c:\work\Jor\vol861_1 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 1-4

Early Outcomes of Transection of Secondary Chordae with Downsized Ring
Annuloplasty in Low Recurrence Risk Severe Ischemic Mitral Regurgitation
Hussein Derbala, Alaa Omar, Ayman Gado, Hesham Zayed Saleh*
Department Cardiothoracic Surgery, Kasr Al Ainy, Faculty of Medicine, Cairo University, Egypt.
*Corresponding Author: Hesham Zayed Saleh, Email: hzayed@hotmail.com

ABSTRACT
Background:
Relying solely on restrictive annuloplasty for the repair of ischemic mitral regurgitation is associated with
an unacceptable rate of recurrence. Transection of secondary chordae as an adjunctive procedure has been proposed to
improve results.
Patient and methods: This is a prospective observational study including 20 patients who underwent mitral repair using
downsized annuloplasty ring and transection of the secondary chordae, at the time of CABG at the Cardiothoracic
Surgery Department of Cairo University Hospitals through the period between March 2016 and October 2018. The
primary outcome being examined was the recurrence of significant mitral regurgitation at 6 months postoperatively.
Secondary outcomes included coaptation length and ejection fraction.
Results: The mean age was 57.5 ± 6.9 years. The mean ejection fraction was 45.1 ± 11%. There was one early mortality
(5%). At 6 months postoperatively, there was no incidence of recurrence of significant mitral regurgitation. Coaptation
length was quite satisfactory (7.2 ± 0.67 mm).
Conclusion: Transection of secondary chordae is a safe and simple option. It may be beneficial when performed in
combination with downsized ring annuloplasty in patients with low-risk ischemic mitral regurgitation.
Keywords: Ischemic mitral regurgitation, Mitral repair, Secondary chordae.

INTRODUCTION

Mitral regurgitation is a common complication of
Among these, resection of secondary chordae
myocardial infarction (1). Independent of age, gender or
proved to be a simple and effective option (12, 13).
ejection
fraction,
significant
ischemic
mitral
In the current study we described the early
regurgitation (IMR) is associated with an increased risk
outcomes of transection of secondary chordae
of heart failure and death in the years following the
combined with downsized ring annuloplasty, in patients
initial ischemic event (2).
with low recurrence risk IMR undergoing coronary
Given the heterogeneity of the underlying
artery bypass grafting (CABG).
mechanisms precipitating chronic IMR in different

subgroups of patients, the ideal surgical management
PATIENTS AND METHODS
remains debatable (3, 4).
This is a prospective observational study
Undersized ring annuloplasty as described by
including 20 patients who underwent mitral repair using
Bolling et al. (5), at the time of coronary bypass surgery,
downsized annuloplasty ring and transection of the
was the commonest used surgical procedure. However,
secondary chordae, at the time of CABG at the
the results of the Cardiothoracic Surgical Trials
Cardiothoracic Surgery Department of Cairo University
Network (CTSN) trial raised serious concerns about the
Hospitals in the period between March 2016 and
rate of recurrence of mitral regurgitation following such
October 2018.
a procedure. In this randomized trial, the recurrence rate
During this period, a total of 26 consecutive
of significant mitral regurgitation reached 58.8% at two
patients underwent this procedure. 6 patients were
years, and was associated with a significantly higher
excluded.
incidence of heart failure and hospital readmissions,

when compared to the group of patients who underwent
Exclusion criteria: being considered high risk for
mitral valve replacement (6).
recurrence of significant mitral regurgitation based on
Such high rates of recurrence led to increasing
preoperative echocardiographic assessment, previous
interest in previously published reports pointing out
cardiac surgery, primary mitral valve lesions of
preoperative echocardiographic parameters, to predict
rheumatic or degenerative origin identified on
the risk of recurrence of mitral regurgitation after mitral
preoperative echocardiography, patients with other
repair in these patients. These echocardiographic
valvular lesions and patients with a left ventricular
parameters included among others, the tenting height,
ejection fraction less than 25%.
tenting area and interpapillary distance, which proved
The remaining 20 patients were included in the
reliable and easy to measure (7-10).
study and their individual files were reviewed to extract
There was also an increasing adoption of more
clinical, operative and outcome data.
complex forms of mitral repair, to improve long-term

outcomes (10-12).


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1
Received: 28 /6 /2021
Accepted: 24 /8 /2021


Full Paper (vol.861 paper# 1)


c:\work\Jor\vol861_2 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 5-8

Mitral Valve Annuloplasty with a Homemade Single-sized
Polytetrafluoroethylene Band in Degenerative Mitral Regurgitation
Mohamed Azzam*1, Ahmed Fakhry2, Ahmed Nabil Khallaf3, Hesham Zayed Saleh1
1Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
2Department of Cardiothoracic Surgery, Faculty of Medicine, Beni-Suef University, Egypt
3Department of Cardiothoracic Surgery, Faculty of Medicine, Fayoum University, Egypt
*Corresponding author: Mohamed Azzam, Mobile: (+20) 01001427368, E-mail: dr.mohamed.ezzazzam@gmail.com

ABSTRACT
Background:
Although mitral annuloplasty is an essential component of mitral repair, there remains little agreement
on the ideal device to be used or the ideal sizing method.
Objectives: The purpose of this study was to report the early clinical and echocardiographic outcomes of patients
undergoing repair for degenerative mitral regurgitation using a homemade single-sized (65 mm) Polytetrafluoroethylene
band, and comparing it to the use of commercially available complete rigid rings.
Patients and methods: This is a retrospective study including 106 patients, who underwent mitral repair for
degenerative mitral regurgitation at Cairo University Hospitals between February 2013 and July 2019. These patients
were divided into 2 groups. Group (A) included 69 patients who underwent repair with a single-sized band, and group
(B) included 37 patients whose repair included the use of a commercial rigid ring. The primary endpoint was freedom
from significant mitral regurgitation at one-year follow-up. Secondary endpoints included mean mitral valve gradient
measured postoperatively, and freedom from reoperation at one year.
Results: There was no statistically significant difference between both groups in any of the above-mentioned endpoints
being examined.
Conclusion: The use of a single-sized Polytetrafluoroethylene band for annuloplasty in degenerative mitral disease
showed satisfactory results comparable to the commercial rigid rings. Further studies with longer follow-up are needed
to confirm the durability of mitral repair using this technique.
Keywords: Mitral regurgitation, Mitral repair, Annuloplsty.

INTRODUCTION

PATIENTS AND METHODS
Since the introduction of mitral repair for the
This retrospective observational study included a
treatment of mitral regurgitation (MR), mitral valve
total of 106 patients who underwent first-time mitral
annuloplasty was deemed an integral part of valve repair,
valve repair for degenerative mitral valve disease, at the
especially in cases of degenerative mitral disease (1).
Cardiothoracic Surgery Department of Cairo University
Annuloplasty not only restores the shape of the
Hospitals, in the period between February 2013 and July
mitral annulus but was also proven by various groups to
2019. During this period, a total of 119 patients
improve the durability of the repair (2, 3).
underwent mitral repair.
In many studies, the type of annuloplasty device

used flexible or rigid and complete or partial seemed to
Exclusion criteria: Previous open heart surgery,
have little impact on the clinical outcomes of the repair,
rheumatic
pathology
found
intraoperatively,
in patients operated for degenerative mitral
concomitant coronary artery bypass grafting, left
insufficiency (4-6).
ventricular ejection fraction less than 40%, or
Given the expense added by the use of a ring, many
incomplete data in individual clinical files. The
groups have tried less expensive annuloplasty
remaining 106 patients were included in the study and
alternatives.
These
included
Dacron
bands,
their individual files were reviewed to extract clinical,
polytetrafluoroethylene (PTFE) bands, and pericardial
operative and outcome data.
bands. Trying such alternatives was met with variable

degrees of success (7-9).
Ethical Consideration: The study was approved by the
In the setting of developing countries with
Local Ethical Committee of Cairo University. Written
relatively limited financial resources such an alternative
consent was obtained from every patient prior to the
is worth exploring.
procedures. This work has been carried out in
The purpose of this study was to report the early
accordance with the code of Ethics of the World
clinical and echocardiographic outcomes of patients
Medical Association (Declaration of Helsinki) for
undergoing repair for degenerative MR using
studies involving humans.
homemade fixed length PTFE bands, and comparing

them to patients who underwent repair using
Study Groups:
commercially available complete rigid rings.
All patients in the study had severe MR, with

obvious degenerative or myxomatous features on

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5
Received: 29 /6 /2021
Accepted: 25 /8 /2021


Full Paper (vol.861 paper# 2)


c:\work\Jor\vol861_3 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 9-16

Myomectomy for Fibroids during Cesarean Section:
A Randomized Controlled Trial
Ayman A. Shabana, Tarek M. Sayyed, Mohamed A. Rezk,
Sara M. Nassar, Ayman Elsayed Solyman*
Department of Obstetrics and Gynecology, Faculty of Medicine-Menoufia University, Menoufia, Egypt
*Corresponding Author: Ayman Elsayed Solyman, Mobile: (+20) 01221012020, E-mail: draymansoliman73@yahoo.com

ABSTRACT
Background:
There is a considerable debate about the management of myoma during cesarean section (CS). Recently,
several studies indicated the safety and feasibility of undertaking myomectomy during CS.
Objectives: To evaluate the safety, accessibility, and short-term morbidity of myomectomy for fibroids during cesarean
section.
Patients and Methods:
This was a randomized controlled trial that included 72 patients who were admitted to the
Obstetrics & Gynecology Department, Menoufia University Hospital with uterine fibroids during pregnancy; who were
randomly allocated equally into a group of cesarean myomectomy (CM; n=36) and another group of CS only (n=36).
The operative events and the outcome were recorded and analyzed.
Results: CM group showed a longer duration of surgery and longer hospital stay, higher amount of blood loss, and
higher mean pain sores, with a highly statistically significant difference (p = 0.000). No cases in both groups required
blood transfusion or ICU admission. No statistically significant differences were noted between both groups as regards
the fetal outcome measures (p=0.583 & 0.601).
Conclusion: CM is safe and applicable in selected cases without deleterious maternal complications. Special
precautions ought to be paid during the procedure, particularly in the intramural type and with large fibroids.
Keywords: Cesarean myomectomy, Fetal outcome, Maternal outcome, Safety, Uterine fibroid.


INTRODUCTION

PATIENTS AND METHODS
Uterine leiomyomas (fibroids) are benign
This is a randomized controlled trial that was
neoplasms derived from the myometrium of the uterus
performed at the Department of Obstetrics &
and they are hormone-responsive. They were
Gynecology in Menoufia University Hospital during the
documented to be the commonest tumor involving the
period from January 2019 to July 2021. The sample size
female reproductive tract. Uterine leiomyomas are
was calculated based on the results of a previous pilot
considered to be a major concern impacting the quality
study to compare between cesarean myomectomy
of life of the affected females (1).
versus no intervention on the amount of operative blood
When women with uterine leiomyomas get
loss and the need for blood transfusion. The estimated
pregnant, they usually have concerns about the potential
sample size was 36 patients in each group.
leiomyoma-related
pregnancy
adverse
events.

However, the inconsistent association between uterine
Ethical Considerations:
leiomyomas and the obstetric outcome was revealed by
The current study was commenced after the
several studies (2).
approval of the university research ethics committee
Both uterine leiomyomas and the cesarean section
of Menoufia University and following the
(CS) rates have been elevated all over the world.
declarations of Helsinki. Informed written consent
Therefore cesarean myomectomy (CS); the leiomyoma
was obtained from each patient included in the
surgical removal in the same setting of the CS, has been
study.
increasingly considered worldwide and suggested by

some authors to be a routine procedure. However, CM
Inclusion Criteria:
is still claimed to be a high-risk surgery, that should be
Patients who attended our antenatal clinic during
indicated in selected cases and performed by
the first half of pregnancy and formally diagnosed with
experienced surgeons only(3).
uterine fibroids and those who referred to our hospital
The current literature conflicting results are
for further assessment were included. All patients had
indicating the trial to provide any strong evidence on the
an obstetric indication for cesarean delivery at term,
CM safety and applicability (4).
such as previous CS and breech presentation).
This study aimed to evaluate the safety,

accessibility, and short-term morbidity of myomectomy
Exclusion Criteria:
for fibroids during cesarean section.
Patients with chronic medical disorders,

bleeding
tendency,
placenta previa,
multiple


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9
Received: 01/10/2021
Accepted: 15/11/2021

Full Paper (vol.861 paper# 3)


c:\work\Jor\vol861_4 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 17-21

Prevalence of Selective IgA Deficiency in a Sample of
Egyptian Patients with Type1 Diabetes Mellitus
Hoda Mohamed Elsayed1, Fawzia Hassan Abou Ali1, Dina Sayed Sheha1,
Nesma Ali Ibrahim2, Yasmin Sayed Sharawy1, Sylvia Talaat Kamal1
Department of Internal Medicine, 1Allergy and Immunology Unit, 2Endocrinology and Metabolism Unit, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
*Corresponding Author: Sylvia Talaat Kamal, E-mail: drsylviatalaat@gmail.com

ABSTRACT


Background: Selective Immunoglobulin A deficiency (SIgAD) is known to be one of the most frequent primary
immunodeficiency diseases. Several studies worldwide confirm the increased frequency of this disease among type 1
diabetes mellitus (T1DM), yet this has not been studied in Egypt.
Objective: This work aimed to define the prevalence of SIgAD among Egyptian patients with T1DM.
Patients and Methods:
Fifty patients with T1DM were compared to fifty apparently healthy individuals. Serum levels
of IgA, IgG, and Immunoglobulin M (IgM) levels were measured by Nephelometry to all participants.
Results: The mean age of the diabetic group was 24.5 ± 5.3 years. Thirty out of fifty patients with T1DM (60%) were
diagnosed as SIgAD with, female predominance (66.7% of SIgAD). We also found a significant relationship between
SIgAD and diabetic ketoacidosis (P-value<0.001). Serum IgA levels were positively correlated to IgG and IgM.
Conclusion:
The current study displays 60% prevalence of SIgAD among adult Egyptians with T1DM, which is higher
than stated in other countries.
Keywords:
Diabetes Mellitus, SIgAD, HbA1C.

INTRODUCTION

augmented autoantibody levels had been reported in
Selective immunoglobulin A deficiency (SIgAD) is
patients with IgA deficiency. This could be explained in
estimated to be one of the most frequent primary
the light of molecular mimicry (9, 10). The relationship
immunodeficiency diseases (1). It is diagnosed
between SIgAD and abnormal T-cell regulation
according to international consensus when: sIgA is
(regulatory T-cells) could also justify the link between
<0.07 g/L, provided that serum IgM and IgG are
SIgAD and autoimmunity due to the failure of immune
normal. Diagnosis should be confirmed after the age of
tolerance (11).
four years (2). SIgAD could be asymptomatic in 85% of
The prevalence of SIgAD in T1DM varied widely in
patients, otherwise, it has diverse presentations as
different studies, ranging from 0.38% to 3.7%. Most of
recurrent infections or allergic disease. Moreover, it is
them found out higher prevalence among diabetic
associated with various autoimmune diseases, such as
patients than in the general population (12). To our
type 1 diabetes mellitus (T1DM), celiac, autoimmune
knowledge, scanty studies have explored the prevalence
hematological
diseases
as
anemia,
and
of SIgAD in adult Egyptian patients with T1DM.
thrombocytopenia (3). T1DM is a chronic autoimmune
Hence, this work aimed to determine the prevalence of
disorder, where beta cells of the pancreas are damaged
SIgAD among Egyptian patients with T1DM.
by CD8+ cytotoxic lymphocyte. Besides, CD4+

helper T cell and B lymphocytes contribute to disease
PATIENTS AND METHODS
pathogenesis (4). Mononuclear cells invade the islets and
This is an observational case-control study that
cause "insulitis,". Soluble mediators and cytokines
included fifty adult Egyptian patients above 18 years of
produced by these inflammatory cells play a pivotal role
age, selected by systematic randomization from the
too in disease progression (5). Acute diabetic
Diabetes Clinic at Ain Shams University Hospital,
complications comprise diabetic ketoacidosis and
diagnosed according to American Diabetes Association
hyperosmolar coma (6), while long-term complications
2016 guidelines (13).
are either macrovascular as ischemic heart disease and
Exclusion criteria:Patients with type 2 diabetes
stroke, or microvascular as nephropathy, neuropathy,
mellitus, associated immunodeficiency disorders such
and retinopathy (7).
as common variable immunodeficiency, systemic organ
In diabetic patients, glycation of immunoglobulin is
failure, patients on immune suppressive drugs (as
noted and is directly proportional to HbA1c level. The
steroids or cytotoxic drugs within the last 3 months),
clinical significance of this observation is not obvious
and malignancy were precluded.
since patients' response to vaccinations and infections
A Control group of fifty apparently healthy subjects
is satisfactory in diabetic patients (8).
of comparable age and sex were also recruited.
Numerous immunological mechanisms have been
Thorough history taking and clinical examination
proposed to illustrate the emergence of autoimmunity in
were done for all participants. Biochemical studies
patients with SIgAD.
included: Fasting blood sugar, 2hrs postprandial blood
The absence of secretory IgA facilitates penetration
sugar, HbA1C.
of environmental antigens in the mucosa. Additionally,
Immunoglobulin assay:

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17

Received: 15/10/2021
Accepted: 1/12/2021

Full Paper (vol.861 paper# 4)


c:\work\Jor\vol861_5 The Egyptian Journal of Hospital Medicine (January2022) Vol. 86 , Page 22-26

Predictors of Angio Access Failure in End Stage Renal Disease
Patients in Southern Egypt
Ali Mahmoud Mohamed Galal 1*, Sherif Omar El Kerdawi 2
Departments of 1Vascular surgery, Aswan University, 2Helwan University, Egypt
*Corresponding author: Ali Mahmoud Mohamed Galal, E mail: a_mando76@yahoo.com, Mobile phone: 01001816078


ABSTRACT
Background:
Hemodialysis (HD) seems to be the most often used Renal Replacement Therapy (RRT) modality
worldwide, and it is the primary modality in the majority of instances with extended RRT. The ability to provide our
patients with high-quality HD treatment while also increasing their chances of survival is heavily reliant on the
functionality of the vascular access (VA). Despite the fact that it is a very necessary component of all clinical practise
standards, it is the most expensive individual component of RRT.
Objectives: This study was aimed at comparing between the group with Angio access failure and group without Angio
access failure and predicting Angio access failure among end stage renal failure patients in Southern Egypt.
Subjects and Methods: a prospective cohort study among 125 patients with end stage renal failure at Aswan University.
The research comprised patients who had NCVA placement [intra-atrial catheter (IAC) and trans-lumbar catheter
(TLC)] between January 1, 2020, and December 31, 2020.
Results: The duration of previous RRT was significantly higher among the Angio access failure than the group without
Angio access failure. In multivariate analysis using logistic regression, the age, duration of previous RRT, diabetes, IHD
(ischemic heart disease), PVD (peripheral vascular disease) and CVD (cardiac vascular disease) were significantly direct
predictors of the Angio access failure in the first one year.
Conclusion: In conclusion the failure of Angio access was positively associated with age, previous RRT and other
comorbidities.
Keywords: Hemodialysis, Angio access failure, end stage renal disease.
INTRODUCTION
of the most challenging aspects of hemodialysis patient
Every year, the number of people being cured for
care (4).
end-stage renal disease (ESRD) increases at a
There are three forms of traditional vascular
substantially faster rate than the worldwide population.
access: 1) autologous arteriovenous fistulas (AVF),
On December 31, 2017, for example 592,779 prevalent
which are the best option in terms of complications and
individuals in Europe were undergoing renal
survival. 2)arterial-venous grafts (AVG; prosthetic
replacement therapy (RRT). Hemodialysis (HD) was
VA's made of synthetic material) and 3) a central
the most common RRT, with 57 percent of patients
venous catheter (CVC) [put in a vein with a high calibre
receiving it. Peritoneal dialysis was utilized by 5 percent
(usually the jugular, femoral, or subclavian veins)] (5).
of patients, while 37 percent had a functional kidney
A main prosthetic AV access for hemodialysis has
transplant (1). Hemodialysis (HD) is now the most
a 1-year problem risk of 33 percent to 99 percent.
prevalent Renal Replacement Therapy (RRT) modality
Various researchers have reported on the viability and
in the globe, and it is the predominant modality in the
problems of AV access. Technique failure is a common
majority of instances with extended RRT. In certain
consequence of peritoneal dialysis (PD) therapy, and it
countries, such as Japan, over 100% of the population
puts patients and healthcare providers at risk. The first
has access to HD. Although it is a common medication
year is known to be a particularly sensitive phase, with
in nations like the United States, there are concerns
studies predicting that slightly under half of patients
regarding its high cost (2).
who have technique failure do so during this time.
The ability to provide high-quality HD treatment
Although stated rates of early method failure range from
that allows our patients to live longer is heavily reliant
4.9 percent to 20.9 percent depending on the criteria (6).
on the vascular access's (VA) ability to operate
However, due of the large range of access
properly, While it is a required component of all clinical
materials, designs, locations, risk factors, and quality of
practice standards, it is also the most costly component
input and outflow vessels, comparing outcomes is
of RRT. In the United States, keeping a VA might cost
challenging (7). The National Kidney Foundation's
up to 30% of the entire cost of an HD programme every
(NKF) offers "Dialysis Outcome Quality Initiative"
year. (3). The development and maintenance of
guidelines for best clinical practices targeted at
arteriovenous hemodialysis access (AV access) are two
increasing dialysis outcomes and patient survival. (4).

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22

Received:26 /7 /2021
Accepted:22 /9 /2021

Full Paper (vol.861 paper# 5)


c:\work\Jor\vol861_6 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 27-32

Stress, Anxiety, Depression Among Medical Undergraduate Students at
Benha University and Their Socio-Demographic Correlates
Hala Ali Abed, Marwa Salah El-dien Abd-Elraouf*
Public health Department, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Marwa Salah El-dien Abd-Elraouf, Mobile: (+20)1065063533,
Email: Marwad24@yahoo.com

ABSTRACT
Background:
Medical students display poorer mental health when compared to equivalent peers. Learning
environment, educational debt, hard workload, and sleep disturbance make them more liable for mental disorders as
anxiety and depression.
Objective:
The aim of the current work was to determine prevalence and factors associated with depression, anxiety and
stress among medical students.
Patients and Methods:
A cross-sectional study using a self-administered questionnaire was distributed to students in
the six grades at Benha Faculty of Medicine. Students were chosen by stratified random sample technique. The total
participants were 597.
Results: Out of included students; 88.8%, 82.6% & 82.7% experienced depression, anxiety, and stress respectively. A
statistically significant difference between smokers and non-smokers (14.3±4.9&11.5±5.6 respectively) was found
regarding depression score. The mean anxiety and stress scores were significantly higher between females (9.78±5.4 &
13.03±4.9 respectively) than males. The third grade had the highest mean of anxiety and stress score (10.1±4.8, p value
=0.03 &14.02±3.9, p value =0.000 respectively). There was a statistically significant difference in depression and
anxiety scores as regarding Personal income. There were statistically significant associations between student average
achievement score, social activity, transportation and mean score of depression, anxiety, stress.
Conclusion: It could be concluded that medical students experienced high degrees of depression, anxiety, and stress.
Smoking, female gender, personal income, achievement score were significantly associated with mental problems.
Keywords: Anxiety, Depression, Medical student, Stress

INTRODUCTION

concentration, affect decision making, and good
Mental and emotional challenges between
physician patients relationships (11). This may lead to
university students constitute an emerging public health
poorer physical health, substance misuse (12).
problem (1, 2). Although this problem includes all

academic studies, it was thought that the prevalence
Rational: Although Medicine is supposed to keep and
may be higher among medical students (3).
promote the health of population, the study of medicine
Medical students show poorer psychosocial state
is difficult and medical students work harder than most
when compared to their same age peers (4), and have
other students making them more liable for mental
higher prevalence of depression and burnout than the
disorders so we have to put in consideration the mental
general population(5). Worldwide, about one third of the
state of the students.
medical students suffer from depression or depressive
The aim of the current study was to determine the
symptoms (6, 7), anxiety and psychosomatic disorder (8).
prevalence of depression, anxiety, and stress among
Different stressors threaten medical students'
medical students at Benha Faculty of Medicine and their
mental health. Some known stressors include:
associations with socio-demographic and other
adaptation to the medical school environment,
characteristics.
educational debt, hard workload, sleep disturbance,

difficult patients, poor learning environments, financial
PATIENTS AND METHOD
issues, information overload and career planning(9).
This cross-sectional study included a total of 597
Medical School is a stressful environment. The
medical students at Benha Faculty of Medicine, Benha
courses expose the student to variable sources of stress
University. This study was conducted between October
since admission into the university include the
to December 2020.
excessive study load, personal and the professors' desire
The six grades of Benha Faculty of Medicine were
for excellence, lack of leisure time and contact with
listed. Students were chosen by stratified random
death, and other stressors (10).
sample technique. The total number of students at
These stressors may have various sequels like
Benha Faculty of Medicine during the academic year
anxiety, depression, poor academic performance,
2020-2021 was 3512. Web-based self-administered
impaired competency, medical errors and attrition from
online questionnaire was distributed upon 664 (at least
medical schools (9). Stress can also impair attention and
10% of population) students via Face book groups

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27
Received: 3/8/2021
Accepted: 29/9/2021

Full Paper (vol.861 paper# 6)


c:\work\Jor\vol861_7 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 33-43

Radiological Evaluation of Postoperative Complications after
Non-Sleeve Gastrectomy Bariatric Procedures
Amgad S. Abdel-Rahman1, Ahmed Elshimy*1, Sayed H. M. Mohamed2
1Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2Radiology Department, National Liver Institute, Menoufia University, Menoufia, Egypt
*Corresponding author: Ahmed Elshimy, Mobile: (+20)01001294030,
E-mail: ahmedchimi@hotmail.com

ABSTRACT
Background:
Obesity is a medical condition, which may lead to serious related diseases, ultimately, resulting in many
morbidities and early mortality. Its management involves many approaches of which bariatric surgery is considered
nowadays as one of the most effective treatment for it. However, follow up of postoperative complications of this surgery
by effective radiological method as computed tomography (CT) is important for assessment of its success.
Objective: The aim of this study was to illuminate the radiological signs and features of postoperative complications
after non sleeve bariatric procedures and stressing the importance of using multi-slice CT (MSCT), and fluoroscopic
study for detection of these complications. Patients and methods: An observational cohort study for 275 patients with
suspected complications after non sleeve gastrectomy bariatric procedures, including 195 patients after Roux-en-Y
gastric bypass (RYGB), 76 patients after laparoscopic adjustable gastric banding (LAGB) and 4 patients after
intragastric balloon placement was done. These patients were subjected to either multi-slice CT and or fluoroscopy.
Results: We detected complications in 21 patients out of the 195 patients who underwent RYGB: leakage, abscess,
intestinal obstruction, internal hernia, port site ventral hernia, intussusception, fistula between the gastric pouch and the
excluded stomach and hiatus hernia. On the other hand, 8 out of 76 patients operated by LAGB developed complications:
band slippage, band erosion, pouch dilatation and tubal disconnection. Lastly two out of the 4 patients who placed intra-
gastric balloon encountered other complications: gastric outlet obstruction, spontaneous balloon deflation and distal
migration with intestinal obstruction.
Conclusion:
It could be concluded that bariatric procedures may be followed by many complications and accurate
diagnosis of these problems by proper radiological procedures as MSCT is imperative.
Keywords: Body mass index (BMI), Laparoscopic adjustable gastric banding (LAGB), Multi-slice CT (MSCT), Roux-
en-Y gastric bypass (RYGB).

INTRODUCTION
is done. Complications from RYGB surgery include
Obesity is a multifactorial chronic illness, which
enteric leak/abscess, hemorrhage, gastrogastric fistula,
showed an increasing prevalence all over the world in the
anastomotic stricture, and small bowel obstruction (10).
last years (1, 2). In Egypt, it becomes a tremendous threat
However, in LAGB, a silicon band is placed around
to health with 35% prevalence in adult population (3), and
the proximal stomach, approximately 2 cm below the
up to 24% of children are also considerably overweight
gastroesophageal junction, creating a proximal pouch
as published by Abdelkarim et al. in 2020 (4). The body
with a volume of ~15­30 mL with diameter less than 4
mass index (BMI) is the most widely used measure of
cm, which communicates to the remainder of the
obesity; and it signifies overweight if between 25 and 30,
stomach through a narrowed adjustable stoma via a
obesity if greater than 30 and morbid obesity if >35 with
subcutaneous access port with a stomal diameter goal of
obesity related serious comorbidities or >40 with or
3­5 mm. Many complications can follow LAGB as
without comorbidities (5, 6).
slippage of band/gastric prolapse, gastric perforation
Current treatment options for patients with obesity
from band erosion, stomal stenosis/pouch dilatation, and
include lifestyle intervention, obesity pharmacotherapy,
mechanical port/tubing complications as tubing
and bariatric surgery (7).
disconnection and port rotation/inversion (11, 12).
Mainly three lines of surgical procedures are known
Endoscopical intragastric balloon temporary
for bariatric surgery: The first line with restrictive
placement is achieving more acceptance owing to its
procedures including laparoscopic adjustable gastric
safety and effectiveness beside the simplicity of its
banding (LAGB) and sleeve gastrectomy (SG), the
procedure with lower cost and lacking the lifelong side
second line with malabsorptive procedures including
effects. It restricts food intake by promoting early satiety
jejunoileal bypass and biliopancreatic diversion and the
and followed up until endoscopically removed 6 month
third line with combined restrictive and malabsorptive
later (13). Its complications include enteric perforation
procedures including the Roux-en-Y gastric bypass
and balloon migration with obstruction of the bowel
(RYGB) (8). RYGB and LAGB are the most commonly
which may necessitate emergent management and
done procedures nowadays, followed by laparoscopic
intervention (14, 15).
sleeve gastrectomy (9).
Evaluation
of
suspected
postoperative
In RYGB procedure, creation of a small gastric
complications is important and could depend on
pouch and reducing the functional length of the jejunum
radiographs, upper gastrointestinal (UGI) series, and CT

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33
Received: 20/10/2021
Accepted: 07/12/2021

Full Paper (vol.861 paper# 7)


c:\work\Jor\vol861_8 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 44-49

Thrombocytopenia in Systemic Lupus Erythematosus Patients and
Its Association with Antiphospholipid Antibodies
Mohamed A. Esmail, Hagar I. Abdelal*, Esam M. Abu Al-Fadl, Rabab H. Ali
Physical Medicine, Rheumatology & Rehabilitation Department, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Rabab H. Ali, Email: rababr777@yahoo.com

ABSTRACT
Introduction:
Systemic lupus erythematosus (SLE) is a complex systemic autoimmune disease, characterized by
immune-mediated inflammation in different organs. The course of the disease is characterized by relapses and
remissions, and the degree of severity of the clinical manifestations is greatly affected by the number and nature of the
various organ affection. The death rate in patients with SLE is still significant, and it may be due to lupus activity, when
vital organs are affected, the complications of treatment especially infections or long-term complications, such as
cardiovascular disorders.
Objective: To detect the relation between thrombocytopenia in SLE patients and presence antiphospholipid antibodies.
Patients and methods: This study was a cross-sectional study included 100 SLE patients who attended to Sohag
University Hospitals. Patients included in this study were classified as SLE patients according to either the 2012 SLICC
criteria or the new 2017 ACR/EULAR SLE classification criteria. All of the participants were subjected to the following:
Full history, full clinical examination, routine investigations, ANA by immunofluorescence, and ANA profile for the
most common 19 autoantibodies by immunoblot. All of the participants were subjected to detection of serum titers of
all antiphospholipid antibodies (aPLs) including lupus anticoagulant (LA), anti-cardiolipin (aCL) and anti-beta2-
glycoprotein I (ab2GPI).
Results: In this study, we demonstrated that aPLs are strongly associated with increased risk of thrombocytopenia in
SLE patients. We identified aPL profiles, especially LA and IgM isotypes, as biomarkers for the risk stratification of
thrombocytopenia in SLE patients.
Conclusions: We concluded that aPLs are strongly associated with increased risk of thrombocytopenia in SLE patients.
Keywords: Thrombocytopenia, Systemic lupus erythematosus, Antiphospholipid antibodies.

INTRODUCTION
diseases, with systemic lupus erythematous (SLE) being
Systemic lupus erythematosus (SLE) is a
the most common (30­50%) (3). The aPLs form a
heterogeneous
systemic
autoimmune
disease
heterogeneous group of autoantibodies, including lupus
characterized by immune-mediated inflammation in
anticoagulant (LA), anti-cardiolipin (aCL) and anti-
multiple organs. The course of the disease is
beta2-glycoprotein I (ab2GPI). The latter two
characterized by exacerbations and remissions, and the
antibodies can be present in IgG, IgM and IgA isoforms,
severity of the clinical picture is greatly affected by the
and are directed against anionic membrane
number of factors and nature of the various organ
phospholipids and associated proteins, and the IgG
manifestations (1). The mortality in patients with SLE is
isotypes in particular are of clinical significance (4).
still considerable, and it may be due to lupus activity,
The aim of this study was to detect the relation
when vital organs are involved, the complications of
between thrombocytopenia in systemic lupus
treatment, in particular infections or long-term
erythematosus
patients
and
presence
of
complications, such as cardiovascular disorders (2).
antiphospholipid antibodies.
Typically, patients with SLE produce numerous

autoantibodies.
Some
of
the
SLE-related
PATIENTS AND METHODS
autoantibodies, e.g., anti-dsDNA, correlate with disease
This study was a cross-sectional study included
activity, while others appear to be markers of specific
100 SLE patients who were attending to Sohag
disease subsets (e.g., anti-Ro/SSA). Moreover, the
University Hospitals. Patients included in this study was
presence of antiphospholipid antibodies (aPLs) is
classified as SLE patients according to either the 2012
definitely pathogenic. aPLs positivity itself predisposes
SLICC criteria or the new 2017 ACR/EULAR SLE
to accelerated atherosclerosis and to an increased
classification criteria (5). This study was conducted in
thromboembolic risk (2).
May 2019 in Rheumatology Department, Sohag
Antiphospholipid
syndrome
(APS)
is
University Hospital.
characterized by arterial and venous thromboembolic

events and pregnancy morbidity (mainly recurrent fetal
Inclusion criteria: Patients diagnosed as SLE
losses), in the presence of antiphospholipid antibodies
according to SLICC 2012 or ACR/EULAR 2017
(aPLs). APS can occur in individuals without an
classification criteria, age from 17 to 60 years, and
underlying systemic autoimmune disease (primary
patient with disease duration > 6 months.
APS) or in the context of other systemic autoimmune

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44
Received: 10/08/2021
Accepted: 06/10/2021

Full Paper (vol.861 paper# 8)


c:\work\Jor\vol861_9 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 50-53

Polymorphism RS2227306 In The Interleukin 8 Gene and
Its Relation to Bronchial Asthma: Review Article
Sahbaa Fehr Mohamed Hafez1, Osama Taha Amer*1, Osama Abd Elaziz Mostafa1, Walaa Mohamed Samy2
Departments of 1Pediatrics and 2Medical Biochemistry, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Osama Abd Elaziz Mostafa Abd Elaziz, Email: drosama.smsm@gmail.com

ABSTRACT
Background:
Allergy symptoms such as wheezing, breathlessness, and coughing are all symptoms of asthma, which
is a long-term respiratory condition characterized by inflammation and reversible airway blockage. If you're a child or
young adult, asthma is the most common long-term condition, with more severe symptoms. The CXC chemokine
superfamily includes the Interleukin 8 (IL-8) chemokine. T lymphocytes, neutrophils, and mast cells are all chemotactic
cytokines that IL-8 attracts in the body. A polymorphism in the promoter region of IL-8 - 781C/T (rs2227306) has been
found to be associated with an elevated level of the cytokine IL-8. There is a gene in the first intron of the IL-8 - 781C/T
(rs2227306) that has been reported to aid in both gene transcription and gene regulation.
Objective: The aim of the present review was to study polymorphism RS2227306 in the interleukin 8 gene and its
relation to bronchial asthma.
Conclusion: IL8 polymorphism rs2227306 has the potential to be utilized as a marker in interpretation of assessment
of severity of asthma.
Keywords: Polymorphism Rs2227306, Interleukin 8, Bronchial asthma.

INTRODUCTION
21. The IL8 gene has been found to have many
Asthma is a life-threatening respiratory disorder.
polymorphisms (6). The IL-8 production can also be
Persistent airway inflammation is the hallmark of this
regulated by certain of these organisms. Several single
common lung illness. A chronic inflammatory disease of
nucleotide polymorphisms (SNPs) in the IL8 gene, such
the airways, asthma, is characterised by symptoms like
as rs2227532, rs738T/C, rs4073, rs396T/G, and
chronic wheezes and dyspnea, as well as tightness in the
rs2227306, have been investigated in patients with
chest and coughing, especially in the early morning or late
aggressive (AgP) periodontitis or chronic periodontitis
at night. These episodes are frequently accompanied by a
(CP) among people of Brazil (7).
wide-spread, yet variable, obstruction of airflow, which

can be resolved either naturally or with treatment (1).
IL-8's Inflammatory Properties:
Asthma frequency among youngsters globally has
Epithelial cells emit IL-8, a proinflammatory
increased gradually during the past two decades. An
chemokine that responds to oxidative stress and causes
estimated 8.2 percent of Egyptian youngsters aged 3 to 15
neutrophil infiltration and inflammation when exposed to
were asthmatic (2).
an oxidising particle. IL-8 is a powerful chemoattractant
Objective: To find out if the IL-8 polymorphism is
and neutrophil activator (8). Post-injury regulation of IL-8
connected to asthma.
depend on proinflammatory stimuli. IL-8 plays a critical

role in a number of wound healing pathways. As a
Chronic inflammation and IL-8:
chemotactic agent for leukocytes, and fibroblasts, it also
Numerous cell types, as endothelial cells,
stimulates myofibroblast growth and angiogenesis (9).
macrophages, neutrophils, fibroblasts, and tumor cells
When cells are subjected to stress, IL-8 is released, which
produce IL-8. Several cell types produce it in reaction to
is associated with an increase in proinflammatory
inflammation (4).
cytokine production. By manipulating the expression
One of the most significant mediators of
levels of this cytokine in human cells, neutrophil
inflammation and wound healing, IL-8 acts as an activator
infiltration into injured tissue can be controlled to a
of neutrophils, which in turn activates T and nonspecific
certain extent (8).
inflammatory cells. In human fibroblasts, it also increases

the synthesis of -smooth muscle actin. As a result, IL-8
Lung Epithelial Cell Injury Prevention:
promotes wound healing in vivo by attracting fibroblasts,
Acute respiratory distress syndrome (ARDS)
promoting their migration and the deposition of collagen
patients' BAL fluid contains high levels of TNF- (10),
I, fibronectin, and tenascin (4, 5).
TNF- and IL-8 levels are linked to each other. In lung
The IL8 gene consists of, 3 introns, 4 exons and the
epithelial cells, TNF- is a key inducer of expression of
proximal promoter, which is found on chromosome 4q13-
IL-8 (11).


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50
Received: 25/8/2021
Accepted: 5/10/2021

Full Paper (vol.861 paper# 9)


c:\work\Jor\vol861_10 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 54-58

Frequency of Hypoglycemia in Type 2 Diabetic Patients in Sample of
Egyptian People in Clinic Based Study
Mohammed Saad Hamed, Ahmed Mohamed Bahaa El-Din, Bassem Murad Mostafa*
Department of Internal Medicine and Endocrinology Department,
Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding Author: Bassem Murad Mostafa, Mobile: 00201144322070, Email: basemmurad44@med.asu.edu.eg,

ABSTRACT
Background:
Hypoglycemia is a serious medical emergency that must be recognised and treated as soon as possible to
avoid organ and brain damage. Hypoglycemia is not a sickness in and of itself; it is a symptom of a more serious health
problem, the significance of which is determined by its impact on brain function. There is always a risk of a proportional
increase in the incidence of hypoglycemia with a growing incidence of diabetes and various modalities of intense blood
glucose management.
Objective: We measured the frequency of hypoglycemic attacks in type 2 diabetic patients (T2DM) in clinic-based
study and correlate the attacks of hypoglycemia with treatment regimens and duration of the diabetes mellitus (DM).
Patients and Methods:
Copies of pre-tested questionnaire were administered directly to 1000 patients with T2DM at
the study site. This questionnaire was previously published as a part of the Workgroup of the American Diabetes
Association and The Endocrine Society (ADA) on 2013. After translating it into public traditional Egyptian Arabic
language. Results: Our main finding was that for people with T2DM the incidence of hypoglycemia was 36% (360 out
of 1000 patients). 26.39% (95 out of 360 patients) were on oral hypoglycemic drugs compared to 71.94% (259 from
360 patients) on insulin. Hypoglycemia was 48.42% (46 out of 95 patients) in diabetic patients having diabetes for more
than five years and on oral hypoglycemic drugs, compared to 76.83% (199 out of 259 patients) in diabetic patients on
insulin. Conclusion: Hypoglycemia is common in T2DM (36%). It is a significant complication of diabetes therapy and
although mild hypoglycemia causes unpleasant symptoms and disrupts patients' daily activities, severe hypoglycemia
can result in coma, seizures, and death.
Keywords
: Diabetes duration, Hypoglycemia, Impaired awareness of hypoglycemia (IAH), Type 2 diabetes mellitus
(T2DM).

INTRODUCTION
various modalities of intense blood glucose
Hypoglycemia is defined as any episode of
management (6).
unusually low plasma glucose concentration (with or
The overarching goal of managing type 2 diabetes
without symptoms) that puts a person at risk (1). A
is to achieve and maintain blood glucose control while
plasma glucose level of less than 70 mg/dL (3.9
lowering the risk of long-term complications. Many
mmol/L) is usually considered hypoglycemia (2).
studies have demonstrated that current diabetes care
Inhibition of endogenous insulin secretion and
with strict glycemic control can reduce, postpone, or
stimulation
of
glucagon,
catecholamines
even avoid the development of chronic problems. This
(norepinephrine, epinephrine), cortisol, and growth
aggressive diabetic therapy, however, may be linked to
hormone secretion are all part of the counter-regulatory
a higher risk of hypoglycemia (7).
response to hypoglycemia, which all work together to
The aim of the present study was measure the
stimulate hepatic glucose production and cut down
frequency of hypoglycemic attacks in type 2 diabetic
glucose utilisation in peripheral tissues, raising plasma
patients in clinic-based study and to correlate the attacks
glucose levels (3).
of hypoglycemia with treatment regimens and duration
Whipple's triad, which includes symptoms
of the diabetes.
associated with hypoglycemia, a low plasma glucose

concentration detected by an accurate method, and
PATIENTS AND METHODS
relief of symptoms when the plasma glucose level is
Through convenience sampling from outpatient
elevated, can be used to diagnose hypoglycemia (4).
clinics of Ain Shams University Hospitals, 1000
The pathophysiology of glucose counter regulation,
patients with type 2 diabetes were chosen in the duration
specifically the rate of beta cell failure and the resulting
from September 2017 to June 2018.
rate of alpha cell failure, is a function of the difference
Copies of pre-tested questionnaire were administered
in the incidence of iatrogenic hypoglycemia (relatively
directly to 1000 patients with type 2 diabetes at the
high throughout the course of type 1 diabetes but
study site. This questionnaire was previously published
progressing from relatively low to relatively high over
as a part of the Workgroup of the American Diabetes
the course of type 2 diabetes) (5). There is always a risk
Association and The Endocrine Society (8). After
of a proportional increase in the incidence of
translating it into public traditional Egyptian Arabic
hypoglycemia with a growing incidence of diabetes and
language to facilitate the mission for the interviewer.

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54
Received: 8/8/2021
Accepted: 4/10/2021

Full Paper (vol.861 paper# 10)


c:\work\Jor\vol861_11 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 59-65

Comparative Evaluation of Dexmedetomidine Versus Magnesium Sulphate on The
Adequacy of Hypotensive Anesthesia and Post-Operative Recovery for Patients
Undergoing Endoscopic Transnasal Transsphenoidal Pituitary Tumor Resection
Ahmed Mohammed Sonbol*, Sameh Ghareeb Ahmed
Department of Anesthesiology, Faculty of medicine, Mansoura University, Egypt.
*Corresponding author: Ahmed Mohammed Sonbol, Mobile: (+20) 01003735129. E-Mail: dr.sonbol@gmail.com

ABSTRACT
Background:
Perioperative use of magnesium sulfate (MgSO4), dexmedetomidine, have been tried in order to provide
beneficial clinical effects during general anesthesia (GA). However, few literature discussed it with varying results.
Several clinical researches have showed that usage of MgSO4 infusion was associated with a reduction in anesthetic
requirement and postsurgical analgesic consumption during GA.
Objective: This study aimed to assess the pharmacologic effects of the use of dexmedetomidine and MgSO4 on
anesthetic requirement, intra operative haemodynamics stability and postsurgical analgesic effects on the adequacy of
hypotensive anesthesia during transsphenoidal resection of pituitary tumours.
Patients and methods: A total of 110 cases were enrolled in this prospective study. They were randomized into 2
groups: Group D (55 cases) that was commenced on dexmedetomidine, and group M (55 cases) which received MgSO4
Results: The mean values of Boezaart score were significantly decreased in Group D in comparison to group M. In
addition, isoflurane and propranolol consumption showed a significant decrease in group D. However, blood loss
showed no significant difference when comparing the same groups. Group D expressed significantly longer emergence
and extubation times compared to Group M.
Conclusion: Dexmedetomidine appears to be superior compared to magnesium sulphate in achieving hypotensive
anesthesia during pituitary surgery.
Key words: Dexmedetomidine; Magnesium sulphate; Hypotensive anesthesia; Pituitary surgery.

INTRODUCTION
stability especially on intubation and extubation. It also

Neuroanesthesia has some basic principles
to decreases anesthetic and opioid consumption (6).
including smooth induction, hemodynamic stability,

Magnesium sulfate (MgSO4) is a NMDA
maintaining cerebral perfusion, and providing optimal
receptor antagonist with antinociceptive effects (7). It has
operative conditions to facilitate good exposure for the
the ability to induce deliberate hypotension by blocking
surgeon. Smooth emergence is of great importance such
of trans-membrane calcium ATPase and Na/K-ATPase
as smooth induction as it allows early evaluation of the
ion channels. In addition, Mg++ suppresses the discharge
neurological functions after surgery (1).
of norepinephrine. It also has a direct vasodilator effect

Trans-sphenoidal excision of pituitary tumours
by increasing prostacyclin synthesis, as well as
is a common neurosurgical approach, as it accounts for
inhibiting ACE activity. A lot of investigations have
20% of all intracranial operations in most neurosurgical
displayed that MgSO4 infusion throughout general
centers (2). Anesthetic management for such cases
anesthesia was accompanied by a reduction in anesthetic
represents a challenge to anesthesiologists as nasal
need and postsurgical analgesic requirement (8).
speculum insertion during the procedure results in a

The current study aimed to compare between
strong nociceptive stimulation, which in turn will lead to
dexmedetomidine and MgSO4 in the context of adequacy
tachycardia and hypertension. This will lead to bleeding
of hypotensive anesthesia during trans-sphenoidal
and difficult visualization of the operative field (3, 4).
excision of pituitary tumours.

Multiple drugs are recommended to obtain

controlled hypotension during neurosurgical procedures
PATIENTS AND METHODS
including;
beta-blockers,
sodium
nitroprusside,

This was a prospective randomized study carried
nitroglycerine, increasing the dosages of inhaled
out at Mansoura University Hospitals within a period of
anesthetic agents, alpha-2 agonists and MgSO4 (5).
two years, starting from December 2018 till December

Dexmedetomidine is an alpha-II adrenergic
2020.
agonist, which has sedative and analgesic, as well as

anesthetic sparing effect, without any negative impact on
Inclusion criteria: Age from 18 and 65 years who were
the respiratory center. It modulates pin signals
electively prepared for pituitary tumour resection.
transmission via acting on both spinal and supraspinal

regions (1). Dexmedetomidine is associates with decrease
Exclusion criteria: patients with Glasgow Coma Scale
of inhaled anesthetic requirements. Additionally, in
(GCS) < 15, American Society of Anesthesiologists
neurosurgical patients, it helps to stabilize intracranial
(ASA) score > II, preoperative hear rate < 50 bpm, first-
pressure along with intraoperative hemodynamic
or second-degree heart block, allergy to the study

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59
Received: 07/08/2021
Accepted: 03/10/2021

Full Paper (vol.861 paper# 11)


c:\work\Jor\vol861_12 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 66-72

Evaluation of serum transferrin receptor level in Children
Undergoing Regular Hemodialysis
Nancy Esam Abdelaleem, Wafaa Elsaeed, Mai Abdelfatah
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Nancy Esam Abdelaleem, E-Mail: nancywaly123@gmail.com

ABSTRACT
Background:
Patients with chronic kidney disease (CKD) are at risk for anemia as a result of a variety of factors. Blood
ferritin levels are an indicator of iron, while blood transferrin receptor (sTfR) levels are an indicator of how much iron
is available for cells to use.
Objective: It was the goal of this work to determine the diagnostic value of serum soluble transferrin receptor (sTfR)
in children undergoing regular hemodialysis in Pediatric Nephrology Unit in Zagazig University.
Patients and Methods: Our study was applied on 44 children admitted to Pediatric Nephrology Unit at the Pediatric
Department in Zagazig University Children Hospital for hemodialysis, during the period from January 2019 to July
2019. Iron profile (serum Iron, ferritin, total iron-binding capacity (TIBC) and serum transferrin) as well as transferrin
saturation-sTfRs TfR/log ferritin index was done to all children.
Results: Statistically significant positive association between iron, ferritin, total saturation of transferrin (TSAT) and
hemoglobin (Hb) as well as statistically significant negative correlation between TSAT, iron, ferritin and sTfR were
found. Anemia of chronic disease (ACD) patients' dialysis time was much longer than that of (Iron deficiency anemia)
IDA patients, while hypertension was significantly higher in IDA patients than in ACD patients. The optimal cutoff
value for sTfR was (1.75) with a sensitivity of 82% and a specificity of 73.6 %.
Conclusion: STfR is a valuable metric for distinguishing between ACD and IDA, as well as between ACD in patients
who get regular hemodialysis. In HD patients, sTfR can be utilized to check iron levels.
Keywords: Regular hemodialysis, Serum transferrin receptor.

INTRODUCTION
inflammation, these alterations make interpretation
Multiple factors contribute to anemia in chronic
problematic (5).
kidney disease (CKD) patients, including inadequate
When administering erythropoietin-stimulating
erythropoietin production, absolute and functional iron
agents (ESAs) and iron doses, care must be taken not to
shortage as well as long-term inflammation (1). Patients
risk major adverse consequences for the patients (1). To
with chronic kidney disease may have anemia as a side
accomplish this goal, a different instrument must be
effect. The delivery and monitoring of erythropoiesis-
employed. sTfR has been demonstrated to be an
stimulating drugs and iron therapy is essential for
indication of iron shortage and is unaffected by
optimal treatment (2).
concurrent chronic disease or inflammation. sTfR
A target hemoglobin level of 10­12 g/dL in children
concentrations alone or the sTfR/log ferritin ratio (i.e.,
between the ages of 2 and 19 years, or 9.5­11.5 g/dL in
the sTfR index) are advised as alternate biomarkers in
kids younger than 2 years, is suggested according to the
the presence of high levels of inflammation because they
National Institute for Clinical Excellence (NICE)
are expected to be less susceptible to inflammation (6, 7).
Anemia Management in Chronic Kidney Disease
The transferrin receptor is a transmembrane cellular
recommendations. Numerous iron indicators can be
protein that is preferentially produced in cells that need
utilized to diagnose iron deficiency anemia in
iron, and the soluble form is raised in serum and plasma
individuals with confounding comorbidities, such as
in situations of iron shortage (8).
those receiving frequent hemodialysis (3).
Ferritin and sTfR levels are two indicators of iron
Ferritin, serum iron total iron-binding capacity
availability for cells. In order to get an accurate
(TIBC) or transferrin, and transferrin saturation (TS) are
assessment of the amount of iron in the body, the
the primary indicators of iron shortage or anemia of
sTfR/log ferritin index (sTfR Index) can be calculated
chronic disease in humans (4). Although these tests are
using these two measurements. Since iron shortage
influenced by chronic disease, the clinical interpretation
causes an increase in sTfR and reduction in ferritin
of data is hindered because of this effect. Iron levels are
concentration, the sTfR index takes advantage of this
normally decreased in IDA, but acute phase reactions
reciprocal link. When it comes to iron deficiency
associated with acute and chronic inflammation may
diagnosis and differentiating between anemia types,
boost ferritin levels. Coexisting iron deficiency and
sTfR and ferritin levels are helpful. Combining sTfR and
acute or chronic infection or inflammation alters the
ferritin readings as well as the sTfR index computation
blood iron, TIBC, and transferrin levels. In individuals
should enhance anemia classification accuracy,
with iron deficiency and a concomitant illness or
according to some research, severe anemia associated

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66
Received: 24/8/2021
Accepted: 4/10/2021

Full Paper (vol.861 paper# 12)


c:\work\Jor\vol861_13 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 73-77

Revision of Total Hip Replacement with Proximal Femur Bone Defect
Mina Samir Abdel Malek*, Khaled Mohamed Hassan, Ali Tawfik Al Alfy, Al Sayed Al Etewy Saody
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mina Samir Abdel Malek, Mobile: (+20)010033473308, E-mail: dr_mina2@yahoo.com

ABSTRACT
Background:
The revision surgery has been evolving constantly. From polyethylene wear, osteolysis and loosening, to
complexities such as pelvic discontinuity, there is a wide range of surgical options for successful reconstruction.
Objective: The aim of the present study was to provide optimal treatment to the increasing number of patients requiring
revision surgery with femur bone defect.
Patients and methods: This study included 10 patients with failed primary total hip replacement and have femoral bone
defects selected as purposive simple random sample requiring revision of total hip replacement at Zagazig University
Hospitals.
Results: All of the patients had femoral defects which were difficult to evaluate accurately preoperatively by radiograph
but were properly evaluated during surgery after removal of the loose implant by simple manual traction. Femoral bone
defects were classified according to Paprosky classification, they were six patients type 1, three patients type 2 and one
patient type 3A. No weight bearing was allowed on the affected limb for 4 weeks. All the patients reached full weight
bearing between 7 ­ 9 weeks after surgery regarding preoperative mean Harris hip score, it was 89. There were no cases
of dislocation or deep infection in this series up to the final follow up visit.
Conclusion: The revision surgery has been evolving constantly. However, we do not have complex solution. The
optimal surgical approach for revision total hip arthroplasty (THA) varies considerably among different settings.
Keywords: Bone Defect, Revision Surgery, Total Hip Replacement.

INTRODUCTION

Total hip arthroplasty (THA) is one of the most
The amount of femoral bone loss and the bone
successful surgical procedures with well documented
quality of the remaining metaphyseal and diaphyseal
survivorship at up to 25 years. With aging of the
bone dictate the selection of appropriate reconstructive
population and higher arthritis prevalence in older
option. The surgical approach for revision surgery is
adults, the demand for the procedure increases
based on surgeon experience and utility of the planned
worldwide (1). In addition, over the last two decades the
reconstruction. Selection of surgical approaches also
age range has been broadened to include younger
influenced by additional exposure (i.e., osteotomy),
patients. Over 270 000 hip replacements are performed
degree and location of bone deficits, presence of
annually in the US alone, and the annual volume of hip
distorted anatomy (e.g. heterotopic ossification), and
joint replacement is projected to double by the year
patient factors (e.g. high risk of instability) (6). The
2030 (2). Although very successful procedure,
extended trochanteric approach, which is most
significant percentage of patients undergoing total hip
commonly used in the setting of revision THA,
arthroplasty require revision within 10 to 15 years after
facilitates acetabular exposure and femoral component
the surgery (3).
removal (4).
Aseptic loosening and the associated osteolysis
Therefore, this study aimed to provide optimal
have been recognized as the main reason for implant
treatment to the increasing number of patients requiring
failure in 71% of cases. Other indications for revision
revision surgery with femur bone defect.
include periprosthetic fracture, dislocation, and

infection (4). New technologies in implant design and
PATIENTS AND METHODS
advances in surgical technique have improved the
In this study 10 patients with failed primary total
outcomes after primary total hip arthroplasty and
hip replacement and have femoral bone defects selected
decreased the rate of complications. However, as a
as purposive simple random sample requiring revision
consequence of increased rate of primary THA's the
of total hip replacement, were included. The study was
prevalence of revision hip surgery is increasing
done at Zagazig University Hospital. The cases reports
proportionally. The increased rate and costs of revision
dated retrospective for 12 months.
procedures impose high demands on both surgeon and
Data were collected from medical records and by
healthcare system (3).
patient structure interview. This study compared fixed
Bone loss is the major challenge in revision
and variable data for the patients preoperatively and
setting. Femoral bone loss as a result of failed total hip
intraoperatively and postoperatively accordingly.
arthroplasty is a problem that continues to challenge
Patients did primary total hip replacement then failed.
orthopaedic surgeons (5).
There was some of femoral bone defects. The cause of


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73
Received: 10/8/2021
Accepted: 6/10/2021

Full Paper (vol.861 paper# 13)


c:\work\Jor\vol861_14 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 78-84

Intrapartum Sonography versus Digital Vaginal Examination in the
First Stage of Labor for Prediction of the Progress of Labor
Rasha Reda Abd-Alhady, Magdi Ragab Elsayed,
Esraa Nasef Abo-Elgheet Sator, Abdulmagid Mahmoud Sarhan
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
*Corresponding author: Esraa Nasef Abo-Elgheet Sator, E-Mail: Dr.esraa1987@gmail.com

ABSTRACT
Background:
The research and advances in obstetrics are performed to overcome abnormal vaginal deliveries. The
obstetrician's skill using digital vaginal examination (DVE) remains a personal skill with limitations.
Objective: Assessment of the ability of intrapartum ultrasound capability to observe the progression of normal labor
in the first stage compared to DVE accurately and objectively.
Patients and methods:
This prospective cohort study, was conducted on 62 singleton pregnancies in their 38-40
weeks of pregnancy at Obstetrics and Gynecology ultrasound unit and Maternity Hospital, during a period between
2018 to 2020. All cases received clinical examination including, general, abdominal, and obstetrical examination and
ultrasonography examination including, transvaginal, transabdominal, and transperineal.
Result: The transvaginal ultrasound evaluated the rate of cervical dilatation at the first stage of labor and the length
of the cervix showed a statistically significant negative correlation and statistically significant positive correlation
between time of labor progress at first and cervical length. There was statistically significantly higher mean cervical
dilatation by DVE than US findings (4.58 & 4.29, respectively).
Conclusion: Ultrasound usage possesses a potential role in predicting vaginal delivery success and helping the
promotion of safe operative delivery.
Keywords: Intrapartum Sonography, Digital Vaginal Examination.

INTRODUCTION
ultrasonography to assess labor progress was reported
Examination of the patient's vagina is considered
for the first time in 1990, physical examination for labor
an essential step in labor for evaluating the progress of
progress is still used till now (6).
labor, it has been used alone or as a part of a partogram
Many studies have documented a significant error
at intervals (1).
rate of conventional obstetrical examination as
Cervical Os dilatation which is evaluated by
intrapartum ultrasonography was not performed as a
digital vaginal assessment considered the most widely
routine practice during labor. Fontanelle position and
used technique for the determination of labor progress. It
fetal head descent are considered difficult even for the
is also used for other clinical purposes, the level and
experienced obstetrician. The usage of two-dimensional
position of descending fetal head, also the cervical
(2D) ultrasound accurately evaluates fetal head descent
position and consistency. The results of vaginal
without the need for between ischial spines drawn line
examination (VE) are represented on a program used for
and also, measures the cervical dilatation (6).
labor decision-making (2).
Transperineal ultrasonography was used to
DVE is a crucial technique in obstetrics, it
evaluate the angle of progression (AOP) and fetal head
remains a personal skill with limitations. Patients'
direction and station and changes faced during labor (7),
dissatisfaction from feeling uncomforted with DVE is
while transabdominal ultrasonography was used for head
considered a disadvantage especially, without regional
rotation and position (8).
analgesia, and when repeated, and can result in
Ultrasonography is considered noninvasive,
psychological complications with so predisposed cases
reproducible, objective, and easy to assess the
(3).
engagement of the fetal head. For accurate evaluation of
The risk of elevated vaginal infection is increased
fetal head station, AOP is considered the best as the
with repeated VE, performing VE twice was found to
higher AOP, the more probability of spontaneous
increase chorioamnionitis probability by 4%, while 13
delivery (8).
VEs recorded a probability of 10%. A previous study
The cervical dilatation evaluation, a distance of
reported a significant decrease in the latency period of
head symphysis, and fetal head-perineum distance
labor in preterm membrane rupture caused by repeated
(FHPD) could be assessed by transperineal
VE (4). The World Health Organization (WHO)
ultrasonography. Providing the maximal safety for the
suggested decreasing the number of DVE (5).
newborn and patient during labor is the real obstetrician
The potential role of Ultrasonography in the
role nowadays (9).
evaluation of labor progress has been reported in many
According to previous studies on labor-guided
previous studies. Despite, The application of
ultrasonography. It is considered an accurate and

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78
Received: 21/8/2021
Accepted: 6/10/2021

Full Paper (vol.861 paper# 14)


c:\work\Jor\vol861_15 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 85-89

Role of Nanoparticles in Diagnosis and Management of
Parasitic Diseases: Review Article
Maha Talaat Elhefny1, Nahed E. Mostafa2, Eman Aly Mohamed1, Reda M. Abdelhameed³, Mohamed
Hassan Sarhan², Howayda Said Fouad Moawad2
1Medical Parasitology Department, Theodor Bilharz Research Institute, Giza, Egypt
2Medical Parasitology Department, Faculty of Medicine, Zagazig University, Egypt
3Applied Organic Chemistry Department, National Research Centre, Dokki, Giza, Egypt
Corresponding author: Maha Talaat Elhefny, E-Mail: mahaeldesouky612@gmail.com

ABSTRACT
Background
: An extensive class of materials, nanoparticles (NPs) include particulate compounds with a minimum
diameter of 100 nanometers (nm). This is because of their tiny size and huge surface area, which allows them to traverse
the blood-brain barrier, enter the respiratory system and be adsorbable through endothelial cells. Today, nanoparticles
for drug administration are being studied to increase their sustained release, intracellular penetrability as well as
bioavailability, due to the constant development and innovation of nanomedicine.
Objective: To determine how nanoparticles can help diagnose and treat parasitic diseases.
Conclusion: Nanoparticles could be conjugated with proteins and immunoglobulins that could help in specific
diagnosis of several parasitic diseases, in addition, improved efficacy and reduced harmful side effects can be achieved
by immobilizing antiparasitic medicines on or inside nanomaterials.
Keywords: Nanoparticles, Parasitic Diseases.


INTRODUCTION

2. Carbon based NPs: carbon nanotubes, fullerenes,
Particulate compounds that have one dimension
carbon nanofibers, carbon black, as well as graphene
smaller than 100 nm at least are known as nanoparticles
are some of the subcategories (6).
(NPs) (1). With their tiny size and wide surface area, the
3. Inorganic NPs: The term "inorganic NPs" refers to
colloidal stability and bioavailability of NPs is boosted,
those that lack carbon as a constituent part of their
allowing them to penetrate blood-brain barriers, enter
structure. Inorganic NPs include metal and metal
the pulmonary system and adhere to endothelial cells (2).
oxide NPs and their derivatives.
To be more specific, metal oxide nanoparticles
(MONPs) have a number of advantageous properties
A. Metal based NPs: cobalt, aluminum, copper,
like simple preparation processes, high stability, ease of
gold, cadmium, silver, and zinc, iron, as well
engineering to the desired size, shape, and porosity, no
as lead are among the most often utilized
swelling variations, ease of functionalization by various
metals for nanoparticle synthesis (4).
molecules, as well as ease of incorporation into both
B. Metal oxides based: Because of their
hydrophobic and hydrophilic systems due to the
improved reactivity and efficiency, they are
negative charge of the surface, which make them a
predominantly synthesized. Zinc oxide,
promising tool for biomedical applications in particular
cerium oxide, aluminium oxide, iron oxide,
(3).
titanium oxide, as well as silicon dioxide, are
The aim of the present review was to determine
the most typically manufactured.
how nanoparticles can help diagnose and treat parasitic
As drug delivery systems, titanium oxide, and zinc oxide
diseases.
(ZnO) NPs are the most often employed oxide NPs (7).


Classification of NPs:
ZnO structure:
The chemical composition of NPs determines
Cubic zinc, hexagonal wurtzite blende are the most
whether they are classified as organic, inorganic, or
common types. In ambient settings, wurtzite structure is
carbon-based (4).
the most stable and consequently the most widely
1. Organic NPs: liposomes, dendrimers, ferritin, as
employed type. Wurtzite ZnO is a hexagonal crystal
well as micelles are the most widely used. Non-
with lattice parameters a = 0.325 nm and c = 0.521 nm
toxic, biodegradable, and sensitive to heat and light,
and with three primary growth directions: {1010},
they can be used in a wide range of applications (5).
{1120} and {0001}. Four oxygen atoms surround each
tetrahedral Zn atom (8).


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85
Received: 22/8/2021
Accepted: 6/10/2021

Full Paper (vol.861 paper# 15)


c:\work\Jor\vol861_16 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 90-95

Diagnosis of Papilledema and Pseudopapilledema Using
Optical Coherence Tomography
Ahmed Gamal Ahmed Elmenezaa*, Khaled Mohamed Fawzy,
Haitham Younis Al-Nashar, Abdullah Ahmed Hassan Nasr
Ophthalmology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed G. Elmenezaa, Email: ahmadgamal30@gmail.com

ABSTRACT


Background: Papilledema is a common clinical problem where the ophthalmologist plays an important role in its
diagnosis. Optical coherence tomography (OCT) provides high resolution images of the retina and the retinal nerve fiber
layer (RNFL).
Objective: The aim of the work was early and non- invasive diagnosis of papilledema and differentiating it from
pseudopapilledema using optical coherence tomography (OCT).
Patients and methods: This observational case control study included a total of 45 eyes stratified into 3 equally groups,
15 each, (Group-1): eyes of healthy normal subjects, (Group-2) eyes with papilledema and (Group-3) eyes with pseudo-
papilledema. Patients presented at Ophthalmology Outpatient Clinic, Zagazig University Hospitals. Follow-up visits
included an interview with the patient for assessing the presence of ocular symptoms, and for ophthalmologic
examination to register all the clinical findings.
Results: There is statistically significant difference between the studied groups regarding result of fundus examination.
Normal control group had normal appearance of fundus. Concerning pseudo papilledema, 73.3% had crowded disc and
26.7% had dusen. Concerning papilledema, 40% had mild lesion, 20% had moderate and remaining 40% had severe
lesion. There is statistically significant difference between the studied groups regarding morphological changes.
Crowded disc and buried optic disc drusen occurred in 73.3% and 26.7% of pseudopapilledema group respectively).
There is statistically significant difference between the studied groups regarding superior RNFL. On LSD comparison,
the difference is significant between each individual groups. There is statistically significant difference between the
studied groups regarding inferior RNFL.
Conclusion: It could be concluded that spectral domain optical coherence tomography can differentiate between
papilledema, pseudopapilledema, and a normal disc.
Keywords: Papilledema, Optical Coherence Tomography, Pseudopapilledema

INTRODUCTION
disc edema by analysis of the contour of the optic disc
Papilledema is a common clinical problem
which may be useful in clinical evaluation of optic disc
where the ophthalmologist plays an important role in its
edema (1).
diagnosis (1). Pseudopapilledema can be defined as any
Therefore, this study was aimed to evaluate the
disc appearance that can be confused with papilledema.
early and non-invasive diagnosis of papilledema and
The distinction is obviously important because of the
differentiating it from pseudopapilledema using OCT.
profound implications associated with papilledema. The

most
frequently
encountered
causes
of
PATIENTS AND METHODS
pseudopapilledema include optic disc drusen,
This observational case control study included a total of
hyperopia, hyaloid remnants, and congenital disc
45 eyes stratified into 3 equally groups, 15 each,
elevations (2). Until a few years ago, diagnosis of
(Group-1): eyes of healthy normal subjects, (Group-2)
papilledema relied solely on fundus examination and
eyes with papilledema and (Group-3) eyes with pseudo-
retinal angiography. It is important to differentiate
papilledema (e.g. optic disc drusen and narrow disc due
pseudoedema from true disc oedema (3).
to hypermetropia). Patients presented at Ophthalmology
Optical coherence tomography (OCT) has
outpatient clinic, Zagazig University Hospitals.
evolved as one of the most important tests in ophthalmic

practice. It is a noninvasive imaging technique and
Inclusion criteria: Eyes of adult patients above 18
provides high resolution, cross-sectional images of the
years, diagnosed clinically to have swollen disc by
retina, the retinal nerve fiber layer (RNFL) and the optic
funds biomicoscopy.
nerve head. With axial resolution in the 5­7 m range,
Exclusion criteria: Patients with other optic disc
it provides close to an in-vivo `optical biopsy' of the
pathology (glaucoma, congenital anomaly), patients
retina (4).
with ocular media opacity and patients with high
Improvement in the quality of OCT can support
myopia (> -6 D. due to presence of myopic
the diagnosis and management of optic disc edema (5).
degeneration).
OCT can be used for quantitative assessment of optic


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90
Received: 07/8/2021
Accepted: 03/10/2021

Full Paper (vol.861 paper# 16)


c:\work\Jor\vol861_17 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 96-99
Role of CD99 in Adult Patients with Acute Myeloid Leukemia
Alaa A Omran, Saad El Osh, Fouad M. Abou Taleb, Amira R. Elsharkawy*
Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Amira R. Elsharkawy, E-mail: amiraelsharkawyaaaa@gmail.com

ABSTRACT
Background
: When it comes to acute myeloid leukemia (AML), the large proportion of patients usually have relapses.
Acute myeloid leukemia, Lymphoblastic lymphoma/leukemia, as well as Ewing sarcoma all have high CD99
expression.
Objective: The aim of the current work was to assess CD99 expression frequency in patients with AML, and also to
evaluate its association with different clinical and laboratory data.
Patients and Methods:
This comprehensive study included a total of 40 AML patients and 20 matched healthy subjects,
attending at Departments of Clinical Pathology and Medical Oncology, Faculty of Medicine, Zagazig University
Hospitals. Clinical and laboratory data were correlated with CD99 expression frequency in patients with AML in order
to examine its usefulness as a predictive and prognostic factor.
Results: Examination of CD99 expression in AML patients revealed that 80% of patients are CD99 positive, while (20%)
are negative.
Conclusion: CD99 expression in acute myeloid leukemia patients is of good prognostic value.
Keywords: AML, CD99, Oncology.

INTRODUCTION

SUBJECTS AND METHODS
Immature myeloid blasts and inefficient blood cell
This comprehensive study included a total of 40
generation are hallmarks of acute myeloid leukemia
AML patients and 20 matched healthy subjects,
(AML), which is a clonal hematopoietic tumor (1). The
attending at Departments of Clinical Pathology and
therapy and prognosis of AMLs differs depending on
Medical Oncology, Faculty of Medicine, Zagazig
the subtype. If left untreated, AML can advance swiftly
University Hospitals. This study was conducted
and lead to death within a matter of weeks or months (2).
between December 2018 to October 2020.
There is a limited chance of long-term survival in

most patients of AML, despite high rates of remission
Ethical Consideration:
after induction and consolidation chemotherapy (3).
This study was ethically approved by Zagazig
Ewing
sarcoma
and
lymphoblastic
Medical
Research
Ethics
Committee.
all
lymphoma/leukemia have both been found to have high
participants signed an informed consent form. The
CD99 expression (4).
work has been carried out in accordance with The
As well as myeloid malignancies (5), tumors of the
Code of Ethics of the World Medical Association
thymus and other cancers. There is evidence that CD99
(Declaration of Helsinki) for studies involving
is acting as an oncogene in each of these cancers (5).
humans.
Anti-CD99 monoclonal antibodies could be used to

distinguish leukemic stem cells from functionally
Inclusion criteria: Diagnosis as de novo AML before
normal hematopoietic stem cells in AML, highlighting
recieving induction chemotherapy, not having any other
the therapeutic potential of CD99 monoclonal
malignancy, and from 18 to 60 years, of both sexes.
antibodies (6).

Immunophenotypic AML leukemic stem cells
Exclusion criteria: Age < 16 years, previously treated
(LSCs) and MDS hematopoietic stem cells (HSCs)
AML patients, promyelocytic leukemia (M3), and other
often express more CD99 compared to hematopoietic
malignancy.
stem and progenitor cell counterparts (HSPCs) in the

normal state (7).
All patients were subjected to the following:
For the treatment of acute myeloid leukemia (AML)
a) History taking with special attention paid to the
and myelodysplastic syndromes (MDS), CD99 has been
occurrence of leukemia-related symptoms in the
identified as a potential therapeutic target (8).
medical history (easy fatigability, fever, bone aches, and
The aim of the current work was to assess CD99
bleeding tendency).
expression frequency in patients with AML, and also to
b) Thorough clinical examination: focusing on leukemia
evaluate its association with different clinical and
involvement, as the existence of lymphadenopathy, size
laboratory data.
of lymph nodes, pallor, liver and spleen sizes, and

purpuric eruptions.


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96
Received: 23/8/2021
Accepted: 4/10/2021

Full Paper (vol.861 paper# 17)


RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 100-104

Role of Circulating Vascular Cell Adhesion Protein­1 as a
Biomarker in Non-Alcoholic Fatty Liver Disease
Ahmed Samir Abo Halima*1, Mohamed Abd EL Moghny Mostafa1, Ahmed Ali El Ray2,
Yasser Mohamed Ali Abdelhady Alsaid2, Khaled Raafat1
1Internal Medicine and Gastroenterology Department, Faculty of Medicine, Ain Shams University, Egypt
2Internal Medicine and Gastroenterology Department, Faculty of Medicine, October 6 University, Egypt
*Corresponding Author: Ahmed Samir Abo Halima, Mobile: (+20)1111194743, E-mail: dr.abohalima@hotmail.com

ABSTRACT
Background:
As a result of the obesity pandemic, non-alcoholic fatty liver disease (NAFLD) has become the most
common cause of chronic liver disease worldwide. NAFLD is the hepatic manifestation of obesity and a precursor of
and independent risk factor for type 2 diabetes.
Objective: The aim of the current work was to assess the level of vascular cell adhesion molecule 1 (VCAM-1) as non-
invasive diagnostic tools for diagnosis of NAFLD degree of fibrosis.
Patients and Methods: This Case-Control clinical study included a total of 60 subjects, 30 patients with fatty liver
disease, FLD (Group A) and 30 healthy subjects as a control (group B), attending at Internal Medicine and Hepatology
Outpatient Clinic, Ain Shams University Hospitals. Group A was further subdivided into NAFLD subgroup (15
patients) and non- alcoholic steatohepatitis (NASH) subgroup (15 patients)
Results: In the present study, the mean VCAM-1 was 2.392± 0.3 in NAFLD group, 9.893± 2.3 in NASH group and
1.983 ± 0.3 in control group with high statistically significant increase in NASH followed by NAFLD than in control
group. Regarding to ROC curve, VCAM-1 had excellent Diagnostic performance with an AUC of 0.994. A best cut-off
criterion of VCAM-1 > 7.7 ng/mL could discriminate between patients with NASH from control group with a sensitivity
of 95% and specificity of 100% In our study, there was no significant correlation in between VCAM-1 and age, AST,
ALT. In the present study, the significant predictors of bad outcome in patients with NAFLD and NASH were higher
VCAM-1, GGT and AST levels.
Conclusion: It could be concluded that the significant predictors of bad outcome in patients with NAFLD and NASH
were higher VCAM-1 level, GGT and higher AST levels.
Keywords: Circulating Vascular cell adhesion protein ­ 1, Non-alcoholic Fatty Liver Disease

INTRODUCTION

non-invasive markers that can adequately distinguish
As a result of the obesity pandemic, non-
NAFLD from NASH (5).
alcoholic fatty liver disease (NAFLD) has become the
In this way, the role of circulating biomarkers
most common cause of chronic liver disease worldwide.
related to endothelial dysfunction and the severity of
NAFLD is the hepatic manifestation of obesity and
underlying liver disease need to be investigated. It is
considered as independent risk factor for type 2 diabetes
suggested that there is a role of VCAM-1 stimulating
(1).
adhesion of lymphocyte and monocytes to the surface
NAFLD comprises a spectrum of disease that
of the vascular endothelium. VCAM-1 is not
ranges from hepatocellular steatosis without necro-
investigated thoroughly in different stages of liver
inflammation (NAFL) to non- alcoholic steatohepatitis
diseases, such as NAFLD (6).
(NASH), fibrosis, cirrhosis, and even hepatocellular
The aim of the present study was to assess the
carcinoma. In addition, NAFLD is an independent risk
level of vascular cell adhesion molecule-1 (VCAM-1)
factor for cardiovascular disease. Recent studies
as non-invasive diagnostic tools for diagnosis of
showed an increased cardiovascular mortality in
NAFLD degree of fibrosis
NAFLD patients (2).

The global prevalence of NAFLD and NASH is
PATIENTS AND METHODS
around 25% and 3%, respectively, although this rises to
This Case-Control clinical study included a total of 60
an estimated 90% and 25%, respectively, in severely
subjects, 30 patients with fatty liver disease (Group A)
obese patients (3).
and 30 healthy subjects as a control (group B), attending
Liver biopsy is still considered as the gold
at Internal Medicine and Hepatology Outpatient Clinic,
standard for the diagnosis of NASH and the assessment
Ain Shams University Hospitals.
of disease activity and fibrosis, although it has
Patients of Group A was further subdivided into
important disadvantages such as its high cost, invasive
NAFLD subgroup (15 patients) and non- alcoholic
nature, and the risk of sampling error (4).
steatohepatitis (NASH) subgroup (15 patients)
This has inspired the search for non-invasive

disease markers, including both serum biomarkers and
Inclusion Criteria: Egyptian outpatient adults over 18
imaging methods. Nevertheless, there are currently no
years, patients with elevated AST and ALT and

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100
Received: 07/8/2021
Accepted: 03/10/2021

Full Paper (vol.861 paper# 18)


c:\work\Jor\vol861_19 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 105-111

The Association between Right Ventricular Function and
Exercise Capacity for Hypertensive Patients
Ragab A. Mahfouz, El-Sayed M. Farag, Radwa A. Elbelbesy, Ahmed K. Hassaan
Department of Cardiology, Faculty of Medicine, Zagazig University Hospital, Egypt
*Corresponding Author: Ahmed K. Hassaan, E-Mail: ahmed.khal.has@gmail.com

ABSTRACT
Background:
Transthoracic echocardiography (TTE) would be used to evaluate right ventricular (RV) function in
patients with arterial hypertension, and the link between RV dysfunction and exercise capacity was studied in the study
population.
Objective: To establish a correlation with exercise capability in the study group by using transthoracic
echocardiography (TTE) to evaluate RV function in patients with arterial hypertension.
Patients and Methods:
Patients with hypertension were surveyed in a cross-sectional research; those known and
treated; whether controlled or not and patients who were recently discovered to be hypertensive. Ninety patients were
included; gender and age were taken into account. A thorough examination was performed on each patient (TTE) as
well as six minute walking distance (6MWD). For all we had a written informed consent prior to enrollment.
Results: Patients with untreated and uncontrolled hypertension showed significantly reduced right ventricular systolic
and diastolic functions compared to those with well-controlled hypertension. Patients with untreated or uncontrolled
hypertension had significant (P <0.001) deterioration on S', wave and diastolic dysfunction parameters (E/A, DTt, E/e t
and IVRT). Untreated and uncontrolled hypertension patients showed a significant decrease in 6MWD compared to the
well-controlled individuals (P <0.001).
Conclusion:
Untreated or ineffectively treated hypertension individuals had considerably reduced right ventricular
function and exercise capacity, according to our findings. In the entire research population, right ventricular functions
are strongly linked to exercise ability.
Keywords:
6 minute walk test, Echocardiography, Exercise capacity, Hypertension, Right ventricle

INTRODUCTION

PATIENTS AND METHODS
In contrast to left ventricle (LV) hypertension, there
Zagazig University Hospital's Cardiology
is a lack of reliable evidence that hypertension affects
Department's outpatient clinic hosted our study from
the RV. Research into the RV can be done in several
March 2021 to October 2021. 90 patients with
ways, including using imaging and functional methods.
hypertension were included divided into 3 groups; 30
When assessing RV structure and function,
well controlled, 30 recently diagnosed untreated and 30
echocardiography is the primary tool (1).
treated patients with unsatisfactory blood pressure
When it comes to RV dysfunction, coronary artery
control. The following factors were used to determine
disease has been the most widely studied topic. RV
whether or not a candidate was eligible: Primary
ejection fraction has been determined in individuals
systemic arterial hypertension had already been
with and without the right coronary artery blockage.
diagnosed before to the trial. (When repeatedly systolic
There have also been studies done on the patterns of
pressure (SP) equal or higher than 140 mm Hg and/or
asynergy of RV in both acute as well as chronic
diastolic pressure (DP) equal or higher than 90 mm Hg)
coronary disease (2). Assessment of functional exercise
(4).
capacity in patients with moderate to severe heart or
Exclusion criteria:
lung illness can be done by conducting the six-minute
Patients <18 years, patients with significant
walk test (6MWT) (3).
valvular heart disease, hypertrophic or infiltrative
When the left ventricle is subjected to the chronic
cardiomyopathy, those who were experiencing atrial
pressure overload that occurs in essential hypertension,
fibrillation and had an abnormally low left ventricular
little is known about RV performance. It's because the
systolic function (Ejection fraction lower than fifty
two ventricles influence each other's performance
percent), pericardial diseases, acute coronary syndrome,
because of their distorted geometry. Furthermore, no
inability to perform 6MWT and/or poor acoustic
research has examined the possible link between
window, chronic obstructive pulmonary disease
exercise capacity and right ventricular function in
(COPD), asthma and sleeping disorders, chronic kidney
hypertension patients (3).
disease (CKD) and chronic liver disease, peripheral
The aim of the present study by using transthoracic
vascular disease, patients with musculoskeletal diseases
echocardiography (TTE) to evaluate RV function in
and arthropathies, patients with decompensated heart
patients with arterial hypertension, so as to establish a
failure (HF), patients with tachyarrhythmias and
correlation with exercise capability in the study group.
bradyarrhythmias, morbidly obese patients, patients

with pulmonary hypertension, patients with severe

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105
Received: 07/08/2021
Accepted: 03/10/2021

Full Paper (vol.861 paper# 19)


c:\work\Jor\vol861_20 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 112-116

Comparison between Laser Hemorrhoidoplasty Procedure and
Conventional Open Surgical Hemorrhoidectomy
Wesam Nuri Yahya*, Doaa Omar Refaat, Waleed Ahmed AbdElhady, Walid Abdelmawla Elsayed
General Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Wesam N. Y. Ahlasa, Mobile: (+2)01201221764, Email: ahlasawesam@gmail.com


ABSTRACT
Background:
Hemorrhoids are a very common anorectal condition defined as the symptomatic enlargement and distal
displacement of the normal anal cushions.
Objective:
The present study aimed to compare between laser hemorrhoidoplasty and conventional open surgical
hemorrhoidectomy in treatment of the hemorrhoidal diseases.
Patients and methods:
This study included 30 patients with symptomatizing hemorrhoidal diseases. They were divided
into two groups: 15 patients underwent open method (MMH) and 15 patients underwent laser method (LHP). They were
admitted to General Surgery Department, Faculty of Medicine, Zagazig University Hospitals with symptomatic
hemorrhoidal diseases. Full history, clinical examination and pre- and post-operative assessment were performed.
Results:
The mean age was distributed as 36.03 ± 7.32 in the MMH group and 35.73 ± 8.39 years in the LHP group
with no significant difference between both groups. The mean operative time was distributed as 29.53 ± 4.05 and 14.60
± 3.13 minutes for MMH and LHP groups respectively. The mean hospital stay for MMH group was 36.25 ± 6.58 hours
and 7.85 ± 2.11 hours for LHP, MMH group significantly associated with longer hospital stay. MMH group was
significantly associated with more bleeding at 1st and 2nd week but no bleeding founded after 2nd week at both groups.
Conclusion:
laser hemorrhoidoplasty (LHP) technique for the management of hemorrhoids was, with shorter operative
time, less postoperative pain, shorter hospital stay, and less postoperative complications than open surgical
hemorrhoidectomy.
Keywords: Laser hemorrhoidoplasty, VAS, Open surgical hemorrhoidectomy

INTRODUCTION


Hemorrhoids are a very common anorectal
sclerotherapy, Doppler-guided artery ligation, and
condition defined as the symptomatic enlargement and
finally surgery (5).
distal displacement of the normal anal cushions. They
Postoperative pain is the most common trouble
affect millions of people around the world, and
with this surgery. The other early complications are
represent a major medical and socioeconomic problem
urinary retention, hemorrhage and abscess formation.
(1). The highest incidence rate of the disease is found
The long-term complications include anal fissure, anal
among patients aged between 45 and 65 years, while the
stenosis, stool incontinence, perianal fistula, and
incidence rate of the disease decrease after 65 years of
recurrence of the disease. These drawbacks have led to
age. Men are more often affected than women (2).
the
introduction
of
diode
laser
treatment.
Bleeding, is the principal and earliest symptom of
Intrahemorrhoidal
laser
coagulation
or
laser
hemorrhoids. The nature of the bleeding is
hemorrhoidoplasty (LHP) was first described in 2009 (2)
characteristically separate from the motion and is seen
and reported in larger series of patients (6), giving rise to
either on the paper for wiping or as a fresh splash in the
numerous advantages such as easy and efficient
pan. Very rarely, the bleeding may be sufficient to cause
application, and noninvasive nontoxic painless nature,
anemia. Pain is not commonly associated with the
in addition to reduction of the need of pharmaceutical
bleeding and its presence should make the clinician alert
drugs, drug interactions, and their side effects (7).
to the possibility of another diagnosis; however, pain
The aim of the present study was to find the better
may result from congestion of pile masses below a
management and improving outcome of the patients of
hypertonic sphincter (3). The patients also may complain
hemorrhoids.
of prolapse and anal irritation, which may occur as a

result of mucus secretion from the caudally displaced
PATIENTS AND METHODS
rectal mucosa, minor leakage through a now imperfect
This prospective comparative clinical study was
anal seal or difficulties in cleaning after defecation
carried out on 30 patients with grade 2 and grade 3
because of the irregularity of the anal verge (4).
hemorrhoidal disease admitted to General Surgery
There are many treatments of hemorrhoids
Department, Faculty of Medicine, Zagazig University
varying from medications and band ligation to stapled
Hospitals with symptomatizing hemorrhoidal diseases.
hemorrhoidopexy, laser photocoagulation,
The study took place from June 2020 to March 2021.





