c:\work\Jor\vol891_1 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4146-4150

One Anastomosis Gastric Bypass Versus Roux-En-Y Gastric Bypass:
A New Limb Length Modification, is it Effective? A Prospective Cohort Study
Mohamed G. Fouly, Ahmed Y. Elrifaie, Mostafa Abdelrahman*
General Surgery Department, Faculty of Medicine, Ain Shams University
*Corresponding author: Mostafa Omar Abdelrahman, Mobile: (+20)1004683384, Email: mostafaomar@med.asu.edu.eg

Bariatric surgeries are effective in treating obesity and its associated co-morbidities. The ideal bariatric
surgery with satisfactory weight or BMI loss and with few complications and nutritional deficiencies still does not
exist. Modifications in one anastomosis gastric bypass (OAGB) and Roux-en-Y gastric bypass (RYGB) are still under
study for best BMI loss with few complications.
Objective: The aim of the current work was to compare both surgeries, OAGB and RYGB, after limb length
modification regarding postoperative complications, resolution of comorbidities, BMI and weight loss, and
operative time.
Patients and Methods: In this prospective cohort study, we reviewed medical records of 200 patients undergoing
mini gastric bypass (MGB) and RYGB with limb length modification. Patients were then followed postoperatively
for BMI loss, estimated weight loss, resolution of comorbidities, and postoperative complications. Patients were
phone called and asked to attend next day for follow-up.
Results: A total of 200 patients were included. Thirteen patients were lost during follow-up. OAGB group has a
statistically significant lower BMI and weight at 3, 6, 12, 24 months compared to RYGB group. Regarding operative
time, minutes, OAGB group has a significantly lower operative time compared to RYGB group (p=0.0001). Patients
who had OAGB had a significantly higher EWL compared to RYGB at 3, 6, 12, 24 months. Regarding resolution of
comorbidities and postoperative complications, no significant difference between both groups, MGB vs RYGB
(p=0.89) and (p=0.98), respectively.
Conclusion: It could be concluded that OAGB is superior to RYGB in BMI and excess weight loss at 3, 6, 12, 24
months, OAGB had lower operative time. No difference between both surgeries in postoperative complications and
resolution of comorbidities.
Keywords: One anastomosis gastric bypass, Roux-en-Y gastric bypass, Limb length modification


nutritional deficiencies, and different lengths of
According to the WHO, the growing incidence of
biliopancreatic limb had comparable BMI loss and
global obesity is a major source of health burden and
comorbidities resolution (6­10).
death (1). Obesity has become much more common
On the other hand, studies had shown that longer
over the world, impacting 42.4 percent of individuals
biliopancreatic limb in RYGB is associated with
in the United States. According to the Centers for
higher excess weight loss, but comparable
Disease Control and Prevention (CDC), 30 percent of
postoperative complications. Darabi et al. (11) studied
the adult population in the United States is morbidly
313 morbidly obese patients who were divided into 3
obese (body mass index greater than 30) (2, 3). Obesity
groups regarding biliopancreatic and alimentary limb
and its related co-morbidities can be effectively treated
length. Authors concluded that longer biliopancreatic
with bariatric surgery.
limb had a higher excess weight loss than shorter
The ideal bariatric surgery with satisfactory weight
counterpart during 36 months of follow-up. Zerrweck
or BMI loss and with few complications and
et al.(12) study on 210 patients showed more BMI loss,
nutritional deficiencies still does not exist.
higher excess weight loss, and more total weight loss
Modifications in one anastomosis gastric bypass
in longer biliopancreatic limb.
(OAGB) and Roux-en-Y gastric bypass (RYGB) are
The aim of the current work was to compare both
still under study for best BMI loss with few
surgeries, OAGB and RYGB, after limb length
complications. Regarding OAGB, Boyle et al.(4)
modification regarding postoperative complications,
compared 150 and 200 cm biliopancreatic limb in 343
resolution of comorbidities, BMI and excess weight
patients for 24 months. Both groups outcome were
loss, and operative time.

However, Ahuja et al. (5) compared three different
lengths of biliopancreatic limb: 150, 180, and 250 cm.
From January 2018 to January 2020, the medical
the authors reported a significant difference between
records of 200 patients undergoing Laparoscopic one
biliopancreatic limb lengths regarding nutritional
deficiencies (higher in 250 cm) and total weight loss.
Laparoscopic Roux en Y gastric bypass (RYGB) were
No difference between three groups in resolution of
reviewed at Department of Bariatric Surgery, Ain
Shams University Hospitals.
biliopancreatic limb <200 cm is associated with lower

Received: 13/03/2022
Accepted: 10/05/2022

Full Paper (vol.891 paper# 1)

c:\work\Jor\vol891_2 Journal of Hospital Medicine (October 2022) Vol. 89, Page 4151-4154

Platelet-Rich Plasma in Treatment of Knee Osteoarthritis
Mohamed Soliman Hamed*
Orthopedic Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed Soliman Hamed, Mobile: (+20) 01288203682, E-mail: yaheahabeb1234@gmail.com

Osteoarthritis (OA) is one of the crucial musculoskeletal disorders that are characterized by the
imbalanced homeostasis and destruction of the articular cartilage.
Objective: This study aimed to evaluate the effect of platelet-rich plasma (PRP) in treatment of knee osteoarthritis.
Patients and Methods: This interventional study was carried out on 20 patients who were suffering from mild to
moderate primary osteoarthritis of knee joint during the period from May 2012 to March 2013. They were diagnosed
clinically, and by plain x- ray and Doppler musculoskeletal ultrasound.
There were 5 patients (25%) experienced slight pain at the site of injection lasted for one week and only one
patient (5%) experienced marked pain. Two patients (10%) had skin discoloration in the form of bruising. No reported
cases suffered from infection nor allergic reaction.
Conclusion: we concluded that PRP intra-articular injection is an effective method for treatment of knee OA. It is a
safe & economic alternative method of treatment. Maximal improvement is obtained in patients with young age and
short disease duration.
Keywords: Platelet-rich plasma, Osteoarthritis, Knee.


Osteoarthritis (OA) is one of the crucial
Inclusion criteria for patients selection:
musculoskeletal disorders that are characterized by the
History of chronic (at least 4 months) pain or swelling
imbalanced homeostasis and destruction of the articular
of the knee and imaging findings (Radiograph or
cartilage, in which pro-inflammatory cytokines are
Ultrasound) of mild to moderate degenerative changes in
important catabolic regulators during OA cascade [1].
the joint. All the patients presented with a chronic
Knee osteoarthritis is a major public health
degenerative condition (knees presented with a
problem, and in elderly people causes pain and
degenerative chondral lesion early osteoarthritis (Kellgren
disability in one third of all affected patients [2].
Platelet-rich plasma (PRP) is a natural concentrate

of autologous growth factors from the blood. The
Exclusion criteria:
method is simple, low cost, and minimally invasive.
Systemic disorders such as diabetes, rheumatoid
Currently, a wide range of experiments is taking place
arthritis, major axial deviation (varus more than 5 degrees
in different fields of medicine in order to test the
and valgus more than 5 degrees), hematological diseases
potential of enhancing tissue regeneration [3]. Platelet
(coagulopathies), severe
rich plasma is a blood product that allows in a simple,
infections, immunosuppression, patients on therapy with
low cost and minimally invasive way to obtain a
anticoagulants­antiaggregants, use of NSAIDs within 5
concentration of many growth factors and experimented
days before blood donation.
in different fields of medicine in order to test its

potential to enhance tissue regeneration [4,5] .
All patients were subjected to the following:
The application of PRP to treat OA of the knee can
Full medical history including preorganized case
be considered a relatively new therapeutic indication
history questionnaire, demographic data (sex, age,
that focuses undoubtly on the most current research [6].
educational level, occupation, number of children,
This study was performed to evaluate the
residence, current marital status and special habits of
effectiveness of local injection of autologous platelet-
medical importance) and plain x-ray of the affected
rich plasma in reducing pain and improving function in
knee (Anteroposterior and lateral views). Grading of
patients with mild to moderate knee osteoarthritis.
knee OA was done according to the Kellgren- Lawrence

grading system [7]. Diagnostic Doppler ultrasonography
of the knee joint with comment on synovial thickness,
This interventional study was conducted in
cartilage thickness, regularity of the cartilage margin,
Orthopedic Department, Zagazig University Hospitals
effusion and analysis of periarticular areas, e.g., bursitis.
during the period from May 2012 to march 2013.

Twenty patients were enrolled and treated with PRP
Ethical consent:
intra-articular knee injections. They were 14 (70%)
The study was approved by The Institutional
females and 6 (30%) males. Their ages ranged from 40-
Review Board (IRB), Faculty of Medicine, Zagazig
70 years with a mean of 50.4 ± 8.7 years.
University. Informed written consent was taken

from every patient or their caregivers.
Received: 2/2/2022
Accepted: 3/4/2022

Full Paper (vol.891 paper# 2)

c:\work\Jor\vol891_3 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4155-4164

Evaluation of Levosimendan in Patients with High Risk Severe
Mitral Valve Disease Undergoing Mitral Valve Surgery
Ahmed M. Elwakeel1, Alaa M. Omar1, Mohamed A. Hussein2, Ehab M. Elshihy1, Abdullah Osama Mahfouz2
1Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Giza, Egypt
2Department of Cardiothoracic Surgery, Faculty of Medicine, Fayoum University, Fayoum, Egypt
*Corresponding author: Ahmed M. Elwakeel, Mobile: (+20) 1005236454, Email: aelwakeel@kasralainy.edu.eg

Levosimendan has anti-ischemic effects, improves myocardial contractility and increases systemic,
pulmonary and coronary vasodilatation.
The present study investigated the perioperative hemodynamic effects of a prophylactic infusion of
levosimendan in high-risk mitral valve surgery patients with left ventricle dysfunction, and compared short-term clinical
outcomes with a control group in which levosimendan wasn't used.
Patients and methods: Between October 2019 and May 2021, a prospective randomized clinical study was performed
in 100 patients with high-risk mitral valve surgery with left ventricular dysfunction and pulmonary hypertension. In the
study group, patients received levosimendan infusion at a dose of 0.1 mcg/kg/min after the induction of anesthesia while
in control group levosimendan was not used. The intraoperative and postoperative data were recorded for each patient
in both groups. The hemodynamic measurements were performed at six predetermined time points (0, 1, 6, 12, 24 and
36 hours postoperatively).
Results: Levosimendan had significantly improved postoperative hemodynamic values. It improved mean arterial
pressure at different times postoperatively (p < 0.05), heart rate at different times postoperatively (p < 0.05). Also,
levosimendan preserved LV systolic performance postoperatively (pulmonary artery pressure (PAP): 51.7 ± 6.4, 57.9 ±
8.6, P<0.001) and (ejection fraction (EF): 37.1 ± 9.3, 33.4 ± 7.1, P=0.03).
Prophylactic levosimendan improved the hemodynamics in high-risk mitral valve surgery patients. So
levosimendan seems to be a safe and effective choice for preventing left ventricular failure in high-risk mitral valve
surgical patients with LV dysfunction.
Keywords: Left ventricular dysfunction, Levosimendan, Mitral valve surgery, Pulmonary hypertension.


allowing the ATP-sensitive potassium channels to be
Many individuals who are candidates for cardiac
surgery today are at significant perioperative risk for
Levosimendan differs from other positive
increased morbidity and death. Pulmonary arterial
inotropic drugs with features such as increasing
hypertension and poor ejection fraction are two
contractility without increasing myocardial oxygen
significant risk factors influencing surgical outcome in
consumption, improving coronary perfusion with its
patients with mitral valve dysfunction. Individually or
vasodilator activity, reducing preload and afterload by
in combination, the presence of these risk factors may
vasodilatation in the pulmonary, renal, splanchnic,
make weaning off cardiopulmonary bypass (CPB)
cerebral and systemic arteries as well as in the
difficult and may result in severe left and right
saphenous, portal and systemic veins (6, 7).
ventricular failure following CPB (1, 2).
This study was designed to evaluate the effect of
levosimendan in patients with mitral valve disease
vasodilation, and hyperthermia generated by the
undergoing high risk mitral valve surgery in comparison
inflammatory response associated with CPB are all
with using only the standard care, regarding
factors that contribute to hemodynamic instability in the
postoperative prognosis, hemodynamics, morbidity and
early postoperative period (3). The recovery from this
phenomena begins one hour (h) after the CPB is

terminated and lasts for 24 hours (4).
Treatment methods for patients who cannot be
This prospective randomized controlled study was
weaned from CPB or develop low cardiac output after
performed at Cairo University and Fayoum University
CPB include use of inotropic agents, vasodilators, intra-
Hospital in Egypt in the period between October 2019
aortic balloon pump, insertion of a balloon pump into
and May 2021.
the pulmonary artery, implementation of right

ventricular assist devices and extracorporeal membrane
Population of study and disease condition:
oxygenation. Levosimendan, a recently introduced
One hundred patients who presented with severe
calcium sensitizer, exhibits positive inotropic activity
mitral valve disease identified by clinical data and
by increasing the ionized calcium sensitivity of cardiac
preoperative echocardiography who needed high risk
troponin C and facilitating calcium binding to the
mitral valve replacement surgery were included. The
myofilaments. Additionally, it exhibits vasodilator
patients were divided into two groups, 50 patients each;
effects on the decrease in intracellular calcium level by
in Group A patients received levosimendan
Received: 22/03/2022
Accepted: 19/05/2022

Full Paper (vol.891 paper# 3)

c:\work\Jor\vol891_4 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4165-4170

The Effect of Time Delay between the Diagnosis of Chronic
Thromboembolic Pulmonary Hypertension and Pulmonary
Thrombo-Endarterectomy on the Postoperative Outcomes
Abdullah Osama Mahfouz*1, Kerellos Max1, Tarek Mohsen2, Tamer Eid Fouda2
1Department of Cardiothoracic Surgery, Faculty of Medicine, Fayoum University, Egypt
2Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Abdullah Osama, Mobile: (+20)1001300022, Email: amo11@fayoum.edu.eg

pulmonary thrombo-endarterectomy (PTE) is the treatment of choice for chronic thromboembolic
pulmonary hypertension in operable patients. Certain risk factors may be associated with bad outcomes after this
Objective: The aim of the current work was to investigate the effect of delay in having surgery on different outcomes
after PTE.
Subjects and Methods: This interventional prospective`e and retrospective study included a total of 20 patients who
underwent pulmonary thromboendarterectomy (PTE), attending at the Department of cardiothoracic surgery, Cairo
University Hospitals. This study was conducted between June 2019 and April 2021.
Results: The more delayed the surgery, the higher the postoperative pulmonary vascular resistance (PVR), patients who
had exceeded 13 months since the diagnosis of chronic thromboembolic pulmonary hypertension )CTEPH( significantly
developed poor postoperative functional class, patients who underwent surgery more than 16 months after the diagnosis
of the disease significantly developed postoperative reperfusion lung injury.
Conclusion: It could be concluded that delayed PTE is associated with poor postoperative functional class, higher
degree of pulmonary vascular resistance and more incidence of reperfusion lung injury.
Keywords: Chronic thromboembolic pulmonary hypertension, Pulmonary thromboendarterectomy, Reperfusion lung
injury, Pulmonary vascular resistance.


The clinical-based classification of pulmonary
This interventional prospective and retrospective
hypertension classified chronic thromboembolic
study included a total of 20 patients who underwent
pulmonary hypertension (CTEPH) as "group (4)
pulmonary thromboendarterectomy (PTE), attending at
pulmonary hypertension" (PH).
the Department of cardiothoracic surgery, Cairo
It results from an organized thromboembolic
University Hospitals. This study was conducted
material obstructing the pulmonary arteries. Usually,
between June 2019 and April 2021.
this condition presents with unexplained dyspnea

accompanied by increased pulmonary artery pressure
Inclusion criteria: The study included all patients
(PAP) and high pulmonary vascular resistance in the
with operable CTEPH having:
presence of the occluding thrombus. If left untreated, it
Unexplained dyspnea (NYHA functional classes
may be complicated with progressive impairment of the
II, III, and IV) after recovery from acute
right heart function and irreversible pulmonary
pulmonary embolism for more than three months
hypertension (1-3).
despite receiving effective anticoagulation.
CTEPH may be a curable disease with early
An echocardiogram revealed an estimated
diagnosis and surgical removal of this offending
pulmonary artery pressure of 25 mmHg or more,
thrombus in addition to performing pulmonary
regardless of RV dilatation or tricuspid
endarterectomy. This procedure is superior to both the
regurgitation. However, heart or pulmonary
medical treatment and lung transplantation (4, 5).
conditions cannot explain PH.
Although this surgery is considered the best
Planner ventilation/perfusion scan showed
option for operable patients, it may be associated with
mismatched major perfusion abnormalities whether
high mortality and a number of morbidities, including
unilateral or bilateral.
reperfusion lung injury, residual or persistent
CT Pulmonary angiogram confirmed obstructed
pulmonary hypertension, neurologic complications, and
arteries with reduced pulmonary vasculature distal
less-than-anticipated postoperative functional status.
to the level of obstruction.
Therefore, careful case selection and risk assessment
Right sided heart catheter revealed mean pulmonary
should be taken into account before surgery (6).
artery pressure of more than 30 mmHg and
The aim of the present study was to investigate the
pulmonary vascular resistance 300 dyn. s.cm-5.
effect of delay in having surgery on different outcomes

after PTE.

Received: 32/03/2022
Accepted: 22/05/2022

Full Paper (vol.891 paper# 4)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4171-4175

Study of the Relation between Peripheral Arterial Disease and
Vitamin D Level among Maintenance Hemodialysis Patients
Ashraf Hassan Abdelmobdy*¹, Amr Abd Elshafy Aboud², Walid Ahmed Bichari1
¹Internal Medicine and Nephrology Department, Faculty of Medicine Ain Shams University, Cairo, Egypt
²Internal Medicine and Nephrology Department, Faculty of Medicine, Kafr El-Sheikh University, Cairo, Egypt
*Corresponding author: Ashraf Hassan Abdelmobdy, Mobile: 01093989048, Email: ashrafnephro@med.asu.edu.eg

Worldwide, chronic kidney disease (CKD) is a major public health issue. The Global Burden of Disease
study stated that, worldwide mortality attributed to renal failure showed a tremendous rise with around 1.2 million deaths
from renal failure in 2015. Atherosclerosis, especially peripheral arterial disease (PAD), is more common in people
undergoing hemodialysis (HD). However, there are some correlations that appear to be unique to dialysis patients when
it comes to risk factors for peripheral artery disease.
To study the relation between PAD assessed by ankle brachial index (ABI) and serum level of 25(OH)
vitamin D among maintenance HD patients from multiple dialysis centers in Kafr El-Sheikh Governorate, Egypt.
Patients and Methods: From the dialysis centers in Kafr El-Sheikh Governorate, Egypt, a total of 90 ESRD patients
on maintenance HD were recruited for this study and were divided into two groups, 45 with PAD assessed by ABI
(value less than 0.9) and 45 without PAD assessed by ABI (value more than or equal 0.9). Study was done over six
months starting from April 2019 till end of October 2019.
Results: Serum 25(OH) vitamin D levels differed statistically significantly between the two groups (P< 0.001). Patients
and control groups both showed a statistically significant positive connection between ABI and their serum vitamin D
level (P< 0.001).
Conclusion: PAD is linked to vitamin D insufficiency in people who are on maintenance hemodialysis.
Chronic kidney disease, Peripheral arterial disease, Vitamin D.


The current work aims to study the relation
Chronic kidney disease (CKD) is a main
between PAD assessed by ABI and serum level of
medical concern globally and is causing significant
25(OH) vitamin D among maintenance HD patients.
increase in morbidity and mortality (1). End-stage renal

disease (ESRD) affects around 675,000 people in the
United States, costing the healthcare system more than
90 ESRD patients on maintenance HD were
$32 billion a year. Despite therapeutic improvements,
selected from multiple dialysis centers in Kafr El-
mortality and morbidity rates for hemodialysis (HD)
Sheikh Governorate, Egypt and were divided into two
patients remain high (2). The death rate was high among
groups: Patient group included 45 with PAD (ABI
maintenance HD patients and the major reason of death
value less than 0.9), and Control group included 45
was cardiovascular (CV) diseases (3).
without PAD (ABI value more than or equal 0.9).
Patients with peripheral arterial disease are
The study population selected included subjects who
classified as those who have atherosclerotic or thrombi-
were 18 years old or above and maintained on regular
embolic processes in their lower limb arteries, which are
hemodialysis for more than six months with dialysis
major health-care issues (4). There are a variety of
regimen of 3 sessions per week, bicarbonate containing
symptoms associated with peripheral artery disease
dialysate and using heparin anticoagulation.
(PAD), ranging from the nonexistence of symptoms to
Patients with active infection, malignancy,
those that are uncommon, such as an inability to do
decompensated liver disease, autoimmune disease were
strenuous activities, typical intermittent claudication, or
excluded. Diabetes mellitus is an important risk factor
lower-limb ischemia discomfort and ulceration (5).
for PAD, so we also excluded diabetic HD patients from
Subclinical and symptomatic PAD can both be
our trial in order to assess the only effects of vitamin D
detected with high accuracy and reliability using the
on ABI. Study was done over six months starting from
ankle­brachial index (ABI) (6). PAD can be diagnosed
April 2019 till end of October 2019.
by comparing it to the gold standard, arteriography.
Personal and family histories, smoking habits,
PAD patients can be accurately identified with 95%
and past cardiovascular disease, like cerebrovascular
sensitivity and 100% specificity using the ABI value.
disease, peripheral vascular disease, as well as coronary
An ABI of less than 0.9 has been associated with an
artery disease, were gathered from all participants in the
increased risk of clinical PAD, myocardial infarction,
composite cardiovascular disease and all-cause
Heart rate, systolic and diastolic blood pressure,
mortality in individuals with chronic renal failure (7).
and height/weight measurements were taken before
However, there are some correlations that appear to be
each HD session to ensure that the patient was healthy
unique to dialysis patients when it comes to risk factors
enough to participate in the treatment. When a person
for peripheral artery disease (PAD).
has hypertension, their blood pressure was either
Received: 07/04/2022
Accepted: 06/06/2022

Full Paper (vol.891 paper# 5)

c:\work\Jor\vol891_6 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4176- 4186

Cerebral Oxygenation and Metabolism after Reversal of Rocuronium:
Comparison between Sugammadex versus Neostigmine
Tamer El Metwaly Abdallah Farahat*1, Sherif Abdo Mousa1,
Nermin Mahmoud Abd El Monem1, Abeer Mosbah Abd El Hamid2, Doaa Galal Diab1
Departments of 1Anesthesia and Surgical Intensive Care and Pain Management and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Tamer El Metwaly Abdallah Farahat; Mobile: (+20)01005468680, E-mail: tamerfarahat2@yahoo.com

Recovery from neuroanesthesia requires stable hemodynamics and optimal cerebral oxygenation.
Objective: The purpose of this study was to compare the effect of low dose sugammadex with neostigmine on recovery
and cerebral hemodynamic profile after supratentorial tumor resection.
Patients and Methods: In this double-blind randomized study, forty patients were allocated according to the reversal
used after supratentorial tumor surgery into, sugammadex 2 mg·kg­1 (group S) or neostigmine 0.05 mg·kg­1 + atropine
0.02 mg·kg­1 (group N). Duration from reversal to train of four 0.9 was a primary outcome. Arterial and jugular bulb
blood samples obtained after induction, before closure of dura, before reversal, ten minutes after reversal then one hourly
for 3 hours postoperative for the calculation of arterial-jugular oxygen content difference "CaO2-jO2," cerebral oxygen
extraction "CEO2", jugular venous oxygen saturation (SjvO2), estimated cerebral metabolic rate "eCMRO2," and
cerebral blood flow equivalent "CBFe," as secondary outcomes.
We demonstrated that recovery time (duration from reversal to train of four 0.9) was significantly shorter with
sugammadex (P=0.001). Sugammadex recorded significant increased CEO2 and CaO2-jO2 at 10 minutes after reversal,
at 1 hour (hr), 2 hr and 3 hr postoperatively. Sugammadex resulted in significant decreased SjvO2 and CBFe at 10
minutes after reversal, at 1 hr, 2 hr and 3 hr postoperatively without significant effect on eCMRO2.
Conclusion: Low dose sugammadex (2 mg.kg-1) provided rapid and effective reversal of rocuronium NMB superior to
neostigmine with improved cerebral hemodynamic profile after supratentorial tumor surgery.
Key words: Cerebral hemodynamic, Neostigmine, Sugammadex, Supratentorial tumor.

as normal temperature. Elevated blood pressure, cough,
Among the requirements of the modern
and asynchrony with mechanical ventilator enhance the
anesthesia practice, is the use of neuromuscular
risk of postoperative hematoma and edema. Residual
blocking agents, which provide good surgical
curarization is particularly risky for patients with cranial
conditions especially in patients subjected to
pathologies in which level of consciousness and
neurosurgical procedures. Reversal agents like
protective reflexes can be compromised due to the
neostigmine are frequently used to hasten the
underlying disease or the neurosurgical intervention(7).
restoration of neuromuscular function. However, this
To our knowledge, rather than recovery profile,
drug neither provides predictable nor a sufficient rapid
there is a little number of studies available in the
recovery of neuromuscular function(1,2), and might
literatures comparing cerebral hemodynamics and
cause many adverse effects in relation reduced activity
oxygenation effects of low dose sugammadex with
of cholinesterase enzyme(3).
neostigmine in neurosurgical patients. So, the current
Sugammadex (Bridion®); a -cyclodextrin
comparative, randomized and double blind study was
derivative is a new reversing agent used to reverse the
conducted to investigate short term effect of low dose
neuromuscular blockade (NMB) produced by
sugammadex versus neostigmine on recovery and
rocuronium or vecuronium. Unlike neostigmine,
cerebral hemodynamic profile after reversing the
sugammadex reverses deep NMB and could be
rocuronium neuromuscular blockade in patients
administered to reverse NMB immediately without
undergone supratentorial tumor excision.
waiting for partial recovery. It does not affect

cholinesterase activity and thus there is no need for
anticholinergic agents (like atropine), which should be
Forty consecutive patients aged 21-60 years of both
used with neostigmine(4,5). Early recovery is targeted in
sexes, admitted to the Neurosurgery Department for
neurosurgery specially those undergoing brain tumor
elective surgical removal of supratentorial brain
resection for achieving early neurologic assessment and
neoplasms were included in this study. The patient flow
therefore for accelerating the diagnosis and
is depicted in Fig. 1.
management of serious complication(6).

Aims during emergence from neurosurgical
Ethical consent:
anesthesia are to maintenance the stability of blood
The study was approved by the medical local
pressure and intracranial pressure, thus normal cerebral
Ethics Committee in Mansoura University
perfusion pressure (CPP) with adequate oxygenation,
Hospital/Egypt (MD 16.07.22 July 2016) and was
normal arterial carbon dioxide tension (PaCO2), as well
Received: 24/4/2022
Accepted: 21/6/2022

Full Paper (vol.891 paper# 6)

c:\work\Jor\vol891_7 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4187- 4190

Inflammatory Markers for Predicting Ischemic Stroke Outcome: Review Article
Eman M. Khedr1, 2, Ayman Gamea3, Islam Gadelrab Ahmed3, Amira Khalifa Ismail*3
1Neuropsychiatry Department, Faculty of Medicine, Assiut University Hospital, Assiut, Egypt
2Neuropsychiatric Department, Faculty of Medicine, Aswan University Hospital, Aswan, Egypt
3Neuropsychiatric Department, Faculty of Medicine, South Valley University, Qena University Hospital, Qena, Egypt
*Corresponding author: Amira Khalifa Ismail, Mobile: (+20) 01096975228, E-Mail: amira442020@yahoo.com

In developed countries, stroke is the third leading cause of mortality and the leading cause of lifelong
disability. Chronic inflammation, oxidative and nitrosative damage to the immune, metabolic and cellular systems and,
neurotoxicity therefore has a role in acute ischemic stroke (IS). It may be possible to employ various biomarkers
simultaneously to forecast the occurrence and prognosis of IS. When inflammation subsides after a stroke, it accelerates
tissue repair and neurodegenerative processes, which are known to expand the ischemic lesion. Post-stroke inflammation
has a substantial impact on a patient's capacity to recover from the disease, and novel diagnostic, prognostic, and
therapeutic treatments are urgently needed.
Objective: An overview of the role of inflammation in stroke pathology is provided in the following review. Stroke
patients' prognosis can be better predicted by using biomarkers of inflammation.
Material and 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 [Ischemic stroke OR
Neuroinflammation AND Stroke outcome] and in peer-reviewed articles between Jun 2001 and November 2021; a 20-
year date range was selected. Documents in a language apart from English have been excluded as sources for
Conclusion: Clearly, inflammation is a major contributor to stroke pathogenesis. Inflammation plays a dual role during
an ischemic stroke, showing both positive and detrimental effects depending on the stage of the disease. Stroke
prognostication is hampered by the absence of sensitive and speedy blood tests for diagnosis.
Keywords: Ischemic stroke, Neuroinflammation, Stroke outcome.


can cause ischemic stroke. When it comes to strokes
One in three adults in the United States suffers
caused by atherosclerosis of the extracranial and
from a stroke each year, with an estimated 795,000
intracranial blood vessels as well as coronary artery
happening annually. Stroke incidence is expected to
disease, hyperlipidemia is an especially relevant risk
climb by 3.4 million people between 2012 and 2030,
factor. Cardioembolic stroke is a possibility for people
owing to an ageing population and a drop in the number
with atrial fibrillation (3).
of stroke deaths. It was thought that the fatality rate

from stroke has been declining steadily for the past two
Objective: An overview of the role of inflammation in
decades, but current patterns in mortality show that this
stroke pathology is provided in the following review.
decline may have stopped or even increased. However,
Stroke patients' prognosis can be better predicted by
it's possible that the obesity global epidemic and its
using biomarkers of inflammation.
accompanying diabetes are to blame for this. Stroke-

related mortality is still high, and the annual healthcare,
medication, and lost productivity expenses are
These databases were searched for articles
estimated at 34 billion $ (1).
published in English in 3 data bases [PubMed ­ Google
Hemorrhagic and ischemic strokes are both types
scholar - Science direct] and Boolean operators (AND,
of stroke. Hemorrhagic strokes account for a smaller
OR, NOT) had been used such as [Ischemic stroke OR
percentage of all strokes (about 20%), whereas ischemic
Neuroinflammation AND Stroke outcome] and in peer-
strokes account for the vast majority (around 80%).
reviewed articles between Jun 2001 and November
Transient ischemic attacks can be intraparenchymal or
2021; a 20-year date range was selected, and no
subarachnoid hemorrhagic strokes. Subtypes of
language limitations, and filtered in selected data basis
ischemic stroke, or classifications that indicate the
for the last 20 years, however, the range of time interval
origins of the stroke, include cardioembolic,
for researches is wide as there's scarcity of data on the
atherosclerosis, lacunar and other particular causes
particular reviewed, accurate and depth in the retrieved
literature. Documents in a language apart from English
abnormalities, among others) (2).
have been excluded as sources for interpretation was not
Ischemic stroke has distinct risk factors, some of
found. Papers apart from main scientific studies had
which are shared by hemorrhagic stroke and others that
been excluded: documents unavailable as total written
are distinct among the many etiologies of ischemic
text, conversation, conference abstract papers and
stroke. Blood clots in the brain can be caused by
hypertension, but it also adds to atherosclerosis, which

Received: 27/04/2022
Accepted: 26/06/2022

Full Paper (vol.891 paper# 7)

c:\work\Jor\vol891_8 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4191- 4196

Removal of Broken Umbilical Venous Catheter from Inferior Vena Cava Via
Cardiac (Femoral) Catheterization: A Case Report in Neonatal
Intensive Care Unit (NICU) of Mataria Teaching Hospital
Neveen Mamdouh Habib1, Sohaila Ali Abd El-Halim*2, Tamer Aly El Kassas3,
Ebtessam Farouk Abdelbadea2, Sherine Salaheldin Baris2, Tarek Salah Hefny2, Nanies Soliman1
1Pediatric Cardiology Department, Faculty of Medicine, Ain Shams University, Egypt
1Pediatric Department, Neonatal Intensive Care Unit, Mataria Teaching Hospital, Egypt
3Radiology Department, Mataria Teaching Hospital, Egypt
*Corresponding author: Sohaila Ali Abd El-Halim, Mobile: (+20)01222842390, Email: sohailabenali@yahoo.com


Background: Arterial and venous umbilical catheters are used for drugs, fluids, and blood products administration and for
exchange transfusion, in delivery room for neonatal resuscitation, and also for admitted critically ill neonates. Neonatologist
can insert both umbilical catheters easily in short time. In spite of this, many unavoidable complications can occur as
pericardial effusion, sepsis, thrombosis, and arrhythmia. Umbilical catheter breakage is a rare complication but it can happen
during insertion or removal of the catheter. Various procedures are used for retrieval of the broken catheter. Surgical,
vascular, and pediatric cardiac expert in catheterization should be consulted to choose the safest method for removal of the
fractured catheter and to be stand by in case of failure of the chosen technique during the intervention.
Case Report: A 20 days old near term infant with a birth weight of 2400 g was born by cesarean section. He was admitted
to NICU of Mataria Teaching Hospital because of respiratory distress due to congenital pneumonia.
Results: A reported case of a near term male at neonatal intensive care unit (NICU), Mataria Teaching Hospital was
diagnosed by X-ray, on the second day of the removal of umbilical venous catheter (UVC), to have a fractured UVC at
junction of hepatic vein and right atrium. Patient was transferred to Ain Shams University Children Hospital Cath Lab for
trial of percutaneous removal of the remaining catheter segment, where it was retrieved successfully.
Conclusion: Fracture and embolization of a UVC is a rare but serious complication. Percutaneous retrieval of broken
catheters using minibasket microsnare is amenable and safe procedure in neonates that can be done with minimal patient
Keywords: Broken umbilical venous catheter (UVC), Cardiac catheterization, NICU.


Arterial and venous umbilical catheters (UAC and
UVC) are used in resuscitation room and in critically ill
A 20 days old near term infant with a birth weight
neonates for drugs, fluids and blood product
of 2400 g was born by cesarean section. He was admitted
administration or exchange transfusion (1).
to NICU of Mataria Teaching Hospital because of

respiratory distress due to congenital pneumonia.
Many unavoidable complications can occur with
Ethical consent:
umbilical catheters insertion as pericardial effusion (2),
An approval of the study was obtained from
sepsis, thrombosis, arrhythmia and catheter breakage (3).
Mataria Teaching Hospital Academic and Ethical
Clues for broken umbilical catheter segments may
Committee. Parent of child were informed that the
include difficulty in insertion of another one (4), as well as
case would be published as case report and this was
other misleading symptoms such as need for mechanical
accepted. This work has been carried out in
ventilation and elevation of acute phase reactants (5).
accordance with The Code of Ethics of the World

Medical Association (Declaration of Helsinki) for
Kotnis et al. (6) reported late presentation of a broken
studies involving humans.
catheter tip presented 15 months later by an umbilical

Table (1) showed the data of the registered cases since.

Received: 27/4/2022
Accepted: 26/6/2022

Full Paper (vol.891 paper# 8)

c:\work\Jor\vol891_9 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4197- 4204

Proenkephalin A119-159 As A Biomarker of Acute
Kidney Injury in ICU Patients with Sepsis
Mohamed E. Ibrahim1, Mohamed Ibrahim Mohamed Badr*1,
Dalia Mohamed Abd El-Hassib2, Ahmed Wageh Mahdey1
Departments of 1Internal Medicine and 2Clinical and Chemical Pathology,
Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mohamed Ibrahim Mohamed Badr, Mobile: (+20) 01001133431,
E-Mail: mohammedbadr810@gmail.com
Sepsis is a potentially fatal illness caused by an unbalanced host response to infection. Sepsis is becoming
more common, indicating that it is a main cause of severe disease and fatality globally. Patients with sepsis commonly
have simultaneous acute kidney injury (AKI), with rates ranging from 5 to 20% among hospital admissions and
increasing to 35-50% among the seriously sick. Because proenkephalin is not bound to proteins in plasma and is only
filtrated in the glomerulus, it is a promising biomarker for renal impairment in critically sick patients. Objective: The
aim of the current study was to assess Proenkephalin A119-159 (penKid) as a biomarker for sepsis related AKI in ICU
patients. Patients and methods: A case control study was conducted at intensive care unit (ICU) department, Benha
Faculty of Medicine on a total of 80 subjects which were divided into 50 septic AKI cases and 30 matched age and sex
controls. Subjects met two or more SIRS-criteria and their estimated glomerular filtration rate (eGFR) was determined
by the formula derived from the Modification of Diet in Renal Disease (MDRD) Study and the Proenkephalin A119-
159 (penkid) was measured by ELISA. Results: The current study demonstrated that, septic AKI cases demonstrated
significant increase in penkid compared to control group(p<0.001) and Penkid level showed significantly positive
correlation with baseline, after 48 h creatinine, CRP, SIRS and SOFA scores. Penkid was better than creatinine, eGFR
and CRP for prediction of non-recovery septic AKI. Conclusion: PenKid was demonstrated to be a reliable surrogate
promising biomarker for sepsis related AKI among unselected patients with sepsis. Additionally, penkid demonstrated
superior advantage over creatinine, eGFR and CRP in terms of non-recovery septic AKI prediction.
Keywords: Sepsis, Systemic Inflammatory Response Syndrome, Proenkephalin, acute kidney injury, Benha University.


There is expression of proenkephalin A119-159
Kidney Disease Improving Global Outcome
(penkid) in a variety of tissues, including the kidney and
(KDIGO) defines acute kidney injury (AKI) as one of
the heart. Penkid is regarded as a marker of kidney
the following: a rise in serum creatinine of 0.3 mg/dL or
function (not injury) because of the substantial negative
more within 48 hours; a rise in serum creatinine of 1.5
correlation between observed glomerular filtration rate
times baseline or more within the last 7 days; or a
(GFR) and plasma concentrations of penkid [7].
decrease in urine output of less than 0.5 mL/kg/h for a
Penkid levels rise faster than creatinine levels do
period of six hours [1]. While, because existing standard
in the presence of acute renal failure. In contrast to other
biomarkers lack sufficient sensitivity or specificity, its
indicators, an increase in plasma penkid does not appear
early diagnosis remains difficult [2].
to be affected by factors unrelated to renal function,
The fact that serum creatinine might not rise
such as systemic inflammation, suggesting that it is a
despite renal damage in sepsis-related AKI may be a
highly specific marker for kidney disease [8].
significant issue. This could be brought on by a
The aim of the current study work was to assess
reduction in the synthesis of serum creatinine or its
penKid as a biomarker for sepsis related AKI among
dilution as a result of IV fluid delivery. It could also be
unselected patients with sepsis.
brought on by serum creatinine's unfavourable kinetics,

which does not increase for 24 to 48 hours following
renal damage [3]. Implementing innovative biomarkers
This study was conducted at intensive care unit
that allow for a trustworthy classification of AKI risk
(ICU) department, Benha Faculty of Medicine on a total
for ICU patients will allow for the early development of
of 50 patients with 30 matched age and sex controls.
effective management regimens with a potential benefit
Ethical approval:
to patient outcomes [4]. With regard to predicting AKI,
After obtaining the Approval from Ethical
the use of biomarkers for kidney damage or injury has
Committee of Benha Faculty of Medicine. All
shown mixed results, mostly because kidney damage
participants signed an informed consent before
and loss of renal function are not correlated with one
being included in the study. This work has been
another [5].
carried out in accordance with The Code of Ethics of
Proenkephalin A119-159 (penkid), a filtration
the World Medical Association (Declaration of
marker, has recently been suggested as a sensitive
Helsinki) for studies involving humans.
biomarker of glomerular function. Penkid, a 5-kDa
We included patients who were 18 years and older, who
peptide thought to be a stable surrogate marker for the
admitted to the ICU for sepsis or septic shock, whom
unstable enkephalins, is generated from the same
had two or more SIRS-criteria and we excluded subjects
precursor as met- and leu-enkephalins [6].
Received: 26/4/2022
Accepted: 23/6/2022

Full Paper (vol.891 paper# 9)

c:\work\Jor\vol891_10 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4205- 4210

Varicose Veins and Associated Risk Factors among Women in the
Childbearing Period in Benha city, Egypt: A cross-sectional study
Mona Ahmed Elawady1*, Eman Abdelfattah Albitar1, Amal Ahmed Salama2,
Hazem Elsayed Algioushy3, and Hala Ali Abed1
Departments of 1Public Health and Community Medicine and
3General Surgery, Faculty of Medicine, Benha University, Egypt
Department of 2Family Medicine, Faculty of Medicine, El-Monufia University, Egypt
*Corresponding author: Mona Ahmed Elawady, Mobile: (+20) 01006719823, E-Mail: dr_monaelawady@yahoo.com

: Varicose veins (VV) are a common chronic venous disorder. Women in childbearing period are at high
risk and suffer from serious complication including pain, discomfort, leg cramps, ulceration, poor quality of life,
absenteeism, and even loss of life. The objective of the present work is to study the prevalence of leg varicose veins,
and to identify socio-demographic, lifestyle and other possible risk factors among women in the childbearing period.
Patients and Methods: A cross-sectional study was conducted among 410 women in the childbearing period (15-50
years old) attending Family Medicine Outpatient Clinic at Benha University Hospital, through an interview
questionnaire and a clinical examination according to CEAP classification [clinical manifestations (C), aetiological
factors (E), the anatomic distribution of disease (A), and underlying pathophysiological findings (P)].
Results: The prevalence of VV was relatively high (51.5%) among the studied population. Univariate analysis showed
that age, occupation, education, BMI, family history of VV, lack of exercise, high blood pressure, major contusion with
prolonged healing, fracture in lower limb, long standing duration, and shorter exercise duration were significantly
associated with the occurrence of VV. Logistic regression showed that family history of VV was the most independent
predictor (OR 6.23, 95% CI: 3.62-11.06). Conclusion: It is concluded that after controlling for age, logistic regression
revealed that family history was the most independent predictors of VV. A suggested comprehensive preventive and
control program was designed by the researcher to be tested in further study in the soon future.
Keywords: Varicose Veins, Risk factors, Childbearing period, Benha University, Cross-sectional study.

Varicose veins (VV) are excessively enlarged,
demonstrated that, in addition to environmental factors,
tortuous, and darkly colored veins that damage the skin's
genetic processes (such as obesity, age, parity, prolonged
superficial surface or above. They are commonly found
standing, and family history) may also contribute to
in the lower limbs (1). VV swell due to a loss of flexibility
vascular disease susceptibility (7). Depending on the
over time and weak vein valves that allow blood to return
individual, VV can start to manifest as early as
through the veins incorrectly. In order to accommodate
adolescence, but prevalence increases with age.
the excess blood, the veins enlarge, which eventually
Pregnancy occurs frequently when VV initially
causes them to lose their suppleness. People may
manifests, and further pregnancies may exacerbate
experience pain in the affected area, notice changes to
problems. Although a family history of severe symptoms
their skin, and develop ulcers there (2).
or ulcers is prevalent, people should be reassured that
VV is a common chronic venous condition that
there is little chance that they will experience a similar
affects 20 to 60% of adults worldwide (3).Aly stated that
problem (8).However, they may cause genuine
the prevalence of VV was 51.1 percent among patients
complications, including agony, distress, leg issues,
at Cairo University's family health care unit (4).
ulceration, diminished quality of life, non-appearance,
According to WHO, women are 3­4 times more
and even death (3). VV of the lower appendages is a
likely than men to have a primary VV than the general
population in the west. One in five people worldwide
take numerous shapes, extending from a non-pathologic
suffers from VV, and its incidence is on the rise in the
condition to an unsettling persistent clutter. When they
majority of countries (1).
been ignored,
Physical requirements are taken into account as a
have frequently been treated by sclerotherapy or
risk factor for VV (5). Due to the hard labor and prolonged
surgery, with dynamically effective results (9).
standing required by their responsibilities (at work and
This study aimed to study the prevalence of leg
at home), women are at high risk (3).
VV, and to identify socio-demographic, lifestyle, and
Millions of workers stand for the majority of the
other possible risk factors among women of childbearing
workday and sit for long periods of time. Standing for
age (15­50 years old) attending Family Medicine
extended periods of time can cause fatigue, lack of focus,
Outpatient Clinic at Benha University Hospital.
and an increase in health hazards, including leg

and foot swelling, foot and joint damage, VV, heart and
circulation abnormalities, and lower back issues (6).
Study design: A cross-sectional study was conducted

among women of childbearing age (15-50 years old).
Received: 29/4/2022
Accepted: 28/6/2022

Full Paper (vol.891 paper# 10)

c:\work\Jor\vol891_11 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4211- 4214

QTc Dispersion in Children with Congenital Hypothyroidism
Ashgan Abdallah Alghobashy, Sara Elsayed Hassan Mohamed Hamam*, Heba Abouzeid
Department of Pediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Sara Elsayed Hassan, Mobile: (+20) 01014465561, E-Mail: sarahamam2017@gmail.com

The effects of thyroid hormones on the cardiovascular system have been well documented. Chronotropic
response and normal tone of the heart muscle during diastole are due to T3. Moreover, triiodothyronine affects the
number of B adrenergic receptors and their sensitivity to catecholamines. Increased corrected QT (QTc) dispersion has
been found to be associated with cardiac arrhythmias and sudden cardiac death in patients with myocardial infarction,
left ventricular hypertrophy, congestive heart failure, diabetes and end-stage renal disease.
Objective: The objective of this study was to evaluate QTc dispersion in children with congenital hypothyroidism.
Patients and Methods:
This was a case-control study that was carried out at Pediatric Cardiology and Endocrinology
Units, Zagazig University Children's Hospital. The study included 74 children with hypothyroidism and control
subjects. Twelve lead ECG was performed to all participants. Serum T4 and TSH were measured to all study members.
Results: There was statistically significant increase among case than control groups regarding QTc dispersion (P <
0.05), while there was no statistically significant difference (P 0.05) regarding longest QTc, shortest QTc and QRS
amplitude. The current study showed that, there was no statistically significant difference (P 0.05) regarding longest
QT, shortest QT, QRS amplitude and QTc dispersion in cases with low versus those with high TSH level. There was no
significant correlation between TSH and QTc dispersion.
QTc dispersion was higher in our patients compared to control group, which indicates heterogeneity of
ventricular repolarization that could contribute to increased risk of ventricular arrhythmias.
QTc dispersion, Assessment, Congenital hypothyroidism.

University Hospitals on 74 participants that were
Congenital hypothyroidism (CH) is one of the most
divided into patients and control groups.
common preventable causes of mental retardation. In

most cases, the disorder is permanent. Less commonly,
Study population: The study retrospectively enrolled
the altered neonatal thyroid function is transient,
48 patients with congenital hypothyroidism between
attributable to the transplacental passage of maternal
April 2021 and May 2022. They were regularly
medication and maternal blocking antibodies (1). In rare
followed up at Outpatient Clinic of Ministry of Health,
cases, CH may result from a pituitary or hypothalamic
Zagazig, Egypt. The control group included 26
asymptomatic healthy children selected from
hypothyroidism) (2). The thyroid hormone is important
Inpatients/Outpatients Units of Zagazig University
for normal growth and development in infancy (3).
Children's Hospital.
Since cardiovascular system is rich in TSH

receptors and is one of the major sites of action for TSH,
Patients: Forty-eight children with congenital
it is relatively sensitive to changes in the levels of TSH
hypothyroidism that were diagnosed to have high TSH
(4). The effects of thyroid hormones deficiency on the
and low T4 levels and who were getting hormonal
cardiovascular system include pericardial effusion,
replacement treatment were included in the study. The
weak arterial pulse, bradycardia, hypotension, facial
patients' group was divided into two subgroups:
and peripheral edema, deepened cardiac sounds, and
patients with TSH levels < 40 uIU/ml and cases with
congestive heart failure manifestations such as ascites,
TSH > 40 uIU/ml. Patients were divided into two
orthopnea, and paroxysmal dyspnea (5). Congenital heart
subgroups based on duration of illness: duration of
disease (CHD) is the most frequent disease condition
illness <12 months and duration of illness >12 months.
associated with congenital hypothyroidism. CHD is also
Control subjects: Twenty-six children of comparable
reported to be a risk factor for non-autoimmune
age and sex to cases served as controls. Control children
hypothyroidism in children (6).
had been investigated to exclude congenital or acquired
QTc dispersion, the difference between the
heart disease and their physical examination and
maximum and minimum QTc interval on the 12-lead
Echocardiography were found to be uneventful.
electrocardiogram (ECG), is a marker of heterogeneity

of ventricular repolarization (7).
The objective of this study was to evaluate QTc
hypothyroidism from birth (full term) to 3 years of age.
dispersion in children with congenital hypothyroidism.

Exclusion criteria: Other endocrinal or CNS
dysfunction, patients on antiepileptic drugs, and
This case-control study was performed at Pediatric
congenital or acquired heart diseases. Patient with
Cardiology and Endocrinology Units, Zagazig
surgical intervention of thyroid gland.
Received: 29/4/2022
Accepted: 28/6/2022

Full Paper (vol.891 paper# 11)

c:\work\Jor\vol891_12 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4215- 4225

Effect of Valproic Acid on Pre and Postnatal Development of the Cerebellar
Cortex of the Albino Rat and the Possible Protective Role of the Folic Acid
Ahmed T. Galal*, Sayed A. Sayed, Wafaa A. Mubarak, Walaa G. Farag
Department of Human Anatomy and Embryology, Faculty of Medicine, Assiut University, Assiut, Egypt
*Corresponding author: Ahmed T. Galal, Mobile: (+20) 01095248259, E-Mail: ahmedgalal870@gmail.com

: Valproic acid (VPA) is one of antiepileptic drugs that causes neurodevelopmental disorders, including
the autism spectrum disorder. Folic acid is essential for DNA synthesis and its periconceptional supplementation protects
against several birth defects.
Objective: To clarify the folic acid's protective potential against the valproic acid induced neurodevelopmental toxicity
on rat cerebellar cortex.
Material and Methods: 60 pregnant albino rats were divided into three groups; group I (control, received saline), group
II (valproic acid 50 mg/kg once daily) and group III (valproic and folic acid (400 mg/kg) once daily). The offspring rats
were sacrificed at day 15 and 17 prenatally, newborn, and at day 15 and 21 postnatally. Samples of cerebellar cortex
were prepared for light and electron microscopic examination, immunohistochemical GFAB study as well as for
histomorphometric analysis.
Results: In group II, the rat offspring's cerebellar cortex showed marked degenerative changes, mostly in Purkinje cells.
The cells appeared shrunken, irregular with vacuolated cytoplasm contained damaged organelles and nuclei. The
external granular layer appeared decreased in thickness and contained less cells with deeply stained nuclei. The
cerebellar cortex of the group III showed restoration of the normal architecture. GFAB immunoreaction in group III
appeared comparable to control against the strong positive reaction (gliosis) in group II. All studied morphometric
parameters in group III were close to the control group and markedly reduced in group II.
Conclusion: Periconceptional folic acid supplementation reduces VPA neurotoxic effects on rat cerebellar cortex
development pre and postnatally.
Keywords: Cerebellar cortex, Valproic acid, Folic acid, GFAP.

VPA are accompanying by obvious increase in the fetal
Antiepileptic drugs are important drugs that are
oxidative stress (7, 8).
used in many pregnant women for prevention and
Folic acid (Vitamin B9) plays a vital role in the
control of the seizures. Non-controlled epileptic attacks
expression of genes and new protein production which
during pregnancy causes harmful effects to both mother
is important for fetal cell differentiation and
and fetus. Valproic acid (VPA) is considered the most
development (7, 9, 10). The folic acid requirements
efficient and in some cases, the only successful
increase during periods of rapid tissue growth as during
treatment for some forms of epilepsy (1). VPA traverses
pregnancy (11, 12). Adequate folic acid intake by pregnant
the placental barrier and accumulates in the fetal blood
women protects against several congenital anomalies
causing injurious effects on the developing embryo (2, 3,
4). It also transferred through the breast milk, so infants
Therefore, the present study was carried out to
can be exposed postnatally to VPA if their mothers
examine the possible protective effect of folic acid
taking it (5).
against the degenerative changes induced in rat
VPA produces various types of developmental
cerebellar cortex due to pre and postnatal exposure to
defects that depend on the dose of the drug (2). Valproic
valproic acid.
acid causes neural tube defects and skeletal

malformations include limb defects, fused vertebrae,
fused ribs, syndactyly, and dysplasias (5, 6). In addition
Drugs used:
to the fetal malformation, exposure to VPA in utero also
1. Valproic acid (VPA): Sodium valproate in the
causes neurodevelopmental disorders including reduced
form of syrup 250 mg/5 mL, produced by Sanofi
cognitive function, learning difficulties, attention-
Company, Egypt.
deficit disorder and increases the prevalence of children
2. Folic acid: in the form of tablets (5 mg), a product
suffering from autism spectrum disorder(3, 5).
of El-Nile Company for pharmaceutical and
It was found that VPA causes harmful effects on
chemicals, Egypt. Each tablet was dispersed in 10
the proteins and genes that play a vital role in guidance
mL of distilled water. Each mL of the produced
of differentiation and cell divisions during
suspension contained 500 g of folic acid.
organogenesis with the production of many apoptotic

pathways (7). Furthermore, it was reported that VPA
Animals used:
induced congenital anomalies and degenerative effects
A total number of 60 pregnant albino rats were used
caused by increasing levels of free radicals in the body.
in the current study that obtained after each 4 adult
It is also found that cerebellar toxic effects caused by
females and one adult male rat (180-200g) were housed
Received: 25/4/2022
Accepted: 22/6/2022

Full Paper (vol.891 paper# 12)

c:\work\Jor\vol891_13 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4226- 4234

Imaging of Normal Craniocervical Junction at Different Ages
Mohamed S. Abd Al-wahab, Nihal M. Batouty, Jehan A. Mazro
Department of Radiodiagnosis, Faculties of Medicine, Mansoura University, Mansoura, Egypt
*Corresponding author: Mohamed S. Abd Al-wahab, Mobile: (+20)1067408482, E-Mail: dr_moh_92@yahoo.com

Evaluation of craniovertebral junction (CVJ) diseases involves the use of a wide range of parameters and
craniometric measures. As a result, figuring out the range of typical craniometric readings is critical.
Objective: The aim of the current work was to determine the morphometric reference values of the bony structures in
the CVJ by computed tomography (CT) and magnetic resonance imaging (MRI) in normal people who have no history
of congenital or acquired abnormalities of craniocervical junction (CCJ)
Patients and methods: In the Radiology Department, Mansoura University, 60 people participated in this study (30 by
CT and 30 by MRI) at different ages with no history of CCJ abnormalities. These individuals were divided into three
age groups. Retrospective analysis was performed on the MDCT and MRI scans. A total of 14 midsagittal parameters
and 2 coronal parameters were investigated. The data were analysed statistically.
Results: C.T. for PAI, BAI, BDI, OPFD, and OPFB: there were statistically significant differences among the three age
groups tested. The ADI was statistically substantially higher in the group of people under the age of 18, then in the
group of people between the ages of 18 and 60, and finally in the group of people older than 60. All other parameters,
on the other hand, showed no statistically significant differences. MRI for PAI, BAI, and BDI: the three groups
investigated showed statistically significant differences.
Conclusion: We found that some parameters show statistically significant differences between different age groups
which are consistent with previous studies and that there is no significant differences between this study in Egyptian
people and previous studies in western population with respect to several parameters in CVJ osteometry so that
researchers studying pathology in this region will find the normal reference ranges valuable.
Keywords: Craniovertebral junction, CT, MRI, Mansoura University.


individuals without a history of congenital or acquired
From an imaginary line produced from an
abnormalities of craniocervical junction (CCJ)
imaginary line drawn from the midpoint of that distance

from dorsum sellae to foramen magnum's anterior edge
to the C2-3 interspace level, the cranocervical junction
This Retrospective study included a total of 60
is formed. At the cervicomedullary junction, there are
individuals (30 by CT and 30 by MRI) with normal
the occipital bone and clivus, as well as the foramen
craniocervical junction, referred to Radiology
magnum and upper cervical vertebrae that serve as both
Department, Mansoura University Hospitals. This
an axis and an atlas, as well as ligaments that connect
study was conducted between 2020 and 2022.
these parts together [1].
The included 60 individuals were 28 male and 32
Conventional tomography, non-contrast 3D CT
female, aged between 2­ 87, and were divided into three
with reconstruction pictures and conventional magnetic
age groups: < 18, 18-60 and > 60 years.
resonance imaging (MRI) are all imaging modalities

that can be used to evaluate the craniocervical junction
Ethical Consideration:
This study was ethically approved by Mansoura
CVJ anomalies such as basilar invagination,
University's Research Ethics Committee. The study
atlantoaxial dislocation, and platybasia can be evaluated
protocol conformed to the Helsinki Declaration, the
using a variety of craniometric measures. Since the
ethical norm of the World Medical Association for
usual reference range for craniometric measurements
human testing.
must be established [3].

Radiological evaluation of the craniocervical
Inclusion criteria:
junction encompass essential anatomical landmarks and
Patients referred to radiology department
craniometric measurements to be aware of. The
(different age groups) with no history of
measurements including Chamberlain line, ADI, BDI,
congenital or acquired abnormalities of
BAI, clivus angle, Welcher basal angle, atlantooccipital
craniocervical junction.
joint axis angle, and the relationship of the odontoid to
Any age.
the cranial base make up the Powers ratio (including
Both sexes.
McGregor and McRae lines) [4].

The aim of the current work was to determine the
Exclusion criteria:
anatomical landmarks and parameters of the CVJ by
Patients with history of craniocervical
CT and MRI, as well as the morphometric reference
values of the bony structures in the CVJ in healthy
Received: 26/4/2022
Accepted: 23/6/2022

Full Paper (vol.891 paper# 13)

c:\work\Jor\vol891_14 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4235- 4239

Correlation between Gross Motor Proficiency and Body Composition in
Children with Down Syndrome
Esraa S. Abd-ElSamea*, Gehan M. Abd El-Maksoud, Shimaa M. Refeat
Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Esraa S. Abd-ElSamea, Mobile: (+20)1005135889, E-Mail: israawahba12@gmail.com

People with Down syndrome seem to have a lower physical fitness than their peers without disabilities.
Objective: The aim of this study was to examine the relationship of gross motor proficiency to body composition in
children with Down syndrome through the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2).
Subjects and Methods: Twenty children with Down syndrome, aged from 6 to 9 years old of both sexes were
participated in this study. They were selected from the public and special needs schools, Cairo government. Assessment
of gross motor proficiency using Burininks-Osertsky Test of Motor Proficiency-Second Edition was performed.
Results: The results of this study indicated that gross motor proficiency, after controlling for age and gender, is
negatively associated with health-related measures including waist circumference, while there was weak non
significance relationship between gross motor proficiency and Body Mass Index.
Conclusion: From the obtained result of this study, it could be concluded that there is a significant correlation between
gross motor proficiency and waist circumference in children with Down syndrome.
Keywords: Body composition, Down syndrome, Gross Motor Proficiency.


So, the current study was aimed to examine the
A whole or partial extra copy of chromosome 21
relationship of gross motor proficiency to body
is what causes Down syndrome (DS). Early after
composition in children with Down syndrome through
delivery, muscular hypotonia (low muscle tone) and
the Bruininks-Oseretsky Test of Motor Proficiency-
other symptoms can be used to diagnose the disease,
Second Edition (BOT-2).
and a blood sample's karyotype can be used to confirm


the diagnosis. According to estimates, Down syndrome
This Correlation study included a total of 20 Down
affects between 1 in 1,000 and 1 in 1,200 live births
syndrome patients of both sexes, with average age from
worldwide (1).
6 to 9 years, selected from public and special needs
Biomedical and molecular studies have suggested
schools from Cairo government. This study was
that the Down syndrome chromosomal anomaly
conducted between February 2021 to August 2021.
determines a number of changes in protein expression

patterns that lead to specific biochemical, physiological,
Ethical Consideration:
anatomical, and behavioral characteristics like an
This study was ethically approved by Ethical
imbalance of the oxidative metabolism (2), a
Committee, Faculty of Physical Therapy, Cairo
compromised nervous system,
University, with number of 012/002553. Written
disorders, congenital problems with the heart,
informed consent of all the participants' parents was
congested airways, decreased dynamic lung function,
obtained before the study, and the steps of
obesity, and poor sinus drainage (3).
assessment polices were explained to the students'
Due to their low strength, low muscular mass, and
parents by the investigators. The study protocol
high body fat percentage, many persons with Down
conformed to the Helsinki Declaration, the ethical
syndrome are predisposed to cardiovascular health
norm of the World Medical Association for human
issues (4).
Children's ability to move in unison is influenced

Inclusion criteria: Children with ability to comprehend
by a variety of developmental processes, including
the study and have strong intellect.
physical and cognitive maturity as well as chances for
motor skill development in the social and environmental
Exclusion criteria: Children with neurological issues
context. Additionally, it has been suggested that
like uncontrolled epilepsy or cardiovascular issues like
mastering movement techniques paves the way for an
congenital heart disease (12). Femoral and acetabular
active lifestyle, adds to physical, social, and
osteotomies, as well as situ screw fixation, are examples
psychological wellness, and may even be a good
of orthopedic surgical intervention (13,14).
predictor of physical activity participation, aerobic


fitness, and body mass (5-8).
The evaluation of gross motor abilities using
Participants height was measured without shoes
norm-referenced scales, such as the Bruininks-
near a wall to the nearest 0.1 cm. Body weight was
Oseretsky Test of Motor Proficiency-Second Edition
measured using standard weight and height scale, when
(BOT-2), which offers a thorough assessment of motor
not available portable weight scale was used in light
skills and is beneficial to a variety of practitioners,
indoor clothing without shoes. Body mass index (BMI)
experts, and researchers in a variety of settings (9-11).
was calculated (kg/m2).
Received: 26/4/2022
Accepted: 23/6/2022

Full Paper (vol.891 paper# 14)

c:\work\Jor\vol891_15 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4240- 4246

Critical Care Nurses' Performance and Obstacles towards
Palliative Care for Critically Ill Patients
Zienab Hussein Ali1, Ayat Mostafa Abdel Hady*2, Ola Abdelwahab Abdallah Srour1
1Department of Adult Health Nursing, Faculty of Nursing, Helwan University, Egypt
2Department of Critical Care Nursing, Faculty of Nursing, Fayoum University, Egypt
*Corresponding author: Ayat Mostafa Abdel Hady, Mobile: (+20)1104790247, E-Mail: ayatmostafa10593@gmail.com

Critically ill patients confer significant disease related symptoms. Palliative care focuses on reducing
symptoms burden and improving quality of life. Objective: The aim of the current work was to assess critical care
nurses' performance and obstacles towards palliative care for critically ill patients. Subjects and Methods: This
descriptive exploratory research design study included a total of all available 120 nurses, conducted at the Intensive
Care Units of Fayoum University Hospitals. Four tools were used. Tool I: A Self- administered interview questionnaire.
Tool II: An observational checklist for nurses' practice regarding palliative care. Tool III: Nurses' attitude regarding
palliative care. Tool IV: Nurses' perception of obstacles towards palliative care. Results: Revealed that 56.7% of the
studied nurses had unsatisfactory knowledge, 59.2% of studied nurses had satisfactory practice and 61.7% of nurses had
positive attitude regarding palliative care. Also, 15.8% of nurses had large obstacle toward palliative care. Conclusion:
It could be concluded that more than half of studied nurses had unsatisfactory knowledge, more than half of studied
nurses had satisfactory level of practice and about two thirds of studied nurses had positive attitude regarding palliative
care. Recommendations: Continuing educational programs are needed to improve knowledge and practice of nurses
regarding palliative care.
Critically ill patients, Obstacles, Palliative Care, Performance.


Around 14% of those who require PC treatment are
The primary goal of delivering intense care in
treated by a PC team globally (8). Patients in the ICU
intensive care units, which are specialized hospital
who are critically sick and their families frequently
wards, is to provide life-sustaining treatment to patients
with life-threatening illnesses (1). As an illness
communication between the medical staff and family (9).
progresses, patients frequently suffer a variety of
The engagement of bedside nurses is a requirement for
physical and psychological symptoms. However,
the introduction of palliative care into the ICU, and it is
uncontrolled pain, dyspnea, exhaustion, and anxiety are
crucial for bedside nurses to have understanding of this
the most typical symptoms in critically sick individuals
field (10).
The aim of the study was to assess critical care
In order to improve the quality of life for patients
nurses' performance and obstacles towards palliative
with serious illnesses, palliative care (PC) is an
care for critically ill patients.
interdisciplinary style of treatment that combines

elicitation of preferences, and assistance with decision-
This descriptive exploratory research design
making. During in ICU (3).
study included a total of all available 120 nurses who
It will need overcoming obstacles to integrate
were working in the selected setting during study period
palliative care into regular clinical practice. Studies
and agreed to participate in the study, conducted at the
indicate that misconceptions regarding the function and
Intensive Care Units of Fayoum University Hospitals.
objectives of palliative care are held by medical staff,

patients, and families. This might make it difficult to
Tools of data collection:
incorporate palliative specialists early in the process. A
Four tools were used to collect the data according to
cultural shift toward early and integrated palliative care
the following:
in the ICU environment will be necessary to address
Tool (1): Self- administered interview questionnaire:
hurdles (4).
it was developed by the investigator after reviewing
The cornerstone of palliative care is nursing (5). In
relevant literature. It was divided into the following two
hospitals, patients' quality of life and satisfaction with
care might be enhanced by nurses who are

knowledgeable, skilled, and at ease giving palliative
Part (1):Nurses' demographic characteristic: It was
care (6).
developed by the investigator based on relevant, recent
More than 5 million patients are admitted to
national and international literature (11, 12), which
intensive care units (ICUs) each year, according to the
included age, gender, marital status, educational level,
Society of Critical Care Medicine, for everything from
clinical area, years of experience of caring critically ill
airway, breathing, and circulatory assistance to comfort
patients, and palliative care training.
while dying in a supportive setting (7).

Received: 26/4/2022
Accepted: 23/6/2022

Full Paper (vol.891 paper# 15)

c:\work\Jor\vol891_16 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4247- 4250

Predictive and Prognostic Value of Mean Platelets Volume in Immune
Thrombocytopenia in Children: Review Article
Mervat Atfy Mohammed1, Shaimaa Saad Abdelhamid1,
Nahla Ibrahim Zidan2, Noor Eldin Ahmed Abd El Karim*1
Departments of 1Pediatrics and 2Clinical Pathology, Zagazig University Hospital, Egypt
*Corresponding author: Noor Eldin Ahmed Abd El Karim, Mobile: (+20) 01010051142, E-Mail: noorjad99.nj@gmail.com

Platelet counts (PLT) of less than 100 x 109/L are diagnostic of immune thrombocytopenia (ITP), a kind of
acquired thrombocytopenia. High rates of destruction of platelets and decreased platelet synthesis are the root causes of
thrombocytopenia among cases with primary immune thrombocytopenia. ITP cannot be definitively diagnosed;
consequently, primary ITP is still a diagnosis of exclusion made after all other possible etiologies of thrombocytopenia
have been ruled out. Multiple studies have found elevated mean platelet volume (MPV) levels in patients with ITP, raising
the prospect of using MPV as a diagnostic and prognostic marker for the disease. However, there has not been sufficient
research into the clinical significance of MPV in children with ITP.
Objective: This review article aimed to assess the role mean platelet volume in the diagnosis and prognosis of ITP.
Mean platelet volume, pediatrics, and idiopathic thrombocytopenia 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 studies from January 2000 to May 2021 were 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: It is possible to predict the course of ITP in children by monitoring changes in mean platelet volume (MPV)
throughout time and the MPV at diagnosis.
Keywords: Mean platelet volume, Idiopathic thrombocytopenia, Pediatric.

reactive. First and foremost, they contribute to fibrosis
Reduced platelet count in the peripheral blood is a
and normal hemostasis. It has been shown to serve
hallmark of the autoimmune disorder known as immune
several purposes, as recent research has shown. Platelets
thrombocytopenia, which is caused by antibodies
are the first blood cells to arrive at an injury site and
directed against platelet surface antigens and
undergo dramatic morphological changes in response to
reticuloendothelial system macrophages resulting in
classical agonists such as adenosine diphosphate
destruction of platelets and thrombopoiesis abnormalities
(ADP), a specific thromboxane (TX) A2 receptor
antagonist (TXA2), a platelet-activating factor (PAF)
The estimated annual incidence among American
antagonist, and inflammatory cytokines (TNF alpha, IL-
kids ranges from 1 to 6.4 per 100,000. Due to the fact
6, and IL-1). As a result, they promote inflammation and
that reported instances are based on symptomatic ITP
fibrosis (3).
requiring hospitalization rather than total ITP cases,
Hematological analyzers used the volume
researchers estimate the annual incidence in children is
distribution of blood cells for evaluation of mean
likely greater. Although it can occur at any time in a
platelet volume (MPV) and precise assessment of their
child's life, the most common ages are between 2 and 5
size. The normal platelet mean granularity ranges from
years old, with another peak in puberty. There is a small
7.5 to 12.0 fl, and the proportion of big platelets should
gender gap between infants and young children, with
be between 0.2 and 5.0%. Maintaining hemostasis and
boys slightly outmatched girls (2).
a steady platelet mass is linked to an inverse relationship
As the smallest of the blood's morphotic
between MPV and platelet count under normal settings
components, thrombocytes are also among the most

Received: 30/4/2022
Accepted: 29/6/2022

Full Paper (vol.891 paper# 16)

c:\work\Jor\vol891_17 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4251- 4259

Effect of Colchicine in Treating Severe COVID-19 Patients on
Hospital Discharge: Retrospective Cohort Study
Lamiaa Mohamed Qenawy*1, Yasmein Yehya Kamel2, Heba Ali El-dash2, Heba Ali Hassen2, Hala Ali Abed3
1Department of Clinical Pharmacy, Shebin Elkom Fever Hospital, Menofia, Ministry of Health, Egypt
2Department of Clinical Pharmacy, Benha Teaching Hospital, EL Qaliobia, Ministry of Health, Egypt
3Department of Community Medicine, Faculty of Medicine, Benha University, EL Qaliobia, Egypt
*Corresponding author: Lamiaa Mohamed Qenawy, Mobile: (+20) 201006972887, E-Mail: lamiaa_asem@yahoo.com

: COVID-19 is highly heterogeneous; it ranges from asymptomatic to severe pneumonia that could progress
to critical illness with hypoxemic respiratory failure requiring oxygenation, ventilator support or even death. This aim
of the present study is to examine the effect of adding colchicine to standard of care in treatment of severely hypoxemic
hospitalized COVID-19 patients on patients' 28 days discharge. Patients and Methods: This was a retrospective, single-
centre cohort study to evaluate the effect of colchicine in the treatment of COVID-19 patients on 28 days discharge and
mortality. Out of 201 patients, 153 patients, suspected and confirmed COVID-19, was included from Shebin Elkom
Fever Hospital, Monofya Governorate, Egypt, from November 2020, to January 2021. Results: Among 201 patients
enrolled, 153 (87.5%) patients were included in this study, and divided into two cohorts; 78 patients (51%) in the non-
colchicine group and 75 (49%) patients in the colchicine group. Among the 76 patients who were discharged within 28
days, 56 patients (74.67%) were in the colchicine group and 20 patients (25.64%) were in the non-colchicine group.
Regarding 28-day mortality was, 77 patients died in the two groups during the 28 days from hospital admission; 19
patients (23.68%) died in the colchicine group and 58 (76.32%) in the non-colchicine group (OR 0.01, 95% CI: 0.001-
0.10, p-value 0.000). Conclusion: Colchicine exerts an anti-inflammatory effect that has a great impact on decreasing
oxygen demand and ICU admission compared to the non-colchicine arm.
Keywords: Colchicine, COVID-19, Pandemic, Hospital discharge rate, ICU, Monofya.


Severe acute respiratory syndrome coronavirus
The optimal approach to the treatment of
2 (SARS-CoV-2) infections were the cause of a cluster
COVID-19 is uncertain, current clinical approaches
of pneumonia cases in Wuhan, China at the end of 2019;
consider the combination of antiviral drugs and
then it had spread to infect millions of people across the
immunomodulatory drugs that can interrupt the
world and taken millions of lives resulting in a global
inflammatory pathway. Approaches that target the virus
pandemic in 2020 (1). More than 83 million cases
itself (antivirals, passive immunity) are more likely to
worldwide had confirmed infections, more than 1.8
work early in the course of infection, while approaches
million patients died since the beginning of the
that modulate the immune response work later in the
pandemic to date (2).
course of the disease (9).
The clinical presentation of COVID-19 is
highly heterogeneous; it ranges from asymptomatic to
immunomodulatory drugs evaluated and tested for
severe pneumonia that could progress to critical illness
COVID-19 management, including glucocorticoids,
with hypoxemic respiratory failure requiring
cytokine inflammatory antagonists (such as IL-6
oxygenation, ventilator support or even death (3,4). It is
inhibitor, monoclonal antibodies, TNF inhibitors, IL-1
characterized by an initial phase of viral replication
inhibitors, Janus kinase inhibitors). However, safety,
followed by a second phase caused by the host
contraindication, efficacy, cost, and availability of some
inflammatory response that mostly affect the respiratory
of them greatly impact their use to treat severe COVID-
system, leading to acute lung injury and acute
19 patients (9). For these reasons, there has been interest
in using agents that may slow the progression of the
pathophysiological features of severe COVID-19
disease and help decreasing cost, especially in limited
patients are acute pneumonia with extensive opacity,
resources countries.
inflammatory infiltrates, and microvascular thrombosis
One of these agents is colchicine, which can
(6). The most critical patients have clinical presentations
exert broad and rapid onset anti-inflammatory and
that resemble cytokine storm, which is characterized by
markedly elevated levels of inflammatory markers,
mechanisms other than that of corticosteroids (10).
including C-reactive protein, D-dimer, ferritin,
Colchicine inhibits NOD-like receptor protein 3
interleukin-1, and interleukin-6 that can produce long-
(NLRP3) inflammasome that had a major role in the
term lung damage and inflammatory organ injury. So,
development of lung injury and was activated by
interrupting the inflammatory pathway has been
viroporin E; a component of SARS-associated
proposed as the potential therapeutic target for severe
coronavirus (SARS-CoV) (10-13). Moreover, it inhibits
COVID-19 cases to prevent disease progression (6,8).
neutrophil chemotaxis and activity in response to

vascular injury, reduces neutrophil-platelet interaction
Received: 28/4/2022
Accepted: 27/6/2022

Full Paper (vol.891 paper# 17)

c:\work\Jor\vol891_18 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4260- 4264

Changes In the Menstrual Cycle Among the Covid-19 Vaccinated Women in The
Eastern Province of Saudi Arabia: A Cross-Sectional Survey, 2022
Ilham Abdulrahman Almousa
Department of Obstetrics and Gynecology, Faculty of Medicine, King Faisal University, Saudi Arabia
Corresponding author: Ilham Abdulrahman Almousa, Mobile: +966567411212, E-mail: elhamalmousa87@gmail.com,
ORCID No.: https://orcid.org/0000-0003-1926-2898

There is growing concerns that COVID-19 vaccination causes disruption to menstrual cycle. The study
has showed that several women required gynecological visits claiming menstrual irregularities or abnormal uterine
bleeding after the first and second doses of vaccination (regardless of the type of vaccine used).
Objective: This study was conducted in the eastern province of Saudi Arabia to assess the effect of Covid-19 vaccination
on the menstrual cycle of the women.
Material and methods: It was a cross-sectional prospective study that was conducted by survey the post Covid-19
vaccinated women in the eastern province of Saudi Arabia. The sample size was calculated using a Fisher's formula
which was 344 women who have been vaccinated by Covid-19 vaccination.
Results: A total of 343 women participated in this study. The mean age of the participants was 30.16 ± 18.20 years.
More than forty two percent of the participants had one time Covid-19 infection while 5% was twice infected with
Covid-19 virus. The vast majority of the participants (91.3%) were immuned by 2 vaccines. More than sixty percent
(60.3%) of the participants were suffering from one and other menstruation irregularities after Covid-19 vaccination.
14% of them were suffering from the menstruation frequency longer than 35 days while 10.2% of them were suffering
from the menstruation frequency shorter than 25 days.
Conclusion: Coronavirus disease 2019 (COVID-19) vaccination is associated with change in menstrual cycle length,
heavy menstruation and painful menstruation. Female with the age group of 15- 24 years were 2 times more likely to
develop menstruation cycle change.
Keywords: Covid-19 infection, Covid-19 vaccination, Menstrual cycle.


messengers, cytokines, that regulate inflammation; and
Coronavirus disease (COVID-19) an infectious
if these are affected by immunization some women
disease caused by the SARS-CoV-2 virus, which
might notice some changes in bleeding. The second
emerged in Wuhan( China) and spread around the world
reason she explained that some women may had taken
as the epidemic of the century, has already infected
NSAIDs to help deal with vaccine after-effects like
more than 52 million people with more than 6 million
fever or aches and pains, so these too may make a small
deaths. More than 121 million people are already
difference in menstrual flow.
vaccinated by different types of COVID-19 vaccine
So, COVID 19 vaccination impact may be linked
thorough the world till date [1].
to the immune system affecting the hormones driving
Covid-19 vaccines have proved to be effective
the menstrual cycle. COVID -19 vaccines affected
counteracting the spread of Sars-Cov-2 infection among
menstruation cycle in different ways. Edelman et al. (4)
the general population reducing significantly both
found that the length of the menstrual cycle (the time
morbidity and mortality. However, the side effects of
between periods) temporarily increased by an average
Covid-19 vaccination have been reported by various
of less than one day in people who received a dose of
researches which are causing concern among the
the COVID-19 vaccine, compared to unvaccinated
general population. Mild body ache, fever and fatigue
people. However, the vaccination was not associated
has been reported as possible side effect of Covid-19
with a change in the number of days of bleeding.
vaccination. But there is growing concerns that
However, researchers have found among the COVID 19
COVID-19 vaccination is also causing disruption to
infected women a range of menstrual changes such as
menstrual cycle especially among women suffering
menstrual volume change (25%), menstrual cycle
from PCOS [2].
change (28%) and prolonged cycle (19%) [5].
The study showed that several women required
Very few studies have been done in the whole
gynecological visits claiming menstrual irregularities or
gulf regions including Saudi Arabia on the effect of
abnormal uterine bleeding after the first and second
Covid-19 vaccination on the menstrual cycle of the
doses of vaccination (regardless the type of vaccine
women. To the best of knowledge this was the first of
used). The researchers don't yet understand exactly how
its kind of study in Eastern province of Saudi Arabia.
vaccines could cause period changes [2]. However there

are many hypotheses supporting the changes in the
menstrual cycle by COVID-19 vaccination. Emma et
It was a cross-sectional prospective study in which data
al. (3) explains one possible reason might be that the
were collected during the 2 months' time by survey for
uterus lining itself also contains the same chemical
the women in eastern province of Saudi Arabia. Women
Received: 30/4/2022
Accepted: 29/6/2022

Full Paper (vol.891 paper# 18)

c:\work\Jor\vol891_19 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4265- 4269

Effect of Sub-Conjunctival, Topical and Systemic Fluconazole On
Refractory Fungal Keratitis
Naeima M. Elzlitni, Mohammed F. Elbarghathi, Ruwida M.S. Abdullah*
Department of Ophthalmology, Faculty of Medicine, Benghazi University, Libya
*Corresponding author: Ruwida M. S. Abdullah, Mobile: 00218928899351, E-Mail: weda.libya@gmail.com


Background: About 40 to 50 percent of all instances of microbial keratitis are caused by fungal keratitis (FK). Untreated
FK can lead to corneal damage and endophthalmitis, both of which can lead to irreversible vision loss. Since long-term
consequences, including blindness, can be prevented by timely diagnoses and treatment of microbial keratitis, there is
no laboratory support for this type of diagnosis. Some experts in the field of ophthalmology have long held that it is
possible to discriminate between fungal and bacterial infections of the cornea using clinical indicators.
The aim of the study: It was assessment of the efficacy and safety of topical and systemic and sub-conjunctival
fluconazole treatment for refractory fungal keratitis.
Patients and Methods:
Eleven people with refractory fungal keratitis took part in this investigation. All cases were
managed with topical fluconazole 2% hourly for 2 days, then tapered 5 times/day for one week, sub-conjunctival
fluconazole 2mg/ml once for 14 days and oral fluconazole 150mg per week daily. The diagnosis was based on KOH
wet mount and clinical signs of fungal keratitis.
Result: The result was eight of patient successfully treated with visual acuity improvement and local nor systemic side
effect were observed.
Conclusion: Severe fungal keratitis can be treated with topical and systemic, sub-conjunctival fluconazole, which may
reduce the need for surgical intervention.
Keywords: Fluconazole, Fungal keratitis.


KOH's ability to detect fungus in 1352 patients with
Since its first description in 1879, the incidence
culture-proven fungal corneal infection was 91%[9].
of fungal keratitis (FK) has steadily risen over the last
Microbial keratitis patients have been
three decades. It is responsible for 40 to 50 percent of
thoroughly examined in other investigations to
all cases of microbial keratitis(1,2).
determine the exact aspects of the disease. Satellite
In the event that untreated FK does not
lesions, increased slough, dry texture, serrated
improve, it might result in corneal damage,
infiltration borders, hypopyon, anterior chamber fibrin,
endophthalmitis, and permanent vision loss. As a result,
and colour were some of the other characteristics noted.
the importance of early detection and treatment cannot
Fungal keratitis was linked to elevated slough and
be overstated(3,4). It is possible to set off FK in more than
serrated infiltration margins, while bacterial keratitis
one hundred distinct kinds of fungi(5).
was linked to anterior chamber fibrin and raised shed
There are two types of fungi that cause FK:
(surface profile)[8].
yeast and filamentous fungi, both of which can be

categorized as monomorphic. Personal risk factors,
regional temperature, climate conditions, geography,
It is to see if topical, systemic, and sub-
and urbanization all play a role in determining which
conjunctival fluconazole are effective and safe in the
fungus is responsible for FK(6).
treatment of refractory fungal keratitis.
Among the most common causes of fungal

infections, trauma, immunocompromised states, ocular
surface illness, and contact lens usage are all risk factors
A prospective, interventional, case series study
for FK (6,7).
was used. It was carried out between June and
Many establishments lack the ability to identify
December 2020 in Dar Altaimuz Eye Center, Benghazi.
the type of microbial keratitis that is present. Based on
Libya. Eleven patients with refractory fungal keratitis
the potassium hydroxide (KOH) wet mount data, this
had their eyes examined using slit-lamp biomicroscopic
opinion is supported. KOH is a simple, affordable, and
examination, and corneal scrapings and potassium
fast test that has a straightforward interpretation. Before
hydroxide (KOH) stains were collected from the corneal
making any clinical judgments, it's critical to test the
ulcer for the study.
validity of any such claims. Additionally, antifungal

therapy is frequently in short supply and prohibitively
Sample preparation:
Slit-lamp magnification and topical anaesthetic
While the KOH has been found to be an
with 0.4 percent Benoxinate hydrochloride prompted
excellent diagnostic tool for patients in resource-poor
corneal gratings to be collected from the base and edge
locations, a large South Indian study indicated that the
of each ulcer, which were then transferred to Al-Akeed
Lab for microscopy assessment. The presence of fungal
Received: 01/05/2022
Accepted: 30/06/2022

Full Paper (vol.891 paper# 19)

c:\work\Jor\vol891_20 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4270- 4272

Possible Role of Fatty Acid Binding Protein in Type 2 Diabetes and
Peripheral Artery Disease: Review Article
Hazem Mohamed EL-Ashmawy1, Rasha El-Sayed Hussien Omar1,
Fathi Mohammed Jubran Almazouq1*, Azza Moustafa Ahmed2
Departments of 1Internal Medicine and 2Clinical Pathology, Zagazig University Hospital, Egypt
*Corresponding author: Fathi Mohammed Jubran Almazouq, Mobile: (+20) 0 110 451 9289, E-Mail: dr.fathi8181@gmail.com

As many as 200 million people around the world are affected with peripheral artery disease (PAD), a long-
term atherosclerotic problem. The majority of individuals with PAD are asymptomatic, but those who do experience
symptoms, such as limb claudication or complete tissue loss, should seek medical attention right away. PAD and its
consequences are widespread because of the worldwide growth in the frequency of Type 2 Diabetes Mellitus (T2DM) and
the ageing of the general population. Peripheral artery disease can be caused by a combination of vessel wall stiffness and
T2DM. Fatty acid binding proteins (FABPs) have been related to the onset of insulin resistance and other manifestations of
the metabolic syndrome, and it has been shown that FABPs play an important role in metabolic control. FABP has been
linked to fatty acid absorption and chylomicron release in the gastrointestinal tract, according to studies.
The present review aims to assess of possible role of FABPs in T2DM and PAD.
FABPs, T2DM and PAD 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
May 2021 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.
: High levels of some of FABPs in the blood have been linked to both the existence and severity of PAD.
Keywords: Fatty Acid Binding Protein, Type 2 Diabetes, Peripheral Artery Disease, Atherosclerosis, Review.


necessary, begin treatment or intervention sooner rather
As a public health issue, type 2 diabetes mellitus
than later (6).
(T2DM) has a significant influence on human life and
The objective of the present review is to assess of
healthcare costs. Many countries throughout the world
possible role of Fatty Acid Binding Proteins (FABPs) in
have seen an increase in the prevalence of diabetes as a
T2DM and PAD.
result of rapid economic development in urban areas (1).

