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
ABSTRACT
Introduction: 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
INTRODUCTION
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.
comparable.
However, Ahuja et al. (5) compared three different
PATIENTS AND METHODS
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
anastomosis
gastric
bypass
(OAGB),
and
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
comorbidities.
Several
studies
agreed
that
Shams University Hospitals.
biliopancreatic limb <200 cm is associated with lower
4146
Received: 13/03/2022
Accepted: 10/05/2022
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
ABSTRACT
Background: 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.
Results: 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.
INTRODUCTION
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].
IIII).
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
cardiovascular
diseases,
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
PATIENTS AND METHODS
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.
4151
Received: 2/2/2022
Accepted: 3/4/2022
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
ABSTRACT
Background: Levosimendan has anti-ischemic effects, improves myocardial contractility and increases systemic,
pulmonary and coronary vasodilatation.
Objectives: 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).
Conclusion: 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.
INTRODUCTION
allowing the ATP-sensitive potassium channels to be
Many individuals who are candidates for cardiac
opened(5).
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
Myocardial
stunning,
anesthetic
drugs,
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
mortality.
phenomena begins one hour (h) after the CPB is
terminated and lasts for 24 hours (4).
PATIENTS AND METHODS
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
4155
Received: 22/03/2022
Accepted: 19/05/2022
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
ABSTRACT
Background: 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
surgery.
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.
INTRODUCTION
SUBJECTS AND METHODS
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.
4165
Received: 32/03/2022
Accepted: 22/05/2022
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
ABSTRACT
Background: 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.
Objective: 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.
Keywords: Chronic kidney disease, Peripheral arterial disease, Vitamin D.
INTRODUCTION
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
PATIENTS AND METHODS
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,
study.
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
4171
Received: 07/04/2022
Accepted: 06/06/2022
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
ABSTRACT
Background: 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.
Results: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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
registered
in
Clinical
trial
registration:
4176
Received: 24/4/2022
Accepted: 21/6/2022
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
ABSTRACT
Background: 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
interpretation
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.
INTRODUCTION
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,
METHODS
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
(dissections,
vasculitis
and
specific
genetic
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
dissertations.
hypertension, but it also adds to atherosclerosis, which
4187
Received: 27/04/2022
Accepted: 26/06/2022
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
ABSTRACT
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
risk.
Keywords: Broken umbilical venous catheter (UVC), Cardiac catheterization, NICU.
INTRODUCTION
Arterial and venous umbilical catheters (UAC and
MATERIAL
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
abscess.
RESULTS
Table (1) showed the data of the registered cases since.
4191
Received: 27/4/2022
Accepted: 26/6/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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].
4197
Received: 26/4/2022
Accepted: 23/6/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
Numerous
epidemiological
studies
have
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
common
complaint
that
can
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).
have
not
been ignored,
uncomplicated
VVs
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
SUBJECTS AND METHODS
circulation abnormalities, and lower back issues (6).
Study design: A cross-sectional study was conducted
among women of childbearing age (15-50 years old).
4205
Received: 29/4/2022
Accepted: 28/6/2022
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
ABSTRACT
Background: 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.
Conclusion:
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.
Keywords: QTc dispersion, Assessment, Congenital hypothyroidism.
INTRODUCTION
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
abnormality
(central
or
secondary/tertiary
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).
Inclusion
criteria:
Patients
with
congenital
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
PATIENTS AND METHODS
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.
4211
Received: 29/4/2022
Accepted: 28/6/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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,
(11).
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,
MATERIAL AND METHODS
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
4215
Received: 25/4/2022
Accepted: 22/6/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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:
[2].
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
abnormalities
values of the bony structures in the CVJ in healthy
4226
Received: 26/4/2022
Accepted: 23/6/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
SUBJECTS AND METHODS
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,
musculoskeletal
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).
testing.
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
Procedures:
fitness, and body mass (5-8).
Anthropometry
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).
4235
Received: 26/4/2022
Accepted: 23/6/2022
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
ABSTRACT
Background: 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.
Keywords: Critically ill patients, Obstacles, Palliative Care, Performance.
INTRODUCTION
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
encounter
difficulties,
such
as
inadequate
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).
(2).
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
symptom
management,
psychological
support,
SUBJECTS AND METHODS
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
parts:
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).
4240
Received: 26/4/2022
Accepted: 23/6/2022
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
ABSTRACT
Background: 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.
Methods: 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.
INTRODUCTION
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
(1).
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
(4).
4247
Received: 30/4/2022
Accepted: 29/6/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
Various
anti-inflammatory
and
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
respiratory
distress
syndrome
(5).
The
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
immunomodulatory
effects
through
multiple
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
4251
Received: 28/4/2022
Accepted: 27/6/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
MATERIALS AND METHODS
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
4260
Received: 30/4/2022
Accepted: 29/6/2022
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
ABSTRACT
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.
INTRODUCTION
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,
Objective:
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
PATIENTS AND METHODS
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:
expensive[8].
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
4265
Received: 01/05/2022
Accepted: 30/06/2022
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
ABSTRACT
Background: 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.
Objective: The present review aims to assess of possible role of FABPs in T2DM and PAD.
Method: 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.
Conclusion: 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.
INTRODUCTION
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
METHOD
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
4270
Received: 02/05/2022
Accepted: 03/07/2022
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
ABSTRACT
Background: 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.
Keywords: Achilles, Percutaneous suture, Tendon, Rupture.
INTRODUCTION
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
function(9).
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
4273
Received: 30/4/2022
Accepted: 29/6/2022
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
ABSTRACT
Background: 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).
Results: 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
prostatitis.
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.
INTRODUCTION
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
PATIENTS AND METHOD
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).
4278
Received: 30/4/2022
Accepted: 29/6/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
psychosocial
processes,
females
are
more
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
hormone).
issue that has adverse effects on human health.
Understanding its responses, linked circumstances, and
SUBJECTS AND METHODS
effects is thus quite difficult. To better understand and
Inclusion Criteria:
4284
Received: 01/05/2022
Accepted: 30/06/2022
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
ABSTRACT
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
chemokines.
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.
INTRODUCTION
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
cycles.
receptive environment. Poor pregnancy outcomes have
also been linked to thin endometrium, which has been
PATIENTS AND METHODS
documented in 5 percent of women under 40 and 25
Study design and setting:
percent of women between 41 and 45 years old (6).
We
conducted
a
prospective
single-blind
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.
4292
Received: 1/5/2022
Accepted: 30/6/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
4298
Received: 01/05/2022
Accepted: 30/06/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
(6).
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
CASE REPORT
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:
fixation.
Right shoulder deformity
Neurology consultation was done
No open wounds
Patient was given good analgesia
And consented for operation.
4308
Received: 03/05/2022
Accepted: 04/07/2022
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
ABSTRACT
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
disease.
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.
INTRODUCTION
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.
ultrasound)
- Patient's refusal
PATIENTS AND METHODS
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.
4312
Received: 3/5/2022
Accepted: 4/7/2022
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
ABSTRACT
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.
Objective: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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
4317
Received: 28/4/2022
Accepted: 27/6/2022
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
ABSTRACT:
Background: 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
University.
INTRODUCTION
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
preoperatively
by
echocardiography
or
RV
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.
(9-11).
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.
PATIENTS AND METODS
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
4323
Received: 02/05/2022
Accepted: 03/07/2022
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
ABSTRACT
Background: 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.
Results: 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.
Conclusion: 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
women.
Keywords: Human papillomavirus, Genital wart, High-risk HPV-DNA, PCR, Al Ahrar Teaching Hospital, Zagazig
University.
INTRODUCTION
Infecting the epithelia of the skin or mucosa, the
PATIENTS AND METHODS
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
patients.
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).
conditions.
4327
Received: 02/05/2022
Accepted: 03/07/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
4332
Received: 03/05/2022
Accepted: 04/07/2022
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
ABSTACT
Background: 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.
Keywords: Fetal complications, Fibroblast growth factor 2, Gestational Diabetes mellitus, Maternal complications,
Type 2 diabetes mellitus.
INTRODUCTION
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).
PATIENTS AND METHODS
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
(4).
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
4340
Received: 8/05/2022
Accepted: 7/07/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
MATERIALS AND METHODS
low mitochondrial content [14,15,16] in contrast with Victor
Subjects:
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
4346
Received: 11/4/2022
Accepted: 8/6/2022
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
ABSTRACT
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.
Methods: 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
exposure.
Keywords: Di ethyl phthalate, Cardiovascular system.
INTRODUCTION
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.
4353
Received: 5/5/2022
Accepted: 6/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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.
Transthoracic
echocardiography
revealed
persistence of the small PDA that measured 1.5 mm at
CASE REPORT
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
5357
Received: 8/5/2022
Accepted: 7/7/2022
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
ABSTRACT
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.
INTRODUCTION
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
MATERIALS AND METHODS
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
(5).
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,
osteoporosis
(glucocorticoid
treated)
group,
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
4362
Received: 28/4/2022
Accepted: 27/6/2022
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
ABSTRACT
Background: 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
abdominoplasty.
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.
INTRODUCTION
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
4372
Received: 3/5/2022
Accepted: 4/7/2022
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
ABSTRACT
Background: 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.
Objectives: 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
incision.
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.
INTRODUCTION
periosteum, to cover the package away from skin
Endaural (EA) incision was first described by
incision(6).
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
incisura(1).
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
incision.
4381
Received: 5/5/2022
Accepted: 6/7/2022
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
ABSTRACT
Background: 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.
Conclusions: 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.
INTRODUCTION
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
coronary
thrombus.
To
rescue
jeopardized
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
PATIENTS AND METHODS
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
4386
Received: 04/05/2022
Accepted: 05/07/2022
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
ABSTRACT
Background: 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.
Results: 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.
Keywords: SLE; lupus nephritis; TNFAIP3; SLEDAI..
INTRODUCTION
immunological, and environmental factors. Despite
As a matter of fact, systemic lupus
intense research efforts in the field, the exact
erythematosus
(SLE) is termed
a
diffused
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
SUBJECTS AND METHODS
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,
4393
Received: 05/05/2022
Accepted: 06/07/2022
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
ABSTRACT
Background: 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
(GHQ).
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.
Conclusion: 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.
Keywords: Workaholism, Prevalence, Risk factors, Work Addiction Risk Test, Work Assessment Questionaire,
Psychological Capital Questionnaire, Zagazig University.
INTRODUCTION
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
tasks.
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
4402
Received: 09/05/2022
Accepted: 08/07/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
undertaken.
(1). Sciatic nerve injury may be caused by an undetected,
long-lasting nerve entrapment carried on by an incorrect
PATIENTS AND METHODS
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
4410
Received: 09/05/2022
Accepted: 08/07/2022
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
ABSTRACT
Background: 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.
Results: 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.
INTRODUCTION
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
patients.
inserting a central venous catheter, which is invasive,
4416
Received: 4/5/2022
Accepted: 5/7/2022
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
ABSTRACT
Background: 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
(p=0.024).
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.
INTRODUCTION
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
AIM OF THE STUDY
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)
4423
Received: 5/5/2022
Accepted: 6/7/2022
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
ABSTRACT
Background: 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
data.
Objective: Assessment of possible correlation between Interleukin 18 and liver cirrhosis.
Methods: 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.
INTRODUCTION
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
Processing:
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).
4430
Received: 8/5/2022
Accepted: 7/7/2022
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
ABSTRACT
Background: 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.
Results: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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
group.
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
4434
Received: 11/5/2022
Accepted: 18/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
(8).
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
pharmacological
modalities
for
treating
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).
PATIENTS AND METHODS
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
immunoglobulin
(IVIG),
D-penicillamine,
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
4439
Received: 11/5/2022
Accepted: 18/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
most
common
orthopedic
injury
requiring
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
PATIENTS AND METHODS
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
4444
Received: 11/5/2022
Accepted: 18/7/2022
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
ABSTRACT
Background: 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
outcome.
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.
INTRODUCTION
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
factors
for
osteoarthritis
(OA)
development,
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).
4450
Received: 11/5/2022
Accepted: 18/7/2022
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
ABSTRACT
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.
INTRODUCTION
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-
processes,
including
cell
division,
apoptosis,
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
MATERIAL AND METHODS
pressure regulation (5).Therefore it is affecting the
Sixty
patients
(men
and
women)
with
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
4457
Received: 11/5/2022
Accepted: 18/7/2022
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
ABSTRACT
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.
INTRODUCTION
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
OBJECTIVES
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,
PATIENTS AND METHODS
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
adults(3).
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-
4461
Received: 11/5/2022
Accepted: 18/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
4470
Received: 12/5/2022
Accepted: 19/7/2022
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
ABSTRACT
Background: 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.
Methods: 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.
INTRODUCTION
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
(4).
minimize side effects by allowing lower PDL dosages
(7).
4478
Received: 15/5/2022
Accepted: 20/7/2022
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:
mohmed892003@gmail.com
ABSTRACT
Background: 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.
Methods: 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
dosage.
Keywords: Dapoxetine, Serotonin reuptake inhibitors, Premature ejaculation.
INTRODUCTION
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
4481
Received: 15/05/2022
Accepted: 20/07/2022
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
ABSTRACT
Background: 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.
Results: 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.
INTRODUCTION
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,
Pre-operative:
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
PATIENTS AND METHODS
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
4484
Received: 16/5/2022
Accepted: 21/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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
analgesia.
screen for abnormal labor. With its use, there is no need
Sample size: Sample size calculation was based on
4488
Received: 15/5/2022
Accepted: 20/7/2022
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
ABSTRACT
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.
INTRODUCTION
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
PATIENTS AND METHODS
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
4495
Received: 8/5/2022
Accepted: 7/7/2022
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
ABSTRACT
Background: 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
transfusions.
Keywords: Cesarean Sections, Intra-Abdominal Adhesions, Wound infections, Blood transfusions, Nair's score.
INTRODUCTION
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
(4).
PATIENTS AND METHODS
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.
(7).
4500
Received: 16/5/2022
Accepted: 21/7/2022
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
ABSTRACT
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.
INTRODUCTION
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
parameters(8).
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
Received:16/5/2022
Acepted:21/7/2022
4507
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
ABSTRACT
Background: 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
Egyptians.
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
INTRODUCTION
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
(15).
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
4516
Received: 9/5/2022
Accepted: 8/7/2022
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
ABSTRACT
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.
vaginalis was very predictable among adult female who had PID.
Keywords: Pelvic inflammatory disease, Pelvic organs tenderness, Trichomoniasis, Trichomonas vaginalis.
INTRODUCTION
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
PATIENTS AND METHODS
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
4526
Received: 17/5/2022
Accepted: 24/7/2022
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
ABSTRACT
Background
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.
INTRODUCTION
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
PATIENTS AND METHODS
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
4535
Received: 10/5/2022
Accepted: 17/7/2022
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
ABSTRACT
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.
INTRODUCTION
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
4540
Received: 12/5/2022
Accepted: 19/7/2022
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
ABSTRACT
Background: 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
children.
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.
Results: 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.
Conclusion: 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.
Keywords: Steroid Resistant Nephrotic Syndrome, Immunoglobulin M, Children.
INTRODUCTION
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
resistant.
correlated with tissue subtype and disease progression
prognosis, the International Study of Kidney Disease in
PATIENTS AND METHODS
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
therapy.
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
4544
Received: 16/05/2022
Accepted: 21/07/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
(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
PATIENTS AND METHODS
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.
4552
Received: 12/05/2022
Accepted: 19/07/2022
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
ABSTRACT
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.
INTRODUCTION
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
4558
Received: 17/5/2022
Accepted: 24/7/2022
c:\work\Jor\vol891_67
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
ABSTRACT
Background: 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.
Methods: 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
omitted.
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.
INTRODUCTION
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
seeing,
reproducing,
vertebrate
embryonic
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).
4562
Received: 18/05/2022
Accepted: 25/07/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
condensation,
chromatin
is
typically
evenly
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
(2).
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
(7).
4566
Received: 17/5/2022
Accepted: 24/7/2022
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
ABSTRACT
Background: 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.
Methods: 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.
INTRODUCTION
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).
4570
Received: 20/05/2022
Accepted: 25/07/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
SUBJECTS AND METHODS
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
4573
Received: 18/05/2022
Accepted: 25/07/2022
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
ABSTRACT
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.
Objective: 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.
INTRODUCTION
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
Intra-abdominal
hypertension
(IAH)
and
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
beyond
the
abdominal
cavity.
From
the
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).
4578
Received: 19/05/2022
Accepted: 26/07/2022
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
ABSTRACT
Background: 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.
Conclusion: 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.
Keywords: Lymphotoxin alpha Gene Polymorphisms, lymphotoxin alpha, Childhood Asthma, Risk factors.
INTRODUCTION
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
Methods:
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
PATIENTS AND METHODS
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
4587
Received: 29/05/2022
Accepted: 26/07/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
PATIENTS AND METHOD
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
groups.
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
N=11.
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)
4592
Received: 2/5/2022
Accepted: 3/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
curette,
bipolar
cautery,
and
power-assisted
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
worked.
symptoms related to their adenoids even after they have
been surgically removed. Sometimes, this viewpoint is
SUBJECTS AND METHODS
what fuels the debate about this procedure. Some authors
Subjects:
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
4597
Received: 14/4/2022
Accepted: 13/6/2022
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
ABSTRACT
Background: 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
investigated.
Objective: The purpose of our study was to improving outcomes of patients with intradural extramedullary spinal
tumors.
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
follow-up.
Keywords: Intradural extra medullary, Intraoperative neurophysiological monitoring, Functional outcome, Oncology.
INTRODUCTION
PATIENTS AND METHODS
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
intraoperative
neurophysiological
monitoring,
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
of
debate
in
the
literature.
Intraoperative
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
4602
Received: 18/05/2022
Accepted: 25/07/2022
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
ABSTRACT
Background: 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).
Objective: 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
patients.
Key words: Elderly, Type 2 Diabetes; Glycated Haemoglobin, Hypertension.
INTRODUCTION
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
PATIENTS AND METHODS
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
4611
Received: 19/5/2022
Accepted: 26/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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.
4617
Received: 18/5/2022
Accepted: 25/7/2022
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
ABSTRACT
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.
Keywords: Palm Pollen, Polycystic Ovaries, PCOS, FSH, LH.
INTRODUCTION
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
[11].
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].
4622
Received: 19/5/2022
Accepted: 16/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
particularly
non-alcoholic
steatohepatitis
(14,15).
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
PATIENTS AND METHODS
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
4626
Received: 22/5/2022
Accepted: 27/7/2022
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
ABSTRACT
Background: 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: Sarcopenia, Skeletal ultrasound, Testosterone, Liver cirrhosis.
INTRODUCTION
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
hypothalamic-pituitary
dysfunction,
peripheral
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).
4632
Received: 22/5/2022
Accepted: 27/7/2022
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
ABSTRACT
Background: 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.
Keywords: Perineal Trauma, Perineal massage, Warm compresses, Second stage of labor.
INTRODUCTION
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
PATIENTS AND METHODS
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
compression.
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
group).
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,
presentation.
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
4640
Received: 23/5/2022
Accepted: 28/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
PATIENT AND METHODS
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,
Inclusion
criteria;
Pregnant
women
with
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,
4645
Received: 23/5/2022
Accepted: 28/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
activity.
involved. Spondylitis, Dip arthritis, arthritis mutilans,
oligoarticular and polyarthritis are the five distinct
PATIENTS AND METHODS
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).
arthritis.
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.
4652
Received: 22/5/2022
Accepted: 27/7/2022
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
ABSTRACT
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.
INTRODUCTION
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
Numerous
diseases
and
disorders
are
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
prognosis
of
neonatal
hypoxic-ischemic
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-
4660
Received: 22/5/2022
Accepted: 27/7/2022
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
ABSTRACT
Background: 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
exercise.
complications are pain and stiffness of neck, ROM
INTRODUCTION
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
4668
Received: 25/5/2022
Accepted: 2/8/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
4676
Received: 22/5/2022
Accepted: 27/7/2022
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
ABSTRACT
Background: 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
complications.
Keywords: Laparoscopic cholecystectomy, Immediate, Delayed, Endoscopic Retrograde cholangiopancreatography.
INTRODUCTION
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
and
endoscopic
retrograde
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
complications.
common bile duct with medicines has been the subject of
debate (2). For minor gallbladder issues, laparoscopic
SUBJECTS AND METHODS
cholecystectomy (LC) is the go-to procedure. Simple
Subjects:
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.
study.
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
pancreatitis.
The
creation
of
laparoscopic
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.
4685
Received: 24/05/2022
Accepted: 01/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
4692
Received: 25/5/2022
Accepted: 2/8/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
Eastern
Cooperative
Oncology
Group
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).
4697
Received: 22/5/2022
Accepted: 27/7/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
for
extensive
apprenticeship,
NHS Cervical Screening program aims to
continuous
training,
&
quality
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
programmes.
Programmes
addressing
clinical
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
PATIENTS & METHODS
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
blood
pressure,
temperature,
complexion,
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
4709
Received: 5/6/2022
Accepted: 10/8/2022
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
ABSTRACT
Background: 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
surgery.
successful blockage. Magnesium is known to have pain-
INTRODUCTION
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
and
regional
anaesthesia
treatments,
mixing
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
PATIENTS AND METHODS
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
4715
Received: 24/05/2022
Accepted: 01/08/2022
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
ABSTRACT
Background: 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.
Methods: 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.
INTRODUCTION
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.
completely
functional,
newly
differentiated
Melanocyte loss can be explained by several different
melanocytes, ultimately restoring normal pigmentation.
processes
including
genetic
susceptibility,
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
sarcoidosis,
atopic
dermatitis,
psoriasis,
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).
4721
Received: 24/05/2022
Accepted: 01/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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
4724
Received: 25/05/2022
Accepted: 02/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
SUBJECTS AND METHODS
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
(4).
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).
4729
Received: 25/05/2022
Accepted: 02/08/2022
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
ABSTRACT
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.
Objectives: 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).
Conclusion: 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.
Keywords: Posterior Pericardiotomy, Pericardial Effusion, CABG surgery, Tamponade.
INTRODUCTION
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.
4735
Received: 26/05/2022
Accepted: 03/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
early postoperative outcomes and effect on abdominal
Historically, caesarean section (CS) was only
contour.
done on mothers who were close to death. And while
vaginal birth remains the most prevalent obstetric
SUBJECTS AND METHODS
intraperitoneal surgery, caesarean deliveries are on the
Subjects:
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
4740
Received: 30/05/2022
Accepted: 07/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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
PATIENTS
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
4747
Received: 25/5/2022
Accepted: 02/08/2022
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
ABSTRACT
Background: 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
control.
Keywords: Predictors, Children, Type 1 Diabetes Mellitus, glycemic control.
INTRODUCTION
PATIENTS AND METHODS
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.
4754
Received: 25/05/2022
Accepted: 02/08/2022
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
ABSTRACT
Background: 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
asymmetry.
Methods: 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.
INTRODUCTION
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).
4762
Received: 26/05/2022
Accepted: 03/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
SUBJECTS AND METHODS
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
4767
Received: 26/05/2022
Accepted: 03/08/2022
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
ABSTRACT
Background: 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.
Results: 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.
Conclusion: 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.
INTRODUCTION
allergic(3).
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
STUDY OBJECTIVES
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.
[SLIT])
or
subcutaneously
(subcutaneous
immunotherapy [SCIT]), as an added bonus, it changes
PATIENTS AND METHODS
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.
4775
Received: 30/05/2022
Accepted: 07/08/2022
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.
ABSTRACT
Background: In the last two decades, extreme obesity and its comorbidities have often been treated with bariatric
surgery.
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.
INTRODUCTION
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
SUBJECTS AND METHOD
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,
patients).
4783
Received: 24/05/2022
Received: 1/08/2022
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:
abdalaalialtabib@gmail.com
ABSTRACT
Background: 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.
Objective: 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.
Patients 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.
Results: 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).
Conclusion: 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.
Keywords: Left Atrium, COVID-19, Exertional Dyspnea, left atrial strain.
INTRODUCTION
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
Hospitals.
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
PATIENTS AND METHODS
acquired with the patient in left lateral decubitus
4790
Received: 12/6/2022
Accepted: 18/8/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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,
hypertension,
antiphospholipid
syndrome,
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
4796
Received: 30/05/2022
Accepted: 05/08/2022
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
ABSTRACT
Background: 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.
Results: 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.
Keywords: PENG block, Femoral fracture, Fascia iliaca block.
INTRODUCTION
PATIENTS AND METHODS
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,
Patients:
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
4802
Received: 24/05/2022
Received: 1/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
4811
Received: 26/05/2022
Accepted: 03/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
variety
of
possible cardioprotective
bioactive
associated to selenium, as inadequate selenium
compounds (6).
consumption has been linked to cardiomyopathy (10).
Therefore, the aim of this investigation was to explore
4817
Received: 30/05/2022
Accepted: 07/08/2022
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
ABSTRACT
Background: 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.
Objective: 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.
Keywords: Ethanol embolization, hepatocellular carcinoma, malignant, portal vein, thrombosis.
INTRODUCTION
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
conventional
trans
arterial
chemoembolization
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
4824
Received: 30/05/2022
Accepted: 07/08/2022
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
ABSTRACT
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.
INTRODUCTION
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].
[2].
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
erythema
nodosum,
papulopustular
eruptions,
PATIENTS AND METHODS
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),
4833
Received: 01/06/2022
Accepted: 08/08/2022
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
ABSTRACT
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
Methods: 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.
INTRODUCTION
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
[2].
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,
activity[4].
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
variants).
Such
molecular
structural
variety
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
4839
Received: 30/05/2022
Accepted: 07/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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).
tool.
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
PATIENTS AND METHODS
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
4842
Received: 26/05/2022
Accepted: 03/08/2022
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
ABSTRACT
Introduction: 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.
Aim: 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.
Methods: 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.
Results: 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).
Conclusion: 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.
Keywords: COVID19, Sudden sensorineural hearing loss, Pandemic, SARS-CoV-2, Intratympanic steroids.
INTRODUCTION
Sudden sensorineural hearing losing (SSNHL) is
respirational distress syndrome (ARDS) and cytokine
defined as sensorineural hearing losing 30 dB at 3
storm(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
fungal
infections,
causing
hearing
losses.
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
injury(5).
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
4848
Received: XX/XX/2022
Accepted: XX/XX/2022
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
ABSTRACT
Background: 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
protein.
INTRODUCTION
that inhibits serine protease (WAP domain proteins),
A
common
malignancy
in
female
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-
4854
Received: 1/6/2022
Accepted: 8/8/2022
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
ABSTRACT
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.
Method: 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
calculated.
Results: 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.
Conclusion: 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
INTRODUCTION
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
4859
Received: 29/5/2022
Accepted: 4/8/2022
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
ABSTRACT
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.
INTRODUCTION
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,
population
and
particularly
elderly
patients
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
4865
Received: 01/06/2022
Accepted: 08/08/2022
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
ABSTRACT
Background: 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.
Methods: 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.
INTRODUCTION
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
4870
Received: 02/06/2022
Accepted: 09/08/2022
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
ABSTRACT
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.
INTRODUCTION
sofosbuvir/daclatasvir regimen on macular and
Chronic
hepatitis,
liver
cirrhosis,
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
PATIENTS AND METHODS
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
eye.
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-
4881
Received: 20/06/2022
Accepted: 29/08/2022
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
ABSTRACT
Background: 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.
Keywords: Myocardial Perfusion, Percutaneous Coronary Intervention, QT Dispersion.
INTRODUCTION
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,
Non-invasive
evaluation
of
ventricular
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.
4887
Received: 05/06/2022
Accepted: 10/08/2022
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
ABSTRACT
Background: The most prevalent form of exotropia is intermittent exotropia. The effect of muscle recession can be
predicted using the limbal insertion distance (LID).
Objective: 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.
INTRODUCTION
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
inclusion.
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.
Declaration.
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.
Surgery:
PATIENTS AND METHODS
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.
4896
Received: 06/06/2022
Accepted: 11/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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,
(10).
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.
4904
Received: 2/6/2022
Accepted: 9/8/2022
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
ABSTRACT
Background 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).
Conclusion: 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.
Keywords: Benign prostatic hyperplasia, Lower urinary tract symptoms, International prostate symptom score, quality
of life score.
4-5). The conservative treatment includes decreasing
INTRODUCTION
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
intermittency,
straining,
hesitancy,
incomplete
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.
PATIENTS AND METHODS
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.
4910
Received: 01/06/2022
Accepted: 08/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
Pulmonary valve stenosis (PS) is a prevalent
PATIENTS AND METHODS
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
Definition
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-
Blood
tests,
biochemistry,
cardiac
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
4915
Received: 2/6/2022
Accepted: 9/8/2022
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
ABSTRACT
Background: 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.
Methods: 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
2022.
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,
Conclusion: 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.
INTRODUCTION
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).
(8).
When compared to control participants, T2D
patients may have greater BMD and lower mean FRAX
PATIENTS AND METHODS
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
2022.
The
extracted
information
included
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
women.
structural analysis (HSA), simultaneous information on
4921
Received: 23/5/2022
Accepted: 28/7/2022
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
ABSTRACT
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
infertility.
Keywords: Vitamin-D, Semen, Infertile, Men, Iraq.
INTRODUCTION
(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).
PATIENTS AND METHODS
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
4926
Received: 5/6/2022
Accepted: 10/8/2022
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.
ABSTRACT
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.
INTRODUCTION
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
Pentoxifylline
is
a
non-steroidal
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
4930
Received: 2/6/2022
Accepted: 9/8/2022
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
ABSTRACT
Background: 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
disease.
Keywords: HRQOL, Psychological Aspects, Foot complications, Diabetic Neuropathic Foot.
INTRODUCTION
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
complications.
have it now or have had it in the past, has diabetic foot
if there is infection, ulceration, or tissue deterioration in
PATIENTS AND METHODS
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.
4938
Received: 09/06/2022
Accepted: 16/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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.
OBSERVATION
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
4945
Received: 05/06/2022
Accepted: 10/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
development
indicates
poor
prognosis
with
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
SUBJECTS AND METHODS
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
4951
Received: 02/06/2022
Accepted: 09/08/2022
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
ABSTRACT
Background: 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
replacement.
Keywords: CMR, Annulo-papillary, Mitral valve replacement, LV function, LV dimensions.
INTRODUCTION
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.
PATIENT AND METHODS
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
preoperative,
operative&
early
postoperative
function (5).
evaluation.
4958
Received: 02/06/2022
Accepted: 09/08/2022
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
ABSTRACT
Background: 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
lesion.
INTRODUCTION
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
Across
changing
inflammation,
accelerating
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
4967
Received: 29/5/2022
Accepted: 4/8/2022
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
ABSTRACT
Background: 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.
Keywords: Radiofrequency ablation, Thyroid nodules, Size of nodules.
minimal chance of long-term consequences, no
INTRODUCTION
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
PATIENTS AND METHODS
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
4970
Received: 06/06/2022
Accepted: 11/08/2022
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
H
1
ind J. Al Obaidi *
N
2
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
ABSTRACT
Background: Nosocomial infections among neonates are responsible for 3040% of death in resource constrained
countries.
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-
1(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.
INTRODUCTION
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
Resistance
to
antibiotics
like
penicillin,
(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
METHODS
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
4975
Received: 6/6/2022
Accepted: 11/8/2022
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
ABSTRACT
Background: 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
haemorrhoids.
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
evaluated.
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.
INTRODUCTION
The symptomatic expansion and/or distal
PATIENTS AND METHODS
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
(2).
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
4985
Received: 07/06/2022
Accepted: 14/08/2022
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
ABSTRACT
Background: 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.
Conclusion: 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
hospitalization.
Keywords: Tibial Fractures Fixation, Pediatrics, Flexible Intramedullary Nailing, Limb- length inequality.
INTRODUCTION
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
nailing.
early mobilization and an excellent functional outcome
(4,5).
PATIENTS AND METHODS
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,
4993
Received: 07/06/2022
Accepted: 14/8/2022
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
ABSTRACT
Background: Plastic surgery role in correction of post-bariatric gynecomastia is clinically called reduction
mammoplasty by reducing breast size, flattening and enhancing the chest contours.
Objective: 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).
Results: 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.
INTRODUCTION
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-
reversible.
It
is
often
confused
with
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.
4998
Received: 8/6/2022
Accepted: 15/8/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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
undergoing
primary
reperfusion
therapy
(3).
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
artery.
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
5003
Received: 07/96/2022
Accepted: 14/8/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
5009
Received: 08/06/2022
Accepted: 15/08/2022
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
ABSTRACT
Background: 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.
Conclusion: 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.
INTRODUCTION
hyperviscosity
manifests
clinically
as
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,
PATIENTS AND METHODS
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.
5017
Received: 07/06/2022
Accepted: 14/08/2022
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
ABSTRACT
Background: 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.
Objectives: 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.
Methodology: 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.
Results: 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
INTRODUCTION
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.
5023
Received: 07/06/2022
Accepted: 14/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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.
MATERIAL AND METHODS
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.
5028
Received: 17/0652022
Accepted: 24/07/2022
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
ABSTRACT
Background: 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.
Methods: 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.
Results: 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.
Conclusion: 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.
INTRODUCTION
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
evaluated.
and are unfit for surgical resection with metastasis or
invasion to the celiac trunk or the superior mesenteric
MATERIALS AND METHODS
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
5040
Received: 07/06/2022
Accepted: 14/08/2022
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
ABSTRACT
Background: 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).
Conclusion: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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
5051
Received: 09/06/2022
Accepted: 16/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
acromioclavicular
joint,
which
was
sutured.
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).
Diagnosis:
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.
CASE REPORT
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.
5060
Received: 08/06/2022
Accepted: 15/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
analogue
(1-deamino-1-monocarba-(2-O-
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
Sheehan's
syndrome
(Pituitary
infarction),
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,
(7,8).
5063
Received: 08/06/2022
Accepted: 15/08/2022
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:
tamershw2y@gmail.com
ABSTRACT
Background: 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.
INTRODUCTION
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
Gestational
hypertension,
preeclampsia,
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
5069
Received: 10/6/2022
Accepted: 17/8/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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].
5075
Received: 6/6/2022
Accepted: 11/8/2022
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
ABSTRACT
Background: 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
toxoplasmosis.
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
placentation.
Keywords: Toxoplasma gondii, Laminin, ELISA, Toxoplasmosis.
INTRODUCTION
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
(2).
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
5083
Received: 9/6/2022
Accepted: 16/8/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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
occurrences
since
the
outbreak's
inception.
not on anticoagulant medication and have severe
Hypercoagulability and small vessel micro thrombosis
symptoms (7).
are regarded to be significant manifestations that can
The
assumption
that
bleeding
from
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
an
associated
mortality
of
around
74%.
bleeding,
the
preventive
anticoagulant
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
5088
Received: 8/6/2022
Accepted: 15/8/2022
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
ABSTRACT
Background: 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.
Methods: 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.
INTRODUCTION
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).
aggregation,
hematopoiesis,
apoptosis,
and
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
mitogenesis
in
fibroblasts,
EC,
VSMC,
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,
proliferation,
migration,
invasion,
survival,
small intestine colon, and placenta (3).
5097
Received: 09/06/2022
Accepted: 16/08/2022
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
ABSTRACT
Background: 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.
Results: 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%).
Conclusion: Poor sleep is a major problem for Egyptian medical students, and there was also a significant relationship
between sleep quality and academic performance.
Keywords: Academic performance, medical students, Pittsburgh Sleep Quality Index.
INTRODUCTION
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-
PARTICIPANTS AND METHODS
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
estimate
the
sample
size
(Heinrich
Heine
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
5101
Received: 16/6/2022
Accepted: 24/8/2022
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
ABSTRACT
Background: 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
jaundice.
INTRODUCTION
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
University.
pathological(3).
Pathological indirect hyperbilirubinemia in
PATIENTS AND METHODS
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).
metabolism(4).
Pyruvate kinase enzyme deficiency was described
Inclusion criteria: neonates with pathological indirect
firstly 1961. Most of cases were found in north
hyperbilirubinemia
and
need
treatment
with
5106
Received: 08/06/2022
Accepted: 15/08/2022
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
ABSTRACT
Background: 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.
Objective: 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.
Keywords: Diabetic foot, Pressure ulcer, Peripheral neuropathy.
INTRODUCTION
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
groups.
admitted to hospitals and one of the main causes of
morbidity [1, 2].The primary causes of foot ulcers are
SUBJECTS AND METHODS
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
5111
Received: 7/6/2022
Accepted: 14/8/2022
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
ABSTRACT
Background: 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).
Conclusion: 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.
INTRODUCTION
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
PATIENTS AND METHODS
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-
stoma.
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
5116
Received: 09/06/2022
Accepted: 16/08/2022
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
ABSTRACT
Background: 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.
Purpose: 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.
INTRODUCTION
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
(a)
with idiopathic obstructive hydrocephalus as candidates
for the ETV procedure at pediatric age.
PATIENTS AND METHODS
5123
Received: 09/06/2022
Accepted: 16/08/2022
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
ABSTRACT
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.
INTRODUCTION
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
5129
Received: 10/06/2022
Accepted: 17/08/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
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-
Finding:
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.
CASE REPORT
Adult oncology clinic as consultation and history of
Assessment plan:
patient:
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
(myxofibrosarcoma).
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:
surgery.
5136
Received: 11/06/2022
Accepted: 18/08/2022
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
ABSTRACT
Background: 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.
Keywords: Sonography, Morphology, Early embryonic complex, Pregnancy, Predictive outcome.
expand until week 10 of pregnancy (7). When the mean
INTRODUCTION
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
intrauterine
pregnancy
using
transvaginal
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
5140
Received: 11/06/2022
Accepted: 18/8/2022
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
ABSTRACT
Background: 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.
INTRODUCTION
Revascularization
with
either
primary
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
strategy.
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
PATIENTS AND METHODS
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 Heart Institute during the period from
angioplasty [4].
September 2019 till September 2021.
It is a qualitative visual assessment of the amount
of contrast medium filling a territory supplied by an
Inclusion criteria: Patients presenting within 12 hours
epicardial coronary artery. Studies are lacking that can
from the onset of symptoms of STEMI, which was
assess the correlation between the noninvasive (QRS
defined as: characteristic chest pain lasting for at least
5148
Received: 14/06/2022
Accepted: 22/08/2022
c:\work\Jor\vol891_160
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5157- 5164
Modified Lateral Approach for Foraminal/Extraforaminal
Lumbar Disc Herniation at L5-S1 Level
Mohammed Mourad*, Ahmed R. Rizk
Department of Neurosurgery, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mohammed Mourad, Mobile: (+20)01558445071, Email: morademan@yahoo.de.
ABSTRACT
Background: Rarely can a herniated disc in the far-lateral extraforaminal area of the lumbar spine cause compression
of a nerve root.
Objective: To focus on L5-S1 foraminal/extraforaminal lumbar disc as well as to analyze the outcome of surgical
management via the lateral approach.
Patients and Methods: From March 2016 to July 2020, 42 patients with L5-S1 foraminal or extraforaminal disc
herniations were included in this study after they received unilateral L5-S1 paraspinal decompression at Benha
University Hospitals and Brüder Hospital Trier. All medical charts of the included patients were reviewed and analyzed
regarding clinical presentation, complete neurological examination, operative findings, complications, and short-term
outcome. MacNab scale of excellent (no pain), good (some pain), fair (moderate pain), and poor was used to assess
patients' subjective levels of postoperative satisfaction (unchanged or worse).
Results: Preoperative sensory and motor deficits showed obvious improvement in the majority of patients. Motor
weakness showed significant improvement in 24 patients out of 30 patients (80%). Pain scoring (Visual Analogue Score;
VAS) after surgery before discharge of the patients from the hospital revealed that 23 patients had no pain, 16 patients
had mild to moderate pain (VAS 1-3) and 3 patients had significant pain (VAS >4).
Conclusions: Orientation of the pathology, proper diagnostic imaging as well as familiarity of the approach are
significant factors for patient's improvement. We have found that our modified lateral approach is a safe, minimally
invasive option with little complications.
Keywords: Extraforaminal disc herniation, Far-lateral disc herniation, Paraspinal approach, Lateral approach.
INTRODUCTION
Foraminal or extraforaminal lumbar disc
analyze the outcome of surgical management via the
herniation can cause compression of the L5 nerve root
lateral approach.
at the L5/S1 lumbosacral level (1). The term
"extraforaminal lumbar disc herniation" (EFLDH)
PATIENTS AND METHODS
refers to a herniated disc in the lumbar spine that occurs
From March 2016 to July 2020, 42 patients with
outside of the spinal canal. Other names for this
L5-S1 foraminal or extraforaminal disc herniations
condition include "far-lateral," "extreme-lateral," and
were included in this study after they received unilateral
"extracanalicular"(2). Comparatively, a foraminal
L5-S1 paraspinal decompression at Benha University
lumbar disc herniation (FLDH) is a herniated disc that
Hospitals and Brüder Hospital Trier.
occurs within the neural foramen, whereas an
We looked at the demographics of these patients
extraforaminal lumbar disc herniation (EFLDH) occurs
by going through their medical records; there were 27
outside of the foramen(3). An appreciable number of
men and 15 women, with a 64/36 male/female ratio and
patients will have both foraminal and extraforaminal
a median age of 50.2 years (range 43- 86 years). In order
manifestations at the same time(4).
to determine the cause of each patient's L5-root
Only 1-12% of all lumbar disc herniations are due
compression, their medical records were reviewed
to EFLDH, or far-lateral disc herniation. While EFLDH
(herniated disc or foraminal stenosis); clinical
at the L5 to S1 level is considered an uncommon disease
symptoms before and after surgery, as well as during
accounting for roughly 2 percent - 4 percent of all
surgery, intraoperative findings, complications, and
lumbar disc herniations (5). EFLDH, on the other hand,
quick recovery time. Foraminal and extraforaminal
is more common among the elderly, especially at the
lesions were confirmed by CT and MRI before surgery.
L4/5 level (6).
Extraforaminal disc was located lateral to the
As diagnostic radiology, especially MRI, has
foramen with no foraminal affection. While foraminal
improved, the proportion of cases in which L5/S1
disc herniation or stenosis were confined to the foramen
EFLDH is initially suspected has increased to between
causing direct root compression.
6.5% and 25% of all cases(7). Foraminal stenosis is
All patients underwent a preoperative,
another possible site of injury to the L5-nerve exiting
postoperative, and final follow-up evaluation to
root (8-9).
evaluate pain and neurological function. The Visual
The purpose of this study was to focus on L5-S1
Analogue Scale for Pain was utilized to evaluate cases
foraminal/extraforaminal lumbar disc as well as to
of back pain and/or sciatica (VAS score 0 = when there
is absence of pain, score ten indicating higher level of
5157
Received: 11/06/2022
Accepted: 18/08/2022
c:\work\Jor\vol891_161
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5165- 5170
In-Hospital Outcomes after Primary Percutaneous Coronary Intervention in
Association with Left Ventricular Ejection Fraction
Salwa Roshdy, Mostafa Talaat*, Mahmoud Abdelsabour
Department of Cardiovascular, Faculty of Medicine, Assiut University, Egypt
*Corresponding author: Mostafa Talaat, Mobile: (+20) 01007952006, E-Mail: mostafa_talat72@yahoo.com
ABSTRACT
Background: The aim of primary percutaneous coronary intervention (pPCI) in acute STEMI is to restore the blood
flow within the infarct-related artery, leading to improvement of survival and quality of life of the patient.
Objective: It was to assess the in-hospital outcomes of pPCI in relation to left ventricular ejection fraction (LVEF).
Patients and Methods: The study was observational cross-sectional. It included 270 patients who had undergone pPCI
in the period between May 2018 and May 2019 at Assiut University Heart Hospital.
Results: Patients were divided according to LVEF into three groups; group I: 28 (10.4%) with LVEF <25%, group II:
150 (55.6%) with LVEF 25-50%, and group III: 92 (34.1%) with LVEF >50%. In-hospital complications; in group I:
17 patients (60.7%), 8 patients developed pulmonary edema, 7 patients with cardiogenic shock and 2 patients with
ventricular tachycardia (VT). In group II: 22 patients (14.7%), 10 patients with pulmonary edema, 4 patients with
cardiogenic shock and each of VT, complete heart block, re-infarction and stent thrombosis occurred in two patients. In
group III: only 4 patients (4.4%), 2 patients with atrial fibrillation and 2 patients with complete heart block.
Conclusion: LVEF is an important predictor of clinical outcomes in STEMI patients. Reduced LVEF is a risk factor
for in-hospital mortality in those patients after pPCI. Other predictors include age (>70 years), pulmonary edema, and
SBP less than 100 mmHg. Awareness of these predictors may assist clinicians to make better clinical decisions for
STEMI patients.
Keywords: In hospital outcomes, pPCI, LVEF.
INTRODUCTION
Patients presented with STEMI and treated with
The superiority of primary percutaneous
thrombolytic therapy.
coronary intervention (pPCI) over conventional
Patients presented more than 24 hours after chest
thrombolytic treatment for ST-elevation myocardial
pain onset.
infarction (STEMI) has been demonstrated in
Patients presented with acute chest pain and ST
randomized controlled trials. This has resulted in it
segment elevation and coronary angiography
becoming the treatment of choice when available (1, 2).
showed normal or vaso-spastic coronary arteries.
The goal of pPCI is to restore normal coronary
Patients who presented with STEMI and referred to
artery perfusion and it is generally effective. In patients
the cath-lab and coronary angiography showed
with acute STEMI, the main goal of pPCI is not only to
multi-vessel disease and referred to cardiothoracic
restore the blood flow in the infarct-related artery, but
surgery for coronary artery bypass graft (CABG)
also to save the patients' quality and duration of their
without any coronary intervention.
life. Given that left ventricular ejection fraction (LVEF)
Patients who refused to be included in the study.
is a recognized indicator of clinical outcomes in STEMI
patients, the potential correlation between pPCI
A checklist was filled out for all patients
patients' features and LVEF need to be evaluated (3).
regarding baseline characteristics [age, gender, family
history of coronary artery disease (CAD), smoking,
Objective: The main objective of this study is to assess
diabetes mellitus, hypertension and prior CAD],
the in-hospital outcomes of pPCI in relation to left
physical examination on admission (systolic and
ventricular ejection fraction (LVEF).
diastolic blood pressure, heart rate, presence of
cardiogenic shock or pulmonary edema), location of
PATIENTS AND METHODS
myocardial infarction (MI) [anterior MI vs. non-anterior
Our
observational
cross-sectional
study
MI].
included 270 patients with STEMI presenting at the
Furthermore,
angiographic
results,
Emergency Department (ED) of Assiut University Heart
thrombolysis in myocardial infarction (TIMI) flow
Hospital between May 2018 and May 2019.
grade, EF at discharge, and in hospital adverse events
(MACE). Electrocardiograms were recorded on arrival
Inclusion criteria:
and 90 min after pPCI. In-hospital follow up including
Patients who were diagnosed as acute STEMI and were
the incidence of MACE as, re-infarction, stent
treated by primary PCI within 12 hours or up to 24 hours
thrombosis, major bleeding, cerebrovascular accident,
of chest pain onset if there was ongoing chest pain or ST
recurrent chest pain, cardiogenic shock, pulmonary
segment elevation at cath-lab of Assiut University Heart
edema and arrhythmias. All studied patients were
Hospital.
examined by transthoracic 2D echocardiography on
Exclusion Criteria:
discharge using GE VIVDE S5 ultrasound system
5165
Received: 13/6/2022
Accepted: 21/8/2022
c:\work\Jor\vol891_162
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5171- 5174
Medical and Psychiatric Comorbidity in Patients with Pregabalin
Abuse: Review Article
Abdallah Saad Ibrahim, Asmaa Ahmed Abdelaziz*
Psychiatry Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Asmaa Ahmed Abdelaziz, Mobile : (+20)01273005852, E-Mail: samakazizo209@gmail.com
ABSTRACT
Background: Anxiety, sadness, personality disorders, and suicide are just some of the common psychiatric conditions
that often co-occur with pregabalin addiction. Pregabalin (PGB) is one of many psychoactive prescription medications
that has seen a rise in its off-label use in recent years. Multiple drug users and patients in methadone treatment programs
have been found to take PGB at high quantities to enhance the effects of methadone, alleviate withdrawal symptoms, or
both. This is why high-risk populations need precise toxicological monitoring.
Objective: This review article aimed to study prevalence of medical and psychiatric comorbidity in patients with
pregabalin Abuse.
Methods: Medical, psychiatric comorbidity and the pregabalin abuse 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 2008 to January 2022 was included. Due to the lack of sources for translation, documents
in languages other than English have been ruled out. Papers that did not fall under the purview of major scientific
investigations, such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations, were
omitted.
Conclusions: Pregabalin abuse was associated with medical illnesses such as neuropathy and epilepsy and psychiatric
disorders such as anxiety and depression.
Keywords: Medical, Psychiatric, Comorbidity, Pregabalin abuse.
INTRODUCTION
Deaths could be prevented by keeping an eye out for
Addiction or substance use disorder is described
signs of depression after therapy has begun and dosage
by a constellation of physical, mental, and behavioral
has been increased. Pregabalin has just been added to
symptoms that arise when substance use persists despite
Egypt's schedule of prohibited substances due to the
obvious risks. As a result of drug overuse and usage,
country's rising usage rate (5).
this may occur (1).
An increasing number of people are misusing
Pregabalin is a d2-serotonin-like molecule that is
prescription drugs for recreational purposes, which is a
structurally related to gabapentin, a chemical that
major public health issue. Prescription psychotherapy
mimics the mammalian neurotransmitter gamma-
medicines were the second most commonly used illegal
aminobutyric acid. As inhibitory modulators of
drug category among all age groups in the United States
neuronal excitability, they dampen the overexcited
in 2015, behind only cannabis. European countries
neurons' activity while leaving the normally active ones
showed comparable data. (6).
alone (2). Accepted daily dosages of pregabalin range
Prescription sedatives and hypnotics are frequently
from 150 to 600 mg, making it a useful therapy option
abused. Barbiturates, benzodiazepines (BZDs), and
for a variety of conditions including fibromyalgia,
BZD-like pharmaceuticals (z-hypnotics), opioids and
generalised anxiety disorder, peripheral neuropathic
opioid substitution treatments (for pain management),
pain, and partial epilepsy. In 2005, the United States
and stimulants (for ADD/ADHD) are all examples
government placed pregabalin in schedule V of the
(ADHD). It's not just stimulants like methylphenidate
Controlled Substances Act (CSA) (3). For whatever
that people abuse, but also antidepressants, Parkinson's
reason, men are more likely to suffer from pregabalin
pharmaceuticals, cold and cough remedies, and more (7,
abuse problem than women. Underage users of
8).
pregabalin are more common than those of legal
drinking age. Pregabalin abuse typically occurs for the
EPIDEMIOLOGY
following reasons: to have a good night's rest; to treat
Pregabalin is a prescription drug that has
one's own anxiety, peer pressure, or despair; and to
psychoactive effects and is used for a variety of medical
enhance one's mood (4).
conditions. Lyrica is the brand name under which it was
There may be more to the problem than just
first sold in the United States and the European Union
pregabalin and gabapentin abuse for their euphoric
(Pfizer, NY, USA). In the European Union (-EU-),
effects. Suicidal thoughts and depression have also been
pregabalin has been approved for use in the treatment of
linked to pregabalin use. Ten percent of patients in one
epilepsy, neuropathic pain, and generalized anxiety
case series who had just begun therapy with pregabalin
disorder. When it comes for treating fibromyalgia,
reported mood disturbances, including depression or
pregabalin was the very first drug to receive FDA
suicidal ideation, or both, which resolved after
approval (9).
medication was stopped or the dose was lowered.
5171
Received: 11/06/2022
Accepted: 18/08/2022
c:\work\Jor\vol891_163
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5175- 5180
Morbidity And Mortality Among Patients with Compensated
Cirrhosis Infected with COVID-19
Usama Mohamed Basha, Alaa Ahmed Farag, Mohamed Ali Ramadan*,
Ashraf Khalifa Elnagar, Ahmed Esmail Ahmed
Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed Ali Ramadan, Mobile: (+20) 01062404267, E-Mail: dr.mohamedali244@gmail.com
ABSTRACT
Background: Patients with liver cirrhosis, due to immunological dysfunction, are at a significant risk for getting SARS-
Cov-2 infection, which accounts for 1.2 million deaths annually around the world.
Objective: To study impact of COVID-19 on morbidity and mortality among patients with compensated cirrhosis.
Patients and Methods: Our prospective cohort study was done at Ahmed Maher Teaching Hospital, and Internal
Medicine Department of Zagazig University Hospitals, this study was performed on 180 patients. The included patients
are classified into two groups; ninety COVID-19-infected patients with chronic liver disease (CLD) and ninety non-
CLD patients with COVID. PCR, liver functions as well as pelvi-abdominal Ultrasound were done to all patients.
Results: There is statistically significant difference between both groups regarding mortality. About 18% and 7% within
CLD with COVID and non-CLD with COVID groups respectively died by the end. There is statistically significant
relation between mortality among CLD patients with COVID and CRP and ESR levels (both were significantly lower
among survivors). There is statistically significant relation between hepatic encephalopathy among CLD patients with
COVID and ESR levels (both were significantly lower among those with hepatic encephalopathy).
Conclusion: Both preexisting medical issues and those that arise during hospitalisation appear to have a significant
impact on the mortality of COVID-19 patients. Hospitalized cirrhotic individuals whose survival rates have been studied
for the impact of SARS-CoV-2 infection can provide further additional details.
Key words: Morbidity, mortality, compensated cirrhosis, COVID-19.