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112
Received: 12/8/2021
Accepted: 8/10/2021

Full Paper (vol.861 paper# 20)


c:\work\Jor\vol861_21 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 117-123

Benign Prostatic Hyperplasia: Enucleation versus Resection Using Plasmakinetic
Energy: A Prospective Randomized Study at Zagazig University Hospital
Mahmoud El Sayed Mohammed Ibrahim*, Mohammed Khairy Mahmoud Yousef,
Salem Ahmed Khalil, Emad Abd El-Hamid Salem
Department of Urology, Faculty of Medicine Zagazig University, Egypt
*Correspondence to Mahmoud El Sayed Mohammed Ibrahim, Mobile: (+20)01553250160, E-mail: mfars4444@gmail.com

ABSTRACT
Background:
Transuretheral resection of the prostate (TURP) has been the gold standard endoscopic treatment for
bladder outlet obstruction (BOO) secondary to benign prostatic hyperplasia (BPH). New technologies have been
developed to minimize the morbidity of TURP. Recently, the Gyrus Plasma Kinetic (PK) System is the first bipolar
device used in urological practice, as a new modality in treatment of BPH.
Objective: To evaluate the efficacy and safety of plasmakinetic enucleation compared to plasmakinetic resection of the
prostate in the management of BOO induced by BPH. Patients and Methods: This study was conducted on 58 volunteers
from Department of Urology, Faculty of Medicine, Zagazig University between January 2018, and January 2020. Patients
were randomized to either plasmakinetic enucleation of the prostate (PKEP) group or plasmakinetic resection of the
prostate (PKRP) group. All patients were indicated for surgical treatment (prostate size 60 g and 120 g). Results:
There were no statistically significant differences between the two groups preoperatively. PKEP resulted in a greater
volume of prostatic tissue removal than the PKRP. Tissue retrieved/total operative time in PKEP group was greater than
in PKRP group (0.69 gm/min vs 0.67 gm/min respectively). The mean indwelling uretheral catheter time was shorter in
PKEP group (34.7 ±4.40 hrs.) than in PKRP (48.79 ±4.31 hrs.). Regarding postoperative complication (early and late),
there were no statistically significant differences between the two groups.
Conclusions:
We concluded that regarding, surgical safety and efficacy PKEP is comparable to PKRP for prostates (60-
120 ml). Either PKEP or PKRP can be on an equal footing to TURP as an endoscopic management of BPH.
Keywords: BOO, BPH, PKEP, PKRP, TURP, Urinary tract.

INTRODUCTION

become widely used because of the perceived steep
Benign prostatic hyperplasia (BPH) is a
learning curve and the costs associated with high power
common urologic disorder that affects 33.5% of men
holmium laser systems (3).
aged 60 to 70 years. About 75% of men >50 years of age
In the era of minimally invasive treatment,
have symptoms due to BPH, and 20­30% of men
various new technologies have been developed to
reaching 80 years of age require surgical intervention for
minimize the morbidity of TURP. Recently, the Gyrus
the management of BPH. BPH can result in lower
PlasmaKinetic (PK) System is the first bipolar device
urinary tract symptoms (LUTS). There are many types
used in urological practice, as a new modality in
of therapy available for patients with BPH including
treatment of benign prostatic hyperplasia. The
watchful waiting, medical management, endoscopic
transurethral plasmakinetic resection of the prostate
treatment and open surgery. Transurethral resection of
(PKRP) provides a new minimally invasive surgical
the prostate (TURP) has been the gold standard
option for treatment of BPH. In this technology, high
endoscopic treatment for BOO secondary to BPH and is
frequency current runs between an active and passive
considered to be safe and effective (1).
electrode,
converting
the
irrigation
solution
In recent decades monopolar TURP morbidity
(electroconductive solution) into a plasma layer energy
has continuously decreased. The perioperative
that disintegrates tissue on contact (4). Compared with
complications as clots' retention (2 vs 5%), blood
conventional TURP, PKRP has been accepted as a safer
transfusion (0.4 vs 7.1%), urinary tract infection (1.7 vs
and more effective therapy for BOO induced by BPH.
8.2%), urinary retention (3 vs 9%) and capsular
The PKRP technique has been further refined by the
perforation (6.2 vs 17.3%) were significantly decreased
development of PK technology that allows enucleation
in recent M-TURP studies compared to the earlier series.
of the prostate. Plasma kinetic enucleation of the
On the other hand, late-term complications such as
prostate (PKEP) is technically feasible and a safe
bladder neck contracture (BNC) (3.8 vs 4.7%) and
procedure (5).In the present study, we aimed to evaluate
urethral stricture (3.8 vs 4.1%) remained stable (2).
the efficacy and safety of plasmakinetic enucleation
Among the most important recent innovation
compared to plasmakinetic resection of the prostate in
was the introduction of holmium laser enucleation of the
the management of BOO induced by BPH.
prostate (HoLEP). Since its inception in 1996, HoLEP

has been rigorously studied and has demonstrated long-
PATIENTS AND METHODS
term clinical improvement and a low rate of
This study was carried out at Department of
complications. Despite proven efficacy, HoLEP has not
Urology, Faculty of Medicine, Zagazig University




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117
Received: 07/08/2021
Accepted: 03/10/2021

Full Paper (vol.861 paper# 21)


c:\work\Jor\vol861_22 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 124-129

Assessment of Level of Serum Cardiac Troponin T in Neonates with
Respiratory Distress Syndrome
Amr Ismail Abd-El Moez*1, HanaaAbd-Elfattah Mohamed1, Azza Ali Khalil1, Hanan Samir Ahmed2
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Amr Ismail Abd-El Moez, E-mail: darkknightrises375@gmail.com

ABSTRACT
Background
: One of the most prevalent reasons for admission to neonatal intensive care units (NICUs) is respiratory
distress syndrome (RDs). When myocardial cells are damaged, cardiac troponin I (cTnT) is released as a biomarker of
myocardial damage, which is very specific and sensitive.
Objective: To determine the level of cTnT in preterm infants who have respiratory distress syndrome as a marker of
cardiac dysfunction.
Patients and Methods
: This study was carried as a case-control trial on forty preterm infants, 20 patients of respiratory
distress syndrome at neonatal intensive care unit as a group I, 20 apparently healthy newborns as a control group. Serum
cardiac troponin T level sample was taken on the 3rd day of delivery.
Results: A statistically significant difference in blood troponin was found between the groups tested, with a negative
connection between serum troponin and gestational age, length, and APGAR scores at the first and fifth minutes of life.
Respiratory rate and serum troponin were found to have a statistically significant connection. Any one of the
echocardiographic measures had a statistically significant positive connection with serum troponin. Serum troponin was
able to diagnose respiratory distress syndrome with cutoff 93.5 ng/mL with the area under the curve, Positive
predictive value: 83.33% Positive predictive value: 83.33% Negative predictive value: 100 percent Accuracy: 90%.
Conclusion
: Cardiac troponin T can be used to detect cardiac dysfunction in ill newborns, especially in centers that do
not have in-house echocardiography.
Keywords: Respiratory Distress Syndrome, Cardiac Troponin T.

INTRODUCTION

long been recognized as the best biochemical indicators.
Premature and sick infants are more likely to have a
As soon as two hours after a full-thickness myocardial
compromised cardiovascular system. Perinatal Asphyxia
infarction, concentrations can stay elevated for two
as well as respiratory distress syndrome are prominent
weeks (5).
causes of impaired myocardial contractility and
Numerous healthy newborns have cardiac troponin
decreased cardiac output (1).
T detected in their blood, but no link has been identified
Hypotension, which is associated with an increased
between the troponin and critical clinical or biological
risk of death and poor neurological sequelae, may be a
factors. Concentrations in sick newborns are far more
clinical sign of a diminished cardiovascular reserve.
pronounced than in healthy neonates. Using a regression
Ischemia and necrosis have been hypothesized to be the
model, the fluctuation in cardiac troponin T
cause of this myocardial dysfunction or stunning (2).
concentration was found to be a significant predictor of
Cardiac biomarkers are increasingly being used as
oxygen consumption or inotropic support. For neonates
measures of myocardial strain in clinical trials. In
and those with cardiorespiratory issues, cardiac troponin
addition, they may be utilized to help guide treatment
T may be a helpful marker (1).
and enhance outcomes. As diagnostic and therapeutic
This study aimed at testing for cardiac failure in
instruments in the case of neonatal disease complicated
preterm babies with respiratory distress syndrome by
by circulatory compromise, they have a great potential
measuring the amount of serum cTnT.
role in helping the management of these conditions (3).

Creatine kinase isoforms have previously been
PATIENTS AND METHODS
employed as biochemical indicators of cardiac damage
In neonatal intensive care, this case-control trial was
in newborns. Since gestational age, gender, mode of
carried out, at Zagazig University Hospitals, between
delivery, and birth weight all affect creatine kinase, these
January 2019 to January 2021.
markers have largely been disregarded (1).
Ethical consent:
There is a sensitive and specific marker for ischemia
Approval of the study was obtained from the
myocardial cell injury in both the adult and juvenile
Zagazig University academic and ethical committee
populations of cardiac troponin T (cTnT) detection in the
(ZU-IRB#6250). Every patient signed informed
blood (4).
written consent for the acceptance of the operation.
Various muscle types have distinct versions of
This work has been carried out following The Code
troponin T, C, and I. Myocardial necrosis can now be
of Ethics of the World Medical Association
diagnosed using cardiac troponins T and I, which have




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124
Received: 22/8/2021

Accepted: 5/10/2021

Full Paper (vol.861 paper# 22)


c:\work\Jor\vol861_23 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 130-134

Ultrasonography Role for Evaluation of Hand Tendon Injuries
Tarek Mohammad Sobhy, Sameh Saber Bayoumi, Mostafa Mohamad Assy, Esmaiel Ali Abdulsalam
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Esmaiel A. Abdulsalam, Mobile: (+2)01087985437, Email: esmaiel84@gmail.com

ABSTRACT
Background:
Most tendons injuries are open injuries to the flexor or extensor tendons, but less frequent injuries.
Ultrasound (US) and MRI used as a diagnostic tool for tendon injuries.
Objective: This study aimed to investigate the overall accuracy of the bedside tendon ultrasonography, which can be
used to the diagnosis and discharge planning in patients with suspected hand tendon injuries.
Patients and methods: A cross sectional study included 24 patients diagnosed with a hand tendon injuries either
preoperative or postoperative and carried out in the Department of Radiodiagnosis at Zagazig University Hospitals.
Preoperative ultrasound was performed to the affected tendon to perform multisectional scans without flexion or
extension of the wrists in all cases. The unaffected hand and fingers were also examined in the same fashion as the
affected fingers for comparison.
Results: There was significant increase in number of patients presented with injury preoperatively who didn't present
with nerve injury. There was significant change in number of patients presented with either single or multiple tendon
injuries. There was significant increase in frequency in patient without foreign body. There were two patients with
ultrasonographic features of tendon injury had no tendon injury proven by surgery with sensitivity of 91.7 %. There was
significant increase in number of patients presented with tendon injury. US can detect tendon injury with 100%
sensitivity, 91.7% positive predictive value and 91.7% accuracy.
Conclusion: Ultrasound is a useful diagnostic tool for modality of predicting and diagnosis of a tendon rupture in hand
injuries.
Keywords: Nerve injury, Tendon Injuries, Ultrasonographic features, Ultrasonography.

INTRODUCTION

surgical techniques vary, and the ultrasound (US)
Tendon injuries are the second most common
appearance of an operated tendon depends on many
injuries in the hand after fractures (1). Most injuries are
factors, which must be known to the US operator before
direct injuries to the tendons, but less frequent indirect
the examination is carried out (6).
traumas may cause damage to the tendon, tendon
Healing of the tendon stumps in case of simple
sheath, and pulley system. The recognition of a tendon
end-to-end suture leads to focal thickening called
rupture is usually based on the physical examination and
"tendon callus". In these cases, a thinned tendon is
history. An acute loss of motion, a patient's report of
highly suggestive of re-rupture (7). Diagnosis of re-
hearing a popping sound during the injury and the final
rupture of the tendon can be difficult depending on the
position of the finger generally demonstrates a tendon
location of the lesion; time elapsed from surgery and
rupture. However, imaging is necessary for diagnosis,
surgical technique (8).
especially in complicated cases (2).
The purpose of this study was to investigate the
Tendon ruptures are uncommon but may cause
overall accuracy of the bedside tendon ultrasonography,
severe initial pain and lead to permanent disability if
which can be used to the diagnosis and discharge
untreated. Tendon ruptures can usually be diagnosed by
planning in patients with suspected hand tendon
clinical assessment. X-rays and ultrasound are used to
injuries.
establish or confirm the diagnosis. Patients aged over 60

years are more prone to tendon damage and therefore
PATIENTS AND METHODS
tendon rupture. Younger people can also be at increased
A cross sectional study included 24 patients
risk associated with sporting activities (3).
diagnosed with a hand tendon injuries either
US can also be used to detect iatrogenic tendon
preoperative or postoperative and carried out in the
lesions in the postoperative period. Extensor tendon
Department of Radiodiagnosis at Zagazig University
injuries are commonly encountered after fixation of
Hospitals.
distal radius fractures with palmar locking plates.
Inclusion criteria: Patients who had a history of
Tenosynovitis and partial/complete tendon rupture in
acute hand tendon injury. Patients who had residual
the extensor compartment are commonly encountered
symptoms of pain, swelling, or instability after
complications after an operation (4). Tenosynovitis can
conservative treatment including rest, analgesia, hand
be diagnosed easily with the presence of an effusion or
guard, and physiotherapy for at least 6 weeks. Patients
thickening of the synovium around the tendons (5).
who had positive clinical findings suggestive of hand
The main objective of tendon surgery is to restore
tendon
injuries.
Postoperative
tendon
repair
satisfactory function of the tendon. Indications and
complicated with re-rupture.

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130
Received: 12/8/2021
Accepted: 8/10/2021

Full Paper (vol.861 paper# 23)


c:\work\Jor\vol861_24 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 135-138

Zero Re-Entry Site Injury in Redo Cases: A New Easy, Safe and Reproducible
Femoral Vein Cannulation Technique
Alaa Omar*, Mahmoud Gamaleldin Ali, Mahmoud Eldegwy
Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
*Corresponding author: Alaa Omar, Mobile: (+20)01001168488, Email: alaaomarcts1@yahoo.com

ABSTRACT
Background:
Despite high progress in surgical techniques and medical strategies, mortality seems higher in redo cases
than in primary surgery. Redo cardiac surgery is challenging. Scarring of tissues leading to loss of anatomical planes
and adhesions increases the risk of injury during re-entry. It is important to implement safe strategies to prevent such
injuries in this cohort of patients.
Objectives: We investigated the outcome of redo patients with a new simple, reproducible technique using pre-operative
chest computed tomography without contrast and peripheral femoral site cannulation with the use of a new technique
of femoral venous cannulation and initiation of cardiopulmonary bypass pre-sternotomy in redo patients.
Patients and Methods: A prospective analytical study involved 97 redo patients between July 2018 and June 2021. All
patients were operated by the same surgical technique involved pre sternotomy femoral cannulation and initiation of
cardiopulmonary bypass. All patients candidate for redo surgery were involved, there were no exclusion criteria, we
used our modified technique for peripheral femoral cannulation using a simple, reproducible, and safe strategy to avoid
fatal re-entry injuries.
Results: There was no re-entry site injury, very low peripheral femoral site cannulation complications, and hospital
mortality 6% due to other causes rather than fatal re-entry site injury.
Conclusion: We believe that our simple modified technique of pre-operative mandatory CT scan of the chest, and pre-
sternotomy peripheral femoral cannulation, and initiation of CPB were very promising in achieving zero re-entry site
injury in redo cardiac surgery cases.
Keywords: Re-entry site injury, Redo cardiac surgery, Femoral venous cannulation.

INTRODUCTION

PATIENTS AND METHODS
The number of patients performing cardiac
A prospective analytical study involved 97 redo
surgeries increased due to the increase in life
patients between July 2018 and June 2021 at Kasr
expectancy dramatically, cohort of patients requiring
Alainy Hospitals. All patients were operated by the
redo surgery is not uncommon. Despite major progress
same surgical technique involved pre- sternotomy
in technology, and recent advanced techniques, redo
femoral cannulation and initiation of cardiopulmonary
cardiac surgery still carries a higher risk of mortality
bypass. All patients candidate for redo surgery were
and morbidity rates than primary surgery (1,2).
involved, there were no exclusion criteria. We used our
Redo cardiac surgery can be performed with
modified technique for peripheral femoral cannulation
conventional aortic and venous cannulation after
using a simple, reproducible, and safe strategy to avoid
sternotomy or, by arterial and venous cannulation
fatal re-entry injuries.
before sternotomy through different methods of

peripheral cannulation (2).
Preoperative evaluation:
Due to increased operative and technical skills and
All patients scheduled for redo surgery had the
intensive care units high potentials there is better long-
usual routine pre-operative evaluation for any primary
term survival following cardiac surgery. In recent years,
patients included full laboratory investigations, plain
surgeons became highly encountered in re-doing more
posteroanterior chest XRay( CXR), echocardiography,
complex surgically and medically demanding cardiac
carotid duplex for any patient more than 45 years old or
surgeries (3). D
history of stroke, coronary angiography for patients
espite high progress in surgical techniques and
more than 40 years or redo coronary artery bypass
medical strategies, mortality seems higher in redo cases
grafting, moreover, we ordered lateral view plain X-ray
than in primary surgery. Redo cardiac surgery is
and CT chest without contrast and arterial both lower
challenging. Scarring of tissues leading to loss of
limbs duplex for every patient.
anatomical planes and adhesions increases the risk of

injury during re-entry. It is important to implement safe
Redo cardiac surgery technique:
strategies to prevent such injuries in this cohort of
In 89 patients, we started the operation with
patients (4).
cannulation of the right common femoral artery, in 8

patients we cannulated the left common femoral artery

due to significant atherosclerotic conditions in the right

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135
Received: 9/8/2021
Accepted: 5/10/2021

Full Paper (vol.861 paper# 24)


c:\work\Jor\vol861_25 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 139-146

Study of Outcomes of Desarda Repair in Emergency Conditions of
Inguinal Hernia
Mohamed Salah Abdel-Kader*, Wesam Mohammed Ali, Hany Mohamed, Sherif Mohammed Holiel
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed Salah Abdel-Kader, E-Mail: mohamedsalahalhosary906@gmail.com


ABSTRACT
Background
There are two types of hernias in men and women: inguinal hernias and abdominal hernias. Inguinal
hernias can be treated with the Desarda technique, a suture-based procedure that is becoming more popular.
Objective: improving inguinal hernia repair outcomes by avoiding complications caused by foreign bodies.
Patients and Methods: 40 male patients with difficult inguinal hernias were studied in the General Surgery
Department of the Faculty of Medicine, Zagazig University Hospital, as part of a prospective study. Six months of
follow-up took place from September 2020 to November 2021. Experienced and trained surgeons performed Desarda
method procedures on patients. Pain and gait were measured at each follow-up.
Results:
Twenty-seven of the studied patients had no postoperative complications. Wound infection, seroma and
scrotal edema occurred in 5, 6 and 2 of the patients respectively. A statistically significant difference in postoperative
Visual Analogue Scale (VAS) scores was found between the groups tested (significantly higher among strangulated
hernia). In terms of postoperative complications, the two groups analyzed differ significantly. In cases with
obstructed hernia, non-complicated hernias accounted for 23, while strangulated hernias accounted for four.
Conclusion
: The Desarda approach appears to be a viable alternative to current practices. There are no problems or
hernia recurrences as a result of this procedure, which is rapid, uncomplicated, and easy to learn and conduct.
Keywords: Desarda Repair, Inguinal Hernia

INTRODUCTION


Protrusion of a viscous or a component of a
Prosthetic mesh is replaced with an external
viscous through an irregular opening in the walls of its
oblique aponeurosis strip to strengthen the posterior
enclosing cavity is known as hernia (1). The inguinal
wall. It is simple, safe, tension-free, permanent, and
hernia is the most frequent hernia in both sexes;
does not use weaker muscle or transversalis fascia for
however, men are more likely to suffer from it. 27
restoration. The cost-effectiveness of treatment is an
percent of men and 3 percent of women have an inguinal
important consideration in the fight against the disease
hernia at some point in their lives (2).
(6).
An inguinal hernia is a common occurrence in
So, this study was carried out to examine the results
both the outpatient and emergency departments. As a
of the Desarda method of inguinal hernia repair so as to
result of its prevalence, it is still a significant medical
improve the outcome of inguinal hernia repair by
issue. Groin hernias are most commonly caused by male
avoiding foreign body related complications.
gender and the ageing process (3).

Desarda is a new suture-based surgery that is
PATIENTS AND METHODS
gaining popularity. A mesh-free, tension-free, and
40 male patients of different types of complicated
surgical physiology of the inguinal canal are the
inguinal hernia at Zagazig University Hospitals between
hallmarks of this surgery. Due to the use of more
September 2020 and November 2021 served as the
established methods, there is a lack of data to evaluate
subjects for this prospective study.
the effectiveness of this strategy (4).

In the developed world, Lichtenstein repair is
Ethical consent:

the most usual procedure. In spite of these drawbacks,
An approval of the study was obtained from
Lichtenstein mesh repair has its advantages, including
Zagazig University Academic and Ethical
its low cost, availability in many developing countries,
Committee (ZU-IRB#6275). Surgical technique was
and ability to fold or wrinkle. Chronic groin sepsis that
explained for all the cases. Every patient signed an
requires mesh removal is also a drawback. Many
informed written consent for acceptance of the
researchers are looking for innovative ways to heal
operation and participation in this study. This work
hernias because of the observed risks and postoperative
has been carried out in accordance with The Code
dysfunctions. The Desarda approach, which was
of Ethics of the World Medical Association
introduced in 2001 and established a new surgical
(Declaration of Helsinki) for studies involving
alternative for tissue-based groin hernia repair, is a good
humans.
illustration of this effort (5).


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139
Received: 23/8/2021
Accepted: 8/10/2021

Full Paper (vol.861 paper# 25)


c:\work\Jor\vol861_26 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 147-155

Family Medicine Postgraduate Clinical Training in two Universities in
Egypt: Physicians' Perspectives
Maha A.Mowafy 1, Nesreen M.Kamal Elden2 , Nagwa Nashat Hegazy3 *
1Family Medicine Department,2 Public Health Department, Faculty of Medicine, Cairo University,3Family Medicine
Department, Faculty of Medicine, Menoufia University
*Corresponding Author: Nagwa Nashat Hegazy, Email: Nagwa.nashaat1@med.menofia.edu.eg

ABSTRACT
Background:
The Family Medicine Specialty was endorsed to fulfill the needs of qualified Primary Health Care
providers. Family Medicine Postgraduate Training in Egypt had started in the universities under the umbrella of Medical
Colleges in the form of postgraduate trainings and degrees.
Objectives: This paper aimed to identify the strengths and weaknesses of the different clinical rotations in Family
Medicine in relation to the learning outcomes and to assess trainees' satisfaction.
Methods: A mixed research exploratory study was conducted among 48 postgraduate family physicians' candidates in
their final year of training from two purposively selected universities (Cairo University and El Menoufia University)
during 2019.
Results: The attitude of the physicians towards their clinical education experience differs significantly between the
Internal Medicine & Pediatrics. About 72% of participants were from Cairo University and 28% from Menoufia. Internal
Medicine training was the best perceived among trained physicians. More than (71%) of the physicians believed they
understood the common clinical cases.
Conclusions: These findings can be useful for the policy makers to emphasize the importance of raising awareness
among staff member regarding family practice and to implement the suggested recommendations and deal with
obstacles to improve the Family Medicine training in order to provide effective and efficient primary care services.
Keywords: Family Medicine; Training; clinical; Satisfaction, Challenges.

INTRODUCTION

According to the training requirements of FM,
Family medicine (FM) specialty is in very high
trainees are demanded to spend a total of 18 months of
demand in Egypt for many factors. The foremost
training to complete the needed qualifications of the
underlying cause is the high need for the services of
postgraduate degrees in FM. Both Master and Doctorate
Family Physicians (FPs) by the Egyptian community
degrees curricula were designed to meet the trainee's
specially with the implementation of the health
practical and theoretical needs in FM in order to graduate
insurance. Other reasons include lack of qualified FPs in
a skilled and experienced FPs.
primary health care (PHC) facilities. National health
The training requirements include different rotations
insurance and universal health coverage rely not only on
in Internal Medicine, Surgery, Pediatrics, Obstetrics and
access to care, but also the quality of that care. Family
Gynecology,
Orthopedics,
Dermatology,
ENT,
physicians, with additional postgraduate training to
Ophthalmology, Emergency Medicine, and Psychiatry (7,
become specialists in FM, can improve the quality of
8). In comparison to other specialties, FM is an
primary care, when they are part of healthcare teams (1, 2)
.

innovative field in Egypt, though in other countries such
Family medicine specialty provides ongoing,
as the Arabian Gulf it appeals an ample number of
comprehensive, and cost-effective care to the whole
graduated physicians than any other specialty.
family within the community through the life-cycle
The high demand on FM as a specialty due to the
approach and based on their needs. (3, 4). Health care
rapid changes in the health sector reform and needs for
services that depend on FPs are more capable to deliver
health insurance have extensively increased pressure on
such good care than specialist- based ones. This is
several aspects of training. This necessitates identifying
mainly critical in developing countries where looking
difficulties or ongoing challenges in FPs' training to be
for lower health expenses and equitable delivery of care
properly evaluated, clarified, discussed and provide
along with better quality health outcomes and patient
solutions. The current study was designed to show that
satisfaction arises as a favorite policy goal (5). Family
the forms of challenges that are confronted in FM
physicians, the "gatekeepers" of PHC services (6), are
clinical rotation programs in two universities in Egypt
qualified to deliver first contact and continuing care to
and how it is perceived by the trained physicians (9, 10, and
both sexes and all age groups in the societies they
11)
support. (3, 4)

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147
Received: 11/8/2021
Accepted: 7/10/2021

Full Paper (vol.861 paper# 26)


c:\work\Jor\vol861_27 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 156-164

The Prevalence of Depression among Adult Asthmatic Patients in
Jizan Region, Saudi Arabia
Mohamed Ahmed Sumaily*1, Salwa Tayel2, Elsiddig Mohamed Noureldin3
1Department of Public Health Jizan ­ MOH, 2Department of Family and Community Medicine KSU, 3National Center
for Vector ­ Borne Diseases Jizan ­ MOH, Saudi Arabia
*Corresponding author: Mohamed Ahmed Sumaily, Mobile: +966558812067, E-mail: mohamedsumaily@gmail.com

ABSTRACT
Background:
Depression is an important issue in asthma. Uncover depression in asthmatic patients has important
implications for identifying patients and suitable treatment of these patients this will improve quality of life, decrease
medication intake and decrease hospitalization.
Objective: The aim of this study was to determine the prevalence of depression among adult asthmatic patients in Jizan
region, Saudi Arabia.
Patients and methods: Cross-sectional study that was conducted in Jizan region at the chest diseases hospital. 270 (18-
90 yrs.) asthmatic patients were recruited. The questionnaire including socio-demographic data, clinical risk factors of
asthma, assessment of asthma by using asthma control test (ACT) and assessment of depression by using Patient Health
Questionnaire-9 (PHQ-9).
Results: Out of 270 adult asthmatic patients, 255 responded (94.4%). The mean age of patients was 41.03 ± 15.893
years. The prevalence of depression among adult asthmatic patients was 32.9%. By multivariate analysis the lower
education level [elementary school or below (Odds ratio 3.219 (95% CI; 1.443-7.177)] and longer asthma duration (22
years and above) Odds ratio 2.065 (95% CI; 1.089-3.916) were independently associated with the development of
depression in adult patients with asthma.
Conclusion: The study showed that there was a high prevalence of depression among adult asthmatic patients in Jizan
region, Saudi Arabia. The higher prevalence of depression was associated with lower education level, longer asthma
duration, poor control of asthma and among married subjects. Screening for depression in adult asthmatic patients should
be emphasized in primary health care centers, chest clinics and in hospitals. Adult asthmatic patients should be motivated
to comply with asthma treatment.
Keywords: Depression, Asthma, Saudi Arabia.

INTRODUCTION
In Saudi Arabia, a study conducted at King Abdul
Asthma is one of the noncommunicable diseases.
Aziz Medical City-National Guard, in the biggest three
It is influencing 235 million individuals around the
primary health care centers in Riyadh, the prevalence of
world and caused 383 000 deaths in 2015 according to
depression was found high 49.9% from ages 18 to 65
the latest WHO estimates (1). In Saudi Arabia, asthma is
years (6). The multiple underlying risk factors for
the main causes of hospitalization (2). In 2013 a national
depression such as chronic diseases, low income, job
household survey found that asthma prevalence in Saudi
loss, female sex, divorced or widowed, single, younger
adults was 4.05 % out of 525,794 Saudis aged 15 years
age and lack of self-esteem (7). Some of the
or older (from a total of 12,000 households survey and
consequences of depression destroys the quality of life,
10,735 participants) (3).
makes relationships difficult and affects the ability to
Depression is a common mental disease in the
work and risk of suicide (8). Psychiatric diseases are a
world that causes low mood, loss of interest, feelings
neglected part in the care of physical disorder and
down, trouble of sleep, disturbed appetite, feeling tired,
management, especially asthma where patients possibly
and bad concentration (4). The burden of depression is
get scared and worried during the acute attack at the
rising globally. It is the major reason of disability
time they sense that they might suffocate (9).
globally. Women are affected more than men by
In 2015 a study by Ciprandi et al. (10) showed that
depression. Depression can cause suicide at worst status
the prevalence of depression was 11% in 263 patients
about 800 000 people die every year due to suicide.
with asthma. The study demonstrated that depression is
Although there is a treatment for depression, fewer than
common and relevant comorbidities in asthmatic
half of affected patients in the world (in different
patients. A study in 2017 at three cities of Saudi Arabia
countries, fewer than 10%) get treatment. Some barriers
(Riyadh, Jeddah, and Alkhobar) showed that the
to health care encompass inadequate mental health
prevalence of depression with asthma patients was 20 %
resource, poor of health care staff, insufficient
(30 cases among 150 patients), including 50 asthmatic
assessment and social stigma related to mental illness.
patients from every city (11). The depression is an
In countries of different income level, depressed people
important issue in asthma and some of the consequences
are not correctly diagnosed and treated (5).
of the depression in asthmatic patients are associated
with decrease in asthma-specific quality of life and
greater medication intake and more hospitalization (12).
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156
Received: 12/08/2021
Accepted: 08/10/2021

Full Paper (vol.861 paper# 27)


c:\work\Jor\vol861_28 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 165-170
CT Patterns Among Covid-19 Patients During the Second Wave:
A Single Institute Study
Aya Yassin1, Maryam A. Abdelkader2, Rehab M. Mohammed2, Mona A. Nagi*1
Departments of 1Radiology and 2Chest Diseases, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Mona Ali Mohamed Ali Nagi, Mobile: +201013367332, Email: mona.babydoc@yahoo.com

ABSTRACT
Background:
The COVID-19 pandemic caused a worldwide dramatic loss of human life. The second wave of
coronavirus showed a very rapid spread. Objective: This study aimed to retrospectively analyze the laboratory
findings and chest computed tomography (CT) features in patients with suspected coronavirus disease (COVID-19)
pneumonia during the second wave. Patients and methods: From November 2020 to February 2021, a total of 295
patients were admitted to our hospital with suspected COVID-19 pneumonia. They underwent multiple laboratory
tests including (s. ferritin, CBC) as well as non­contrast CT. Only 144 patients had PCR results available. The CT
findings were reported as regards the presence of ground glassing, consolidation and pleural effusion. Results: 198
(67.1%) showed ground glassing and 36.9% (109 cases) had consolidation in their CT. These lesions were bilateral in
181 cases about 63.3% being single in in 71 cases (25.3 %). Pleural effusion was found in 202 cases (68.7%).
Significant correlation was found between CRP, s. ferritin and d-dimer with presence of consolidation. Significant
decreased neutrophil count and decreased DD among positive in comparison with negative ground glassing. PCR
results were available in only 144 out of 295 patients (48.8%). It was positive in 100 out of 144 patients (69.4%) and
negative in 44 patients (30.6%). Highly significant relation between COVID-19 Reporting and Data System (CO-
RADS) categories & PCR among all studied cases. Conclusion: During the second wave, the CT findings were
similar to wave one with PCR proved COVID-19 cases more frequent with higher CO-RADS and RSNA categories.
Keywords: COVID-19, Pneumonia, Computed Tomography.

INTRODUCTION
The second wave of coronavirus disease
This study aimed to point out the correlation
(COVID-19) has caused a major worldwide dramatic
between suspected COVID-19 patients with variable
increase in COVID-19 cases with increase in the death
laboratory data as well as the CT findings during the
rates globally. Chest imaging is important in
second wave. Further correlation between positive
assessment of patients with COVID-19 (1). The chest
PCR cases with laboratory and CT chest findings were
imaging findings of COVID-19 were first described in
done.
January 2020, namely bilateral ground-glass opacities

in most of the hospitalized patients (2). Several studies
PATIENTS AND METHODS
were done to evaluate the diagnostic value of chest CT
295 patients (122 females and 173 males) with
in COVID-19 cases. CT reporting systems for
age ranging from 13 to 95 years and a mean of 58
COVID-19 have evolved, namely the COVID-19
years were admitted to our hospital with suspected
Reporting and Data System (CO-RADS) (3) as well as
COVID-19 pneumonia during the period from
the Radiological Society of North America (RSNA)
November 2020 to February 2021. They underwent
classification system for reporting COVID-19
multiple laboratory tests including s. ferritin and CBC
pneumonia (4). CO-RADS includes five categories
with differential count. Besides, non­contrast CT was
(CO-RADS 1 to 5) as shown in table (1). The
done.
employment of these standardized diagnostic

classification systems decreases observer variation and
CT imaging:
improve the clinical communication (5).
CT scans were acquired for the 295 patients in the
supine location on a Dual-source CT (Somatom
Table (1): CORADS classification for COVID-19
Definition, Siemens Medical Solutions, Forchheim,
pneumonia (The radiology assistant)
Germany) with the subsequent parameters: 1.0-mm
CO-RADS (Level of suspicion COVID-19 infection)
section thickness, 5-mm gap, 120 kV, and 150 mA.


CT findings
The CT images were displayed with standard lung
CO-RADS 1
No
Normal or non-infectious
(window width, 1000 to 2000 HU; window level
abnormalities
- 700 to ­ 500 HU) and mediastinal (window width
CO-RADS 2
Low
Abnormalities consistent with
infections other than COVID-19
300 to 400 HU; window level 30 to 50 HU) settings.
CO-RADS 3
Indeterminate Unclear whether COVID-19 is
The CT scans were assessed for the presence of
present
ground-glass opacities and consolidation, as well as
CO-RADS 4
High
Abnormalities suspicious for
pleural effusion.
COVID-19

CO-RADS 5
Very high
Typical COVID-19

CO-RADS 6
PCR +



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165
Received: 23/8/2021
Accepted: 8/10/2021

Full Paper (vol.861 paper# 28)


Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 172-177

Multislice CT in Sinonasal Polypi; Functional Endoscopic Sinus Surgery Correlation
Tarek Raslan El-Sayed 1, Mohamed Fathy Ahmed Goda 1,
Khaled Mohamed El-Gerby 1, Ezzat Ahmed Merwad 2
Departments of 1Radiodiagnosis and 2Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Tarek Raslan El-Sayed, Email: Tarekraslan2008@gmail.com

ABSTRACT
Background
: Nasal and sinus illnesses are diagnosed with computed tomography (CT) because CT scans effectively
bone anatomy is depicted with air spaces, opacified sinuses, and detailed structural details. Objective: The significance
of using multislice CT for the detection and characterization of sinus polyps and the relationship between the CT findings
and those of functional endoscopic sinus surgery (FESS) have been studied. Patients and Methods: At Zagazig
University's Radiodiagnosis Department, we conducted this study on 18 patients, 10 of which were females and eight
were males, from a total of 33 individuals. To emphasize the role of multislice (CT) in diagnosis and characterization
of sinonasal polypi during functional endoscopic sinus surgery, numerous CT parameters were used and correlated with
operational findings. Results: There was a strong correlation calculated by Spearman correlation coefficient (r) for right-
sided and left-sided surgeries of 0.76 and 0.87, respectively, for operative endoscopic and Lund-Mackay staging scores.
Conclusion: Based on functional endoscopic sinus results, CT and diagnostic endoscopy may be the new standard of
care in the diagnosis of sinonasal diseases.
Keywords: Functional Endoscopic Sinus Surgery, Multislice CT, Sinonasal Polyp.

INTRODUCTION

chronic sinus illness can now be diagnosed and managed
Sinonasal polyps can be traced back more than 4,000
with CT (6).
years to ancient Egypt, when they were first discovered
Anatomical variations that may lead to difficulties
(1). In the context of the nasal cavity and paranasal sinuses,
before and after functional endoscopic sinus surgery
non-cancerous semi-transparent lesions are referred to as
(FESS) can be diagnosed with CT, which minimizes the
"nostril polyps." (2).
risk of death and morbidity for patients (7).
It is described by the European position paper on
Functional endoscopic sinus surgery (FESS) has been
rhino sinusitis as an inflammation of the nose and the
widely accepted as a successful therapeutic option for
paranasal sinuses accompanied by two or more
medically refractory chronic rhino sinusitis (CRS) with
symptoms, as specified by the publication. Anterior or
and without sinonasal polyposis, and is the therapy of
posterior nasal drip (nasal blockage, congestion, or
choice for patients with outstanding success rates.
discharge) is the most common symptom, however facial
Improved CT techniques. The surgeon can benefit from
pain or pressure can also be a sign of nasal obstruction.
Multidetector CT (MDCT), which has the potential to
Nasal polyps can be seen endoscopically as well as
enhance diagnostic precision (8).
discharge that comes mostly from the middle meatus,
We aimed at this study to emphasize role of multislice
swelling and/or mucosal blockage in the middle meatus,
(CT) in diagnosis and characterization of sinonasal polypi
and/or signs of mucosal changes in the Ostiomeatal
using various CT parameters and comparing CT findings
Complex (OMC) and/or sinuses on computed
to findings from functional endoscopic sinus surgery.
tomography (CT) (3).

Asthma, allergies, infections (bacterial and fungal),
SUBJECTS AND METHODS
illnesses associated with nasal polyps, and environmental
At Radiodiagnosis Department, Zagazig University
pollutants have all been connected to the development of
Hospital, Egypt, between the months of December 2018
nasal polyps (4).
and December 2019, we conducted this investigation. We
For the radiological diagnosis of nose and sinus
enrolled 18 patients in this study (10 females, 8 males)
disorders, CT scans have become the examination of
out of 33 patients, who were suspected to have sinonasal
choice since they vividly display air gaps, opacified
polyps. 15 cases were excluded, 2 of them were pregnant
sinuses, and fine structural architecture of bone anatomy.
women, 3 cases were suspected to have malignant
Surgeons contemplating functional endoscopic sinus
lesions, 5 uncooperative and neurotic patients, and 5
surgery should use multislice CT because it can disclose
cases with extreme ages.
anatomical structures that physical examination or

diagnostic nasal endoscopy cannot (5).
Ethical considerations:
Because of its 3D high-resolution capacity, 3D high-
As long as all participants signed informed consent
resolution CT is optimal for recognizing the complex
forms and submitted them to Zagazig University's
anatomy and anatomic variants that are not accessible by
Research Ethics Committee, the study was allowed
physical examination or endoscopy. Recurrence and
(ZU-IRB#6270). We followed the World Medical
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172
Received: 26/8/2021
Accepted: 9/10/2021

Full Paper (vol.861 paper# 29)


c:\work\Jor\vol861_30 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 178-189

The Role of Transcranial Grayscale and Doppler Ultrasound Examination in
Diagnosis of Neonatal Hypoxic-ischemic Encephalopathy
Yasmin H. Hemeda*, Zeinab A. Aly, Adel M. Al-Ghannam
Department of Radiodiagnosis, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding Author: Yasmin H. Hemeda, Mobile: (+20)01061173115, E-mail: hosneyyasmin@gmail.com

ABSTRACT
Background:
The role of transcranial grayscale ultrasound (TC-GSUS) and transcranial color Doppler (TCD) in the
diagnosis and prognosis of neonatal hypoxic-ischemic encephalopathy (HIE) is still questionable.
Objective: This study targeted to evaluate the role of TC-GSUS and TCD in diagnosis and prediction of the outcome
of neonates with suspected HIE in comparison to Sarnat's clinical scoring.
Patients and methods: 26 neonates with suspected HIE were clinically evaluated and the severity of HIE was
categorized according to Sarnat's clinical staging. Then, all neonates underwent sonographic examinations. TC-GSUS
was performed at levels of anterior, mastoid, and posterior fontanelles and the level of the temporal window.
Results: Cranial biometry had negative and positive rates for HIE of 7.7% and 92.3%, respectively. Using TC-GSUS,
periventricular leukomalacia, intraventricular hemorrhage, brain edema, and hydrocephalus were detected in 17, 19, 14,
and 16 patients, respectively. According to the resistive index (RI) of intracranial vessels, TCD excluded HIE in 11
patients and assured diagnosis of HIE with varying severity in 15 patients. Five neonates died and four developed
neurological affection during follow-up. The outcome was correlated with Sarnat's scoring, ventricular-hemispheric
ratio, and abnormalities of RI. Statistical analyses defined severity of HIE as judged by RI as the significant predictor
for mortality and abnormal RI of anterior cerebral (ACA) and internal carotid arteries (ICA) are the most significant
predictors of outcomes.
Conclusion: TCD can diagnose HIE in neonates with high sensitivity and specificity and abnormal RI of ICA and ACA
might be used as valuable diagnostic and prognostic tests.
Keywords: Neonatal hypoxic-ischemic encephalopathy, Transcranial Doppler, Gray-scale ultrasound, Resistive index,
Sarnat's clinical staging.

INTRODUCTION


Hypoxic-ischemic encephalopathy (HIE) is
use of a gadolinium contrast agent, lack of replicated
prevailing leading to severe brain damage affecting
testing secondary to a cumulative effect, and other
neonates [1]. HIE mostly affects preterm neonates, but
factors [10].
also may affect term neonates and obstetric
MRI and MR spectroscopy provides early
complications especially placental abruption, which had
biomarkers of brain injury and treatment response in
a strong association with HIE. Previous section,
neonates with HIE, but its applicability is challenging.
ruptured uterus, and shoulder dystocia are often
The 3D pseudo-continuous arterial spin-labeled
associated with a high prevalence of HIE [2]. Perinatal
technique provides several advantages, as the nonuse of
asphyxia and/or cerebral ischemia and reperfusion can
a contrast agent or radiation and repeatable testing, over
cause brain injury, which is often associated with
perfusion MRI technique [11]. However, postmortem
subsequent neurological deficits, such as cerebral palsy
examinations frequently show cerebellar injury in
or mental retardation [3].
infants with severe HIE, while it is less well visible on
Moreover, infants with HIE had poorer motor
MRI [12].
repertoire, in comparison with their peers, and were
Transcranial sonography (TCS) is a widely
seriously affected by HIE severity [4]. Clinically, HIE
used non-invasive bedside method to evaluate the brain,
most commonly present by neonatal seizures, which are
its vessels, perfusion, and pathologies [12].
the most common neurological event in newborns that
Transcranial Doppler ultrasonography (TCD) is
show higher prevalence in preterm than in full-term
a real-time physiologic monitor that can detect altered
infants [4]. Sensorineural hearing loss [5] or cerebral
cerebral hemodynamics during catastrophic brain injury
palsy with subsequent learning disabilities [6] are other
[13], allows both imaging of parenchymal structures and
clinical sequelae of HIE. Early diagnosis of the extent
Doppler assessment of intracranial vessels [14].
and severity of neonatal brain injury secondary to HIE
TCDS is a generally safe, repeatable, non-
is an important issue because of the serious sequelae of
invasive technique that has a strong potential in
HIE, but it remains a dilemma [7].
neurocritical care patients in many clinical scenarios
MRI and DWI imaging has high detection rates
and is applicable for pediatric patients to allow for better
for the diagnosis of hypoxic-ischemic encephalopathy
care of children with neurologic insults [15]. This study
[8]. Perfusion MRI scan can accurately reflect neonatal
targeted to evaluate the role of transcranial grayscale
cerebral blood flow [9], but its effect is limited due to the
ultrasound (TC-GSUS) and transcranial color Doppler

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178
Received: 16/08/2021
Accepted: 12/10/2021

Full Paper (vol.861 paper# 30)


c:\work\Jor\vol861_31 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 190-193

Comparative Study between Medial and Posterior Approaches in
Management of Popliteal Artery Aneurysm
Hany Abdelmomen
Department of Vascular Surgery, Faculty of Medicine, Al-Azhar University

Corresponding author: Hany Abdelmomen, Mobile:(+20)01002767339,
E-mail: hadydayman@gmail.com

ABSTRACT
Background:
Popliteal artery aneurysm (PAA) represents 1% in men. Bilateral conditions occur in more than 50% the
cases. The most common cause of such aneurysms is atherosclerosis. About 80 % of the PAAs are asymptomatic at the
time of diagnosis while 20% carry high risk for thrombosis and amputation subsequently.
Objectives: This study was conducted to compare the medial and posterior approaches in management of popliteal
artery aneurysm repair.
Patients and methods: 40 cases of PAAs were included. Medial approach was done in 20 cases and posterior approach
was done to the other 20 cases. Carful history taking and clinical examination was done for proper assessment.
Results: primary patency after 30 day was 100 % with average hospital stay 3.5 days. In the post-operative period, there
was few complications with medial approach where one wound hematoma occurred. One asymptomatic graft
thrombosis after 11 months occurred. One patient required angioplasty at 24 months with stenting of the distal
anastomosis. Graft complications with posterior approach was minimal including one wound seroma, one distal showers
in the anterior and posterior tibial arteries at 10 months, one case required balloon angioplasty to the proximal
anastomosis at 17 months.
Conclusion: After 6 months, there was no significant difference between the two approaches but if we take in
consideration the risk of persistent PAA growth (up to 25%) after the medial approach, the posterior approach might be
the preferred.
Keywords: Popliteal artery aneurysm; surgical approach.

INTRODUCTION
January 2015 and January 2020. In 20 cases, the medial
Popliteal artery aneurysm (PAA) is an
approach was done, and posterior approach was done
uncommon problem affecting the vascularity of the
to the other 20 cases. Selection of the cases was done
lower limb. It represents 1% in men (1). The age varied
on random bases. Carful history taking and clinical
from 60 to 85 years. Bilateral conditions occur in more

than 50% of cases. The most common cause of such
examination was done for proper assessment. In some
aneurysms is atherosclerosis, another rare causes
cases, Doppler and CT angiography was done to
include, trauma, infections or familial, in addition to
confirm that the aneurysm did not extend to the
some connective tissue diseases such as Behcet's
adductor hiatus. Also, to confirm the presence of good
disease or Marfan's syndrome (2). Two types of popliteal
distal run-off, otherwise the medial approach was
artery aneurysm are present, the first one is confined to
useful for possibility of easy anastomosis proximal to
the popliteal artery and the second type extends to the
the aneurysm and good thrombectomy of both anterior
superficial femoral artery above the adductor hiatus.
and posterior tibial arteries. Anesthesia was either
About 80 % of the PAAs are asymptomatic at the time
spinal or general with endotracheal tube.
of diagnosis. There are many approaches in the

management of PAAs (3). Our research included the
Ethical approval:
most common two types of them, medial are posterior
The study was approved by the Ethics
approaches.
Board of Al-Azhar University and an informed

written consent was taken from each participant in
AIM OF THE WORK
the study. This work has been carried out in
To compare the medial and posterior
accordance with The Code of Ethics of the World
approaches in management of popliteal artery
Medical Association (Declaration of Helsinki) for
aneurysm repair as regards the feasibility of the
studies involving humans.
technique, patency rate, results and complications.


Operative details
PATIENTS AND METHODS
Written concent was taken from the patient then:
Our study was conducted on 40 cases of PAAs
In posterior approach (Figure 1), the patient was
in Sayed Galal and AL-Hussein University Hospitals
positioned in prone position with the knee joint slightly
and private hospital through the period between
flexed, the whole limb was sterilized by povidone

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190
Received: 26/8/2021
Accepted: 9/10/2021

Full Paper (vol.861 paper# 31)


c:\work\Jor\vol861_32 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 194-198

The Outcome of Staple-Line Oversewing Using V-Loc Suture During
Laparoscopic Sleeve Gastrectomy
Mahmoud Elsayed Nagaty Elsayed
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Corresponding author: Mahmoud Elsayed Nagaty, email: dr_nagaty84@yahoo.com

ABSTRACT
Background:
Laparoscopic sleeve gastrectomy (LSG) is a simple procedure; however, postprocedural hemorrhage and/or
leak remain the most troublesome outcomes. To prevent these serious complications, some surgeons have recommended
the necessity to support the staple-line (SL). The target of the existing work was to estimate the occurrence rate of SL leak
or hemorrhage after LSG with using and without using V-Loc running sutures to support the SL.
Patients and methods: This work was carried out in the General Surgery Department, Al-Hussein Hospital, Faculty of
Medicine, Al-Azhar University between January 2017 and January 2020. A sum of forty cases suffering from morbid obesity
prepared for LSG. Patients were separated randomly into 2 groups; Group-I; 20 cases; prepared for LSG without suturing
of SL, and Group-II; 20 cases; prepared for LSG with suturing of the SL by v-lock suture.
Results: The average procedure duration in Group-I was 75 min and in Group-II was 92 min. The duration of hospital
admission was around 3 days in group-I and 2 in group-II. Postoperative hemorrhage was more in Group-I; 4 patients (20%)
versus one patient (5%) in Group-II. The postoperative leak was more in Group-I; 2 patients (10%) while in Group-II; no
patients (0%) had it.
Conclusion: Strengthening the SL is a simple technique to prevent postoperative hemorrhage and/or leak. Although sewing
the complete SL is time-consuming together with additional cost, but it decreases the procedure complications rate.
Keywords Laparoscopy; Sleeve Gastrectomy; Staple-line oversewing.

INTRODUCTION
2020 on 40 patients between January 2017 and January
Gastric sleeve was first described in 1993, by
2020. Participants were allocated randomly by using the
Marceau as a step of the biliopancreatic diversion. Then,
simple random allocation method, where 40 cards were
at the start of the 2000s, it became a separate procedure
prepared by the investigator and were put in closed
done by many bariatric surgeons. After that, LSG has
envelopes and mixed. Patients were separated into 2
settled to be the standard restrictive bariatric surgery [1-3].
groups; group-I; 20 cases; prepared for LSG without
This procedure gained its success because of its simple
strengthening of SL. and group-II; 20 cases; prepared for
technique, short procedure time, lack of intestinal
LSG with supporting of the SL by v-lock suture.
anastomosis, and low complications rate [4,5].

SL leakage and/or bleeding are the furthermost
Inclusion criteria: Morbidly obese individuals with,
troublesome postoperative complications. The occurrence
BMI >40 kg/m² or BMI >35 kg/m² with one or more co-
rate of hemorrhage varies from 1.1 to 8.7%, and it may
morbidities.
need reoperation [6]. Leakage through the SL is less

common than bleeding but more life-threatening, and its
Exclusion criteria
incidence rate is from 0.5 to 2.7% [7]. Although, the
Patients unfit for general anesthesia
various approaches to make the procedure safer, no
BMI < 35 kg/m2
agreement has settled on which approach is best [8].
Revision of bariatric surgery
Several studies have indicated that SL strengthening
Age< 18 or >55 years
reduces the possibility of leakage and hemorrhage, but its

efficacy is still being debated.
Preoperative assessment:
Our study's target was to weigh the outcome
All patients underwent clinical assessment; history and
between non reinforced and reinforced SL using V-Loc
physical examination including height and weight and
suture during LSG regarding postoperative hemorrhage
were investigated by routine blood tests, chest X-ray,
and/or leak.
ECG, thyroid, and growth hormone levels, and pulmonary

function tests.
PATIENTS AND METHODS

This study was carried out in General Surgery
Operative procedure: Operations were achieved by the
Department, Al-Hussein Hospital, Faculty of Medicine,
laparoscopic method under general anesthesia by one
Al-Azhar University between January 2017 and January
team.

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194
Received: 26/8/2021
Accepted: 9/10/2021

Full Paper (vol.861 paper# 32)


c:\work\Jor\vol861_33 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 199-210

Could Cardiac MR Imaging with Late Gadolinium Enhancement Affect The Risk
Stratification and Outcome Prediction In Non-Ischemic Cardiomyopathies?
Reham Sameeh*1, Samy Abd Elaziz Sayed1, Mostafa Hashem Mahmoud Othman1,
Ahmed Ali Obeidalla2, Marwa Samy1
Departments of 1Radiodiagnosis and 2Cardiology, Critical Care and Internal Medicine,
Faculty of Medicine, Assiut University, Egypt
*Corresponding author: Reham Sameeh Sayed, Email: Reham.sameeh@aun.edu.eg

ABSTRACT
Background:
Cardiac MR (CMR) evaluating non-ischemic cardiomyopathies (NICMs) is superior 3D imaging with non-
invasiveness, more accuracy and reproducibility of measurements. It provides comprehensive structural, functional
information, tissue characterization, and assesses fibrosis by LGE.
Objective: The study aimed to investigate these imaging data and their prognostic value in NICM.
Patients and methods: 46 NICM patients were assessed by echocardiography/cardiac magnetic resonance (CMR). They
were divided into 3 groups: dilated, hypertrophic and miscellaneous types. Late gadolinium enhancement (LGE) presence
and myocardial extent/percentage were assessed with clinical follow up for a median of 1-year for any Major adverse
cardiac events (MACE). For each group, univariate analysis of clinical/imaging risk factors in the associations with
LGE/MACE was performed. Results: Twenty-six dilated cardiomyopathy patients, 62% had LGE and 31% had MACE.
Using LGE as a predictor for MACE was statistically significant (p = 0.007). Using univariate analysis, the presence of
LGE (p=0.00) and the extent of LGE (p < 0.0001) demonstrated the strongest unadjusted association with MACE. ROC
curves revealed a cutoff value of LGE > 4.5% as MACE predictor. Twelve hypertrophic cardiomyopathy patients (67%)
had LGE and (50%) had MACE. Using LGE as a predictor for MACE was statistically significant (p=0.014). Using
univariate analysis, the presence of LGE (p=0.01) and the extent of LGE (p=0.01) demonstrated the strongest unadjusted
association with MACE. ROC curves revealed a cutoff value of LGE > 4.5% as MACE predictor.
Conclusion: CMR with LGE is crucial in NICM evaluation with prognostic value; changing the way that myocardial
disorders will be understood and managed in the near future.
Keywords: NICM, CMR, LGE.

INTRODUCTION

by LGE sequence in NICM has different patterns, unlike
NICM is a variety of structural functional myocardial
ischemic heart disease, has no particular coronary artery
disorders in the absence of hypertension, coronary artery,
distribution and is often midwall rather than
valvular and congenital heart diseases. Classification of
subendocardial or transmural. The first-pass perfusion
cardiomyopathies is complex with many available systems
study usually does not show any focal perfusion defect in
such as The American Heart Association and The
NICM but instead may show normal results or early
European Society of Cardiology classifications (1, 2).
increased enhancement (8).
Cardiomyopathy has a prevalence of 0.02% of the
Aim of the study was to use these imaging data for
population and more common in younger individuals and
prognostic determination, risk stratification and outcome
women (3). Echocardiography is the simplest first
prediction in NICM; aiming for better understanding and
investigatory line imaging technique used for screening
management of NICM in the near future.
and diagnosis of cardiomyopathies on the basis of

morphology as in multiple previous studies (4). MRI as an
PATIENTS AND METHODS
imaging modality in these issues, is superior and three
Study design and population: We performed a
dimensional with non-invasiveness, high soft-tissue
prospective observational (cross-sectional study) from
contrast, availability of a large FOV, multiplanar
April 2018 to April 2021.
acquisition capability, accuracy and reproducibility of the

The study included 49 adult patients of both sex
measurements and without ionizing radiation (5).
and different ages with any type of clinically suspected
There are multiple technical challenges unique to CMR
non-ischemic
cardiomyopathy
or
by
Doppler
as rapid complex cardiac motion, pulsations of the
echocardiography.
surrounding great vessels, respiratory motion and systolic
Exclusion criteria: Those with significant coronary
blood velocities, which complicate cardiac imaging. These
disease by clinical history or cardiac investigations
challenges are under trials to be overcome by
(coronary angiography and/or positive imaging stress
implementation of ECG gating, navigator echo respiratory
testing), those with previous cardiac myomectomy or
gating, breath-hold techniques, rapid high-performance
alcohol septal ablation and uncontrollable dysrhythmia
gradients and advanced pulse sequences (6, 7). CMR has the
affecting ECG-gating. Also, those with any general
ability to assess cardiac morphology, ventricular function,
MRI or Gadolinium-based contrast agent-related
edema, perfusion, viability and imaging characteristics of
contraindications.

the surrounding vasculature (8). Myocardial enhancement

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199
Received: 16/08/2021
Accepted: 12/10/2021

Full Paper (vol.861 paper# 33)


c:\work\Jor\vol861_34 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 211-217

Superficial Cryotherapy Versus Intralesional Corticosteroid Injection In Alopecia
Areata: A Comparative Clinical And Dermoscopic Study
Afaf Ibrahiem Ahmad Mohammed, Asmaa Saied Farag*, Hala S.A. Hafiz
Department of Dermatology and Venereology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
*Corresponding author: Asmaa Saied Farag, Mobile: (+20) 01111138832, E-Mail: assmaa_saied@yahoo.com

ABSTRACT




Background: Alopecia areata (AA) is a common, non-scarring type of hair loss, affecting approximately 2.1% of the
population. Many modalities of treatment are recommended like steroid injection, topical Immunotherapy, and several
systemic therapies, but none of them can prevent or alter the course of the disease with variable degrees of improvement.
Objective: To evaluate efficacy and safety of superficial cryotherapy versus intralesional corticosteroid injection in the
treatment of alopecia areata. Patients and Methods: Thirty patients aged 14-58 years, with localized multiple patchy
alopecia areata (at least two patches), were enrolled in this study. In each patient, one patch was treated by superficial
cryotherapy via liquid nitrogen spray. This involved two treatment cycles/sessions, each lasting 3-5 seconds. The other
patch was treated with intralesional steroid injection (triamcinolone acetonide 5 mg/ml, 0.1ml /cm2. Sessions were
repeated every three weeks up to three months. The target lesions were evaluated clinically using SALT score and by 2
blinded dermatologists and dermoscopically at baseline, every session, and the end of the study (one month after the
last session). Results: At the end of the study, the clinical response (number of the patients with hair growth > 20%) to
superficial cryotherapy was about 83.3% (25 patients out of 30 patients). While in the steroid group the clinical response
was about 80% (24 patients out of 30 patients). There was a statistically significant reduction in SALT score and
dermoscopic parameters at the end of the study in both groups with no significant difference between them. There was
a significant clinico-dermoscopic relation between hair regrowth and dermoscopic findings.
Conclusion: Superficial cryotherapy is an effective and safe therapeutic modality for AA with advantages of simplicity
and noninvasiveness.
Keywords: Intralesional steroid, Superficial cryotherapy, Alopecia areata, Dermoscopy.

INTRODUCTION
destruction. The response to cryotherapy can be divided
Alopecia areata (AA) (focal alopecia) is the
into two mechanisms: Early effect and a delayed effect.
most common form of hair loss seen in the dermatology
The early effect is due to the formation of ice crystals
outpatient department comprising 25% of all alopecia
which can distract cells due to direct effect or osmotic
cases(1). The etiopathogenesis of AA is multifactorial
effect. The delayed effect included vascular damage,
consisting of genetic predisposition, autoimmunity, and
apoptosis, immunological effect, vascular constriction,
environmental factors (2). AA in certain patients may
platelet aggravation, ischemia, and increased
progress to alopecia totalis (AT) or alopecia universalis
permeability. So because of those effects, it can be
(AU) which is up to 5­10% (2). Dermoscopy can be used
effective in AA(6).
for the diagnosis of AA and to monitor the response to
This study aimed to evaluate the efficacy and
therapy. The characteristic features of alopecia areata on
safety of superficial cryotherapy versus intralesional
dermoscopy are yellow dots, black dots, broken hair,
corticosteroid injection in the treatment of alopecia
exclamation mark hair, and vellus hair. These findings
areata clinically and dermoscopically.
significantly decrease after therapy (3).

Common modalities of treatment include
PATIENTS AND METHODS
topical medications as steroids, tacrolimus, anthralin,

This comparative interventional study was
minoxidil, psoralen with ultraviolet A solution, narrow-
conducted with patients attending the Dermatology
band ultraviolet B (NB-UVB), immunotherapy with
Outpatient Clinic of Al-Zahraa University Hospital,
diphenylcyclopropenone or squaric acid dibutyl ester
Faculty of Medicine for Girls, Al-Azhar University,
(SADBE), and systemic therapy such as oral
Cairo, Egypt, during the period from November 2020 to
corticosteroids, levamisole, methotrexate, azathioprine
April 2021. In total, 30 adult patients with localized
and others (2).
patchy AA were enrolled.
Intralesional corticosteroids are considered
The study was approved by the Research Ethics
first-line treatment in localized AA involving <50% of
Committee of the Faculty of Medicine for Girls, Al-
scalp, although painful and associated with various side
Azhar University.
effects(4). Thus, searching for alternatives has been felt
Children less than 14 years old, pregnant and
as the need of the hour (5).
lactating women, patients with an active infection at the
There are few reports of AA treated with
treated area, patients with premalignant or malignant
cryotherapy (1). The tissue response to cryotherapy
lesions in the treatment area, patients with cicatricial
ranges from an inflammatory reaction to mild or severe
alopecia, alopecia totalis or universalis, and patients
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211

Received: 18/08/2021
Accepted: 14/10/2021

Full Paper (vol.861 paper# 34)


c:\work\Jor\vol861_35 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 218-221

Safe Laparoscopic Cholecystectomy: Adoption of Universal Culture of
Safety in Cholecystectomy
Eslam Taha Ghalwash
Departments of General Surgery, Faculty of Medicine, Al-Azhar University Cairo, Egypt
Corresponding author: Eslam Taha Ghalwash,E mail: ghalwash2006@gmail.com,
Mobile phone: 01006784958

ABSTRACT
Background:
Laparoscopic cholecystectomy (LC) has been the favored technique for treating symptomatic
cholelithiasis. LC has several benefits over the normal open cholecystectomy: negligible traumas, reduced pains, shorter
hospitalization, acceptable cosmetic outcomes, rapid recovery, and back to work.
Aim and objectives: The aim of this study was to identify the predictors of safe LC.
Patients and methods: This prospective study was performed among 500 patients underwent LC who was attending to
Al-Hussein Hospital, Al-Azhar University from January 2019 to June 2021. Cases with cholecystitis either acute or
chronic, patients with age equal or more than 18 years old, and both sexes were included. While patients with age lower
than 18 years old, patients with common bile duct (CBD) stone, pregnancy or patients with bleeding tendency history
were excluded.
Results: Upon assessing factors associated with postoperative complications of laparoscopic cholecystectomy, the male
gender was statistically significantly correlated with complications while a non-significant change was found among
complications and other sociodemographic variables. A significant association was found among WBCs, total bilirubin,
ALT, AST, and complications while a non-significant association was found among gall bladder thickness and
complications.
Conclusion: In conclusion, this study evaluated the parameters that expect the complications in LC. Patient factors
included male sex, leukocytic count, ALT and AST.
Keywords: Complications, Laparoscopic cholecystectomy, Predictors, Safe laparoscopic cholecystectomy

BACKGROUND

This work aimed to recognize the prognosticators of
Laparoscopic cholecystectomy (LC) since its beginning
safe LC.
in 1987, has dramatically substituted conservative open

cholecystectomy. LC has been quickly the golden
PATIENTS AND METHODS
standard for repetitive gall bladder removals.
This prospective research was performed among
Managements of biliary tract disorders has progressed
500 cases feeling LC who were attending to Al-Hussein
from being a key operation to a comparatively safer and
Hospital, Al- Azhar University from January 2019 to
tolerable day care technique nowadays, presenting early
June 2021.
resume to full activities (1).
Inclusion criteria: Patients with cholecystitis either
It reduces postoperative pains and ileus, permits faster
acute or chronic, patients with age equal or more than
oral intakes, shortens hospitalization and develops early
18 years old and both sexes were included.
return to usual activities and progresses cosmesis. (2)
Exclusion criteria: Patients with age lower than 18
Conversions to open cholecystectomy are not failures or
years old and pregnancy or patients with bleeding
complications, but a try to prevent side-effects. It can be
tendency history.
supportive to determine the danger of conversions early.
The demographic data and preoperative information
This can permit cases to have satisfactory psychological
of the cases who needed laparoscopic cholecystectomy
preparations, to be better ready for operation and to plot
were investigated. The parameters analyzed were age,
their convalescences (3).
sex, BMI. Physical examination and preoperative lab
Repetitive general surgical techniques, involving
were done. Ultrasonography, computed tomography
laparoscopic
appendectomy
and
LC
have
and magnetic resonance cholangiopancreatography
accompanying perioperative death rate of less than 1%,
(MRCP) were done.
leaving death a hard parameter to evaluate patients
Formerly validated main complications counting
outcome (4).
acute myocardial infarctions, pulmonic compromise,
Morbidities, definitely advance of postoperative side-
postoperative infections, deep vein thrombosis,
effects, may be a more beneficial way to assess outcome
pulmonic embolism, haemorrhage, and re-operation
thereafter common operations. Moreover, inspecting
were evaluated.
whether hospital and/or surgeon volume influences the

outcomes for common operations would be a beneficial
Ethical approval:
accumulation to our existing sympathetic of the
The Ethics Committee of the Faculty of Medicine,
interplay among volume and outcomes (5).
Al-Azhar University approved the study protocol
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218

Received: 18/08/2021
Accepted: 14/10/2021

Full Paper (vol.861 paper# 35)


c:\work\Jor\vol861_36 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 222-227

Assessment of Left Ventricular Function by Global Longitudinal Strain in
Patients with non-ST Elevation Myocardial Infarction:
Comparative Study with Conventional Method
Sena Mohamed S. Ahmad, Elsayed Mohamed Farag, Mohammad Abdalla Eltahlawi, Alaa Elsayed Salama
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Sena M. S. Ahmad, Mobile: (+20)10467874428, Email: sana.sultan2030@gmail.com

ABSTRACT
Background
: Left ventricular ejection fraction (LVEF) is a strong prognostic parameter in patients with heart disease.
The assessment of global longitudinal strain (GLS) from speckle-tracking analysis of 2-dimensional echocardiography
has become a clinically feasible alternative to LVEF for the measurement of myocardial function.
Objective:
The aim of the current work was to compare between GLS speckle tracking echocardiography and Simpson's
biplane methods for assessment of left ventricular function in non-STEMI patients.
Patients and methods:
This study was carried out in Cardiology Department, Faculty of Medicine, Zagazig University
on 44 nonSTelevation myocardial infarction (NSTEMI) patients scheduled for assessment of Left ventricular function
by GLS and biplane Simpson method.
Result:
Mean systolic blood pressure was 122.05±18.37 mmHg. No statistically significant difference in systolic blood
pressure was found across GLS groups (P= 0.17). Mean diastolic blood pressure was 73.41±12.00 mmHg. No
statistically significant difference in diastolic blood pressure was found across GLS groups (P= 0.35). Mean heart rate
was 68.84±7.13 bpm, and a statistically significant difference was found in heart rate across GLS groups (P= 0.039).
Conclusion: It could be concluded that GLS speckle tracking echocardiography and Simpson's biplane methods can
be used as alternative different parameters for assessment of left ventricular function in non-STEMI patients.
Keywords: Left Ventricular Function; Speckle-Tracking; Global Longitudinal Strain

INTRODUCTION


The noninvasive assessment of ventricular
cardioverter-defibrillator
(ICD)
or
cardiac
function remains central to modern cardiology. The
resynchronization therapy (CRT) (5).
volume-based measurement of left ventricular ejection
In addition, LVEF is used to define systolic heart
fraction (LVEF) is fundamentally different from direct
failure and has a great impact on the selection of
measurement of myocardial motion by tissue Doppler
medical treatment (6).
imaging and myocardial deformation, and the reliability
Several echocardiographic methods have been
and precision of these measurements are also different
used to measure LVEF but at present, the Simpson's
(1). In the era of precision medicine, patient-specific
biplane method is most widely used (7). Determining
measurements are used to make decisions about
LVEF by echocardiography is associated with a high
therapies in individual patients, as well as guidance
level of inter-observer variability, which to a certain
across patient populations. Moreover, the current era is
degree can be improved using contrast enhanced
also marked by the emergence of heart failure with
echocardiography
and
3D
echocardiography.
preserved ejection fraction (HFpEF) in which ejection
Reliability of LVEF depends on image quality and in
fraction (EF) is not useful prognostically as the
particular the ability to visualize the endocardial border
predominant form of heart failure (HF) (2). Acute
(8). Strain by speckle tracking echocardiography is a
coronary syndromes (ACS) continue to be a major cause
technique that utilizes 2-dimensional gray scale images
of morbidity and mortality. Data from the United States
to evaluate both global and regional function of the left
and Europe have reported a decrease in the incidence of
ventricle. Peak global longitudinal strain (GLS) may be
STelevation myocardial infarction (STEMI) with an
used to measure systolic function. Previous studies have
increase in NSTEMI in the past decade (3).
shown that GLS may both diagnose and exclude acute
Left ventricular ejection fraction (LVEF) is the
coronary heart disease (9).
established method for evaluation of LV systolic
In addition, GLS has better intra- and inter-
function and can be measured by a number of imaging
observer reproducibility in post hoc analysis compared
modalities. LVEF by echocardiography has been
to LVEF (10). Furthermore, GLS may be analyzed in a
regarded as a cornerstone in the prediction of outcome
majority of patients with good feasibility and may be
and is the most widely available method for evaluation
measured as fast as LVE (11).
of LV function (4).
The aim of the study was to compare between
It is a vital measurement when determining
GLS speckle tracking echocardiography and Simpson's
whether patients benefit from an implantable
biplane methods for assessment of left ventricular

function in non STEMI patients.
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222
Received: 18/08/2021
Accepted: 14/10/2021

Full Paper (vol.861 paper# 36)


z The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 228-237

Clinical, Biochemical and Inflammatory Predictors of Mortality in
Patients with Spontaneous Bacterial Peritonitis
Talaat Zakareya Ibrahim*1, Wael Mohamed Abd El-Razek1, Mohamed Akl Rady1,
Heba Mohamed Abdallah2, Ahmed Ali El-Awady3, Mohamed Ali Abbasy1
Departments of 1Hepatology and Gastroenterology, 2 Clinical Pathology,
National Liver Institute, Menoufia University, Egypt
Department of 3Internal Medicine and Hepatology, El Mahalla Liver Teaching Hospital, Gharbia, Egypt
*Corresponding author: Talaat Zakareya Ibrahim, Mobile: (+20)1111815877, E-mail: talaatzakareya@gmail.com

ABSTRACT
Background:
Spontaneous bacterial peritonitis (SBP) is a serious complication of liver cirrhosis. It contributes to
high morbidity and mortality in this population. In-hospital mortality of SBP ranges between 20% and 40%,
suggesting that further refinements are essential in managing SBP. Early recognition of high-risk patients would
enable us to reduce the short-term mortality.
Objective: The current study aimed to evaluate the value of clinical, biochemical and inflammatory markers in the
prediction of 1-month and 3-month cumulative mortality in patients with SBP.
Patients and methods: Two hundred patients with a confirmed diagnosis of SBP were enrolled. They were admitted
and received the proper treatment at the National Liver Institute Hospital-Menoufia University, Egypt. Patients were
prospectively followed up for mortality over a period of three months. Predictors of mortality were assessed and
analyzed.
Results: Mortality rates were 20% and 41% at 1 month and 3 month respectively. Our findings showed that low blood
pressure, abdominal pain, fever, higher Child-Pugh score, MELD score, serum bilirubin, INR, serum creatinine, C-
reactive protein to albumin (CRP/Albumin) ratio, neutrophil­lymphocyte ratio (NLR), massive splenomegaly and
large ascites have been demonstrated as risk factors associated with short-term mortality.
Conclusion: SBP carries a high risk of mortality among cirrhotic patients. Clinical parameters (low blood pressure,
abdominal pain, fever, massive splenomegaly and large ascites), prognostic scores (Child-Pugh and MELD) and
inflammatory markers (CRP, CRP/albumin ratio, and NLR) seem to be accurate and reliable tools that could
independently predict short-term mortality in patients with SBP.
Keywords: Spontaneous bacterial peritonitis, SBP mortality predictors, C-reactive protein, CRP-albumin ratio,
Neutrophil­lymphocyte ratio.

INTRODUCTION

The most common clinical manifestations of SBP
Spontaneous bacterial peritonitis (SBP) in patients
are fever, abdominal pain and tenderness; however, it
with liver cirrhosis is considered a serious
may be asymptomatic. The definitive diagnosis of SBP
complication that contributes to the high morbidity and
is established when polymorph nuclear leukocytes
mortality rate seen in this population. In the early
(PMNL) in ascitic fluid is 250 cell/mm3 or more with
1970s, Harold Conn used the term "spontaneous
a positive ascitic fluid culture for a single organism (5-
bacterial peritonitis" for the first time to describe a
7).
condition characterized by bacterial infection of the
A culture negative neutrocytic ascites is a common
ascitic fluid in the absence of any obvious intra-
variant of ascitic fluid infection. It is essentially
abdominal or surgical source (1). The reported yearly
diagnosed when ascitic PMNL count 250 cells/ mm3
incidence of SBP in cirrhotic patients varies between 7
in the absence of culture positivity (8,9).
and 30% (2).
A lot of complications can occur due to SBP e.g.:
In general, there are five variants of ascitic fluid
sepsis, septic shock, hepatic encephalopathy, renal
infection; the most common type is SBP. The principal
failure, or even death. In-hospital mortality of SBP
mechanism of SBP is bacterial translocation; where
ranges between 20% ­ 40%, suggesting that further
bacteria travel from the gut lumen to the mesenteric
refinements are essential in managing SBP. Early
lymph nodes and thereafter to the blood stream and
recognition of high-risk patients would enable us to
other extra-intestinal sites (3).
reduce the short-term mortality (5,6).
The most common causative microorganisms
Patients' clinical status, laboratory data, as well as
isolated from the ascitic fluid in patients with SBP are
inflammatory markers might be used to stratify those
Escherichia coli (70%), Klebsiella (10%), Proteus
patients as regards the risk of mortality (10).
species (4%), Enterococcus faecalis (4%) and
The current study aimed to evaluate the value of
Pseudomonas species (2%) (4).
clinical, biochemical and inflammatory markers in the

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228

Received: 21/10/2021
Accepted: 29/12/2021

Full Paper (vol.861 paper# 37)


c:\work\Jor\vol861_38 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 238-241

Effectiveness of Tranexamic Acid in Preventing Postpartum
Hemorrhage in Cesarean Delivery of High-Risk Pregnancy
Ashraf Talat Abdel-Fatah, Safaa Abdel- Salam Ibrahim,
Sadina Ahmad Ali Mohammed, Basem Mohamed Hamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Sadina Ahmad Ali Mohammed, Mobile: (+20)01008716039, E-mail: sadina8383@gmail.com

ABSTRACT
Background:
Caesarean section delivery is associated with severe maternal morbidity, including obstetric
haemorrhage, hysterectomy, anaemia, blood transfusion, and infection. Among these operative morbidities associated
with CS, obstetric haemorrhage is the leading cause of maternal mortality worldwide.
Objective: The aim of this work was to achieve the minimal blood loss during elective cesarean section (CS) in order
to decrease patients' morbidity by using tranexamic acid (TXA) injection before operation time.
Patients and Methods: The current study was randomized-controlled clinical trial that was conducted at Department
of Obstetrics and Gynecology, Zagazig University Hospitals through the period from April 2021 to September 2022.
Results: The mean of blood loss during CS in tranexamic acid intervention group was 484.87 cc and mean of blood loss
during CS in control group was 705 cc. The difference was highly statistically significant p=0.0001. Per cent of blood
loss was 37% more among control group.
Conclusions
. Tranexamic acid is a good option to reduce the amount of blood loss during CS on high risk pregnancy.
Keywords: Tranexamic acid (TXA), Postpartum haemorrhage, Caesarean section.

INTRODUCTION

inhibits the activation of plasminogen, thus inhibiting
Cesarean section (CS) rates have increased to as
fibrinolysis and reducing bleeding (5). TXA has been used
high as 25 ­ 30% in many areas of the world. Women
to reduce blood loss and the need for allogeneic blood
delivering in a private health facility were slightly more
transfusion in cardiac surgery, liver transplantation, and
likely than women delivering in a government facility to
orthopedic surgical procedures, with variable results.
have a cesarean delivery. The likelihood of a cesarean
Furthermore, the clinical randomization of an
delivery increased with the age of the mother and
antifibrinolytic in significant haemorrhage study
decreased with the child's birth order. 37% of urban
concluded that tranexamic acid decreases the risk of
births were cesarean deliveries compared to 22% of rural
death in bleeding trauma patients (6). Tranexamic acid
births. Considering place of residence, urban Lower
decreases post-partum blood loss after vaginal birth and
Egypt had the highest proportion of Cesarean deliveries
after cesarean section based on randomized controlled
(43%) followed by the Urban Governorates (39%). The
trials (RCTs) (7). In gynecology and obstetrics, TXA is
likelihood of a cesarean delivery increased with both the
most commonly used to treat idiopathic menorrhagia and
mother's educational status and was greater among
is an effective and well-tolerated treatment when
women working for cash than among other women (1).
administered orally (6, 8). Bleeding associated with
The incidence of cesarean delivery is increasing, and the
pregnancy (placental abruption, placenta previa) has also
average blood loss during cesarean delivery (1000 mL)
been treated with TXA (9).
is double the amount lost during vaginal delivery (500
The aim of this study was to achieve the minimal
mL). The hematocrit falls by 10% and blood transfusion
blood loss during elective cesarean section (CS) in order
is required in 6% of women undergoing cesarean
to decrease patients' morbidity by using Tranexamic acid
delivery compared with 4% of women who have a
(TXA) injection before operation time.
vaginal birth (2).

Obstetric hemorrhage remains one of the major
PATIENTS AND METHODS
determinants of maternal death in both developed and
The current study was randomized-controlled
developing countries. Because of its weight as a leading
clinical trial conducted at Department of Obstetrics and
cause of maternal mortality and morbidity, obstetric
Gynecology, Zagazig University Hospitals through the
hemorrhage (ante-partum and post-partum hemorrhages)
period from April 2021 to September 2022. The study
must be investigated for national guideline development
included 78 women who were divided into two groups
(3). In severe cases, CS may result in major obstetric
39 in each group: Group 1 (study Group) who were
hemorrhage, hysterectomy, admission to an intensive
subjected to 1 gm tranexamic acid (kapron®, Amoun,
care unit, or maternal death. Medications, such as
Egypt) (2 ampules = 10 ml) were administered
oxytocin, misoprostol, prostaglandin F2, and methyl
intravenous 10 minutes before skin incision slowly
ergonovine, have been used to control bleeding after CS
infused (over 5 min). After delivery of the neonate,
(4). Tranexamic acid (TXA), a synthetic derivate of the
oxytocin 10 units IV drip were administered. Group II
amino acid lysine, is an antifibrinolytic that reversibly
(The control group) who were subjected to 10 ml

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238
Received: 18/08/2021
Accepted: 14/10/2021

Full Paper (vol.861 paper# 38)


c:\work\Jor\vol861_39 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 242-249

Neutrophil -To- Lymphocyte Ratio [NLR] as A Promising
Prognostic Marker in Critically Ill Septic Patients
Khaled Ali Esmaeil Ali Shalaby*, Tarek Elsayed Gouda, Afaf Abdel Hafez Abdel Mageed
Departments of Internal Medicine, Faculty of Medicine, Mansoura University
*Corresponding author: Khaled Ali Esmaeil Ali Shalaby, E-Mail: tantawy22wael@gmail.com

ABSTRACT
Background:
NLR is advantageous in regard to simplicity, low cost, and availability compared to many other
previously proposed biomarkers, which makes it promising for diagnostic clinicians. Several studies have reported that
the NLR is useful in various clinical situations.
Objective: To determine whether NLR obtained from complete blood count (CBC) and with simple calculation can be
used to predict mortality in patients with sepsis and septic shock in the ICU in comparison with intensive care unit (ICU)
severity scores.
Patients and methods: This prospective trial was carried out on 84 ICU cases with severe sepsis, who were admitted
to Specialized Medical Hospital ICUs from June 2020 to June 2021.
Results: There was statistically significantly higher systolic blood pressure (mmHg), mean arterial pressure, rate
pressure product *10^3, EF, INR, RBS, PH, HCO3, L *10^3, platelet count, CRP on admission, ABACHEII score,
SOFA score on admission, duration of hospital stay (days), and a statistically significantly lower age (years), diastolic
blood pressure (mmHg), heart rate, respiratory rate (RR), GCS, serum creatinine (mg/dl), serum albumin, serum
bilirubin, Na, K, total leucocytic count *10^3, N *10^3, in group B NLR >10 vs. group A NLR 10.
Conclusion:
Neutrophil to lymphocyte ratio is a cheap and rapidly available predictor of sepsis and has shown a
significant correlation with other relatively expensive and non-rapidly existing markers of inflammation and sepsis with
comparable efficacy with ICU severity scores [SOFA and APACHE II].
Keywords: ICU, Neutrophil-to-lymphocyte ratio, Sepsis.

INTRODUCTION

treatment response in sepsis patients for their simplicity
Sepsis is a major cause of morbidity and
(4). Neutrophil to lymphocyte ratio calculated from
mortality resulting from a devastating host response to
white cell differential count provides a rapid indication
the infection, and it affects millions of people
of the extent of an inflammatory process.
worldwide each year. As per the recent advances in the
Immunocompetent white blood cell populations play an
knowledge about the disease and the critical care
important role in the systemic inflammatory response to
modalities, the short-term mortality rate in patients
infection (5).
with severe sepsis and septic shock remains high
Neutrophilia is well recognized as infection
accounting for 30%(1).
marker whereas the clinician is less familiar with
Despite recent advances in knowledge about
absolute lymphocytopenia (lymphocyte count below
the disease and critical care modalities, the short-term
1.0×109/l) as a possible marker in infectious disease
mortality rate in patients with severe sepsis and septic
management. Combining both parameters seems a
shock remains high, accounting for approximately 30%
logical step and the ratio of neutrophil and lymphocyte
of all cases (2).
counts is increasingly used in several clinical
Although various clinical biomarkers are
circumstances (5).
widely explored, only a few have been currently applied
The neutrophil-to-lymphocyte ratio (NLR), as a
in the clinical practice. Therefore, the search continues
readily accessible biomarker, can be calculated based on
for preferable infection markers that may facilitate the
a complete blood count. Although a growing body of
prognosis prediction of sepsis in critically ill patients (3).
evidence has shown that NLR is proposed as an
Acute physiological and chronic health
independent predictor of poor survival in various
evaluation II (APACHE) and sequential organ failure
clinical critical illness circumstances ranging from
assessment (SOFA) scores are well known mortality
oncological patients to patients with cardiovascular
predictors in ICU patients with sepsis. SOFA and
diseases (6).
APACHE II scores are calculated to assess disease
There is no consensus about the relationship
severity, treatment response, and risk of mortality in the
between NLR levels and clinical prognosis in patients
ICU, and these are not easy to calculate at the bed side
with sepsis until now. In the context of infection,
in daily practice (4).
researchers in a recent study showed a reversed NLR
There are some inflammatory markers, such as
evolution according to the timing of death (7), whereas
the neutrophil to lymphocyte ratio (NLR) and platelet to
some other studies suggested that NLR was not
lymphocyte ratio (PLR), that are used to assess
associated with mortality in patients with sepsis (8).
This article is an open access article dis tributed under the terms and conditions of the Creative Commons



Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
242

Received: 16/8/2021
Accepted: 12/10/2021

Full Paper (vol.861 paper# 39)


c:\work\Jor\vol861_40 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 250-257
Tissue P53-Induced Glycolysis and Apoptosis Regulator (TIGAR) is Associated with
Oxidative Stress in Benign and Malignant Colorectal Lesions
Maha Ali1, Ragaa H.M. Salama1, Asmaa A. Kamal1, Heba E El-Deek2, AbdelMotaleb AA3, Abeer S. Abd-El-
Rehim4, Elham A. Hassan4, Alsanory AA5, Mahmoud M. Saad6, Marwa A. Dahpy*1,7
1 Department of Medical Biochemistry and Molecular Biology, 2 Department of Pathology, 3 Department of Surgery,4
Department of tropical medicine,5 Nuclear Medicine Unit, South Egypt Cancer Institute, 6 Department of Orthopedic,
Faculty of Medicine, Assiut University, Assiut, Egypt,7 Department of Medical Biochemistry and Molecular Biology,
Armed forces collage of Medicine (AFCM), Cairo, Egypt.
*Correspondence: Dr/: Marwa A. Dahpy E-mail: marwadahpy@aun.edu.eg, marwadahpy@yahoo.com,
Mobile:00201121188159.