In order to prevent T2DM, you need to change
your diet, exercise, and control your weight. The
FABPs, T2DM and PAD were all looked for in
containment of this burgeoning epidemic is still
PubMed, Google scholar, and Science direct. References
dependent on the public's understanding of the disease.
from relevant literature were also evaluated by the
There is still no cure for the disease, despite new
authors, but only the most recent or complete study from
knowledge about the disease's pathogenesis being gained
January 2000 to May 2021 was included. Due to the lack
(2). With a 17.9 percent prevalence rate in 2014, Egypt was
of sources for translation, documents in languages other
ranked third among the Middle East and North Africa
than English have been ruled out. Papers that did not fall
region for diabetes, according to the World Health
under the purview of major scientific investigations, such
Organization (WHO). Egypt came in second place in the
as unpublished manuscripts, oral presentations,
Middle East and North Africa in 2019. The most recent
conference abstracts, and dissertations, were omitted.
update (3), diabetes affects 18.4% of Egyptian adults, with

a total of 10,000,000 cases.
Fatty Acid Binding Proteins (FABPs):
Diabetic complications and co-morbidities, such as
They are a family of transporters for fatty acids
peripheral arterial disease (PAD), are all too prevalent. As
and other lipophilic substances such as eicosanoid and
many as half the people who suffer from diabetic foot
retinal transporters. These proteins are thought to aid in
ulcers are also suffering from PAD (4). Diabetes-related
the transfer of fatty acids (7).
PAD is a major health problem. An atherosclerotic
Fettle proteins help to transport and store fats by
constriction of the peripheral arteries of the legs, stomach,
attaching to their respective fatty acid chains. In addition
arms, and head, most typically affecting the arteries of the
to oxidation and signalling, these lipid chaperones also
lower limbs, is known as PAD (5).
regulate gene transcription and storage. There are a
The lower limbs systemic atherosclerotic process,
variety of FABP isoforms that can be found in a variety
which includes coronary artery disease (CAD),
of tissues, although some are active in several organs. In
frequently, coexists with the onset of PAD. Detecting
both number and quality, pathological disorders are
PAD in CAD patients can enable cardiac rehab
connected to variations in FABPs. Among other things,
programmes tailor their activity plans to better
FABPs are biomarkers for obesity, insulin resistance,
accommodate individuals with both conditions and, if
heart disease, and cancer. A genetic alteration or a
Received: 02/05/2022
Accepted: 03/07/2022

Full Paper (vol.891 paper# 20)

c:\work\Jor\vol891_21 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4273- 4277

Results of Percutaneous Sutures Technique in the Treatment of
Achilles Tendon Ruptures
Ahmed Mohammed Altaher Saeed*, Ali Towfik Elalfy,
Tarek Abd ElSamad Elhewala, Ahmed Mashhour Gaber Abdelsalam
Department of Orthopedic Surgery, Faculty of Medicine Zagazig University, Egypt
*Corresponding Author: Ahmed Mohammed Altaher Saeed, Mobile: (+20)01019024748,
E-mail: ahmed.m.t.saeed@gmail.com

The incidence rates of Achilles tendon (AT) ruptures varies, with previous studies reporting a rate of 18
patients per 100,000 patient populations annually and has been shown to be increasing. The treatment of acute Achilles
tendon ruptures can be broadly classified into operative and non-operative.
Objective: Management of Achilles tendon rupture to evaluate the results of percutaneous suture technique followed
by early functional postoperative treatment for surgical intervention of Achilles tendon ruptures, and to assess wound
complication and hospital stay.
Patients and Methods: A prospective operation clinical study of 18 patients with complete tear of Achilles tendon
who underwent percutaneous suture repair (the Ma­Griffith technique). Follow up clinical evaluation was performed
and any complications were recorded.
Results: Mean of Achilles Tendon Total Rupture Score (ATRS) was 90.1 ± 4.2. The mean Overall patient's satisfaction
was 8.8 ± 0.83 ranged from 8 to 10 and the mean Aesthetic satisfaction was 9.5 ± 0.51 ranged from 9 to 10. Only one
patient had sural nerve injury and another one had infection.
Conclusions: Our results suggested that satisfactory clinical and functional outcomes can be obtained for percutaneous
sutures technique in the treatment of Achilles tendon ruptures.
Achilles, Percutaneous suture, Tendon, Rupture.

structural variations, and biomechanical changes related
Achilles, the ancient Greek hero of the Trojan
to ageing may all contribute(9).
war, gave his name to the AT. Achilles was the son of
The treatment of acute Achilles tendon ruptures
the nymph, Thetis, who tried to make him immortal by
can be broadly classified into operative and non-
dipping him in the river Styx. However, he was left
operative. Clinical assessment involves using objective
vulnerable at the part of the body she held him by: his
rating scales (10) and also the Achilles Tendon Total
heel(1). Achilles was killed by a poisoned arrow fired by
Rupture Score (ATRS) (11). There is a need for a patient-
the Trojan prince Paris which embedded in his only
relevant instrument to evaluate outcome after treatment
vulnerable point; his heel. This has given rise to the
in patients with a total Achilles tendon rupture.
description of a person weakest point being called their
The surgical treatment of ruptured Achilles
"Achilles heel"(2).
tendon encompasses two distinct elements namely the
The Achilles tendon is the strongest tendon in the
actual surgical technique and the postoperative regime.
human body and transmits forces from the
The surgical management of a ruptured Achilles can be
gastrocnemius and soleus muscles to the calcaneus
divided into four categories: open repair, percutaneous
enabling walking, jumping, and running(3). However,
repair, mini-open repair, and augmentative repair. In
the incidence of Achilles tendon rupture has increased
general, operative intervention is usually preferred for
over recent years (4). The incidence rates of Achilles
younger patients and those patients who demand greater
tendon ruptures varies, with previous studies reporting
a rate of 18 patients per 100,000 patient populations
In 1977 the percutaneous repair of an acute
annually and has been shown to be increasing(5). In
Achilles rupture was described, which had the benefit
regard to athletic populations, the incidence rate of
of a relatively low rerupture rate, while also reducing
Achilles tendon injuries ranges from 6% to 18%(6), and
the rates of infection and other soft-tissue
football players are the least likely to develop this
complications. Yang et al.(9) reported the percutaneous
problem compared to gymnasts and tennis players. It is
method involves suturing the Achilles tendon through
believed that about a million athletes suffer from
multiple small incisions, made under local anesthesia
Achilles tendon injuries each year (7).
without directly exposing the rupture site. Percutaneous
Achilles tendon rupture has been shown to cause
repair has also been reported to be a good option for
significant morbidity and regardless of treatment major
athletes tendon rupture, allowing for prompt return to
functional deficits persist 2 years after acute Achilles
sporting activities(12).
tendon rupture and only 50-60% of sportsmen return to
The aim of this study was management of
pre-injury levels following rupture (8). Although most
Achilles tendon rupture to evaluate the results of
Achilles tendon ruptures occur during sporting
percutaneous suture technique followed by early
activities, other factors such as gender, drugs, intrinsic
functional postoperative treatment for surgical
Received: 30/4/2022
Accepted: 29/6/2022

Full Paper (vol.891 paper# 21)

c:\work\Jor\vol891_22 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4278- 4283

The Impact of IL-35, Bacterial Prostatitis in Development
Male Infertility in Najaf Province Patients
Kais Khudhair Al-hadrawi 1*, Raid Talib ALGarawy2, Mayyada F. Darweesh 3
1Radiology Techniques Department, College of Medical Technology, Islamic University, Najaf, Iraq.
2University of Kufa- College of Medicine, Kufa, Iraq
3Department of Biology, Faculty of Science, University of Kufa, Iraq
*Corresponding author E-mail: kaisalhadrawii@gmail.com, Mobile: 009647810111300

A case-control study examined the relationship between bacterial prostatitis and IL-35 blood levels in the
emergence of male infertility.
Objective: This study aimed to assess the role that bacterial prostatitis and IL-35 play in the progression of male infertility
in patients from Najaf province.
Patients and Procedures:
120 patients were seen at AL-Sadder Medical City, Al-Najaf province through the period from
January to June, 2021. This number included sixty prostatitis-related infertile patients, 30 prostatitis-related fertile patients,
and 30 infertile patients. 30 healthy fertile male subjects served as control group. All subjects provided blood and semen
samples and three ml of the blood were placed in a gel tube to separate the serum used to calculate IL-35 level by ELISA.
A loop of semen was collected to identify the bacterial culprits as well as semen liquefaction, volume, appearance, and
fundamental sperm characteristics in the residual semen (density, motility, viability, and morphology).
Prostatitis patients had considerably lower serum concentrations of IL-35 than infertile patients did, according to
the findings (P< 0.05). The concentration of IL-35, which is thought of as a biomarker for a progressive state, decreased
with the severity of the disease. The findings showed that S. aureus and E. coli were the most frequent bacterial causes of
Conclusion: The current study found a correlation between infertility and the infection with prostatitis condition, which is
reflected in the body's immune response as a lower level of IL-35.
Keywords: IL-35, Serum level, Infertility, Prostatitis, Men.

Uropathogenic infections in the semen of
Cytokines are multifunctional glycoproteins that
individuals with acute and chronic bacterial prostatitis
are released by several areas of the male genital tract and
impair the vitality and mobility of sperm, resulting in
are active in a variety of processes that may influence
infertility (7). Male infertility may develop from chronic
steroidogenesis, spermatogenesis, sperm functions, and
prostatitis. The production of its cytokines has been
fertility regulation. Because cytokines' concentrations
linked to changes in the reproductive system and testicles
monitor their release and reflect how they interact with
(8). Changes in cytokine levels may affect the
spermatozoa, they can be used to learn more about male
physiological mechanisms underlying both male
infertility (1). Male semen's pro- and anti-inflammatory
reproductive function and fertility, according to Mary et
ratios may become unbalanced as a result of the
al. (9).
inflammation caused by prostatitis, which could have a

negative impact on sperm quality and function (2). By
controlling inflammatory responses linked to male
A hospital-based case-control study included 120
infertility, cytokines contribute to prostatitis and male
patients who visited AL-Saddar Medical City in the
infertility (3).
region of Al-Najaf through the period from January to
IL-35 is the newest member of the interleukin-12
June of 2021. The patients were classified into three
cytokine family that is produced by a variety of regulatory
groups: 60 prostatitis-related infertile patients, 30
lymphocytes, and functions as an anti-inflammatory
prostatitis fertile patients and 30 infertile subjects.
cytokine that is essential for immune suppression (4).
Furthermore, 30 healthy fertile male subjects served as
CD+8, IL-17, IL-12, and interferon can be inhibited
control group. For the ELISA system's evaluation of IL-
from being secreted, as can the development of CD4+ T
35 (Elabscience® Company, China), 3 ml of blood from
cells into Th17 and Th1 cells. IL-35 can also promote the
each subject was taken, placed in a gel tube to separate
growth of Treg cells and increase the expression of IL-10
the serum, and maintained at -20 oC. To identify bacterial
(5). IL-35 plays an immunomodulatory role by increasing
causes, a loop of semen was collected. The leftover semen
the secretion of IL-10 and TGF- and encouraging the
was examined to measure its density, motility, viability,
growth of Treg and Breg cells (6).
and morphology as well as its volume, appearance, and
semen liquefaction (10).
Received: 30/4/2022
Accepted: 29/6/2022

Full Paper (vol.891 paper# 22)

c:\work\Jor\vol891_23 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4284- 4291

Effect of Mental Health Promotion Program Application on
Workplace Stress Parameters among Academic Working Staff Women
Samah S. Sheta*1, May M. Sam2, Nesma Abdalla1
Departments of Community, Environmental and Occupational Medicine, and
2Clinical Pathology Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Samah S. Sheta, Mobile: (+20) 01143500624, E-Mail: shtasmah@gmail.com

Workplace stress is a well-documented problem in a number of professions. However, recent studies have
shown that women are more likely to be affected by stress than men. Excessive pressure or performance expectations at
work are believed to lead to stress. Emotional, physical, and mental symptoms and indicators are all part of this reaction.
Office stress develops when demands on employees are greater than their ability to cope with them. Because women
being female, their career objectives can be influenced. It can be difficult for women to advance their careers and careers
as doctors in various faculties because they lack the inner motivation to overcome the many challenges that stand in
their way, identification of protective factors for resiliency and overcoming the barriers for women to achieve their
academic success beside their family and life responsibilities. Objectives: To assess work related stress parameters
among a group of female postgraduate staff workers, train them to mitigate stress by workplace mental health promotion
program and test its feedback. Subjects and Methods: A-Assessment of stress among study group at a baseline using
Workplace Stress Model, which measure 5 parameters. B- Measurement of stress hormone (cortisol) in the study group.
C- Training and application of workplace health promotion program for 3 months before reassessment of work stress
and compare its results. Results: Improvement of work stress parameters and cortisol level was detected after application
of the WorkProMentH's Program among participants. Conclusion: Working staff women are vulnerable to workstress.
Adaptation on special exercises and coping skills can relieve stress and prevent its drawbacks.
Keywords: Workstress, Working female, Promotion, Program.


manage the stress, many models relating to stress have
As more women have shared in the workforce
been created. The WRS model defines stress as all
over the past decades, employment patterns have
responses that cause any modification of an individual's
undergone a significant change. The percentage of
cognitive, physical, psychological, and emotional
women who were in the labour force climbed over the
state(5). Due to differences in biological and
past ten years, reaching 57.8% in December 2006. Their
position in the workforce has also altered subsequently,
disadvantaged and vulnerable than males when it comes
with more women taking on roles that were filled by
to the impacts of stress (6). Compared to males, women
males only. The difficulties faced by professional
are twice as likely to experience stress-related
women in a male-dominated workplace are
symptoms, according to research. The biological and
compounded by additional stresses that are unique to
psychological structure of women, all of these elements
women (1).
have been taken into account as a possible cause. One's
Gender-role stereotypes, occupational sex
cultural attitude has a considerable impact on the
discrimination, social isolation, sexual harassment, and
prevention and management of WRS (7).
work-home conflict are largely reported by professional
However, recently, employees have faced
women (2). Postgraduate study for women is constrained
greater challenges as a result of the economy and
by a number of issues. Students around the world
working conditions. Therefore, it is essential to reduce
struggle with balancing familial and academic
occupational stress as much as possible before it leads
obligations, particularly when their studies overlap with
to problems on the long run for the employees,
key life events like childbearing years (3).
particularly women employees (4).
This evidence makes it evident why there has
Aim of the study was to prevent stress among
been so much interest in the topic of women's roles at
working females for better life on the long run.
the workplace. However, prior studies revealed that

little emphasis had been paid to stress management and
Objectives: 1-To address work related stress among a
coping strategies for female office workers. It is
sample of female working staff in Zagazig University
intended that a more balanced approach must be
and train them to overcome stress by workplace mental
adopted to the stress problem that female employees
health promotion program. 2- To detect the impact of
face in the modern workplace to be more appropriately
the Workplace Mental Health Promotion Program
addressed (4).
(Work-ProMentH) application on participating females'
In recent years, work-related stress (WRS) has
stress that is related to jobs and cortisol level (stress
significantly increased in importance as a public health
issue that has adverse effects on human health.

Understanding its responses, linked circumstances, and
effects is thus quite difficult. To better understand and
Inclusion Criteria:
Received: 01/05/2022
Accepted: 30/06/2022

Full Paper (vol.891 paper# 23)

c:\work\Jor\vol891_24 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4292- 4297

Value of Intrauterine Injection of HCG (Human Chorionic Gonadotropin) before
Fresh Embryo Transfer on Clinical Pregnancy Rate in Women with Previous Failed
One or Two ICSI (Intra Cytoplasmic Sperm Injection) Trials
Adel Atef1*, Ayat Fathy Farag 2, Noura S. El-Nassery1, Abdel-Maguid I. Ramzy1
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo 11562,
Egypt,2 Obstetrics and Gynecology, Toukh General Hospital, Al Qalyubia Governorate, Egypt
Corresponding author: Adel Atef, Email:dr.adel90@cu.edu.eg,Telephone:01115241250, ORCID:0000-0002-5220-5302

The human endometrium is a complex, multicellular tissue that is regulated by steroid hormones (estrogens,
progesterone, androgens, and glucocorticoids) and has different characteristics in the various phases of the menstrual
cycle. HCG plays a major role in endometrial receptivity via modulation of the production of various cytokines and
Aim of the Work: The study aimed to show the effect of intrauterine injection of Human Chorionic Gonadotropin
(HCG) on the day of ovum pickup in patients with a history of one or two failed Intra Cytoplasmic Sperm injections
(ICSI). Patients, and Methods: A sample of 110 patients was obtained, half of them were candidates for intrauterine
injection of 500 units of HCG immediately after ovum retrieval during the mock, while the other half were controls. All
patients underwent controlled ovarian stimulation using the long protocol. The study was conducted at the Assisted
reproduction unit of Obstetrics and Gynecology Hospital, Faculty of Medicine, Cairo University, between December
2019 and November 2021. Results: The rate of chemical pregnancy was 39.6 % in the first group and 27.8% in the
second group. The clinical pregnancy rate was 28.3% in the first group and 18.5% in the second group. There was no
significant difference between the two studied groups regarding the proportion of chemical pregnancies (P-value 0.195)
and the proportion of clinical pregnancies (P-value 0.232).
Conclusion: Although intrauterine injection of HCG improves chemical and clinical pregnancy rates in patients
undergoing ICSI trial after failed one or two trials, statistically seems with no differences.
Keywords: HCG injection; Endometrial receptivity; Infertility; In vitro fertilization; ICSI failure.


endometrial thickness that might ensure implantation.
The embryonic syncytiotrophoblastic cells generate
One explanation for this discrepancy may be that
the glycoprotein hormone known as human chorionic
endometrial histology during IVF is considerably
gonadotropin (HCG) largely during pregnancy. To
aberrant when compared to the histological picture of
continue the pregnancy, the hormone induces the corpus
the endometrium during normal cycles (7).
luteum to generate progesterone (1). Before the embryo
IVF patients, particularly those who transfer
enters the uterine cavity on days 5 and 6 as a blastocyst,
blastocysts, do not experience HCG's effects on the
HCG has already started the embryo-endometrial
uterus before embryo transfer. In the early stages of
conversation (2).
embryo development, IVF reduces HCG signaling to
HCG has been linked to T cell regulation, and it has
the endometrium, which may explain the comparatively
been discovered that embryonic HCG release is related
low implantation rate (8). Since the beginning of IVF,
to morphological grading in the blastocyst stage and
additives like progesterone supplementation have been
embryos with significant implantation potential on day
used in the luteal phase to boost endometrial thickness
3. In a recent study, Schumacher et al employed
and receptivity. This increases receptivity and improves
migration experiments to show that trophoblasts that
pregnancy success (9).
produced HCG attracted regulatory T cells (Treg) (3).
Before embryo transfer, intrauterine HCG injection
More importantly, new reports indicate that HCG plays
was expected to significantly boost the rates of clinical
a role in Treg differentiation (4).
pregnancy and embryo implantation in IVF (10). We
The endometrium is crucial for implantation,
conducted this study to assess the impact of intrauterine
therefore its thickness has long been seen as a sign of
hCG administration on clinical pregnancy rates and live
quality (5), particularly in assisted reproduction, where
birth rates following a fresh embryo transfer in ICSI
the chosen embryos should ideally be put into a
receptive environment. Poor pregnancy outcomes have

also been linked to thin endometrium, which has been
documented in 5 percent of women under 40 and 25
Study design and setting:
percent of women between 41 and 45 years old (6).
The exposure of the endometrium to higher levels
randomized controlled trial on patients with previous
of sex steroid during IVF treatment make it thicker than
failed one or two ICSI trials at the Assisted reproduction
during a natural cycle. However, the rate of
unit of Obstetrics and Gynecology Hospital, Faculty of
implantation is still low when compared to natural
Medicine, Cairo University, between December 2019
conception cycles, indicating that it is not only
and November 2021.
Received: 1/5/2022
Accepted: 30/6/2022

Full Paper (vol.891 paper# 24)

c:\work\Jor\vol891_25 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4298- 4307

A Systematic Review and Proposed Model for Integrating Virtual Reality
Simulation Tools with Problem-Based Learning Method in Preclinical and
Clinical Endodontics and Restorative Dentistry
Ranya Faraj Elemam*1, João Dias2, Nagwa N. Hegazy3
1Department of Restorative Dental Science, College of Dentistry, Gulf Medical University, Ajman, UAE
2Department of Evidence Based Dentistry, Egas Moniz University, Lisbon, Portugal
3Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Ranya Faraj Elemam, Mobile: +971569518379,
E-Mail: dr.ranya@gmu.ac.ae, ORCID: 0000-0002-3220-0563

Recent technological advancement have brought many opportunities for educators to integrate innovative
techniques to maximize student learning. Problem-based learning (PBL) remains the cornerstone of teaching in
preclinical and clinical dentistry. Objective: This study aimed to identify the applicability of virtual reality (VR) tools
within the educational framework of PBL, and to propose a model for integrating VR techniques into PBL for dental
education. Methodology: We conducted a systematic review of the literature. We identified articles between January
2003 and January 2022 by searching five electronic databases (PubMed, Scopus, Cochrane, Ovid MEDLINE, and Ovid
OLDMEDLINE). Obtained literatures were examined based on PICO criteria following a preset of inclusion and
exclusion principles. Results: A total of 17 studies were included in this review based on the search methodology
employed. No observational studies directly explored VR in conjunction with PBL in endodontics or restorative
dentistry. Studies however discussed either VR or PBL in relation to endodontic and/or restorative dentistry indicating
lack of empirical work in this area. Nonetheless, the limited data available demonstrated the need for improvements in
the performance levels of students adopting VR-enhanced PBL.
Conclusion: Problem-based learning method can benefit from augmentation with VR and simulation platforms for
teaching preclinical dental students a wide variety of clinical procedures, refine their motor skills, thereby minimizing
errors on actual patients and promoting more integrated learning. We propose that a learning model integrating VR and
PBL is integrated in dental education.
Keywords: Problem-Based Learning, Virtual Reality Simulation, Endodontic, Restorative Dentistry.

the effectiveness of merging these two techniques exist
Problem-based learning (PBL) has consistently
within the current literature(4). Problem-based learning's
received support for being one of the most effective
advantages include active participation in knowledge
approaches to teaching in both preclinical and clinical
acquisition and a student-centered approach to learning
medical and dental education (1-3). Nonetheless, rapid
that is anchored in a realistic setting, as evidenced by its
advances in technology continue to influence the
popularity. Learning that takes place through PBL is
landscape of education and training. Educators are
focused primarily on concepts, rather than a specified
regularly exposed to new and innovative methods in
amount of acquired knowledge, and draws heavily from
facilitating the acquisition of knowledge, as well as
the individual's existing knowledge base, which may
sophisticated technology for use in augmenting
further enhance concept building. Based upon the use of
instruction. While PBL is widely used within
group discussions, the PBL student is asked to reflect
institutions where its instructors readily have access to
and provide feedback as they tackle each assigned
this technology, very little effort has been made in
clinical problem, thereby completing the cycle of
integrating these advanced tools within the PBL
learning(7,8). Curriculums developed on the foundation
curriculum(4). In fact, virtual reality (VR) and
of PBL are comprised of the following four crucial
simulation technology, which emerged as a result of the
elements: (i) Requiring students to use their knowledge
surge in scientific advancement, are becoming more
in a clinical context, (ii) Improving students' clinical
common as useful tools for training and assessment in
thinking skills, (iii) Advancing students' abilities to
the clinical environment(2). VR systems are one method
undertake self-directed learning, and (iv) Increasing
of simulation, which allows medical professionals and
students' intrinsic motivation for the subject matter.
trainees to practice and refine their ability to perform
Because the PBL technique is mostly centered
complex clinical procedures(4). VR simulation, in
on group discussion, there are some clear drawbacks to
particular, targets the individual's haptic, or tactile
using it for skill acquisition in the clinical competency
perception, sense by providing the individual with
phase of medical and dental training(3). Indeed, the
computer-generated sensory feedback (visual, auditory,
acquisition and refinement of core clinical skills
or tactile) as they interact with the simulated
requires more practice-based experiences. Most training
environment in real time(5,6). It is likely that VR
programs rely on an apprenticeship approach for
simulation may be used in conjunction with PBL for
clinical competency training, such that the medical or
medical and dental education, though limited data on
dental student sees patients under the close supervision
Received: 01/05/2022
Accepted: 30/06/2022

Full Paper (vol.891 paper# 25)

c:\work\Jor\vol891_26 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4308- 4311

Bilateral Anterior and Posterior Shoulder Dislocation: Case Report
Waleed M. Alsuwayh*, Hany Ahmed Elsayed Ahmed
Department of Orthopedic Surgery, Dr. Suliman Fakeeh Hospital, Jeddah, Saudi Arabia
*Corresponding author: Waleed M. Alsuwayh, Mobile: 00966509248223, E-mail: wal_112@hotmail.com

Shoulder dislocations are the most common major joint dislocations encountered in the emergency
departments. Bilateral shoulder dislocations are rare and of these, bilateral posterior shoulder dislocations are more
prevalent than bilateral anterior shoulder dislocations. Bilateral anterior shoulder dislocation is very rare.
Objective: We present a case of traumatic bilateral anterior and posterior shoulder dislocation and review the literature
on this rare type of injury.
Case report: A 35 years old male patient known case of epilepsy had history of loss of consciousnesses and fell down
from standing height. Patient came complaining of sever bilateral shoulder pain and inability of movement. Upon
examination, patient was conscious, alert and oriented and vitally stable. Local examination showed right shoulder
deformity, no open wounds and no ecchymosis. There was swelling around the shoulder joint and distal neurovascular
exams were unremarkable with painful range of motion.
Conclusion: Bilateral anterior and posterior shoulder dislocation are the rarest of all shoulder dislocations. It is
important to take accurate clinical history, a thorough clinical examination and adequate imaging in order to exclude
this injury.
Keywords: Bilateral anterior, Posterior shoulder dislocation.


Shoulder dislocation is the most common type of
No ecchymosis
joint dislocation encountered in humans (1, 2). Anterior
There was swelling around the shoulder
shoulder dislocation represents 95% of unilateral
Distal neurovascular exams were unremarkable
shoulder dislocations while unilateral posterior
Painful range of motion
dislocation is far less common (4%) (2, 3).

Bilateral shoulder dislocations do occur and
Local examination of left shoulder:
unlike unilateral dislocations they are most commonly
No open wounds
of the posterior type (2, 4). Bilateral posterior dislocations
No ecchymosis
are usually associated with seizures, electrocution and
There was swelling around the shoulder joint
electroconvulsive therapy while bilateral anterior
Distal neurovascular exams were unremarkable
dislocations result from significant trauma (2, 5).

Asymmetrical bilateral dislocations with one shoulder
dislocated anterior and the other one posterior are
X-ray done showed:

extremely rare and have been reported in the literature
Right anterior shoulder dislocation with
proximal humerus fracture (Figures 1, 2, 3 & 7).
Simple bilateral anterior and posterior shoulder
Left proximal humerus fracture and posterior
dislocation without associated fracture are extremely
dislocation (Figures 4, 5, 6 & 7).
rare. Very few cases have been reported in the literature

(4, 7).
Right shoulder CT showed:

Anterior shoulder dislocation. Hill sachs
comminuted fracture was noted. Bony bankert
A 35 years old male patient known case of epilepsy
was seen. There was shoulder joint effusion and
had history of loss of consciousnesses and fell down
surrounding soft tissue edema and hematoma.
from standing height.

Patient came complaining of sever bilateral shoulder
Left shoulder CT showed:
pain and inability of movement.
Posterior shoulder dislocation. Reversed

comminuted hill sachs was noted. No definitive
Upon examination:
reverse bony bankert lesion. Shoulder joint
Patient was conscious, alert and oriented.
effusion and surrounding soft tissue edema and
Vitally stable
hematoma were seen.

Patient was admitted for fracture reduction and
Local examination of right shoulder:
Right shoulder deformity
Neurology consultation was done
No open wounds
Patient was given good analgesia

And consented for operation.
Received: 03/05/2022
Accepted: 04/07/2022

Full Paper (vol.891 paper# 26)

c:\work\Jor\vol891_27 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4312- 4316
Renal Status of Inflammatory Bowel Disease Patients in
Assiut University Hospital: Single Center Study
Faiza Kamal Abl El-khalek Khalifa*, Hala Mostafa Kamel, Samir Kamal Abdul-Hamid
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
*Corresponding author: Faiza Kamal Abd El-khalek Khalifa, Mobile: (+20) 01060564991, E-mail: faizakamal002@gmail.com


Background: Idiopathic inflammatory bowel disease (IBD) is characterised by significant gastrointestinal tract
inflammation. IBD is strongly correlated with extraintestinal symptoms (EIMs). Renal complication is considered as
one of the EIMs.
Objective: The current study was done to assess whether patients with inflammatory bowel disease have some degree
of renal involvement and also to determine if associated with disease activity or not.
Patients and methods: A cross sectional study included a total of 121 patients who were confirmed to have
inflammatory bowel disease were enrolled in the study. Thorough history taking and clinical evaluation of enrolled
patients were done. Different data of the patients were gathered based on development of kidney disease
Results: A total of 20 (16.5%) patients were found to have kidney disease. Patients with kidney disease had significantly
younger age at time of diagnosis (36.40 ± 9.66 vs. 29.65 ± 8.19) and longer disease duration (2.63 ± 1.28 vs. 4.11 ±
2.47) in comparison to those without kidney disease. Based on the current study, predictors of kidney disease in patients
with inflammatory bowel disease were younger age of diagnosis, duration of the disease and family history of chronic
Conclusion: Early detection of these kidney manifestations is of major importance, and regular monitoring of renal
function in IBD patients could help guide therapy and eventually reduce the overall morbidity.
Keywords: Renal impairment, Kidney disease, Inflammatory bowel disease.

Ethical consideration:
The hallmark of inflammatory bowel disease
This work was conducted in accordance with
(IBD) is recurrent bouts of gastrointestinal tract
Code of Good Practice and the guidelines of
inflammation brought on by an inappropriate immune
Declaration of Helsinki, 7th revision, 2013. Also,
response to gut bacteria. Ulcerative colitis and Crohn's
approval by Institutional Review Board, Faculty of
disease, two idiopathic intestinal diseases that differ in
Medicine, Assiut University was obtained. The
their location and degree of gut wall involvement, are
study was registered on clinicaltrials. gove with
included in the category of "inflammatory bowel
NCT04301297. Patients signed informed consent.
disease" (1).

IBDs, or inflammatory bowel illnesses, can
Inclusion criteria: Any patient with clinical,
affect many other bodily systems in addition to the
laboratory, radiological and/or histopathological
digestive system. Extraintestinal symptoms of IBD,
evidence of IBD was enrolled in the study.
which include organs outside the gastrointestinal

system, are more commonly known (1-3).
Exclusion criteria:
EIMs might happen more or less frequently
Any patient with one or more of the following criteria
depending on the organ involved. EIMs can happen
was excluded;
both before and after an IBD diagnosis. They can have
- Signs of urinary tract infection
a significant negative effect on individuals with IBD's
- Known renal disease
quality of life, often even more so than the intestinal
- Hypertension
condition itself. According to reports, 4% to 23% of
- Diabetes mellitus
IBD patients have renal and urine involvement, which
- Use of nonsteroidal anti-inflammatory drugs
often manifests as urinary calculi, fistulas, and ureteral
(NSAIDs) or other nephrotoxic drugs known
blockage (4, 5).
rather than those used in the protocol of therapy
This study was conducted to detect whether
of IBD
patients with inflammatory bowel disease (IBD) have
- Recent pregnancy
some degree of renal involvement and also to determine
- Morphological changes of kidney (proven by
if associated with disease activity or not.

- Patient's refusal

Study design and setting
Sample size calculation:

A cross sectional hospital based study was

Total coverage sample where any patient
conducted at Department of Internal Medicine of Assiut
fulfilled the inclusion criteria during the study period
University Hospitals. It was done in period between
was recruited in the study. A total of 121 patients who
January 2020 and December 2020.
were proven to have IBD were enrolled in the study.
Received: 3/5/2022
Accepted: 4/7/2022

Full Paper (vol.891 paper# 27)

c:\work\Jor\vol891_28 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4317- 4322
Effect of Weight Reduction on Inflammatory Mediators in
Patients with and without Metabolic Syndrome
Hassan M. Hassanin1*, Usama A. Khalil1, Amany M. Sediq2, Arafa M. Elshabrawy1
1 Department of Internal Medicine and 2 Department of Clinical Pathology,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hassan M. Hassanin, Mobile: +201113657464, Email: Drhassan_h99@yahoo.com.
ORCID: 0000-0002-9548-652X

Background: Obesity is now considered a low grade, chronic inflammatory disease that is associated with metabolic
disorders like type 2 diabetes and insulin resistance. Weight loss in obese and overweight subjects, achieved both by
energy-restricted diet or surgery, was found to be a critical factor for reducing the level of inflammatory markers.
To find if the effect of weight loss on inflammatory mediators in overweight and obese patients will be
affected by the presence or absence of metabolic syndrome (MetS).
Methods: The final patient sample was (114) patients. According to BMI and presence or absence of MetS, they
were divided into 4 groups: Group (1): overweight with MetS. Group (2): overweight without MetS. Group (3):
obese with MetS. Group (4): obese without MetS.
An eight-week program for weight reduction including dietary restrictions and physical activity was followed by all
patients. Obesity parameters and inflammatory mediators were measured before and after weight reduction.
Results: Adiponectin, TNF and IL6 (the significantly different inflammatory mediators before the weight loss
program) showed that the highest degree of significant difference was in TNF between group 2 and 4. Delta change
showed that after the weight loss program the changes were significant between the four groups in CRP, TNF, and
IL6. Group 2 and 3 were the only two groups showing significant difference in the 3 parameters.
Conclusions: Presence of MetS augments the beneficial effect of weight loss in those patients in comparison to
patients who lack the criteria of MetS.
Keywords: Weight reduction; Inflammatory mediators; Metabolic syndrome.

induces a hypercoagulable state, and produces pro-
Obesity is now accepted as a low grade, chronic
inflammatory cytokines, which are released from the
inflammatory disease that is linked to metabolic
adipose tissue promoting the increased risk of
disorders, including type 2 diabetes and insulin
cardiovascular disease (CVD) (7).
resistance (1). Overweight persons (those who have
In a meta-analysis including 76 articles, weight
body mass index (BMI) 25 kg/m2) are nearly 30% of
loss in obese and overweight subjects, achieved both
the world population, i.e., 2.1 billion people, more than
by energy-restricted diet or surgery, was found to be a
600,000 of them are classified as obese (defined as
critical factor for reducing the level of inflammatory
BMI 30 kg/m2) (2). Inflammation is a physiological
markers (8).So, the value of weight loss on level of
reaction of the organism to injurious stimuli, be they
inflammatory markers is well known now.
biological, chemical, or physical. If working well, the
Not all patients with obesity have a MetS. As
damaging factor is cleared leading to inflammation
stated by the International Diabetes Federation (IDF)
resolution with healing of tissues. However, if the
2006; the MetS can be diagnosed by presence of waist
dealing with the injurious stimuli or even if the
> 94 cm (men) or > 80 cm (women) in addition to the
removal of apoptotic inflammatory cells fails, the
presence of two at least from the following: 1. Blood
inflammation process will continue with development
glucose higher than 5.6 mmol/L (100 mg/dl) or having
of chronic inflammation or autoimmunity (3).
treatment for diabetes mellitus (DM) -2. High-density
Visceral adiposity is considered now as an initial
lipoprotein cholesterol (HDL-C) < 1.0 mmol/L (40
trigger for most of the pathways implicated in
mg/dl) in men, < 1.3 mmol/L (50 mg/dl) in women or
metabolic syndrome (MetS). From all the suggested
taking medications for low high-density HDL-C -3.
mechanisms, insulin resistance, activation of
Blood triglycerides (TG) > 1.7 mmol/L (150 mg/dl) or
neurohormones, and chronic inflammation seem to be
taking medications for hypertriglyceridaemia -4.
the leading players in the commencement,
Blood pressure > 130/85 (9).
advancement, and transformation of MetS (4).
In this research, we tried to find if the effect of
Visceral adiposity increases free fatty acids
weight loss on inflammatory mediators in overweight
(FFAs), which impede the antilipolytic effect of
and obese patients will be affected by the presence or
insulin. FFAs prevent the activation of protein kinase
absence of MetS. Up to our knowledge, no previous
in the muscle which leads to reduced glucose uptake
studies examined this effect.
with subsequent insulin resistance development (5). In

turn, insulin resistance leads to the development of
hypertension as the vasodilator effect of insulin is lost
This is a prospective cohort study. Willing
(6). Insulin resistance also increases serum viscosity,
overweight or obese subjects were recruited from
Received: 28/4/2022
Accepted: 27/6/2022

Full Paper (vol.891 paper# 28)

c:\work\Jor\vol891_29 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4323- 4326

Pulmonary Artery Venting in Ventricular Septal Defects with Pulmonary
Hypertension Compared to Ordinary Routes of Left Ventricular Venting
Ihab M. Elsharkawy1, Ahmed M. Elwakeel1*, Mahmoud M. Elwakeel2, Ahmed H. Lamloom1

Departments of 1Cardiothoracic Surgery and 2Anesthesia, Surgical ICU, and Pain Management,
Faculty of Medicine, Cairo University, Giza, Egypt
*Corresponding author: Ahmed M. Elwakeel, Mobile: (+20)1005236454, Email: aelwakeel@cu.edu.eg,
ORCID: 0000-0003-2877-3446

Ventricular septal defect (VSD) closure in patients with reversible pulmonary hypertension is a risky
procedure regarding intra- and post-operative course. The classic left ventricle (LV) venting has its own reported
complications and cannot unload the distending right ventricle (RV) at the end of the repair. We are assuming usage of
pulmonary artery (PA) venting in ventricular septal defect-pulmonary hypertension (VSD-PH) cases will be less
problematic and more effective compared to venting through other ways.
Patients and methods: Data of 100 patients with VSD-PH listed for isolated VSD closure in Cairo University Hospitals
were collected and cases were divided into 2 groups; Group 1 had pulmonary artery venting, and Group 2 had no
pulmonary artery venting. Both groups were compared for preoperative, operative and postoperative variables.
Results: Both groups had similar preoperative characteristics, with Group 1 including 51 patients compared to 49
patients in Group 2. Data reported 15 minutes shorter cross clamping time (AXC) (p-value 0.001), transesophageal
echocardiogram (TEE) has never observed air in the left heart or aorta and 0.6 days shorter ICU stay (p-value 0.002) in
Group 1, mean hospital stay was 6.4 (SD 1.7) in Group 1 and 8.7 (SD 2.2) in Group 2 (p-value 0.001). There was no
significant difference in the incidence of ventricular fibrillation after each type of vent had been used (p-value >0.05),
and there was 30% less need for inotropic support in Group 1 (29 % vs 59%, p-value 0.02).
Conclusion: venting through PA on operating cases with VSD-PH is effective regarding creating bloodless field
facilitating the surgical procedure, decompressing right ventricle after aortic de-clamping, and is associated with shorter
ICU and hospital stay.
Keywords: Ventricular septal defect, pulmonary hypertension, pulmonary artery venting, ICU, surgical outcome, Cairo


out in the period from January 2019 to December 2021,
Ventricular septal defect (VSD) is the commonest
aiming to assess the effectiveness of PA venting
congenital cause for pulmonary hypertension (PH)
regarding impact on cross clamp time, bypass time,
accounting for 42% of cases with congenital heart
need for inotropic support, time to extubation, ICU stay,
disease-pulmonary hypertension (CHD-PH) and 3% of
and total hospital stay.
cases show persistent PH even after surgical closure (1).

Despite complexity of pathophysiology causing
Pulmonary hypertension was defined as a mean
pulmonary hypertension in cases of VSD, right
pulmonary arterial pressure 25 mmHg as assessed
ventricular (RV) dysfunction is the main problem
surgeons face after VSD closure due to loss of the
catheterization or intraoperatively through invasive PA
bidirectional shunt that vent patient's RV in presence of
line inserted through purse taken for PA venting line.
high pulmonary vascular resistance (2-6).

We are assuming that venting through pulmonary
Reversibility of PH was defined through assessing the
artery will protect against complications related to
vasoreactivity to high oxygen, drop of the pulmonary
venting via right superior respiratory vein (RSPV) (3,8),
vascular resistance index (PVRI) by 20% was
and will help decompressing RV at end of the surgery
considered operable.

We aimed to assess whether the use of PA vent will
Inotropic support was defined as "requiring one or
yield better clinical results such as shorter cross clamp
more of norepinephrine/ epinephrine/ amrinone/
time, bypass time; and to determine whether it is
dobutamine/ >2.5 mug/kg/min dopamine, for at least 45
beneficial for the heart as indicated by less need for
minutes intraoperatively" (5) while those requiring
inotropes, shorter ICU stay, and easier weaning off
small doses of inotropes, which was weaned before
bypass, in cases of VSD-PH.
transfer from OR are not counted.

Inclusion criteria: Patients with isolated VSD-PH
This randomized prospective study includes 100
beyond age of 6 month.
patients who underwent isolated surgical closure of

VSD complicated with reversible PH and were
Exclusion criteria: patients with left ventricular (LV)
essentially involved two venting techniques: Pulmonary
decompaction, or with LV EF< 35%, coexistent cause
artery (PA) venting and venting through RSPV carried
of PH such as lung disease, coexistent aortic
Received: 02/05/2022
Accepted: 03/07/2022

Full Paper (vol.891 paper# 29)

c:\work\Jor\vol891_30 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4327- 4331

Genotyping of Human Papilloma Virus Infections
Ahmed Mohamed Atef*1, Amira R El Sheikh2, Rasha Mohamed Besheer3
Departments of 1Obstetrics & Gynecology and 3Dermatology & Venereology, Al Ahrar Teaching Hospital, Egypt
Department of 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Ahmed Mohamed Atef, Mobile (+20)1007598182. Email ahmed.atef.zn88@gmail.com

The human papillomavirus (HPV) is a virus that only infects epithelial cells. Skin and mucosal lesions,
as well as malignancies, are usually associated with it. In anogenital carcinogenesis, HPV is a key player. Persistent
HPV infections have been linked to an increased risk of developing cervical cancer in several studies. The objective of
the current study is the detection of HPV-DNA in cutaneous and genital warts by polymerase chain reaction (PCR) and
to evaluate their possible association with malignant and non-malignant conditions. Patients and methods: This study
comprised 24 patients. They are classified into 4 groups (common wart, planter wart, genital wart and cancer cervix
groups) according to the clinical and pathological results. Biopsies from lesions were subjected to DNA extraction.
Extracted DNA was amplified in the PCR reaction For the purpose of detecting low-risk HPV Samples found to be
positive by PCR were then exposed to an additional amplification in order to find high-risk forms of HPV.
revealed that low risk HPV-DNA was detected in 60% among common wart group, 26.6% among genital wart
group and 13.3% among cancer cervix group. Meanwhile, it was not detected in planter wart group, with overall
detection of HPV-DNA in 62.5 % of the study groups. About 46.7% of the positive cases had high-risk HPV-DNA.
Common wart is the most benign lesions as it rarely converts to malignancy. Genital HPV infection was
detected in both malignant and nonmalignant conditions. HPV is a potential risk for cervical neoplasia among Egyptian
Human papillomavirus, Genital wart, High-risk HPV-DNA, PCR, Al Ahrar Teaching Hospital, Zagazig


Infecting the epithelia of the skin or mucosa, the
human papilloma viruses (HPV) are a big group of
This work was carried out at the PCR unit at
roughly 120 genotypes. It is possible to contract more
Clinical Pathology Department. Patients were drawn
than 40 different types of genital infections.
from the Gynaecology and Dermatology Clinics at
Asymptomatic or subclinical infection is the most
Zagazig University Hospitals and Al-Ahrar Teaching
common form of HPV infection. Cervical cancer is
Hospital's outpatient clinics for this study.
caused by HPV types 16 and 18, which are oncogenic
A thorough history, skin, gynecological, and
or high-risk. However, HPV strains 6 and 11 are more
histological examination were performed on all
commonly associated with anogenital warts or
condylomata acuminate (1).
The specimens from patients were obtained either
Epidermal infections caused by HPV are
by local excision, colposcopic directed biopsy or total
widespread and can result in a wide range of clinical
specimen after total hysterectomy. In order to use PCR
symptoms. HPV-infected genital warts (condylomata
to detect HPV, each biopsy was immediately frozen at
acuminata) are typically considered to be harmless
-70oC in aluminum foil (4). Positive samples were
growths of the anogenital skin and mucosa. Sexual
subjected to second amplification another time to
contact can spread genital warts. Infectious genital
detect high-risk HPV typing (16/18/31/33/52b/58).
warts affect approximately two-thirds of those who

have sexual contact with an infected partner. For the
Polymerase chain reaction technique:
most part, the incubation period ranges from three
DNA was extracted from the tissue biopsy using
weeks to eight months (2).
Nucleo Spin Nucleic Acid purification Kits
Anogenital cancer can occur despite the benign
CLONTECH Laboratories, Inc. 1020 East Meadow
nature of most HPV-related proliferations. However,
Circle Palo, ALTO, CA94303-4230, USA.
specific forms of HPV can increase anogenital cancer
HPV typing fast kit. Supplied by (EXPERTEAM
risk. These include laryngeal, oral, as well as some
VENEZIA, Italy), done by PCR with L1open reading
pulmonary malignancies (3).
frame using My09/MY11 consensus primers. The
Skin cancer research would benefit greatly from
technique involved two amplifications (Nested PCR):
more knowledge about papilloma viruses.
(a) The first one for L1 region screening (low risk
The goals of our work were detection of HPV-
group). (b) The second one for HPV (high risk groups).
DNA in cutaneous and genital warts by polymerase
Ethidium bromide staining and UV light
chain reaction (PCR) and to evaluate their possible
transillumination were used to identify the amplified
association with malignant and non-malignant
DNA products (5).
Received: 02/05/2022
Accepted: 03/07/2022

Full Paper (vol.891 paper# 30)

c:\work\Jor\vol891_31 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4332- 4339

Commitment to COVID-19 Protective Measures in Schools and among
School Children, Egypt
Reda Abdel Latif Ibrahem, Aziza Saad Elbadry*, Shaimaa Yaihya Abdel Raouf
Public Health and Community Medicine Department, Faculty of Medicine,
Menoufia University, Menoufia Governorate, Egypt
*Corresponding author: Aziza Saad Elbadry, Mobile: (+20) 01003784772, E-mail: azza_saad1984@yahoo.com

School closure was taken as one of the international measures to combat the COVID-19 pandemic. After
the recession of the first wave of COVID-19, reopening of schools was decided to gain the educational and psychological
support proposed by schools, on condition that they apply strict hygienic measures in schools and by students to prevent
the spread of infection. Objective: This study aimed to estimate the degree to which school students committed to
hygienic measures related to COVID-19 prevention as well as estimate schools' commitment to public health measures
related to COVID-19 as reported by students.
Patients and methods: A cross-sectional study was conducted in December 2020 on Egyptian school students. A
stratified random sampling technique was used to select 20 basic education schools from the ten districts in Menoufia
governorate, Egypt. A sample of 786 students were included and subjected to a self-administered questionnaire
containing socio-demographic characteristics, students' commitment to hygienic measures related to COVID-19, and
the commitment of the schools to preventive measures of COVID-19.
Results: The studied students were 52.3% males with an average age ranging from 6 to 15 years. About 55.1% were
from rural residences and 92% of them were with adequately educated mothers. Hand washing practice was mostly done
after returning home from outside (95.2%). More than 95% of them wore masks at school entry but only 39.2%
continued wearing them throughout the day. Students' commitment was significantly related to older age students,
females, urban residence, and mother's education. Conclusion: Commitment of students to hygienic measures against
COVID-19 improved mainly with increasing age, female sex, urban areas, and with higher education of mothers. Also,
it was significantly correlated with the school's commitment score, so continuing health education and training of parents
and students, especially those who are young, will improve students' commitment.
Keywords: COVID-19 infection, Preventive measures, School children.


public health and social measures (PHSM), which may
The outbreak of coronavirus disease (COVID-
include closing schools. The impact of school opening
19) has been declared a Public Health Emergency of
on community transmission depends on adherence to
International Concern (PHEIC) and the virus has now
preventative measures put in place by the government,
spread through many countries and territories. On
since most nations are only gradually loosening
March 12, 2020, the WHO declared it as a pandemic,
restrictions on activities and social gatherings, including
requiring urgent joint international efforts to control it.
the reopening of schools. The spread of the illness must
Public awareness of infectious viruses remains the most
be stopped at all costs (5).
important factor in limiting disease spread (1).
Shutting down educational facilities should only
Compared to adults, young children appear to be
be considered when there are no other alternatives. In
less susceptible to infection, with age often leading to
contrast, school closures have clear negative impacts on
an increase in susceptibility (2). All children are
child health, education and development, family
vulnerable to and capable of spreading SARS-CoV-2.
income, and the overall economy. National and local
Compared to cases in older children and adults, SARS-
governments should consider prioritizing continuity of
CoV-2 infections in younger children seem to result in
education by investing in comprehensive, multi-layered
subsequent transmission less frequently. According to
measures to prevent the introduction and further spread
surveillance statistics, children between the ages of one
of SARS-CoV-2 in educational settings while also
and eighteen had considerably lower rates of
limiting transmission in the wider community (6). Basic
hospitalization, serious illness requiring in-patient
principles in schools are to keep students, teachers, and
treatment, and mortality than any other age group.
staff safe at school and help stop the spread of COVID-
Research is urgently needed to identify the precise
19 (7).
impact of COVID-19 and its long-term effects on the
In Egypt, after the interruption of the scholastic
pediatric population (3).
year 2019/2020 after WHO declaration that COVID-19
It's important for parents and caregivers to
is a worldwide pandemic, the Egyptian ministries of
understand that children can be infected with SARS-
health and education settled precautions to limit the
CoV-2 and can transmit it to others. That is why it is
spread of infection, including decreased number of
important to use precautions and prevent infection in
school days, decreased classroom crowding, and
children as well as adults (4).
ensuring social distancing; mask wearing; hand
To stop the spread of the SARS-CoV-2 virus,
hygiene; and availability of soap, alcohol, and other
nations all over the world are implementing extensive
hand sanitizers; as well as, recording of cases that
Received: 03/05/2022
Accepted: 04/07/2022

Full Paper (vol.891 paper# 31)

c:\work\Jor\vol891_32 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4340- 4345
Correlation of Fibroblast Growth Factor 21 (FGF-21) with Fetal and Maternal
Complications in Patients with Gestational Diabetes Mellitus
Mohamed Reda Halawa1, Magdy Hassan Kolaib2, Ola Mohamed Mostafa Shaheen1,
Dina Ahmed Marawan1, Salah Hussein ElHalawany1*
Departments of 1Internal Medicine & Diabetes and Endocrinology and 2Obstetrics and Gynecology,
Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Salah Hussein El-Halawany, Mobile: (+20) 01098127872, E-Mail: salah.hussein@med.asu.edu.eg

In the second or third trimester of pregnancy, gestational diabetes mellitus (GDM) can be characterized
as glucose intolerance that was not overt prior to gestation. It can have long-term health effects, even if most GDMs go
away on their own after delivery. It involves a higher risk for mothers to develop cardiovascular problems or type 2
diabetes mellitus (T2DM), and the child's propensity for obesity, cardiovascular disease, or T2DM. In addition to the
liver, other metabolically active tissues such as fat, skeletal muscle, and the pancreas express the hepatokine FGF-21.
T2DM can be predicted by a high level of FGF-21. T2DM and GDM are thought to share comparable pathogenesis, but
the link between FGF-21 and GDM remains vague. The aim of the study to assess the correlation of FGF-21 with fetal
and maternal complications among cases who had GDM.
Patients and methods: There were 50 women diagnosed with GDM at 24-28 weeks of gestation and 50 healthy women
recruited from the Diabetes and Obstetrics outpatient clinic to participate in this case-control research.
Results: GDM patients had greater concentrations of FGF-21 compared to control group (p-value <0.01). Fasting blood
glucose, 2-hour postprandial glucose, and haemoglobin A1C all had a significant correlation with serum FGF-21 in our
research. Moreover, serum FGF-21 was correlated with the incidence of maternal hypertension in the studied groups (p-
value 0.011), while the correlation of FGF-21 with the incidence of fetal complications whether fetal macrosomia,
respiratory distress, or neonatal hypoglycemia was not significant.
Conclusion: : FGF-21 levels are elevated in patients with GDM. Pregnant women who had greater levels of FGF-21 in
their blood were shown to have higher blood pressure readings in this study. Maternal and fetal outcomes should be
better linked to FGF-21 levels during pregnancy through additional research.
Fetal complications, Fibroblast growth factor 2, Gestational Diabetes mellitus, Maternal complications,
Type 2 diabetes mellitus.

illnesses because it has been discovered to influence
It's not uncommon for pregnant women to suffer
glucose-lipid metabolism (5,6).
from gestational diabetes mellitus (GDM). Around 18
An increased level of FGF-21 has been reported in
million babies are born each year to women with
obesity and insulin resistance status (7). Moreover,
gestational diabetes, according to the International
Placenta has appeared as an active endocrine organ
Diabetes Federation (IDF) (1).
expressing and secreting FGF-21(8); however, its role in
Risk factors for GDM include a history of insulin
normal pregnancy and GDM is poorly understood
resistance or diabetes in the mother's family, advanced
T2DM patients had significantly higher levels of
maternal age, overweight/obesity, deficiencies in
circulating FGF-21, but FGF-21 levels are lower in
micronutrients, and a westernized diet. GDM is a
those with type 1 diabetes and adults with latent
common complication of pregnancy, but it can have
autoimmune diabetes (9,10). Unluckily, there is a lack of
long-term health consequences, involving a higher risk
consensus on the level of FGF-21 circulating in GDM
to mothers to develop heart problems or type 2 diabetes,
and its correlation with maternal and fetal outcomes.
and the child's propensity for obesity, cardiovascular
The aim of the current study is to examine the link
disease, or type 2 diabetes mellitus (T2DM) (2). Adding
between FGF-21 and fetal and maternal problems in
insulin to medical nutrition therapy and a change in
patients with GDM.
lifestyle has most consistently been found to minimize

fetal morbidities (3).
FGF-21 is a metabolic hormone synthesized by the
The current cases-control study included 50
liver, adipose tissue, skeletal muscle, and pancreas that
women with GDM and 50 pregnant normoglycemic
is related to glucose metabolism and insulin resistance
(control) women of the same gestational age. Patients
from Ain Sham University Hospitals were recruited
Several trials have established that FGF21
between December 2020 and July 2021 to participate in
promotes fatty acids oxidation and ketone bodies
the study.
production, and inhibits lipogenesis Therefore,
Fasting blood glucose (FBG) had been obtained
FGF21regulates glucose-lipid metabolism. FGF21 is
after 8 hours of fasting, for all participants at the first
therefore a promising therapeutic target for metabolic
prenatal visit in the first trimester to exclude
undiagnosed preexisting diabetes. Demographic
Received: 8/05/2022
Accepted: 7/07/2022

Full Paper (vol.891 paper# 32)

c:\work\Jor\vol891_33 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4346- 4352

Total And Mitochondrial Cell Free DNA Quantification in Day 5 Embryos
Culture Media Reflect Embryos Quality
Mohammed H. Sheaba1, Ali G. Gadel-Rab2, Alaa M.H. EL-Bitar2, Moustafa Sarhan1
1Molecular biology research lab, Zoology Dep, 2Zoology Department,
Faculty of Science, Al-Azhar University, Assiut, Egypt.
Corresponding authors: Ali G. Gadel-Rab, Email: aligamal200992@azhar.univ.eg,
Mobile: 00201146042211,https://orcid.org/0000-0002-8741-3048

In vitro fertilization (IVF) technology still uses the morphological criteria as the main approach for selecting
embryos of a certain quality, embryo fragmentation, blastomere size and cleavage rate. This group of tools is routinely used
to grade cleavage stages of human embryos.
As a result of blastomere fragmentation, cell free mitochondrial DNA (cf mtDNA) is released into the embryo culture
medium. Our study aims to confirm the presence of cell-free DNA (cfDNA) in embryos culture media by detecting a specific
gene using PCR and to evaluate the correlation between two kinds of cf DNA (total cfDNA and cf mtDNA) content in
blastocyst stage (Day 5 embryos) culture media and embryo grading.
Subject and Method: 40 spent culture media samples are collected; each blastocyst was morphologically graded. cfDNA
is extracted from embryo culture media. Quality of cfDNA is checked by conventional PCR with specific primer then
visualized by agarose gel. The cf mtDNA is profiled by isothermal PCR.
Results: Purified cfDNA from embryo culture media could be used to amplify specific genes by PCR. Further studies
indicated that insignificant interdependent relationship is found when correlating the total cfDNA amount on day 5 and
embryo grading. Similarly, the significant interdependent relationship is found when correlating cf mtDNA amount on day
5 and embryo grade. Notably, a significant correlation is noticed between cf mtDNA amount and blastocyst formation.
Conclusion: We confirmed the presence of cfDNA in embryo's culture media and noticed a significant correlation between
the quality and embryos secrotome cf mtDNA levels.
Keywords: Blastocyst / cfDNA / Human embryos / cf mtDNA.

levels between all successful and unsuccessful
Mitochondria are the main source of cellular
embryos of their study revealed no significant differences.
energy; also play crucial roles in apoptosis, necrosis and
The detection of cf mtDNA levels in spent culture
cellular homeostasis including calcium regulation levels.
media can be considered as a non-invasive technique
During oocyte growth, mitochondrial number increases
[7,20,21,22] to assess the potential development of the
[1], which play vital roles in fertilization and embryonic
blastocyst stage through the fragmentation of the embryo
development competence [2,3,4]. Embryo grade is
cells in the culture media [22,31].
important to the pregnancy rate results in IVF.
For embryo selection and testing there are pre
Any changes to the components of the culture
implantation genetic diagnosis (PGD) [25].
medium could potentially affect the grade and quality of
The use of these methods requires blastomere
the embryos since it is the direct near environment to the
biopsy which may affect the quality of embryos on the
embryos in vitro [5,6]. In vitro fertilization successful
future development. This method is not only invasive but
pregnancy and potential implanta
also expensive in addition to mosaicism which leads to a
tion rates depend on the morphological criteria [7,8].
false result [26,27].
One of the main tools used for grading the human
In the present study, we hypothesized that
embryo and its potential implantation rate is the embryo
fragmentation, should suggest that cell free DNA is
fragmentation. Fragments of human embryo cells are the
passed into the human embryo spent culture media. Our
source of cell free mitochondrial DNA that passed into the
study aimed to explore the presence of cfDNA/cf mtDNA
embryo culture media (secretome), so the embryos with
in spent culture media of human embryos and to
low quality contain high cfDNA/cf mtDNA levels in their
investigate that cfDNA levels were correlated with the
spent culture media [9,10[ as a result for cfDNA losing by
morphological criteria of the embryos and with maternal
physiological and apoptosis processes [11,12,13].
age [28,29].
Previous studies reported that, the high

implantation capacity is related to the blastocysts with
low mitochondrial content [14,15,16] in contrast with Victor
et al [18] and Victor et al [19]; who reported that cf mtDNA
12 patients (couples), were scheduled for
intracytoplasmic sperm injection (ICSI) in Al Riyadh
Received: 11/4/2022
Accepted: 8/6/2022

Full Paper (vol.891 paper# 33)

c:\work\Jor\vol891_34 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4353- 4356

Possible Effects of Diethyl Phthalate on Cardiovascular System: A Review Article
Marian Salama Youssef Salama*, Maha Amin Khattab,
Shaimaa Ali Abdelrahman, Abeer Abd Elazeem Mahmoud
Medical Histology and Cell Biology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Marian Salama Youssef Salama, Mobile: (+20) 01227444965,
E-Mail: mariansalama2015@gmail.com


Background: Several ailments, including cancer and cardiovascular disease, have been linked to today's sedentary
lifestyle and unhealthy eating habits. However, environmental toxins have also been linked to this rise in recent decades.
Phthalates, a chemical found in plastics, are a concern because of the amount of time people spend in contact with them
on a daily basis. Phthalates exposure has been linked to cardiovascular health in several studies, which have already
established a favorable correlation with hypertension and atherosclerosis development in adults and some cardiovascular
risk factors in kids, pregnant women as well as adults
Objective: Assessment of possible effects of di ethyl phthalate on different functions of cardiovascular system.
Di ethyl phthalate, and cardiovascular system 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 May 2021 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: Cardiovascular health may be adversely affected by phthalate exposure, with changes in blood pressure
and the risk of atherosclerosis as well as metabolic syndromes occurring as a result of early childhood and adult
Keywords: Di ethyl phthalate, Cardiovascular system.

Because of this, the right atrium and ventricle are
The cardiovascular system (CVS) serves as the
sometimes referred to as the "right heart" and its left
body's primary means of transporting nutrients and
counterparts as the "left heart," respectively, in order to
oxygen throughout the body. A vital function of the
ensure proper blood flow. Four valves; cuspid and
circulatory system is to transport oxygenated blood,
semilunar are present in between atria, ventricles and at
essential nutrients, and chemical signals such as
the base of large vessels to guard the exits of the
hormones throughout the body. In addition, it delivers
chambers preventing the backflow of blood(1).
waste materials such as urea and uric acid to the kidneys
Embryologically, in the human body, the heart
for excretion, as well as carbon dioxide through
is the earliest functioning organ to emerge. It is active by
respiratory system. Thermoregulatory control is
the beginning of the 4th week when the placenta is unable
facilitated in part by CVS. A well-functioning CVS is
to meet the requirements of growing embryo. It arises
critical to a person's health and lifespan(1).
from the mesodermal layer near the head in a region
Cardiovascular system consists mainly of the
called cardiogenic area. After that, cardiogenic area
heart, which is the muscular pumping device simulating
begins to develop 2 strands called cardiogenic cords that
man's closed fist and closed system of vessels including
rapidly form lumen and subsequently referred as
arteries, veins and capillaries. Human heart is a four
cardiogenic tubes(2).
chambered muscular organ, 2 atria and 2 ventricles.
Received: 5/5/2022
Accepted: 6/7/2022

Full Paper (vol.891 paper# 34)

c:\work\Jor\vol891_35 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4357- 4361

Transcatheter Closure of a Patent Ductus Arteriosus with
Healed Vegetation: A Case Report
Fatma Aboalsoud Taha*, Sahar Elshedoudy
Department of Cardiology, Faculty of Medicine, Tanta University, Tanta, Egypt
*Corresponding author: Fatma Aboalsoud Taha, Mobile: (+20) 01026194470,
E-Mail: fatmastaha@yahoo.com, ORCID: 0000-0002-4450-7

The unrepaired patent ductus arteriosus (PDA) is at risk for congestive heart failure (CHF) and/or
infective endocarditis (IE). Transcatheter closure of PDAs with occluder devices has been advanced to be the strategy
of choice for managing anatomically feasible PDAs. Despite it is not clear if the closure of a small PDA is beneficial,
routine closure of any PDA in children and young adults appeared reasonable to decrease the risk of IE.
Case report: We report on a one-year and two-month-old boy who had a small Krichenko type D PDA, with two
constrictions at its middle part and its pulmonary end, and with healed vegetation within the PDA. We successfully
closed the PDA percutaneously using a 5x4 mm Nit-Occlud® PDA coil (PFM medical, Köln, Germany) with an
unremarkable 2-year follow-up. To our knowledge, this is the first reported case of a PDA with a previous IE and healed
vegetation within the duct that was closed by the transcatheter approach.
Conclusion: Closure of PDAs is indicated in patients with left ventricular overload or with continuous murmurs. Despite
it is not clear if the closure of small PDAs is beneficial, routine closure of any PDA in children and young adults appeared
reasonable to decrease the risk of IE. A history of previous IE makes PDA closure mandatory. Differentiation between
IE recurrence and the persistence of healed vegetation from a previously treated IE can be difficult.
Keywords: Patent Ductus Arteriosus, Transcatheter Closure, Infective Endocarditis, Congestive Heart Failure, Tanta
University, Healed Vegetation.

The unrepaired patent ductus arteriosus (PDA) is
small PDA with an attack of infective endocarditis with
at risk for congestive heart failure (CHF) and/or
positive blood cultures for Streptococcus Viridans,
infective endocarditis (IE). Since transcatheter closure
which was managed by hospitalization and
of PDA with occluder devices started in 1967 [1], the
administration of high doses of intravenous (IV)
technique and the devices used have been advanced to
antibiotics [Ceftriaxone 200 mg/kg/day for 4 weeks and
make transcatheter PDA closure the strategy of choice
gentamycin 5 mg/kg/day for two weeks]. Then, the
for managing anatomically feasible PDA. In pediatrics,
patient was discharged after control of the fever and
although transcatheter closure of PDA is generally a
resolving of the blood cultures.
simple procedure, some challenges are still facing the
The patient's cardiac examination revealed a
interventionist; low body weights, venous anomalies,
grade 3/6 continuous murmur on the upper left sternal
complex duct configurations, and complicated ducts
border. His Oxygen saturation (SaO2) was 99%. He had
with IE [1].
mild hypochromic microcytic anemia with a
Here we report on a one-year and two-month-old
hemoglobin (Hb) level of 10.2 gm/dl. All his other
boy who had a small Krichenko type D PDA with
laboratory findings were within normal ranges. His
healed vegetation within the PDA from a previous
chest X-ray showed a mildly increased cardiothoracic
attack of IE. We successfully closed the PDA
ratio with mildly increased pulmonary vascular
percutaneously using a 5x4 mm Nit-Occlud® PDA coil
markings. His electroencephalogram (EEG), brain
(PFM medical, Köln, Germany). To our knowledge, this
magnetic resonance imaging (MRI), electromyography
is the first reported case of a PDA with a previous IE
(EMG), and bilateral lower limbs' motor nerve
and healed vegetation within the duct that was closed by
conduction study were unremarkable.
the transcatheter approach.

persistence of the small PDA that measured 1.5 mm at
its pulmonary end leaving left to right shunt with a peak
Case description:
systolic pressure gradient of 76 mmHg and a diastolic
Here we report on a one-year and two-month-old
one of 45 mmHg, figure 1. The left ventricle (LV) was
boy, weighing 8 Kg, with a body surface area (BSA) of
mildly dilated with a good systolic function [Ejection
0.74, who presented with dyspnea grade II-III, repeated
fraction (EF) of 68%]. Also, there was mild mitral valve
attacks of chest infection, and with delayed milestones.
regurgitation (MR).
At the age of 10 months, the patient's history denoted a
Received: 8/5/2022
Accepted: 7/7/2022

Full Paper (vol.891 paper# 35)

c:\work\Jor\vol891_36 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4362- 4371

The Possible Pre-emptive Role of Royal Jelly and Alpha Lipoic Acid on
Osteoporosis Caused by Glucocorticoid in Adult Male Albino Rats
Mai Hassan Ibrahim*, Marim Fayz Abdow
Anatomy & Embryology Department, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding Author: Mai Hassan Ibrahim, Mobile: (+20)01145779734,
Email: may.ibrahim@fmed.bu.edu.eg, ORCID: 0000-0001-5999-2612
Introduction: extreme or extended glucocorticoid (GC) management may lead to high risk of bone fractures and
osteoporosis (OP). Alpha lipoic acid and Royal Jelly are effective anti- oxidants. Objective: This study examined effects
of glucocorticoid on the bone structure and the possible preventive role of alpha Lipoic acid and royal jelly.
Materials and Methods: Forty rats were categorized into four groups. Control group, corticosteroid group: rats were
administrated with glucocorticoid at a dose of 30 mg/kg/day S.C for 60 days, third group rats were given Glucocorticoid
and 100 mg/kg/day of alpha lipoic acid orally for 60 days. Group IV: rats were given glucocorticoid and royal jelly 100
mg/Kg /day orally for 2 months. Bone specimens were prepared for the histological and immunohistochemical studies.
Results: Glucocorticoid induced resorption and damage of the bone histological structure. Percent of both collagen fibre
deposition and osteopontin immunoreactivity were markedly decreased in comparison with the control group. Royal
jelly and alpha lipoic acid reversed the damage effect of glucocorticoid on the bone histological structure.
Conclusion: Chronic use of glucocorticoid in adult male albino rats caused osteoporosis that could be reversed by
administration of royal jelly and alpha lipoic acid.
Keywords: Glucocorticoid, Alpha lipoic acid, Royal jelly, Osteoporosis.


manifestation, few who studied its role in inhibiting the
The bone is an unfamiliar tissue in that, many
loss of bone tissue, which is the most harmful symptoms
types of hormones are required to control its growth,
of post-menopausal women (7).
remodeling and maturation. It is being regularly
Destruction of collagen and other bone-related
manufactured, damaged, and recreated in a process
proteins in the osteoporosis process may mediated by
called bone reforming (1). There are two levels regulate
highly reactive hydroxyl radical (OH) (9) which in turn
this dynamic process. Systemic hormones, as
produced by reaction between O2 and H2O2 with
parathyroid hormones, sex steroid hormones,
tartrate-resistant acid-phosphatase. This chemical
calcitonin, growth hormone, and cortisol, at the first
compound presented highly in osteoclast of the bone
level (2). The balance between the activities of bone-
tissue (10).
forming osteoblasts and bone-resorbing osteoclasts, is
Alpha-lipoic acid (ALA) is an anti-oxidative
the other regulation level (3).
agent that can be made both by animals and plants.
Osteoporosis is a silent illness, defined as a
It can scavenge ROS, like the superoxide anion (O2) and
systemic skeletal disease manifested by decreased bone
hydrogen peroxide (H2O2), decreasing loss of bone
mass and micro tissue construction damage of bone
during osteoporosis (11).
tissue, with a resultant increase in bone fragility,

compromised bone strength and an increased risk of
fractures that are not due to substantial trauma (4).
Experimental animals:
Glucocorticoids (GCs) are extensively used to
Forty adult male albino rats aged 16-20 weeks and
treat various diseases as immunosuppressive diseases.
weighing 185-225 grams were used in this study. The
But, extreme or prolonged treatment with it, increase the
animals were housed in plastic cages with a metallic
liability of bone fractures and osteoporosis (OP).
mesh cover and dimension of 50×40×30 cm3. Each
Glucocorticoid-induced osteoporosis (GIOP) developed
cage contained five animals. The animals were fed an
in about 35-50% of patients treated with prolonged GC
ordinary laboratory diet, vegetables and bread with a
liberal supply of water. The used rats were divided into
GIOP is a secondary osteoporosis, it is different
four groups (each was formed of 10 rats): control group,
from the primary osteoporosis, which includes senile,
postmenopausal and juvenile osteoporosis (6).
glucocorticoid + ALA treated group, glucocorticoid +
Royal jelly (RJ) has been utilized globally as
royal jelly treated group.
marketable medicinal products, cosmetics and health
Ethical Consent:
foods. It is composed chemically of lipids, sugars,
All the experimental procedures were carried out
vitamins, and proteins (7). It implicates many active
according to the principles and guidelines of the
biological substances as antibacterial protein and 10-
Ethics committee of the Faculty of veterinary
hydroxy-2-decenoic acid (8). RJ can be useful for
medicine at Benha University, Benha- Egypt
osteoporosis, as it includes testosterone and has actions
conformed to the Guide for the care and use of
like other steroid hormones. Although RJ has been
Laboratory Animals, Published by US National
conventionally known to advance post-menopausal
Received: 28/4/2022
Accepted: 27/6/2022

Full Paper (vol.891 paper# 36)

c:\work\Jor\vol891_37 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4372- 4380

Dexmedetomidine plus Bupivacaine versus Bupivacaine Alone in
Pararectus and Intercostal Blocks in Abdominoplasty:
A Randomized Comparative Study
Sameh Ghareeb, Asmaa Askar, Mohamed A. Ghanem, Nabil A. Mageed
Department of Anesthesia and Surgical Critical Care, Mansoura University Hospitals, Mansoura, Egypt
Corresponding author: Sameh Ghareeb, Mobile: 01005589289, E-Mail: sameh926@yahoo.com

Dexmedetomidine is known for its efficacy as a local anesthetic adjuvant. Herein, we studied the beneficial
impact of adding dexmedetomidine to bupivacaine in combined intercostal and pararectus block in patients scheduled for
Patients and methods: This prospective research enrolled 66 patients allocated into two groups; Group I included 33
patients who received combined intercostal and pararectus blocks using bupivacaine plus dexmedetomidine, and Group II
included the remaining participants who received the same blocks using bupivacaine alone.
Results: All preoperative patient demographic and clinical criteria expressed no significant difference between the two
groups. Group I showed a significant decline in opioid requirements throughout the first postoperative day. The time to the
first analgesic request showed a significant delay in Group I (14.73 vs 7.39 hours in Group II). Pain scores showed a
significant decline in Group I during rest, cough, and movement, compared to Group II. O2 saturation, heart rate, and mean
arterial pressure showed no significant difference between the two studied groups. Adding dexmedetomidine was not
associated with a significant rise in the incidence of postoperative complications.
Conclusion: The addition of dexmedetomidine to the local anesthetic agent during intercostal and pararectal blocks is
associated with a better analgesic profile. It is associated with lower pain scores and lower morphine consumption without
increased associated side effects.
Keywords: Dexmedetomidine; Intercostal block; Pararectus block; Abdominoplasty.


As an example of abdominal wall blocks,

The "abdominal trunk" is a medical term used to
pararectus block or combined ilioinguinal iliohypogastric
describe the region located between the inferior breast
nerve blocks could provide analgesia for the lower
aspect and the start of the pelvis. The abdominoplasty is a
territory of the anterior abdominal wall. However, the
plastic procedure performed to stretch the abdominal wall
upper abdominal wall is not covered by this block.
muscles and decrease the amount of excess fat in the
Therefore, it could be combined with other regional block
previously described region [1]. With the rising trend of
procedures intercostal nerve blocks to provide analgesia
bariatric procedures in Egypt, which offers a durable
to the upper territory of the anterior abdominal wall [6].
mean for decreasing excess weight, the need for

Pain physicians also searched for other methods
abdominoplasty subsequently increased to remove the
to prolong the action of these blocks to enhance patient
redundant abdominal wall tissues following significant
recovery and satisfaction. Adding adjuvants to the local
weight loss [2].
anesthetic agents could prolong the period of sensory

Pain management after abdominoplasty is a
block [7]. Dexmedetomidine is an alpha-2 adrenergic
significant challenge for the surgeon, the anesthetist, and
receptor agonist proved to be an effective adjuvant to
the pain management physician. Proper pain control after
local anesthesia as its administration significantly
surgery is associated with better patient recovery, earlier
prolongs the sensory block in numerous regional and
mobilization and increased patient satisfaction.
peripheral nerve blocks [8]. Its action is mediated through
Nonetheless, excess administration of pain medications
multiple mechanisms, including local vasoconstriction,
like narcotics has its disadvantages, including nausea,
inhibition of pain transmission through myelinated C
pruritus, constipation, and respiratory depression [3].
fibres, and release of encephalin-like substances, in

Regional abdominal wall blocks could provide
addition to its local anesthetic action [9, 10].
sufficient analgesia for the majority of patients after such

After extensive literature research, no previous
procedures [3,4]. The administration of bupivacaine, a
studies have studied the analgesic efficacy of adding
long-acting local anesthetic agent, into the proper
dexmedetomidine to bupivacaine in combined intercostal
neurovascular plane blocks voltage-gated ion channels
and pararectus block in patients scheduled for elective
causing decreased pain transmission, which could
abdominoplasty surgery. That is why we conducted the
decrease the need for postoperative opioid analgesia [5].
current study. We hypothesized that adding this adjuvant
Received: 3/5/2022
Accepted: 4/7/2022

Full Paper (vol.891 paper# 37)

c:\work\Jor\vol891_38 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4381- 4385

Modified Endaural Incision, Wahba's Incision, in Cochlear Implantation Surgery
Yasser Ahmed Fouad1, Lobna Elfiky2, Mohamed Mobashir1, Ibrahim Saber1*
1Otorhinolaryngology Department, Faculty of Medicine, Zagazig University, Egypt
2Otorhinolaryngology Department, Faculty of Medicine, Ain-Shams University, Egypt
*Corresponding author: Ibrahim Mohamed Saber, Mobile: (+20) 01063661992, E-Mail: ibrahimsaber25@yahoo.com

Endaural incision was first described by Lempert, in 1938, for mastoidectomy surgery, it was described
in cochlear implantation (CI) surgery since the 1980s at Hannover and Melbourne. In our study we described a
modification of this incision.
Description and evaluation of the surgical outcomes of the modified endaural incision "Wahba's incision"
in cochlear implantation surgery and comparing it with the traditional post auricular incision.
Patients and method: Retrospective study of 95 cases of CI, all cases were implanted in one institute by the same
surgical team from 2010 to 2018 with minimum follow up period of 3 years. All cases were implanted by the Wahba's
Results: The average duration for CI using Whaba's incision was higher than postauricular incision. The rate of
postoperative hematoma ­ migration ­ extrusion ­ wound dehiscence after CI using Whaba's incision was less than
postauricular incision.
Conclusion: Modified endaural incision "Wahba's incision" is a safe and effective incision for CI that aims at reducing
the incidence of wound related complications of CI surgery.
Keywords: Wahba incision, Modified Endaural incision, Cochlear implantation.


periosteum, to cover the package away from skin
Endaural (EA) incision was first described by
Lempert, in 1938, for mastoidectomy surgery in cases
This principle necessity making the skin
of chronic middle ear diseases. He described an incision
incision at different site periosteal incision. Most
made of three parts that avoids cutting the cartilage of
surgeons use 2 separate flaps in cochlear implantation
the auricle to obviate the possible subsequent
by making the skin incision and periosteal incision at
development of perichondritis. The first incision,
different sites(7).
Lempert one, was described starting in superior
In our study we described a modification of the
posterior wall of external auditory canal (EAC) at the
incision by doing the transverse incision, Lempert one,
junction of the membranous and the osseous part of the
more laterally, at the medial edge of the conchal
EAC. The second incision, Lempert two, was described
cartilage lateral to the cartilaginous part of the external
starting from the beginning of the first incision, then it
auditory canal. Additionally, this modified incision
is carried outward adjacent to the tragus through the
involves creation of two separate flaps. The first inferior
based flap involves the auricle and post auricular skin
Endaural incision was described in cochlear
and subcutaneous (SC) tissue. The second anterior
implantation (CI) surgery since the 1980s at Hannover
based flap, Palva flap, involves the periosteum covering
and Melbourne(2-4). The described incision was similar
the mastoid part of the temporal bone. The idea of the
to the first and second Lempert incision, but the second
incision was taken from Professor Hassan Wahba
incision was extended posteriorly till finishing about 80
(1900-2018), thus we named it Wahba's incision.
mm behind the postaural sulcus(3), also the incision was

involving the skin, subcutaneous (SC) tissue, muscle,
Objectives of the study description and evaluation of
and periosteum simultaneously to create an single
the surgical outcomes of the modified endaural incision
inferiorly based flap that includes the auricle(3-5).
"Wahba's incision" in cochlear implantation surgery
It is better for preventing foreign body
and comparing it with the traditional post auricular
extrusion to make a separate flap of fascia, or

Received: 5/5/2022
Accepted: 6/7/2022

Full Paper (vol.891 paper# 38)

c:\work\Jor\vol891_39 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4386- 4392

Outcome of Primary versus Facilitated Percutaneous Coronary Intervention on Different
Times in Patients Presenting with ST Segment Elevation Myocardial Infarction
Mohammed Wafaie Aboleineen, Nader Talat Kandil, Ahmed Abdelzaher Farahat*, Alaa Elsayed Salama
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Abdelzaher Farahat, Mobile: (+20) 01158400094, E-mail: zazosty@hotmail.com

Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in patients with
ST segment elevation myocardial infarction (STEMI) within 12 h of symptom onset, provided it can be performed
expeditiously (i.e. 120 min from STEMI diagnosis, by an experienced team. An experienced team includes not only
interventional cardiologists but also skilled support staff.
Objective: This study aimed to assess the early and 6-month outcomes of ST-elevation myocardial infarction patients
according to the use of primary PCI and three different protocols of pharmaco-invasive reperfusion in the acute stage
based on timing of PCI after thrombolytic therapy.
Patients and Methods:
This prospective cohort study was conducted in Cardiology Department, Zagazig University
Hospitals and National Heart Institute. We included 104 consecutive patients with anterior STEMI, within a time period
of six months from January 2021 to June 2021.
Results: We found that group A patients had the lowest incidence of major adverse cardiac events (MACE) (death,
Maximal Killip class II, severe and life-threatening bleeding) and highest median EF, Group B patients had almost
similar MACE rates and 2nd high median LVEF, followed by group C with slightly impaired results, while Group D
patients had the highest MACE rates and lowest median LVEF.
Our study showed that pharmaco-invasive strategy with early PCI after fibrinolysis within 24 hours
constitutes a valid reperfusion strategy for patients presenting with ST elevation Myocardial infarction, where primary
PCI was not feasible, and that the best acute stage and 6 month outcome is achieved with performance of early coronary
angiography and intervention within 3-17 hours after fibrinolysis.
Keywords: ST segment elevation myocardial infarction, Primary PCI, Left ventricular ejection fraction.

many areas or countries, and fibrinolytic therapy is still
The most severe form of acute coronary
widely used. In the past 10 years, evidence has been
syndrome (ACS) after sudden cardiac death is ST-
brought that fibrinolytic treatment should not be used as
segment elevation myocardial infarction (STEMI).
stand-alone therapy, but rather as part of a pharmaco-
According to the NRMI-4 (Fourth National Registry of
invasive strategy, with the patients brought to PCI-
Myocardial Infarction), 29% of infarction patients
capable facilities after fibrinolysis, to perform semi-
experience a STEMI (1). Whereas a survey in Europe,
urgent coronary angiography and secondary PCI, when
the EHS-ACS-II (Second Euro Heart Survey on Acute
necessary (4).
Coronary Syndromes), reported that 47% of ACS
Fibrinolytic therapy given before an already
patients present with STEMI (2). The incidence and
planned PCI to mitigate the delay associated with
fatality rates of an acute STEMI are going down in
primary PCI does not improve outcome. Several more
Western countries as a result of better prevention and
recent studies, however, suggest that coronary
treatment. It is likely that STEMI will also become a
angiography and PCI performed between 3 and 24
major cause of death in developing countries due to the
hours after administration of the lytic, in case of
reduced mortality from infectious diseases and the
successful reperfusion, reduces the risk of new ischemic
adoption of a Western life style. STEMI is generally
events. As now mentioned in the guidelines, if
precipitated by rupture or erosion of an atherosclerotic
fibrinolysis is indicated, it needs to be followed by an
plaque triggering the formation of an occlusive
early coronary angiography. Because of the absence of
cross-linking of fibrin in the fresh occlusive clot, such a
myocardium, rapid restoration of coronary blood flow
strategy is especially effective in patients presenting
is critical. Thus, prompt induction of complete and
early after symptom onset (5).
sustained infarct related artery recanalization is
In the present study, we aimed to assess the early
paramount. Reperfusion therapy is one of the most
and 6-month outcomes of STEMI patients according to
successful therapies of modern medicine (3).
the use of primary PCI and three different protocols of
Primary percutaneous coronary intervention
pharmaco-invasive reperfusion in the acute stage based
(PCI) is the recommended default reperfusion strategy
on timing of PCI after thrombolytic therapy.
for patients seen in the first hours following the onset of

STEMI. From a practical standpoint, however, primary
PCI requires permanent availability of cardiologists,
This prospective cohort study was conducted in
nurses and technicians 24 hours a day and 7 days a
Cardiology Department, Zagazig University Hospitals
week, which may still be a goal difficult to achieve in
and National Heart Institute. We included 104
Received: 04/05/2022
Accepted: 05/07/2022

Full Paper (vol.891 paper# 39)

c:\work\Jor\vol891_40 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4393- 4401

Dysregulation of Tumor Necrosis Factor Alpha-Induced Protein 3 mRNA
Expression in Lupus Nephritis in Relation to Clinic-pathologic
Characteristics and Disease Activity of Systemic Lupus Erythematosus
Nearmeen M. Rashad*1, Walaa Samy2, Manar H. Soliman 3, Dalia Samir Fahmi4, Ahmed M. Salah1
Departments of 1Internal Medicine,2Medical Biochemistry, 3Medical Microbiology and Immunology, and
4Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Nearmeen M. Rashad, Mobile: (+20)1224248642, E-mail: nrashad78@yahoo.com

Lupus nephritis (LN) is one of the most dangerous manifestations of systemic lupus erythematosus (SLE).
LN is a complex interplay between genetics, immunological, and environmental factors.
Objective: Our study aimed to evaluate tumor necrosis factor -induced protein-3 (TNFAIP3) mRNA expression level
as a noninvasive predictive test of LN and to assess its correlations with clinic-pathologic characteristics as well as
disease activity of SLE.
Subjects and Methods:
Among 150 studied subjects; 80 had SLE and 70 were healthy controls. Patients were stratified
into LN group (n=35) and the non-LN group (n=45). TNFAIP3 mRNA expression level was measured using a
quantitative real-time PCR.
: TNFAIP3 mRNA expression level was upregulated in the SLE group compared to the control group. While
TNFAIP3 mRNA expression level was downregulated in the LN group of SLE patients compared to the non-LN group.
Our results show that the lowest values of TNFAIP3 mRNA expression level were in Class V compared to Class IV,
Class III, and Class II. According to the current study results, the effectiveness and strength of TNFAIP3 mRNA
expression level for differentiating SLE a from the control group we applied ROC curve, the sensitivities and
specificities were 96.8% and 83.3%, respectively. Regards discriminating LN among SLE the sensitivities and
specificities were 91.7% and 82.2%, respectively. Thus, TNFAIP3 mRNA expression level could be a useful diagnostic
test to discriminate between SLE patients in particular LN patients.
Conclusion: Non-LN group had statistically significant higher values of TNFAIP3 mRNA expression level compared
to LN and control groups. However, the values decreased with more damage to kidney tissues and progression of SLE
activity thus, TNFAIP3 mRNA expression level could be used as a genetic marker of LN susceptibility and severity.
: SLE; lupus nephritis; TNFAIP3; SLEDAI..

immunological, and environmental factors. Despite
As a matter of fact, systemic lupus
intense research efforts in the field, the exact
(SLE) is termed
etiopathogenesis of LN remains elusive. It may be
autoimmunological disease (1), and affects many organs
assumed that many crucial factors perform a significant
and tissue, for instance, the kidney. Several pieces of
role in the pathogenesis of LN. Renal biopsy is the gold
evidence have shown that SLE is characterized by the
standard for LN diagnosis as well as assessment of LN
formation of autoantibodies (2). Lupus nephritis (LN) is
activity and severity. Identification of noninvasive LN
a major variety of SLE (3). The prevalence of LN is about
predictors or diagnostic, markers are of importance for
~30­50% of patients with SLE present with renal
enhancing early diagnosis and proper treatment. Thus,
damage (4). Several pieces of evidence have shown that
we aimed to explore TNFAIP3 mRNA expression level
the clinical manifestations of LN include proteinuria,
as a noninvasive predictive test of LN and to assess its
hematuria, and pyuria (5).
correlations with clinic-pathologic characteristics as
Tumor necrosis factor -induced protein-3
well as disease activity of SLE.
(TNFAIP3) is a zinc finger and ubiquitin-editing protein

that regulate the inflammatory and immunological
reactions via the NF-B signaling cascade (6). Several
Our study enrolled 80 SLE patients who were
research has reported that TNFAIP3 inhibits both TNF
recruited from Internal Medicine Departments at
and NF-B (7). There is growing evidence that
Zagazig University Hospitals and 70 healthy control
dysregulated TNFAIP3 is correlated with many
subjects. The enrolled subjects were matched regarding
autoimmune diseases, for example, SLE (8). In this
age, sex, and race. We selected the SLE patients who
context, a study by Oeckinghaus and Ghosh(9) detected
met the criteria for SLE(11), LN(12), and disease activity
that dysregulated NF-B, and genetic polymorphism of
(13) and categorized them according to the flowchart of
TNFAIP3 was correlated with SLE risk(10).
the study as illustrated in figure 1.
A preponderance of evidence suggests that the
etiology of LN is a complex interplay between genetics,
Received: 05/05/2022
Accepted: 06/07/2022

Full Paper (vol.891 paper# 40)

c:\work\Jor\vol891_41 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4402- 4409

Risk for Workaholism among Working Physicians of Zagazig University Hospitals:
A Massage for Achieving Productive Work and Balanced Life
Samah S. Sheta*, Merhan A. Hammouda
Department of Community, Environmental and Occupational Medicine,
Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Samah S. Sheta, Mobile: (+20)01143500624, E-mail: shtasmah@gmail.com

Workaholics are characterized by an intense desire to work, even at the expense of other aspects of their
lives (such as their health, their personal relationships, and their leisure time). The term work-life imbalance is an
occupational stressor based on depleted resources of energy, time and feelings about work or personal life. By time,
researchers increasingly agree on making workaholism a subtype of work addiction. Concern that one's job would turn
one into a workaholic is common among physicians. Doctors need to take notice of this trend. The objective of our study
is to measure prevalence of workaholism and its risk among physicians of Zagazig University Hospitals, to prioritize
workaholism predisposing factors and to assess its implications on their lives and mental health.
Patients and Methods: A cross-sectional study was executed among working physicians of Zagazig University
Hospitals, where 262 physicians were recruited. Sociodemographic and occupational characteristics were recorded, in
addition to validated questionnaires for assessment of workaholic character among the participants through Work
Addiction Risk Test (WART) and part from Work Assessment Questionnaire (WAQ) inquiring about unpleasantness,
Psychological Capital Questionnaire (PCQ), Quality of Life (QoL) Questionnaire, and General Health Questionnaire
Results: About 14.5% of physicians are workaholics, 30.2% are at risk and 55.3% are non-workaholics. Most
workaholic physicians are suffering from unpleasantness, having lower quality of life and general health parameters and
significant decrease in psychological parameters.
: a significant association between workaholism and bad general health condition, poor mental health and
quality of life are common among physicians, which needs better handling of their work schedule and thinking about
their work attitude.
Workaholism, Prevalence, Risk factors, Work Addiction Risk Test, Work Assessment Questionaire,
Psychological Capital Questionnaire, Zagazig University.


potential to become major sources of stress that
Having a job is important for most individuals
permeate every aspect of an individual's existence. It's
because it offers us a sense of purpose and provides us
common knowledge that doctors tend to be workaholics
with a variety of benefits. Some people, for whatever
since they care so deeply about their careers.
reason (maybe both internal and external), appear
Workaholism, by its very definition, cannot be
compelled to work excessively and compulsively.
diagnosed solely by quantitative criteria, such as the
People like this are typically labelled as "workaholics."
amount of time spent working each week or how well
(1). Andreassen et al. (2) defined as "an excessive
they've adjusted to their workplace (1-3).
preoccupation with, and investment of time, energy, and
The core idea of workaholism is an inward
focus on one's job to the detriment of one's personal
obsession with one's work, which is linked to many
relationships, other activities, and health. Many
undesirable consequences (2, 5).
different things might set off or keep someone in a state
Talking about workaholism necessitates
of workaholism(3). Recently, there has been the greatest
bringing up "work ethic," which is defined as "a set of
consensus on the idea that workaholism is an addiction,
attitudes and beliefs that makes work a major value in
particularly among Sussman(4) as well as Andreassen
life and that hard work is a means to success. While the
et al. (5).
Japanese work ethic is well-known, the country's
Taris et al. (2008) identifies two primary
reputation for workaholism is not. Death from
factors that contribute to workaholism; First, there is the
overwork, known as Karoshi in Japan, is as common as
human element, which is exemplified by the action of
heart disease, starvation diets, and suicide there.
working hard, which might mean putting in extremely
Overwork-related deaths in Japan are common, with the
long hours. The second aspect is psychological and
National Defense Council for Victims of Karoshi
takes the form of a preoccupation with one's work, such
putting the annual burden at 10,000 (6).
as a failure to disengage and an excessive need to do
Lower levels of happiness in both one's personal
life and one's career have been linked to increased work
As a whole, the healthcare industry operates in
motivation (7). Furthermore, it has become clear that
environments that demand exceptional effort from
workaholism is associated with worse levels of
everyone involved. Work requirements have the
psychological well-being, happiness, and self-perceived
Received: 09/05/2022
Accepted: 08/07/2022

Full Paper (vol.891 paper# 41)

c:\work\Jor\vol891_42 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4410- 4415

Effect of Pulsed Ultrasound Therapy Compared with Low Level Laser Therapy on
Postpartum Sciatica: A Randomized Controlled Clinical Trail
Sara N. Sedek*1, Sohier M. El kosery2, Ahmed M. Darwish3, Elham S. Hassan2
1Department of Physiotherapy, 3Department of Obstetrics and
Gynecology, Police Academy New Cairo Hospital, Cairo, Egypt
2Departments of Physical Therapy for Woman's Health, Faculty of Physical Therapy, Cairo University , Giza, Egypt
*Corresponding Author: Sara N. Sedek, Mobile: (+20)01286630432, Email: soonaeem91@gmail.com

Postpartum Sciatica is one of the most often reported symptoms that lowers social and economic
efficiency and lowers quality of life.
Objective: Our objective is to evaluate the effects of ultrasound and low-level laser therapy on postpartum sciatica.
Patients and Methods: Sixty women suffering from postpartum sciatica between the ages 25 and 40 were randomly
allocated to one of two equal sets. For 12 weeks, Group (A) got pulsed ultrasound therapy for 20 minutes each session,
3 times/week for 12 weeks, in addition to flexibility exercise for abdominal and back muscles. While Group (B)
performed the same flexibility exercises as Group (A) but additionally got low level laser therapy for 2 minutes per
point 3 times per week for 12 weeks. Both groups (A and B) were assessed before and after the treatment therapy
program by evaluating hip ROM with a goniometer and pain intensity using a visual analogue scale.
Results: Our results showed that both Group (A) and Group (B) experienced significantly lower pain levels after therapy
compared to before treatment (P-value 0.0001) and significantly improved hip range of motion (P-value 0.0001). When
compared to Group B, Group A's hip ROM (P-value 0.001) and VAS score (P-value 0.001) significantly improved
following therapy. Conclusion: Pulsed ultrasound treatment is better than low level laser to treat postpartum sciatica,
with more reducing of pain intensity and enhancing hip range of motion.
Keywords: Postpartum sciatica, ultrasound therapy, low level laser therapy, visual analogue scale, goniometer.

in Schwann cells (8). Studies on the impact of physical
Sciatica is a common form of lumbosacral
therapy therapies on postnatal sciatica are few. In order
radiculopathy that is characterized by low back pain that
to assess the efficacy of low-level laser treatment and
radiates to the leg. It may also be accompanied with
ultrasound therapy for sciatica postnatal, this study was
sensory loss, motor weakness, and/or abnormal reflexes
(1). Sciatic nerve injury may be caused by an undetected,

long-lasting nerve entrapment carried on by an incorrect
lithotomy location beneath a sensory block (2). In
Study Design
addition to sensory complaints, limited forward lumbar
The investigation was planned as a randomized
spine flexion, unsteady gait, and unilateral paraspinal
controlled clinical trial. It was conducted between
muscle spasm, patients may also experience coughing,
September 2021 and February 2022.
which exacerbates their sciatic pain worse (3).
Before the study began, it was ethically approved
Due to the prevalence of postoperative sciatica,
by the Institutional Review Board of the Faculty of
statistics state that 50% of pregnant women will
Physical Therapy at Cairo University (No:
experience low back pain at some point throughout their
P.T.REC/012/00376). Every patient signed an informed
pregnancies or in the postpartum period (4). Prevalence
written consent for acceptance of participation in the
rates for pregnant women were 17%, 22.1%, and 24.6%,
study. The Declaration of Helsinki principles for the
respectively, in America, Australia, and Mediterranean
conduct of human research were followed in this study.
countries, according to studies (5).

