art
icle 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/)

2372
Received:26 /4 /2021

Accepted:22 /6 /2021


Full Paper (vol.841 paper# 118)


c:\work\Jor\vol841_119 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2378-2382
Perineal Body Length as a Predictor of Labor Progress
Ali El-Shabrawy Ali, Waleed Abdallah Abdel-Salam, Ahmed Mohamed El-Sayed Abdallah,
Alaa Eldin Abdelsalam Ahmed, Mostafa Abdo Ahmed
Department of Obstetrics & Gynecology, Faculty of Medicine ­ Zagazig University, Egypt.
Corresponding Author: Ahmed Mohamed El-Sayed Abdallah, Mobile: (+20) 01000262668,
Email: Elmodeer90@icloud.com

ABSTRACT
Background:
Trauma to the genital tract does occur in about two thirds of women during the first and subsequent
deliveries and the majority of these traumas require suturing. There is a continuous inverse relationship between the rate
of episiotomy and the rate of spontaneous trauma. Perineal trauma is associated with a high prevalence of certain health
problems. Perineal pain is the most significant with its impact on daily activities.
Objective: The aim was to assess the relationship between the length of perineal body and mode of delivery, need for
episiotomy and possibility of perineal and vaginal tears needing repair.
Patients and Methods:
This study was conducted at Maternity Hospital, Faculty of Medicine, Zagazig University. All
patients were subjected to the following: Complete history taking, complete general examination and antenatal care.
Procedure: The perineum was measured as the distance from the fourchette (the mid-point of the posterior edge of the
vaginal interoitus at the muco-cutaneous junction) to the center of the anal orifice. Measurement was performed by
trained research nurses using standard tape in dorsal lithotomy position.
Results:
This study showed that perineal tear, was present among 32.6% of the studied group. This study showed that
need for episiotomy was 78.3%. The percentage of perineal tear was statistically lower among cases with perineal length
> 4 cm than cases with perineal length < 4 cm (5.9% and 48.3%). The percentage for need of episiotomy was statistically
lower among cases with perineal length > 4 cm than cases with perineal length < 4 cm (64.7% and 86.2%). Women with
shortened perineal body length (< 4 cm) had a higher chance of a perineal laceration.
Conclusion:
Longer perineum is associated with increase in the duration of the second stage of labor. The incidence of
episiotomy and perineal tears were increased in patients with a perineal length of <4 cm.
Keywords: Perineal body length, Episiotomy, Perineal tears.

INTRODUCTION
importance in the diagnosis and classification of pelvic
Trauma to the genital tract does occur in about two
organ prolapse has been appreciated near the end of the
thirds of women during the first and subsequent
20th century. Objective measurements of the perineum
deliveries and the majority of these traumas require
have been included by the International Continence
suturing. There is a continuous inverse relationship
Society (ICS) in its new standardized terminology of
between the rate of episiotomy and the rate of
pelvic organ prolapse and pelvic floor dysfunction. The
spontaneous trauma. Perineal trauma is associated with
length of the perineum, however, was first cited in the
a high prevalence of certain health problems. Perineal
literature as a cause of traumatic vaginal delivery by
pain is the most significant with its impact on daily
Nicholas and Randall (2).
activities. Additional health issues, like blood loss,
Vaginal birth has been associated with pelvic floor
bowel and urinary dysfunction, sexual problems, fatigue
dysfunction. Past studies indicating that maternal
and depression have been also reported. The severity of
expulsive efforts and perineal trauma are risk factors for
postnatal perineal pain is directly related to the degree
postpartum pelvic floor disorders. Perineal and introital
and complexity of the genital tract injury sustained.
stretch in the second stage is thought to contribute to
Episiotomy is usually performed for the sake of
pelvic floor muscle damage. However, with the
protection against these complications. Nevertheless, it
exception of overt levator damage and third and fourth
is not allowed to do this protection. Episiotomy by itself
degree perineal lacerations, the relationship of perineal
represents a trauma and its suturing may convey more
injury to postpartum pelvic floor dysfunction has not
pain to the new mothers. Meta-analysis of data from six
been consistently demonstrated (3, 4).
randomized controlled trials recommended that
Rizk and Thomas (5) were the first to study the
episiotomy should not be a routine practice and its use
effect of perineal length and anal position on vaginal
should be restricted to certain specific fetal and maternal
delivery in 212 primigravidae with singleton term
indications (1).
pregnancy. They reported that the incidence of
However, these indications have not yet been
episiotomy, perineal tears and instrumental delivery
clearly specified. Perineum is the fibro-muscular
were increased in patients with a perineal length to what
structures which are situated between the vaginal orifice
extent having scared lesions of FGC that affect the
and the anus. The functional importance of the perineum
process of labor, which is not much studied. WHO Study
has been largely neglected by the clinicians, however its
Group on Female Genital Mutilation and Obstetric

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/)
2378
Received:25 /4 /2021

Accepted:2 /6 /2021


Full Paper (vol.841 paper# 119)


c:\work\Jor\vol841_120 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2383-2386

Coronary Sinus Filling Time in Patients with Angina and
Normal Coronary Angiography in Zagazig University Hospitals
Mohammad Elsayed Mohammad Ibrahim, Tarek Ahmed Naguib, Tamer M Mostafa, Hisham Samir Roshdy
Cardiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
*Corresponding author: Mohammad Elsayed Mohammad Ibrahim, Mobile: (002) 010 07912660,
E-mail: dr.mohamed.hadhoud.2020@gmail.com

ABSTRACT
Background:
Dysfunction of the coronary microcirculation may be one of the factors responsible for persistent
anginal symptoms. Noninvasive as well as invasive modes for assessing microcirculation have yielded inconsistent
results. Aim of work: To determine the usefulness of coronary sinus filling time (CSFT) for assessment of
microcirculatory transit time in the coronary circulation.
Subjects and methods: A case-control study carried out in the Cardiology Department, Zagazig University Hospital
on 57 patients divided into three groups: Group A included diabetics with angina, Group B included non-diabetics
with angina, and Group C included control group. All patients were subjected to complete history taking, general
examination and local cardiac examination. 12 Lead ECG, stress ECG (treadmill test), transthoracic echocardiography
and coronary angiography were done.
Results: regarding CSFT in group A the mean was 5.247 ± 0.562, in group B the mean was 4.635 ± 0.224 sec and in
group C the mean was 3.295 ± 0.525 sec. There were significant difference between group A and control group (P <
0.001), between group B and control group (P < 0.001) and between group A and group B (P < 0.001). There were
statistically significant relation between prolongation of coronary sinus filling time and presence of comorbid
hypertension (P < 0.001), dyslipidemia (P < 0.05), Family History of CAD (P < 0.001) and obesity (P < 0.05).
Conclusion: The coronary sinus filling time is a useful method for assessment of microcirculatory transit time in the
coronary circulation. The prolongation of coronary sinus filling time is significantly associated with the presence of
diabetes mellitus.
Keywords: CSFT, Coronary, Angiography, Cardiology.

INTRODUCTION

SUBJECTS AND METHODS
Normal epicardial coronary arteries are found in
A case-control study carried out in the Cardiology
20% of all diagnostic angiograms done for persons
Department, Zagazig University Hospital on 57
with chest pain. A heterogeneous group of patients
patients divided into three groups: Group A included
with typical angina, a positive exercise stress test,
diabetics with angina, Group B included non-diabetics
intact epicardial coronaries without a proof of
with angina and Group C included control group.
epicardial coronary artery spasm either clinically or
Inclusion criteria: Patients with typical angina with
angiographically represent Syndrome X [1].
risk factors, normal ECG, positive stress ECG, and
One of the causes of recurrent anginal problems
apparently normal coronaries.
and inappropriate stress tests could be a problem with
the coronary circulation. The prognosis for these cases
Exclusion criteria: Patients with abnormal coronaries
may not be as good as initial cohort research shows.
on angiography, current or prior cardiovascular events
There have been findings that indicate a higher risk of
or presence of any cardiac diseases other than
cardiovascular events and cardiac mortality in
permitted in control group. The control group
cases that have a positive stress test [2].
consisted of patients referred for preoperative coronary
The Women Ischemic Symptom Evaluation
angiography for mitral valve replacement surgery not
(WISE) trial found that persistent signs are linked to a
including patients with moderate to severe pulmonary
rise in the incidence of cardiac problems, leading to the
hypertension, more than mild tricuspid regurge and left
recommendation that those patients must do vascular
ventricular hypertrophy. The control group should
function testing and continuous risk factor assessment
have no significant epicardial coronary abnormality in
[3]. Noninvasive and invasive methods for measuring
coronary angiography.
microcirculation have shown mixed results, and there
All patients were subjected to complete history
is currently no clear procedure for coronary
taking, general examination and local cardiac
microcirculation evaluation [4]. The aim of the present
examination. 12 Lead ECG, stress ECG (treadmill
study was to determinate the usefulness of coronary
test), transthoracic echocardiography and coronary
sinus filling time (CSFT) for assessment of
angiography were done. Coronary angiogram was
microcirculatory transit time in the coronary
done with Philips Allura Xper FD20 at a rate of 15
circulation.
frames/s. Left coronary artery injection was taken with


This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2383
Received:26 /4 /2021

Accepted:22 /6 /2021


Full Paper (vol.841 paper# 120)


c:\work\Jor\vol841_121 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2387-2390

Role of Serum Prolactin as A Cardiovascular Risk in Type 2
Diabetes Mellitus Patients in Zagazig University Hospitals
Lamiaa Abd-Elwahab Mohamed1, Essam El Din Mahmoud Lotfy Omer2,
Sherihan Ahmed Mortada Ibrahim1
Departments of 1Clinical Pathology and 2Internal Medicine,
Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding Author: Sherihan Ahmed Mortada Ibrahim, Mobile: (+20) 01064142133,
Email: sherihan_mortada@yahoo.com

ABSTRACT
Background:
Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly
developing countries. Hyperprolactinemia may reflect neuroendocrine stress reaction to acute coronary syndromes,
which induces acute endothelial dysfunction, insulin resistance, and induction of vascular immune reactions; thus,
prolonged hyperprolactinemia lead to arteriosclerosis, augmentation of arterial stiffness, and hypertension.
Objective: To assess role of prolactin as a cardiovascular risk in type 2 diabetes mellitus patients in Zagazig University
Hospitals.
Patients and Methods:
This study was performed in Clinical Pathology, Cardiology and Internal Medicine
Departments Zagazig University Hospitals in the period between July and October 2019. Approval for study was
obtained from research administration and research ethics committee, Faculty of Medicine Zagazig University.
Results:
Regarding prolactin level, there was a statistically significant increase on comparing group 1 with group 2, 3
and 4 (P= 0.016, P<0.001, respectively). Also, there was a statistically significant increase on comparing group 2 with
group 3 and 4 (p<0.001), in addition to significant increase on comparing group 3 with 4 (p=0.012). In the present study,
serum prolactin increased in patients with acute myocardial infarction (AMI) either in group1 (MI and DM)
(mean=26±SD=8.09) or group 2(MI) (mean=16.24± SD =3.37), which points to the possible role of hyperprolactinemia
in myocardial infarction. Prolactin was found to be increased as a marker of atherosclerosis so it can be used as
biomarker for atherosclerosis or coronary artery disease.
Conclusion: Prolactin can be used as biomarker for coronary artery disease and this is explained by its participation in
the process of atherosclerosis. Serum prolactin level increased in acute myocardial infarction.
Keywords: Cardiovascular risk, Prolactin, Type 2 diabetes mellitus.

INTRODUCTION

augmentation of platelets aggregation and amplification
Type 2 diabetes is a global public health crisis
of vascular thrombosis that lead to increase in the risk
that threatens the economies of all nations, particularly
score of acute coronary syndrome (6).
developing countries (1). The American Heart
The study aimed to assess role of prolactin as a
Association has designated diabetes mellitus (DM) as a
cardiovascular risk in type 2 diabetes mellitus patients
major risk factor for cardiovascular disease (same
in Zagazig University Hospitals.
category as smoking, hypertension, and hyperlipidemia).

Type 2 diabetes patients without a prior myocardial
PATIENTS AND METHODS
infarction (MI) have a similar risk for coronary artery
This study was performed in Clinical Pathology,
related events as non-diabetic individuals, who have
Cardiology and Internal Medicine Departments
had a prior MI (2).
Zagazig University Hospitals in the period between
Prolactin is a hormone that is synthesized and
July and October 2019.
secreted from the anterior pituitary lactotrophic cells,

which their numbers do not alter with age (3).
Ethical approval:
Hyperprolactinemia may reflect neuroendocrine stress
Approval for study was obtained from research
reaction to acute coronary syndromes, which induces
administration and Research Ethics Committee,
acute endothelial dysfunction, insulin resistance, and
Faculty of Medicine Zagazig University.
induction of vascular immune reactions thus; prolonged
Every patient signed an informed written
hyperprolactinemia lead to arteriosclerosis, augmentation
consent for acceptance of the operation. This work
of arterial stiffness, and hypertension (4).
has been carried out in accordance with The Code
Prolactin could also stimulate the atherosclerotic
of Ethics of the World Medical Association
process through its autocrine or paracrine action not
(Declaration of Helsinki) for studies involving
through systemic inflammatory induction (5). All these
humans.
observations showed that a high prolactin level plays a

potential role in the development of ischemic cardiac
This study was conducted on 88 male subjects (66
disease, also; hyperprolactinemia leads to dyslipidemia,
patients and 22 healthy subjects as a control group).

This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2387
Received:25 /4 /2021

Accepted:21 /6 /2021


Full Paper (vol.841 paper# 121)


c:\work\Jor\vol841_122 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2391-2399

Epidemiological Study of COVID-19 among Healthcare Workers
Mahmoud Saif-Al-Islam*1, Hamdy Saad Mohamed2, Ahmad Mokhtar Abodahab3,
Doaa Gadallah Hassanin4, Magda Mohamed Ali5, Mustafa A Younis6, Safaa Khalaf1.
Departments of Tropical Medicine and Gastroenterology1, Internal Medicine2, Radiology3,
Chest Diseases and Tuberculosis4, Community Medicine5, and Clinical and Chemical Pathology6,
Sohag University Hospitals, Sohag, Egypt.
*Corresponding author: Mahmoud Saif-Al-Islam, Mobile: 01091055908, E-mail: happyyear5000@yahoo.com

ABSTRACT
Background:
Health care workers (HCWs) are crucial to maintaining healthcare services during COVID-19 pandemic.
One of the greatest risks to healthcare system is the potentially high rate of infections due to COVID-19 among HCWs.
Objective:
To summarize the epidemiologic characteristics, clinical features, radiologic findings, laboratory data, and
outcomes of health care workers diagnosed with coronavirus disease 2019 (COVID-19) in Sohag University Hospitals.
Patients and methods:
A retrospective study included 101 HCWs who were proved to have COVID-19. HCWs with
COVID-19 were categorized to asymptomatic cases, mild cases which included patients with mild clinical symptoms
and normal lung computed tomography (CT), and moderate cases which included patients with mild or moderate clinical
features and abnormal lung CT.
Results: 89.11% of infected HCWs had no definite history of contact with a confirmed case of COVID-19. A
considerable percent of the patients presented with non-respiratory symptoms such as GIT, and neurological symptoms.
Patients who had a moderate respiratory illness were significantly older than those who had a mild respiratory illness
and were more likely to have diabetes. Home isolation was recommended in most cases (n=73). Several cases (n=24)
preferred isolation in university undergraduate houses, and 4 patients were treated at isolation hospital, 2 of them needed
oxygen therapy.
Conclusion:
COVID-19 in HCWs exhibited a wide spectrum of disease severity. Symptom-based screening for
COVID-19 in HCWs may underestimate the affected number as there is a considerable percent of asymptomatic cases.
For HCWs' safety, the use of protective personal equipment and adherence to proper hand-hygiene practice are
important protective tools during this pandemic. Also, there is a growing need for educational and training programs for
all levels of HCWs.
Keywords:
COVID-19, Health care worker.

INTRODUCTION

transmitting the infection to their co-workers, patients,
COVID-19 is an emerging respiratory disease
and families(10).
with high infectivity and mortality rates. The causative
Early identification of COVID-19 cases with
organism for COVID-19 is severe acute respiratory
the determination of disease severity and prognosis is
syndrome coronavirus 2 (SARS-CoV-2). COVID-19
very important for the reduction of mortality risk. Egypt
was firstly reported in Wuhan city in China at the end
registered the first COVID-19 case on the 14th of
of 2019(1). The novel coronavirus rapidly spread outside
February 2020(11). Egypt began a strategy to prevent the
China throughout the world causing pandemic crisis(2).
spread of infection. Nasopharyngeal swabs for real-time
SARS-CoV-2 can cause a spectrum of disease
reverse transcriptase-polymerase chain reaction (rRT-
severity ranging from mild illness to severe symptoms
PCR) were done for patients with suspicious symptoms,
especially in the elderly and patients with
and the contacts of COVID-19 confirmed cases(12).
comorbidities(3,4). The commonly reported symptoms
The Egyptian studies that could be traced in the
included fever, fatigue, dry cough, myalgia, dyspnea,
literature regarding COVID-19 in HCWs are scarce, so
and sore throat(5).
we performed a retrospective analysis of a cohort of
COVID-19 is considered an important HCWs
HCWs proved to have COVID-19 from those who work
occupational disease. Globally several thousand of
in Sohag University Hospitals, Upper Egypt.
HCWs have been reported to get the infection by SARS-
The aim of this study is to summarize the
CoV-2(6). Hence HCWs are at the first lines of the
epidemiologic
characteristics,
clinical
features,
COVID-19 outbreak response, they are exposed to the
radiologic findings, laboratory data, and outcomes of
hazard of infection(7).
HCWs diagnosed with COVID-19 in Sohag University
Also, HCWs are vulnerable to get the infection
Hospitals.
through either household or community transmission.

Besides, transmission might come from unrecognized
PATIENTS AND METHODS
sources, including asymptomatic or pre-symptomatic
This is a retrospective study that was carried out
persons(8,9). HCWs were understandably worried not
from the 2nd of May 2020 to the 12th of July 2020 at
only about becoming infected but also about
Sohag University Hospitals, Sohag city, Upper Egypt.

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/)
2391
Received: 25/4/2021

Accepted: 21/6/2021


Full Paper (vol.841 paper# 122)


c:\work\Jor\vol841_123 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2400-2404

Diagnosis of Sepsis among Adult Patients with AML Using Scd14
Rania Ghonaim1*, Rasha Haggag2, Thoraya Hosny1
Departments of 1Clinical Pathology and 2Department of Medical Oncology,
Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding Author: Rania Ghonaim, Mobile: (+20) 01115900632, Email: rania_ghonaim@yahoo.com

ABSTRACT
Background:
Millions of dead cases are reported every year due to sepsis. Sepsis has been estimated in 1-2 % of
hospitalized patients especially leukemic patients. The diagnosis of sepsis remains a clinical challenge. Many studies
suggest that presepsin plays a role in diagnosing sepsis, but the results remain controversial.
Objective: To evaluate the potential of presepsin as an early biochemical marker of sepsis in adult acute leukemic
patients and to assess the correlation between severity of sepsis and level of presepsin. Comparing between presepsin
& CRP in diagnosing bacterial infection in critically ill adult leukemic patients.
Patients and Methods: This study was conducted on 24 patients having acute leukemia after receiving chemotherapy
and 24 controls at Medical Oncology and Clinical Pathology Departments, Zagazig University Hospitals during the
period from June 2018 to August 2019.
Results: There was statistically significant difference between patients and control regarding presepsin levels. The
highest levels of presepsin were in patients with septic shock followed by severe sepsis, sepsis, SIRS then control group.
There was statistically significant difference between types of sepsis and presepsin (P value = 0.000). There was
statistically significant positive correlation between CRP and presepsin (r = 0.658). AT cut off value of 440 the clinical
sensitivity of presepsin was 82.5% and its clinical specificity was 90%, AUC was 0.89. On comparing these results with
the normal cut off value of CRP level (6), the clinical sensitivity and specificity were 90% & 61% respectively and AUC
was 0.70.
Conclusion: Presepsin can be used as a better indicator to the degree of severity of sepsis than CRP in septic adult
leukemic patients.
Keywords: Presepsin, Systemic inflammatory response syndrome (SIRS).