ABSTRACT
Background:
Colorectal cancer (CRC) is the fourth leading cause of cancer-mortality worldwide. Tissue p53-induced
glycolysis and apoptosis regulator gene (TIGAR) has an important role in cellular glycolysis and acts as an oncogene.
Objectives: We aimed to investigate the diagnostic utility of TIGAR in both CRC and benign bowel deceases.
Methods: One-hundred-eighty tissue samples were recruited and classified into 3 groups: group (1) 60 CRC samples
from the tumor mass of colorectal cancer patients, group (2), 60 non-neoplastic colorectal tissue samples and group (3),
60 benign bowel lesions samples (ulcerative-colitis, Chron's disease, adenoma, and familial adenomatous polyposis).
The expressions of tissue mRNA and protein levels of TIGAR were determined. Levels of malondialdehyde and reduced
glutathione were also measured.
Results:
Our results showed upregulated expressions of TIGAR gene and protein levels in CRC tissues and benign
colonic lesions compared to non-tumor tissues (p < 0.0001). Their levels were higher in inflammatory bowel diseases
compared to non-inflammatory benign lesions. There were significant relations among TIGAR expression, protein
levels, TNM staging, and the presence of metastasis (p<0.0001). ROC curve analysis showed that TIGAR mRNA
expression and its protein can discriminate between CRC and benign lesions and between benign bowel disease and
controls.
Conclusions: To the best of our knowledge this is the first study to assess the level of TIGAR in different benign bowel
diseases. TIGAR might be involved in the pathogenesis of benign and malignant bowel diseases and could be a potential
biomarker for diagnosis.
Keywords: Tissue p53-induced glycolysis and apoptosis regulator gene (TIGAR), Benign colonic lesions, Colorectal
cancer.

INTRODUCTION
of NADPH (10). PPP provides NADPH and ribose
In Egypt, CRC constitutes 4.2% of all cancers (1), and it
necessary for the synthesis and repair of DNA that play
has a relatively high young onset (2). CRC is known as a
an essential role in tumor development and cellular
"silent disease," as many people do not have complaints
survival (11).
and mostly diagnosed at an advanced stage (3). Despite
TIGAR also interact with hexokinase 2 as it translocates
recent advances in diagnosis and management of CRC,
to the mitochondria, this help reducing ROS levels by
the radical cure still a challenge work because of
contributing in mitochondrial membrane potential
complexity of CRC, beside the drug resistance, and the
regulation (12).
recurrence and/or metastasis after surgical intervention
Many studies suggested that as TIGAR
(4). People with a family history of CRC have the risk to
expression is up-regulated and uncoupled from p53,
develop the disease (5), the most common hereditary
which suggests its role as an oncogene that help cellular
forms are familial adenomatous polyposis (FAP) and
proliferation, tumorigenesis and cancer progression (13).
lynch syndrome (6,7). Inflammatory bowel diseases
A high expression level of TIGAR was observed
(IBD) patients such as ulcerative colitis and Crohn's
in several cancers such as glioblastoma (14). invasive
disease, are also at high risk of developing the CRC,
breast cancer (15), hepatocellular carcinoma (16), and
especially with increasing duration and extent of the
intestinal cancers (11). The role of TIGAR in benign bowel
disease (8).
diseases and CRC so far still unclear. In this study we
Tissue P53-induced glycolysis and apoptosis
aimed to evaluate the diagnostic value of TIGAR in CRC
regulator (TIGAR) has the function of fructose 2,6-
patients and in patients with benign bowel diseases,
bisphosphatase, decreases the levels of fructose 2,6-
which is considered as high-risk groups or precancerous
bisphophate, thus blocks glycolysis and increasing
conditions. Also, we aimed to investigate how its
pentose phosphate pathway (PPP) flux(9). Therefore,
expression correlates with the cancer pathology and the
TIGAR decreases intracellular levels of reactive oxygen
clinicopathological staging. In addition, studying its
species (ROS)through the PPP shunt by the generation
relationship with malondialdehyde (MDA) and reduced
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250

Received: 17/08/2021
Accepted: 05/12/2021

Full Paper (vol.861 paper# 40)


c:\work\Jor\vol861_41 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 258-265

Study of some Physicochemical Parameters in the Water of El-Bagouria Canal
at El-Menoufia Governorate, Egypt
Mohamed Hamed Ghanem
Department of Zoology, Faculty of Science, Al-Azhar University, Egypt.
Corresponding author: Mohamed H. Ghanem,
email: mohamedhamed.201@azhar.edu.eg & ghanemhamed@yahoo.com
Mobile: 00201002660759

ABSTRACT
Background
: Environmental pollution is one of the most serious problems facing humanity in the 20th century and
still require great efforts at all levels. This is especially rivers are the main sources for drinking and irrigation.

Objective:
The present study was aimed to investigate some physicochemical parameters in the water at different sites
of El-Bagouria Canal, El-Menoufia Governorate during the period of study.

Materials and methods:
Water samples were collected seasonally from the four stations during the year and stored
for the final examination. Environmental factors and heavy metals concentrations were determined by using specific
methods.

Results:
Spring showed the highest value of pH and turbidity, while autumn and winter showed the highest levels of
electric conductivity, total dissolved solids, and chloride. However, alkalinity and total hardness were peaked during
autumn. Statistically, there is strong positive correlation between pH, alkalinity with water temperatures, turbidity,
(TDS) and total hardness with pH. The results indicated that the maximum levels of the concentrations of studied
heavy metals in water were recorded during the hot season compared to the cold seasons. Correlation coefficient
indicated that, a positive correlation between cadmium concentration in the water with lead, plus positive correlation
between lead, copper with iron were present.

Conclusion:
It could be concluded that increased levels of physicochemical factors and heavy metal concentrations
may pose a high risk to aquatic organisms and human health. So, the present study shows that precautionary measures
must be taken to reduce pollution at the freshwater canals in the future.

Keywords:
Physicochemical parameters, Heavy metals, Water, El-Bagouria Canal.

INTRODUCTION

quantity of domestic agricultural effluents, mostly
The River Nile travels along Egypt for about
untreated waste waters (1-4).
940 km behind the High Dam. At the north area of
El-Menoufia Governorate is one of the central
Cairo (El-Kanater El-Khyria), the River Nile bifurcates
parts for Nile Delta and extends along wide area more
into two branches namely Damietta and Rosetta
than 2500 km2. The area is bordered to the west by the
branches and four Rayahs (Canals) namely El-Nassery,
Rosetta branch and to the east by the Damietta branch.
El-Behery, El-Menofy and El-Toufeky.
The Governorate consists of eight centers; all of them
The length of Rosetta branch is about 220 km,
are cultivated lands and densely populated (1).
and the width varies from 50­200 meters, the depth
El-Bagouria Canal is diverting from El-
fluctuates from 1.5­ 16 meters. Whereas, length of
Monofy Rayah at km 21.3, it is 90.0 km long and it
Damietta branch is about 242 km with average width
serves around 326,000 feddans. The total length of this
and depth 200 and 12 meters, respectively.
channel in El-Menoufia Governorate is approximately
They are the main sources of drinking and
35-40 km, which considers a support channel. The
irrigation waters for Nile Delta including, El-Qalubia,
selective stations (Fig., 1) included four sites (Shubra
El-Menoufia, El-Gharbia, El-Dakahlia and Damietta
Zinji, Kafr Shubra-Beloulah, Sengerg and Shubra
Governorates (1). The River Nile receives a large
Bas).

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Commons Attribution (CC BY-SA) license (http://creativecommons.org/licenses/by/4.0/)
258
Received: 16/08/2021

Accepted: 12/10/2021

Full Paper (vol.861 paper# 41)


c:\work\Jor\vol861_42 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 266-271

Serum Homocysteine as an Early Diagnostic Marker of Spontaneous
Bacterial Peritonitis in Patients with Hepatic Cirrhosis
Mohamed Abd Ellatif Afifi*, Mohammed Zekria Kashmoola, Ahmed Mohamed Hussein
Internal Medicine Department, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding Author: Mohamed Abd Ellatif Afifi, Mobile: 00201001588752, Email: dr_malatif82@yahoo.com

ABSTRACT
Background: Spontaneous bacterial peritonitis (SBP) is a term used to describe acute infection of ascites, an
abnormal accumulation of fluid in the abdomen, without a distinct or identifiable source of infection.
Objective: This study aimed to assess serum homocysteine as a novel reliable early diagnostic marker for
spontaneous bacterial peritonitis in patients with hepatic cirrhosis. As the diagnosis of SBP depends primarily on a
polymorphonuclear leukocyte cell (PMN) count 250 mm3, however this method is invasive and sometimes not
diagnostic. Patients and methods: This study was conducted on 50 cirrhotic patients with ascites. Patients were
divided into 2 groups: Group (A) included 30 cirrhotic patients with SBP on the basis of PMN count in the ascitic
fluid 250 cells/L with or without positive ascitic fluid culture. Group (B) included 20 cirrhotic patients with
ascites but without SBP (control group). Results: There was a significant difference between the two studied groups
regarding C-reactive protein (CRP) (P=0.001) and erythrocyte sedimentation rate (ESR) (P=0.008). There was also
significant difference between the two studied groups regarding ascitic fluid analysis parameters; as ascitic glucose
and albumin were significantly lower in SBP group (P=0.002 & P=0.027, respectively) while ascitic lactate
dehydrogenase (LDH) and PMN count were significantly higher in SBP group (P < 0.001, for both). Serum
homocysteine was significantly higher in SBP group compared to non-SBP group (18.43 ± 6.95 vs. 12.13 ± 5.54
mol/l; P=0.001). Serum homocysteine was significant at a cutoff level of 17.65 mol/l with a sensitivity of 88.6%
and 95.2% specificity for diagnosing SBP with an area under the curve (AUC) = 0.928.
Conclusion: Serum homocysteine could serve as a convenient novel and reliable noninvasive early diagnostic
marker for SBP in cirrhotic patients with ascites.
Key words: Homocysteine, Spontaneous bacterial peritonitis, Cirrhosis; Ascites.

INTRODUCTION
Liver disease accounts for approximately 2 million
250/mm3 is considered to indicate empirical antibiotic
deaths per year worldwide, 1 million due to
therapy based on the current guidelines (6).
complications of liver cirrhosis (LC). According to the
Ascetic fluid culture (AF) is the gold standard for
Global Burden of Disease 2010 study, LC is the 11th
the diagnosis of SBP. However, cultures have been
most common cause of death globally, and accounting
negative in about 60% of patients despite the clinical
for 1.6% of the worldwide burden (1). LC results from
manifestations suggestive of SBP and the increased
progressive fibrosis and is the final outcome of all
ascites neutrophil count. Lysis of the ascetic fluid
chronic liver disease. Cirrhosis can result in portal
PMNs during transport to the laboratory may lead to
hypertension and/or hepatic dysfunction. Both of these
false negative results. Manual measurement of the
either alone or in combination can lead to many
ascetic fluid PMN count is operator-dependent makes
complications, including ascites, varices, hepatic
quality control difficult and can delay the diagnosis (7).
encephalopathy,
hepatocellular
carcinoma,
Homocysteine is a sulfhydryl-containing amino
hepatopulmonary
syndrome,
and
coagulation
acid mainly produced and catabolized in the liver (8).
disorders. Cirrhosis and its complications not only
Plasma homocysteine (tHcy) is a marker of folate and
impair quality of life but also decrease survival (2).
cobalamin deficiency states and a risk factor for
SBP is a well-recognized and prevalent
cardiovascular diseases, and is altered by renal
complication seen in cirrhotic patients with ascites,
insufficiency. Increased tHcy in liver diseases may
occurring in 10­25% of these patients (3). It leads to
also play a role in hepatic disorders (9).
more severe liver function damage, sepsis and multi-
Recently, Ahmeda et al. (10) demonstrated that
organ failure thus affecting the prognosis of such
homocysteine is considerably higher in SBP
patients (4). Once SBP is diagnosed, appropriate
participants versus non-SBP patients. Serum
antibiotic treatment must be started as soon as
homocysteine may have reliable diagnostic role in
possible, without prior knowledge of the causative
patients with SBP.
organisms or their in vitro drug sensitivities (5).
The aim of this study was to assess serum
Bacterial translocation is the major cause of SBP;
homocysteine as a novel reliable early diagnostic
therefore, no intra-abdominal source of infection can
marker for SBP in patients with hepatic cirrhosis.
be found. Ascites culture is the gold standard for SBP

diagnosis, and a high ascites PMN count is accepted as
PATIENTS AND METHODS
an early indicator of SBP. An ascites PMN count
This study was conducted on 50 Ascetic cirrhotic
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266

Received: 15/09/2021
Accepted: 29/11/2021

Full Paper (vol.861 paper# 42)


c:\work\Jor\vol861_43 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 272-279

Enhanced Bone Tendon Healing Using Anatomic Single-Bundle Anterior
Cruciate Ligament Reconstruction with Remnant Augmentation
Alaa Mohammed Mohammed Alswiei, Adel Mohammed Salama,
Mohamed Hamed Fahmy Afifi, Hossam Fathi Mahmoud Mohamed
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
Corresponding Author: Alaa Mohammed Mohammed, Email: alaaswei1@gmail.com
ABSTRACT
Background
: When dealing with anterior cruciate ligament (ACL) tears, anatomic single-bundle reconstruction with
remnant-preserving method offers numerous advantages, including enhanced revascularization and graft
ligamentization, prevention of synovial fluid bath to the tunnels, and enhanced bone tendon healing
. Objective: assess the efficacy and outcome of anatomic single-bundle reconstruction with remnant-augmenting
technique in patients with an ACL tear.
Patients and Methods: At the Orthopedic Departments of Zagazig University hospital, 18 patients with complete ACL
damage were studied in prospective cohort research. The study was carried out from 2-11/2021. All patients received
an anatomic single-bundle reconstruction using a remnant-preserving approach, and all patients were periodically
monitored clinically and radiographically for a week, then every 2, 4, 6, and 12 weeks after the index procedure. Results:
33.3% of studied patients were complicated; superficial Infection was in 27.8%, Failure was just in one case and stiffness
2 cases only there were no other complications. VAS was significantly higher among complicated cases at the post but
Lysholm knee score was significantly lower at pre and post and regard IKDS was significantly lower at post only.
Conclusion: Patients with ACL tears benefit more from anatomic single-bundle restoration using the remnant-
augmenting method, which improves proprioceptive functions, stability, and healing of the graft.
Keywords: Anterior Cruciate Ligament Reconstruction, Anatomic Single-Bundle, Remnant Augmentation.

INTRODUCTION
One of the most common orthopedic sports injuries,
Neuromuscular coordination is dependent on
anterior cruciate ligament rupture has an incidence rate of
proprioceptive input since it affects the knee and ACL's
thirty to eighty in each one hundred thousand, according
biomechanical function. The precise complicated
to a 21-year population-based study(1).
interplay between the neurological and musculoskeletal
The gold standard treatment for anterior cruciate
systems is critical to restoring knee function following an
ligament (ACL) ruptures is arthroscopically assisted
ACL injury, not just surgical methods (2).
anterior cruciate ligament (ACL) reconstruction. help
In addition to the ACL's tibial connection, the
restore knee stability, regain pre-injury sports ability, and
synovium's inner membrane contains mechanoreceptors
prevent meniscal or chondral injury as well as
that
mediate
knee
proprioception.
Remaining
osteoarthritis (2).
mechanoreceptors can be discovered in the stump of a
The anteromedial (AM) and the posterolateral (PL)
torn ACL, attached to the posterior cruciate ligament,
bundles of the functional ACL are two separate sections.
three years following ACL rupture, according to
The rebuilt ACL graft's anatomical placement has
Georgoulis et al findings. .'s Because of this, it is
equivalent forces to the normal ACL. A normal
important to preserve as much of the original tissue as
anatomical repair is the ultimate goal of the various ACL
possible, even in the case of chronic injuries (6).
reconstruction procedures (3).
Studies have shown the advantages of anatomic
The single-bundle approach for ACL reconstruction
single-bundle reconstruction with remnant-preserving
has long been the standard treatment because of its
technique, including enhanced revascularization and graft
excellent clinical outcomes. Double-bundle ACL surgery
ligamentization, improved bone tendon healing,
has gradually replaced single-bundle ACL reconstruction
prevention of synovial fluid bath to the tunnels,
in recent years. This technique is regarded to be superior
preservation of proprioceptive cells as well as early
in theory to the single-bundle technique in ACL
rehabilitation. This method also makes it easier to arrange
reconstruction (4).
the tunnels accurately, compared to the usual method.
Although the double-bundle technique has better
However, the procedure is more difficult to perform
results in terms of rotational laxity, the most recent meta-
because of the higher incidence of impingement and
analyses have shown no significant difference between
cyclops lesions (7).
the two techniques in terms of functional recovery.
An anatomical single-bundle reconstruction using a
Single-bundle ACL reconstruction is still the most often
remnant-augmenting approach to increase ACL stability,
utilized procedure, as its clinical outcomes have improved
graft healing, proprioceptive functions, and clinical
over time (5).
results are the objectives of this study.
PATIENTS AND METHODS:

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



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272
Received: 28/8/2021
Accepted: 14/10/2021

Full Paper (vol.861 paper# 43)


c:\work\Jor\vol861_44 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 280-285
Liver Function Status in Bacterascites versus Spontaneous Bacterial
Peritonitis in Patients with Liver Cirrhosis
Ahmed M. Hussein, Hiba W. H. Kashmoola*, Amira K. El-Alfy
Department of Internal Medicine, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Hiba W. H. Kashmoola, E-Mail: heba_waleed79@yahoo.com

ABSTRACT
Background:
Spontaneous bacterial peritonitis (SBP) is a severe complication of decompensated cirrhosis, and the in
hospital mortality for SBP ranges from 21.3% to 37%.
Objective: The aim of the present study was to assess the clinical characteristics, microbiological findings, and clinical
course in patients diagnosed with bacterascites in comparison with patients with spontaneous bacterial peritonitis,
regarding liver status.
Patients and methods: This study was conducted on 50 Patients with ascites who were admitted at Internal Medicine
Department, Benha University Hospital.
Results: There was no significant difference between the two studied groups. There was no significant difference
between the two studied groups regarding hemoglobin, total leukocyte count (TLC) and platelets. There was no
significant difference between the two studied groups regarding liver parameters. There was a significant difference
between the two studied groups regarding polymorphonuclear neutrophil (PMN) count. There was a significant
difference between the two studied groups regarding positive cultures and prevalence of isolated organisms from the
ascitic fluid. There was a significant difference between the two studied groups regarding antimicrobial agents use.
Conclusion: Bacterascites is a complication of cirrhosis comparable to SBP with respect to clinical background and
prognosis. There is a significant difference between the two studied groups regarding positive cultures and prevalence
of isolated organisms from the ascitic fluid. There is a significant difference between the two studied groups regarding
antimicrobial agents use.
Keywords: Bacterascites, Spontaneous Bacterial Peritonitis, Liver Cirrhosis.

INTRODUCTION

prevalent in 8%11% of all patients with cirrhosis and
Ascites is the accumulation of lymphatic fluid
ascites, and the clinical significance seems to vary
within the peritoneal cavity. It is one of the major
according to how the infection was acquired (4).
complications of decompensated liver disease, along
Several hypotheses have been proposed to explain
with variceal hemorrhage and hepatic encephalopathy.
the
potential
underlying
pathophysiological
Additionally, ascites is the most common cause of
mechanisms. The most common theory implicates that
hospitalization in cirrhotic patients (1). The development
the bacterial colonization of ascites is caused by
of ascites is a marker of prognosis in liver cirrhosis, as
bacterial translocation from the intestinal lumen or by
it indicates a reduction in 1- and 5-years survival rates
secondary translocation from a concomitant infection
by 15% and 23.5%, respectively (2).
from extra-intestinal sites (e.g. urogenital or respiratory
Spontaneous bacterial peritonitis (SBP) is a severe
tract) (5).
complication of decompensated cirrhosis. The
The absence of an inflammatory response could be
inhospital mortality for SBP ranges from 21.3% to 37%.
interpreted as an early phase of SBP in which the
Bacterial translocation is the major cause of SBP.
neutrophil response has not commenced yet, or a
Therefore, no intra-abdominal source of infection can
spontaneously resolving infection, determined by good
be found. Ascites culture is the gold standard for SBP
host defences or less virulent pathogens. Furthermore,
diagnosis, and a high ascites polymorphonuclear
bacterascites caused by commensal skin bacteria has
leukocyte (PMN) count is accepted as an early indicator
been attributed to exogenous contamination of the
of SBP. An ascites PMN count 250/mm3 is considered
ascitic fluid sample and bacterascites with multiple
to indicate empirical antibiotic therapy based on the
pathogens may be caused by traumatic paracentesis.
current guidelines (3).
The indication for antibiotic treatment of bacterascites
Bacterascites is defined by an ascitic fluid
is generally regarded to be dependent on the supposed
polymorphonuclear neutrophil (PMN) count below
pathophysiological mechanism and the clinical situation
250/L and a positive ascitic fluid culture results in the
(6).
absence of an evident intraabdominal, surgically
The AASLD practice guideline regarding the
treatable source of infection. It is a different clinical
management of ascites states that patients with ascites
entity than spontaneous bacterial peritonitis (SBP),
and convincing signs or symptoms of infection should
which is characterized by a neutrophil reaction in ascites
receive empiric antibiotic treatment (7). This
regardless of the bacterial culture result. Bacterascites is
recommendation is based on one study with 36 cases of

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280
Received: 15/09/2021
Accepted: 29/11/2021

Full Paper (vol.861 paper# 44)


c:\work\Jor\vol861_45 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 286-290

Oral Contraceptive Pills use and adverse effects
Mai Alsayed Mahmoud Kotb*1, Hosnia M. Ragab2, Youssef Abo Elwan3, Yasmin Husseiny Hassan Hussein4
Departments of 1Family Medicine in Ministry of Health and Population, Egypt
Departments of 2Puplic Health, 3Gynacology and 4Family Medicine, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding author: Mai Alsayed Mahmoud Kotb, Mobile: (+20)01152700997, Email: drmaikob87@gmail.com

ABSTRACT
Background:
Egyptian women value contraceptive methods for their effectiveness against pregnancy.
Objective: This study aimed to determine the usage and side effects of oral contraceptive pills among the target group.
Patients and methods:
A cross-sectional study was carried out on 350 women from family health centers and units in
Abo Hammad District, Sharkia Governorate. Data were collected through a questionnaire
Results:
Majority (81.1%) of the studied group used combined pills The most frequent side effects found among them
were depression, breast pain & inflammation, weight gain and abnormal vaginal secretions (63.7%, 57.7%, 56.6% &
56.3% respectively).
Conclusion
The present study revealed that prevalence of pills usage among 350 studied females in Abo Hammad
District, Sharkia Governorate was 62.9%. The prevalence of combined pills was 81.1% and Mini pills was 18.9%.
Keywords:
Contraceptive, Depression, Side effects, Biomarkers
Introduction:
Contraception is a common practice among women during their childbearing period (1). Oral contraceptive pills are
widely available and accepted in Egyptian society (2). Over 100 million women currently use oral contraceptive pills
worldwide (3). There are three types of oral contraceptive pills: combined estrogen-progesterone (cocs), progesterone
only (pops) and the continuous or extended use pill. The birth control pill is the most commonly prescribed form of
contraception in the US. Approximately 25% of women aged 15-44 who currently use contraception reported using the
pill as their method of choice. The most commonly prescribed pill is the combined hormonal pill with estrogen and
progesterone (4).
This study aimed to determine the usage and side effects of oral contraceptive pills among the target group.


PATIENTS AND METHODS

contraceptive pills including pregnancy on use,
This study is a cross-sectional study that was done
abnormal discharge, bleeding and dysmenorrhea,
on 350 women. The study was carried out in Family
weight gain, back pain, headache, diarrhea, loss of
Health Centers and Units in Abo Hammad District,
vision, bad breath, depression, nausea, lumps in breast,
Sharkia Governorate.
abnormal vaginal bleeding, sore throat and tender or

sore breast.
Inclusion criteria: Married women in child bearing

period (19-49) years old those use oral contraceptive
Ethical consent:
pills (OCPs) during the last six months.
An approval of the study was obtained from

Zagazig
University Academic
and
Ethical
Exclusion criteria: Married women with chronic
Committee. Every patient signed an informed
disease e.g., diabetes mellitus, hypertension or cardiac
written consent for acceptance of the study. This
diseases.
work has been carried out in accordance with The
All subjects were subjected to the following:
Code of Ethics of the World Medical Association
Detailed history taking (with special emphasis on:
(Declaration of Helsinki) for studies involving
Name, age, marital state, gravity and parity, menstrual
humans.
history, obstetric history, past history of any medical

problems and family history.
Statistical analysis
Contraceptive pills usage: Pattern of OCPs use,

The collected data were coded, processed and
duration of OCPs taken, types of OCPs (mini pills or
analyzed using the SPSS (Statistical Package for Social
combined), OCPs efficacy, OCPs safety, benefits of
Sciences) version 22 for Windows® (IBM SPSS Inc.,
OCPs and action when forgot one pill. Prophylactic
Chicago, IL, USA). Data were tested for normal
check-ups
performed: Breast
self-examination,
distribution using the Shapiro Walk test. Qualitative
cytology mammography, laboratory blood test, chest X-
data were represented as frequencies and relative
ray, ultrasonography of the female reproductive organs,
percentages. Chi square test (2) was used to calculate
blood pressure measurement and other breast
difference between two or more groups of qualitative
ultrasound. Asking about side effects of oral
variables. Quantitative data were expressed as mean ±

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286
Received: 20/8/2021
Accepted: 16/10/2021

Full Paper (vol.861 paper# 45)


c:\work\Jor\vol861_46 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 291-298
MRI value in Characterization of Tendon and Ligament Lesions of the Fingers
Hayam Abdelmonsif Abdellatif, Mohammed Shawky Abduallah, Mohammed Abd El Aziz Maaly, Belal Said
Soltan
Radiology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
*Corresponding author: Hayam Abdelmonsif Abdellatif, Mobile: (+20) 01098057324, E-mail: hayam_drar@yahoo.com

ABSTRACT
Background:
MR imaging is a powerful method for characterization of swellings arising from the tendon sheath
especially giant cell tumors and ganglion cyst of the tendon sheath. A trigger finger is a common condition and is either
blockage or triggering of the finger from flexion to extension.
Objective: To evaluate the diagnostic performance of MRI in non-traumatic finger tendon and ligament-related lesions
to allow a more focused assessment of the soft tissue structures of this region.
Patients and methods: This study was performed in Radiology Department, Menoufia University Hospitals, during the
period from August 2018 to April 2020. This study included 44 patients; 25 males, 19 females with an age range from
13 years to 58 years (mean age 35 years). In terms of clinical presentation, 73% of cases presented by swelling and cases
presented by pain were 27%.
Results: Primary diagnosis by MRI revealed 50% of cases were giant cell tumors, 25% were ganglion cysts and the
remainder were hemangiomas, MRI detection of characterization represented by 100%, the results then compared with
pathology and laboratory results with accuracy of MRI in the detection of tissue characterization is 93.3%, MRI evidence
of non-traumatic tenosynovitis constituted about 75% of all cases of tenosynovitis. On the other hand, only 25% of cases
had a radiological diagnosis of trigger finger.
Conclusions: MRI is a great assessment of the tendon and ligaments tear whether partial or complete, any associated
marrow edema or bony fragment avulsion, and the extent of retraction in cases of a complete tear.
Keywords:
Finger, Ganglion, Tendon sheath Giant cell tumor, Hemangioma, Ligament, Magnetic Resonance Imaging,
Tendon.

INTRODUCTION

tissue tumors) are more frequent, particularly the subset
Recent studies have demonstrated the significant
epitheloid sarcoma occurring in the hand in 43% of
impact of MR on treatment approaches. MR studies
cases. On MR it appears as a heterogeneous
changed the clinical diagnosis in 55%, modified the
multilocular mass with internal septations. It has a
treatment plan in 45%, and improved the physicians'
homogenous bright T2 & low-to-intermediate T1 signal
understanding of the disease process in 67% of cases (1).
but it is not a fluid signal. Fluid-fluid levels are due to
MRI also plays important role in the characterization of
hemorrhage (2).
soft tissue messes arising from the tendon sheath. Giant
Cystic lesions are the most common lesions with
cell tumor is the most common neoplasm & the second
mass effects arising in the hand and wrist, accounting
most common soft tissue space-occupying lesion of the
for 50­70% of all soft tissue tumors of the hand and
hand constituting 12% of these lesions (2). On MR,
wrist. The terminology of cystic lesions is very
haemosiderin leads to low T1 & T2 signals. The low T2
confusing. The terms synovial cyst and ganglion cyst
signal is useful as it is rarely seen in other soft tissue
are often used interchangeably. A tendon sheath cyst
tumors of the hand although other lesions like fibroma
consists of a special ganglion cyst subtype located on
of the tendon sheath can show similar findings.
the course of a tendon sheath. The etiology of tendon
Sometimes intra-lesional heterogenicity with a low
sheath ganglia is still unclear (6). MRI demonstrates the
signal rim is seen due to hemorrhage or necrosis.
exact location and extent of the cystic lesions and their
Usually, slight inhomogeneous post-gadolinium
relationship to the joint and surrounding structures.
enhancement is seen (3).
Cystic lesions are usually well-circumscribed but may
Fibroma of the tendon sheath is a rare benign
be lobulated or multicystic with internal septa. The
tumor of the tendon sheath which may be confused with
diagnosis of a typical cyst is usually straight forward by
GCTTS (4). The MRI appearance is variable but usually,
analysis of the signal intensities of the lesion. They are
the presence of fibrous tissue results in low signal on
typically hypo- or isointense to muscle on T1-WI, and
both T1 and T2 weighted images with no or little
homogeneously hyperintense on T2-WI. After
enhancement (4).
gadolinium contrast medium administration, subtle rim
Malignant tumors of the hand and wrist are
enhancement of the peripheral fibrovascular tissue in
uncommon. Their initial behavior may be similar to that
the cyst wall is seen (6). Therefore, this study aimed to
of a benign lesion and hence may be missed with a
evaluate the diagnostic performance of MRI in non-
disastrous consequence for the patient (5). Some
traumatic finger tendon and ligament-related lesions to
sarcomas such as synovial sarcoma (10 % of all soft

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291
Received: 19/8/2021
Accepted: 15/10/2021

Full Paper (vol.861 paper# 46)


c:\work\Jor\vol861_47 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 299-305

Surgical Management of Fracture Both Bone Forearm in Pediatric Using
Elastic Stable Intramedullary Nail
El Sayed Eletwy Soudy, Mohamed El Sadek Attia, Hosam Eldien Abdelaziz Mohamed,
Ahmed Mohammed Abdelwahab, Akrem Khaled Lagha*
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding Author: Akrem Khaled Lagha, E-Mail: Akremlagha1983@gmail.com

ABSTRACT

Background: In children, forearm fractures are among the most prevalent types of fractures Operative procedures
such as, pinning with K-wires, plate osteosynthesis as well as elastic-stable intramedullary nailing (ESIN) are
necessary for these fractures.
Objective: This study aimed to assess treating and outcomes of pediatric forearm fractures with elastic stable
intramedullary nailing (ESIN).
Patients and methods: At Orthopedic Departments of Zagazig University Hospital and Tripoli University Hospital,
8 skeletally immature patients with diaphyseal forearm fractures were studied in prospective cohort research. The
study was carried out from November 2020 to May 2021. Pre-operative X-ray and CT were done and the patient
was prepared for surgery. Elastic-stable intramedullary nailing technique was done to all patients, all patients were
regularly followed clinically and radiographically for 1 week and then 2, 4, 6, 12 week after end of surgery.
Results: we found that all patients progressed to union without the need for any further surgical intervention with
good functional outcome as regards forearm rotation. One case had residual radius angulation more than 20 degree,
no case had residual ulna angulation, 2 cases had superficial infection, 1 case had superficial radial nerve palsy and
1 case had elbow joint stiffness.
Conclusion: Intramedullary fixation by flexible intramedullary nails (ESIN) is successful treatment option and
recommended for pediatric patients with 4-14 years of age or older because it is simple safe and minimally invasive
procedure and effective method of treatment that provides many biological and mechanical advantages.
Keywords: Fracture both bone forearm, Elastic stable intramedullary nail.

INTRODUCTION

(7). Fracture callus development is encouraged by this
Fractures of the forearms are the most prevalent
type of stability. When comparing ESIN to other
among children. Treatment procedures are most suited
treatment options, early forearm mobilisation and
to the patient's age and level of skeletal maturity, which
reduced procedure invasiveness are the two biggest
influence how much deformity is tolerated (1). Three to
advantages (8). A three- to four-week period of
six percent of all fractures in children are radial and
postoperative immobilisation using a back slap above
ulnar shaft fractures. The distal third of the radius and
the elbow. With 3 weeks, the quantity of callus
ulna shafts account for 75% of fractures, 15% of the
formation is comparable to the amount of callus
middle third, and 5% of the proximal third. The
formation that occurs after conservative treatment (9).
remaining 5% could be of complex injuries as well as
Treating pediatric forearm fractures with elastic
Monteggia fracture dislocations (2).
stable intramedullary nailing (ESIN) with assessment
It is not uncommon to see a toddler with a fractured
of the outcomes are the goals of this study.
forearm, compared to an adult. Fractures result in a

periosteum that is thicker and less easily torn (3). There
PATIENTS AND METHODS
are more cancellous bones while smaller medullary
At Orthopedic Departments of Zagazig University
canals around the epiphysis of long bones in children
Hospital and Tripoli University Hospital where 8
compared to the epiphysis in adults. In children,
skeletally immature patients with diaphyseal forearm
torsional as well as greenstick fractures are prevalent.
fractures were incorporated in prospective cohort
Anatomical alignment isn't usually important because
research. The study was carried out from November
of a child's ability to repair their bones, therefore open
2020 to May 2021.
reduction is infrequently necessary (4). For children with

stable and only slightly displaced forearm fractures,
Ethical approval:
conservative treatment is the most common method of
All participants signed informed consent forms that
care (5). Operative therapies such as, pinning of the
were submitted them to Zagazig University's
fracture by K-wires, plate osteosynthesis as well as
Research Ethics Committee and the study was
elastically stable intramedullary nailing are required for
allowed (ZU-IRB#6057). We followed the World
some forearm fractures (ESIN) (6). The interosseous
Medical Association's ethical code for human
membrane acts as an additional support for the fracture
experimentation (The Helsinki Declaration).

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299
Received: 1/9/2021
Accepted: 17/10/2021

Full Paper (vol.861 paper# 47)


c:\work\Jor\vol861_48 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 306-311

Study of Serum Levels of Visfatin Amongst Pre-Diabetic Obese Patients
Salem Ali Alnoggah1, Abdelmonem Fathy Zeid1, Hatem M. Salem1, Ahmad Baraka2
Department of 1Internal Medicine and 2Clinical and Chemical Pathology,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Salem Ali Alnoggah, E-mail: salemali20102000@yahoo.com

ABSTRACT
Background:
Insulin resistance, pre-diabetes, and obesity have all been linked to excess adiposity. Proinflammatory
adipokine visfatin is thought to play a key role in type 2 diabetes inflammation. Objective: This study aimed to
estimate visfatin level among prediabetic obese patients and to observe and detect the interplay between visfatin,
insulin resistance and obesity.
Patients and methods: 96 adult subjects were studied in case-control research at Internal Medicine Department and
Clinical Pathology Department, Zagazig University Hospital. The study was carried out from January 2021 to
November 2021. Subjects were divided into 3 groups: Group (1) included 24 healthy individuals as a control group,
group (2) included 48 prediabetic individuals and group (3) that included 24 patients type 2 diabetes who never been
treated in any of these. Serum visfatin was assessed in all participants.
Results: Diabetes mellitus (DM) patients had higher visfatin levels than those with impaired glucose tolerance (IGT)
or impaired fasting glucose (IFG). Visfatin had a significant positive correlation with BMI, WC, FBS, PPS, HA1c,
LDL, fasting insulin, and HOMA IR, while HDL had a significant negative correlation.
Conclusion:
Visfatin levels were significantly linked to type 2 diabetes. HOMA-IR, fasting insulin, and BMI all
showed a strong positive correlation with visfatin levels, suggesting that it may be a useful biomarker for detecting
type 2 diabetes.
Keywords: Visfatin, Prediabetes.

INTRODUCTION
patients induces a state of inflammation, which may
One of the most major risk factors related to
lead to insulin resistance. Fukuhara and colleagues (2)
prediabetes, insulin resistance as well as type 2 diabetes
have previously showed that visfatin may have a
is obesity. Adipocyte-derived hormones, now known as
glucose-lowering effect, but the study was later
adipokines, and various proteins and enzymes are all
withdrawn by the Editor of "Science" because of the
produced by adipose tissue, in addition to serving as a
controversy surrounding the findings (7).
significant endocrine and metabolically active organ (1).
Insulin resistance and other metabolic illnesses such
Adipocytokine visfatin, pre-B cell colony-
as obesity and type 2 diabetes have been related to
enhancing factor (PBEF), is identified as a protein that
persistent low-grade inflammation characterize by
is strongly produced then secreted by fat of viscera. It
aberrant cytokines over the years, and that these
was isolated by Fukuhara et al. (2) in 2005 from patients
inflammatory markers may be directly linked to an
who had blood levels of visfatin correlated with obesity.
increased risk of developing diabetes. Type 2 diabetes
Biosynthesis of Nicotinamide Adenine Dinucleotide
and insulin resistance are both closely associated with
is regulated by visfatin role as nicotinamide
obesity, and previous research suggests that
phosphoribosyl transferase (NAD). Stress-induced
adipocytokines and inflammatory markers may play a
energy metabolism is controlled by visfatin, which
role in their development (8, 9).
possesses anti-apoptotic effects. Activation of the
The goal of this case-control analytic investigation
immune system is also an important purpose for this
was to estimate visfatin level among prediabetic obese
compound (3, 4).
patients and to observe and detect the interplay between
It was previously hypothesized that visfatin, which
visfatin, insulin resistance and obesity potentially
is produced mostly by macrophages, would act as an
enhancing our knowledge of this controversial marker.
insulin mimic because of its involvement in promoting

triglyceride (TG) synthesis and glucose transfer. The
PATIENTS AND METHODS
novel adipokine, visfatin, plays an important part in the
96 adult subjects were studied in case-control
inflammatory process associated with type 2 diabetes (5).
research at Internal Medicine and Clinical Pathology
However, the results on visfatin levels are based on
Departments, Zagazig University Hospital. The study
research using a non-specific test based on the C-
was carried out from January to November 2021.
terminus of visfatin, which led to significant

inconsistencies. Visfatin concentrations in obese and
Ethical approval:
healthy individuals are not known to be consistent (6). It
All participants signed informed consent forms
has been suggested that increased visceral fat in these
that were submitted to Zagazig University's

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306
Received: 01/09/2021
Accepted: 16/10/2021

Full Paper (vol.861 paper# 48)


c:\work\Jor\vol861_49 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 312-317

Effect of Induced Hyperthyroidism on Pancreas of Adult Female Albino Rats
Zeinab M. Alazouny, Osama Y. Ibrahim, Mariam A. Abd Elmaksoud*, Karima F. Abdelfadeel
Medical Histology Department, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Mariam A. Abd Elmaksoud, Email: maryam_ahmed17@yahoo.com

ABSTRACT
Introduction:
A condition known as hyperthyroidism can lead to a wide range of health issues, including osteoporosis,
oxidative liver damage, diabetes mellitus, as well as cardiovascular disease.
Objective: To examine the detrimental effects of hyperthyroidism on the pancreatic structure of adult female albino
rats.
Materials and Methods: twenty-one adult virgin female albino rats were assigned to 2 groups; control and induction
of hyperthyroidism. Serological analysis to assess thyroid functions, oxidative stress and lipid peroxidation analysis was
carried out. Pancreatic samples were processed for light microscopic examination.
Results: Hyperthyroidism caused both biochemical and histological changes on pancreas of adult female albino rats.
The biochemical changes in the form of significant decreased in the thyroid stimulating hormone serum level, significant
reduction in level of serum superoxide dismutase and the malondialdehyde level was significantly increased in the
hyperthyroid rats. The histological changes were loss of its general architecture. The pancreatic acini appeared irregular,
vacuolated and had dark nuclei. Some islets of Langerhans appeared shrunken and the acini did not have the normal
smooth demarcation from the surface.
Conclusion: Hyperthyroidism seriously affected the histological structure of the pancreas with subsequent disturbance
in the biochemical markers.
Keywords: Hyperthyroidism, Pancreas, Adult Female Albino Rats


INTRODUCTION
enzyme production to be out of whack and exocrine
Hyperthyroidism (HT) is one of hyper-
dysfunction to ensue(5, 6).
metabolic problems that result from increased free T4
The aim of the present study was to examine the
and/or free T3 serum levels (1). T4 is the thyroid gland's
detrimental effects of hyperthyroidism on the pancreatic
most important hormone. Administration of L-T4 drug
structure of adult female albino rats.
produces effect similar to that of thyroid hormone in

vivo. It is converted to T3 in kidneys and liver and then
MATERIALS AND METHODOLOGY
binds to thyroid binding hormones in the blood to be
Substances:
transferred to various tissues in order to exert its
L-Thyroxine (L-T4): To make a solution containing 1
functions. It is given as a replacement therapy in the
ml of 100 µg g of L-thyroxine, one tablet (100µg) was
hypothyroid patients. At high doses, it can develop the
dissolving in 1 ml of water. It was purchased from
same symptoms and distress of hyperthyroidism (2).
GlaxoSmithKline, Cairo, Egypt.
Hyperthyroidism is a serious disorder as it can

lead to a wide range of health issues, including
Animals used in research:
osteoporosis, oxidative liver damage, diabetes mellitus,
We used a total of twenty-one adult, virgin
as well as cardiovascular disease (3).
albino female rats for this study, ten to 18 weeks old.
The thyroid gland is linked to the endocrine
They weighed between 180 and 200 grams. At Zagazig
portion of pancreas through regulation of carbohydrate
University, they were taken from the Breading Animal
metabolism. Excess thyroid hormones (THs) produce
House. A room temperature and regular light/dark
diabetogenic effect through stimulation of intestinal
cycles were maintained for the animals with ad libitum
absorption of glucose, decrease in the ability of the liver
access to food and water. Before beginning the
to store glucose as glycogen, impairment of pancreatic
experiment, the animals were maintained for at least
insulin release, increase in peripheral insulin resistance
two weeks to get used to their new surroundings.
(IR), decrease in plasma insulin half-life and increase in

the expression of catecholamine receptors(4).
The rats were divided into two major groups:
Physiologically as well as anatomically, the
Group I (control): a total of 14 rats divided into two
pancreas' endocrine and exocrine systems are
groups of equal size.
interconnected. The pancreas' endocrine function can be
Subgroup Ia (negative control): were left without
compromised due to pathological abnormalities in the
intervention for two weeks.
exocrine tissue, and conversely insulin and glucagon
Subgroup Ib (vehicle L-T4): which received 1 ml of
hormones govern exocrine tissue (e.g., glucagon and
distilled water by oral gavage for two weeks.
somatostatin), so a deficiency of these hormones causes
Group II (induction of hyperthyroidism): in which 7

rats were hyperthyroid by daily oral gavage of L-T4

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312
Received: 27/8/2021
Accepted: 13/10/2021

Full Paper (vol.861 paper# 49)


c:\work\Jor\vol861_50 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 318-323

Cardiovascular Manifestations in Echocardiography in Patients
Recently Recovered From COVID-19 Infection
Lubna Abdalah Bensaeed, Islam Abd Elmoniem Elsherbiny,
Ahmed Shawky Shereef, Mohamed Mohsen Mohamed
Department of Cardiology, Faculty of Medicine, Zagazig University Hospital, Egypt
*Corresponding Author: Lubna Abdalah Bensaeed, Mail: lubnabensaeed1979@gmail.com

ABSTRACT
Background
: As a major source of morbidity and mortality, COVID-19 (coronavirus disease 2019) has developed.
In both COVID-19 and other pneumonias, high T/I troponin levels may indicate damage to the heart. Objective: ln
order to expand our understanding of COVID-19 cardiology effects, as well as provide insights into the features of
people who are more prone to cardiovascular diseases. Methods: At isolation hospital in Zagazig, and the isolation
hospital in Tripoli, Libya, 42 COVID-19 positive subjects were studied for their echocardiographic parameters, the
study was carried out from March 5th, 2021, to September 4th 2021. Results: Arrhythmias, myocardial infarctions,
valvular dysfunction, pulmonary hypertension, and right ventricular dysfunction (RVD) were found to have no
statistically significant association to the severity of COVID-19. Mean of left ventricular ejection fraction (LVEF)
was statistically lower among severe COVID-19 patients than moderate and mild cases but means of RV diameter
(mm) was statistically higher among severe COVID-19 patients than moderate and mild cases, mean of fractional area
change (FAC) was statistically lower in severe COVID-19 patients. Pulmonary hypertension was the second most
common echocardiographic finding (38% of patients). There was no statistically significant difference in pulmonary
hypertension across COVID-19 patients in relation to the severity (P=0.211).
Conclusion: Echocardiography can provide us with important information which can help in managing of patients
with COVID-19 while we must consider contamination risks as well as transmission of diseases.
Keywords: Coronavirus Disease, Echocardiography.

INTRODUCTION
As a major source of morbidity and mortality,
increased hemodynamic overload (9). One or two
COVID-19 (coronavirus disease 2019) has emerged as a
postmortem cases showed the presence of interstitial
substantial burden on healthcare systems around the
mononuclear inflammatory cells; this suggests the
world (1). After infecting a person's respiratory system,
underlying cause of cardiac inflammation (10). In
COVID-19 can progress to cause systemic illness. The
individuals with cardiogenic shock and COVID-19,
virus causes multi-organ dysfunction and failure, with
virus particles have been found in the heart and vascular
the lungs being the most afflicted and the cardiovascular
endothelium. There is, however, no data on how
system following it closely (2). SARS-CoV-2, the virus
common these cardiac issues are or how best to treat
that causes COVID-19, mostly affects the respiratory
them or allocate resources in the event that they occur.
system, however people who have a history of
Because of this, it is imperative that we better understand
cardiovascular illness or have high cardiac biomarkers
how COVID-19 and the heart interact (11). As a result of
are more vulnerable and have a worse prognosis (3).
the pandemic, non-invasive diagnostic cardiology
For now, we don't know what's going on behind
services have been restructured to emphasize bedside
these findings. Acute myocardial infarction has been
transthoracic echocardiography (TTE) (12).
reported as a possible side effect of COVID-19,
This study aimed to increase our knowledge of the
according to preliminary case reports (4), myocarditis, (5)
cardiac manifestations of COVID-19 in people who do
as well as takotsubo cardiomyopathy. Cardiac pathology
not have a history of cardiovascular disease and offer
can cause both acute left and right ventricular failure,
information on the features of persons who are more
with the latter also occurring as the result of an increase
likely to develop cardiovascular disease.
in the right ventricular afterload due to pneumonia or

pulmonary embolism (6).
PATIENTS AND METHODS
Chen et al. (7) and Varga et al. (8) Angiotensin-
At isolation hospital in Zagazig, and the isolation
converting enzyme 2 receptor-mediated systemic
hospital in Tripoli, Libya, 42 COVID-19 positive
endotheliitis
has
been
hypothesized
as
a
subjects were studied for their echocardiographic
pathophysiological mechanism of heart injury,
parameters. The study was carried out from March 5th
according to a study in the Journal of the American
2021 to September 4th 2021.
College of Cardiology. T/I troponins and natriuretic
Ethical considerations:
peptides may be high in both COVID-19 and other
As long as all participants signed informed consent
pneumonias, indicating damaged myocardium or
forms and submitted them to Zagazig and Tripoli

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318
Received: 27/8/2021
Accepted: 13/10/2021

Full Paper (vol.861 paper# 50)


c:\work\Jor\vol861_51 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 324-328

Evaluation of Serum Visfatin in Children and Adolescent with
Type1 Diabetes Mellitus
Nahed Mahmoud Khater1, Hadeel Mohammed Abd ELrahman1,
Randa Hussieny Mohammed2, Mahmoud Ali Elashery*2
Departments of 1Pediatrics and 2Biochemistry, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding Author: Mahmoud Ali Elashery, Mobile: (+20)01093002398, Email: mahmoudelasheery@gmail.com

ABSTRACT
Background:
Type 1 diabetes mellitus (T1DM) is a chronic illness characterized by the body's inability to produce
insulin due to the autoimmune destruction of the beta cells in the pancreas. Visfatin is a ubiquitous intracellular enzyme,
known as nicotine amide phosphoribosyl transferase (NAMPT) and pre-B-cell colony-enhancing factor (PBEF-1).
Objective: The aim of this study was to evaluate serum visfatin level in children and adolescent with type 1 diabetes
mellitus (T1DM).
Patients and methods: The present study was a case-control study observation that was conducted in Pediatric
Endocrinology Unit, Pediatric Ward, Zagazig University Hospitals. The study included 46 children; 23 with T1DM
and 23 healthy age- and sex- matched children.
Results: In this study, we found that serum visfatin level in diabetic group is statistically highly significant lower than
healthy group. The mean serum level of visfatin in healthy group was 19.53 ± 10.5 ng/ml, while in T1DM patients was
2.85 ± 2.09 ng/ml. The best cutoff of serum visfatin level in excluding T1DM was 3.6 ng/ml with area under curve
0.968 with sensitivity 91.3%, specificity 82.6%, positive predictive value 84%, negative predictive value 90.5%,
positive likelihood ratio 5.25, negative likelihood ratio 0.11 and accuracy 87% (p < 0.001). The result showed that
serum visfatin could be helpful in prediction of T1DM among children and adolescents with an accuracy 87%.
Conclusion:
Serum visfatin level is lower in T1DM patients compared to healthy control. Visfatin play a role in early
prediction and understanding the mechanism of its action in T1DM could lead to new therapeutic targets.
Keywords: Visfatin, Pediatric, Type1 Diabetes mellitus, Assessment.

INTRODUCTION

Type 1 diabetes mellitus (T1DM) is a chronic
reflecting excess body fat. The PBEF gene encodes a
illness characterized by the body's inability to produce
polypeptide of 491 amino acid residues. The secreted
insulin due to the autoimmune destruction of the beta
form of this polypeptide, i.e. visfatin, contains 465
cells in the pancreas (1). Internationally the rates of
residues and lacks the first 26 N-terminal residues of
T1DM are increasing. In Europe, Middle East, and
the PBEF gene product (5).
Australia. T1DM is increasing by 2-5% per year (2).
Recently, visfatin was isolated from visceral fat
T1DM is associated with a high morbidity and
deposits. Like insulin, visfatin exerts hypoglycemic
premature mortality. More than 60% of patients with
effects by interacting with the insulin receptor. The
T1DM do not develop serious complications over the
binding affinity of visfatin for the insulin receptor is
long-term, but many experience blindness, end-stage
similar to that of insulin, but it does not compete with
renal disease (ESRD), and, in some cases, early death.
insulin, suggesting that the two proteins interact with
The risk of ESRD and proliferative retinopathy is twice
different receptor sites (6). Visfatin, have an insulin-
as high in men as in women when the onset of diabetes
mimetic effects and lowers plasma glucose levels in
occurs before age 15 years (3).
mice via activating insulin receptor pathways (7).
Complications of T1DM include hypoglycemia
Visfatin binds to the insulin receptor at a site distinct
from management errors, increased risk of infections,
from insulin and stimulates phosphorylation of the
microvascular
complications
(retinopathy
and
insulin receptor, insulin receptor substrate 1 and 2
nephropathy),
neuropathic
complications
and
(IRS-1 and IRS-2), and the binding of
macrovascular disease (3).
phosphatidylinositol-3-kinase to IRS-1 and IRS-2 (8).
Adipose tissue secretes numerous bioactive
The aim of this study was to evaluate serum
peptides called `adipokines'. Visfatin is a ubiquitous
visfatin level in children and adolescents with Type 1
intracellular enzyme, known as nicotine amide
diabetes mellitus (T1DM).
phosphoribosyl transferase (NAMPT) and pre-B-cell

colony-enhancing factor (PBEF-1). It is also identified
PATIENTS AND METHODS
as a novel adipocytokine (4). Although the metabolic
This study is a case-control study. It was
function of visfatin is still unknown, it appears that this
conducted at the Pediatric Endocrinology Unit,
newly identified adipocytokine might play an
Pediatric Ward, Zagazig University Hospitals through
important role, similar to that of leptin, in the
the period from March 2019 to March 2020.
regulation of body weight, i.e. as an afferent signal

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324
Received: 22/08/2021
Accepted: 18/10/2021

Full Paper (vol.861 paper# 51)


c:\work\Jor\vol861_52 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 329-335

Predictors of Contractile Recovery After Successful Primary
Percutaneous Coronary Intervention
Mohamed Ibraheem M Al Awady, Hisham Samir Roshdy,
Mohammad Gouda Mohammad, Mohamed Mostafa Mohamed Ibrahim*
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Mohamed Mostafa Mohamed Ibrahim, Mobile: 01001679356,
Email: j_mmm_2007@yahoo.co.uk

ABSTRACT
Background:
Accurate diagnosis, characterization, and quantification of myocardial infarction (MI) are essential
to assess the impact of therapy and to aid in predicting prognosis of patients with ischaemic heart disease.
Objective: This study aimed to define different parameters regarding prediction of myocardial functional recovery
following successful reperfusion of acute ST segment elevation myocardial infarction (STEMI).
Patients and methods: This prospective study was carried out in Zagazig University and National Heart Institute (NHI)
of Egypt during the period from June 2020 to June 2021. The study included 48 patients admitted with first acute
STEMI. All patients were subjected to demographic data taking, electrocardiography and echocardiography
examination (two examinations were done, the first was immediately after reperfusion and the second was 3 months
from primary percutaneous coronary intervention (PCI).
Results: There was no statistically significant difference between demographic data and risk factors except smoking
habit. Regarding laboratory findings there were significant lower troponin value, peak CKMB value compared to
patients had remolding (p=0.0001, p=0.027 respectively). Regarding ECG parameters, there was no statistical
significant difference between the study groups regarding sum ST elevation and MI territory (p value > 0.05), but
there was highly statistically significant difference between the study groups regarding 90 min ST resolution among
contractile recovery (group I) p=0.0001.
Conclusions: In this study patients affected by AMI with ST segment elevation and treated by primary PCI showed
contractile recovery in 60.4% of the patients, while the remodeling of the LV has been observed in 39.6%.
Keywords: ST-segment elevation myocardial infarction (STEMI), Myocardial infarction, ECG, CHD.

INTRODUCTION
necrosis plays a central role in the prediction of
Coronary heart disease (CHD) is a major cause
prognosis (9).
of death and disability in developed countries.
A successful restoration of epicardial coronary
Although CHD mortality rates worldwide have
artery blood flow after primary percutaneous
declined over the past four decades, CHD remains
coronary intervention (PPCI) for ST-segment
responsible for about one-third or more of all deaths
elevation myocardial infarction (STEMI) does not
in individuals over age 35(1).
always lead to adequate myocardial perfusion or
Acute myocardial infarction (AMI) is a leading
optimal outcome. Prior studies have shown that
cause of morbidity and mortality in the world (2).
microvascular obstruction (MVO) is present in up to
Reperfusion strategies are the current standard
50% of patients with STEMI even after timely
therapy
for
AMI
(3). Accurate
diagnosis,
reperfusion by PPCI and independently associated
characterization, and quantification of myocardial
with ventricular remodeling and adverse clinical
infarction (MI) are essential to assess the impact of
outcomes (10).
therapy and to aid in predicting prognosis of patients
Measurement of myocardial deformation by
with ischaemic heart disease. After MI, the alteration
strain has emerged as a promising tool to evaluate
of global and regional LV function and the presence
normal and ischemic myocardium in order to evaluate
of myocardial viability depend on both infarct size
regional and LV global function. Strain determines
(IS) and transmural extension of necrosis (4). Clinical
regional myocardial function and can be measured by
outcomes after an acute myocardial infarction (AMI)
Doppler or speckle tracking (11). Global longitudinal
are determined by the initial morphological and
strain (GLS) is considered an effective parameter for
functional alterations resulting from myocardial
quantifying left-ventricular function (12) more
necrosis (5). Infarct size is a major determinant of
sensitive
than
LVEF
assessed
by
2D
mortality, Pislaru et al. (6) and Reffelmann et al. (7)
echocardiography and their role in large MI has been
and transmural infarcts are associated with a worse
previously reported (13). Two-dimensional speckle-
prognosis and more adverse cardiac events (8).
tracking echocardiography (2DSTE) is emerging as a
Therefore, accurate assessment of IS and the
novel technique to allow the assessment of LV
identification of segments with transmural extent of
systolic and diastolic function through the

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329
Received: 23/8/2021
Accepted: 18/10/2021

Full Paper (vol.861 paper# 52)


Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 336-341

Assessment of Early Outcomes of Surgical Treatment of Comminuted
Fracture Calcaneus through Trans Calcaneal Approach
Mohsen Mohamed Abdo Mar'e'I , Reda Hussien Elka, Mohamed Abdelazeez Aly, Ziyad Ibrahim Ali*
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Ziyad Ibrahim Ali, Email: drziadrabti85@gmail.com

ABSTRACT
Background
: Treatment options for displaced intra-articular calcaneal fractures are still up for debate. The gold
standard treatment for intra-articular calcaneal fractures is the conventional extensile lateral approach (ELA).
Objective: achievement of good reduction with stable support for intra-articular calcaneal fractures by using trans
calcaneal approach aiming for better functional outcome. Methods On the basis of a prospective cohort research,
at Zagazig University Hospital Orthopedic Department we recruited 18 patients with comminuted fractures in the
calcaneus who had been admitted to the hospital with intra-articular fractures, Extensive lateral approach and T-
plate fixation were used to treat this condition 3 and 6 months after surgery, the American Orthopedic Foot And
Ankle Society's functional assessment was performed. Results: All patients eventually achieved full union by the
end of follow-up. Only one patient had delayed union. Most of patients (55.56%) had good outcome according to
AOFAS score. 11.11% had excellent outcome. While about one third of patients had unsatisfactory outcome, either
fair (27.77%) or poor (5.56) AOFAS score. In regard to complications, most of the studied group (61.11%) didn't
have any complications, three patients had surgical site infection, and 11.11% of patients had sural neuritis.
Conclusion: The trans-calcaneal method of reduction through ELA is an excellent method for treatment of
displaced intra-articular calcaneal fractures, as it provides good exposure and facilitates anatomical reduction of
fracture.
Keywords: Calcaneal fractures, Extensile lateral approach (ELA).

INTRODUCTION

Many surgical procedures have been developed
There are seven tarsal bones in all, the largest of
in an effort to minimize these consequences, such as
which being the calcaneus. Stand, walk, and run are all
the limited lateral approach: (plantar, ollier, and sinus
possible because of its connection to the Achilles
tarsi). Smaller, less invasive incisions minimize soft
tendon. Correct gait relies on the normal development
tissue dissection and allow better vision and control of
of the subtalar and mid-tarsal joints (1). In addition to
the articular reduction (6). A good stable fixation is
supporting the weight of the body, the calcaneus serves
needed for better outcomes and results when dealing
as a lever for the calf muscles, allowing them to exert
with intra-articular fractures. Minimally invasive
more effort. On lateral radiography, the anatomy is
surgical procedures have a limited surgical field of
depicted from two distinct perspectives. It is clear that
view, which makes it difficult to achieve a satisfying
Bohler's angle has the most significant impact on
closure reduction (7).
walking dynamics. The angle of Gissane is the second
We aimed at this study for achievement of good
one (2).
reduction with stable support for intra-articular
About 2% of all fractures and 60% of all tarsal
calcaneal fractures by utilization of trans calcaneal
injuries are caused by calcaneus fractures. Using the
technique aiming for better functional outcome.
Sander's approach to describe intra-articular fractures

of the calcaneus is the most usual method (3). Treatment
PATIENTS AND METHODS
options for displaced intra-articular calcaneal fractures
At Orthopedic Department, Zagazig University
are still up for debate. In recent years, the classic lateral
Hospital, Egypt. This research included 18 patients
approach to intra-articular calcaneal fractures has been
with complaining intra-articular calcaneal fractures,
regarded as the gold standard way of treatment (4).
treated through extensile lateral approach, and fixed by
Using this technique, the sural nerve is more
T-plate.
protected and the posterior facet fragment and lateral

wall can be reduced directly. However, orthopedic
Ethical considerations:
specialists are concerned about the high rate of wound
As long as all participants signed informed
complications. Some patients who undergo open
consent forms and submitted them to Zagazig
reduction and internal fixation via the extensile lateral
University's Research Ethics Committee, the study
approach are at risk of developing superficial wound
was allowed (ZU-IRB#6280). We followed the
edge necrosis, which is accompanied by a number of
World Medical Association's ethical code for
other complications, including peroneal tendonitis,
human experimentation, the Helsinki Declaration.
sural nerve injury, vascularization injury, infections,

and amputations (5).
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336
Received: 28/08/2021
Accepted: 16/10/2021

Full Paper (vol.861 paper# 53)


c:\work\Jor\vol861_54 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 342-349

Dexmedetomidine As an Adjuvant to Bupivacaine in Ultrasound Fascia Iliaca
Compartment Block in Proximal End Femur Surgeries
Hazem El-Sayed Moawad*, Abdel-Aziz A. Motawea, Ibrahim M. Elnemr, Mohamed A. Elmorshedi
Department of Anesthesia and Surgical Intensive Care, Faculty of medicine - Mansoura University
*Corresponding author: Hazem El Sayed Moawad Weheba, Mobile: +201121516041 (+20) 01012805817,
E-Mail: hazemmoawad@yahoo.com - hazemsayed@mans.edu.eg

ABSTRACT
Background:
Fracture neck femur is a common cause of hospital admission among the elderly population. Many
patients admitted with fracture femur have long-standing cardiac, hepatic or renal problems. This makes a challenge to
balance adequate analgesia with side effects of opioids. Fascia iliaca compartment block (FICB) is one of the peripheral
nerve block techniques. It became widely used in providing postoperative analgesia for patient with fracture neck femur
either in emergency department or in the operating room.
Objective: To evaluate the efficacy of addition of dexmedetomidine to bupivacaine on the duration and quality of
postoperative analgesia in ultrasound guided fascia iliaca compartment block in proximal end femur surgeries.
Patients and methods: Sixty patients with American Society of Anesthesiologists (ASA) physical status I - II of both
sexes aged from 20-60 years scheduled for proximal end femur surgeries. They were randomly assigned to one of two
equal groups (n=30 each), using closed envelope technique: Bupivacaine group (B group), and Bupivacaine +
dexmedetomidine (BD group). Result: Our study demonstrated prolongation of postoperative analgesia in
bupivacaine-dexmedetomidine group (BD) compared to bupivacaine group (B). It showed statistically significant
reduction in cumulative pethidine doses and prolongation in the time till first rescue analgesic is required in the BD
group in comparison with the B group in the first 24 hours. Hemodynamic changes and incidence of side effects, were
statistically insignificant among the two groups. Conclusion: Addition of dexmedetomidine, as an adjuvant to the local
anesthetic bupivacaine, in ultrasound fascia iliaca compartment block provides prolongation of the duration of
postoperative analgesia with less opioid consumption without remarkable side effects.
Keywords:
Dexmedetomidine, Bupivacaine, Ultrasound-guided fascia iliaca, Proximal end femur surgeries.

INTRODUCTION
evidence that peripheral nerve blocks performed by
Lower extremities fractures are common
ultrasound guidance are superior in terms of improved
injuries, which are associated with severe pain (1).
sensory and motor block, reduced need for analgesic
Positioning for neuraxial blocks is always a challenge,
supplements with fewer minor complications (7). The
because even slight overriding of the fracture ends is
use of ultrasound to perform the fascia iliaca block was
intensely painful. Hence, prior to neuraxial blockade,
found to be superior when compared with the
analgesia is provided by conventional modes of pain
traditional approach using, loss-of- resistance to
relief like non-steroidal anti-inflammatory drugs
identify the correct plane, but still requires high
(NSAIDs), opioids and also by peripheral nerve blocks
volumes of local anesthetic (8).
such as, femoral nerve block, and fascia iliaca
Many additives to local anesthetics such as
compartment block (FICB) (2).
opioids, clonidine, neostigmine and tramadol have
Significant postoperative pain and other
been used to increase the duration of the block,
morbidities almost always complicate orthopedic
improve postoperative pain management and avoid the
surgeries. Despite the publication of multiple clinical
need for placing catheter for continuous local
practice guidelines for pain management throughout
anesthetic drug infusion (9).
the last decade, effective analgesia remains a
Dexmedetomidine is currently in focus for its
significant health care concern (3). Regional anesthesia
sedative, anxiolytic and analgesic properties. Pre- and
is now proved as the best modality used by the
intra-operative
intravenous
dexmedetomidine
anesthesiologists to face postoperative pain. It
administration has shown to prolong the duration of
improves surgical outcome, reduces blood loss and
sensory block with local anesthetics during peripheral
furthermore reduces the postoperative morbidity (4).
nerve blocks (10). Many recent studies have suggested
Regional nerve blocks have increased popularity in the
that the addition of dexmedetomidine as adjuvant to
last few years with acceptance from both the surgeon
local anesthetics shortens the sensory and motor block
and patient (5).
onset time, prolongs both sensory and motor block
(FICB) is an anterior approach to the lumbar
duration (11). It also significantly delays the first
plexus and was first described in 1989 and performed
demand for analgesic supplementation, decreases 24 h
initially on children and later on adults. It was mainly
analgesic consumption and is not associated with any
used to provide analgesia following surgical
major side-effect (12).
procedures in the hip, femur and knee (6). There is
The aim of this study was to evaluate the
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distributed under the terms and conditions of the Creative



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342

Received: 23/08/2021
Accepted: 19/10/2021

Full Paper (vol.861 paper# 54)


c:\work\Jor\vol861_55 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 350-357

Comparison between Autologous Serum Eye Drops and
Punctal Occlusion for Treatment of Dry Eye Syndrome
Ahmed N Elsayed
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt

ABSTRACT
Background:
Dried cornea condition characterized with mispreception regarding eye coat because of slit insufficiency
otherwise unreasonable vanishing that makes harm to dried surfaces also visual shell which related to manifestations
regarding visual inconvenience.
Purpose: Comparing efficiency and safety of AS eye drops and Punctal occlusion for management of dry eye syndrome.
Patients and Methods: A prospective study was conducted in, (Al-Hussein and Bab-Elsheryia hospitals), a sum of 40 eyes
of 40 patients suffering from Dry eye (24 males, 16 females) were recruited in this study. The first group contain 20 eyes
that undergo AS eye drops. The 2nd group contain 20 eyes that undergo Punctal occlusion.
Results: The visual acuity in the first group before treatment was 3.5/9.3 ± 1.91/9.2 (mean ± standard deviation) and after
treatment in the second visit was 5.25/10 ± 3.75/10 (P < 0.01) with standard improvement 2 Snellen lines. In the second
group visual acuity before treatment was 2.85/9.1 ± 2.04/9.2 and after treatment in the second visit was 4.65/9.2 ± 4.37/10,
the normal increase is 3 visual letters. The VA become better in both groups
Conclusion: In summary, both two methods of management have similar efficiency in reducing discomfortable sensation
in dry eyes, and almost have equivalent and improve in subjective symptoms. Punctual occlusion shows many benefits in
conserving natural tears and enhancing tear quality and seemed to be better on tear film stabilization. AS eye drops and
punctual occlusion improved BCVA
Keywords: Dry eye syndrome, Autologous serum eye drops, Punctal occlusion, Silicon plugs.

INTRODUCTION
optical assurance, plugging is useful to lessen split waste,
Dried cornea condition characterized by means of
also against inflammatory
confusion regarding eye coat because of slit insufficiency
decreasing supportive of fiery physiology of dry eye
otherwise unreasonable vanishing that makes harm to
auxiliary regarding different components. dysfunctional
dried surfaces also visual shell which related to
tear syndrome is regularly partitioned into 2 kinds:
manifestations regarding visual inconvenience (1).
lacking slit creation or evaporation. Inadequacy also tear
All studies proved occurrence regarding dried
creation additionally partitioned as 2 additional classes:
cornea increased over time, that it is more pervasive in
dry eye disorder as immune system malady otherwise
women than in men as of late, reclassified dried cornea "
addition dry eye condition (6, 7).
multiple factor sickness regarding slit, visual shell shows
Content regarding blood looks like a precorneal
outcomes regarding side effects, (counting unfamiliar eye
film; all focuses were identical to special cases
feel dehydration otherwise bothering, consuming, bright
considering blood has nutrients. chemical changing
affectability, hotness), optical aggravation, discharge
development nutrient than is found regarding blood.
crust over lashes, unsteadiness due to expected injury
Given that huge numbers of the basic parts are available
regarding visual coat (2, 3).
with slit, utilization support of visual surface appears to
The condition has been related to age, sex,
be doable essentially dry eye. (8).
Sjögren's disorder, joint inflammation, also expanded
The basis regarding utilization for AS serum
naturality regarding its component, irritation to visual
emerges transfer solid closeness toward serum, where it
coat expanded tear naturality, lead to visual coat
includes development aspect, nutrients, parts give
aggravation, which is believed that cause focal
important healthful elements for keeping up cells also
component of dysfunctional tear syndrome. Precorneal
diminish danger regarding defilement disease fix
slit assumes a basic function in shaping an efficient
measures. Truth be told, person tears include factors, for
standard visual surface. Also, a Precarious slit affects
example, epithelium development factor, given new
optical surfaces. Hypothetically, management adding to
nutrients and high movement and useful impacts (9, 10).
the dry eye may viably increase practical BCVA for
Management with AS suggested to patients with
dysfunctional tear syndrome (4, 5). Management of dry eye
a few visual surfaces unsettling influences, lack,
around 3 principle draws near ­ fake oil, wetting and
inadequacy related illness, persevering imperfections,
predominant, and postoperative dry eye incited.




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350
Received: 23/8/2021
Accepted: 18/10/2021

Full Paper (vol.861 paper# 55)


c:\work\Jor\vol861_56 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 358-361

Exposure of Femoral Vessels Through Transverse Inguinal
Crease versus Vertical Incision
Hany Abd El-Momen Abd El-Fattah*
* Vascular Surgery Department - Al-Azhar University, Cairo, Egypt
Corresponding author: Hany Abd El-momen Abd El-fattah,
E-Mail: Hadydayman@gmail.com, Phone: (+02)-01002767339

ABSTRACT
Background:
Traditional vertical wound in the femoral triangle carries high risk of more lymphatic affection and
complication. So, alternative transverse inguinal crease incision (TICI) is used to avoid such complications.
Aim: to compare the transverse inguinal crease incision with the traditional vertical one (VII) during exposure of femoral
vessels for any vascular purpose.
Patients and methods: a comparative study was done. 80 groin incisions (40 for transverse and 40 for vertical incisions
for femoral vessel exposure) in SAYED GALAL and ALHUSSIEN University Hospitals from January 2019 to January
2021.
Results: Wound infection rate was 12.6% in VII group compared to 6.3% in TICI group. 13% seroma were observed
in VII group; while in TICI group, only 6 (7.5%) seroma were observed. Nine hematomas were observed in VII group
(11%) compared to 7.5% in TICI group. Graft occlusion was 7.5% in VII which was higher than TICI that was 5% (4
cases). 7.5% suffered from paresthesia in VII group compared to no case of paresthesia in TICI group. The duration of
postoperative stay after VII surgery was relatively longer than that following TICI group which were 14 day compared
to 9 days respectively.
Conclusion: The TICI is a good maneuver for exposure of the femoral vessels used for all supra- and infra-inguinal
procedures except when the wound extension is expected. TICI has decreased complications rate and shortened hospital
stay compared to VII.
Key words: Vascular, Exposure, Femoral, Incision.

INTRODUCTION

written consent was taken from each participant in the
Decreasing the rate of wound infection in
study. This work has been carried out in accordance
surgical vascular wound is the corner stone. The use of
with The Code of Ethics of the World Medical
traditional vertical wound in the femoral triangle carries
Association (Declaration of Helsinki) for studies
high risk of more lymphatic affection and complications
involving humans.
such as edema, seroma and infection leading to wound

dehiscence, graft exposure and rupture of the
Surgical procedure:
anastomosis (1, 2).
Patients included in this study underwent any
So, alternative transvers inguinal crease
vascular infrainguinal surgery, bypass, repair or even
incision is used to avoid such complications (3).
profundoplasty for occlusive diseases or arteriovenous
The aim of this work is to compare the new
fistula for dialysis. Also, aorto-bifemoral, aorto-
transverse inguinal crease incision (TICI) versus the
monofemoral, iliofemoral or even inguinal incision
traditional vertical one during exposure of femoral
used for endovascular aortic aneurysm repair (EVAR).
vessels for any purpose. This comparison included

many points such as wound infection, seroma
Exclusion criteria:
formation, hematoma, wound paresthesia, length of
Patients were excluded if they had undergone
hospital stay and graft patency.
previous groin incision, if the profound vessels are too

high or too low and its exposure is necessary in the
PATIENTS AND METHODS
operation, immunocompromised patient and in patients
A 2-year comparative study was done on groin
or if the wound extension may be needed. 80 incisions
incision for vascular reconstructive surgery on 60
in 60 patients in whom femoral vessels were required
patients with 80 groin incisions (40 for transverse and
for different vascular procedures (Table 1).
40 for vertical incisions) in SAYED GALAL and
Two MD licensed surgeons performed the
ALHUSSIEN University Hospital from January 2019 to
transverse inguinal crease incision (TICI) and vertical
January 2021.
inguinal incisions (VII), respectively (Figure 1).
Ethical approval: The study was approved by the
Ethics Board of Al-Azhar University and an informed




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358
Received:24 /8 /2021
Accepted:20 /10 /2021

Full Paper (vol.861 paper# 56)


c:\work\Jor\vol861_57 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 362-365

Effect of Intraoperative Wound Irrigation with Topical Phenytoin on
Postoperative Seroma Formation after Modified Radical Mastectomy
Salah Mansour Abdel-Aal, Mohamed Ibrahim Abdelhamid Elsayed,
Mohamed Mohamed Abdelsalam*, Loay Mohamed Elhady Gertallah
Department of General Surgery, Faculty of Medicine, Zagazig University Hospitals, Zagazig, Egypt
*Corresponding author: Mohamed Mohamed Abdelsalam, Mobile: (+20)01000682578,
E-mail: docmohammed19921992@gmail.com

ABSTRACT
Background:
Modified radical mastectomy (MRM), as a surgical treatment in breast cancer patients, may lead to
important complications with significant morbidities including seroma formation. Objective: This study aimed to
determine the effect of wound irrigation with topical phenytoin on postoperative seroma formation after modified radical
mastectomy.
Patients and methods:
This is a double-blinded randomized clinical trial study, which was carried out in Zagazig
University Hospital during a period of 6 months. It included 60 patients who were candidates for modified radical
mastectomy (MRM). All patients were subjected to demographic data taking, clinical and chemical examination, clinical
evaluation, radiological evaluation, Lab. Investigations.
Results: Average daily breast drainage (in milliliters) of drains according to their location and day of evaluation: Group
A (Phenytoin) in day 5 drained a mean of 24.62 with SD of 32.79, in day 7 mean of drainage was 28.89 and SD was
18.33, in days 8 to 10 mean of drainage was 32 and SD was 10.95, and in days 11 to 13 mean of drainage was 15 and
SD was 7.07. Group B (Control): day 5 group drained a mean of 35.88 with SD of 12.93, in day 7 mean of drainage was
28.18 and SD was 12.68, in days 8 to 10 mean of drainage was 21.43 and SD was 11.07, in days 11 to 13 only one
patient in control group had breast drain after 11th postoperative day drainage was 50 and in days 14 to 16 drainage was
20. Conclusion: Topical irrigation of the surgery site with phenytoin was effective in reducing axillary surgical wound
drainage.
Keywords: Breast surgery, MRM, Seroma.

INTRODUCTION

Modified radical mastectomy (MRM) is defined as
widely used and has been shown to have considerable
complete removal of the breast and the underlying
effects on reducing seroma formation(8,9).
fascia along with the removal of level I and II axillary
Other methods like using fibrin glue, topical
lymph nodes. Although this procedure has been
phenytoin, and quilting sutures have been applied to
replaced by conservative breast surgery in most patients
reduce seroma formation, as well. The efficacy of these
with early stage breast cancer, it is still the treatment of
methods is controversial and yet must be
choice in patients diagnosed with more advanced
determined(10,11).
disease. In contrast to its therapeutic benefits, MRM
The effect of phenytoin on wound healing has been
may lead to important complications with significant
investigated in several studies and evidence suggests
morbidities. Lymphedema and compromised range of
that phenytoin can accelerate the healing process(12,13).
motion of the shoulder are known complications that
In this study, we used topical phenytoin during the
can be quite troublesome(1,2).
MRM procedure to evaluate its impact on breast and
Seroma formation is the most common
axillary wound drainage and seroma formation.
complication after breast cancer surgery. Seroma

formation is a relatively common complication in
PATIENTS AND METHODS
MRM, which may occur on early postoperative days. It
This study is a double-blinded randomized clinical
is probably secondary to the disruption of lymphatic
trial carried out at the General Surgery outpatient clinic
vessels during surgery that leads to the accumulation of
of Zagazig University Hospital during a period of 6
lymphatic fluid beneath the skin(3,4).
months.
It may cause patient discomfort, requires repeated

aspirations, and is a potential source of wound infection,
Sample size:
as well(5) .
Assuming the total number that met the inclusion
The incidence of seroma has been reported to vary
and exclusion criteria would be included in the study.
from 15 to 55 percent in different studies(6,7).
During the study period (6 months), 10 cases/ month,
Adopting measures to prevent seroma formation
60 cases (30 cases in each group) were included as a
helps to reduce morbidity and improve postoperative
comprehensive sample.
wellbeing of the patients. Placing drains in the axilla is





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362
Received: 20/8/2021
Accepted: 16/10/2021

Full Paper (vol.861 paper# 57)


Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 366-371

Value of Dimeglio Scoring System During Ponseti Correction of
Congenital Talipes Equinovarus Deformity
Khaled Edris Abdelrahman, Ahmed Mohammed Abdelwahab,
Ahmed Muftah Abdullah Alfallah*, Yamen Safwat Abdadayem
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Muftah Abdullah Alfallah, Email: ahmedalfallah2019@gmail.com

ABSTRACT
Background
: When it comes to assessing the severity of an isolated clubfoot deformity and its response to therapy,
the Dimeglio scoring system is universally accepted.
Objective: The aim of the current work was to increase the knowledge about application of dimeglio scoring system
during Ponseti correction of clubfoot.
Patients and Methods: On the basis of a Randomized clinical research, at Zagazig University Hospital Orthopedic
Department, and Alhawary general hospital, Benghazi, Libya, we recruited 12 patients aged lower than 1 year
having idiopathic clubfoot treated using ponseti technique in duration from January 2021 to October 2021.
Results: There was a statistically significant decreases in Demiglio score among cases did not need tenotomy
compared to cases needed it at all times of follow up. Also, there was a statistically significant decrease in score
when comparing 1st & last read in cases needed tenotomy by 89.03% and in cases did not need by 94.26 percent.
The different readings of Demiglio score had accuracy 100%, 100%. 91%, 83.3% & 100% respectively in prediction
of not needing tenotomy among the studied cases.
Conclusion: It could be concluded that in terms of dependability, the Dimeglio scoring system is clinically relevant
and may be simply used in clinical practice. The Dimeglio score is practical, easy to use, and applicable in children
also above the age of 1.5 years old.
Keywords: Ponseti Correction, Congenital Talipes Equinovarus, Dimeglio Scoring

INTRODUCTION
For the treatment of clubfoot, the Ponseti method
As one of the most prevalent skeletal deformities,
has been found to be the most effective; this includes
Idiopathic Congenital Talipes Equinovarus (clubfoot) is
manipulation, serial casting, and bracing (7).
one of the most frequent congenital skeletal deformities.
The aim of the current work was to increase the
It occurs in one to two out of every thousand live births.
knowledge about application of dimeglio scoring system
The male-to-female ratio is two to one (1).
during Ponseti correction of clubfoot.
Idiopathic clubfoot is a mystery. The precise

causes of the clubfoot are still matter of debate. Main
SUBJECTS AND METHODS
pathological changes include that talar neck is medially
This randomized clinical trial study included a total
and plantarly deviated, and the talar body is laterally
of 12 patients with idiopathic clubfoot managed with
rotated, calcaneus is in varus and rotated medially
ponseti technique, attending at Orthopedic Department,
around talus (2).
Zagazig University Hospital, Egypt, as well as Al-
Myelodysplastic syndromes, arthrogryposis, and
Hawari General Hospital, Benghazi, Libya. This study
various congenital abnormalities can all cause talipes
was conducted between January 2021 to October 2021.
equinovarus deformity, however it is more usually an

isolated birth defect and is believed to be idiopathic (3).
Ethical Consideration:
In order to assess a patient's condition before to
When all participants' parents completed
treatment and monitor treatment progress, severity
informed permission papers and submitted them to
classification is critical. Pirani and Dimeglio scoring
the research ethics committee at Zagazig University
systems are two classifications that can be easily
and Alhawary General Hospital, the study was
employed in clinical practice (4).
permitted (ZU-IRB#6689). Ethics guidelines for
One of the most frequently acknowledged scoring
human experimentation were adhered to in
systems for assessing the severity of an isolated clubfoot
accordance with the Helsinki Declaration of the
deformity and monitoring treatment progress is the
World Medical Association.
Dimeglio scoring system (5).

The management of clubfoot deformity has been
The Ponseti procedure was used to treat idiopathic
changed in the last two decades from surgical correction
clubfoot in children younger than one year of age.
(posteromedial soft tissue release) to the non-surgical

Ponseti method (6).
Exclusion Criteria: Ponseti-corrected patients who had
previously undergone surgery, residual talipes-
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366
Received: 03/09/2021
Accepted: 19/10/2021

Full Paper (vol.861 paper# 58)


Treatment of Comminuted Distal Radius Fractures Using Spanning External Fixator The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 372-378

Treatment of Comminuted Distal Radius Fractures Using
Spanning External Fixator
Abdelsalam Eid Abdelsala, Osam Mohammed Metwally,
Salah Mahmoud Abd El Kader, Emad Mohammed Ali Alfirjani*
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Emad Mohammed Ali Alfirjani, Mobile : (+20)1564499509, Email: a981988157716@gmail.com

ABSTRACT
Background:
Distal radius fractures are common orthopedic injuries with a bimodal age distribution, affecting young
patients following high-energy trauma and elderly patients with osteoporotic bone following low-energy falls.
Objectives: The aim of the study was to understand the advantages and disadvantages of spanning external fixation
technique for treatment of comminuted distal radius fractures.
Patients and methods: This Prospective Cohort study was conducted in Orthopedic Surgery Department, Zagazig
University Hospitals, Egypt on twenty-four patients with comminuted distal radius fractures treated by spanning
External Fixator, during the period from January 2021 to December 2021.
Result:
All patients achieved the full union; only 2 patients had delayed union beyond the 3 months. According to
MMWS, 50% of patients had excellent outcome, 29.2% had good, while fair and poor outcome occurred in 12.5% &
8.3% respectively. Regarding the Complications, ten patients developed complications, most of them were minor
complications, while 2 patients developed Delayed union and one patient had DRUJ instability.
Conclusion: It could be concluded that spanning external fixation is a good option for treatment of intra-articular
DRF. The good outcomes achieved in this study suggest that use of the Spanning external fixators could be an
alternative treatment method for intra articular distal radius fractures, as it is easier, need less operation time, decrease
amount of blood loss and decrease risk of infection in comparison with spanning bridging plate or locked distal radius
plates. All DRFs achieved good results; Functional outcomes were promising, including wide wrist ROM and no mal
or non-union occurred.
Keywords: Distal Radius, Intra-articular, External fixator

INTRODUCTION

compartment syndrome, missed associated injury, loss
Distal radius fractures tend to occur in bimodal
of reduction, tendon rupture and infection (4).
age distribution, in young age due to high-energy
The aim of the currents study was to
trauma, and low to moderate energy trauma in old age
understand the advantages and disadvantages of
patients secondary to osteoporosis (1).
spanning external fixation technique for treatment of
There are many types of classification systems
comminuted distal radius fractures.
describing distal radius fracture (Fernandez, Frykman,

Melon and AO classifications ...etc.). The AO
PATIENTS AND METHODS
classification divides distal radius fractures into 3
This prospective Cohort study included a total of on
broad groups that can divided into 27 distinct fracture
twenty-four patients with comminuted distal radius
patterns. Type A describes an extra-articular fracture,
fractures treated by spanning External Fixator,
type B involves a partial disruption of the articular
attending at Orthopedic Surgery Department,, Zagazig
surface, and type C represents a complete disruption of
University Hospitals, Egypt. This study was
the articular fragments from the shaft (2).
conducted between January 2021 to December 2021.
The surgical indications for distal radius

fractures generally include displaced or unstable
The mean age was 43.9±11.6 years, ranged from 27 to
fracture patterns. Several fracture fixation constructs
69 years. Males were affected more than females. Most
are available, with external fixation (Ex. Fix.) being a
of patients injured due to RTA (41.7%)
common and proven technique. The technique

involves a closed reduction, or limited open reduction,
Ethical Consideration:
with ligamentotaxis and application of an Ex. Fix.
Written informed consent was obtained from
Frame to the radius proximally and the second
all patients and the study was approved by the
metacarpal distally thereby spanning the fracture and
research ethical committee of Faculty of Medicine,
wrist joint (3).
Zagazig University (International review board:
The complications after distal radius fractures
IRB#). The study was done according to The Code
occur for many reasons and often vary depending on
of Ethics of the World Medical Association
the method of treatment. The nerve injury is relatively
(Declaration of Helsinki) for studies involving
common and the mostly median nerve injury,
humans.