Low intensity light therapy, also known as low
Study Participants
level light therapy or photobiomodulation (PBM),
Sixty postpartum women with postpartum sciatic pain
includes low level laser therapy (LLLT). The result is
were chosen from the Obstetrics and Gynaecology
photochemical rather than thermal. It activates
Outpatient Clinic at the Police Academy New Cairo
mitochondria, increases the potential of the
Hospital. Six months after giving birth, 60 sedentary,
mitochondrial membrane, and may thus be expected to
non-smoking, multiparas' mothers with two or more
augment rather than reduce the metabolism and transit
children to participate in the study. Every participant
of action potentials in neurons (6).
had postnatal sciatica according to visual analogue scale
It has been shown that pulsed ultrasound can be
(VAS), their ages varied from 25 to 40 and their BMI
used as a non-invasive physical stimulation for
30kg/m2. Those with severe fungal infections, acute
therapeutic purposes (7).
viral diseases, active TB, polyneuropathy, thyroid
In the case of sciatic nerve damage, it improves
issues, pregnancy, implanted cardiac rhythm devices, or
nerve regeneration. PUS may encourage the production
skin conditions that interfered with ultrasonography or
of the neurotrophins (NT-3) gene and cell proliferation
laser treatment were excluded from the study. To ensure
Received: 09/05/2022
Accepted: 08/07/2022

Full Paper (vol.891 paper# 42)

c:\work\Jor\vol891_43 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4416- 4422

Central Venous Pressure versus Internal Jugular Vein or Inferior Vena Cava
Collapsibility Indices to Predict Fluid Status in Critically Ill Patients
Ahmed Elasyed Elsayed Ibrahim*, Fatma Mahmoud Ahmed,
Farahat Ibrahim Ahmed, Doaa Mohamed Farid
Anesthesia and Surgical Intensive Care Department, Faculty of medicine,
Zagazig University, Zagazig, El Sharkia, Egypt
*Corresponding author: Ahmed Elasyed Elsayed Ibrahim, Mobile: (+20)01151699666, E-mail: Ahmedabozeed92@gmail.com

The assessment of the volume status in critically ill paediatric patients in intensive care units is vitally
important for fluid therapy management. The most commonly used parameter for detecting volume status is still central
venous pressure (CVP). However, in recent years, various kinds of methods and devices are being used for volume
assessment in intensive care units to minimize the many complications of invasive central venous catheter insertion.
Objective: This study aimed to use internal jugular vein (IJV) or inferior vena cava collapsibility indices (CI) by
ultrasonography as a first-line approach for the bedside non-invasive assessment of central venous pressure/fluid status
in critical ill intensive care unit patients.
Patients and Methods:
This study was carried out on 67 patients of both sex who were admitted to the Surgical
Intensive Care Units of Anesthesia Department, Faculty of Medicine, Zagazig University Hospitals during the period
from January 2021 to January 2022.
There were a statistical significance decrease in all CI among cases had CVP >10 mmHg compared to cases
had CVP 10. CI of IJV at 0 degree at cut off >21.4 had sensitivity 88.4%, specificity 79.2% and accuracy 85.1% in
prediction of CVP 10 while at 30 degree at cut off 20.7 had sensitivity 90.7%, specificity 83.3% and accuracy 88.1%
in prediction of CVP 10 mmHg. Finally, CI of IVC at cut off >31.75 had sensitivity 74.4%, specificity 70.8% and
accuracy 73.1% in prediction of CVP 10 mmHg among the studied cases.
Conclusions: Ultrasonographic measurement of venous parameters of IJV provides a useful non-invasive tool for
assessment of intravascular volume status in critically ill patients.
Keywords: Internal jugular vein, Inferior vena cava, Collapsibility index, Central venous pressure.


time-consuming, and labor-intensive. Additionally, it
A demanding and difficult responsibility for
has its own risks and difficulties and is not practicable
intensivists and emergency physicians is hemodynamic
in pre-hospital settings or in an urgent resuscitation
monitoring and quick evaluation of intravascular fluid
scenario (4). Due to the high compliance of central
status for the early, rapid, and successful resuscitation
venous veins, many non-invasive methods of CVP
of hypovolemia in critically sick ICU patients. In
assessment employing portable ultrasonography as an
patients with severe sepsis and septic shock, early goal-
alternative approach to invasive CVP monitoring have
directed treatment for achieving an ideal fluid state has
been proposed (3). The CVP was indirectly measured
been proven to lower morbidity and death (1).
using several IJV characteristics. In ordinary clinical
Cornerstones of treatment to stabilise hemodynamics in
practice, the height of jugular venous pulsation has been
critically unwell patients are fluid resuscitation and the
employed as an indirect measure of central venous and
introduction of vasoactive medications. Yet it might be
right atrial pressure, albeit with low sensitivity. Physical
difficult to select the best resuscitation technique. A
examination was only 50% accurate in assessing right
poor overinfusion might be harmful because, for
atrial pressure in 50% of individuals (5).
instance pulmonary edema can worsen the patient's
The inferior vena cava (IVC) collapsibility
health. However, in cases of volume depletion,
index (CI) has been examined as an indirect measure of
inotropic support and vasopressors will be ineffective
CVP to determine the volume status of critically sick
and cause ventricular arrhythmia. As a result, it is
patients, with diverse and contradictory results (5). The
critical to develop methodologies for assessing the
CI is computed by taking measurements during
patient's intravascular volume condition (2). Blood
inhalation and exhalation (the difference in IVC or IJV
pressure or heart rate are not accurate indicators of low
diameter during inhalation and exhalation divided by
volume status in the early stages of shock. In the early
IVC or IJV diameter during exhalation) (6).
stages of hemorrhagic shock, considerable blood loss is
In the present study, we aimed to use internal
still possible even in the absence of tachycardia or
jugular vein or inferior vena cava collapsibility indices
hypotension. Using only the clinical examination and
by ultrasonography as a first-line approach for the
vital signs might be dangerous and waste valuable time
bedside non-invasive assessment of central venous
during resuscitation (3).
pressure/fluid status in critically ill intensive care unit
The gold standard for measuring CVP involves
inserting a central venous catheter, which is invasive,

Received: 4/5/2022
Accepted: 5/7/2022

Full Paper (vol.891 paper# 43)

c:\work\Jor\vol891_44 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4423- 4429

Assessment of Circulatory Management in Pediatric Polytrauma According to
International Guidelines in Suez Canal University Hospital
Musab Ibrahim Mohamed Hussein*, Ahmed Elsayed Abouzeid,
Nashwa M. Abdelgeleel, Rasha Mahmoud Ahmed
Emergency Medicine Department, Faculty of Medicine, Suez Canal University, Egypt
*Corresponding author: Musab Ibrahim Mohamed Hussein, Mobile: (+20) 01010956397,
Email: Musab-albadrawy@hotmail.com

Among kids older than a year old, trauma is the primary cause of illness and death. Injuries to two or
more organ systems that could prove fatal or disabling are unfortunately not out of the ordinary in pediatric patients who
have sustained multiple severe injuries.
Objective: To improve the circulatory management in pediatric polytrauma by detection of pitfalls according to
international guidelines in Suez Canal University Hospital.
Patients and Methods: All children with polytrauma who were brought to the Emergency Department (ED) at Suez
Canal University Hospital were included in a cross-sectional study. Patients were evaluated and cared for with an
emphasis on circulatory management in accordance with Advanced Trauma Life Support (ATLS) standards. Next, the
patient's outcome was documented.
Results: Obstruction of the airway, breathing difficulties, bradycardia, and extended capillary refill were substantially
linked with the 9.5% death rate among pediatric polytrauma patients who presented to ED at Suez Canal University
Hospital. Survival of the studied patients was statistically significant associated with higher frequency of performing
chest X-ray (p < 0.001), pelvis X-ray (p < 0.012) and Focused Assessment with Sonography for Trauma (FAST) study
Conclusion: Adherence to the international guidelines in evaluation and management of pediatric polytrauma patients
is a cornerstone in improving outcomes and decreasing mortality.
Keywords: Pediatrics, Polytrauma, Circulatory management.


worldwide are due to falls. It is the severity of the
The worldwide burden of disease is mostly
traumatic brain injury that plays the most important role
attributable to injuries. Injuries to children account for a
in determining the outcome of up to 27% of pediatric
greater proportion of childhood deaths than all of the
patients with multiple traumatic injuries(7).
world's leading infectious diseases put together, making
Blood pressure in children can be maintained
this a critical issue in public health. In children older
even after a massive and sudden loss of blood, which is
than one year old, trauma is the leading cause of death
not the case for adults (from 25 to 30 percent). Cardio-
and illness(1).
respiratory failure can manifest itself subtly, therefore
It's not unusual for paediatric patients with
it's important to keep an eye out for subtle changes in
multiple severe injuries to present with damage to two
vital signs like heart rate, arterial pressure, and
or more organ systems, including those responsible for
peripheral perfusion(8).
breathing, circulation, and digestion(2).
Last but not least, youngsters have a hard time
The global rate of child fatalities due to
adjusting to new environments, which makes
automobile accidents is 10.7 per 100,000. In contrast,
determining their health even more challenging (9).
the rate is 7.4 per 100,000 people in South and Southeast
Children's systolic blood pressure may drop,
Asia and 19.9 per 100,000 people in Africa. Although
but only after a reduction in blood volume of up to 30
deaths from traffic accidents are less common in
percent. For doctors unfamiliar with the subtle
Europe, they still account for about 20% of all injury-
physiologic changes children in hypovolemic shock
related deaths among EU children(3).
exhibit, this could be deceptive. The only reliable
In 2004, 424 thousand persons of all ages died
indicators of hypovolemia and the need for prompt fluid
from falls around the world, according to the World
resuscitation are a rapid heart rate and a lack of
Health Organization (WHO) Global Burden of Disease
perfusion to the skin(10).
research. Although adults were more likely to die from
Up to our knowlage no such study was done to
a fall, children aged 5 to 9 had it as the eleventh greatest
assess the Circulatory Management of pediatric
cause of mortality(4).
polytrauma patients in our hospital.
Almost half of all child abuse fatalities in 2018

involved children younger than one year old, and
roughly 16 percent of abused children experienced more
To assess and treat pediatric patients who have
than one form of maltreatment(5,6).
been harmed by polytrauma and so to improving the
Between 25 and 52 percent of all pediatric
circulatory management by detection of pitfalls
injury evaluations in Emergency Departments (ED)
Received: 5/5/2022
Accepted: 6/7/2022

Full Paper (vol.891 paper# 44)

c:\work\Jor\vol891_45 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4430- 4433

Clinical Significance of Interleukin 18 in Chronic Liver Disease:
Review Article
Fady M. Wadea1, Ahmed Elsayed Elbadawy Abdou*2, Doaa M. Abd-El Monem3, Mahmoud A. Sharafeddin1
Departments of 1Internal Medicine and 3Clinical Pathology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
2Gastroenterology Department, Kafr El-shikh Liver Research Center, Ministry of Health, Kafr El-shikh, Egypt
*Corresponding author: Ahmed Elsayed Elbadawy Abdou,
Mobile: (+20) 0100 410 4083, E-Mail: dr.ahmadelbadawy@gmail.com

The end stage of chronic liver disease (CLD) is cirrhosis, which is characterised by progressive scarring
(fibrosis) of the liver due to chronic liver injury and subsequent loss of liver function. Early diagnosis and prevention of
complication of liver cirrhosis is challenging, so Interleukin-18 is one of the surrogate serum indicators being investigated
for noninvasive evaluation of liver fibrosis. The interferon-gamma inducing factor IL-18 plays a crucial role in the
development of chronic liver disease by promoting inflammation. However, its precise role is unclear due to a paucity of
Objective: Assessment of possible correlation between Interleukin 18 and liver cirrhosis.
Interleukin 18, hepatitis, and liver cirrhosis 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 May 2020 were 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: IL-18 plays a pathogenic role in liver cirrhosis as well as portal hypertension development and may
represent non-invasive marker for HCV related cirrhosis.
Keywords: Interleukin 18, Liver cirrhosis.

inflammatory diseases have been associated to IL-18
Cirrhosis of the liver is a form of advanced liver
dysregulation (3).
disease caused by chronic inflammation and injury that

results in the replacement of healthy liver tissue with
scar tissue (1).
The signal peptide required for cytokine release is
In poor and medium income nations, viral hepatitis
present in the vast majority of cytokines. While, the
is the primary cause of cirrhosis, while in the West,
other members of the IL-1 family all have signal
alcohol and non-alcoholic fatty liver disease are key
peptides, the IL18 gene does not. Much like IL-1, IL-
factors. Cirrhosis strikes more males than women.
18 is produced from a biologically inactive precursor.
Cirrhosis has a high economic cost due to human
An inactive 24-kilodalton precursor missing a signal
suffering, medical costs, and loosing expenses (2).
peptide and accumulating in the cytoplasm of cells,

whose 193-amino-acid sequence is encoded by the IL-
Introduction to Interleukin 18:
18 gene. Similar to IL-1, the 18kDa mature, The IL-18
Interleukin-18 (IL18) is a member of the IL-1
caspase 1 in the NLRP3 inflammasome converts the 30
family of pro-inflammatory cytokines. It is generated as
kDa IL-18 precursor into the physiologically active
an inactive precursor that must be processed by caspase-
version of IL-18.
1 before it can function. Many different kinds of cells,
Multiple mechanisms control the intracellular
both hematopoietic and non-hematopoietic, can release
production of the biologically active form of IL-18 and
IL-18 (3). Kupffer cells, which are resident macrophages
its subsequent release into the extracellular
in the liver, were the first to be identified as producing
environment, control of genes after their initial
IL-18. Different from hematopoietic cells, intestine
transcription and again after they've been translated are
epithelium cells, keratinocytes, and endothelial cells all
all examples of the type of gene regulation known as
express IL-18 at steady-state levels. Autoimmune and
post-transcriptional regulation (4).
Received: 8/5/2022
Accepted: 7/7/2022

Full Paper (vol.891 paper# 45)

c:\work\Jor\vol891_46 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4434- 4438

Minimally Invasive Osteosynthesis in Patients with Ipsilateral Fracture
Femur and Tibia (Floating Knee) Type 1 and Type 2 Injuries
Abdelsalam Eid Abdelsalam, Osam Mohamed Metwally,
Hashim Musbah Mihat*, Salah Mahmoud Abd El Kader
Orthopedic Department, Faculty of Medicine, Zagazeg University, Egypt
*Corresponding author: Hashim Musbah Mihat, Mobile: (+20) 1551837037, E-Mail: hashim1mehat@gmail.com

Floating knee is a flail knee joint resulting from fractures of the shafts or adjacent metaphyses of the
femur and ipsilateral tibia. Floating knee injuries may include a combination of diaphyseal, metaphyseal, and intra-
articular fractures. Objective: The purpose of this study was to evaluate the radiological and clinical outcome of
minimally invasive osteosynthesis in ipsilateral fracture of femur and Tibia (floating knee) type 1 and type 2 injuries.
Patients and Methods: This is one-arm clinical trial conducted at Orthopedic Surgery Department, Zagazig University
Hospital during the period from March 2021 to March 2022. This study included 18 patients with floating knee injury
treated by minimally invasive osteosynthesis.
: This study showed that 6 patients (33.3%) had complications, distributed as follow; 11.1% of patients suffered
from superficial skin infection, 11.1% of patients had knee stiffness, and 11.1% presented with delayed union. Of the
studied patients 5 (27.8%), 7(38.9%), 4(22.2%) and 2(11.1%) had excellent, good, fair, poor outcome according to
Karistrom score, respectively.
Conclusion: Minimally invasive osteosynthesis in ipsilateral fracture of femur and tibia achieves excellent clinical and
functional outcomes. Individualized planning of treatment which is dependent on the patient's general condition, type
of fracture, and severity of soft tissue injury by an experienced multidisciplinary team is needed, instead of a fixed
definite management for all patients.
Keywords: Minimally Invasive Osteosynthesis, Floating knee, Ipsilateral Fracture Femur.


unstable and require close monitoring and resuscitation
Ipsilateral fractures of the tibia and femur, also
during the initial post-injury period. Identifying
known as the floating knee, typically occur in the
ABCDE's. Therefore, advanced trauma life support
polytrauma patient. These fractures are high-energy
protocols should be followed rigorously and the patient
injuries and are often associated with other severe and
stabilized before orthopedic treatment can be
potentially life-threatening injuries (1).
considered (6).
The incidence of fractures resulting from motor
This study aimed to evaluate the radiological and
vehicle accidents is increasing. Consequently, high-
clinical outcome of minimally invasive osteosynthesis
velocity accidents are now more common. Such
in floating knee type 1 and type 2 injuries.
accidents produce violent and complex injuries. The

floating knee is a complex injury and is typically more
than a simple ipsilateral fracture of the tibia and femur
This one-arm clinical trial included 18 patients with
and may involve both extra-articular and intra-articular
floating knee injury coming to the Department of
fracture patterns (2).
Orthopedics at Zagazig University Hospitals; their ages
Fraser et al. (3) classified the floating knee into
ranged from 18-60.
three types). Type 1 includes extra-articular fractures of

the femur and tibia. Type 2 A refers to extra-articular
Inclusion criteria: All cases of floating knee (type 1
fractures of the femur and articular involvement of the
and type 2), all cases hemodynamic stable, and adult age
tibia. Type 2 B refers to articular fractures of the femur
and extra-articular involvement of the tibia. Type 2 C

includes articular fractures of both the femur and tibia.
Exclusion criteria: Pathological fractures other than
Ran et al modified Fraser's classification, reporting the
osteoporosis, hemodynamic unstable, extensive open
Type 3 floating knee, which includes injury to the
fracture (Type 3), and Infection.
extensor mechanism of the knee (4).

The management and prognosis of floating knee
Preoperative design:
depend on the systemic condition of the patient, fracture
Patients with floating knee are victims of
pattern, soft tissue and neurovascular injuries, and
polytrauma and the involvement of other organs is
associated injuries to other systems (5).
strongly suspected. The patients were observed closely
These injuries are often associated with other
for the development of a fat embolism (tachypnea,
life-threatening conditions, as well as other fractures
confusion, or tachycardia). If a fat embolism was
and varying degrees of the soft-tissue lesion. In
diagnosed, the patients were managed in the surgical
consequence, patients are usually hemodynamically
intensive care and surgical fixation of the fractures was
Received: 11/5/2022
Accepted: 18/7/2022

Full Paper (vol.891 paper# 46)

c:\work\Jor\vol891_47 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4439- 4443

Fenofibrate As an Adjuvant to Phototherapy in Term Neonates with
Hyperbilirubinemia; A Randomized Controlled Clinical Trial
Khaled Abouelenin Khafaga*, Lofty Mohamed Alsaid, Raafat Hassan Salama, Maged Taher Abougabal
Department of Paediatrics, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Khaled Abouelenin Khafaga, Mobile: (+20) 01061788891, E-Mail: drkhaledkhafaga@gmail.com

Neonatal jaundice results from accumulation of bilirubin as fetal hemoglobin is metabolized by the
immature liver. It may be physiological or pathological. Although most infants recover without major morbidity, yet
some might develop sever hyperbilirubinemia and acute bilirubin encephalopathy as result of high levels of serum
bilirubin. Fenofibrate is a member of the fibrates group. It is a safe and inexpensive orally administered fibric acid
derivative conventionally used to treat dyslipidemia. In contrast to clofibrate, studies investigating value of fenofibrate
in treatment of the conditions are scarce. The aim was to assess Fenofibrate as an adjuvant to phototherapy in Term
Neonates with Hyperbilirubinemia; a prospective randomized controlled trial.
Patients and Methods: The study recruited 74 patients randomly divided into 2 equal groups. Patients were assigned
to receive either phototherapy with single oral dose of fenofibrate suspension (10 mg/kg) on day 1 of phototherapy
(Group 1), or phototherapy alone (Group 2).
Results: The 2 studied groups were comparable regarding the basic clinical and laboratory data. The whole series
comprised 45 (60.8%) males and 29 (39.2%) females. Comparison between total serum bilirubin levels during treatment
and on discharge levels showed significant improvement of bilirubin levels in the two studied groups (P-value 0.0001).
Comparison between bilirubin levels in the 2 studied groups revealed significantly lower bilirubin levels in fenofibrate
treated group when compared with the control group starting at 36 hours after admission till discharge. Conclusion:
Fenofibrate as an adjuvant to phototherapy in neonates with hyperbilirubinemia is associated with significant reduction
of serum bilirubin levels.
Keywords: Oral Fenofibrate, Serum Bilirubin, Term Neonates, Hyperbilirubinemia.


longer routinely used for hyperlipidemia in adults due
Neonatal jaundice is a common disease in
to its adverse effect profile. Fenofibrate is now the most
neonates. Based on current statistics, 60% of term
widely used fibrate in treating hyperlipidemia and has a
neonates and 80% of preterm neonates suffer from
comparatively much better safety profile than clofibrate
jaundice during the first week of birth (1). Although the
disease usually has a good prognosis; but in cases where
Although fenofibrate is as the same as clofibrate
its intensity increases it can cause irreversible lesions of
in terms of the mechanism of action, it has fewer side
the central nervous system (Kernicterus) (2).
effects than clofibrate so it is much safer than clofibrate
There are several non-pharmacological and
in the pediatric group. However, no side effects of
fenofibrate have been observed by a single dose
hyperbilirubinemia. Phototherapy has emerged as the
administration in the neonatal period(6).
most widely used non-pharmacological therapy for the
The aim of the present study was to assess
treatment and prophylaxis of neonatal unconjugated
Fenofibrate as an adjuvant to phototherapy in term
hyperbilirubinemia, but it has several untoward
neonates with hyperbilirubinemia.
complications such as deleterious effect to eyes, high

temperature, loose stool and bronze baby syndrome (3).
There are little pharmacological agents for the
Study design and period: Randomized controlled
treatment of hyperbilirubinemia, including intravenous
clinical trial. The study was carried out from June 2020
to May 2021.
metalloporphyrin, phenobarbital, zinc sulfate and

colofibrate (4).
Setting: Neonatal intensive care unit (NICU) of
Fibrates have been used as a hypolipidemic drug
Zagazig University Children Hospital.
for several years; it also enhances the bilirubin
Patients: 74 newborns were selected to participate in
conjugation and excretion through induction of
this study, on the basis of the following criteria;
glucuronyl transferase activity. Most studies focused on

the effect of fibrates on hyperbilirubinemia have been
Inclusion criteria: Appropriate for gestational age full-
done with clofibrate (5). Clofibrate has been used for
term (37 to 41 weeks), TSB levels between 15 to
prophylaxis and treatment of hyperbilirubinemia in
21mg/kg and weight between 2500 to 3500 gm infants
neonates at a dose of 100 mg/kg (6).
with uncomplicated neonatal hyperbilirubinaemia who
Mohammadzadeh et al. (7) studied Clofibrate
are candidate for phototherapy according to American
effect on reducing serum bilirubin level of neonates
academy guidelines (9) were included in the study.
beyond the first week of life. Clofibrate, however, is no
Received: 11/5/2022
Accepted: 18/7/2022

Full Paper (vol.891 paper# 47)

c:\work\Jor\vol891_48 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4444- 4449
Flexible Nails versus Plate for Fixation of Fracture Shaft Femur in
Children from 5-12 Years
Ahmed Mohamed Hussien*, Mohamed Abd-Elwahab Ibrahim,
Reda Hussein El-kady, Ehab Mohamed Shehata
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed M. Hussien, Mobile: (+2) 01054798765, Email: ahmed7ussin90@gmail.com

Pediatric femoral shaft fractures are the most common fractures requiring hospitalization in children and
often require prolonged immobilization or surgery. Various techniques have been used to avoid complications in
children. This study aimed to evaluate the early clinical and functional outcome after surgical management of femoral
shaft fracture in children between 5 to 12 year either by plate or flexible nails.
Patients and methods: This study was carried on 24 patients; 12 patients managed by elastic stabile intramedullary
nailing (ESIN) and 12 patients managed by plate. All the patients were subjected to history and physical examination,
together with plain X-ray antro-posterior and lateral views of femur from hip to knee. Functional outcome was assessed
by using Flynn's TENS outcome score, applied to both the groups at the end of follow up.
Results: Mean age of study group was 9.17 (SD 2.12) ranged from 5 years to 12 years. About 62.5% of cases were
males and 37.5% were females. Fractures were 70.8% transverse, 25% oblique, and 4.2% spiral. The mean operation
time was 36.88 (SD 7.34) minutes and the mean clinical union was 11.58 (SD 2.28) weeks. Time to metal removal was
7.56 (SD 2.80) months. About 8.3% of patients had major complication, and 12.5% had mild complications. Three-
fourth of cases had excellent score. ESIN had better outcomes and fewer complications compared with plate.
Conclusion: ESIN is the implant of choice for femoral diaphyseal fractures in children aged from 5-12 years.
Keywords: Fracture Shaft Femur; Flexible Nails; Plate; Intramedullary Nailing, Children.

include a lower incidence of mal-union and stronger
Femoral diaphyseal fractures account for
axial and torsional stability in loading (5). In addition,
nearly 2 % of all bony injuries in children, and are the
plate osteosynthesis allows stable fixation with good
results in the pediatric population. Traditional plates
hospitalization (1). Males more commonly sustain femur
require extensive exposure with soft tissue disruption.
fractures, as they account for greater than 70% of
Minimally invasive plating and submuscular techniques
injuries. There is a bimodal age distribution of fractures,
have evolved to reduce soft tissue dissection (6).
first in early childhood, where falls are the predominant
Therefore, this study aimed to evaluate the
cause of injury, then again peaking in adolescence
early clinical and functional outcome after surgical
where motor vehicle collisions cause most of the
management of femoral shaft fracture in children
fractures (2).
between 5 to 12 year either by plate or flexible nails and
In the past, femoral fractures in all children
to analyze any possible complications.
were commonly treated with immediate spica casting or

a period of traction followed by casting (3). Non-surgical
treatment with spica casting remains the standard for
This is an interventional prospective comparative study
infants and toddlers less than 5 years; however, school-
in patients admitted at Department of Orthopedic and
age children are now more commonly undergoing
Traumatology Surgery of Zagazig University hospital.
surgical intervention. Surgical treatment has reduced
The study was carried out on 24 patients with age group
the burden of care for families, shortened hospital stays,
(5-12 years) and sex type (15 male - 9 female) the side
and decreased the early disability and disruption in the
affected was (13 left side - 11 right side).
families' lives (4). In skeletally immature children aged
The patients were randomly divided into two groups
older than five years, surgical fixation is the standard of
according to method of reduction and fixation: Group
care and is recommended by the American Academy of
(A) involved 12 patients: Fluoroscopic guided reduction
Orthopaedic Surgeons over nonoperative methods such
and fixation by Elastic Stabile Intramedullary Nailing
as spica casting and skeletal traction (4).
(ESIN) was done. Group (B) involved 12 patients: Open
The use of flexible nails (FNs), which enables
reduction and fixation by plate and screws were done.
rapid mobilization with few complications, is a well-

established method for treating length-stable fractures
Inclusion criteria: Patients with a closed or open
in children aged 5 to 12 years. Its advantages include
fracture (Gustilo type 1), age: 5 -12 years, and simple or
small incisions and relatively simple instrumentation (4).
comminuted fracture.
Plating techniques have been a popular

alternative to ESIN and were primarily indicated in
Exclusion criteria: Patients with an open fractures
oblique fracture, comminuted fractures, long oblique
(Gustilo type 2,3), accompanying fracture in the lower
fracture or patients overweight. The benefits of plates
limbs and pathological fractures or neurovascular
Received: 11/5/2022
Accepted: 18/7/2022

Full Paper (vol.891 paper# 48)

c:\work\Jor\vol891_49 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4450- 4456

Clinical Results of Primary Total Knee Arthroplasty in Morbid Obese Patients
Mohamed Ibrahim Salama, Mohamed Mahmoud Abdelazim*,
Mohamed El Sadek Attia, Ahmed Hashem Amin
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed M. Abdelazim, Mobile: (+20): 01023986760,
Email: mohamedmahmoudabdelazem@gmail.com

Obesity is one of the most serious health threats facing today's society that considering key risk factors
for osteoarthritis development. This increase in total knee arthroplasty (TKA) is due to its superior postoperative
Objective: This study aimed to reduce morbidity and improving outcomes of patients suffering from primary knee
osteoarthritis by using TKA.
Patients and methods: This study included 12 obese patients with advanced knee osteoarthritis at conducted in
Orthopedic Department, Zagazig University Hospitals. All patients had undergone TKA prosthesis that used in this
study was the NexGen Legacy posterior- stabilized (LPS)-Fixed Bearing Knee Systems with or without stem. All
patients were followed up post operatively for clinical evaluations.
Results: There are progressive improving of knee function, range of motion and whole patient lifestyle after TKA
noticed obvious after 6 months from surgery as the score values show that mean post-operative KSKS score (45.42 ±
6.64) was higher than mean pre-operative KSKS score (73.17 ± 12.9), with change improvement 61.1% (p-value
<0.001). The Also, mean post-operative KSFS score (51.5 ± 3.8) was higher than mean pre-operative KSFS score
(73.17 ± 12.90), with change improvement 41.3% (p-value <0.001).
Conclusion: TKA in morbid obese patients, regardless their age and other comorbidities had many advantages as a very
obvious pain improving. The functional improvement was very obvious with great impact on the whole lifestyle.
Keywords: Obesity, Total Knee Arthroplasty, KSFS score, KSKS score, Zagazig University.


A popular theory is that patients with high BMI
Obesity is emerging as rising epidemic and one
experience knee overload, which increases impact stress
of the greatest worldwide health risks to the modern-day
on the tibial component and increases component
population. In a previous report, the World Health
loosening while decreasing prosthesis short-term
Organization (WHO) stated that 500 million of the
survival (8). There are conflicting findings regarding the
world's population was obese (1). In USA and UK,
influence of obesity on post-operative complications
obesity affects nearly a third of the population in both
following TKA (9), as some studies have shown higher
countries. In 2015, Egypt had ranked firstly among the
revision rates and lower functional scores in obese
20 most populous countries, as it show the highest level
patients. On the other hand, other studies have reported
of age-standardized adult obesity (2). In order to
similar results regardless of BMI (10).
categorization and grading of obesity, WHO had
According to Gaillard et al. (11), obese patients
described it in three classes according to body mass
have inferior clinical outcomes and a higher risk of
index (BMI): class I (over weight) 30.0-34.9 kg/m2,
surgical complications, but obesity has no effect on the
class II (obese) 35.0- 39.9 kg/m2, and class III (morbid
mid-term survival of implants. A systemic review of 9
obese) 40.0 kg/m2 (3).
studies demonstrated good outcomes of TKA in
In addition to obesity being one of the major risk
situations of morbid obesity (12). The substantial
improvement in that review may be explained by the
epidemiologic research have shown a correlation
function of sedentary lifestyle in minimizing the
between increasing BMI and rising risk of numerous
increasing rate of prosthesis wear in morbidly obese
chronic illnesses (4). Since the primary TKA rate is
patients (13).
higher in obese patients than in individuals with normal
The procedure is likely to offer them a
BMI, the link between obesity and knee OA is clearly
significant improvement in functional outcome and
established in the literature (5).
quality of life, even though they should be encouraged
According to statistical research, the number of
to lose weight before having TKA. Despite the
obese patients who underwent TKA and had a BMI of
increased risk of failure and inferior functional outcome
40 or more (morbid obesity) has continuously climbed
of TKA in morbid obese patients, they should not be
(6). This rise in TKA is attributable to its favorable
refused for the procedure based on their BMI value
postoperative results when compared to those of many
alone (14). Therefore, this study aimed to reduce
other orthopedic procedures, which led to a significant
morbidity and improving outcomes of patients suffering
and sustained reduction in knee pain and disability as
from primary knee OA by using TKA.
well as an improvement in quality of life, especially in

patients who were resistant to conservative treatment (7).

Received: 11/5/2022
Accepted: 18/7/2022

Full Paper (vol.891 paper# 49)

c:\work\Jor\vol891_50 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4457- 4460

Evaluation of Some Pro-Inflammatory Cytokines Level in Sample of
Iraqi Patients with Hyperthyroidism
1Noor Taleb Akber* and 1Jabbar H. Yenzeel
Department of Biology, College of Science, University of Baghdad, Iraq
* Corresponding author: Noor Taleb Akber E-mail: tanoor593@gmail.com, mobile: +9647709945277


Background: Hyperthyroidism is a serious public concern, due the continuous increase in its prevalence and its impact on
the mortality rates. Autoimmune hyperthyroidism is seen as a thyroid gland problem. Pro-inflammatory cytokines are
crucial for the growth and development of hyperthyroidism, it was shown that the level of several pro-inflammatory
cytokines were higher in the hyperthyroidism patients.
Objective: This work was aimed to assessment the concentration of certain cytokine in hyperthyroid patients.
Materials and Methods: Sixty hyperthyroidism patients and 30 healthy individuals with age range from (30-65) years old
were enrolled in this study through their presence at the National Center for Diabetes Treatment and Research in Baghdad
through the period from December 2021 to April 2022.Blood samples were collected to evaluate the level of IL-6, IL-18
and TNF- using ELISA technique. Results: Results showed highly significant (P0.01) increasew in IL-6, IL-18, and
TNF- levels in comparison with the control groups. Thus, it can be believed that the pro-inflammatory cytokines can play
a role in the pathogenicity of hyperthyroidism. Conclusion: It can be concluded that the pro- inflammatory cytokines play
a major role in the pathogenicity of hyperthyroidism.
Keywords: IL-6, IL-18, Hyperthyroidism, TNF-, pro-inflammatory cytokines.


18 is a key immune response regulator that controls both
Hyperthyroidism is a clinical condition
innate and adaptive immune responses and is the cause of
characterized by excessive serum T4 and T3, or both, with
immunological-mediated diseases. It is likely one of the
suppression of TSH (1). It has multiple etiologies, (2, 3, 4).
elements involved in the pathophysiology of autoimmune
Typical signs of hyperthyroidism are weight loss despite
disorders (11). Cytokines are elevated in both autoimmune
increased appetite, tachycardia, restlessness, tremor,
and non-autoimmune hyperthyroidism, which may be
weakness and heat intolerance (5).
related to the long-term effects of an increase in thyroid
Small signaling proteins known as pro-
hormone (12).
inflammatory cytokines are up-regulated through
TNF- is a protein produced by body cells that plays
inflammation because there is essential for starting and
a significant role in triggering inflammation. TNF
fostering inflammatory responses to illnesses (6).
encourages inflammation, along with the fever and
Macrophages are primarily responsible for the production
symptoms (pain, soreness, and edema) that are related to
of most cytokines. The most notable pro-inflammatory
it, in a number of inflammatory conditions (13, 14). It has a
cytokines are Interleukins (IL-1, -6, -8, -12 and-18),
key role as an immunological and inflammatory mediator
interferons like IFN-, and tumor necrosis factors like
in the pathogenesis, growth, and progression of a number
TNF- (7).
of infectious, autoimmune, neoplastic, and other
Interleukin-6 is the most pro-inflammatory
disorders. TNF- play critical role in the onset of
cytokine, and is responsible for numerous physiological
autoimmune thyroid disease (AITD) as a powerful pro-
inflammatory cytokine. Patients with AITD and Graves'
differentiation, and survival, which are influenced by IL-
ophthalmopathy had thyrocytes and ocular tissues that
6. IL-6 has a variety of activities in the immunological,
contained both TNF- and TNF- mRNA (15).
endocrine, neurological, and hematological systems,

including inflammation, bone metabolism, and blood
pressure regulation (5).Therefore it is affecting the
function of B lymphocytes, stimulating the body to
hyperthyroidism after being diagnosed by the physician
produce autoantibodies and stimulates the incidence of
in addition to thirty healthy subjects with the same age
hyperthyroidism (8).
range (30 to 65) years old were included in the research
Interleukin-18 is a member of the IL-1 family, has
through their attendance to National Center for Diabetes
pleiotropic and powerful pro-inflammatory properties
Treatment and Research in Baghdad through the period
that are strictly regulated at the production and
from December 2021 to April 2022. The necessary
extracellular space levels (9). Interleukin-18 plays
information were taken from all subjects after taking their
essential role in response of T helper cell, by its ability to
permission depending on the letter of college of science
induce IFN- c production in T cells and NK- cells (10). IL-
Ethics Committee referenced by the number
Received: 11/5/2022
Accepted: 18/7/2022

Full Paper (vol.891 paper# 50)

c:\work\Jor\vol891_51 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4461- 4469
Iron Deficiency as a Risk Factor for Bronchial Asthma in
Late Childhood and Adolescence
Mohamed Shawky Elbahy*1, Tarek El-Desoky2, Ahmad Darwish3
Departments of 1Pediatrics, 2Pediatric Chest and Allergy Unit and 3Pediatric Hematology and
Oncology Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*Corresponding author: Mohamed Shawky Elbahy, Mobile: (+20) 01061689107, E-Mail: drmedo290@gmail.com


Background: Asthma is a major global public health issue worldwide. It's the most frequent chronic disease in children
and one of the primary causes of morbidity. Hemoglobin, myoglobin, and a number of enzymes all include iron, which
is an essential mineral.
Objective: It was to evaluate iron deficiency as a risk factor affected children with bronchial asthma in order to back up
the clinical findings at Mansoura University Children Hospital.
Patients and Methods: In this study, 50 asthmatic patients and 50 control participants, ranging in age from 6 to 18,
were matched. We investigated the effects of iron deficiency on children with bronchial asthma by analysing laboratory
results for the following tests and parameters; 1) Pulmonary function tests (FEV1, FVC, PEF, FEV1/FVC), 2) Complete
blood count (HB, MCV, MCH, MCHC, RBC, RDW, HCT), 3) Serum iron, 4) Serum ferritin level, 5) Total iron binding
capacity, and 6) Transferrin saturation.
Results: Both FEV1/FVC and FEV1/FVC percent had statistically significant relationships with RBCs. Among the
cases analysed, there was no statistically significant association between ferritin and pulmonary function tests or
between TIBC and pulmonary function tests. All lung function tests had no statistically significant link with transferrin
saturation (Tsat).
Conclusion: Iron deficiency anaemia may have a negative impact on spirometry in asthmatic children, resulting to an
increase in the severity of asthmatic attacks. Iron supplementation in infants may show to be a safe and successful
technique for reducing the incidence of asthma, but further research is needed to determine the causality.
Keywords: Forced expiratory volume, Total iron binding capacity, Global Initiative for Asthma.


blood, brain, and muscles functioning normally. If the
Asthma is a widespread chronic respiratory
anemia has not lasted long enough or been severe
illness that affects 1­18% of the population. Asthma
enough to cause the hemoglobin concentration to fall
symptoms include wheezing, shortness of breath, chest
below the threshold for the certain sex and age group,
tightness, and/or cough, as well as intermittent
iron deficiency can persist without anemia(4).
expiratory airflow limitation. Both symptoms and
Some reports made a spot on the link between
airflow restriction are known to change over time and
iron deficiency and allergic illnesses. Maazi et al.(5),
intensity. Exercise, allergy or irritant exposure, changes
cited that iron supplementation declines airway hyper
in weather, or viral respiratory infections are all known
reactivity as well as eosinophilia in a mouse model of
to trigger these changes(1).
allergic asthma, while Hale et al.(6) study showed that
Asthma is a chronic inflammatory disease of
diet rich with iron stepped inflammation severity down.
lung airways that causes recurrent airflow blockage.

Asthma is caused by a variety of etiological reasons
including hereditary and environmental variables.
They are to clearly understand the importance
Infection, allergen exposure, absence of controller
of the high prevalence of iron deficiency and atopic
drugs, black race and the winter season are all risk
morbidities and to know the effect of iron deficiency on
factors for asthma exacerbation(2).
asthma and wheezing in childhood. So, our specific
Symptoms and airflow restriction can go away
objective is to evaluate the effect of iron deficiency as a
on their own or in response to therapy, and they can
risk factor of bronchial asthma on children.
even remain away for weeks or months at a time. But,

experienced individuals can predict asthma flare-ups,
which can be life-threatening and put a huge burden on
Over the course of a year (November 2019-
patients and the community. Asthma is linked to airway
2020), we conducted a comparative study on 50
hyper-responsiveness and inflammation that present
asthmatic children aged 6 to <18 years who visited
even with absent symptoms or normal lung function but
Mansoura University Children Hospital's Pediatric
may disappear with therapy(1). Dietary issues have been
Outpatient Chest Clinics.
linked to the onset of asthma in both children and
The population putted in two groups; 50
asthmatic children represented as group A with further
Iron deficiency is a condition in which there
sub-grouped according to [Global Initiative for Asthma,
isn't enough iron in the body to keep tissues like the
2017 (GINA(1))] into; well-controlled, partially-
Received: 11/5/2022
Accepted: 18/7/2022

Full Paper (vol.891 paper# 51)

c:\work\Jor\vol891_52 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4470- 4477

Outcome After Arthroscopic Capsular Release for Refractory Idiopathic
Frozen Shoulder between Diabetic and Non-Diabetic Patients
Ahmed Mohamed El Deriny*, Abd -El-Rahman Ahmed El-Ganainy, Moheib Sayed Ahmed,
Osama Samir Garour
Department of Orthopaedic Surgery, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Mohamed El Deriny, Mobile:(+20)01016933658,
E-mail: Dr_ahmed_ed@yahoo.com, ORCID: 0000-0001-6699-7729

: This study evaluated the clinical outcome of the arthroscopic capsular release for refractory idiopathic
frozen shoulder between diabetic and non-diabetic patients.
Patients and Methods: Between August 2020 and April 2022 a prospective study investigated thirty shoulders in 30
patients who had refractory primary frozen and undergone arthroscopic arthrolysis. Assessment was fulfilled using the
Constant's shoulder score, Oxford shoulder score, visual analogue scale (VAS) for pain and measuring ranges of motion
(ROM) at preoperative, six months postoperatively and at the final follow-up.
Results: There were 17 females and 13 males with a mean age of 47.8 (SD 7.5) years. The right shoulder was affected
in ten patients and the other 20 had left frozen shoulder. Before surgery, the average time of frozen shoulder was 12.53
(SD 4.2) months. Diabetic patients constituted 56.6%, and mean follow-up was 12.33 (SD 2.9) months. Arthroscopy
revealed subacromial adhesions in 73.3% and partial rotator cuff tears in 23%. The Constant's score, Oxford shoulder
score, VAS for pain and ROM in all directions significantly increased at the final follow-up, compared to preoperative
levels. There were statistically significant differences between diabetic and non-diabetic patients regarding
postoperative flexion ROM, postoperative external rotation at 0° abduction, postoperative external rotation with
abduction and postoperative internal rotation where non-diabetics showed better ROM and significant improvement in
postoperative Constant shoulder score. The mean course of disease after surgery was 3.1 (SD 1.2) and complications
represented 6.6%.
Conclusions: Arthroscopic release for refractory idiopathic frozen shoulder is an effective procedure. Better results are
encountered in non-diabetic patients than diabetic counterparts.
Keywords: Arthroscopic, Release, Refractory, Frozen shoulder, Mansoura University.

resulting in contracture of the rotator interval capsule
Frozen shoulder is a painful condition in which
and ligaments (6). Based on pain and stiffness, frozen
the movement of the shoulder becomes restricted. It
shoulder can be broken up into three clinical stages:
influences the active and passive range of motion of the
initially is the freezing stage (gradual onset of shoulder
glenohumeral joint accompanied with debilitating pain.
pain with increasing loss of motion), the frozen stage
The prevalence rate of frozen shoulder is 2­5%, and it
(gradual decrease of pain, increasing stiffness with
affects females more commonly in their sixth decade
equal active and passive ROM), and finally the thawing
(1,2). The expression "frozen shoulder" was developed
stage (gradual improvement of motion and settlement of
by Codman in 1934. He described a gradual painful
symptoms) (7).
shoulder condition associated with stiffness and
Although it has a self-limited course, recovery
difficulty in sleeping on the affected shoulder. He also
usually happens after 6 to 12 months. However, many
found that marked reduction in shoulder forward flexion
patients can still report a prolonged period of shoulder
and external rotation are the indicators of this disease.
pain , stiffness and disability (8). Several conservative
In 1945, the term "adhesive capsulitis" was used to
measures (physical therapy, anti-inflammatory drugs,
describe frozen shoulder (3).
and steroid intaarticular injections) are usually enough
Even though its exact cause remains unclear,
for pain settlement (9, 10).
some factors escalate the risk of developing this
Shoulder manipulation under anesthesia (MUA)
disorder, including female gender, poorly controlled
(11), percutaneous hydrodilatation (12) and arthroscopic
diabetes mellitus (DM), hyperlipidemia state,
capsular release (ACR) (13) are indicated for refractory
prolonged thyroid dysfunction, genetic predisposition,
frozen shoulder when conservative measures fail.
and Caucasian race (4).
Although the long-term improvement in joint range of
Frozen shoulder is classified into either primary
motion is similar with such techniques, performing
(idiopathic) or secondary. Secondary frozen shoulder
(MUA) alone can lead to fractures especially with
can follow trauma, rotator cuff lesions, shoulder
osteoporotic patients (14). ACR holds multiple benefits
impingement syndromes, cardiovascular disorders and
as precise and selective release of contracted ligaments
hemiparesis (5). The cardinal pathology is marked
and capsule. On the other hand, radiofrequency
synovitis and extensive fibroblastic proliferation
utilization lessens postoperative hematoma, adhesions
and delays capsular healing. ACR also decreases the
Received: 12/5/2022
Accepted: 19/7/2022

Full Paper (vol.891 paper# 52)

c:\work\Jor\vol891_53 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4478- 4480

Role of Pulsed Dye Laser in Management of Keloids: Review Article
Alyaa Ebrahem Hassan Said*, Soheir Mohammed Ghoneimy, Ahmed Said Abdelshafy
Department of Dermatology, Venerology & Andrology, Zagazig University Hospital, Egypt
*Corresponding author: Alyaa Ebrahem Hassan Said, Mobile: (+20)010 9 322 4990, E-Mail: eldeebalyaa@gmail.com

Hyperproliferation of collagen in the dermis, caused by an aberrant healing response to injury, causes a
keloidal scar that extends beyond the original lesion and grows in a pseudotumor pattern, with tissue deformation and a
high recurrence rate following excision. The lasing medium of a pulsed dye laser (PDL) is an organic dye dissolved in a
solvent. This list includes some of the most often used laser dyes: rhodamine, fluorescein, coumarin, stilbene and
umbelliferone. Ethanol, Water, methanol, hexane, glycol and cyclodextrin, as well as cyclohexane are some of the
solvents that are employed. Fast discharge flashlamp or external laser with high energy output. The PDL is hypothesized
to improve keloids and hypertrophic scars by causing capillary breakdown, which leads to hypoxia and, in turn, changes
the production of local collagen.
Objective: This review article aimed to assess the possible efficacy of pulsed dye laser in managing keloids.
Pulsed dye, laser, and keloids 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 June 2008 to May 2021 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: One of the most promising laser treatments for younger hypertrophic scars and keloids has been the 585-
nm pulsed dye laser (PDL), which has shown positive outcomes in numerous trials.
Keywords: Pulsed dye laser, Keloids, Zagazig University Hospital.

Keloids can be treated with a pulsed dye laser:
Humans are the only species known to have keloids,
It is possible to employ LASERs or light
which are benign tumors of the skin. Patients with
amplification by stimulated emission of radiation, to
darker skin pigmentation are more likely to develop
treat a wide range of dermatological problems,
keloids than those with lighter skin pigmentation.
depending on the laser's wavelength, pulse
Contractures, discomfort, itching, paresthesia, and
characteristics, and fluence (energy output) as well as
psychological issues can all be side effects of excessive
the condition being treated (5).
or abnormal scar development (1).
Lasers come in a variety of shapes and sizes, and
To repair a wound, the body uses a complicated set
they are distinguished by the medium used to generate
of cellular and humoral activities to bring the damaged
the beam. Depending on the wavelength and
skin back into proper function. There are three stages of
penetration, each type of laser has a distinct spectrum
healing: inflammation, proliferation, and maturity,
of applications (5).
which can be interpreted in terms of the three classic

phases (2).
Pulsed dye laser:
There is a higher prevalence of keloids during
A dye laser emits light by irradiating a target
pregnancy and puberty, which has been linked to the
material with an organic dye and solvent. In the laser
hormone profile, but alternative causes, such as
dye arsenal are rhodamine, fluorescein and malachite
enhanced neo-angiogenesis during pregnancy, are also
green in addition to fluorescein and stilbene. These
likely. More research is required to confirm a link
include Ethanol (water), Water (methanol), Hexane,
between the formation of keloid scars and hormone
Glycol (cyclodextrin), and Cyclohexane. Fast
levels (3).
discharge flashlamp or external laser with high energy
Keloids don't stop growing, unlike hypertrophic
output (as an external laser, ruby laser, or ND: YAG
scars, which tend to stabilize or recede once they've
laser, or a quick discharge flashlamp) is required (6).
reached a particular size. To distinguish between
High-speed circulation of the dye solution helps
keloids and hypertrophic scars, there are strict clinical
to prevent triplet absorption and reduces dye
and histological criteria (3).
degradation. Fluorescent dye molecules are excited
Unexplained causes of keloids are more common
and ready to generate stimulated radiation when light
on the chest and shoulders than on the upper back,
from an external source strikes them. Pulsed dye lasers
neck, or ear lobes. The site of vaccination was the site
emit pulses of visible light with pulse durations
of a large keloid weighing 1.8 kg in one example.
ranging from 0.45­40 ms at a wavelength of 585 or
Keloids have been debated extensively as to whether
595 nm. Radiofrequency can be used in conjunction
they are more likely to form in places of high tension
with pulsed dye laser treatment to improve results and
minimize side effects by allowing lower PDL dosages

Received: 15/5/2022
Accepted: 20/7/2022

Full Paper (vol.891 paper# 53)

c:\work\Jor\vol891_54 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4481- 4483

Use of Dapoxetine in Premature Ejaculation Management: Review Article

Ibrahim M Ibrahim, Mohammed Abdalghani Almaqtouf*,
Mostafa Kamel Ahmed, Mohammed Mostafa Ahmed
Department of Urology, Faculty of Medicine - Zagazig University, Egypt
*Corresponding author: Mohammed Abdalghani Almaqtouf, Mobile: (+20) 01096509879, E-Mail:

Premature ejaculation (PE) isn't life-threatening, but it has a negative influence on the lives of both the
patient and their partners. Varied researches have employed different definitions of PE, which include, for example, the
number of intra-vaginal thrusts and the duration of male voluntary control. Dapoxetine is a selective serotonin reuptake
inhibitor (SSRI) medication, one of many commonly prescribed for depressive symptoms. Cognitive behavioral therapy
(CBT) has been widely utilised to treat PE prior to the availability of dapoxetine. Other than dapoxetine, other Off-
label usage of SSRIs in the treatment of PE has increased in recent years.
Objective: Assessment of possible role of dapoxetine in premature ejaculation management.
Dapoxetine, serotonin reuptake inhibitors, and premature ejaculation 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 studies from February 2001 to May 2021 were 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: Clinical evidence demonstrated that treatment for people with long-term or acquired PE, dapoxetine is
highly effective as well as safe, and the unique properties of dapoxetine make it an appropriate choice for on-demand
Keywords: Dapoxetine, Serotonin reuptake inhibitors, Premature ejaculation.

PE, at least three 5-HT receptor subtypes (5-HT1a, 5-
Patients and their partners are affected by PE in a
HT1b, and 5-HT2c) have been identified(3).
substantial way, even though it is not life-threatening.

PE has been defined in several ways by various
The current treatment options:
researchers, including the length of ejaculatory latency,
Sex therapy and cognitive therapy have both been
the sum of intra-vaginal thrusts, and the degree of male
utilised traditionally to treat PE because of the
voluntary control (1).
disorder's stigma as a mental health issue. It is hoped
Althof et al. (2) reported that ejaculation, which is
that this type of treatment may help patients with PE
always or nearly always occurring before or within one
gain more self-confidence and intimacy with their
minute of vaginal penetration, in men with erectile
partners, therefore increasing their performance and
dysfunction, was classified as "premature ejaculation"
lowering the stress associated with sexual encounters.
as well as term for vaginal penetrations and the inability
Squeezing the penis glans or intermittent penetration
to delay ejaculation with unfavourable personal
are two other behavioural ways for reducing the need
repercussions like distress or trouble or dissatisfaction
to ejaculate urgency, albeit the latter may lead to longer
and/or the avoidance of sexual relations (3).
periods of sexual frustration rather than more
Some researchers predict that as many as seventy
penetrative duration (2).
percent of all men will develop PE at some point in their

lives. Based on the results of a recent study, it was
Selective serotonin reuptake inhibitors (SSRIs):
reported that 20 to 30% of men have the condition. Most
Depression is routinely treated with SSRIs.
people in the age range of 18 to 59 never bring up the
Clomipramine, a tricyclic antidepressant, was found to
matter with their doctors. The Global Study on Sexual
extend ejaculatory latency in rats by inhibiting
Attitudes and Behaviors polled over 13,000 men aged
serotonin reuptake in the central nervous system. In
40 to 80 from 19 countries (4).
contrast, SSRI medicine only mildly activates 5-HT1C
PE has been linked to a variety of issues,
receptors after a few hours, therefore on-demand SSRI
including those involving the mind, body, hormones,
treatment is expected to have only a small ejaculation-
and brain. A number of neurotransmitters are involved
postponing effect because of this (5).
in neuronal control of ejaculation at the supraspinal
Even yet, SSRIs have been employed in
level, the most studied of which is serotonin (5-
numerous trials, and Waldinger et al. (6) were the first
hydroxytryptamine, 5-HT). In the pathophysiology of
to do methodological assessments of these studies in
Received: 15/05/2022
Accepted: 20/07/2022

Full Paper (vol.891 paper# 54)

c:\work\Jor\vol891_55 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4484- 4487

High Fibular Osteotomy in Management of Medial Compartment
Osteoarthritis of the Knee
Omar Abd Elwahab Kelany, Emad Elsayed Abd El Hady,
Mohammed Mostafa Samra*, Mohsen Fawzy Omar
Department of Orthopedic, Faculty of Medicine, Zagazeg University, Egypt
*Corresponding author: Mohammed Mostafa Abdel Mohsen Mostafa Samra,
Mobile: (+20) 01000246880, E-Mail: mohamedsamra002@gmail.com

Osteoarthritis of the knee is a prevalent form of joint disease that can result in debilitating pain and limited
movement. Objectives: This study aimed to know the better management of medial compartment osteoarthritis with
varus deformity. Patients and Methods: This clinical trial was conducted at Orthopedic Surgery Department, Zagazig
University through the period from January 2019 to June 2022. Twenty-four cases of medial compartment knee
osteoarthritis were included in this study, all of which had proximal fibular osteotomy (PFO). The mean age of the
included cases was 56.6 years.
In this study, American Knee Society (AKS) scores showed a significant increase (p < 0.001) from 41.6 ± 5.4
preoperatively up to 80.6 ± 2.6 at 12th month postoperatively. There was significant decrease in visual analogue scale
from 8.4 ± 1.6 pre-operation to 1.5 ± 0.8 at 12th month post-operation.
Conclusion: Patients with medial compartment knee osteoarthritis often find relief from their symptoms and an increase
in their quality of life following a proximal fibular osteotomy.
Keywords: Osteoarthritis, Proximal fibular osteotomy, High fibular, Medial compartment.


Inclusion criteria: Patients with moderate to severe
High tibial osteotomy (HTO) can be substituted
knee symptoms, radiographic KL grade 3 or 4 according
with a proximal fibular osteotomy (PFO) (1). To correct
to Kellegran and Lawrence (8), age 20 years or older,
medial compartment osteoarthritis, a surgical treatment
isolated medial compartment arthritis, at least 2 mm
is performed. PFO is preferable to HTO in several ways
medial joint space on weight-bearing X-rays, body mass
(2). Primarily, the surgical method is easy to understand
index (BMI) less than 32, and varus less than 20 are
and implement. For another, it requires no internal
candidates for knee arthroscopic surgery.
fixation and only a small incision. The time needed to

get back to normal following surgery is less than it
Exclusion criteria: Patients under the age of 20 years,
would be with HTO. Additionally, HTO complications
those with varus greater than 20 degrees, bi- or
might be a significant problem, further diminishing
tricompartmental arthritis, severe obesity with bone-on-
prognosis (3).In contrast, PFO rarely causes any adverse
bone showing on weight-bearing X-rays, rheumatoid
outcomes (4). Similar to HTO, PFO can correct the lower
arthritis, post-traumatic arthritis, congenital deformities
extremity and alleviate KOA symptoms. Fibular
of the lower limb, joint infection, and a history of
osteotomy is based on the premise of non-uniform
ligament or meniscus injury. All admitted patients were
settlement, even though the primary purpose of HTO is
assessed in terms of their clinical condition, radiological
to rectify alignment (6). Owing to osteoporosis, the tibial
findings, and functional status.
plateau appears to have sunk dramatically. Plateau

settlement is uneven due to the fibula's supporting role,
with the medial plateau settling more noticeably than
Gender, age, duration of symptoms, and severity
the lateral plateau. When this happens, the medial
grades were all included in the clinical data collected.
plateau becomes much flatter than the lateral plateau
The latter contained a VAS and a Knee Society scores,
and the foot becomes varus deformed. The primary
radiographic evaluation (plain x-ray both knee AP view
pathological alterations in KOA are cartilage and
standing position, lat. View, skyline view, Ap in 45o, CT
meniscus degradation, which are brought on by a shift
if needed and MRI if needed).
in the mechanical axis of the joint (6, 7). This study aimed
Surgical technique:
to get insight into the optimal treatment for varus
Patients were supine on a standard radiolucent
deformity and medial compartment osteoarthritis.
orthopaedic table while under spinal anesthesia. The

tourniquet on the lower limb was inflated. The fibular
head was located to prevent damage to the common
Our study comprised 24 patients hospitalized to
peroneal nerve. The patient's fibula was cut open about
Zagazig University with primary medial compartment
3­5 cm laterally at its top. The fibula was exposed when
knee osteoarthritis and indication for PFO between
the fascia was cut along the septum between the
January 2019 and June 2022.
peroneus and soleus muscles. The fibula was sawed off

around 6-10 cm below the head. After the incisions were
Received: 16/5/2022
Accepted: 21/7/2022

Full Paper (vol.891 paper# 55)

c:\work\Jor\vol891_56 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4488- 4494

The Effect of Use of A Modified Type of Partogram on Cesarean
Section Rates: A Randomized Controlled Clinical Trial
Mohammed Fawzi Abo Elkheir, Rafik Ibrahim Barakat,
Mohammed Alsayed Abdelhafez, Kholoud Almosad Gomaa Aldakdousy*
Department of Obstetrics and Gynecology, Faculty of Medicine - Mansoura University, Egypt
*Corresponding author: Kholoud Almosad Gomaa, Mobile: (+20) 01092421182, E-Mail: kholoudalmosad@gmail.com

The partograph is an inexpensive tool designed to provide a continuous pictorial overview of labor and
has been shown to improve outcomes when used to monitor and manage labor. It is a single sheet of paper which
includes information about the fetus' heart rate, uterine contraction, any drugs used and other important factors that
could help avoid extensive descriptive notes. The objective of the current study is to detect the value of use of modified
type of partogram and comparing it with the classical type of partogram in reducing unindicated cesarean section rate,
and to detect obstructed labor early to make earlier decision in management of labor.
Patients and methods: This randomized controlled clinical trial was carried out by simple random sampling using
sealed envelopes technique. Partograms were conducted on 140 females with cervical dilatation less than 6 cm, single
tone pregnancies, gestation of at least 37 completed weeks, cephalic presentation, and no reported use of oxytocin in the
first stage of labor. Thereafter, they were divided into two groups according to the type of partogram used during labor
monitoring as the following: Classic partogram with one hour two lines, and WHO 2007 modified type of partogram.
Results: Cesarean section rate is lower among group with modified type of partogram than classical one (2.9% versus
12.9%). Mean time of start active phase of labor was earlier and shorter time from entrance in the hospital till labor
among group with classical than group with modified partogram.
Conclusion: Modified partogram lowered the incidence of cesarean section rate, compared with classical partogram.
Also, mean time of start active phase of labor and duration from admission to delivery were shorter with modified
partogram compared with classic partogram. Monitoring and audit of the partogram in practice, including completion,
decision making and referral and outcomes, is recommended.
Keywords: Partogram, Modified Partogram, Cesarean Section, Pregnancy, Labor, Morbidity.

to record labor events repeatedly. It helps to predict
The caesarean section (CS) rates have dramatically
deviation from normal progress of labor and supports
increased all over the world. However, there is no clear
timely and proven intervention. It also helps to facilitate
evidence of a simultaneous decrease in maternal or
responsibility to the person conducting labor (8).
perinatal morbidity or mortality (1, 2). The process of
The aim of this study was to detect the value of use
labor is associated with both maternal and fetal potential
of modified type of partogram and comparing it with the
risks, regardless of the mode of delivery (3).
classical type of partogram in reducing unindicated
There are various CS indications that aim to reduce
cesarean section rate, and to detect obstructed labor
the maternal/fetal risks (4). The economic aspect of labor
early to make earlier decision in management of labor.
is also of importance as an intrapartum cesarean section

is significantly higher coast compared to a spontaneous
vaginal delivery (5). The use of the partogram reduces
This randomized controlled clinical trial was
the risk of prolonged labor, un indicated cesarean
carried out on women who were attended Emergency
sections, and perinatal mortality (6,7).
Unit at Obstetric Gynecology Department, Mansoura
Partograph is a visual/graphical representation of
University Hospital. The study was conducted from
related values or events over the course of labor. It is an
September 2019 to September 2020.
important tool for managing labor. The first graphic

assessment of progress of labor was designed by
Inclusion criteria: Patients were early in labor,
Friedman in 1954, and further improved by Philpot and
singleton pregnancies, gestation of at least 37
Castle (8).
completed weeks, cephalic presentation, and no use of
The partograph is an inexpensive tool designed to
oxytocin in the first stage of labor.
provide a continuous pictorial overview of labor and has

been shown to improve outcomes when used to monitor
Exclusion criteria: Non-cephalic presentation,
and manage labor. It is a single sheet of paper which
multifetal pregnancies, any medical disorder with the
includes information about the fetus' heart rate, uterine
patient (Hypertension, pulmonary embolism, DM),
contraction, any drugs used and other important factors
antepartum hemorrhage, post term pregnancies, any
that could help to avoid extensive descriptive notes (8).
complicated labor, presence of rupture of membrane,
It is a practical device to be employed in a busy
evidence of ill fetal state, and women received epidural
labor room with many cases, but limited personnel to
screen for abnormal labor. With its use, there is no need
Sample size: Sample size calculation was based on
Received: 15/5/2022
Accepted: 20/7/2022

Full Paper (vol.891 paper# 56)

c:\work\Jor\vol891_57 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4495- 4499

The Outcome of Daily Low Dose of Tadalafil in Diabetic Men with
Erectile Dysfunction
Mohammad Sayed Abdel-Kader, Atef Fathy Ali, Mostafa Mahmoud Rashed Ali*, Gamal A. Alsagheer
Department of Urology, Qena Faculty of Medicine, South Valley University, Egypt
*Corresponding author: Mostafa Mahmoud Rashed Ali, Mobile: (+20) 01065449093,
E-Mail: mostafarashed2222@gmail.com

Background: Men with diabetes mellitus frequently experience erectile dysfunction (ED).
Objective: The purpose of this study is to determine whether or not 5 mg of tadalafil daily is effective in treating
erectile dysfunction in men who are diabetic.
Patients and methods: In this trial, 50 diabetic males with ED were given 5 mg of tadalafil once daily for 12 weeks.
Using the International Index of Erectile Function (IIEF) and penis-specific Color Duplex Doppler Ultrasonography,
researchers evaluated tadalafil's effects on erection quality and duration.
Results: Age of 45 was the median, and the average body mass index was 30.3 kg/m², 54 % of them were smokers.
We found statistical significant (p-value < 0.001) increased 12 weeks IIEF score (median = 18.5, IQR = 13 ­ 22)
when compared baseline IIEF score (median = 12.4, IQR = 10 ­ 17). Our results showed statistical significant (p-
value < 0.001) increased 12 weeks PSV (median = 36, IQR = 35 ­ 37) when compared with baseline PSV (median
= 33, IQR = 30 ­ 35). Using multivariate logistic regression analysis, we demonstrated that smoking, BMI,
dyslipidemia and bad glycemic control were predictive factors for ED severity.
Conclusion: Taking 5 milligrams of tadalafil once a day may help diabetic men's erectile dysfunction.
Keywords: Treatment outcome, Tadalafil, Erectile dysfunction.

endothelial dysfunction characterised by decreased
The International Consultation on Sexual
nitric oxide (NO). Reflexogenic erection centre
Medicine defines erectile dysfunction as the chronic
dysfunctions due to microvascular problems causing
and recurrent inability to get or keep an erection of
ischemia in autonomic and peripheral neurons (4).
adequate stiffness and duration to engage in acceptable
Anti-phosphodiesterase 5 (PDE5) inhibitors
sexual intercourse. Although ED is quite common,
have dominated the treatment of erectile dysfunction
nothing was known about it until the 1970s. The
(ED) in recent years: like vardenafil hydrochloride,
etiology of ED and our understanding of penile
tadalafil, as well as sildenafil citrate (sildenafil). The
physiology have both come a long way since then,
PDE5 inhibitor tadalafil has a significantly longer
thanks to advancements in molecular biology
mean elimination half-life of 17.5 hours compared to
techniques (1).
the about 4-5 hours required by sildenafil and
The physiological reaction in the penile
vardenafil. These effective and well tolerated oral
vasculature is triggered by a complex interplay of
medicines are given on demand, just before desired
psychological, neurological, and vascular pathways. In
sexual activity (5). But the effectiveness is diminished
men, nitric oxide is secreted by the penile cavernosal
in diabetic men with ED, perhaps because of
tissue in response to parasympathetic transmission
underlying endothelial dysfunction and reduced
from the pudendal and pelvic splanchnic nerve
endothelium-derived factors in penile arteries. This
plexuses (NO). Cavernosal smooth muscle is relaxed
may help explain why men with diabetes have a harder
by nitric oxide via a reduction in intracellular calcium
time treating their ED (6).
that is mediated by cyclic guanosine monophosphate
The study's objective was to assess the efficacy
(2). When the cavernosal sinusoids are filled, the veins
of a daily low dose of tadalafil in treating erectile
in the penis are compressed against the tunica
dysfunction in men with diabetes.
albuginea, preventing blood from leaving the penis and

allowing the erection to last. Phosphodiesterase type 5
inhibits the short-lived rise in cyclic guanosine
Fifty individuals who had been diagnosed with
monophosphate (3).
ED for at least 3 months were included in this
Erectile dysfunction affects between 35% and
prospective case series study.
75% of guys with diabetes. Erectile dysfunction is far
Setting: Outpatient Clinic of Urology Department,
more common in men with diabetes than in men
Qena University Hospital.
without the disease. Sexual dysfunction is thought to

be exacerbated by diabetes-related microvascular and
Inclusion criteria: A history of erectile dysfunction
macrovascular problems due to hyperglycemia. The
(ED) lasting at least three months in a heterosexual
decrease in blood flow to the penis is caused by
relationship with the same partner, age 18 or older, and
atherosclerosis in the arterial vessels, which is in turn
type II diabetes.
caused by macrovascular complications and
Received: 8/5/2022
Accepted: 7/7/2022

Full Paper (vol.891 paper# 57)

c:\work\Jor\vol891_58 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4500- 4506

Effect of Multiple Repeat Cesarean Sections on Intra-Abdominal Adhesions
Ihab Mohamed El-Nashar, Ahmed Mohamed Abbas, Christine Girges Zaki*
Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Egypt
*Corresponding author: Christine Girges Zaki, Mobile: (+20) 01288648066, E-Mail: doc.obs.christine@gmail.com

Cesarean section (CS) births have substantially grown during the past several decades all across the
world. Multiple caesarean sections are linked to a higher risk of placenta previa, abdominal adhesions, ureteric,
bladder, and bowel injuries, as well as uterine rupture and dehiscence. When previous procedures cause inflammation
and damage normal tissue, fibrous, band-like formations called abdominal and pelvic adhesions develop between
the abdominal organs. The current study aims to compare the rate of adhesions based on number of CSs. Patients
and methods:
A total of 160 patients were recruited and divided into two groups: women with 3CS (100 patients)
and women with 4 CS (60 patients). In the first group, 15 women had dense adhesions, 43 had filmy adhesions and
42 had no adhesions, and in the second group 42 women had dense adhesions, 15 women had filmy adhesions and
only 3 had no adhesions.
Results: Operative data of both groups had important differences where women with 4 CS had significantly higher
Nair's score and modified Nair's score compared with women with 3CS. Frequency of bladder injury was
significantly lower among women with 3CS. Women with 4 CS had significantly higher amount of suction and
longer duration of operation.
Conclusion: Multiple cesarean sections are associated with increased risk of intra-abdominal adhesions, bladder
injury and longer operation time. Post-operative complications included wound infections and need for blood
Keywords: Cesarean Sections, Intra-Abdominal Adhesions, Wound infections, Blood transfusions, Nair's score.

There are few studies that describe the rates of
Cesarean section (CS) births have substantially
maternal and foetal complications in women who have
grown in frequency during the past few decades (1). In
had four or more CSs in the literature (8, 9).
the USA, the caesarean birth rate was 4.5% in 1965
The aim of the current study was: (1) To
but, according to data from 2007, it was 31.8% and is
compare the rate of intra-abdominal adhesions in
now expected to be over 50% (2,3). The reasons for this
women who had four or more CSs with women who
include the women's advanced maternal age, a variety
had fewer repeated (two or three) CSs. (2) To compare
of causes, patient requests, the prevalence of women
the maternal and neonatal complications in women
who have had prior caesarean sections, the fact that
who had four or more CSs with women who had fewer
women frequently decline offers of sterilization, and
repeated (two or three) CSs.
the widespread use of assisted reproductive procedures

While CS can be a life-saving procedure when a
This cross sectional study was conducted at Assiut
mother or her child has complications during
Women Health Hospital during the period from
pregnancy or birth, it is a major abdominal operation
September 2019 to September 2021. A Total of 160
that carries risks for both the mother and the foetus as
patients were recruited and divided into two groups:
well as potential long-term effects on subsequent
women with 3CS (100 patients) and women with 4
pregnancies. These include the potential for uterine
CS (60 patients). In the first group 15 women had
rupture, anesthesia-related bleeding, organ damage,
dense adhesions, 43 had filmy adhesions and 42 had no
embolism, infections, aberrant placental invasion,
adhesions, and in the second group 42 women had
intra-abdominal adhesions, and newborn morbidity
dense adhesions, 15 women had filmy adhesions and
and death (5).
only 3 had no adhesions.
In general, many obstetricians do not advise CS

delivery after three CSs. The precise number of repeat
Inclusion criteria: Women with at least previous one
CSs that are regarded safe has not yet been determined
CS, patient who were 18 to 50 years old, and women
by study (6). CS has a number of intrinsic difficulties,
accepted to participate in the study.
but factors like as the health of the mother and the

foetus, the timing of the delivery, the surgeon's
Exclusion criteria: Previous abdominopelvic surgery
expertise, the center's competency, the surgical
other than CS, history of PID, placenta previa and
technique, and the danger of anaesthesia all play
accrete, women refuse to participate in the study, and
significant roles in the development of complications
intrauterine fetal death.