INTRODUCTION
Research in this direction has paved the way for
Sepsis is the leading cause of death in critically
identification of CD14, which is a glycoprotein
ill patients and requires early goal-directed management
expressed on the membrane surface of monocytes and
to reduce its high burden of mortality and morbidity (1).
macrophages (Mcd14) and serves as a high-affinity
The evaluation of sepsis severity and outcome is
receptor for complexes of lipopolysaccharides (LPSs),
complicated by the lack of gold standard for the
a compound from the outer cell wall of Gram-negative
diagnosis of sepsis and the variability in its presentation
bacteria, and LPS-binding proteins (LPB) (8). Presepsin
(2). Many scores and biomarkers had been studied in this
(sCD14-ST) is a soluble N-terminal fragment of the
perspective, with Acute Physiology and Chronic Health
cluster of differentiation (CD) marker protein CD14,
Evaluation II (APACHE II) score being traditionally
which is released into the circulation during monocyte
used for this clinical situation (3).
activation upon the recognition of lipopolysaccharide
Being immunocompromised cancer patients
(LPS) from infectious agents (9).
carries the risk of infection with resistant organisms
Plasma levels of sCD14-ST specifically increase
especially those receiving high dose chemotherapy.
during sepsis and less intensively during SIRS with
There is a high risk of neutropenic fever, so the patients
magnitude correlated to phagocytosis process and to the
susceptibility to be infected with resistant organisms
cleavage with lysosomal enzymes from bacteria and
increases (4). Survival outcome after infections can be
microorganisms (10).
influenced by the capacity of the host immune system
Evaluation of the prognostic value of presepsin
in identifying the microbial pathogens and triggering an
as an early marker to detect sepsis in adult acute
immediate and effective response (5).
leukemic patients and to assess the correlation between
The activation of innate immunity responses
severity of sepsis and level of presepsin. Moreover to
needs the recognition of the pathogens by different
determine which marker, presepsin or CRP, is superior
receptors at the cellular surface of immune effector cells
in the diagnosis of bacterial infection in critically ill
particularly monocytes/macrophages (6). Guidelines
adult leukemic patients.
emphasize that early diagnosis and timely

administration of antimicrobial therapy are crucial in
PATIENTS AND METHODS
reducing morbidity and mortality in sepsis patients.
This study was held in the Clinical Pathology
However, no single clinical or biological marker is
and Medical Oncology Departments, Faculty of
strictly indicative of sepsis has been adopted totally (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/)
2400
Received:27 /4 /2021


Accepted:23 /6 /2021


Full Paper (vol.841 paper# 123)


c:\work\Jor\vol841_124 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2405-2410

Study of Vitamin D and Calcium Levels in Patient with Rosacea
Magda Mostafa Hagag1, Noha Rabie Bayomy2, Doha Bakr Mohamed El-Horish*1

Departments of 1Dermatology, Andrology and STDs and 2 Medical Biochemistry and Molecular Biology,
Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Doha Bakr Mohamed El-Horish, Mobile: (+20) 01065062844, E-Mail: dohabakr22@yahoo.com

ABSTRACT
Background:
Rosacea is a chronic skin condition that primarily affects the central face, and is often characterized by
flare-ups and remissions. The increase in serum vitamin D levels is associated with rosacea. Rosacea may be happened
due to high level of vitamin D that increases level of cathelicidin, which affect inflammatory process and vascular
response. In the other hand Ca level does not have relationship to the cause of rosacea.
Objective: To investigate the relationship between serum vitamin D and calcium levels in patients with rosacea and
analyze the association of vitamin D with clinical features.
Patient and methods: This prospective case control study was carried out on thirty patients with rosacea and twenty
age and gender matched healthy controls. All enrolled participants were subjected to a full history taking, general and
detailed dermatological examination.
Results: Rosacea group showed significantly higher mean vitamin D level when compared to control group (25.5±5.3
versus 17.7±5.2) (p<0.001). Rosacea cases had 17 with optimal vitamin D levels and 13 with mild to moderate
deficiency, while control group cases had 4 with optimal vitamin D level and 16 with mild to moderate deficient vitamin
D levels. There was significant (p=0.010) difference between cases and controls regarding vitamin D status. Total and
ionized calcium levels did not differ significantly (p= 0.662 and 0.888 respectively) between cases and control groups.
Conclusion: Increased vitamin D levels may lead to the development of rosacea. New findings can be increased the
understanding of pathogenesis of rosacea and may lead to development of new treatment options for rosacea.
Keywords: Calcium, Rosacea, Vitamin D.

INTRODUCTION
(UV-B) irradiation and microbial component increase
Rosacea (L. rosaceus, rosy) is a chronic
vitamin D3 and toll like receptor 2 expression in
inflammatory and vascular skin condition that affects
keratinocytes leading to an increase of cathelicidin
around 10% of the population (1). In persons with darker
production. The production of cathelicidin, an
complexion, masking of face redness by skin pigment,
antimicrobial peptide (AMP), is strongly increased in
protective effects of melanin against UV radiation (an
rosacea. (7).
aggravating factor for rosacea), or hereditary
In our study, we aimed to investigate the
predisposition to rosacea appear to be the most
relationship between serum vitamin D levels in patients
important factors contributing to the lower probability
with rosacea and analyze the association of vitamin D
of diagnosis (2, 3). Microbes, UV radiation, diet, extremes
with clinical features.
of temperature, (skin) barrier disruption, psychosocial

PATIENTS AND METHODS
stress, and hormones are all potential triggers for an
30 patients suffering from rosacea aged 20 ­ 50
increased innate immune response and/or neurovascular
years old and 20 apparently normal subjects matched for
dysregulation that increase rosacea symptoms(4-5).
age and sex were chosen as control, from June 2019 to
Vitamin D (also known as "calciferol") is a fat-
the end of February 2020.
soluble vitamin that can be found naturally in a few
The rosacea patients were collected from the
foods, added to others, or purchased as a dietary
outpatient Dermatology and Andrology Clinic,
supplement. When ultraviolet (UV) rays from sunshine
Menoufia University Hospital at Menoufia Faculty of
impact the skin and induce vitamin D production, it is
Medicine. The laboratory work was carried out in
also generated endogenously. Vitamin D received from
Medical Biochemistry and Molecular Biology
the sun, meals, and supplements is physiologically
Department, Faculty of Medicine, Menoufia University.
inactive and must be activated in the body by two
Patients with acne vulgaris, seborrheic dermatitis,
hydroxylations. Vitamin D is converted to 25-
pustular folliculitis, and systemic lupus erythematosus
hydroxyvitamin D (25(OH)D), commonly known as
were excluded from our study. Also, presence of any
"calcidiol," via the first hydroxylation, which takes
systemic chronic inflammatory or autoimmune
place in the liver. The second hydroxylation, which
disorders were considered as exclusion criteria.
takes place largely in the kidney, results in the
Ethical approval:
physiologically active 1,25-dihydroxyvitamin D
Informed consent according to ethics was obtained
(1,25(OH)2D), commonly known as "calcitriol" (6).
from all participants (including cases and controls)

after being informed about the aim and process of
Cathelicidin LL-37 is an important effector
the study as well as applicable objectives. The study
molecule of innate immunity in the skin. Ultraviolet B

This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2405
Received: 26/4/2021

Accepted: 22/6/2021


Full Paper (vol.841 paper# 124)


c:\work\Jor\vol841_125 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2411-2416

Effects of Levetiracetam and Topiramate Monotherapy on
Oral Health in Epileptic Children
Mennatallah O. Shata1, Hamed M Shatla1, Sherine Badawy2, Mostafa M Metkees3
1Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
21Department of Pediatric Dentistry, Faculty of Dentistry, Fayoum University, Fayoum, Egypt
3Department of Pediatrics, Egyptian Ministry of Health, Egypt
*Corresponding author: Mennatallah O. Shata, Mobile: (+20)01006636930, E-Mail: mennahshata@gmail.com

ABSTRACT
Background:
Epilepsy is a common neurologic disease in children associated with multiple
neurodevelopmental comorbidities or related to adverse drug reactions due to antiepileptic drugs.
Objective: To study the effects of Levetiracetam (LEV) and Topiramate (TPM) monotherapy on oral cavity, to
improve oral health care of epileptic children.
Patients and methods: This study was conducted on 60 epileptic children of age group 6 -12 years compared to 30
normal age- and sex-matched controls, 30 children on LEV monotherapy and 30 on TPM monotherapy. All were
subjected to full clinical dental examination by a pediatric dental expert.
Results: There was significant increase in plaque index 50% grade 3 in children receiving antiepileptic medications,
the decay-missing-filled (DMF) index was significantly more in children than in epileptic children, 43.3 % of children
on antiepileptic having grade 1 Gingival index, while grade 2 gingival enlargements were noticed in 43.3% and dental
hygiene was missed in 76.7% of children on antiepileptic drugs. Most of the indices were little more with TPM group
than LEV group.
Conclusions: Both LEV and TPM affect oral health of epileptic children, which makes regular screening for oral
health by a pediatric dental expert necessary to detect early changes and intervene to improve their quality of life.
Keywords: Epilepsy, Children, Oral health, Antiepileptic drugs.

INTRODUCTION
SUBJECT AND METHODS
Epilepsy is the most common chronic brain
Study design: A cross-sectional study done at the
disorder in children. The incidence of epilepsy in
Pediatric Neurology Clinic and Pediatric Outpatients'
children ranges from 41-187/100,000. Higher
Clinic, Children's Hospital, Ain Shams University,
incidence is reported from underdeveloped countries,
Cairo, Egypt during the period from January 2018 to
particularly from rural areas (1). According to the new
June 2019.
International League Against Epilepsy (ILAE)

definition of epilepsy, it is a brain disease defined by
Subjects: The study population was 60 children who
the following conditions:
were diagnosed epileptics, aging from 6 to 12 years old,
(1) two unprovoked (or reflex) seizures occurring
participated in this cross-sectional study. They were
more than 24 h apart; (2) one unprovoked (or reflex)
divided into two groups according to the antiepileptic
seizure and a probability of further seizures similar to
drug administrated.
the general recurrence risk (at least 60%) after two
Group 1: thirty epileptic patients on Levetiracetam.
unprovoked seizures, occurring over the next 10 years;
Group 2: formed of thirty epileptic patients on
and (3) diagnosis of an epilepsy syndrome(2). Efficacy
Topiramate. Thirty healthy age- and sex- cross
of antiepileptic drugs (AEDs) are often equivalent,
matched children who were not receiving any
hence selection of an AED is often determined by the
antiepileptic drug and were selected from the
adverse effects (AEs) (3).
Outpatient Departments of Pediatrics and Neurology,
Gingival hyperplasia (GH) is characterized by the
Faculty of Medicine, Ain Shams University to act as a
overgrowth of gingival sub-epithelial connective tissue
control.
and epithelium that develops about 1­3 months after

the start of phenytoin (PHT) treatment. Although
Inclusion criteria: Epileptic children on regular
several studies examined the effects of PHT on oral
monotherapy with antiepileptic drugs, (LEV and TPM)
health, none have studied those of the newer generation
taken for at least 3 to 6 months prior to the study along
of AEDs (4).
with their medical records. They were examined by the
Aim of the work was to study effects of
neurologist to document the exact cause of epilepsy and
Levetiracetam (LEV) and Topiramate (TPM)
to record the AED that they were taking.
monotherapy on oral cavity in order to improve oral

health care of epileptic children.
Exclusion criteria: Gingival surgery or periodontal

treatment prior to the screening visit, mental

retardation and children with systemic diseases

This article is an open access article distributed under the terms and conditions of the Creative


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

2411
Received: 27/4/2021

Accepted: 23/6/2021


Full Paper (vol.841 paper# 125)


c:\work\Jor\vol841_126 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2417-2423
Evaluation and Management of Syncope in Pediatrics:
A prospective Observational study at Sohag University Hospital
Asmaa Ali Hassan*, Safaa Hussein Ali, Shaimaa Mohamed Mahmoud
Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt.
*Corresponding author: Asmaa Ali Hassan, Mobile: (+20) 01002768567, E-Mail: r.asmaa.3ly@gmail.com

ABSTRACT
Background:
Syncope is defined as temporary loss of consciousness and postural tone resulting from an abrupt transient
decrease in cerebral blood flow. It is characterized by rapid onset, short duration and spontaneous complete recovery.
Objective: Our study aimed to analyze the frequency of syncope due to cardiac, neurocardiogenic, neurologic,
situational, psychiatric, and other causes and make a differential diagnosis of syncope types according to detailed
medical history and further investigations with focus on cardiac cause as the most serious type of syncope.
Patients and Methods: 125 pediatric patients were recruited from Arrhythmia Clinic in our Cardiology Unit, Sohag
University Hospital. They presented with a primary complaint of syncope aged from 1year to 18 years with a mean age
of 6.49 ± 3.77 years.
Results: The most common diagnosis was neurocardiogenic syncope (n=76, 60.8%). Sixty-four cases (84.2%) had
recurrent episodes. Epilepsy was found in Thirty-four cases (27.2%) and psychogenic pseudo-syncope affected one
female child. There were fourteen cases (11.2%) with cardiac syncope: 8 patients with LQTS, one patient with CPVT,
one patient with AVNRT, 2 patients with dilated cardiomyopathy, 1 patients with history of atrioventricular (AV) canal
defect closure and one patient with cardiac mass. There was significant relationship between arrhythmia and cardiac
syncope (p < 0.001). Exercise-induced syncopes were significantly associated with cardiac origins (p < 0.001). Positive
ECG, Holter and echocardiographic findings were statistically significant for cardiac syncope (P < 0.001).
Conclusion: Syncope is a common pediatric complaint. Most cases seen were resulting from benign causes, with only
a small percentage because of serious medical conditions. In addition, most syncopal episodes in the pediatric population
were diagnosed clinically or with minimally invasive testing, emphasizing the importance of a detailed history and
physical examination.
Keywords: Pediatric, cardiac, syncope.

INTRODUCTION

Syncope is defined as temporary loss of
detailed medical history and further investigations with
consciousness and postural tone resulting from an abrupt
focus on cardiac cause as the most serious type of
transient decrease in cerebral blood flow (1). It is
syncope.
characterized by rapid onset, short duration and

spontaneous complete recovery. It's a relatively frequent
PATIENTS AND METHODS
symptom in children and its evaluation is an important
This prospective observational study was conducted
aspect in pediatric medical practice (2). Syncope is caused
from April 2019 to April 2020 at Pediatric Arrhythmia
by a wide array of etiologies that include abnormalities
Clinic in Sohag University Hospital.
of the autonomic nervous system, as well as cardiac,
Inclusion criteria: Children aged from 1 year to 18
neurologic, psychogenic and metabolic problems (3).
years presenting with syncope to the Pediatric
Whereas the vast majority of episodes of syncope
Arrhythmia Clinic in our Cardiology Unit after clinical
are benign, a minority are caused by more serious or
assessment by any pediatrician or from Emergency Unit
even life-threatening malignant cardiac condition
in Sohag University Hospital.
prompting referral to pediatric cardiologists (4, 5).
Exclusion criteria: Previously diagnosed cardiac or
Neurocardiogenic (vasovagal) syncope is most
neurologic disease, children with diabetes mellitus,
common and usually has a favourable prognosis (6). More
material ingestion, trauma, chronic medication use and
serious, but less frequent causes of syncope include
those with history of channelopathies or arrhythmia.
hypertrophic cardiomyopathy and the socalled primary

electrophysiological disorders, which can result in
Methods of the study:
ventricular tachycardia (VT) and fibrillation (7). The
All patients in this study were subjected to the
presence of structural heart disease increases the
followings:
likelihood of a serious cause of syncope, such as
(A) Clinical history focusing on:
malignant ventricular arrhythmias.
Full medical history: Significant systemic hypotension
This study aimed to analyze the frequency of
associated with paradoxical bradycardia is characteristic
syncope due to cardiac, neurocardiogenic, neurologic,
of the majority of pediatric patients. The upright
situational, psychiatric, and other causes and make a
position, such as prolonged period of standing or change
differential diagnosis of syncope types according to
in posture (orthostasis) can be the reason for most

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/)
2417
Received:28 /4 /2021

Accepted:24 /6 /2021



Full Paper (vol.841 paper# 126)


c:\work\Jor\vol841_127 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2424-2429

Health-Related Quality of Life in School Children with
Short Stature in Gharbia Governorate in Egypt
Seham Fathy Azab, Ashgan Abdalla Alghobashy, Ahmed Nagy Elsafty*
Department of Pediatrics, Faculty of Medicine ­ Zagazig University, Zagazig, Egypt.
*Corresponding Author: Ahmed Nagy Elsafty, Mobile: (+20) 01278789769, Email: ahmedelsafty35@gmail.com

ABSTRACT
Background:
Short stature (SS) in a child is defined as a child 2 or more standard deviations below the mean height for
children of that gender and chronological age. Health-related quality of life (HRQOL) reflects physical, psychological,
social, cognitive, functional and behavioral dimensions of well-being and functioning as perceived by the person
concerned, in a wide range of conditions between excellent and poor health.
Objective: To assess HRQOL for children and adolescents with short stature (SS).
Patients and Methods: In order to assess the HRQOL for SS patients, we studied 392 school children (preparatory and
secondary) who meet the diagnosis of SS according to definition of WHO for short stature of child height below or
equal 3rd percentile on WHO Growth chart in children of same gender and chronological age . Both sexes were included
and age ranged from 12 to 18 years.
Results: According to family history, more than 2/3 of the children with SS had negative consanguinity. 1.5% was with
positive family history of a similar condition and 15 % had positive family history of chronic disease. There was
significant lower HRQOL in children with SS concerning physical, psychological and environmental World Health
Organization Quality of Life (WHOQOL) domains. The psychological domain is the most affected one. A comparison
of sex groups (males and females) in relation to different domains among cases but it did not reach statistically
significant difference.
Conclusion: Pediatric patients with SS have lower HRQOL. Social domain is the most affected among SS children.
Keywords: Short stature, Health-related quality of life, Gharbia Governorate.

INTRODUCTION
HRQOL reflects physical, psychological, social,
Short stature (SS) in a child is defined as a child
cognitive, functional and behavioral dimensions of
2 or more standard deviations below the mean height
well-being and functioning as perceived by the person
for children of that gender and chronological age. A
concerned, in a wide range of conditions between
child's growth is important because it is a strong
excellent and poor health. The concept of HRQOL is
indicator of his or her health. SS in a child must be fully
therefore increasingly considered as a relevant `patient-
investigated to distinguish between a normal variation
reported outcome (5). As a multidimensional construct,
and an underlying pathological condition (1). Short
HRQOL offers the possibility to focus on different
stature in children may have different causes, including
aspects of well-being and functioning and addresses the
normal variation, genetic defects, malnutrition, chronic
subjective perceptions of individuals. HRQOL
systemic disease, endocrine disorders or psychosocial
evaluation of SS broadens our understanding of the
deprivation. Growth hormone deficiency (GHD)
psychosocial impact of this condition, by providing
represents a relatively rare cause for SS, which is due
insights into potential impairments of functioning and
to insufficient secretion of growth hormone (2).
well-being in comparison to other clinical and non-
Among children without GHD, short stature may
clinical populations. In addition, the effects of
be caused by Turner syndrome, chronic renal
treatment in patient cohorts can serve as an empirical
insufficiency, being small for gestational age at birth,
basis for clinical decision making as well as individual
Prader-Willi syndrome, or other conditions. When the
tailoring of treatment (6).
cause is unknown, it is called idiopathic SS (3).
The present work aimed to assess health-related quality
The child's history is an important step for
of life (HRQOL) for children and adolescents with
evaluation of SS. Whenever possible, obtain the
short stature (SS).
original birth records to document length, weight and

skull circumference at birth to exclude intrauterine
PATIENTS AND METHODS
growth retardation, also the mode of delivery to
Cross-sectional study that was conducted in Gharbia
exclude abnormal presentation or difficult and
Governorate on preparatory and secondary school
traumatic delivery. The medical history should also
children.
include the presence of other members of the family

with a similar condition to exclude a genetic cause,
Inclusion criteria: School children who meet the
familial SS or constitutional delay of growth and
diagnosis of SS according to the definition of WHO for
development (4).
short stature of child height below or equal 3rd

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/)
2424
Received:29 /4 /2021

Accepted:25 /6 /2021



Full Paper (vol.841 paper# 127)


c:\work\Jor\vol841_128 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2430-2434

The Role of Atorvastatin in Suppressing Fibroid Related Symptom and
Fibroid Size in Perimenopausal Women
Ahmed Elsayed Abdel Aleem Seada, Yasser Abdel Dayem Elmorsy,
Emad Ahmed Fayala, Ehsan Mohamed Raghib Refaie
Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*Corresponding author: Ahmed Elsayed Abdel Aleem Seada, Mobile: (+20)01025020643,
E-Mail: ahmedseada1201011@gmail.com

ABSTRACT
Background:
Uterine fibroids are the most common benign gynecologic tumors, with a lifetime incidence of
approximately 70%. They are associated with multiple symptoms, including heavy uterine bleeding and pelvic pain.
Currently used treatments include contraceptive steroids, Gonadotropin-releasing hormone agonist (GnRHa),
progesterone modulators, uterine artery embolization (UAE), magnetic resonance imaging-guided focused ultrasound
surgery (MRgFUS), and radiofrequency ablation (RFA).
Objective: To evaluate the effect of atorvastatin on decreasing fibroid related symptoms and fibroid size, endometrial
thickness and cholesterol level in perimenopausal women.
Patients and methods: Prospective randomized controlled trial that was conducted over a period of 12 months during
2019 and 2021 on 105 patients with symptomatic uterine fibroid in perimenopausal age, admitted to emergency unit
and gynecology outpatient clinic at Mansoura University Hospital and after obtaining acceptance from institutional
research board faculty of medicine then patients were prospectively recruited and randomized by computer program.
Results:
All groups at presentation demonstrated insignificant differences concerning demographic characteristics,
gravidity and symptoms of uterine fibroid. Uterine fibroid demonstrated significant reduction in size as well as
significant changes following the atorvastatin treatment after 6 months in a dose dependent manner, while endometrial
thickness demonstrated insignificant differences as measured by transvaginal ultrasound (TVS). Cholesterol level
demonstrated highly statistically significant decrease following atorvastatin treatment in a dose dependent manner.
Conclusion:
The current study demonstrated that atorvastatin has promising effects in cases with uterine fibroids as it
was associated with a reduction of fibroid size with reduction of fibroid related symptom (menorrhagia, dysmenorrhea).
Keywords: Atorvastatin, Perimenopausal Women, Uterine fibroids

INTRODUCTION
both cholesterol and its isoprenoid precursors; farnesyl
Uterine fibroids are the most common benign
pyrophosphate
(FPP)
and
geranylgeranyl
tumor in women, with a lifetime incidence of
pyrophosphate (GGPP) (3).
approximately 70%. It is associated with variety of
Statins can inhibit the production of 2
problems including menorrhagia, pelvic pain, pelvic
endogenous cholesterol and block protein prenylation,
pressure, as well as infertility and pregnancy
and thus statins use may therefore influence cell
complication (1, 2).
proliferation and migration. An increasing evidence
Current therapeutic options mainly involve
suggests that statins use related to several potential
surgical interventions to remove or destroy uterine
anticancer properties and a reduced risk of cancer
fibroids. However, these procedures have significant
recurrence, such as hepatocellular cancer, multiple
morbidity and mortality, which are the major
myeloma, breast cancer and ovarian cancer (2, 6).
limitations of surgical intervention. To avoid the risks
It was reported that the use of statins was
of surgical intervention many novel therapies are
related to a lower risk of uterine fibroids and fibroid-
currently under investigation. At present, medical
caused symptoms. Simvastatin and atorvastatin inhibit
interventions used to manage uterine fibroids include
progression of certain benign steroid dependent
mifepristone, ulipristal acetate, and GnRH-agonists.
gynecological disorders such as endometriosis. Statins
Nevertheless, uterine fibroids will regrow fast after the
also inhibit proliferation and induce calcium dependent
cessation of mifepristone, and the duration of treatment
programmed cell death in human uterine fibroids cells
with GnRH-agonists is limited by the induction of
in vitro and in vivo (7).
hypoestrogenic symptoms (3-5).
Atorvastatin is the most widely used anti-
Medical therapeutic options are quite limited
hyperlipidemia, and its effect on fibroid growth
for uterine fibroids treatment. Therefore, it is of great
remains unknown. Therefore, in the present study, we
clinical value to develop new treatment strategy for
proceeded to investigate therapeutic effects of
uterine fibroids. Statins are a drug family primarily
atorvastatin on uterine fibroids.
used for hyperlipidemia. By inhibiting 3-hydroxy-3-
The aim of the current study was to evaluate
methylglutaryl coenzyme A (HMG-CoA) reductase,
the effect of atorvastatin on decreasing fibroid related
statins prevent the conversion of HMG-CoA to
symptoms and fibroid size, endometrial thickness and
mevalonate, and thus lead to dramatic reductions in
cholesterol level in perimenopausal women.