INTRODUCTION
with COVID-19 who also have liver disease need more
Patients with cirrhosis are particularly vulnerable
intense surveillance or individualized therapy methods
to complications from 2019 coronavirus illness
(4). With a compromised immune system, people with
(COVID-19). When comparing patients with
liver cirrhosis are at increased risk for contracting
decompensated cirrhosis to those with compensated
SARS-CoV-2, which is responsible for an estimated 1.2
cirrhosis, and when comparing patients with cirrhosis to
million fatalities annually around the world. The virus
those with noncirrhotic chronic liver disease, the
causes liver damage, which can progress to cirrhosis's
morbidity and mortality associated with COVID-19 are
worsening stage or even cause death, in these patients.
much higher (1). Type 2 alveolar cells, cholangiocytes,
Because of this, it's possible that the high mortality rate
enterocytes, and myocardial cells all include
among cirrhotic patients who have COVID-19 can be
angiotensin-converting enzyme (ACE) receptors, which
explained (5). The study aims to study impact of
act as the virus's entry point. This could help explain
COVID-19 on morbidity and mortality among patients
why people with preexisting conditions tend to have
with compensated cirrhosis.
more severe forms of the disease and why coronavirus
tends to affect multiple systems at once (2).
PATIENTS AND METHODS
Despite the absence of chronic liver disease,
Our prospective cohort study was done at
patients with COVID-19 frequently exhibit abnormal
Internal Medicine Department of Zagazig University
liver function tests (LFT). According to a study of the
Hospitals, this study was done on 180 subjects. The
literature conducted by Ghoshal et al.(3) individuals
included patients were classified into two groups ninety
with COVID-19 were more likely to have elevated liver
COVID-19-infected patients with chronic liver disease
enzymes (10.5%-53%), while only 5.1%-18% of
(CLD) and ninety non-CLD patients with COVID.
patients developed jaundice due to an increase in total
Inclusion Criteria: All the members of this group were
bilirubin. Multiple studies have also noted a drop in
adults (more than 18 years), and patients hospitalized
serum albumin levels. Abnormalities in liver function
with compensated chronic liver disease with a positive
tests were more common in patients with severe
RT-PCR or characteristic CT scan findings have been
COVID-19-associated illness(3).
found to have COVID-19 infection.
Among people infected with COVID-19, 211%
Exclusion Criteria: Patients with COVID-19
already had some sort of liver illness. Only 0.4% of
negativity, people who are under the age of 18, patients
participants in the New York research had cirrhosis at
with decompensated liver disease who are not cirrhotic,
the outset. Cirrhosis has been linked to higher mortality
and patients who are fall outside the inclusion criteria.
in individuals with acute respiratory distress syndrome,
All patients were subjected in the following:
while its effect on COVID-19 illness is still unclear
1-
Complete history talking: Personal history
(ARDS). Cirrhotic have low immune function and
(name, age, sex, occupational, special habits), present
worse outcomes when critically ill, so severe patients
history, and past history.
5175
Received: 13/6/2022
Accepted: 21/8/2022
c:\work\Jor\vol891_164
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5181- 5185
Accelerated Fractionation Radiotherapy and Chemotherapy Might Improve
Loco-Regional Control of Head and Neck Squamous Cell Carcinoma
Amr Muhammed1, Rafaat Abdelaal Bakheet1, Elsayed Mostafa Ali1, Mohamed Gaber1
1 Clinical Oncology Department, Faculty of Medicine, Sohag University Hospital, Egypt
Corresponding author; Amr Muhammed, Tel: +20-01124773335, email: amr.muhammed@med.sohag.edu.eg
ABSTRACT
Background: Managing advanced head and neck squamous cell carcinoma is challenging with a limited outcome,
especially in stage IVA disease. However, altered fractionation proved to be a promising alternative to standard
radiotherapy.
Objectives: This study aimed to explore the effect of concomitant chemotherapy with accelerated fractionation on the
disease outcomes.
Material and methods: Forty-seven patients were enrolled in this trial. A phase 2 trial with two arms was conducted
between Jan 2018 and March 2021. The experimental arm used accelerated fractionation 70 Gy given on 35, six fractions
per week. The control arm used a standard fractionation protocol of 70 Gy on 35 fractions, five fractions per week.
Chemotherapy using platinum salts was given in both arms.
Results: At the end of this study, 44.7% of patients had local-regional relapses, with a one-year loco-regional failure of
40.9%. There was a near significant difference in the one-year loco-regional failure rate between the accelerated and
standard fractionation arms (25% versus 54.2%, respectively, p = 0.069). The same near-significant difference was also
seen in the cumulative probability of loco-regional failure (28.6% versus 57.7%, respectively, P= 0.076). The rates of grade
3 and 4 acute and late toxicities were comparable in both arms.
Conclusion: Accelerated fractionation with concomitant chemotherapy did not improve loco-regional control. However,
there was a trend toward improvement. Further evaluation by a large phase 3 trial is mandatory to confirm the results.
Keywords: Accelerated fractionation, HNSCC, Radiotherapy, Radiation therapy, Altered fractionation, Cancer.
INTRODUCTION
twice daily) and accelerated fractionation increased
One million individual suffers from head and neck
disease-free survival and loco-regional control (11).
cancer each year. Roughly 50% of them will die from this
However, as shown by the MARCH meta-analysis, the
disease. Head and neck cancer is more pronounced in
improved outcome comes at the expense of higher acute
gentlemen, especially in the Middle East (1). Tobacco
toxicity and treatment complexity (12).
smoking is associated with increased head and neck
Two
trials
explored
using
concomitant
squamous cell carcinoma (HNSCC). The risk was
chemotherapy with accelerated fractionation, the RTOG
reported as high as 8.5 times the risk of non-smokers (2).
0129 and the GORTEC 99-02 (13). They failed to show any
The presence of nitrosamines and polycyclic aromatic
benefit in terms of overall and distant metastasis-free
hydrocarbons in inhaled smoke negatively affects cell
survival. However, they showed modest improvement in
proliferation and apoptosis pathways (3). Consumption of
the loco-regional control (13, 14). In this study, we explored
alcohol over 50 grams/day was linked to increased risk of
the effect of concomitant chemotherapy with accelerated
developing HNSCC by 5-6 times (4). There is a strong link
fractionation on the disease outcomes.
between oropharyngeal cancer and human papillomavirus
(HPV) infection (5). However, the prevalence of HPV
MATERIAL AND METHODS
related-oropharyngeal cancer was low in Egypt. It was
This phase two study investigated two different
reported as low as 3 per cent (6).
radiotherapy schedules in advanced (stage III-IV based on
The initial diagnosis of HNSCC depends on tissue
TNM 8th edition) HNSCC (oral cavity, oropharynx,
biopsy (7). HNSCC usually express cytokeratin as a pan-
hypopharynx or larynx). The standard arm used a
marker. In addition, there was some specialised marker
standard fractionation protocol of 70 Gy given on 35
for the specific subsite, such as p16, which is seen with
fractions, five fractions per week. The experimental arm
HPV-positive oropharyngeal cancer (8). Radiation therapy
was 70 Gy given on 35, six fractions per week
represents an acceptable alternative to surgery in selected
(accelerated RT protocol). Chemotherapy with platinum
head and neck subsites. The RTOG 7303 proved that
salts was given in both arms. The choice between cisplatin
definitive radiotherapy had a comparable outcome to
and carboplatin was based on the physician's evaluation
surgical resection in selected HNSCC (9). The commonly
of the patient's eligibility for cisplatin. Eligibility to
used fractionation schedule is 70 Gy in 35 fractions, 2 Gy
cisplatin was defined as (age less than 65 years, ECOG
per fraction and five fractions per week (10). Several trials
PS 0-1, eGFR 50 mL/min, no G2 or worse neuropathy,
found that hyperfractionation (1.2 Gray per fraction,
normal hearing function).
5181
Received: XX/XX/2022
Accepted: XX/XX/2022
Psychological Outcome of Women with Morbidly Adherent Placenta Following Hystrectomy: Prospective Matched Case-control Study
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5186- 5191
Laparoscopic Single Anastomosis Sleeve-Jejunal Bypass vs
Laparoscopic Mini-Gastric Bypass in Morbid Obese Patients and
Resolution of Diabetes Mellitus, A Single Centre Experience
Ramy Helmy, Mostafa Nagy*, Amr H. Afifi
Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Mostafa Nagy, Mobile: (+20)1096870455, E-Mail: mostafa_nagy218@hotmail.com
ABSTRACT
Background: The most effective therapy for morbid obese patients now available is bariatric surgery, which can help
patients losing weight effectively and sustainably while also improving their quality of life and comorbidities
associated with obesity. Worldwide, the one anastomosis gastric bypass (OAGB) technique is one of the most
performed bariatric surgeries.
Objective: The study's objective was to compare the outcomes of the OAGB, with those of the single anastomosis
sleeve jejunal bypass (SASJ) as a new method in terms of weight reduction, operating time, postoperative
complications, and impact on comorbidities three years following surgery.
Patients and Methods: This prospective randomized study included a total of 200 morbidly obese patients
undergoing OAGB or SASJ for the treatment of morbid obesity and comorbidities, attending at Department of the
bariatric Surgery, tertiary care hospital, Ain Shams University Hospitals. The included subjects were divided into two
equal groups: 100 each; SASJ and OAGB groups.
Results: The operative time was prolonged in SASJ group (104.7 minutes) compared to OAGB group (76.4 minutes).
OAGB group had significant lower Body mass index (BMI) mean as well as significant lower body weight mean at all
time intervals through the 3 years follow up. OAGB group had 92% resolution of comorbidities while 68% of SASJ
group had resolution. Post-operative HbA1c showed rapid improvement in both groups. Concerning the post-operative
complications, no statistically significant differences.
Conclusion: It could be concluded that OAGB and SASJ bypass are efficient bariatric surgeries for weight reduction
and comorbidities resolution with favorable outcomes in OAGB group.
Keywords: Laparoscopic Single anastomosis sleeve-jejunal bypass (SASJ), Laparoscopic Mini-gastric bypass
(OAGB), Morbid Obesity.
INTRODUCTION
benefits. There is less possibility of leaking since there
Obesity is a serious health problem that lowers
are fewer anastomoses. Additionally, we do not
life expectancy and lowers quality of life due to the
separate the mesentery, which decrease the occurrence
increased risk of diabetes, cardiovascular disease, and
post operative internal hernia. With a shortened
osteoarthritis (1). Effective treatment and prevention are
biliopancreatic limb, some people believe it to be a
necessary due to the rising incidence of obesity and
modification of single anastomosis sleeve ileal bypass
associated diseases. Prior research has shown that
(SASI) bypass (6).
bariatric surgery is linked to better and more sustained
SASJ the main concern of our study, appears
weight reduction than non-surgical treatment (2).
to be safer than the SASI operation in morbid obese
Therefore, bariatric surgery is the most effective
patients with nutritional deficiencies and more simple
therapeutic option that not only encourages weight
because of its better surgical ergonomics (6).
reduction but also improves the comorbidities in
The study's objective was to compare the outcomes of
patients with a body mass index above 35 kg/m2.
the most common bariatric treatment, the OAGB, with
However, a number of problems might arise during
those of the SASJ as a new bariatric surgery in aspects
surgery (3).
of weight loss, operating time, post operative
The sleeve gastrectomy (SG), the Roux en-Y
complications and resolution of comorbidities three
gastric bypass (RYGB), and the mini-gastric bypass
years following surgery.
are the most performed bariatric surgeries globally and
have been shown to give outstanding metabolic and
PATIENTS AND METHODS
bariatric results. A single anastomosis duodenal-ileal
This prospective randomized study included a total of
bypass with a sleeve gastrectomy or a one loop
200 morbidly obese patients undergoing OAGB or
duodenal switch are two more successful procedures
SASJ for the treatment of morbid obesity and
that the IFSO has recently authorized (SADI-S) (4).
comorbidities, attending at Department of the bariatric
A more modern operation known as SASJ
Surgery, tertiary care hospital, Ain Shams University
includes performing SG with a gastrojejunostomy
Hospitals. This study was conducted between June
established between gastric sleeve and jejunum two
2019 and April 2022.
meters distal to duodenojejunal junction (5). The transit
bipartition and sleeve gastrectomy procedures are
The included subjects were divided into two equal
modified in this operation, but it has additional
groups: 100 each; SASJ and OAGB groups. Data from
5186
Received: 12/6/2022
Accepted: 18/8/2022
c:\work\Jor\vol891_166
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5192- 5200
Hernio-Abdominoplasty Versus Hernioplasty of Incisional Hernia
Associated with Pendulant Abdomen: A Comparative Study
Mahmoud Abdou Yassin, Amr A. Abdelghani, Mostafa M Elaidy, Ahmed Shafik Mohamed El Hefnawy
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mahmoud Abdou Yassin, Mobile: (+20) 01226523031, E-Mail: mahmoudyassin42@yahoo.com
ABSTRACT
Background: Incisional hernia is one of the most common types of the ventral hernia. It nearly complicates 4-18% of
abdominal operations within 5 years follow up. In women with pendulous abdomen, a combined hernio-abdominoplasty
anticipated to improve the cosmoses as well as life quality. As it is expected to reinforce the muscular bending, improve
intertrigo, stead lumbar spine and decrease the postoperative drawbacks.
Objective: The aim of this study is to enhance the result of incisional hernia repair and to compare the outcome of
combined hernio-abdominoplasty and hernioplasty of incisional hernia in obese female with lax redundant abdomen.
Patients and Methods: The present study was carried out at Zagazig University Hospitals, in the period between March
2021 and June 2022, on 80 multiparous women admitted for incisional hernia repair. Patients were divided randomly
into two equal groups, the first group (A) included 40 patients corrected by hernioplasty alone, while the second group
(B) corrected by concomitant hernioplasty and abdominoplasty.
Results: Both time of operation and hospital stay were significantly more in the group (B). However, recurrence,
infection, intertrigo, abdominal deformity and need for refashioning, were significantly complicate the patients of group
(A). Although, hematoma and seroma were more common in group (B) yet, without significant difference, and the
quality of life was highly improved in this group.
Conclusion: A combined hernio-abdominoplasty of incisional hernia in female with pendulous abdomen, significantly
improves the esthetic results and the quality of life, and can also decrease the postoperative complications.
Keywords: Incisional hernia, Tummy Tuck abdominoplasty, Hernio-abdominoplasty, pendulous abdomen, Diastasis of
recti.
INTRODUCTION
advantages as cost and time saving, declines back pain,
Ventral hernia (Umbilical, para-umbilical,
and recurrence (9), it improves the cosmoses, quality of
epigastric, and incisional hernia) is one of the most
life and decreases the postoperative complications (10).
common surgical problems in general. Twenty millions
As much as, improving lipid profile, hypertension
of hernias operations are carried out yearly, 4-18% of
controls and lowering the diabetic risk by 75%, and the
them are on the incisional hernia (1).
mortality associated with obesity can be declined by
Incisional hernia, associated with pendulant
24% (11).
abdomen, is commonly found in obese multiparous
female with abdominal wall laxity and deformity (2).
AIM OF THE STUDY
This redundancy can't be corrected either by diet control
The aim of this study is to enhance the result of
or muscular exercise (3).
incisional hernia repair, and to compare the outcome of
Management of incisional hernias have been
combined hernio-abdominoplasty and hernioplasty of
evaluated by many literatures, however they lacking its
incisional hernia in obese female with lax redundant
evaluation when associated with redundant abdomen(4).
abdomen.
Abdominoplasty is one of Tummy Tuck procedures
performed for making the lax abdominal wall, as well
PATIENTS AND METHODS
as firm and thin. It has an esthetic component done by
A comparative study was carried out on 80
removal of lower abdominal redundant skin and fat and
obese female patients with incisional hernia. Patients
reconstructive component on diastasis of recti (5). Mini-
were randomly allocated into two equal groups, each
abdominoplasty is similar but with no umbilical
containing 40 patients. In the first group (group A) we
reposition. Weakness of the linea Alba is common in
did hernioplasty alone, while in the second group
obese multiparous women with pendulant abdomen,
(group B) we did combined hernio-abdominoplasty,
aggravated by incisional hernia especially, if developed
was carried out at Zagazig University Hospitals, in the
in midline (6).
period between March 2021 and June 2022.
Incisional hernia is the protrusion appearing
along a prior abdominal wound, it complicates 4-18%
Ethical consent:
of abdominal operations and increases up to 23% if
An approval of the study was obtained from
associated with wound infection (1). It has a wide range
Zagazig
University Academic
and
Ethical
(0%-46%) of recurrence (7) especially when corrected by
Committee (IRB#:9768-27-2-2021). Every patient
primary closure (2). Recurrence cannot be avoided even
signed an informed written consent for acceptance of
with prosthetic mesh and perfect repair of the defect (8).
participation in the study. This work has been
Concomitant
hernio-abdominoplasty
has
many
carried out in accordance with The Code of Ethics of
5192
Received: 16/06/2022
Accepted: 28/08/2022
c:\work\Jor\vol891_167
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5201- 5206
Short Term Prognostic Value of CHA2DS2 -VASc Score in ST Elevation
Myocardial Infarction in Patients without Atrial Fibrillation
Ahmed Shawky Shereef, Montaser M. Alcekelly, Aml Abd Alqawi Aljibali*, Radwa M. Elbelbesy
Cardiology Department, Faculty of Medicine- Zagazig University, Zagazig, Egypt
*Corresponding author: Aml Abd Alqawi Aljibali, Mobile: (+20)1097736637, E-mail: amlgbale@gmail.com
ABSTRACT
Background: ST elevation myocardial infarction (STEMI) is a clinical syndrome defined by characteristic symptoms
of myocardial ischemia accompanied by persistent elevation the ST segment on electrocardiograph (ECG) and
subsequent release of biomarkers of myocardial necrosis. Objective: The aim of the study was to evaluate the possibility
of usefulness of CHA2DS2 -VASc Score as a predictor of short-term complications in STEMI patients without atrial
fibrillation. Patients and methods: This prospective cohort study was carried out on 80 STEMI patients who presented
to the Coronary Care Unit (CCU), Zagazig University Hospital, during the period from December 2021 to June 2022.
They were divided into two equal groups: Group (A); STEMI without AF, included 40 patients, 31 (77.5%) males and
9 (22.5%) females whose age ranged from 35 to 75 years. Group (B); STEMI with AF, included 40 patients, 28 (70%)
males and 12 (30%) females whose age ranged from 42 to 78 years. CHA2DS2- VASc Score, and syntax score were
calculated for each patient. Results: The average EF% among STEMI patients without AF was higher than STEMI
patients with AF (53.5 ± 7.5> 49.4 ± 10.5) ranged from (36 to 66) and from (33 to 68) respectively, this difference was
statistically significant (p-value=<0.04*). CHA2DS2-VASC score with cutoff value 4 was very good predictor for
high syntax score in both groups.
Conclusion: It could be concluded that CHA2DS2-VASc score could be applied to predict the risk of subsequent
thromboembolic events in patient with atrial fibrillation. This score has represented ample power in estimating major
adverse cardiovascular outcomes in the sitting of acute coronary syndrome.
Keywords: STEMI, Coronary artery disease, Atrial Fibrillation.
INTRODUCTION
ST elevation myocardial infarction (STEMI) is a
consideration. Heart failure was described as ranging
clinical syndrome characterised by enduring ST
from frank pulmonary edoema to crepts in the chest,
segment elevation on the electrocardiogram (ECG) and
with S3 and elevated JVP(1). Adverse outcomes are
subsequent release of biomarkers of myocardial
complex and require acute clinical, laboratory
necrosis. It is characterised by the typical symptoms of
electrocardiography (ECG) parameters, and even
myocardial ischemia. Acute MI happens when an intra
angiographic evaluation (4).
arterial thrombus spreads and totally obstructs an artery,
A score of 1 point is given for each of the
causing ischemia and necrosis of cardiomyocytes distal
following conditions: congestive heart failure (ejection
to the obstruction. It significantly increases morbidity
fraction 40%), hypertension, age between 65 and 74
and death globally (1).
years, diabetes mellitus, vascular disease (myocardial
In affluent nations, acute coronary syndrome is
infarction or peripheral arterial disease), and female
the major cause of death for millions of people each
gender; a score of 2 points is given for the conditions:
year. The two kinds of acute myocardial infarction are
history of stroke or transient ischemic attack (TIA), and
non-ST segment elevation myocardial infarction
age > 75 years. This method yields the CHA2DS2-
(NSTEMI) and ST segment elevation myocardial
VASc risk score, which In nonvalvular AF patients, the
infarction (STEMI). Myocardial infarction must be
risk of thromboembolism is predicted using the
treated by reperfusion of the heart. The prognosis
CHA2DS2-VASc risk score (3).
improves with earlier treatment (2).
In patients with multivessel coronary artery
Early ST-elevation myocardial infarction
disease (CAD) and/or left main disease, the SYNTAX
(STEMI) therapy's primary goal is to quickly restore
score (SS), an anatomic scoring system based on the
coronary blood flow in the blocked coronary artery. The
coronary angiography, not only assesses lesion
optimal reperfusion technique for acute STEMI patients
complexity but also predicts outcome after
who present within the first few hours of symptoms is
percutaneous coronary intervention (PCI). The SS
primary percutaneous coronary intervention (p-PCI) (3).
permits patients with multivessel CAD undergoing PCI
Heart failure, stroke, myocardial reinfarction,
to be prospectively risk stratified. However, because the
and hospital readmission were among the negative
SS is angiography-based, it has a number of intrinsic
outcomes. When ST elevation 0.1 mV returns, new
limitations. When used to measure lesions and the
pathognomonic Q waves appear in at least two adjacent
complexity of coronary artery disease in patients with
leads, or the cardiac enzyme creatine kinase (CK),
stable angina, SS was initially intended to help
creatine kinase-MB fraction (CK-MB), is relevant and
physicians decide whether to do percutaneous coronary
there have been ischemic symptoms for at least 20
intervention (PCI) or coronary artery bypass grafting
minutes, myocardial reinfarction is taken into
(CABG). However, it has been shown to be an
5201
Received: 12/6/2022
Accepted: 18/8/2022
c:\work\Jor\vol891_168
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5207- 5212
Comparative Study of Aspiration Cytology, Video-Assisted
Thoracoscope and Open Biopsy in Undiagnosed Pleural Effusion
Mustafa Abdalsatar Kotb, Mahmoud Mohamed AbdRabouh,
Muath Azmi Mohamed Abouiznied*, Dina M. Osman
Cardiothoracic Department, Faculty of Medicine- Zagazig University, Zagazig, Egypt
*Corresponding author: Muath Azmi Mohamed Abouiznied, Mobile: (+20)01553316761,
E-mail: muath.abouiznied@gmail.com
ABSTRACT
Background: Pleural effusion is a common challenging problem in the cardiothoracic surgery. We have different
modalities for diagnosis and hence establishing the management control for the pleural effusion.
Objectives: The aim of the study was to compare outcomes, in patients who underwent video-assisted thoracoscope
(VATS) and patients who underwent aspiration cytology and standard thoracotomy, in diagnosis of pleural effusion.
Patients and methods: This randomized clinical (interventional) study was conducted in Cardiothoracic Surgery
Department, Zagazig University Hospitals. We included 48 patients with undiagnosed pleural effusion after initial and
repeated biochemical and cytological analysis of the pleural fluid, they were enrolled in this study. Patients were
randomly divided into three groups. Group A: Where all patients were subjected to aspiration cytology, group B: 35
cases were subjected to VATS biopsy in undiagnosed pleural effusion and group C: 13 cases were subjected to open
biopsy in undiagnosed pleural effusion.
Results: Pleural effusion was diagnosed by CT preoperatively and also confirmed by intra-operative findings either by
VATS or by open biopsy and there were no differences between CT and intra-operative findings in presence of pleural
effusion, pleural nodules and lung masses. While, there was significant difference regarding pleural thickening and
mediastinal LN. 5 patients (14.3%) in VATs biopsy group failed and converted to open biopsy, 3 of them because of
adhesion and 2 cases because of hemorrhage.
Conclusion: Video-assisted thoracoscope is safe and minimally invasive procedure in undiagnosed pleural effusion
with less operative time, blood loss, chest tube duration, intra-operative and post-operative complications and length of
hospital stay compared to open biopsy.
Keywords: Video-assisted thoracoscopic surgery, Pleural effusion.
INTRODUCTION
surgery (VATS) is a minimal recent technique for
Pleural effusion is a collection of the fluid in the
visualization of thoracic cavity aiming to diagnose and
pleural space. A lot of medical disease cause pleural
treat many intrathoracic problems and the pleural
effusion including cancers (primary or secondary lung
effusion is one of them (5).
cancers), liver cell failure, renal disease, cardiac disease
VATS is done through port or multiple port axis
and many lung diseases as pneumonia, TB pneumonia,
through small incisions in the chest wall and the
trauma and lung infarction (1).
technique is associated with less intra-operative time
Pleural effusion is a common challenging
and less post-operative morbidity, mortality and less
problem in the cardiothoracic surgery. We have
hospital stay (6).
different modalities for diagnosis and hence
The aim of this study was to compare outcomes,
establishing the management control for the pleural
in patients who underwent VATS, and patients who
effusion. The diagnosis of the pleural effusion starting
underwent
aspiration
cytology
and
standard
from chest x-ray, CT chest, MRI, ultrasound-guided
thoracotomy, in diagnosis of pleural effusion.
aspiration, video-assisted thoracoscopic surgery
(VATS) and open thoracotomy (2).
PATIENTS AND METHODS
CT chest is an important and mandatory tool for
This randomized clinical (interventional) study was
cases of pleural effusion to localize the site, amount and
conducted at Cardiothoracic Surgery Department,
radiological opacity of the effusion and to differentiate
Zagazig University Hospitals in the period from
between loculated and non loculated pleural effusion
December 2021 to August 2022.
(3).Pleural effusion must be sent for cytological studies
The study was carried out on 48 patients with
on a diagnostic aspiration. A little sum (10 ml) is an
undiagnosed pleural effusion. After initial and repeated
adequate in most circumstances. Pleural fluid cytology
biochemical and cytological analysis of the pleural
is accurate by 60% in most patients and decreases its
fluid, they were enrolled in this study. Definition of
accuracy by 20% in cancer cases like mesothelioma.
undiagnosed pleural effusion was considered as the
Another sample from pleural effusion aspirate increases
failure to achieve an etiologic diagnosis by initial
the diagnosis (by 10% in cancer), but there's no increase
pleural fluid microscopic and biochemical analysis
with a third sample. About 40% of cases of pleural
including protein, sugar, lactate dehydrogenase, gram
threat will therefore remain undiscovered after
stain, acid fast bacilli smear and culture and at least
cytological sampling. Advanced tests are required in
three pleural fluid cytologies negative for malignant
this patient group (4). Video-assisted thoracoscopic
cells or other definite causes.
5207
Received: 15/6/2022
Accepted: 23/8/2022
c:\work\Jor\vol891_169
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5213- 5219
Assessment of Late Complications after Laparoscopic Sleeve
Gastrectomy for Morbid Obesity Patients
Amr Ibrahim, Tarek Ezzat Abdel Latif, Amir Ahmed Eldurssi*, Tamer Mohamed Elshahidy
General Surgery Department, Faculty of Medicine, Zagazig, University, Egypt
*Corresponding author: Amir Ahmed Saleh Eldurssi, Mobile: (+20)01032035939, E-Mail: aldrsyamyr@gmail.com
ABSTRACT
Background: Despite laparoscopic sleeve gastrectomy's (LSG) success as a surgical treatment for morbid obesity,
complications are not uncommon and can have serious consequences, including patient death.
Objective: To report late complications of LSG that may be encountered after one month, including stricture,
nutritional complications, and gastroesophageal reflux disease (GERD).
Subjects and Methods: At General Surgery Department, Zagazig University Hospitals, 18patients were involved
in our prospective cohort study, they were obese with body mass index (BMI) exceeding 40kg/m2 or BMI exceeding
35kg/m2, and associated comorbidities such as hypertension and diabetes mellitus (DM).
Results: More than fourth (27.7%) of the patients were positive GERD. No mortality was reported among them,
16.7% of cases were positive gall bladder stones (GBS). Two cases (11.1%) suffered from hiatus hernia. Post-
operatively, there was a considerable drop in BMI, the mean baseline BMI of cases group was 47±1.85 ranging
from 44 to 50, the mean post-operative BMI after 6months became 36.78±2.67 and the mean BMI after 1year
reached 31.61±2.99kg/m2 and significant increase in percentage of weight loss after operation was observed. About
2/3 (64.3%) of DM cases showed full remission and 35.7% of cases were good DM controlled.
Conclusion: Laparoscopic sleeve gastrectomy is a simple surgical procedure resulting in low rate of late
complication with insignificant long-term nutritional deficiencies, especially when compared to the other
alternatives. General surgeons should have understood of the complications associated with LSG and an approach
for dealing with them. Late complications include strictures, nutritional deficiencies, and GERD.
Keywords: Laparoscopic Sleeve Gastrectomy, Late Complications.
INTRODUCTION
as 14%, 3%, 3%, 23%, and 3%, respectively in LSG
Overweight and obesity have reached
cases.
epidemic proportions in the West and are beginning
In patients undergoing bariatric surgery,
to impact other parts of the world. According to
gastroesophageal reflux disease (GERD) is a common
projections, 40% of the United States population will
complication. Some surgeries, including the Roux-en-
be clinically obese by 2025. Patients may respond best
Y gastric bypass, are linked to a lower risk of reflux
to surgery despite the availability of several
after surgery, but this is debatable for LSG. The
nutritional treatments(1). The surgical treatment of
effects of LSG on GERD have been the subject of a
morbid obesity has advanced with the advent of
prior systematic review by Chiu et al. (5), who
laparoscopic sleeve gastrectomy (LSG). As a result,
concluded that the data were inconclusive.
we should expect to see a sustained increase in the
number of patients having this treatment. Surgeons in
AIM OF THE STUDY
general should be familiar with the risks and potential
It's to report the late complications of LSG
solutions to LSG problems (2).
that may be encountered after one month, including
Significant problems are extremely rare
stricture, nutritional deficits, and GERD.
following LSG, occurring in about 0-6% of cases.
Constriction formation is a potential problem
SUBJECTS AND METHODS
following LSG. Tissue edema following surgery can
Subjects:
cause an immediate onset of symptoms, but more
At General Surgery Department, Zagazig
usually the condition manifests itself much later. Food
University Hospitals, 18 patients were involved in our
intolerance, dysphagia, and vomiting and nausea are
prospective cohort study, they were obese patients
the presenting symptoms. Even though stomach
with body mass index (BMI) exceeding 40kg/m2 or
kinking after LSG has been described, stenosis
BMI exceeding 35kg/m2, associated comorbidities
typically occurs at the incisura angularis. Upper
such as hypertension and diabetes mellitus (DM).
endoscopy is frequently used as a diagnostic tool (3).
Despite the success of bariatric surgery,
Inclusion criteria: Age from 15 to 60 years. Patients
nutritional deficits are frequent in the post-operative
with a BMI of 40 or greater or a BMI of 35 or greater
period. There are a number of causes, but poor
with at least one other obesity-related conditions such
digestion and eating less are major contributors. In a
as high blood pressure, DM, high cholesterol, joint
study, Gehrer et al.(4), deficiency of zinc, iron, folate,
ain, or heart disease.
vitamin D as well as vitamin B12 have been described
Exclusion criteria: Patients on anticoagulants or
those with coagulation defects. Prior open or
5213
Received: 02/06/2022
Accepted: 09/08/2022
c:\work\Jor\vol891_170
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5220- 5225
Free Hand Technique for Lateral Mass Screws Insertion: A Safe,
Accurate, and Simple Procedure for Posterior Cervical Spine Fixation
Mahmoud Wahdan, Ahmed Saleh, Mohammed Mourad*
Department of Neurosurgery, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mohammed Mourad, Mobile: (+20)01558445071, Email: morademan@yahoo.de.
ABSTRACT
Background: In the surgical treatment of disorders of the subaxial cervical spine, posterior cervical fixation procedures
are routine. The posterior cervical spine is often fixed with lateral mass screws. It is regarded an ideal strategy for
cervical stability repair following posterior cervical decompression. The aim of the study was to evaluate the efficacy
of the free hand technique defining the optimum trajectory to insert safely lateral mass screws into the cervical spine.
Patients and methods: A total of 30 patients with cervical canal stenosis and multiple disc prolapse were operated on
in Benha university hospitals with 172 lateral mass screws inserted using the freehand technique through a midline
posterior approach. Post-operative clinical assessment as well as CT scans were utilized to evaluate how well the free-
hand method worked and whether it was safe to use.
Results: One hundred seventy-two screws were inserted in 30 patients with an average of 6 screws per case. After the
surgery, a CT scan was performed to check the screw placement and trajectory. 172 screws inserted easily and correctly
with no complications while 8 screws were failed to be inserted because of a violation of the lateral mass during the
insertion. No vascular or neurological complications were encountered in the postoperative period or the follow-up
period. Conclusion: The freehand technique is a safe and reliable surgical technique to insert lateral mass screws with
a very good post-operative purchase and a high level of safety and feasibility. Neurovascular complications are usually
avoidable when using this trajectory.
Keywords: Posterior cervical spine fixation, Free hand technique, Lateral mass screws insertion, Cervical canal
stenosis.
INTRODUCTION
The cervical spine, which has a natural lordotic
Rogers (4) in 1942 to figure-of-eight wiring. The triple
curve, is made up of seven cervical vertebrae held
wiring technique then was described by Bohlman (5).
together by intervertebral discs and a web of ligaments.
Roy-Camille et al. (6) in the early 1980s, Presented
The cervical spine is more prone to degenerative and
the idea of lateral mass fixation. Grob and Magerl (7)
traumatic illnesses because of its greater mobility
made some adjustments, most notably to the drilling
compared to the dorsal and lumbar sections of the spine
trajectory of the divergently oriented lateral masses.
(1).
The advantage of lateral mass screwing over other
When viewed from behind, the bony junction
fixation methods is that the lateral mass can be screwed
between the superior and inferior articular processes
without the need for intraoperative fluoroscopic control,
forms a quadrilateral area called the lateral mass. This
making the procedure quick, easy, and successful (8).
area is separated from the lamina medially by a sulcus,
Because of these benefits, posterior cervical fixation
and it lies lateral to the lamina and between the borders
with this technique is among the most widely used
of the superior and inferior facets (the medial facet line).
methods in the world (9).
The pedicle attaches the lateral mass to the vertebral
The aim of the study was to evaluate the efficacy of
body (2).
the free hand technique defining the optimum trajectory
Various screws such as the transarticular screw,
to insert safely lateral mass screws into the cervical
pedicle screw, as well as lateral mass screw are selected
spine.
commonly for posterior cervical fixation techniques to
treat the degenerative as well as traumatic diseases of
PATIENTS AND METHODS
the subaxial cervical spine. For the best results in
A total of 30 patients with cervical canal stenosis
reestablishing cervical stability after a posterior cervical
and multiple disc prolapse were operated upon in Benha
laminectomy, lateral mass screw fixation has replaced
university hospitals with 172 lateral mass screws
previous methods. Lateral mass screws, unlike posterior
inserted with freehand technique through a midline
wiring, do not depend on the posterior elements. Rods
posterior approach. Post-operative CT scans were used
system with lateral mass screws can be used effectively
to assess the accuracy and safety of the free hand
to restore normal curvatures, especially in degenerative
technique .
spondylosis where the rods can be contoured besides the
polyaxiality feature of the screws which solves previous
alignment problems (3).
Many attempts had been done to fix the posterior
The surgical technique:
cervical spine; Harda (3) in 1891 introduced wiring of
Under general anesthesia, we placed the patient in
the spinous process, which was modified later on by
the prone position (Figure 1) with the neck should be
5220
Received: 11/6/2022
Accepted: 18/8/2022
c:\work\Jor\vol891_171
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5226- 5232
Evaluation of Cardioprotective Effect of a Single Oral Dose of
Nicorandil before Primary PCI in Patients Presenting with Anterior STEMI
Beshoy Romany Louis, Tarek Khairy Abdel Dayem, Mostafa El Nozahi
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Mostafa El Nozahi, Mobile: (+20) 01112377774, E-Mail: mostafa_elnozahi@hotmail.com
ABSTRACT
Background: Nicorandil has been demonstrated to have a cardioprotective effect, when used in conjunction with
primary percutaneous coronary intervention (PCI). Even over the long term, PPCI using intravenous and intracoronary
forms have evidence that it improves cardiac function and lessen the effects of reperfusion injury. There is however
little data on role of oral form in ST segment elevation myocardial infarction (STEMI) patients.
Objective: The purpose of this trial was to determine whether giving a single oral dosage of nicorandil before primary
PCI had any cardioprotective effects on patients who had their first anterior STEMI following the onset of symptoms
by six hours.
Patients and Methods: 80 patients who had undergone primary PCI as a mean of reperfusion for first attack of anterior
STEMI were enrolled in the study. The patients were split into two equal groups: Nicorandil 20 mg single oral dose was
given to group A, the study group, and group B, the control group, didn't receive nicorandil.
Results: Group A had higher left ventricle ejection fraction, (43.550 % ± 5.114) compared to control (40.325 % ±5.753),
(P=0.010), lower peak values of cardiac enzymes, CK total levels peaked at 1899.1 U/L ± 601.000 compared to control
[2386.300 U/L ± 844.318, (P=0.004)], peak level of CK MB was 264.100 U/L ± 86.982 compared to control [329.325
U/L ± 147.404 (P=0.018)].
Conclusion: Before reperfusion with primary PCI, giving 20 mg single oral dose of nicorandil in the first six hours in
patients presenting with a first attack of anterior STEMI, had a significant cardioprotective effect, as shown by higher
left ventricular ejection fraction and lesser release of cardiac enzymes, indicating less myocardial damage caused by
reperfusion and greater myocardial salvage of the area at risk.
Keywords: Primary PCI, Nicorandil, Reperfusion injury.
INTRODUCTION
mitochondrial (K-ATP), and plays an important role in
Prompt and efficient myocardial reperfusion
cardioprotection (8).
using either primary PCI or thrombolytic treatment
An earlier study showed that giving nicorandil
reduces ischemic injury, limits the size of myocardial
intravenously to patients with anterior AMI increases
infarction (MI), maintains left ventricular function, and
tissue perfusion, speeds up the restoration of cardiac
prevents the onset of heart failure in patients with an
function, and lowers in-hospital complications (9). In
acute STEMI (1).
acute MI, intracoronary nicorandil treatment decreased
In acute STEMI, effective reperfusion of the
the incidence of no-reflow, sluggish reflow, and
occluded coronary artery significantly improved
reperfusion arrhythmia, enhanced TIMI flow during
prognosis and reduced myocardial necrosis (2), largely
PCI, hence improving clinical outcomes (10). There were
as a result of advancements in accessibility and
few reports known concerning the cardioprotective
effectiveness of reperfusion therapies, in particular
effect of orally administered nicorandil and they
PPCI. Modern rapidly acting antiplatelets and
addressed its use mainly in patients with NSTACS or in
anticoagulants have been widely used in clinical
elective PCI setting in which nicorandil administration
practice, in addition to primary PCI, significantly
was associated with less incidence of periprocedural
enhancing the patency of the infarct-related artery and
myocardial injury (11, 12).
the efficiency of reperfusion (3).
Our goal was to determine whether a single oral
A lot of research work was dedicated to
dosage of 20 mg of nicorandil administered prior to
investigate the role of many therapeutic strategies (both
primary PCI had any cardioprotective effects on
pharmacological and non-pharmacological) when used
individuals who had their first anterior STEMI within
as adjuvant to reperfusion therapy to protect the heart
six hours of the beginning of symptoms.
from RI. Pharmacological treatments as an adjuvant to
reperfusion therapy were also shown to attenuate
PATIENTS AND METHODS
myocardial dysfunction associated with AMI (1, 6).
80 patients, who presented with a first attack of
Nicorandil,
a
dual
mechanism
action
anterior wall STEMI following the onset of symptoms
nicotinamide ester, combining opening of ATP-
by six hours and had primary PCI as a cardiac
sensitive potassium channels with nitrate like actions,
reperfusion technique were included in this prospective
has favorable effects on patients with ischemic heart
multicenter research. The included patients were
disease when used as an additional therapy (7). Studies
presented to emergency rooms and coronary care units
show that these effects are brought on by its impact on
of Ain Shams University Hospitals and National Heart
the
preconditioning
pathway's
end
effector,
Institute. Patients were considered eligible for the study
5226
Received: 15/06/2022
Accepted: 23/08/2022
c:\work\Jor\vol891_172
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5233- 5240
Impact of Bronchial Asthma on Medical Student Attendance
Rahmah A. Alsilmi1*, Afnan S. Younis2, Mohammed H. Alsaleh1, Nawaf A. Albardi1,
Jalal A. Alwabari1, Ali F. Alfaraj1, Mohammed A. Alsmakh1, Hamza M. Elabbasy1,
Abdulrahman M. Alharthi1, Khalid S. Alzahrani1, Yahya Z. Habis1, Ahmed A. Alzahrani1
1 Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, King Abdulaziz University
Hospital, Jeddah, Saudi Arabia
2 Department of Family and Community Medicine, King Saud University, Riyadh, Saudi Arabia
*Corresponding author: Rahmah A. Alsilmi. Mobile : (00966549323657), E-mail: ralsilmi@kau.edu.sa
ABSTRACT
Background: Asthma symptoms may result in student absenteeism and affect their academic performance. We aimed to
assess the rate of absenteeism among medical students with asthma.
Patients and methods: An online survey was conducted among medical students with asthma at King Abdulaziz
University. The survey questions domain included:1) demographic data; 2) the student's asthma management; 3) the effect
of asthma on attendance by estimating the missing days in the academic year; 4) the student's opinions on the effect of
asthma on their attendance, and 5) the student's asthma control status.
Results: A total of 70 asthmatic students responded to our survey. Twelve (17.1%) students had missed at least one
examination, and 27 (38.6%) students reported having missed at least one teaching session due to asthma symptoms. Severe
asthma attacks requiring emergency room visits or hospital admission in the last 12 months, ongoing exposure to asthma
triggers, and male gender were associated with a higher rate of missing examinations: 4 students (40%, p = 0.038), 12
students (23.1%, p = 0.025), and 11 students (25.6%, p = 0.018), respectively. No clinical features were associated with an
increased rate of missing teaching sessions. Associations between absenteeism, asthma control in the preceding four weeks,
and the use of asthma medications were not significant.
Conclusion: History of severe asthma attacks, ongoing antigen exposure, and male gender were associated with an
increased rate of absenteeism from examinations among medical students. Accommodating medical health issues is an
important step in optimizing the academic environment for medical students.
Keywords: Asthma, Absenteeism Academic performance, Medical students, King Abdulaziz University
INTRODUCTION
Asthma is one of the most common chronic illnesses
PATIENTS AND METHODS
in Saudi Arabia. The prevalence has increased in past
Study design
decades (1), and its substantial morbidity and mortality
A cross-sectional online-based survey was conducted
require prompt identification and treatment (2).
among fourth-, fifth-, and sixth-year medical students in a
Asthma prevalence among medical students is
Medical College at King Abdulaziz University, Jeddah,
estimated to be between 10% and 19.2%, which is a
Saudi Arabia. The study was conducted from April 15,
substantial proportion of medical students suffering from
2022, to May 15, 2022.
this respiratory morbidity that can affect their attendance
and academic achievement (3-5).
Data collection
Studies have shown a relationship between days of
The questionnaire consisted of 14 questions in 5 parts:
school absenteeism and uncontrolled asthma among
1) demographic data; 2) asthma management, including
schoolchildren (6).
current asthma treatment and follow-up with a
In addition, an inverse relationship between asthma
pulmonologist; 3) effect of asthma on attendance at
and academic performance has been suggested in prior
written tests or clinical examinations and clinical teaching
research, highlighting the potential influence of asthma on
sessions by estimating the missing days; 4) opinions on
how students proceed with their academic journey (7).
the effect of asthma on attendance at written tests or
The aim of this study was to assess the effect of
clinical examinations and clinical teaching sessions, its
asthma on medical students' attendance at King
effect on the students' concentration during written tests
Abdulaziz University for written tests, clinical
or clinical examinations and clinical teaching sessions and
examinations, and clinical teaching sessions and their
their examination scores; and 5) asthma control status
perception of its effect on their academic performance.
using the Global Initiative for Asthma (GINA) tool, the
number of severe asthma attacks needing emergency
room visits or hospital admission in the last 12 months,
5233
Received: 9/6/2022
Accepted: 16/8/2022
RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5241- 5247
Patched Homolog Gene (PTCHI) As a Reliable Marker for Predicting
Imatinib Response in Chronic Phase Chronic Myeloid Leukemia Patients in
Correlation with Early Response to First Line of Treatment Imatinib
Nahed Moawad Rakha1, Tamer Mohamed Ibrahim1,
Nour Elhoda Hussein Abdalla1, Esraa Shaaban Ali1, Rasha Magdy Said1
1Clinical Hematology and Bone Marrow Transplantation Unit,
Faculty of medicine, Ain shams university, Cairo, Egypt.
Corresponding author: Name/ Nahed Moawad Rakha , E-mail address: nahedrakha@med.asu.edu.eg ,
Telephone: 0201149598018, ORCID Id: 0000-0002-3999-6656
ABSTRACT
Background: Chronic myeloid leukaemia (CML) is a clonal disease of a hematopoietic stem cell. The incidence of this
disease is about 15% of leukemias and may be present at any age. The presence of the Philadelphia (Ph) chromosome
confirms the diagnosis of CML. The expression of the Patched homolog 1 gene (PTCH1) has been proposed as a
prognostic marker of imatinib response in chronic phase chronic myeloid leukaemia (CP-CML) patients.
Aim: This study aimed to measure the level of PTCH1 protein in newly diagnosed CP-CML and to find correlation
between its level in those patients and response to first line of treatment, imatinib and other prognostic factors.
Patients and Methods: Our study enrolled 50 patients of newly diagnosed CP-CML. We have measured the level of
PTCH1 protein initially once the patient diagnosed and after 6 months of treatment with imatinib by ELISA test.
Results: There was highly significant difference between initial PTCH1 level and its level after 6 months of imatinib
treatment (P=0.000). The level of PTCH 1 was correlated significantly with the molecular response both at the beginning
of treatment with imatinib and six months later. (P=0.002), (p=0.001) respectively.
Conclusion: To the best of our knowledge that we are the first to report on PTCH1 protein as a new diagnostic and
prognostic marker in CP-CML patients.
Keywords: Chronic Phase, Patched Homolog Gene (PTCHI), Chronic Myeloid Leukemia, ELISA, Imatinib.
INTRODUCTION
differentiation, is essential for embryonic development
CML is a type of pluripotent hematopoietic stem
and tumor development. PTCH1 protein is acting as an
cell tumor that is distinguished by the presence of the
inhibitor of the transmembrane protein smoothened
BCR-ABL fusion gene which is resulting from
(SMO). Extracellular ligands interacting to the PTCH1
Philadelphia (Ph) chromosome. Ph chromosome is the
receptor released this inhibition, allowing SMO to
result of a translocation between chromosomes 9 and 22
communicate with downstream transcription factors
long arm, t (9;22) (q34; q11). CML accounts for 15% to
and activate GLI transcription factors. PTCH1 is
20% of adult leukemia cases [1]. In the IRIS study,
considered as a tumor suppressor gene based on its role
imatinib was tested as a first-generation TKI and
in inhibiting uncontrolled cell proliferation. On the
reported higher rates of cytogenetic and molecular
other hand, SMO is considered as an oncogene [4].
responses compared to recombinant interferon alpha
Regarding the role of the Hh pathway in CML,
(IFN) and low-dose cytarabine regimen with better
numerous studies have shown that Hh signaling is
overall survival (OS) and progression-free survival
activated in progenitor cells that are positive for BCR-
(PFS). As a result, imatinib is now considered the first-
ABL, and that Hh signaling is further elevated as the
line option for CML treatment [2].
disease progresses [5].
The determination of the optimal response to
Patched homolog 1 gene (PTCH1) is marker for
continue the treatment, the failure or resistant to change
expecting first line of treatment imatinib response in
the drug, or warning sign to carefully continue or
CP-CML in correlation with response to imatinib. It is
change the drug according to patient's risk factors like
detected by PCR and proved to be a reliable marker to
comorbidities and tolerability by monitoring of IS of
detect early imatinib response in CP-CML patients [6].
BCR-ABL1 transcript level at 3rd, 6th, and 12th months.
In our study, we measured the level of PTCH1 protein
Additional quantitative PCR testing is indicated to
in CP-CML patients by ELISA as a cost benefit in
detect accurate drug response. Achieving a Major
comparison to PCR in newly diagnosed CML patients
Molecular Response (MMR) (BCR-ABL1 0.1%) is
on first line of treatment imatinib then follow up after 6
associated with improved CML-specific survival [3].
months of treatment.
The PTCH1 gene, which is located on
chromosome 9q22.3, is the human homolog of the
PATIENTS
Drosophila patched-1 gene. PTCH1 is a transmembrane
In our study there were 50 newly diagnosed CP-
glycoprotein with 1447 amino acids that is part of the
CML patients recruited from Hematology Outpatient
hedgehog (Hh) pathway. The Hh pathway, which
Clinic in Ain Shams University Hospital within
controls cell proliferation, tissue polarity, and cell
duration from August 2021 to May 2022. We have
5241
Received: 14/6/2022
Accepted: 22/8/2022
c:\work\Jor\vol891_174
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5248- 5257
Comparative Study between Glasgow Coma Scale and Full Outline of
Unresponsiveness Scale in Clinical Outcomes Prediction of
Neurological Disorders Patients
Furat Hussein Mahmoud1, Doaa Abdel Hakim Mansour*2,
Alshaimaa Ismail Roshdy3, Ola Abdel Wahab Abdallah Srour1
1Department of Medical Surgical Nursing, Faculty of Nursing, Helwan University, Egypt
2 Department of Critical Care Nursing, Faculty of Nursing, El Minya University, Egypt
3Department of Anesthetic and Intensive Care, Faculty of Medicine, El Minya University, Egypt
*Corresponding author: Doaa Abdel hakim Mansour, Mobile: (+20) 01014487907, E-Mail: abdelhakimmansour123@gmail.com
ABSTRACT
Background: Neurological disorders (NDs) that affect the nervous system as trauma to the brain as well as spinal cord.
NDs are the main cause of disability and death in the world, and they affect consciousness. Assessment level of
consciousness are done through Glasgow coma scale (GCS) and Full Outline of Unresponsiveness Scale (FOUR).
Objective: The present study aimed to compare between FOUR and GCS.
Patients and methods: A comparative exploratory study was conducted at Intensive Care Unit and surgical emergency at
Elminya University Hospitals. A purposeful sampling yielded a total of 126 patients with traumatic brain injury (TBI) or
traumatic spinal cord injury (TSCI) in adults. All participants were subjected to structured interview questionnaire, GCS,
FOUR, and Glasgow Outcome Scale Extended (GOSE).
Results: GCS and FOUR scores of the studied patients had a proper cut-off predictive value 12, but GCS was more
specific and accurate than FOUR in the predictability of full recovery. Both scores were similar for the prediction of loss
of consciousness (LOS) in hospital with the same cut-off 13 at the 24 hours. There was a statistically significant
correlation between GOSE, GCS, and FOUR.
Conclusion: GCS is the same as FOUR score in predicting clinical outcomes but FOUR can assess patients on mechanical
ventilation and predict clinical outcomes for intubation, weaning of ventilator, and speech impairment. Predicting death
and full recovery using the FOUR score is more accurate than using the GCS. Continuous Educational programs should
be planned to ICU and using GCS and FOUR.
Keywords: Clinical Outcomes, Extended Glasgow Outcomes scale, Full Outline of Unresponsiveness Scale, Glasgow
Coma Scale, Neurological Disorders.
INTRODUCTION
globally, with an estimated 5.3 million Americans living
Debilitating conditions affecting the brain, spinal
with the effects of one (2).
cord, or nerves are classified as neurological disorders. As
The term "spinal cord injury" (SCI) refers to any
a result, the central nervous system, the peripheral
damage to the spinal cord that results in either a temporary
nervous system, the cranial nerves, the nerve roots, the
or permanent impairment of the cord's ability to perform
vegetative nervous system, the neuromuscular junction,
its normal functions. Causes of spinal cord injuries can be
and the muscles are all negatively impacted. Infections of
either traumatic or non-traumatic. A traumatic spinal cord
the nervous system, brain tumors, traumatic disorders of
injury (SCI) occurs when the spinal cord is suddenly and
the nervous system (such as head injuries), and
severely damaged by an external physical impact, such as
neurological disorders (NDs) caused by malnutrition are
in a car accident, a fall, while playing sports, or as the
all included in this category, as are epilepsy, Alzheimer's
result of violence, and a non-traumatic SCI occurs when
disease, dementias, and cerebrovascular diseases like
the spinal cord is damaged by an acute or chronic disease
stroke, migraine and other headaches, multiple sclerosis,
process, such as a tumor, an infection, or degenerative disc
and Parkinson's disease. Not only are ND the leading
disease (3).
cause of disability, but they are also the second leading
The Glasgow coma scale (GCS) was originally
cause of death worldwide (1).
created in 1974 to evaluate patients' degree of
An external mechanical force can cause
consciousness after traumatic brain injury. Since then, it
temporary or permanent secondary injuries in the brain, a
has been widely used to evaluate patients' level of
condition known as traumatic brain injury. Consciousness
consciousness after admission to Intensive Care Units.
can be altered to the point where cognitive, somatic, and
Multiple scales to evaluate consciousness have been
social processes are impaired. Traumatic brain injuries are
developed because of the GCS's inability to accurately
a primary cause of death, disability, and morbidity
assess intubated patients' verbal replies and brainstem
reflexes (4).