Received: 16/5/2022
Accepted: 21/7/2022

Full Paper (vol.891 paper# 58)

c:\work\Jor\vol891_59 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4507- 4515

Shoulder Joint Angle and Forward Reaching Speed in
Hemiparetic Cerebral Palsy Children
Riham MR. Mahmoud1, Kaled A. Olama2, Nanees E. Mohamed2*
1Department of Physical Therapy, Al-Mataria Teaching Hospital, Cairo, Egypt
2Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
*Corresponding Author: Nanees Essam Mohamed, Mobile: +201115960603, Email: nanessam2015@cu.edu.eg


Background: Different daily activities depend on proper forward reach. Doing functional activities bilaterally may
improve daily performance.
Objective: The aims of the current study are to determine if the bilateral forward reaching task can alter the shoulder
joint flexion angle and the reaching speed of non-affected and affected upper limbs and to detect the relation between
shoulder flexion angle and reaching speed in hemiparetic cerebral palsied children.
Patients and Methods: A total of 50 hemiparetic cerebral palsy children, 52% boys, their ages ranged from 6 to 10
years participated in this study. From an erect sitting position, they were asked to forward reach a ball fixed on a table
in front of them. Three different measurements were done, the first two times by the non-affected and the affected limbs
separately then the third time by using both limbs at the same time. All measurements were photographed then kinovea
software was used to measure the joint angle and speed during unilateral and bilateral forward reaching tasks.
Results: The results of the joint angle and speed showed significant change in both limbs in bilateral task compared
with that in unilateral task (p=0.0001). There was a negative correlation (r= -0.59, p=0.0001) between joint angle and
speed in unilateral task of the affected limb. Less negative correlation (r= -0.45, p=0.001) was observed between joint
angle and speed in bilateral task of the affected limb.
Conclusion: The better outcomes were gained when the task done bilaterally and there was an inverse relationship
between the joint angle and the speed of movement of the affected limb of hemiparetic cerebral palsy children during
forward reaching activity.
Keywords: Bilateral tasks, Cerebral palsy, Forward reaching function, Hemiparesis, Shoulder Joint Angle.

to the less affected. There was a segmental coordination
Reaching skill is essential in daily tasks and
of shoulder flexion and elbow movement with more
activities done from sitting and standing positions (1).
trunk contribution to compensate the decreased elbow
Functional arm reaching is multilinked joints where
and shoulder excursion (6).
shoulder and elbow were prime movers of the limb so
Goniometer clinically used to measure joints
the hand reaches the target position (2). Reaching
range of motion (ROM). In spite of, it is easily used and
develops from early jerky and tortuous motion to more
less expensive, a little bit it has some degree of error
smooth and coordinated movement (3), during mid-
especially when dealing with a complex joint like the
childhood from (5-10) years, there is an accurate and
shoulder complex. Recently, Kinovea software was
less variable adjustment of the reaching movement to
widely used for analyzing motion, and measuring the
any changes of target position (2).
position, velocity, and acceleration of the limbs
Cerebral palsy (CP) is a group of non-progressive
motion(7). Kinovea software (GPLv2 license) is free 2D
impairment syndromes due to lesions or abnormalities
motion analysis, portable, easily used and require little
in early developed fetus/infant's brain. There are
training, saving time and less expensive with no sensors
heterogeneous symptoms including sensorimotor,
needed for analysis. It permits frame by frame
cognitive, and social aspects (4). In hemiplegic CP the
measuring of different temporal and spatial
muscle tone and movement of one body's side are
affected where the upper limb is more affected than the
Furuya et al. (9) studied the impact of three angles
lower limb. Children with hemiparetic CP show limited
of shoulder flexion (60°, 90° and 120°) on the reach
performance of activities that depend on the
trajectory of more affected hand in children with spastic
coordination of both upper limbs. They always depend
CP. Mild cases straightly and smoothly moved at the
on the unaffected limb in their activities. So the less
three shoulder flexion angles while in severe CP more
used affected limb lacks the opportunity to learn and
outward deviation in the trajectory seen in greater
develop, making a larger gap with normal children (5).
shoulder angles.
Mild to moderate spastic hemiparetic CP children
Some studies investigated the upper limb
can perform unilateral and bilateral reach activities at
spatiotemporal and kinematics parameters during
speed however most of them did not fully extend the
unilateral reaching with hemiparetic side (10,11,12), others
more affected arm. They depended on different way of
investigated both sides (13,6). However, some studies
reaching with the more affected upper limb compared
investigated them for the affected upper extremity

Full Paper (vol.891 paper# 59)

c:\work\Jor\vol891_60 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4516- 4525

Assessment of Self-Treatment Knowledge, Beliefs and Practice during COVID-19
Pandemic among Egyptian Population: A Cross Sectional Study
Sarah Hamed N. Taha1*, Asmaa Mohammad Moawad1*, Ramy Mohamed Ghazy2 and
Walaa Abdelhady Abdelhalim1
1 Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Egypt
2 Tropical Health Department, High Institute of Public Health, Alexandria University, Egypt
Corresponding author:Asmaa Mohammad Moawad, Email: asmaamoawad90@cu.edu.eg,
ORCID: http://orcid.org/0000-0002-8448-0034, Mobile: 01114665109

Owing to absence of definitive treatment to coronavirus disease 2019 (COVID-19) and vaccine hesitancy,
the general population sought information from various sources to prevent or treat the disease. Consequently, self-treatment
(ST) was boosted in many parts of the world.
Aim: The current study aimed to assess ST knowledge, beliefs and practice during the COVID-19 pandemic among
Subjects and Method: A cross-sectional, anonymous online survey was conducted using different social media platforms
to recruit participants. The survey assessed the sociodemographic characteristics, past COVID-19 infection and vaccination,
exposure to ST, and reasons for ST.
Results: A total of 400 participants completed the questionnaire; their mean age was 34.9±11.5, females represented 67.8%,
married (63.3%), living in urban areas (76.8%) and had chronic diseases (28%). About 67.5% had received vitamins or
minerals, antibiotics or herbals or food supplements either due to ST (59.6%) or non-ST (40.4%). Among the ST group,
vitamins were used by (81.9%), antibiotics (45.9%), and herbals and supplements (40.9%).
Conclusion: ST may delay medical advice seeking leading to worsening of the patient's health. Efforts to raise public
awareness about risks of ST should be done by healthcare members especially in the media.
Keywords: Self-treatment; Drug use; COVID-19; Multivitamins; Antibiotics; Egypt


during the COVID-19, significantly limited the access to
In 11th March 2020, coronavirus disease 2019
health care providers, particularly in low-resource
(COVID-19) was declared a pandemic by the World
settings. In this context, the chance for exposure to ST and
Health Organization (WHO)(1). A global lockdown has
seeking medicine-related information from less reliable
been triggered by the COVID-19 pandemic, with many
sources such as social and digital media has been
individuals feeling that their only option is to aid
increasing remarkably (12).
themselves, take care of themselves, and self-treat (2).
This interest in online information about ST
Public health and social measures (PHSMs) to limit
has been dramatically increased between 7th January and
spread of this pandemic include social distancing,
1st June 2020, which was reflected in Google trend for ST
wearing masks, regular hand wash, and staying at home
searches (13). Other sources for ST including family
(3). Moreover, experts have advised adequate intake of
members, friends, neighbors, previous prescriptions and
vitamins, mineral products and herbal medicines to lower
pharmacists have been recently documented (14).
the risk and severity of infection as well as to bolster the
Egypt, a lower-middle-income country, has a
immune system (4­6). Up to April 2, 2022, about 468,8
significant challenge as a result of the COVID-19
million cases reported with 6.1 million deaths globally (7).
pandemic: a suffering economy with limited resources, an
In Egypt, on April 2, 2022, the reported number of
insufficient health-care system and infrastructure. The
COVID-19 cases was 505,264 with 24,417 deaths (8).
Egyptian government's participation in disseminating
As a result of panic, public fear and
COVID-19-related information through various media
misinformation about the COVID-19 pandemic, many
outlets is commendable. However, dealing with
people bought and saved medicines and started self-
misconceptions and widespread misinformation and
treatment (9). Self-medication is defined by the WHO as
deception about COVID-19 therapy is a pressing concern
self-treatment (ST) of known symptoms or illness by
medications without physician consultation (10).
To the best of our knowledge no previous
It also includes the use or repeated use of
studies were done among the general population during
previously prescribed drugs or buying prescribed drugs
the COVID-19 pandemic in Egypt about ST (16,17). The
without consultation and illegitimate use of over the
current study aimed to assess the knowledge, beliefs, and
counter (OTC) drugs (11). The lockdown, implemented
Received: 9/5/2022
Accepted: 8/7/2022

Full Paper (vol.891 paper# 60)

c:\work\Jor\vol891_61 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4526- 4534

Some Clinical Features of Trichomoniasis Associated with Pelvic Organs
Tenderness in Sample of Iraqi women
Zainab Rasheed Abdul Jabbar *1, Harith Saeed Al-Warid 2
1 Medical Laboratory Techniques Department, Al-Esraa University College, Baghdad, Iraq
2 Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq
*Corresponding author: Zainab Rasheed Abdul Jabbar, email: zainab.rasheed@esraa.edu.iq
ORCID: 0000-0003-1988-9703. Mobile No:. +6947714365265


Background: Trichomoniasis resulted in negative health issues that may be connected to infertility and pelvic inflammatory
disease. Objectives:This study aimed to find an evidence of a link between T. vaginalis and various pelvic organs, such as
adnexal, cervical, and vaginal erythema, friability, and mucopurulent discharge.
Patients and methods: One hundered and sixty married women who visited some private clinics in Baghdad between
October 2020 and February 2021 were included in the study. Lower abdominal pain and vaginal discharge were both present
in all of these women. The women were split into two groups: those with pelvic inflammatory disease (PID) (n=41) and
those without (n=119). All woman had pelvic and vaginal organs examination and vaginal swabs were obtained.
Results: The research showed a strong association between T. vaginalis and pelvic inflammatory illness (P<0.05). The
results showed that vaginal erythema (60%) and other symptoms such as cervical friability (21.7%), cervical motion
discomfort (13.3%), and adnexal tenderness (26%), were not significantly associated to T. vaginalis positive diagnosis.
While the correlation between T. vaginalis positivity and mucopurulent discharge was significant (P< 0.05).
Conclusions: This research provided information on several clinical traits of trichomoniasis in women with PID. T.
was very predictable among adult female who had PID.
Keywords: Pelvic inflammatory disease, Pelvic organs tenderness, Trichomoniasis, Trichomonas vaginalis.

health complications and PID when colonized with other
Trichomonas vaginalis is the most widespread
STD (10). The parasite may develope erythema in the
sexually transmitted disease (STD) in the world and the
vaginal and cervical walls as well as strawberry cervix
primary cause of trichomoniasis. (1). It was residing in the
diagnosed in 2% of infected women (4). Mucopurulent
human urogenital track, which adhere to the vaginal
cervicitis was detected in 22% of women in which the
epithelial cells in women and in urethra of men (2). In
parasite isolated from the vaginal epithelium of
women, the infection was ranging from non-symptomatic
reproductive track (11). Furthermore, there was a relation
to severe vaginitis, whereas the man has asymptomatic
between T. vaginalis and bacterial vaginosis infection
infection there for screening for the parasite is very
with the cervical friability as well as cervical motion
important (3). The symptoms of the infection presented
tenderness (12). Pelvic examination and laboratory
with yellowish-green frothy discharge, itching with bad
diagnosis showed significant association of T. vaginalis
odour and associated with adverse health problem, and
infection and other STD with the vaginal bleeding,
infertility in women while the infection was rarely
cervical motion tenderness, and adnexal tenderness (13).
associated with prostatitis and decrease sperm viability in
Speculum screening with laboratory detection of the T.
man (4). The parasite has recently received more attention
vaginalis and other STD is an effective way to ovoid the
after WHO estimates in 2016, that the infection rate was
infection (3). Limited investigation on the relation between
increased with 276 million new cases annually (5). The
trichomoniasis associated with clinical suspected PID
true prevalence of trichomoniasis was not well recognized
(14,15). So the aim of the cuuren study was to assess the
and affected by the surveyed population, time, and area of
clinical examination sorts of trichomoniasis in adult
the study (6). Trichomoniasis was highly associated with
females who had pelvic inflammatory disease and
pelvic inflammatory disease and increased acquisition
identify the possible effect of T. vaginalis infection on
and shedding of HIV infection (7). The correct detection
pelvic organs tenderness.
and successful clinical management of STDs is an

energetic approach for improving reproductive and sexual
health protection (8).
Study design and patients
Many studies have suggested significant
Vaginal swabs were obtained from 160 married,
relation between acute endometritis and T. vaginalis, C.
non-pregnant women who visited a few gynecology
trachomatis as well as N. gonorrhoea infection (9). T.
private clinics in Baghdad between October 2020 and
vaginalis has the ability to change the state of the
February 2021. They either simply experienced vaginal
reproductive tract and is likely associated with adverse
discharge symptoms or experienced both vaginal
Received: 17/5/2022
Accepted: 24/7/2022

Full Paper (vol.891 paper# 61)

c:\work\Jor\vol891_62 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4535- 4539

The Accuracy of Transcerebellar Diameter in Assessment of Gestational Age in
Normal and Growth Restricted Fetuses and Diagnosis of Intrauterine Growth Restriction
Mohamed A Maher*, Mohamed M. Waly, Ahmad Elsheikhah, Ahmed Kamel
Obstetrics and Gynecology Department, Kasr Alainy, Cairo University Hospital, Cairo University, Cairo, Egypt.
* Corresponding author: Mohamed A Maher, E-mail: m.alaa.maher@gmail.com


In many pregnant women, it is very difficult to accurately assess the fetal gestation age, due to pregnancy on top of
lactation or contraceptive method, unsure of date, irregular cycles, late booking and missing the dating scan. Therefore,
we might have a wrong diagnosis of preterm or postterm pregnancy, which will affect the outcome of pregnancy.
Patients and methods: In our prospective study, we examined 70 normal pregnant women and 70 intrauterine growth
restricted (IUGR) pregnancy cases after Ethical Committee approval and informed written consent, to assess the effectivity
of transcerebellar diameter (TCD) in detection the age of gestation in normal pregnancy and IUGR cases in relation to
other ultrasound parameters as biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal
circumference (AC). In addition, TCD/AC ratio was assessed for its efficiency in diagnosing IUGR pregnancy if its value
was above 95th percentile. Results: Our results showed no significant difference between the mean gestation age detected
by TCD compared to the actual mean gestation age in normal as well as IUGR cases, in addition the TCD showed the
highest diagnostic accuracy of 95% in detection of gestation age in IUGR within 2 weeks. TCD/AC ratio showed accuracy
of 91.43% in diagnosis of IUGR if ratio above 95Th percentile.
Conclusion: TCD is a very important parameter in diagnosis of IUGR cases and proper assessment of gestation age.
Keywords: TCD, gestation age, intrauterine growth retardation, BPD, HC, AC, FL, TCD/AC.

cardiac output, the brain will remain unaffected in a
The accurate assessment of gestational age is very
process known as brain sparing, therefore the cerebellar
important to achieve a good pregnancy outcome,
growth will be within normal range and consequently the
inaccuracy might lead to adverse outcome, as preterm
TCD in prediction of gestation age(7).
induction of labor, or postterm pregnancy, still birth and

neonatal morbidity. The cerebellum position is in the
posterior cranial fossa, it is separated from the pons and
Ethical approve
the medulla by the fourth ventricle (1,2). Since the last
This study was only started after being approved by
decade, ultrasound parameter `transcerebellar diameter
the Ethics Board of Cairo University. An informed
(TCD)' has been assessed as a good predictor of
written consent was taken from each participant in
gestational age in intrauterine growth retardation
the study. This work has been carried out in
(IGUR) as well as normal pregnancy(3). With ultrasound
accordance with the code of Ethics of the World
technology, we begin to see the fetal cerebellum by 12
Medical Association (Declaration of Helsinki) for
weeks .The growth of the cerebellum is linear throughout
studies involving humans (8).
the second trimester, however in the third trimester the

growth curve is more flattened. Consequently, TCD
Study protocol
measurements have been correlating with the gestational
A total of 140 pregnant women were assessed in a
age up to 24 weeks, for example at 19 weeks, the TCD is
prospective study done over 3 years (2017-2019) in
around 19 mm (4). Moreover, measurement of TCD is not
Cairo University Hospital by 2-dimensional ultrasound.
affected much by growth restriction or acceleration (5).
Examinations were performed with the patient lying in
In third trimester, femur length together with other
the dorsal supine position. 2D ultrasound was done and
US parameters are used for the assessment of gestational
whole fetal measurements and liquor volume was
age, FL has been diagnosed to show margin of error 2.5
checked. In 70 cases, singleton pregnant women, who
- 3.1 weeks from the actual gestational age (6). Also, the
were sure of dates, pregnant in second or third trimester
biparietal diameter (BPD) was proven to show margin of
of gestation, calculated by LMP or dating scan and
error of 3 ­ 4 weeks. Transcerebellar diameter (TCD)
diagnosed with intrauterine growth restriction were
represents an independent biometric parameter as it is
included. The other 70 cases were pregnant in 2nd or 3rd
not affected by change in the shape of the skull because
trimester with normal singleton pregnancy, sure of dates
of the surrounding occipital bone and petrous ridge(5).
by LMP or dating scan. Exclusion criteria were: multiple
Intrauterine growth retardation (IUGR) is caused
pregnancy, congenital anomalies, unsure of dates and
mostly by alteration of blood flow through the placenta.
intrauterine fetal death (IUFD). IUGR was diagnosed
Proper ultrasound assessment of gestational age in cases
either clinically through measuring the fundal height less
of IUGR reduces the mortality rates by 60%. In most
by 4 cm than what was expected, and confirmed by
cases of IUGR, due to the redistribution process of the
Received: 10/5/2022
Accepted: 17/7/2022

Full Paper (vol.891 paper# 62)

c:\work\Jor\vol891_63 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4540- 4543

Lymphoid Malignancies and Direct-Acting Antivirals: Review Article
Walaa Gamal Soliman1, Amr Mohamed Zaghloul2, Ali Mohammed Ali1, Mohamed Soliman Gaber1
1Department of Clinical Oncology and Nuclear Medicine, 2Department of Tropical Medicine and Gastroenterology,
Sohag Faculty of Medicine, Sohag University, Egypt.
Corresponding author: Walaa Gamal Soliman, Mobile:(+2)01001316515 E-Mail: walaasoliman700@yahoo.com

Hepatotropic virus HCV, which can infect hepatocytes, is also lymphotropic and can infect lymphocytes as well.
Epidemiological, clinical, and biological evidence suggests that the pathogenesis of at least a portion of B-cell non-Hodgkin
lymphomas (NHLs) are related to HCV infection. In the last six years, the approval of the new IFN-free antiviral treatment
(AVT) with DAAs revolutionized the treatment of chronic HCV infection and many studies show improvement of lymphoid
malignancies associated with HCV infection upon the use of direct-acting antivirals (DAAs). DAAs alone can improve
indolent lymphomas and DAAs combined with chemotherapy improve the outcome of more aggressive lymphomas as many
studies show that patients with HCV infection and lymphoid malignancies usually presented with a higher stage, have a
higher frequency of extranodal presentation and a lower response rate (RR), disease free survival (DFS), and overall survival
(OS) compared with other patients with lymphoid malignancies without HCV infection.
Moreover, a number of lymphoid malignancies had reported soon after DAAs treatment for HCV infection. This is a
systematic review of DAAs and their effect on lymphoid malignancies when given either combined or without
chemotherapy. In addition, the review contains all cases reported before for the development of lymphoid malignancies
after DAAs treatment for HCV infection.
Keywords: HCV, Lymphoid malignancies, DAAs.

higher frequency of extra-nodal presentation, and have
Some infections are related to lymphoma such as
inferior RR, DFS, and OS (7). It is plausible to conclude
The Epstein-Barr virus (EBV) and Hodgkin disease or
from this that treating HCV infection will enhance
Burkitt's lymphoma, human T-cell leukemia virus type 1
lymphoid malignancy outcomes in people who are also
and adult T cell leukemia and lymphoma, and
infected with the virus.
Helicobacter pylori and lymphoma of the stomach
IFNa and peg INF plus minus ribavirin (RBV) were
mucosa associated lymphoid tissue (1).
once the standard treatments for HCV infection, and
EBV-positive diffuse large B-cell lymphoma
numerous studies have shown that using these
(DLBCL) and human herpesvirus type-8 (HHV-8)-
medications can improve the prognosis for lymphoid
positive DLBCL are two distinct subtypes of NHL, which
malignancies, particularly indolent B cell lymphoma, and
related to specific viral infection and classified separately
that the hematological response is directly related to the
according to the 2016 revision of the World Health
viral response (8).
Organization (WHO) classification of lymphoid
However, unfortunately these drugs have a high
neoplasms (2), which means that these types of lymphoma
toxicity profile and a low rate of virology response and
carry different manifestations and prognosis.
the hematological response might be related to the direct
Hepatotropic virus HCV, which can infect
anti proliferative effect of INF rather than the virology
hepatocytes, is also lymphotropic and can infect
response (9).
lymphocytes as well. Epidemiological, clinical, and
The recent approval of the new IFN-free AVT with
biological evidence suggests that the pathogenesis of at
DAAs transformed the treatment of chronic HCV
least a portion of B-cell non-Hodgkin lymphomas (NHLs)
infection by enabling sustained virologic response (SVR)
are related to HCV infection (3).
rates to peak at 100% in all viral genotypes and,
HCV was found in peripheral blood mononuclear
importantly, with almost negligible toxicity (10).
cells and lymph nodes, indicating HCV infection (4).
DAAs lacks the direct anti proliferative effect of
Hepatitis C NS3 protein was also found in tumor cells in
interferon (9) and improvement of the lymphoid
individuals with NHL who were also HCV-infected (5).
malignancies outcome on these drugs would provide
There is evidence from a meta-analysis that HCV
more conclusive evidence of the link between HCV
infection increases the chance of getting NHL by 2.5
infection and lymphoid malignancies.
times (6).
Moreover, it has been observed that different types
Numerous studies demonstrate that when compared
of lymphoid malignancies were diagnosed in patients
to patients with lymphoid malignancies who do not have
after treatment with DAAs. It may be just an association
HCV infection, those with HCV infection and lymphoid
or DAAs might have some relation to this. Many studies
malignancies typically present with a higher stage, have a
shows large number of patients who developed
Received: 12/5/2022
Accepted: 19/7/2022

Full Paper (vol.891 paper# 63)

c:\work\Jor\vol891_64 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4544- 4551
Assessment of Immunoglobulin M in Children with Steroid
Resistant Nephrotic Syndrome
Fateh Alhadi Mohammed1, Hatem Mohamed Hussein1,
Mona Mohammed Ali Elsharkawy1, Naglaa Ali Ali Hussein Khalifa2
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Fateh Alhadi Mohammed, Mobile: (+20) 0 067913203, Email: fm2257306@gmail.com

Nephrotic syndrome (NS), which accounts for 40% of renal morbidities in Egypt, is thought to be the
most common kidney illness in Africa.
Objective: This study aimed to evaluate the role of IgM in early diagnosis of nephrotic syndrome of steroid resistant in
Patients and methods: This cohort study included 48 children with NS. It was conducted in the Pediatrics Nephrology
Unit, Faculty of Medicine at Zagazig University Pediatric Hospitals. Patients were divided into Group (A) 24 children:
new cases of nephrotic syndrome with steroid resistance. All patients were in the active stage of the disease (heavy
proteinuria >40 mg/m2/hour, hypoalbuminemia <2.5 g/dL, edema and hyperlipidemia) and Group (B): included 24
children with steroid sensitive nephrotic syndrome.
There was a significant higher percent of infection of steroid resistant nephrotic group compared to steroid
sensitive nephrotic group. There was a significant higher percent of albuminuria and lower 24 hours protein in urine of
steroid resistant nephrotic group compared to steroid sensitive nephrotic group. There was a significant lower serum
total protein of steroid resistant nephrotic group compared to steroid sensitive nephrotic group. There was a significant
lower serum IgG and IgM of steroid resistant nephrotic group compared to steroid sensitive nephrotic group.
Serum IgM and IgG levels have prognostic value in patients with nephrotic syndrome and can predict the
outcome and the frequency of recurrence of the disease.
Steroid Resistant Nephrotic Syndrome, Immunoglobulin M, Children.

IgM increase, like the serum concentration of many
Patients who experience a syndrome complex of
other high­molecular weight liver-derived proteins (5).
low levels of serum albumin, high levels of blood lipid,
Atypical IgM on the surface of T cells predisposed
lipids in the urine, and edema are said to have nephrotic
patients to the onset of severe childhood INS. However,
syndrome (NS), which is caused by a growing loss of
few studies have evaluated the difference in serum IgM
albumin, proteins, and other plasma components with
between SSNS and SRNS. Conversely, the total serum
similar mass (1).
protein­albumin ratio (TA ratio) would directly reflect
Idiopathic nephrotic syndrome (INS) is divided
protein excretion in the urine (6).
into steroid-sensitive nephrotic syndrome (SSNS) and
Therefore, this study aimed to evaluate the role of
steroid-resistant nephrotic syndrome (SRNS) taking in
IgM in early diagnosis nephrotic syndrome of steroid
account that response to steroid therapies is highly
correlated with tissue subtype and disease progression

prognosis, the International Study of Kidney Disease in
Children (ISKDC), revealed that the great portion of
This cohort study included 48 children with
children with INS had minimal change nephrotic
nephrotic syndrome, which was conducted in the
syndrome (MCNS) in their renal biopsies (2).
Pediatrics Nephrology Unit, Faculty of Medicine at
According to the International Study of Kidney
Zagazig University Pediatric Hospitals.
Disease in Children (ISKDC), SRNS is defined as a

non-response to an 8-week exposure (at a minimum) of
Inclusion criteria: Children aged from 2 to 14 years of
60 mg/m2 prednisone per day, or 2 mg/kg prednisone
both gender with NS. Patients who fulfilled the criteria
per day for 4 weeks followed by 40 mg/m2 per day on
of minimal change NS (MCNS) were included in this
alternate days for 4 weeks (2).
study. Patients had uncomplicated NS at initial onset
Different diseases are observed between steroid-
and were treated at one of the hospitals. Patients were
sensitive NS (SSNS) and SRNS. Most children with
under treatment with 1-2 mg/kg corticosteroid (CS)
SSNS have minimal change disease (MCD), whereas
children with SRNS have focal segmental

glomerulosclerosis (FSGS), mesangial proliferative
Exclusion criteria: Children aged below one year or
glomerulonephritis (MesPGN), or MCD (3).
above 15 years. Children with severe protein energy
Previously, various studies have been conducted
malnutrition, congenital or infantile NS, hereditary or
on NS and immunity. It was postulated that MCNS
secondary forms of NS, low complement components
could be caused by a systemic dysfunction of T-cells (4).
and known active chronic infection (hepatitis B virus,
Serum concentrations of the high­molecular weight
hepatitis C virus, HIV, syphilis). Any patient who had
Received: 16/05/2022
Accepted: 21/07/2022

Full Paper (vol.891 paper# 64)

c:\work\Jor\vol891_65 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4552- 4557

Age and Gender are Predictors for Occult Hepatitis C in Egyptian
Sustained Responders to Directly Acting Antivirals
Tarek Yosef1, Maha M. Hussein1, Amr Elzohary2, Tari M. A. George Michael*1
1Department of Internal Medicine, Gastroenterology and Hepatology Unit,
Faculty of Medicine, Ain Shams University, Egypt
2Department of Internal Medicine, Elgomhoria Teaching Hospital, Egypt
*Corresponding author: Tari Magdy Aziz George Michael, Mobile: (+20) 01222390320,
Email: tari@med.asu.edu.eg, ORCID: 0000-0002-9684-6056
Occult HCV infection (OCI) describes detectable viral RNA in the hepatocytes and in peripheral blood
mononuclear cells (PBMCs) in the absence of conventional markers for HCV. The present study aimed to detect the
prevalence of occult hepatitis C virus infection in patients who achieved a sustained virologic response (SVR) to direct-
acting antiviral agents (DAAs) and to outline predictors of OCI. Patients and methods: This multicenter cross-sectional
study included 50 males and 50 females seeking treatment for chronic hepatitis C patients without liver cirrhosis who
were treated with combination of sofosbuvir (SOF) and daclatasvir (DCV) with or without ribavirin for three months
and achieved SVR as proved by negative PCR after 12 weeks of the end of treatment. Twelve weeks after the end of
treatment, HCV RNA was tested in PBMCs to detect OCI in patients with SVR. Logistic regression was used to find
out factors affecting the presence of OCI. ROC curve was used to evaluate the performance of different tests to predict
OCI. Results: Of the 100 patients, 12 (12%) had detectable HCV RNA in PBMCs after achieving SVR12 denoting
presence of occult HCV infection. Age 45 years and male gender were significant predictors for occurrence of OCI.
However, direct bilirubin 0.40 mg/dL was a significant predictor with low diagnostic performance.
Conclusion: OCI can persist in sustained responders to DAA therapy and the risk of OCI is more prevalent in males
younger than 45 years. Age and direct bilirubin can be possible predictors for OCI.
Keywords: Directly acting antivirals, sofosbuvir, daclatasvir, Hepatitis C, Occult hepatitis C, Ain Shams University.


(10) which can lead to induction of immunosenescence,
Hepatitis C Virus (HCV) infection is known to
T cell exhaustion, promotion of immune cell apoptosis
pose a serious public health problem all over the world;
and stimulation of carcinogenesis (11). Accordingly,
therefore, efforts have been made worldwide to
persistence of OCI in hepatocytes of patients treated for
eliminate HCV by 2030 (1). In Egypt, the latest
HCV may lead to residual histological abnormality and
demographic health survey reported a seroprevalence of
HCC (12), risk of reactivation of HCV on exposure to
HCV of about 10% (2) and the Egyptian government has
immunosuppression (13), risk of transmission of HCV by
exerted enormous efforts to screen 49.6 million people
blood donors (5) or in hemodialysis centers (14).
and treat nearly 2.2 million (3). In 2004, a new category
The present study aimed to detect the prevalence
of patients was described to have occult HCV infection
of occult hepatitis C virus infection in patients who
(OCI) where they had persistently deranged liver
achieved a sustained virologic response (SVR) to direct-
functions despite being negative for anti-HCV
acting antiviral agents (DAAs) and to outline predictors
antibodies and HCV RNA tested by polymerase chain
of OCI.
reaction (PCR) (4). OCI describes detectable viral RNA
in the hepatocytes and in peripheral blood mononuclear
This multicenter cross-sectional study was carried out
cells (PBMCs) in the absence of conventional markers
in Ain Shams University Hospital, Ahmed Maher
for HCV. It has also been described in asymptomatic
Teaching hospital and Elgomhorya Teaching Hospital
carriers with normal liver enzymes and in patients who
on 100 patients attending hepatitis C clinics over the
showed spontaneous or post antiviral clearance of
period of 1 year, treated for chronic hepatitis C with
infection (5). OCI is best diagnosed by liver biopsy but
sofosbuvir (400mg) plus daclatasvir (60mg) daily with
due to the invasive nature of the procedure, HCV RNA
or without ribavirin for 12 weeks according to NCCVH
can be alternatively tested in PBMCs which can detect
protocol (15).
70% of cases (6). After treatment, chronic hepatitis C
cure is defined as sustained virologic response with
Inclusion and exclusion criteria:
negative results of HCV PCR in serum samples (7). This
Participants included in our study were chronic hepatitis
was found to be associated with clinical and histological
C patients without liver cirrhosis who were treated with
improvement even in patients with advanced fibrosis (8).
combination of sofosbuvir (SOF) and daclatasvir
In OCI, although the hepatic injury is considered
(DCV) with or without ribavirin for three months and
milder, an association with hepatic necroinflammation
achieved SVR as proved by negative PCR after 12
and fibrosis has been described and is thought to be
weeks of the end of treatment.
related to the persistence of viral RNA in hepatocytes of
Patients with liver cirrhosis, hepatitis B or HIV co-
patients treated for HCV (9). Moreover, development of
infection, chronic kidney disease, alcohol intake,
hepatocellular carcinoma (HCC) after treatment of
history of HCC and patients on treatment with
HCV was linked to the presence of OCI in liver tissue
hepatotoxic medications were excluded from the study.
Received: 12/05/2022
Accepted: 19/07/2022

Full Paper (vol.891 paper# 65)

c:\work\Jor\vol891_66 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4558- 4561

Role of Certain Pro-Inflammatory Cytokines in Pathogenicity of
Cardiomyopathy in Sample of Iraqi Patients
1Maryam A. Al-Khayatt* and 1Jabbar H. Yenzeel
Department of Biology, College of Science, University of Baghdad, Iraq
* Corresponding author: Maryam Abdul Majeed Al-Khayatt E-mail: maryamalkhayatt@gmail.com
mobile: +9647800059061 ORCID: 0000-0003-2147-4531


Background: Cardiomyopathy (CM) is a cardiac muscle disorder that can lead to heart failure (HF). It has several
phenotypes, including dilated, hypertrophic, and restricted. Pro-inflammatory cytokines play a crucial part in the
development and advancement of CM.
Objective: This study aimed to measure the concentration of certain cytokines [Interleukin- 1 (IL-1), Interleukin-6 (IL-
6), and Tumor Necrosis Factor (TNF-)] in the serum of Iraqi patients with CM.
Materials and Methods: Sixty CM patients and 30 healthy individuals with age ranged from 40 to 70 years old were
enrolled in this study through their presence at Iraqi Center for Heart Diseases, Ghazy Al-Hariri Hospital for Surgical
Specialties in the Medical City in Baghdad. The study was conducted from November 2021 to April 2022. Blood samples
were collected to evaluate the level of Interleukin IL-1, IL-6, and TNF- using ELISA technique.
Results: The findings revealed a highly significant (P0.01) increase in the level of IL-1 IL-6 and TNF- (15.71 ±0.33
pg/ml, 65.84 ±0.73pg/ml, and 17.81 ±0.58 pg/mL) respectively in comparison with control (4.59 ±0.17 pg/ml, 7.60
±0.18pg/ml, and 6.26 ±0.34 pg/mL) respectively.
Conclusion: It can be concluded from the current results that the pro-inflammatory cytokines play a major role in the
development and severity of cardiomyopathy in Iraqi patients.
Keywords: IL-1, IL-6, TNF-, Cardiomyopathy, pro-inflammatory cytokines.


Cardiomyopathy (CM) is a diverse collection of
by aberrant ventricular wall thickening in the absence of
illnesses of the myocardium, typically with inappropriate
abnormal loading conditions (6).
ventricular hypertrophy or dilatation. It is an anatomical
Restrictive cardiomyopathy (RCM) is a cardiac
and pathologic diagnosis connected to muscular or
disorder that is frequently brought on by increased
electrical malfunction of the heart. It frequently results in
myocardial stiffness and inadequate ventricular filling.
cardiovascular mortality or progressive heart failure-
The biventricular chamber size and systolic function are
related impairment and may be heart-specific or a
frequently normal or almost normal up to the latter stages
component of a more widespread systemic illness (1).
of the disease. the ventricles, either the left or right. Due
Dilated cardiomyopathy (DCM) is a nonischemic
to increased end-diastolic pressure in the ventricles,
condition that affects the myocardium and has structural
genetic RCM is frequently characterized by a left
and functional abnormalities. The clinical features of
ventricle that is almost normal in size, increased stiffness,
DCM are present if the arterial muscles of the heart are
and enlarged atria the rarest form, accounting for only 5%,
dilated at systole, resulting in valvular disease, genetically
however, it has the worst prognosis and treatment options
transmissible heart disease, or hypertension (2-3).
of all the cardiomyopathies (7).
Currently, DCM is It is characterized system-
Cytokines are defined as pleiotropic low
related disease, resulting in various other disorders like
molecular weight polypeptides that can produce
autoimmune disease, endocrinological disease, and
autocrine, juxtracrine, and paracrine effects. They play
neuromuscular or infectious disease. It indicates if
important role in regulating inflammatory and immune
transplantation of a heart is needed or not (4). Hypertrophic
responses (8).
cardiomyopathy (HCM) is virtually a hereditary condition
Cytokines that promote inflammation (such as
and is defined by an increase in the number of heart
TNF- , IL-6, and IL-1) and chemokines have been
muscle cells. This disease is caused if any mutations occur
found in the hearts of both ischemic cardiomyopathy
in genes responsible for the coding of sarcomeres protein,
patients and DCM patients (9).
resulting in myocyte disarray which is a characteristic of
The usual inflammatory cytokine IL-1 reduces
HCM (5).
heart contractility after being administered quickly. It
Nearly 70% of all deaths in hypertrophic
results in reduced b1-adrenergic response, reversible
obstructive cardiomyopathy are unexpected. HCM
acute and chronic contractile dysfunction, and may have
frequently offers a silent course. It is the most prevalent
an effect on the pathophysiology of acute decompensated
form of hereditary cardiomyopathy, and it is characterized
HF as well as the pathogenesis of inflammatory
Received: 17/5/2022
Accepted: 24/7/2022

Full Paper (vol.891 paper# 66)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4562- 4565

Possible Side Effects of Isotretinoin Use in Dermatology: Review Article
Ghada Omar Hussein Abou Zommar*, Ahmad Nofal, Al Shimaa Mohammad Ibrahim
Department of Dermatology, Venerology and Andrology, Zagazig University Hospital, Egypt
*Corresponding author: Ghada Omar Hussein Abou Zommar, Mobile: (+20) 0 100 627 0518,
E-Mail: ghzummar@hotmail.com

Isotretinoin is an essential medication for a variety of conditions and uses, including the treatment of
severe acne and chemoprevention. Because of the rise in isotretinoin prescriptions, doctors need to be well-versed in
the drug's potential side effects, toxicities, and management challenges. The manufacturer has responded to the most
pressing problem, congenital abnormalities, by introducing new policies and programmes designed to reduce the
likelihood of unplanned pregnancy. Depression in patients using isotretinoin is a new cause for alarm. While
mucocutaneous and ocular side effects are the most common, effects on the neurological, musculoskeletal,
gastrointestinal, pulmonary, and hematologic systems are also recorded, along with laboratory abnormalities.
Additionally, precautions against toxicity, possible drug interactions, and further monitoring are recommended.
Objective: Assessment of side effects of isotretinoin use in dermatology.
Isotretinoin, dermatology, and side effects 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 2001 to February 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
Conclusion: Isotretinoin is a medicine used all over the world to treat various skin conditions in both sexes and
people of all ages. Despite its widespread usage, however, isotretinoin is not without its share of negative side
effects. To enhance clinical results and reduce the likelihood of adverse events, it is crucial to obtain thorough
informed consent from patients and to counsel and follow them closely.
Keywords: Isotretinoin, Dermatology, Side effects.

trans-retinoic acid (ATRA) play crucial roles in a wide
During world war 2, researchers learned how vital
range of biological activities, like the processes of
retinol (vitamin A) was. In 1968, scientists began
working on the retinoid drug project, which aimed to
morphogenesis and organogenesis, arresting cell
chemically modify the molecule of vitamin A in order
development, differentiating cells, triggering cell death,
to manufacture molecules with similar effects and
and regulating the immune system (2).
safety profiles. Liver was used to treat endemic night
Vitamin A (retinol) has a tripartite biological
blindness in ancient Egypt, putting this therapeutic use
structure, (Figure 1) consisting of a cyclic end group
of these compounds back some three thousand years.
(cyclic ring), a polyene side chain, and a polar end.
However, modern retinoids may be traced back to 1909,
Synthetic retinoids can be made by tinkering with any
when vitamin A, a key element in embryo viability, was
one of these three components (3).
identified in the fatty extract of the egg yolk. Nearly
Isotretinoin is a derivative of retinoic acid (RA)
twenty years ago, retinoids were first used to treat
and a derivative of retinol (vitamin A). This substance
dermatoses like photoaging (1).
is a 13-cis retinoic acid in its chemical make-up. As
Retinoids are chemically derived from vitamin A.
seen, its molecular formula is C20H28O2, and its
They influence cellular division and differentiation of
chemical structure is depicted (Figure 2). Its molecular
stratified structures of epidermis. Natural retinoids such
weight is 300.44 g/mol and it appears as a yellow to
as vitamin A (retinol), beta-carotene, retinal, and all-
orange crystalline powder (4).
Received: 18/05/2022
Accepted: 25/07/2022

Full Paper (vol.891 paper# 67)

c:\work\Jor\vol891_68 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4566- 4569

Toxic Effects of Methotrexate on Cerebellar Cortex: Review Article
Samar Mahmoud Osama Lutfy*, Azza Saad Ahmed Shehata,
Samah Mohamed Ahmed, Maha Zayed Mohammed Hassan
Medical Histology and Cell Biology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Samar Mahmoud Osama Lutfy, Mobile: (+20) 0 100 709 9848,
E-Mail: samarelwakeel1992@yahoo.com

Cerebellum, also known as the "small brain," is a highly stereotypical cortical structure located in the
vertebrate hindbrain. Its primary function is to aid in motor control, but it also processes a wide range of sensory functions.
Methotrexate (MTX) is widely used as a chemotherapy agent for treating many different kinds of cancer. Psoriasis, SLE,
IBD, vasculitis, and a wide variety of other connective tissue illnesses can all benefit from it without any negative side
effects. The neurological system is particularly vulnerable to methotrexate's adverse effects. Although neuronal symptom
is also frequently observed. Since MTX-induced neurotoxicity has received less attention than its other side effects, its
causes remain unknown. Objective: This review article aimed to assess the possible toxic effects of Di Ethyl phthalate
(Methotrexate) on cerebellar cortex. Methods: Methotrexate, cerebellar cortex 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 May 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: Purkinje cell shrinkage, karyolitic alterations in granule cells, and nuclear damage were
observed as pathological changes at the cellular component of the cerebellar cortex after methotrexate exposure.
Keywords: Methotrexate, Cerebellar Cortex.

thin, varicose collaterals and radiating, twisted
The cerebellum is found in the back of the skull, in
dendrites (4). The nuclei of superficial stellate cells are
the posterior fossa. In front of it are the pons, medulla,
spherical, and their cytoplasm is almost completely
and fourth cerebral ventricle. The tentorium cerebelli and
occupied by one or more shallow indentation(s),
all cerebellar connections with other areas of the brain
whereas the cell bodies of deeper stellate cells might be
pass through the pons, which is separated from the
significantly larger and have more copious cytoplasm.
overlaying cerebrum by a layer of leathery dura mater (1).
Compared to the outer stellate cells, these ones are more
The cerebellum is divided into the anterior lobe,
ellipsoidal in shape, and they often exhibit complex
the posterior lobe, and the flocculonodular lobe, each of
nuclear indentations. Except for a thin, uneven border
which has a specific physiological function. Fissures
called the major fissure and the posterolateral fissure
disseminated throughout the karyoplasm. Additionally,
separate these lobes. The spinocerebellum is made up
the nucleolus is typically located near the periphery of
of the middle section of the cerebrum's anterior and
the cell (5).
posterior lobes. The cerebrocerebellum, also known as
When compared to larger neurons, stellate cells
the neocerebellum, is located in the brain's lateral zone
have very little cytoplasm. Unruly protrusions from the
nuclear envelope frequently fuse with the rough
Histology of the cerebellum:
endoplasmic reticulum. Rosettes of ribosomes can be
The molecular cell layer is the outermost, followed
seen dispersed throughout the membrane-free zones
by the Purkinje cell layer and finally the granule cell
and indentations of the nucleus, as well as in the rough
layer, which is the innermost and most primitive layer
endoplasmic reticulum. Golgi apparatuses, however,
of the cerebellar cortex. Flattened Purkinje cell
show a great deal of variation in their arrangement from
dendritic trees and a vast array of parallel fibers from
one cell to the next ones (6).
the granule cell layer, which enter the Purkinje cells'
Multiple "stellate" (sparsely branched) dendrites
dendritic trees at right angles, make up the molecular
are characteristic of the molecular layer's stellate cells.
cell layer (3). Stellate cells and basket cells, two types of
Stellate cells have synaptic contacts with parallel fibers,
inhibitory interneurons, can also be found in the
climbing fibers and basket cell axons. The axon of a
molecular cell layer. The form of stellate cells
stellate cell is a distinctive process that grows in the
resembles a star. They are the only type of neuron
center and outer thirds of the molecular layer, and it is
present in the outer and middle thirds of the cerebellar
directed toward the secondary and tertiary dendritic
cortex's molecular layer. Their dendritic and axonal
branches of the Purkinje cell. A complex neuropil
architectures allow for the following categorizations:
formed by the Purkinje-parallel and climbing fiber
Cells in the upper third of the molecular layer have
spine synapses, surrounded by the Bergmann glial cell
short, circinate, twisted dendrites and small axonal
cytoplasm is observed adjacent to the stellate neurons
fields, whereas deep stellate cells have long axons with
Received: 17/5/2022
Accepted: 24/7/2022

Full Paper (vol.891 paper# 68)

c:\work\Jor\vol891_69 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4570- 4572

An Overview about Microneedling and its Use in Dermatology: Review Article
Abdulsalam Mohammed Bin Khalel*, Amin Mohamed Amer, Ayman EL Sayed Ahmed Youssef
Department of Dermatology, Venerology & Andrology, Zagazig University Hospital, Egypt.
*Corresponding author: Abdulsalam Mohammed Bin Khalel, Mobile: (+20) 01550801286,
E-Mail: kamonna2006@gmail.com

Microneedling (MN) has been used to treat scars, rhytides, and dyschromia, among other dermatological
conditions. Small channels of dermal as well as epidermal damage are created by puncturing the skin with needles. After
being damaged collagen is removed, then new growth and remodeling. Neovascularization and neocollagenesis are aided
by elastic fiber formation and fibroblasts as well as platelet-derived growth factors. In the end, scars, particularly atrophic
scars, will look better. Cytokines such as interleukin-1 alpha, interleukin-6, tumor necrosis factor-alpha, and granulocyte
and macrophage colony-stimulating factor are released quickly after microneedling, and keratinocyte migration as well as
vasodilation occurs to heal micropunctured epidermal damage. Objective: This review article aimed to discuss general
overview of microneedling and assessment of its uses in dermatology.
Microneedling, and Dermatology, 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 May 2021 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: Percutaneous collagen induction therapy, or microneedling, is a cutting-edge non-surgical method that
involves puncturing the skin with a series of extremely thin needles in a short time. This approach has garnered
widespread support among practitioners of many therapeutic modalities (cheap, effective procedure, which don't need
much experience, safe and simple).
Keywords: Microneedling, Dermatology, Percutaneous.

Subcision is a skin needling method first described
in 1994 by Orentreich and Orentreich to remove fibrous
strands responsible for depressed cutaneous scars and
rhytides. Needle dermabrasion, a procedure involving
the use of a tattoo gun that isn't filled with ink, was
reported by Camirand and Doucet to improve the
clinical appearance and texture of surgical scars after
three years. In 2006, Fernandes presented the first
microneedle stamping technology to the market (1).
Using these ideas and a dermaroller equipped with
very fine needles, Fernandes created percutaneous
collagen induction (PCI) therapy. A current
microneedling device has a barrel with a number of very
thin needles (0.5 to 1.5 mm in length) on it. These

needles are rolled over the skin, puncturing the stratum
corneum and the papillary dermis multiple times. In
response to these tiny injuries, the dermis produces new
collagen and elastin fibers (through the release of
growth factors) (2).
Acne atrophic scarring is typically treated with
microneedling, which is performed in an office setting.
Its clinical utility has been repeatedly demonstrated. In
most cases, a series of 3­5 therapy sessions spaced out
every 2­4 weeks will result in an improvement of 50%­
70%. Microneedling has been compared to chemical
peels, cryorolling, and carbon dioxide laser therapy for
the treatment of acne scars, and these treatments are
often used together for optimal results (1).

Figure (1): Wireless electric derma pen (1).

Received: 20/05/2022
Accepted: 25/07/2022

Full Paper (vol.891 paper# 69)

c:\work\Jor\vol891_70 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4573- 4577

Frequency of Insulin Resistance Among Infertile Women with Polycystic Ovary
Syndrome at Zagazig University Hospitals
Ali El-Shabrawy Ali 1, Ahmad Nader Mohammed Mustafa1,
Ahmed Mohammed Baraka2, Mostafa Abdo Ahmed1
Departments of 1Obstetrics and Gynecology and 2Clinical Pathology,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmad Nader Mohammed, Mobile: (+20) 01111606660, E-Mail: ahmadnader70@gmail.com

: Assessment of Insulin Resistance (IR) as well as glucose intolerance are advised among Polycystic
Ovary Syndrome (PCOS) cases.
Objective: To study the rate of IR among infertile women with PCOS at Zagazig University Hospitals.
Subjects and Methods: the study was conducted on 60 infertile women with age from 18 to 35 years old as cross
sectional trial, at Clinical Pathology Department and outpatient clinic of Obstetrics and Gynecology Department
Zagazig University Hospitals with calculation the frequency of insulin resistant among infertile women with
polycystic ovaries.
Results: The prevalence of IR among the studied cases was 60%. body mass index (BMI), waist circumference
(WC), and presence of hirsutism differed significantly between both studied groups. Testosterone levels and FBI
were significantly higher among IR cases compared to non IR cases.
Conclusion: incidence of insulin resistance is around 60% in PCOS infertile cases. Clinically, the G/I ratio may be
beneficial in identifying insulin-resistant PCOS women and choosing those most likely to benefit from therapy
interventions that increase insulin sensitivity.
Keywords: Insulin Resistance, Polycystic Ovary Syndrome, Infertility.

anovulatory but do not have hyperandrogenism should
Polycystic ovaries, oligo/amenorrhea as well
have their free testosterone measured, and if it is high,
as hyperandrogenism, are the three main phenotypic
their insulin resistance and glucose tolerance should be
characteristics of polycystic ovarian syndrome
checked. Women with IR and those at risk for
(PCOS), which impacts six to ten percent of women
developing IR should be sought out, since this may
worldwide. Weight problems, insulin resistance (IR),
lead to the prevention of some, or all of the symptoms
high insulin levels, and type 2 diabetes mellitus are
associated with polycystic ovary syndrome (5). Patients
among metabolic conditions that may accompany
with polycystic ovary syndrome should be evaluated
PCOS (IR prevalence is about 80 % among PCOS) (1).
for insulin resistance and glucose intolerance. The
Cancers of the breast and uterus are linked to
hyperinsulinemic euglycemic clamp is the gold
polycystic ovary syndrome (PCOS), as are
standard for evaluating IR, although it is notoriously
neurological and psychological impacts on quality of
difficult to perform in clinical settings (6).
life (such as anxiety and sadness). PCOS has been
Rotterdam criteria for PCOS diagnosis call for
identified in as much as 20% of infertile women. That
two of oligo/anovulation, hyperandrogenism, and
study goal was to evaluate the safety, efficacy, and
ultrasound evidence of polycystic ovaries. Twelve or
adverse effects of both oral and vaginal contraceptive
more follicles between 2 and 9 mm in diameter, or an
methods. Using misoprostol 600 mcg for ovum that
ovarian volume increase of more than 10 cm3, are
has been blighted (2).
among the Rotterdam consensus group's proposed
Impairment in insulin's capacity to promote
criteria for polycystic ovarian morphology. The
glucose consumption constitutes IR. In response
presence of many cysts in a single ovary is diagnostic
(hyperinsulinemia), pancreatic -cells produce and
of polycystic ovarian syndrome (7).
secrete more insulin, although glucose tolerance is
It was the goal of our study to study the rate of
unaffected. As a result of an insufficient physiological
IR among infertile women with PCOS at Zagazig
response of peripheral tissues to circulating insulin, IR
University Hospitals.
leads to CVD and T2D. IR is also present in conditions

such as poor glucose tolerance, obesity, polycystic
ovary syndrome, essential hypertension, and non-
Sixty infertile women aged from 18 to 35
alcoholic fatty liver disease (3).
years old were included in this cross-sectional trial, at
IR is a key player in PCOS's etiology and
Clinical Pathology Department and outpatient clinic of
progression. Treatment for polycystic ovary syndrome
Obstetrics and Gynecology Department Zagazig
has traditionally included the use of medications to
University hospitals.
increase insulin sensitivity (4). Women who are

Received: 18/05/2022
Accepted: 25/07/2022

Full Paper (vol.891 paper# 70)

c:\work\Jor\vol891_71 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4578- 4586

Assessment of Nurses' Knowledge and Practice Regarding Intra- Abdominal
Pressure Measurement and Abdominal Compartment Syndrome Prevention
Omnia Ramzy Reyad Abd El-gwaad*, Furat Hussein Mahmoud, Sabah Nazeh Mohmmed Eldriny
Departments of Medical Surgical Nursing, Faculty of Nursing, Helwan University, Egypt
*Corresponding author: Omnia Ramzy Reyad Abd El-gwaad, Mobile: (+20) 01024945124, E-Mail: omniaraamzy@gmail.com


Background: Intra-abdominal pressure monitoring helps in the early detection of patients who are susceptible for
developing intra-abdominal hypertension and enabling prompt treatment to prevent the development of abdominal
compartment syndrome. The management of critically ill patients and the identification of potential causes for clinical
worsening are the main role of critical care nurses.
The objective of the present study is to assess nurses' knowledge and practice regarding intra-abdominal
pressure measurement and abdominal compartment syndrome prevention.
Patients and methods: A descriptive exploratory design was utilized in this study. The study was carried out at intensive
care units, cardiac care units and emergency unit at Kom Hamada and Itay El Baroad Hospital. A convenient sample of
60 male and female nurses was recruited. Two tools were used for data collection; (I) Knowledge assessment
questionnaire and (II) Observational checklist to assess nurses' practices regarding intra-abdominal pressure
measurement. Results: Most studied nurses had poor knowledge regarding all items related to intra-abdominal pressure
measurement, intra-abdominal hypertension, and complications of abdominal compartment syndrome. Moreover, about
more than two-third of the studied nurses had an unsatisfactory level of practice regarding intra-abdominal pressure
measurement. Conclusion: The majority of the studied nurses had unsatisfactory level of knowledge and incompetent
level of practice regarding intra-abdominal pressure measurement and abdominal compartment syndrome
prevention.Recommendation: Continuous educational programs should be planned to nurses for enhancing their
knowledge and practice to achieve a high quality of care.
Keywords: Intra-abdominal pressure, Intra-abdominal hypertension, Abdominal compartment syndrome, Critically ill
patients, Descriptive study.


An IAP of 12 mmHg or more is known as intra-
Critical care patients are extremely vulnerable to
abdominal hypertension (IAH). IAH is further divided
serious health problems that could kill them. Patients
into four classes based on increasing pressures (grade 1:
who are more critically ill require nursing care that is
12 -15 mmHg; grade 2: 16-20 mmHg; grade 3: 21 -25
more intensive and watchful. Nurses are knowledge
mmHg; and grade 4: >25 mmHg). IAH may be acute or
workers because they can swiftly assemble several bits
chronic and might turn into a fatal abdominal
of information to make decisions on subtle or
compartment syndrome in case of sudden functional
deteriorating conditions. This is possible because nurses
changes in vital organs such as cardiovascular,
have high levels of attentiveness, intelligence, and
respiratory, and renal systems (4).
cognition. They employ both technical and theoretical
When the IAP is greater than 20 mmHg, with or
expertise in their job (1).
without an abdominal perfusion pressure (PP) less than
60 mmHg, abdominal compartment syndrome (ACS) is
abdominal compartment syndrome (ACS) are two
considered and is a constellation of signs and symptoms
problems for critical care patients that need quick
of end organ dysfunction or failure. It can also be
diagnosis and rapid management. Increases in intra-
divided into primary, secondary, and recurrent
abdominal pressure that are higher than the range of
categories. Primary ACS results from adisease or
physiologically normal values may have an impact on
damage to the abdominal/pelvic region. Conditions that
how well organs are vascularized and, ultimately, may
originate outside of the abdominopelvic cavity can
cause organ function to cease. Although critical care
cause secondary ACS. Abdominal compartment
nurses are responsible for measuring intraabdominal
syndrome that persists despite radiological or surgical
pressure, there is little literature that focuses explicitly
treatment is known as recurrent ACS (5).
on registered nurses' understanding of IAH and ACS(2).
Among critically ill patients, IAH and ACS are
The intra-abdominal pressure (IAP) is the steady-
associated with higher morbidity and mortality rates.
state pressure within the abdominal cavity. It is dynamic
Because of the limited space and its close anatomical
and varies with breathing (raising with inhalation and
contact with adjoining cavities, it not only affects the
falling with expiration), as well as the volume of the
function of intra-abdominal organs but also causes
intra-abdominal volume (IAV). IAP and IAV function
physiological alterations and malfunction of organs
well together. Whether it is filled with fluid, diseased
masses, or solid organs, as the volume grows, the
pathophysiological perspective, IAH and ACS can
abdominal cavity's compliance decreases, which raises
cause cardiovascular, respiratory and renal dysfunction
intra-abdominal pressure. IAP's typical range is (0- 5
and ultimately cause multiple organ failure (6).
mmHg). This rises in the critically ill to 5­7 mmHg (3).
Received: 19/05/2022
Accepted: 26/07/2022

Full Paper (vol.891 paper# 71)

c:\work\Jor\vol891_72 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4587- 4591

Impact of Lymphotoxin alpha Gene Polymorphisms on Childhood Asthma
Mohamed Sanad Nagiub1, Nermeen Samy Mohamed Ahmed*1,
Reham Hassan Anis Mohammed2, Sahbaa Fehr Mohamed Hafez1
Departments of 1Pediatrics and 2Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Nermeen Samy Mohamed Ahmed, Mobile: (+20) 01148996168, E-Mail: nermeensamy180@gmail.com

Bronchial asthma, a common allergic disorder among children, is a chronic airway inflammatory disease.
Clinically, it tends to occur with recurrent symptoms mainly involve dyspnea, wheezing, cough, and chest distress.
Objective: The aim of the study was to evaluate the association between lymphotoxin alpha (LT) gene polymorphisms
and childhood bronchial asthma.
Patients and methods: A case control study was carried out on 116 children divided to 29 control group and 87 cases.
Detection of lymphpotoxin alpha gene polymorphism was assessed.
Result: There was statistically significant difference between asthma group and control group regarding genotypes (P-
value 0.044). There was a statistically significant negative correlation between FEV1 and IgE level, and a significant
positive correlation between FEV1 and eosinophilic count.
The genetic predisposition is considered one of the important attributable risk factors of childhood asthma.
In addition, the polymorphism of lymphotoxin alpha A/G (rs2844484) is correlated with the risk of childhood asthma.
Lymphotoxin alpha Gene Polymorphisms, lymphotoxin alpha, Childhood Asthma, Risk factors.


Bronchial asthma, a common allergic disorder
Zagazig University during the period from November
among children, is a chronic airway inflammatory
2020 to July 2021.
disease. Clinically, it tends to occur with recurrent

symptoms mainly involve dyspnea, wheezing, cough,
Sample size:
and chest distress (1).
A total of 116 children were included in our study.
Asthma is the most common chronic disease in
The recruited children were divided into two groups:
childhood and the main cause of childhood leading
The first group included 29 non-asthmatic children, and
morbidity of chronic disease years, the incidence rate of
the second group included 87 asthmatic children.
childhood asthma has been increasing each year, which
Participant children were classified according to GINA
means a serious risk to the physical and mental health
2018 (4) into:
of children (2).
- 29 well controlled asthmatic children.
According to global statistics, it is among the top
- 29 partially controlled asthmatic children.
10 chronic conditions in children aged 5-14 years.
- 29 uncontrolled asthmatic children.
Bronchial asthma mortality rate in children globally

ranges from 0 to0.7 per 100 000 (1).
Inclusion criteria: Children with bronchial asthma,
Lymphoxin alpha (LT) is an immune-related
approval to participate in the study, both sexes, and age
cytokine that belongs to the tumor necrosis factor
from 5-15 years.
family. It has a molecular structure and an active region
Exclusion Criteria: Refusal to participate in the study,
similar to those of tumor necrosis factor- (TNF-).
asthmatic children younger than 5 years old or older
LT is located on the MHC class III region of the short
than 15 years old, children with accompanied
arm of chromosome 6. It is produced in autoimmune
inflammatory diseases as (inflammatory bowel,
diseases and tumors after the stimulation of mitogen and
rheumatic fever, vasculitis), and children suffering from
lymphocyte antigen (3).
liver, renal or other chronic diseases rather than
It can affect cell apoptosis and regulate
bronchial asthma.
inflammatory immunity. Recently, some studies have

showed that TNF- may be one of the crucial candidate
sites for the susceptibility to bronchitis but the role of
All patients were subjected for:
LT has not been proved yet (3).
A) Detailed history taking from patients or parents.
The objective of our study was to study the genetic
B) Physical examination includes anthropometric
polymorphism of lymphotoxin alpha (LT) in children
measures, weight in kg and height in cm.
with bronchial asthma.
C) Laboratory investigations: Complete blood count, C-

reactive protein, liver function tests, and kidney
function tests.
This was prospective case control study conducted
D) Pulmonary function test: It was performed for
at Pulmonology & Allergy Unit of Pediatric Department
asthmatic patients with 5 years and more using
in Pediatric Hospital, and Medical Microbiology and
forced spirometry by D-97024 Hochberg, Germany,
Immunology Department, Faculty of Medicine,
which is a program that allows a fast and reliable
Received: 29/05/2022
Accepted: 26/07/2022

Full Paper (vol.891 paper# 72)

c:\work\Jor\vol891_73 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4592- 4596

Fibromodulin Level in Association with Clubfoot Disease and Congenital
Dislocation of Hip in Children Patients in Najaf Province
Iman Ali Mohammed 1, Arshad Noori Al-Dujaili 2*
1Ministry of Education, Najaf Education Directorate, Iraq
2Department of Biology, Faculty of Science, University of Kufa, Iraq
*Corresponding author E-mail: arshad.aldujaili@uokufa.edu.iq, Mobile: 009647809325264

The main characterizations of foot deformity, which is called congenital talipes equinovarus, in severity and
variation degree depend on complications and congenital malformations. They are classified into four main components
such as midfoot cavus, forefoot adducts, heel/hind foot various and hind foot equines.
Objective: This study aimed to estimate some of biochemical markers such as asporin, fibromodulin and tenascin-C in club
foot child disease to determine pathological causes of severe deformity of bone, for monitoring complications of bone
mineralization and calcification and for early treatment using drugs of choice.
Patients and Methods:
60 Clubfoot patients with dislocation dysplasia of Hip (DDH) disease were included in this study.
The samples were collected from Clubfoot Unit and private centers in Holy Najaf, Iraq during the period from December
2020 to February 2021. The patients groups were divided into subgroups according to age, gender, idiopathic, syndrome,
Parina score, body mass index (BMI) and clubfoot. The control group included 30 apparent healthy participants and the age
was nearly matched with patients' groups.
Results: The level of tenascin-C was increased significantly in clubfoot patients than in control group. Also, tenascin-C
level was highly increased in advanced ages (3-5) years in comparison with other ages and in males than in females. Also,
high score (6-7) was significantly increased than other scores. The present results showed that club foot with dislocation
dysplasia of hip was highly significant compared to clubfoot only and dislocation dysplasia of hip only in all children
patients. Moreover, clubfoot syndrome was higher than idiopathic syndrome significantly whereas no differences in
tenascin-C level in all subgroups according to BMI (normal, overweight and obese) of children of clubfoot.
Conclusion: Increased levels of tenascin-C is very important as a pathological marker in patients of clubfoot with dysplasia
of Hip.
Keyword: Clubfoot, Children, Tenascin-C, BMI, Ages, Gender, Syndrome.

complications of bone mineralization and calcification for
Clubfoot, also known as talipes equinovarus, is one of
early treatment using drugs of choice.
the most universal human limb disorders, more than 2%

of newborns. Also, the deformity manifests as an instep
that has an adductus, the midfoot has a cavus, and the
Patients and healthy groups:
posterior foot has an equinovarus (1). Fibromodulin is the
The current study included sixty patients suffering
primary hormone of fibril formation (2). Fibromodulin and
from clubfoot and dislocation dysplasia of hip (DDH)
lumican have similar primary components and bind to
disease. The samples were collected from clubfoot unit
almost the same site on type I collagen (3).
and private centers in Holy- Najaf /Iraq during the period
Only fibromodulin and lumican are engaged in tissue-
from December 2020 to May 2021. The patients groups
specific management of fibrillogenesis, in addition to
were subdivided into subgroups according to age, gender,
tendon. In the vicinity of fibromodulin, lumican was
idiopathic, syndromic, parina score, body mass index
expanded (4). Fibromodulin (FMOD) is one of the
(BMI) and clubfoot. The control group was thirty appear
extracellular matrix's small leucine-rich proteoglycans
control and the age were nearly matched with patients
(SLRPs). It has many physiological functions including
fibrillogenesis, muscle cell formation, cell fate

determination, and angiogenesis enhancement (5). Also
Experimental design:
participates in the pathogenesis of several pathological
The clubfoot patient's total numbers of sixty clubfoot
systemic fibrosis, cancers, and atherosclerotic plaques are
group was subdivided into seven groups as the following;
examples of such conditions (6). Therefore, this study
1. Ages (1> year; N=36, (1-2year); N=13, (3-5year)
aimed to estimate some of biochemical markers such as
asporin, fibromodulin and tenascin-C in club foot child
2. Gender (male; N=40, female; N=20)
disease to determine pathological causes of disease by
3. Pirani score (2-3 degree); N=20, (4-5 degree) N=34, (<
severe deformity of bone and for monitoring
6 degree; N=6)
Received: 2/5/2022
Accepted: 3/7/2022

Full Paper (vol.891 paper# 73)

c:\work\Jor\vol891_74 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4597- 4601

Anatomical Variables as Predictive Factors of Intra-Operative
Residual during Adenoidectomy
Mohamed Ahmed Alshawadfy Saleh, Nasser Najeeb Nasr, Monira
Abdulrahman Salem Elkaseh, Ibrahim Mohamed Saber
Department of Otorhinolaryngology, Head and Neck surgery, Faculty of Medicine, Zagazig University
*Corresponding author: Monira Abdulrahman Salem Elkaseh, Mobile: (+20) 01012585954,
E-mail: 0925548894mk@gmail.com

Children with adenoids that have grown too large often have difficulty breathing or get infections among
upper respiratory tract because their airways are blocked. In most cases, adenoidectomy can reduce clinical symptoms
and boost quality of life.
Objectives: This study aimed to determine if there are any factors that can influence the usual procedure of
adenoidectomy and its ability to remove all adenoid tissue.
Subjects and Methods: Intra-operative variables for assessing demographic and anatomical characteristics, such as
age, sex, weight, height, BMI, and soft palate length were observed in a retrospective analysis to determine their impact
on adenoidectomy success. Every child had a standard trans-oral curettage adenoidectomy completed under endoscopic
control, and if there were any adenoid remnants, a revision adenoidectomy was done at the same time. The total number
of patients included was 208.
Results: In 43.7% of patients (91/208), complete adenoidectomy was challenging since traditional surgery could not
access the most important parts of the nasopharynx. The average soft palate length in this group was 2.8 centimeters, 5
millimeters longer than the sample as a whole, and 1 cm larger than the typical patient who undergoes only standard
surgical procedure alone (p < 0.001). Conclusion: Intraoperatively, the soft palate length can be used as a factor for
choosing which patients would undergo endoscopic control following standard adenoidectomy.
Keywords: Intra-operative residual, Adenoidectomy, TECCA, Revision adenoidectomy.

other than a deviated septum or overgrown turbinates
Hypertrophied adenoids are a common cause of
could be to blame for post-operative discomfort (5).
pediatrics upper airway obstruction. Along with,
Otolaryngologists perform adenoidectomy and
obstructive sleep disorder, snoring, persistent rhinorrhea,
tonsillectomy more frequently than any other surgical
as well as hyponasal speech, nasal blockage is one of the
operation in children. Several methods have been offered
main symptoms they come with. Hyperplastic adenoids,
to lessen the risk of bleeding and make it simpler and
on the other hand, can be colonized by bacteria and may
safer to remove adenoid tissue. The co-ablator, adenoid
serve as a source of chronic illness (1, 2). Obstruction of
the upper airway, particularly during sleep, can cause
microdebrider are all variable options for this procedure
distress to the respiratory system and a host of related
(6). The nasopharyngeal airway is clearly visible in the
problems. Adenoid hypertrophy is the leading cause of
lateral view of the skull, in stark contrast to the shadows
childhood upper airway obstruction, and it is quite
cast by the soft tissues and the skull base. As a result, the
prevalent. Mouth breathing, snoring, sleep apnea, and a
lateral skull view is frequently employed in the detection
hoarse or weak voice are just some of the symptoms that
of adenoid hypertrophy (7).
may result from nasal passage obstruction caused by
When the adenoid or tonsil is removed, the
enlarged adenoids. Adenoid hypertrophy can also lead to
obstructive symptoms typically improve. With
facial asymmetry, chronic middle ear infections, and
adenotonsillectomy, there is an estimated 80% success
sinus infections (3).
rate in curing obstructive sleep apnea (5). Adenoid
When performed alone, adenoidectomy can
residual following surgeries is a potential cause of
alleviate nasal congestion and the symptoms of frequent
recurrent nasopharyngeal blockage symptoms. Residual
colds and other respiratory illnesses (4). However, after
rates might be anywhere from 1.3% to 26.4%. Recent
surgery, some patients still experience considerable nasal
focus has been virtually entirely on intra-operative
problems. Nineteen to twenty-six percent of individuals
patient-independent factors (8).
suffer persistent symptoms, like stuffy noses and frequent
This study aimed to determine whether or not
infections of the upper respiratory tract (5).
factors specific to each patient would affect how well the
It is widely held among doctors and the general
standard method of removing adenoid lymphoid tissue
public that some individuals may continue to experience
symptoms related to their adenoids even after they have

been surgically removed. Sometimes, this viewpoint is
what fuels the debate about this procedure. Some authors
claim that adenoids rarely re-grow to the point where they
Children were included in retrospective
induce symptoms of nasal obstruction, however there is
observational research that included 208 participants
a lack of data to support this. Others argue that anomalies
(aged less than fifteen years) who underwent
Received: 14/4/2022
Accepted: 13/6/2022

Full Paper (vol.891 paper# 74)

c:\work\Jor\vol891_75 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4602- 4610

Surgical Outcomes of Intradural Extramedullary Spinal Tumors Excision Using
Intraoperative Neurophysiological Monitoring
Mohamed A. Samir, Adel S. Ismail, Ahmed Basher Mohamed, Ahmed A. Morsy
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Ahmed Basher Mohamed Madi Abdulwahid, Mobile: (+20) 1090006152,
E-mail: ahmedabdulwahed89@gmail.com

: Resection significantly improves the clinical symptoms and functional outcomes of patients with
intradural extramedullary tumors. However, patient quality of life following resection has not been adequately
Objective: The purpose of our study was to improving outcomes of patients with intradural extramedullary spinal
Patients and methods: A prospective study of 20 cases with intradural extramedullary spinal tumors treated by using
intraoperative neurophysiological monitoring (IOM) in Neurosurgery department, Zagazig University Hospitals, Egypt,
from March 2021 to February 2022. All patients were subjected to complete clinical examination according to medical
research council scale (MRC) and modified McCormick scale (MMS) and MRI Imaging.
Results: This study showed that 90% of patients had total extent of resection with only 10% of patients had immediate
neurological deficit. The intraoperative neurophysiological recovery monitoring to predict immediate neurological
deficit had 66.7% sensitivity and 94.12% specificity with 90% accuracy. While intraoperative neurophysiological
recovery monitoring to predict neurological deficit at 3 months had 100% sensitivity and 89.47 % specificity with 90%
accuracy. Conclusion: A reliable prediction of clinical improvement could be made based on pre-operative clinical
status. The use of intraoperative neurophysiological monitoring leads to better neurological outcomes at discharge and
Keywords: Intradural extra medullary, Intraoperative neurophysiological monitoring, Functional outcome, Oncology.


Intradural extramedullary (IDEM) tumors are
This prospective study included a total of 20
generally benign neoplasms arising in the spinal canal,
patients for evaluation of the surgical outcome using
accounting for about two thirds of primary spinal
tumors and 15% of tumors affecting the Central
attending at Department of Neurosurgery, Zagazig
Nervous System (1). Owing to their relative rarity, no
University Hospitals. This study was conducted
specific treatment guidelines are currently available,
between March 2021 to February 2022. Patients were
although radical excision surgery is considered to be the
8 (40%) males and 12 (60%) females.
treatment choice. The anatomical location of these

tumors and the limited space for maneuvering pose a
Inclusion criteria: Patients of all age groups with
considerable challenge for surgeons, as the aim is to
radiologically confirmed intradural extramedullary
achieve complete surgical resection good functional
(IDEM) spinal tumor. Preoperative motor power grade
outcome and preserving spinal stability (2). Technical
III or more according to medical research council
advances in imaging, neuromonitoring, and minimally
(MRC) grading system. Fit for surgery with stable
invasive approaches have been developed for surgery of
cardiopulmonary and good general condition. Patient is
intradural tumors, aiming to reduce complications and
accepting and understanding the technique.
improve functional outcomes (3).

The real clinical benefits of these new concepts for
Exclusion criteria: Patients with radiologically
the treatment of extramedullary lesions remain a matter
confirmed other types of spinal tumors rather than
intradural extramedullary spinal tumors or proved
neurophysiological monitoring (IONM) could be
intraoperative not to be intradural extramedullary spinal
considered a valid tool to detect during the procedure
tumors. Patients with recurrent Intradural spinal tumors.
the occurrence of a neurological injury, then being able
Severe preoperative motor deficit (motor power < grade
- potentially - to suggest both corrective measures to
III). Patients who were not candidate for surgical
surgeons and to predict clinical outcomes in a short and
treatment. Prescence of Contraindication to trans cranial
long term follow-up (4). However, the heterogeneity of
electric stimulation.
available studies in terms of methods and monitoring

modalities have often made questionable any
Preoperative investigations:
conclusion about the therapeutic role of IONM (5).
All patients were subjected to Demographic data
This study was aimed to improving outcomes of
taking, complete clinical examination, laboratory
patients with intradural extramedullary spinal tumors.
investigations included complete blood picture (CBC),

bleeding profile (PT, PTT, and INR), Liver function
Received: 18/05/2022
Accepted: 25/07/2022

Full Paper (vol.891 paper# 75)

c:\work\Jor\vol891_76 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4611- 4616

The Situation Among Egyptian Elderly with Type 2 Diabetes; A Call for Action
Hossam Arafa Ghazi
Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura - Egypt
Corresponding Author: Hossam Arafa Ghazi, Mobile: (+20)1006408074, Email: hossamghazi7@gmail.com

Egypt is listed as one of the top ten countries with people with diabetes. Moreover, percentage of elderly
population is growing due to improvement of health care services. Unfortunately, there is a paucity of national data
about the situation among elderly patients with type 2 diabetes (T2D).
The aim of this study was to estimate the gap between recommendations of guidelines and real-world data
regarding control of glycaemic state and its associated risk factors.
Patents and methods: The current study was conducted on 207 patients with T2D aged 60 years and more, both males
and females. Comprehensive geriatric assessment was done, and laboratory data were collected from the participants
after exclusion of other types of diabetes
Results: The mean age of the patients was 66.59 ± 4.36 years and 132 of participants were females. 69 % of the patients
were known to have hypertension and on regular medical treatment. Furthermore, the mean glycated haemoglobin
(HbA1c) was 8.34±1.09 % and only 14% have HbA1c less than 7.5 %. On the other hand, just 28 patients were taking
statins regularly.
Conclusion: It could be concluded that there is a large gap between the guideline's recommendation and the situation
in real life. Morbidity and mortality rates will increase among those population and surely will increase the health burden
on the health care providers in a developing country like Egypt. More education is recommended for the doctors and
Key words: Elderly, Type 2 Diabetes; Glycated Haemoglobin, Hypertension.

annually. Furthermore, paucity of patients who are
Diabetes Mellitus (DM) is considered as rapidly
doing their routine screening tests is away from the
growing global health problem. Egypt is listed as one of
target of most guidelines particularly the American
the top ten countries having people living with DM.
Diabetes Association (ADA) which is popular
According to the International Diabetes Federation
guidelines for many physicians in Egypt.
(IDF), Egypt has 10.9 million people living with
This study was aimed to explore the control of
diabetes (aged from 20-79 years) in 2021 and it is
glycaemic state, blood pressure and lipid profile among
expected to be duplicated in 2045 by reaching about 20
Egyptian elderly patients with T2D according to ADA
million patients with DM (1).
2022 guidelines.
On the other hand, in the last few decades it is

documented that there is increase in the absolute and
relative number of elderlies in Egypt. According to the
This non-interventional cross-sectional study
central agency for public mobilization and statistics,
included a total of 207 Egyptian elderly patients, both
elderlies represent about 7% of total Egyptian
males and females aged 60 years or older, attending at
population in 2019 and by the year 2030 they expected
Geriatric and Diabetes Outpatient Clinics of
to represent about 12% to the total population (2).
Specialized Medical Hospital, Mansoura University,
Prevalence of DM is increased with age. The
and private clinics.
lowest prevalence is recorded among adults aged

between 20­24 years (2.2% in 2021). Surprisingly,
Exclusion criteria: Other types of DM rather than T2D,
prevalence of DM is 24.0% in 2021 among adults aged
patients with secondary hypertension, patients who
between 75­79 years and expected to reach 24.7% by
were not compliant on their treatment, patients had
the year 2045 (1).
psychological disease as depression and psychosis,
Certainly, with growing of the Egyptian elderlies
patient with known other endocrinal diseases like
the proportion of DM among them will increase and
hypopituitarism, acromegaly, Cushing's disease, and
subsequently -if not managed properly- the morbidity
patients with familial dyslipidaemia.
and mortality rates will increase, and health care

providers will pay more cost for that, and this is a major
Detailed medical history was taken (including drug
problem in a developing country like Egypt. With daily
history and comorbid conditions). General Examination
practice, detailed history taking with elderly patients
was done for all participants including measurement of
with Type 2 diabetes (T2D) show that many of them are
brachial blood pressure and body mass index (BMI).
not keen to monitor their blood pressure and their
Glycated Haemoglobin (HbA1c), lipid profile and
glycaemic state nor screen for diabetes complications
creatinine were measured and estimated Glomerular

Filtration Rate (eGFR) was calculated using the original
Received: 19/5/2022
Accepted: 26/7/2022

Full Paper (vol.891 paper# 76)

c:\work\Jor\vol891_77 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4617- 4621

Vacuum Assisted Therapy in Management of Deep Sternal Wound
Infections in Pediatric Cardiac Surgery
Alaa Omar*, Mahmoud Gamaleldin, Mahmoud Eldegwy
Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Alaa Omar, Mobile: (+20)1001168488, E-Mail: alaaomarcts1@yahoo.com

In adult and pediatric cardiac surgery, median sternotomy is considered the usual access to gain variable
cardiac operations. Although the rarity of this complication in pediatrics, it is serious and carry a high risk of morbidity
and mortality. Vacuum assisted closure (VAC) system is increasingly used for treating deep sternal wound infection
(DSWI), VAC therapy becomes a widely accepted method for treating DSWI and mediastinitis in adults. In spite of this,
there is no wide experience of using the VAC system in pediatric cardiac surgery.
Objective: The aim of the current work was to investigate the safety and efficacy of vacuum-assisted therapy in
management of deep sternal wound infections in pediatric cardiac surgery.
Subjects and Methods: Between May 2012 to April 2022, we treat 44 infant and child complicated with postoperative
DSWI and mediastinitis. This prospective analytical study was conducted at Abo Elrish Hospitals, Cairo University.
The main primary end point of our study was complete resolution of sternal wound and patient survival.
Results: Since 2012 to 2022 about 44 patients treated from DSWI and/or mediastinitis post pediatric cardiac surgery
using VAC system. Age of the patients ranging from 3 months to 9 years with mean 2.5 years. There was one case of
mortality not related to VAC therapy in our study group due to severe chest infection in spite of dramatic improvement
of the local wound condition within one week of starting treatment. No complications were encountered during the
period of VAC treatment. Most importantly, there was no VAC device related complications experienced in all patients.
The VAC was used as a destination therapy in 42 cases with wound closure by secondary sutures. There was only one
case needed a sternal rewiring with good results.
Conclusion: It could be concluded that VAC therapy is a safe and effective treatment modality for either infant and
children and provide a good alternative to the conventional methods of treatment in settings of mediastinitis and deep
sternal wound infections with excellent results.
Keywords: DSWI ­ VAC Therapy­ Pediatric Cardiac Surgery.


flow, removing localized edema, increasing granulation
In adult and pediatric cardiac surgery, median
tissue formation and angiogenesis (6,7).
sternotomy is considered the usual access to gain
The aim of the current work was to investigate the
variable cardiac operations. In spite of the huge number
safety and efficacy of vacuum-assisted therapy in
of procedures done annually, the incidence of deep
management of deep sternal wound infections in
sternal wound infection (DSWI) and mediastinitis in
pediatric cardiac surgery. We report our 10 years'
pediatric patients is low (1,2). The incidence of DSWI is
experience of using the VAC system as a safe and
about 0.2% to 5% among postoperative pediatric
effective technique in management of DSWI and
cardiac populations which is less than incidence in adult
mediastinitis in infants and children till complete sternal
age group (2,3). Although the rarity of this complication
wound healing.
in pediatrics, it is serious and carry a high risk of

morbidity and mortality (4). DSWI postoperatively
causes prolonged intensive care unit duration and
This prospective analytical study included a total
hospital stay with additive cost to the patients and health
of 44 infant and child complicated with postoperative
systems (5). Many treatment methods had evolved in
DSWI and mediastinitis, treated at Abo Elrish
management of DSWI including early aggressive
Hospitals, Cairo university. This study was conducted
surgical debridement with repeated dressing, closed
between May 2012 to April 2022.
irrigation, muscle and omental flaps, but results still not
The diagnosis of the DSWI and mediastinitis
satisfactory with mortality rates ranging from 5% to
based on the United States Centre for Disease Control
47% (6,7). Vacuum assisted closure (VAC) system was
and Prevention guidelines(8). All patients subjected to
first introduced by Obdeijn et al in 1997 as a new
full history analysis including:
technique for treating DSWI (8). Since then, VAC
Demographic characteristics.
therapy becomes a widely accepted method for treating
Echocardiographic diagnosis.
DSWI and mediastinitis in adults. Despite this, there is
Type of surgical operation.
no wide experience of using the VAC system in
Full laboratory investigations: renal function tests,
pediatric cardiac Surgery (9,10).
liver function tests, bleeding profile, complete
The VAC system allows a uniform negative
blood count (CBC), and blood & wound culture.
pressure all over the wound surface which promotes
Chest X-ray and/ or chest Computed Tomography
wound healing by increasing vascular and lymphatic
(CT) scan.
Received: 18/5/2022
Accepted: 25/7/2022

Full Paper (vol.891 paper# 77)

Type of the Paper (Article The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4622- 4625

Effects of Date Palm Pollen on Women with the Polycystic Ovarian Syndrome
Rania Mahfouz Abd El-Wahed*1, Alshaymaa Abdelbadie Abdelalim Nasr2
Departments of 1Obstetrics and Gynecology and 2Clinical Pathology,
Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
*Corresponding author: Rania Mahfouz Abd El-Wahed, Mobile: (+20) 01088916521, E-Mail: rania.mahfouz2@gmail.com


Background: Polycystic Ovarian Syndrome (PCOS) is characterized by metabolic, endocrine, and genetic
abnormalities, as well as the absence of ovulation and clinical and biochemical manifestations of hyperandrogenism.
Menstrual irregularities, hirsutism, acne, alopecia, and infertility are all symptoms of PCOS. PCOS is a gynecological
condition that affects women of reproductive age. Drugs like clomiphene citrate, tamoxifen, and metformin are used to
treat PCOS in women. Alternative medications with fewer side effects and more relative treatment, such as plant-based
drugs, especially estrogen-containing drugs, should be sought. The objective of the present study was to evaluate the
effectiveness of date palm pollen in PCOS.
Patients and methods:
One-arm clinical trial was conducted at Alzahraa University Hospital over 2 years from 2018
to 2020; 50 women who met the Rotterdam criteria for PCOS were enrolled in the study, which included daily
administration of 3 gm of date palm pollen (DPP) for three months, and followed up for sex hormones, follicle-
stimulating hormone (FSH) luteinizing hormone (LH), estrogen, and progesterone after three months of treatment and
growth of the follicles every month.
Result: There was an improvement in sex hormone levels, with lower estrogen and LH levels and higher progesterone
and FSH levels, and a cumulative effect on ovulation. Only 6% of the participated women became pregnant during the
study period.
Conclusion: Date palm pollen can be used for the management of women with infertility with PCOS.
Palm Pollen, Polycystic Ovaries, PCOS, FSH, LH.

and managing PCOS, such as plant-based drugs,
Polycystic Ovarian Syndrome (PCOS) is a
especially estrogen-containing ones, is a must [7].
gynecological condition that affects women of
The date palm (Phoenix dactylifera) has high
reproductive age. The prevalence ranges between 4 and
antioxidant content in its fruit. Southwest Asia and
12% [1]. In roughly 75% of instances, chronic
northern Africa are home to this fruit [8]. The date palm
anovulation is the cause of infertility [2].
fruit contains 44­88% carbs, 2.3­5.6% proteins, and
PCOS is characterized by metabolic, endocrine,
0.2­0.5% fat. The presence of more than 23 different
and genetic abnormalities and the absence of ovulation
amino acids in the protein of date palm fruit contributes
and hyperandrogenism in clinical and biochemical
to its high quality. In addition, the date palm fruit
manifestations [3]. Menstrual irregularities, hirsutism,
contains 0.5% to 3.9% pectin and 6.4 to 11.5% fiber.
acne, alopecia, and infertility are all symptoms of
The date palm fruit has antibacterial, anti-
PCOS. Endocrine hormone alterations include
inflammatory, and antioxidant properties [9].
increased estrogen, androgen, decreased progesterone
The date palm fruit contains around 80,400 mg
levels, and metabolic problems such as insulin
of antioxidant chemicals per 100 g and 3942 mg of
resistance, type 2 diabetes, and dyslipidemia. However,
carotenoids and phenolic compounds per 100 g [10].
estradiol levels do not change in some cases [4].
Polyphenols at a concentration of 30,000 ppm (3 g/100
Androgen hormone levels rise because ovarian cells are
g) were also found in the date palm fruit's components
far more active in converting androgenic precursors into
testosterone in women with PCOS than in healthy
Furthermore, phytoestrogens, which have a
women. This is due to the response of theca cells to
molecular structure comparable to estradiol, are one of
luteinizing hormone (LH) [5]. High levels of androgens
the components of date palm. Due to the features
and testosterone in women with PCOS contribute to
mentioned above, the fruit of the date palm is a good
ovulation dysfunction and altered sex hormone
source of antioxidants [12]. Male date palm blooms
production, resulting in symptoms and ovary
generate pollen, which is a powder. Fresh pollen is
dysfunction in patients, the leading cause of infertility
made up of 64% to 95% solids and 5% to 36% water.
in reproductive-age women [6].
Date palm pollen contains many carbohydrates,
Nowadays, drugs like clomiphene citrate,
minerals, trace elements, lipids, nucleic acids, organic
tamoxifen, and metformin are used to treat PCOS in
acids, free amino acids, proteins, and over 100 enzymes
women despite their severe side effects and relatively
and cofactors [13]. Date palm pollen is high in
poor therapeutic efficacy. Consequently, discovering
carotenoids and flavonoids, and phytochemicals and is
alternative therapeutics with fewer side effects and
a potent source of vitamins A, B, C, D, and E, as well
having the capacity to provide better efficacy in treating
as minerals and hormones [14].
Received: 19/5/2022
Accepted: 16/7/2022

Full Paper (vol.891 paper# 78)

c:\work\Jor\vol891_79 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4626- 4631

Usefulness of Gait Speed as a Screening Parameter for Sarcopenia in Cirrhotic Patients
Marwa Abdel Razek Salama*1, Elham Ahmed Hassan1, Nahed A Makhlouf1, Mohamed Eltaher Ibrahim1,
Hany M Dabbous2, Medhat A Salah3, Hani Sayed Aboalam4, Mohamed Zidan Mohamed5
Departments of 1Gastroenterology and Tropical Medicine, 3Public Health and Community Medicine and 5Diagnostic
Radiology, Faculty of Medicine, Assiut University, Egypt,Department of 2Tropical Medicine, Faculty of Medicine,
Ain Shams University, Egypt,4Assiut Liver Center, Ministry of Health, Egypt
*Corresponding author: Marwa Abdel Razek Salama, Mobile: 01155544090, E-mail: marwamakhlof088@gmail.com
Sarcopenia in cirrhotic patients has a serious effect on their outcome. Although several modalities are
used for diagnosing sarcopenia by measuring skeletal muscle mass, they are expensive and may not be available. The
objective of the present study is to assess the utility of gait speed for diagnosing sarcopenia in cirrhosis as compared
with computed tomography skeletal muscle index (CT-SMI). Patients and methods: A cross-sectional study recruited
331 adult patients with hepatitis C-related cirrhosis. Clinical assessment, gait speed, and CT-SMI in the third lumbar
vertebra were determined. Sarcopenia was defined when CT-SMI < 52.4 cm2/m2 in men and when < 38.5 cm2/m2 in
women. Diagnostic performance of gait speed at a cut-off value <0.8 m/s for diagnosing sarcopenia in cirrhosis was
assessed. Results: Sarcopenia by CT-SMI was detected in 52.6% of patients. A significant correlation was found
between CT-SMI and gait speed with slightly higher in women. Using the existing cut-off value of gait speed lower
than 0.8 m/s, we detected sarcopenia in 146 (44.1%) patients, and when compared with CT-SMI for diagnosing
sarcopenia, the specificity, sensitivity and overall accuracy were 91.7%, 84.5%, and 87.9%, respectively. Better
performance was observed in women; 82.5% sensitivity, 96.1% specificity and 91.4% accuracy. Conclusion: Gait speed
could be used as a marker of sarcopenia for cirrhotic patients in areas where modalities of diagnosing skeletal muscle
index are deficient. Although gait speed is not the only method for diagnosing sarcopenia, it has the potential to be a
helpful clinical tool for identifying sarcopenic patients.
Keywords: Gait speed, Liver cirrhosis, Sarcopenia, Skeletal muscle index.


is needed to determine how much of a CT scan is
Sarcopenia is the progressive wasting away of
devoted to muscle before making any adjustments (10).
muscular mass and function, manifesting itself in
On the other hand, gait speed has been considered
diminished performance or strength (1). The incidence
a simple, objective, and disease-specific measuring
among cirrhotic individuals ranges from 40-70%,
parameter of physical performance in several diseases
depending on the severity of the underlying liver disease
e.g., chronic obstructive pulmonary disease, as well as
and the diagnostic methods and criteria employed (2,3).
chronic kidney disease (11,12). Hospitalization for these
Loss of muscle mass and strength is also linked to
disorders' consequences is also linked to this (13).
physical frailty, which can render patients immobile and
Several studies revealed a link between muscle
restrict their outdoor activity (4).
performance or motor function and liver diseases
Sarcopenia is implicated in the pathogenesis of
decompensation in liver cirrhosis and is linked to worse
Moreover, the cut-off values used to define sarcopenia
outcomes like decreased quality of life, increased risk of
and reduced muscle function by gait speed were
cirrhosis complications, infections, hospitalizations,
validated in several conditions e.g., patients with tumors
and mortality (5). For this reason, the early detection and
and obesity (16,17), but their utility in cirrhotic patients
proper management of sarcopenia in cirrhotic patients
particularly those with hepatitis C virus (HCV)-related
are crucial for the potential improvement of survival (6).
cirrhosis that is more prevalent in our locality is lacking.
Several works evaluated sarcopenia in cirrhosis
Therefore, the purpose of this study was to investigate
with different modalities including bioelectrical
the validity of using speed gait as a screening tool for
impedance analysis (BIA), Dual Energy X-ray
sarcopenia in cirrhotic patients by examining the
Absorptiometry (DXA), magnetic Resonance Imaging
association between muscular function as determined
(MRI), ultrasonography, and computerized tomography
by gait speed and skeletal mass index (SMI) as assessed
(CT) scan which may not available in clinical locations
by CT scan.
besides anthropometric parameters (2,6,7). Furthermore,

these modalities cannot be used routinely for the clinical
diagnosis of sarcopenia due to both cost and access
This cross-sectional study was conducted at Assiut
difficulties (8). On the other hand, anthropometric
University Hospital, Assiut, Egypt, from August 2018
parameters are less expensive but more prone to error
to December 2021.
(9). The most commonly used and thoroughly studied
Study population
measure of sarcopenia in people with cirrhosis is
The study population included 331 adult patients,
computed tomography (CT), which is also the most
diagnosed with cirrhosis due to hepatitis C who were
expensive tool for detecting sarcopenia (2,5). There is
hospitalised at the AL-Rajhi Liver Center at Assiut
some radiation exposure involved, and special software
University Hospital in Assiut, Egypt. The diagnostic
Received: 22/5/2022
Accepted: 27/7/2022

Full Paper (vol.891 paper# 79)

c:\work\Jor\vol891_80 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4632- 4639
Sarcopenia in Patients with Liver Cirrhosis Assessed by Skeletal Muscle
Ultrasound and Its Relation to Serum Testosterone Level
Amira K. El-Alfy1, Basma A. Badr1, Walid S. El-Din2,
Raof M. Rashed*1, Mohamed Abd Ellatif Afifi1
Department of 1Internal Medicine and 2Rheumatology, Faculty of Medicine, Benha University, Egypt.
*Corresponding author: Raof M. Rashed, Mobile: (+20) 01112066346, Email: raofrashed4@gmail.com

When it comes to quantifying muscle mass in cirrhotic patients, Computed Tomography (CT) is the gold
standard; nevertheless, CT is not practical for muscle measurement due to its high cost, radiation exposure, and logistical
issues. Ultrasound detection of quadriceps muscle thickness has been recently presented as a more convenient bedside
method to assess sarcopenia. The objective of the present study is to evaluate the role of ultrasound in assessment of
biceps and quadriceps muscles thickness and echogenicity index as diagnostic parameters in liver cirrhosis patients and
to study the relationship between sarcopenia and testosterone levels in these patients.
Patients and methods: A total of 50 cirrhotic patients were enrolled in this study from June 2021 to June 2022 at the
Internal Medicine Department of Benha University Hospital. Our study included patients having diagnostic evidence of
advanced liver cirrhosis (clinical, laboratory, and/or ultrasonographic) and aged >18 years.
Results: Testosterone in men was found to have a favorable and statistically significant relationship with handgrip (r =
0.667, P <0.001). In contrast, it showed significant negative correlations with rectus femoris echo index (r = -0.459, P
= 0.008) and F-SARC (r = -0.766, P <0.001). Non-significant correlations were reported between testosterone and biceps
echo index (P = 0.523), biceps thickness (P = 0.340), and rectus femoris thickness (P = 0.185).
Conclusion: The thickness and echogenicity index of muscle is a reliable index for gauging muscle wasting in cirrhotic
individuals. Sarcopenia can be evaluated with ultrasound, which might make it possible to track patients' nutritional
condition over time.
Keywords: S
arcopenia, Skeletal ultrasound, Testosterone, Liver cirrhosis.