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372

Received:23 /8 /2021
Accepted:19 /10 /2021

Full Paper (vol.861 paper# 59)


c:\work\Jor\vol861_60 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 379-383
Evaluation of Surgical Procedures in Emergency Cases during
Pandemic of Covid 19
Marwan Mansour Borham
Departments of General Surgery, Faculty of Medicine, Al-Azhar University, Egypt
Corresponding author: Marwan Mansour Borham, Mobile: (+20) 01090480337, E-Mail: marwanborham74@gmail.com

ABSTRACT

Background: Covid 19 is worldwide problem defined as infection caused by corona virus. World Health
Organization defined it as a pandemic disease that can be controlled. It is public health problem. The regimen and
ways of management of surgical patient changed after epidemic attack of Covid 19
Objective: To evaluate the procedures, infection control and follow up in emergency patient during attack of Covid
19.
Patient and methods: Cross sectional study done on 35 patient selected in emergency room in Al-Hussain University
Hospital during the period from the 1st May to 1st August, done on emergency cases only and elective cases were
excluded during attack of Covid 19.
Results: Total number of 35 patient, through them 28 patient (80%) were discharged without complication, 10 patient
(28.6%) of them were admitted to ICU, 13 patient (37.1%) has postoperative morbidity, 3 patient (8.6%) died from
postoperative complication. 3 patient were postoperatively Covid 19 positive, all discharged patient were negative for
Covid 19 and no positive cases were found during follow up.
Conclusion: This study was done on the surgical patient in the hospital not on positive patient for Covid 19 and it
described the best way to treatment and isolation of the surgical patient during attack of Covid 19. Patient were
successfully managed and discharged with follow up for 14 days negative result of Covid 19.
Keywords: Covid 19, Emergency cases, General surgery, Health service, Recommendation and Pandemic

INTRODUCTION

than usual, in time of Covid 19 crises during the
First case of Covid 19 was discovered in Wuhan
epidemic attack. Absence of previous history of Covid
city in China in December 2019 as outbreak of
epidemic turn the deal with surgical cases very
pneumonia of unknown cause(1). In January 2020 the
difficult and strict, shortage of literature about Covid
Chines government discovered the cause of
19 before made plane for response also difficult(8, 9).
pneumonia, which was corona virus (sars-cov-2)(2). In
Covid 19 has changed some protocols inside the
February 2020, the World Health Organization named
operating theater. The virus was detected in blood,
the outbreak of disease corona virus disease or Covid
saliva and peritoneal fluid in patient underwent
19(3). In March, World Health Organization declared
laparotomy(10). There was also asymptomatic carrier
that outbreak of corona Covid 19 virus is pandemic(4).
reported during the time of epidemic surgery. Uses of
Covid 19 is worldwide problem defined as
diathermy or laparoscopic air may spread the virus
infection caused by corona virus. World health
from peritoneal fluid and risk the staff in operating
organization, defined it as a pandemic disease that can
theater for contaminations(11, 12).
be controlled and it is public health problem as Covid
The Royal Colleges of Surgeons in Ireland and
19 spread across the world(5).
Great Britain recommended a risk reduction strategy
Egypt considered as part of the issue, the especial
for managing these patients, including use of personal
hospital for treatment of the pandemic problem is
protective equipment (PPE), opting for conservative
infectious, as epidemic spread of many disease
management where possible, and choosing open rather
happened before like Spanish flu, 1918­1919, which
than laparoscopic operations unless the laparoscopic
killed an estimated 40 million people, and the
approach may have substantial clinical benefits for the
HIV/AIDS epidemic which has caused widespread
patient that give priority to take precautions against
morbidity and mortality(6).
Covid 19 for the staff and the emergency patient (13).
The number of patient admitted to emergency
The pandemic affect the healthcare system and
unit in our hospital diagnosed or suspected Covid 19
methods of treatment. As we were studying the best
was increasing, with progressive increasing spread of
way for facing the Covid19 in general and Covid 19
the disease. In our country the number of patients
especially in surgical patient we should make plane for
having surgical emergency was increased, the elective
the future similar crises
cases at time of break should be postponed until the
The aim of the present study was to evaluate the
pandemic subsides(7).
recommendation for the emergency surgical patient
Emergency surgical patient cannot wait or
with Covid 19 and their follow up in our hospital. The
postponed. There was increased incidence of mortality
aim of this study was also to examine the impact of




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379
Received: 22/08/2021
Accepted: 18/10/2021

Full Paper (vol.861 paper# 60)


c:\work\Jor\vol861_61 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 384-390

An Inverted Virtual Faculty Development Program for Remote Teaching:
Pilot for Replication
Nagwa N Hegazy1*, Saeed SA Soliman2, Samar A Ahmed3 and Marwa M Ahmed2
1Family Medicine Department, Faculty of Medicine, Menoufia University,
2Family Medicine Department, Faculty of Medicine, Cairo University,
3Forensic Medicine Department, Ain Shams University, Director Ain Shams University
*Corresponding Author: Nagwa Nashat Hegazy, Email: Nagwa.nashaat1@med.menofia.edu.eg

ABSTRACT

Background: Due to the COVID 19 pandemic, all the universities worldwide are experiencing a paradigm shift to
online learning. Baby boomers and Generation X need to cope with the challenging transformation, so an emerging need
for a faculty development program was needed towards achieving the goal of that transformation. Objectives: To
describe and assess an inverted virtual faculty development program (VFDP) that was designed and implemented for
the first time in the school to equip educators with the necessary technology competencies for remote online learning.
Methods: An interventional prospective study held in a university setting post need analysis conduction to prioritize the
required technological skills for faculty members. The program was designed to integrate five essential skills needed to
by faculty members to teach remotely. The intervention comprised attending five virtual sessions after watching a pre-
distributed material, then evaluated using the Kirkpatrick model.
Results: Almost 81% of faculty members completed the program and 80 % of participants were satisfied with the
content of the program. There was a statistically significant difference between the perceived ability of the participants
to share and record video lectures before and after the VFDP (p value <0.001). The percentage of the departments that
applied the program components showed that 96% of them were able to record lectures. In addition, 80% of them were
able to develop online quizzes. Conclusion: The inverted virtual faculty development program (VFDP) has supported
the participating faculty in developing their needed technological competencies required to bridge the gap of remote
teaching/learning.
Keywords:
Academic training, Active learning, Distance, Education, Educational Technology, Program Evaluation.

INTRODUCTION

More than 120 countries have closed their
directed,
selfsustaining
and
collegial
work
educational institutions and suspended physical classes
environment (3). Development of the educator's
in response to health authorities' advice due to the viral
technology competencies has set the stage for educator
spread of COVID19 pandemic. Globally, theses
preparation programs to gauge current abilities and
closures impacted more than 60% of the students at
establish goals in order to meet the current needs (4).
different educational levels (1).
The inverted or inverted classroom method (ICM)
Since mid-March 2020, universities in Egypt have
in this pandemic sounds to be a suitable approach for
been going through a radical shift from traditional face
delivery that ensures active learning through adult
toface, inclass teaching to remote online teaching
learning strategy. The flipped classroom (FC) also
modality. Most universities have resorted to the remote
called inverted, reverse, or backward classroom has
online instruction to abide by the Egyptian
reaped universal consideration in the past few years as
government's decree of "nonstop teaching and learning"
an unconventional and groundbreaking teaching and
(2). Online learning management systems (LMSs) have
learning approach in medical education (5).
been actively employed. The university council in
It is mainly the inverse of the traditional
Menoufia University in Egypt has been approved,
classroom and homework elements where obligation for
emphasizing the use of "Microsoft teams" in teaching
the attainment of knowledge lies with the scholars
and formative assessment. Since the faculty have never
through videos, and other online resources. On the other
used any online LMSs before, an immediate faculty
hand the classroom is devoted to scholar centered
development program was needed to ensure consistent
activities (6).
implementation of the new policy (1).
Inverted classroom displayed positive effects
With the continued uncertainty in the instructional
concerning
engagement,
motivation,
overall
delivery with COVID-19 pandemic, the faculty
satisfaction and learning outcomes (6). This paper aims
development program (FDP) is a stand-alone
to describe a virtual faculty development program
educational program that aims to foster knowledge and
(VFDP) designed to equip educators with technology
professional skills of the university faculty. It hence
competencies shown to enhance educators' remote
ensures the faculty readiness, continued teaching skills
teaching in response to COVID-19 pandemic.
and strategies, and the creation of a positive, self

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





384
Received:19/8/2021
Accepted:15/10/2021


Full Paper (vol.861 paper# 61)


c:\work\Jor\vol861_62 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 391-397

Frequency of Neurological Manifestations in -Thalassaemic Patients in
Zagazig University Hospitals
Mervat Abdallah Hesham1, Usama Roshdy El-Safy1,
Yosria Abd-Hameed El-Taweel2, Mohammed Mahmoud Hassan Omar*1
Departments of 1Pediatrics and 2Neurology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohammed Mahmoud Hassan Omar, Mobile: (+20)01090838278, Email: drmohdomar83@gmail.com

ABSTRACT
Background:
Beta thalassemia syndrome is a hereditary disorder characterized by reduced or absent synthesis of the
beta chains of hemoglobin that disturbs the normal shape of red blood cells. Chronic hypoxia of the nerves resulting
from severe anemia may contribute to the pathogenesis of the peripheral neuropathy in patients with -thalassemia. The
aim of this study was to find out the frequency of neurological manifestations in - thalassemia patients and to determine
the contributing factors that lead to these manifestations.
Patients and Methods: This study was prospective cross sectional study conducted during the period from June 2019
to December 2020. This study was carried out on 120 thalassemia patients (67 males and 53 females), with ages ranged
from 11 to 22 years old with a mean age of 16.45+3.31 years.
Results: About 31.7% of the studied cases had neurological manifestations. Tingling and numbness were the main
neurological symptoms among cases (24.1% and 23.3% respectively) followed by headache (21.7%), joint and muscle
pain (20.8%) and tremors in hands (3.3%). Hypotonia was found in 25 cases (20.8%). Grade 4 muscle power was
reported in 13 cases (10.8%) and normal (grade 5) muscle power was reported in 107 cases (89.1%). Deep tendon
reflexes were normal in (89.2%) cases, while (10.8%) cases had brisk deep tendon reflexes.
Conclusion: Frequency of neurological manifestations in beta thalassemia patients was 31.7%. About 26.3% of them
had abnormal nerve conduction study (NCS). Age >16 years old, short stature, prolonged duration of the disease,
transfusion frequency >10 times/year, delayed puberty and jaundice were risk factors for neurological manifestations in
our studied cases.
Keywords: -Thalassaemic Patients, Frequency, Neurological Manifestations.

INTRODUCTION
Neurological manifestations also have been attributed
Thalassemia is an inherited blood disorder in which
to various factors such as, chronic hypoxia, bone
the body makes an abnormal form of hemoglobin. It is

an
autosomal
recessive
inheritance
disease
marrow expansion, iron overload and desferrioxamine
characterized by inability to produce one or more of
neurotoxicity, and also nutrition deficiency. Chronic
globin chains forming hemoglobin molecule (1).
hypoxia of the nerves resulting from severe anemia may
Thalassemia is, more common in Mediterranean and
contribute to the pathogenesis of the peripheral
Southeast Asia regions, Iran and Pakistan (2).
neuropathy in patients with -thalassemia (6, 7).
-Thalassemia caused by genetic abnormalities in
Iron overload in many body organs, due to chronic
-globin chains synthesis resulting in an excess of -
hemolysis and repeated blood transfusion, may be the
globin chains that precipitate in and destroy red cell
cause of cellular damage and neurotoxicity by the way
precursors. Imbalanced globin synthesis results in the
of free radicals (8). Erythropoietic tissue masses occur as
chronic
hemolytic
anemia
and
ineffective
a compensatory mechanism to overcome chronic
erythropoiesis that causes chronic hypoxia in patients
hemolysis. Paraspinal masses may cause spinal cord
with thalassemia (3).
compression and neurological changes due to the
There are two clinically important presentations of
compression. The size and location of lesions as well as
-thalassemia. Homozygous -thalassemia usually
the extent of spinal cord involvement determine the
results in thalassemia major, a severe anemia which
severity, and multiplicity of signs and symptoms (9).
requires regular blood transfusions and iron chelation
The aim of this study was to find out the frequency
therapy for survival. A milder form of the disorder
of neurological manifestations in -thalassemia and to
exists, called thalassemia intermedia, with milder
determine the contributing factors that lead to these
clinical presentation with less marked imbalance of the
manifestations.
: globin chain ratio (4).

Anemia, hemosiderosis and iron chelation therapy
SUBJECTS AND METHODS
may be the main three factors responsible for the
This was a prospective cross sectional study, which
neurological changes in - thalassemic patients (5).
was conducted at the outpatient clinics of Haematology
Unit of Pediatric Department and Neurology




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391
Received: 25/08/2021
Accepted: 21/10/2021


Full Paper (vol.861 paper# 62)


c:\work\Jor\vol861_63 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 398-401

Role of Spontaneous Breathing Trial as Predictors in
Extubation Failure in Preterm Infants
Mohamed Elsayed Elsetouhi, Lotfy Mohamed Elsayed, Ali Abd El-Hameed Abdo, M. M. Shehab
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed E. Elsetouhi, Email: mohamadelsotohy@gmail.com

ABSTRACT
Background:
Invasive respiratory support is associated with risk and complications including mortality and
neurological impairments. Consequently, extubation of a ventilated infant should be as early as possible.
Objective: This study aimed to assess the efficacy of spontaneous breathing trial as indicator for the success of
extubation in mechanically ventilated preterm infants.
Patients and methods:
A prospective cohort study included 62 preterm born infants who were maintained on
mechanical ventilation. They were divided into: (32 infants) group for whom a spontaneous breathing trial was carried
out for 5 minutes. Second (30 infants) group for whom a spontaneous breathing test was carried out for 3 minutes. Then,
rapid Shallow Breathing Index (RSBI) was calculated for each patient. At the end of the test, the newborns were
extubated and placed on continued positive airway pressure (CPAP) or just oxygen, as needed, according to the unit's
routine protocol.
Results: On multivariate logistic regression of factors associated with failure of weaning, APGAR at 5 minutes was >
6, absence of maternal PIH, birth weight > 400 gm. Pre-extubation MAP < 5.5 and preextubation PO2 > 28 were
protective against failure of weaning. On the other hand, lower preextubation PCO2 was a predictor of weaning failure
(increase risk of failure by about 63 times). Failure of weaning forecated in RSBI trial can predict actual failure of
weaning with sensitivity of 97.9%, specificity of 73.3%, positive predictive value of 92%, negative predictive value of
91.7% and accuracy of 91.9%.
Conclusion: Failure of weaning associated with lower birth weight, PO2, PCO2 and higher pre-extubation MAP. 3
minutes and 5 minutes spontaneous breathing trial (SBT) can predict actual failure of weaning with sensitivity 97.9%,
specificity 73.3%.
Keywords: Spontaneous Breathing Trial, Preterm Infants, Extubation Failure.

INTRODUCTION
specific patient needs, and delivered through positive
Respiratory distress syndrome (RDS) is the
pressure to the patient. Endotracheal tubes possess the
commonest morbidity following preterm birth, and a
added advantage of occluding the airway, thus
major contributor to early neonatal death and long-term
preventing aspiration of blood, secretions, etc. in
sequelae. RDS, and resulting respiratory failure, occurs
patients unable to protect their own airways (3).
in these infants secondary to immature lung
Mechanical ventilation (MV) is considered one
development, surfactant deficiency and immaturity in
of the major advances in neonatal medicine and is a
other organs. In those infants presenting with RDS, a
widely used method of treatment, especially in the
substantial proportion go on to develop chronic lung
extremely preterm population. In a large cohort analysis
disease (CLD), and remain at high risk of on-going
of extremely low-birth-weight infants (ELBW), 89%
respiratory morbidity into childhood and adulthood (1).
were treated with MV during the first day of life, and,
Preterm infants born with insufficient
almost 95% of survivors were invasively ventilated
pulmonary surfactant have respiratory distress that
during their hospital stay. In a large cohort of infants
manifests clinically by laboured, rapid breathing,
born at less than 28 weeks' gestational age (GA), 74%
grunting, and central cyanosis. Respiratory distress
were intubated and received surfactant therapy during
typically becomes more severe during the first few days
their hospital stay (4).
after birth as the airways progressively collapse because
Prolonged mechanical ventilation is a risk for
of increased surface tension. If infants survive the first
morbidity and mortality in critical ill patients. Weaning
few days, the lungs start to produce surfactant, the
failure is frequently associated with development of a
respiratory distress stabilises and then abates as the
rapid shallow breathing pattern. Measurement of the
lungs reinflate. Effective treatment for respiratory
rapid shallow breathing index (RSBI) is a simple
distress syndrome was limited to supplemental oxygen
bedside determinant that may be utilized to identify this
therapy (2).
respiratory pattern classically thought to predict
Ventilators are machines that breathe for a
respiratory failure. However, despite being widely used
patient, either through a tracheostomy or endotracheal
and extensively studied, RSBI has variable sensitivity
tube. The ventilator can have oxygen delivery titrated to




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398
Received: 24/08/2021
Accepted: 20/10/2021

Full Paper (vol.861 paper# 63)


c:\work\Jor\vol861_64 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 402-407

Quality of Life among Asthmatic Children in Zagazig University Hospitals
Sherif Sobhy I. Alsabagh, Mohamed Mahmoud A. Romih, Yousif Mohamed Y. Hasan
Pediatrics Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Sherif S. I. Alsabagh, Mobile: (+2)01279520545, Email: sherifsobhy2016@gmail.com

ABSTRACT
Background:
Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. The Pediatric
Asthma Quality of Life Questionnaire (PAQLQ) is one of the most widely used instruments for measuring health-related
QOL in children with asthma.
Objective: to evaluate health-related quality of life (HRQOL) in children with bronchial asthma to identify the most
important determinants adversely affecting their QOL.
Patients and methods: This study was conducted on 72 asthmatic children over six months period. They were recruited
from The Outpatient Clinic of Pediatrics Pulmonology Unit, Zagazig University Hospitals. All study patients were
subjected to complete history taking, clinical examination, determination of level of asthma symptom control and filling
PAQLQ.
Results:
About 58% of patients had partially controlled asthma and one quarter of them had well controlled asthma
(Symptoms domain was the most affected domain ranged from 3 to 5.2 with mean 4.056). There was statistically
significant relation between sex and physical, emotional and overall score of PQLQ. There was statistically significant
relation between residence & social class and QOL scores. There was statistically significant relation between BMI and
QOL scores
Conclusion: Asthma significantly adversely affects the QOL of the affected children. Control of the main determinants
of QOL scores might improve the QOL of these patients.
Keywords: Asthma, Quality of life, Children.

INTRODUCTION
= no impairment, 1 = severe impairment). Three of the
Bronchial asthma is a heterogeneous chronic
activity questions were "patient-specific" which means
inflammatory airway disease characterized by recurrent
that each child identified and scored three activities,
respiratory symptoms such as cough, dyspnea and
which were limited by his asthma (8).
wheeze with variable expiratory airflow limitation (1).
Therefore, this study aimed to evaluate health-
Asthma is a major public health problem in all
related quality of life (HRQOL) in children with
countries. Asthma affects around three hundred million
bronchial asthma to identify the most important
people worldwide according to the Global Burden of
determinants adversely affecting their QOL.
asthma report in 2016. the prevalence of asthma is

increasing among children (2). Asthma puts a serious
PATIENTS AND METHODS
burden on the child's health-related quality of life
This study was conducted on 72 asthmatic
(HRQoL), despite the availability of effective and safe
children over six months period. They were recruited
treatment (3). The overall goal of asthma management
from the Outpatient clinic of pediatrics pulmonology
is to achieve optimal disease control and HRQOL
unit at Zagazig university hospitals.
improvements (4).

The use of HRQOL as an essential outcome
Inclusion criteria: Patients with bronchial asthma,
measure of childhood asthma treatment and
aged between 7 and 14 years whose parents agreed to
management has increased. Poorly controlled asthma
participate on the study. Both sexes were involved.
symptoms impair the HRQOL of children (5). The

Pediatric Asthma Quality of Life Questionnaire

(PAQLQ) was developed to measure the functional
Exclusion criteria:
problems (physical, emotional, and social) that have the
Patients with bronchial asthma younger than 7
most impact on children (7­17 years) with asthma (6).
years of age or older than 14 years. Patients whose
PAQLQ has 23 questions in three domains
parents refused to participate in the study. Patients
(symptoms, activity limitation and emotional function).
diagnosed with other chronic pulmonary disorder.
The PAQLQ has a time specification of one week so

children were asked to recall their experiences during
Operative Assessment:
the previous week, there is evidence that this is the
Full history in the form of personal history (name,
maximum length of time over which younger children
age, sex, residence, parental education and occupation
can recall their experiences with any degree of accuracy
and parental smoking), history of present illness, history
(7) and to respond to each question on a 7-point scale (7
of other diseases or associated co-morbidities and past




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402
Received: 25/08/2021
Accepted: 21/10/2021

Full Paper (vol.861 paper# 64)


c:\work\Jor\vol861_65 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 408-412

Correlation of Polycystic Ovary Syndrome and Recurrent Miscarriage
Ali El-Shabarawy Ali, Mai Moustafa Zaitoun, Raafat Gamal Mohammed, Safaa Abdel Salam Ibrahim
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Raafat Gamal Mohammed, Mobile: (+20) 01112584410,
E-mail: raafatelgandyelgandy1151991@gmail.com

ABSTRACT
Background:
Numerous studies have investigated the association between polycystic ovary syndrome (PCOS) and
recurrent miscarriage (RM). Increased rates of PCOS have been reported for women with RM. However, the actual
prevalence is controversially discussed by the scientific community and remains unclear, since a wide range of rates
from 8­82% can be found in the literature. Objective: To assess the relation between polycystic ovary syndrome and
recurrent miscarriage and to evaluate the prevalence of polycystic ovarian syndrome within the recurrent miscarriage
population. Patients and method: It is a cross sectional conducted at the infertility clinic in the outpatient department
of University Hospital from March 2019 to March 2020. Patient sample was 47 participant. Hormonal profile FSH,
LH, TSH, TSH, assessment of glycemic status and insulin resistance and ultrasonography for diagnosis of polycystic
ovaries were done to every patients. Result: There was high statistically significant relation between the PCO and
total number of follicles, number of follicles 18 mm and endometrial thickness. There was high statistically
significant relation between the PCO and testosterone hormones and statistically significant relation between the PCO
and FSH and LH. There was no statistically significant relation between the PCO and insulin resistance. Conclusion:
In this study we concluded that the prevalence of PCOS seems slightly increased in women with recurrent
miscarriage, PCOS on the other hand showed a rather high prevalence compared to the general population.
Keywords: Polycystic Ovary Syndrome, Recurrent Miscarriage.

INTRODUCTION
investigation. The aim of this study was to assess the
According to the World Health Organization
relation between polycystic ovary syndrome and
(WHO), recurrent miscarriage (RM) is defined as three
recurrent miscarriage and to evaluate the prevalence of
or more consecutive pregnancy losses before the 20th
polycystic ovarian syndrome within the recurrent
gestation week (1). It is estimated that five percent of all
miscarriage population.
couples trying to conceive are affected by two

PATIENT AND METHODS
consecutive miscarriages and that one percent is
It is a cross sectional conducted at the infertility
affected by three or more (2).
clinic in the outpatient department of University
In 50% of the cases of RM, the underlying cause
Hospital from March 2019 to March 2020. Patient
remains unknown. Potential pathologies leading to
sample was 47 participants.
RM include genetic abnormalities, infection, immune

dysfunction, endocrine disorders, antiphospholipid
Inclusion criteria: Women with history of recurrent
syndrome,
thrombophilic
disorders,
uterine
pregnancy loss 3 or more, women age 20-40 years old,
pathologies, and cervical weakness (3). Polycystic
patients diagnosed according to Rotterdam criteria
ovarian syndrome (PCOS) is a clinically and
)two of three)1= oligoovulation and or anovulation, 2=
biochemically heterogeneous disorder. It is the most
hyperandrogenism=excess androgen activity, 3=
common endocrinopathy in reproductive aged women
polycystic ovaries )>12 cysts, 2-9 mm in one or two
affecting 4%­12% (4). Numerous studies have
ovaries and ovarian volume >10 ml=(, and women
investigated the association between PCOS and RM.
with normal ultrasonographic measurement of the
Increased rates of PCOS have been reported for women
uterus.
with RM (5). However, the actual prevalence is
Exclusion Criteria: Pregnant women, women with
controversially discussed by the scientific community
diabetes mellitus (DM), hypertensive patients, patients
and remains unclear, since a wide range of rates from
with liver or cardiac or renal diseases, women with
8­82% can be found in the literature (5). Certain
uterine anatomical anomalies, and patients with
features of PCOS are associated with an increased risk
positive tests for antiphospholipid syndrome (APS) )
of RM, including hyperandrogenism,
insulin
lupus anti-coagulant and anticardiolipin antibodies).

resistance, hyperinsulinemia, obesity, elevated level of
All participants in this research were subjected to:
plasminogen-activator
inhibitor
(PAI)-1,
and
Full history taking.
hyperhomocysteinemia (6).
Examination: General examination blood pressure,
Therefore, pathophysiological connections can
pulse, temperature pallor, jaundice, weight, height,
be assumed and it is unclear whether PCOS would
hirsutism, examination of thyroid gland, breast, chest,
cause RM directly or whether the association is due to
heart. Examination of abdomen and pelvis for
certain factors that are linked to both conditions. These
inspection of hair distribution and palpation of pelvi
uncertainties underline the need for further
abdominal masses.




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408
Received: 25/08/2021
Accepted: 21/10/2021

Full Paper (vol.861 paper# 65)


c:\work\Jor\vol861_66 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 413-419

Osteoprotegerin, Soluble Receptor Activator Nuclear Factor-B Ligand, Nuclear
Factor Kappa B and Intestinal Trefoil Factor 3 are Promising Biomarkers in
Diagnosis and Follow- up Inflammatory Bowel Disease Patients
Ragaa HM Salama 1*, Mohammed A Medhat2, Shimaa A Elghazally 3,
Nesma G Farag1, Aya A El Sanory 4, Mohamed O Herdan5, Tasneem A El Sanory6 , Amira A. Kamel 1
1 Department of Medical Biochemistry, 2 Department of Tropical Medicine, 3Department of Public Health, 4 Department
of Nuclear Medicine, South Egypt cancer Institute , 5 Department of General Medicine, Faculty of Medicine, 6
Department of Biochemistry, Faculty of Pharmacy, Assiut University, Assiut, Egypt
*Corresponding Author: Ragaa H M Salama, Tel: (+20)1063492008, P.O: 51717, E-mail: ragaa_2002@yahoo.com

ABSTRACT
Background:
Inflammatory bowel disease (IBD) is a condition in which the gastrointestinal system becomes inflamed for
no apparent reason. Its incidence increased during the last few decades. As a result, it's critical to understand how to
validate a clinical diagnosis and monitor any progress using a simple procedure. Osteoprotegerin (OPG), which interacts
with RANKL, regulates RANK/RANKL signaling. OPG is a decoy receptor for soluble receptor activator of nuclear
factor-B ligand (sRANKL), which stimulates nuclear factor kappa-light-chain-enhancer of activated B cells (NF-B) and
the healing trefoil factor 3 (TFF3), which could be employed as in the diagnosis and follow-up of IBD patients,
biomarkers are used. Objectives: The aim of the current work was to evaluate the role of RANKL (sRANKL), OPG, NF-
B , and TFF3 in in the diagnosis of active IBD. Subjects and methods: Thirty-five newly diagnosed untreated IBD
patients and thirty-five healthy controls were included in this study. Patients were then given particular treatment either in
the form of cortisone, mesalamin, immunotherapy or infliximab and immunotherapy for 3 months and attend for second
visit. OPG, sRANKL, NF-B and TFF3 levels were estimated by ELISA method using commercial kits in patients before
and after treatment and healthy control. Results: Patients with IBD had significantly increased levels of OPG, sRANKL,
NF-B, and TFF3 than healthy controls (P =0.0001). After 3 months of treatment, patients' levels of NF-B and TFF3 were
significantly lower (p = 0.0001 and 0.03, respectively). Conclusion: The biomarkers OPG, sRANKL, NF-B , and TFF3
show promise in the diagnosis of active IBD. The decrease in NF-B and TFF3 following treatment suggests that be used
as biomarkers to track disease activity and treatment effectiveness.
Keywords: Inflammatory bowel disease, OPG , sRANKL, NFB ,TFF3.

INTRODUCTION

chemotactic factor that enhances inflammatory responses
IBDs are a set of chronic gastrointestinal
in T cells by stimulating chemokine release, matrix
inflammatory illnesses that affect millions of people
metalloproteinase activity, and chemokine release (7).
around the world. The disease's progression is
OPG dimerization is required for RANK/RANKL
unpredictable, with flares complicating matters, as well as
inhibition because it bind with high affinity for RANKL.
the necessity for long-term medication and, in some cases,
RANK/RANKL signalling inhibition may improve the
surgery (1). Although the cause of IBD is unknown, A
efficacy of checkpoint blockade in cancer treatment.
dysregulated intestinal mucosal immune response,
When treated as monotherapy, anti-RANKL monoclonal
genetic factors, gut microbiota, and environmental factors
antibodies (mAbs) have limited antimetastatic activity (8).
are all thought to play a role in its development. (2,3).
When sRANKL binds to its membrane receptor RANK,
The most essential use of serological
the receptor becomes trimerized, triggering TNF
biomarkers is to assess disease aggressiveness,
receptor-related components, adaptor proteins, and
complications, or the need for surgery, as well as to
downstream signalling pathways, such as NF-B, are all
predict illness prognosis (4). However, have limited utility
recruited. (9). Inflammatory stimuli activate NF-B, a
in establishing an initial definitive diagnosis for IBD. As
transcription factor that activates the inhibitor of kappa B
a result, future research should focus on more effective
(IB) kinase in the cytosol.. Following that, NF- B
biomarkers with high sensitivity and specificity (5).
migrates to the nucleus via canonical or non-canonical
Osteoprotegerin is a protein that belongs to the
signaling pathways, triggering the targeted genes that
tumour necrosis factor receptor superfamily and is
promote the development of pro-inflammatory cells
involved in bone turnover, inflammatory pathways, and
including monocytes, macrophages, T and B cells (10).
cell survival (6). It acts as a decoy receptor for nuclear
Intestinal trefoil factor 3 (TFF3) is largely generated
factor-B ligand soluble receptor activator (sRANKL), a
and secreted by intestinal mucosa goblet cells (11), which




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413
Received: 24/08/2021
Accepted: 20/10/2021

Full Paper (vol.861 paper# 66)


c:\work\Jor\vol861_67 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 420-426

Management of Comminuted Distal Radial Fractures Using Volar
Plating versus External Fixation Augmented by K wires
Usama Fawzy Attia*, Mohamed El Soufy, Tarek ElHewala, Mohamed Adel Abdelrazek
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Usama F. Attia, Mobile: (+20) 0129876054, Email: usamafawzy19@yahoo.com

ABSTRACT
Background:
Distal radius fractures are the most common fractures of the upper extremity, representing approximately
one-sixth of all fractures treated in the emergency room. Various classification systems are used to classify distal radius
fractures. There are different methods for treatment of this type of fractures.
Objective: This study aimed to evaluate the best procedure in management of comminuted distal radial fractures and
attainment of better outcomes.
Patient and methods: This study involved 30 patients with distal radial fractures who divided equally into: 15 patients
performed volar plate in group (A) and other 15 patients applied external fixation augmented by K-wires group (B). The
follow-up in was six months.
Results:
The mean operation time was 54.00 ± 12.28 minutes in volar plating group, in comparison with 36.33 ± 5.16
minutes in external fixation group. There was statistically clinical significance between the two groups. Patients treated
with volar plating had flexion range of 10-85, radial deviation range of 5-30 and ulnar deviation range of 20-40, while
patients treated with external fixation augmented by k-wires had flexion range of 60-85, radial deviation range of 10-28
and ulnar deviation range of 20-35. Patients treated with external fixation augmented by k-wires had extension range of
45-85 better than those treated with volar plating (10-85). Patients treated with external fixation augmented by k-wires
had grip strength range of 15-27, while patients treated with volar plating had grip strength range (8-27).
Conclusion: Volar plating had better functional outcomes when compared to external fixation. Whereas grip strength
and ROM data were similar between the two groups.
Keywords: Volar plating; External fixation; Radial fractures.

INTRODUCTION
fractures. An external fixator is the only tool to do this
A fracture of the distal radius is considered
in high-energy fractures (6). Complications associated
unstable by definition if it is unable to resist
with external fixator are pin-track infection, iatrogenic
displacement following anatomic reduction (1).
lesion of the superficial radial nerve. Overdistraction of
Treatment of broken bones follows one basic rule: the
the wrist joint may lead to complex regional pain
broken pieces must be put back into position and
syndrome (CRPS). Usually the external fixator is
prevented from moving out of place until they are
applied for 6 weeks especially in osteoporotic bone
healed (2). The treatment of distal radius fractures
quality with weak hold of the pins, loosening of the pins
requires a meticulous reconstruction of the joint surface,
occurs quite early so that they have to be removed
as well as stable internal fixation and early functional
before definitive bone healing (7).
post-operative treatment. Extra-articular fractures
The aim of the present study was to evaluate the
require both the restoration of the volar tilt and radial
best procedure in management of comminuted distal
length to reduce the possibility of displacement (3).
radial fractures and attainment of better outcomes.
Closed reduction and cast immobilization is still

the mainstay of treatment for non-displaced and stable
PATIENTS AND METHODS
fractures (4). There are multiple surgical options of
This study included 30 patients with distal radial
treatment for patients with distal radius fractures,
fractures who enrolled for open reduction and internal
including percutaneous K-wire fixation, use of an
fixation by volar plate in group (A), external fixation
external fixator, fixation with volar or dorsal plates
augmented by K-wires in group (B). Participants were
(locking or nonlocking), bridge plating, or a
numbered from 1 to 30 and divided equally into: 15
combination of these techniques. Although the best
patients performed volar plate in group (A) and other 15
choice depends to some extent on the characteristics of
patients applied external fixation augmented by K-wires
the fracture (open/closed, non-displaced/displaced,
group (B).
extra-/intra-articular), there is little high-quality
Inclusion criteria: Patient with closed unilateral
evidence to inform this decision-making (5).
comminuted distal radius fractures (occurred in less
External fixation can play a role in fractures of
than 14 days). Extra-articular fracture type A3 and intra-
the distal radius with epiphyseal lesions or with
articular distal radius fractures type C2, C3 according to
associated dislocations, which can be considered
AO/OTA Classification in patients who surgically fit.
composite osteoligamentous lesions rather than




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420
Received: 25/8/2021
Accepted: 21/10/2021

Full Paper (vol.861 paper# 67)


c:\work\Jor\vol861_68 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 427-430

Emerging Relationship between Vitamin D and LL-37 in the Immune System's
Response to Infection and Their Possible Role in Combating Sepsis
Nagwa M. Shawky 1, Neveen G. EL-Antouny 2, Noha K. Hassaan1, Alshymaa Ahmed Abdullah1
Departments of 1Clinical and Chemical Pathology, 2Internal Medicine, Zagazig University Hospital, Egypt
*Corresponding author: Noha Khaled Hassaan, EMail: noha.k.h@hotmail.com
ABSTRACT
Background
: In patients who are critically unwell, sepsis could be one of major causes of mortality as well as many
complications. Sepsis is the medical term describing dysfunctional body reaction to infection that results in
dysfunctions in various body systems and hence severe organ failure could occur. A rise of 2 or more points in the
sequential organ failure evaluation is an early indicator of organ dysfunction (SOFA score). Severe organ failure can
occur if sepsis is left untreated. An infection-controlling effect of vitamin D has been demonstrated. With an increase
in cathelicidin antimicrobial peptide (AMP) LL-37, human skin, blood plasma, monocytes, and macrophages are all
affected. LL-37 and other AMPs, which operate directly against bacteria, regulate numerous innate and adaptive
immunological functions. Objective: To make an overview of role of lack of vitamin D (25(OH) D) as well as AMP,
LL-37, as risk factors for sepsis. Conclusion: Severe infections, as well as sepsis, have been linked to a deficiency of
vitamin D. However, it is not yet clear what the underlying linkage and its clinical consequence is between sepsis and
respiratory tract infections as well as critical illness.
Keywords: Sepsis, Vitamin D.

INTRODUCTION

to fight off diseases through immunity reactions
Sepsis can progress from infection to septic shock,
pathways. Staph aureus, Klebsiella pneumoniae, E.
that might prime to mortality as well as multiple organ
coli, and streptococcus pyogenes cultures were
dysfunction syndrome, depending on the severity of the
inhibited or destroyed in in vitro studies using 50,000­
disease. When it comes to diagnosing and treating
90,000 IU/ml of active vitamin D (D3). Reductions in
bacterial infections, a lot of changes have taken place
inflammation and virus replication were observed in
since the early 1990s (1). Septic patient definitions and
tracheobronchial epithelial cells infected with
clinical criteria have been updated by a task team of 19
respiratory syncytial virus (RSV) that were treated
professionals from critical care to infectious disease to
with 1,25(OH)2D. Researchers found that injecting
pulmonary medicine in an effort to improve patient
infected mammary tissue-derived monocytes led to
treatment. The sepsis-3 task force was formed as a result
higher levels of VDR and 1 -OHase gene expression
(2). Minor levels of vitamin D can be seen in cases with
in a cow mastitis experimental model. With this study
sepsis because of decrease in the vitamin D binding
we can see how vitamin D-dependent immune
protein concentrations. Sepsis, additionally, vitamin D
responses can be activated in the face of local infection
deficiency may have a role in the most catastrophic
(6). Catheliciden (LL-37) is an antibacterial peptide,
outcome of a severe illness (3). It has not yet been
which have a broad range of activities. It was in the
clearly studied how vitamin D affects the development
1980's that host defence peptides (AMPs) were first
of severe sepsis in humans. Septic shock can occur due
found. A wide variety of naturally occurring chemicals
to deficiency of vitamin D supplementation. When it
are produced by all multicellular organisms as a first
comes to the link between 25 (OH) D and LL-37 in
line of defence against pathogens (7). Antimicrobial
hospitalized patients, there are inconsistent results (4).
activity of AMPs against bacteria, fungi, and viruses is
Vitamin D's function in general health, homeostasis of
demonstrated by their broad spectrum and high
calcium as well as bone integrity has long been
potency (8).
acknowledged. Researchers realizing the significance
Humans, animals, and plants all have an inherent
of this steroid hormone in the proper operation of
immune system that relies on antimicrobial peptides (9,
numerous organ systems. More than 900 genes contain
10). They are essential to the immune system because of
the vitamin D response element (VDRE), which is
their broad spectrum of activity against infections and
found in vitamin D receptors and the 25-
cancerous cells. Defensin and cathelicidin are two
hydroxyvitamin D-1 -hydroxylase (1-OHase).
types of antimicrobial peptides (AMPs) in mammals
Systemic infections, cardiovascular illness, lung
(11, 12).
disease, and diabetes have been associated to a lack of
Antimicrobial peptide LL-37 is able to fight a
vitamin D, based on current clinical as well as
variety of infections. Many researches have showed
epidemiological investigations (5).
that it has antibacterial and immunomodulatory
Supplementation with Vitamin D and Immunity:
characteristics. Recent research has focused on its
Aside from inflammation reduction and pathogen
ability to boost the body's natural defenses (12).
management, vitamin D is critical to the body's ability




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427
Received: 10/9/2021
Accepted: 28/10/2021

Full Paper (vol.861 paper# 68)


c:\work\Jor\vol861_69 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 430-436

Plasma Level of Interleukin 37 in Children with Primary Immune Thrombocytopenia
Mohamed Badr1, Asmaa El-Esh2, Adel Sherif1, Samira Osman*1, Doaa Abd Elrahman1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding author: Samira Osman Hussein, Mobile: (+20) 01095527827, Email: dr.samira.osman@gmail.com

ABSTRACT
Background:
Interleukin (IL)-37, a novel anti-inflammatory cytokine previously known as interleukin-1 family
member 7 before it was renamed, has a pivotal role in the suppression of immune responses. Objective: The present
study aimed to investigate the expression of IL-37 and its potential role in the pathogenesis of immune thrombocytopenia
(ITP). Patients and Methods: The study was carried out in Zagazig University Hospital, Pediatric Department. The
total sample size was 60 participants divided into 4 groups. They were 45 patients (15 patients with newly diagnosed
ITP, 15 patients with complete remission after 1st line therapy and 15 patients with chronic ITP) and 15 age - sex matched
healthy children as a control group.
Results: Our study showed that the mean value of age among patients group was (6.89± 4.13) with female predominance
than males (60%). The current work showed that regarding history of bleeding tendency it was present in 45 (100%).
This study showed the bone marrow examination was done for 8 of our patients (17.8%) and revealed hypercellular
megakaryopoiesis. In the current study there was no statistically significant difference between patients group and
control group regarding hemoglobin (HB) and white blood cells (WBC). Our study showed that there was no statistically
significant correlation between IL 37 level and platelets in patients group.
Conclusion: Accumulating evidence suggests that serum level of IL 37 has a pivotal role in autoimmune diseases. In
the present study, the expression of IL-37 in ITP patients was evaluated for the first time in Egypt, but no significant
abnormal expression of IL-37 was identified in these patients. It was therefore concluded that serum level of IL 37 may
not have a pivotal role in the development of ITP.
Keywords:
Children, Interleukin 37, Plasma Level, Primary Immune Thrombocytopenia

INTRODUCTION
Interleukin (IL)-37, a novel anti-inflammatory cytokine
Immune thrombocytopenia (ITP) is an
previously known as interleukin-1 family member 7
autoimmune disorder characterized by a low platelet
before it was renamed, has a pivotal role in the
count with mucocutaneous or other types of bleeding.
suppression of immune responses (8).
The pathogenesis of ITP remains poorly understood,
Aberrant expression of IL-37 has been observed
while immune disorders are thought to have an
in several inflammatory and autoimmune diseases,
important implication. The presence of anti-platelet
including rheumatoid arthritis (RA) (9,10), systemic lupus
glycoprotein (GP) antibodies is also considered to be
erythematosus (SLE) (11,12), inflammatory bowel disease
critically involved in ITP (1).
(IBD) (13,12), ankylosing spondylitis (AS) (11) and Graves'
In addition, a complex dysregulation of cellular
disease (GD) (14). Interleukin (IL)-37 has an important
mechanisms has been reported, including the imbalance
role in autoimmune diseases by suppressing immunity
of the type 1 T-helper cell (Th1)/Th2 ratio (2), increased
and inflammation; however, the role of IL-37 in
number of Th17 cells, decreased number or functional
immune thrombocytopenia (ITP) has remained largely
deficit of regulatory T cells (3,4) and increased cytotoxic
elusive. (15).
T lymphocyte-mediated cytotoxicity (5).. Biomarkers are
The present study aimed to investigate the
very important to the pathogenesis of disease. Many
expression of IL-37 and its potential role in the
abnormal immune biomarkers play crucial roles in ITP
pathogenesis of ITP.
pathogenesis. The abnormal B, T cell, such as

transforming growth factor-beta1, Toll- like receptors
PATIENTS AND METHODS
helper 1 and T helper 2 and some new biomarkers in
Site of study: The study was carried out in Zagazig
ITP were introduced. It may help people to know the
University Hospitals and Zagazig University outpatient
complicated pathogenesis of ITP (6).
clinic.
The major role of IL-37 is to decrease excessive
Sample size: Assuming that the mean ± SD of
inflammation in innate and adaptive immune diseases,
interlukin-37 in the control group is 75.61 ± 17.1 and
mainly by inhibiting the expression, production and
that of ITP patients is 90.41 ±17.8. So, the total sample
function of pro-inflammatory cytokines, including IL-
size is 60 participants divided into four groups. They
1, IL-6, tumor necrosis factor (TNF) and macrophage
were 45 patients who had ITP (15 patients with newly
inflammatory protein-2. The abundance of these
diagnosed ITP, 15 patients with complete remission
cytokines has been reported to increase with the
after 1st line therapy and 15 patients with chronic ITP)
silencing of endogenous IL-37 in human blood cells (7).
and 15 age - sex matched healthy children as a control




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431
Received: 26/08/2021
Accepted: 22/10/2021

Full Paper (vol.861 paper# 69)


c:\work\Jor\vol861_70 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 437-446

Positive Susceptibility Vessel Sign on SWI-MRI Sequence Imaging Might Differentiate
Patients Had Silent Brain Ischemia among Apparently Neurologically-Free Patients
Yasmin H. Hemeda
Department of Radiodiagnosis, Interventional Radiology and Medical Imaging,
Faculty of Medicine, Menoufia University, Egypt
Corresponding author: Yasmin H. Hemeda, Mobile: (+20) 01061173115, E-Mail: hosneyyasmin@gmail.com

ABSTRACT
Background:
The susceptibility-weighted imaging (SWI) is an essential MRI sequence in the assessment of acute
ischemic stroke. Silent cerebrovascular disease is five times more prevalent than symptomatic brain infarcts and is
associated with future risk for stroke and dementia.
Objectives: Evaluation of the diagnostic performance of susceptibility-weighted magnetic resonance sequence imaging
(SWI) for early diagnosis of silent brain infarction (SBI) in apparently neurologically-free patients presented by transient
neurological manifestations.
Patients and Methods: The study included 218 patients who were clinically evaluated for demographic, clinical data
concerning presence of chronic medical diseases, presenting symptoms and its frequency and severity. Routine lab
investigations and lipid profile were performed and the plasma atherogenic index (PAI) for oncoming cardiovascular
insults was calculated. MRI scan was performed using 1.5 T MRI scanner (Toshiba Vantage) with a head coil.
Results: 102 patients (46.8%) had chronic medical diseases and hypertension (HTN) and diabetes mellitus (DM) are
the most common. The commonest complaint was occasional amnesia, slurred speech and weak handgrip. PAI defined
53 patients at high, 101 patients at intermediate and 64 patients at low risk of cardiovascular insults. Susceptibility vein
sign (SVS)+ were detected in 78 SWI scans and showed positive significant correlation with smoking, multiple co-
morbidities, presence of chronic kidney disease, DM, hypertension and with PAI.
Conclusion: The presence of SVS in SWI during MRI examination is pathognomonic sign for the presence of SBI. The
incidence of SBI on SWI scans of apparently neurologically free patients who presented by transient neurological
manifestations is high and was found to be associated with the presence of chronic medical diseases especially in obese
dyslipidemic patients.
Keywords: Apparently neurologically-free patients, Silent brain infarction, Susceptibility-weighted magnetic resonance
sequence imaging, Susceptibility vein sign.

INTRODUCTION
had current coronary heart diseases (8), and patients with
Silent cerebrovascular disease including silent
internal carotid atherosclerosis (6) or had prosthetic
brain infarction (SBI) and white matter disease (WMD)
cardiac valves or stents and maintained on
is commonly found incidentally on neuroimaging scans
anticoagulants (9).
obtained in routine clinical care (1). Silent brain
Epidemiological research showed that silent
infarction was defined as a brain lesion that is
cerebrovascular disease is five times more prevalent
presumably a result of vascular occlusion that was
than symptomatic brain infarcts (10) and is associated
detected incidentally by neuroimaging scans in
with future risk for stroke and dementia (11), thus
otherwise healthy subjects or during autopsy (2).
representing an important opportunity for stroke
According to MRI findings, SBI was defined as
prevention (1).
asymptomatic, well-defined lesions with a diameter 3
The susceptibility-weighted imaging (SWI) is
mm with the same signal characteristics as the
an essential MRI sequence in the assessment of acute
cerebrospinal fluid on T1- or T2-weighted images (3) and
ischemic stroke (12). The susceptibility vessel sign (SVS)
were detected by neuroimaging in up to 20% of
on gradient echo imaging is defined as a hypointense
asymptomatic patients (4).
signal exceeding the diameter of the contralateral artery
The prevalence of SBI showed racial, ethnic,
at the site of the thrombus (13). The appearance of SVS
and age differences; however, in the general population
is due to the presence of deoxyhemoglobin secondary to
it ranges between 8 and 28% and is higher in
occlusion and decreased oxygenation and leads to local
symptomatic stroke patients up to 38% (5). Multiple risk
magnetic field inhomogeneity with a subsequent signal
factors other than age could point to the possibility of
loss on the T2* sequences (14).
the presence or development of SBI in the future and
The detection of SVS showed multiple clinical
include hypertension, hyperlipidemia, smoking,
applications, its diameter and length may predict stroke
hyperhomocysteinemia, low high-density lipoprotein,
subtype, and longer thrombus size was independently
and alcohol consumption (6). Moreover, SBI is the most
associated with early neurological deterioration in
common neurological complication in sickle cell
patients with minor stroke and long vessel occlusion
disease patients (7), patients with a family history or who
following intravenous thrombolysis (15). Moreover, the




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437
Received: 27/08/2021
Accepted: 23/10/2021

Full Paper (vol.861 paper# 70)


c:\work\Jor\vol861_71 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 447-451

Oxygen Therapy and Their Risk in The Premature Neonates: Review Article
Ahmed El-Abd Ahmed Saad1, Hala M. Sakhr1, Osama Abd-Elmonem Elkady2 and
Eslam Mohammed Mohammed Eltaky*1
Department of 1Pediatrics and 2Ophthalmology, South Valley University, Egypt
*Corresponding author: Eslam Mohammed Mohammed Eltaky, Mobile: (+20)0105050546,
E-mail: doctoreltaqy@gmail.com
ABSTRACT
Background:
Neonatal respiratory care includes oxygen therapy, which is more common due to the improved survival
rates of premature infants. Considering that most current studies demonstrate that preterm newborns benefit most from
oxygen saturations (SpO2) of 91-95 percent, which reduces the risk of complications such as retinopathy of prematurity,
we set out to study oxygen treatment and its risks in premature neonates.
Objective: The reviews article highlight oxygen therapy and their risk in the premature neonates.
Conclusion: There have been improvements in outcomes for babies with extremely low birth weight when using a
larger goal range (85%-93%), but these ranges have not been thoroughly assessed in major clinical trials; additional data
is required. High oxygen levels may be avoided with early use of a pulmonary vasodilator.
Keywords: Hypoxia, Neonatal Resuscitation, Neonate, Oxygen, Oxygen Saturation, Retinopathy of Prematurity.


INTRODUCTION

preterm and term birth, precise estimates of gestational
According to the Vermont Oxford Network (VON),
age are essential (6).
95% of extremely preterm new-born at or before 30

weeks gestation got oxygen treatment in 2016 (1).
Subcategories of Preterm:
Pneumovascular and pulmonary artery hypertension are
According to gestational age, there are three types
well-known outcomes of alveolar hypoxia, but
of preterm birth: Extremely preterm (before 28 weeks),
bronchopulmonary dysplasia (BPD, also known as
very preterm (between 28 and 32 weeks), and moderate
chronic lung disease of prematurity or infancy)
to late preterm (32 to 37 weeks). (7).
retinopathy of prematurity (ROP) and white matter

damage are less well-known (2).
Epidemiology:
The oxygen pulse saturation is used to monitor
Every year, an estimated 15 million premature
supplementary oxygen in preterm newborns because of
births occur. The figure is a little more than one in ten
this (SpO2). Low (85-89%) or high (91-95) SpO2 goal
newborns. Preterm birth problems claim the lives of
remains open, with the low target increasing mortality
over one million children each year. Many cancer
(3) and the risk of necrotizing enterocolitis, while high
patients will be disabled for the rest of their lives,
(91-95%) SpO2 target raises the risk of ROP (3).
whether it's through learning difficulties or issues with
Currently, the American Academy of Pediatrics
their vision or hearing. For children under the age of
recommends a SpO2 goal of 90-95 percent, which is in
five, preterm is by far the largest cause of mortality
keeping with European standards that recommend a
worldwide. As a result, preterm birth rates are rising in
SpO2 target of 90-94 percent (4).
almost every country with good data (8). According to
Consequences include frequent hypoxia and
these global and regional estimates, there are significant
hyperoxia exposure, which may be harmful to the
differences between and within nations (6). Preterm
patient's health. The proportion of time spent above
problems account for 38% of all newborn fatalities in
(>95 percent) the goal was reduced, while the
Egypt, despite the fact that the general population's
percentage of time spent under (85 percent) the target
prevalence of preterm delivery is estimated at less than
was increased as a consequence of education and
10% (9).
training of the clinical staff to enhance SpO2

maintenance within the target range (5).
Causes of preterm labour:
The objective of review article the highlight oxygen
Infection or inflammation, uteroplacental ischaemia
therapy and their risk in the premature neonates.
or hemorrhage, uterine overdistension, stress, and other

immunologically driven processes are now all
Prematurity
recognised to have a role in preterm labour syndrome
Definition of preterm:
(10). Factors that are related with preterm delivery, but
Preterm birth refers to an infant being born before
are not clearly linked to the onset of preterm labour,
the mother has reached the full 37 weeks of her
have been used to explain premature labour. Risk
pregnancy (259 days). To reliably distinguish between
factors are increasingly being linked to the transition

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447
Received: 27/08/2021
Accepted: 23/10/2021

Full Paper (vol.861 paper# 71)


c:\work\Jor\vol861_72 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 452-456

Laparoscopic Salpingectomy or Hysteroscopic Tubal Occlusion in Patients with
Hydrosalpinx and Intracytoplasmic Sperm Injection Outcomes
Ibrahim Mohiy El-Maghraby*, Adel Gaber Allam
Department of Obstetrics and Gynecology, Shibin El Kom Teaching Hospital, Egypt
*Corresponding author: Ibrahim Mohiy El-Maghraby, Mobile: (+2)0100035 7896, E-Mail: ibrahim_mohie@yahoo.com

ABSTRACT

Background: Tubal factor of infertility resulting from various forms of tub peritoneal damage remains an extremely
common cause of female infertility. Probably the most severe form of tubal pathology is hydrosalpinx.
Objectives:
To compare the efficacy of hysteroscopic tubal electrocoagulation versus laparoscopic salpingectomy for
management of hydrosalpinx related infertility among patients undergoing intracytoplasmic sperm injection (ICSI).
Patients and Methods: This retrospective study was conducted at outpatient clinic in Private Infertility Unit, Menoufia,
Egypt, from November 2018 to August 2019. This study included 120 infertile patients who were candidate for ICSI
and fulfilled inclusion and exclusion criteria, half of the patients underwent hysteroscopic tubal electrocoagulation who
have laparoscopic contraindications, while the other half underwent laparoscopic salpingectomy. After tubal occlusion
was done, an ICSI cycle was started with assessment of chemical pregnancy rate. Results: The rate of positive chemical
pregnancy was 56.16% in hysteroscopic group and 43.84% in laparoscopic group. Conclusion: Hysteroscopic tubal
electrocoagulation was found to be a successful treatment for hydrosalpinges before ICSI when laparoscopy is
contraindicated with chemical pregnancy rate comparable to laparoscopic tubal disconnection.
Keywords: Hydrosalpinx, Hysteroscopy, Infertility, Intracytoplasmic sperm injection.
INTRODUCTION
When the tube is clogged at its distal end or both
The American Society for Reproductive Medicine
ends, secretions build up and cause hydrosalpinx.
(ASRM) suggested laparoscopic fibroblast or neo
Transient distention of the fallopian tubes might develop
salpingostomy to treat minor hydrosalpinx in young
due to the retrograde movement of blood from the uterus
women without any evident reproductive problems (6). It
without total distal blockage on rare instances.
may be preferable to proceed directly to salpingectomy
Hydrosalpinx is most usually a complication of pelvic
and IVF treatment in older women or those with more
inflammatory illness, but it can also occur after tubal
severe hydrosalpinxes. Despite the fact that
ligation for ovulation induction. Other reasons include
salpingectomy is the most commonly recommended
primary or secondary fallopian tube cancers (1). As a
treatment for hydrosalpinx in clinical practice, other
result of a previous pelvic infection, hydrosalpinx is
common treatments for hydrosalpinx before IVF include
virtually usually the result. Gonorrhea, chlamydia,
ultrasonic-guided
hydrosalpinx
aspiration,
tubal
staphylococcus, streptococcus, and pelvic tuberculosis
sclerotherapy, hysteroscopic tubal occlusion, and
are the most prevalent causing organisms. (2). The most
antibiotic treatment, among others (7). Ultrasonic-guided
common treatment options suggested by the clinicians
hydrosalpinx aspiration was found to be less invasive,
were
laparoscopic
salpingectomy
and
tubal
safer, and easier to conduct under dense adhesion, as
disconnection, followed by open salpingectomy,
well as requiring less time in the hospital. Hydrosalpinx
salpingostomy, proximal tubal occlusion, and
aspiration has also been shown to improve the pregnancy
transvaginal ultrasonographic guided hydrosalpinx
outcome of hydrosalpinx patients, and it is used in
aspiration either before or during oocyte retrieval. The
clinical practice. Before IVF, hysteroscopic occlusion
proximal closure of hydrosalpinx by hysteroscopic
was also found to be an effective treatment for
implantation of micro inserts was the most recent
hydrosalpinx in women (8). Although laparoscopic
treatment option introduced (3).
salpingectomy was the preferred way of surgical therapy,
Tubal ligation-related infertility accounts for 25­35
over half of Society for Reproduction Endocrinology and
percent of female infertility. Hydrosalpinx is a serious
Infertility (SREI)/Society of Reproductive Surgeons
type of tubal disease that has been linked to poor
(SRS) members said hysteroscopic tubal occlusion
pregnancy outcomes in tubal infertility patients (4).
should have a role as a major mode of intervention (9).
Hydrosalpinx diagnosed by trans-vaginal ultrasound had
With the benefits of hysteroscopic operations such as
a 10% prevalence rate, while hydrosalpinx diagnosed via
speedier recovery, fewer hospitalisation, and quicker
hysterosalpingography (HSG) or laparoscopy had a 30%
return to work, it may be done in the outpatient clinic as
prevalence rate. Initially, hysterosalpingography (HSG)
an office surgery in the future. In order to examine the
was used to diagnose hydrosalpinx, which was then
efficacy of hysteroscopic tubal electrocoagulation vs
verified by laparoscopy. Later, image diagnosis, such as
laparoscopic salpingectomy for the treatment of
HSG and ultrasound, was used nearly solely to make the
hydrosalpinx-related infertility in patients having
diagnosis (5).
surgery, researchers conducted this study.
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452
Received: 27/08/2021
Accepted: 23/10/2021

Full Paper (vol.861 paper# 72)


c:\work\Jor\vol861_73 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 457-463

Complications of Percutaneous Endoscopic Gastrostomy (PEG) Tube
Applied to Endoscopy Unit Patients
Samir Abdel Azim Morsy Afifi, Ihab Fawzy Abdel Aziz,
Ahmed Kamal Soliman*, Marwan Nabil Elgohary
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Ahmed Kamal Soliman, Email: doc_ak_91@yahoo.com


ABSTRACT
Background:
In patients who find difficulty in eating or who have lost the ability to swallow food, percutaneous
endoscopic gastrostomy (PEG) is the preferred method of long-term tube feeding. Although PEG is a usually safe
technique, several complications sometimes arise.
Objective: To study the advantage and disadvantage of PEG to improve the maneuver and increase the success rate by
identification of outcome complications of PEG and their management and evaluation of the efficacy of PEG in
improving patient's lifestyles.
Patients and methods: This retrospective, single-center study was done on 60 patients who needed PEG tube in the
endoscopy unit of internal medicine department, Zagazig University Hospital during the period from December 2020 to
May 2021. All patients were subjected to complete relevant evaluation before the study in the form of complete history
taking, clinical examination, lab investigation, pelvi-abdominal ultrasound, multislice CT or MRI to assess advanced
cancer or peritoneal metastasis and endoscopic examination for outlet patency.
Results: A total of 16 patients (26.67 %) had PEG-related complications. Fourteen (23.3 %) patients had minor
complications. The most common minor complication recorded was insertion site infection that found in 5 (8.3 %)
patients. Two (3.3%) patients in our study reported major PEG-related complications. One (1.7%) patient had massive
hematemesis and melena and one (1.7%) patient reported buried bumper syndrome.
Conclusion: We concluded that PEG had received global acceptability as a safe approach for administering enteral
feeding in patients with inadequate oral intake for more than 28 days and a functioning GI system.
Keywords: Complications, Endoscopy, Gastrostomy, PEG.

INTRODUCTION

In order to meet the metabolic needs of those who
individuals. So PEG is regarded to be a superior option
are unable to eat normally, enteral and parenteral
than a nasogastric tube (3).
feeding is the primary rationale. Enteral nutrition is
Cerebrovascular illness, bulbar dysphagia, mental
preferred over parenteral nutrition in patients with a
retardation, dementia, and head and neck malignancy
functioning gastrointestinal system due to the risks,
are the most prevalent indications for PEG insertion.
costs, and incapacity of parenteral nutrition to provide
Gastric decompression can also be treated using a PEG
enteral stimulation and thereby erode the gut defense
tube. Contraindications to utilizing a PEG tube include
barrier (1).
severe coagulation problems, hemodynamic instability,
The most prevalent enteral feeding method is
sepsis, infection of the access site, distal gastrointestinal
gastric feeding. Endoscopy, radiologically placed tubes,
blockage (unless this is done for decompression), and
and surgical procedures can all be used to get access to
peritoneal carcinomatosis. Obesity, pregnancy, or
the gastrostomy tube. PEG (percutaneous endoscopic
ascites are examples of unique circumstances (2).
gastrostomy) is the preferred approach for long-term
PEG is less effective in some individuals, such as
tube feeding in patients who are unable to eat or who
those with diabetes or those over the age of 80, while
have lost their deglutition reflex. PEG gives continuous
also taking into consideration the limited prognosis of
nourishment through a tube put into the stomach (2).
patients with underlying or concurrent disease.
Nasogastric tube feeding is simple and
Although PEG is a usually safe technique, problems
inexpensive; however, many clinical studies have found
sometimes arise and their incidence is not significant.
that PEG is a more comfortable technique due to its low
They are characterized as endoscopic (procedure-
cost, minimal invasiveness, in most circumstances, there
related) and early or late post-procedural by severity
is no requirement for general anesthesia and lower risk
(minor vs. major) and time of occurrence (early or late
of adverse outcomes like aspiration pneumonia,
post-procedural). Although PEG-related mortality has
ulceration, irritation, esophageal reflux, as well as
been observed to be minimal, it may be higher in
bleeding. The use of a long-term enteral feeding tube for
individuals with significant comorbidities (4).
more than 30 days is recommended for certain

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457
Received: 05/10/2021
Accepted: 15/11/2021

Full Paper (vol.861 paper# 73)


c:\work\Jor\vol861_74 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 464-469

Factors Influencing Pain and Functional Impairment in Patients with
Knee Osteoarthritis
Mazen Mohamed El-Sheikh1, Reham Mohamed El Shabrawy2, Mai Adel Alsayed Khalel*1, Marwa Hammad1
Departments of 1Rheumatology and Rehabilitation and 2Medical Microbiology and Immunology,
Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Mai Adel Alsayed Khalel, Email: mood672@yahoo.com

ABSTRACT
Introduction: Arthritic pain and impairment are all too prevalent with osteoarthritis (OA), the most common form of
the illness. Numeric scoring systems can be used to assess knee osteoarthritis (OA) patients' levels of pain. Objective:
This study aimed to evaluate the possible factors that increase pain and functional impairment in knee OA leading to
increased VAS and WOMAC score.
Patients and Methods
: On 58 osteoarthritis patients, at Zagazig University Hospitals' Rheumatology and Rehabilitation
Department, we conducted this cross-sectional trial. An extensive physical examination, a set of lab tests, and a series
of X-rays were all performed on each patient. We utilized the WOMAC index from the Western Ontario and McMasters
Universities as well as Visual Analogue Scale (VAS "0-10 cm") to assess functions and pain. For determining the
severity, we utilized grading scale of Kellgren and Lawrence.
Results: BMI, deformity, ESR, radiological grading are indicators of functional impairment and pain index among cases
who had knee osteoarthritis.
Conclusion:
Presence of knee deformities and advanced X-ray grading were associated with higher pain score and more
functional impairment, so we should prevent their progression. BMI is a main risk factor for higher pain scores and
functional impairments.
Keywords: Severity of OA, VAS, WOMAC.

INTRODUCTION
complexity. A person's age is the single most significant
About ten percent of the global population is
predictor of developing OA. Up to eighty percent of
affected by osteoarthritis (1). If you're over 65 years old,
people globally over 75 are affected by OA, which is
you're more likely to suffer from arthritis than anyone
the most frequent chronic illness in later years. As
else in the world (2). As the most common joint disease,
people become older, radiologic alterations in OA
OA affects people of all ages and races and in all parts
become more prominent (9).
of the world. In addition, it is the most frequent kind of
OA is more prevalent in women than in men, with
arthritis in the elder population (3).
an estimated two-to-one ratio. The prevalence of
The most frequent type of OA is primary
osteoarthritis (OA) in women increases dramatically
generalized OA (PGOA), which affects more women
beyond the age of 50, particularly in the knee (10).
than men. Localized OA and secondary OA, on the
Another key risk factor for OA is obesity. Knee OA is
other hand, are more common in men than in women (4).
more common in men and women with a higher BMI,
Bakry (5) observed that the prevalence of OA was 23.3
while hip OA is not (11).
percent in Al-Sharkia Governorate, with 1652
Treatment options are still limited to analgesia,
individuals, and that knee OA was more common in
chondroprotective,
intraarticular
injection,
and
rural regions than in urban ones.
arthroplasty in this multifactorial environment (12).
When it comes to OA, biological, metabolic as
Bony anomalies (osteophytes, subchondral
well as mechanical factors all play a part. Changes
sclerosis) and synovitis attacks as well as functional
among the composition and mechanical characteristics
ratings in OA patients are all variable in their clinical
of articular cartilage result from the interaction of these
presentation. The purpose of this study was to determine
processes (6). The chondrocyte's attempts to repair
which factors will lead to a higher VAS and WOMAC
damage as a result of deterioration are the root cause of
score in patients with knee OA.
OA. Pro-inflammatory cytokines, such as IL-1, as well

as proteolytic enzymes are among the chemical
PATIENTS AND METHODS
components that cause destruction (7). Articular
At Zagazig University Hospitals' Rheumatology and
cartilage loss and the growth of osteophytes, as well as
Rehabilitation Department, Faculty of Medicine, we
the presence of synovial inflammation (synovitis) in a
conducted this cross-sectional trial.
significant number of patients, are hallmarks of this

condition (8).
Ethical considerations:
Obesity, advanced age, and the presence of a
The study was reviewed and approved by the
female gender all contribute to this disease's
Institutional Review Board of Zagazig University

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464
Received: 03/10/2021
Accepted: 14/11/2021

Full Paper (vol.861 paper# 74)


c:\work\Jor\vol861_75 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 470-476

Seronegative And Occult Hepatitis C Virus Infection in Patients with
Acute and Chronic Myeloid Leukemia
Seham Mahrous, Ahmad Baraka, Ayman Fathy, Madonna Fayez*
Depratment of Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
*Corresponding author: Madonna Fayez, Email: donnafayez.92@gmail.com

ABSTRACT
Background:
Around the world, Hepatitis C (HCV) is the primary cause of liver disease. HCV infection in absence of
a positive HCV test (Occult hepatitis C) is a significant clinical and epidemiological issue, although the pathogenic
mechanisms behind this illness are not well comprehended.
Objective: This study aimed at investigation of seronegative and occult hepatitis C virus among patient with acute and
chronic myeloid leukemia.
Patients and methods: 85 leukemic patients were studied in the current cross-sectional trial. In accordance with the
kind of myeloid leukaemia (ML), patients were divided into 72 patients with acute ML (AML group) and 13 patients
with chronic ML (CML group). And according to the presence of occult HCV infections, they were divided into 12
patients (14.1%) with negative serum HCV Abs and positive serum HCV RNA (seronegative), while the other 73
(85.9%) were free of HCV RNA in their bloodstreams.
Results: Patients with occult HCV infections had significantly higher monocytic count and significantly lower platelet
count. Also, they had significantly lower total plasma protein and serum creatinine levels compared to those in the
seronegative group. Patients with CML had either normal platelet count or even thrombocytosis, while those with AML
showed thrombocytopenia with a statistical significant difference. Patients with AML had significantly higher AST.
Conclusions: Seronegative and occult HCV are significant clinical problems in leukemic patients and needed to be
more and more evaluated.
Keywords: Seronegative HCV, Occult HCV, Myeloid leukemia.

INTRODUCTION

Infection with hepatitis C is transmitted by
One of the primary causes of liver illness in the
injection. Infection with the human hepatitis C virus
world is hepatitis C virus (HCV), which causes chronic
(HCV) can occur in people who often come into contact
viral hepatitis that frequently develops to liver necrosis
with blood and blood products. Everyone from
and cancer of the hepatocytes (1). Egypt has the world's
healthcare workers to those with haematological
highest rate of HCV infection (15 percent . Some
diseases to those on dialysis is at risk for the HCV virus
communities around the Nile in Egypt have prevalence
(6). In different regions of the world, studies on the link
rates in excess of twenty two percent (2).
between seronegative and OCI HCV infections and
Despite the existence of HCV RNA in some
haematological diseases have produced conflicting
patients, anti-HCV antibodies (Abs) are not present in
results (7).
these individuals. This is known as "seronegative" HCV
We aimed in this work at investigation of
infection,
and
it
may
be
associated
in
seronegative and occult hepatitis C virus among patient
immunocompromised cases of hemodialysis, onco-
with acute and chronic myeloid leukemia.
hematological illness, as well as HIV (3).

If hepatitis C (HCV) RNA is found in the liver
MATERIAL AND METHODS
and blood mononuclear cells (PBMCs) but not in serum,
This cross-sectional, comparative study was
it is known as "occult HCV infection (OHC)" It can
conducted on Eighty five subjects including both male
occur in anti-HCV positive patients with normal serum
and female at Oncology and Hematology Unit in
levels of liver enzymes, as well as those who have
Clinical Pathology Department, Zagazig University
persistently elevated liver enzymes of unknown origin
Hospitals in the duration between January 2019 and
(4).
January 2020.
Patients with OCI may not be able to detect HCV

RNA in their blood because of a mystery. Conventional
Inclusion criteria: Negative anti-HCV Abs test in all
molecular approaches may be incapable of detecting
individuals with myeloid leukaemia, either AML or
modest levels of circulating virus particles in patients
CML. Who were under the age of 18. Hepatitis B
with OCI. Another mystery is why these people fail to
surface antigen (HBVs Ag) and anti-HIV Abs were
produce antibodies to the pathogen. Mutant HCV strains
included.
that generate antibodies but are not identified by

currently available serological testing could be the
source of concealed infection (5).

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470
Received: 02/10/2021
Accepted: 14/11/2021

Full Paper (vol.861 paper# 75)


c:\work\Jor\vol861_76 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 477-485
Closure of Emergency Midline Laparotomy over Subcutaneous
Closed Suction Drain to Mitigate Incisional Surgical Site Infection,
Dehiscence and Hernia: A Prospective Comparative Study
Ashraf Mohammad El-Badry, Ahmed Gaber Mahmoud, Mohamed Mahmoud Ali*
Department of Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Mohamed Mahmoud Ali, Mobile: (+20)1004564240, E-mail: drmohamedmahmoud1969@gmail.com

Abstract
Background:
The role of subcutaneous closed suction drainage (SCSD) during closure of emergency midline
laparotomy (EML) for reduction of incisional surgical site infection (ISSI) remains debatable. Objective: The aim of
the work was to investigate whether SCSD could minimize ISSI in the setting of emergency abdominal surgery.
Patients and Methods: Adult patients with non-traumatic acute abdomen who underwent EML from June 2017 to
January 2021 by single surgical team at Sohag University Hospital were prospectively enrolled. Patients were
randomized according to EML incision closure technique into group A without SCSD and group B with closure of
EML over SCSD. Both groups were compared regarding ISSI, wound dehiscence and incisional hernia. Results:
Fifty-four patients were eligible (27 per group) with median age of 62 (range: 19-81) years. Both groups were
comparable regarding gender and age. Group B exhibited significantly lower rates of ISSI (3 patients, 11%) and
wound dehiscence (zero) compared with group A, (12 patients, 44%) and (5 patients, 15%), respectively. Likewise,
the duration of hospital stay was significantly shorter among patients in group B versus those in group A.
Relaparotomy was required in 2 cases due to disruption of small bowel anastomosis in group A and leaking repair of
duodenal ulcer in group B. After a median follow-up of 26 (range: 7 - 44) months, the protective effect of SCSD
against ISSI correlated with significantly lower incidence of incisional hernia in group B (1 patient, 3.7%) in
comparison with group A (5 patients, 18.5%). Conclusion: It could be concluded that mitigation of ISSI, wound
dehiscence and incisional hernia with subcutaneous closed suction drainage favors its routine application during
closure of non-traumatic EML.
Keywords: Laparotomy, Subcutaneous drainage, Surgical site infection

INTRODUCTION

before wound closure by antiseptic solutions is also
Emergency midline laparotomy (EML) is
advocated (10-13).
fundamental to rescue emergency patients who suffer
Closure of EML over subcutaneous closed
from non-traumatic acute abdomen (1-3). Two forms of
suction drainage (SCSD) systems remains arguable (14-
infections at the surgical site, including incisional
16). Proponent of this strategy were able to demonstrate
surgical site infections (ISSI) and organ/space
significant reduction of EML wound complications (16,
infections, are encountered in more than one third of
17). However, other studies failed to show such
patients following EML (4). ISSI may hinder adjuvant
beneficial effect (18, 19).
therapy, trigger wound dehiscence and incisional
The aim of the present study was to investigate
hernia, prolong hospital stay and increase re-operations
whether SCSD could minimize ISSI in the setting of
and mortality (5). There is increased risk of ISSI with
emergency abdominal surgery.
advanced age, lifestyle (smoking and alcohol intake),

medications (steroids and immunosuppressive drugs)
PATIENTS AND METHODS
and associated co-morbidities (diabetes mellitus,
This prospective study included a total of fifty-four
hypertension, chronic obstructive pulmonary disease,
patients with acute abdomen who underwent EML at
renal insufficiency, etc) (6).
Sohag University Hospital. This study was conducted
Prophylaxis
against
ISSI
comprises
between June 2017 to January 2021 .
implementation of updated protocols for operative
Exclusion criteria: age < 18 years, trauma, bowel
theaters' cleaning, sterilization of surgical instruments
ischemia, laparotomy due to gynecologic, urologic,
and maintenance of sterile barrier around the surgical
and vascular disorders and history of chemo- or
field.7 Likewise, optimizing patient's specific risk
radiotherapy within 6 months prior to presentation.
factors, bowel preparation, skin decontamination,
Patients were divided into 2 groups (27 in each group),
prophylactic antibiotics prior to skin incision and
group A (closure of EML without SCSD) versus group
maintenance
of
normoglycemia
should
be
B (closure of EML over SCSD tube). Surgical site
accomplished before surgery (7, 8).
infection was defined according to the definitions of
Intra-operatively, intra-peritoneal contamination
the Centers for Disease Control (CDC) and Prevention
can be diminished by copious wash-out of the
of the United States of America (20), figure 1.
peritoneal cavity and appropriate placement of drains
(9)
. Irrigation and drainage of the subcutaneous tissues

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ons.
org/l 477
icens es/by/4.0/)
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Accepted: 25/10/2021


Full Paper (vol.861 paper# 76)


c:\work\Jor\vol861_77 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 486-492
Enucleation Versus Standard Pancreatic Resection for Benign Lesions and
Borderline Tumors: A Comparative Study
Ashraf Mohammad El-Badry, Ahmed Gaber Mahmoud, Mohamed Mahmoud Ali*
Department of Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Mohamed Mahmoud Ali, Mobile: (+20)1004564240, E-mail: drmohamedmahmoud1969@gmail.com

ABSTRACT
Background:
Enucleation of pancreatic benign lesions and borderline tumors, compared with standard pancreatic
resection, may avoid postoperative impairment of the metabolic pancreatic functions. However, its influence on
postoperative morbidity and disease recurrence seems obscure. Therefore, the choice between both approaches
remains controversial.Objective: To evaluate the outcome of enucleation compared with standard pancreatic resection
(SPR) of pancreatic benign lesions and borderline tumors among patients presented to Sohag University Hospital.
Patients and Methods: Adult patients who underwent enucleation (group A) versus standard resections (group B) of
pancreatic benign lesions and borderline tumors at Sohag University Hospital (June 2017 - May 2021) were
prospectively enrolled. Both surgical techniques were compared regarding their influence on postoperative metabolic
functions of the pancreas, surgical complications, and disease recurrence. Results: Sixteen patients (eight per group)
with comparable gender and age distribution were eligible. Group A had significantly shorter operative time, lower
amounts of intra-operative blood loss and less transfusions compared to group B. Likewise, patients in group A
exhibited significantly reduced severity of surgical complications, including postoperative pancreatic fistula, and
required significantly shorter periods of hospital stay. The incidence of new onset diabetes mellitus and pancreatic
exocrine insuffficiency were significantly lower among patients in group A compared with those in group B. During
follow-up, no recurrence was found in both groups. Conclusion: It could be concluded that enucleation of pancreatic
benign lesions and borderline tumors preserves pancreatic metabolic functions, reduces postoperative morbidity and
confers satisfactory oncologic outcome.
Keywords: Enucleation, Pancreatectomy, Pancreatic cysts, Pancreatic fistula

Introduction:

mucinous cystic neoplasm, intraductal papillary
Presurgical distinction between pancreatic benign
mucinous neoplasm and solid pseudopapillary
lesions (non-neoplastic, pseudotumors) and borderline
neoplasm (10-13). Furthermore, villous adenoma of the
tumors from pancreatic adenocarcinoma remains
pancreatic duct is a rare premalignant pancreatic lesion
challenging (1). The diagnostic difficulty is related
(14). Prophylactic excision of villous adenoma is
mainly to their imaging features which frequently
beneficial because about 50% of cases would harbour
overlap with those of adenocarcinoma in addition to
foci of adenocarcinoma (15).
lack of pathognomonic biochemical markers (2).
Due to the common preoperative diagnostic
In Egypt, pancreatic cancer ranks eleventh among
uncertainty, selection of enucleation versus standard
all types of malignant diseases, probably due delayed
pancreatic resection (SPR) to remove doubtful
diagnosis. Therefore, the Global Cancer Observatory
pancreatic lesions remains unsettled(16-18).
report does not describe pancreas cancer among
To
address
this
complex
subject,
we
common malignant diseases affecting Egyptians (3).
prospectively evaluated the outcome of enucleation
Subsequently, pancreatic benign lesions and even
compared with SPR of pancreatic benign lesions and
borderline tumors are not frequently discovered, given
borderline tumors among patients presented to Sohag
the scarcity and late presentation of the majority of
University Hospital. Both techniques were compared
cases (4). A variety of benign pancreatic lesions may
regarding postoperative quality of pancreatic metabolic
grossly appear intra-operatively as well-demarcated
functions, surgical complications and disease
zone of parenchymal fibrosis and retention cysts as a
recurrence.
result of chronic pancreatitis. Other benign lesions

include inflammatory masses and pseudotumors,
PATIENTS AND METHODS
lymphoepithelial and epidermoid cysts and pancreatic
This prospective study included a total of sixteen
hamartomas, hemangiomas and lymphangiomas(5-8).
patients with pancreatic benign lesions and borderline
These benign diseases may be designated as pancreatic
tumors, attending at Sohag University Hospitals. This
tumor-like lesions or pseudotumors(6, 8, 9).
study was conducted between June 2017 - May 2021.
According to the World Health Organization
Exclusion criteria: age <18 years, histologically
classification, benign cyctic pancreatic tumors entail
proven pancreatic adenocarcinoma, presence of distant
serous
cystadenoma,
mucinous
cystadenoma,
metastasis and recurrent lesions.
intraductal papillary mucinous adenoma and mature
According to the surgical treatment strategy,
teratoma. Borderline pancreatic tumors include
patients were divided into two equal groups, 8 each,

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486
Received: 30/08/2021
Accepted: 26/10/2021

Full Paper (vol.861 paper# 77)


c:\work\Jor\vol861_78 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 493-498

Role of Kapandji Technique in Percutaneous Fixation of Distal Radius Fractures
Adel Abd-Elazim Ahmed Salem, Khaled Edris Abdelrahman,
Muhammad Osama Mansour*, Mahmoud Elsayed Elbadawy Thabet
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Muhammad Osama Mansour, E-Mail: muhammadosama93719@gmail.com

ABSTRACT
Background
: The most common fracture in adults is distal radius fracture (DRF). The surgical treatment for distal
radius fractures is Kapandji's surgical procedure that uses intrafocal pinning and provides unique fixation.
Objective: The aim of the work was to evaluate distal radius fracture union and healing after Kapandji's technique of
percutaneous fixing.
Patients and Methods: We managed a group of twenty patients, aged from 18 years to 50 years of both sexes with
distal radius fracture by K- wires using Kapandji technique at Zagazig University Hospitals and Al Farafra Hospital.
The results have been studied regarding complications, time of recovery and rehabilitation.
Results: Mean Patient-Rated Wrist Evaluation (PRWE) -Specific Function was 30.95, the mean PRWE-Pain subscore
was 29.25, the mean PRWE-total score was 54.29. Radial inclination, Volar tilt, and radial height were statistically
significant higher in the examined group following surgery. Only 40% of the studied group had superficial infection
but no cases had tendon or NV injury or Sudek's atrophy.
Conclusion: It could be concluded that for totally displaced fractures, the Kapandji method of K-wiring is an
effective means of reducing the fracture and keeping it reduced over time. By employing the Kapandji technique
approach, a close reduction can be achieved with minimal effort.
Keywords : Kapandji Technique, Distal Radius Fractures.

INTRODUCTION

others, the gold standard treatment method is still a
Distal radius fractures (DRF) are the most common
matter of discussion (4).
in adults. In the emergency room, it accounts for 17.5%
Kapandji was the first to identify a surgical
of all fractures (1). About 2.5 percent of all emergency
procedure that involved intrafocal pinning and provided
room visits are attributed to distal radius fractures (2).
unique fixation. Different from the standard method of
The trochanteric fracture is the most common
pinning, this procedure is unique in that the pins are
fragility fracture in persons over the age of 50. Women
implanted directly into fracture sites on both sides of the
have a 15 percent lifetime risk of distal radius fracture,
fracture line. Francophone countries have embraced this
while men have a 2 percent lifetime risk (3).
new method of teaching. By the late 1980s, it had
The frequency of DRF is gender-specific. DRF
become the standard treatment for distal radius fractures
commonly occurs in younger male patients as a result of
in those countries (5).
high-energy trauma, older women are more likely to
The purpose of this study was to examine the healing
suffer from DRF due to low-energy trauma, such as falls
and union of distal radius fractures after Kapandji's
from a standing height, than younger women (1).
technique of percutaneous fixation.
Osteopenia and osteoporosis are risk factors in

women with DRF with percentage of 85%, 52%
PATIENTS AND METHODS
respectively. For reasons not fully understood, DRF
This cross-sectional study included a total of
frequency is rising faster than the ages of the Western
twenty patients of both sexes, aged from 18 to 50 years
population. Changes in lifestyle, such as more physical
with distal radius fracture managed by K- wires using
exercise among the elderly, alone cannot explain this
Kapandji technique, at Zagazig University Hospitals
finding. The most frequent pattern of fracture is dorsally
and Al Farafra Hospital.
displaced distal radius fractures. Abraham Colles first

described this pattern in 1814, and named it after him (3).
Ethical Consideration:
Distal radius fractures have met different kinds of
This study was ethically approved by Zagazig
managements such as conservative treatment that first
University's ethical committee (ZU-IRB#6240). Ethics
Colle's described, external fixation, closed reduction and
guidelines for human experimentation were adhered to
cast immobilization, as well as closed reduction and
in accordance with the Helsinki Declaration of the World
percutaneous fixation with Kirschner wires and open
Medical Association. Written informed consent of all
reduction and internal fixation. There have been many
the subjects was obtained.
studies since their introductions to find out the

advantages of one over the other and although some of
Inclusion criteria: Patients who are skeletally mature
these treatment methods have known advantages among
and have extra-articular fractures of the distal radius are
admitted to the orthopedic department.

