c:\work\Jor\vol881_1
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2280-2287
Knowledge and Preventive Behavior Regarding COVID-19 among
School-children in Saudi Arabia: A Regional Survey
Aisha Almutairi
Department of Pediatrics, College of Medicine, Qassim University, Buraidah, Saudi Arabia
Mobile :966503142618, Email: mtieryat@qu.edu.sa
ABSTRACT
Introduction: COVID-19 is the fastest spreading viral infection because it is highly contagious in nature and
asymptomatic carriers, therefore individuals of all age groups are at risk. Most of the children who got infected have
mild symptoms or are asymptomatic but still can spread the infection to others.
Aim: This study aimed to assess the knowledge and adoption of preventive behavioral practices regarding COVID
19 among school children in Saudi Arabia.
Subjects and methods: This is a cross-sectional study conducted among 336 school children (66.7% girls vs 33.3%
boys) aging 7-12 years old in the Qassim region, Saudi Arabia. A self-administered questionnaire was distributed
to the targeted students of primary schools. The questionnaire includes basic demographic data, knowledge of the
potential sources of transmission and risk factors for infection, and preventive behavioral practices toward COVID-
19. Results: The knowledge of the students regarding the potential sources of transmission and risk factors for
infection were average, high, and low among 59.2%, 29.5%, and 11.3%, respectively. The level of preventive
behavioral practices was high, average, and low among 48.5%, 38.4%, and 13.1%, respectively. The factor
associated with increased knowledge was being aged 9 10 years old while the factor associated with increased
preventive behavioral practices was being a female student.
Conclusion: Most of the school children were knowledgeable about the mode of transmission and risk factors of
COVID-19 infection. They are even more aware of the preventive behavior necessary to control the spread of the
disease. Continuous awareness about COVID-19 prevention is necessary to control the transmission of infection.
Keywords: COVID-19, school children, knowledge, preventive behavior, transmission.
INTRODUCTION
Respiratory epidemics and pandemics are
SUBJECTS AND METHODS
alarming due to their rapid spread through interpersonal
This is a quantitative cross-sectional research
contact and droplets. COVID-19 is the fastest spreading
using a standardized survey questionnaire which was
viral infection because it is highly contagious in nature
collected from previous studies with some minor
and asymptomatic carriers, therefore individuals of all
changes and a few additional questions. It was
age groups are at risk. Most of the children who got
validated among 20 school children which will not
infected have mild symptoms or are asymptomatic but
be included in the analysis. The questionnaire
still can spread the infection to others [1]. Few studies
consisted of three sections. The first section
have discovered comparative transmissibility of SARS-
contained demographic data, the second one was
CoV-2 from asymptomatic patients [2-3].
about knowledge while the third section included
These qualities could prompt a higher likelihood
questions about preventive behavior regarding
of school related transmission as students without
COVID-19.
manifestations could keep on attending school and
This study was conducted among 7-12 years old
spread the virus to others during lessons or other
boys and girls of primary school students in the
activities. Moreover, the infected students can in this
Qassim region. The sample size was calculated using
manner transmit the infection to others in their family
the formula: n = z²p(1-p) \d² with 95% confidence
and community. Likewise, a few studies have
level and 5% margin of error.
discovered comparative transmissibility of SARS-CoV-
Where n= sample size, z= 1.96 p= 0.5, d= 0.04
2 from asymptomatic patients [4-5].
These qualities could prompt a higher
Ethical considerations
likelihood of school-related transmission as children
Data of all students studying in various
without manifestations could keep on attending school,
primary schools were collected after seeking
spread the virus to others during school activities.
permission from the school principal. These
Moreover, the infected children can in this manner
participants were contacted and written
transmit the infection to others in their family and
informed consents were obtained from the
community. That is why assessing the information and
parents after a brief introduction of the study and
practice of preventive behaviors on COVID 19 among
ethical approval was taken from the ethical
children in the schools is very important. The outcomes
committee of Qassim University (QUCOM )
of the present study will provide substantial insight
before proceeding to the study.
about the readiness of primary school students to deal
with COVID-19.
2280
Received: 5/3/2022
Accepted: 1/4/2022
c:\work\Jor\vol881_2
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2288-2292
Association between Serum Zinc level and Febrile Seizures
Abdullatif Mohammed Amneenah 1 and Hamad Ali Hamad Alqatani*
1 Associate Professor of Pediatrics, Derna University, Consultant Pediatrician,
*Head of Pediatrics Department- Al Wahda Hospital (Derna), Libya
Corresponding author: Abdullatif Mohammed Amneenah, E mail: aemnaina@gmail.com, Mobile phone: 0021891385153
ABSTRACT
Background: The febrile seizure is the commonest form of seizure in children. Several hypotheses propose that
neurotransmitters and trace elements have a role in the beginning of a febrile seizure. Inhibitory pathways in the central
nervous system (CNS) can be affected by zinc, an essential component of many enzymes.
Aim and objectives: This study aimed to determine the relation between serum zinc level and febrile seizures.
Subjects and methods: This prospective case control study was carried in Al -Wahda hospital- pediatrics department
in Derna city in the north-eastern part of Libya in the period between March 2019 to March 2020. This study comprised
120 children aged between 2 months and 6 years. They were divided to 3 groups: 40 children with febrile seizures, 40
children with fever and no seizures, and 40 healthy children.
Results: Zinc levels varied significantly amongst the three groups investigated. The differences between the groups
with and without febrile seizures, as well as between febrile seizure groups and the controls, are also notable. The
seizure-free group and the controls, on the other hand, showed no considerable differences.
Conclusion: According to the current findings, serum levels of zinc were lower in children with febrile seizures.
Seizures in febrile children may be facilitated by zinc deficiency.
Keywords: Seizures, Febrile, Zinc, Central nervous system, Children.
INTRODUCTION
Febrile convulsions afflict 2-5% of children aged 6
history of chronic diseases or malnutrition, electrolytes
months to 60 months (1), as well as 2 months to 6 years
imbalance and acute and chronic diarrhea.
old, according to the International League against
Epilepsy (ILAE). There must be no central nervous
Ethical approval:
system infection or metabolic condition in order for
The study was approved by the Ethics Board of
febrile seizures to occur, according to the American
University of Derna and an informed written
Academy of Pediatrics (AAP) (1).
consent was taken from every participant in the
A fair prognosis exists for febrile seizures (2).
study. This work has been carried out in accordance
Fever-induced seizures have yet to be explained. Some
with The Code of Ethics of the World Medical
elements are hypothesized to have a considerable role in
Association (Declaration of Helsinki) for studies
febrile seizures because of their coenzyme activity and
involving humans.
influence on ion channels and receptors.
Deficiencies of iron, zinc and magnesium may lead
Statistical Analysis
to fetal convulsions (1). Zinc involvement in the nervous
SPSS 22.0 for Windows was used to assemble and
system has been studied. The studies indicated that zinc
analyse the data (SPSS Inc., Chicago, IL, USA). Data
deficiency may have a function in pathophysiology of
were subjected to the Shapiro Walk test in order to see
febrile seizures.
if they were distributed normally. Qualitative data was
This work aimed to determine the relationship
represented using frequencies and percentages. The
between serum level of zinc and febrile seizures.
qualitative variables were compared using Fisher exact
and chi square tests, as described. The variation between
SUBJECTS AND METHODS
quantitative variables in two groups was calculated
This study was performed in Al -Wahda hospital-
using the t-test. In order to compare more than two
pediatrics department in Derna city in the north-eastern
dependent groups of normally distributed variables, the
part of Libya in the period between March 2019 to
one-way ANOVA test available with the LSD test was
March 2020
employed. If p-value was 0.05, there is considerable
It's a prospective case-control study that was
variation for all of our comparisons. To be regarded
performed on 120 children aged between 2 months and
nonsignificant, p-Values over 0.05 were used to show
6 years. They were divided into 3 groups 40 children for
that the variation was not statistically significant,
each: Children with febrile seizures (40), children with
whereas values below 0.001 indicated a highly
fever and no seizures (40) , and (40) healthy children.
considerable difference.
Inclusion criteria: Age from 2 months up to 6 years,
simple febrile seizure and normal development.
RESULTS
Exclusion criteria: Age less than 2 months and more
In terms of age or gender, there was no
than 6 years, complex febrile seizure, CNS infection,
discernible variation among the three groups
history of recent zinc intake, developmental delay,
investigated (Table 1).
2288
Received: 8/11/2022
Accepted: 6/1/2022
c:\work\Jor\vol881_3
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2293-2296
The Diagnostic Yield of Capsule Endoscopy in Egyptian Patients with
Obscure Gastrointestinal Tract Bleeding
Soha Saoud Abdelmoneim 1, Shereen A. Saleh2, Mohamed Zakaria Ali Abu Rahma 1,
Ahmed Monis 2, Ehab MiKhael Naieem 1, Reginia Nabil Mikhail Guirguis 2
Department of Tropical Medicine and Gastroenterology, Assiut University 1,
Department of Internal Medicine, Gastroenterology and Hepatology Unit, Ain Shams University2, Cairo 11591, Egypt
Corresponding author: Reginia Nabil Mikhail Guirguis, Mobile: +20 1006511119, Email: reginia87@med.asu.edu.eg,
Reginia87@hotmail.com, ORCID: 0000-0003-3442-3629
ABSTRACT
Background: Obscure gastrointestinal bleeding (OGB) is defined as a gastrointestinal (GI) bleeding of unknown
aetiology that persists despite conventional assessment. OGB accounts for about 5% of all GI bleeding and is a real
issue for doctors.
Objective: The major goal of this study was to see how effective capsule endoscopy (CE) was at diagnosing Egyptian
patients with gastrointestinal (GI) bleeding, whether it was occult or overt.
Patients and methods: This is a prospective observational single center study. 32 patients with OGIB (overt or
occult) were referred for capsule endoscopy during the 30-month period (from June 2017 to December 2019) to the
Endoscopy Unit at Hospital of Ain Shams University. Follow up patients after performing capsule endoscopy was
done, some of them were recommended to do enteroscopy, and the others were referred for either surgery, radiological
intervention or just medical treatment according to the pathology detected by the capsule.
Results: In the current study, capsule endoscopy was able to detect accurate findings in all studied cases (twenty five)
with exception of seven cases (22%) with overall diagnostic accuracy were 78%
Conclusion: Capsule endoscopy is an excellent tool in evaluation of obscure gastrointestinal bleeding (both overt and
occult) with relative safety and high diagnostic yield, which helps guiding therapeutic management.
Keywords: Capsule endoscopy (CE), Obscure gastrointestinal bleeding (OGIB)
INTRODUCTION
Capsule endoscopy procedure:
Obscure gastrointestinal bleeding (OGB) is
Capsule endoscopy was carried out after informed
defined as persistent, recurrent gastrointestinal (GI)
consent if upper endoscopy, ileocolonoscopy and
bleeding of unknown aetiology despite standard
radiological imaging modalities were failed to diagnose
evaluations such as upper endoscopy, colonoscopy, and
the cause of blood loss.
small intestine specific radiological and endoscopic
OMOMTM capsule endoscopy (Chongqing Jinshan
investigations. OGB accounts for about 5% of all GI
Science and Technology Company, Chongqing, China)
bleeding and is a real challenge for clinicians(1). Because
was used for this study. The recording was continued
endoscopists find difficulty in reaching the small bowel,
until 8 hours. When the assembly was turned off and the
it is dubbed "the dark continent of the GI system"(2).
data were downloaded to a computer using conventional
In the evaluation and therapy for OGIB, capsule
software (Rapid Reader) to examine the images.
endoscopy (CE) and device-assisted enteroscopy
Patients were allowed to start drinking colourless
(DAE) have shown their worth and have a substantial
fluids at 2 and 4 hours after ingestion of the capsule and
impact on the result (3).
eating of light meal after 6 hours from capsule ingestion.
In every case, the capsule's excretion in the stool
PATIENTS AND METHODS
was monitored. If the capsule's excretion failed after 7
This is a prospective observational single center
days, the capsule's position was verified by a plain X-
study. Patients with OGIB (overt or occult) were
ray of the abdomen.
referred for capsule endoscopy during the 30-month
period (from June 2017 to December 2019) to the
Interpretation:
Endoscopy Unit at Ain shams (AL Demerdash)
When a bleeding source was discovered within
University Hospital. History taking, examination and
the small bowel, CE findings were classified as positive,
investigations including complete blood count, liver and
and when no source of haemorrhage was detected
kidney functions, serum electrolytes, fecal occult blood
within the small bowel, they were classified as negative.
test and coagulation profile for all cases of obscure GI
A bleeding source is described as a lesion that has
hemorrhage. Abdominal ultrasound and CT abdomen
evident bleeding (current bleeding or blood clot) or a
with contrast was done to every patient.
lesion that does not have obvious bleeding but could be
All participants were instructed to undergo bowel
the source of blood loss.
preparation, which included adherence to a clear fluid
Follow up patients after performing capsule endoscopy
diet and ingestion of poly ethylene glycol mixed with 2
was done, some of them were recommended to do
liters of water for 24 hours prior to the procedure and
enteroscopy, the other were referred for either surgery,
also to avoid food or water for 12 hours before capsule.
2293
Received: 16/1/2022
Accepted: 18/3/2022
ABSTRACT
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2297-2303
Measurement of The Fetal Occiput-Spine Angle during The First Stage of
Labor as A Predictor of The Progress and Outcome of Labor
Mohamed Mahmoud Salman*, Mohamed Ibrahim Mohamed Amer,
Hanan Khalaf Matloob Almatloob, Aliaa Mohammed Maaty
Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Mohamed Mahmoud Salman, Mobile: 01005999419
Email: m7md_salman@yahoo.com
ABSTRACT
Background: Spontaneous vaginal delivery without intervention is the ideal route for most pregnancies. Failure of
progression in some women may need interventions including Caesarian section or instrumental delivery.
Objective: To assess the accuracy of the fetal occiput-spine angle measured through transabdominal ultrasound during
the first stage of labor on the prediction of progress and outcome of labor.
Patients and Methods: The study included (65) cases recruited from the prelabour unit in Ain Shams University
hospital who was in labor. The fetal OSA is measured by abdominal ultrasound during the first stage of labor to assess
its effect on the progress of labor, mode of delivery, and postnatal events.
Results: It was found that there is a significant relationship between occiput-spinal angle with both mode of delivery
and duration of the first and second stage of labor, Cut off was more than (118) degrees. Which had a high negative
predictive value in predicting caesarian section at the present age of 97.7% while less than or equal to (118) degrees had
a positive predictive value for caesarian section and instrumental delivery of 52.6% only, at the same time it was found
that there was a positive correlation between the fetal occiput-spinal angle with advanced gestational age, the angle
increased with advanced gestational age we did not have any obvious explanation for it.
Conclusion: OSA equal to or less than (118) degrees correlates with a significant increase in the rate of cesarean delivery
and prolongation of the active and second stage of labor. There is no correlation between the angle and maternal or fetal
complications.
Keywords: Occiput-spinal angle, Primigravida, First stage of labor, Obstetric ultrasound.
INTRODUCTION
to the Meta-analysis of Observational Studies in
Fetal
malpositions
and
cephalic
Epidemiology guidelines. We systematically searched
malpresentation are found in about 10%of all
PubMed for the following terms: malpositions,
pregnancies and continue to present a challenge for
malpresentation, occiput posterior, deep transverse
obstetricians. They are well-recognized causes of
arrest, deflexed presentation, face, brow, sinciput, and
failure to progress in labor and usually result in
asynclitism as related to intrapartum sonography. The
protracted or arrested descent, an increasingly important
initial yield included 172 articles; 23 of these provided
dilemma of contemporary obstetrics (1). They frequently
details on the methodology and findings of intrapartum
require operative delivery and are associated with an
sonography (3).
increased probability of fetal and maternal
We combined information from these articles
complications (2).
with our own experience collected over a decade of
Thus far, the diagnosis relied entirely on digital
intensive use of ultrasound in labor. The following
examination, which is notoriously subjective and
discussion focuses on the second stage of labor, as this
imprecise (3).
is the most optimal time for the diagnosis of
Difficulties in the prospective identification
malpositions and cephalic malpresentation (4).
contribute to creating uncertainties in the management
Traditionally, the assessment and management
of these conditions. Intrapartum sonography was
of a woman in labor are based upon clinical findings.
recently reported to be an objective and accurate
The diagnosis of the arrest of labor and decisions
diagnostic tool. However, except for persistent posterior
regarding the timing or type of intervention rely mostly
occiput, the subject of many studies, the most available
on digital evaluation of cervical dilatation and fetal head
experience with other abnormalities of cephalic position
station and position. However, clinical examination of
and presentation is based on case reports and small
the head station and position is inaccurate and
series. The sonographic technique and findings are also
subjective, especially when caput succedaneum impairs
demonstrated in a video accompanying the article.
palpation of the sutures and fontanelles. The use of
Furthermore, the approach to diagnosis is variable, as
ultrasound has been proposed to aid in the management
transabdominal, transperineal, and transvaginal
of labor. Several studies have demonstrated that
sonography, or a combination of methods, were used (3).
ultrasound examination is more accurate and
The objective of this review is to summarize the
reproducible than clinical examination in the diagnosis
current body of literature and provide recommendations
of fetal head position and station and the prediction of
to identify malpositions and cephalic malpresentation
the arrest of labor. Ultrasound examination can, to some
with ultrasound. The review was performed according
extent, distinguish those women destined for
2297
Received: 06/12/2021
Accepted: 03/02/2022
Apelin and tumour necrosis Factor alpha in obese frail elderly
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2304-2310
Outcome and Survival of Severe to Critical COVID-19 Patients Admitted at
Zagazig University Hospitals
Mohamed El-Shabrawy Mahmoudy, Waheed M. Shouman,
Abdul Moneam Al-Bahlol Mansor, Dalia Anas Ibrahim
Department of Chest Diseases, Faculty of Medicine, Zagazig University, Egypt
*Corrosponding author: Abdul Moneam Al-Bahlol Ali Mansor, E-mail: abdulmonam1986@gmail.com
ABSTRACT
Background: More than 356 million people have been infected with the new coronavirus (SARS-CoV-2) that causes
COVID-19. Objective: to assess outcomes and survival of COVID-19 patients admitted at Zigzag University Hospitals.
Patients and methods: Retrospective cohort study was conducted at COVID isolation Sednawy Hospital, Zagazig
University during the period from Jan 2021 to Dec 2021 including 900 cases as a comprehensive sample, were selected
as severe to critical COVID patients according to the criteria of Egyptian protocol for management of COVID-19
patients. All patients had real-time polymerase chain reaction (RT-PCR) in respiratory tract materials.
Results: There was significant relation between severity and overall survival, which was significantly higher in those
with severe disease. There was significant relation between comorbidity and overall survival, which was significantly
higher in those without comorbidity and overall survival, death was 40.9% of all cases; 84.9% of critical and 12% of
severe (P 0.001). Survival was highest in 3rd group 72.8%, while lowest in 1st group 42.3% (P 0.001). Remdesivir was
used in 58.4% of critical and 45% in severe cases, while non-used antiviral was in 29% of critical and 27% of severe
cases. CRP, IL6, Albumin/IL6 ratio, neutrophil/lymphocytes ratio were all statistically different between critical and
severe cases, while PCT and CRP were insignificantly different.
Conclusion: Outcome improving over different groups with time, this means improvement in medical care, different
comorbidities, change in the level of acute phase reactant and anti-inflammatory drugs may affect the survival of severe
and critically ill COVID 19 patients.
Keywords: COVID-19, Mortality, Outcome and survival, Severity.
INTRODUCTION
well as the inflammatory marker D-dimer greater than
Multiple organ damage illness COVID-19 is
0.5 mg/mL. Inflammatory responses were thought to be
caused by severe acute respiratory syndrome with the
linked to elevated D-dimer levels, which indicate
lung as its primary target organ; it can lead to severe
coagulation activity. Since higher disease severity and
pulmonary injury and acute respiratory distress
death were found in COVID-19 patients with
syndrome, which may lead to mortality in severe cases
lymphopenia, it was assumed that lymphocytopenia was
(1, 2). One of the most difficult aspects of treating
caused by lymphocyte apoptosis in these severely ill
COVID-19 patients is determining how severe their
Middle East Respiratory Syndrome (MERS) patients.
sickness is (3).
As a result, necrosis or apoptosis of lymphocytes may
The identification of parameters related with
have also contributed to lymphocytopenia in individuals
COVID-19 results is vital in the context of a healthcare
with severe SARS-CoV-2 infection, as previously
system that is already overburdened. When COVID-19
suggested (6).
was first discovered, it was initially linked to a cytokine
When the severity of lymphocytopenia was
storm (4). Since then, cytokines, particularly IL-6, have
severe, it was a potent predictor of mortality in patients
received a lot of interest as possible indicators for
with COVID-19. As a result, the percentage of
disease outcomes. In the past, however, it has been
neutrophils reduced, which may be linked to a cytokine
difficult to establish a relationship between poor clinical
storm triggered by virus invasion (7).
outcomes and elevated levels of IL-6 in the blood at
It was the goal of this work to detect the
baseline. Septic shock with or without the acute
outcome and survival of COVID-19 patients admitted at
respiratory distress syndrome has been shown to have
Zagazig University Hospitals.
lower levels of IL-6 and IL-8 in critically ill patients
with COVID-19. As a result, information about the
PATIENTS AND METHODS
clinical history of COVID-19 may be gleaned from
At COVID isolation Sednawy Hospital, Zagazig
measurements of certain cytokines taken at the time of
University during the period from 1/1/2021 to
initial presentation (5).
31/12/2021, we conducted this retrospective cohort
Many patients died as a result of organ failure
study.
caused by their treatment. Toxins generated by
The study included 900 cases as a
activated immune and infected cells contributed to
comprehensive sample, the patients were selected as
organ failure in SARS patients, as well as COVID-19
severe to critical COVID19 patients, with total number
mortality, according to that study(6). There was a high
1204 cases where 304 cases were excluded from study
association between the death rate of severe COVID-19
with a lot missing data according to the criteria of
patients and the inflammatory marker procalcitonin as
2304
Received: 05/01/2022
Accepted: 24/02/2022
c:\work\Jor\vol881_6
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2311-2318
Assessment of Serum Level of Adipocyte Fatty Acid Binding Protein in
Patients with Psoriasis Vulgaris before and after Treatment with Acitretin
Nora Mostafa Darwish, Fatma Faisal El Dakrory, Shimaa
Rabea Abdel Qader Hendawy2, May Mohamed Gamal*
Departments of 1Dermatology, Andrology &STDs and
2Clinical Pathology, Faculty of Medicine - Mansoura University, Egypt
*Corresponding author: May Mohamed Gamal, Mobile: (+20) 01062001249, E-Mail: mmgmab4@gmail.com
ABSTRACT
Background: Psoriasis is a common immune mediated and chronic inflammatory skin disorder portrayed as
hyperproliferation and maturation impairment of keratinocytes, increased immune cells infiltration and blood vessel
formation, and accumulation in proinflammatory cytokines. Psoriasis is now considered a systemic disease where it is
associated with psychological, metabolic, arthritic, and cardiovascular comorbidities. Lifespan is reduced as a
consequence.
Objective: The aim of this study was to evaluate serum level of adipocyte fatty acid-binding protein (FABP4) in patients
with psoriasis vulgaris and to compare it with its level in healthy control.
Patients and methods: Seventy-four were included in this study. They were chosen from the Out-patient Clinic of
Dermatology, Andrology & STDs Department, Mansoura University Hospitals. A case study group of 37 patients with
psoriasis vulgaris and 37 of healthy people age- and sex-matched were used as a control group.
Results: ROC curve for detection of FABP4 before acitretin validity in differentiating studied cases illustrated excellent
area under curve of 0.728 (p < 0.001)* with the best detected cut off point was 2.7 yielding sensitivity of 75%, specificity
of 81.1% and total accuracy of 78.1%. So, the present study demonstrated that; detection of FABP4 level before acitretin
therapy could be used as reliable indicator in differentiating studied cases with high sensitivity and specificity.
Conclusions: Serum FABP4 levels were significantly increased in patients with psoriasis, indicating that this protein
may be a potential marker of psoriasis and an independent predictor for the risk of comorbidities or complications in
psoriatic patients. Additionally, it could be used also as a reliable indicator of acitretin therapy.
Keywords: Psoriasis, Fatty acid-binding protein, Acitretin.
INTRODUCTION
their differentiation in the treatment of psoriasis, but it
Psoriasis is an immune-mediated, chronic
has little effect on Th1, Th17, and Tregs (6).
inflammatory condition affecting about 2-4% of the
There is emerging evidence suggesting an
general population (1). Psoriasis onset is triggered when
underlying shared chronic inflammatory process
genetic and/or environmental factors activate
between psoriasis and obesity (7). While it is noteworthy
plasmacytoid dendritic cells, resulting in the production
to mention that some anti-psoriatic drugs may also
of numerous proinflammatory cytokines, including
influence obesity and obesity-associated comorbidities
tumor necrosis factor (TNF)-, interferon (IFN)-,
through their adverse effects (8).
interleukin (IL)-17, IL-22, IL-23 and IL-1. Many of
Adipocyte fatty acid-binding protein, also
these
cytokines
stimulate
keratinocyte
called adipocyte protein 2 (aP2) is mainly expressed in
hyperproliferation, which perpetuates a cycle of chronic
adipocytes and macrophages. Besides its pivotal role in
inflammation (2). Elevated levels of multiple
lipid metabolism and insulin sensitivity, it has also been
proinflammatory cytokines are found not only in skin
recognized as adipokine influencing several (9).
lesions, but also in the blood (3). Systemic elevations in
Increased levels of FABP4 were associated with
these
cytokines
promote
chronic
subclinical
obesity, IR, DM, nonalcoholic fatty liver disease
inflammation (asymptomatic inflammation that can
(NAFLD), and cardiovascular artery disease (CAD),
cause tissue damage over time) associated with
which in turn are closely related to psoriasis (10).
comorbidities that disproportionately affect patients
Adipocyte-type FABP has been proposed as a potential
with psoriasis, including psoriatic arthritis (PsA),
therapeutic target for CVD, which points to its high
cardiovascular disease (CVD), diabetes mellitus,
clinical relevance (9). Furthermore, adipocyte-type
obesity, inflammatory bowel disease and nonalcoholic
FABP has been proposed as a potential therapeutic
fatty liver disease (NAFLD) (4).
target for heart failure or CVD, which points to its high
Although a wide range of treatment modalities
clinical relevance. Considering psoriasis as an
have been developed for psoriasis over the last two
independent cardiovascular predictor, lowering the
decades, systemic retinoids may have an advantage over
FABP4 level would be valuable (11).
other systemic treatments due to their non-
The aim of this study was to evaluate serum
immunosuppressive properties and safety profile (5).
level of adipocyte fatty acid-binding protein (FABP4)
It has been reported that acitretin could
in patients with psoriasis vulgaris and to compare it with
suppress the proliferation of keratinocytes and regulate
its level in healthy control. Also, to compare between
serum level of adipocyte fatty acid binding protein
2311
Received: 02/12/2021
Accepted: 01/02/2022
c:\work\Jor\vol881_7
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2319-2324
Prediction and Prevention of Pre-eclampsia by Measuring Mean Platelet
Volume and Uterine Artery Doppler Indices in High-Risk Pregnant Women
Ali El-Shabrawy Ali, Youssef Abo Elwan Elsayed, Hana Matoog Dawo Saad*, Ahmed Metwally Elkataway
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Hana Matoog Dawo Saad, E-mail: soslobna@gmail.com,mobile:+201286172144
ABSTRACT
Background: Pre-eclampsia (PE) is a multisystem disorder of unknown cause that is unique to human pregnancy.
Objective: This work aimed to evaluate platelet volume and its significance in the prediction of preeclampsia.
Methods: This is a prospective cohort study that was carried out in the Obstetrics and Gynecology Department (High-
risk unit) at Zagazig University Hospitals. Sixty high-risk pregnant women were involved during the period from July
2021 to February 2022. Ultrasound scanning was done to evaluate fetal biometric parameters according to fetal
morphology and localization of the placenta. The uterine arteries were identified, and the pulsatility index and resistive
index were measured bilaterally. Ultrasound examinations were performed by one observer only.
Results: Platelet (PLT) was significantly higher among control and unaffected groups at all times but MPV and PDW
were significantly higher among cases at all times. The first, second, third, fourth, and fifth visits were at 12, 14, 16, 18,
and 20 weeks gestation respectively
Conclusions Abnormal platelet indices and uterine artery Doppler indices can be considered as an early, economical,
and rapid procedure for the assessment of PE.
Keywords: Pre-eclampsia, Mean platelet volume (MPV), Platelet indices, Prediction.
INTRODUCTION
Pre-eclampsia is a multisystem disorder of
antenatal surveillance. Extensive research over the past
unknown cause that is unique to human pregnancy. It is
35 years has evaluated the use of uterine artery Doppler
characterized by an abnormal vascular response to
for the prediction of PE(6).
placentation that is associated with increased systemic
The aim of this study is the prevention and
vascular resistance, enhanced platelet aggregation,
prediction of pre-eclampsia by measuring mean platelet
activation of the coagulation system, and endothelial
volume and uterine artery Doppler indices in high-risk
cell dysfunction(1).
pregnant women.
The clinical findings of pre-eclampsia can
manifest as either a maternal syndrome (hypertension
PATIENTS AND METHODS
and proteinuria with or without other multisystem
This is a prospective cohort study of pregnant
abnormalities with or without body edema) after 20
women. The study was carried out on 60 pregnant
weeks of gestation or fetal syndrome (fetal growth
women in the Obstetrics and Gynecology Outpatient
restriction, reduced amniotic fluid, and abnormal
Clinic at Zagazig University Hospitals. The participants
oxygenation). Preeclampsia resolves by 6-12 weeks
were divided into two equal groups with matched ages.
postpartum in previously normotensive women(2).
Group A included pregnant women with a history of
Pre-eclampsia is the most commonest medical
high-risk factors, while the others who had no history of
disorder during pregnancy, it complicates about 5 to
risk factors, were included in Group (B).
10% of pregnancies and continues to be a major cause
of maternal and perinatal morbidity and mortality(3).
Ethical consent:
The early identification of patients with an
Written informed consent was obtained from
increased risk for preeclampsia is therefore one of the
all participants, the study was approved by the
most important goals in obstetrics.
research ethics committee of the Faculty of
Thrombocytopenia
is
probably
due
to
Medicine, Zagazig University. The work was carried
consumption
during
low-grade
intravascular
out for studies involving humans following the
coagulation(4).
World Medical Association's Code of Ethics
Mean platelet volume (MPV) is significantly
(Helsinki Declaration) IRB number.
higher in patients with pre-eclampsia compared to those
with normal pregnancy. The physiological changes in
Inclusion criteria:
pregnancy normally show decreasing platelet count
High-risk patients with singleton pregnancy seen
with increasing gestational age. However, in patients
between 11 and 13 + 6 weeks with confirmed viable
with pregnancy-induced hypertension (PIH), the effect
intrauterine pregnancy with no active bleeding or
on platelets is increased significantly leading to many
evidence of subchorionic hematoma. Gestational age
complications in mother and fetus(5).
was ascertained based on the first day of the last reliable
Accurate prediction of PE is essential for the
menstrual period unless the difference from the first-
initiation of preventive therapy and this also aids in
trimester ultrasound was greater than 5 days.
targeting the group which would need increased
2319
Received: 07/12/2021
Accepted: 06/02/2022
c:\work\Jor\vol881_8
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2325-2331
Internet Addiction in Relation to Mental Health among Medical Students,
Menoufia University, Egypt
Reda A. Ibrahem 1, Amr S. Shalaby 2, Nagwa N. Hegazy 3
1Public Health and Community Medicine Department, 2Neuropsychiatry Department,
3Family Medicine Department, Faculty of Medicine, Menoufia University, Egypt
Corresponding author: Reda Abdel Latif Ibrahem, Telephone: 002-01095776864, email: reda_8083@yahoo.com
Orcid number: https://orcid.org/0000 0003
-
1
- 224 7695
-
ABSTRACT
Background: Use of the Internet, computers, smartphones, and other electronic devices has dramatically increased over
recent years, and this increase is associated not only with tremendous benefits to the users but also with documented
cases of excessive use, which has negative health consequences. In many countries, the problem has reached the
magnitude of a significant public health concern.
Objective: This study aimed at estimating the prevalence of Internet addiction among Egyptian medical students and
its relation to their depression, anxiety and stress.
Results: Across sectional study including 678 medical students. Their age ranged from 17 24 years, 41.4% of them
were males. The participants were subjected to a self-administered questionnaire that included personal data, family
history and their previous year academic degree, compulsive Internet use scale (CIUS) was used, and also Depression
Anxiety Stress Scale-21 (DASS -21) was used for assessing anxiety, depression, and stress. Problematic Internet use
(PIU) among the participant students was 68.3%, PIU was significantly associated with increased family income,
depression, anxiety and stress were also associated with PIU with odds ratio [1.57 (1.11 2.22), 1.65 (1.11 2.43), 1.48
(1.03 2.12)] respectively.
Conclusion: The high prevalence of problematic internet use (PIU) among medical students in Menoufia University is
a matter of concern that is also associated with stress, anxiety, and depression as well as its negative impact on their
academic achievement. It is important to plan comprehensive programs to raise public awareness about the hazards and
introducing awareness and treatment services in primary health care facilities.
Keywords: Anxiety, Depression, Internet addiction, Medical students, Stress.
INTRODUCTION
The Internet nowadays is an important way for
globe. Although the Internet has many educational
communication, source of information and knowledge,
benefits, excessive usage may result in negative
education tool, social network and entertainment hub in
consequences such as medical and neurological
the contemporary world [1]. Internet use has become a
difficulties, psychological instability, social isolation,
normal and important daily activity especially among
and poor academic performance [6]. Internet addiction
adolescents and young adults [2].
has sparked widespread alarm and has been identified
In 2015 it was found that about 90% of young adults
as one of the greatest public health threats, especially
used social media [3]. Egypt's Internet user base has
among teenagers [8].
grown from 34.1 million in 2013 to 77.66 million in
Many Egyptian research have shown links between
2022, representing a 22 percent growth in internet use
Internet addiction and mental symptoms including
between 2019 and 2020 and proceeding increase till
sadness, anxiety, personality characteristics, loneliness,
now as it registered +1.9% increase between 2021 and
and low self-esteem among university students. The
2022. In January 2022, Egypt had a 71.9 percent
most common mental symptom linked to excessive
Internet penetration rate [4].
usage of the Internet is depression. [9,10].
Internet addiction is defined as excessive or poorly
Adolescents are at an especially high risk for mental
managed preoccupations, urges, or attitudes related to
illnesses; half of all mental illnesses begin before the
computer usage and Internet access that cause
age of 14, yet the majority of cases go unnoticed and
impairment or suffering [5].
untreated. Failure to treat teenage mental health
The problem with Internet Addiction Disorder
concerns has long-term consequences that impair both
arises when these activities begin to interfere with daily
physical and mental health, as well as the ability to live
life activities. Many research shows that it is not the sum
normal productive lives as adults [11,12]. As a result,
of time spent online that is particularly problematic, but
raising awareness of the physical and emotional effects
rather how it is used [6].
of excessive internet usage is critical for improved
Teenagers (1219 years) and young youth (2029
management.
years) use the Internet more than any other age group
The purpose of this research was to determine the
and are at a greater risk of misuse, hence Internet
incidence of Internet addiction, examine its association
addiction is more common among young people [7].
to depression, anxiety, and stress, and also its impact on
Addiction to the Internet is becoming more
students' academic achievement.
common among university students all around the
2325
Received: 02/12/2021
Accepted: 01/02/2022
c:\work\Jor\vol881_9
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2332-2336
Evaluation of Thyroid Functions in Patients with Diabetic Ketoacidosis
Mohammad O. Abdel Aziz1, Amr Mahmoud Abdel Wahab2, Eman Alsayed3,
Ali O. Abdel Aziz4, Hend M. Monees3, Ahmed Amin Ibrahim*5
Departments of 1Internal Medicine and Critical Care, 2Internal Medicine and Endocrinology,
3Clinical Pathology and Chemistry and 4Chest, Faculty of Medicine, Minia University, Egypt
Department of 5Internal Medicine, Faculty of Medicine, Beni-Suef University, Egypt
*Corresponding author: Ahmed Amin Ibrahim, E-Mail: massa2000@yahoo.com
ABSTRACT
Background: Diabetic ketoacidosis (DKA) is an acute life-threatening complication of diabetes. It is not only a sign of
acute absolute insulin deficiency in type 1 diabetes mellitus (T1DM) but also increasingly seen in patients with type 2
diabetes mellitus. DKA can affect the function of the hypothalamus-pituitary- thyroid axis directly or indirectly due to
various factors such as relatively insufficient insulin secretion and metabolic disorders.
Subjects and Methods: This study was performed in the ICU of Minia University Hospital and Beni-Suef University
Hospital. It included 90 patients admitted in ICU of both Hospitals who had diabetic ketoacidosis and 30 normal
individuals as control group. The thyroid function of patients group and control group, impact of Ketoacidosis on thyroid
function of patients group and its correlation with the clinical features and laboratory findings at diagnosis were
evaluated.
Results: As regard thyroid profile TSH, FT3 and FT4 were significantly lower in patients compared to control groups
(p <0.001). The mean reverse T3 was 780.1±55.6 in DKA patients, which was significantly higher than control group
(325±62.5) with p value p<0.001. The mean TSH was (1.9±0.4) in DKA patients, which was significantly lower than
control group (2.6±0.6) with p value p<0.001. The mean FT3 was (3±0.4) in DKA patients, which was significantly
lower than control group (3±0.4) with p value p<0.001. The mean FT4 was (12.9±1.3) in DKA patients, which was
significantly lower than control group (13.8±1.4) with p value p<0.013. There was significant negative association
between rT3 and pH (r= -0.610, p<0.001).
Conclusions: Our study demonstrated that thyroid profile TSH, FT3 and FT4 were significantly lower in patients with
DKA, while the mean reverse T3 was significantly higher in DKA patients. This dysfunction was correlated with
severity of ketoacidosis. Findings of our study may have important therapeutic applications.
Keywords: Diabetic Ketoacidosis, FT3, FT4, rT3, Thyroid, TSH.
INTRODUCTION
The body sometimes converts T4 into rT3
Diabetes is chronic endocrine/metabolic
(Reverse T3) instead. This rT3 has little biological
disease with heterogeneous etiologies, clinical
activity and is considered an inactive compound (5). The
presentations and associated complications. Its
serum concentration of rT3 is typically 1/10 of that of
biochemical hallmark is hyperglycemia caused mainly
T3 in elderly (10 to 24 ng/dL) but in some situations
by insulin deficiency and/or insulin resistance (1).
may exceed that of T3. The most common perturbation
Diabetic ketoacidosis (DKA) is the most common acute
of serum rT3 concentration occurs in response to
hyperglycemic emergency in people with diabetes
carbohydrate deprivation during starvation or severe
mellitus. Usually resulting in the triad of
illness (the no thyroidal illness syndrome or NTIS) (6).
hyperglycemia, metabolic acidosis and ketosis (elevated
In our study, we aimed to evaluate the impact
levels of ketones in the blood or urine; a serum ketone
of diabetic ketoacidosis on thyroid function of the
concentration of>3.0 mmol/l (2).
patients (TSH, Free T3, FreeT4 and rT3) and its
DKA shows a rapid onset, quick
correlation with the clinical features and laboratory
progression and severe conditions, with a mortality of
findings at diagnosis.
5%. Therefore, it is necessary to identify new and
effective markers for the evaluation of DKA conditions,
PATIENTS AND METHODS
which is of prime importance to the screening of high
The current study was conducted in the medical
risk patients and proper treatment (3).
ICUs of both Minia University Hospital and Beni-Suef
The thyroid gland primarily produces two
University Hospital during the period from May 2020 to
hormones: T4 (thyroxine) is the most abundant thyroid
February 2021.
hormone but it has very little biological activity and
All patients with diabetic ketoacidosis who were
must be converted into T3 to play out the roles normally
admitted to the ICU and aged more than 18 years old
associated with thyroid hormones, and T3
were eligible to be included in the study. Thirty age and
(triiodothyronine) is a thyroid hormone that plays many
gender-matched person were allocated as a control
roles in the body, including metabolism, growth, and
group.
body temperature. The thyroid gland produces some T3,
Patients were excluded from the study if they:
but most available T3 comes from the conversion of T4
have any history of thyroid disorders, received any local
(4).
and/or systemic treatment for hyper- or hypothyroidism,
2332
Received: 08/12/2021
Accepted: 07/02/2022
c:\work\Jor\vol881_10
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2337-2343
Closed Treatment of Displaced Fracture Neck of Radius in
Children by Metaizeau Technique
Khaled Edris Abdelrahman Ghonim, Adel Abdelazem Ahmed Salem,
Mahmoud Elsayed Albadawy Thabet, Fuad Khallefah Ali*
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Fuad Khallefah Ali, E-mail: fouadashalor@gmail.com,mobile:00201270342658
ABSTRACT
Background: Radial neck fractures in the pediatric population represent up to 1% of all pediatric fractures. Judet type
III and IV radial neck fractures represent difficulties in closed and open reduction. The Metaizeau technique has been
used as a tool to reduce these.
Objective: This study aimed to evaluate the clinical and radiological outcomes following Metaizeau technique for
displaced radial neck fracture in children.
Patients and methods: A prospective operation clinical study of 18 patients, with fracture radial neck, who underwent
closed reduction and internal fixation with Métaizeau technique. Follow up Clinical and radiological evaluation was
performed and any complications were recorded.
Results: The function of elbow according to Mayo elbow performance score was excellent and good in 22.2% and
77.8% respectively. Also, the radiological results were excellent and good in 22.2% and 77.8% respectively. No
complications were noted.
Conclusion: We have managed to achieve stable fixation of the reduction without any loss of position and consequently,
better outcomes with no complications.
Keywords: Metaizeau technique, Radial neck, Judet classification.
INTRODUCTION
associated with those bad outcomes (most frequent being
Radial neck fractures in children are rare and
significant stiffness) (7).
account for about 1% of all pediatric fractures and 5-10%
The method of closed intramedullary pinning of
of elbow fractures in children (1). Radial neck fractures
displaced radial neck fractures was described by
rarely occur at age of 2 years or less. Since radial head
Métaizeau et al. in 1980 (8). They also appreciated that
ossification does not occur prior to age of 5 years, these
the prognosis for radial neck fractures was strongly
fractures are frequently seen in children aged 4-14 years
dictated by 2 factors: severity of displacement and
(2). The age group with the highest prevalence is between
associated injuries to the elbow. It must be remembered
8 and 12 years old. The main injury mechanism is a fall
that there is remarkably little remodeling potential in the
with the elbow in hyperextension, the forearm supinated
proximal radius as it has been shown that by 8 years of
and valgus force causing radial head compression against
age only 10% of the growth of the radius comes from this
the capitulum (3).
region (9).
Radial neck fractures are among the most common
Indications for surgery are primarily driven by
pediatric elbow fractures and they account for a
fracture displacement, which includes angulation and
disproportionate amount of bad outcomes. Thus
translation. There are 2 frequently used displacement-
displaced radial neck fractures represent unique
focused classification schemes for pediatric radial neck
treatment challenges to the orthopaedic surgeons caring
fractures. O'Brien (10) classification is most commonly
for these children (4).
used to categorize radial neck fractures, while European
The proximal radius represents a low growth area
authors typically apply the Judet system. Fracture
(as compared to the distal radius) and thus it possesses
angulation that meets or exceeds 30° ( O'Brien II or
limited remodeling potential at best. Symptomatic radial
Judet III) is the chief indication for surgery (9). Small
neck malunion have been reported along with subsequent
series from older literature suggest that translation that
corrective osteotomy (5). Radial head fractures and true
meets or exceeds 3-4 mm should also trigger efforts at
growth plate fractures of the proximal radius are both
reduction and stabilization mainly due to concern for
quite rare in children as this portion of the bone
cross union (11). Since closed reduction alone fails over
consistently fails through the periphyseal metaphyseal
40% of the time, there has been increasing enthusiasm for
region otherwise referred to as the radial neck (6).
internal fixation and stabilization of these fractures
In contrast to these other fractures, true radial neck
following reduction. In fairness, there are instances when
fractures are quite common as they are among the top 2-
supplemental reduction is necessary (temporary
3 most frequent pediatric elbow fractures and they are
percutaneous leverage with Kirschner wire) prior to final
quite clearly associated with a disproportionate amount
flexible nail fixation, thus resulting in a Böhler-
of bad results (7). Increasing amounts of fracture
Metaizeau technique (12).
angulation and translation (uncovering of the
The study aimed to evaluate clinical and
metaphyseal fracture surface) have most commonly been
radiological outcomes following Metaizeau technique
for displaced radial neck fracture in children.
2337
Received: 02/12/2021
Accepted: 01/02/2022
c:\work\Jor\vol881_11
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2344-2350
Assessment of Central Auditory Processing Impairment and
Cognitive Profiles in Children with Specific Learning Disabilities
Soha Abdelraouf Mekki1, Eman Hassan ELsafy2, Wafaa Hosney Ghannam*1, Nahla Hassan Gad1
Departments of 1ENT (Audio-Vestibular Medicine Unit),
2Psychiatry, Faculty of Medicine, Zagazig University, Egypt
* Corresponding author: Wafaa Hosney Ghannam, Mobile: (+20)01227658965, E-mail: wafaahosneyghanam@gmail.com
ABSTRACT
Background: Specific learning disabilities (SLDs) are a significant factor in children's academic underachievement.
Around 46% of SLDs children have comorbid auditory processing disorder (APD). Cognitive functions are the ability
to think and plan. Consequently, learning and academic progress are significantly affected by these disabilities.
Objective: Our study sought to evaluate whether children with SLDs have both central auditory processing (CAP) and
cognitive abnormalities.
Patients and methods: A case-control study was conducted on 36 children from different schools of Zagazig city,
Alsharquia government, Egypt, allocated into 2 groups, 18 with SLDs and academic underachievement (study group
I) and 18 without SLDs (control group II). Medical history, otological evaluation, basic audiological examination,
central screening tests (speech in noise (SPIN), dichotic digit (DDT), and pitch pattern sequence (PPS)), test for
temporal resolution (Gaps in noise, (GIN)), IQ, and visuomotor ability evaluation were used to collect data.
Results: The SLDs group had lower DDT, PPS, total score and percent of GIN test versus the control groups. At the
same time, the approximate threshold of GIN test in the SLDs group was significantly greater relative to the normal
group. Regarding Bender-Gestalt test (BGT) test, there was highly statically significant increase scores on copy and
recall phases among control group. A significant positive relationship was detected between the BGT copy and recall
phases and PPS on both sides.
Conclusion: Our findings endorsed our hypothesis that most children with SLDs had subnormal scores on CAP
abilities and cognitive function. The most severely affected CAP were temporal resolution and temporal ordering. Most
SLDs children had visuomotor affection.
Keywords: Central auditory processing, Cognitive functions, Comorbidity, Specific learning disabilities, Visuomotor
skills.
INTRODUCTION
The term "specific learning disabilities" refers to
Zagazig, with no gender distinction, ~ 46% of patients
a group of conditions that have a deficit in verbal ability
were presented with comorbid auditory processing
(both spoken and written) that cause problems with
disorder (APD) (4), making APD a possible complicating
understanding or comprehending what is being said,
factor in SLD cases. A comprehensive psychometric test
written, reading, writing, spelling, or performing
should be performed on all kids suspected of having
mathematical calculations. These include dyslexia,
APD (5).
dysgraphia, dyscalculia, dyspraxia, and developmental
APD testing involves observing a child's
aphasia (1).
performance in several activities, such as recognizing
To accurately diagnose SLDs, various elements,
the direction of a sound source, identifying words and
such as temporal processing abnormalities, auditory
phrases heard in competitive or distorted acoustic
processing disorders (APD), eye movement alterations
environments, or distinguishing syllable-type sounds
during reading, and attention deficit and hyperactivity
and brief pure tones. This test identifies the child's
disorder (ADHD), along with other comorbidities, make
auditory issues and the type of gnostic impairment,
the assessment more complicated (2). There are several
which is the child's particular relationship between
reasons why children with "learning challenges"
hearing disability and language learning.
struggle in school, including behavioral, psychological,
Central auditory processing (CAP) describes a
and emotional issues; English as a second language
set of processes and procedures that occur between the
rather than their native tongue; inadequate education;
time sound is picked up by the outer ear, and the time it
excessive absences; or a lack of adequate curriculum.
is processed in the auditory cortex. It includes the
These youngsters can attain age-appropriate levels if
following abilities: localization and lateralization of
they are supported and receive evidence-based
sound; detection and identification of auditory stimulus
education.
variations; temporal processing (resolution, masking,
SLDs are one of the most serious
and integration); and sequencing, as well as auditory
neurodevelopmental disorders that interfere with
context and perception in competitive contexts of the
students' academic progress regardless of average or
intended stimulus signals. Auditory processing involves
above-average intellectual capacity when proper
the following mechanisms: binaural interaction, dichotic
classroom and home support are provided (3). They
listening, monoaural low redundancy, and temporal
account for around 37% of all public-school students in
processing (6).
2344
Received: 08/12/2021
Accepted: 07/02/2022
c:\work\Jor\vol881_12
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2351-2356
Evaluation of Result of Percutaneous Fixation Proximal Humerus
Fracture in Adults in Zagazig University Hospitals
Abdelsalam Eid, Osam Mohamed Metwally,
Hany Mohamed Abdelfattah Bakr, Mohammed Saad Amer Daw
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohammed Saad Amer Daw, E-Mail: Dr.alferjani@gmail.com, Mobile: (+20) 01025923883
ABSTRACT
Background: Percutaneous pinning is a minimally invasive treatment with a limited number of applications for
fractures of the proximal humerus.
Objective: to assess whether closed reduction with percutaneous pinning gives sufficient stability to allow early
active range of motion and eventual bone healing in the proximal humerus.
Patients and Methods: 18 patients with age above 18 years with closed proximal humeral fracture in adults at
Zagazig University Hospital by closed reduction and percutaneous pinning by K-wire were the subject of our study.
Percutaneous K-wire fixation was used to treat the patients. We followed up patients and evaluated our results at 1,
3 then 6 months according to constant score (CS).
Results: The radiographic union of all but one of the patients occurred by 12 weeks. Intraoperatively, there were no
serious issues, eighteen patients had superficial (mild) pin tract infection (100%), One patient had delayed union
(5.6%), the last patient had pin loosening (5.6%), and no patient had nonunion or avascular necrosis (AVN). The
average Constant-Murley score was 81.
Conclusion: By using a closed reduction with percutaneous pinning (CRP) to stabilise fractures of two and three
parts, the advantages of minimum soft tissue invasiveness and less blood loss can be achieved.
Keywords: Percutaneous Fixation, Proximal Humerus.
INTRODUCTION
Only a few conditions call for the use of
Proximal humerus fractures, which account for
percutaneous pinning, a minimally invasive procedure
4% to 5% of all fractures, are common(1). Patients over
with few potential applications. A 3- or 4-part proximal
the age of 60 account for 71% of all proximal humerus
humerus fracture with appropriate bone stock can be
fractures, a startlingly high number. Elderly populations
accepted. This technique minimizes scarring at the
may have a 7:1 male to female ratio, which is higher
scapulohumeral contact and reduces the risk of vascular
than the average ratio of 3:1(2).
compromise, postoperative pain, operating time, and
Falling on an outstretched arm in an elderly
blood loss. 70% of the time, two-part fracture patterns
patient with osteoporotic bone is the most common
can yield good results (8).
cause of proximal humerus fractures. There is a risk of
It was the goal of this work to assess whether
fracturing the humerus if the humeral head hits the
closed reduction with percutaneous pinning gives
glenoid or the acromion directly (3). Traumatic events
sufficient stability to allow early active range of motion
like vehicle accidents or falls from great heights are less
and eventual bone healing in the proximal humerus.
likely to cause fractures in younger persons. Muscle
spasms brought on by an electric shock or seizure are an
PATIENTS AND METHODS
uncommon cause (4).
Eighteen patients with age above 18 years with
While the majority of these fractures can be
closed proximal humeral fracture in adult at Zagazig
stabilized without surgery, 1520 percent will require it
University Hospital by closed reduction and
due to their instability or displacement (5). Open
percutaneous pinning by K-wire were the subject of our
reduction and internal fixation procedures can be
study. Percutaneous K-wire fixation was used to treat
employed to treat these fractures. While anatomical
the patients.
reduction and stable fixation are the primary benefits of
open reduction and internal fixation, there are several
Ethical consent:
drawbacks, including increased joint stiffness, implant
Zagazig University's Research Ethics
failure, an increased infection rate, and an increased risk
Committee approved the study as long as all
of humeral heave avascular necrosis (6).
participants' parents signed informed consent forms
While less invasive, closed reduction and
and submitted them to Zagazig University (ZU-
percutaneous fixation with straight wires have the
IRB#6853). We adhered to the Helsinki Declaration,
potential for insecure fixation, reduction deterioration,
the ethical guideline of the World Health
and wire migration (7). Closing reduction and
Organization for human trials.
percutaneous pinning (CRPP) was first described by
Inclusion criteria: Patients of both genders presented
Bohler in 1962, but has garnered increasing attention in
with proximal humeral fractures, aged above 18 years,
the literature in recent years (8).
and in most cases, the proximal humerus fracture is
operated on within two to seven days after the injury.
2351
Received: 08/12/2021
Accepted: 07/02/2022
c:\work\Jor\vol881_13
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2357-2364
Reconstruction of Posterior Meatal Wall After Canal Wall Down
Mastoidectomy: Cartilage versus Bone Graft
Ahmed Solieman Ramadan, Amr Hasan El Senbawy,
Sherif Mohammad Askar, Mohamed Salah Abd El Azeem El Sayed*
Department of Otorhinolaryngology, Faculty of Medicine Zagazig University, Sharkia, Egypt
*Corresponding author: Mohamed Salah Abd El Azeem El Sayed, Mobile: (+20)01222987701,
Email: mohamedsalah8686@yahoo.com
ABSTRACT
Background: Acquired middle ear cholesteatoma remains a common problem nowadays. The mainstay of treatment is
surgery. Surgeries for cholesteatoma are usually classified as canal wall down (CWD) or canal wall up (CWU)
procedures. The concept of canal wall reconstruction (CWR) mastoidectomy has been shown up in an attempt to
combine the advantages of both CWD and CWU techniques. In this procedure, the posterior meatal wall (PMW) is
removed, providing exposure to the entire attic and middle ear, helping to ensure complete disease eradication. Hence,
the recurrence rate is as low as 2% for this procedure.
Objective: This study aimed to assess the results of the reconstruction of the posterior meatal wall with bone and
cartilage graft. Patients and Methods: This study was carried out on 24 ears of 24 patients in the Department of
Otorhinolaryngology, Head and Neck Surgery, Zagazig University Hospitals during the period from September 2019 to
September 2021. Twenty-four subjects were divided into two groups, group A (treated by canal wall down
mastoidectomy with the reconstruction of the posterior meatal wall with cartilage from conchal cartilage), and group B
(treated by canal wall down mastoidectomy with the reconstruction of the posterior meatal wall with bone from cortical
bone). Results: There was a statistically insignificant difference between the cartilage graft group and bone graft group
regarding post-operative complications. There was a decreased median of PTA-AC at post-operative cartilage graft
compared to pre-operative; the difference was statistically significant with a percent of improvement of 31.36%.
Conclusions: We concluded that CWDM eradicates disease in the middle ear and epitympanum by direct visualization
and prevents common complications of the traditional CWDM technique.
Keywords: CWD, CWU, CWR, Cholesteatoma, Mastoidectomy.
INTRODUCTION
ensure complete disease eradication. Hence, the
Acquired middle ear cholesteatoma remains a
recurrence rate is as low as 2% for this procedure [7].
common problem nowadays. The mainstay of treatment
CWD mastoidectomy followed by concomitant
is surgery. Surgeries for cholesteatoma are usually
reconstruction of the PMW achieves a low recurrence
classified as canal wall down (CWD) or canal wall up
rate of cholesteatoma after it besides the advantages of
(CWU) procedures [1]. The canal wall-down (CWD)
CWU mastoidectomy. This provides structural support,
operation, offers a lower rate of cholesteatoma
which plays an important role in the prevention of the
recurrence but frequently results in postoperative
postoperative formation of a retraction pocket and
otorrhea, the latter is mainly due to the absence of the
subsequent cholesteatoma development [8].
posterior canal wall and hence exposed mastoid bowl
The goal of reconstruction of the posterior
that quite often catches infection on its surface [2]. The
external auditory canal is to provide a safe, dry mastoid
canal wall-up (CWU) procedure, yields a high rate of
and restore hearing to near-normal levels. No single
"dry ear" but can lead to a substantially high
procedure has yet been devised that entirely
cholesteatoma recurrence rate [3].
accomplishes these purposes consistently [9]. Various
The posterior canal wall hinders the eradication
materials have been used to fill the mastoid, including
of cholesteatoma in the middle ear, especially the
fascia, fat, muscle, cartilage, bone paste, cancellous
anterior epitympanum, facial recess, and sinus tympani.
bone strips, bioactive glass ceramics, Proplast (a
This may explain the reported high rate of
combination of polytetrafluoroethylene and glassy
cholesteatoma recurrence in patients subjected to the
carbon fibers) methylmethacrylate, and ionomer-based
closed procedure. Removal of the posterior canal wall
bone substitutes [10].
was reported to significantly reduce the rate of
Most alloplastic implant materials, such as
postoperative cholesteatoma recurrence[4]. The concept
plastic mesh, Proplast, and porous polypropylene, have
of canal wall reconstruction (CWR) mastoidectomy has
not been successful long-term due to difficulties in the
been shown up in an attempt to combine the advantages
face of infection [11], Although there was initial
of both CWD and CWU techniques [5, 6].
enthusiasm for Proplast, it was subsequently discovered
In the canal wall down (CWD) mastoidectomy,
that the material caused a lasting giant cell reaction.
the posterior meatal wall (PMW) is removed, providing
Antibiotics could not clear the infection when the
exposure to the entire attic and middle ear, helping to
organisms became harbored in the pores [12].
2357
Received: 12/12/2021
Accepted: 09/02/2022
Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2365-2372
Ultrasonographic Measurement of Optic Nerve Sheath Diameter for Detection of
Increased Intracranial Pressure in Patients Scheduled for Elective Tumor Craniotomy
Howaydh Ahmed Othman, Ahmed Mohamed Mahmoud Mohamed*,
Ekram Fawzy Sayouh, Nahla Mohamed Amin
Anesthesia, Intensive care and Pain Management Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Mohamed Mahmoud Mohamed, Email: ahmed161291@yahoo.com,
Mobile: (+20) 01553093366
ABSTRACT
Background: Elevated intracranial pressure (EICP) is a serious neurological condition. The diameter of the optic nerve
sheath can be determined by means of ultrasonography as a non-invasive method of detecting EICP.
Objective: The aim of the current work was to evaluate the accuracy of bedside optic nerve sheath diameter (ONSD) by
ultrasound (US) as a non-invasive method of detecting increased intracranial pressure (ICP) in patients underwent
elective tumor craniotomy in comparison to clinical and radiological computed tomography (CT) findings of EICP.
Patients and Methods: From January 2020 to May 2020, this prospective observational study was conducted on
seventy-one patients underwent elective tumor craniotomy at Zagazig University Hospitals. ONSD measurements were
done and compared with clinical and radiographic features on CT brain suggesting increase in ICP pre and post-
operatively.
Results: There were good relation between ONSD and clinical signs of EICP. it was found that there were increase in
preoperative mean ONSD among cases had nausea (4.94±0.57 mm), vomiting (4.97±0.55) mm and headache (4.87±0.6
mm), disturbed conscious level (4.9±0.62 mm) and visual field affection (5±0.46 mm). also, there was increase in
postoperative mean ONSD among cases with nausea (4.81±0.67 mm), vomiting (4.81±0.62 mm), headache (4.83±0.63
mm). The cut-off value of ONSD for diagnosing increased ICP was >4.8 mm with sensitivity 78.9%, specificity 63.6%
and accuracy 71.8%.
Conclusion: It could be concluded that bedside ultrasonographic measurement of ONSD is a reliable technique for
prediction of elevated intracranial pressure.
Keywords: Optic Nerve Sheath Diameter, Elevated Intracranial Pressure, Tumor Craniotomy
INTRODUCTION
rise in ICP will cause the optic nerve sheath to dilate with
An increased intracranial pressure is a serious
resultant increase in the sheath diameter as a result of
neurological problem that can result in long-term
increased CSF pressure (6).
neurological consequences. Therefore, rapid detection of
This optic nerve sheath diameter can be
raised ICP is of great importance to obtain good outcome
measured using ultrasonography, which is a non-invasive
in such patients. An EICP may be developed by a variety
and rapid method of detecting EICP (7).
of causes such as head trauma, an intracranial mass
Trauma, neurosurgery, and emergency medicine
lesion, venous sinus obstruction etc. Patients with a mass
all use this technique. Traumatic brain injury (TBI) has
lesion are at risk for EICP because of the compressive
been the subject of numerous research that compare
effect of the lesion or obstructive hydrocephalus (1-2).
ONSD findings to CT/MRI findings and the effect of
Although the invasive methods such as intra-
brain dehydration measures on its follow-up assessments
parenchymal and intra-ventricular devices are the
(8).
reference standard for ICP monitoring but they not
We aimed to evaluate the diagnostic accuracy of
always used due to many causes such as unavailability of
optic nerve sheath diameter guided by ultrasound in
the technique expert in many hospitals, presence of
predicating rise in ICP in patients undergoing elective
contraindications (coagulopathy) and cost. In addition,
tumour craniotomy and to correlate ONSD
they have serious complications such as intra-cranial
measurements to clinical and radiographic features on
hemorrhage, seizure and infection (3-4).
CT brain suggesting increase in ICP pre and post-
With the possible complications of invasive ICP
operatively in patients scheduled for elective tumour
monitoring, non-invasive tools for detection of raised
craniotomy.
ICP is of potential benefit. Non-invasive tools such as
Magnetic Resonance Imaging (MRI) and Computed
PATIENTS AND METHODS
Tomography (CT) scans of the brain are free of these
From January 2020 to May 2020, this prospective
limitations and complications. However, they are time
observational study was conducted on seventy-one
consuming, costly, not always available and have risk of
patients underwent elective tumor craniotomy at
radiation exposure for CT scan. Also, they are not
Zagazig University hospitals.
feasible in unstable patient and only give snap shot
information. (3&5).
Ethical Consideration:
The optic nerve surrounded by a sheath that was
An approval of the study was obtained from Zagazig
in a direct continuation with the meninges so that, Any
University Academic and Ethical Committee (ZU-
2365
Received: 09/12/2021
Accepted: 08/02/2022
c:\work\Jor\vol881_15
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2373-2381
Impact of Left Atrium Function on In-hospital Course in Patient with
ST-segment Elevation Myocardial Infarction undergoing
Primary Percutaneous Coronary Intervention
Aya Elsayed Abozied*, Ragab Abdelsalam Mahfouz,
Ekhlas mohamed Hussein and Mohamed Safwat Abdeldayem
Department of Cardiovascular Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aya Elsayed Abozied, E-Mail: draya.abozied@gmail.com, Mobile: (+20) 01064282696
ABSTRACT
Background: Left atrial (LA) volumetric assessment by echocardiography remains a simple, non-invasive technique
for left atrial functional assessment.
Objective: The aim of the current work was to assess the left atrial function and its relation to the severity of the lesion
in-hospital course in patients with ST-segment Elevation Myocardial Infarction (STEMI) undergoing Primary
Percutaneous coronary intervention (PCI).
Patients and Methods: This cross-sectional study included a total of 135 patients with acute STEMI, attending at
Department of Cardiology, Zagazig University Hospitals. The included subjects were categorized into two groups;
Group 1 included those, who developed adverse events. (31 patients "23%"), and Group 2: included patients with
benign course. (104 patients "77%"). Coronary angioplasty as well as Echocardiography were done to all patients.
Results: Regarding the echocardiographic parameters, there were significant differences between both study groups
as regards Wall motion score index, left atrium volume index, Left atrium expansion index, LA total ejection fraction
and E/e ratio. There was no significant difference between the two groups regarding LVEF. There was a high
significant correlation between left atrial volume index and Wall Motion Score Index, Syntax score, Left atrium
expansion index, LA total ejection fraction and E/e ratio. On a multivariate model for independent predictors for
hospital adverse events were High syntax score, Left atrium volume index and Left atrium expansion index.
Conclusion: It could be concluded that LA functions has high significant correlated with the severity of the lesion
and a good prognostic factor in hospital course of STEMI patients undergoing primary PCI.
Keywords: Left Atrium, ST-segment Elevation Myocardial Infarction, Percutaneous Coronary Intervention
INTRODUCTION
a third (38 percent) of patients with MI had symptoms of
Despite breakthroughs in the identification and
diastolic dysfunction, and a quarter (24 percent) had
treatment of acute coronary syndromes, they are still the
restrictive left ventricular filling due to this dysfunction
greatest cause of death and disability in the world(1).
(7).
Primary percutaneous coronary intervention,
As part of the LA phasic function, the Left
current antithrombotic treatment and secondary
Atrium functions as a continuation of the Left
preventative measures have all contributed to the
Ventricular system, especially during diastole, hence its
reduction in immediate and long-term mortality
function and size are greatly influenced by the left
following a STEMI (2).
ventricular compliance (8).
Even still, mortality is significant, with 13% of
During ventricular systole, the pulmonary
patients dying within six months, with higher death rates
venous return is stored in the LA. Early in ventricular
among patients with higher risks, which warrants
diastole, it becomes a route for pulmonary venous return.
ongoing efforts to enhance care quality, adherence to
The late diastole LV filling is aided by this pump, which
recommendations, and research (3).
acts as a backup pump (8).
Prior to a fibrinolytic treatment procedure
The early emergence of ischemic mitral
known as primary PCI, individuals with a STEMI should
regurgitation, which is frequent in heart failure patients,
be treated with an immediate percutaneous catheter
can be prevented by better understanding the adverse
intervention (PCI). By preventing some of the bleeding
effects of left atrial ischemia, such as LA dysfunction
risks of fibrinolysis and preserving coronary artery
and dilatation. Managing ischemia in the LA would
patency, it lowers the mortality rate (4).
eventually benefit patients with CAD, with higher rates
In coronary angiography, the SYNTAX score is
of morbidity as well as mortality (9). Though CT or MRI
one of several measures of CAD severity. When
are more advanced methods of assessing left atrial
performing three-vessel PCI, it's important to know your
function, the ability to use echocardiography to measure
patient's SYNTAX score because it can help you decide
the volume of the left atrium (LA) during the acute phase
whether or not they'll have a successful outcome(5).
of a myocardial infarction has rarely been studied (10).
Highest risk and poorest prognosis for
Semiquantitative less angle dependent non-
revascularization with PCI than with coronary bypass
invasive Tissue Doppler Imaging can identify the
surgery is found in patients with the highest grades (6).
inherent low velocities of atrial myocardial wall in a non-
CAD has been demonstrated to produce both systolic
invasive manner (10).
and diastolic dysfunction of the left ventricle. More than
2373
Received: 09/12/2021
Accepted: 08/02/2022
c:\work\Jor\vol881_16
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2382-2387
Comparison of Dexmedetomidine Versus Dexamethasone as Adjuvants to
Intrathecal Bupivacaine in Emergency Orthopedic Lower Limb Operations
Mohamed E. Elshahawy, Hani I. Taman, Mostafa S. Elawady, Ahmed M. Farid*
Anaesthesia and Surgical Intensive Care Department, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed M. Farid, Mobile: (+20)1002356222, E-Mail: ahmfarid15@hotmail.com
ABSTRACT
Background: Various adjuvants were added to intrathecal anesthetics to improve quality of the block and postoperative
analgesia.
Objective: The aim of the current work was to compare the efficacy of adding dexmedetomidine versus dexamethasone
as adjuvants to intrathecal bupivacaine in emergency orthopedic lower limb surgery.
Patients and Methods: This prospective comparative double blinded study included a total of 90 patients with lower
limb trauma requiring surgery, attending at Mansoura University emergency Hospital. Cases were randomly divided
into three groups; each consisted of 30 cases. Group A received dexmedetomidine as an adjuvant to bupivacaine, Group
B received dexamethasone as an adjuvant, and Group C received spinal bupivacaine plus 1 cm of normal saline. Sensory
and motor blocks as well as post-operative VAS score in addition to need for analgesics were assessed.
Results: Demographic data did not differ between the three study groups (p > 0.05). Group A showed a significantly
earlier onset of sensory block (p =0.005), motor block (p = 0.009), as well as late regression to L1 sensory level (p
<0.001). Additionally, longer analgesia (p < 0.05) and longer time before the first call for analgesics (p = 0.005) was
associated with group A. However, complications encountered did not differ between the three study groups (p > 0.05).
Conclusion: It could be concluded that intrathecal dexmedetomidine is superior to both dexamethasone and bupivacaine
alone regarding duration of analgesia and pain severity. Moreover, it has more rapid onset and longer duration of sensory
blockade. No significant side effects were noted when compared to the remaining groups.
Keywords: Adjuvants, Intrathecal, Emergency, Orthopedic, Analgesia.
INTRODUCTION
drug that has been studied for its function as an adjuvant
Although lower limb procedures can be
to local anesthetics in neuraxial and peripheral nerve
conducted under local or general anesthesia, neuraxial
blocks throughout the last decade (10).
blocking is the preferable approach. Spinal blockade is
Steroids' methods for potentiating analgesic
distinguished by its cost-effectiveness, fast start, and
effects appear to be distinct from its inherent anti-
ability to achieve deep block with a lesser risk of
inflammatory activity (11, 12). There's additional evidence
infection. Nonetheless, because the medications used
that dexamethasone's analgesic actions are amplified by
for this sort of block have a short duration of effect, the
both local and systemic effects on nerve fibers (13).
patient's experience with post-operative pain is critical.
Research compared the effects of 8 mg
As a result, pain management requires the use of
(preservative-free) intrathecal dexamethasone with
postoperative analgesics (1,2).
conventional dosages of 0.5 percent hyperbaric
Multiple adjuvants have been proposed to extend
bupivacaine in orthopedic procedures. It has been
the duration of action and lessen the negative effects of
proven to extend the duration of sensory block in spinal
local anesthetic medicines (3). Opioids, alpha 2 agonists,
anesthesia without causing any notable side effects (14).
steroids, neostigmine, and vasoconstrictors are
This study was aimed to compare the efficacy of
examples of adjuvants (2, 4).
adding
dexmedetomidine
compared
with
Clonidine and dexmedetomidine are two 2
dexamethasone to intrathecal bupivacaine regarding
agonists that impact 2 receptors pre- and post-
duration of anesthesia and post-operative analgesia for
synaptically (5). Dexmedetomidine is a 7-fold more
emergency lower limb orthopedic operations.
selective alpha·2 receptor agonist than clonidine and
works in a similar way to block hyperpolarization
PATIENTS AND METHODS
activated cation channels. Dexmedetomidine has a long
This prospective comparative double blinded study
history of usage as an analgesic and anesthetic. It is
included a total of 90 patients with lower limb trauma
known for its analgesic, anti-anxiety, neuroprotective,
requiring surgery, attending at Mansoura University
and anesthetic sparing properties (6). Additionally, it was
emergency Hospital. Cases were randomly divided into
utilized to prolong analgesia in epidural, subarachnoid,
three groups; each consisted of 30 cases.
and caudal blocks (7,8). Intrathecal dexmedetomidine has
Group A received dexmedetomidine as an
been demonstrated to have a longer duration of block. It
adjuvant to bupivacaine, Group B received
also enhanced postoperative analgesia without causing
dexamethasone as an adjuvant, and Group C received
any major side effects, especially when given at dosages
spinal bupivacaine plus 1 cm of normal saline.
of less than 5g (9).
Ethical Consideration:
An approval from Institutional Review Board
Dexamethasone is a strong anti-inflammatory
(IRB-MFM) of Mansoura University, Faculty of
2382
Received: 09/12/2021
Accepted: 08/02/2022
c:\work\Jor\vol881_17
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2388-2393
Clinical and Radiological Diagnosis of Talar Fractures: Review Article
Mohsen Mohamed Abdo Mar'éi, Reda Hussien El-kady,
Ali Adyaab Ali Adyaab, Mohamed Abdelaziz Mohamed Gaith
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt.
Corresponding Author: Ali Adyaab Ali Adyaab, E- Mail: alawei4u@gmail.com, Mobile: (+20) 01110489874
ABSTRACT
Background: Less than one percent of all foot and ankle fractures are caused by talar neck fractures. Arthritis,
osteonecrosis, and fractures due to malunion were also common. High suspicion is needed to identify talar process
fractures, especially in the context of ankle sprain-like processes including inversion and/or eversion, as these injuries
are difficult to detect on routinely radiographs.
Objective: This review article aimed to characterize talus neck fractures and their clinical and radiological diagnosis.
Methods: These databases were searched for articles published in English in 3 data bases [PubMed Google scholar-
science direct] and Boolean operators (and, OR, not) had been used such as [Talar fractures, foot & ankle fractures] and
in peer-reviewed articles between May 1977 and January 2021, no language limitations, and filtered in selected data
basis. However, the range of time interval for researches was wide as there was scarcity of data on the particular
reviewed, accurate and depth in the retrieved literature. Documents in a language apart from English had been excluded
as sources for interpretation. Papers apart from main scientific studies had been excluded (documents unavailable as
total written text, conversation, conference abstract papers and dissertations).
Conclusion: In some cases, talar fractures are accompanied by soft tissue envelope damage (A common link between
open talus fractures). Talar body extrusion and deltoid ligament encirclement are two distinct features of Hawkins type
III fracture dislocations. It is typically possible to detect talar neck or body fractures by taking routine ankle radiographs.
Keywords: Talar fractures, Foot and ankle fractures.
INTRODUCTION
most common cause of talar neck fractures. Accidents
Both fractures preceding and those occurring
involving automobiles and falls from great heights are
laterally or laterally next to the lateral process were
two of the most common causes of injury today (1, 3).
identified as separate types of fractures in the talus. It is
important to distinguish between tibiotalar and subtalar
Talar Neck Fractures:
fractures since they both impact the mechanical
Classification: Hawkins (5) described a classification
alignment and congruence of the joints. The talus fracture
system that might be linked to prognosis in his seminal
is the second most common type of tarsal bone fracture,
study. He divided fractures into three groups: I, II, and
with around half of all talus fractures occurring (1).
III. Canale and Kelly published the long-term outcomes
There are only 1% of all foot and ankle fractures
of their talus fracture series in 1978. The three Hawkins
that result in fractures to the talar neck, which is the most
groups were referred to as "types," and a previously
prevalent area for talus damage (2-4). A high-energy axial
unidentified "type IV" was included (6).
load coupled with excessive ankle dorsiflexion is the
Figure (1): Hawkins classification (7)
Type I fracture: Non-displaced talus neck fractures are the most common talus fracture type (Figure 2). Type I fractures
become non-type I fractures when there is sufficient displacement. At some point along the tibia's middle or posterior
side, the fracture line crosses the subtalar joint. Talias stays in its original position within ankle and subtalar joints. One
of three primary blood supply pathways, the anterolateral neck, is impacted in principle (7).
2388
Received: 14/12/2021
Accepted: 13/02/2022
c:\work\Jor\vol881_18
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2394-2399
Assessment of the Ideal Time Interval between Repeated Shock
Wave Lithotripsy Sessions for Renal Stones
Abdulrahman Abubaker Alzubir*, Aref Mohamed Maarouf,
Maged Mohamed Ali, Mahmoud Mohamed Malek
Department of Urology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Abdulrahman Abubaker Alzubir, E-mail: abdulrahmanalzubir@gmail.com,
Mobile: (+20) 01552920034
ABSTRACT
Background: An extracorporeal shock wave lithotripsy (ESWL) procedure is frequently used to treat upper urinary
tract urolithiasis.
Objective: Determining the optimal interval between repeated sessions of shock wave lithotripsy for renal stones.
Patients and Methods: Between June 2021 and February 2022, three groups of thirty-six patients underwent elective
outpatient lithotripsy for renal stones. Patients who required many SWL sessions were studied and classified into 3
groups, 12 patients each. The first group's SWL sessions were separated by three days, while the second group's sessions
were separated by one week. Those in the third group, sessions were repeated after two weeks. Three groups were
compared on the VAS scores they recorded during and after the ESWL.
Results: Stone clearance rates were 83.3%, 75.0%, and 91.7% (P= 0.54) for groups 1, 2, and 3. There was no significant
difference between three groups as regard laboratory parameter (B2-microglobulinuria and Microalbuminuria) after 1st
session, after 2nd session the laboratory parameter was significantly higher in group 1 with no significant difference
between groups 2 and 3. All groups increased after 2nd session then decreased after one month. Steinstrasse was
insignificantly associated with group 3 (8.33%, P =0.51).
Conclusion: Our findings support the transient effect of ESWL through measurement and follow up the laboratory
parameters and possible complications. We concluded using SWL to treat renal stones is safe and effective, and short-
interval treatments do not raise the risk of complications.
Keywords: Laboratory parameter (B2-microglobulinuria and Microalbuminuria), Renal stones, Repeat sessions, Shock
wave lithotripsy.
INTRODUCTION
group 2 within 7 days intervals, and group 3 within 14
Long before the advent of ESWL in the field of
days intervals).
kidney stone treatment, this technique was used to treat
kidney stones. SWL has been recommended as an
Inclusion criteria:
alternative to endoscopy for the treatment of renal
1. Aged > 18 years.
calculi larger than 1 centimetre but smaller than 2
2. Renal stone burden in an adult patient less than
centimetres, according to the most recent standards (1).
two centimeters in a normally functioning
Outpatients can benefit from SWL because it doesn't
kidney.
require anesthesia and has a low risk of consequences
(2).
Exclusion criteria:
Repeated SWL treatment of kidney stones have
1. Uncontrolled hypertension.
been linked to renal damage, as is well-documented (3).
2. Renal insufficiency, GFR less than <60
"There are no solid data on periods required between
ml/min/1.73m2.
repeated SWL sessions," as indicated by EUA standards
3. Uncontrolled coagulopathy.
for 2019. However, clinical evidence shows that more
4. Morbid obesity; body mass index (BMI) >35
sessions can be successfully completed (within 1 day for
(stone to skin distance >10 cm).
ureteral stones) (4).
5. Uncontrolled urinary tract infection.
We aimed to determine the optimal interval
6. Pregnancy.
between repeated sessions of shock wave lithotripsy for
7. Patients who had received treatment for less
renal stones.
than two sessions were excluded from the
study.
PATIENTS AND METHODS
8. Single kidney.
The trial included 36 patients who reported to the
9. Massive hydronephrosis.
Urology Department with a kidney stone between June
10. Elevated microalbuminuria prior to 1st SWL
2021 and February 2022 and were treated with ESWL
session (> 30 mg/day).
using an electromagnetic Dornier lithotripter. Patients
11. Radiolucent stone.
were grouped equally and randomly in 3 Groups,
(Group 1 performed ESWL within 3 days intervals,
Pre-procedural evaluation:
2394
Received: 13/12/2021
Accepted: 10/02/2022
c:\work\Jor\vol881_19
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2400-2405
Assessment of Role of Computed Tomography Volumetry in Preoperative
Evaluation of Liver Volume in Living Donor Liver Transplantation
Mohamed Ibrahim Taema1, Mohamed Mohsen Tolba Fawzi2,
Aya Mohamed Abd El-Rhim Ali*1, Mohamed Moataz Al-Fawal1
Departments of 1Radiodiagnosis, and 2National Hepatology and
Tropical Medicine Research Institute Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aya Mohamed Abd El-Rhim Ali, E-Mail: ayaboraey@yahoo.com Mobile: (+20) 01069946457,
ABSTRACT
Background: It has been frequently utilized in liver transplantation surgeries to determine the liver's preoperative
computed tomography volumetry (CTV) to avoid issues that may arise from graft size and residual liver volume.
Objective: Liver transplantation in Zagazig University Hospitals was studied to determine the accuracy of the
estimation of graft size using manual and automated interactive software. Patients and Methods: Eighteen patients;
with age range from 21 to 42 years (mean age 30.4 years) and gender distribution of 6 females (33.3%) and 12 males
(66.7%). The outpatient clinic of liver transplantation at the National Hepatology and Tropical Medicine Research
Institute in Cairo, Egypt, directed all patients to the Radiology Department. All patients had computed tomography
volumetry. Results: Differences in graft size between preoperative and actual graft measurements had an average
volume of 21.7+33.65 cm3 and between the pre-op and actual graft volumes, the mean difference was 51.96+33.65 cm3
(range 4-131 cm3). Mean estimated graft-to-recipient weight ratio (GRWR) was (1.1±.2) and mean actual GRWR was
(1.1±.3). Correlation between estimated GRWR and actual GRWR was statistically significant. A significant association
was found between mean preoperative volume and total volume of the graft. The findings were statistically significant.
Conclusion: For determining the volume of preoperative grafts, CT volumetry is a reliable method that was found to
be highly correlated with the actual graft volume.
Keywords: Computed tomography volumetry, Liver transplantation.
INTRODUCTION
with the surgical process. Important anatomical
End-stage liver failure can only be treated by a
differences that could affect surgical methods should be
liver transplant. Living donor liver transplantation
addressed (5). There are only 55.61% of people who have
(LDLT) has emerged as an option to cadaveric liver
the usual anatomy of the hepatic arterial. The left gastric
transplantation in areas where it is uncommon. However,
artery can be used to substitute the left hepatic artery, and
this procedure necessitates a lengthy and meticulous
the superior mesenteric artery can be used to replace the
initial evaluation. Preoperative volume appraisal is one
right hepatic artery, in addition to auxiliary hepatic
of these difficult steps, and it is of critical relevance to
arteries on the right or left (6).
both the donor and the recipient alike. Accordingly, the
The predicted volume and graft weight
graft's volume to weight ratio should be at least 0.8% in
acquired by CTV have a strong agreement (7).
order to avoid small-for-size problems (cellular damage,
Nakayama et al. (8) reported that the mean weight of an
liver with limited capacity to perform metabolic
adult liver was (881.1± 249.8 g), while mean volume of
processes or synthesize new blood cells, and ascites,
liver was (956.99± 280.1 cm3).
poor liver perfusion, increased abdominal pressure). To
CT scans and computer systems that
avoid life-threatening complications for the donor, the
automatically calculate donor graft volume are
residual liver capacity must be at least 30 percent larger
frequently used in the preoperative planning of LDLT.
(1). If the liver graft is excessively large, it might cause
Nevertheless, despite advances in technology, variations
liver necrosis and slow wound healing, which can have
in volume assessments between preoperative and
a devastating effect on the recipient (large-for-size) (2).
intraoperative procedures continue to be observed (9).
As long as the donor does not have steatosis or
Liver anatomy and the size of potential donor
any kind of liver disease, a 30-percent remnant liver
organs are currently assessed preoperatively using CT-
volume for an adult donor is regarded the minimum
volumetry (8). CT-volumetry can be utilized following
criterion for transplantation to proceed (3). A donor's pre-
clinical assessments of the optimal graft size (e.g., using
existing liver condition can have an impact on the graft
the "graft weight to body weight ratio") to find the most
function and survival in addition to its size, which is a
suitable liver segments for donation (10-11).
relevant consideration. Steatosis of the liver is a typical
A radiologist typically sums up the liver area
occurrence in industrialized countries and can have a
on each axial slice of a CTV using manual contour
substantial impact on surgical outcomes in the
tracing of the hepatic outlines. The basic optical mouse
transplantation process (4).
is frequently used for contour tracing. A freehand
A thorough understanding of intrahepatic
electromagnetic pen tablet has been used to trace the
vascular and biliary anatomy is necessary for accurate
liver margins in novel ways (12,13). Both procedures are
liver volume assessment. An accurate measurement of
equally accurate and precise. With the freehand
the donor liver volume necessitates thorough familiarity
electromagnetic pen contour-tracing method, the
2400
Received: 13/12/2021
Accepted: 10/02/2022
c:\work\Jor\vol881_20
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2406-2411
Assessment and Validation of Ultrasound liver Imaging Reporting and
Data System Version 2017 (US-LI-RADS V 2017) in Patients at
High Risk of Hepatocellular Carcinoma
Rana Akram Awad*, Mohamed Zakaria Elazazy, Farida Mohammed Elfawal, Sameh Saber Baiomy
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University Hospital, Sharkia, Egypt
*Corresponding author: Rana Akram Awad, E-Mail: rana.akram.awad@gmail.com, Mobile: (+20) 01143021161
ABSTRACT
Background: Improvement of patient-centered outcomes through standardization of ultrasound reporting in patients at
high risk of developing Hepatocellular Carcinoma (HCC).
Objective: To assess the role of US-LI-RADS in the detection of HCC in high-risk patients.
Patients and Methods: Fifty patients of both sexes referred from Tropical and Internal Medicine Departments with
cirrhosis due to chronic viral hepatitis (C&B) with a mean age of 58 years were included in this comprehensive study,
at the Radiodiagnosis Department, Faculty of Medicine, Zagazig University Hospital. All patients were subjected to
conventional B-mode ultrasound. Results: Out of the 50 cirrhotic patients, 13 patients (26%) had positive findings by
the US. Using US-3 as a positive finding had a high specificity and negative predictive value (100 percent). Instead of
being high, the sensitivity and positive predictive value (PPV) were poor when a positive observation was classified as
US-3 (43.3 percent). Conclusion: It was found that the LI-RADS US-3 category had a high specificity for
hepatocellular carcinoma diagnoses, however, it had a low sensitivity.
Keywords: Ultrasound liver Imaging Reporting and Data System Version 2017, Hepatocellular Carcinoma.
INTRODUCTION
Visualization A: Minimal or no restrictions.
Hepatocellular carcinoma is the third most
Sensitivity is unlikely to be affected by any limitations.
prevalent cause of cancer-related death worldwide, and it
Visualization B: With some limits. Small masses can be
is the sixth most common type of cancer (1). HCC is a
obscured by limitations. Visualization C: Sensitivity to
public health issue in Egypt, where it accounts for 33.63
focal liver lesions is greatly reduced as a result of severe
percent of male malignancies and 13.54 percent of
restrictions. In patients at high risk of developing HCC,
female cancers (2) Hepatitis C and B, alcoholic and
Improved communication with patients, referring
nonalcoholic cirrhosis, and hepatocellular carcinoma are
physicians and improved patient-centered outcomes can
all risk factors for hepatocellular carcinoma. Once it is
be achieved by standardizing ultrasound reporting (5).
discovered, which is usually at a late stage of the disease,
The present study aimed to assess the role of US-
the prognosis is bad (2). Overall survival improves when
LIRADS in the detection of HCC in high-risk patients.
a patient is diagnosed at an early stage and given a
curative treatment plan (3).
PATIENTS AND METHODS
For HCC surveillance, ultrasound (US) is a
This study was undertaken in the period between
commonly utilized imaging technique since it is widely
October 2020 to June 2021, at the Radiodiagnosis
available and inexpensive, noninvasive, and doesn't
Department; Zagazig university hospitals as a
involve radiation exposure (4) When it was first
comprehensive study, It included 50 cirrhotic patients of
developed, this test had no established criteria for
both sexes (27 males and 23 females) referred from the
interpreting the results and making management
Tropical and Internal Medicine Departments due to
decisions. The (US-LIRADS®) algorithm has been
chronic viral hepatitis (C&B) with a mean age of 58
created by the ACR to address this issue (5). A detection
years.
score and a visualization score are part of this algorithm.
US-detection LIRADS's score is broken down into three
Ethical consent:
areas to help managers make decisions.
Approval of the study was obtained from Zagazig
US-1: Negative. (There was either no observation
University Academic and Ethical Committee (ZU-
or benign observations). like, calcified granuloma, focal
IRB#6829). Every patient signed informed written
parenchymal sparing from steatosis, as well as a simple
consent for the acceptance of participation in the
cyst. US-2: Sub-threshold. (Uncertainty about the
study. This work has been carried out following The
benignity of observations smaller than 10 mm in
Code of Ethics of the World Medical Association
diameter), Keeping an eye on them could be warranted in
(Declaration of Helsinki) for studies involving
the short term by the US. US-3: Positive. (Multiphase
humans.
contrast-enhanced imaging may be warranted if the
Inclusion criteria: Radiologic diagnosis of liver
diameter of the thrombus is more than or equal to 10 mm,
cirrhosis of any etiology, and >18 years old.
or if the thrombus is a fresh thrombus), and the
Exclusion criteria: Creatinine level > or = 2.0 mg/dl.
visualization score also has three categories and informs
the expected sensitivity of the US examination (5).
All patients were subjected to:
2406
Received: 14/12/2021
Accepted: 13/02/2022
c:\work\Jor\vol881_21
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2412-2416
Erythrocyte Glutathione Transferase is A Sensitive Marker of
Hemodialysis Adequacy
Gamal E. Mady1, Tamer W. Elsaid1, Ghada M. Abdelazim1, Shaimaa Z. Abdelmegied1*
1-Nephrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Shaimaa Z. Abdelmegied, E-Mail: shaimaazaki@med.asu.edu.eg,
Mobile: (+20) 01280321730
ABSTRACT
Background: Erythrocyte glutathione transferase (e-GST) is a non-dialyzable dimeric protein in red cells. It binds and
sequesters a variety of small or large toxic compounds.