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/)

2430
Received:27 /4 /2021

Accepted:23 /6 /2021



Full Paper (vol.841 paper# 128)


c:\work\Jor\vol841_129 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2435-2441

Thrombocytosis in Children: Clinical and Heamatological Study in
Pediatric Department, Sohag University Hospital
Abd El-Rahman M. Lotfy, Al Zahraa El Sayed Ahmed, Eman M. Fahmy
Department of Pediatric, Faculty of Medicine, Sohag University, Sohag, Egypt.
*Corresponding author: Abd El-Rahman M. Lotfy, Mobile: (+20) 01090616020,
E-Mail: pediatrician.lotfy@gmail.com

ABSTRACT
Background:
Thrombocythemia (ET) is defined as elevation in the platelets count more than 400,000/ µ L in peripheral
smear. It is common in infant and children that occurs in 3 to 13% of children. Thrombocytosis is classified into
primary/clonal or secondary according to the pathological origin.
Objective: To determine incidence, causes and types of thrombocytosis in children also the correlations between the
severity of thrombocytosis and the etiology and platelets indices.
Patients and methods: Prospective, observational study was done in Pediatric Department and Pediatric Out-Patient
Clinic, Sohag University Hospital. A total of 117 cases of thrombocytosis were included in this study. All children had
thrombocytosis and aged from one month to twelve years old.
Results: Reactive thrombocytosis was observed in 114 cases (97.44%), while primary type was found only in 3 cases
(2.56%), 2 of them had chronic myelogenouse leukemia and one case is diagnosed as essential thrombocytosis.
Majority of children (96 cases) in our study patients had mild thrombocytosis (82.05%) while moderate thrombocytosis
was found in 16 cases and severe thrombocytosis were seen in 5 cases with 13.67% and 4.27% of children respectively.
The correlation between platelet number and the mean platelet volume (MPV) showed significant negative correlation
(p < 0.001), while the correlation between the platelet number and plateletcrit (PCT) showed significant positive
correlation (p < 0.001) but platelet distribution width (PDW) had no correlation with platelet number (P= 0.7).
Conclusion: Among our study platelet indices, the MPV had a significant negative correlation with platelet count and
MPV was considered normal in patients with reactive thrombocytosis.
Keywords: Thrombocytosis, Platelet volume, Plateletcrit, Platelet indices.

INTRODUCTION
thrombocytosis may cause thromboembolic or
Thrombocytosis is defined as increase of platelet
haemorrhagic complications, and require treatment with
count more than 400,000/ µ L in peripheral smear. It is
platelet lowering agents in some patients according to
more common during infancy and childhood and occurs
several factors. Asymptomatic patients need just close
in 3 to 13% of children (1). Thrombocytosis is classified
follow up and monitoring. Low risk patients need
as primary/clonal or secondary by the pathological
prophylaxis with low dose aspirin. High risk patients
origin. Primary thrombocytosis also called essential
need treatment with cytoreductive therapy e.g.
thrombocythemia is a clonal disease that is exceedingly
hydroxyurea (7). Regarding familial type, familial
rare in childhood with the incidence is 1 per million
autosomal recessive, dominant, as well as X linked
children, which is 60 times lower in children than in
forms of primary thrombocytosis have been reported.
adults (2), and may be associated with thromboembolic
Spontaneous
formation
of
megakaryopoietic
or hemorrhagic complications. Secondary or reactive
progenitors with increased sensitivity to thrombopoietin
thrombocytosis is very common, affects up to 15% of
(TPO) is found to be the primary mechanisms. In
hospitalized children (3), and occurs secondary to variety
several pedigrees, overproduction of Tpo has been
of conditions, like acute or chronic infections, iron
found to be responsible for the disease. In some adult
deficiency anemia, bleeding disorders, hemolytic
patients mutations in the Tpo gene locus have been
anemia, collagen vascular diseases, malignancies, drugs
found. These mutations typically occur in the 5'
or splenectomy (4). Reactive thrombocytosis does not
untranslated region of the Tpo gene and result in
cause any complications and improves spontaneously
deletions of untranslated open reading frames and
with treatment of the underlying cause (4). Extreme
overproduction of Tpo. In children with familial
thrombocytosis (platelets count >1,000,000/ µ L) is less
thrombocytosis, platelet counts are lower than in ET.
common, occurring in less than 2% of children, but may
Also, splenomegaly is usually not found with almost no
occur more common in critically ill children (5).
thrombotic or hemorrhagic complications occur and
Primary thrombocytosis is divided into familial
prophylaxis is not usually required (6).
and essential. The familial has been described in a
Hereditary or familial thrombocytosis has been
number of families and appears to be heterogeneous
found in several families with varying ethnic origin.
according to the underlying patho- physiological
Different mutations in the thrombopoietin gene (THPO)
echanism (6), while essential thrombocytosis, is a
have been identified, which affect the upstream open
chronic clonal myeloproliferative disease (7). Primary
reading frame 7 (uORF 7), which normally has an

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/)
2435
Received:29 /4 /2021

Accepted:25 /6 /2021



Full Paper (vol.841 paper# 129)


c:\work\Jor\vol841_130 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2442-2446

Age Related Effects of Sleep Apnea in Adults: A Polysomnographic Study
Doaa Mohamed Gad*1, Ann Ali Abd-Elkader2, Usama Mohamed Rashad1,
Samar Thabet Abu Bakre3, Mostafa Abdel-Moneim Mohamed1
Departments of 1Otorhinolaryngology Head and Neck Surgery and 3Anesthesia,
Intensive Care and Pain Management, Faculty of Medicine, Sohag University, Sohag, Egypt
Department of 2Clinical Neurophysiology, Faculty of Medicine, Cairo University, Cairo, Egypt.
*Corresponding author: Doaa Mohamed Gad, Mobile: (+20) 01095874485, E-Mail: doaagad73@gmail.com@gmail.com

ABSTRACT
Background:
Age is a risk factor of obstructive sleep apnea (OSA). It has been shown that OSA progresses over time,
full-night polysomnographic sleep study is considered to be the gold standard method for the diagnosis of obstructive
sleep apnea syndrome (OSAS).
Objective: This study aims to determine the effect of age on sleep apnea patients.
Patients and Methods: A cross sectional study that included 95 patients conducted at a sleep laboratory in the ENT
Department, Sohag University Hospital and in the Clinical Neurophysiology Unit, Cairo University. The study
population age range was (20-60). All participants were subjected to personal history taking, detailed sleep history,
medical history, general examination, ENT examination, Epworth sleepiness score (ESS), and polysomnography.
Results: Mean age was (43.99 ± 10.96). The male-to-female ratio was 1.7/1.3. Mean BMI was 35.27 ± 7.19. Mallampati
score of grade II and III represented the majority of the patients (83.1%). The range of oropharyngeal collapse (tonsil
collapse) was ranging from (no collapse-100%), with a mean of (62.31±25.50). The mean value of the Epworth sleep
scale score in all patients was 8.09 ± 4.26. The mean of apnea hypopnea index (AHI) was 24.08 ± 28.33. Average O2
was 82.73 ± 31.61. A statistically significant linear correlation was observed between age and BMI, the circumference
of the waist and neck, duration of complaints, and collapse of the tonsils (p <0.05).
Conclusion: Prevalence estimates of OSA increased continuously with age. Obesity could play an important role in
elderly patients with OSAS and BMI could be a significant variable in determining the severity of OSAS in elderly
patients.
Keywords: Body Mass Index, Obstructive sleep apnea, Polysomnography, Sleep apnea syndromes.

INTRODUCTION
airflow), thoracic/abdominal impedance belts (for
Obstructive sleep apnea syndrome (OSAS) is
respiratory effort), and position sensors (for sleep
thought to affect 3% to 7% of adult men and 2% to 5%
position), as well as pulse oximetry (for SpO2) and
of adult women. It is marked by recurring episodes of
audio recording through a tracheal microphone (for
total or partial upper airway obstruction that occur
snoring). Polysomnographic recordings were manually
during sleep (1). The diagnostic criteria of OSAS must
evaluated and interpreted according to established
have both subjective symptoms and five or more
guidelines by an experienced sleep physician (5). OSA
obstructive breathing events per hour night sleep
has been linked to the development of hypertension,
measured by overnight monitoring. Apneas, hypopneas,
myocardial ischemia, congestive heart failure,
and respiratory effort-related arousals (RERAs) are all
arrhythmias, stroke, and cerebrovascular illness in many
examples of obstructive breathing events (2).
reports (6).
High BMI, male sex, elderly age, supine
The diagnosis of OSA is based on clinical signs
positioning during sleep, and structural abnormalities in
and symptoms that were validated with a thorough sleep
the upper airway are all risk factors for OSAS (3). OSAS
evaluation that included a sleep-oriented history,
prevalence appears to rise consistently with age,
physical examination, and sleep test findings. OSA is
peaking in aging individuals before plateauing about 65
defined as symptoms (snoring, observed apneas,
years of age. Fat deposits in the pharyngeal area and
gasping/choking episodes, increased sleepiness)
gradual somatic deposition in adipose tissue mass,
occurring in the presence of at least five obstructive
lengthening of the upper airway structures, and other
respiratory events per hour of sleep (apneas, hypopneas,
age-related anatomic changes could all be contributing
or arousals due to respiratory effort), according to the
to the constant rise in occurrence (4).
International Classification of Sleep Disorders. Because
For
diagnosing
OSAS,
a
full-night
of the stronger link of obstructive frequency with
polysomnographic sleep study is considered the gold
significant outcomes such as increased risk of
standard. It is consisting of continuous polygraphic
cardiovascular disease, the occurrence of 15 or more
recording
from
surface
leads
(for
obstructive respiratory episodes per hour of sleep in the
electroencephalography,
electrooculography,
absence of sleep-related symptoms is also appropriate
electromyography
of
the
chin/legs,
and
for the diagnosis of OSA (7).
electrocardiography), thermistors (for nasal/oral

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/)
2442
Received:28 /4 /2021

Accepted:24 /6 /2021



Full Paper (vol.841 paper# 130)


c:\work\Jor\vol841_131 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2447-2455

Economic Analysis of HCV Different Screening Algorithms in Egypt
Amal S. Sedrak1, Amany A. Salem1, Mohamed Hassany2, Eman H. Elsebaie1
1. Public Health &Community Medicine Department, Faculty of Medicine, Cairo University,Egypt
2.National Hepatology & Tropical Medicine Research Institute,Egypt
Corresponding author: Eman Hany Ahmed Elsebaie, Email: eman.elsebaei@kasralainy.edu.eg Tel: 01005645129

ABSTRACT
Background:
A top ranked public health problems especially in developing countries is hepatitis C virus infection. Being
asymptomatic infection, screening has been proposed as a credible public health strategy. Egyptian national guidelines were
emphasizing on adopting screening programs nationwide. No economic evaluation studies tackling HCV screening based
on risk exposure was conducted in Egypt so far.
Aim: To evaluate the cost effectiveness of screening algorithms among two different population subgroups.
Methods: A Cost-Utility analysis was conducted using a validated decision tree model linked to a Markov Model, to
compare the Incremental Cost-Effectiveness Ratio (ICER) of two policy scenarios: No screening versus Screen-and-treat
with direct-acting antiviral agents (DAA) ON two Egyptian population subgroups (high risk populations of acquiring HCV
infection versus the overall population).
Results: The ICER for implementing screening on high-risk populations was 3895.31 EGY/ QALY, considered cost-
effective (below the Egyptian Threshold 46000 EGY/ QALY). Conclusion: The ICER for implementing screening on high-
risk populations was cost-effective. Whereas concerning the general population, it is considered cost-saving strategy.
Keywords: Cost-effectiveness, economic evaluation, Hepatitis C, screening.

INTRODUCTION

targets have been set to increase the number of diagnosed
Globally, Viral hepatitis is considered a serious
tests performed for hepatitis by 100% and to test 80% of
public health problem, ranking the 7th chief cause of
all health care workers for HBV and HCV (12). WHO is
death (1). Hepatitis C virus (HCV) infection contributes to
determined to ensure the affordability and accessibility of
almost half of this mortality (2, 3). Worldwide, it is
DAAs particural for those in need. Dramatic dropping of
estimated that 170 million individuals and approximately
prices was facilitated by introducing generic versions of
350 thousands patients, die annually from HCV-related
these medicines (specially in a group of high-burden,
diseases (4). The progressive nature of HCV infection, is
low- middle-income countries) (10). In this context, Egypt
emphasized with the high global prevalence of cirrhosis
has initatied a national strategy for HCV control and
and hepatocellular carcinoma (HCC), 27% and 25%
implemented HCV prevention and treatment programs
respectively (5). Despite the global prevalence of HCV
(13). Egypt ambitious national HCV treatment program,
worldwidem, countries as Egypt, Cameroon and
was launched following successful negotiations for 99%
Mongolia, report the uppermost HCV prevalence more
discounted DAAs prices (14). The treatment program is
than 10% (6). Egypt Demographic and Health Surveys
planning to treat over 250,000 chronic HCV infected
(EDHS), conveyed a reducing in anti-HCV antibodies
patients per year, targeting to achieve a prevalence
prevalence among 15­59 years aged population, in 2009
(chronic infection) of less than 2% by 2025 (15). On
compared to 2015, estimated to be 14.7% versus 10%
contrary, existing evidence suggests persistence of higher
respectively (7), that is substantially higher than global
incidence levels in Egypt, than other countries, due to
levels (2,3). Given the asymptomatic nature of most
continuing HCV transmission (9). There is scarcity of
chronic HCV infections , early detection of cases ( during
studies estimating the economic impact of HCV screening
the long pre-symptomatic period) will allow patients to
followed by treatment particurlarly in countries with high
receive
treatment
before
developing
chronic
prevalence. Earlier economic analyses have mostly
complications (8). In the same context, the existence of
focused on the U.S. population recommended targeting
oral direct-acting antivirals (DAAs), with considerable
high-risk population HCV screening, rather than, general
efficacy, affords a priceless oppurtunity for dropping the
population screening. This could be reasonable with low
epidemiological burden of HCV disease as well as its
prevalence of HCV infections in United States
transmission (4, 9). Thus, complete cure of Hepatitis C
(16,17). Thus, anticipating the need for supporting evidence
could be achieved within 3 months using direct-acting
for policymakers on the health and economic
antivirals (DAAs) (10). World Health Organization (WHO)
consequences of hepatitis C screening, this research was
has recently published the 'Global Health Sector Strategy
aimed at evaluating screening algorithms among different
on Viral Hepatitis 2016­2021 (11), which accentuated,
population groups as proposed by Egypt national plan, in
achieving service coverage targets to eliminate HCV, a
order to integrate the highest cost-effective HCV
prominent public health threat by 2030 (11,12). The 2020
screening strategy in the Egyptian National plan of HCV

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/)
2447
Received:27 /4 /2021

Accepted:23 /6 /2021



Full Paper (vol.841 paper# 131)


Treatment of Genu Valgum Deformity in Adolescent by Closed Wedge Femoral Ostetomy The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2456-2460
Treatment of Genu Valgum Deformity in Adolescent by
Closed Wedge Femoral Osteotomy
Mohammed Saeid Adrees*, Khaled Mohamad Hassan, Reda Hussein Al-kady, Ehab Mohamed Shehata
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Mohammed Saeid Adrees, Mobile: (+20) 01020867907,
Email: mohammedsaed.edris.1988@gmail.com

ABSTRACT
Background:
Various types of corrective osteotomies of the distal femur have been described in the literature for
genu valgum deformity such as lateral opening wedge, medial closing wedge, dome osteotomy, wedgeless spike
osteotomy, and wedgeless "V" osteotomy.
Objectives: We aimed in this study to evaluate the effectiveness of medial closing wedge osteotomy in correction of
deformity.
Patients and Methods: This study was done on 32 knees (18 patients) with age ranged from 10 to 18 years with mean
average of 15.61 ± 1.28 years. After recording history and physical examination, appropriate radiographs were taken.
We did varus distal femoral osteotomy by standard medial subvastus approach then followed the patients clinically
and radiographically.
Results: Mean operation time was 139.72 ± 42.4 minutes, with minimum 90 minutes and maximum 170 minutes.
The mean time to union of osteotomy was 8.9 weeks (ranged from 7 to 11 weeks). The mean preoperative
tibiofemoral angle (TFA) was 16.5° (range: 12°­19°) that improved after surgery to a mean postoperative value of
2.57° (range: 1.3°­4.7°), which was statistically significant (P < 0.001).
Conclusion: Distal femoral varus osteotomy can be a reliable procedure for the treatment of valgus knee deformity. In
this procedure, with more tibiofemoral angle correction, more congruence angle correction can be achieved.
Therefore, along with genu valgum correction, the patella should be stabilized simultaneously.
Key words: Genu valgum, Pathological, Femur, Osteotomy.

INTRODUCTION

Genu valgum involves medial angulation of the
directly under the iliotibial band (6). Corrective
knee and outward deviation of the longitudinal axis of
osteotomy for excessive genu valgum is appropriate
both the tibia and femur. Persistent genu valgum in
when the patient presents near or after skeletal
adolescents induces abnormal gait and functional
maturity (7). Young patients with valgus alignment and
disturbances (including difficulty in running, knee
lateral compartment disease including isolated lateral
discomfort, patellar malalignment, lateral patellar
compartment arthritis, lateral meniscal deficiency,
instability, and ligamentous instability) (1).
and/or focal chondral or osteochondral lateral
Angular knee alignment changes according to the
compartment defects are excellent candidates for a
age of the child. It is genu varum with internal tibial
distal femoral osteotomy (8).
torsion at birth and then aligns to straight legs by the
The aim of the present study was to evaluate the
eighteenth month to the twenty-fourth months. Further
effectiveness of medial closing wedge osteotomy in
drifts into valgus with about 12 degrees around five
correction of deformity.
years. This genu valgum spontaneously correct by age

of seven years to that of normal adult values of around
SUBJECTS AND METHODS
8 degrees (2).
This prospective clinical study was conducted on
After seven years old, correction of excessive
18 adolescents aged between 10 and 18 years
physiologic genu valgum may be indicated (3).
presenting with a genu valgum deformity. They were
Nutritional rickets is the leading cause of these
admitted
to
Orthopedic
Department
Zagazig
deformities in developing countries. The deformity
University Hospitals during the period from April
may originate from the distal femur, proximal tibia, or
2020 to April 2021.
the knee joint (4). Genu valgum usually originates from

the distal femur that may be confirmed by various
Ethical approval:
angle measurements on standing radiographs of both
Written informed consent was obtained from all
lower limbs including hips, knees, and ankles (5).
participants and the study was approved by the
The advantages of medial closing wedge are:
Research Ethical Committee, Faculty of Medicine,
Direct bony contact leads to inherent stability and
Zagazig University. The work has been carried out
reliable bony healing compared to the need for bone
in accordance with The Code of Ethics of the World
grafting of an opening-wedge technique. There is less
Medical Association (Declaration of Helsinki) for
hardware irritation because of the plate not being
studies involving humans.