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493
Received: 13/10/2021
Accepted: 14/11/2021

Full Paper (vol.861 paper# 78)


c:\work\Jor\vol861_79 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 499-505

The Relationship between Serum Osteopontin level and Parameters of Chronic Kidney
Disease ­ Mineral Bone Disease in Patients on Regular Hemodialysis
Alaa M. Nawar*1, Yasser A. A. Elhendy2, Malak Nabil1, May M. Sami3, Ahmed M Salah2, Hala M. Allam2
1Theodor Bilharz Research Institute, Cairo, Egypt
2Department of Internal Medicine and Nephrology, 3Department of Clinical Pathology,
Faculty of Medicine, Zagazig University, Alsharquia, Egypt
*Corresponding author: Alaa M Nawar, Mobile: (+20) 01117597723, E-Mail: alaamnawar1291@gmail.com

ABSTRACT
Background:
Chronic Kidney Disease (CKD) is becoming a major health concern worldwide. For many patients, CKD
is associated with substantial morbidity and mortality. Osteopontin (OPN) is an extracellular matrix protein first identified
in bone tissue and has pleiotropic functions due to its common expression in the main organs and apparatuses. It is a
phosphorylated glycophosphoprotein composed of 314 amino acids, involved in biomineralization and remodeling.
Objective: This research aimed to assess the serum level of osteopontin in patients with end-stage renal disease (ESRD)
on regular haemodialysis and to correlate osteopontin level in patients with ESRD on hemodialysis with other biomarkers
CKD-MBD.
Patients & Methods: This Study was conducted on 160 participants that were divided into two groups. Control group
included 80 healthy subjects of both sexes, and patients group that included 80 ESRD patients on regular hemodialysis of
both sexes. All studied groups were subjected to osteopontin level by enzyme-linked immunosorbent assay (ELISA).
Results: Serum osteopontin levels were higher in ESRD patients on regular dialysis than in healthy individuals, where it
might have a higher predictive value for CKD development. Also, they were positively correlated with serum phosphorus,
serum alkaline phosphatase and serum parathyroid hormone, which are parameters of chronic kidney disease-mineral
and bone disorder.
Conclusion: Osteopontin may be considered an early marker of chronic kidney disease.
Keywords: Osteopontin, Kidney, Hemodialysis.

INTRODUCTION

OPN was also found to promote angiogenesis,
End-stage renal disease (ESRD) is the fifth stage
encourage growth and invasion of renal cancer, impact
of renal failure necessitating dialysis or kidney
the development of lupus nephritis in patients with
transplantation. Chronic kidney disease leads to
systemic lupus erythematosus, and potentially be useful
dysregulation of calcium (Ca2+), phosphorus (P),
as a marker of acute allograft rejection in kidney
parathyroid hormone (PTH), and vitamin D
transplants (4). Local increases in OPN in vessel walls
metabolism, resulting in biochemical laboratory
have been linked to atherosclerotic plaque formation,
abnormalities, significant bone disease, and/or vascular
inflammation within arteries, and smooth muscle
calcification that define chronic kidney disease­mineral
mineralization (5). The function of OPN in bone is
and bone disorder (CKD-MBD) (1). Even with careful
defined by its ability to anchor osteoclasts via the
monitoring of these markers, patients with ESRD on
v3 integrin. (6).
maintained hemodialysis have poorer health outcomes

related to mineral and bone disorder (MBD) such as the
PATIENTS AND METHODS
increased risk of developing cardiovascular disease and
Study design and population:
increased fracture risk (1). While obtaining abdominal
A case-control study was conducted at Internal
radiographs, computed tomography-based imaging, or
Medicine Department, Zagazig University Hospitals
dual-energy X-ray absorptiometry scans or performing
and Nephrology Department, Theodor Bilharz Research
a bone biopsy to help evaluate calcification and bone
Institute from February 2021 to August 2021 on end-
mineral density (BMD) status, the strength of
stage renal disease patients on regular hemodialysis and
recommendation of these practices is low (2).
apparently healthy subjects. Demographic information
Osteopontin (OPN) is a glycol-phosphoprotein
was collected. The enrolled number of the study was
found in bone, acute and chronic inflammatory cells,
160 participants.
smooth muscle, epithelial and endothelial cells, neurons

and fetal renal tissue and is expressed in the thick
The population of the study:
ascending limb of the loop of Henle. Some of its
This study included 160 subjects with different age
functions include increasing macrophage and T-cell
groups and of both sexes. Participants were classified
counts, the perpetuation of inflammation, wound
into two groups: Control group included 80 healthy
healing, tumor development and progression, roles in
subjects of both sexes with a mean age of 49.66 ± 19.96
diabetes, and possible roles in regulating nephrolithiasis
years old, and patients' group that included 80 patients
and nephrogenesis (3).
of both sexes with a mean age of 54.09 ± 15.6

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499
Received: 30/ 8/2021
Accepted:26 /10 /2021

Full Paper (vol.861 paper# 79)


c:\work\Jor\vol861_80 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 506-512

Diagnostic Value of Portal Venous Pulsatility Index in Patients with
High-Risk Nonalcoholic Fatty Liver Disease
Nadia Haleem Hamed*, Manal Farouk Al Tohamy, Amr Osama Khalil, Mohammed Ibrahim Amin
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Nadia Haleem Hamed, Email: nadiafadda1@gmail.com
ABSTRACT
Background:
As commonest form among liver diseases, nonalcoholic fatty liver disease (NAFLD) presents no
symptoms. It is possible to use regular ultrasound scanning, which are always available in medical care centers
everywhere, to quickly and quantitatively assess portal vein pulsatility. Objective: To evaluate the value of the portal
venous pulsatility index for noninvasively diagnosing nonalcoholic fatty liver disease who are at high risk.
Patients and Methods:
The trial was a comparative cross-sectional trial involving 145 NAFLD patients, conducted
in Radiodiagnosis Department, Faculty of Medicine, Zagazig University Hospitals. Abdominal ultrasound fibroscan,
and Doppler US examinations of portal venous system were done to all patients.
Results: Basal lab features, triphasic right hepatic vein flow pattern, and Doppler flow characteristics differed
significantly between the two groups. Except for the BARD score, there was a high statistically significant difference
between the two groups for venous pulsatility index values as well as all clinical risk scores. VPI, NAFLD-FS, and
FIB-4 odds ratios all showed high significant differences between the two groups. Optimism-Corrected ROC AUC
of VPI +NAFLD FS was 0.89, VPI + FIB-4 was 0.90, VPI+BARD score was 0.86 and VPI + APRI was 0.85. There
was a high significant difference regarding VPI +NAFLD FS & VPI + FIB-4.
Conclusion: High-risk NAFLD can be predicted using VPI and this could improve the effectiveness of frequently
used clinical predictor tools.
Keywords: Nonalcoholic fatty liver disease, Venous pulsatility index.

INTRODUCTION

critical in the treatment of NAFLD since it identifies the
As long as alcohol consumption isn't excessive,
patients who mostly in need of treatment and study (6).
it's possible to develop NAFLD, which is marked by fat
Liver biopsy is the gold standard for diagnosing
collection at parenchymal liver (known medically as
liver fibrosis. As a result of the procedure's invasiveness,
hepatic steatosis). Because of its prevalence and lack of
high cost, and danger of uncommon but serious
symptoms, NAFLD is the world's most common liver
consequences and sampling errors, it isn't used as a
conditions (1). Approximately 25.2% of people
screening tool (7). There are therefore several
worldwide have nonalcoholic fatty liver disease, and that
noninvasive methods of staging liver fibrosis, like serum
number rises to about 31.8% among Middle East
biomarkers, fibroscan, as well as clinical-laboratory
population. About 33% of Americans are affected,
decision aids, that have been developed, such as BARD
associated with metabolic syndrome's comorbidities,
score (body mass index), fibrosis-4 index (FIB-4), the
such as being diabetic, overweight or having high
NAFLD fibrosis score (NAFLD FS), AST to platelet
cholesterol. In diabetics, NAFLD affects roughly 60% of
ratio index (APRI), and aspartate aminotransferase to
those who have it (2), whereas in obese individuals, this
alanine aminotransferase ratio (AST/ALT). However,
number is increasing to 90 percent (3). As far as
these methods have drawbacks when employed in
nonalcoholic fatty liver disease develops, it encompasses
clinical practice (8).
several different types of liver damage, ranging from
Now, the most promising noninvasive way to
mild simple steatosis to severe steatohepatitis [non-
diagnose liver fibrosis is transient hepatic elastography
alcoholic steatohepatitis (NASH)], and cirrhosis as well
(THE). Rapidity and safety are the primary benefits of
liver fibrosis (4).
this procedure (9). In individuals with NAFLD, transient
There are five stages of fibrosis in NAFLD,
hepatic elastography outperformed APRI, FIB4 and the
according to the NASH Clinical Research Network
NAFLD fibrosis score when compared to the gold
(NASH CRN) classification scheme (5): Fibrosis types
standard, introducing the best performance for
include F Zero (where there is no fibrosis), F One (portal
diagnosing and excluding advanced fibrosis (10).
fibrosis without septa), F2 (portal fibrosis with low
As an ultrasound biomarker for liver fibrosis, one
number of septa), F3 (central vein bridging septa), and
of the most commonly used ones is the portal vein
F4 (cirrhosis) (5). When liver fibrosis progresses to stage
pulsatility index (VPI), which is a measurement of portal
F2 or higher, the long-term mortality and morbidity
vein duplex Doppler assessment and a quantitative
accompanied with the liver are significantly increased (5).
measure of venous pulsatility that is estimated by (Vmax
As a result, expression of high-risk NAFLD refers to
­ Vmin) / Vmax, the maximum pulsed-wave Doppler
people whose disease has progressed beyond the F2
ultrasonography estimate of blood velocity in the portal
stage. Monitoring for high-risk fatty liver disease is
vein is Vmax, whereas the minimum is Vmin. It is
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(


506
)
Received: 12/10/2021
Accepted: 15/11/2021

Full Paper (vol.861 paper# 80)


c:\work\Jor\vol861_81 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 513-517
Diagnostic Value of Angiopoietin-1 and -2 as Markers for Disease Severity in
Hemolytic Uremic Syndrome in Children
Magda Abdulaziz Ahmad Alakrea*1, Hatem Mohammed Hussein1,
Mohammed Abdel-Salam Gomaa1, Ahmad Mokhtar Ahmad Ibrahem2
Departments of 1Pediatric and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Magda Abdulaziz Ahmad Alakrea, Mobile: 01008204389, Email: drmagda@yahoo.com

ABSTRACT
Introduction:
Hemolytic uremic syndrome (HUS) is defined as a triad of microangiopathic hemolytic anemia (MHA),
thrombocytopenia, and acute renal failure. It is the most common cause of acute renal failure in children, and the
incidence of this syndrome is increasing worldwide. Angiopoietin-1 and -2 each competitively bind to the endothelial
Tie-2 receptor and play an important role in regulating endothelial cell function. The aim of this study was investigating
the clinical significance of serum levels of angiopoietin (Ang) 1 and 2 in enterohemorrhagic Escherichia Coli (EHEC)-
induced HUS and determining their correlation with disease severity.
Patients and Methods:
Forty eight children aged between 1-16 years were included in the study and were divided into
two groups, 24 patients with diagnosis of hemolytic uremic syndrome induced by EHEC infection and 24 healthy
children as a control group. Serum samples were obtained from healthy control group and patients with EHEC-induced
HUS at time of diagnosis. Serum samples from the patients were obtained for analysis for angiopoietin-1 and -2 by
enzyme-linked immunosorbent assay.
Results: Our findings indicated that, serum Ang-1 levels might be useful for the prediction of the development of HUS.
In HUS phase, in addition to more significant decrease of serum Ang-1 levels, serum Ang-2 level increased. These
changes might be useful for the diagnosis of HUS and also be useful as a marker of disease activity of HUS.
Conclusion: Serum angiopoietin-1 and angiopoietin-2 levels and the Ang-2/Ang-1 ratio may be promising indicators
of disease activity in HUS.
Keywords:
Angiopoietin 1 and 2, EHEC infection, Hemolytic uremic syndrome.

INTRODUCTION

Hemolytic uremic syndrome (HUS) is a severe
occur. Dialysis is needed because of severe renal
complication
of
Shigella
toxin­producing
damage in more than half of cases (3).
enterohemorrhagic Escherichia coli (EHEC) infection
Recent reports have highlighted the roles of
and it is a clinical syndrome characterized with the triad
cytokines and chemokines in the pathogenesis of
of
microangiopathy
hemolytic
anemia,
EHEC- induced HUS. 174 serum cytokines were
thrombocytopenia and acute renal damage (1).
detected and five serum biomarkers have been
Hemolytic uremic syndrome is the most common cause
identified to predict severity of EHEC-induced HUS.
of acute renal damage in children. The clinical finding
Among these biomarkers were angiopoietin (Ang)-2 (4).
in hemolytic uremic syndrome occurs as a result of
Angiopoietin-1 and -2 each competitively bind to the
thrombotic microangiopathy (TMA). The Pathological
endothelial Tie-2 receptor and play an important role in
lesion is thickening of arterioles and capillary walls,
regulating endothelial cell function (5).
endothelial swelling and detachment. Fibrin and
The aim of this study was investigating the clinical
platelet-rich thrombi leads to obstruction in the vascular
significance of serum levels of angiopoietin 1 and 2 in
lumen. Many tissues and organs including mainly the
EHEC-induced HUS.
kidney are affected(2).

Microangiopathic hemolytic anemia of HUS has the
PATIENTS AND METHODS
following properties (Hemoglobin <10 g/dl, frequently

This was a retrospective, analytical, case-
<8 g/dl, negative Coombs test, increased reticulocyte
control study. This study was carried out at Nephrology
count, increased serum lactic dehydrogenase (LDH)
Unit at Children Hospital, Pediatrics and Clinical
level, decreased serum hepatoglobulin level,
Pathology Departments, Faculty of Medicine, Zagazig
fragmented erythrocytes on peripheral blood smear
University over a period of 7 months from January 2020
(helmet cells, schistocytes). In thrombocytopenia the
to July 2020.
platelet
count
is
below
150,000/mm3

(commonly<40,000/mm3). Bleeding is rarely observed.
Enrollment:
In acute renal damage there are different degrees of
This study included 48 children aged between 1-16
renal involvement. Hematuria, proteinuria and
years divided into two groups, 24 patients with
increased serum creatinine are the most important
diagnosis of hemolytic uremic syndrome induced by
indicators of renal damage. Oliguria or oligoanuria may
EHEC infection who fulfilled the inclusion criteria of

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513
Received: 30/08/2021
Accepted: 26/10/2021

Full Paper (vol.861 paper# 81)


Detection of Subclinical LV dysfunction in Patients with Coronary Artery Ectasia Using 2D Speckle Tracking Echocardiography The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 518-525

Effect of Isolated Coronary Artery Ectasia on Left Ventricular
Global Longitudinal Strain
Mostafa Abdelmonaem*, Walaa Adel, Radwa Tarek, Viola William
Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Mostafa Abdelmonaem, Mobile: 0201020139399, Email: mostafaabdelmonaem@yahoo.com

ABSTRACT
Background
: Coronary artery ectasia (CAE), known as a dilatation of coronary segment to at least 150% of the diameter
of adjacent healthy segment. Despite the fact that coronary ectasia is under-treated angiographic finding, it has a
tremendous impact on patients mortality and morbidity. The hypothesis that isolated CAE is a cause of subtle left
ventricle (LV) systolic dysfunction needs intense and thorough research. Objective: To assess longitudinal LV functions
in patients with isolated coronary ectasia using 2 dimensional (2D) speckle tracking echocardiography. Patients and
Methods:
This study is a case control study conducted on two groups of patients referred to our tertiary centre for
elective coronary angiography. The first group included 30 consecutive symptomatic patients proved to have CAE
without obstructive coronary artery disease. The second group included 30 patients with normal coronary angiography
serving as a control group. Patients with any form of structural heart disease affecting LV systolic functions were
excluded, echocardiographic evaluation was held for every patient targeting 2D assessment of systolic and diastolic
functions, tissue Doppler measurements and finally offline 2D speckle tracking for assessment of global LV longitudinal
strain. Results: Males were more dominant in CAE group. Hypertension and dyslipidemia were more prevalent in CAE
group unlike diabetes that was more common among control subjects. LV volumes, dimensions, mass index, left atrium
(LA) volume index and aortic root diameter were significantly higher among CAE group. Mean global longitudinal
strain was significantly lower in CAE group with value of (-16.5%) versus (-19.5%) in control group. Conclusions:
Global longitudinal strain is significantly reduced in patients with CAE even in the absence of obstructive coronary
artery disease denoting subclinical LV systolic dysfunction.
Keywords:
Coronary, Ectasia, Speckle tracking, Strain.

INTRODUCTION

of stagnant flow include delayed antegrade contrast
Coronary artery ectasia (CAE) is defined as
filling, a segmental back flow phenomenon and local
dilatation of arterial segment to at least 1.5 times the
stasis of dye (9, 10).
diameter of the adjacent healthy segment, involving at
The clinical presentations of patients affected by
least 1/3 of the whole arterial length (1). It is seen in
CAE include a variety of manifestations that range
approximately 1.5-5% of patients who underwent
from angina and myocardial infarction to sudden
coronary angiography with male to female ratio of 3:1
cardiac death. Stable angina is the most common
(2,3).
presentation, and approximately 20% of symptomatic
20-30% of cases of CAE are considered
patients required repeated hospital admission (11).
congenital, 50% were attributed to atherosclerosis, 20%
Patients with isolated CAE without obstructive CAD
were linked to connective tissue disease as Ehlers-
had positive results during myocardial perfusion
Danlos, Kawasaki, Scleroderma and bacterial infections
imaging and treadmill exercise tests. Disturbance of
(4-6).
the coronary flow and diseased microvasculature are
Definite pathophysiology of disease is not well
possible pathophysiological mechanisms for
defined, however, many postulations existed, including;
myocardial ischemia in those patients (12-14).
endothelial dysfunction, micro-vascular disease,
Complications such as thrombus formation, distal
oxidative stress, inflammation, enhanced platelet
embolization, and rupture can occur. Coronary artery
activity and exaggerated positive vascular remodeling
ectasia may rarely break through into the right atrium,
(7).
right ventricle, or coronary sinus, creating left-to-right
Coronary ectasia is most likely an extreme type of
shunts (15-18).
atherosclerotic plaque growth-induced expansive
The main stay of treatment relies on anti-platelets
vascular remodeling. The enzymatic degradation of the
and anticoagulants with appreciable role of high dose
medial extracellular matrix, which appears to be a
statins (19, 20). Administration of nitrates may provocate
fundamental pathologic process, is influenced by a
anginal pain in patients with CAE and should not be
number of variables (8).
administered (14). In patients with coexisting obstructive
Alterations in blood flow filling and washout are
CAD with limiting symptoms, despite optimal medical
core features of CAE. They represent the direct outcome
therapy, invasive treatment can be offered as
of inappropriate coronary dilatation and are linked
percutaneous
coronary
interventions.
directly to the severity of CAE (9). Angiographic signs

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518
Received: 01/09/2021
Accepted: 27/10/2021

Full Paper (vol.861 paper# 82)


c:\work\Jor\vol861_83 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 526-531
Laparoscopic versus Open Surgery for Treatment of Colorectal Cancer
Yasser Mohammad Abd-elshafy*, Islam Mohammad Mohammad,
Hazem Nour Abdelatif Ashry, Mohammad Abdullah Zaitoun
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Yasser Mohammad Abd-elshafy, Mobile: (+20) 01005418407,
E-mail: yaser_7835@yahoo.com

ABSTRACT
Background
: Colorectal cancer (CRC) is the fourth most frequently diagnosed cancer in United States and has the
second highest cancer related mortality rate after lung cancer. Cancer of the colon is equally frequent in men and women
while cancer of the rectum occur 20-50% more frequently in men. This study aimed to compare the outcome of
laparoscopic and open approach in surgical management of colorectal carcinoma and to better selection of the best
procedure for treatment of colorectal cancer.
Patients and Method
: This prospective randomized study included 18 cases who underwent colorectal surgeries during
the period October, 2019 till October, 2020 in the Surgery Unit at Zagazig Faculty of Medicine. These patients were
subdivided into equal two groups: 9 cases underwent the open approach while the remaining 9 cases underwent the
laparoscopic approach, with a period of one year follow up postoperative. Results: Intraoperatively, the laparoscopic
group showed some cons like total operative time (p = 0.001) and time needed for dissection (p < 0.001), which were
significantly higher when compared to the open group. In the postoperative period, close monitoring of all clinical and
laboratory parameters was performed with bedside imaging by ultrasound in indicated cases. The laparoscopic group
took the upper hand over open group regarding day of first motion, when to start oral intake and hospital stay (p =
<0.001, <0.001 and 0.002 respectively).
Conclusion
: Analysis of the scientific literature confirmed that for the curative treatment of colon and rectal cancer,
laparoscopy is not inferior to open surgery with respect to overall survival, disease-free survival and rate of recurrence.
Keywords
: Colorectal cancer, Laparoscopic surgery, Oncologic outcomes, Traditional surgery.

INTRODUCTION
Laparoscopic resection should result in the
Colorectal cancer is the slowly developing
removal of the colon or rectal segment containing the
cancer that begins as a tumor or tissue growth on the
tumour and associated lymphatic drainage to the same
inner lining of the rectum or colon(1). It is the third most
extent as open surgery. Surgery can be performed
common form of cancer and the second leading cause
entirely by laparoscopy, be laparoscopy-assisted
of cancer related deaths in the western world; with 1.65
(anastomosis is then performed extracorporeally) or be
million new cases and 835,000 case of death in 2017(2).
hand-assisted (in which case a sufficiently long incision
Surgery is the only curative therapy for
is made to allow the surgeon's hand to enter the
colorectal cancer(3).
abdominal cavity). For all 3 strategies, the abdominal
Curative surgery requires resection of the
wall incision should be protected to prevent tumour
primary tumour with negative margins and a complete
dissemination(6).
oncologic lymphadenectomy. The resected colic
The aim of this study was to compare the
segment depends on vascularization and lymphatic
outcome of laparoscopic and open approach in surgical
drainage at the tumour site and, according to the
management of colorectal carcinoma and to better
American Joint Committee on Cancer, a minimum of 12
selection of the best procedure for treatment of
lymph nodes should be retrieved in surgical
colorectal cancer.
specimens(4).

The surgical approach for colorectal cancer is
PATIENTS AND METHODS
affected by tumour stage and localization. Generally, 6
This current observational retrospective study was
types of resection can be performed: right
conducted in Surgery Unit at Zagazig Faculty of
hemicolectomy, left hemicolectomy, extended right
Medicine among 18 patients who underwent
hemicolectomy, extended left hemicolectomy, anterior
laparoscopic or open surgery for colorectal cancers in
resection of the sigmoid, or abdominoperineal resection.
the time period from October 2019 to October with a
Traditionally, colorectal cancer resection has been
period of one year follow up postoperatively.
performed exclusively through open surgery. However,
These patients were subdivided into equal two
following successful laparoscopic procedures, such as
groups: 9 cases underwent the open approach while the
cholecystectomy, appendectomy and treatment of
remaining 9 cases underwent the laparoscopic
incisional hernias, this surgical approach has gradually
approach.
been introduced first in the treatment of colon cancer
Inclusion criteria: Age from 18 to 80 years old, all
and then in the treatment of rectal cancer(5).
sexes, and operable patients.

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526
Received: 01/09/2021
Accepted: 27/10/2021

Full Paper (vol.861 paper# 83)


c:\work\Jor\vol861_84 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 532-537

Hyperchloremia in Critically Ill Patients in ICU: Review Article
Fawzy Abbas Badawy, Ahmed Alsaied Abdelrahman Ali,
Nehal Samir Esmail*, Abdel-hady Ahmed HelmyAbdelhady
Departments of Anesthesia ICU and Pain management, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Nehal Samir Esmail, Mobile: (+20)01019251143, E-Mail: nehalsamir98@gmail.com

ABSTRACT
Background:
Chloride (Cl) is required for the regulation of blood pressure, renal function, gastrointestinal homeostasis
and decarboxylation/gas transport. "Dyschloremia" or levels of serum Cl beyond the normal range, is a frequent
occurrence in intensive care units and seems to be mostly caused by iatrogenic procedures (i.e. intravenous infusion of
fluids rich in Cl). Hypochloremia and hyperchloremia seem to be related to high risk of death in specified intensive care
unit (ICU) groups, although the data is inconclusive. Hyperchloremia may be associated with higher hemodynamic
unstable changes and need for vasopressors, in addition to hyperchloremic metabolic acidosis (e.g., following major
surgeries). Nonetheless, the direct or indirect mediation of these effects is still uncertain. Additionally, new research
suggests that individuals with advanced hyperchloremia have a higher risk of acute renal damage and require renal
replacement treatment. Objective: The purpose of this study was to describe significant chloride-related outcomes in
critical illness and to evaluate their relevance for everyday clinical practice and therapeutic alternatives. Conclusion:
One may conclude that the concern about understanding the impact of chloride disorders on negative outcomes is rising;
there seems to be a link between chloride disorders and negative outcomes, particularly death, in the ICU setting; one
could theorize the need to rationalize the use of solutions with electrolyte components separate from the physiological
solutions; and consider the presence or the development of hyperchloremia as a prognostic factor, without taking into
consideration the severity of the critical patient.
Keywords: Hyperchloremia, Dyschloremia, Treatment of hyperchloremia.

INTRODUCTION
Hypertonic saline administration: Drowning in
Hyperchloremia is common in critically sick
saltwater.
patients, with evidence indicating that it may occur in
Losses of net water: Perspiration (excessive
between 25%­45% of ICU patients; nevertheless, it
sweating), fever, diabetes insipidus, and inadequate
appears not to be mentioned in earlier studies or
water intake.
textbooks(1).Temporary hyperchloremia occurs in
Water loss due to an excess of electrolytes: Some
around 75% of ICU patients within the initial 24 hours
types of diarrheas, osmotic diuresis, and some
of their hospitalization. Despite its relatively high
instances of post-obstructive diuresis.
occurrence in critically sick patients, insufficient data
Metabolic acidosis-associated hyperchloremia:
on the outcome of systemic chloride levels are
Some types of diarrheas, carbonic anhydrase
available. According to current evidence, higher illness
inhibitors, acidosis of the renal tubules, intake of
severity is often related with aberrant chloride levels(2).
ammonium chloride (NH4Cl), ureteral diversion

(e.g., ileal bladder), consumption of lysine
Definition of "dyschloremia":

hydrochloride or arginine, some types of chronic
Hypochloremia is often described as serum Cl
renal disorders, and organic acidosis that results in
concentrations of less than 96­101 mmol/l.
rapid excretion of acid anion (e.g. toluene
Typically, hyperchloremia is characterized as
overdose).
serum Cl concentrations more than 106­111
Respiratory alkalosis(5).
mmol/l.

The definition differs by laboratory. Chloride
Pathophysiology:
levels are inextricably linked to the body's water contact
Hyperchloremic metabolic acidosis (HMA) is a
and are very vulnerable to plasma changes in
clinical condition that occurs due to the loss of
contraction or dilution(3).
bicarbonate rather than the generation or retention of

acid. Loss of bicarbonate happens in a number of
Causes of hyperchloremia:
mechanisms that result inHMA: renal causes,
Pseudohyperchloremia:
When
procedures
gastrointestinal (GI) causes, and exogenous reasons(6).
requiring sample dilution are utilized, large
Gastrointestinal causes:
volumes of serum solids (proteins or lipids) are
Pancreatic fistula, nasojejunal tube suctioning
produced. Bromide or iodide poisoning(4).
from the duodenum, severe diarrhea and prolonged
Excessive administration of chloride: Consuming
laxative usage all result in GI bicarbonate loss.
a large amount of 0.9% (isotonic) NaCl solution.
Normally, some bicarbonate is released into the
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532
Received: 01/09/2021
Accepted: 27/10/2021

Full Paper (vol.861 paper# 84)


c:\work\Jor\vol861_85 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 538-540

Mechanical Ventilation in Critically Ill Patients in ICU: Review Article
Fawzy Abbas Badawy, Ahmed Alsaied Abdelrahman Ali, Nehal Samir Esmail*,
Abdel-hady Ahmed Helmy Abdelhady
Departments of Anesthesia ICU and Pain Management, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Nehal Samir Esmail, Mobile: (+20)01019251143, E-Mail: nehalsamir98@gmail.com

ABSTRACT
Background:
Mechanically ventilating is frequently performed life-saving procedure in the emergency room (ER).
With the duration of stay of ventilated patients in ERs rising, it is critical for emergency physicians to have a firm grasp
on procedures for optimizing mechanical ventilation and minimizing consequences. Numerous positively
pressured ventilation techniques are available; they are derived from different permutations of triggered volume- and
pressure-cycled ventilations and supply ventilation at a variety of rates, pressures and volumes. Inadequate ventilatory
treatment may result in significant respiratory and extrapulmonary injury that may go undetected.
Objective:
The aim of this review article was to highlight mechanical ventilation in critically ill patients in ICU.
Conclusion: Non-invasive ventilation is an excellent first-line therapy for hypoxemic or hypercapnic respiratory failure
in critically ill patients, failure of non-invasive ventilation necessitates introduction of intubation and invasive
mechanical ventilation as second line therapy.
Keywords: Intubation, Invasive ventilation, Mechanical ventilation, Noninvasive ventilation.

INTRODUCTION
off the ventilator. The observations indicated a much-
The requirement for ventilatory assistance is
increased incidence of weaning failure. This is related
among the most frequent reasons for intensive care unit
with a prolonged length of ventilation and the sequel
(ICU) admission. The ICU known today was born
that accompany it. However, there are several elements
when mechanical ventilation was introduced into
that contribute to effective weaning(5).
medical practice in the 1940s. In spite of its use,
Weaning was significantly affected by the
mechanical
ventilation
has
been
extensively
duration of mechanical ventilation. The longer a patient
acknowledged for its detrimental impact on the lungs.
is ventilated during their ICU stay, the lower the
Thus, while deciding whether to mechanically ventilate
likelihood of the weaning process occurring. This
a patient, the main reason for ventilatory assistance and
discovery, however, should be regarded cautiously. It
its reversibility must be considered. Additionally, the
may be due to unclear if prolonged ventilation caused
ventilation objective and hence the optimal method of
difficulties with weaning or whether a lack of judgment
ventilation must be determined for each patient in order
on weaning resulted in prolonged ventilation(6).
to maximize benefit and minimize adverse effects(1).
Blackwood and colleagues previously
Mechanical ventilation is indicated for a variety
determined that using an uniform weaning approach in
of reasons, which have historically been classified as
the intensive care unit resulted in a decrease in
hypoxia
and
ventilatory
respiratory
failures.
mechanical breathing time. As a result, it is prudent to
Respiratory distress, blockage of the airway, decreased
undertake a ventilated weaning procedure(7).
or inadequate respiratory drive, irregular chest wall, and
The treatment of critically sick patients
respiratory muscle exhaustion are among factors that
necessitating
mechanical
ventilation
requires
lead to respiratory failure. It should be highlighted,
considerable time and resources. These individuals need
however, that the main rationale for ventilation must be
specialized treatment and are at an increased risk of
curable to enable sooner weaning off(2).
unfavorable outcomes. Inadequate monitoring and/or
Previously, the effect of mechanical ventilation
care of the individuals may constitute a significant risk
was investigated. Esteban and colleagues described
to patients' safety, resulting in issues and bad results(8).
the characteristics and results of mechanically
Critical sickness management is currently
ventilated adult patients. They discovered that 33% of
regarded as a continuum that starts with prehospital
the admissions to the ICU were on mechanical
treatment and progresses through emergency
ventilation and that "survival relied on both variables
department intervention to ICU admission and
existing at the time of mechanical ventilation initiation
managing. However, in the emergency department,
and patient treatment in the ICU"(3, 4).
physician engagement with this group of high-risk
Taking the patient off ventilator assistance is
patients may vary. Additionally, emergency rooms
termed as weaning a patient off mechanical ventilation.
often lack the resources and staff necessary for long-
The choice of weaning a patient off the ventilator is
term care of the seriously sick(8).
determined by the attending clinician's clinical
Emergency doctors and nurses have little
judgment. Up to 20% of patients on mechanical
training in the continuous treatment of patients who are
ventilation in the ICU had recurring problems weaning
ventilated invasively or noninvasively, especially in
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538
Received: 02/09/2021
Accepted: 28/10/2021

Full Paper (vol.861 paper# 85)


c:\work\Jor\vol861_86 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 541-547

Multidrug Resistant Acinetobacter Species Infection among Neonatal Sepsis
Mohamed Mamdouh Gaafar1, Azza Ali Khalil1, Ahmed Anwr Shaheen2, Eman Mohamed Kamel*1
Departments of 1Pediatrics and 2Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Eman Mohamed Kamel, E-mail: whiteheart2013@yahoo.com

ABSTRACT
Background
: Neonatal septicemia is regarded as one of the leading causes of mortality as well as morbidity
globally. There is emerging evidence that multidrug resistant Acinetobacter baumannii (MDRAB) and mortality
are linked in the scientific literature.
Objective: It was the goal of this work to improve the prognosis of neonates with Acinetobacter species through early
detection of infection and risk factors associated with increased mortality and effective management.
Patients and Methods: Our study was done on 60 neonates who were suspected to having sepsis at Zagazig
University Hospitals, Pediatric Department. All neonatal blood samples were taken aseptically and the bacteria that
caused septicemia were identified. Acinetobacter species were identified. Drug sensitivity tests were performed on
a variety of risk variables.
Results: Only nine patients had Acinetobacter infection (15% of all patients) and two thirds of them had multi drug
resistance (resistant for 3 antimicrobials). Gestational age more than or equal 36 weeks was protective factor
against getting infection with MDR-Acinetobacter among the studied patients. Acinetobacter was most sensitive to
ciprofloxacin and tigecycline antibiotic, while it was most resistant to sulphamethoxazole/trimethoprim antibiotics
Conclusion: Neonatal MDR Acinetobacter septicemia is on the rise, and it's connected with high morbidity as well
as mortality rates. There must be an infection control policy in place at every neonatal intensive care unit (NICU)
in order to control Acinetobacter infection and enhance outcomes.
Keywords: Multidrug Resistant Acinetobacter, Neonatal sepsis.

INTRODUCTION

If a newborn child is diagnosed with sepsis, they
catheterization, as well as parenteral nutrition, are
have a bloodstream infection that is less than 28 days
known risk factors for Acinetobacter spp. infection
old. Neonatal morbidity as well as mortality continue
induced sepsis (4). Mortality has been linked to MDR
to be a major problem in low and middle-income
Acinetobacter baumannii (MDRAB) in the recent years
countries. Based on the period of manifestation after
literatures (5).
birth, neonatal sepsis can be separated into two types:

Neonatal
Acinetobacter
infection
is
early-onset sepsis (EOS) in addition to late-onset
associated with a significant death rate, however there
sepsis (LOS). Neonatal sepsis occurring within the first
is a lack of research pinpointing the elements that
72 hours of life (some specialists use 7 days) is referred
contribute to this (6). Bacterial pathogen Acinetobacter
to as EOS, while sepsis happening at or after the last
baumannii is an opportunistic hospital-acquired
72 hours of life is referred to as LOS (1).
infection-causing pleomorphic, nonmotile Gram-
In neonatal intensive care units (NICUs),
negative bacillus, as well as aerobic organisms (7).
identifying and treating sepsis is a major issue for
Infections such as meningitis, wound infections,
neonatologists. Nonspecific symptoms and indications
urinary tract infections, bacteremia and lower
make it difficult to make a clinical diagnosis. As a
respiratory tract can be caused by it. Antibiotic-resistant
result, laboratory testing is a time-consuming process.
strains of Acinetobacter baumannii have spread around
When a patient is suspected of having sepsis, it is
the globe in a short period of time. Bacteria resistant to
imperative to begin empirical antibiotic therapy
three or more of the following types of antimicrobials
immediately. As a result, the number of treatment
are known as multidrug resistant Acinetobacter
alternatives is decreasing and the time it takes for an
baumannii (MDRAB): aminoglycosides, penicillins,
effective treatment is increasing (2).
fluoroquinolones, antipseudomonal, carbapenems,
Additionally, Acinetobacter spp. are becoming
cephalosporins, beta-lactamase inhibitors, polymyxins,
increasingly important as a possible pathogen in
and tetracycline, folate pathway inhibitors. Pandrug-
neonatal septicemia due to their frequent isolation,
resistant to qualify as Acinetobacter baumannii, one
antibiotic resistance, and greater fatality rates compared
must be resistant to all of these categories (8).
to Klebsiella and Salmonella spp. (3).
It was the goal of this work to improve the
Acinetobacter spp. is generally considered to be a
prognosis of neonates with Acinetobacter species
low-virulence
organism,
but conditions like
through early detection of infection and risk factors
immunocompromised
status,
critical
illness,
associated with increased mortality and effective
prematurity, broad-spectrum antibiotic therapy,
management.
endotracheal intubation, low birth weight, intravascular


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541
Received: 12/10/2021
Accepted: 16/11/2021

Full Paper (vol.861 paper# 86)


c:\work\Jor\vol861_87 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 548-554

Diagnostic Value of Ascitic Fluid Homocysteine and Calprotectin in
Cirrhotic Patients with Spontaneous Bacterial Peritonitis
Amr Ahmed Hamed ¹, Khairy Hammam Morsy ¹, Laila Mohammad Yousef 2
, Mohamed Ramadan Izzaldin 3, Asmaa Naser Mohammad ¹
¹ Tropical Medicine and Gastroenterology Department, 2 Clinical Pathology Department, Faculty of Medicine, Sohag
University,3 Clinical Pathology Department, Faculty of Medicine, El-Azhar Assuit University, Egypt
Corresponding author: Amr Ahmed Hamed, E-mail: amr.hamed@med.sohag.edu.eg
Tel: 02/01007065530

ABSTRACT
Background and study aim:
Spontaneous bacterial peritonitis (SBP) is mainly diagnosed by ascitic
polymorphonuclear (PMNL) leukocyte greater than 250/mm3. We intended to assess ascitic homocysteine and
calprotectin for SBP diagnosis.
Materials and methods: In our study, we collected ascitic fluids from 70 patients with liver cirrhosis (46 SBP plus
24 non-SBP according to PMNL>250 cells/mm3). Complete blood count, alanine aminotransferase, aspartate
aminotransferase, serum albumin, total bilirubin, prothrombin time, INR, and serum creatinine were measured.
Ascitic fluid sample was taken for chemical analysis, homocysteine was calculated in ascites by human homocysteine
enzyme-linked immunosorbent assays (ELISA) kits and calprotectin was measured in the ascitic fluids using available
human calprotectin enzyme-linked immunosorbent assays (ELISA) kits.


Results: SBP patients had considerably greater ascitic homocysteine levels than non-SBP (5.66± 7.15 vs. 2.97±.61
mol/l) P=0.001. Homocysteine at a cut-off of 3.6 mol/l had 91.7% specificity, 69.9% sensitivity, PPV 94.1% and
NPV 61.1% for SBP diagnosis (area under the curve: 0. 754). SBP patients had considerably greater ascitic
calprotectin than the non-SBP (182.98± 76.27 vs. 118.1± 27 ng/mL) P=0.000. Using a cut-off 142 ng/mL, calprotectin
had 91.7% specificity, 71.7% sensitivity, PPV 94.2% and NPV 62.9% for SBP diagnosis (area under the curve: 0.768).
Conclusion: We found that ascitic homocysteine and calprotectin can be suitable diagnostic markers for SBP
diagnosis.
Keywords: Calprotectin, Homocysteine, Liver cirrhosis, SBP.

INTRODUCTION

Spontaneous bacterial peritonitis (SBP) is a
to manually count PMN in ascitic fluid affects the
common consequence in cirrhotic patients. It is about
diagnosis [5]. So, finding novel biomarkers may help in
10 to 30% in cirrhotic patients with ascites at
SBP diagnosis and treatment [6].
hospitalization and nearly 50% develop along the stay,
Homocysteine is an amino acid which present
with a rate of mortality of around 20-30% according to
in small amounts in human cells. Homocysteine may
many circumstances [1].
present as disulfide proteins or freely. Free form is
SBP means infection of ascites without
about 1­2%
surgical cause as visceral perforation or intra-
from the overall homocysteine, while protein-bound
abdominal inflammation such as abscess, acute
homocysteine is about 80%, mainly to albumin [7].
pancreatitis [2].
Calprotectin.is.an.acute.phase.inflammatory
Patients with cirrhotic ascites must have a
protein, which has regulatory and antimicrobial
diagnostic paracentesis when admitted for the first
functions and related to the neutrophils influx [8].
time and/or if there are signs of infection,
Ascitic calprotectin can predict polymorphonuclear
encephalopathy, hypotension, GIT hemorrhage, and
leukocytes (PMNs) count more than 250/mm3, that can
deterioration of liver or kidney function [3].
help in SBP diagnosis [9].
It was established that late SBP diagnosis is
All markers for SBP diagnosis present
connected to a higher mortality rate. So, a precise
dissimilar sensitivities and specificities and are not
marker for the early SBP diagnosis would be of great
routinely applied in all laboratories. So, we have to
help. SBP is diagnosed if ascitic fluid neutrophils are
find a new, dependable, and accessible indicator for
> 250/mm3 [4].
SBP diagnosis.
PMNs lysis during transfer to the laboratory
We tried to assess ascitic homocysteine and
can cause false-negative results. The operator's ability
calprotectin in diagnosis of SBP.

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548
Received: 6 /9 /2021
Accepted: 2 /11 /2021

Full Paper (vol.861 paper# 87)


c:\work\Jor\vol861_88 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 555-560

Prolongation of Corrected QT Interval in
Diabetic Patients with Ketoacidosis
Ahmed M, Hussein1, Hala Abdel Moniem*1, Ahmed Bendary2, Amira K. El-Alfy1
Departments 1Internal Medicine and 2Cardiology, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Hala Abdel Moniem, Mobile: (+20)1003295100, E-Mail: halaabdelmonem22@gmail.com

ABSTRACT
Background
: Diabetic ketoacidosis (DKA) is the most common acute hyperglycemic complication of diabetes.
According to a recent report DKA affects approximately 8 per 1000 diabetics annually. It is associated with significant
morbidity and mortality, with a worldwide mortality rate of 2-10%.
Objective:
The aim of the work was to assessment of QTc interval prolongation among patients with DKA.
Patients and Methods: This prospective observational cohort study included 100 patients who were diagnosed with
DKA. The mean age of patients was 37.29±11.63 years, and 53% of them were males. All patients were subjected to
detailed history taking, full clinical examination, laboratory investigations and 12-lead ECG.
Results: Frequency of Prolonged QTmaxc amongst studied patients was 59%. Mean QTmaxc declined significantly
after treatment to be 414.6±44.1ms compared to 482.45±63.56ms before treatment with p<0.0001 and Frequency of
prolonged QTmaxc was significantly decreased with treatment from 59% to 20%. Anion gap was significantly higher
for Prolonged QTmaxc patients compared to normal QTmaxc patients p<0.0001. While ABG (PH, HCO3) were
significantly lower for Prolonged QTmaxc patients compared to normal QTmaxc patients p<0.0001. Logistic
regression revealed that anion gap was significant independent risk factor for QTmaxc prolongation while.
Conclusion: patients with DKA have a potential risk of QTmaxc interval prolongation due to acidosis regardless
electrolytes abnormalities, and associated with a relative risk of 1.732-fold for mortality. Carful measuring of anion
gap at time of admission can be used in diagnosis and prediction of occurrence of prolonged QTmaxc with high
sensitivity and specificity.
Keywords: Prolongation, QT Interval, Diabetes mellitus, Ketoacidosis

INTRODUCTION

accessible by digital ECG as a simple, low-cost
Diabetes mellitus is a global healthcare burden
measure to predict all-cause and cardiovascular
because the prevalence of this common disease is
mortality in emergency and intensive care units (4).
increasing significantly. Urbanization and economic
During DKA, ketosis or acidosis may directly
trend are the two major factors influencing the
affect cardiac repolarization with prolongation of QTc
prevalence of diabetes, which differs among several
interval, leading to arrhythmia and cardiac arrest (5).
population groups. There is a close link between
Most of the previous studies had reported prolongation
diabetes
and
cardiovascular
diseases,
and
of QTc interval in children during DKA with a
Electrocardiogram (ECG) is a routine cardiac
suggestion of whether ketosis or acidosis may directly
examination (1). Diabetic ketoacidosis (DKA) is the
affect cardiac repolarization and cause arrhythmia and
most common acute hyperglycemic complication of
cardiac arrest during DKA, but few data were reported
diabetes. According to a recent report DKA affects
in adult (5,6).
approximately 8 per 1000 diabetics annually. It is
The aim of the work was to assessment of QTc
associated with significant morbidity and mortality,
interval prolongation among patients with DKA.
with a worldwide mortality rate of 2-10% (2).

Cardiac arrest has been described as a
PATIENTS AND METHODS
complication of DKA and is often attributed to
This prospective observational cohort study
electrolyte disturbances such as hyperkalemia or
included a total of 100 patients with DKA, attending
hypomagnesemia. Ventricular arrhythmias including
at medical ICU, Benha University Hospitals. This
bigeminy and trigeminy have been described and there
study was conducted between March 2020 to February
are multiple reports of sudden death while asleep in
2021.
patients with diabetes mellitus which have been

attributed to possible malignant arrhythmias (3).
Inclusion criteria:
QT interval in ECG is measured from the
Patients admitted to medical ICU with diagnosis of
beginning of QRS complex to the end of the T wave,
DKA.
as a measure of `electrical' ventricular contraction time
Patients aged 18 years old.
and is highly dependent on heart rate. Therefore, QT
DKA was diagnosed by all of the following
interval length corrected by heart rate (QTc interval) is
criteria: plasma glucose more than 250 mg/dl,
used in clinical practice. This interval is easily
arterial pH of less than or equal to 7.30,

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555
Received: 11/10/2021
Accepted: 15/11/2021

Full Paper (vol.861 paper# 88)


c:\work\Jor\vol861_89 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 561-565

The Association between Helicobacter Pylori Infection and
Hyperemesis Gravidarum
Youssef Abu Elwan Elsayed, Ali Elshabrawy Ali,
Walid Abdullah Abd Elsalam, Mustafa Mohamed Osama El-Masry
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mustafa Mohamed Osama, Mobile: (+2) 01015958485, Email: mostafamohamedelmasry@gmail.com

ABSTRACT
Background:
Hyperemesis gravidarum (HG), a disorder characterized by ongoing severe nausea and vomiting with
resulting ketosis, affects 0.3­2% of women during pregnancy. Helicobacter pylori (H. pylori) infection is one of the
most common and endemic human infections worldwide, causing a number of very common and important
gastrointestinal problems.
Objective: We aimed to find the association between H. pylori infection and hyperemesis gravidarum.
Patients and Methods: This prospective case control study was conducted at Manshiet El-Bakry General Hospital from
October 2020 till June 2021 and performed on 32 patients who had a clinical diagnosis of hyperemesis gravidarum in
the first trimester and 32 normal pregnant women who served as control group
Results: Our results revealed that Helicobacter pylori stool antigen was significantly more frequent in hyperemesis
gravidarum group.
Conclusion: As evident from the current study, there was a strong association between H. pylori infection and HG,
allowing us to conclude that H. pylori should, therefore, be considered as one of the risk factors of HG pointing to H.
pylori as one contributing factor of this complication of pregnancy. H. pylori testing should be included in investigations
of HG, especially when the condition does not respond to treatment and in cases continuing past the first trimester.
Appropriate therapeutic non-teratogenic regimens for eradication of H. pylori could be considered to relieve the
symptoms of HG in some intractable cases.
Keywords: Association, Helicobacter Pylori Infection, Hyperemesis Gravidarum.


INTRODUCTION


Hyperemesis gravidarum (HG), a disorder
The aim of this study was to find the relation between
characterized by ongoing severe nausea and vomiting
H. pylori infection and hyperemesis gravidarum.
with resulting ketosis, affects 0.3­2% of women during

pregnancy (1).
PATIENTS AND METHODS
Those affected lose over 5% of their
This prospective case-control study was performed on
prepregnancy weight. Hyperemesis gravidarum can
pregnant women with gestational age within the first
also result in dehydration, nutritional deficits, ketonuria,
trimester at Manshiet El-Bakry General Hospital
ketonemia, irregularities in the electrolyte, and acid­
starting from October 2020 till June 2021.
base balance, and, in the most severe cases, even death

(2).
Study population: First trimesteric pregnant women
Helicobacter pylori (H. pylori) infection is one of
divided into two groups:
the most common and endemic human infections

worldwide, causing a number of very common and
Study Group: included 32 pregnant women who had a
important gastrointestinal problems such as peptic
clinical diagnosis of hyperemesis gravidarum. Control
ulcer, chronic gastritis, and gastric cancer. Several case
Group: included 32 pregnant women who had normal
control studies demonstrated strong association
pregnancy without symptoms of nausea and vomiting.
between HG and H. pylori infection (3).

With pregnancy comes a rise in the risk of H.
Patients' inclusion criteria: Pregnant women who had
pylori, and the rate of H. pylori infection in pregnant
a clinical diagnosis of hyperemesis gravidarum.
women differs based on geographical region and
Singleton pregnancies. Gestational age within the first
socioeconomic conditions. Even the technique used for
trimester. The fetus is alive with regular heart beats by
H. pylori testing can affect H. pylori prevalence (4).
ultrasound, and confirmation of infection of H. pylori
Various mechanisms have been suggested to
by detection of H. pylori antigen in stool
explain the link between H. pylori infection and

undesirable effects during pregnancy. These include
Exclusion criteria: Gestational age 13 weeks of
anemia, low blood platelet count, intrauterine fetal
gestation or more. Uncertain gestational age. Mothers
growth restriction, and miscarriage (2).
who had any chronic medical diseases. Infants with


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561

Received: 04/09/2021
Accepted: 30/10/2021

Full Paper (vol.861 paper# 89)


c:\work\Jor\vol861_90 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 566-569

Preoperative Unrestricted Clear Fluid and Association with
Postoperative Nausea And Vomiting: Review Article
Ahmed Mohammed Salama, Doaa Mohammed Farid,
Heba Helmy Mohammed*, Rehab Abd-Allah Wahdan
Department of Anesthesia & Surgical Intensive Care, Faculty of Medicine, Zagazig University, Egypt
*Corrspionding author: Heba Helmy Mohammed, Email: dr.hebahelmy09@gmail.com

ABSTRACT
Background
: One of the most distressing side effects of general anaesthesia is postoperative nausea and vomiting
(PONV). Recovery room and hospital stay and overall health care costs can be increased by PONV. Reduced frequency
of PONV is still significant even after the introduction of shorter surgical procedures, shorter acting anesthesias and
newer anti-emetic medicines; many anti-emetic treatments are expensive and do not totally eliminate PONV with some
adverse effects; yet. As a precaution against regurgitation and aspiration of stomach contents, pre-operative fasting
reduces stomach volume and acidity. The current standards in Europe, on the other hand, advocate the consumption of
oral clear fluids up to two hours prior to the onset of general anaesthetic induction. In order to limit the danger of
regurgitation and aspiration, patients are advised to fast prior to general anaesthesia.
Objective: Review of free oral consumption of clear fluids before the anaesthesia and their effects on nausea and
vomiting beyond surgery.
Methods: The databases were searched for articles published in English in 4 data bases [PubMed ­ Medline - Google
scholar- science direct] and Boolean operators (and, or, not) had been used such as [Preoperative Clear Fluid,
Postoperative Nausea and Vomiting] and in peer-reviewed articles between 2001 and 2021.
Conclusion: The incidence of postoperative nausea and vomiting was lowered when patients drank freely clear fluids
prior to the scheduled induction of day case anaesthesia.
Keywords: Preoperative Clear Fluid, Postoperative Nausea and Vomiting.

INTRODUCTION

Clear Fluid, Postoperative Nausea and Vomiting] and
Anesthesiologists face one of the most difficult and
in peer-reviewed articles between December 2001 and
major challenges in their practise when it comes to
January 2021; a 20-year date range was selected, and no
dealing with postoperative nausea and vomiting (1).
language limitations, and filtered in selected data basis
Within 24 hours of surgery, patients who experience
for the last 20 years, however, the range of time interval
nausea and/or vomiting in the post-anesthesia care unit
for researches is wide as there's scarcity of data on the
(PACU) are said to have PONV (postoperative nausea
particular reviewed, accurate and depth in the retrieved
and vomiting) (2).
literature. Documents in a language apart from English
These are the symptoms that follow an outpatient
have been excluded as sources for interpretation was not
procedure's discharge and are known as "post-discharge
found. Papers apart from main scientific studies had
nausea and vomiting" or "PDNV" (3).
been excluded: documents unavailable as total written
Children are more likely than adults to experience
text, conversation, conference abstract papers and
postoperative vomiting, with some studies estimating
dissertations.
that the incidence rate can reach as high as seventy
Postoperative nausea and vomiting (PONV) is
percent (4).
the second common complaint with pain being the most

common. We searched the online PubMed and Medline
Objective: Review of the preoperative clear fluid's role
databases for articles published in English between
in preventing nausea and vomiting beyond surgery.
2001 and 2021 using keywords ­ postoperative nausea

and vomiting, PONV, nausea-vomiting, PONV
Methods:
prophylaxis, and rescue. The review shows that the
A search strategy has been performed to
incidence of PONV is still unacceptably high despite a
determine the related literature. Review of free oral
number of studies on PONV over decades, due to
consumption of clear fluids before the anaesthesia and
complex mechanism of PONV pathogenesis as well as
their effects on nausea and vomiting beyond surgery.
relative lack of concern regarding this issue. PONV
Relevant keywords included: Preoperative Clear Fluid,
remains a significant problem in modern anesthetic
Postoperative Nausea and Vomiting.
practice because of the adverse consequences such as
These databases were searched for articles
delayed recovery, unexpected hospital admission,
published in English in 4 data bases [PubMed ­ Medline
delayed return to work of ambulatory patients,
- Google search - science direct] and Boolean operators
pulmonary aspiration, wound dehiscence, and
(AND, OR, NOT) had been used such as [Preoperative
dehydration.

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566

Received: 03/10/2021
Accepted: 16/11/2021

Full Paper (vol.861 paper# 90)


c:\work\Jor\vol861_91 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 570-573

An Overview of Various Lines in The Treatment of Warts: Review Article
Ahmad Nofal, Esraa Ragab Abd Elmonsef, Basma M. Elkholy
Department of Dermatology, Venereology and Andrology,
Faculty of Medicine, Zagazig University Hospitals, Egypt
Corresponding author: Esraa Ragab Abd Elmonsef, Email: ragabesraa14@gmail.com

ABSTRACT
Background
: Human papillomavirus (HPV) infection, which can be obtained through direct contact with an
infected person or through exposure to the environment, is the most prevalent cause of warts. For example, they
can be categorized into common warts, plantar warts, and genital warts based on appearance or location. Common
warts have been treated with a variety of invasive and non-invasive methods, both destructive and
immunotherapeutic. Cryosurgery, surgical excision, electrocautery, and laser ablation are all examples of
destructive therapies. Medical compounds like salicylic acid and trichloroacetic acid are also destructive, as is
formaldehyde and 5-flurouracil.
Objective: To make an overview of various lines in the treatment of warts.
Methods: The databases were searched for articles published in English in 4 data bases [PubMed ­ Google search
- Google scholar- science direct] and Boolean operators (and, or, not) had been used such as [Human
papillomavirus, treatment of warts, warts] and in peer-reviewed articles between 2009 and 2021.
Conclusion: A wide range of treatments are currently available to help individuals with warts, whether as a
single treatment or in combination.
Keywords: Human papillomavirus, Warts, Treatment

INTRODUCTION


HPV is the primary cause of warts, a common
range of time interval for researches is wide as there's
skin condition. For both patients and practitioners,
scarcity of data on the particular reviewed, accurate
plantar warts are a source of irritation because no one
and depth in the retrieved literature.
treatment works for everyone. More than two years of
Documents in a language apart from English
treatment has failed to get rid of recalcitrant warts, thus
have been excluded as sources for interpretation was
they're referred to as "recalcitrant." Treating
not found. Papers apart from main scientific studies
recalcitrant patients with immunotherapy and
had been excluded: documents unavailable as total
preventing its recurrence have been good outcomes (1).
written text, conversation, conference abstract papers
HPV is thought to be present in the bodies of
and dissertations.
40% of the world's population. Plantar warts affect

14% of the general population each year. When it
Evidence:
comes to plantar warts, young people are more likely
Treatment of warts:
to have them due to a variety of factors, the most
At least 30 percent recurrence after therapy
common of which are immunodeficiency or overuse
appears to be successful is the most disturbing aspect
of public showers and/or public restrooms (2).
of wart management, presumably due to resurgence
The aim of the review article was to make an
of virus from surrounding tissue reservoir. Both
overview of various lines in the treatment of warts.
destructive and immunological operations have a

success rate between 65 and 85 percent, although no
Methods:
single treatment is 100% effective in all patients (1).
A search strategy has been performed to
There are efficient Local destructive techniques
determine the related literature. overview of various
for the treatment of warts, including cryotherapy,
lines in the treatment of warts. Relevant keywords
electrocautery, and laser. However, scarring,
included: treatment of warts, and warts more
dyspigmentation, or recurrence make these therapies
synonymous key words had been used.
impractical for patients with many lesions. Host
These databases were searched for articles
immune status, age, HPV serotype, and site of
published in English in 4 data bases [PubMed ­
infection all have a role in resolving the infection. In
Google search - Google scholar- science direct] and
immunocompetent individuals, a wart or verruca can
Boolean operators (AND, OR, NOT) had been used
disappear within two years of the onset of symptoms
such as [Human papillomavirus, treatment of warts,
(2).
warts] and in peer-reviewed articles between January
For the most part, warts can be treated with
2009 and October 2021; a 13-year date range was
either a typical aggressive way, such as chemical
selected, and no language limitations, and filtered in
cautery or cryotherapy or electro-cauterization or
selected data basis for the last 13 years, however, the

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570
Received: 03/09/2021
Accepted: 29/10/2021

Full Paper (vol.861 paper# 91)


c:\work\Jor\vol861_92 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 574-578

The Effect of Invasive and Non-Invasive Ventilation on Neonatal Hearing Impairment
Mohamed Mamdouh Gaafar1, Ehab Abdelmoniem Al Banna1,
Mohammed Ramadan Hasaan2, Nouradin Abdourahman Ibrahim*1
Departments of 1Pediatrics and 2Audio-vestibular Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Nouradin A. Ibrahim, Mobile: (+2) 01554858761, Email: nuoradin18@gmail.com

ABSTRACT
Background:
The incidence of hearing loss in neonates is 2-4 cases in every 1000 live births. Hearing loss, especially
in mild and moderate forms, may not be recognized before the second year, but may produce great defects in
conversational abilities.
Objective: The aim of the present study was to assess the hearing impairment with invasive and non-invasive ventilation
in Zagazig University Hospitals.
Patients and methods:
This was a retrospective cohort study of preterm infants attending in neonatal intensive care
unit (NICU) of Zagazig University hospital in the period of time between February 2021 and August 2021. The
studied population included thirty preterm infants. Visual examination of the external auditory meatus and tympanic
membrane was performed using a Welch Allyn Halogen Otoscope. Results: There was non-significant difference
between the studied groups regarding gender, gestational age, or birth weight. There was significant increase in cesarean
(CS) mode in nasal continuous positive airway pressure (NCPAP) group (86.7%) compared to 40% in synchronized
intermittent mandatory ventilation (SIMV) group. On the other hand, there was non-significant difference between them
regarding presence of maternal risk factors. About 50% of patients underwent NCPAP, while the other 50% underwent
SIMV. The duration ranged from 7 to 13 days with mean 9.03 days. The Apgar at 1, 5 and 10 minutes and Down score;
all were significantly lower in SIMV group. In each group, there was significant increase in Apgar score over time.
Conclusion: There was no significant effect of invasive ventilation (SIMV) and non-invasive ventilation (NCPAP) on
auditory function of preterm infants.
Keywords: Hearing Loss; Invasive Ventilation; Neonates, Non-Invasive Ventilation.

INTRODUCTION
observed between normal full-term neonates and
Hearing impairment in children across the world
premature neonates (0.82% vs. 3.1%) (4).
constitutes a particularly serious obstacle to their
In light of this higher prevalence of SNHL among
optimal development and education, including language
premature neonates, several researchers tried to
acquisition. Neonatal hearing loss has a prevalence that
delineate factors related to prematurity that contributed
is more than twice that of other newborn disorders such
to the increased risk of SNHL. Of neonatal factors,
as congenital hypothyroidism and phenylketonuria (1). It
hyperbilirubinemia, surgical ligation of patent ductus
has been estimated that bilateral sensorineural hearing
arteriosus (5), and respiratory status (duration of
loss (SNHL) occurs in approximately 1.86 of 1000
ventilation and oxygen treatment) appeared to be
newborns. The prevalence of bilateral severe SNHL was
associated with significant SNHL (6). However,
previously reported to be 9.7% in neonates who
although a number of maternal conditions have been
survived with a very low birth weight (1500 g) and
reported to be associated with preterm birth (e.g.
16.7% in neonates who survived after neonatal seizure
intrauterine infection and preeclampsia), little
(2).
information is available concerning maternal risk
There have been reports suggesting that
factors for the development of SNHL. In particular,
prematurity itself is a cause of neonatal published
several reports provided somewhat contradictory results
incidence of SNHL in neonates with extremely low
with regard to the role of histological chorioamnionitis
birth weight. Ten (3.0%) out of 337 such neonates were
in the development of SNHL (7).
documented to have a hearing impairment. Of these, one
Therefore, this study aimed to assess the hearing
infant (0.3%) showed bilateral moderate-to severe
impairment with invasive and non-invasive ventilation
SNHL, while the other nine infants (2.7%) turned out to
in Zagazig University Hospital. Also, to determine the
have conductive hearing loss. SNHL (3). Low gestational
incidence and risk factors associated with hearing
age (GA) and low birth weight resulted in a higher rate
impairment among newborns in a tertiary care center.
of no response to transient-evoked otoacoustic

emission: the odds ratios for an abnormal transient-
PATIENTS AND METHODS
evoked otoacoustic emission result were 1.76 and 1.58,
This was a retrospective cohort study of preterm
respectively, in neonates with < 30 weeks of gestation
infants attending in NICU of Zagazig University
and birth weight < 1500 g. Finally, a statistically
hospital in the period of time between February 2021
significant difference in the prevalence of SNHL was
and August 2021. The studied population included
thirty preterm infants.

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574

Received: 04/09/2021
Accepted: 30/10/2021

Full Paper (vol.861 paper# 92)


c:\work\Jor\vol861_93 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 579-585

Assessment of the impact of Intrauterine Growth Restriction on
Gastrointestinal Tract Tolerance to Nutrition in Very Low
Birth Weight Neonates at Zagazig University Hospital
Abdel Razek Mohamed El sheikh, Atef Mohamed Mohamed Khalil, Rabab Reyad Abdallah*
Department of Pediatric, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding author: Rabab Reyad Abdallah, Mobile: (+20) 01141289126, Email: rabab_reyad@yahoo.com

ABSTRACT
Introduction:
Very low birth weight (VLBW) is a term used to describe babies who are born weighing less than1.5
kilograms. The main cause of a baby having VLBW is being born too early and this is called preterm or premature birth.
Premature means a baby is born before 37 weeks of pregnancy. Another cause of very low birth weight is when a baby
does not grow well during pregnancy and this is called intrauterine growth restriction (IUGR), it may happen because
of problems with the placenta, the mother's health, or birth defects.
Objective: This study aimed to assess the impact of intrauterine growth restriction on gastrointestinal tract tolerance to
nutrition in very low birth weight neonates. Patients and Methods: This study was applied on 48 very low birth weight
neonates who were divided into two equal groups (AGA and SGA groups). They were admitted to NICU in Zagazig
University Children Hospital, during the period from March 2020 to September 2020.
Results:
Incidence rate of feeding intolerance was nearly equal in SGA and AGA very low birth weight neonates, but
incidence of feeding intolerance signs were different between them. Conclusion: Intra-uterine growth restricted Very
low birth weight newborns were susceptible to intrauterine deprivation of nutrients to gastrointestinal tract due to
placental insufficiency resulting in prematurity and immaturity of gastrointestinal tract function resulting in poor
tolerability of GIT to enteral feeding. Trophic feeding, which was early initiation of enteral feeding along with parenteral
nutrition seemed to improve feeding tolerance, decrease duration of parenteral nutrition, insure more mature intestinal
motility patterns and increase growth rate.
Keywords:
Intrauterine growth restriction, Gastrointestinal tract tolerance, Nutrition.

INTRODUCTION
enterocolitis is documented in IUGR and preterm
Very low birth weight (VLBW) is a term used to
infants. So, a common practice in neonatal intensive
describe babies who are born weighing less than1.5
care unit is to delay feeds to reduce the risk of feeding
kilograms. The main cause of a baby having VLBW
intolerance but recent trials have shown that early
is being born too early and this is called preterm or
enteral feeding in IUGR infants is safe (3).
premature birth. Premature means a baby is born before
Parenteral nutrition is essential for VLBW
37 weeks of pregnancy. VLBW babies are often born
(premature or IUGR) to provide sufficient fluids,
before 30 weeks of pregnancy. A premature baby has
calories, amino acid, electrolytes and vitamins to sustain
less time in the mother's uterus to grow and gain weight.
the growth of ill neonate but long-term parenteral
Much of baby's weight is gained during the latter part of
nutrition and no receiving enteral nutrition can cause
pregnancy (1). Another cause of VLBW is when a baby
cholestatic jaundice and liver disease (4).
does not grow well during pregnancy and this is called
The parenteral nutrition component should contain
intrauterine growth restriction (IUGR), which may
2.5 ­ 3.5 g / dl of synthetic amino acids and usually 10
happen because of problems with the placenta, the
­ 15 g / dl of glucose, in addition to appropriate
mother's health, or birth defects. Most VLBW babies
quantities of electrolytes, trace minerals and vitamins.
who have IUGR are also born early and they are usually
Intravenous fat emulsion such as intra-lipid 20% maybe
very small and physically immature. IUGR is associated
administrated to provide calories initiated at 2 g/kg/24
with medical conditions that interfere with circulation
hours within 24 hours after birth and increased to 3
and efficiency of placenta with the development or
g/kg/24 hours by the next day (5).
growth of the fetus, these medical conditions are
When neonate is clinically stable, we start trophic
maternal hypertension and placental separation (2).
feeding. Trophic feeding is practice of feeding very
A condition of placental dysfunction lead to
small amounts of enteral nourishment to VLBW
cardiovascular adaptation in the fetus characterized by
neonate (10 ­ 20 ml/kg/24 hours as a continuous naso-
redistribution of cardiac output to maintain oxygen
gastric tube drip or by intermittent gavage every 2-3
supply to the heart, adrenal glands and brain, the so
hours for 5 ­ 10 days) to enhance gut motility, improve
called brain sparing effect at the expense of visceral
growth, and decrease need for parenteral nutrition. If
organs such as gastrointestinal tract. This condition may
initial feedings are tolerated, the volume is increased by
predispose to IUGR infants to impaired gut function
20 ­ 30 ml/kg/24 hours till a volume of 150 ml/kg/24
after birth. A higher incidence of necrotizing
hours has been achieved (4).

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579

Received: 04/09/2021
Accepted: 30/10/2021

Full Paper (vol.861 paper# 93)


c:\work\Jor\vol861_94 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 586-592

Evaluation of Outcome of Percutaneous K-wires Fixation of
Pediatric Both Bone Forearm Fractures
Abdel-Salam Mohamed Hefny, Mohamed Hussein Elsayed,
Osam Mohamed Metwally, Ehab Mohamed Mohamed Ahmed
Department of Orthopedic Surgery, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding author: Ehab Mohamed Mohamed Ahmed, Mobile: (+20) 01118860688

ABSTRACT
Background:
Forearm fractures are the most common fractures in children, representing 40 to 50 percent of all
childhood fractures. Objective: To improving outcome of pediatric both bone forearm fractures using K-wires. Patients
and
Methods: This study included 24 patients aged between 3 and 12 years with closed displaced fractures of shaft of
both bones forearm presented to Zagazig General Hospital. On admission all patients were assessed by history taking,
clinical examination and radiological evaluation. The K-wires were passed under control of image intensifier across the
fracture site as far as the proximal physis in the radius and the distal metaphysis in the ulna taking care not to reach the
growth plate. Postoperatively the limb was placed in above elbow plaster cast with the elbow at 90 degrees of flexion
and the forearm at mid pronation. After the follow up period (6 - 12) month the results of patients were assessed clinically
and radiologically and were classified according to the Price criteria. Results: 9 patients (37.5%) were classified as
excellent results while 15 patients (62.5%) were classified as good results and no patients were classified as fair or poor
results. Conclusion: Closed reduction percutaneous intramedullary fixation of pediatric displaced diaphyseal forearm
fractures by K-wires is a safe, reliable, minimally invasive procedure and effective method of treatment. Based upon
this study, it is concluded that displaced fractures of both forearm bones in children are preferred to be intramedullary
fixed with K-wires when surgery is indicated with excellent and good results.
Keywords: Bone Forearm Fractures, Outcome, Pediatric, Percutaneous K-wires Fixation.

INTRODUCTION
ends of the same bones. Many experienced clinicians
Forearm fractures are the most common fractures
have pointed out the increasing level of treatment
in children, representing 40 to 50 percent of all
difficulty as the level of forearm fracture moves
childhood fractures. In one large series, forearm shaft
proximally and more proximal fractures tend to occur in
fractures of the radius ranked as the third most common
older patients (5). The goal of treatment of forearm and
fracture after distal radial fractures and supracondylar
distal radius injuries is to facilitate union of the fracture
humeral fractures. In addition, midshaft forearm
in a position that restores functional range of motion to
fractures are the most common sites for refracture in
the elbow and forearm. Most shaft injuries present no
children and among the most common sites of pediatric
unusual challenges and require nothing more than
open fractures (1).
skillful closed reduction and cast immobilization due to
The rate of forearm shaft fractures in school-age
the unique property of the growth potential of the
children (more than 5 years old) is more than double that
immature skeleton (6).
in toddlers (1.5 to 5 years old). Age also may have an
There is a subset of patients in whom surgical
effect on injury severity. In boys there is a bimodality
intervention is indicated. The most common indications
peak, the first at approximately age 9 years and the
for surgery are failure of closed reduction, open
second at approximately 13 or 14 years of age. Girls
fractures, and fracture instability. When operative
show a single peak at approximately 5 or 6 years (2).
intervention is indicated different techniques can be
Approximately 75 % to 84 % of forearm fractures
employed
such
as
intramedullary
nailing,
occur in the distal third with another 15 % to 18 % in
osteosynthesis with plate and screw fixation and
the middle third, while 1 % to 7 % of cases occur in the
external fixators. Intramedullary nailing has been
proximal third. A small percentage are bilateral, and as
shown to produce excellent clinical results and in
many as 13 % have an associated supracondylar
contrast to plate fixation is considered as a minimal
fracture. Just over 50% of these fractures are greenstick
invasive procedure (7).
fractures (3). Initial preoperative translation of more than
The aim of this study was to improving outcome
100% (no cortical contact) has been correlated with a
of pediatric both bone forearm fractures using K-wires.
greater chance of tissue interposition that requires a

mini-open reduction (4).
PATIENTS AND METHODS
Because of numerous differences in both treatment
This a clinical trial study included 24 patients
and prognosis, shaft fractures are considered to be
with fractures of forearm bones in children aged
clinically distinct from fractures of the distal
between 3 and 12 years with closed displaced fractures
(metaphyseal fractures and physeal fractures) and
of shaft of both bones forearm presented to Zagazig
proximal (radial neck fractures and physeal fractures)
General Hospital.

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586

Received: 03/09/2021
Accepted: 29/10/2021

Full Paper (vol.861 paper# 94)


References The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 593-599

Safety and Complications of Diagnostic Medical Thoracoscopy:
A 3-year experience of a single centre
Houssam Eldin Hassanin Abd Elnaby*, Ahmed Ibrahim Aboseif
The Department of Chest Diseases, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
*Corresponding author: Houssam Eldin Hassanin Abd Elnaby, Mobile: (+2)01011605616, E-mail: drhoussam151979@gmail.com.
ABSTRACT
Background:
Medical thoracoscopy (MT) is one of the oldest invasive interventional techniques in the recent history of
respiratory medicine. Its role in clinical practice was emphasized in the last few years, and it almost replaced the traditional
closed pleural biopsy method.
Aim of the Study: To evaluate the safety and the rate of possible complications during and after medical thoracoscopy
performed for diagnostic purposes at a single centre in Cairo, Egypt.
Patients and Methods: This is a retrospective analytical study of data collected from the medical records of all patients
(226 patients) that underwent diagnostic medical thoracoscopy at our center in successive three years.
Results: The mean age of the study patients was 55.37 ± 13.69 years, 125 (55.3%) of them were males, while 101
(44.7%) were females and 137 patients (60.62%) had a risk of asbestos exposure. Persistent air-leak 7 days was the
most frequent major thoracoscopic complication, detected in 10 patients (4.42%), followed by hypoxemia in 9 patients
(3.98%), then post-procedure pneumonia and arrhythmia in 5 patients (2.21%) for each. The most common minor
thoracoscopic complication was post-procedure pain in 74 patients (32.74%), followed by transient air-leak <7 days in
25 patients (11.61%) then post-procedure unexplained fever in 23 patients (10.17%) and subcutaneous emphysema in
19 patients (8.4%).
Conclusion: Medical thoracoscopy is a simple, valuable and safe diagnostic procedure, which carries a limited
possibility of complications, most of them are not serious and easy to be controlled.
Keywords: Safety, Complications, Medical thoracoscopy.

INTRODUCTION


Medical thoracoscopy is a minimally invasive
PATIENTS AND METHODS
ambulatory procedure performed under local anesthesia

This was a retrospective-descriptive analytical
or conscious sedation which allows for direct
study, included the data of 226 subjects, representing the
visualization of the pleural cavity for biopsy targets, as
total number of patients who underwent medical
well as simultaneous therapeutic interventions, including
thoracoscopy at our University Hospital in Cairo, Egypt,
chemical pleurodesis and indwelling tunneled pleural
in successive three years. This hospital is a large tertiary
catheter (ITPC) placement (1).
health care hospital, which received referrals from the

As the differential diagnosis of pleural effusion
four quadrants of the republic. All cases had exudative
can present a considerable challenge, and about 25-40%
pleural effusion according to Light's criteria (6), and the
of the pleural effusions remain undiagnosed after fluid
etiology of pleural effusion was still undiagnosed after
cytology and/or blind pleural biopsy (2), (MT) has become
initial laboratory tests including pleural fluid cytology and
increasingly used by chest physicians (3). It is considered
assessment for tuberculosis (TB).
to be one of the main areas of interventional pulmonology
Medical thoracoscopic technique
(4) and an important part of a specialist pleural disease

Thoracic ultrasound (using the apparatus
service (5). Although the risks of (MT) are generally low,
Sonoscape - SS1, China) was performed before
the advantages of the procedure should be weighed
thoracoscopy to assess for the nature, amount, presence of
against the discomfort of the patient and the slight
adhesions and septations of pleural effusion and to judge
potential for morbidity and mortality. In addition, it is
the convenience and safety of the procedure; during
important for adequate precautions to be taken, including
thoracoscopy to choose the optimal entry point and to
the recommended technical procedure, as well as
guide thoracoscope; and lastly after the end of the
monitoring of cardiac rhythm, haemodynamic parameters
procedure to assess for complications (7,8). Medical
and oxygen saturation during the procedure (3).
thoracoscopies were performed in the Endoscopy Suite

This study aimed at evaluating the safety and the
(Interventional Pulmonology Unit) in our University
rate of possible complications during and after medical
Hospital, using a seven-mm rigid thoracoscope set (Karl
thoracoscopy performed for diagnostic purposes at a
Storz Endoscope; Karl Storz; Tuttlingen, Germany) and a
single centre in Cairo, Egypt.
three-mm biopsy forceps. The procedure was performed

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593

Received:4 /9 /2021
Accepted:1 /11 /2021

Full Paper (vol.861 paper# 95)


Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 600-604

Prospective Study of Ultrasound Guided Percutaneous Tracheostomy in
Critically ill Patients in Zagazig University Hospitals in Egypt
Khaled Abd ELShakour Mohammed Ali, Abd El Raof Said Mohamed, Alsayed Abdulmageed Alsayed,
Sharifa Mohamed Almahdi, Ali Mohamd Ali Hassn Barakat
Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Sharifa Mohamed Almahdi, Email: sherefalshereef2016@gmail.com



ABSTRACT
Background:
Before doing percutaneous tracheostomy (PCT), studies have shown that mapping the neck region with
ultrasound (US) is beneficial.
Objective: This study aimed to check the effectiveness of ultrasound guided percutaneous tracheostomy for patients in
critical condition.
Patients and Methods: 24 mechanically ventilated patients at the Otorhinolaryngology Department and the Anesthesia
and Intensive Care Unit of Zagazig University Hospital who were indicted for elective ultrasonography guided
percutaneous tracheostomy in the period from June 2021 to December 2021.
Results: The mean incision length was less than 2 cm and the duration of procedure was 22.08 minutes while the average
duration of intubation was 13.25 days.75% of patients had excellent, 12.5% of patients were good, and 12.5% were
unsatisfactory, for ease of ultrasonic visualization.
Conclusion: Using ultrasound to guide the percutaneous tracheostomy operation could be an effective and less invasive
technique.
Keywords: Percutaneous tracheostomy, Ultrasound, Critically ill.

INTRODUCTION
PATIENTS AND METHODS
Patients admitted to the intensive care unit (ICU)
At Otorhinolaryngology Department and Anesthesia
may require tracheostomy if ventilatory weaning fails or
and Intensive Care Unit Department, at Zagazig
mechanical ventilation is required for an extended period
University Hospital, Egypt, this prospective cohort trial
of time (1, 2). In this regard, PCT under bronchoscopic
was performed during the period from June 2021 to
supervision was established. Transillumination helps
December 2021. This research included 24 critically ill
bronchoscopy identify the puncture site, confirm needle
cases who were admitted to Zagazig University
position, manage the dilation and placement of
Hospital's Intensive Care Unit and for whom U/S guided
tracheostomy tube dilation and positioning. As it stands,
PCT was indicated.
the bronchoscopy does not reveal the vascular and

thyroid systems in the neck region, and so does not avoid
Ethical approval:
consequences linked to local organ abnormalities (3).
All participants completed informed permission
A physical examination may not be able to identify
papers (written consents) and submitted them to the
certain anatomical landmarks in obese patients. Obesity-
Research Ethics Committee at Zagazig University.
related problems have been documented by many
The study was permitted (ZU-IRB#6785). Ethics
authors. A combination of technological advancement
guidelines for human experimentation were adhered
and low invasiveness has led to an increase in the use of
to in line with the Helsinki Declaration of the World
ultrasonography (US) in anesthesia and critical care. In
Medical Association.
obese individuals, this is especially true for treatments

like peripheral nerve block, cannulation of arteries, as
Inclusion criteria:
well as central venous cannulation (4).
Patients with
prolonged
mechanical
A number of studies have shown the benefit of US
ventilation or expected prolonged mechanical ventilation
neck mapping prior to PCT. Even when only anatomical
and patients who had difficult weaning from mechanical
palpation data are used to determine the puncture site, an
ventilation, as well as advanced maxillofacial injury
ultrasound scan will often change that choice (5). In a
patients.
neurosurgical ICU, Rajajee et al. (6) showed that US-

guided PCT was feasible.
Exclusion Criteria:
We aimed at this study for evaluating the efficacy
Patients below age of 15 years, infection of
of ultrasound guided percutaneous tracheostomy
tracheostomy site, emergency tracheostomy, unidentified
(USPCT) among patients who are critically ill at Zagazig
anatomic landmarks, coagulation abnormalities (platelet
University Hospital.
count lower than 80000/mm3 and an international


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600
Received: 08/10/2021
Accepted: 16/11/2021

Full Paper (vol.861 paper# 96)


c:\work\Jor\vol861_97 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 605-612

Diffusion-Weighted Images and its Application in the
Clinical Diagnostic Testing of Endometrial Focal Lesions
Sondos Elsayed Ahmed Elsayed*, Ghada Kamal Gouhar,
Enas Mahmoud Hamed, Mohamed Ibrahim Amin
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Sondos Elsayed Ahmed, Mobile: (+20) 01123764654, E-Mail: sondoselaraby92@gmail.com

ABSTRACT
Background:
Numerous endometrial disorders can create several difficulties for the radiologist due to the overlapping
of imaging characteristics and diverse endometrial pathologies. The most frequently utilized imaging tool for diagnosing
and characterizing endometrial focal lesions is magnetic resonance imaging (MRI) with diffusion weighted images
(DWI).
Objective: We conducted this study to determine the efficacy of MRI with DWI in improving the diagnostic accuracy
of endometrial focal lesions, especially in the differential diagnosis of benign and malignant focal endometrial masses.
Patients and Methods: This study recruited 36 women (21 postmenopausal and 15 premenopausal) who
experienced vaginal bleeding and had endometrial thickness and focal endometrial lesions with a distinct echo pattern
on ultrasound (US) examination. The age of patients was between 27 to 85 years, with an average of 45.2years. Ethics
Committee approval was obtained in addition to written informed consent from all included patients.
Results: The 36 patients included in this study, were classified according to their lesions histopathological results;
Benign group (15 lesions; 41.67%) and malignant group (21 lesions; 58.33%). The most common benign lesion was
endometrial polyp (9/15) while the most common malignant lesion was endometrial carcinoma (21/21). In the current
study MRI with diffusion could correctly diagnose 33 lesions out of 36 lesions, achieving (91.6%) sensitivity, (100%)
specificity, (100%) positive predictive value (PPV), (95.6%) negative predictive value (NPV) and accuracy (97.05 %).
Conclusion:
Integrating DWI and ADC mapping at a high b value in pelvic MRI examination improves the sensitivity,
specificity, and precision of diagnosing endometrial focal lesions.
Keywords: ADC value, Diffusion-Weighted, Endometrial Focal Lesions, MRI.

INTRODUCTION
(diffusion restricted) regain signal, as no significant
Several
endometrial
conditions
may
be
phase shift occurs even by time of the second gradient,
challenging for radiologists due to the overlap of
and the signal lost during the first gradient is recovered
imaging features and variable endometrial pathologies.
by the second opposite gradient (restricted diffusion) (5).
MRI with DWI is the most commonly used imaging
The ADC value is a quantitative representation of
technique for the diagnosis and characterization of
the diffusion in each pixel, and it displays as an image
endometrial focal lesions (1).
that may be used to examine the diffusion value
The majority of endometrial states share imaging
visually. The amount of b values taken varies; generally,
characteristics with normal menstrual endometrial
the more b values taken, the more precise the ADC
phases and diverse endometrial diseases, including
value produced (6).
endometrial hyperplasia, polyps, as well as endometrial
Endometrial diseases ranked among the most
cancer (2).
common gynecological disorders that affect women
Diffusion-weighted magnetic resonance imaging
globally. These diseases cut across all age groups and
(MRI) is based on the random mobility of water
contribute significantly to increased maternal morbidity
molecules inside various tissues (3). When combined
and mortality. Most females with endometrial diseases
with apparent diffusion coefficient (ADC) mapping,
present with abnormal uterine bleeding (AUB). Thus,
DWI can indeed be employed to examine metastatic
AUB justify the need for urgent diagnosis. This is
lesions, peritoneal deposits, tumor relapse, as well as
because of the wide range of histopathological patterns
therapeutic response (4).
of endometrium diseases. These lesions range from
DWI is a T2-weighted sequence in which two
simple endometrial hyperplasia to more complex
equal and opposite motion-probing gradients are used
disorders including endometrial carcinoma (7).
prior to and following the 180° refocusing pulse.
DWI is not only beneficial for differentiating
Whenever freely moving water molecules are subjected
benign and malignant processes; it could also be used to
to the first gradient pulse, they gain phase shift data;
assess metastatic lesions, peritoneal spread, tumor
however, because they are moving, they are not at the
recurrence, and therapeutic response (8). Due to the fact
same place and hence are not subjected to the exact
that it does not necessitate the injection of a gadolinium-
identical gradients. Thus, no signal is generated during
based contrast agent, it is suitable for individuals with
acquisition (free diffusion), but static water molecules
renal impairment or an allergy to contrast material (9).