5248
Received: 11/06/2022
Accepted: 18/08/2022
c:\work\Jor\vol891_175
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5258- 5265
The Prevalence and Severity of Headaches in
Hemodialysis Children: A Comparative Study
*Eman Abobakr Abd Alazem¹, Rasha E E Galal¹, Mona M.R. Hammady 2, Ahmed Selim 3
Departments of 1 Pediatrics and 2 Internal medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
3 Department of Pediatrics, Benha Specialized Children Hospital, Ministry of Health, Benha, Egypt
*The corresponding author: Eman Abobakr Abd Alazem, Email: emanabobaker363@yahoo.com/emanabobaker363@cu.edu.eg
Mobile: +02 01005574801/ +02 01205551851, ORCID: 0000-0003-2247-2183
ABSTRACT
Background: One of the symptoms of chronic kidney disease (CKD), especially in individuals receiving regular
hemodialysis (HD), is headache.
Objective: This study aims to describe the prevalence, characteristics, and consequences of headaches on children with
CKD's quality of life as assessed by the Headache Impact Test-6 (HIT-6) score.
Methods: The CKD group (n = 50) and the HD group (n = 50) were included in this cross-sectional comparative
analysis. The prevalence, characteristics, frequency, and severity of headaches were compared between the two patient
groups.
Results: The prevalence and frequency of headache were significantly higher in the HD group than in the CKD group with
p-values: <0.001, 0.003 respectively. Patients with headache had significantly lower GFR and serum sodium (p-values:
0.002, 0.006) but higher serum phosphate and PTH (p-values: 0.035, 0.005) than those without headache. In HD patients,
The HIT-6 score was found to have a statistically significant positive correlation with serum magnesium (p = 0.012, r =
0.412) and a statistically significant negative correlation with serum sodium (p = 0.006, r: -0.474).
Conclusions: Headaches are more prevalent and more frequent in CKD children on HD than in those on conservative
treatment. In HD patients, lower serum sodium and higher serum magnesium increase the headache severity based on the
HIT-6 score.
Keywords: Chronic Kidney Disease, Hemodialysis, Headache.
INTRODUCTION
therapies, as well as how these headaches affect their
In children, the frequency of chronic kidney disease
quality of life as measured by the HIT-6 score.
(CKD) has been rising globally (1), and it affects their
quality of life because of comorbid conditions that are
PATIENTS AND METHODS
related to it and the requirement for kidney replacement
One hundred patients enrolled in this cross-sectional
therapy (KRT), such as hemodialysis (HD) or peritoneal
study. The CKD group consisted of fifty patients with
dialysis (PD) (2).
CKD (stages 3, 4 and 5) who received conservative
One of the symptoms associated with CKD
treatment and followed up at a nephrology clinic at a
patients, especially those receiving regular hemodialysis,
tertiary care Cairo University Children's Hospital, and
is headache, as a result of abnormal hemodynamic
fifty patients (HD group) with CKD5D who received
parameters such as blood pressure and abnormal levels of
regular hemodialysis by conventional low flux machines
electrolytes such as urea, sodium, and magnesium (3).
with bicarbonate-based dialysate three times per week at
Headaches have a significant impact on children's
the Dialysis Unit of the Centre of Pediatric Nephrology
quality of life. The Headache Impact Test-6 (HIT-6) score
and Transplantation, Children's Hospital, Cairo
is used to measure how much a headache impacts an
University, for at least six months.
individual's quality of life; a higher score means that the
The study included children ages between 10 and
headache has a greater effect on the daily life of the
18 years old (as they can describe the symptoms). Patients
respondent. (4)
with neurological or cognitive abnormalities, as well as
Several studies have described headache in CKD
those with dental, otolaryngological, or ophthalmological
and hemodialysis patients in adults (5, 6), although the
issues, were excluded. (8)
published data in pediatric patients is limited (7).
In relation to the HIT-6 score, this study is the first
Ethical Consideration:
to describe headache in pediatric CKD patients, whether
The work was approved by the Ethical Committee
on HD or not.
of Faculty of Medicine, Cairo University number MS-
This study aims to describe the prevalence,
164-2019. Informed consent was obtained and
frequency, and characteristics of headaches in children
documented from the legal guardian/parents of the
with CKD who are receiving HD or conservative
participants.
5258
Received: 12/6/2022
Accepted: 19/8/2022
c:\work\Jor\vol891_176
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5266- 5271
Detection of NCF-2 Gene Expression in Egyptian Children with
Chronic Granulomatous Disease
Dalia Youssef Samaha*1, Salwa Ibrahim Bakr1, Rasha Hassan El Owaidy2,
Gehad Ahmed Abdelmonem1, Nancy Samir Wahba1
1Department of Clinical Pathology, 2Department of Pediatrics, Faculty of Medicine, Ain Shams University
*Corresponding author: Dalia Youssef Samaha, Mobile: 01227268490, Email: daliasamaha2@gmail.com
ABSTRACT
Background: An uncommon inherited primary immunodeficiency illness (PID) known as chronic granulomatous
disease (CGD) is characterised by an increased vulnerability to serious bacterial and fungal infections. It results from
defects in one of the five polypeptide subunits of the nicotinamide adenine dinucleotide phosphate-oxidase (NADPH)
oxidase complex, CYBB (gp91-phox), NCF1 (p47-phox), CYBA (p22-phox), NCF2 (p67-phox), or NCF4 (p40-phox)
with a resulting failure of the phagocytes in generating a variety of microbicidal reactive oxygen radicals during
respiratory burst. Objective: In the present study we aimed to diagnose AR-type of CGD by detection of NCF-2 gene
expression using real time RT-PCR as a cheaper diagnostic method for CGD subtypes categorization among CGD
children. Patients and methods: This case-control study was conducted on 15 children provisionally diagnosed as CGD
patients with dihydrorhodamine (DHR) stimulation index (Group I). The study also included 12 mothers and 8 fathers
of the studied patients (Group IIa and IIb respectively) to detect the genetic mutations in carriers, if any, and 14
apparently healthy children as a control group (Group III). Results: In the present study, cases with a fold change of
NCF-2 gene expression less than 0.67 were considered defective for NCF-2 gene expression. At this cut-off value, from
our molecularly studied subjects, 2 CGD cases and one mother showed under-expression of NCF-2 gene.
Conclusion: We could establish the diagnosis of 2 out of 15 CGD cases as AR- CGD form, derived from defects in the
NCF-2 gene, which encodes gp67-phox of the oxidase, without the need to use complex and expensive methodologies
such as northern blot, or genomic DNA sequencing.
Keywords: CGD, PID, NADPH, NCF-2 gene, DHR, RT-PCR.
INTRODUCTION
mutations are the rarest and are previously reported as
A class of hereditary diseases known as primary
clinically milder than others(5).
immunodeficiency disorders (PIDs) prevent normally
Patients with CGD typically have symptoms in
developing and functioning immune systems. PIDs are
the first two years of life, at a young age. However, some
still underdiagnosed despite numerous improvements in
people may also show up later in life due to the disease's
diagnosis, treatment, and research in this area,
varied hereditary causes. Because a mutation in an X-
particularly in less developed nations (1).
chromosome-linked gene is the primary cause of CGD,
The nicotinamide adenosine dinucleotide
the majority of patients (around 80%) are men (6).
phosphate (NADPH) oxidase complex in neutrophils and
In the present study we aimed to diagnose the
macrophages is defective in chronic granulomatous
AR type of CGD in a group of Egyptian children by
disease (CGD), which is an inherited immunodeficiency
detection of NCF-2 gene expression using real time RT-
disease, causing these cells to ineffectively create
PCR as an aiding tool in the molecular diagnosis of gene
superoxide anions and their metabolites to kill
expression of NCF-2 among CGD patients and correlate
peroxidase-positive bacteria and fungi. These flaws put
it to patients' clinical and laboratory data.
patients at risk for repeated, serious infections and
overactive inflammation at an early age (2).
PATIENTS AND METHODS
NADPH oxidase enzyme consists of five
Study Subjects:
subunits: gp91phox, p22phox, p47phox, p67phox, and
This case-control study was conducted on 15
p40phox encoded by the genes cytochrome b-245 beta
children diagnosed with CGD recruited from children's
subunit (CYBB), cytochrome b-245 alpha subunit
hospitals of different universities in Egypt. The
(CYBA), Neutrophil Cytosolic Factor-1(NCF-1),
laboratory work was conducted in the Clinical
Neutrophil Cytosolic Factor-2 (NCF-2), and Neutrophil
Pathology Department, Immunology Unit, Ain Shams
Cytosolic Factor-4 (NCF-4) respectively. They are
University Hospitals from October 2018 to October
dormant in resting cells and become activated in response
2020. The study included three groups; Group (I)
to pro-inflammatory mediators, the presence of microbes,
included 15 children (9 males and 6 females)
phagocytosis, and/or the activation of pattern recognition
provisionally diagnosed as CGD patients based on DHR
receptors (PRRs)(3). Chronic granulomatous disease is
testing using phorbol myristate acetate (PMA) with
caused by pathogenic variants in one of the five genes
stimulation index < 30%. Patients with known positive
that encode the subunits of phagocyte NADPH oxidase:
HIV serology or HIV nucleic acid testing, active
biallelic pathogenic variants in CYBA, NCF-1, NCF-2,
malignancy and known myelodysplasia of the bone
and NCF4 cause autosomal recessive CGD (AR-CGD);
marrow or abnormal bone marrow cytogenetics, all
mutation of CYBB causes X-linked CGD (XL-CGD)(4).
were excluded from the study. Group (II) included 20
Of all mutations associated with CGD, NCF2 gene
subjects from the parents of the enrolled CGD cases,
5266
Received: 12/06/2022
Accepted: 18/08/2022
c:\work\Jor\vol891_177
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5272- 5278
Results of Pulmonary Artery Debanding: Simple Band Removal Versus
Pulmonary Artery Repair with Pericardial Patch
Ihab Mohamed Salah El Din Elsharkawy*, Mohamed Nasr Esmail Ali,
Mohammad Fawzy Badreddeen Abbas, Hesham Alkady
Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Ihab Mohamed Salah El Din Elsharkawy, Mobile: (+20) 01222222213,
E-Mail: bebosharkawy@gmail.com
ABSTRACT
Background: Among the complications noted after debanding is those related to residual pulmonary stenosis. Removal
of band without repairing pulmonary artery could be enough. Others recommend patching pulmonary artery at the site
of band during debanding because of possibility of residual gradient caused by a residual shelf or narrowing and
distortion of the arterial wall. This may necessitate re-operation especially if it leads to pressure over-load on the right
ventricle.
Objective: To compare between simple band removal and band removal with pulmonary artery repair using pericardial
patch, at time of debanding; concerning early postoperative pressure gradients across the main pulmonary artery.
Patients and methods: This retrospective observational study included 40 patients who underwent pulmonary artery
debanding in the period between January 2016 and January 2020 at the Cardiothoracic Surgery Department, Cairo
University hospitals and Atfal Masr Hospital. Patients were divided into two groups; group A, which included 20
patients who underwent simple band removal and group B, which included 20 patients who underwent pulmonary artery
debanding with pericardial patch repair.
Results: The median pressure gradient across the main pulmonary artery postoperatively was 15 mm Hg for group A
(mean 22.58±18.0) and 10 mm Hg for group B (mean 11.3±8.0) with statistically significant value (p=0.020). 40.0%
of cases in Group A had significant residual pressure gradient compared to only 10.0% of cases in Group B, and that
difference was statistically significant (p=0.028). The median pressure gradient across the band immediate
preoperatively was 60mmHg for group A (mean 62.0±9.8) and 70mmHg (mean 64.2±10.6) with statistically
insignificant value (p=0.065).
Conclusion: Pulmonary artery repair with pericardial patch showed the advantage of reducing the risk of significant
residual pressure gradient across the band site over simple band removal in pulmonary artery debanding.
Keywords: Ventricular septal defect, Atrio-ventricular canal, Pulmonary artery debanding, Pericardial Patch.
INTRODUCTION
that in most of patients, the removal of band without
Pulmonary artery banding was first suggested by
repairing Pulmonary artery could be enough (5).
Muller and Dammann(1) in 1952 as a palliative
Nevertheless, other studies recommend patching of
procedure for patients with large left-to-right (L-R)
the pulmonary artery at the site of the band during the
shunt who fail to thrive, to prevent further development
debanding procedure because of the possibility of a
of pulmonary vascular obstructive disease.
residual gradient caused by a residual shelf or narrowing
Current indications for pulmonary artery banding
and distortion of the arterial wall from extensive
(PAB) include multiple ventricular septal defects
fibrosis. This may necessitate re-operation especially if
(VSDs) (Swiss cheese ventricular septum), large apical
it leads to pressure over-load on the right ventricle (6).
VSD, VSD and complete atrioventricular canal defect
The aim of the study was to compare between
(CAVC) complicated by other non-cardiac anomalies
simple band removal and band removal with pulmonary
(2).
artery repair using pericardial patch, at time of
Indications for pulmonary artery banding have
debanding; concerning early postoperative pressure
been reduced in the last two decades, since early total
gradients across the main pulmonary artery.
repair has been proved to be superior to palliation and
staged approaches. However, there is now an increasing
PATIENTS AND METHODS
support for pulmonary banding raised by new
Study place: This study was done at the Pediatric
indications such as left ventricular training in delayed
Cardiac Surgery Unit in Abo-elreesh hospital at Cairo
arterial switch operation. Debanding is usually
University as well as Atfal Masr Hospital.
performed several months after palliation during the
Study design: It is a retrospective observational study
total repair of the cardiac malformations. It can be done
including 40 patients who underwent pulmonary artery
by simple band removal or by removal of the band and
debanding after passing the appropriate Hegar dilator
pulmonary artery repair with a pericardial patch (3).
through the pulmonary artery and its branches (no
One of the complications noted after debanding is
obvious pulmonary artery stenosis), either by simple
related to the right ventricular outflow tract obstruction
band removal or band removal and pulmonary artery
occurring mainly at the band site (4). Some Studies show
repair with a pericardial patch. The study cases were
5272
Received: 12/06/2022
Accepted: 18/08/2022
c:\work\Jor\vol891_178
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5279- 5285
Left Atrial Remodeling and short-Term Outcome in Patients
Presenting with Non- ST Segment Elevation Myocardial Infarction
Jihan N. Al Khaweldi*, Abdel Alfattah H. Frere, Ahmed El-Zayat, Ahmed S. Eldamanhory
Cardiology Department, Faculty of Medicine- Zagazig University, Zagazig, Egypt
*Corresponding Author: Jihan Nuri Khalifa Al Khaweldi, Mobile: (+20)01021593043, E-mail: gogonuri85@gmail.com
ABSTRACT
Background: NonST elevation myocardial infarction (NSTEMI) is an acute ischemic event causing cardiomyocyte
death by necrosis in a clinical setting consistent with acute myocardial ischemia.
Objective: The aim of the current study was to clarify relationship between left atrial remodeling especially LAVI and
short term clinical outcome in patients with acute NSTEMI.
Patients and methods: We conducted this study on 110 non-STEMI patients who were referred to Cardiology
Department, Faculty of Medicine, Zagazig University. Echo was performed within 48 hours of non-STEMI and 3
months later. Data were collected and analyzed and patients were divided into 2 groups according to left atrial volume
index (LAVI) after 3 months of non-STEMI using cut-off point 34 mL/m2.
Results: Ejection fraction after 3 months was lower among malone ante grade continence enema (MACE) group with
statistically significant difference (p=0.023). Left atrial volume and left atrial volume index were higher among MACE
group with statistically significant differences (p=0.0001; 0.0001). Percent of patients with LAVI>34 was higher among
MACE group with statistically significant difference (p= 0.0008).
Conclusion: left atrial volume index is a good predictor for incidence of major adverse cardiac events after non-STEMI
especially heart failure and angina. At cutoff value equal to 34.2, LAVI exhibited 95.2% sensitivity and 83.2%
specificity in predicting incidence of MACE. Determinants of LAVI was baseline left atrial volume, E/A ratio, lesions
in left anterior descending and left circumflex artery and ejection fraction after 3 months of non STEMI.
Keywords: Left Atrial, NonST elevation myocardial infarction, Heart Disease.
INTRODUCTION
filling pressure and reflects the severity and chronicity
Atherosclerotic
cardiovascular
disease
of diastolic dysfunction in those without atrial
(ASCVD), a chronic inflammatory disorder, is often
fibrillation (AF) and significant valvular disease. Unlike
asymptomatic and has a slow progression during the
other Doppler variables of LV diastolic function
lifetime of an individual. It can manifest as coronary
affected by acute hemodynamic changes, it is a stable
heart disease (CHD), stroke, peripheral artery disease,
parameter that combines the effects of chronic
and aortic aneurysm. The CHD is the most common
cardiovascular conditions and acute disease(4). The Left
form of heart disease encountered in the adults,
Atrial Volume Index (LAVI) is a measurement that has
accounting for 50% of the ASCVD(1,2).
gained importance in daily clinical practice due to
NonST
elevation
myocardial
infarction
evidence of its capacity to predict mortality, in patients
(NSTEMI) with resultant sub-endocardial myocardial
followed after an Acute Myocardial Infarction (AMI),
necrosis represents a group of patients with coronary
as well as in the general population(5). The left
artery disease (CAD) with a high incidence of future
ventricular (LV) function is an important prognostic
adverse cardiac events. Previous studies have
marker for patients with ACS. The left atrial volume
demonstrated that following NSTEMI, there can be
(LAV) is a robust predictor of the CV outcomes and has
associated left atrial (LA) dilatation and abnormal atrial
upcoming evidence supporting its role(1).
depolarization.
However,
few
studies
have
The aim of this study was to clarify relationship
systematically examined temporal changes in LA
between left atrial remodeling and short term clinical
volume or alterations in LA phasic function following
outcome in patients with acute NSTEMI.
NSTEMI. LA remodeling following NSTEMI could
increase the occurrence of atrial fibrillation. In the
PATIENTS AND METHODS
setting of NSTEMI with consequent LV dysfunction,
This prospective cohort study was conducted in
atrial fibrillation could further reduce LV filling,
Cardiology Department, Faculty of Medicine, Zagazig
precipitating diastolic heart failure. Therefore, serially
University, on 110 patients diagnosed with acute
monitoring LA volumes and function following
NSTEMI during the period from March 2022 to August
NSTEMI may provide valuable prognostic information
2022 to determine the relationship of left atrial
and enable appropriate targeted treatment. LA function
remodeling with short term clinical outcome and
includes phases of reservoir (during ventricular systole),
major adverse events following acute NSTEMI.
conduit (during early diastole and diastasis), and active
Ethical consent:
contraction (during late diastole) (3).
Written informed consents were obtained
The left atrium modulates left ventricular (LV)
from all patients and the study was approved by the
filling and cardiovascular performance, acting as a
Research Ethical Committee of Faculty of Medicine,
reservoir, a conduit and a contractile pump during the
Zagazig University (Institutional review board) ZU-
cardiac cycle. Left atrial (LA) size is a marker of LV
5279
Received: 14/06/2022
Accepted: 22/08/2022
c:\work\Jor\vol891_180
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5291- 5300
Tibial Nerve Decompression in The Tarsal Tunnel versus Conservative
Measures in The Treatment of Painful Diabetic Polyneuropathy
Mohamed Mostafa Mahmoud*1, Khalid Mowaphy2, Ahmed Hamdy3,
Mohamed Mohsen4, Ahmed Elshazli¹
Departments of 1General Surgery, 2Vascular Surgery, 3Neurology and
4Diagnostic Radiology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Mohamed Mostafa Mahmoud, Mobile: (+20)01063566019,
E-mail: mailto:mohamedmostafa85@mans.edu.eg.
ABSTRACT
Background: The response of diabetic polyneuropathy (DPN) to conservative treatment is usually unsatisfactory. As
the manifestations of DPN usually mimic nerve compression, we evaluated the outcomes of tibial nerve decompression
at the tarsal tunnel compared to the conservative measures in patients presenting with painful lower limb diabetic
neuropathy. Patients and methods: This randomized controlled clinical trial included 42 patients who were randomly
assigned into two groups; Group 1 included 21 patients who were surgically managed by tibial nerve decompression at
the tarsal tunnel level, and Group 2 included the remaining cases who received the standard conservative management.
Follow-up was done after six months via clinical, nerve conduction, and ultrasound assessment.
Results: All pre-intervention patient and disease criteria showed no significant difference between the study groups.
Nevertheless, a significant improvement in neuropathic pain and ischemic manifestations was noticed in Group 1. The
same group also expressed better improvement of nerve conduction studies at follow-up compared to its baseline values
and Group 2. Posterior tibial artery indices and cross-sectional area of the posterior tibial nerve (PTN) were significantly
improved in Group 1 compared to Group 2. Consequently, there was a great improvement in patient satisfaction with
the surgical intervention. Conclusion: The surgical decompression of the PTN is associated with better short-term
outcomes regarding pain improvement, nerve conduction findings, and ultrasonographic arterial and nerve parameters
compared to the conservative treatment.
Keywords: Diabetic neuropathy, Tibial nerve, Decompression, Conservative treatment.
INTRODUCTION
management protocol, including lifestyle modification,
Diabetic polyneuropathy (DPN) is a clinical entity
strict glycemic control, and pharmacological therapy[6].
that describes the manifestations of peripheral nerve
The entrapment of the tibial nerve at the tarsal
dysfunction in diabetic personnel after other causes
tunnel level was initially described in 1962. After that,
have been excluded. Its diagnosis is established based
multiple reports have been published describing its
on the clinical findings as well as objective quantitative
clinical manifestations, diagnostic criteria, and
testing, which may reveal the condition despite the
management protocols which are mainly surgical. Later
absence of related symptoms [1]. It is one of the most
in 1980, a higher incidence of tarsal tunnel syndrome
common consequences of diabetes mellitus (DM), as it
(TTS) was described in patients with DM, as diabetes is
affects about 66% and 59% of diabetic patients with
associated with a higher risk for peripheral nerve
types I and II, respectively [2]. Not only does DPN
compression [7].
constitute a major healthcare and economic problem,
In the current study, we evaluated the outcomes of tibial
but also it is associated with an increased risk of
nerve decompression at the tarsal tunnel and compared
morbidity and mortality in such patients [3].
it to the conservative measures in patients presenting
According to a recent community-based review,
with painful lower limb diabetic neuropathy.
about one-third of diabetic individuals have neuropathic
pain, which is the most distressing complaint and the
PATIENTS AND METHODS
main motive for these individuals to seek medical
This randomized controlled clinical trial entailed
advice [4]. The management of neuropathic pain in such
42 patients who presented with painful lower extremity
cases is still challenging for many physicians due to its
DPN, confirmed to have tibial nerve entrapment at the
different distribution, wide severity spectrum, and
tarsal tunnel by nerve conduction velocity (NCV)
numerous clinical presentations [5].
studies, and attended at Mansoura University Hospitals
Based on previous clinical observation, one could
during the period between January 2018 and June 2021.
notice that the manifestations of DPN could be more or
Our sample size was estimated via the "sample
less similar to chronic nerve compression. This suggests
size and power analysis software" based on the average
that chronic nerve entrapment could play a crucial role
pain improvement rates reported after surgical and
in the pathogenesis of pain in patients with DPN.
conservative management of these cases, which are
Therefore, surgical intervention aiming at nerve
80% and 38%, respectively. We needed to enroll 21
decompression may be a hopeful solution for these
patients in each group to achieve an 80% power and
distressing symptoms rather than the traditional
0.05 significance level. Based on the previous
5291
Received: 13/06/2022
Accepted: 21/08/2022
c:\work\Jor\vol891_181
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5301- 5309
Individualized versus Conventional Positive End-expiratory Pressure during
One Lung Ventilation in Thoracic Surgeries: A Randomized Controlled Study
Mohammed A.M. Hegazy, Hamed H. M. Neamatallah, Mohammed A.A. Sultan, Salwa M. S. Hayes
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*Corresponding author: Salwa M. S. Hayes, Mobile: (+20)01002223272, E-mail: salwa.hayes@yahoo.com
ABSTRACT
Background: Postoperative pulmonary problems from thoracic procedures are more likely to occur, which may lead to
higher morbidity, a longer hospital stay, higher expenses, and a higher fatality rate.
Objective: This study was done to compare efficacy of using either individualized or the conventional positive end-
expiratory pressure (PEEP) for one-lung ventilation on postoperative pulmonary complications.
Patients and Methods: This prospective randomized controlled study was done on 116 patients of age between 18 and
70 years with American Society of Anesthesiologists physical status II to of either sex who underwent elective
thoracic surgeries using one-lung ventilation. Patients were allocated randomly to either conventional PEEP group in
which patients underwent thoracic surgeries using conventional PEEP (5 cmH2O) or individualized PEEP group in
which patients underwent thoracic surgeries using individualized optimal PEEP which produces the best static lung
compliance.
Results: The incidence of postoperative pulmonary complications (PPCs) was lower in individualized PEEP group
(12.1%) compared to conventional PEEP group (34.5%) with p (0.004). The most common complication incidence was
lung collapse, which was greater in the conventional PEEP group (10.3%) than in the individualized PEEP group
(27.6%). Arterial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2) ratio was greater in the individualized
compared to conventional PEEP group (p < 0.001). There were no significant differences in incidence of pneumonia,
pleural effusion, pneumothorax, ARDS, or pulmonary embolism.
Conclusion: Using individualized PEEP in patients receiving one-lung ventilation for thoracic surgeries resulted in
decreased incidence of postoperative pulmonary complications, lower postoperative lung aeration score, better
intraoperative respiratory mechanics, and oxygenation with no significant changes in hemodynamics.
Keywords: Individualized PEEP, Conventional PEEP, One Lung Ventilation, Pulmonary Complications.
INTRODUCTION
which were identified and studied in the intensive care
Postoperative pulmonary complications (PPCs)
unit (ICU) patients who had acute respiratory distress
are accompanied with higher morbidity, prolonged
syndrome (ARDS). This strategy has been
hospital stay, increased costs of healthcare, and even
demonstrated to may be suitable for healthy lungs (6).
higher mortality rates. PPCs have been related to a
PEEP should be chosen based on the patient's
number of independent risk factors, including, patient
unique data, patient position, and surgical approach.
health issues like anemia, smoking, and age, as well as
During general anesthesia, individual titration of PEEP
surgical techniques and anesthetic management (1).
offers a number of advantages, including; improving
Thoracic surgeries are more likely to result in
respiratory system mechanics, distribution of
PPCs due to many variables including patient related
ventilation, and oxygenation (7). PEEP is adjusted
factors, the surgery itself, and other factors, such as
through titration to the level of optimal static
ventilation-induced lung injury (2). Barotrauma due to
compliance that allows the lungs to remain open,
repeated opening and closure of alveoli together with
leading to a more individualized PEEP adjustment (8).
the inflammatory process of the lung may be the
To our knowledge, the impact of individualized PEEP
explanation of ventilator-induced lung injury (3).
on PPCs is currently unknown. This study aimed to
During one-lung ventilation (OLV), the
evaluate the effects of individualized versus
ventilation of one lung is interrupted while the perfusion
conventional PEEP during one-lung ventilation on
persists, so oxygenation is a major challenge during
postoperative pulmonary complications (the primary
OLV (4). During thoracic procedures, surgical
outcome). We hypothesized that using individualized
manipulation, mediastinal displacement, and chest
PEEP is superior to conventional PEEP in decreasing
immobility are additional factors that might cause PPCs.
postoperative pulmonary complications during one-
When compared to other forms of surgery, thoracic
lung ventilation in thoracic surgeries.
surgery results in higher pressures in the dependent lung
and the development of atelectasis (5).
PATIENTS AND METHODS
The principal factors that contribute to
This prospective randomized controlled study was
ventilation-induced lung injury as atelectrauma, and
done at Mansoura University Hospital over 16 months
overdistention seem to be reduced by lung protective
starting in March 2020. This study included 116 patients
ventilation, hence minimizing PPCs. Positive end-
of age between 18 and 70 years with American Society
expiratory pressure (PEEP) and a lower tidal volume are
of Anesthesiologists physical status (ASA) II to of
the two key elements of lung protective ventilation,
5301
Received: 14/6/2022
Accepted: 22/8/2022
c:\work\Jor\vol891_182
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5310- 5316
Clinical and Laboratory Characterization of Systemic Lupus
Erythematosus Patients with Activity in Zagazig University Hospitals
Mahmoud AbdElkader*1, Esam Nasr2, Ayman Fathy2, Haitham ELSheikh2
1Internal Medicine Department, Elqabbary General Hospital, Alexandria, Egypt
2Clinical Hematology Unit, Internal Medicine Department, Zagazig University, Egypt
*Corresponding author: Mahmoud Mohammed Ahmed AbdElkader, Mobile: (+20) 0112635058,
Email : mahmoudabdelkader630@gmail.com
ABSTRACT
Background: The autoimmune disease systemic lupus erythematosus (SLE) frequently manifests as hematological
abnormalities which; cytopenia of one or more blood cell lineages is one of the possible presenting symptoms of SLE.
Objective: To compare the correlation between disease activity and clinical and laboratory characterization among
SLE patients.
Patients and Methods: We did a comparative cross-sectional study at Clinical Hematology and Nephrology Units,
Internal Medicine Department of Zagazig University Hospitals. This study was performed on (30) SLE patients. The
included patients are classified into two groups according to their activity including: Low/ moderate activity group
(40%):12 patients. High to very high activity group (60%): 18 patients. Their clinical and lab parameters were assessed.
Results: There was statistically significant difference between low/moderate activity SLE and high/ very high SLE
activity as regards laboratory data except for MCV. There was statistically significant difference between low/moderate
activity SLE and high/ very high SLE activity as regards antiphospholipid antibodies being positive in high/ very high
activity SLE more than low/moderate disease activity with p-value=0.009 and Proteinuria >500 mg/24h with p-
value=0.001 being more with high/very high grade SLE group lupus nephritis with p-value =0.003 being more with
high/very high SLE group. Clinical parameters (EULAR/ACR) differed significantly between low/moderate activity
SLE and high/ very high SLE activity.
Conclusion: Clinical parameters (EULAR/ACR) differed significantly between low/moderate activity SLE and high/
very high SLE activity and no significant differences among labs except for MCV.
Keywords: Systemic Lupus Erythematosus, Clinical, Laboratory Characterization.
INTRODUCTION
with other clinical characteristics (4).
The autoimmune disease systemic lupus
Antiphospholipid antibodies are linked to an
erythematosus (SLE) affects people of all sexual
increased risk of venous thrombosis and stroke, but
orientations and is found in every country. Lupus
other autoantibodies such anti-Ro/SSA, anti-La/SSB,
typically has a varied clinical appearance with a
and rheumatoid factor are detected in milder disease.
fluctuating course of flares and remissions, and it can
Nonetheless, congenital heart block is a significant
affect many different organs, including the skeleton,
issue linked to maternal anti-Ro/ SSA antibodies (3).
skin, mucous membranes, blood cells, brain, and
The study aims to compare the correlation
kidneys (1).
between disease activity and clinical and laboratory
The majority of research about 'Asian' or
characterization among SLE patients.
'Oriental lupus' had previously been extrapolated from
studies on Asian minorities living in the West, despite
PATIENTS AND METHODS
the fact that systemic lupus erythematosus is more
We did this comparative cross-sectional study
widespread and severe in non-Caucasian populations
at Clinical Hematology and Nephrology Units, Internal
(2).
Medicine Department of Zagazig University Hospitals,
Lupus erythematosus is diagnosed when
this study was done on (30) SLE patients.
specific autoantibodies are present in addition to the
presence of classic clinical manifestations, which
Ethical consent:
include signs and symptoms affecting several organ
An approval of the study was obtained from
systems. Even for trained rheumatologists, SLE can be
Zagazig
University Academic and
Ethical
difficult to diagnose since its symptoms are often
Committee (IRB#5962-9-3-2020). Every patient
vague and may be confused with those of other,
signed an informed written consent for acceptance
comparable systemic autoimmune illnesses(3).
of participation in the study. This work has been
The skin (in both its chronic and acute forms)
carried out in accordance with The Code of Ethics of
and the joints are just two of the many organs that can
the World Medical Association (Declaration of
be affected (ranging from persistent polyarthritis to
Helsinki) for studies involving humans.
arthralgia). Inflammation of the kidneys or the brain
could be an additional complication in more severe
Inclusion Criteria: Age: 18 years, and systemic
illness conditions. Patients with glomerulonephritis are
lupus erythematosus is diagnosed when patients meet
more likely to have anti dsDNA antibodies than those
the 2019 EULAR and ACR classification criteria (5).
5310
Received: 16/6/2022
Accepted: 24/8/2022
c:\work\Jor\vol891_183
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5317- 5322
Evaluation of Intradural Extramedullary Spinal Tumors
Management: Single Institutional Experience
Ahmed A. Arab, Mohamed H. Eltantawy, Mohamed M. Elmaghrabi*
Department of Neurosurgery, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mohamed M. Elmaghrabi, Mobile: (+20) 01222751406, E-Mail: dr_elmaghrabi@yahoo.com
ABSTRACT
Background: Surgical treatment of Symptomatic intradural extramedullary spinal (IDEM) tumors is the most effective
treatment. The development in diagnostic and surgical techniques helped for early diagnosis and excellent surgical
results. The aim of the present study is to overview the management experience of IDEM spinal tumor cases in our
university hospital for upgrading our competency and sharing it with other institutions.
Patients and methods: A retrospective study was conducted in which the medical records of patients who had surgical
treatment for IDEM spinal tumors in between the periods from May 2015 to May 2020 in Benha University hospitals
were evaluated and reviewed.
Results: A total of 23 patients, 11 males and 12 females were included with a mean age of 41.04 (SD 10.32) years and
mean follow up of 22.9 (SD 7.52) months. Nerve sheath tumor (neurofibromas and schwanomas) accounted for most of
tumors (52.2%) followed by meningiomas (34.8%). The 6 cases managed using IONM had excellent outcome.
hemilaminectomy was done in 4 (17.4%) patients, and fusion was needed in 4 (17.4%) patients. Patients' functional
outcome was assessed using Frankel grades; we had postoperative 8E, 4D, and 1C grades compared to 7E, 8D, 5C, and
3B preoperatively, and 22 (95.7%) patients had improvement. VAS showed significant from 8.57 (SD 1.21)
preoperatively to 1.33 (SD 1.39) at last follow up visit (P value <0.001).
Conclusion: Surgical treatment of symptomatic an IDEM spine tumor is successful and safe with good functional
outcome and pain improvement. Most tumors are benign. Use of IONM is helpful and small unilaterally located tumor
can be approached via hemilaminectomy.
Keywords: Intradural, Extramedullary, Spinal tumors, Retrospective study.
INTRODUCTION
CT that helped for a clear understanding of anatomical
Primary spinal tumors represent 4.5% of primary
structure (10,11). The real clinical benefits of use of
central nervous system tumors, and intradural
improved and minimally invasive techniques, and
extramedullary (IDEM) spinal tumors constitutes 70 to
neuromonitoring are still debatable (12).
80% of all primary spinal cord tumors (1, 2). Most of the
The aim of the present study is to overview the
IDEM tumor are benign tumor (WHO grade I) as
management experience of IDEM spinal tumor cases in
meningioma, schwanoma, and neurofibroma which had
our university hospital for upgrading our competency
similar incidence (3,4), other IDEM include metastasis,
and sharing it with other institutions.
lipomas, nerve sheath tumor, paraganglioma and
vascular tumor (5).
PATIENTS AND METHODS
The surgical treatment aims to complete and
This is a retrospective study that was conducted on
radical excision is the treatment of choice and offers the
23 patients with spinal intradural extramedullary tumors
best results, but as these tumors are considered rare,
who had underwent surgical treatment through the
there is no specific treatment guidelines and usually
period from May 2015 to May 2020 in Benha
surgery is tailored for each tumor to obtain complete
University hospitals, their data was extracted from
excision (6,7), surgery also aims to achieve good
patients' files and follow up cards. The patients' clinical
functional outcome, and preserves spinal stability and
data was reviewed as regarding the presence of motor
preoperative neurological status (8).
weakness, sensory deficit and symptoms, sphincteric
Different surgical techniques are used for excision
disturbance, and back pain, and radicular pain.
of IDEM spinal tumors. Laminectomy has been the
Radiological data included magnetic resonance imaging
classic approach and also hemilaminectomy and they
(MRI) with contrast preoperatively ± computerized
are still used for that despite the development of
tomography (CT) for surgical preparation, and all cases
minimally invasive technique that aim to avoid potential
had routine X-ray done preoperatively. Patients were
complication of the classic approach, the laminectomy
prepared for surgery as regard anesthesia so they did full
allows for better exposure, convenient work, and
laboratory investigations to evaluate their surgical
continue to be the preferred method for resection of
fitness.
large tumors with complex morphology (9).
In the last years, surgical excision offered good
Surgical technique:
result with the presence of operating microscope,
After anesthesia, patients were operated upon
microsurgical
instrument,
improved
surgical
in a prone position; spinal level was checked with
techniques, intraoperative neuromonitoring and proper
fluoroscopy before skin sterilization and just before
preparation by improved diagnostic tools as MRI and
starting laminectomy. Patients were operated with the
5317
Received: 12/06/2022
Accepted: 18/08/2022
c:\work\Jor\vol891_184
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5323- 5327
Relation of Concha Bullosa Types to Sinusitis and Nasal Septal Deviation
Sameh Mohamed Hosny, Magdy Ibrahem Gouda,
Mohammed Ali Abdulqadir Ihreez*, Mohamed Mohamed Rabea
Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Mohammed Ali Abdulqadir Ihreez, Mobile: (+20)01115652000,
E-Mail : ehrezmohammed@gmail.com
ABSTRACT
Background: Concha bullosa (CB) is the most prevalent anatomical variant in the osteo-meatal complex. Middle
Easterners have a disproportionately high incidence of nasal septal deviation (NSD).
Objectives: To determine if concha bullosa increases the risk of developing rhinosinusitis and NSD.
Subjects and Methods: Thirty people who were diagnosed with chronic rhinosinusitis at the ENT Outpatient Clinic
at Zagazig University Hospitals participated in this prospective study. All subjects undergone full clinical evaluation
as well as Computerized tomography study on the nose and paranasal sinuses.
Results: None of the groups differed significantly in terms of the quantity or location of NSD, and between 88%
and 12% of the patients with CB, the air channel was either intact or completely obliterated. About 96% of the
patients with NSD had preserved air channel and 4% of them had obliterated air channel.
Conclusion: CT-imaged concha bullosa, regardless of its size or shape, does not increase the likelihood of sinusitis
or NSD.
Keywords: Concha Bullosa, Nasal Septal Deviation, Sinusitis.
INTRODUCTION
higher risk for developing serious, life-threatening
Concha bullosa (CB) is the most prevalent
orbital and intracranial infections, hence screening for
skeletal abnormality in the osteo-meatal complex
NSD and CB presence may be warranted to avoid the
region. Pneumatized middle turbinate is the simplest
development of maxillary sinusitis. A variety of
way to put it(1). Prevalence of Concha bullosa was
diagnostic methods, such as anterior rhinoscopy, nasal
reported at 55% in a previous study's sample. While
endoscopy, and imaging, can be utilized to spot potential
34% of Zinreich et al. (2) sample had Concha bullosa,
problems. More frequently, septum surgery should
this was not the case for the rest of the sample. Although
likely be scheduled(7).
nasal septal deviation (NSD), mouth breathing, and
This study goal was to assess if the presence of
trauma have all been identified as risk factors for
concha bullosa is associated with the development of
Concha bullosa, the actual causes of pneumatization
rhinosinusitis and NSD.
remain unknown (3).
Mucociliary drainage in the maxillary sinuses
SUBJECTS AND METHODS
can be disrupted by CB, which can increase the risk of
Subjects:
maxillary sinus illness. Concha bullosa is typically
This prospective study was conducted on 30
asymptomatic, although its link to sinus disease is
patients, 23 male and 7 female; their mean age was
currently the subject of investigation. This occurs when
31.2 years chosen randomly from ENT Outpatient
the osteo-meatal complex becomes obstructed(4).
Clinic in Zagazig University Hospitals.
Septal deviation of the nose is particularly
Inclusion criteria: Patients with symptoms of
frequent in Middle Eastern people. Early childhood
headache, nasal obstruction or other symptoms of
trauma has been identified as the leading cause of
chronic rhinosinusitis for whom CT paranasal sinuses
reported septal deformities. However, there is scant
is indicated, age 12 years, and both sexes were
evidence suggesting that variations in nasal air volume,
included.
such as those caused by nasal septal deviation or
pneumatization of the middle turbinate, contribute to the
Exclusion criteria: Age < 12 years. Patients with
development of sinus pathology(5).
history of malignant lesions in nose or paranasal
Because of this, nasal septal deviation and
sinuses. Sinonasal or maxillofacial trauma and/or
concha bullosa may enhance an individual's
surgical intervention. Patients who had undergone
susceptibility to sinus disease; nevertheless, the
prior surgical procedures were not included since CT
connection between this phenomena and volumetric
bone scans may show altered bone structures in these
changes of the nasal sinuses remains unclear(6).
patients. Pregnancy. Adults showing signs of
A more thorough examination of nasal septal
developmental abnormalities on imaging studies, and
deviation may be necessary for patients with chronic
those with growth and development-altering systemic
rhinosinusitis. When it comes to the sinonasal complex,
disorders, as well as those with head and neck
CT scans are a go-to diagnostic tool for spotting
syndromes.
anomalies and diseases. Patients with cystic fibrosis,
immunodeficiency, and immunosuppression are at a
5323
Received: 16/06/2022
Accepted: 24/08/2022
c:\work\Jor\vol891_185
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5328- 5334
Safety and Effectiveness of Two Surgical Interventions in
Treatment of Grade I and II Lumber Spondylolisthesis
Mohammed A. T. El-Olemy*1, Hosni H. Salama2, Waleed M. E. Essa2, Wael A. Elmesallamy2
1Department of Neurosurgery, Damietta Specialist Hospital, Egypt
2Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohammed A. T. El-Olemy, Mobile: (+20)01111557667, E-mail: melolemy@gmail.com
ABSTRACT
Background: There are different techniques and technologies available for fusion, and each operative technique has its
inherent benefits and disadvantages.
Objective: To assess safety and effectiveness of two surgical interventions in grade I and II lumbar spondylolisthesis.
Patients and Methods: A Randomized Controlled Clinical Trial of 42 patients aged 18-60years with grade I and II
isthmic or degenerative lumber spondylolisthesis attending the Neurosurgery Department, Zagazig University hospitals
were recruited to either posterolateral fusion (PLF) or posterior lumbar interbody fusion (PLIF) techniques.
Perioperative and postoperative complications were assessed and dealt with appropriately. Radiological investigation,
pain score scale (VAS) and Oswestry disability index (ODI) pre- and post-operative were measured.
Results: The main complaint was low back pain in all patients and leg pain in 85.71%; 73.81% had degenerative and
26.19% had isthmic spondylolisthesis. L4-5 listhesis (64.29%) and L5/S1 (33.33%). First degree spondylolisthesis
(64.29%) and 2nd degree (35.71%). The mean duration of surgery was 157.14±23.04minutes in PLF group and
190.74±25.62minutes in PLIF group (p=0.0001). The mean amount of blood loss in PLF group was 615±142milliliter,
while 730±105milliliter in PLIF group (p=0.028). The mean length of hospital stay was 5.81±1.47days in PLF group
compared with 7.1±2.55days In the PLIF group. In PLIF group, complete reduction occurred in 61.9% compared with
38.1% in PLF one. VAS and ODI had significantly decreased postoperative.
Conclusion: better results of fusion rate in PLIF surgery in spite of more blood loss, longer duration of surgery and
lengthy hospital stay. Similar results for VAS and ODI in both surgeries.
Key words: Spondylolisthesis, PLF, PLIF, VAS, ODI.
INTRODUCTION
segmental spinal fixation(11). The success of every spine
Spondylolisthesis is forward slipping of upper
fusion procedure depends on bone healing that in turn
vertebra in relation to its lower one, which is classified
depends on many factors, including host factors,
by Wiltse and Rothman(1) into dysplastic, isthmic,
technique, type of graft and the rigidity of the particular
degenerative, traumatic, pathologic and iatrogenic.
surgical construct(12).
Spondylolisthesis is a condition characterized by a
Posterolateral inter-transverse fusion is a
failure of the three-column support with severe complex
useful procedure with acceptable fusion rates for most
instability requiring reconstruction of the altered
degenerative
conditions(13).
Complete
neural
supporting structures(2). The degree of slip is measured
decompression, solid fusion and restoration of normal
with Meyerding Grades into I, II, III, IV and V or
inter-segmental alignment in addition to preservation of
spondyloptosis(3). Of its 5 subtypes, degenerative and
normal spinal function are the goals of PLIF in the
isthmic spondylolisthesis are the most common in
treatment of spinal instability(14). During the last
adults. Both can lead to compression and instability,
decades, PLIF has been widely used in arthrodesis for
which result in radicular and low back pain(4).
segmental instability of the lumbar spine(15). In both
Conservative treatment often fails to provide relief.
interventions the outcomes of the studies shows that
In the past decades, a wide variety of spinal
there is no evidence of the superiority of one approach
instrumentation
was
developed
for
treating
over another one in terms of the fusion rate. The choice
spondylolisthesis. The surgical procedures that have
amongst surgical management is in debate now(Ref).
been advocated include anterior interbody fusion,
Certain
studies
show
that
PLF
is
posterior interbody fusion, posterolateral fusion, repair
effective(8,10,11), whereas in other studies, PLIF had been
of the pars interarticularis, and reduction and fusion(5-9).
proved to be superior to PLF (6,7,9). Hence, it is essential
Posterolateral fusion (PLF) and posterior lumbar
to assess safety and effectiveness of both techniques
interbody fusion (PLIF) are common choices among the
which is the objective of the present study.
various techniques available for the treatment of lumbar
spondylolisthesis. The fusion rate was found to improve
PATIENTS AND METHODS
with the use of internal fixation using transpedicular
A randomized Controlled Clinical Trial of two
screw fixation that allowed segmental fixation of the
different interventions for treatment of low-grade
spine for treating spondylolisthesis(10). The use of
lumbar spondylolisthesis was applied on 42 patients
posterior lumbar pedicle screw instrumentation is now
aged 18-60 years old with isthmic or degenerative
the standard for reconstruction of the affected segment;
spondylolisthesis attending the Department of
its widespread application introduced the era of
5328
Received: 16/06/2022
Accepted: 24/08/2022
c:\work\Jor\vol891_186
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5335- 5341
Self-Assessment of Interprofessional Collaboration: Attitude and
Experience of Pediatric Physical Therapists in the Clinical Context
Reem A. Abdelghany*1, Maya G. Aly2, Khaled A. Mamdouh2, Hoda A. Eltalawy1
1Department of Physical Therapy, El-Manzala General Hospital, Daqahlia, Egypt
2Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Reem A. Abdelghany, Mobile: (+20)01273960984, Email: reemahmed677.ra@gmail.com
ABSTRACT
Background: Pediatric rehabilitation is a team-mission that plays an important role in providing comprehensive
services by healthcare professionals with diverse academic and professional backgrounds to provide a high-level quality
care for children. The Interprofessional education (IPE) is important foundation for Interprofessional collaboration
(IPC) of the healthcare system. It positively affects patients and healthcare personnel, especially children and their
families. Objective: To assess and compare the development of Interprofessional team collaboration between pediatric
physical therapists (PTs), nurses and pediatricians and to assess particular attributes of these professionals that relate to
their attitudes towards IPC.
Subjects and Methods: This cross-sectional study was carried out from April 2021 to May 2022, it included 182
medical staff workers of both genders; they held professional degrees and were currently working in governmental
hospitals in pediatric settings. They were invited to complete personal information sheets, Assessment of
Interprofessional Team Collaboration Scale-II (AITCS-II) and Adapted Version of Attitudes Toward Interprofessional
Healthcare Teams Scale (ATHCTS). Data were collected and analysed using one-way-MANOVA for quantitative
analysis and unpaired t-test for descriptive data.
Results: Comparison of overall scores of both AITCS-II and ATHCTS between physical therapists, nurses and
pediatricians indicated non-significant differences. Non-Significant effects were found regarding gender and working
periods as a team member (in years) among all professional categories (P>0.05). Comparison between different clinical
experience categories AITCS-II were statistically significant (P < 0.05), however the corresponding values of ATHCTS
revealed nonsignificant differences (P>0.05).
Conclusion: There is an evident degree of IPC between pediatric PTs, nurses and pediatricians. Participants' attitudes
were positive toward interprofessional health care teams. However, further IPE programs can lay better foundation for
achieving IPC in order to guarantee higher-quality health service and better patient outcomes.
Keywords: Interprofessional Collaboration, Interprofessional Education, Self-assessment, Pediatric Physical
Therapists, Healthcare.
INTRODUCTION
Interprofessional collaborative practice (IPCP)
Many
professions
work
together
is made to enhance the active participation of individual
collaboratively to provide optimal healthcare services(1),
disciplines in healthcare(9). It facilitates patient and
interdisciplinary collaboration is clear requirement to
family-centred objectives and values, provides a
achieve high quality healthcare to the community.
mechanism for successful communication between
Absence of interdisciplinary teamwork leads to serious
caregivers, enhances staff involvement in clinical
breakdowns in the healthcare hierarchy, while its
decision-making and promotes mutual respect among
presence, on the other hand, improves both health
all professionals(10). Future healthcare professionals
service and outcomes(2). Pediatric rehabilitation is
may be better suited for their future work in
composed of comprehensive services in which a wide
interdisciplinary teams. The harmony between several
range of healthcare professionals with diverse
professionals, especially in pediatrics, is a cornerstone
professional backgrounds participate to provide high-
in patient care(8, 11-13). The high proportion of
quality service to patients. Interprofessional education
comorbidities and the disease complexity have made it
(IPE) is important for Interprofessional collaboration
more vivid that IPC is an inevitable, yet overlooked,
(IPC) in the healthcare system. It positively affects
component in the healthcare plan(14).
patients and healthcare providers, particularly in
Investigating the effectiveness of expert
pediatrics, and it is essential to provide sufficient care to
collaboration necessitates further exploration of
patients and caregivers(3).
healthcare professionals' expertise and attitudes toward
Interprofessional competencies in healthcare
IPE and IPC. This study aimed to evaluate the IPC
mean to integrally apply knowledge, skill, values and
between pediatric physical therapists (PPTs),
attitudes that ensure collaborative working among
pediatricians and nurses in clinical pediatric settings.
professionals, with their colleagues, patients, families
Consequently, feedback can be used to improve
and communities. It aims to improve health outcomes in
Interprofessional team collaboration in pediatric
clinical settings(4). IPE is a precursor to IPC; especially
settings and provide guidance for hospitals to improve
in terms of acquiring the fundamental skills and
service quality and patient needs.
competencies required for Interprofessional work(5-8).
5335
Received: 15/6/2022
Accepted: 23/8/2022
c:\work\Jor\vol891_187
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5342- 5344
Study on Some Parameters and Anti-Rubella Igg in A Sample of
Systemic Lupus Erythematosus Patients
Marwah Mohammed Jasim1, Dunya Fareed Salloom1
Department of Biology, Collage of Science, University of Baghdad,Iraq
*Corresponding author: marwamohammed90n@gmail.com, mobile: +9647707373618
ABSTRACT
Background: Systemic lupus erythematosus (SLE) is an autoimmune syndrome causing both organ and cell damage
done by tissue-binding autoantibodies and immune complexes. Skin, joints, kidneys, lungs, and the neurological system
can all be affected by this condition. Viral infections are main environmental variables in the pathogenesis of SLE, and
they can cause illness initiation and recurrence, as well as modify clinical phenotypes.
Objective: The aim of this study was to measure levels of anti-rubella virus IgG in serum of Iraqi patients with SLE
disease and to measure the levels of some markers including S. creatinine, blood urea, aspartate transaminase (AST),
alanine aminotransferase (ALT), and the reasons for their elevation in serum of patients.
Materials and Methods: This study was conducted in Baghdad Teaching Hospital and Typical Rheumatology Unit
through the period from October 2021 to January 2022. 103 Iraqi patients with SLE disease and 50 healthy Iraqi
individuals were included as control group Blood samples were collected and the anti-rubella IgG for all subjects (for
57 patients and 34 control) was measured by the sandwich enzyme-linked immune-sorbent assay technology. Serum
creatinine, blood urea, AST and ALT were measured using the automated method.
Results: Anti-Rubella IgG, B. urea, S. creatinine, AST and ALT were significantly higher in patients' group compared
to control group. While, there was non- significant difference regarding age between studied groups.
Conclusion: Anti rubella virus IgG and some parameter can be used as markers for SLE disease activity.
Keywords: Systemic lupus erythematosus, ELISA, Rubella.
INTRODUCTION
result of inflammation in the target organ. Bystander
Systemic lupus erythematosus (SLE) is a
activation, molecular mimicry, and viral persistence are
systemic chronic autoimmune condition characterized
three processes that are frequently utilized to
by the onset of autoantibodies, immunological
understand the link between autoimmune and viral
dysfunction, inflammation, and a variety of symptoms
infection (8). The aim of the current study was to
(1). Several aspects, especially genetic predisposition,
estimate the anti-rubella IgG and other parameters such
environmental triggers, and hormonal milieu, each play
as bl. urea, S. creatinine, ALT and AST in the serum of
role in disease development and manifestation (2).
Iraqi patients with SLE.
Arthritis, oral ulcers, fever, blood disorders, serositis,
photosensitivity, renal involvement, malar rash,
MATERIALS AND METHODS
immunological manifestations, discoid rash, neurologic
Blood samples of 103 cases with a recognized
disorders, and hair loss are all typical signs of SLE
diagnosis of SLE based on the information about
illness (3). The estimated frequency of lupus in the
clinical symptoms and laboratory tests conducted in
global population ranged from 6.5 to 178.0 cases per
Baghdad
Teaching
Hospital
and
Typical
100,000 individuals. However, the prevalence rate
Rheumatology Unit. In addition, a control group
varies greatly by gender, race, and geography, with
included 50 apparently healthy subjects in term of non-
SLE incidence rates ranging from about 0.3-23.7 per
SLE whose ages ranged from 12 to 60 years.