Objective: This study verifies whether e-GST can assess hemodialysis (HD) adequacy in different techniques or is
complementary to the Kt/V urea parameter.
Patients and Methods: This is a pilot cross-sectional study included 20 end-stage renal diseases (ESRD) patients on
conventional HD, 20 ESRD patients on hemodiafiltration (HDF) for at least 6 months, and 20 healthy controls. Serum
e-GST was measured for all patients and controls.
Results: Serum e-GST can predict inadequate dialysis at cut off value >14 ng/ml with area under curve (AUC) 0.871,
sensitivity 95%, specificity 60%, PPV 70.4% and NPV 92.3%. e-GST was significantly high in patients on conventional
HD and HDF (mean ±SD 18.35±5.61 ng/ml, 15.20±4.40 ng/ml) respectively compared with control subjects (mean ±SD
2.80±1.36 ng/ml) P-value <0.0001. Post hoc analysis showed a significant difference between control and both
conventional HD and HDF patients (P <0.0001, 0.0001) respectively while no significant differences between
conventional HD and HDF patients' P-value (0.061). Patients were redistributed according to kt/v. Patients with kt/v
1.3 have significantly higher e-GST (mean ±SD 20.05±4.35 ng/ml) compared with kt/v >1.3 (mean ±SD 13.5±3.82
ng/ml) p-value 0.0001. The patients who have elevated e-GST have increased odds of inadequate dialysis (odds ratio:
28.5). In Conventional HD and HDF, e-GST was negatively correlated with kt/v and URR (P<0.0001).
Conclusion: Erythrocyte glutathione transferase is a highly sensitive marker for hemodialysis adequacy in different
modalities and didn't need any calculations for interpretation.
Keywords: Erythrocyte glutathione transferase, Hemodialysis, Adequacy.
INTRODUCTION
End-stage renal disease (ESRD) is a major
Erythrocyte glutathione transferase (e-GST) is
public health problem worldwide (1). An ideal dialysis
a non-dialyzable enzyme compartmentalized in the red
therapy should remove all toxins (small, middle
cells devoted to cell protection by promoting the
molecules, and protein-bound solutes) However, only
conjugation of glutathione with toxins of very different
small toxins are easily removed by all dialysis
shapes also via binding and sequestering small or large
techniques (2). Assessment of solute removal during
toxic compounds and peptides (5), e-GST may be
dialysis has always been based on urea removal in a
considered a sort of ideal long-term biomarker that
single hemodialysis session despite the adverse effect of
should provide a measure of circulating toxins in the
middle molecules and protein-bound solutes on patient
period not limited to a single day or dialysis session but
survival so it should not be used as the sole indicator of
extended up to multiple dialytic sessions within 12
dialysis adequacy (3).
months of the life span of circulating erythrocytes (6).
The identification of new clinical indicators
The study aims to verify whether e-GST can
able to reveal the degree of blood purification from
assess hemodialysis adequacy in different techniques or
small as well as large toxins in a wide range of dialysis
is complementary to the Kt/V urea parameter.
sessions will be of medical interest. Glutathione-S-
MATERIALS AND METHODS
transferases is a dimeric protein composed of 2 identical
This pilot cross-sectional study was carried
subunits of about 25 kDa. Glutathione-S-transferases
out on 20 ESRD patients on conventional HD, 20
represent a superfamily of enzymes involved in cell
ESRD patients on HDF matched as regard age and sex
protection and detoxification, prominent function of
between 18 and 60 years old on regular hemodialysis
these enzymes is the conjugation of glutathione (GSH)
3 sessions /week, each session 4 hours for at least 6
to toxic hydrophobic compounds provided by an
months and 20 healthy controls with normal renal
electrophilic center. This reaction facilitates toxin
function.
inactivation and renal elimination. Red blood cells
Excluding patients with hyperbilirubinemia
express almost exclusively a single GST isoenzyme,
and Chronic liver disease. Then patients were
GST-P1which represents more than 95% of the
redistributed according to Kt/V into 2 groups: The
erythrocyte GST (e-GST) pool. Over-expression of e-
adequate dialysis group: (Kt/V > 1.3) and the
GST has been found in uremic patients under
inadequate dialysis group: (Kt/V 1.3). All patients
maintenance hemodialysis (MHD)(4).
were subjected to detailed history taking, clinical
examination, complete blood count (CBC), Chemistry:
2412
Received: 15/12/2021
Accepted: 14/02/2022
c:\work\Jor\vol881_22
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2417-2421
Is the Treatment with Direct Acting Antiviral Agents (DAAs)
Affecting Glomerular Filtration Rate (GFR)?
Iman Ibrahem Sarhan1, Reem Mohsen Elsharabasy1,
Mohamed Hassan Abdel Gawad Mohamed2, Fatma Abdelrahman Ahmed*1
1Department of Internal Medicine and Nephrology, Faculty of Medicine, Ain Shams University, Egypt
2Department of Internal Medicine and Nephrology, Faculty of Medicine, Alexandria University, Egypt
*Corresponding author: Fatma Abdelrahnman Ahmed, E mail: fatmaabdelrahman14@yahoo.com,
Mobile: (+20) 01101216222
ABSTRACT
Background: The kidney is a major component of extrahepatic manifestations of hepatitis C virus (HCV) clinical
syndrome and the risk of chronic kidney disease (CKD) is more than 20% higher in patients with HCV infection than
in seronegative individuals. Introduction of direct acting antivirals (DAA) represented a transforming point in the
treatment of HCV.
Patients and Method: Retrospective cohort study of 118 adult HCV infected patients with normal baseline kidney
functions and eGFR >60 ml/min were included. Patients coinfected with HBV and those with impaired kidney functions
at beginning of treatment were excluded. Patients were divided into 3 groups according to their DAA-combination
treatment regimen. Patients' eGFR were measured at baseline, at the end of treatment and one year later.
Results: Our results showed that patients who received sofosbuvir/daclatasvir/ribavirin, their pre-treatment eGFR
mean±SD was (86.156±16.37). Post treatment eGFR showed an insignificant change after end of treatment (84.736±
17.41) and 1 year after treatment (82.06± 18.07). Those who received sofosbuvir/daclatasvir, their pretreatment eGFR
mean ±SD was (94.606 ±19.32). Post treatment eGFR showed an insignificant change after end of treatment (89.396
±18.39) and 1 year after treatment (89.176±20.27). As for patients who received sofosbuvir/simeprevir, their
pretreatment eGFR mean ± SD was (92.716 ± 15.11). Post treatment eGFR showed an insignificant change after end of
treatment (88.366 ±16.27) and 1 year after treatment (89.016± 15.72).
Conclusion: The new direct antiviral agents like sofosbuvir, daclatasvir and simeprevir are safe regarding glomerular
filtration rate in patients with normal renal function. However, the treated patients need careful monitoring of kidney
function tests during the period of treatment.
Keywords: Direct acting antiviral, GFR, HCV, Renal function
INTRODUCTION
Aim of the present study was to evaluate the
In both chronic kidney diseases (CKD) patients
effect of direct antiviral agents on glomerular filtration
and kidney transplant recipients, HCV infection raises
rate (GFR) in HCV positive patients with normal renal
the risk of end-stage renal disease (ESRD) and increases
function after the full treatment period (12 weeks) and
the rates of morbidity and death (1).
1 year after the end of regimen.
Different histological patterns of renal
manifestations are reported in association with HCV
PATIENTS AND METHODS
infection such as membranous nephropathy (MN),
Our study was observational retrospective cohort
membranoproliferative glomerulonephritis (MPGN),
study, conducted in Hepatology Unit in Sharque
focal segmental glomerulosclerosis (FSGS), fibrillary
Elmadinah Hospital Alexandria, at the period between
glomerulonephritis, IgA nephropathy, immunotactoid
January 2018 and December 2018. It included 118
glomerulopathy, interstitial nephritis and vasculitic
patients adult >18 years who had received DAAs and
renal involvement. The most common HCV-associated
attended hepatology clinic during the study period, they
glomerulopathy is type I MPGN associated with type II
were recruited irrespective of their virological response.
mixed cryoglobulinemia (2).
Only patients with normal kidney functions at the
HCV-associated CKD may be attributed to viral
beginning of the treatment were included in our study
antigen- antibody complexes, cryoglobulinemia and
(eGFR> 60 ml/min, normal serum creatinine). We
possibility of a direct viral cytopathic effect (3). Treating
excluded: those with co-infection with HBV, patients
HCV decreases these complications and improves life
with chronic kidney disease and those maintained on
span (4).
regular hemodialysis or transplant recipients and hard to
There is a very rapid advancement in the
treat
patients
(decompensated
liver
disease,
development of DAAs that made the pharmacological
hepatocellular carcinoma).
details of each DAA more difficult (5). Nephrotoxicity
Patients were divided into 3 groups according to
has been reported after administration of sofosbuvir-
their treatment regimens as follows: Group 1: 61
containing antiviral regimen in HCV infected cases,
patients received sofosbuvir 400 mg /daclatasvir 60 mg
especially in patients with underlying chronic kidney
/ribavirin 600 mg for 12 weeks, Group 2: 35 patients
diseases (6).
received sofosbuvir 400 mg/daclatasvir 600 mg for 12
weeks, and Group 3: 22 patients received sofosbuvir
2417
Received: 13/12/2021
Accepted: 10/02/2022
Functional assessment of anorexia cachexia therapy among Egyptian children undergoing treatment for cancer disease
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 87, Page 2422-2429
Functional Assessment of Anorexia/Cachexia Therapy among Egyptian
Children with Cancer Disease after Nutritional Management
Hesham Sami Abdelmeged, Mahmoud Almahdi Omar, Ghada Mohammed Abdellatif
Department of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Mahmoud Almahdi Omar, Mobile: (+20)01092679334,
E-mail: mahmoud.1.1.1988.mohalhel@gmail.com
ABSTRACT
Background: Nutrition plays a deciding role and a key factor in children with cancer and can influence their outcome.
It is essential for appropriate growth and development and a critical component in the optimization of clinical
outcomes. Objective: This study aimed to improve the nutritional status of children and evaluate the impact of
nutritional counseling and support for these children with cancer.
Patients and Methods: This interventional study was performed in the Oncology Pediatric Department, at the
Zagazig University Children's Hospital for the period from February to August 2021. The study included 54 pediatric
cancer patients who will start chemotherapy. Results: there were no statistically significant differences between the
studied groups according to the Patient-Generated Subjective Global Assessment (PG-SGA) scale at a baseline or 45th
day but there was a statistically significant increase in the frequency of type A among the interventional group and a
statistically significant increase in C and D type among the control group at 90th day. The interventional group showed
a statistically significant increase in type A at 90th day compared to baseline. There was a statistically significant
increase in the mean physical, social, functional domain, anorexia/cachexia subscale (A/CS), and total FAACT scores
among the interventional group compared to the control group.
Conclusion: nutritional intervention is mandatory for cancer patients to prevent cachexia and improve their physical
and social state. Functional assessment of anorexia/cachexia therapy (FAACT) scale and anorexia/cachexia subscale
(A/CS) have good content validity and can be used for characterizing the effect of nutritional intervention and
treatment of anorexia symptoms and/or anorexia-related concerns in patients with cancer.
Keywords: Children Cancer, Nutritional Status, Impaired quality of life, PG-SGA scale, FAACT.
INTRODUCTION
comorbid conditions, fever, and medications such as
Children's cancer is an illness related to severe
steroids which impact nutrition as well as a detailed
morbidity and mortality. Diagnosed children with
physical examination of seven muscle groups, three
specific cancer types develop nutritional-related
adipose depots, and evidence of edema at three sites (4).
problems more often than others. Nutritional status in
Quality of life (QoL) for children diagnosed
those children at diagnosis and during therapy is
with cancer decreases due to chemotherapy,
important to maintain the appropriate functioning of
radiotherapy, surgical
interventions,
prolonged
vital
organ
systems.
Respiratory,
cardiac,
hospitalization, side effects of treatments, being
gastrointestinal,
hepatic,
pancreatic,
renal,
isolated from the society, physical and emotional
hematopoietic, and lymphoreticular dysfunction has
problems, changes in the child's position, and absence
been documented in malnutrition situations (1).
of role within the family and society, disruption of
Nutrition plays a deciding role and a key factor
school life, lack of support systems and coping
in children with cancer and can influence their
methods. Early and effective treatment is essential for
outcome. It is essential for appropriate growth and
successful cancer treatment and high QoL (5).
development and a critical component in the
Assessing QoL is the critical endpoint in
optimization of clinical outcomes (2).
cancer patients with cachexia. The functional
The importance of nutrition in children with
assessment of the anorexia/cachexia therapy (FAACT)
cancer is indisputable. Nutrition influences most
scale consists of the functional assessment of cancer
cancer control parameters in pediatric oncology,
therapy
general
(FACT-G)
scale
and
the
including
prevention,
epidemiology,
biology,
anorexia/cachexia subscale (AC/S) and is a QoL scale
treatment, supportive care, recuperation, and survival.
specific for cancer patients with cachexia (6).
It is widely recognized that the nutritional status (NS)
The current study aimed to improve the
of children diagnosed with and treated for cancer will
nutritional status of children and evaluate the impact of
be probably affected during the disease (3).
nutritional counseling and support for these children
The Subjective Global Assessment (SGA) is a
with cancer.
validated screening tool for malnutrition in
hospitalized patients and the PG-SGA has been
PATIENTS AND METHODS
adapted for cancer patients. The PG-SGA incorporates
This interventional study enrolled 54 pediatric
questions for patients regarding weight history, caloric
oncology inpatients (age 2 to 18 years) in the
intake, functional status and requires additional
Oncology Unit, at the Department of Pediatrics,
assessments by a healthcare professional including
Zagazig University Children's Hospital between
2422
Received: 12/12/2021
Accepted: 09/02/2022
c:\work\Jor\vol881_24
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2430-2435
Evaluation of Distal Radius Fractures in Adults Using Kirschner Wires among
Zagazig University Hospitals
Abdulbari Sulayman Al Mabrouk, Hossam Fathi Mahmoud,
Mohamed Abdallah M. Abdelsalam, Riad Mansour Megahed
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
Corresponding Author: Abdulbari Sulayman Al Mabrouk, E-Mail: abdelbareedres7@gmail.comMobile: (+20) 0122256376,
ABSTRACT
Background: The use of closed reduction and percutaneous K-wires, with or without external fixation, is a common
surgical solution for patients with an unstable distal radius fracture. Objective: To detect effectiveness of K-wiring as an
efficient method for treating distal radius fractures in adults and elderly in Zagazig University Hospitals. Patients and
Methods: At Orthopedic Departments of Zagazig University Hospitals, 24 cases with distal radius fractures were treated
by percutaneous K-wiring with six months follow-up. Results: Most of the participants met the Mayo wrist score criteria
in 13 of the cases where they were evaluated clinically as outstanding. One patient had Sudeck atrophy, seven patients
had superficial skin infection, and two patients had stiffness. Conclusion: In adults and the elderly, distal radius fractures
can be effectively treated by percutaneous K-wiring. The surgery is safe, has a low rate of complications, and requires
only a brief stay in the hospital. By sticking to the fundamental principles and technical features, most of the complications
can be avoided.
Keywords: Distal radius fractures, Kirschner wires.
INTRODUCTION
fractures in adults and elderly in Zagazig University
Fractures of the distal radius are prevalent in
Hospitals.
adults, especially in those who are white and older and live
in high-income nations (1). Starting about age 40, women
PATIENTS AND METHODS
are more likely to suffer from these fractures. For guys
At Orthopedic Departments of Zagazig University
younger than this, the prevalence is higher (2).
Hospitals, 24 cases with distal radius fractures were treated
A fall on outstretched arms or direct impact to
by percutaneous K-wiring in prospective research.
the distal radius can cause the injury. In most cases, wrist
Ethical consent:
abnormalities and impairment result from a fracture in an
An approval of the study was obtained from Zagazig
abnormal posture (3). It is common for young individuals to
University Academic and Ethical Committee (ZU-
suffer a comminuted fracture of the distal end of the radius,
IRB#8025). Every patient signed an informed written
while elderly patients are more likely to have a fracture of
consent for acceptance of participation in the study.
this type due to low-energy trauma (4).
This work has been carried out in accordance with
In order to better manage fractures, surgeons have
The Code of Ethics of the World Medical Association
categorised them according to their anatomical
(Declaration of Helsinki) for studies involving
configuration or fracture pattern. Radio-carpal and radio-
humans.
ulnar joint fractures can be classified using the Frykman
Inclusion criteria: Patients included were older than 18
classification system, which explains whether or not a
years and of both sexes, patients with distal radius fracture
distal ulnar fracture is present (5). Open reduction and
for 2 weeks post injury, and when acceptable reduction was
casting, closed reduction and percutaneous pinning, and
obtained by closed method.
others are among the treatment options accessible to
Exclusion criteria: Patients below 18 years old, failure to
orthopedic surgeons for distal radius fractures (6).
achievement of acceptable reduction by closed methods,
Open reduction and external fixation, as well as
previous wrist deformity, intra-articular fractures, and
open reduction and internal fixation with implants like
associated ulna fracture proximal to the ulnar styloid of
screws, plates or screws with locking plates, are further
the same wrist.
treatment options (6). The use of closed reduction and
percutaneous K-wires, with or without external fixation, is
Primary management: Careful history taking was
a common surgical solution for patients with an unstable
done for all patients as follows:
distal radius fracture (7).
1. Full personal history: name, age, sex, occupation,
The K-wire fixing is inexpensive and less
and dominant side.
intrusive. Osteopenic bone was successfully handled by
2. Past history: details of previous disease or injury to
this treatment, which permitted early return to work,
the affected wrist.
satisfactory final results, and a low complication rate in the
3. Mechanism of injury: fall on outstretched hands,
older population (8). The main complications of this
road traffic accident, direct trauma, or others.
technique will be pin loosing, pin tract infection at the skin
4. Clinical examination: throughout examination of
entry point, loose of reduction, carpal tunnel syndrome,
ipsilateral elbow and shoulder. Neurological
and radial nerve injury (9-11).
examination: median and ulnar nerves, and vascular
It was the goal of this study to detect effectiveness
examination: capillary refill.
of K-wiring as an efficient method for treating distal radius
2430
Received: 15/12/2021
Accepted: 14/02/2022
c:\work\Jor\vol881_25
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2436-2442
Study of the Accuracy of Ultrasonography in Predication of Fetal Growth Restriction
at Thirty-two versus Thirty-six weeks of Gestation
Hend Salah Abdo Saleh, Mahmoud Attia Seksaka, Hanan Hamid Mohammed Aqeelah and
Abd Elrazik Elsayed Abd Elrazik
Department of Obstetrics & Gynecology, Faculty of Medicine - Zagazig University, Egypt
Corresponding Author: Hanan Hamid Mohammed Aqeelah, E-Mail: hanan.hamed1717@gmail.com,
Mobile: (+20) 01032867020
ABSTRACT
Background: In some countries, third-trimester ultrasound monitoring of foetal growth is a standard practice, increasing
detection rates to 40-80%.
Objective: Evaluation of the effectiveness of standard third-trimester ultrasound examinations at 36 weeks' gestation
with those at 32 weeks' gestation for detecting fetal growth restriction (FGR).
Patients and Methods: 132 women who meet the inclusion criteria. Biparietal diameter, head and abdominal
circumferences, and length of the femur were used to calculate the estimated fetal weight (EFW). It was determined that
an immediate Doppler assessment of the umbilical artery pulsatility index from a free-floating umbilical cord section
was necessary when EFW was less than 10th centile by local standard. Automated pulse Doppler measurements were
made. After delivery, neonates were assessed by pediatrician to assess fetal growth.
Results: There was a statistical significance increase in EFW at 36 weeks of gestation compared to values at week 32.
All US parameters had significant validity in predication of fetal growth restriction (FGR) but with higher accuracy in
differentiation than that assessed at 32 weeks of gestation, the most precise was abdominal circumference (AC with)
59.1% accuracy, 65.9% sensitivity and 48.3% specificity for negative cases, then 55.7% and 51.5% for FL and BPD
respectively.
Conclusion: Detection of FGR and related perinatal and neonatal outcomes was more accurate when ultrasound was
performed at 36 weeks' gestation than when it was performed at 32 weeks' gestation.
Keywords: Ultrasonography, Fetal growth restriction.
INTRODUCTION
Preeclampsia may be a warning sign in as many
Increased risks of bad pregnancy outcomes, such
as 60% of these pregnancies. Conversely, while
as fetal death, morbidity and mortality in the perinatal and
accounting for the majority of unfavorable neonatal
neonatal period, and poor neurodevelopment in the
outcomes and stillbirths, growth restriction in late
newborn are linked to growth restriction, as are harmful
pregnancy is still widely ignored (9, 7).
effects in adolescence and adulthood that are delayed (1).
When it comes to predicting late onset growth
If this condition is not detected during pregnancy, it can
restriction, estimates on ultrasound (US) performance
lead to an increased risk of mortality and difficulties for
have been based on systematic reviews of routine US
both the mother and the baby. Prenatal non identification
performance that show detection rates in the vicinity of
has been recognized as a major cause of preventable
50%, which challenges the value of foetal size by US as
prenatal death. Two distinct clinical phenotypes of growth
an established part of the antenatal care (1). Late-onset
restriction exist, each with its own unique course of
clinical forms have yet to be differentiated from earlier
development and course of action (2).
clinical forms, and no efforts have been made to adjust for
Deterioration in Doppler parameters and
potentially significant factors such as baseline risk of the
biophysical parameters in children with early-onset
population, the gestational age at scan, or the growth
growth restriction (generally defined as that identified
assessment parameter utilised (AC alone vs EFW) (3).
after 32 weeks) follows a regular progression (3, 4). Normal
Late-onset small-for-gestational-age (SGA) vs
or slightly raised umbilical Doppler indexes are prevalent
late-onset growth restriction performance is another area
in late-onset growth restriction, with moderately aberrant
where current understanding is lacking. SGA is the lowest
cerebral Doppler but no apparent cardiovascular or
end of the size range, which accounts for many cases of
biophysical abnormalities (5).
constitutional smallness. Growth restriction, on the other
While preeclampsia has a strong correlation with
hand, is a pathological disease (1). Symphysisfundus
early-onset growth restriction, this is not the case with
height measurements are currently used to track growth in
late-onset growth restriction. Using uterine Doppler
the third trimester. SGA children in low-risk populations,
velocimetry, biochemical markers (angiogenic factors),
on the other hand, are rarely discovered in this way. Some
and maternal features, up to 90% of cases of early-onset
countries' routine third-trimester ultrasonography
growth restriction can be detected in the first or second
surveillance of fetal growth increases detection rates to
trimester (6, 7). Detection of early-onset fetal growth
40%80%. It is not yet known, however, if this will have
restriction (FGR) can be improved by integrating uterine
an effect on the perinatal outcome (10).
artery Doppler data obtained in the first or second
It was the goal of this study to evaluate the
trimester with baseline maternal variables (8).
effectiveness of standard third-trimester ultrasound
2436
Received: 14/12/2021
Accepted: 13/02/2022
c:\work\Jor\vol881_26
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 87, Page 2443-2451
Assessment of Outcomes of Headless Intramedullary Screws versus
K-wires Fixation in Metacarpal Fractures
Mohammed Almukhtar Dougdoug, Adel Mohammad Salama,
Amr Mohamed El Adawy, Ahmed Mashhour Gaber
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohammed Almukhtar Dougdoug, E-Mail:
mohammeddougdoug@gmail.comMobile: (+20) 01023710421,
ABSTRACT
Background: In metacarpal fractures of the hand, intramedullary screw fixation (IMS) has been recognized as an
alternate treatment option. Objective: This study aimed to compare hand function restoration and pain reduction at
postoperative follow-up between intramedullary versus K-wire fixation. Patients and Methods: 18 consecutive
patients presented by a total of 20 metacarpal fractures were managed by two methods of surgical fixation;
percutaneous pinning (PCP), and intramedullary headless compression screws (IMHS). They were followed up for a
mean period of 12-24 weeks with an average period of 18 weeks. The study was conducted at Orthopedic
Departments, Zagazig University Hospital (ZUH), and Alkhadra Hospital Tripoli (Libya). Results: Follow up
(months), duration physiotherapy (weeks) and period to return work (days) were significantly shorter in IMHS group.
Also, the same group significantly associated with no splint. Favorable outcome was associated more with IMHS
group but non-significant (may be due to low number of study groups). Conclusion: It's possible to safely and
efficiently treat metacarpal fractures with intramedullary screw fixation because of its reduced risk of complications
and superior prognosis after surgery. The screws required less casting and allowed workers to return to work more
quickly than previously.
Keywords: Intramedullary screws, K-wires Fixation, Metacarpal Fractures.
INTRODUCTION
It was the goal of this study to compare hand
Metacarpal fractures are widespread, it accounts
function restoration and pain reduction at postoperative
for the majority of hand fractures, and orthopedic
follow-up between intramedullary versus K-wire
doctors treat it as one of the most prevalent ailments (1).
fixation.
Fractures of the metacarpal bones are generally due to
accidental falls and direct blows and between the ages of
PATIENTS AND METHODS
15 and 24, the rate is predicted to be more than 250 per
18 consecutive patients presented by a total of 20
100,000. Metacarpal fractures can affect the proximal
metacarpals shaft fractures were managed by two
base, shaft, neck, or head of the bone (2).
methods of surgical fixation; percutaneous pinning
Treatment of metacarpal fractures can lead to
(PCP), and intra medullary headless compression screws
deformity and stiffness as a result of mistreatment, as
(IMHS). The study was conducted at Orthopedic
well as both deformity and stiffness (3). Metacarpal
Departments of Zagazig University Hospital (ZUH), and
fractures can be treated non-operatively or operatively,
Alkhadra Hospital Tripoli (Libya).
depending on criteria such as the location of the fracture,
Ethical consent:
the degree of angulation, shortening, mal-rotation, and
An approval of the study was obtained from
the presence of numerous fractures (4).
Zagazig University Academic and Ethical
Currently,
Kirschner
wires
(K-wires),
Committee (ZU-IRB#8083). Every patient signed an
intramedullary screws, plates, and screws are used in the
informed written consent for acceptance of
treatment. Metacarpal fractures that leave little or no
participation in the study. This work has been
functional impairment can be treated using these well-
carried out in accordance with The Code of Ethics
established techniques. Intramedullary headless screw
of the World Medical Association (Declaration of
fixation may not necessitate the use of splints, allowing
Helsinki) for studies involving humans.
patients to return to work sooner than with the use of K-
wires (5).
Inclusion criteria: Skeletal mature patient, fractures of
There is a growing body of evidence that
the metacarpals (single, multiple) and closed fracture.
alternative methods of fixation can reduce tissue
dissection and reduce infection, reduce the likelihood of
Exclusion criteria:
adhesion of the extensor tendon to the bone, and allow
Skeletal immature, fracture dislocation,
early active motion and speedy return to function (6). In
pathological fractures, neglected cases, associated
metacarpal fractures of the hand, intramedullary screw
injuries (tendon, nerve, vessels and soft tissue), failed
fixation (IMS) has been recognized as an alternate
previous fixation, need for open reduction, and
treatment option (7).
presence of infection.
All patients had gone through:
2443
Received: 15/12/2021
Accepted: 14/02/2022
c:\work\Jor\vol881_27
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2452-2458
Cost effectiveness analysis of adopting Gene-Xpert® (GX) for the
Diagnosis of Tuberculosis in Egypt
Amal Samir Sedrak1*, Amany Ahmed Salem1, Tarek Tawfik Amin1, Wagdy Amin2
1Department of Public Health, Cairo University, 2National T.B. Program, Ministry of Health and Population, Egypt
*Corresponding author: Amal Samir Sedrak,
Email address: Amalnewlife82@gmail.com, Mobile number: 01203344637
ABSTRACT
Background: Tuberculosis is one of the most devastating infectious diseases worldwide. It constitutes a major global
health problem infecting millions of people each year, with a particular heavier burden on the developing world.
Objective: evaluating the cost effectiveness of incorporating Gene Xpert to sputum microscopy compared to sputum
microscopy and culture for diagnosis of tuberculosis and multidrug-resistant (MDR) tuberculosis in low- to middle-
prevalence settings like Egypt.
Design: An economic evaluation study was conducted using a decision analysis model representing the diagnostic
process starting with tuberculosis suspects, continuing to tuberculosis cases, and ending with treatment. The model
outcome was the incremental cost per incremental DALYs (Disability Adjusted Live Years) averted between the new
GX algorithms incorporated with smear microscopy versus the standard algorithm for detection of suspect TB case.
Results: Xpert testing is estimated to result in additional costs (EGP 2,320) per each
DALY averted compared to sputum microscopy and culture.
Conclusion: The results of this study advocate that GXpert is a cost-effective method of TB diagnosis, compared to a
base case of smear microscopy and clinical diagnosis with its ability to substantial increase in case finding. It has also
important potential for improving tuberculosis diagnosis and disease control.
Keywords: Cost-effectiveness, Economic analysis, Gene-Xpert®, TB, Tuberculosis
INTRODUCTION
Tuberculosis (TB) is one of the most potentially
In developing and high-burden countries,
fatal contagious diseases on the earth (1). It is a significant
WHO suggests employing accurate and rapid
global health concern that infects millions of individuals
molecular diagnostic tests (MTBDR plus) and Gene-
each year, with the developing world bearing a
Xpert® (GX) to recognise tuberculosis (10,11). Egypt is
disproportionately heavy burden (2). 9.6 million new
categorized as a country with a low-to-moderate
tuberculosis instances (133 per 1000 persons) and 1.5
occurrence of tuberculosis (TB), as per WHO estimates.
million tuberculosis deaths occurred in 2014, with 0.4
Annually, 11 instances per 100,000 of the population
high mortality and morbidity among HIV-positive
advance pulmonary smear positive stimulated TB, while
individuals (3).
24 cases per 100,000 establish all types of TB (12).
TB global incidence is waning sluggishly, at a rate
Almost all cases of tuberculosis can be cured with
compared with fewer than 2% per year. To achieve the
prompt diagnosis and treatment (13). For several years, the
TB eradication objective of less than 1 case/1,000,000
therapies rate of success among new confirmed cases by
population in 2050, the prevalence of TB must decrease
National TB Programs has remained consistent at around
by 20% per year (4). Diagnoses that are missed or
85 percent. Multidrug-resistant tuberculosis (about 0.5
prolonged, as well as issues with access to the highest
million new instances per year) is more difficult to treat
care, lead to increased risk, boost struggling with
in all settings because therapeutic options necessitate
devastating financial implications, and delay the
protracted therapies with efficient and expensive drugs;
eradication of tuberculosis. Such wasted opportunities
the global cure rate in such instances is about 50% (13).
also make a contribution to individuals' contagiousness
The GX-MTB/RIF test is a two-hour automated
lasting longer, allowing transmission to continue (5,6)
nucleic acid amplification experiment for tuberculosis
particularly among high density population with poor
diagnosis. GX also necessitates little in the way of
living and working conditions (7). Approximately a third
laboratory equipment, space, and technician duration. It
of the determined 9 million people infected with
also allows for the early detection of rifampin resistance,
tuberculosis (TB) do not obtain the treatment they need
enabling for more effective treatment of drug-resistant
each year (8).
tuberculosis. On smear positive samples, specificity and
In addition, MDR-TB is on the rise, posing a serious
sensitivity for tuberculosis and drug resistance have been
threat to global tuberculosis control (9). Rifampicin
found to be >97%, On the other hand, sensitivity on
and isoniazid (INH) resistance are both present in MDR-
smear-negative specimens can be as high as 70%80%
TB (RIF). Diagnostic services, notably for MDR-TB, are
(14). GX has the best sensitivity and specificity for
difficult to come by in many countries. Furthermore, the
rifampicin mono-resistance, with a 100 percent match to
consequences of traditional diagnostics can take up to
the reference test MGIT 960.
two months to arrive (8).
GX is accessible at a reduced cost in low-income areas;
however, its purchase price in areas with low TB
2452
Received: 15/12/2021
Accepted: 14/02/2022
c:\work\Jor\vol881_28
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2459-2463
Impact of Hysteroscopy on Patients with Secondary Infertility
Abd El-monsef Abdelghaffar Moustafa
1Obstetrics and gynecology Departments, Faculty of Medicine, Al-Azhar University, Egypt
*Corresponding author: Abd El-monsef Abdelghaffar Moustafa, E mail: princemonsef555@gmail.com
Mobile phone: +20 122 731 6530
ABSTRACT
Background: decreased rates of gestation are detected in cases with uterine space irregularities. The correction of these
irregularities was accompanying with better rates of gestation. Diagnostic hysteroscopy could be accomplished with
negligeable distress and higher sensitivity and specificity in assessment of the uterine space.
Objective: This study aimed to assess the role of hysteroscopy in diagnosing the abnormalities of the uterine space
among females having secondary infertility.
Subjects and methods: This work was conducted on138 cases having secondary infertility with no suspected uterine
defect at the Gynecological Outpatient Clinic in Al-Hussein University Hospital, Al-Azhar University.
Result: The majority of the patients had hysteroscopy as part of their infertility treatment (77.5 percent ). Among the
patients investigated, there was a statistically significant difference between pre-hysteroscopic diagnostic and
hysteroscopy findings. There were also 76 females with normal hysterography and US, and 18 females with abnormal
hysteroscopy results, resulting in an NPV of 86.8% for both ultrasonography and hysterography.
Conclusion: hysteroscopy was the most precise diagnostic examination for lesions in comparison with ultra-
sonography. The technique was of limited usage in the diagnosing of intra-uterine adhesions and some uterine
deformities, while its global consequences in diagnosis of uterine deformities were better than those attained by
ultrasonography.
Keywords; Secondary, Infertility, Hysteroscopy, Findings.
INTRODUCTION
following IVF procedures in females with a history of
Secondary infertility is defined as the incapability
recurrent implantation failures (RIF) (7).
to conceive a fetus or has a gestation to full-term
Aim of the work was to assess the advantage of
thereafter formerly giving delivery. This condition
hysteroscopy in diagnosing the abnormalities of the
cause recurrent pregnancy with ability to conceive but
uterine-space among females having secondary
disability carry to term. The preceding delivery should
infertility 12-mths or more of steady un-protected
have happened with no assistance from fertility drugs or
intercourses and having normal uterine-space by 2DUS
treatment, like in vitro fertilizations. Secondary
and normal H.S.G.
infertility
characteristically
detected
afterward
unsuccessful conceive for 6-mths to a 1-yr (1).
PATIENTS AND METHODS
Globally approximately 10-15% of the couples
The present study was conducted on 138 patients
are infertile and the primary and secondary infertility
having secondary infertility with no suspected uterine
rates are 67.3% & 32.6% respectively from total number
defect, aged between 20 and 40 years attending the
of infertile subjects. Prevalence of secondary infertility
Gynecological Outpatient Clinic in Al-Hussein
elevated abruptly with age, from 2.60% (2.30%-3.00%)
University Hospital, Al-Azhar University.
in women aging between 20 & 24 years to 27.10%
(24.70%-29.90%) in women aging between 40 & 44
Patient selection and inclusion criteria:
years (2).
Women aged 20-40 years, women with secondary
Most endometrial pathologies concerned in
infertility (12 months or more after last pregnancy with
infertility cause both structural and functional damages
regular sexual intercourse without lactation), females
(3). Consequently, endometrial space evaluation must be
with ordinary uterine space by 2 DUS and women with
comprised in the assessment of non-fertile couples. This
a normal uterine-space by hysterosalpingography
may
be
performed
through TVS,
hystero-
following last pregnancy.
salpingography (HSG), sono-hysterography and
Exclusion criteria: Women with untreated cervicitis,
hysteroscopy (4).
women with undiagnosed AUB, women with cardiac
However, the WHO recommends HSG alone, for
disease
and
other
diseases
contraindicating
managements of non-fertile females that may be owing
hysteroscopy or pregnancy, women who refuse to join
to its capability to deliver information concerning tubal
our study and women with any uterine abnormality in 2
patency (5). Nevertheless, hysteroscopy is a more precise
DUS or HSG.
tool owing to the elevated false-positive and false
negative rates of intra-uterine abnormalities with HSG
All patients were subjected to the following:
(6). Furthermore, anomalous hysteroscopy results are
History taking and general examinations [BMI,
significantly elevated in cases with preceding ART
vital signs, abdominal and pelvic examination, base line
failures. Hysteroscopy can be realized as a positive
2D transvaginal ultrasound and review of the recent
prognostic factor for accomplishing of gestation in
HSG ( less than 1 year ) and documentation].
2459
Received:14/12/2022
Accepted:13/02/2022
c:\work\Jor\vol881_29
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2464-2471
Value of Non-Invasive Scores and Modalities in Predicting the Presence of
Esophageal Varices in Patients with Liver Cirrhosis
Heba Ahmed Faheem*, Marwa Ahmed Mohamed, Engy Ezzat Eid, Nouran Mohamed Said
Internal Medicine Department, Gastroenterology and Hepatology Unit, Ain Shams University, Cairo, Egypt
*Corresponding author: Heba Ahmed Faheem, Mobile: (+20)1003148228,
Email: dr.hebafaheem@med.asu.edu.eg, doc_hobafaheem@yahoo.com
ABSTRACT
Background: Esophageal varices (EVs) represent the main complication of portal hypertension and carry a significant
risk of morbidity and mortality. Esophagogastroduodenoscopy (EGD) is the gold standard test for screening of
esophageal varices in patients with cirrhosis, but many studies explored noninvasive modalities in order to overcome its
cost and invasiveness.
Objective: The aim of the current work was to assess the potential role of five non-invasive scoring systems/modalities
(AST to platelet ratio index {APRI} score, ALT/AST ratio {AAR}, fibrosis 4 {FIB-4} index, King's score, and platelet
count/ spleen diameter {PC/SD ratio}) in detection of esophageal varices in patients with liver cirrhosis.
Patients and Methods: This prospective cohort study included a total of 120 cirrhotic patients, attending at Hepatology
Outpatient Clinic, Endoscopy Unit and Radiodiagnosis Department, El-Demerdash Hospital, Ain Shams University.
Patients were classified according to presence of esophageal varices (EVs) detected by esophagogastroduodenoscopy
(EGD) into two groups; Group 1 consisted of 9 patients with no EVs, and Group 2 consisted of 111 patients with EVs.
group II were further subdivided according to the grade of esophageal varices (EVs) into three subgroups. The following
noninvasive scores and indices were calculated for all patients: APRI score, AAR, FIB-4 index, King's score, and PC/SD
ratio.Results: Among the five scores studied, AAR at a cut off value >0.88 showed the greatest sensitivity (86.49%)
and accuracy (92.8 %), followed by PC/SD ratio at a cut off value <668.97 with an 86.49% sensitivity and 90.1%
accuracy and FIB-4 index at a cut off value >5.1 with an 83.78% sensitivity and 90.1% accuracy. While the least
sensitive scores were APRI and King's score with a 70.27% and 67.57% sensitivity respectively.
Conclusion: It could be concluded that AAR and PC/SD ratio are the most sensitive scores that can predict the presence
of esophageal varices (EVs) in cirrhotic patients with acceptable accuracy. Being cheap and applicable they could be
used as an initial screening tests to detect esophageal varices in patients with liver cirrhosis.
Keywords: Liver cirrhosis, Esophageal varices, Non-invasive scores, Non-invasive modalities.
INTRODUCTION
PATIENTS AND METHODS
Cirrhosis is the end stage of chronic liver
This prospective cohort study included a total of
disease, it results in distortion of liver architecture, and
One hundred and twenty cirrhotic patients, attending at
nodule formation leading to portal hypertension (1).
Hepatology Outpatient Clinic, Endoscopy Unit and
Clinically significant portal hypertension (CSPH) refers
Radiodiagnosis Department, El-Demerdash Hospital,
to increase in the pressure of the portal venous system
Ain Shams university. This study was conducted from
causing a hepatic venous pressure gradient (HVPG)
November 2020 to November 2021.
greater than 10 mmHg (2).
Patients were classified according to presence of
Esophageal
varices
(EVs),
the
main
esophageal
varices
(EVs)
detected
by
complication of portal hypertension, are present in
esophagogastroduodenoscopy (EGD) into two groups;
approximately 50% of cirrhotic patients at time of
Group 1 consisted of nine patients (7.5%) with no EVs,
diagnosis and carry a significant risk of morbidity and
and Group 2 consisted of one hundred and eleven
mortality (1,3). Esophageal varices are estimated to be
patients (92.5%) with EVs. group II were further
present in about 70% of Child-Pugh B or C patients, and
subdivided according to the grade of esophageal varices
only in approximately 40% of Child-Pugh A patients (4).
(EVs) into three subgroups: small EVs (48 patients),
Esophagogastroduodenoscopy (EGD) remains
medium EVs (45 patients), and large EVs (18 patients).
the gold standard test for screening of esophageal
varices in patients with cirrhosis, but owing to its
Diagnosis of liver cirrhosis:
invasiveness, cost and patient discomfort, multiple non-
All patients met the diagnostic criteria for cirrhosis,
invasive modalities for detection of esophageal varices
which was based on the presence of two or all three of
are being explored to potentially overcome these
the following (6).
obstacles (5).
(1) Clinical features (spider naevi, gynecomastia,
Thus, the objective of the study was to assess
hepatic
encephalopathy,
palmar
erythema,
the potential role of five non-invasive scoring
clubbing, distended abdominal veins, female pubic
systems/modalities (APRI score, AAR, FIB-4 index,
hair pattern, splenomegaly or ascites),
King's score, and PC/SD ratio) in detection of
(2) Impaired laboratory tests consistent with cirrhosis
esophageal varices in patients with liver cirrhosis.
(high international normalization ratio {INR}, high
total bilirubin and low serum albumin)
2464
Received: 16/12/2021
Accepted: 15/2/2022
c:\work\Jor\vol881_30
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2472-2474
An Insight of Platelet Rich Plasma (PRP) Role in
Dermatology: Review Article
Eman Abdelkarim Abdelgawad*, Howyda Mohamed Ibrahim, and Mai Ahmed Samir
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Eman Abdelkarim Abdelgawad, E-Mail: emanabdelkarim899@gmail.com,
Mobile: (+20) 01011121698
ABSTRACT
Background: Platelet-rich plasma (PRP) is a plasma concentrate containing platelets from a patient's own blood. Safety,
rapid release of platelet-derived growth factors, autologous preparation, and avoidance of disease transmission from
animal to human are some of the benefits that PRP's biological approach may offer. While PRP has been evaluated and
proved to be beneficial in a range of orthopedic and maxillofacial injury repair treatments, such as bone grafting and
orthopedic surgery, it has also been found to be useful in the treatment of skin conditions.
Objective: To characterize platelet rich plasma role in dermatological diseases.
Methods: PubMed, Google Scholar and ScienceDirect were searched using the following keywords: Platelet Rich
Plasma, PRP, Treatment of skin conditions and Application of PRP in dermatology. The authors also screened references
from the relevant literature, between January 1997 and November 2021, including all the identified studies and reviews,
only the most recent or complete study was included. Documents in a language apart from English have been excluded
as sources for interpretation was not found. Papers apart from main scientific studies had been excluded: documents
unavailable as total written text, conversation, conference abstract papers and dissertations.
Conclusion: Using higher concentrations of platelets and growth factors, platelet-rich plasma aids in wound healing and
tissue regeneration. The number of dermatologists using PRP is steadily rising.
Keywords: Platelet Rich Plasma, Treatment of skin conditions.
INTRODUCTION
Blood is vital to human health because it transports
several nutrients and metabolites between different types
B) Facial wrinkles:
of cells in the circulatory system. Instead of looking at
In some cases, PRP injection might have a positive
blood cells as a whole, researchers are instead focusing
effect on the appearance of facial wrinkles. In a study
on individual blood cell components for research. Pure
including a total of 20 people, each with varying degrees
platelet-rich plasma (P-PRP), leucocyte- and platelet-rich
of facial wrinkles (5). One intradermal injection of PRP
plasma (L-PRP), and pure platelet-rich fibrin (P-PRF). A
resulted in the assessment of all individuals for one to
constant release of growth factors can be maintained by
eight weeks on numerous professional scales. In the
P-PRF and leucocyte- and platelet-rich fibrin (L-PRF)
end, the final score was much greater than the baseline,
because of their high fibrin density (1).
wrinkles in particular, the nasolabial folds and the less
White blood cells contain proteases and acid
severe grades. Only skin inflexibility-sagging was
hydrolases, which can cause inflammation. PRP, on the
found to have a substantial effect on self-assessed
other hand, is a blood-derived product with a low
appearance in a similar study; this was only found to be
proportion of leukocytes and a high concentration of
the case for skin inflexibility (6).
platelets (2). Additionally, the chemoattractant, mitogen,
and extracellular matrix component synthesising effects
C) Striae distensae:
of PRP growth factors can help slow down the ageing
When pregnant, women are more likely to suffer
process of the skin. Although PRP has previously been
from stress-related conditions like striae distensae that
tested for its use in orthopedic surgery, bone grafting, and
form on their abdomens and buttocks, as well as their
the healing of musculoskeletal and craniofacial injuries,
thighs and legs. No treatment has sufficient proof to be
a high number of dermatological conditions has shown
totally successful without adverse effects, including
that it is practical and efficacious (3).
topical drugs, fractional laser, and so on. According to
a clinical and histological study including 68 patients,
Application of PRP in dermatology:
PRP injection is superior to microdermabrasion alone in
A) Facial rejuvenation:
treating striae distensae, and the two therapies combined
The need for a youthful-looking face has led to a
are even more successful. An injection of PRP three
surge in the usage of PRP in facial rejuvenation
months later revealed that the elastic fibres had grown
treatments. PRP treatment was found to be an excellent
in number, length, and thickness (7).
alternative for regenerating the infraorbital area in tests
involving 20 Asian women. Autologous PRP appears to
D) Hair:
be safer and more effective for skin rejuvenation than
1- Androgenic alopecia (AGA):
manufactured growth factors, even though PPP and
There have been various clinical trials on PRP as a
normal saline can be delivered swiftly and safely (4).
potential therapeutic treatment. Twenty male patients
2472
Received: 19/12/2021
Accepted: 16/2/2022
c:\work\Jor\vol881_31
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2475-2479
Utility of Serum Anti-C1q Autoantibodies as a Biomarker of
Lupus Nephritis in Children
Hany Elsayed1, Ahmed Ibrahim Bayoumi Imam*1, Hasan EL-Banna Khedr1, Naglaa Ali Khalifa2
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Ahmed Ibrahim Bayoumi, E-Mail: medo938382@gmail.com
ABSTRACT
Background: Deficiencies in anti-C1q antibodies were substantially linked to the development of lupus nephritis.
Objective: To investigate the diagnostic value of serum anti-C1q auto antibodies used as a reliable marker for diagnosis
of lupus nephritis in children.
Patients and Methods: at Zagazig University Children's Hospital seventy-two child included in the study were
classified into 3 groups: Group (A): 18 children diagnosed with lupus nephritis flare at time of study. Group (B): 18
children diagnosed with lupus nephritis quiescence stage at time of study, and Group (C): 36 healthy children. Serum
anti-C1q autoantibodies was assessed in all participants.
Results: Anti C1q at cutoff point 35 in Group (A) 15 (83.3%) had anti C1q value more than or equal 35.1 (5.56%) had
anti C1q value between 9 35 and 2 (11.1%) had anti C1q value less than 9 while in Group (B) 14 (77.8%) had anti
C1q value between 9 35 and 4 (22.3%) had anti C1q value less than 9 and in group (C) all children had anti C1q value
less than 9. Lupus nephritis had a superior positive prognostic marker in the form of anti-C1Q, which had a sensitivities
of 100 and specificities of 81.82. Lupus nephritis activity was associated with anti-C1q antibodies, suggesting that they
could be beneficial in forming predictions regarding the disease and in assessing its activity. Conclusion: Anti-C1q
antibodies can be considered a reliable, sensitive, and specific biomarker for the diagnosis of nephritis flares in pediatric
and Egyptian SLE patients, in addition to and possibly replacing other proven disease activity indices.
Keywords: Anti-C1q autoantibodies, Children, Lupus nephritis.
INTRODUCTION
anti-C1q Ab positivity in childhood onset systemic lupus
One-fifth of all cases of systemic lupus
erythematous (9).
erythematous (SLE) have symptoms that appear before
It was the goal of this study to investigate the
the age of 18 due to a multisystem autoimmune illness
diagnostic value of serum anti-C1q autoantibodies used
called childhood onset (cSLE) (1).
as a reliable marker for diagnosis of lupus nephritis in
Patients with SLE are more likely to develop a
children.
condition known as Lupus Nephritis (LN), which can
lead to an increased risk of death and morbidity. An
PATIENTS AND METHODS
accurate assessment of renal flaring remains a major
At Children's Hospital, Zagazig University and
difficulty due to the complexity of SLE and LN serology
Clinical Pathology Department, Faculty of Medicine,
and clinical presentation (2).
Zagazig University, seventy-two child included in the
Several autoantibodies (Abs) have been linked to
study were classified into 3 groups: Group (A): 18
systemic lupus erythematous, including antibodies that
children diagnosed with lupus nephritis flare at time of
target the classical route complement fragment 1 (C1q)
study. Group (B): 18 children diagnosed with lupus
(3). C1q, the initial component of the classical
nephritis quiescence stage at time of study, and Group
complement pathway, plays a critical function in the
(C): 36 healthy children.
clearance of immune complexes and apoptotic cell debris
from tissues (4). A small percentage of people with SLE
Ethical consent:
have anti-C1q Abs, ranging from one-third to one-half of
An approval of the study was obtained from
the population (5). It was also found that lupus nephritis is
Zagazig
University Academic
and
Ethical
related with C1q deficiency (6). As a genetic risk factor
Committee (ZU-IRB#6071). Every patient signed an
for systemic lupus erythematous, inherited C1q
informed written consent for acceptance of
deficiency has been found to be the most common one.
participation in the study. This work has been
Patients with LN who have anti-C1q antibodies have a
carried out in accordance with The Code of Ethics of
secondary C1q deficit (7).
the World Medical Association (Declaration of
Anti-C1q antibody appears to be more closely
Helsinki) for studies involving humans.
associated to renal disease activity than other
autoantibodies, such as anti-double-stranded DNA
Inclusion criteria:
antibody, in terms of predicting a renal proliferative flare
There were at least four patients diagnosed with
(8).
childhood-onset systemic lupus (SLE) who satisfied
More research is needed on the diagnostic utility
the new American College of Rheumatology (ACR)
of anti-C1 autoantibody in SLE and LN because few
criteria for SLE.
studies show the positive correlation between LN and
Patients with SLE with renal activity.
Normal children under 18 years of age not diagnosed
2475
Received: 19/12/2021
Accepted: 16/02/2022
c:\work\Jor\vol881_32
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2480-2485
Nickel Allergic Reaction post-Transcatheter Atrial Septal Defect
Device Closure: A Case Report
Fatma Aboalsoud Taha
Department of Cardiology, Faculty of Medicine, Tanta University, Gharbia, Egypt
Corresponding author: Fatma Aboalsoud Taha, Mobile: (+20) 01026194470, Email: fatmastaha@yahoo.com,
ORCID ID: https://orcid.org/0000-0002-4450-7
ABSTRACT
Background: Although transcatheter device closure of atrial septal defect (ASD) is a common, safe, and effective
interventional cardiac procedure, some adverse effects have been reported including device migration, cardiac erosion,
and nickel allergic hypersensitivity reaction.
Objective: Here we report on an eleven-year-old boy who experienced a nickel allergic reaction after transcatheter ASD
device closure, and we report on how we managed this critical situation.
Case Report: Here we report on an eleven-year-old boy who experienced a nickel allergic reaction after transcatheter
device closure of a large ostium secundum ASD with a 34-mm HyperionTM ASD occluder (Comed, Netherlands). Ten
days post-procedure, the patient complained of fever, severe allergic reaction; dermatitis, and pruritic rash on his face,
arms, trunk, and genital area. Dug allergic reaction and infective endocarditis was excluded. Immediately the patient
was managed as a case of device-induced nickel allergic reaction. All manifestations were resolved completely after
one week with high doses of dexamethasone and clopidogrel 75 mg orally for 6 months. Subsequent follow-up for 6-
month post-procedure showed that the device was properly seated with no recurrence of the nickel allergic symptoms.
Conclusions: Nickel allergy and device allergic syndrome must be considered during transcatheter device closure.
Despite still controversial, confirmation of a nickel allergy pre-procedure with the patch testing or with the device itself
may be useful. Nickel-avoidance strategies using modified devices could be considered a treatment option for patients
with nickel allergy.
Keywords: Nickel allergy, Nickel allergic reaction, Atrial septal defect, Occluder devices, Transcatheter atrial septal
defect device closure.
INTRODUCTION
ASD device closure, and we report on how we managed
In patients with adequate anatomy, transcatheter
this critical situation.
closure of atrial septal defects (ASDs) is a common,
safe,
and
successful
interventional
cardiac
CASE REPORT
catheterization technique. Although device closure is
An eleven years old boy, weighing 31 Kg, with a
safe and successful, there have been reports of device
body surface area (BSA) of 1.3, presented with grade II
migration, embolization, cardiac erosion, and allergic
dyspnea, with a systolic ejection murmur on the left
hypersensitivity reactions (1,2).
upper sternal border. Transthoracic and transesophageal
The main component of the most often used
echocardiograms were performed and revealed a large
ASD occlusion devices is nitinol, a nickel-titanium
ostium secundum ASD that measured 32 x 30 x 29 mm
alloy. Nickel is the most allergenic of the nitinol alloys,
in diameters, with a left to right shunt, a sufficient
followed by titanium. Nickel allergy affects up to 30%
atrioventricular rim of 8 mm, a sufficient inferior vena
of the general population, with the greatest rates seen in
cava rim of 9 mm, a deficient flimsy posterior rim of 3
young females under the age of 30. Nickel allergy
mm, and a deficient superior-posterior rim of 4 mm,
causes a pruritic rash and dermatitis at the site of nickel
with a total septum of 58 mm (Figure 1).
contact, and it can happen even after occlusion devices
The right side was dilated with a right ventricular
have been implanted (3,4).
diastolic diameter (RVDD) of 35 mm with mild
Here we report on an eleven-year-old boy who
tricuspid valve regurgitation (TR) and with normal right
experienced a nickel allergic reaction after transcatheter
ventricular systolic pressure (RVSP) of 19 mmHg.
2480
Received: 21/12/2021
Accepted: 20/2/2022
Assessment of Triangular Fibro-cartilaginous Complex Injuries of The Wrist Using High Resolution Ultrasound versus Magnetic Resonance Imaging
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2486-2490
Assessment of Thyroid Dysfunction in Children with Trisomy 21 and
Cardiac Abnormalities
Alshimaa Arafa Abdou*1, Amr Megahed Mohammed1, Basher Abd Allah Hassan1, Hanan Samir Ahmed2
Departments of 1Pediatric and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Alshimaa Arafa Abdou, Mobile: (+20) 01002327771, Email: shimoooo.doc@gmail.com
ABSTRACT
Background: Developmental difficulties, muscle hypotonia, small stature, unique facial traits, and congenital
abnormalities, notably cardiac, are all phenotypic aspects of Down syndrome. Aim and objectives: to assess thyroid
function abnormalities in children with Down syndrome and congenital heart disease. Subjects and methods: The study
was conducted at Cardiology Unit of Pediatric and Neonatology Department at Zagazig University Hospitals as a cross-
sectional study on 50 subjects, Patients were evaluated for congenital heart disease using plain chest X-ray,
electrocardiography, two-dimensional echocardiography and Doppler studies. Thyroid function parameters were also
performed including plasma TSH, FT3 and FT4. Results: Highly significant differences were found between the studied
groups as regard TSH, FT4 and FT3 levels, but no statistically significant differences between them as regard age or
gender. In addition, there was no significant relation between genetic types of Down syndrome and thyroid function.
Conclusion: Thyroid dysfunctions, most commonly subclinical hypothyroidism, are frequent in children with Down
syndrome, with no relation of length, weight, maternal age or gender to the thyroid function.
Keywords: Cardiac Abnormalities, Thyroid Dysfunction, Trisomy 21.
INTRODUCTION
data from African countries, as well as an issue with
Having an extra copy of the chromosome 21
regional variation around the world, which hinder our
genetic material is a chromosomal anomaly known as
capacity to make informed decisions (4).
Down syndrome (DS). DS is the most prevalent
There are numerous congenital deformities
chromosomal abnormality in humans and the most
associated with Down syndrome, including heart
common cause of severe learning difficulties, with an
problems and digestive system abnormalities. Primary
incidence of 1:800 live births (1).
(or thyroid) hypothyroidism and autoimmunity are two
Trisomy 21 is more likely to occur in mothers who
of the most common conditions in patients with Down
are older than 35 years old. There are more than 80
syndrome. Patients with DS are more likely to have
distinct features that define this illness. The most
subclinical hypothyroidism, when the TSH level is just
common phenotypic manifestations are developmental
slightly elevated. Compared to non-Down syndrome
difficulties, muscle hypotonia, small stature, certain
neonates, Down syndrome infants have a slightly higher
facial traits, and congenital abnormalities, particularly
rate of TSH and lower levels of T4 (5).
heart problems. To begin with, the DS phenol form was
A hypothalamic-pituitary-thyroid axis abnormality
created as a result of an imbalance in the chromosomes.
or a mild form of congenital hypothyroidism unique to
The lack of phenotypic heterogeneity in other autosomal
the thyroid has been hypothesised in DS. Thyroxine
trisomies cast doubt on this notion. In patients with
therapy in children with DS was thought to improve
incomplete chromosome 21 trisomy, genotype and
psychomotor development in the first two years of life,
phenol type correlations reveal that the limited area in
based on the hypothesis that young children with DS
21q 22.2 is associated with the key clinical aspects of DS.
have a moderate form of congenital thyroid
This is in accordance with the gene-dose-effect theory (2).
hypothyroidism (5).
One of the most common causes of infant mortality and
We aimed at this study to assess thyroid function
morbidity in people with Down syndrome (DS) is
abnormalities in children with Down syndrome and
congenital heart disease (CHD) syndrome, which affects
congenital heart disease.
40 to 63.5 percent of patients (2).
There has been some recent speculation that the
SUBJECTS AND METHODS
frequency of Down syndrome and other birth
From April 2019 throughout October 2019, at
abnormalities varies seasonally. Since genetic traits do
Cardiology Unit of Pediatric and Neonatology
not exhibit seasonality, this provides indirect evidence
Department at Zagazig University Hospitals, our cross-
that environmental influences play a causal effect (3).
sectional trial was conducted on 50 subjects CHD-
The prevalence and structural features of CHD in
affected patients diagnosed with DS.
DS, as well as the associated consequences and causes of
morbidity and mortality, must be known in order to
Ethical consent:
include preventative efforts and improve the quality of
When all parents of participants completed informed
life of the patient in a specific environment. Furthermore,
permission papers and submitted them to the
early detection of cardiac problems is crucial for the best
research ethics committee at Zagazig University, the
chance of survival because the kind and timing of CHD
study was permitted (ZU-IRB#6421). Ethics
might alter the prognosis. There is a dearth of reliable
guidelines for human experimentation were adhered
2486
Received: 21/12/2021
Accepted: 20/02/2022
c:\work\Jor\vol881_34
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2491-2495
Right Mini-Thoracotomy Aortic Valve Replacement Versus
Full Sternotomy Approach
Khaled M. Awadalla1, Ahmed Sultan1, Mina Wahba2
1Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
2Department of Cardiothoracic Surgery, Faculty of Medicine, Beni-Suef University, Egypt
*Corresponding author: Khaled M. Awadalla, E-Mail: khaled.mortada@gmail.com
ABSTRACT
Background: For a long time, full median sternotomy was the standard approach for heart surgery. With the
advancement of the new technology there is a trend for minimal invasion in all types of surgeries including heart
surgery aiming to avoiding and minimizing surgical trauma and morbidity. Objective: The aim of the current work
was to compare the outcome of right mini-thoracotomy aortic valve replacement versus full sternotomy. Patients and
Methods: A retrospective study that was done in multicentre in in Cairo University and Beni-Suef University.
Between June 2015 to October 2021, 219 patients had aortic valve replacement for aortic valve disease of them 124
had the surgery through full sternotomy and 95 patients had it through right mini thoracotomy. We collected their
clinical data and compared their inpatient course and outcome. Results: Right mini-thoracotomy was associated with
more aortic cross clamp, total bypass and total surgery time, but less mechanical ventilation, blood loss, blood
transfusion, ICU stay, re-exploration for bleeding than the full sternotomy group. Also, it was associated with less
wound complications with no significant difference in mortalities in both groups. In addition, it had shorter hospital
stay that was 6.9 ± 0.8 days (mean ±SD) in comparison to 8.2 ± 1.1 days (mean ±SD) in the full sternotomy group
with a p value of 0.02. Also, right mini-thoracotomy showed more patient satisfaction and shorter wound than the full
sternotomy group.Conclusion: It could be concluded that right Mini-thoracotomy aortic valve replacement is safe
alternative to full sternotomy with shorter MV, ICU and inpatient stay, less wound infection, smaller wound and more
patient satisfaction but with longer cross clamp, bypass and surgery time.
Keywords: Aortic valve replacement, Right Mini-thoracotomy, full sternotomy, morbidity, mortality.
INTRODUCTION
health and are important core in comparing both
Full median sternotomy has been used as the
approaches (8). The aim of the current work was to
standard approach in all heart surgeries for a long time
compare the outcome of right mini-thoracotomy aortic
although it has a lot of consideration like its length,
valve replacement versus full sternotomy.
wound pain and possible wound complications like
PATIENTS AND METHODS
instability and infection (1).
This retrospective study included a total of 219
Its complications are more common with obesity
patients with aortic valve disease undergoing valve
and diabetes mullites and it can be fatal especially
replacement, attending at cardiothoracic surgery
deep Sternal Wound Infection. Keloid and
multicentre in in Cairo University and Beni-Suef
hypertrophic scars are common and more common
University. This study was conducted between June
with black races also itching is a common
2015 to October 2021.
complication (2).
With the advancement of the new technology
The included subjects were divided into two groups;
there is trend for minimal invasion in all types of
Group A where right Mini-thoracotomy was
surgeries including heart surgery aiming to avoiding
performed for 95 patients and, Group B where full
and minimizing surgical trauma and morbidity.
sternotomy was performed for 124 patients.
Traditional surgeons resisted it because of the
Inclusion criteria: Adult Patients who had isolated
technology used, and they think that the small
aortic valve surgery.
incisions lead to small surgical field with limited
Exclusion criteria: Patients with assocaited other
exposure and poorer outcomes (3).
valvular surgery, patients with associated coronary
Minimally invasive aortic valve replacement can
surgery, and patients with assocaited complex aortic
be done through anterior right-thoracotomy, min-
root surgery including small aortic annulus.
sternotomy and para-sternal approach (4). Aortic valve
replacement through right anterior thoracotomy was
Preoperative assessment data were collected for all
first introduced by Rao and Kumar in 1993(5), then
patients including:
rediscovered by Galloway and others (6).
1. Medical history, clinical examination findings and
Minimally invasive surgeries require good
identified risk factors.
training and surgical skills to be safe and to get the
2. Full laboratory results.
best outcome (7), and should not be done except after
3. Electrocardiogram (ECG) result.
good training for conventional surgery (3).
4. Chest x ray result.
Postoperative mortality, morbidities, pain,
5. Transthoracic echocardiography result.
recovery and wound size and shape are important
6. Cardiac catheterization result if was done for whom
points that affects patients physical and psychological
indicated like males above forty years old,
2491
Received: 20/12/2021
Accepted: 17/02/2022
c:\work\Jor\vol881_35
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2496-2502
Prognostic Value of HER2 in Metastatic Colorectal Cancer:
A Single Institutional Experience
Mai Ezz El Din1*, Radwa Abd El-Azeem Yassin1, Mohamed Mohamed El Bassiouny1,
Manal Mohamed El-Mahdy2, Mohamed Yassin Mostafa1
1Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Mai Ezz El Din, Mobile: (+20)1223176730,
E-Mail: mai.ezzeldin@med.asu.edu.eg; maiooyaz@yahoo.com
ABSTRACT
Background: HER2 (Human epidermal growth factor receptor 2) activation has been associated with poor prognosis
in a number of tumours as breast, gastric and lung cancers, but the prognostic role of HER2 in colorectal cancer (CRC)
remains unclear.
Objective: The aim of the current work was to detect the incidence and prognostic impact of HER2 overexpression
in metastatic CRC patients in relation to clinico-pathologic features and outcome.
Patients and Methods: Data of metastatic CRC patients treated from January 2012 to end of December 2016 in a
tertiary referral university hospital were collected. Eligible patients had their paraffin block tested for HER2.
Results: Clinico-pathologic features of 70 patients were available for analysis. Age ranged 20-73 years, at a median
of 39.5 years. Fifty (71.4%) of these cases were left sided. Male to female ratio was 3:4. Mucinous variant was present
in 27.1 %( 19 cases). Synchronous metastasis constituted 61.4%. HER2 incidence was found in 8.57% (6 cases). Her2
positivity was significantly associated with a shorter time to progression on both first line of therapy, PFS1 (mPFS1
3 vs. 6 months, p=0.045) and PFS2 (mPFS2 4 vs.6 months, p=0.036). No significant relation to clinico-pathological
characteristics or OS were detected.
Conclusion: HER2 positivity was not associated with clinico-pathologic features but was related to outcome with a
shorter PFS but not OS in metastatic CRC. Further prospective data sets are required to confirm its prognostic role.
Keywords: HER2, Metastatic colorectal cancer, Prognostic factor.
INTRODUCTION
HER2's role as a prognostic biomarker in CRC
Colorectal cancer (CRC) is the third most
remains uncertain, unlike its use as a therapeutic target
frequently diagnosed cancer and the second leading
that seems promising (8). Additionally harboring this
cause of cancer death. Colorectal cancer incidence
anomaly offers itself as a mechanism of resistance to
rates are about 4-fold higher in transitioned versus
EGFRtargeted therapies such as cetuximab and
transitioning countries (1).
panitumumab (9).
Various genomic landscapes contribute to the
The mere definition of HER2 presence was a
heterogeneity of CRC and have led to different
subject extensively researched (10), in order to
diagnostic, prognostic and predictive approaches to
substantiate the use of targeted therapies effectively.
characterize the disease (2).
HER2 Amplification for Colorectal Cancer Enhanced
Stratification (HERACLES) trial, a proof-of-concept,
The epidermal growth factor receptors
multicenter, open-label, phase 2 trial, in which eight of
(EGFRs) family is composed of four members of
27 patients with HER2-amplified/overexpressing,
which the185-kDa transmembrane tyrosine kinase
KRAS wild-type metastatic colon cancer (30%) had
(TK) receptor HER2 protein (HER2/neu, ERBB2) is a
objective responses to dual HER2 blockage with
member (3). HER2 acts as an oncogene, amplification
trastuzumab plus lapatinib (11). Even further
of the gene induces protein overexpression in the
DESTINY-CRC01 also a phase 2 study on progressing
cellular membrane, cell growth, proliferation, and
CRC patients also reported an objective response of
tumourigenesis (4).
45·3% with trastuzumab deruxtecan (12).
HER2 overexpression and/or amplification
These encouraging data and personalized
has been implicated in numerous cancers. Invasive
therapeutic approach urged us to explore further HER2
breast HER2 positive cancers constitute 13%20% and
alterations in our area with all its implications, as
are associated with a poor prognosis and inferior
regional incidence rates in HER2-CRC are lacking.
outcomes (5). It has also been observed in gastric and
lung amongst other malignancies (6, 7).
2496
Received: 20/12/2021
Accepted: 17/02/2022
c:\work\Jor\vol881_36
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2503-2511
Potential Prediction of Myocardial Viability Using Strain/Strain Rate at Low-
Dobutamine Stress Echocardiography on a Segment-by-segment Basis
Amr Hanafy*1, Aml Soliman1, Saud Mohamed Elsaughier1, Hossam-Eldein Mansour1,
Mohamed Kamal Salama2 , Soliman Gharib3, Naggeh Mohamed Mahmoud1
1 Cardiovascular Department, Faculty of Medicine, Aswan University, Aswan, Egypt
2 Cardiovascular Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
3 Cardiovascular Department, Faculty of Medicine, Cairo University, Giza, Egypt
*Corresponding Author: Amr Hanafy, Mobile: (+20)01091000345, E-mail: amrhanafy75@yahoo.com
ABSTRACT
Background: It is crucial to determine if the myocardium with highly impaired function is irreversibly harmed or
reversibly dysfunctional in acute myocardial infarction. Although dobutamine-induced wall motion improvement is
suitable for assessing viability, it is vulnerable to significant inter- and intra-observer variability because it is subjective.
Objectives: It was determined whether peak longitudinal strain (PLS) and peak longitudinal strain rate (PLSR) in
individual myocardial segments with low dose dobutamine stress echocardiography (LDDSE) could diagnose
myocardial viability in patients with acute ST segment elevation myocardial infarction using delayed contrast-enhanced
cardiac magnetic resonance (DE-CMR) as a reference (STEMI).
Patients and Methods: This study included 60 individuals who had been in the hospital for at least three months after
acute myocardial infarction. LDDSE with delayed contrast-enhanced cardiac magnetic resonance and offline
deformation indices analysis was performed on all patients.
Results: There were 268 segments having significant resting wall motion anomalies available for the final analysis.
Dobutamine-induced peak longitudinal strain was greater in viable than non-viable segments in all investigated
individual myocardial segments (< 0.001 for mid inferoseptum, p=0.001 for mid inferolateral, and < 0.001 for all other
segments). Furthermore, dobutamine-induced peak longitudinal strain rate was significantly lower in non-viable
segments compared to viable segments within the studied individual myocardial segments (p< 0.001 for basal antro-
septum, < 0.001 for apical inferior, <0.001 for mid inferolateral, < 0.001 for mid antrolateral, <0.001 for mid
inferoseptum, <0.001 basal anterior, <0.001 for basal inferolateral, <0.001 basal inferoseptum, and < 0.001 for all other
segments).
Conclusion: Dobutamine-induced peak longitudinal strain and strain rate could predict myocardial viability segment
by segment in those suffering from acute ST segment elevation myocardial infarction.
Keywords: Myocardial viability, Strain rate, Strain, Acute myocardial infarction, Stress Echocardiography
INTRODUCTION
could be because strain rate imaging has a lower load
Because reperfusion therapy saves viable
dependence and gives a more accurate picture of
myocardium only after an AMI, it is critical to
contractility. Global cardiac displacement has no
determine if a myocardium with considerably reduced
influence, and the anchoring impact of nearby wall
function is permanently damaged or reversibly
segments obstructs two-dimensional visual inspections.
malfunctioning. Relying on the factors which promote
Deformation indices are more objective and
ischemia-induced myocardial dysfunction, the time it
quantitative measures for assessing cardiac contraction,
takes to regain myocardial function following
and, therefore may be more useful than wall motion
reperfusion might range from a few hours to many
analyses (3).
months (stunning, hibernation, or subendocardial
To overcome subjectivity of dobutamine stress
infarction)
(1).
Low-dose
dobutamine
stress
echocardiographic (DSE) and making benefit from the
echocardiography (LDDSE) offers the advantages of
ability of speckle tracking (STE) to detect subtle
being practicable, safe, and affordable, as well as having
myocardia dysfunction, some researchers looked at the
good diagnostic and prognostic accuracy. It is
possibility of adding strain rate and strain depending on
commonly used to assess viability after AMI. Wall
speckle tracking to DSE's protocol. They observed that
motion improvement during LDDSE is specific for
STE offers an additional benefit in detecting mild
predicting viability, but because it is subjective, it is
myocardial damage and coronary artery disease in those
prone to substantial inter-and intra-observer variability
suffering from cardiovascular risk factors and even the
(2).
extent of myocardial scarring following either an acute
Deformation rate (strain rate) and myocardial
or chronic myocardial infarction, and in detecting
deformation (strain) permit a multi-dimensional
microvascular injury. Although the results were
evaluation
of
myocardial
mechanics
(radial,
promising, the absence of uniformity and reference
circumferential function, and longitudinal), as well as
cutoffs makes it difficult to use in clinical settings (4).
the detection of modest regional function problems that
More and more studies are required to establish
do not compromise global left ventricular function. This
reference cutoffs.
2503
Received: 21/12/2021
Accepted: 20/02/2022
c:\work\Jor\vol881_37
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2512-2519
Assessment of Interleukin 27 Serum Levels and Echocardiographic Parameters in
Children and Adolescents with Type 1 Diabetes Mellitus
Ghada Mohamed Abdellatif1, Sahar Abdelraof Elsharawy 1, Weaam Ibrahim Ismail 2,
Maha Metwali 3, Hamza Mohammed Ali Oun*1, Doaa Mohammed Abdelrahman 1
Departments of 1Pediatrics, 2Clinical Pathology and
3 Radiodiagnosis Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hamza Mohammed Ali Oun, Mobile: (+20)01063367265, E-Mail: hamzaoun2019@gmail.com
ABSTRACT
Background: New treatment methods for cardiovascular and autoimmune illnesses take advantage of (IL-27) pro-
and anti-inflammatory properties. Objective: To assess the level of IL-27 level and echocardiographic parameters
in children, and adolescents with type 1 diabetes mellitus (T1DM).
Patients and Methods: at Department of Pediatrics, Diabetes Outpatient and Echocardiography Cardiology Unit,
Zagazig University Hospitals, we conducted this case-control study on 30 children diagnosed with T1DM and 30
healthy age- and sex-matched subjects who were selected as non-diabetic group (controls). Serum lipid and IL-27
measurements in addition to echocardiography were done.
Results: There was significant higher value of following echocardiography measures: LVIDs, LVIDd, LVId, LVIsd,
PWD S, PWD D, RWT, LVMI, LVM both of bad and good control diabetic children compared to healthy control.
While there was no significant difference regarding EF and FS between studied groups. There was significant higher
value of serum interleukin 27 of bad control diabetic children compared to both; good control diabetic children and
healthy children. But there was no significant difference, of good control diabetes children and healthy control
children regarding serum interleukin 27. There was significant positive relation between serum interleukin 27 and
disease duration of bad control type1 diabetic children.
Conclusion: T1DM is connected with rise of IL-27 levels and lipid profile. This link is particularly evident in poorly
managed patients demonstrating a relevant involvement of IL- 27 and dyslipidemia on the etiology of the condition.
Keywords: Cardiovascular, Interleukin 27, Type 1 Diabetes Mellitus
INTRODUCTION
T1DM, as prior echocardiographic studies have
High-risk individuals, such as those with DM,
demonstrated varying changes in left ventricular shape,
should be given extra attention. In those with diabetes,
mass, and function (9).
CVD is the primary cause of death and disability(1).
Pro-inflammatory
and
anti-inflammatory
Atherosclerosis is twice to four times more likely to
effects can be achieved by interlukin-27 (IL-27), which
occur in people with diabetes. Having type 1 diabetes is
is now being used in novel treatment approaches for
a significant risk factor for CVD. T1DM should be
cardiovascular and autoimmune disorders(10). T1DM
given more attention because it affects younger people
development and immunological balance maintenance
and lasts longer than other forms of diabetes(2).
are both likely to be influenced by the ability to express
Patients with diabetes have accelerated
IL-27 (11).
atherosclerosis and early CVD consequences for a
It was the goal of this study to assess the level
variety of reasons that are as yet unresolved (3). Female
of IL-27 and echocardiographic parameters in children,
diabetics are more likely to develop coronary heart
and adolescents with (T1DM).
disease than male diabetics, especially those with
(T1DM)(4). There is a clear link between high HbA1c
SUBJECTS AND METHODS
levels and an elevated risk of heart failure and
At Department of Pediatrics, Diabetes Outpatient
cardiovascular disease death. In addition, cholesterol
and Echocardiography Cardiology Unit of Pediatrics
(HDL-C and LDL-C) are powerful predictors of
Department, Faculty of Medicine at Zagazig University
cardiovascular disease in non-diabetic children and
Pediatric Hospital, sixty children were included in the
adults as well as in those with type 1 diabetes (5).
As a result, blood pressure regulation is helpful
study, 30 children were diagnosed with T1DM, which
in reducing cardiovascular morbidity and death in
was confirmed according to the criteria of American
diabetics (6). A cost-effective and time-saving
Diabetes Association (ADA) guideline, and 30 healthy
procedure, echocardiography delivers accurate and
age- and sex-matched subjects who were selected as
repeatable diagnostic and prognostic information in
non-diabetic group (controls).
patients with diabetes mellitus (7). Diabetes patients can
be thoroughly studied with the use of two-dimensional
Ethical consent:
and speckle-track echocardiography (8). However, little
Research Ethics Council at Zagazig
is known regarding the progression of early cardiac
structural and functional problems in children with
University approved the study (ZU-IRB#6891) as
long as all parents of participants provided
1512
Received: 22/12/2021
Accepted: 21/02/2022
c:\work\Jor\vol881_38
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2520-2526
Comparative Study between Implantation of an Empty Polyethylethylketone
Cage versus Cage with Bone Graft in Anterior Cervical Discectomy and Fusion
Yasser Ahmed Mashal*, Mohamed Ahmed Samir, Ahmed Ali Morsy, Hosny Hassan Salama
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Yasser Ahmed Mashal, Mobile: (+20) 01201524694, Email: yasser.mashal30@gmail.com
ABSTRACT
Background: Cervical spondylosis is a chronic degenerative process of the cervical spine that affects the vertebral
bodies and intervertebral discs of the neck and may progress into disc herniation, bone spur formation, compression of
the spinal cord. The majority of cervical spine disorders are self-limited and may be treated non-operatively.
Objective: To compare implantation of empty polyethylethylketone cage versus cage with bone graft in Anterior
cervical discectomy and fusion regarding clinical improvement & radiological fusion rate and cage subsidence.
Patients and Methods: 48 patients suffering from 2 levels or more cervical degenerative disc disease who were
unresponsive to medical treatment were divided into 2 groups: Group A: Included 17 patients who underwent ACDF
with an empty cage. Group B: Included 15 patients who underwent the same procedure with cages with bone grafts.
Results: The mean operative time in our study in group A was 128.3±11.63 while in group B was 125.77±14.16 with
no significant difference between the 2 groups (p=0.00**). The mean amount of blood loss in group A was
178.11±11.63 while in group B was 172.77±14.16 with no significant difference between the 2 groups (p=0.00**). The
mean VAS of neck pain improved in group A from 6.71±0.78 preoperatively to 2.2±0.7 postoperatively, and also
improved in group B from 5.11±0.78 preoperatively to 0.77±0.62 postoperatively, there was a significant improvement
in both groups. Conclusion: Interbody cage-based fusion with or without plate fixation in two levels or more cervical
discectomies achieved good stability and neurological outcome.
Keywords: Implantation, Empty Polyethylethylketone Cage, Cage with Bone Graft, Anterior Cervical Discectomy,
Fusion.
INTRODUCTION
The current radiological modality of choice to
Cervical spondylosis is a chronic degenerative
assess the severity of cervical myelopathy is magnetic
process of the cervical spine that affects the vertebral
resonance imaging (MRI). It provides information about
bodies and intervertebral discs of the neck and may
the etiology of canal stenosis, the degree of cord
progress into disc herniation, bone spur formation, and
compression, and pathological changes within the cord
compression of the spinal cord (1).
(3). Bailey and Badgley measured canal compromise on
Chronic cervical degeneration is the most common
computed tomographic (CT) and T1- and T2-weighted
cause of progressive spinal cord and nerve root
MR images, as well as cord compression on T1- and T2-
compression. Spondylotic changes are frequently found
weighted MR images from patients with spinal cord
in many asymptomatic adults, resulting in stenosis of the
injury (5).
spinal canal, lateral recess, and foramina. Radiculopathy
Anterior cervical discectomy and fusion have first
is a result of intervertebral foramina narrowing. Spinal
introduced for degenerative diseases of the cervical
canal stenosis can lead to spinal cord compression,
spine. To overcome the graft-related complications (e.g.,
ultimately resulting in cervical spondylosis myelopathy
graft compression fracture, graft resorptions or
(2).
dislocation, and pseudoarthrosis) anterior plating to the
Cervical disc herniation occurs when the nucleus
treated segment is highly recommended (6).
in the center of the disc pushes out of its normal space.
Anterior plate and screw constructs provide
The nucleus presses against the annulus, causing the disc
enhanced stability and maintenance of deformity
to bulge outward. Gradually, the nucleus herniates
correction, and lordotic curvature and increase the
completely through the annulus and crushes the disc,
stability and probability of fusion, compared to no plates
compressing the spinal canal or nerve roots.
and it may eliminate the need for rigid collar
Additionally, the nucleus releases chemicals that can
immobilization postoperatively (7).
irritate the surrounding nerves causing inflammation and
This study aimed to compare between
pain (3).
implantation of empty polyethylethylketone cage versus
Prolonged cord compression from cervical
cage with bone graft in anterior cervical discectomy and
spondylosis can result in irreversible histological spinal
fusion regarding clinical improvement & radiological
cord changes such as intradural fibrosis, ischemia,
fusion rate and cage subsidence.
destruction of the blood-spinal cord barrier,
demyelination, and neuronal apoptosis within the spinal
PATIENTS AND METHOD
cord (1). Decompressive surgery may rescue these
This was a prospective randomized study conducted
changes and halt or even reverse the deterioration in
on 48 cases who were admitted to Neurosurgery
myelopathy patients and contribute to an improvement in
Department, Zagazig University Hospital for 4 months
functional and neurological status (4).
2520
Received: 22/12/2021
Accepted: 21/02/2022
c:\work\Jor\vol881_39
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2527-2534
Study of Forkhead Box p3 Gene Polymorphism in Asthmatic Children
Dina Tawfeek Sarhan1, Marwa Abd Elmonem Abd El Rehiem*1,
Khalid Mohamed Salah1, Ahmad Mohammed Baraka2
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine Zagazig University, Egypt
*Corresponding author: Marwa Abd Elmonem Abd El Rehiem, Mobile: (+20)01024159241, Email: dr_marmr_love@ymail.com
ABSTRACT
Background: One of the heterogenous chronic diseases affecting the lungs is asthma. Etiology of asthma could be
attributed to altered functions of forkhead box p3 Gene (FOXP3) through epigenetic mechanism and genetic
polymorphism.
Objective: To assess the frequency of two FOXP3 polymorphism rs3761548 and rs2232365 among asthmatic children
in comparison with healthy children.
Patients and methods: A total of 202 Egyptian children were recruited and divided into 2 separate groups, 1st one of
asthmatic contained 101 children with asthma and a control group of 101 non-asthmatic apparently healthy children.
Results: We found a statistically significant difference in FVC, FEV1 concerning degree of asthma. The lowest values
were reported among sever asthmatic cases. The genotype analysis of patients and controls revealed non-statistical
significant difference was found in patients when compared to control concerning foxp3 polymorphism for 2 different
single nucleotide polymorphisms (SNPs) rs 3761548 and rs 2232365. The AC genotype of rs3761548 and the GG
genotype of rs2232365 polymorphisms were the most frequent genotypes among the studied children. The rs3761548
C allele carriers could be more susceptible to have asthma since it could be considered a bronchial asthma allele risk
factor.
Conclusion: We investigated the association between FOXP3 polymorphism in (rs 3761548 and rs2232365) and
occurrence of asthma in Egyptian children. The AC genotype of rs3761548 and the GG genotype of rs2232365
polymorphisms were the most frequent genotypes among the studied children. The rs3761548 C allele carriers could be
more susceptible to have asthma since it could be considered a bronchial asthma allele risk factor.
Keywords: Asthmatic Children, Forkhead box p3 Gene (FOXP3).
INTRODUCTION
PATIENTS AND METHODS
Regarding asthma, which is a chronic
This study was done as a case control trial that
inflammatory illness, whereas Th1 and regulatory T
contained 101 asthmatic children who were categorized
cells may protect against asthma, auto-reactive Th2
to 91 asthmatic children taking steroid and 10 not taking
cells promote the disease. CD4+ T lymphocytes and
steroid, they were five to fifteen years old. The control
eosinophils entered the bronchial mucosa, resulting in
group contained 101 healthy children with almost same
asthma etiology. Instead of infection fighting Th1 cells,
age and sex.
CD4+ T cells develop into pro-inflammatory Th2 cells
Asthmatic children were recruited from
by allergen provoked dendritic cells. Some key Th2
Pulmonology, Allergic Disease Unit and Clinical
type cytokines, including Granulocyte monocyte-
Pathology Department in the period from October 2019
Colony stimulating factor (Gm-CSF) IL3, IL4, and IL5,
to March 2020. We confirmed diagnoses of asthma
are secreted during allergic asthma and may play a role
according to Global Initiative for Asthma Management
in the development of the condition (1).
and Prevention guidelines (3).
Asthma is mostly caused by pathogens such as
We collected the healthy subjects from clinics of
bacteria, viruses and parasites activating Treg cells.
general outpatients at Children Hospital of Zagazig
These cells are classified into thymus-derived foxp3
University.
Treg cells, which express foxp3 and peripheral Treg
Patients with cardiovascular diseases, malignant
cells. Then there are Th1 cells that do not express Foxp3
tumors,
autoimmune
diseases,
acquired
(2).
immunodeficiency, patients treated with B-blockers,
In CD4 CD25 Treg cells, Foxp3 is a transcription
patients who had mental disorders, patients who were on
factor that may be associated with T cell suppression
or monoamine oxidase inhibitors or Ace inhibitors,
activation. It is natural anti-inflammatory released by
children aged less than 5 years, severe uncontrolled
Treg either thymus or peripheral type in hyper immune
asthma, and children who were under immunotherapy as
condition attributing to bronchial asthma (1).
it alters cytokine profile have been excluded from the
We aimed in this work to assess the frequency of
study.
two FOXP3 polymorphism rs3761548 and rs2232365
among asthmatic children in comparison with healthy
children.
2527
Received: 26/12/2021
Accepted: 23/02/2022
c:\work\Jor\vol881_40
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2535-2538
Role of Triphasic Computed Tomography for Detection of
Hepatitis C Virus Consequences: Review Article
Heba Fathy Tantawy, Stefany Adel AbdElMalak*, Adel Mohamed Sanoor, Maha Ibrahim Metwally
Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Stefany Adel AbdElMalak, Mobile: (+20)01228935916, E-Mail: stefanyadel@gmail.com
ABSTRACT
Background: Chronic hepatitis-C, a necroinflammatory disease of the liver that leads to liver cirrhosis in roughly 20%
to 30% of patients, is caused by hepatitis C virus (HCV) infection. Liver cancer occurs at an average of 3.5 percent
every year when cirrhosis has been formed in the liver. Nowadays, computed tomography (CT) scan is considered as a
promising screening tools. Triphasic CT often shows enhanced contrast enhancement of the focal lesion during the
arterial phase of the test (wash-in) and contrast wash-out during the portal/venous and late equilibrium phases for
hepatocellular carcinoma (HCC) radiology.
Objective: To assess possible role of triphasic computed tomography for detection of hepatitis C virus consequences.
Methods: PubMed, Google scholar and Science direct were searched using the following keywords: Triphasic
Computed Tomography, Hepatitis C virus and Hepatocellular Carcinoma. The authors also screened references from
the relevant literature, including all the identified studies and reviews, only the most recent or complete study between
January 2003 and February 2021 was included. Documents in a language apart from English have been excluded as
sources for interpretation was not found. Papers apart from main scientific studies had been excluded: documents
unavailable as total written text, conversation, conference abstract papers and dissertations.
Conclusion: Using of triphasic CT has been considered as a golden diagnostic imaging technique to detect the incidence
of hepatocellular carcinoma as well as its possible complications.
Keywords: Hepatitis C virus, Hepatocellular Carcinoma, Triphasic Computed Tomography.
INTRODUCTION
activate hepatic stellate cells. Tumor necrosis factor
One of the most common causes of chronic liver
(TNF), interferons (IFNs), and chronic inflammation due
disease in the United States is hepatitis C virus, a
to HCV are all factors that contribute to a host-induced
hepatotropic RNA virus. Hepatocellular carcinoma
immune response (3).