This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2456
Received:30 /4 /202
1

Accepted:26 /6 /2021




Full Paper (vol.841 paper# 132)


c:\work\Jor\vol841_133 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2461-2466

COVID-19 Pandemic and Hemodialysis: Disease Parameters and Outcome:
Single Center Study
Mohamed Saeed Hassan, Howayda Abdelhamid Elshinnawy, Sahar Mohamed Shawky,
Ahmed AbdelMoniem Emara, Reem Mohsen Elsharabasy, Mostafa Abdelnasier Abdelgawad
Department of Nephrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Ahmed AbdelMoniem Emara, Mobile: (+20) 01006721401, E-Mail: ahmed_emara@med.asu.edu.eg

ABSTRACT
Background:
Coronavirus disease 2019 (COVID-19) has significantly affected the provision of medical services. The
hemodialysis (HD) facilities together with other medical facilities faced challenges in safely providing clinical care to
patients and staff during the pandemic.
Objective: To describe our experience during the COVID-19 pandemic as regard infection, mortality rate, clinical
manifestations, illness duration and the efficacy of our local infection control measures in our Hemodialysis Unit, Ain
Shams University Hospital, Cairo, Egypt.
Patients and Methods: followed the interim guidance provided by the US Centers for Disease Control and Prevention
(CDC) together with the European Renal Association­ European Dialysis Transplantation Association (ERA-EDTA)
for dealing with the emerging COVID19 pandemic in HD centers. The study included 238 patients on regular HD from
Dialysis Unit in Ain Shams University Hospitals. We monitored all patients and staff members for any symptoms or
signs of respiratory tract infection and those confirmed to have COVID-19 infection were followed up through their
illness.
Results: 42 out of total 238 patients were diagnosed to have COVID19 infection by combination of symptoms, chest
imaging and SARS COV PCR. Their mean age was 49.8 ± 8.9 years, 19 were males, the mean ± SD total illness duration
for all COVID-19 positive patients was 17 ± 8.7. Patients were further subdivided based on survival into cure group (34
patients) and death group (8 patients). CRP and D-dimer were all significantly higher in death group while O2% were
significantly lower in death group compared to cure group.
Conclusion: COVID 19 pandemic still a major health problem worldwide with significant morbidity and mortality
among hemodialysis patients.
Keywords:
Ain Shams University Hospital, COVID-19 pandemic, Hemodialysis.

INTRODUCTION
patients are older and have concomitant diseases
The SARS-CoV-2 virus causes novel coronavirus
including cardiovascular disease, hypertension, diabetes,
disease (COVID-19), which predominantly manifests as
and lung disease, as well as an underlying immune-
an acute upper and lower respiratory tract sickness that
compromised state, all of which are linked to worse
can be exacerbated by interstitial and alveolar
outcomes in COVID-19 infection patients (4). The
pneumonia. Multiple additional tissues, including the
logistical features of MHD, such as recurring physical
heart, digestive tract, kidneys, blood, and neurological
presence at health care facilities and physical closeness
system, may be affected (1).
of patients during hemodialysis, enhance the risk of
The clinical course varies greatly, ranging from
disease transmission. As a result, it's critical to
asymptomatic or very mild (up to 80%), to severe
implement suitable preventative tactics as soon as
involvement with unilateral or bilateral pneumonia
possible in outpatient hemodialysis centres (4).
(approximately 15%), to a very serious course with
Estimates of mortality in the general population
bilateral pneumonia and respiratory distress requiring
range from 1.4 percent to 8%, with the risk of death
ventilatory support in the intensive care unit (ICU; 3%­
rising dramatically if the patient necessitates
5%). In extreme circumstances, an immune response can
hospitalization (1). The impact of this virus on individuals
cause a significant inflammatory response, as well as a
with chronic renal disease, on the other hand, remains
cytokine storm, which can exacerbate respiratory
unknown. Given these patients' advanced age and
symptoms and even lead to death (2).
comorbidities, mortality may be greater than in the
Until July 2021, the COVID-19 pandemic in
normal population, particularly among dialysis patients
Egypt had a steadily increasing curve of 283k verified
(5). We still do not know the specific characteristics of the
cases with 16,403 death reports. In Egyptian hospitals,
disease in this population. To date, only isolated
however, restrictions have been developed to limit
observations or small case series on prevalence and
elective hospitalizations and stop needless procedures,
mortality rate have been reported(6).
although not hemodialysis therapy, of course (3).
"Interim Guidance for Infection Prevention and
For a variety of reasons, patients on maintenance
Control Recommendations for Patients with Suspected
hemodialysis (MHD) are more susceptible to COVID-19
or Confirmed COVID-19 in Outpatient Hemodialysis
infection and accompanying consequences. Many MHD
Facilities" official guidance can be freely accessed at 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/)
2461
Received: 28/4/2021

Accepted: 24/6/2021



Full Paper (vol.841 paper# 133)


Measurement of Serum Lipid Level in Children with Congenital Heart Diseases The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2467-2473

Serum Level of Preptin in Children with Type-1 Diabetes Mellitus and
Its Relation to Diabetic Nephropathy
Wafaa Fathy Mohamed Elsaeed1, Hadeel Mohamed Abdel Rahman1,
Nader Guima Sasi1, Haidy Essam Eldin Zidan2
Departments of 1Pediatrics and 2Medical Biochemistry & Molecular Biology,
Faculty of Medicine - Zagazig University, Egypt.
*Corresponding author: Nader Guima Sasi, Mobile: (+20)01102916031, E-mail: narrabty@gmail.com

ABSTRACT
Background:
Type 1 diabetes is one of the most prevalent long-term diseases of childhood globally.
Objective: This study aimed to evaluate a new biomarker such as preptin in patients with type 1 diabetes and to assess
its relation to diabetic nephropathy.
Patients and methods: This study was a case-control study that carried on 34 children and adolescents with type 1
diabetes mellitus in addition to 17 healthy children at the Pediatric Endocrinology Unit, Pediatric Department, Zagazig
University Hospitals, from June 2020 to April 2021. All patients were subjected to laboratory investigations including fasting
blood glucose levels, HbA1c, kidney function tests, lipid profile, serum albumin, urinary albumin, albumin creatinine ratio,
glomerular filtration rate (GFR) and serum preptin.
Results:
This study showed that age, weight and BMI were significantly higher among group II with no significant difference
between group I and II by LSD. Also, there was no significant difference among groups regarding gender or family history of
DM.
Conclusion: Serum preptin is significantly lower in patients with diabetic nephropathy compared with diabetic patients
without nephropathy and healthy subjects.
Keywords:
Preptin, Type-1 Diabetes Mellitus, Diabetic nephropathy.

INTRODUCTION
Insulin is one of the most important hormones in
Type 1 diabetes mellitus (T1DM) is a chronic
regulating body metabolism. Insulin secretion and/ or
autoimmune disease characterized by increased blood
action are affected by several other peptides (7). Preptin
glucose levels (hyperglycemia), which are due to insulin
is a peptide related to glucose metabolism, which
deficiency that occurs as the consequence of the loss of
consists of 34 amino acids. Preptin originates from pro-
the pancreatic islet -cells (1, 2). Type 1 diabetes is one
insulin-like growth factor II (pro IGF II). It is secreted
of the most prevalent long-term diseases of childhood
from pancreatic cells in response to glucose (8). Preptin
globally. It has major health consequences for
levels were reported to be altered in patients with type 2
individuals and society. Numerous studies have
diabetes with glucose intolerance. Besides, preptin was
reported an increasing incidence of Type 1 diabetes in
also
reported
to
mediate
insulin
secretion
children worldwide, with significant variation in
physiologically depending on glucose concentrations (9).
incidence by country (3).
Pancreatic -cell destruction in patients with type I
The complications of chronic diabetes are
diabetes mellitus avoids the secretion of insulin and
subdivided into microvascular and macrovascular
preptin, whereby falling their effects on the RUNX2
complications. Microvascular complications include
gene (10).
nephropathy, neuropathy and retinopathy, which are
Wnt signaling pathway plays an important role in
specific to diabetes. Macrovascular complications
podocyte dysfunction of DN (11). Xiao et al. (12) reported
manifest predominantly as coronary heart disease, but
that preptin promoted the proliferation and osteogenesis
also cerebrovascular disease and peripheral artery
of osteoblast-like cells by activating Wnt/-catenin
disease; these conditions are not specific to diabetes, but
signaling pathway. Therefore, preptin may promote the
people with T1DM are at risk of developing these
podocyte dysfunction, the progression of albuminuria,
conditions (4). Diabetic nephropathy (DN), a chronic and
and at last DN through Wnt/-catenin pathway (6).
progressive process leading to end-stage renal failure,
This study aimed to evaluate a new biomarker
has a prevalence of approximately 20% - 40% in
such as preptin in patients with type 1 diabetes and to
patients with diabetes. Metabolic and hemodynamic
assess its relation to diabetic nephropathy.
alterations caused by hyperglycemia and hypertension

are considered to be regulators in the pathogenesis of
PATIENTS AND METHODS
DN (5). There are no effective treatments for DN except
A total of 34 children and adolscents selected from
delaying the progression of DN or renal replacement
the Pediatric Diabetes Clinic were included in the study
therapies. Hence, it is essential to look for new
in addition to 17 healthy children.
biomarkers for early diagnosis and perform some
reasonable treatments for patients at risk (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/)

2467
Received:30 /4 /2021


Accepted:26 /6 /2021



Full Paper (vol.841 paper# 134)


Research Proposal The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2474-2479

Can Relative Blood Loss and Operative Time Predict Prolonged Length of
Stay following Total Joint Arthroplasty? A Retrospective Study from
Single Center in Saudi Arabia
Fahd Ibrahim Aljuaid*
Department of Surgery, Faculty of Medicine, Taif University, Taif, Saudi Arabia
*Corresponding author: Fahd Ibrahim Aljuaid, Mobile: +966532667738, E-mail: aljuaidfahd@gmail.com

ABSTRACT
Background:
Total joint arthroplasty still causes a lot of blood loss, and many patients require blood transfusions
thereafter. Blood transfusions can increase the risk of surgical site infection and periprosthetic joint infection, which can
lengthen hospital stays and have a negative impact on patient outcomes.
Objective: This study aimed to examine if relative blood loss and operative time could predict the postoperative
increased length of stay following total joint arthroplasty.
Patients and methods: A total of 187 procedures done during 2018­2021 were collected. Any revision case or any
patient with hematological disorders was excluded. This led to a cohort of 181 procedures. The following data were
collected: age, height, weight, body mass index (BMI), sex, procedure, surgery start time, surgery end time, preoperative
hemoglobin and hematocrit levels, postoperative hemoglobin and hematocrit levels, number of packed red blood cells
(PRBCs) transfused and the volume of each unit, and the length of stay (LOS).
Results: In our study, age (p = 0.027, odds ratio = 1.076) and relative blood loss (p = 0.038, odds ratio = 1.036) were
predictors of prolonged LOS. Similarly, there was a significant association between age, operative time (p < 0.01), and
blood loss (p < 0.001) and LOS.
Conclusion: The operative time, relative blood loss, and age were found to significantly affect the LOS. However, no
significant association was found between LOS and gender or BMI.
Keywords: Blood loss, Total joint arthroplasty, Length of stay.

INTRODUCTION
level of blood loss. Furthermore, the measurement of the
Osteoarthritis is one of the most common chronic
relative blood loss is easy and requires few resources (6).
diseases (1). Over 80% of its patients present with some
This study is a retrospective review of our
degree of movement limitation, and 40% of these
institute's electronic system of TJA patients, which was
individuals rate their quality of life as fair or poor (2).
performed to identify patients who underwent primary
When the disease progresses to advanced stages and the
unilateral total knee replacement, bilateral total knee
conservative management fails, total joint arthroplasty
arthroplasty, or total hip arthroplasty from 2018 to 2021.
(TJA) is an excellent choice to decrease the pain and
A total of 187 procedures were identified. Any revision
improve the quality of life (2).
case or any patient with bleeding disorder or missing
TJA is performed on a large number of patients
data was excluded. This resulted in a cohort of 181
annually. It is a well-described and safe treatment. The
procedures.
mean length of stay (LOS) following TJA surgery is
The electronic files for the patients undergoing
around 3 days (3). The literature shows that 30% of the
the procedure were reviewed in detail to extract data
cost of TJA is associated with the hospital room (4).
pertaining to the study: age, height, weight, body mass
Decreasing the LOS helps in decreasing the cost,
index (BMI), sex, procedure, surgery start time, surgery
improving efficacy, and freeing up resources, which will
end time, preoperative hemoglobin and hematocrit (Hct)
help decrease patient waiting time to receive the
levels, postoperative hemoglobin and hematocrit levels,
treatment. Identified predicators of prolonged LOS are
number of packed red blood cells (PRBCs) transfused
age over 64 years, operating time, American Society of
and the volume of each unit, and the LOS. LOS was
Anesthesiologists score of 2 or greater, and comorbid
defined as the number of nights the patient was admitted
conditions (1,2, 5­8).
from the date of surgery to the date of discharge.
This study aimed to examine if relative blood loss
For the postoperative hemoglobin and
and operative time could predict the postoperative
hematocrit, we tried to collect the reading at the 3rd day
increased LOS following TJA. To our knowledge, this is
postoperatively. If not available, we selected the 2nd day
the first study in Saudi Arabia with this aim.
postoperative reading, and if not available we selected

the 1st day postoperative reading.
PATIENTS AND METHODS
Our institute uses allogeneic blood for
The present study uses patient-specific measure
transfusion. The volume of each unit is variable and
of relative blood loss, which is calculated as a percentage
recorded for each dispensed unit from the blood bank.
by dividing the intraoperative blood loss by the estimated
The decision to give blood transfusion is physician
preoperative total blood volume. This patient-specific
dependent, with general rules as hemoglobin drop below
measure may describe more accurately the acceptable
8 g/L or signs and symptoms of postoperative anemia.

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/)

2474
Received:28 /4 /2021

Accepted:24 /6 /2021



Full Paper (vol.841 paper# 135)


c:\work\Jor\vol841_136 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2480-2485

Circulatory Hsa_Circ_0007777 Expression Level as A Predictive Biomarker of
Thyroid Dysfunction in Patients with Hashimoto's Thyroiditis
Nearmeen M. Rashad1, Marwa H.S Hussien2, Rehab M. Atef3, Shimaa Abdelmoneem1, Mohamed G. Hamed1
Departments of 1Internal Medicine, 2Medical Biochemistry and
3Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed G. Hamed, Mobile: (+20) 01228588047, E-mail: mohamed1gaber@gmail.com

ABSTRACT
Background:
Hashimoto's thyroiditis (HT) is the most common cause of hypothyroidism in iodine-sufficient areas of
the world.The pathophysiology of HT is contributed to a combination of genetic susceptibility and environmental
factors.
Objective: We aimed in the current study to investigate the relative expression level of hsa_circ_0007777 in patients
with or without HT and to assess their associations with thyroid dysfunction.
Patients and Methods: A case-control study included 70 patients with HT and 70 healthy control subjects.Anti-
thyroglobulin (anti-TG), anti-thyroid peroxidase (anti-TPO) were measured. Real-Time Quantitative PCR (RT-qPCR)
analyses were used to detect the relative expression levels of hsa_circ_0007777.
Results: Hsa_circ_0007777 relative expression level was up regulated in patients with HT in particular patients with
clinical hypothyroidism (CHT) and subclinical hypothyroidism (SCHT) compared to the euthyroid group. Andit was
correlated positively with TSH, anti-TPO, and anti-TG. Moreover, linear regression analyses test revealed that in HT
patients the main independent variables associated with hsa_circ_0007777 relative expression level were anti-TPO and
anti-TG.
Conclusion: The relative expression levels of hsa_circ_0007777 were significantly increased in patients with HT more
specifically in patients with clinical and subclinical hypothyroidism.
Keywords: hsa_circ_0007777, HT; RT-qPCR, Gene expression, Anti-TPO.

INTRODUCTION


Hashimoto's thyroiditis (HT), which is
complex activities such as serving as endogenous RNAs
characterized by thyroid-specific autoantibodies, is one
for sponge miRNAs and controlling parental gene
of the most common autoimmune diseases. Although
expression. Furthermore, through suppressing miR-145
the exact origin of Hashimoto's thyroiditis is unknown,
expression, circRNAs are responsible for the regulation
it is believed to be caused by a mix of inherited,
of vascular smooth muscle cells (VSMCs) migration,
environmental, and epigenetic factors. It is also known
proliferation, and differentiation (7).
as chronic lymphocytic thyroiditis (1). Although HT can
Furthermore, Li et al. (8) detected dysregulation
induce overt hypothyroidism, the majority of patients
of hsa_circ_0045272expression level in systemic lupus
with high TSH and normal thyroid hormone levels have
erythematosus.
subclinical hypothyroidism (2). Several important
We aimed in the current study to investigate the relative
genetics and environmental variables that contribute to
expression level of hsa_circ_0007777 in patients with
the pathogenesis of HT have been studied in depth (3).
or without HT and to assess their associations with
Despite this, little is known about the epigenetic
thyroid dysfunction.
anomalies that occur in HT, particularly those that

involve circular RNA (circRNA). According to
PATIENTS AND METHODS
accumulating evidence, non-genetic factors control
A case-control study included 140 unrelated
gene expression and phenotypes, as well as their
women: 70 patients with HT and 70 healthy controls.
involvement in disease development (4). As a result,
The enrolled HT patients were stratified into 5
epigenetic processes can affect genes involved in the
subgroups based on the guidelines for the use of thyroid
immune system or thyroid, and epigenetic dysfunctions
function tests, all patients were subjected to thorough
of these genes can result in autoimmune diseases (5).
history taking and full clinical assessment. Patients with
CircRNAs are single-stranded closed circular
a history of cancer, liver, kidney or any active
RNA molecules that lack poly (A) tails and 5-3 ends
inflammatory diseases were excluded from this study.
(1). CircRNAs were discovered in eukaryotes in 1979 as
All the participants had the following
an endogenous RNA splicing product and in humans in
laboratory investigation, thyroid function tests
1986 after hepatitis delta virus infection (3, 4). CircRNAs
including FT3, FT4, anti-thyroglobulin antibodies (anti-
have been related to the pathophysiology of a variety of
TG), anti-thyroid peroxidase antibodies (anti-TPO) and
human illnesses, including osteoarthritis (5) and
serum thyroid-stimulating hormone (TSH), FT3, and
diabetes (6). CircRNAs have been found to play a key
FT4 concentrations were measured by luminescence-
function in autoimmunity among epigenetic regulators
based immunoassay using Immulite 2000 (Diagnostic
(4). According to new findings, circRNAs perform
Products Corp., Los Angeles, California, USA) (10).

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/)
2480
Received:30 /4 /2021

Accepted:26 /6 /2021



Full Paper (vol.841 paper# 136)


c:\work\Jor\vol841_137 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2486-2494

Role of Visual Field Testing and OCT in Evaluation of Brimonidine as a
Neuroprotector in Primary Open Angle Glaucoma
Moustafa Kamal Nassar, Hany Ahmed Khairy, Sameh Mohamed El Gohary, Ahmed Mohamed Fawzy Deif *
Department of Ophthalmology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Ahmed Mohamed Fawzy Deif, Mobile: (+20)1227413780, Email: ahmedfawzyeyedr@gmail.com


ABSTRACT
Background:
Glaucoma is the leading cause of global irreversible blindness optic neuropathy and retinal ganglion cell
(RGC) death are the hallmarks of glaucoma. If intraocular pressure (IOP) is held within "normal" ranges, the disease
process and RGC death can still progress in some patients. Neuroprotective therapies for glaucoma should aim to halt
RGC loss thus preventing further structural and functional damage of the optic nerve
Objective: The aim of the current work was to study the ability of visual field testing and optical coherence tomography
to reveal the neuroprotective role of brimonidine.
Patients and Methods:
This prospective randomized controlled trial study included a total of 98 eyes from 50 patients
affected by primary open-angle glaucoma (POAG). They were recruited from a larger population of 70 POAG patients,
attending at Menofiya University Hospitals.
Results: The use of visual field-testing parameters have revealed that brimonidine had insignificantly halted glaucoma
progression: MD (-0.1115 dB and -.2465 dB), VFI (-0.5882 and-1.1471) and PSD (0.1729 and 0.1894). On the other
hand, some OCT parameters: average RNFL thickness (-0.7273 u and-2.2121 u), inferior RNFL thickness (-0.735 u and
-1.559 u), superior RNFL thickness (-0.6364u and -1.4848 u), rim area (-0.0162 mm2 and-0.0797 mm2), average cup
disc ratio (-0.01765 and 0.01824) and vertical cup disc ratio (-0.0167 and 0.0321) for study and control groups
respectively, gave promising neuroprotective results for brimonidine.
Conclusion: It could be concluded that the use of visual field-testing parameters (MD, VFI and PSD) has revealed that
brimonidine had insignificantly halted glaucoma progression.
Keywords: Brimonidine, Primary open angle glaucoma, Neuroprotection

INTRODUCTION


Glaucoma is the leading cause of global irreversible
PATIENTS AND METHODS
blindness. Over 79 million people worldwide are
This prospective randomized controlled trial study
expected to be affected by primary open angle
included a total of 98 eyes from 50 patients affected by
glaucoma in 2020 and 111.8 million by 2040 (1).
POAG, attending at Menofiya University Hospitals.
Optic neuropathy and RGC death are the hallmarks

of glaucoma(2). Elevated intraocular pressure has
Ethical Consideration:

remained a clinical focus in glaucoma. However, the
This study was ethically approved by the
relationship between IOP reduction and glaucoma
Menofiya University Ethics Committee. Written
damage is less than clear. If IOP is held within "normal"
informed consent of all the subjects was obtained.
ranges, the disease process and RGC death can still
This work has been carried out in accordance with
progress in some patients (3).
The Code of Ethics of the World Medical
Neuroprotective therapies for glaucoma should aim
Association (Declaration of Helsinki) for studies
to halt RGC loss thus preventing further structural and
involving humans.
functional damage of the optic nerve (4). Since its

introduction in 1996, the use of brimonidine has become
Inclusion Criteria:
an increasingly popular ocular hypotensive therapy(5).
The study included 98 eyes from 50 patients affected by
Preclinical studies have clarified numerous mechanisms
POAG were recruited from a larger population of 70
for neuroprotection that brimonidine may exhibit.
POAG patients based on the following inclusion
Moreover, many clinical trials on brimonidine as a
criteria:
neuroprotection agent have been conducted either
Best-corrected visual acuity of 20/40 (Refractive
within or outside the field of glaucoma.
errors below +/- 6 diopters).
The aim of this study was to investigate the role of
No history or evidence of retinal or
visual field testing and OCT in evaluation of
nonglaucomatous optic nerve diseases, laser
brimonidine eye drops as a neuroprotector in primary
therapy, or ocular surgery.
open-angle glaucoma (POAG) by providing functional
Absence of any contraindication for the
and structural evidence of brimonidine ability to slow
medications used in this study.
the progression of POAG throughout a non-IOP related
Each patient had a definite diagnosis of glaucoma
mechanism.
based on glaucomatous damage to the optic disc