100,000 person-year (4).
Laboratory tests were performed for 57 patients
It is important to know about rubella virus. It is a
and 34 healthy controls samples to assess disease
single-stranded RNA togaviridae family virus with a
activity including S. creatinine, ALT, AST and blood
nucleo-capsid made of polypeptide C (C protein) and
urea by using the automated method (Roche,
covered by a lipid-containing envelope. The outer
Germany), also measuring of anti-rubella IgG by using
envelope includes many copies of two virus-specific
sandwich enzyme-linked immunosorbent assay
polypeptides (E1, E2) that are essential for viral
(Monocent, USA). Also, demographic data of the both
virulence and immunity (5).
subject groups were recorded.
A slight form of measles, usually termed as
'German' (thus, 'German') measles. The infection is
Ethics approval:
marked by a rash, fever, and lymphadenopathy (6). Most
An approval of this study was obtained from
rubella infections lead to long-lasting immunity
University of Baghdad Academic and Ethical
mediated by antibodies it is countered by both humoral
Committee. Informed consents of all patients was
and cell-mediated immune responses. IgM and IgG
taken. This study was carried out in accordance
antibodies are identified during infection (7).
with the World Medical Association Code of Ethics
Autoimmune disorders and viral infections have long
(Declaration of Helsinki) for studies involving
been related. These infections frequently occur as a
humans.
5342
Received: 14/6/2022
Accepted: 22/8/2022
c:\work\Jor\vol891_188
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5345- 5349
Intralesional Methotrexate Versus Curettage and Application of
100% Trichloroacetic Acid in Planter Warts
Sahar Mohamed Abd El Fattah Al Mokadem, Sarah Elzarooq Ali Elfazani*, Mohamed Hamed Khater
Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University
*Corresponding author: Sarah Elzarooq Ali Elfazani, Mobile: (+20)01141873364, E-Mail: elfazanisarah@gmail.com
ABSTRACT
Background: Human papillomavirus causes warts, which are benign growths on the skin or in the mucosa.
Methotrexate (MTX), trichloroacetic acid (TCA) as well as curettage are just a few of the options for treating common
warts. Objective: To compare the safety and clinical outcome of MTX application versus curettage and TCA (100%)
application in managing planter warts.
Subjects and Methods: At Zagazig University's Department of Dermatology, Venerology, and Andrology, Faculty
of Medicine, we did a randomized, controlled clinical trial study from September 2021 to February 2022. Ninety
individuals between the ages of 18 and 50 who presented with plantar warts at the time of their initial visit were
included in the analysis. Two groups of patients were chosen at random. 45 patients were put into the IL-MTX group
(MTX). Group TCA consisted of 45 individuals who were treated with (TCA) 100 % needling. Results: Number and
size of warts were examined before and after treatment, and both groups showed a statistically significant decrease
after treatment compared to before treatment. There was slight advantage of TCA therapy over MTX therapy. Also,
assessment of number of sessions required to achieve clinical response revealed statistically significant better response
with TCA therapy compared to MTX therapy.
Conclusion: Intralesional MTX is the most economically viable option because it is simple to administer and requires
no special equipment. Therefore, it may be used as a primary treatment modality in plantar warts in patients where
electrosurgery is limited due to the pain.
Keywords: Methotrexate, Curettage, Trichloroacetic acid, Plantar warts.
INTRODUCTION
to eliminate warts by stimulating the immune system so
Warts, which are produced by the human
that it can identify and eliminate the virus(5).
papillomavirus (HPV), are benign growths that can
appear on the skin or in the mucosa. There are more than
In 1971, the FDA in the United States approved
170 different kinds of HPV now known. Warts can be
methotrexate (MTX) as a medication for treating cancer,
caused by any HPV, although some HPV strains have a
inflammation, and immune system dysfunction (6).
stronger propensity to infect certain areas of skin. Warts
Inhibiting DNA synthesis in proliferating cells is
can spread through casual or intimate contact, and an
the pharmacological justification for using MTX. MTX's
impaired epithelial barrier is a risk factor for contracting
antiviral effect was observed in the treatment of cells
them (1).
infected with the Zika virus, and this effect was
Common warts (verruca vulgaris), flat warts
accounted for by the drug's ability to inhibit dihydrofolate
(verruca plana), filiform warts (sometimes called genital
reductase(7).
warts), plantar warts, and genital warts are the clinically
Hydrolysis of cellular proteins is triggered by the
recognized forms of warts (condyloma accuminta) (2).
application of trichloroacetic acid (TCA), which is a
In healthy, immune-competent persons, warts are
topical damaging agent. At concentrations of 7080%, it
completely harmless and typically go away on their own
is equally effective as cryotherapy in treating common,
within a few months to a few years. However, warts on
cervical, genital, and anal warts. The benefit is that it is
the face and hands carry a heavy social stigma, and those
not poisonous to the body as a whole. However,
on the soles of the feet and in the nail beds can be rather
discomfort,
burning,
hyperpigmentation,
and
painful. As a result, many people seek out medical
infrequently scar formation may occur at the site of
attention for their warts(3).
application (8).
Cryotherapy,
electrocoagulation,
topical
This study objective was to compare the safety
salicylic acid, topical 5-fluorouracil, and laser surgery are
and clinical outcome of MTX application versus
only some of the options for treating warts. None of these
curettage and TCA (100%) application in managing
treatments is ideal, and they can all be uncomfortable,
planter warts.
time-consuming, or costly(4).
Tuberculin pure protein derivative (PPD),
SUBJECTS AND METHODS
measles, mumps, and rubella (MMR) vaccination, and
Subjects:
Candida albicans antigen have all been used as injectable
During the 6-month period of September 2021 -
treatments
for
warts
(candidin).
Intralesional
February 2022, the Department of Dermatology,
immunotherapy refers to a group of treatments that aim
Venerology, and Andrology of the Zagazig University
5345
Received: 15/06/2022
Accepted: 23/08/2022
c:\work\Jor\vol891_189
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5350- 5355
Advantages of Laparoscopic Sleeve Gastrectomy with
Intraoperative Endoscopic Guidance
Sameh Mohamed Naguib, Abdelrahman Mohamed Amin Sarhan,
Mohamed Negm, Nuzha Saleh Abdulraheem*, Walid Abdelmawla Elsayed Ali
General Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Nuzha Saleh Abdulraheem, Mobile: (+20)012914404064, E-Mail: nozhaalzwie@gmail.com
ABSTRAC
Background: For optimal safety following Laparoscopic Sleeve Gastrectomy (LSG), regular intraoperative
endoscopy is recommended to prevent postoperative stenosis and gastric leak.
Objective: The aim of the present study is to assess the advantage of using intraoperative endoscopic guidance
during sleeve gastrectomy and its efficiency to decrease various complications.
Patients and methods: A follow up case series study was conducted at Laparoscopic Gastrointestinal Surgery Unit,
General Surgery Department of Zagazig University Hospitals. The study included 18 cases planned for laparoscopic
sleeve gastrectomy.
Results: Operative time ranged from 2 to 3 hours with mean of 2.19 hours. Concerning intraoperative complications,
no patient had bleeding. One patient had leak which was corrected by reinforcement suture. Another patient had
twisting which was corrected. Postoperatively, all patients did not develop leak, bleeding or obstructive symptoms.
Two (11.1%) patients had postoperative vomiting which was corrected by prescribing antiemetics. There were no
statistically significant associations between incidence of intra/postoperative complications and either age, weight,
body mass index, operative time or comorbidities.
Conclusion: Important complications after LSG, such as bleeding or even deadly ones like gastric leak, can be
avoided with the help of an endoscope, which is used during the calibration of the gastric sleeve.
Keywords: Laparoscopic Sleeve Gastrectomy, Intraoperative Endoscopic Guidance, Leak, Bleeding.
INTRODUCTION
endoscope can be fixed in the early section of the
The development and success of bariatric
duodenum, and after a brief retraction, it will remain in
surgery can be directly attributed to the increasing
this position for the duration of the treatment (6).
prevalence of obesity and the large number of people
Easily check the stomach tube for leaks or
who fail to lose weight while participating in medically
bleeding at the end of the procedure by looking at the
supervised weight loss programs. Bariatric surgery has
inner surface of the steady line. The perigastric region
progressed from its original focus on weight loss to
and the leftover stomach can be carefully insufflated to
include health benefits (1).
look for leak spots in the steady line. Leak testing prior
Hess and Marceau were the first to provide a
to dye injection into the stomach residual is preferred
description of the laparoscopic sleeve gastrectomy
(7).
(LSG) (2), during the procedure of biliopancreatic
For the prevention of postoperative stenosis and
division and duodenal switch. LSG is the most
gastric leak, two significant problems following LSG,
common bariatric procedure performed today. A large
Nimeri and colleagues (8) advocated for the routine
amount of weight can be lost in a relatively short time
use of intraoperative endoscopy. Endoscopy is carried
with this easy, low-cost technique, and the risks
out after the transection of the stomach to check for
involved are minimal (3).
leak, hemorrhage, or stenosis, and a 32-Fr endoscope
There are immediate, intermediate, and long-
is utilized as a bougie at the outset of the process. As a
term risks associated with LSG. Gastric leak, bleeding,
result, normal intraoperative endoscopy can be
blockage, abscess formation, and infection are all
incorporated into surgical operations without
considered to be early problems. Fistula formation,
significantly increasing the duration or expense of the
stenosis, weight regain, dietary inadequacies, and
surgery (9).
gastroesophageal reflux disease (GERD) are all
The aim of the present study was to assess the
examples of difficulties that can arise in the later stages
advantage of using intraoperative endoscopic guidance
of treatment (4).
during sleeve gastrectomy and its efficiency to
Asymptomatic benign disorders (such as peptic
decrease various complications.
ulcers or hiatus hernias) or premalignant (such as
Barrett's oesophagus) or malignant (like gastric or
PATIENTS AND METHODS
esophageal cancer) lesions can be detected with routine
A follow up case series study was conducted at
preoperative endoscopic screening (5).
Laparoscopic Gastrointestinal Surgery Unit, General
Because of the intraoperative endoscope's bright
Surgery Department of Zagazig University Hospitals.
illumination, we can see how close we are to the lesser
The study included 18 cases planned for laparoscopic
curvature, which improves our ability to precisely
sleeve gastrectomy.
position the instrument. In addition to the stomach, the
5350
Received: 13/06/2022
Accepted: 21/08/2022
c:\work\Jor\vol891_190
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5356- 5361
Perioperative Multimodal Analgesia Overview: Review Article
Mohammed Ahmed Younus*, Mona Abdel-Hameed El-Harrisi,
Sahar Mohammad SaadAldeen El Gammal, Essamedin Mamdouh Negm
Department of Anesthesia Intensive, Care and Pain Management, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohammed Ahmed Younus, Mobile: (+20) 01006448928, E-Mail: shanka1187@gmail.com
ABSTRACT
Background: Multimodal analgesia refers to the use of several medications, often started preoperatively that target
multiple loci along the pain pathway. Multimodal therapy attempts to modify the inflammatory response to surgery or
decrease the immediate or long-term consequences of tissue injury and the pain that ensues. Such an approach may
theoretically improve pain control, limit the dose and adverse effects of any one drug, and reduce opioid requirements. In
most practice, the combination of acetaminophen and nonsteroidal inflammatory drugs (NSAIDs) is the basis for
multimodal postoperative analgesia for most patients who are without contraindications. However, while there are data
suggesting efficacy of multimodal analgesic therapy in adults.
Objective: Assessment of roles and benefits of perioperative multimodal analgesia.
Methods: Multimodal, and analgesia 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: Combined use of multimodal opioid sparing analgesics such as Paracetamol, NSAIDs, Gabapentin,
Dexmedetomidine, the clinical neurologic evaluation can be maintained while the patient receives the benefits of a scalp
block for pain management and opioid reduction.
Keywords: Multimodal, Analgesia, Zagazig University.
INTRODUCTION
acetaminophen, NSAIDs, dexamethasone, ketamine,
Multimodal analgesia refers to the use of several
clonidine, and dexmedetomidine, but insufficient or no
medications, often started preoperatively, that target
available data on the benefits of other medications (4).
multiple loci along the pain pathway. Multimodal therapy
Opioid sparing effects are difficult to demonstrate partly
attempts to modify the inflammatory response to surgery
because of variability in dose and intervals of
or decrease the immediate or long-term consequences of
administration, drug combinations, variety of surgical
tissue injury and the pain that ensues (1) (Fig. 1).
procedures, age and patient population, follow-up
Such an approach may theoretically improve
duration, and outcome measures in existing studies (5).
pain control, limit the dose and adverse effects of any one
Insufficient analgesia during the early
drug, and reduce opioid requirements. In most practice,
perioperative phase is theorized to play a role in the
the combination of acetaminophen and nonsteroidal
progression of acute postsurgical pain to chronic
inflammatory drugs (NSAIDs) is the basis for
postsurgical pain (6). It makes sense to pharmacological
multimodal postoperative analgesia for most patients
target pain pathways outside of opioid receptors, as there
who are without contraindications. However, while there
are many different types of pain pathways, and the effects
are data suggesting efficacy of multimodal analgesic
of a multimodal strategy are believed to be synergistic
therapy in adults (2), an opioid sparing effect remains
rather than additive. These measures can start before
difficult to prove in children (3).
surgery and continue through the perioperative period,
A 2017 systematic review of the literature on
the intensive care unit, the regular ward, and the patient's
analgesic efficacy of systemic nonopioid analgesics
time spent recovering at home. The Enhanced Recovery
found evidence of clinical analgesic efficacy (i.e.,
after Surgery (ERAS) procedures can also make use of
decrease in narcotic use and postoperative pain) for
them (7).
5356
Received: 16/06/2022
Accepted: 24/08/2022
c:\work\Jor\vol891_191
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5362- 5366
Hysteroscopic Evaluation of the Uterus in Obese Female with
Post-Menopausal Bleeding
Aljali Abu Bakr Aljali*, Ashraf Mohamed Nasr, Khaled Fathy Elsayed Helal, Ahmed Hamdy Elsayad
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Correspondence author: Aljali Abu Bakr Aljali, Mobile: (+20)01555668236, E-mail: aljalyh@gmail.com
ABSTRACT
Background: The causes of postmenopausal vaginal bleeding included endometrial atrophy, hyperplasia, polyps,
submucosal myoma, and cancer. Every woman with postmenopausal bleeding (PMB) needs a meticulous clinical
investigation since it has a 10 to 15 % of endometrial cancer.
Objective: The aim of this work was to achieve an accurate evaluation of the uterine cavity in obese females with post-
menopausal bleeding.
Patient and Methods: A case-control study that was carried out over 6 months from March 2022 to August 2022 on
68 cases at Gynecology Outpatients in Obstetrics and Gynecology Department, Zagazig University Maternity Hospital
where office hysteroscopy is performed. All patients were divided into two groups: Group A included 34 obese patients
with post-menopausal uterine bleeding, while group B included 34 non-obese patients with post-menopausal uterine
bleeding. All patients were subjected to full history taking, routine clinical examination, laboratory investigations and
hysteroscopic evaluation.
Results: There was no significant difference between the studied groups concerning the endometrial thickness, time,
and amount of bleeding or histological sample distribution. They also revealed that endometrial polyps were
significantly associated with non-obese group, but endometrial polyps + fibroids and proliferative endometrial
hyperplasia were significantly associated with obese group.
Conclusions: Obesity is a risk factor for the development of abnormal uterine bleeding in postmenopausal women
considering its association with several uterine and endometrial pathologies causing postmenopausal bleeding.
Keywords: Hysteroscopy, Post-menopausal, Bleeding.
INTRODUCTION
postmenopausal bleeding for prioritized investigations
The World Health Organization (WHO) defines
(4). Hysteroscopy enables to directly visualize the
menopause as the permanent cessation of menstruation
uterine cavity completely and in case of any abnormal
caused by the reduction of ovarian follicular activity.
visualization, the representative tissue can be collected
Postmenopausal bleeding (PMB) is an anomaly that
for histopathological examination (5). The aim of this
occurs after menopause. After at least a year of
study was to explore the relationship between
amenorrhea, it is characterized as uterine bleeding.
hysteroscopy findings of abnormal uterine bleeding and
PMB is a prevalent complaint among gynecology
body mass index in women with postmenopausal
patients, accounting for about 5-10% of total patient
bleeding.
turnover in a gynecological clinic during the
postmenopausal time (1).
PATIENTS AND METHODS
The causes of postmenopausal vaginal bleeding
Patients fulfilling inclusion criteria were recruited
included endometrial atrophy, hyperplasia, polyps,
to the study from the attendants at the Department of
submucosal myoma, and cancer. Every woman with
Obstetrics and Gynecology, Zagazig University
PMB needs a meticulous clinical investigation since it
Hospitals until the fulfillment of the needed sample.
has a 10 to 15 % of endometrial cancer. The burden of
The number of patients included in the study was 68
endometrial cancer is increasing worldwide, therefore
cases at Gynecology Outpatients where office
increasing the need for early diagnosis and treatment (2).
hysteroscopy was performed. All patients were divided
Although in almost half the cases, clinical
into two groups; Group A included 34 obese patients
assessment, transvaginal sonography (TVS), and/or
with post-menopausal uterine bleeding while Group B
saline infusion sonography are able to diagnose and
included 34 non-obese patients with post-menopausal
detect the cause of PMB yet in a large proportion of
uterine bleeding.
cases, the diagnosis remains uncertain and needs to be
validated. A high body mass index (BMI) has been
Inclusion criteria:
linked to an increased risk of endometrial disease. In
Women age 45 - 70 years old. Women that have
affluent cultures, obesity is thought to be responsible for
reached menopause with bleeding after menopause 12
around 40% of endometrial cancer cases (3).
months. Patients with postmenopausal bleeding.
When managing postmenopausal bleeding in
Obese and non-obese women with postmenopausal
women, the BMI standard for obesity at 25 kg/m2
bleeding. BMI 30 kg/m2. Endometrial thickness by
identified 51% of endometrial disease in this group and
transvaginal ultrasound (TVUS) 5 mm.
denoted a 57% increased endometrial risk factor. Thus,
obesity could be used to triage women presenting with
5362
Received: 16/6/2022
Accepted: 24/8/2022
c:\work\Jor\vol891_192
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5367- 5375
Sonohysterographic Evaluation of Cesarean Scar Defect after Purse-String versus
Double-Layer Uterine Closure Techniques: A Randomized Controlled Trial
Ahmed Ismail Heraiz, Mohamed A. Ibrahem, Basem Hamed.
Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Egypt.
Corresponding author: Basem Hamed,Tel: 020/01004132040; E-mail: basem@zu.edu.eg
ABSTRACT
Background: cesarean scar niche is one of the novels mentioned complications of cesarean section due to the rising numbers
of cesarean sections and improved imaging modalities. The causes of cesarean scar niche are still being investigated, one
of them is the uterine closure method that should be studied to pick up the best one to decrease the incidence of niche after
cesarean delivery.
Objective: The aim of this work was to find the best way of uterine closure decreasing the incidence of cesarean section
niche. Material and methods: A prospective randomized controlled study that was conducted between May 2021 and
April 2022 at the department of Obstetrics and Gynecology, Zagazig University. Full term ninety-eight primigravida
undergoing first elective cesarean section were equally randomized to either purse string or double-layer unlocked suture.
Six months after cesarean section, Sonohysterography was done for assessment of cesarean scar integrity. Markers of
cesarean scar healing included residual myometrial thickness "RMT", niche depth "D", hypoechoic triangular niche width
"W" and healing ratio "D/RMT". All these markers were calculated by experienced sonographers who were not aware of
the uterine closure technique. Results: In terms of estimated blood loss, there was no significant differences between both
groups. However, frequency of appearance of niche in purse-string group was 25% compared to 56.8% in the double layer
group (P=0.002). The mean thickness of the residual myometrium covering the defect was significantly higher 7.8 ± 1.1
mm after purse-string than 5.9 ± 0.6 mm after a double-layer closure (P = 0.001). The mean healing ratio in purse-string
group was 0.449 versus 0.600 in the double-layer closure (p<0.001).
Conclusion: Purse-string uterine closure was associated with better uterine scar healing, higher residual myometrial
thickness and lower rate of cesarean scar defect than double layer closure.
Keywords: Niche, Uterine scar, Healing ratio, Sonohysterography.
INTRODUCTION
cavity makes enhancement through anechoic contrast
Cesarean section (CS) is considered the most
medium. Thus, SHG combines the advantages of both US
commonly performed surgery in obstetrics. Because
and hysterosalpingography 7. Recently, SHG had added
many women are undergoing this surgery every year, it
significantly to uterine cavity evaluation residual
becomes of great importance to study this operation
myometrial thickness 8, adjacent myometrial thickness,
sequels on the female future fertility 1. Postmenstrual
depth of the cesarean scar defect (niche) and any presence
spotting and dysmenorrhea are one of the recent common
of intrauterine adhesions that can be scar-related 9.
sequels in women with previous cesarean sections 2, 4.
Uterine closure method should be evaluated according to
These sequels are mostly attributed to cesarean scar defect
the possible benefits and the anticipated harm to get the
that is called the niche which is defined as "at least 2 mm
best method for uterine closure in women undergoing
depth indentation at the site of cesarean scar" that can be
cesarean section 10. Uterine wound integrity is greatly
seen by the transvaginal ultrasound (TVUS) 3. Relation
affected by mechanical tension and suturing technique.
between cesarean section niche and presentation of
So, this prospective randomized trial was to compare the
postmenstrual spotting was proved and reported by two
classical double layer closure of the uterine incision to the
studies with 3.1 odd ratio [1.56.3] at confidence interval
double layer purse-string closure as regards occurrence of
95% in the first study 2 and 5.5 odd ratio [1.126.5] in the
postoperative cesarean scar defect "niche" and other
second study 4. According to these studies, by the
short-term results.
transvaginal ultrasound, the niche was seen in 50 to 60%
in patients undergoing previous cesarean sections.
PATIENTS AND METHODS
Postmenstrual spotting had a positive relation with the
A prospective randomized clinical trial done at the
volume of the niche; however, it had a negative relation
Department of Obstetrics and Gynecology, Zagazig Faculty
with the residual myometrium thickness (RMT) 2, 4.
of Medicine between May 2021 and April 2022. Sample
However, the ultrasonography (US) had an important role
size was calculated by assuming incidence of cesarean
in pregnant uterus scar assessment, its role in non-
section niche in double layer uterine closure (26.3%) at
pregnant uterus scar assessment is still limited 5, 6.
confidence level 95%, power 80%, sample was 98 patients
Sonohysterography (SHG) is a better uterine cavity
divided in 2 groups, 49 patients in each group. Group (A)
evaluation method as instillation of fluid into the uterine
included purse string uterine closure women & Group (B)
5367
Received: 16/6/2022
Accepted: 24/8/2022
c:\work\Jor\vol891_193
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5375- 5378
Overlap of Pain Character in Patients with Inflammatory Back Pain versus
Chronic Mechanical Back Pain: Review Article
Eman Elshahawy 1, Mohamed Mortada1, Safaa Abdelmoez Elnaggar2, Noha Ehab*1
Departments of 1Rheumatology and 2Industrial Medicine, and Occupational Health,
Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Noha Ehab, Mobile: (+20) 01121476628, E-Mail: thedream93419@gmail.com
ABSTRACT
Background: Back pain (BP) is a common musculoskeletal symptom that affects a large percentage of the population. Back
pain can be classified according to the cause into mechanical and inflammatory. Inflammatory back pain (IBP) has some
distinguishing characters that help in differentiation of it from mechanical back pain. Back pain in axial spondyloarthritis is
usually of inflammatory type. There are a number of sets of criteria that have been devised to define IBP. These include the
assessment of spondyloarthritis international society (ASAS) IBP experts' criteria, Berlin criteria, as well as Calin criteria.
Objective: Assessment of overlap of pain character in patients with inflammatory back pain versus chronic mechanical
back pain.
Methods: Pain, Inflammatory Back Pain, and Chronic Mechanical Back Pain 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 2006 to June 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: There is a great overlap in character of back pain between patients with chronic mechanical back pain and
those with axial spondyloarthritis.
Keywords: Inflammatory back pain, Chronic mechanical back pain, Pain character.
INTRODUCTION
and sacral spine. It is a progressive condition can lead to
Back pain (BP) is a common musculoskeletal
canal stenosis and radicular pain. Most cases of
symptom that affects a large percentage of the population.
spondylosis without neurological impairment are best
It can affect anyone of any age. Back pain has an impact
treated conservatively. But patients with radicular
on one's life quality which can lead to disability. As such,
symptoms have good outcomes after surgery (4).
it is recognized as a global public health issue with far-
reaching economic consequences for both developed and
2) Disc herniation
developing nations (1).
A lot of people get back pain because of this. There are
Mattiuzzi et al. (1), found that the prevalence of back
many risk factors for disc prolapse such as axial overload,
pain is about 577.0 million cases and incidence is about
dehydration, and genetic predisposition. Back pain that is
245.9 million cases/year and disability-adjusted life years
caused by disc prolapse usually increases with sitting and
(DALYs) of LBPs is about 64.9 million DALYs during the
forward flexion. Disc herniation may be associated with
last 20 years. This reflects considerable ~50% increase in
radicular pain, sensory impairment, or paresis according to
all measures of epidemiology of back pain during the last
distribution of the compressed nerve roots. Radiograph has
20 years .
a role in suggesting disc prolapse. Also, CT has a role in
A staggering 75% of people will suffer from back
diagnosis but MRI is the gold standard. Management of
discomfort at some point in their lives. Back pain can be
disc prolapse includes operative and non-operative
classified according to the cause into mechanical (90%)
options. Non operative options should include education
and systemic causes (10%) that includes rheumatological
and physical exercises besides anti-inflammatory
causes (axial spondyloarthritis (AxSpA), neoplastic
medication (5).
diseases, metabolic diseases and referred pain (2).
Mechanical back pain refers to discomfort felt in the spine,
3) Spondylolysis
discs, or surrounding soft tissues as a result of conditions
Spondylolysis, or a fracture through the pars
such as disc herniation, lumbosacral muscular strain,
interarticularis, is a common cause of back discomfort in
lumbar spondylosis, spondylolisthesis, acute or chronic
children and teenagers. Radiography, CT, and MRI help in
traumatic damage, vertebral compression fractures, as well
diagnosis of spondylolysis. Early detection is critical for
as spondylolysis (3).
early treatment, which involves rest, brace treatment, and
physical therapy. Spondylolysis can lead to nonunion or a
Causes of chronic back pain other than AxSpA:
pars defect if it is left untreated. Some patients may need
1) Spondylosis
surgery to correct the par interarticularis or fuse the lumbar
Spondylosis is a degenerative spinal disorder that affects
facet joints (6).
lumbar spines mainly due to mechanical load and relative
mobility of the lumbar spines in comparison with thoracic
5375
Received: 16/06/2022
Accepted: 24/08/2022
c:\work\Jor\vol891_194
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5379- 5385
The Relationship between Elevated Pre-procedural Random Blood Glucose
Level and Periprocedural Myocardial Injury in Patients Undergoing
Elective Percutaneous Coronary Intervention
Ahmad E. Mostafa, Nehal Badr Elnahhas, Khaled El-Menyawi, Mostafa El Nozahi*
Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Mostafa El Nozahi, Mobile: (+20) 0111237 7774, Email: mostafa_elnozahi@hotmail.com
ABSTRACT
Background: In patients with coronary artery disease (CAD), regardless of their diabetes status, both hypoglycemia
and hyperglycemia are unfavourably associated to cardiovascular events. According to the results of numerous research,
both diabetic and non-diabetic patients with ST-elevation myocardial infarction (STEMI) frequently experience
hyperglycemia, which is linked to a higher risk of in-hospital morbidity and mortality.
Objective: In patients undergoing elective percutaneous coronary intervention (PCI), the goal of this study is to evaluate
the association between elevated pre-procedural random blood glucose levels and peri-procedural myocardial injury.
Patients and Methods: 110 patients with chronic coronary syndrome who underwent elective PCI at Ain Shams
University Hospitals' Cardiology Department. made up this cohort study. They were split into two equal groups, 55
were hyperglycemic and the rest 55 were euglycemic. Prior to the procedure, cardiac troponin (I) and blood glucose
levels were assessed. Blood samples for cardiac troponin were then collected 12 hours later
Results: Regarding the incidence of myocardial injury and infarction, there were statistically significant difference
between the 2 groups, with the incidence of both conditions being greater in the hyperglycemic group (P-value = 0.001,
0.022 respectively). All five individuals with myocardial infarction had higher blood sugar levels. 23 patients belonging
to the hyperglycemic group had myocardial injury. On the contrary only 7 patients with myocardial injury belonged to
the euglycemic group. The cut-off point of blood glucose level at which myocardial infarction occurred was 166 mg/dl
with 100% sensitivity and 72.4% specificity, and that at which myocardial injury occurred was 130 mg/dl with 76.7%
sensitivity and 62.5% specificity.
Conclusion: We draw the conclusion that patients undergoing elective PCI are more likely to experience peri-procedural
myocardial damage and infarction when their pre-procedural plasma glucose levels are excessively high, regardless of
their diabetes status.
Keywords: Elective PCI, Myocardial infarction, Hyperglycemia.
INTRODUCTION
Due to the lack of studies examining the
Regardless of a person's diabetes status, both
relationship between blood glucose levels at the time of
hypoglycemia and hyperglycemia are unfavourably
elective PCI and peri-procedural complications and the
connected to cardiovascular events (1). In STEMI
confusion around whether cardiac events are more
patients receiving primary PCI, diabetes mellitus is
likely to be associated to hyperglycemia than
independently associated with reduced myocardial
euglycemia. The goal of this study is to evaluate the
reperfusion, a larger infarct size, the development of
association between elevated pre-procedural random
congestive heart failure, and a lower life expectancy (2).
blood glucose levels and peri-procedural myocardial
Studies on human post-mortem tissues have
damage.
shown that, at the level of the vascular wall, lesions
from diabetic individuals have a larger macrophage
PATIENTS AND METHODS
content than lesions from people without diabetes. This
110 patients who underwent elective PCI and presented
difference correlates with glycated hemoglobin levels
with chronic coronary syndrome to the Cardiology
rather than lipid levels(3).
Department of Ain Shams University Hospitals made
In individuals with acute myocardial infarction
up this cohort study. They were split into two equal
(MI), there is a strong association between
groups: 55 patients were the hyperglycemic group, and
hyperglycemia and major adverse cardiac events
the rest were the euglycemic group.
(MACE) within 30 days following PPCI (4). Numerous
studies have demonstrated that hyperglycemia is
Exclusion criteria: Patients with chronic kidney
common in people with ST-elevation myocardial
disease with estimated GFR below 60 mL/min., patients
infarction (STEMI) who are diabetic or non-diabetic
with any form of active infection, patients with recent
and is associated with an increased risk of death and
cerebrovascular accident, patients with pre-existing left
hospital complications (4,5). Data from human and
ventricular dysfunction, patients with anemia, patients
animal studies support that high glucose has a direct
with any type of different cardiomyopathies, patients
pro-atherogenic effect on vascular cells since there is
with infiltrative cardiac diseases, patients with storage
suggestive evidence that it is atherogenic, particularly at
diseases, patients receiving chemotherapeutic drugs and
the level of the arterial endothelium.
5379
Received: 16/6/2022
Accepted: 24/8/2022
c:\work\Jor\vol891_195
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5386- 5391
Exploration of Parental Satisfaction with Physical Therapy Services in
Pediatrics Out-Patient Clinics
Reham Abdelhamid Mohamed*, Hebatallah Mohamed Kamal, Rami Mahmoud Gharib
Physical Therapy for Pediatrics Department, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Reham Abdelhamid Mohamed, Mobile: (+20) 01093727518, E-Mail: reham_physio_727@yahoo.com
ABSTRACT
Background: One of the means to assess health related quality of care can be through detecting patient satisfaction. On
the other hand, clinicians can more accurately plan for offered physical therapy service when evaluating patient
satisfaction. Objective: This study aimed to explore the parents/caregivers of spastic cerebral palsy children satisfaction
with the physiotherapy services delivered in the pediatric out-patient clinic of Faculty of Physical Therapy, Cairo
University and how it is impacting their children´s quality of life.
Subjects and Methods: The study sample included 100 parents of spastic cerebral palsy children aged from 2 to 7
years. Parents' satisfaction was evaluated using the MedRisk Instrument (MRPS) and their children´s health related
quality of life was measured by pediatric quality of life (PedsQl).
Results: The results revealed that the overall satisfaction level was very good according to MRPS and there was weak
positive non-significant correlation between MARS and PedsQl. Conclusion: Parent satisfaction with physical therapy
services in pediatric outpatient clinics at the Faculty of Physical Therapy, Cairo University was very good although
there was non-significant correlation between parent satisfaction and their children´s health related quality of life.
Keywords: Patient satisfaction, MedRisk patient satisfaction instrument, Physical therapy services, Health related
quality of life, Pediatric quality of life.
INTRODUCTION
physical functional tasks, pain management, completion
The effectiveness of the rehabilitation process is
of the treatment plan, and treatment satisfaction (8).
largely attributed to the patients' pleasure, which is
In
physiotherapy
field,
therapist-patient
measured by the calibre of medical services. It offers
interaction is more powerful compared to other medical
unbiased comments on the services, encourages
professions. This is mainly related to the environment
patients, and helps them stick with the treatment plan.
of the physiotherapy treatment and the extensive
Additionally, it improves quality of life by gathering
encounter between patient and therapist and
statistics and information that health authorities use to
consequently the patient's perception of this relation
make financing decisions and to accredit medical clinics
can be directly influenced (9,10).
(1). Patient perception of the calibre of the services they
The primary movement and postural problems
received is reflected in their level of satisfaction. It
associated with cerebral palsy (CP) are caused by non-
serves as a gauge of the standard of care provided by the
progressive brain injury that occurs in infancy; typically
healthcare system (2). The connection between the
linked to emotional, social, and familial challenges as well
therapist and the patient, the external environment, and
as disability (11).
societal values all play a significant role in this broad
The past decade has evidenced a dramatic
issue (3). When evaluating the calibre and output of a
increase in the development and use of pediatric health-
specific healthcare service, patients' pleasure is thought
related quality of life (HRQOL) measures in an effort to
to be a crucial factor (4). It has been discovered that
improve pediatric patient health and determine the value
patients who report higher satisfaction rates also show
of health care services (12,13). HRQOL is a
better health. One way to get data regarding the
multidimensional construct, consisting at the minimum
perceived quality of care is through patient feedback on
of the physical, psychological (including emotional and
healthcare services (5).
cognitive), and social health dimensions delineated by
According to several studies, satisfied people are
the World Health Organization(14). A number of authors
more loyal to their healthcare providers and follow their
have argued that improving quality of life is the ultimate
advice and recommendations than dissatisfied patients
goal of health care(15).
(6). This is because the physiotherapist develops a
This
study
aimed
to
explore
the
trusting relationship with the patient because
parents/caregivers of spastic cerebral palsy children
rehabilitation takes a long time. As a result, they assist
satisfaction with the physiotherapy services delivered in
patients and allay their anxieties, which encourages
the pediatric out-patient clinic of Faculty of Physical
patients to work hard throughout treatment and see
Therapy, Cairo University and how it is impacting their
improvements (7). Numerous studies that included
children´s quality of life.
patients with various pathologies discovered that the
therapeutic relationship between the patient and the
SUBJECTS AND METHODS
therapist has an advantageous effect on the course of
One hundred parents of spastic cerebral palsy
treatment, the patient's ability to perform daily tasks,
(hemiplegia, paraplegia, diplegia and quadriplegia)
5386
Received: 16/6/2022
Accepted: 24/8/2022
c:\work\Jor\vol891_196
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5392- 5399
Relationship between Caspase-8 and SARS-CoV-2 Variants in a
Sample of Iraqi Population
Jinan J. Ghazzi* , Hula Y. Fadhil
1 department of biology, college of science, university of Baghdad, Baghdad, Iraq
* Corresponding author: Jinan J. Al-Kafagi, Mobile: (+964) 7741786166, E-Mail: jaliljinan1@gmail.com
ABSTRACT
Background: Mutations started to accumulate in SARS-CoV-2 due to replication errors leading to emergence of
variants. New variant appeared in December 2020. Caspase-8 can process pro-IL-1 and IL-18 causing the release of
bioactive cytokines through immunogenic cell death that can kill virus-infected cells and activate the innate and adaptive
immune systems. Objective: This study aimed to find the relationship between caspase-8 levels and wild-type, alpha,
beta or gamma and omicron variants and its correlation with severity, CRP, and WBC.
Materials and methods: 134 nasal swabs and blood samples were collected from COVID-19 patients and 48 healthy
individuals. RNA was extracted and rRT-PCR assay to detect variants using a special kit. Caspase-8 levels were
determined by ELISA. Results: There was a significant relationship (p < 0.001) in patients median caspase-8 than in
control. Logistic regression analysis showed that odds ratio (OR) of unadjusted patients was 4.33 and with age-adjusted
was 7.24. Caspase-8 levels showed a significant relationship with the severity of infection by COVID-19 (p < 0.01) and
highly significant relation with variants of SARS-CoV-2 (p < 0.0001), as follows: Alpha, wild type, beta or gamma and
omicron. Caspase-8 levels were significantly increased with increase of CRP levels (p < 0.05) making both of them good
prognostic markers for infection progress. Observed negative Spearman correlation (rs = -0.27; p < 0. 01) were detected
between caspase-8 and WBC.
Conclusion: The most severe infections with SARS-CoV-2 appeared in wild type and alpha variant. Caspase-8 and CRP
are excellent biomarkers for the progression of infection.
Keywords: SARS-CoV-2, Caspase-8, rRT-PCR, COVID-19, ELISA.
INTRODUCTION
these mutations in the spike (S) protein. In Nelson
On December 31, the Wuhan Municipal Health
Mandela Bay, South Africa, a second wave of COVID-
Commission made a pneumonia outbreak announcement
19 infections was brought on in October 2020 by a novel
on their website. Later, researchers revealed the
SARS-CoV-2 lineage, the Beta variant (6).
discovery of a previously unidentified coronavirus (1).
The Beta form of the spike protein carries nine
World Health Organization (WHO) designated the illness
mutations. The third variant of interest is Gamma variant.
as coronavirus disease 2019 (COVID-19), and the
It was first seen in the US in January 2021 after being
International Committee on Taxonomy of Viruses
found in Brazil in December 2020. There are ten
(ICTV) designated the new infectious agent as severe
mutations in the variant's spike protein. This variant has
acute respiratory corona virus-2 (SARS-CoV-2) (2). The
spread to 45 nations, according to the WHO
first confirmed SARS-CoV-2 case was reported in Iraq
epidemiological bulletin from March 30, 2021 (7).
on February 24, 2020, by an Iranian student. Since then,
The WHO has named the most recent variant of
the number of cases has climbed both domestically and
concern as the Omicron variant. It was discovered for the
globally (3).
first time in South Africa on November 23, 2021,
Rapid global spread of the SARS-CoV-2 resulted
following an increase in the number of COVID-19
in several variants of concern (VOCs), which finally
patients. Along with the high increase in cases seen in
developed into a serious and lethal outbreak
South Africa, Omicron had more than 30 mutations to the
(4).Unsurprisingly, as the number of COVID-19 instances
virus' spike protein (8).
rose, mutational differences that may have a greater
Caspase-8 has been discovered to be a master
influence on fitness, such as those that could result in
regulator of the three primary cell death pathways,
immunological escape, also occurred. In actuality, there
including apoptosis, pyroptosis, and necroptosis.
are likely escape mutations in the ten human monoclonal
Previously, it was only recognized as an apoptotic
antibodies that target the SARS-CoV-2 RBD (4). A novel
caspase (9). Recently, it was found that caspase-8 can
SARS-CoV-2 variant of concern, the Alpha variant, was
function similarly to caspase-1 in processing pro-IL-1
discovered in the UK in late December 2020 based on
and IL-18, releasing bioactive cytokines through either
whole-genome sequencing of samples from patients who
pyroptosis or necroptosis and triggering the generation of
tested positive for SARS-CoV-2 (5). The alpha form of the
pro-inflammatory
cytokines.
Necroptosis,
an
viral genome carries 17 mutations. There are eight of
immunogenic cell death process, can kill virus-infected
5392
Received: 17/06/2022
Accepted: 25/08/2022
Effect of Heart Rate at Admission on Outcome of Patients Undergoing Primary Percutaneous Coronary Intervention
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5400- 5406
Effect of Heart Rate at Admission on Outcome of Patients
Undergoing Primary Percutaneous Coronary Intervention
Ahmed Shafie Ammar, Ahmed Mohamed El-Zayat,
Ahmed Said El-Damanhory, Nezar Mohamed Hussein Mresa*
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Nezar Mohamed Hussein Mresa, Mobile: (+20)01007355767, E-mail: nezarmresa@gmail.com
ABSTRACT
Background: Several studies showed that there is high correlation between heart rate and high adverse outcomes rates.
Objective: The aim of the current study is to investigate the effect of heart rate on admission in hospital-outcome of
patients undergoing primary percutaneous coronary intervention.
Patients and methods: Over the course of 7 months, from July 2019 to January 2020, 63 patients were enrolled in a
prospective comparative study at the Cardiology Department of Zagazig University Hospitals. Enrolled patients were
diagnosed with acute ST-elevation myocardial infarction (STEMI) and then treated with primary percutaneous coronary
intervention. Ejection fraction and coronary angioplasty were assessed in all patients.
Results: Significant positive correlations were found between age and heart rate above 100 bpm, also between systolic
blood pressure and diastolic blood pressure, with significant negative correlations between systolic blood pressure and
left ventricular end-diastolic volume (LVEDV), between diastolic blood pressure and LVEDV, and also between
ejection fraction and LVEDV and left ventricular end-systolic volume (LVESV). Among group with heart rate above
100 bpm a significant positive correlation between LVEDV and LVESV was found.
Conclusion: The presence of admission tachycardia was linked to increased risk of severe adverse cardiac events in
patients with STEMI following primary percutaneous coronary intervention, despite the lack of an association between
admission bradycardia and serious cardiac outcomes. Further studies with large sample size are recommended to
confirm the current results.
Keywords: Percutaneous Coronary Intervention, Heart Rate, Coronary artery disease, myocardial infarction, ST-
elevation myocardial infarction.
INTRODUCTION
PATIENTS AND METHODS
Acute
myocardial
infarction
and
other
Between July 2019 and January 2020, 63 patients
consequences of coronary artery disease continue to be
were enrolled in a prospective comparative study at the
among the leading causes of death and disability
Cardiology Department of Zagazig University
worldwide (1). Several factors influence heart rate (HR)
Hospitals. Enrolled patients were diagnosed with acute
during the initial stages of acute myocardial infarction,
STEMI and then treated with primary percutaneous
which may have consequences for clinical outcome (2).
coronary intervention.
At admission, heart rates of patients with inferior
ST-elevation myocardial infarction (STEMI) were less
Inclusion criteria: Patients with acute STEMI
than 60 beats per minute, while only 15% of those of
undergoing primary PCI, Definition of acute STEMI:
anterior STEMI have sinus bradycardia (HR <60/min)
ST segment elevation >2 mm in more than 2 contiguous
(3). On the other hand, it has been concluded from
leads or fresh beginning of left bundle branch block
previous studies that admission tachycardia could have
(LBBB) with characteristic ischemic chest pain
an impact on both short and long term prognosis after
lasting >20 minutes (7).
acute myocardial infarction (4).
Impact on clinical outcome that is expected from
Exclusion criteria:
admission high heart rates (tachycardia patients) could
Thrombolytic reperfusion therapy. Patients who
be concluded from direct link between tachycardia as a
presented >12 hours onset of chest pain. Patients with
compensatory mechanism of acute heart failure (5).
Mobitz II, III, or 2:1 Atrioventricular Block (AVB)
On the other hand, admission HR during acute MI
were not included. Patients who refused to participate
could be simply a reflex change secondary to acute
in the study. Those who suffer from cardiomyopathy or
chest pain for which patients respond by tachycardia
valvular heart disease, and patient with end stage renal
and in case of severe pain by reflex bradycardia.
failure or severe liver disease or systemic.
Whether the grouping of STEMI patients according to
full range of admission heart rate (AHR) would have a
The studied subjects were divided into 3 groups;
significant impact on further risk stratification and in-
Group 1 included 21 patients with heart rate less than
hospital outcome is not fully clear (6)
60 b/min on admission, Group 2 included 21 patients
The current study objective was to investigate the
with heart rate between 60 to 100 b/min on admission,
effect of heart rate on admission in hospital-outcome of
and Group 3 included 21 patients with heart rate more
patients undergoing primary percutaneous coronary
than 100 beats/ minute on admission.
intervention (PCI).
5400
Received: 17/6/2022
Accepted: 25/8/2022
c:\work\Jor\vol891_198
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5407- 5413
Heart Rate and Blood Pressure Variability as Predictors for the
Attacks in Patients with Neurocardiogenic Syncope
Hisham Samir Roshdy, Ahmed Shafiea Amaar, Shaimaa Nabil Hashim Mostafa*,
Radwa Muhammad Abdullah
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Shaimaa Nabil Hashim Mostafa, Mobile: (+20)01000912059, Email: dr.shaimaa.2oct@gmail.com
ABSTRACT
Background: For a long time, researchers have employed head-up tilt to analyze how the heart and blood pressure react
to different positions. The vasovagal reflex is responsible for the most prevalent type of reflex syncope, known as
vasovagal syncope (VVS) or neurocardiogenic syncope.
Objective: The goal of teaching patients to notice prodromal symptoms and doing suitable physical counter-maneuvers
(PCMs) to increase blood pressure in order to prevent or postpone attacks is to reduce the likelihood of future attacks.
Patients and methods: In a case-control study, fifty-seven subjects were enrolled in the study. Thirty-five patients were
in 1st case group with recurrent history of presyncope or syncope and positive tilt test. Twenty-two age matched healthy
subjects were in 2nd control group. All underwent head up tilt testing (HUTT).
Results: there was a statistical significance increase in LF power during P2 in cases compared to controls and also
significant increase in LF/HF ration in P1 and P2 reflecting the high sympathetic predominance just preceding the
episode of syncope. The magnitude of effect of LFP2, LF/HF at rest and LF between P2 and P1, LF/HF between
P1 and R was high denoting the rapid autonomic alteration resulting from postural and stressful conditions preceding
the occurrence of syncope. Conclusion: Variability in heart rate provides information about the autonomic nervous
system's health (ANS). How much the heart rate (HR) varies tells us about how well the nervous system regulates the
heart rate and how quickly the heart can react to external stimuli.
Key words: Heart Rate, Blood Pressure, Variability, Neurocardiogenic Syncope.
INTRODUCTION
lost consciousness completely or nearly completely for
The overall lifetime prevalence of syncope in the
a short period of time, and in other cases, hypotension
population is close to 20%, making it a prevalent
was accompanied by a sudden, profound bradycardia
clinical condition. Syncope becomes more common as
consistent with a vasovagal syncope (VVS) reaction(4).
people get older, with a noticeable spike beyond age
Only in cases where patient hydration and
70(1).
physical interventions have failed can pharmaceutical
Extreme lightheadedness, visual disturbances
management of reflex syncope (and especially
like "tunnel vision" or "greying out," and varying
vasovagal syncope) be considered. Midodrine and
degrees of altered consciousness without total loss of
fludrocortisone, a mineralocorticoid that retains salt, are
consciousness are all indications of presyncope, which
the only treatments that have shown any promise (5).
occurs before syncope. You may experience syncope,
The purpose of this research was to teach
or it may end before that happens(1).
patients how to recognize prodromal symptoms and
Cardiac, orthostatic, and neurogenic syncope are
how to do physical counter-maneuvers (PCMs) to raise
the most common types, however other causes, such as
blood pressure, which can prevent or postpone attacks.
carotid sinus hypersensitivity, situations, and vasovagal
collapse, are also considered causes of syncope. Those
PATIENTS AND METHODS
over the age of 65 are more likely to experience
We performed our study in Zagazig University
orthostatic, carotid sinus hypersensitivity, or cardiac
Hospitals Autonomic Laboratory. during the period
syncope, whereas those under the age of 35 are more
from February 2019 to February 2020. Fifty-seven
likely to experience vasovagal syncope. Besides
subjects were enrolled in the study:
neurally mediated and orthostatic syncope, patients who
report with syncope have an elevated risk of death (2).
The studied population was classified into two
Recognizing prodromal symptoms and learning
groups:
how to use physical counter-maneuvers (PCMs) that
Group 1 (Cases): This included 35 patients with
raise blood pressure (such crossing legs, sitting,
recurrent history of presyncope or syncope and positive
crouching, hand gripping, and arm tensing) to prevent
tilt test.
or postpone attacks is the focus of education. Physical
Group 2 (controls): Twenty-two age matched healthy
activity (lower body isometrics, rowing), as well as
subjects.
standing training, may reduce vulnerability over the
long run. Patients should also be informed of factors
Inclusion Criteria: Patients who had: (1) Having
that put them at higher risk for an adverse outcome (3).
experienced syncope twice before. (2) One syncopal
Studies of how the heart and blood pressure react
episode and four or more presyncopal episodes. (3)
to shifts in position have long made use of head-up tilt
Single occurrence of syncope leading to catastrophic
(HUT). As a side effect of the testing, some participants
harm.
5407
Received: 16/06/2022
Accepted: 24/08/2022
c:\work\Jor\vol891_199
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5414- 5419
Prevalence of Congenital Malformations among Neonates at
Al-Ahrar Teaching Hospital
Ahmed Hassan Mahmoud Hassan*1, Aly Hassan Muhammad Fayyadh2, Alaa Hassieb Elsadek3
Departments of 1Pediatrics, 2Radiodiagnosis and 3Obstetrics and Gynecology,
Al-Ahrar Teaching Hospital, Zagazig, Egypt
*Corresponding author: Ahmed Hassan Mahmoud Hassan, Mobile: (+20)1225953895, Email: drahmhassan@gmail.com
ABSTRACT
Background: Congenital disorders are common conditions. The incidence of malformations in the neonate variations
both between countries and between regions within the same nation.
Objective: The aim of the current work was to determine the spot incidence of congenital malformations among
neonates at Obstetric Department of El-Ahrar Zagazig Hospital.
Patients and methods: This prospective descriptive study included a total of 31 babies who were noted to have
congenital malformation, attending with their parents at the Obstetric Department and the Neonatal Intensive Care Unit
(NICU), El-Ahrar Zagazig Hospital. The total number of deliveries during the period of the study was 1254.
Results: Congenital anomalies incidence was 2.47%. The greatest incidence of congenital abnormalities (CAs)
involved the musculoskeletal system, abdominal wall and skin (in 23%), the central nervous system (in 19%), the
cardiovascular system (in 19%), the genitourinary system (in 13%), the gastrointestinal tract (in 10%), the orofacial (in
10%) and chromosomal aberrations (in 6.5%). Most cases of congenital anomalies were full term.
Conclusion: It could be concluded that the spot incidence of congenital anomalies among liveborn neonates in
Zagazig locality accounts for 2.5% (31/1254 deliveries).
Keywords: Congenital Malformations, Neonates, Al-Ahrar Teaching Hospital.
INTRODUCTION
rates are lower in such areas (5).
Structural or functional abnormalities, such as
There are many potential prenatal causes for
metabolic problems, that are present at birth are what
birth defects, including mutations in a single gene,
are referred to as birth defects. Both "birth defect" and
chromosomal
abnormalities,
multifactorial
"congenital disorder" are used interchangeably since
inheritance, teratogens in the environment, and
they mean the same thing (1).
nutritional inadequacies in the fetus. Birth
Birth defects, regardless of classification, are a
malformations are common in low and middle-income
substantial but underrecognized cause of mortality and
nations, and maternal illnesses like syphilis and rubella
impairment among newborns and children under the
are a major contributor. Causes of birth abnormalities
age of five. They are also a leading cause of abortion
include iodine and folic acid deficiencies, maternal
and stillbirth. They pose serious health risks, can cause
illnesses like diabetes mellitus (DM), and exposure to
permanent disability, and have far-reaching
medical and recreational substances like alcohol and
consequences for people's lives, families, healthcare
nicotine, as well as environmental toxins and high
systems, and communities (2).
amounts of radiation (2).
The prevalence of congenital anomalies varies
Existing health-care services, especially those
greatly from country to country and even from area to
concerned with maternal and child health, should
region within a same country. Infants have a 1-3%
include treatments and interventions for the prevention
chance of being born with complete abnormalities
and care of birth abnormalities. Education,
across all body systems (3). About 3% of all live births
preconception care, population screening, genetic
are associated with a birth abnormality that can be
counselling, and access to diagnostic tests should all be
identified, while between 15% and 20% of stillbirths
part of a comprehensive, preventative approach to
are associated with a significant congenital deformity.
providing the best possible care to their patients. As
Genealogical and environmental factors both play a
part of a larger set of interventions for mother and child
role in the development of congenital anomalies.
health, this plan must provide services for the detection
However, a large percentage of birth abnormalities
and treatment of congenital anomalies. Services should
have unknown causes and many are known to result
include secondary and tertiary care, such as obstetrics,
from a combination of genetic and environmental
pediatrics, surgery, laboratory, radiology, and clinical
variables (multifactorial inheritance) (4).
genetics, if these are accessible in the country (2).