(HCC) is a potentially lethal or seriously health-
Hepatocytes may become cancerous because of the
damaging consequence of chronic hepatitis C (HCV)
accumulation of mutations that occur during repeated cell
infection. Hepatitis C virus (HCV) spreads via blood.
divisions. Mutations in the telomerase reverse
Medical equipment, particularly needles and syringes, is
transcriptase, tumour protein 53, and b-catenin genes are
a major factor in the transmission of HCV in low-income
prevalent in HCC patients. Telomeres are threatened and
countries. Unscreened blood and blood products, on the
oxidative stress is elevated as a result of these alterations.
other hand, continue to be a major source of new diseases
The most prevalent genesis of HCC is cirrhotic nodules
around the world. The most typical way that HCV is
containing hepatocytes with sufficient mutations to
spread in developed countries is through the sharing of
reenter the cell cycle, reactivate telomerase, and proceed
injecting equipment. Iatrogenic transmissions, on the
through cancer checkpoints. HCC growth is exacerbated
other hand, are extremely infrequent (1).
by the fact that both the virus and the host immune
This means that 90% of all HCV infections occur
response promote cell death and regeneration (3).
in Egypt, making it the country with the highest infection
Chronic HCV-infected patients who have cirrhosis
rate worldwide. Males are more likely to have genotype
develop HCC at a rate of 14 percent each year once
4 than females, which complicates treatment and raises
cirrhosis has been established. When it comes to
the risk of chronic hepatitis, liver cirrhosis, and
advanced liver scarring (cirrhosis) and an increased risk
hepatocellular cancer (2).
of liver cancer, HCV infection is a major cause. Those
It may take up to 40 years for HCC to develop as a
with chronic HCV infection are at an increased risk of
result of HCV infection. When the virus causes cancer, it
developing hepatocellular carcinoma (HCC), which is
also causes the host's immune system to respond.
caused by a variety of conditions, including the presence
Inhibition of cell cycle progression by HCV viral
of obesity and diabetes. The incidence of hepatocellular
proteins, which can also activate signaling pathways that
carcinoma (HCC) in HCV-infected patients is
promote cell growth and division, may occur by blocking
significantly increased by HCV and HIV co-infection (3).
anti-tumor suppressor genes and checkpoints. HCV core
There are several different types of liver damage
protein inhibits tumour suppressor genes including
that can result in chronic liver cirrhosis, including
retinoblastoma protein and p53. The combination of
metabolic (alcohol, steatohepatitis, hemochromatosis,
retinoblastoma and p53 deficiency raises the risk of
and Wilson disease), infectious (chronic hepatitis B or
malignancy. Transforming growth factor-beta is
C), and inflammatory (primary biliary or primary
produced by HCV nonstructural protein genes, which
serositis). Cirrhosis is characterised by fibrosis and an
2535
Received: 23/12/2021
Accepted: 22/02/2022
c:\work\Jor\vol881_41
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2339-2548
Correlation between Gastrointestinal Symptoms Questionnaire and Findings of
Upper Gastrointestinal Endoscopy in Gastrointestinal Disorders
Khaled Mohamed Raafat*, Khaled Hamdy Abd El Majeed, Asmaa Ibrahim Ahmed, Ahmed Samir Allam
Gastroenterology and Internal Medicine Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Khaled Mohamed Raafat, Mobile: (+20) 01221056736, E-mail: khaled.Raafat@med.asu.edu.eg
ABSTRACT
Background: Gastrointestinal diseases are among the most common problems in tropical countries and commonly
manifest as diarrhea, abdominal pain, abdominal distention, gastrointestinal bleeding, intestinal obstruction,
malabsorption, or malnutrition.
Objective: The aim of this work was to compare the efficacy of gastrointestinal symptoms questionnaire and results of
upper gastrointestinal endoscopy to create an optimally reliable tool for measuring the presence and severity of GI
symptoms and to measure the symptomatic response to treatment more objectively.
Subjects and Methods: This study has been conducted on 100 patients complaining of gastrointestinal symptoms
attending the Gastrointestinal Endoscopy Unit in Faculty of Medicine, Ain Shams University Hospital. All patients have
been evaluated by upper GI endoscopy to measure the correlation between gastrointestinal symptoms questionnaire and
upper GI endoscopy.
Results: There was significant correlation between gastrointestinal symptoms questionnaire and results of upper
gastrointestinal disorders.
Conclusion: Gastrointestinal symptoms questionnaire is an easy used tool, which can be used to measure the presence,
severity of gastrointestinal symptoms and the symptomatic response to treatment more objectively.
Keywords: Gastrointestinal disorders, Gastrointestinal symptoms questionnaire, Upper gastrointestinal endoscopy,
INTRODUCTION
Upper GIT endoscopy that visualizes the upper part of
Gastrointestinal diseases are among the most
the GIT up to duodenum is an established mode of
common problems in tropical countries and commonly
investigation and treatment of wide range of upper GIT
manifest as diarrhea, abdominal pain, abdominal
conditions. It also offers the opportunity for biopsy of
distention,
gastrointestinal
bleeding,
intestinal
neoplastic and non-neoplastic lesions. It is a simple, safe
obstruction, malabsorption, or malnutrition (1).
and well tolerated procedure with direct visualization of
Gastroesopha geal refl
i
ux s one of the commonestGIT
the pathologic site and biopsy leading to early detection
which is symptomstypically characterized by
of pathologic changes and therefore helps to start
symptoms of heartburn, regurgitation and can lead to
appropriate treatment (7).
significant complications such as erosive esophagitis,
Gastrointestinal Symptoms Questionnaire is a
Barrett's esophagus and esophageal adenocarcinoma(2).
widely used instruments to measure the presence and
Patients with peptic ulcer disease may be
severity of GI symptoms. These questionnaires can be
symptomatic or asymptomatic. Symptomatic patients
used to measure the symptomatic response to treatment
generally present with dyspepsia. Most of the time, the
more objectively. Furthermore, these questionnaires are
pain is felt in the epigastric region, but sometimes it can
widely used in trials to describe the prevalence and
be in the right upper quadrant or left upper quadrant of
severity of gastrointestinal symptoms in the study
the abdomen. The pain is burning, or dull aching in
population as well as to evaluate treatment outcome (8).
nature and can radiate to the back in the case of posterior
The aim of this work was to compare the efficacy
penetrating ulcer (3). Ulcerative colitis (UC) presents
of gastrointestinal symptoms questionnaire and results
w
ith wide spectrum of symptomsc including abdominal
of upper gastrointestinal endoscopy to create an
pain, diarrhea, and hematochezia. The inflammation
optimally reliable tool for measuring the presence and
begins in the rectum and extends up the colon in a
severity of GI symptoms and to measure the
continuous manner till it reaches the ileum (4). Crohn's
symptomatic response to treatment more objectively.
disease usually presents with abdominal pain, fatigue,
anemia and mineral deficiencies. Some patients will
SUBJECTS AND METHODS
present with constitutional symptoms as fever, weight
This study has been conducted on 100 patients
loss and growth failure among younger patients (5).
complaining of gastrointestinal symptoms attending the
In patients with gastrointestinal tract GIT
Gastrointestinal Endoscopy Unit in Faculty of
symptoms, endoscopy is the gold standard and is often
Medicine, Ain Shams University Hospital.
the primary exploration. Positive findings in upper
All patients have been evaluated by upper GI
gastrointestinal endoscopy occur in 30 to 40% in
endoscopy to measure the correlation between
relation to a benign or malignant structural disease.
gastrointestinal symptoms questionnaire and upper GI
Negative findings occur in 60 to 70% of cases (1).
endoscopy.
The upper gastrointestinal flexible fiber optic
Inclusion criteria of selected patients under
endoscope was first used in 1968 and proved to be a
the study: Patient aged above 18 years old, both
major breakthrough in the diagnosis of GIT lesions (6).
2539
Received: 26/12/2021
Accepted: 23/02/2022
c:\work\Jor\vol881_42
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2549-2553
Study of the Relation between Il-6, Insulin Resistance, and
Blood Pressure in Essential Hypertensive Patients
Amira M. Elsayed *, Walaa M. lbrahim, Sayed A. Grawesh, Ayman M. Elbadawy
Department of Internal Medicine, Faculty of Medicine, Benha, University. Egypt.
*Corresponding Author: Amira M. Elsayed, Mobile:0201017994486,
E-mail: amiramohamady@gmail.com.
ABSTRACT
Background: One of the most important cardiovascular risk factors is essential hypertension, a disease that affects
a large percentage of the population.
Objective: The purpose of this study was to establish a probable relationship between IL-6 levels and both insulin
resistance and essential hypertension.
Methods: This is a case-control study. Ninety participants were involved: sixty essential hypertensive patients and
thirty healthy control who were matched for age and gender. The fasting and two-hour postprandial plasma glucose,
serum fasting insulin, HOMA-IR, and serum IL6 levels of all patients and control group were all examined.
Results: In comparison to the control group, fasting insulin and the HOMA-IR values in the hypertension group
were considerably higher. The median level of IL-6 in the hypertensive group (5.85 pg /ml) was substantially greater
than in the control group (1.49 pg /ml). Overall fasting insulin, fasting blood glucose, and HOMA-IR showed
positive correlation with IL-6, which is an indicator of insulin resistance.
Conclusion: Screening of IL-6 may be an indicator of insulin resistance in hypertensive patient. Further research
into the processes underlying these connections is required.
Keywords: Blood pressure, IL-6, Insulin resistance.
INTRODUCTION
Our study aimed to explore the relationship
Hypertension affects more than a billion people
between IL-6, insulin resistance, and blood pressure in
worldwide, with up to 45 percent of the adult
an essential hypertensive patient.
population suffering. Up to 60% of those over the age
of 60 are affected by Alzheimer's disease (1).
SUBJECTS AND METHODS
Approximately 1.5 billion people are expected to
This is a cross section hospital-based study at
have hypertension in the next decade, based on recent
internal medicine outpatient clinics in Benha
predictions. It is true that insulin is a major anabolic
University Hospital from January to July 2020. We
hormone in the management of glucose, lipid
recruited 60 patients who had been diagnosed with
homeostasis, and energy storage because of its
essential hypertension according to European Society
metabolic influence on insulin-responsive tissues.
of Hypertension/European Society of Cardiology
Glycogen storage in liver and skeletal muscles is
guidelines (ESH/ESC) (6). The patients were receiving
promoted by insulin. However, at high levels of insulin
antihypertensive medications regularly. In term of
resistance, it is impossible for insulin-responsive
control group, we collected 30 healthy individuals who
tissues to perform their normal anabolic metabolic
were similar in age and gender. Patients with one or
functions (2).
more of the following were excluded; obesity, smoking,
Interleukin 6 (IL-6) has a dual role as an
pre-diabetes, diabetes, infections, (acute or chronic),
autocrine and/or paracrine cytokine that influences
inflammation (acute or chronic), autoimmune
adipocyte activity (3). It also has been related to
disorders, cancer, and chronic liver illnesses. In
metabolic illnesses such as multiple sclerosis (MS) and
addition, patients receiving somatostatin analogues,
type 2 diabetes through accumulated evidence. It has
hormonal contraceptives, corticosteroids, or lipid
been proved that people with diabetes or obesity,
lowering agent were excluded from the research.
especially those with multiple sclerosis (MS)-like
Demographic and anthropometric data were collected,
symptoms, have elevated levels of IL-6 in their adipose
as well as information on the history of hypertension
tissues. When IL-6 level was increased in MS, it had a
and its duration.
direct effect on insulin resistance, increased glucose
synthesis in the liver along with an inhibitor of insulin-
Laboratory data:
mediated glucose uptake in muscle, as well as the
Fasting plasma glucose (FPG) , 2 hours
facilitation of hypertension (4). Many studies have
postprandial plasma glucose (2h PPG) levels, fasting
linked elevated levels of IL-6 and tumor necrosis factor
insulin, total cholesterol (TC), high density lipoprotein-
alpha (TNF-) in the bloodstream to the development
cholesterol (HDL-C), low density lipoprotein-
of high blood pressure in otherwise healthy individuals.
cholesterol (LDL-C), triglycerides (TGs), and kidney
Plasma levels of IL-6 and TNF- in hypertensive
function tests were measured at the Clinical Pathology
individuals were revealed to be associated with
Department, Benha University Hospital, according to
coronary endothelial dysfunction (5).
the laboratory's standard procedures. For detection of
2549
Received: 23/12/2021
Accepted: 22/02/2022
c:\work\Jor\vol881_43
The Egyptian Journal of Hospital Medicine (July2022) Vol. 88, Page 2554-2560
Evaluation of the Effect of Combination Chemotherapy with Five-day Infusion of
Fluorouracil plus Vinorelbine in Pretreated Metastatic Breast Cancer Patients
Mai Ezz El Din1*, Rasha Salah2, Tarek Kamel1, Ahmed Nagy1
1Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Egypt
2Department of Clinical Oncology, El Salam Oncology Centre, Cairo, Egypt
*Corresponding author: Mai Ezz El Din, Mobile: (+20) 01223176730,
E-Mail: mai.ezzeldin@med.asu.edu.eg; maiooyaz@yahoo.com
ABSTRACT
Background: Continuous infusion (CI) of 5-fluorouracil (5FU) and vinorelbine, individually and in combination, has
been proven in several studies to be active and well tolerated for advanced pretreated breast cancer.
Objective: This study sought to evaluate the clinical activity and side effects of their combination in pretreated
metastatic breast cancer patients.
Patients and Methods: This retrospective study collected and analysed the medical records of fifty-four patients who
attended El-Salam Oncology Center and Ain Shams University Hospitals, Department of Clinical Oncology during the
period from July 2013 to June 2018. Combination chemotherapy received was 5FU 600 mg/m2/d for 5 consecutive days
as a CI and vinorelbine 25 mg/m2 on days 1 and 5 as a short intravenous (IV) infusion every 3 weeks.
Results: Eleven (20.4%) complete responses, 20 (37%) partial responses and 14 (25.9%) stable disease were
documented, accounting for a clinical benefit rate of 83.3%. The median progression free survival was 6.8 months. The
median overall survival (mOS) was 25.8 months. Treatment was well tolerated, with grade 3 anemia, febrile neutropenia
and stomatitis in 9.3%, 5.6% and 1.9% respectively as the main adverse reactions.
Conclusions: This drug combination is active in metastatic previously treated breast cancer patients with an acceptable
toxicity profile and continues to be present in the treatment armamentarium in this setting.
Keywords: Chemotherapy, Fluorouracil (Infusion), Metastatic Breast Cancer, Vinorelbine.
INTRODUCTION
In fact, compared with conventional route,
Breast cancer has surpassed lung cancer as the
increasing the duration of exposure to fluorouracil can
most commonly diagnosed cancer worldwide,
potentially enhance tumor cell kill, and low drug levels
accounting for over two million cases each year
are generally detected in bone marrow, a finding
including low- and middle-income countries (1). Despite
consistent with the absence of myelodepression
the gains in early detection, up to 30% of women with
reported after protracted infusion of this compound (14-
early-stage, non-metastatic breast cancer at diagnosis
15).
will develop distant metastatic disease. Although
One randomised phase III study (16) demonstrated
metastatic breast cancer is unlikely to be cured,
that docetaxel showed comparable efficacy to 5-
meaningful improvements in survival have been seen,
fluorouracil+vinorelbine in anthracycline-pretreated
which can be explained by the introduction of newer
metastatic breast cancer patients with docetaxel.
systemic therapies (2-4).
So, in this retrospective study we evaluated the
For selected patients, the use of a combination
effect of the combination of 5-days CI of fluorouracil
regimen rather than a single agent is preferred because
plus IV vinorelbine in pretreated metastatic breast
combination therapy results in a higher response rate,
cancer patients.
which may justify the risks of treatment (5). Apart from
PATIENTS AND METHODS
new agents, another treatment strategy is represented by
This retrospective study collected and analysed the
different ways of administering known drugs with a
medical records of fifty-four patients who attended El-
possible enhancement of their therapeutic activity.
Salam Oncology Center and Ain Shams University
Vinorelbine is active as a single agent (Objective
Hospitals, Department of Clinical Oncology during the
response rate (ORR) 25- 45%) even in heavily
period from July 2013 to June 2018.
pretreated patients (6-8), some authors also reported a
For patients entered in this study, the diagnosis of breast
possible lack of cross-resistance with anthracyclines (9-
carcinoma had been histologically confirmed. Eligibility
10).The effectiveness of CI 5FU in adenocarcinoma is
criteria included metastatic disease, previous chemotherapy
well established (11), where low dose CI 5FU has been
administration in the metastatic setting and Eastern
shown to offer useful palliation for advanced breast
Cooperative Oncology Group (ECOG) score less than 3
cancer, with an ORR ranging from 16% to 53% (12). In
with normal hematological, hepatic and renal functions.
addition to its moderate hematologic toxicity, which
allows for combinations with other myelosuppressive
Treatment plan:
agents, this route of administration is usually associated
Fluorouracil was administered at the dose of 600
with an acceptable toxicity profile mainly consisting of
mg/m2 CI for five days and vinorelbine 25 mg/m2 IV
mucositis and hand-foot syndrome (13).
bolus, was delivered on day 1 and 5. Cycles were
planned every three weeks.
Received: 26/10/2021
Accepted: 25/12/2021
2554
c:\work\Jor\vol881_44
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2561-2567
Endoscopic Inferior Turbinoplasty Versus Radiofrequency Ablation for
Treatment of Inferior Turbinate Hypertrophy
Ruwaydah Husayn Amhimmid*, Waleed Mohamed Basha Amin,
Said Abdel Monem Mohamed, and Ashraf Elhussiny Odabasha
Oto-Rhino-Laryngology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Ruwaydah Husayn Amhimmid, Mobile: (+20)01150454738, Email : rr9173500@gmail.com
ABSTRACT
Background: A variety of methods can be used to treat inferior turbinate hypertrophy that has not improved with the
medical treatment including turbinectomy, laser and turbinoplasty as well as radiofrequency ablation.
Objectives: This study aimed to compare the results and outcome of radiofrequency ablation with that of endoscopic
turbinoplasty in cases of inferior turbinate hypertrophy that are resistant to the medical treatment.
Patients and methods: Thirty-four patients having refractory inferior turbinate hypertrophy have been divided
randomly into two groups. Group (A) included patients who underwent endoscopic inferior turbinoplasty, while group
(B) contained patients who underwent radiofrequency ablation.
Results: Three-months postoperatively, within each group, there was a statistically significant decrease in the inferior
turbinate hypertrophy grading, but with no statistically significant difference between the two groups. As well, there
was a statistically significant improvement of the nasal symptoms VAS in each group. However, there was a statistically
significant more improvement of the postoperative nasal obstruction VAS in the radiofrequency group than in the
endoscopic turbinoplasty group. Whilst, there was a statistically significant more improvement of the postoperative
sneezing VAS in the endoscopic turbinoplasty group than in the radiofrequency group.
Conclusion: Both techniques are effective for inferior turbinate reduction. Radiofrequency ablation is a minimally
invasive technique and more effective than endoscopic turbinoplasty in relieving nasal obstruction.
Keywords: Endoscopic inferior turbinoplasty, Radiofrequency ablation, Inferior turbinate hypertrophy.
INTRODUCTION
When it comes to noses and breathing, the lower
studies makes it impossible to suggest a particular
part of the turbinate is the most important part. It is made
strategy based on data (6).
up of an osseous skeleton core and mucosal layers on
Comparing
radiofrequency
ablation
and
both sides. One of the most significant functions of the
endoscopic turbinoplasty in cases of inferior turbinate
inferior turbinate is that it regulates air temperature and
hypertrophy refractory to medicinal treatment was the
humidity and filters out the foreign particles by
goal of this study.
mucociliary clearance, which protects the lungs from
inhaled irritants (1, 2). Asthma, allergies, or an evident
PATIENTS AND METHODS
distortion of the septum are the most common causes of
Preliminary data from a prospective cohort study
inferotemporal
turbinate
hyperplasia.
was gathered in the Oto-Rhino-Laryngology
Otorhinolaryngologists consider nasal blockage as a
Department, Faculty of Medicine, Zagazig University,
prevalent symptom. Even while this isn't a life-
Egypt.
threatening ailment, it has a negative impact on one's
well-being because it makes it difficult to enjoy the little
Ethical approval:
things (3).
Research Ethics Council at Zagazig University
Medications used to treat inferior turbinate
approved the study as long as all participants
hypertrophy include antihistamines used orally,
provided informed consent forms. Ethics guidelines
decongestants applied topically and systemically, and
for human experimentation were adhered to by the
corticosteroid sprays administered topically intranasal.
World Medical Association's Helsinki Declaration.
Some patients' condition appears to be deteriorating,
Inclusion criteria: Medical treatment has failed to
while other cases remain resistant to medical treatment.
alleviate a patient's nasal obstruction due to hypertrophy
In such circumstances, surgical reduction of the inferior
of the inferior turbinate (antihistaminic via oral route
turbinate can be undertaken. An appropriate nasal airway
and steroid sprays intranasal, as well as systemic
for breathing as well as the preservation of the inferior
decongestants) for a minimum of three months.
turbinate physiological function are the primary goals of
inferior turbinate surgery (4, 5).
Exclusion criteria: Patients younger than 14-years old,
Cryosurgery, monopolar or bipolar electrocautery,
pregnant patients, chronic rhinosinusitis patients with
turbinectomy and turbinoplasty, as well as laser-assisted
nasal septal deviation, sinus tumour patients with
turbinoplasty, are only a few of the therapy possibilities
granulomas, patients with sino-nasal polyposis, past
for inferior turbinate hypertrophy. It's not clear what the
history of inferior turbinate surgery, and patients who
best course of action is. In addition, the lack of long-term
were unfit for general anesthesia.
2561
Received: 28/12/2021
Accepted: 25/02/2022
c:\work\Jor\vol881_45
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2568-2570
An Overview of Post Mastectomy Seroma and
Treatment Options: Review Article
Wael Elsayed Lotfy, Osama Abdel Aziz Mohamed, Loay Mohamed Elhady, Maryam Asmaeil Abuojaylah
Department of Surgery and Surgical Oncology, Zagazig University Hospital, Sharkia, Egypt
*Corresponding author: Maryam Asmaeil Abuojaylah, Mobile: (+20)01120372052, E-Mail: Mar.abdullatif@gmail.com
ABSTRACT
Background: Among women, breast cancer is the most common kind of diagnosis, the main cause of cancer-related
death, and the leading source of lost life years due to disability-adjusted for global mortality. Breast-conserving surgery
or mastectomy is common in the treatment of the disease which was relied on for many years. Seroma is a common side
effect after mastectomy. Some surgeons view it as a necessary evil that must be endured after surgery. Seroma formation
following breast surgery can occur anywhere from 3% to 85% of the time.
Objective: This review aims to give an overview of seroma formation after mastectomy surgeries and the possible
treatment options.
Methods: The databases were searched for articles published on 3 databases [PubMed -Google scholar-science direct]
and Boolean operators (and, or, not) had been used such as [Post Mastectomy Seroma, Breast cancer surgery and
Treatment for breast cancer] and in peer-reviewed articles between January 2009 and June 2021.
Conclusion: Although post-mastectomy seroma occurs in the vast majority of individuals, tightening the flap after
surgery may help avoid its development.
Keywords: Post Mastectomy Seroma, Breast cancer surgery, Treatment for breast cancer.
INTRODUCTION
Among women, breast cancer is the most common
Breast cancer surgery, Treatment for breast cancer, and
cause of cancer-related death and the leading source of
more synonymous keywords were used.
lost life years due to the disability-adjusted for global
These databases were searched for articles
mortality (1).
published on 3 databases [PubMed - Google scholar-
Breast-conserving surgery or mastectomy is
Science direct] and Boolean operators (AND, OR,
common in the treatment of the disease for many years
NOT) had been used such as [Post Mastectomy Seroma
(2).
AND Breast cancer surgery OR Treatment for breast
Seroma is a common side effect after mastectomy
cancer] and in peer-reviewed articles between January
and is no longer viewed as a problem but as a side effect
2009 and June 2021. A 12-years date range was
of surgery. Some surgeons view it as a necessary evil that
selected, and no language limitations, and filtered on the
must be endured after surgery. Seroma formation
selected data basis. However, the range of time intervals
following breast surgery can occur anywhere from 3% to
for research is wide as data are scarce particularly on
85% of the time (3).
reviewed, accurate, and depth in the retrieved literature.
This condition isn't fatal, but it causes flap necrosis
Documents in a language apart from English were
and wound dehiscence, which can lead to sepsis as well
excluded as sources for interpretation were not found.
as a long recovery period and several physician visits. It
Papers apart from main scientific studies were also
could also postpone adjuvant treatment (4).
excluded and documents unavailable as a total written
It is caused by cellular damage caused by heat
text, conversation, conference abstract papers, and
action and obliteration of partial arteries and lymph ducts
dissertations.
during dissection, both of which are currently being
debated (5).
Post-mastectomy seroma:
Surgeons have been researching the most effective
Definition and incidence of post-mastectomy
methods of reducing the occurrence of seromas. Using
seroma:
electrocautery to stop blood loss during surgery may
It's a common complication of mastectomy, and
increase the incidence of seroma since it damages tissues
it occurs when serous fluid builds up in the axillary
with heat (6).
dead space following skin flap creation. Three to 85
The review article aims to give an overview of
percent of breast or axillary surgeries, patients
seroma formation after mastectomy operations and
experienced a buildup of serous fluid (7).
possible treatment options.
When several aspirations were required or a
new drain was inserted due to chronic instances, seroma
Methods:
was observed. The word "seroma" has also been used
A search strategy was performed to determine the
in other research were more than 5 to 20 cc of fluid has
related literature and the objective of this review was to
been aspirated and validated as a result (8).
identify and give an overview of seroma formation after
Detection methods, as well as the definition of
mastectomy operations and possible treatment options.
seroma, influenced the prevalence of the disease. Most
Relevant keywords included: Post Mastectomy Seroma,
seromas were found to be mild and self-limiting if fluid
2568
Received: 23/12/2021
Accepted: 22/02/2022
c:\work\Jor\vol881_46
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2571-2577
Accuracy Of Multi-Detector Computed Tomography in Assessment of
Lower Limb Peripheral Arterial Diseases in Diabetic Patients
Misbah Salim Ali*, Ayman Fathi Zied, Ahmed Abdelhamid Mohammed,
Ahmed Gamil Ibrahim Abdelmegid
Department of Radiology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Misbah Salim Ali, Mobile: (+20) 01557724451, Email: mis.ali@sebhau.edu.ly
ABSTRACT
Background: The risk of peripheral arterial disease is significantly increased among diabetic individuals, as presented
through multidetector computed tomography angiography (MDCT). There are numerous benefits to choosing this path.
Objective: To evaluate the lower limb arteries by multidetector computed tomography angiography.
Patients and methods: MDCT examinations were performed on 24 diabetic patients who presented with signs and
symptoms of lower limb ischemia; MDCT will be performed with PHILIPS ingenuity 128 slice CT scanner. For stenosis,
occlusion, calcification, plaque structure, collaterals, transverse, maximum intensity projection, multi-planar, and
volume-rendering images were used.
Results: At least 22 segments had severe stenosis, defined as luminal narrowing of more than 50% and PSV ratio of
more than 2, Fifty segments were occluded, eight had no distal collateral refilling, and five had nonsignificant stenosis
(luminal constriction lower than 50% of arterial diameter and PSV lower than ratio 2).
Conclusion: MDCT for evaluation of lower limb ischemia should be considered as the investigation of choice for pre-
operative assessment & follow-up; being less invasive and provides angiography-like high-resolution images which are
familiar to vascular surgeons.
Keywords: Multidetector computed tomography angiography, Peripheral arterial disease, Diabetic patients.
INTRODUCTION
males (54.17%) and 11 females (45.83%) who were
In comparison to non-diabetic populations, the
referred to the Radiology Department, Faculty of
risk of arterial disease and ischemic events is much
higher in diabetics who have arterial disease. The sooner
Medicine, Zagazig University Hospitals from outpatient
a diagnosis can be made, the better (1). Diabetics can have
clinics and Vascular Surgery Department.
mild or moderate to severe peripheral vascular disease,
depending on whether or not they can feel the dorsalis
Ethical Considerations:
pedis and/or tibial pulses on either side of their body (2).
The study was done after permission from the
In the lower extremities, the superficial femoral
hospital's institutional review board and informed
artery is in the adductor canal.is the most common site of
consent from patients was taken before the trial. This
involvement in a non-diabetic patient (2). Diabetic
work has been carried out following The Code of
patients have a higher prevalence of arteriosclerosis of
Ethics of the World Medical Association (Declaration
these blood vessels than non-diabetic patients (3).
of Helsinki) for studies involving humans.
Younger diabetics are at significantly increased
risk of atherosclerosis and therefore ischemic heart
Inclusion criteria: For this study, all adult diabetic
disease, lower limbs ischemia, and a tendency towards
patients with clinically indicated peripheral arterial
cerebral thrombosis and infarction (3). multidetector
insufficiency were enrolled regardless of the type of
computed tomography angiography (MDCT). Several
diabetes or gender.
factors make it an attractive option, including the fact
that it is non-invasive, there are shorter acquisition
Exclusion criteria: Patients having a history of arterial
periods, thinner slices, and higher spatial resolution that
vascular trauma, those who have already undergone
allow scanning of the entire vascular tree in less time and
arterial interventions, ultrasound Doppler assessment is
with fewer contrast media. The diagnosis of PAD can be
hindered in patients with extensive scarring or skin
made with 98% sensitivity and 98% specificity,
damage, and pregnancy.
according to recent investigations (4).
The present study aimed to evaluate the lower
All patients were subjected to:
limb arteries by multidetector computed tomography
All patients were subjected to a full detailed history,
angiography.
and clinical examination with special emphasis on the
lower limb for signs of arterial insufficiency laboratory
PATIENTS AND METHODS
investigations (fasting blood glucose level and blood
Twenty-four diabetic patients who presented with
urea, serum creatinine).
signs and symptoms of lower limb ischemia were
included in this trial. Their ages ranged from (43) to (79)
Multi-Detector
Computed
Tomography
years with a mean of (66.58) years, 13 of them were
examination:
At first, we explained the examination to the patient.
2571
Received: 23/12/2021
Accepted: 22/02/2022
c:\work\Jor\vol881_47
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2578-2581
Clinico-Epidemiological Study of Maxillary Squamous Cell Carcinoma
Cases with Infiltration of The Base of The Skull and/or The Orbit
Elham H.El-Bana1, Shimaa E.Attia1, Engy Aboelnaga1, Alaa M Maria2, Amal Halim1
1Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Mansoura University, Egypt
2Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Tanta University, Egypt
*Corresponding author: Elham H.El-Bana, Mobile: (+20) 01025094497, E-Mail: dr.elham92@gmail.com
ABSTRACT
Background: The most common site of sinonasal and paranasal carcinoma is the maxillary sinus, which accounts for
60-70 percent of all cases. Squamous cell carcinoma (SCC) is the most common histopathological type, accounting for
6075% . Infiltration of the skull base and/or orbit is one of the complications of such tumours which can have a negative
impact on one's quality of life.Objective: The study looked at the epidemiological characteristics and treatment
outcomes of patients with maxillary sinus squamous cell carcinoma (MxSSCC) with skull base and/or orbital invasion
who were admitted to Mansoura Clinical Oncology and Nuclear Medicine Department and Tanta Clinical Oncology
and Nuclear Medicine Department for treatment between January 2000 and December 2018.
Patients and methods: This is a retrospective study. Thirteen patient records fulfilled the eligibility criteria of our
study. Females were slightly more in number (7 patients (53.8%). The majority of the cases were of age between 40-69
years (N= 11 patients representing 84.6%). Radiotherapy (RT) was the main line of treatment. It was used as the
definitive line in ten patients (76.9%) and surgery with postoperative radiotherapy (PORT) was used in (N=3, 23.1%)
patients. Results: 5-years overall survival (OAS) of patients with skull base and/or orbital invasion was 15.4% while 2-
years progression-free survival (PFS) was 30.8%.Conclusion: This study highlights the effect of the skull base and/or
orbital invasion on OAS and PFS of patients with MxSSCC.
Keywords: Base of skull tumors, Gingival carcinoma, Mandibular carcinoma, Maxillary carcinoma, Orbital infiltrating
tumors.
INTRODUCTION
Oncology and Nuclear Medicine Department and Tanta
Because of the close proximity and relative
Clinical Oncology and Nuclear Medicine Department
radiosensitivity of adjacent critical structures such as
for treatment through the period from January 2000 to
the orbit, central nervous system, and internal carotid
December 2018 inclusive.
artery, treatment of advanced head and neck cancers
(HNC) is difficult for both radiation oncologists and
PATIENTS AND METHODS
surgeons. Obtaining adequate surgical margins in this
This is a retrospective analytical study of 13
area is difficult, and is associated with a high risk of
patients with MxSSCC with skull base and/or orbit
postoperative morbidity(1-2). The maxillary sinus
involvement who were admitted to Clinical Oncology
carcinoma (MxSSCC) represents 3% of HNC.
and Nuclear Medicine Department, Mansoura
MxSSCC is accounting for 60 to 75 % of paranasal
University Hospital and Clinical Oncology Department,
sinus cancers(3-5). As the maxillary sinus is a pyramidal
Tanta University Hospital, Egypt between January 2000
cavity filled with air, the tumour grows silently with
and December 2018 inclusive.
few or no signs and symptoms until it reaches a
significant size. Early symptoms are generally
Inclusion criteria:
nonspecific and similar to common nasal complaints.
· Pathologically proven maxillary sinus or related
Because of that the majority of patients are diagnosed at
hard palate SCC.
an advanced stage, with >80% of them presented with
· Patients with different stages of the disease from
at
least
stage
T3
disease.
that explaining
stage I to IV.
MxSSCC lower survival rates than those of other types
· Patients of both sex
of HNC(6-7).
· Age between (18 - 80 years).
MxSSCC tumor size (T) had the greatest
Exclusion criteria:
influence on local control, progression free survival
· Patients with other malignancies were excluded.
(PFS), and overall survival (OAS)(8). Among the
Various aspects were analyzed in the records
complications of such tumors is infiltration of the skull
such as epidemiology, detailed history, radiological and
base or/and orbit, which can severely affect the quality
endoscopic assessment, pathological features of the
of life.
tumor, the treatment plan, treatment outcome, survival,
and patient status at follow-up visits were recorded.
AIM OF WORK
Ethical consent:
Studing the epidemiological characteristics and
An approval of the study was obtained from
treatment outcome of maxillary squamous cell
Mansoura and Tanta University Academic and
carcinoma patients with skull base and/or orbital
Ethical Committees. Every patient signed an
involvement, who were admitted to Mansoura Clinical
2578
Received: 26/12/2021
Accepted: 23/02/2022
c:\work\Jor\vol881_48
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2582-2587
The Impact of Laxative Drops on The Bowel Motility and
Post Caesarean Section Recovery
Heba Farag Salama*, Mahy N. Egiz, Amira Ahmed Fathy
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Heba Farag Salama, Mobile: (+20)01003570673,
Email: hoba.salama22@gmail.com, ORCID ID: 0000-0002-7471-3826
ABSTRACT
Background: Enhanced recovery after surgery (ERAS) has been considered as a widely dependable paradigm to
increase the goodness of patient care by better management of surgical patients in the perioperative period. There is no
specific method has been established yet to prevent and treat postoperative ileus but different strategies were used,
however the efficacy of them were unclear.
Purpose: To determine the effectiveness of stimulant laxative on the resumption of intestinal motility and its reflection
on the post caesarean section recovery.
Patients and methods: A prospective cohort study, included 120 women who had caesarean section (CS) in Menoufia
University Hospital, from June 2021 till October 2021. They were divided into case group (A) which included 60
patients who drank a cup of anise added to it 15 drops of picolax 4 hours after CS and control group (B) included 60
patients who just drank a cup of anise only 4 hours after surgery. Resumption of intestinal sound, first flatus and motion
were compared between the two group.
Results: Case group which used laxative showed significantly shorter time for first intestinal sounds (Mean ± SD 6.87
± 1.38), time to first flatus (Mean ± SD 16.78 ± 4.46) and mean time to first bowel movement (Mean ± SD 20.65 ± 5.81)
(p < 0.05).
Conclusion: Usage of stimulant laxative 4 hours after CS enhance the intestinal motility and improved the CS recovery.
Keywords: Caesarean Section, Ileus, Sodium-picosulfate
INTRODUCTION
Malnutrition, nosocomial infection, pulmonary
Cesarean section is considered the most
disorders, deep venous thrombosis, and decreased
commonly performed surgery in the world. A recent
patient satisfaction are considered as followed sequels
study documented that Egypt ranked 3rd among world
of delayed postsurgical oral food intake (6). Enhanced
countries with an estimated rate of cesarean section of
recovery after surgery (ERAS) is considered now as an
51.8% (1). Cesarean section rates have been steadily
adopted protocol aiming to improve the patient care
increasing in Egypt from a low of 4.6% in 1992, 6.7%
through better preoperative management of surgical
in 1995, 10.3 % in 2000, to about 52% in 2014 (1).
patients (7).
Ileus is considered as prevalent and
Now, enhanced recovery after surgery pathways
unpreventable sequel of abdominal operations which
are applied to different surgeries including colorectal,
has no definitive mortality but increases morbidity after
bariatric,
gynecologic
procedures
and
knee
surgery (2). Postoperative ileus (POI) is defined as the
replacement. Recently, application of these models in
transient cessation of harmonious bowel motility after
cesarean delivery showed significantly reduction in
surgical intervention, which lead to delayed intestinal
hospital stay duration and costs (8).
motility after operation. It is developed within 5 days
Sodium picosulfate is a contact stimulant
after open abdominal surgery or 3 days after abdominal
laxative used as a treatment for constipation or to
endoscopic surgery (3).
prepare the large bowel before colonoscopy or surgery.
Gynecologist and obstetricians prefer not to
It is sold under the trade names sodipic picofast,
introduce oral intake after abdominal or caesarean
laxoberal, laxoberon, purg-odan, picolax, guttalax,
section until resumption of bowel function because they
namilax, pico-salax, picoprep, and prepopik, among
believe that early feeding worsen postoperative ileus.
others (9).
Resumption of bowel function is known as return of
Sodium picosulfate is not absorbed from the
bowel motility, passing gas, bowel movement, and
gastrointestinal tract or its active metabolite. It is not
feelings of hunger(4).
detectable in breastmilk. Sodium picosulfate can be
Delaying the resumption of oral food intake can
taken during breastfeeding and no special precautions
negatively affect production of the mother's milk and
are required (9).
breastfeeding and requires intravenous nutrition, which
This study hypothesized that, using stimulant
extends the hospital stay and increases the cost of
laxative (Picolax) in women who underwent CS can
postoperative care. It also increases the rate of cellular
improve and speed the resumption of postoperative
breakdown, delays healing, and increases the likelihood
intestinal motility, so early feeding, less hospital stay
of infection (5).
and better postoperative recovery would be possible.
2582
Received: 28/12/2022
Accepted: 25/02/2022
c:\work\Jor\vol881_49
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2588-2592
Assessment of T-Regulatory Cell in Children with Chronic
Immune Thrombocytopenia
Laila M. Sherief1, Heba Allah Elsayed bdelrhman2, Saleem Emran Ali Abead*1, Shereif Mohammed Elgebaly1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Saleem Emran Ali Abead, Mobile: (+20) 01554929879, E-Mail: saleemomran964@gmail.com
ABSTRACT
Background: Immune thrombocytopenia (ITP) is an autoimmune disease characterized by isolated thrombocytopenia
and increase risk of bleeding. The initial event leading to anti-platelet autoimmunity remains unclear.
Objective: The aim of this study was to assess the role of T-regulatory cells in chronic ITP.
Patients and methods: This cohort study was carried on 34 children with chronic immune thrombocytopenia who
presented to the Pediatric Hematology Unit and Outpatient Clinic of Zagazig University Hospitals during the period
from June 2020 up to march 2021 to assess the role of T-regulatory cells in children with chronic immune
thrombocytopenia.
Results: ITP patients were 20 females (58.8%), while 14 were males (41.2%). Consanguinity was reported in 6 patient
(17.6%) while similar condition was found only in one patient (2.9 %). Patients were presented initially with purpura
(44%) and ecchymosis (73.5%) while hematuria was detected in 5.9% and epistaxis in 38.2%. After six months
significant improvement was detected in purpura (17.6%), ecchymosis (47%) and epistaxis (17.6%). The T regulatory
cells were significantly increased after six months of follow up and there was significant positive correlation between
platelet count and T regulatory cell level after six month of therapy.
Conclusion: T- regulatory cells may play role in pathogenesis of chronic immune thrombocytopenia. Thus, T regulatory
cells may play a role in modifying immune responses in these patients, resulting in new strategies of treatment and
monitoring of disease activity.
Keywords: Chronic immune thrombocytopenia, T-regulatory cells, Children.
INTRODUCTION
Hematology Unit and Outpatient Clinic, Zagazig
Low platelet count and increased bleeding risk
University Hospitals during the period from June 2020
characterize the autoimmune disease known as immune
up to March 2021 to assess the role of T-regulatory cells
thrombocytopenia. There are numerous levels of the
in children with chronic immune thrombocytopenia.
immune system involved in the pathophysiology of ITP.
Many factors contribute to the development of
Ethical consent:
autoimmunity, including abnormalities in regulation,
All parents gave their consent after being informed.
cytokine production, as well as signaling pathways (1).
Faculty of Medicine's Research Ethics Committee,
An imbalance in T-cell subsets appears to be supportive
Zagazig University accepted the study's research
of ITP's generation of autoantibodies. ITP exhibits a
objectives. In compliance with the World Medical
shift between Th1 and Th17 cells, which is
Association's ethical standards for human studies,
characteristic of many autoimmune diseases and
Helsinki Declaration, it was carried out.
conditions. Loss of tolerance may also come from a
decrease in regulatory B and T cells (2).
Inclusion criteria:
Chronic ITP is defined as the presence of illness
1. Children aged from 3 to 16 years, both sexes,
more than 12 months following diagnosis. It occurs in
with chronic thrombocytopenia and Had a
13-36% of children with ITP. Those children with low
platelet count < 30×103/ mm3.
platelet counts for long periods of time have
Exclusion criteria:
considerable bleeding risks and quality-of-life issues (3).
1. Other causes of pediatric thrombocytopenia,
ITP treatment options fall into two broad
like leukemia, lymphoma, bone marrow failure,
categories: treatment of acute bleeding or bleeding risk
infections, medications, and exposure to certain
by interrupting the platelet destruction process promptly
toxic chemicals.
and temporarily (front-line therapies), and those that
2. Age less than 3 years.
have the ability to improve platelet count for a long-
3. Children recently received rituximab or other
term management (second-line therapies) (4).
immune suppressive therapy.
The aim of our work was to assess the role of T-
regulatory cells in children with chronic immune
The diagnosis of immune thrombocytopenia was
thrombocytopenia.
made on the basis of the patient's medical history,
physical examination, and laboratory tests including the
PATIENTS AND METHODS
finding of isolated thrombocytopenia, normal
Our cohort study was carried on 34 children
hemoglobin concentration, normal white blood cell
with chronic immune thrombocytopenia (ranging in age
count, and normal peripheral blood smear except for the
from 3 year to 16 years) who presented to the Pediatric
presence of large platelets and thrombocytopenia (5).
2588
Received: 30/12/2021
Accepted: 28/02/2022
c:\work\Jor\vol881_50
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2593-2598
Comparison of Intralesional Vitamin D3 Injection, 5% Koh Cream and
Their Combination in Treatment of Cutaneous Warts
Ahlam Abdulsalam Almabrouk1, Gamal Ahmed Duweb2
1Department of Biology, Libyan Academy for Post Graduate Studies, Tripoli, Libya
2Department of Dermatology, Faculty of Medicine, Benghazi University, Libya
*Corresponding author: Ahlam Abdulsalam Almabrouk, Mobile: )00218(925448775,
Email: ahlam.almabrouk1981@gmail.com
ABSTRACT
Background: Warts are a common skin condition that affects people all over the world. This ailment affects 220% of
students in primary school. A well-known keratolytic agent, potassium hydroxide (KOH), has many dermatological
uses. Vitamin D is important in the proliferation and differentiation of keratinocytes.
Objective: The aim of the current work was to compare the efficacy and safety of intralesional vitamin D3 injections
and 5% KOH cream separately and in combination with each other in the treatment of warts.
Patients and Methods: This study was carried out at the private outpatient Al- Ahlam Center of Dermatology and
Cosmetology in Gharyan, Libya from 1st of Sep to last of Dec 2021. 45 patients with warts were included in the study.
They were classified into 3 groups according to method of treatment into Vitamin D3 group, 5% KOH cream group,
and combination group.
Results: The mean age of patients was 27.04 ± 11.7 years. 31 patients completed the study. Complete response was
seen in 12 patients with vitamin D injection after period of 4 months, 9 patients with 5% KOH cream after period 2-3
months, and 10 patients with combination both treatment after a period of 1 month.
Conclusions: It could be concluded that intralesional vitamin D with 5% KOH cream is safe, effective, and
inexpensive treatment option for recalcitrant palmoplantar and periungual warts.
Keywords: Vitamin D3, Palmoplanter, Periungual, KOH, Warts.
INTRODUCTION
condition, and previous treatment options. The most
The Human Papilloma Virus (HPV) is the most
common reason for treatment is the cosmetic discomfort
common cause of cutaneous warts, a common condition
and the risk of spreading the disease to other parts of the
in dermatology. To date, more than a hundred distinct
body (8).
HPV genotypes have been discovered. With a
Scarring can occur as a result of current wart
prevalence of up to 33% in primary school children and
treatments, which involve physically destroying wart-
up to 22% in the general population, the incidence of
infected cells, Warts can be treated with electrosurgery
disease varies widely among different age groups and
(e.g., cryocautery or chemical cautery), carbon dioxide
demographics (1,2). Direct or indirect transmission can
lasers (carbon dioxide laser, bleomycin and
occur when the epithelial barrier is breached, such as in
photodynamic therapy), oral cimetidine (orally), topical
minor trauma (3). As a result of histological examination,
immunotherapy (e.g., contact sensitizers, intralesional
the pathognomonic presence of koilocytic cells in the
injection of antigens), and topical immune response
dermal capillaries of the dermis can be identified (4). In
modifiers (topical immunotherapy) (9).
order to determine whether a wart is caused by HPV,
Recalcitrant warts, repeat warts, extensive warts,
the anatomical location or morphology of the wart is
and hard-to-treat areas like the periungual and
examined. Common warts, flat warts, plantar warts,
palmoplantar sites can all benefit from immunotherapy
periungual warts, and genital warts are all examples of
(10). Vitamin D3 is an immunotherapeutic agent used to
warts that can be examined (condyloma acuminata) (5).
treat warts. It works by inhibiting the expression of
Based on clinical observation, genital warts are
tumor
necrosis
factor
(TNF)-
through
typically diagnosed. Subclinical genital warts are more
immunomodulatory effects among others TNF- and
common in both men and women than visible genital
interleukin-6 through VDR-dependent pathway (11).
warts. In cases where lesions are very small or flattened,
One of the most commonly used metal bases in
acetic acid solution (5 percent) for 3 to 5 minutes can be
medicine, potassium hydroxide (KOH) can be used to
helpful. There may be a need to perform a biopsy and
diagnose fungal infections and to treat both male genital
HPV genotype testing to confirm the diagnosis (6).
warts and the molluscum contagiosum infection in
As a therapeutic challenge, treating warts has yet
children (12). Keratolytic effects of the drug cause the
to yield a single treatment that has been shown to be
destruction of virus-infected cells, resulting in the
effective in every patient (7). There are a variety of
removal of warts. In comparison to other topical
treatment options for treating common warts, each of
methods, this one is much less painful, less scar-
which must be tailored to the specifics of the patient's
forming, and less irritating to the skin. Itching,
case, including the number of warts, size, location,
erythema, and darkening of the skin are possible side
symptoms, personal preference, cost, immune system
effects (13).
2593
Received: 5/1/2022
Accepted: 3/3/2022
c:\work\Jor\vol881_51
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2599-2605
Knowledge and Self-Care Management Practice Among Asthmatic
Children (6-12 Years): An Educational Intervention Study
Hala Mostafa Elhady Hashim, Ahmady Mohammed Ismail,
Marwa Salah El dien Abd Elraouf, Mai Magdy Anwer Saber*, Hala Ali Abed Hassan
Department of Community, Environmental, and Occupational Medicine,
Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mai Magdy Anwer Saber, Mobile: (+20)1005536990, E-Mail: mai.saber@fmed.bu.edu.eg
ABSTRACT
Background: Asthma is a highly prevalent chronic respiratory disease which has been increasing worldwide. Education
to support self-management is an integral part of asthma care that improves disease control, reduces exacerbations and
admissions, and improves quality of life of asthmatic children and their caregivers.
Objective: The aim of the current work was to assess factors affecting knowledge and self-care management practice of
asthmatics and their care givers and to evaluate the effect of implementing an asthma educational intervention.
Patients and Method: An interventional study (pre and post comparison study design) was conducted that compared
the change in knowledge and self-care practices among participants before and after implementing a health educational
program. Results: Asthma educational intervention significantly increased asthma symptoms control and pediatric
asthma quality of life among studied asthmatic children, asthma knowledge and pediatric asthma caregivers quality of
life among caregivers of the studied asthmatic children after the application of the educational program (P<0.001).
Conclusions: It is postulated that children with asthma who receive an interactive, comprehensive educational program
would improve their quality of life, asthma management and asthma control compared with children receiving usual
care.
Keywords: Knowledge, asthmatic children, educational intervention
INTRODUCTION
supported by regular professional review improves
Asthma is a highly prevalent chronic respiratory
asthma control, reduces exacerbations and admissions,
disease affecting 300 million people world-wide (1). In
and improves quality of life (8).
recent decades, both asthma prevalence and incidence
The aim of the present study was to assess factors
have been increasing worldwide, not only due to the
affecting knowledge and self-care management practice
genetic background, but mainly to the effect of a wide
of asthmatic school aged children and their care givers
number of environmental risk factors, many of which
and to evaluate the effect of implementing an asthma
included under the umbrella of "modern lifestyle (2).
educational intervention program on knowledge and
In 2019, it was estimated that 262 million people
self-care management practice of asthmatic school aged
all over the world were affected with asthma that caused
children and care givers.
461000 deaths (3) and was responsible for 21.6 million
DALYs which was 20·8% of total DALYs from chronic
SUBJECTS AND METHODS
respiratory disease (4). Asthma affects people from
Study design: An interventional study (pre and post
different age range, recent data from the general
comparison study design) was conducted. It compared
population showed that in children up to 5 years old, the
the change in knowledge and self-care practices among
overall asthma incidence rate was 23/1,000 children per
participants before and after implementing a health
year; this incidence rate decreased among youth aged
educational program.
1217 years old to 4,4/1,000/year(2). The observed
prevalence of asthma in the Middle East ranges from
Study setting: This study was carried out in pediatric
4.4% to 7.6% while in Egypt is 6.7% (5).
outpatient clinic at Benha University Hospitals, due to
Poorly controlled asthma in the growing child may
high attendance rate of asthmatic children and better
impact
emotional,
intellectual
and
physical
quality of care on hands of professional physicians with
development (6) and it accounts for a large proportion of
availability of getting repeated follow-up visits.
childhood
hospitalizations,
healthcare
visits,
Study period: This study was carried out in two years;
absenteeism from day care/school and missed work
from the first of December 2019 to the end of November
days by parents(7), People with asthma and their families
2021.
need education to understand more about their disease,
their treatment, triggers to avoid, and how to manage
Study subjects: It included well-diagnosed asthmatic
their symptoms at home. It is also important to raise
children attending pediatric outpatient clinic at Benha
community awareness, to reduce the myths and stigma
University Hospitals and fulfilling the inclusion criteria
associated with asthma in some settings (2). Education to
of this study.
support self-management is an integral part of asthma
care not an optional extra, overviews of the extensive
Inclusion criteria: Asthmatic children attending
evidence-base concluded that asthma self-management
pediatric outpatient chest clinic at Benha University
2599
Received: 26/12/2021
Accepted: 23/02/2022
c:\work\Jor\vol881_52
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2606-2612
Sirtuin 1 Gene Expression in Non-alcoholic Fatty Liver Disease and
Its Correlation with Biochemical and Clinical Features
Shadi Mufeed Sulayman*1, Emad Fawzi Hamed1, Samia Hussein Ali2, Tarek M. H. Ibrahim1
Departments of 1Internal Medicine and 2Medical Biochemistry, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Shadi Mufeed Sulayman, Mobile: (+20)1066340518, E-Mail: mufeedshady@gmail.com
ABSTRACT
Background: Silent information regulator 1 [sirt1] is a protein that is widely expressed and has a crucial function in
the prevention of oxidative stress, which is implicated in the development of a number of chronic disorders, such as
fatty liver disease.
Objective: The aim of the current work was to investigate SIRT1 gene expression in non-alcoholic fatty liver disease
and it is emerging role in pathogenesis of non-alcoholic fatty liver disease. Subjects and Methods: This case-control
study included a total of twenty cases of Non-Alcoholic Fatty Liver Disease; NAFLD (Group A) and ten individuals
as a control (Group B), attending at Departments of Internal Medicine and Medical Biochemistry, Zagazig
University Hospitals. They were assessed clinically by lab investigations and quantitative real time polymerase
chain reaction (RT-PCR) to assess Sirt1 gene fold expression.
Results: There was a significant lowering of sirt1 gene expression p=0.0001 for patient with NAFLD compared to
healthy controls. There was significant association between SIRT1 and BMI, as well as hyperlipidemia in NAFLD
compared to healthy group. We found a significant association between SIRT1 and NAFLD patients with mild fibrosis
and those without fibrosis. Cut off value 0.61 had 80.0% sensitivity and 80.0% specificity, positive predictive value
57.0%, negative predictive value 92.0% and accuracy was 80.0%.
Conclusion: It could be concluded that the significant correlation between SIRT1 gene expression and non-alcoholic
fatty liver disease helps to differentiate patients with nonalcoholic fatty liver diseases and healthy ones.
Keywords: Sirtuin 1, Non-alcoholic Fatty Liver Disease.
INTRODUCTION
increase in ROS and an inflammatory response. Sirt1
Chronic hepatic steatosis that is not caused by
may play a role in preventing these processes, which are
genetic, metabolic, infections, side effects of drugs,
thought to be responsible for a variety of chronic
alcohol intake or malnutrition is described as
diseases (4).
nonalcoholic fatty liver disease (NAFLD) (1).
It was shown that SIRT1 acted through
NAFLD is a condition in which the liver's
regulating PPARa activity and the oxidation of fatty
hepatocytes accumulate too much lipid, which is linked
acids SIR-1's role in promoting insulin sensitivity and
to insulin resistance, obesity, and the metabolic
reducing inflammatory gene expressions was
syndrome. The prevalence of NAFLD in adults around
discovered to be elevated by an increase in SIRT1
the world ranges from 10% to 40%, with an estimated
activation (5).
2425% of the global population suffering from the
It was the goal of this study to investigate SIRT1
disease (2).
gene expression in non-alcoholic fatty liver disease and
The Middle East has the highest incidence,
it is emerging role in pathogenesis of non-alcoholic fatty
followed by South America and Asia, while Africa has
liver disease.
the lowest. Men are more likely than women to develop
it between their fourth and sixth decade (3). In the
SUBJECTS AND METHODS
majority of cases, NAFLD goes unnoticed until tests for
This case-control study included a total of twenty
liver enzymes reveal abnormally high levels. Other
cases of Non-Alcoholic Fatty Liver Disease; NAFLD
symptoms include bloating, right hypochondria pain,
(Group A) and ten individuals as a control (Group
sleep difficulty, and/or apnea. Ultrasounds are
B), attending at Departments of Internal Medicine and
commonly used to diagnose NAFLD, but a liver biopsy
Medical Biochemistry, Zagazig University
is the gold standard for determining the existence of
Hospitals.
NASH and the fibrosis stage of the liver (3).
A significant function for Silent information
They were assessed clinically by lab
regulator 1[sirt1] in the pathophysiology, progression,
investigations and Quantitative real time polymerase
and therapy of a number of diseases has been established
chain reaction (RT-PCR) to assess Sirt1 gene fold
by the discovery of this ubiquitously expressed protein.
expression.
In order to control gene expression, Sirt1 functions as a
NAD+-dependent deacetylase. When Sirt1 is knocked
Ethical Consideration:
out in the liver, pancreas, and brain, the oxidative stress
This study was ethically approved by Zagazig
and inflammation that accompany these organ
University's Research Ethics Committee. Written
dysfunctions -- such as fatty liver disease -- lead to an
informed consent of all the participants was
2606
Received: 27/12/2021
Accepted: 24/02/2022
c:\work\Jor\vol881_53
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2613-2616
Anxiety in Hearing Impairment Subjects
Nashwa Mohamed Refaat
-
Audiology Department, ORL, Shebein Elkoom Teaching Hospital, Egypt.
D
E-mail: nrefat1@gmail.com,Mobile number: +201092836328
e
ABST
p RACT
Purp
a ose: With an increasing incidence for hearing impairment, it is necessary to search for the psychological impact on
patien
r ts. Anxiety prevalence may be raised in people with hearing impairment. This study aimed to evaluate the prevalence
of anx
t iety in hearing loss patients.
Method
m
s A case control study included 100 subjects: 50 controls and 50 subjects diagnosed with hearing loss of variable
types
e , degree, and causes. They underwent audiological and Modified Arabic Beck anxiety inventory questionnaire
evaluat
n
ion. First Pure-Tone Audiometry (PTA) was performed in all frequencies to determine the type and level of hearing
impai
t rment, then Beck anxiety inventory questionnaire (Modified Arabic form) was done.
Result
o s The sample collected showed results of 42% single sided hearing loss while, 58% was bilaterally affected. Anxiety
was es
f timated in 68% of hearing impairment patient with a percentage of 41% male and 59% females.
Concl
O usion Anxiety is a very prevalent problem facing not only subjects with hearing impairment, but also affects a
notitceable ratio of apparently normal subjects. So, the psychological assessment and support are needed to be in mind.
Keyw
o ords: Anxiety, BAI, Hearing impairment.
r
h
INTiRODUCTION
METHODS AND MATERIALS
n
Hearing disorders are prevalent in ageing adults;
Our study was performed through patients referred
howev
o er, hearing deterioration prevalence doubles with
from ENT clinic of Shebein Elkoom Teaching Hospital.
everly age decade, such that by the age of seventy, two-
It was conducted between February 2021 and October
thirds o
a
f adults have hearing loss [1,2].
2021. The study groups included 100 subjects. Group A
r
People with hearing impairment (HI) have been
(HL group) represented those diagnosed with any level of
shown
y to have poorer health outcomes, including reduced
hearing impairment and consisted of 22 males and 28
funcntion of cognition[3,4] life quality reduction[5,6], and
females, with age ranged from eighteen to sixty five years
mobi
g lity disorders[7]. Healthy ageing key component is
with a mean age of 39.35 years ± 9.45, and group B
ment
o al health. The estimated anxiety disorders prevalence
(control group) represented those healthy volunteers,
rangles from 9.2% to 28.7% with the highest rates in aging
collected from colleagues and relatives who were
adult
o s [8]. Limited research has examined the way that
apparently free from any disease consisted of 19 males
heari
g ng impairment may affect anxiety [9-12].
and 31 females, aged 21 to 62 years with a mean age
y
Anxiety disorder is defined as a neurosis
of36.5 ± 9.04. The exclusion criteria were: any subject
charac
, terized by anxious over concern and associated
with past history of psychological consultation or therapy.
with
F somatic symptoms frequently. It affects the manner
Any patient with associated audiovestibular symptoms as
we beha
a
ve and feel. A severe form of anxiety can be
tinnitus or dizziness.
extrem
c ely debilitating, having a serious effect on daily life
whilue, mild anxiety is vague and unsettling [13].
Ethical Approval
l
Anxiety disorders are very prevalent. In Europe
The Research Ethics Committee of Shebein
prevtalence of any anxiety disorder is 13.6% [14]. The ICD-
Elkoom Teaching Hospital gave the authors an
10 cr
y iteria reported hat anxiety manifestations include
approval to perform this study. Before being included
physi
o cal manifestations such as dizziness, muscular
in the research, all individuals supplied their informed
tensi
f on, palpitations, and epigastric discomfort with
consent. This study was designed to coincide with The
persis
M tent nervousness [15]. Among common risk factors
Code of Ethics of the World Medical Association
for e anxiety are functional and cognitive disorders,
(Declaration of Helsinki) for studies involving
traum
d atic events, poorer social support networks, and
humans.
loneiliness [16]. All of these risk factors are correlated with
hearcing impairment[17,18].
During this study, all subjects underwent the
i
The objective of the current study is to evaluate
following: Detailed clinical history, audiological
prevnalence of anxiety as one of these psychosocial
evaluation consisting of pure-tone audiometry, using
cons
e equences of hearing impairment in Egyptian subjects
Resonance audiometer R27A DD45 Diagnostic.
sampl
, e.
M
2613
e
Received: 30/12/2021
n
Accepted: 28/02/2021
o
u
c:\work\Jor\vol881_54
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2619-2624
The Role of Posterior Pericardiotomy on The Incidence of Atrial
Fibrillation and Pericardial Effusion after Coronary Revascularization
Mohamed Abd El-Wahab*1, Ehab El-Shihy2, Ahmed Sayed2, Abdullah Osama Mahfouz1
1Department of Cardiothoracic Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt
2Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
*Corresponding author: Abdullah Osama Mahfouz, Mobile: (+20) 01001300022, E-Mail: amo11@fayoum.edu.eg
ABSTRACT
Background: The most common type of arrhythmia following coronary artery bypass grafting (CABG) is atrial
fibrillation (AF) with an incidence rate of 20-30%. Even though postoperative atrial fibrillation (POAF) can be self-
limited, it may be complicated by lack of hemodynamic stability, increased hospital stay, home mortality, stroke,
thrombotic complications, embolus, extra drug therapy, and consequently increased hospital expenses.
Objective: This prospective and retrospective study aims to demonstrate the effectiveness of posterior pericardiotomy
in reducing the incidence of pericardial effusions and consequently reducing the related atrial fibrillation and
development of delayed posterior cardiac effusions.
Patients and Methods: This prospective and retrospective randomized study was carried out on 100 patients undergoing
coronary artery bypass grafting at Kasr El Ainy Hospital, Cairo University, and at Fayoum University Hospital,
Department of Cardiothoracic Surgery between May 2017 and January 2018. One hundred patients were divided into
two groups; each group included 50 patients. A 4-cm longitudinal incision was made parallel and posterior to the left
phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in the posterior pericardiotomy group
(group A). Posterior pericardiotomy was not performed in the conventional group (group B).
Results: Atrial fibrillation developed in five patients (10%) in group (A) and in 12 patients (24%) in group B (P =0.118).
Early pericardial effusion developed in 6 patients (12%) in group A and 18 patients (36%) in group B (P =0.022), but
no late pericardial effusion developed in group A despite six (12%) late pericardial effusions developing in group B
(P=0.027).
Conclusion: Posterior pericardiotomy is a simple, safe, and effective technique for reducing not only the prevalence of
early pericardial effusion but also delayed posterior pericardial effusion and tamponade without significant reduction in
post-operative atrial fibrillation (POAF).
Keywords: Atrial fibrillation, Coronary artery bypass grafting, Posterior pericardiotomy, Pericardial effusion.
INTRODUCTION
of the bypassed grafts, as a result, of compression by the
The most common type of arrhythmia following
PP ridges and cardiac hernia [5]. Posterior
coronary artery bypass grafting (CABG) is atrial
pericardiotomy is technically easy to perform and is a
fibrillation (AF) with an incidence rate of 20-30% [1].
safe and effective technique that reduces not only the
Even though postoperative atrial fibrillation (POAF)
prevalence of early pericardial effusion and related
can be self-limited, it may be complicated by lack of
atrial fibrillation but also delayed posterior pericardial
hemodynamic stability, increased hospital stay, home
effusion and tamponade.
mortality, stroke, thrombotic complications, embolus,
extra drug therapy, and consequently increased hospital
PATIENTS AND METHODS
expenses [2].
This study is a non-randomized comparative
Various factors contribute to the development of
prospective retrospective study aimed to evaluate the
AF. Yet, the exact cause remains unknown. Among the
effectiveness of posterior pericardiotomy in reducing
factors contributing to the occurrence of AF are
the incidence of early, late postoperative pericardial
increased sympathetic and parasympathetic tone, an
effusion and postoperative atrial fibrillation. The study
enlarged atrium, transmission of electrolytes and
was conducted at Kasr El Ainy Hospital, Cairo
intercellular fluids, pericardial inflammation, metabolic
University, and Fayoum University Hospitals during
disturbances, and pericardial effusion [3]. Some studies
the period between May 2017 and January 2018. The
have reported that posterior pericardiotomy (PP) can
study included one hundred patients with ischemic heart
decrease the postoperative AF in patients undergoing
disease undergoing CABG, forty patients were studied
on-pump CABG [1].
retrospectively from medical reports, and sixty patients
However, the mechanism by which PP causes a
were studied prospectively.
decrease in postoperative arrhythmia is unknown. Yet,
Patients are eligible for enrollment in this study if
it is possible that the pericardial effusion induces a
they have been referred for on-pump CABG. Patients
mechanical pressure on the atrium leading to atrial
were excluded from this study if they had a history of
irritation and finally to arrhythmia [3]. PP causes the
atrial fibrillation before surgery, known history of
drainage of blood and fluids from the pericardial space
thyrotoxicosis, redo cardiac surgery, severe chronic
into the pleura leading to decreased pericardial effusion
obstructive pulmonary disease (COPD), poor left
[4]. PP can produce complications such as obstruction
ventricular function ejection (LVEF) <30%, left atrial
2619
Received: 03/01/2022
Accepted: 01/03/2022
c:\work\Jor\vol881_55
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2625-2633
Recording of Complications of Treatment of Hypoxic Ischemic
Neonates by Passive Whole-Body Cooling: A Study in
Neonatal Intensive Care Unit of Mataria Teaching Hospital
Sohaila Ali abd El-Halim
Department of Pediatrics, Mataria Teaching Hospital, Egypt
*Corresponding author: Sohaila Ali abd El-Halim, Mobile: (+20) 01222842390, E-Mail: sohailabenali@yahoo.com
ABSTRACT
Background: Hypoxic-Ischemic Encephalopathy (HIE) is a type of neonatal encephalopathy where mortality rate is
estimated by 11.2%, globally. The only known management for HIE is therapeutic hypothermia. However, many
drawbacks have been associated with therapeutic hypothermia including death.
Objective: Recording complications of treatment of hypoxic ischemic neonates using therapeutic hypothermia (TH)
for improvement of the results of the management using TH.
Patients and Methods: In this case-series study, which was conducted at the Neonatal Intensive Care Unit (NICU)
of Mataria Teaching Hospital (MTH), Cairo, Egypt. The study was conducted from January 2018 to December 2019.
All medical files of fourteen neonates presented with HIE and treated with hypothermia were reviewed.
Results: Among the 14 neonates with HIE, survivor cases were 71.6%. They were discharged on single oral
anticonvulsant and was weaned off after one month and all were on full oral feeding. One case died on second day of
hypothermia due to severe pulmonary hypertension and uncontrolled hypotension (7.1%) and 21.3% had sepsis and
7.1% had early onset and died on 4th day with maternal history of chorioamnionitis and 14.3% died from late onset
sepsis.
Conclusion: Although therapeutic hypothermia is a well-established treatment to neonates with hypoxic ischemic
disease, their short-term effects can be easily controlled but low incidence of devastating complication can occur.
Further controlled studies are needed to detect the factors associated with the elevated risk of such consequences.
Keywords: Hypoxic ischemic neonates, Passive whole-body cooling.
INTRODUCTION
outcome after NE with RR: 1.53. In developing
Neonatal Encephalopathy (NE) is a neurological
countries, such units are not readily available and care
disorder triggered by a disorder of the brain with an
may be sub-optimal. In addition, in low-and middle-
incidence of 3 per 1000 live births (1). Symptoms
income countries the therapeutic time-window for
associated with NE include alteration of consciousness,
admission to such units in hospitals is delayed as well
respiratory depression, seizures, and abnormal muscle
as the presence of prolonged or obstructed labor, and
tone and reflexes (2). Hypoxic-Ischemic Encephalopathy
lack of neonatal transport facilities can cause delayed
(HIE) is a subtype of NE with characteristic lesions
treatment (8, 9).
observed in an MRI (3). The rate of HIE is 1.3 to 1.7 per
1000 live full term births (1). The mortality rate
Therapeutic hypothermia adverse effects:
associated with HIE is 11.2% (567000 deaths in 2019),
Although TH is well tolerated in NE, short-term
globally (4) and was previously reported in another study
adverse effects can occur such as bradycardia (may
by 1520% due to complications of perinatal asphyxia
occur even on decrease one degree C in temperature),
(1). Therapeutic Hypothermia (TH) is a useful
hypotension as a result of decreased cardiac output and
management for HIE where it must be used within the
respiratory problems such as decreased surfactant
first 6 h of life (5). This is done through a total body
production, induced pulmonary vasoconstriction and
cooling or selective head cooling to 32°C - 34°C in
pulmonary hypertension as well as reduced oxygen
infants 36 weeks' gestational age (6).
delivery. Also, electrolyte imbalance, particularly
In moderate to severe NE, the brain has a phase
hypokalemia, hyponatremia, hypomagnesemia, and
of secondary injury with nearly whole failure in
hypophosphatemia. Additionally, hypothermia can
mitochondrial energy production, cytotoxic oedema,
cause platelet dysfunction and increased incidence of
cell death and clinical decline associated with seizures.
sepsis (9).
This usually happens after 615 hours of HIE (7). The
Aim: Recoding all complications associated with
effect of TH is accomplished through enhancement of
treatment of hypoxic ischemic neonates with
apoptosis, reduced loss of high-energy phosphates,
therapeutic hypothermia (TH) for improvement of the
decreased oxygen consumption, reduced release of
results of the management using TH.
nitric oxide, glutamate, free radicals and excitatory
amino acid neurotransmitters, and the initiation of
SUBJECTS AND METHODS
genes that diminish neuronal death (6). Although TH
This was a case-series study conducted at the
procedure is widely presented in developed countries,
Neonatal Intensive Care Unit (NICU) of Mataria
which showed a reduction in mortality of risk ratio (RR)
Teaching Hospital (MTH) from January 2018 to
0.78 and improved survival with normal neurological
December 2019.
2625
Received: 30/12/2021
Accepted: 28/02/2022
c:\work\Jor\vol881_56
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2634-2642
Can Dual-Energy Contrast-Enhanced Digital Mammography Change
The Final BI-RADS Category of Equivocal Breast Lesions Characterized by
Sonomammography in Women with Dense Breast?
Mai M. K. Barakat*, Sherif N. A. Hegazy, Noha M. Taha
Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Mai M. K. Barakat, Mobile: (+20) 01006294780, E-Mail: mai_mokhtar85@yahoo.com
ABSTRACT
Background: Equivocal and indeterminate breast lesions which are detected on sonomammography should be further
evaluated by either biopsy or follow-up. Contrast-enhanced digital mammography can act as a problem-solving tool to
avoid biopsies of some problematic breast lesions and help clinicians to take a proper decision about these lesions in
the same setting. Objective: This study aimed to evaluate the complementary role of contrast-enhanced digital
mammography (CEDM) to characterize indeterminate and equivocal breast lesions detected on sonomammography
and its role to downgrade or upgrade the final BI-RADS category of these lesions.
Patients and Methods: This prospective study included 35 females with mean age of 48.26 years. Ladies were
referred from the clinic for screening mammograms during the period from august 2020 to September 2021.
Results: Contrast-enhanced digital mammography showed higher specificity (86.4%), PPV (80.0%), NPV (95.0%),
and accuracy (88.6%). While sonomammography revealed specificity of 63.6%, PPV of 60.0%, NPV of 93.3%, and
accuracy of 74.29%. However, both showed a comparable sensitivity of about 92.3%. Fourteen lesions (40%) were
downgraded by CEDM and proved to be benign lesions and five lesions (14.2%) were upgraded and proved to be
malignant lesions.
Conclusion: Contrast-enhanced digital mammography is a promising technique in the characterization of equivocal
and indeterminate breast lesions (BI-RADS 3 and 4). It can be utilized to help in the final assessment of these findings
in the same setting and offer assistance in avoiding biopsies in numerous patients with more prominent specificity and
precision than sonomammography.
Keywords: Mammography, Indeterminate, Equivocal, Breast cancer, Contrast-enhanced digital mammography
(CEDM), Dual-energy.
INTRODUCTION
ability to detect and characterize lesions even in dense
Abnormalities
recognized
at
screening
breasts, and stereotactic biopsy can be performed in
mammography are reviewed for complementary more
the same setting (9).
diagnostic imaging modalities, counting MRI, and US
This study aimed to evaluate the complementary role
(1). MRI has many limitations due to its low specificity,
of (CEDM) to characterize indeterminate and
spatial resolution, high cost, and long examination
equivocal
breast
lesions
detected
on
time (2). Ultrasound is operator-dependent and many
sonomammography and its role to downgrade or
lesions could be missed during the examination.
upgrade the final BI-RADS category of these lesions.
Subsequently, other imaging modalities are needed to
decide the likelihood of malignancy of these
PATIENTS AND METHODS
abnormalities. CEDM is progressively being utilized
Patients: This prospective study included ladies
for the final assessment of these query findings (1).
referred from the clinic for screening mammograms
Structured reporting was developed to
during the period from august 2020 to September
establish reliable and detailed reporting for both
2021. 35 females with ages ranging from 24 77 years
radiologists and clinicians (3-5). One of them was the
(mean age 48.26) were included in our study.
BI-RADS categorization of breast lesions. (BI-RADS
Digital mammography was done for all the patients.
3) lesions are categorized as probably benign lesions
Women with dense breasts classified as ACR C or D
and this subsequently confuses the final decision of
on mammography were subjected to further ultrasound
clinicians. In clinical practice, 0.97.9% of potentially
evaluation.
Lesions
were
detected
by
benign findings on mammography are upgraded and
sonomammography and classified according to the
subsequently, a histopathological biopsy was done (6).
ACR BI-RADS system. BI-RADS 3 and 4 lesions
Equivocal or suspicious findings cause a clinical
were considered as equivocal and indeterminate breast
dilemma either by follow-up or biopsy (5). Breast
lesions. Fifteen lesions were classified as BI-RADS 3
mammography and MR imaging may result in an
lesions, and twenty lesions were classified as BI-
increase in the number of false-positive cases and lead
RADS 4 lesions. Afterwards, complementary CEDM
to unnecessary biopsies (7-8).
was done for all these patients. Sonomammography
Contrast-enhanced digital mammography is a
results were reported by an experienced radiologist
new imaging modality that could be used as a
with ten years of experience in women's imaging.
complementary tool to usual digital mammography in
Another different experienced radiologist with 10
the diagnosis of breast cancer (1). CEDM has a great
years of experience in women imaging analyzed the
2634
Received: 03/01/2022
Accepted: 01/03/2022
c:\work\Jor\vol881_57
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2643-2647
Prognostic Value of Asymmetric Dimethylarginine in Patients with
Acute Coronary Syndrome
Sameh Attia Amin*, Reem Ali Ibrahim, Mohsen Mahmoud Mahdy, Ahmed Mohamed Onsy
Department of Cardiology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Sameh Attia Amin, Mobile: (+20) 01141991996,
E-Mail: drsamehattia201@hotmail.co.uk, ORCID number: 0000-0002-3034-4467
ABSTRACT
Background: Evidence has accumulated that asymmetric dimethylarginine (ADMA) is an endogenous competitive
inhibitor of nitric oxide (NO) synthase. Nitric oxide reduction is considered the hallmark of endothelial dysfunction.
Objective: The study aimed to determine the value of the asymmetric dimethylarginine in patients with acute coronary
syndrome as a predictor of major adverse cardiac events (MACE) and mortality during hospitalization and up to 6
months.
Patients and Methods: This study included 80 patients who were admitted to the critical care unit (CCU) with acute
coronary syndrome. Serum ADMA marker was obtained within 24 hours of admission. Depending on ADMA value,
patients were divided into three groups; Group A included patients with ADMA values up to 1.2 micromole/liter, Group
B included those with ADMA values of more than 1.2 and up to 1.56 micromole/liter, and Group C comprised patients
with ADMA value of more than 1.56 micromole/liter. During hospitalization and up to 6 months after discharge, patients
were subjected to clinical follow-up to detect the occurrence of MACE including re-infarction, heart failure, re-
intervention, and stroke or mortality.
Results: Significant correlation was detected between ADMA value and patients' prognosis (i.e. as the ADMA value
increased, the prognosis was worsened) with a significant correlation between patients' groups and prognosis with a P-
value of 0.001.
Conclusion: ADMA level had a prognostic value in patients with acute coronary syndrome with a cut-off value >1.2
micromole/liter, whereas patients with higher levels of ADMA were associated with a higher incidence of MACE and
higher mortality than patients with lower levels of ADMA.
Keywords: Acute coronary syndrome, Asymmetric dimethylarginine, Endothelial dysfunction, Nitric oxide.
INTRODUCTION
The study aimed to determine the value of the
Acute coronary syndrome (ACS) occurs due to
asymmetric dimethylarginine in patients with acute
decreased blood flow in the coronary circulation
coronary syndrome as a predictor of major adverse
causing a part of the cardiac muscle to function
cardiac events (MACE) and mortality during
improperly or die. It is usually caused by one of the
hospitalization and up to 6 months.
following:
ST-elevation
myocardial
infarction
(STEMI), non-ST elevation myocardial infarction
PATIENTS AND METHODS
(NSTEMI), or unstable angina (1). Evidence has
This study included 80 patients who were
accumulated
that
asymmetric
dimethylarginine
admitted to the CCU with acute coronary syndrome.
(ADMA), which is a methyl derivate of the amino acid
Guideline-directed medical therapy was given to all
arginine that is produced due to the physiological
patients. Coronary angiography was also performed
degradation of methylated proteins, is considered an
with either primary or pre-discharge percutaneous
endogenous competitive inhibitor of nitric oxide (NO)
coronary intervention.
synthase (2).
Full labs were obtained from all the patients
Now reduction of nitric oxide levels represents
including complete blood count, cardiac troponin,
the hallmark of endothelial dysfunction (3). Endothelial
creatine phosphokinase, creatine kinase-MB, total lipid
dysfunction leads to reduction of anticoagulant
profile, liver and kidney function tests in addition to
properties, increased expression of adhesion molecules,
serum ADMA within 24 hours of admission. Depending
the release of chemokine, and other cytokines in
on ADMA value, we classified the patients into; Group
addition to the production of reactive oxygen species
A, which included those with ADMA values up to 1.2
from the endothelium. This eventually results in
micromole/liter, Group B including those with ADMA
inflammation and migration of myofibroblasts and their
values of more than 1.2 and up to 1.56 micromole/liter
proliferation inside the vessel wall leading to the
and Group C, which comprised patients with ADMA
development of atherosclerosis (4).
value of more than 1.56 micromole/liter. The groups
In several studies, ADMA has evolved as a
were compared later as regards their follow-up.
marker of increased cardiovascular risk. A large number
During hospitalization, electrocardiogram and
of prospective clinical trials have shown a strong
echocardiography were performed, Killip class of the
association between elevated ADMA levels and their
patients was determined. Also, Grace Score was
relation to major cardiovascular events and total
calculated using the Grace ACS risk and mortality
mortality that extends to different patient populations(5).
calculator (www. mdcalc.com/grace-as-risk-mortality-
2643
Received: 29/01/2021
Accepted: 26/02/2022
c:\work\Jor\vol881_58
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2648-2652
Assessment of Cerebrovascular and Cognitive Changes in
Chronic Hepatitis C Patients
Elham Ahmed Hassan1, Noha A. Masoud1*, Abeer S. Abdel Rehim1, Ghaydaa A. Shehata2,
Saad Z. Mahmoud1, Gehan S. Seifeldein3, Khaled O. Aboshaera2, Khaled A. Khalaf1, Ahmed M. Abu-Elfatth1
1Department of Gastroenterology and Tropical Medicine, 2Department of Neurology,
3Department of Radiology, Faculty of Medicine, Assiut University, Assiut, Egypt
*Corresponding author: Noha A. Masoud, Mobile: (+20) 01021996629, E-mail: nohaaliahmed@yahoo.com
ABSTRACT
Background: Hepatitis C viral (HCV) infection is associated with systemic inflammation and metabolic complications
that might predispose patients to cerebrovascular atherosclerosis and may report neurocognitive complaints.
Objective: This case-control study aimed to assess cerebrovascular and cognitive changes in patients with chronic
hepatitis C (CHC) infection.
Patients and methods: Transcranial color Doppler assessment of cerebrovascular reactivity and cognitive abilities
screening instruments (CASI) was conducted in 100 CHC patients and 100 healthy controls. All enrolled patients were
evaluated by Fibroscan and the current study employed a cut-off of 12.5 kPa for excluding cirrhosis.
Results: Compared to controls, CHC patients had significantly lower scores on CASI and its components. Patients had
significantly lower-middle carotid artery (MCA) intimal media thickening (IMT), peak systolic velocity (PSV), end-
diastolic velocity (EDV), and mean flow velocity (MEV) than controls. Additionally, the total CASI score significantly
correlated with PSV and EDV of MCA and negatively correlated with IMT, pulsatility index (PI), and resistance index
(RI).
Conclusion: CHC patients have impaired cognitive function that may be associated with cerebrovascular affection in
absence of cirrhosis. Future multi-center studies with the evaluation of the effect of antiviral on cerebrovascular
reactivity and cognitive function in such patients are warranted.
Keywords: Hepatitis C virus, Cerebrovascular changes, Cognitive function, CASI score, Transcranial color Doppler.
INTRODUCTION
evaluated noninvasively using transcranial color
Hepatitis C virus (HCV) infection is widespread
Doppler (TCCD) (7).
in Egypt. HCV antibodies are thought to be present in
The TCCD calculates the mean flow velocities
15 to 20% of the general population. Changes in brain
(MFV) of the major basal intracranial arteries.
functioning in chronic HCV infection patients may
Parameters related to cerebrovascular resistance are
manifest long before development to severe liver
pulsatility index (PI), a measure of the MFV variability,
cirrhosis in the absence of hepatic encephalopathy.
and the resistance index (RI). The current work was
Regardless of the severity of the liver illness, roughly
designed to evaluate cerebrovascular and cognitive
half of patients with chronic HCV infection developed
changes in non-cirrhotic HCV-positive individuals.
neuropsychiatric symptoms, resulting in a worse quality
of life (1, 2).
PATIENTS AND METHODS
Cirrhosis and hepatic encephalopathy are
This case-control study was conducted over one-year
prevalent in persons infected with the Hepatitis C virus,
duration between May 2020 and May 2021. It was
and neurocognitive impairment is widespread (HCV).
performed at the Outpatient Clinic of Tropical Medicine
Neurocognitive impairment has been documented in
and Gastroenterology Department.
non-cirrhotic HCV patients, and there have been
indications of HCV invasion in the central nervous
Participants
system (CNS). HCV is considered to enter the CNS by
One hundred naïve-treatment patients with
direct viral invasion or indirect neuroinflammation (3).
chronic hepatitis C (CHC) infection were enrolled.
There have been reports of neurological
HCV infection was confirmed by positive HCV
abnormalities in areas such as the prefrontal cortex,
antibody and HCV-ribonucleic acid positive by
basal ganglia, thalamus, and white matter tracts.
polymerase chain reaction. In addition, 100 healthy
Memory, attention, processing speed, and executive
individuals were enrolled in the study as controls.
skills are hypothesized to be hampered by dysfunction
Patients and controls were matched for age, gender, and
in these frontostriatal networks (4,5). However, the
socioeconomic status.
reported incidence of HCV-associated neurocognitive
Exclusion criteria included; unwillingness to
impairment varies widely (6).
participate, smoking, liver cirrhosis (as confirmed by
The significance of the association between HCV
ultrasound, Fibroscan, and/or endoscopic evidence of
infection and cerebrovascular illness is currently
portal hypertension), cerebrovascular disease, systemic
debated. Despite fluctuations in cerebral perfusion,
hypertension, diabetes mellitus, Lifetime diagnosis of a
healthy brain arteries may maintain a consistent cerebral
psychotic disorder, use of pharmaceuticals known to
blood flow. The primary basal cerebral arteries can be
affect cognitive functioning, history of neurological
2648
Received: 03/01/2022
Accepted: 02/03/2022
c:\work\Jor\vol881_59
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2653-2660
Assessment of Different Radioactive Iodine Ablation Strategies in
Intermediate and High Risk Papillary Thyroid Cancer
Hend Ahmed El-Hadaad, Mohamed Farouk Akl, Abd El-Monem Mohamed Youssef,
Mohamed Ali Abo El-khier*
Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Mohamed Ali Abo El-khier, Mobile: (+20) 01094120312, E-Mail: moha.ali2020@gmail.com
ABSTRACT
Background: Papillary thyroid cancer (PTC) represents most of cases of differentiated thyroid cancers. Thyroidectomy
followed by radioactive iodine (RAI) remnant ablation represent the cornerstone management of many intermediate
and high-risk patients according to American Thyroid Association (ATA).
Objective: This study aimed to evaluate the outcome of different used I131 ablation doses (80, 100 and 120 mCi) in
intermediate and high-risk patients in our hospital and to analyze the predictors affecting RAI failure. Besides, survival
analysis was conducted as a secondary objective of the study.
Patients and Methods: This was a retrospective study conducted on 63 patients diagnosed as PTC at our hospital from
January 2015 till February 2020. Our study involved only PTC pathology, mean age of 40.6 ± 13.4 years at diagnosis,
and intermediate- and high-risk patients according to ATA initial risk stratification system, 2015.
Results: Among the 63 patients included in this study (17 males and 46 females), 41 were classified as intermediate-
risk, while 22 were classified as high-risk based on the ATA guideline. Overall RAI ablation success, in both groups,
was observed in 43/63 (68.25%) patients. Moreover, it was achieved in 31/41 (75.6%) of intermediate-risk patients and
in 12/22 (54.5%) high-risk patients. Pre-ablation stimulated Tg >1ng/ml was statistically significant negative predictor
of ablation failure [P-value < 0.001, odd`s ratio 61.5, 95% CI (10.8-51.5)].
Conclusion: There was no statistically significant difference between success rates of I131 doses in intermediate- and
high-risk groups. However, the failure rates were more after 120 mCi due to the associated more aggressive underlying
disease, especially higher-risk patients so higher RAI activities are recommended for this risk group.
Keywords Papillary thyroid cancer, Radioactive iodine, Remnant ablation.
INTRODUCTION
system classified DTC into three groups; low-,
Thyroid cancers represent nearly about 3% of
intermediate- and high-risk group of recurrence (3).
new cancer cases diagnosed yearly. Thyroid cancer
Thyroidectomy is the cornerstone surgery in
incidence rates have increased in the last thirty years
management of thyroid carcinomas. Many studies
around the world but not in Africa, mainly due to
have estimated the role of different types of
insufficient screening (1). In Egypt, thyroid cancer
thyroidectomies. They compared total and near-total
represents about 1.5% of all cancers and is responsible
thyroidectomy alongside the less eradicating surgical
for 30% of endocrine neoplasms. Female to male ratio
procedures. These studies advocate that higher risk
among Egyptians is less than 3. Thyroid cancer is
patients have a significantly improved survival when
generally categorized primarily on the cell of origin.
they undergone a more aggressive surgery (4, 5). For
PTC is the most common kind of thyroid cancer,
post-operative management in non-metastatic cases,
representing roughly 80% of all patients. Follicular
the term "radioiodine remnant ablation (RRA)" is
thyroid carcinoma (FTC) is the second frequent form,
used and it is defined as "the destruction of residual
accounting for around 15% of all cases. Both papillary
macroscopically normal thyroid tissue after surgical
and follicular malignancies are classified as
resection of the thyroid gland (6)."
differentiated thyroid cancer (DTC) because they arise
from thyroid follicular cells (2, 3).
The Dose of post-operative RAI varies between
At 2009, the American Thyroid association
different scenarios. A wide range of RAI activities are
(ATA) published her first stratification system
used in various ATA risk groups starting with 30 mCi
specialized to thyroid cancer with different categories
as ablative dose for low-risk patient. As for
according to histological type of the disease. Recently,
intermediate- and high-risk setting, more activity is
at 2015, ATA has modified their risk system with
needed to achieve best ablation results or in adjuvant
more risk items added to the initial one published at
way. The recommended range starts with 50 mCi for
2009. After every publishing the oncologists preferred
patients having relatively lower-risk features, while it
applying ATA system in practice with further more
may reach up to 150 mCi for patients possessing
thorough monitoring of its implication on the disease
additional riskier criterion (4, 7, 8). For response
course. Also, major cancer institutes and hospitals
evaluation after thyroidectomy with post-operative
adopted the clinical practice according to ATA risk
RAI, ATA guidelines recommended a strict criterion
stratification, besides the leading guidelines included
for defining the response during the follow up after
it within its recommendations. ATA risk stratification
finishing therapy using three main factors; (1) Neck
ultrasound and clinical evidence, (2) Whole body
2653
Received: 06/01/2022
Accepted: 06/03/2022
c:\work\Jor\vol881_60
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2661-2667
Role of Renal Doppler Ultrasound in Early Detection of
Acute Kidney Injury in Critically Ill Patients
Marwa K. Khairallah1, Abdalla Kellani1, Hamdy M. Ibrahim2,
Manar Salah Ahmed*1, Mohammad Hassan Mostafa1
Departments of 1Internal Medicine, Nephrology Unit and 2Radiology, Faculty of Medicine, Assiut University, Egypt
*Corresponding author: Manar Salah Ahmed, Mobile: (+20) 01092058750, E-Mail: salahmanar741@gmail.com
ABSTRACT
Background: Acute kidney injury is a potentially fatal condition with high mortality rate, treatment cost and poor
outcome. The most crucial end-point in forecasting AKI is monitoring microcirculation parameters. Renal resistive
index has been proposed as a new tool in intensive care unit (ICU) patient's microcirculation monitoring.