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/)
2486
Received: 29/4/2021

Accepted: 25/6/2021



Full Paper (vol.841 paper# 137)


c:\work\Jor\vol841_138 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2495-2499
Effectiveness of Angioplasty in Treatment of Diabetic Foot Patients with
Infragenicular Single Stenosis or Occlusion: A Prospective Study
Ali Mahmoud Mohamed Galal*, Mohamed Ahmed Mohamed Ismail
Vascular Surgery Department, Faculty of Medicine, Aswan University, Egypt
*Corresponding author: Ali M. M. Galal, Mobile: (+20)1001816078, E-Mail: a_mando76@yahoo.com

ABSTRACT
Background:
Diabetes is linked to both microvascular and macrovascular complications, such as retinopathy,
nephropathy, and neuropathy (microvascular) and ischemic heart disease, peripheral vascular disease, and
cerebrovascular disease (macrovascular), resulting in organ and tissue damage in approximately one third to one half of
people with diabetes.
Objectives: The aim of the current work was to examine the effectiveness and safety of infragenicular angioplasty in
diabetic patients with critical limb ischemia (CLI) due to single stenosis or occlusion.
Patients and Methods: The current study was a prospective cohort investigation that recruited diabetic patient with
infragenicular CLI with or without supragenicular lesion at Vascular Surgery Department, Aswan University Hospital.
The primary endpoint in our study was the primary patency at the end of sixth month of follow-up.
Results
: This study included 20 patients with age ranged between 42 years and 82 years; the majority of patients were
males (75%). Eighteen patients (90%) had immediate success; after six months, 14 patients (70%) remained patent. By
the end of the sixth month post-revascularization, 15 patients (75%) had limb salvage, while four out of the remaining
patients had rest pain relief (80%). Healing of minor ulcers occurred in 80% of the patients, and healing of tissue after
debridement or minor amputation occurred in 60% of the patients.
Conclusion: It could be concluded that infragenicular angioplasty exhibited efficacy in the management of CLI due to
single stenosis or occlusion in diabetic patients, with acceptable patency rate and safety profile.
Keywords: Diabetes, Diabetic Foot, Limb Ischemia, Infragenicular Angioplasty,

INTRODUCTION


The epidemic of diabetes mellitus (DM) has
ulcers and more extensive tissue damage as consequence
increased dramatically over the past decades and become
of peripheral neuropathy (4). CLI can lead lo leg
on the apex of chronic diseases across different parts of
amputation in up to 40% of the affected patients and an
the world. According to recent literature, DM affects
over-all mortality in up to 25%, which reflect the adverse
nearly 9% of the global population, with highest
effect exerted by CLI on diabetic patients (10). The leg
prevalence in the Eastern Mediterranean Region. The
amputation itself is a risky procedure in this type of
number of affected people is expected to rise to 642
population -who are usually old and have several
million patients worldwide by the end of 2040 (1,2).
comorbidities- with reported postoperative mortality of
Moreover, DM is a major cause of mortality and exerts
10% and unfavorable long-term survival (11). Thus,
substantial burden on healthcare expenditure amongst
reducing the rate of leg amputation represents the
different parts of the world (3).
cornerstone in the management of CLI patients. In the
Patients with DM are prone to increased risks of
setting of lower limb ischemia, surgical bypass is the
wide range of complications, which mainly develop
modality of choice owing to anatomical factors and
secondarily to micro and macro-vascular affection (4). It
favorable clinical outcomes (12).
was reported that diabetic patients had two-to-four folds
A growing body of evidence highlighted
increase in the risk of peripheral arterial disease (PAD),
promising results of infragenicular angioplasty in
compared to healthy population (5).
diabetic patients with CLI; it was shown that
Various risk factors are incorporated in the
infragenicular angioplasty achieved high patency rates
development of PAD in diabetic patients, which lead to
and limb salvage in diabetic patients, which were
impaired metabolic status and chronic vascular
comparable to non-diabetic patients (13). Nonetheless,
inflammation; in return, diabetic patients exhibit rapid
limited data are available about the safety and efficacy
progression of atherosclerosis and ischemic symptoms
of infragenicular angioplasty in limited resources areas
(6). The co-existence of PAD in diabetic patient is a well-
like Egypt.
established risk factor for cardiovascular morbidity and
Accordingly, our study was aimed to examine
mortality (7).
the effectiveness and safety of infragenicular angioplasty
Critical limb ischemia (CLI) is the end-stage
in diabetic patients with critical limb ischemia (CLI) due
form of PAD that significantly increase the risk of
to single stenosis or occlusion.
amputation and overall mortality in diabetic patients (8).

The progression to CLI was noted to occur at faster rate
PATIENTS AND METHODS
in diabetic than non-diabetic patients (9). Moreover, in
This prospective cohort study included a total of 20
diabetic patients, CLI is usually associated with foot
diabetic patients with infragenicular CLI due to single

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/)
2495
Received:29 /4 /2021

Accepted:25 /6 /2021



Full Paper (vol.841 paper# 138)


c:\work\Jor\vol841_139 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2500-2504

A Comparative Study between Different Therapeutic Modalities for the
Management of Patients with Graves' Disease
Elshorbagy EA, Najlaa Ali Khalifa, Mohamed El Hamali Mohamed Zawia*, Mohamed M. Awad
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Mohamed El Hamali Mohamed Zawia, Mobil: (00218)927520875,
E-mail: mahamedzawia@gmail.com



ABSTRACT


Background: The most prevalent cause of thyrotoxicosis is Graves' disease. It can be treated with antithyroid
medications (ATD), radioactive iodine (RAI), or a near-total thyroidectomy, among other options.
Objective:
The aim of the current study was to compare between different therapeutic modalities for the management
of patients with Graves disease.
Patients and Methods: This Prospective Cohort study included a total of 48 patients with Graves' disease, treated and
followed up at the Endocrinology Unit, Department of Internal Medicine, Faculty of Medicine, Zagazig University and
both Outpatient Clinics and Medical Departments of Tripoli Medical Center. All patients were subjected to clinical
examination of thyroid gland, thyroid function tests (FT3, FT4, TSH) and measurement of thyroid stimulating hormone
receptor autoantibodies (TRAb) level.
Results: There was statistically significant difference of mean TRAb value before and after treatment in three
therapeutic modalities. On other hand, there was marked decreased mean TRAb after treatment with different modalities;
difference statistically significant p<0.05. The decline percent of TRAb values were 97.41%, 93.48%, 82.01% by
surgical modalities, GI modalities and GII modalities respectively.
Conclusion:
It could be concluded that surgery appear to be the useful therapeutic modality associated with significant
decrease in TRAb level and inducing remission of graves' disease.
Keywords: Graves' disease, TRAb, Antithyroid drugs, Radioiodin therapy.


INTRODUCTION


Graves' disease is an autoimmune disease
Ethical Consideration:
characterized by the activation of thyroid-stimulating
This study was ethically approved by Research Ethics
hormone (TSH) receptor antibodies (TRAb) and
Committee of the Faculty of Medicine, University of
hypersecretion of thyroid hormone(1). It is treated using
Zagazig. Study had been performed on research with
three different modalities: antithyroid drugs, radioactive
human subjects in accordance with the Code of Ethics of
iodine (RAI) ablation, or surgery (2).
the World Medical Association (Declaration Helsinki).
TRAb is a useful diagnostic tool for diagnosis of
Written informed consent of all the subjects was
Graves' disease. The prevalence of TRAb in
obtained.
hyperthyroid and Graves disease is 70-100 % (3,4).

The fate of TRAb during and following Graves'
Individuals aged between 37-53 years with GD.
disease (GD) treatment is an important aspect of the
Participants were categorized into three groups; Group
pathophysiology of GD and has been examined
I: included 16 patients with GD (3 male & 13 female,
previously (5). Most studies showed a decline in TRAb
mean age value 44.56±4.23 and duration of disease
levels over months to years (6). The rate of decline
2.88±1.15). They had received antithyroid drugs.
depended on treatment modality and initial TRAb
Group II: included 16 patients (2 male &14 female,
levels(5).
mean age value 44.13±4.75 and duration of disease
The aim of the present study was to comparative
3.06±1.12) with GD They had received radioiodine
study between different Therapeutic Modalities for the
therapy. Group III: included 16 patients with GD (2
management of patients with Graves disease.
male & 14 female, mean age value 46.94±4.65 and

duration of disease 3.25±1.13). They were subjected to
PATIENTS AND METHODS
near total thyroidectomy.
This Prospective Cohort study included a total of
Inclusion criteria included patients with Graves'
48 patients with Graves' disease, treated and followed
disease diagnosed by Clinical, biochemical and
up at the Endocrinology Unit, Department of Internal
immunological evidence, TRAb, with or without goiter.
Medicine, Faculty of Medicine, Zagazig University and
Exclusion criteria included other causes of
both Outpatient Clinic and Medical Departments of
thyrotoxicosis.
Tripoli Medical Center. This study was conducted

between March 2020 to March 2021.



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/)
2500
Received: 30/4/2021

Accepted: 26/6/2021



Full Paper (vol.841 paper# 139)


c:\work\Jor\vol841_140 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2505-2509
Frequency and Correlation of Serum Uric Acid to Different Stages of
Albuminuria in Type II Diabetic Nephropathy
Nafesa M. Kamal*1, Eman Magdy Abdull-Aty2, Amal Zedan3,
Yasser Abd El Monen El Hendy1, Ibrahim M. Salem1
Departments of 1Internal Medicine and 3Clinical Pathology, Faculty of Medicine,
Zagazig University, Zagazig, Egypt
Department 2Internal Medicine, Al-Ahrar Teaching Hospital, Zagazig, Egypt
*Corresponding author: Nafesa M. Kamal, Mobile: (+20) 01005618371, E-Mail: Nanaashraf8979@gmail.com


ABSTRACT
Background:
Albuminuria is considered the gold standard of onset and progression of diabetic nephropathy (DN).
Higher levels of serum insulin may decrease uric acid clearance by the kidneys leading to hyperuricemia, which has
injurious effect on kidneys.
Objective: To evaluate the frequency and relationship of uric acid to different levels of albuminuria in type II
diabetes mellitus.
Patients and Method:
This cohort study included 56 T2DM patients classified according to stages of DN into: Group
I that including 12 patients with normoalbuminuria, group II included 26 patients with microalbuminuria, and group
III including 18 patients with macroalbuminuria. All of them were evaluated for serum creatinine and albumin, CBC,
ACR, UAE, HbA1c, ESR, Serum TSH and serum uric acid (SUA).
Results: Hyperurecemia frequency was (62.5%) and it had highly statistical significant difference with albuminuria in
the three studied groups. There was strong significant positive correlation of SUA with UAE (p < 0.014), Cr (p <
0.037), ACR (p < 0.006), HbA1c (p < 0.017) in macroalbuminuria and UAE (p<0.042) and ACR (p < 0.043) in
microalbuminuria group, and TLC (p < 0.024) in normoalbuminuria group. While there was a significant negative
correlation between UA with albumin (p < 0.029) in macroalbuminuria group.
Conclusions: Hyperinsulinemia and chronic inflammation associated with type IIDM leads to hyperuricemia, which
had high frequency in our study (62.5%) and carry a hazardous effect on kidney function contributing to progressive
increase of albuminuria. So we must search for management of elevated UA in these patients to delay onset &
progression of its morbidity.
Keywords:
Uric Acid, Type II diabetes mellitus, Albuminuria, Egypt.


INTRODUCTION

The overall effects of hyperglycaemia leading to
Organization diagnostic criteria (5). FBS 126 mg/dl,
release of proinflammatory and profibrotic mediators
2-h PPG 200 mg/dl and HbA1c 6.4% in 2 repeated
that cause alterations in intra-renal haemodynamics
times. The patients were classified into group I
resulting in the classic structural and functional
including 12 diabetic patients with normoalbuminuria
alterations of diabetic kidney disease with alterations
(ACR < 30 mg/g), UAE (12.2 ± 8.4), (8 males and 4
in glomerular permeability, and, ultimately, the
females) and eGFR of 92.33 ± 12.45 ml/min/1.73 m2,
development of glomerulosclerosis and interstitial
group II including 26 diabetic patients with
fibrosis (1).
microalbuminurea (ACR = 30-300 mg/g), UAE (95.1
Elevated UA is associated with endothelial
± 60.9) (10 males and 16 females), eGFR of 72.23 ±
dysfunction, insulin resistance, and progression of non-
12.72 ml/min/1.73 m2, and group III including 18
diabetic renal disease (2). These findings have led us to
diabetic patients with macroalbuminurea (ACR > 300
find out the role of uric acid in the onset and
mg/g), UAE of 366.6 ± 26.3 (11 males and 7 females)
progression of diabetic nephropathy (3, 4). The aim of
and eGFR of 42.11 ± 11.82 ml/min/1.73 m2.
the present work was to evaluate frequency and

correlation of hyperuricemia with albuminuria in type
Inclusion criteria: Age equal or more than 18 years,
II DM patients.
T2DM patients and patients on antidiabetic

management or insulin therapy.
PATIENTS AND METHODS


Cohort study had been carried out in
Exclusion criteria including: Age < 18 years or more
Outpatient Clinic of Endocrinal and Nephrology Units
than 65 years, patients refusing to participate in the
of Internal Medicine Department, Zagazig
study, presence of type1DM, diabetic ketoacidosis,
University Hospitals, from October 2017 to November
chronic glomerulonephritis, transplanted recipients,
2018. We conducted this study on 56 T2DM patients
liver disease, evidence of current infection or
(27 females and 29 males) diagnosed according to The
inflammation, blood diseases, blood transfusion or
National Diabetes Data Group and World Health
malignancy, pregnancy, or taking UA lowering agents

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/)
2505
Received:11 /5 /2021


Accepted:26 /6 /2021




Full Paper (vol.841 paper# 140)


c:\work\Jor\vol841_141 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2510-2515

Sputum Bacteriology in Patients with Acute Exacerbation of
Chronic Obstructive Pulmonary Disease
Mahmoud Ahmed Arafa1, 2
1 Department of Chest Disease, Faculty of Medicine, Al-Azhar University, Egypt
2 Pulmonary Consultant, Buraidah Central Hospital, Alqasim, Saudi Arabia
Corresponding author: Mahmoud Ahmed Arafa, Mobile: 00966561429453, E-Mail: mahmoudarfa1977@gmail.com

Abstract
Background:
Acute exacerbation is a common problem in the usual course of chronic obstructive pulmonary disease
(COPD). Infections play a chief role in Acute Exacerbation of Chronic Obstructive Lung Disease (AECOPD) that leads
to significant morbidity and mortality.
Objective: To assess the bacteriology in COPD exacerbations of hospitalized patients and correlate with clinical and
laboratory data of the patients.
Patients and Method:
a prospective study was conducted to correlate clinical, laboratory data with sputum culture
results of 52 patients, admitted to the Pulmonology Department of Buraidah Central Hospital (BCH) with an AECOPD
from 1st January 2018 till 31 August 2018. All collected sputum samples were subjected to standard microbiological
procedures.
Results: Growth of pathogenic organisms was seen in 37 (71%) of the 52 sputum samples tested. Gram-positive
organisms were found in the majority 20 (54 %). Gram negative microbes accounted for 17 (46%). Streptococcus
pneumoniae (24.3 %) was found to be the most common bacterial agent responsible for COPD exacerbations, followed
by Klebsiella pneumonia 7 (18.9 %), Haemophilus influenzae (H influenzae) and Staphylococcus aureus; each was 5
(13.5%), Streptococcus pyogenes (Streptococcus pyogenes) 4 (10.8%), Moraxella catarrhalis (M catarrhalis),
Pseudomonas aeruginosa, and Methicillin-resistant Staphylococcus aureus (MRSA) each was 2 (5.4%)
Conclusion: Sputum culture is considered a simple and good diagnostic modality to identify bacteria in AECOPD.
Antibiogram would assist in developing a local antibiotic strategy and reducing the appearance of resistance stains.
Keywords: Antibiogram, Bacteria, Sputum, Culture.

INTRODUCTION
moderate (treated with short acting bronchodilator,
Chronic obstructive pulmonary disease
antibiotic and or corticosteroid) and severe (necessitate
(COPD) is a common treatable and preventable disease
hospitalization or visit to the emergency department),
characterized by limitation of the airflow, which is
respiratory failure may present (1). Infection and air
progressive and persistent and caused by alveolar and/or
pollution are common causes of COPD exacerbations,
airway inflammation, caused by prolonged exposure to
in one-third of patients the cause remains idiopathic (7).
noxious gases or particles and affected by host factors
Three classes of pathogens included in
such as lung development abnormality (1).
AECOPD are: viruses, atypical bacteria, typical
COPD is a range of airway diseases that
bacteria (aerobic gram positive and gram-negative).
includes chronic bronchitis on one side and emphysema
Bacterial infection is responsible for about 50% of
on the other side. Actually, the majority of patients have
COPD acute exacerbations (8), most common organisms
both (2). COPD remains a major reason of morbidity and
are S. pneumoniae, H. influenzae which are common in
mortality and this varies across countries. In the United
mild and moderate cases, while M. catarrhalis, and P.
States of America alone, around twenty-four million
aeruginosa are more prevalent in advanced cases (9).
persons agonize from COPD and has become the 3rd
The current study was carried out in order to
principal cause of death (3). Usual history of COPD is
assess sputum bacteriology in AECOPD of the patients
interrupted by exacerbations, which is persistent
admitted at the Chest Department of Buraidah Central
worsening of the condition of the patient from the stable
Hospital (BCH). Also, the patients' clinical and
condition and outside ordinary daily variation, it is acute
laboratory data were compared with culture results to
in onset and needs change in ordinary medications (1).
determine whether these parameters can provide a clue
Recurrent attacks of exacerbations lead to rapid
of bacterial infection before the availability of culture
reduction of lung function, decreased physical activity,
results.
poorer quality of life, and increased mortality (4,5). To

PATIENTS AND METHOD
decide if the patient needs antibiotic or not and to assess
The current study was conducted at Chest Department
the severity of exacerbation attack, Winnipeg criteria
in Buraidah Central Hospital, Alqasim Area from 1st of
are used, which are based on new events, which include
January 2018 to 31st of August 2018. It was a
increased shortness of breath, increase amount of
prospective observational study.
sputum and purulence of sputum. Antibiotics are
Inclusion criteria: Patients diagnosed as COPD
indicated if there are at least 2 or more of symptoms (6).
according to GOLD guidelines 2017, and admitted with
Exacerbations are classified into mild, moderate and
AECOPD.
severe. Mild (need only short acting bronchodilator),

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/)
2510
Received: 1/5/2021

Accepted: 27/6/2021



Full Paper (vol.841 paper# 141)


c:\work\Jor\vol841_142 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2516-2521

Evaluation of Intraperitoneal Instillation of Levobupivacaine versus
Ultrasound Guided Rectus Sheath Block for Post-Operative Pain Relief
Following Laparoscopic Cholecystectomy
Ahmed A. Metwally, Nagwa M. Doha, Amany A. Sultan, Hend A. Okasha*
Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Menoufia University,
Egypt.
*Corresponding author: Hend A. Okasha, Mobile: (+20) 01220593448, E-Mail: hendokasha93@gmail.com
Abstract
Background:
Laparoscopic cholecystectomy (LC) is not a painless process, with the most acute pain occurring on the
day of surgery and the next day. Postoperative pain management methods include intraperitoneal instillation of local
anaesthetics and rectus sheath block (RSB), both of which may give excellent pain reduction.
Objectives: The aim of this study was to evaluate the efficacy of intraperitoneal instillation versus rectus sheath block
using levobupivacaine for postoperative pain relief after laparoscopic cholecystectomy.
Patients and methods:
The study was a prospective randomized double-blind study. Patients were randomized into
two groups using a closed envelope technique in sequentially numbered opaque envelopes that was opened by an
anesthesiologist not involved in the study. The study was conducted on 50 patients, 25 each for each group. Group I
received intraperitoneal instillation of 40 ml 0.25% levobupivacaine. Group II (Rectus sheath block) received bilateral
RSB with 40 ml of 0.25% levobupivacaine (20 ml on each side).
Results:
There was high statistical significant difference between groups as regard VAS. There was high statistical
significant difference between groups as regards patient satisfaction, which was more increased among rectus sheath
group. Conclusion: U/S-guided rectus sheath block is effective as analgesic technique as intraperitoneal instillation of
levobupivacaine led to more patient satisfaction, lower postoperative pain and lower amount of anaesthetic consumption.
Both techniques are simple, safe, and without adverse effects. This study favors the administration of rectus sheath block
pre-emptively for postoperative pain relief after laparoscopic cholecystectomy.
Keywords: Laparoscopic Cholecystectomy, Intraperitoneal Instillation, Levobupivacaine
rectus sheath block.