Disorders present at birth, known as congenital
The aim of the current work was to determine the
disorders, are quite frequent. CAs were responsible for
spot incidence of congenital malformations among
around 265,000 deaths globally, or about 7% of all
neonates at Obstetric Department of El-Ahrar Zagazig
neonatal deaths. Some regions, including the WHO
Hospital.
European Region, have as high as 25% of neonatal
PATIENTS AND METHODS
deaths attributable to CAs, even if overall mortality
This prospective descriptive study included a total of 31
5414
Received: 17/6/2022
Accepted: 25/8/2022
c:\work\Jor\vol891_200
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5420- 5426
Evaluation of Laryngeal Tumors by Multi-Detector Computed
Tomography and Magnetic Resonance Imaging
Mohamed Abdelkhalk Basha, Mennatallah Ahmed Ali Abd-Elmacsoud*,
Esam Mohamed Hemat, Mohamed Ibrahim Amin
Department of Radiodiagnosis, Faculty of Medicine Zagazig University, Egypt
*Corresponding author: Mennatallah Ahmed Ali Abd-Elmacsoud, Mobile: (+20)1060375818,
E-Mail: mennaahmed9101990@gmail.com
ABSTRACT
Background: Twenty to forty percent of all head and neck malignant tumors are laryngeal tumors, while sixty to seventy
percent of laryngeal cancers are found at advanced stages. Laryngeal cancer is diagnosed using several techniques, such
as magnetic resonance imaging (MRI) and contrast-enhanced Computed Tomography (CT).
Objective: The aim of this study was to evaluate the role of multislice computed tomography (MSCT) and magnetic
resonance imaging (MRI) in diagnosis of laryngeal tumors.
Patients and methods: Twenty-four patients, 21 men and 3 women. Their ages ranged from 25 to 75 years who were
referred form ENT department, Zagazig University Hospital. All patients underwent clinical examination, indirect
laryngoscopic examination, CT, MRI and histopathological study.
Results: A highly significant difference was found between MRI and CT in masses and LNs finding among the studied
patients by both MRI and CT. Both investigations agreed that 16.7 % of the studied patients had glottic mass, 12.5 %
had glottic and infra glottic, and 41.7% had supra glottic and glottic with infiltration, degree of agreement in diagnosis
of masses and LNs between both MRI and CT is very good (kappa= 0.775, p-value=0.000*). Agreement between CT
and MRI regarding masses and LNs among the studied cases; glottic mass alone by CT 33.3% but by MRI 16.7% and
glottic mass plus other sites and lymph nodes by CT 66.7% but by MRI 83.3%.
Conclusion: When it comes to T staging of laryngeal carcinomas, MRI shows greater accuracy than CT. Laryngeal
carcinomas with AVC involvement may be better assessed for thyroid cartilage involvement and T stage if CT and MRI
are used together.
Keywords: Laryngeal Tumors, Multi-Detector Computed Tomography, Magnetic Resonance Imaging.
INTRODUCTION
superior soft tissue differentiation and functional
Twenty to forty percent of all head and neck
imaging ability. This is because CT is better at
malignant tumors are laryngeal tumors, while sixty to
delineating the cortical disruption of ossified cartilage,
seventy percent of laryngeal cancers are found at
and it also allows submillimeter images to be acquired
advanced stages (III-IV). As of right now, video
with motion freezing in a matter of seconds. However,
laryngoscopy combined with autofluorescence,
since cortical disruption may be required to detect
contrast-enhanced CT, and MRI are all employed for
cartilage invasion, uneven ossification frequently acts
diagnosing laryngeal cancer (rate of invasion).
as a barrier to an accurate diagnosis. To get around this
However, early-stage, tiny tumors do not respond well
limitation, a recent study used dual-energy CT scans
to these techniques for differential diagnosis. DWI-MRI
and iodine overlay pictures to tell tumors apart from
is employed for accurate localization, growth and
non-ossified cartilage (6).
dissemination status (supraglottic and glottic tumors are
Radiology techniques including computed
found more commonly, while subglottic tumors are
tomography (CT) and magnetic resonance imaging
located less frequently). DWI is a cutting-edge method
(MRI) can portray the laryngeal anatomy and detect
for finding laryngeal cancers, even the tiniest ones. Our
malignancies with varying degrees of accuracy.
study aims to determine how well DWI-MRI can detect
The availability of necessary equipment and
laryngeal tumors (1).
knowledge determines which imaging modality can be
MRI has been demonstrated to be useful in
used. While MRI's enhanced contrast resolution is
preoperative staging and assessment of glottic tumors in
helpful for evaluating the involvement of the skull base
recent studies (2). In clinical settings, contrast-enhanced
and intracranial structures, the unmineralized laryngeal
computed tomography (CT) continues to dominate (3).
cartilage, the paranasal sinuses, and some other soft
The uneven mixture of calcified, ossified, and
tissues (such as the base of the tongue and the
non-calcified cartilage in the larynx makes CT imaging
thyroarytenoid muscle), MRI is still prone to artefacts
difficult, especially for identifying cartilage invasion.
brought on by swallowing and movement. With a
However, the therapeutic consequences of neoplastic
frantic patient who is short of breath and fidgeting, the
invasion of the laryngeal cartilage are substantial.
time savings offered by CT are invaluable. Improved
Involvement of cartilage decreases the efficacy of
nodal coverage, superior assessment of cortical bone
radiation and may rule out voice-saving surgery,
degradation, and the option to combine with chest
making total laryngectomy necessary (4, 5).
imaging are further benefits (6).
CT has long been used for imaging of laryngo-
It was the goal of this trial to assess the role of
hypopharyngeal cancer, despite the fact that MRI offers
multi-slice computed tomography (MSCT) and MRI in
5420
Received: 17/6/2022
Accepted: 25/8/2022
c:\work\Jor\vol891_201
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5427- 5429
Role of both Azathioprine and methotrexate in Management of
Alopecia Areata: Review Article
Abdalla Hasan Kandil, Hassan Senoussi Houssin Osman*, Mohamed Ibrahim El Ghareeb
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
*Corresponding author: Hassan Senoussi Houssin Osman, Mobile: (+20) 0 109 642 2406, E-Mail: Majdoooly@gmail.com
ABSTRACT
Background: Alopecia areata (AA) is a type of alopecia that does not leave scars and can affect any portion of the body
or scalp. It accounts for 25% of all cases of alopecia, making it one of the most prevalent causes of hair loss treated by
dermatologists. Psychosocial stigmatization makes it hard for AA patients to advocate for better medical care and
treatment. To treat AA, azathioprine can be used as an effective alternative therapy, and it can be introduced early on in
the treatment timeline. In the treatment of inflammatory and immune-mediated skin problems, methotrexate is a common
conventional immunosuppressant. The objective of this review is to assess the possible role of both Azathioprine and
methotrexate in Management of AA.
Development: Azathioprine and methotrexate 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 2010 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: Methotrexate as well as azathioprine can be considered an effective monotherapy or adjunctive for treating
alopecia areata.
Keywords: Azathioprine, Methotrexate, Alopecia Areata, Review, Psychosocial stigmatization.
INTRODUCTION
therapeutic response varies greatly. Therapeutic
Inflammation of the hair follicle and, in rare
measures, such as the Severity of Alopecia Tool, have
cases, the nail plate, is the root cause of alopecia areata,
been attempted in recent clinical research (3).
a chronic inflammatory illness. There is no fixed age of
It is difficult to gauge the success of these
onset and no established gender or racial predominance.
therapies due to the high percentage of spontaneous
Though alopecia areata most commonly causes bald
remission seen in AA patients, and there is no assurance
spots on the scalp, it can affect any place of the body
that hair regrowth will continue after treatment has
where hair grows. It causes mild redness but otherwise
ended (4).
has no visible effects on the skin (1).
Treatments for alopecia areata have evolved
Transient, non-scarring hair loss that can last
over time and can be broadly classified as either (first
anywhere from weeks to decades is just one symptom of
line, second line, as well as third line therapies) (4).
alopecia areata, an autoimmune illness caused by T cell
Purine antagonist azathioprine has traditionally
attack of hair follicles and dissolution of their immune
been thought of being an s-phase cell cycle-targeting
privilege. There are currently no effective treatments for
medication. Although azathioprine has been used
AA that have been authorised by the FDA (1).
extensively in clinical settings for the better part of 50
Psychosocial stigmatisation makes it hard to
years, a clear knowledge of its mechanism of action is
advocate for adequate medical care and treatment for
still lacking. Because azathioprine's 6-thioguanine
AA patients. Available therapies for AA include
active metabolites inhibit the activity of endogenous
corticosteroids (both topically and intralesionally),
purines, this is the widely accepted mechanism by
minoxidil solution (topically), anthralin (topically), and
which the drug exerts its cytotoxic and
contact sensitizers. The severity of the alopecia, the
immunosuppressive effects. Different laboratory
patient's age and overall health, the patient's motivation
experiments have confirmed that azathioprine is more
to undergo treatment, and the patient's physiological
selective for T lymphocytes than for B lymphocytes,
stress are all factors to consider when deciding whether
and that it inhibits T-cell activity and critical
or not to administer systemic treatment for AA.
components of T-cell activation (interleukin-2) (5).
Systemic therapy may be investigated as a therapeutic
Many autoimmune disorders and immune-
option for people with rapidly advancing disease,
mediated dermatologic ailments, such as pemphigus
severe hair loss, or resistant cases. Drugs with
vulgaris, dermatomyositis, and psoriasis, have shown
immunosuppressive properties, such as cyclosporine,
improvement on azathioprine since its introduction in
systemic
corticosteroids,
methotrexate,
or
the early 1960s (5).
sulfasalazine, are used in systemic treatment of AA (2).
There are many ways in which azathioprine
Although there have been many attempts to treat
impacts the immune system beyond its effects on DNA
AA, currently there is no cure. As it is difficult to
replication.
Studies
have
demonstrated
that
objectively measure the therapeutic response, the long-
azathioprine can cause a dose-dependent, reversible
term efficacy of existing treatments is modest, and
5427
Received: 17/6/2022
Accepted: 25/8/2022
c:\work\Jor\vol891_202
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5430- 5432
Sexual and Functional Outcome after Anterior Urethroplasty: A Mini Review
Mohamed Gomaa Aabdeen Abdel-Rahman*, Hussein Mohamed Kamel,
Lotfy Abdel latif Bendary, Aref Mohamed Maarouf
Urology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed Gomaa Aabdeen Abdel-Rahman, Mobile: (+20)01229399343,
E-mail: mohamedgomaa8691@gmail.com
ABSTRACT
Background: Urethral surgery outcomes are often evaluated by assessing urinary flow and urethral patency. However,
sexual consequences may appear after urethroplasty, impairing quality of life and patient's perception of success.
Objective: The aim of the study was to evaluate the relationship between anterior urethral reconstruction and
postoperative sexual dysfunction, including the proposed factors predicting sexual outcomes.
Methods: PubMed, Google scholar and Science direct were searched using the following keywords: Sexual
dysfunction, Urethroplasty, Erectile dysfunction and Urethral stricture. The authors also screened references from the
relevant literature, including all the identified studies and reviews, only the most recent or complete study was included
between January 2002 and June 2021. Documents in a language apart from English have been excluded as sources for
interpretation. Papers apart from main scientific studies had been excluded (documents unavailable as total written
text, conversation, conference abstract papers and dissertations).
Conclusion: Sexual dysfunction after anterior urethral reconstruction is an important issue that must be appropriately
discussed during preoperative patient counselling. Reported outcomes after anterior urethroplasty should include
sexual consequences and relevance, evaluated using validated tools.
Keywords: Sexual dysfunction, Urethroplasty, Erectile dysfunction, Urethral stricture.
INTRODUCTION
Erectile dysfunction after anterior urethroplasty:
The goal of urethroplasty is to restore voiding
Etiology of ED:
function, thus most literatures apply this criterion to
De novo ED after anterior urethral repair may have
define successful urethroplasty, but now focus is
a neurogenic or vascular origin (4-5) due to:
shifting toward inadvertent complications such as
(1) Damage to the cavernosalspongiosal branches or
sexual dysfunction (SD). Sexual dysfunction includes
bulbar arteries while mobilising or transecting the
erectile dysfunction, ejaculatory disorders, penile
bulbar urethra.
chordee and genital sensory disorders. Current
(2) Damage to the cavernous nerves caused by urethral
available studies declare that the denovo post-
intercrural dissection. These nerves travel near the
urethroplasty SD is not common, nearly 1% after
proximal bulbar urethra at the 1 and 11 o'clock
anterior urethroplasty (1).
locations.
In 1993, Mundy et al. (2) were the first to
(3) Damage to the perineal nerve, which travels next to
document erectile dysfunction (ED) following
the ischiocavernous and bulbospongiosus muscles
urethroplasty. In a series of 200 patients, they
as it arises from the pudendal nerve at the
reported 5% persistent ED following anastomotic
ischiorectal fossa.
urethroplasty (AU) and 0.9% after patch
(4) It increases the length of the branches that innervate
urethroplasty. Numerous more research have
the bulbospongiosus muscle and helps the corpus
evaluated the subject since their report (2).
spongiosum, which may be crucial for erection,
Palminteri et al. (3) emphasised the value of
however the exact process is unknown. The perineal
preoperative counselling for patients, particularly
nerve extends along the ventral side of the penis,
with regard to the effects of operations on sexual
providing sensory branches that innervate the
health. In a research analysing the results of ventral
frenular region as well as the ventral side of the
buccal mucosa graft (BMG) urethroplasty, 73% of
penis.
patients reported experiencing medium to high levels
(5) Yucel and Baskin (4) identified a connection
of anxiety before the procedure, and 27% said they
between the perineal and penile dorsal nerves,
had not received enough information on potential
suggesting that this connection may be the cause of
sexual side effects.
some mysterious neurological reflexes that result in
The majority (85%) of those who underwent
erection, orgasm, and ejaculation (4).
urethroplasty admitted to being frightened that the
Psychosomatic factors may also play a role
procedure might not fix their issue, while 35% and
in the onset of ED. Coursey et al. (5) found that
31%, respectively, claimed to be afraid of
27.3% of the patients related worsened erections
postoperative genital scars and a worsening of their
after circumcision in otherwise healthy controls.
sexual life (3).
They suggest that alterations in penile appearance
could affect short-term sexual performance (5).
5430
Received: 19/6/2022
Accepted: 27/8/2022
c:\work\Jor\vol891_203
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5433- 5438
Pathophysiology and Risk Factors of Non-alcoholic Fatty Liver
Disease: Review Article
Moustafa Abd El Hamid Ali*, Reem Mahmoud Makbol
Tropical Medicine and Gastroenterology Department, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Moustafa Abd El Hamid Ali, Mobile: (+20) 01004348810, E-Mail: m_metwally88@yahoo.com
ABSTRACT
Background: About 25% of the global population suffers from non-alcoholic fatty liver disease (NAFLD), making it
the most prevalent form of liver disease. One form of NAFLD, nonalcoholic steatohepatitis (NASH), can ultimately
lead to cirrhosis, hepatocellular carcinoma (HCC), and mortality. The most common causes of fatty liver disease are
being overweight or obese, having insulin resistance, leading an inactive lifestyle, consuming a high-fat diet and having
a family history of the condition. The pathogenesis of NAFLD is associated with a weaker intestinal barrier caused by
an altered gut microbiota, which exposes the host to bacterial components and triggers immunological defense and
inflammation pathways via toll-like receptor signalling, ultimately leading to the development of NASH. The objective
of the present review article is to discuss the risk factors and pathophysiological pathways that lead to NAFLD.
Development: PubMed, Google scholar and Science direct were searched using the following keywords:
Steatohepatitis, Steatosis, Hepatocellular carcinoma, Metabolic syndrome, Dysbiosis and Non-alcoholic fatty liver
disease. The authors also screened references from the relevant literature, including all the identified studies and reviews,
only the most recent or complete study was included between December 2002 and April 2021. Documents in a language
apart from English have been excluded as sources for interpretation was not found. Papers apart from main scientific
studies had been excluded: documents unavailable as total written text, conversation, conference abstract papers and
dissertations.
Conclusion: Globally, NAFLD is the most prevalent form of chronic liver disease. The pathophysiology of NAFLD is
complex and requires the interaction of multiple factors. Metabolic syndrome, insulin resistance, unhealthy dietary
habits and gut microbiota play major roles for the development of NAFLD.
Keywords: Steatohepatitis, Steatosis, Hepatocellular carcinoma, Metabolic syndrome, Dysbiosis, Non-alcoholic fatty
liver disease.
INTRODUCTION
Nonalcoholic fatty liver disease (NAFLD) affects
RISK FACTORS
about 25% of the global population (1).
Disorders of metabolism such as metabolic
Steatosis, nonalcoholic fatty liver (NAFL), and
syndrome and Type 2 Diabetes
nonalcoholic steatohepatitis (NASH) are both
Three of the following conditions must be met for a
histological manifestations of NAFLD. NASH is an
diagnosis of metabolic syndrome (Table 1). NAFLD is
inflammatory, progressive disease that can lead to
on the rise, and that trend is linked to the prevalence of
fibrosis, cirrhosis, and ultimately hepatocellular cancer
Mets. More and more of the Mets criteria must be met
(HCC) (2).
before a person is diagnosed with NAFLD, and it has
NAFLD has a multifaceted and intricate aetiology.
been reported that this is the case (6,7).
Most cases of NAFLD and NASH can be traced back to
having the metabolic syndrome (MetS). NAFLD is
Table (1): Metabolic syndrome diagnostic criteria (6).
more common in people with metabolic syndrome, and
Hypertension
Systolic to be equal or more than
it has been shown to worsen a number of MetS
(In rest)
130 mmHg
symptoms and comorbidities (3).
Diastolic to be equal or more than
Hepatic de novo lipogenesis (DNL), decreased
90 mmHg
lipolysis in adipose tissue (AT), and an accumulation of
fatty acids in the liver are all factors in the
Triglycerides (in Equal or higher to 1.5 gm/L
pathophysiology of steatosis/NASH (4).
fasting state)
Both NAFLD and NASH have been linked to
HDL
To be lower than four hundred
dysbiosis, which is characterized by both qualitative and
cholesterol
milligrams per liter in males
quantitative alterations of the gut microbiota (5). Fatty
To be lower than five hundred
liver disease is exacerbated by dysbiosis, which both
milligrams per liter in females
raises the mucosal permeability and exposure of the
Fasting
To be equal or more than 1.1 gm/
liver to pro-inflammatory bacterial metabolites (5).
Hyperglycemia liter
The focus of this review article is on the
Waist
102 centimeters among male
pathophysiological mechanisms behind NAFLD and
circumference
88 centimeters among female
the primary risk factors contributing to its development.
5433
Received: 17/06/2022
Accepted: 25/08/2022
c:\work\Jor\vol891_204
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5439- 5443
Percutaneous Nephrolithotomy Role in Management of
Renal Stones: Review Article
Esam Aboulqasim Almahdi Zaed*, Lotfy Abdellatef Bendary,
Maged Mohamed Ali, Mohamed Salah Eldin Eldereey
Department of Urology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Esam Aboulqasim Almahdi Zaed, Mobile: (+20) 01090445149, E-mail: alzwagi2@gmail.com
ABSTRACT
Background: Three decades have passed since the creation of percutaneous nephrolithotomy (PNL), the medical name
for the non-invasive removal of kidney stones. It has been documented that a percutaneous track was created to later aid
in the removal of an intrarenal stone. When it comes to the fundamental surgical procedure, individual urologists may
have their own preferences and little alterations. For a procedure to be considered the gold standard, it must be well-
documented, risk-free, consistently effective, easy to teach and learn, and consistently reproducible.
Objective: Assessment of percutaneous nephrolithotomy role in managing renal stones.
Methods: Percutaneous nephrolithotomy, renal, and stones 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 2010 to April 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: Stones smaller than 2 centimeters in diameter may be candidates for percutaneous nephrolithotomy
(PCNL), the treatment of choice for larger stones.
Keywords: Percutaneous nephrolithotomy, Renal, Stones.
INTRODUCTION
Contraindications:
Nephrolithiasis affects between 5% and 15% of the
Patients with unresolvable coagulopathy should not
global population, most commonly affecting individuals
undergo percutaneous nephrolithotomy. Aspirin and
in their thirties and forties (1).
other blood-thinning drugs must be stopped 7 days
The procedure for PNL was developed more than
before surgery (3).
30 years ago. Percutaneous stone removal has been
Sterility of the urinary tract is required for any
around since at least 2004, when it was initially
elective surgery. This is best accomplished by doing a
reported. Since then, it has been shown to be a
urine culture, and then administering sensitivity-
successful and safe method of dissolving and clearing
specific antibiotics for 57 days prior to the operation.
not just tiny stones in the renal pelvis, but any intra-renal
Although it is ideal, it is not always possible to collect
stone. Nephro-lithotomy and nephrolithotripsy are also
additional sterile urine for follow-up testing (e.g.,
possible abbreviations for PNL, with lithotomy
indwelling nephrostomy or urethral catheter, struvite
referring to the removal of stones and lithotripsy to the
stone). Selected patients with a history of urosepsis,
shearing or fragmentation of stones. When it comes to
struvite calculi, or indwelling catheters may benefit
the fundamental surgical procedure, individual
from receiving intravenous antibiotics for 12 days
urologists may have their own preferences and little
prior to surgery. A temporary percutaneous
alterations. The preferred approach should be one that
nephrostomy can be placed to drain a clogged and
has been studied extensively, can be used without risk
infected P/C system before percutaneous entry,
in any setting, reliably yields desirable outcomes with
reducing the risk of sepsis and death in the event of
predictable variability, and is simple enough to be
untreated urinary tract infection (3).
taught
and
learned
easily.
Percutaneous
nephrolithotomy is an effective treatment option for
Preoperative preparation:
virtually all cases of renal stone obstruction.
Prior to surgery, a thorough patient medical history is
Percutaneous removal is the therapy of choice for
required. Prior surgical history, bleeding disorders,
obstructive stones that have been impacted for a long
antibiotic treatments, immunosuppression, and other
time or for stones that are regarded too large (>1.5 cm)
potential risk factors for infection should all be
to be appropriate for SWL, as it reduces the risk of
specifically addressed in the questions asked. Assessing
infection and obstruction and results in more complete
the need for a PNL is made possible by radiologic
stone clearance (2).
determination of stone size and collecting system
Stones in the calyceal diverticulum, horseshoe
anatomy. Blood electrolytes and coagulation markers
kidney, kidney transplant recipients, and children are all
must be tested in the lab. Urine screening by culture is
treatable with PNL, despite the high degree of technical
recommended prior to surgery (4).
difficulties that would be expected in such cases (3).
5439
Received: 13/6/2022
Accepted: 21/8/2022
c:\work\Jor\vol891_205
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5444- 5451
Influence of Cytokeratin-19 Level on Pattern of Hepatocellular
Carcinoma in Patients with Liver Cirrhosis
Ahmed Adel Saad*1, Salah El Din Abdel hakim El Gamal1, Shimaa R. Hendawy2, Ahmed Saleh1
Departments of 1Internal Medicine, Hepatology and Gastroenterology and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Adel Saad, Mobile: (+20) 01111884841, E-Mail: dr.a_adelsaad@yahoo.com
ABSTRACT
Background: In hepatocellular carcinoma (HCC), CK19 is a marker of hepatic progenitor cells and acts as a key player
in tumor invasion, indicating poor prognosis. Early diagnosis of HCC heavily affects the clinical outcome of patients.
The widely accepted serological marker for HCC diagnosis is alpha-fetoprotein (AFP). However, its diagnostic accuracy
is controversial and unsatisfactory because of its low sensitivity. The objective of the current study is to evaluate the
influence of CK19 level on Pattern of HCC in patients with liver cirrhosis.
Patients and methods: This was a prospective case -control study that was conducted on patients attending at early
detection of HCC Outpatient Clinic or admitted to Hepatology and Gastroenterology Unit, Specialized Medical Hospital
Mansoura University, over past year. The current study included 75 participants divided into 3 groups: Group 1 (HCC),
Group 2 (cirrhosis only) and Group 3 (healthy people without any medical disease).
Results: There was statistically significant increase as regard median CK19 level, between degrees of aggressiveness
index (A, B and C) (P >0.05). Regarding the validity of CK19 in differentiating the studied groups, there was no
statistically significant difference as regard median CK19 level in cirrhosis and control groups with Sensitivity 56% and
Specificity 40%. There was no statistically significant difference as regard median CK19 level in HCC and control
groups with Sensitivity 64% and Specificity 40%. There was no statistically significant difference as regard median
CK19 level in HCC and cirrhosis groups with Sensitivity 64% and Specificity 44%. There is weak significant
relationship between the levels of CK19 and AFP in HCC cases (P-value 0.07).
Conclusion: CK19 associated carry a poor prognosis as it associated with more aggressive pattern of HCC. CK19 is
good negative marker of early HCC, So CK19 negative HCC patients has no priority for treatment.
Keywords: Hepatocellular carcinoma, liver cirrhosis, alpha-fetoprotein, CK19.
INTRODUCTION
specific biomarkers may be potential therapeutic targets
HCC is a serious public health issue and the fourth
(4).
leading cause of cancer mortality worldwide (1). HCC
AFP level usually starts to increase approximately
accounts for about 80% of the primary liver cancer
6 months before diagnosis of HCC. Adopting a lower
while the other types include cholangiocarcinoma (10
cut-off value of AFP level at 6 Ug/L .Elevated AFP to
20%) and angiosarcoma (1%) (2).
>20 Ug/L has a very high specificity for HCC (5).
There are a wide variety of tumor markers for
HCC characteristics are generally considered in
HCC. Studies are ongoing regarding the roles of tumor
assessing an individual patient's tumor-related
markers in screening, diagnosis, treatment, and
management and prognosis. They are: maximum tumor
prognostic prediction of HCC. Serum AFP can be very
diameter (MTD), number of tumor nodules, portal vein
useful for HCC surveillance, prognostic prediction, and
invasion (PVI) and blood AFP levels (as well as
treatment response evaluation in high-risk patients with
presence or absence of metastasis, as with most solid
HCC. Other tumor markers such as PIVKA-II and AFP-
tumor types). `HCC Aggressiveness' scoring system
L3% have also been proven to be effective in HCC
was described, which incorporated all 4 of these
diagnosis, follow-up, and prognostic prediction; these
parameters and related them to survival (6).
markers are increasingly used with serum AFP in
Cytokeratins have been extensively used as serum
clinical trials. However, the roles of tumor markers in
tumour markers for monitoring of disease progression
surveillance are poorly understood and still
in cancer patients. The source of cytokeratins in the
controversial, requiring further research. HCC
circulation as well as the mechanisms of release from
surveillance in at-risk population is a critical issue in
cells has long been unclear. Recent evidence suggests
management of HCC. Further data regarding the
that cytokeratins present in the circulation of cancer
predictive value and cost-effectiveness of tumor
patients are released from apoptotic or necrotic tumour
markers could facilitate their uses in HCC surveillance
cells (7).
(3). Particularly novel biomarkers, such as microRNAs,
CK19 is suggested to be an epithelial stem cell
over the last two decades are of profound importance.
marker as it correlates with differentiation potential. Its
Both traditional tumor markers including AFP,
level is highest in epithelial stem cells decreasing during
glypican-3 and transforming growth factor (TGF)- and
differentiation and becomes absent in specialized cells.
novel biomarkers including microRNAs provide useful
A reverse process is observed during carcinogenesis
clinical data, not only on prognosis, but also on
where there is an increase in CK19 levels as the
pathogenesis and treatment efficacy. Furthermore,
5444
Received: 19/06/2022
Accepted: 27/08/2022
c:\work\Jor\vol891_206
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5452- 5457
Neutrophil-Lymphocyte Ratio and Platelet to Lymphocyte Ratio in
Prediction of Severe Acute Pancreatitis: A Prospective Single Center Study
Ahmed Mohammed Abu-Elfatth*1, Mohammed Abd El Sabour Mohamed Mekky1,
Ashraf Mahmoud Othman1, Sara Mostafa Mohammed1, Mohamed A. El-Mokhtar2
Departments of 1Tropical Medicine and Gastroenterology and 2Medical Microbiology and Immunology,
Faculty of Medicine, Assiut University, Egypt
*Corresponding Author: Ahmed Mohammed Abu-Elfatth, Mobil: 00201118677791,
E-mail: ahmed111@aun.edu.eg, ORCID: 0000-0003-3269-5284
ABSTRACT
Background: Acute pancreatitis (AP) was the most common discharge diagnosis of gastrointestinal disorder that places
a substantial burden on the healthcare system. The clinical course of most patient with AP is often mild and it often
resolves without sequelae. And yet a considerable percentage of people develop severe AP (SAP) that would greatly
affect the outcome. The objective of the current study is to assess the value of neutrophil-lymphocyte ratio (NLR) and
platelet to lymphocyte ratio (PLR) in prediction of SAP.
Patients and methods: A prospective cohort study was conducted in the Department of Tropical Medicine and
Gastroenterology of Assiut University Hospital in the Period between 2018 and 2020. A total of 100 patients with AP
were enrolled in the study. Demographic, clinical, laboratory and outcome data of those patients were recorded. NLR
and PLR were calculated.
Results: Out of the enrolled patients; based on the revised Atlanta Criteria, 19 (19%) patients had SAP and 81 (81%)
patients had mild AP. Patients with SAP had significantly higher serum creatinine, NLR and PLR. Also, frequency of
mortality and admission to intensive care unit was significantly higher in patients with SAP. NLR at cutoff point >2.43
had 100% overall accuracy in prediction of SAP with area under curve (AUC) was1 while PLR at cutoff >187.04 had
87% overall accuracy with AUC was 0.850.
Conclusion: patients with SAP had bad prognosis. Usage of NLR and PLR can help in prediction of those patients with
NLR and PLR. Future studies to confirm such findings are recommended.
Keywords: Acute pancreatitis, Neutrophil-lymphocyte ratio, Platelet to lymphocyte ratio, Severe acute pancreatitis.
INTRODUCTION
have been adopted as prognostic factors for the
One of the most prevalent gastrointestinal tract
management of AP (7). Also, serum levels of the
disorders, acute pancreatitis (AP), is a quickly
inflammatory mediators interleukin (IL) 6, 8, and IL-10
developing pancreatic inflammatory condition that
have been found to be accurate for predicting persistent
varies in severity and clinical appearance. Worldwide,
organ dysfunction in AP patients (8,9).
there are between 4.9 and 73.4 instances of AP for per
However, these serum markers are expensive, not
100,000 people. Although the condition is moderate in
readily available, and cannot adequately predict the
the majority of patients and has a fair prognosis, 15% to
prognosis or severity of AP. Recently, neutrophil-
20% of AP patients experience a severe clinical course
lymphocyte ratio (NLR) and platelet to lymphocyte
with increased rates of morbidity and mortality (1,2).
ratio (PLR) have been proposed as widely available
In addition to medications, endoscopic retrograde
markers that provide a rapid evaluation of the extent of
cholangiopancreatography
(ERCP),
endoscopic
the inflammatory process in AP patients. Secondary to
metabolic abnormalities, drugs, trauma, ischemia,
paucity in our locality about use of NLR and PLR in
neoplasms, infections, and hereditary factors, the main
prediction of SAP, the current study was conducted to
risk factors for AP are gallstones and alcohol abuse.
evaluate such markers in patients with AP.
Uncertain mechanisms underlie the many etiological
factors that cause an AP attack (3,4).
PATIENTS AND METHODS
Recognizing individuals at risk of severe acute
Study design and setting:
pancreatitis (SAP) at an early stage is crucial for prompt
A prospective cohort study was conducted in the
treatment and therapy optimization. To evaluate and
Department of Tropical Medicine and Gastroenterology
categorize the severity of AP today, a number of
of Assiut University Hospital in the Period between
severity rating systems have been presented and
2018 and 2020.
recognized. The ones that are most frequently used in
standard clinical practice include the APACHE II
Selection criteria:
system, Ranson criteria, and bedside index for severity
Any patient with 18 years or above and met criteria
in acute pancreatitis (BISAP) score (5,6).
for diagnosis of AP was eligible for the study. The
Among several serum biochemical markers,
following patients were excluded from this study: age
serum procalcitonin (>1.8 ng/mL) and C-reactive
<18 years old, patients with metastatic tumor, acquired
protein (CRP) 150 mg/L at 48 hours post-admission
immunodeficiency syndrome, uremia, late stage of liver
5452
Received: 19/06/2022
Accepted: 27/08/2022
c:\work\Jor\vol891_207
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5458- 5463
Laparoscopic Transabdominal Preperitoneal Approach with Abandon
Sac Technique in Management of Large Inguinoscrotal Hernia;
Randomized Clinical Trial
Mahmoud Abdou Yassin*, Baher Atef, Alaaedin Ramadan, Mostafa M. Elaidy
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mahmoud Abdou Yassin, Mobile: (+20) 01226523031, E-Mail: mahmoudyassin42@yahoo.com
ABSTRACT
Background: Inguinoscrotal hernia is the commonest type of all hernias. Although, Lichtenstein tension-free technique
was the main procedure for its repair, laparoscopic transabdominal preperitoneal (TAPP) approach has been widely
used, but with a great challenge for large size hernia. In this article, we described a modified laparoscopic trial in order
to overcome this obstacle by transecting the large hernia sac, vice complete intra-abdominal inversion.
Objective: This study aimed to evaluate the initial results of a modified TAPP technique (abandon sac trial), in
laparoscopic management of large inguinoscrotal hernia type I.
Patients and methods: Our study was conducted at Zagazig University Hospitals, on 50 cases of large inguinoscrotal
hernia type I through the period from January 2021 and June 2022.
Results: As regards surgical results, both scrotal edema and hematoma were reported in 6% and seroma in 12%. While
there was no detected cases of either infection, funiculitis, chronic groin pain or recurrence. Postoperative pain was mild
to moderate, and the hospital stay was 1-2 days only.
Conclusion: A large inguinoscrotal hernia type I, can be managed safely with introduction of a slight modification on
the TAPP laparoscopic method (abandon sac technique). With this modification, big size hernias will have a chance to
be managed laparoscopically and obtained its advantages as small wound size and marked reduction of both
postoperative pain, and recurrence.
Key words: Inguinoscrotal, Lichtenstein, TAPP, Seroma, Abandon sac technique, Laparoscopic, Large hernia.
INTRODUCTION
PATIENTS AND METHODS
Inguinoscrotal hernia is the commonest type of all
This prospective randomize surgical trial was
hernias. Patient's fright of surgery as well as negligence
conducted on 50 cases of large inguinoscrotal hernia
and enlarging hernia size. A large hernia simply
type I. All patients were operated by a modified TAPP
categorized into; type I extending to mid of the thigh,
method with ligation and transection of the sac
type II from the last point to the level of the knee joint,
(abandon of the sac). The study was conducted through
while type III exceeding the last level (1).
the period from January 2021 to July 2022, at General
Large inguinoscrotal hernia, making laparoscopic
Surgery Department, Zagazig University, Egypt. All
management more difficult. Although, Lichtenstein
our patients informed and consented for surgical
repair was the first option for its correction (2),
procedure. This study was approved by the Institutional
laparoscopic transabdominal preperitoneal (TAPP)
Review Board of Faculty of Medicine, Zagazig
approach has been widely performed, but with a great
University, Egypt.
challenge for large size hernia with large sac (3).
TAPP technique became the most widely
Inclusion criteria: Both male and female patients aged
performed laparoscopic procedure for inguinal hernia
from 18 to 80 years, patients with large inguinoscrotal
repair. It has favorable results such as short
hernia type I, uncomplicated inguinoscrotal hernia, and
hospitalization time, minimizing the postoperative pain,
patients fit for surgery (ASA stage I & II).
and decreasing risk of wound infection. However,
seroma is the most detectable complication post
Exclusion criteria: Patients with small direct and
laparoscopic repair (4).
indirect inguinal hernia, patients with large
Seroma complicates (0.5%15%) of laparoscopic
inguinoscrotal hernia type II & III, complicated
groin hernia correction and increases concomitantly
inguinoscrotal hernias, patients with disturbed
with the size of the hernia (5). The best approach to the
coagulation profile, and patients unfit for surgery (ASA
distal large sac in laparoscopic inguinoscrotal hernia
stage > II).
repair is still debated up till now. Thus, in our study, we
discussed a clinical trial to overcome this obstacle. We
Patient preparation and ports insertion:
transected the hernia sac, aiming to decrease the
Before induction of anesthesia, 1 gram of intravenous
difficulty of laparoscopic dissection and inversion of
cefazolin had been given. Under general anesthesia, the
large inguinoscrotal sac and to avoid injury of cord
patient was placed in the supine position with his arms
structures. We expect that, this technique is more
close to the trunk, and a Foley catheter was inserted. The
reasonable as well as safe.
surgeon stands contralateral to the hernia to be operated.
Creating a small infra-umbilical incision through which,
5458
Received: 19/06/2022
Accepted: 27/08/2022
c:\work\Jor\vol891_208
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5464- 5468
Clinicopathological Study and Management of Malignant Ovarian Tumors in
Children and Adolescents, A Three-Years Study
Ibrahim El Zayat*1, Osama Abdullah Abdulraheem2, Hany Soliman3, Sherif El Prince Sayed4
1Department of General Surgery, Faculty of Medicine, Aswan University, Aswan, Egypt
2Department of General Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
3Department of Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt
4Department of General Surgery, Faculty of Medicine, Bani Swif University, Bani Swif, Egypt
*Corresponding author: Ibrahim El Zayat, Mobile: (+20) 01028842275, E-Mail: ibrahimelzayat@med.aswu.edu.eg
ABSTRACT
Background: Ovarian tumors true incidence in young females is not known. Objective: To review the incidence of
ovarian tumors in children and adolescents and their clinical presentation in these patients in Aswan city and district as
representative of Egypt. We also characterized the pathological features of these ovarian tumors and tailor the best
management of these tumors in young females(less than 18 years old). Patients and Methods: Thirty-six malignant
ovarian tumors in females <18 years were followed in Surgery Department, Aswan University hospital. Different aspects
were analyzed regarding clinicopathological data, investigations and treatment. Follow up by clinical examination, CT
scan and laboratory profile was done every 3 months in the first year, then every 6 months in the second year and then
yearly. The follow up period for each case was calculated from end of the treatment to the last follow up visit. Results:
Thirty-six young female patients with malignant ovarian tumors were recorded, which represented 18% of total pediatric
malignancy throughout the 3 years of the study. All patients underwent primary surgical resection through laparotomy.
Unilateral salpingo-oophrectomy (USO) was performed. AFP was the commonest elevated marker in 6 cases and CA125
in 4 cases. The most common symptom was abdominal mass in 14 cases and most common tumor was yolk sac tumor
14 cases. All cases received chemotherapy adjuvantly except the four cases stage 1. However, due to progression and
recurrence, six cases required further chemotherapy lines. Conclusion: Yolk sac tumor and dysgerminoma are the
commonest pediatric malignant ovarian tumors in this study. Multimodality treatment is essential. Fertility preservation
should be respected. The advanced stages have the highest mortality.
Keywords: Ovarian tumors, Children and adolescents.
INTRODUCTION
(less than 18 years old) aiming to preserve fertility.
Only 0.9% of all malignancies in children and
Outcome of treatment also is recorded.
adolescents are malignant ovarian tumours. Malignant
ovarian tumours may arise as primary tumours from
PATIENTS AND METHODS
healthy ovarian tissue or as metastases. 70% of all
A prospective study was done during the period
ovarian malignancies are epithelial ovarian carcinomas,
from May 2018 to May 2021, thirty-six malignant
which are primary ovarian tumours. Most of these
ovarian tumors in young females less than 18 years old
cancers develop in the fallopian tubes (1,2).
were followed in Surgery Department of Aswan
Less than 5% of juvenile malignancies and less
University Hospital.
than 10% of paediatric abdominal tumours are ovarian
tumours in young female patients (1,2). Most patients are
Inclusion criteria included:
detected at an advanced stage because the disease has
1. Pelvic ultrasonography is used to diagnose ovarian
few, vague, or even no symptoms (3).
tumours. Unilocular cysts, smooth multilocular
Germ-cell tumours (GCT), sex-cord stromal
tumours, solid components smaller than 7 mm, the
tumours (SCST), and various stromal tumours of the
absence of an acoustic shadow, and a Doppler signal are
ovary are examples. Endometrial, breast, colon,
ultrasonography indicators of a benign tumour. On the
stomach, and cervical tumours are among the tumour
other hand, a solid, unregulated tumour, a multilocular
types that can metastasize to the ovaries. Malignant
solid mass with at least four papillary structures, ascites,
ovarian tumours are uncommon in young females, who
and a strong doppler signal are signs of a malignant
typically have germ cell tumours, and their prognosis is
mass.
better than that of adult females (4-7).
2. Pathologically-confirmed malignant ovarian mass,
age less than 18 years.
AIMS OF THE STUDY
Thirty-six malignant ovarian tumors were
To review the true incidence of ovarian tumors
recorded in Surgery Department of Aswan University
in children and adolescents, which is unknown, the
hospital. According to intraoperative results, the extent
clinical presentation of ovarian malignant tumors in
of gonad resection varied from total, in which case the
young female patients in the city and district of Aswan
whole gonad affected by the lesion was removed, to
as representative of Egypt. It's also to characterize the
partial resection, in which case at least a small amount
pathological features of these ovarian tumors and tailor
of ovarian tissue was spared. Comparing preservation
the best management of these tumors in young females
rates was done while taking into account the surgical
5464
Received: 20/06/2022
Accepted: 28/08/2022
c:\work\Jor\vol891_209
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5469- 5472
Erythrocyte Sedimentation Rate as An Inflammatory Biomarker for
Prediction of Prognosis of Guillain-Barre Syndrome
Nada Elsaid, Khaled Eltoukhy, Ahmed Saied
Neurology Department, Faculty of Medicine, Mansoura University, Egypt
Corresponding author: Nada Elsaid, PhD. Clinical lecturer of Neurology, Faculty of Medicine, Mansoura University,
Egypt.Tel: +201005891235Nada.neurology@gmail.com
ABSTRACT
Background: Guillain-Barre syndrome (GBS) is an acute or subacute inflammatory autoimmune postinfectious poly-
radiculoneuropathy, usually triggered by antecedent infections during the preceding six weeks suggesting a humoral
immune-pathogenic mechanism. Inflammation raises the erythrocyte sedimentation rate (ESR), which can be used to
monitor the inflammatory process. Objective: This study aimed to find out if there is correlation between the ESR as a
marker of the inflammatory process and the Erasmus GBS outcome score.
Methods: Patients were diagnosed with GBS based Asbury and Cornblath diagnostic criteria. Assessment of GBS disability
score and the Erasmus GBS outcome score (EGOS) were performed.
Results: Among 37 patients with GBS; the GBS disability score was 3 in 13 patients (35.2%), and 4 in 24 patients (64.5%).
None of our patients showed other grades of the GBS score. As regard the EGOS 4 patients (10.8%) scored 3, 3 (8.1%)
scored 3.5, 11 (29.7%) scored 4, 6 (16.2%) scored 4.5, 10 (27.1%) scored 5, 2 (5.4%) scored 5.5, and only one patient
(2.7%) scored 6. Assessed first hour ESR mean value was 42.97 ± 18.01, with minimum value of 16, maximum 110. Positive
correlation between the ESR and the EGOS was detected with r value of 0.7328.
Conclusion: ESR may serve as a simple prognostic biomarker of clinical severity as higher ESR levels were associated
with increase severity of GBS.
Keywords : ESR, GBS disability score, EGOS, Guillain-Barre.
INTRODUCTION
Methods:
Guillain-Barre syndrome (GBS) is an acute or
Thirty-seven patients diagnosed as Guillain-Barre
subacute inflammatory autoimmune postinfectious poly-
syndrome via thorough history taking including history of
radiculoneuropathy, usually triggered by antecedent
diarrhea or upper respiratory tract infection preceding the
infections during the preceding six weeks suggesting a
onset of illness. Full neurological examination, and
humoral
immunopathogenic
mechanism
[1,
2].
complete laboratory profile including ESR were done.
Campylobacter jejuni is the most common pathogen
Nerve conduction studies (NCSs) were carried out and
associated with GBS. Several viruses have been also
based on the deduced distal motor latencies, amplitudes,
reported to be associated with GBS including; Epstein
conduction velocities and F wave latencies, patients were
Barr virus, influenza A virus, cytomegalovirus and most
classified
into
demyelinating
or
axonal
recently COVID-19 [3, 4].
polyradiculoneuropathy. The Asbury and Cornblath GBS
Molecular mimicry of such pathogens is responsible
diagnostic criteria were taken as the reference for the
for triggering a humoral and cell mediated inflammatory
clinical diagnosis. GBS disability score and the Erasmus
responses that result in poly-radicular and neuropathic
GBS outcome score were assessed (Table 1) [9].
affection [5]. The erythrocyte sedimentation rate (ESR) is
an acute phase inflammatory biomarker that measure the
Table (1): The Erasmus GBS outcome score
amount of precipitated red blood cells (RBC) in a test tube
Age at onset
> 60
1
within a known time interval. It depends on the
(years)
4160
0.5
concentrations of the serum protein especially fibrinogen,
40
0
in addition to the interactions of the RBC with these
Diarrhea
Absence
0
proteins. While the ESR is not a diagnostic test itself,
(4 weeks)
Presence
1
however, it is used to monitor the inflammatory disease
GBS
0 A healthy state
1
activity and treatment response [6].
disability
1 Minor symptoms and capable of
1
score
running
2
The Erasmus GBS Outcome Score (EGOS) is a
2 Able to walk 10 m or more
3
validated prognostic score based on assessment of
without assistance but unable to run
4
multiple parameters including age, diarrhea, and GBS
3 Able to walk 10 m across an
5
disability score at 2 weeks after hospital admission that
open space with help
accurately predicts the odd of independent motor activity
4 Bedridden or chair bound
at 6 months. This can be utilized to starify the disease
5 Requiring assisted ventilation
severity among the patients and determine the high-risk
for at least part of the day
groups [7, 8].
Erasmus GBS outcome score
17
5469
Received: 20/06/2022
Accepted: 28/08/2022
c:\work\Jor\vol891_210
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5473- 5478
Remineralizing Effect of NovaMin and Nano-hydroxyapatite
Toothpastes on Initial Enamel Carious Lesions in Primary Teeth
Eman Mohamed Abd-elmottleb Elmancy*, Amr Mahmoud Abd El Aziz, Basma Gamal Awad
Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Ain Shams University, Egypt
*Corresponding author: Eman Mohamed Abd-elmottleb Elmancy,
Mobile: (+20) 01008661550, Email: denteman39@gmail.com
ABSTRACT
Background: Modern dentistry aims to treat caries as little invasively as possible while preserving the tooth. To do this,
use the tooth's ability to remineralize early caries lesions that aren't cavitated. Changing oral environment, can do this
and tilt the scales in favor of remineralization rather than demineralization.
Objective: To examine ability of two commercially toothpastes; one containing NovaMin and other containing HAP-
NPs to remineralize artificially depleted enamel surfaces on baby teeth. Vickers microhardness tester used to measure
surface microhardness. Surface roughness using SJ-210 surface roughness tester. In comparison to fluoridated
toothpaste.
Materials and Methods: Primary anterior teeth from 87removed individuals were allocated into three groups at random
(n=29). Group A toothpastes include (NovaMin), Group B toothpastes include NHA, and Group C toothpastes contain
fluoride. Before teeth were immersed in a demineralizing solution for 96hours, the baseline surface microhardness
(SMH) and surface roughness were assessed using the vickers microhardness tester and the SJ-210 surface roughness
tester, respectively. Demineralized sample SMH and roughness were measured after 10days of pH cycling.
Results: Mean SMH was the highest value in NovaMin group (216.35±11.13) followed by fluoride (205.19±33.48),
while the lowest value was found in Nano-hydroxyapatite group (203.67±14.14). Mean surface roughness was the
highest value in fluoride group (0.98±0.27) followed by NovaMin (0.89±0.21), while the lowest value was found in
Nano-hydroxyapatite group (0.88±0.21).
Conclusion: NovaMin or Nano-hydroxyapatite are effective as fluoride in preventing the demineralization of enamel
and promoting remineralization. For remineralizing caries-like lesions of primary anterior teeth; NovaMin and Nano-
hydroxyapatite toothpastes are efficient.
Keywords: Demineralization, Caries, NovaMin, Remineralization, Nano-hydroxyapatite, Surface microhardness,
surface roughness.
INTRODUCTION
for bone regeneration applications(9). The crystal
Dental caries is a complicated illness that
structure and size of (HAP-NP) are substantially
affects people differently depending on their gender,
comparable to those of natural hydroxyapatite, which
age, and race (1).
adds to their usage in dental care therapies)10).
In children, it is the most prevalent oral
Nanohydroxyapatite have recently been
infectious illness. Early stages of tooth decay or
incorporated to dental care products like toothpastes and
demineralization, known as incipient carious lesions,
mouthwashes to treat dental sensitivity by blocking the
can be stopped, reversed, or develop to cavitation (1).
open dentinal tubules that are linked to the pulp or to
Incipient carious lesions, also known as smooth surface
encourage enamel remineralization by adding calcium
caries or white spot lesions, are active lesions that are
and phosphate ions to areas where minerals have
restricted to the enamel (2). By topically applying
dissolved, rebuilding its integrity and gloss (10,11).
various fluoride products, including as mouthwash
As a multi-component inorganic product
solutions, toothpaste, gels, and varnish, these types of
including elements like calcium, sodium, phosphorus,
lesions can be remineralized (2,3).
and silicon, bioactive glass (BAG) is being heralded as
It
has
been
proposed
that
enamel
a major advancement in remineralization technology
remineralization, which has been studied for nearly 100
(12,13).
years, has the potential to be one of the most significant
AIM OF THE STUDY
developments in the therapeutic therapy of dental caries
This in-vitro study's goal is to compare the
(4). Fluoride is a useful tool for minimising enamel
effectiveness of BAG containing toothpaste (NovaMin)
demineralization because it forms a calcium fluoride
and HAP-NP toothpaste in remineralizing an artificial
(CaF2)-like coating on the demineralized surface,
incipient enamel carious lesion in primary teeth, as
which in turn reduces enamel mineral loss from acid
measured by changes in surface microhardness (using a
assault (5,6).
Vickers microhardness tester) and surface roughness
Casein
phosphopeptide
(CPP),
(using an SJ-210 surface roughness tester).
nanohydroxyapatite (HAP-NP), and NovaMin have all
MATERIALS AND METHODS
been suggested as fluoride substitutes in recent years
Eighty-seven extracted (n=87), sound upper
due to their anticariogenic effects (7,8).
(n=34), lower (n=53), and primary canines were
In dentistry and orthopaedics, hydroxyapatite
collected from the outpatient clinic of the Pediatric
(HA) is a calcium phosphate that is frequently utilised
Dentistry and Dental Public Health Department, Faculty
5473
Received: 20/6/2022
Accepted: 28/8/2022
c:\work\Jor\vol891_211
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5479- 5481
Giant Ovarian Serous Cystadenoma in a 3-Month-Old Infant A Case Report
Hamad AlMadi1; Hareth Aldosaimani1; Abdullah Al-Shamrani2; Saleh A. Alshehri1; Mohammed AlFaifi3
1Pediatric Emergency Medicine, Prince Sultan Military Medical City (PSMMC), 2Pediatric Pulmonologist,
Prince Sultan Military Medical City (PSMMC); 3Pediatric Emergency Medicine, King Faisal Specialist Hospital &
Research Centre (KFSH-RC), Riyadh, Saudi Arabia.
Mobile: +966555222710, Email: dr.h.madi@gmail.com, ORCID No.:0000-0002-2611-778X
ABSTRACT
Introduction: Ovarian cysts are uncommon in live-born female newborns, with a frequency of roughly 1: 2500. Few
occurrences of serous cystadenoma have been recorded, however, increasing gestational age, maternal diabetes,
preeclampsia, and rhesus isoimmunization may increase the frequency of ovarian cysts.
Case report: A 3-month-old girl born 34 weeks prematurely and complaining of increased abdominal distension was
brought by her mother. On abdominal computed tomography, a large unilocular ovarian cyst occupied the whole
abdomen. Laparoscopic assessment indicated a pelvic ovarian cyst mass containing 1000 ml and gross examination
revealed a unilocular ovarian cyst.
Keywords: Ovary, Cystadenoma, Infant, Cystectomy, Oophorectomy.
CASE PRESENTATION
organs superiorly; and the kidneys posteriorly, resulting
A 3-month-old girl, born 34 weeks premature, was
in posterior compression of the kidneys. No enhanced
brought by her mother with complaints of ncreasing
wall, solid component, fat content, or calcification within
abdominal distension; that began for 45 days ago, she was
the cyst.
passing normal stool, no history of fever or vomiting, she
Differential diagnosis included large ovarian cyst; or
was good feeding. Vital signs were stable, distended
less likely mesenteric cyst or lymphangioma.
abdomen and other clinical examination unremarkable.
On laparoscopic evaluation, a cystic mass in the
pelvic region filled with 1000 ml of dark yellow fluid. It
Ultrasonography of the abdomen:
was aspirated and then sent for histopathological
There was a huge abdominopelvic cystic mass
examination. The cyst originated from the right ovary and
extending from the right upper quadrant down to the
formed the entire, no solid component within the cyst, it
pelvis exerting a mass effect on adjacent organs. The mass
was twisted more than twice. Detorsion was performed,
was approximately 9.4 x 13.5 x 14.8 cm corresponding to
the cyst was removed, preserving the fallopian tubes
a volume of 1000 ml, with no any internal septations, solid
(oophorectomy).
components, or vascularization on Doppler.