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605

Received: 5/09/2021
Accepted: 2/11/2021

Full Paper (vol.861 paper# 97)


c:\work\Jor\vol861_98 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 613-616

Fetal adrenal Biometry, Cervical Assessment and Inflammatory Cytokine for
Prediction of Preterm Labor: Comparative Study
Rasha R. Abd Elhady1, Alia A. El Shahaway2, Basem Hamed1
1Department of Obstetrics and Gynecology, 2Department of Medical Microbiology and Immunology,
Faculty of Medicine, Zagazig University, Egypt
Corresponding Author: Rasha R. Abd Elhady, mobile:00201011252854, Email address: rashareda@gmail.com

ABSTRACT
Background:
Preterm birth is a multifactorial problem with a confounding management. Latent interval (Time to
delivery) always shows wide variation and presence of a valid, reliable and applicable predictor is a controversial issue.
Objectives: to evaluate the role of fetal adrenal biometry (corrected-total gland volume c-TGV and fetal zone
enlargement FZE), cervical length and IL17 serum level (maternal inflammatory biomarker) in prediction of preterm
that could help in proper management and decreased morbidities.
Patient and Methods: Observational comparative study for 100 case (28 to 36 weeks gestation) showing clinical signs
of threatened preterm labor. Corrected fetal adrenal gland volume, fetal zone enlargement, cervical length and IL17
serum level were measured then all candidates were followed up till delivery to classify the results into two groups
according to the (latent interval). Diagnostic performance for all variables was done to detect the best cutoff value that
can predict impending preterm delivery within 7 days using univariate analysis and receiver operating characteristic
(ROC) curve.
Results: The studied predictors were showing best cutoff, sensitivity%, specificity% and accuracy% as follow: c-TGV
(400 mm3/kg, 80, 75, 85), FZE( 50%, 90, 80, 92), cervical length (16 mm, 70, 67, 65), IL17 serum level (8 pg/ml,
80, 95, 83) respectively.
Conclusion Utility of corrected fetal adrenal gland volume, fetal zone enlargement in addition to the IL17 (inflammatory
marker) as a non-invasive predictors for impending preterm birth can guide a proper decision.
Keywords: Cervix, Fetal adrenal, Inflammatory biomarker, Preterm labor

INTRODUCTION


Preterm labor is the start of delivery before 37
premature release of placental CRH is considered as a
weeks gestation and beyond the age of viability,
biological alarm in the early onset delivery (7,8). Thus,
unfortunately it is a worldwide problem and represents
the release of fetal adrenal steroid precursors could be
a socioeconomic burden especially in the developing
associated with enlargement of the central zone of the
countries(1).
gland (9).
Prediction of preterm birth has a great
Preterm labor is commonly associated with
importance to reduce the neonate's morbidity and
uterine subclinical infection and inflammatory response
mortality, as many clinical, biochemical and
causes contraction and delivery. Therefore, the release
sonographic methods are tested to get the best tool with
of pro-inflammatory cytokines such as TNFa, IL-1, IL-
the highest accuracy, they include modified Bishop
6 and IL-8 is expected to increase in amniotic fluid,
score, fetal fibronectin test, maternal cortisol levels and
decidual and chorionic tissue. IL-17 is important to host
plasma level of corticotrophin-releasing hormone
immune response and is considered a key cytokine that
(CRH), but with controversial results owing to their
induces inflammation also might have some roles in
variable accuracy, practical implementation, cost
pathophysiology of preterm birth (10).
benefit relation and subjective operator dependence(2).
Recent possible suggestion supposes that
Sonographic cervical length is considered as an
preterm birth specially associated with chorioamnionitis
essential part of the routine obstetric ultrasound
is accompanied by Th-17 activation with further
assessment (3). Short cervix is defined as 25 mm or
production a pro-inflammatory cytokine IL-17 that
10th centile at (24­28) weeks gestation (4).
causes the liberation of prostaglandin E2 resulting in
Parturition is a complex process that based on
uterine contraction and preterm labor (11,12).
the integration of multiple maternal and fetal factors
The final result of all possible mechanisms is
initially controlled by fetal hypothalamic-pituitary-
cervical
remodeling,
softening,
ripening
and
adrenal (HPA) axis (5). Fetal cortisol theory (as called
progressive dilatation (13). So, in the current study we
previously) states that adrenal gland plays a vital role
tried to evaluate the validity of the previously
by secretion of dehydroepiandrosterone- sulfate
mentioned factors that could help in preterm birth
(DHEA-S), which in turn up regulates the placental
prediction.
CRH with further secretion of prostaglandins PGE2 and

PGF2a leading to the onset of contraction(6). So,


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613
Received:5 /9 /2021
Accepted:1 /11 /2021

Full Paper (vol.861 paper# 98)


c:\work\Jor\vol861_99 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 617-622

Association between Aortic Sclerosis and Coronary Artery Disease
Said S. Montaser, Mahmoud K. Ahmed, Awny G. Shalaby, Mohammed S. Assayed
* Cardiology department, Faculty Medicine, Menoufia, Egypt
Corresponding author and reprint: Name: Mohammed Sarhan Assayed, Telephone: 00966501724928,
Email: Dr.sarhan68@gmail.com

ABSTRACT
Background:
Although there is a recognized link between cardiovascular hazards and coronary artery disease (CAD),
it is still unknown whether aortic sclerosis and CAD are linked.
Objective: This study aimed to check whether if there is a link between aortic sclerosis and the existence and severity
of coronary artery disease .
Patients and methods: 204 individuals were enrolled in the study, transthoracic echocardiographic, and coronary
angiography were done. Aortic leaflets were tested for the amount of thickness in the short axis view. The involvement
of coronary arteries represented by the gensini score and the association between aortic valve sclerosis score and the
degree and severity of coronary affection was investigated using the Gensini score.
Results: The individuals were divided into 2 groups grounded on the severity of aortic valve sclerosis. Group A (GP A)
included patients with aortic valve sclerosis (AVS) 2 and group B (GP B) included patients with AVS < 2. In GP A,
the right coronary cusp was the most afflicted one, whereas the LAD was the most affected in coronaries. The degree
and severity of CAD were more significant in GP A, as evidenced by a higher Gensini score value of 39.27 versus 28.84
in GP B.
Conclusion:
AVS has been found to be correlated with the presence and severity of CAD and could be used as a
potential surrogate marker for the illness.
Keywords
: Aortic valve sclerosis (AVS), Coronary angiography, Coronary artery disease (CAD).

INTRODUCTION

Multiple research has described calcification or
consent was taken from every participant in the
bright echoes in defining sclerosis [1, 2], with a peak
study. This work has been carried out in accordance
Doppler velocity of 2.5 meters per second, [3] 2 meters
with The Code of Ethics of the World Medical
per second [2], but the usage of Doppler in describing
Association
AVS is not yet widespread [5]. In symptomatic patients

[3] and patients presenting with chest discomfort [1],
(Declaration of Helsinki) for studies involving
some studies have shown a link between aortic sclerosis
humans.
and cardiovascular events. Epidemiological studies

suggest that AVS is associated with both all-cause and
Study population: We have included 204 patients with
cardiovascular mortality, independently of age [3].
suspected CAD, referred to the Cath Department,
Because AVS does not generate hemodynamic changes
Menufia University Hospital for elective coronary
that affect cardiovascular function, the mechanisms that
angiogram for evaluation of CAD.
underpin its link to poor cardiovascular outcomes

remain unknown.[1]. Several studies have shown that
Exclusion criteria: Patients with aortic valve stenosis,
more extensive calcifications in AVS, despite not
or congenital valvular anomalies (bicuspid valve,
having a hemodynamic effect, amplify the likelihood of
supravalvular stenosis, subvalvular obstruction), or
CAD and cardiovascular events [4].
other primary valvular diseases, patients with chronic
Independent risks for CAD as with dyslipidemia,
kidney disease or with poor echo window were also
hypertension, and male sex have been shown in several
excluded.
studies to influence aortic sclerosis and its progression

to aortic stenosis [1].
All participants in the trial were subjected to complete
The aim of the study was to see if there was an
medical history, as with the previous history of
association between AVS with the presence and
hypertension, diabetes mellitus, CAD, dyslipidemia,
severity of CAD.
and CAD among the subject's families. They were also

given a full physical examination and a 12-lead ECG.
PATIENTS AND METHODS


Echocardiography:
Ethical approval:
A complete examination was performed (utilizing
The study was approved by the Ethics Board of
GE Vivid S5, Vivid E9 echocardiography equipment
Al-Azhar University and an informed written
with
1.7­4MHz
phased
array
transducers).



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617
Received:6 /9 /2021
Accepted:3 /11 /2021

Full Paper (vol.861 paper# 99)


c:\work\Jor\vol861_100 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 623-626

Early Improvement in Left Atrial Remodeling and Function after
Mitral Valve Replacement in Organic Symptomatic Mitral Regurgitation
Assessed by Three-Dimensional Echocardiography
Haytham Mohamed Abd El Moaty1*, Ahmed Mahmoud Mansy2
1 Cardio Thoracic Surgery Department, 2 Cardiology Department,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Haytham Mohame Abd El Moaty, Mobile: (+2)01007217084,
E mail: drhaythmabdelmoaty@gmail.com

ABSTRACT
Background:
Mitral regurgitation increases the volume of the left ventricle and the atrium. Reverse LA remodeling is
caused after surgical mitral valve replacement. There have been few studies that look at LA function following MV
replacement. LA strain may be used to power LA reservoirs, conduits, and pumps. TMR causes atrial re-modeling in
the left ventricle. The use of 3DE enables for more precise and dependable estimation of LA emptying fractions (total,
active, and passive). In terms of estimating LA quantities, 3DE is currently more accurate than 2DE. We wanted to look
at these issues.
Objectives:
The current work aimed to evaluate early improvement in left atrial remodeling and function after mitral
valve replacement in organic symptomatic mitral regurgitation assessed by three-dimensional echocardiography in Al-
Hussein University Hospital.
Methods: Prospective 3DE study that was performed on 60 patients with symptomatic chronic organic MR before and
after surgery (valve replacement with prosthetic mechanical valve). Additionally, the maximum volume (Vol-max),
lowest volume (Vol-min), and pre-contraction volume (Vol-preA) volumes of the LA were computed.
Results:
Mean age of patients was 48 ± 15 years. Mean BMI reached 26 ± 5 kg/m2. Mean systolic blood pressure
reached 123 ± 16 mmHg and diastolic blood pressure reached 74 ± 8. Male to female ratio was 1:1 and 51.7% of
participants had a previous history of hypertension. Regarding etiology of MR, rheumatic cause was in 33.3% of cases,
mitral prolapse was the cause in most of the participants. Regarding 2DE variables of the patients, there was high
significant difference between pre- and post-operative results in all variables except for LA total emptying fraction.
There was no significant difference in pre and post-operative LA total emptying fraction results.
Conclusion:
After a successful surgery on the mitral valve, some patients who had an organic MR and intact LV
function may have a reversal of LA remodeling and functional alterations. Before surgery, a rise in active atria emptying
fraction (AAEF) is linked to an increase in LV relaxation capacity. Preoperative transmitral mean gradient variation and
diastolic blood pressure are factors that influence short-term postoperative reverse remodeling of the left atrium in
patients.
Keywords: Left atrial function, left atrial volume, Mitral regurgitation, Mitral replacement, Three-dimensional
echocardiography

INTRODUCTION

Before surgery, we anticipated to see an
When
mitral
regurgitation
(MR)
is
immediate improvement in LA structure and function,
hemodynamically significant, the LV and LA volumes
even if there had been preexisting complaints.
increase. Reversible remodeling of the atrium happens
To find out what factors are responsible for the
after successful mitral valve replacement surgery (1).
early postoperative morphological and functional
Even though surgical MV replacement has been shown
changes in the left atrium, this study sought to examine
to alter LA volumes in several studies, little is known
these parameters by 3DE one month following a
about how the LA really functions. LA strains about the
successful surgical mitral valve replacement.
LA reservoir, conduit, and pump may be used to derive

information about their functions. The left atrium (LA)
MATERIAL AND METHODS
undergoes reversible remodeling after mitral valve
60 patients with severe organic mitral
replacement (2).
regurgitation were studied in this prospective research.
Due to the availability of data from three-
Candidates for surgical mitral valve replacement with
dimensional echocardiography (3DE), it is now possible
prosthetic mechanical valve, who had symptoms, had a
to calculate LA emptying fractions with greater
sinus rhythm with intact left ventricular (LV) systolic
precision and confidence throughout the cardiac cycle
function at Cardiothoracic Surgery Department of Al-
(total, active, and passive). Recent research has
Hussein University Hospital during the period from
demonstrated that 3DE is more accurate than 2DE when
June 2019 to June 2021. Pre-operative and follow up
analysing LA volumes using magnetic resonance (3).
echocardiographic examinations were performed at

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623

Received:5 /9 /2021
Accepted:1 /11 /2021

Full Paper (vol.861 paper# 100)


c:\work\Jor\vol861_101 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 627-633

Study of Diagnostic Value of D-Dimer Serum Level as a Marker in Neonatal Sepsis
Abdel Razek El Shiekh1, Noura Hussein El-Shahat*1, Ziaad Mohamad Alaa2, Sherief Mohammed Elgebaly1
Department of Pediatrics1, Clinical Pathology2, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Noura Hussein El-Shahat, Email: drnourahussein@gmail.com

ABSTRACT
Background:
Neonatal septicemia is widely recognized around the world. A prominent cause of infant mortality
and morbidity. Folinolysis in sepsis causes a rise in the D-dimer marker, which is generated when cross-linked fibrin
breaks down.
Objective: The goal of this work was to evaluate the clinical significance of D-Dimer level for diagnosis of neonatal
sepsis.
Patients and Methods: Our study was done on 90 neonates divided into two groups: 45 septic neonates as cases
and 45 healthy controls. A complete medical history, clinical examination, and diagnostic tests were performed for
all newborns (CBC, CRP, blood culture, D-dimer).
Results: Most of blood cultures were negative (42.2%) and the other positive cultures showed that klebsiella was
the most common organism (22.2%), E-coli was 15.5%, Pseudomonas was 8.89%, Staph. Aureus was 6.67% and
the less common was GBS (4.4%). CRP and D-dimer levels were significantly elevated in neonatal sepsis cases
compared to controls. D-dimer at a cutoff point higher than 2 had 97.8% accuracy for detection of neonatal sepsis
with 100.0% sensitivity and 95.6% specificity. D-dimer levels were significantly higher in infant sepsis patients who
died compared to those who survived (5.5 ± 1.3 versus 3.2 ± 1.4) respectively indicating that D-dimer increased with
increased severity of cases who had bad prognosis.
Conclusion: D-dimer had 97.8% accuracy for detection of neonatal sepsis with 100.0% sensitivity and 95.6%
specificity. So it may be used as a marker in neonatal sepsis.
Keywords: D-Dimer, CRP, Neonatal sepsis.

INTRODUCTION

deposition of fibrin and a prothrombotic condition,
Sepsis is still a critical challenge in pediatric
which in turn causes microvascular thrombosis, which
critical care medicine, in spite of continued advances in
in turn causes various organs to be damaged by anoxic
neonatal medicine (1). Neonatal sepsis mortality has
injury (7). When fibrin is broken down, a molecule called
dropped from 87% in 1928 to 3% in 2003, yet it remains
D-dimer is created, and this molecule's concentration
a major cause of illness and mortality in newborns (2).
rises in sepsis as a result of fibrinolysis. D-dimer is also
Neonatal sepsis is a phrase used to describe a systemic
elevated in DIC, which indicates that the coagulation
bacterial, viral, or fungal infection that causes
mechanism has been activated (8).
hemodynamic abnormalities and other clinical
The goal of this work was to evaluate the
symptoms as well as significant morbidity and death in
clinical significance of D-Dimer level for diagnosis of
the newborn population. Severe neonatal sepsis can be
neonatal sepsis.
characterized as either early or late onset, based on the

age and time of the sepsis episode (3). Neonatal sepsis
PATIENTS AND METHODS
causes some nonspecific symptoms and signs, involving
Ninety newborns hospitalized at Zagazig
jaundice, hypnosis, bradycardia, apnea, tachycardia,
University Hospitals, in the Neonatal Intensive Care
respiratory distress, hypotonia, bulging fontanel,
Unit between February 2020 and August 2021 served as
feeding difficulties, seizures, long capillary refill time
the subjects for this cross-sectional trial. The neonates
and temperature instability (4).
were divided into two groups. Group 1 (Study group)
Neonatal sepsis can only be accurately
that included 45 neonates diagnosed to have sepsis.
diagnosed by a blood culture, which is the gold standard
Group 2 (control group), which included 45
in this field. It is possible to miss the causative agent due
newborns, all of the same age and gender. They were
to technical issues like as poor blood sample or
gathered from the resuscitation room and found to be in
antibiotic use by the mother (5).
good health.
Neonatal sepsis is associated with a high

incidence of coagulation malfunction, which might
Inclusion criteria: For septic group, all established
appear clinically or subclinically in the setting of DIC.
newborns with sepsis-related symptoms, and signs at
When the clotting system is overactive, it leads to an
the time of admission or who contracted sepsis during
increase in fibrin deposition and a decrease in clotting
their hospital stay. For control group, to be non-septic
factor and platelet consumption, which is known as DIC
clinically and laboratory.
(6). Chronic inflammation causes intravascular

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627
Received: 14/10/2021
Accepted: 21/11/2021

Full Paper (vol.861 paper# 101)


c:\work\Jor\vol861_102 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 634-640

Evaluation of Serotonin Serum Level in Cases of Alopecia Areata and Vitiligo
Fawzia Farag Mostafa1, Naglaa Ali Khalifa2,
Sammar Mohammad Ibrahim*1, Ahmed Said Abdel Shafy1
Departments of 1Dermatology, Venereology and Andrology,
2Clinical Pathology, Zagazig University Hospital, Egypt
*Corresponding author: Sammar Mohammad Ibrahim, E-Mail: sammaromarmohammed@gmail.com


ABSTRACT
Background
: There are cutaneous illnesses that could be exacerbated or precipitated by stress, including alopecia
areata, psoriasis, and even vitiligo. Psychological sequelae mainly affected by serotonin have been studied among
these patients.
Objective: Assessment of blood serotonin levels in alopecia areata and vitiligo patients for psychological impacts.
Patients and Methods: 15 individuals with vitiligo, 15 with alopecia areata, and 15 healthy age and sex matched
controls were studied in this study. A modified version of the Social Readjustment Rating Scale (SRRS) was used
to quantify the stress index, and blood serotonin levels were also measured to study the role of stress in alopecia
areata and vitiligo.
Results:
Patients who had alopecia areata as well as vitiligo had considerably greater serum serotonin levels than
controls. In the vitiligo group, there was a strong positive connection between serum serotonin, the vitiligo area
scoring index (VASI) score, and the stress index. On the other hand, no positive correlation was found between
serum serotonin and both severity of alopecia tool (SALT) score and stress index in alopecia areata group.
Conclusion
: In both alopecia areata and vitiligo, psychological stress appears to play a significant role as a
triggering factor and we should pay attention to psychiatric role to get proper treatment for such chronic diseases.
Keywords : Alopecia Areata, Serotonin, Stress, Vitiligo


INTRODUCTION

The prevalence of vitiligo, a chronic autoimmune
instability, and tumor formation are all possible side
inflammatory illness that causes skin discoloration, is
effects of prolonged high levels of stress (7).
between 0.5 and 1 percent all over the world. A lack of
Dietary tryptophan, an essential amino acid, yields
melanocytes in the epidermis causes white areas (1, 2).
serotonin (5-hydroxytryptamine), a monoamine.
Despite the fact that vitiligo does not shorten a person's
Central nervous system (CNS) neurotransmitter 5-HT
life expectancy, the discoloration has a detrimental
has been implicated in a wide range of cognitive and
effect on their quality of life and mental health, leading
emotional processes as well as arousal and sleep (8).
to social exclusion and an increased risk of mental

health problems (3).
The purpose of this study was detection of
An auto-immune disorder called alopecia areata
psychiatric impact among cases who have vitiligo or
(AA) causes hair loss in genetically vulnerable people
alopecia areata by evaluation of serum serotonin level
in reaction to unknown environmental factors (4).
in these patients.
Alopecia areata can be triggered by stressful life

situations. Even if stressful life events play only a little
PATIENTS AND METHODS
influence in the onset of alopecia areata, the worry and
From December 2019 to July 2020, at Zagazig
despair that accompany this long-term condition may
University Hospitals' Dermatology, Venereology, and
have an impact on the course of the disease by way of
Andrology Out-patient Clinic and Clinical Pathology
stress mediators (5).
Department, we conducted this study. Our trial
Many diseases and pathological disorders can be
involved 15 patients who had vitiligo, 15 patients who
aggravated or triggered by stress. Stress exacerbates
had alopecia areata and 15 apparently healthy age and
illness complications, and people who are exposed to
sex matched controls.
stress, such as those who work or live in high-stress

environments, are more likely to suffer from a wide
Ethical considerations:
range of ailments (6).
In order for the trial to proceed, all participants had
Stress can contribute to cancer by lowering the
to sign informed consent forms and submit them to
body's ability to fight infection. A decrease in cytotoxic
Zagazig University's ethical committee (ZU-
T lymphocyte and natural killer cell activity, as well as
IRB#352).
Ethics
guidelines
for
human
an increase in malignant cell proliferation, genetic
experimentation were adhered to in accordance


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634
Received: 07/10/2021
Accepted: 15/11/2021

Full Paper (vol.861 paper# 102)


c:\work\Jor\vol861_103 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 641-644

An Overview of Role of Retinoids in Management of Warts:
Review Article
Ahmad Nofal, Samar Mohammad Mohammad Najah*,
Ahmed Said Abdel Shafy
Department of Dermatology, Venereology and Andrology, Zagazig University Hospital, Egypt
*Corresponding author: Samar Mohammad Mohammad Najah, E-Mail: mohammedsamar512@gmail.com

ABSTRACT
Background
: Human papillomavirus (HPV)-inducing HPV-types can cause a wide range of cutaneous wart
morphology and histological patterns that are distinct from one another. Certain forms of warts are more
commonly related with various HPVs that cause cutaneous warts. It is essential that treatments for different
forms of warts are both safe and painless. As warts can resolve up to two-thirds of the time without treatment,
and treatments should not increase morbidity, this is particularly significant. In contrast, a large number of warts
do not self-resolve fast and are associated with diminished quality of life, embarrassment, and pain in the skin.
In terms of structure and function, retinoids resemble vitamin A in many ways. Both the differentiation and
proliferation of keratinocytes and the immune system are hampered by their immunomodulatory effects.
Objective: Assessment of role of retinoids in management of warts.
Conclusion: Oral retinoids such as isotretinoin and acitretin are safe and reported to be effective therapy for
different types of warts.
Keywords : Human papillomavirus, Retinoids, Warts


INTRODUCTION


Human papillomavirus (HPV) infection of the
resistant to one HPV type while still being susceptible
skin is extremely common. Warts are noncancerous
to other HPV kinds (2).
skin growths caused by HPV infection (verrucae).
A cure for warts has eluded scientists for
The rapid proliferation of cells on the outer layer of
decades, despite extensive research. There is no one
the skin is what causes warts. Even while warts have
treatment that works for all warts, thus new
been documented since ancient Greece, it wasn't until
treatment options are constantly being developed.
1907 that the virus responsible for their development
Approximately 9.1 percent to 21.7 percent of
was identified (1).
dermatological referrals are for the treatment of
These skin warts normally form and then
cutaneous warts in primary school students (3).
disappear over the course of a few weeks or months.
The treatments for different forms of warts
There are many cases of warts that recur on the skin.
must be safe and, if possible, not painful. As warts
Small numbers of skin-derived stem cells may
can resolve up to two-thirds of the time without
harbour long-term "latent" infections from any one of
treatment, and treatments should not increase
the HPVs. Although these latent infections may never
morbidity, this is particularly significant. In
be completely eliminated, immune management is
contrast, many warts don't promptly self-resolve,
expected to prevent symptoms like warts from
resulting in a lower quality of life, shame, as well as
developing. It is possible for a person to grow
physical suffering for the patient (4).

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641
Received: 7 /9 /2021
Accepted: 4 /11 /2021

Full Paper (vol.861 paper# 103)


Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 645-652

Medical Students' Satisfaction Regarding Blended Learning during
COVID-19 Pandemic
Lamiaa Lotfy El-Hawy, Khaldon Abosnenah Alssarat*,
Shahira Ramsis Dimetry, Marwa Bayomi Awad Allah
Department of Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Khaldon Abosnenah Alssarat, Email: Kh.Khaldoun.Kk@gmail.com

ABSTRACT

Background: The realization of the profession's role in both of global and personal concept affected the self-identification
among 2020 medical students. COVID-19 pandemic can hinder, accelerate, or change medical students' professional
identity formation. Objective: To assess the level of satisfaction about blended learning among undergraduate medical
students at Zagazig University and to determine challenges, which face the medical students during blended learning
education in Faculty of Medicine. Patients and Methods: This cross-sectional study was performed during the period from
September 2020 to July 2021 at Zagazig University, Egypt. This research included 277 undergraduate medical students.
Results: The current study reported that interaction satisfaction score ranged from 18 to 53 with median 37 and 53.1% of
students reported high satisfaction with interaction domain. There was statistically significant correlation between total
satisfaction score and both age and technology barrier. There was statistically non-significant correlation between total
satisfaction score and communication barrier. Conclusion: The results show that the majority of our sample students were
highly satisfied with blended learning and reported low barriers to e-learning. Students still prefer face-to-face courses
despite their satisfaction with their grades and performance in blended learning courses.
Keywords: Blended learning, COVID-19, Satisfaction grading.

INTRODUCTION

the distraction reduced student's motivation toward
The medical studies choice based on different
learning (10). Besides the medical students, the pandemic
factors, a previous study identified three domains;
also, had a significant effect on lives worldwide (11). Many
humanitarian, scientific, and societal (1). Another study
studied identified the negative effects of the pandemic on
reported that scientific and selfless and scientific reasons
the psychological aspects of students causing depression,
are the major purposes for medical career choosing (2).
anxiety, post-traumatic stress disorder, and other stress
Narayanasamy et al. reported other factors that affect
symptoms (12).
medicine enrollment: professional calling, personal
The current study was performed to assess the level
growth, professional concerns factor, and personal
of satisfaction about blended learning among
concerns (3). Regarding COVID-19 , this pandemic caused
undergraduate medical students during clinical and
obstacles worldwide, and healthcare providers at the
preclinical phases in the Faculty of Medicine, Zagazig
summit of this extraordinary situation (4,5).
University. Also to compare between level of satisfaction
The realization of the profession's role in both of
among students in preclinical and clinical phases, with
global and personal concept affected the self-
determining associated risk factors affecting the level of
identification among 2020 medical students. COVID-19
satisfaction among students and challenges, which face the
pandemic can hinder, accelerate, or change medical
medical students during blended learning education.
students' professional identity formation (6). A study

conducted on first-year medical students in the USA
PATIENTS AND METHODS
reported that 30% of students were interested about their
This cross-sectional study was performed during the
professional or academic futures (7). The internal and
period from September 2020 to July 2021 at Faculty of
external stimulation associates positively with professional
Medicine, Zagazig University. Assuming the proportion of
specification (8). Chandratre also figured out the elevated
the students adapted the blended learning was 75% and the
obstacles in professional character formation in medical
total number of students was (6773) students. At 95% CI
students (9). After university enrollment, the educational
and size effect=1, the estimated sample was (277) students
process of the students is mainly affected by their passion
by using Epi program. By stratified sampling technique
to study. Regarding the social-cognitive, student's
students were divided into two strata (preclinical and
educational motifs is the interaction between the student's
clinical stages), then from each stratum by cluster random
responsiveness towards the educational environment,
method, the desired sample was obtained, taking
environmental factors, and learning behavior (5).
proportional allocation in consideration.
The transmission of the learning process toward the

virtual learning had a significant effect on medical
Ethical consent:
learning. Indeed, this virtual instead of in situ learning
An approval of the study was obtained from Zagazig
reduced student's motifs. During COVID-19 pandemic,
University Academic and Ethical Committee. Every

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645
Received: 17/10/2021
Accepted: 21/11/2021

Full Paper (vol.861 paper# 104)


c:\work\Jor\vol861_105 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 653-659

Diagnostics and Outcome Predictorso Drug Induced Liver Injury:
A Single Center Prospective Study
Omkolsoum M. Alhaddad*1, Amany S. ElSharkawy1, Olfat M. Hendy2,
Maha M. Elsabaawy1, Mohamed A. Mazaly1, Aliaa A. Sabry1
1Hepatology and Gastroenterology Department, 2Clinical Pathology Department,
National Liver Institute, Menoufia University, Shebin El Kom, Egypt.
*Corresponding author: Omkolsoum Mohamed Alhaddad, Mobile: (+20) 01001779069, Email: dromkolsoum@yahoo.com

ABSTRACT
Background:
Although drug-induced liver injury (DILI) is a rare clinical event, it carries significant morbidity and
mortality. The diagnostic approach of DILI is still challenging because of lack of reliable markers that would allow
distinguishing DILI from other causes of liver injury. Objective: To study the demographic, clinical and laboratory
characteristics, and their relation to outcome of patients with DILI. Patients and Methods: Case control study
conducted on 80 participants divided into two groups; Group I 40 patients with acute DILI and Group II 40 patients
with acute viral induced liver injury. Subjects were systematically evaluated for clinical and laboratory characteristics,
other etiologies, severity of DILI with application of Roussel Uclaf Causality Assessment Method (RUCAM) and
liver biopsy whenever feasible and were all followed for 6 months thereafter. Results: Diclofenac was the most
incriminated drug in DILI group (16 cases, 40%). Hepatocellular injury pattern was more common (28 cases, 70%).
Infection with acute hepatitis B virus (HBV) and hepatitis A virus (HAV) were the commonest etiology of viral
hepatitis (32 cases, 80%). All patients with acute viral hepatitis, improved with no recorded mortality nor chronicity.
While 6 patients (15%) with DILI died. Conclusion: The diagnostic approach of DILI is still rudimentary and
inaccurate and require high index of suspicion and thus, careful assessment is required to distinguish DILI from other
causes of liver injury.
Keywords
: Diclofenac, Drug-induced liver injury, Hepatocellular, Viral hepatitis.

INTRODUCTION
Recognizing the pattern of liver injury at the initial
Drug-induced liver injury (DILI) remains a
presentation is vital. It provides a useful foundation to
challenging diagnosis and gains increased attention
establish a differential diagnosis and guides the
annually, as it poses a significant risk to the patient
diagnostic evaluation accordingly. The R-ratio is a
health. DILI broadly describes any injury to the liver
quantitative expression of the injury pattern; it is
that might occur as a result of medications
defined as the ratio of serum ALT to alkaline
(prescription or Over the Counter (OTC)), herbal and
phosphatase (ALP) values, both expressed as multiples
dietary supplements (HDS), or other xenobiotics that
of upper limit of normal (ULN), obtained at the onset
may develop from asymptomatic liver test
of injury. An R-ratio of >5 indicates hepatocellular
abnormalities up to acute liver failure that cannot be
injury, <2 indicates cholestatic injury, and 2-5
attributed to other causes (1, 2).
indicates mixed injury (6,7).
Diagnosis is complex, with no unifying criteria
Several clinical scales have been developed to
and a relatively high index of suspicion is necessary.
establish a causal relationship between a certain
In addition, drugs that cause toxic effects on the liver
medication and liver injury. The Roussel Uclaf
exhibit diverse pathological responses that mimic all
Causality Assessment Method (RUCAM) continues to
forms of acute and chronic hepatobiliary liver disease
increase in use as a causality assessment tool. The
(3).
success of RUCAM is attributable to its objective,
The differential diagnosis for acute hepatocellular
standardized, and liver-injury-specific approach (8).
injury includes acute viral hepatitis, autoimmune
However, it has limitations in assessment method and
hepatitis (AIH), ischemic liver injury, acute Budd-
arbitrary scoring, such as old age and alcohol use (9).
Chiari syndrome, and Wilson disease. One should keep
The aim of this study was to provide a more
in mind that acute biliary obstruction may initially
detailed description and characterization of patients
present with a hepatocellular pattern of injury but
with DILI and their outcome predictors and to improve
subsequently evolves into a cholestatic presentation (4).
our ability to diagnose DILI and perform a causality
A general approach to a suspected case of DILI
assessment in comparison with patients with acute
includes taking a comprehensive medical and drug
viral hepatitis.
history, with clear timing around drug administration
PATIENTS AND METHODS
and exclusion of other potential factors that could
This prospective study was conducted on 80
contribute to the liver injury (5).
patients, in Hepatology and Gastroenterology
Department, National Liver Institute (NLI), Menoufia



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license (http://creativecommons.org/licenses/by/4.0/)



653
Received: 9/10/2021
Accepted: 18/11/2021

Full Paper (vol.861 paper# 105)


c:\work\Jor\vol861_106 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 660-663

Prevention of Ventilator-Associated Pneumonia: Zero-VAP Implementation:
Review Article
Dalia A. Abdulrahman, Mohammed Mahmoud Romih, Eman Mustafa Fathy El Attar*
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Eman Mustafa Fathy El Attar, E-mail: ema.elattar@gmail.com
ABSTRACT
Background:
Mechanical ventilation via an endotracheal tube (ETT) or tracheostomy can lead to a condition known
as ventilator associated pneumonia (VAP). Up to 20% of all nosocomial infections in pediatric care facilities
following blood stream infections are most commonly brought on by Ventilator Associated Pneumonia (VAP).
Pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) had very different rates of VAP
infections per 1000 ventilator days. Patients who have VAP are more likely to have a longer stay in the hospital and a
higher rate of morbidity and mortality. If implemented, "Zero VAP" was found to be an all-encompassing strategy for
prevention of higher rates of VAP in Spain. This strategy could be widely used for more prevention of VAP globally.
Objective:
To evaluate the role of the Spanish "Zero- VAP" bundle in reduction of VAP in PICU. Conclusion: Zero-
VAP compromises of many levels among health working personnel and system, it gives a clear description of steps,
approach, preventive actions to minimize incidence of VAP among ICUs that could be used globally.
Keywords:
Ventilator Associated Pneumonia, Pediatric intensive care units.

INTRODUCTION

occurrence, risk factors, and prevention methods. To
Mechanically ventilated patients are more likely
keep tabs on VAP or infection rates, it is essential to
to develop ventilator associated pneumonia (VAP),
use bundled care and performance measurements (5).
which is a type among nosocomial pneumonia that
Shared protocols:
usually happens 48­72 hours after the patient has
Pediatric patients must be treated with caution
received mechanical ventilation. VAP is one of the
because they aren't ready to remain intubated without
most prevalent hospital-acquired infections in
sedation. Some protocols are not suitable for use with
mechanically ventilated patients, and it is related with
children of all ages. Adults may benefit from daily
increased morbidity and mortality in these patients (1).
sedation-free trials and spontaneous breathing trials to
Ventilator is a device that delivers oxygen to a
prevent VAP, but children may be at greater risk of
patient's lungs via a tube inserted into his or her mouth,
unintentional extubation if these trials are offered (6).
nose, or a hole in the front of the patient's neck. It is
Interprofessional
workflow
or
device
possible that bacteria will enter the patient's lungs via
management solutions suggested by surveillance
the tube and cause an illness (1). In order for VAP to
models might be tested to see if they reduce the VAP
occur, the oropharynx and stomach must be
rate. The Centers for Disease Control and Prevention
vaccinated. Typically, VAP is acquired through
(CDC) provides examples of pneumonia flow
aspiration from the paranasal sinuses, nose or even
diagrams. Patients' outcomes can be improved by
stomach (2). To prevent contamination of the
including various members of the PICU team (7).
connection port, extreme care must be taken when
VAP Guidelines 2021:
putting an endotracheal tube into the mechanical
New Guidelines for Treatment of VAP:
ventilator. Contagious diseases spread more easily
Antibiotics are effective against several bacterial
when people have poor personal hygiene. As a result
types of VAP. For treatment suggestions, it is critical
of mechanical ventilation utilizing heated humidifiers,
to identify the exact infections involved. Sputum
bacteria may proliferate (3).
samples may be collected by doctors who then give
The aim of this review was to evaluate the role of
broad-spectrum antibiotics or even a variety of broad-
the Spanish "Zero- VAP" bundle in reduction of VAP
spectrum antibiotics as they await the results of the lab
in PICU.
tests (8). When a ventilated patient develops
Preventing pediatric ventilator-associated pneumonia:
pneumonia, healthcare providers should not presume
In the neonatal intensive care units, newborns that are
that the ventilator is at blame. Even without proper
dangerously unwell and preterm are cared for. The
suctioning, aspiration pneumonia is common in this
majority of mechanically ventilated paediatric patients
population. Similar to viruses, fungal infections can
are seen in the PICU, and they are typically between
also cause lung infections, especially in vulnerable
the ages of one and 21 days or months. 10% to 20% of
groups like patients in the intensive care unit (ICU).
mechanically ventilated patients suffer with VAP. Risk
This is especially true. Get the patient to cough out a
factors for this condition must be considered (4).
sample of his or her sputum for testing (9).
Steps for VAP prevention: Interprofessional VAP
Bronchoscopy
specimens
were
cultured
management is based on an understanding of VAP's
quantitatively,
whereas
Drakulovic
and
his



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license (http://creativecommons.org/licenses/by/4.0/)
660
Received: 10/10/2021
Accepted: 18/11/2021

Full Paper (vol.861 paper# 106)


c:\work\Jor\vol861_107 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 664-669

Correlation between Serum Interleukin- lß and Neonatal Sepsis in
Neonatal Intensive Care Unit in Zagazig University Hospitals
Mohammad Hamad Awad*1, Hesham Samy Abd elhamid 1,
Seham Fathy Abd elhamid 1, Ahmed Mohamed Gaballah 2
Departments of Pediatrics1 and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohammad Hamad Awad, Mail: mohammedhamad1133@gmail.com

Abstract
Background:
The role of interleukin-lß in the pathogenesis of sepsis is widely accepted, but less is known
regarding its role in the newborn period.
Objective: The aim of the work was to detect relation between serum level of IL- lß and clinical presentation of
neonatal sepsis.
Patients and Methods: This case control trial study included a total of thirty-six newborns, attending at the
Neonatal Intensive Care Unit, Zagazig University Hospitals. They were categorized into two groups; 18 each:
Group I: newborns with suspected clinical sepsis, and Group II (control group) healthy newborns with no sepsis.
Interleukin- lß was assessed in all neonates.
Results: IL-lß showed significant increase in diseased versus control group (20.07±8.68 versus 1.21±0.48,
respectively with p <0.001). IL-lß showed insignificant difference in preterm versus full term neonates. IL-lß
showed significant difference in subgroup analysis. Full term neonates in patient group had the highest mean
(23.811±10.55 pg/ml, p<0.001).
Conclusion: It could be concluded that premature babies have lower IL-1ß serum concentrations, while mature
newborns with sepsis had higher IL-1ß serum concentrations than healthy newborns.
Keywords: Interleukin- lß, Intensive Care Unit, Neonatal Sepsis

INTRODUCTION

to stimulate T and B lymphocytes, enhance cell
Every year, the WHO estimates that 130
proliferation, and initiate or suppress gene production
million newborns are born around the world. More
of a number of proteins. As a result of infection,
over 10 million of those infants die before they reach
microbial toxin, inflammatory agents, lymphocyte
the age of five months, with about eight million dying
activation products, and clotting components, the
before their first birthday (1). Four million newborns
production of IL-1 has been shown to increase
die each year in the first month of their lives. The bulk
dramatically. Acute phase reactions are linked to the
of newborn deaths are reported in developing nations
systemic effects of IL-lß. Fever, the production of
like Egypt. In the poor world, around 1.6 million
hepatic acute-phase proteins, and the release of
newborns die each year because of infections, and
neutrophils are all caused by it, and systemic
infections are the leading cause of neonatal mortality
hypotension occurs when it is produced in excess (4).
(2).
The role of IL- lß in the etiology of sepsis is
In resource-limited nations, neonatal sepsis is a
widely accepted, but its role in the newborn period is
leading cause of infant morbidity and mortality.
unknown. Research on the ability of systemic
Hospitalized neonates are at danger for developing
infection to create IL-lß has given mixed results.
sepsis if they are not properly cared for in a neonatal
Increased levels of IL- lß have been reported by
intensive care unit (NICU) or a hospital nursery, which
several researchers (5), Others, however, have found
is why it's important to keep an eye out for signs of
that the levels remained the same (6) and even in lower
infection. The diagnosis of newborn sepsis in the
levels (7) among neonates with sepsis.
absence of blood culture data is a matter of clinical
Septicemia caused by bacteria is the leading
judgement. Temperature instability, apneic episodes,
cause of newborn death (mortality in the first 28 days
food intolerance, poor blood perfusion, and shock are
of life) (8). Neonatal infection is still a substantial cause
some of the symptoms. Detecting and treating sepsis
of long-term illness and death despite advances in
in environments with limited clinical laboratory
perinatal care, with an incidence of 1 to 10 per 1000
capacity, antibiotic medication, and supportive care
live births (9). Sepsis is more common in newborns
can be particularly difficult (3).
than in any other stage of life, and it varies greatly from
Monocytes and macrophages are the primary
place to place. Neonatal sepsis was found in 1­5 cases
producers of interleukin lß, a soluble protein. It is a
per 1,000 live births in some wealthy countries,
member of the cytokine family (IL-6 as well as tumor
whereas other population-based studies in developing
necrosis factor (TNF)) with a wide range of biological
countries revealed rates of 49­170 per 1,000 live births
characteristics. All three cytokines have the potential
(10).



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664
Received: 13/10/2021
Accepted: 19/11/2021

Full Paper (vol.861 paper# 107)


c:\work\Jor\vol861_108 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 670-674

Effect of Magnesium Sulphate on Emergence Agitation in
Children undergoing Adenotonsillectomy
Najwa Mohmuod Farahat*, Samia Mohamed Masoud, Amal A. Azeem Salah, Hala Mohamed Rashad
Department of Anesthesia and surgical intensive care, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Najwa Mohmuod Farahat, Mail: njwyfrhat353@gmail.com

ABSTRACT
Background:
There is some evidence that intraoperative magnesium infusions prevent postoperative delirium in
children.
Objective: The aim of the work was to study the effects of intra-operative magnesium sulphate administration on the
children's risk of post-adenotonsillectomy post-agitation.
Patients and Methods: At Anesthesia & Surgical Intensive Care Department, Zagazig University Hospitals, this
randomized, double-blind clinical trial included 90 children with American Society of Anesthesiologists (ASA)
physical status classes I or II who were scheduled to undergo adenotonsillectomy. Patients were allocated randomly
into two equal groups (45 for each group): Group C: received intraoperative 0.9% normal saline initial loading dose
of 0.3ml/kg over 10 min as a bolus, then 0.1ml/kg/hr. of infusion for the length of the procedure. Group MG: Patients
were given 30 mg/kg of a 10% solution of magnesium sulphate intraoperatively over the course of 10 minutes as an
initial loading dose, then 0.1ml/kg/hr. of infusion for the length of the procedure.
Results: Group MG was significantly lower than Group C regarding fentanyl needed and also total dose of fentanyl.
As regard Pediatric Anesthesia Emergence Delirium (PAED) score, we found that there was No significant difference
regarding pre but at post group MG was significantly lower at post also agitation was significantly associated with
Group C.
Conclusion: It could be concluded that sevoflurane anesthesia using magnesium sulphate is used for
adenotonsillectomy surgery in children. A 30-mg/kg loading dose is given intraoperatively, followed by a continuous
infusion at 0.1ml/kg/hr. for the duration of surgery. This combination reduces the incidence of emergent anxiety and
the need for postoperative fentanyl.
Keywords: Magnesium Sulphate, Emergence Agitation, Adenotonsillectomy.

INTRODUCTION

nociceptive impulses and pain perception. Analgesic
One of the most common surgical consequences
effects of magnesium in abdominal, orthopedic,
after general anesthesia is emergent agitation (EA). Not
otolaryngological as well as cardiac surgery have been
only are parents and caregivers put through a difficult
supported by that investigation (7).
time when their children engage in EA, but it can also
Increased sedation, analgesia, reduced usage of
lead to unanticipated outcomes, such as the removal of
neuromuscular blockade medications, and avoidance of
drains or catheters, self-harm, and a delay in the patient's
ischemic-reperfusion injury have been linked to the use
discharge. EA can occur at any age, however it is most
of magnesium during the perioperative phase (8).
common in children between the ages of 3 and 9 (1).
Intraoperative magnesium infusions in children
Literature on the prevalence of emergency
have been shown to minimize postoperative emergence
agitation/delirium ranges from 10% to 80% (2). In the
delirium. Children's emerging delirium rates were
early stages of emergence, delirium and agitation are
unaffected by magnesium supplementation (9).
common, but emergency agitation/emergency delirium
The aim of the current work was to study the
has been observed as late as 45 minutes after the
effects of intra-operative magnesium sulphate
stoppage of general anesthesia, on average 14 minutes (
administration on the children's risk of post-
±11 minutes) (3).
adenotonsillectomy post-agitation.
Intravenous sedatives, anesthetics, and opioid

drugs are the most commonly prescribed treatments for
PATIENTS AND METHODS
children with emerging agitation, but their success rates
This randomized double blind clinical trial included
are inconsistent, recovery times are lengthy, and they can
a total of 90 pediatric patients with ASA physical status
have unpleasant side effects as vomiting as well as
classes I and II, scheduled for adenotonsillectomy,
nausea (4, 5). As the fourth most abundant cation in the
attending at Anesthesia & Surgical Intensive Care
human body, magnesium has been shown to influence
Department, Zagazig University Hospitals.
ion transport and energy metabolism (6).

Magnesium may block NMDA receptors and
Ethical Consideration:
calcium channels in the central nervous system, brain,
This study was ethically approved by Zagazig
and spinal cord, hence modulating the transmission of
University's research ethics committee. Written



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670
Received: 10/10/2021
Accepted: 18/11/2021

Full Paper (vol.861 paper# 108)


c:\work\Jor\vol861_109 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 675-680

The Serum Thyroid Hormone Profile in Mechanically Ventilated
Children: Does Euthyroid Sick Syndrome Exist?
Tarek A. Abdelaziz1*, Mohamed Mahmoud. Romih1, Weaam Ibrahim. Ismail2,
Khadija AL Mabrouk Emhalhal1, Eman Gamal Baz1
1Pediatric and 2 Clinical Pathology Departments, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Tarek A. Abdelaziz, Email: tareklatef43@gmail.com

ABSTRACT
Background:
The term "euthyroid sick syndrome" refers to alterations in thyroid function testing during critical illness.
Mechanically ventilated children's thyroid hormone levels may be altered, although the reason for this remains a
mystery.
Objective: This study was aimed to evaluate thyroid hormone profile in mechanically ventilated children and their
correlation with mortality.
Patients and Methods: Thirty-four mechanically ventilated children were enrolled in a prospective cohort study. On
the first and third days of mechanical ventilation, serum TSH, FT3, FT4 and reverse T3 were measured.
Results: The mean age of the studied patients was of 31.06 ± 35.94 months. After three days of mechanical ventilation,
the serum levels of FT3 and FT4 in the blood were significantly lower than the serum levels on the first day. The serum
reverse T3 levels increased significantly on the third day of mechanical ventilation compared to the first day. There was
a statistically significant increase in the number of patients with low FT3 and FT4 serum levels on the third day compared
to the first day. Twenty-two patients (64.7%) died, and the frequency of low FT3 among dead patients was
signiisignificantlycantly higher than among surviving patients.
Conclusions: It could be concluded that the mechanically ventilated children had signs of euthyroid sick syndrome,
shown by low levels of FT3 and FT4 and a rise in rT3 without a compensatory rise in TSH. Serum FT3 and FT4
decreased, but reverse T3 increased, on the third day of mechanical ventilation compared to the first day. Patients who
had low FT3 levels died at a higher rate.
Keywords: Euthyroid sick syndrome, Thyroid profile, Reverse T3, Mechanically ventilated children


INTRODUCTION


Euthyroid sick syndrome refers to abnormalities
The aim of the current work was to evaluate thyroid
in thyroid function tests in children admitted to the
hormone profile in mechanically ventilated children
pediatric intensive care unit during critical illness.
and their correlation with mortality.
Seventy five percent of hospitalized patients with this

condition had abnormalities in the hypothalamic-
PATIENTS AND METHODS
pituitary-thyroid axis. As a result of acute critical
This prospective cohort study included a total of
illness, calorie restriction, and major surgery, many
34 mechanically ventilated patients, attending at
children suffer from this syndrome. Normal T4 and
Pediatric Intensive Care Unit (PICU) and Clinical
TSH and low TT3 and FT3 levels are the hallmarks of
Pathology Department, Zagazig University Hospitals.
euthyroid sick syndrome's hormonal pattern (1).

Several hormones, protein messengers, and a
Inclusion criteria:
complex system of injury-induced stimuli that
This study included all mechanically ventilated
stimulates the central nervous system can be triggered
patients aged between 1 month and 16 years admitted
by injury, trauma, or sepsis. As a result, the
to the PICU during the study period.
hypothalamic anterior pituitary axis is altered, including

the adrenal gland, the somatotrophic, the thyrotrophic,
Exclusion criteria:
and the gonado-lactotrophic. The CNS also stimulates
Patients who died within 48 hours of PICU
catecholamine secretion via the peripheral sympathetic
admission and those with the decision are made to
nervous system (2).
provide only palliative care were excluded from the
The alteration in thyroid hormone levels in
study. Also, we excluded patients with a history of
mechanically ventilated children remains unclear.
thyroid disorders.
There is little evidence to suggest overt pathology in this

setting.




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675
Received: 11/10/2021

Accepted: 17/11/2021

Full Paper (vol.861 paper# 109)


RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 681-688

Effect of Intracoronary Glycoprotein IIb/IIIa Inhibitor and Manual
Aspiration Thrombectomy on Primary Percutaneous Coronary
Intervention Outcome in High Thrombus Burden Patients
Mohammed Hussam Al-Din Al-Shaer, Yasser Gaber Ibrahim Metwally,
Mohammed Abdelhady Mohammed, Alsalhen Fathi A. Ibsaekri*
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Alsalhen Fathi A. Ibsaekri, Mobile: (+20) 01061948143, E-mail: mohf76174@gmail.com

ABSTRACT
Background:
The opening of a related artery in myocardial infarction as quickly as possible is the key to treating
infarct. Percutaneous coronary intervention (PCI) for recanalization of related infarcted arteries is considered the most
effective therapy for myocardial infarction.
Objective:
To estimate the intracoronary delivery of glycoprotein IIb/IIIa following manual thrombus aspiration on
outcomes post PCI for patients with high thrombus burden.
Patients and Methods:
This was a randomized control trial that was conducted on 48 patients presented to Zagazig
University Hospital Emergency Cardiac Unit with ST elevation myocardial infarction for primary percutaneous
coronary intervention, the need for reperfusion therapy was assessed according the European Society of Cardiology
(ESC) Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment
elevation. Patients were randomized into three groups: (1) Manual aspiration group (16 patients). (2) Manual
aspiration with intracoronary glycoprotein IIb/IIIa group (19 patients), and (3) Intracoronary glycoprotein IIb/IIIa
group (13 patients).
Results: There was significant difference between manual aspiration group, manual aspiration with intracoronary
glycoprotein IIb/IIIa group and intracoronary glycoprotein IIb/IIIa group as regard the outcomes in high thrombus
burden patients.
Conclusion: Combination glycoprotein IIb/IIIa and manual aspiration is better then single modality for high thrombus
burden patients.
Keywords: Intracoronary Glycoprotein, Manual Aspiration, Percutaneous Coronary Intervention, Thrombectomy.

INTRODUCTION
Some studies suggest that the intracoronary
The opening of a related artery in myocardial
application of platelet membrane GP IIb/IIIa receptor
infarction as quickly as possible is the key to treating
antagonists improves myocardial perfusion; however,
infarct (1). Percutaneous coronary intervention (PCI)

for recanalization of related infarcted arteries is
such studies are currently few, and their results are
considered the most effective therapy for myocardial
controversial (8,9). Most of these studies used
infarction (2).
abciximab as their GP IIb/IIIa receptor antagonist, and
Myocardial recovery after the primary percutaneous
tirofiban was rarely used (10).
coronary intervention (PCI) is often suboptimal despite
This study aimed to selection of best method for
restoration of thrombolysis in myocardial infarction
treatment of patients with high thrombus burden.
(TIMI) 3 flow, in part due to thrombus remobilization,

which results in impaired microvascular perfusion and
PATIENTS AND METHODS
increased infarct size (3).
A randomized control trial that was conducted on
Aspiration thrombectomy and intracoronary
48 patients presented to Zagazig University Hospital
platelet glycoprotein (GP) IIb/IIIa receptor antagonists
Emergency Cardiac Unit with ST elevation myocardial
are widely used to reduce distal embolization (4,5). GP
infarction for primary percutaneous coronary
IIb/IIIa receptor antagonists can reduce thrombus
intervention, the need for reperfusion therapy was
burden
and
secondary
distal
embolization
assessed according the ESC Guidelines for the
microcirculation (6).
management of acute myocardial infarction in patients
Measuring infarct size after reperfusion therapy
presenting with ST-segment elevation(11).
offers important prognostic utility. Laboratory

measures of infarct size include biomarkers such as
Ethical consideration:
creatinine phosphokinase, lactate dehydrogenase, and
This study was submitted for approval by
troponin levels. While these tests are promptly
the Institution Research Board (IRB) of Zagazig
available and can be obtained in the acute setting, they
University Institution. Informed consent was
are unreliable in comparison to infarct size assessed by
obtained from each participant sharing the study.
cardiac imaging(7).
Confidentiality and personal privacy were

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681
Received: 05/10/2021
Accepted: 15/11/2021

Full Paper (vol.861 paper# 110)


c:\work\Jor\vol861_111 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 689-695

Does Ultrasound-Guided Continuous Suprascapular Nerve Block Affect
Frozen Shoulder Rehabilitation Programme Outcome?
Hosam I. El Said Saber1*, Amal Rashad1, Ebrahim Eltnany1, Reham M. Shaat 2, Zaglool A1
1Department of Anesthesia and Surgical Intensive Care, 2Department of Rheumatology and Rehabilitation,
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
*Corresponding author: Hosam I. El Said Saber, Mobile: +201005785775 - +201110383210,
E-mail: hosamsaber@yahoo.com -hosamibrahim@mans.edu.eg,

ABSTRACT
Background:
Physical therapy (PT) is often recommended for patients with frozen shoulder. However, it could be painful
for some patients, and this could hinder the rehabilitation programme. Some procedures like joint injection and
suprascapular nerve block (SSNB) could alleviate pain during this setting. Objective: The purpose of this study was to
compare the effectiveness of continuous SSNB plus PT compared to PT alone in managing frozen shoulder.
Patients and methods: A total of 76 patients with frozen shoulder were included in this study. They were divided into
two groups: 38 patients in the injection group (IG) received SSNB via catheter before PT, while the remaining 38
participants in the control group (CG) received no block prior to PT (CG). The functional state of the shoulder joint was
assessed via the constant shoulder scale before and just after PT, then one month later.
Results: General patient characteristics, including age, gender, BMI, comorbidities, and trauma history, were statistically
comparable between the two groups. When we examined the constant scores of the two groups, we found that both had
low scores before treatment, which increased immediately after treatment and then increased again one month later.
Nonetheless, the injection group had a much greater increase than the control group.
Conclusion: When used with PT for the treatment of adhesive capsulitis, continuous SSNB is an effective option that
enhances the response to PT. It is associated with better improvement in shoulder function.
Keywords: Frozen shoulder, Outcome, Suprascapular Nerve Block.


INTRODUCTION

In 1934, Codman invented the phrase "frozen
intraarticular injection therapy may be commenced for
shoulder" to characterize insidiously-onset painful
these patients prior to PT (5).
shoulder diseases with shoulder movement restriction.
About 70 percent of the shoulder area is
The term adhesive capsulitis is now extensively used to
innervated by the suprascapular nerve, which includes
describe the underlying pathology (1).
the acromioclavicular joint, the posterior and superior
Frozen shoulder affects women two to four times
regions of the shoulder joint, and the joint capsule (6).
more than men and is more common in people aged 40
SSNB is an interventional procedure that reduces
to 60. It affects about 2% to 5% of the population (2). The
shoulder pain caused by various illnesses by blocking
presence of progressive limited joint mobility and
pain signal transmission from the shoulder joint to the
generalized pain despite conservative therapies is used to
corresponding segments in the spinal cord (7).
make the clinical diagnosis. A painful treatment process
This blockade technique was initially described
and a lengthy recovery, which can last up to two years,
in 1941 (8).
are characteristic features of this pathology (3).
Although this block technique is not often used
Frozen shoulder discomfort and spasm are
because of its complications (like injury to the
routinely treated with physical therapy (PT) techniques
supraclavicular nerve, pneumothorax, and vascular
such as analgesic currents that are used to apply
injuries), Dangoisse et al. modified the original
superficial and deep heat. To enhance joint mobility and
technique, which led to a dramatic decrease in post-
restore function, rehabilitation techniques such as
procedural complication rate(9). The local anesthetic
stretching, strengthening exercises, and mobilization
injected during SSNB could be combined with steroids
movements are also commenced (4).
to prolong its action and enhance its efficacy (10).
These procedures, on the other hand, are
The goal of this study was to compare the
frequently associated with pain, which could hinder the
efficacy of continuous SSNB plus PT versus PT alone in
patient from completing his planned rehabilitation
managing frozen shoulder patients.

programme. As a result, in the case of frozen shoulder,
suprascapular nerve block (SSNB) or
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689
Received:8 /9 /2021
Accepted:5 /11 /2021


Full Paper (vol.861 paper# 111)


c:\work\Jor\vol861_112 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 696-699

Overview on Hepatitis B vaccination
Mona Ali Saber1, Hatem Abdul-Monsef Sarhan2, Yasser Mahrous Fouad3,
Mahmoud MA Elsayed4 and Alshymaa Ahmed Hassnine3
1 Clinical Pharmacy Department, Faculty of Pharmacy, Minia University, Minia, Egypt
2 Pharmaceutics Department, Faculty of Pharmacy, Minia University, Minia, Egypt
3 Tropical medicine Department - Faculty of medicine, Minia University, Minia, Egypt
4 Pharmaceutics and Clinical Pharmacy Department, Faculty of Pharmacy, Sohag University, Minia, Egypt

Corresponding author: Mona Ali Saber, E mail: drmonaali2014@gmail.com, Mobile phone: 01021788274


ABSTRACT
Background: Hepatitis B virus (HBV) infection is increasing globally, posing a serious public health problem. Hepatitis
B virus (HBV) infection and mortality are among the leading causes of death worldwide. Concerns for public health are
amplified by the fact that about a third of the world's population is afflicted with HBV. HBV infection may result in
cirrhosis, hepatocellular cancer, or both (HCC).
Immunization is the most cost-effective strategy available worldwide for controlling and preventing hepatitis B in terms
of benefit-cost ratio. Objective: This review article discusses the most critical components of the HBV vaccine and the
most efficient strategies for increasing HBV vaccination.
Keywords:
Antibodies, HBs-antigen, Hepatitis B vaccine, Hepatitis B virus, Immunization.

Hepatitis B virus
HBV is a 3200 base pair DNA virus that
predominantly infects human liver cells (Figure 1) (1).
People who have been exposed to acute hepatitis
B virus infection (HBsAg) have their immune response
markers removed from circulation (anti-HBc and anti-
HBs). Despite the fact that HBV's circular DNA is
found in just about a tenth of one percent of hepatocytes,
it frequently reactivates, causing illness flare-ups (2).
Infection with the hepatitis B virus (HBV) and
death from it are among the main causes of death
globally (3).
The fact that nearly a third of the world's
population is infected with HBV adds to public health
concerns.
Chronic
hepatitis,
cirrhosis,
and
hepatocellular cancer may develop in some carriers (4).
Every year, 780000 individuals die from HBV-
related causes around the world. An infection's long-
term repercussions are inversely related to its onset age
(3).
If an infection occurs during pregnancy, chronic

illness and its effects are almost always to be expected
Figure (1): A schematic figure of the Dane element,
(5).
the infectious H-B-V particle, is obtainable at the

bottom with many structural things, including an
electron micro graph of circulating forms of HBV
particles in the blood (6)





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696
Received:8 /9 /2021
Accepted:5 /11 /2021


Full Paper (vol.861 paper# 112)


c:\work\Jor\vol861_113 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 700-707

Comparative Study of The Effect of Topical Minoxidil 5% Versus
Combined Fractional CO2 Laser and Topical Minoxidil 5% in Treatment of
Male Androgenetic Alopecia
Mai Ibrahim Abd El-Motlib Rashed*, Leila Sharaf, Bothaina Mahrous Ghanem
Department of Dermatology, Andrology& STDs, Faculty of Medicine - Mansoura University, Egypt
*Corresponding author: Mai Ibrahim Abd El-Motlib, Mobile: (+20) 01011969553, E-Mail: mairashed@gmail.com


ABSTRACT
Background:
Male androgenetic alopecia (MAA) is the most common hair problem among men. Androgenetic alopecia
(AGA) is a non-scarring progressive miniaturization of the hair follicle with a usual characteristic pattern of distribution
in genetically predisposed men and women.
Objective: To compare between the efficacy of topical minoxidil 5% alone and combined topical minoxidil 5% and
fractional laser in treatment of male androgenic alopecia and detection of any side effects occurring with each line of
treatment.
Patients and Methods: This prospective randomized comparative controlled study was conducted for one year on 40
patients with male androgenic alopecia attending to out Patient Clinic of Dermatology, Andrology and STDs
Department, Mansoura University Hospitals. Patients were classified into two groups: Group A received minoxidil alone
(minoxidil group) and group B where patients received minoxidil plus fractional CO2 laser.
Results: In group A and B, there was a statistically significant improvement between the clinical assessment scale at
baseline and after 1 month (p<0.001). Also, there was a statistically significant improvement between the clinical
assessment scale after 1 month and after 3 months (p=0.002). In group A, there was a statistically significant
improvement between the clinical assessment scale at baseline and after 1 month, however, there was no statistically
significant improvement between the clinical assessment scale after 1 month and after 3 months. In group B, there was
a statistically significant improvement between the clinical assessment scale at baseline and after 1 month, however,
also, there was a statistically significant improvement between the clinical assessment scale after 1 month and after 3
months.
Conclusion:
Our study revealed the superiority of combination therapy, using a fractional laser and 5% minoxidil, over
5% minoxidil alone, for the treatment of male AGA, with no serious adverse effects of treatment identified.
Keywords: Androgenetic alopecia, Topical minoxidil 5%, Fractional CO2 laser, Topical minoxidil 5%

INTRODUCTION


Androgenetic alopecia (AGA) is a non-scarring
therapy, scalp microneedling, hair mesotherapy, and
disease with a progressive thinning of the scalp hair that
hair transplantation (4).
follows a characteristic pattern. The pathogenesis of
There are several mechanisms by which
androgenetic alopecia involves both genetic and
minoxidil may promote hair growth; however, the exact
hormonal (androgens) factors (1). Male pattern baldness
mechanism of action is unclear. It has been shown both
affects up to 50% of men worldwide. The disorder
in vivo and in vitro to have a direct mitogenic effect on
occurs in almost all patients before 40 years and in many
epidermal cells, and in vitro it prolongs the survival
patients below the age of 30 years (2). This phenomenon
time of keratinocytes. In addition, topical minoxidil
is caused by androgen hyperactivity and various genetic
may oppose calcium entry into the cells, which may
predispositions. Subsequently, hair follicles decrease in
increase epidermal growth factors to allow hair growth
size and exhibit a reduced anagen-to-telogen ratio (3).
(5). Rossi et al. (6) reported stoppage of hair loss in 50%
Traditionally, pharmacologic treatment of
of men and hair regrowth in a small percentage of men
AGA targets decreasing dihydrotestosterone (DHT) and
after topical minoxidil therapy. Jones (7) suggests a dose
stimulating hair follicles through the use of 5-alpha
of 1ml minoxidil twice per day. Local erythema and
reductase (5AR) inhibitors or minoxidil; however, new
pruritis were reported as side effects. The drug must be
and experimental therapies are exploring inhibition of
continued indefinitely or hair regrowth will subside.
Janus kinase (JAK) (Regulates the activation of key hair
In 2007, low-level laser therapy has been
follicle populations such as the hair germ and improves
approved by the US Food and Drug Administration and
the inductivity of cultured human dermal papilla cells
appeared to be safe and effective in treatment of male-
by controlling a molecular signature enriched in intact,
and female-pattern hair loss (8).
fully inductive dermal papillae) and the use of platelet-
Huang et al. (9) reported that a fractional laser-
rich plasma (PRP). Other therapies include laser
assisted drug system can be used to provide supportive
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700
Received: 11/9/2021
Accepted: 8/11/2021


Full Paper (vol.861 paper# 113)


c:\work\Jor\vol861_114 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 707-713

Skin Prick Test Results and Total IgE Levels of Asthma Patients in
Zagazig University Hospital (2015-2019)
Lama Adel Mohamed Salama*, Tarek Abd El-Hakeem Mahfouz,
Ashraf El-Sayed Sileem, Mohammad Walaa Said
Department of Chest Diseases, Faculty of Medicine, Zagazig University, Sharkia, Egypt
* Corresponding author: Lama Adel Mohamed Salama, Email: lamaadel33@yahoo.com

ABSTRACT
Background:
Bronchial asthma is one of the relevant diseases of the respiratory tract, the asthma is one of the forms of
respiratory allergy. The change in environment and aeroallergens are the main etiology of asthma. Allergy of asthma is
thought to affect the bronchial region of the respiratory airway.
Objective: The current study aimed to compare the total IgE elevation and skin prick test (SPT) positivity to evaluate
the IgE and SPT ability to assess the asthmatic severity.
Subjects and Methods: This retrospective case study was carried out on 3450 cases at the outpatient clinic and Chest
Department at Zagazig University and did skin prick test and IgE in authorized centers were collected from 2015 -2019.
The cases were already diagnosed asthmatic according to Global Initiative for Asthma (GINA) (9) guidelines and were
divided according to severity into mild, moderate, and severe according to GINA guidelines.
Results:
IgE has been tested for different aeroallergens and has strong significant elevation with (P< 0.001) in
Alternaria, cat hair, cotton, birch, and helminths aeroallergen. Most of the cases with elevated IgE had moderate asthma
severity followed by mild severity cases then severe cases.
Conclusion: Comparing the results of SPT and IgE, the SPT test is more accurate, reliable, and easy in detecting the
aeroallergen sensitivity.
Keywords: Aeroallergen, IgE, Allergic asthma, Asthmatic severity, Skin prick test.

INTRODUCTION
type I was determined by IgE and SPT, and help in
Asthma is considered one of the most significant
atopic diseases phenotypic diagnosis (7). Both IgE and
causes of mortality and morbidity, which is
SPT can detect atopic status. The skin test is economic,
accompanied by an uncontrolled spasmatic narrowing
rapid and sensitive that expression of IgE specific-
of the bronchus and bronchioles as a result of bronchitis
antigen in the mast cells. The incidence of allergy is
and bronchial myocytic contraction (1). Allergy is
elevating worldwide with the trend of SPT positivity (8).
considered an immune-mediated hypersensitivity
The current study was concerned with the evaluation
reaction associated with expression of specific
of IgE and SPT ability to assess the asthmatic severity.
immunoglobulins mainly IgE caused by identification

of antigens of specific allergen (2).
SUBJECTS AND METHODS
Patients with familial history of allergic diseases like
This retrospective case study was carried out on
allergic rhinitis, drug and food allergy, and eczema were
3450 cases at the outpatient clinic and Chest
diagnosed with allergic asthma. The atopic patients had
Department at Zagazig University and did skin prick
elevated levels of IgE caused by natural aeroallergens.
test and IgE in authorized centers were collected from
A previous study hypothesis that half of the allergic
2015 -2019. The cases were already diagnosed
cases had symptoms, commonly manifest in the
asthmatic according to Global Initiative for Asthma
respiratory tract diagnosed as allergic sensitization (3).
(GINA) (9) guidelines and were divided according to
Atopy is considered the most susceptible factor for
severity into mild, moderate, and severe according to
allergic asthma. Atopy is also resulted from altered
GINA guidelines.
immunologic response for the activation of T-helper
The cases were diagnosed atopic bronchial asthma
type 2 lymphocyte, causing chronic response correlated
with raised serum IgE and peripheral blood eosinophilia
with the induced eosinophilia and IgE (4).
and were above 18 years old, were included in this
Aeroallergens exposure have a potential role in
study.
bronchial asthma pathogenesis. Regarding the locations
The excluded cases included; all patients that had
within countries, the aeroallergens differ (5). The
dermatological diseases other than allergic skin diseases
treatment and diagnosis of bronchial asthma were
or were not a resident of Sharkia.
determined by the type of aeroallergens (6).

A previous study on atopic disease, in vitro analysis
Technique:
using IgE and in vivo skin prick test (SPT) were carried
The records of all patients contain the following:
out on inhalant and food extracts. The hypersensitivity
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708
Received: 11/10/2021
Accepted: 17/11/2021

Full Paper (vol.861 paper# 114)


c:\work\Jor\vol861_115 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 715-720

Preemptive Nebulization of Lidocaine Epinephrine Before Anesthesia for
Rigid Bronchoscopy in Pediatric: A Randomized Controlled Study
Hosam I. El Said Saber, T. El-Desoky, Mostafa S. Elawady, Hani I. Taman
From Anaesthesia and Surgical Intensive Care Department, From Pediatrics Department,
Faculty of Medicine, Mansoura University, Egypt
Corresponding author: Hani I. Taman, Mobile: +201008288242, E-mail: hani_taman@hotmail.com

ABSTRACT
Background:
Foreign body aspiration in pediatrics is usually managed by rigid bronchoscopy, which is associated with
plenty of adverse events. Objective: We tried to compare the effect of nebulized saline, lidocaine or combined lidocaine
with epinephrine on postoperative respiratory complications.
Patients and methods: This prospective study included 90 children, who were divided into three groups according to
the nebulized solution; NS group (normal saline 0.9%), L group (lidocaine 1% 4 mg.kg- 1) and LA group [4 mg.kg- 1
lidocaine 1% and adrenaline (1:1000) 3 mg). Our primary outcome was the incidence of post-operative respiratory
complications, while the secondary ones included hemodynamic changes and the incidence of intraoperative cough or
desaturation. Results: All pre-procedural data were insignificant among the three groups. The LA group expressed
higher heart rates, while the L group showed a significant reduction when compared to NS group. Propofol consumption
showed a significant decline in two studied groups compared to the NS group. Intraoperative cough was higher in NS
group in comparison to L and LA groups. Although, intraoperative desaturation per case along with post-operative
sedation showed no significant difference among the three groups, post-operative cough frequency attacks and severity
were higher in NS group when compared to L and LA group and when L group were compared to LA group. Post-
operative stridor was insignificant among the three groups.
Conclusion: Nebulized lidocaine/adrenaline combination is appropriate option to achieve proper intraoperative sedation
and upper airway conditions with reduction of post-operative negative respiratory outcomes together with minor
hemodynamic changes.
Keywords: Rigid bronchoscopy; Nebulization; Lidocaine; Epinephrine.

INTRODUCTION
early clinicians used topical anaesthesia for rigid

Foreign body aspiration by children is a
bronchoscopy interventions 1, most anaesthetists prefer
common problem that is frequently encountered in
general anaesthesia nowadays, thanks to advances in
emergency pediatric practice. Impaction of the inhaled
anaesthetic delivery and the increased experience with
foreign body could lead to asphyxia, and it is the major
rigid bronchoscopy procedures 7, 13. During the
cause of mortality in children aged less than four years
procedure, anaesthetists usually try to maintain an
1. Therefore, this serious entity should be immediately
adequate depth of anaesthesia to prevent cough and
managed to avoid subsequent complications and
straining during the intervention. Stable hemodynamics
irreversible lung damage 2. It was managed by emetics
and rapid post-procedural recovery are crucial needs as
and purges in the 19th century, but these management
well 14, 15.
Lidocaine is an inexpensive, widely
modalities were ineffective and were associated with a
available anaesthetic agent with an excellent safety
23% mortality rate 3. However, this rate dramatically
profile when nebulized. This contrasts the fact that
decreased following the intervention of bronchoscopy4.
topical anaesthetics are rapidly absorbed into the

For more than a century, rigid bronchoscopy
circulation following application onto mucosal
has been a crucial tool in the diagnosis and treatment of
surfaces, which increases the risk of systemic adverse
various airway pathologies 5. Despite the widespread
events 15.
Epinephrine (adrenaline) is a potent
use of flexible bronchoscopy, the rigid one is still used
adrenergic alpha and beta receptor stimulant. It is used
as the gold standard option for many complex airway
during cardiopulmonary resuscitation. In addition, it
diseases, including foreign body aspiration 6, 7. It allows
could be nebulized in pediatric patients with airway
the operator to properly visualize and manipulate the
inflammatory diseases like croup and bronchiolitis 16, 17.
aspirated object, with proper management of mucosal
Its potential positive impact on the airway is due to a
haemorrhage, if it occurred 8. Although rigid
decrease in airway secretions and oedema (alpha
bronchoscopy has a 95% success rate with a safe profile
effect), together with airway dilatation and inhibition of
(less than 1% complication rate) 9, 10, multiple
inflammatory cascades (beta effect) 18.
complications could be encountered, including

Based on local anaesthetic effects of lidocaine
bronchospasm, laryngeal oedema, pneumothorax,
and anti-edematous effects of adrenaline, our
tracheobronchial lacerations, hypoxic brain damage,
hypothesis is that preoperative nebulization of both
infection, bleeding and cardiac arrest 1, 11, 12. Although
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715
Received: 9/9 /2021

Accepted:6 /11 /2021

Full Paper (vol.861 paper# 115)


Measurement of Serum Lipid Level in Children with Congenital Heart Diseases The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 721-726

Effect of Intensive Phototherapy on T and B Lymphocyte Function in
Neonatal Jaundice
Tarq Abd Alrahman Atia1, Usama Mahmoud Alkholy1, Hanan Samir Ahmed2,
Aesha Aghab Abdalslam*1, Al Shaymaa Ahmed Ali1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University
*Corresponding author: Aesha Aghab Abdalslam, Mobile: (+20)01028790806, E-mail:
aishaogabsallah@gmail.com
Abstract
Background:
Jaundice is one of the most common problems that affect newborns in the first few days of life.
Approximately 60% of full-term and 80% of the preterm newborn may develop neonatal jaundice. Although neonatal
jaundice is of physiological type in most of these cases, some cases may have elevated serum bilirubin levels which, if
not treated, may lead to bilirubin encephalopathy and subsequently bilirubin induced neurological dysfunction (BIND).
Objective: This study aimed to evaluate the effect of intensive phototherapy on B and T cells by measuring the
percentages of CD19+, CD4+ and CD8+ lymphocytes subsets in newborns after 72 hours from exposure to intensive
phototherapy to evaluate its effect on the immune system.
Patients and methods: A prospective cohort study carried out in Zagazig University Hospital, Pediatric Neonatal
Intensive Care Unit (NICU) and Clinical Pathology Departments. The study included 50 full-term newborns. Results:
There was no significant difference regarding CD4, CD8 and CD19 for the patient group. Furthermore, the study showed
that the percentages of CD4+ and CD8+ lymphocytes subsets showed no change in newborns after 72 hours of exposure
to phototherapy, but CD19+ was highly significantly lower before treatment only. In addition, the follow up of those 25
jaundiced newborns for occurrence and frequency of infection and need for hospitalization for a period of six months
after discharge showed no effect.
Conclusion: our results showed no effect of phototherapy on lymphocyte subsets after 72 hours of exposure and no
effect on infant immunity.
Keywords:
Intensive phototherapy, Neonatal Jaundice, T and B Lymphocyte.

Introduction:

Neonatal phototherapy (NNPT), a non-
Neonatal jaundice is one of the most common
invasive, readily available therapy, has been widely
conditions challenging neonatologists daily. Yellow
used to treat neonatal for more than half a century. It
discoloration of a newborn baby's skin and eyes caused
effectively decreases or prevents the rise of serum
by hyperbilirubinemia resulted from an accumulation of
unconjugated bilirubin levels and reduces the need for
unconjugated bilirubin(1). Although most neonatal
exchange transfusion in neonates(5). Fundamentally,
hyperbilirubinemia cases are physiological and reflect a
phototherapy uses light energy to treat severe
normal
transitional
phenomenon,
excessive
hyperbilirubinemia in both; term and large preterm
unconjugated bilirubin is a potential neurotoxin. In
infants within the neonatal period. Technically,
some infants, hyperbilirubinemia can become
exposing the visible light will cause changes to the
dangerous where serum bilirubin levels may rise
molecular structure of bilirubin. Thus, resultant
excessively and cause death in neonates and lifelong
products are less lipophilic than bilirubin and can be
neurologic sequelae in infants who survive (kernicterus)
excreted in bile or urine without conjugation(2,6).
(2).
The effectiveness of phototherapy is dependent
Total bilirubin (TB) levels may rise and exceed
on the intensity and wavelength of used light. There is
the physiological limit, rarely to very high levels and
no standardized method of delivering phototherapy, and
cause kernicterus. Infant jaundice usually occurs
its units vary widely; several phototherapy devices are
because a baby's liver isn't mature enough to eliminate
available, which use light sources with different
excessive bilirubin levels in the bloodstream. About
wavelengths and densities. Current phototherapy
60% of term and 80% of preterm infants develop
systems use conventional compact fluorescent lamps or
jaundice in the first week of life. In some babies, an
light-emitting diodes (LEDs), of which LEDs generate
underlying disease may cause infant jaundice.
significantly higher light irradiance levels(5).
Particularly in the presence of certain risk factors for
Although phototherapy is currently available
severe jaundice, infants should be monitored to identify
and generally considered safe and well-tolerated in
those who may develop severe hyperbilirubinemia.
neonatal jaundice treatment due to its efficacy and
Besides, in rare cases, acute bilirubin encephalopathy or
apparent safety, concerns about the potentially toxic
kernicterus necessitates a rapid intervention strategy.
effects of phototherapy have been expressed. Some
Phototherapy is the most widely used therapy for
reports indicated an increase in mortality in low birth
neonatal jaundice management(3,4).
weight (ELBW) infants exposed to prolonged
phototherapy (PT) had raised questions about its safety.

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721
Received: 4/10/2021
Accepted: 13/11/2021

Full Paper (vol.861 paper# 116)


c:\work\Jor\vol861_117 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 727-733

Comparative Study between Effectiveness of Dermapen versus Dermapen
Combined with Topical Ascorbic Acid in Treatment of Stretch Marks
Fawzia Amin Saafan, Moheiddin Fakhry Alghobary,
Fatma Feisal El dakrory, Eman Gaber Hamed Tky-Eldeen*
Department of Dermatology, Andrology & STDs, Faculty of Medicine - Mansoura University, Egypt
*Corresponding author: Eman Gaber Hamed, Mobile: (+20) 01064961174, E-Mail: emangaber24@yahoo.com

ABSTRACT
Backgound:
Stria distensea is considered a destress for the women. Weight gain,family history of stretch marks,steroid
use and pregnancy are considered the most common causes of its existance. Striae distensea treatment is considered a
challenge, there are different methods in treatment of stria, but till now no single treatment is considered the best
treatment for it.
Objective: This study aimed to evaluate and compare the effect of dermapen alone and dermapen combined with topical
ascorbic acid in treatment of striae distensae.
Patients and methods: This study was conducted on 45 patients with stretch marks. Stretch marks treatment in each
patient was divided into 2 groups. First group of stretch marks (right side) was treated with dermapen only: 3 sessions
with 4 weeks interval. Second group (left side) was treated with dermapen combined with topical ascorbic acid with the
same number of sessions.
Result: Our study revealed the effectiveness of both methods in treatment of stretch marks, but also it showed a
difference in clinical improvement among the two groups concerning change in Manchester Scar Scale (MSS) score
after treatment in favor of using dermapen with topical ascorbic acid, which gave better result than using dermapen
alone.
Conclusion: The current study concluded that combination of vitamin C and dermapen is promising therapeutic
modality with better satisfaction compared to dermapen alone in terms of stretch marks treatment with no adverse events.
Keywords:
Stretch marks, Dermapen, Topical ascorbic acid.

INTRODUCTION
laser. However, high-quality evidence for effective and
Striae distensae (stretch marks) are a permanent
long-lasting therapies is limited or lacking (4, 5). Thus,
type of dermal scarring. The unattractive appearance of
there are no consensus guidelines for treating striae. The
stretch marks may have a significant negative
lack of effective treatment results are either due to the
psychological impact on some individuals. Although
permanence of skin atrophy or poor improvement in
their exact etiology is unknown, the incidence of stretch
skin color.
marks is often associated with rapid growth, abrupt
Microneedling is one method of treating stretch
changes in weight, and the use of corticosteroids (1).
marks that works by stimulating intradermal collagen
Consequently, they occur primarily among adolescents,
production (6), also it can be used as a means for
obese individuals, and pregnant women. By the third
achieving trans-epidermal drug delivery (7). Ascorbic
trimester, approximately 90% of pregnant women
acid, which also enhances the production of normal
develop stretch marks on their abdomen and/or breasts
collagen, can be delivered in this manner (8). It therefore
(2). Striae generally follow cleavage lines that are
seems likely that ascorbic acid can improve the atrophic
transverse to the direction of the greatest tension, where
appearance of stretch marks. At the level of gene
the tissue is the weakest and least able to withstand
expression, ascorbic acid has also been shown to
mechanical stress. They are initially red (striae rubrae),
upregulate collagen synthesis and increase the synthesis
later becoming white and more atrophic (striae albae)
of the inhibitor of metalloproteinase I, which decreases
(1). Histologically, inflammatory changes are initially
ultraviolet-induced collagen degradation (9).
evident with dermal atrophy and loss of rete ridges.
Review of literature revealed a lot of studies
Stretch marks are distinguished from normal skin by
that addressed the efficacy of dermapen whether as
densely packed areas of thin, horizontally arranged
single therapy (6), or in combination with other treatment
bundles of collagen lying parallel to the skin surface.
options (10, 11), but no available studies investigated the
Compared with normal skin, the number of vertical
efficacy and safety of dermapen combined with topical
fibrillin fibers adjacent to the dermal-epidermal junction
ascorbic acid (12).
and elastin fibers in the papillary dermis are
The objective of this study was to compare
significantly reduced within stretch marks (3).
between effectiveness of dermapen alone versus
A number of different methods are available for
dermapen and topical ascorbic acid for treatment of
treating stretch marks as microneedling- topical
stretch marks to find the better treatment for stretch
tretinoin, glycolic acid peel, topical ascorbic acid and
marks.



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SA) licens (http://creativecommons.org/licenses/by/4.0/)
727
Received: 12/9/2021
Accepted: 9/11/2021

Full Paper (vol.861 paper# 117)


c:\work\Jor\vol861_118 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 734-737

Primary Versus Deferred Ureteroscopy for Management of
Calculus Anuria in Children: Review Article
Mostafa Abdel Razik Ahmed, Atef Fathi Ali, Mostafa Mohamed Mostafa*, Mohammad Sayed Abdel-Kader
Department of Urology, Faculty of Medicine, South Valley University, Egypt
*Corresponding author: Mostafa Mohamed Mostafa, Mobile: (+20)01069432827, E-mail: mostafaalsoghier@yahoo.com

ABSTRACT
Background:
The incidence of urolithiasis in the pediatric population is on the rise. Urolithiasis in the pediatric age group,
although occurring less in adults, causes considerable morbidity. The role of ureteroscopy (URS) in the management of
calculus anuria could be primary or deferred. The deferred URS after initial ureteral stenting or percutaneous drainage is
the standard one. However, the remarkable progress in the manufacturing of ureteroscopes and lithotripters favored the
primary URS.
Objective:
This study aimed to evaluate the results of primary versus deferred URS for management of obstructive calculus
anuria (OCA) in children in previous literatures.
Methods: We have searched literature in the American National Center for Biotechnology Information (NCBI), PubMed,
Google scholar, Egyptian bank of knowledge, and science direct.
Conclusion: Primary URS is a definitive stone management technique and an appropriate option that can reduce hospital
stay, prevent multiple anesthesia, and alleviate the costs in children with OCA when performed by skilled endourologists.
However the deferred URS is a favored procedure for management of calculus anuria in pediatric patients compared to
primary URS.
Keywords: Calcular anuria, Deferred, Ureteroscopy, Pediatric.

INTRODUCTION
· Drugs or their metabolites (e.g. phenytoin,
With the development of small diameter endoscopes,
triamterene).
improvement in the techniques of endoscopic lithotripsy
· Melamine-contaminated milk powder consumption.
in children has gradually become a major technique for
Etiology:
the treatment of urinary stones (1). The risk of anuria is
Renal stones occur as a result of the following 3
associated with electrolyte imbalance, especially
factors:
hyperkalemia, which leads to cardiac dysrhythmia and
· Supersaturation of stone-forming compounds in
sudden death. Therefore, an imperative and urgent
urine
intervention must be considered. However, before making
· Presence of chemical or physical stimuli in urine that
a decision of intervention we have to consider the
promote stone formation
availability of endoscopic experience and the instruments
· Inadequate amount of compounds in urine that
(2).
inhibit stone formation (eg, magnesium, citrate).
This work aimed to evaluate the results of primary versus
In children, hypercalciuria and a reduction in the gap
deferred URS for management of obstructive calculus
between calcium phosphate upper limit of
anuria in children in previous literatures.
metastability and supersaturation are significant risk
1. Calculus anuria in children:
factors for stones (3). Other factors such as
Pathophysiology:
developmental abnormalities of the urinary tract,
Renal, urologic, endocrine, and metabolic disorders
urinary obstruction, urinary stasis, and infection with
may
lead
to
the
development
of
urea-splitting microorganisms may also be important.
crystallized material in the urinary system. Materials
Epidemiology:
that produce stones in the urinary tract of children
Frequency of urolithiasis in children has not been
include the following:
studied in a systematic population based fashion.
· Calcium with phosphate or oxalate.
Institutional and case reports indicate regional
· Purine derivatives.
variation. A significant increase in the number of
· Magnesium and ammonium phosphate (struvite).
children diagnosed with and treated for urolithiasis
· Cysteine.
has occurred in the last decade (4).
· Combinations of the preceding items.
Management of ureteric stone in pediatric
patients:
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734
Received: 12 /9 /2021
Accepted: 9 /11 /2021

Full Paper (vol.861 paper# 118)


c:\work\Jor\vol861_119 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 738-741

Evaluation of the Efficacy of Acitretin in the Treatment of
Multiple Viral Warts: A Pilot Study
Sahar Al Mokadem, Heba El-Feky*, Eman Salah

Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University.
*Corresponding author: Heba El-Feky, Email: noranlama698@gmail.com

ABSTRACT
Background:
Wart treatment should be painless, safe, time-efficient, and cost-effective, according to the ideal model.
Objective: To study patients with widespread recalcitrant warts to see if oral acitretin was clinically effective and safe.
Patients and Methods: A total of 21 patients with multiple recalcitrant warts were studied in this study. At Zagazig
University Hospitals, they were recruited from the Dermatology and Venereology Outpatient Clinic. For a maximum of
four months, the patients received oral acitretin at a dose of (0.5 mg/Kg/day) until complete clearance.
Results
: There were a total of 21 participants in the study. They ranged in age from 18 to 59 years old, with 11 males and
10 females; 52.4 percent, 47.6 percent respectively. Four patients (19%) showed complete response to the treatment, 12
patients (57.2%) showed partial response and 5 patients (23.8%) showed no response. With no patients stopping treatment
because of side effects, the medication was found to be safe. Dry skin and cheilitis were the most common mild side effects
observed. During a three-month follow-up period, there were no recurrences.
Conclusion: Patients with recalcitrant multiple warts respond favourably to the safe, effective, and well-tolerated treatment
with acitretin.
Keywords
: Acitretin, Recalcitrant, Treatment, Wart.