Objective: The research study aimed to determine if there is a relation between change in renal resistive index (RRI)
and acute kidney injury (AKI) in the first week of ICU admission.
Patients and Methods: This was an observational prospective study of ICU patients. All participants underwent history
taking, clinical examination with calculation of sequential organ failure assessment (SOFA) and acute physiology and
chronic health evaluation (APACHE II) score. RRI was calculated using Doppler ultrasound with the following formula:
(peak systolic velocity end diastolic velocity)/ peak systolic velocity.
Results: Patients with AKI had significantly higher peak-systolic velocity, end-diastolic velocity and renal resistive
index (P< 0.001). Patients with stage III AKI had significant higher RRI in comparison with stage I and stage II (p value
< 0.001). RRI had 75% sensitivity, 87% specificity for prediction of stage II and III AKI with over all accuracy was
83%.
Conclusions: Assessment of RRI in the first 24 hours of ICU admissions was valuable in predicting the development
of AKI especially in the stage II, III and persistent AKI. It is recommended to evaluate it early to prevent AKI
development in ICU patients.
Keywords: Renal resistive index, Acute kidney injury, Intensive care unit, APACHE, SOFA.
INTRODUCTION
changes in renal function, and it fluctuates greatly
Acute kidney injury is a complex of functional
depending on sex, age, muscle mass, diet, medicines,
renal disorders, presents with an abrupt loss of kidney
and hydration state. Furthermore, serum creatinine is a
function, which is detected by an elevated serum
reflection of the glomerular filtration rate (GFR) rather
creatinine level and decreased urinary output that is
than a direct indicator of renal tubular damage (6).
limited to 7 days (1). Incidence of AKI in the ICU ranges
Furthermore, serum creatinine rise occurs many hours
from 5.7% to 67%. The length of hospital stays, as well
after renal damage and only when the GFR is
as the expense of treatment, has increased in recent
significantly lowered. As a result, AKI stage III is
years as a result of the large increase in complications
frequently diagnosed within 12 to 24 hours, and patients
and mortality(2). Old age, acute infections, sepsis, severe
with this stage of AKI have consistently bad prognosis.
trauma, hypovolemia, major surgeries, preexisting
As a result, an indication that may predict AKI stage III
CKD, urinary tract obstruction, acute organ failure,
within 6 hours after admission can assist patients in
nephrotoxic drugs administration, chemotherapy, graft
receiving proper medical care and achieving better
rejection, and autoimmune disorders with rapid
results (7).
progressive kidney injury are all important risk factors
Because renal artery vasoconstriction is an early
for AKI (3). Both functional impairments (elevated
indicator of AKI, monitoring microcirculatory measures
serum creatinine and/or decreased urine output) and the
may be the most essential end-point for predicting AKI
presence of biomarkers suggesting renal structural
and optimising therapy, because microcirculatory
damage are linked to a three- to seven-fold increase in
dysfunction may continue despite improvements in
hospital mortality (3). AKI is potentially fatal. As a
macrocirculatory parameters (8). Renal resistive index is
result, meticulous treatment, including, if necessary,
a noninvasive ultrasonographic Doppler measure of
kidney replacement therapy, is required (1).
blood flow velocity in intra-parenchymal renal arteries
Evidence is growing that the impact of AKI goes
that can be used to predict renal failure (9). It represents
beyond the acute phase, with progression to CKD,
the relationship between the apex of systole and the end
increased cardiovascular consequences, repeated AKI
of diastole in renal vessels and the drop in flow velocity.
events, and death (4).
Its value is computed using this formula = peak systolic
Hemodynamic and fluid status stabilization, as
velocity end-diastolic velocity)/ peak-systolic
well as avoidance of nephrotoxic drugs, are used to
velocity. Normal values are reported between 0.60 and
prevent AKI development (5). A spike in serum
0.70 with the difference between both kidneys being
creatinine and/or a decrease in urine output are used to
mostly less than 5% (10).
diagnose AKI. Serum creatinine, on the other hand, has
We aimed to evaluate the reliability of RRI in
been shown in studies to be a poor predictor of acute
predicting AKI development in the ICU patients in the
2661
Received: 06/01/2022
Accepted: 06/03/2022
c:\work\Jor\vol881_61
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2668-2676
The Impact of Quarantine Restrictive Measures on Gifted Students' Academic
Achievement and Behavior During COVID-19 Outbreak, in Saudi Arabia:
Educational and Psychological Aspects
Ahmed O. Alsabih 1, Rim M. Bougatfa2, Ahmed A. Morsi *3, Abdulaziz Q. Ali 2, 4,
Hussian H. Alsafwani 5, Saleh A. Alatiya 5, Ahmad K. Alzaaliay 5,
Adeeb H. Alsaqr 5 Ahmed M. Abdelmoneim 6, Ahmed H. Ahmed 7, Ezat A. Mersal 8, 2
1 Department of Physiology, College of Medicine, King Saud University, KSA
2 Department of Basic Medical Sciences, 7 Department of Basic Sciences, 5 Students, Vision College of Medicine, Vision
Colleges, Riyadh, KSA,
3 Histology and Cell Biology Department, 6 Physiology Department, Faculty of Medicine, Fayoum University, Fayoum,
Egypt
4 Faculty of Medicine, University of Sciences and Technology, Yemen
8 Biochemistry Department, Faculty of Science, Assiut University, Assiut, Egypt
*Correspondence: Ahmed Morsi, ORCID: 0000-0001-7911-0795, Mobile:+201005376570, Email: aaa21@fayoum.edu.eg
ABSTRACT
Background: Quarantine is used worldwide to interfere with COVID-19 transmission. It had a negative effect on the
scholastic performance and behavior of regular students.
Objective: The study strived to investigate such parameters on gifted students.
Methods: A self-administered questionnaire was distributed to the parents of 378 gifted students all over Saudi Arabia,
through their schools. These students were represented by Mawhiba Foundation, Saudi Arabia.
Results: The findings showed that 70.4 % of the gifted students had an increase in their academic achievement at the end
of the second semester. Moreover, 50.3% of the participants had experienced major behavioral changes during quarantine.
Also, 56.9% of students suffered from annoying dreams and difficult sleeping. More than half of the participants faced
distant learning problems. The correlation analysis indicated a significant and positive correlation between gifted students'
academic achievement, entertainment hours, and parenteral help, while it was significant and negative between the
academic achievement and the number of sleeping hours.
Conclusion: Quarantine had a great psychological burden on the parents of the gifted students that was reflected on their
behavior. However, most students faced different problems during the online distance learning, but their academic
achievement had increased that might explain their unique mental ability.
Keywords: Academic performance, Behavioral changes, COVID-19, Gifted students, Quarantine
INTRODUCTION
physiological aspects of students' life and have given
Quarantine is the isolation and limitation of
rise to many psychological and educational issues (3). To
movement, which could be introduced at a simple level
the authors' knowledge, the current study is the first
to include an individual or group of peoples such as
such attempt that was applied on a wide scale of private
those exposed during travelling abroad or may extend to
category of gifted students, Mawhiba students.
include a wider population or geographic-level basis (1).
Each community determines giftedness according
During COVID-19 outbreak, almost all countries
to its needs, interest, values, and culture, which are
worldwide used quarantine as a tool to control the
progressively changing over time (6). In KSA, the term
transmission of the virus (2).
"gifted" has been applied to anyone who has exceptional
Limitations on travel, social constraints,
academic capabilities and whose needs and educational
forbidding public meetings, and voluntary home arrest
requirements exceed those available in the regular
were different forms of the applied quarantine (3).
classrooms (7).
Kingdom of Saudi Arabia (KSA) has taken many
Gifted education has started since several years
precautions to cope with this epidemic. KSA announced
and has expanded with the establishment of the King
lockdown and curfew on March 23, 2020 to interfere
Abdul-Aziz and his Companions Foundation for
with the disease cycle (4).
Giftedness and Creativity (Mawhiba), which supervises
Social interaction is essential for human
the creative and gifted educational program (8).
psychological development, mental health and creativity
Mawhiba students are particular sector of students and
of children, in particular (5). One of the consequences of
are provided with several enrichment programs,
the current quarantine situation was the suspension of
competitions, in addition to the gifted classes supported
the social and public events and face-to-face learning
by the school partnership that enable these students to
and academic activities that have great influence on the
enhance their higher thinking and talent (9).
2668
Received: 06/01/2022
Accepted: 06/03/2022
c:\work\Jor\vol881_62
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2677-2682
Study of Some Predictors of Neonatal Mortality among Preterm
Newborn at Zagazig University Hospital
Amr Mgahed Abo El Naga*, Mohammed Othman Hafez,
Ehab Abdelmonem El Bana, Aya Mohammed Ibrahim Shehata
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aya Mohammed Ibrahim Shehata, Mobile: (+20) 0114442 9226,
Email: ayashehata270@gmail.com
ABSTRACT
Background: Birth before the 37th week (259th day) of pregnancy, measured from the first day of the last menstrual
cycle, is referred to as preterm.
Objective: Early prediction of neonatal outcome in preterm neonate.
Patients and Methods: This was a prospective cohort study carried out in Neonatal Intensive Care Unit in Zagazig
University Children Hospitals for 6 months. The estimated sample was 58 neonates.
Results: About 65.5% died and 34.5% were discharged alive. There was statistically significant relation between
outcome and maternal age. Singleton pregnancy represented 92.1% and 95% of those died and discharged respectively.
There was statistically significant relation between outcome and order in family. Mortality was significantly higher
among those with first order (42.1% and 15% within who died and discharged respectively). There was statistically
significant relation between outcome and Apgar score at 1 minute, at 5 minutes and at 10 minutes. The best cutoff of
Apgar at 1 minute in prediction of mortality was 6.5 with area under curve 0.961, sensitivity 92.1%, and specificity
90%. The best cutoff of Apgar at 5 minutes in prediction of mortality was 7.5 with area under curve 0.944, sensitivity
84.2%, and specificity 95%. The best cutoff of Apgar at 10 minutes in prediction of mortality was 8.5 with area under
curve 0.914, with sensitivity 84.2%, and specificity 90%.
Conclusion: Premature infants with a low Apgar score have a higher mortality rate.
Keywords: Apgar Score, Neonatal Mortality, Predictors, Preterm Newborn.
INTRODUCTION
This aim of this study was early prediction of
Birth before the 37th week (259th day) of
neonatal outcome in preterm neonate.
pregnancy, measured from the first day of the last
menstrual cycle, is referred to as preterm, it's a common
PATIENTS AND METHODS
medical word that is endorsed by organizations like the
This study was carried out in Neonatal Intensive
American Academy of Pediatrics, the American
Care Unit in Zagazig University Children Hospitals as
College of Obstetricians and Gynecologists, and the
prospective cohort study on 58 neonates.
WHO. Even while preterm neonates are known for their
high mortality and other morbidities, the overall
Ethical considerations:
prevalence of prematurity-related issues decreases
The study protocol was submitted for approval
considerably if the baby was delivered after 34 weeks
by Zagazig University Institutional Review Board
gestational age. Infants born at lower preterm levels are
(IRB). Consent was obtained from patient's parents.
generally considered functionally full-term in the
This work has been carried out in accordance with
obstetric and pediatric community, and as a result, they
The Code of Ethics of the World Medical
receive postnatal care in the well-baby nursery. In the
Association (Declaration of Helsinki) for studies
recent decade, the topic of the health of near-term
involving humans.
neonates was highlighted(1).
The Apgar score was first suggested in 1952 as a
Inclusion criteria: Preterm newborn <37 weeks, lives
quick way to examine a baby's clinical state, and it is
in Sharkia Governorate, and admitted to Neonatal
still widely used today for newborn infant assessments
Intensive Care Unit in Zagazig University Children
shortly after birth. Predicting infant death with a
Hospital.
reduced Apgar score (one with fewer than five
Exclusion criteria: Full term newborn >37 weeks.
components) is just as accurate as using the full Apgar
score(2).
All neonates included in the study were subjected to
Neonatal and newborn deaths revealed a high
the following:
connection with low Apgar scores (3). Low Apgar scores
(1) Detailed history taking:
have been linked to increased perinatal morbidity and
With special focus on gestational age (full-term-
mortality. Infants with low Apgar scores at 5 minutes
preterm), full maternal history, delivery history
have a greater risk of neonatal respiratory distress,
(antenatal, natal, postnatal). Assessment of the
mechanical ventilation and hospitalization in the
gestational age in most of the neonatal units in sick
neonatal intensive care unit, as well as a higher chance
infants or those in incubators by The New Ballard score
of childhood cancer(3).
(NBS) (4). Preterm birth was stratified into extremely
2677
Received: 03/01/2022
Accepted: 01/03/2022
c:\work\Jor\vol881_63
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2683-2696
Wide-Angle Digital Breast Tomosynthesis Might Be Used for The Early
Detection and Grading of Breast Cancer during Screening Campaigns
Yasmin Hosny Hemeda*1, Emad Abdel Hafez2
1Department of Radiodiagnosis, Interventional Radiology & Medical Imaging,
Faculty of Medicine, Menoufia University, Menoufia Egypt
2Department of General Surgery, Faculty of Medicine, Benha University, Qalyubia, Egypt
*Corresponding author: Yasmin Hosny Hemeda, Mobile: (+20) 01061173115, E-Mail: hosneyyasmin@gmail.com
ABSTRACT
Background: Digital breast tomosynthesis (DBT) is a new imaging modality for improving breast cancer detection
because it allowed for better detection of abnormalities, especially in females with dense breasts, and the diagnosis of
benign lesions, which resulted in fewer recalled cases and negative biopsies, as well as assessing therapeutic efficacy.
Objectives: Evaluation of the diagnostic validity of 3D wide-angle Digital Breast Tomosynthesis (WA-DBT) during
screening programs for breast cancer (BC).
Patients and Methods: 449 women with breast lesions who attended the screening campaign were examined by Full-
field Digital Mammography (DMG) and WA-DBT using HologicTM Selenia® Dimensions® 3D Performance System
and ultrasound (US) imaging using GE LOGIQ P7® linear probe (7-12 MHz). Then, a surgical biopsy was obtained
from women who had lesions of BI-RADS grade 4 or 5 and examined pathologically, the pathological diagnosis was
used as the gold standard for comparison of radiological diagnoses.
Results: Pathological diagnosis defined 30 malignant and 9 benign lesions. The performance characteristics of WA-
DBT imaging were superior to that of DMG and US and the agreement of diagnoses obtained by WA-DBT and both
DMG and US was moderate and substantial with coefficient of 0.421 and 0.726, respectively. ROC curve analysis
defined WA-DBT as the best diagnostic test with a significantly higher area under the curve (AUC) in relation to the
reference AUC as a discriminative diagnostic modality for breast lumps of BI-RADS grade 5 and as the most sensitive
modality for differentiation between masses that are probably benign (BI-RADS grade 3) and that suspicious of
malignancy (BI-RADS grade 4).
Conclusion: WA-DBT is a valuable radiologic modality for screening women with breast lesions especially those in
dense/extremely dense breasts. Also, WA-DBT can precisely identify microcalcifications obscuring very small-to-
small breast lesions thus allowing early detection of BC.
Keywords: Breast lump, Screening, Mammography, Tomosynthesis, Ultrasound, Biopsy.
INTRODUCTION
Breast cancer (BC) is the most prevalent
Digital breast tomosynthesis (DBT) is an
cancer among women (1). However, the known risk
emerging BC screening and diagnostic modality that
factors, either reproductive, hormonal, lifestyle, and/or
depends on three-dimensional (3D) breast images to
genetic play a role in BC tumorigenesis in about 58%
provide detailed assessments of the dense breast tissue
of cases (2), and for the remaining cases, the cause is
(8). DBT was characterized by anisotropic resolution,
unknown, but microRNAs were found to regulate the
which resolved intra- and inter-slice quite different
expression of key genes in BC tumorigenesis (1).
from the sharpness of microcalcifications (MCs) in
Epidemiological studies indicated a lower
different slices (9). DBT is gradually being
mortality rate for women had BC that was diagnosed
implemented in routine clinical breast imaging practice
from mammographic screening than women with
because the technique of image acquisition reduces the
symptomatizing BC(3). However, disparities in
confounding effect of overlapping breast tissue, which
screening mammography and barriers to access BC
substantially affects cancer detection (10).
screening are most prevalent among low-income
This study targets to evaluate the diagnostic
women with subsequent significant mortality rates
validity
of
3D
wide-angle
Digital
Breast
among these populations due to delayed or neglected
Tomosynthesis (WA-DBT) during screening programs
screening (4).
for breast cancer.
Breast ultrasonography (US) is an alternative
to mammography in young asymptomatic individuals
PATIENTS AND METHODS
and a complimentary examination in screening of
This
was
a
prospective
screening-based
women with dense breasts(5). US imaging is preferred
comparative study, conducted at the Department of
over X-ray mammography during needle breast-biopsy
Radiodiagnosis, Interventional Radiology & Medical
taking because of its capability to visualize the biopsy
Imaging, Faculty of Medicine, Menoufia University in
needles without radiation hazards(6). US imaging is the
conjunction with the General Surgery Department,
only imaging technique available during breast-
Benha Faculty of Medicine, and El-Arabi Medical
conserving surgery (7).
Centers at Menoufia and Qalyubia Provinces.
2683
Received: 04/01/2022
Accepted: 02/03/2022
c:\work\Jor\vol881_64
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2697-2703
High Flux Versus Low Flux Dialysis: Impact on
Intradialytic Hypertension and Adequacy of Dialysis
Ahmed M. Tawfik*1, Ahmed M. Elgendy2, Hisham A. Abou El Leil1, Gamal E. Mady1
1Department of Internal Medicine and Nephrology, Faculty of Medicine Ain Shams University, Cairo, Egypt
2Department of Nephrology, Ministry of Health, El-Behaira, Egypt
*Corresponding author: Ahmed M. Tawfik, Mobile: (+20)1003669416, E-Mail: ahmedtawfik84@yahoo.com
ABSTRACT
Background: Intradialytic hypertension is an underrecognized complication in hemodialysis patients, increasing
cardiovascular morbidity, mortality, and hospitalization.
Objective: The aim of the current work was to detect the incidence of intradialytic hypertension in hemodialysis patients
and to compare the effect of high flux versus low flux dialysis on intradialytic hypertension and adequacy of dialysis.
Patients and Methods: The study was conducted on 200 patients on regular hemodialysis in Beheira governorate. The
patients were divided into: Group 1 including 100 patients on hemodialysis with high flux dialyzers and Group 2
including 100 patients on hemodialysis with low flux dialyzers.
Results: The incidence of intradialytic hypertension in hemodialysis patients was 23.5 % at the start, 21% after one
month and 13% after three months duration. There was a significant reduction in number of intradialytic hypertension
patients after one month duration and after three months in both groups. Adequacy of dialysis in the form of Kt/V and
urea reduction ratio showed highly significant improvement by the end of the study in the high flux group. Kidney
function tests, serum parathyroid hormone levels and serum hemoglobin levels showed significant improvement at the
end of the study in high flux group compared to low flux group.
Conclusion: It could be concluded that the current study has not demonstrated a significant difference between both
groups regarding the effect on intradialytic hypertension, but adequacy of dialysis in the form of Kt/V and urea
reduction ratio improved significantly by the end our study in the high flux group.
Keywords: Intradialytic hypertension, Hemodialysis, High/low flux dialysis
INTRODUCTION
prolonged periods of time to identify patients who
In newly diagnosed patients with end stage renal
experience IDH most frequently(2).
disease (ESRD), more than 85% of them present with
No standard definition of IDH exists but has most
hypertension (HTN). HTN in those patients is
commonly been defined as 10 mmHg rise in systolic
multifactorial. Elevated peripheral vascular resistance
blood pressure (SBP) during dialysis. IDH (intradialytic
and persistent hypervolemia are important contributing
SBP rise 10 mmHg at 4 over six consecutive
factors. In patients maintained on 3 HD sessions per
sessions) is estimated at 515% of HD patients and is
week, blood pressure (BP) rises during the hemodialysis
associated with poor prognosis (3). IDH has been
(HD) session, especially in older patients and those with
associated with higher ambulatory BP, increased
higher dry weight. The main goal of HD is to control the
cardiovascular morbidity and mortality, and frequent
extracellular volume (ECV), as inadequate sodium and
hospitalizations in HD patients (4).
fluid removal leads to fluid overload, HTN and higher
IDH has been associated with higher risk for both
mortality rates (1).
short-term (6 months) and long-term (2 years)
It is well-known that HTN is associated with
morbidity and mortality. It is still unclear if IDH can be
abnormalities in cardiac structure and function
considered a marker for modifiable risk factors known
including diastolic dysfunction, left ventricular
to affect cardiovascular morbidity and mortality (5).
hypertrophy, and arterial stiffness. BP shows dynamic
Although clinically significant, little is known about the
changes during HD sessions including both intradialytic
pathophysiologic mechanisms underlying IDH (6).
hypotension and HTN, which are 2 special situations
Proposed
pathophysiological
mechanisms
significantly increasing the risk of mortality in those
leading to IDH are volume overload, stimulation of
patients. It was found that intradialytic hypertension
renin angiotensin system, activation of sympathetic
(IDH) was associated with a higher mortality risk than
nervous system together with the effects of vasoactive
intradialytic hypotension (1).
peptides,
increased
hematocrit
levels
with
During the HD session, a reduction in systolic BP
ultrafiltration, changes in electrolyte levels during HD
of about 10-15 mm Hg is expected with BP decreasing
and removal of antihypertensive medications (7).
steeply during the first hour and then decreasing more
Some studies stated that IDH may be due to an
slowly during the remaining hours of the session.
impaired endothelial cell (EC) response to HD, with
However, some patients experience rises in BP during
more increases in plasma endothelin-1 (ET-1) relative
HD sessions. As BP readings vary frequently both
to nitric oxide, together with impaired flow-mediated
during and between HD sessions in most ESRD
vasodilation (FMD) (8).
patients, it is better to observe BP patterns over
It is not fully understood how IDH can lead to
adverse cardiovascular outcomes. It is apparent that
2697
Received: 05/01/2022
Accepted: 03/03/2022
c:\work\Jor\vol881_65
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2704-2709
Serum Osteopontin Level as Biomarker in the Diagnosis of
Pediatric Bronchial Asthma in Different Age Groups
Mohammed Sanad Nagiub1, Ehab Mahmoud Rasheed1, Atef Goda Hussein2,
Ahmed Ibraheem Abd El Hameed Atya*1
Departments of 1Pediatrics and 2Biochemistry, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Ibraheem Abd El Hameed, Mobile: (+20)1011990799, E-Mail: totti1010.ar@gmail.com
ABSTRACT
Background: Bronchial asthma is chronic inflammatory disease of the respiratory tract, in which many cells of innate
and adaptive immune system in combination with epithelial cells are involved causing the main clinical typical criteria
for the disease. Osteopontin (OPN) is identified in many cell types in the immune system. OPN is a protein expressed
during the inflammatory processes related to Th2 lymphocyte activity.
Objective: The aim of the current study was to evaluate serum osteopontin level as biomarker in the diagnosis of
bronchial asthma in different age groups. Patients and Methods: This prospective case-control study was carried out
at the Pediatric Department, Zagazig University Hospitals from May 2019 till December 2019. All patients were
subjected to full history taking and laboratory investigations including measurement of Human Osteopontin (OPN).
Results: There was high significant positive correlation between osteopontin and S. IgE and AEC. Also, there was high
significant negative correlation between osteopontin and forced expiratory volume 1 (FEV1), forced vital capacity
(FVC) and peak expiratory flow (PEF) in both age groups. There was significant difference between <5 years severe
asthma and 5-12 years severe asthma as regard Osteopontin level.
Conclusion: It could be concluded that there is strong association between OPN concentration and disease severity.
OPN shows high significant difference between asthmatic and control group. Serum OPN is a good biomarker in the
diagnosis of bronchial asthma at different age groups.
Keywords: Osteopontin, Biomarker, Diagnosis, Bronchial asthma, Pediatric.
INTRODUCTION
OPN is a protein expressed during the inflammatory
Bronchial asthma is chronic inflammatory disease
processes related to Th2 lymphocyte activity (5). It was
of the respiratory tract, in which many cells of innate
demonstrated in previous studies that OPN plays role in
and adaptive immune system in combination with
asthma (6), allergic rhinitis, allergic conjunctivitis and
epithelial cells are involved causing the main clinical
response to venom immunotherapy. However, the role
typical criteria for the disease (1).
of OPN in pediatric asthma has not been studied.
Bronchial asthma more closely resembles a
The aim of the current study was to evaluate serum
complex of clinical diseases than a single condition.
osteopontin level as biomarker in the diagnosis of
Within the past few years, it has emerged as the most
bronchial asthma in different age groups
common incommunicable respiratory disease affecting
children worldwide (2).
PATIENTS AND METHODS
According to epidemiological studies, 510%
This prospective case-control study included a total of
children suffer from bronchial asthma (BA) .In most
152 children with bronchial asthma, and 38 healthy,
children BA formation is associated with Th2-variant of
nonasthmatic children as controls, attending at Pediatric
an immune response, atopy, innate tendency for hyper
Department, Zagazig University Hospitals. This study
production of total and specific IgE, reduced functional
was conducted between May 2019 till December 2019.
activity
of
T-regulatory cells (Tr1, CD4+, CD25+) and Th1/Th2
Inclusion criteria:
imbalance (3).
Cases: all patients presented by wheezy chest
The interaction of specific IgE with causally
and diagnosed as bronchial asthma by history,
significant allergens on the surface of mast cells and
clinical picture and investigations in preschool
basophils induces the release of preformed and
and school age children.
synthesized de novo mediators causing acute
Healthy control: age and sex comparable
inflammation of bronchi accompanied by cell migration
healthy children.
in respiratory mucosa and formation of cell infiltrate
Exclusion criteria:
including eosinophils, basophils, Th2-lymphocytes
1. Age less than 1 year.
with the involvement of macrophages, monocytes, mast
2. Terminal stages of disease (malignancy, end-
and epithelial cells, platelets, neutrophils, fibroblasts (4).
stage liver, or renal diseases).
Osteopontin (OPN) is identified in many cell types
3. Cystic fibrosis, pulmonary tuberculosis.
in the immune system. It has been shown to be produced
4. Immune compromised.
especially
by
T-cells,
B-cells,
macrophages,
5. Patient or relatives don't consent to participate
neutrophils, eosinophil, natural killer cells, CD11c-
in the study.
positive dendritic cells (DCs) and bronchial epithelium.
6. All other cases of wheezy chest except asthma.
2704
Received: 05/01/2022
Accepted: 03/03/2022
c:\work\Jor\vol881_66
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2710-2715
Genotyping of Rotavirus RNA by Sequencing among Children with
Diarrhea at Zagazig University Hospital
Elhamy Rifky abdelkhalik1, Mohamed Abdelkader Adallah Almalky1,
Rania Mohamed Mohamed Ebrahim Amer2, Hazem Ali Abd Elraouf1
Departments of 1Pediatrics and 2Microbiology and Immunology,
Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Hazem Ali Abd Elraouf, Mobile: (+20) 01003497579, E-Mail: hazem032012@gmail.com
ABSTRACT
Background: Worldwide, rotavirus (RV) is the most common cause of severe gastroenteritis among infants and young
children. While diarrhea is the second most common cause of fatal childhood illness. RV can be detected in high
concentrations in the stool of children suffering from gastroenteritis.
Objectives: To determine rotavirus genotyping among diarrheic children at Sharkia Governorate.
Patients and Methods: For one-year surveillance, the data and the stool samples were gathered from January 2015 to
January 2016. A total of 140 stool specimens were collected from the inpatients diagnosed with acute diarrhea in the
Pediatric Department, Zagazig University Hospitals.
Results: Our results showed that there was a statistically significant difference between positive and negative rotavirus
infection cases in Veslkari score of severity and hospital stay. 12.5% of the study group had G3 genotype and 33.6% of
the study group had strain P8. By comparing clinical data between G3 and non-typeable genotyping in the studied
group, there was a statistically significant difference between G3 and non-typeable genotyping in the Veslkari score of
severity. There was a highly statistically significant negative correlation between the Veslkari score of severity and
weight. On the other side, there was a statistically significant positive correlation between the Veslkari score of severity
and age.
Conclusion: We concluded that rotavirus represents a high percentage of hospitalized cases of GE in Zagazig
University Hospital with a significant difference in severity and complications between positive and negative rota cases.
Keywords: Rotavirus RNA, Genotyping, Sequencing, Children, Diarrhea.
INTRODUCTION
The most common cause of severe gastroenteritis
Objectives: To determine rotavirus genotyping among
among infants and young children is Rotavirus infection
diarrheic children at Sharkia Governorate.
(1). Diarrhea is the second most common cause of fatal
childhood illness, about 1.34 million deaths occur
PATIENTS AND METHODS
around the world among children aged less than 5 years
This cross-sectional study was conducted in the
due to RV (2). Though the incidence of RV infection
Departments of Pediatrics and Medical Microbiology
among children in developed and developing countries
and Immunology as well as the Medical Scientific and
is similar outcomes vary widely with 82% of fatalities
Research Centre, Faculty of Medicine, Zagazig
estimated to occur in developing countries. Most death
University Hospitals.
occurs in low-and middle-income countries, such as
Egypt (3).
Sample size estimation:
At least one episode of RV gastroenteritis
For one year of surveillance, the data and the
encounters every child by the age of 5 years. Each year,
stool samples were collected from January 2015 to
about 2 million subjects have to be hospitalized for
January 2016 (in November, December, and January
developing severe RV gastroenteritis while about 25
months which was the peak of RV). A total of 140 stool
million patients seek medical help by visiting a
specimens were collected from the diagnosed inpatients
physician's office or clinic and 111 million cases require
with acute diarrhea in the Pediatric Department,
care at home (4).
Zagazig University Hospitals.
RV can be detected in high concentrations in the
stool of children suffering from gastroenteritis. Control
Inclusion criteria: Infants and children aged from one
measures such as improved sanitation are not effective
month to five years presented with gastroenteritis or
in preventing this disease (5). Rotavirus (RV) belongs to
acute diarrhea.
the Reoviridae virus family and the virion comprises
three concentric protein layers. The outer capsid
Exclusion criteria: Children with chronic and/or
consists of two proteins, VP7 and VP4 that are used to
persistent diarrhea, which was defined as diarrhea that
classify rotavirus strains into G (glycoprotein) and P
lasted for more than two weeks.
(protease-sensitive) genotypes, respectively. Out of the
12 G and 15 genotypes known to infect humans,
Data Collection:
genotypes G1P [81, G2Pl4], G3P [8], G4P [8], and G9P
1. All study subjects underwent: Thorough history
[8] cause over 90%of rotavirus diseases worldwide (6).
taking including personal history (age, sex,
2710
Received: 06/01/2022
Accepted: 06/03/2022
c:\work\Jor\vol881_67
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2716-2721
Assessment of Mitral Valve Replacement Through Standard Median
Sternotomy Versus Minimally Invasive Approach
(Anterolateral Thoracotomy) with Short-Term Results
Ahmed Eid Ahmed Hussein, Khalid Hassan AbdelBary,
Mostafa Abdel Sattar Mohamed, Ahmed Samy Fadaly
Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Eid Ahmed Hussein, Mobile: (+20) 01203841118, Email: drahmedeid2004@gmail.com
ABSTRACT
Background: When it comes to mitral valve repair, minimally invasive procedures are safe, have low post-operative
morbidity, and have a low recurrence rate.
Objective: This aimed to compare procedure & early outcomes of patients who met the inclusion criteria for mitral
valve surgery to those who do not need surgery using the standard method.
Patients and methods: Mitral valve surgery was performed on 40 individuals with mitral valve disease (MVD) who
were selected at random. The study was conducted in Zagazig University Hospital and El-Maadi, El-galaa, and Kobri
El-Koba military hospitals. A standard sternotomy was used to perform mitral valve surgery on 20 patients in group A,
whereas a level I less invasive procedure, involving a Rt. anterolateral minithoracotomy under direct vision and femoral
artery and vein cannulation, was performed on the other 20 patients in group B.
Results: In group (A), postoperative discomfort was much less than in group (B). Compared to group (B), group (A)
spent less time in the hospital overall. No statistical significance could be found in the number of complex patients
between groups A and B, despite the fact that complications in group A were less severe. The minimally invasive mitral
valve surgery (MIMVS) procedure was more affordable than sternotomy surgery.
Conclusion: Primary mitral valve surgery can be performed with this technique, which is nearly as safe as a median
sternotomy. Using this method, extra incisions in the groin can be avoided while still getting outstanding cosmetic
outcomes.
Keywords: Mitral valve replacement, median sternotomy, anterolateral thoracotomy.
INTRODUCTION
recovery and a shorter hospital stay in the process, and
For many years, the full median sternotomy has
less blood transfusion. When the risk of sternotomy
been the conventional method for open heart surgery.
dehiscence is high in chronic obstructive pulmonary
As long as it has been accepted, the full sternotomy
disease (COPD) patients, when it comes to surgery, the
incision is regularly criticised for being too long and
sternotomy strategy is easier to apply because most
resulting in post-operative pain and complications such
doctors are already familiar with this method. There is
as wound infection and unstableness (1). Reducing post-
no need for specialized equipment or a battle for the
operative pain and recovery time are some of the
depth of the operative field with this method (1).
benefits of mitral valve procedures that are less
All minimally invasive approaches benefit from
extensive (2).
the use of TEE in the installation of a venous cannula
The procedure to repair the mitral valve using
and de-airing of the patient. The tiny incision makes it
minimally invasive techniques is safe, with low
difficult to detect dissection, periprothetic leaking, and
postoperative morbidity and a low reoperation rate.
LV distension, all of which can be detected with this
Surgeons have shown that MIMVS is an option to full
technique. In all cases, external defibrillator pads should
sternotomy with low post-operative morbidity and
be used (1).
mortality. Without compromising on surgical repair or
The goal of this study was to compare the
replacement techniques and with an emphasis on
procedure & early outcome of traditional sternotomy
minimally invasive procedures to lessen surgical stress
versus less invasive technique in patients with mitral
and speed up the recovery of patients, minimally
valve disease requiring surgery according to inclusion
invasive procedures are becoming increasingly popular
criteria.
(3).
A major goal of today's minimally invasive
PATIENTS AND METHODS
surgical methods is to reduce complications associated
Mitral valve surgery was performed on 40 individuals
with the big incisions that are currently being used (4).
with MVD who were selected at random. The study was
Increasing numbers of patients have demonstrated the
conducted in Zagazig University Hospital and El-
effectiveness of a less invasive procedure for mitral
Maadi, El-galaa, and Kobri El-Koba military hospitals.
valve surgery, and it is now widely recognized. Greater
A standard sternotomy was used to perform mitral valve
surgical vision and precision can be achieved due to the
surgery on 20 patients in group A, whereas a level I less
absence of cannula in the operating room. With this
invasive procedure, involving a Rt. anterolateral
method, you get better cosmetic outcomes, less sternal
minithoracotomy under direct vision and femoral artery
infection, less discomfort and blood transfusion, faster
and vein cannulation, was performed on the other 20
2716
Received: 28/12/2021
Accepted: 25/2/2022
c:\work\Jor\vol881_68
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2722-2726
Analysis of Risk Factors for Hepatic Decompensation Post Trans Arterial
Chemo Embolization (TACE) for Hepatocellular
Carcinoma (HCC) on Top of Cirrhotic Liver
Muhammad Abbas El-Masry1, Fatema Abu-Bakr Abdel-Moez1, Moustafa Hashem Mahmoud Othman2,
Abdelmajeed M. Moussa3, Amr Abdel-Rady Ismaiel Mohammed*1
Departments of 1Internal Medicine and 2Radiology, Faculty of Medicine, Assiut University, Egypt
Department of 3Tropical Medicine and Gastroenterology, Faculty of Medicine, Aswan University, Aswan, Egypt
*Corresponding author: Amr Abdelrady Ismaiel, Mobile: (+20) 01004331923, E-Mail: amrismaiel68@gmail.com
ABSTRACT
Background: Trans Arterial Chemo-Embolization (TACE) is usually employed for unresectable hepatocellular
carcinoma (HCC) and is largely considered to be palliative, but may be curative depending upon the stage of HCC. A
common complication of TACE is decompensation of cirrhosis. The development of complications may depend upon
various risk factors related to the liver disease, the patient and to the procedure itself.
Objective: To identify the incidence and analyze the risk factors for of hepatic decompensation following TACE.
Patients and methods: Retrospective descriptive study was conducted in Al-Rajhy Liver University Hospital, and
Assiut University Hospitals. This study included 50 cases with HCC on top of liver cirrhosis, evaluation of liver function
and proper staging of the tumour were done prior to TACE.
Results: Basal Child and MELD score, initial tumor size and basal albumin level were statistically significantly
(p<0.005) correlated with decompensation following TACE.
Conclusion: Proper selection of patients is essential for a better outcome and lower risk of hepatic decompensation after
TACE. Serum albumin and tumour size were the independent predictors of decompensation.
Keywords: Liver cancer, MELD score, Trans Arterial Chemo-Embolization.
INTRODUCTION
include the stage of cirrhosis as indicated by the Child
Primary liver cancers are the fifth most
Turcotte Pugh (CTP) and Model for End-stage Liver
common cancers worldwide and the third most deadly,
Disease (MELD) score, the morphology of HCC,
with approximately 600,000 deaths annually. HCC, a
including the size, location, presence or absence of
primary liver malignancy, accounts for approximately
thrombosis of portal vein, the baseline liver function as
85% to 90% of all primary liver cancers (1).
indicated by the prothrombin time (PT) and the albumin
Hepatocellular carcinoma (HCC) ranks 2nd and 6th most
levels. The patient-related factors may include the
common cancer among men and women in Egypt. The
presence of comorbidities and the level of
incidence of HCC is rising in Egypt mostly due to high
immunocompetence. The dose of chemotherapeutic
prevalence of viral hepatitis and its complications (2).
agent and skills of the performer of TACE procedure
Different treatment options are available for
may also influence the outcome(5).
HCC. The therapies that are known to offer a high rate
The aim of the present study was to identify the
of complete responses and thus, a potential for cure, are
incidence and analyze the risk factors for of hepatic
surgical resection, transplantation and percutaneous
decompensation following TACE.
ablation. Trans Arterial Chemo-Embolization (TACE)
is usually employed for unresectable HCC and is largely
PATIENTS AND METHODS
considered to be palliative, but may be curative
Retrospective descriptive study was conducted in Al-
depending upon the stage of HCC. It has been shown to
Rajhy Liver University Hospital, Assiut University
improve survival in unresectable HCC (3).
Hospitals. This study included 50 cases with HCC on
TACE is an interventional radiology procedure
top of liver cirrhosis.
performed in the angiography suite. A common
complication of TACE is decompensation of cirrhosis.
Inclusion criteria:
Hepatic decompensation was defined by the occurrence
1. Subjects participating in this retrospective study
of any one of the following: the development of
were cirrhotic patients having HCC on top who have
encephalopathy, increasing ascites, increase in the
been undergoing trans arterial chemoembolization
prothrombin time by >3 seconds of the level before
(TACE) where the mean dosage of lipiodol and
TACE, increase in the serum bilirubin level to twice the
cisplatin injected were fixed for all sessions and
upper limit of normal (i.e., 38 umol/L) if the pre-TACE
embolization was performed in all of them at Al-
level was normal, or an increase to twice the basal level
Rajhy Liver University Hospital, and Assiut
if the pre-TACE level was abnormal(4).
University Hospitals.
The development of complications may depend
2. Patients eligible for TACE were studied for the
upon various risk factors. The risk factors may be
development of hepatic decompensation within 6
related to the liver disease, the patient and to the
weeks of the procedure.
procedure itself. Factors related to the liver disease
3.
2722
Received: 09/01/2022
Accepted: 07/03/2022
c:\work\Jor\vol881_69
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2727-2732
Assessment of Left Ventricular Remodeling and Myocardial
Reperfusion among Diabetics Treated with Primary Coronary
Intervention for Acute Myocardial Infarction
Mohey Eldeen Abo Elftouh Eldeeb, Kamal Saad Mansour,
Ahmed Abo Amer Ibrahim Mansour*, Mohamed Mohsen Mohamed
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Abo Amer Ibrahim Mansour, Mobile: (+20)1273227968, E-Mail: ahmed.amer23@outlook.com
ABSTRACT
Background: Left ventricle (LV) remodeling and poor myocardial reperfusion have been linked in various
investigations, particularly in diabetics.
Objective: The aim of this study was to assess the influence of diabetes mellitus on both left ventricular systolic function
recovery as well as myocardial reperfusion following primary percutaneous coronary intervention (PCI).
Patients and methods: One hundred primary percutaneous coronary intervention of (IRA) alone was used in 50 diabetic
and 50 nondiabetic individuals who had their first STEMI attack, underwent echocardiography (conventional TTE) and
coronary catheterization to determine effect of diabetes on LV remodeling and myocardial reperfusion.
Results: ST elevation after 1ry PCI in diabetics differed significantly compared to non-diabetics. Left ventricular end-
systolic diameter (LVESD), wall motion score index (WMSI) and incidence of remodeling after 3 months follow up
was significantly higher in diabetic group compared to non- diabetics. Follow up beyond 3 months indicated positive
significant correlation between ejection fraction (EF) by m-mode and myocardial blush grade (MBG), negative
correlation between LVEDV and MBG, positive significant correlation between E/A ratio and MBG negative significant
correlation between WMSI and MBG.
Conclusion: It could be concluded that diabetes has a negative impact on cardiac reperfusion in STEMI patients.
Patients with diabetes are more likely to experience remodeling than those without diabetes.
Keywords: Myocardial Reperfusion, Diabetes Mellitus, Left Ventricular Remodeling.
INTRODUCTION
platelets and leukocytes' clogging of the endothelium,
People with diabetes mellitus (DM) are expected
and decreased myocardial reperfusion in the initial
to increase by more than half by the year 2030, 537
phase of MI have been linked to diabetes mellitus (9).
million adults (20-79 years) are living with diabetes - 1
The aim of the current study was to assess the
in 10. This number is predicted to rise to 643 million by
influence of diabetes mellitus on both left ventricular
2030 and 783 million by 2045 (1).
systolic function recovery as well as myocardial
About one-third of patients treated with an acute
reperfusion following primary PCI.
myocardial infarction (AMI) do not have diabetes
mellitus (DM) at the time of admission, even though
PATIENTS AND METHODS
DM is associated with an elevated risk of cardiovascular
This comparative study included a total of 100
disease (2). Mortality from cardiovascular disease
patients with STEMI (50 diabetic and 50 non-diabetic),
(CVD) is two- to four-times higher in those with
attending at Cardiac Catheterization Laboratory,
diabetes mellitus than in healthy individuals without the
Cardiology
Department,
Zagazig
University
illness (3).
Hospitals and El-Zaitoun Specialized Hospital. All
Short- and long-term mortality in patients with
patients underwent PCI for IRA only (culprit-only
acute myocardial infarction (MI) and diabetes mellitus
revascularization). This study was conducted between
(DM) have both been linked (4). A higher incidence of
September 2020 to March 2021.
post-infarction heart failure has been linked to diabetes
Acute myocardial infarction diagnosis was based
mellitus (5).
on clinical symptoms, elevated cardiac biomarkers (CK,
Chronic heart failure (CHF) after an acute
CKMB, and Troponin), and 12-lead electrocardiogram
myocardial infarction (MI) is mostly due to the
results (10).
remodeling of the left ventricular (LV) wall, which is
affected by numerous variables, including myocardial
Inclusion Criteria:
reperfusion (6).
All patients fulfilling the diagnosis of STEMI and
Only a small amount of evidence about the
admitted to cath lab for primary PCI.
influence of diabetes on post-infarction LV remodeling
Myocardial infarction patients with an elevated
is known in diabetic individuals, particularly following
ST segment.
primary coronary intervention (7). Several investigations
Patients not receiving thrombolytic therapy.
have found a correlation between LV remodeling and
Patients within 12 hours of presenting
poor myocardial reperfusion (8).
symptom.
An enhanced inflammatory response, increased
2727
Received: 28/12/2021
Accepted: 25/02/2022
c:\work\Jor\vol881_70
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2733-2735
An Overview of Zinc and its Intralesional Role in Treatment of
Multiple Recalcitrant Warts: Review Article
Nada Mohamed Ali Abd Elkareem*, Fawzia Farag Mostafa, Doaa Hosny
Department of Dermatology, Venereology and Andrology, Zagazig University Hospital, Egypt
*Corresponding author: Nada Mohamed Ali Abd Elkareem, Mobile: (+20)01146903268,
E-Mail: nabdelkareem938@gmail.com
ABSTRACT
Background: Human papilloma virus (HPV) causes viral warts, which affect around 10% of the population. HPV types
1, 2, and 57 are frequently implicated as etiological factors in the majority of cases. It's more difficult to diagnose and
cure HPV 4 and 7 because of their rarity. It is possible to combine several treatments for viral warts because treatment
might be time-consuming in some circumstances, even when various options are accessible. In spite of reports of
successful systemic acitretin therapy for viral warts resistant to previous treatments, oral acitretin therapy has only been
used in a limited number of cases.
Objective: Assessment of role of intralesional zinc sulphate 2% in the treatment of multiple recalcitrant warts.
Methods: Warts, Zinc sulphate, Recalcitrant warts, and the Human Papillomavirus were all looked for in PubMed,
Google scholar, and Science direct. References from relevant literature were also evaluated by the authors, but only
the most recent or complete study from January 2000 to January 2022 was included. Due to the lack of sources for
translation, documents in languages other than English have been ruled out. Papers that did not fall under the purview
of major scientific investigations, such as unpublished manuscripts, oral presentations, conference abstracts, and
dissertations, were omitted.
Conclusion: Warts can also be cleared with intralesional 2 percent zinc sulphate. Children may benefit from using
topical or oral zinc as an alternative to harsh manual treatments for warts.
Keywords: Human Papillomavirus, Recalcitrant warts, Warts, Zinc sulphate.
INTRODUCTION
Zinc:
Warts can develop as a result of a genital HPV
Zn (which is considered the 2nd most abundant
infection. Genital warts will not develop in 90% of HPV-
transition metal after Fe) is believed to make up
infected people. People who contract the virus will only
roughly 23 grammes of Zn in the human body, making
transfer it to roughly 10% of those who are infected.
it the second most abundant divalent cation after
Human papillomavirus types 6 and 11 are to blame for
calcium. Trace elements like Zn are essential for the
genital warts. There are more than 100 distinct HPV
survival of all organisms. When unstable atoms with at
strains. HPV is transmitted through direct skin-to-skin
least one unpaired electron cause cell damage, an
contact with an infected person, most commonly during
antioxidant mineral like manganese can help prevent
intercourse. The HPV strains that cause genital warts are
their formation and reactive response (5). Growth,
different from those that cause cervical and anal cancer.
transport, endocrine and immune systems, and cell
It is possible for a person to have many strains of HPV
differentiation Only a few of Zn's various roles in
(1).
cellular activity are RNA and DNA synthesis and DNA
The prevalence of genital HPV infections ranges
replication(6).
from 10% to 20%, with clinical symptoms occurring in
The majority of it is located in the testicles, muscle,
1% of those infected. HPV infections have been on the
liver, bones, and the brain (7). It is a key component of
rise. At its height, the infection rate is among people
learning and memory and it is found in abundance in
aged 20 to 24, with 80 percent of those affected being
the synaptic vesicles (8).
between 17 and 33. Genital HPV DNA is expected to be
Besides iron, zinc is the body's second most essential
present in 2.9% of the general population. (2).
trace element (9). As a structural, catalytic, and
There is no HPV cure. Removal of visible warts
regulatory component, Zn participates in numerous
does not necessarily reduce transmission of the HPV
metabolic processes(10). It is a cofactor for more than
virus underlying the wart. It depends on how many,
300 enzymes and is found in the structures of over
how big, and where the warts are. There is a risk of
2,000 transcription factors(11). A variety of enzymes,
lasting
scarring,
irritation,
and
irreversible
such as hydrolytic enzymes, oxyreductase, ligases,
depigmentation as a result of treatment (3).
isomerases, and lyases, are also included (12).
Patients can have their tumours removed
The immune system and the regulation of gene
surgically or with topical medicines that are either
expression are two more areas in which zinc plays an
ablative (vaporisation, resection, coagulation, or
important role.(11).
excision). Warts can be removed more effectively with
Zinc's use in dermatology has increased dramatically
physically ablative therapies, but patients often choose
in the last ten years. A variety of skin conditions, such
topical medicines as an initial treatment, especially for
as cutaneous leishmaniasis, melanomas, acne vulgaris,
minor lesions(4).
and even skin cancers like basal cell carcinoma, have
been effectively treated with this medication (13).
2733
Received: 10/01/2022
Accepted: 09/03/2022
c:\work\Jor\vol881_71
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2736-2741
Interleukin-23 and its Receptor Expression (IL-23R) in
Psoriatic and Psoriatic Arthritis Patients
Mohamed Saad Serria*1, Eman Hamza1,4, Nessma A. Nosser2, Marwa Zohdy3, Fatma Azzahraa Hisham1
Departments of 1Medical Biochemistry and Molecular Biology, 2Clinical Pathology, and 3Dermatology,
Venereology and Andrology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Department of 4Biochemistry and Molecular Biology, Horus University, Damietta, Egypt
*Corresponding author: Mohamed Saad Serria, Mobile: (+20)01015980585, E-mail: sorriaeg@mans.edu.eg
ABSTRACT
Background: Psoriasis (Ps) is a systemic autoimmune disorder that develops under the influence of environmental
factors in a genetically susceptible person. The IL-23/IL-17 axis is the primary signaling pathway for cellular and
molecular alterations in Ps. Objective: This study aimed to investigate the serum levels of interleukin-23 (IL-23) and
its receptor (IL-23R) expression in patients with Ps and psoriatic arthritis (PsA), as well as to evaluate the possibility of
using (IL-23R) in blood as a helpful marker for diagnosis of psoriasis and susceptibility to psoriatic arthritis. Patients
and Methods: Medical data and clinical evaluations were done, and blood samples from patients and control groups
were collected. Serum IL-23 concentration was measured using enzyme-linked immunosorbent assay (ELISA) and the
expression of IL-23R in human peripheral blood mononuclear cells (PBMCs) was determined using western blotting.
Results: Serum IL-23 concentration was significantly higher among Ps cases than in controls and it was significantly
different between Ps and PsA groups. The protein expression of IL-23R was significantly greater in the Ps group than
in the control group, with no significant difference between Ps and PsA groups. The receiver operating characteristics
curve (ROC) curve showed a diagnostic value for the increased blood IL-23R with a sensitivity of 83.3% and a
specificity of 73.3% for psoriasis. Also, ROC curve showed a diagnostic value for the increased blood IL-23 with a
sensitivity of 80% and a specificity of 73.3% for the diagnosis of psoriasis. Conclusion: Serum IL-23 and its receptor
expression measurements are helpful tools in the diagnosis of Ps as well as in the prediction of PsA. We demonstrated
that there is a link between IL-23 and IL-23R and the risk of Ps in addition to PsA, with evidence that the expression of
IL-23R is linked to a significantly greater risk of psoriasis.
Keywords: IL-23, IL-23R, Expression, Psoriasis, Psoriatic arthritis.
INTRODUCTION
development as augmented by the transgenic K23 mice,
Psoriasis is one of the most prevalent autoimmune,
(mouse model of Ps and PsA caused by selective and
inflammatory and proliferative dermatosis which
conditional skin expression of IL-23) (6). Thus, factors
involves 2%-3% of the world's population and is
induced by IL-23 in the skin (IL-17 and IL-22) can be
frequently associated with other comorbidities,
pathogenic and initiate joint disease (7).
including inflammatory bowel disease and arthritis.
Interleukin-23 belongs to IL-12 cytokine family
Classical plaque psoriasis has focal inflamed, red and
and is formed of two subunits; p19 is a unique for IL-23
raised plaques due to overgrowth of epithelial cells (1).
and p40 which is also a component of IL-12. It binds to
Other clinical subtypes include (guttate, pustular,
a receptor complex that consists of IL-23R and the IL-
and erythrodermic). Early onset Psoriasis accounts for
12 receptor 1(8). IL-23 is released by keratinocyte and
75% of cases and occurs before the age of 40(2).
activated antigen-presenting cells (APCs), and its action
Psoriasis is caused by the imbalance between innate and
is mainly mediated by the production of inflammatory
adaptive immune components of skin cells due to
mediators (9).
disturbance in cytokines (3). The skin inflammation
There is accumulating evidence that IL-23 has a
increases the serum and local concentrations of many
role in maintaining the immune responses through
cytokines as TNF-, IFN-, IL-1, IL-23 and IL-17.
controlling the function of T-cell memory and affecting
Psoriasis was thought to be a Th1-driven disease
the proliferation and survival of IL- 17- producing T
because of the increased Th1-cell pro-inflammatory
helper 17 (Th17) cells. Many data revealed that T
cytokines in relation to Th2-type cytokines (4).
lymphocyte expresses IL-23R and respond to IL-23 by
It was demonstrated that mice received IL-23
releasing IL-17 and IL-22(10). IL-23 stimulates IL-17
minicircle DNA in vivo developed psoriasis and
synthesis by natural killer cells and neutrophils to
arthritis (5). Furthermore, the interference with IL-23
control the acute infections and by Th17 cells leading to
signalling pathway by neutralizing antibodies showed
the formation of autoreactive IL-17-producing T-
effectiveness against several inflammatory conditions
lymphocytes that provoke chronic autoimmune
including psoriasis. In addition, intradermal injections
inflammatory process (adaptive)(11). Thus IL-23 links
of IL-23 in mice result in a psoriasis-like disease with
the innate with adaptive immunity. More than 160
increased transcription of IL-23/Th17-related genes.
unique genes were activated by IL-23, including new
Therefore, IL-23 and Th17 axis might have an
DNA-binding proteins and a large number of expression
important role in Ps pathogenesis. It was revealed by
sequence tags that are still of unknown functions. Also,
some studies that increased systemic level of IL-23 is
IL-23 promotes upregulation of the matrix
not an absolute necessity for skin or joint disease
2736
Received: 09/01/2022
Accepted: 07/03/2022
c:\work\Jor\vol881_72
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2742-2745
Assessment of Total Serum Bilirubin Level for
Neonatal Jaundice after Intensive Phototherapy
Heba Elsayed Gabr, Moustafa Gamal Amin Ghonem, Wael Husseiny Soliman Bakir
Department of Pediatric, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, Egypt
*Corresponding author: Heba Elsayed Gabr, Mobile: (+20)01271786273, Email: heba.gabr78@yahoo.com
ABSTRACT
Background: Intensive phototherapy in neonatal hyperbilirubinemia rapidly decreases serum total bilirubin (STB)
below the threshold for treatment. Intensive phototherapy implies the use of high levels of irradiance to as much of
infant's surface area as possible.
Objectives: This study aimed to assess the total serum bilirubin level for neonatal jaundice after intensive phototherapy.
Patients and Methods: This study was conducted on 200 newborns with neonatal jaundice who were admitted to the
NICU of Benha Teaching Hospital, Egypt, requiring double surface, and intensive phototherapy treatment during the
period of the study from March 2020 till December 2020.
Results: Among the 200 neonates with hyperbilirubinemia, the mean STB measurement at presentation was 12.12 ±
4.6 mg/dl, after phototherapy the mean of STB was 8.4 ± 3.39 mg/dl. After stoppage of phototherapy by 24± 6 hours
the mean was 11.34 ± 3.17 mg/dl. The mean STB after phototherapy was 8.4 ± 3.39 mg/dl, while after stoppage by 24
± 6 hours the mean was 11.34 ± 3.17 mg/dl. There was significant difference between the three measurements regarding
present serum total bilirubin, after phototherapy & after stoppage by 24 ± 6 hours (with P < 0.001).
Conclusion: Intensive phototherapy in neonatal hyperbilirubinemia rapidly decreases serum total bilirubin (STB) below
the threshold for treatment. However, underlying alteration in bilirubin production and excretion may persist and cause
bilirubin rebound after stopping phototherapy.
Keywords: NICU, Serum bilirubin, Neonatal jaundice, Phototherapy.
INTRODUCTION
Treatment of CHB is more complex and depends mainly
Neonatal jaundice or neonatal hyperbilirubinemia
on the etiology. Despite advances in care and
results from elevated total serum bilirubin (TSB) and
management of hyperbilirubinemia, it remains a
clinically manifests as yellowish discoloration of the
significant cause of morbidity and mortality (4).
skin, sclera, and mucous membrane. The term jaundice
Intensive
phototherapy
in
neonatal
is derived from the French word "jaune", which means
hyperbilirubinemia rapidly decreases serum total
yellow. It is the most commonly encountered medical
bilirubin (STB) below the threshold for treatment.
problem in the first two weeks of life and a common
Intensive phototherapy implies the use of high levels of
cause of readmission to the hospital after
irradiance to as much of infant's surface area as possible
birth. Approximately 60% of term and 80% of preterm
(5). Risk factors for phototherapy neonatal bilirubin
newborns develop clinical jaundice in the first week
rebound include a positive Coombs test, pre-maturity,
after birth (1).
and treatment at or before 72 hours. This study included
In most cases, it is a mild, transient, and self-
neonates born at term or pre-term gestation. Those with
limiting condition and resolves without treatment
or without positive Coombs test have concluded that
referred to as "physiological jaundice." However, it is
significant bilirubin rebound is rare. Therefore,
imperative to distinguish this from a more severe form
measurement of bilirubin rebound is not needed. In
called "pathological jaundice." Failure to identify and
addition, routine measurement of bilirubin rebound may
treat this entity may result in bilirubin encephalopathy
increase workload to expense and prolong the hospital
and associated neurological sequelae. Unconjugated
stay (6).
hyperbilirubinemia (UHB) is the cause of clinical
This study aimed to determine the incidence and
jaundice in most neonates, but some infants with
magnitude of post phototherapy neonatal serum total
jaundice have conjugated hyperbilirubinemia (CHB),
bilirubin (STB) rebound needing reinstitution of
which is always pathological and signifies an
phototherapy.
underlying medical or surgical cause (2).
The etiology of pathological UHB and CHB is
PATIENTS AND METHODS
vast and varied. Preterm infants and those born with
This study was conducted on 200 neonatal
congenital enzyme deficiencies are particularly prone to
jaundice who were admitted to the NICU of Benha
the harmful effects of unconjugated bilirubin on the
Teaching Hospital, requiring double surface, and
central nervous system. Severe hyperbilirubinemia can
intensive phototherapy treatment during the period of
cause bilirubin-induced neurological dysfunction
the study from March 2020 till December 2020.
(BIND), which if not treated adequately, may lead to
acute and chronic bilirubin encephalopathy (3).
Inclusion criteria: Neonatal hyperbilirubinemia.
Phototherapy and exchange transfusions are the
Exclusion criteria: Neonatal hyperbilirubinemia with
mainstay of treatment of UHB, and a subset of patients
cholestasis or obstructive jaundice, and or due to RH
also respond to intravenous immunoglobulin (IVIG).
incompatibility.
2742
Received: 10/01/2022
Accepted: 09/03/2022
c:\work\Jor\vol881_73
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2746-2750
The Assessment of Cord Blood Selenium Level in Preterm and Full-Term Neonates
Wael Husseiny Soliman Bakir, Moustafa Gamal Amin Ghonem, Heba Elsayed Gabr*
Department of Pediatric, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, Egypt
*Corresponding author: Heba Elsayed Gabr, Mobile: (+20)01271786273, Email: heba.gabr78@yahoo.com
ABSTRACT
Background: Low selenium concentrations in the mother or her fetus can affect on infection risk, a major cause of
preterm birth. Selenium status is also important in the group of hospitalized neonates and infants.
Objective: This study aimed to measure cord blood selenium levels in full term and preterm neonates.
Subjects and Methods: A total of 120 full and preterm neonates and their mothers included in this study. They were
admitted to delivery room, Pediatric Department at Benha Teaching Hospital, Egypt. The study was conducted through
the period from February 2020 to December 2020. They were subjected to full history taking, routine, physical
examination and cord blood selenium was measured.
Results: Full-term neonates had significantly higher GA, Wt., Lt and selenium levels than pre-term neonates. Also,
there was no significant differences between full-term neonates and pre-term neonates regarding CRP, TLC and PLT.
Also, selenium supplementation didn't show any significant effect on several clinical parameters as gestational age,
weight, height, circumference, mother age, C-reactive protein, TLC and PLT among full-term neonates. On contrast,
selenium supplementation showed a significant improved serum selenium level among preterm and full-term neonates.
Conclusions: Full-term neonates had significantly higher selenium levels than pre-term neonates. Selenium
concentrations are reduced in neonates, especially in those with lower gestational age and birth weight. Supplementation
significantly affected serum selenium levels as compared to non- supplemented.
Keywords: Cord blood selenium, Full-term, Neonates, Preterm, Supplementation.
INTRODUCTION
Pregnancy is a period of increased metabolic
preterm birth. Preeclampsia causes symptoms such as
demands and deficiency of trace elements during
hypertension, oedema, and proteinuria (excess protein
pregnancy is closely related to mortality and morbidity
in the urine) and may also lead to rare but potentially
in the newborn (1). Deficiencies of specific antioxidant
life-threatening conditions like eclampsia (9).
activities associated with the micronutrients selenium,
Selenium deficiency has also been associated
copper, zinc, and manganese can result in poor
with the use of oral infant formula, enteral and
pregnancy outcomes, including fetal growth restriction
parenteral nutrition (with or without selenium addition).
and preeclampsia (2).Most selenium is in the form of
The optimal dose and length of selenium
selenomethionine in animal and human tissues, where it
supplementation is not well-established, since they are
can be incorporated nonspecifically with the amino acid
based only on age group and selenium ingestion by
methionine in body proteins. Skeletal muscle is the
breastfed children. Furthermore, the clinical status of
major site of selenium storage, accounting for
the infant affected by conditions that may increase
approximately 28% to 46% of the total selenium pool.
oxidative stress, and consequently, selenium
Both selenocysteine and selenite are reduced to generate
requirements is not considered (10). They concluded that
hydrogen selenide, which in turn is converted to
prematurity and low birth weight can contribute to low
selenophosphate for selenoprotein biosynthesis (3).
blood selenium in premature infants. Selenium
Selenium deficiency has also been associated
supplementation seems to minimize or prevent clinical
with a greater number of diseases and clinical
complications caused by prematurity. The few studies
complications. Klinger et al. (4) found selenium
of plasma selenium status in parenterally fed neonates
deficiency in most premature infants however, there
have shown that plasma selenium concentration
was not a significant correlation between selenium
decreased during parenteral feeding and tended to
levels and thyroid hormones. Freitas et al. (5) found no
increase when oral feedings were introduced (11).
relationship
between
the
incidence
of
Different factors such as gestation age, habitat,
bronchopulmonary dysplasia and selenium status.
mother's age and nutritional index can effect selenium
Available studies suggest that this is the case. Earlier
concentration in maternal blood, umbilical cord (UC)
research has also demonstrated that supplements of
blood and placenta (12). The maternal trans-placental
selenium yeast may help make the pregnancy and birth
transfer of Se to fetus is limited. Selenium is stored in
safer (6). In the pediatric population, selenium deficiency
fetal liver between 20th and 40th week. The average cord
is most commonly found in preterm infants, associated
blood selenium level is reported to be 35107 µg/l
with gestational age, feeding after birth and clinical
related to some factors like selenium content of soil in
status (7). According to the National Health and Medical
the different geographic region, gestational age, and
Research Council (NH & MRC) (8). Pregnant women
serum Selenium concentration after 36 weeks (13). The
who took supplements of selenium yeast had a lower
aim of this study was to measure cord blood selenium
rate of preeclampsia, which is the leading cause of
levels in full term and preterm neonates.
2746
Received: 11/01/2022
Accepted: 10/03/2022
c:\work\Jor\vol881_74
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2751-2757
Association between Interleukin 6 Serum Level and Severity of
Disease among Pediatrics with Covid-19
Moustafa Gamal Amin Ghonem, Wael Husseiny Soliman Bakir, Heba Elsayed Gabr*
Department of Pediatric, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, Egypt
*Corresponding author: Heba Elsayed Gabr, Mobile: (+20)01271786273, Email: heba.gabr78@yahoo.com
ABSTRACT
Background: Most studies quantify IL-6 only at patient admission, a strategy that may not be appropriate to accurately
predict the outcome or to guide treatment due to the dynamic inflammatory process occurring during infection with
SARS-CoV-2.
Objective: This study aimed to investigate the association between interleukin-6 serum level and severity of disease
among pediatrics with covid-19.
Patients and methods: A cross-sectional study was conducted on 130 children with COVID-19. All children were
divided into 4 groups according to WHO criteria as asymptomatic, which included 20 children, mild included that 60
cases, moderate that included 40 cases and severe, which included 10 cases. All cases were admitted to Benha Teaching
Hospital, with a diagnosis of COVID-19 during the period study from February 2020 to December 2020.
Results: Interleukin-6 serum level was significantly increased with severe than other severity features groups. ROC
curve analysis showed that procalcitonin and interleukin-6 were the best markers for early prediction of severity of
disuses among children with covid-19. The sensitivity of interleukin-6 was 87.9% and specificity was 63.5%, at AUC
of 0.640 with cut-off of 7.41.
Conclusion: Children at any age seem to be susceptible to COVID-19, and even though their symptoms are milder,
they still present a diverse range of clinical presentations. Interleukin-6 was the best marker for determining the severity
of disease among pediatrics with covid-19.
Keywords: COVID-19, Interleukin-6, Pediatrics, Disease severity.
INTRODUCTION
COVID-19 [8]. In these cases, the loss of negative
A novel coronavirus was identified following a
feedback in the immune response caused excessive
cluster of cases of pneumonia in Wuhan, China, in
production of inflammatory cytokines, leading to
December 2019 [1].
deleterious effects and poor prognosis [9].
It rapidly spread as an outbreak there. A limited
A large group of cytokines has been recognized
human-to-human transmission mainly within families
as significantly increased in severe COVID-19 patients:
was recorded, and the World Health Organization
interleukin-1 (IL-1), IL-1RA, IL-2, IL-6, IL-7, IL-8
(WHO) announced this on January 22, 2020. On the
(CXCL8), IL-9, IL-10, IL-17, IL-18, tumor necrosis
23rd of January, it was announced that the outbreak
factor (TNF-), interferon-gamma (IFN-gamma),
constituted a public health emergency of international
granulocyte colony-stimulating factor (G-CSF),
concern [2].
granulocyte-macrophage colony-stimulating factor
WHO designated the disease as coronavirus
(GM-CSF), macrophage inflammatory protein 1 (MIP-
disease 2019 (COVID-19) and that the causative agent
1alpha/CCL3), monocyte chemoattractant protein-1
was severe acute respiratory syndrome coronavirus 2
(MCP-1/CCL2), interferon gamma-induced protein 10
(SARS-CoV-2) in February 2020 [3].
(IP-10/CXCL10), and fibroblast growth factor (FGF)
A few weeks later, the virus spread was recorded
[10]. Most importantly, some of them (IL-6, IL-8, and
worldwide and was announced as a pandemic by WHO
TNF-) were regarded as independent markers of the
on March 11, 2020 [4]. The global spread included
severe disease [11].
Egypt, and the first case was recorded in Egypt on
A deeper knowledge of the SARS-CoV-2-
February 14, 2020 [5].
induced cytokine storm, including its triggering
The total number of confirmed cases on May 1,
mechanisms, molecular components, and kinetics, is
2020, was 5895, with a case fatality rate of 6.9%.
necessary for a better understanding of the pathological
Children were affected like other age groups, but the
process in COVID-19 and therefore for the
total incidence was less than 10%. Confirmed cases
identification of the most adequate therapeutic targets
among health care workers were 11% of the total
and timing of drugs administration. So far, several
confirmed cases [6].
studies have been published on the potential effects of
Considering the challenge of controlling virus
specific (anti-IL-6, anti-IL-1, anti-GM-CSF, and anti-
transmission, and the lack of an unquestionably
TNF-) and non-specific therapies (corticosteroids) [12].
effective antiviral treatment, a therapeutic strategy of
Of all the upregulated cytokines that may represent
immunomodulation has been advocated [7]. This
selective therapeutic targets, IL-6 has been regarded as
strategy particularly relevant gave the excessive
particularly important in the COVID-19 pathogenesis
production of proinflammatory cytokines recognized as
and may be antagonized by existing drugs. IL-6 is an
crucial in the pathophysiologic process of severe
inflammatory interleukin mainly produced by
2751
Received: 11/01/2022
Accepted: 10/03/2022
c:\work\Jor\vol881_75
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2758-2765
Role of High-Resolution Multidetector Computed Tomography in
Characterization of Pulmonary Ground Glass Opacity
Rasha Shawky Zaki*, Osama Abdallah Dawoud, Ayman Fathy Ahmed and Ahmed Fekry Salem
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Rasha Shawky Zaki, Mobile: (+20) 0100 4293609, E-Mail: zakirasha197@yahoo.com
ABSTRACT
Background: Multislice computed tomography not only improves the detection and characterization of parenchymal
abnormalities but also increases the accuracy of diagnosis.
Objective: To study and differentiate multidetector computed tomography findings and the pathologic characteristics
in different pulmonary ground-glass opacity causes.
Patients and methods: Thirty patients referred from the Chest Department, Zagazig University Hospital to the
Radiology Department during the period from November 2018 to December 2019, were included in this cross-sectional
trial. Diagnosis of GGO is based on careful history taking and clinical data, restrictive or obstructive pulmonary defect,
and conclusive radiographic as well as histopathologic findings.
Results: parenchymal lung diseases were predominant as seen in 24 patients accounting for 80 % of such patients while
vascular diseases were responsible for ground-glass attenuation were only 6 patients accounting for 20%. The
commonest diagnosis for the diffuse pattern of ground-glass opacity was interstitial lung diseases (16.7%), followed by
pulmonary fibrosis (13.3%), cardiogenic pulmonary edema (10%), then pulmonary hemorrhage (6.7%), and lastly
pulmonary hypertension with (3.3%). In the patchy pattern of ground glass, the commonest diagnosis was infectious
pneumonia (10%), followed by post-irradiation and post patchy and diffuse patterns showing restrictive dysfunction
(high FEV1/FVC and FVC is reduced) and the nodular pattern shows mixed dysfunction (low FEV1and low FVC).
Conclusion: we offer a diagnostic approach for the evaluation of ground-glass patterns in HRCT of the chest based on
all previous consensus data. It could help to narrow the list of differential diagnosis and reach the most accurate one.
Keywords: High-Resolution Multidetector Computed Tomography, Ground Glass Opacity.
INTRODUCTION
there is an impossibly broad differential generated,
A hazy opacity on computed tomography scans
which includes a large number of interstitial diseases
of the lungs, known as pulmonary ground-glass opacity
and a large array of alveolar diseases (5). Because of this,
(GGO), does not conceal the underlying bronchial
the difference formed by grouping all the causes of
structures or pulmonary arteries (CT) (1). On the
GGOs is unreasonably vast, including numerous
pathological side, GGO can be produced by partial
interstitial disorders and a wide range of alveolar
airspace
filling,
interstitial
thickening
with
diseases. Detection and diagnosis of lung GGO lesions
inflammation, edema, and fibrosis, proliferation of
have improved dramatically with the introduction of
malignant cells, the normal state of the respiratory
HRCT (6).
system, or increased pulmonary capillary blood volume.
In a single breath-hold, multislice CT can cover
Because of this, CT should be carried out under a set of
a larger area, with better longitudinal and in-plane
predetermined guidelines (2).
spatial resolution, as well as superior temporal
Depending on the existence of solid components,
resolution. Images of the airways, including those
GGO can be classed as pure (pGGO) or mixed
generated by techniques developed expressly for airway
(mGGO). As a non-specific finding on lung CT, GGO
imaging, such as virtual bronchography and virtual
may be seen in diseases such as organized pneumonia
bronchoscopy, can be generated using this data set (6).
or localized fibrosis (3). As a result, it has recently
Workstation-based
interpretation
of
the
garnered a lot of attention because it may suggest early
reconstructed images should be made available or the
underlying lung cancer, which in most cases appears as
radiologist at the workstation can undertake interactive
a bronchiole-alveolar carcinoma (BAC) and an
picture reconstruction using hard copies (7). Many
adenocarcinoma with a BAC component (4).
clinical scenarios could benefit from high-quality
Using a computed tomography (CT) scan, GGO
multiplanar and three-dimensional (3D) pictures (8).
is barely visible or only the solid portion of the lung can
Multislice computed tomography not only improves the
be detected in this window. CT scans often show GGOs
detection and characterization of parenchymal
alongside other interstitial or alveolar abnormalities. As
abnormalities but also increases the accuracy of
an alveolar finding, GGO denotes partially filled
diagnosis (9).
alveoli, and it is frequently found on or near the
To study and differentiate multidetector
periphery of the consolidated lung. In some
computed tomography findings and the pathologic
circumstances, active inflammation has been linked to
characteristics in different pulmonary ground-glass
interstitial illnesses. Fine fibrosis can be seen on CT
opacity causes was the goal of this study.
imaging if GGO is found next to interstitial
abnormalities (5).
PATIENTS AND METHODS
Therefore, if all causes of GGOs are grouped,
Thirty patients referred from the Chest
2758
Received: 11/01/2022
Accepted: 10/03/2022
c:\work\Jor\vol881_76
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2767-2771
Effects of the Anti-obesity Drugs Vita Slim and Green Tea on Certain
Biochemical and Physiological Indices of Obese Adult Male Albino Rats
Eman G. E. Helal1*, Nora A. Aljalaud2, Ashraf M. M. Algendy3, Suzan S. Elpasty1
1Department of Zoology, Faculty of Science (Girls), Al-Azhar University.
2Biology Department, College of Science, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
3Department of Physiology, Faculty of Medicine (Boys), Al-Azhar University, Egypt.
*Corresponding author: Eman G. E. Helal, Mobile: (+20) 01001025364, E-Mail: emanhelal@hotmail.com
ABSTRACT
Background: Because obesity is linked to an increased risk of diabetes and heart disease, the ideal anti-obesity
medication would have weight loss that was long-lasting and had few side effects.
Objective: To detect if the weight-loss drugs; green tea and Vita slim negatively affect several biochemical and
physiological markers.
Materials and Methods: Three groups consisted of 21 mature obese male albino rats (with a body weight of 220 ±20
gram): In Group one: control (vehicle treatment), in group two: for a period of 30 days, rats were given Vita slim
(0.1mg/kg/day), and in group three: for 30 days, rats were given green tea (0.1 mg/kg/day).
Results: Significant changes were observed in the weight of the treated groups, in serum levels of AST/ALT, albumin,
triglycerides, low-density lipoproteins (LDL), LDL/HDL ratio, urea, creatinine, as well as triiodothyronine (T3) as
compared with the control group.
Conclusion: Several physiological and biochemical markers, including kidney and liver functions, have been shown to
be negatively impacted by Vita slim and green tea after 30 days of ingestion.
Keywords: Anti-obesity drugs, Green tea, Hormones, Kidney functions, Lipid profile, Liver functions, Vita slim.
INTRODUCTION
and the formation of fat, and increase energy
A larger number and larger size of fat cells
expenditure via thermogenesis (fat burning), fat
characterize as obesity, a condition that has a
oxidation (fat burning), and fecal lipid excretion (fat
detrimental effect on one's health. Adipocytes in a
excretion) (9).
person's fat tissue expand first in size, then in number,
This study aims to compare between two slimming
as weight is added to the body; conversely, as weight is
drugs: Vita slim and green tea. Also, to explore the
reduced, adipocytes retract in size but not in number.
various effects of both on some physiological indices
Adipocytes are the fat cells found in the body of a
of obese adult male rats.
person (1). Obesity is primarily caused by a deficit in
energy expenditure relative to calorie intake (2). As a
MATERIALS AND METHODS
result, there are a variety of other factors, including
Experimental animals
environmental (e.g., diet, lifestyle, lack of physical
This study utilized a total of twenty-one albino
activity, and some medicine), as well as genetic (e.g.,
male rats (220±20 g). Rats were purchased from animal
predispositions inheritance to weight gain). Obesity, on
unit of the Nile Pharmaceutical Company, Cairo, Egypt.
the other hand, is often blamed on a poor diet and an
They were housed in a room with controlled
unhealthy lifestyle (3). Overproduction of preadipocytes
circumstances in well-aerated polypropylene clear
and differentiation into mature adipocytes are two
cages (average dimensions 50 x 30 x 25 cm) .We put 7
important steps in obesity development (4).
rats in each cage. Temperature ranges from 25 plus or
Vita slim drug is composed from natural products.
minus 2°C, humidity of 55 ±5 percent, and a 12-hour
The formula of Vita slim contains many natural
light/dark cycle. Two weeks before the experiment, they
ingredients, which is clinically proven to lose weight by
were freely fed and watered, allowing them to adapt and
suppressing appetite and accelerating burning, and the
detect any signs of pathological features.
most prominent components of the following: Garcinia
camuglia, Gymnema herb, chromium, sweet potato
Ethical approval
fibres, green coffee extract and green tea extract(5).
To ensure that all experiments were conducted
Green tea may have a significant impact on body
in accordance with Al-Azhar University's Faculty of
composition because of catechins, according to some
Science, Cairo, Egypt's "Ethics Committee for the
researchers (6). Caffeine is also found in green tea, which
Faculty of Science," Cairo, Egypt's, and "Guide for
has catechins. Camellia sinensis leaves are used to make
the Care and Use of Laboratory Animals" (NIH
green
tea,
which
contains
catechins,
like
publication No. 8523, 1996).
epigallocatechin-3-gallate (7). Along with quercetin,
Drugs and chemicals
theaflavins, thearubigins, theaflavinol, caffeine gallic
Med Care for Pharma Clinic, Egypt provided Vita slim
acid, as well as chlorogenic acid (8). Green tea's weight-
pills (400 mg/capsule). In addition, green tea (in
loss properties have been attributed to a variety of
capsules
form)
was
obtained
Herbal
factors. Reduce food intake, interrupt lipid
company , Australia (400 mg /capsule).
emulsification and absorption, decrease adipogenesis
2766
Received: 10/01/2022
Accepted: 09/03/2022
c:\work\Jor\vol881_77
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2772-2776
Combined CTP-IGF-1 Score: A New Score for Assessment of
Disease Severity in Patients With HCV- Related Liver Cirrhosis
Elsayed Ghoneem¹, Ahmed Marwan¹, Mervat El-Sayed Mashaly²,
Mohamed Mofreh Salem², Abeer Saad El zekred³, Ahmed Saleh*¹
Departments of 1Internal Medicine, Hepatology & Gastroenterology Unit, 2Clinical Pathology and
3Biochemistry, Specialized Medical Hospital, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Abdel Ghafar Saleh, Mobile: 0201003958489,
E-mail: drahmedsaleh1981@gmail.com, ORCID: org/0000-0001-8028-1997
ABSTRACT
Background: Liver is the largest endocrine organ in the body. It is the key organ in insulin mediated metabolism,
growth hormone and insulin like growth factors (IGF) pathway. Liver cirrhosis is the end result of many chronic diseases
including hepatitis C virus infection. Child-Turcotte-Pugh (CTP) score is the standard used in assessment of hepatic
reserve but it has its drawbacks in the form of subjective variables, hepatic encephalopathy and ascites.
Objective: The work aimed to assess IGF-1 in patients with liver cirrhosis and its correlation with CTP score and to
assess the value of modified combined CTP-IGF-1 score.
Patients and methods: This was a case-control study that enrolled 170 patients with chronic liver disease (CLD) and
72 healthy controls. CLD (liver cirrhosis) in the study group was caused by chronic hepatitis C virus (HCV) infection.
Liver cirrhosis was identified by clinical assessment, abdominal ultrasonography (US), and laboratory assessment.
Results: IGF1 showed highly significant low values in the study group compared to controls (42.15 ± 27.976 and 66.31
± 33.084 ng/ml respectively, p <0.001). The combined CTP-IGF-1 score in comparison with the classic CTP score
showed improved area under curve (0.848 and 0.854), sensitivity (71.2% and 88%), negative predictive value (41.7%
and 53.7%), false negative results (49 and 19) and accuracy (75.73% and 83.98%) but decreased specificity (97.22%
and 61.1%), positive predictive value (99.2% and 91.5%) and higher false positive results (1 and 14) respectively.
Conclusion: IGF-1 showed progressive decrements with progression of liver cirrhosis and is negatively correlated with
CTP score. Addition of IGF-1 to CTP score to formulate combined score improves the AUC, negative predictive value,
sensitivity, and the accuracy of CTP score and decreases the false negative results.
Keywords: IGF-1, Child, Turcotte-Pugh, Liver cirrhosis.
INTRODUCTION
End stage Liver Disease (MELD) score [8] and splenic
Liver is the main metabolic organ in the body,
size [9] was reported, and correlation was positive with
involved in glucose, lipid and hormone metabolism.
serum albumin levels [8, 9].
Liver is the largest endocrine organ in the body and it is
Reduced IGF1 levels were reported in cases with
a key organ in insulin-mediated metabolism and insulin
hepatocellular carcinoma (HCC) compared to cirrhotic
like growth factors (IGFs) pathway including insulin
and healthy controls [10]. The Child-Turcotte-Pugh
like growth factors-1, 2 (IGF-1, 2), and their binding
(CTP) score is the main score used to assess the hepatic
proteins (IGFBPs) [1, 2].
reserve, overall survival and treatment outcomes in
In mammals, IGF-1 is related to post-natal growth
patients with CLD [11, 12].
mediated by growth hormone and IGF-2 is related to
The work aimed to assess IGF1 levels in patients
stimulation of foetal and placental growths that are less
with liver cirrhosis in comparison with healthy controls
dependent on growth hormone [3]. Growth factors
and to correlate IGF1 levels with CTP score in those
produced in the liver, including IGF-1 and IGF-2, affect
patients.
hepatocytes proliferation, differentiation and apoptosis
[4].
PATIENTS AND METHODS
Liver cirrhosis is the end result of many chronic
This is a case-control study that enrolled 170
liver diseases (CLD) including alcoholic liver diseases,
patients with CLD and 72 healthy controls. CLD (liver
chronic viral hepatitis, and non-alcoholic fatty liver
cirrhosis) in the study group was caused by chronic
disease. Liver cirrhosis is characterized by replacement
hepatitis C virus (HCV) infection. Liver cirrhosis was
of liver tissue by fibrotic tissue, necrosis and
identified
by
clinical
assessment,
abdominal
regenerating nodules [5, 6].
ultrasonography (US), and laboratory assessment.
Liver cirrhosis is associated with IGF pathway
All subjects in the study were assessed by a
changes that result in progressive hepatocellular
thorough history and clinical examination, including
function deterioration [5]. Patients with chronic liver
residency (urban or rural), smoking history, history of
disease show reductions in hepatic response to growth
chronic diseases including diabetes mellitus and
hormone resulting in elevated growth hormone levels
hypertension, history of previous surgical or dental
and decreased IGFs levels. This leads to clinical
procedures, and history of anti-bilharzial treatment.
features of IGF1 deficiency [6, 7].
Laboratory investigations included CBC, INR, ALT,
Negative correlations between IGF1 and
AST, serum albumin, serum bilirubin, serum creatinine,
International Normalization Ratio (INR) [8], Model for
alpha-fetoprotein and random blood glucose.
2772
Received: 12/01/2022
Accepted: 13/03/2022
c:\work\Jor\vol881_78
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2777-2780
An Updated Overview of Keratoconus Management: Review Article
Mohamed Magdy Ibrahim Mahmoud*, Alaa Mohamed Hamdy,
Ashraf Bor'i Mohamed, and Yasmine Ahmed Diaa El Din
Department of Ophthalmology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed Magdy Ibrahim Mahmoud, Mobile: (+20) 01012821666,
E-Mail: mohamedmedo.1234yes@gmail.com
ABSTRACT
Background: Non-inflammatory corneal stromal thinness causes the central or paracentral region of the cornea to thin
and protrude anteriorly, leading to myopia, irregular astigmatism, and vision impairment with keratoconus (KC). About
90% of the time, it is bilateral, but the severity and progression are asymmetrical. It normally begins around the time of
puberty and continues until the third or fourth decade of life before stopping. The severity of the condition, the degree
of visual impairment, and the benefits and drawbacks of each treatment option all play a role in determining the best
course of medical or surgical treatment.
Objective: review article aimed to assess the new modalities of keratoconus management.
Methods: PubMed, Google scholar and Science direct were searched using the following keywords: Keratoconus,
keratoconus management, corneal cross linking and intrastromal corneal ring segments. The authors also screened
references from the relevant literature, including all the identified studies and reviews, only the most recent or complete
study was included between March 2009 and January 2022. Documents in a language apart from English have been
excluded as sources for interpretation. Papers apart from main scientific studies (documents unavailable as total written
text, conversation, conference abstract papers and dissertations) were excluded.
Conclusion: It is possible to conduct corneal cross linking and intrastromal corneal ring segments methods
simultaneously or in a sequential order, which has a beneficial effect on KC treatment. Several other methods with
promising outcomes have been described in the literature.
Keywords: Keratoconus, Management, Corneal cross linking, Intrastromal corneal ring segments.
INTRODUCTION
Anteriorly bulging, cone-shaped cornea in KC is
Twin studies:
caused by non-inflammatory thinning of the corneal
Most of the time, both identical twins were affected,
stroma. This causes myopia, astigmatism, and other
though to varying degrees of severity, which shows that
vision problems, including blurred vision. About 90% of
disease development has a strong genetic component (2).
the time, it is bilateral, but the severity and progression
are asymmetrical. It normally begins around the time of
B- Environmental factors:
puberty and continues until the third or fourth decade of
Many studies have linked the condition to
life before stopping. Both men and women are at risk
environmental variables such as atopic dermatitis,
from the side effects of KC according to sex, but it isn't
frequent eye rubbing, and wearing contact lenses (3).
apparent whether there is a major difference between
men and women (1).
DIAGNOSIS
The aim of the review article was assessment of new
Asymptomatic onset is typical for KC. Myopia,
modalities of management of keratoconus.
uneven astigmatism, corneal thinning, steepening, and
corneal scarring all contribute to deterioration of vision
ETIOLOGY AND PATHOGENESIS
and frequent eyeglasses replacement. Patients with acute
A mix of genetic and environmental factors appears
hydrops, which is caused by a sudden inflow of aqueous
to be at the root of KC, but the exact extent to which each
into the cornea due to cracks in the Descemet's
component contributes to the disease's development
membrane, complain of pain, photophobia, and a loss in
remains a mystery (1).
vision (4).
A- Genetic factors:
*External signs:
Study after study has demonstrated that there is a
- Downgaze with bulging lower eyelids (Munson's sign).
genetic basis for KC, including family studies, twin
- This is known as Rizzuti's sign, and it occurs when the
studies, and genomic analyses (1).
cornea is lighted from the temporal side (5).
* Slit lamp signs:
Family studies:
- Corneal stroma and Descemet's membrane are marked
More than 15-67 times greater than the overall
by small vertical lines known as Vogt's striae.
population's prevalence of KC among first degree
- There is an iron deposition ring around the cone's base,
relatives (3.34 percent). Keratoconic patients' family
known as the Fleischer's ring, which might be partial or
histories in two or three generations show a hereditary
complete.
component (1).
- Thinner stroma.
- Scarring in the epithelium or beneath the epithelium (5).
2777
Received: 10/01/2022
Accepted: 09/03/2022
c:\work\Jor\vol881_79
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2781-2787
Uric Acid as a Predictor of Peripheral Arterial Disease as
Indicated by Ankle Brachial Index
Hazem Mansour1, Sameh Shahen1, Heba Sultan1, Hamdy AbdelAzeem AboElNeel2, Hassen Shehata1
Departments of 1Cardiology and 2Vascular Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Hazem Mansour, Mobile: (+20) 01000540100, E-Mail: hazemmansour79@gmail.com
ABSTRACT
Background: Peripheral arterial disease (PAD) is a chronic atherosclerotic progressive disorder that affects the arterial
tree especially those of the lower limb which can be screened by the ankle-brachial index (ABI). Generally, uric acid
(UA) has been accused of the initiation and progression of atherosclerosis in various arterial segments however, it is a
less studied risk factor in PAD.
Objective: Our study aimed to evaluate the correlation between increased serum uric acid levels and PAD as indicated
by ABI and whether there is a cut-off value for UA to predict PAD.
Patients and methods: A case-control study compared 100 patients with PAD as indicated by ABI with 100 cross-
matched controls as regards serum UA levels and other risk factors. Moreover, the receiver operating characteristic
curve (ROC) was plotted to determine the best cut-off point for UA to detect PAD as indicated by ABI.
Results: The BMI, DM, and dyslipidemia were highly significant among the patient's group (P- value= 0.001).
Moreover, UA was significantly correlated to low ABI (P- value=0.003). Besides, UA cut-off value > 6.5 exhibited a
specificity of 90% and a positive predictive value of 80% to diagnose PAD.
Conclusion: Low ABI was significantly associated with UA denoting its probable relation with lower limb
atherosclerosis, with a good positive predictive value to predict it.
Keywords: Peripheral arterial disease, Uric Acid, Ankle-brachial index.