Gross examination revealed a unilocular ovarian cyst
Computed tomography of the abdomen showed a
measuring 9.0 x 5.0 cm, with no solid component and an
huge cyst occupying the entire abdomen. The unilocular
average wall thickness of 0.2 cm. On microscopic
cyst measured 14 x 9.7 x 13 cm in anterior-posterior,
examination, the hypocellular smear showed rare, pale
transverse, and craniocaudal directions. The cyst
looking cells against a background of debris and few
originates in the pelvis and displaces other abdominal
macrophages.
Figure (1): US of abdomen
There was an abdominopelvic cystic mass, approximately measures 9.4 x 13.5 x 14.8 cm
5479
Received: 20/06/2022
Accepted: 28/08/2022
c:\work\Jor\vol891_212
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5482- 5487
Laparoscopic Sleeve Gastrectomy with or without Hiatal Hernia Repair:
Effect on Gastroesophageal Reflux Disease in Morbidly Obese Patients
Mohammed Matar, Fady Makram, Amr H. Afifi*
Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Amr H. Afifi, Mobile: (+20) 01007872550, E-Mail: dr_amrhamed1984@yahoo.com
ABSTRACT
Background: Gastroesophageal reflux disease (GERD) is considered an obesity-related comorbidity. Hiatal hernia (HH)
plays a role in the pathophysiology of GERD in the obese population. Roux-en-Y gastric bypass is considered the
operation of choice when GERD is diagnosed in these population, the effect of laparoscopic sleeve gastrectomy (LSG)
with hiatal hernia repair (HHR) on GERD still debated.
Objective: To compare the outcomes of performing LSG with concomitant HHR vs LSG alone in patients with GERD.
Patients and Methods: This was a retrospective analysis of maintained data of 241 patients undergoing LSG after
refusing to undergo a bypass surgery in the Bariatric Surgery Department, Ain Shams University Hospital. The
difference in outcomes between performing LSG with concomitant HHR and performing LSG alone was analyzed. The
interest outcomes were postoperative GERD symptoms, development of de novo GERD, postoperative complications,
resolution of comorbidities, and excess weight loss.
Results: Preoperatively, 129 patients (53.5%) had mild GERD symptoms while 33 patients (13.7%) had moderate
GERD symptoms, and the rest of the patients were asymptomatic for GERD. Seventy-five patients (31.12%) were
diagnosed with HH by endoscopy preoperatively out of which 11 patients were asymptomatic for GERD.
Intraoperatively, 35 patients (14.5%) were diagnosed with HH 4-5 cm in diameter, 67 patients (27.8%) were diagnosed
with HH smaller than 2 cm in diameter and 42 patients (17.4%) had only small depression or weakness among the
intercrural fibers with no actual defect in the hiatus.
Conclusion: LSG with concomitant HHR provides adequate management of GERD and should be performed if HH
diagnosis was made in obese population as it's feasible and safe.
Keywords: Laparoscopic sleeve gastrectomy, Gastroesophageal reflux disease, Hiatal Hernia repair.
INTRODUCTION
communities that it has now become the most popular
Gastroesophageal reflux disease (GERD) has a
bariatric procedure mainly due to its results regarding
much higher prevalence in the obese and overweight
excess weight loss (EWL) and resolution of metabolic
population compared to its prevalence in non-obese
comorbidities (1619). Nevertheless, data concerning the
individuals. It has also been demonstrated that obesity
effect of LSG on GERD are sparse and mixed leading
and overweight are independent predictors of GERD (1).
to controversy (20,21).
Studies demonstrated that elevated body mass
Additionally, there's no solid consensus
index (BMI) is associated with the presence of GERD
regarding the indication or contraindication of SG in
and is positively correlated to its severity, this effect is
morbidly obese patients diagnosed with HH (2228). The
caused by loss of normal physiologic and anatomical
present study aims to analyze the difference in
anti-reflux mechanisms (24).
postoperative outcomes and effect on GERD symptoms
This is explained by various changes such as
between patients who underwent LSG only and patients
associations with esophageal motility disorders, higher
who had LSG with concomitant hiatal hernia repair
gastroesophageal
pressure
gradient,
and
the
(HHR).
development of hiatal hernia (HH), which has a greater
prevalence in the obese population compared to the
PATIENTS AND METHODS
non-obese (47).
This is a retrospective analysis of prospectively
Moreover, obesity causes a high failure rate of
maintained data from the Bariatric Surgery Department
anti-reflux surgery and an increased rate of hiatal hernia
of our institution; Ain Shams University Hospital,
(HH) recurrence or occurrence (8,9). On the other hand,
which is a tertiary hospital.
bariatric surgery has been demonstrated to positively
affect GERD symptoms while also having the
Patients
advantage of weight reduction and a great positive
From August 2017 to October 2019, 262
effect on other obesity-related metabolic comorbidities
patients were operated upon by LSG in our department.
such as diabetes mellitus (DM), hypertension (HTN),
Out of those patients, 21 were lost during follow up and
and dyslipidemia (10,11). Presently, the most effective
the rest were followed up for 2 years postoperatively.
bariatric operation in obese patients with GERD is
All patients with mild to moderate GERD symptoms
Roux-en-Y gastric bypass (RYGB)(1215).
undergoing LSG at the time of the study were included
Laparoscopic sleeve gastrectomy (LSG) has
together with GERD asymptomatic patients, only
been gaining a lot of popularity in the bariatric surgery
patients with previous anti-reflux surgery, previous
5482
Received: 20/06/2022
Accepted: 28/08/2022
c:\work\Jor\vol891_213
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5488- 5492
The Effects of COVID-19 Infection on Hematologic Parameters
Karrar Abbas Tikki1*, Eman Hamza Mohammed2, Ali Abbas Mahdi1, Thualfakar Hayder Hasan1
1University of AlKafeel, Faculty of Medical & Healthy Techniques,
Department of Pathologic Analysis Techniques, Iraq
2Ministry of Higher Education and Scientific Research, Alamal College, Iraq
*Corresponding Author: E-mail: karrar.abbas@alkafeel.edu.iq, Mobile: 009647807995628
ABSTRACT
Background: The coronavirus disease "COVID-19" was reported in 2019 as an outbreak in Wuhan, China, and
categorized as a pandemic disease in 2020 with severe complications. Objective: This study aimed to test the effects of
COVID-19 infection on blood parameters and to assess these effects with disease progress.
Patients and Methods: 120 patients with COVID-19 in Al-Amal Specialized Hospital for Communicable Diseases in
Al-Najaf Al-Ashraf province with 30 healthy (control) individuals of both genders were included in this study. Blood
parameters (complete blood count, PLT and ferritin) were measured for 3 weeks from the 1st day of hospitalization.
Results: The study revealed significant differences in the hematological parameters for COVID-19 patients in
comparison with the control group and these variations increased with the progress and severity of the disease. No
significant variations were noticed in Hb and HCT of patients compared to control, but these parameters decreased with
disease progression.
Conclusion: A comparison of COVID-19 patients with healthy individuals revealed significant differences in
hematological parameters, which became more pronounced with the progression and severity of the disease.
Keywords: COVID-19, Coronavirus, SARSCoV-2, Hematologic parameters
INTRODUCTION
disease progression. Also, several studies reported that
The world experienced a pandemic of a novel
haemoglobin levels are decreased in COVID-19
corona virus disease "COVID-19" that caused by severe
patients and this is correlated with disease severity (9).
acute respiratory syndrome coronavirus 2 (SARS-CoV-
The haematological effects of the COVID-19
2) (1). SARS-CoV-2 is analogous to SARS-COV of
virus have to be traced up closely as this epidemic
about 80%; binds with angiotensin-converting enzyme2
developed (10). Haematology and inflammation tests
(ACE2) receptor to invade host human cells (2).
such as CBC, CRP, ferritin, D-dimer and coagulation
Coronavirus-19 disease had fast prevalence worldwide
parameters can have an important role in the early
with destructive consequences. Approximately 80% of
prognosis of disease gravity, thus helping in the
COVID-19 patients were hospitalized and 60% of them
reduction of disease morbidity and mortality (11).
came into intensive care units (ICUs), while the
Therefore, this study aimed to investigate the
mortality ranged between 3-5% (3). X
effect of the COVID-19 virus on haematological criteria
Although, the disease infects the respiratory
and to evaluate the hematologic markers changes with
tract, many studies have validated that it is a multi-
disease progression.
systemic disease as it is associated with cardiovascular
disorders, gastrointestinal diseases, neurological signs,
PATIENTS AND METHODS
as well as hematopoietic and immunity dysfunction (4, 5).
This is a retrospective cross-sectional study
The haematological abnormalities associated with
performed in Alamal Specialized Hospital in Al-Najaf
COVID-19 disease are attributed to multi factors, these
Province. Data for six months from July to December
disorders are linked with the progress, severity and
2020 were included, a total of 120 patients and 30
mortality of the disease. Decreased lymphocyte and
healthy individuals (as control) of both genders between
thrombocyte, coagulation disorders and disseminated
35-80 years of age were studied. Blood parameters
intravascular coagulation (DIC) are usually reported in
(WBC, Neu, Lym, Mon, RBCs, Hb, HCT, PLT and
COVID-19 patients (6). COVID-19 infection has a
ferritin) were measured over 20 days from the first day
respectable effect on haematopoiesis and haemostasis.
of admission at the hospital (12, 13). Studied COVID-19
Lymphopenia rate, neutrophil to lymphocyte ratio and
patients were selected without any h
platelet to lymphocyte ratio may have importance in
aematological or special chronic diseases that could
prediction and determining the severity of cases (7).
affect the blood parameters under study (14, 15). Complete
Blood tests including WBCs count and characteristics
blood count done by Sysmex KX-21N Hematology
such as neutrophil or lymphocyte percent have a
Analyzers (China). While serum ferritins don by Abbot
considerable role in the early diagnosis and monitoring
Architect I 1000 SR (China).
of the progress of the disease (8). Frequently laboratory
variations particularly hematologic abnormalities have
Ethical considerations:
been reported in COVID-19 patients. Leukocyte count
The study concept for human studies was approved
and lymphocytes may alter with the disease progression.
from
Al-Amal
Specialized
Hospital
for
Moreover, thrombocytopenia is usually correlated with
Communicable Diseases and AlKafeel Hospital by
5488
Received: 20/06/2022
Accepted: 28/08/2022
c:\work\Jor\vol891_214
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5493- 5497
An Uncommon Primary Splenic Hydatid Cyst in Human: A Case Report Study
Haitham Elaadli1, Hany El Adly2, Raafat M. Shaapan3* and Mohamed Bessat4
1Department of Animal Hygiene and Zoonoses, 4Department of Parasitology,
Faculty of Veterinary Medicine, Alexandria University.
2Department of Internal Medicine, Damanhur Medical National Institute (DMNI),
3*Department of Zoonotic Diseases, National Research Center, Giza, Egypt.
*Corresponding Author: Raafat M. Shaapan, Mobile: (+20) 01005280571, E-mail: rmshaapan2005@yahoo.com ,
ORCID: https://orcid.org/0000-0002-2620-4189
ABSTRACT
Background: Cystic Echinococcosis (CE) is one of the most prevalent important neglected zoonotic diseases caused
by the larval form of the tapeworm, Echinococcus granulosus, and it represents a significant public health threat in
many Mediterranean countries like Egypt. Human acts as the accidental intermediate host where the larval stage, hydatid
cyst is formed. While liver and lung constitute the most commonly involved sites for primary cysts, other organs are
occasionally affected. Primary hydatid cysts of the spleen are rarely present.
Patients and methods: This study reported an uncommon case of multiple primary hydatid cysts of the spleen in a 55-
year-old man presented with pain in the left hypochondrium. A history of close contact with dogs was reported. The
initial diagnosis was based on the abdominal ultrasonography and confirmed by the computed tomography (CT) scan
and the serological detection using indirect hemagglutination test (IHAT) in the clinic.
Results: The ultrasonography and CT scan revealed subcapsular hydatid cyst in the spleen with peripheral small
daughter cysts. Serologically, hydatid cyst positive patient serum was recorded at 1:1280 titer by IHAT. Total
splenectomy was successfully done, and the patient was discharged and prescribed with a prophylactic albendazole.
Conclusions: ultrasonography, computerized tomography and serology are useful diagnostic tools for hydatidosis and
the disease is considered a public health challenge and needs accurate differential diagnosis from any cystic mass/s in
the abdomen.
Keywords: Hydatid cyst, Echinococcus, Spleen, Ultrasonography, CT scan.
INTRODUCTION
including computerised tomography, ultrasonography,
Hydatidosis (Cystic Echinococcosis) is a
and X-rays (8). Evaluation and antigen purification are
zoonotic parasitic disease caused by the larval form of
required to improve serological techniques' sensitivity
the cestode Echinococcus granulosus (1).
to identify and confirm disease in its early stages
The adult worm occurs in the small intestine of dogs,
because they currently lack diagnostic specificity,
who serve as its primary host. Cattle, sheep, and camels
especially in endemic areas (9).
are the most frequent intermediate hosts, where the
For the accurate diagnosis of hydatidosis in
larval stages (metacestodes), that can develop into
humans by immunoblotting, hydatid fluid and
advanced hydatid cysts, can be found (2). In the life
protoscoleces crude antigens of camel and sheep
cycle, humans serve as an incidental intermediate host.
hydatid cysts may both be helpful (10). When coupled
The fecal-oral pathway or eating food contaminated
with a confirmatory ELISA test, the latex agglutination
with dog feces that contain Echinococcus eggs cause
test (LAT) is a suitable and useful diagnostic tool for the
infection (3). In areas where the disease is prevalent, such
diagnosis of cystic echinococcosis (11). In effectively
as the Middle East, North Africa, India, Turkey, South
diagnosing hydatidosis in both camels' and humans' sera
America, New Zealand, and Australia, in terms of
with ELISA, the diagnostic antigens, made from camel
public health, cystic echinococcosis is still a major
hydatid cysts, may be able to control the infection and
concern (4).
lessen human transmission (12).
Hydatid cysts can regularly multiply in any
organ, however they typically affect the liver (6070%)
PATIENT AND METHODS
and lungs (30%) and are infrequently detected in the
A 55-years-old male patient who is a farmer
kidney, spleen, brain, heart, pancreas, breast, bone, and
from a rural area located in the Western part of Behera
thyroid. Even in areas where the disease is endemic,
province, Egypt, was admitted to a private clinic of the
spleen cysts account for less than 3% of cases (5). Rarely,
internal medicine and nephrology with left
after the parasite has passed the hepatic and pulmonary
hypochondrium dull aching pain and recurrent fever. He
filters, does a primary infection take place, and it
had no history of icterus, respiratory problems,
typically does so via the arterial pathway (6). Due to the
abdominal complaints, weight loss, and medical history
release of the extremely allergic hydatid fluid, any
record only indicated a Bilharzial Hepatic Fibrosis
spontaneous or violent rupture could result in a life-
(BHF). On examination, his vital parameters were
threatening anaphylactic shock (7).
within the normal limits. The physical study revealed an
Investigation of hydatidosis/echinococcosis
asymmetric abdomen and splenomegaly with smooth
currently relies on a variety of imaging technologies,
surface in the left upper abdominal quadrant. Routine
5493
Received: 20/06/2022
Accepted: 28/08/2022
c:\work\Jor\vol891_215
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5498- 5500
Different Uses of 5-FLUROURACIL in Dermatology: Review Article
Mohamed Nabil Ibrahim Mahdy*, Ahmad Nofal, Elsayed Mohamed Galal Khater
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Mohamed Nabil Ibrahim Mahdy, Mobile: (+20) 01092499244,
E-Mail: mohamednabilelmahdy3@gmail.com
ABSTRACT
Background: The 5-FLUROURACIL (5-FU) is easily absorbed by all tissues after intravenous injection, even those with
active cell proliferation such the spleen, small intestine, and bone marrow. Topical administration of 5-FU is the
recommended method for treating dermatological diseases because of the significant cytotoxicity of 5-FU for growing
cells. 5-fluorouracil is offered as creams or solutions with concentrations ranging from 0.5 percent to 5 percent. Treatment
requires two daily applications, although a controlled-release 0.5 percent microsphere formulation should only be used
once daily.
Objective: Assessment of uses of 5-FLUROURACIL in Dermatology practice.
Methods: The 5-FLUROURACIL, transfer ribonucleic acid 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 March 2003 to November 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: The data we reviewed suggested that 5-FU might be useful for a variety of noncancerous
cutaneous causes, including the treatment of scars, pigmentary diseases, cutaneous infections (viral warts, molluscum
contagiosum), inflammatory dermatoses, and cosmetics purposes.
Keywords: 5-FLUROURACIL, Transfer ribonucleic acid, Dermatology.
INTRODUCTION
pyrimidine, and plain uracil is its fluorinated number 5
In 1954, Heidelberger et al.(1) created the 5-
carbon. Fluorouracil is susceptible to light, precipitates at
fluorinated pyrimidines (it was observed that laboratory
low temperatures, and when left out at room temperature
mice hepatomas consume radiolabeled uracil more than
for an extended period of time.
non-malignant tissues).
The 5-FU metabolite (FUTP) is widely
One of the most used anti-cancer medications,
incorporated into RNA so disrupts normal RNA
5-FU is used to treat a variety of solid tumours, including
function and causes toxicity to RNA at several levels. It
ovarian, breast, head and neck, and gastrointestinal
inhibits the transformation of pre-rRNA (pre-ribosomal
cancers (including esophageal, gastric, pancreatic,
ribonucleic acid) into mature rRNA (mature ribosomal
colorectal, anal, and hepatic cancers). The distinction
ribonucleic acid), and also disrupts post trans-criptional
between five-fluorouracil (5-FU), a fluorinated
modification of tRNAs (transfer ribonucleic acid) (1).
----------------------------------------------------------------------------------------------------------------------------------------------
Figure (1): Structure and Mechanism of 5-FU action (1).
5498
Received: 21/06/2022
Accepted: 29/08/2022
c:\work\Jor\vol891_216
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5501- 5504
Serum Level of Wingless Integration 5a Protein in Rheumatoid Arthritis
Asmaa E. Yaseen*1, Mohammad H. El-Gawish2, Ibrahim T. AbdElal 2, Eman S. Algharabawy3
Department of 1Rheumatology and Rehabilitation, Diarb Negm Central Hospital, Egypt
Departments of 2Rheumatology and Rehabilitation,
3Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Asmaa E. Yaseen, Mobile: (+20) 01069874961, E-Mail: dr.hassanhema@gmail.com
ABSTRACT
Background: Genesis and molecular etiology of rheumatoid arthritis (RA) remain important in spite novel achievements
of disease modifying anti-rheumatic drugs (DMARDs). Wnt5a is up regulated in synovial fibroblasts among RA patients,
suggesting it could contribute to the development of illness.
Objective: To measure Wnt5a protein levels among RA patients' serum and to find its relationship with disease activity.
Patients and Methods: Twenty patients with RA and twenty people without the disease who were matched for age and
sex served as the study's control group. The patients were all examined thoroughly and had taken their histories. The
Disease Activity Score-28 was used to measure disease severity (DAS-28). All participants gave their serum Wnt5a levels
assessed using an enzyme-linked immunosorbent test (ELISA). Patients' complete blood cell count, anti-cyclic
citrullinated peptide (anti-CCP) titer, rheumatoid factor titer, C-reactive protein, as well as erythrocyte sedimentation rate
were determined.
Results: Serum Wnt5a levels of RA patients were significantly higher than those of the control group. Wnt5a levels
correlated positively with several other measures of inflammation and illness severity (DAS-28, ESR, CRP, RF, and
disease duration). Serum Wnt5a was not correlated with age, sex, or Anti-CCP. With an area under the curve of 0.891, a
specificity of 75%, a sensitivity of 80%, NPV of 65.2%, PPV of 86.5% and an accuracy of 78.3%, a cutoff of being equal
or higher than 2.06 ng/ml for serum Wnt5a protein in the diagnosis of RA was optimal.
Conclusion: Results from the current investigation revealed a correlation between Wnt5a and RA.
Keywords: Wnt5a, Rheumatoid arthritis, Disease activity.
INTRODUCTION
To initiate intracellular signalling pathways,
Significant morbidity and death are associated
wintless integration (Wnt) proteins serve as ligands by
with rheumatoid arthritis (RA), a prevalent chronic
binding with frizzled (FZD) receptors on the cell surface
autoimmune disease. In the United States, the prevalence
(5). Planar cell polarity (PCP) and the WNT/Ca2+ route
of this condition is around 1%, with a higher chance of
are two examples of non-canonical WNT pathways
occurrence among women (1).
(catenin-independent pathways) (6).
There is still much mystery around the precise
Wnt5a has been considered non-canonical Wnt
cause of RA, however many factors have been
ligand. Human pathological problems like fibrosis,
implicated (2).
cancer, inflammatory illnesses, and metabolic
The evolution of the disease, without adequate
abnormalities have all been linked to Wnt5a signalling
treatment, implies the formation of pannus, in which the
dysregulation, often caused by Wnt5a overexpression (7).
synovial membrane behaves like a mass of growing
Evidence suggests that Wnt5a has a significant role in
tissue composed by macrophages, osteoclasts and
the development of RA, and further research is
fibroblast-like synoviocytes (FLS). In this sense the FLS
warranted
(8).
The
chronic
inflammatory
play an important role, their activation and proliferation
chemokines/cytokines IL-15, IL-8 as well as IL-6 are
contribute to processes of recruitment, retention and
mostly induced by Wnt5a-mediated signalling in RA-
activation of inflammatory cells through the creation of
FLS (9).
adhesion molecules, chemokines, and cytokines, with
formation of new vessels through regulators of
THE STUDY AIMS
angiogenesis and destruction of articular cartilage and
It was to measure Wnt5a protein levels among
bone as a result of the production of collagenases and
RA patients' serum and to find its relation with disease
metalloproteases (3).
activity.
Several studies are focusing on identifying new
genetic clues that can be involved in the pathogenetic
PATIENTS AND METHODS
processes, leading to the development of RA. A sub
Institutional review board (IRB) Committee, at
group of the non-canonical wingless integration (Wnt)
Faculty of Medicine, Zagazig University, reviewed and
molecule, named Wnt5a, has been recently identified.
approved this study before it could be conducted at
This molecule is able to modulate cellular
Physical
Medicine,
and
the
Rheumatology,
differentiation, migration and inflammation. In
Rehabilitation Departments of the Zagazig University
particular, FLS of RA patients has overexpressed of
Hospitals. Between June 2020 and June 2022, 20 RA
Wnt5a, implying for Wnt5a role in disease development
patients participated in this trial. Rheumatoid arthritis
(4).
patients met the 2010 ACR and EULAR (European
5501
Received: 21/6/2022
Accepted: 29/8/2022
c:\work\Jor\vol891_217
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5505- 5508
Role of Liver Biopsy in Evaluation of Fibrosis: Review Article
Omar Ahmed Abdellatif Ahmed*
Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Omar Ahmed Abdellatif Ahmed, Mobile: (+20), 01025653232,
E-Mail: omar_ahmed@med.sohag.edu.eg
ABSTRACT
Background: When determining the cause and severity of liver disease, a liver biopsy is still the gold standard. Experts
in gastroenterology and hepatology or radiologists are the most common providers for percutaneous biopsies. The
collection of liver tissue can be accomplished in several ways. Intravascular tissue sample through the hepatic vein,
laparoscopy and laparotomy for intra-abdominal biopsy, and a blind percutaneous technique following percussion of the
chest wall are all viable options. Availability, individual desire, and the needs of the patient inform which methods are
used. Additionally, different needles might be used based on the treatment modality and the practitioner's level of
expertise.
Objective: Assessment of possible role of liver biopsy in evaluation of fibrosis.
Methods: Liver biopsy, pediatrics, and fibrosis 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 2013 to June 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: Sampling mistake, uncommon complications, and occasional patient worry are possible outcomes of the
typically safe procedure known as liver biopsy, which is now the gold standard for assessing hepatic inflammation and
fibrosis.
Keywords: Liver biopsy, Fibrosis, Pediatrics.
INTRODUCTION
HCV, or hemochromatosis may also benefit greatly
Even when a sizable portion of the liver is
from liver histology (3).
damaged, the organ can recover to its pre-injury state and
Liver biopsies are expected to remain an
original design in a short period of time. However,
important part of treating patients with diagnostic
chronic liver injury, which can be caused by a variety of
mysteries. Patients with suspected but unconfirmed
factors, leads to ongoing tissue damage and a diminished
liver illness or those with abnormal liver tests of unclear
ability to recover. This is characterized by a changed
cause fall under this category. Patients with genetic
inflammatory infiltration and a chronic wound healing
illnesses such Wilson disease, alpha-1 antitrypsin
response. Parenchymal cells undergo necrosis and/or
deficiency, glycogen storage diseases, and others are
death and are subsequently replaced by extracellular
used as examples (4).
matrix in response to chronic damage (ECM). In the
Patients who appear to have systemic disorders in
liver, for example, the wound-healing process can
which the liver plays a role may also benefit from liver
become malignant if it leads to the gradual replacement
histology for diagnostic purposes. Patients suspected of
of parenchyma by scar tissue and a distortion of the
having hereditary hemorrhagic telangiectasia should
vascular architecture (1).
have their livers examined microscopically only if
Historically, liver biopsies served primarily as
absolutely required, and this should be done
diagnostic tools. Liver biopsies and histological
transvenously in tandem with a measurement of the
examination of the liver have always played an important
portosystemic pressure gradient (4).
role in clinical therapy, but this has only been more so as
In addition to its diagnostic value, liver biopsies
additional natural history data has been developed and
are also useful for predicting the development of portal
several novel medicines for patients with liver disease
hypertension complications and other related hepatic
have been introduced. In 2009, the three most common
mortality or morbidity by identifying pre-cirrhotic
causes for a liver biopsy were diagnostic, prognostic
stages of the illness, such as fibrosis. The importance of
(disease staging), and therapeutic (helping decide
fibrosis evaluation in HCV prognosis has been
between several treatment options) (2).
highlighted by recent evidence. Histology is presently
A liver biopsy can be very helpful for patients who
the gold standard for assessing factors including alcohol
are experiencing strange symptoms. Liver histology can
use, elevated hepatic iron content, and/or hepatic
help determine if a patient with raised alanine
steatosis, which are all linked to a more rapid
aminotransferase levels, an elevated immunoglobulin G
advancement of fibrosis in individuals with chronic
concentration, and/or a positive antinuclear anti-body
HCV (5).
titer has autoimmune hepatitis or nonalcoholic fatty
Patients with AIH may potentially benefit from
liver disease. Patients with overlapping syndromes of
prognostic information that may be gleaned from their
PBC and autoimmune hepatitis (AIH), steatosis and
liver histology, as it appears that those with cirrhosis
5505
Received: 21/06/2022
Accepted: 29/08/2022
c:\work\Jor\vol891_218
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5509- 5514
Half and Half Nail (Lindsay's Nail) for Prediction of Biochemical Disorders and
Unveiling its Etiopathogenesis in Chronic Kidney Disease Stage 5
Mohamed E. Ibrahim, El-Metwally L. El-Shahawy, Ashraf T. Mahmoud,
Ahmed M. El-Kady*, Ahmed E. Mansour
Department of Internal Medicine, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Ahmed M. El-Kady, Mobile: (+20)1220759130, E-Mail: ahmedkady2022@gmail.com
ABSTRACT
Background: Specific nail abnormalities, such as half-and-half nails (sometimes called Lindsay's nails), are frequently
associated with chronic kidney disease (CKD). In 1963, William B. Bean first noted it in two of his renal illness patients.
Half-nail deformities have a mysterious origin that has yet to be identified. It doesn't improve with dialysis, but it goes
away completely following a kidney transplant.
Objective: This study was aimed to shed light on study the predictive value of half-and-half nail for biochemical
disorders in patients with CKD stage 5 and try to unveil its etiopathogenesis.
Patients and methods: This case-control study included a total of 100 patients with chronic kidney disease, stage 5,
classified into four equal groups, the first two groups were without hemodialysis, and One has regular nails, while the
other has half-and-half nails, the second two groups were on hemodialysis and one without half and half nails and the
other group with half-and-half nails.
Results: According to kidney function tests and other laboratory results, this study found no statistically significant
difference (p value >.05) between the study groups. Patients with half-and-half nails had a higher mean age and duration
of hemodialysis, both of which were statistically significant (p<0.05), and additionally, the research groups varied
greatly in terms of the prevalence of DM as a root cause of CKD.
Conclusion: It could be concluded that there are significant positive correlations between age, duration on
hemodialysis, diabetes as causes of chronic kidney disease (CKD), and presence of half -and- half nails.
Keywords: Half-and-half nails, chronic kidney disease, Diabetes mellitus, hemodialysis
INTRODUCTION
In this case, the nail bed is dominated by a
To have CKD, also known as chronic renal
brownish-red distal band, which occupies 20-60% of
disease, is that you have kidney damage or an eGFR of
the nail bed, and is clearly separated from the white
less than 60 ml/min/1.73 m2 that has persisted for at
proximal band. Nails, particularly fingernails, are
least three months. It is a condition characterized by a
susceptible, but toenails can get it too. Band width has
progressive decrease in kidney function that eventually
no effect on serum creatinine concentrations (6).
necessitates renal replacement therapy (dialysis or
According to the 1968 description by Baran, Gioanni, it
transplantation) (1).
has a tight relationship with chronic renal illness (7).
One of the main causes of chronic renal failure
Little is known about what may have led to its
(CRF) and the subsequent need for dialysis in patients
creation. There's a suggestion that urea's toxicants
is the development of diabetes mellitus and
activate melanocytes, leading to an increase in distal
hypertension.
Other
diseases
as
chronic
nail melanin deposition. Other possible explanations
glomerulonephritis,
amyloidosis,
systemic
include thickening of the capillary walls and increased
erythematous lupus, and some genetic diseases
nail bed capillary density. Proximal white band may be
(polycystic kidneys) may impair kidney function (2).
caused by chronic anemia (8).
Almost all the body's systems are impacted by
Nail changes of a similar nature have been
CRF, which can lead to neurological, gastrointestinal,
associated to a wide variety of diseases and disorders,
cardiovascular, pulmonary, hematological, endocrine,
such as Crohn's, Kawasaki, Behcet's, cirrhosis, zinc
metabolic, illness of the skin or the nails. Patients with
deficiency, pellagra, and HIV infection. On the other
CRF have been seen to experience alterations in skin
hand, it is a very reliable clinical indicator of end stage
pigmentation, bullous dermatosis, metastatic calcinosis,
renal disease (9).
perforating diseases, xerosis, and pruritis (3).
Because this illness is benign and simply needs
Half-and-half nails, absent lunula, and splinter
counselling and assurance, treatment is only cosmetic.
hemorrhages are the nail conditions most frequently
The transition band often doesn't alter following
observed in CRF patients (4).
dialysis, but it does after a successful kidney transplant.
It was in 1963 when William B. Bean first
Typically, disappearance takes two to three weeks (10).
described half-and-half nails in two of his renal illness
The study's primary objective was to study the
patients (5). One of its other names is " Lindsay's nails"
predictive value of half-and-half nail for biochemical
which was established by Lindsay in 1967. About 40%
disorders in patients with CKD stage5 and try to unveil
of individuals with chronic renal illness have this
its etiopathogenesis.
finding, although it is not pathognomonic (6).
5509
Received: 20/6/2022
Accepted: 28/8/2022
c:\work\Jor\vol891_219
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5515- 5520
Functional and Radiological Outcome after Syndesmotic
Screw Fixation and Removal
Mohamed Elsadek Atia, Elsayed El Etwey Soudy,
Ahmed Mohamed Abodief Elsayed*, Ehab Mohamed Shehata
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Ahmed Mohamed Abodief Elsayed, Mobile: (+20)1286172144,
E-mail: ahmedabodief999@gmail.com
ABSTRACT
Background: There is a wide debate about the necessity and timing for syndesmotic screw and removal.
Objective: The aim of the current work was to assess the improvement in functional and radiological outcome after
syndesmotic screw fixation and removal.
Materials and Methods: This prospective cohort study included a total of 18 patients who underwent ankle fracture
surgery with syndesmotic fixation, attending at Department of Orthopedic, Zagazig University Hospitals and Sharq El-
Madina Hospital. Patients were divided into two groups: Group (I): included 9 patients who underwent ankle fracture
ORIF with syndesmotic fixation followed by subsequent syndesmotic screw removal (SSR). Group (II): included 9
patients, who underwent ankle fracture ORIF with syndesmotic fixation without subsequent SSR.
Result: Clinical and x-rays results were similar in both groups at follow-up. There were no significant differences
between both groups regarding to clinical data, clinical outcomes, radiological outcomes, and complications.
Conclusions: It could be concluded that syndesmotic screw removal is not necessary. Removal's timing of the device
must guarantee the complete healing of the injured syndesmotic soft tissues.
Keywords: Ankle, Fracture, Syndesmosis, Screw, Fixation.
INTRODUCTION
as the ligaments heal. Extensive clinical and bio
Ankle fractures remain one of the most common
mechanical research has been done regarding various
fracture types, representing up to 50% of all lower
aspects of this screw like number, diameter, level of
extremity fractures (1). The mechanism of injury is
placement and number of cortices to be engaged (9, 10).
mainly a traumatic event in external rotation with the
However, screw fixation is the gold-standard in
foot supinated (SER) or pronated (PER), as described
treatment of syndesmotic injury, some important issues
by Lauge Hansen (2). The consequence is often a Denis-
should be considered, such as screw loosening,
Weber Type B or C lesion associated to syndesmotic
breakage, discomfort, reoperation, loss of reduction due
injury occurring in up to 40% of all Type B injuries, and
to early implant removal (11, 12).
up to 80% of all Type C (3).
Two recent studies examined patients before and
Syndesmotic injuries occur frequently with 30%
after screw removal. Moore et al examined 120 patients
39% of bimalleolar ankle fractures having concomitant
to compare 3- versus 4-cortex fixation. They found that
syndesmotic disruption (4). Syndesmotic injuries
in both groups, there were no differences clinically if
involve rupture of one or more of the ligamentous
screws were left in place (13). In the second study,
structures between the distal fibula and tibia, just
patients with syndesmotic screw fixation were divided
proximal to the ankle joint. These ligaments play a
into 2 groups: those allowed weight bearing before
critical role in stabilizing the distal tibiofibular anatomy
screw removal and those who had screws removed
and enable physiological motion of the ankle joint (5).
before bearing weight. They found no difference in
The distal tibiofibular syndesmosis stabilizes the
functional outcomes or range of motion between these
ankle joint and transmits loads during weight-bearing
groups but recommended screw removal to avoid screw
(6). Anatomical restoration and stabilization of the
breakage once weight bearing commenced (9).
disrupted distal tibiofibular syndesmosis are essential in
The aim of the present study was to assess the
order to prevent changes in contact load and
improvement in functional and radiological outcome
posttraumatic osteoarthritis, and to improve functional
after syndesmotic screw fixation and removal.
outcome (7).
The presence of these injuries has been reported to
PATIENTS AND METHODS
have a significant negative impact on functional ankle
This prospective cohort study included a total of
fractures' functional outcomes, whether treated
18 patients who underwent ankle fracture surgery with
operatively or non-operatively (8). Despite the high
syndesmotic fixation, attending at Department of
prevalence of ankle fractures and high incidence of
Orthopedic, Zagazig University Hospitals and Sharq El-
associated syndesmotic injuries, a standard protocol of
Madina Hospital. This study was conducted between
syndesmotic injury management is yet to be established.
January 2022 to June 2022.
Intra-operative syndesmotic fixation traditionally
involves placing a positional syndesmotic screw
through the fibula onto the tibia to maintain reduction
5515
Received: 20/6/2022
Accepted: 28/8/2022
c:\work\Jor\vol891_220
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5521- 5527
Neutrophil-to-Lymphocyte Ratio as a Novel Marker for Early
Detection of Hypertensive Nephropathy and as a Predictor of
Worsening Renal Functions in Hypertensive Patients
Mohamed E. Ibrahim1, El Metwaly L. El Shahawy1, Shimaa M. Mohammed1,
Ashraf T. Mahmoud2, Ahmed A. Hefnawy*1, Ahmed E. Mansour1
1Department of Internal Medicine & Nephrology, Faculty of Medicine, Benha University, Benha, Egypt
2Department of Internal Medicine and Nephrology, Faculty of Medicine, Damietta University, Egypt
*Corresponding author: Ahmed A. Hefnawy, Mobile: (+20)1061461461, E-Mail: ahmedhefnawy551@gmail.com
ABSTRACT
Background: Hypertension (HTN) is one of the most important causes of chronic kidney disease (CKD) and may
also be the presenting feature of asymptomatic primary renal disease. However, a progressive reduction in estimated
glomerular filtration rate (eGFR) and increased albuminuria indicate progressive loss of renal function, an alteration
of renal function is an insensitive marker of renal impairment because a major reduction in renal function is needed
before serum creatinine rise. Low-grade inflammation plays crucial pathophysiological role in both hypertension and
CKD.
Objective: This work was aimed to study neutrophil-to-lymphocyte ratio (NLR) as a marker for early detection of
hypertensive kidney disease and as a predictor of worsening renal function in patients with high normal blood pressure
and in hypertensive patients.
Patient and methods: This case control study included a total of 125 hypertensive patients and 50 subjects with
normal blood pressure, attending at Department of Internal Medicine, Banha University Hospital. All participants
were subjected to careful history taking, clinical examination, and laboratory investigations including NLR.
Results: NLR was significantly higher among HTN group with low eGFR (3.2±1), followed by HTN group with
normal eGFR (1.9±0.98) with p value = 0.019, while lymphocyte was significantly lower among HTN group with
low eGFR (1.7±0.3) followed by HTN group with normal eGFR (2.2±0.5) with P value 0.005. Neutrophils and NLR
were significantly higher among stage IV CKD patients (6.1±2, 3.3±1.1 respectively) followed by stage III patients
(5.8±1.4, 2.9±0.99 respectively) with p values were 0.031, 0.022 respectively. There was significant correlation
between NLR and blood pressure, urea, creatinine, eGFR, albumin/creatinine ratio, and CRP.
Conclusion: It could be concluded that NLR can be used as a marker with significant sensitivity and specificity for
hypertensive nephropathy at different CKD stages.
Keywords: Neutrophil lymphocyte ratio, Chronic kidney disease, Hypertension.
INTRODUCTION
hypertension induced renal damage is based on the
Elevated blood pressure (Bp) was the leading
finding of reduced renal function and or the detection
global contributor to premature death in 2015,
of albuminuria (6).
accounting for almost 10 million deaths (1). Both office
A progressive reduction in eGFR and increased
BP and out-of-office BP have an independent and
albuminuria indicate progressive loss of renal function,
continuous relationship with the incidence of several
and both are independent and additive predictors of
cardiovascular events [haemorrhagic stroke, ischaemic
increased cardiovascular risk and progression of renal
stroke, myocardial infarction, sudden death, heart
disease (6). An alteration of renal function is an
failure, and peripheral artery disease (PAD)], as well
insensitive marker of renal impairment because a
as chronic kidney disease (CKD) (2).
major reduction in renal function is needed before
Hypertension is defined as office systolic blood
serum creatinine rises(7). Low-grade inflammation
pressure (SBP) values 140 mmHg and/or diastolic BP
plays crucial pathophysiological role in hypertension,
(DBP) values > 90 mmHg (2). HMOD (hypertension
as it facilitates the development of essential
mediated organ dysfunction) refers to structural or
hypertension and target organ damage (8).
functional changes in arteries or end organs (heart,
Inflammation participates in many processes that
blood vessels, brain, eyes, and kidney) caused by an
contribute to the development of elevated BP: for
elevated blood pressure (3). With wider use of imaging,
example, several studies have shown a positive
HMOD is becoming increasingly apparent in
association between hypertension and elevated white
asymptomatic patients (4). Hypertension is the second
blood cell (WBC), C-reactive protein (CRP) and
most important cause of CKD after diabetes and
interleukin-6 (IL6) levels (9).
hypertension may also be the presenting feature of
The role of inflammation in acute kidney injury
asymptomatic primary renal disease (2).
and end-stage kidney disease (ESKD) is also well
Chronic kidney disease (CKD) is a major health
recognized (10). Inflammation has proven to be
issue worldwide, which leads to end-stage renal failure
associated with CKD and CKD patients has shown to
and cardiovascular events (5). The diagnosis of
possess a low grade inflammatory status (11). Although
5521
Received: 20/6/2022
Accepted: 28/8/2022
c:\work\Jor\vol891_221
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5528- 5538
Evaluation of Oxidative Status and Antioxidants in Patients with
Coronary Artery Disease
El-Saeid M. El-Bawab, Mohammed M. Abu El-Fottouh, Arafa Alm Eldin Salim*
Department of Medical Biochemistry, Faculty of Medicine, Al-Azhar University (Assuit), Egypt
*Corresponding author: Arafa Alm-Eldin Salim, Mobile: (+20) 01025339623, E-Mail: arafaalmeldinsalim@gmail.com
ABSTRACT
Background: Oxidative stress is the result of enhanced production of reactive oxygen species (ROS), which are the key
molecules in the signaling pathways implicated in vascular inflammation in atherogenesis, starting from the initiation
of fatty streak formation to lesion progression and plaque rupture. ROS are established to damage the fundamental
biomolecules in cells including DNA, proteins and lipids.
Objective: To evaluate the relationship between plasma levels of 8-isoprostaglandin F2-alpha as a marker of oxidative
status and the severity of coronary artery disease (CAD) whether or not accompanied with hypertension and/or
dyslipidemia.
Patients and Methods: This study was carried out from October 2020 to October 2021 at Medical Biochemistry
Department, Faculty of Medicine, Al-Azhar University, Cardiac Department in Al-Azhar University Hospital, Egyptian
National Heart Institute, Cardiac Department of Police Hospital and Cardiac Department of Minia University Hospital,
on one hundred and twenty-five subjects.
Results: There was high statistically significant difference between the studied groups as regard systolic BP, diastolic
BP and mean arterial pressure blood (MAPB). There was high statistically significant difference between studied groups
as regard TC, LDL and triglycerides (TAG). There was high statistically significant difference between studied groups
as regard 8-Isoprostane and blood vitamin C. There was high statistically significant difference between studied groups
as regard coronary artery disease (CAD) severity.
Conclusion: Oxidative stress may play an important role in the pathogenesis of CAD. A high 8-isoPGF2 is a strong
and independent risk factor for presence of CAD.
Keywords: Oxidative status, Antioxidants, Coronary artery diseases, reactive oxygen species.
INTRODUCTION
density lipoprotein (LDL) is a key mechanism rendering
Atherosclerosis, the formation of plaque inside
lipoproteins atherogenic (7).
the arteries, is the main cause of CAD (1).
It has been reported that lipid peroxidation
Several pathological events contribute to
produces unsaturated aldehydes including acrolein and
atherosclerosis, including endothelial dysfunction,
malondialdehyde (MDA), which exert toxic effects due
extensive lipid deposition in the tunica intima,
to their reactivity with nucleophile compounds and their
exacerbated innate and adaptive immune responses,
ability to produce protein and DNA adducts without
vascular smooth muscle cell proliferation and
prior metabolic activation. These aldehydes are
remodeling of the extracellular matrix (2).
considered to function as mediators of inflammation
Two major hypotheses have been proposed to
and vascular dysfunction (8).
describe the origin of atherosclerosis:
There are a several key cellular and circulating
(i) the thrombogenic theory, which suggests that
antioxidant systems, including the superoxide
thickening of the intima layer of vessels is a result of the
dismutases, glutathione peroxidases, and catalase that
organization of fibrin by fibroblasts, associated with
collectively reduce superoxide/hydrogen peroxide (or
secondary lipid enrichment; and (ii) the lipogenic
lipid hydroperoxides) to water (or lipid hydroxides).
theory, which suggests that the deposition of lipid inside
There are also many important small-molecule
the arterial walls is caused by an imbalance between the
antioxidants such as -tocopherol, ascorbic acid, -
mechanisms responsible for lipid accumulation and
carotene, and reduced glutathione (GSH). Thus, when
removal (3).
antioxidant activity is decreased or small molecule
Several lines of study have indicated a role for
antioxidant availability is limited, oxidant stress may
oxidative stress in atherosclerosis and cardiovascular
occur as a result of diminished net antioxidant capacity
diseases (CVDs)(4). Oxidative stress is the result of
(9).
enhanced production of reactive oxygen species (ROS),
AIMS OF THE STUDY
which are the key molecules in the signaling pathways
The study is aimed to evaluate the relationship
implicated in vascular inflammation in atherogenesis,
between plasma levels of 8-isoprostaglandin F2-alpha
starting from the initiation of fatty streak formation to
(also called isoprostane F2- alpha) as a marker of
lesion progression and plaque rupture (5).
oxidative status and the severity of coronary artery
Reactive oxygen species (ROS) are established
disease (CAD) whether or not accompanied with
to damage the fundamental biomolecules in cells
hypertension and/or dyslipidemia. In addition, also, we
including DNA, proteins and lipids (6). A previous report
selected blood vitamin C as antioxidant and studied its
demonstrated that oxidative modification of low-
5528
Received: 21/6/2022
Accepted: 29/8/2022
c:\work\Jor\vol891_222
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5539- 5543
Role of Sonoelastography in Evaluation of Liver Fibrosis: Review Article
Omar Ahmed Abdellatif Ahmed*
Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Omar Ahmed Abdellatif Ahmed, Mobile: (+20), 01025653232,
E-Mail: omar_ahmed@med.sohag.edu.eg
ABSTRACT
Background: Liver parenchymal cells, non-parenchymal liver cells, and infiltrating immune cells all play roles in the
development and regression of fibrosis. Hepatocyte mortality through chronic causes such apoptosis, necrosis, or
necroptosis is essential. Death of cells activates inflammatory and pro-fibrogenic pathways in non-parenchymal cells
and invading immune cells, which in turn triggers fibrosis advancement but may also contribute to fibrosis resolution.
Patients with hepatitis C have made elastography's usefulness in the diagnosis of fibrosis a priority. Traditional
treatment relied heavily on interferon injections, which can have serious adverse effects.
Objective: Assessment of possible role of sonoelastography in evaluation of liver fibrosis.
Methods: Mean Platelet Volume, Pediatrics, and Idiopathic Thrombocytopenic 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 December 2003 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 omitted.
Conclusion: Patients with chronic liver illness have an alternative in sonoelastography that is safe, noninvasive, and
accurate for assessing fibrosis.
Keywords: Sonoelastography, Ultrasound, Hepatitis C, Liver fibrosis.
INTRODUCTION
medications. Given that this medicine may only be
In the last decade, elastography has become a
used in patients with advanced fibrosis or cirrhosis
standard method for determining liver stiffness. Hepatic
under the present payment schemes, fibrosis staging is
fibrosis, the outcome of long-term liver injury, causes
necessary (METAVIR F3 and above).
the liver to stiffen by producing an abnormally high
A primary cause of the need for a liver transplant
amount of extracellular matrix via fibroblast-like cells.
in the United States is nonalcoholic fatty liver disease
Noninvasively measuring liver stiffness with
(NAFLD), the most common form of chronic liver
elastography is possible. Ultrasound (US) or magnetic
disease.
Those
who
develop
nonalcoholic
resonance imaging (MRI) can be used to monitor
steatohepatitis and are at high risk for fibrosis
changes in tissue response to mechanical actuation from
progression should be identified early and monitored
the outside or acoustic radiation from the inside (MRI)
noninvasively. Due to its lack of invasiveness,
(1).
elastography has increased use in assessing fibrosis in
Patients with chronic liver illness have an
these individuals (2).
alternative in sonoelastography that is safe,
noninvasive, and accurate for assessing fibrosis. Liver
Imaging of static or quasistatic strain:
elastography is mostly used in the clinic for the
Compression elastography, sometimes known as
purpose of diagnosing and classifying the severity of
quasistatic or static elastography, is a kind of
fibrosis in patients with chronic liver disease, as well
elastography, subjects tissue to repeated compression
as to follow up patients who have already been
to induce stress, and then uses color-coding to
diagnosed with fibrosis or who are undergoing
quantitatively and visually display the degree to which
treatment for hepatic fibrosis (1).
lesion deformation compares to that of surrounding
Patients with hepatitis C have made
normal tissue.
elastography's usefulness in the diagnosis of fibrosis a
Compression can be given either manually with
priority. When interferons were used as the
the transducer (quasistatic) or physiologically, when
cornerstone of therapy, patients often experienced
tissues around organs that are constantly in motion,
unpleasant side effects. Polymerase inhibitor treatment
such the heart and lungs, are compressed (static). A
for hepatitis C has reduced adverse effects and
great deal of inconsistency can be attributed to the fact
increased cure rates to around 100 percent. The high
that the degree of compression used I s subjective and
cost of therapy is a major drawback of this category of
difficult to measure (3).
5539
Received: 21/6/2022
Accepted: 29/8/2022
c:\work\Jor\vol891_223
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5544- 5549
Thyroid Autotransplantation after Total Thyroidectomy in
Benign Thyroid Diseases
Mohamed Bakr Mohamed Kotb, Ahmed Mohamed Gamal Hemdan*, Mahmoud Thabet Ayoub
Department of General Surgery, Faculty of Medicine, Assuit University
Corresponding authors: Ahmed Mohamed Gamal Hemdan, E-mail: kottb73@gmail.com,
Mobile number:01012127297
ABSTRACT
Background: After achievement of parathyroid autotransplantation, thyroid autotransplantation was presented
with goal of preventing or lessening severity of post-thyroidectomy hypothyroidism in noncompliant patients.
Goal and objectives: In this research, we intended to evaluate efficacy of autotransplantation of thyroid tissue after
total thyroidectomy (TT) in benign thyroid disorders to keep the patient euthyroid with no need for life long hormone
replacement therapy.
Studied cases and methods: The study included thirty patients with benign thyroid disorders for whom total
thyroidectomy was done. Autotransplantation was done by excising an apparently healthy portion weighing about 2-5
gm from the resected thyroid gland after total thyroidectomy and slicing this portion into about 10 small fragments then
inserting these fragments into pocket made in the sternomastoid muscle. Follow up process contained measurement of
serum levels of T3, T4 and TSH and thyroid scanning by 99mTC-MIBI scintigraphy. Results: Serum calcium level
following total thyroidectomy: 28 patients had normal serum calcium level (8.5mg/dl- 10.5mg/dl) and only 2 patients
developed hypocalcaemia. These 2 patients were advised to take oral calcium to correct hypocalcaemia with regular
follow up. Conclusion: Thyroid autotransplantation after total thyroidectomy is effective way to avoid postoperative
hypothyroidism in benign thyroid disorders.
Keywords: Thyroid; Auto-transplantation; Total thyroidectomy; Benign; Auto-implanted
INTRODUCTION
clinic. The outpatient clinic was run by general surgery
Whole thyroidectomy is standard of care for
professor who was assisted by assistant lecturer, senior
patients with bilateral benign thyroid complaints (1).
residents, intern doctors, and nursing officers.
Several authors stated that TT can be done safely
The study included thirty studied cases presented in the
and with little problem rates using meticulous surgical
outpatient clinic with benign thyroid disorders for
method (2,3,4). Even though surgery is good option for
whom total thyroidectomy was performed.
avoiding
habitual
medication
consumption,
patients still
necessitate
life-long
Ethical Approval:
levothyroxine replacement treatment, that was linked to
This research was approved by Assuit University
coronary heart disease and lipid metabolism
Ethics Board, and each participant signed informed
dysfunction (5,6).
written consent form. Research's goal and therapy
Postoperative control of hypothyroidism after TT
techniques were carefully explained to each studied
by L-T4 replacement treatment appears simple,
case individually. They were free to ask questions to
however for patients, daily dose of L-T4 and regular
confirm that they understood. This work was done in
follow-up visits to hospital may become somewhat
burdensome, and can interfere with achieving euthyroid
accordance with World Medical Association's Code of
status using replacement treatment because of patients
Ethics for human researches.
noncompliance (7,8). Another issue that may impede
achieving
euthyroid
status
with
replacement
Inclusion Criteria: Adult men or women with benign
treatment is medication mal-absorption caused by any
thyroid disease, suitable for anaesthesia, providing
gastrointestinal disorder (9).
written informed consent, and agreeing to provide short
Heterotopic thyroid auto-transplantation was suggested
term result data and contact information.
to prevent reoperation at location of previous neck
Exclusion Criteria: Children, patients deemed unfit
surgery (10).
for anaesthesia (ASA score greater than two), and
At this study, we aimed at evaluating efficacy of auto-
suffering from malignant or recurring goiter.
transplantation of thyroid tissue after TT in benign
thyroid disorders to keep the patient euthyroid with no
Sampling Procedure: studied cases with benign
need for life long hormone replacement therapy.
thyroid disorders seen in outpatient clinic were
interviewed and clinically assessed by principal
STUDIED CASES AND METHODS
investigator.
This study was carried out at Assiut University
History taking, physical test, requesting and reviewing
Hospital. The hospital is a main education hospital for
laboratory examinations, and imaging researches were
Assiut University Faculty of Medicine. Adult patients
all part of screening process for surgical suitability.
with goiters wre seen in the general surgery outpatient
5544
Received: 6/6/2022
Accepted: 11/8/2022
c:\work\Jor\vol891_224
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5550- 5555
Role of Preoperative Vit D Administration in Decrease Incidence of
Post Thyroidectomy Hypocalcemia
Mohammed Safwat Shahin1, Salah Eldin Shaltout1, Mohamed Ramadan Ahmed2, Mahmoud Refaat2
1Maxillofacial Surgery Department, 2General Surgery Department, Faculty of Medicine, Assuit University, Egypt
Corresponding author: Mohamed Ramadan Ahmed, Email: mhmdrmdn1994@gmail.com
Mobile: 01024529525
ABSTRACT
Background: Thyroid disorders are less common in men and can present at any age. According to reports, the majority
of goiter treatments is thyroid surgery.