INTRODUCTION
of a clear definition for the term. Plantar and periungual
Verrucae, or warts, affect the skin's epithelium and
warts, in particular, can develop refractory in up to one-
are thought to be the result of a human papillomavirus
third of patients with non-genital warts. The size of the
infection (HPV). About 7 to 10 percent of the population
affected area, rather than the length of time the warts have
will develop warts at some point in their lives. Heat and
been there, is what determines the recalcitrance of genital
moisture, such as those found in public swimming pools
warts ]5,6[. There are a variety of wart treatments available,
and locker rooms, are ideal habitats for the HPV, which is
many of which have little or no evidence to support their
spread through direct touch or even small scratches or
utility. As a rule, the best treatment should leave no scars
abrasions in the skin's stratum corneum. Autoinoculation
]7[.
is another method through which warts can spread locally
A precise antiviral treatment for HPV is not yet
to infect other parts of the body. Children and adults with
available, but a few other medicines can disrupt the viral
impaired immune systems are more likely than healthy
life cycle. The treatment's goals are to either kill the wart
people to contract the virus and develop more severe
on the skin's surface or boost the immune system's ability
lesions ]1[.
to combat the virus ]8[. Warts can be treated with a variety
Based on DNA research and serological
of methods that are both destructive and anti-mitotic, as
identification of type-specific antibodies against HPV
well
as immunotherapeutic.
Surgical
removal,
capsid antigens, numerous HPV strains have been
cryocoagulation, electro-cautery, chemical cautery
discovered. Papillomaviruses have over 200 distinct
(salicylic acid 70% and trichloroacetic acid (TCA)), and
genotypes that are more typically associated with benign
laser ablations are examples of destructive therapy.
epithelial lesions ]2[.
Bleomycin, retinoids (tretinoin cream, isotretinoin,
HPV types 1, 2, 4, and 7 are the most common cause
acitretin) and podophyllin are anti-mitotic medicines.
of warts on the hands and feet, but the genital tract is
Zinc sulfate, diphenylcyclopropenone, 5-flurouracil, and
infected by more than 35 different types of HPV. HPV
intralesional injection of an antigen are examples of
types 6, 11, 42, 44, and 70 are linked to low-risk
immunotherapeutic drugs]9[.
anogenital warts, while HPV types 16, 18, 31, 33, 45, and
Warts such as epidermodysplasia verruciformis,
59 are most frequently linked to cervix squamous cell and
condyloma
acuminatum,
and
epidermodysplasia
adenocarcinomas ]3,4[.
verruciformis can be treated with oral acitretin ]10[.
Recalcitrant warts are those that remain throughout
Psoriasis and other disorders of keratinization have been
several months of conventional therapy despite the lack
widely treated with acitretin because of its



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738
Received: 13/10/2021
Accepted: 18/11/2021

Full Paper (vol.861 paper# 119)


c:\work\Jor\vol861_120 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 742-747

Predictors of high Calcium Score in Patients with
Negative Myocardial Perfusion Imaging
Mahmoud Abdelaziz Abdelrashid, Montaser Mostafa Alcekelly,
Ghada Ibrahim Mohammed, Adel Hassan Allam, Abanoub Ezzat Faheem*
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Abanoub E. Faheem, Mobile: (+20) 01014468790, Email: dr.abanoub.ezzat@gmail.com

ABSTRACT
Background:
Coronary artery disease (CAD) is one of the major cardiovascular diseases. Myocardial perfusion imaging
(MPI) using single photon emission computed tomography (SPECT) plays an important role in the diagnosis and
prognosis of CAD.
Objective: The aim of the present study was to reduce the generalization of doing calcium score for all coronary cardiac
patients with negative myocardial perfusion imaging.
Patients and methods: A retrospective cohort study analysis using data from Alfa Scan Center, a major outpatient
radiology center in Cairo, Egypt, and conducted in Cardiology Department, Faculty of Medicine, Zagazig University
that included a total sample of 1168 participants with negative myocardial perfusion imaging not known to have history
of CAD, and age ranged between 20 to 80 years from both sexes. All patients were subjected for SPECT-MPI after the
intravenous injection of 99mTc-sestamibi.
Results:
There was statistically significant difference between the two groups regarding age, gender, weight, chest pain,
hypertension, dyslipidemia, diabetes, family history of CAD, beta blockers, aspirin, resting diastolic blood pressure
(DBP), rest ECG abnormalities and exercise duration. Age, gender, diabetes mellitus and dyslipidemia were the
predictors of any coronary artery calcification (CAC > 0) in patients with negative myocardial perfusion imaging. Age,
gender and Duke Treadmill Score were the predictors of significant coronary artery calcification (CAC > 100) in patients
with negative myocardial perfusion imaging.
Conclusion: Calcium score for all not known coronary cardiac patients with negative MPI is a mandatory, particularly
if they are old, male gender and have multiple risk factors.
Keywords: Calcium Score, Coronary Arteriography, Myocardial Perfusion.

INTRODUCTION

Coronary artery disease (CAD) is one of the
Coronary computed tomography angiography
major cardiovascular diseases affecting the global
(CCTA) is also an important method in the evaluation
human population. This disease has been proved to be
of the coronary arteries with high accuracy in the
the major cause of death in both the developed and
diagnosis and prognosis of coronary heart disease. In
developing countries. Lifestyle, environmental factors,
addition, coronary artery calcium (CAC) scoring has an
and genetic factors pose as risk factors for the
established role in risk-stratifying asymptomatic
development of cardiovascular disease. The prevalence
patients at intermediate risk of CAD (4).
of risk factors among healthy individuals elucidates the
Evidence shows that CAC scoring is a strong
probable occurrence of CAD in near future (1).
independent predictor of CHD events and improves
The diagnosis of CAD takes into account the
classification of intermediate risk individuals, causing a
presence of symptoms, risk factors and complementary
large shift in the distribution of CVD risk. Currently,
diagnostic methods that generally use stress
European, and American guidelines recommend
mechanisms, with the goal of diagnosing the presence
considering additional CAC scoring to guide preventive
of myocardial ischemia. Among these, myocardial
therapy decisions in intermediate-risk adults (5,6).
perfusion imaging (MPI) using single photon emission
Therefore, this study aimed to reduce the
computed tomography (SPECT) plays an important role
generalization of doing calcium score for all coronary
in the diagnosis and prognosis of CAD (2).
cardiac patients with negative myocardial perfusion
SPECT studies with non-significant perfusion
imaging.
defects for myocardial ischemia may represent a

challenge, sometimes leading to unnecessary indication
PATIENTS AND METHODS
for cardiac catheterization. A multicenter study
The study was carried out as retrospective study
demonstrated that, based on the available algorithms
in Alfa Scan Center, a major outpatient radiology center
used for the evaluation of patients with suspected CAD,
in Cairo, Egypt. Data were collected from the records of
about 40% of patients undergoing coronary
patients from 1st of January 2014 to 31st of December
arteriography showed no coronary obstruction (3).
2019 .

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742
Received: 13/9/2021
Accepted: 10/11/2021

Full Paper (vol.861 paper# 120)


c:\work\Jor\vol861_121 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 748-754

Assessment of Difference in the Clinical and Microbial Spectrum of
Community-Acquired Pneumonia among Egyptian Children
Abdelrazek Mohamed Elshiekh1, Rabab Mohamed El Behedy1,
Ghada El Siad Amro2, Salem Faraj Salem Alayan*1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Salem Faraj Salem Alayan, Email: ayansalem22@gmail.com

ABSTRACT
Background:
Community-acquired pneumonia (CAP) is a significant cause of respiratory morbidity and mortality in
children, especially in developing countries. Chest radiography and rapid viral testing may be helpful when the diagnosis
is unclear.
Objective: This study aimed to find pattern community-acquired pneumonia (CAP) pathogen after introduction of
Haemophilus influenzae type B (HIB) vaccine in Egypt and also to provide an update on the evaluation, diagnosis and
treatment of CAP in children.
Patients and methods: A cross sectional study that was conducted on 54 patients with pneumonia infection.
Participation to this study was offered to all consecutive children aged 2 months to 7 years old presenting with CAP
according to the WHO criteria. All cases with CAP were subjected to full history, clinical examination, radiological
plan chest X-ray and laboratory and microbiological investigations. Results: The mean age was 1.79 years and mean
weight was 9.61 Kg, more than half of them were male (57.4%). About 94.4% of the studied group had respiratory
distress (RD) Grade I followed 70.4% had Grade II, 46.3% had grade III. The mean hemoglobin (Hb) level was 11.06
gm/dl, mean hematocrit was 32.44%, while mean neutrophil was 6.61%. Additionally, the mean platelets count was
345.81 × 103/mm3 mean CRP was 43.26 mg/dl, and the median of PCT was 1.13. All 64.8% of the studied group had
disease less than 1 week ago. Regarding oxygen support 14.8% needed ventilator. Finally 22.2% were admitted to ICU.
Conclusion: Bacteremia is an unusual complication of CAP in hospitalized children. Our study suggests that
approximately 1% of admitted children with CAP are bacteremic.
Keywords: CAP, Egyptian Children, Microbiological Investigations.

INTRODUCTION
as Mycoplasma pneumoniae, Chlamydia pneumoniae,
Community-acquired pneumonia (CAP) is a
Legionella pneumophila, and others. The clinical course
significant cause of respiratory morbidity and mortality
among children infected with these pathogens is
in
children,
especially
in
developing
different from that of other bacterial or viral infection,
countries. Worldwide, CAP is the leading cause of
most of them progress slowly and have no specific
death in children younger than five years (1). Factors that
symptoms. Many studies reported that Mycoplasma
increase the incidence and severity of pneumonia in
pneumoniae is the most common atypical pathogen
children include prematurity, malnutrition, low
found among children with CAP, followed
socioeconomic status, exposure to tobacco smoke, and
by Chlamydia pneumoniae (5,6).
child care attendance (2).
While recognizing the etiology of community-
The diagnosis of CAP in children is mainly based
acquired pneumonia is necessary for formulating local
on clinical symptoms. Tachypnea is the most sensitive
antimicrobial guidelines, limited data are published
sign for predicting pneumonia in children, evident on
about this etiology in Egyptian pediatric patients (7).
chest radiography. In children over the age of one
This study aimed to find pattern community-
month, cough is the commonest symptom. Fever is
acquired pneumonia (CAP) pathogen after introduction
common but not always present at the time of
of HIB vaccine in Egypt. Also, it aimed to provide an
assessment. Fever alone occurring without cough or
update on the evaluation, diagnosis and treatment of
respiratory distress may still be due to pneumonia (3).
CAP in children.
Determining the etiology of CAP is still difficult

in routine clinical settings considering the difficulty in
PATIENTS AND METHODS
obtaining appropriate lower respiratory tract specimens
A cross sectional study was conducted on 54
from children. A considerable seasonal and
patients with pneumonia infection, at Zagazig
geographical difference in such etiology has been
University Hospital. Participation to this study was
reported.
In
most
studies, Streptococcus
offered to all consecutive children aged 2 months to
pneumoniae has been the most common etiologic agent
10 years old presenting with CAP according to the
identified (4).
WHO criteria.
Atypical pneumonia is used to describe
Inclusion and exclusion criteria: Children with CAP
pneumonia caused by atypical pathogens such
were 31 males and 23 females, their age ranged from 2

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748
Received: 13/09/2021
Accepted: 10/11/2021

Full Paper (vol.861 paper# 121)


c:\work\Jor\vol861_122 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 755-758

Mothers Attributes and Supervision Behaviors Relevant to Child Injury
Rasha Mohammed Bahaa Eldin*1, Abeer Mohammed Ibrahim Abdel Hafez2, Hosnia Mohammed Ragab3
Departments 1Family Medicine and 3Public Health and Community, Faculty of Medicine, Zagazig University, Egypt
Department 2Family Health Care, Diarb Negm District, Sharqia Governorate, Egypt
*Corresponding author: Rasha Mohammed Bahaa Eldin, Mobile: (+20) 01228258724, E-Mail: rasha_bhaa@yahoo.com

ABSTRACT
Background
: Home injuries are a major health problem in children. They are the most common cause of death in children
under 5 years of age. Every year they leave many thousands permanently disabled. Most of these accidents are
preventable through increased awareness and improvements in the home environment.
Objectives: To assess mothers attitude about home related injuries among children younger than 5 years of age.
Patients and methods: A cross-sectional study included 330 mothers conducted in health unit of Safour Village, Diarb
Negm District, Sharqia Governorate. A predesigned validated questionnaire was administered to mothers who have
children equal or less than five years old to assess the parent supervision attributes profile.
Results: the result revealed that mothers have satisfactory score as regard subscale of protectiveness, risk tolerance and
supervision beliefs respectively (84.8%, 74.5% and 72.2%).
Conclusion: Mothers in Diarb Negm district have satisfactory supervision attribute as regards home injuries of their
under five years children.
Keywords: Home injuries, Mothers attribute, Mother supervision.

INTRODUCTION

was 35.1% and total population of women had children
Child injuries are a growing global public health
age from 1 -5 years attending health unit of Safour
problem. They are a significant area of concern from the
Village, Diarb Negm District was 6000 women per
age of one year, and progressively contribute more to
year. So sample size was 330 using epi info at power
overall rates of death until children reach adulthood (1).
80% and CI 95%. Through a systematic random sample
Injuries are most commonly categorized as
was adopted for selection of the mothers during
unintentional or intentional, based on the injured party's
vaccination sessions.
presumed intent (2). Unintentional injury is a major

cause of hospitalization and death for children
Study participants and data collection:
elsewhere; moreover, it is a heavy burden for society (3).
The study included women attending health care
Most of the injuries are preventable since studies show
unit for their children vaccination session. Women were
that inadequate supervision is an important contributing
interviewed using validated questionnaire to assess their
factor to child injury (4). Appropriate supervision could
attitude about their children supervision:
prevent children from attempting unsafe activities and

assist them to accomplish tasks successfully (5).
The
parent
supervision
attributes
profile
In Egypt, it also a public health problem (6). For
questionnaire (PSAPQ)(9):
example, in 1998 the overall rate of injuries in the
The questionnaire consists of four subscales
indoor home environment was 72.5% among children
comprises including 29 items. The first part is about
under the age of 5 years (7). The incidence of home
protectiveness and consists of (nine items). The second
accidents among children under 6 years of age in Assiut
part is about supervision beliefs and consists of (nine
governorate in the year 2003 as perceived by their
items). The third part is about tolerance for children's
mothers was 50.3%. The most common injuries include
risk taking and consists of (eight items). The fourth part
drowning, falls, fires or burns, poisoning, suffocation,
is about extent of belief in fate as the primary
and transportation-related injuries. Moreover, findings
determinant of children's safety and consists of (three
from selected Arab countries between 2004 and 2012
items). These items were randomly ordered and
suggest increasing rates of domestic violence (8).
presented to parents in the present study. A three point
The aim of the study was to assess mother's
scale (1 = disagree, 2 = neutral, and to 3 = agree) was
protectiveness and supervision of children from
used in judging each statement. The total score higher
mothers' interaction with the observational measures.
than 70% is considered satisfactory score for each

subscale.
PATIENTS AND METHODS

A cross-sectional study was conducted. The
Administrative and Ethical Design:
sample was calculated by assuming that percentage of
The study protocol was approved from the Ethical
knowledge of mother about first aids of home injury
Committee at Faculty of Medicine Zagazig University

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755
Received: 14/09/2021
Accepted: 11/11/2021

Full Paper (vol.861 paper# 122)


c:\work\Jor\vol861_123 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 759-761

New Insight in the Treatment of Wide Facial Pores: Review Article
Esraa Mohammad Attia Nawwar, Abdalla Hasan Kandil, Basma Magdy El-Kholy
Department of Dermatology, Andrology and Venereology department,
Faculty of Medicine Zagazig University Hospital, Egypt.
*Corresponding author:: Esraa Mohammad Attia Nawwar, Mail: drroaa.noor@gmail.com

ABSTRACT
Background:
Having large face pores is a frequent cosmetic and dermatological issue for many people. Due to its
complex pathophysiology and poor influence on patients' quality of life, treatment is challenging. Because of this,
reducing the size of face pores is a hot topic in the cosmetics world. Skin rejuvenation, and reduction in sebum
production are just a few of the treatment options available for treating facial pores. The effectiveness and safety of
any of the presently offered medications or therapies have not been studied in humans in a lot of clinical studies.
Hormonal medication, including cyproterone acetate, spironolactone, and combination of oral contraceptives, are
among the treatment possibilities in addition to isoretinoin. Medications applied topically, such as L-carnitine,
niacinamide at a concentration of 2 percent, tretinoin or tazarotene, glycolic acid and salicylic acid peels,
moisturisers, and sunscreens, require formulations free of occlusive, comedogenic, and oil-free substances. Laser
diodes, non-ablative radiofrequency technologies, and photodynamic therapy all showed promising results.
Objective: To make an overview of updated guidelines for treating wide facial pores.
Methods: The databases were searched for articles published in English in 3 data bases [PubMed ­ Google scholar
and Egyptian bank of knowledge] and Boolean operators had been used such as [Wide facial pores AND Novel
Treatment OR hair removal] and in reviewed articles.
Conclusion: Treatment of enlarged facial pores aims at reducing sebum production and/or reducing folliculler size.
The treatment options include oral and topical medication, diet modification, laser, Botulinum toxin as well as hair
removal.
Keywords: Wide facial pores, Novel Treatment.


INTRODUCTION

Wide facial pores are a common dermatologic and
aesthetic problem. Because of the disease's complex
pathophysiology and detrimental effects on the well-
being of patients, treating it is a challenging endeavour.
Because of this, reducing the size of face pores is a hot
topic in the cosmetics world )1).
Pores on the facial skin are superficial skin
structures that resemble the pilosebaceous apparatus's
apertures in terms of size and shape. Empty funnel-
shaped structures, which are present in all people but
their size can vary, are biologically present (2).
Horny follicular plugs with sebaceous debris may

fill these spaces, causing them to resemble a comedone-
Figure (1): Enlarged facial pores are linked to thick
like cylindrical plug (1).
hair on the nose and perinasal. pores appear as black
Sebum production has been reduced, the skin has
patches (black arrows) (3).
been rejuvenated, and facial pores have been reduced
Objective of the study was to make an overview
using a variety of therapeutic treatments. The
of updated guidelines in Wide Facial Pores
effectiveness and safety of any of the presently offered
management.
medications or therapies have not been studied in

humans in a lot of clinical studies (1).
Treatment of wide facial pores:

In order to reduce sebum production, renew the
skin, eliminate hair, and/or reduce follicular size, the
most common treatments for enlarged face pores are
used (1).



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759
Received: 12/10/2021
Accepted: 17/11/2021

Full Paper (vol.861 paper# 123)


c:\work\Jor\vol861_124 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 762-769

The Neurotoxic Effects of Methotrxate (MTX) on Rat Hippocampus and to
Explore the Neuroprotective Role of Alpha Lipoic Acid (ALA): Review Article
Muhammad O. Balhaj*, Amal Elshahat Ibrahim, Amira E. Alsemeh, Heba Osama Mohammed
Department of Anatomy and Embryology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Muhammad O. Balhaj, Mobile: (+20) 01065359115, Email: muhammadbalhaj75@gmail.com

ABSTRACT
Background:
The hippocampus is a major component of the mammalian brains and the brains of other vertebrates. It
belongs to the limbic system and plays important roles in memory consolidation. Methotrexate (MTX) belongs to the
antimetabolite group, which is an antineoplastic group of drugs. MTX has a wide range of therapeutic effects: e.g. at
high doses in many malignancies and at low doses in autoimmune diseases such as rheumatoid arthritis and psoriasis,
due to its anti-inflammatory and immunosuppressive effects. The therapeutic actions of Alpha Lipoic Acid (ALA) is
based on its antioxidant properties including its capacity in regenerating endogenous antioxidants, its metal chelating
abilities, its action as a scavenger of reactive oxygen species (ROS) and its capability to repair oxidative damage.
Objective: This work aimed to study the neurotoxic effects of methotrxate (MTX) on rat hippocampus and to explore
the neuroprotective role of alpha lipoic acid (ALA).
Methods: The databases were searched for articles published in English in 4 data bases [PubMed ­ Google scholar-
Science direct and Egyptian bank of knowledge] and Boolean operators (and, or, not) had been used such as
neurotoxic effects of methotrxate and rat hippocampus OR alpha lipoic acid and in reviewed articles.
Conclusion: So, from this review article, it can be concluded that, alpha lipoic acid administration along with
methotrxate therapy can ameliorate the harmfull effects of methotrxate on hippocampus.
Keywords: Rat hippocampus, Methotrxate, Alpha lipoic acid.

INTRODUCTION
body. In addition, it is one of the very few substances
The hippocampus is a part of limbic system. It is
that can actually cross the blood­brain barrier, and it
responsible for memory and learning. The blood-brain
does not elicit any serious side effects. Different
barrier protects the brain from some drugs but many
mechanisms of ALA's positive effects on cognitive
chemotherapeutic drugs can affect its function by direct
function have been suggested, including improvement
or indirect methods (1).
of memory-related signalling pathways, diminution of
Methotrexate (MTX) is a well-known cytostatic
oxidative stress, and enhancement of mitochondrial
agent used as an essential drug in combination
function (4).
chemotherapy for lymphatic system malignancies. It
This work aimed to study the neurotoxic effects
significantly improves the survival of patients with
of methotrxate (MTX) on rat hippocampus and to
lymphoma or acute lymphoblastic leukaemia (ALL)
explore the neuroprotective role of alpha lipoic acid
and effectively prevents the recurrence of central
(ALA).
nervous system (CNS) leukaemia. MTX is an

antimetabolite drug that has been found to have
I-Hippocampus:
beneficial effects on a number of chronic inflammatory
Anatomy of hippocampus:
diseases. This drug is crucial for prophylaxis and
The hippocampus is a main component of
treatment in sanctuary sites, including the CNS (2).
human brains and the brains of other vertebrates. It
Several reports have demonstrated that MTX changes
belongs to the limbic system and has important roles in
memory ability and interferes with the neurogenesis
memory. Humans and other mammals have two
process in terms of both physiology and pathology,
hippocampi, one in each side of the brain. The
which may cause breakdown of the memory system.
hippocampus is situated under the cerebral cortex (5).
Alpha lipoic acid (ALA) has been referred to as the
In both humans and rats, the hippocampus
"universal antioxidant" because of its unique
region of the brain is similar in its anatomical structure
antioxidant properties; as a coenzyme present in the
and its function in memory formation. The
mitochondria, ALA can eliminate pathogenic free
hippocampus of rats is similar to humans as it
radicals (3).
undergoes age-associated changes and degenerations
ALA acts as an antioxidant in both hydrophilic
to its circuits. The volume of the human hippocampus
and lipophilic environments in any cell or tissue type
is 100 times that of the rat. Furthermore 10 times that
as well as in any subcellular compartments in the
of the monkey (6).

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762
Received: 14/09/2021
Accepted: 11/11/2021

Full Paper (vol.861 paper# 124)


c:\work\Jor\vol861_125 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 770-772

Sphenopalatine Ganglion Block for Treatment of Post Dural
Puncture Headache: Review Article
Abdelrahem Agila Mohammad A. Najem, Abdelmohsen E.M. Aly,
Farahat I. Ahmed, Shereen E. Abd Ellatif
Department of Anesthesia, Intensive care and pain management, Zagazig University, Egypt
*Corresponding author: Abdelrahem Agila Mohammad A Najem, Mobile: (+20) 01095890124,
E-Mail: abdulrahimnajem@gmail.com

ABSTRACT
Background:
Post-Dural puncture headache (PDPH) is a consequence of spinal and epidural anesthesia. The gold
standard for its treatment is epidural blood patch. Sphenopalatine ganglion block (SPGB) has been proposed as a non-
invasive intervention with minimal adverse effect.
Objective: The aim of this study was to assess the efficacy of sphenopalatine ganglion block for treatment of post-dural
puncture headache.
Methods: The databases were searched for articles published in English in 3 data bases [PubMed ­ Google scholar and
Egyptian bank of knowledge] and Boolean operators had been used such as [Sphenopalatine ganglion block and post
dural puncture headache] and in reviewed articles.
Conclusion: SPGB is an effective initial modality for managing severe headache in patients with PDPH.
Keywords: Analgesia, Post-dural puncture headache, Sphenopalatine ganglion block.


INTRODUCTION
The role of SPG in headache:
Sphenopalatine ganglion (SPG) block was first
While the mechanism of headache pain is still not
described in 1908 by Greenfield Sluder, MD, chairmen
completely understood, there are a few supported
of Otolaryngology at Washington University in St.
theories as to why SPG blocks may help relieve
Louis (1).
headache pain. The SPG is the main source of cranial
The SPG contains postganglionic sympathetic
and facial parasympathetics. A widely proposed theory
fibers, synapses between pre- and postganglionic
is that SPG blocks interfere with the parasympathetic
parasympathetic fibers, and somatosensory fibers of the
outflow from the SPG and that is the main mechanisms
head and neck region, making it a good target for pain
for the pain relief. Various headache pain triggers and
intervention (2).
activates brain areas that converge on the superior
The methods of administration of SPG blocks
salvatory nucleus. When a trigger is encountered, the
have been greatly expanded since Sluder's time, as
trigeminoautonomic reflex is stimulated. The afferent
more anecdotal studies were published. SPG blocks are
trigeminal sensory neurons from meningeal vessels
now used to treat pain of trigeminal neuralgia, persistent
project through the thalamus to the pons. The neurons
idiopathic facial pain, acute migraine, acute and chronic
in the pons reflexively stimulate the Superior Salvatory
cluster headaches, Herpes Zoster neuralgia involving
Nucleus (SSN), which increases parasympathetic output
the ophthalmic nerve, and various facial neuralgias (3).
from the SP, otic, and carotid ganglia via the facial

nerve (7).
Physiology:
The parasympathetic outflow from the SPG
The transnasal sphenopalatine ganglion block
contributes to the vasodilation of cranial blood vessels
(TSGB) was developed by Dr. Sluder in 1908 for
that occurs during headache. This allows inflammatory
treatment of headaches and it continued to be an
mediators to be extravasated from blood vessels and
effective methodology for various chronic headache
activate meningeal nociceptors, causing headache pain
scenarios, trigeminal neuralgia, and ENT surgeries (4).
(3). Wei et al. (8) demonstrated that patients experiencing
The sphenopalatine ganglion block inhibits the
parasympathetic symptoms are more likely to have pain
parasympathetic stimulation so meningeal and cerebral
relief from an SPG block with lidocaine. Additionally,
vessels can regulate without excess parasympathetic
it is clear that the autonomic pathway is activated during
vasodilation and the headache dissipates (5).
headache because of the common symptoms
It also blocks the activation of meningeal
experienced by migraineurs, including lacrimation,
nociceptor fibers (6).
nausea, emesis, nasal congestion, rhinorrhea,
Transnasal Sphenopalatine Ganglion Block
forehead/facial sweating, conjunctival infection,
(TSBG) is a newly proposed alternative method for
salivation, diarrhea, and polyuria (9).
treatment of postdural puncture headaches (PDPH).
Another common feature of headache that has

been proven is central sensitization to pain via




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770
Received: 17/09/2021
Accepted: 14/11/2021

Full Paper (vol.861 paper# 125)


c:\work\Jor\vol861_126 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 773-780

Effect of Preoperative Fluoroscopic Guided Single Shot Erector Spinae Block for
Posterior Lumbar Spine Surgery: A Surgeon and Patient Prospective
Ahmed Mohammed Sonbol*, Hazem El Sayed Weheba
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Mohammed Sonbol, Mobile: (+20) 01003735129. E-Mail: dr.sonbol@gmail.com


ABSTRACT
Background:
Posterior spinal surgery is considered one of the most painful surgeries. Erector Spinae Block is likely to
produce effective pain management as it causes blockade of the dorsal rami .
Objective:
This study was conducted to assess the efficacy of ESPB in controlling intraoperative and POP and surgical
field during lumbar spine fixation.
Patients and methods: A total of 70 cases were enrolled, and they were haphazardly divided into two groups; ESPB
group which comprised 35 cases who underwent the blockade technique, and the control group which included the
remaining 35 cases that underwent surgery without blockade. The primary outcome was POP, while secondary outcomes
involved intraoperative bleeding, and surgeon satisfaction.
Results: No significant differences were detected among both groups concerning patient demographic features.
Operative bed bleeding was significantly decreased in the ESPB group. Also, ESPB group expressed lower pain scores
during the initial 6 hours after surgery with no difference detected between both studied groups on subsequent
assessment. Surgeon satisfaction was significantly better in the ESPB group.
Conclusion: ESPB appears to be safe and efficacious technique not only in decreasing POP, but also in improving
operative bed bleeding, and surgeon satisfaction.
Keywords: Erector Spinae Plane Block, Fluoroscopy, Spine Surgery, Surgeon satisfaction.


INTRODUCTION



The ESPB is a new regional anesthetic
Although opioid therapy plays an important role in
approach which could be utilized to offer pain relief
managing pain after surgery, it has multiple side effects
after numerous surgical interventions. It can be also
including dependence (10).
used to treat acute or chronic painful conditions. This
Hence, the application of regional anesthetic
approach includes introduction of the blocking agent
techniques should be considered (11, 12).
into the paraspinal fascial plane located between erector
In cases with spine diseases requiring
spinae muscle and the thoracic transverse processes (1).
instrumentation, ESPB is likely to produce effective
This leads to blockade of both dorsal and ventral rami
pain management as it causes blockade of the dorsal
of thoracic and abdominal spinal nerves, which in turn
rami (13).
causes multilevel sensory blockade of anterior, lateral,

Herein, we assess ESPB effect on blood loss,
and posterior thoracic and abdominal walls. This multi-
POP, and surgeon satisfaction in patients undergoing
level block could be explained by both cranial and
spinal instrumentation for degenerative causes.
caudal spread of the blocking agent that is aided by

thoracolumbar fascia extending over the posterior
PATIENTS AND METHODS
thoracic and abdominal walls (2).

This prospective randomized study was carried
Its efficacy was first reported in 2016 when it was
out at Neurosurgery Department, Mansoura University
utilized to manage neuropathic thoracic pain in cases
Hospitals.
with metastatic rib tumor or rib fractures (3). After that,

its use became widely accepted as efficacy was also
Inclusion criteria: age more than 18 years who were
proved in multiple operations including thoracotomy,
prepared for spinal fixation due to degenerative causes
nephrolithotomy, lumbar fixation, along with ventral
with lumbar involvement.
hernia repair (2, 4-7).

It could be carried out whether via a single-injection
Exclusion criteria: patients with uncontrolled systemic
technique, or via continuous infusion through catheter.
comorbidities, and refusal to contribute to the study
Moreover, the technique could be carried out either via
were causes of exclusion.
ultrasound or fluoroscopy (8).
The sample size was calculated by utilizing

Posterior spinal surgery is considered a painful
PASS version 15.0.5 for windows (2017) based on data
surgical intervention, with a median pain score ranging
acquired from li et al. study with the efficacy of ESPB
between 5 and 7 on the 1st postoperative day on
in controlling POP after spine surgery at six hours as the
numerical pain scale (9).
primary outcome.

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Commons Attribution (CC BY-SA licens
)
e htt
( p://creativecommons.org/licenses/by/4.0/
)



773

Received: 11/10/2021
Accepted: 18/11/2021

Full Paper (vol.861 paper# 126)


Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 781-787

Study of Nasofrontal Beak Identification as a Useful Landmark in
Endoscopic Frontal Sinus Surgery
Magdy Mohamed Abdel Fattah, Ismael Seddik El Nashar,
Abdel Rahman Abdel Aziz Mohammed, Mohamed Mohamed Rabea
Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Abdel Rahman Abdel Aziz Mohammed, Email: azaz81154@gmail.com


ABSTRACT
Background
: The nasal process of the frontal bone creates a bony thickening in the midline known as the nasofrontal
beak (NFB). Surgery on the frontal sinuses can be safer when the NFB is used as a marker. Objective: To assess if
identification of the nasofrontal beak during endoscopic frontal sinus surgery will add benefit to the identification of
fontal sinus drainage pathway. Patients and Methods: From July 2020 to July 2021, At Zagazig University Hospitals,
Otorhinolaryngology Department; trial included twelve patients with chronic frontal sinusitis who had been refractory
to medical treatment for at least twelve weeks. All patients were scheduled for functional endoscopic sinus surgery.
Results: The mean of distance from superior border of nasal beak to skull base in the right (Rt) side was 4.8 ± 2.9 and
in the left (Lt) side was 5.4 ± 3.1. In terms of difficulty and distance, there was a significant negative association between
the two variables; meaning that increasing distance would make the surgery easier. No recurrence of symptoms in Rt.
side while in Lt. side recurrence occurs in only one case. Restenosis of frontal ostium didn't occur in any case in Rt side
or Lt side. No nasal adhesions in Rt side, but occurred in Lt side in only one case Conclusion: The frontonasal beak is
one of these fixed anatomical bony landmarks as frontal sinus ostium is located at the anterior edge of the anterior recess.
Preoperative imaging can anticipate the difficulties of frontal recess surgery by identifying it.
Keywords: Endoscopic Frontal Sinus Surgery, Nasofrontal Beak.

INTRODUCTION

directly above the olfactory fossa (OF). In theory,
Chronic sinusitis that does not respond to medical
however, variations in the pneumatization of the frontal
treatment can be treated with endoscopic sinus surgery
sinuses and their outflow tracts or in the growth of the
(ESS) (1). Anatomical knowledge has improved thanks to
NFB might lead to scenarios in which parts of the NFB
the widespread use of the endoscopic sinus surgery. In
either approximate or lie posterior to the anteriorly
spite of this, the surgeon is still confused by the frontal
projected olfactory fossa (6). As seen by parasagittal CT,
recess of the nose (2). As a result of CT scans, surgeons
frontal beak lies posteriorly a protrusion of lower part of
have been able to better understand the anatomy of
anterior table of frontal sinus (7).
previously unknown locations such the middle meatal
It was the goal of this study to evaluate whether or
complex and the frontal recess (3).
not the NFB can be used as a safe landmark to avoid skull
Frontal sinus disease may necessitate frontal sinus
base injury while doing frontal sinus surgery.
surgery in which a coronal CT scan of the frontal sinus
PATIENTS AND METHODS
architecture is used to determine the best course of action.
This clinical trial took place from July 2020 to July
There are several anatomical variances in this region, and
2021
at
Zagazig
University
Hospitals'
the surgeon must be able to translate the two-dimensional
Otorhinolaryngology Department in Egypt. This research
CT data into a three-dimensional anatomical picture in
included twelve patients with chronic frontal sinusitis
order to complete the dissection safely (4). Sagittal
resistant to medical treatment for a period not less than
reconstructions have been described in several studies as
twelve weeks.
a tool for determining the relationship and morphology
Ethical considerations:
of the frontal recess and the frontal sinus ostium (5).
When all participants completed informed written
Nasofrontal beaks (NFB) are the midline bone
consent and submitted them to the Research Ethics
thickenings created by the nasal process in frontal bone
Committee at Zagazig University, the study was
and are thought to represent an anterior boundary of the
permitted (ZU-IRB#6889). Ethics guidelines for human
frontal sinus and frontal recess, respectively. The term
experimentation were adhered to in line with the Helsinki
"beak" refers to the posterior part of the nasal process of
Declaration of the World Medical Association.
the frontal bone, which can produce a restriction of the
Inclusion Criteria: There was no response to medical
frontal sinus ostium and outflow tract. Because the
treatment in any of the patients who underwent a CT scan
frontal sinus drains inferiorly into the frontal recess, the
and needed further treatment for persistent sinusitis
narrowest aperture between the NFB and the skull base
lasting more than three months. Surgery for the sinuses
is known as the internal frontal sinus ostium (6).
by use of endoscopic means patient must be fit for
Intuitively, the NFB, which is the frontal bone's
surgery, and aged 20-60 years old
midline anterior thickening, should be located forward of
Exclusion Criteria: Chronic sinusitis patients who
the posterior table of the frontal sinus, the bone that sits
improved after receiving medical therapy, patients who

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781

Received: 11/10/2021
Accepted: 18/11/2021

Full Paper (vol.861 paper# 127)


c:\work\Jor\vol861_128 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 788-793

Osteomyelitis Presenting as Swollen Elbow in A Child: A Case Report
Saud N. Aldanyowi
Department of Surgery, College of Medicine, King Faisal University, Al Hofuf, Saudi Arabia
Email: aldanyowi@gmail.com ,Mobile: +966552888858

ABSTRACT
Background: Pediatric osteomyelitis is a severe disease that requires early diagnosis and prompt treatment to minimize
the potential risk of developing severe complications, including septic arthritis. Identifying clinical features and applying
relevant diagnostic tools are necessary to yield an early diagnosis. Osteomyelitis may show various clinical presentations
depending on the etiology, especially in children, making the diagnosis difficult. Therefore, a thorough clinical history,
detailed physical examination, and a high index of suspicion are imperative to early diagnose this condition. One should
be aware of the evolving epidemiology, emergence of antibiotic-resistant strains, and requirement of specialized targeted
therapy to tackle the disease.
Case presentation: Here, we present a case of an eight-year-old male patient with an extra-articular abscess around his
left-elbow osteomyelitis, which was clinically confused with septic arthritis. The causative organism was methicillin-
resistant Staphylococcus aureus (MRSA), which was resistant to most of the antibiotics but sensitive to linezolid. Given
that pediatric osteomyelitis has a higher chance of articular extension, prompt treatment is essential to avoid permanent
damage to the joint.
Conclusion: In conclusion, considering the rarity of MRSA-induced intra-articular osteomyelitis, a high index of
suspicion is needed to diagnose it as soon as possible clinically and radiologically. This disease should be considered as a
differential diagnosis in patients with painful joint swelling.
Keywords: Juxta-articular osteomyelitis, MRSA, Osteomyelitis, Septic Arthritis.


INTRODUCTION


Osteomyelitis is a bone infection that is frequently
Instance, our patient in this case presented with
caused by bacteria, leading to necrosis and bone
osteomyelitis near the joint.
destruction. However, in immunocompromised children,

it can also be caused by fungal infiltration. Osteomyelitis
CASE REPORT
is classified into three major categories according to the
We present a case of an eight-year-old male Saudi
duration of symptoms and their progression: acute (<2
patient with no known medical condition who presented
weeks), subacute (between 2 weeks and 3 months), and
to the Emergency Department (ED) of King Fahad
chronic (>3 months) [1].
Hospital in Al-Hofuf in the eastern province of Saudi
Osteomyelitis
commonly
spreads
through
Arabia after falling from stairs 2 days ago. He complained
hematogenous seeding of the pathogens. Other potential
of pain in the left elbow, inability to move the joint, and a
sources of spread include penetrating injury, surgery,
fever of 39.5 °C measured at home. Neonatal and family
trauma, and nearby infection, exposing the bone to an
histories were uneventful, and no evidence of any recent
adjacent contaminated environment. It commonly affects
infections was found.
the metaphysis of long bones in the upper and lower limbs
On physical examination, he was febrile, conscious,
[2].
alert, and oriented; other vital signs were also stable.
Pediatric osteomyelitis is a severe disease that
Local physical examination revealed a hot and reddish left
requires early diagnosis and prompt treatment to
elbow with tenderness at the anterior aspect of the
minimize the potential risk for severe complications, such
proximal forearm and a restricted range of motion
as septic arthritis. Identifying clinical features and
associated with pain. The patient kept his forearm in a
applying relevant diagnostic tools are important for an
neutral position. The ED physician who initially assessed
early diagnosis. However, the occurrence of atypical
him suspected septic arthritis based on an X-ray of the left
clinical features is challenging for clinicians [3]. For
elbow (Figure 1). Thus, he was referred to an orthopedic

on-call.

h
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788

Received: 18/09/2021
Accepted: 15/11/2021


Full Paper (vol.861 paper# 128)


c:\work\Jor\vol861_129 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 794-797

Intra Pleural Streptokinase in Management of Empyema, Is It Beneficial?
Alaa Omar*, Mahmoud Gamaleldin Ali, Mahmoud Eldegwy
Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
*Corresponding author: Alaa Omar, Mobile: (+20)01001168488, Email: alaaomarcts1@yahoo.com

ABSTRACT
Background:
Around 15-20 % of patients suffering from parapneumonic effusion their condition is complicated by
empyema. Despite treatment using aggressive antibiotics, it is associated with significant morbidity and mortality.
Drainage of the collection in early stage by intercostal tube with administration of proper antibiotics according to the
culture and sensitivity is considered the cornerstone of treatment. Intrapleural fibrinolytics as streptokinase is gaining
more popularity.
Objective: This study aimed to show the advantages of adding streptokinase to the protocol of conservative management
of empyema by studying its effectiveness and safety.
Patients and Methods: Our study was conducted on 58 patients on retrospective analytical manner through the period
from December 2017 to March 2021 at Kasr Alainy Hospitals. All patients in this study were complaining of empyema
following pneumonia. The diagnosis was based on frank pus aspiration from the pleural collection appeared on chest
radiography (X-ray, ultrasonography or CT), confirmed by the results of bacteriological culture and gram staining of
retrieved samples. Those patients received intrapleural instillation of streptokinase.
Results: Mean age of patients was 49. 2 years. The majority of them were males (n=42, 72. 4 %) and females were
16(27. 6 %). According to the causative organisms, Staphylococcus aureus was the commonest (n=31), kleibsiella (n=6),
E. coli (n=5), pseudomonas (n=3), mixed (n=2) and others (n=2). Successful treatment occurred in 43 patients (74.1%),
partial success in 13 patients (22.4%) and failure of treatment in 2 patients (3.5 %).
Conclusion: In our study, intrapleural instillation of fibrinolytics was a safe and effective procedure in management of
empyema with decreased incidence of surgical referral.
Keywords: Empyema, Intrapleural instillation of streptokinase, Para pneumonic effusion.

INTRODUCTION
In recent era, intrapleural fibrinolytics as
Empyema refers to the accumulation of pus in
streptokinase
are
gaining
more
popularity.
the pleural space, around 15-20 % of patients suffering
Streptokinase can help in destruction of pleural fibrin
from parapneumonic effusion post pneumonia suffer
bands and open the other difficult loculi, which makes
from empyema(1). Empyema is classified into three
better drainage (8, 9). Three studies emphasized the
stages according to the American Thoracic Society;
positive effectiveness of using fibrinolytics in treatment
Exudative phase (stage I) at which fibrin deposits on
of empyema, which had an impact both on the clinical
both pleural surfaces as reaction to infectious agent,
and radiological parameters (10, 11, 12). The use of
fibrinopurulant phase (stage II) is an intermediate phase
intrapleural injection of streptokinase can decrease the
characterized by fibrous septations and loculations and
period of hospital stay and intensity of fever and
organizing phase (stage III) is alate stage characterized
improve drainage of the collection (11, 12). In this study
by spider web and thick pleurae preventing lung
we aimed to investigate the advantages of adding
expansion due to prolonged enhancement of fibroblastic
streptokinase to the protocol of conservative
activity(1).
management of empyema by studying of its
Despite treatment using aggressive antibiotics,
effectiveness and safety.
it is associated with significant morbidity and

mortality(2, 3). Drainage of the collection in early stage
PATIENTS AND METHODS
by intercostal tube with administration of proper
Our study was conducted on 58 patients on
antibiotics according to the culture and sensitivity is
retrospective manner through the period from
considered the cornerstone of treatment(4).
December 2017 to March 2021 at Kasr Alainy
Septations and fibrous pleural loculation are
Hospitals. All patients in this study were complaining
common radiological signs, which carry a bad
of empyema following pneumonia. The diagnosis was
prognosis in management of empyema and make
based on frank pus aspiration from the pleural collection
drainage of pleural collection more difficult(5, 6). To
that appeared on chest radiography (X-ray,
overcome this problem there is many surgical
ultrasonography or CT), which was confirmed by the
techniques used to treat such condition as conventional
results of bacteriological culture and gram staining of
rib resection and drainage or video assisted
retrieved samples. Those patients received intrapleural
thoracoscopic evacuation(7).
instillation of streptokinase.






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294
Received: 17/9/2021
Accepted: 14/11/2021

Full Paper (vol.861 paper# 129)


Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 798-803

Assessment of Magnetic Resonance Imaging Role in Evaluation of
Failed Back Surgery Syndrome
Mohamed Alaa Eldin Algayar, Maged Abdelgalil Hamed,
Shaimaa Ragab Ahmed Elshahat*, Marwa Elsayed Abd Elhamed
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Shaimaa Ragab Ahmed Elshahat, Email: shaimaaragab3@yahoo.com

ABSTRACT
Background:
Failed back surgery syndrome (FBSS) is a fairly common problem. Magnetic resonance imaging (MRI)
with its multi-planar capabilities and superior soft tissue characterization is the modality of choice for imaging the
postoperative spine.
Objective: This study aimed to investigate the role of MRI in evaluation of FBSS.
Methods: Forty-eight patients with FBSS were referred to Zagazig University Hospitals who had previous lumbar spine
surgery. All patients were evaluated by history taking and radiological evaluation by dynamic x-ray and a post-operative
spine MRI study that consisted of seven series: T1 -weighted sagittal & TI -weighted axial series, a sagittal & axial
series for T2-weighted series, post-gadolinium T1-weighted axial and sagittal series and Heavy T2 MRI myelogram.
Results: The major identifiable causes of FBSS in operated patients for lumbar disc herniation included recurrent disc
herniation and epidural fibrosis (27 and 10.4% of our patients, respectively), and both occurred in 22.9 %, post-operative
infected fluid collection in 10.4%, spondylodiscitis in 6.3%, spondylodiscitis with epidural fibrosis in 4.2%, filum
terminal ependymoma and postoperative infected fluid collection with epidural fibrosis in 4.2%, postoperative infected
fluid collection with spondylodiscitis in 4.2%, epidural fibrosis with spinal stenosis in 4.2%, pseudo- meningocele with
RDH in 2%, both epidural scar & RDH with deposits in 2% and RDH with spinal stenosis in 2%.
Conclusion: MRI is generally a safe and accurate technique, which has been proven to be the technique of choice in
evaluation of FBSS with its excellent resolution and multi-planar capabilities.
Keywords: Failed back surgery syndrome, Magnetic resonance imaging.

INTRODUCTION
may have occurred, but artefact reduction techniques can
Eighty percent of the population suffers from back
increase the clarity of the images so that they are more
discomfort at some point in their lives (1). With a
easily detectable (7).
substantial geographic variance in spine surgery rates and
Postoperative MRI is now more readily available
spinal fusion rates, the number of spinal surgeries is
than ever before, even if symptoms haven't worsened, or
increasing (2).
new deficiencies haven't emerged as a result of the
Failed back surgery syndrome (FBSS) affects a
surgery. Additionally, MRIs that have no effect on the
large percentage of people who have undergone a back
patient's clinical course may be performed for
surgery. Recurrent or persistent back pain following
medicolegal reasons (8).
spinal surgery characterises this syndrome, which has a
It was the goal of this study to study the role of
reported frequency of five to forty percent (3).
magnetic resonance imaging in evaluation of FBSS.
Postoperative radiological examination necessitates

an understanding of both the typical changes in the
PATIENTS AND METHODS
postoperative spine and the possible postoperative
This study included 48 patients (31males and 17
problems. Patient's quality of life is severely impacted by
females) with history of low back pain or sciatica after
this illness, which is devastating (4).
having previous lumbar spine surgery. Their ages ranged
For imaging the post-operative spine, Magnetic
from 23 to 73 years. This work was performed at the MRI
resonance imaging (MRI) is the modality of choice
Unit of Radiodiagnosis Department, Zagazig University
because of its multi-planar capabilities and improved soft
Hospitals.
tissue characterization. This test is critical in determining

the root of most cases of failed back syndrome (5). If post-
Ethical approval: All participants completed informed
operative problems are suspected, MRI is the preferred
permission papers and submitted them to the research
modality. MRI is superior for soft tissue, bone marrow,
ethics committee at Zagazig University, the study was
and intra-spinal content examination is made possible by
permitted (ZU-IRB#6598). Ethics guidelines for human
its great spatial and contrast resolution (3). Due to its
experimentation were adhered to in line with the Helsinki
outstanding capacity to detect soft tissue anomalies such
Declaration of the World Medical Association.
as epidural fibrosis and disc herniation, MRI with and

without gadolinium contrast remains the gold standard
Inclusion criteria: Postoperative spine patient 3 months
imaging modality for FBSS (6). It is common practice to
after spine operation, and all age and sex groups are
perform an MRI after surgery to check for any issues that
included.

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798

Received: 18/9/2021
Accepted: 15/11/2021

Full Paper (vol.861 paper# 130)


c:\work\Jor\vol861_131 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 804-809

Evaluation of Pediatric Bradycardia: A Single Center Experience
Beshoy Tamer Atta, Mohamed Abd EL Aal Mohamed, Shaimaa Mohamed Mahmoud
Department of Pediatrics, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Shaimaa Mohamed Mahmoud, Mobile: (+20) 01026682473,
E-Mail: shaymaa_sayed@med.sohag.edu.eg
ABSTRACT
Background:
Heart rate is an integral part of the clinical assessment of the children with acute illness and is commonly
used in pediatric early warning scores.
Objective: The aim of this study was to assess our current practice for evaluation and management of bradycardia in
children.
Patients and methods:
The study was conducted in Pediatric Arrhythmia Clinic, Neonatal Intensive Care Unit and
Pediatric Intensive Care Unit from March 2020 to August 2021. 61 Neonates and children aged from 1 day to 18 years
presenting with bradycardia were included in this study. Predeath bradycardia was excluded. Full medical history,
physical examination, basic investigations, 12 leads ECG and echocardiography were performed to all patients. Thyroid
function tests, 24 hours Holter monitoring, and stress ECG were done if indicated.
Results: 61 patients were included in the study. Heart rate ranged from 44 to 94 beat/minute with mean 69.44
beat/minute, the most common form of presentation was abnormal echocardiography. Hypocalcemia was present in
85.2% of patients. 70.5% of patients had sinus bradycardia, 13% had complete heart block (CHB),10% of patients had
long QTc Syndrome with sinus bradycardia, 3.3% had 1st and 2nd degree heart block, 1.6% had ECG changes of
ALCAPA with sinus bradycardia and 1.6% had ventricular ectopic.
Conclusion: It could be concluded that bradycardia in children needs accurate assessment to rule out the need of acute
intervention and to decrease the risk of life-threatening conditions.
Keywords: Pediatric, bradycardia, hypocalcemia, ECG.

INTRODUCTION

The aim of this study was to assess our current
Heart rate is frequently applied in pediatric early
practice for evaluation and management of bradycardia
warning scores. In pediatric population age related
in neonates and children.
anatomical and physiological changes produce normal

ranges for electrocardiogram parameters that differ
PATIENTS AND METHODS
from adults and vary with age, heart rate below the
This prospective cohort observational study
lowest normal value regarding age is defined as
included a total of 61 neonates and children aged from
bradycardia. Sinus bradycardia, junctional bradycardia,
1 day to 18 years presenting with bradycardia, attending
or atrioventricular block are the most common
at Pediatric Arrhythmia Clinic, Neonatal Intensive Care
manifestation of pediatric bradycardia. Due to several
Unit and Pediatric Intensive Care Unit, Sohag
different etiologies, it may occur in a completely
University Hospital. This study was conducted
structurally normal heart or in presence of associated
between March 2020 to August 2021. Predeath
congenital heart disease. Recently mutation in multiple
bradycardia was excluded.
genes has been involved as a cause of inherited sinus
All patients underwent accurate evaluation,
node dysfunction or progressive cardiac conduction
which included: detailed medical history included
abnormalities. Treatment and prognosis of bradycardia
Socio-demographic factors. Cardiac symptoms, such as
in pediatrics are completely dependent upon the
feeding difficulties, exercise intolerance, syncope,
underlying cause. Management of bradycardia is
medication history and chronic maternal disease,
indicated when it is related to symptoms and/or there is
physical examination included general condition,
a risk of heart failure or pause-dependent
anthropometric measures, vital signs. (Including HR,
tachyarrhythmia. Rapid diagnosis and suitable
BP, RR, Body temperature). Cardiac examination
treatment are crucial in most cases to avoid sudden
(including any associated murmur, Heart failure). Basic
death (1).
investigations (CBC, serum electrolytes including total
Because there is an overlap of heart rate ranges
and ionized calcium level).12-lead electrocardiogram
with non-pathologic changes, evaluation of symptoms
12 leads ECG were performed to all included children
is a very important aspect in the assessment and
using (Fukuda Denshi CardiMax ECG device model
treatment of bradycardia. In the 2018 ACC/AHA/HRS
FCP-7101).
Guideline on the assessment and treatment of Patients
The electrocardiograms were reviewed through
with Bradycardia and Cardiac Conduction Delay, there
the creation of descriptive reports and determination of
was a great change from prior guidelines that
the following variables: heart rate, PR interval and QRS
recommend device-based implantation to a focus on
duration, The QT interval was measured from the
evaluation and treatment of disease states (2).
beginning of the QRS complex to the end of the T wave,




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804

Received: 15/09/2021
Accepted: 12/11/2021

Full Paper (vol.861 paper# 131)


Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 810-815

Assessment of Livin Expression in Childhood B-lineage Acute
Lymphoblastic Leukemia Patients
Hosneia Khalaf Akl1, Amina Mohamed Talaat1,
Mervat Abd Allah Hesham2, Sara Mohamed Mohamed Ibrahim*1
Departments of 1Clinical Pathology and 2Pediatrics, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Sara Mohamed Mohamed Ibrahim, Email: saraabdelwahab1980@hotmail.com

ABSTRACT
Background
: When it comes to childhood acute lymphoblastic leukemia (ALL) patients, Livin is related with good
prognostic characteristics.
Objective: The aim of the work was to assess livin expression in childhood B-lineage acute lymphoblastic leukemia to
determine its significance.
Patients and Methods: From September 2018 and September 2019, at Zagazig University Hospitals Clinical Pathology
and Pediatric departments, our case control trial was conducted on 50 subjects, patients' group (25 cases of newly
diagnosed ALL) and control group (25 healthy children). Assessment of livin expression was done using real time
polymerase chain reaction (PCR).
Results: There was statistically significant difference between the age of livin positive and livin negative cases (the
mean age of livin positive cases was 6.2±3 years while the mean age of livin negative cases was 12.3±1.4 years). Mean
livin expression level was significantly higher in age group < 10 than in age group group 10 years (294.53± 154.03 in
age group <10 years versus 31 ±12.37 in age group 10). In livin negative group there were 3 patients with leucocytic
count> 50.000/mm3 at diagnosis while 5 patients with leucocytic count 50.000/mm3 or more at diagnosis compared
to 14 and 3 patients among livin positive group respectively (p=0.025). Regarding age, sex, WBCs, and risk
stratification, there were statistically significant differences between the livin negative and positive groups.
Conclusion: It could be concluded that livin was associated with favorable prognostic factors among ALL patients:
(age<10 years, female patients, WBCs <50,000/mm3).
Keywords: Livin expression, Acute Lymphoblastic Leukemia.

INTRODUCTION

More specifically, livin was found to be related with
Around 80% of all pediatric leukemias are acute
positive prognostic characteristics in children with acute
lymphoblastic leukemia (ALL), making it the most
lymphoblastic leukemia (ALL) (6).
frequent form of childhood cancer (1).
It was the goal of this study to assess the
Apoptosis is a self-sustaining process in which a
significance of livin expression in childhood B -lineage
large number of genes are activated, expressed, and
acute lymphoblastic leukemia.
regulated to cause programmed cell death in order to

eliminate undesirable or defective cells (2).
PATIENTS AND METHODS
There is a class of apoptotic regulators, known as
This case-control trial study included a total of 25
Inhibitor apoptotic Proteins (IAPs), that promote cancer
cases of newly diagnosed All and 25 healthy children
cells' resistance to apoptosis, notably in cancer treatment
served as control, attending at Departments of Clinical
and chemotherapy. In order to reestablish the apoptotic
Pathology and Pediatrics, Zagazig University
response to proapoptotic stimuli, disrupting the binding
Hospitals, Egypt. This study was conducted between
of IAPs to their functional partners is a viable method (3).
July 2020 to July 2021.
Cell cycle and proliferation are affected as well as
The included 50 subjects were divided into two
apoptosis when Livin/ML-IAP/BIRC7 is present,
groups; Control Group: Included 25 apparently healthy
making it an important player in these processes. Livin,
children with mean age 9.1±3.6 years; 60% of them were
which is over-expressed in a number of cancers, has an
males (15 males) and 40% of them were females (10
anti-apoptotic effect mediated by the direct suppression
females), and Case Group: Included 25 newly diagnosed
of caspase 3, but also caspases 7 and 9 as well as
ALL patients who attended the Pediatric Hematology and
DIABLO (4).
Oncology unit with mean age 8.1±3.9 years; (56%) of
Different isoforms of livin may play different
them were males (14 males), and (44%) of them were
functions in apoptosis. Truncated proteins are formed
females (11females).
when Livin isoforms are cleaved. To be effective, the

shortened form of the protein, known as livin (t- livin),
Ethical Consideration:
must also have the ability to cause cell death. Thus, livin
This study was ethically approved by Zagazig
has both the ability to shield csll cells from cell death and
University's research ethics committee. Written
the ability to promote it once it is cleaved (5).
informed consent of all the participants' parents was

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810

Received: 16/9/2021
Accepted: 13/11/2021

Full Paper (vol.861 paper# 132)


c:\work\Jor\vol861_133 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 816-821

ECG Changes After Parenteral Ondansetron Administration in
Children with Vomiting
Ashraf Mahmoud Radwan, Raed Eldeeb Faheem, Shaimaa Mohamed Mahmoud*
Department of Pediatric, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Shaimaa Mohamed Mahmoud, Mobile: (+20) 01026682473,
E-Mail: shaymaa_sayed@med.sohag.edu.eg

ABSTRACT
Background:
The potential for ondansetron to cause ECG changes as QT prolongation is well-reported.
Objectives: The aim of this study was to evaluate the effect of parenteral ondansetron on the PR interval, QRS duration
and QTc interval of ECG at peak effect and at post peak effect in pediatric patients with vomiting in PED.
Patients and methods: The study was conducted in the Pediatric Emergency Department, Sohag University Hospital.
ECG was done for 110 patients before and after injection of ondansetron 0.15 mg/ kg for vomiting. 60 Patients received
ondansetron by intravenous injection and 50 patients received ondansetron by intramuscular injection.
Results: IV ondansetron administration resulted in a significant increase in QTc interval after 15 minutes and 45 minutes
p= 0.03 and p= 0.0003 respectively, significant decrease in PR interval after 15 minutes p= 0.02 and there was a
significant decrease in QRS duration at 15 minutes after injection of ondansetron p= 0.02. IM ondansetron
administration resulted in a significant increase in QTc interval after 30 minutes and 60 minutes p= 0.04, p= 0.0001
respectively, significant decrease in PR interval after 30 minutes and 60 minutes p<0.0001, p= 0.04 respectively and a
statistically significant decrease between QRS duration before and after 30 minutes of ondansetron injection p<0.0001.
Conclusion:
It could be concluded that significant ECG changes occurred in children receiving a single dose of
parenteral Ondansetron 0.15 mg/ kg. None of the patients had an ondansetron related cardiac adverse events.
Keywords:
Ondansetron, Vomiting, ECG, QTc

INTRODUCTION

patients aged from one month to 12 years complaining
Ondansetron is a potent and highly specific
of vomiting.
antagonist of the 5HT3 receptor. Its method of action in
We excluded from the study, patients who did not
controlling vomiting is unknown, however it might be
give consent. Also, we excluded patients with known
linked to antagonism of 5HT3 receptors on peripheral
cardiac disease or dysrhythmias.
and central nervous system neurons (1).

A single dose of oral ondansetron lowers vomiting
ECG was done for the 110 patients before and after
and allows oral rehydration in children with
injection of ondansetron 0.15 mg/ kg for vomiting. 60
gastroenteritis (GE) and dehydration, making it ideally
Patients received ondansetron by intravenous injection
suited for usage in the emergency room (2).
and 50 patients received ondansetron by intramuscular
Although ondansetron is a widely accepted
injection.
treatment for vomiting with gastroenteritis in children,

ondansetron is being used for a broader spectrum of
Data collection:
primary diagnoses. Ondansetron improves the success
For all the patients enrolled in the study
of oral rehydration in children with gastroenteritis. The
checklist was filled by the investigators. The checklist
potential for Ondansetron to cause ECG changes as QT
included data of the patients concerning age, sex,
prolongation is well-reported, few clinical trials
duration of vomiting, previous treatment and previous
evaluating
ECG
changes
after
ondansetron
illnesses. Blood samples were collected from the
administration in the PED setting exist (3).
patients. They were analyzed for complete blood count,
The aim of this study was to evaluate the effect of
liver function tests, serum creatinine and serum
parenteral ondansetron on the PR interval, QRS
electrolytes (Na, k, and Ca).
duration and QTc interval of ECG at peak effect and at
ECG: 12 leads ECG was performed for all
post peak effect in pediatric patients with vomiting in
children with vomiting before and after 15 min, 45 min
PED.
in children received ondansetron 0.15 mg/ kg by IV

route injection and 30 min, 60 min in children received
PATIENTS AND METHODS
ondansetron 0.15 mg/ kg by IM route using (Fukuda
This
cross-sectional
hospital-based
study
Denshi CardiMax ECG device model FCP-7101 with a
conducted for 6 months period between August 2020 to
25 mm/s paper speed, gain 10 mm/mV).
February 2021in Pediatric Emergency Department at
Location of chest electrodes was not changed
Sohag University Hospital included a total of 110
before and after ondansetron administration. The
electrocardiograms were reviewed through the creation




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816
Received: 15/9/2021
Accepted: 12/11/2021

Full Paper (vol.861 paper# 133)


c:\work\Jor\vol861_134 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 822-825

Validity of Sphenoid Ostium in Relation to Posterior Wall of Maxillary
Sinus by Computed Tomography
Tarek Abdelmoaty Omran1, Sameh Mohammad Hosny1, Magdy Kamel Abdelkmaksod1,
Hend El Sayed Koraim*1, Mohamed Ibrahim Amin2, Mohamed Ahmed Alshawadfy1
Departments of 1Otorhinolaryngology and 2Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Hend El Sayed Koraim, Email: hndkrym054@gmail.com

ABSTRACT
Background:
Sphenoid sinus is the most inaccessible paranasal sinus, enclosed within the sphenoid bone and intimately
related to numerous vital neural and vascular structures. Anatomic variation of the sphenoid sinus is well documented and
may complicate surgery in such a place.
Objective: To assess the reliability of preoperative computed tomography (CT) in determination of the distance between
the posterior wall of maxillary sinus (PWMS) and the sphenoid sinus ostium (SSO) in the coronal plane.
Patients and methods: This was a prospective study of the distance between the SSO and the PWMS in the coronal
plane, which was measured both radiologically in preoperative CT and intraoperatively during endoscopic sinus surgery
for patients in need for middle meatal antrostomy and sphenoid sinusotomy at the same side. Distances obtained by both
techniques have been tested for the degree of correlation. Number of the included patients was 25.
Results: Forty four nasal sides were included in the study. The mean distance between the sphenoid sinus ostium and
posterior wall of maxillary sinus in the coronal plane was 6.6 ± 1.8 mm when measured by preoperative CT and 6.9 ±
1.9 mm when measured directly during surgery. No significant difference was found between the mean distances
measured by both techniques (p = 0.246) with good agreement between them (r = 0.864).
Conclusion: Preoperative CT may be a reliable tool to preoperatively determine the difference in depth between the
PWMS and the SSO.
Keywords:
Computed tomography, Posterior wall of maxillary sinus, Sphenoid ostium.

INTRODUCTION


The sphenoid sinus is related to important vascular
PATIENTS AND METHODS
and neural structures including the internal carotid
This prospective study has been conducted between
artery, cavernous sinus, optic nerve, trigeminal nerve,
September 2020 and July 2021 at otolaryngology Head
vidian nerve and pituitary gland(1,2). Also, the position of
and Neck Surgery Department, Zagazig University (ZU)
the sinus at skull base makes it a suitable route to

approach the anterior and middle cranial fossae(3,4). So,
Hospitals. 25 patients for whom endoscopic sinus surgery
understanding of the anatomy of the sinus region is
was planned were screened and those who fulfilled
essential for ENT and neuro surgeons to avoid major
criteria of the study were enrolled. Inclusion criteria were
complications during endoscopic sinus surgery (ESS)
age above 18 years and indicated middle meatal
and skull base surgery.
antrostomy and sphenoid sinusotomy at the same side.
Although the position of the sphenoid sinus ostium
Patients with expansile sinus lesions, destructive sinus
(SSO) may be affected by variability of pneumatization
pathologies including malignant tumors, craniofacial
of the sinus and nearby structures, it is still the safest
anomalies and history of maxillofacial or skull base
place and one of the most consistent and principal routes
fractures were excluded from the study.
to enter the sphenoid sinus. Therefore identification of
All enrolled patients were subjected to preoperative
the ostium is considered a key step during endoscopic
full history taking, general examination, endoscopic nasal
surgery(5). This is especially important for beginners and
examination, laboratory investigation and CT of
trainers and for even experienced surgeons in revision
paranasal sinuses.
surgery and in presence of extensive pathological

lesions(6).
Ethical considerations:
Different anatomical landmarks have been reported
All participants signed informed consent and
as references for localization of the SSO including
approval of Institutional Review Board (ZU-IBR #
medial orbital floor(6), posteroinferior end superior
6563) was obtained. This work has been carried out in
turbinate(7), superior margin of choana(8), nasal spine(9),
accordance with the Code of Ethics of the World
sphenovomerian suture(10) and sphenoid skull base(11).
Medical Association (Declaration of Helsinki) for
Few studies in literature have investigated the posterior
studies involving humans.
wall of maxillary sinus (PWMS) as a landmark to locate

the SSO either radiologically or by direct measurement

during surgery or cadaveric dissection(12-14).


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)
SA
-
license (http://creativecommons.org/licenses/by/4.0/
)

822
Received: 16/09/2021
Accepted: 13/11/2021

Full Paper (vol.861 paper# 134)


c:\work\Jor\vol861_135 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 826-830

Prevalence Of Strabismus and Its Types in Pediatric Population and
The Outcomes of Different Treatment Modalities:
A 3-Year Prospective Study in A Referral Eye Center in Upper Egypt
Mohamed Elmoddather
Ophthalmology Department, Faculty of Medicine, AL-Azhar University (Assuit), Egypt
Email: almoddather2016@gmail.com, Phone: 01090969424

ABSTRACT
Background:
Strabismus is one of the most frequent eye conditions influencing a considerable percentage of children and
could cause severe medical and psychological burdens.
Aim: To determine the prevalence of strabismus and its types in pediatric patients and the outcomes of different treatment
modalities in a referral eye center in Upper Egypt during a 3 years period.
Patients and Methods:This is an observational cross-sectional study that was carried out on pediatric cases attending a large
private referral ophthalmology center in Assiut City, Upper Egypt during the period of 3 years (January 2018 to December
2020). All pediatric patients (3-15 years) were included and cases with different types of strabismus were subjected to full
history taking, full ophthalmic examination and cyclopedic autorefraction.
Results: A total of 1356 pediatric patients attended the center during the study period. Cases with different types of
strabismus were 561 cases with a prevalence of 41.4%, about two-thirds of them (66.3%) were rural and 60.0% were in the
age group of 3-6 years.Esotropia was found in 54.3%, latent squint in 33.7% and pseudo strabismus in 6.4%. Surgical
correction was used in treatment of 42.6% of cases with satisfying outcome in 97.6% of them.
Conclusion: The prevalence of strabismus in the pediatric population attending the referral eye center was 41.4%, which
was extremely higher compared to other studies and this prevalence was higher in rural areas than in urban ones and in the
age group of 3-6 years than in the other age groups in the pediatric period.
Keywords: Incidence, Outcomes, Squint,Strabismus, Pediatric population, Treatment modalities.

INTRODUCTION
seeking treatment of strabismus for their children
Strabismus "also called squint or crossed eye" is
(especially females).
one of the most frequent eye conditions influencing a
There are several treatment options for
considerable portion of children. It is defined as any
strabismus, including eyeglasses, prisms, orthoptics (eye
deviation of the binocular alignment that causes poor
exercises), medications, vision therapy, or eye muscle
binocularity resulting in lacking binocular vision (1).
surgery and these different treatment modalities yielded
Strabismus could cause serious medical and
various outcomes in selected patients (10,11). The current
psychological problems such as poor self-esteem,
study evaluates all pediatric patients who attended a
depression and low job opportunities in adulthood due to
tertiary private eye care center in Upper Egypt during the
undesirable appearance (2). The etiopathogenesis of
period of 3 years, in an attempt to determine the
strabismus is unclear and it is generically classified as
prevalence of strabismus in the pediatric age groups and
pseudostrabismus, latent and manifest squint (3).
the different used treatment modalities and their outcome.
The prevalence of strabismus and its types varies

according to race however, esotropia is the commonest
PATIENTS AND METHODS
type of strabismus (>50% of all misaligned eyes) (4). In
This study is a prospective observational cross-
African children, strabismus prevalence was 0.5-4.4%
sectional one that was carried out on the pediatric cases
and it was estimated as 0.9-7.4% in other parts worldwide
attending Al-Nahar center (a large private referral
(5). In Egypt, the prevalence of strabismus is
ophthalmology center in Assiut City, Upper Egypt)
underestimated in general, owing to the lack of both
during the period of 3 years (January 2018 to December
awareness and data. Studies reported that the prevalence
2020). All pediatric patients (3-15 years) were included.
of strabismus in primary school children was 1.4% in
During the 3 years study period, a total of 1356 pediatric
Sohag City (6) and 1.49% in Minia City (7) (both in Upper
cases attended the center (392 cases in 2018, 486 cases in
Egypt) while it was 1.98% in central Cairo (8). Actually,
2019 and 478 cases in 2020). Cases with different types
there is a high prevalence of illiteracy and poverty in
of strabismus were subjected to full history taking, full
Upper Egypt (9) and this plays a crucial role in restricting
ophthalmic examination in terms of; slit lamp,
people from getting medical care for their children and in
examination of extraocular muscles, cover test,
addition, there are some traditions prevent parents from
Hirschberg's test, Worth 4 dots test, and fundus

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826
Received: 15 /9 /2021
Accepted:12 /11 /2021

Full Paper (vol.861 paper# 135)


c:\work\Jor\vol861_136 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 831-836

Serum IL-21 Level and Its Relation to Activity and Severity of Alopecia Areata
Amira Magdy Hamdin Ahmed*, Ahmed Abdel Khabir Ahmed Ibrahim,
Ziyad Mohamed Essam Eldin Tawhid, Ahmed Fawzi Ismael Ismael
Departments of 1Dermatology, Andrology and STDs and 2Clinical Pathology,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Amira Magdy Hamdin, Mobile: (+20)01002099100, E-Mail: dr.amira_alsheikh@hotmail.com

ABSTRACT
Background:
Alopecia areata (AA) is a non-cicatricial alopecia that is postulated to be a hair-specific
autoimmune disease, with genetic factors playing a role in disease susceptibility and severity. The disease
presentation ranges from circular patches on the scalp to complete hair loss with devastating psychosocial
consequences.
Patients and methods: This was a case control study carried out on 40 patients diagnosed as alopecia areata. They were
recruited from the outpatient clinic of Dermatology, Andrology and STDs Department, Mansoura University Hospitals.
In addition 40 normal healthy subjects with matched age and sex were selected to act as a control group.
Results: Serum levels of IL-21 were significantly increased in AA patients, and showed significant positive correlation
with activity of the disease. Higher serum levels of IL-21 in active cases support its role as predictor of disease activity.
There were no significant differences in IL-21 level with different SALT scores. Receiver Operating Characteristic
(ROC) curve analysis of IL-21 was conducted to evaluate the sensitivity and specificity of serum IL-21 as a diagnostic
index for AA. The AUC-ROC of IL-21 was excellent (0.962); and the best cut off point for IL-21 was determined to be
22.22 pg/ml. It was good predictive value. Its accuracy was 86.3%.
Conclusions: The results of this study indicate that the serum IL-21 could be promising marker in the diagnosis of
alopecia areata, and also can be used as prognostic marker of its activity.
Keywords:
Alopecia areata, Serum IL-21 level.

INTRODUCTION

disrupted in AA, with increase in major

Alopecia areata (AA) is a non-cicatricial
histocompatibility complex (MHC) I and II molecules.
alopecia that is postulated to be a hair-specific
These changes increase the antigens presentation by HF
autoimmune disease. Several genetic factors play role
cells and enhance T cells migration to close proximity
in disease susceptibility and severity. This condition is
of HF in AA lesions (6).
a relatively common cause of hair loss, without
Histological features of the disease include
demonstrated predilection for gender or age (1).
perifollicular and intrafollicular cellular infiltrates
Alopecia areata presentation includes round or
consisting predominately of CD4+ and CD8+ T cells.
oval patches of non-scarring hair loss. At the margins of
This infiltrate surround anagen follicles, with extension
areas of alopecia, short "exclamation point" hairs (i.e.
into the hair matrix keratinocytes. The lymphocytes
distal end broader than the proximal end) can often be
accumulation results in disorganization and apoptosis of
seen. Other presentations include alopecia totalis (loss
hair matrix cells. In chronic alopecia areata, the
of all scalp hair), alopecia universalis (loss of all scalp
majority of follicles are in telogen phase (7).
and body hair), an ophiasis pattern (band-like pattern of
The immune attack in AA spares the stem cell
hair loss along the periphery of the temporal and
compartment, preventing permanent organ destruction.
occipital scalp), and alopecia involving the beard area.
The future regrowth remain possible in most cases (8).
In addition to the hair follicle affection, nails may be
The involvement of autoreactive T cells rises the
involved (2).Trichoscopy should be done during
hypothesis of HF-derived autoantigens (9).
evaluation of the patient to allow for evaluation of the
Cytokines are immunomodulators, which
follicle, hair shaft, and surrounding skin. The clinician
mediate inflammation and regulate cell proliferation.
should examine for exclamation point hairs, which are
Cytokines have a significant pathogenic role in AA (10).
pathognomonic indicator of AA (3). The bad prognostic
T helper 17 (TH17) has become a focus of current
signs include association with atopy, ophiasis, affection
immunology in association with autoimmune disease
of eye brow, nail changes, and presence of multiple
.The maturation of it needs the stimulation of naļve T
exclamation marks (4).
cell by both TGF and IL-21 (10). Interleukin-21 is a
There is an increased frequency of other
cytokine that is produced mostly by activated CD4+ T
autoimmune disorders in patients with alopecia areata
cells. It regulates the function of immune and non-
compared to the general population (4). The proximal
immune cells. It controls the differentiation and activity
portion of the anagen hair follicle (HF) is an immune
of T cells, B cells and NK cells. It limits the
privileged site (5). The hair follicle immune privilege is
differentiation of regulatory T cells (Tregs), and makes

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831
Received: 16/09/2021
Accepted: 13/11/2021

Full Paper (vol.861 paper# 136)


c:\work\Jor\vol861_137 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 837-839

Invasive Pneumonia with Skin Peeling caused by Group A
Beta-Hemolytic Streptococcus and Kawasaki Disease
Meshal Almeshary1, Alanoud Abdullah Abuhaimed2, Dania Mohammed Alkelabi2, Mohamad-Hani Temsah3
1- General Pediatric Unit, 2- College of Medicine,
3- Pediatric Intensive Care Unit, King Saud University Medical City, Riyadh, Saudi Arabia
Corresponding author: Meshal Zaid Almeshary,Email: Malmeshary1@ksu.edu.sa,mobile:00966548453267

ABSTRACT
Group A Streptococcus commonly causes cellulitis and pharyngitis, but in rare instances, it may cause pneumonia. Herein,
we report a case of invasive pneumonia with classic symptoms of Kawasaki disease (KD). This case highlights the
importance of considering KD in patients with pneumonia, especially when they present with typical KD features and do
not respond to antibiotics.
Objectives: To present our case of invasive pneumonia with skin peeling caused by group a beta-hemolytic streptococcus
and kawasaki disease presented to General Pediatric Unit, King Saud University Medical City, Riyadh, Saudi Arabia.
Subjects and Methods: Case study of a four-years-old boy who was presented to the hospital with fever, cough, and
dyspnea that persisted for 7 days. His medical history was unremarkable, and his immunizations were up to date as per the
Saudi Ministry of Health vaccination schedule for children of that age.
Results: As a result, the final diagnosis was confirmed as KD with GAS. Treatment with vancomycin
and tazocin was sustained for a whole of three weeks, and subsequently the case was discharged after a follow-
up cardiology examination. Echocardiography was repeated after six weeks of illness with no evidence of coronary
dilatation.
Conclusion: A diagnosis of KD should be considered in patients with pneumonia who exhibit the characteristic symptoms
of KD, especially when a poor response to antibiotic treatment is observed.
Key words: Invasive pneumonia, Group A streptococcus, Kawasaki disease.


INTRODUCTION

mmHg. His lung sounds were equal and bilaterally
Pneumonia is a common but serious infection affecting
vesicular.
children worldwide (1). The major bacterial pathogens of
In addition, he had bilateral, non-exudative
this disease are Streptococcus pneumoniae and
conjunctivitis, cracked lips, strawberry tongue, unilateral
Staphylococcus aureus (2). Group A Streptococcus (GAS)
cervical
lymphadenopathy
measuring
1.5
cm,
typically causes cellulitis and pharyngitis (3), and the
erythematous macular rash in the truncal area and
lower respiratory tract is an uncommon site of GAS
erythema of the hands and feet. Upon hospitalization,
infections (4). Kawasaki disease (KD) is an acute and self-
laboratory checks showed the next values: white blood
limiting disease that results in medium-vessel vasculitis
cell (WBC) count of 13.9/µl (57% neutrophils),
and mostly comprises the coronary arteries. The clinical
hemoglobin level of 10 g/dl, platelet count of 135/µl, C-
manifestation of KD is exceedingly mutable, with no
reactive protein level of 160 mg/l, erythrocyte
pathognomonic laboratory results.
sedimentation rate of 104 mm/hour, and albumin level of

21 g/l. Urine analysis indicated 13 WBC/HPF with
CASE PRESENTATION
negative culture. The liver and renal function test findings
A four-year-old boy was brought to the hospital in
were normal.
January 2019 with fever, cough, and dyspnea that
Several investigations including blood culture,
persisted for 7 days. His medical history was
mycoplasma IgM tests, and nasopharyngeal aspirates for
unremarkable, and his immunizations were up to date as
virology tests such as H1N1 and MERS-CoV, were
per the Saudi Ministry of Health vaccination schedule for
performed for detection of infectious. The results from
children of that age. On examination, he appeared ill with
these tests were all negative.
respiratory distress and had a respiratory rate of 50
However, the result of rapid antigen detection test
breaths/min, while maintaining an oxygen saturation of
for GAS was positive, and the ASO titer was 1110
98% on room air. The patient was febrile (39.3°C) with a
units/ml.
Chest
radiograph
revealed
multiple
heart rate of 158/min and a blood pressure of 103/66
homogeneous circular opacities (Figure 1).


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837
Received:17 /9 /2021
Accepted:14 /11 /2021

Full Paper (vol.861 paper# 137)


c:\work\Jor\vol861_138 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 840-844
A Comparative Study of Psoriasis and Psoriasiform Dermatoses on
Basis of Ki-67 Immunohistochemical Expression
Hajir Fathalla Farag Abdelsalam*, Mai Ahmad Gobran,
Mai Mohamed Abdelwahab, Hesham Radwan Abdelaziz

Pathology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hajir Fathalla Farag Abdelsalam, Email: hajirfathalla@gmail.com

ABSTRACT
Introduction:
The prototypical psoriasiform tissue pattern is psoriasis, both clinically and histopathologically.
However, it should be distinguished from other psoriasiform dermatoses.
Objective: This study aimed to determine the expression of Ki-67 immunohistochemically in psoriasis and psoriasiform
dermatoses for diagnostic reasons. Material and Methods: Between January 2020 and January 2021, a cross-sectional
study was conducted on the paraffin blocks of 22 psoriasis and 22 psoriasiform dermatoses patients. Four-micron
sections were cut from formalin-fixed paraffin-embedded tissue from each biopsy specimen. Hematoxylin and eosin
staining was used to colour the initial sections. Additionally, Ki-67 immunohistochemistry was performed.
Results: Mean value of KI-67 expression was highly significant in psoriasis (94.4 ± 11) versus (21.1 ± 5.7) than in
psoriasiform dermatoses (P value < 0.001). Conclusion: Ki-67 expression was shown to be significantly elevated in
psoriasis compared to the other types of dermatoses studied.
Keywords: Immunohistochemistry, Psoriasis, Dermatoses, Ki-67.

INTRODUCTION

Psoriasis is a chronic inflammatory disease
Ethical approval:
mediated by the immune system. It affects 2-3% of the
The study was conducted after taking approval
people all over the world, and the cause of psoriasis is
of The Local Ethical Committee Institutional review
still unknown. There is a complex interaction between
board (IRB) with approval number of 6660.
genetic, immunological and environmental factors (1).

Psoriasis is clinically diagnosed with the presence
Inclusion criteria: Psoriasis (active, healed, acute on
of scaly, erythematous plaques on the skin surface with
top of chronic and chronic) and psoriasiform
additional joint, and nail manifestations. Plaque
dermatoses (active, healed, acute on top of chronic and
psoriasis is the most common type, guttate, pustular,
chronic).
and erythrodermic are atypical forms (2).
Exclusion criteria: Co-existing dermatological
The psoriasiform lesions have similar histological
diseases, pregnancy and breast-feeding.
and clinical characteristics to those of psoriasis. Lichen

simplex chronicus, pityriasis rosea, pityriasis rubra
Steps of performance and techniques that were used:
pilaris, atopic dermatitis, seborrheic dermatitis, and
I- Clinical evaluation: The clinicopathological data of
allergic contact dermatitis are examples of psoriasiform
age, sex, and clinical presentation were retrieved from
lesions. Therefore, clinical and histopathological
pathology reports available with the tissue specimens.
similarities between psoriasis and psoriasiform lesions
II- Histopathological evaluation: To double-check the
contribute to diagnostic difficulties in obtaining a final
diagnosis, routine Hematoxylin and Eosin stain (H & E)
diagnosis (3). Psoriasis and psoriasiform dermatoses can
was used to segment paraffin blocks at a thickness of 3-
occasionally
be
differentiated
using
4 microns.
immunohistochemistry for diagnostic, prognostic, and
Assessment of the disease activity (Histopathological
therapeutic purposes. Psoriasis has a higher level of the
changes of the epidermis) in both psoriasis and
cell proliferation marker Ki-67 in its lesions than does
psoriasiform dermatoses for epidermal changes as
normal skin, and this higher level of Ki-67 expression
(hyperkeratosis, parakeratosis, regular acanthosis, and
is associated with the severity of the disease (4).
elongated rete ridges)

A three -point scoring procedure was used: Zero for
MATERIAL AND METHODS
no changes, one for minimal changes, isolated changes
This cross-sectional study was performed on a total
in few microscopic fields, two for mild changes, few
of 44 paraffin blocks of skin tissue between January
changes in several microscopic fields and three for
2020 and January 2021. Data was gathered from the
moderate and focal changes in nearly all microscopic
pathology department at Zagazig University. Twenty
fields (5).
two blocks with psoriasis (14 males and 8 females) and
Assessment of grades of inflammation by counting of
twenty two blocks with psoriasiform dermatoses (12
the inflammatory cells numbers per mm of section per
males and 10 females) were enrolled in this study.
ten high power fields in both psoriasis and psoriasiform

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840
Received: 26/09/2021
Accepted: 15/11/2021

Full Paper (vol.861 paper# 138)


c:\work\Jor\vol861_139 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 845-851

Added Value of Diffusion-Weighted Magnetic Resonance Imaging in
Characterization and Staging of Rectal Cancer
Basma Gamal Eddin*, Esam Mohamed Hemat, Maged Abd El Galil Hamed, Ahmed Fekry Salem
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Alsharquia, Egypt
*Corresponding author: Basma Gamal Eddin, Mobile: (+20) 01098869335, E-Mail: basmaagamal227@gmail.com

ABSTRACT
Background
: Approximately 15% of all cancers are found in the rectum. Rectal cancer is one of the most common
malignant tumors in patients. According to the National Cancer Institute, it's the third most frequent cancer in males and
the second most prevalent cancer in women. About 96 percent of all colon cancers are adenocarcinomas, with
lymphoma, gastrointestinal stromal tumors, and carcinoid among the more uncommon malignancies.
Aim of the study: to discuss the accuracy of MRI at staging cancer rectum using high-resolution MRI sequences and
to give a brief review about more emerging important aspects of rectal cancer staging, such as the circumferential
resection margin, extramural vascular invasion, and the staging of low rectal cancers.
Patients and Methods: Our study was done in the Radiodiagnosis Department, Zagazig University Hospital, with 24
patients with primary rectal cancer referred from the Surgery Department for preoperative local staging of cancer
rectum; the results of MRI were compared to pathologic findings.
Results: Patients included in the study were 16 females and eight males; their ages ranged from 45 to 75 years with a
mean age of 60 years. Adenocarcinoma comprised about 83.3 % of all of our cases. T3 and N1 tumors were found to be
the most common stages in our cases.
Conclusion: Preoperative MRI utilizing high-resolution sequences is an accurate modality for preoperative grading of
rectal carcinoma, delineation of affection of mesorectal fascia, circumferential resection margin, and extramural vascular
invasion.
Keywords: Cancer, MRI, Rectal, Tumors.