INTRODUCTION
So, in the present study, we aim to evaluate the
Peripheral arterial disease (PAD) is a chronic
correlation between increased serum uric acid levels &
progressive disorder caused mainly through the
peripheral arterial disease as indicated by ABI &
atherosclerotic process that affects peripheral
whether there is a cut-off value for UA to predict PAD.
vasculature, especially those of the lower limb causing
PATIENTS AND METHODS
gradual narrowing of their lumens with eventual
This was a case-control study carried out on 200
complete obstruction& limb loss unless treated. It
subjects, divided into two groups: The group A (the case
affects about 200 million people over the world (1).
group) composed of 100 subjects identified as having a
Symptoms differ usually according to; the
peripheral arterial disease (PAD), were recruited from
grade& location of stenosis. It diverges from
the Vascular Surgery Department. Group B (the control
asymptomatic to exercise- induced intermittent
group) was composed of 100 subjects who matched the
claudication, rest pain, and critical limb ischemia
participants in group A in age and sex and had
(CLI)(2). Numerous risk factors have been linked to
traditional cardiovascular risk factors. Informed consent
PAD. Age and male gender were correlated to PAD
was done, and the steps of the research were explained
incidence in many epidemiological studies. DM,
to the subjects with the protection of their privacy and
Smoking, Hypertension& Hyperlipidemia were
confidentiality.
reflected as the most evaluated modifiable risk factors.
However, less studied risk factors such as Chronic
The inclusion criteria:
Kidney Disease (CKD), elevated C-reactive protein
We divided our subjects into two groups, Group A
(CRP)& other inflammatory markers, uric acid,
(included):
hyperhomocysteinemia, and D-dimer, also have been
1. Patients presented with claudication pain.
accused.
2. Patients having low ABI <0.9.
Uric Acid (UA) has been associated with
3. Patients with critical limb ischemia (rest pain
atherosclerosis, especially in PAD Moreover, treatment
and/or tissue loss).
with hypouricemic drugs was associated with
4. Patients having peripheral vascular disease
improvement in limb function in some trials(3). Uric
diagnosed by arterial duplex or CT angiography
acid has been assumed to have a role in the initiation of
& being treated medically or underwent
inflammation & the upsurge in oxidative stress because
angioplasty or surgical bypass.
of its accumulation in the arterial wall & activation of
Group B (included): People with normal ABI (0.9-1.2)
the Xanthine Oxidoreductase (XOR) enzyme(4). Ankle
& have one or more risk factors for PAD who matched
Brachial Index (ABI) is a non-invasive modality to
the patients as regards age& sex.
screen for PAD with a sensitivity that reaches 75%,
We excluded patients with acute limb ischemia, Renal
subsequently, it is the utmost commonly used screening
Failure on dialysis, recent TIA or stroke, and patients on
method, and it is recommended by American Diabetes
chemotherapy or bedridden patients.
Association (ADA) in people with DM above 50 years.
2781
Received: 12/01/2022
Accepted: 13/03/2022
c:\work\Jor\vol881_80
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2788-2794
Childhood Psychological Trauma and Psychiatric Comorbidity in
Patients with Breast Cancer
Nashaat A. Abdel-Fadeel*, Mervat M. Zanaty, Ahmed M. Kamal, Maha A. Hassan, Mohamed Taha
Department of Neurology and Psychiatry, Faculty of Medicine, Minia University, Egypt
* Corresponding author: Nashaat Adel Mohamed Abdel-Fadeel, Mobile: (+20) 1121044100,
E-Mail: nashaatadel2014@gmail.com; nashaat.adel@minia.edu.eg
ABSTRACT
Background: Most patients with breast cancer experience some psychosocial distress. These increased levels of distress
increase the risk of depression and anxiety with subsequent adverse effect on compliance to cancer treatment. In patients
with breast cancer, childhood trauma is associated with higher levels of fatigue, stress and psychological distress and
has a significant impact on patients' reaction and adjustment to cancer diagnosis.
Objective: The aim of this study was to detect psychiatric comorbidity and impact of childhood trauma in patients with
breast cancer and study their relations with tumor grading and histopathological characteristics.
Patients and Methods: In this cross-sectional study, we recruited 150 patients diagnosed with breast cancer.
Participants were females aged 18 years or older. Patients with history of another cancer, comorbid serious medical
condition, in their investigation phase of cancer diagnosis or those who refused to participate in the study were excluded.
The tools applied to participants were the Symptom Checklist 90 Revised and Childhood Trauma Questionnaire.
Results: 113 patients (75.3%) had psychiatric comorbidity; somatization was the most common psychiatric comorbidity
(58.7%) followed by depression (40.7%). Patients reported severe to extreme childhood trauma in domains of physical
neglect (28%), physical abuse (22.7%), emotional neglect (7.3%), emotional abuse (18%) and sexual abuse (2%).
Patients with psychiatric comorbidity had more grade III and IV in tumor grading. Patients with grade IV breast cancer
had more severe psychiatric symptoms.
Conclusions: Psychiatric comorbidity and childhood trauma are common in patients with breast cancer. Patients with
psychiatric comorbidity have more grades III and IV tumor grading. Patients with grade IV breast cancer have more
severe psychiatric symptoms.
Keywords: Breast cancer, Childhood trauma, Psychiatric comorbidity
INTRODUCTION
cancer who were exposed to childhood trauma were
Breast cancer is the most common cancer in
found to suffer from cognitive dysfunction following
females in developed countries(1). In Egypt, breast
chemotherapy (11), and to be at increased risk of
cancer is the most common malignancy in women,
emotional distress related to cancer (12).
accounting for 38.8% of cancers in this population, with
During the first year following diagnosis of breast
the estimated number of breast cancer cases nearly
cancer, patients are particularly vulnerable to anxiety
22,700 in 2020 and forecasted to be approximately
and depression (5). Unrecognized and untreated
46,000 in 2050. It is estimated that the breast cancer
depression increases functional impairment and
mortality rate is around 11%, being the second cause of
physical symptoms and leads to poor adherence to
cancer-related mortality after liver cancer (2).
treatment leading to reduced quality of life, more
Most patients with breast cancer experience some
substance use, anxiety, sleep disorders, sexual
psychosocial distress as problems in interpersonal
dysfunction, immune system dysfunction, more fatigue
relationships, financial strains and emotional distress(3),
and pain, rapid cancer progression and increased
as about one half of breast cancer patients experience
mortality (13-15).
significant distress levels (4). These high levels of
The rates of comorbid psychiatric disorders with
distress increase the risk of depression and anxiety with
breast cancer following diagnosis and recurrence range
subsequent adverse effect on compliance to cancer
from 14% to 38% of patients (12,16). Moreover, because
treatment (5,6).
of illness and treatment related variables as physical
The common psychosocial difficulties reported by
symptoms, the rates of developing serious levels of
patients with breast cancer include fear of recurrence,
depression and anxiety increase (17).
disturbed body image, physical symptoms, sexual
In Egypt, 48% of patients with breast cancer were
dysfunction, illness and treatment related persistent
found to have psychiatric problems; the rates were
anxiety, marital problems, and mortality related
38.8% for major depressive disorder, 29.6 % for
existential concerns (7).
generalized anxiety disorder and 9.2% for panic
In patients with breast cancer, childhood trauma is
disorder (18).
associated with higher levels of fatigue, stress and
In comprehensive management of patients with
psychological distress (8), and has a significant impact
breast cancer, it is necessary to enhance coping
on patients' reaction and adjustment to cancer diagnosis
strategies, improve environmental and personal
(9), as exposure to childhood trauma together with
resources, and to implement counseling, psycho-
environmental stress may lead to gene and gene
education, individual as well as group psychotherapy,
expression alterations (10). The patients with breast
2788
Received: 13/1/2022
Accepted: 14/3/2022
Study Of Comprehensive Geriatric Care In Sharkia Governorate
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2795-2797
Cancer Cervix and Human Papilloma Virus (HPV) among
Women Attending Gynecological Out Clinic Patients Al-Azhar
University Hospitals: Newly Screening Technique
Yousef Mohamed El-Mazzally*1, Saged Mohamed El-Mazzally2
Departments of 1Community and Industrial Medicine and 2Obstetrics and Gynecology,
Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Yousef Mohamed El-Mazzally, Mobile: (+20) 01227298616, E-Mail: yousefmetwaly11@yahoo.com
ABSTRACT
Background: Most incidences of cervical cancer are caused by the human papillomavirus (HPV), which can be prevented
with a vaccination. In around 90% of cases, HPV infections have no symptoms and disappear on their own within two
years. In certain situations, however, an HPV infection might remain and cause warts or precancerous lesions. HPV causes
nearly all cervical cancer cases; two strains, HPV16 and HPV18, accounting for 70% of cases.
Objectives: The study was designed to re-assess the prevalence of HPV infection among women attending the
Gynecological Outpatient Clinic Al-Azhar University Hospitals using the new liquid-based cytology technique and our
results provide important information for public health authorities considering HPV prevention in Egypt.
Subjects and methods: Our study was conducted on 1000 gynecological patients attending Al-Azhar University Hospitals
between March 2021 and December 2021. Their ages ranged from 35 - 70 years old. Cervical samples were collected by a
gynecologist using a cytobrush and placed in a liquid-based cytology medium (using the DC LBC from GZLBP) for the
presence of HPV DNA using Linear Array HPV genotyping at Cytolab Laboratory, Cairo, Egypt.
Results Among 1000 women who underwent the LBC test, 97 women were positive for HPV DNA findings (9.7%), while
the rest of women 903 were test free (90.3%). 57 cases (58.7%) of positive women showed different degrees of cervical
intra-epithelial neoplasia CIN.
Conclusion: The essential need for a proper screening system for cervical pathologies and further multi-central randomized
studies are strongly recommended through our study.
Keywords: HPV, Screening Test, Cancer Cervix.
INTRODUCTION
considering HPV prevention in Egypt.
Cancer cervix is the fourth most often diagnosed
cancer and the fourth main cause of cancer mortality in
PATIENTS AND METHODS
women worldwide. It has a tremendous global impact, with
Our study was conducted on gynecological patients
over 570,000 new instances of cervical cancer identified
attending Al-Azhar University Hospitals during the
each year and 311,000 fatalities reported [1].
period between March 2021 and December 2021 and
The bulk of cervical cancer-related deaths occurs in
their ages ranged from 35-70 years old.
developing nations, such as Egypt, where 25.76 million
women over the age of 15 are at risk of acquiring cervical
Inclusion Criteria:
cancer. In Egypt, it is projected that 514 women are
Age between 35 and 70.
diagnosed with cervical cancer each year, with 299 dying
Asymptomatic women.
from the disease; hence, cervical cancer is the second most
No recurrent vaginal or cervical infection.
common cancer among Egyptians[2].
No previous cervical precancerous condition.
Human papillomavirus is the most prevalent sexually
No history of malignant disease including cervical
transmitted infection (HPV). Up to 80% of sexually active
cancer.
women become infected at some time in their life, with 10-
20% developing a chronic infection [3].
Exclusion Criteria:
Human papillomavirus infection (HPV infection) is a
History of malignancy including cervical cancer.
sexually transmitted infection (STI) caused by a DNA virus
Recurrent vaginal or cervical infection.
from the Papillomaviridae family that has more than 170
Previous total hysterectomy.
subtypes. It is generally known as the most frequent viral
STI globally. Early age of first sexual intercourse, frequent
Virgin.
sexual partners, smoking, and impaired immune function
Pregnancy.
are all risk factors for chronic infection by sexually
Postpartum within 6 months.
transmitted diseases [4]. HPV is found in more than 95
percent of women who develop cervical cancer[5].
Cervical samples were collected by a gynecologist
The study was designed to re-assess the prevalence of
using a cytobrush and placed in a liquid-based cytology
HPV infection among women attending the gynecological
medium (using the DC LBC from GZLBP) for the
outpatient clinic at Al-Azhar University Hospitals using the
presence of HPV DNA using Linear Array HPV
new liquid-based cytology technique and our results
genotyping at Cytolab Laboratory, Cairo, Egypt.
provide important information for public health authorities
2795
Received: 13/1/2022
Accepted: 14/3/2022
c:\work\Jor\vol881_82
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2798-2804
Body Dysmorphic Disorder in Females Seeking Aesthetic Dermatology
Minimally Invasive Cosmetic Procedures
Mohamed A. El-khayyat1, Hassan M. El-Fakahany1, Fatma A. Latif1, Nashaat A. Abdel-Fadeel*2
Departments of 1Dermatology, Andrology and STDs and 2Neurology and Psychiatry,
Faculty of Medicine, Minia University, Egypt
* Corresponding author: Nashaat Adel Mohamed Abdel-Fadeel, Mobile: (+20) 1121044100,
E-Mail: nashaatadel2014@gmail.com; nashaat.adel@minia.edu.eg
ABSTRACT
Background: Body image is defined as the internal representation of person's external appearance and it plays a
significant role in quality of life and self-esteem of individuals. Body Dysmorphic Disorder (BDD) affects 1-2% of
general population. Patients with BDD report significant dissatisfaction with their external appearance and represent
about 5-15% of individuals seeking aesthetic interventions.
Objective: The aim of this study was to estimate rates of BDD in females seeking aesthetic dermatology services in
Egyptian culture in a step to raise awareness about BDD in dermatology practice.
Patients and Methods: we recruited 150 female subjects from those seeking different aesthetic dermatology
interventions from dermatology clinics in Minia governorate. Our study is a cross sectional study that involved collecting
data about sociodemographic and illness related characteristics, history taking and clinical examination. The tools
applied to participants were the Body Dysmorphic Disorder Questionnaire, the Body Dysmorphic Disorder modification
for Yale-Brown Obsessive-Compulsive Scale (Adult version) and the Body Dysmorphic Disorder modification for
Yale-Brown Obsessive Compulsive Scale (Adolescent version).
Results: The most common age group was 25-35 years representing 42.7% of the sample. Based on BDD-YBOCS
results, 62% of our sample screened positive for BDD while lower rates of BDD were found based on Body Dysmorphic
Disorder Questionnaire (BDD-Q).
Conclusions: Patients with BDD frequently present to aesthetic dermatology settings. Rates of BDD in aesthetic
dermatology seekers are high reaching up to 62%. It is important to screen all persons seeking aesthetic interventions
for BDD.
Keywords: Aesthetic dermatology, Body dysmorphic disorder, Cosmetic.
INTRODUCTION
are usually not successful in satisfying or improving the
Body image is defined as the internal
suffering of patients with BDD. Moreover, they often
representation of person's external appearance (1) and it
have negative consequences on the overall wellbeing of
plays a significant role in quality of life and self-esteem
patients. Aesthetic interventions usually prove no
of individuals and its multidimensional construct
benefit for BDD patients, because even the results are
involves, thoughts, perceptions, feelings as well as
good, they are not good enough, and the obsessional
behaviors related to physical appearance(2). Patients
thoughts are still there. And, if aesthetic intervention
who are significantly and extremely unsatisfied with
physically corrected a defect, satisfaction is temporary,
their external appearance and body image with
as obsessions may shift to other parts of the body with
associated impairment in their daily functioning are
worsening of symptoms (7).
known to be suffering from Body Dysmorphic Disorder
Screening for BDD by dermatologists is of
(BDD)(2).
paramount importance. Dermatologists should ask
BDD is a psychiatric condition involving
patients with minimal or non-existing defects about how
distressing preoccupation with slight or imagined
much time each day they spend in thinking about their
defects in external appearance with accompanying
defects and how much such concerns cause distress or
repetitive behaviors and occasionally poor insight
interfere with functioning. Patients who are concerned
regarding these beliefs. Although, BDD is relatively
and preoccupied with perceived defects, spending at
common and leads to functional impairment, its
least one hour thinking about them and their concerns
diagnosis is sometimes missed(3). BDD patients believe
lead to functioning impairment or clinically significant
that they are ugly, unattractive and deformed. These
distress should be considered for BDD diagnosis (8). Pre
cognitive distortions develop to distressing difficult to
intervention screening is also important in determining
suppress obsessional thoughts. In average, patients
patient's motivations to and expectations of
spend from three to eight hours per day in worries
intervention and that they are realistic. Furthermore,
regarding their appearance. In psychiatric settings,
screening helps in identifying patients with body
about half of BDD patients have unshakable beliefs
dysmorphic disorder or any other psychiatric disorder
about their appearance reaching a delusional level (4).
that may contraindicate procedure (9,10).
Not only patients with this severe and under
The aim of this study was to estimate rates of
diagnosed psychiatric condition seek advice from
BDD in females seeking aesthetic dermatology services
cosmetic dermatologists(5), but also they prefer and like
in Egyptian culture in a step to raise awareness about
to be seen by dermatologists (6). Aesthetic interventions
BDD in dermatology practice.
2798
Received: 16/01/2022
Accepted: 15/03/2022
c:\work\Jor\vol881_83
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2805-2811
Comparative Study between Primary Percutaneous Coronary Intervention,
Pharmacoinvasive Strategy and Pharmacological Reperfusion Strategy in Acute
Myocardial Infarction. A Long-Term Follow-Up Analysis
Ahmed Shafie Ammar, Ahmed Fathy Ahmed El Sayed, Mohammad Gouda Mohammad, Mostafa Fathy
Mohammed*
Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Mostafa Fathy Mohammed Helmy, Mobile: (+20)1096015177, E-mail: mostafafathy246@gmail.com
ABSTRACT
Background: Until now there is no clear evidence to support the superiority of one strategy over the others to treat
STEMI patients. Serial Btype natriuretic peptide (BNP) measurements accurately predict the risk of death or congestive
heart failure in STEMI patients.
Objective: The aim of the study was to determine which strategy is the best strategy to treat acute STEMI and if BNP
give an incremental prognostic value in treated STEMI patients. Patients presented with acute STEMI were enrolled in
the present study.
Patients and methods: Only 93 patients were followed up with us for 6 months and divided to 3 groups according to
the treatment strategy. All patient underwent BNP analysis, echocardiography and treated with either received only
thrombolytic therapy (Group I), primary PCI (Group II) or received thrombolytic therapy then went to catheterization
(Group III).
Results: Regarding BNP level change was higher in Group I and in Group III had high BNP level higher than Group II
but this difference doesn`t reach level for statistically significant correlation between BNP levels and type of reperfusion
in the three groups. Regarding LV systolic function, there was no statistically difference between the percent change in
LV systolic function in Group I and Group III (P-value = 0.854, 0.152 respectively) but there was statistically significant
difference between the percent change in LV systolic function in Group II (P-value=0.031).
Conclusion: The best way for treatment of acute STEMI patients, is a primary PCI the most significant predictive
methods are recovery of EF% and reduction of BNP, however pharmacoinavsive strategy like PCI strategy has good
follow up prognosis and better than thrombolytic alone therapy.
Keywords: PCI, ST-segment elevation myocardial infarction, Pharmacoinvasive strategy, Pharmacological
reperfusion strategy.
INTRODUCTION
elevation myocardial infarction. The study was
ST-segment elevation myocardial infarction
performed in the period from March 2016 to March
(STEMI) accounts for 25-40% of acute coronary
2020. Institutional review board and medical ethics
syndrome (ACS) cases (1). Re-establishing prompt
committee approved the study and written informed
coronary blood flow and myocardial tissue perfusion as
consent was taken from all participants.
quickly as possible remains the most important
principle underlying early STEMI management (2).
Patients were divided into three groups:
Although primary PCI is the preferred reperfusion method
Group I: including the patients who received
for STEMI, it remains difficult to implement in areas, and
thrombolytic therapy alone.
fibrinolytic therapy is still widely used but rather as part of
Group II: including the patients who had primary
a pharmacoinvasive strategy, with the patients brought to
percutaneous coronary intervention (PCI).
PCI-capable facilities after fibrinolysis, to perform semi-
Group III: (pharmacoinvasive group) including the
urgent coronary angiography (3). Plasma levels of these
patients who received thrombolytic therapy followed by
neurohormones may thus reflect not only existing left
PCI (either as rescue PCI or scheduled PCI).
ventricular systolic dysfunction but in addition be a
sensitive index of abnormal wall stress preceding the
Inclusion criteria: All symptomatic patients presented
process of ventricular remodeling (4).
with acute STEMI with Killip class I or II are eligible
The aim of the present study was to determine which
for inclusion in the study.
strategy is the best method to treat acute ST-segment
Exclusion criteria: Severe valvular disease,
elevation myocardial infarction (STEMI) and if BNP
cardiomyopathy, any form of congenital cardiac
can predict the clinical outcome in acute STEMI treated
disease, and symptoms of chronic heart failure (HF).
by different modalities.
Complete history was taken included age, gender,
special habits of medical importance, and risk factors
PATIENTS AND METHODS
such
as
diabetes
mellitus,
hypertension,
This prospective study enrolled 93 consecutive patients
hypercholesterolemia and smoking. Also, clinical
admitted to Coronary Care Units of Zagazig University
examination such as heart rate and blood pressure &
and Police Authority Hospital with acute ST segment
manifestation of heart failure. Standard 12-lead
2805
Received: 13/1/2022
Accepted: 14/3/2022
c:\work\Jor\vol881_84
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2812-2819
Computed Tomography Imaging in Orbital Complications of
Acute Inflammatory Paranasal Sinuses Diseases
Sherin Wagdy Mohamed*, Ibrahim Abdelaziz Libda,
Hanan Abdelhameed Esmail, and Mahmoud Mohamed Ibrahim Gabal
Department of Radiodiagnosis, Faculty of Medicine Zagazig University, Egypt
*Corresponding author: Sherin Wagdy Mohamed, Mobile: (+20) 01022811789, E-Mail: sherinwagdy91@gmail.com
ABSTRACT
Background: When it comes for identifying paranasal sinus disease (PSD) problems, CT scans are frequently the go-
to imaging modality.
Objective: To diagnose orbital complications of acute inflammatory paranasal sinuses diseases by computed
tomography.
Patients and methods: Thirty patients with orbital complications as pain, edema, and visual acuity disorders were
referred from Ophthalmology Department to Radiology Unit at Zagazig University Hospitals. All patients were included
in this comprehensive sample trial and were subjected to thorough history and clinical evaluation as well as multi
detector CT examinations.
Results: 40% had opacity in maxillary ethmoid bone (erosion), 30% had opacity in Max sphenoid ethmoid, 20% had
opacity in maxillary ethmoid and 10% had maxillary opacity. Majority were invasive fungal (40%), allergic fungal
(30%), acute bacterial with 20% and mucocale (10%). Significant association and agreement between Opacity in Max,
sphenoid ethmoid and allergic fungal also between opacity in maxillary with mucocele and between opacity in maxillary
ethmoid and acute bacterial also between opacity in maxillary ethmoid bone erosion and invasive fungal.
Conclusion: CT has important role in diagnosis of orbital complications resulting from acute inflammatory paranasal
sinuses diseases, as it can detect cause, site of lesion, erosion of bone, and it can give feedback about response to
treatment or need for surgical interference and success rate of surgery. CT could be with contrast or without contrast for
better evaluation of lesion extension and invasion to surrounding structures.
Keywords: Computed tomography, Paranasal sinuses disease.
INTRODUCTION
preferable than ceCT in people who do not require
Anatomical connections explain the association
sedation, especially if the CT scan shows no
between disorders of the paranasal sinuses and those of
abnormalities but the patient continues to experience
the orbit. Because of its proximity to the nose and
symptoms that suggest orbital problems (5).
paranasal sinuses, the orbit is particularly vulnerable to
The aim of the present work was to diagnose
diseases that originate in the surrounding area. To the
orbital complications of acute inflammatory paranasal
superior nasal floor, the medial wall of the ethmoid
sinuses diseases by computed tomography.
sinus, the inferior nasal roof, and to the posteromedial
wall of the sphenoid sinus, the orbital wall was
PATIENTS AND METHODS
associated (1).
Thirty patients with orbital complications (pain,
The walls of the paranasal sinuses make about
edema, and visual acuity) were included in this
60 to 80% of the orbital wall. A mass or an
comprehensive sample trial. They were referred from
inflammation process can easily penetrate these areas
Ophthalmology Department, Zagazig University
since the frontal sinus floor and the lateral wall of the
Hospital to Radiology Department. All cases with
ethmoid sinus walls are both thin (2). Sinonasal and
inclusion criteria were taken in the study. As number of
orbital cavities can be affected by a wide range of
cases did not exceed 5 cases per month, so in the study
illnesses. Sinonasal disease is more likely to influence
period, it will be 30 patients.
the orbit than the other way around (3).
The distinction between self-limiting infection and
Inclusion Criteria: Patients with upper and lower
rhinosinusitis with ocular complications might be
orbital edema, orbital pain, ocular motility defect,
difficult. An orbital cross-sectional imaging study is
opthalmoplegia, as well as visual acuity defects.
required when clinical suspicion exists of an orbital
problem (4).
Exclusion Criteria: Patients with allergic reaction to
Doppler and/or contrast-enhanced imaging should
contrast media, hyperthyroidism, renal insufficiency,
be performed. CT is frequently the imaging modality of
and pregnant or lactating females.
choice for studying the bone sinus architecture because
of this. As a result, CT is widely available as well as
Ethical consent:
rapid and provides high-quality pictures with great
An approval of the study was obtained from
spatial resolution. Sedation is rarely necessary because
Zagazig
University Academic and
Ethical
of the rapidity of the acquisition. The use of ionising
Committee (ZU-IRB#6783). Every patient signed an
radiation is a major drawback of CT. CeMRI may be
informed written consent for acceptance of
2812
Received: 19/01/2022
Accepted: 20/03/2022
c:\work\Jor\vol881_85
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2820-2825
Role of Suction Pipelle in Diagnosis of Endometrial Lesions in
Patients with Perimenopausal Bleeding
Amna Elsayed Ismail Abdel-Mageed1, Yousif Abou-Elwan Elsayed1,
Manal El-Behiery1, Ola Abd Elraouf Ahmed Harb2, Hala Sherif Elsayed1
Departments 1Obstetrics & Gynecology and 2Pathology, Faculty of Medicine - Zagazig,
Faculty of Medicine - Zagazig University
*Corresponding author: Amna Elsayed Ismail Abdel-Mageed, Mobile: (+20 )01064429343,
E-Mail: amna1993ammar@gmail.com
ABSTRACT
Background: Suction pipelle helps for taking endometrial samples for detection of abnormal uterine bleeding.
Objective: To determine if suction pipelle can be used instead of traditional dilatation and curettage (D & C) for
detection of endometrial lesions among perimenopausal bleeding patients.
Subjects and Methods: We conducted our cross-sectional study, at Obstetrics and Gynecology Department, Faculty of
Medicine, Zagazig University Hospitals, and Matrouh Maternity Hospital on sixty patients with abnormal uterine
bleeding (AUB). Two samples were taken from women complaining of perimenopausal bleeding, one by pipelle device
without need to anesthesia and the other by D & C after general anesthesia, then comparing the findings of histological
analysis of both, with D & C, which is the gold standard approach for endometrial sampling.
Results: When it came to detecting secretory and hormone-dependent endometrium, atypical hyperplasia and EEC
grade 1 with both methods, there was a perfect match. Some cases of proliferative endometrium and simple hyperplasia
were correctly diagnosed using the pipelle after D & C failed to do so (20% and 16.6% by pipelle versus 16.6% and
13.3% by D & C respectively). Endometrial polyps and disorganised proliferative hyperplasia were among the
conditions that the pipelle failed to detect, and this is disappointing.
Conclusion: EEC grade 1 and simple endometrial hyperplasia, as well as secretory endometrium, hormone-dependent
endometrium, and simple hyperplasia were all easily diagnosed using pipelle's high sensitivity and specificity.
Endometrial polyp and disorganized endometrial hyperplasia were difficult to detect with this test because of its limited
sensitivity.
Keywords: Suction pipelle, Endometrial lesions, Perimenopausal bleeding.
INTRODUCTION
Endometrial sampling has relied on dilatation and
Among women who see doctors for endometrial
curettage since the 1970s. However, in 60% of cases, it
cancer screening, perimenopausal bleeding is a common
may result in an endometrial curettage that is less than
complication (1). It is possible for a woman to have
50% effective, and there is also a risk of infection and
abnormal uterine bleeding even when she does not have
peroration. Additionally, a trip to the hospital and either
a medical condition, pelvic pathology, or pregnancy.
local or general anesthesia are required (4).
Endometrial stimulation by ovulatory hormones is
In contrast, pipelle is a straightforward outpatient
disrupted, and this is reflected in the irregular cyclic
procedure that does not necessitate hospitalization,
pattern. The bleeding might be heavy or mild, long or
general anaesthesia, or cervical dilation and allows for
short, frequent or sporadic, and it can be frequent or
nearly painless endometrial samples (6).
seldom (2).
It was the goal of this study to determine if suction
Non-gravid women's AUB has been classified by
pipelle can be used instead of traditional D & C for
the International Federation of Gynecology and
detection of endometrial lesions among perimenopausal
Obstetrics
(FIGO)
using
the
PALM-COEIN
bleeding patients.
classification system, which contains nine major
categories: endometrial, leiomyoma, adenomyosis,
SUBJECTS AND METHODS
polyp, hyperplasia, malignancy, ovulatory dysfunction,
At Obstetrics and Gynecology Department, Zagazig
coagulopathy, iatrogenic, as well as others which were
University Hospital and Matrouh Maternity Hospital,
not yet classified (3).
sixty patients with abnormal uterine bleeding were
There are many ways to examine the endometrium
studied in cross-sectional trial.
in women who are experiencing abnormal uterine
bleeding, including ultrasound, D & C, office-based
Ethical consent:
procedures such as hysteroscopy, and samplers such as
An approval of the study was obtained from
the suction pipelle (4).
Zagazig
University Academic
and
Ethical
Because endometrial carcinoma is the most
Committee (ZU-IRB #8071). Every patient signed an
common cause of perimenopause-related uterine
informed written consent for acceptance of
haemorrhage, a biopsy is the best way to rule out the
participation in the study. This work has been
cancer and avoid needless, potentially dangerous, surgery
carried out in accordance with The Code of Ethics of
(5).
the World Medical Association (Declaration of
Helsinki) for studies involving humans.
2820
Received: 20/01/2022
Accepted: 21/03/2022
c:\work\Jor\vol881_86
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2826-2829
Correlation between Radiological and Total Nasal Symptom Severity Score Effect
of Montelukast in Patient with Allergic Rhinitis Associated with
Inferior Turbinate Hypertrophy
Ayat A. Awwad1, Mohamed Fekry Farag2, Said Sharaf Mohammed Mohammed El Sayed3, Fayez
Mohammed Abd Elfattah Elbayoumy4, Mosaad Mohmed Ibrrahim5, Husseini Fathi Husseini
Mohamed El Boraey6
Departments of 1Otorhinolaryngology, 4Anatomy & Embryology, 5Medical Biochemistry, ART Unit,
International Islamic Center for Population Studies & Research, and 6Radiodiagnosis, Faculty of
Medicine, Al-Azhar University, New Damyetta, Egypt
2Department of Medical Physiology, Armed Force Faculty of Medicine, Cairo, Egypt
3Department of Medical Physiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding author: Ayat A. Awwad, Mobile: (+20)1006577631, E-mail: ayatnasr7419@yahoo.com
ABSTRACT
Background: Allergic rhinitis (AR) is immunoglobulin E (IgE)-mediated inflammation of the nasal mucosa on
exposure to allergens. Hypertrophic rhinitis (HR) is a common complication for AR, and often need turbinate surgery.
Montelukast was evidenced to have an effective role in treatment in AR. Objective: The aim of the current work was to
correlate between radiological and total nasal symptom severity score (TNSSS) effect of montelukast in patient with
allergic rhinitis associated with inferior turbinate hypertrophy. Patients and methods: This prospective comparative
case control study included a total of 100 allergic patients suffering from nasal obstruction due to inferior turbinate
hypertrophy (study group) and 100 non-allergic patients (control group), attending at Outpatient Clinics, ENT
Department, Al-Azhar University Hospitals, Egypt. The effect Montelukast was assessed by (TNSSS), radiologically
by (CT) scan. Serum levels of IgE, TGF- and IL13 were measured. Result: Montelukast showed improvement of all
nasal symptoms score with highly significant improvement TNSSS (P=0.003) and significant reduction on inferior
turbinate size (p=0.001) compared to control. In addition to, significant reduction in serum levels of IgE, TGF- and
IL13. Conclusion: Montelukast could be effective alternative treatment for inferior turbinate hypertrophy.
Keywords: Total nasal symptom severity score, Montelukast, Allergic rhinitis, Inferior turbinate hypertrophy.
INTRODUCTION
group), attending at Outpatient Clinics, ENT
Allergic rhinitis (AR) is an immunoglobulin E
Department, Al-Azhar University Hospitals, Egypt.
(IgE)-mediated inflammation of the nasal mucosa that
This study was conducted between April 2015 to March
causes sneezing, nasal congestion, nasal itching, and
2020.
rhinorrhea [1, 2]. Many studies have found a link between
Study Group had received montelukast 10 mg
(AR) and Hypertrophic rhinitis (HR), which is the
for 3 months. They were 40 (40%) male and 60 (60%)
second most common cause of nasal obstruction [3-5].
female. Their age ranged from 23-44 years (mean
Long Hypertrophic rhinitis may be irreversible and need
38±1.29 years). Control group received placebo for the
turbinate surgery [6].
same period, they were 52 (52%) male and 48(48%)
The total nasal symptom severity score
female. Their age ranged from 22-44 years (mean
(TNSSS) is a four-point scale used to assess the severity
35±62.21 years). They were nonallergic patient without
of individual symptoms over the previous 24 hours [7].
inferior turbinate hypertrophy and were chosen from
The scale uses four points (0,1,2,3) for (none, mild,
those admitted for myringoplasty operations.
moderate, severe) and four points (sneezing, nasal
congestion, rhinorrhea, and postnasal drip) respectively.
Exclusion criteria: Patients with sepal deviation,
Cytokines are important mediators, originators, and
history of previous nasal intervention, patients who had
maintainers of allergic inflammation [8].
received montelukast, any corticosteroids or antibiotics
Montelukast is the antagonist cysteinyl-
or having acute upper respiratory tract infection within
leukotriene receptor [7], FDA approved [9] to be
one month preceding the initial study.
effective, safe down to six months of age [10]
bioavailable and oral [11], well tolerated [12] and not
Both study group and control group were subjected to
induced tolerance in long-term studies [13].
pre and post (after 3 months) treatment clinical and
The aim of the current work was to correlate
laboratory assessment by:
between montelukast effects on nasal symptoms in
1. The total nasal symptom severity score (TNSSS)
patient with allergic rhinitis and hypertrophied inferior
and computed tomography (CT) scan. Calculation
turbinate proved by CT scan.
of total nasal symptom severity score (TNSSS) was
done by adding of four nasal symptoms (sneezing,
PATIENTS AND METHODS
nasal congestion, rhinorrhea, and postnasal drip).
This prospective comparative case control study
Patients were evaluated according to the symptom
included a total of 100 allergic patients suffering from
severity score [7]. These symptoms against the 4-
nasal obstruction due to inferior turbinate hypertrophy
point scoring scale after clarification of the scoring
(study group) and 100 non-allergic patients (control
2826
Received: 17/01/2022
Accepted: 16/03/2022
c:\work\Jor\vol881_87
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2830-2837
Combined Albumin-Bilirubin Grade and Platelets (ALBI-PLT) Score and
Albumin-Bilirubin Score (ALBI) as Simple Noninvasive Laboratory
Markers for Prediction of Esophageal Varices in Cirrhotic Patients
Hatem S. Alegaily1, Medhat A. Khalil2, Aida Thabet3, Badawy A. Abdulaziz*1
Departments of 1Hepatology, Gastroenterology and infectious Diseases, 2Internal Medicine and
3Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Badawy A. Abdulaziz, Mobile: (+20)1000940774 E-Mail: badawi.omar@fmed.bu.edu.eg
ABSTRACT
Background: Esophageal varices (OVs) are common side effects of liver cirrhosis that can be life-threatening.
Esophago-gastroduodenoscopy (EGD) is the gold standard for detecting OVs. In spite of this, it is intrusive and
expensive.
Objective: The aim of the current work was to evaluate albumin-Bilirubin Score (ALBI), AST/ALT ratio, aspartate to
platelet count ratio index (APRI), Child-Pugh Score, albumin-bilirubin grade, platelets (ALBI-PLT score) and platelet
count/spleen diameter ratio as noninvasive laboratory markers for prediction of OVs in cirrhotic patients.
Patients and Methods: Two hundred and sixty patients with liver cirrhosis were screened for OVs.
CBC, liver and kidney profiles and abdominal ultrasonography were done, ALBI, ALBI-PLT score, AST/ALT ratio,
APRI, a Child-Pugh Score and platelet count/spleen diameter ratio were measured for all patients. Also, EGDs were
performed by one professional endoscopist for all patients.
Results: ALBI, ALBI-PLT, Platelet count/spleen diameter ratio and Child-Pugh Score were reliable indicators of
esophageal varices. The best one was ALBI-PLT where at cut-off >2, may predict OVs with sensitivity 96.48 and
specificity 87.76 (P< 0.001). Using ALBI at a cutoff >-2.6. may predict OVs with sensitivity of 83.77% and specificity
of 53.26% (P = 0.001). Also, these noninvasive markers could help in detecting OV's size (P <0.001).
Conclusion: It could be concluded that the combined albumin-bilirubin and platelet grade (ALBI-PLT) and the albumin-
bilirubin ratio (ALBI), Platelet count/spleen diameter ratio and Child-Pugh Score could be used as noninvasive markers
for detecting esophageal varices and grading them.
Keywords: Albumin-bilirubin ratio, Combined albumin-bilirubin grade and platelets, Varices, Cirrhosis.
INTRODUCTION
varices (Baveno VI). For "compensated advanced
It is important to know that patients with cirrhosis
chronic liver disease" (cACLD), which is the same as
are at risk for life-threatening bleeding and worsening
the Baveno VI, patients who have normal platelets do
of their illness if they have developed esophageal
not require monitoring endoscopy (>150x109/L) liver
varices (EVs) [1]. Decompensated and compensated
stiffness assessment as well (LSM)[4].
cirrhosis both have 60% and 40% of the population with
In a resource-limited environment, a non-
this condition [2].
invasive and more accessible technique is needed to
Every year, the prevalence of esophageal varices
anticipate the existence and hence the severity of OV.
(EVs) rises by 5%, and the progression rate from minor
This noninvasive, already-available, low-cost method
to large varices is between 5% and 10% [3].
of predicting OV will be valuable in medical settings to
As a result, the first five editions of the Baveno
help prioritize, stratify, and schedule early referrals for
consensus on portal hypertension had advocated
patients who are more likely to develop the condition
frequent upper endoscopies for these patients in order to
for centers with upper endoscopy equipment and
detect those at high risk of bleeding should begin a main
expertise [8].
prevention plan as soon as possible [4].
Noninvasive predictors of EVs are of particular
If you've ever had an extended period of
interest in impoverished countries like Egypt, where
"compensated" disease, you've likely been diagnosed
screening endoscopies are challenging due to the large
with liver cirrhosis thanks to new non-invasive
number of patients with liver cirrhosis [9].
technologies for measuring the severity of liver damage
Using the albumin-bilirubin (ALBI) score, the
[5].
severity of liver malfunction in patients with
At screening endoscopy, less than half of
hepatocellular carcinoma can be assessed more easily
cirrhotic patients have varices, and the majority of them
and objectively [10].
had small varices with a low risk of bleeding [6].
It was discovered that the ALBI score was more
Due to the fact that many cirrhotic patients don't
accurate than the Child-Pugh (CP) and MELD ratings
show up with high-risk varices, conducting endoscopy
for noninvasively predicting the presence of esophageal
is a non-ideal screening technique that costs a lot of
varices and for grading them [11].
money and is unpleasant for the patient [7].
Potentially simple, objective, accurate, and
The Sixth Baveno Consensus on Portal
practically relevant noninvasive methods for screening
Hypertension originally recommended the use of non-
for high-risk varices (HRV) may be provided by the
invasive procedures to rule out the presence of bleeding
ALBI-PLT score [12].
2830
Received: 17/01/2022
Accepted: 16/03/2022
c:\work\Jor\vol881_88
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2838-2844
Relationship of Transcription Factor 7-Like-2 (TCF7L2) Gene Polymorphism
rs12255372 and Glycemic Control in Type 2 Diabetes Mellitus
Somia Abd El-Hamid Bawady1, Nermine Helmy Mahmoud1, Manar Hassan Farouk Alzayet1,
Rania A. Radwan*2, Marwa Ali Abdel-Wahed1
Departments of 1Clinical Pathology and 2Internal Medicine, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Rania Abdel-Moniem Radwan, Mobile: (+20) 01274575988, E-Mail: raniaradwan5@gmail.com
ABSTRACT
Background: Diabetes mellitus is a collection of metabolic illnesses defined by hyperglycemia caused by an insulin
secretion deficiency and/or enhanced insulin cellular resistance. TCF7L2 (Transcription Factor 7-like 2) is a
transcription factor that has been linked to blood glucose control. Objective: Our study aimed to assess the association
of TCF7L2 rs12255372 gene polymorphism with T2DM and to evaluate the impact of TCF7L2 rs12255372
polymorphism on glycemic control in type 2 diabetic patients. Patients and Methods: The study was conducted on
forty-seven (47) diabetic patients who were collected from the out-patient clinic and in-patient of Department of Internal
Medicine and Endocrinology at Ain Shams University Hospitals; in addition, twenty-three (23) age- and sex- matched
healthy subjects taken as healthy control group. Assay of TCF7L2 rs12255372 gene polymorphism was performed by
real-time PCR analysis. Results: The study had showed that there was no significant association between TCF7L2
rs12255372 G>T gene polymorphism and T2DM. However, there was significant association between the concordance
of this polymorphism and higher level of post treatment HbA1c and higher level of serum lipids among patients' group.
Conclusion: TCF7L2 rs12255372 G>T gene polymorphism is associated with poor therapeutic response to oral
antidiabetic agents and occurrence of dyslipidemia.
Keywords: Gene Polymorphism rs12255372, Poor glycaemic control, Real-time PCR, Transcription Factor 7-Like-2
(TCF7L2), Type 2 Diabetes Mellitus.
INTRODUCTION
This study is a case-control study, conducted at
Diabetes mellitus (DM) is a collection of
Clinical Pathology and Internal Medicine Departments,
metabolic illnesses defined by hyperglycemia caused by
Ain Shams University Hospitals, from December 2018
an insulin secretion deficiency and/or enhanced insulin
till December 2019. Subjects included in the study were
cellular resistance (1). Long-term organ damage is
two groups; Group : diabetic patients (n=47): T2DM
caused by the metabolic abnormalities of diabetes and
patients diagnosed according to the American
chronic hyperglycemia, which affect the eyes, kidneys,
Diabetes Association (5) criteria.
neurons, and vascular system. The great majority of
The response to treatment with sulfonylurea
diabetes patients fall into one of two main
was defined by three criteria. Criterion "1" was a
etiopathogenetic groups, with 90% having type 2
decrease of recent HbA1c level (e.g. after 3-months
diabetes mellitus (T2DM) and only 10% having type 1
therapy) to be less than 7%. Criterion "2" was a decrease
diabetes (2).
of 0.5% in the recent HbA1c level (HbA1c 0.5%).
In T2D, the most prevalent type of diabetes,
Criterion "3" was a decrease of 1% in the recent
there is a combination of insulin resistance and an
HbA1c level (HbA1c 1%) (6, 7).
insufficient compensatory insulin secretory response.
Group : Control Group (n=23): age- and
The underlying environmental variables are thought to
sex- matched healthy subjects. Exclusion criteria: type
produce T2DM only in the presence of genetic
1 diabetes mellitus, any other endocrinal disorders,
vulnerability (3). TCF7L2 (Transcription Factor 7-like 2)
chronic kidney or liver disease, alcoholism, and subjects
is a transcription factor that has been linked to blood
taking medications as steroids, beta-blocking drugs, or
glucose control (3).
women taking oral contraceptives.
The TCF7L2 pleomorphic gene, which is found
All subjects enrolled in this study were
on chromosome 10q25.3, encodes the TCF7L2 protein.
subjected to complete history taking, careful clinical
It's a part of the Wnt signaling pathway, which is
examination, laboratory tests including HbA1c, lipid
important for beta-cell proliferation and insulin release.
profile; TC, HDL-C, LDL-C and TG and determination
It affects the manufacture of glucagon-like peptide 1
of TCF7L2 gene polymorphism by real-time
(GLP-1) in intestinal cells, which are critical for blood
quantitative polymerase chain reaction (RT-PCR).
glucose regulation, and it's been suggested that TCF7L2
Analytical Method:
gene variations may influence T2D vulnerability by
Serum lipid profile was assayed by enzymatic
modifying GLP-1 levels indirectly (4).
colorimetric method, glycated hemoglobin (HbA1c)
Our study aimed to assess the association of
was assayed by turbidimetric inhibition immunoassay
TCF7L2 rs12255372 gene polymorphism with T2DM
and both were done using Roche/Hitachi Cobas® c501
and to evaluate the impact of TCF7L2 rs12255372
System (Roche Diagnostics International Ltd.,
polymorphism on glycemic control in type 2 diabetic
Switzerland). DNA was extracted from whole blood by
patients.
using DNA purification mini kit; ThermoFisher®
PATIENTS AND METHODS
(ThermoFisher Scientific, USA) and TaqMan®
2838
Received: 16/01/2022
Accepted: 15/03/2022
c:\work\Jor\vol881_89
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2845-2851
Assessment of Immune Response to Pneumococcal Conjugate Vaccine in
Hemodialysis Children after One Year
Mayy Abd-Alfattah Neemat-Allah1, Jawdah Abduljalil Abd Alraheem Azqeer*1,
Usama Mahmoud AlKholy1, Mai Mahmoud Sami Ibrahim2
Departments of 1Pediatrics and 2 Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Jawdah Abduljalil Abd Alraheem, Mobile: (+20)1120718259, Email: jouda024@gmail.com
ABSTRACT
Background: Pediatric patients with impaired immune systems, including those with chronic renal failure, should
receive pneumococcal vaccinations which have a great role in prevention of chest infections.
Objective: The aim of the current work was to evaluate immune response for Pneumococcal Conjugate Vaccine 13
(PCV13) in Hemodialysis (HD) children after 3 months 1 year and 2 years of vaccination.
Patients and methods: Thirty-six children and adolescent on regular HD were included in this trial. All patients were
not previously vaccinated by PCV13. We had determined pneumococcal immunoglobulin (IgG) antibodies 3 months, 1
year and 2 years after vaccination by PCV13. This study was carried out in Dialysis Nephrology Unit at Zagazig
University Hospital of Children.
Results: As regard frequency of chest infection after PCV13, there was a statistically significant decrease in frequency
for patients who developed chest infections after PCV vaccinations from 75% to 16.7%. Chest infections and antibody
titers were statistically linked at three months, one year, and two years. The best cutoff of serum antibody titer at 2
years0.03825 for prediction of absence of infection with area under curve 0.917, sensitivity 90%, specificity 83.3%,
positive predictive value 96.4% and negative predictive value 62.5% and accuracy 91.7% (p<0.05).
Conclusion: It is possible for patients with end-stage renal disease (ESRD) and dialysis to produce enough antibodies
against the PCV13 vaccine to reduce their risk of developing chest infections. Adequate protective concentration of
antibody post PCV13 which is higher than 0.35ug/ml was maintained for most of cases at 1 year.
Keywords: Pneumococcal Conjugate Vaccine, Hemodialysis.
INTRODUCTION
PPSV23 and PCV13 vaccines differ greatly in
Bacterial Streptococcus pneumoniae infection is
their construction. Capsular polysaccharide antigens are
the cause of pneumonia, bacterial hemorrhage,
included in PPSV23. T-cell-independent antibodies are
meningitis as well as otitis media (1).
elicited
in
response
to
certain
antigens.
Pneumococcal infection is more common in
Immunoglobulins produced increase phagocytic cell
people who are on dialysis because of advanced renal
activity
and
cause
pneumococcus
death.
impairment (2).
Polysaccharides from the capsular polysaccharides are
Dialysis patients are 10 to 16 times more likely
conjugated with a protein carrier to form PCV13.
to die of pneumonia than the general population.
Adding the protein to PCV13 activates a T-cell-
Pneumococcal strains that are resistant to numerous
dependent immunological response, which results in the
antibiotics
have
exacerbated
this
problem.
creation of antibodies and the possibility for immune
Pneumococcal illness has become a major concern for
memory (9, 10).
this population of individuals because of this (3).
Dialysis patients have a compromised immune
Pneumococcal infection can be prevented with
system, which raises the risk of serious infections. In
two vaccinations (4). One vaccination is required.
dialysis patients, pneumococcal illness is prevalent,
Because children under the age of 2 are more
with S. pneumonia accounting for more than half of all
susceptible to a variety of serious diseases, including
reported cases of pneumonia (11). For patients with
pneumonia, bacterial meningitis, and bacterial
chronic kidney disease, the risk of pneumococcal
meningitis, the pneumococcal conjugate vaccination
infection is higher for those who do not establish a
(PCV13) is essential. In some cases, older children may
sufficient immune response to PPSV23 (12).
additionally require PCV13 treatment (5).
Antigen presentation, T-cell-mediated immune
The second vaccine is now available for use.
response, and immunological memory are all impaired
Children two years of age and older should be
in patients with ESRD, which has a negative impact on
vaccinated with the pneumococcal polysaccharide
their overall health (11, 13). As a result, vaccination hypo
vaccine (PPSV23). Pneumococcal disease is prevented
responsiveness is a real possibility for these people.
with this vaccine (6, 7).
According to research, patients on dialysis have a lower
Strict guidelines have been put in place for
immune response to PPSV23 than healthy individuals.
people with chronic renal illness to receive a
Furthermore, within one year of immunization with
pneumococcal
immunization.
Vaccination
and
PPSV23, patients with end-stage renal disease (ESRD)
revaccination, on the other hand, have varying effects,
show a rapid reduction in anti-pneumococcal IgG levels
and the appropriateness of vaccination is up for debate
(14).
(8).
This study's purpose was to evaluate immune
2845
Received: 17/01/2022
Accepted: 16/03/2022
c:\work\Jor\vol881_90
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2852-2855
General Insight about Male Infertility: Review Article
Abdulrhman Belgasem Alhusayn*, Ahmed Ragab Ali,
Mohamed Mahmoud Seleem, Mahmoud Mohamed Malek
Department of Urology and Andrology, Faculty of Medicine Zagazig University. Egypt
*Corresponding author: Abdulrhman Belgasem Alhusayn, Mobile: (+20)01027265172, E-mail: abdoobell91@gmail.com
ABSTRACT
Background: Failure to get pregnant after 12 months of unprotected sexual intercourse is described as infertility.
Infertility affects 15 percent of the world's population, and in 50 percent of cases, a male component, such as poor sperm
quality, is involved. Male infertility is now a mystery, with many theories as to what causes it. Semen analysis
abnormality is usually invariably a sign of male infertility, but other male variables may still play a role even if the
semen analysis is normal. Infertility in males can be caused by varicocele, genital infections, endocrine disruptors,
genetic and immunological and systemic illnesses as well as environmental causes.
Objective: To discuss overview of male infertility causes, risk factors, diagnosis with special care of semen analysis.
Methods: PubMed, Google scholar and Science direct were searched using the following keywords: Male Infertility,
Semen analysis and Risk factors of infertility. The authors also screened references from the relevant literature, including
all the identified studies and reviews, only the most recent or complete study was included between May 2012 and July
2021. Documents in a language apart from English have been excluded as sources for interpretation was not found.
Papers apart from main scientific studies had been excluded: documents unavailable as total written text, conversation,
conference abstract papers and dissertations.
Conclusion: Male infertility accounts for over 20% of all causes of infertility in couples, and semen analysis is the only
test that can reliably diagnose 9 out of 10 men who have a real issue with male infertility, with a sensitivity of 89.6%.
Keywords: Male Infertility, Risk factors of infertility, Semen analysis.
INTRODUCTION
undergo an adequate male evaluation. In the absence of
One year of unprotected intercourse can result
a specific treatment, assisted reproductive procedures
in infertility in approximately 15% of couples. One-
such as sperm retrieval from the testicles or epididymis
third to one-half of all infertile couples have a male
and intracytoplasmic sperm injection may still be an
component to blame, and another third to one-half have
option. Adoption or therapeutic donor insemination are
a contributing factor[1].
other options for such couples. Finally, male infertility
Semen analysis abnormality is usually
may be a symptom of a more serious medical condition
invariably a sign of male infertility, but other male
that has to be addressed. There can be grave
variables may still play a role even if the semen analysis
implications if cancer of the testicles or pituitary tumors
is normal. Several conditions can cause male infertility.
are not identified, including death in rare cases. Men
Some of these diseases, such as ductal blockage and
who are unable to conceive naturally should have their
hypogonadotropic hypogonadism, are recognized and
fertility evaluated to determine whether there are any
reversible. Other disorders, such as viral orchitis-
issues that may be corrected or whether there are any
induced bilateral testicular atrophy, are detectable but
conditions that cannot be corrected and for which donor
not curable. Idiopathic conditions are those in which the
insemination or adoption may be a possibility. Genetic
cause of an abnormal semen analysis cannot be
problems if assisted reproductive techniques are used,
determined, as is the situation with many cases. It's
which may influence the health of the offspring if the
called 'unexplained infertility' when a normal semen
infertility is life- or health-threatening [3].
analysis and a partner examination don't reveal the
The aim of the review of article was to discuss
cause of infertility. Fertility-essential sperm can be
overview of male infertility causes, risk factors,
found in patients with normal semen analysis. In order
diagnosis with special care of semen analysis.
to determine these conditions, the male examination is
necessary[2].
Causes and risk factors of infertility:
Men's fertility can be improved and conception
estimates that 50% of male infertility cases are the result
can be achieved through sexual activity if reversible
of an unknown cause. Non-genetic and genetic factors
problems are found and treated. It's possible that
are the most common causes of male infertility. Among
azoospermic patients may still be capable of producing
the non-genetic factors that affect fertility, previous
their own eggs. Finding disorders that don't respond to
exposure to disease is one of the most important. Men
therapy will spare couples the agony of trying
with diabetes are at an increased risk of sperm nuclear
unsuccessful treatments [2].
and mtDNA damage, which may affect their ability to
Couples can be alerted to the possibility of
become pregnant. For optimal testicular function, an
passing down health-related genetic defects to future
ambient temperature of 2°C to 4°C below body
generations if certain hereditary reasons of male
temperature is required. For the next six months, a fever
infertility can be identified. As a result, the couple may
of 38°C or above can disrupt spermatogenesis [4].
benefit from receiving genetic counselling if they
Other:
2852
Received: 18/01/2022
Accepted: 17/03/2022
c:\work\Jor\vol881_91
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2856-2860
Study on The Relationship between Thyroid Function and Frailty in Elderly
Nany Hasan El Gayar1; Mohamed Ahmed Mehana1; Rasha Mohamed Zaki1 ; Abeer Shawky El-Hadedy2
Departments of 1Geriatrics and 2Clinical and chemical pathology,
Faculty of Medicine, Alexandria University, Alexandria, Egypt.
Corresponding Author:Nany Hasan El Gayar,mobile:00201006528544,
E-mail address: dr_nany_hasan@yahoo.com
ABSTRACT
Background: Frailty arises from the "physiologic triad" of sarcopenia, immune and neuroendocrine dysregulation. With
aging, serum levels of thyroid hormones show marked changes.
Objectives: To study the circulating thyroid hormones (TSH, FT3, and FT4) and determine the relationship between
circulating thyroid hormones and frailty in the Elderly.
Methods: This cross-sectional observational descriptive study included 50 subjects who were attending the outpatient
geriatric clinic and geriatric unit at Alexandria Main University Hospital and were divided into; group A: 30 frail
subjects aged 65 years (case group) and group B: 20 healthy subjects aged <65 years (control group) during the period
from March till October 2019. Frailty assessment was done using Frail Questionnaire as well as thyroid function tests
(TSH, FT3, and FT4) and other routine laboratory investigations. Anthropometric measurements were taken, including
weight, height, and BMI (body mass index).
Results: No statistically significant variation between the studied candidates as regards gender (p=0.729), BMI
(p=0.144), or TSH levels (p=0.401) but T3 and T4 were significantly lower in group A. with noting of weak non-
significance positive results parallel between age and TSH levels (r=0.150, p=0.298), high significant moderate negative
correspondence in-between age and serum FT3 levels (r=-0.530, p<0.001) and non-significant weak negative correlation
between age and FT4(r=-0.246, p=0.085). TSH levels in group A were: (3.3%) low, (66.7%) normal, (30%) high. Level
of FT3 was: (46.7%) low, and (53.3%) normal while FT4 level was: (26.7%) low, (66.7%) normal and (6.7%) high.
Conclusion: Aging and frailty are associated with changes in thyroid functions in the form of significantly decreased
hormonal levels including FT3 and FT4, with a non-significant change in TSH levels.
Keywords: Elderly, Frailty, Thyroid function.
INTRODUCTION
included in this study were recruited after obtaining
Frailty is a common syndrome of the elderly with
informed consent.
a high-risk decrease in general health and different body
Thorough history taking, and complete general and
functions [1].
local thyroid examination were performed for all subjects.
The concentration of triiodothyronine (T3) in the
Laboratory investigations were done for all the
blood decreases as people become older. [2].
subjects including:
More than the two-fold increased risk for frailty in
a. Routine laboratory examination (complete
the elderly with high TSH levels suggests that the loss
blood count, blood urea, serum creatinine, liver
of thyroid function is associated with frailty. FT3, but
enzymes including ALT and AST).
not FT4, was significantly correlated with frailty [3].
b. Thyroid function (TSH, FT3, and FT4).
Lower values of FT3 lead to greater severity of
comorbidity and disability [4].
Venous blood samples were taken using normal
The purpose of the research was to look at the
aseptic techniques and transferred to gel separator
blood levels of thyroid gland hormones (TSH, FT3,
tubes. All samples were analyzed the same day they
FT4) and see whether there was a link between thyroid
were collected. The study eliminated samples that were
hormone levels and frailty in the elderly.
extensively haemolyzed.
Thyroid-stimulating hormone was measured by
METHODS
using The TSH EIA test. Free tri-iodothyronine (fT3)
This cross-sectional observational descriptive
was
measured
using
Competitive
Enzyme
study included 50 subjects divided into two groups;
Immunoassay Analog. Free thyroxine (fT4) was
group A included 30 elderly subjects aged 65 years
measured using the Standard strategy.
living with frailty (cases group) attending the outpatient
Anthropometric measures including the weight per
geriatric clinic and geriatric unit at at Alexandria Main
Kg, the height per Cm, and body mass index (BMI)
University Hospital throughout the dated time from
were considered for all candidates for the research and
March 2019 till October 2019 and group B included 20
frailty assessment by using FRAIL Questionnaire. The
healthy subjects <65 years (control group).
FRAIL scale includes 5 components; Fatigue,
The exclusion criteria included; thyroid
Resistance, Ambulation, Illness, and Loss of weight.
dysfunction, patients on steroid therapy, presence of
Frail scale scores range from 05 (i.e., 1 point for each
metabolic diseases, and muscle diseases. All individuals
component; 0=best to 5=worst) and represent frail (3
5), pre-frail (12), and robust (0) health status (14).
2856
Received: 17/01/2022
Accepted: 16/03/2022
c:\work\Jor\vol881_92
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2861-2870
Magnesium Sulphate, Lidocaine or Nitroglycerin for
Controlled Hypotension and Quality of the Surgical Field in
Patients Undergoing Tympanoplasty
Ahmed Yousry Nour Eldeen*, Zaki Taha Saleh, Hala Abd Elsadek Elattar, Reham Mohamed Aamer
Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Yousry Nour Eldeen, Mobile: (+2)0101067913203, Email: ahmedyousryanesth@gmail.com
ABSTRACT
Background: Intraoperative bleeding impairs surgical field visibility during tympanoplasty; several methods have been
used to decrease blood loss and improve the quality of the surgical field, one of them is usage of hypotensive anesthetic
agents.
Objective: This study aimed to compare the effect of magnesium sulphate, lidocaine or nitroglycerin for controlled
hypotension on hemodynamics, quality of the surgical field and blood loss in patients undergoing tympanoplasty.
Patients and methods: A prospective double blind randomized clinical study included 45 patients of both genders,
ASA I&II undergoing tympanoplasty were allocated into Three groups ( 15 patients each ) group (M) received
magnesium sulphate by giving loading dose 40 mg/kg then the maintenance dose 15 mg/kg/hr, group (L) received
lidocaine by giving an infusion dose of 2 mg/kg/hr and group (N) received nitroglycerin by giving an infusion dose of
5-10 g/kg/min. For each group ( mean arterial blood pressure "MABP", heart rate "HR", quality of the surgical field,
total IV fluids given, total blood loss, intraoperative complications, duration of the surgery and the extubation time)
were recorded.
Results: The studied doses of the drugs achieved the target mean arterial pressure (5065 mmHg) with superior
hemodynamic stability in the lidocaine group. Group L showed a statistically significant decrease in blood loss (p<0.05)
, a statistically significant better quality of the surgical field (p<0.05) and a statistically significant less complications
(p<0.05) compared to the other studied groups.
Conclusion: It was showed that using any of these three drugs can be effective for controlled hypotension in patients
undergoing tympanoplasty but lidocaine has the priority for the achieving stablility of the hemodynamics, the best
quality of the surgical field and the least blood loss.
Keywords: Tympanoplasty, controlled hypotention, magnesium sulphate, lidocaine, nitroglycerin.
INTRODUCTION
combining with hydrogen ions. The resulting cation
Bleeding is a common complication during surgery,
binds reversibly to sodium channels from the inside,
particularly in the paranasal sinuses, middle ear cavity,
locking them in the open state and preventing nerve
and spine. It is preferable to control the bleeding rather
depolarization interacting with hydrogen ions. From the
than to expose the patient to the hazards of blood
inside, the resultant cation binds reversibly to sodium
transfusion (1). Controlled hypotension, in which arterial
channels, locking them open and preventing nerve
blood pressure is decreased reliably during surgery, is
depolarization (10).
becoming more popular (2).
Nitroglycerine is a directly acting vasodilator and it
Ideally, a hypotensive medication should be simple
is used to produce controlled hypotension because it is
to use, have a fast start, have effects that fade quickly
easily treatable and having very rapid onset as well as
when treatment is stopped, be rapidly eliminated without
rapid offset of action. However the disadvantages of
hazardous metabolites, have little effects on essential
nitroglycerine are reflex tachycardia and venous
organs, and have predictable and dose-dependent effects
congestion leading to increased blood loss (11).
(3,4).
Nitroglycerin converts to nitric oxide (NO) in the body.
Magnesium sulphate was historically used to cause
NO then activates the enzyme guanylyl cyclase, which
hypotension on purpose (5). Magnesium works as a
converts guanosine triphosphate (GTP) to guanosine
hypotensive by reducing calcium outflow from the
3',5'-monophosphate (cGMP) in vascular smooth muscle
sarcoplasmic reticulum and as a vasodilator by
and other tissues. cGMP then activates many protein
enhancing prostacyclin production and lowering
kinase-dependent phosphorylations, ultimately resulting
angiotensin converting enzyme activity (6).
in the dephosphorylation of myosin light chains within
Lidocaine is one of the most commonly used amide
smooth muscle fibers. This activity causes the relaxation
anesthetics. It can be safely given systemically to treat
of smooth muscle within blood vessels, resulting in the
ventricular arrhythmias (7) and blunt the pressor response
desired vasodilatory effect (12).
of endotracheal intubation (8). Hypotension has been
Therefore, this study aimed to compare the effect of
observed to occur after submucosal injection of lidocaine
magnesium sulphate, lidocaine and nitroglycerin for
(9). The site of action of lidocaine is at sodium ion
controlled hypotension on hemodynamics, quality of the
channels on the internal surface of nerve cell
field and amount of blood loss in patients undergoing
membranes. The uncharged form diffuses through neural
unilateral tympanoplasty.
sheaths into the axoplasm before it then ionizes by
2861
Received: 20/1/2022
Accepted: 21/3/2022
c:\work\Jor\vol881_93
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2871-2877
Assessment of Outcomes of Closed Reduction and Percutaneous
Fixation of Lisfranc's Injuries of The Foot
Abduraouf Mosbah Ramadan El-Ajnaf*, Mohammed Othman Mohammed,
Ashraf Abd Eldayem Mohamed and Sami Ibrahim Sadek Ali
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Abduraouf Mosbah Ramadan El-Ajnaf, Mobile: (+20)01095342010, Email: lajnaf.raouf3@gmail.com
ABSTRACT
Background: An early surgical intervention for metatarsal joint injuries (Lisfranc injury) is essential to prevent or treat
any foot compartmental syndrome that is the most common outcomes.
Objective: to manage outcomes of percutaneous fixation with closed reduction in managing foot Lisfranc's injuries.
Patients and Methods: At Orthopedic Departments, Zagazig University Hospital, 18 patients with displaced Lisfranc
injury were studied in prospective research. Closed reduction and percutaneous fixation of the Lisfranc injuries by k-wires
or screw were done to all patients. All patients were periodically monitored clinically and radiographically for a week,
then every 2, 4, 6, and 12 weeks after the index procedure.
Results: Favorable outcome were majority with 88.9% (16 cases) (11 patients excellent and 5 good) and unfavorable
11.1% (2 patients) (1 fair and 1 poor). The current study estimated the complication as overall with 4 cases and we found
superficial infection in 22.2%, stiffness in only one case (5.6%) and delayed union in 1 case also no case of compartment
syndrome of foot in our series.
Conclusion: Lisfranc injuries treated with k-wire or screw percutaneous reduction and fixation could be treated efficiently,
quickly and simply surgically with predictable and dependable consequences without routine removal of hardware.
Keywords: Lisfranc's injuries, Percutaneous fixation, Closed reduction.
INTRODUCTION
displaced Lisfranc injuries, cast immobilization for six to
A Lisfranc injury is one in which one or more of
12 weeks is the norm (3). 1) Anteroposterior x-ray widening
the foot's metatarsals are displaced from the tarsus. It was
of the space between the 1st and 2nd metatarsals by > 4
a French surgeon and gynaecologist of the Napoleonic era
mm is an indication for surgical therapy. 2)
in 1815 who first described the injury and described an
Tarsometatarsal incongruence of more than 2 mm in
amputation at that level. This name is ascribed to him (1).
length. 3) Bony pieces trapped within the joint. 2nd
Injuries to the Lisfranc joint account for 0.2% to 0.8% of
Metatarsal Bone Fragment (M.T.B). The so-called
all fractures. An'mortise' between the midfoot and forefoot
"complex dislocation" occurs when soft tissue (e.g., the
creates the base of the 2nd metatarsal, which helps to keep
tibialis anterior tendon) is trapped in a joint (5).
it in place at the ankle joint. When it comes to supporting
Several factors affect Lisfranc injury treatment, but
the tarsal joint, interosseous ligament (Lisfranc's ligament)
the most critical is how severe the soft tissue damage was
is the most significant structure. It encompasses from the
to begin with. surgical recovery period after an injury. A
medial cuneiform to the base of the second metatarsal.
third aspect is the level of precision in the reduction process
Joint stability depends heavily on this ligament and the
(6).
inter cuneiforms interosseous ligament. If one of these
Preventing and/or treating foot compartmental
ligaments is damaged, instability between the medial and
syndrome, the most common and most dreaded
middle columns will result. Because there is no ligament
consequence, requires surgical intervention as soon as
between the first and second metatarsals, the third, fourth,
possible (7). Treatment options include open reduction,
and fifth metatarsals are connected by inter-metatarsal and
temporary screw fixation, and primary arthrodesis in cases
thin dorsomedial ligaments (2).
of severe fracture dislocations as well as closed reduction
This injury is caused by both low- and high-energy
and percutaneous pinning (8). It was the goal of this study
sources, such as a sports injury or a motor vehicle accident.
to manage outcomes of percutaneous fixation with closed
Medially or laterally directed rotational forces or a direct
reduction in managing foot Lisfranc's injuries.
impact to the joint are two common ways in which injuries
occur (3). Dislocations of the Lisfranc fracture have been
PATIENTS AND METHODS
categorised in a variety of ways. Myerson et al. (4)
At Orthopedic Departments, Zagazig University
modifications of the Hardcastle classification is the most
hospital. 18 patients with displaced Lisfranc injury were
commonly used classification. Incongruity can be
studied in prospective research. Closed reduction and
classified into three categories.: full incongruity refers to
percutaneous fixation of the Lisfranc injuries by k-wires or
type A, partial incongruity is referred to as type B (B1
screw were done to all patients.
medial column and B2), and diverging injury in which the
1st digit is pushed medially and the mid- and side-columns
Ethical consent:
are moved laterally is classified as type C.
Research Ethics Council at Zagazig University
Restrictions on movement and stability of the
approved the study (ZU-IRB #8061) as long as all
midfoot are part of conservative treatment. For non-
participants provided informed consent forms. Ethics
2871
Received: 20/1/2022
Accepted: 21/3/2022
c:\work\Jor\vol881_94
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2878-2882
Uterine Packing with Gauze Versus Bakri Balloon for Arresting
Atonic Postpartum Hemorrhage after Cesarean Delivery
Elsayed Elshamy*¹,², Wael Gaber¹, and Abd-Elhamid Shaheen¹
¹Department of Obstetrics and Gynecology, Menoufia University Hospital, Menoufia, Egypt.
2Department of Obstetrics and Gynecology, Rabia Hospital, Riyadh, Saudi Arabia.
*Corresponding author: Elsayed Elshamy, Mobile: (+2)0100307124, E-mail: s_shamy77@ yahoo.com
ABSTRACT
Background: There is no adequately sufficient evidence to determine the effectiveness and safety of mechanical and
surgical interventions for treating primary postpartum hemorrhage (PPH).
Objective: To assess the safety, efficacy and acceptability of uterine packing with gauze compared to Bakri balloon
tamponade for treatment of atonic PPH after cesarean section.
Patients and Methods: A prospective observational study. A total of 176 patients with atonic PPH after cesarean section
were treated either with uterine packing with gauze (n=84) or Bakri balloon tamponade (n=92). The success rate together
with early and late complications were recorded and statistically analyzed.
Results: 90.4 percent of individuals with uterine packing were able to cease their active bleeding compared to 75 percent
of those with the Bakri balloons (p<0.05). The uterine packing group's surgery took longer time, and the Bakri Balloon
group's requirement for further vascular ligation was much higher, indicating a significant difference in procedure
duration and need for further intervention (p<0.05). There were no significant differences in other operational and
postoperative statistics between the two groups of patients. Uterine packing patients were more likely to be accepted by
the patients (p<0.05), more satisfied with the surgery (p<0.001), and more likely to recommend it to others (p<0.001).
Conclusion: Although uterine packing with gauze may require longer time to insert with similar safety to Bakri balloon,
yet it is more effective and more acceptable, less costly and readily available.
Keywords: Bakri balloon, Cesarean section, Postpartum hemorrhage, Uterine packing.
INTRODUCTION
After vaginal delivery and more after caesarean
PATIENTS AND METHODS
delivery, women are likely to experience primary
During this investigation, we observed
postpartum hemorrhage (PPH), which is defined as a
individuals who had atonic PPH following caesarean
loss of 500 milliliters (1000 milliliters in CS) or more
delivery and who were unable to respond to uterotonic
of blood, with uterine atony accounting for more than
medications and bimanual compression of the uterus.
eighty percent of all cases [1,2].
Between September 2018 and September 2021,
Atonic PPH treatment hinges on a timely
research participants were selected from the operating
diagnosis, reasonable assessment of blood loss, and
room of the Department of Obstetrics and Gynecology
immediate therapies. PPH treatment includes uterine
at Rabia Hospital in Riyadh, Saudi Arabia.
compression, uterotonic medications, and surgical
treatments, as well as maternal resuscitation. If all else
Ethical considerations:
fails, a hysterectomy and/or vascular ligation (of the
With written informed permission from all
uterus, ovaries, or internal iliac vessels) will be the final
participants signed before the start of the trial, the
option [3].
hospital's (Rabia Hospital in Riyadh, Saudi Arabia)
According to a recent Cochrane study, mechanical
Institutional Review Board and Ethics Committee
and surgical procedures to treat primary PPH are
formally reviewed the study protocol in compliance
insufficiently supported by data [4]. When compared to
with the 1964 Helsinki declarations as well as all
less expensive, readily available devices like condom
their modifications.
catheter balloons, the success rate and cost-
effectiveness of the Bakri balloon have recently been
Based on a recent trial to assess the efficacy of
questioned [5-7]. Also, uterine packing with gauze has
Bakri Balloon, 45 cases are required in each single
been proved recently as effective as Bakri balloon for
group to detect significant difference in the success rate
arresting PPH after cesarean section for placenta previa
compared to control group [9].
[8].
After excluding cases caused by soft birth canal
We aimed to compare uterine packing with gauze
injury, uterine deformity, and placenta previa/accreta,
and Bakri balloon tamponade for the treatment of atonic
176 individuals with primary PPH were included in this
postpartum hemorrhage (PPH) following caesarean
study (Figure 1).
section in terms of safety, effectiveness, and
acceptability.
2878
Received: 19/01/2022
Accepted: 20/03/2022
c:\work\Jor\vol881_95
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2883-2890
Prevalence and Antibiotic Resistance Profiles of Carbapenem-Resistant
Klebsiella Pneumoniae Isolated from Tertiary Care Hospital, Egypt
Aya A. Al-Baz*1, Aref Maarouf2, Ayman Marei1, Alshimaa L. Abdallah1
Departments of 1Medical Microbiology and Immunology and
2 Urology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aya Adel Al-Baz, Mobile: (+20)01003235562; E-mail: aya.a.baz@gmail.com
ABSTRACT
Background: Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) dissemination is a major healthcare problem due
to its limited treatment options.
Objective: This study aimed to determine the prevalence and antimicrobial resistance profile of hospital infections
caused by CR-Kp in Al-Ahrar Teaching Hospital. The study was conducted through the period from January 1, 2021 to
December 31, 2021.
Patients and Methods: 650 clinical samples were collected from different ICU departments. Klebsiella pneumoniae
isolates were identified by conventional methods. Susceptibility to carbapenems and other antibiotics was determined
by disk diffusion method.
Results: Out of 650 clinical specimens, 142 K. pneumoniae were isolated with an isolation rate of 21.8%. K. pneumoniae
showed that the majority (60.6%) of isolates were extensively-drug resistant (XDR), while 30.3% were multidrug
resistant (MDR) and only 9.2% were susceptible. By disk diffusion method, the incidence of CR-Kp was 25.4%
(36/142). Antibiotic susceptibility test showed that 100% of CR-Kp isolates were resistant to Amoxicillin/Clavulanic
acid, Ampicillin/Sulbactam, Pipracillin/Tazobactam, cefepime, ceftriaxone, cefotaxime, cefoxitin, ceftazidime and
nitrofurantoin. High rate of resistance was also evident to aztreonam, norfloxacin (88.9%, for each) and amikacin
(61.1%). Levofloxacin owned the lowest resistance rate (30.6%), followed by ciprofloxacin (44.4%) and gentamycin
(47.2%). Antibiotic resistance pattern of isolated CR-Kp showed that the majority of the isolates (97.2%) were XDR,
while only 2.8% were MDR.
Conclusion: About quarter of K. pneumoniae isolates were carbapenem-resistant with predominance of XDR isolates
which represents a warning sign for which application of antibiotic stewardship is mandatory as well as strict infection
control policies for prevention of development of pan-drug resistant bacteria.
Keywords: Klebsiella pneumoniae, Carbapenem resistance, Multidrug resistance, Extensively-drug resistant, Hospital
acquired infection.
INTRODUCTION
PATIENTS AND METHODS
After Streptococcus pneumoniae (22.5%) and
This cross-sectional study was carried out over
Pseudomonas aeruginosa, Klebsiella pneumoniae has
one year at the Medical Microbiology and Immunology
been recognised as the third main cause of Hospital
Department, Faculty of Medicine, Zagazig University
Acquired Infections (HAIs) in Egypt (16.7%t) (21.5%)
in collaboration with ICU Departments in Al-Ahrar
respectively. In immunocompromised people, K.
Teaching Hospital.
pneumoniae causes dangerous infections such as
Inclusion criteria: Patients showing clinical criteria of
pneumonia, urinary tract infections, and bloodstream
nosocomial infections that developed at least 48-72
infections (1).
hours after admission including ventilator association
Carbapenems are antibiotics with a broad
pneumonia (VAP), urinary tract infection (UTI),
spectrum of activity against Gram-negative and Gram-
surgical site infection (SSI), septicemia and chest
positive bacteria. They are administered as a last resort
infection.
to infected individuals who are critically unwell or are
Exclusion criteria: Patients with community acquired
suspected of possessing germs that are resistant to
infection, patients had positive cultures for more than
antibiotics (2). Resistance to carbapenems in K.
two bacterial species, or patients who were receiving
pneumoniae is primarily due to the production of
antibiotic treatment were excluded.
carbapenemase enzymes or, in rare cases, to the
Demographic data (age, sex, etc.) and clinical
production of extended-spectrum -lactamase (ESL)
data (cause of admission, devices, antibiotic
and/or AmpC cephalosporinases combined with
administration) were collected from all patients.
decreased permeability of the outer membrane due to
Medical
history
of
comorbidities;
diabetes,
loss or mutations in porins (3). Rapid diagnosis of
hypertension, renal insufficiency, etc. and length of
carbapenem-resistant Enterobacterales is critical for
hospitalization were reported for each patient.
infection management, patient treatment success, and
carbapenem effectiveness maintenance (4). Hence, this
Microbiological work up:
study was conducted to determine the prevalence and
antimicrobial resistance profile of carbapenem resistant
Clinical samples collection: 650 non-duplicate
K. pneumoniae isolates.
clinical samples were aseptically collected from
2883
Received: 23/1/2022
Accepted: 22/3/2022
c:\work\Jor\vol881_96
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2891-2896
The Results of Fragment-Specific Fixation for Treatment of
Intra-Articular Distal Radius Fractures
Mohammed Raafat Khalil*, Abdelsalam Eid Abdelsalam,
Mohamed Mansour Elzohairy, Ahmed Mashhour Gaber
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohammed Raafat Khalil, Mobile: (+20) 01149814356, Email: drraafatkhalil90@gmail.com
ABSTRACT
Background: Distal radius and ulna fractures are the most common fracture in adults representing 44% of all fractures.
Fragment-specific fixation can be a useful tool in treating distal radius fractures.
Objective: The aim of the present study was to evaluate the results of treating intra-articular distal radius fractures with
fragment-specific fixation to provide good functional outcome.
Patients and methods: This prospective study included 36 patients with distal radial fractures. They were admitted and
operated in the Casualty Unit of the Orthopedic Department, Zagazig University Hospitals. The average time of follow
up period of the cases was 9 months. Results: Age was distributed as 39.5 ± 9.17 years, male were 61.1% and dominant
right were in 88.9%. Mayo score distribution at different time among studied group was significant increase from 6
weeks to 3 months and to 6 months. There was significant increase in range of motion distribution from 6 weeks & 3
months to 6 months. There was significant increase in grip strength distribution from 6 weeks & 3 months to 6 months.
Overall complicated cases were 6 cases. Complicated cases were significantly associated with longer union time and
significant delayed return to work. Conclusion: Fragment-specific fixation is a valuable technique for intra articular
distal radius fractures in well planned and selected patients. As it achieves a high rate of union and good functional
outcome on follow up and it allows excellent grip strength and range of motion of wrist joint.
Keywords: Distal radius fractures, AO classification, Fragment-specific fixation.
INTRODUCTION
University Hospitals. According to the AO
One-sixth of all fractures seen and treated in
classification of distal radius fractures, 18 patients had
Emergency Departments are distal radial fractures. This
type B fractures, 14 patients had C1 fractures, and 4
injury is most likely to occur in children and the elderly
patients had type C2. The follow up period of the cases
(1). A simple fall in the elderly with weak bones can
ranged from 6 to 12 months with average of 9 months.
result in a distal radius fracture, as can high-energy
Inclusion criteria: Patients with less than 1 month old
trauma in young individuals. The AO categorization
injury fractures, Age 18 and 60 years old. Type B,
system is one of the classification systems used for
C1, C2 fractures according to AO classification.
prognostic management and prediction. All fractures
Exclusion criteria: Patients with pathological fractures
should be treated with the objective of restoring wrist
due to tumors or secondaries. Age > 60 and <18 years
function and minimising discomfort as much as possible
old, neurovascular injury and type A fractures according
(2). There are various alternatives for fixing comminuted
to AO classification.
distal radial fractures to achieve this aim as quickly as
feasible, including K-wire pinning, volar fixed angle
Pre-operative evaluation:
locking plate, enhanced external fixators, and fragment-
1- History: Careful history taking were done for all
specific fixations. Each approach has benefits and
patients with special care was given to the mode of
drawbacks, but there is no consensus on which is the
trauma, time of trauma, hand dominance,
best (3). The fragment-specific approach uses metal pins
occupation, any previous surgery especially
and plates that are shaped to exactly fit the normal
involving the wrist and history of chronic medical
contour of the distal radius (4). The fragment-specific
illness.
implants, despite their small size, are engineered to
2- Clinical examination: Careful examination was
endure the stresses of instant wrist motion and are meant
done to detect any associated injuries, abrasions and
to be employed as part of a post-surgery early wrist
deformity of the affected wrist. Assessment of
mobility program (5).
peripheral arterial pulsation at the affected
This study aims to assess the clinical, radiological
extremity. Detection of any possible insult to radial
and functional outcome of treating intra-articular distal
arteries. Whenever the patient's condition permitted,
radius fracture with fragment-specific fixation, and
a complete neurological examination was performed
whether it is a safe, sufficient and beneficial method of
to assess any median nerve injury with special
fixation for this particular type of fractures.
attention to the axillary nerve. In our study the motor
testing was usually not possible at this stage because
PATIENTS AND METHODS
of pain.
This prospective study was conducted during the
3- Radiological evaluation: Each patient underwent
period from 2018 to 2021. Thirty-six patients with distal
wrist trauma series, which included antero-posterior
radial fractures were admitted and operated in the
(AP),
and
lateral
radiographs.
Computed
Casualty Unit of the Orthopedic Department, Zagazig
tomography (CT) was indicated.
2891
Received: 23/1/2022
Accepted: 22/3/2022
c:\work\Jor\vol881_97
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2897-2903
Alopecia Areata: An Overview of the Disease and its Genetic Basis: Review Article
Raghda Atef Abd Elshafy*1, Naglaa Ali Khalifa2, Rasha Mohamed Besher3,
Howyda Mohamed Ebrahim1, Mahmoud Yousry M. Abdel Mawla1
Departments of 1Dermatology, Venereology, and Andrology and
2Clinical Pathology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
Department of 3Dermatology, Al-Ahrar Teaching Hospital, Sharkia, Egypt
*Corresponding author: Raghda Atef Abd Elshafy, Mobile: (+20)01145449382, Email: raghdaatef333@gmail.com
ABSTRACT
Background: Alopecia areata (AA) is a frequent, reversible kind of hair loss. It is commonly seen as patchy regions of
full hair loss on the scalp and other body parts that might lead to complete loss of all body hair. The condition is
characterized by localized inflammatory lesions with perifollicular T-cell infiltrates, demonstrating the importance of
local cytokine generation in the formation of patchy hair loss. IL-1 is a major inhibitor of hair development in vitro.
Its impact is blocked by the interleukin-1 receptor antagonist, IL-1ra.
Objective: To review the epidemiology, clinical characteristics, pathogenesis, and associated genetic factors and the
emerging therapeutics for AA in this review article. Greater knowledge of the disease pathophysiology may contribute
to establishing novel medicines that are more targeted and effective against AA.
Methodology: The databases were searched for articles published in English in 3 databases [PubMed Google scholar
science direct] and Boolean operators (AND, OR, NOT) had been used such as [Alopecia Areata AND Genetic
Polymorphisms OR Overview] and in peer-reviewed articles between January 2001 and May 2022.
Conclusion: Comprehensive understanding of the genetic basis of AA may mediate an efficient therapeutic approach
for managing and treating this life quality affecting condition.
Keywords: Alopecia Areata; Genetic; Polymorphisms.
INTRODUCTION
follicular pathophysiology of AA, making the genes
Alopecia areata is characterized by patchy hair
encoding those cytokines potential genes for AA. At
loss and T-cell infiltration at the perifollicular and
least 2 agonist compounds, IL-1 and IL-1, plus a
intrafollicular levels. The relationship between AA and
structurally similar receptor antagonist molecule, IL-
autoimmunity,
particularly
thyroid
problems,
1ra, make up the IL-1 system. IL-1ra is a strong anti-
pernicious anemia, and vitiligo, is well-established, and
inflammatory chemical because it binds to the type 1 IL-
AA is often considered an autoimmune illness [1].
1 receptor but does not transduce a signal [5].
A family history of AA affects up to 40% of those
Variations of IL1RN are related to the intensity of
who suffer from the condition. It has been established
various inflammatory /autoimmune disorders. Previous
that the illness has a hereditary component [2]. HLA
research established a link between the unique IL1RN
Class I alleles A28, B12, B13, B18, and B27, have been
VNTR allele and Alopecia Universalis, the most severe
linked to alopecia areata; however, HLA Class II alleles
type of AA [7]. Using additional markers inside the
DR4, DR11, DPw4, DQw3, DQw7, and DQw8 are
IL1RN gene and the novel IL1RN analog, IL1L1, a
regarded more significant. People with severe illness
recent study demonstrated a high connection between
and an early start had a higher relative risk of disease
AA severity and the IL1RN gene [4].
for HLA DR5 (RR=3.14, P 0.01), and the significance
of HLA genes was verified in the sole family
Etiopathogenesis:
investigation to date [3]. Nevertheless, HLA by itself
Etiopathogenesis of alopecia is unknown. Alopecia
could not describe the complete genetic foundation of
areata is a symptom and a disease caused by various,
AA, and evidence would suggest the existence of an
very complex etiological factors in persons with
additional alopecia areata locus on chromosome 21 [4].
positive individual and family history. The etiology of
As demonstrated for systemic lupus erythematosus
AA is T-cell-mediated autoimmunity, which mostly
(SLE), interaction among HLA and other loci is likely
affects genetically susceptible individuals. In addition
necessary for the illness phenotype.
to disturbances in immune function, illness progression
As an important pro-inflammatory mediator,
is triggered by complex interactions among
Interleukin-1 (IL-1) is a key cytokine in recruiting
predisposing genetic and environmental variables. Also
inflammatory cells such as T-lymphocytes, neutrophils,
speculated are perifollicular nerves and vasculature,
and macrophages to inflamed tissues [5]. Additionally
viruses, trace element changes, endocrine problems, and
known to suppress hair development in-vitro are IL-1,
thyroid dysfunction. There are speculations that an
IL-1, and TNF- [6]. These 3 cytokines have comparable
imbalance of trace elements might precipitate the
effects on the morphology of cultured explant hair
beginning of AA [8].
follicles, leading to a dystrophic anagen pattern defined
by condensing of the dermal papilla and disruption and
Genetic factors:
aberrant keratinization of the pericortical cells of the
There is substantial evidence that the
hair matrices. These characteristics resemble the
pathophysiology of AA has a genetic foundation.
2897
Received: 23/1/2022
Accepted: 22/3/2022
c:\work\Jor\vol881_98
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2904-2909
Evaluation of Anatomical Characteristics of Cesarean Scar Niche by
Sonohysterography and Diagnostic Hysteroscopy in Women with
Secondary Infertility
Usama Helmy Almarzuki*, Taha Abdel Fattah Ahmed,
Tarek Mohamed AlBehedy, Hussein Mohamed Abdel Dayem
Obstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Usama H. Almarzuki, Mobile: (+20) 01060445668, Email: usama.helmy777@gmail.com
ABSTRACT
Background: Cesarean section complications are becoming more common as cesarean scar defects.
Objective: This study aimed to evaluate the anatomical characteristics of cesarean scar niche by diagnostic hysteroscopy
and sonohysterography in women with unexplained secondary infertility.
Patients and methods: This observational cross-sectional study included 100 women who attended our outpatient
clinic, complaining of unexplained secondary infertility with a history of at least one CS and showing scar niche in
office hysteroscopy followed by re-assessment by saline infusion sonohysterography with the evaluation of scar depth,
width, and shape in both methods.
Results: The present work revealed that 45 cases had unhealthy (fibrotic) scars, 41 cases had collected blood in the
niche, 24 cases had infected scars, 5 cases had endometritis, and 4 cases had a small submucosal polyp, as well as one
case, had a small uterine septum. There were 32 cases with post-menstrual spotting, the mean duration of post-menstrual
spotting was 2.5 days (±0.9 SD), 19 cases had chronic pelvic pain, 15 cases had both post-menstrual spotting and chronic
pelvic pain, 12 cases had dyspareunia. There were 25, 31, and 44 cases that had 2ry infertility 1, 2, and 3 years
respectively. There was a non-significant correlation between features of the niche through diagnostic hysteroscopy and
correlated symptoms.
Conclusion: Cesarean scar may play an intermediate role in fertility. Hysteroscopy is considered the golden standard
tool for the diagnosis of different intrauterine lesions, however; the procedure of sonohysterography is well-tolerated,
cost-effective, and can be performed in an office-based gynecological practice, and doesn't require special training.