Aim and objectives: This research's primary objective was to compare the incidence of post thyroidectomy
hypocalcemia among patients who received vitamin D preoperatively in comparison to the patients who didn't receive,
provided that whole included patients have preoperative normal both serum calcium and vitamin D levels.
Subjects and methods: 100 patients who had complete thyroidectomy at Assiut University Hospital's General Surgery
Department between October 2019 and January 2021 for toxic, nontoxic goiters, or malignant thyroid pathology. The
individuals that were enrolled in the study varied in age from 25 to 60. Group A who received vit D before operation.
Group B who received placebo.
Results postoperative calcium level was substantially reduced among the control group in comparison to the study group
(7.10 ± 1.81 vs. 8.15 ± 0.58 (mg/dl). In case of the study group, there was no statistically substantial variation between
pre-and postoperative calcium level (8.27 ± 0.29 vs. 8.15 ± 0.58 (mg/dl) but in case of control group, there was
substantial drop in serum calcium (8.23 ± 0.27 vs. 7.10 ± 1.81).
Conclusion: Our work demonstrates that thyroidectomy without preoperative vitamin D supplementation might result
in postoperative hypocalcemia in patients of all ages. Vitamin D supplements used before surgery may halt postoperative
hypocalcemia, enabling a safe and quick release from the hospital. In the end, this will increase patient happiness and
result in considerable cost savings.
Keywords: Preoperative vit D, Decrease incidence, Post thyroidectomy hypocalcemia.
INTRODUCTION
PATIENTS AND METHODS
Thyroid disorders are less common in men and
In our study: Between October 2019 and January
can present at any age. According to reports, the
2021, 100 patients were hospitalized to the General
majority of goiter therapy is thyroid surgery (1).
Surgery Department at Assiut University Hospital for
Symptoms of dyspnea, orthopnea, and
complete thyroidectomies for toxic, nontoxic goiters, or
dysphagia are more commonly associated with
malignant thyroid pathology. The patients were selected
substernal goiter (2). Tachycardia, exophthalmos and
for the study one by one. The study included patients
heat intolerance are more commonly associated with
from both sexes and their age ranged from 25 to 60.
toxic goiter (3). The surgical therapy of goiter may be
Inclusion criteria: The patients included were
accomplished by lobectomy, partial thyroidectomy,
indicated for total thyroidectomy with normal
near-total thyroidectomy, or complete thyroidectomy
preoperative serum calcium value and preoperative
(4).The gold standard therapy for thyroid carcinoma,
vitamin D value.
multi-nodular goiter, and grave's disease is a total
Exclusion Criteria: patients were not indicated for
thyroidectomy (5), however there is a chance of
total thyroidectomy, low preoperative serum calcium
postoperative complications (transient or permanent
value, low preoperative serum vitamin D value, patients
hypocalcemia and recurrent laryngeal nerve paralysis)
with renal impairment and patients with hyper or
(6). Although there are few postoperative problems after
hypoparathyroidism.
a subtotal thyroidectomy, recurrence rates might reach
28% (7). When compared to complete thyroidectomy,
Patients were divided into two groups: Group A who
near-total thyroidectomy has lower recurrence and
received vit D before operation. Group B who received
complication rates, making it a safe treatment choice for
placebo.
a variety of benign thyroid conditions (8,9).
24 hours before surgery, participants in group A
received 200,000 IU of intramuscular vitamin D. Group
THE AIM OF THE STUDY
2 served as the control.
This research's primary objective was to compare
Serum calcium values were assessed 24 hours after a
the incidence of post thyroidectomy hypocalcemia
thyroid operation and after the procedure.
among patients who received vitamin D preoperatively
in comparison to the patients who didn't receive,
Patient assessment: History: detailed history was taken
provided that whole included patients have preoperative
including personal, past and family history. Patient
normal both serum calcium and vitamin D levels.
complaints varied from accidentally discovered neck
5550
Received:23/5/2022
Accepted:28/7/2022
c:\work\Jor\vol891_225
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5556- 5560
Fibroblast Growth Factor23 as a Novel Marker of Renal
Impairment in Multiple Myeloma
Nahed Moawad Rakha*, Amal Mostafa El Afifi, Nada Shawky Abdelallim,
Nour El Hoda Hussein Abdallah
Clinical Hematology Unit, Internal Medicine Department, Faculty of medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Nahed Moawad Rakha, E-mail: nahedrakha@med.asu.edu.eg,
Telephone: 0201149598018, ORCID Id: 0000-0002-3999-6656, Postal code: 4621010
ABSTRACT
Background: Osteoblasts, the cells that make up bone, produce and secrete fibroblast growth factor 23 (FGF23). People
with chronic renal disease had a higher-than-normal levels of FGF23 in their blood.
Objective: The goal of this study was to examine FGF23's possible predictive function for renal impairment (RI) in
patients with multiple myeloma (MM).
Patients and Methods: Intact FGF23 serum levels were measured in four groups of patients: 1st Group: 20 MM patients
with RI either on dialysis or not; 2nd Group: 20 MM patients without RI; 3rd Group: 30 healthy individuals; 4th Group:
10 RI patients without MM.
Results In this study, we found that both MM patients with and without RI had elevated levels of FGF23 (mean=158.50
and 94.75, respectively) than in healthy individuals (mean=25.17). The difference in results between the MM and
healthy individual groups was highly significant (p<0.01). Patients with MM and RI have greater serum iFGF23 levels
compared to those with MM and no RI (p<0.05). Significant direct link exists between iFGF23 and creatinine (p<0.01),
(r=0.689). There is a strong inverse correlation between eGFR and iFGF23 in the serum (p<0.01).
Conclusion: FGF23 levels increase significantly in MM with RI patients and are higher in MM patients with RI than
those without RI. Renal impairment in MM may be diagnosed and predicted with the help of FGF23.
Keywords: Fibroblast Growth Factor 23, glomerular filtration rate, biomarker, Multiple Myeloma, Renal Impairment.
Footnote: This abstract was presented at the 2021 annual meeting of the Society of Hematologic Oncology (SOHO)..
INTRODUCTION
malignant plasma cells in bone marrow trephines from
According to the World Health Organization
individuals with myeloma demonstrated cytoplasmic
(WHO), multiple myeloma (MM) is a type of plasma
expression of FGF23. Myeloma is characterised by
cell neoplasm that develops in the bone marrow and
aberrant signalling involving lFGF and FGF
causes haematological blood cancer. Multiple myeloma
receptors(5). Serum FGF23 rises with declining renal
is characterised by the transformation of normal plasma
function, according to the findings of multiple studies
cells into malignant myeloma cells and the subsequent
on the involvement of FGF23 in FGF and secondary
overproduction of an aberrant immunoglobulin known
hyperparathyroidism(6).
as monoclonal protein or M protein(1). As part of the
Elevated FGF23 levels in renal failure
spectrum of plasma cell dyscrasias that includes
presumably result from a compensatory mechanism for
monoclonal gammopathy of undetermined significance
hyperphosphataemia, while retention of FGF23 in the
(MGUS) and progresses to overt plasma cell leukaemia
circulation and calcitriol medication are also possible
and extramedullary myeloma, MM is the second most
causes [6]. In conclusion, elevated blood FGF-23
frequent hematologic malignancy. Morbidity is high in
concentrations were associated with higher mortality in
MM patients since the disease destroys vital organs. The
hemodialysis maintenance patients and accelerated
elderly are disproportionately affected by this illness(2).
disease progression in chronic kidney disease (CKD)
Bone cells, especially osteoblasts, produce and
patients not on dialysis. Therefore, FGF-23 may
secrete a protein called fibroblast growth factor 23
become an important therapeutic target for the treatment
(FGF-23), which is composed of 251 amino acids and
of CKD(3). In multiple myeloma, however, details on
has a molecular weight of 26 kDa(3). The phosphate
FGF23's function are scarce. Therefore, this study
metabolism-regulating FGF23 is well-known. Elevated
reports the level of serum iFGF23 and investigates
blood FGF23 concentrations have been reported for a
predictability in renal impaired individuals with
variety of mesenchymal malignancies, including those
multiple myeloma.
that cause oncogenic osteomalacia(4).
Non-mesenchymal tumours are less common
Objective:
causes of hypophosphatemic osteomalacia. Serum
The goal of this study is to examine FGF23's
paraprotein and beta-2 microglobulin concentrations
possible predictive function for renal impairment (RI)
were substantially correlated with FGF23 levels, which
in patients with multiple myeloma (MM).
were shown to be increased in some patients with
myeloma and MGUS(5). Similar to the cytoplasmic
PATIENTS AND METHODS
localization of FGF23 observed in mesenchymal
Eighty participants, 40 males and 40 females,
tumours associated with oncogenic osteomalacia,
were analysed in this cross-sectional study (Fifty
5556
Received:20/6/2022
Accepted:28/8/2022
c:\work\Jor\vol891_226
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5561- 5566
Effect of Reciprocal Electrical Stimulation in Erb's Palsy Children
Emad R. Abdelaziz1, Emam H Elnegmy1, Amina Elhendawy2, Amira E El-Bagalaty1
1Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
2Department of Neuropediatrics, Faculty of Medicine, Cairo University, Giza, Egypt
*Corresponding author: Emad R. Abdelaziz, Mobile: (+20) 01096664078, E-Mail: emadrashad500@gmail.com
ABSTRACT
Background: Erb's palsy is a disorder in which the upper section of the brachial plexus (C5, C6) that innervates the
arm is destroyed, resulting in an adducted, internally rotated shoulder and a pronated forearm, commonly referred to as
"waiter's tip position". The purpose of this study was to detect the effect of reciprocal electrical stimulation in Erb's
palsy children. Patients and methods: A total of 30 Erb's palsy children of both sexes participated in this study with
age ranging from 1 to 3 years; they were divided randomly into two groups of equal number (15 children in each group).
Group A received a specially designed physical therapy program only. Group B received the same specially designed
physical therapy program given to group A in addition to reciprocal electrical stimulation for biceps and triceps muscles.
Electroneurography technique was used for measuring the percentage of degeneration of the biceps brachii muscle. A
computerized electromyography apparatus was used before and after treatment for both groups.
Results: There was improvement in functional recovery of the upper limb in Erb's palsy children of both groups, but in
favor of Group B.
Conclusion: Reciprocal electrical stimulation has an effect on functional recovery of the upper limb in Erb's palsy
children.
Keywords: Reciprocal electrical stimulation, Erb's palsy, brachial plexus, Physical therapy, Electroneurography
technique.
INTRODUCTION
developmental neglection and disuse of the affected arm
A newborn with obstetric brachial plexus injury
and hand (4).
(OBPI) has a peripheral nerve injury. It is frequently,
Arm paralysis, loss of muscle control in the arm,
but not always, associated with a traumatic birth injury
hand, or wrist, and loss of feeling or sensation in the arm
and can result in long-term disability. Physicians who
are all possible outcomes. Although there are various
treat newborns should be familiar with the presenting
causes for brachial plexus injuries, nerve compression
symptoms, comorbid conditions, and prognostic
or strain is the most prevalent cause. Infants, in
factors. OBPI injuries have traditionally been labelled
particular, are susceptible to brachial plexus injuries
with the eponyms Erb's palsy or Klumpke palsy (1).
during delivery, which manifest as specific patterns of
The continuation of the ventricular branches of the
weakness depending on which region of the brachial
spinal nerves from C5 to T1, gives rise to seven terminal
plexus is affected. Nerve root avulsion is the most
nerves and ten accessory branches, forming the brachial
serious type of injury, resulting in full paralysis of the
plexus. It usually receives a C4 ascending genus
associated muscles (5).
(prefixed plexus) and less often, a T2 ascending genus
Excessive stretching of the plexus during delivery
(suffix plexus). The upper trunk is made up of C5 and
causes brachial plexus traction injuries. This is linked to
C6 nerve roots, the middle trunk is made up of only C7
either a difficult breech extraction, even in little
nerve roots, and the lower trunk is made up of C8 and
newborns, or a cephalic presentation in a large child
T1 nerve roots. Then each upper body divides into two
with shoulder dystocia (6).
anterior and posterior branches (2).
Electrodiagnostic testing can help to confirm the
The most common type of obstetric brachial
diagnosis, locate lesions, determine the severity of axial
plexus injury (OBPI) affects the upper trunk root (C5,
discontinuity, and rule out other clinical possibilities.
C6) (Erb's palsy), which can sometimes be associated
They are useful tools that should be used in conjunction
with damage to the C7 root. The deltoid, biceps, biceps,
with a thorough physical examination and proper
coracobrachialis, and supraclavicular muscles all lose
imaging evaluation, not as a replacement for them (7).
function in Erb's palsy, resulting in shoulder flattening
In this investigation, electroneurography was
and elbow flexion. Along with the loss of the C7 root
chosen as a method of diagnosis and prognosis as
there is also the loss of the wrist extension(3).
Sinclair (8) confirmed that electrodiagnostic tests can
Motion limitation in the shoulder, elbow, forearm,
help to determine the site (root and/or plexus), extent,
and hand affect infants and children with obstetric
and severity of a brachial plexus lesion. Motor nerve
brachial plexus injury (OBPI), depending on the
conduction tests including assessment of the amplitude
severity of the injury and the extent of recovery.
of compound muscle action potential (CMAP) in distal
Because the injury and recovery period occur during
and proximal muscles, provide useful prognostic
important stages of central and spinal neuronal
information. These CMAP amplitudes can be compared
development, babies and children are at risk of
to the intact side to see how much degeneration there
are.
5561
Received: 21/6/2022
Accepted: 29/8/2022
c:\work\Jor\vol891_227
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5567- 5573
Whole-Body Diffusion-Weighted Imaging with Background Suppression
Magnetic Resonance Imaging in Patients with Multiple Myeloma
Haidy Abdelaziz*1, Nihal M. Batouty1, Shaimaa El-Ashwah2, Magda Shady1
Departments of 1Diagnostic and Interventional Radiology and 2Clinical Hematology Unit,
Internal Medicine, OCMU, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*Corresponding author: Haidy Abdelaziz, Mobile: (+20) 01020271699, E-Mail: haidyazzab@gmail.com
ABSTRACT
Background:
Multiple myeloma (MM) is a monoclonal plasma cell proliferative disease characterized by primary bone marrow
infiltration and excessive production of abnormal monoclonal immunoglobulin. The aim of the present study is to
assess the detection of bony lesions in patients with MM using whole-body diffusion-weighted imaging with
background body signal suppression (WB-DWIBS).
Patients and methods: A prospective study was conducted on 28 consecutive patients (18 males, 10 females); mean
age 55 (SD 9) years with pathologically proven MM, who underwent WB-DWIBS on a 1.5-T MR scanner. Image
analysis was performed and numbers of bony lesion were recorded according to affection of each anatomical site. For
this study, we compared the number of lesions detected by T1, STIR and DWIBS.
Results: Our results showed that DWIBS was able to detect a large number of lesions compared toT1and STIR, but
yet did not reach statistical significance (P value >0.05).
Conclusion: that WB-MRI using morphological sequences and the DWIBS technique is a reliable imaging modality
for detection of MM lesions, whether focal, diffuse or combined. DWIBS was able to detect larger number of lesions
than morphological sequences yet did not reach statistical significance.
Keywords: Multiple myeloma, Whole-body MRI, DWIBS.
INTRODUCTION
degree of bone marrow involvement as measured by
Multiple myeloma (MM) is a monoclonal plasma
WB-MRI corresponds with other conventional disease
cell proliferative disease characterized by primary
indicators and may independently predict survival.
bone marrow infiltration and excessive production of
With MRI, Turbo Spin-Echo (TSE) short TI Inversion
abnormal
monoclonal
immunoglobulin
[1].
Recovery (STIR) sequences are the most effective at
Up to 90% of MM patients experience bone lesions
identifying focal bone marrow involvement. In the
during the course of their illness, highlighting the
event of diffuse infiltration, unenhanced T1-weighted
value of imaging tests both at the time of diagnosis and
SE pictures are preferable, and signal intensity
during follow-up, especially in light of the fact that the
measures following contrast delivery can improve
number and size of focal bone lesions have been
sensitivity for detecting diffuse infiltration. Due to
shown to be indicators of prognosis [2, 3].
reduced renal function, contrast media, however, pose
Despite the fact that whole-body MRI (WB-MRI)
a danger to patients with multiple myeloma. Contrast
with T1- and T2-weighted contrast-enhanced images
studies may be replaced by diffusion-weighted
has been shown to have advantages over traditional
imaging with background body signal suppression
skeletal survey in clinical routine, conventional
(DWIBS) is suggested [7].
radiography is still used in the staging procedure for
Takahara et al. provided the initial description of
newly diagnosed and relapsed MM patients. It offers
DWIBS in 2004.Since then ,Numerous authors have
crucial further information since, for instance,
emphasized the technique's significant promise for
osteoporosis can be a symptom of tumour infiltration
oncological imaging. The inherent contrast of DWIBS,
but is hard to distinguish from senile osteoporosis on
which is based on enhanced signal intensity in tissue
traditional radiography. Additionally, an additional
with constrained water diffusivity, is used to diagnose
medullary tumour expansion may be undetected on x-
malignant tumour illness. By observing the
ray imaging but is easily detected by MRI [4, 5].
microscopic movement of water molecules, the
WB- MRI is thus advised in all patients with an
method enables non-invasive detection of tissue
apparent single plasmocytoma of the bone and at least
with increased cellularity. Different solid tumour
in MM patients with normal conventional radiography.
entities have been staged using diffusion-weighted
It is important to note that a restricted MR examination
WB- MRI [7, 8].
that only examines the spinal and pelvic bone marrow
The main aim of this study is to assess role of
maybe inferior to radiographic skeletal scan , but
whole-body diffusion magnetic resonance imaging
whole body MRI has been demonstrated to be superior
with background body signal suppression [DWIBS] in
to skeletal survey and also to computed tomography [6].
the evaluation of MM patients.
There is some evidence to suggest that MRI can
even measure the disease load in MM patients. In
patients with MM at the time of initial diagnosis, the
5567
Received:23/5/2022
Accepted:28/7/2022
c:\work\Jor\vol891_228
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5574- 5585
Benign Cysts and Cysts-Like Lesions in and Around the Knee: Ultrasound Versus
Magnetic Resonance Imaging Assessment with Gold Standard Correlation
Abeer Houssein Ali1*, Mostafa Thabet Hussein1, Mohamed Abd El-Radi Abd El-Salam2,
Marina Bahaa Boshra3, Hamdy M Ibrahim1
Departments of 1Diagnostic Radiology, 2Orthopeadic Surgery and Traumatology,
Faculty of Medicine, Assiut University, 3Diagnostic Radiology, Health Insurance Hospital,
Egyptian Ministry of Health and Population, Assiut, Egypt.
*Corresponding author: Abeer Houssein Ali, Mobile: 01007078382,
E-mail: abeeryaa@aun.edu.eg ORCID: 0000-0003-4207-9311
ABSTRACT
Background: Knee cysts are common clinical findings and MRI is frequently used in their assessment. However, compared
to ultrasound (US), MRI is expensive and of limited availability. The objective of the current study is to compare the efficacy
of US and MRI in the detection and characterization of benign cysts and cyst-like lesions in and around the knee with a gold
standard correlation.
Patients and methods. Patients with benign cysts or cyst-like lesions in or around the knee were included. All patients
underwent MRI followed by US of the affected knee. Based on the gold-standard correlation, the diagnostic performances
of both imaging modalities in each type of cystic lesion were quantified and compared. Finally, the agreement between each
imaging modality and the gold standard and between both modalities was calculated.
Results. The diagnosis of benign knee cystic lesions was confirmed in 96 patients. Baker's cyst was the most frequent
followed by meniscal and ganglion cysts. There was a predominance of males, young and middle-aged, and right knee
affection. MRI showed insignificantly higher accuracies (100%, 100%, and 99%) than those of US (97%, 95.8%, and 97%)
in diagnosing Baker's, meniscal, and ganglion cysts (p>0.05). The agreement between MRI and US was substantial
regarding the detection of ganglion cysts (k=0.75), and almost perfect regarding Baker's and meniscal cysts (k=0.96 and
0.90).
Conclusion. US is a time- and cost-effective, easily available, and non-invasive imaging modality with comparable
accuracy to MRI in diagnosing benign knee cysts and cyst-like lesions. However, US is of limited performance as regards
small parameniscal and intra-articular ganglion cysts.
Keywords: Knee, benign lesion, Cysts, Cyst-like lesion, Baker's cyst, Ultrasound, MRI.
INTRODUCTION
Cysts and cyst-like lesions in and around the knee
MRI can delineate the location of the lesion and its
are common clinical and imaging findings and most are
relation to the surrounding anatomical structures and the
benign (1,2).
typical MRI appearances of knee cysts have been
A confident diagnosis of benign knee cystic lesions
documented in many previous studies (5-7).
can present an investigational challenge to the radiologist.
However, MRI is of high cost, limited availability, and
In most instances; the location, consistency, and pattern
sometimes can determine the cystic or solid nature and
of vascularity are the most important factors in
vascular pattern of the lesion only after contrast
determining the etiology and nature of the knee cysts (1,3).
administration (3,4).
Hence, for optimal patient management with specific
US is the second most frequently used modality in
therapy and avoidance of unwarranted interventional
the radiological assessment of clinically suspected
procedures such as biopsy or arthroscopy, it is of
musculoskeletal soft tissue lesions with previously
paramount importance for the radiologist to be familiar
documented considerable sensitivity and specificity in the
with the characteristic imaging features, the spectrum of
detection of multiple knee cysts (4,8-10).
appearances, and potential imaging pitfalls of each knee
US is superior to MRI in being widely available,
cystic lesion (1-4).
time- and cost-effective with a real-time capability to
Because of its excellent tissue contrast and
assess lesion consistency and vascularity without the need
multiplanar capability, MRI has become the modality of
for contrast administration(4,10). Dynamic evaluation and
choice in the assessment of various knee pathologies
the possible percutaneous US-guided aspiration and
including
post-traumatic
and
sports
injuries,
therapeutic injection of the depicted cystic lesion are other
rheumatological, and oncological imaging (2,5).
important advantages of US (4,11,12). Despite its several
Consequently, cystic and cyst-like lesions are
advantages, US is operator dependent and requires a long
frequently encountered during the routine knee MRI
period of training. Furthermore, musculoskeletal US has
assessment.
a number of drawbacks that challenge its wide usage
5574
Received: 20/6/2022
Accepted: 28/8/2022
c:\work\Jor\vol891_229
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5586- 5590
Assessment of Urinary Calprotectin in Early Diagnosis of Intrinsic Acute
Kidney Injury in Critically Ill Children at Zagazig University Hospitals
Hany Elsayed Ibrahim1, Naglaa Ali Khalifa2, Rehab Afifi Gouda Afifi1, Ahmed Hosni Mowafy1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Rehab Afifi Gouda Afifi, Mobile: (+20) 01096623254, Email: rehabafify92@gmail.com
ABSTRACT
Background: Acute kidney injury (AKI) is a common and potentially life-threatening condition. AKI is defined by an
increase of serum creatinine by 0.3 mg/dL in 48 h or an increase by 1.5-fold from a known or assumed baseline or
by a decrease of urinary output to less than 0.5 mL/kg/1 hour (h) for 6 h.
Objectives: To assess the specificity and sensitivity of urinary calprotectin in early detection of intrinsic AKI.
Patients and Methods: This was a cross sectional study that was conducted on 100 children in Pediatric Intensive Care
Unit in the Department of Pediatrics, Zagazig University Hospitals.
Results: In this study, 39% of our cases were diagnosed with AKI. The current study showed that, regarding urinary
calprotectin on first and third day of admission, there was statistically significant increase in calprotectin level when
comparing first and third day levels; p value less than 0.001. Regarding validity of Urinary (U) calprotectin, the value
of sensitivity was (76.9%), specificity= (76.9%), PPV = (81.1%), NPV = (81.1%), and (79.5%) accuracy.
Conclusion: The results of our study show that urinary calprotectin has higher sensitivity and specificity than serum
creatinine levels for detecting early stages of intrinsic AKI.
Keywords: Urinary Calprotectin, Biomarker, Early Diagnosis, Intrinsic Acute Kidney Injury.
INTRODUCTION
is to interact with the cytoskeleton whereas when is
Acute kidney injury (AKI) is a common and
secreted by activated immune cells it acts as a danger-
potentially life-threatening condition. AKI is defined by
associated molecular pattern protein (4).
an increase of serum creatinine by 0.3 mg /dL in 48 h
There are many studies investigating the
or an increase by 1.5-fold from a known or assumed
diagnostic accuracy of calprotectin in its ability of
baseline or by a decrease of urinary output to less than
distinguishing
pre-renal
from
intrinsic
AKI.
0.5 mL/kg/1 h for 6 h (1). It is associated with elevated
Calprotectin showed a very high accuracy in predicting
short-term morbidity and mortality as well as with
intrinsic AKI with an AUC ranging from 0.92 to 0.97 in
unfavourable long-term outcomes caused by the
these studies (5).
development of chronic kidney disease (CKD) or the
The objectives of this study were to assess the
occurrence of cardiovascular events (2).
specificity and sensitivity of urinary calprotectin in
At the time of AKI diagnosis, a number of
early detection of intrinsic AKI.
diagnostic and therapeutic measures are needed. These
measures include the determination of the underlying
PATIENTS AND METHODS
cause of AKI and the initiation of specific and
I- Technical design:
supportive therapeutic measures, such as antibiotic
Site of the study: Pediatric Intensive Care Unit in the
therapy for sepsis, immunosuppression for autoimmune
Department of Pediatrics, Zagazig University
disease, an adjustment of nephrotoxic drugs or directed
Hospitals.
fluid management (3).
The patients with the most elevated creatinine
Sample size: Comprehensive sample as number of
could be those with the best muscle mass, that is the best
cases admitted with inclusion criteria did not exceed 10
health status at baseline. Long periods of azotemia may
cases per month so in study period of 10 months, we
correlate with time-consuming repair of the renal
included all of them, which equaled 100.
tubule, while short periods of azotemia may correlate
with rapidly reversible hemodynamic variation. In
Type of the study: cross sectional study.
addition, the lack of specificity is the concern over
Tools and instruments: Records of the patient, urine
sensitivity because a healthy renal reserve would blunt
output, blood pressure, serum creatinine, Routine lab
the rise in creatinine. In fact, removal or damage of a
and specific investigation, which was for urinary
portion of a kidney may not elevate serum creatinine,
calprotectin.
despite loss of renal mass (1).
One major advance to detect AKI at an earlier
Inclusion criteria: All children from 6 month till 15
stage would be the implementation of new reliable
years old admitted to the Pediatric Intensive Care Unit
biomarkers that identify AKI earlier than conventional
(PICU) in Zagazig University Hospital.
tests or that detect subclinical AKI (2).
Calprotectin has been identified as an
Exclusion criteria: Patients with urinary tract
antimicrobial protein in the cytoplasm of neutrophil
obstruction. Patients with preexisting primary renal
granulocytes. Intracellular calprotectin's main function
disease. Patients with systemic diseases with renal
5586
Received: 20/6/2022
Accepted: 28/8/2022
c:\work\Jor\vol891_230
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5591- 5596
Elastic Stable Intramedullary Nailing Functional and Clinical Outcomes among
Femoral Fractures in Pediatrics Aged 4-11 Years
Mohamed A. Sebaei, Khaled E. Abdelrahman, Haytham Saif Aleslam Ali*, Yehia Elbromboly
Department of Orthopedic Surgery Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Haytham Saif Aleslam Mohammed Ali, Mobile: (+20) 01020056955,
E-Mail: haythamsaif04@gmail.com
ABSTRACT
Background: In children, femoral shaft fractures are often treated using elastic stable intramedullary nailing (ESIN).
Objective: To evaluate the functional as well as clinical outcomes of ESIN for femoral fractures in children aged 4-
11 years.
Patients and Methods: At Orthopedic Surgery Department of Zagazig General Hospital 18 cases diagnosed as
pediatric femoral fractures were stabilized using flexible intramedullary nailing.
Results: Skin irritation due to nail endings was the most prevalent consequence and was seen in 7 patients. Other
complications were superficial infection (n=2), limb length inequility (n=2) and varus angulation (n=1). At 3 months
follow-up, all patients had complete range of motion in their hips and knees; three patients (27.77%) had slight
restriction in knee flexion, but this was recovered by 6 months follow-up. Excellent Flynn elastic nail scoring results
were demonstrated in 72.22%, satisfactory results in 27.77% and none of the patients showed poor results.
Conclusion: Flexible Intramedullary Nailing resulted in the best possible functional and radiological outcomes for
patients with femoral shaft fractures and is a safe treatment option.
Keywords: Elastic Stable Intramedullary Nailing, Outcomes, Children.
INTRODUCTION
(>50 kg) and in children older than 11 years old, they
Nearly about two percent of fractures among
may become shorter and more angular (1).
pediatrics are femoral shaft fractures. The femoral
The purpose of this research was to examine the
diaphysis is fragile during childhood and can be broken
clinical and functional outcomes and consequences of
during everyday activities (childhood games);
Elastic Stable Intramedullary Nailing (ESIN) for
nevertheless, most adolescent femur fractures are
children aged 4-11 years old who had suffered a femur
caused by high-energy trauma, such as those sustained
fracture.
in car accidents (1).
Age, body mass index, accompanying lesions,
PATIENTS AND METHODS
fracture
type,
surgeon
preference,
patient
Patients:
socioeconomic status, and fracture location are just few
At Orthopedic Surgery Department of Zagazig
of the variables that can impact how a femoral shaft
General Hospital 18 cases diagnosed as pediatric
fracture is treated in a child (2).
femoral fractures were stabilized using flexible
Pediatric femoral shaft fractures are commonly
intramedullary nailing. Patients were distributed into
treated with ESIN or elastic stable intramedullary
two groups as the following:
nailing. Nail elasticity facilitates the development of
Group (1); patients between 4-<8 years and Group
micromovements that lead to the production of an
(2); patients between 8-11years.
external callus at the fracture site. This therapy does not
affect growth plates, allowing for early mobilization (3).
Inclusion criteria:
The procedure is carried out in accordance with
Children between 4-11 years.
the guidelines of minimally invasive surgery. Without
Both genders were included.
opening the fracture, the hematoma can be kept in place
Patients with isolated femoral fractures.
during surgery. When performing osteosynthesis, the
Mode of trauma include both low and high
nails are often placed away from the fracture site,
velocity injuries.
making the risk of bacterial contamination extremely
low (4).
Exclusion criteria:
When compared to external fixation and plate
Age less than 4 years or more 11 years.
fixation, it offers the advantages of being easily
Patients with bilateral femoral fractures.
removed, decreasing the patient's time spent in the
Multiple trauma patients with other surgical
hospital, being cost-effective, and having a smaller
injuries.
emotional impact on the patient (5).
Comminution of the bone, types 2-4 (Winquist
When a fracture is treated using an elastic nail,
classification).
the area is not rigidly fixed. However, this has
drawbacks in unstable fractures including comminuted
Injury to the cervico-trochanteric or femoral
and lengthy spiral fractures, which occur frequently in
condyle area.
youngsters. Particularly in patients with excess body fat
5591
Received: 22/06/2022
Accepted: 30/08/2022
c:\work\Jor\vol891_231
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5597- 5600
Latex Allergy Prevalence among Egyptian Health Care Workers at
a Tertiary Care Hospital in Cairo
Dina Sayed Sheha1, Nayera Samy Mostafa2, Fatema Elzahraa Abd El Kader1, Hossam Moustafa Elkady*1
Departments of 1Internal Medicine, Allergy and Clinical Immunology and 2Community, Environmental and
Occupational Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Hossam Moustafa Elkady, Mobile: (+20)01090751701, E-mail: hossamelkady86@ymail.com
ABSTRACT
Background: Latex allergy is a common occupational problem among healthcare workers (HCWs). Although latex
allergy prevalence has been researched in various countries, data in Egyptian hospitals is lacking.
Objectives: To determine the frequency of latex allergy among the HCWs in a tertiary hospital in Egypt.
Patients and Methods: One hundred and thirty healthcare workers at Ain Shams University Hospitals participated in
the current cross-sectional study in the period from September 2020 to March 2021. All participants were evaluated for
symptoms related to exposure of latex products, and skin prick test (SPT) for latex protein was done.
Results: Twenty-six (20%) of HCWs had positive SPT to latex. The most common allergic manifestations reported
were skin allergy (53.84%), followed by allergic rhinitis (23.07%), allergic conjunctivitis (11.53%), bronchial asthma
(7.69%), and angioedema (3.84%).
Conclusion: Latex allergy prevalence among HCWs was 20%. This rate is relatively higher than previous studies.
Keyword: Latex allergy, Skin prick test, Health care workers.
INTRODUCTION
latex and nitrile gloves were selected over vinyl and
Latex allergy is an allergic response on
polyethylene gloves as part of biosafety procedures (11).
exposure to latex proteins. It remains a widespread
Since The epidemiological data of latex sensitivity is
health risk for numerous occupations (1).
lacking in Egypt, the aim of the current study was to
As a result of frequent usage of latex gloves to
detect latex allergy prevalence among HCWs at Ain
prevent the spread of infectious diseases since the
Shams University Hospitals (ASUHs).
1980s, healthcare professionals (such as doctors, nurses,
dentists, laboratory workers) are the occupational group
PATIENTS AND METHODS
most impacted by latex allergy (2, 3).
One hundred and thirty healthcare workers at
The prevalence of latex hypersensitivity among
ASUHs (Ain shams university hospitals) participated in
healthcare workers (HCWs) varies according to the
this cross-sectional study during the period from
professional work, range from 25% to 50% among
September 2020 to March 2021.
nurses, 30% among dentists, 50% for surgeons, and
Inclusion criteria: Clinicians, nurses, laboratory
other healthcare practitioners show rates near 15% (4).
technicians and allied health care professionals at Ain
Latex exposure occurs by contact of skin
Shams University Hospitals.
directly with latex containing products. Latex allergens
Exclusion criteria: Participants with history of
in gloves can bond to powder particles and become
anaphylaxis, severe asthma, cardiovascular disease
airborne, which can be breathed in and induce
particularly on beta blocker medications, and pregnant
respiratory allergy (5, 6).
and lactating females.
Depending on the route of exposure (skin,
mucosa or intravenous), allergen amount and
Ethical Considerations:
sensitization level of patients, the manifestations
The study design was approved by The
induced by immunoglobulin E (IgE) hypersensitivity
Scientific Research Ethics Committee of Faculty of
(type I) reaction occur within seconds to minutes of
Medicine, Ain Shams University. Written informed
exposure to allergens. The patient may develop
consents were obtained from all participants. This
urticarial wheals, wheezy chest, allergic rhinitis, and
work has been carried out in accordance with The
conjunctivitis(7,8). Additionally, patients may present
Code of Ethics of the World Medical Association
with allergic contact dermatitis, a type IV delayed
(Declaration of Helsinki) for studies involving
hypersensitivity reaction that occurs 24 48 hours after
humans.
exposure to latex (8).
All the selected participants were subjected to the
Skin tests and specific IgE are the main
following:
diagnostic methods for latex allergy, positive results of
Demographic data, history of co-morbidities
either may be considered a sign of sensitization to latex
(past history of medical diseases as diabetes,
(9). Skin prick test is the first line investigation, when
hypertension, heart disease or any other medical
available, with specificity close to 100% and sensitivity
history), using gloves during patient encounter,
up to 93% (10).
changing gloves after contact with each patient, and the
Latex gloves usage has increased recently due
type of the used gloves. Personal and family history of
to COVID-19 pandemic, Due to their greater durability,
allergic disorders and symptoms suggestive of latex
5597
Received: 22/6/2022
Accepted: 30/8/2022
INTRODUCTION
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5601- 5613
Risk Factors for Rehospitalization among Bipolar Patients
Omar Abdul Hameed Abdul Moneam*, Mohamed Mostafa El-Hamady,
Shorouk Fathi Abd-Elmaksoud, Marwa Mohamed Mahmoud
Department of Psychiatry, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Omar Abdul Hameed Abdul Moneam, Mobile: (+20)01115477446,
Email: omar_abd_elhameed@yahoo.com
ABSTRACT
Background: Bipolar disorder (BP) is one of the main causes of disability and morbidity globally. It has been linked
to medical and mental comorbidity, premature death, functional impairment, and poor quality of life.
Objective: Recognizing predictors of psychiatric readmission among bipolar patients who were admitted to hospital
within six months since last admission.
Subjects and Procedures: One hundred bipolar patients who had been admitted to Abbassyia Mental Hospital were
included in this cross-sectional study. They were asked to fill out a questionnaire designed specifically for study,
which cover number of presumed risk factors.
Results: About one-third of patients with BP relapse into depression or mania even with treatment. Our study revealed
risk factors significantly differed between the two groups, such that patients who were rehospitalized within less than
3 months were significantly more likely to be unemployed, living in highly crowded places, socially isolated,
experiencing stressful life events, having neither fixed income nor supportive families. Thus, insufficient
psychoeducation, smoking, relapse during postpartum period and readmission with manic episode were highly
significant at this group. Regarding sociodemographic status, child abuse, using long-acting medications or ECT,
compliance, number of admissions, last admission duration, presence of insurance, all showed statistically non-
significant differences between the two groups.
Conclusion: It is estimated that around one-third of people with BP illness may have a recurrence of depressive or
manic symptoms despite therapy. Across all time periods, people with bipolar disorder were more likely to be
readmitted when they had certain risk indicators.
Keywords: Risk factors, Rehospitalization, Bipolar patients.
INTRODUCTION
prognosis, longer treatment delays, more severe
Additional study is required to identify risk
depressive episodes, and greater prevalences of
factors and key time periods for readmission for
concomitant anxiety and drug use disorders when it
individuals with bipolar disorder (BD), since BD has
presents at a younger age. Most people with BD I or II
been linked to high inpatient hospital usage and
have a depressed episode initially, and throughout the
healthcare expenditures. The purpose of policies and
duration of their disease, depressive episodes tend to
community mental health care planning is to reduce
persist longer than manic or hypomanic ones (5). About
rehospitalization rates, therefore understanding what
a third of patients who get therapy nevertheless have a
variables contribute to early psychiatric readmission is
recurrence of depressive or manic symptoms within a
important (1).
year. Moreover, therapeutic action and disease
Whether caused by positive or negative
management depend on a complete comprehension of
experiences, mood swings are a typical part of
the bipolar disorder illness course (6).
everyday living. Extreme and prolonged changes in
Being uninsured, having three or more mental
mood that cause emotional and behavioural discomfort
hospitalizations, and having a poorer Global
may, however, be indicative of an underlying affective
Assessment of Functioning score were all substantially
illness. Depression is one form of affective diseases,
linked in the multivariate models with a higher risk of
while bipolar I and II are two others on the spectrum
readmission across all time periods studied.
(2). All three types of bipolar disorder (BD I, BD II, and
Homelessness was another factor that increased the
cyclothymic disorders) are included together under the
likelihood of psychiatric readmission within 30 or 90
umbrella term "bipolar and associated disorders" in the
days after release. Within the one-year time frame,
DSM-5. The "other specified and bipolar associated
however, male patients were more likely to be
condition" covers atypical manifestations of bipolar
readmitted than their female counterparts regardless of
illness that do not map well into the standard
race/ethnicity, BD type, or the presence or absence of a
classifications (3).
current manic episode (7).
Recently published ICD-11 has a chapter on BD
as well. Types I and II of BD impact around 2% of the
THE OBJECTIVE OF THE STUDY
global population, and Bipolar Affective Disorder is
The goal of this research was to identify
the sixth greatest cause of disability globally,
predictors of psychiatric readmission among
according to the World Health Organization (WHO)
individuals with bipolar illness who were admitted to a
(4). BD commonly manifests itself in people after the
hospital less than six months after their last
age of twenty. Depression illness has a worse
hospitalisation.
5601
Received: 21/6/2022
Accepted: 29/8/2022
c:\work\Jor\vol891_233
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5614- 5618
Open Thoracotomy versus Video-Assisted Thoracic Surgery for Bullectomy in
Primary Spontaneous Pneumothorax
Mohamed Alanwar, Magdy Mobasher, Yahya Mahmoud Ali Alsaedi*, Amr El Sayed Tawfek
Cardiothoracic Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Yahya Mahmoud Ali Alsaedi, Mobile: (+20)01229561221, E-mail: Yahyaalsaadi87@gmail.com
ABSTRACT
Background: Spontaneous pneumothorax (SP) remains a significant health problem because of the high recurrence rate
during thoracic drainage and conservative treatments. SP can appear under two forms: primary SP occurs in otherwise
healthy patients, most commonly in tall, young, lean men, and particularly in those who smoke. Secondary SP occurs
as a complication of an underlying lung disease, which most often is chronic obstructive pulmonary disease.
Objective: The aim of the study was to compare outcome in patient who undergo thoracoscope and patients who
undergo thoracotomy in primary spontaneous pneumothorax.
Patients and Methods: This randomized clinical trial study was conducted at Cardiothoracic Surgery Department,
Zagazig University Hospitals. We included 30 patients with primary spontaneous pneumothorax in a randomly selected
(allocation sealed envelope). Patients were randomly divided into two groups; Group A: 15 cases were subjected to
video-assisted thoracic surgery (VATS) Bullectomy in primary spontaneous pneumothorax. Group B: 15 cases were
subjected to open thoracotomy in primary spontaneous pneumothorax.
Results: This study showed that there was significant difference between both groups regarding to intraoperative blood
loss, chest tube duration and hospital stay that was higher in thoracotomy group than VATS group. The complications
were higher in open thoracotomy than VATS group but it did not reach significant difference. Also, there was no
significant difference regarding to recurrence. Conclusion: VATS is associated with shorter length of hospital stay and
less blood loss with no difference of recurrence, and postoperative outcome compared to open thoracotomy in primary
spontaneous pneumothorax patients.
Keywords: Spontaneous pneumothorax, VATS, Thoracoscope, Thoracotomy.
INTRODUCTION
pleural drainage. The advantages of this procedure over
Pneumothorax is defined as air or gas
thoracoscopic techniques are the ability to perform
accumulated in the pleural cavity. A pneumothorax can
extensive mechanical pleurodesis and the resection of
occur spontaneously or after trauma to the lung or chest
blebs(8). The aim of this study was to compare outcome
wall. Pneumothorax can also be divided into tension and
in patient who undergo thoracoscope and patients who
non-tension (1). A tension pneumothorax can be a
undergo thoracotomy in primary spontaneous
medical emergency due to rising intrathoracic pressure
pneumothorax.
from progressive air accumulation in the pleural space.
Circulatory or respiratory failure might be developed
PATIENTS AND METHODS
from subsequent lung or mediastinal compression(2,3).
This randomized clinical trial study was
Primary spontaneous pneumothorax (PSP),
conducted at Cardiothoracic Surgery Department in
which is defined as a pneumothorax without underlying
Zagazig University Hospitals after fulfilling Ethical
lung disease, predominantly occurs in young, thin
Committee requirements and having written informed
males. It is usually caused by ruptured pleural blebs or
consent of the patients or their surrogate. The study was
bullae(4,5).
carried out on 30 patients with primary spontaneous
The thoracoscopic surgery (video-assisted
pneumothorax in a randomly selected (allocation sealed
thoracoscopic surgery) for primary spontaneous
envelope) fashion.
pneumothorax has been proposed and studied by a lot
of clinicians as the main treatment for recurrent or
All patients were divided into two groups; Group A:
persistent spontaneous pneumothorax (6,7). Surgical
15 cases were subjected to VATS Bullectomy in
treatment is more invasive and has a lower recurrence
primary spontaneous pneumothorax and Group B: 15
rate than the conservative treatment but increases
cases were subjected to open thoracotomy in primary
patient discomfort, which has restricted the application
spontaneous pneumothorax.
of open thoracotomy. This technique has been used not
only for prolonged air leak or recurrence but also in
Inclusion criteria were: Age (18-60) years. First
patients at the first episode of pneumothorax, when
episode with (prolonged air leak after 2 weak, No re-
blebs or bullae are identified with CT scan (8).
expansion of the lung after 2weak of insertion of
Open thoracotomy is an incision into the pleural
intercostal tube, bi-laterality). Secondary episode, and
space of the chest, and it has been the classic surgical
contralateral recurrence after primary pneumothorax.
treatment of PSP. Surgery is indicated when there is a
Exclusion criteria were: Age < 18 years > 60 years.
recurrence of an initial episode of PSP, which produces
Secondary spontaneous pneumothorax. Traumatic
persistent air leaks, or collapsed lung after placement of
pneumothorax, and severe chest wall deformity.
5614
Received: 22/6/2022
Accepted: 30/8/2022
c:\work\Jor\vol891_234
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5619- 5621
Possible Role of Microneedling in Dermatology.
Especially Androgenic Alopecia: Review Article
Ola Mahmoud El Sayed *, Mohamed Hamed Khater, Hagar Awad
Department of Dermatology, Venerology & Andrology, Faculty of Medicine, Zagazig University
*Corresponding author: Ola Mahmoud El Sayed, Mobile: (+20) 0 106 951 5859, E-Mail: drolamkhater@gmail.com
ABSTRACT
Background: Microneedling (also called "percutaneous collagen induction") is a minimally invasive technique used to
treat a wide variety of skin disorders. This treatment's creation was come to light in 1995, when Orentreich and
Orentreich employed dermal needling to address subcision scars. To do this, subcuticular incisions were made by putting
needles under the skin and guiding them to the desired location. One of its recent developments is the use of
microneedling to treat androgenic alopecia (AGA) on the scalp. Microneedling has been demonstrated to improve results
when compared to using minoxidil alone.
Objective: This review article aimed to throw the light on possible role of microneedling in dermatology, especially
androgenic alopecia.
Methods: Microneedling, Dermatology, and Androgenic Alopecia 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 2008 to 2022 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: Several clinical studies demonstrated in most cases, a positive outcome for microneedling as an adjunct
therapy for androgenic aopecia.
Keywords: Microneedling, Dermatology, Androgenic alopecia.
INTRODUCTION
Hair transplantation operates on the premise of
Androgenetic alopecia, also known as pattern
"donor dominance." When hair follicles are taken from
alopecia, is a hereditary hair loss condition that affects a
the non-balding occipital scalp and transplanted into
disproportionate number of people of both sexes. The
incidence of AGA is thought to be higher in males than
areas afflicted by AGA, the recipient area will take on
in females. Because of this disorder, terminal hair
the same qualities as the donor spot. Hair transplants will
gradually transforms into vellus hair, although the total
continue to grow to a full size because to the occipital
number of hair follicles in an affected area remains
region's naturally high resistance to androgenetic
unchanged over time. The etiology is complicated by the
alopecia. Follicular units, or groups of one to four hair
involvement of both environmental and genetic
follicles found naturally in the scalp, are the building
variables. Sites of usual involvement include the front of
blocks of today's hair transplant methods. The terms
the head, the center of the head, the sides of the head, and
"follicular unit transplantation" (FUT) and "follicular
the top of the head (the vertex). Common names for this
unit extraction" (FUE) refer to two different methods of
ailment include male and female pattern baldness (1).
doing a hair transplant using follicular units (1).
In patients with AGA, both quality of life and self-
esteem can be negatively impacted, and patients' hopes
Microneedling:
for therapy's effectiveness are often too high. Since
The stratum corneum is punctured by
improvement and regrowth may not have always been
microneedling, a less invasive dermatological technique
accomplished, it is crucial to emphasize that the primary
that involves rolling small needles over the skin.
treatment aim is to stop progression and prevent
Neovascularization and growth factor synthesis are
additional thinning (2).
induced in treated regions, which stimulates dermal
Surgical treatment for AGA can result in long-
papillae stem cells and hair development. Microneedling
lasting improvement. Follicular unit hair transplantation
has been found to enhance hair follicle development
has become the standard surgical therapy for hair loss.
when combined with other hair growth stimulating
Scalp reduction and flap procedures, which are more
treatments such minoxidil, platelet-rich plasma, and
invasive and difficult, are now seldom undertaken with
topical steroids. It has been hypothesized that
the intention of reorienting vast portions of hair-bearing
microneedling makes it easier for these first-line drugs
skin. Patients with stable or medically managed AGA
to enter the skin (4).
who want lasting improvements in hair loss and who
Percutaneous collagen induction (PCI) or
have a sufficient reserve of hair for transplantation are
"microneedling" is a minimally invasive technique used
the best candidates for hair transplantation (3).
to treat a wide variety of skin disorders. This treatment's
foundation was laid in 1995, when Orentreich and
5619
Received: 21/6/2022
Accepted: 29/8/2022
c:\work\Jor\vol891_235
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5622- 5627
Obstetric Traditions, Which Is True? Outcome of Midwife
Deliveries in Assiut Governorate
Mahmoud Ibrahim Elrashidy1, Mahmoud Ahmad Mohammed Badawy1, Eslam Fawzy El Sayed 1*
1Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar (Assiut) University, Egypt
*Corresponding author: Eslam Fawzy El Sayed, E mail: eslamfawzyhabib2030@yahoo .com
ABSTRACT
Background: Many pregnant females in rural Africa recommend traditional birth attendants (TBAs) services over
trained midwives as they believe childbearing is normal rite of passage for females and is assumed to be free of problems
that TBAs can easily control.
Aim and objectives was to shed light on obstetric traditions and cultural behaviors and was to identify the factors related
to the choice of birth attendants in home delivery and to assessment of safety of midwifery practice and satisfaction of
women underwent home deliveries.
Subjects and methods: The current study was a mixed study, retrospective study on 50 women who delivered at home
and prospective on 100 women delivered at Obstetrics and Gynecology Department of Al-Azhar University Hospital
Assiut.
Results: There was non-significant variations among groups (P>0.05) regarding maternal mortality, 3rd or 4th degree
tear, history of postpartum hemorrhage. However, there was significant difference concerning history of maternal
infection, Conclusion: Rates of maternal and fetal adverse results for this study in Assiut with well-established and
integrated community midwifery were high overall except postpartum hemorrhage, maternal mortality and caesarean
section (CS) rate. Well-trained midwives may have a role in reducing CS rate. Midwife delivery is not as bad according
to our study as it is showing low rate of postpartum hemorrhage and caesarean section.
Keywords: Obstetric traditions, Outcome; Midwife deliveries; Cultural behaviors; Postpartum hemorrhage
INTRODUCTION
on 100 women delivered at Obstetrics and Gynecology
Egypt made a significant progress in decreasing
Department of Al-Azhar University Hospital Assiut.
maternal mortality rate and infant mortality rate to
achieve the 5th Millennium Development goal (which is
Place of study: Included women of rural areas of Assiut
a reduction of maternal mortality rate (MMR) to 43.2
Governorate who were supervised by community
maternal death/100,000 live births by 2015 (1).
midwives and those attending the outpatient clinics of
Between 1992 and 2015, MMR has declined from
Obstetrics and Gynecology Department of Al-Azhar
174 maternal death/100,000 live births to 43.5 maternal
University Hospital between the 1st of March 2021 and
death /100,000 live births (2).
31st of December 2021.
However, Assiut Governorate in Upper Egypt was
among the highest governorates in maternal deaths; 60
Inclusion criteria: population of women in procreative
- 65 maternal death /100,000 live births in 2013 (3).
years old (fifteenforty years), singleton pregnant
In Egypt, the Ministry of Health and Population
women, and home delivery was supervised by
(MOHP) took many efforts in training nurses on
community midwife and women delivered at Al-Azhar
midwifery skills. However, since the start of that
University Hospital.
training program at year 2000, up to the authors'
knowledge, no research was shown to estimate training
Exclusion criteria: Elective caesarean section, baby
effect on home deliveries and whether it needs to be
had congenital abnormality, and their labor was induced
upgraded to meet women's need. This study could
for any purpose.
provide decision makers with evidence-based
knowledge on ways to improve skills of midwives and
Definitions of place of birth: Midwifery delivery is
hence increase their using as birth attendants, which will
where females give birth outside formal health
be reflected on improving women's health eventually
facility--usually in their homes--and plan to get care
(4).
from midwife (privately or publicly-funded). Hospital
Aim of the work was to shed light on obstetric
labor ward is in hospital and is staffed by doctors.
traditions and cultural behaviors and was to identify the
factors related to the choice of birth attendants in home
Study design:
delivery and to assessment of safety of midwifery
We have 2 groups: Group (Hospital delivery):
practice and satisfaction of women underwent home
included 100 patients. Group (Midwifery delivery):
deliveries.
included 50 patients.
PATIENTS AND METHODS
Intervention and follow-up: For group I: Labor
The current study was a mixed study, retrospective
progression was continued to be assessed every ½ - 1
study on 50 women who delivered at home, prospective
hour for assessment of cervical dilatation, consistency,
5622
Received: 17/6/2022
Accepted: 25/8/2022
c:\work\Jor\vol891_236
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5628- 5631
Effects of Liraglutide on Glycemic Control and Lipid Profile in
Obese Type 2 Diabetes Mellitus Iraqi Patients
Ahmed Jamal Abdulrahman 1, Mohammed Abdul-Hassan Jabarah AL-Zobaidy* 1, Samer Ahmed Najjar 2
1 Department of Pharmacology, College of Medicine, University of Baghdad, Iraq,
2 Ministry of Health, Baquba Teaching Hospital, Iraq.
Corresponding author: Mohammed Abdul-Hassan Jabarah AL-Zobaidy
Mobile: 009647705982654, Email: mohammed.a@comed.uobaghdad.edu.iq
ABSTRACT
Introduction: Diabetes mellitus is the most common endocrine illness, affecting over 100 million individuals globally (6%
of the population). Methods: A prospective open-label study was conducted from November 2021 to June 2022 at Baquba
Teaching Hospital/ Diyala., In current study, 50 patients (23 males and 27 females) had type 2 Diabetic from 2 to 4 years
and they were obese, hypertensive and dyslipidemic. They received liraglutide for 12 weeks as 0.6 mg/day. Patients
underwent measurements for fasting glucose level, lipid profile, glycosylated hemoglobin and their liver function before and
after 12 weeks of treatment. Results: The results of current study revealed that treatment with liraglutide for 12 weeks
showed significant beneficial effects on fasting glucose level, lipid profile and glycosylated hemoglobin (P<0.05) but without
adversely affecting liver function (P>0.05). Conclusion: In obese type 2 diabetic patients, liraglutide can exert beneficial
effects on glycemic control and lipid profile but without producing adverse effects on liver functions.