INTRODUCTION

In the treatment of gallbladder illness, LC has
The aim of this study was to evaluate the efficacy
replaced open surgery as the preferred method (1).
of intraperitoneal instillation versus rectus sheath block
Parenteral analgesia (NSAIDS and opioids), epidural
using levobupivacaine for postoperative pain relief after
analgesia, peripheral nerve block, incisional infiltration,
laparoscopic cholecystectomy.
and intraperitoneal instillation utilising local

anaesthetics are all options for postoperative pain
PATIENTS AND METHODS
management (2).
This study was conducted in the operative
Prevention of transmission of nerve signals from
theatres of Menoufia University Hospitals. The study
the trauma site to the spinal cord and reduction of
was a prospective randomized double-blind study.
neurogenic local inflammation at the trauma site has
Patients were randomized into two groups using a
been reported with the use of local anesthetics. As large
closed envelope technique in sequentially numbered
volumes
are
required
in
these
techniques,
opaque envelopes that was opened by an
levobupivacaine, a newer amide may be preferred due
anesthesiologist not involved in the study.
to less risk of cardiovascular toxicity and central
The study was conducted on 50 patients, 25 for
nervous system side effects. Intraperitoneal local
each group. Group I (Intraperitoneal instillation)
anesthetic administration and rectus sheath block (RSB)
received intraperitoneal instillation of 40 ml 0.25%
have been used as a methods for reducing postoperative
levobupivacaine. Group II (Rectus sheath block)
pain (3).
received bilateral RSB with 40 ml of 0.25%
Intraperitoneal local anesthetics acts on visceral
levobupivacaine (20ml on each side).
nociceptors of peritoneum whereas rectus sheath block,
Postoperative: If VAS is 4 the patient was given
with successful blockade of intercostal nerves, provides
Ketorolac 30 mg IV slowly. If after half an hour VAS is
full thickness anesthesia of anterior abdominal wall (4).
still 4, the patient was given 25 mg pethidine, which
Individual studies have been conducted to evaluate the
was repeated every 30 minutes till VAS is < 4.
efficacy of intraperitoneal instillation of local

anaesthetics and RSB, but we have not found any
Data Collection:
studies comparing the efficacy of intraperitoneal
Baseline:
Patients'
demographic
data
and
instillation versus RSB to determine which is superior
hemodynamics (pulse- heart rate- mean blood pressure),
for postoperative pain relief after LC (3).
baseline before induction of anesthesia were recorded.

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/)
2516
Received:1 /5 /2021

Accepted:27 /6 /2021



Full Paper (vol.841 paper# 142)


c:\work\Jor\vol841_143 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2522-2526

Medical and Surgical Treatment of First Trimester Miscarriage,
A Randomized Controlled Trial
Amr Ahmed Abdelrhman, Tarek Abd Elhamid El Behiedy,
Aya El Sayed Mostafa Mohamed*, Mohamed Ramadan Ali
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Aya El Sayed Mostafa Mohamed, Mobil: 01013321544, E-mail: ayaatty8@gmail.com


ABSTRACT
Background:
Abortion is a common complication of early pregnancy that can have both medical and psychological
consequences. Complications following spontaneous or induced abortion are a major cause of maternal morbidity.
Objective: To better management and improving outcome of first trimestric miscarriage.
Patients and Methods: A randomized clinical trial study was conducted at obstetric outpatient clinic, Gynecology and
Obstetrics Department, Zagazig University during the period from May 2019 until June 2021. The study included 52
women suffering from abortion who were randomized to receive either medical treatment: 800 µg misoprostol
prescribed as 400 mg orally and 400 mg vaginally or surgical treatment: evacuation with dilatation and curettage. All
patients were followed up with a transvaginal ultrasonography (U/S). Results: The mean of endometrial thickness after
treatment was 12.5±2.65 mm and 8.3±1.97 mm in misoprostol and surgical evacuation group respectively, the difference
between both groups was statistically significant (p<0.05). Failed treatment was in 8 (30.7%) patients in misoprostol
group and in 2 (7.7%) patients in surgical evacuation group. The difference in failure rate between both groups was
significant statistically. Conclusions: A single dose of 800µg misoprostol given as outpatient treatment may be used as
first line in management of incomplete abortion.
Keywords: Abortion, First Trimestric Miscarriage, Misoprostol.

INTRODUCTION
prostaglandin EP1 receptor and therefore is expected to
Abortion is the most common complication of
have a more restricted range of physiological and
early pregnancy, and remains an important clinical
potentially toxic actions than prostaglandin E2 or other
problem. Approximately 20% of women attending early
analogs, which activate all four prostaglandin
pregnancy units suffer an abortion. Most women will
receptors(7).
present with history of vaginal bleeding, abdominal pain
The drug, misoprostol, has been used to reduce the
or both, which are traditionally associated with
risk of stomach ulcers that occur in people who take
abortion. However significant proportion of women will
certain pain relievers. Misoprostol is now more
be asymptomatic. Knowledge of the pathophysiology of
commonly used to stimulate contractions of the uterus.
this condition is limited and therefore therapeutic
In recent years, physicians have begun prescribing
regimens are based on few data(1).
misoprostol in place of surgery to women who have
The overall early pregnancy loss rate is thought to
experienced an abortion(8).
be nearly 50%. At least 15% of fertilized ova are lost
In recent years, the medical management of
before implantation (2) and 20­25% of pregnancies end
abortion, which can achieve complete uterine
before they can be clinically detected(3), leading to an
evacuation in 95% of early abortions, has been
incidence of spontaneous abortion of some 12­19%
developed as a realistic alternative to surgical
among clinically recognized pregnancies(4).
evacuation(9). The aim of this study was better
The management of abortion has changed little and
management and improving outcome of first trimestric
conventional surgical evacuation of the uterus has been
miscarriage.
recommended when there are retained products of

conception. However, the technique carries a small but
PATIENTS AND METHODS
a real risk of morbidity and mortality(5).
52 patients were recruited for this study from
The method involves the combined use of the
obstetric outpatient clinic. They were suffering from
antiprogesterone, mifepristone, and the prostaglandin
first trimestric abortion.
E1 analogue, misoprostol has been shown to result in

lower costs per patient, compared with surgical
Ethical consent:
treatment(6).
An approval of the study was obtained from
Misoprostol, a prostaglandin analogue, binds to
Zagazig
University Academic
and
Ethical
myometrial cells to cause strong myometrial
Committee. Every patient signed an informed
contractions leading to expulsion of tissue. This agent
written consent for acceptance of sharing in the
also causes cervical ripening with softening and dilation
study. This work has was out in accordance with the
of the cervix. Misoprostol binds to and stimulates
Code of Ethics of the World Medical Association
prostaglandin EP2 receptors, prostaglandin EP3
(Declaration of Helsinki) for studies involving
receptor and prostaglandin EP4 receptor but not
humans.

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/)
2522
Received:1 /5 /2021

Accepted:27 /6 /2021



Full Paper (vol.841 paper# 143)


c:\work\Jor\vol841_144 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2527-2533

Transient Constrictive Pericarditis: A Recent 2 Countries Study
Alaa Omar1, Ashraf Fawzy Mahmoud1, Omar Dawoud1, Mahmoud Eldegwy1, Abdullah Osama Mahfouz2
1Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
2Department of Cardiothoracic Surgery, Faculty of Medicine, Fayom University, Egypt
*Corresponding author: Alaa Omar, Mobile: (+20) 01001168488, Email: alaaomarcts1@yahoo.com

ABSTRACT

Background: Constrictive pericarditis (CP) is a disease of the pericardium that leads to impaired diastolic fil ing of the
heart. The treatment of such a disease entity is known to be purely surgical by pericardiectomy.
Patients and methods: This is a prospective, analytical non-randomized study conducted during the period from January
2014 to November 2020. 34 cases of constrictive pericarditis were referred to us for management; 12 of them (35.29%) had
a classic picture of definite constrictive pericarditis with areas of calcifications and typical symptoms of constrictive
pericarditis (group A). 22 cases (64.71%) had typical symptoms but they responded to medical treatment with complete
resolution of the pathology and symptoms (group B).
Results: In group A, the mean age was 37 ± 12.3 years. They were treated with pericardiectomy via median sternotomy. 2
cases had persistent symptoms; there was no mortality operative or post-operative. 4 of them were TB positive. In group B,
the mean age was 42 ± 14.1years. Al were treated medical y and resolved total y. Al were preceded with influenza like
symptoms or chest infection with bilateral pleural effusion and al were TB negative. Biopsies were taken from the
pericardium revealing nonspecific reaction.
Conclusion: There was an entity of constrictive pericarditis, which is known as transient constrictive pericarditis. It is a
different pathology which is mostly autoimmune. It responds to medical treatment. There was no calcification, it might be
recurrent and is associated with variable amounts of pericardial effusion and bilateral pleural effusions.
Keywords: Constrictive pericarditis (CP), Transient CP, Classic CP.

INTRODUCTION

In the 1980s, Hancock (3) described that kind of
Constrictive pericarditis (CP) is a pericardial disease
pathology but within the context of the classic one,
process characterized by the development of right sided
attributing this elastic form as acute or subacute reversible
heart failure secondary to impaired diastolic fil ing of
inflammation. In his opinion it was a step in the same
pericardial etiology despite preserved right and left
pathological entity. But later in 1987 Sagrista-Sauleda
ventricular myocardial function. CP can be classified into
and his colleagues (2) described the transient constrictive
three different subtypes including transient CP, effusive
pericarditis as a separate entity not as a phase of the
CP, and chronic pericardial constriction. In fact, overlap
classic constrictive pericarditis describing it in 9%-17%
may present between these distinct subtypes. Transient
of al cases of pericarditis with effusion that resolved on
pericarditis was first described in 1987 when a case series
medical treatment only. Patients of transient CP were
of 16 patients with pericardial constriction were proven to
mostly idiopathic or attributed to viral infections. The
have
permanent
resolution
of
constrictive
patients they fol owed had no other similar attacks with
pathophysiology by echocardiography after an average of
no eventual constriction, fibrosis or calcification of the
2.7 months spontaneously (range of 12 days to 10 months)
pericardium. They attributed the pathology to
(1, 2, 3).
inflammation, edema and fibrin deposits. Sagrista-
In 2015 the European Society of Cardiology (ESC)
Sauleda and colleagues(2) did not report recurrence in 31
addressed the transient constrictive pericarditis as a
months fol ow up period but they did not emphasize on
variant of CP. The main effect of constrictive pericarditis
the single attack nature of this disease but they declared a
is the impedance of the diastolic fil ing (biventricular) of
three phases evolutionary pattern; phase 1, no constriction
the heart leading to low cardiac output (COP) and
and moderate effusion, Phase 2, decreased amount of
congestive heart failure, which is reversible even
effusion and constriction, and Phase 3, normal
spontaneously, regardless of the cause (1). Constrictive
pericardium and normal hemodynamics. Other authors
pericarditis is caused by fibrosis of the parietal
reported cases fol owing viral infection, autoimmune
pericardium and sometimes affects the visceral
diseases, bacterial infection and idiopathic. Al authors
pericardium too. It might be acute, subacute or chronic
denied radiation therapy correlation to transient CP.
but what characterizes that pathological entity is fibrosis,
Others proposed causes of transient CP might be
calcification, loss of elasticity and fixity of the pathology
malignancy, trauma, col agen vascular diseases or post-
(2).
pericadiectomy (4, 5). Despite most authors reporting good

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/)
2527
Received:3 /5 /2021

Accepted:29 /6 /2021



Full Paper (vol.841 paper# 144)


c:\work\Jor\vol841_145 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2534-2537

Evaluation of Cytomegalo Virus Seropositivity in Haemodialysis
Patients and its Relation to Metabolic Syndrome
George Emad Shaker1, Heba Shafeak Abd El Khalik1, Rehab Ahmed Rabie2
, Ramy Wagdy Ahmed Abd ElAziz1
Departments of 1Internal Medicine and 2Medical Microbiology and Immunology,
Faculty of Medicine ­ Zagazig University, Egypt

ABSTRACT

Background: Chronic haemodialysis patients are at high risk for infection because the process of haemodialysis (HM)
requires vascular access for prolonged periods. The human Cytomegalo Virus (CMV) is a DNA virus belonging to the
Herpesviridae family, Betaherpsvirnae subfamily and Cytomegalo virus gender, known as Human Herpes Virus Type 5,
one of the main causes of morbidity. Acute CMV infection is characterized by system-wide viremia after which latency
and lifelong persistence is established in selected cel s such as CD34+ monocytes and hematopoietic progenitor cel s in
humans.
Objective: The work was designed for early detection of CMV infection and metabolic syndrome (MetS) in patients on
HD.
Patients and Methods:
In this cross-sectional study, 80 patients under regular HD due to end-stage renal disease (ESRD)
had participated in the study from HD Unite of Nasr City Health Insurance Hospital in Cairo in the period from June
2019 to December 2019.
Results: In the present study, patients were divided into three groups, first group 78 patients were positive for CMV IgG
(97.5%), second group 11 patients were positive for CMV IgM (13.8%) and third group 10 patients were positive for
both IgG and IgM (12.3%). In our study the females have more CMV antibodies. In the present study, patients with
metabolic syndrome were 68 (85%). Patients who had MetS and CMV IgG were 68 (100%). The relationship between
MetS and CMV IgG is statistical y proved.
Conclusion:
the importance of early investigation for metabolic syndrome components especial y in patients who are
immunocompromised like HD patients because of the high prevalence of both chronic CMV infection and reactivation.
Keywords: Metabolic syndrome, Haemodialysis, Cytomegalo virus, Evaluation.

INTRODUCTION
spread and reactivation. One wel described arm of anti-
The number of patients with end-stage renal
CMV immunity, the CD8 T cel compartment, is
disease treated by maintenance haemodialysis has
heavily involved in viral control with up to 5­10% of
increased sharply during the last 30 years. Chronic
total CD8s in the blood and secondary lymphoid tissues
haemodialysis patients are at high risk for infection
reactive to CMV antigens during a primary immune
because the process of haemodialysis requires vascular
response (4). It has become clear that the blood contains
access for prolonged periods. In an environment where
a major pool of CMV-reactive T effector memory
multiple patients receive dialysis concurrently, repeated
(TEM) cel s that presumably scan the vasculature as a
opportunities exist for person-to-person transmission of
bulwark against systemic CMV reactivation and that
infectious
agents, directly
or indirectly
via
accumulate with age (5).
contaminated devices, equipment, environmental
Metabolic syndrome (syndrome X, insulin
surfaces or hands of personnel (1).
resistance) is a multiplex risk factor that arises from
The human CMV is a DNA virus belonging to the
insulin resistance accompanying abnormal adipose
Herpesviridae family, Betaherpsvirnae subfamily and
deposition and function (6). It is a risk factor for coronary
Cytomegalo virus gender, known as Human Herpes
heart disease, as wel as diabetes, fatty liver, and several
Virus Type 5, one of the main causes of morbidity.
cancers. The clinical manifestations of this syndrome
Acute CMV infection is characterized by system-wide
may
include
hypertension,
hyperglycaemia,
viremia after which latency and lifelong persistence is
hypertriglyceridemia, reduced high-density lipoprotein
established in selected cel s such as CD34+ monocytes
cholesterol (HDL-C), and abdominal obesity (7).
and hematopoietic progenitor cel s in humans (2).
The work was designed for early detection of CMV
Although CMV infections are general y asymptomatic,
infection and metabolic syndrome in patients on HD.
untreated infections in utero or amongst the

immunocompromised
individuals
can result in
PATIENTS AND METHODS
substantial developmental defects, pathology, and death
In this study a total of 80 patients who were under
(3).
regular hemodialysis due to ESRD, were evaluated for
However, in immunocompetent patients the
CMV antibodies and metabolic syndrome components.
substantial and varied NK, CD8, CD4, and B cel s
The study involved patients of HD unite from Nasr city
resources are mobilized to successful y control viral
health insurance hospital in Cairo in the period from

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/)
2534
Received:2 /5 /2021

Accepted28 /6 /2021



Full Paper (vol.841 paper# 145)


c:\work\Jor\vol841_146 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2538-2541

Evaluation of Lacrimal Sac Diameter in Different Age groups
Using Ultrasound Biomicroscopy
Mohamed Ezzat Abdelfatah, Emad Mohamed Elhady, Tamer Gamal Elsayed,
Nawal Elsayed Mohamed Elyamani
Ophthalmology, Faculty of Medicine, Zagazig University, Egypt
Corresponding Author: Nawal Elsayed Mohamed Elyamani, Mobil: (+20)01009085472,
E-mail: mohamedsalahallsurgery@gmail.com


ABSTRACT

Background: Chronic dacryocystitis is the most frequent disorder in the lacrimal drainage system. The disease has been
considered to be strongly associated with obstruction of the lacrimal duct, which creates a fertile environment for bacterial
colonization and promotes lacrimal sac inflammation.
Objective:
The aim of this work was to evaluate lacrimal sac diameter in different age groups using ultrasound
biomicroscopy (UBM).
Patients and Methods: Twenty-four eyes of 24 normal individuals. They were divided according to age into 3 groups;
group A: age ranging between 30 and 40 years, group B: age ranging between 40 and 50 years and group C: age above
50 years. Lacrimal sac diameter was assessed. Ocular examination and special tests were done for lacrimal drainage
system (regurge test and fluorescein dye disappearance test) with imaging of lacrimal passages by ultrasound
biomicroscopy.
Results:
All patients had no symptoms of epiphora, negative both regurge test and dye disappearance test and clear
contents of the lacrimal sac. There was no statistically significant difference between groups regarding either longitudinal
or horizontal lacrimal sac diameter. Conclusion: UBM can be used for imaging and measuring lacrimal passages and thus
can be useful as an adjunctive to clinical examination and surgical planning in cases with lacrimal system diseases.
Keywords:
Chronic dacryocystitis, Lacrimal, UBM.

INTRODUCTION


Ultrasonography was first applied as a diagnostic
Meanwhile, all human tissues exhibit ultrasound
tool for ophthalmology in 1956. A-mode was followed
attenuation coefficients that increase almost linearly
by B-mode ultrasonic imaging modalities that presented
with frequency, which results in less penetration (5). The
anatomical information in a distinctive display format
use of conventional frequency ultrasound has been
(1). Subsequently, further technological developments
reported in evaluation of the lacrimal sac (LS) tumours
had a major impact on our ability to measure ocular
or diseases causing distention of the sac, but evaluation
dimensions, accurately confirm diagnoses, monitor
is difficult in the normal-sized sac and canalicular
ocular diseases, and visualize valuable characteristics of
system (6). Considering the superficial position and fine
orbital lesions. Ultrasonography has evolved markedly
structure of the lacrimal duct system, the frequently used
in the past three decades with the era of digital image
imaging techniques for the examination of the lacrimal
processing and development of very high frequency
duct, such as dacryocystography, B-scan ultrasound,
ultrasound that led to ultrasound biomicroscopy (UBM)
computed tomography (CT), magnetic resonance
(2).
imaging (MRI), and radioisotope scanning, cannot
UBM permits observation of living tissues at
clearly display the lacrimal duct system (7). The
microscopic resolution using high ultrasound
application of an imaging technique that can clearly
frequencies of 25 MHz or higher. The name is derived
display the structure of the lacrimal canaliculi would
from its similarity to optical biomicroscopy, as it
facilitate the diagnosis of lacrimal duct system diseases
enables visualisation of living tissues in 20-60 mm
(8).
resolutions depending upon its frequency (3).
UBM is a non-invasive technique and has been
Commercial 50 MHz ultrasound biomicroscopy became
widely applied in the evaluation of diseases of the
available in the early 1990s (4).
anterior segment of the eye due to its high resolution.
To evaluate human tissues, we need maximum
UBM has a potential to be an ideal technique for the
resolution as well as deeper penetration of the
imaging examination of the entire upper part of lacrimal
ultrasound beam. The real challenge facing developers
drainage system particularly lacrimal puncta and
of the UBM was that resolution of the ultrasound
canaliculi. UBM has been used in the examination of
increases with higher frequencies.
normal lacrimal canaliculus and in the detection of

lacrimal canalicular diseases (9).

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/)
2538
Received:2 /5 /2021

Accepted:28 /6 /2021



Full Paper (vol.841 paper# 146)


c:\work\Jor\vol841_147 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2542-2547

Postoperative Parents' Satisfaction in Cases of Simple Unilateral
Cleft Lip Repaired by Millard's Procedure
Mohamed Elekiaby, Tarek Gobran, Ahmad Rozik, Wael Mansy, Omar Elekiaby
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt.
Corresponding Author: Mohamed Hosny Abdelhamied Khalil Elekiaby, Mobile: 00201000433326,
E-mail: Mohamed_elekiaby@hotmail.com

ABSTRACT
Background:
Cleft lip is the second most common congenital anomaly (after club foot) accounting for about 13% of
all congenital anomalies, and the overall incidence is 1 in 1000 live births. An individual with a disfigurement may be
more prone to developing psychological problems. Patient and parent satisfaction is a key indicator of treatment quality.
Objective: The purpose of this study was to improve satisfaction after repaired simple unilateral cleft lip by Millard's
procedure. Patients and Methods: This was a prospective cohort study including 24 patients with unilateral cleft lip.
The study was performed in the Pediatric Surgery Department, Zagazig University Hospitals. The study was performed
in the period from September 2020 to May 2021. All patients were subjected to full history taking, general and local
examinations and investigations; including complete blood count and coagulation profile tests. Results: There was
statistically significant relation between severity of cleft lip and symmetry at the Cupid's bow p=0.043 and nasal
symmetry p=0.002. It was obvious that incomplete cleft lip had hundred percent good result regarding symmetry at the
Cupid's bow and nose while there was statistically insignificant relation between parents opinion about symmetry and
severity of cleft lip p>0.05. Conclusions: Counseling the parents and thereby motivating them and educating them
regarding the cleft and the various procedures by which the deformity can be tackled are one of the most important
aspects of treatment.
Keywords: Millard's, Parents, Unilateral Cleft Lip.