Many studies of cirrhotic patients awaiting liver
It is becoming more and more apparent that
transplantation report a prevalence of sarcopenia
sarcopenia, or the wasting away of muscular mass and
nearing 70%; however, the actual number might range
function, is a common consequence of advanced
greatly depending on the diagnostic method used, the
cirrhosis that is linked to poor clinical outcomes.
study population, and the gender of the patients (4).
Sarcopenia in patients with advanced liver illness has
The prevalence of sarcopenia is lower in
been the subject of numerous studies recently, although
individuals with NAFLD compared to patients with
there is still no agreed-upon "optimal method" for
other disease etiologies, but the prevalence of frailty is
making the diagnosis. Other fields, such as geriatrics,
higher; this may be due to a relative rather than absolute
from which many diagnostic techniques are derived,
deficiency of muscle mass in relation to fat mass (5).
also struggle to establish a definitive "gold standard" (1).
Despite being the current gold standard for quantifying
Disagreements about how to diagnose
muscle mass in cirrhotic patients, Computed
sarcopenia are slowing down efforts to design clinical
Tomography (CT) is not practical for muscle evaluation
trials to identify effective treatments for the condition
because of its high cost, high radiation exposure, and
and have serious consequences for the quality and
logistical issues. Ultrasound detection of quadriceps
reproducibility of cohort research in the field. We still
muscle thickness has been recently presented as a more
don't know much about the pathophysiology of
convenient bedside method to assess sarcopenia (6).
sarcopenia in cirrhosis, the mechanisms by which it
Metabolic problems, inadequate nutrition,
affects patient outcomes, the diversity of patient
malabsorption, reduced liver ability to metabolize, and
populations, and the reliability, accessibility, and
endocrine abnormalities are major factors to muscle
affordability of tests that measure muscle mass and
atrophy in cirrhosis. In populations with renal failure,
function, all of which contribute to the difficulty of
heart failure, and chronic obstructive pulmonary
making a diagnosis (2).
disease, reduced testosterone levels have been linked to
The association between sarcopenia and worse
the development of sarcopenia. Testosterone levels in
outcomes in cirrhotic individuals is now extensively
men with cirrhosis are lower than in healthy controls
documented in the hepatology literatures. Clinically
because of a combination of factors, including
significant sarcopenia appears to be more prevalent in
males than females with cirrhosis. yet the mortality (50
aromatization of androgens, and gonad failure. The loss
percent increase in waitlist mortality) and dropping out
of adipose tissue in female individuals with Cirrhosis is
of the liver transplant waitlist in both sexes have been
more likely to happen before the loss of muscle tissue.
strongly linked to higher functional metrics assessing
In cirrhosis, low testosterone levels are a significant risk
frailty (3).
factor for death (7).
Received: 22/5/2022
Accepted: 27/7/2022

Full Paper (vol.891 paper# 80)

c:\work\Jor\vol891_81 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4640- 4644

Perineal Management Techniques to Reduce Perineal Trauma During
The Second Stage of Labor
Mohammed Lotfy Mohammed El-Sayed, Mohammed Abdallah El-Bakry Lashin,
Ahmed Shehta Abdel-Aal Mohammed*, Amr Mostafa Abo El-Fath
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Shehta Abdel-Aal Mohammed, Mobile: (+20)01064614391,
E-mail: a.shehta021@medicine.zu.edu.eg
: Perineal trauma is common among parturient women during vaginal delivery. Perineal trauma is mostly
associated with pain and serious long life complications. Thus, prevention of perineal trauma becomes necessary. This
study was conducted to assess the effect of perineal management techniques (warm compress and perineal massage) in
reducing the incidence of perineal trauma during the second stage of labor. Patients and method: A randomized
controlled clinical trial was carried out at Zagazig University Maternity Hospital during the period between February
2020 and November 2020. The study included 69 female patients divided into 3 groups; Group 1: including 23 women
assigned to lubricated perineal massage, Group 2: including 23 women assigned to warm perineal compression, and
Group 3: including 23 women assigned to routine care provided according to hospital protocol with neither perineal
massage nor warm perineal compression (control group). Result: There was significant difference between the studied
groups as regard the degree of perineal lacerations, as it was frequent in the control group (Group 3) especially 3rd- and
4th- degree perineal lacerations compared to the other two groups (P-value 0.0346). There was also significant difference
between the studied groups as regard perineal suturing; it was more frequent in the control group (Group 3) compared
to the other two groups (P-value 0.02635). Conclusion: The application of perineal warm compresses and lubricated
perineal massage during the second stage of labor can reduce the occurrence and the degree of perineal laceration, and
postpartum perineal pain.
Perineal Trauma, Perineal massage, Warm compresses, Second stage of labor.


often considered unnecessary, and impacts on a
Perineal trauma or genital tract injury occurs in
woman's sexuality and self-esteem (8).
more than 65% of vaginal births and is generally the
The aim of this study was to assess the effect of
result of spontaneous laceration or episiotomy. In the
perineal management techniques (warm compress and
United States (U.S.), lacerations occur in approximately
perineal massage) in reducing the incidence of perineal
43%of all vaginal births and episiotomy occurs in
trauma during the second stage of labor.
approximately 23% of all vaginal births (1). Episiotomy

rates in other countries range from 44% to 84% of all
vaginal births (2).
A randomized controlled clinical trial was carried out
Several risk factors have been established for the
on 69 healthy low risk parturient women at Zagazig
development of severe perineal injuries such as midline
University Maternity Hospital during the period
episiotomy, fundal pressure, upright delivery postures,
between February 2020 and November 2020.
prolonged second stage of labor, vaginal operative
The participant females were divided into 3 groups:
procedures, and fetal macrosomia. However, nulliparity
Group 1 included 23 women assigned to lubricated
has been identified as the main risk factor (3).
perineal massage.
The extent of perineal trauma is related to parity
Group 2 included 23 women assigned to warm perineal
and factors such as; birth weight of the infant, ethnicity
and maternal body mass index (BMI) (4,5).
Group 3 included 23 women with neither perineal
Trauma of the genital tract at birth can cause short
massage nor warm perineal compression (control
term and long term problems. The degree of postnatal
morbidity is directly related to the extent and
Inclusion criteria: Age between 18-45 years. Single
complexity of the genital tract trauma. Short term
viable mature fetus 37weeks or more. Vertex
problems (immediately after birth) include blood loss,
need for suturing and pain. While long term problems
Exclusion criteria: Medical disorders either pre-
include dyspareunia, weakness of the pelvic floor
exciting or arising during pregnancy. Known fetal
muscle as well as bowel, urinary or sexual problems (5).
congenital malformations. Any evidence of active
These problems are less likely in women whose
maternal infection (chorioamnionitis). History of any
perineum remains intact, the achievement of which has
perineal or ano-rectal surgery.
long been highly regarded (6).
All participated women in this study were
Both childbearing women and health professionals
subjected to full medical history, full clinical
place a high value on minimizing perineal trauma and
examination including vaginal examination to assess
reducing potential associated morbidity (7). Perineal
the onset of labor and to exclude any abnormality.
trauma, particularly from routine episiotomy, is painful,
Vaginal examination gave an idea about the condition
Received: 23/5/2022
Accepted: 28/7/2022

Full Paper (vol.891 paper# 81)

c:\work\Jor\vol891_82 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4645- 4651

The Role of Hemoglobin A1c Level in Prediction of Adverse Obstetric and
Neonatal Outcomes in Pregestational Diabetic Pregnancies
Khuloud Mohamed Khalifa Elmaghirbi*, Amr Kamel El-sayed El-fayomy,
Hala Sherif El-Sayed, Ahmed Metwally El katawy
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Khuloud Mohamed Khalifa Elmaghirbi, Mobile: (+20)01033241750,
E-mail: khuloudmoh21@gmail.com

: An elevated HbA1c has been associated with a significantly increased risk of many adverse obstetric
outcomes including congenital anomalies, spontaneous abortions, preeclampsia, and large for gestational age infants at
birth. Objective: This study aimed to predict adverse obstetric and neonatal outcomes in pregestational diabetic
pregnancies. Patients and method: The study included 72 pregnant diabetic women in the third trimester of pregnancy
(28 weeks to 40 weeks) divided into two groups; Good glycemic control group (Hb A1c <6.5%) (n=30), and poor
glycemic study group (HbA1c >6.5%) (n=42). Participants were followed up till delivery and maternal and perinatal
outcomes were studied. All participants were subjected to careful history taking, through clinical and obstetric
examination. The newborns were examined, and their conditions were assessed by pediatricians.
Result: There was a statistically non-significant association between glycemic control of the studied patients and mode
of delivery; Poor glycemic study group had 35 (83.3%) cesarean sections (CS) versus 20 (66.7%) CS in good glycemic
control group. There was a statistically significant association between glycemic control of the studied patients and body
mass index. There was a statistically significant association between glycemic control of the studied patients and parity
which was significantly higher in those with high parity. There was a statistically non-significant association between
glycemic control of the studied patients and their age, gravidity, history of abortion, IUFD or macrosomia. Conclusion:
Antenatal HbA1c values are useful to predict adverse obstetric and neonatal outcomes, especially preterm delivery and
hyperbilruinemia in pregnancies complicated by pregestational diabetes. Also, antenatal HbA1c values are useful for
objective risk stratification of patients with pregestational diabetes.
Keywords: Hemoglobin A1c, Pregnant diabetic, Women neonatal outcomes, Cesarean section.


HbA1c is slightly lower in normal pregnancy than in
All women of childbearing age with diabetes
normal non-pregnant women (4).
should be counseled about the importance of tight
The aim of this work was to predict the adverse obstetric
glycemic control prior to conception. Observational
and neonatal outcomes in pregestational diabetic
studies show an increased risk of diabetic embryopathy,
pregnancies by single 3rd trimester HbA1c level.
especially anencephaly, microcephaly, congenital heart

disease, and caudal regression, directly proportional to
elevations in HbA1c during the first 10 weeks of
This study was a prospective cohort study was
pregnancy (1).
carried out in the Department of Obstetrics and
There has been increasing interest in the use of
Gynecology at Zagazig University Hospitals, Sharkia,
the HbA1c during pregnancy for an objective
Egypt in the period from December 2021 till June 2022.
assessment of glycemic control and risk stratification.
The study included 72 pregnant diabetic women in the
An elevated HbA1c has been associated with a
third trimester of pregnancy (28 weeks to 40 weeks)
significantly increased risk of many adverse obstetric
attending at Zagazig University Hospitals Antenatal
outcomes including congenital anomalies, spontaneous
Care Clinic. They were divided into; Group I: Poor
abortions, preeclampsia, and large for gestational age
glycemic study group (Hb A1c >6.5%), and Group II:
infants at birth (2).
Good glycemic control group (Hb A1c <6.5%).
There remains debate regarding the accuracy of

HbA1c throughout gestation. As erythrocytes circulate,
hemoglobin undergoes a gradual glycation that is
pregestational diabetes mellitus (type 1 or type 2
significantly correlated with the degree and chronicity
diabetes). Maternal age >18 years and gestational age
of hyperglycemia exposure. However, the accuracy of
28 weeks to 40 weeks. Singleton pregnancy.
the HbA1c value can be affected by race/ethnicity,

anemia, chronic renal failure, liver disease, HIV, as well
Exclusion criteria:
as any condition that increases red blood cell turnover,
Multiple pregnancy. Placenta previa. Known fetal
including pregnancy (3). Although there has been
anomaly. Uncertain gestational age. Chronic medical
considerable debate on the ability of the HbA1c to
disorder as thyroid, renal and cardiac disease. Pregnant
predict obstetric outcomes, current published studies
women diagnosed with gestational diabetes mellitus
focus on single values in either the first or third
(GDM). Pregnant diabetic women with vascular
trimester due to increased red blood cell turnover. Also,
Received: 23/5/2022
Accepted: 28/7/2022

Full Paper (vol.891 paper# 82)

c:\work\Jor\vol891_83 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4652- 4659
Eye Affection in Psoriatic Arthritis Patients and its Relation to Disease Activity
Aya Mohammed Said El-Sheshtawy*1, Salah Ahmed Al-Baioumy1,
Shimaa Mostafa Abdelwahab1, Haitham Younes El-Nashar2
Departments of 1Rheumatology and Rehabilitation and
2Ophthalmology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aya Mohammed Said El-Sheshtawy, Mobile: (+20) 01015566401,
E-Mail: ayaelshshtawy.com@gmail.com

Various ocular complications could develop due to psoriatic arthritis or through adverse effects of different
treatment modalities.
Objective: Analyze whether ocular abnormalities and psoriatic arthritis disease activity are linked in any way.
Patients and methods:
A total of 54 patients from those attending outpatient clinics of Rheumatology and
Rehabilitation, and Ophthalmology Departments, Zagazig University Hospitals who were diagnosed as psoriatic arthritis
(PsA) patients. They were investigated for presence or absence of ocular affections and the ocular affections were
correlated to the activity of the psoriatic arthritis. Results: There was significant and inverse relation between best
corrected visual acuity (BCVA) and ESR, CRP. Also, there was significant and direct relation between anterior chamber
cells (acute iritis) and LDI. While there was significant and direct relation between macular thickness and LDI.
Significant relation between Disease Activity in Psoriatic Arthritis (DAPSA) activity level among PsA patients and eye
affection. These eye affections were associated with moderate and high DAPSA activity.
Conclusion: Ocular manifestations represented 38.9% of cases of psoriatic arthritis; dry eye, iritis and intraocular
inflammation were the most common distributed types. A statistically significant relation was found between DAPSA
activity level among PsA patients and eye affection.
Keywords: Eye Affection, Psoriatic Arthritis, Zagazig University.

PsA can occur before uveitis (4).
Inflammatory and chronic illness psoriatic
Treatments for psoriatic arthritis can have a
arthritis is considered. It is a result of a combination of
variety of side effects, including ocular ones. Eye
hereditary and environmental factors. One to three
problems such as nyctalopia, cataracts can be caused by
percent of the world's adult population suffers from it.
long-term use of systemic corticosteroids and/or oral
As many as 30 percent of patients have a recurrent and
retinoids (5). Consequently, ophthalmologists urge
relapsing course of joint disease (1).
regular eye exams for psoriatic arthritis patients in order
Psoriatic arthritis (PsA) is a spondyloarthritis-
to achieve an early diagnosis and avoid ocular morbidity
related type of psoriatic arthritis that manifests as a
(6). It was the goal of this trial to analyze the potential
variety of symptoms. Peripheral joint illness, axial
correlations between morphological and functional
involvement, enthesitis, dactylitis, and psoriatic arthritis
ocular abnormalities and psoriatic arthritis disease
of the skin and nails are the health issues that are
involved. Spondylitis, Dip arthritis, arthritis mutilans,

oligoarticular and polyarthritis are the five distinct
psoriatic arthritis patterns (2). Psoriatic arthritis can cause
Fifty-four patients from those attending outpatient
multiple ocular problems, affecting practically every
clinics of Rheumatology and Rehabilitation, and
area of the eye. Psoriatic arthritis patients with one or
Ophthalmology Departments, Zagazig University
more ocular manifestations are about 10% of the total
Hospitals who were diagnosed as psoriatic arthritis
psoriatic population (3).
(PsA) patients were included in this cross-sectional
Ocular damage may develop as a result of
observational study.
psoriatic arthritis flare-ups, according to current
Inclusion Criteria: (All included patients were
thinking. Psoriatic arthritis-related immune-mediated
diagnosed as psoriatic arthritis (PsA) patients according
inflammatory processes, as well as the consequences of
to CASPAR classification criteria (7).
psoriatic arthritis treatments, may all have a role in the
Exclusion Criteria:
development of ocular symptoms. Psoriatic arthritis has
1- Other seronegative spondylo-arthropathy: e.g.
been linked to ophthalmic inflammatory disorders, such
(Ankylosing spondylitis, inflammatory bowel
as uveitis. There have also been findings of ocular
disease, and reactive arthritis).
anterior segment diseases and abnormalities in the tear
2- Other autoimmune diseases: e.g., rheumatoid
film in people with psoriatic arthritis (4).
The relationship between these ocular ailments
3- Connective tissue diseases: e.g. (Systemic lupus
and PsA is a topic of debate. Uveitis may be the first
erythematosus, scleroderma, and overlap syndrome
indication of psoriatic arthritis in up to 11.4% of patients,
and mixed connective tissue disease).
according to some studies, although others claim that
4- Other causes of eye manifestations: e.g.
Received: 22/5/2022
Accepted: 27/7/2022

Full Paper (vol.891 paper# 83)

c:\work\Jor\vol891_84 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4660- 4667

Circulating Dickkopf-1 as a Biomarker in Neonates with
Hypoxic Ischemic Encephalopathy (HIE)
Sohaila Ali Abd El-Halim1*, Sameh Abd-Allah Abd EL-Naby2, Thoria Ahmad Omar3, Mahmoud Omar
Hussein Mahmoud4, Basim Abdelfattah Ali Elgazzar2
Department of 1Pediatrics ­ Mataria Teaching Hospital, Egypt
Departments of 2Pediatrics and 3Clinical Pathology, Faculty of Medicine, Menoufia University, Egypt
Department of 4Pediatric, Embaba General Hospital, Egypt
*Corresponding author: Sohaila Ali Abd El-Halim, Mobile: (+20) 01222842390, E-Mail: sohailabenali@yahoo.com


Background: The brain damage caused by perinatal hypoxic-ischemic encephalopathy (HIE) can have fatal
implications for the baby. Wingless-related integration site (Wnt) signalling is crucial for embryonic cell proliferation,
fate determination, and patterning, as Dickkopf-1 (DKK-1) is a secreted protein that plays a role in these processes.
Objective: To understand the role of Dkk-1 in the prognosis of newborns with HIE.
Patients and Methods: From November 2019 to April 2020, at the neonatal intensive care unit (NICU), Menoufia
University Hospitals we undertook a case­control research. Two groups of patients: Asphyxiated 15 newborns were
included in patient group (Group 1). Group 2: 15 newborns in good health. Blood count, liver and kidney function test,
and blood gas analysis were performed. CT or MRI scans were performed. Serum DDK-1 levels at admission and
discharge were measured. Results: In newborns with HIE, the DKK1 level was greater than in normal neonates. DKK-1
level correlated positively with degree of HIE. DKK-1 level correlated positively with worse outcome among HIE
neonates. Serum - level >27 µg /L with a sensitivity of 100% and a specificity of 100% for prediction of mortality in the
studied HIE neonates.
Conclusion: There were association between serum DKK-1 level as diagnostic factor and if an Apgar score was less than
3 at the 5th minute, pH less than 7.0, or base excess (BE) less than 12 in the venous or cord blood of neonates within 60
minutes of delivery, asphyxia was diagnosed as a prognostic factor in neonates having HIE.
Keywords: Dickkopfs, Hypoxic-ischemic encephalopathy, Neonates.

newborn be moved from the neonatal intensive care
The condition known as hypoxic-ischemic
unit (NICU) to the imaging room, a job that can be
encephalopathy affects newborns who have had an
challenging under certain conditions. Head ultrasound
acute peripartum or intrapartum incident that results in
(HUS) can be used as an imaging biomarker to overcome
systemic hypoxemia and/or diminished cerebral blood
both of these issues (6). Because of its lesser sensitivity,
flow. Having this illness can be fatal and lead to long-
HUS has not been thoroughly tested or widely
term health issues. Asphyxia of the perinatal, delivery,
recognized for this purpose. Umbilical arterial blood
and/or neonatal period can result in the development of
gases have traditionally been used to evaluate the
HIE (1). 23% of all newborn deaths are the result of
severity of birth asphyxia, although this technique is
asphyxia during birth. According to the World Health
ineffective (7).
Organization (WHO), it is one of the highest 20 most
common causes of disability in all age groups (in terms
communicated through the Wingless-related integration
of disability-adjusted years of life) (8 percent) (2).
site (Wnt) family of glycoproteins. Through alterations
To rule out neonatal encephalopathy in infants
in proliferation, and survival cells respond to Wnt in a
who are born with low blood oxygen levels, look for
situation-dependent manner. Wnt pathways have been
symptoms such as seizures or difficulty initiating or
linked to a wide variety of illnesses. It is possible to use
maintaining respiration in addition to other signs of
Wnt signalling suppression to treat some disorders. The
neurological dysfunction (3).
activation of Wnt signalling offers novel therapeutic
However, even though hypothermia is the only
options for a variety of medical disorders (8).
currently approved treatment for moderate to severe
In order to influence cell fate, cell migration, and
neonatal hypoxic-ischemic encephalopathy, over 45
tissue polarity, Wnt signals are transmitted via the
percent of neonates still have abnormal outcomes
canonical as well as the non-canonical pathways (9). Wnt
despite receiving treatment (4).
pathways are regulated by several secreted antagonists,
Biomarkers that can quantify the severity of
including soluble receptors and Dickkopfs (DKK).
injury, aid in therapy selection, and provide predictive
Dickkof-1, the most studied of them, inhibits Wnt
information are lacking in the management of newborns
signalling by binding to LRP5/6 and a cell surface co-
with HIE. It is being used to diagnose and predict the
receptor, Kremen-1, and promotes receptor complex
internalization (10).
encephalopathy (5). Hypoxic injury biomarkers have
Serum levels of Dkk-1 are higher in people with
often been conducted several days after birth due to a
stable and unstable angina pectoris than in healthy
lack of early sensitivity, and MRI demands that the
controls, and this protein has been related to platelet-
Received: 22/5/2022
Accepted: 27/7/2022

Full Paper (vol.891 paper# 84)

c:\work\Jor\vol891_85 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4668- 4675

Effect of Manual Pressure Release and Scapular Stabilization Exercises on
Myofascial Pain Syndrome Following Neck Dissection Surgery
Alzahraa Mohammed Mohammed Attia*1, Nancy Hassan Aboelnour1,
Ragab Ali Sherif2, Karim Ibrahim Saafaan1
1Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt
2Department of Surgical Oncology, Damanhur Oncology Centre, Egypt
*Corresponding author: Alzahraa Mohammed Mohammed Attia, Mobile: (+20)01060472579,
E-mail: zahra_mohammed56@yahoo.com
Neck dissection (ND) is a popular technique to treat malignant growths in the head and neck caused
by carcinoma of squamous cells. Spinal accessory nerve damage related to the type of neck dissection surgery (NDS)
results in scapular dyskinesia, trapezius atrophy, shoulder dysfunction, and chronic neck pain. Myofascial pain
syndrome (MPS) is identified in 13% of individuals with neck and head cancer.
Objective: The aim of the study is to explore the impact of MPR and SSE at MPS following ND surgery in reducing
pain and improving cervical ROM. Patients and methods: A total of 40 patients with cervical MPS post NDS were
enrolled, and divided into 2 equal groups in a random manner. The intervention group (Group A) applied manual
pressure release (MPR) for 20 minutes and scapular stabilization exercises (SSE) for approximately 30 minutes, in
addition to traditional therapy (ROM exercises, strengthening exercises, and stretching exercises) for about 15
minutes. The control group (Group B) received only traditional therapy. The trial lasted 8 weeks and involved
3sessions per week.
Results: Comparing between the intervention group and the control group after treatment showed that the
intervention group had a significantly lower VAS (p=0.001) and a significantly higher pressure pain threshold
(p=0.002). Moreover, side bending and rotation ROM of the neck for both sides were significantly improved within
the intervention group compared to the control group (p=0.001).
Conclusion Better results were observed within neck pain and ROM in the patients who received MPR and SSE.
Keywords: Neck dissection surgery, Myofascial pain syndrome, Manual pressure release, Scapular stabilization

complications are pain and stiffness of neck, ROM
restrictions of shoulder, reduction in the width of the
Neck dissection (ND) is a surgical operation in
mouth's aperture, swallowing problems and
which surgeon apply removal of the fibro fatty tissue
lymphedema. Neck morbidity was common after
and the lymphatic of the neck as a management for
cancer treatment, including pain of neck, feeling loss,
cervical lymphatic tumor [1]. Tumor starts in head and
and reduced ROM. For at least a year after ND,
neck then migrate to the lymph nodes in the neck [2].
Shoulder and neck pain can have an adverse influence
For many head and neck malignancies, excision of
on a patient's clinical condition and quality of life [5].
cervical lymph nodes is the standard therapy [3]. Spinal
After ND, shoulder and neck dysfunction's
accessory nerve which coordinates the full range of
prevalence and incidence vary depending on the kind
motion (ROM) of arm and shoulder is particularly
of operation and the dysfunctional measurement
sensitive to iatrogenic damage during ND due to its
utilized. Teymoortash and colleagues found that 13%
superficial position in the posterior triangle. New
of participants had difficulty turning to the non-
techniques have been developed to save spinal
operated direction, while 3.8% of participants showed
accessory nerve [4]. Radical neck dissection (RND) is a
moderate restriction. 11.5% of participants showed
technique which entails removal of neck whole lymph
slight to moderate restriction during leisure time and
nodes on one side, internal jugular vein,
everyday activities [7].
sternocleidomastoid muscle, and spinal accessory
Two forms of neck pain were detected in a survey
nerve [5].
of 25 cases that had persisting pain in the neck post-
Furthermore, excision of all lymph nodes normally
ND; myofascial and neuropathic pains. Furthermore,
excised during RND was referred to as modified
symptoms of shoulder and neck were reported in 37%
radical neck dissection (MRND) but keeping one or
and 33% of the 220 participants who received neck
more non-lymphatic components such as internal
dissection surgery (NDS), respectively, while
jugular vein, spinal accessory nerve, and
myofascial and neuropathic pains were reported in
sternocleidomastoid muscle intact [3]. A type of
46% and 32% of the patients, respectively [5].
lymphadenectomy known as selective neck dissection
Myofascial pain syndrome (MPS), which typically
(SND) preserves one or even several groups of cervical
affects the muscles and manifests as motor, sensory,
lymph nodes [6].
and autonomic dysfunctional symptoms, Myofascial
Early post-surgical complications that may affect
trigger points (MTrPs) are tender areas of hyper-tense
patient are: infection, thrombosis and cardiac
muscle tissue that typically consist of a tight band of
problems, while the more well-known late
skeletal muscle that aches when compressed or deeply
Received: 25/5/2022
Accepted: 2/8/2022

Full Paper (vol.891 paper# 85)

c:\work\Jor\vol891_86 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4676- 4684

Combined Sofosbuvir/Daclatasvir and Chemotherapy Markedly Improve
The Outcome of B-Lymphoid Malignancies in Patients with
Both HCV Infection and B-Lymphoid Malignancy
Walaa Gamal Soliman1, Amr Mohamed Zaghloul2, Ali Mohammed Ali1, Mohamed Soliman Gaber1
1Department of Clinical Oncology and Nuclear Medicine,
2Department of Tropical Medicine and Gastroenterology, Sohag Faculty of Medicine, Sohag University, Egypt.
Corresponding author: Walaa Gamal Soliman, Mobile: (+2)01001316515 E-Mail: walaasoliman700@yahoo.com

A high prevalence of hepatitis C virus (HCV) seropositivity is found in patients with B-cell
lymphoproliferative disorders. Many studies show improvement of lymphoid malignancies outcome with the use of anti
HCV treatment in patients with HCV infection and lymphoid malignancies especially indolent B cell lymphoma.
Objective: This study aimed to examine the hypothesis if sofosbuvir based direct-acting antivirals (DAAs) combination
could improve the outcome of patients with B cell lymphoid malignancies and HCV infection.
Patient and Methods: During the period from January 2017 to December 2019 all eligible patients diagnosed with B-
lymphoid malignancies presented at Sohag University Hospital and Sohag Cancer Institute were included in the study. HCV
positive patients were randomized to receive sofosbuvir based DAAs combination either concomitant with or after the end
of chemotherapy.
Results: Patients with HCV infection are more likely to have advanced stage disease (stage 3/4), extra-nodal presentation,
liver and BM infiltration. Disease free survival (DFS) and overall survival (OS) were better in the group that received
sofosbuvir DAAs combination after the end of chemotherapy treatment compared to the other groups (P = 0.000, 0.000
respectively) and was not different between patients who received sofosbuvir based combination concomitant with
chemotherapy and HCV negative B-lymphoid malignancies.
Conclusion: Sofosbuvir based DAAs combination improve the outcome of different types of lymphoid malignancies (DFS,
OS) in patients with HCV infection associated lymphoid malignancies especially when given after the end of chemotherapy.
Keywords: HCV, B-lymphoid malignancies, Sofosbuvir, Daclatasvir, DAAs.


NCI. lymphoid neoplasms collectively represent the 2nd
HCV is RNA virus widely known for the
most common malignancy (11.7%) 2nd only to breast
development of hepatitis and its hepatotropism. This virus
cancer (21.8%) and followed by bladder (7.6%) and lung
is also a lymphotropic one because it has recently been
(6.8%) cancer with NHL representing the most common
linked to some types of non-lymphoma Hodgkin's (NHL),
type (6).
particularly B cell NHL (1).
The frequency of HCV chronic infection varies
Numerous studies have found that patients with B-
significantly by region, with Egypt, Central Africa,
cell lymphoproliferative disorders, notably B-cell NHL,
Mongolia, and Bolivia having the highest rates
have a high prevalence of HCV seropositivity. However,
(approximately 10%) (7). The mechanism of HCV-
the evidence for a connection with T-cell lymphoma,
induced lymphogenesis is not fully understood but
Hodgkin lymphoma, and plasma cell disorders is less
indirect and direct mechanisms are suggested (8). Many
compelling (2, 3). The association with B-cell NHL is
studies shows that patients with HCV infection and
particularly evident in countries with a high prevalence of
lymphoid malignancies usually presented with a higher
HCV infection. Egypt is one of the countries with a very
stage, has a higher frequency of extra-nodal presentation
high incidence of both HCV infection and lymphoid
and a lower response rate (RR), DFS and OS compared to
malignancies. Egypt is one of the few developing nations
other patients with lymphoid malignancies without HCV
where hematopoietic malignancies are more common
infection (9, 10). According to this it is reasonable to say
than average. More so than even the United States, Egypt
that eradication of HCV infection in patients with
has one of the highest incidence rates of lymphoma in the
lymphoid malignancies and infected with HCV will lead
world, specifically NHL (4).
to improvement of the lymphoid malignancy outcome.
According to the National Cancer Institute (NCI),
In the past interferon alpha (IFNa) and pegylated
NHL accounts for 10.9% of all cancers in Egypt
interferon (peg INF) plus minus ribavirin (RBV) were the
diagnosed every year representing the third most common
standard treatment for HCV infection and many studies
malignancy in adult men and second most common one
show improvement of lymphoid malignancies outcome
in women (5). The most prevalent subtype of NHL in
with the use of these drugs in patient with HCV infection
Egypt is diffuse large B-cell lymphoma (DLBCL), which
and lymphoid malignancies especially indolent B cell
represents about 49% of all NHL cases reported to the
lymphoma and the lymphoid malignancy response was
Received: 22/5/2022
Accepted: 27/7/2022

Full Paper (vol.891 paper# 86)

c:\work\Jor\vol891_87 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4685- 4691

Immediate versus Delayed Laparoscopic Cholecystectomy after Endoscopic
Retrograde Cholangiopancreatography in Choledocholithiasis
Ashraf Goda Farag, Ahmed Yahya Ahmed Afhima,
Mohamed Negm Abdel-Ghaffar, Waleed Ahmed Abdelhady
General Surgery Department, Faculty of Medicine - Zagazig, University, Egypt
Corresponding Author: Ahmed Yahya Ahmed Afhima, Mobile: (+20)01023149668, E-Mail: ahmedafhima1991@gmail.com

There would be less need for emergency open cholecystectomy and fewer problems if cholecystectomy
was performed soon following endoscopic retrograde cholangiopancreatography (ERCP).
Objective: This study aimed to evaluate the advantages of immediate over delayed laparoscopic cholecystectomy
among patients who had common bile duct stones post ERCP regarding outcome, safety and complications.
Subjects and Methods: At General Surgery Department of Zagazig University Hospitals, 60 patients with
cholecystolithiasis after doing ERCP were divided into 2 groups. Group (A) for immediate laparoscopic
cholecystectomy (LC) in same sitting after ERCP and Group (B) for delayed LC (4 weeks or more) after ERCP.
Conversion rate, operative time, intra- and post-operative complications were assessed.
Results: The mean operative time was shorter in the immediate group (54.96 ± 14.21 min.) than in the delayed group
(71.66 ± 24.72 min.), which represented a significant difference in favor of the immediate group. There was a statistically
significant distinction in the incidence of complications after surgery where in delayed group five patients showed
intraoperative bleeding and three patients converted to open cholecystectomy. Length of hospital stays also differed
significantly between groups, 0.9 versus 1.95 for immediate LC group & delayed LC group, respectively.
Conclusion: Performing immediate LC post, ERCP in comparison to delayed LC after ERCP had better outcomes. It
had the lower conversion rate, less operative time, shorter hospital stay, and less intra-operative and post-operative
Keywords: Laparoscopic cholecystectomy, Immediate, Delayed, Endoscopic Retrograde cholangiopancreatography.

strategy of treatment for gall bladder stones with
Cholelithiasis is a major disease that demands
secondary CBD stones is ERCP followed by
surgical management and affect nearly 10% of adults.
laparoscopic cholecystectomy. Although immediate
Choledocholithiasis affects roughly 10-20% of those
laparoscopic cholecystectomy is recommended there is
who have gallbladder stones. Common bile duct (CBD)
no consensus about suitable gap between laparoscopic
stones affect between 3 and 10% of people who have
cholecystectomy. Liver function tests (LFTs) are
cholangiopancreatography (ERCP) (5).
performed to keep an eye on a bile duct stone. Although
There would be less need for open
elevated levels of blood bilirubin and alkaline
cholecystectomy and fewer problems during and after
phosphatase are a reliable indicator of biliary obstruction,
surgery if cholecystectomies were performed soon after
they lack the sensitivity and specificity needed to
ERCP (6). The goal of this study was to evaluate the
diagnose a common bile duct stone (1).
advantages of immediate over delayed laparoscopic
Endoscopic retrograde cholangiopancreatography
cholecystectomy in patients with common bile duct
(ERCP) is effective in the removal of about 90% of
stones post ERCP regarding outcome, safety and
common bile duct stones. Treatment of stones in the
common bile duct with medicines has been the subject of

debate (2). For minor gallbladder issues, laparoscopic
cholecystectomy (LC) is the go-to procedure. Simple
cholecystectomy is effective for cholecystitis,
In the Zagazig University Hospitals' General Surgery
cholelithiasis, and biliary colic. Stones in the common
Department, sixty patients with cholecystolithiasis after
bile duct (CBD) can make any of these conditions more
doing ERCP were studied in comparative randomized
severe, but the best course of action is hotly contested.
Treatment options for choledocholithiasis includes either

simultaneous ERCP or laparoscopic cholecystectomy
Inclusion criteria: Patients with cholelithiasis after
within the first 24 hours, or postponing the surgery by 4-
ERCP, and age between 18 to 70 years.
8 weeks (3). The greatest risk of CBD stone extraction by

ERCP before or after surgery are cholangitis and
Exclusion criteria: Patients not fit for surgery, acute
cholecystitis with biliary pancreatitis patients, patients
cholecystectomy has reopened the controversy on the
who cannot undergo laparoscopic surgery due to medical
best treatment of cases with CBD stones or suspected
conditions, and patients who underwent previous upper
CBD stones that undergo cholecystectomy (4). The
abdominal surgeries.
Received: 24/05/2022
Accepted: 01/08/2022

Full Paper (vol.891 paper# 87)

c:\work\Jor\vol891_88 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4692- 4696

Effect of Different Types of Deep Breathing Training on Functional
Capacity and Fatigue Level in Hemodialysis Patients
Eman Mohammad Sabry Moussa*, AkramAbd El-Aziz Sayed,
Ahmed Mohammad Donia, Gehad Ali Abd El-Haseeb
Department of Physical Therapy for Cardiovascular/ Respiratory Disorders and Geriatrics,
Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Eman Mohammad Sabry Moussa, Mobile: (+20)01064265617,
E-mail: drmennamousa2011@yahoo.com

Functional capacity (defined as the ability of individuals to do their daily living activities) in hemodialysis
patients is affected due to peripheral muscles and pulmonary function impairment.
Objective: This study aimed to evaluate the effect of different types of deep breathing training on functional capacity
and fatigue level in hemodialysis patients. Patients and methods: A total of 111 hemodialysis patients of both sexes
with end stage renal disease (ESRD) participated in the study with age ranged from 55 to 65 years old. They were
randomly recruited from Quesna Central Hospital from Dialysis Unit. They were assigned randomly into three groups
(A, B & C). Group (A) consisted of 37 patients who received Diaphragmatic Breathing Exercise 3 sessions per week,
20 minutes for each session with 6 sets per each session, for 8 successive weeks. Group (B) consisted of 37 patients who
received breathing training by incentive Spirometer Device 3 sessions per week, 20 minutes for each session with 6 sets
per each session, for 8 successive weeks. Group (C) consisted of 37 patients who received their medical treatment and
hemodialysis only. Results: A significant change in six-minute walk test (6MWT) and fatigue assessment scale (FAS)
in the 3 groups post-training compared with that pre-training was observed. There was no discernible difference existed
between the 3e post-training groups in terms of 6MWT. However, there was significant decrease in FAS of the group
A and B post training compared with that of the group C. Conclusion: Different types of deep breathing training improve
the functional capacity and the fatigue level in hemodialysis patients.
Keywords: Diaphragmatic Breathing Exercise, Incentive Spirometer, Functional Capacity, Hemodialysis, Chronic
kidney disease.

high mortality rate may be due to reduction in functional
Permanent urine abnormalities, structural
capacity (5).
changes, or reduced kidney excretory function that may
In adults with respiratory and heart illness, assess
indicate the loss of functional nephrons is all signs of
functional capability and therapy impact, six-minute
chronic kidney disease (CKD). Most CKD patients are
walk test (6MWT) is the most common submaximal,
more vulnerable to cardiovascular illnesses and death
valid and reproducible test used (6).
(1). Inspiratory muscle impairments in hemodialysis
Fatigue Assessment Scale (FAS) initial's version
patients lead to loss in their functional abilities.
was created in 2003 and consisted of 10 questions about
Inspiratory muscle weakness (IMW) leads to decrease
perceived patient's physical and level of mental
of the functional capacity in some populations that
tiredness. The replies are scored using a 7-point Likert
suffer from muscle wasting. In end stage renal disease
scale (1= never to 5= always). As a result, the score
(ESRD), uremic myopathy may influence the strength
ranges from 10 to 50. A total of 10 questions are
and endurance loss in inspiratory muscles, and also
answered by the patients to calculate the total score. The
muscles of the locomotor system (2).
scale is divided into 3 categories: exhausted, not
Muscle wasting leads to high rates of mortality
exhausted, and very exhausted. Patients are classified as
and morbidity, among patients with CKD particularly
"non-exhausted" if their FAS score is less than 22;
those receiving hemodialysis (HD). However, little is
"fatigued" if it is between 22 and 35, and "very fatigued"
understood about diaphragm dysfunction in HD
if it is greater than 35 (7).
patients. The high incidence of dyspnea and the fatigue
Incentive spirometer is amedical device used for
scores in HD patients were related to diaphragmatic
achieving and maintaining maximal to serve as
dysfunction (3).
motivation and to support maintaining optimal lung
CKD consists of renal damage and progressive
health to improve respiratory function. For patients, it is
and irreversible loss of kidney function (glomerular,
a device that is simple to use. This device's visual input
tubular and endocrine). This is a worldwide problem,
on airflow and volume is a key benefit. Effective
with an estimated prevalence of 8- 16%, which incurs
inspiration, better controlled flow, and higher practice
high costs for the health system. It is believed that these
motivation are brought about by prolonged use. It
numbers will increase disproportionately in the coming
improved pulmonary function (FVC, FEV1) in
years, especially in developing countries (4).
hemodialysis patients (8).
In CKD patients, the decrease in exercise
tolerance and levels of physical activity in daily life, and
Received: 25/5/2022
Accepted: 2/8/2022

Full Paper (vol.891 paper# 88)

c:\work\Jor\vol891_89 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4697- 4708
Single Nucleotide Polymorphism of ERCC1 Gene in Patients with Non-Small Cell
Lung Cancer and its Relation to the Response to Platinum Chemotherapy
Heba M. Adel Abou Zaghla* 1, Dina A. Abdelhakam1, Abeer Ibrahim Abd el-Mageed 1,
Rana Ehab Moustafa Ahmed1, Manal Mohsen1
1Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Egypt
* Corresponding author: Heba M. Adel Abou Zaghla; E-mail: hebazaghla@hotmail.com Phone: 01227191589

Non-small cell lung cancer (NSCLC) accounts for eighty five percent of lung cancer cases. Among
drugs most commonly used are platinum-based chemotherapy as cisplatin and carboplatin & 3rd generation
chemotherapy. Excision Repair Cross Complementing Group 1 (ERCC1) Gene is one of members of nucleotide
excision repair pathway. It causes inhibition in the action produced by platinum and third generation chemotherapy.
So, the produced DNA repair will be resistance to these drugs. Single nucleotide polymorphism in ERCC1 impairs
this function and this may help in prediction of response to platinum-based chemotherapy.
Aim of the Work:
This work aimed to study association among single nucleotide polymorphism of ERCC1 rs11615
in studied cases with non-small cell lung cancer and the response to platinum-based chemotherapy as to reduce
exposure of chemotherapy side effect.
Materials & Methods:
research was done on 50 NSCLC patients. Thirty of them were non-responders to platinum-based
chemotherapy & other 20 were responders based on RECIST criteria. Detection of the ERCC1 (T/C) polymorphism by
real-time PCR was done for all patients' groups.
Results: In responders' group, 19 patients (95%) had wild type homozygous CC genotype & 1patient (5%) had
heterozygous TC genotype. In non-responders' group, 29 patients (96.7%) had wild type homozygous CC genotype
and one patient (3.3%) had TC genotypes. There was no significant statistical variation observed among responders'
& non-responders' groups regarding genotype frequencies (2= 0.8, p>0.05).
Conclusion: Our findings did not support existence of significant link among ERCC1 rs 11615 polymorphism &
response to platinum-based chemotherapy in advanced cases of NSCLC.
Keywords: ERCC1- Lung cancer ­ Platinum-based chemotherapy.


conditions. When planning trials to research new
Behind prostate cancer in men & breast cancer
treatment technique, researchers all over world
in females, lung cancer is the 2nd most common
consider ECOGPS (5). Patients with ECOGPS 1 score
cancer diagnosed in both genders. It is leading reason
are fully ambulatory & can perform light work,
for cancer-related mortality worldwide, & its
whereas studied cases with ECOGPS 2 score are
prevalence is rising rapidly. It accounts for twenty
ambulatory but cannot perform any work activities.
seven percent of all cancer deaths worldwide (1). Lung
Studied cases with ECOGPS 2 make up sizable
cancer is classified into 2 histological types: small cell
proportion of cancer population (6).
lung cancer & non-small cell lung cancer (2). Non-
Chemotherapy plan for lung cancer often
small cell lung cancer accounts for eighty five percent
consists of drug combination. Among drugs most
of all cases of lung cancer. Squamous cell carcinoma,
commonly used, platinum based chemotherapy as
adenocarcinoma, & large cell carcinoma are 3
cisplatin and carboplatin in addition to 3rd generation
subtypes of NSCLC (3). Common of the studied cases
drugs as vinorelbine and gemcitabine. These agents
are diagnosed at progressive stages mainly (3 & 4) at
act by disrupting the genetic material integrity by
time of presentation. Treatment options for NSCLC
causing crosslinking of DNA, which results in
depend mainly on the stage at diagnosis and include:
inhibiting DNA repair and DNA synthesis in cancer
surgical resection, chemotherapy often along with
cells and leads to cancer cells apoptosis (3).
radiotherapy. In early stages (0, I, II), surgical
Studied cases are classified into: Responder
resection is possible. Therefore, chemotherapy &
patients that further were subdivided into patients with
radiotherapy play dominant role in treatment of
complete response with disappearance of all target
NSCLC (4).
lesions and patients with partial response with more
than thirty percent reduction of all target lesions. Non-
Performance Status (ECOGPS) score is used to
responder patients that further subdivided into patients
evaluate performance status of lung cancer studied
with progressive disease with more than or equal
cases. It is classified into six grades (grade zero to
twenty percent rise from smallest sum of diameters
five). Grade zero is fully operational, while grade
recorded & five mm absolute rise over lowest sum and
five is dormant. ECOGPS score is used to quantify
patients with stable disease with neither sufficient
cancer studied cases' functional status & is important
shrinkage to qualify for complete response nor
factor in determining prognosis in malignant
sufficient rise to qualify for progressive disease (3).
Received: 22/5/2022
Accepted: 27/7/2022

Full Paper (vol.891 paper# 89)

c:\work\Jor\vol891_90 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4709-4714

Clinical Audits in Colposcopy at Al-Azhar University Hospital
Abdel Aziz Galal El deen Al -Darwish1, Khaled Mohammed Ahmed Abdallah1, Sabreen Mohamed Ahmed*1
1Obstetrics and Gynecology Department, Faculty of Medicine Al-Azhar University (Assiut), Egypt
*Corresponding author: Sabreen Mohamed Ahmed,
Email: sabreenmelemam@gmail.com, Mobile phone: 01099171742

Cervical cancer is 2nd prevalent cancer between females in developed countries. Colposcopy is a simple
diagnostic process used to look at cervix, vagina and vulva with illumination and magnification of the view,
Aim and objectives: This study aimed to investigate the role of colposcopy performance according to the standard
guidelines in enhancing patient care and outcomes according to National Health Service Cervical screening program.
Subjects & methods: This cross-sectional observational research was carried out on 100 studied cases who came to
the Outpatient Colposcopy Unit of Al-Azhar University Hospital (Assiut).
Result: As regards excisional form of biopsy, recording ectocervix when substituted with high-grade abnormality and
when low grade coloposcopic variation was related to high grade dyskaryosis or worse, there were significant different
from guidelines (p=0.214 & 0.003 respectively),
Conclusion: In selected studied cases, colposcopy is critical to "see-and-treat" method of treating great-grade cervical
cytologic abnormalities,
Keywords: National health service, Cervical screening program.

confirm that quality of colposcopy services meets or
Colposcopy, first step in management of
exceeds minimum requirements, based on desire for
women with abnormal Pap smear outcomes, is visual
quality assurance & continuous improvement
method that is prone to observe distinction,
of clinical practice (5).
implying need
NHS Cervical Screening program aims to
decrease incidence & mortality from cervical cancer
assurance measures. Level of responsibility for
by providing eligible females with systematic, quality-
organising subjects, geographic coverage, scope,
assured population-based screening programme.
model, & type of actions vary among colposcopy QA
As result, screening programme has reduced number
of cervical cancer cases by half, saving approximately
standards of colposcopy are more limited in space
4.500 lives per year in Netherland (6).
& less long-term than those focusing on service

provision (1). Key step in management of females with
abnormal Pap smear outcomes is colposcopy, which
Cross-sectional observational research that was carried
is visual test of uterine cervix & vagina using lighted
out on 100 patients referred for colposcopic
field microscope after application of diluted solution
examination at the Colposcopic Unit in the
of acetic acid & Lugol's iodine solution as staining
Department of Obstetrics & Gynaecology, Al-Azhar
agents. Colposcopy is used to identify macroscopic
University Hospital (Assuit) Egypt through the period
variations in tissue characteristics like colour &
from January 2021 till the completion of this study.
morphology. Clinician can characterise lesions &

recognise abnormal areas that may need to be biopsied
All the participants were subjected for:
for recognizing precancerous or cancerous lesions by
Full detailed history: Last menstrual period and
comparing these features to established patterns of
current contraception, past obstetric history, past
disease (2).
gynaecology history and menstrual history. Patient
Colposcopy's role in identifying studied
information leaflet was recorded, and pelvic
cases with important lesions becomes even more
examination was carried out and findings.
critical (3). Colposcopy allows identification &

treatment of underlying significant lesions as early as
General and systemic examination: Including pulse,
possible. This primary benefit is especially important
in areas with great incidence of cervical cancer, like
cardiovascular disease, central nervous system
Chiang Mai as underlying invasive lesions are notably
disorders, respiratory system, GIT system, urinary
great across all grades of cervical smear abnormalities
system, lymphatic system and endocrine diseases.
(4). Colposcopy service requires periodic auditing to
Local examination: vulval inspection (look for

anatomical appearance e.g. juvenile external genitalia
Received: 5/6/2022
Accepted: 10/8/2022

Full Paper (vol.891 paper# 90)

c:\work\Jor\vol891_91 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4715- 4720

Comparative Study between Magnesium Sulfate and Dexamedetomidine
Added to Lidocaine in Ultrasound Guided Supraclavicular
Brachial Plexus Block in Upper Limb Surgery
Alaa Bakr Foad Elmaleh, Amira Mohammed Mohammed Nassar, Zeinab Abdo Ibrahim Mohammed*
Department of Anesthesiology, Intensive care and Pain Management,
Faculty of Medicine for Girls, Al-Azhar University, Egypt
*Corresponding author: Zeinab Abdo Ibrahim, Mobile: (+20) 01069989572, E-Mail: drzenibabdo@gmail.com

The anaesthetic sector makes substantial use of local anaesthetic drugs, although anaesthetists have
challenges due to the diverse local anaesthetics' short acting times. Numerous perineural adjuvants have been explored
to speed up the onset and prolong the analgesic effects of nerve blocks. The role of central sensitizations and N-methyl-
D-aspartate (NMDA) receptors in post-operative pains has been highlighted by the acquaintance with pain mechanisms.
Objective: The current study aimed to compare the effect of magnesium sulfate (100 mg in 1mL volume) and
Dexmedetomidine (100 mcg in 1mL volume) added to lidocaine (20 ml 2%) on the onset time and duration of
supraclavicular brachial plexuses block in patients undergoing upper limb surgery.
Patients and methods: This prospective randomized-controlled study included 60 patients that were subjected to
surgical procedure in upper limb as part of the standard anesthetic techniques.
Results: There was statistically significant increase of the duration of motor and sensory block among group D than in
group M. Duration of motor block for group M was 277.17 ± 54.34 min versus 482.50 ± 72.75 min for group D. Time
to first analgesia for group M was 5.10 ± 1.56 h versus 8.70 ± 3.38 h for group D. A statistically high significant increase
total dose of analgesia consumed was detected for group M as compared to group D (8.80 ± 2.44 mg for group D versus
12.53 ± 4.03 mg for group M).
Conclusion: Addition of magnesium sulfate or dexmedetomidine to lidocaine in supraclavicular brachial plexus block
prolong the duration of sensory and motor block. Both magnesium sulfate and Dexmedetomidine groups showed
improved postoperative analgesia with less analgesic requirements.
Keywords: Magnesium Sulfate, Dexamedetomidine, Lidocaine, Supraclavicular brachial plexus block, Upper limb

successful blockage. Magnesium is known to have pain-
relieving properties and helps to regulate the quantity of
For upper limb surgical anaesthetic and
calcium in cells. For instance, magnesium sulphate
postoperative pain management, brachial plexus blocks
(MgSO4) can assist lower the quantity of anaesthetics
(BPB) are frequently employed. There have been
used during surgery and the amount of opioids required
several methods employed, and each one has pros and
afterwards. Magnesium hasn't been extensively
cons. The supraclavicular nerve block is the simplest
researched for its effects as an adjuvant to anaesthetics
and most effective since it blocks the majority of the
during brachial plexus blocks (BPB) despite its well-
brachial plexus branches, which leads to a quick start
known advantages for pain management (4).
and high success rates for upper limb surgery and
Dexmedetomidine has analgesic, sedative, and
analgesia (1). In recent years, ultrasound (US) has
antihypertensive effects and is a highly selective,
developed into a crucial technique for nerve blocks.
specific, and powerful 2-adrenergic agonist. For
Identification of vascular structures and other
surgical patients undergoing peripheral nerve blockade
aberrations in the needle's route is a key advantage of
using US guidance in nerve blocks. This allows for the
dexmedetomidine with local anaesthetics may also be
avoidance of these structures and thereby lowers the
effective (5).
risk of complications (2).
The present study was designed to compare the
A local anaesthetic with a very broad range of
effect of magnesium sulfate (100 mg in 1ml volume)
applications, lidocaine has a medium solubility in both
and dexmedetomidine (100 mcg in 1mL volume) added
water and lipids. With a lower pKa, it may be employed
to lidocaine 2% (20 ml) on the onset time and duration
in all regional block types. The majority of doctors
of supraclavicular brachial plexus block in patients
favour long-acting anaesthetics for peripheral nerve
undergoing upper limb surgery.
blocks, despite the fact that it is one of the drugs that

may also be utilised in these blocks. The requirement
for a sustained anaesthetic effect in the postoperative
This prospective randomized controlled study
phase is the cause of this (3).
included 60 patients who were subjected to surgical
A variety of medications that are used with
procedure in upper limb as part of the standard
local anaesthetics to speed up the start of action, extend
anesthetic techniques.
the duration of action, and improve the likelihood of a

Received: 24/05/2022
Accepted: 01/08/2022

Full Paper (vol.891 paper# 91)

c:\work\Jor\vol891_92 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4721- 4723

Assessment of Role of Topical Methotrexate in the
Treatment of Vitiligo: Review Article
Khaled Mohamed Gharib 1, Yasmeen Ahmed Fahmi El Sharkawi *1,
Nagia Ahmed Elmegrab2 Al Shimaa Mohamed Ibrahim1
Departments of 1 Dermatology, Venereology & Andrology and 2 Pharmaceutics, Zagazig University Hospital, Egypt.
*Corresponding author: Yasmeen Ahmed Fahmi El Sharkawi, Mobile: (+20) 0 109 043 6692,
E-Mail: yasmeenfahmi1992@gmail.com

Long-term treatment with low to moderate dosages of the antimetabolite and antifolate medication
methotrexate (MTX) has been shown to be effective, safe, and well-tolerated for a wide range of autoimmune diseases. As
a result, methotrexate may be used to treat vitiligo and other autoimmune disorders. The hepatotoxic and hematologic side
effects of the drug's topical formulations, which were developed for the treatment of localized lesions, were deemed to be
clinically insignificant.
Objective: This review article aimed to assess the possible role of topical methotrexate in the management of vitiligo.
Methotrexate, and the vitiligo 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 studies from January
2005 to May 2021 were included. Due to the lack of sources for translation, documents in languages other than English
were 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: Topical methotrexate use could be an effective and safe treatment modality of vitiligo.
Keywords: Methotrexate, Vitiligo, Topical.

immunological privilege. This is true not only in the
A kind of vitiligo, in which the body's immune
brain, eye, and inner ear, but also in other highly
system attacks and destroys melanocytes, resulting in
specialised organs that include melanocytes. Found in
white patches of skin and hair, was one of the earliest
hair follicles, melanocyte stem cells have the ability to
skin conditions to be formally identified by doctors. Skin
repopulate the epidermis of vitiligo lesions with
and mucous membranes both suffer from melanin loss.
Melanocyte loss can be explained by several different
melanocytes, ultimately restoring normal pigmentation.
In this way, areas of vitiligo lesions that previously had
environmental stimuli (such friction), metabolic
no hair or white hairs repigment in a punctate,
changes, and altered inflammatory and immunological
perifollicular pattern (4).
responses (1).
Vitiligo is difficult to treat, and the current options
Depigmentation of the skin, hair, and mucosal
for doing so are not promising. Phototherapy, topical
surfaces is caused by the selective loss of melanocytes in
treatment (calcineurin inhibitors, corticosteroid), and
the most prevalent depigmentation disorder, vitiligo.
systemic treatment are all moderately successful
Approximately 1% of the population is affected by this
remedies, although they can be both time-consuming
condition, with an average onset age of 24 years. It
and expensive to implement (5).
appears to be equally common in males and females, and

there is no discernible variation in the incidence rate
Methotrexate in the treatment of vitiligo:
based on skin color or ethnicity (2).
Inhibitor of cell proliferation and folic acid
Genetic and environmental variables interact with
antagonist methotrexate (MTX) has a profound effect
metabolic, oxidative stress, and cell detachment
on the proliferation of T lymphocytes. It acts as a
disorders to cause vitiligo, making it a complex
competitive inhibitor of dihydrofolate reductase,
(multifactorial) illness. The pathophysiology of vitiligo
making it an antimetabolite. Protein, RNA, and DNA
defies reduction to the sum of its parts, and the two
synthesis are all stymied (6).
separate mechanisms cannot do so. Instead, the
Its antiproliferative and immunomodulatory actions
convergence hypothesis has been offered as a unifying
made it a popular treatment in dermatology,
approach, combining immunological, biochemical, and
environmental components in genetically predisposed
dermatomyositis, mycosis fungoides alopecia areata
patients (3).
and cutaneous lupus erythematosus as well as prurigo
Treatment of Vitiligo:
nodularis are only some of the skin disorders that
Specifically, vitiligo attacks the epidermal
respond well to systemic MTX (7).
melanocytes that reside in the skin's outermost layer, in
It has been claimed that vitiligo can be treated with
the spaces between hair follicles (interfollicular
MTX at a dose of 12.5-25 mg/week, with the latter
epidermis). However, melanocytes in the hair follicle
being the optimal range. No serious side effects were
are typically resistant to infection because of their
noted (8).
Received: 24/05/2022
Accepted: 01/08/2022

Full Paper (vol.891 paper# 92)

c:\work\Jor\vol891_93 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4723- 4727

Prevalence of Diarrhea Caused by Intestinal Parasites in
Children in AL-Kufa City, Iraq
Shaimaa Rahim Hussein1, Ali A. mohy2
1The General Directorate of Education Al-Najaf, the Almutafawiqat Students` School in Al-Najaf, Iraq.
2Department of Biology, Faculty of Science, University of Kufa, Iraq
Corresponding author: Shaimaa Rahim Hussein, E-mail: werta441981@gmail.com, Mobile: 009647808547340

Intestinal parasites are one of the most common causes of diarrhea in children and it has almost global
prevalence with high prevalence rates in developing countries.
Objective: The aim of this study was to compare between the prevalence of Entamoeba histolytica (E. histolytica) and
Giardia lamblia (G. lamblia) as a cause of diarrhea in children in AL-Kufa City, Iraq.
Patients and methods: Four hundred children with age ranged between 1-10 years old that had diarrhea and were admitted
to the General Hospital in AL-Kufa City from June 2021 to February 2022. Parasites were diagnosed according to stool
microscopic examination.
Results: Out of 400 children, there were 325 infected by parasites (190 E. histolytica and 135 G. lamblia), age group 4-6
yeas was the most infected with 80 and 54 cases by E. histolytica and G. lamblia respectively. The rural area was the highest
infected than urban with 105 and 85 cases by E. histolytica respectively, and 90 and 45 by G. lamblia respectively.
Conclusion: There were high prevalence of diarrheal infections in children caused by E. histolytica and G. lamblia, and the
most infections were more in rural than urban.
Keywords: Prevalence, Diarrhea, E. histolytica, G. lamblia, AL-Kufa City, Iraq.

that can result from negligence, asymptomatic E.
Intestinal parasites are one of the causes of diarrhea
histolytica infections are more dangerous than those with
in children and it has an almost global prevalence with
symptoms (9).
high prevalence rates in developing countries, especially
There are few published studies that describe the
since at least five million children suffer from diarrhea
relative contribution of these different parasitic infections
annually (1). Diarrhea is the largest contributor to
in school-age children in AL-Kufa City, Iraq and there
malnutrition and more serious in rural areas as poor
were few reports that focus on the relationship between
sanitary conditions, lack of cleanliness or unavailability
infection by parasites and lifestyle. Therefore, the aim of
of drinking water, and the low educational level of
this study was to compare between the prevalence of E.
mothers are all factors that increase the incidence of
histolytica and G. lamblia as a cause of diarrhea in
diarrhea (2, 3). The use of human excreta and untreated
children in AL-Kufa City, Iraq according to gender, age
sewage water as fertilizer for many crops is a cause of
group and lifestyle during nine months.
transmission of intestinal parasites (4). About 70% of

diarrhea cases in developing countries are caused by food
contamination with intestinal parasites as a result of lack
Sample collection: This epidemiological study
of health awareness and lack of hygiene (5).
performed in AL-Kufa City from June 2021 to February
Entamoeba histolytica and G. lamblia are the most
2022. 400 stool samples were collected from children of
parasites that cause diarrhea in children especially in
age ranged between 1-10 years old suffering from
developing countries such as Iraq (6). Across the globe,
diarrhea and primary enteritis at AL-Kufa General
more than three billion people suffer from intestinal
Hospital. During the collection process, clean plastic
protozoan parasites, which are highly prevalent (7). Food
bottles containing specific information about the
or water contaminated with the parasites is typically used
children, including their name, age and lifestyle (urban or
to transmit by the faecal-oral route. Furthermore, it can
rural) (10, 11).
be spread through soil, fresh vegetables, direct contact,

residing in endemic areas, and swimming in infected
Diagnosis of parasites: A direct saline method prepared
water (8). Entamoeba histolytica and G. lamblia infections
with 0.9% sodium chloride was used to examine stools
commonly cause weight loss, bloody diarrhea, severe
under a light microscope to determine their
dysentery, physical exhaustion, fatigue, and abdominal
characteristics (mucous, serous, greasy, and bloody) as
pain. Due to the severe side effects of amoebic dysentery
well as colors (yellow, brown, semi-brown, and greenish).

We took a little bit of recently passed stool with a wood

applicator, mixed it with physiological saline and Lugol's

iodine solution, and then placed onto a glass slide. Using
Received: 25/05/2022
Accepted: 02/08/2022

Full Paper (vol.891 paper# 93)

c:\work\Jor\vol891_94 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4729- 4734

Early Enteral Feeding Post-Resection Anastomosis without
Diversion in Colon Cancer
Osama Abdullaziz Altih, Miftah Abdullah Mohammed Hiyoum,
Mansour Mohammed Morsy, Adel Mahmoud Attia
Surgery and Surgical oncology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Miftah Abdullah Mohammed Hiyoum, Mobile: (+20)1021721631,
E-Mail: meftahhaume87@gmail.com

Understanding early oral feeding (EOF) benefits among post colon cancer surgery patients is essential,
as it allows surgeons to decrease the incidence of dangerous complications.
Objective: The aim of the current work was to prove that early enteral feeding is safe with little incidence of
complications like fecal fistula.
Subjects and Methods: At General Surgery Department, Zagazig University Hospitals, 18 patients underwent urgent
and elective colonic cancer surgery. The patients were randomly allocated by the closed envelop technique after
completion of surgery into 2 groups: Group (A): consisted of 18 patients who followed early postoperative oral feeding
protocol with oral fluids the first day after surgery and progressed to a normal diet within the next 24 to 48 hours, as
tolerated with no leakage. Group (B): consisted of the same 18 patients who followed post-operative early oral feeding
with anastomosis leakage.
Results: early post-operative feeding after colonic resection anastomosis was tolerated in 80.8% of patients. Also, there
was no affection for the nutritional status. Also, the study revealed safety of early oral feeding in the recently performed
anastomosis even in emergency situations as there was no increase in morbidity. In group research, those who were
given solid foods as soon as they were able after surgery had a much shorter hospital stay (median of 4 days)., while
among group (B) Complications after surgery led to a 10-day hospital stay as the average length of care.
Conclusion: Early post-operative feeding is safe and tolerable after colorectal surgery.
Keywords: Enteral Feeding, Post-Resection Anastomosis, Diversion, Colon Cancer.


With a prevalence estimate between 40% and
It has been hypothesized that this gap is due to a
80%, malnutrition is a typical observation in patients
number of factors, including a failure to appreciate the
presenting for surgical therapy of colon cancers (1).
potential advantages, a deficiency in nutrition education
Patients may be at risk for malnutrition due to a wide
during surgical training, and the persistent yet
range of circumstances, including but not limited to tumor
unsubstantiated dogma of waiting for bowel activity to
location; type; disease stage; preoperative radiation
return before feeding (6). Successfully introducing new
and/or chemotherapy; and other factors (2).
rehabilitation program calls for a shift in organizational
Weight loss is a powerful predictive indication of
culture to foster better lines of communication, teamwork,
poor outcome in terms of survival and responsiveness to
and overall support (7).
therapy and can be caused by a number of factors,
The aim of the current work was to prove that early
including nausea, vomiting, reduced appetite, early
enteral feeding is safe with little incidence of
satiety, taste alterations, diarrhea, discomfort, mucositis,
complications like fecal fistula.
physical obstruction, and malabsorption. Cancer cachexia

is also commonly seen in individuals with colon cancer
solid tumors, and it is believed that the loss of both fat and
This prospective cohort clinical study included a total
lean body tissue associated with this disease contributes
of 18 patients with colorectal cancer having elective
to 30%-50% of all cancer deaths (3).
open colon resection with anastomosis without diversion,
By reducing postoperative infection, hospital
attending at Onco-Surgery Unit's, Department of General
length of stay, and mortality, EOF has the potential to
Surgery, Zagazig University Hospitals.
enhance patient outcomes following colorectal surgery.

The evidence-based guidelines for the management of
Ethical Consideration:
complications following colorectal surgery now include
This study was ethically approved by Zagazig
EOF recommendations that advocate the prescription of
University's Research Ethics Committee. Written
an unrestricted meal within 24 hours after the procedure
informed consent of all the participants was obtained
and submitted them to Zagazig University (ZU-IRB
Putting the evidence from EOF into clinical
#9856). The study protocol conformed to the Helsinki
practice is difficult even with defined guidelines. Poor
Declaration, the ethical norm of the World Medical
adherence to postoperative feeding instructions has been
Association for human testing.
previously observed, with a higher prevalence of delayed

feeding after colon cancer treatments (5).

Received: 25/05/2022
Accepted: 02/08/2022

Full Paper (vol.891 paper# 94)

c:\work\Jor\vol891_95 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4735- 4739

Influence of Posterior Pericardiotomy on Early and Late Pericardial
Effusions Post CABG
Mohamed Elkhouly*, Ahmed Fouad
Department of Cardiovascular Surgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding authors: Mohamed Elkhouly Ahmed, Mobile: (+20)1115551412, E-mail: elkhoulymohamed98@gmail.com


Background: Pericardial effusion (PE) develops very frequently after cardiac surgeries. It is one of the critical causes
of cardiac tamponade developing after coronary artery bypass grafting (CABG). Posterior left pericardiotomy (PP) is a
simple, easy, and efficient procedure in which the left pleural cavity is used to drain the pericardial area.
we aimed at 2 targets for our study. First, to detect the protectivity power of posterior pericardiotomy (PP)
technique after CABG against the occurrence of early and late pericardial effusion (PE). Second, to detect the effect of
posterior pericardiotomy (PP) procedure for preventing tamponade as a complication.
Patients and Methods:
A prospective randomized clinical trial was accomplished between November 2016 and
November 2018 including 120 consecutive patients underwent CABG, in Elkasr Elaini Medical Center, Cardiovascular
Surgery Department, Cairo University. Patients were allocated in two groups: 60 patients for each. Group 1 was a control
one and Group 2 was a posterior pericardiotomy intervention group where a T-shaped incision was created from left
inferior pulmonary vein to the diaphragm.
Results: detected early PE in 13 patients (22%) in control group versus only in 3 patients (5 %) in PP group (p < 0.001).
There was no late PE effusion or posterior tamponade noticed in the intervention group despite 6 (10 %) late PE
developing (p < 0.001) and 7 (12%) posterior tamponade occurring in control group (p < 0.002).
It could be concluded that posterior pericardiotomy (PP) has a beneficial effect in lowering the incidence
of early and late pericardial effusions (PE) and cardiac tamponade in patients undergoing CABG surgery.
Posterior Pericardiotomy, Pericardial Effusion, CABG surgery, Tamponade.


stay and high adverse events, as stroke and high
Pericardial effusion (PE) occurred in a high rate,
mortality rates (1).
about 65 % of patients, after cardiac operations (1). It is
The key cause mechanisms of AF after CABG are
also one of the causes of Atrial fibrillation (AF)
autonomic dysfunction, inflammation, structure and
developed following coronary artery bypass grafting (2).
electric remodeling and oxidative stress (13). In addition,
According to study definitions and designs, PE rates
there is evidence related to the reduction of AF by the
varies from 1% to 85% (3). It is generally insignificant
off-pump CABG rather than the on-pump procedure (14).
and in modest amounts. However, PE may be self-
Posterior left pericardiotomy (pp) is an easy,
limiting and does not need any treatment (it may be
simple and efficient technique in which the left pleural
discovered through computed tomography or control
cavity is used to drain the pericardial area (15). During
echocardiography), or it may be regional and loculated,
heart surgery, the retrosternal area may collect liquid
or it may prolong recovery in large effusion, or it may
and is simply drained from a chest drain; but, fibrous
be life-threatening and impedes cardiac filling, reduces
strands between the cardiac inferior surface and the
cardiac output, and leads to tamponade (4,5).
diaphragm may develop an enclosed room (8).
First, the regional PE are posterior located and
Mulay and colleagues (15) stated that PP might
associate with high mortality rates if the treatment
easily drain blood into the left pleural area. In their study
delays (6­8). Second, the large PE occur between day 4 to
pericardial effusion was lower (8%) in intervention
day10 after surgery in 30% of patients with bleeding in
group (PP) than control one (40%). Furthermore, it
early postoperative days , after valve surgeries, and in
significantly reduces late PE and late posterior
cardiac transplant receivers (4,6).
tamponade (9).
Third, in 1% of patients, cardiac tamponade occurs
For full PE draining, two drains are essential in
after days or weeks from surgery, especially in
chest, one in the anterior mediastinum and one in the left
anticoagulants treated patients (4).
pleural cavity (16).
Finally, Delayed PE, may be moderate or massive,
Several trials ascertain that PP is also a costly
represent 1.11 % of cases leading to posterior cardiac
beneficial and efficient procedure for controlling post-
tamponade in 40 % of these patients (9). Late cardiac
cardiac operations complications as AF (17­19).
tamponade is infrequent, develops in about 6 % of
In a systematic review and meta-analysis study,
patients after cardiac surgery, but has serious adverse
Gaudino et al. (20) stated that there was high and
prognosis (10).
significant link between posterior left pericardiotomy
Atrial fibrillation (AF) has high incidence as a
and the AF incidence reduction after CABG, aortic
postoperative complication (11). According to the
surgery, or aortic valve. In addition, there was no
operation type and evaluation methods, AF occurs in 30
postoperative adverse events or complications when
to 40% of patients (12). It has a great link to long hospital
compared to control group.
Received: 26/05/2022
Accepted: 03/08/2022

Full Paper (vol.891 paper# 95)

c:\work\Jor\vol891_96 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4740- 4746

Closure versus Non-Closure of the Rectus Muscle at Cesarean Section
Mahmoud Mahmoud Mohamed Abdelalim
Department of Obstetrics and Gynecology, Al Galaa Teaching Hospital, Egypt
Corresponding Author: Mahmoud Mahmoud Mohamed Abdelalim,
Mobile: (+20)01223176248, E-Mail: mmalim78@yahoo.com

A lower transverse abdominal scar and varying degrees of weakening of the abdominal muscles are both
side effects of caesarean section (CS). Many methods have been documented, and there is considerable variation in
approach from surgeon to surgeon. Objective: To compare closure and non-closure of the rectus muscle during primary
CS as regard early postoperative outcomes and effect on abdominal contour.
Subjects and Methods: This research was conducted using a randomized controlled trial design. It took place between
January 2015 and July 2015 at the Labor/delivery wards of Ain Shams University Maternity Hospital and El-Galaa
Teaching Hospital. A total of 124 women were approached, of them 110 were eligible and were enrolled in the study
and randomly allocated into 2 equal Groups, Group I Rectus closure and Group 2 Rectus non-closure, the finally
analyzed cases were 52 and 49 respectively.
Results: The mean operative time was statistically significantly longer in women of group I. The mean time to
postoperative bowel movement was statistically slightly longer in women of group I; the difference was, however,
statistically insignificant [mean difference = 0.75 hours, 95% CI (-0.19 to 1.69), p=0.115]. Conclusion: Closure of the
rectus muscles during CS seems to be associated with longer operative time and comparable postoperative pain, bowel
recovery time and patient's satisfaction about her abdominal contour over 12 weeks postpartum.
Keywords: Closure, Rectus Muscle, Cesarean Section.


early postoperative outcomes and effect on abdominal
Historically, caesarean section (CS) was only
done on mothers who were close to death. And while

vaginal birth remains the most prevalent obstetric
intraperitoneal surgery, caesarean deliveries are on the
rise around the world(1).
This research was conducted using a randomized
There can be reasons for the mother or the baby,
controlled trial design. It took place between January
or both, to have a caesarean section. Previous caesarean
2015 and July 2015 at the Labor/delivery wards of Ain
delivery, breech presentation, dystocia, and fetal distress
Shams University Maternity Hospital and El-Galaa
are the most common reasons for a caesarean section.
Teaching Hospital. A total of 124 women were contacted
Roughly 85% of all caesareans are performed due to
for the study, 110 consented to participate, and were
these causes (2).
randomly assigned to either Group I (rectus closure) or
Cesarean sections are performed using a wide
Group II (rectus non-closure).
range of surgical procedures. There is still uncertainty as

to whether any of these practices actually improve
Ethical consent:
maternal and infant health because they have not been
Research Ethics Council approved the study
subjected to rigorous evaluation in randomized
as long as all participants provided informed consent
controlled studies. Given the prevalence of caesarean
forms. Every patient signed an informed written
sections, even modest changes in postoperative
consent for acceptance of participation in the study.
morbidity rates between procedures have the potential to
Ethics guidelines for human experimentation were
improve the health of a sizable proportion of women and
adhered to by the World Medical Association's
reduce healthcare expenditures (3).
Helsinki Declaration.
The abdominal muscles of the patient, especially

those that have undergone several caesarean deliveries,
Inclusion criteria: Women planned to undergo elective
can become weak and the patient can develop a lower
or scheduled primary cesarean section, either: (a)
transverse scar after each delivery(4). These alterations
Elective cesarean section was defined as a cesarean
directly cause an altered abdominal shape (5).
section performed at a time that suits the woman and
Despite this, many different methods have been
maternity team, with no maternal or fetal compromise.
documented for conducting a caesarean section, and there
(b) Scheduled cesarean section is defined as the condition
is significant variation in technique from one surgeon to
that needs early cesarean delivery with no maternal or
the another(6).
fetal compromise. (c) Primary cesarean section is defined

as cesarean section in a non-previously scarred uterus.
Goal of the study:

To compare closure and non-closure of the
Exclusion criteria: (a) Women with previous
rectus muscle during primary cesarean section as regard
laparotomies through a midline, para-median or low
transverse incisions. (b) Women with over-sized uterus
Received: 30/05/2022
Accepted: 07/08/2022

Full Paper (vol.891 paper# 96)

c:\work\Jor\vol891_97 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4747- 4753

Mckenzie versus William's Exercise for Non-Specific Low Back Pain in
Adolescents: A Comparative Study
Hesham H.M. Elmahdy1, Naglaa A. Zaky1, Ali T. Elalfy2, Maya G. Aly*1
1Department of Pediatrics Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
2Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Maya G. Aly, Mobile: (+20)01002631238, E-Mail: maya.galal@pt.cu.edu.eg

Non-specific low back pain (NSLBP) in adolescence is common and crucial problem that affects a
child's ability to function in daily life, their relationships with others, their happiness, and their mental health. Also, it
may become compounded into adulthood. Williams and McKenzie exercises are the most commonly used to treat
patient's back pain. Objective: This study aimed to compare between Mckenzie and William exercises regarding their
affection pain, spinal flexibility and balance for adolescents with NSLBP. Patients and methods: A total of 34
adolescent males with NSLBP participated in this study. Those who met the criteria for inclusion, were divided
randomly into two groups; Group A received Mckenzie extension exercises; and Group B received William flexion
exercises. Data was collected from groups pre-treatment, 2 and 4 weeks post-treatment (Post I and II) regarding visual
analogue scale, flexibility score, vestibular balance and balance board scores. Results: Comparative analysis showed
that both groups were similar at baselines. Patients in both study groups showed significant reduction of pain and
improvement in spinal flexibility and balance. No significant differences were observed between the effectiveness of
McKenzie and William exercises on pain, flexibility and balance for treating NSLBP in adolescents. Conclusions:
Both McKenzie extension exercises and William flexion exercises are effective in treating adolescents with NSLBP.
The effectiveness of both exercises regarding pain, spinal flexibility and balance were comparable.
Keywords: Adolescents, Balance, Low Back Pain, McKenzie Exercises, William's Exercises.


has been recommended by previous systematic
Pain felt in the lumbar spine (lumbosacral
reviews, and there is a lack of evidence to support
region) below the twelfth rib and above the gluteal
any particular form of exercise (like, abdominal
crease that cannot be attributed to a specific
strengthening, flexion/extension, or William's
etiology (as cauda equina, radicular syndrome,
exercises, stretching, McKenzie) (7).
fracture, infection, osteoporosis, tumor, structural
Inexpensive and simple back exercises have
deformity, as well as inflammatory disorder)is
been shown to be an effective treatment option for
referred to as "non-specific low back pain"
NSLBP, the most well-known types of back
(NSLBP). It is mostly benign, but it can become
exercises are that of McKenzie and the William (8).
chronic low back pain (LBP) if not treated properly
Physical therapists frequently use McKenzie
(1,2). In young people, NSLBP is the major cause of
method as a means of treating LBP (9). It's a helpful
disability (3).
treatment for reducing back pain and enhancing
As a rule, adolescence is characterized by rapid
spinal mobility (5). Studies have shown that
maturation of the body. Musculoskeletal conditions,
individuals with mechanical chronic LBP who
like NSLBP, are known to be brought on by changes
performed William's exercises saw a decrease in
in the spine's physical morphology (4). Late
pain intensity and an increase in daily activities.
activation, weakness, and decreased resistance in the
The purpose of this study was to evaluate the
deep muscles of the trunk were observed in patients
effectiveness of Mckenzie extension exercises
with LBP. Conditions associated with LBP have also
against William flexion exercises in reducing pain
been linked to alterations in the hip extensor activation
and improving spinal flexibility and balance in
pattern and dysfunction of the gluteus maximus.
adolescents with non-specific low back pain.
Collectively, these alterations appear to increase


susceptibility to falling and lessen the capacity to
Study Design and Setting
maintain balance. Indeed, people with NSLBP
Prospective quasi-experimental comparative trial of
exhibited greater center of pressure displacement and
pre-post study design was used. Patients were
velocity, especially with eyes closed and on unstable
recruited from the Outpatient Clinic of Zagazig
surfaces, as compared to healthy persons (3).
General Hospital, Egypt.
Reduced lumbar range of motion is associated with

LBP patients, who have less spinal mobility as a result
of their condition. The range of motion in the spine is
A total of 34 four adolescent males were recruited
evaluated with the modified Schober's test (5,6). First-
according to the following inclusion criteria: aged from
line treatment for NSLBP according to the European
14 to 18 years, diagnosed as NSLBP, medically and
Guidelines includes supervised exercise therapy. The
clinically stable and within normal range weight and
significance of exercise in the management of LBP
height. Adolescents have one or more of the followings
Received: 25/5/2022
Accepted: 02/08/2022

Full Paper (vol.891 paper# 97)

c:\work\Jor\vol891_98 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4754- 4761

Proportion And Determinants of Glycemic Control in Type 1 Diabetes
Mellitus among Children and Adolescents Attending Assiut Health Insurance Clinic
Mahmoud A. Abdelaty, Faten M. Rabei, Mennatallah M. Abdelhakem*
Department of Public Health and Community Medicine, Faculty of Medicine Assiut University, Egypt
*Corresponding author: Mennatallah Mostafa, Mobile: (+20) 0102124040, E-Mail: mennamostafa6206@gmail.com

Long-term health issues associated with type 1 diabetes mellitus (T1DM), such as renal impairment,
retinal affection, as well as heart and neurological conditions, can have an impact on a patient's quality of life. The
degree of control of diabetes and its complications are known to be directly correlated, and achieving optimal blood
glucose levels lowers the risk of long-term complications.
Objective: The aim of the present study is to evaluate the proportion of uncontrolled T1DM and factors that influence
glycemic control in children and adolescents with T1DM in the Assiut Governorate of Egypt.
Patients and methods: A total of 500 participants with TIDM for at least three years, ranging in age from 3 to 18 were
recruited. We conducted a thorough history taking that covered sociodemographic factors, disease-related factors,
disease management plans, and the level of patient disease knowledge. All study participants had their body mass
indexes evaluated. We divided the study participants into two groups; those with controlled T1DM and those without,
based on the glycosylated haemoglobin (HbA1c) targets.
Results: The mean age was 13.56 (SD 3.49) years, and 52% of the study participants were female and 48% were males.
Only 38% of participants lived in urban area, while 62% lived in rural area. Only16.8% of the studied diabetic children
and adolescents had controlled T1DM while 83.2% had uncontrolled T1DM. Predictors for uncontrolled T1DM in
children and adolescents were female gender, irregular treatment and poor level knowledge. Conclusion: Most of the
diabetic children and teenagers in this study had uncontrolled T1DM. Poor knowledge about diabetes was the most risk
factor for uncontrolled T1DM. Health education programs for T1DM patients are needed to achieve good glycemic
Predictors, Children, Type 1 Diabetes Mellitus, glycemic control.


Type 1 diabetes mellitus (T1DM) is a common
Study setting and design
chronic disease in children and adolescents. It is caused
A cross-sectional study conducted on children and
by insulin deficiency as a result of destruction of the
adolescents with type I DM attending Sidi-Galal Health
insulin-producing beta cells in the pancreas. It accounts
Insurance Clinic in Assuit City in Upper Egypt, which
for 75%­80% of newly diagnosed diabetes in patients
provides health care to all diabetic children and
younger than 18 years [1].
adolescents from Assiut governorate during the period
Due to the fact that children need to constantly
between 2017 and 2018.
inject insulin and monitor their blood glucose levels,

involvement of parents, lifestyle adaptation, and good
Inclusion and exclusion criteria
communication with the treating physicians, nurses, and
All children and adolescents with a proven diagnosis of
dieticians are essential. The responsibility for attaining
T1DM with 3 years' duration or more were eligible to
the appropriate glycated hemoglobin (HbA1c) goal
participate in the study. Any patients with age less than
rests upon the children and their caregivers, with close
3 years old or more than 18 years old, and/ or with type
and continuing support from the clinic [2].
2 DM was excluded from the study.
T1DM carries a long-term burden of increased

micro- vascular and macrovascular complications. As
Sample size calculation
the incidence of T1DM continues to rise, the load of
The sample size was calculated using Epi-Info, version
microvascular complications will also in- crease and
7. Based on a previous study, the proportion of
negatively influence the prognosis of young patients.
uncontrolled children and adolescents with T1DM was
Microvascular complications of diabetes include
50%, with a power of 80% and a confidence level of
retinopathy which is the leading cause of blindness in
95%. The sample needed for the study was estimated to
working age people [3].
be about 322 children and adolescents. To compensate
Here, in this work, we aimed to determine the
for the dropouts, 20% was added, giving a final sample
proportion of uncontrolled T1DM predictors of
size of about 500 children and adolescents.
glycemic control among children and adolescents with

T1DM in Assiut Governorate-Egypt.

Received: 25/05/2022
Accepted: 02/08/2022

Full Paper (vol.891 paper# 98)

c:\work\Jor\vol891_99 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4762- 4766

Breast Asymmetry and Value of Contrast-Enhanced Spectral
Mammography: Review Article
Shaimaa Mohamed Abdel Ghany *, Aml Mohamed Hassan,
Hanan Abdelhamed Ismail, Mohamad Gamal Nada
Department of Radiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Shaimaa Mohamed Abdel Ghany, Mobile: (+20) 01009872522, E-Mail: shimadoc90@gmail.com

The major imaging method for early diagnosis of breast cancer is screening mammography. One and half
to four years before a malignancy becomes clinically apparent, mammography may identify it. Faster scanning times in
the mammography suite are possible with contrast-enhanced spectral mammography. Clinical effectiveness of contrast-
enhanced spectral mammography for detecting asymmetry in mammograms was assessed in this study.
Objective: Assessment of possible role of contrast-enhanced spectral mammography for diagnosing breast
Breast asymmetry, and contrast-enhanced spectral mammography 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 March 2006 to April 2021 was included. Due to the lack of sources for translation,
documents in languages other than English were 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: Especially for women with dense breasts, contrast-enhanced spectral mammography has the potential to
be effective in identifying lesions that would otherwise go undetected due to breast asymmetry. This would improve
the rate at which breast cancer is detected in its earliest stages.
Keywords: Breast asymmetry, Contrast-enhanced spectral mammography.


When one breast has a greater volume or density of
(CESM) may be helpful for lesion detection in the
breast tissue than the other, this is referred to as
mammographically dense breast. Further research on
asymmetric breast tissue. While asymmetry is
the diagnostic potential of contrast-enhanced spectral
frequently a non-obtrusive observation, it may warrant
mammography, an emerging technology derived from
further investigation in some cases. Tissue loss,
spectral mammography, is warranted (2).
underdevelopment, or a more pronounced parenchyma

in one side can all contribute to an appearance of
Breast asymmetry and value of CESM:
asymmetry (1).
If you look at two separate mammogram
Focal asymmetry is defined by the Breast
projections, you can notice a density with concave
Imaging Reporting and Data System as having similar
edges in just one quadrant. This is called focal
features in more than one quadrant of the breast but
asymmetry (3).
lacking convex borders and including interspersed fat.
A "focal asymmetry" is an area of increased density
While both asymmetry and focal asymmetry appear on
that may be seen from two different vantage points as a
one of the two conventional mammography images,
confined asymmetry of about the same shape.
the latter is more common. In contrast, growing
However, it does not qualify as a mass and has no
asymmetry refers to focal asymmetry that wasn't seen
clearly defined boundaries (4).
in earlier mammograms but is now more noticeable or
demonstrates size increases (2).
Received: 26/05/2022
Accepted: 03/08/2022

Full Paper (vol.891 paper# 99)

c:\work\Jor\vol891_100 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4767- 4774

Maternal Knowledge of Recommended Weight Gain in Pregnancy and
Its Effect on Gestational Weight Gain
Rahma Aly Mohamed Ahmed, Mahmoud Mahmoud Mohamed Abdelalim, Fatma Abd El-Salam
Mohamed Newira, Mohamed Elsayed Younes Elsayed Khalaf, Tamer Shawkey Gouda Ahmed
Department of Obstetrics & Gynecology, Al Galaa Teaching Hospital, Cairo
*Corresponding Author: Mohamed Elsayed Younes Elsayed Khalaf, Mobile: (+20)1006328676,
E-Mail: mohamedyounes48@gmail.com
: Pregnant women and their doctors continue to worry about the potential health consequences of maternal
weight increase. Objective: The aim of the current work was to describe the accurate maternal knowledge of
recommended weight gain during pregnancy and assessment of this knowledge effect on actual gestational weight gain.
Subjects and Methods: This cross-sectional study included a total of 523 pregnant women receiving antenatal
treatment, attending at the Prenatal Outpatient Clinic, Al-Azhar university hospitals, using a self-administered
questionnaire. This study was conducted between October 2016 and April 2017.
Results: Low rates of acceptable gestational weight growth (27.6%) and low rates of proper understanding of weight
increase recommendations during pregnancy (10.3%) characterize our sample cohort (40.4 percent). Accurate awareness
of prenatal weight increase guidelines was linked to healthy weight gain. (P=0.007). Mothers' understanding of healthy
weight increase did not improve with higher levels of education. (P=0.458).
Conclusion: It could be concluded that the findings of this study support the need for improvements in educational
efforts about weight gain in pregnancy. The main source of ANC knowledge especially gestational weight gain
knowledge is low. The vast majority of pregnant women do not regularly practice exercise before pregnancy.
Keywords: Maternal Knowledge, Weight Gain, Pregnancy.


of data, we conducted a survey among expectant mothers
Pregnant women and their doctors continue to be
to ascertain whether or not they understood their doctor's
concerned about pregnancy weight gain. Because
advice regarding weight increase and the dangers of
excessive weight gain during pregnancy might
excess weight gain during pregnancy (4). Few research
negatively affect the baby, weight anxiety is a real
have evaluated mothers' familiarity with the IOM's 2009
concern. Worldwide, there is a growing cause for alarm
guidelines for prenatal weight gain as of yet. There was
regarding the increased incidence of maternal obesity
a range of 31%-48% of people in previous surveys who
and overweight. Obesity is a major nutritional issue for
could correctly identify these recommendations.
pregnant women, especially in developed countries.
However, it is not known if there is a correlation between
However, as more and more people in developing
knowing the recommendations and actual weight
countries adopt Western ways of life, the prevalence of
increase during pregnancy (4, 5). It was the goal of this
obesity during pregnancy could rise to levels previously
study; description of accurate maternal knowledge of
seen only in developed nations (1,2).
weight gain recommended during pregnancy and
Only 30­40% of pregnant women achieve a
assessment of this knowledge effect on actual gestational
healthy body mass index (BMI) range, notwithstanding
weight gain for pregnant women.
the current recommendations and their predecessor from

1990. More than half of pregnant women are overweight
or obese, which greatly increases their risk of difficulties
This cross-sectional study included a total of
during and after birth (including diabetes mellitus,
523 pregnant women receiving antenatal treatment,
hypertension, and the need for a caesarean section or
attending at the Prenatal Outpatient Clinic, Al-Azhar
surgical vaginal delivery). Macrosomia, birth trauma,
university hospitals, using a self-administered
and later childhood obesity are all increased with
questionnaire. This study was conducted between
excessive weight growth during pregnancy. On the other
October 2016 and April 2017.
hand, low birth weight and premature birth are more
Ethical Consideration:
likely among babies whose mothers did not acquire
This study was ethically approved by Research
enough weight throughout pregnancy (3). There is a
Ethics Council Al-Azhar university. Written informed
dearth of data on the extent to which women are advised
consent of all the participants was obtained. The
about the hazards of inappropriate weight increase
study protocol conformed to the Helsinki Declaration,
during pregnancy, despite the well-documented negative
the ethical norm of the World Medical Association for
maternal, baby, and childhood outcomes that accompany
human testing.
both excess and deficient gestational weight growth,
Inclusion criteria: Patients which were eligible to
Moreover, since the new recommendations were
be included in the study were pregnant women with a
announced, there has been a lack of information on the
viable singleton pregnancy.
percentage of women who have been counselled
regarding gestational weight gain. To remedy the dearth
Received: 26/05/2022
Accepted: 03/08/2022

Full Paper (vol.891 paper# 100)

c:\work\Jor\vol891_101 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4775- 4782

Assessment of Efficacy of Sublingual Immunotherapy Compared to the Standard
Treatment in Children with Bronchial Asthma in Zagazig University Hospitals
Samah Sarhan Elsayed*1, Dina Mohamed Shokry1, Rabab Mohamed El-Behedy1,
Nissreen Elsayed ElBadawy Ali2
Departments of 1Pediatrics and 2Medical Microbiology & Immunology,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Samah Sarhan Elsayed, Mobile: (+20) 01115039958, E-Mail: samahsarhan0@gmail.com

Sublingual allergy immunotherapy (AIT) has been proven in meta-analyses to reduce both symptoms and
medication use in asthma. Objective: To assess safety and efficacy of sublingual immunotherapy as add on treatment
for 6 months on asthmatic children.
Patients and Methods:
In a randomized controlled study, we did this study at Department of Pediatrics at Zagazig
University Hospitals, during the period from May 2019 to October 2019. It included 60 children who have mild to
moderate persistent asthma symptoms according to (GINA guide lines 2015) confirmed with skin prick test for positive
allergen sensitivity. Sixty asthmatic children were categorized in two groups (30 children, each): Group A: received
only the standard treatment of asthma, Group B: received specific sublingual immunotherapy (SLIT) with the standard
treatment of asthma.
After receiving SLIT treatment, total IgE was significantly lower than before treatment with improvement in
pulmonary functional parameters in SLIT group. The SLIT group showed significant increase in control of asthma after
six months of treatment with SLIT. There was a significant decrease in using medications after receiving SLIT group.
Clinical evidence supports the use of SLIT for the treatment of asthma in children. Reduces allergic asthma
symptoms and the need for medication.
Keywords: Sublingual Immunotherapy, Bronchial Asthma.