Keywords: Hysteroscopy, Secondary infertility, Cesarean Scar Niche.
INTRODUCTION
which anechoic contrast media is instilled into the
Cesarean section (CS) rates have risen from 6.7
uterine cavity to improve the transvaginal US of the
to 19.1 percent worldwide in recent decades, with a
uterus. As a result, SIS brings together the benefits of
current European CS rate of 25 percent of all deliveries
both US and hysterosalpingography (5). The
(1). In Egypt, the incidence of CS has increased
advancement of SIS in recent years has aided in the
dramatically over the last decade, with the most recent
evaluation of the uterine cavity: the thickness of the
Egypt Demographic and Health Survey (EDHS)
remaining myometrium, the thickness of myometrium
reporting a CS rate of 52 percent, implying that cesarean
surrounding the scar, the depth of the filling defect in
birth may be overused or utilized for unsuitable reasons
the scar (niche), and intrauterine adhesions connected to
(2).
the scar may all be assessed (6).
A scar defect, niche, isthmocele, uterine pouch,
In addition to being a safe, minimally invasive
or diverticula are some of the terms used to describe the
method, office hysteroscopy (OH) "gold standard" for
abnormality revealed by ultrasonography following a
the diagnosis of intrauterine abnormalities; has been
cesarean section. A niche is linked to a variety of
proved to be a sensitive instrument for direct viewing of
symptoms, including abnormal uterine bleeding (AUB),
uterine scar and intrauterine adhesions (7). The evolution
which
includes
extended
menstruation
and
of patient evaluation methods, particularly the vaginal
postmenstrual spotting in 30% of women with a niche
speculum approach, which eliminates the need for a
(3). In the literature, uterine disease, intra-abdominal
vaginal speculum to view the cervix or cervical
adhesions, and women's reproductive decisions have all
instrumentation to grasp and steady the cervix, reducing
been postulated as reasons for subfertility following
patient pain and increasing operator experience, has
Caesarean section. Not all niches induce symptoms, and
been instrumental in expanding the use of Office
the link between subfertility and a niche in the uterine
Hysteroscopy with all of its benefits (8).
scar requires more research because the direct proof is
currently missing (4).
Therefore, this study aimed to evaluate the
Ultrasound is a non-invasive way to examine the
anatomical characteristics of the cesarean scar niche by
uterus and any scars that may be present. While
diagnostic hysteroscopy and sonohysterography in
ultrasonography (US) is quite useful in assessing the
women with unexplained secondary infertility and to
scars of a pregnant uterus, its use in assessing the scars
correlate the appearance of the scar with its related
of a non-pregnant uterus is limited. Saline infusion
symptoms.
sonohysterography (SIS) is a type of examination in
2904
Received: 23/01/2022
Accepted: 22/03/2022
c:\work\Jor\vol881_99
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2910-2916
Anatomical Repair Versus Intra Peritoneal Mesh Repair of Umbilical and
Paraumbilical Hernia in Ascitic Patients: Randomized Controlled Study
Abdel-Rahman Albahy1, Mohamed Elsaid1, Ahmed Negm1, Abdel-Rahman Mokhtar2,
AbdelAzim ElGansh1, Mohamed Shetewy1
Departments of 1General Surgery and 2Hepatology and Gastroentrology,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Abdel-Rahman Albahy, Mobile: (+20) 01003637555, Email: abdobahy@mans.edu.eg
ABSTRACT
Background: Umbilical hernia occurs in 20% of the patients with liver cirrhosis complicated with ascites, having a
tendency to enlarge rapidly and to complicate. The treatment of umbilical hernia in these patients is a surgical challenge.
Ascites control is the mainstay to reduce hernia recurrence and postoperative complications, mesh repair is associated
with lower recurrence rate, but with higher surgical site infection when compared to conventional fascial suture.
Intraperitoneal mesh repair has advantages of avoiding recurrence, decreasing ascetic leak and wound infection.
Objective: The purpose of this study was to compare the safety and effectiveness of surgical management of umbilical
and paraumbilical hernia via anatomical repair and intraperitoneal mesh repair in relation to conservative treatment in
ascetic patients.
Patients and methods: This randomized controlled study included 94 patients presented with umbilical and
paraumbilical hernia with ascites. The study was conducted in Mansoura University Hospitals through the period from
2016 to 2018. The patients were divided randomly into 3 groups; Conservative treatment group (28 cases), anatomical
repair group (36 cases) and intraperitoneal mesh repair via composite mesh group (30 cases). Comparison was done for
effectiveness and complications.
Results: Conservative treatment had high rate of complications (60%) and deterioration of hepatic condition (18%),
elective surgical correction appeared more safe, intraperitoneal composite mesh repair decreased leak and significantly
reduced recurrence and associated complications compared to anatomical repair (17% versus 3%).
Conclusion: Both elective anatomical repair and intraperitoneal mesh repair of umbilical and paraumbilical hernia in
ascetic patients were safer and better than conservative treatment. Intraperitoneal mesh repair has advantages of avoiding
recurrence and decreasing ascetic leak.
Keywords: Anatomical repair, Intra peritoneal mesh repair, Umbilical and paraumbilical hernia, Ascitic patients.
INTRODUCTION
strangulation, ascetic fluid leakage and spontaneous
Ascites is a common problem because Egypt has
rupture with subsequent hernia repair in an emergency
the highest prevalence of hepatitis C virus (HCV). A
setting and therefore is not preferred (5). Ruptured
recently published survey in 2015 showed that 10% of
umbilical hernia in ascetic patients with umbilical
Egyptians between 15 59 years of age had been
hernia primarily complicated with peritonitis.
infected with HCV, while 7% are chronic active
Staphylococcus aureus was the predominant organism
hepatitis C patients (1). Patients with liver cirrhosis
cultured from ascetic fluid, occurring in 46% of the
complicated with ascites have a risk of 20% of
patients with peritonitis (6). Anatomical repair of
developing an umbilical hernia in the course of their
umbilical hernia in cirrhotic patients may cause
disease (2). The factors that contribute to the
expressive morbidity, such as wound infection and
development of umbilical hernia in these patients are
dehiscence, ascetic drainage through the incision,
variable such as increased intra-abdominal pressure
peritonitis, liver failure, and hernia recurrence (7).
from the ascites , weakness of the abdominal fascia and
Prosthetic mesh reinforcement of abdominal wall
muscle wasting as a result of hypoalbuminemia and the
hernias gained acceptance as a result of its easy
dilated umbilical vein enlarging the pre-existent supra
placement and a lower incidence of hernia recurrence
umbilical fascial opening in patients with portal
(8). There has been reluctance to use synthetic mesh for
hypertension (3).
the repair of hernia in ascetic patients for fear of seroma,
Anesthesia in chronic liver disease is a scary and
hematoma, and deterioration of general condition,
pretty challenging condition for every anesthesiologist
wound dehiscence, infection, and mesh removal (9).
that could be diminished by meticulous attention on
The use of composite mesh provides good quality
optimizing the patient's condition preoperatively and
prosthesis. The mesh is well tolerated and integrated,
choosing appropriate anesthetic regimen and drugs in
because it does not allow the formation of adhesions or
this setting. Careful monitoring and considering the
bacterial infection. By intraperitoneal placing, the
proper anesthetic rules achieve a safe anesthesia in these
wound is protected against ascetic leak and
patients (4).
postoperative complications (dehiscence, infections and
Non-operative management of umbilical hernia in
relapse) (10). However, mesh is a foreign substance,
patients with liver cirrhosis and ascites leads to a higher
which may increase the risk of repair-related
risk of complications such as bowel incarceration or
complications, including hematoma, seroma, foreign
2910
Received: 27/1/2022
Accepted: 28/3/2022
c:\work\Jor\vol881_100
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2917-2922
Relationship between Monocyte to High Density Lipoprotein
Cholesterol Ratio and Coronary Artery Tortuosity
Tarek Ahmed Naguib, El Sayed Mohamad Farag, Mohammad Abd Allah El Tahlawi, Ahmed Fathy Shawky
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Ahmed Fathy Shawky, Mobile: (+20)01004474020, Email: shawky_82@hotmail.com
ABSTRACT
Background: Coronary artery tortuosity (CorT) is a prevalent angiographic finding commonly associated with aging,
hypertension, atherosclerosis and other cardiovascular conditions. It has been suggested that coronary artery tortuosity
causes alteration in blood flow and reduction in coronary artery pressure distal to the tortuous segment and can thus lead
to ischemia.
Objective: This study aimed to find the relationship between monocytes to high density lipoprotein cholesterol ratio
(MHR) and isolated coronary artery tortuosity (CorT) without obstructive coronary artery disease (CAD). Patients and
Methods: This study is an observational retrospective case control study that was performed in National Heart Institute
and Zagazig University Hospital between January 2018 and January 2020 for patients with stable coronary artery disease
that underwent coronary angiography. In this study 60 patients with chronic stable angina were enrolled, 30 patients
showed Cor-T without obstructive CAD (cases) on coronary angiography, while the other 30 patients showed normal
coronaries (Control).
Results: The most two predictable factors for the detection of Cor-T are MHR and C-reactive protein (CRP). In Cor-T
group there was a significant positive correlation between the number of tortuous vessels and the MHR with P-value
<0.001, the more number of tortuous vessels the higher MHR.
Conclusions: The relationships between the noninvasive laboratory index MHR and coronary artery tortuosity is
significant. These findings consider MHR as an accurate, quantitative, non-invasive, highly available and non-expensive
parameter for the prediction and detection of Cor-T and may be useful for risk stratification.
Keywords: Coronary artery disease, Coronary artery tortuosity, MHR, Monocyte to High Density Lipoprotein
Cholesterol ratio.
INTRODUCTION
and rupture of atherosclerotic plaques and prepare better
Coronary artery disease (CAD) is the leading
conditions for developing acute coronary syndrome(4).
cause of both morbidity and mortality worldwide. It
It has been shown that high monocyte count and
encompasses a wide clinical spectrum ranging from
low HDL-C levels may be relevant to inflammation(5)
silent ischemia to sudden death(1).
and oxidative stress(6), and it has been reported that the
Arterial tortuosity is characterized by multiple
MHR is a new prognostic marker in several CVDs (7).
elongations in arteries, especially coronary arteries. It is
In the present study, we aimed to find the
usually detected during angiography. Few studies have
relationship between monocytes to high density
evaluated this phenomenon and its etiology, signs, and
lipoprotein cholesterol ratio (MHR) and isolated
complications have not yet been fully understood. Some
coronary artery tortuosity (CorT) without obstructive
studies have shown that coronary artery tortuosity
coronary artery disease.
(CorT) without coronary artery obstruction or
atherosclerosis may cause angina pectoris during
PATIENTS AND METHODS
activity or exercise test(2).
This study is a retrospective observational case
Coronary artery tortuosity (CorT) is a prevalent
control study that was performed in National Heart
angiographic finding commonly associated with aging,
Institute and Zagazig University Hospital between
hypertension, atherosclerosis and other conditions.
January 2018 and January 2020 for patients with stable
Preliminary evidence suggests that degradation of
coronary artery disease that underwent coronary
elastin, a key component of extracellular matrix in the
angiography. The study included 60 patients and they
vascular wall, may be responsible for the development
were divided into two groups; the case group consisted
of CorT. The clinical significance of CorT should be
of 30 persons who had tortuous coronaries without
considered in several aspects(3).
obstructive CAD and the control group consisted of 30
Therefore, it has been suggested that coronary
persons who had normal coronaries.
artery tortuosity causes alteration in blood flow and
reduction in coronary artery pressure distal to the
Inclusion criteria:
tortuous segment and can thus lead to ischemia. Severe
Patients with chronic stable angina with evidence
tortuosity in coronary arteries facilitates atherosclerosis.
of myocardial ischemia in the form of treadmill
As a result, atherosclerosis is more common in patients
electrocardiogram, dobutamine stress echo or nuclear
with coronary artery tortuosity(2). Hemodynamic shear
perfusion stress imaging.
stress in tortuous arteries may enhance the formation
2917
Received: 24/1/2022
Accepted: 23/3/2022
c:\work\Jor\vol881_101
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2923-2929
Reno Protective Effect of Sodium Glucose Cotransporter-2 Inhibitor
(Dapagliflozin) in Type 2 Diabetic Patients
Rasha O. Abdelmoniem, Marwa S. Shaalan*, M. Shawky, Walaa M. Ibrahim,, Ayman M. Elbadawy
Department of Internal Medicine, Faculty of Medicine, Benha University, Egypt
*Corresponding Author: Marwa S. Shaalan, Mobile: (+20)01024443875, E-Mail: marwa88shalaan@gmail.com.
ABSTRACT
Background: Many studies reported a renal protection by sodium glucose cotransporter-2 inhibitor (SGLT2i) using in
Type 2 diabetes mellitus (T2DM). Objective: Our study was designed to evaluate the renal benefit offered by SGLT2
inhibitor (dapagliflozin) in type 2 diabetic patients. Patients and Methods: 100 diabetic patients, 50 treated by
dapagliflozin 10 mg once daily for 12 months and 50 treated by placebo for the same period. Patients were recruited
from those attending Endocrinology Unit in Benha University Hospital. Clinical and laboratory data were performed to
patients who were followed up every 3 months for 1 year. Results: No significant difference among the two groups
regarding age, sex, residence, and the common adverse effects. Urinary albumin/creatinine ratio was statistically lower
in SGLT2i group compared to placebo group at the end of the study but was non-significant at base line. Estimated
glomerular filtration rate (eGFR) was statistically higher in SGLT2i group compared to placebo group at the end of the
study although there was non-significant difference at base line. No significant difference between the two groups
regarding HbA1c at base line, 3 and 6 months later but was statistically lower in SGLT2i group after 9 months and 1
year. BMI, SBP and DBP were statistically lower in SGLT2i group at the end of the study but there was non-significant
difference at base line. Conclusion: We found reno protective properties by using sodium glucose cotransporter-2
inhibitor (dapagliflozin) in type 2 diabetic patients, a great impact on glycemic control and other pleiotropic effects
without significant differences regarding common adverse effects.
Keywords: Renal protection, SGLT2i, T2DM.
INTRODUCTION
reactive oxygen species (ROS) generation and RAGE-
Diabetic kidney disease is the leading cause of
AGEs induction in tubular cells. In addition, SGLT2
kidney failure worldwide. In the USA, it accounts for
inhibitor has been shown to reduce high glucose-induced
over 50% of individuals entering dialysis or transplant
inflammatory and fibrotic markers in HK2 cells as
programmes. Unlike other complications of diabetes, the
shown by the decreased expressions of toll-like receptor-
prevalence of diabetic kidney disease has failed to
4 (TLR4), type IV collagen, interleukin-6 secretion and
decline over the past 30 years. Hyperglycemia is the
nuclear factor kappa B (NF-kB) (4). Correspondingly, the
primary etiological factor responsible for the
inhibition of high glucose-induced ROS generation in
development of diabetic kidney disease. Once
proximal tubular epithelial cells by SGLT2 inhibitor led
hyperglycemia
becomes
established,
multiple
to decreases of MCP-1 mRNA, and DNA fragments (5).
pathophysiological
disturbances,
including
These findings indicated that SGLT2 inhibitor might
hypertension, altered tubuloglomerular feedback, renal
prevent proximal tubular damage associated with
hypoxia, lipotoxicity, podocyte injury, inflammation,
glucotoxicity. SGLT2 inhibitor could also ameliorate
mitochondrial dysfunction, impaired autophagy and
high glucose-induced oxidative stress and inflammation
increased activity of the sodiumhydrogen exchange,
in kidney (6).
which contribute to progressive glomerular sclerosis and
Dapagliflozin is reversible, extremely particular and
the decline in glomerular filtration rate. The quantitative
active when taken orally and a competitive human
contribution of each of these abnormalities to the
SGLT2 inhibitor approved by the European Union. In
progression of diabetic kidney disease, as well as their
the structure, an aglycone group enables it to compete
role in type 1 and type 2 diabetes mellitus, remains to be
for the glucose binding site and blocks the reabsorption
determined (1).SGLT2 protein is a symporter involved in
of glucose. This increases the elimination of glucose,
the cotransport of glucose and sodium in the proximal
enhanced glycemic regulation and loss of weight. The
convoluted tubule (PCT) of a nephron. The SGLT2
activity of drug is determined by blood glucose control
protein mediates the active transport of glucose through
and hepatic function of the patient. The advantages of
the luminal membrane against a concentration gradient
this drug include reduced risk of hypoglycemia and a
along with sodium (2). Therefore, pharmacological
drop in blood pressure. Dapagliflozin can be taken alone
inhibition of SGLT2 promotes renal glucose excretion,
or along with other drugs including metformin,
thereby lowering plasma glucose levels without
sulfonylurea, DPP-4 inhibitors, or insulin (7).
affecting hypoglycemia, because the inhibition of
The aim of the present study was to evaluate the renal
SGLT2 could trigger alpha cell to secrete glucagon to
benefit offered by SGLT2 inhibitor (dapagliflozin) in
circulation, thereby increasing the hepatic glucose
type 2 diabetic patients.
production, which in turn maintain the blood glucose
level (3).
PATIENTS AND METHODS
The inhibition of glucose accumulation in tubular
This is prospective study of 100 diabetic patients, 50
cells by SGLT2i significantly decreased high-induced
treated by dapagliflozin in a dose of 10 mg once daily
2923
Received: 25/01/2022
Accepted: 24/03/2022
c:\work\Jor\vol881_102
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2930-2935
Outcomes of Two Surgical Techniques for Mid-Shaft Clavicle Fractures Fixation
Husayn Jamal Ahseen Abraydah*, Adel Mohammed Salama,
Mohamed AbdAlla M. Abdelsalam, Ahmed Hatem Farhan Imam
*Corresponding author: Husayn Jamal Ahseen Abraydah, Mobile: (+20) 01096041560, E-Mail: hossaunjamal@gmail.com
ABSTRACT
Background: Fractures of the clavicle account for 44% of injuries around the shoulder girdle, several techniques of
fixation have been described in literature, including the use of plates, Kirschner wires, Steinman pins, external fixators
and even plaster constructs.
Objective: The purpose of this prospective cohort study was to compare the outcomes of intra-medullary fixation and
plating in the treatment of mid-shaft clavicle fractures.
Patients and Methods: In this study, 24 patients ranging in age from 18 to 60 were enrolled. They were split into two
groups and given intra-medullary nailing or plating as their treatment options. Comparison of the two groups' outcomes
and complications was done.
Results: The nail group's union time was markedly reduced. In terms of the functional outcome, as measured by the
Quick DASH Score, there was no significant difference between groups. A higher rate of infection and nonunion was
found in those who used plates, although there was no statistically significant difference between the groups. The nail
group had much more skin irritation (hardware prominence) than the control group. When compared to the plate group,
patient dissatisfaction was much higher due to scar development.
Conclusion: It is possible to employ intra-medullary fixation in the treatment of mid-shaft clavicle fractures as a viable
alternative to plate fixation since it is a minimally invasive procedure with fewer risks, faster healing, and better
cosmetic and functional outcomes.
Keywords: Intra-medullary nailing, Mid-shaft clavicle fracture, Plating.
INTRODUCTION
has its drawbacks, including infection, non-union, and
In the past few years, the incidence of clavicle
poor cosmetic results due to the scarring of the big
fractures has risen from an annual average of 24 per
incisions(8).
100,000 to 71 per 100,000 people(1, 2). The most
However, intramedullary fixation is another
common type of clavicle fracture is the mid-shaft
surgical option for mid-shaft clavicle fracture
clavicular fracture, which accounts for between 69 and
stabilization, and a variety of devices, such as smooth
82% of all clavicle fractures (3,4).
K-wires, Hagie pins, Knowles pins, Rockwood clavicle
Rehabilitation focuses on getting the shoulder
pins, and titanium elastic nails, have been utilised for
back to its pre-injury state as quickly as possible. With
intramedullary clavicle fixation over the years, with the
minor deformation of the clavicle, there will be less
last option being the most widely used alternative
pain and less loss of motion(3). Even when the fractures
today(8).
were clearly displaced, non-operative therapy for mid-
Intra-medullary fixation (IMF) prefers a
shaft clavicle fractures was the norm, with satisfactory
minimally invasive method since it requires just a short
to excellent results. New research demonstrates that
incision and no periosteal stripping, which reduces the
non-operative treatment of middle shaft clavicle
risk of small scars, infection as well as nonunion (8).
fractures,
especially
those
with
substantial
However, it comes with its own set of drawbacks,
displacement or shortening, may result in greater rates
including the requirement for radiological intervention,
of non-union and delayed union as well as pain and
which entails radiation exposure, iatrogenic damage to
weakness in the shoulder after the fractures have
neurovascular systems, and the possibility of implant
healed(5).
migration, all of which necessitate removal of the
Intramedullary or plate-and-screw open
implant (9).
reduction and internal fixation (ORIF) surgery are both
The purpose of this prospective cohort study
options for surgical therapy(6). Patients who require
was to compare the outcomes of intra-medullary
traditional surgical intervention usually have one of the
fixation and plating in the treatment of mid-shaft
following: open fractures, skin damage, neurovascular
clavicle fractures.
problems, fractures that are badly comminuted and
dislocated, painful non- or malunion, or an additional
PATIENTS AND METHODS
scapular neck fracture (floating shoulder)(7).
At The Zagazig University Hospital, we
The most common surgical treatment for a mid-
conducted a prospective cohort study of 24 individuals.
shaft clavicle fracture is open reduction and plating
All of the patients were eligible because they met the
mid-shaft clavicle fractures (MCF). It is employed
study's inclusion and exclusion criteria.
because of its capacity to restore and maintain the
clavicle's length and structure. However, the procedure
Inclusion criteria: Mid-shaft dislocation of the
clavicle, with no cortical contact between the major
2930
Received: 24/1/2022
Accepted: 23/3/2022
c:\work\Jor\vol881_103
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2936-2941
Incidence of Hyperammonemia among High-Risk Infants Admitted to
Pediatric Intensive Care Unit
Mohamed Mamdouh Gaafar, Ali Ahmed Mohammed*, Wesam A. Mokhtar
Pediatrics Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ali Ahmed Mohammed, Mobile: (+20)01235867601, Email: aaliali198619861986@gmail.com
ABSTRACT
Introduction: Severe liver failure and inborn metabolic abnormalities produce hyperammonemia in children. Because
of the pre-analytical challenges that must be properly controlled, achieving valid plasma ammonia levels in acute
instances might be difficult.
Objective: The aim of the present study was to estimate the prevalence of plasma ammonia levels among high risk
infants admitted to pediatric intensive care unit (PICU).
Patients and Methods: A cross-sectional study was carried out at NICU in Pediatric Department at Zagazig University
Children Hospital. This study involved 60 neonates and children who were subjected to full medical history, thorough
clinical examination and laboratory investigations. Frequency of suspected and confirmed inborn errors of metabolism
(IEMs) cases was assessed.
Results: The mean age was 2.15±1.89 years and weight was 8.95±6.56, 50.0% were male, regarding mode of delivery
in 66.7% was cesarean section (CS). 48.3% had consanguinity. The main complaints for patients were respiratory
distress (51.7%), convulsion (33.3%) and encephalopathy (10%) and the hyperammonemia was detected in 25% of the
studied group. The hyperammonemia was detected in 66.7% of the confirmed IEM cases. About 16 cases (26.7%) of
the studied group, unfortunately, died while 73.3% survived.
Conclusion: Hyperammonemia represented a one of the main significant cause of sick infants' admission to PICU.
Hyperammonemia must be rapidly suspected in case of neurologic symptoms in pediatrics. An adequate management
should start rapidly as coma duration and ammonia peak level.
Keywords: Hyperammonemia, Inborn Errors of Metabolism, Pediatric Intensive Care Unit.
INTRODUCTION
edema, 2) lowering ammonia production by reducing
Inborn errors of metabolism (IEMs) are a
protein intake and reversing catabolism, and 3)
phenotypically and genetically diverse group of
removing ammonia with pharmacologic treatment and,
metabolic illnesses caused by malfunctioning enzymes,
in the most severe instances, extracorporeal therapies.
cofactors, and transporters, which result in the
In situations of severe coma, transcranial Doppler
accumulation of toxic substrates, the production of by-
ultrasonography can be used to noninvasively monitor
products, and reduced product levels, resulting in a
cerebral blood flow and titrate treatment(5).
variety of clinical manifestations (1). Clinical indicators
This study aimed to early detection of plasma
include acute metabolic crisis, convulsions, metabolic
ammonia level among high risk infants admitted to
acidosis, severe low blood sugar, high blood ammonia,
pediatric intensive care unit (PICU), Zagazig University
and diverse organ damage. Some of these are treatable,
Children Hospital in order to provide early treatment of
but if not treated in a timely manner, they can result in
treatable and transient disorders associated with IEM
irreparable physical disability, mental retardation, and
(Inborn Errors of Metabolism).
even death (2).
Hyperammonemia is a life-threatening condition
PATIENTS AND METHODS
that can result in brain damage and edema(3). A
This cross-sectional prospective study was
plasmatic level more than 80 mol/L in babies under one
conducted during the period from December 2019 to
month of age and greater than 55 mol/L in older children
January 2020. It included 60 cases admitted to Pediatric
is considered hyperammonemia (4).
Intensive Care Unit (PICU) aged from 28 days to 14
Ammonia is produced when proteins are broken
years. This study was conducted at Pediatric
down during amino acid metabolism, and 90% of it
Department, Faculty of Medicine, at Zagazig
enters the urea cycle and is transformed to urea. The
University.
glutamine synthase enzyme is found in the brain,
kidneys, and skeletal muscle and is responsible for the
Inclusion criteria:
elimination of ammonia, which is either excreted in
Children from 28 days to 14 years of age, of both
urine or utilised by the stomach for energy synthesis.
gender. Lethargy, poor feeding, frequent vomiting,
Ammonia accumulates and is shunted to the systemic
intractable seizures, rapid deep breathing, and
circulation when removal is inhibited or production is
unexplained neurological indications in a previously
increased, resulting in brain buildup and eventual
healthy infant were all hallmarks of IEM. Unusual
dysfunction (2).
developmental
delays,
repeated
unexplained
Hyperammonemia is treated by 1) identifying
encephalopathy, skin and hair changes, or ocular
precipitating events and the existence of cerebral
abnormalities in children.
2936
Received: 24/01/2022
Accepted: 23/03/2022
c:\work\Jor\vol881_104
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2942-2947
Efficacy of Ezetimibe as Monotherapy in Hypercholesterolemic Patients
with and without Diabetes: A Randomized Controlled Clinical Trial
Yasmine Farouk Shamseldin*1, Amal Kamal Hussein2, Eman Mohamed Sadek3,
Hassan Shalaby4, Houssam Mowafi5
Department of 1Clinical Pharmacy, Faculty of Pharmacy, Misr University for Science and Technology, Giza, Egypt
Departments of 2Pharmaceutics and 3Clinical Pharmacy, Faculty of Pharmacy, Minia University, Egypt
Departments of 4Gastroenterology and Endoscopy, and
5Critical Care, Faculty of Medicine, Misr University for Science and Technology, Egypt
*Corresponding author: Yasmine Farouk Shamseldin, Mobile: (+20) 01005080494, E-Mail: yasmine.shamseldin@must.edu.eg
ABSTRACT
Background: Hyperlipidemia, hypertension, and diabetes are common diseases in the elderly. They are the main factor
of cardiovascular disease and thus increase the risk of mortality. Recently, the death rate caused by COVID-19 is not
predictable but has been increased by many factors, including age, hyperlipidemia, diabetes mellitus, obesity, and
cardiovascular disorders.
Objective: Since many patients with these conditions are under lipid-lowering therapy, we carried out this study to
evaluate the effect of ezetimibe on hyperlipidemia in patients with type 2 diabetes mellitus, non-diabetic, and COVID-
19.
Patients and methods: In this study, 13 hypercholesterolemic patients were categorized per disease suffering from
(Diabetes, non-diabetic and COVID-19). All patients were administered 10 mg of ezetimibe each day for 90 days.
Afterward, their lipid profile was measured at baseline and then after 30, 60, and 90 days. Plasma total cholesterol (TC),
triglycerides (TG), low-density lipoprotein (LDL)-cholesterol, high-density lipoprotein (HDL), and very-low-density
lipoprotein (VLDL) were measured.
Results: HDL increased in diabetic and hypertensive patients by 24% and 6.2 % but decreased in the COVID patients
by 1.29 %, in response to ezetimibe. Total Cholesterol and LDL decreased by 39.64 %, 30.32 % & 58.58% and 38.4 %,
25.33%, & 54.93 %, respectively. Results showed a considerable increase in triglyceride concentration by 13.5% and
23 % at 30 and 90 days of treatment in COVID-19 patients.
Conclusion: These findings reveal that ezetimibe was an effective treatment of hyperlipidemia among diabetic patients.
In addition Sars-CoV-2 might be a factor interacting with hyperlipidemia-reducing therapy and lower ezetimibe
efficacy. However, larger cohort studies are required to confirm these findings.
Keywords: Ezetimibe, Covid-19, Hyperlipidemias, Diabetes Mellites.
INTRODUCTION
well-tolerated (5). Ezetimibe is absorbed rapidly and
Hyperlipidemia is a medical disorder characterized
undergoes wide glucuronidation in the liver. Both
by an elevation of any or all lipid profile and
ezetimibe and ezetimibe-glucuronide are transported
lipoproteins in the blood. It is also called
through the enterohepatic circulation and are brought to
hypercholesterolemia/hyperlipoproteinemia
(1).
the intestinal epithelial cell brush border which is the
Hyperlipoproteinemia includes several metabolic
site of pharmacological action. As it is rapidly absorbed,
disorders that involve elevations in the plasma
ezetimibe reaches a peak serum concentration in 4 h to
lipoprotein levels, whereas hyperlipidemia represents
12 hours, the serum half-life is approximately 22 hours,
the increased levels of plasma triglycerides (2).
in addition to its high protein-bound affinity (99.7%)(4).
Hyperlipoproteinemia
has
two
main
clinical
The drug is excreted in the bile back into the intestinal
consequences, including acute pancreatitis and
lumen, where it inhibits the Nieman Pick C1 like 1
atherosclerosis. The latter can also occur in patients
protein (NPC1L1) protein again (6). NPC1L1 protein is
with marked hyperlipidemia, which results in recurrent
essential for intestinal cholesterol absorption and is the
attacks
of
the
life-threatening
disease
(3).
molecular target of ezetimibe (7), which is finally
Hyperlipidemia is the presence of high levels of
excreted in feces, with a minor 10% excretion in the
cholesterol in the blood. The normal range for total
urine (6).
blood cholesterol in humans is between 140 to 200 mg
Although ezetimibe was developed as an acyl-
per deciliter (mg/dL) of blood and above 240 mg/dl is
coenzyme A cholesterol acyltransferase (ACAT)
classified as a high cholesterol level in blood(4).
inhibitor, but it is proved that its target of action is the
Elevated plasma triglyceride level in association with
cholesterol transport protein NPC1L1 thus inhibiting
hyperlipidemia is common and contributes to an
cholesterol uptake from small intestine (8, 9). In other
increased risk of heart disease, high VLDL and LDL
words ezetimibe act as selective intestinal cholesterol
cholesterol levels, and decreased HDL cholesterol
absorption interacting with hepatic NPC1L1 to inhibit
levels(5).
biliary cholesterol absorption and further reduce serum
Ezetimibe is a cholesterol absorption inhibitor; it
cholesterol levels (5).
is an effective LDL-C lowering agent and is safe and
2942
Received: 30/01/2022
Accepted: 29/03/2022
c:\work\Jor\vol881_105
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2948-2954
Non-Traditional Predictors for Occurrence and Severity of
Premature Atherosclerosis in Acute Coronary Syndrome
Rehab Rashad Ibrahim*, Khalid Tammam, Salwa Mohammed Ghoneim, El Sayed Mohammed Farag,
Alaa Elsayed Salama
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Rehab R. Ibrahim, Mobile: (+20)012986453210, Email: dr_rehab_rashad@yahoo.com
ABSTRACT
Background: Several non-traditional factors are associated with increased risk of atherosclerosis among patients with
acute coronary syndrome (ACS). Objective: This study aimed to detect predictors for the premature atherosclerosis in
patients less or equal than 45 years old in men and less than 55 years old in female and severity of premature atherosclerosis
in acute coronary syndrome. Patients and methods: This cross-sectional study included 105 patients with acute coronary
syndrome attended for angiography at Cardiology Department, Zagazig University Hospitals. Patients were divided
equally into: Group (I) included young patient having traditional risk factors only with acute coronary syndrome, group (II)
included young patients having nontraditional risk factors only such as Apo A-I and Apo B and increased lymphocyte to
monocyte ratio with acute coronary syndrome and group (III) that included young patient having both traditional and non-
traditional risk factors such as ApoA-I, m Apo B and increased lymphocyte to monocyte ratio with acute coronary
syndrome. In all groups severity of atherosclerosis was assessed by Gensini score system.
Results: About 2/3 of acute coronary syndrome with traditional risk factors group (62.9%) had severe atherosclerosis,
with high statistically significant difference between the 3 groups. Hypertension was the only significant traditional
factor in relation to severity of atherosclerosis. Also, obese patients had severe atherosclerosis 5 times more than non-
obese. Odds of having severe atherosclerosis was 2.66 times more among males than females. Conclusion: A variety of
significant non-traditional risk factors place patients at higher risk for ACS. We recommend taking these factors in
consideration as regards assessment of occurrence and severity of premature atherosclerosis and ACS.
Keywords: ACS, Premature atherosclerosis, Gensini score.
INTRODUCTION
Increased LDL-C levels have been linked to an
Cardiovascular disease is one of the leading causes
increased risk of atherosclerosis in previous
of mortality worldwide, accounting for about half of all
epidemiological investigations (9). The mechanisms
fatalities (1). As a result, atherosclerosis, in which the
through which LDL enhances the advancement of fatty
inflammatory process plays a key role, is a possible
streak lesions have yet to be discovered (8).
pathophysiological mechanism that might contribute to
Atherosclerosis is a complex inflammatory process
cardiovascular disease (2). Despite the fact that young
that
is characterized
by the
presence
of
people have been demonstrated to suffer from acute
monocytes/macrophages and T lymphocytes in the
coronary syndrome, earlier research concentrated on
atheroma (10). Inflammation plays an essential role in
ACS in older patients more than younger ones (3).
atherosclerosis. Among the various inflammatory
Many variables, such as a family history of
markers, the leukocyte count and whole subtypes of
coronary artery disease, arterial hypertension, diabetes
white blood cell counts including neutrophils,
mellitus, current smoking, hyperlipidemia, and obesity,
monocytes, and lymphocytes are associated with
have been examined in prior research that have been
increasing cardiovascular events (11). Previous study
linked to an acute coronary syndrome (4). As a result, the
showed that neutrophil to lymphocyte ratios (NLRs)
prevalence of acute coronary syndrome in adults under
were emerging markers of the incidence and severity of
45 years old varies depending on the target demographic
CAD (12). Therefore, this study aimed to detect predictors
(5). Early-stage ACS patients' health risks, as well as
for the premature atherosclerosis in patients less or equal
their social and economic resources, are growing as they
than 45 years old in men and less than 55 years old in
get older (4). On the other hand, there is some evidence
female and severity of premature atherosclerosis in acute
of a biochemical marker of significant relevance for
coronary syndrome using Gensini score.
cardiovascular events that have been linked to
PATIENTS AND METHODS
atherosclerosis etiology. Another independent risk
This cross-sectional study included 105 patients
factor, such as fibrinogen and CRP, can impact
with acute coronary syndrome who attended
to
cardiovascular disease (6). In males and females around
Cardiology Department, Zagazig
University for
the age of 40, abnormalities in lipoprotein concentration
angiography. Patients were divided equally into (3) groups:
in the blood are linked to the onset of atherosclerosis (7).
Group (I): Young patient having traditional risk factors
Furthermore, research in another location, such as Asia-
only with acute coronary syndrome (n= 35), group (II):
Pacific, found a link between high blood total
Young patient having non-traditional risk factors only such
cholesterol (TC), low-density lipoproteins (LDL-C),
as ApoA-I and ApoB and increased lymphocyte to
and coronary artery disease (CAD). In Saudi Arabia,
monocyte ratio with acute coronary syndrome (n =35), and
however, just a few studies have looked at lipid levels
group (III): Young patient having both traditional and non-
in the blood, which have been linked to the development
traditional risk factors only such as ApoA-I and ApoB and
of early atherosclerosis in the coronary arteries (8).
increased lymphocyte to monocyte ratio with acute
2948
Received: 27/1/2022
Accepted: 28/3/2022
c:\work\Jor\vol881_106
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2955-2957
Results of Closure of Patent Ductus Arteriosus in Adult Population Using
Cardiopulmonary Bypass
Ahmad AbdelAleem ElDerie*, Hatem Abdelmoneim Elsorogy,
Mohammed Abdel-Fattah Sanad, Gehad Ibrahim Awad
Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Dakahlia Egypt
*Corresponding author: Ahmad AbdelAleem ElDerie, Mobile: (+2)01026626923, Email: ahmadelderie@mans.edu.eg,
ORCID: 0000-0001-6111-0439
ABSTRACT
Background: Surgical repair of patent ductus arteriosus (PDA) in adults is more challenging compared to children.
This study was conducted to report our experience using cardiopulmonary bypass (CPB) in adult cases with PDA.
Aim of the work: The objective of this study is to evaluate the safety and efficacy of the usage of the cardiopulmonary
bypass in management of PDA in the adult population, not suitable for trans-catheter closure.
Patients and methods: This is a retrospective study that included all adult cases with PDA who had surgical closure
for 5 years (July 2014 to July 2019) at the Cardiothoracic Surgery Department at Mansoura University, Egypt. All
demographic, clinical, and Echo-derived data were collected, New York Heart Association (NYHA) class was
calculated for all cases before operation. All cases underwent PDA repair using CBP. Postoperatively, clinical and
radiological assessments were performed 6 months after surgery.
Results: The study included a total of 10 cases (7 males and 3 females). Their mean age was 32.2 years. Eight cases of
them had NYHA class II, and the remaining cases had NYHA class III. Direct closure was performed in 6 cases (60%),
and the other 4 cases had patch closure. The mean CBP and aortic clamping times were 97 and 45.5 minutes respectively.
The mean esophageal temperature was 30.50 ºC. Neither mortality nor reoperation was encountered in the current study.
Six months after the operation, pulmonary artery pressure decreased from 43.6 mmHg down to 25 mmHg and NYHA
class I was present in 8 cases while the other 2 cases had NYHA class II. Conclusions: A cardiopulmonary bypass is a
safe option for adult cases with patent ductus arteriosus unsuitable for percutaneous or minimally invasive closure.
Keywords: Patent ductus arteriosus, Adult congenital heart disease, Cardiopulmonary bypass.
INTRODUCTION
were initially referred for surgical closure whenever the
Multiple medical and interventional options are
ductus criteria were not suitable for the trans-catheter
currently available to manage pediatric patients with
approach per the cardiology team. All demographic,
patent ductus arteriosus (PDA) (1, 2). Although most
clinical, and radiological data of the selected patients
patent ductus arteriosus patients undergo closure during
were collected including New York Heart Association
childhood, some cases may be missed until a later age
(NYHA) classification. All patients had grade I-II
(3). Recently, less invasive procedures are getting more
tricuspid regurgitation (TR), so we can get the systolic
interest, either by transcatheter device closure or
pulmonary artery pressure by echocardiography. In
minimally invasive surgical ligation thru videoassisted
addition, all patients had a diagnostic catheterization
thoracoscopic surgery (VATS), however, open surgical
before surgery to assess the pulmonary artery pressure
intervention is still needed in selected cases such as
(PAP) and resistance (PVR) and the ratio of pulmonary
short, wide, or tortuous PDA, or if it is associated with
to systemic blood flows (Qp/Qs). All patients had
another
concomitant
cardiac
procedure
(3).
follow-up echocardiography 6 months after surgery
Cardiopulmonary
bypass
(CPB)
is
usually
where the right-side function, left-side volumes, and
recommended in such cases due to the stiff, less-
pulmonary artery systolic pressure were evaluated.
mobilized, and friable nature of the ductal tissue in the
Surgical procedure
adult population (4). This study was conducted to report
A median sternotomy incision was used to
our results on PDA closure in the adult population using
expose the heart. CBP was established with mild
cardiopulmonary bypass.
hypothermia (32º C) after inserting the arterial and
venous cannulas. Then, the PDA was temporarily
PATIENTS AND METHODS
controlled by external compression while the
This is a retrospective study that included adult
pulmonary trunk was opened longitudinally extending
cases (> 18 years) who underwent PDA closure using
toward the confluence, then a Foley's Catheter size 20
CPB at the Cardiothoracic Surgery Department at
was introduced thru the pulmonary end of the PDA, and
Mansoura University during the period from July 2014
its balloon was inflated to control the blood flowing
to July 2019 after approval of the Institutional
from the aorta, then the size of the defect is assessed and
Research Board (IRB) of the Faculty of Medicine of
then closed either by a piece of Dacron patch or direct
Mansoura University. Patients with the following
suture, if it is slit-like, with the withdrawal of the
criteria were included: (1) Age is more than 18 years,
catheter before the last 2-3 stitches, a momentary
(2) diagnosed with PDA, and (3) underwent open
cessation of the CPB may be required at this step.
surgical closure. Patients with other cardiovascular
anomalies, except for small-sized atrial septal defect or
Postoperative course
patent foramen ovale (< 5 mm), were excluded. Patients
2955
Received: 01/02/2022
Accepted: 30/03/2022
c:\work\Jor\vol881_107
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2958-2963
Difference between Oral Isosorbide Mononitrate & Sildenafil Citrate Therapy in
Reducing Umbilical Artery Doppler Indices in Pregnancies with
Fetal Growth Restriction; A Prospective Randomized Control Trial
Paul Naseef, Ihab Abd El Fatah, Ahmed Tharwat, Mortada El Sayed
Obstetrics and Gynaecology Department, Faculty of Medicine, Ain shams University, Cairo, Egypt
Corresponding Author: P. Naseef, ORCID number: 0000-0003-4279-5844, E-mail: paulabeh@hotmail.com,
Telephone no.: 01203155546
ABSTRACT
Background: Fetal growth restriction (FGR) occurs when a fetus does not attain its genetically assigned expected
growth rate. An estimated fetal weight (EFW) or abdominal circumference (AC) below the 10th percentile for
gestational age is the ideal definition of this condition.
Objectives: This study aimed to compare isosorbide mononitrate and sildenafil citrate therapies in the context of
pregnancies complicated by FGR regarding the magnitude of reduction in umbilical artery (UA) Doppler resistance
index (RI) in a randomized fashion.
Patients and Methods: This research was carried out in the Maternity Hospital of Ain Shams University during the
period from March to September 2020. 64 pregnant women with FGR, were recruited from the antenatal clinic. They
were subdivided into 2 groups according to a randomization table (Isosorbide mononitrate group versus sildenafil
citrate group).
Results: The administration of isosorbide mononitrate 30 mg twice daily is as effective as sildenafil citrate 50 mg
twice daily in reducing umbilical artery Doppler resistance index (RI), thereby enhancing fetal growth in pregnancies
with FGR and in turn reducing the overall perinatal morbidity and mortality caused by iatrogenic prematurity or FGR
itself.
Conclusion: We recommend the use of isosorbide mononitrate as a therapeutic agent in pregnancies with FGR caused
by placental insufficiency.
Keywords: FGR, Doppler ultrasound, Isosorbide mononitrate, Sildenafil citrate.
INTRODUCTION
which is a precursor of cyclic guanosine
Fetal growth restriction (FGR) occurs when a
monophosphate (cGMP). NO enhances the production
fetus is unable to reach its genetically set potential size.
of cGMP, which then stimulates protein kinase G that
It is defined as an estimated fetal weight (EFW) or
in turn activates myosin phosphatase causing calcium to
abdominal circumference (AC) below the 10th
be released from its intracellular stores. Therefore, it
percentile for gestational age (1).
helps to regulate fetoplacental perfusion by
Increased perinatal mortality and morbidities,
counteracting the action of other vasoconstrictive
including hypothermia, hypoglycemia, neonatal
substances (4). Isosorbide mononitrate and other nitrates
jaundice, respiratory distress syndrome (RDS),
are powerful vasodilators. They cause venodilation at
necrotizing enterocolitis (NEC), and sepsis, are all
relatively low doses. They do, however, cause arterial
likely consequences of iatrogenic prematurity in
vasodilatation at low to moderate doses. The degree of
growth-restricted fetuses with significantly reduced
sympathetic reflex discharge, the dose given, and the
umbilical artery (UA) blood flow (2).
presence or lack of nitrate tolerance all influence the
In a physiological pregnancy, nitric oxide (NO), a
overall hemodynamic response to nitrate (5).
strong vasodilator that also suppresses platelet
aggregation, is secreted by the placental trophoblast. It
MATERIALS AND METHODS
was found that placental ischemia and endothelial
This research study was carried out at Maternity
dysfunction are linked to reduced NO production and
Hospital of Ain Shams University during the period
enhanced phosphodiesterase type 5 (PDE-5) activity in
from March to September 2020. It included 64 pregnant
FGR-affected pregnancies. As a result, isosorbide
women with FGR recruited from the antenatal clinic.
mononitrate (NO donor) and sildenafil citrate (PDE-5
They were randomised into two groups using a
inhibitor) may be used to both prevent and treat FGR (3).
randomization procedure.
Isosorbide mononitrate, as a nitric oxide (NO)
donor, can induce vasodilation in the fetoplacental
Inclusion criteria: Patients with a singleton
circulation, in order to promote nutrient and oxygen
intrauterine pregnancy complicated by FGR (EFW<10th
supply to the fetus, via its direct effects on smooth
percentile for GA) whose age ranges from 18-35 years
muscle. Through its impact on guanylate cyclase (GC),
2958
Received:30/01/2022
Accepted:29/03/2022
c:\work\Jor\vol881_108
Journal of Hospital Medicine (July 2022) Vol. 88, Page 2964-2966
Role of Tetracycline in Management of Seroma Post-operative in
Native Access for Hemodialysis, Post Appendicectomy and Post Mastectomy
Michael Samuel Ayad 1,Mina Makram Hendy 2
1 Vascular surgery Department, 2 General Surgery Department, Faculty of Medicine, Minia University, Egypt
*Corresponding author: Michael Samuel Ayad
E mail: Michel.Samoeil@Mu.edu.eg
Mobile phone:01228722786
ABSTRACT
Background: Seroma is a frequent surgical complication. Complications include compression of other tissues,
infection, and abscesses. Patients with mastectomy, appendicectomy and native access had 4.3%-63% seromas. Seroma
commonly occurs after lymphatic channel injury. Tetracycline (TCN) is an antibiotic used to treat illnesses such as acne,
cholera, brucellosis, plague, malaria, and syphilis. It is an effective topical sclerosing agent.
Objective: The present study aimed to determine the role of tetracycline in management of post-operative seroma in
native access for haemodialysis, post-appendicectomy and post-mastectomy.
Methods: This was a prospective cross-sectional study conducted on 104 patients with post-operative seroma at Minya
University Hospital and The Good Shepherd Hospital. All patients provided their demographic information. Locally
administered tetracycline to a wound. The patients were monitored for post-operative wound problems and seroma
healing.
Results: Native access patients were 44. Mean age was 45.59 ± 16.75 years. 47.7% were females and 52.3% were males.
Diabetes prevalence reached 68.2% and HTN prevalence reached 56.8%. Post-appendicectomy patients were 29. Mean
Age was 28.5 ± 7.53 years. 41% were females and 46% were males. 33% of patients had diabetes. Appendicular abscess
was recognized in 36% of patients. Post-mastectomy patients were 30. Mean age was 56.6 ± 9.49 years. 96.67% were
females. 50% of participants had diabetes.
Conclusion: Tetracycline was effective in seroma treatment in most patients with complete improvement in less than
10 days. Only post-mastectomy patients that showed resolve days more than other patients.
Key words: Appendicectomy, Mastectomy, Seroma, Native access, Tetracycline.
INTRODUCTION
MATERIAL AND METHODS
One of the most common surgical consequences is
This was a prospective cross-sectional study done
seroma. This complication is related with morbidity due
in Minya University Hospital and The Good shepherd
to seroma accumulation and pressing on other tissues,
Hospital. The study was conducted on 104 patients
as well as the likelihood of infection and abscesses (1).
suffering from post-operative seroma.
Seroma may need surgical procedures such as aspiration
or draining, and patients may be required to return to the
Exclusion criteria: Pregnant or lactating patients,
operating room (2).
known sensitivity to TCN, history of keloid formation
Many factors contribute to the formation of
and immediate breast reconstruction.
seromas, including damage to blood vessels and
In native access for hemodialysis and appendicectomy,
lymphatic channels, which eventually accumulate in the
once seroma was observed opening of one stitch was
empty spaces left by surgery, trauma, shear pressures
done and tetracycline was applied in the wound. In
and tissue adhesions. Sclerotherapy, which involves
mastectomy 50 ml of TCN solution (1 g in 50 ml 0.9%
injecting sclerotic material into the dead space to
NaCl) were instilled through each of the 2 drains.
produce inflammation and a fibrotic reaction that fills
Patients were followed up for recovery from seroma,
the dead space, has been used in the literature (3).
post-operative pain and wound complications.
Seromas occur in 4.3% to 63% of patients after
native access for hemodialysis, appendectomy and
Ethical considerations:
mastectomy. Although postoperative seromas generally
The study was approved by the Faculty's Ethics
resolve with repeated aspiration, they are a source of
Committee, Minia University. All the patients were
great annoyance and concern to patients (4).
informed about the surgery and the auto transplantation
Tetracycline (TCN), an antibiotic in the tetracycline
technique, value and possible complications. Informed
family of medications, is used to treat a number of
written consent was taken from every patients. This
infections, including acne, cholera, brucellosis, plague,
work has been carried out in accordance with The Code
malaria, and syphilis. It was found to be an efficient
of Ethics of the World Medical Association
topical sclerosing agent (5).
(Declaration of Helsinki) for studies involving humans.
The present study aimed to determine the role of
Statistical analysis:
tetracycline in management of post-operative seroma in
IBM SPSS version 22.0 was used to analyse computer-
native access for hemodialysis, post-appendicectomy
generated data. To express quantitative data,
and post-mastectomy.
percentages and numbers were employed. No
comparison tests used.
2964
Received:18/1/2022
Accepted:17/3/2022
c:\work\Jor\vol881_109
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2967-2975
Perinatal Outcomes of Pregnancies with Preterm Premature
Rupture of Membranes after 34 Weeks of Gestation
Wael Sabry Nossair, Youssef Abo Elwan El-Sayed, Yasmin Ali El-Shabrawy*,
Safaa Abdel-Salam Ibrahim
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Yasmin Ali El-Shabrawy, Mobile: (+2)01029735910, Email ya964378@gmail.com
ABSTRACT
Background: Preterm premature rupture of the membranes (PPROM) is an important contributor to perinatal mortality and
morbidity. Neonatal complications are related primarily to the gestational age at rupture of membranes.
Objective: The aim of the present study was to improve the perinatal maternal and fetal/neonatal outcomes in cases
with preterm premature rupture of membranes between 34 -37 weeks of gestations.
Patients and methods: This prospective case control study included 82 women comprised 41 with PPROM (group I)
and 41 without ROM as matched controls (group II). All women were presented to maternity unit of Obstetrics and
Gynecology Department over 8 months period, at Zagazig University Hospitals.
Results: In this study (73.2%) with PPROM were below the age of 30 years. Urinary tract infection was 17.1% versus
12.2 %, cervicitis 4.9% versus 0% in patients with PPROM versus controls respectively. Maternal outcome in this study
was evaluated; there were 82.9% of patients with PPROM versus 95.1% discharged from hospital within 4 days after
delivery with no bad outcomes. Good Apgar score was (68.3%) in patients with PPROM and 82.9% in control group.
In PPROM group; 7 fetuses were diagnosed as fetal distress and only 2 (4.9%) cases had clinical chorioamnionitis.
Regarding neonatal morbidity in patients with PPROM, the results showed that respiratory distress syndrome (RDS)
was diagnosed in 4 neonates, 7 with tachypnea, 6 with jaundice, and 3 with sepsis and no case of perinatal mortality.
Conclusion: With appropriate care, the maternal risks of expectant management after 34 weeks of gestation are
generally accepted to be minimal and a clear neonatal advantage exists by reducing risks of neonatal respiratory
problems, admission for neonatal intensive care, and cesarean section.
Keywords: Fetal/neonatal outcomes, Maternal outcome, Perinatal, Preterm premature rupture of membranes
(PPROM).
INTRODUCTION
Survival rates have increased considerably as a
Premature rupture of fetal membranes (PROM)
result of advances in newborn care, particularly
refers to the rupture of fetal membranes prior to the
intensive care for infants on the verge of viability.
onset of labour. Despite improved prenatal care, the
Advances in newborn stabilization, surfactant
causes and management of this obstetric dilemma
administration, and optimizing respiratory support, the
remain a mystery. Increased newborn and maternal
use of nitric oxide and reduction in associated
morbidity have long been related to PROM and preterm
morbidities such as infection and intraventricular
premature rupture of membranes before 37 weeks of
hemorrhage, and the use of probiotics to reduce
pregnancy (1).
necrotizing enterocolitis (NEC) are among the changes
Spontaneous preterm rupture of the membranes
that reflect a multimodal approach to care (5).
(SPROM) occurs when ROM occurs after or before the
Many studies have demonstrated significant
start of labour before 37 weeks. Prolonged ROM is
benefits of expectant or conservative management in
defined as any ROM that lasts more than 24 hours and
PPROM at less than 34 weeks of gestation but the
occurs before the start of labour. Membranes rupture
management of PPROM between 34-37 weeks
occurs owing to mechanical stresses, as well as
continues to be a controversial issue. Very few studies
programmed cell death and activation of catabolic
were done so far regarding management of PPROM at
enzymes like collagenase. PPROM is most likely
34 37 weeks' gestation. So it is not clear whether
caused by the same mechanisms and premature
intentional delivery or expectant management will be
activation of these pathways (2).
beneficial to both mother and baby. Several aspects
A ruptured membrane is diagnosed by vaginal
must be considered when considering the management
watery leakage and sterile speculum inspection of fluid
of PPROM. Prematurity is the most serious risk to the
buildup in the posterior fornix, which is validated by
fetus, while infection morbidity is the most serious risk
other biochemical tests such as Nitrazine or AmniSure
to the mother (6).
rupture of fetal membrane test (placental alpha
Therefore, this study aimed to improve the perinatal
microglobulin-1) (3).
maternal and fetal/neonatal outcomes in cases with
PROM is managed by striking a balance between
preterm premature rupture of membranes after 34 and
the advantages of extending the pregnancy and the risks
below 37 weeks of gestations. Also in this prospective
of intraamniotic infection and its effects on the mother
study, we tried to find out the optimum management
and the fetus/neonate. As a result, the goal of therapy is
option for PPROM at that gestational age.
to extend the latency period without complications (4).
2967
Received: 27/1/2022
Accepted: 28/3/2022
c:\work\Jor\vol881_110
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2976-2981
Frequency of Hepatitis C Virus in Pregnancy and Pregnancy Outcome at
Al-Ahrar Teaching Hospital, Zagazig, Egypt
Ahmed Mohamed Atef, Sabah Mohamed Saada, Diana Nageeb Salama,
Alaa Hassieb Elsadek, Loay Mohamed Abdallah
Department of Obstetrics and Gynecology, Al-Ahrar Teaching Hospital, Zagazig, Egypt
*Corresponding Author: Ahmed Mohamed Atef, Mobile: (+20)1007598182, E-Mail: ahmed.atef.zn88@gmail.com
ABSTRACT
Background: hepatitis C virus (HCV) has infected an estimated 170 million people. Pregnancy may worse the liver
function in a case of severe liver disease.
Objective: The aim of the current work was to assess the frequency of HCV in parturient women and their pregnancy
outcome at Al-Ahrar Teaching Hospital.
Patients and Methods: This cross-sectional prospective study included a total of 1,135 pregnant women, attending at
Obstetrics and Gynecology Department, Al-Ahrar Teaching Hospital, Zagazig. Pregnant women were admitted between
28- and 42-weeks' gestation. They were tested for HCV+ antibodies using the Rapid Test Technique.
Results: The frequency of HCV in pregnant women tested was 7.7%. There were statistically high significant
relationships between HCV and occupation, history of blood transfusion, history of HCV treatment, type of previous
delivery and laboratory findings among the study cases.
Conclusion: It could be concluded that history of HCV treatment, previous operations, risky occupations, blood
transfusion and family history of HCV are risk factors for HCV infection.
Keywords: Hepatitis C Virus, Pregnancy Outcome, Frequency.
INTRODUCTION
There are an estimated 170 million persons
Transfusions of blood and blood products and
worldwide who have been infected with hepatitis C virus
organ transplants from infected donors, drug use,
(HCV). Chronic liver disease, cirrhosis, and
improper therapeutic injections, occupational contact to
hepatocellular carcinoma (HCC) are all possible
blood, and delivery to an infected mother are all risk
outcomes for HCV-infected individuals. They also serve
factors for HCV infection. There have been several, but
as reservoirs for transmission to others (1).
the most significant have been transfusions from
It is believed that 2.2% of the world's population
unscreened donors, medication injections, and hazardous
is infected with hepatitis C. A weighted average for
therapeutic injections (6).
regions rather than individual countries was used because
Many tests are used to diagnose hepatitis C virus
of the absence of data in many nations. There are
infection. Screening test by detection of the viral
estimates ranging from 1% in Northern Europe to 2.9 %
antibody is not diagnostic but it indicates the possibility
in Northern Africa for each region. Countries in the
of infection. Enzyme linked immunoassay (ELISA) is a
United Kingdom have recorded a prevalence of just 0.1
diagnostic test approved by FDA by detection of viral
percent. There are other reports from Scandinavia, with
antibodies. PCR indicates antigen infection by detection
the highest prevalence of 8.6 percent coming from Egypt.
the genotypes of virus and counting the virus to detect the
27 percent of cirrhosis and 25 percent of hepatocellular
prognosis of the disease and follow up the mode of
carcinoma (HCC) worldwide are caused by HCV
therapy (2).
infection (2).
Raid test is a screening test used to aid in
In affluent countries, the majority of hepatitis C
diagnosis of HCV infection and based on
virus-related disease has been caused by injecting drugs,
chromatographic immunoassay for detection of
receiving blood transfusions prior to donor screening,
antibodies (6). Pregnancy may worse the liver functions in
and high-risk sexual activities. Egypt has the world's
a case of severe liver disease or HCC. In presence of liver
highest rate of HCV infection, and that rate rises steadily
cirrhosis, FibroScan is useful to give the patient approval
with age. Because most acute HCV infections are
to get pregnant as it determines stages of liver fibrosis (3).
asymptomatic, it is difficult to estimate the prevalence of
The aim of the current work was to assess the
the disease (3, 4).
frequency of HCV in parturient women and their
Hepatitis C virus is a major cause of chronic liver
pregnancy outcome at Al-Ahrar Teaching Hospital.
disease in children in developed nations. During the
intrapartum phase, the mother and fetus are both exposed
PATIENTS AND METHODS
to viruses. While the mother's breast milk contains HCV
This cross-sectional prospective study included
RNA, it does not transmit the disease to her baby (5).
a total of 1,135 pregnant women, attending at
Obstetrics and Gynecology Department, Al-Ahrar
2976
Received: 26/01/2022
Accepted: 27/03/2022
c:\work\Jor\vol881_111
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2982-2989
The Metabolic Syndrome in Survivors of Acute Lymphoblastic Leukemia of
Pediatrics Patients at Zagazig University Hospitals
Abeer Atef Mohamed1, Elhamy Rifky Abdelkhalek1, Mohamed Refaat Beshir1, Thoraya Hosny2
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Abeer Atef Mohamed, Mobile: (+20)1098495077, Email: engisma3il1234@gmail.com
ABSTRACT
Background: Insulin resistance is considered to be of the major causes of the metabolic syndrome. There is a growing
body of evidence showing that treatment for Acute Lymphoblastic Leukemia (ALL) has side effects.
Objective: The aim of the current work was to detect the prevalence of metabolic syndrome in survivors of childhood
ALL to determine the relationship between metabolic syndrome and growth parameters in ALL survivors.
Patients and methods: This cross-sectional study included a total of twenty-four ALL survivors, attending at Pediatrics
Hematology and Oncology Unit, Faculty of Medicine, Zagazig University Hospitals. Full clinical examination as well
as laboratory investigations including estimation of serum insulin, total cholesterol, triglycerides, HDLc, LDLc, fasting
plasma glucose were done for all patients.
Results: Obesity was significantly higher among metabolic syndrome (MS) cases. Patients with metabolic syndrome in
ALL showed greater systolic and diastolic blood pressure than those without metabolic syndrome. It was found that
children with metabolic syndrome had higher fasting plasma insulin levels and fasting plasma glucose levels than those
without the syndrome. ALL patients who had metabolic syndrome had higher triglyceride levels than those without MS.
Conclusion: It could be concluded that ALL survivors are at an elevated risk for metabolic syndrome, as the increased
risk for obesity and disturbed lipid profile in those patients.
Keywords: Metabolic Syndrome, Acute Lymphoblastic Leukemia, Survivors.
INTRODUCTION
One-fourth of all cases of juvenile cancer are
PATIENTS AND METHODS
attributed to hematological malignancies, the most
This cross-sectional study included a total of
frequent type of cancer in children (1). Using modern
twenty-four acute lymphoblastic leukemia survivors,
treatment methods, the 5-year survival rate for ALL has
attending at Pediatrics Hematology and Oncology
increased from practically zero in the 1950s to almost
Unit, Faculty of Medicine, Zagazig University
80% (2). As the number of ALL survivors grows, the
Hospitals. This study was conducted between March
negative effects of their therapy become more obvious.
2020 to November 2020.
Surviving patients have been shown to have numerous
endocrine/metabolic side effects, such as low growth
Acute myocardial infarction diagnosis was based on
hormone, gonadotropin, and thyroid hormone secretion,
clinical symptoms, elevated cardiac biomarkers (CK,
as well as metabolic syndrome (3).
CK-MB, and Troponin), and 12-lead electrocardiogram
The metabolic syndrome is a group of diseases
results.
all linked to insulin resistance that includes abdominal
obesity, high blood sugar, high cholesterol, and high
Inclusion Criteria:
blood pressure (4). Children with obesity, metabolic
Both sexes below 18 years of age.
syndrome, and type 2 diabetes are at greater risk for
Pediatric cancer survivors who were treated at
cardiovascular disease and diabetes mellitus, according
Zagazig University's hematology/oncology unit
to research (5). Metabolic syndrome in healthy children
using the regimen in place.
and adolescents with modified Adult Treatment Panel
ALL survivors for a minimum of 2 years after the
(ATP) III criteria ranges from 2.0-11.5 percent in
end of chemotherapy provided that, they were below
developed nations (5).
(age of 18 years) at time of diagnosis of having
30% of obese and overweight patients evaluated
cancer.
by Cruz et al. had the metabolic syndrome, according to
In remission.
their findings (6). It has long been hypothesized that
obesity and its metabolic consequences such as insulin
Exclusion Criteria
intolerance and dyslipidemia are caused by a growth
ALL survivors above the age of 18.
hormone deficiency (GH). Talvensaari et al. found in
Children affected by any illness other than cancer
their study that long-term survivors of childhood cancer
e.g., TB, Diabetes.
had lower GH secretion, which was linked to metabolic
Patients who had a relapse of leukemia.
issues (7).
Children who had undergone bone marrow
The purpose of this study was to find out if
transplantation.
metabolic syndrome is common among childhood ALL
survivors and if so, what effect it has on growth
Pre-existing
cognitive,
psychological
or
parameters.
communication disorders in children.
2982
Received: 26/1/2022
Accepted: 27/3/2022
c:\work\Jor\vol881_112
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2990-2995
Comparison between Transabdominal Preperitoneal Approach and the
Totally Extraperitoneal Approach for Inguinal Hernia Repair on the
Effect on Testicular Blood Flow
Abdel-Rahman Albahy*1, Mohamed Abu Sheasha1, Ahmed Elghrieb1, Mohamed El-Adalany2, Magdy Beshir1
Departments of 1General Surgery and 2Diagnostic Radiology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Abdel-Rahman Albahy, Mobile: (+20)1003637555, Email: abdobahy@mans.edu.eg
ABSTRACT
Background: Inguinal hernia repairs are one of the most common procedures performed in general surgery departments.
Various techniques have been used to repair inguinal hernias. But now only 3 methods are generally accepted as the
best evidence-based treatment options for inguinal hernia repair: the Shouldice technique, Lichtenstein tension-free
repair and laparoscopic repair either via the transabdominal preperitoneal (TAPP) approach or the totally extraperitoneal
(TEP) approach. There is limited number of studies that have compared the effects of both techniques on the spermatic
cord and testicular functions in long term. Objective: The aim of the current work was to compare the effect of
laparoscopic inguinal hernioplasty either totally extraperitoneal (TEP) approach or transabdominal preperitoneal
(TAPP) approach on testicular blood flow and volume on the same side of the hernia repair.
Patients and methods: This prospective study was performed on 47 male patients admitted to general surgery ward at
Mansoura University Hospital between February 2019 and February 2020 with clinically diagnosed inguinal hernias
and fulfilling the eligibility criteria. The study population was distributed into 2 groups by computer generating program;
Group A that included 28 patients with inguinal hernia who were operated by laparoscopic techniques (TAPP) approach
and group B that included 19 patients with inguinal hernia who were operated laparoscopically by (TEP) approach.
Results: There is non-statistically significant higher improvement in resistive index (RI) in TEP group than TAPP at
levels of Testicular and Capsular Artery but the same percentage of improvement at the level of intratesticular artery.
Conclusion: It could be concluded that laparoscopic inguinal hernioplasty either TAPP or TEP approaches are safe
regarding testicular blood flow but also, they improve it.
Keywords: Inguinal hernia, Hernioplasty, Lichtenstein, Tension-Free Repair, TAPP, PSV, EDV, RI.
INTRODUCTION
interruption of the testicular blood supply may result in
The whole life risk of the occurrence of inguinal
testicular atrophy (5).
hernia is estimated at 27% in men and 3% in women.
The testicular veins (spermatic veins) form
Inguinal hernia repairs are one of the most common
several highly anastomotic channels that surround the
procedures performed in general surgical departments.
testicular artery as the pampiniform plexus. This
Approximately 20 million hernia repairs are performed
arrangement allows countercurrent heat exchange,
annually all over the world (1).
which cools the blood in the testicular artery (6).
Various techniques have been used to repair
High resolution Color Doppler Ultrasound
inguinal hernias since the first reconstructive technique
(CDUS) is capable of imaging small vessels in
described by Bassini in 1887 (2). Today, only 3 methods
superficial organs and non-invasively measuring flow in
are generally accepted as the best evidence-based
them. It reliably shows the testicular arterial anatomy by
treatment options for inguinal hernia repair: the
imaging intra-arterial blood flow and a knowledge of the
Shouldice technique, a form of suture repair, open
normal CDUS appearance and waveform characteristic
anterior "tension free" flat mesh repair according to
of the testicular artery aids in detecting alteration in
Lichtenstein, and laparoscopic/endoscopic posterior flat
blood flow(7).
mesh repair, principally via the transabdominal
The aim of all inguinal hernia repair techniques
preperitoneal (TAPP) approach and the totally
is to tighten the internal ring with a suture or a
extraperitoneal (TEP) approach(3).
biomaterial such as polypropylene mesh. The matter has
Anatomy of the spermatic cord has been well
been raised whether or not the spermatic cord structures
studied because of its important role in testicular
are compromised with these techniques (4).
physiology and surgery. The testicular arteries arise from
Although some studies describe the laparoscopic
the abdominal aorta just below the renal artery and travel
approach as advantageous in terms of short-term
in the intermediate stratum of the retroperitoneum to
perioperative outcomes. The open approach has been
reach the internal inguinal ring and become a component
reported by other studies as a better overall choice in
of spermatic cord. At the internal ring, the vessel are
terms of intraoperative complications (8).
joined by the genital branch of the genitofemoral nerve,
The impact of inguinal hernia and mesh repair
the ilioinguinal nerve, the cremasteric artery, the vas
on testicular functions, sexual functions and quality of
deferens and its artery. Each of these structures could
life has not been very well studied. There has been an
have various effects on testicular perfusion (4). Human
ongoing debate of the impact of groin hernia and its
testicular parenchyma is provided with approximately 9
repair on testicular functions and sexual functions (9). The
ml of blood per 100 g of tissue per minute and
limited number of studies that have compared the effects
2990
Received: 25/01/2022
Accepted: 23/03/2022
c:\work\Jor\vol881_113
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 2996-2999
Spacers versus Nebulizers in Treatment of Acute Asthma
A Prospective Randomized Study in Preschool Children
Mohamed B. Hamza1*, Ahmed Ibrahim Harkan2
1Pediatric pulmonology Department, 2Pediatric ICU Department, Faculty of Medicine, Tanta University, Egypt
*Corresponding author: mohamed B. Hamza,E mail: mohamed.hamza@med.tanta.edu.eg ,
Mobile phone: +20 102 022 0271
ABSTRACT
Background: Asthma affects approximately 14 million adult Americans and is responsible for over 450,000
hospitalizations each year. Every year, approximately 1.8 million asthma patients visit the emergency department.
Aerosol delivery to mechanically ventilated patients utilizing nebulizers or metered dose inhalers (MDI) with spacers
has been shown to be feasible and beneficial. Aim and Objectives: The goal of this study was to analyse MDI aerosol
administration with spacer delivery and nebulizer among preschool kids.
Material and Methods: A randomized, double-blind medical experiment involving 200 preschool children were
divided into 2 groups received active drug either by nebulizer (group 1=100 patients) or MDI-spacer (group 2=100
patients). Assessment was done including clinical history, medications history, height, weight and BMI. All of the
following parameters were measured: heart rate, respiratory rate, and arterial oxygen saturation while the children were
awake and breathing room air. FEV1 was calculated using a portable spirometer. These clinical and laboratory tests
were performed 10, 20, and 40 minutes after using the nebulizer. Results: The mean age in months was 25.4 ± 12.7
among group 1 and 26.6 ± 11.6 among group 2. Group 1 included 43% males and 57% females while group 2 included
52% males and 48% females. The mean BMI for age z score in group 1 was 0.31 & 0.97 and 0.32 & 0.89 in group 2.
There was a statistically substantial variation between the two groups in terms of FEV1. In terms of heart rate, respiratory
rate oxygen saturation, or hospital stay duration, there was no statistically substantial variation between the two groups.
Conclusion: The MDI-spacer and the nebulizer both delivered salbutamol equally well aerosol therapy to preschool
children suffering from wheezes and acute asthma exacerbations. The spacer had higher effect on FEV1 than nebulizer
but there was no difference regarding oxygen saturation and hospital stay duration.
Key words: Metered dose inhaler, Spacers, nebulizers, Preschool children, Wheezes.
INTRODUCTION
effects (1). Albuterol, the most commonly used
Asthma affects approximately 14 million adult
bronchodilator, was previously administered via
Americans and is responsible for over 450,000
nebulization (NEB) with compressed air/oxygen.
hospitalizations each year. Every year, approximately
However, metered dosage inhalers with a spacer
1.8 million asthma patients visit the emergency
(MDI+S) have been shown to be beneficial and
department (1). Exacerbations of pediatric asthma place
achieved substantial popularity as an alternate route of
a huge medical and financial strain on healthcare
albuterol administration (5).
systems as well as society at large. Acute exacerbations
Studies estimate that more than half of children who
and poor asthma control have been identified as the
use MDIs without devices, such as a spacers and valved
cause of approximately one-third of direct and virtually
holding chambers (VHCs) with mouthpieces or masks,
all indirect asthma expenditures, with asthma treatment
gain little to no clinical benefit from their medication
costs tripling when an exacerbation occurs (2). Aerosol
due to incorrect inhaler technique (6).
delivery to mechanically ventilated patients has been
Prior research has defined correct inhaler technique
demonstrated to be feasible as well as nebulizers or
based on a patient performing a series of steps, ranging
metered doses inhalers (MDI) with spacers.
from five to 14, which are necessary for the inhaled
A variety of factors influence the inhaled dose and
medication to be effectively deposited into the lungs.
the aerodynamic properties of aerosol administration
While MDIs allow for some forgiveness in medication
within the ventilation circuit. Nebulizers' effects on the
delivery even when misused due to the fine particles
aerodynamic properties of the dose emitted in a
they contain, inhaler misuse is cited as one of the key
ventilation circuit have received a lot of attention. The
reasons for failure of inhaled therapies (7). The
impact of the location of the aerosol distribution
implications of inhaler misuse are broad, not only for
mechanism position in various types of ventilation
patients but also for health systems as a whole. Patients
circuits has also been investigated (3). Even the
with incorrect inhaler technique are more likely to have
ventilator mode, as well as the effects of heat and
poorly controlled asthma, which is associated with
humidity, have been studied. Many studies have
higher exacerbations and healthcare utilization.
recommended that vibrating mesh nebulizers must be
Individuals with inhaler misuse may also lose
used instead of jet nebulizers to reduce dose (4). Because
confidence in their treatment regimen and subsequently
it delivers drugs directly to the target organ, inhaled
have poor adherence, thereby contributing to asthma
bronchodilator therapy is the first and most important
morbidity (8).
treatment for asthma exacerbations. Even after multiple
This study aimed at comparing aerosol delivery
doses or continuous treatment, lower doses can be used
from MDI with spacer and nebulizer among preschool
to achieve comparable efficacy while reducing side
children.
2996
Received: 01/02/2022
Accepted: 30/03/2022
c:\work\Jor\vol881_114
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3000-3004
Patterns and Outcome of Autoimmune Chronic Liver Diseases in
Assiut University Hospital: A Retrospective Study
Adnan Ahmed Mohamed, Mohammed Abd El Sabour Mohamed Mekky,
Yomna Hammam Abo El-Wafa, Ahmed Mohammed Abu-Elfatth
Department of Tropical Medicine and Gastroenterology, Faculty of Medicine, Assiut University, Egypt
Corresponding Author: Ahmed Mohammed Abu-Elfatth , ORCID: 0000-0003-3269-5284,
E-mail: ahmed111@aun.edu.eg, Mobil Phone: 00201118677791
ABSTRACT
Background& aim: Autoimmune liver diseases (AILD) are relatively low diseases but their pattern and outcome are still
unclear. It includes primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and autoimmune hepatitis
(AIH). The current study was conducted to assess pattern of AILDs in our locality
Methods: This retrospective study was conducted between 2016 and 2019 in Tropical Medicine and Gastroenterology
Department, Assiut University Hospitals. In addition to characteristics of patients, types and outcome of AILDs were
registered.
Results: A total of 1750 patients with various chronic liver diseases were identified only 2.9% of those patients had different
types of AILDs, as follows: 40 patients had AIH, 6 patients had PSC, and 4 patients had PBC, 80% of them were females.
Conclusion: AILDs are still underappreciated in our community. Patients with unexplained abnormalities in liver functions
should be suspected of having such diseases. Future multi-center studies on this topic are necessary.
Keywords: Autoimmune liver diseases, Chronic hepatitis, Autoantibodies, Antinuclear antibodies.
INTRODUCTION
conflict of interest to report. We certify that it is not
Hepatologists and gastroenterologists are
under review at any other publication.
frequently facing different forms of chronic hepatitis;
autoimmune liver diseases are one of these forms but in
Study setting& design
less frequency than other chronic diseases. Immune
A retrospective-prospective cross-sectional study
mediated pathophysiology with formation of different
was achieved at Tropical Medicine and Gastroenterology
types of autoantibodies is the main accepted, till now,
Department. The study reviewed the medical records of
theory about initiation of such diseases (1, 2).
patients with AILD between 2016 and 2019.
There are different subtypes of AILD include
Patient's selection
autoimmune hepatitis (AIH), primary sclerosing
Any patient with any form of AILD and was
cholangitis (PSC), primary biliary cirrhosis (PBC) and
admitted to the hospital in the study period was recruited
overlap syndrome. Raised serum immunoglobulin (IgG)
in the study. All other forms of liver diseases were
with specific pattern of autoantibodies in a common
excluded.
feature in AILD and help in its prediction and diagnosis
(1, 2). Till now, there is paucity in literature about the
The following data were collected
accurate frequency of such issue globally. Also, the
Demographics (age, sex and causes of hospital
literature didn't supply a full view about age predication,
admission) and physical evaluation were recorded, in
sex predominance and the course of different subtypes of
addition to, liver function tests, kidney function tests and
AILD (3, 4). The pattern and frequency of AILD also, are
different autoantibodies panel. Also, different lines of
not well reported in our locality. As a result, the current
therapy, radiological data and outcome in those patients
study sought to assess the various patterns of AILD in our
were recorded. Final diagnoses of AILDs was obtained
setting.
based on different diagnostic criteria for each type of
AILD (5-7).
PATIENTS AND METHODS
Statistical analysis
Ethical approval:
Statistical Package for the Social Science version
The study protocol was approved by the Ethics
20 (SPSS, IBM, and Armonk, New York) was used for
Review Board of Faculty of Medicine, Assiut
data analysis. Continuous data were expressed in the form
University and was conducted according to the
of mean ± SD and were compared with ANOVA test
declaration of Helsinki. The committee's reference
between different forms of AILDs. Nominal data were
number
is
17100051.
Clinicaltrails.gov
ID:
expressed in form of frequency (percentage) and were
NCT03898414. All co-authors have seen and agreed
compared by Chi²-test. The level of confidence was kept
with the contents of the manuscript and there is no
at 95%, hence a P value 0.05 indicated a significant
association.
3000
Received:30/1/2022
Accepted:29/3/2022
Protective effect of hesperidin on kidneys and testes of adult male rats exposed to bisphenol A
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3005-3013
Protective Effect of Hesperidin on Kidneys and Testes of Adult Male Rats
Exposed to Bisphenol A
Sara E. Kasem*1, Amira A. Abdelnaby2 , Palqees A. Mohammed1,
Shimaa B. Hemdan3, Rasha M. Z. Abd El-Fattah4, Reda M. Elsayed1
Departments of 1Forensic Medicine and Clinical Toxicology, 2Pathology, 3Biochemistry,
4Anatomy, Faculty of Medicine, Sohag University, Egypt
*Corresponding Author: Sara E. Kasem, Mobile: 01092635906, E-mail: sara_alsayed86@yahoo.com
ABSTRACT
Background: Bisphenol A, a global environmental pollutant, has been reported to induce organs toxicity. Hesperidin
is a flavanone glycoside which is found in citrus fruits. It has antioxidant properties; so it can protect cells from oxidative
stress. Objectives: The current study aimed to investigate the toxic effects of bisphenol A on the kidneys and testes after
repeated oral dose and evaluate the possible protective effect of hesperidin when co-administered with it.
Materials and Methods: Forty-two adult male albino rats were divided into four groups: Group I (Control group),
Group II (Hesperidin only group) received hesperidin orally at the dose of 200 mg /kg /day. Group III (Bisphenol only
group) treated orally with bisphenol A at dose 160 mg /kg /day. Group IV (Bisphenol& hesperidin group) received
bisphenol A and hesperidin. After two months, all animals were sacrificed, and blood was collected for analysis (kidney
functions and hormones level). The kidneys and testes were preserved for histopathological examination.
Results: Repeated oral administration of bisphenol A induced statistically significant increase in the level of urea and
creatinine, statistically significant decrease in serum level of FSH, LH and testosterone. Histopathological examination
of kidneys and testes revealed multiple histopathological changes. These toxic effects declined markedly when
hesperidin was co-administered with bisphenol A.
Conclusion: The present study concluded that bisphenol A has many toxic effects on kidneys and testes both structurally
and functionally and hesperidin has a protective role against such harmful effects.
Keywords: Bisphenol A, Hesperidin, kidney, Testes toxicity.
INTRODUCTION
MATERIAL AND METHODS
Bisphenol A (BPA) is considered one of the
Type of the study: Experimental study.
most common industrial manufactured chemicals all
Experimental animals: The study was conducted on
over the world (1). BPA is used in a wide range of daily
42 adult male healthy, albino rats having weight of 200
used plastic products, it can contaminate the
± 20 g. They were housed at laboratory condition for 1
environment extensively either by leaching from plastic
week prior to experimentation. Animals were housed 5
food and water containers, or as byproducts of
rats/cage in a temperature-controlled room (22 ± 2 °C)
industrialization. So, the food and drink are the major
with 1212 h darklight cycles at a humidity of 50
source of exposure (2).
±10%. Animals were fed with standard pellet feed and
Experiments using cultured cells and laboratory
water.
animals demonstrated that BPA is able to accumulate
and affect several vital organ functions, including the
Ethics considerations:
testis, brain, heart, liver and pancreas (3).
Ethical approval was obtained from the Medical
Hesperidin (HSD) is a flavanone glycoside
Research Ethics Committee of Faculty of Medicine -
which is found in citrus fruits and is considered as anti-
Sohag University, according to the commitment
inflammatory and antioxidant agent. It can decrease
standard operating procedure guidelines on
oxidative stress and produce pro-inflammatory
8/2/2022 under IRB registration number: Soh-Med-
cytokines in mice (4).
22-02-34. The experimental procedure was
Due to its antioxidant and anti-inflammatory
conducted in accordance with the guide of the care
properties, HSD has several biological effects for the
and use of laboratory animals approved by the
prevention of diseases, such as cardiovascular disease,
Medical Research Ethics Committee of Faculty of
diabetes and cancer (5). In addition, it has been reported
Medicine, Sohag University.
that HSD has beneficial effects on toxicities caused by
Drugs:
drugs and chemicals (6).
Bisphenol A: BPA was purchased from Sigma Aldrich
Majority of the population especially in the
corporation (manufacturing company).
developing countries may not be aware of the harmful
Hesperidin: HSD was purchased from Sigma Aldrich
effects of BPA on the human body (7). Hence, this study
corporation (manufacturing company).
aimed to study toxicity of bisphenol A on the function
Study design: The rats were divided randomly into 4
and structure of kidneys and testes of adult male albino
groups:
rats and study the efficacy of hesperidin in the protection
Group I (Control group): this group included 12
against kidneys and testes consequences that could result
animals. They were subdivided into two subgroups (6
from bisphenol A.
animals each): Group IA (Negative control): the rats
were fed on basal diet and distilled water for two
3005
Received:30/01/2022
Accepted:29/03/2022
c:\work\Jor\vol881_116
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3014-3021
Treatment of Open Femoral Fracture with Bone Loss: Review Article
Ahmed El-Sayed Soliman Mohamed*, Mohamed Ahmed Abdallah Mohamed Gharib, Wael Mansour
AbdElsamiae Abdallah, Mohamed Soliman hamed, Mohamed Aly Abdelraouf Ammar
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Ahmed El-Sayed Soliman, Mobile: (+20) 01011009082, E-Mail: dr.ahmedsoliman1978@gmail.com
ABSTRACT
Background: Attempting limb reconstruction in the presence of critical bone loss usually involves surgery which had
technically difficult, time-consuming, physically, and psychologically demanding for the case, with no guarantee of a
satisfactory outcome. The function of the salvaged limb might be disappointing due to residual pain, joint stiffness, and
neurovascular deficit. The case might require a secondary amputation due to refractory disease or non-union. Thus, the
correct initial decision as to whether to embark upon limb reconstruction or to perform a primary amputation had
important but difficult.
Objective: The aim of this essay had to evaluate various treatment options for open femoral fracture with bone loss
regarding, different methods to compensate for bone loss, and the complications of each one.
Methods: PubMed, Google Scholar, and Science Direct were searched using the following keywords: Treatment of
open femoral fracture, Bone loss, and Bone loss and complications. The authors also screened references from the
relevant literature, including all the identified studies and reviews, only the most recent or complete study was included
between June 2000 and December 2020. Documents in a language apart from English have been excluded as sources
for interpretation were not found. Papers apart from main scientific studies had been excluded: documents unavailable
as total written text, conversation, conference abstract papers, and dissertations.
Conclusion: Bone loss had a relatively uncommon problem encountered in the treatment of open fractures, and usually
occurs in the femur and tibia. The majority of defects had small and could be managed with standard methods of fixation,
and autogenous bone grafting. Larger defects with complex soft-tissue problems could be managed by shortening,
fixation with later lengthening.
Keywords: Treatment of open femoral fracture, Bone loss, Bone loss, and complications.
INTRODUCTION
procedures usually
require multiple
surgical
Historically,
because
of
the
problems
procedures, no weight-bearing during treatment,
involved in initial limb salvage, and the
had a limited extent of bone defect reconstruction
subsequent difficulty of reconstructing large
[3].
skeletal defects many fractures with critical bone
Various donor sites could be used for
loss had been treated by primary amputation.
vascularized bone grafting, such as the iliac crest,
Modern techniques of fracture stabilization, and
ribs, or the fibula. The accompanying skin
soft-tissue reconstruction made many severely
paddles (fibula, rib, ilium) or muscle components
injured limbs with bone defects salvaged in the
(latissimus dorsi, serratus anterior in rib flaps)
acute phase of treatment [1].
might be harvested at the same time. Thus,
Loss of bone might occur acutely in high-
reconstruction of combined soft-tissue and bone
energy open fractures, or it might result after the
defects could be provided by this technique.
debridement of devascularised or contaminated
There had also been indications for use in smaller
bone, the surgeon had faced with deciding how
defects, where improved blood supply had
much bone to remove. Aggressive debridement
needed for healing. The fibula had generally
of bone fragments helps in reducing the risk of
accepted as the most suitable vascularized bone
disease, but it also might create posttraumatic
graft
for
the
reconstruction
of
composite
segmental bone defects (PTSBD). Most authors
segmental long-bone defects[4].
recommend the removal of bone fragments that
Internal
bone
transport
or
distraction
had contaminated, and devoid of soft-tissue
osteogenesis had used successfully for bony
attachment. Inadequate resection of contaminated
reconstruction
for
bone
loss
procedures.
tissue, specifically bone, increases the risk of
Techniques include gradual or acute shortening,
chronic
disease
because
this
contaminated
rapid
distraction
using
auto-distractors,
devitalized tissue had an excellent medium for
transporting,
using
orthobiologic,
adjuvant
disease, the injured blood supply limits the
techniques to assist in the consolidation of
body's local resistance to disease[2].
regenerate, docking sites[3].
Surgical reconstruction of bone defects
For several years, circular external fixators
presents a critical challenge for orthopedic
had the method of choice for the correction of
surgeons.
Traditional
procedures
to
bridge
shortening and deformity in the long bones.
segmental bone defects had autogenous or
Besides
bone
lengthening,
circular
external
allogenic
bone
grafting.
However,
these
3014
Received: 01/02/2022
Accepted: 30/03/2022
c:\work\Jor\vol881_117
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3022-3028
Sonography Assessment of Amniotic Fluid Volume as a Predictor of
Fetal Outcome in Low-Risk Pregnancy
Alaa Hassieb Elsadek*, Ahmed Mohamed Atef, Diana Nageeb Salama,
Loay Mohamed Abdallah, Sabah Mohamed Saada
Department of Obstetrics and Gynecology, Al-Ahrar Teaching Hospital
*Corresponding Author: Alaa Hassieb Elsadek, Mobile: (+20)01092013675, E-Mail: dr3laaa@gmail.com
ABSTRACT
Background: An essential component of the amniotic sac, amniotic fluid (AF) aids in the growth of the developing
fetus. The volume of amniotic fluid (AFV) can be measured using a variety of methods. Objective: To determine which
is better in assessment of amniotic fluid volume, amniotic fluid index technique (AFI) or single deepest vertical pocket
technique (SDVP) for prediction of fetal outcome in low-risk pregnancies.
Patients and Methods: This work is a randomized comparative trial done at Zagazig University Hospitals on 240
pregnant women. Group (A): (Amniotic fluid index group); 120 women. Group (B): (Single deepest pocket group); 120
women. Ultrasound was used to measure amniotic fluid either by AFI or SDP methods. Cardiotocography (CTG) was
used to observe fetus intrapartum and Apgar score was used to assess infant post-partum.
Results: mean AFI was 8.8 cm in group A, mean SDP was 3.8 in group B. There was high statistically significant
difference between study groups in amniotic fluid assessment. A group had significantly more oligohydramnios than B
group. There was high statistically significant difference between study groups in CTG assessment of oligohydramnios
cases. Oligohydramnios cases in A group had significantly more reassuring CTG than oligohydramnios cases in B group.
In the A group, the difference between normal and abnormal AF was highly statistically significant.
Conclusion: Oligohydramnios and labour inductions for oligohydramnios were increased by using the AFI method,
however perinatal outcomes did not improve. Therefore, the SDP approach is the best way for determining amniotic
fluid volume.
Keywords: Amniotic Fluid Volume, Low risk pregnancy, Ultrasonography.