INTRODUCTION

flattened upper lip and loss of the shape of the cupid's
Clefts of the lip (CLP) are common congenital
bow(6).
malformation(1). The incidence of cleft lip, globally, is

3.4 to 22.9 per 10,000 live births. An individual with a
Thus, the method used by surgeon to determine
disfigurement may be more prone to developing
whether a patient needs a lip revision has been based
psychological problems(2). The impact on quality of life
mainly on the surgeon subject evaluation of the
for the child and the family can be severe, particularly
nasolabial appearance at rest. On the other hand,
in unsuspecting families. Emotional and psychological
objective functional or movement measures developed
needs must be recognized and addressed, in addition to
to assess the outcome of facial soft tissue surgeries(7). So
surgical care, for all those involved with the patient(3).
we designed this study to improving satisfaction after
Several techniques have been described for
repaired simple unilateral cleft lip by Millard's
surgical management of cleft lips. The Millard rotation-
procedure.
advancement flap, which aims to preserve the philtral

dimple, remains the most widely used approach,
PATIENTS AND METHODS
comprising 84% of all repairs performed in North
A prospective cohort study was carried out in the
America(4). The Mohler modification on the Millard
Pediatric Surgery Department, Zagazig University
technique uses the columella to lengthen the lip to
Hospitals. The study was performed at a period from
minimize scarring on the upper third of the philtrum.
September 2020 to May 2021. It included 24 patients
Recently, Fisher described a method that produces a
with unilateral cleft lip.
scar mirroring the non-cleft side's philtral column from

the base of the nose to the peak of the Cupid's bow.
Ethical consent:
Fisher's technique also uses a smaller triangle back cut
An approval of the study was obtained from
and has lower tension on the lip repair and purportedly
Zagazig
University Academic
and
Ethical
approximates natural anatomic subunits more closely
Committee. Every caregiver of each patient signed
than the Millard or Mohler techniques. However, the
an informed written consent for acceptance of the
Fisher technique uses 25 anatomical landmarks to guide
operation. This work was carried out in accordance
the reconstruction, making it time-consuming and
with the Code of Ethics of the World Medical
complex(5).
Association (Declaration of Helsinki) for studies
A repaired cleft lip is characterized by presence of
involving humans.
scar tissue that generally results in obvious deformities

like asymptomatic upper lip vermilion, tightened and
Inclusion Criteria:

This article is an open access article distributed under the terms and conditions of the Creative


Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
2542
Received: 1/5/2021

Accepted:27/6 /2021



Full Paper (vol.841 paper# 147)


c:\work\Jor\vol841_148 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2548-2553

The Effect of Omega 3 Fatty Acids Intake on Drug Resistant
Epilepsy (DRE) in Children
Mennatallah O Shata*1, Rasha H Aly1, Manar A ElHalim2
1Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
2Department of General Practitioner, Ministry of Health, Cairo, Egypt.
*Corresponding author: Mennatallah Osama Shata, Mobile: +201006636930, E-mail: mennahshata@gmail.com

ABSTRACT
Background:
Epilepsy is a frequent neurologic disease in children. Epilepsy is one of humanity's oldest diseases, and it is
still the most prevalent neurological disorder afflicting people of all ages. It is estimated that 50 million people worldwide
suffer from epilepsy at any given moment.
Objectives: To assess the effect of omega 3 supplementation on seizure control in patients with drug resistant
epilepsy, and to compare the effect of the use of low-dose omega 3 versus high dose on seizures control of these
patients.
Patients and Methods: The study included 44 patients 26 males (59.1%) and 18 females (40.9%) as one patient
dropped off during the study. Their mean age was 6.35±3.59 years, they were followed up at Outpatient Pediatric
Neurology Clinic, Children's Hospital, Ain Shams University.
Results:
The primary finding in the current study was that there was a statistically significant decrease in seizure
frequency after low-dose omega 3 (1 capsule/day, 1000 mg of eicosapentaenoic (EPA) + docosahexaenoic acid
(DHA)). The secondary finding in the current study was that there was a statistically significant decrease in severity of
seizures after low-dose fish oil (1 capsule/day, 1000 mg of EPA+DHA). The tertiary finding in the current study is
that there was no statistically significant decrease in seizure frequency, duration, and severity after high dose omega 3
(2 capsules/ day, 2000 mg EPA +DHA) compared with before using omega 3 at the beginning of the study.
Conclusion: Low dose fish oil (1 capsule/day, total of 1000 mg EPA+DHA) was associated with a 50% reduction in
seizure frequency and reduction rate 4.62% in seizure severity compared with before using omega 3 supplementation in
patients of drug resistant epilepsy.
Keywords: Drug Resistant Epilepsy, Omega 3 Fatty

Acids.



INTRODUCTION

Epilepsy is a noncommunicable brain disorder
central nervous system by affecting cell membrane
that affects about 50 million individuals worldwide.
fluidity and phospholipid composition.
Recurrent seizures, which are brief periods of
Omega-3 fatty acids can be obtained through
involuntary movement involving a section of the body
consumption of oily fish - such as a trout, mackerel,
(partial) or the full body (generalised) and are
tuna, herring, sardines, and salmon - and fish oil
occasionally followed by loss of awareness and control
supplements (5).
of bowel or bladder function (1).

Medication resistant epilepsy is defined as the
Objectives: To assess the effect of omega 3
failure of adequate trials of two tolerated, adequately
supplementation on seizure control in patients with
chosen and utilised antiepileptic drug regimens
drug resistant epilepsy, and to compare the effect of
(whether as monotherapies or in combination) to
the use of low-dose omega 3 versus high dose on
achieve persistent seizure independence (2).
seizures control of these patients.
Because the brain is one of the organs with the

largest concentration of lipids in the form of fatty
PATIENTS AND METHODS
acids, which play a role in membrane construction, 50
Prospective case-control randomized, clinical
percent of fatty acids in the grey matter are
trial of two doses of fish oil: low dose and high dose,
polyunsaturated, with 33 percent belonging to the
in participants with drug resistant epilepsy
omega-3 family. The omega-3 fatty acids (mainly
The study was conducted on 45 children
alpha-linolenic acid, ALA) participated in one of the
following up in the Pediatrics Neurology Clinic-Ain
first experimental demonstration of the effect of
Shams Children's Hospital. Patients were classified into
dietary substances on the structure and function of the
three groups {group 1 receiving low dose omega 3,
brain (3).
group 2 receiving high dose omega 3, group 3 control
Bloch and Qawasmi (4) proved that increasing
group} seizure control was evaluated at recruitment and
omega-3 fatty acid levels in the diet can affect the
3 months after (at the end of the study).
structure and function of proteins embedded in the
Seizure control was assessed by seizures

frequency, seizure duration, and severity using Chalfont

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/)

2548
Received:1 /5 /20 21

Accepted:27 /6 /2021



Full Paper (vol.841 paper# 148)


c:\work\Jor\vol841_149 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2554-2558

CT Evaluation of Rotational Malalignment after Intertrochanteric Fracture Fixation
Elshazly Saleh Mosa, Mosaab Ahmed Mohamed*, Ahmed Saleh Sleem, Hosam El-Azab
Department of Orthopedic, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Mosaab Ahmed Mohamed, Mobile: (+20) 01014672739, E-Mail: mos3ab22333@gmil.com

ABSTRACT
Background:
Intertrochanteric fractures account for 60% of all proximal fractures of femur and most of these fractures
occur in patients over 65 years of age and mostly affect females. They are fixed mostly either by proximal femoral nails
(PFN) or dynamic hip screw (DHS) post reduction under C- arm images.
Objective: To evaluation by CT the quality of reduction in the horizontal plane.
Patients and methods: Prospective study including 20 patients operated for intertrochanteric fracture femur between
April 2019 and December 2019. Thirteen fractures were treated using DHS plate and screw fixation and 7 with PFN.
All these patients underwent postoperative CT of the pelvis and knee on the same day of the operation during their
hospitalization with measurement of anteversion of the operated and healthy necks of femur compared with a tangent
posterior condyles of femur.
Results: There was malalignment greater than 15° on the operated side compared to the unoperated side at 30% of
patients.
Conclusion: The rate of rotational malreductions of operated trochanteric fractures is very high; 30%, with a majority
of external over rotation occurred during reduction maneuvers. The criteria normally used for reduction of trochanteric
fractures are insufficient to prevent rotational malalignment. The increase in the number of C-arm images seems to be
an advantageous to avoid these reduction errors during pre- and intraoperative maneuvers.
Keywords: CT, Intertrochanteric Fracture Fixation, Rotational Malalignment.

INTRODUCTION

The majority of intertrochanteric fractures in
(4). When the femur s inspected along its long axis from
occurs in patients over 65 years old and are mostly
top to bottom, the angle created by a line anteriorly
affecting woman. They are associated with an
protruding from the femoral neck in comparison to the
increasing incidence due to population aging and
femoral shaft is known as femoral anteversion angle
associated bone fragility and osteoporosis. Trochanteric
(FAVA). Assessment entails measurement of the
fractures represent 60 percent of all proximal femoral
femoral neck angle with modifications made for
fractures (1).
rotation of the femoral condyles (5).
Intra-medullary nailing and dynamic hip screw
The purpose of this research was to assess the
are the two most widely-used kinds of open reduction
rotational malalignment after trochanteric fractures
and internal fixations (ORIFs). Often DHS is performed
reductions and osteosynthesis.
by surgeons because to its frequency and reputation for

ease (2). In treatment of osteoporotic intertrochanteric
PATIENTS AND METHODS
fractures, dynamic hip screw (DHS) has been regarded
A prospective study including 20 patients, 7
the gold standard. Nailing has, however, become
males and 13 females was conducted between April
popular among surgeons, especially for certain types of
2019 and December 2019 in the Orthopedic Department
unstable fractures with improved cephalomedullary
of Sohag University Hospital. Follow-up visits were
nailing techniques (3).
scheduled at 1, 3, 6 and 12 months following the
The quality of postoperative reductions of these
operation.
fractures is determined for the most part at the time of

the pre- and intraoperative reduction maneuvers.
Exclusion criteria:
Although the quality of reduction is simple to evaluate
1. Poly traumatized patient.
in the frontal plane and has been reported in the
2. Patient with bilateral trochanteric fracture.
literature. The frontal images do not hold true for
3. Patient with subtrochanteric extension (type A3).
rotational malalignment. The objective of this
4. Patients with congenital anomalies.
prospective study was the CT evaluation of the quality
5. Patients had surgery on the contralateral femur.
of hip reduction in the horizontal plane (4). After
6. Patients with neoplasm.
procedure, the same day of the operation, a CT was done
7. Patients with osteomyelitis.
with measurement of anteversion in neck of both

femurs. Anteversion of neck femur average was
Preoperative assessment:
measured using Jeanmart et al. technique to determine
History taking, evaluation of the general condition,
the angle between the tangent through the both posterior
associated other injures, clinical examination of the
condyles of the femur and the axis of the neck of femur
fracture site, neurovascular assessment, the radiological

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/)
2554
Received:2 /5 /2021

Accepted:27 /6 /2021



Full Paper (vol.841 paper# 149)


TITLE PAGE The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2559-2564

Study of Embolic Cerebral Stroke in Atrial Fibrillation Patients.
Severity, Recurrence and Outcome
Ashraf M. Mohamed Mostafa1, Yaser I. Fathy1, Mahmoud K. Ahmed2,
Khaled H. Afifi3, Naglaa S. Abd El hady Hammad1
Departments of 1Anesthesia, Intensive Care & Pain Management, 2Cardiology and 3Neurology,
Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Naglaa Samy Abd El hady Hammad, Mobile: (+20)01066361920, Email: naglasamy.ns@gmail.com

ABSTRACT
Background:
Patients with AF and concomitant potential cardiac sources of embolism increase the risk of recurrent
embolism despite anticoagulation.
Objectives: The aim of this study was to study different cardiac sources of embolism in stroke patients with AF and
was to study if the presence of concomitant cardiac sources of embolism in AF stroke patients has impact on stroke
severity, recurrence, response to treatment & outcome.
Patients and methods:
The study was a prospective clinical study that was conducted on 60 patients admitted to the
Intensive Care Unit (ICU), Menoufia University Hospitals. The patients were divided into 2 groups: Group I: Patients
with concomitant cardiac sources of embolism. Group II: Patients without concomitant cardiac sources of embolism.
Results: There was significant difference found between the two groups regarding recurrence (P=0.045). We found
that Elders, diabetics, patients with dyslipidemia, patients with CVD, severe National Institutes of Health Stroke Scale
(NIHSS) score patients and big infarction size were significantly associated with poor stroke outcome.
Conclusion: In conclusion, we found that most of the recurrent ischemic strokes were associated with elders, diabetics,
patients with dyslipidemia, patients with CVD, severe NIHSS score patients and big infarction size.
Keywords:
Stroke, Atrial fibrillation, Recurrence, NIHSS score, Infarction.

INTRODUCTION


Approximately 20% of ischemic strokes are
concomitant potential cardiac sources of embolism and
caused by cardioembolic mechanisms (1). Atrial
those without among stroke patients with AF.
fibrillation (AF) is the most common cause of embolic

sources from the heart, and AF-related strokes
PATIENTS AND METHODS
constitute about 60% of all cardioembolic strokes (2).
The study was a prospective clinical study that
Stroke patients with AF frequently have
was conducted on 60 patients admitted to the Intensive
concomitant potential cardiac sources of embolism.
Care Unit (ICU), Menoufia University Hospitals.
Many of those potential cardiac sources of embolism
Inclusion criteria: Any adult patient admitted to ICU
can be identified through the echocardiographic
with stroke and AF.
studies. Transesophageal echocardiography (TEE) is
Exclusion criteria: Patients with relevant proximal
superior to transthoracic echocardiography (TTE) for
arterial occlusion, lacunar stroke, procedural stroke,
the detection of potential cardiac sources of embolism
TIA (transient ischemic attack) and patients who have
in ischemic stroke (3). Some potential cardiac sources
any contraindication to TEE.
of embolism, which include intracardiac thrombus,

cardiac
tumors,
infective
and
non-infective
ABSOLUTE CONTRAINDICATIONS:
endocarditis, spontaneous echo contrast (SEC), and
Esophageal
spasm,
esophageal
stricture,
patent foramen ovale, are diagnosed mainly based on
esophageal laceration, esophageal perforation and
TEE evaluation. In addition, TEE is the gold standard
esophageal diverticula.
for the detection of aortic plaques (4). AF patients with
RELATIVE CONTRAINDICATIONS:
coexisting SEC may have increased frequency of
Large diaphragmatic hernia may significantly
intracardiac thrombus and increased risk of stroke.
hinder TEE imaging because of lack of transducer
Stroke patients with AF and concomitant cardiac
mucosal approximation. Atlantoaxial disease and
sources of embolism had more severe stroke.
severe generalized cervical arthritis: TEE should never
Studies hypothesized that thrombi from AF with
be performed if there is any question about stability of
the concomitant potential cardiac sources of embolism
cervical spine. Patients who received extensive
are larger and/or more resistant to an endogenous
radiation to the mediastinum; this can cause significant
thrombolytic system than those from AF without
difficulty in probe manipulation within the esophagus
concomitant potential cardiac sources of embolism,
and is a relative contraindication if the anatomy of the
which may lead to more severe stroke. Therefore, we
esophagus is not known. Upper gastrointestinal
investigated whether stroke severity, recurrence and
bleeding, significant dysphagia and odynophagia are
outcome is different between patients with
also relative contraindications.



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/)
2559

Received:3 /5 /2021


Accepted:29 /6 /2021



Full Paper (vol.841 paper# 150)


c:\work\Jor\vol841_151 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2565-2575

Ultrasonographic Optic Nerve Sheath Diameter as A Surrogate
Measurement of Intracranial Pressure in Preeclampsia
Ahmed Mohamed Mohamed Ali El-Din*, Doaa Galal Diab,
Ibrahim Ibrahim Abd El-Basir, Amal Rashad Reyad
Department of Anesthesia, Surgical Intensive Care and Pain, Faculty of Medicine, Mansoura University,Egypt
*Corresponding author: Ahmed Mohamed Mohamed, Mobile: (+20) 01288045390, E-Mail: ahmedalieldin2000@gmail.com

ABSTRACT
Background:
Preeclampsia affects five to ten percent of pregnant women and accounts for about twelve percent of
maternal mortality. It is the third most common cause of maternal mortality worldwide. Papilledema is an indirect and
late indicator of raised intracranial pressure (ICP), whereas a pressure rise in optic nerve sheath (and the resulting
enlargement of the optic nerve diameter) is a more dynamic process. The retrobulbar optic nerve sheath diameter
(ONSD) can be measured at a position 3 mm posterior to the globe, where ultrasound contrast is greatest with more
reproducible results.
Objective: To evaluate the correlation between ultrasonographic measurement of ONSD with the degree of severity of
preeclampsia.
Patients and methods: This prospective observational study was conducted at Mansoura University Hospital Intensive
Care Unit from July 2019 to June 2020. Just after delivery, 175 pregnant females aged between 18 and 45 years old
were enrolled for participating in this study. Out of them, 25 females were excluded.
Results:
As regarding body weight, there was a significant difference between the control group (79.9±6.36 kg) and
preeclamptic without severe feature group (87.7±10.58 kg). The mean body weight in severe preeclampsia group was
(91.5 ±14.73kg) which showed no significant difference from that of the non-severe group. ONSD values showed
significant difference between the studied groups. The control group had ONSD mean value of 4.85±0.32 mm, mild
preeclamptic group had mean value of 6.05±0.096 mm, while severe preeclampsia group had a mean value of 6.76±0.25
mm.
Conclusion: Ultrasonographic measurement of ONSD provides a non-invasive, quick and readily accessible tool for
evaluation of raised intracranial pressure (ICP).
Keywords: Intracranial pressure, Optic nerve sheath diameter, Preeclampsia, Ultrasonographic.

INTRODUCTION

Preeclampsia is an exclusive complication of
characteristics of raised ICP can be visualized(7).
pregnancy that is defined as the presence of high blood
Nowadays, CT scans are readily available in many
pressure with proteinuria after twenty weeks of gestation
hospitals, but in many cases, they are still not easily
(1). However, in the absence of proteinuria, preeclampsia
accessible and the transfer of the patient could be
can be diagnosed by the presence of hypertension in
problematic(8). Therefore, the measurement and
ass0ciation with thrombocytopenia, impaired liver
monitoring of ICP should be performed using a non-
function, renal insufficiency, pulm0nary edema, or new-
invasive, simple, reproducible and bedside method
onset cerebral or visual disturbances(2).
especially f0r emergency department patients(9).
Major complications that threaten the preeclamptic
Changes in the optic nerve sheath diameter (ONSD)
patient include severe hypertension and hypertensive
is an important clinical and radiographic demonstration
emergencies (Intracranial hemorrhage, hypertensive
of raised ICP. Several studies have reported a significant
encephalopathy), acute renal failure, congestive heart
relationship between elevated ICP (independent of the
failure, placental abruption, disseminated intravascular
underlying cause) and the increase in ONSD(10). From a
coagulation (DIC), increased intracranial pressure (ICP),
physiologic standpoint, it can be stated that the increase
retinal
detachment
and
pulmonary
edema(3).
in ICP exerts a pressure on the subarachnoid space
Preeclampsia can also cause fetal growth restriction and
around the optic nerve expanding the nerve sheath(11).
early delivery, and in some cases can lead to fetal death
Several studies have proved the correlation between the
by increasing the incidence of placental complications(4).
high ICP in other pathologies and ultrasonographic
Raised ICP is one of the consequences of
measurement of ONSD(12).
preeclampsia(5). The most precise method of ICP
Thus it is expected that a positive relationship
measurement is the direct invasive measurement of the
between preeclampsia (as one of the causes of increased
intraventricular or subdural pressure. This invasive
ICP) and ONSD exists and if confirmed, the routine use
method is not practical in emergency departments and
of bedside ultrasonography to measure ONSD can be
carries the risk of intracerebral hemorrhage and
used to monitor the increase in ICP. This method can be
infection(6).
also considered as a potential tool for monitoring the
ICP can be non-invasively measured by computed
effects of preeclampsia and anticipating its potential
tomography (CT) scan, but only the secondary
risks and complications(13).