Adults and children alike bear a significant
Therefore, for sensitised asthmatic patients in
socioeconomic burden due to asthma, a chronic and
steps 3 and 4 who are not under control, House Dust
diverse illness. According to some estimates, by 2025
Mite (HDM) SLIT is proposed in the most recent
there could be as many as 400 million individuals
version of the Global Initiative on Asthma (GINA)
worldwide living with bronchial asthma(1). Even though
recommendations, combined with a high degree of lung
there are a variety of tests available, diagnosing allergic
function preservation (Forced Expiratory volume in the
illness can be difficult, especially in young children.
First Second - FEV1 >70% of expected) and the
Many allergic illnesses require skin testing as part of the
presence of allergic rhinitis(4). The efficacy, cost-
diagnosis process. Although these tests are most
effectiveness, and safety of AIT in asthma were recently
commonly used for diagnosing inhalant allergies, there
demonstrated in a systematic review and meta-analysis
is a growing trend to utilise them for other types of
by the European Academy of Allergy and Clinical
allergies, including those to food, venom, occupational
Immunology (EAACI)(5).
agents, and medications. There is still a strong reliance
Evidence-based practical instructions on how
on skin prick tests (SPTs) and intradermal testing as the
to properly employ AIT in asthma were also published
gold standard for diagnosing IgE-mediated (type I)
by the European Academy of Allergy and Clinical
allergies and bronchial asthma. They are extensively
Immunology (EAACI) in their latest guidelines on
used in outpatient clinics because they are simple to
allergen immunotherapy for allergic asthma (6).
administer, cheap, and provide results rapidly(2).

However, current pharmaceutical therapy
options successfully manage clinical symptoms and the
This study's purposes are to assess safety as
underlying inflammatory process but have little impact
well as efficacy of sublingual immunotherapy as add on
on the disease progression since they do not alter the
treatment for 6 months on asthmatic children, in
dysregulated immune response(1).
addition to evaluate the prevalence of sensitization to
In both allergic rhinitis and allergic asthma,
common allergens using skin prick test. Also, it aims to
allergy immunotherapy (AIT) has been demonstrated in
detect the impact of sublingual immunotherapy on the
meta-analyses to reduce symptoms and medication use
improvement of pulmonary function, clinical
when given sublingually (sublingual immunotherapy
symptoms, and decrease of medication usage.


immunotherapy [SCIT]), as an added bonus, it changes
the immunologic abnormalities that lead to allergy
Sixty children at Zagazig University Hospitals,
sensitization, making the reaction to the administered
Department of Pediatrics, Faculty of Medicine, in this
allergen more similar to that seen in people who aren't
nonrandomized controlled trial study were involved.
Received: 30/05/2022
Accepted: 07/08/2022

Full Paper (vol.891 paper# 101)

c:\work\Jor\vol891_102 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4783- 4789

Levels of GLP-1 In Response to The Most Common Used Bariatric
Procedures in Obese Patients with Type 2 Diabetes Mellitus
Amira M. Elsayed*1, Walaa M. lbrahim1, Ahmed M.F.Salama2 ,
Maha H.Morsy4 , Eman M. Araby3 , Rasha O. Abdelmoniem1.
1 Department of Internal Medicine, 2 Department of General Surgery,
3 Department of Public Health and Community, Faculty of Medicine, Benha University, Egypt.
4 Department of Respiratory Care Technology, Faculty of Applied Health Sciences Technology,
Misr Univeristy for Science and Technology, Egypt.
*Corresponding author: Amira M. Elasyed, Mobile: 00201017994486, E-mail: amiramohamady@gmail.com,
ORCID ID: 0000-0002-2863-3120.


Background: In the last two decades, extreme obesity and its comorbidities have often been treated with bariatric
Objective: Our goal was to compare the levels of GLP-1 in individuals who are severely obese three months after
undergoing any of the three more frequent bariatric methods: sleeve gastrectomy (SG), Roux en Y gastric bypass
(RYGB), or intragastric balloon (IGB).
Patients and Methods: This is prospective research being done at Benha University Hospital for people with obesity
and type 2 diabetes who have been recruited 3 months prior to having any bariatric surgeries. Patients were subjected
to measurement of WC, BMI and laboratory assay of HbA1c, fasting plasma glucose (FPG), fasting insulin, HOMA-
IR, ALT, AST, glucagon-like peptide-1 (GLP-1) and lipid profile before and after 3 months of procedures.
Results: There was significant improvement of FPG, and HbA1c in RYGB operation in comparison with other bariatric
procedures. Fasting insulin was substantially lower in the RYGB surgery than the in SG and IGB (p 0.05) with
substantial improvements of HOMA-IR for RYGB surgery (p 0.05). In RYGB surgery, there was highly substantial
increase in GLP-1 levels compared to SG and IGB procedures (p <0.001). The change in BMI were significant (p
0.001) in RYGB but waist circumference did not change significantly after 3 months of any of three procedures.
Conclusion: Our results demonstrated that GLP-1 values were increased after RYGB compared to SG and IGB after
three months of the procedures.
Keywords: Diabetes Mellitus, GLP-1, Bariatric procedures.

precisely GLP-1, seems to be the most crucial hormone
In the last two decades, extreme obesity and its
for glucose regulation and weight reduction [9].
comorbidities have often been treated with bariatric
Remission of diabetes varied from 45 to 97% of
surgery [1]. Bariatric operations often involve restrictive
patients based on the type of operation (restrictive,
or a mix of restrictive and malabsorptive approaches [2].
poorly absorbing, or both) and the design of the study
Sleeve gastrectomy (SG) is a type of restrictive
[10]. Even though several trials showed comparable
operation keeping the whole length of the
elevations in postprandial active GLP-1, some
gastrointestinal tract [3].
publications claim that RYGB boosts postprandial
While, the restrictive and malabsorptive surgery
GLP-1 more than VSG [11].
is accomplished by gastric bypass that was known as a
Our aim was to perform a comparative analysis of
Roux-en-Y gastric bypass (RYGB) [4]. Intragastric
the levels of GLP-1 in morbidly obese patients after 3
balloon (IGB) placement is a transitory, less invasive
months of any of the three most popular bariatric
procedures for weight reduction by causing satiety
procedures; SG, RYGB or IGB. Additionally, to
through application of a balloon with a 400 ml volume
determine whether treatments may lead to greater
[5]. Numerous gastrointestinal (GI) hormones, such as
improvements in the metabolic syndrome's constituents
ghrelin, peptide YY (PYY), and glucagon-like peptide-
as possible indicators of future comorbidities.
1 (GLP-1), communicate with peripheral tissues and the

central nervous system to control glucose regulation and
energy balance. Distal intestine L-cells release PYY and
The study was conducted at Benha University
GLP-1 to reduce hunger, boost satiety, and delay
Hospital. A total of 49 type 2 diabetic patients with
gastrointestinal motility [6].
morbid obesity (BMI 35), were planned to undergo
Additionally, GLP-1 functions as an incretin to
either RYGB, IGB or SG. The following clinical data
boost glucose-stimulated insulin release, while PYY
were recruited; age, sex, type of bariatric surgeries,
enhances insulin sensitivity [7]. Ghrelin is an orexigenic
waist circumference (WC), body mass index (BMI) and
hormone that is released by the proximal small intestine
blood pressure. The patients were divided into 3 groups;
and gastric fundus to promote hunger, boost gut
IGB-operated group (15 patients), RYGB-operated
motility, and reduce insulin excretion [8]. The levels of
group (17 patients) and SG-operated group (17
postprandial GI hormones after bariatric operation,
Received: 24/05/2022
Received: 1/08/2022

Full Paper (vol.891 paper# 102)

c:\work\Jor\vol891_103 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4790- 4795
Left Atrial Strain evaluation in Post Covid 19 Recovered Patients
Abdelsalam El-Sayed Hessen Sherif*, Nader Talaat Kandil, Abdulali Mohammed Omar Altabeeb,
Shimaa Gamal Zein El-Abdeen
Department of Cardiology, Faculty of Medicine- Zagazig University, Zagazig, Egypt
*Corresponding Author: Abdulali Mohammed Omar Altabeeb, Mobile: (+20)1010621320, E-mail:

The COVID-19 pandemic has affected more than 170 million people around the world, and
previous studies of complications and long-term effects of SARS-CoV-2 infection have found that patients
who are hospitalized with COVID-19 have more than double the rate of arrhythmias, including atrial
fibrillation and atrial flutter, a similar rapid rhythm that can lead to heart failure and stroke.
The aim of the study was to evaluate the left atrial structural remodeling in patients with persistent
dyspnea and exertional dyspnea post covid 19 infections.
and methods: This case-control study included a total of 60 patients in sinus rhythm, aged > 18 years,
attending at Department of Cardiology, Zagazig University Hospitals. They were divided into two groups
:(A) included 30 symptomatic subjects recovered from covid 19 who developed exertional dyspnea, compared
to group B (30) volunteers without any symptoms. All participants were in sinus rhythm.
Left Atrial (LA) reservoir Strain is decreased in post covid in cases with exertional dyspnea &
associated with this dyspnea at odds ratio (OR) of 3.28 (95% CI 1.4 to 7.6), ALSO, LA diameter at OR of 2.7
CI (1.22- 6.77) & p wave dispersion at OR 126 CI (20- 813).
It could be concluded that LAS parameters have a high feasibility to predict symptomatic subjects
who developed exertional dyspnea, and fatigue after recovery from covid-19 infection.

Left Atrium, COVID-19, Exertional Dyspnea, left atrial strain.


The COVID-19 pandemic has affected
This case-control study included a total of 60
more than 170 million people around the world,
patients in sinus rhythm, aged > 18 years, attending
and previous studies of complications and long-
at Department of Cardiology, Zagazig University
term effects of SARS-CoV-2 infection have found
that patients who are hospitalized with COVID-19
The included subjects were divided into two
have more than double the rate of arrhythmias,
groups; Group (A) included 30 symptomatic
including atrial fibrillation and atrial flutter, a
subjects recovered from covid 19 who developed
similar rapid rhythm that can lead to heart failure
exertional dyspnea, and Group (B) included 30
and stroke. But exactly how the virus causes these
volunteers without any symptoms.
heart complications, has been poorly understood [1].

Myocardial injury in Coronavirus disease
Inclusion criteria: Post covid-19 patients with
2019 (COVID-19) has been associated with
residual symptoms (exertional dyspnea, and
ventricular affection and adverse outcomes;
exercise intolerance) and other control volunteers
however, associations between atrial affection and
without symptoms.
arrhythmias, such as atrial fibrillation/flutter (AF)
Exclusion criteria: Patients with valvular heart
or orthostatic sinus tachycardia, are not well
disease. All sorts of cardiomyopathy, Arrhythmia,
established in this population [2].
Diabetic patients, hypertensive, ischemic heart
Recent advances in two-dimensional
disease, chronic obstructive pulmonary disease,
echocardiography (2DE), including speckle-based
congenital heart disease, thyroid disease, covid 19
strain, enable the quantification of left atrial strain
infection with pulmonary embolism.
(LAS), a measure of atrial deformation that has
Patients were subjected to history taking, physical
previously been shown to be associated
examination, and investigations which included
cardiovascular events [3].
polymerase chain reaction (PCR), complete blood
The aim of this study was to evaluate the
count (CBC) and CRP.
left atrial structural remodeling in patients with
Transthoracic echocardiography:
persistent dyspnea and exertional dyspnea post
The echocardiographic examination was
covid 19 infections.
performed using a Vivid E9 (General Electric

Health Care) ultrasound machine and images were
acquired with the patient in left lateral decubitus

Received: 12/6/2022
Accepted: 18/8/2022

Full Paper (vol.891 paper# 103)

c:\work\Jor\vol891_104 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4796- 4801

Evaluation of First Trimester Uterine Artery Doppler, Placental Growth
Factor and Maternal Characteristics in Prediction of Preeclampsia
Mahmoud Abubakr Negm*, Mohamed Ahmed Wasfy, Ahmed Ismail Heraiz
Obstetrics and Gynecology department, Faculty of Medicine, Zagazig University, Zagazig, El Sharkia, Egypt
*Corresponding Author: Mahmoud Abubakr Negm, Mobile: (+20)01228874439,
E-mail: mahmoudabubakrnegm@gmail.com

Preeclampsia is a major contributor of maternal and perinatal morbidity and mortality. The purpose of
this study was to look at the predictive usefulness of placental growth factor (PLGF), maternal characteristics (MC),
and uterine artery Doppler for preeclampsia in the first trimester.
Patients and methods: A cross-sectional survey was conducted on 805 pregnant women between 11 + 0 and 13 + 6
weeks' gestation. A complete history and clinical examination were taken at the booking visit, a bilateral uterine artery
Doppler study was estimated, and the mean pulse index (PI) was computed and recorded. A venous blood sample was
drawn and centrifuged for 10 minutes at 3000 rpm to extract the serum, which was then frozen at 80 C for further
examination for placental growth factor (PLGF).
Results: PE developed in 54 (6.7%) cases; 11 (20.4%) early-onset and 43 (79.6%) late-onset. The following
parameters were calculated: sensitivity, specificity, positive and negative value (PPV and NPV), and accuracy. The
sensitivities for MC, PLGF and UADPI for prediction of early-onset preeclampsia were 27.3%, 54.5%, and 72.7%,
respectively. The sensitivities for MC, PLGF and UADPI for prediction of late-onset preeclampsia were 14%, 55.8%,
and 51.2%, respectively. The sensitivity for combination between the three factors used to predict PE were 85.7% for
early-onset and 79.4% for late-onset preeclampsia, respectively.
Conclusions: Effective screening for PE may be accomplished in the first trimester of pregnancy, at 11-14 weeks'
gestation, by combining maternal features with the findings of uterine artery Doppler and placental growth factor to
determine the risk of PE development.
Keywords: Preeclampsia, Placental growth factor, Maternal characteristics, Uterine artery Doppler pulsatility index.

and preeclampsia in the first trimester. In the first
Preeclampsia (PE) is a pregnancy complication
trimester, a combined evaluation of "maternal history
marked by hypertension and proteinuria, and which
and features" together with the aforementioned
may occasionally result in a multi-organ cluster with
biomarkers and uterine artery Doppler demonstrated
quite varied clinical characteristics [1]. Preeclampsia
great specificity in identifying women at risk of
affects roughly 2 to 8% of pregnancies and is a major
developing preeclampsia [6].
cause of maternal and perinatal death and morbidity [2].
The purpose of this study was to look at the
Identifying the risk of developing preeclampsia is
predictive usefulness of placental growth factor
an essential part of prenatal care, and research to perfect
(PLGF), maternal characteristics (MC), and uterine
it is continuing. There are many prediction models for
artery Doppler for preeclampsia in the first trimester.
early prediction of preeclampsia have been developed

[3]. These prediction models may play a role in
improving risk selection by identifying risks early and
The research was carried out at the Zagazig Faculty
allowing for preventative actions such as low-dose
of Medicine's Department of Obstetrics and
aspirin therapy [4]. Women can be categorized
Gynecology and the Laboratory Unit. This research
according to prediction models into "low" and "high"
was divided into two phases: phase I was a cross-
risk groups. Pregnant ladies can receive care based on
sectional study, and phase II was a case control study.
their risk (tailored care pathways) [5].
The study started with 909 cases from these, 35
The degree of trophoblastic invasion of the spiral
cases aborted and 69 cases missed during follow up and
arteries is inversely linked to the uterine artery
the remaining ones were 805 cases. In phase II, the
pulsatility index (PI). Impaired placentation is
sample was categorized according to results of phase I
characterized by an aberrant functional and
during follow up. Inclusion criteria were pregnant
biochemical environment that includes an increase in
women between 11 + 0 and 13 + 6 weeks' gestation.
uterine artery PI, an increase in antiangiogenetic
Multiple pregnancy, chronic renal illness, chronic
factors, such as Soluble Endoglin (sEng), Soluble fms,
such as Tyrosine Kinase-1 (sFLT1) and Inhibin-A; a
pregestational diabetes mellitus, or systemic lupus
side from a decrease in angiogenetic and mitogenic
erythematosus were all exclusion factors. Withdrawal
hormones, such Pregnancy Associated Plasma Protein-
criteria included cases that couldn't be followed up or
A (PAPP-A), Placental Growth Factor (PLGF), and
those missed during the study were excluded (69 cases)
Placental Protein 13, (PP13). These indicators are
and cases of abortion or when termination of pregnancy
crucial for subclinical syncitiotrophoblastic damage
Received: 30/05/2022
Accepted: 05/08/2022

Full Paper (vol.891 paper# 104)

c:\work\Jor\vol891_105 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4802- 4810

Efficacy of Combined Lateral Femoral Cutaneous Nerve Block with Pericapsular
Nerve Group Block Versus Fascia Iliaca Block in Proximal Femoral Fractures
* Shimaa Abd El-Satar Shalaby, Eiad Ahmed Ramzy, Mona Abd Elgalil Hasheesh, Sherine Ali Bakrey
Department of Anesthesia and Surgical Critical Care, Mansoura University Hospitals, Mansoura, Egypt
*Corresponding author: Shimaa Abd El-Satar Shalaby, Mobile: 01098252796, E-Mail: shimaashalaby1@ gmail.com

peripheral nerve blocks were introduced to offer analgesia in hip surgery.
Objective: This study compared the analgesic efficacy of combined lateral femoral cutaneous nerve (LFCN) block with
pericapsular nerve group (PENG) block versus fascia iliaca block (FIB) for proximal femur surgery.
Patients and Methods: One hundred patients underwent proximal femoral fracture surgeries were equally randomized to
either group : FIB or group : combined LFCN block with PENG block. The primary outcome was how long it took to
perform spinal anesthesia. The secondary outcomes were the assessment of sensory block, VAS during spinal anesthesia,
anesthesiologist satisfaction, time to first analgesic request, postoperative pain score and total morphine requirements.
The VAS scores did not significantly differ from one another during positioning for spinal anesthesia between two
groups. After 15 minutes and 30 min of blocks, VAS score at rest was reduced in group compared to group but with no
significant difference. The median (VAS) score at rest immediately and one hour at post anesthesia care unit (PACU) was
significantly lower in group compared to group . Time to first analgesic request, total morphine consumption in the
postoperative 24 hours (h) showed no significant statistical difference between both groups.
Conclusions: PENG block is an effective and safe practice that could be an alternative to FIB for pain relief and comfort
during positioning in patients with proximal femur fractures with preservation of motor function.
PENG block, Femoral fracture, Fascia iliaca block.


Elderly patients frequently experience proximal
This randomized single-blinded study was carried out
femoral fractures, which have high rates of morbidity and
at Mansoura University Emergency Hospital from April
mortality (1). Ineffective pain management results in
2020 to April 2021.
delirium, extended hospital stays, and subpar functional

outcomes (2). Due to its superior opioid sparing properties,
regional analgesia, which includes femoral nerve (FN)
Patients of both sex and aged from 50 to 90 years
block, 3-in-1 FN block and FIB is a widespread analgesic
old, ASA physical status from I to III listed for elective
method (3). The obturator nerve (ON) is not covered;
and emergent proximal femoral fracture surgery were
hence these blocks only provide modest analgesia (4).
involved. Patient refused to participate, pregnancy,
The FN, ON and accessory obturator nerve
coagulopathy, hematological disorders, neuromuscular
(AON) innervate the anterior portion of the hip capsule,
disorders, psychiatric disorders, multi-traumatized
which is the portion of the joint that is most densely
patients, local skin infection at site of the block, severely
innervated (4-6). The PENG block, a method for blocking
obese patients (BMI >40), history of allergy to anesthetic
these articular divisions to the hip, was created and
drugs and patients on opioids analgesics or opioid abuse
considerably decreased pain scores (4). PENG block and
were excluded.
LFCN block were advised to be used as an auxiliary to
All patients underwent preoperative evaluations.
cover the dermatomal incision for THA(7).
Upon the patient's admission to the preanesthetic room,
Few researches were concerned about the
under standard monitoring, peripheral venous cannula
analgesic efficacy of PENG block in proximal femoral
was secured and normal saline solution (6 ml/kg) was
surgery. However, the present study compared the effect
infused, VAS scale was explained to all patients and 0.01
of combined LFCN block with PENG block versus FIB
to 0.03 mg/kg IV midazolam was given if needed.
for proximal femur surgery. The primary outcome was the

analgesic effect reflecting ease of the positioning of
Study design:
patients for spinal anesthesia before surgery via
A randomly generated table produced by a
assessment of time of performance of spinal anesthesia
computer was used to divide eligible 100 patients into two
(SA). The secondary outcomes included VAS during
equal groups at random. Group assignments were kept
spinal anesthesia, anesthesiologist satisfaction, effective
secret by being placed in sealed, opaque envelopes. Group
duration of analgesia, postoperative pain score, any
(n=50): Patients received suprainguinal FIB with 30 ml
complications or adverse effects.
of 0.25% bupivacaine before spinal anesthesia and group

(n=50): Patients received combined LFCN block (5 ml
Received: 24/05/2022
Received: 1/08/2022

Full Paper (vol.891 paper# 105)

c:\work\Jor\vol891_106 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4811- 4816

Lifestyle Modification and Its Effect on The Control of Hypertension
Mahmoud Fawzy Elgendy, Abd-Elmoniem Abd Elfatah Dawah,
Mona Ahmed Elawady, Samar Yusif Ebrahim Zidan*, Mai Abdullah Elmahdy
Community, Environmental and Occupational Medicine, Department, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Samar Yusif Ebrahim Zidan, Mobile: (+20) 01147106070, E-Mail: samarzidan29@gmail.com

An estimated 1.13 billion people worldwide (26%) have hypertension, most of them live in low-and
middle-income countries. Hypertension has been considered as a major risk factor of cardiovascular diseases. Objective:
Promoting health of hypertensive patients through improving their lifestyle. Patients and methods: An interventional
study conducted on 300 grade I hypertensive patients who were recruited from outpatient clinics of two hospitals in
Alexandria and Kafr El-Shiekh Governorates. All hospitals of each governorates(Alexandria or kafr elshiekh) were
listed in tables. One hospital was chosen randomly from each governorate using random numder tables. Patients were
investigated to measure the effect of lifestyle modification on control of their hypertension. Health education was
prepared and blood pressure was measured before health education and followed after modifying their life style.
Systemic sampling technique was used to identify subjects. Two days of high patients flow on outpatient clinics was
detected. A list of the patients' names attending on those days was prepared. The participants were interviewed by the
investigator to assess their health through measuring blood pressure, height, weight and BMI was calculated. Results:
The mean total score of overall of fantastic lifestyle pretreatment of study group was 29.56±3.89, while post treatment
was 35.39+3.92, with significant increased total score of overall of fantastic life style in study group post treatment
compared with that pretreatment (P <0.001). Conclusion: Following healthy lifestyle, as being active on more than four
days per week, weight loss, diet rich in fruits and vegetables, low sodium diet (BMI was a significant predictor), avoiding
smoking, have been established as effective therapies to prevent and control hypertension stage1.
Keywords: HTN, SBP, DB, Lifestyle modification, Quality of life.

was still unclear, there were several risk factors that had
Hypertension (HTN) is one of the commonest non
been associated with the condition. These elements may
communicable diseases that has been more prevalent
be broken down into two classes: those that can be
nowadays than before (1). Chronically elevated blood
changed and those that cannot (6). Factors like age, sex,
pressure (BP) in the systemic arteries is diagnostic of
ethnicity, family history, and genetic make-up cannot be
systemic arterial hypertension. The standard method of
changed, but there were other, more manageable risks. In
expressing blood pressure is as a ratio between the
contrast, modifiable risk factors of hypertension are those
systolic and diastolic readings (2). Hypertension affects 46%
that can be altered to avert the onset of the condition.
of adults in Africa, but only 35% of adults in the
Obesity, high-sodium diets, lack of physical activity,
Americas have the condition. High-income nations have
high-fat diets, cigarette use, and alcohol drinking were all
a lower prevalence of hypertension (35% vs. 40%) than
preventable causes of disease (7). Coronary heart disease
low-income ones. In Egypt, 26.3% of the adult
(CHD), myocardial infarction (MI), stroke (CVA),
population has hypertension, making it a major public
hypertensive encephalopathy, acute versus chronic renal
health concern. The leading preventable cause of death in
failure and death (typically from coronary heart disease,
the United States from cardiovascular disease was high
vascular disease, or stroke-related causes) had all been
blood pressure (3). Hypertension was the cause of an
linked to uncontrolled hypertension (8). Patient quality of
increased number of events among women (32%) than
life suffers when hypertension was present. Previous
among men (19%). The prevalence rises with age; half of
research has linked hypertension patients' comorbidities,
Egyptians over 60 had hypertension. If your blood
diagnostic knowledge, and drug side effects to a
pressure is less than 120 over 80 millimetres of mercury,
substantial decline in health-related quality of life
it was considered normal. When a person's blood
(HRQOL). The prevalence of hypertension and the
pressure is between 120/80 mmHg and 138/89 mmHg,
general public's lack of knowledge about it inevitably had
they were considered to be at risk for developing
an effect on patients' quality of life (9).
hypertension; when it rises beyond 140/90 mmHg, they
A person's lifestyle is the result of their unique
are diagnosed with hypertension (4).
combination of personality traits, social interactions, and
Primary (essential) hypertension and secondary
material and ecological constraints(10). Changing one's
hypertension are the two types of the condition. Primary
way of life is the foundation of fighting and avoiding
hypertension accounts for more than 90% of all
chronic disorders like hypertension (11).
occurrences of hypertension; it has no clear identified
Treatment of high blood pressure should include
etiology but was associated with known risk factors.
attention to how you live. If you're able to keep your
Secondary hypertension accounted for the remaining 10%
blood pressure under control by healthy living choices,
of instances and is caused by preexisting conditions such
you may be able to put off or perhaps minimize the need
renal disease, cardiovascular disease (CVD), and
for medication. Here are some ways to improve your
coronary heart disease (5). Some variables had been linked
lifestyle and reduce your blood pressure (12).
to primary hypertension, although the specific etiology
Received: 26/05/2022
Accepted: 03/08/2022

Full Paper (vol.891 paper# 106)

c:\work\Jor\vol891_107 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4817- 4823

Prophylactic Effect of Costus and Selenium Nanoparticles in
Isoproterenol Induced Myocardial Infarction in Rats
Manal M. Abbas*, Hanan A. Abdelmonem, Amal H. Mahmoud
Biological Applications Department, Isotops Applications Division,
Nuclear Research Centre, Egyptian Atomic Energy Authority
*Corresponding author: Manal M. Abbas, Mobile: (+20)01112408081, E-Mail : dr.manalmounir2020@gmail.com
Myocardial infarction (MI) is a serious condition caused by an imbalance between blood supply and the
demand of the myocardium leading to cardiac arrhythmia, heart failure, cardiogenic shock, and myocardial fibrosis.
Objective: This study aimed to investigate the protective effect of Costus and Selenium Nanoparticles (SeNPs) to
ameliorate the myocardial infarct damage that has been induced by isoproterenol (ISO).
Material and methods:
Six groups of weight matched rats (n=7) were used. G1 (control) received saline (1ml/rat)
orally, G2 rats were orally given Costus 500 ml/kg body weight (b.wt), G3 rats were intraperitoneally injected with
SeNPs (30 µgm/kg b.wt), G4 rats were injected subcutaneously with ISO (85 mg/kg b.wt) once daily at last two
consecutive days, G5 where rats were pretreated with Costus prior to ISO injection and G6 where rats were pretreated
with SeNPs prior to ISO injection. Results: ISO-treated group exhibited an elevation in serum creatine kinase (CK-
MB) & aspartate aminotransferase (AST), and C- reactive protein (CRP) as well as disturbances in the levels of
glucose & insulin. Also, there was significant increment in total cholesterol, and triglyceride with a noticeable decline
in HDL. Additionally, changes in serum electrolytes and the parameters suggestive of oxidative damage. Rats either
pretreated with Costus or SeNPs manifested significant decrease in CKMB & AST levels. Besides, a significant
reduction in fasting blood glucose and insulin. This treatment reversed the hyperlipidemia. Conclusion: Serum
electrolytes including Na, K, Ca+2 & Mg were significantly improved. Moreover, the previous treatment imposed anti-
inflammatory effects by the mitigation of serum CRP and reduced the oxidative stress. Thus, Costus & SeNPs act as
promising cardioprotective modalities to alleviate the unfavorable outcome of myocardial infarction.
Keywords: Isoproterenol, Myocardial infarction, Costus, Selenium nanoparticles.

Many medications are used to treat myocardial
Globally, cardiovascular diseases (CVDs) are
infarctions, despite they are not devoid of adverse
the leading cause of death. The incidence and mortality
effects and have a limited effect on annual costs and
of CVDs continue to increase in spite of the availability
survival. Thus, numerous studies have concentrated on
of advanced treatment. CVDs are caused by
developing novel therapeutic strategies to avoid MI.
pathological disorders such as cardiomyopathy,
Traditional medicine is gaining popularity around the
atherosclerosis, coronary heart disease (CHD) and
world. Many herbal plants extracts and products have
myocardial infarction (MI) (1). MI is an extremely
been used for a long-time and are widely used
dangerous condition that takes place due to a serious
worldwide. Recently, they have been utilized to treat a
unbalance between the blood supply and demand for
number of fatal disorders (7).
the myocardium. The mechanical, electrical, structural,
Costus is a member of the Zingiberaceae family
and biochemical functions of the heart are all impacted
of medicinal plants. Alkaloids, Tanning, terpenoids,
by MI (2). Damage to the myocardium is caused by
flavonoids, glycosides, sapogenins, steroids & furan
oxidative stress, which is brought on by an increase in
derivatives were all present in costus. They may exhibit
free radical production in ischemic tissue and a
therapeutic effects in humans and animals. It is widely
decrease in antioxidant levels (3). There were several
used in folkloric medicine to treat ailments such as
experimental protocols available for developing
cough, inflammation, rheumatism, diarrhea, arthritis,
cardiomyopathy in animal models. Catecholamines
hepatic disorders, epileptic attack, haemorrhoids and
cause complex structural and biochemical changes
also had served as an antidote for poison. Costus has
leading to myocardial infarction, cellular damage, and
anti-inflammatory, antioxidant, antifungal, antitumor,
necrosis (4). ISO (isoproterenol hydrochloride) is a
antiulcer, antibacterial, and immunostimulant properties
catecholamine, cardiotoxic substance due to its ability
(8). Nanotechnology has shown to be a promising
to destroy myocardial cell & induce MI in experimental
technique for a variety of applications. SeNPs have
animals. ISO produce extremely cytotoxic free radicals,
distinct properties such as high surface area, low
which cause cardiac membrane perioxidation, resulting
toxicity and improved bioactivity. So, they have gained
in damage and destruction (5). ISO is a model that is
a great attention (9). They guard cells against oxidative
standardized and is frequently utilized for inducing MI
stress and death. Additionally, it demonstrated anti-
in rats in order to examine the therapeutic benefits of
apoptotic, antioxidant, and anti-inflammatory effects.
several medicines and investigate the effects of a
Cardiovascular disease is one of the disorders
possible cardioprotective
associated to selenium, as inadequate selenium
compounds (6).
consumption has been linked to cardiomyopathy (10).
Therefore, the aim of this investigation was to explore
Received: 30/05/2022
Accepted: 07/08/2022

Full Paper (vol.891 paper# 107)

c:\work\Jor\vol891_108 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4824- 4832

Efficacy of Intra-Arterial Ethanol Embolization as A Treatment for Patients with
Hepatocellular Carcinoma with Malignant Portal Vein Thrombosis
Mostafa Mohammed Adel*, Mahmoud Mohammed El-Sakhawy,
Enas Mohammed Koraym, Mohammed Shawky Al-Warraky
Interventional and Diagnostic Radiology, National Liver Institute, Menoufia University, Menoufia, Egypt
*Corresponding author: Mostafa Mohammed Adel, Mobile: (+20) 01061291112, Email: mostafaadel123456@gmail.com

: With rising rates of hepatocellular carcinoma, Egypt has the highest global prevalence of hepatocellular
carcinoma (HCC). It has been demonstrated that intra-arterial lipiodol ethanol combination embolization is efficient in
the treatment of HCC.
To highlight the efficacy of the intra-arterial ethanol embolization in treatment of hepatocellular carcinoma
with malignant portal vein thrombosis (PVT).
Patients and Methods: This follow up study was conducted on 46 patients with hepatocellular carcinoma and malignant
portal vein thrombosis done in National Liver Institute, Menoufiya University from March 2020 to March 2022.
Results: Status and reaction at the conclusion of the research both substantially correlated with PVT (P<0.001).
Complete responses were more frequently found in grade II patients (4 patients) than in grade III patients (12 patients),
according to data (50.00%). In this trial, 46 patients were involved; 8 patients (17.4%) died, and 38 patients (82.6%)
survived; 26.1% of these patients declined follow-up or lost touch, and 17.4% had a full response. Status at the
conclusion of the program was revealed to be significantly negatively correlated with PVT grade. However, there was
no discernible relationship between study status at the conclusion and gender, ascites, Child score, or number of sessions.
Conclusion: Trans arterial ethanol embolization (TAELE) can be used for early-stage HCC, as well as for intermediate-
stage disease if other curative modalities are not feasible and can be considered when treating selected patients with
segmental portal vein tumor thrombosis (PVTT) (grade I) and preserved liver function.
Ethanol embolization, hepatocellular carcinoma, malignant, portal vein, thrombosis.

the same blood supply characteristics as intrahepatic
Hepatocellular carcinoma (HCC) is the seventh
lesions, indicating that most nutrient vessels of PVTT
most common malignancy worldwide in terms of cancer
correspond to liver arteries (4).
diagnosis rates. It is currently the third most common
Slowly infusing an insoluble substance, such as
cause of cancer-related mortality and its incidence is
the lipiodol ethanol mixture, which manifests as tiny
rising. Due to late-stage presentation, co-morbidities,
droplets travelling through the hepatic sinusoids and to
and a lack of donors, only 10% of patients can receive
the portal vein, may cause dual embolization. By doing
curative therapy (1). HCC has a wide range of causes,
so, the tumor's supply arteries and its nearby
including alcohol use, chemical exposure, cirrhosis,
parenchymal portal veins are completely embolized.
nonalcoholic steatohepatitis, nonalcoholic fatty liver
The entire tumor, including the tumor border, which is
disease, and hepatitis B and C infection. In addition to
frequently supplied by portal venules, can be infarcted
the diverse etiological reasons of HCC, patients with the
very effectively by long-term embolization of both the
condition have varying liver function, which has an
arterioles and portal venules (5).
effect on treatment planning (2).
In contrast to a gelatin sponge, the treatment
The cornerstone of treatment for intermediate
group diffuses within tumor cells in addition to inducing
BCLC B illness, according to the Barcelona Clinic
tumor ischemia and hypoxia. Hypoxia and ischemia
Liver Cancer (BCLC) staging classification, is
may act as powerful angiogenesis and carcinogenesis
stimulators, promoting collateral circulation and
(cTACE). With the development of drug-eluting beads
reestablishing tumor blood supply; and these may
and TACE, chemotherapy can now be administered in
eventually lead to tumor proliferation and recurrence (6).
a more regulated manner (DEB-TACE). For HCC
For cTACE, lipiodol is injected directly into the target
patients with BCLC B illness, radioembolization, which
vasculature while being combined with one or more
is also an intra-arterial therapy, represents an alternative
chemotherapeutics. The drugs are transported by
route of care (3). By inflicting endothelial injury and
lipiodol, which then settles close to the tumor.
thrombus on the arteriolar lumen of tumor feeder
Doxorubicin is loaded into drug-eluting microspheres in
arteries and tumor vasculature, ethanol can have an
DEB-TACE, an evolution of cTACE. Once injected
embolization effect, resulting in tumor infarction. It has
close to the tumor, the medication is released slowly and
been demonstrated that intra-arterial lipiodol ethanol
deliberately, producing anti-tumoral effects. In the end,
combination embolization is efficient in the treatment
radioembolization involves injecting 30-micron-sized
of HCC. Portal vein tumor thrombosis (PVTT) feeding
particles that eventually lodge inside the tumor. While
channels are intricate. However, in most of PVTT had
Received: 30/05/2022
Accepted: 07/08/2022

Full Paper (vol.891 paper# 108)

c:\work\Jor\vol891_109 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4833- 4838

Clinical Manifestations in Behçet's Diseased Patients:
Is It Affected by Disease Activity?
Zahraa Ibraheem Abo Aloioun, ,Naema Mohamed Mostafa,
Esraa Omar Ali Ismael Doaa Kamal *,
Department of Rheumatology , Rehabilitation and physical medicine, Faculty of Medicine, Assuit University, Egypt
*Corresponding author: Esraa Omar Ali Ismael, Mobile: (+20) 01142171590, E-Mail: esraaomar9901836@gmail.com


Background: Behçet's disease (BD) can affect both tiny and large blood vessels. However, there are scant reports on
the relationship between clinical features and illness progression in Egyptian BD patients. Objective: To examine the
connection between clinical symptoms and disease progression in patients diagnosed with Behçet's disease.
Patients and methods: A total of 36 BD patients were included in the current study. They were all diagnosed in
accordance with the International Study Group for Behçet's Disease criteria and recruited from the outpatient clinics and
inpatient Department of Rheumatology, Rehabilitation, and Physical Medicine at Assiut University Hospital, Egypt.
Disease activity was assessed using Behçet's Disease Current Activity Form (BDCAF). The patients were categorized
into two groups, 18 with active BD and 18 with inactive BD, using the BDCAF. Medical history and physical
examination were done for all participants in the study.
Results: The median age of the studied participants was 37 years (range 20-52 years), with high male predominance as
we found that, out of 36 studied BD patients; 30 (83.3%) were males and 6 (16.7%) were females. Median BDCAF was
4 (range 2­5). Mouth ulceration, arthritis, and arthralgia were the most common clinical manifestations among the
studied cases documented in 18 (50.0%) cases, followed by headache in 15 (41.7%) cases, then genital ulceration in 14
(38.9%) cases, and red painful eye in 14 (38.9%) cases. Muco-cutaneous manifestations (mouth and genital ulcerations),
erythema, blackout, and active CNS events were more prevalent among patients with active BD (P<0.05, for all).
Conclusion: Clinical manifestations may be useful indicators of Behçet's disease progression, according to the results
of the current investigation. Mucocutaneous, ocular, and central nervous system symptoms, as well as disease activity,
may indicate a poor prognosis.
Keywords: Behçet's diseased, Clinical manifestations, Disease activity.

The natural course of BD is mainly acute with
Behçet's disease (BD) is a rare, life-threatening
frequent recurrence, the degree of various organs
vasculitis that can affect both large and small arteries
involvement lead to variable disease activity and
and veins, resulting in a wide range of clinical
outcome [1]. Behçet's disease mortality rates can be
manifestations [1]. BD typically manifests itself between
anywhere from 0.9% and 10%; the disease's
the ages of 30 and 40, and its prevalence may be equal
neurological symptoms and major organ vasculitis are
between the two sexes or may be more common in men
the primary causes of death [8].
The objective of this study is to examine the
The main clinical presentations of BD are
connection between clinical symptoms and disease
recurrent mouth and genital ulcerations in addition to
progression in patients diagnosed with Behçet's disease.
ocular involvement [3]. Skin abnormalities such as

cutaneous vasculitis, and a positive pathergy test result
Study Design and Setting
are other possible skin presentations of Behçet's illness
At the Rheumatology, Rehabilitation, and Physical
[2], articular, neurological manifestations [4], vascular ,
Medicine Department at Assiut University Hospital in
urogenital [5], pulmonary as well as intestinal
Assiut, Egypt, we conducted this comparative cross
presentations [6]. It is important to note that Behçet's
sectional study.
disease is a separate clinical entity from other similar

conditions, and there are regional variations in how it
Study Population
manifests. Individuals from the United States and
Patients with BD who met the Revised
Northern Europe are more likely to experience central
International Criteria for Adamantiades-disease
nervous system involvement, while Japanese patients
Behçet's [9]. All eligible patients, admitted to the
are more likely to experience gastrointestinal
aforementioned hospital between September 1, 2018
symptoms. Geographic variation is also seen in the
and April 30, 2019, were invited to participate in the
progression rate, frequencies of the various symptoms,
study. Patients who met the Revised International
and also associated with the HLA-B51. Patients from
Criteria for Adamantiades-illness Behçet's and were 18
Japan and the Mediterranean region have more severe
years old and of either sex were considered eligible for
conditions and a stronger correlation with HLA-B51 [7].
participation in our study [9], that characterized by
frequent instances of ulcers of mouth (2 point),
Received: 01/06/2022
Accepted: 08/08/2022

Full Paper (vol.891 paper# 109)

c:\work\Jor\vol891_110 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4839- 4841

Role of Tenascin-C in Systemic Lupus Erythematosus and Its Association with
Disease Activity: Review Article
Shaimaa Mustafa Abdelwahab1, Adlia Mohamed Abdelhady1,
Doaa S Atta1, Ghada Abdelsalam Ali*2, Amany M Sediq3
1 Department of Rheumatology and Rehabilitation, 3Department of Clinical Pathology,
Faculty of Medicine, Zagazig University, Sharkia, Egypt
2 Department of Clinical Pathology, Sharkia General Hospital, Egypt
*Corresponding author: Ghada Abdelsalam Ali, Mobile: (+20) 01069515839, E-Mail: gogo.dodo144@gmail.com


Background: The cause and the mechanism for the development of systemic lupus erythematosus (SLE) are shrouded
in mystery. The fact that tenascin-C (TN-C) is upregulated in response to trauma, inflammation, or cancer growth
demonstrates that it is involved in cell signaling. Within the scope of this brief review, we discuss the significance of
TN-C in the pathophysiology of SLE disease and the correlation between serum TN-C levels and disease activity.
Objective: Analyzing the Role of Tenascin-C and Its Relationship to Disease Activity in SLE
Tenascin-C, Systemic Lupus Erythematosus, and Disease Activity 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 May 2021 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: Important novel biomarker for active SLE, TN-C is also a crucial molecule in tissue remodeling and is
linked to SLE. There has to be more high-quality research done on TN-C before it can be recommended as a helpful
blood biomarker for tracking disease activity and anticipating flares in SLE patients.
Keywords: disease activity, systemic lupus erythematosus, Tenascin-C.

production of several cytokines and the recruitment of
Inflammatory and with far-reaching effects on
immune cells to areas of inflammation or damage[6].
multiple organs and tissues, systemic lupus
It was shown that many chronic inflammatory
erythematosus (SLE) is a devastating condition.
disorders share a common characteristic: elevated levels
Polyclonal activation of T and B cells, followed by the
of tissue and plasma TN-C (myocarditis, inflammatory
production of autoantibodies and immunological
bowel disease, chronic hepatitis C)[7].
complexes, which then precipitate in various tissues and

organs, causing their damage and ultimately leading to
Structure of tenascin-C:
significant morbidity and mortality, characterizes this
A total of 25 distinct molecules can be brought
condition [1].
together by the four domains that make up tenascin-C.
Individuals may experience a wide range of
Some examples of these factors include pathogens,
symptoms, such as joint pain, swelling, arthritis, a
matrix proteins, soluble factors, and proteins found on
butterfly rash, hair loss, swollen lymph nodes, and more
the surface of cells. The EGF-like repeats operate as a
low-affinity ligand for the EGF-receptor to stimulate
Symptoms of systemic lupus erythematosus
mitogen-activated protein kinase and phospholipase-C
(SLE) patients can vary widely, both serologically and
signaling, while the tenascin assembly domain creates
clinically, and flares and remissions can be extremely
inter-molecular hydrophobic contacts and disulfide
unexpected, making it difficult to detect disease activity
bridges, Fibronectin's type III-like repetitions bind a
and provide appropriate treatment[3].
wide variety of proteins that interact with it, including
Anti-dsDNA antibodies and complement
integrins, aggrecan, perlecan, and members of the
levels, two common traditional serological biomarkers,
platelet-derived growth factor family. Oligomerization,
are unreliable predictors of disease recurrence and
stimulation of mitogenic responses, cell motility,
adhesion, spreading, and more are all driven by
Variations in the extracellular matrix
tenascin-C because of this, functions such as protease
glycoprotein tenascin-C (TN-C) size (small & large
and pro-inflammatory cytokine production, matrix
assembly, neurite outgrowth and potentiation, and focal
demonstrates the existence of a rich variety of potential
adhesion creation[8].
biological effects[5].
These protein building blocks are strung
TN-C has been found to regulate both the innate
together like beads to form very lengthy molecules.
and adaptive immune systems by affecting the
Every Tenascin possesses an oligomerization domain at
its N-terminus; this domain is responsible for hexamer
Received: 30/05/2022
Accepted: 07/08/2022

Full Paper (vol.891 paper# 110)

c:\work\Jor\vol891_111 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4842- 4847

Effect of Instrument Assisted Soft Tissue Mobilization on Hamstring
Flexibility in Children with Diplegic Cerebral Palsy
Dina E. Mostafa*, Khaled A. Olama, Maya G. Aly
Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy Cairo University, Egypt
*Corresponding author: Dina E. Mostafa, Mobile: (+20) 01092829714, E-Mail: deenam44@gmail.com

Generally, muscles of children with cerebral palsy (CP) lack flexibility. Muscle flexibility is a basic
element for muscle action and an important milestone in the rehabilitation program for children with CP. Instrument
assisted soft tissue mobilization (IASTM) is indicated for tissue extensibility dysfunction. Objective: To investigate the
short-term effect of IASTM on hamstring flexibility of children with diplegic CP. Patients and Methods: This study
included thirty children diagnosed as diplegic CP with mild to moderate spasticity, their ages ranged from 4 to 8 years
of both genders (13 girls and 17 boys). They were assigned into two equal groups; control group received conventional
physical therapy program and study group received same program of controls in addition to IASTM application on
hamstrings of both sides. All participated children received session two times weekly for two successive weeks. The
Knee extension angle test was used to assess hamstring flexibility before and after treatment (immediate effect after the
first session and post 2 weeks). Results: There was a significant difference in hamstring flexibility after treatment
sessions of both groups compared with pretreatment. The study group was significantly improved in comparison to the
control group. Conclusion: Adding IASTM to the physical therapy program was found to improve hamstring flexibility
in children with diplegic CP after application of four sessions.
Keywords: Cerebral palsy, Children, Hamstring, Instrument assisted soft tissue mobilization, Muscle flexibility.


Instrument assisted soft tissue mobilization (IASTM) is
Cerebral palsy (CP) is a group of permanent
a current treatment approach for myofascial restriction
disorders in children (1), it is caused by a non-
that makes use of specifically designed tools to mobilize
progressive brain malformation that arose in the
soft tissue that has developed myofascial adhesion in
developing fetus or infant (2). Spastic diplegia is the
order to lessen discomfort and increase range of motion
most common type of CP (3), children with diplegic CP
and function. The use of an instrument is supposed to
exhibit muscle weakness, poor muscle coordination,
give therapists a mechanical advantage by allowing for
unsteadiness on their feet, and poor postural control (4,
more focused treatment and deeper penetration (11). The
5). Most of them have normal cognitive function and a
IASTM treatment is believed to promote connective
reasonable chance of being able to walk independently
tissue remodeling by encouraging the removal of
(6). The semitendinosus, semimembranosus, and biceps
superfluous fibrosis. It also promotes collagen repair
femoris muscles are the three separate muscles that
and regeneration as a result of fibroblast recruitment (12).
make up the hamstring muscle complex. Most of them

The fast rhythm of modern life needs more
cross the femoroacetabular and tibiofemoral joints as it
options to merge the children with CP in their
extends from the pelvis posteriorly along the length of
communities such as schools and gardens. Treatment
the femur. As an exception to this rule, the short head of
options provided to improve muscles flexibility and
the biceps femoris arises from the lateral lip of the
functions of children must not be limited to invasive
femoral linea aspera, which is located distal to the
methods like Botox injection which are also financially
femoroacetabular joint. Flexibility of the hamstring
expensive. The IASTM is a non-invasive method that
muscles is essential for maintaining an efficient and
depends on an easy-held, cheap, and light-weighted
functioning gait (7).
A child with CP may experience muscle

The aim of this study was to investigate the
shortening that both impairs and facilitates some
short-term effect of IASTM on hamstring muscle
functions (8). Hip, knee, and ankle involvements are
flexibility in children with diplegic CP.
present in the vast majority of diplegic CP children.

Despite this greater level of engagement, the majority
of diplegic CP youngsters can walk on their own (9).
Study Design and Setting:
They must therefore be able to move normally, without

Prospective experimental pre-post study
limping, in order to engage in daily activities at home
design was used.

and in the community. This idea encompasses activities
Ethical Considerations:
like standing, bending, walking, and climbing and
The ethical committee at Faculty of Physical
significantly enhances the child's quality of life in terms
Therapy, Cairo University approved the protocol of this
of their health (10).
research (No: P.T.REC/012/003399). Parent of each
child signed an informed consent form before

Received: 26/05/2022
Accepted: 03/08/2022

Full Paper (vol.891 paper# 111)

c:\work\Jor\vol891_112 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4848- 4853

Comparative Study for Use of Steroids in Treatment of
Sudden Sensorineural Hearing Loss in COVID19 Patients
Michael Rezk, Mina Fayez Saleeb
Department of Otorhinolaryngology, Ain Shams University, Cairo, Egypt
Corresponding author: Mina Fayez Saleeb, minafayezw@gmail.com
Orcid: 0000-0003-0461-7545, phone number: 01223612412

Viruses are identified to lead to neurological manifestation, like anosmia, facial paralysis and sudden
sensorineural hearing loss (SSNHL). Throughout the preceding SARS epidemic, corona-viruses were stated be accompanied
with losses of smell and taste senses because of neural injuries.
This research aims to study the existence of (SARS-CoV-2) in cases with only SSHNL throughout the COVID19
pandemic and effectiveness on intratympanic steroid injections on development of cases.
This work involved 20-cases with the single complaint of unilateral SSNHL to the otolaryngology out-patient
clinics. The cases were directed to be assessed for SARS-CoV-2 by real time polymerase chain reactions (RT-PCR) test.
Cases received systemic steroids, intratympanic steroids or combined and were then audiologically assessed.
RT-PCR test for SARS-CoV-2 was positive in 13 cases. A positive responding to COVID19-definite therapy in
the SARS-CoV-2 positive SSNHL cases has been observed. Most of cases received intratympanic steroids showed
significant improvement than non-received (p=0.005). Also, cases received combined intratympanic and systemic steroids
showed significant improvement than non-received (p=0.021), while improvement in cases received systemic steroids or
vasodilators showed no statistical significant difference than non-received (p=0.306 and 0.595, respectively).
It must be recalled that nonspecific signs like SSNHL can be the only symptom with which to know a
COVID19 case. Recognition of such nonspecific presentations of COVID19 cases is crucial throughout this pandemic time
for avoiding infectious spreading via isolations and early initiations of COVID19 targeted therapy.
COVID19, Sudden sensorineural hearing loss, Pandemic, SARS-CoV-2, Intratympanic steroids.


Sudden sensorineural hearing losing (SSNHL) is
respirational distress syndrome (ARDS) and cytokine
defined as sensorineural hearing losing 30 dB at 3
consecutive audiometric frequencies among over 3 days.
Numerous infections with viruses could lead to
SSNHL is considered one of the commonest complaints
hearing loss. These cases made by viruses could be
in otologic and audiologic routines (1.5-1.7/100 new
acquired or congenital, unilateral or bilateral. Specific
cases presented in our work). In only 7 to 45% of cases, a
viral infection can directly harm inner ear, others could
definite cause may be recognized and definite treatment
persuade inflammatory responding which then lead to this
regimen can be utilized for therapy. Most of cases with
injury, while others may cause superadded bacterial or
SSNHL has no recognizable reason for hear losing and is
considered as "idiopathic" (1).
Characteristically, virus-made hearing losses are
An acute respiratory disorder, produced by a new
sensorineural, while conductive and mixed hearing losses
corona-virus (SARSCoV-2, formerly identified as 2019-
can occur with bacterial rather than viral infections.
nCoV), the corona-virus disorder-2019 (COVID19) has
Infrequently, hearing recovery afterward the infections
spread through China and received universal
could happen spontaneously (4).
consideration. WHO declared the COVID19 epidemic as
Hearing losses caused by virus may be mild or
an emergency to the public health with worldwide. The
severe to deep, unilateral or bilateral. Mechanisms of
majority cases infected with the COVID19 suffered from
incidence of hearing losses caused by various viruses
mild to moderate respirational sickness and recovered
differ significantly, ranged between direct injury to inner
without aggressive therapy(2).
ear structure, inner ear hair cells and organs of Corti,
COVID19 signs appear in 2 to 14 days following
reaching to inductions of host immune-intermediated
to exposures (built on the incubating interval of
COVID19). The signs of COVID19 can be fatigue,
Viruses were recognized to lead to neurological
cough, fever, and a small number of cases presented with
manifestation, like facial paralysis, anosmia, and SSNHL
stomach infections signs. The aging and comorbidities
(6). Throughout SARS epidemic, corona-viruses have
can be accompanied with acute
been stated to be accompanied with losses of taste and
Received: XX/XX/2022
Accepted: XX/XX/2022

Full Paper (vol.891 paper# 112)

c:\work\Jor\vol891_113 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4854-4858

Evaluation of Certain Physiological Biomarkers in Iraqi
Endometrial Carcinoma Patients
Hajer S. Hameed, Jabbar H. Yenzeel1 & Majeed A. Sabbah2
1Department of Biology, College of Science, University of Baghdad
2Forensic DNA for research and training center
*Corresponding author: Hajer S. Hameed E-mail: hajar.sabah91@gmail.com, mobile: +9647727359776

Endometrial Cancer (EC) is the malignant tumor originating from endometrium cell (lining of the uterus).
EC incidence and mortality have increased in recent years. Routinely used methods for EC diagnosis and treatment are
histopathological tissue culture after surgery and postoperative radiotherapy, however there is still not enough efficient
treatment for recurrence or progression of this disease. So, there is a critical need for further EC identification by new
biological ways for the prognostic diagnosis of it.
Objective: This study aimed to look for ways by which could help in diagnosis of EC before the hysterectomy.
Materials and Methods: 55 patients with EC and 57 healthy women were involved in this study (up to 45 years) during
their attendance at the Medicine City Hospital of Baghdad and Al-Yarmouk Hospital. The study was conducted from
October 2020 to October 2021. Via vein puncture collection of blood samples from each women participated in this
study for measurement of the levels of some proteins including Hepcidin hormone (hepc), Human epididymis protein-4
(HE-4), Transforming growth factor-beta (TGF-) and CRP biomarker levels in serum of EC and healthy women by
ELIZA method.
Results: This study showed a highly significant (P0.01) increase in TGF- and HE4 in EC patients compared with
healthy control. Hepc and CRP also revealed a highly significant (P0.01) increase in EC patients' women when
compared to healthy control.
Conclusion: It can be concluded that TGF- and HE-4 proteins could be used in the early diagnosis for EC. Addition
of hepcidin and CRP estimation to TGF- and HE-4 proteins results in accurate prognostic diagnosis.
Keywords: Endometrial cancer, Hepcidin, Transforming growth factor-, Human epididymis protein- 4, C-reactive

that inhibits serine protease (WAP domain proteins),
which plays a function in carcinogenesis, tumor
reproductive system is EC with an increased incidence
initiation and metastasis (7). Based on identified
(1). EC is a tumor with heterogeneous texture. To
activity, it is plausible that HE-4 plays an essential role
enhance the prognosis of EC in patients by early,
in fertilization, specifically in maturation, motility and
accurate, and effective diagnosis, the diagnosis is
capacitation of sperm (8). Although first distinguished
related to tumor size, grade and stage (2). EC occurrence
HE-4 was in the reproductive tract of male, also it is
after menopause is most common. Hormones are key
present in other organs, like breast, kidney, lungs and
agents in sex-related cancers, such as EC; which is the
reproductive tract of female (9). HE-4 is a tumor marker
6th most prevalent cancer in women and poor prognostic
of ovarian cancer, with 80% sensitivity (8).
indicators lead to their mortality (3). In 2018, 380,000
Transforming growth factor (TGF-), a cytokine
new EC cases were noticed worldwide; in the UK, 9703
with a strong pleiotropy, which plays an important
new cases were diagnosed between 2016 and 2018 (4).
effect in cell proliferation, differentiation, migration,
Significantly, instance rates increased in countries with
wound healing, apoptosis, adhesion, angiogenesis,
fast economic advancement, including Asian countries
immune surveillance and survival, angiogenesis,
(5). EC became the most prevalent gynecologic cancer
immunoregulation and cancer (10). In vitro studies
in countries that under developed, which are
suggest that TGF signaling regulates EC cell
responsible for almost 5% of cases of cancer and up to
proliferation, survival and metastasis. Cells of the
2% of deaths by cancer in women (4).
immune system produced TGF-1 isoform, which
Human epididymis protein-4 (HE-4) is a
exerts powerful activities as anti-inflammatory effect,
glycoprotein firstly discovered in the epithelial cells of
and is a crucial regulator of immune response (11). TGF-
the human epididymis. It was discovered by Kirchoff
beta isoforms of (TGF-beta 1, 2 and 3) exist in
et al. (6) who's the first recognized HE-4 in males in
mammals, which play key roles in regulation of growth
distal epithelium of epididymis, which typically
and development of the cells (12). Various cellular
functions as proteinase inhibitor. It is under the family
processes regulated by signaling pathway of TGF-

Received: 1/6/2022
Accepted: 8/8/2022

Full Paper (vol.891 paper# 113)

c:\work\Jor\vol891_114 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4859- 4864

Combined suPAR and qSOFA as A Mortality Predictor in ICU Patients with Sepsis
Amany M. Sediq1*, Hassan M. Hassanin2, Heba M. Matar3, Mohamed A. Saada4, Ghada E. Amr1
1 Department of clinical pathology,2 Department of Internal Medicine,
3 Department of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Egypt
4 Zayed AL-Nahyan Hospital, Ministry of Health, Cairo, Egypt
*Corresponding author: Amany M. Sediq, Mobile: +20 1005052678,
Email: amany_mohy2006@yahoo.com, ORCID: 0000-0003-1371-2595

Introduction: Prediction of 28 days mortality in ICU patients with sepsis enables physicians to pay special attention to
concerned patients and may affect their management. Scoring systems are widely used in clinical practice as mortality
predictors. But all have their limitation. Different biomarkers also lack enough sensitivity and specificity. We studied
the concentrations of suPAR, measured in serum on the first day of suspected sepsis, comparing combined suPAR and
qSOFA with suPAR, qSOFA and SOFA (alone) as a predictor of 28 days mortality in ICU patients.
This study was conducted in ICU at Zagazig University Hospitals. 131 sepsis patients were included and
classified according to 28 days mortality into: survivors (113/86.3%) and non-survivors (18/13.7%). Serum sample for
suPAR measurement, and parameters of SOFA were collected upon suspicion of sepsis. Then, SOFA and qSOFA were
The best predictor of 28 days mortality was SOFA at cutoff 9 (AUC) followed by suPAR at cutoff 12.32 ng/ml
(AUC 0.918 and 0.770) and (95% CI 0.849-0.988 and 0.634-0.906) respectively with no statistical difference between
them. Combining suPAR and SOFA and combining suPAR and qSOFA increased AUC to 0.941 and 0.827 (95% CI
0.892-0.990 and 0.729-0.926) respectively. There was no statistical difference between AUC of combined suPAR and
qSOFA and AUC of standard SOFA score.
In our model, suPAR had 28 days mortality prognostic ability comparable to SOFA and better than qSOFA.
Combining suPAR and qSOFA increased the prognostic ability of qSOFA to be not inferior to that of SOFA.
Key words:
suPAR, Sepsis, qSOFA, SOFA, ICU mortality


have limitations. To be calculated, multiple laboratory
The 3rd International Consensus (Sepsis-3) has
and clinical parameters are required. So, in some
described sepsis as a fatal/near fatal flawed organ
instance, the calculation may be delayed. If health care
function caused by an abnormal body reaction to
is subject to financial restriction, their application will
infection. Detection of this flawed organ function
be limited. Moreover, none of these scores has perfect
should be by using the Sequential Organ Failure
sensitivity or perfect specificity (7).
Assessment (SOFA) criteria or the 'quick' (q)SOFA
For long, positive blood culture was considered
criteria (1). SOFA score uses 6 clinical and laboratory
as the golden measure in sepsis diagnosis. But positivity
parameters to describe the degree of organ dysfunction
occur in only 20-30% of sepsis patients and the result is
and predict mortality in septic patients (2,3). Delta SOFA
obtained late (8). And so, using biomarkers can improve
score 2 points (from baseline) resultant to the infection
the timeliness of sepsis diagnosis and as indicators of
would define sepsis (1,4). Unless the patient is a known
prognosis. C-reactive protein (CRP) and procalcitonin
case of organ dysfunction, the initial SOFA score would
(PCT) are broadly used in these fields. However, both
be assumed as zero (5).
of them has low sensitivity and specificity as a
The qSOFA score was developed as a surrogate
prognostic marker in critical patients. In addition,
to SOFA score in sepsis screening. The positivity of 2
results of infection's markers may be within normal in
or more out of its 3 parameters will raise the suspension
sepsis, especially in patients who are immunologically
of high risk of mortality in patients with presumed
suppressed (9,10).
infection. It has the advantage (over SOFA score) of
Soluble urokinase plasminogen activator
not requiring laboratory tests and so can be assessed
receptor (suPAR) is another biomarker that shows a
swiftly and frequently (5). However, the latest
promising role as a prognostic marker in sepsis. suPAR
International Guidelines for Management of Sepsis and
is produced by proteolytic cleavage of the urokinase-
Septic Shock 2021 recommended against using qSOFA-
plasminogen-activator-receptor from the cell surface
compared to other scoring systems- as a single
and is believed to indicate activation of the immune
screening tool for sepsis (6).
system. It is involved in many steps in immune response
Other intensive care unit (ICU) scoring system
including the plasminogen-activating pathway, and cell
are also on hand and widely applied in clinical practice
relocation (11).
as acute physiology and chronic health evaluation
As reviewed by various studies, suPAR has a
(APACHE II), simplified acute physiology score
potential prognostic value in the ICU (12,13).
(SAPS), mortality prediction model (MPM). Each has
The current study sought to test whether the
its own uses and merits. However, all scoring systems
concentrations of suPAR, measured in serum on the first
Received: 29/5/2022
Accepted: 4/8/2022

Full Paper (vol.891 paper# 114)

c:\work\Jor\vol891_115 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4865- 4869

Neutral Protamine Hagedorn versus Glargine 100 International Units among
Elderly Patients with Type 2 Diabetes Fasting Ramadan
Hossam Arafa Ghazi
Department of Internal Medicine, Mansoura Faculty of Medicine, Mansoura, Egypt
*Corresponding author: Hossam Arafa Ghazi, Mobile: (+20) 01006408074, Email: hossamghazi7@gmail.com


Background: One of the main five pillars of Islam is Ramadan fasting. In Egypt, Muslims usually fast from 12 to 16
hours. Neutral Protamine Hagedorn (NPH) is cheaper basal insulin in comparison to Glargine U100, and has shorter
duration of action. Main fear from insulin usage in elderly with type 2 diabetes mellitus (T2DM) in Ramadan is
hypoglycaemia. Objective: The aim of the present study was to compare the safety and efficacy NPH versus Glargine
U100 among elderly patients fasting Ramadan.
Patients and methods: The study was conducted on 100 patients of both genders with T2DM aged 60 years and more.
Comprehensive geriatric assessment was done. Weight, glycated haemoglobin (HbA1c) and creatinine (1 month before
Ramadan and 2 months after Ramadan) were estimated. Moreover, numbers of documented hypoglycaemia and days
of breaking fast were compared.
Results: The mean age of the patients was 65.9 (SD 3.6) years among glargine group, and 66.2 (SD 3.7) years among
NPH group, and 58 of the participants were females. There was significant difference in days to break fasting from
hypoglycemia [3 days in NPH group versus 10 days in glargine group (P-value 0.03)]. No statistical difference regarding
weight and creatinine before and after Ramadan among both groups.
Conclusion: NPH could be a better option than Glargine U100 for elderly patients with T2DM willing to fast Ramadan,
with less reported attacks of hypoglycaemia and lower cost.
Keywords: Elderly, Type 2 Diabetes Mellitus, Ramadan Fasting, NPH, Glargine U100.


2019, and expected to represent about 12% to the total
One of the five main pillars of Islam is
population by the year 2030 [5]. Prevalence of DM is
Ramadan fasting. Usually, Muslims fast 29 to 30 days
increased with age, subsequently total number of elderly
from the sunrise (sohor) to sunset (iftar). In Egypt -in
patients having type 2 diabetes mellitus (T2DM), and
the last few years- these fasting hours range from 12 to
fasting Ramadan will increase. Complications of fasting
16 hours. Although many elderly patients with diabetes
are relatively higher among elderly in comparison to
have the chance not to fast, but the majority of them
those younger patients [2].
refuse this and insist to fast [1]. Moreover, Ramadan
Insulin therapy is the corner stone in treatment
fasting may carry some hazards on some patients with
of type 1 diabetes, while it is used for treatment of many
diabetes especially elderly patients. First, fluctuation of
patients having T2DM. One of the protocols used in our
blood glucose level may occur during fasting
daily practice in management of patients with T2DM is
(hyperglycaemia and/or hypoglycaemia), increase risk
basal oral protocol, in which the basal insulin is
of thromboembolic manifestation and increase risk of
introduced (initiated) on top of oral therapy to intensity
ketosis [2].
the control of blood sugar and mainly to reduce the
It's well established that cultural habits of
fasting blood sugar rather than the postprandial blood
Ramadan fasting have great variability of traditions in
glucose [6].
different countries and communities. In addition,
For physicians treating people with diabetes,
Muslims in Egypt have the main meal after sunset while
the main fear from treating diabetes among general
another meal is consumed in the midnight. Moreover,
Egyptian food during Ramadan usually contains
hypoglycaemia. Moreover, hypoglycaemia is the most
relatively high amounts of carbohydrates and fats [3].
famous side effect of insulin therapy and considered as
On the other hand, Egypt is listed as one of the
a big barrier for physicians who treat patients with
top ten countries having large number of people living
diabetes. This risk is increased in patients who are on
with diabetes mellitus (DM). According to the
insulin therapy. All patients who are willing to fast
International Diabetes Federation (IDF), 10.9 million
should be educated to break their fasting when the
people living in Egypt having diabetes (in the age range
random blood glucose at any time of fasting become less
from 20-79 years) in 2021 and it is supposed to be
than 70 mg/dl [3].
doubled in 2045, reaching about 20 million patients
Neutral Protamine Hagedorn (NPH) is one of
with diabetes [4]. Also, in the last few years it was
the old human insulins which may be used with short
noticed that there is increase in the relative and absolute
acting regular insulin or with oral anti-diabetic drugs.
number of elderlies in Egypt. Central agency for public
Once injected subcutaneously its onset of action about
mobilization and statistics reported that elderlies
2 hours and its peak appears after 6-14 hours and its
represent about 7% of total Egyptian population in
duration of action lasts for 10-16 hours. On the other
Received: 01/06/2022
Accepted: 08/08/2022

Full Paper (vol.891 paper# 115)

c:\work\Jor\vol891_116 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4870- 4873

Skin Flaps Utilization for Urethroplasty: Review Article
Hazem Mohamed Algalaly, Aref Mohamed Maarouf,
Mohammed Ali Saed Shanabi*, Hamdy Mohamed Desouky
Department of Urology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohammed Ali Saed Shanabi, Mobile: (+20) 01092746961, E-Mail: dr.shanbi2020@gmail.com

As there is no dedicated artery to the flaps used in urethroplasty, a big dartos pedicle must be produced to
ensure the skin stays alive. These flaps are typically made from the penile or scrotal skin. Flaps can be used to repair
damage, but they need considerable dissection and a significant amount of time to harvest. When the dartos layer of the
penis is redistributed from some or all of its typical circumference, scarring and loss of normal shape result.
Objective: This review article aimed to assess different roles of skin flaps for urethroplasty.
Skin flap, and Urethroplasty 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 studies from January
2000 to May 2021 were 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: Because of its high success rate and low risk of complications, urethroplasty flaps are an excellent choice
for treating urethral strictures.
Keywords: Skin flaps, Urethroplasty.

circumference, scarring and a change in the penis's
Pseudostratified columnar epithelium is the primary
usual shape occur (4).
lining of the normal urethra. Vascular sinusoids and
Because they need to be revascularized, grafts are
smooth muscles are abundant in the spongiosum, a
theoretically less dependable. Additionally, they require
connective tissue layer that lies beneath the basement
less time in the grafting procedure, making them more
membrane. Fibroblasts with an extracellular matrix made
convenient for harvesting and deployment (4). Multiple
up of collagen, proteoglycans, glycoproteins, and elastic
series of short- and medium-term graft and flap follow-
fibers make up the majority of connective tissue (1).
up data show little difference in re-stricture rate between
Stricture of the urethra is caused by a fibrotic process
the two. For this reason, graft urethroplasty is favoured
characterized by variable degrees of spongiofibrosis and
over open surgery whenever possible (5).
resulting in diminished tissue compliance and a narrowed
There are occasions where a flap is better than a
urethral lumen. Significant alterations in connective
transplant, such when there has been local
tissue are the hallmark of urethral strictures on the
devascularization (due to radiotherapy or severe
histologic front. Strictures, in conclusion, develop from
peripheral vascular disease), or when there is an
epithelial harm and spongiofibrosis (1). It was reported by
infection at the site of the surgery. All of these problems
Ueshima et al. (2) that injured epithelium developed
make it impossible to perform a graft (4).
ulcers and a covering of stratified columnar cells.

Myofibroblasts and gigantic multinucleated giant cells
Flap characteristics:
were seen in abundance in the stricture. Collagen and
The perfect flap is defined by four main
strictures are products of both cell types.
characteristics. The ideal flapping creature is (1)
Treatment options such as urethral dilatation and
hairless, (2) at home in water, (3) versatile, and (4)
internal urethrotomy are underutilised because they are
Cosmically minded (6, 7).
not curative when spongiofibrosis is present. Since the

goal of treating urethral stricture disease is to cure the
a- Hairless:
patient, urethral reconstruction has become the standard
Flaps should be made from skin that does not naturally
treatment (3).
produce hair. Urine that sits in touch with hair for long

periods of time can cause bacterial colonization of the
Skin Flaps of Urethroplasty:
urethra, stone formation, and irritation. That's why you
Since there is no dedicated artery to the penile or
shouldn't settle for scrotal skin or skin closer to the
scrotal skin flaps utilized in urethroplasty, a big dartos
proximal penile shaft, go for the prepuce instead (7).
pedicle must be established in order to maintain the skin

alive during the procedure. Harvesting a flap and
b- Aqueous environment:
performing the necessary amount of dissection can take
Tissue that is native to or easily adapted to water should
a significant amount of time, which is a major drawback
be given preference when deciding on a urethral graft.
when employing a flap to do a repair. When the dartos
Skin that is not adapted to the climate will experience
layer of the penis is redistributed from some or all of its
irritation and even squamous metaplasia. Stricture
recurrence and malignant transformation are both
Received: 02/06/2022
Accepted: 09/08/2022

Full Paper (vol.891 paper# 116)

Full Paper (vol.891 paper# 117)

c:\work\Jor\vol891_118 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4881- 4886
Evaluation of Macular and Choroidal Thickness by
Optical Coherence Tomography with Direct Acting Antiviral Agents in
Patients with Chronic Hepatitis C Virus Infection
Doaa Saad Yusuf1, Abdelrahman Gaber Salman2, Tarek M. Yosef3,
Walid Mohamed Elzawahry2, Walaa M. Hashem*3
Department of 1Ophthalmology, Damanhour Eye Hospital, Egypt
Departments of 2Ophthalmology and 3Gastroenterology, Hepatology and Internal Medicine,
Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Walaa M. Hashem, Mobile: (+20) 01001597662, Email: walaa.hashem@med.asu.edu.eg


Background: One of the most significant threats to public health is hepatitis C virus infection (HCV). Pegylated
interferon alpha (Peg-IFN) and ribavirin (RBV) had been the main stay of treatment for hepatitis C until recently. This
combination often causes systemic and ocular side effects. More effective and safer than IFN therapy is direct acting
antiviral agents (DAAs). Objective: The objective of the current study was to assess the impact of sofosbuvir (SOF)
and daclatasvir (DAC) on choroidal and macular thickness among HCV cases. Patients and methods: Between June
2018 and February 2019, 30 HCV cases were included and treated using RBV-free SOF/DAC regimen for 12 weeks.
They were referred to the ophthalmology department where full ophthalmological assessment was done before and at
the end of treatment. Furthermore, macular and choroidal thicknesses were assessed by optical coherence tomography
(OCT). Results: 60 eyes of 30 HCV cases (aged from 24-56 years, males: 18 [60%], females: 12 [40%]) received RBV-
free SOF/DAC regimen for 12 weeks. During the 3 months of follow-up, no ocular complications were reported. Best
corrected visual acuity (BCVA) was not changed. OCT showed increase in macular thickness from baseline. Although
there was an increase, it didn't show statistical significance (p=0.743). The choroidal thickness measurements showed
no statistically significant difference. Conclusion: There are no observable ophthalmic sequelae among patients treated
with DAAs, and this includes the RBV-free SOF/DAC regimen. There appears to be a decreased need for routine
ophthalmic follow-up among patients treated with DAAs in comparison to INF.
Keywords: Hepatitis C, Ocular complications, Macula, Choroid, Optical Coherence Tomography, Direct Acting
Antivirals, Sofosbuvir, Daclatasvir.


sofosbuvir/daclatasvir regimen on macular and
choroidal thickness in Egyptian patients with chronic
decompensation, as well as hepatocellular carcinoma
HCV infection.
are all caused by HCV, making it a global health

problem. About 1.5 million new cases of HCV infection
are reported annually, bringing the total number of
people with the virus worldwide to 58 million (1). Egypt
Thirty chronic hepatitis C (CHC) patients who
has the world's highest prevalence, with 92.5% infected
were presented to our institution between June 2018 and
with genotype 4 (2).
February 2019 to receive treatment with DAAs were
IFN treatment remained for several years the
invited to participate in this prospective study. Full
treatment of choice for HCV. However, many side
ophthalmological examination was carried out in the
effects mainly affecting the retina have been linked to
outpatient clinic of the ophthalmology department of
using IFN with or without ribavirin. IFN-associated
Ain Shams University Hospitals.
retinopathy incidence is variable ranging from 18-86%
(3). Cotton-wool patches and retinal hemorrhage are two
Participants were not included if they had any of
types of common retinal abnormalities (4,5). In addition
the following conditions: retinopathy; diabetes mellitus;
to retinopathies, other posterior pole disorders have
hypertension; autoimmune disease that could impact the
been documented, including macular edema, bilateral
retina; glaucoma; visual field abnormalities; or a single
anterior ischemic optic neuropathy, and optic nerve
infarction (3).
With the advent of DAAs, treatment of chronic
The sociodemographic data of the enrolled
HCV has undergone dramatic revival, with sustained
participants was recorded. Complete blood count
virological response (SVR) of >90%. DAAs are now the
(CBC), liver function tests, kidney functions,
current standard of care for treating HCV because of
their shorter treatment duration and fewer adverse
coagulation profile, and pelvi-abdominal ultrasound
effects (6).
were performed at baseline. All patients received

sofosbuvir 400mg and daclatasvir 60mg daily for 12
Our objective was to evaluate the effect of
weeks. SVR12 was described as an undetectable HCV-
Received: 20/06/2022
Accepted: 29/08/2022

Full Paper (vol.891 paper# 118)

c:\work\Jor\vol891_119 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4887- 4895

QT Dispersion Correlation with Myocardial Perfusion in Patients with ST Elevation
Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention
Ismail Mohamed Ibrahim, Aya Tarek Farag*, Kamel Hasan Ghazal, Mohamed Abdala Eltahlawi
Cardiology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aya Tarek Farag, Mobile: (+20) 01001231726, E-Mail: youoosh.91@gmail.com

The QT dispersion (QTd) can be used as effective reperfusion marker among cases who undergo primary
Percutaneous Coronary Intervention (PCI) after having acute myocardial infarction.
Objective: Study of the correlation between myocardial perfusion and QT dispersion on 12 lead surface ECG among
patients who had acute ST-elevation myocardial infarction (STEMI) managed by primary PCI.
Patients and methods: In a prospective cohort study, 100 cases admitted to the Cardiology Departments of Zagazig
University Hospital and El-Zaitoun Specialized Hospital within 12 hours of symptom onset were recruited. This study
included all patients who fulfilled the criteria for acute STEMI and were candidates for primary PCI. All cases underwent
electrocardiogram (ECG), echocardiogram (ECHO), and coronary angiogram.
Results: Myocardial electrical heterogeneity was rapidly restored to normal after effective reperfusion, whereas
insufficient tissue reperfusion (Myocardial blush grade (MBG) lower or equal to 2) even with Thrombolysis in
Myocardial Infarction (TIMI) III flow, was not related to the resolution of the increased QTd. QTd and corrected QTD
(QTcd) were significantly shortened following recanalization of the infarct-related artery among cases with successful
tissue-level myocardial reperfusion (MBG3). The pre-procedural QTd is a significant predictor of the patients' MBG
(i.e., The MBG improves with lower pre-procedural QTd values and worsens with higher QTd values.)
Conclusion: Effective revascularization of myocardial tissue was determined by MBG related to normal electrical
heterogeneity restoration with reduction of QTd in the jeopardized myocardium. The pre-procedural QTd is a significant
predictor of the patients' MBG.
Myocardial Perfusion, Percutaneous Coronary Intervention, QT Dispersion.


Among all causes of death, coronary artery
In grade 2 the contrast shows slow in and out from the
disease (CAD) stands out as the top global cause of
microvasculature. The highest possible grade is 3, which
mortality. Every year, CAD cause a death of about seven
indicates normal entry and exit from myocardial
million individuals worldwide, or 12.8% of all deaths. In
microcirculation (4).
terms of mortality, morbidity, and economic burden,
acute myocardial infarction is a devastating disease that
homogeneity and also prediction of electrical instability
affects many people. When it comes to the underlying
may be possible using QT interval parameters. The (QT)
substrate, coronary atherosclerosis plays a vital role in
interval measures a duration of the ventricular activity
many patients (1).
both depolarization (start of the QRS complex) and
Restoration of blood flow to the heart as soon as
repolarization (the end of T wave) (5).
possible in the treatment of (AMI) is to protect the heart
The duration of the electrical activity of the
muscle, its electrical and mechanical functions is known
ventricles is reflected by QT dispersion (QTd), which is
as reperfusion therapy. Recanalization of infarct-related
the difference between the longest and shortest QT
arteries (IRAs) is now successful in >90% of cases
intervals (QTi). This is a crucial predictor of mortality
because of percutaneous coronary intervention (PCI) (2).
for patients diagnosed with acute STEMI. Myocardial
To assess coronary artery flow in acute coronary
infarcted patients with a prolonged QT interval have an
syndrome, Thrombolysis in Myocardial Infarction
increased risk of fatal arrhythmia (6).
(TIMI) flow grade is commonly used. Grade 0 flow
In patients undergoing primary percutaneous
(refers to no flow), grade 1 flow (penetration but without
coronary intervention for acute myocardial infarction,
perfusion), grade 2 flow (perfusion is present partially)
the success of myocardial revascularization was
or grade 3 flow (perfusion is done completely). TIMI 3
evaluated by the QT dispersion (7).
flow necessitates equal velocities of antegrade flow
There is still much to learn about the use of ECG
distally and proximally. TIMI grade 3 flow is redefined
in diagnosing MI and evaluating myocardial reperfusion
by PAMI investigators (`PAMI' grade 3 flow) as vessels'
as it is a vitally important, easy, speedy, and non-
opacification within 3 cardiac cycles(3).
invasive diagnostic tool (8).
Myocardial blush grade (MBG) has been used as
The study objective was to study of the
angiographic measure of myocardial perfusion. During
correlation between myocardial perfusion represented
angiogram, the 1-3 MBG is applied to asses wash out the
by MBG and QT dispersion on 12 lead surface ECG
myocardial blush. Grade 0 means that the contrast
among patients who had acute ST-elevation myocardial
cannot enter the microvasculature. In grade 1 contrast
infarction (STEMI) managed by primary PCI.
enters the microvasculature slowly but cannot leave it.

Received: 05/06/2022
Accepted: 10/08/2022

Full Paper (vol.891 paper# 119)

c:\work\Jor\vol891_120 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4896- 4903

Correlation between Limbal Insertion Distance and Surgical Effect of
Lateral Rectus Recession in Cases of Intermittent Exotropia
Ali El-Sadek Mohamed Matli*, Adel kamalAbdeen, Haitham Younis Al-Nashar, Abdullah Ahmed Hassan Nasr
Departments of Ophthalmology, Faculty of Medicine Zagazig University, Egypt
*Corresponding author: Ali El-Sadek Mohamed Matli, Mobile: (+20) 01225957164, E-Mail: alimatli.1141989@gmail.com

The most prevalent form of exotropia is intermittent exotropia. The effect of muscle recession can be
predicted using the limbal insertion distance (LID).
This study aimed to assess the treatment of intermittent exotropia (IXT) among both children as well as
adults assembled on lateral rectus muscle LID using bilateral lateral rectus (LR) recession.
Patients and methods:
46 participants ranged in age from 5 to 30 years old. Patients were separated into groups based
on age. Group I included 35 patients (76.1%) with a mean age of 10.26 ± 4.11 years and group II included 11 patients
(23.9%) older than 17 years (23.55 ± 4.8). All patients were operated either bilateral or unilateral LR recession to
alleviate exotropia under general anesthesia based on preoperative angle of deviation.
Results: Mean dose-response differed significantly between groups which was significantly lower among patients older
than 17 years. The mean dose-response was 4.73 and 4.4 in group I and group II respectively. Preoperative angle
deviation, limbus insertion distance, and amount of recession all exhibited a strong positive significant correlation with
the mean dosage response. Both preoperative angle deviation, LID, and amount of recession were found to exhibit a
strong positive significant correlation with the mean dose-response. Conclusion: For intermittent exotropia treatment,
preoperative lateral rectus muscle weakness, angle deviation, limbus insertion distance, and recession amount are all
positively correlated with the mean dose-response in both eyes and in one eye separately.
Keywords: Limbal insertion distance, Lateral rectus recession, Intermittent exotropia.

Inclusion criteria: Primary LR recession in either the
About half to three-quarters of all patients with
left or right eye or both, with normal anterior segment
exodeviation suffer from intermittent exotropia, the
structures and concurrent IXT were eligible for
most frequent form of the condition. The optical axis
diverges intermittently, commonly at first during
Exclusion Criteria: Oblique muscle dysfunction,
distance fixation or when the kid is fatigued, and this is
significant neurological impairment such as cerebral
the defining characteristic of the condition. Optic
palsy, Prior strabismus surgery or botulinum toxin
discrepancy may progress to chronic exotropia, which
injection, limitation of ocular rotations due to restrictive
compromises stereo vision and may lead to amblyopia
or paretic strabismus, severe myopia (> 6), amblyopia,
if left untreated (1).
nystagmus, related vertical deviation, prior squint
Predicting surgical outcomes in IXT patients has
surgery, anisometropia > 2D, and convergence
been the subject of numerous investigations. To ensure
insufficiency. Patients with significant Intermittent XT
the best possible surgical outcomes, a wide range of
angles > 55 degrees were also disqualified.
parameters were taken into account (2). IXT surgical

results have been predicted by several parameters,
Ethical consent:
including the LR muscle LID (limbal insertion
Research Ethics Council at Zagazig University
distance), which has been shown to anticipate muscle
approved the study (ZU-IRB#6764) as long as all
atrophy in kids receiving unilateral or bilateral muscle
participants provided informed consent forms.
recession surgery. In order to measure LID, you need to
Ethics guidelines for human experimentation were
know how far the corneal limbus extends from LR
adhered to the World Medical Association's Helsinki
muscle insertion to the midpoint of the posterior margin.
LID may have an impact on the surgical result (3).
All studied patients were subjected to the following:
The purpose of our study was to assess the
1- History taking: Full history was collected, as well
treatment of intermittent exotropia (IXT) among both
as family history.
children as well as adults assembled on lateral rectus
2- Clinical examination: General examinations as well
muscle LID using bilateral lateral rectus recession.
as local ocular examination were done.