INTRODUCTION
stillbirth are all associated with oligohydramnios (a
An essential component of the amniotic sac, AF
decrease in amniotic fluid) (2).
aids in the growth of the developing fetus. The
It is possible to measure amniotic fluid using a
development of the fetal musculoskeletal system and the
variety of ways. Biophysical profiles testing uses the
growth and development of the gastrointestinal tract (GIT)
amniotic fluid index (AFI) and the single deepest pocket
are both aided by the consumption of amniotic fluid, which
(SDP) approach. Aside from that, there is also a two-
also serves as a vital source of nutrients for the developing
pocket approach and a subjective assessment, which are
baby. Bacteriostatic characteristics keep the body
less precise. To assess the health of the fetus, these
temperature stable and protect the fetus from harm. It
amniotic fluid volume measurements were made(2).
reduces fluid loss from the lungs and aids in the
There are a variety of ways to calculate AFV. To
development of the pulmonary system (1).
diagnose oligohydramnios (a lack of amniotic fluid), the
During the second and third trimesters of
maximum vertical pocket (MVP) method was developed.
pregnancy, the volume of amniotic fluid (AFV) grows to
The deepest amniotic fluid void of cords and limbs is used
700-850 ml, which equates to an AFI of 14-15 cm(1).
for this purpose. Oligohydramnios is usually diagnosed if
Fetal growth may be impeded by irregularities in fluid
the amniotic sac is less than 2 cm in diameter. The amniotic
volume, which may be an indication of an underlying
fluid index (AFI) is calculated by summing the amniotic
illness, such as fetal hypoxia or neural tube defects.
fluid in each of the four quadrants of the uterus(3).
Sultana et al. first identified oligohydramnios as a
SDP equals or more than 8 cm and AFI equals or
condition in which the amniotic fluid index (AFI) is less
more than 25 cm, both of which surpass the 95th percentile
than or equal to 5 cm(1).
of their respective gestational age dependent reference
According to numerous research findings,
ranges, or the extremely subjective feeling of a
oligohydramnios is linked to a number of unfavorable
polyhydramnios might be used to describe it(4).
pregnancy outcomes, such as fetal discomfort and an
Since the use of AFI leads to an increase in
increased risk of caesarean section and low birth weight.
oligohydramnios diagnoses and a rise in labour induction
Fetal health assessment is a crucial aspect of prenatal and
rates, it appears that the single deepest vertical pocket
postpartum treatment since it leads to the most appropriate
(SDVP) measurement is a superior alternative for
intra and postpartum care(1). Monitoring a pregnant
assessing AFV during fetal surveillance. The diagnostic
woman's health includes determining the amount of
accuracy of both approaches in identifying decreasing
amniotic fluid in her womb. Fetal growth limitation,
amniotic fluid has to be studied in a systematic manner.
meconium-stained amniotic fluid, fetal deformity, and
The use of AFI raises the number of pregnancies treated,
although there is no discernible benefit in the outcomes of
3022
Received: 26/01/2022
Accepted: 27/03/2022
c:\work\Jor\vol881_118
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3029-3032
Effect of Correction of Metabolic Acidosis on Serum Interleukin 10
Levels in Chronic Hemodialysis Patients
Mohamed Sary Gharib1, Fawzia Hassan Ahmed Abo Ali2, Heba William Adly1, Hossam Moustafa Elkady2
1Nephrology, 2Clinical Immunology and Allergy, Department, Internal Medicine,
Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Mohamed Sary Gharib, Mobile: (+20) 01000322177, E-mail: mohamedsary@med.asu.edu.eg
ABSTRACT
Background: Metabolic acidosis is a common complication in chronic hemodialysis (HD) patients and can cause loss
of lean body mass. Interleukin 10 (IL-10) also is increased in chronic HD patients and has a prognostic value.
Objectives: The aim of this study was to evaluate the effect of correction of metabolic acidosis on serum IL-10 levels
in chronic hemodialysis patients.
Patients and Methods: Forty chronic hemodialysis patients with predialysis bicarbonate levels <22 mEq/l were treated
by increasing dialysate bicarbonate concentration till achieving serum bicarbonate 22 mEq/l. Serum IL-10 levels were
measured at baseline and one month after correction of metabolic acidosis.
Results: Bicarbonate levels significantly increased at end of study (22.83±0.71 vs 18.85±1.12 mEq/l, p<0.001). Serum
IL-10 levels significantly decreased after correction of metabolic acidosis (19.91±6.68 vs 25.89±10.64 pg/ml, p<0.001)
and the change of IL-10 was significantly correlated with the change in bicarbonate (r = - 0.436, p = 0.005).
Conclusions: Correction of metabolic acidosis in chronic hemodialysis patients was associated with decrease in serum
IL-10.
Keywords: Hemodialysis (HD), Interleukin 10 (IL-10), Metabolic acidosis.
INTRODUCTION
Metabolic acidosis is a common complication in
The aim of this study was to evaluate the effect of
hemodialysis patients, which can cause loss of lean
correction of metabolic acidosis on serum IL-10 levels
body mass by impairing the activation of adaptive
in chronic hemodialysis patients.
responses that maintain protein stores (1). Some effects
of acidosis include negative nitrogen balance, protein
PATIENTS AND METHODS
catabolism, muscle wasting, increased corticosteroid,
The study was conducted at Ain Shams
and parathyroid hormone production (2). It is
University Hospital Dialysis Center. It included forty
recommended
to
maintain
predialysis serum
adult patients aged 18 years with end-stage renal
bicarbonate at 22 mEq/L (3).
disease (ESRD) treated with regular hemodialysis thrice
In patients with renal failure, the systemic
weekly for at least 3 months and having a mean
concentrations of both pro-inflammatory and anti-
predialysis serum bicarbonate of <22 mEq/L on
inflammatory cytokines are high compared to healthy
monthly laboratory analyses during the 3 months before
individuals due to both decreased renal clearance and
initiation of the study. Exclusion criteria were catabolic
increased production (4). Interleukin 10 (IL-10) is a
state (infection, surgery, steroid therapy) for 1 month
cytokine with potent anti-inflammatory properties. It
before the study, patients with hemodialysis catheter as
counter-regulates the cascade of proinflammatory
access for dialysis and patients on chemotherapy or
cytokines, including IL-6, as part of the acute-phase
other immunosuppressive drugs.
reaction.
A group of 20 healthy subjects served as the
The importance of IL-10 as an anti-inflammatory
control group only for measurement of serum IL-10 for
cytokine is emphasized by a study that showed a higher
comparison with study population. We collected
cardiovascular morbidity and mortality in maintenance
demographic data including age, gender. Medical
HD patients who had a low producing IL-10 gene
history including cause of ESRD, hypertension,
polymorphism (5).
diabetes mellitus (DM), smoking, cardiovascular
HD induces production of cytokines, which can
disease (CVD). The interdialytic weight gain (IWG)
induce protein catabolism and promote apoptosis (6).
was calculated as the mean of body weight gain before
High levels of interleukins and presence of metabolic
the mid-week HD session.
acidosis are described as independent risk factors for
morbidity and mortality in HD patients. Although
Ethical consent:
regular hemodialysis causes decreased levels of
An approval of the study was obtained from Ain
mortality, it is considered a condition associated with
Shams University Academic and Ethical Committee.
inflammation (7). To that end, we hypothesized that
Every patient signed an informed written consent
serum IL10, anti-inflammatory cytokine, will decrease
for acceptance of participation in the study. This
after metabolic acidosis correction.
work has been carried out in accordance with The
Code of Ethics of the World Medical Association
3029
Received: 01/02/2022
Accepted: 30/03/2022
c:\work\Jor\vol881_119
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3033-3037
Cementless Total Hip Arthroplasty in Drug-Induced Osteonecrosis
Mohamed Aly Abdelraouf Ammar*, Ahmed El-Sayed Soliman Mohamed, Mohamed Ahmed Abdallah Mohamed Gharib,
Ahmed Hamdy Elsayed, Wael Mansour AbdElsamiae Abdallah, and Mohamed Soliman Hamed
Orthopedic Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Mohamed Aly Abdelraouf Ammar, Mobile: (+20)01221980374, E-mail: ammar87ortho@gmail.com
ABSTRACT
Background: Osteonecrosis is a debilitating disease that may progress to collapse the subchondral bone and the articular
cartilage of the joint.
Objective: This study aimed to document the clinical and radiographic results of cementless total hip replacement
(THA) in patients with osteonecrosis of the femoral head.
Patients and Methods: This prospective clinical trial study was conducted on eighteen patients diagnosed with steroid-
induced osteonecrosis of the femoral head at the Orthopedic Department, Zagazig University Hospitals during the period
from August 2020 to the end of January 2021. All patients were subjected to Pre and post-operative clinical evaluation,
special radiological assessment was applied.
Results We assessed the clinical signs and symptoms using a modified Harris hip score pre and post-operatively. MHHS
of 90 points or more was categorized as an excellent result; 80-89 points were good; 70-79 points were fair; less than
70 points were poor results.
Conclusion: Advancements in surgical technique and better designs have greatly improved the long-term survival of
cementless implants in young patients with osteonecrosis of the femoral head.
Keywords: Osteonecrosis, Total hip replacement, Osteonecrosis.
INTRODUCTION
with higher failure rates when compared with the same
Osteonecrosis (ON) of the femoral head is a
performed in an older population. Moreover, it is
debilitating and potentially devastating condition that
believed that there is a difference in the prognosis of
has a poorly understood pathogenesis and a wide range
THA performed for various etiologies of osteonecrosis.
of causes (1). The etiology of osteonecrosis of the
The results of THA for osteonecrosis are less
femoral head (ONFH) is multifactorial, unclear, and
satisfactory compared with those of THA for other
partly unknown but this pathologic entity is the final
sources of osteoarthritis(6). There exists a debate about
common pathway of traumatic or non-traumatic factors
the method of fixation of the implants and the best
that compromise and at last interrupt the particular
possible bearing combination for these high-demand
circulation of the femoral head (2).
young patients. The advances in surgical techniques and
Many risk factors have been identified, but none
prostheses designs over the years have improved the
of them is a certain cause. The estimated frequency of
overall survivorship of total hip replacement (THA) in
the most frequent risk factors for ONFH is alcohol (20-
general. However, there are mixed reports about the
40%), corticosteroid therapy (35-40%), and idiopathic
improvement
that
occurs
in
patients
with
(20-40%) (2). The most commonly reported laboratory
osteonecrosis(7).
abnormalities include decreased function and
So, the purpose of this study was to document the
concentration of fibrinolytic agents, as well as increased
clinical and radiographic results of cementless THA in
levels of thrombophilic agents (3). Osteonecrosis of the
patients with osteonecrosis of the femoral head and to
femoral head commonly affects patients in the third,
determine the advantages and limitations of this kind of
fourth, and fifth decades of life (4).
treatment.
The collapse of the femoral head, accompanied
by secondary osteoarthritic changes occurs towards the
PATIENTS AND METHODS
later course of the disease. When the collapse is beyond
This study included patients diagnosed with
salvage by any other means, i.e: drilling, varus
steroid-induced osteonecrosis of the femoral head
derotation osteotomy, or free vascularized graft, three
studied prospectively. Patients were covered for six
options remain for treatment in young patients: total hip
months from the first of August 2020 to the end of
arthroplasty (THA), arthrodesis of the hip joint, and
January 2021. A sample of eighteen patients was
resection arthroplasty of the femoral head (5).
included. Female patients were more than males with a
Total hip arthroplasty (THA) is indicated for the
mean age of 36.39 years old.
alleviation of incapacitating hip pain due to trauma or
degenerative diseases of the hip joint and when the
Ethical consent:
femoral head has collapsed and the joint shows
Approval of the study was obtained from
advanced degenerative changes (1).
Zagazig
University
Academic
and
Ethical
THA remains the only helpful solution in
Committee. Every patient signed informed written
advanced stages of osteonecrosis; however, in the long
consent for the acceptance of participation in the
run, this intervention in young individuals is associated
study. This work has been carried out following The
3033
Received: 01/02/2022
Accepted: 30/03/2022
c:\work\Jor\vol881_120
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3038-3044
Recurrence of Hepatocellular Carcinoma in Hepatitis (C) Virus Related
Cirrhosis Treated with Direct Acting Antiviral Therapy
Salama Mohammed El-Ghoneimy, Rashed Mohammed Hassan,
Elsayed Saad Abd Elbaser, Eman Mohammed Elsaid Dief*
Department of Tropical Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Eman Mohammed Elsaid Dief, Mobile: (+20) 01008318180, E-Mail: emandief8181@gmail.com
ABSTRACT
Background: Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world. Its appearance is
mainly linked to the presence of liver cirrhosis, hepatitis viruses (HCV and HBV) are major etiological factors of
chronic hepatitis and fibrosis. The infection with HCV is still risk factor for HCC.
Objective: The aim of this work was to estimate recurrence rate of HCC in patients with HCV related cirrhosis after
direct-acting antivirals (DAAs) in (Sharkia Governorate).
Patients and Methods: This prospective cohort study was conducted in Tropical Medicine Department, Zagazig
University Hospitals, during the period between December 2017 and May 2018. This study included 120 patients with
cirrhosis caused by chronic HCV infection. Group A: included 60 patients with HCC treated with different modality of
intervention (ethanol alcohol injection, radiofrequency ablation and trans-arterial chemo-embolisation) showing
complete radiologic response and had HCV related cirrhosis and treated with DAAs. While Group B: included 60
patients with HCV related cirrhosis without development of HCC and treated with DAAs.
Results: There was no significant difference between the two groups regarding age, sex or any other demographic data.
Incidence of HCC was 33% in group A while 30% in group B 6 months after DAAs.
Conclusion: Recurrence of hepatocellular carcinoma in hepatitis (C) virus related cirrhosis treated with direct acting
antiviral therapy was common.
Keywords: Cirrhosis, Direct Acting Antiviral Therapy, Hepatitis (C) Virus, Hepatocellular Carcinoma.
INTRODUCTION
Accumulating clinical experience of DAA-based
Hepatocellular carcinoma (HCC) is the fifth most
treatment has suggested that post-SVR HCC recurrence
common malignancy in the world and the third cause of
may be more frequent compared to interferon based
the cancer related mortality. Its appearance is mainly
treatment. In a small series of HCC patients who
linked to the presence of liver cirrhosis, hepatitis viruses
achieved a SVR by oral DAAs after HCC treatment
(HCV and HBV) are major etiological factors of
cancer recurrence rates of approximately 30% within 6
chronic hepatitis and fibrosis (1).
months were reported; these rates are alarmingly high
The HCV infection is still risk factor for HCC.
(6).
The HCV virus, unlike the HBV virus, does not
The aim of this work was to estimate recurrence
integrate into the genome and its oncogenic power
rate of HCC in patients with HCV related cirrhosis after
seems to be related primarily to the effect of chronic
DAAs in (Sharkia Governorate).
inflammation with the progressive development of
fibrosis and cirrhosis. The average time between
PATIENTS AND METHODS
infection and the development of cirrhosis is about 20-
This prospective cohort study was conducted in
30 years; a variable proportion of patients with HCV
Tropical Medicine Department, Zagazig University
cirrhosis develop HCC with wide range of annual
Hospitals, during the period between December 2017
incidence of between 1-8% (2).
and May 2018. This study included 120 patients with
Other factors identified, which are associated
cirrhosis caused by chronic HCV infection. Cirrhosis
with increased risk of HCC, include the duration of
was diagnosed by history, clinical examination,
fibrosis, age, sex, platelet counts and level of HCV-
laboratory and radiological investigations (7). Chronic
RNA (3). However, some HCV viral components may
HCV infected patients were defined as positive HCV
have direct oncogenic effect; viral proteins can induce
RNA for more than 6 months.
deregulation of the host cells, the DNA mutations of the
infected cells and cause immune-mediated oxidative
All patients were divided into 2 groups:
stress (4).
Group A: included 60 patients with confirmed HCC.
New antiviral therapy such as the direct-acting
Diagnosis of HCC was based on the radiological criteria
antivirals (DAA) treatments have shown high
according to EASL (8). They were treated with different
effectiveness with sustained virologic response (SVR)
modalities of intervention (alcohol injection,
rates above 90%. Such therapies stop the
radiofrequency ablation and trans-arterial chemo-
necroinflammatory activity and so prevent the
embolisation) according to the stage of the HCC based
progression of fibrosis to cirrhosis and may reduce the
on the AASLD guidelines (9). Patients who had
risk of HCC (5).
complete radiologic response were included and treated
with DAAs sofosbuvir (400 mg/ day), daclatasvir (90
3038
Received: 02/02/2022
Accepted: 03/04/2022
c:\work\Jor\vol881_121
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3045-3050
Urinary PGF- 2 and Carotid intima Media Thickness in Simple
Obese Children: a Cross-sectional Study
Noura Mohammed Ibrahim El Bakry1, Ayat Mostafa Mohamed Ahmed2*
1 Pediatrics Department, 2Clinical pathology Department, Faculty of Medicine, Minia University, Egypt
*Corresponding author: Noura Mohammed ElBakry,E mail: Nour_elbakry86@yahoo.com,
Mobile phone: +20-1000-497498
ABSTRACT
Background: Obese children of all ages show signs of low-grade chronic inflammation. Circulating acute phase
reactants (CPR) and urinary PGF-2 are used to determine the severity of inflammation. Childhood obesity-related
inflammation seems to have a key role in the advancement of atherosclerosis. Obesity is a key contributor in the
evolution of metabolic disorder and collection of cardiovascular risk variables that may lead to heart illness and stroke.
Doppler ultrasound estimations of the intima media thickness (IMT) are a practical, direct, and noninvasive method for
evaluating and detecting preclinical artery wall diseases. It was connected to cardiovascular risk variables and was able
to foresee the likelihood of future cardio-cerebrovascular disease.
Objectives: The aim of this research was to look into inflammatory status as measured by serum highly sensitive acute
phase reactants (hs-CPR), oxidative stress as measured by urinary PGF-2, early arterial wall anomalies as measured
by IMT, and associations between the above studied parameters, clinical, and anthropometric measurements.
Methods: The research included 40 obese children aged 4 to 12 years who were chosen from The Outpatient Clinic of
Children University Hospital, Faculty of Medicine, Minia University. A control group of 25 age and sex matched
seemingly healthy youngsters was also recruited. Patients and controls had a comprehensive clinical assessment and had
their serum hs-CRP and urine PGF-2 levels analyzed. High-resolution B-mode ultrasonography was used to assess
IMT in the right and left carotid arteries.
Results: Serum hs-CRP and PGF-2 levels in obese children were considerably greater than in controls. Obese juvenile
patients had considerably greater median values of the left and right carotid arteries than controls.
Conclusion: Serum CRP and Urinary PGF- 2 were the most important and statistically significant factors affecting
IMT and can predict CVD risk in obese children.
Keywords: BMI, IMT, PGF-2, Simple obese children, Cross section study.
INTRODUCTION
IMT is a new, noninvasive marker for detecting
Obesity is described as having a body mass index
circulatory abnormalities and thereby CVD in children
(BMI) of 95th percentile or above for children of the
who are obese (7). The goal of this research was to look
identical age and sex. Obesity in children has been
into inflammatory status as measured by serum highly
shown to be more prevalent in industrialized nations,
sensitive acute phase reactants (hs-CPR), oxidative
although it is also becoming more prevalent in
stress as measured by urinary PGF-2, early arterial
underdeveloped countries (1).
wall abnormalities as measured by IMT, and
In Egypt, obesity had been markedly increased
associations between the above studied parameters,
among children and adolescent from 2004 to 2007. As
clinical and anthropometric measurements.
it was 2.4% among boys and 4.5% among girls in the
former, while 5.5% among boys and 5.6% among girls
PATIENTS AND METHODS
in the later (2).
From April 2020 to April 2021, cross-sectional
Multiple cardiovascular risk factors as,
research was done at Pediatric Department, Faculty of
hypercholesterolemia, hypertriglyceridemia, low levels
Medicine, Minia University Children Hospital. This
of HDL, hyperinsulinism, insulin resistance, and
research comprised 40 obese children (Group I) who
hypertension were found to be associated with obesity
were chosen from the Outpatient Clinic of the
(3). Obesity has been linked to a raise in systemic
University Children Hospital. Their ages varied from 4
inflammatory indicators like serum C-reactive protein
to 12 years. According to the Egyptian Growth Charts,
(CRP) and urinary PGF-2, which originate in adipose
children with simple exogenous obesity have a BMI
tissue, the liver, and numerous inflammatory tissues (4).
over the 95th percentile (8).
Obesity is accompanied with hepatic rise of CRP, which
is elevated in response to IL-6 released from visceral
Exclusion criteria: Obese children with chronic
adipose and reaching the portal circulation (4).
diseases as diabetes mellitus, endocrinal disorders as
Furthermore, in addition to CRP produced by the liver,
Cushing syndrome. Also, hereditary diseases, and
CRP produced by adipose tissue may have a role in
systemic inflammation as systemic lupus erythematosus
obesity-related elevated CRP levels (1).
or under any medication as corticosteroids.
Prostaglandin (PG)-F2 is regarded as a valid
A control group of 25 age- and sex-matched seemingly
oxidative stress indicator. PGF2 levels are increased in
healthy youngsters (Group II) was also recruited, with
obese children. In urine, the concentration of PGF2 is
ages ranging from 7 to 11 years.
forty times higher than that in plasma (6).
Baseline clinical assessment: All patients and controls
underwent a general medical examination, which
3045
Received: 01/02/2022
Accepted: 30/03/2022
c:\work\Jor\vol881_122
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3051-3057
Relation between Admission Troponin Level and TIMI Flow, Myocardial Tissue
Perfusion and Clinical Outcomes after Primary Percutaneous Coronary Intervention
Kamal Saad Mansour, Mohammad Moustafa Al-daydamony,
Mahmoud Korashy Mahmoud Khidewy*, Ekhlas Hussein
Department of Cardiology, Faculty of Medicine Zagazig University, Egypt
*Corresponding Author: Mahmoud Korashy Mahmoud Khidewy, Mobile: (+20)01150795879, Email: ddkorashy@gmail.com
ABSTRACT
Background: Cardiac troponin is a structural protein within the cardiac myocytes and is a highly sensitive and specific
marker to diagnose cardiac cells injury and damage.
Objective: This study aimed to detect the effect of troponin level assessed on admission on the angiographic and clinical
outcome post primary PCI.
Patients and Methods: We conducted a cohort study to assess the prognostic relation between rise of first troponin on
presentation and primary PCI success and post-primary PCI clinical outcome either during the hospital stay or during
the follow up period after discharge. This study was conducted on forty-four patients presented to the Emergency
Department with STEMI and underwent primary PCI.
Results: The TIMI flow grade post PCI was (I) in 5 patients (11.4%), (II) in 7 patients (15.9%) and (III) in 32 patients
(72.7%). For the 32 patients who had TIMI III flow, we went for further analysis of reperfusion by assessing the
myocardial blush by evaluating the TMPG. It was found that 3 patients (9.4%) had TMPG (I), 4 patients (12.5%) had
TMPG (II) and 25 patients (78.1%) had TMPG (III). No patients were recorded to have major flow limiting dissection
that ended with complications or coronary perforation. The in-hospital outcome was assessed and the total number of
patients who had complications during hospitalization was 12 patients (27.3%).
Conclusions: This study findings support that a single measurement of hs-cTnT provides significant incremental
information to risk stratification after STEMI.
Keywords: Cardiac troponin, STEMI, Percutaneous coronary intervention.
INTRODUCTION
first troponin on presentation and primary PCI success
Although the incidence of ST-segment elevation
and post-primary PCI clinical outcome either during the
myocardial infarction (STEMI) has decreased over the
hospital stay or during the follow up period after
past decade, it remains a common and morbid diagnosis
discharge. They were divided into two groups: Group 1
[1].
included patients of elevated hs-cTnT with levels equal
Primary PCI is a form of reperfusion therapy for STEMI,
to or more than 52 ng/l and this group has included 25
which should be done as soon as possible. This is
cases, 56.8% of the total patients' population. Group 2
because heart muscle starts to be lost once a coronary
that included patients with normal hs-cTnT with levels
artery is blocked and the sooner reperfusion therapy is
less than 52 ng/l and this group had included a slightly
delivered the better the outcome for the patient. The key
less percentage of patients, 19 patients, representing
points for dealing with STEMI are early diagnosis and
43.2% of total patients' population. Patients were
immediate reperfusion to limit myocardial ischemia and
informed about purpose of the study and were told that
infarct size and thereby reduce the risk of post-STEMI
their participation was voluntary.
complications including heart failure [2]. Due to the
development of prevention and treatment, the 6-month
Inclusion criteria: Patients with clinical presentation of
mortality after acute myocardial infarction (MI) has
STEMI who presented within 12 hours of symptoms
decreased considerably for patients with STEMI and
onset and were candidates for primary coronary
Non-ST-segment elevation myocardial infarction over
intervention as noted by elevation of total CK or CK-
the past 20 years [3]. To ensure the best outcomes for
MB twice above normal or high serum troponin levels
adults with STEMI, the ambulance service and hospitals
[4].
delivering primary PCI should work together to
Exclusion criteria: Patients who present late more than
minimise delays in treatment.
12 hours after onset of symptoms or if time of symptoms
In the present study, we aimed to detect the effect of
onset was unclear. Patients who had chronic renal failure
troponin level assessed on admission on the
on regular dialysis. History of recent PCI, within 30 days
angiographic and clinical outcome post primary PCI.
and expected to have early stent thrombosis. Patients
who had previous surgical revascularization, (CABG),
PATIENTS AND METHODS
as the Duke Jeopardy Scoring system for assessment of
This study cohort was study conducted on forty-
CAD severity couldn't be applied to them. Patients who
four patients admitted to the Cardiology Departments,
developed cardiac arrest on presentation. Patients who
Zagazig University and the National Heart Institute in
had Prinzmetal angina or had normal coronaries free of
the period from July 2019 till June 2021. The study
lesions and thrombi with angiography.
aimed to assess the prognostic relation between rise of
3051
Received: 06/02/2022
Accepted: 05/04/2022
c:\work\Jor\vol881_123
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3058-3062
Management of Pulmonary Alveolar Proteinosis Using
Whole Lung Lavage, Recent Update
Waleed Adel, Mahmoud Eldegwy, Alaa Omar*
Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Alaa Omar, Mobile: (+20)01001168488, Email: alaaomarcts1@yahoo.com
ABSTRACT
Background: Alveolar proteinosis is mainly autoimmune disease in which lipoproteins accumulate inside alveoli. In
severe cases it presents with dyspnea, tachypnea and cough. Lung lavage is the treatment of choice in symptomatic
cases. Objective: The aim of this study was to illustrate two different techniques of management of pulmonary alveolar
proteinosis (PAP) whether unilateral or bilateral whole lung lavage (WLL), analysis of indications, superiority and the
efficacy of the two techniques. Patients and Methods: This is a retrospective analytical study that included 31 patients;
all were done in Kasr Alainy Teaching Hospitals in the period between 2012 and 2021. All of our patients had
progressive severe respiratory symptoms. Pre-procedural, intra-procedural, and post-procedural data were recorded as
well as postoperative mortality, complications, ICU stay, relapses, and the need for recurrent settings of WLL. Results:
The median time from diagnosis of PAP to treatment was 10.6 months (range from 1 to 40 months). The median age
was 39.7 years (ranging from 19 to 70 years). Male patients were 22 (71%), while female patients were 9 (29%).
Unilateral WLL was utilized in 21 patients (67.7%) and bilateral WLL in 10 patients (32.3%). Marked improvement
occurred in 13 patients (41.9%), 12 patients showed partial improved (38.7%), 3 patients were stationary (9.7%), and
unfortunately, 3 patients (9.7%) worsened post lavage. Single relapse occurred in 9 patients, while multiple relapses
occurred in 5 patients. Conclusion: Bilateral WLL was found to be a good alternative to unilateral WLL, which is cost-
effective, less time consuming and even may decrease the incidence of relapses (single or multiple) with no significant
difference in the incidence of complications.
Keywords: Pulmonary alveolar proteinosis PAP, Whole lung lavage WLL.
INTRODUCTION
anesthesia. Unilateral or bilateral WLL are generally
Pulmonary alveolar proteinosis (PAP) is a rare
tolerated but associated with some complications(4).
disease that is characterized by a steady decline in gas
Possible complications of WLL include fever, fluid
exchange due to the progressive accumulation of
leakage, pneumothorax, pneumonia, pleural effusion,
phospholipoproteinaceous material in the alveolar space
metabolic acidosis, hypoxemia, wheezes, respiratory
(1). Phospholipoproteins are stained by periodic acid-
acidosis, and transient neuropathy. Also prolonged
Schiff (1-3). Patients of this disease complain of
mechanical ventilation, pulmonary thromboembolism,
progressive respiratory symptoms in the form of cough
transient cardiac ischemia, and cardiac arrest. Some of
and dyspnea which may lead to death from progressive
these complications were thought to have a higher
hypoxemia and cor pulmonale (1, 3). Radiologically,
incidence with bilateral WLL especially those related to
patient diagnosis depends on the typical appearance of
pulmonary edema and prolonged ventilation. However,
the "crazy-paving" pattern by high-resolution computed
all that mentioned complications are rare and the
tomography (HRCT) of the chest and by bronchoscopy
procedure generally is considered safe (3,4).
the presence of "milky" fluid in bronchoalveolar lavage
The aim of this study was to illustrate two different
(BAL) (3). It can be confirmed by staining using periodic
techniques of management of pulmonary alveolar
acid-Schiff (positive staining of proteins and lipids in
proteinosis (PAP) whether unilateral or bilateral whole
transbronchial, transthoracic or surgical biopsy)(3).
lung lavage (WLL), analysis of indications, superiority
According to the etiology of PAP, it can be
and the efficacy of the two techniques.
classified into three types autoimmune (primary, or
PATIENTS AND METHODS
idiopathic), secondary, and genetic (3, 4). Autoimmune is
This is a retrospective analytical study that included
the most common form characterized by anti-
31 patients all were done in Kasr Alainy teaching
granulocyte macrophage colony-stimulating factor
hospitals in the period between 2012 and 2021. All of
(GM-CSF) antibodies formation leads to deficient in
our patients had progressive, severe exertional dyspnea.
macrophage function and accumulation of proteins and
The diagnosis depended on CT characteristics of the
lipids in alveoli. In recent years, novel therapies were
PAP (Crazy paving) pattern which was confirmed by
introduced for the management of PAP, such as inhaled
bronchoalveolar lavage staining by periodic acid Schiff
GM-CSF, plasmapheresis, rituximab, and selective lobar
stain. All Patients were symptomatic (dyspnea,
lavage by fiberoptic bronchoscopy, the results of these
tachypnea) showing decline in lung function, decline in
therapies are not fully evaluated and costy (3).
resting PaO
Whole-lung lavage (WLL) is the standard level
2, decline in SpO2, and worsening of chest X-
ray or CT (Fig. 1). However, patients with heart failure,
of care for the treatment of PAP that was first described
severe cardiovascular disease, significant lung infection,
in 1963 (1-4). The procedure involves irrigation of the
sepsis, end-stage pulmonary fibrosis, and bleeding
lungs with warm saline and washing out the alveolar
tendency were excluded.
space. The procedure is conducted under general
3058
Received: 03/02/2022
Accepted: 04/04/2022
Original Article
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3063-3068
Association of Vitamin D with Inflammatory Bowel Diseases
Activity in Pediatric Patients
Hatem Mohammed Hussien, Motasim Mustafa Mohammed Salim*, Heba Gamal Anany Emam
Department of Pediatrics, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Motasim Mustafa Mohammed Salim, Mobile: (+20)01146618786, E-mail: Moro.moro866@gmail.com
ABSTRACT
Background: Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract and
is divided into Crohn's disease and ulcerative colitis.
Objective: This study aimed to find the correlation between vitamin D deficiency and IBD activity in pediatric
patients.
Patients and Methods: A case-control study was conducted at the Gastroenterology Clinic, Pediatric Department,
Zagazig University Hospital performed on 36 subjects divided into two equal groups; (group A) was a comprehensive
sample, and (group B) contained apparently healthy participants as a control group of the same age, sex, and ethnically
matched to the cases in the period between March 2021 to September 2021.
Results: The Mean 1,25 dihydroxycholecalciferol (ng/l) levels in the remission and active phases were 28.18 ± 3.42
and 14.06 ± 3.92 respectively and the fecal calprotectin ranged from 50 to 257 with a mean of 118.28 ± 55.06. There
was a non-statically significant correlation between Vit D and 1,25 dihydroxycholecalciferol levels in the remission
and active phases. Conclusion: This study found that 1, 25 dihydroxycholecalciferol level was lower in patients with
IBD than in healthy people.
Keywords: Vitamin D, Hypovitaminosis D, Inflammatory bowel disease.
INTRODUCTION
This study aimed to determine the association
Inflammatory bowel diseases (IBDs), such as
between vitamin D levels and IBD activity in pediatric
ulcerative colitis (UC) and Crohn's disease (CD), are
patients.
chronic inflammatory diseases that involve the
inflammation of the gastrointestinal tract(1). The
PATIENTS AND METHODS
underlying causes of IBD are not well understood,
This study included 36 children (their mean age
although the current hypothesis of pathogenesis
was 9.39 ±3.03), they were divided into equally two
involves the interaction between environmental
groups; Group (A) (Control) which included 18
triggers, gut microbiota, and genetic risk factors(2).
apparently healthy participants. Group (B) (Patients)
Vitamin D is an important micronutrient that
included 18 children with inflammatory bowel disease.
plays a critical biological role in various processes in
human tissues. Vitamin D can be obtained from dermal
Inclusion criteria: Children with documented IBD
synthesis following ultraviolet B (UVB) exposure,
diagnosis. Age below 18 years. Not on any VD
dietary intake, and supplementation(3).
supplements.
Vitamin D has a role not only in bone health and
calcium homeostasis but also a significant role in
Exclusion criteria: Children > 18 years. Missing
immune system function(4).
medical records. Missing informed consent. Written
However, both intestinal epithelial cells (IEC) and
Informed consent was taken from patients' parents
a wide variety of immune cells also possess the vitamin
and/or their caregivers.
D receptor (VDR), suggesting a role for vitamin D in
the regulation of IECs and the immune system. The
Ethical consent:
VDR has been identified in multiple types of immune
The permission for the study was received from the
cells including T-helper cells (CD4+), cytotoxic T-
Pediatrics Departments of Zagazig University
cells (CD8+), B cells, neutrophils, dendritic cells, and
Hospitals after the permission of the Institutional
macrophages(2).
Review Board (IRB). The research was carried out
Many studies have revealed a relationship
in compliance with the Code of Ethics of the World
between vitamin D status with the development and
Medical Association (Declaration of Helsinki) for
progression of different chronic autoimmune disorders
studies involving humans.
(5). Vitamin D is even proposed as a treatment for
autoimmune
diseases
such
as
multiple
METHODS
sclerosis, systemic lupus erythematosus, and IBD(6).
The medical records of the enrolled patients were
Recent studies have reported that vitamin D
retrospectively analyzed. Clinical records and laboratory
deficiency may play a role in the increased risk of
test results during the active and remission phases were
malignancies in IBD. However, limited studies have
collected for each patient. We recorded the highest
been conducted about the relationship between vitamin
disease activity score and longest duration of remission in
D and IBD activity, especially in pediatric patients(7).
cases when there were multiple active phases or remission
3063
Received: 06/02/2022
Accepted: 05/04/2022
c:\work\Jor\vol881_125
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3069-3077
Characterization of 42 Egyptian Children with
Lysosomal Storage Disorders
Eman M. Fahmy, Elsayed Abdelkreem, Osama E. Mohamed,
Mostafa M. Abosdera, Abdelrahim A. Sadek
Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Elsayed Abdelkreem, Mobile: (+20) 01114232126, Email: d.elsayedmohammed@med.sohag.edu.eg
ABSTRACT
Background: Lysosomal storage disorders (LSDs) are a heterogeneous family of genetic diseases with a broad
phenotypic spectrum. There is a paucity of data on LSDs from developing countries.
Objective: We aimed to study the pattern, relative frequency, and phenotypic spectrum of LSDs in children at an
Egyptian medical center.
Patients and Methods: This study included children < 18 years with LSDs diagnosed and followed up at an Egyptian
medical center from January 2018 to December 2021. Data were collected on patients' demographics, clinical features,
characteristic metabolites, specific enzyme assay, and genetic testing.
Results: Forty-two children (62% males, 74% parental consanguinity and 26% positive family history) were diagnosed
with 10 different LSDs, representing 14% of all cases with inborn errors of metabolism (IEMs). The most frequent LSDs
groups were mucopolysaccharidosis (MPS) (52.4%) and sphingolipidosis (40.8%). The most common individual
diseases were MPS I (26.2%), Gaucher disease (23.8), MPS III (16.7%), and acid sphingomyelinase deficiency (11.9%).
The median age at presentation was two years with a median diagnostic delay of 12 months. The most common clinical
manifestations were delayed development, intellectual disability, visceromegaly, coarse facial features, and skeletal
abnormalities. Finally, genetic data were available for only 12 patients (8 Gaucher disease, 3 MPS-III, and 1 MPS-VI).
Conclusion: LSDs (most commonly MPS and Gaucher disease) represent an important part of IEMs at our medical
center, and the diagnosis seems challenging and often delayed.
Keywords: Lysosomal storage disorders, Mucopolysaccharidosis, Gaucher disease, Enzyme assay, Gene analysis.
INTRODUCTION
with the advent of therapies for more diseases (e.g.,
Lysosomal storage disorders (LSDs) are a
enzyme replacement therapy, hematopoietic stem cell
heterogeneous family of inborn errors of metabolism
transplantation, small molecules, and gene therapies),
(IEMs), which causes lysosomal dysfunction with
but this remains highly challenging, particularly in
devastating consequences on patients, their families,
developing countries (2).
and health systems. To date, more than 70 different
LSDs are individually rare but collectively have
monogenic LSDs have been described, most of which
an estimated prevalence of 1 in 5,000 live births, but
have autosomal recessive inheritance, except for three
these diseases are likely more frequent among
X-linked entities (Fabry Disease, Hunter syndrome, and
populations with a high percentage of consanguineous
Dannon disease) (1). LSDs are caused by pathogenic
marriage, such as the Middle East and North Africa (1).
mutations in genes encoding for lysosomal proteins
The most commonly reported individual LSDs are
(e.g., lysosomal hydrolases), lysosomal membrane
Fabry disease, Gaucher disease, MPS, metachromatic
proteins, lipid and ion transporters, and enzyme
leukodystrophy, Pompe disease, and neuronal ceroid
modifiers/activators). These diseases are classified
lipofuscinosis (NCL). However, the prevalence and
based on the nature of accumulated intralysosomal
relative frequency of LSDs vary among studies from
macromolecules, such as mucopolysaccharidosis
different regions and ethnicities. For instance, NCL is
(MPS),
sphingolipidosis,
oligosaccharidosis,
relatively common in the Finnish population, Gaucher
mucolipidosis, and lysosomal membrane proteins
disease type I, Tay-Sachs disease, and acid
defects (2).
sphingomyelinase deficiency (ASMD) in Ashkenazi
LSDs are characterized by a broad phenotypic
Jewish, and Hermansky-Pudlak syndrome in
spectrum of nonspecific and overlapping clinical
northwestern Puerto Rico. This underscores the need for
manifestations, disease severity, and age at
specific regional and ethnic studies on the pattern and
presentations, which depends, at least in part, on the
characteristics of LSD (1, 3, 4).
degree of residual enzyme activity and rate of
Egypt is one of the largest countries in the Middle
intracellular macromolecule accumulation. They
East, spanning over 1 million Km2, has >100 million
frequently manifest as pediatric neurodegenerative
population (with around 2 million are added every
diseases that are oftentimes associated with
year), and is characterized by a high prevalence (35.3%)
visceromegaly. Nevertheless, based on the specific
of consanguineous marriage (5). Based on these data, the
genetic problem and accumulated macromolecules,
number of patients with LSDs is expected to be high,
LSDs can affect multiple organ systems with many
but it seems that only a small fraction (around 20%) is
other manifestations (3). Early diagnosis and
actually diagnosed (6). There is a paucity of data on the
management of LSDs have become quite important
prevalence, spectrum, and characteristics of LSDs in the
3069
Received: 03/02/2022
Accepted: 04/04/2022
RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3078-3082
Valvular Calcification in Hemodialysis Cases: Relation to Functional
Deficiency of Vitamin K and 25-Hydroxyvit-D Serum Level
Sherif El Sayed Mansour*, Ghada Mohamed Hasan Elkanishy,
Tarek Medhat Abbas, Ahmed Bahy Eldeen Ibrahim
Internal Medicine and Nephrology Department, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Sherif El Sayed Mansour, Mobile: (+20) 1091900828, E-mail: sherif_mansour1@yahoo.com
ABSTRACT
Background: Elevated incidence of death in hemodialysis (HD) cases is frequently accompanying with quicker
atherosclerosis and increased vascular calcification.
Objective: The current study aimed to determine the relation between valvular calcification in HD cases and
functional vitamin-K (Vit-K) as presented by serum level of uncarboxylated matrix Gla protein (ucMGP) and 25(OH)
vitamin-D (Vit-D) levels.
Patients and Methods: This work was conducted over six months and included 90 HD cases and 20 apparently
healthy adults with normal kidney function (to establish normal range of ucMGP); age and gender matched to the HD
cases.
Results: About one-third of the patients (41.1%) had calcifications on the aortic valve, and about one-quarter had
calcifications on the mitral valve (27.8%). Non-significant association was noted between MGP and vit-D (P = 0.439).
Conclusion: We suggested that the end-stage renal disease (ESRD) in HD is accompanied by a shortage levels of vit-
K and vit-D built in present work. The most important result of the present work was the significant difference in
MGP between patients and controls, suggesting a correlation between MGP level and aortic valve calcifications.
Keywords: Hemodialysis, Serum Level, Vit-K, 25-Hydroxyvit-D.
INTRODUCTION
hydroxyvit-D levels on vascular and valvular
Functional shortage of proteins concerned in the
calcifications isn't very obvious.
regulating calcium metabolism is perhaps a crucial
The current study aimed to determine the relation
mechanism for this procedure (1). A straight connection
between valvular calcification in HD cases and
amid the reduced accessibility of vit-K and vascular
functional vitamin-K (Vit-K) as presented by serum
calcifications had been proposed by many
level of uncarboxylated matrix Gla protein (ucMGP)
researchers(2).
and 25(OH) vitamin-D (Vit-D) levels.
Vit-K intake is influenced by reduced-potassium
and reduced-phosphorus-suggested diet in HD cases.
PATIENTS AND METHODS
Shortage of vit-K, either because of reduced intakes or
This study was done over six months and
the usage of coumarin derivatives, causes below
included 90 HD cases, and 20 healthy controls of
carboxylation of vit-K-depending proteins (VKDPs)(3).
comparable age to the HD cases, with ordinary kidney
The buildup of ucMGP in atherosclerotic lesions
functions (to establish normal range for ucMGP).
and zones of calcifications had been stated in many
Ninety HD cases were included in this work to assess
reports (4,5). Generally, cases with chronic kidneys
the presence of valvular calcification, and cases were
diseases, the shortage of active vit-D is very frequent
allocated according to the incidence of valvular
(6,7). Low level of 25-hydroxyvit-D is very clear in HD
calcifications to case group or controls and to evaluate
cases, and is accompanied with increased mortality
the relation with functional vit-K as presented by
rate (8).
serum level of uncarboxylated matrix Gla protein
Vit-D could raise the calcium and phosphorus
(ucMGP) and 25(OH) vit-D levels in these cases.
absorptions in the gastro-intestinal tract, thus elevating
the calcium-phosphorus products and vascular
Sample size:
calcifications, but in contrast, vit-D has positive
The needed sample size was determined via the
straight impact on the vascular wall (9).
Med Calc statistical software. The primary outcome
It was revealed that the serum vit-D levels in HD
measure is the correlation of valvular calcification with
cases is harmfully associated with vascular sclerosis
functional deficiency of vit-K and serum 25-
(10) and vascular calcifications grade (11). This proposes
hydroxyvit-D level in a cohort of HD cases. Sample
that, vit-D can be a calcification inhibitor, and low
size was estimated by using results from a preceding
levels of 25-hydroxyvit-D is strictly linked with
studies (14). So, it was reported that a suitable sample
cardio-vascular conditions and cardio-vascular death in
size was of 90 HD cases and 20 apparently healthy
HD cases (12, 13).
adults of comparable ages to the HD cases, with
Clinically, the active vit-D is frequently utilized in
normal kidneys functions (to establish normal range
HD cases on the foundation of high levels of
for ucMGP). The power of 80% (type-II error, 0.2)
parathyroid hormone, and 25-hydroxyvit-D isn't
chi-squared test with a confidence of 95% (two-sided
regularly determined. Consequently, the impact of 25-
type I error, of 0.05). This variance reflects the small
3078
Received: 07/02/2022
Accepted: 06/04/2022
c:\work\Jor\vol881_127
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3083-3088
Prediction of Atopic Asthma in Children with Asthma in Early Life
Rehab Goda Mohamed Abd Elkader1, Rasha Faisel Abd El Alim Abu El Dahab2
1 Egyptian fellowship in pediatrics, 2 Otorhinolaryngology Department, Shebin El-Kom teaching hospital, Egypt
*Corresponding author: Rehab Goda Mohamed Abd Elkader, E mail: rehabgoda79@gmail.com
ABSTRACT
Background: Childhood asthma is the most frequent chronic non-communicable condition. Preschool and early
childhood wheeze is common for many children. Asthma can be a lifelong problem for some children. Atopic asthma
is the commonest based on geneenvironment interactions identified by international research over the past 20 years.
Objective: This study aimed to predict atopic bronchial asthma in children at risk.
Methods: The present cross-sectional study was carried out on 50 asthmatic patients (29 males and 21 females).
Apparently normal 20 children of comparable age, sex and socioeconomic status were taken as a control group. The
patients were recruited from Otorhinolaryngology Clinics. They were suspected of atopic asthma with allergic rhinitis
or repeated attacks of common cold or other risk factors. The study was conducted through the period from May 2021
to December 2021. Results: Asthma was more prevalent in males in 2 groups with significant difference. There were
significant differences between asthmatic groups regarding family history of atopic diseases, seasonal variations, serum
IgE titer but non-significant regarding parasitic infestations, chest X-ray abnormalities and studied variables. There was
significant positive correlation between serum IgE titer and attacks severity, history of atopy and eosinophilia but not
with seasonal and diurnal variation. Conclusion: The presence of atopic diseases, family history of atopic diseases, high
serum eosinophilic count and high serum IgE titer in children with asthma in early life was found to be predictive to the
development of persistent asthma in adulthood.
Keywords: Asthma, Atopic, Children, Early Life.
INTRODUCTION
hypersensitive to aeroallergens with symptoms of atopy,
Preschool and early childhood wheeze is a common
such as dermatitis and rhino-conjunctivitis (7).
occurrence for many children. The majority of children
Asthma that lasts throughout childhood and into
grow out of their asthma symptoms, but for some, it
adulthood is the biggest burden on families and the
might be a lifelong problem. Families and physicians are
society, and hence is the primary goal of preventative
looking for ways to anticipate the course of sickness in
program (8). While the word "persistent asthma" is often
early children (1). There is a growing understanding that
associated with the clinical stage of asthma, it is used
the long-term answer to the asthma epidemic rests in
here to refer to a condition that lasts from infancy into
prevention rather than in the development of
adulthood. Childhood asthma and sensitization to
increasingly more sophisticated anti-inflammatory drugs
aeroallergens extend into adolescence,411 at least in the
for treatment of established disease (2).
developed world, and in some circumstances even into
The most frequent kind of asthma, atopic asthma, is
early adulthood in certain situations (9).
based on geneenvironment interactions that have been
The present study aim was prediction of atopic bronchial
identified by international research over the past 20
asthma in susceptible children in early life.
years. Because current treatment techniques for children
with asthma do not affect their long-term prognosis
MATERIAL AND METHODS
despite reducing symptoms and enhancing quality of
The present cross-sectional study was carried out
life, a new strategy is required (3). The ideal grail of
on 50 patients with bronchial asthma disease, 29 males
primary prevention is still an unattainable objective
and 21 females with an age range 2-14 years. Apparently
because of interactions that are still unknown. However,
normal 20 children of comparable age, sex and
the progress that has been achieved in this area is
socioeconomic status were taken as a control group. The
sufficient to justify a more structured approach to early
patients were recruited from Otorhinolaryngology
identification of high-risk children (4).
Clinics. They were suspected for atopic asthma with
Childhood asthma is the most frequent chronic non-
allergic rhinitis or repeated attacks of common cold or
communicable condition. Recurrent wheezing is
other risk factors as family history and other atopic
common in children, with estimates ranging up to 20%.
diseases affection among the period from May 2021 to
Some children's wheeze subsides as they become older,
December 2021.
while others develop lifelong asthma (5). Types include
Inclusion criteria: The children who have recurrent
transient infantile wheeze, in which children have
wheeze during early six years of life. The ability to
frequent episodes of wheezing for the first two to three
perform the required spirometry maneuvers in an
years of life but rarely do so afterward, viral-associated
acceptable and reliable technique.
wheezing, in which children typically have episodes of
Exclusion criteria: Children who had any clinical
wheezing linked to respiratory viral infections but may
and/or laboratory evidence suggestive of other chest
not wheeze at other times (6), and atopic asthma,
diseases and manifestations of heart failure clinically or
characterized by wheezing in children who have become
subclinically. Children with eosinophilia due to any
3083
Received: 08/02/2022
Accepted: 07/04/2022
c:\work\Jor\vol881_128
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3089-3093
Clinical Outcomes for Patients with Acute Myeloid Leukemia
Harboring IDH1 Mutation After Intensive Chemotherapy
Mohamed O. Azzazi, Walaa A. El Salakawy, John A. Saweris, Nour El Hoda H. Abdalla*
Department of Internal Medicine and Clinical Hematology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Nour EL Hoda Hussien Abdallah, Mobile: (+20)01069150063, E-mail: nourelhoda@med.asu.ed
ABSTRACT
Background: Acute myeloid leukemia (AML) is heterogeneous myeloid disorder with multifactorial pathogenic
mechanisms and a broad range of prognosis. AML is characterized by clonal proliferation of poorly differentiated cells
of the myeloid lineage.
Objective: This study aimed to detect Isocitrate Dehydrogenase 1 (IDH1) mutation in adult Egyptian AML patients and
to find correlation between the mutation and prognosis & survival in those patients after intensive chemotherapy.
Patients and Methods: Our study included 98 subjects with newly diagnosed AML. They all presented to Ain Shams
University Hospital (Hematology Unit). All Patients included in the study were subjected to: History taking and clinical
examination, laboratory investigations including routine investigations and cytogenetic studies for detection of IDH 1
mutation. All patients were followed up for their response to treatment for a period of 6 months.
Results: IDH1 mutation occurs in a considerable percentage of Egyptian AML patients that shows independent bad
prognostic impact on the clinical outcome.
Conclusion: IDH1 mutation occurred in a considerable percentage of Egyptian AML patients that showed independent
bad prognostic impact on the clinical outcome.
Key words: Myeloid leukemia, IDH1 mutation, Intensive chemotherapy.
INTRODUCTION
132 in exon 4 of the IDH1 gene. Additionally, a
Acute myeloid leukemia (AML) is heterogeneous
germline-synonymous single-nucleotide polymorphism
myeloid disorder with multifactorial pathogenic
(rs11554137) located in codon 105 in exon 4 of the
mechanisms and a broad range of prognosis. AML is
IDH1 gene has been reported to have prognostic
characterized by clonal proliferation of poorly
relevance in AML(7). The aim of the present study was
differentiated cells of the myeloid lineage (1). The
to detect IDH1 mutation in adult Egyptian AML
pathogenesis involves recurrent genomic alterations,
patients and to find correlation between the mutation
including somatic gene mutations and/or chromosomal
and prognosis & survival in those patients after
abnormalities that can define biologically distinct
intensive chemotherapy.
clinical subtypes (2). Comprehensive genomic profiling
at the time of diagnosis can inform disease
PATIENTS AND METHODS
classification, risk stratification and prognosis and
The study included 98 subjects with newly
ultimately allow for more selective therapeutic
diagnosed acute myeloid leukemia. They all presented
interventions. Alterations to cellular metabolism, as
to Ain Shams University Hospital (Hematology Unit).
well as somatic mutations of genes essential to
Inclusion criteria: The study included patients with
epigenetic regulation, are implicated in the pathogenesis
age between 18 to 60 years who are eligible to receive
of several human malignancies (3).
intensive chemotherapy newly diagnosed AML not
Isocitrate
dehydrogenases
(IDHs)
are
secondary to another malignancy or autoimmune
homodimeric enzymes involved in diverse cellular
disease.
processes, including adaptation to hypoxia, histone
Exclusion criteria: Patients with age under 18 years or
demethylation and DNA modification. IDH1 enzymes
older than 60 years, patients who are not eligible to
are localized to the cytoplasm and peroxisomes (4). IDH1
receive induction chemotherapy with curative intent
protein catalyze the oxidative decarboxylation of
thanks to their old age, poor performance status and/or
isocitrate to -ketoglutarate (-KG) to produce reduced
comorbidities and acute Promyelocytic Leukemia.
nicotinamide adenine dinucleotide phosphate. Diverse
dioxygenases depend on sufficient levels of -KG for
Patients included in the study were subjected to the
multiple cellular processes, as well as for epigenetic
following:
regulation (5).
History taking and clinical examination,
Somatic mutations in IDH1 (mIDH1) genes have
laboratory investigations including complete blood
been described in both solid and hematological
picture, coagulation profile, kidney & liver function
malignancies (6). IDH1mutations are heterozygous,
tests, electrolytes and LDH. Bone marrow aspirate
retaining one wild-type, suggestive of an oncogenic
examination at diagnosis for immunophenotyping by
gain of function. IDH proteins are encoded by the IDH1
flow cytometry, cytogenetic studies on bone marrow
gene located at chromosome 2q33. Recurrent IDH1
aspirate and molecular study when possible. Detection
mutations are missense variants leading to a single
of IDH 1 mutation by High Resolution Melting- (HRM-
amino-acid substitution of arginine residues at codon
PCR). All patients were followed up for their response
3089
Received: 09/02/2022
Accepted: 10/4/2022
Introduction
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3094-3100
The Frequency of Penile and Scrotal Abnormalities in Early Childhood
Boys Attending Pediatric Mansoura University Hospital
Ibrahim Abo Bakr Abdel-Hamid1, Nanees Abd El-Badie Salem2,
Ahmed Fathy State1, Amir Yahia Abdel-Raheem Abdel-Aal Leila*1
Departments of 1Dermatology, Andrology and STDs and 2Pediatric Endocrinology and Diabetes,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Amir Yahia Abdel-Raheem Abdel-Aal Leila, Mobile: (+20) 01060352021,
E-Mail: amiryahialeila@yahoo.com
ABSTRACT
Background: Scrotal and penile anomalies are among the common lesions in children, and some have no gross
functional or morphological import on the patient. But many of them can be corrected by surgical operation at the earliest
possible period, preferably when less than 23 years of age.
Objective: To determine the frequency of penile and scrotal abnormalities among boys (between 1-7 years of age)
attending Pediatric Mansoura University Hospital.
Patients and methods: This was an observational cross-sectional study which set in the Mansoura University Children
Hospital over a period of one year (February 2020 to January 2021). The study was undertaken on 5005 boys aged from
1-7 years.
Results: 0.2 % of the studied boys have phimosis, 0.3% hooded prepuce, 1.2% concealed penis, 0.8% penile torsion,
0.1% webbed penis and 0.1 % trapped penis. Chordee was detected among 0.4% of the studied cases, 0.4% hypospadias
and 0.1 % penile epidermoid inclusion cysts. 0.4% have bifid scrotum, 0.2% scrotal pigmentation and 0.1% of the cases
have scrotal hypoplasia. Mean anogenital distance was 4.186 cm ranging from 2.9 and 6.2 cm. Hydrocele and
undescended testis (1.2% and 1% respectively). Inguinoscrotal hernia was detected among 1.5%. Highest mean stretched
penile length among boys aged from 64 to 86 months (5.92 cm) followed by boys aged 38 to 63 months (5.5 cm) and
the least for group aged 12 to 37 months (4.7 cm).
Conclusion: External genitalia abnormalities are common in boys. Careful screenings of children are mandatory to
avoid the further complications.
Keywords: Early childhood boys, Frequency of penile, Scrotal abnormalities.
INTRODUCTION
differentiation and genital growth. They may be
Abnormalities of the male external genitalia
associated with different organ anomalies or other
and groins are a set of lesions, which may be congenital
syndromes. Acquired anomalies may be caused by
or acquired but are rather obscured to many kids and
infections and obesity, while iatrogenic anomalies could
their parents. This is particularly so where the parents
be due to circumcision and other penile surgeries (3).
may not be certain of what a normal external genitalia
Disorders of sex development (DSD) are a wide
and groin should look like (1).
variety of conditions with various features and
Among the congenital ones are hypospadias,
pathophysiology that most commonly present in the
epispadias, buried penis, micropenis, ambiguous
newborn or the adolescent. Affected newborns usually
genitalia, phimosis, paraphimosis, aphallia (penile
present with deformed genitalia, whereas adolescents
agenesis), diphallia, chordee without hypospadia,
present with delayed sexual development during the
hernia, hydrocoele, bifid scrotum, ectopic scrotum,
pubertal years (4).
cryptorchidism/undescended testis, retractile testes and
With the recent progress in prenatal diagnosis
epididymal cyst. The acquired ones may result from
including prenatal ultrasound (US) techniques and
circumcision which includes excessive residual
amniocentesis, fetal genitalia abnormalities can be
foreskin, excessive removal of skin, meatal stenosis,
diagnosed as early as 1316 weeks of pregnancy
granuloma, penile torsion, secondary chordee, skin
(5). Early diagnosis and treatment of certain
bridges, glans amputation, inclusion cyst and urethro-
abnormalities such as undescended testis, hypospadias
cutaneous fistula (1).
and varicocele could be of great importance for future
When a male child is born, it requires full
children fertility (6).
examination for the symmetry of external genitalia,
The aim of this study was to determine the
pigmentation of the genitals, presence of palpable
frequency of penile and scrotal abnormalities among
gonads and labioscrotal fusion. The measurement of the
boys (between 1-7 years of age) attending Pediatric
penis should be noted. The position of the penile meatus
Mansoura University Hospital.
and the number of perineal openings also need
assessment (2).
PATIENTS AND METHODS
Genital anomalies are common, they may be
This was an observational cross-sectional
congenital, acquired or iatrogenic. Congenital
study, which set in the Mansoura University Hospital
anomalies usually result from a disorder of genital
[Mansoura University Children Hospital (MUCH)], a
3094
Received: 09/02/2022
Accepted: 10/04/2022
c:\work\Jor\vol881_130
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3101-3104
Lower Respiratory Conditions in Down Syndrome: Review Article
Nasser S Alharbi
Department of Pediatrics, College of Medicine, King Saud University and Department of Pediatrics, King Saud
University Medical City, Riyadh, Saudi Arabia
Corresponding Author: Nasser S. Alharbi, Email: nsalharbi@ksu.edu.sa, Tele: +966118066318 or +966504442287,
orcid.org/0000-0001-9623-7093
ABSTRACT
Background: Down syndrome (DS) is by far the most common chromosomal abnormality, manifested clinically with
distinctive dysmorphism, functional and anatomical defects compromising multiple body systems with greater impact on
respiratory system. Objective: This review aim to review and summarize reported lower respiratory conditions that
exceeded the general population prevalence and their clinical outcomes in DS.
Methods: The databases were searched for articles published on 2 databases [PubMed and Google scholar] and Boolean
operators (and, or, not) had been used such as [Down syndrome, trismomy21, respiratory, pulmonary] and in peer-
reviewed articles between January 2005 and June 2022.
Conclusion: The spectrum of lower respiratory conditions in Down syndrome is wide. Multiple conditions confirmed to
be higher in individuals with DS compared to normal population. In this article we reviewed the prevalence and outcomes
of lower respiratory infections, recurrent wheezing, airways anomalies, pulmonary artery hypertension (PHN), Morgagni
hernia and subpleural cysts. The rarity and the non-specific clinical presentation of some conditions lead to delayed
diagnosis and intervention, warranting a need for awareness efforts targeting general practitioners and general
pediatricians.
Keyword: Congenital anomalies, Down syndrome, Pneumonia, Pulmonary hypertension, Wheezing.
INTRODUCTION
structural abnormalities, inability to control respiratory
Down syndrome (DS) is the most common
secretions and immune impairment involving both
chromosomal abnormality in the general population with
humoral and cellular arms of the immune system [4,9].
an incidence around 1 in 700 live birth [1]. It was first
Pneumonia is more common in DS than general
described by John Langdon Down in 1866 [2]. In most
population [9]. Individual with DS are prescribed with
cases it is caused by an additional partial or complete copy
antibiotics for pneumonia more often than general
of human chromosome 21 [3].
population [10]. They have higher risk for respiratory tract
This chromosomal anomaly is characterized by
related hospitalization with longer hospital stay [4,9,11].
distinctive dysmorphic features, anatomical anomalies
Pneumonia was also a lot more common cause of death
and functional defects. Variable body systems can be
amongst people with Down syndrome than in the general
involved, including but not limited to respiratory system
population [4].
[1].
Aspiration pneumonia is higher in individual with
People with Down syndrome have a life expectancy about
Down syndrome compared to normal population [4].
3 decades lower than the general population. Congenital
Day et al. [12] reported standardized mortality
heart disease and respiratory illnesses are the most
ratios of 140.4 for aspiration pneumonia as a cause of
common causes of early death [4]. Respiratory conditions
death among individuals with Down syndrome compared
account for one third of deaths of children with DS [5].
with the general population.
Lower respiratory illnesses spectrum includes but not
Stanley et al. [8] reported that 39% of screened
limited to increased risks of lower respiratory tract
Down syndrome had dysphagia severe enough to warrant
infections, recurrent wheezing, airways anomalies,
formula consistency change or nonoral feeds in particular
interstitial lung disease, pulmonary artery hypertension
individual
with
functional
airway/respiratory
(PHT), and Morgagni hernia [1,6-8].
abnormalities. Infants with desaturation with feedings and
Although there has been a noticeable improvement in
respiratory/airway anomalies had a significant risk for
Down syndrome care, awareness of lower respiratory
feeding and swallowing disorders. DS who are premature
illnesses in DS is necessary [1,4]. In this article we will
or underweight had an increased risk of dysphagia.
review lower respiratory conditions that could be
Bronchiolitis, especially that caused by
encountered in DS.
respiratory syncytial virus (RSV) is a common cause of
hospitalization in the general population, up to 3% of
Lower respiratory tract infections
children are hospitalized because d of RSV bronchiolitis
Individuals with Down syndrome has increased
[13,14]. The percentage of DS children who are hospitalized
risk of contracting respiratory infections because of their
with RSV-Bronchiolitis varying from 9.6% to 19.5% [15-
3101
Received: 8/02/2022
Accepted: 7/04/2022
c:\work\Jor\vol881_131
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3105-3111
Assessment of Pneumonia in Children with Acute Bronchiolitis Using Lung Ultrasound
Ahmed Taleb Mohamed Lemine*1, Hassan Albana Mohammed Salim1,
Khalid Mohammed Salah Abdelmeged1, Sameh Saber Bayoumi2
Departments of 1Pediatrics and 2Radiodiagnostic, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed T. Lemine, Mobile (+2): 010876585433, Email: ahmed6331137@gmail.com
ABSTRACT
Background: Bronchiolitis is a lower respiratory tract infection (LRTI), resulting from the inhalation of virus-
containing droplets. Chest ultrasound is not considered in the diagnostic algorithm for assessment of pneumonia in
children with acute bronchiolitis even though its usefulness has been tested in several studies in the last years as an
emerging diagnostic tool. Objective: The aim of the present study was to assess the diagnostic accuracy of lung
ultrasound (LUS) for the detection of pneumonia in children with acute bronchiolitis.
Patients and methods: This cross-sectional study included children from birth to 24 months of age admitted to
Pulmonology and Allergy Unit, Pediatric Hospital of Zagazig University. Children were diagnosed with bronchiolitis
according to the American Academy of Pediatrics guideline. All patients underwent posteroanterior chest X-ray (CXR)
because of clinical suspicion of concomitant bacterial pneumonia, persistent oxygen saturation (SatO2) < 90%, and
asymmetric breath sounds on auscultation.
Results: The mean age of the studied cases was 4.19 months and 86.7% of them were from 1 to 6 months. The most
common clinical findings among the studied group was wheezes (96.7%) followed by fever (60%). 63.3% of the studied
group had moderate respiratory distress, 26.7% had mild and 10% had severe. Abnormal findings of X-ray were peri-
bronchial thickening, lung consolidation and hyperinflation (13.3%, 13.3% and 10% respectively). Abnormal findings
of ultrasound were compact B line, subpleural lung consolidation and irregular pleural lines (53.3%, 26.7% and 3.3%
respectively).
Conclusion: Lung ultrasonography is more accurate and sensitive than chest X-ray to diagnose suspected cases of
pneumonia in the pediatric age group. LUS is a sensitive and highly specific diagnostic tool in children with community-
acquired pneumonia (CAP).
Keywords: Acute Bronchiolitis, CXR, Lung Ultrasound, Pneumonia.
INTRODUCTION
bronchiolitis, none have investigated the role of LUS in
Bronchiolitis is a viral lower respiratory tract
children with clinical bronchiolitis and suspected
infection (LRTI) that affects children less than 24
pulmonary bacterial co-infection (6).
months and represents the leading cause of
To date, the limited number of studies included in
hospitalization in infants (1). The main responsible
meta-analyses did not allow for subgroup analyses
pathogen is Respiratory Syncytial Virus (RSV), with
comparing the diagnostic accuracy of LUS for
infection typically occurring as recurrent seasonal
childhood pneumonia performed by novice versus
epidemics (2). There is evidence that RSV is the
advanced sonographers. It is currently unknown
predominant virus associated with bronchiolitis and
whether LUS's accuracy is significantly dependent on
pneumonia in young children. However, in older age
sonographer experience (3).
groups the role of other viruses, especially rhinoviruses
Therefore, this study aimed to assess the
becomes more pronounced (3).
diagnostic accuracy of LUS for the detection of
Nevertheless, there is high variation in the use of
pneumonia in children with acute bronchiolitis.
diagnostic tests across hospitals and chest X-ray (CXR)
is still performed in about 50% of bronchiolitis, mainly
PATIENTS AND METHODS
to diagnose or rule out bacterial pneumonia. It has been
A cross sectional study was conducted in
shown that children with clinical bronchiolitis are more
Pulmonology and Allergy Unit, Pediatric Department,
likely to receive antibiotics when radiography is
Zagazig University Hospital (ZUH) during the period
performed owing to similar radiographic appearance of
from May 2021 to October 2021. We have chosen 30
infiltrate and atelectasis (4).
cases of patients with acute bronchiolitis admitted to
Despite
these
attempts,
no
significant
ZUH within 6 months, 15 cases female and 15 cases
enhancement into clinical practice has been reached.
males (5 cases/month), which fulfill inclusion criteria
Lung Ultrasound (LUS) is a feasible, portable, easy to
with mean age = 4.19±3.32 months.
learn, and nonionizing radiation technique. In the last
Inclusion criteria: (1) Children from birth to 24 months
decades, it has become an emerging diagnostic tool for
of age, both sexes, admitted to Pediatric Hospital of
diagnosing pneumonia in children and adults, with
Zagazig University. (2) Children diagnosed with
remarkable sensitivity and specificity (5).
bronchiolitis according to the American Academy of
At present LUS is not included in the diagnostic
Pediatrics guideline(7) and undergone posteroanterior
work-up of bronchiolitis. In fact, although few studies
CXR because of clinical suspicion of concomitant
describe
the
sonographic
characteristics
of
bacterial pneumonia. (3) Bacterial pneumonia was
3105
Received: 10/02/2022
Accepted: 11/04/2022
Computerized tomographic study of the normal dimensions of the anterior horn of lateral ventricle in adults
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3112-3116
Vaginal Misoprostol Safety and Efficacy in Second Trimester Pregnancy
Termination in Women with a Previous Cesarean Section
Nadia Khairy Fathi Abou Elela*
Obstetrics & Gynecology Department, Alahrar Teaching Hospital, Zagazig, Sharkia, Egypt
*Corresponding author: Nadia Khairy Fathi Abou Elela, Mobile: (+20)01011140552, E-Mail: nadiakhairy056@gmail.com
ABSTRACT
Background: In patients who have already undergone a cesarean section, there is increasing use of medications to
terminate the pregnancy due to fetal death or fetal anomalies.
Objectives: To study the safety and efficacy of pregnancy termination using vaginal misoprostol in women undergone
a single lower segment cesarean section.
Patients and methods: This clinical trial study included 100 women (attending the Department of Gynecology and
Obstetrics, Benha University hospitals) with one previous lower segment cesarean section who were advised to
terminate their pregnancy (after 13-26 weeks) due to intrauterine fetal death or fetal structural anomalies. They were
divided into two equal groups Group I (cases) who had uterine scars, while Group II (control) without scars. History,
clinical examination, and ultrasound imaging were performed on all patients. There were 72 hours in which the patient
was given misoprostol every four hours via the vaginal route.
Results: It was found that the induction-to-abortion period was much shorter in the control group than in the cases group
despite no significant differences in age, parity, gestational age, or doses required to induce abortion between the two
groups. There were non-significant differences between patient group I with uterine scar and control group II without
uterine scar regarding doses needed, except for 1-4 doses and 9-12 doses which exhibited significant differences.
Conclusion: In women who have had a previous cesarean section, the vaginal route of misoprostol in a dose of 50 µg
/4 hours is safe and successful for inducing a second-trimester abortion.
Keywords: Second-trimester pregnancy termination, Vaginal misoprostol, Previous one cesarean section.
INTRODUCTION
are likely to play a greater role in deciding on a second-
Fetal abnormalities are easier to detect using
trimester termination method than objective outcomes
prenatal ultrasonography and serum screening tests. (1).
data(12).
When it comes to congenital abnormalities, prenatal
When Misoprostol was first developed, it was
ultrasonography and strategies for treatment vary
meant to prevent NSAID-induced stomach ulcers by
greatly from country to country(2). Unlike their
mimicking the effects of prostaglandin E1. Because of
American counterparts(3), France, where three prenatal
its cervical ripening and uterotonic properties,
ultrasounds are covered by the national health insurance
misoprostol has become one of the most important
program (4), is seeing an increase in the number of
medications in obstetrics and gynecology. Taking
women seeking an abortion after 15 weeks of
Misoprostol via the mouth, rectally, vaginally, and
pregnancy(5).
sublingually has shown to be a very convenient and
As a result, about 12 percent of all pregnancies
flexible method of administering the medicine. With
are clinically missed abortions(6). Historically, the
unsupervised
use,
significant
problems
and
treatment for missed abortion has been dilation and
teratogenicity can occur, despite the considerable
curettage, which is often performed in a hospital setting,
amount of medical evidence supporting its efficacy and
increasing costs greatly(7). Second-trimester missed
relative safety(13).
abortions treated medically rather than surgically save a
Misoprostol can be used even if a patient has had
great deal of money(8).
a cesarean section in the past (14). Regardless of
Expectant management comes with a certain
gestational age, uterine rupture is a greater concern, so
amount of uncertainty, and the psychological pain of
extreme care must be used(15).
carrying a nonviable pregnancy for an extended time
The purpose of this research is to find out if
can be overwhelming for some women(9).
vaginal misoprostol may safely and effectively
In light of the increasing prevalence of cesarean
terminate second-trimester pregnancies in women who
sections(10), Among women who have previously
have had a previous single lower segment cesarean
undergone a cesarean section, the likelihood of a
surgery.
medical reason to terminate the pregnancy is rising.
Second-trimester pregnancy termination in the case of a
PATIENTS AND METHODS
past cesarean delivery is becoming more common
The Benha University Hospital's Department of
among obstetricians due to the growing number of
Gynecology and Obstetrics conducted this clinical trial
women who have given birth by cesarean section(11).
investigation. All women aged 19 to 41 who had had a
In the context of previous uterine surgery, there
previous lower segment cesarean section and who were
is little data on how safe any termination approach is,
being evaluated for termination of pregnancy due to
and no treatment is risk-free. Physician opinion and skill
either intrauterine fetal death or fetal structural
3112
Received: 09/02/2022
Accepted: 10/04/2022
c:\work\Jor\vol881_133
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3117-3123
Study of Circulating Apelin in Type 1 Diabetic Patients and its
Association with Glycemic Control in a Group of Egyptian Population
Hanan Mohammed Ali Amer, Maram Mohammed Maher Mahdy,
Doaa Abd Ellatif Ahmed Taha, Dina Ahmed Marawan Marawan*
Department of Internal Medicine, Diabetes & Endocrinology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Dina Ahmed Marawan, Mobile: (+20)1018086289, E-mail: dr_dina2010@hotmail.com
ABSTRACT
Background: Type 1 diabetes mellitus (T1DM) is a common chronic and metabolic disease characterized by
hyperglycemia as a cardinal metabolic feature. Chronic hyperglycemia proved to cause macro and microvascular
complications. Studies proved that TIDM is associated with metabolic abnormalities and alteration of adipose tissue
hormones (adipokines). Adipose tissue yields many adipocytokines that modulate insulin sensitivity and play essential
role in the pathogenesis of diabetes. apelin is a multifunction neuropeptide, involved in the regulation of food intake,
cell proliferation and angiogenesis.
Objectives: The aim of this study was to evaluate the level of serum apelin in type 1 diabetic patients and to its
correlation with glycemic control.
Patients and Methods: This cross-sectional study was conducted on 100 Egyptian subjects including 60 type 1 diabetic
patients admitted to Endocrinology and Diabetes inpatient and outpatient clinics, Ain Shams University Hospitals and
40 healthy control subjects, during the period from June 2019 to January 2020.
Results: plasma apelin levels were significantly higher in diabetic group when compared to controls. Significant
negative correlation was found between the apelin level and HbA1c. The best cut off value of apelin between diabetic
and control is > 180 with 99.7% accuracy. Serum apelin 180 (ng/L) had sensitivity of 96.6 %, moderate specificity of
97.5%, positive predictive value of 98.3% and Negative Predictive value of 95.1%.
Conclusion: Increased levels of serum apelin in T1DM patients could be considered as promising adipokine for the
development of diabetic complications.
Keywords: Adipokines, Circulating apelin, Type 1 Diabetic Patients, Glycemic Control.
INTRODUCTION
Apelin, as a member of the adipose tissue-
Type 1 diabetes mellitus (T1DM) is a common,
derived peptides, might contribute to metabolic
chronic and metabolic disease characterized by
disorders. Some data have indicated that there is a
hyperglycemia as a cardinal metabolic feature. Long-
correlation between plasma insulin level and apelin
term damage, dysfunction and failure of various organs
expression in adipocytes. Apelin plays a beneficial role
especially eyes, kidneys, nerves, heart and blood vessels
in energy metabolism by increasing glucose uptake and
are caused by chronic hyperglycemia of diabetes. The
insulin sensitivity (4). One of the first apelin effects
incidence of T1DM is reported to be increasing by 3-5%
observed on glucose metabolism, apart from that on
per year, and the number of people with diabetes is
insulin secretion is apelin stimulated glucose transport
estimated to reach 380 million by 2025 (1). Several
and its glucose-lowering effect was additive to that of
studies have shown that TIDM is associated with
insulin (6). Apelin inhibits lipolysis in adipocytes and is
metabolic abnormalities and alteration of adipose tissue
involved in angiogenesis in adipose tissue.
hormones (adipocytokines or adipokines) (2).
Literature data documented also that glucose
Apelin, a described adipocytokine, is
arrival in the intestine causes its own absorption by
abundantly expressed in adipose tissue and produced in
inducing the paracrine secretion of apelin. A transient
many body parts by the endothelial cells. Apelin is a
increase in blood glucose levels in the portal vein could
bioactive peptide, produced by white adipose tissue. It
induce rapid secretion of insulin, and an improved
is synthesized as a prepropeptide then modified into
insulin sensitivity (7). Thus, apelin could also regulate
smaller peptides with higher potency. It produces its
glucose metabolism, by promoting glucose absorption
effects through a cell surface G protein coupled receptor
by the enterocytes and then by increasing portal blood
called APJ (3). Preproapelin is cleaved from its C-
glucose and insulin secretion. This could be in
terminus to produce a mature apelin peptides.
agreement with the fact that apelin was shown to
Its extensive tissue distribution suggests that the
increase GLP-1 secretion (8).
apelin /APJ system, also known as an apelinergic
Levels of apelin and APJ mRNA increase in
system, is involved in a wide range of functions
white adipose tissue and plasma with obesity.
including regulation of body fluid homeostasis, blood
Hyperinsulinemia may be the main cause for the rise in
pressure,
endocrine
stress
response,
cardiac
the expression of apelin. Data showed a positive
contractility, angiogenesis, and energy metabolism (4).
correlation between the level of apelin in plasma and the
Additionally, apelin participates in pathological
body mass index (9). Patients with obesity have impaired
processes, including heart failure, obesity, diabetes, and
insulin-stimulated vasodilation and increased ET-1
cancer (5).
(endothelin 1) vasoconstriction, which may contribute
3117
Received: 10/02/2022
Accepted: 11/04/2022
c:\work\Jor\vol881_134
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3124-3128
Assessment of Growth among Preparatory School Students in
Menia El-Kamh Sharkia Governorate
Hisham Sami Abdel Hamid1, Hosnia Mohamed Ragab2,
Ashgan Abdallah Alghobashy1, Engy El-Sayed Abdel Hamid*1
Departments of 1Pediatrics and 2Community Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Engy El-Sayed Abdel Hamid, Mobile: (+20)1095698558, Email: drengypediatric@gmail.com
ABSTRACT
Background: Normal growth is essential for development and general health of children. Height and weight
measurements are therefore the most important clinical findings in child development. In fact, short stature is a common
problem for children. It should not be neglected because the underlying medical conditions must be detected and treated
before satisfactory catch-up growth can be demonstrated.
Objective: This study was aimed to improve health status of the preparatory school children in Sharkia Governorate,
and to find the impairment factors associated with growth.
Patients and Methods: This cross-sectional study included a total of 538 students aged 12-15 years selected from
preparatory schools in Menia El-Kamh Sharkia governorate. This study was conducted between July 2017 to March
2018.
Results: The overall prevalence of short stature (SS), underweight, overweight, and obesity were 7.1%, 2.4%, 24.5%,
and 11.7% respectively.
Conclusion: The importance of assessment of Anthropometric measurement in children. Prevelance of overweight and
obesity in Preparatory School students was common. Obesity was common among females than males in our study.
Keywords: Assessment, Growth, Preparatory School students.
INTRODUCTION
concerns affecting developed and developing countries
Normal growth is essential for development and
alike. Short stature is also associated with
general health of children. Height and weight
cardiovascular system. In addition, SS in females may
measurements are therefore the most important clinical
be adversely affect the health and survival of her
findings in child development. In fact, short stature is a
offspring (6).
common problem for children. It should not be
It is also more prevalent in regions with high
neglected because the underlying medical conditions
infectious disease rates, and is linked to impaired host
must be detected and treated before satisfactory catch-
immunity. Children with SS always enroll later in
up growth can be demonstrated (1).
school compared to their healthy peers, and have lower
Assessment of growth of children and adolescents
overall years of education (7).
by using growth charts is an important part of clinical
Childhood obesity is also a strong predictor of adult
practice. The history of development of growth charts
obesity, and is currently, as well as childhood
dates back to the end of the 18th century and with
overweight, more prevalent in developed countries.
continued improvements mainly in terms of statistical
However, this might change in the future (8).
methods and chart design (2).
Zayed et al. (9) investigated the prevalence of SS,
In a previous systematic review, worldwide
underweight, overweight, and obesity among school
variations of human growth was demonstrated,
aged children in Jordan. They concluded that variations
indicating the risks of using a single reference growth
in height and weight among school children might be
chart in all countries (3).
affected by socioeconomic status.
In fact, the same remarks have been reported in
This study was aimed to assess the prevalence of
previous studies from KSA and USA. This was
short stature, underweight, overweight and obesity
confirmed in two reports regarding the implications of
among preparatory school children in Sharkia
using the Centers for Disease Control and Prevention
Governorate and to find the impairment factors
(CDC) or WHO growth charts for assessment of
associated with growth to improve health status.
nutrition and growth of Saudi children, potentially
exaggerating the prevalence of short stature and
PATIENTS AND METHODS
malnutrition (4).
This cross-sectional study included a total of 538
In short child, the prevalence of known growth
students aged 12-15 years selected from preparatory
disorders is more than in the total population, but these
schools in Menia El-Kamh Sharkia governorate. This
still represent the minority. In most short children no
study was conducted between July 2017 to March 2018.
diagnosis can be made, and these are known as having
idiopathic short stature (5).
Sample size and methods of selection: the total
It is increasingly apparent that different forms of
population was 38451 students, and the estimated
childhood malnutrition, from short stature (SS) and
prevalence was 15% at 80% power and 95%
underweight to overweight, are growing global health
3124
Received: 10/02/2022
Accepted: 11/04/2022
c:\work\Jor\vol881_135
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3129-3134
KFU Medical Students' Perceptions of Medical Professionalism
Muneera Alhajri, Latteefah Alnaeem, Muneera Alrubayii, Maathir Alhumam,
Sarah Alomar, Taif Alshammari
College of Medicine, Obstetrics and Gynecology Department, King Faisal University,
AI Hfouf, Kingdom of Saudi Arabia.
*Corresponding author: Latteefah Saleh Alnaeem, E-mail: Latifa_alnaeem@hotmail.com, Mobile No.: +966504935792,
orcid.org/0000-0002-3677-2454
ABSTRACT
Background: Transformation of medical students into medical professionals is a core competency required for
physicians since training and practice of medicine focus upon character, personal integrity, academic and technical skills.
Professionalism is associated with better clinical outcomes. Evidence shows that professionalism affects decision-
making, medical errors, patient interactions, patient satisfaction, and health outcomes. Professionalism is taught at the
Medical College in King Faisal University (KFU), but the importance is unclear for learners.
Aim: To understand if there is a difference between pre-clinical and clinical students' perception of professionalism
among students at the College of Medicine, King Faisal University.
Method: A cross-sectional study was conducted at King Faisal University, College of Medicine. Data were collected
through a Google electronic questionnaire involving 296 medical students. Data were analyzed using SPSS version 21.
Result: Of all pre-clinical-year, 97.1% of students had a good perception of personal characteristics that reflect
professionalism compared to 85.5% of students during the clinical years. The internal motivation was the most essential
characteristic of the personal characteristics at 77.3%, while personal appearance was ranked lowest at 48.6%. 90.9% of
respondents rated professionalism regarding respect interactions with patients as extremely important, followed by
confidentiality at 87.5%. Moreover, 83.8% of students considered respecting other team members is significant, while
51% agree that dishonesty should be reported.
Conclusion: The results of the analysis showed an increased insight of professionalism among students when it comes to
treating members or working with colleagues during a clinical setting.
Keywords: Medical; Perception; Professionalism
INTRODUCTION
The subject of professionalism is critically
Medical doctors' competencies could be
important because it can chart where healthcare has been
determined
by
several
factors,
including
and where it is headed(7). Several studies suggest that pre-
professionalism. Moreover, the overall outcome of
clinical years' students have different perceptions of
healthcare services is influenced by poor professionalism
professionalism than clinical years' students have, which
(1). Role modeling has been critical in transforming
is due to the application and observation of professional
medical students into medical professionals (2).
behavior among their senior doctors and consultants
Currently, medical schools develop medical curricula to
within the practice (transmitted by role models), rather
explicitly ensure medical students develop competency
than just learning it objectively. A study showed that
and understand the attributes and values relating to the
residents' ideas at King Abdulaziz University Hospital
role (3). However, there are divergent perceptions among
about professionalism are formed in the clinical setting,
young learners on the importance of a professional
both by input from seniors (consultants and senior
course. Although King Faisal University (KFU) medical
residents) and by that from peers (hospital staff and
college offers the course, there seems to be an unclear
fellow residents)(8).
understanding among the students on its importance.
Mentoring, role modeling, and exemplifying
Addressing
professionalism
in
medical
professionalism are critical in promoting the
education is challenging.(4). Even though several
development of optimal professional behaviors for the
definitions of professionalism in the context of medical
next generation of clinicians(8). This supports the findings
education are described in the literature, it is difficult to
of another study held at the College of Medicine in the
identify one that is universally applicable, as it is `context
University of Dammam (Imam Abdulrahman Bin Faisal
dependent' and includes several different culturally and
University (IAU), now), which revealed deficiency in
socially determined qualities and competencies(5). The
professional behavior among its participant. It was
American Board of Internal Medicine (ABIM) defines
rooted in the concept of decreased number of role models
professionalism in three statements: highly committed to
as well as that the curriculum lacked exposing students
excellence, interest in patient welfare, and response to
to the clinical settings in order to enhance their
the society's health needs. These statements focus on the
professional behavior(9).
main six elements of professionalism: honor and
It has been previously argued that professional
integrity, accountability, altruism, excellence, duty, and
values are `caught and not taught in the majority of
respect for others(6).
students(5) and remained largely within the domain of the
`hidden curriculum,' which is defined as the process,
3129
Received: 7/02/2022
Accepted: 6/04/2022
c:\work\Jor\vol881_136
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3135-3142
Value of Longitudinal Strain in Assessment of Patients with Suspected Acute
Coronary Syndrome and No Wall Motion Abnormalities
Magdy Mohamad Abdelsamie, Ahmed Abd Elfattah Elzayat, Waleed Salem Elawady,
Bosy Hamed Mohamed*, Moataz Elsanan
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Bosy Hamed Mohamed, Mobile: (+20)0107684322197, Email: bosy.hamed8054@gmail.com
ABSTRACT
Background: Echocardiography is a first simple technique for the evaluation of coronary artery disease (CAD), which
is useful in the diagnostic and prognostic workup of these syndromes. The clinical work-up of patients presenting with
chest pain is a diagnostic challenge.
Objective: We inspected the diagnostic performance of global (GLS) and territorial (TLS) longitudinal strain to predict
CAD in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) but
apparent normal global and regional systolic function.
Patients And Method: A cross sectional study included 90 patients with suspected NSTE-ACS with normal left
ventricular ejection fraction (LVEF) (50%) and wall motion score index (WMSI) (=1). Speckle-tracking
echocardiography was performed to all patients on admission then patients underwent coronary angiography or
noninvasive test according to their risk stratification. Patients were classified to 2 groups (CAD and No CAD).
Results: There was significant sensitivity and specificity of cardiac enzymes, GRACE score, Global longitudinal strain
and territorial longitudinal strain in identifying CAD. However there was no statistically significant difference in
conventional echocardiographic data between both studied groups. A cutoff value of GLS -17.1, TLS-LAD cutoff level
>-17.15, TLS-LCX cutoff level >-16.9 and TLS-RCA cutoff level >-16.3. GLS as a predictor for the number of affected
vessels, cutoff point of -15.4 can be used. A predictor for the presence of proximal lesions, cutoff point of TLS LAD
-15.1 and TLS LCX -15.3 can be used.
Conclusions: Global longitudinal strain and territorial longitudinal strain can be used for early detection of the presence
of coronary artery occlusion to identify patients who may benefit from early reperfusion. GLS also can predict
multivessel disease and TLS can be used as a predictor for the presence of proximal lesions.
Keywords: Acute Coronary Syndrome; Global and Territorial strain; Speckle-tracking Echocardiography.
INTRODUCTION
speckle tracking to support diagnosis in patients
There is a challenge to make a positive diagnosis
referred to echocardiography for clinical suspicion of
of acute coronary syndrome (ACS), especially in
ischemic disease and absence of visual wall motion
patients who have an equivocal initial clinical and
abnormalities. High sensitivity and specificity (86% and
paraclinical assessment (1). By allowing evaluation of
73%, respectively) were reported for cutoff values of
global and segmental systolic function and avoiding
LV GLS > -18,8% to detect significant coronary
differential diagnoses, echocardiography plays an
stenosis in patients with chest pain and inconclusive
important role in the clinical work-up of patients with
electrocardiographic (ECG) and blood test results,
chest discomfort (2,3).
providing an additive value to the wall motion score
Echocardiography is a first simple technique for
index (WMSI) (7,8).
the evaluation of coronary artery disease (CAD), which
The present study aimed to find a better
is useful in the diagnostic and prognostic workup of
characterization and management of patient with
these syndromes (4). Visual estimation of wall motion
suspected NSTE-ACS with apparent normal LV global
abnormalities may fails in detecting less clear or
and regional function and to determine the role of
transient myocardial ischemia and in providing accurate
longitudinal strain as assessed by speckle-tracking in
differential diagnosis (5).
those patients, also to correlate the results of
Speckle tracking echocardiography (STE) is a
longitudinal strain with the results of coronary
quick, easy and available noninvasive tool that provides
angiography.
additive information over basic echocardiography. It is
able to identify subtle myocardial damage and to
MATERIALS and METHOD
localize ischemic territories in accordance to the
This is a single center, cross sectional study,
coronary lesions. A clear "polar map" is useful for
conducted in Cardiology Department, Zagazig
differential diagnosis and management (1). However, the
University Hospitals, Egypt. We enrolled 90 patients
diagnostic value of 2D strain in suspected ACS patients
who had suspected NSTE-ACS and apparent normal
without global or regional wall motion abnormality has
LV global and regional function.
not yet been reported (6).