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/)

2565
Received:3 /5 /2021

Accepted:29 /6 /2021



Full Paper (vol.841 paper# 151)


c:\work\Jor\vol841_152 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2576-2580

Short Term Outcome of Closure or Non-Closure of Peritoneum in Caesarian Section
Ali El-Shabrawy Ali, Ahmed El-Sayed Ibrahim, Ahmed Mohamed Abdel-Aziz*, Mustafa Taha Abdel-fottoh
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Mohamed Abdel-Aziz, Mobile: (+20)01021513255, E-mail: dr.Ahmed.elnegehy@gmail

ABSTRACT
Background:
Cesarean section (CS) can be considered as one of the most frequently performed surgical procedure
worldwide, accounting for up to 70% of deliveries, depending on the facility being assessed and the country involved.
In Egypt its rate reach about 51.8% from deliveries. Objetive: To compare closure versus non-closure of visceral and
parietal peritoneum during primary cesarean section regarding early postoperative outcome.
Patients and Methods: A randomized-controlled study that was conducted at Ismailia General Hospitals during the
period from November 2018 to March 2019. Included 142 pregnant women attending Obstetrics and Gynecology
Department for primary cesarean section who were divided into two groups. Group I (Control) 71 patients with closure
of both the visceral and parietal peritoneum (Study) 71 patients with non-closure of both the visceral and parietal
peritoneum. Patients were assessed for intra-operative parameters including operation time. Postoperatively, patients
were assessed for pain degree, distention, fever, regain of intestinal sound, wound infection and duration of hospital
stay.
Results: There was statistically significant difference between both groups regarding age, BMI, parity, gestational age
and type of CS. Non-closure technique of both visceral and parietal peritoneum in CS is associated with shorter operation
time, less postoperative pain score, rapid regain of intestinal motility and less duration of hospital stay.
Conclusion: Non-closure of both visceral and parietal peritoneum at CS is associated with less operative time, less
postoperative pain and distention and wound infection hence routine closure of peritoneum at CS can be avoided.
Keywords: Peritoneal closure , Caesarian section, Peritoneum.

INTRODUCTION

clinical trials, this stage could be easily eliminated since
Caesarean section (CS) is one of the most
it does not increase the rate of morbidity (3). A series of
frequently performed surgical procedures worldwide,
studies evaluated the effects of leaving the peritoneum
accounting for anything up to 70% of deliveries,
open and compared it with closing after CS. Reasons
depending on the facility assessed and the country
noted for closure of the peritoneum include restoring
involved. In general, rates around the world range from
anatomy and re-approximating tissues, reducing infection
about 5% to over 20% of all deliveries (1).
by re-establishing an anatomical barrier, decreasing
There are many ways of performing a caesarean
wound dehiscence, reducing hemorrhage and minimizing
section and the techniques used depend on a number of
adhesions. Reasons cited for non­closure of the
factors including the clinical situation and the preference
peritoneum include: reduction of operation duration,
of the operator. The peritoneum is a thin membrane made
shortening of hospitalization stay, use of less analgesic,
of primitive cells called mesothelium and supported by a
earlier return of bowel function, reduction of urinary
thin layer of connective tissue. It lines both the
bladder adhesion following next CS, and immediate post-
abdominal and pelvic cavities where it is called parietal
operative recovery. It would also reduce the number of
peritoneum. When it covers the external surface of
stitches, which is the preferred option given that the body
internal organs like the intestine, the bladder and the
responds to stitches as if they were a foreign material (4).
uterus, it is termed visceral peritoneum, and during
The step of either suturing or not suturing the
caesarean section these peritoneal surfaces have to be cut
peritoneal surfaces is one of several surgical techniques of
through in order to reach the uterus and for the baby to
caesarean section addressed in Cochrane reviews. If this
be born. Following a caesarean section, it has been
step could be omitted without adverse effect or with
standard practice to close the peritoneum by stitching
benefit for the individual patient, and with a reduction in
(suturing) the two layers of tissue that line the abdomen
operating time and suture material, this could lead to a
and cover the internal organs, to restore the anatomy. It
meaningful cost saving, taking into cognizance the large
has however been suggested that peritoneal adhesions
numbers of caesarean sections performed worldwide (5).
may be more likely rather than less likely when the
The aim of this study was to compare closure
peritoneum is sutured, possibly as a result of a tissue
versus non-closure of visceral and parietal peritoneum
reaction to the suture material (2).
during primary cesarean section regarding early
In CS, surgical complications such as fever,
postoperative outcome.
wound infection, post-operative pain and bleeding occur

more frequently than in normal vaginal delivery and
PATIENTS AND METHODS
these conditions may affect the postnatal care of
This randomized controlled study included 142
newborn infants. Traditionally, suturing of peritoneal
patients with age range from 19-30 years subjected to
layers in CSs have been done, but in many randomized
primary cesarean section. They were divided into two

groups: Group I included 71 patients performed a

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/)
2576
Received: 3/5/2021

Accepted: 29/6/2021




Full Paper (vol.841 paper# 152)


Appendix D2: Templates for Annual Course Reports The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2581-2585

Efficacy of Cybele Scagel Phonophoresis on Post-Burn Hypertrophic Scar
Rofaida Mohie Eldeen Ali Sobh1, Haidy Nady Asham 1,
Sameh Mohammed El-Taher 2, Karim Ibrahim Saafan 1
1Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt.
2Department of Plastic and reconstructive Surgery, Faculty of Medicine, Ain Shams University, Egypt.
*Corresponding Author: Rofaida Mohie Eldeen Ali Sobh, Mobile: (+20) 01270214420,
E-mail: rofaida.sobh202m@yahoo.com
ABSTRACT
Background:
Hypertrophic scar (HTS) formation after burn remains a major issue for burned patients and is considered
a huge problem for clinicians because the hypertrophic scar is painful, reddish, elevated, pruritic, and aesthetically
unacceptable. Objective: To evaluate the therapeutic efficacy of Cybele Scagel phonophoresis on the treatment of
hypertrophic scar post burn cases. Patients and methods: Thirty patients who had hypertrophic scar after wound closure
with ages ranged from 20 to 45 years were selected randomly and divided into two equal groups in number (15 patients
each). Group A (study group): received Cybele scagel phonophoresis, 3 sessions per week for 8 weeks (24 sessions),
while patients in group B (control group): received topical cybele scagel for 8 weeks. Methods of assessment before
and after the study included Modified Vancouver scar scale (VSS) to assess hypertrophic scar characteristics (height,
vascularity, pigmentation and pliability) and digital imaging for visual assessment of the scars.
Results: the results of the study showed that between groups comparison, there was no significant difference in VSS
between both groups pre-treatment (p > 0.05). Comparison between group A and group B post-treatment revealed a
significant decrease in VSS of the group A compared to that of group B (p > 0.05).
Conclusion:
It could be concluded that Cybele Scagel phonophoresis is an effective and safe modality that can be used
for improving appearance of post burn hypertrophic scar.
Keywords:
Post burn hypertrophic Scar, Cybele Scagel, Phonophoresis, Modified Vancouver Scale and Digital
imaging.

INTRODUCTION

This action provides a controlled and
After thermal injuries, hypertrophic scars are a
safe technique to increase the transdermal absorption of
serious problem. Scar contractures form and spread to
a wide range of ionizable drugs. As a result, many
the connective tissue beneath the skin, then to the
medications that are delivered to the surface layer of the
muscles, reducing joint range of motion and interfering
skin, such as anti-inflammatories and analgesics, are
with daily activities (1). The majority of superficial
potentiated as they penetrate deeper into the underlying
injuries do not leave visible scars, but deep cutaneous
tissue (6). Scar-improving agents such as Allium cepa
injuries can result in serious problems such as
extract, Centella asiatica extract, Aloe vera extract,
hypertrophic scars and keloids (2). Depending on the
paper mulberry extract, and nanohydroxyprolisilane CN
depth of the wound, hypertrophic scarring rates range
are among the herbal extracts plus silicone derivatives
from 40 % to 70 % after surgery to up to 91 % after a
in Cybele Scagel (Bangkok Botanica, Bangkok,
burn injury (3). Apart from a variety of personal issues,
Thailand). It was created to prevent the formation of
patients frequently report itching, redness, and hard
scars from surgical wounds (7). This agent can decrease
nodular scar tissue, along with unusual sensations (4).
pain and itching after epithelialization of burn wound,
Hypertrophic scars and keloids can have a significant
as well as preventing hypertrophic scar formation
impact on patients' quality of life, physical status, and
following a burn injury (8).
psychological health due to cosmetic issues, functional

PATIENTS AND METHODS
issues such as contractures, and patients' subjective
This study was carried out on thirty patients who
complaints such as itching and pain (5).
had hypertrophic scar after wound closure and their ages
Transdermal drug delivery is a viable alternative
ranged from 20 to 45 years. The participants were
to the traditional drug delivery methods of injection and
selected from Outpatient Clinic at Faculty of Physical
oral administration. The stratum corneum, on the other
Therapy, Cairo University. The patients were randomly
hand, works as a barrier, preventing substances from
divided into two equal groups in number (15 patients
penetrating the skin. The use of ultrasound on the skin
each). Group (A): the patients received cybele scagel
improves its permeability (phonophoresis) and allows
phonophoresis, 3 sessions per week for 8 weeks (24
various substances to be delivered into and through the
sessions). While, patients in group (B): received topical
skin (6). Phonophoresis is a non-invasive technique that
cybele scagel for 8 weeks. Methods of assessment pre-
converts electrical energy into mechanical energy using
treatment and 2 months post-treatment for both groups
piezoelectric potential. In practice, this effect is
included Modified Vancouver scar scale (VSS) to
obtained by using a therapeutic ultrasound apparatus to
assess hypertrophic scar characteristics (height,
generate high-frequency oscillation sound waves (US).
vascularity, pigmentation and pliability) and digital
imaging for visual assessment of the scars.

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/)

2581
Received: 3/5/2021

Accepted: 29/9/2021


Full Paper (vol.841 paper# 153)


c:\work\Jor\vol841_154 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2586-2590

Effect of Transcutaneous Electrical Nerve Stimulation on Pruritus in
Lichen Planus Patient
Nessrien Afifi 1, Mohammed Lotfy Elsaie2, Marwa Mahdy Abd EL-Hameed1,
Ghada Magdy Abd Elrhim1
1Department of Physical Therapy for Surgery, 2National Research Center,
Faculty of Physical Therapy, Cairo University, Giza, Egypt
*Corresponding author: Ghada Magdy Abd Elrhim, Mobile: (+20)1154968268, E-Mail: ghadamagdy1982@gmail.com

ABSTRACT
Background
: Lichen planus is a chronic inflammatory and immune mediated disease that is usually intensely pruritic,
and this symptom does not subside after common antipruritic treatment.
Objective: The purpose of the study was to evaluate the therapeutic effect of transcutaneous electrical nerve stimulation
on lichen planus patient.
Patients and methods: Thirty patients who had lichen planus with age ranged from 20-40 years were selected randomly
from El-Saff Hospital, only who agreed to be volunteers participated in the study and were randomized into two groups
of equal number, 15 patient for each group. Group (A) received medical medication and transcutaneous electrical nerve
stimulation (TENS): frequency 100 Hz, with the duration of each session being 1 h, administered on 3 days/week for 4
weeks and intensity of TENS was according to patient tolerance and Group (B) who only received the same medical
medication only.
Results: Compared to result before and after TENS treatment, our study showed that there was significant decrease in
the results of visual analogue scale (VAS) and Dermatology Life Quality Index (DLQI); but the result of group (A)
were superior to that of group (B) when comparing the groups' results together.
Conclusion: TENS was beneficial and had a good effect on pruritus in lichen planus patients.
Keywords: Lichen Planus, Pruritus, Transcutaneous electrical nerve stimulation, Visual Analogue Scale.

INTRODUCTION
Lichen planus (LP) is a chronic inflammatory
nociceptive polymodal nerve fibres, are activated by
papulosquamous skin, nail, hair, and mucous membrane
pruritogenic stimuli, while nociceptive polymodal
disorder with a wide range of severity and progression.
fibres are also implicated to some extent (6).
The LP rash is defined by the `5 Ps': pruritic, planar,
TENS treatment has recently been shown to have
purple, polygonal papules with well-defined borders(1).
an antipruritic effect on lichen planus. TENS is a non-
Many variants of LP exist, differentiated on the basis of
invasive and safe therapy for itching caused by LP (7).
the morphology of lesions and body site (s) involved.
TENS is a non-invasive, non-pharmacological therapy
The disease can negatively affect the quality of life of
that has recently been presented as a possible treatment
patients, particularly forms such as hypertrophic LP and
for pruritic dermatoses (8). In dermatology, the most
erosive oral LP (2). The cause is unknown, although it's
prevalent use of TENS therapy is to relieve itching.
assumed to be the outcome of an autoimmune reaction
TENS may have an antipruritic impact in itchy skin
that started with an unknown trigger. Although there is
diseases since pain and pruritus are two sensations that
no cure, several drugs and surgeries have been tried to
are comparable at the peripheral and central levels (9).
control the symptoms (3).
The aim of this study was to evaluate the
Pruritus is the most prevalent symptom of skin
therapeutic effect of transcutaneous electrical nerve
disorders, sometimes trifling or light, and sometimes
stimulation (TENS) on lichen planus patient.
intolerable. It includes a variety of clinic complaints

encompassing dermatologic, neurologic, systemic, and
PATIENTS AND METHODS
mental problems(4). Itching, or pruritus, is a frequent and
Thirty patient (8 male and 22 female) were enrolled
occasionally irritating symptom of a variety of
in the study. They were selected from the Outpatient
dermatological conditions. Cutaneous LP is notoriously
Dermatology of El-Saff Hospital with mean age of 40
pruritic, and current antipruritic treatments rarely
years. Random allocations were determined by a
alleviate this condition. Pruritus is a common symptom
computer-generated random number program.
of LP skin lesions, which can include things like

decreased psychophysical activity, sadness, dread, and
Group (A) included 15 patients who received medical
tension(5).
treatments and TENS and Group (B) who received
Itch, sometimes called pruritus, is a cutaneous
medical treatments. All of the patients had a history of
feeling that is not the same as pain. Different subgroups
itching attacks that were limited to one place and caused
of specialised primary afferent C-fibers, including both
them to scratch or massage that area a lot. Patients
histamine-sensitive and histamine-insensitive non
received a physical examination and provided a

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/)

2586
Received: 3/5/2021

Accepted: 29/6/2021



Full Paper (vol.841 paper# 154)


c:\work\Jor\vol841_155 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2591-2598

Erector Spinae Plane Block: Review Article
Ahmed Mahmoud Azmy*, Abdelrahman Hassan Abdelrahman, Fawzy Abbas Badwy,
Wael Alham Mahmoud, Al Haitham Mohamed Taha
Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Ahmed Mahmoud Azmy, Mobile: (+20) 01004793896, E-Mail: ahmedazmy19692@yahoo.com

ABSTRACT
Background:
Erector Spinae Plane Block (ESPB) belongs to the family of fascial plane blocks in which local anesthetic
is injected into a plane between two layers of fascia and subsequently spreads to nerves located within that plane or
within adjacent tissue compartments. ESPB has been used in pain management, cervical, thoracic and cardiovascular
surgeries.
Objective: The goal of this narrative review article is to go through the pertinent anatomy, explain how the injectant
spreads, show several ways to erector spinae plane block, and summarise case studies and clinical trials.
Conclusion: Because the craniocaudal and vertical spread of local anesthetics and sensory block are not well understood
or predicted, it appears that, unlike other blocks, the mechanism of erector spinae plane block and spread of local
anesthetics will be decided by clinical data.
Keywords: Erector Spinae Plane Block, Pain management.


INTRODUCTION


Erector Spinae Plane Block (ESPB) is one of
Anatomic features of erector spinae plane block:
the fascial plane blocks, in which local anesthetic is
The spinae erector is an anatomical word that
injected in plane between two fascial layers, afterwards
describes a three-fold muscle group: iliocostalis
extends to nerves situated inside that plane or
lumborum, longissimus thoracis and spinalis thoracis.
neighboring tissue compartments (1).
These muscles are derived from the transverse
It is classified as a paraspinal block due to the
processes of ribs, thoracic and lumbar and inserted on
location of injection above the vertebral transverse
the sacrum and ilium (7). The erector spinae constitute a
processes, and the local anesthetic is administered
paraspinal muscular column that overlooks the
underneath the erector spinae muscle and superficial to
osteoporosis laminae and transverse events, along with
extremities of the transverse processes (TPs) (2).
the more medial transversal-spinalis group of muscles
Forero et al. (3) initially reported two methods
next to spinal processes. The muscles lie in a complex
for applying local anesthetic. The first is an application
integrated sheet of aponeuroses and fasciae (a
into the interfascial plane between the rhomboid major
retinaculum) that runs from the sacrum to the base of
and erector spinae muscles, while the second is an
the crane, which is synonymous to the thoracolumbar
application deep into the erector spinae muscle.
fascia in the lower parts of the retinaculum (8). This
fascial column envelope makes it possible to distribute
The authors stated that the first method may be
fluid into the deep ESP from a single injection site in
inadequate and that more efficacy might be obtained by
cranial-caudal direction, which is one of the distinctive
injecting the drug deep in erector spinae muscle at
qualities of ESPB (1).
interfascial plane (4).
Shortly after the intervertebral foramen
In a postoperative analgesic procedure with a
emerges, each thoracolumbar spinal neuron splits in
child having surgery for the funnel chest, the rhombus
dorsal and ventral ram. The rear ram goes backwards
major and erector spinae method was found to have
and divides the back tissue in medium and side
experienced bilateral ESPB (5).
branches. In the intercostal area between the internal
Due to a deep interfascial level with the erector
and the most intercostal muscles the ventral rami T1­
spinae, bilateral ESPB was performed (6).
T12 runs down the inside side of the rib. This gives rise

to different musculoskeletal branches and lateral
cutaneous branches of ripple angle as shown in Figure

(1) (1).

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/)
2591
Received: 3/5/2021

Accepted: 29/6/2021



Full Paper (vol.841 paper# 155)


c:\work\Jor\vol841_156 The Egyptian Journal of Hospital Medicine (July 2021) Vol. 84, Page 2599-2604

Quality of Life in Behçet's Disease in Three Centers Experience
Enas S. Zahran1, Sabry Shoeib1, Mona R. Waly*2, Nibal Mourad3, Emad M. El-Shebiny1
1Rheumatology and Immunology Unit, Department of Internal Medicine,
Faculty of Medicine, Menoufia University, Egypt.
2Department of Internal Medicine, Benha Teaching Hospital, the General Organization for
Teaching Hospitals and Institutes, Egypt.
3Rheumatology and Immunology Unit, Department of Internal Medicine,
Faculty of Medicine, Mansoura University, Egypt.
*Corresponding Author: Mona Refaat Mohamed Waly, Mobile: (+20)01229689584, E-Mail: tokayousef123@gmail.com

ABSTRACT
Background:
Behçet's syndrome (BS) is a systemic inflammatory vasculitis of unknown etiology, characinoid by
recurrent oral, genital ulcers and uveitis. Its symptoms may affect patients' quality of life.
Objective: This study aimed to evaluate the quality of life (QoL) in patients with Behçet's disease (BD) in three centers
experience (Menoufia University Hospital, Mansoura University Hospital, and Banha Teaching Hospital)
Patients and methods:
A cross sectional study that was carried out on 70 BD patients selected from Rheumatology and
Immunology Unit from Menoufia University Hospital, Benha Teaching Hospital, and Mansoura University Hospital
from January 2019 till December 2020 on patients who were diagnosed by trained well qualified dermatologists and
rheumatologist. All participants were assessed by the SF-36 QoL Scale to evaluate the QoL.
Results:
The mean general health score was 12.0 ± 2.09 . The mean limitations of activities score was 10.57± 2.44 .
The mean physical health problems score was 2.04 ± 0.97 . The mean emotional health problems score was 1.53 ± 0.90.
The mean social activities was 3.94 ± 1.15 . The mean pain was 4.03 ± 1.19 . The mean energy and emotions was 17.63
± 2.27 , and the mean overall QoL was 51.74 ± 5.03 . Conclusion: QoL scores do not correlated with demographic
characteristics such as age, gender, BMI and weight. We also found that disease characteristics such as presence of oral
ulcer, genital ulcer, and arthritis and skin lesion do not affect QoL scores.
Keywords: Behçet's syndrome, quality of life.

INTRODUCTION
Chronic rheumatologic problems in patients
Rheumatologic diseases are common all around
with Behçet's disease are reported to limit their daily
the world. Most rheumatologic diseases are chronic and
activities and have a negative impact on their self-esteem
result in loss of power. They could also be life-
and relationships with others. It was also found that
threatening in certain cases (1). The mortality rate of
painful oral ulcers impede alimentation and speech as
rheumatologic diseases in general population is 0.02%.
well as negatively affect the body image of the
Behçet's disease is one of the rheumatologic diseases
patients(6). All these problems related to Behçet's disease
related to vasculitis(2).
negatively affect the biopsychological and social life of
Behçet's disease (BD) is a chronic inflammatory
the patients and reduce their QoL(8). QoL is a concept
disease that leads to recurrent aphthous ulcers of the
that encompasses being able to satisfy one's own basic
mouth and genitalia, relapsing uveitis, and skin lesions
needs, being satisfied with life, showing an adequate
such as erythema nodosum. Because BD is a chronic
level of social interaction, allocating time to fun, feeling
multisystem disorder, it may cause various problems in
good emotionally and physically, being good at
daily life or lead to functional disability(3).
interpersonal relationships, having self-esteem as well as
Behçet's disease is thought to be more common
previous experiences(9).
along the ancient Silk Road, extending from Asia to the
Evaluations of QoL could assist in developing
Mediterranean. Estimates from Turkey vary from 80-370
care plans that ensure a better understanding of the
cases per 100,000 populations, whereas prevalence
behaviors and the psychological reactions of the patients
estimates from Japan, Korea, China, and the Middle East
as well as the difficulties they experience with adjusting
vary from 13-20 cases per 100,000 populations(4).
to the disease and developing effective coping
Certain genetic and/or environmental factors play an
mechanisms(10).
important role in its development. The mean age at onset
Complaints associated with Behçet's disease
is between 20 and 30. The disease is less prevalent in
deteriorate the physical and mental health of the patients
children and seniors(5). Common symptoms of the
on the one hand, and reduces QoL by generating certain
disease include oral and genital ulcers, skin lesions and
physical impairments on the other. It could be also said
arthritis, which might be accompanied by ocular and
that assessing QoL in patients with Behçet's disease
vascular involvem