INTRODUCTION

Rectal cancer is one of the most common clinical
resolution T2 imaging sequences is essential in staging
malignant tumors, which accounts for about 15% of all
accuracy(9).
malignant tumors (1). It is the third most common cancer
However, structural imaging techniques have
in men and the second most common cancer in women
shown clear limitations in tumor evaluation. Different
(2). Adenocarcinomas comprise approximately 96% of
functional and molecular imaging techniques such as
all colorectal cancers, whereas the uncommon
DWI and dynamic contrast-enhanced (DCE) imaging
malignancies include lymphoma, gastrointestinal
are useful tools for providing insights into tumor
stromal tumors, and carcinoid (3).
phenotype and improving tumor response to treatment
The prognosis of rectal cancer is directly related
(10,11).
to tumor infiltration into the mesorectum and the ability
DW-MRI enables a noninvasive characterization
to surgically achieve negative circumferential resection
of biologic tissues on the basis of their water diffusion
margins (CRMs) (4). The use of total mesorectal excision
properties (12).
(TME) as the standard treatment of rectal cancer and the
Aim of the study was to discuss the accuracy of
adoption of neoadjuvant chemoradiotherapy for patients
MRI at staging cancer rectum using high-resolution
with locally advanced rectal cancers, diagnosed on the
MRI sequences and to give a brief review about more
basis of MRI features, has led to substantial
emerging important aspects of rectal cancer staging,
improvement in local disease control (5).
such as the circumferential resection margin, extramural
There is a need for accurate clinical staging of
vascular invasion, and the staging of low rectal cancers.
rectal cancer to optimize individualized treatment (6).

Rectal cancer is staged based on the TNM classification
PATIENTS AND METHODS
system. The T stage refers to local tumor extent, the N
A prospective study has been conducted on 24
stage refers to regional lymph node status, and the M
patients; they were clinically suspected of having cancer
stage refers to the presence or absence of distant
rectum. The patients were referred from the Surgery
metastatic disease (7).
Department to the Radiodiagnosis Department,
Currently, MRI is the preferred imaging
Magnetic Resonance Imaging Unit, Zagazig University
modality for local staging of rectal cancer(8). High-
Hospitals over a period between October 2019 and
resolution T2-weighted images are the gold standard for
October 2020.
evaluating rectal cancer. Proper planning of high-


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845
Received: 19/09/2021
Accepted: 16/11/2021

Full Paper (vol.861 paper# 139)


c:\work\Jor\vol861_140 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 852-858

The Relationship between a New Type of Partogram and Rate of
Cesarean Section at Zagazig University
Ali El-Shabrawy Ali, Youssef Abo Elwan El-Sayed, Safaa Abdelsalam Ibrahem,
Esraa Khalil Hasaneen Alsaadani
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.
Corresponding author: Name: Esraa Khalil Hasaneen Alsaadani, Mobile: 01116994581,
Email: esraaelsaadany4@gmail.com

ABSTRACT

Background: The cesarean section (CS) rates have dramatically increased worldwide. The process of labor is
associated with both maternal and fetal potential risks, regardless of the mode of delivery. Objective: The aim of this
study was to investigate the value of the use of a new type of partogram and compare it with Fisher partogram in
reducing the cesarean section rates.
Patients and Methods: This cohort prospective study was carried out at the Department of Obstetrics and
Gynecology, at Zagazig University Hospital and Menia Al-Kamh Central Hospital during the period study; year 2019.
This study included 150 patients. We compared the efficacy of the two types of partograms during labor. Results:
There were statistically significant differences between groups as regard newborns' Apgar at 5th min, and as regard
cesarean section rate, which in Group (A) according to Fisher partogram was 6 (5.8%) and according to new type of
partogram was 3 (2.9%) while in Group (B) according to Fisher partogram it was 23 (48.9%) and according to new
type of partogram was 14 (29.8%). Conclusions: The new partogram is more helpful in the recognition of the initiation
of the acceleration stage during the active phase of labor and in the timely use of appropriate actions in order to achieve
a safer delivery.
Key words:
Cesarean section rate, Labor, New type of partogram

INTRODUCTION
provides an early warning system. The World Health
The worldwide increase in cesarean section (CS)
Organization (WHO) partographs are the best-known
rates is due to indications such as labor abnormalities,
partographs in the low-resource setting. Partographs
fetal distress maternal age, and parity, which are often
when used with defined management protocols is an
over-diagnosed (1). Previously, CS rates have
inexpensive tool, which can effectively monitor labor
dramatically increased worldwide. However, there is
and be helpful in reducing incidence of both maternal
no clear evidence of a simultaneous decrease in
and fetal morbidity and mortality by reducing the
maternal or perinatal morbidity or mortality (2). The
number of operative interventions, prolonged labor,
process of labor is associated with both maternal and
obstructed labor and cesarean section (6).
fetal potential risks, regardless of the mode of
The modified WHO partograph is an inexpensive
delivery. There are various CS indications that aim to
but valuable tool that provides a continuous pictorial
reduce the maternal/fetal risks. However, most of the
overview of progress of labor. It helps to detect the
cesarean deliveries are performed because of relative
abnormal progress of labor. It helps the obstetrician to
indications, according to which the maternal/fetal
decide about the need for augmentation of labor and
risks are thought to be relatively less in CS compared
helps to recognize prolong labor before obstruction
with vaginal delivery (3).
occurs (7).
In the developing countries, prolonged labor is
In the classical Fisher partogram, cervical
one of the most frequent causes of maternal mortality
dilatation and action line are the recorded parameters
and is generally related to cephalopelvic disproportion
of the progress of labor. It consists of two straight
and cervical dystocia (4). An early detection of the
diagonal parallel lines, where the action line is parallel
abnormal progress of labor was shown to prevent
and at the right of the alert line, but the fetal head
prolonged labor; reduce the risk of postpartum
descent is not included (8).
hemorrhage; and eliminate the obstructed labor,
An early decision about the appropriate
uterine rupture, and perinatal fetal asphyxia cases and
management to overcome the labor delay is possible
admissions to the intensive neonatal care unit (5).
with the use of the new type of partogram with only
The partogram is a graphic record of progress of
one graphic line (9). Active management, opposed to
labor and maternal and fetal condition during labor in
expectant management, has reduced the prolonged
a single sheet of paper which is useful in detecting the
labor incidence and the cesarean section rates. The
labor that is not progressing normally at an early stage
documentation of the partogram includes the
and helpful in its management. The partograph
administration of oxytocin and procedures such as
graphically represents key events in labor and
amniotomy (10).

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852
Received: 16/9/2021
Accepted: 16/11/2021

Full Paper (vol.861 paper# 140)


c:\work\Jor\vol861_141 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 859-863

The In-Hospital Prognostic Value of High Sensitivity C-Reactive Protein in
STEMI Patients Treated by Thrombolysis Versus Primary
Percutaneous Coronary Intervention
Mahmoud Hassan Abdul Kader Shah, Ahmed Shawky Shereef,
Mohammad Gouda Mohammad, Haitham Ahmed Mahmoud*
Cardiology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Haitham Ahmed Mahmoud, Email: inteldr2011@yahoo.com

ABSTRACT
Introduction:
Coronary artery disease (CAD) is considered a major causative agent of mortality and morbidity. Many
reports recommended the use of C-reactive protein (CRP) as an inflammatory marker for its high sensitivity that could
help in prevention of CAD.
Objective: This work aimed to clarify the in-hospital prognostic value of high-sensitivity CRP (hs-CRP) in ST-elevation
myocardial infarction (STEMI) cases who are treated by thrombolysis vs. primary percutaneous coronary intervention
(PCI) and comparing the outcome of the treatment between the two groups.
Patients and methods: 48 STEMI cases were divided into two groups in this cross-section study: Patients in group A
had Primary PCI, whereas those in group B received thrombolysis treatment. Patients were evaluated by history,
examinations, investigations and coronary angiography.
Results: Most of patients had grade II mitral regurge (68.8%) with statistical insignificant differences between the study
groups. Most of patients had wall motion abnormalities in anterior septum (43.8%) with statistical insignificant
difference between groups. In this study, 41.7% of patients had positive troponin with statistical insignificant difference
between groups. According to distribution of patients as regards outcomes, died patient and patients with heart failure
had significantly higher median of first- and second-hour CRP than patients without adverse events
Conclusion: Impaired reperfusion was correlated with higher hs-CRP compared to optimal reperfusion. This study was
conducted on CRP so further investigation with larger population size are necessary especially for inflammatory
cascade.
Keywords: Hs CRP, PCI, STEMI, Thrombolysis.

INTRODUCTION

3 mg/L are considered average, those over 3 mg/L are
Acute myocardial infarction (AMI) is potential
considered high risk, and hs-CRP levels over 10 mg/L
causative for morbidity as well as mortality worldwide.
suggest acute inflammation (4).
MI occurs as a result of ischemia of the myocardium,
There is probable importance of hs-CRP in the
which is a poor blood supply that increases critical
clinical practice as a prognostic value for the success of
threshold, and reduces the cellular repairing mechanism
treatment of STEMI by pharmacological therapy or
of the myocardium that maintain homeostasis and
medical intervention. This importance will benefit us in
normal function. Death or irreversible myocardial
predicting the outcome and incidence of complications
damage were consequences of prolonged ischemia at
on the short-term-run in STEMI patients. Thus,
this critical threshold level (1).
reducing the morbidity and mortality in patients having
A
previous
studies
reported
prognostic
coronary artery disease.
improvement in AMI patients. The clinical practice
This work aimed to clarify the in-hospital
supported clinical trials regarding the potential effect of
prognostic value of hs-CRP in STEMI patients who are
novel treatments as the recommendations of guidelines
treated by thrombolysis vs. primary PCI and comparing
improved the prognosis (2). The high sensitivity is the
the outcome of the treatment between the two groups.
difference between hs-CRP and CRP. CRP levels were

measured below 3-5 mg/L, while hs-CRP can be
PATIENTS AND METHODS
measured down to 0.3 mg/L, which can detect lower
Forty-eight STEMI cases were divided into two
inflammatory levels than CRP (1).
groups in this cross-section study: Patients in group A
Hs-CRP blood tests were used for evaluation of the
had primary percutaneous coronary intervention,
risk of cardiac disease in future, also hs-CRP can help
whereas those in group B received thrombolysis
in targeted therapy to intercept cardiovascular disease
treatment.
(CVD). The hs-CRP cut-off point 2 mg/L were used in

clinical trial as increased CVD risk, and the normal hs-
Inclusion Criteria: We recruited all the STEMI cases
CRP level is less than 1 mg/L (3). hs-CRP values below
in the period from January 2020 to July 2020 treated by
1 mg/L are regarded low risk, while those between 1 and
I.V. streptokinase or 1ry PCI.

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859
Received: 19/10/2021
Accepted: 28/11/2021

Full Paper (vol.861 paper# 141)


c:\work\Jor\vol861_142 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 864-870

MicroRNA-377 Expression Level as a Marker of Nephropathy in
Type 2 Diabetes Mellitus
Saffaa M. Elalawi1, Samir A. Afifi2, Abeer A. Fikry*1
Departments of 1Clinical Pathology and 2Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Abeer A. Fikry, Mobile: 00201029153181, Email: abfikry@gmail.com

ABSTRACT
Background:
Diabetic nephropathy is one of the most dangerous complications of diabetes mellitus. To prevent these
complications in diabetic patients monitoring of patients is a must. In last decades many authors were trying to
investigate molecular biomarker to detect patients who are at risk. MicroRNA-377 is one of the promising biomarkers
for prediction of diabetic nephropathy. Objective: This study aimed to investigate the role of miRNA-377 as early
predictor of diabetic nephropathy in patients with type 2 diabetes mellitus.
Patients and methods:
Seventy five patients with type 2 diabetes and 25 healthy control participants are enrolled in a
case-control study. Clinical evaluation, and laboratory investigations including fasting plasma glucose, serum creatinine,
fasting lipid profile, glycosylated hemoglobin, estimated glomerular filtration rate (eGFR) and albumin creatinine ratio,
The expression of serum miRNA-377 was measured via quantitative real-time-polymerase chain reaction (qRT-PCR).
Results:
Expression of miR-377 could differentiate diabetic patients from healthy control as the expression of miR-377
was significantly higher in overall T2DM patients than in the healthy control (2.5 fold change, P<0.001), and was
progressively increased in the normoalbuminuric group and further increased in the microalbuminuric and
macroalbuminuric groups (1.92, 2.76, 3.38 fold change respectively, P<0.001). MiR-377 expression levels were
positively correlated with diabetes duration, fasting plasma glucose, HbA1C, total cholesterol, LDL-C, triglycerides,
creatinine and ACR, while miR-377 expression levels were significantly negatively correlated with HDL-C and eGFR.
Conclusions: MiR-377 might act as a promising biomarker for prediction of development of diabetic nephropathy in
type 2 diabetes patients.
Keywords: Diabetic nephropathy, Micro RNA-377, Albumin/creatinine ratio

INTRODUCTION

despite having biopsy-proven diabetic kidney disease
Diabetes Mellitus (DM) is seen as one of the
(DKD) (6).
strongest enemies we must defeat. In line with the
MicroRNAs are tiny molecules containing about
International Diabetes Federation (IDF), Egypt is
22 nucleotides created inside cells as short regulating
ranked as the 8th country for the number of adults with
noncoding RNA. They regulate several fundamental
diabetes (2079 years) and for their healthcare
biological pathways and act on different cell functions
expenditure. In accordance with WHO, the prevalence
to produce normal and pathological conditions in
of type 2 diabetes mellitus (T2DM) in Egypt was
myriad biological systems. They act on RNA silencing
roughly tripled over the last two decades. By 2030, it is
and control post-transcriptional gene expression (7).
estimated that the number of Egyptians with DM will
Various microRNAs are implicated in the pathogenesis
increase to 6,726,000 (1). Diabetic nephropathy (DN) is
of DKD, whereas others have a role in nephroprotection
one of the most dangerous and prevalent complications
and so serve as promising therapeutic targets for DKD.
that can lead to death in diabetic patients, in addition to
Serum and urine microRNAs levels have additionally
being a principal causative factor to end-stage renal
been considered in the early diagnosis and monitoring
disease (ESRD) (2). It is characterized by albuminuria
of patients with DKD. The detection of microRNA in
(urine albumin/creatinine ratio (ACR) is >300 mg/g),
biological materials is applicable in clinical research for
and/or a glomerular filtration rate (GFR) less than 60
the progress of diagnostic biomarkers for DKD, since
ml/min/1.73 m (3). Current guidelines recommend that
early diagnosis may inhibit progression to kidney
both parameters have to be measured, at least once a
failure and cardiovascular events (8). One of the
year, to diagnose and screen for or monitor DN (4).
miRNAs formerly reported to be implicated in the
Although microalbuminuria is considered as the
pathogenesis of DN is miRNA-377 that was found to
gold standard for the diagnosis of DN, there are many
enhance fibronectin expression in mesangial cells
reasons to consider ACR is not the perfect biomarker to
(MCs) through the reduction of manganese superoxide
be measured for the early detection of DN. Albuminuria
dismutase and p21-activated kinase (9).
is a non-specific biomarker as some other conditions
The current study aimed to investigate the role of
may result in increased urinary excretion of albumin
miRNA-377 as early predictor of diabetic nephropathy
such as urinary tract infection, fever, exercise,
in patients with type 2 diabetes mellitus and to correlate
hypertension, and congestive heart failure (5).
it with other parameters of disease progression.
Alternatively up to 25% of patients with T2DM and
PATIENTS AND METHODS
diminished kidney function have little or no proteinuria,
This case-control study comprised 75 patients
with T2DM and 25 healthy age- and sex-matched

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864
Received: 19/09/2021
Accepted: 16/11/2021

Full Paper (vol.861 paper# 142)


Zagazig University The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 871-876
Diagnostic Evaluation of Blunt Abdominal Trauma Scoring System (BATSS)
Khaled Safwat Elsayed Fahmi, Doaa Omar Refaat, Kamal Ahmed Ali and Mohammad Negm Abd Elghafar
General Surgery Department, Faculty of Medicine-Zagazig University, Egypt
*Corresponding author: Kamal Ahmed Ali, Mobile: (+20)01068032855, E-mail: tehha44@yahoo.com

ABSTRACT
Background:
Blunt force abdominal trauma is a typical emergency room presentation in both adults and children.
Trauma is widely acknowledged as one of the primary causes of illness and mortality in poor nations, as well as the
greatest cause of death in those under the age of 45.
Objectives: This study aims to study the diagnostic evaluation of blunt abdominal trauma scoring system (BATSS) in
patients with blunt abdominal trauma in Zagazig University Hospital.
Patients and methods: This study was conducted on 48 patients suffering from blunt abdominal trauma in Emergency
Department of Zagazig University Hospital from January 2021 to June 2021.
Result: The mean age of patients in the study was 25.87±10.7 years (range 17­61 years). Of the forty eight patients in
the study there were 13 females (27.1%) and thirty five males (72.9%).There was statistically significant difference
between blunt abdominal trauma scoring system (BATSS) and types of injury p<0.001. There was no statistically
significant difference between blunt abdominal trauma scoring system (BATSS) and each of patients' sex and causes of
injury p>0.05. Conclusion: The BATSS score system can be used as an initial screening to predict blunt abdominal
trauma outcome and can be the basis of management in patients who experience blunt abdominal trauma.
Keywords: Blunt abdominal trauma, Diagnostic, Scoring system (BATSS).

INTRODUCTION

Blunt force abdominal trauma is a typical
Exclusion criteria:
emergency room presentation in both adults and
Life threatening injuries other than abdomen injury,
children (1). The spleen and liver are the most often
penetrating abdominal trauma, pregnant women, and
injured organs after acute abdominal trauma,
patients who did not have reliable history or physical
accounting for around 85 percent of all abdominal
exam (Such as Glasgow Coma Scale (GCS) less than
injuries (2). 70 percent of spleen, liver, and kidney
15, alcohol intoxication history diagnosed by taking and
injuries may be treated conservatively, but hollow
physical exam, impaired verbal patients).
organs (such as the intestines) almost always require

laparotomy (3).
All patients were subjected to the following:
Motor vehicle accidents are the leading cause of
Full history taking: Age, sex, mechanism of
blunt abdominal injuries in the United States. Other
injury, ICU admission, concurrent injury, and
uncommon causes include falls from great heights,
associated medical illness. Operative findings,
bicycle injuries, sports-related injuries, and industrial
operative procedures, complications during the stay in
accidents. The most prevalent causes of death in
the hospital and during subsequent follow-up period.
youngsters are motor vehicle and bicycle accidents (4).
Complete general and abdominal examination to
Up to 20% of severe trauma patients have
detect different factors like fractures of lower chest ribs,
severe abdominal trauma, which is associated with a
contusion and abrasions of the abdominal wall, presence
high fatality risk of roughly 20% (5). In situations of
of fractured lumbar vertebrae with retroperitoneal
blunt abdominal trauma, quick examination and
hematoma, and reduced level of consciousness.
identification of abdominal injury is critical for care and
Lab investigations: Complete blood count;
avoidance of morbidity and death (6).
kidney functions, liver functions, coagulation profile,
This study aimed to early assessment of
serum sodium and potassium level, blood sugar level;
patients with blunt abdominal trauma in Zagazig
and serum amylase.
University Hospital, by studying the diagnostic
The presence of free fluid within the abdominal
evaluation of blunt abdominal trauma scoring system
cavity was accepted as a positive sign for
(BATSS) in these patients.
hemoperitoneum. US examinations were performed

with SSA-270A (Toshiba, Japan) sonography device
PATIENTS AND METHODS
with a 3.75 MHz convex probe.
This prospective clinical study was conducted
Scans were obtained with the patient in the
in Emergency Department of Zagazig University
supine position to evaluate for the presence of free fluid
Hospital from January 2021 to June 2021, on 48
in the bilateral upper quadrants, including the
patients suffering from blunt abdominal trauma.
hepatorenal and splenorenal regions, and paracolic
Inclusion criteria: Patients with blunt injury abdomen,
gutters. The pelvis was also scanned for free fluid,
age more than 18 years.
although this scan was sometimes obtained without the

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871
Received: 17/10/2021
Accepted: 27/11/2021

Full Paper (vol.861 paper# 143)


c:\work\Jor\vol861_144 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 877-881

Visceral Adipose Tissue-Derived Serine Protease Inhibitor (VASPIN) as
A Prognostic Marker in Systemic Hypertension
Hanaa Fathey*1, Esam A. Wahid1, Moemen Ahmad1, Nermeen T. Aly Fouad2
Departments of 1Internal Medicine and 2Clinical Pathlogy, Faculty of Medicine, Ain Shams University
*Corresponding author: Hanaa Fathey, Mobile: (+20) 01001414844, E-mail:drhanaafathey@yahoo.com

ABSTRACT
Background:
Visceral adipose tissue-derived serine protease inhibitor (VASPIN) is an adipocytokine that exerts anti-
migratory and anti-inflammatory roles through certain anti-oxidative effects in the peripheral vascular wall.
Objective: In this study, we studied the relevance of plasma VASPIN levels in patients with hypertension, correlating
VASPIN level assay to absence or occurrence of hypertension and its related complications.
Patient and Methods: This was a cross-sectional observational study. A total of 87 subjects were included, divided
into 21 age- and sex- matched control (patients' healthy relatives of some of the study- patients) and 66 hypertensive
patients. Of the 66 patients with hypertension, thirty-two were newly diagnosed with uncomplicated essential
hypertension and thirty four hypertensive patients with macro- and/or microvascular/ complications. Patients with any
other chronic diseases like diabetes, chronic renal disease, liver disease, any rheumatological disease and malignancy
were excluded. Plasma VASPIN levels and clinical parameters were assessed at baseline for all studied groups.
Results: Comparing VASPIN levels among hypertensive patients showed a negative correlation between serum
VASPIN levels and hypertension. Serum VASPIN levels were found lower in the newly diagnosed uncomplicated
hypertensive patients group than in control group, and much lower in those with macrovascular and/or microvascular
complications group compared to both uncomplicated hypertensive and control groups.
Conclusions: Plasma VASPIN may be used as an independent predictive biomarker for early detection of
macrovascular and/or microvascular hypertensive complications.
Keywords: Plasma VASPIN, Biomarker, Hypertension, Microvascular and macrovascular complications.

INTRODUCTION
(11), and is considered as a major risk for many vascular
Adipose tissue is now regarded not only as an
disorders as heart diseases, strokes (hemorrhagic and
energy reservoir, but also as an active endocrine organ,
ischemic strokes) and chronic kidney disease (12).
which can secrete a variety of metabolically active
Recent guidelines have defined hypertension as a
adipocytokines (1). VASPIN, a member of the serine
sustained systolic blood pressure greater than 130 mm
protease inhibitor family, is among the adipocytokines
Hg, making almost half of the adult population
secreted from white adipose tissue. VASPIN was first
hypertensive (13). Hypertension may be primary, which
isolated from a rat model of abdominal obesity with
may develop as a result of environmental or genetic
type 2 diabetes mellitus (T2DM) (2). Multiple studies
causes (90-95% of adult cases), or secondary, which has
showed association between VASPIN concentration
multiple etiologies, including renal, vascular, and
and metabolic disorders, including type II diabetes
endocrine causes (2-10% of cases) (13). The
mellitus (T2DM), cardiovascular diseases (3, 4),
pathogenesis of essential hypertension is multifactorial
polycystic ovary syndrome (5) and osteoarthritis (6).
and complex. Multiple factors modulate the blood
VASPIN was also reported to protect against high fat
pressure (BP) including humoral mediators, vascular
diet induced bone loss, and to promote osteogenic
reactivity, circulating blood volume, vascular caliber,
differentiation (7).
blood viscosity, cardiac output, blood vessel elasticity,
VASPIN can exert its anti-inflammatory and anti-
and neural stimulation (14). End-organ damage to the
migratory roles by a variety of anti-oxidative effects on
kidneys, heart, brain, and vasculature are among the
vascular smooth muscle cells. In this way VASPIN may
diverse complications of hypertension. Hence, those
play an important role in prevention of hypertension (8).
who suffer from hypertension are more likely to
Wang and Wang (9) found that VASPIN levels have an
develop atherosclerosis, stroke, myocardial infarction,
inverse relationship with the risk of developing
heart failure, chronic kidney disease, and dementia (15).
cardiovascular events, suggesting a protective role of
Increasingly, it has become apparent that a
VASPIN in the pathophysiology of coronary
substantial portion of the vascular, renal, cardiac, and
atherosclerosis. Although experimental studies have
brain damage and dysfunction that accompanies
indicated that VASPIN is a vasculo-protective
hypertension is mediated by inflammation within these
adipocytokine, its specific role and clinical relevance in
target organs. Phalitakul et al. (16) demonstrated that
coronary artery disease (CAD) is not clear (10).
VASPIN inhibited TNF- and platelet-derived growth
Hypertension globally affects individuals in both
factor (PDGF)-induced inflammatory responses in
economically developed and developing nations alike
vascular smooth muscle cells (SMCs) via antioxidant




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877
Received: 21xx/9xx/2021
Accepted: 19xx/11xx/2021

Full Paper (vol.861 paper# 144)


c:\work\Jor\vol861_145 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 882-890

Intravenous versus Perineural Dexamethasone in Interscalene
Nerve Block with Levobupivacaine for Shoulder and Upper Arm Surgeries
Hazem El-Sayed Moawad, Nahla Salama El-Ebahnsawy,
Mahmoud Nabil Badr-Eldin, Rania El-Mohamady El-Badrawy
Department of Anesthesia and Surgical Intensive care, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Hazem El Sayed Moawad Weheba, Mobile: (+20) 01012805817, (+20) 01121516041,
E-Mail: hazemmoawad@yahoo.com - hazemsayed@mans.edu.eg

ABSTRACT
Background:
Interscalene brachial plexus block (IBPB) has gained importance for surgical purposes and pain
management. It provides effective postoperative pain relief essential for patient comfort and early ambulation.
Objective: To evaluate the effect of dexamethasone as adjuvant to levobupivacaine in ultrasound-guided IBPB in
shoulder and upper arm surgeries, and which route, the perineural or the intravenous was more effective.
Patients and methods: Ninety patients randomly allocated into 3 equal groups: Group L: received IBPB with 20 ml
of 0.5% levobupivacaine plus 2 ml normal saline (NS) with intravenous (iv) 10 ml NS. Group LDP: received IBPB
with 20 ml of 0.5% levobupivacaine plus dexamethasone 4 mg diluted in 2 ml NS with iv 10 ml NS. Group LDIV:
received IBPB with 20 ml of 0.5% levobupivacaine plus 2 ml NS with iv dexamethasone 4 mg diluted in 10 ml NS.
Results: Patients in group LDP took prolonged time to ask for the first request for analgesia compared with patients in
group L and group LDIV (15.57±3.89 vs 13.23±2.65 and 13.57±3.22, respectively) (p=0.007 and p=0.02, respectively),
but no significant difference between group L and group LDIV (p=0.696). Pethidine consumption was significantly
increased in patients of group L compared with patients in group LDP and group LDIV (p<0.001 and p<0.001,
respectively), but no significant difference in pethidine dose between group LDP and group LDIV (p=0.283).
Conclusion: This study concluded that the addition of dexamethasone as an adjuvant to perineural levobupivacaine
for IBPB prolonged the duration of analgesia, decreased the postoperative pain score, decreased pethidine consumption
and improved patient satisfaction.
Keywords: Dexamethasone, Interscalene block, Levobupivacaine, Upper arm Surgeries.

INTRODUCTION

Pain management after shoulder procedures
Dexamethasone had been shown to prolong the
poses a challenge to both anesthesiologists and
duration of postoperative analgesia when given as an
orthopedic surgeons. In an effort to improve analgesia
adjuvant for peripheral nerve blocks. It has multiple
and facilitate mobilization, regional anesthesia in the
systemic effects, such as reducing postoperative
form of IBPB is often used, either as an adjunct to
nausea, vomiting, and postoperative pain. In this study
general anesthesia or as the primary anesthetic (1).
low dose was chosen to minimize the possibility of side
The addition of regional analgesia can shorten
effects of dexamethasone as hyperglycemia (6).
the postoperative recovery period and provide the
The mechanisms behind the beneficial effect of
ability to perform open and arthroscopic shoulder
dexamethasone and the route of administration remain
surgery on an outpatient basis. IBPB is commonly used
to be determined. It has been suggested that the effect
for these purposes as it can effectively control acute
is mediated by direct blockade of nociceptive c-fibers,
postoperative pain that occurs approximately 8-10
reducing the release of inflammatory mediators and
hours after surgery, and has a high success and low
ectopic neuronal discharge, and upregulation of
complication rate. It provides safe and effective patient
potassium channels (7).
care that is associated with a high degree of satisfaction
The purpose of this study was to compare
to the patient and health care providers (2,3).
perineural versus intravenous dexamethasone on
Ultrasound guidance for IBPB significantly
prolongation of the action of levobupivacaine in
reduces the number of needle passes, required local
ultrasound-guided IBPB for shoulder and upper arm
anesthetic volume, and postoperative pain compared
surgeries.
Hemodynamic
stability,
analgesic
with a nerve stimulator-guided technique (4).
requirement and patient satisfaction were evaluated.
Levobupivacaine is the latest local anesthetic

introduced in clinical practice. It is the pure S (-) -
PATIENTS AND METHODS
enantiomer of the racemic formulation bupivacaine.
This double blinded randomized comparative
Whereas both the R- and S- enantiomers of bupivacaine
controlled trial was conducted at Mansoura University
have anesthetic activity, preclinical studies suggested
Hospitals. The clinical part of the study was conducted
that levobupivacaine might be less cardiotoxic than the
from the first of April 2018 to the first of May 2020.
racemic mixture (5).


Ethical approval:


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882
Received: 19/09/2021
Accepted: 16/11/2021

Full Paper (vol.861 paper# 145)


c:\work\Jor\vol861_146 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 891-897
The Prognostic Value of CD133 in Ovarian Surface Epithelial Tumors
Fatma El-Zahraa Salah El-Deen Yassin1*, Sarah R. Dawood Mejalaa2, Afaf Taha Ebrahim El Nashar1
1Department of Pathology, Faculty of Medicine, Sohag University, Sohag, Egypt
2Department of Pathology, Sohag Oncology Center, Sohag, Egypt
*Corresponding author: Fatma El-Zahraa Salah El-Deen Yassin, Mobile: (+20)01007970144,
Email: fatmafm2002@yahoo.com

ABSTRACT
Background
: Ovarian cancer, the fifth leading cause of cancer-related death in women, is a highly lethal disease
among all gynecologic malignancies.Stem cells (SCs) are undifferentiated cells destined to replenish the pool of
mature cells whenever needed.In recent years, accumulating data demonstrate that a small subset of cells exists within
a tumor, termed cancer stem cells (CSC), responsible for cancer development and recurrence. CD133 is considered a
CSC marker in several non-ovarian cancers including cancers of the colon, the lung, and the brain.
Objective: To evaluate the expression of the stem cells marker CD133 in surface epithelial tumors of the ovary and its
correlation with clinic-pathological parameters.
Patients and methods:
60 cases, divided into 39 cases of serous tumors, 12 cases of mucinous tumors, 6 cases of
endometrioid carcinoma and 3 Brenner tumors from 2018 to 2020, were stained for CD133 antibodies by
immunohistochemistry. All clinical data were obtained from patients reports.
Results:
CD133 expression was found in 84.62% of ovarian epithelial cancer and in 37.5% of borderline tumors.
CD133 expression showed a significant correlation with histopathological subtypes: high-grade serous carcinoma and
mucinous tumors (P=0.001). Evaluation of CD133 in relation to other histopathological parameters: CD133 showed
significant correlation with presence of psammoma bodies, and presence of necrosis (P= 0.049, and 0.005)
respectively. Also, statistical evaluation of CD133 expression according to presence of lymphovascular emboli,
peritoneal nodules, and infiltration to other organs showed high significance with (P= 0.001) similarly to all.
Conclusion:
CD133 expression could be a predictor of poor clinical outcome for patients with ovarian surface
epithelial tumors as its expression was associated with high-grade serous carcinoma, necrosis, lympho-vascular emboli
and peritoneal nodules.
Keywords:
Stem cell, Ovarian cancer, CD133.

INTRODUCTION
as a stem cell marker for normal and cancerous
Ovarian cancer is a heterogeneous disease
tissues[3].
composed of different types of tumors. Malignant
CD 133 positive tumor cells of ovarian cancer
epithelial tumors are the most common ovarian cancers
displayed a greater resistance to chemotherapy. In
and the most lethal gynecological malignancies.
addition and they have hyperactivity in migration and
Cancer stem cells (CSCs) have been isolated from
invasion due to activation of chemokines (c-c motif)
several malignant tumors including leukemia, breast,
ligand 5 (CCL5)[4].
brain, and colon cancers. Furthermore, studies in
Aim of the work to evaluate the expression of
different organs have shown that CSCs are more
the stem cells marker CD133 in surface epithelial
resistant than non-CSCs to conventional cytotoxic
tumors of the ovary and its correlation with clinic-
treatment. In early stage of ovarian cancer, the number
pathological parameters.
of epithelial ovarian cancer (EOC) stem cells can be

used to predict the progression of the disease[1].
PATIENTS AND METHODS
Cancer stem cells or tumor-initiating cells

60 specimens were obtained from Pathology
(CSC/TICs), which can undergo self-renewal and
Department, Sohag University Hospital and Sohag
differentiation, are thought to play critical roles in
Oncology Center at the period from 2018 to 2020. All
tumorigenesis, therapy resistance, tumor recurrence,
specimens were formalin- fixed and paraffin-
and metastasis. Tumor recurrence and chemoresistance
embedded.H&Estained sections were examined,
are major causes of poor survival rates of ovarian
diagnosed and graded according to the FIGO
cancer patients, which may be due in part to the
Committee on Gynecologic Oncology[5].
existence of CSC/TIC[2].

CD133, also known as prominin or AC133, is a
Inclusion criteria: Patients who had undergone total
marker frequently found on multipotent progenitor
hysterectomy, subtotal hysterectomy and adnexectomy
cells, including immature hematopoietic stem and
specimens.
progenitor cells. The protein has been extensively used


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891
Received: 19/09/2021

Accepted: 16/11/2021

Full Paper (vol.861 paper# 146)


c:\work\Jor\vol861_147 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 898-901

Transversus Abdominis Plane (TAP) Block: Review Article
Wael Alham Mahmoud, Mahmoud Mohamed Mahmoud Omar*,
Islam Mokhtar Ahmed, Hala Mahmoud Hashim EL Khayat
Anaesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Mahmoud Mohamed Mahmoud Omar, Mobile: (+20) 01010087770, E-Mail: shonehaa@gmail.com

ABSTRACT
Background:
The transversus abdominis plane (TAP) block is a localized analgesic method for the abdomen wall on
the anterolateral side. Ultrasound (US) guided TAP blocks are currently regarded as the gold standard. It is simple to
obtain US images; it could be utilized in several surgical procedures including the abdominal wall on the anterolateral
side. Though, US-guided TAP blocks' effectiveness varies, that may be owing to the variety of techniques used. The
approach chosen has an effect on the area included and the duration of the block. To examine the true analgesic
consequences of TAP blocks, we standardized the nomenclature system and defined all methods. While a single-shot
TAP block has a restricted period, it remains an applicant for the analgesia threshold for abdominal wall operation due
to the possibility of overcoming this restriction using the catheter method and liposomal bupivacaine. TAP blocks could
be used more effectively to attain improvement of pain control with an integrated nomenclature and the advance of
catheter method and/or local liposomal analgesics.
Objective: This review discusses the nomenclature system and current improvements in TAP block approaches.
Methods: The databases were searched for articles published in English in 4 data bases [PubMed ­ Google scholar-
Egyptian bank of knowledge -Science direct] and Boolean operators (and, or, not) had been used such as [Transversus
abdominis plane block AND Internal Oblique Muscle OR Ultrasound guided] and in peer-reviewed articles between
January 2000 and August 2021.
Conclusion: With the improvement in US method, the successful rate and protection of TAP blocks have clearly
enhanced.
Keywords: Internal Oblique Muscle, Transversus abdominis plane block, Ultrasound guided.


INTRODUCTION

The abdominal wall is made up of three
anterior abdominal wall are blocked prior to piercing
muscles' layers: external oblique, internal oblique, and
the muscles and innervating the abdomin (4).
transversus abdominis, as well as their fascial sheaths.

Nerve afferents passing by the transversus abdominis
Anatomy:
neuro-fascial plane innervate this muscle wall (1).
The external oblique, the internal oblique, the
The current method to providing analgesia after
transversalis muscles, and the rectus abdominis muscle
operation following incision of abdominal for inhibition
comprise the muscles of abdominal wall (Figure (1) (5).
the sensory innervation to the anterior wall of abdomen;

despite, the clinical value of present techniques for
The External Oblique Muscle
blocking these nerve supplies is restricted, and the grade
It is the biggest and most superficial muscle of
of block attained is unexpected. A significant cause of
the three muscles. It extends inferiorly from the lower 8
these blocks' qualified ineffectiveness is a deficiency of
ribs' exterior and inferior sides. The fibers that originate
well-defined anatomic landmarks, which creates
in the lower ribs travel inferiorly and fuse with the iliac
uncertainty about the precise needle placement and a
crest. The fibers run infero-anteriorly from the mid and
deficiency of an obvious indicator that the local
highest ribs and terminate in a thick aponeurosis. The
anesthesia isn't being put the accurate anatomical plane
aponeurosis of the transversus abdominis and external
(2). A more dependable method of blocking neuronal
oblique muscles links anteriorly to the aponeurosis of
afferents to the front wall of abdomen is based on
the transversus abdominis and external oblique muscles,
anatomical research. The neural afferents pass within
forming the linea alba. The aponeurosis is responsible
the neuro fascial plane. The lumbar triangle of Petit's is
for forming the inferior inguinal ligament (6).
suggested as a possible entry site to this neuro fascial

plane. The latissimus dorsi muscle encompasses the
The Internal Oblique Muscle
triangle posteriorly, while the external oblique muscle
This muscle is a minor, more delicate than
encompasses it anteriorly, with the iliac crest creating
external oblique muscle. The iliac crest, and the
the triangle's base. The triangle is a stable and
inguinal ligament combine to form it. Its fibers wrap
perceptible landmark (3).
around the anterolateral abdomen, penetrating linea alba
Through the injecting local anaesthetia (LA) into
just over the transversus abdominis muscle anteriorly
TAP via the triangle of Petit, nerves of sensation of the
and lower six rib cartilages superiorly (7).




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898
Received: 19/09/2021
Accepted: 16/11/2021

Full Paper (vol.861 paper# 147)


c:\work\Jor\vol861_148 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 902-906

Role of Nucleated Red Blood Cells in Diagnosis of Neonatal Asphyxia in
Neonate with Meconium Stained and Clear Amniotic Fluid
Ali El Shabrawy Ali1, Naglaa Ali Ali Khalifa2, Ihab Abd El-Moniem El-Bana3,
Fatma Medhat Abdel-salam Ali*1
Departments of 1Obstetrics and Gynecology, 2Clinical Pathology and
3Pediatric and Neonatology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Fatma Medhat Abdel-salam Ali, Mobile: (+20)01061135467, Email: dr.euroka@yahoo.com

ABSTRACT
Background:
Perinatal asphyxia has been defined as the lack of oxygen that occurs either before, during, or after birth.
Many studies in recent past have suggested that an increased number of nucleated red blood cells (NRBC) in umbilical
cord blood may be a useful marker to identify birth asphyxia.
Objective: To find out the relationship between meconium-stained amniotic fluid and NRBC in umbilical cord blood.
Patients and Methods: This was a comparative cross-section study, which was carried out at Obstetrics and
Gynecology Department, Zagazig University Hospitals on 54 cases divided into 2 groups: (Group 1): included 27
pregnant females with meconium-stained amniotic fluid who gave birth to neonates (male 15 and female12) showing
criteria of perinatal asphyxia, (Group 2): included 27 pregnant females with clear amniotic fluid who gave birth to
neonate's apparently healthy full-term (male17 and female10) as control group with no obstetrical problems.
Results: There was no statistically significant difference between case and control groups in basic characteristics or
obstetric history. NRBC's/100 WBCs and lactate were highly significantly increased in group 1. The mean value of
lactate was increasing in relation to stage of hypoxic ischemic encephalopathy (HIE).
Conclusion: There was a strong correlation between markers of acute asphyxia (i.e., umbilical artery blood nucleated
red blood cells and lactate,) and meconium-stained liquor cases. These markers were significantly elevated in newborns
with meconium-stained amniotic fluid.
Key words
: Amniotic fluid, Lactate, Neonatal Asphyxia, Nucleated Red Blood Cells, Stained.

INTRODUCTION

Perinatal asphyxia is a common and serious
Nucleated red blood cells (NRBCs) are commonly
neonatal problem and contributes to both neonatal
found in the cord blood of the newborn infants. Various
morbidity and mortality. According to the World Health
situations may contribute to elevated level of NRBC
Organization (WHO) in 2000, of the 130 million infants
such as prematurity, maternal diabetes mellitus, fetal
born globally each year, approximately 4 million babies
anemia, growth retardation and Rh sensitization (4).
die before they reach the age of 1 month. Furthermore,
Nucleated red blood cells count per 100 white
of 1.2 million neonatal deaths in India, 300,000-350,000
blood cells in umbilical venous blood of newborn has
babies die due to perinatal asphyxia mostly within first
been reported as a simple, quick and cheap marker of
3 days of life (1).Hypoxic ischemic encephalopathy
prenatal asphyxia, based on the fact that hypoxic events
(HIE) after prenatal asphyxia is an important cause of
induce fetal compensatory response in the form of
neonatal morbidity, neurological disability and
exaggerated erythropoiesis and influx of immature red
mortality. The early prediction of hypoxic ischemic
blood cells fetal circulation (5).
encephalopathy is particularly important because of the
Lactate is produced in the event of hypoxia and
brief therapeutic window and possible side effects of
poor tissue perfusion. Any reduction of oxygen and
neuroprotective intervention (2).
substrate delivery to the fetus, aerobic metabolism
Meconium-stained amniotic fluid is common
through Krebs cycle cannot be sustained and tissue need
during labor and affects 10­15% of neonates.
anaerobic metabolism to meet energy requirement, this
Approximately 5% of these neonates develop
in turn leads to increase in the production and
meconium aspiration syndrome (MAS). Despite
accumulation of blood lactate (6).
advances in neonatal resuscitation and respiratory care,
Blood lactate concentration in critically ill and
MAS remains a serious cause of neonatal mortality and
injured patients can be used to detect tissue hypoxia at
morbidity, especially in developing countries and low-
an early stage which is simple, cheap and quick marker
resource settings. It is generally accepted that activation
to predict and asses illness severity and outcome (7).
of colonic peristalsis triggered by fetal hypoxia­
The objective of this study was to find out the
ischemia leads to the passage of meconium and fetal
relationship between meconium stained amniotic fluid
gasping movements, resulting in meconium aspiration
and NRBC in umbilical cord blood.
and respiratory distress (3).







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902
Received: 21/09/2021
Accepted: 18/11/2021

Full Paper (vol.861 paper# 148)


c:\work\Jor\vol861_149 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 907-912

Combined Trans-arterial Chemoembolization with Microwave
Ablation for Single Large Hepatocellular Carcinoma
Mahmoud Riad Mohamed El Bana*, Ahmed Abdel Aziz AlSamak, Hossam ElDin Mansour
Department of Radiodiagnosis, Faculty of medicine, Zagazig University, Alsharquia, Egypt
*Corresponding author: Mahmoud Riad Mohamed El Bana, Mobile: (+20) 01116425060, E-Mail: elbana19921992@gmail.com

ABSTRACT
Background:
Hepato-cellular carcinoma (HCC) is considered to be one of the most common malignancies worldwide.
In Egypt a high incidence rate of HCC has been reported with a strong association between chronic HCV infection,
cirrhosis and HCC. Therapeutic strategies in HCC should concentrate on early detection and screening in individuals at
risk. There are multiple strategies in the treatment of HCC including: transplantation, resection, ablation, and
embolization. Objective: This study aimed to use combined trans-arterial chemoembolization (TACE) and microwave
ablation (MWA) in the management of large HCC for better outcome.
Patients and Methods: In our study, we used TACE combined with MWA for group of patients having single large
HCC more than 5 cm. TACE was done first followed by MWA after one month then doing Triphasic CT to evaluate
the effect of treatment and assessment of the response according to mRECIST criteria.
Results: TACE combined with MWA had good effect in managing large HCC and reduced recurrence rate and thus
reduced the need for multiple sessions of TACE. Conclusion: Combined TACE/MWA technique is a simple, effective,
and less expensive with a low morbidity rate compared to surgical or other combined treatments.
Keywords: Trans-arterial, Hepatocellular, Carcinoma, Chemoembolization.

INTRODUCTION
survival (OS) with a satisfactory time to tumour
Hepato-cellular carcinoma (HCC) is one of the
progression (TTP) for inpatients with solitary large
most common malignancies worldwide, with a rising
HCCs. Treatment method, tumor size, and tumor
incidence in both Eastern and Western countries (1).
number are significant prognostic factors for TTP and
Hepatocellular carcinoma (HCC) larger than 5 cm in
OS (6). The aim of the present study was to use combined
size are considered large lesions, and >70% of tumors
TACE and microwave ablation in the management of
belong to this category. In recent years, Trans-arterial
large HCC for better outcome.
Chemoembolization (TACE) as a palliative treatment

has been accepted as the firstly considerable treatment
PATIENTS AND METHODS
for patients with surgically unresectable HCC (2).
This study was conducted from July 2019 to
However, the long-term outcomes of TACE were not
December 2020 on patients who presented to the
satisfying. The complete necrosis rate of tumor tissue
Radiology Department Interventional Unit, Zagazig
after TACE was just about 10%-20%. Hence, in order
University. The patients were diagnosed to have HCC.
to improve clinical effectiveness of TACE and provide
14 patients were included in our study for management
better prognosis for patients with HCC, alternative
by combined TACE and MWA.
treatment strategies are being explored. One such

strategy is TACE sequentially combined with
Inclusion Criteria: Aged 18­80 years, Child Pugh
microwave ablation (3).
class A & B liver function, Single HCC < 5cm in
Microwave ablation (MWA), a method for
diameter, visible lesions on ultrasound (US) with an
performing thermal ablation of HCCs, has the capacity
acceptable and safe pathway between the lesion and
to achieve larger and faster ablations than RFA through
skin as shown on US, and no previous treatment.
maintaining guarded and consistently higher intra-
Exclusion criteria: Multifocal or diffuse-type HCC,
tumoral temperatures (4).
Child Pugh class C liver function, TACE combined with
TACE slows tumor progression and improves
any treatment other than MWA, such as percutaneous
survival by combining the effect of targeted
ethanol injection, RFA, sorafenib, extra hepatic
chemotherapy with ischemic necrosis by arterial
metastases, lost to follow up, renal dysfunction and high
embolization. TACE is the most used therapy for
bleeding tendency.
intermediate-stage HCC in patients with reasonable
liver function. Both MWA and TACE have their own
Procedure and peri-procedure Care:
limitations; in particular, neither can achieve adequate
Pre-procedural assessment included imaging
control of large HCCs. The combined use of MWA with
[Cross-sectional imaging of the liver (U/S and triphasic
TACE is appealing (5).
CT)]. CXR, CT: for exclusion of extra-hepatic spread
TACE plus MWA appears to have more
Laboratory studies included CBC, PT, PC, PTT, INR,
advantages compared to TACE in prolonging overall
creatinine and liver function tests. Tumor markers.




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907
Received: 210/9/2021
Accepted: 18/11/2021

Full Paper (vol.861 paper# 149)


c:\work\Jor\vol861_150 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 913-923
Causative Organisms of Pyospermia in Infertile Male Patients
Mohamed Mahmoud Ramzy Mostafa*, Samir Mohamed Elhanbly, Mohammed Fawzy Elkamel
Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Mohamed Mahmoud Ramzy, Mobile: (+20)1004985570, E-Mail: dr.ramzy10@gmail.com

ABSTRACT
Background:
Male urogenital tract infection is one of the most important causes of male infertility worldwide.
Infection processes may lead to impairment of sperm quality, and obstruction of the seminal tract. On the light of this,
there is a need to institute a microbiological intervention to detect the probable causative microbial agents.
Objective: The aim of the work was to detect the common bacteria causing pyospermia in a cross-section of infertile
men and the sensitive antimicrobials against these bacteria.
Patients and methods: This study included 205 infertile men who were recruited from the outpatient clinic,
Andrology Unit, Dermatology and Andrology & STDs Department, Mansoura University Hospital for management of
infertility. Patients with grade II or grade III varicocele, more than 60-year, smoker, drug abuser and those who were
treated with antibiotics during last 3 months were excluded from the study.
Results: Over the period of the study, out of 205 infertile male patients with documented pyospermia, 95.6 % of
semen samples revealed bacteriologic growth. It was obvious that gram positive bacteria (75.1%) were common than
the gram-negative bacteria (20.5%). Six bacterial species (Staphylococcus aureus, Streptococci, Enterococci, E. coli,
Klebsiella and Pseudomonas) were isolated from semen samples. The most common causative organisms were Staph.
Aureus (49.3%) followed by Streptococci (22.4%) then E. Coli (8.3%), Klebsiella (8.3%) then Pseudomonas (3.9%)
and finally Enterococci (3.4%).
Conclusion: It could be concluded that semen analysis with peroxidase stain and semen culture are an important
diagnostic tool in all patients undergoing fertility investigations to detect genitourinary infections and pyospermia.
Keywords: Causative organisms of pyospermia, Infertile male, Sensitive antimicrobials

INTRODUCTION


Infertility means the failure to achieve a
There is association between pyospermia and
clinical pregnancy after 12 months of regular
sperm DNA fragmentation in infertile men.
unprotected
sexual
intercourse;
it
affects
Moderately increased leukocytes are also associated
approximately 15% of couples (1). The male factor is
with increased levels of cytokines IL-6 and IL-8 in
the main cause of infertility in 20% of cases and
semen (9).
contributes in about 50% (2). There are many etiologies
Male genital tract infections are difficult to
for male factor infertility; Infectious processes
detect as they are asymptomatic in many cases (10). A
contribute to about 15% of such cases (3).
number of patients seeking treatment for impaired
Pyospermia means the presence of more than
fertility are increasing so the diagnosis of "silent"
one million leukocytes in 1 mL of semen (1). It has
genital tract infections should receive attention as the
been proposed as an indicator for genital tract infection
infection may be linked to asthenozoospermia (11).
and/or inflammation (4). Pyospermia negatively
Infections are potentially treatable causes of
impacts spermatogenesis or sperm maturation and has
male infertility, but the resistance to common
been linked to a worsening of many qualitative and
antibiotics and the poor compliance may impede the
quantitative sperm parameters. The white blood cells
efficacy of antibiotics in resolving complicated GTI or
are produced by the body's immune system to fight off
restoring fertility. In a study on 140 patients with
invading organisms that cause infection, but when
pyospermia, 92 of them (65.7%) yielded bacterial
leukocyte count is elevated in semen, male fertility can
growth with Staphylococcus aureus, Staphylococcus
be compromised due to increase in oxidative stress and
saprophyticus and Escherichia coli with the highest
decrease in sperm quality (5).
incidence rate by (28.3%), (19.6%) and (13.0%)
Infertile men have significantly increased ROS
respectively, then there were Proteus mirabilis,
levels with a reduction in antioxidant capacity
Klebsiella pneumonia and Proteus vulgaris with
compared with fertile controls (6). It is postulated that
(10.8% for each). Pseudomonas aeruginosa was (5%)
ROS generated by leukocytes are responsible for
(12).
negatively affecting sperm function (7). Excessive ROS
The aim of the present study was to detect the
can induce lipid peroxidation, disrupt DNA, RNA as
common bacteria causing pyospermia in a cross-
well as protein functions in the spermatozoa and other
section of infertile men and the sensitive
testicular cells. Oxidative stress can also decrease
antimicrobials against these bacteria.
success rates of assisted reproduction procedures (8).




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913
Received: 22/09/202 1
Accepted: 19/11/2021

Full Paper (vol.861 paper# 150)


c:\work\Jor\vol861_151 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 924-932

A Prospective Study Correlating Fluid Balance and Outcome in Critically Ill Patients
Mohammed Abdel Monem Saeed*1, Mena Gerges Abdoh2, Hesham Mohammed Mahmoud Elazzazi2,
Mayar Hassan Said Ahmed Elsersi2, Sameh Ahmed Refaat Mustafa2
1Critical Care Medicine Department, Faculty of Medicine, Helwan University, Egypt
2Anesthesia Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Mohammed Abdel Monem Saeed, Mobile: (+20)1099292999, E-Mail: mohammedicu1@gmail.com

ABSTRACT

Background: Fluid administration can be lifesaving as fluid accumulation after initial resuscitation and stabilization
of hemodynamics can lead to avoidable adverse effects and less favorable outcomes.
Objective: The aim of the work was to evaluate whether even fluid balance in comparison to negative or even fluid
status is correlated with increased morbidity and mortality rates in critically ill patients.
Patients and Methods: An observational prospective study was done on 145 patients older than eighteen years,
admitted to the general intensive care (Medical & Surgical ICU) units in Helwan University Hospitals and Ain Shams
University Hospitals during the period from November 2020 till May 2021.
Results: One hundred twenty-four patients (85.5%) who survived, having the median cumulative fluid balance of -
110ml (IQR-2.1 ­ 2.2L) after four days following randomization while the median cumulative fluid balance of the 21
patients (14.5%) who didn't survive was 3800 ml (IQR 1.7-5.2L), after four days of ICU admission. Fluid balance more
than 1.2 liters per day in our study had higher ICU complications: Increased risk of AKI, longer ICU and hospital stays,
mechanical ventilation and fluid balance was an independent factor associated with increased mortality.
Conclusion: It could be concluded that negative fluid balance for 4 days in critically ill patients was associated with
less length of stay in the general ICU, and less mechanical ventilation duration, while positive fluid balance, leads to
higher mechanical ventilation duration, vasopressors requirements, and significantly associated with higher mortality.
Keywords: Fluid balance, ICU, ICU Mortality


INTRODUCTION

acute renal failure (4), acute lung injury(6), aneurysmal
Appropriate fluid management in critically sick
subarachnoid hemorrhage (ASH)(7), and surgical
patients is one of the most difficult parts of treatment
patients(8).
for the ICU patient care team (1).
Also, Payen et al. found that the mean ICU fluid
Fluid resuscitation is vital for maintaining
balance, was an independent factor correlated with a
hemodynamic
stability
and
enhancing
tissue
high risk of ICU mortality (4). An essential part of the
oxygenation; nevertheless, in critically sick patients,
process of care of critically ill patients is the fluid
there is a link between fluid excess and poor outcomes.
balance monitoring; balancing of the intake and output
Multiple studies have found that a positive cumulative
of fluid permit metabolic processes to function
fluid balance (FB) is a powerful predictive factor for
correctly, fluid balance plays an important role in
death in sepsis (2).
managing critically ill patients, accurate balancing of
Further fluid administration, once adequate
fluid balance activities is a vital part of patients baseline
fluid resuscitation has been achieved, may increase
information, which directs medical and nursing
intravascular pressure and vascular permeability,
interventions to achieve physiological stability (9).
resulting in fluid leakage, tissue edoema, decreased
For patients admitted to intensive care units,
oxygenation index, higher incidence of acute kidney
fluid balance should be carefully monitored and
injury (AKI), and increased mortality, as found in many
recorded (ICUS). Fluid balance is one of the crucial
studies (3).
metrics noted in the patient's daily observation sheet,
Fluid accumulation consequences was tudied in
along with nursing interventions, vital signs, and
many researches especially in critically ill patients such
medical procedures. The fluid balance is the difference
as hypertension, tissue and peripheral edema,
between the intake and output quantities (10).
respiratory failure and increased cardiac demand (4).
Conservative fluid administration and diuretics
One day of negative balance is a predictor of
were widely targeted to achieve earlier and more
survival in patients with septic shock, while positive
negative fluid balance once the hemodynamic status
mean daily fluid balance was a significant predictor of
was stable, this is the current evidence proven(11).
mortality in ICU, at the same time, a more positive fluid
Our study targeted to assess whether positive
balance (in both resuscitation and cumulatively over 4
fluid balance in comparison with negative or even fluid
days) is associated with increased risk of mortality (5),
balance is associated with increased morbidity and
same results were also reported in other populations like
mortality rates in critically ill patients.




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924
Received: 22/09/2021
Accepted: 20/11/2021

Full Paper (vol.861 paper# 151)


c:\work\Jor\vol861_152 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 933-942
Association Between Type 2 Diabetes Mellitus and TCF7L2 And
FTO Gene Variants Among Upper Egyptian Population
M. Hossam Maghraby1, Refat Fathy1, Sara A. Atta2, Mohammed Hassan Mostafa1,
Ghada Abdelrahman1, Heba M. Abdelraouf1, Taghreed A. Ismael3, Ayat A. Sayed2
1Internal Medicine Department, 2 Biochemistry Department, 3 Public Health and Community Medicine Department,
Faculty of Medicine, Assiut University, Assiut, Egypt
*Corresponding author: Sara Abdel-Reheem Atta, Mobile: 01005737159, E-Mail: Saraatta@aun.edu.eg

ABSTRACT
Background:
Type 2 diabetes mellitus (T2DM) is a metabolic disorder caused by a complex interaction of genetic and
environmental variables. T2DM is associated with transcription factor 7-like 2 (TCF7L2) and fat mass and obesity-
associated (FTO) genetic polymorphism.
Objectives: The goal of this study was to examine the common genetic risk factors of T2DM and related metabolic traits
in Upper Egyptian population, in attempt to understand the genetic structure of T2DM in the Egyptian community.
Methods and Materials: This case control study included 250 participants, 124 T2DM patients and 126 non-diabetics.
Using mutagenically separated polymerase chain reaction (MS-PCR), genotyping of single nucleotide polymorphisms
(SNP) rs7903146 of TCF7L2 and rs17817449 of FTO genes was carried out.
Results:
T allele of TCF7L2 variant rs7903146 confers a risk for T2DM (allelic OR=1.97, 95% CI: (1.34 to 2.88) p
=<0.001). The minor G allele of FTO rs17817449 polymorphism was significantly higher in diabetics than controls (allelic
OR=1.87, 95% CI=1.30 to 2.68, p<0.001). Genotype risk was evident under both recessive and dominant modes of
inheritance (OR=3.18, CI (1.35-7.45), P =0.008, OR= 2.04, CI (1.23-3.38), p=0.006) for TCF7L2 and (OR= 2.55, CI (1.28
-5.09), p=0.008 and OR= 2.14, CI (1.25-3.63), p= 0.005) for FTO respectively
Conclusion:
TCF7L2 rs7903146 and FTO rs17817449 variant conferred risk for T2DM in Upper Egyptian population. The
study noted the interaction between certain biological and environmental risk factors including BMI, age, and sex and the
conferred genetic risk.
Keywords: FTO gene, Obesity, T2DM, TF7L2 gene.

INTRODUCTION
genes (e.g., IRX3 and IRX5) that can lead the cell to store
Diabetes is a class of metabolic diseases
or burn energy (7). Polymorphisms in the FTO gene have
characterized by hyperglycemia believed to be associated
now been caused by obesity in numerous studies, and
with insulin secretion, insulin action, or both. T2DM
obesity is a major risk factor for type 2 diabetes (T2DM)
persistent hyperglycemia has been related to long-term
(8).
organ damage and failure (1). Type 2 diabetes is a common
The present study aimed to demonstrate whether T,
type of diabetes, accounting for over 90% of cases and
and C alleles of TCF7L2 SNP rs7903146, and FTO SNP
affecting 10­20% of individuals over 50 years of age in
rs17817449 T/G are risk variants for T2DM in population
many developed countries (2).
of Upper Egypt and the impact of these SNPs on the
TCF7L2 is a transcription factor with an
glycemic control, HBA1c, fasting blood glucose, insulin
evolutionarily conserved sequence that is a crucial
level and lipid profile.
element of the Wnt signaling cascade (3). It regulates the

expression of genes involved with lipid and glucose
SUBJECTS AND METHODS
metabolism, acting as a main transcription factor of the
a.
Subjects:
adipocyte metabolic pathway (4). The rs7903146 mutation
This is a case control study that included a total of
of the TCF7L2 gene is considerably associated with the
250 subjects, 124 cases and 126 controls. They were
risk of T2DM, with such a pooled odds ratio of 1.46.
recruited from patients attending Assiut University
TCF7L2 does have an influence on T2D, even though the
Hospital.
methods by which it does so are currently unclear (5).
Medical history was taken, and physical
Obesity is aided by fat-mass and obesity-associated
examination was carried out by specialized physicians.
gene (FTO) proteins, that also enhance energy intake,
Demographic,
anthropometric
and
physical
gluconeogenesis, adipogenesis, and mitochondrial
characteristics were collected including age, sex, family
oxidative phosphorylation (6). FTO controls energy
history, body weight, height, and BMI, systolic and
storage and expenditures by turning on and off different
diastolic blood pressure. For diabetics, duration of




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933
Received: 22/09/2021
Accepted: 20/11/2021

Full Paper (vol.861 paper# 152)


c:\work\Jor\vol861_153 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 943-951

Acute Oral Toxicity of two Products from a Microbial Pest Control Agent
(Beauveria bassiana) on Physiological Status Aspects of Male Albino Rats
Ahmed A. Gh. Farag1*; Sahar S. Ali2; Ibrahim, A. A. 2; El- Saadany H. M.2
1Plant Protection Department, Agriculture Faculty, Zagazig University, Egypt
2Bio-Insecticide Production Unit, Plant Protection Research Institute, Agricultural Research Center, Giza, Egypt
*Corresponding author: Ahmed A. Gh. Farag, E-Mail: elfarag_4@zu.edu.eg
Mobile: 00201113955677

ABSTRACT
Background
: Synthetic pesticides have accumulated in environment causing harm to humans and ecosystems. As a
result, the use of biopesticides in agriculture and public health has expanded as a substitute for traditional pesticides.
Purpose: To investigate the acute oral toxicity of Beauveria bassiana, on physiological status aspects of male rats.
Material and Methods: Metabolic crude (MC), and wettable powder formulation (2.5% WP) from the local isolate of
B. bassiana (AUMC 9896) were tested on adult Sprague Dawley (SD) male rats by single oral dose. Results: There
was no evidence of death or toxic symptoms in any of the treated groups. In contrast, each product caused a significant
increase in the body weight gain and relative liver weights of B. bassiana-exposed male and reduced the brain somatic
index with WP only as compared to the control. The studied bioinsecticide also caused a substantial rise in total
erythrocyte and absolute differential leucocyte counts, while red blood cell distribution width (RDW) and platelet count
(Plt) were decreased significantly. Furthermore, male rats exposed to both types of B. bassiana, aspartate
aminotransferases (AST), total protein (TP), albumin (Alb), AST/ALT, triglyceride, and very low-density lipoprotein
cholesterol (VLDL) were elevated compared to the untreated group, whereas alkaline phosphatase (ALP) activity,
globulin (Glb), Alb/Glb, urea content, and low-density lipoprotein cholesterol (LDL) count fluctuated between increased
and decreased. Also, B. bassiana-treated rats had lower serum cholesterol and high-density lipoprotein cholesterol levels
(HDL) values.
Conclusion:
These results suggest that both treatments have slight effects on complete blood count (CBC) of treated
male rats and marked effect on liver function, lipid profile, body weight gain and somatic index of the liver and brain.
Keywords:
Acute oral toxicity, Bioinsecticide, Beauveria bassiana, Hematotoxicity, Hepato- and renal toxicity, Lipid
profile, Male rats.

INTRODUCTION


Alternative pest management strategies that are
fungus due to its global distribution and wide range of
less damaging and safe to non-targeted pests, plants,
target pests. It was discovered more than 60 years ago
animals, and humans are being used to protect
that it may induce diseases in insects. Beauveria has
agricultural products due to the environmental and
become the most studied alternative control agent since
human dangers connected with the widespread use of
then, and its conidia are now the basis for several
synthetic pesticides [1].
commercial insecticides on the market [7].
Biological management with entomopathogenic
Although several mycoinsecticides, as EPF,
organisms (EPO) such as bacteria, viruses, nematodes,
have previously been developed for commercial use in
fungi, and protistes agents are most of these techniques
microbial control of insect pests and are marketed in a
[2]. For more than 150 years, many species (EPO) have
few countries, not all their bio-safety processes and risk
been used as biological control agents of insect pests [3]
assessments for mammals and humans have been
in row and glasshouse crops, orchards, ornamentals,
evaluated [8]. As a result, registration of bioproducts
range, turf and lawn, stored products, and forestry, as
based on microorganisms, particularly B. bassiana,
well as for the control of pest and vector insects of
pays special attention to the following aspects: 1-
veterinary and medical importance [4].
Allergic characteristics, 2- Toxic metabolite risks, 3-
More than 1000 species of entomopathogenic
Genetic recombination and natural strain displacement,
fungi (EPF) from 85 genera have been found to infect
and 4- Impact on biodiversity [4].
pests in agricultural, veterinary, and medical pests [5]. In
Furthermore, acute toxicity studies in an animal
the Hyphomycetes class, about 100 mycoinsecticides
model (oral, dermal, and inhalation) are one of a set of
are commercially registered worldwide and among
biosafety protocols that must be designed to provide
them,
Beauveria
bassiana
(Balsamo-Crivelli)
information on health hazards while considering the
Vuillemin, a cosmopolitan anamorphic genus of
periods in which workers are in direct or indirect contact
soilborne necrotrophic entomopathogenic fungi, is one
with the microbial agent when used for pest control. As
of the most useful fungi, based­mycopesticides [6].
a result, the goal of this investigation is to determine the
Beauveria is the most well-known entomopathogenic
oral LD50 of Beauveria bassiana culture (AUMC 9896)




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943
Received: 22/09/2021
Accepted: 20/11/2021

Full Paper (vol.861 paper# 153)


c:\work\Jor\vol861_154 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 952-957

The Effect of Laparoscopic Sleeve Gastrectomy on Erectile and
Sexual Function in Obese Adult Men
Mohamed Hasan Mohamed Elkaseer
General Surgery Department, Al-Azhar University, Cairo, Egypt
Email: dr.Elkaseer@gmail.com, Mob.: 01002066157
ABSTRACT
Background:
Obesity is often associated with multiple negative health-related comorbidities. There is an increased risk
of sexual dysfunction in the obese population. Although multiple studies reported significant improvement of these
complaints after different bariatric surgeries, there are few studies evaluating the role of laparoscopic sleeve gastrectomy
(LSG) on this specific outcome. Objective: This study was conducted to evaluate the effect of LSG on sexual function
in male patients with morbid obesity. Patients and methods: This prospective study included 114 morbid obese patients
with erectile dysfunction (ED). All patients underwent the conventional LSG. Sexual function was evaluated using the
International Index of Erectile Function (IIEF) score before surgery, then after six and 12 months after surgery. The
severity of ED was evaluated according to the erectile function component of the same previous score.
Results: The one-year % of excess weight loss (EWL) had a mean value of 61.18%. At the same visit, there was a
significant improvement in the total IIEF score from 49.04 to 67.88, erectile function from 18.25 to 25.94, orgasm
function from 6.99 to 9.41, sexual desire from 7.06 to 9.35, intercourse satisfaction from 9.25 to 13.56, and overall
satisfaction from 7.49 to 9.61. A significant positive association was noted between the % EWL and the total IIEF score
and its components. Conclusion: LSG led to significant improvement of sexual and erectile dysfunction in obese male
patients. Weight loss led to a significant decline in the prevalence of ED, and if the problem did not resolve, its severity
would be markedly decreased.
Keywords: Sleeve gastrectomy; Erectile dysfunction; Sexual function.

INTRODUCTION
Although many studies have evaluated the effect of

Sexual dysfunction in males entails a wide
different bariatric procedures on male sexual and erectile
spectrum of problems, including erectile dysfunction
function (16, 17), there is a clear paucity of studies handling
(ED), orgasm problems, a decrease in sexual desire, and
the effect of lsg on such outcomes. the purpose of this
ejaculatory dysfunction. The incidence of this problem is
study was to see how lsg affected the sexual function in
linked to multiple medical diseases, including diabetes,
obese male patients (including the prevalence and
hypertension, metabolic syndrome, atherosclerosis, and
severity of ed).
obesity (1-3).
Obesity has been a major public health

concern all over the world because of its increasing
PATIENTS AND METHODS
prevalence and its associated comorbidities that have a

The current prospective interventional study was
negative impact on an individual's quality of life (4, 5). In
performed at the General Surgery Department, Al-Azhar
Egypt, 39.8% of the adult Egyptian population suffers
University Hospitals. The study was conducted during
from obesity, according to the "100 million health"
the period between July 2018 and August 2021 (three-
survey conducted in 2019 (6). Obese males are more
year duration). We calculated the sample size via
likely to experience sexual problems (7). Normal sexual
G*Power version 3.1.9.6 for windows (2020) using data
function is influenced by a number of elements,
published by Mora et al. (18) with IIEF total score change
including vascular, neurological, hormonal, and
after a one-year follow-up period as the primary
psychological aspects. All of which can be negatively
outcome. The absence of difference in the IIEF total
affected by obesity (8). Furthermore, being overweight or
score before and after LSG was considered as the null
obese increases the risk of ED by 30­90% when
hypothesis. According to Mora et al. (18), IIEF's total
compared to people of normal weight. Subjects with ED,
score had a mean value of 54.85 ± 16.59 before the
on the other hand, are more likely to have a larger waist
procedure and 61.21 ± 14.10 at one-year follow-up. In
circumference, higher blood pressure, and elevated
the proposed investigation, a sample size of 95 patients
cholesterol level than those without ED (9).
was required to obtain a 90% power using a two-sided,

Bariatric procedures have been widely used for
paired-samples t-test with a 5% significance level. With
durable management of obesity and its associated
a 20% drop expected drop rate, a total of 114 patients
comorbidities like diabetes mellitus, obstructive sleep
were enrolled in the current study. We included married
apnea, insulin resistance, and hypertension (10-12). One of
adult patients diagnosed with morbid obesity (body mass
the most popular bariatric operations in Egypt is
index BMI > 40 kg/m2) and diagnosed with ED.
laparoscopic sleeve gastrectomy (LSG) (13), which
Contrarily, patients with obesity-related comorbidities,
proved its efficacy in achieving durable weight loss and
age less than 18 years, psychiatric problems,
improving comorbidities associated with obesity (14, 15).
hypogonadism, or known sexual hormone imbalance




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952
Received: 22/09/2021

Accepted: 20/11/2021

Full Paper (vol.861 paper# 154)


c:\work\Jor\vol861_155 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 958-962

Concomitant versus Delayed Cholecystectomy in Morbidly Obese Patients with
Asymptomatic Gall Stones Undergoing Laparoscopic Sleeve Gastrectomy
Mohamed Hasan Mohamed Elkaseer
General Surgery Department, Al-Azhar University, Cairo
Email: dr.Elkaseer@gmail.com, Mob.: 01002066157

ABSTRACT
Background:
Performing cholecystectomy concomitant to laparoscopic sleeve gastrectomy (LSG) in morbidly obese
patients with asymptomatic cholelithiasis is poorly discussed.
Objectives: We conducted the current investigation to compare concomitant to late cholecystectomy in asymptomatic gall
stone patients undergoing LSG.
Patients and methods: One hundred morbid obese patients scheduled for LSG were included in this retrospective analysis.
They were divided into two groups: Group 1 included patients who underwent concomitant cholecystectomy, and group 2
that included patients who omitted such a procedure. Delayed cholecystectomy was scheduled if the patient developed
symptoms related to gall bladder disease. The incidence of post-operative complications and percentage of developing
symptomatic cholelithiasis in group 2 were our outcomes. Results: All preoperative data were statistically comparable
between the two groups. However, operative time and intraoperative blood loss were significantly increased in group 1. The
incidence of total early post-operative complications also increased in the same group (14% vs 0% in the other group). In
Group 1, we encountered two patients with intraperitoneal bleeding (4%) who required laparoscopic management, in
addition to the other two cases with biliary leakage (4%). In group 2, 18% of patients expressed symptomatic gall stone
disease before the scheduled operation, while two cases (4%) developed acute complications that required early
cholecystectomy. Conclusion: Cholecystectomy is associated with an increased incidence of early post-operative
complications when performed in association with LSG. However, about 25% of asymptomatic cases who omitted the
concomitant procedure will develop symptoms before the scheduled cholecystectomy.
Keywords: Cholecystectomy timing; Asymptomatic cholelithiasis; Sleeve gastrectomy.

INTRODUCTION
pathology. This was based on the concept of increased

Bariatric surgery has proved to be an effective
risk of developing cholelithiasis after the procedure, with
plan in achieving durable and sufficient weight loss
difficult endoscopic access to the biliary tree. Also, the
compared to other obesity management plans (1, 2).
large midline incision used allowed easy access to the gall
Laparoscopic sleeve gastrectomy, which is a restrictive
bladder (11, 12, 15). However, this approach became less
bariatric procedure, has become popular over the past two
popular with the introduction of laparoscopy, as access to
decades in managing such a condition for both patients
cholecystectomy during the primary bariatric procedure
and bariatric surgeons. It nearly represents about 50% of
was difficult and associated with an increased risk of
bariatric procedures performed around the globe (3). It can
biliary complications (11, 12).
achieve satisfactory weight loss along with improvement

It is agreed that asymptomatic gall stone disease
or resolution of associated comorbidities (4, 5).
Morbid
is an indication for cholecystectomy, either in the setting
obesity is a documented risk factor for cholelithiasis (6).
of bariatric surgery or not (16). Nevertheless, there is a
Although the incidence of gall stone disease ranges
great debate regarding performing cholecystectomy in
between 10% and 20% in the general population (7). This
bariatric surgery patients with asymptomatic gall stones
risk increases by about three to five times in association
(17). Most literature studies handle the previous debate in
with obesity when compared to non-obese individuals (8,
patients undergoing laparoscopic RYGB (16, 18), and there
9). Although bariatric surgery is a successful way of
is a clear paucity of trials handling the issue of
improving obesity-related comorbidities (1), the risk of
asymptomatic gall stone disease in patients undergoing
gall stone disease significantly increases following rapid
LSG. That is why we conducted the current investigation
weight loss (28 ­ 71%) (10, 11). In addition, about 3% to
to compare concomitant to late cholecystectomy in
28% of bariatric surgery patients require cholecystectomy
asymptomatic gall stone patients undergoing LSG.
for symptomatic gall stones following the bariatric

procedure (12-14).
In the era of open roux en Y
PATIENTS AND METHODS
gastric bypass (RYGB), routine cholecystectomy was

The study was designed for adult morbid obese
performed regardless of the presence of gall bladder
patients scheduled for LSG and having asymptomatic




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958
Received: 22/09/2021
Accepted: 20/11/2021

Full Paper (vol.861 paper# 155)


c:\work\Jor\vol861_156 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 963-967

Association of Helicobacter pylori Infection and Severity of Coronary Artery
Atherosclerosis in Patients with Suspected Coronary Artery Disease
Hamdy Abdel Azeem1, Mohamed S. Zaghlol2, Mohamed M. Elawady 3 and Majid Darraj 4
1 Cardiology Department, Faculty of Medicine, 3 Hepatogastroentrology and
Infectious Diseases Department, Al-Azhar University, Cairo, Egypt
2 Clinical Pathology Department, Faculty of Medicine, Al-Azhar University, Assuit, Egypt,
4 Internal Medicine Department, Faculty of Medicine, Jazan University, KSA
Corresponding author: Mohamed Zaghlol,
E mail: Zaghlol_msz@yahoo.com, Mobile phone: 01006560985

ABSTRACT
Background:
There is a strong correlation between Helicobacter pylori (HP) infection and coronary artery disease
(CAD). There is also a strong correlation between HP infection and the severity of coronary artery atherosclerosis in
patients with CAD. Our study determined the association of HP infection and severity of coronary artery atherosclerosis
in patients with suspected CAD. Methods: A prospective study of 100 individuals who had coronary angiography for
coronary atherosclerosis was conducted. Body mass index (BMI), blood pressure, blood cholesterol, blood glucose,
leukocyte count, hemoglobin, and urea breath test were all done on the patients. Coronary angiograms were graded
based on vascular and angiographic severity scores. Results: Triglyceride, (TG), Low Density Lipoprotein (LDL), C-
Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), vessel score, and angiographic severity score all
showed high correlations with Gensini score. There was a substantial association between vessel score and TG, LDL
and angiographic severity score. It was found that angiographic severity score has a substantial positive link to a person's
BMI; LDL; CRP; ESR, and vessel score. Conclusion: Although HP infection has been linked to an increased risk of
coronary artery disease (CAD), established risk variables outweigh their potential impact.
Key words:
Atherosclerosis, Coronary artery disease, Helicobacter pylori, Inflammation.

INTRODUCTION

This study, which focused on patients with known or
As the most frequent infection in the world,
suspected heart disease, to find a relationship between
Helicobacter pylori (HP) contribute to the development
HP infection and coronary atherosclerosis.
of digestive system diseases, particularly in poor nations

(1). H. Pylori has long been suspected of causing a wide
PATIENTS AND METHODS
spectrum of illnesses that are not related to
This was a prospective cross-sectional study
gastrointestinal issues. Gastritis, peptic ulcers, gastric
done in Alemeis Hospital and Alhayat National
MALTOMA (mucosa associated lymphoid tissue
Hospital, Jazan, KSA and was conducted on 100
lymphoma), and adenocarcinomas of the stomach in the
patients suffering from coronary atherosclerosis as
esophagus are among the many conditions linked to H.
confirmed by coronary angiography.
pylori (2). The illness has also been linked to
We excluded those with spastic angina pectoris,
thrombocytopenia and iron deficient anemia (3).
infectious diseases within two weeks of the
Angina, myocardial infarction, and heart failure are all
catheterization, heart failure (Killip Class = 2) after an
symptoms of coronary artery disease (4). Cardiovascular
acute myocardial infarction, hepatic dysfunction,
disease (CVD) is exacerbated by hyperlipidemia,
cardiovascular diseases, familial hypercholesterolemia,
smoking, diabetes, inactivity, and the male gender (5).
thyroid dysfunction, adrenal dysfunction, or mental
The proinflammatory cytokines (IL-8, IL-7, IL-15, IL-
illness that would have precluded informed consent
18), acute phase proteins, fibrinogen and C-reactive
from participating in this research.
protein all have a role in cardiovascular disease (6).
All patients' demographic information, including
Thrombosis and inflammation are both thought to be
their age, gender, history of chronic illnesses (such as
factors to atherosclerosis, although the fundamental
hypertension, diabetes, heart failure, stroke, and chronic
source of inflammation remains a mystery (7).
kidney disease), and their use of tobacco products or
Several studies have linked H. pylori, the bacteria that
other substances of abuse, was collected.
cause stomach ulcers, to CAD. There was an increased
An examination gown was put on the patients
risk of H. pylori infection in people with
after they removed their shoes and shirts for the
angiographically-diagnosed heart disease (CAD) (8). H.
procedure. A wall-mounted stadiometer allowed us to
pylori antibody seropositivity was shown to be more
measure height to the tenth of a centimeter. Weighing
prevalent in those with coronary artery calcification
was done using a hospital balance beam scale to within
than those without CAD, according to researchers (9).
0.1 kg of the actual weight. The person's weight in




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963
Received: 22/09/2021
Accepted: 20/11/2021

Full Paper (vol.861 paper# 156)


c:\work\Jor\vol861_157 The Egyptian Journal of Hospital Medicine (January 2022) Vol. 86, Page 968-972

Evaluation of The Diagnostic Value of Brain Natriuretic Peptide for Detection of
Left Ventricular Systolic Dysfunction and Pulmonary Hypertension in Patients with
Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Hamdy Abdel Azeem1, Mohamed S. Zaghlol 2,4, Ahmed Lotfi 3
1 Cardiology Department, 3 Department of Chest Diseases, Faculty of Medicine, Al- Azhar University, Cairo, Egypt
2 Clinical Pathology Department, Faculty of Medicine, Al- Azhar Uneversity, Assuit, Egypt, 4 Internal Medicine
Department, Faculty of Medicine,Jazan University, KSA
@Corresponding author: Mohamed Zaghlol
E mail: Zaghlol_msz@yahoo.com, Mobile phone: 01006560985


ABSTRACT
Background:
One of the most critical health concerns of our day is acute deterioration of chronic obstructive lung
disease (COPD). Detecting concurrent heart illness in these individuals might be challenging.
Objective: Aims of this study were determining the diagnostic value of B-type natriuretic peptide (BNP) levels in the
identification of acute COPD exacerbations (AECOPD) that were linked with left ventricular (LV) dysfunction and
pulmonary hypertension. Methods: a prospective study of 100 patients with acute COPD exacerbations was done. All
research participants were subjected to history taking, clinical examination, laboratory testing, blood gas analysis,
echocardiography, and NT-pro BNP plasma level estimation.
Results:
Receiver operating characteristic (ROC) curve for BNP as a diagnostic for LV systolic dysfunction showed
that area under the curve (AUC) was 0.923 at cut off point of 72.1 ng/ml with sensitivity of 93.3% and specificity of
84.6% (P<0.001).
Conclusion:
Heart failure is confirmed when the average natriuretic (NT)-BNP level in the left ventricle during
AECOPD is higher than normal, which should prompt quick treatment for both conditions.
Key words: Acute exacerbation of COPD, Brain natriuretic peptide, Cardiac dysfunction, Pulmonary hypertension

INTRODUCTION


Despite recent advances, COPD continues to be a
Despite their broad use in the identification of
major public health problem. It has significant
cardiac disease, acute COPD exacerbation biomarkers
extrapulmonary effects and may aggravate the sickness
have received little attention. Previously, biomarkers for
in certain patients (1).
respiratory sickness were investigated utilising the B-
A COPD flare-up is defined as "a change in the
type natriuretic peptide (BNP) as a biomarker (9). Apart
patient's baseline dyspnea, cough, and/or sputum that
from sodium regulation, vasodilation, renin­
exceeds normal daily changes, is abrupt in start, and
angiotensin­aldosterone suppression, and protection
may justify a change in routine therapy in a patient with
against unfavorable ventricular remodeling, B-type
underlying COPD" (2). Exacerbations are most
natriuretic peptide has an effect on cardiorenal
frequently caused by infection of the tracheobronchial
homeostasis (10).
tree and air pollution, while roughly one-third of severe
The current study's objective is to determine BNP
exacerbations are unknown (3).
levels in individuals with acute COPD exacerbations
Detecting left ventricular heart failure caused by
associated with reduced LV function and elevated
a systolic left ventricular systolic dysfunction (LVSD)
pulmonary hypertension.
or diastolic (LVDD) etiology during an acute COPD

exacerbation is particularly difficult due to the clinical
PATIENTS AND METHODS
presentation overlap (4). Misdiagnosis of left ventricular
This was a prospective observational study done in
heart failure during a COPD exacerbation might result
Alemeis Hospital and Alhayat National Hospital, Jazan,
in a bad prognosis and perhaps death (5).
KSA and was conducted on 100 patients suffering from
Pulmonary arterial hypertension (PAH) is related
acute exacerbation of COPD.
with the development of severe hypoxemia late in the
Written
informed
permission,
an
acute
natural history of COPD patients (6). COPD causes right
exacerbation of pre-existing COPD, a minimum age of
ventricular hypertrophy (referred to as the "cor
18 years, and the capacity to undergo echocardiography
pulmonale"), with a dismal prognosis (7).
were all included as inclusion criteria. Abrupt right
Echocardiography can be used to diagnose PAH
ventricular overload confirmed by echocardiography,
and LVSD. Due to the fact that chest hyperinflation
pulmonary embolism, severe pneumonia, renal failure,
alters the propagation of sound waves in the chest,
acute coronary event, mitral and aortic stenosis, and
measurements cannot be taken in all scenarios (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/)

968
Received: 23/9/2021

Accepted: 21/11/2021

Full Paper (vol.861 paper# 157)