The latest European Society of Cardiology (ESC)
Inclusion and exclusion criteria:
guidelines for the diagnosis and management of non-
The study included all patients with suspected
ST-elevation ACS (NSTE-ACS) suggest the use of
NSTE-ACS but apparent normal left ventricular
3135
Received: 13/02/2022
Accepted: 12/04/2022
Introduction
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3143-3147
Screening of Charcot Foot and associated Risk Factors in Assiut
Diabetic Foot Care Clinic
Heba Mohamed Abdel Hafez*, Mohamed Hossam Eldin Hassan Maghraby, Walaa Anwar Khalifa
Department of Internal Medicine, faculty of Medicine, Assiut University Hospital, Assiut, Egypt
*Corresponding Author: Heba Mohamed Abdel Hafez, Mobile: (+20)01001386872, E-mail: dr.heba.abdelhafez@gmail.com
ABSTRACT
Background: Charcot foot is considered the most serious complications of poorly controlled diabetes mellitus. Till
now, there is paucity in assessment of frequent and risk factors of such complications in our locality.
Objective: This study aimed to estimate the percentage of Charcot foot in patients attending Diabetic Foot Care Clinic
and to evaluate the risk factors for its development.
Patients and methods: A cross-sectional study was conducted at Diabetic Foot Care Clinic over one-year duration
between 2015 and 2016. The study enrolled a total of 720 diabetic patient came for evaluation for diabetic foot. All
patients were subjected to history taking and physical evaluation especially foot examination. Characteristics of any foot
lesion was recorded with neurological evaluation of the affected foot.
Results: Out of 720 patients came to the clinic with diabetic foot, 100 (13.8%) patients were diagnosed to have Charcot
foot. Patients with Charcot foot had significantly higher age, frequency of male sex, type 2 diabetes that is poorly
controlled. Predictors for Charcot foot in the current study were old age, presence of hypertension, use of oral
hypoglycaemic agents, low albumin level, poorly controlled diabetes mellitus and hyperlipidemia
Conclusion: Diabetic Charcot arthropathy is associated with multifactorial risk factors and requires a concerted effort
from multidisciplinary teams. Special scrutiny, foot care and education are imperative, especially in chronic diabetic
patients with micro- and macro-vascular complications. Further prospective research with matched peripheral
neuropathy groups should be conducted.
Keywords: Diabetes mellitus, Charcot foot, Assiut Diabetic Foot Care Clinic.
INTRODUCTION
So, frequency of Charcot foot in the current study was
Diabetes mellitus is a long-term illness that can
13.8%. Based on the presence of Charcot foot, the
lead to a variety of consequences, including peripheral
patients were divided into two groups:
artery disease, foot ulcers, peripheral neuropathy, and
Charcot osteoarthropathy. The incidence of these
Group I included patients with Charcot foot (100) and
problems is predicted to rise (1).
Group II that included patients without Charcot foot
Charcot osteoarthropathy is a major limb-
(620).
threatening consequence of diabetes mellitus that is
often neglected. It's marked by painless swelling in the
Inclusion criteria: All diabetic patients attending
feet and ankles, as well as bone and joint deterioration.
diabetic foot care clinic (100 patients)
It can cause bone and joint deformities as a result of
underlying neuropathy, trauma, or any change in bone
Exclusion criteria: Patients with other diseases
metabolism (2). The "rocker bottom deformity," which is
affecting joints (rheumatoid arthritis and systemic lupus
a collapse of the midfoot, is the most common
erythromatosus or osteoarthropathy)
deformity linked with Charcot foot. X-rays are
important in determining the diagnosis of Charcot foot
Methodology:
and differentiating it from osteomyelitis. Charcot foot
All patients were subjected to through history
can also be diagnosed using other imaging techniques
taking (age, sex, residence, weight, height and body
such as CT scans, MRIs, and PET scans (3). In this study
mass index) with full clinical evaluation include
we aimed to estimate the percentage of Charcot foot in
duration of diabetes mellitus, therapeutic history either
patients attending Diabetic Foot Care Clinic and to
oral hypoglycemic drugs or insulin, history of previous
evaluate the risk factors for its development.
ulcerations and amputations.
Also, complete general physical and systemic
PATIENTS AND METHODS
examination was carried out. Physical examination of
A cross-sectional study was conducted at Diabetic
the lower limb was carried out both dorsal and planter
Foot Care Clinics of Internal Medicine Department,
surfaces of the foot were examined for swelling,
Assiut University Hospitals through the period between
erythema, increase in temperature and any
May 2015 and May 2016.
musculoskeletal deformity which were later on
confirmed by X-rays. Evidence of neuropathy is
Study subjects:
determined by decreased or absent sensation to pin
Out of 720 patients came to the Clinic of Diabetic
prick, light touch or vibration (Table 1).
Foot, 100 patients were diagnosed to have Charcot foot.
3143
Received: 15/02/2022
Accepted: 14/04/2022
c:\work\Jor\vol881_138
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3148-3154
Effectiveness of Transvaginal Sonoelastography in Differentiation between
Normal Cervix, Cervical Intraepithelial Neoplasia and Cancer Cervix
Mohamed Fathy Abo Hashim, Mohamed Lotfy Al Sayed,
Ahmed Nashat Fatah Allah*, Mohamed Ibrahem Amin
Department of Gynecology and Obstetrics, Zagazig University Faculty of Medicine, Zagazig, Egypt
*Corresponding author: Ahmed Nashat Fatah Allah, Mobile: (+20)0157855497, Email: ahmednashat784@gmail.com
ABSTRACT
Background: Early cervical cancer is mainly treated with surgery, whereas middle- and late-stage of cervical
intraepithelial neoplasia (CIN) is mainly treated with radiotherapy. Therefore, accurate preoperative diagnosis and
staging of cervical lesions are crucial to patients with cervical lesions.
Objective: The present study aimed to assess transvaginal sonoelastography in differentiation between normal cervix,
CIN and cancer cervix. Patients and methods: A Case-control study carried out in Departments of Obstetrics &
Gynecology and Radiology, Zagazig University Hospitals. Women were classified into three groups: Group A: 20 cases
with normal cervix, group B: 10 cases with CIN and group C: 10 cases with cancer cervix.
Results: There was non-significant difference between studied groups as regards age and smoking. While there was
significant difference regarding family history, weakened immune system, endometrial thickness and strain ratio.
Conclusion: Real time elastography (RTE) strain ratio (SR) of the uterine cervix, performed with a silicone ED as a
reference material, seems a reliable method for distinguishing between a normal cervix and malignancy. The technique
also showed promising results as a complementary investigation in diagnosing CIN.
Keywords: Sonoelastography, Transvaginal, Cervical cancer.
INTRODUCTION
PATIENTS AND METHODS
Cervical cancer (CC) is among the leading causes
A Case-control study carried out in Departments
of oncologic morbidity and mortality worldwide
of Obstetrics & Gynecology and Radiology at Zagazig
accounting for 6% of all cancers in women. The
University Hospitals, Sharkia, Egypt.
particular feature of CC is the possibility to detect its
precursor, cervical intraepithelial neoplasia (CIN).
Sample size:
Early intervention prevents the development of invasive
Assuming that all cases that fulfill the inclusion
forms of cancer (1). Cancer cervix is the only
and exclusion criteria included during the study period
gynecological cancer with clinical staging, according to
(6 months) were 3-4 cases/month, 20 cases were
FIGO. The stage is the key to the choice of treatment (2).
included as a comprehensive sample. Cases were
Techniques as magnetic resonance imaging
classified into three groups: Group A included 20 cases
(MRI), diffusion-weighted MRI, dynamic contrast
with normal cervix (control), group B included 10 cases
enhanced MRI and 18 F-fluorodeoxyglucose positron
with CIN and group C that included 10 cases with
emission tomography (FDG- PET). Although superior
cancer cervix.
diagnostic abilities of these techniques but not used in
existing practice due to high costs, long examination
Inclusion criteria: Women diagnosed or
time, large-scale equipment unavailability, radiation
suspected to have cervical malignant changes
exposure, and possible adverse reactions to contrast
attending at Zagazig University Hospitals with
agents (3). Complementary to conventional ultrasound
age group between 25 - 60 years.
examinations, sonoelastography has been the focus of
Exclusion criteria: Pregnant women and virgin
much medical research, as it is a non-invasive, widely
cases.
available imaging technique. So far, sonoelastography
has been intensively studied in thyroid and breast
Operational Design:
lesions, in liver and lymph node pathology (4).
All cases were subjected to full history taking
According to the physical principle underlying the
including: family, obstetric, contraceptive and
technique,
there
are
two
main
types
of
menstrual history. Screening for pregnancy. The
sonoelastography: strain elastography (SE) and shear
concentrations of hCG and TVS were tested in our
wave elastography (SWE). Both SE and SWE started to
cases and all samples were negative. Complete
be assessed in exploring the premalignant and
physical examination were done including vital signs
malignant lesions of the cervix (5, 6). The aim of the
as blood pressure, temperature, heart rate and
present study was to assess the usefulness of
respiratory rate. Signs of pallor, cyanosis, jaundice,
sonoelastography in differentiation between normal
and lymph node enlargement were examined.
cervix, CIN and cancer cervix in order to early detect
malignant
changes
using
transvaginal
Transvaginal sonoelastography:
sonoelastography.
Transvaginal sonoelastography was done at
Radiology Department using Canon applio 1 500
3148
Received: 14/02/2022
Accepted: 13/04/2022
c:\work\Jor\vol881_139
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3155-3162
Comparative Study among Gabapentin, Midazolam and Granisetron for
Prevention of Postoperative Nausea and Vomiting after Middle Ear Surgery
Ahmed Mohamed Salama Al-Najjar, Dalal El-Sayed Mohammad Soud,
Haitham Nuri Farg Hassan*, Nermeen Mohammad Ali Mohammed
Department of Anesthesia, Intensive Care and pain management, Faculty of Medicine Zagazig University, Egypt
*Corresponding author: Haitham Nuri Farg Hassan, Mobile: (+20) 01069022954, E-mail: haithamnuri85@gmail.com
ABSTRACT
Background: Postoperative nausea and vomiting (PONV) is the one of the most unpleasant complications. PONV is
more distressing for patients than pain.
Objective: The aim of the present study was to prevent PONV after middle ear surgery by comparing one hour
preinduction use of oral gabapentin, intravenous Midazolam or Granisetron.
Patients and methods: This was a prospective double-blinded randomized placebo controlled clinical study that was
conducted in Anesthesia, Intensive Care and Pain Management Department in Zagazig University Hospitals. The study
was carried out within 6 months on 108 adult patients between the ages of 21 and 65 years planned for middle ear
surgery. The study included 46 men and 62 women. The patients were divided into four groups: Control (C) group,
Gabapentin (G) group, Midazolam (M) group and Granisetron (GR) group (27 patients in each). Patients were followed-
up 24 hours postoperatively for the incidence and severity of PONV, hemodynamic changes, side effects of these drugs
and the need for rescue antiemetics.
Results: Vomiting and nausea was considerably higher in Group C. Moreover, nausea was noticeably associated with
Group G, It was reduced from 14.3% at 8-16 hr interval to 9.5% at 16-24 hr interval in M group. There was no significant
difference among studied groups regarding side effects. Only one patient in G group felt dizziness, one patient suffered
from extra pyramidal symptoms and one patient complained from vertigo. One patient in C group felt vertigo and 2
patients in GR group felt headache.
Conclusions: Using oral Gabapentin 300 mg, intravenous Midazolam 0.075 mg/kg or Granisetron 3 mg one hour before
induction of anesthesia in middle ear surgeries, surely causes a substantial reduction in occurrence of PONV.
Keywords: PONV, Gabapentin, Midazolam, Granisetron.
INTRODUCTION
PATIENTS and METHODS
PONV is the one of the most unpleasant
This prospective double-blinded randomized
complications. PONV is more distressing for patients
placebo-controlled clinical study was conducted on 108
than pain. The etiology of PONV is multi-factorial and
cases planned for middle ear surgery attended the
its occurrence depends on the type and duration of
Anesthesia, Intensive Care, and Pain Management
surgery, the type of drugs used during anesthesia, the
Department in Zagazig University Hospitals throughout
technique of anesthesia, age, sex, and smoking habit.
six months started from November 2021 to May 2022.
PONV increases intraocular and intracranial pressure,
causes wound dehiscence and prolongs duration of stay
Inclusion criteria:
in the recovery room and hospital. Also, PONV is an
Patients undergoing elective unilateral middle ear
uncommon cause of aspiration, dehydration,
surgeries under general anesthesia with age between 21
electrolytes disorder and even death especially in
and 65 years, both males and females, and belonging to
children and elderly patients and increase the cost of
ASA I or II. BMI 25-30 kg/m2.
treatment [1].
The incidence of PONV after middle ear surgeries
Exclusion criteria:
is high. It has been reported that 50-80% of the patients
Patients with a known allergy, sensitivity, or any
who undergo middle ear surgeries experience PONV [2].
other form of reaction to gabapentin, midazolam, and
To prevent PONV, different kinds of drugs could
granisetron. Patients with systemic comorbidities.
be
used
including
promethazine,
droperidol,
Patients with preoperative involvement of the inner ear
ondansetron, dexamethasone and propofol. Despite
or intraoperative gross damage to the inner ear. Pregnant
using different kinds of drugs, PONV is a common side
and lactating females or during menstruation period.
effect yet [3]. The objectives of the present study were to
History of motion sickness, CNS disorder especially
compare the incidence and severity of PONV after using
cerebellar problems and using antiemetic drugs. Addicts
oral Gabapentin, intravenous Midazolam or Granisetron
receiving benzodiazepine medication.
after middle ear surgery and to assess the side effects of
The patients were allocated randomly using a
the used drugs, which may include drowsiness, nausea,
computer-generated table into four equal groups (27
vomiting, diarrhea, blurred vision, dry mouth,
patients for each group). Group C (control) (n= 27)
headache, hiccups, stomach pain, weakness and feeling
where patients received a placebo tablet 1 hour before
sleepy.
induction with sips of water and 2 ml saline before
induction. Group G (Gabapentin) (n=27) where patients
3155
Received: 13/02/2022
Accepted: 12/04/2022
c:\work\Jor\vol881_140
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3163-3169
Results of Open Reduction and Internal Fixation of Proximal Third
Both Bones of Forearm Fractures in Adults
Salah Eldeen Ali Muftah Abdul-Aziz*, Ahmed Hashim Amin, Ahmed Mohamed Nahla, Mohamed Nagy Elalfy
Department of Orthopedic Surgery Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Salah Eldeen Ali Muftah Abdul-Aziz, Mobile: (+20)0101606 9417,
Email : salaheldeen755@gmail.com
ABSTRACT
Background: For displaced proximal fractures of the forearm in the adult, open reduction and internal fixation with
plating is usually considered as the best therapeutic option.
Objective: Improving functional outcome of patients with proximal third both bones forearm fracture in adults.
Patients and Methods: At Orthopedic Department of Zagazig University Hospital 12 patients with proximal third both
bones of forearm fractures in adults were studied in prospective research. Open reduction and internal fixation through
dynamic compression plate were done to all patients.
Results: the average operation time among the studied group were (59.8±6.8) minutes ranged from 30 to 95 minutes.
Only one case, which had infection, had delayed union (19 weeks), which was treated by antibiotics, otherwise the
average union time for all cases was (13.7±2.5) weeks and there was no un-union. Most of the studied group (66.7%)
had excellent Mayo elbow performance index followed by (16.7%) had good score then fair and poor (8.3%) for each.
There was statistically significant higher AO classification among poor and fair outcome than excellent and good
outcome as (100.0%) of poor and fair outcome were A2.
Conclusion: Open reduction and internal fixation (ORIF) is appropriate treatment of both bones forearm fracture. Plate
fixation was safe and effective treatment option for proximal both bones forearm fracture because it provided good
function outcomes.
Keywords: Forearm Fractures, Internal Fixation, Open Reduction.
INTRODUCTION
It was the goal of this study; improving functional
Adults commonly sustain upper extremity
outcome of patients with proximal third both bones
injuries such as concordant radius and ulna fractures (also
forearm fracture in adults in Zagazig University
known as both bones forearm fractures). Direct or
Hospitals.
indirect stresses acting on the radius and ulna can cause
these injuries. Indirect forces, such as axial loads during
PATIENTS AND METHODS
falls onto an outstretched hand, can produce fractures at
At Orthopedic Departments of Zagazig University
different levels, but they are more likely to cause
Hospital, 12 patients with proximal third both bones of
fractures at the same level in both bones. This type of
forearm fractures in adults were studied in prospective
fracture is difficult to stabilize in adults because of the
research, open reduction and internal fixation through
large force required for fractured both bones(1).
dynamic compression plate were done to all patients.
Bony union and satisfactory functional outcomes
can only be achieved in adult forearm fractures when the
Ethical consent:
anatomy is restored correctly. Because of this, most adult
Research Ethics Council at Zagazig University
forearm fractures necessitate surgery (2). Both bones of
approved the study (ZU-IRB #9070) as long as all
the forearm fractures exhibit unique issues in addition to
participants provided informed consent forms. Ethics
those found in all long-bone fractures, and conservative
guidelines for human experimentation were adhered
treatment of these fractures results in a poor functional
to by the World Medical Association's Helsinki
outcome because of their anatomical qualities. A small
Declaration.
amount of shortening and rotational misalignment occurs
Inclusion criteria: Gender: both male and female, closed
in other long bones, but the outcome is not significantly
fracture in upper third of forearm, displaced fractures,
harmed. The forearm, on the other hand, is an exception.
and compound fractures (Gustilo classification type I).
Regaining length, apposition, and axial alignment, as
well as normal rotational alignment and the radial bow is
Exclusion criteria: Pathological fractures, associated
essential for restoring appropriate range of supination and
neurovascular injuries, presence of infection, compound
pronation of the forearm (3).
fractures (Gustilo classification type II -III), and as a
For displaced proximal fractures of the forearm in
result of other injuries such as distal radioulnar joint
the adult, open reduction and internal fixation with
(DRUJ) disruption and distal fracture of the forearm.
plating is the preferred treatment approach. Compression
All Patients were subjected to:
has long been recognized as a useful technique for
1. A thorough review of the patient's medical history
achieving rigid internal fixation. It has been discovered
and an orthopedic examination.
that compression treatments have a decreased non-union
2. X-ray anteroposterior and lateral views on affected
rate and reduce joint stiffness during rehabilitation (4).
side, elbow and wrist X-ray.
3163
Received: 13/02/2022
Accepted: 12/04/2022
c:\work\Jor\vol881_141
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3170-3173
Study of Heel Pain in Rheumatic Diseases
Ahmed Mohamed Ahmed Mohamed*, Ahmad Farrag Thabet
Department of Internal Medicine, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt
*Corresponding Author: Ahmed Mohamed Ahmed Mohamed, Mobile: (+20)01008685514,
E-mail: ahmedharidy987@yahoo.com
ABSTRACT
Background: The differential diagnosis of heel and foot pain is extensive, but the most common is mechanical etiology.
The anatomic location of the pain can aid in diagnosis. Plantar fasciitis is the most common diagnosis, resulting in
medial plantar heel pain, particularly with the first weight-bearing steps after rest.
Objective: We tried to describe most common causes of non-traumatic heel pain in our locality.
Patients and methods: The current study was prospectively conducted between May 2019 and May 2020. The study
enrolled 100 patients who were complaining of heel pain. Full history evaluation and clinical assessment were done in
all patients
Results: Mean age of enrolled patients was 39.92 ± 14.49 years with range between 18 and 68 years. The majority
(52%) of enrolled patients were females and 48 (48%) patients were males. Based on clinical, laboratory and radiological
findings of enrolled patients; 45 (45%) had planter fasciitis, 32 (32%) had heel spur and 23 (23%) had Achilles tendinitis.
Conclusion: Non-traumatic heel pain is a common issue in the clinical practice. Planter fasciitis is considered the most
frequent etiology of such pain in our setting. Comparative studies between different available modalities for
management of heel pain are warranted.
Keywords: Achilles tendinitis, Heel pain, Heel spur, Planter fasciitis
INTRODUCTION
PATIENTS AND METHODS
One of the most prevalent foot problems
The current study was prospectively conducted
addressed by medical practitioners is chronic plantar
in Internal Medicine Department, Rheumatology Unit,
heel discomfort. It is estimated that 15% of all adult foot
Assiut University from May 2019 to May 2020.
issues requiring professional care are caused by it, and
it affects both sporty and non-athletic people (1).
Ethical consideration:
It is most frequent in persons over 40, but it has
This work was conducted in accordance with
been observed in people as young as seven years old and
Code of Good Practice and the guidelines of
does not appear to be gender-specific. Most people have
Declaration of Helsinki, 7th revision, 2013. Also,
pain beneath their medial heel when they bear weight,
approval by Institutional Review Board, Faculty of
especially first thing in the morning and when they
Medicine, Assiut University was obtained
begin weight-bearing activities like walking (2).
(No.17101163). This study was registered on
Burning, aching, and lancinating pain have all been
clinicaltrials.gov with ID no. NCT03311035.
mentioned as symptoms. Athletes may feel discomfort
Patients signed informed consent.
at the start of a run that intensifies as the race progresses.
Inclusion criteria: Any patient was complaining from
While it is seldom debilitating, it can significantly
heel pain was enrolled in the study.
restrict weight-bearing activities, leading in a reduction
Exclusion criteria: Any patient with recent trauma or
in both athletic and daily activities (3).
foot infection was excluded from the study.
Heel pain has become a catch-all word
embracing a wide range of diseases affecting the heel,
Methods:
as it has with many other disorders when the real
All enrolled patients were subjected to full
etiology is unknown. The most prevalent cause of
history taking and thorough physical examination. Age,
discomfort, on the other hand, is plantar fasciitis, and
sex and any chronic morbidity as diabetes mellitus,
the phrases are used interchangeably in the literature (2).
hypertension, ischemic heart disease, and chronic renal
Heel discomfort has an unknown origin,
failure were recorded.
however it is most likely complex. Many intrinsic and
Patients were asked about onset, course and
extrinsic risk factors for the development of the illness
duration of the heel pain. Any precipitating and
have been proposed in the literature and are typically
relieving factors were recorded. Patients were asked
classed as intrinsic or extrinsic. Intrinsic risk factors are
about any associated manifestation as dysentery,
anatomical and biological traits that make people more
diarrhea, urogenital association, skin or oral ulcers.
vulnerable to damage (4).
Degree to which this pain affected the daily activities of
There is paucity in the literature about
the patients was assessed, and any medication was
epidemiology of heel pain in our setting so, we designed
recorded.
this work to evaluate the most frequent etiologies of
Full physical examination was done with
non-traumatic heel pain.
special consideration to the foot. Any tenderness,
swelling or swelling at the heel was noticed. Special
3170
Received: 14/02/2022
Accepted: 13/04/2022
c:\work\Jor\vol881_142
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3174-3179
Laparoscopic Versus Open Surgery for Suspected Appendicitis
Mohamed Mahmoud Eltaweel
General Surgery Department, Faculty of Medicine, Al Azhar University, Cairo, Egypt
*Corresponding author: Mohamed Mahmoud Eltaweel, E-mail: dr.mo1718@gmail.com ,
Mobile phone: 00201009948830
ABSTRACT
Background: Laparoscopic appendectomy has mostly replaced open surgery. Appendectomy, or surgical removal of
the appendix, is one of the most common operations performed by a specialized surgeon and is used to teach the
fundamentals of laparoscopy - first by observing and then performing the procedure independently.
Aim of the work: This study compared laparoscopic and open surgery for suspected appendicitis.
Methods: A total of 200 individuals with probable appendicitis participated in this prospective randomized clinical
study. All patients over the age of 18 who had a clinical diagnosis of appendicitis were randomly randomized to either
open appendectomy (OA) or laparoscopic appendectomy (LA). First prophylactic antimicrobial treatment was
administered intravenously. Supine posture and general anesthesia were provided to all patients. After the operation, we
followed up for complications and survival. Results: The operating time in laparoscopic patients was significantly
greater. However, blood loss was substantially lower. The need for analgesics was substantially reduced in the
laparoscopic group. There was a substantial difference between included patients in both groups in terms of
postoperative stay length, time to return to work/normal activities, and the incidence of postoperative complications. In
terms of survival time or complication incidence, there was no significant difference between the two groups.
Conclusion: Despite the longer operational time, LA has a favorable hands-on OA in terms of blood loss, length of
postoperative stay, time to return to work/normal activities, and the incidence of postoperative problems. In terms of
survival time and complication incidence, there was no significant difference.
Keywords: Appendectomy, Appendicitis, Laparoscopic, Open surgery
INTRODUCTION
procedures done by a specialized surgeon and is used to
In Egypt, the majority of persons with stomach
teach the foundations of laparoscopy - first by watching
pain seek medical assistance in emergency rooms each
and then autonomously conducting the procedure.
year (1). The underlying causes of pain range from
Preoperative preparation, accurate diagnosis, good
benign processes to potentially fatal disorders. The
surgical technique, and follow-up treatment are the
prompt diagnosis and treatment of conditions for which
foundations of successful care. The anatomy of the
a delay in care might have significant consequences
patient must be considered while placing trocars (8).
remain a problem. The most common emergency
The appendix is usually straightforward to locate,
abdominal surgery is an appendectomy (2).
however, its position and location may fluctuate. The
Although appendicitis is commonly diagnosed in
appendix's base and artery are ligated during the
young boys with stomach pain, the diagnostic variables
treatment, and the appendix is removed in a plastic bag
for premenopausal women with a comparable clinical
(9). A healthy appendix should also be removed,
presentation are more difficult (3). Furthermore, stomach
although in this case, other causes of the symptoms
pain in the elderly might be difficult to diagnose owing
should be examined. A burst appendix requires
to delays in seeking medical attention or difficulty
significantly more difficult surgical excision, and
compiling a history and performing a thorough physical
peritonitis should be treated as quickly as feasible (10). A
examination (4). Because delayed diagnosis and
periappendicular abscess is a difficult procedure that
treatment of appendicitis are associated with a higher
should be conducted during the day. Most people who
risk of perforation, which leads to increased morbidity
have undergone a non-perforated appendix ectomy may
and mortality, quick intervention is crucial (5).
go home within 23 hours after the operation (11).
Although laparoscopy has been promoted for
In this study, we compared laparoscopic and open
appendicitis diagnosis, its invasiveness has precluded it
surgery for suspected appendicitis.
from being extensively employed. Minimally invasive
abdominal surgery became extensively employed in a
MATERIAL AND METHODS
very short time with the introduction of laparoscopic
A total of 200 individuals with probable
appendicectomy (6). Laparoscopic appendicectomy was
appendicitis participated in this prospective randomized
not previously used to treat acute appendicitis since
clinical study. The study was performed in Al Azhar
open appendicectomy had fewer risks and side effects.
University Hospitals from December 2018 to February
It is, however, now routinely used in hospitals and has
2021. All patients over the age of 18 who had a clinical
been demonstrated to be a safe therapy (7).
diagnosis of appendicitis were randomly chosen for
Laparoscopic appendectomy has mainly taken the
either open appendectomy (OA) or laparoscopic
place of open surgery. Appendectomy, or surgical
appendectomy (LA).
removal of the appendix, is one of the most common
3174
Received: 9/02/2022
Accepted: 10/04/2022
c:\work\Jor\vol881_143
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3180-3184
The Association of Diabetes Mellitus and Inflammatory Bowel Disease
Fatema AboBakr AbdEl-Moez, Lobna Abdel-Wahid, Mario Medhat Farag*,
Mohamed Abozaid Ali Abozaid
Internal Medicine Department, Faculty of medicine, Assiut University, Assiut, Egypt.
Corresponding Author: Mario Medhat Farag *, e-mail: mariomedhat109@yahoo.com, Tel: +201271256766
ABSTRACT
Background and aim: Inflammatory Bowel Disease (IBD) and Diabetes mellitus (DM) etiology are still unclear, but
both have genetic basis and share several complications. So we aimed to search for whether the two diseases are
associated with each other and whether there are risk factors that increase the incidence of diabetes mellitus in
inflammatory bowel disease patients.
Methods: This study was conducted on 130 inflammatory bowel disease patients who were diagnosed by
colonoscopy and biopsy from EL-Raghy Assiut University Hospital and were not known to have DM before the study
in the period from October 2019 to June 2021.
These patients underwent a full history, a thorough clinical examination, and routine lab investigation, especially
fasting blood sugar (FBS) and glycosylated hemoglobin (HbA1c).
Results: Out of 130 patients; 26 (20%) were found to be diabetics and the other 104 (80%) were non-diabetics. The
mean age of the studied patients was 32.45 ± 9.05 years, majority (78.5%) of them were males. And we found that
patients with DM were significantly younger than those without DM. The family history of DM was higher among
those patients with DM. The susceptibility of DM is increasing with the lengthening of IBD duration. No significant
difference was present between both groups of patients as regards the type of treatment for IBD.
Conclusion: Diabetes mellitus risk increases in patients with IBD who are younger than 30 years old, have a positive
family history of diabetes mellitus, and have had IBD for more than 3 years.
Key words: Association, Diabetes mellitus, Inflammatory Bowel Disease.
INTRODUCTION
MATERIALS AND METHODS
Inflammatory bowel disease (IBD) is relapsing
Ethical approval:
destructive inflammation of the gastrointestinal tract
The study protocol was approved by the Medical
due to an abnormal immune reaction to gut microflora.
Ethics Committee of the Institutional Review Board
This is subdivided into two main groups: Ulcerative
of the Faculty of Medicine, Assiut University, Egypt
colitis and Crohn's disease (1). IBD happens in
(IRB No. 17101049). Informed and written consent
genetically susceptible patients (2).
were obtained from all participants according to The
Diabetes mellitus is chronic hyperglycemia due to
Code of Ethics of the World Medical Association
insulin secretion defects, lack of insulin action, or both.
(declaration of Helsinki) for studies involving
with abnormalities in proteins, carbohydrates, and lipids
humans. The study protocol is registered at
due to the anabolic function of insulin (3). There are two
clinicaltrials.gov ID: NCT04105348.
types: type one and type two: Type one is caused by
pancreatic beta cell destruction, mostly due to
Study Participants:
autoimmune destruction. Type two is caused by insulin
A cross-sectional hospital-based study at EL-Raghy
resistance and causes a functional insulin defect (4).
Assiut University Hospital on all IBD patients who
Though both diseases' etiology is still unclear, it's
needed medical advice in the period from the first of
mostly that in individuals who are genetically
October 2019 to the end of June 2021. 130 patients were
susceptible, both environmental and host factors lead to
enrolled with IBD in the form of 100 patients with
uncontrolled immune reactions(5). Both diseases share
ulcerative colitis (UC) and 30 patients with Crohn's
multiple complications as; hepatobiliary, neurological,
disease (CD), as diagnosed by colonoscopy and
post-operative, vascular and osteoarticular (6).
histopathological examination and who were not known
Corticosteroids are used as a line of treatment for
to have DM. 102 of them were males and 28 of them
IBD (7). The information about the incidence of
were females, with a mean age of 32.45 ± 9.05 years
hyperglycemia or diabetes due to corticosteroid in IBD
old, with a body mass index (BMI) of 24.12 ± 2.37
is limited (8). IBD may show both metabolic or
Kg/m2 and 100 patients (76.9%) had UC and 30 patients
endocrinal associations as; insulin resistance and lipid
(23.1%) had CD. Patients were excluded from the study
abnormality (9).
if they were under the age of 18 or had DM before IBD
In this study; our target was to evaluate the
diagnosis.
association and the risk factors that increase the
All patients in this study were subjected to a full
incidence of diabetes mellitus in inflammatory bowel
history including the patient's age, residence in a rural
disease patients.
or urban area, smoking, marital status, family history of
DM, family history of IBD, time of IBD onset, and type
3180
Received: 7/02/2022
Accepted: 6/04/2022
c:\work\Jor\vol881_144
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3185-3191
Intraperitoneal Bupivacaine with Dexamethasone versus Bupivacaine Alone for Pain
Relief after Laparoscopic Bariatric Surgeries: A Randomized Controlled Trial
Yasser M. Nasr1, Salwa H. Waly*1, Wael Elsayed Lotfy Mokhtar2
Departments of 1Anesthesia, Surgical Intensive Care and Pain Management and
2General Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Salwa H. Waly, Mobile: (+20) 01224329364, E-Mail: salwa.waly@yahoo.com
ABSTRACT
Background: Pain after laparoscopic bariatric surgeries has negative effects on patients' recovery.
Objective: To evaluate efficacy and safety of adding intraperitoneal dexamethasone to bupivacaine for postoperative
pain relief after laparoscopic bariatric surgeries.
Patients and Methods: Sixty patients were randomly allocated into 3 groups as follows: Group B (n=20): bupivacaine
100 ml 0.25% + 5 ml normal saline. Group BD4 (n=20): bupivacaine 100 ml 0.25% + 4 mg dexamethasone (1 ml) +
saline 4 ml, and Group BD8: (n=20) bupivacaine 100 ml 0.25% + 8 mg dexamethasone (2 ml) + saline 3 ml.
Postoperatively ketorolac IV 30 mg/6 hours + Paracetamol IV 1 g/8 hours were given± nalbuphine.
Results: Pain was lower in Group BD8. Sedation was deeper in Group B. Time to first supplementary analgesia was
longer in Group BD8 than Groups B or BD4, and longer in Group BD4 compared to Group B. Patients requiring
supplementary analgesia were less in Group BD8 than Groups B or BD4. Total postoperative consumption of nalbuphine
in the first postoperative day (POD 1) was less in Group BD8 than Groups B or BD4, and less in Group BD4 than Group
B. Time for independent ambulation was shorter in Group BD8 than Groups B or BD4, and shorter in Group BD4 than
Group B. Postoperative nausea and vomiting (PONV) was higher in Group B compared to other groups.
Conclusion: Intraperitoneal administration of either 4 mg or 8 mg dexamethasone to bupivacaine (0.25%) resulted in
better recovery and pain relief after bariatric surgeries. Dexamethasone 8 mg is superior to 4 mg.
Keywords: Bariatric surgery, Dexamethasone, Intraperitoneal bupivacaine.
INTRODUCTION
Using local anesthetics for attenuation of pain
Morbid obesity is a growing health problem with
following bariatric surgery have been discussed in
significant complications and increased risk of
previous studies aiming to reduce or avoid
potentially associated diseases as type II diabetes
postoperative opioid consumption (6, 15). Bupivacaine
mellitus, hypertension, coronary heart disease, and
has a good role in reducing postoperative pain (16), and
obstructive sleep apnea (OSA) (1). Laparoscopic
adding steroids is thought to be an advantageous step
bariatric surgery is an effective treatment for morbid
(17). Dexamethasone is a glucocorticoid that has a
obesity (2,3). However, serious perioperative challenges
beneficial analgesic and anti-emetic effect with a single
do exist (4). Although laparoscopic surgeries are
perioperative dose that might extend up to 2-3 days (18).
accompanied by less postoperative pain than open
The analgesic effect of steroids was attributed to various
surgeries (5), postoperative pain after laparoscopic
mechanisms including suppressing bradykinin and
bariatric surgery may be significant and has negative
releasing neuropeptides at nerve terminals, and
effect on patients' recovery and regaining of
decreasing prostaglandin synthesis through suppressing
physiological
functions
including
respiration,
the formation of cyclooxygenase in both peripheral
hemodynamics, ambulation, gastric motility, and total
tissues and central nervous system. Moreover, steroids
time of hospital stay (6). Opioids in morbidly obese
inhibit inflammatory mediators of hyperalgesia as
patients are accompanied by serious unwanted effects as
tumor necrosis factor-, interleukin-17b, and
postoperative nausea and vomiting (PONV), respiratory
interleukin-6 (19). It was hypothesized in the current
depression, ileus, sedation, delayed ambulation and
study that postoperative pain in bariatric surgery would
higher rates of mortality (7). These potential
be reduced by intraperitoneal instillation of bupivacaine
complications are added to the pre-existing problems of
with dexamethasone more than intraperitoneal
as OSA or cardio- and/or respiratory impairment (8,9).
instillation of bupivacaine alone.
Some studies used low-opioid (10) or non-opioid-based
The aim of the present study was to evaluate
(11) multimodal analgesic regimens for postoperative
efficacy and safety of adding two different doses of
pain management after bariatric surgeries.
intraperitoneal dexamethasone (4 mg or 8 mg) to
Chronic postsurgical pain (CPSP) is pain
bupivacaine (0.25%) versus intraperitoneal bupivacaine
persisting for more than 3 months after the expected
(0.25%) alone for postoperative analgesia after
healing time (12). In some cases of bariatric surgeries,
laparoscopic bariatric surgeries.
CPSP extended to one year of postoperative
suffering(13). Prevention of acute postoperative pain
PATIENTS AND METHODS
reduces the incidence of CPSP after bariatric surgeries
This was a double-blind, prospective, randomized
(14).
controlled trial conducted at Zagazig University
Hospitals from June to December 2019. 60 adult (aged
3185
Received: 20/02/2022
Accepted: 19/04/2022
Review Of Literature
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3192-3196
Association of Systemic Inflammatory Response syndrome with Serum Creatinine,
Albumin, and C-Reactive Protein in Acute Pancreatitis Patients
Soha Mohammad Nageb*1, Mostafa Abd-Allah Haredi1, Muhammad Abbas El-Masry1, Ghada M. Ezzat2
Departments of 1Internal Medicine and 2Biochemistry and
Molecular Biology, Assiut University Hospital, Assiut, Egypt
*Corresponding author: Soha Mohammad Nageb, Mobile: (+20) 01095317850, E-mail: snageb@rocketmail.com
ABSTRACT
Background and aim: Acute pancreatitis (AP) is one of the leading causes of hospital admission from gastrointestinal
diseases, with approximately 300,000 emergency department visits each year. Outcomes from acute pancreatitis are
influenced by risk stratification, fluid and nutritional management, follow-up care, and risk-reduction strategies.
Objective: The current work aimed to assess the pattern and outcome of acute pancreatitis.
Patients and methods: A total of 70 patients with acute pancreatitis were enrolled. Those patients were subjected to
history and clinical evaluation. All baseline laboratory and radiological data were recorded.
Results: Serum albumin was negatively correlated with the length of hospitalization. Severe inflammatory response
syndrome was associated with higher C-reactive protein and serum albumin level, in the Contrast-enhanced CT (CECT)
scan and systemic inflammatory response syndrome (SIRS) in the first 48 hours were significantly associated with
severe inflammation and necrosis.
Conclusion: Acute pancreatitis is a challenging condition, which vary in severity and duration. Early diagnosis and
severity classification have substantial impact on proper care. A more complicated disease is associated with the early
onset of systemic inflammatory response syndrome.
Keywords: Acute pancreatitis, C-reactive protein, Severe inflammatory response syndrome.
INTRODUCTION
Acute pancreatitis (AP) is an inflammation of the
diagnosis of AP. The study was conducted through the
pancreas that occurs suddenly. It might range from a
period from September 2019 to September 2020.
minor ailment to a life-threatening illness. Abdominal
A total of 70 patients with acute pancreatitis were
discomfort and elevated pancreatic enzyme levels in the
enrolled. Those patients were subjected to history and
blood or urine are symptoms. Gallstones, alcohol
clinical evaluation. All baseline laboratory and
misuse,
and
post-endoscopic
retrograde
radiological data were recorded.
cholangiopancreatography
pancreatitis
(ERCP)
intervention are all recognised as risk factors (1). For the
Study Population:
duration of the disease, the Revised Atlanta
Seventy AP patients were recruited for the study.
classification classifies AP into mild, moderately
The diagnosis of AP was based on two of the three
severe, and severe acute pancreatitis (2, 3).
following features: characteristic abdominal pain,
Hyperthermia (> 38.0°C) or hypothermia
serum amylase and/or lipase levels three times higher
(36.0°C), tachycardia (> 90 beats/m), tachypnea (> 20
than the upper limit of normal and characteristic
breaths/m), and WBCs > 12.000/mm3 or 4.000/mm3
imaging findings (8).
with a score more than or equal to 2 are all signs of a
Clinical Data Collection and Assessment: Patients'
severe inflammatory reaction (4). Different severity
demographics (age, gender, length of hospital stays).
grading systems, including SIRS, APACHE II,
Physical examination including vital signs, urine output,
modified Glasgow score, and Ranson score, can be used
consciousness, GIT symptoms, and signs.
to forecast the severity of the disease early (5).
Many laboratory biomarkers, such as, C-reactive
Laboratory tests: Renal and liver function tests,
protein (CRP), procalcitonin, and interleukin-6, can
hematocrit level, differential white blood cells,
successfully predict the course of AP (6). Severe
electrolytes, blood PH, and CRP. All blood samples
pancreatitis is associated with marked inflammation and
were withdrawn within the first day of admission with
cell necrosis. Increased levels of cytokines or cytokine
follow-up within 48 hours.
storm because of cellular injury is linked to severe
Imaging studies: Abdominal ultrasound to determine
inflammatory response syndrome (SIRS) and multi-
etiology and CECT scan.
organ failure (7). In this study, we aimed to assess the
Scores: APACHE-II, BISAP and SIRS were calculated
pattern and outcome of AP in our locality.
within the first 48 hours. CT scan findings were
classified according to the Balthazar computed
PATIENTS AND METHODS
tomography severity index (CTSI).
Study Design: This was cross-sectional study in which
patients were recruited from El-Rajhi hospital with a
Ethical consent:
The study was approved by the Ethics Board of
Assiut University and informed written consent was
3192
Received: 20/02/2022
Accepted: 19/04/2022
c:\work\Jor\vol881_146
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3197-3205
Thoracic Epidural versus Surgically placed Rectus Sheath Catheters for Postoperative
Analgesia after Midline Laparotomies: A Randomized clinical Trial
Salwa H. Waly*1, Yasser M. Nasr1, Wael Elsayed Lotfy Mokhtar2
Departments of 1Anesthesia, Surgical Intensive Care and Pain Management and
2General Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Salwa H. Waly, Mobile: (+20)01224329364, E-Mail: salwa.waly@yahoo.com
ABSTRACT
Background: Midline laparotomies are accompanied by severe postoperative pain that is mainly related to abdominal
wall incision. Objective: This study aimed to find if the analgesia provided through rectus sheath catheters can be safe
and effective as thoracic epidural analgesia for early postoperative pain relief after midline laparotomies.
Patients and Method: 50 patients were randomly allocated into 2 groups: Group TEA (n=25): on wound closure 20
mL of 0.25% bupivacaine + 40 g fentanyl were injected into epidural catheter. Thereafter, every 6 h, 20 mL 0.125%
bupivacaine + 40 g Fentanyl for 48 h were injected into the catheter. Group RSB (n=25): bilateral rectus sheaths
catheters were surgically placed during wound closure. On each side, 20 mL bupivacaine 0.125% + 20 g fentanyl were
injected. Then, every 6 h, 10 mL 0.125% bupivacaine + 20 g fentanyl were given through each catheter for 48 h. In
both groups, IV 1 gm paracetamol/8h was given. If visual analogue scale (VAS) score became 4. Also, IV fentanyl
was given. Results: intraoperative and postoperative fentanyl consumption, time to first analgesia, VAS and sedation
levels were comparable between groups. Time for first oral intake was shorter in group TEA. Time for independent
ambulation was shorter in group RSB. Post-operative nausea and vomiting (PONV) and pruritus were higher in group
TEA. Patients' satisfaction was higher in group RSB.
Conclusion: Analgesia through surgically placed rectus sheath catheters is a safe and effective alternative to thoracic
epidural analgesia in midline laparotomies. Clinical trials registration number: NCT04262622.
Keywords: Thoracic epidural analgesia, Rectus sheath block.
INTRODUCTION
availability of new local anesthetic agents, small-caliber
Adequate post-operative analgesia after midline
catheters with or without ultrasound guidance (10). RSB is
laparotomies through multimodal interventions reduces
a regional anesthetic technique that provides midline
complications (e.g. chest infection or deep venous
somatic analgesia from xiphoid process to symphysis
thrombosis) and leads to rapid recovery and early
pubis with no visceral analgesia. Thereby, systemic
mobilization, better patients' satisfaction, and less
analgesics are required (9). Rectus sheath analgesia
hospital stay (1).The standard technique for post-
(RSA) can be achieved by injecting local anesthetic
operative analgesia after major abdominal surgery is
through the inserted catheter with or without adjuvants
thoracic epidural analgesia (TEA) (2). Postoperative ileus
into the potential space between the rectus muscle and
is a serious complication and can be defined as decreased
the posterior rectus sheath either as intermittent doses
motility of the gastrointestinal tract (GIT) after
every 6-12 hours, or by continuous infusion of local
abdominal or non-abdominal surgeries in the absence of
anesthetic during the early postoperative period (12-36
mechanical cause for GIT obstruction (3). Its incidence
h) (9). It was hypothesized that rectus sheath analgesia
has been reduced with TEA when compared to systemic
(RSA) might be an alternative to thoracic epidural
opioids for postoperative analgesia in major abdominal
analgesia. Thereby, the aim of the current study was to
surgeries and was explained by the sympathetic block
find whether analgesia provided through surgically
during TEA (4). On the other hand, the complications
placed rectus sheath catheters can be a safe and effective
encountered with TEA motivates the search for another
alternative to thoracic epidural analgesia for early
technique, besides that in some situations, midline
postoperative pain relief in patients undergoing elective
incision is a need while TEA is contraindicated e.g.
abdominal surgery through midline incision.
emergency laparotomy. Complications of TEA might be
a high failure rate (up to 30%) (2), hypotension is
PATIENTS AND METHODS
common and may be accompanied by iatrogenic fluid
This prospective randomized study was conducted
overload (5), and motor block of the lower limbs with
on 50 adult patients (of 21-65 years), American Society
resultant delayed post-operative mobilization (6). Rarely
of Anesthesiology (ASA) physical status classification
(although serious), complications as nerve injury or
of I III (11), with body mass index (BMI) of 18.529.9
epidural hematoma with or without paraplegia or
kg/m2, of both sexes, who were posted for elective
epidural abscess might occur (7).
abdominal operations with midline incision under
Rectus sheath nerve block (RSB) (8) (blocking
general anesthesia (e.g. colorectal resections including
anterior division of the 7th to 11th intercostal nerves
right or left hemicolectomy or segmental colonic
supplying the rectus abdominis muscle and its overlying
resection). The study was conducted at Zagazig
skin) was first described by the end of the last century
University Hospitals during the period from June 2019
without so much attention payed to the technique (9). The
to February 2021.
growing attention nowadays was attributed to the
3197
Received: 20/02/2022
Accepted: 19/04/2022
c:\work\Jor\vol881_147
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3206-3212
Utilization of Pelvic Ultrasonography and CA125 Level to
Diagnose Uterine Myoma and Adenomyosis
Nadia Khairy Fathi Abou Elela*, Mohamed Mohamed Abd Alsalam Suliman, Dina Mohamed Gamal Eldin
Soliman, Sara Atef Zaki , Ragab Alsayed Amin Ibrahim, Mostafa Gamal Abdelhaleem Mohammed
Department Obstetrics & Gynecology, Alahrar Teaching Hospital. Zagazig, Al Sharqia, Egypt
*Corresponding Author: Nadia Khairy Fathi Abou Elela, Mobile: (+20) 01011140552, E-Mail: nadiakhairy056@gmail.com
ABSTRACT
Background: Preoperative diagnosis of adenomyosis and uterine myoma can be aided by pelvic ultrasonography
and cancer antigen 125 (CA125). Objective: This study aimed to evaluate the usefulness of CA125 level and
transvaginal ultrasonography in diagnosis of uterine myoma and adenomyosis and to differentiate both lesion.
Patients and Methods: One hundred patients complaining of abnormal uterine bleeding were included in this
study. They were attending the Obstetrics and Gynecology Departments at Zagazig University Hospitals and Al-
Ahrar Teaching Hospital for hysterectomy. Transvaginal ultrasonography (TVS) was done for all selected cases to
examine the pelvis for detecting any pathology. CA 125 level was measured. Hysterectomy specimens were
histopathologically examined. Results: The combination of serum CA125 level and TVS showed that it was useful
in adenomyosis group as CA125 level increased the accuracy of TVS from 77% to 80.2%, while in myoma group
the combination was not useful as CA 125 decreased the accuracy of TVS from 100% to 83.3%. Conclusion:
Transvaginal ultrasonography is the most sensitive for myoma (100%) & CA125 level is the most specific (77%)
for adenomyosis. CA125 level had the highest sensitivity (87.5%) for adenomyosis than transvaginal
ultrasonography (80.1%). Combining both TVS and CA125 level increased the accuracy for detection of
adenomyosis to 80.2% but decreased it to 83.3% in detection of uterine myoma.
Keywords: Ultrasonography, CA125, Adenomyosis, Uterine myoma.
INTRODUCTION
fibroids. When the clinical signs are benign, a high
The most common benign tumour in women of
CA125 result is not cause for alarm (4). Depending on
childbearing age is a uterine myoma, often known as a
the results, pelvic ultrasonography can be used to make
leiomyoma or a fibroid. Their occurrence increases
a preoperative diagnosis of adenomyosis and uterine
with age, peaking during childbearing years and
myoma. Adenomyosis can be diagnosed on ultrasound
declining in the years following menopause. By the
if the uterus is enlarged, there are cystic anechoic
time they reached age 50, up to 80% of women had a
spaces or lakes in the myometrium, the uterine wall is
fibroid diagnosed. They account for 39% of all
thickened, there are linear striations under the
hysterectomies performed each year, making them the
endometrium that are echogenic, the echo texture of the
most common cause for the procedure (1).
myometrium
is
irregular,
and
the
Preoperative diagnostic rates of adenomyosis
endometrial/myometrial border is not clear (5). Patient
based on clinical signs are poor, ranging from 3% to
tolerance and
cost-effectiveness make
pelvic
26%, which is not surprising given how rarely
ultrasonography a popular choice, although results
adenomyosis was recognized before hysterectomy.
depend heavily on the skill of the ultrasonographer and
Even though the prevalence of adenomyosis at the time
the quality of the equipment (2).
of hysterectomy varies widely (from 5% to 70%).
Since total resection of adenomyosis is
Menorrhagia, dysmenorrhea, and dyspareunia are all
extremely difficult to execute, it is helpful to
symptoms of uterine myoma or adenomyosis.
differentiate between adenomyosis and uterine myoma
Premenopausal women are especially vulnerable (2).
prior to hysterectomy in order to decide whether
Due to the difficulty of performing a complete resection
medicinal or surgical treatment is warranted (6). It was
of a focused adenomyosis, preoperative differential
the goal of this study to evaluate the usefulness of
diagnosis between adenomyosis and myoma is crucial.
CA125 level and transvaginal ultrasonography in
Inadequate results have been seen from hormone
diagnosis of uterine myoma and adenomyosis and to
treatment of adenomyosis (3).
differentiate both lesion.
Cancer antigen 125 is commonly abbreviated as
CA-125. Some patients with certain types of cancer, as
PATIENTS AND METHODS
well as those with benign diseases, have been found to
One hundred patients complaining of abnormal
have increased levels of this blood marker. Even in the
uterine bleeding were included in this cross-sectional
absence of pelvi-abdominal pathology, the severity of
interventional study. The patients were attending the
adenomyosis-related uterine enlargement (defined as a
Obstetrics and Gynecology Departments at Zagazig
uterine volume more than 240 cm3 or a gestational age
University Hospitals and Al-Ahrar Teaching Hospital
of 12 weeks) was associated with an increase in CA125
for hysterectomy.
levels. However, CA125 levels did not increase above
The enrolled patients were classified into three
normal in women whose uteruses were enlarged due to
different groups: Group 1: 28 patients with no organic
3206
Received: 23/2/2022
Accepted: 24/4/2022
c:\work\Jor\vol881_148
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3213-3216
Role of Serum Procalcitonin in Monitoring the Response to Treatment of
Pediatric Bacterial Meningitis
Eman Elhaddad, Rania Shatla, Maha Z. Mohammed
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Corresponding author: Maha Z. Mohammed, ORCID 0000-0002-6098-561X.
mahazakariya@med.asu.edu.eg,mobile:002 01124215285
ABSTRACT
Background: Early diagnosis and appropriate management are important to reduce the complications of acute bacterial
meningitis (ABM). Serum procalcitonin (PCT) is one of the most sensitive and specific markers for identification of ABM.
Objective: This study was done to evaluate serum PCT as a marker to confirm ABM especially after oral antibiotics intake
or when cerebrospinal fluid (CSF) culture is negative and to assess its correlation with outcome of ABM in children.
Methods: This is a prospective cohort study that included 38 children with suspected ABM who presented to Ain Shams
University Children Hospital over a period of 6 months. The PCT levels were measured on admission and 72 hours (h) after
treatment. Results: Sixteen cases received oral antibiotics before admission, out of which only 6 (38%) patients showed
growth in CSF bacterial culture. All the 38 cases showed elevated levels of PCT on admission. There was a significant drop
in the mean of PCT level after 72 h of treatment compared to level on admission (7.1±6.5 vs. 11.4±3.7, p=0.001)
respectively. There was a significant difference in the mean of PCT level between cases with good versus poor outcome, on
admission (7.2±2.8 vs. 13.2±4.4, p<0.001) and 72 h after treatment (4.2±3.5 vs. 12.9±5.3, p<0.001) respectively.
Conclusion: Serum PCT levels were high in all patients with suspected ABM, including those who received oral
antimicrobials for 1-3 days before admission. The decline in PCT levels after treatment was associated with favorable
outcome in our cohort.
Keywords: Bacterial meningitis, CSF, Pediatric, Procalcitonin.
INTRODUCTION
serum PCT as a marker to confirm ABM specially when
Despite effective vaccines, bacterial meningitis
CSF culture is negative and to assess its correlation with
remains a major concern in the pediatric age group all
outcome of ABM in children.
throughout the world (1). Low- and middle-income
countries (LMICs) have the highest risk of meningitis-
PATIENTS AND METHODS
related sequelae, with 25% of children who survive
This study was conducted among suspected cases of
meningitis develop complications (2,3). The cornerstones
ABM who presented to Ain Shams University Children
of reducing these problems are early diagnosis and
Hospital over a period of six months. A total of 38 cases
adequate management (4). Acute meningitis in children is
of ABM participated in the study.
still considered a diagnostic dilemma since routine
laboratory analysis cannot readily differentiate between
Inclusion criteria: children from age of 1 month to 15
septic and aseptic cases (5).
years of age with suspected ABM.
Demonstrating the presence of bacteria in
Exclusion criteria: neonates below 1 month of age,
cerebrospinal fluid (CSF) samples using CSF cultures is
presence of another site of infection in addition to
the gold standard in diagnosing acute bacterial meningitis
meningitis. Children who had received antimicrobials for
(ABM). CSF cultures can also provide guidance for
more than 3 days prior to admission were excluded.
antibiotic therapy (6). In the acute setting, however, CSF
bacterial cultures take too much time to be used in the
All relevant demographic information as well as
decision to start proper antimicrobial according to culture
clinical symptoms and signs were recorded on admission
and sensitivity (7).
and 72 h after treatment, including fever, Glasgow Coma
A good biomarker for ABM should help with early
Scale (GCS), frequency of seizures, duration of seizures
identification, and assessment of prognosis and should
and feeding tolerance. All the enrolled cases underwent
also direct clinicians to make decisions for proper
investigations that included total/ differential leukocyte
therapeutic strategies (8). Serum procalcitonin (PCT) level
count (TLC), C-reactive protein (CRP), CSF analysis by
was reported to be one of the most effective predictors for
lumbar puncture. CSF analysis included physical and
discriminating between bacterial and non-bacterial causes
chemical examinations, cell count and type in addition to
of meningitis (9).
direct gram staining and CSF culture. Serum PCT
The aim of this study was to assess the effect of oral
estimation was performed using Human Procalcitonin
antibiotics administration on PCT level and to evaluate
3213
Received: 22/2/2022
Accepted: 21/4/2022
c:\work\Jor\vol881_149
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3217-3222
Microbiological Decontamination of Aflatoxin B1 in Peanuts by Backer's Yeast
Amany K. Shahat*, Hasnaa S. Abd el Hamid1, Mysa S. Mostafa
Microbiology and Immunology Department, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Amany Kasem Shahat, Mobile: (+20): 01004228720, Email: dramanykasem2020@gmail.com
ABSTRACT
Background: Peanuts are one of the commonly consumed snacks but with poor storage practices and handling can
make them prone to food borne infections.
Objective: The study aimed to measure the level of aflatoxin B1 in peanuts, which are contaminated with Aspergillus
flavus before and after decontamination by yeast to detect the effect of biological decontamination of aflatoxin B1 in
peanuts by yeast in selected locations in Qalubia Governorate in Egypt.
Materials and Methods: This study was carried out on 30 peanut samples from 3 different cities.Fungal Counts was
determined by the dilution plate technique, Isolation of Fungi was done by direct plating method on SDA and incubated
at 25 and 30°C, for 7 days, suspected aflatoxigenic fungi (A. flavus) that identified from peanuts were taken for
aflatoxin analysis using Aflatoxin B1 ELISA Assay Kit then decontamination of peanuts by baker's yeast for 6 h and 24
h at 37 °c then requantitation of aflatoxin B1 after 6 h and 24 h by ELIZA method.
Results: There was significant strong positive correlation between fungal count and aflatoxin concentration with the
samples from "Qalub" had the highest fungal count (30 ×10³ cfu/g) while "Benha" had the lowest count of (5 ×10³
cfu/g). Also we found that the aflatoxin concentration in "Benha" and "Kaha" less than the concentrations in "Qalub".
The aflatoxin B1 concentration is decreased after microbiological decontamination with prolonged contact with backer's
yeast.
Conclusion: This study showed that the peanuts were contaminated with toxigenic fungi, and we observed that yeasts
have a huge potential application in aflatoxin degradation in foodstuffs.
Keywords: Aflatoxin B1, Microbiological decontamination, Peanuts, Yeasts.
INTRODUCTION
washing before storage. Due to bad handling of peanuts
Mycotoxins formed primarily by Aspergillus,
at this stage, it leads to fungal growth especially when
Penicillium and Fusarium spp., which are natural
seeds are not properly dried to the appropriate moisture
contaminants in different food staffs [1]. Mycotoxins are
degree before storage [6,7]. There are other sources of
the main causes of toxicities to animals and humans.
fungal invasion, which can happen during storage as
Presence of contamination by mycotoxins in foods is
when peanuts are stored in conditions as humidity and
more in the subtropical and tropical countries leading to
high temperature [8].
acute and chronic mycotoxicoses in animals and
Both fungi and bacteria are capable of causing
humans [2]. Aflatoxins are powerful, cancerous, toxic
damage of food crops so can lead to economic and food
secondary metabolites formed mainly by Aspergillus
losses, thus leads to reduction of the exports of the food
flavus, Aspergillus parasiticus and Aspergillus
crops [9]. The proper management of food collection,
nomius in different foodstuff as maize, grains, peanuts
transportation, storage and handling can help in
and cereals [3].
decreasing the risk of exposing peanuts to invasion by
Aflatoxins ingested by man can cause many forms
mycotoxigenic moulds [10].
of diseases as cirrhosis, cancer, other liver diseases,
Decontamination of mycotoxin involves; physical
immunosuppression, spontaneous abortion, and stunted
methods such as ultraviolet light, thermal inactivation,
growth. Aflatoxin B1 (AFB1) exhibits the highest
extraction with solvents or ionizing radiation; chemical
toxicity of the discovered aflatoxins and it is one of the
methods, which are based on materials that destruct the
strongest of all mycotoxins. It has a strong genotoxic
structure of mycotoxin, such as oxidizing agents
and carcinogenic effect, to which the liver is particularly
(hydrogen peroxide, sodium disulfide and ozone),
susceptible [4]. Peanuts are very delicious so received by
treatment with chlorine (chlorine gas or sodium
most of the people due to their taste and high nutritive
hypochlorite), or hydrolytic agents (ammonia, acids and
value [5]. Peanuts are also important for many industrial
alkalis) but, these two methods have disadvantages, as
goals such as obtaining oils for industrial and human
inefficient removal, high costs or loss of nutritional
uses [6].
value of the product [11]. So, there is other methods as
Peanuts are rich in fats, proteins, minerals, and have
biological methods that depend on the effect of
little water inside it; so, they are very highly susceptible
microorganisms on mycotoxins produced. These
to fungal attack invasion more than other bacterial
microorganisms include different types as, filamentous
invasion at different stages and time [5], as while peanuts
fungi, algae, bacteria and yeasts, and their mechanisms
still on the trees and this often occurs when the shells of
of action may be based on interactions, competition by
the peanuts are split open so the insects attack the seeds,
space and nutrients, and antibiosis [12].
which forms rooms for the fungal spores to get inside
Biodegradation by microorganisms of aflatoxins
the developing seeds. There are other sources of
provide an excellent alternative for the control or
invasion such as sorting, harvesting and peanuts
degradation of aflatoxins in animal feed and foods,
3217
Received: 21/2/2022
Accepted: 20/4/2022
c:\work\Jor\vol881_150
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3222-3229
Early Bedside Predictors of Cardiac Involvement in COVID-19
Amr Setouhi*, Gamal Fathy, Tarek Abdelrahman, Khaled Mahmoud
Cardiology Department, Faculty of Medicine, Minia University, Minia, Egypt
*Corresponding author: Amr Setouhi, Mobile: (+20)1010635356, E-Mail: amr_setouhi@yahoo.com
ABSTRACT
Background: COVID-19 could lead to severe acute respiratory syndrome leading to myocardial injury. It is
associated with high morbidity and mortality. COVID-19 progression severity can be predicted by cardiac signs.
Biomarkers can be used for early detection of cardiac injury and damage and prediction of severe prognosis
ultimately. Echocardiography is used for therapeutic management and diagnostic procedures for COVID-19 patients.
Detection of subtle cardiac damage early allows for providing efficient treatment.
Objective: The aim of the current study was to predict early cardiac involvement in COVID-19 depending on different
laboratory and echocardiographic parameters.
Patients and methods: This prospective analytical observational study included a total of 100 patients diagnosed as
positive COVID-19, depending on polymerase chain reaction `PCR' of nasopharyngeal swabs. Patients underwent full
echocardiographic assessment, electrocardiogram (ECG) and laboratory investigations just upon admission. Further
grouping of patients according to clinical deterioration was done to detect the prognostic value of investigations.
Results: Group I of clinically deteriorated patients had more lymphopenia (mean ±SD: 954.2± 6.5x109 /l), higher
neutrophils-lymphocytic ratio (mean ±SD: 3.9± 0.2), less TAPSE (tricuspid annular plane systolic excursion) (mean
±SD: 14.85 ± 3.29mm) and more basal RV (right ventricle) diameter (mean ±SD: 39.93 ± 3.08 mm) in comparison with
clinically stable patients. Deterioration of TAPSE (p value = 0.017) & basal RV diameter (p value = 0.044) were found
to have significant relation with grading of respiratory failure using PO2/FiO2 ratio which had significant positive
correlation with RV diameter (p value= <0.001 and r= 0.357).
Conclusions: TAPSE & basal RV diameter can early predict cardiac involvement in COVID 19 disease and have the
prognostic ability to predict the degree of respiratory failure in deteriorated patients.
Keywords: COVID 19, Coronavirus, Acute respiratory syndrome, Transthoracic echocardiography.
INTRODUCTION
(ACE2) in the brain leading to chronic damage to
Coronavirus disease (COVID-19) is initiated as
the cardiovascular system and acute myocardial injury.
a result of severe acute respiratory syndrome
The high rates of cardiovascular symptoms are due to
coronavirus-2 (SARS-CoV-2). It belongs to the vast
immune system disorders caused by the systemic
family of viruses recognized as coronaviruses. COVID-
inflammatory response as disease progression. The
19 is a positive-sense single-stranded RNA (+ ssRNA)
percentage
of
thrombosis and
venous
virus, distinguished by a single linear ribonucleic acid
thromboembolism is 31% and 25%, respectively. This
(RNA) segment containing around 30,000 bases long
high percentage detected in ICU COVID-19 patients is
(1).
attributed to the poor prognosis (9). The high D-dimer
The SARS-CoV-2 virion diameter is 50
levels indicate that mortality is due to blood vessel
200 nanometres consisting of 4 different structural
dysfunction and clot formation. Blood vessel
proteins. The structural proteins are the S (spike), E
constriction is observed inside the pulmonary
(envelope), M (membrane), and N (nucleocapsid)
circulation causing a reduction in the oxygenation
proteins (2). The S1 subunit facilitates the virus
process. Around 30% of the deaths were attributed to
attachment, and the S2 subunit plays a role in virus
kidney complications (10, 11).
fusion (3).
Classical serum biomarkers of
Cytokine
The SARS-CoV-2 harbors the virus for long
release syndrome (CRS) are observed in COVID-19
periods without pathogenic effects. It can be transmitted
and acute respiratory distress syndrome patients causing
while patients are symptomatic. Developing symptoms
a higher C-reactive protein (CRP), ferritin and lactate
usually takes two days (4). Yet patients stay infectious in
dehydrogenase (LDH)(12,13). Pathogenic granulocyte
severe and moderate cases for two weeks and 7 to 12
macrophage-colony
stimulating
factor (GM-CSF)
days, respectively (5). Airborne transmission happens
discharges T-cells relative to the inflammatory
especially in very overcrowded or poorly ventilated
interleukin-6
(IL-6)
occurrence
leading
to
closed areas (6). Infection may take place if patients are
secreting monocytes and severe lung pathology (14). The
subjected to contaminated surfaces followed by eyes,
inflammatory
cytokines
and
other
systemic
nose, or mouth touch with contaminated hands, but this
inflammation markers increase refer to a hyper-
is not decisively confirmed (7).
inflammatory state (15). Several organs may be subjected
SARS-CoV-2 respiratory failure affects the
to inflammation and followed by dysfunction of the
brainstem and invades the central nervous system
endothelium due to the infection of endothelial cells and
(CNS)(8). The peripheral nerve invasion is attributed to
the host inflammatory response (16, 17).
the low levels of angiotensin-converting enzyme 2
3222
Received: 17/02/2022
Accepted: 18/04/2022
c:\work\Jor\vol881_151
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3231-3236
Evaluation of Thyroid Function Tests in Patients with Type 2 diabetes at Mansoura
Specialized Medical Hospital and Its Relation to Cardiovascular Risk Factors
Mohamed Gweeq*1, Nagy Shaaban1, Osama Saad Salama2, Ahmed Albehairy1
Departments of 1Endocrinology and Diabetes, Internal Medicine and
2Clinical Pathology Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Mohamed Gweeq, Mobile: (+20)1270302257, E-Mail: mgweeq@gmail.com
ABSTRACT
Background: The two most common endocrinopathies are diabetes mellitus (DM) and thyroid diseases (TD), which
frequently coexist and influence each other. Thyroid dysfunction in type 2 diabetic patients can help clinicians to provide
the best treatment for metabolic disorders, as thyroid abnormalities like hypothyroidism can make achieving glucose
targets and other comorbidities difficult.
Objective: The aim of the current work was to detect prevalence of thyroid dysfunction in patients with type 2 diabetes
attending diabetes outpatient clinic at Mansoura Medical Specialized Hospital and their association with cardiovascular
risk factors.
Patients and methods: This cross-sectional study included a total of 100 type 2 diabetic patients aged 35-55years,
attending at Mansoura Specialized Medical Hospital (SMH) and 50 normal healthy controls. The included subjects
were divided into two groups; Group 1 (diabetics) consisted of 100 patients, and Group 2 (control) consisted of 50
normal healthy individuals matched in age, sex with group 1.
Results: There was a statistically significant increase in the mean BMI, SBP and W/H ratio in (Group 1) compared to
(Group 2). The median duration of diabetes mellitus in the group 1 was 9 years (1-25). There was a statistically
significant increase in the mean serum triacylglycerols (TG), serum LDL and serum cholesterol levels in (Group 1)
compared to (Group 2). There was a significant difference between studied groups with higher percentage of normal
thyroid among group 2 (90% versus 71%) (P < 0.05) .and significant higher percentage of subclinical hypothyroidism
in (Group 1) as compared to (Group 2).
Conclusion: It could be concluded that thyroid dysfunction is frequently developed among patients with type 2
diabetes mellitus. Screening for the thyroid functions among diabetic patients is needed to prevent cardiovascular
risks.
Keywords: Type 2 Diabetes, Thyroid dysfunction, TSH, Dyslipidemia.
INTRODUCTION
(Hypothyroidism) and Graves' disease (thyroid over
Diabetes mellitus (DM) and thyroid disorders
activity) has been explored in reference to DM. The
(TD) are the two foremost common endocrinopathies,
consequence of hyperinsulinemia/insulin resistance, in
which often co-exist and mutually influence each other.
thyroid cell proliferation, which manifested as increased
Numerous research studies have reported the alliance
thyroid volume and nodule have been also observed (6).
among diabetes and thyroid disorders (1).
Detecting thyroid dysfunction in type 2 diabetes
Confirmed associations involving abnormal
patients will inform clinicians to give optimal treatment
biochemical pathways, aberrant genetic expressions,
for metabolic conditions since thyroid condition such as
and hormonal malfunctions, explaining their
hypothyroidism will delicate achievement of glycemic
pathophysiological association (2).
target and other comorbidities (7).
The association between thyroid dysfunction and
The aim of the present study was to detect
type 2 diabetes mellitus (T2DM) has also been
prevalence of thyroid dysfunction in patients with type
recommended, but the potential causative mechanisms
2 diabetes attending diabetes outpatient clinic at
are intricate (3).
Mansoura Medical Specialized Hospital and their
The most accepted mechanism for advancement of
association with cardiovascular risk factors.
T2DM in patients with thyroid dysfunction could be due
to disturbed genetic expression of several genes in
PATIENTS AND METHODS
conjunction with physiological aberrations leading to
This cross-sectional study included a total of 100
impaired glucose consumption by the muscles,
patients with type 2 diabetes aged 35-55years,
augmented hepatic glucose output and higher glucose
attending at Mansoura Specialized Medical Hospital
absorption from intestine (4).
(SMH) and 50 normal healthy controls. This study was
These endocrine disorders impact each other in a
conducted between March 2021 to December 2021.
variety of ways. Thyroid hormones (TH) contribute to
the regulation of carbohydrate metabolism and
The included subjects were divided into two groups;
pancreatic function, and on the contrary, diabetes
Group 1 (diabetics) consisted of 100 patients, and Group
affects thyroid function tests to variable extents (5).
2 (control) consisted of 50 normal healthy individuals
To clarify the link between DM and TD, the
matched in age, sex with group 1.
association
of
Hashimoto's
thyroiditis
3231
Received: 17/02/2022
Accepted: 18/04/2022
c:\work\Jor\vol881_152
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3237-3243
Evaluation of Functional Outcome of Rectal Cancer Management in
Two Specialized Centers in the Last Three Years
Ali Helmy El-Shewy, Ahmed M. Sallam, Mohammed Ahmed Ibrahim*, Mohammed Algazar
Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Mohammed Ahmed Ibrahim, Mobile: (+20)1068289616, E-mail: dr.mohamed.lotfy7288@gmail.com
ABSTRACT
Background: Rectal cancer surgery had achieved remarkable evolution over the past years. Thanks to the adoption of
total mesorectal excision and neoadjuvant chemoradiation, local recurrence rates dropped significantly down to 5%.
Objective: This study was aimed to evaluate the functional and oncological outcome of rectal cancer management in
specialized two centers.
Patients and methods: This retrospective study included a total of 30 patients operated for rectal cancer, attending at
Zagazig University Hospitals and Meet Ghamer Oncology Center. This study was conducted between 2017 to 2019.
Results: This study included 30 cases, 16 were males and 14 were females, operative time ranged from 120-140 minutes
with mean 130 minutes. Blood loss ranged between 250-600 cc. Only one case was converted to open surgery. No
intraoperative complications like ureteric or bowel injuries were recorded. Postoperative complications were noted in 7
patients, of them 4 patients developed perineal wound infection and they improved with conservative management, one
case developed chest infection who was improved with medical treatment, 1 patient developed stoma and sunken
refashioning was successfully done, and 1 patient complained of postoperative urinary incontinence and impotence.
Conclusion: It could be concluded that laparoscopic surgery improves oncologic and functional outcome better than
open because of good visualization of pelvic anatomy.
Keywords: Rectal cancer rectum, Oncologic, Open surgery, Laparoscopic surgery.
INTRODUCTION
rectal cancer. TME also preserves the autonomic nerves
Colorectal cancer (CRC) is the third most
and reduces the risk of presacral bleeding (4).
common cancer in males and the second most common
Neo-adjuvant and adjuvant chemotherapy and
in females, with 1.2 million annual new cases
radiotherapy serve as adjuvants to improve the outcome
worldwide. Over 143000 new cases of CRC are
after surgery; the dose and timing of these adjuncts are
diagnosed annually in the United States, and
variable based on the disease stage and patient related
approximately 52000 Americans die of the disease every
factors. However, these adjuncts are not a substitute for
year. These deaths account for approximately 9% of all
a proper TME, with poor surgery yielding an inadequate
cancer mortality (1).
surgical specimen invariably leading to local recurrence
With better surgical tools enabling a low
(5).
anastomosis, a shift toward sphincter -saving approaches
Randomized
controlled
trials
comparing
began, with the anterior resection replacing
laparoscopic to open TME for rectal cancer have
abdominoperineal resection as the standard curative
demonstrated numerous advantages to laparoscopy
resection, when possible. These approaches resulted in
including less postoperative pain and shorter hospital
poor oncologic outcomes for recurrence and overall
stay and recovery time and quicker return of
survival. Technical advancement came to light in 1982,
gastrointestinal function. Although several studies have
when Heald et al published the total mesorectal excision
proven that there were no significant differences with
(TME) technique. The local recurrence rate in rectal
respect to involvement of the circumferential resection
cancer exceeds 25% before implementation of TME
margin, macroscopic quality of the total mesorectal
technique, whereas the local recurrence rate was reduced
excision specimen, number of harvested lymph nodes ,
to 4 % to 5 %with TME (2).
loco-regional recurrence and survival(6).
TME has replaced blunt dissection as the standard
This study was aimed to assess the short term
technique when performing radical rectal cancer surgery
surgical, oncological, and functional outcomes of rectal
(sphincter-sparing or abdominoperineal resection).
surgery and comparing the outcomes of laparoscopic
Conventional blunt dissection has the potential of
and open approaches.
violating the mesorectal envelop, leaving residual tumor
in the pelvis, and causing major bleeding from the
PATIENTS AND METHODS
presacral plane (3).
This retrospective study included a total of 30
TME employs a precise, sharp dissection between
patients operated for rectal cancer, attending at Zagazig
the visceral and parietal layers of the endopelvic fascia
University Hospitals and Meet Ghamer Oncology
to ensure en bloc removal of the perirectal areolar tissue,
Center. This study was conducted between 2017 to
including the lateral and circumferential margins of the
2019.
mesorectal
envelope,
lymphatics,
and
The included subjects were divided into two groups;
vascular/perineural tumor deposits with the primary
Group 1 (Meet Ghammer) consisted of 16 patients, and
Group 2 (Zagazig) consisted of 14 patients.
3237
Received: 17/02/2022
Accepted: 18/04/2022
c:\work\Jor\vol881_153
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3244-3249
Dobutamine-Stress Echocardiography as a Predictor of Cardiac Function after
Surgery for Aortic Valve Regurgitation with Poor Function
Ahmad AbdelAleem ElDerie1*, Mohammed Sanad1, Hatem Beshir2,
Mohammed Adel3, Amr Aboelfotoh4, Gehad Awad1
1Department of Cardiothoracic Surgery, 3Department of Anesthesia, Faculty of Medicine, Mansoura University,
Egypt.2Department of Cardiothoracic surgery, Amreya General Hospital, Egyptian Ministry of Health, Alexandria,
Egypt.4Department of Cardiology and Angiology, National Heart Institute, Cairo, Egypt.
*Corresponding author: Ahmad AbdelAleem ElDerie, Mobile: (+2)01026626923,
Email: ahmadelderie@mans.edu.eg, ORCID: 0000-0001-6111-0439
ABSTRACT
Background: Patients with aortic valve regurgitation (AR) present at a late stage with impaired function. Some may
not show improved function after surgery.
Aim of the work: To evaluate the functional outcome in patients with and without poor left ventricular (LV) function
and to evaluate the role of dobutamine echocardiography in predicting persistent dysfunction after surgery.
Patients and Methods: Patients with severe AR (71) who underwent valve replacement (AVR) were divided into 2
groups based on the ejection fraction (EF); Group I: patients with EF <50% and Group II: patients with EF >50%. Group
I was subdivided into 2 subgroups according to the response to dobutamine-stress echocardiography (DSE): Group Ia:
patients whose EF increased to >50%, and Group Ib: patients whose EF remained <50%. Six months postoperatively,
echocardiography was performed to assess the cardiac function and volumes.
Results: Seventy one patients were included in the study: 39(54.9%) in Group I, 32(45.1%) in Group II, 21(29.6%) in
Group Ia and 18(25.4%) in Group Ib. Preoperative criteria was not significantly different between the 2 groups apart
from the intensive care unit (ICU) stay which was longer in group I (p = 0.006). In group Ia, EF raised on DSE (p <
0.001) and after surgery (p < 0.001). In group II, EF showed significant change on DSE (p < 0.001), but not after surgery
(p = 0.203).
Conclusions: Preoperative DSE can predict improvement of LV function after AVR in cases with severe AR with
ventricular dysfunction.
Keywords: Dobutamine-stress echocardiography, Aortic regurgitation, Myocardial dysfunction.
INTRODUCTION
It is reported that preoperative left ventricular
Aortic valve regurgitation (AR) is associated
end-systolic volume (ESV) and dimensions are
with left ventricular volume overload, which may lead
independent predictors for persistent dysfunction after
eventually to severe dilatation of the left ventricle,
operation. It would be more useful to depend on
which is usually associated with changes at the cellular
preoperative systolic wall stress and ejection fraction to
level in the form of myocardial fibrosis and contractile
predict ventricular dysfunction after surgery(8).
dysfunction(1). Nuclear studies have revealed the
This study aims to compare between the 6-
presence of perfusion defects in cases with left
month functional outcomes after aortic valve
ventricular dysfunction due to decreased coronary
replacement in cases with and without poor ventricular
perfusion pressure, which is correlated well with the
function. Also, to evaluate the role of dobutamine
results of DSE test(2, 3).
echocardiography in predicting persistent dysfunction
The resulting dysfunction may persist after
after surgery.
surgical correction of the valvular pathology. Hence,
patients with chronic valvular lesions must be carefully
PATIENTS AND METHODS
assessed before surgery to predict such persistent
This is a prospective comparative study that
dysfunction(4).
included cases with severe aortic regurgitation who
It is reported that all cases who had their aortic
underwent aortic valve replacement at Cardiothoracic
valve replaced for regurgitation with good ventricular
Surgery Department at Mansoura University during the
function showed good prognosis at a 10-year follow-up,
period from December 2017 to December 2019. All
while patients with ejection fraction below 30% showed
patients with severe aortic regurgitation who underwent
persistent ventricular dysfunction after surgery(5,6).
aortic valve replacement were included in the study.
Symptoms do not necessarily reflect the degree
Patients with less than severe AR, ischemic heart
of ventricular dysfunction. Patients with more
disease, hypertrophic cardiomyopathy, ventricular
manifesting symptoms (> Class II New York Heart
arrhythmia, or dobutamine hypersensitivity were
Association (NYHA)) may show normal ventricular
excluded from the study.
function, and on the other hand, ventricular function
A total of 71 patients were included in the
may be significantly impaired in patients with milder
study. Patients were divided into 2 groups based on the
symptoms (< NYHA class II)(7).
preoperative LV ejection fraction (LVEF): Group (I)
3244
Received: 27/02/2022
Accepted: 26/04/2022
c:\work\Jor\vol881_154
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3249-3254
Antenatal Steroid in Preterm Infants with Respiratory Distress Syndrome
Heba Elsayed Gabr1, Mariam Adel Fouad2
Departments of 1Pediatric and 2Clinical Pathology, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, Egypt
*Corresponding author: Heba Elsayed Gabr, Mobile: (+20)01271786273, Email: heba.gabr78@yahoo.com
ABSTRACT
Background: Respiratory distress syndrome (RDS) remains the most important determinant of increasing neonatal
morbidity in preterm infants. A low secretory capacity of the adrenal cortex may cause a diminished stress response
during the acute illness in preterm infants and could lead to increased morbidity in these infants.
Objective: To evaluate the levels of antenatal steroid (cortisol) in the 1st and 3rd days of life in preterm neonates with
respiratory distress syndrome.
Patients and methods: This study was carried out in neonatal intensive care unit (NICU) of Benha University Hospital
from June, 2020 to January, 2022. The study included 45 preterm neonates (23 females and 22 males), with gestational
age ranged from 30 to 36 weeks, and their weights ranged between 1.100 kg to 2.700 kg (all of them were appropriate
for gestational age (AGA) with mean weight 1.800 + 0.300 kg).
Results: In the current study, in ROC curve and area under the curve shows that 3rd day serum cortisol significantly
could be used as a predictive measure in cases prognosis with probability of 71% that the assay result for a randomly
chosen positive case will exceed the result for a randomly chosen negative case. Among respiratory distress groups (2
and 3) 3rd day serum cortisol level of 485.5 (nmol/l) was chosen as a cutoff point below which cases with respiratory
distress tend to show improvement in prognosis with sensitivity of 80% and specificity of 80%.
Conclusion: Preterm infants with severe RDS (mechanically ventilated) release more cortisol, which could be the result
of severe stress associated with respiratory distress and positive pressure ventilation. Increased incidence and severity
of RDS were noticed more in cesarean section (CS) than in vaginal delivery (VD). Antenatal steroids have effective role
in decreasing incidence and severity of RDS.
Keywords: Preterm Infants, Respiratory Distress Syndrome, Serum Cortisol.
INTRODUCTION
disease in preterm infants. It has been suggested that
Respiratory distress syndrome (RDS) remains the
preterm infants may have developmental immaturity of
most important determinant of increasing neonatal
the hypothalamic-pituitary-adrenal axis, and that
morbidity in preterm infants [1]. A low secretory
decrease cortisol response to stress and increases risk of
capacity of the adrenal cortex may cause a diminished
chronic lung disease secondary to inflammatory lung
stress response during the acute illness in preterm
injury [7].
infants and could lead to increased morbidity in these
Adrenal function in very low birth weight
infants [2]. The function of the adrenal cortex in the
preterm infants has received increasing attention during
neonatal period was related to many factors such as
recent years, small studies have recently suggested that
respiratory distress, gestational age, birth weight and
these patients may exhibit a relative adrenal
arterial hypotension [3]. Higher incidence of
insufficiency in the face of critical illness [8].
hronchopulmonary dysplasia (BPD) in patients with an
The aim of this work is to evaluate the levels of
insufficient cortisol response to adrenocorticotropic
serum cortisol in the 1st and 3rd days of life in preterm
hormone (ACTH) has been found [4].
neonates with respiratory distress syndrome. Also, to
During the final prenatal period of fetal lung
study the correlation of serum cortisol levels in early
development in humans, important maturation
days of life with clinical status and prognosis for
processes occur, including the production of surfactant,
assessment of its predictive value of short-term
which is necessary to decrease surface tension at the air-
outcome.
liquid interface of the alveoli [5]. During early gestation,
the glucocorticoid receptor is expressed in the fetal
PATIENTS AND METHODS
lung, and glucocorticoid stimulate the production of
This study was carried out in neonatal intensive
surfactant-associated
proteins
and
increase
care unit (NICU) of Benha University Hospital from
phospholipids synthesis by enhancing the activity of
June, 2020 to January, 2022. The study included 45
phosphatidylcholine. Other glucocorticoid-induced
preterm neonates (23 females and 22 males), with
effect may include stimulation of cell maturation and
gestational age ranged from 30 to 36 weeks, and their
differentiation, inhibition of DNA synthesis, changes in
weights ranged between 1.100 kg to 2.700 kg (all of
interstitial
tissue components, stimulation
of
them were AGA with mean weight 1.800 + 0.300 kg).
antioxidant enzymes, and regulation of pulmonary fluid
The neonates included in the study were divided into
metabolism [6].
three groups: Group I: Preterm neonates without RDS
Recently, it was suggested that glucocorticoids
as control (n =15). Group II: Preterm neonates with
are also important in postnatal pulmonary development,
mild to moderate respiratory distress syndrome, were on
and may be related to the development of neonatal lung
continuous positive airway pressure (CPAP) (n =15).
3250
Received: 21/02/2022
Accepted: 20/04/2022
c:\work\Jor\vol881_155
The Egyptian Journal of Hospital Medicine (July 2022) Vol. 88, Page 3256-3261
Prevalence of Bronchial Asthma among Primary School Children
Moustafa Gamal Amin Ghonem
Department of Pediatric, Shebin El Kom Teaching Hospital, GOTHI, Menoufia, Egypt
Corresponding author: Moustafa G.A. Ghonem, Mobile: (+20) 0111 985 9457), Email: dr.moustafagamal1972@gmail.com
ABSTRACT
Background: Asthma the most common chronic condition among children is operationally defined as "recurrent
wheezing and or persistent coughing in a setting where asthma is likely and other rare condition have been excluded.
Bronchial asthma is prevalent worldwide, especially in developed countries where its prevalence is increasing to
epidemic proportions.
Objectives: This study aimed to assess the prevalence of bronchial asthma among primary school children.
Patients and Methods: This study was carried out on 2763 children that consisted of a representative sample of children
attending eight primary schools in El Menoufiya Governorate. Four schools of them are located inside Shebin El Koum
city the capital of the governorate. The other four schools are located in villages around the capital. Children were
screened for chest symptoms by a questionnaire. Results: Clinical presentation of asthmatic children as cough, wheezes,
dyspnea and chest tightness were the most common presenting symptoms. Also, rhinitis was the most common allergic
condition that was associated with asthmatic children. Viral upper respiratory tract infection and environmental changes
were the most common exacerbating factors while drugs and emotion were the least ones.
Conclusion: This work highlighted on the prevalence of childhood bronchial asthma among primary school children in
El-Menoufia governorate, with overall point prevalence of 6.5 %, which showed significant increase during the last 20
years as by comparing the result of our study to the result of same study in 20 years ago, which reported that the
prevalence of bronchial asthma in primary school children in Menoufiya governorate was 2.2 % , as the prevalence
increased by 4.3 % (Triple times) during this period. This explain the magnitude of the problem of bronchial asthma in
our community.
Keywords: Bronchial asthma, Primary school children, Wheezing, Persistent coughing.
INTRODUCTION
under treated, particularly among children from less
The word asthma originates from an ancient Greek
wealthy families [6].
word meaning panting. Essentially, asthma is an
In Egypt, it was reported that asthma prevalence
inability to breathe properly [1]. Asthma, the most
was 4.8% in Egyptian infants and children aged less
common chronic condition among children is
than 4 years, from five governorates [7]. Studies from
operationally defined as "recurrent wheezing and or
Egypt reported that prevalence of asthma is 9.4% in 11
persistent coughing in a setting where asthma is likely
15-year-old school in Cairo and 8.2% was reported in
and other rare condition have been excluded [2].
another study of children with age of 315 years [8]. As
Bronchial asthma is prevalent worldwide, especially in
few studies evaluated asthma prevalence in Egypt, so
developed countries where its prevalence is increased to
this study was conducted on El-Menoufia governorate
epidemic proportions [3]. There have been few studies
including both urban and rural areas. This study was
on the epidemiology of asthma in Egypt, but none in
planned to determine the prevalence of bronchial
Damietta governorate. Therefore, the present study has
asthma among school children aged 6-12 years old in
been carried out to determine the prevalence of
El-Menoufia governorate and to identify the risk factors
bronchial asthma and to investigate its impact on the
associated with childhood asthma [9].
cognitive functions and academic achievement among
Asthma is sometimes diagnosed based on the
preparatory school children in Damietta Governorate. In
history and physical examination as recurrent episodes
Egypt, the bronchial asthma is a significant health
of coughing or wheezing, especially if they follow
problem among school children, and the prevalence was
exposure to asthma triggers and respond to asthma
7.7% [4].Asthma is a complex respiratory disease
medication. Pulmonary function testing can confirm the
characterized by inflammation and reversible
diagnosis if necessary [5]. The treatment of pediatric
obstruction of the airways that can lead to diverse
asthma requires balancing the efficacy and safety of
symptoms such as wheeze, breathlessness, chest
various asthma medication, facilitating patient and
tightness, and cough. Asthma affects approximately 350
family education, and developing a supportive
million people from all age groups worldwide and
treatment network to allow the affected child and his
causes around 350,000 deaths per year. Although
family to have life style as normal as possible [10]. So,
asthma is a lifelong disease, it is considered the most
the aim of the work was to assess the prevalence of
common chronic condition in children, where
bronchial asthma among primary school children.
symptoms are usually more severe [5]. In Egypt, the
prevalence of asthma among school children in the Nile
PATIENTS AND METHODS
Delta region is about 7.7%. 2 Asthma is relatively
As an epidemiological study this work was carried out
common in Egypt, and probably under diagnosed and
on eight primary school children in El-Menoufia
3256
Received: 21/02/2022
Accepted: 20/04/2022