All patients received LR recession for exotropia
46 patients ranged in age from 5 to 30. They were
correction, either unilaterally or bilaterally while under
divided according to age into 2 groups. Group I
general anesthesia. During every procedure, a limbal
included 35 patients (76.1%) aged from 5 to 17 years,
conjunctival approach was used to get access to the
and Group II composed 11 patients (23.9%) older than
lateral rectus muscle and hook it. In order to quantify
17 years. All were involved in this prospective study at
the limbus insertion distance (LID) following the
Ophthalmology Department, Faculty of Medicine,
removal of the LR muscle from the sclera, an instrument
Zagazig University Hospitals.
that graded 0.25 mm was employed.
Received: 06/06/2022
Accepted: 11/08/2022

Full Paper (vol.891 paper# 120)

c:\work\Jor\vol891_121 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4904- 4909

Mesh Fixation by Fibrin Glue versus Tackers in Laparoscopic
Transabdominal Preperitoneal (TAPP) Repair of Inguinal Hernia
Emad Salah, Rafia Ramadhan Salim*, Mohamed Ibrahim Mansour,
Ahmed M. Sallam, Fady Mehaney Habib
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Rafia Ramadhan Salim, Mobile: (+20)1553492224, E-Mail: mas2411ter@gmail.com

As laparoscopic repair of groin hernia is gaining popularity; most surgeons argue over which mesh fixation
techniques are the best. Objective: The present study was conducted to compare the outcomes of mesh fixation using
fibrin glue versus tackers in laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia, with the
ultimate goal of bettering the health and happiness of inguinal hernia patients.
Subjects and Methods: This study included a total of 24 inguinal hernia patients chosen for laparoscopic transabdominal
preperitoneal repair with mesh fixation by fibrin glue versus tackers, attending at General Surgery Department, Zagazig
University Hospitals. Patients were randomly divided into 2 equally groups: Group (A) A fibrin glue was used to fix the
mesh and Group (B) Using tackers, to fixed the mesh.
Results: There was a statistically significant difference between the groups investigated in terms of operative time, with
the fibrin glue group taking significantly longer than the tackers group. Within-day pain and length of hospital stay did
not differ significantly between the groups. While return to daily activity was faster in fibrin glue groups. The cost of all
cases of fibrin glue group was lower than that of tackers group.
Conclusion: It could be concluded that mesh fixation by fibrin glue is better than tacker as mesh fixation with glue
causes less post-operative pain and less analgesia is needed as well as low financial cost.
Keywords: Mesh Fixation, Fibrin Glue, Tackers, Inguinal Hernia.


As a result of the anatomical predisposition of men
of the thigh were the most frequently reported
for the development of inguinal hernias, men account for
consequences. Due to adhesion between the viscera and
nearly all cases of this prevalent surgical ailment. An
the utilized tacks, certain studies have observed colonic
inguinal hernia can become life-threatening if the bowel
and small intestinal fistula, which can cause severe pain
inside the peritoneal sac is suffocated, gets clogged, or
and may require surgical intervention (5).
both. Among the many types of general surgical
Injuries to the inferior epigastric arteries, femoral
procedures, inguinal hernia repair is extremely common
nerve, genitofemoral nerve, and lateral cutaneous nerve of
(1). Tension-free repair with the use of a mesh prosthesis
the thigh were the most frequently reported consequences.
has been shown to have the lowest recurrence rate in the
Due to adhesion between the viscera and the utilized tacks,
history of inguinal hernia surgery, dropping from about
certain studies have observed colonic and small intestinal
20% to 1% (2). Laparoscopic inguinal hernia repair has
fistula, which can cause severe pain and may require
risen in popularity during the past two decades (3).
surgical intervention (6).
Inguinal hernias can now be treated with
Fibrin glue and N-butyl-2 cyanoacrylate are the
laparoscopic hernia repair because to advancements in the
two most popular glues for fixing mesh. Biodegradable
field. The most common type of laparoscopic hernia repair
"fibrin glue" is made by mixing fibrinogen and thrombin
is the transabdominal preperitoneal (TAPP) approach. It
from human sources. Fibrinogen not only acts as a blood
has been claimed that TAPP repair decreases the
clot but also provides the product with tensile strength and
likelihood of experiencing postoperative discomfort,
adhesive qualities. Newer cyanoacrylates, such N-butyl-2-
shortens the duration of the hospital stay, and speeds up
cyanoacrylate, have been put to use as surgical tissue
the recovery process. As laparoscopic inguinal hernia
adhesives since the 1960s (7).
repair utilizing tension-free mesh becomes more common,
There was some slight inflammation at the site of
its benefits are increasingly being weighed against its
application in the experimental tests involving
more invasive counterpart. The success of this surgical
cyanoacrylate glue. However, no direct clinical relevance
treatment hinges on two factors: choosing a mesh of the
to this discovery has been established (8).
right size and fixing it properly to the surrounding tissues
Decisions about the type of fixation device utilized
(4).Using tissue piercing procedures (tacks), either titanium
are heavily influenced by the preferences of individual
or absorbable tacks, to fix mesh prostheses guarantees
surgeons (9). In an effort to prevent chronic pain from a
mesh stability and absorption into surrounding tissues;
fixation device, many surgeons opt to not fixate the mesh
nonetheless, difficulties of these treatments were not rare,
since numerous studies documented a variety of
Our aim was using TAPP repair for an inguinal
complications (1).
hernia and compare fibrin glue and tackers for mesh
Injuries to the inferior epigastric arteries, femoral
fixation with the ultimate goal of bettering the health and
nerve, genito-femoral nerve, and lateral cutaneous nerve
happiness of inguinal hernia patients.
Received: 2/6/2022
Accepted: 9/8/2022

Full Paper (vol.891 paper# 121)

c:\work\Jor\vol891_122 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4910- 4914

Follow-Up of Post-Prostatectomy Patients with Persistent
Lower Urinary Tract Symptoms
Mohamed Alyeldeen Abou-zeid*, Hazem Abdel Sabour Deif, Alaa Refaat Mahmoud Ali, Emadeldeen Salah
Department of Urology, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
*Corresponding Author: Mohamed Alyeldeen Abou-zeid, Mobile: (+20) 0106 097 6776, E-mail: dr.mohamed635@gmail.com

Benign prostatic hyperplasia (BPH) is a prevalent condition that affects males. The prevalence rises with
age; around 25% of men in their 40s and 50s are affected, compared to more than 80% of men in their 70s and 80s.
Objective: This study aimed to follow-up patients with persistent lower urinary tract symptoms (LUTS) following
removal of the prostate and to find the best strategy to treat and to manage such conditions so the patients have a better
outcome and quality of life.
Patients and Methods: This observational study was conducted between January 2021 and January 2022 in Urology
Department, Al-Azhar university hospital, Assiut branch, Egypt. We recruited 40 Post-PBH operations patients
complaining of LUTS. Files were initially read to identify eligible subjects. When a subject was deemed eligible, their
notes were reviewed for baseline data. Baseline data included preoperative international prostate symptom score (IPSS),
quality of life (QOL) score, Peak urinary flow rate (Qmax), voided volume (VV), and postvoid residual (PVR).
Result: The median IPSS is 21 and ranges from 5 to 35. The QOL ranged from 3 to 6 with a median of 4.00. The
uroflowmetry ranged from 8 to 16 with a median of 12.00. The PVR ranged from 10-to 1000 with a median of 62.50.
IPSS changed from 21 at baseline to 7 at follow-up, with an improvement of 66%. This is significant under Wilcoxon's
signed-rank test (P < 0.001). Quality of life was improved from 4 at the baseline to 1.5 at follow-up, with an improvement
of 62% (P < 0.001).
We found that B-TURP was the more effective therapy, had the least rate of postoperative complications,
could minimize morbidity, and increase the quality of life.
Benign prostatic hyperplasia, Lower urinary tract symptoms, International prostate symptom score, quality
of life score.

4-5). The conservative treatment includes decreasing
alcohol and caffeine intake, adjusting the fluids intake,
Benign prostatic hyperplasia (BPH) is a
monitoring the symptoms, doing the relaxation
prevalent condition that affects males. The prevalence
exercise. Medical treatment includes alpha1-receptor
rises with age. Around 25% of men in their 40s and 50s
inhibitors, phosphodiesterase 5 (PDE5) inhibitors, and
are affected, compared to more than 80% of men in their
5-alpha-reductase inhibitors. Indications of surgical
70s and 80s (1). BPH is characterized by proliferation of
treatment include failure of medical therapy and
the epithelial and stromal cells of the transition zone of
recurrence of symptoms. The surgical intervention
the prostate around the prostatic urethra, resulting in
includes transurethral incision of the prostate (TUIP),
bladder outflow obstruction (BOO), which can lead to
monopolar or bipolar transurethral resection of the
lower urinary tract symptoms (LUTS) (2). Pathogenesis
prostate (M-TURP), bipolar transurethral resection of
of BPH is still unknown, however the role of the
the prostate (B-TURP), Bipolar vaporization of the
androgen is well defined in which its receptors are
prostate (TUVP), open simple prostatectomy,
expressed and activated in BPH tissue. Recently,
endoscopic enucleation of the prostate and
prostatic inflammation and metabolic parameters have
laparoscopic/robot-assisted simple prostatectomy (6).
been recognized to produce BPH (3). Other risk factors
Unfortunately, 20­50% of patients develop LUTS
for BPH include age, genetics, obesity, and
following surgery. These patients require extra care
geographical area (2).
because the underlying cause of their LUTS may not
BPH results in a group of symptoms known as
have been fully treated by surgery, and their quality of
LUTS. These symptoms are either storage or voiding.
life deteriorate (7).
Voiding symptoms include weak stream, dysuria,
The aim of this study was to follow up patients
with persistent lower urinary tract symptoms following
emptying, and terminal dribble. Storage symptoms
removal of the prostate and to find the best strategy to
include urgency, frequency, and nocturia. LUTS may be
treat and manage such conditions, so the patients have
in the form of distressing symptoms such as sexual
better outcomes and quality of life.
dysfunction, depression, sleep disturbances, and

lowering the capacity to carry out day-to-day tasks.
BOO produces multiple complications due to urine
Study populations
retention. These complications include infection, stone
This observational study was done between
formation, and hydronephrosis. These symptoms and
January 2021 and January 2022 in the Urology
complications affect the quality of life, so many patients
Department, Al-Azhar University Hospital, Assiut
seek treatment, which is ranging from conservative
branch, Egypt. With a power of 80%, a sample size of
treatment and medical therapy to total prostatectomy (1,
40 male patients was calculated.
Received: 01/06/2022
Accepted: 08/08/2022

Full Paper (vol.891 paper# 122)

c:\work\Jor\vol891_123 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4915- 4920

Outcome of Balloon Valvuloplasty in Children with Pulmonary Valve
Stenosis ­ Multi-Center Experience
Mohamed Abdelsaboor1, Amal Mahmoud El-Sisi2, Saud M. Elsaughier*3,
Mohamed Nashat Moawed1, Naggeh Mohammed Mahmoud3
Departments of 1Pediatrics and 3Cardiology, Cardiology, Faculty of Medicine, Aswan University, Egypt
Department of 2Pediatrics, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Saud M. Elsaughier, Mobile: (+20)01157166779, E-mail: soud_elsoughier_66@yahoo.com

Pulmonary valve stenosis (PS) is a prevalent congenital heart disorder in children, and symptoms
include chest distress, dyspnea, cyanosis, and heart failure in its severe criteria. Objective: To learn more about the
short-term results of balloon pulmonary valvuloplasty in children who had severe pulmonary stenosis.
Patients and methods:
Between January 2015 and December 2018, a 4-year cross-sectional study was conducted in
various centers across Egypt, with funding from the "Dar Al Orman charity". We included 146 Children varied from
5 months to 17 years of either sex diagnosed as severe pulmonary stenosis' case with doming valve with mean value
of peak pressure gradient across the pulmonary valve of 74 mmHg on echocardiography. Patients were intervened
with balloon-valvuloplasty. Results: There were 74 (50.7%) men and 72 (49.3%) women among the 146 patients. The
average age was 5.34 (SD 0.5) years. On echocardiography, the mean pre-cath gradient via the pulmonary valve was
74.44 (SD 9.5) mmHg. The mean pressure gradient across PV was 19.54 (SD 1.9) mmHg after the intervention, (P-
value 0.001). Before intervention, the pulmonary valve annulus on echocardiography varied from 8.5 to 20 mm, with
a mean of 13.44 (SD 3.2) mm. Most patients (89%) had no complications. Only 2 (1.4%) patients had severe
pulmonary valve regurgitation, and 1 (0.7%) patient had right ventricular outflow tract perforation (0.7%).
Conclusion: Balloon pulmonary valvuloplasty is the preferred treatment for stenosis of the pulmonary valve in people
of all ages, and it has few side effects.
Keywords: Pulmonary valve stenosis, Pulmonary valvuloplasty, Outcome, Children.


Pulmonary valve stenosis (PS) is a prevalent
congenital heart disorder in children. It could be
Study population
asymptomatic with an incidental outcome of a
A retrospective study of 146 PS children who
symptomatic or murmur with cyanosis, dyspnea,
received BPV was carried out; done in different centers
malfunction in severe stenosis, and chest pain (1). Patel
all-over Egypt in four years in the period between
et al.(2) found that the pulmonary valve stenosis'
January, 2015 and December, 2018, sponsored by "Dar
incidence was 3.1%. PS is said to be more prevalent in
Al Orman charity". Individuals of either sex diagnosed
Asian nations than in Western nations like Europe and
with severe PS associated with doming pulmonary
United States (3-5).
valve and aged 17 years or less at the time of
PS occur alone or conjugated with other
intervention met the inclusion criteria. PS patients
congenital heart diseases (CHDs) involving a
without hemodynamic compromise, who had a patent
ventricular septal defect, patent ductus arteriosus,
atrial septal defect (ASD), atrial septal defects (ASDs),
patent foramen ovale, or atrial septal defect. PS is
ventricular septal defects (VSDs), or patent ductus
divided into three subtypes: sub valvular stenosis, most
arteriosus (PDA), were involved in the study. Children
valvular stenosis, and supra valvular stenosis (6).
with mild PS who did not require intervention,
Treatment of choice for children with severe,
syndromic characteristics, other related congenital
intensive, or moderate PS is pulmonary balloon
cardiac anomalies needing surgery, and other heart
valvuloplasty, which is an effective and safe method (7).
disorders related to hemodynamic compromise were all
Kan et al. (8) performed the first trans-catheter balloon
ruled out.
pulmonary valvuloplasty (BPV) in 1982, and

pulmonary valvuloplasty has since become the desired
approach for simple PS patients with minimally
In this study, the transpulmonary pressure gradient was
invasive strategies and favorable findings.
utilized to conduct a quantitative evaluation of PS
The majority of the information on the outcomes
intensity. PS severity was ascertained utilizing 2006
and effectiveness of pulmonary valve ballooning comes
ACC/AHA recommendations for valvular heart disease
from developed nations, but information from
management (9).
developing nations is scarce. The purpose of this study

is to gain knowledge about the pulmonary
Data collection
valvuloplasty's outcomes in children with PS in low-
resource settings in a number of centers along through
catheterization, hepatic and kidney function, 12-lead
Egypt that are all endorsed by the "Al Orman charity."
electrocardiogram (ECG), coagulation time, chest
Received: 2/6/2022
Accepted: 9/8/2022

Full Paper (vol.891 paper# 123)

c:\work\Jor\vol891_124 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4921- 4925

Fracture Risk Assessment Using Trabecular Bone Score in Postmenopausal
Women with Type 2 Diabetes Having Vertebral Fractures
Amany Abd Elhamid Mousa1, Mohamed Sherif El Desoky1,
Mohamed Salah El tantawy2 Riham Hisham Ahmed Magar3*
1Diabetes and endocrinology Department, 2 Radiology Department, Faculty of Medicine,
Mansoura University, Egypt, 3Resident of internal Medicine, Mansura fever hospital, Egypt
*Corresponding author: Riham Hisham Ahmed Magar, E mail: Drrehammagar@gmail.com, Mobile phone: 01002415977

The most frequent type of osteoporotic fractures is vertebral fractures (VFs), and identifying them is
crucial for the diagnosis of osteoporosis as well as for future fracture risk assessment and treatment options
Aim of the work: This study aimed to determine the utility of trabecular bone score (TBS) in post-menopausal type 2
diabetic patients with vertebral fractures (VFs) and the relationship of TBS with bone mineral density (BMD) and
fracture risk assessment (FRAX) score.
This case-control study included a total number of 100 postmenopausal women patients from Endocrinology
Clinics and Mansoura Specialized Hospital. They were divided into 4 groups: 25 postmenopausal women with T2DM
and VFs, 25 postmenopausal women with T2DM without VFS, 25 postmenopausal women without T2DM with VFS
and 25 postmenopausal women without T2DM without VFS. The study's period was from November 2020 to February
Results: A statistically significant difference in all studied parameters between the 4 groups except body weight. In the
two DM groups' age, menopausal length, HbA1c, FRAX-MOPF (percent), and FRAX-HF (percent) values were
statistically greater than those of the two non-DM groups. Also, TBS T-score was statistically significantly lower in the
DM/VF group vs. non-DM/non-VF group. BMD T-score was lesser in DM/VF group vs. the two non-DM groups,
This study demonstrated that there are many factors contributing to the prevalence of vertebral fractures.
These factors include duration of diabetes, poor diabetic control, BMI, drugs taken, BMD, and duration of menopause.
Key words: Vertebral fractures, Trabecular bone score, Postmenopausal, Fracture risk assessment, Diabetes mellitus
type 2.


the BMD of the lumbar spine, and high, moderate, and
Diabetes mellitus type 2 (T2DM) is a prevalent
low exposure to glucocorticoids) (7).
metabolic condition, whose prevalence increases with
TBS is a low-cost approach of assessing bone
age. Despite having greater bone mineral density
quality that may be estimated immediately from a
(BMD) readings, T2DM patients have an increased risk
lumbar spine dual X-ray absorptiometry (DEXA) study
of fracture (1). These have been linked to a variety of
without subjecting patients to more radiation. However,
circumstances, including the types of medications
there are few studies on TBS's ability to predict
taken, the existence of T2DM complications, and the
vertebral fracture (VF) in people with diabetes mellitus
length of the condition (2).
When compared to control participants, T2D

patients may have greater BMD and lower mean FRAX
scores despite having a higher risk of fracture (3). As a
This case-control study included a total number of 100
result, the Fracture Risk Algorithm (FRAX), which
postmenopausal women patients who were divided into
measures other elements rather than BMD including
4 groups. 25 postmenopausal women with T2DM and
(age, bone mineralization, bone micro-damage, bone
VFs, 25 postmenopausal women with T2DM without
turnover, and fracture history), helps to determine the
VFS, 25 postmenopausal women without T2DM with
overall evaluation of fracture risk (4).
VFS and 25 postmenopausal women without T2DM
The most frequent type of osteoporotic fractures is
without VFS. This study recruited 215 participants from
vertebral fractures (VFs), and identifying them is crucial
Endocrinology Clinics and Mansoura Specialized
for the diagnosis of osteoporosis as well as for future
Hospital. Then, cases were selected based on inclusion
fracture risk assessment and treatment options (5). They
and exclusion criteria so that at the end 100 participants
are very often asymptomatic, and there is evidence that
(25 in each group) were enrolled in the study. The
they are greatly underdiagnosed worldwide (6).
study's period was from November 2020 to February
Simple arithmetic operations have been used to
modify the probability assessment of standard FRAX
sociodemographic, clinical, and laboratory data.
estimations of fracture probabilities in order to get

around some of the limitations of FRAX (For instance,
Inclusion criteria: All patients were postmenopausal
details on the trabecular bone score (TBS), the hip
structural analysis (HSA), simultaneous information on

Received: 23/5/2022
Accepted: 28/7/2022

Full Paper (vol.891 paper# 124)

c:\work\Jor\vol891_125 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4926- 4929

Assessment of Vitamin-D Levels Among Infertile Men in Iraq,
A Comparative Study
Abtisam F. Al-Shukry 1, Kais Khudair Al-Hadrawi 2,
Maysoon Khudair AL-Hadrawi1*, Zainab Salah Abdul-Jabar 1
1Department of medical laboratory techniques, Kufa Technical Institute, Al-Furat Al-Awsat Technical
University31001, Kufa, Al-Najaf, Iraq
2Radiology Techniques Department, Collage of Medical Technology, Islamic University, Najaf, Iraq
*Corresponding author: Maysoon Khudair AL-Hadrawi, E-mail: kin.msn@atu.edu.iq, Mobile: 009647810111300


Background: Vitamin-D is one important steroid hormone in the body, which is obtained from direct sunlight and food
or supplements.
Objective: The current study aimed to evaluate the relationship between Vitamin-D levels and semen parameters among
infertile men in Najaf Governorate.
Patients and method: The study included sixty infertile men who presented to the Infertility Unit, Saad Medical City
during the period from January 2020 to September 2020. The results were compared with the results of thirty healthy
men as a control group. The level of Vitamin-D in the blood was detected using a French-origin Fujifilm machine,
semen analysis, and sperm counting by using a Microcell counting chamber. Sperm morphology was evaluated by the
Diff-Quick kit.
Results: The results demonstrated that infertile men had average age of 34 ± 0.50 years and their mean body mass index
(BMI) was 60.60 ± 5.06 kg/m2. The results showed that the level of vitamin-D in the body recorded a significant decrease
(P-value < 0.0001) in infertile men (12.55 ± 0.02) as compared to fertile men (43.16 ± 0.005).
Conclusion: This study proved the positive relationship between the level of Vitamin-D and the levels of semen
parameters, which can insure for the possibility of relying on the level of Vitamin-D in determining the cause of male
Keywords: Vitamin-D, Semen, Infertile, Men, Iraq.

(ICSI), which includes the direct injection of oocyte
Infertility affects more than 186 million people
cytoplasm by single sperm (6). Other causes may be due
in various countries of the world, especially developing
to Asthenozoospermia (AZS), diagnosed by lack of
countries (1). The World Health Organization has
sperm motility where < 40% sperm motility or less than
identified infertility as a public health problem and
32% with progressive motility. Low motility of sperm
considered it a disease that affects both sexes and leaves
is a frequent escort of oligospermia and is often linked
physical and psychological effects. Semen analysis is
with a mixed image of appearance flaws that indicate
important in assessing the possibility of infertility (2).
faulty spermatogenesis (7).
Studies interested on this subject indicated a decrease in
The study of semen quality, the count and
the percentages and concentrations of normal sperm in
motility of sperm are the first diagnostic markers to be
men of China, Brazil, North America, Europe,
estimated. Sperm cell morphology (Teratospermia) is
Australia, and New Zealand that maybe due to changes
an undervalued men parameter, because of the loss of
in lifestyle such as alcohol and tobacco use, diet,
a general accepted estimated method though, the
obesity, and other causes (3).
morphologic features of the sperm cell are the result of
The major causes of infertility of males may be
highly cellular modifications occurring through
due to changes of semen parameters. Oligospermia is a
spermatogenesis (8). The percentage of abnormal
lack in the sperm number in the semen of less than 15
spermatozoa and specific structural abnormalities
million/milliliter, which is subdivided into light (10­15
suggest a flaw related to spermatozoa formation and
million sperm/mL) severe (< 5 million sperm/mL) and
maturation of abnormal spermatozoa morphology that
moderate (5­10 million sperm/mL). Oligospermia is a
is associated with increased contemporary signs of
conceder defect in sperm form or other causes like
sperm damage and decrease of semen quality
exposure to chemical or thermal factors that inactivated
parameters (9). The current study aimed to evaluate the
spermatogenesis, varicocele, hormonal factors, or
relationship between vitamin-D levels and semen
idiopathic (4). So, patients must be given guidelines to
parameters among infertile men in Najaf Governorate.
correct their lifestyle and prevent factors that affect

spermatogenesis (5).
Approximately 10% of infertile men with
The place and period of study: Al­Saader Medical
oligospermia have non-normal karyotypes, suggesting
city/Infertility Unite in Najaf Governorate, from
that mutation of stem cells is responsible for sperm
January 2020 to September 2020.
production disorder. So, men with severe oligospermia

were treated using intracytoplasmic sperm injection
Received: 5/6/2022
Accepted: 10/8/2022

Full Paper (vol.891 paper# 125)

c:\work\Jor\vol891_126 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4930- 4937

Effect of Pentoxifylline on Late-onset Sepsis and Protein C Level in Preterm
Neonates: a Double-blinded Randomized Controlled Trial
Dahlia El Sebaie 1, Yasmeen Mansi 1, Aml S. Nasr 2, Shahenda A. Khairy 3, Angie M.S. Tosson 1
1 Pediatric Department and 2 Clinical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
3 Neonatal Intensive Care Unit, Obestetric and Gynecology Hospital, Ain Shams University, Cairo, Egypt.
*Corresponding author: Shahenda A. Khairy. Mobile: (+20)1226437073.
E.mail: shahendakhairy11@gmail.com. Orcid: 0000-0003-0976-2303.


Background: Pathological coagulation system activation is linked to neonatal sepsis, which leads to disseminated
intravascular coagulation. Late-onset sepsis (LOS) in preterm neonates leads to serious morbidities and increased mortality.
Aim and objectives: The purpose of this research was to assess how pentoxifylline affectes protein C in septic preterm infants
as well as their clinical development and outcomes.
Patients and methods: Eighty preterm newborns who were hospitalized in Kasr Alaini, Cairo University Hospital's neonatal
critical care units and with clinical or blood culture-proven LOS participated in this double-blinded, randomized controlled
experiment. The pentoxifylline group got pentoxifylline (5 mg/kg/hour for six hours), whereas the control group received
normal saline as a placebo. Both infusions were administrated for six successive days. Protein C levels were measured before
and after the intervention.
Result: Gram-negative sepsis was predominant with Klebsiella pneumonia being the most common isolated organism. After
the intervention, there was a significant increase in protein C levels in the pentoxifylline group (P value = 0.020). Significant
reductions in the duration of antimicrobial therapy,duration of hospital stay in survivors and continuous positive airway
pressure therapy, (P values =0.001, 0.012 and 0.03 respectively) were documented, as well as the decreased requirement for
plasma transfusions (P value = 0.03).
Conclusion: In preterm newborns with LOS, pentoxifylline has a good impact on the protein C system and lengths of antibiotic
treatment, hospital stay and continuous positive airway pressure therapy.
Keywords: Coagulation; Neonate; Pentoxifylline; Protein C; Sepsis.


The leading cause of newborn fatalities,
vascular, and inflammatory disorders in both children and
particularly in middle- and low-income nations, is
adults (6,7). It is a xanthine or theobromine derivative and
neonatal sepsis (1).
a phosphodiesterase inhibitor. Pentoxifylline's special
It typically occurs in conjunction with platelet
characteristics explain why it may be beneficial for a
fatigue, pathological activation of the coagulation system,
variety of disorders in neonates that are characterized by
and fibrinolytic agents. In addition, antithrombin III,
inflammatory cytokine cascade activation, free radical
protein C, and protein S levels are significantly decreased
toxicity, and poor microcirculation (8). Additionally, it
in septic neonates (2,3), which promotes the growth of
improves platelet function by increasing erythrocyte
numerous microvascular thrombi and the development of
flexibility, fibrinolytic and tissue plasminogen activator
disseminated intravascular coagulation (DIC) and
activity, and inhibiting platelet adhesion (9). Additionally,
multiple organ failure.
it reduces blood viscosity and enhances tissue perfusion
Pro-inflammatory cytokines have been given the
and microcirculation (10).
primary responsibility for the pathophysiology of sepsis
Pentoxifylline's impact on cyclic adenosine
because they cause DIC to form via the tissue factor-
monophosphate has been linked to a wide range of
dependent route of coagulation (4). Endotoxins stimulate
outcomes, including the preservation of protein C in
neutrophils, macrophages, and the secretion of cytokines
sepsis. Theobromine is the least toxic of the
such as tumor necrosis factor (TNF) and interleukins as
methylxanthines and has no appreciable cardiac or
well as humoral and cellular defense systems (5). Agents
bronchodilator effects at therapeutic levels (11).
that control inflammation may improve outcomes since
Pentoxifylline's effectiveness in treating newborn sepsis
newborn sepsis mortality and morbidity are still high
is still unknown, and published research has shown
despite the use of strong antimicrobials.
contradictory results (4,12­17). Additionally, its function in
the neonatal physiological inhibitory mechanism of
immunomodulating drug with distinctive hemorrhagic
coagulation has not yet been researched. In order to assess
effects that has been utilized in a variety of infectious,
the possible impact of pentoxifylline on protein C in
Received: 2/6/2022
Accepted: 9/8/2022

Full Paper (vol.891 paper# 126)

c:\work\Jor\vol891_127 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4938- 4944

Psychological Aspects of Patients with Diabetic Neuropathic Foot
Manal Mostafa Abbas Tarshoby1, Mohamed Sherif Abdelgawad Eldesouky1,
Mohamed Ahmed Elwasify2, Elsherbiny Ibrahim Elsherbiny Ibrahim1*
Departments of 1Internal Medicine and 2Psychiatry, Diabetes and Endocrinology Unit,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Elsherbiny Ibrahim Elsherbiny Ibrahim, Mobile: (+20) 01068816937,
E-Mail: drelsherbinyibrahim@yahoo.com

Diabetic foot complications disturb the daily life of patients including changes in sleep pattern, impaired
mobility, and interference with certain aspects of life such as sexuality, feelings of loneliness, powerlessness, anxiety
and depression. While research into biology of the diabetic foot (DF) is making great strides, the psychology of patient
experience with diabetic foot remains a somewhat underappreciated topic.
Objective: The aim of the present study is to evaluate the impact of DF on the psychological aspects of the patients,
and compare such findings to patients with diabetes but no DF complications.
Patients and methods: The study was a cross-sectional comparative study that included 186 patients attending at the
diabetic clinic and diabetic foot clinic at Specialized Medical Hospital, Mansoura University, from June 2020 to May
2021. The participants were divided into 93 diabetic patients with diabetic neuropathic foot complications as Group I
and 93 diabetic patients without diabetic neuropathic foot complications as Group II.
Results: There was a non-statistically significant difference between studied groups as regard insomnia severity scale.
There was a statistically significant association between insomnia severity scale and neuropathic foot complications as
regard deformity and diabetic foot ulcer (DFU). Among cases with severe insomnia severity scale; 50% have deformity
and 75% DFU. Conclusion: Diabetic neuropathic foot complications has an impact on psychological aspects of patients.
The prevention of diabetes-related complications is important to improve patient's Health-related quality of life
(HRQOL) which is an important outcome measurement from the patient's perspective relating to the impact of the
Keywords: HRQOL, Psychological Aspects, Foot complications, Diabetic Neuropathic Foot.

depression is twice as likely to be linked to amputation.
"The presence of symptoms and/or evidence of
Additionally, it is linked to a two-fold rise in mortality
peripheral nerve damage in patients with diabetes
over five years among people with their first diabetic
following the exclusion of alternative causes" is the
foot ulcer (10). The present study aimed to evaluate the
definition of diabetic peripheral neuropathy. In the
impact of diabetic neuropathic foot complications on
USA, it is estimated that 28% of persons with diabetes
the psychological aspects of the patients, and compare
have peripheral neuropathy (1).
such findings to diabetics without neuropathic foot
A person with diabetes mellitus, whether they
have it now or have had it in the past, has diabetic foot

if there is infection, ulceration, or tissue deterioration in
their feet. It is typically accompanied by neuropathy
This was a cross-sectional comparative study that was
and/or PAD in the lower leg (2).
carried out on 186 patients divided into two groups;
Both the patient and the healthcare system are
Group 1: Diabetic patients with neuropathic foot
heavily burdened by diabetic foot disease. In 2035, it is
complications, and Group 2: Diabetic patients without
anticipated that over 600 million individuals globally
neuropathic foot complications.
would have diabetes (3). Diabetes-related foot ulcers
Selection of sample:
interfere with patients' daily lives, including changes in
Group 1: The group consisted of 93 Egyptian diabetic
sleep patterns, mobility issues, and problems with their
patients with neuropathic foot complications attending
sexuality as well as emotions of loneliness,
at diabetic foot clinic, Mansoura Specialized Hospital,
helplessness, worry, and melancholy (4). Additionally,
Mansoura University.
physically demanding regimens that use offloading
Group 2: The group consisted of 93 Egyptian diabetic
techniques for the lower limbs may lead to an increase
patients without neuropathic foot complications
in psychological stress (5). Compared to the general
attending at diabetic clinic, Mansoura Specialized
population, diabetic individuals are around twice as
Hospital, Mansoura University. They were selected to
likely to experience anxiety and sadness (6). On the other
be matched to the patient group as regards the age, sex
hand, depression is a significant risk factor for diabetic
and other demographic variables.
patients' hospital hospitalizations (7), and outpatient
Patients were recruited over 12 months, starting from
presentations with issues connected to their diabetes (8).
June 2020 to May 2021.
Depression and anxiety are more common in diabetic
Inclusion criteria: The study included Egyptian
foot patients than in diabetics without foot issues (9).
patients with the following criteria: (1) Age from 18 to
When compared to people without type 2 diabetes,
65 years. (2) Sex: both males and females.
Received: 09/06/2022
Accepted: 16/08/2022

Full Paper (vol.891 paper# 127)

c:\work\Jor\vol891_128 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4945- 4950

Sciatic Nerve Tumor: Malignant Peripheral Nerve Sheath Tumor: Case Report
Ahmed Salah Ezz Eldin, Mostafa Ahmady Elgendy, Abdulaziz Khalid Bakhaider*
Department of Orthopedic Surgery, Saudi German Hospital, Jeddah, Saudi Arabia
*Corresponding author: Abdulaziz Khalid Bakhaider, Mobile: +966546445674, E-mail: a.bakhaider92@gmail.com

Malignant peripheral nerve sheath tumour (MPNST) is rare. It is a type of peripheral nerve sheath tumour
that is cancerous (malignant). Most peripheral nerve sheath tumours are not cancerous (benign). A tumour is a lump or
growth in the body.
Objective: This paper reports a case of a malignant peripheral nerve sheath tumour revealed from the Magnetic
Resonance Imaging (MRI) examination and other processes, with remarkable unusual size of the tumour.
Case report:
A 36 years old male patient with a three months history of massive right-thigh medial side swelling came
to the clinic. The patient reported that he fell while walking before the beginning of the symptoms. He then visited the
clinic with medial side thigh pain, limping, and massive swelling in the medial side of his right thigh. The provider
recommended a triple assessment; 1- clinical, 2- laboratory, and 3- radiological. The clinical evaluation showed that the
swelling was about 20 cm x 10 cm diffuse fusiform swelling, with tense stretched skin over cystic to a firm consistency.
Conclusion: There is usually a poor MPNST prognosis, so the doctors must be sure about the diagnosis before treating
the condition. Typically, there are three ways to treat MPNST: surgery, chemotherapy and radiotherapy.
Keywords: Sciatic Nerve Tumor, Malignant Peripheral Nerve Sheath Tumor.

20 cm x 10 cm diffuse fusiform swelling, with tense

Malignant peripheral nerve sheath tumour
stretched skin over cystic to a firm consistency. In
(MPNST) is a cancer type that occurs in the lining of
addition, the results showed a non-mobile mass, mild
the nerves that spread out from the spinal cord into the
tenderness with pressure, and intact distal neurovascular
body. This type of cancer is a rare condition known as
status. Also, the results indicated a non-pulsatile mass
neurofibrosarcomas. Cancer can also occur anywhere in
and no other palpable mass. From the patient's report,
the body, but in most cases, it appears in the deep tissue
the clinician stated an adverse family history, no
of the legs, arms, and trunk. They cause weakness and
palpable lymph nodes, and no history of smoking or
pain in the affected area, and many also grow a mass or
exposure to radiation. Next, the laboratory procedure
a lump. Function loss mutations characterise MPNST
for basic tests, CBC, CRP, and ESR, was conducted.
occurrences to the tumour suppressor neurofibromin (1).
The third procedure followed with radiology included
The prognosis is usually poor with increased relapse
an ultrasound and X-ray (Figures 1 and 2), then,
rates and other multimodality therapy in early disease,
Magnetic Resonance Imaging (MRI) examination with
low propensity for rapid disease progression and high
contrast (Figures 3, 4 and 5), which showed a 20 cm
mortality and low response rates to cytotoxic
swelling on the medial side of the thigh with possible
chemotherapy for advanced disease (2).
sarcomatous changes.
This paper reports a patient case of a malignant

peripheral nerve sheath tumour revealed from the
Magnetic Resonance Imaging (MRI) examination and
other processes. MRI showed 20 cm of swelling on the
medial side thigh with possible sarcomatous changes.
The issue was then approached by a multidisciplinary
team consisting of a radiologist, histopathologist and
orthopedic surgeon. A surgery excision was then
completed, and the histopathological assessment
showed high-grade spindle cell sarcoma compatible
with high-grade malignant peripheral nerve sheath.


A 36 years old male patient with a three months
history of massive right-thigh medial side swelling
came to the clinic. The patient reported that he fell while
walking before the beginning of the symptoms. He then
visited the clinic with medial side thigh pain, limping,
and massive swelling in the medial side of his right

thigh. The provider recommended a triple assessment;

1- clinical, 2- laboratory, and 3- radiological. The
Figure (1): X-ray lateral view of the right femur
clinical evaluation showed that the swelling was about
showing no bone abnormalities
Received: 05/06/2022
Accepted: 10/08/2022

Full Paper (vol.891 paper# 128)

c:\work\Jor\vol891_129 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4951- 4957

Impact of Serum and Ascitic Fluid Procalcitonin on Diagnosis and
Outcome of Patients with Spontaneous Bacterial Peritonitis
Ahmed Saleh*¹, Ahmed Khafagy¹, Ahmed Shawki Hasan², Ayman Menessy¹, Salah Rozaik¹
Departments of 1Internal Medicine, Hepatology and Gastroenterology Unit and 2Clinical Pathology,
Haematology Unit, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Abdel Ghafar Saleh, Mobile: (+20)01003958489, E-mail: drahmedsaleh1981@gmail.com

Cirrhosis is the main cause of ascites, where it indicates poor prognosis with approximately 50% mortality
at 2 years. The risk is increased with other complications including spontaneous bacterial peritonitis (SBP).
Procalcitonin (PCT) is a significant marker for sepsis because its level is usually high in septic conditions but remains
low in nonspecific inflammatory diseases and viral infections.
Objective: To assess the impact of serum and ascitic fluid procalcitonin on diagnosis and optimization of antibiotic
therapy in SBP in cirrhotic patients.
Patients and Methods: 55 patients with liver cirrhosis and ascites, 25 of them suffered from SBP and the other 30
patients free from bacterial infection were enrolled in the study. All patients were subjected to full history, examination
and assessment for serum and ascitic fluid procalcitonin.
Results: The median age was 60.4±10.2 years in the SBP and 61.3±10.6 years in non SBP patients. There was no
statistically significant difference between non SBP and SBP groups regarding their age, sex and diabetes meelitus (DM)
frequency. Ascitic fluid culture was done to the SBP group where 3 cases were sensitive to ciprofloxacin, one case
sensitive to amikacin and 1 case sensitive to meropenem and one case sensitive to vancomycin. A statistically significant
higher median ascitic fluid and serum PCT was found among SBP than non SBP group. with every increase one unit
increases risk of SBP by 1.01 (Odds ratio= 1.01, 95% CI: 1.0 -1.01). The overall percent predicted was 87.3%.
Conclusion: PCT was significantly high in the serum and ascitic fluid of SBP patients with high specificity, sensitivity,
positive and negative predictive value. Ascitic fluid analysis with polymorphonuclear leukocyte (PMN) count remains
the standard key to diagnose SBP.
Keywords: Ascitic fluid, Spontaneous bacterial peritonitis, Procalcitonin.


viral infections, so serum PCT has a diagnostic role in
Cirrhosis is the main cause of ascites. Ascites
SBP and bacterial infections in advanced hepatic
disease. Recent studies proved that the level of PCT can
approximately 50% mortality at 2 years with increased
reflect hepatocytes damage and that hepatic disease
risk of other complications of hepatic disease including
severity can affect the diagnostic value of PCT in
spontaneous bacterial peritonitis (SBP), intractable
bacterial infection (6).
ascites, and hepatorenal syndrome (HRS) (1, 2).
PCT is considered as an early biomarker for
Bacterial infection is one of the most common and
diagnosis of bacterial infections in advanced hepatic
serious complications in decompensated cirrhotic
diseases, and is considered as a good indicator when
patients (DCPs) (3). Bacterial infections are considered
compared to C-reactive protein (CRP), tumor necrosis
the important cause of high mortality and morbidity in
factor (TNF) alpha or interleukins 6 and 2 (7). As serum
these cases. SBP is the most common form of infection
PCT levels increase earlier and normalize faster than
in DCPs which accounts for 40%­70% of patients. The
CRP, it has benefit of earlier diagnosis of disease, as
early diagnosis of infections improves the prognosis of
well as better follow up of the progression of the
patients. However, it is so difficult to diagnose SBP
disease. Rapid identification of infection has a major
early in DCPs because the clinical picture and ascitic
effect on course, management, and outcome of critically
biochemical characteristics are usually inconsistent.
ill intensive care unit (ICU) cases (8).
Last guidelines show that positive culture for a
The aim of the present study was to assess the
pathogen in ascitic fluid is the gold standard for SBP
impact of serum and ascitic fluid procalcitonin on
diagnosis. However, ascitic fluid cultures are negative
diagnosis and optimization of antibiotic therapy in SBP
in about 60% of cases with clinical picture suggestive
in cirrhotic patients.
of SBP and increased ascitic fluid polymorph (4).

Procalcitonin (PCT) is a 116 amino acids peptide
which is the precursor of calcitonin hormone that is
This study was a prospective analytical study, a
secreted by parafollicular cells (C cells) of the thyroid
sample size of 55 cases (which involved 25 diseased
gland, neuroendocrine cells of the lung, liver and
subjects with confirmed SBP) reaches 93% power to
intestine (5).
determine improvement in sensitivity from 0.5 to 0.82
PCT is considered as a significant marker for sepsis
via a two sided binomial test and 99% power to
because its level is usually high in septic conditions but
determine improvement in specificity from 0.5 to 0.86
remains low in nonspecific inflammatory diseases and
via a two-sided binomial test. The target significance
Received: 02/06/2022
Accepted: 09/08/2022

Full Paper (vol.891 paper# 129)

c:\work\Jor\vol891_130 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4958- 4966

Effect of Partial Versus Complete Annulo-Papillary Preservation During Mitral Valve
Replacement on Left Ventricular Geometry and Function Using CMR
Mostafa M. Abdalraouf*1, Mohamed Abdalraouf Khalil1, Ahmed Hussein Gafaar1,
Ahmed Ramadan2, Tamer Eid Fouda1, Noha Behairy2, Mohamed Abuldahab1
Departments of 1Cardiothoracic Surgery and 2Radiology, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Mostafa Mohammad Abdalraouf, Mobile: (+20)1003051304, E-Mail: mostafa.abdalraouf@gmail.com

Evaluation of left ventricular function after mitral valve surgery was always debated. Evolution of new
diagnostic techniques as cardiovascular magnetic resonance imaging (CMR) may help in discovering advantages or
disadvantages of different surgical techniques used during mitral valve surgery. Many comparative studies were done
depending on the traditional diagnostic methods as Echocardiography.
Objective: The aim of the current work was to assess the immediate and short-term effect of partial and complete
annulo-papillary preservation on left ventricular function and geometry, using CMR, in patients undergoing mitral valve
replacement for predominant mitral incompetence.
Patient and methods: Prospective randomized controlled trial study, on 32 patients with mitral valve disease and
predominant mitral regurgitation, mitral valve replacement was done. The study was done at different institutions (Kasr
AlAiny hospitals, Sheikh Zayed specialized Hospital), with the same group of surgeons, in the period between May
2015 and Feb 2017. All patients went through preoperative, operative& early postoperative evaluation.
Results: According to our knowledge this is the first study in Egypt to use CMR in evaluating the effect of mitral valve
replacement on cardiac function. Postoperative evaluation demonstrated a significant improvement in left ventricular
function and dimensions in both groups using echocardiography or CMR. The study failed to quantify significant
superiority of either technique in our selected patient groups. This was consistent with many trails done before using
echocardiography only.
Conclusion: CMR as an available investigation should be used in a larger scale specially in debatable conditions
regarding cardiac function and in tissue evaluation. Mitral valve repair is the gold standard whenever possible during
surgical management of mitral valve disease, but mitral replacement is a modality may be needed in many situations.
Every effort should be exerted to avoid complete separation of the annulo-papillary continuity during mitral valve
Keywords: CMR, Annulo-papillary, Mitral valve replacement, LV function, LV dimensions.


CMR is a highly reliable, well-validated
The advent of cardiopulmonary bypass in 1953
technique for measuring heart function and analyzing
opened the door for open cardiac surgery, but the first
the structural anatomy of the heart (6). CMR is superior
mitral valve replacement was not performed until 1959
to other frequently used imaging modalities such as 2D
by Nina Starr Braunwald, the first surgeon to perform
echocardiography and SPECT imaging in evaluating
Mitral valve replacement (1).
anatomical defects, e.g. LV aneurysms. Also, MRI is a
Despite the emphasis on mitral valve repair,
non-invasive technique without the use of radiation or
there are circumstances when a reliable, durable result
radioactivity. Moreover, reproducibility of the
cannot be achieved. Replacement therefore, remains a
technique is high allowing accurate detection of
necessary and viable modality (2).
changes in different parameters (7).
During Mitral valve replacement, the most
The aim of the current work was to assess the
important issue is to preserve the continuity of mitral
immediate and short-term effect of partial and
annulus, sub-valvular apparatus, and left ventricular
complete annulo-papillary preservation on left
chamber to maintain normal left ventricular geometry
ventricular function and geometry, Using
and reduce left ventricular impairment following mitral
Cardiovascular Magnetic resonance CMR, in patients
valve replacement. This target can be achieved using
undergoing mitral valve replacement for predominant
different techniques (3).
mitral incompetence.
This may involve preservation of the entire

leaflet tissue to the annulus using the valve sutures.
Alternatively, a portion of each leaflet is excised and
This prospective randomized controlled trial
then the remaining leaflet with the attached chordate is
study included a total of 32 patients with mitral valve
fixed to the annulus (4).
disease and predominant mitral regurgitation, attending
Assessment of left ventricular geometry by
at Kasr AlAiny hospitals and Sheikh Zayed specialized
Echocardiographic studies carry a higher rate of
Hospital for mitral valve replacement with the same
inaccurate values. Three-dimensional left ventricular
group of surgeons. This study was conducted between
geometric evaluation using CMR provides more
May 2015 and Feb 2017. All patients went through
accurate details about left ventricular geometry and
function (5).
Received: 02/06/2022
Accepted: 09/08/2022

Full Paper (vol.891 paper# 130)

Review of literature The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4967- 4969

Role of Insulin in Dermatology: Review Article
Howyda Mohamed Ibrahim, Eman Ahmed Mohamed Fahmy, Manal Mohamed Elsayed, Amal Elardi
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding Author: Eman Ahmed Mohamed Fahmy, E mail: eman33350@gmail.com
Mobile phone: 01118656571
Insulin exerts metabolic and growth-stimulating actions both through its own receptors and the receptors
of its homologous factors (IGFs), although with different degrees of affinity. The A receptor of insulin acts more
intensely on the cell membrane, with a metabolic response, whereas the B receptor is quickly internalized, stimulates
cell growth, can be directed to the treatment of wounds difficult to heal. The intraregional use of insulin ensures its
absorption, greater stability, longer activity period and absence of contact with necrotic or enzymatic materials capable
of preventing or changes its activity in topical use.
Objective: in this article, we aimed to study the role of insulin in dermatology and skin diseases.
Methods: We searched online databases (PubMed, Embase, and the Cochrane Library), to include studies that discuss
the role of insulin in skin diseases, all types of studies are included.
Conclusion: Insulin therapy has been shown to be effective and without adverse effects. Different intervals between
applications did not change the obtained results. The availability of insulin and the safety of its use indicate the authors'
method as an advantageous therapeutic option in the recovery of tissues. The availability, low cost and wide knowledge
available on this substance justify its indication as a therapeutic method for, are difficult to heal wounds.
Keywords: Insulin, Growth factor, Wounds and injuries, Difficult wound healing, Insulin therapy, Lichen planus, Oral


chemotactic protein-1, growth factor-, & other
Insulin is peptide hormone released by pancreatic
cytokines. These cells are involved in inflammatory
islets of Langerhans cells that preserves normal blood
response & in resolution of fibrin clots, angiogenesis, &
glucose levels by easing cellular glucose uptake,
re-epithelialization (9).
regulating carbohydrate, lipid, and protein metabolism,

and promoting cell division & growth via mitogenic
Types of topical insulin application
impacts (1). In 1921, Insulin was eventually isolated,
Topical insulin application for wound healing dates
purified, & became available therapeutically in
back to 1960s & 1970s. Application of topical insulin
effective way. Since Banting's discovery of insulin
to heal wounds declined next that time, however few
many benefits other than regulating blood glucose have
researches were conducted till late 1990s (6). Local
been documented (2).
injection, sprays, cream, & dressings have lately been
The effect of insulin on wound healing has been
used successfully to treat diabetic & non-diabetic
reported in various animal wound models, containing
wounds. Moreover, with advancement of more
fracture wounds, skin ulcers and incision wounds (3). In
advanced technologies for long-term release of
real, systemic insulin cure decreases infections
bioactive insulin, topical insulin has maintained its
following surgical procedures in diabetic studied cases
popularity (10).
& enhances pressure ulcer healing (4). This cure, even
Intralesional insulin solution
so, has disadvantage of causing hypoglycemia &
Normal saline & betadine were used to clean ulcers
hypokalemia. In diabetic and non-diabetic studied
& erosions. With insulin syringe and spray 0.5-1ml
cases, however, topical insulin enhances wound healing
insulin over each ulcer (11). Ulcers are then wrapped in
without affecting blood glucose levels (5). Earlier
sterile gauze. Blood sugar levels before & after
research found that insulin could decrease inflammation
treatment were tested. Everyday twelve hourly such two
& rise collagen deposition, resulting in faster burn
sittings were performed, whereas disease-specific
wound healing. Furthermore, intralesional injected
treatment remained unchanged (12).
insulin that disperses into wound can hasten wound re-
epithelialization (6).
Advantages of intralesional insulin

Biology of wound healing
epithelialization, & neovascularization, intralesional
Hemostasis, inflammation, proliferation, & remodeling
insulin usage can enhance wound closure, decrease
are all overlapping phases of wound healing.
wound healing time, & enhance wound remodeling (10).
Hemostasis is 1st stage of healing after injury (7).
There were no adverse systemic & local impacts
Raised capillary permeability & cell migration
reported (6).
to wound tissue characterize inflammation process.
Intralesional insulin in oral lichen planus (OLP)
Neutrophils are 1st cells to infiltrate injured tissue &
Although OLP is not hereditary disease, it is
reveal proteases to minimize denatured extracellular
believed to be linked to cell-mediated immunity.
matrix (8). Following that, since monocytes enter wound
Because OLP is thought to be T cell-mediated disease
site, they are changed into macrophages by monocyte
with Th1 cytokine imbalance, most therapeutic
Received: 29/5/2022
Accepted: 4/8/2022

Full Paper (vol.891 paper# 131)

c:\work\Jor\vol891_132 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4970- 4974
Benign Thyroid Nodule Management Using Radiofrequency Ablation
Hossam H. Farahat*1, Ihab M. Salem1, Ayman A. M. Nsrallah1, Sameh Saber 2, Mohamed G. Hamed1
1Internal Medicine & Endocrinology Department, Faculty of Medicine, Zagazig University, Egypt
2Interventional Radiology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hossam Hosny Farahat, Mobile: (+20) 01216251270, Email: thepoortoallah15@gmail.com

Thyroid nodule results in morbidity due to local compression or hyperthyroidism. There are several
methods available now, including Radiofrequency Ablation (RF), for image-guided ablation of benign thyroid nodule.
Objective: This study's goal is to assess how well RF ablation works for managing benign solitary thyroid nodule.
Patients and methods:
This study involved 40 participants from the internal medicine and endocrinology
department's outpatient clinic at Zagazig University Hospitals. All subjects with benign thyroid nodule received RF
ablation, and six-month follow-up were carried out. Results: Thyroid Imaging Reporting and Data Systems
(TIRADS) 2, TIRADS 3, and TIRADS 4 categories were present in 20%, 60%, and 20% of cases, respectively.
Regarding the initial assessment before RF; the mean values of TSH, T3 and T4 were 3.6 ± 0.87, 2.76 ± 0.39 and 1.07
± 0.23, respectively. The mean size of nodules was 9.51 ± 2.11. Concerning echogenicity, 53.3% of patients were
isoechoic.73.3% of patients had no calcifications; 80% had regular contour. Regarding the final assessment at 6 month
after RF; the mean values of TSH, T3 and T4 were 1.86 ± 0.43, 2.8 ± 0.41 and 1.11 ± 0.21, respectively. The mean
size of nodules was 2.3 ± 0.43. About 93.3 % of patients had no calcifications. All managed subjects with RF ablation
had 100 % regular contour with no halo. Conclusion: RF ablation is regarded as a successful technique for the
management of benign thyroid nodules.
Radiofrequency ablation, Thyroid nodules, Size of nodules.

minimal chance of long-term consequences, no
cervical scarring, and no loss of thyroid function(1).
Thyroid nodules are frequently discovered
Since its introduction in 2006, RF ablation of
incidentally in the general population. The majority of
thyroid nodules has been said to be both secure and
thyroid nodules are benign, and 10% of people who
successful in managing benign thyroid nodules and
have thyroid nodules when they first present are at risk
recurrent thyroid cancer (7). However, the effectiveness
of cancer (1). When using the ultrasound (US)
of RF ablation can also be diminished by perfusion-
evaluation, which is the first form of examination
mediated tissue cooling or (1) the heterogeneous
utilized for neck imaging, thyroid nodules are
structure of the target tissue in the presence of fibrosis
frequently found in the general population, primarily
or calcification by changing electrical and heat
as incidental discoveries, with a prevalence of 19­
conduction or (2) nearby blood flow (8).
68%(2).Thyroid follicular cells are the source of the
There have been several difficulties noted. An
majority of thyroid nodules. The most frequent mass
unfavourable occurrence that results from heat injury
lesions are benign follicular nodules, which can be
and/or compression from bleeding of the RLN or the
either solitary or part of a multinodular goiter(3).
vagus nerve is voice alteration(9). Burns to the skin,
The majority of patients are symptom-free. Pain,
discomfort at the surgery site, hypothyroidism, damage
dysphagia (difficulties swallowing), and globus feeling
to the brachial plexus, and nodule rupture brought on
(the sensation of a lump or foreign body in the throat)
by haemorrhage are other potential side effects. Horner
are all indications of a thyroid nodule or thyroid
Syndrome, damage to cranial nerve XI (spinal
enlargement (due to acute increase of nodule size, as in
accessory), lidocaine toxicity that manifests as
case of bleeding into the nodule). Depending on its
muscular twitching, seizures, and rarely confusion are
size and location, a thyroid nodule may or may not
examples of potential rare RF Ablation side effects (10).
cause symptoms. Particularly, a nodule that is larger
Therefore, the purpose of this study is to
than 3 cm in size and located close to the trachea is
evaluate the effectiveness of RF ablation to manage
more likely to cause a globus sensation (isthmic
benign solitary thyroid nodule.
nodules more than paraisthmic nodules)(4).Due to many

thyroid nodules' modest size, posterior placement
inside the gland, or consistency resembling the thyroid
This study involved 40 participants from the
gland, physical examinations are commonly normal (5).
outpatient clinic of the internal medicine and
There are currently a number of US-guided,
endocrinology department at Zagazig University
minimally invasive treatments (MIT) available for
Hospitals. All participants with a benign thyroid
nonsurgical management of thyroid lesions that are
nodule underwent RF ablation of the thyroid nodule
symptomatic or expanding (6). When compared to
and followed-up for 6 months.
surgery, these methods have a number of benefits. MIT

are inexpensive outpatient treatments with almost
Received: 06/06/2022
Accepted: 11/08/2022

Full Paper (vol.891 paper# 132)

c:\work\Jor\vol891_133 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4975- 4984

Detection of Bacterial Resistance Genes from Neonatal's Incubators
Environment at Selected Sites of Baghdad Hospitals

ind J. Al Obaidi *

and ada A. R. F. Al Easawi
Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq
*Corresponding author: Hind J. Al Obaidi E-mail: hind81jabbar@gmail.co ,
m mobile: +964771388985


Background: Nosocomial infections among neonates are responsible for 30­40% of death in resource constrained
Objective: This study aimed to detect isolated bacterial resistance genes and to assess chlorine gas values, which were
emitted during using Didecyl
dimethylammonium Chloride (DDAC) sterilizer in incubators of neonates at selected sites of Baghdad Hospitals.
Materials and Methods: Cl2 was detected by a portable sensor device, antibiotic susceptibility test was determined using
disc diffusion and detection of resistance genes by PCR technique.
Results: Presence of chlorine gas concentrations in the second and first sites during winter, which were higher than in
summer and concentrations were highly significant (P < 0.0001) in second site and significant (P < 0.05) in first site. Third
and fourth sites did not record any concentrations of chlorine. Pathogenic bacterial were isolated from these sites that
included Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus, Escherichia coli, Kleibsiella pneumonia,
Pseudomonas aurogenosa and Enterobacter.
Antibiotic susceptibility test was done using disc diffusion method, which
showed that all isolates were resistant to tested antibiotics specially to ampiclox and azithromycin (P <0.05). Detection of
resistance genes by PCR showed Gram negative isolate possess various percentages of genes including TEM (88.9%), OXA-
(77.8%), CTX-M (72.2%), SHV (66.7%) and Gram positive isolate possess blaz (100%). aacA and mecA1 had same
resistance genes prevalent (45.5%).
Conclusion: Using DDAC a sterilizer showed effectiveness in eliminating bacterial presence. Therefore, effective
disinfectants must be used to eliminate microbes.
Keywords: Neonatal incubator, chlorine, Nosocomial infection.

Pseudomonas species, Acinetobacter species, and
Early-onset infections (occurring in the first 72
Enterococcus species are among the clinically significant
hours of life), which are acquired at the moment of
possible pathogens (4).
delivery, are separated from late-onset infections
(occurring beyond 72 hours from birth), which are
cephalosporin, carbapenem, and fluoroquinolones has also
acquired at home or in a hospital. Cleaning is a crucial first
been significantly reported (5). Based on comparisons of
step in any disinfection process since it helps to get rid of
their amino acid sequences, the more than 350 different
pathogens or greatly reduce their load on contaminated
natural ESBL variants currently known have been divided
surfaces, however cleaning does not get rid of
into nine different structural and evolutionary families,
microorganisms (1).
including TEM, SHV, and CTX-M (6).
Alkyl dimethyl benzyl ammonium chloride
The antibiotic resistance genes mecA and aacA-D,
(ADBAC) and Didecyldimethylammonium Chloride
respectively, make the antibiotic groups methicillin,
(DDAC) are registered active ingredients as antimicrobial
aminoglycosides, tetracyclines, macrolide-lincosamide-
products with the US Environmental Protection Agency
streptogramin B, macrolides, lincosamides, and
(EPA) and other regulatory agencies around the world.
streptogramin A all are susceptible to resistance (7).
Based on currently available data from EPA regulations
Therefore, this study aimed to detect of bacterial
(40 CFR 158.2230), the main hazard associated with
resistance genes isolated from incubators environment of
DDAC and C12­C16 ADBAC is local effects through
neonates at selected sites of Baghdad hospitals.
irritation (2).

One of the most frequent occurrences in hospitalized
neonates is bacterial bloodstream infection, which is
The Field of study
primarily brought on by coagulase-negative staphylococci.
This study was performed at four pediatric hospitals
The most frequent species that result in bacterial
in Baghdad two in AL-Karkh and two in AL-Rusafa. The
contamination of neonatal incubators are S. aureus and S.
samples were collected in tow season summer (June and
saprophyticus (3). S. aureus, particularly methicillin-
July( and winter (December and January( for each
resistant S. aureus (MRSA), Kleibsiella species, E. coli,
pediatric neonatal hospital intensive care unit (NICU) the
Received: 6/6/2022
Accepted: 11/8/2022

Full Paper (vol.891 paper# 133)

c:\work\Jor\vol891_134 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4985- 4992

A Comparative Study between Stapled and Harmonic Hemorrhoidectomy for
Treatment of Third-and Fourth-Degree Piles
Eslam Fayz Tolba Nada*, Hany Mohamed, Hatem Mohammad, Elsayed I. Elhendawey
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Eslam F. Nada, Mobile: (+20) 01090879745, Email: islamfaiznada33@gmail.com

The best surgical method for hemorrhoidectomy is still unknown; hence innovative procedures like
harmonic scalpel hemorrhoidectomy and stapled hemorrhoidectomy need to be researched.
Objective: The aim of this work was the selection of best method of treatment of third and fourth degree primary
Patients and methods: The present clinical trial included 36 patients with the diagnosis of symptomatic 3rd and 4th
degree primary hemorrhoids, admitted to the Department of General Surgery, Zagazig University Hospitals for surgical
management. The patients were divided equally into Group 1 who underwent Stapled hemorrhoidopexy, and Group 2
who underwent harmonic scalpel hemorrhoidectomy. All patients in both groups were followed up weekly for the first
4 postoperative weeks. Postoperative pain, fecal incontinence, time of complete healing, and early recurrence were
Results: Postoperative pain was less in the Stapler group with significantly difference from the harmonic group. Fecal
incontinence was higher in harmonic group but with no statistically significant difference from Stapler group. Healing
and return work were significantly higher among Stapler group with no significant difference from harmonic group.
Regarding early recurrence, Stapler group had two cases, while harmonic group had only one case with no statistically
significant difference between both groups.
Conclusion: Stapled hemorrhoidopexy had better results than harmonic scalpel hemorrhoidectomy because it was
associated with less postoperative pain, less fecal incontinence and less incidence of wound complications.
Keywords: Scalpel Hemorrhoidectomy, Stapled hemorrhoidopexy, Fecal Incontinence, Wound Healing.


The symptomatic expansion and/or distal
displacement of anal cushions, which are prominences
The present clinical trial included 36 patients with
of the anal mucosa created by loose connective tissue,
the diagnosis of symptomatic 3rd and 4th degree
smooth muscle, artery, and venous vessels, is a fairly
primary hemorrhoids, admitted to the Department of
common anorectal illness known as haemorrhoids (1).
General Surgery, Zagazig University Hospitals for
Hemorrhoids typically manifest with painless
surgical management.
rectal bleeding with faeces, either with or without
The patients were divided into two groups, each
prolapsing anal tissue. Internal haemorrhoids, which
included 18 patients: Group 1 underwent Stapled
originate above the dentate line and are covered by anal
Hemorrhoidopexy, and Group 2 underwent harmonic
mucosa, external haemorrhoids, which originate below
scalpel hemorrhoidectomy. Randomization to each
the dentate line and are covered with anoderm, and
group was done by computer software.
mixed type haemorrhoids are the three main categories

Inclusion Criteria: All patients with symptomatic 3rd
Hemorrhoids can be divided into three categories:
and 4th degree primary haemorrhoids with age of >18
primary haemorrhoids, secondary haemorrhoids, and
years and <55 years old.
circumferential haemorrhoids, which are caused by a

variety of disorders, the most significant of which is
Exclusion Criteria: Patients with age <18 years and
anorectal cancer (3).
>55 years old. Contraindication to surgery such as
On the basis of how they appear and how much
bleeding tendency. Recurrent cases of piles. Cases of
they prolapse, internal haemorrhoids are graded further:
1st and 2nd degree piles. Coincident anal pathology e.g.
Hemorrhoids are classified into four grades: Grade I,
Perianal fistula. ASA (American Society of
which are non-prolapsing haemorrhoids, Grade II,
Anesthesiologists) III, IV and V.
which prolapsing haemorrhoids on straining but reduce
All patients had full history taken including name,
spontaneously, Grade III, which require manual
age, sex with emphasis on associated medical disorders
reduction, and Grade IV, which includes intensely
and previous surgical interventions. Careful general
thrombosed, imprisoned haemorrhoids (4).
examination carried out, together with local
Therefore, this study aimed to determine which
examination of the piles for its degree and associated
better procedure in treatment of third and fourth degree
pathology like rectal prolapse. Routine laboratory
primary piles, comparing the efficiency, short-term
investigations included CBC, liver function tests
results, and complications of stapled hemorrhoidopexy
(LFTs), kidney function tests (KFTs), random blood
and harmonic scalpel hemorrhoidectomy.
glucose level, coagulation profile, and hepatitis
Received: 07/06/2022
Accepted: 14/08/2022

Full Paper (vol.891 paper# 134)

c:\work\Jor\vol891_135 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4993- 4997

Evaluation of Early Results of Tibial Fractures Fixation in
Pediatrics by Flexible Intramedullary Nailing
Hossam Mohammed Khairy, Mohammed Abdel fatah Sabaei,
Ahmed Mohammed Abdel Wahab, Mina Latif Fathi *
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mina Latif Fathi, Mobile: (+20) 01273601467, E-Mail: nicefathi90@gmail.com

Tibial shaft fracture is an incapacitating pediatric injury. The treatment has traditionally been age-related,
influenced by the type of injury, associated injuries and the location and type of the fracture. To a great extent, treatment
options vary according to the surgeon's preference.
Objective: The aim of the present study was to evaluate the results of treatment of displaced diaphyseal fractures of
the tibia in children aged between5 and 15 years by closed reduction and percutaneous flexible intramedullary nailing.
Patients and methods:
A total of 18 patients were included in the study; they were admitted to the hospital suffering
from tibial shaft fractures. On admission all patients were assessed by history taking, clinical examination and
radiological evaluation. Results: The mean age was 10.22 (SD 1.99) years. Only 5 (27.8%) patients were girls, while
13 (72.2%) patients were boys. The mechanism of trauma in the patients was road traffic accidents in 15 (83.3%)
patients and falling from height in 3 (16.7%) patients. Radiographic angulation occurred in 1 patient had varus
malalignment (more than 5 and less than 10°). Limb- length inequality is less than 1 cm in all cases. The final results
obtained were excellent in 15 (83.3%) patients and satisfactory in 3 (16.7%) patients. There was no statistically
significant difference found between two reduction methods (opened and closed) regarding malalignment,
complications and score flynn.
Flexible intramedullary nailing is a relatively simple and effective way to stabilize open and closed
fractures of diaphyseal tibial fractures in the six to twelve years age group with few complications, allowing early
mobilization and excellent functional outcome. The procedure has low morbidity and good results with short
Keywords: Tibial Fractures Fixation, Pediatrics, Flexible Intramedullary Nailing, Limb- length inequality.


Tibial fractures in the skeletally immature patient
skeletally immature pediatric patient with an unstable
are frequent and can usually be treated without surgery
fracture of the tibial diaphysis, it is concluded that the
by closed reduction and casting during 6 or 8 weeks (1).
vast majority of pediatric tibial fractures can be
External fixation, although producing acceptable
successfully treated conservatively with immobilization
results, is fraught with many complications as is plate
in a cast. Unstable or open fractures, polytrauma and
osteosynthesis and rigid intramedullary nailing which
neurovascular compromise may each necessitate a
may also require a second major surgery for removal of
surgical procedure. Elastic stable intramedullary nailing
implant (2).
provides an acceptable option where surgery is
Flexible intramedullary nailing is commonly used
unavoidable (5).
in femoral shaft fractures, but much less so for tibial
Griffet et al. assessed the use of flexible
fractures. This technique has many advantages.
intramedullary nailing with flexible nails to treat
Namely, it does not require a postoperative cast; there
displaced tibial fractures in children over 6 years old.
is primary bone union with avoidance of growth plate
They concluded that fixation of pediatric diaphyseal
injury, early weight bearing, and minimally invasive
tibial fractures with flexible intramedullary nailing is a
surgery with a short duration of hospitalization. The
rapid, well-codified and effective method for treating
good results of flexible intramedullary nailing in femur
long-bone closed fractures in children. Advantages over
and forearm fractures justify the use of this technique to
other fixation techniques include a lower infection rate,
treat tibial shaft fractures (3).
a lower refracture rate, ease of management, and an
Multiple studies reported good results using
aesthetically pleasing scar(6).
flexible titanium nails in the treatment of unstable
The aim of this study was to evaluate the results
fractures of the tibia in children. They concluded that
of treatment of displaced diaphyseal fractures of the
flexible intramedullary nailing is a relatively simple and
tibia in children aged between5 and 15 years by closed
effective way to stabilize open and closed fractures of
reduction and percutaneous flexible intramedullary
the tibia in children with few complications, allowing
early mobilization and an excellent functional outcome

Reviewed the currently available evidence for the
The study included 18 patients presented at Zagazig
use of Elastic Stable Intramedullary Nails (ESIN) in the
University Hospital and Nasser Institute Hospital,
Received: 07/06/2022
Accepted: 14/8/2022

Full Paper (vol.891 paper# 135)

c:\work\Jor\vol891_136 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 4998- 5002

Management of Post-Bariatric Gynecomastia in Zagazig University Hospitals
Tarek Ezzat Abd Ellatef1, Mohammed Salah Awad1, Mohammed Ali Nasr2,
Amr AbdElshafy Ibrahim*1
Departments of 1General Surgery and 2Plastic and Reconstructive Surgery,
Zagazig University Hospitals, Zagazig, Egypt
*Corresponding author: Amr AbdElshafy Ibrahim, Mobile: (+20) 01003404772, E-Mail: amrabdelshafy887@yahoo.com

Plastic surgery role in correction of post-bariatric gynecomastia is clinically called reduction
mammoplasty by reducing breast size, flattening and enhancing the chest contours.
This study aimed to assess the aesthetic outcome of management of post-bariatric gynecomastia in Zagazig
University Hospitals.
Patients and methods:
Randomized-controlled clinical trial study was carried out in Plastic & Reconstructive Surgery
Department, Zagazig University Hospitals during the period from February 2018 to February 2020. It included 30
patients with post-bariatric gynecomastia. Patients included in the study was divided into two groups: Group A that
included 15 patients who underwent postero-inferior pedicle surgical technique, and group B, which included 15 patients
who underwent circum-areolar reduction surgical technique (Doughnut Technique).
In group (A), there was no residual skin redundancy in all cases of that group. Nipple necrosis was found in
two (2) cases, and the rest was intact. Four (4) cases were presented by a defective scar and eleven (11) cases had no
defective scar. Hematoma was found in only one (1) case. In group (B) that was corrected with circum-areolar reduction
surgical technique, there were five (5) cases with nipple in-sensitivity, and ten (10) cases with intact nipple sensation.
Four (4) cases with no nipple projection, and eleven (11) cases with normal nipple projection. Residual skin redundancy
was complicated in eleven (11) cases, and four (4) cases with no skin redundancy.
Conclusion: The postero-inferior pedicle technique gave better results than the circum-areolar reduction surgical
technique especially in grade IV post-bariatric gynecomastia.
Keywords: Plastic surgery, Post-bariatric, Gynecomastia.

and the beta cells of the pancreas (4). This ectopic fat
Gynecomastia is a unilateral or bilateral
deposition may seriously affect the functions of these
mammary gland enlargement in men that is benign and
organs and contribute to the pathogenesis of obesity-
related conditions for example, insulin resistance
pseudogynecomastia, which refers to subareolar fat
diabetes, steatohepatitis and cardiovascular disease (5).
accumulation without gland involvement (1).
In addition to its storage function, fat tissue also has
Fat tissue plays a key role in the development of
endocrine, paracrine and autocrine activities.
obesity and metabolic complications, functioning both
Adipocytes secrete different peptides that control a wide
as energy store and major endocrine organ. The
range of functions including whole-body energy
adipocyte is the principle cell type in adipose tissue, but
balance, inflammation, insulin sensitivity, blood
the tissue is also comprised of adipocyte precursor cells,
pressure regulation, angiogenesis and cell development
stromal-vascular cells, immune cells, and nerve cells (2).
(6). A lean adult has about 35 billion adipocytes and each
In mammals, two types of fat tissues are
adipocyte contains about 0.4 to 0.6 ug of triglyceride;
available: White fat tissue, which mainly serves as
an extremely obese adult can have 4 times as many
energy storing tissue, and brown fat tissue, which is
adipocytes (125 billion), each containing twice as much
mainly a thermogenic tissue. White adipocytes are
lipid (0.8 to 1.2 u g of triglyceride)(7).
characterized by a large lipid droplet that occupies the
With increasing obesity between population
major part of the cytoplasmic space, while brown
augment the problem of gynecomastia between males
adipocytes contain numerous and relatively smaller
reflecting the psychological aspect and embarrassment.
lipid droplets and a large number of mitochondria (3).
So, solving this problem by modern trends of bariatric
The function of the white adipocyte is to store
surgery for weight reduction augment gynecomastia
excess energy and to provide other tissues with energy
problem and increase the demand for correctional
during periods of negative energy balance, by
surgery (8-9).
discharging unsaturated fats and glycerol from lipolysis
The aim of the treatment was to restore a
of triglycerides stored in the adipocyte droplet. The
masculine chest by resecting breast tissue and excess
storage function of fat tissue appears to be an important
skin, reducing and adequately replacing the nipple-
factor in obesity-related metabolic disorders. When the
areola complex and removing the sub-mammary fold
storing capacity of the fat tissue is exceeded or when the
with minimal scar-ring to the chest (10). The aim of the
fat tissue is not functioning properly, fatty acids
current study was to assess the aesthetic outcome of
increase in the circulation and triglycerides accumulate
management of post-bariatric gynecomastia in Zagazig
in different organs, for example, liver, muscle, heart,
University Hospitals.
Received: 8/6/2022
Accepted: 15/8/2022

Full Paper (vol.891 paper# 136)

c:\work\Jor\vol891_137 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5003- 5008

Predictors and Outcomes of No Reflow Phenomenon Post-Primary
Coronary Intervention in Young Patient
Marwa Mohamed Gad, Laila Mohamad Elmaghawry, Mohammed Alzarouq Alfathi*, Moataz Elsanan
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohammed Alzarouq Alfathi, Mobile: (+20) 01012517630 E-mail: malfthy@gmail.com

Acute treatment of ST elevation myocardial infarction (STEMI) is restoration of myocardial perfusion
by recanalization of the occluded vessel. Objective: The aim of the present study is to detect no reflow post primary
percutaneous coronary intervention (PCI) in young STEMI patients and to correlate clinical, electrocardiogram,
angiographic and procedural variables with no reflow.
Patients and methods: This Cohort study was conducted in the Cardiology Department, Faculty of Medicine, Zagazig
University on 106 young patients with acute myocardial infarction treated with PPCI during the period from January
2021 to April 2022. The patients were divided into 2 groups according to myocardial blush; Group (I) which included
80 patients with normal flow, and Group (II) which included 26 patients with No reflow.
Results: We found that No significant difference between the 2 studied groups regarding Initial Thrombolysis in
Myocardial Infarction (TIMI) flow 0 or 1. The admission EF was significantly lower among the No Reflow Group and
the no reflow group significantly associated with major adverse cardiovascular events (MACE), mortality, smoking,
low EF and anterior wall myocardial infarction (AWMI) were independent predictors for no reflow.
Conclusions: No reflow in young patient with STEMI could be attributed to novel predictors such as Smoking, low EF
and AWMI. This phenomenon was associated with MACE and higher mortality.
Keywords: STEMI, Anterior wall myocardial infarction Percutaneous Coronary Intervention, major adverse
cardiovascular events, No reflow phenomenon.


Knowing the predictors or risk factors of no reflow can
Primary percutaneous coronary intervention (PPCI)
help prevent this dreaded complication of PPCI (8).
has been established as the most effective management
In the present study, we aimed to detect no reflow post
strategy to restore antegrade blood flow in ST-elevation
primary PCI in young STEMI patients and to correlate
myocardial infarction (STEMI) (1).
clinical, ECG, angiographic, procedural variables and
The no reflow phenomenon is defined as inadequate
with no reflow.
myocardial perfusion passing through a given segment

of coronary circulation with no angiographic evidence
of mechanical vessel obstruction (2).
This Cohort study was conducted in the Cardiology
The no reflow phenomenon occurs in a considerable
Department, Faculty of Medicine, Zagazig University
number of patients with acute STEMI (25%)
on 106 young patients with acute myocardial infarction
treated with PPCI during the period from January 2021
Experimental and clinical studies have shown that the
to April 2022. The patients were divided into 2 groups
no reflow phenomenon is associated with large
according to myocardial blush; Group (I) which
myocardial necrosis and high mortality (4).
included 80 patients with normal flow, and Group (II)
Suggested mechanisms for no reflow or slow flow
which included 26 patients with No reflow.
include coronary microcirculation disturbances, such as
Inclusion criteria: Consecutive patients with acute
distal embolization of thrombus and plaque debris,
myocardial infarction who had undergone PPCI were
microvascular damage, and reperfusion injury (5).
included in the study, after giving informed consent.
No reflow is associated with larger infarct size,

lower left ventricular ejection fraction (LVEF), adverse
Exclusion criteria:
left ventricular remodeling in the late phase of
Rescue PCI. MI Patient with cardiogenic shock.
myocardial infarction (MI), and increased risk of heart
Patients with coronary dissection (whether spontaneous
failure, risk of cardiac rupture, and risk of death (6). Both
or procedure-related). Patients in whom no stenting will
short term and long term prognosis of no reflow are poor
be done for various reasons such as unsuitable anatomy
in humans. Malignant arrhythmias, pump failure,
or insignificant lesions in coronary angiogram or high
cardiac rupture and re-infarction are potential
thrombus burden. Previous revascularization.
complications of no reflow during the immediate in-
Diagnosis of no reflow was defined as post PPCI
hospital course (7).
Myocardial blush grade (MBG) <2 infarct related
A number of clinical, serologic, and angiographic
parameters have been shown to be associated with no
All patients in the study were subjected to full
reflow (2). In addition, a number of treatment strategies
history taking and full clinical examination. Severity of
have been tried with variable results in no reflow.
heart failure was assessed according to the Killip
classification. Twelve-lead ECGs (recorded at 25 mm/s
Received: 07/96/2022
Accepted: 14/8/2022

Full Paper (vol.891 paper# 137)

c:\work\Jor\vol891_138 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5009- 5016

Assessment of Left Ventricular Function by Global Longitudinal Strain in
Patients Recovered from Covid -19
El-Sayed Mohamed Farag, Ahmad Mohamed Elzayat , Ayiman Ali Akhlleefah,
Samaa Nabil Hassan, Mohamed Saad El-Shetry
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ayiman Ali Akhlleefah, Mobile: (+20) 01140584079, E-mail: emanmesmary19@gmail.com

Patients with COVID-19 infection may have an additional marker of outcomes with left ventricular (LV)
strain evaluation by transthoracic echocardiography (TTE).
Objective: This study aimed to use two-dimensional (2D) speckle-tracking echocardiography to evaluate left ventricular
(LV) global longitudinal strain (GLS) in order to identify subclinical cardiac impairment among recovered cases from
Covid-19 infection.
Patients and methods: A case-control study in the isolation Hospital, Zagazig University in the duration from October
2021 to March 2022. We included 110 patients that were categorized in 2 groups according to clinical, radiological,
laboratory and echocardiographic parameters: Group I: included patients recovered from Covid-19 (Study group).
Group II: Non-Covid patients (Control group). This group included healthy subjects who have not encountered Covid-
19 infection. Results: When comparing both groups, significant differences were found regarding echocardiographic
data using speckle tracking. LVGLS was significantly decreased in cases compared to controls (19.18 ± 2.76 vs 21.58
± 1.35, P<0.001), AP2GLS (18.90 ± 2.47 vs 21.58 ± 1.35, P<0.001), AP3GLS (20.28 ± 2.98 vs 21.94 ± 3.13, P = 0.005).
A statistically difference existed between the two groups with respect to GLS, with all controls having a GLS value
greater than -18 and 27.35% of cases had decreased GLS < -18%.
Conclusion: As a primary method, it's nearly as secure as the more traditional median sternotomy for mitral valve
repair. Excellent cosmetic outcomes can be achieved without the need for additional groin incisions and the risks
associated with them.
Keywords: Left ventricular function, Global longitudinal strain, Covid -19 infection.


clarifying the specific roles of these pathogens in
Since December 2019, when it was first detected,
myocardial strain (5).
the 2019 coronavirus illness (COVID-19) has killed
Transthoracic echocardiography (TTE) evaluation
more than 1.9 million people around the world.
of left ventricular strain is a useful supplemental marker
Although our collective knowledge of COVID-19
of outcomes in individuals with COVID-19 infection.
illness pathogenesis, progression, and treatment has
Echocardiography using a method called strain by
been expanding, it is still inadequate. An increase in
speckle tracking makes use of 2-dimensional grey scale
mortality has been linked to heart damage caused by
pictures to assess global and localized left ventricular
COVID-19 infection (1). Acute respiratory distress
function. Systolic function can be evaluated using peak
syndrome, the respiratory system is the most heavily
global longitudinal strain (GLS) (6).
affected by SARS-CoV-2 (the agent of COVID-19), but
Abnormal global longitudinal strain (GLS) in the
other organs, notably the cardiovascular system, play
left ventricle (LV) may indicate subclinical
important roles in the development of the disease (2).
involvement of heart among COVID-19 cases. Long-
Eighteen to twenty-eight percent of patients with
term predictive usefulness of LV-GLS has been
COVID-19 have been documented to experience acute
demonstrated across a variety of cardiac diseases,
cardiac damage, as characterized by increased high-
involving valvular disease as well as heart failure,
sensitivity cardiac troponin-I levels, which are
suggesting that it is a precise measure of dysfunction of
associated with poorer clinical outcomes. Subclinical
left ventricle. In addition, there is mounting proof that
myocardial dysfunction has been shown to affect
aberrant LV-GLS can detect myocardial damage before
outcomes in COVID-19 patients, although our
a decrease in LV ejection fraction occurs (EF). Given
knowledge of this phenomenon is still restricted. Two-
the lack of information about the long-term effects of
dimensional (2D) speckle-tracking strain measurement
COVID-19, it is essential to quickly identify individuals
by transthoracic echocardiography is a predictor of
who may be at increased risk (3).
cardiovascular events that can be detected before they
Moreover, in post hoc analysis, GLS had higher
become clinically apparent (3).
intra- and inter-observer repeatability than LVEF. In
Monitoring cardiotoxic effects of chemotherapy
addition, GLS analysis is feasible in the vast majority of
and predicting morbidity and mortality in heart failure
patients, and GLS measurements can be made just as
have both made use of LV strain assessment (4). Acute
quickly as LVEF measurements (7).
myocardial injury has been linked to respiratory viral
This study goal was evaluation of left ventricular
illnesses like influenza and acute respiratory distress
(LV) global longitudinal strain (GLS) by using two-
syndrome (ARDS), but there is a severe dearth of data
dimensional (2D) speckle-tracking echocardiography in
Received: 08/06/2022
Accepted: 15/08/2022

Full Paper (vol.891 paper# 138)

Original Article The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5017- 5022
Iron Deficiency in Children with Cyanotic and Noncyanotic Congenital Heart Disease
Eman Mahmoud Mohammed Elmoghazy, Mohammed Osman Hafez Ibrahim,
Sulayman Nasr Ali Abdulnabi*, Nagwa Mohammed Shawky
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Sulayman Nasr Ali Abdulnabi, Mobile: (+20)01556599501, E-mail: solomovitch311@gmail.com

Cyanotic congenital heart disease (CCHD) predisposes patients to iron deficiency due to compensatory
secondary erythrocytosis. Objective: This study aimed to assess the prevalence of iron deficiency among infants and
children having cyanotic and non-cyanotic congenital heart disease.
Patients and methods: This was a case-control study enrolled 30 children with congenital heart disease whether
cyanotic or non-cyanotic at the Department of Pediatrics and Intensive Care Cardiology Unit, Faculty of Medicine at
Zagazig University Pediatrics Hospital. They divided into 15 cyanotic and 15 non-cyanotic congenital heart disease.
In addition, 15 healthy age- and sex-matched children were included as a control group ranged from 1 to 5 years ago.
Children were investigated by doing complete blood count, pulse oximetry, erythrocyte indices and iron profile, based
on the transferrin saturation.
Results: Iron deficiency anemia was found among 7 (53.3%) patients with CCHD, 2 (13.3%) patients with non-
cyanotic congenital heart disease and 5 (33.3%) healthy children. There was no statistically difference between
CCHD children, non-cyanotic congenital heart disease children and normal healthy children.
: Iron deficiency anemia remains a very common health problem and leads to high morbidity and
mortality rates among children with congenital heart disease.
Keywords: Congenital heart disease, Iron deficiency anemia, CCHD, Heart Disease.


Structures of the heart or intrathoracic great
thromboembolic events in the children with CCHD (6).
vessels that are aberrant during foetal development are
CCHD is usually isolated and sporadic, but it can
referred to as congenital heart disease (CHD). The
also be associated with genetic syndromes.
most prevalent birth defect and the main factor in the
Approximately 15% to 20% of infants with CCHD are
death of children with congenital abnormalities is
related to known chromosomal abnormalities.
CHD (1). Noncyanotic CHD and cyanotic CHD,
Globally, an estimate of 8 defects per 1000 live births
commonly known as critical congenital heart disease
is reported (7,8).
are two subtypes of CHD (2).
CCHD predisposes patients to iron deficiency
There are many types of congenital heart defects.
due to compensatory secondary erythrocytosis (9). The
If the defect lowers the amount of oxygen in the body,
presence of iron deficiency anemia (IDA) in these
it is called cyanotic. If the defect doesn't affect oxygen
children further increases their chances of morbidity
in the body, it is called acyanotic (1).
in the form of cerebrovascular events and cyanotic
In recent literature, critical congenital heart
spells (10). However, the clinical detection of anemia
disease can be further classified into 3 different types
based on pallor is hampered by the occurrence of
of lesions: right heart obstructive lesions, left heart
hypoxia-induced polycythaemia in CCHD (11).
obstructive lesions, and mixing lesions (3,4).
Laboratory tests and periodic screening are therefore
Acyanotic congenital heart diseases or left-to-
mandatory for diagnosis (12).
right shunting lesions are the most common form of
This study aimed to assess the prevalence of iron
congenital heart disease. Although most resolve
deficiency among infants and children having cyanotic
spontaneously, many will remain hemodynamically
and non-cyanotic congenital heart disease.
significant, particularly in the premature infant.

Understanding the difference in pathophysiology,
diagnosis, and management between the term and
This was a case-control study which was conducted
preterm infant is imperative to minimize the risk of
at the Department of Pediatrics and Intensive Care
secondary organ dysfunction and ensure proper
Cardiology Unit, Faculty of Medicine at Zagazig
growth and development (5).
University Pediatrics Hospital from June to November
Cyanotic congenital heart disease (CCHD) is
2021. The study included 30 children divided into 15
congenital heart also defect with right to left shunting
cyanotic and 15 non-cyanotic congenital heart disease.
of desaturated blood. This results in decreased oxygen
In addition, 15 healthy age- and sex-matched children
saturation in the systemic circulation which acts as a
were included as a control group.
trigger for increase in erythropoietin production and
Inclusion Criteria were: Age range 1 - 5 years. Both
secondary erythropoiesis in an effort to maintain
male and female. Children with CHD whether
tissue oxygenation (2). The resultant polycythemia and
cyanotic or non-cyanotic.

Received: 07/06/2022
Accepted: 14/08/2022

Full Paper (vol.891 paper# 139)

c:\work\Jor\vol891_140 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5023- 5027

The Safety of Selective Episiotomy Compared to Routine Episiotomy During
Vaginal Birth in Primigravida in Cairo University Hospitals
Adel Atef *, Taher Abd-Elazeem Fahmy, Ismail Ibrahim Abu-Elfotouh, Mohamed Mahmoud Mohamed Kotb1
Department of Obstetrics and Gynecology, Faculty of Medicine,
Cairo University, Kasr Alainy Street, Cairo 11562, Egypt
Corresponding author: Adel Atef, Email: dr.adel90@cu.edu.eg, Telephone:01115241250, ORCID:0000-0002-5220-5302

: Episiotomy is a surgical procedure that can result in postpartum hemorrhage, perineal pain, and
dyspareunia. Moreover, episiotomy is not totally protective against severe perineal lacerations or maternal and neonatal
morbidity; thus, its benefit in reducing the occurrence of severe perineal tears has to be investigated.
We aimed to assess the pros and cons of a policy of selective episiotomy (only if needed) compared with a
policy of routine episiotomy (part of routine management) for vaginal births.
: Nulliparous women in the active phase of labor with gestational age 37-41 and a single viable fetus with
vertex presentation attending the Obstetrics and Gynecology Emergency Department, Kasr Al Aini Cairo University
Hospital were included. One hundred and twenty laboring women were divided into 2 groups. Group A: Conducting
routine episiotomy and Group B: Conducting selective episiotomy.
There was no significant difference between the groups regarding the incidence of perineal tears and obstetrical
anal sphincter injuries (OASIS).
Conclusion: In comparison to conventional episiotomy, selective episiotomy is equally risky for severe perineal/vaginal
trauma. In Egypt, obstetric and tertiary care establishments may recommend selective episiotomy. Regarding the volume
of intrapartum blood loss, selective episiotomy is superior to routine episiotomy.
Keywords: Episiotomy, Labor, Perineal Tear, Postpartum Hemorrhage, Obstetrics


sphincter injury (OASIS), affects between 0.8 and 5.9
The most frequent obstetric procedure is
percent of women who give birth vaginally (7).
episiotomy (1).
Episiotomy rates in different departments should
Episiotomies come in at least three different
be approximately 10%, as per the World Health
varieties (midline, mediolateral, and lateral) and have
Organization, which is now the case in many European
numerous causes (2). In circumstances of impending fetal
nations. When determining whether the operation is
distress, an episiotomy may be performed to hasten the
needed, obstetricians should be encouraged to apply
second stage of labor for the benefit of the fetus. The
their clinical judgment. Episiotomy is not yet
reasons for conducting an episiotomy for the mother
recognized to be necessary in any circumstance in
include preventing anal sphincter lacerations, protecting
obstetric practice because there are no clinical data
the vagina, and relaxing the pelvic floor (3).
supporting its justification (8).
Primiparous women are thought to require
The ability of episiotomy to prevent or reduce
episiotomies more frequently than multiparous women
the occurrence of severe perineal tears has generated
do, and aided vaginal births are linked to more
debate (9).
episiotomies than natural births (4).
Episiotomy was a common obstetric procedure
An episiotomy may deepen and become one of
in the 1990s and was carried out in approximately half
the following types of tears (5):
of vaginal deliveries in high-income nations (10). Since
1- Only tears involving vaginal mucosa or perineal skin.
then, strong data have demonstrated that a routine
2 -
Tears involving muscles of the perineum.
episiotomy policy was not relevant, was not protective
3 -Involvement of anal sphincters, that is furtherly
against severe perineal tears or maternal and newborn
divided into:
morbidity and was not superior to a selected policy (11).
3a. < 50% involvement of the external anal sphincter.
Episiotomy may also be linked to sexual dysfunction,
3b. > 50% involvement of the external anal sphincter.
perineal discomfort, and postpartum hemorrhage (12).
3C. Involvement of internal anal sphincter.
As a result, the use of episiotomies has reduced
4 -
Extension of tears through the anal epithelium.
globally, and a restrictive approach has been pushed.

However, selective episiotomy is still not widely
According to estimates, 35% to 75% of women
practiced in our hospital. Therefore, we aimed to assess
who give birth vaginally will experience a perineal tear
the effects of a policy of selective episiotomy (only if
(6). The importance of these perineum rips varies on their
needed) compared with a policy of routine episiotomy
severity. They may have short-, medium-, or long-term
(part of routine management) for vaginal births on
effects. The most severe type, known as obstetrical anal
mothers and babies.

Received: 07/06/2022
Accepted: 14/08/2022

Full Paper (vol.891 paper# 140)

c:\work\Jor\vol891_141 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5028- 5039

The Potential Histological Effect of Experimental Obesity on The Liver of
Male Albino Rats (Light and Electron Microscopic Study)
Ahmad Mohmmad Abdel-Aleem Desoky
Histology Department - Faculty of Medicine - Al-Azhar University - Assiut - Egypt
E mail: dr.ahmad.abdel.aleem@azhar.edu.eg Tel: Tel: 002 01155988640,
Orcid no.: 0000-0001-8543-7102
There is a growing global awareness to the hazards of obesity. The obese patients are much more liable to
many serious diseases including liver failure.
The aim of work: was to study light and electron microscopic changes of the liver, as well as, the liver enzymes in the
experimentally obese albino rats.
Methodology: Sixty male albino rats were divided to 3 groups: 1- control group: was fed standard laboratory diet for 4
weeks. 2- Obese group: were given one intraperitoneal injection of Triton WR 1339 to induce obesity and fed normal
laboratory diet for 4 weeks. 3- Recovery group: similar to obese group but left for additional 4 weeks for recovery. The
weights of animals were recorded, blood samples were collected for liver enzymes (ALT, AST and GGT) and the livers
were weighted. Liver samples were fixed in glutaraldehyde for EM examination; and other samples were fixed in 10%
formol saline then stained by H&E, Mallory trichrome and PAS stains for LM examination.
Results: Obese animals had significantly higher body weights, liver weights, and liver enzymes than the control group.
Histologically, there was a non-significant increase in the collagen area of obese group. There was a highly significant
reduction in the optical density of glycogen in the obese group. However, the optical density in the recovery group was
lower than that of control group. Conclusion: obesity may induce several abnormal changes in the hepatocytes, and
inflammation similar to steatosis or steatohepatitis.
Keywords: liver - triton - obese ­ Obesity - albino rats.


experimental procedures were carried out according to
Obesity is a global disorder that impacts both
the principles and guidelines of Ethics Committee
developed and developing countries; it represents
of Faculty of Science at Al-Azhar University ­ Cairo,
the world's second reason for preventable death (1).
Egypt, and according to "Guide for care, and use of
According to the WHO, obesity has nearly tripled since
experimental laboratory animals" issued by US National
1975; in 2016 over 650 million adults were obese,
Institute of Health for use and welfare of experimental
counting approximately 13% of the total population.
animals (7).
Additionally, 39 million children under five years were
In this study, sixty male albino rats weighing 120
overweight or obese worldwide in 2020 (2). High-fat
± 5 grams and ranging from 4-5 weeks in age were
and high-cholesterol diets cause increased cholesterol and
used. Rats were housed in 6 clean metallic cages
triglycerides in blood, both of which cause oxidative
with metallic mish cover that measured
stress which is a major factor in the development of
120 X 60 X 60 cm containing ten rats in each
nonalcoholic fatty liver disease (3). Today, oxidative stress
cage. Animals were fed standard laboratory diet with
is one of the major health threats; it became the medical
plenty of water to ensure normal growth. All animals were
and nutritional puzzle for the twenty first century (4). Non-
housed for 1 week prior to our study for acclimatization
alcoholic fatty liver disease, being the most common liver
with the current conditions. Every week, the weight
disorder worldwide, is affected by obesity. Its prevalence
of animals was recorded. The 60 male albino rats were
ranges from seventy to ninety percent (5). It is
divided into 3 groups, each group consisted of
characterized by triacylglycerol accumulation inside liver
twenty rats, as follows:
cells. It can progress to more dangerous conditions, such
Group I (Control group): twenty rats were fed standard
as non-alcoholic steatohepatitis, liver fibrosis and liver
laboratory diet for four weeks before being sacrificed.
cirrhosis, and in rare cases, liver carcinoma (6). This work
This group served as a negative control.
was performed to study the light and electron microscopic
Group II (Obese group): Twenty rats were
changes, as well as enzymatic changes in the liver caused
given intraperitoneal injection of Triton 250 mg/kg to
by Triton-induced obesity in male albino rats as a model
induce obesity (8) then fed normal laboratory diet for 4
of experimental obesity.
weeks before being sacrificed. This group served as a

positive control.
Group III (Recovery group): twenty rats were treated as
This research was carried out at Al-Azhar
group II but were left for additional 4 weeks (to allow for
University's Faculty of Science in Cairo, Egypt. All
spontaneous recovery) before being sacrificed.
Received: 17/0652022
Accepted: 24/07/2022

Full Paper (vol.891 paper# 141)

c:\work\Jor\vol891_142 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5040- 5050
Prognostic Value of SMAD4 Expression in Pancreatic Ductal Adenocarcinoma and
its Correlation with Clinicopathological Parameters and HER2 Status
Walaa Ahmed Yusuf¹, Heba Sheta¹, Hend Mohamed Hamdey Rashed Elkalla²,
Sylvia Albair Ashamallha¹, Asmaa Mohammed Ibrahim Gado¹.
1.Department of Pathology, 2. Clinical Oncology and Nuclear Medicine,
Mansoura University Hospitals, Mansoura, Egypt
*Corresponding author: Walaa Ahmed Yusuf, Mobile: 01062340508, E-Mail: Walaa.yusuf@hotmail.com

This research seeks to assess the immunohistochemical (IHC) expression of Mothers against
decapentaplegic homolog 4 (SMAD4) in pancreatic ductal adenocarcinoma (PDAC), explore its association with
Human Epidermal Growth Factor Receptor 2 (HER2) expression, and to assess its relation to different PDAC
prognostic clinico-pathological variables. The association of SMAD4 and HER2 IHC expression with patients'
disease-free survival (DFS) and overall survival (OS) is also evaluated.
This retrospective cohort research had 83 patients who were diagnosed with primary PDAC from surgical
resection specimens at the Gastrointestinal Surgery Center (GISC), Faculty of Medicine, Mansoura University,
Egypt. SMAD4 and HER2 expression were evaluated by immunohistochemistry (IHC) on PDAC tumor samples.
Statistical analysis was carried out with the SPSS version 20.0 to assess significant associations.
SMAD4 was aberrantly expressed in 51.8% of PDACs, while only 8.4% of them were positive for HER2
(score +3). There was a statistically substantial connection between SMAD4 expression and the following variables:
tumor site (p=0.05), tumor size (p=0.042), pancreatic safety (PS) margin infiltration (p=0.028) and the presence of
lymphovascular invasion (LVI) (p=0.017), and `statistically significant associations between HER2 expression and
the presence of LVI (p=0.03) and TNM stage (p=0.049). No substantial association was identified between SMAD4
and HER2. SMAD4 loss was connected with shorter DFS and OS, but with no statistical significance.
SMAD4 loss is associated with a poor prognosis in PDAC patients. SMAD4 and HER2 status could
affect the treatment strategies in PDAC patients.
Keywords: SMAD4, Pancreatic cancer, immunohistochemistry, HER2.

Human epidermal growth factor receptor 2
PDAC is one of the most fatal malignant
(HER2) is transmembrane growth factor receptor.
neoplasms in the world. It accounts for 2% of all cancers
When it is overexpressed, it acts as an oncogene and
and it is the 7th most major cause of cancer mortality in
considered as an independent adverse prognostic factor
both sexes worldwide (1).
in PDACs (7).
PDAC has a very poor prognosis with a 5-year-
Therefore, this research seeks to assess the
survival rate less than 5% and median survival of 6
immunohistochemical (IHC) expression of SMAD4 in
months if untreated. The 5-year-survival rate could
pancreatic ductal adenocarcinoma (PDAC), explore its
increase to 20% with early detection, radical surgical
association with HER2 expression, and to assess its
resection, and (2) adjuvant chemotherapy. Early
relation to different PDAC prognostic clinico-
detection of PDAC is very difficult due to the
pathological variables. The association of SMAD4 and
symptoms vagueness and the absence of specific early
HER2 IHC expression with patients' disease-free
clinical indicators of PDAC (3). Unfortunately, 80% of
survival (DFS) and overall survival (OS) is further
patients have advanced illness at time of presentation
and are unfit for surgical resection with metastasis or

invasion to the celiac trunk or the superior mesenteric
artery (4).
Study Settings and Design:
Mothers against decapentaplegic homolog 4
The 83 primary PDAC patients who were
(SMAD4), or DPC4 (Deleted in Pancreatic Cancer-4)
diagnosed from surgical resection specimens at the
is an important member of the co-mediated SMAD
GISC, Faculty of Medicine, Mansoura University,
protein group. In normal conditions; it acts as a tumor
Egypt, between January 2014 and June 2019
suppressor gene (5). Aberrant expression of SMAD4,
participated in this retrospective cohort research using
via genetic alteration or homozygous deletion,
formalin-fixed, paraffin-embedded (FFPE) tissue
promotes uncontrolled cell growth and participates in
blocks. These patients had not received prior
the epithelial mesenchymal transition (EMT) process.
chemotherapy or radiotherapy.
That is why SMAD4 is thought to be involved in tumor
The pathologic database of the Surgical
progression and metastasis (6).
Pathology Laboratory at the GISC was used to
Received: 07/06/2022
Accepted: 14/08/2022

Full Paper (vol.891 paper# 142)

c:\work\Jor\vol891_143 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5051- 5059

Role of Lung Recruitment Maneuvers in Elderly Post-operative
Upper Abdominal Surgery
Eman Shokry Abd-allah1, Noha Gamal Ghoniem2,
Fatma Mohammed Ahmed Abd El-Fattah2, Ahmed Mohamed Said*3
Departments of 1Gerontological Nursing and 2Community Health Nursing,
Faculty of Nursing, Zagazig University, Egypt
Department of 3Chest Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Mohamed Said, Mobile: (+20) 0122708462, E-Mail: kingarmstrong100@yahoo.com

A significant catastrophic side effect of upper abdominal surgery is postoperative pulmonary
complications (PPCs), which raise costs, morbidity, and mortality.
Objective: The aim of the present study is to assess how lung recruitment maneuvers (LRMs) affect both the ventilatory
functions and frequency of PPCs in geriatric patients.
Patients and methods: A total of 80 geriatric patients from New Surgery Hospital in Zagazig University Hospitals for
open upper abdomen surgery were recruited. The participants were randomly divided into two groups; 40 patients in the
intervention group (preoperative LRMs training) and 40 patients in the control group (conventional perioperative care).
Results: When compared to the first postoperative day, the intervention group's forced expiratory volume in one second,
forced vital capacity, and oxygen saturation were significantly improved throughout the ventilatory function tests (p
0.001). Furthermore, the intervention group's reported lower PPCs incidence compared to the control group (15% vs.
30% on the 3rd postoperative day and 15% vs.37.5% on the 5th postoperative day, respectively).
By restoring the measured lung volumes, LRMs effectively improve the perioperative management of
geriatric patients by preventing PPCs.
Keywords: Elderly, Lung recruitment maneuvers, Abdominal surgery, Pulmonary complications, Perioperative care.


Therefore, the aim of the present study was to
Upper abdominal surgery (UAS) is followed by a
evaluate the effect of lung recruitment maneuvers
period of impaired respiratory muscle function and
(LRMs) on ventilatory functions and length of hospital
diminished physical capacity, both of which are linked
stay in postoperative UAS at geriatric patients.
to the emergence of postoperative pulmonary problems.

These effects occur particularly in older patients due to
the physiological changes brought on by ageing and the
This experimental study included 80 elderly patients
increased prevalence of comorbidities (1).
who admitted at inpatient Surgical Departments, the
Patients' movement and respiratory mechanics are
New Surgery Hospital in Zagazig University Hospitals
impacted by anaesthesia, the stress of surgery, and
within the period from May 2021 to December 2021.
postoperative conditions (such incisions, drains, and

catheters) (2).
Inclusion criteria:
The emergence of postoperative pulmonary
The 80 patients aged 60 years or older who were
complications following UAS are due to impaired
undergoing open UAS, could communicate, had no
diaphragmatic activity, atelectasis, early airway closure,
cognitive impairment, no cerebrovascular illness, no
impaired ventilation and perfusion matching,
decompensated cardiac issues, no postoperative
mucociliary dysfunction and an increase in bacterial
peritonitis, and who agreed to participate in the study
colonization (3).
were included in this clinical trial.
In worldwide, awareness of the value and

necessity of lung recruitment maneuvers and physical
Exclusion criteria:
rehabilitations for postoperative respiratory care has
Patients undergoing home oxygen therapy or those with
increased recently and has a favorable effect on the
a history of severe pulmonary illness were excluded
prognosis, quality of life, and ability to resume normal
from this research. Additionally, exclusion of those
activities for patients (4).
patients was done who met the criteria for the American
By removing mucus from the airways, lowering
Society of Anesthesiologists physical status (ASA PS)
the work of breathing, strengthening respiratory
classification system with a score of four or above (6).
function, and increasing lung inflation, lung recruitment

maneuvers tries to help postoperative patients regain
Sample size:
voluntary breathing (5).
It was calculated according to the study of Manzano et
The effectiveness of these combined maneuvers in
al. (7) who reported that the mean oxygen saturation
elderly patients following open major surgeries is still
percentage before surgery was 96.4 (SD 1.9) versus
debatable (4).
94.7 (SD 2.4) after surgery. At 80% power and a 95%
level of confidence, using Open Epi software, the
Received: 09/06/2022
Accepted: 16/08/2022

Full Paper (vol.891 paper# 143)

c:\work\Jor\vol891_144 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5060- 5062

Isolated Displaced Fracture of Acromion Process: A Case-Report
Riyadh Omar Al-Qithmi*
Department of Orthopedic Surgery, Dammam Medical Complex Hospital, Dammam, Saudi Arabia
*Corresponding author: Riyadh Omar Al-Qithmi, Mobile: +966553422302, E-mail: ralgothmi@gmail.com

Fracture of the acromion process is an uncommon injury, which is often diagnosed late. Though, usually
managed conservatively, the indications for surgery in these fractures are very specific. The acromion is a large bony
projection on the superior end of the scapula. Acromion fractures are rare injuries. They constitute 8%­16% of scapula
fractures. Recently, they are seen at the rate of 5%­6.9% as the complication of reverse shoulder arthroplasty.
Objective: We aimed to present a case report to highlight isolated displaced fracture of acromion process.
Case report: 58 years old male, known case hypertension, presented to emergency department on 16 December 2021,
after history of fall down from ladder on his left shoulder complaining of pain over left shoulder and limitation of
movement. Pain was started after fall, dull in nature, not radiating to left upper limb, increased with movement and
decreased with analgesia mildly.
Conclusion: Acromial fractures are usually associated with other lesions of the shoulder girdle. Isolated displaced
fractures of the acromion are clearly the exception to the rule. Acromion fracture can be treated with good results with
early surgical treatment and proper fixation. Surgical treatment is important to regain shoulder functions, as it enables
early rehabilitation of treatment.
Keywords: Acromion process, Isolated displaced fracture, CT, X-ray.


and decreased with analgesia mildly. No history of
Scapular fracture is a rare occurrence. The
previous attack. Patient was retired and not enrolled in
acromion, which is the lateral projection of the scapula's
any sport activity. Non-smoker and non-alcoholic.
spine, only makes up to 8% of all scapular fractures, is

an uncommon orthopaedic problem (1). The majority of
On examination:
these fractures involve concurrent shoulder skeletal and
Patient conscious, alert and oriented. Not in pain
soft tissue damage (2). The normal function of the
distress. Vitally stable.
shoulder may be hampered or the sub acromial area

compromised with a severely displaced acromion
Local examination of left shoulder:
fracture due to compression of the rotator cuff, long
Left shoulder open wound superficial over
head of the biceps tendon, or deltoid muscle, leading to
impingement syndrome (3).
Tenderness over left acromion and scapular spine left
Overuse injuries and shoulder trauma can both
sided. Decreased active abduction 0-30 degrees,
result in acromion fractures. In addition to scapula or
forward flexion 0- 60 degrees, internal rotation till L2
clavicle distal fractures and rupture of the superior
and external rotation unable to touch his head. Intact
shoulder suspensory complex, acromion fractures can
distal neurovascular.
also occur (4). There is no widely used acromion fracture

treatment plan or fixing technique (5).
We aimed to present a case report to highlight
Case of left acromion process, was diagnosed
isolated displaced fracture of acromion process.
based on x-rays upon presentation to ER. CT scan and

X-ray was done.
Patient was diagnosed accordingly and managed
58 years old male, hypertensive case was
primarily as conservative management that failed as
presented to emergency department on 16 December
high displacement of acromion process. Patient then
2021, after history of fall down from ladder on his left
was operated by open reduction of the left acromion
shoulder complaining of pain over left shoulder and
process and fixation by 2 lag screws and plate. Patient
limitation of movement.
was discharged in good condition and during follow up
Pain was started after fall, dull in nature, not
there was improved range of motion and discharged
radiating to left upper limb, increased with movement
from clinic accordingly.

Received: 08/06/2022
Accepted: 15/08/2022

Full Paper (vol.891 paper# 144)

c:\work\Jor\vol891_145 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5063- 5068

Carbetocin versus Oxytocin: A Comparative Study to Prevent Postpartum
Hemorrhage in Pre-eclamptic Women Delivered by Caesarean Section
Amal Mohamed Al Anwar, Hoda Sibai Abdal Salam,
Sabrin Mohamed Esukni*, Mohamed Mahmoud Abdel Rahman
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Sabrin Mohamed Esukni, Mobile: (+20) 01020325548, E-Mail: sesukni@gmail.com

: Postpartum hemorrhage and hypertensive disorders are the greatest contributors to maternal death in
developing countries accounting for more than 50% of direct causes.
Objective: This study aimed to improve the clinical outcomes of carbetocin versus oxytocin in preventing postpartum
hemorrhage in women with pre-eclampsia during C
aesarean Section (CS).
Patients and methods
: This study included 120 pre-eclamptic pregnant women and were randomized (by alternation)
into two groups of 60 patients: Group A received a single dose of carbetocin (100g) diluted in 100ml 0.9% Nacl
administered slowly over (30-60 seconds) intravenously after the delivery of the baby, while Group B received oxytocin
(40 IU diluted in 100ml of 0.9% Nacl run at 25 ml per hour over 4 hours) intravenously after the delivery of baby.
Results: Regarding preoperative hemoglobin and HCT, there was no statistically significant difference between the 2
studied groups. There were statistical significant differences between the 2 groups in postoperative hemoglobin and HCT
with higher levels among Group A compared with Group B. There was significant increase in frequency of blood
transfusion and need of other uterotonic drugs in oxytocin group compared with carbetocin group. No significant
difference was observed between the 2 studied groups in frequency of headache, but there were statistically significant
increase in frequency of nausea, vomiting, abdominal pain and oligourea in oxytocin group compared to carbetocin
group. There was significant increase in frequency of elevated temperature in carbetocine group compared to oxytocin
group. Conclusion: Carbetocin has a superior effect on oxytocin for prevention of postpartum hemorrhage in women
with pre-eclampsia.
Keywords: Carbetocin, Oxytocin, Postpartum hemorrhage, Pre-eclampsia, Cesarean section.


Uterotonic agents as oxytocin (10 IU)
Primary postpartum hemorrhage (PPH) and
intramuscularly usually prevent PPH in low-risk vaginal
hypertensive disorders are the greatest contributors to
and caesarean deliveries, or intravenous infusion (20­40
maternal death in developing countries, accounting for
IU in 1000 ml, 150 ml/h) which is another alternative
more than 50% of direct causes (1). In developed
because of its short duration (its half-life is
countries both pathologies, together with embolism, are
approximately 3.5 min) (9).
the main reasons women die during pregnancy. Any
Carbetocin is a long-acting synthetic oxytocin
potential for improvement in management of these two
disorders should be investigated (2).
methyltyrosine)-oxytocin that binds to oxytocin
Definition of PPH is the loss of 500 ml of blood in
receptors with higher affinity), with a half-life of 40
vaginal delivery or 1000 ml in Caesarean Section (CS)
minutes. Within two minutes of intravenous
from the genital tract within 24 h of the delivery of the
administration, it has the capacity to generate tetanic
baby (3). It is classified as: Minor PPH (blood loss 500­
uterine contractions that last for six minutes. These
1000 ml) and major PPH (more than 1000 ml). Almost
tetanic contractions are followed by more rhythmic ones
500,000 women die due to this preventable cause each
for approximately one hour (10).
year, especially hemorrhage that occurred at time of
Carbetocin has half-life of 40 min (4­10 times
delivery (4). Other nonfatal complications may occur as
longer than oxytocin). Thus, it is given as single IV
bolus following the delivery of baby at elective or
coagulopathy, and organ damage due to hypotension,
emergency cesarean section and if further uterine
shock, and risk of hysterectomy (5).
stimulation is needed, treatment with other uterotonic
Uterine atony is the first cause of hemorrhage at
drugs should be used. Carbetocin has also been shown
time of delivery; therefore, active management is better
to stimulate milk letdown due to its action on oxytocin
than expectant management of the third stage of labor.
receptors on the myoepithelial cells and there is not a
Third stage of labor is the period that following the
significant amount of it in breast milk. Side effects are
delivery of a baby till placental delivery (6).
nausea, vomiting, chest pain, tachycardia, hypotension
For many years, pharmacological options for the
and respiratory distress (11).
prevention of postpartum hemorrhage have been
Considering its potential advantages over
explored, among them is the oxytocin agonist carbetocin
oxytocin (more rapid and longer duration of effect,
Received: 08/06/2022
Accepted: 15/08/2022

Full Paper (vol.891 paper# 145)

c:\work\Jor\vol891_146 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5069- 5074

Value of Random Urinary Albumin-Creatinine Ratio in Detection of
Proteinuria in Preeclampsia
Mohamed Elsayed Younes Elsayed Khalaf, Rahma Aly Mohamed Ahmed, Mahmoud Mahmoud
Mohamed Abdelalim, Tamer Shawkey Gouda Ahmed*, Ezz El din Salama Abdel Atti El Sayed
Department of Obstetrics & Gynecology, Al Galaa Teaching Hospital, Cairo, Egypt
*Corresponding author: Tamer Shawkey Gouda Ahmed, Mobile: (+20) 01002066869, E-Mail:

: Outside of pregnancies, the protein-to and albumin-to creatinine ratios have been extensively
investigated and applied. In most cases, these tests (rather than a 24-hour urine collection) are currently what the
National Kidney Foundation advises for diagnosing proteinuria. The aim of the present study is to compare the
diagnostic accuracy of the random urine albumin-creatinine ratio (ACR) to that of the gold standard, the 24-hour
urinary protein, in patients with preeclampsia.
Patients and methods: At Said Galal Hospital, we enrolled 100 women who had been diagnosed with
hypertension problems during pregnancy and were admitted for further diagnostic testing. Albumin 24 hour
collection and albumin creatinine ratio (ACR) were measured for all participants.
Results: Albumin in a 24-hour urine collection was positively correlated with albumin-to-creatinine ratio in a
random urine sample (r = 0.935, P <0.001). ACR of 303 mg/g creatinine was found to be the "ideal" cutoff value
for the identification of substantial proteinuria with a sensitivity of 96% and a specificity of 92%. Albumin
creatinine ratio cutoff value for predicting severe proteinuria in cases of preeclampsia was 2 gm/24hr. We found
that cutoff value of >1238 mg/g creatinine had a sensitivity of 100% and a specificity of 86%.
Conclusion: Since ACR in random urine corresponds well with 24-hour urine protein, using it as a substitute was
deemed appropriate. Thus, it can be used as a clinical screening test, benefiting from the fact that the ACR rarely
changes significantly throughout the day, more easy and rapid method, not affected by urine concentration.
Keywords: Albumin-Creatinine Ratio, Proteinuria, Preeclampsia, Diagnostic Test.


Common names for preeclampsia include
the spot albumin: creatinine ratio outside of
defective placental angiogenesis, as well as pregnant
pregnancy. Without mentioning pregnancy by name,
hypertension with proteinuria (1).
the National Kidney Foundation now recommends
these tests (instead of 24-hour urine collection) to
eclampsia, a combination of preeclampsia and
identify proteinuria in most instances. Both NICE
chronic hypertension, and chronic hypertension are
and SOMANZ endorse the spot protein-creatinine
the four types of hypertensive disorders that can
ratio test as a reliable way of detecting proteinuria in
occur during pregnancy (2).
the general population (6).
In non-pregnant people, 150 mg/day is
Contradictory findings have been found while
commonly regarded as the cutoff after which urine
analyzing the efficacy of the spot PCR for use during
protein excretion is deemed excessive; nevertheless,
pregnancy. High correlations between PCR and 24-
both lower and higher levels have been
hour collections have been used to justify its use by
recommended. These thresholds typically double
some researchers, while others have warned against
during pregnancy, with 300 mg/day being the most
using it too quickly because to the rapid decline in
common value (3).
renal function that occurs in preeclampsia (7).
Collection of urine over the course of 24 hours
It has been recognized by a number of
is considered the gold standard for measuring
worldwide groups, such as the International Society
proteinuria, although it has significant drawbacks.
for the Study of Hypertension in Pregnancy and the
Patient inconvenience, inaccuracy from under
Society of Obstetric Medicine of Australia and New
collection, and a wait of at least 24 hours for results
Zealand., and the Canadian obstetricians and
are all issues with this method (4).
gynecologists have agreed that the spot urine ACR is
Spot urine protein-to-creatinine ratios (PCRs) or
a reliable approach for diagnosing high proteinuria (>
urine albumin-to-creatinine ratios (ACRs) are now
0.3 g/24 h) in pregnant women (8).
the preferred procedures for evaluating proteinuria
The aim of the present study is to compare the
and albuminuria because they account for
diagnostic accuracy of the random urine ACR to that
fluctuations in protein concentration caused by
of the gold standard, the 24-hour urinary protein, in
measuring creatinine at the same time (5).
patients with preeclampsia.
There has been extensive research and clinical

application of the spot protein: creatinine ratio and

Received: 10/6/2022
Accepted: 17/8/2022

Full Paper (vol.891 paper# 146)

c:\work\Jor\vol891_147 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5075- 5082

A Modified ICSI Technique: Using Zona Pellucida as A Natural Bait
Hager Abu Elmag, Eman Anwar Hassa, Moustafa Sarha, Nehal Abu-Elnag
1Faculty of Science, Zoology Department, Al-Azhar University, Girls Branch, Cairo, Egypt.2International
Islamic Center for Population Studies and Researches, Al-Azhar University, Cairo, Egypt.
3Faculty of Science, Zoology Department, Al-Azhar University, Assuit Branch, Egypt.
Corresponding author: Hager Abu Elmagd, Sama Towers, Telephone: 01092741896. Email: hager.muhammed24@gmail.com

In vivo, the zona pellucida (ZP) of the oocyte can bind to normally functional sperm. The ZP-sperm
interaction is one of the final steps of natural selection during their journey in the female reproductive tract.
Aim: In the current study, we evaluated the ability of the ZP of immature oocytes to harvest the fittest sperm.
Method: We compared the embryological outcomes (i.e., rates of fertilization, cleavage, blastocyst formation, and high-
quality blastocysts) of intracytoplasmic sperm injection (ICSI) using conventionally selected sperm (control group) and
ZP-bound sperm (treated group).
Results: Our results showed that there were no statistically significant differences for the ZP binding technique over the
conventional sperm selection with respect to the rates of fertilization and cleavage. However; the rates of blastocyst
formation and high-quality blastocysts were significantly higher in the treated group compared to the control group.
Conclusion: These findings imply that the proposed technique (ZP-bound sperm) can serve as a cost-effective and
natural sperm selection method that has the potential to improve the embryological and clinical outcomes of
intracytoplasmic sperm injection (ICSI).
Keywords: Intracytoplasmic sperm injection (ICSI), zona pellucida (ZP), natural sperm selection, ZP-bound sperm,
Acrosomal reaction (AR), Sperm-oocyte interaction.


The sperm traits that make in vitro fertilization
The quality of the selected sperm used for
effective are still debated. ICSI is now the standard
intracytoplasmic injection (ICSI) plays a detrimental
practice for most Assisted Reproduction (ART) centers
role in embryonic quality and development and,
worldwide and accounts for approximately 70% of all
subsequently, in the clinical outcomes of ICSI [1]. In in
in vitro fertilization [4&8]. The routine selection of
vitro fertilization (IVF) and during the sperm journey
spermatozoa for ICSI depends on an embryologist
through the female reproductive tract in vivo, sperm
subjectively selecting sperm based on their motility and
interact with the zona pellucida (ZP) of the oocyte,
morphology. It is done after an analysis of the seminal
which is the last stage of sperm selection before entering
fluid, which is a poor predictive tool of male fertility
the oocyte [2&3].
and does not express the fertilization capacity of the
The ZP is selective with regard to binding and can
sperm [9].
bind to normally functioning sperm, especially those
It was assumed that mimicking the natural sperm
with a normal acrosomal region [3]. According to Liu et
selection may improve the quality of selected
al. [4], only 14 % of the motile spermatozoa in fertile
spermatozoa and hence, the clinical outcomes of ICSI.
men can bind to the ZP. Only those spermatozoa with
Ideally, a sperm selection method that reduces the
relatively normal size and shape of the acrosomal region
number of spermatozoa to a subpopulation with
can bind to and penetrate the ZP and fuse with the
potentially the highest quality can improve fertilization
plasma membrane of the oocyte (oolemma) and thus are
and embryo quality and development and subsequent
capable of fertilizing the oocyte [5]. Human sperm vary
clinical outcomes of ICSI, including implantation,
in size, morphology, DNA integrity, motility,
pregnancy, and live birth rates.
membrane composition, etc., and this can be observed
Over the years, several sperm selection
even in the same ejaculate [6]. In vivo, sperm pass
techniques have been developed for ICSI. However,
through various sperm selection checkpoints and
these techniques were designed to select sperm based on
barriers to reach the oocyte. Spermatozoa have to
a single sperm parameter (i.e. motility, density,
overcome obstacles in the vagina, cervix, uterus,
sedimentation, nuclear integrity, etc.) and ignoring
fallopian tube (site of fertilization), and finally, the ZP
other sperm parameters related to the capability to
of the oocyte where less than 500 sperm would have
fertilize the oocyte observed in vivo [10&11]. Sperm
made it through [7].
selection techniques such as swim-up, microfluidics,
Thus, it is a given fact that thorough sperm
and density gradient centrifugation yield a population of
selection procedures befall spermatozoa in the female
highly motile sperm but fail to mimic the rigorous
genital tract to filter superior sperm and allow only a
natural sperm selection that considers other sperm
small subpopulation of spermatozoa with superior
parameters. Moreover, most of these methods require
quality to reach the site of fertilization where another
centrifugation which may negatively affect the paternal
sperm selection occurs (i.e. ZP interaction) .
DNA and reduces the quality of sperm by increasing
reactive oxygen species [10].
Received: 6/6/2022
Accepted: 11/8/2022

Full Paper (vol.891 paper# 147)

c:\work\Jor\vol891_148 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5083- 5087

Laminin Is a Promising Predictive Biomarker for Acute and
Chronic Toxoplasmosis
Mariam Ali Najeeb*, Amjed Qays Ibrahim Alqaisi*
Department of Biology, College of Science University of Baghdad, Iraq
Corresponding author: Amjed Qays Ibrahim Alqaisi, Email: amjeddurham@gmail.com ,
Mobile Number: 009647710952808, Ordcid number: 0000-0002-4759-1085

Laminin (LN) is an important extracellular matrix glycoprotein plays an important role in early embryonic
development by promoting the cell adhesion and angiogenesis. It regulates many functions in the cell including proliferation,
invasion, and signaling. However; the role of laminin is poorly known in relation with Toxoplasma gondii infection.
Objective: The current study aimed to examine the possibility of using the laminin as an indicator of an early infection of
Methods: Eighty-seven women aged from 15-45 years. They were included in this study from September 2021 to February
2022. Blood samples were collected from healthy pregnant women and aborted and pregnant women infected with
toxoplasmosis. Toxo-latex agglutination test was done followed by the detection of IgM and IgG antibodies, which were
determined in sera from cases and controls using a commercially available enzyme-linked immunoassay. Finally, an ELISA
test for laminin was performed as well.
Results: The seroprevalence of anti-T. gondii antibodies IgM or IgG were 14.94% (13/87) and 62.07% (54/87) respectively.
Levels of laminin showed a significant decrease in the serum of 1-5 months aborted women with acute and chronic
Toxoplasma Gondii infection in comparison with the control.
Conclusion: The levels of laminin in female patients infected with Toxoplasma Gondii might play an important role in
early diagnosis of toxoplasmosis especially during the first 5 months of abortion or pregnancy because laminin is an
important glycoprotein in the extracellular matrix component, which involved in embryogenesis, implantation, and
Keywords: Toxoplasma gondii, Laminin, ELISA, Toxoplasmosis.

The contamination through ingestion is the most
Toxoplasma gondii, is an obligate intracellular
common mode of transmission, and animals become
parasite, could infect humans and warm-blooded animals,
vectors that will later infect humans who ingest those
including mammals and birds. It was firstly described in
contaminated meats. The contact with parasites found in
a rodent from North Africa by Nicolle and Manceaux in
cat feces is another mode of transmission to humans.
1908 and progressively recognized as the agent of a
Another ways of transmission are also through
widespread zoonosis (1).
transplanted tissues, blood, laboratory accidents and
The infection with this parasite is known to affect
congenital infection (pregnant woman infected with
about 30% of the worldwide population, making it as one
parasites transmits the parasite to her fetus) (6).
of the most efficient parasites (2). The infection in humans
One of the most important steps in women's lives is
could be asymptomatic, however it may result in serious
pregnancy, specifically for women who intend to have a
complications affecting the vital organs in human body in
baby for the first time, while abortion during pregnancy is
particular the brain, eyes and fetuses of pregnant women
a problem that any women might experience, which then
they face mental issues and medical expenses because of
The infection of this parasite has two stages: an
it. Toxoplasmosis infection is one of the reasons for
acute stage and chronic stage. Early infection of T. gondii
abortion (7 and 8). The prevalence of T. gondii infection in
and the appearance of clinical symptoms coincide with
pregnant women is measured and is estimated to be 14-
the acute phase. At this stage, the parasite rapidly
77% (4).
replicates, and many different cells will be attacked later
Congenital toxoplasmosis that occurs during
throughout the body. The patient then enters the chronic
pregnancy could lead to series of complications including
phase few months later, where a very slow replication for
stillbirth, spontaneous abortion, and some degrees of
the parasite would happen (3).
physical and mental deterioration, blindness, deafness and
The proliferation of the parasite is controlled by the
hydrocephalus (9 and 10).
host immune system activation, and tissue cysts would be
Furthermore, the gestational age is associated with
formed in the neuro-muscular system of the host (4). There
both the frequency and intensity of the congenital
is no treatment to a complete elimination of the parasite
toxoplasmosis. The first and second trimesters showed
once the host is infected (5).
highest infection severity, which in turn causes either
Received: 9/6/2022
Accepted: 16/8/2022

Full Paper (vol.891 paper# 148)

c:\work\Jor\vol891_149 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5088- 5096

COVID 19-Related Life-Threatening Spontaneous Retroperitoneal Bleeding:
Therapeutic Modalities and Prognostic Factors of Mortality:
A Retrospective Observational Study in An Isolation University Hospital
Sherief M. Mohsen, Ahmed M. Farrag, Mohamed Abdwahed
Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Sherief M. Mohsen, Mobile: (+20) 01001662303, E-Mail: dr.sheriefmohsen@outlook.com,
ORCID ID: 0000-0003-0402-5848

COVID-19 infection was linked to an increased risk of thromboembolism in high-risk individuals, so
different anticoagulants were employed at varying doses. Anticoagulant-induced spontaneous retroperitoneal bleeding
(SRB) is a rare condition.
Objective: To analyze spontaneous retroperitoneal bleeding (SRB) associated with COVID-19 infection owing to
anticoagulation on a larger scale in terms of comorbidities and factors related with SRB, as well as discuss existing
therapeutics modalities, factors influencing decision, prognosis, and associated mortality.
Patients and Methods: Twenty COVID-19 patients presented with SRB; 12 were treated surgically, and 8 were treated
conservatively. Patients' demographic information, comorbidity evaluation, type of intervention, results, and prognostic
factors were all evaluated.
Results: Eight patients were treated conservatively; three died as a result of refractory shock. Twelve patients were
operated on; eight of them died as a result of myocardial infarction, pulmonary problems, and multiple organ failure.
The date of the surgical consultation influenced care and outcome significantly. Increased blood component
requirements were found to be substantially associated to mortality.
Conclusion: Management should be wise, yet not hesitate to intervene if necessary. In a progressive hematoma, this
produces better results than conservation. Independent variables that necessitate intervention include vital instability,
increasing hemoglobin decline, and transfusion requirements.
Keywords: COVID-19, Retroperitoneal bleeding, Anticoagulant therapy.

wings. SRB as a side effect of anticoagulant therapy is
COVID-19 (produced by the SARS-COV-2
regarded as a self-limiting condition. Surprisingly, such
virus) has been linked to a number of clinical
a consequence occurs in COVID-19 individuals who are
not on anticoagulant medication and have severe
Hypercoagulability and small vessel micro thrombosis
symptoms (7).
are regarded to be significant manifestations that can
lead to pulmonary thromboembolism and, ultimately,
anticoagulants is an established consequence is
respiratory failure (1). One of the characteristics of micro
debatable because neither anti-factor Xa tests nor
thrombosis is cerebrovascular stroke (2).
plasma heparin levels were performed to corroborate
In COVID-19 infections, the incidence of
this data, leaving the cause of bleeding uncertain. In
thromboembolic symptoms may reach up to 21%, with
individuals with modest symptoms and a low risk of
Thromboembolic manifestations can affect up to 11%
recommendations propose a dose of 40 mg of low
of COVID-19 infected patients admitted to the ICU (3).
molecular weight heparin (LMWH) once daily and a
Many trials, while with limited evidence, demonstrated
dose of 0.5 mg/kg of LMWH in severe cases in ICU
that anticoagulant medication was successful in
settings (8, 9).
COVID-19, particularly in ICU settings, with heparin or
The use of therapeutic anticoagulants may be
its alternatives recommended for thromboembolism
required in cases of severe respiratory manifestations in
prophylaxis (4). Retroperitoneal hemorrhage is a rare
need of ventilation and a rising trend of D-dimer levels
consequence of heparin, according to limited data and a
(8, 9). SRB is usually characterized by non-specific
few cases in the literature. Many randomized controlled
clinical manifestations, which may result in a delay in
trials, however, indicate that heparin is both safe and
management due to misdiagnosis with other conditions.
effective in patients of severe COVID-19 pneumonia (4).
In the general population, SRB associated with
Nowadays, many researchers are discussing internal
anticoagulant therapy is considered a serious and life-
bleeding such as spontaneous retroperitoneal bleeding
threatening complication with an incidence ranging
(SRB) as a life-threatening complication as a result of
between 0.0 and 6.6% and a mortality rate ranging from
the COVID-19 treatment strategy (5,6).
10 to 20% (10).
Pelvic hematoma is described as bleeding in
A computed tomography (CT) study on the
retroperitoneal zone 3, which is anatomically bounded
abdomen and pelvis with contrast is considered the
anteriorly by the dome of the urinary bladder,
imaging procedure of choice in the diagnosis and
posteriorly by the sacrum, and laterally by the iliac
suspicion of SRB. It is extremely valuable in detecting
Received: 8/6/2022
Accepted: 15/8/2022

Full Paper (vol.891 paper# 149)

c:\work\Jor\vol891_150 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5097- 5100

Role of Growth Arrest Specific 6 Protein and TAM Receptors in
Rheumatic Diseases: Review Article
Omima Zakaria Shehata1, Shimaa M. Abdel-Wahab1, Alshymaa A. Ahmed2, Amina M. Abdalla*1
Departments of 1 Rheumatology & Rehabilitation and 2 Clinical Pathology, Zagazig University Hospital, Egypt
*Corresponding author: Amina M. Abdalla, Mobile: (+20) 01124113445, E-Mail: hlaloka4215@gmail.com

Growth arrest specific 6 (GAS 6) is the ligand for the TAM family of receptors. The TAM acronym is for
the three members of this family: Tyro3, Axl, and Mer. Deficiencies in GAS 6/TAM pathway are involved in chronic
inflammation, impaired immunity and cancer development. Several studies have been made to declare the exact
mechanisms of its work and how it can be used as a promising therapeutic target in autoimmune diseases.
Objective: This review article aimed to summarize what recent studies revealed about GAS6 and TAM receptors and
its role in rheumatic diseases.
Growth Arrest Specific 6 Protein, TAM receptors, and the Rheumatic Diseases 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 February 2004 to February 2021 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: GAS 6 and protein S are well known ligands of TAM receptors that are structurally and functionally
similar. Plasma levels of GAS 6 and its soluble TAM receptors increase in blood of cases affected by systemic lupus
erythematosus and lupus nephritis and can be used as markers for disease diagnosis and severity.
Keywords: GAS 6, TAM, Autoimmune diseases.


GAS 6 is one of vitamin K­dependent proteins
Proteolysis causes its shedding from the cell
(VKD) (1). GAS 6 is not synthesized in the liver like other
membrane to be present in the soluble form (sAxl) (7).
VKD, but produced by heart, lungs, kidneys,
sAxl binds to all GAS 6 particles and that is why blood
endothelial, and muscle cells (2). It is present in plasma in
sAxl level (0.6nmol/L) are higher than GAS 6 level (0.25
concentration around 20-50 ng/mL (0.25 nmol/L) (3).
nmol/L) (7). The soluble receptors inhibit signaling by
The gene that codes GAS 6 was not discovered until
removing the ligand from cell bound receptors (8).
1988 through the screening of genes increased in growth

arrest embryonic mice fibroblasts and its name came
Function of GAS 6/TAM system:
from its discover. They found six genes, which were
GAS 6 is involved in several biological processes
named GAS 1 to GAS 6. In 1993, the gene was
such as: proliferation, migration, differentiation,
sequenced and they found similarity with plasma
adhesion and leukocyte sequestration, platelet
anticoagulant protein S sharing 44% of its structure (4).
Interestingly, both of them have different functions (5).
phagocytosis. Additionally, it is involved in injury,
GAS 6 protein is composed of multiple domains
inflammation, and repair mechanisms (9).
with molecular weight of 75 kDa. It has an amino

terminal carboxyglutamic acid (Gla domain) that
Anti-apoptotic and mitogenesis:
enables VKD proteins to bind to anionic phospholipids
Bassyouni et al. (6) declared that several studies have
at the cell surface. Gla domain is followed by a loop,
investigated GAS 6 role in inhibition of apoptosis and
which is held by a disulfide bridge and followed by 4
epidermal growth factor­like domains and in the end the
oligodendrocytes, Schwann cells, lens epithelial cells,
carboxyterminal (C-terminal), consisting of 2 laminin G
neurons and liver cells. GAS 6 was found to decrease
repeats, exists. They all form the sex hormone­binding
cell death after serum starvation and TNF-treatment in
globulin domain interacting with the TAM receptors (6).
different cell types. TAM receptors and GAS 6 protein
Tyro3, Axl, and Mer form the 3 types of the
levels were noticed to increase in many cancer types
TAM receptors group. Gas 6 and protein S act as ligands
such as leukemia, cancer of the thyroid gland, lung,
for the TAM receptors (4). GAS 6 has higher affinity for
uterus, endometrium, ovary, prostate, GIT tumors, breast
Axl than Tyro than Mer receptors (2). Cells of
cancer, Kaposi's sarcoma, malignant gliomas and renal
hematopoietic, epithelial, and mesenchymal sources
cell carcinoma (4).
express Axl while Tyro3 exists mainly in the central
The interaction between GAS 6 protein and Axl in
nervous system, kidneys, ovaries, and testes. Mer is
cancer cells is involved in different mechanisms of
mainly present in ovaries, testes, prostate, lungs, and
tumor progression and metastasis, including tumor cell
kidneys and less commonly in the thymus, spleen, liver,
small intestine colon, and placenta (3).
Received: 09/06/2022
Accepted: 16/08/2022

Full Paper (vol.891 paper# 150)

c:\work\Jor\vol891_151 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5101- 5105

Sleep Quality as a Predictor for Academic Performance in
Menoufia University Medical Students
Yasser Atta Shehata, Asmaa Yehia Sharfeldin, Ghadeer Maher El Sheikh*.
Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Ghadeer Maher El Sheikh, Mobile: +201004039259, Email: ghadeer_maher@yahoo.com

Poor sleep quality is an important public health problem with multiple unfavourable consequences. Sleep
disorders are widespread among university students and have a significant impact on their general health and academic
performance. Aim: To investigate the relationship between sleep quality and academic performance among medical
students in Menoufia University. Participants and methods: This cross-sectional study was carried out from 1st
November 2021 to the end of March 2022 on 1033 undergraduate medical students from Menoufia University in Egypt.
The data were collected using self-administered questionnaire to obtain information regarding sociodemographic
variables, academic achievement in the previous year, sleep habits and environmental sleep factors like smoking,
exercise and media use. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality.
The mean overall score of the PSQI was 18.03 (SD ± 7.59); the majority of students (96.5%) had bad sleep
quality with PSQI score greater than 5. There was a highly significant difference between good and bad academic
performance regarding Pittsburgh sleep quality score. Mean sleep duration was 6.67 (SD ± 2.05) hours. Most of
participants were non-smokers (91.9%), physically not active (50.6%), and use the internet for more than two hours
daily (55.8%).
Poor sleep is a major problem for Egyptian medical students, and there was also a significant relationship
between sleep quality and academic performance.
Academic performance, medical students, Pittsburgh Sleep Quality Index.

invalid questionnaires were excluded. So, the final
Sleep is a crucial process that is required for the
sample size was 1033 students. As regards sampling
enhancement of normal cognitive functioning such as
techniques, in Menoufia medical faculty, each academic
attention, decision-making, communication, and, most
year is subdivided into four small groups of about 100
importantly, learning and memory, and hence, student
students for their practical and clinical round rotations.
academic performance (1). "Good" subjective sleep
The study sample was randomized through selection of
quality is described as the ability to fall asleep easily,
two random groups of students from each grade.
sleep for enough time to wake up feeling rested, and get
Each participant was asked to complete a self-
through the day without feeling drowsy (2).
administered questionnaire to obtain information about
The Pittsburgh Sleep Quality Index (PSQI) is the
sociodemographic variables (age, gender, year of
gold standard for subjective sleep quality measurement
education, residence, student's habitat during the study,
(3). In Egypt, there is scarcity of information about the
height, weight), sleep habits and environmental sleep
association between sleep quality and academic
factors like smoking, exercise and media use, academic
performance among the students. So, it has been
achievement in the previous year. The grading system
urgently necessary to conduct this study to assess the
of students at the faculty of Medicine in Menoufia
relationship between sleep quality and academic
University is classified according to the overall score of
performance among undergraduate medical students at
the student. Student is considered (failed) if he/she had
Faculty of Medicine, Menoufia University, and
< 60% of the overall score of subjects studied at the
subsequently, provide relevant scientific based
nominated year and is considered (passed) if he/she had
information about situation in Egypt.
>60% of the overall score of subjects studied at the

nominated year. Furthermore, passed students are sub-
classified into four categories: Accepted 60-<65%,
This cross-sectional analytic study was carried
Good 65-<75%, Very Good 75-<85%, and Excellent
out from 1st November 2021 to the end of March 2022
>85% of the overall score of subjects studied at the
on 1033 undergraduate medical students from Menoufia
nominated year.
University, Egypt. The G*power software was used to

Instrumental tool used in the study: - The Pittsburgh
University Düsseldorf, Germany). A former study
Sleep Quality Index (PSQI) is a self-reported
stated that 58% of the medical students had poor sleep
questionnaire used to assess sleep quality over a one-
quality (4). With 5% alpha error and 80% study power,
month period. The measure consists of 19 distinct items
the sample size was calculated to be 980. To account for
that combine to form 7 components that result in a
non-responders, we increased the sample size by an
single global score, and it takes 5­10 minutes to
additional 98 students (10%). Thus, the total sample size
complete. Subjective sleep quality, latency, duration,
was 1078, (which was spread over medical students
habitual sleep efficiency, sleep disruptions, usage of
from grade 2 to grade 6 and house officers). Forty-five
sleep medication, and daytime dysfunction are all
Received: 16/6/2022
Accepted: 24/8/2022

Full Paper (vol.891 paper# 151)

c:\work\Jor\vol891_152 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5106- 5110

Study of RBCs Pyruvate Kinase Deficiency in Neonatal
Pathological Indirect Hyperbilirubinemia
Ahmed Galal Syam1, Adel Sherif Ahmed1, Alaa El Din A. Hadhood2, Eriny Saad Gerges*1
Departments of 1Pediatric and 2Microbiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Eriny Saad Gerges, Mobile: (+20) 01111134983, E-Mail: erinysaad2020@gmail.com

Pyruvate kinase (PK) enzyme deficiency is an autosomal recessive disorder with both male and female
equally affected. It is the most common enzyme abnormality in the glycolytic pathway of red blood cell metabolism.
Clinical presentation of PK deficiency ranges from hydrops fetalis to mild compensated hemolytic jaundice.
Objective: The aim of this work was to determine prevalence of RBCs pyruvate kinase enzyme deficiency among
neonates with pathological indirect jaundice in Sharkia Governorate.
Patients and Methods: This Cross-sectional study was done in Neonatal Intensive Care Unit, Pediatric Department at
Zagazig University Hospitals during the period between June 2018 and December 2018. This study included 95 patients
with pathological indirect hyperbilirubinemia.
Results: There was statistically significant positive correlation between total bilirubin and all of reticulocytes' count,
and platelet count. There was statistically significant negative correlation between total bilirubin and all of hemoglobin,
red blood cells (RBCs), mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC).
There was non-significant correlation between it and other parameters. Pyruvate kinase deficiency was diagnosed in
4.2% of 95 patients with indirect hyperbilirubinemia. Glucose-6-phosphate dehydrogenase (G6PD) deficiency was
diagnosed in 16.8%.
Conclusion: Red blood cells (RBCs) pyruvate kinase enzyme deficiency among neonates with pathological indirect
jaundice is the second enzyme deficiency cause indirect jaundice after G6PD and is a risk factor related to pathological
jaundice in neonates.
Keywords: Indirect hyperbilirubinemia, Pyruvate kinase enzyme, non-spherocytic, hemolytic anemia, Neonatal

European area while few cases diagnosed in Middle
Mature erythrocytes completely depend on
East, Japan, China, Spain and Saudi Arabia. Clinical
glucose as a source of energy. Glucose is catabolized to
presentation of PK deficiency ranges from hydrops
pyruvate and lactate in the Embden-Meyerhof pathway,
fetalis to mild compensated hemolytic jaundice. Severe
which is the major anaerobic glycolytic pathway (1). In
enzyme deficiency presented early in life, while mild
glycolytic pathway the enzyme pyruvate kinase acts on
deficiency passes unnoticed till later age (6).
phosphoenolpyruvate and convert it to pyruvate, so
The second most common cause of neonatal non-
generate adenosine triphosphate (2).
spherocytic non-immune indirect hyperbilirubinemia in
Four known PK isoenzymes (M1, M2, L and R),
the United States is pyruvate kinase deficiency after
encoded by two separate genes (PK-M and PK- LR).
G6PD deficiency (7). In India the prevalence of pyruvate
PK-R isoenzyme is specific for RBCs (3). Insufficient
kinase deficiency in neonates with indirect
ATP formation due to pyruvate kinase deficiency
hyperbilirubinemia was 3.21%(6). In Egypt, 2.8% was
affects RBCs metabolism and loss of RBCs membrane
the prevalence of pyruvate Kinase deficiency in
plasticity leading to its trapping and destruction in
research study in Cairo University(3).
spleen resulting in hemolytic jaundice (4). Unconjugated
In our study we tried to know the prevalence of
jaundice in neonates is one of the most frequent diseases
pyruvate kinase deficiency in Egyptian neonates with
in neonatal period. Many causes can be encountered in
indirect hyperbilirubinemia in Sharkia Zagazig
this condition, which may be physiological or

Pathological indirect hyperbilirubinemia in
neonates may be immune or non-immune. Non-immune
This cross-sectional study was done in Neonatal
causes are RBCs enzymopathy, RBCs membrane
Intensive Care Unit (NICU), Pediatric Department at
abnormalities and haemoglobinopathies. Kernicterus is
Zagazig University Hospitals during the period between
serious neurological sequelae of severe rise of indirect
June 2018 and December 2018. This study included 95
bilirubin(5). Pyruvate kinase enzyme deficiency is an
patients with pathological indirect hyperbilirubinemia.
autosomal recessive disorder with both male and female

equally affected. It is the most common enzyme
Patient criteria:
abnormality in the glycolytic pathway of red blood cell
Age group: less than 28 days of life (neonates).

Pyruvate kinase enzyme deficiency was described
Inclusion criteria: neonates with pathological indirect
firstly 1961. Most of cases were found in north
Received: 08/06/2022
Accepted: 15/08/2022

Full Paper (vol.891 paper# 152)

c:\work\Jor\vol891_153 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5111- 5115

Surgical Offloading versus Medical Conservative Methods in Management of
Diabetic Foot Plantar Ulcers (Interventional Study)
1Abdelwahab S*, 2AbdElbaryM,3AbdElnasserA,3Abd-erRazik M
1National Institute of DM and Endocrinology
2Vascular Surgery Division, 3Department of General Surgery, Faculty of Medicine, Ain Shams University
*Corresponding author: SamehAbd-ElgawadAbd-Elwahab, Mobile: (+20)01019191647;
Email: dr.samehghazi55@gmail.com

As a result, peripheral neuropathy is frequently caused by diabetes (DM). Diabetic plantar foot pressure
ulcers develop from the lack of protective pain sensibility as a result of recurrent shear and tear pressures. Relieving
pressure on the foot's sole is necessary for the ulcers to heal.
This study aimed to test the effectiveness of surgical and non-surgical unloading procedures in healing of
plantar ulcers.
Subjects and methods: 50 diabetic foot ulcer patients who visited Ain Shams University, The National Institute of DM,
and the Endocrinology Outpatient Clinic participated in this interventional trial (NIDE). We employed mechanical and
surgical unloading methods in this trial, and patients were monitored for 6 months to see how long it took for their
injuries to recover.
Results: At the conclusion of the follow-up period, 88% of the surgical group's pressure ulcers were fully healed
compared to 86.7% of the non-surgical patients (6 months). Infection, recurrence, and non-healing were complications
we encountered throughout the follow-up period. Regarding the treatment of plantar diabetic foot ulcers (DFUs),
offloading is crucial. Compared to using only non-surgical methods, surgical offloading may hasten the recovery time.
A well-trained team is necessary to prevent the issues with improperly fitting footwear and to teach the patient how to
use them on a regular basis with the non-surgical offloading technique.
Diabetic foot, Pressure ulcer, Peripheral neuropathy.

crucial for diabetic foot plantar ulcer treatment [8].This
Patients with DM typically experience foot issues
study compared surgical and nonsurgical methods of
that deteriorate their health. Due to variations in
offloading in order to compare the rates of complete
socioeconomic standards, foot care practices, and foot
plantar diabetic foot ulcer healing, as well as the time
diseases, the severity of foot problems differs by region.
until healing and the incidence of recurrence in both
DFU is one of the main reasons diabetes patients are
admitted to hospitals and one of the main causes of

morbidity [1, 2].The primary causes of foot ulcers are
peripheral neuropathy, mild trauma to the foot,
50 diabetic patients who visited the Outpatient
peripheral arterial disease, and diabetes mellitus [3,4].
Clinic at Ain-Shams University, National DM Institute,
In diabetic patients, higher plantar pressure
had diabetic foot ulcers, and the Endocrinology
increases the risk of developing plantar ulcers, which
Department participated in this interventional trial
increases the need for lower extremity amputation
(NIDE). They all had an unloading technique, including
[5,6].The possibility of infection exists if a skin ulcer has
25 surgical and 25 non-surgical ones. They were
developed. Only one-third of foot ulcers fully heal [3].
monitored for a minimum of six months.
Education, blood sugar management, wound

debridement, improved dressing, unloading, advanced
Inclusion criteria: Diabetes patients with plantar non-
therapies, and, in certain cases, surgery, can all help to
ischemic ulcers that did not heal after six months.
lessen the severity of problems brought on by DFU [2].

Offloading, a pressure modulation technique, works
Exclusion criteria: Patients with coagulopathy, those
best when pressure is reduced in an area with significant
with persistent infections that have not improved after
vertical or shear stress while treating diabetic foot
their first surgical debridement, those undergoing
ulcers. Bed rest, wheel chair usage, and walking with
radiation or chemotherapy, those in poor cardiological
crutches are common methods of unloading the foot.
condition (with an ejection fraction less than 35%), and
However, they are impracticable due to the patient's
those on dialysis if they had renal failure.
autonomy and quality of life restrictions. Patients with
Cases suffering from ischemic diabetic foot ulcers were
diabetic foot problems can move around without
evenly divided into two groups using the closed
limitation thanks to offloading orthotics. Whole contact
envelope simple randomization approach, with group
casts, felted foam, therapeutic shoes, partial shoes,
(A) getting group (B) receiving surgical unloading as
detachable cast walkers, and surgical offloading are a
opposed to non-surgical offloading. The research work-
few other offloading techniques [7,8]. Off-loading is
Received: 7/6/2022
Accepted: 14/8/2022

Full Paper (vol.891 paper# 153)

c:\work\Jor\vol891_154 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5116- 5122

Side-to-End Versus End-to-End Colorectal Anastomosis Following Anterior
Resection of Rectal and Recto-Sigmoid Cancers, A Randomized Clinical Trial
Mohamed Abdwahed*, Sherief M. Mohsen, Ahmed M. Farrag
Department of General Surgery, Faculty of Medicine, Ain Shams University
*Corresponding author: Mohamed Abdwahed, Mobile: (+20)1004764432, E-Mail: Adel2171985@gmail.com

Recto-sigmoid and rectal tumors are now treated with anterior resection as the gold standard. However,
anastomotic leakage and the temporary use of a covering stoma after resection provide a significant problem for
colorectal surgeons. The technique of anastomosis is critical in preventing anastomotic leakage. Some surgeons believe
that side-to-end anastomosis is superior to end-to-end anastomosis, whereas others do not.
Objective: The current study was aimed to compare the surgical outcome, particularly the incidence of anastomosis
leakage, between two groups using various surgical techniques.
Patients and Methods: This is a prospective randomized clinical trial (RCT) that included 107 patients with recto-
sigmoid and rectal malignancies. Between March 2018 and March 2022, patients were treated at Ain-Shams University
Hospitals with elective laparoscopic anterior resection. Patients were divided into two groups using sealed envelope
method. Following anterior resection, Group A had side-to-end anastomosis (SEA) using a double stapling technique,
while Group B had end-to-end anastomosis (EEA) utilizing a trans-anal circular stapler.
Results: After anterior resection, Group A (35 men and 20 women) received side-to-end anastomosis, while Group B
(31 men and 21 women) underwent end-to-end anastomosis. There were no statistically significant differences between
the two groups as regard body mass index (BMI), smoking and tumor location. The end-to-end anastomosis group had
a statistically significantly longer mean operative time than the side-to-end anastomosis group (251.71 vs. 227.15
minutes, respectively) (P value 0.001). There was no statistically significant difference in anastomotic leakage between
the two groups, with a P value of 0.262 (2 instances, 3.6% in SEA Group vs. 5 cases, 9.6% in EEA Group).
: It could be concluded that side to end colorectal anastomosis could be an alternative to end to end with
shorter operative time.
Keywords: anastomotic leakage, anterior resection, side to end anastomosis.


anastomotic leakage between the side-to-end
The standard operation for rectal and recto-sigmoid
anastomosis group (SEA group) and the end-to-end
cancer is anterior resection (1,2). Despite advancements
anastomosis group (EEA group) following anterior
in laparoscopic equipment and, more recently, robotic
resection for recto-sigmoid and rectal cancers.
surgery, anastomotic leakage remains a serious

difficulty and a terrifying consequence that occurs in the
early postoperative period following resection (2). The
This prospective randomized clinical trial included a
incidence of anastomotic leakage has been documented
total of 112 patients with recto-sigmoid and rectal
in the literature ranging from 2% to 15%, regardless of
malignancies, treated at Ain-Shams University
temporary usage of a covering stoma (3). Anastomotic
Hospitals with elective laparoscopic anterior resection.
leaking is complicated. However, many of these
This study was conducted between March 2018 and
characteristics are still debatable. An increase in
March 2022.
anastomotic leakage rate has been associated to male

sex, increased BMI, and medical comorbidities such as
A preoperative colonoscopy and histopathological
diabetes, hypertension, and chronic illnesses (4).
evaluation revealed that the patients had sigmoid or
On the other hand, the technique of the anastomosis
rectal cancer. Pre-operative tri-phase pelvic-abdominal
represents a crucial factor in avoiding anastomotic
computed tomography (CT) and pelvic magnetic
leakage. It has been reported that blood flow is better at
resonance imaging (MRI) revealed no distant
the anti-mesenteric border than at the end of the colon
metastases. Curative resection (R0), followed by
(5). Moreover, blood flow at the anastomotic site is
colorectal continuity repair with or without a covering
associated with anastomotic leakage (6). Therefore, side-
to-end anastomosis could be associated with a better

outcome than end-to-end anastomosis. Furthermore, the
Following anterior resection, the included subjects were
principle of side-to-end anastomosis is considered the
divided into two equal groups using sealed envelope
standard technique in other gastrointestinal surgeries,
randomization method; Group A (SEA Group):
such as esophago-jejunal anastomosis.
consisted of 56 patients who underwent side-to-end
The aim of this study was to compare the
colorectal anastomosis (SEA) with double stapling
surgical outcomes in terms of the incidence of
(linear and trans-anal circular staplers) and Group B
Received: 09/06/2022
Accepted: 16/08/2022

Full Paper (vol.891 paper# 154)

c:\work\Jor\vol891_155 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5123- 5128

Predictors of Endoscopy Success in Treatment of Pediatric
Idiopathic Obstructive Hydrocephalus
Mohamed M. Elmaghrabi*1, Ahmed A. Arab1, Tamer A. Samih2, Mona A. Elawady3, Mahmoud M. Wahdan1
Departments of 1Neurosurgery, 2Radiology, 3Public Health, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Mohamed M. Elmaghrabi, Mobile: (+20)1222751406, Email: dr_elmaghrabi@yahoo.com

Hydrocephalus is defined as an inappropriate increased pressure of cerebrospinal fluid (CSF) within the
intracranial spaces with an inappropriate amount of CSF. Endoscopic third ventriculostomy (ETV) is considered an
effective procedure that is safe.
: The aim of the current work was to detect the factors those predict success parameters in selecting patients
with idiopathic obstructive hydrocephalus as candidates for the ETV procedure at a pediatric age.
Patients and methods:
A clinical prospective cohort study was conducted at Benha University Hospitals from
September 2018 to July 2021. A total of 61 patients with inclusion criteria of idiopathic (congenital) obstructive
hydrocephalus of pediatric age (under 18 years old) with and without previous ventriculoperitoneal (VP) shunt insertion
were included according to calculated sample size who undergoing ETV with a follow-up period of 6-12 months. All
patients were evaluated by pre and post-operative operative MRI CSF flowmetry.
Results: Sixty-one patients were operated on, with age ranged from 3 to 120 months, and the median (IQR) was 13.0
(5.5-24). Previous VP shunting was done in 15 patients (24.6%). According to the receiving operator characteristic
(ROC) curve, the cut off point for ETV success age was 11.5 months; while the cut off point for ETV success score
(ETVSS) was 70. MRI CSF flowmetry detected and measured the size of the ventriculostomy stoma and evaluated the
flow direction and stroke volume.
Conclusions: It could be concluded that endoscopy has reliable validity and safety in the treatment of idiopathic
obstructive hydrocephalus. ETV success predictors are patients' age above 11.5 months and ETVSS 70, led to increase
validity of endoscopy. MRI CSF flowmetry is safe and accurate method for evaluation of the ventriculostomy stoma.
Keywords: Predictors, Endoscopy, Hydrocephalus, Pediatric.

This clinical prospective cohort study included a total
Hydrocephalus is defined as an inappropriate
of 61 patients with inclusion criteria of idiopathic
increased pressure of cerebrospinal fluid (CSF) within
obstructive hydrocephalus, treated at Benha University
the intracranial spaces with an inappropriate amount of
Hospitals. This study was conducted between
CSF. So it included a variety of childhood and adult
September 2018 to July 2021.
syndromes of abnormal CSF flow, production, or

absorption patterns with the sequelae of their
Figure 1 shows patients with inclusion criteria of
management. The main cause of congenital
idiopathic obstructive hydrocephalus, aqueduct stenosis,
hydrocephalus is obstruction resulting from local
and pediatric age (under 18 years old) with and without
narrowing of the CSF pathway due to idiopathic
previous ventriculoperitoneal (VP) shunt insertion were
aqueduct stenosis (1).
included. Sample size was calculated according to data
Endoscopy is considered a good alternative for
obtained using the Epi Info program Version 3, open-
shunt dependence; an opening is created in the floor of
source calculator, SS Cohort (4).
the third ventricle (endoscopic third ventriculostomy;

ETV) using an endoscope placed within the ventricular
system through a burr hole. So, allowing the movement
of CSF across the blocked ventricular pathway into the
interpeduncular cistern (a normal CSF space) results in
bypassing the obstruction. The aim of ETV is to
normalize the intracranial pressure and its compression
on the brain matter without using a shunt (2).
ETV is considered as a safe effective procedure.
The pre-operative ETV success score may be useful for
predicting post-operative outcomes (1).
This study was aimed to identify the factors
predicting the success parameters in selecting patients

with idiopathic obstructive hydrocephalus as candidates
for the ETV procedure at pediatric age.


Received: 09/06/2022
Accepted: 16/08/2022

Full Paper (vol.891 paper# 155)

c:\work\Jor\vol891_156 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5129- 5135

Upper Endoscopy Biopsy Versus Helicobacter Pylori Antigen in
Stool Test in Evaluation of Helicobacter Pylori Infection
Mohamed Ahmed Abo El-Ennen1, Sherif M. Galal1,
Salama S. Alghonaimy1, Hesham Radwan Abdel Aziz2, Nabila Hassan Ahmed*1
Departments of 1Tropical Medicine and 2Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Nabila Hassan Ahmed, Mobile: (+20) 01050027032, E-Mail: nhhasan@medicine.zu.edu.eg


Background: Infection with the bacteria Helicobacter pylori is frequent in both young and old. Antibiotic susceptibility
testing on an individual or community level, as well as data on antibiotic use and clinical outcomes, should inform the
most effective local regimen for eradication. Objective: The aim of the current work was to evaluate the efficacy of
commonly used antibiotics against Helicobacter pylori and to determine diagnostic stool antigen test accuracy performed
after H. pylori medical treatment.
Patients and Methods: This prospective single arm cohort study included a total of 55 patients who tested positive for
H. pylori, followed at Departments of Tropical Medicine and Pathology, Zagazig University Hospitals. This study was
conducted between July 2020 and January 2021.
Results: H. pylori infection was more common in middle age group 32.6±8.58 and more in female (56.4%). The most
frequent presentations were dyspepsia (63.6%), epigastric pain (23.6%) and abdominal fullness 12.7% of the cases.
Gastritis 49.1%, duodenitis 32.7%, gastric ulcer 12.7% and duodenal ulcer 10.9%, are the common endoscopic diagnosis
in H. pylori infection. After therapy, there was a moderate statistically significant agreement between biopsy and stool
in diagnosis of H. pylori infection with sensitivity 90%, but specificity 73.3% and accuracy 76.4%.
Conclusion: It could be concluded that Helicobacter Pylori stool antigen test is highly sensitive with moderate
specificity and accuracy for diagnosis of H. pylori infection post anti H. pylori therapy.
Keywords: Helicobacter, Antigen, Histopathology, Endoscopy; biopsy.


The cost of a stool antigen test is low, and while
Both toddlers and adults suffer from Helicobacter
some patients may be hesitant to provide a fecal sample,
pylori infection at alarming rates (1). Helicobacter pylori
doing so is typically painless. Enzyme immunoassays
infects around 50% of the global population (2).
and immunological chromatography can be used to
Helicobacter pylori are Gram-negative bacteria
detect Helicobacter-specific antigen in stool samples (5).
that do not produce spores (3). Almost all cases of H.
Rapid in-office immuno-chromatographic stool
pylori infection are acquired, and at first, the vast
antigen testing are as easy as a pregnancy test but less
majority of infected people show no signs of illness.
precise because they do not require a laboratory (6).
Gastritis, gastric or duodenal ulcer, mucosa-associated
Monoclonal test kits for stool antigens are more
lymphoid tissue (MALT) lymphoma, and gastric cancer
sensitive than polyclonal testing. If a patient has
are only some of the gastrointestinal problems that can
diarrhea and their stools are loose and watery, the
be caused by H. pylori infection throughout the course
antigen concentration will be diluted, decreasing the
of a patient's lifetime, making this infection clinically
sensitivity (5).
significant. Infection with the bacterium Helicobacter
Rather than only testing for H. pylori infection to
pylori has been linked to health issues outside of the
rule it out, it is suggested that patients with a family
digestive tract, including malnutrition, iron deficiency
history of stomach cancer undergo diagnostic testing (4).
anemia and stunted development (4).
However, H. pylori testing may also be explored
Due to the rarity of natural eradication, infection
for people with iron deficiency anemia that has not
typically persists for life in the absence of effective
responded to previous treatments. In both children and
therapy (1).
adults, H. pylori infection can be confirmed using a
The proper care of symptomatic H. pylori-
rapid urease test, a culture for H. pylori, and tissue
infected individuals depends on prompt and accurate
staining using stomach tissues obtained during an
diagnosis. Several different H. pylori diagnostic tests
endoscopy of the upper gastrointestinal tract.
based on the bacteria's morphological, immunological,
Histological testing of at least two tissue samples from
genetic, or enzymatic properties have been established.
the stomach antrum and body is required according to
Methods can be categorized as either non-invasive
evidence-based criteria for H. pylori infection (4).
(stool antigen test, 13C-urea breath test as well as
The optimum locally effective regimen for
serology) or invasive (culture, urease test, histology)
eradication should be based on either individual or
based on whether or not they necessitate endoscopy of
community antibiotic susceptibility testing, or data
the upper gastrointestinal tract and gastric biopsies.
regarding antibiotic use and clinical results (7, 8).
Each test has benefits, drawbacks, and restrictions
The effectiveness of eradication therapy should
depending on the clinical context and question being
be monitored regularly (test for cure), preferably with
asked (5).
noninvasive methods. For H pylori treatment to be
Received: 10/06/2022
Accepted: 17/08/2022

Full Paper (vol.891 paper# 156)

c:\work\Jor\vol891_157 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5136- 5139

A Rare Tumor: Hibernoma in The Thigh: Case Report
Abdullah Alhazmi1, Othman Saeed Alghamdi2, Almufarrh Dhafer Saad2, Abdulaziz Ahmed N. Alanazi3
1Department Orthopedic Surgery, King Abdulaziz Medical City, Jeddah, Saudi Arabia
2Department Orthopedic Surgery, East Jeddah Hospital, Jeddah, Saudi Arabia
3Department Orthopedic Surgery, King Faisal Specialist and Research Center Jeddah, Jeddah, Saudi Arabia
*Corresponding author: Abdulaziz Ahmed N. Alanazi, Mobile: +966509988659, E-Mail: a.alanzee7@gmail.com

Hibernomas are soft tissue tumors that form from lingering brown fat cells and tend to form in locations
where brown fat is more prevalent in fetuses and babies. They are uncommon, grow slowly, cause no discomfort, and
are benign. Because of its rarity, this tumor type is commonly misdiagnosed as liposarcoma or dismissed altogether.
Objective: The objective of this case study was to achieve accurate diagnosis for the rare tumor hibernoma in the thigh.
Case report: 33-Years-old female not known to have any chronic medical illness, gastric sleeve before 4 years,
cholecystectomy 1 year back, and her condition started 5 year back when she noticed left knee lump. Initially she sought
medical advice and was told it is lipoma. She was advised for weight loss. No history of trauma or falling. After she lost
weight, it become more prominent with knee pain for the last year.
Conclusion: As a result of their rarity and underreporting, hibernomas are frequently misinterpreted as either big
lipomas or malignant soft tissue tumors, which necessitate the need of histology in achieving an accurate diagnosis and
anticipating intraoperative outcomes. Tumors can only be removed safely through meticulous dissection and ligation of
the vasculature, which requires knowledge of the surrounding anatomy.
Keywords: Rare tumor, Hibernoma, CT, X-ray, Orthopedic surgery.

Social history:
Hibernomas are uncommon soft tissue tumours that
-She was single living in orphanage in Altaif (Alamin
originate in the body's remaining brown fat cells and are
hospital). Currently, she is living with her friend in
considered benign (1). They are rare in the skull and
Jeddah, currently unemployed and currently taking
popliteal fossa, and are seen most often in individuals
multivitamins since her gastric sleeve.
between the ages of 30 and 40 years (2). In addition to

the lower and upper extremities, the abdomen is a rare
Discussed with most responsible physician (MRP):
site (1, 2). Hibernomas present as slow-growing, painless
On 20 October (2020), patient was informed to come to
masses that are often mistaken for other tumour forms
be assessed.
like liposarcomas (3). With six distinct histological types

recognized (4), atypical lipomas and well-differentiated
Follow up clinic with oncology orthopedic:
liposarcomas are common misdiagnosis of the lipoma-
like variety (1).
Patient was 33 years old female and not having
In most cases, surgical removal of a hibernoma is
any medical illness. She came to the clinic complaining
the treatment of choice. Generally speaking, a total
of left thigh swelling and pain for 5 years not increasing,
surgical removal is curative (5, 6).
not associated with fever, trauma, weight loss or other

masses, MRI done outside without contrast.

Adult oncology clinic as consultation and history of
Assessment plan:
Patient had left thigh middle to distal anteromedial
33-Years-old female not known to have any
mass 10 CM X 8 CM mobile with skin and
chronic medical illness, gastric sleeve before 4 years
subcutaneous not adherent to deep soft tissue with no
and cholecystectomy 1 year back. Her condition started
color change. It was mildly painful and there was no
5 years back when she noticed left knee lump initially
hotness or signs of inflammation. MRI from outside
sought medical advice and was told it is lipoma that
showed a mass originating from the fatty tissue not
recommend to lose weight. No history of trauma or
invading the muscular structure and separated by the
falling, after she lost weight, it become more prominent
muscular septa.
with knee pain for the last year.

She asked for medical advice in Altaif (Alamin
Diagnosis: US-guided biopsy, lipoma vs liposarcoma
hospital). Initially ultrasound showed suspicious lesion
invading muscles recommended for resection but

patient refused for resection or biopsy, before 3 months

she sought another medical advice.

MRI was done 9 cm X 3 cm and was recommended for
CT guided Biopsy:

Received: 11/06/2022
Accepted: 18/08/2022

Full Paper (vol.891 paper# 157)

c:\work\Jor\vol891_158 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5140- 5147

Is Sonographic Morphology of Early Embryonic Complex Can
Predict of Pregnancy Outcome?
Hatshepsot Magdy Abd_Elhamed Seliha*, Mohamed Mohamed Eltoutongy,
Mohamed Hassan Hussein Bediary, Emad Ahmed Fayala
Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Hatshepsot Magdy Abd_Elhamed, Mobile: (+20) 01066885412, E-Mail: dr.hatshepsot@hotmail.com

There is a high rate of spontaneous abortion in the first trimester of pregnancy, affecting an estimated 30­
40% of all implantations. A low implantation location, a large or irregular yolk sac, a weak decidual reaction, and a
sluggish embryonic heart rate are just few of the many sonographic indicators of predictors of poor result that have been
identified by many authors. The aim of the current study is to investigate the predictive value of abnormal gestational
sac morphology at 6-8 week for the pregnancy outcome.
Patients and methods: The present study was a follow up observational study that included 188 patients aged 18-35
years, who presented at 6-8 weeks of gestation between May 2019 and February 2021 at Mansoura University Hospital's
Antenatal Care Outpatient Clinic.
Results: Larger gestational sac was associated with abnormal pregnancy outcome, like abortion (2.25±0.58 cm), preterm
labor (2.33±0.0 cm), intrauterine feal death (IUFD) (2.70±0.28 cm), intrauterine growth retardation (IUGR) (2.93±0.93
cm) and abruptio placenta (3.45±2.19 cm). Also, larger yolk sac was also associated with abnormal pregnancy outcome,
like preterm labor (5.0±0.0 cm), IUGR (5.57±1.07 cm), and IUFD (5.50±0.71 cm). Moreover, higher fetal HR was
associated with abnormal pregnancy outcome, like preterm labor (155.0±0.0 bpm), IUFD (157.50±3.53 bpm), and IUGR
(171.0±4.58 bpm). Conclusion: Statistically highly significant correlations were found between both yolk sac size and
fetal heart rate, and abnormal pregnancy outcome, despite the fact that there was no link between gestational sac size
and an increased risk of a negative pregnancy outcome.
Sonography, Morphology, Early embryonic complex, Pregnancy, Predictive outcome.

expand until week 10 of pregnancy (7). When the mean
gestational sac diameter is greater than 8 mm without a
Twenty-five to 30% of embryos are lost before
yolk sac, or greater than 16 mm without an embryo, a
the pregnancy is clinically identified, and 15% to 25% of
blighted ovum can be definitively diagnosed using
clinical pregnancies spontaneously abort during the first
transvaginal sonography. A blighted ovum can be
trimester (1).
diagnosed transabdominally if the gestational sac is
During embryonic development, the major
larger than 20 mm without a yolk sac, or 25 mm without
viscera take shape. These structures mature and reach
an embryo (8).
their full functional potential throughout gestation. In the
First, the yolk sac appears, then the embryo
context of a prenatal diagnosis, ultrasound is the gold
develops, and finally the heart begins to beat (9). At
standard (2,3). Kratochwil and Eisenhut were the first to
around 5-6 weeks, a healthy resting fetal heart rate
report the successful demonstration of an early
(FHR) is around 110 beats per minute (bpm). 9-10 weeks
to get 170 bpm. After this, the average FHR will drop to:
ultrasonography (TVS) (3).
150 beats per minute by week 14, 140 by week 20, and.
With TVS, a yolk sac and a Hypoechoic complex
Term-average heart rate of 130 beats per minute (10).
within the thickened Decidualized endometrium are
Fetal bradycardia refers to a low fetal heart rate,
among the earliest indicators of an intrauterine
which is typically described as: FHR 100 bpm before 6
pregnancy (IUP). When a sonogram is performed on a
weeks gestation, or FHR 120 bpm between 6 and 7
pregnant woman, the secondary yolk sac is the first
weeks. Fetal tachycardia refers to an abnormally high
extraembryonic structure that may be seen (2).
heart rate in a developing baby and is typically classified
When the mead sac diameter (MSD) is 5 to 6mm,
as: Fetal tachycardia is defined as a heart rate in the fetus
a yolk sac is plainly visible using transvaginal
that is greater than 160 to 180 beats per minute, with a
sonography. When a gestational sac is bigger than 8 mm,
heart rate of around 170 being on the cusp of being
it is standard practice to check on the yolk sac (4).
considered (10).
The normal appearance of the yolk sac is that of
Approximately 30-40% of all implantations are
a spherical structure with an anechoic center surrounded
lost to spontaneous abortion, and the vast majority of
by a homogeneous well-defined echogenic wall. So, the
these abortions occur within the first trimester (6). If fetal
yolk sac is important, and then the embryo appears and
cardiac activity has been established, however, the
the heart starts beating (5). The presence of a yolk sac is
chance of a spontaneous abortion is reduced to 2-5% (7).
definitive evidence of a genuine gestational sac (6).
At 6 weeks of pregnancy, antenatal sonography
A yolk sac's diameter is typically 2-5 mm
with a transvaginal transducer can typically detect the
between weeks 6-8 of pregnancy and continues to
embryonic heartbeat, and the heart rate can be examined
Received: 11/06/2022
Accepted: 18/8/2022

Full Paper (vol.891 paper# 158)

c:\work\Jor\vol891_159 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5148- 5156

Correlation of QRS Duration with Myocardial Blush Grade as a Marker of
Myocardial Reperfusion in Patients with ST Segment Elevation
Myocardial Infarction Undergoing Revascularization
Abdelsalam Elsayed Sherif, Nader Talat Kandil, Waleed Salem El-Awady, Amr Abdallah Ahmed Sherif*
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Amr Abdallah Ahmed Sherif, Mobile: (+20)1111345333, E-mail: newmiro2000@gmail.com

Acute myocardial infarction represents a major cause of heart failure, arrhythmia, and mortality in patients
with coronary artery disease and impaired microvascular reperfusion is an important prognostic determinant in patients
undergoing revascularization with either primary percutaneous coronary intervention (PCI) or pharmaco-invasive
strategy after ST-segment elevation myocardial infarction (STEMI).
Objective: The aim of the current work was to evaluate the outcome of patients presenting with acute ST-segment
elevation myocardial infarction by determining the impact of correlation of QRS duration with myocardial blush grade
of myocardium as a marker of myocardial reperfusion following revascularization procedures.
Patients and Methods: This prospective cohort study was conducted at Cardiology Department, Zagazig University
Hospitals and National Heart Institute. We included 119 patients with acute ST-segment elevation myocardial infarction
undergoing revascularization. Patients were divided into two groups according to the reperfusion strategy. Group I:
included 70 patients with primary percutaneous coronary intervention (PCI) and Group II: included 49 patients with
pharmaco-invasive strategy.
Results: Post catheter QRS duration of the studied patients was 82 msec, and it was significantly higher in group II (92
msec) than group I (74 msec) (P-value < 0.001). QRS duration 60 minutes post PCI was 83 msec, and it was significantly
higher in group II (96 msec) than group I (73 msec) (P-value was < 0.001). The mean ST resolution was 51, and it was
significantly higher in group I (61) than group II (36) (P-value < 0.001).
Conclusions: It could be concluded that longer QRS duration after angioplasty seemed to indicate the presence of
impaired microvascular reperfusion in patients with STEMI.
Keywords: Primary angioplasty, Coronary flow, STEMI.


duration) and the invasive marker (MBG) of myocardial
percutaneous coronary intervention (PCI) or pharmaco-
reperfusion. Risk stratification using the Thrombolysis
invasive strategy is the treatment of choice for patients
in Myocardial Infarction (TIMI) risk score for STEMI
presenting with ST-elevation myocardial infarction
is a simple assessment tool based on clinical data of
(STEMI). Patency of the infarct-related artery (IRA)
patients at hospital admission [5].
along with a good microvascular flow is the goal of
It is applied to patients with acute STEMI to
reperfusion therapy. However, restoration of the
predict mortality and to identify patients at high risk of
epicardial flow does not necessarily lead to restoration
developing other Major Adverse Cardiac Events
at the tissue level in all cases [1,2].
(MACE) as early prediction and expectations allows
Electrocardiographic (ECG) assessment of
prompt and effective interventions and follow-up
reperfusion therapy is mainly based on changes of the
ST-segment, but the significance of the QRS duration is
The aim of the current work was to evaluate the
still not very well established. Prolonged QRS duration
outcome of patients presenting with acute ST-segment
is associated with an increased risk of impaired
elevation myocardial infarction by determining the
ventricular systolic function and adverse effects [3].
impact of correlation of QRS duration with myocardial
While ST-segment resolution is related to
blush grade of myocardium as a marker of myocardial
myocardial perfusion and cell membrane integrity,
reperfusion following revascularization procedures.
myocardial blush grade (MBG) reflects myocardial

perfusion and microvascular patency. MBG has been
found to be a predictor [independent of thrombolysis in
This prospective cohort study included a total of 119
myocardial infarction (TIMI) flow] of both in-hospital
patients with acute ST-segment elevation myocardial
and long-term mortality in patients with acute
infarction undergoing revascularization, attending at
myocardial infarction who underwent primary
the National