Keywords: Blood sugar, Glycosylated hemoglobin, Lipid profile, Liraglutide, Liver function.
INTRODUCTION
Diabetes mellitus (DM) is the most common
control, lipid profile and liver function in obese type 2
endocrine illness, affecting over 100 million individuals
diabetic Iraqi patients.
globally (6% of the population). It is caused by a lack, or
inadequate synthesis, of insulin by the pancreas, which
METHODS
causes an increase in blood glucose concentrations. It has
A prospective open-label study was conducted from
been discovered to harm a variety of biological systems,
November 2021 to June 2022 at Baquba Teaching
including blood vessels, eyes, kidneys, heart, and nerves(1).
Hospital/ Diyala. In current study, 50 patients (23 males
In only 34 years, the number of diabetic patients has
and 27 females) had type 2 diabetic from 2 to 4 years and
quadrupled (from 108 million in 1980 to 422 million in
they were obese (Body mass index > 30), hypertensive and
2014) (2). Diabetes is expected to be the 7th leading cause of
dyslipidemic. Moreover, recruited patients were on
death by 2030, according to the WHO (3). Obesity, diet and
treatment with statins, angiotensin receptor blockers and
physical inactivity, advancing age, insulin resistance, a
metformin, in a dose of 1 g/day, before starting the study
family history of diabetes, genetic variables, and race and
and liraglutide (0.6 mg/day by subcutaneous route) was
ethnicity are all risk factors for type II diabetes (4).
added on for 12 weeks. Patients who met the above criteria
Moreover, the complications of diabetes may be in the
underwent measurements for fasting glucose level, lipid
form of short-term (Hypoglycemia, hyperglycemia,
profile, glycosylated hemoglobin and their liver function.
diabetic ketoacidosis, and hyperosmolar hyperglycemia) or
long-term (neuropathy, nephropathy, retinopathy, and
Ethical Approval:
cardiovascular disease) diabetic problems (5).
Ethical approval was obtained from the Scientific
Regarding treatment of type 2 diabetes mellitus
Research Ethics Committee and Department of
(T2DM), lifestyle changes alone can help people having
Pharmacology, College of Medicine, University of
reduced glucose tolerance to avoid developing diabetes.
Baghdad and that at Baquba Teaching Hospital/
Also, it might sometimes be the only treatment option in
Diyala. This work has been carried out in accordance
the early stages of the disease (6).
with The Code of Ethics of the World Medical
Liraglutide stimulates insulin secretion in a glucose-
Association (Declaration of Helsinki) for studies
dependent manner, lowers plasma glucagon levels, delays
involving humans.
stomach emptying, suppresses appetite via neural
mechanisms, and lowers hepatic glucose synthesis (7-9).
Statistical analysis of data
As a consequence, weight reduction in diabetic obese
Was performed using SAS (Statistical Analysis System
patients may pave the way for successful and long-term
- version 9.1). Data were expressed as number and p
control of their diabetes. Therefore, current study aimed to
ercentage for qualitative data and mean + standard
evaluate the effectiveness of liraglutide on glycemic
deviation (SD) for quantitative data. Paired t-test was used
to compare quantitative data. P<0.05 was considered
significant.
5628
Received: 19/6/2022
Accepted: 27/8/2022
c:\work\Jor\vol891_237
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5632- 5638
The Biosimilar CT-P13 Infliximab Is More Immunogenic Than the Original
Infliximab In Iraqi Patients with Ankylosing Spondylitis
Mohammed Mahmood Kamil 1, Nizar Abdulateef Jasim 2, Mohammed Abdul-Hassan Jabarah AL-Zobaidy * 1
1 Department of Pharmacology, 2 Department of Medicine, College of Medicine,University of Baghdad, Iraq
Corresponding author: Mohammed Abdul-Hassan Jabarah AL-Zobaidy. Mobile: 009647705982654,
Email: mohammed.a@comed.uobaghdad.edu.iq
ABSTRACT
Introduction: Ankylosing spondylitis is also known as radiographic axial spondyloarthritis, a rare genetic disease affecting
people with hereditary factors. In addition, it is one of the autoimmune diseases with systemic chronic inflammatory,
progressive, immune-mediated reactions. It may be classified as seronegative spondyloarthropathy, which tests negative for
rheumatoid factor and antinuclear antibody. Treatment of ankylosing spondylitis includes lifestyle modification and use of
drugs such as the biologic agent infliximab or its biosimilar, CT-P13 infliximab. Despite their therapeutic usefulness, these
agents are associated with a number of serious adverse effects such as immunogenicity.
Methods: A retrospective open-label study was conducted from December 2021 to March 2022 at the Rheumatology Unit,
Baghdad Teaching Hospital, Medical City, Baghdad. Forty-four patients were taking Infliximab, and another 50 patients
were taking CT-P13 (Remsima), both at a dose of 5 mg/kg for 3 months prior to recruitment in current study. Disease
activity was assessed by ankylosing spondylitis disease activity (ASDAS-CRP) score, while antibodies and C-reactive
protein were tested using ELISA technique. Results: Immunogenicity of the biosimilar CT-P13 infliximab was higher than
that of the reference infliximab (P< 0.05). In addition, a number of patients in both treatment groups developed
hypersensitivity reaction to either drug. However, there was no statistically significant correlation between the two variables
(P> 0.05). Conclusion: Immunogenicity of infliximab or its biosimilar (CT - P13) may result in reduced therapeutic
effectiveness manifested as increased disease activity. Also, such immunogenicity may be triggered by previous biological
treatment and/or the total number of doses.
Keywords: Ankylosing spondylitis, Biologics, Biosimilar, Disease activity, Immunogenicity
INTRODUCTION
Safety in Korea, in 2013 from the EMA and in 2016 from
Ankylosing spondylitis (AS) is also known as
the US FDA. Moreover, currently it is marketed under the
radiographic axial spondyloarthritis, a rare genetic disease
brand name Remsima 12.
affecting people with hereditary factors. In addition, AS
TNF- inhibitors are generally well-tolerated, but
is one of the autoimmune diseases with systemic chronic
risks associated with these medications may appear,
inflammatory, progressive, immune-mediated reactions.
which include infusion reactions with infliximab, and
It may be classified as seronegative spondyloarthropathy,
injection site reactions to subcutaneously administered
which tests negative for rheumatoid factor and antinuclear
drugs (i.e., local erythema and swelling), opportunistic
antibody 1. Ankylosing spondylitis affects the sacroiliac
infections, and others. Moreover, the use of these agents
joints and spine and nearby soft tissues such as tendons
may also increase the risk of developing a delayed
and ligaments, to a lesser extent peripheral joints and
hypersensitivity reaction (HSR) 13. Furthermore, there is
other soft tissues. In addition, this inflammation can
a strong relationship between immunogenicity of these
eventually progress to fibrosis and calcification, which
medications and the loss of clinical effectiveness, because
leads to the loss of flexibility and fusion of the spine,
when immune complex is formed the ADAb is connected
resulting in an appearance similar to "bamboo" and an
to therapeutic medication. This immune complex
immobile position in more severe 1, 3, 4. In addition to
interferes with the function of biologics while also
HLA-B27 seropositivity, a family history of AS, male
facilitating the clearance of drugs 14, 15. On the other hand,
gender, age, vitamin D deficiency, mechanical stress,
immunogenicity of a product can be affected by a variety
smoking, obesity, and recurrent gastrointestinal infections
of factors, including product-specific characteristics (e.g.
all increase the likelihood of developing AS in a given
protein structure), treatment-related factors (e.g. usage of
individual 1, 2, 5-11. On the other hand, treatment of AS
concomitant medications, dose, continuous or intermittent
includes lifestyle modifications 3, administration of
delivery) and patient-related factors (e.g. genetic pre-
NSAIDs and TNF- inhibitor such as adalimumab,
predisposition underlying disease(s)) 16, 17. Genetic
infliximab, certolizumab, and golimumab, etanercept 13.
variables and the patient's age are among the factors that
In addition, the biosimilar of infliximab, CT-P13, and
influence the immunological response. Among the age-
infliximab 12. The latter is the first biosimilar version of
related factors are the age-dependent maturation of the
infliximab, known as CT-P13 infliximab, received
immune system found in children, as well as the
approval in 2012 from the Ministry of Food and Drug
possibility of altered immunological response in elderly
5632
Received: 19/6/2022
Accepted: 27/8/2022
c:\work\Jor\vol891_238
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5639- 5646
Prevalence and Determinants of Sport Injuries among the
Egyptian National Handball Players
Ahmed Mahmoud El Adl1, Abdel Hamied Mohamed Abdel Hamied*2,
Bernadette Sarraf1, Mohamed Azmy Khafagy1
Departments of 1Public Health and Community Medicine and 2Industrial Medicine and Occupational Health,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Abd El-Hamied Mohamed Abd El-Hamied, Mobile: (+20) 01001257474,
E-Mail: abdelhamied_com @yahoo.com
ABSTRACT
Background: Worldwide, handball is one of the most popular sports played by all ages. Handball injuries result from
intrinsic risk factors (as age, gender and previous injuries) and extrinsic risk factors (as playing position, floor type and
equipment).
Objective: Study the distribution and determinants of sport injuries among the Egyptian National handball players.
Patients and methods: A descriptive cross-sectional study with analytic component was carried out upon all the
Egyptian National handball players during the period from October 2016 to November 2017. According to the Egyptian
Handball Federation, the total number of these players was 234 players. All these players were included in the present
study.
Results: The present study revealed that 83.3% of the national handball players had one or more sport injury in the last
season, 81% of them were injured once and 40.2% of total injuries were overuse injuries. The most frequent injured
sites were knee (47.5 %) followed by ankle (18.9 %). Higher injury prevalence was reported by the first team players
(93.1%) and players above 20 years (90.7%). Females reported a higher injury prevalence compared to males (90.5%
and 78.4% respectively, OR= 2.6). In addition, the highest prevalence rates were reported among backcourt players
(OR= 4.5) and wingmen (OR= 3.7), players on artificial floor (OR= 4.3) and those didn't use protective equipment
(OR=2.3).
Conclusion: Older age, females, backcourt position, artificial floor and lack of protective equipment were significant
predictors of sport injuries among the national handball players.
Keywords: Sport injuries, Risk factors, Egyptian national handball players.
INTRODUCTION
injuries. Knee injuries represent the greatest share of
Although physical activity has numerous health
extensive injuries, and females are clearly more liable
benefits, such as reducing risks for chronic diseases and
for knee injuries, with regard to ACL tears. Backcourt
mortality (1), contribution to sports in addition comprises
players appear to sustain more injuries in comparison
a risk of injury (2). Sports injuries are a main issue for
with other player positions, then wing players. Overuse
athletes, coaches and sports clubs. These injuries affect
injuries are the result of a cumulative process of tissue
negatively the health of the injured athlete and might be
damage instead of prompt energy transfer (9).
associated with disability or even terminate his sports
Handball injuries result from extrinsic and intrinsic
career (3). In addition, these injuries burden the
risk factors. Intrinsic factors involve age, sex, body
healthcare system (3) as the management of such injuries
composition, physical fitness, prior injuries and sports-
is usually expensive and time-consuming (4). As a result,
specific skills as well as psychological parameters (4).
the International Olympic Committee (IOC) has
Extrinsic predisposing factors could be divided into
designed a research center for the prevention of injuries
factors associated with exposure, training, equipment
in various sports (5).
and environment. Exposure time, position in team and
Handball is a pivoting team sport in which players
level of competition are exposure factors. Training
are mainly affected by injuries. Compared to the
factors involve type, amount, rate and intensity of
remaining sports, it could be found in the top five with
training (4). Equipment factors comprise protective
regard to the number and gravity of injuries. Owing to
equipment (such as helmets, shin guards).
its speed nature, and players' frequent and severe
Environmental factors comprise type of a playing
collisions with each other, handball is considered
surface and weather condition as well as season (4).
traumatic and may lead to musculoskeletal injuries,
Therefore, understanding the epidemiology of these
which might be associated with suspensions of elite
injuries is the initial stage in creating efficient injury
players from sport fields and maintains a lot of money
prevention methods. Injury epidemiology is the study of
loss to the club and community (6). Several researchers
the distribution and causes of handball injuries with the
have examined the predisposing factors and the most
goal of putting into action countermeasures to stop their
frequent types of handball injuries (6). Most injuries take
growth and spread (10).
happen throughout matches in comparison with training
According to research by Andersson and
(7), and more injuries happen throughout the offensive
colleagues (11), practicing a set of exercises throughout
stage of the game in comparison with the defensive
the warm-up can cut the incidence of shoulder overuse
stage (8). Lower limbs represent the majority of the acute
injuries in handball by 28%. Zebis et al. (12)
injuries, then injuries of the upper limbs and lastly head
implemented neuromuscular training throughout a full
5639
Received: 22/6/2022
Accepted: 30/8/2022
c:\work\Jor\vol891_239
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5647- 5652
Role of Anti-C1q Antibodies as Indicator of Renal Activity in
Systemic Lupus Erythematosus
Usama Ragab1, Yaser Abdelmonem Elhendy1, Heba Hassan Gawish2,
Mayada Adel Elsadek Ahmed*1, Ahmed Noaman1
Departments of 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine, Zagazig University
*Corresponding author: Mayada Adel Elsadek Ahmed, Mobile: (+20)01127907118, Email: mayadalasheen043@gmail.com
ABSTRACT
Background: Several investigations have found a correlation between serum anti-C1q autoantibodies and peripheral
lymphocyte apoptosis among systemic lupus erythematosus (SLE) patients.
Objective: It was to assess correlation between anti-C1q, lupus nephritis and other markers of lupus activity.
Patients and Methods: This case-control study was conducted in Internal Medicine Department in cooperation with
Clinical Pathology Department. This study was performed on 72 cases and were allocated into three equal groups: SLE
with nephritis group, SLE without nephritis group, and control group. Measurements of anti-C1q titers were carried out
with by (ELISA) kits. Results: Anti-C1q antibody levels varied significantly amongst the groups. Post hoc test showed
that there was a statistical significance increase in anti-C1q among SLE with nephritis compared to SLE who don't have
nephritis and control and among SLE without nephritis compared to control. Anti-C1q antibodies validity to diagnose
LN among the studied group showed that anti-C1q at cut off >88.058 ng/ml had sensitivity 75%, specificity 75%,
accuracy 75%, PPV of 75% and NPV of 75% in diagnosis of LN among cases groups.
Conclusion: Anti-Clq autoantibodies, like other standard markers like renal SLEDAI, correlate with renal flare-ups as
well as renal disease activity.
Keywords: Systemic Lupus Erythematosus, Renal Activity, Anti-C1q antibodies.
INTRODUCTION
anti-C1q autoantibodies, showing that these antibodies
A variety of immunological abnormalities that
could have a harmful role, especially in the case of
manifest in a variety of systemic manifestations are
active disease (4).
characters of systemic lupus erythematosus (1).
This study aim was to assess correlation between
The most up-to-date speculations on the cause of
antiC1q, lupus nephritis and other markers of lupus
SLE center on the idea that abnormal apoptosis and
activity.
necrosis release nuclear antigens into the immune
system, immunological complexes containing nucleic
PATIENTS AND METHODS
acids that induce Type I interferon overexpression upon
At Internal Medicine Department in cooperation
uptake by plasmacytoid dendritic cells (2). The
with Clinical Pathology Department, Zagazig
complement system participate in waste material
University hospitals. We conducted this case-control
collection, immunological tolerance, and the formation
study on total of 72 people who were randomly assigned
of an adaptive immune response. Expression of the
to one of three groups for this case-control study:
adaptive immune response's humoral component occurs
Group (I): Twenty-four SLE with active lupus
through antibodies; these antibodies have a dynamic
nephritis (LN) (24 female, no male, age range 18-40
connection with the body's complement system (3).
year, mean 29.21±7.23 year). Proteinuria > 0.5 g/day
The complement system's first component, C1q,
and an increased serum creatinine level higher than 1.2
is expected to perform a key role in clearing away
and 1.1 among males and females respectively, and
immune complexes and other waste products of
estimated eGFR <60 mL/min/1.73 m2 are both
apoptotic cells. Autoimmune disease can be triggered
hallmarks of clinical nephritis.
by the immune system coming into prolonged link with
Group (II): Twenty-four SLE patients with no lupus
C1q epitopes (4).
nephritis (22 female, 2 male, age range 18-42 year,
The Systemic Lupus Activity Measurement
mean 32.38±5.92 year). In addition to having normal
(SLAM) as well as the Systemic Lupus Erythematosus
kidney function (serum creatinine level less than 1.2 and
Disease Activity Index (SLEDAI) are considered
1.1 among males and females respectively) and an
representative of the global scoring systems used to
estimated GFR higher than 90 mL/min/1.73 m2, all of
evaluate SLE activity, while the specific scales of
these patients also have low proteinuria (0.5 g/day), no
organ/system evaluation used to evaluate SLE activity
urinary casts sediment, and no hematuria upon
on a per-organ basis are typical of the other important
admission.
kind of SLE activity assessment (5).
Group (III): Twenty-four healthy-looking participants
Lupus nephritis affects up to 60% of those who
who were of a similar age and sex distribution to the
have lupus that may progress to proteinuria and chronic
patients served as controls (22 female, 2 male, age range
kidney disease if untreated (6).
22-42 year, mean 31.71±5.72 year).
In individuals with SLE, death of peripheral
Systemic lupus erythematosus was identified
lymphocytes has been linked to higher serum levels of
and diagnosed using criteria of Systemic Lupus
5647
Received: 22/6/2022
Accepted: 30/8/2022
c:\work\Jor\vol891_240
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5653- 5659
Association between Hyperemesis Gravidarum in Iraqi Women with
Helicobacter pylori Infection
Baydaa H. Rasin1 and Rana S. Aboud2
1 Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq.
2Department of Biology, College of Science, University of Baghdad, Baghdad-Al-Jadiria, Iraq.
Corresponding author: Baydaa, H. Rasin, e-mail:bydah 1708 @ gmail .com,mobile:009647736310723
ABSTRACT
Background: Helicobacter pylori are gram-negative microaerophilic bacteria, and it is considered prevalent bacteria that
affect people when transmitted fecally or orally. The infection in the acute stage manifests as stomach pain and acute
gastritis, but the chronic infection causes peptic ulcers and gastritis, 2% of which may progress to stomach cancer. Nausea
and vomiting during pregnancy, which may occur in 75% of pregnant women in the first three months and hyperemesis
gravidarum, which is extreme, persistent nausea and vomiting during pregnancy that occurs in about 2% only.
Objective: Finding out how H. pylori infection relates to hyperemesis gravidarum was the main objective of this work.
Subjects and Methods: One hundred blood samples were taken from people aged (16-35) years for the period from
10/1/2021 to 1/3/2022. Subjects were divided into four groups. The first group included twenty-five patients with severe
H.G, the second group had twenty-three patients with mild H.G, the third group had twentytwo patients with a few H.G,
and the fourth group included thirty pregnant without H.G. Measurements were made for all study groups to anti-IgA Ab,
anti-IgG Ab, and anti-Cag A Ab level by enzyme-linked immunosorbent assay (ELISA) technique.
Results: The statistical analysis showed a highly significant increase in the concentration of IgA in H.G compared to the
control group (p > 0.01), a highly significant elevation in the concentration of IgG in H.G compared to the control group
(p > 0.01), and a significant increase in concentration of anti-CagA Ab in H.G compared to control group (p>0.05).
Conclusion: The present study shows that infection with Helicobacter pylori plays a role in hyperemesis gravidarum.
Keywords: Pregnant women, H.pylori, ELISA.
INTRODUCTION
and inhibit the production of both histamine and acid
Helicobacter pylori (H. pylori) infects more than
secretion (8). These mechanisms combat the stomach's
half of the world's humans(1). A gram-negative
acidic condition (the first line of defense) and are crucial
bacterium called H. pylori colonizes the stomach
to H. pylori's survival and colonization. In addition to its
epithelium(2). It is a flagellated, helical bacillus,
role in acid neutralization, urease contributes to the
microaerophilic, fastidious bacterium, and slow-
pathogenicity of H. pylori by developing ammonia
growing (3). This bacteria is known to be associated with
(disrupting cell junctions and destroying epithelium) and
gastric epithelial cells, which contributes to the success
reactive oxygen species, triggering lipoxygenase,
of its infection and is one of the major causes of gastric
inducing angiogenesis, factor-induced hypoxia, and
cancer (4).
apoptosis. H. pylori induce activation of most
H. pylori has microbiological features that allow it
components of innate immunity (epithelial, neutrophil,
to live in extremely adverse conditions, such as the
macrophage, and dendritic cells) and adaptive immunity
gastric acidic climate. Infection can be transmitted
(B and T cells) (9).
primarily via the oral-fecal route, in particular via
Following bacterial adhesion, the cag type IV
polluted water and food. As shown by the isolation of
secretion system translocates the terminal gene product
the bacterium in saliva and dental plaque, oral-oral
of the cag island, CagA, into host cells. Gastric epithelial
transmission is also possible (5).
cell hyperproliferation and gastric cancer develop in
The bacteria are a peptic ulcer and chronic gastritis
transgenic mice that overexpress CagA, this molecule
pathogenic cause. Its infection can also be associated
has been identified as a bacterial oncoprotein. CagA is a
with several elderly cardiovascular disorders, such as
120140 kD protein with a carboxyl-terminal variable
arteriosclerosis, coronary heart disease, and cerebral
region containing tyrosine phosphorylation motifs
infarction, with deleterious effects on their health (6). To
(glutamate-proline-isoleucine-tyrosine-alanine,
survive in the stomach, it creates an exceptionally potent
EPIYA). H. pylori infection is a leading cause of the
urease that can neutralize gastric acid, pierce, and
peptic ulcer, gastric cancer, gastric lymphoma, and
colonize the gastric epithelium (7). Acute H. pylori
pregnancy-related clinical events, including HG and
infection also affects the mechanism of the parietal cell
preterm birth (PTB). It has also been shown that
proton pump, increases cytokine production, and
pregnant women with H. pylori infection experience
stimulates neural pathways that stimulate somatostatin
5653
Received: 21/6/2022
Accepted: 29/8/2022
c:\work\Jor\vol891_241
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5660- 5665
Evaluation of the Use of Ultrasound Guided Compression versus Ultrasound
Guided Thrombin Injection for Post-Catheterization Femoral Pseudoaneurysms
Mahmoud Mohammed Moawed
Assistant professor of vascular surgery, Faculty of medicine, Al Azhar University, New damitia hospital, Egypt
*Corresponding author: Mahmoud Mohammed Moawed, E mail: moawedsurgeon@yahoo.com, Mobile phone: 01115757883
ABSTRACT
Background: After femoral artery catheterization, pseudoaneurysms are linked with considerable morbidity. Recently,
percutaneous ultrasound-guided thrombin injection has become a possible first-line therapy.
Objectives: This study aimed to compare the efficacy and safety of ultrasound-guided compression repair vs ultrasound-
guided thrombin injection in treating post-catheterization femoral artery pseudoaneurysms were compared.
Methods: One hundred patients with femoral pseudoaneurysms were randomised to receive either an ultrasound-guided
compression or ultrasound-guided thrombin injection in this interventional study.
Results: Success rates for ultrasound-guided thrombin injection were one hundred percent, whereas those for
ultrasound-guided compression repair were only eighty percent, perhaps because of anticoagulant medication,
hypertension, and aneurysms greater than six centimeters in size. Nevertheless, neither of these elements had an impact
on how well thrombin injections worked.
Conclusion: The success rate of ultrasound-guided thrombin administration is quite high and is simple procedure that
were accepted and tolerated well by the patients.
Keywords: Ultrasound-guided compression, Femoral pseudoaneurysm, Ultrasound-guided thrombin injection.
INTRODUCTION
The literature documented success rates for UGCR
False aneurysms, or pseudoaneurysms, are areas of
ranging from 54% to 100%, and it is unclear what
constrained pulsatile blood flow that have tissues
factors contribute to UGCR success (8).
around them and all three vessel layer disruptions
In order to treat iatrogenic pseudoaneurysms, in
(intima, media, and adventitia) (1).
1997, Liau and his colleagues (9) came up with
The main entry point in the vast majority of
ultrasound-guided percutaneous thrombin injection
therapeutic and diagnostic endovascular procedures is
(UGTI). The UGTI had success rates between 91% and
the femoral artery (cardiac, aortic, and peripheral). In
100%, with a complication rate of only 1.3% and an
the literature, the incidence of femoral artery fake
embolic event rate of only 0.5% (10). High success rates,
aneurysms ranges considerably from 0.05% to 8.0% (2).
rapidity of surgery, good patient tolerance, and
Iatrogenic femoral artery pseudoaneurysms (FAP) can
independence of operation success from anticoagulation
arise if the arteriotomy is not sealed properly following
are only some of the benefits of UGTI despite the
endovascular procedures or if the clot obstructing the
hazards involved (11).
arteriotomy gets moved during the time after the
The goal of this study was to compare how well
procedure. The lumen of the artery at the base of the
ultrasound-guided compression repair and ultrasound-
neck is being communicated with, and blood is leaking
guided thrombin injection work to treat femoral artery
out into the surrounding tissue. The only parts of the
pseudoaneurysms after catheterization.
pseudoaneurysm's wall are the squeezed thrombus and
the soft tissue around it (3).
MATERIAL AND METHODS
FAP may result in skin necrosis, infection, critical
At the brand-new Damietta Hospital, this
limb ischemia, compressive neuropathy, venous
retrospective clinical research was carried out. There
thrombosis, or even rupture (4). If a follow-up duplex
were 100 patients in our research population. They were
scan is performed after two months, small
identified
as
post-catheterization
femoral
pseudoaneurysms that are asymptomatic can be treated
pseudoaneurysms by Doppler ultrasonography and
without surgery if they aren't visible. Large (> 2 cm),
treated by compression or thrombin injection during the
symptomatic, or difficult FAPs, on the other hand, need
same scanning session. They were above the age of 18.
to be treated (5).
Patients who required surgical repair or who had a
The most often utilised procedures are thrombin
history of thrombin hypersensitivity were not included
injection, surgical repair, and ultrasound-guided
in the research. Patients were randomly assigned to
compression (UGC) (6). In 1991, it was written that
either a UGTI group or a UGCR group.
femoral artery pseudoaneurysms could be fixed with
The following data about each patient were
ultrasound-guided compression repair (UGCR) (7). In
collected: Personal history, pain characters, murmur, or
many cases, doctors have found that this method can
edema, as well as the results of a physical examination
achieve the same results as surgery without causing as
were clinical indications of post-catheterization femoral
much damage. Compression should be avoided in cases
pseudoaneurysms.
of skin ischemia, infection, pressure sensations on the
All patients' ultrasound pictures, exact locations,
neighbouring neurovascular systems, and intense pain.
aneurysmal diameters, and peripheral pulse status were
5660
Received: 21/6/2022
Accepted: 29/8 2022
c:\work\Jor\vol891_242
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5666- 5671
Smartphone Addiction and Manual Coordination, Strength and Hand Pain in
Normal Teenage Students: A Cross-Sectional Study
Amira E. Mohamed*1, Khaled A. Mamdouh1, Shorouk Elshennawy1,2, Maya G. Aly1, Hoda A. Eltalawy1
1Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Egypt
2Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Misr University for Science
and Technology, Egypt
*Corresponding author: Amira Eid Mohamed, Mobile: (+20) 01145188641, E-Mail: amira.eid43@yahoo.com
ABSTRACT
Background: These days, we can't imagine living without our smartphones. Physical functions of your hands and
fingers like dexterity and coordination could be impaired from too much time spent on your smartphone due to the
constant grasping and tapping of its screen.
Objective: The purpose of this study was to look into how smartphone addiction affects normal adolescent students'
manual coordination (manual dexterity and upper limb coordination), grip strength, pinch strength, and wrist and hand
pain.
Subjects and Methods: An observational cross-sectional study for governmental and private preparatory and secondary
schools at Ashmoun educational administration, Menoufia Governorate, Egypt was done. The study included one
hundred normal teenage students (54 girls and 46 boys), aged from 12 to 18years. The Bruininks-Oseretsky Test of
Motor Proficiency was employed to evaluate manual coordination (manual dexterity and upper limb coordination)
(BOT-2). A hand dynamometer and a pinch meter were used to measure grip and pinch strength. The PRWHE
questionnaire was used to assess wrist and hand pain as reported by participants.
Results: Research found a significant positive association between smartphone addiction ratings and pain in the wrist
and hand (r = 0.304, P = 0.002). Scores on a scale measuring smart phone addiction were not significantly correlated
with any of the other characteristics studied.
Conclusion: In a typical sample of adolescent students, researchers observed a significant positive association between
smartphone use and wrist/hand pain. This finding indicates that the heavy usage of smartphones is considered a risk
factor that leads to wrist/hand pain.
Keywords: Hand pain, Manual coordination, Manual strength, Smartphone addiction, Teenage students.
INTRODUCTION
undoubtedly altered by the ever-increasing prevalence
Smartphones are now available all over the
of smartphone use, and this fact should be taken into
world; more than one third of the human mankind has
account when gauging the influence of smartphone use
mobile access to the internet (1). A large number of
on manual dexterity(6). Constant use of a smartphone
young adults, teenagers, and children are addicted to
without breaks can lead to repetitive stress injuries in
their smartphones, which is a well-known problem.
the head, neck, shoulders, hands and wrists. Because
Addiction to smartphones is defined as a behavioral
smartphones often demand thumb and finger
addiction characterized by loss of control due to
interactions with the screen, they may contribute to
excessive immersion and obsessions with smartphones,
these illnesses. Overuse injuries to the wrist, hand, and
disruption of daily functioning due to nervousness and
finger joints are common among those who use their
anxiety, and a preference for the virtual world that is
smartphones for long periods of time while maintaining
more enjoyable with smartphone than with friends(2).
an unnatural grip on the device(7). Pain and muscle
Forty percent of both teenagers and adults
weariness can be brought on by repetitive static motion
report using their phones for more than four hours a day,
of the hands because blood supply is cut off and
mostly for communication purposes. In addition, they
nutrients aren't being given to the muscles(8).
had more behavioral, interpersonal, and physiological
Upper limb (UL) work that is performed
issues than individuals who used their phones for less
repeatedly can create discomfort in the neck, shoulders,
than four hours daily(3). The function of hands is the
arms, wrists, and fingers, as well as mild to moderate
most important tool to connect with the world, it
damage to the UL's muscles, nerves, joints, and blood
includes a variety of functions such as dexterity,
vessels. The research on how much time teenagers
coordination, grip and endurance, the most important
spend on their smartphones may affect their manual
function in manipulating or performing things with
coordination, such as their manual dexterity and UL
agility is dexterity, which is the main physical function
coordination, is limited and often contradictory(9).
of smartphone use (4).
The purpose of this study was to examine the
Problems with your wrists and neck aren't the
effects of smartphone addiction on manual
only ones you can experience if you use your phone all
coordination, hand-grip and pinch strength, and
the time. Constantly holding your phone can put a lot of
wrist/hand pain in healthy adolescent students.
strain on your hands, which can cause pain and other
issues with your thumb and fingers(5). Everyday life is
SUBJECTS AND METHODS
5666
Received: 22/6/2022
Accepted: 30/8/2022
c:\work\Jor\vol891_243
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5672- 5676
Prophylactic Tramadol versus Nefopam for Post-operative Catheter-Related
Bladder Discomfort in Patients Undergoing Elective Percutaneous
Nephrolithotomy: Randomized Controlled Trial
Mona Gad*1, Hatem Saber Mohamed1, Amany Tarbay1, Ahmed Fathy Abdel-Latif2
1Department of Anesthesia and Intensive Care, Mansoura Faculty of Medicine, Mansoura University, Egypt
2Department of Anesthesia and Intensive Care, Qena Faculty of Medicine, South Valley University, Qena, Egypt
*Corresponding author: Mona Gad, Mobile: (+20) 01062106155, E-Mail: monagad78@mans.edu.eg
ABSTRACT
Background: Individuals waking from general anesthesia frequently experience disagreeable symptoms of catheter-
related bladder discomfort (CRBD) due to intraoperative catheterization.
Objective: Comparing efficacy of nefopam versus tramadol to prevent (CRBD) after percutaneous nephrolithotomy
(PCNL) surgery.
Patients and methods: This was a prospective double-blind study conducted on a total of 150 adult patients between
the ages of 18 and 60, of both sexes, who were undergoing percutaneous nephrolithotomy (PCNL) for a renal upper
ureteric stone. They were divided into three groups; Tramadol group, Nefopam group and Control group.
Results: The demographic data showed no statistically significant differences between the three groups (P value >0.05).
Average fentanyl use after surgery was much higher in the control group (326.50±35.14 mcg/24 hours) compared with
both tramadol (165.00±15.15 mcg/24 hours) and nefopam groups (183.00±21.69 mcg/24 hours) (P value <0.001). The
severity of CRBD, when comparing the control group to the tramadol and nefopam groups, the control group had
significantly higher post-operative pain and rescue analgesic use throughout all study timeframes (P value <0.05).
Sedation, an increase in the number of patients reporting post-operative nausea and vomiting (PONV), and dry mouth
were all significantly more common in the tramadol group than in the nefopam or control groups (P value<0.05).
Conclusions: Intra-operative administration of both tramadol and nefopam significantly reduced post-operative CRBD,
pain together with reduced consumption of post-operative fentanyl requirements in patients undergoing PCNL.
However, nefopam was superior to tramadol as it was not associated with post-operative sedation and had lesser
incidence of post-operative adverse events.
Keywords: Catheter-related bladder discomfort, Tramadol, Nefopam, Percutaneous Nephrolithotomy.
INTRODUCTION
tramadol has been shown in animal experiments to have
With the development of Enhanced Recovery After
a suppressive impact on both detrusor hyperactivity and
Surgery (ERAS) protocol, there is a new trend for a
normal micturition (12).
more satisfying post-operative pain control and early
In the field of perioperative analgesia, nefopam
discharge following short-lasting surgery as recovery
stands out as a popular choice due to its centrally acting,
and discharge from the hospital are often held back by
non-opioid,
non-steroidal
analgesic
properties.
inadequate pain management(1).
Reuptake inhibition of serotonin, dopamine, and
Patients who have urinary catheterization as part of
norepinephrine may be responsible for its central
their surgery experience a painful side effect known as
analgesic action (13).
catheter-related bladder discomfort (CRBD)(2). It's
Patients
undergoing
elective
percutaneous
characterized by symptoms including an urgent need to
nephrolithotomy were included in this trial to evaluate
urinate and burning pain above the pubic bone, and it's
the efficacy of prophylactic tramadol against nefopam
sometimes linked to abnormal behavior (3). This
in reducing post-operative CRBD. Reducing the
symptom can be explained by the stimulation of
occurrence or severity of CRBD was the primary aim,
muscarinic receptors, namely type 3 muscarinic
while minimizing the need for post-operative fentanyl
receptors (M3) due to release of acetylcholine from
and the occurrence of adverse effects such sedation,
irritated cholinergic nerves secondary to involuntary
PONV, and respiratory depression were secondary
contraction of the proximal urethra or bladder by the
endpoints.
indwelling catheter, which results in the frequent urge
to void (4).
PATIENTS AND METHODS
The reported prevalence of CRBD ranges from 58%
This is randomised, placebo-controlled, double-
to 80% (5), in addition to mild to severe males are more
blind trial. Adult patients (aged 18-60) of either sex who
likely to be affected by CRBD (6).
were undergoing PCNL for a renal upper ureteric stone
There are a number of anesthetics with anti-
and required urinary bladder catheterization were
muscarinic characteristics that have been claimed to be
included in the trial. Patients had to be ASA I or II status
useful in preventing CRBD(7-10).
to be eligible. Nephrostomy and post-operative bladder
For pain relief, tramadol is a synthetic, centrally-
drainage for 12-24 hours are common after this
acting Mu1 (U1) agonist analgesic that also blocks the
operation.
activity of M1 and M3 muscarinic receptors (11). Further,
5672
Received: 20/6/2022
Accepted: 28/8/2022
c:\work\Jor\vol891_244
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5677- 5681
Assessment of Adult Attention-Deficit/Hyperactivity Disorder
(ADHD) in Substance Use Disorder Patients
Mostafa Mahmoud Elsabban*, Mohammed Gamal Abd Al Ghany, Mohammed Metwally Abo Alabass
Department of Psychiatry, Al-Azhar University, Faculty of Medicine, New Damietta, Egypt.
*Corresponding Author: Mostafa Mahmoud Elsabban, Phone: +20 102 888 6416, E-mail: drsapan2010@gmail.com,
Affiliation: Assistant lecture of Psychiatry, Al-Azhar University, Faculty of Medicine, New Damietta., Egypt.
ABSTRACT
Background: One of the public health concerns is connection between diagnosed attention-deficit/hyperactivity disorder
(ADHD) and substance use disorders (SUD). According to several studies, having ADHD predisposes one to using both
legal and illegal substances, especially those associated with SUD.
Aim: This study was set out to determine how common adult ADHD was between people with substance use disorders. A
comparison of the onset, severity, and the substance of usage in patients with adult ADHD and those without might also be
intriguing.
Patients and Method: This was a cross-sectional comparative study that included 200 inpatients with SUD picked
randomly from the Addiction Treatment Center at Port Said Psychiatric Hospital, over 6 months from December 2021 to
May 2022.
Results: We found 57 (28.5%) of the participants have ADHD, while according to the Wender Utah Rating Scale (WURS)
119 (59.5%) had ADHD in their childhood. In ADHD participants' alcohol, tramadol, opioids, and stimulants were
significantly higher than non-ADHD participants. Addiction Severity Index (ASI) analysis was statistically significant
severity in all aspects of addiction severity index in patients with ADHD except psychiatric section.
Conclusion: The adult ADHD strongly influences the development of SUD. Adult ADHD patients had higher rates of
relapse, as evidenced by more frequent hospitalizations for substance abuse problems, earlier onset of substance use, and
shorter abstinence intervals. Therefore, effective care for SUD should be included in screening for ADHD symptoms and
including them in treatment regimens.
Keywords: ADHD; Dependence; Substance abuse
INTRODUCTION
stage of life brings because of their symptoms. In these
During childhood one of the most frequent
conditions, people may be more susceptible to using both
neuropsychiatric
conditions
is
attention-
legal and illegal drugs as well as acquiring SUD (4,6).
deficit/hyperactivity disorder (ADHD), which frequently
In order to avoid bad outcomes and reduce the
persists into adulthood (estimated frequent: 5.2%6.1% in
impact of ADHD in life later, it may be essential to gain
male and 3.3% in female) (1).
a greater understanding of the link between adult ADHD,
According to recent studies, 4.0% of adults in the
drug abuse, and associated issues. There is already a
US have ADHD. Over the course of an individual's whole
significant number of studies looking into this connection.
lifespan, ADHD had a major impact on mental wellness
however, connection between ADHD and substance
and performance throughout various life areas (2,3).
abuse still questionable (6,7).
The link between ADHD and substance use
Additionally, earlier research mainly concentrated
disorders (SUD) is one of the public health issues.
on the connection between ADHD and SUD(8). Few
According to certain studies, having ADHD predicts drug
studies have looked at how ADHD affects more general
use, both legal and illegal, and is particularly linked to
substance use patterns that may be a contributor to SUD,
SUD (4,5).
such as the first use's age, its prevalence over time, and
This is a concern since people with ADHD
dangerous substance usage. It may be possible to stop the
already have considerable disadvantages in a number of
emergence of dysfunction related to substance misuse in
life domains. Further impairments in these domains can
people with diagnosed ADHD by identifying target usage
also be brought on by ongoing substance misuse and
patterns(9).
related disorders. The shift from youth to adulthood is
crucial for all young adults since it brings about
AIM OF THE STUDY
significant changes in many areas of life, such as
Calculating the frequency of adult ADHD in
beginning a work. Additionally, throughout this years,
patients with drug abuse problems is the goal of our
substance usage and related issues frequently rise. People
investigation. A comparison of the onset, severity, and the
with ADHD may have more trouble adjusting to new
substance of usage in patients diagnosed with adult
circumstances and overcoming the various problems this
ADHD and those without might also be intriguing.
5677
Received: 22/6/2022
Accepted: 30/8/2022
c:\work\Jor\vol891_245
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5682- 5690
Stellate Ganglion Block: Comparison of Different Doses of
Ketorolac After Breast Cancer Surgeries
Salwa M. S. Hayes, Tarek M. A. Shams, Fatma A. M. Negm, Naglaa A. Elnegeery
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Corresponding Author: Salwa M. S. Hayes, Mobile: (+20)01002223272, E-mail: salwa.hayes@yahoo.com
ABSTRACT
Background: Despite advances in breast conservation therapy, upper limb edema is still a typical concern for those
who have undergone treatment for breast cancer.
Objective: The purpose of this research was to evaluate the effects of a fixed dose of lidocaine combined with two
different doses of ketorolac for stellate ganglion block (SGB) for decreasing pain and size of post mastectomy upper
limb lymphedema after breast cancer surgery
Patients and methods: Forty patients that underwent mastectomy were randomly assigned to one of two research
groups in this prospective randomized study (20 patients in each group) received either ultrasound guided SGB with
solution of 4 ml lidocaine 2% & 15 mg ketorolac in total volume 10 ml (group 1) or ultrasound guided SGB with solution
of 4 ml lidocaine 2% & 30 mg ketorolac in total volume 10 ml (group 2). Assessment was done after SGB for 3 weeks
by collecting data of total analgesic consumption as primary outcome, first analgesic request, VAS score and arm
circumference.
Results: Total analgesic dose /tablet was significantly decreased 19 (4-30) in group 2 versus 34 (20-63) in group 1, first
analgesic request /hours 8 (5-54) in group 2 versus 4 (2-8) in group 1. At 2 and 3 weeks post-block, there was a
significant reduction in group members' arm circumference both 5 and 10 centimeters above and below the elbow crease.
Conclusion: Higher dose of ketorolac could be associated with better analgesia, lower VAS score and with more upper
limb lymphedema size reduction post-mastectomy.
Keywords: Upper limb lymphedema, Stellate ganglion block, Ketorolac.
INTRODUCTION
cervical and first thoracic vertebrae. When the inferior
Lymphedema is a chronic condition that can
cervical ganglion fuses with the first thoracic ganglion,
arise as a result of axillary lymph node dissection
the resulting structure is called a stellate ganglion and
(ALND) and is associated with a plethora of issues,
located anterior to the C7 transverse process, it is lateral
including discomfort, impaired function, an unattractive
to the longus colli muscle and the trachea, medial to the
appearance, and even psychological distress.
scalene muscles, and medial to the recurrent laryngeal
Furthermore, it can negatively impact the quality-of-life
nerve (5).
(QOL) of breast cancer patients (1). In addition to
Lymphedema patients can benefit from a
psychological morbidity, women who suffer from
stellate ganglion block (SGB), which was first used to
lymphedema have experience of anxiety, depression
treat the condition in 1983 by Swedborg et al. (6) taking
and social isolation (2). In spite of the advent of breast
into account the hypothesis that the overlap between the
conservation therapy, arm swelling is still a prevalent
sympathetic nervous system and the blocked veins
issue for those who have undergone treatment for breast
causes the veins to relax and the post-capillary
cancer. Complex decongestive therapy (CDT), also
resistance to decrease, thereby releasing the collected
known as lymphatic physiotherapeutic intervention, is
interstitial fluid into the venous system (7). When
the gold standard for the effective management of
opposed to steroids, NSAIDs like ketorolac have fewer
lymphedema involving physical exercise, skin care,
and milder adverse effects, yet they nevertheless
manual lymph drainage (MLD), bandages of
provide analgesic, anti-inflammatory, and antipyretic
compression, lymphedema self-management training
relief. Inhibition of prostaglandin production is the
throughout the long term as well as stocking
primary mechanism by which ketorolac and other
compression. However, CDT is not useful for treating
NSAIDs produce their pharmacological effects.
persistent large lymphedema when there is also an
Evidence suggests that NSAIDs may potentially operate
obesity component as the newly produced adipose
centrally, despite the fact that their effects are primarily
tissue that persists under the skin after microsurgery
seen at the periphery (8).
frequently prevents successful limb reduction (3).
This study was done to compare between adding
Lymphedema is a condition that, if left
2 different doses of ketorolac to fixed dose of lidocaine
untreated, can worsen over time, making an early
local anesthetic for stellate ganglion block as a method
diagnosis crucial. If the right therapeutic measures are
for decreasing pain and size of post mastectomy upper
taken quickly enough, it may be possible to stop the
limb lymphedema after breast cancer surgery with total
progression and even bring the limb back to normal (4).
analgesia requirements in 3 weeks after the injection as
The stellate ganglion block (SGB) is a common
a primary outcome. While, the first requested analgesia,
method for relieving chronic pain. Anatomically, the
visual analogue (VAS) score, the arm circumference
inferior cervical ganglion sits between the seventh
after the block, lymphedema and breast cancer
5682
Received: 22/6/2022
Accepted: 30/8/2022
c:\work\Jor\vol891_246
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5691- 5697
Supracostal Puncture versus Subcostal Puncture in
Percutaneous Nephrolithotomy
Mohamed Sadek Ahmed Elsayed Marei, Safwat Elsayed Abo Hashem,
Emad AbdElhamid Salem, Diab Elsayed Mohamed
Department of Urology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed Sadek Ahmed Elsayed Marei, Mobile: (+20)01222538881, Email: mar3y84@gmail.com
ABSTRACT
Background: In order to reach the posterior upper-pole calyx of the kidney, which is the farthest back part of the kidney,
a supracostal puncture is recommended for staghorn calculus management.
Objective: To compare safety, operative time and efficacy of supracostal puncture versus subcostal puncture in
percutaneous nephrolithotomy (PCNL).
Patients and methods: Urology clinics at Zagazig University were the site for this prospective randomized comparison
research. Fifty patients with an indication for percutaneous nephrolithotomy were enlisted and randomly assigned to
one of two groups; in Group A, PCNL was performed through supracostal puncture. Patients in Group B had subcostal
puncture for PCNL.
Results: Hospital stay was 1.84±0.64 and 1.44±0.48 in supracostal and subcostal groups respectively without significant
difference between groups. In supracostal puncture 36.0% had complication as (2 cases 8.0% had hydrothorax , 4 cases
16.0% parenchymal bleeding two of them need transfusion and 2 cases 8.0% had transient fever) and 1 case 4.0% had
transient increase in serum creatinine regard subcostal puncture 28.0% had complication as (3 cases 12.0% had
parenchymal bleeding just one of them needed transfusion) 3 cases 12.0% had transient fever) and 1 case 4.0% had
transient increase in serum creatinine with no significant difference between groups. Supra group was 72 % stone free
while subgroup was 64%.
Conclusion: When treating staghorn renal calculi, the success rate was marginally higher in the supracostal puncture
group compared to the subcostal puncture group with nearly similar complication rates in both groups.
Keywords: Supracostal Puncture, Subcostal Puncture, Percutaneous Nephrolithotomy.
INTRODUCTION
the collecting system and makes it simpler to
Management of staghorn and large renal stones is
manipulate the rigid nephroscope and other rigid
problematic as it is hard to eradicate the stone in single
devices (6). Therefore, supracostal puncture is perhaps
minimal invasive procedure because of the distribution
the greatest method for gaining access to the upper pole
of the stones in the pelvicalyceal system and if residual
posterior calyx, where staghorn and big, complicated
remains the risk of stone regrowth will be very high
renal stones are most likely to be located (7).
with subsequent affection of renal function hence, it is
Although pneumothorax, hydrothorax, and lung
crucial to get rid of the stone entirely (1).
damage (1-10%) can result after a supracostal puncture,
An expert committee from the American Urological
this injury can now be handled with minimal morbidity
Association issued guidelines for the treatment of
thanks to advances in surgical technique and
nephrolithiasis. For big and staghorn kidney stones,
understanding of pleural and diaphragmatic architecture
percutaneous nephrolithotomy is the therapy of choice
(8).
(2). Overall stone burden, stone location and distribution,
This study objective was to compare, safety,
and collecting system anatomy all influence the
efficacy, as well as operative time of supracostal
treatment plan for renal stones. The key to a smooth
puncture versus subcostal puncture in percutaneous
removal is the precise insertion of a percutaneous tract
nephrolithotomy (PCNL).
that allows for easy stone manipulation (3).
Shock-wave lithotripsy as a monotherapy is
PATIENTS AND METHODS
difficult way to reach the stone free rate in staghorn and
Urology clinics at Zagazig University were the site
large renal stone (54%) (4).
for this prospective randomized comparison research,
When performing percutaneous nephrolithotomy,
from April 2014 to December 2017. Fifty patients (men,
gaining access to the upper caliceal infundibulum
women) with an indication for percutaneous
through a subcostal puncture can be challenging, and
nephrolithotomy from patients attending our Urology
the resulting angulation and torquing of the kidney
Outpatient Clinic were included and randomly assigned
during nephroscopy and stone fragmentation can induce
to one of two research groups.
trauma, hemorrhage, and stone fragmentation (5).
Patients were randomly assigned to one of two therapy
Since it is positioned more conveniently and closer
groups: Group A included 25 patients, PCNL was done
to the body's midline, the upper pole of the kidney is
by supracostal puncture, and Group B included 25
more commonly accessed than the lower pole. By
patients, PCNL was done by subcostal puncture.
creating a straight path along the kidney's long axis, the
upper-pole method guarantees access to the majority of
Inclusion criteria: Patients fit for surgery and has
5691
Received: 19/6/2022
Accepted: 27/8/2022
c:\work\Jor\vol891_247
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5698- 5701
Role of Different Immunotherapy Agents in Anogenital Warts
Management: Review Article
Naglaa Abdelkhalek Ahmed Mahmoud*, Eman AbdElgawad Nofal
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Naglaa Abdelkhalek Ahmed Mahmoud,
Mobile: (+20) 01003518236, E-Mail: naglaaabdelkhalek66@gmail.com
ABSTRACT
Background: Human Papillomavirus (HPV) types 6 and 11 are the causative agents of genital warts. HPV viruses come
in over a hundred different varieties. The most common time for such skin-to-skin contact to occur is during sexual activity,
where the risk of contracting HPV is highest. Cervical and anal cancer are caused by different kinds of HPV than genital
warts. It's possible to be infected with multiple forms of HPV at once. For the treatment of warts immunotherapy could be
used, which relies on the body's natural defenses to combat the infection and dampen down its activity. Immunotherapy
can be administered orally, topically, intralesionally, or systemically.
Objective: Assessment of role of different immunotherapy agents in anogenital warts management.
Methods: Immunotherapy Agents, Anogenital Warts, and Management 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 2006 to 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: This review article aimed to throw the light on the effectiveness of immunotherapy, which varies greatly
from patient to patient, but the procedure is very promising because it works outside the injected wart.
Keywords: Immunotherapy Agents, Anogenital Warts.
INTRODUCTION
podophyllotoxin, and laser ablation. Since then, the
Warts are a well-known sign of HPV infections in
range of therapeutic choices has been widened by new
the anogenital area. Ninety percent of those who are
pharmacological substances and techniques. The
HPV-positive will never get warts on their genitalia.
current study aimed to provide an overview of all
Only about 10% of infected people actually spread the
currently available condylomata treatments and to
virus. Types 6 and 11 of the human papillomavirus
explain the importance and utility of various treatment
produce genital warts. More than a hundred distinct
alternatives (4).
strains of HPV have been identified. The most common
Provider-administered treatments and self-
time for such intimate skin-to-skin contact to occur and
administered treatments can be broadly classified into
hence spread HPV is during sexual activity. The types of
two types. Ablative therapy (including microwave
HPV that cause genital warts are distinct from the kind
ablation, cryoablation, laser ablation, electrosurgery)
that cause cervical and anal cancer. Multiple human
and non-ablative therapy make up the majority of the
papillomavirus (HPV) infections are conceivable (1).
provider's therapeutic options (e.g., trichloroacetic
Numerous research has documented the
acid). Podophyllotoxin, imiquimod, and polyphenon E
psychological burden of genital warts morbidity, which
are the most common of the self-administered therapies
includes anxieties, emotional and sexual consequences,
(5).
self-image issues, and control/life impact. But
Treatment methods for warts include chemical
compared to males, women felt more burden. The
cautery, cryotherapy, electrocautery, surgical excision,
psychological impacts of genital warts also have an
and laser ablation, all of which are considered damaging
impact on men (2).
and aggressive. Immunotherapy is the second line of
The human papillomavirus (HPV) causes
defense, and it works by boosting the body's immune
anogenital warts, which are benign epithelial skin
system to combat the virus and reduce its activity. Oral,
lesions. HPV types 6 and 11 infection account for
topical, intralesional, and systemic administration are
greater than 90% of all cases of anogenital warts. They
all viable options for immunotherapy (6).
are benign lesions that form in the anogenital region and
The effectiveness of immunotherapy varies
manifest as lumps or raised plaques on the skin. In most
greatly from patient to patient, but the procedure is very
cases, there will be no pain, but there is always the
promising because it works outside the injected wart,
chance of discomfort or even bleeding. They can be
curing a large proportion of patients with remote warts.
distressing to deal with on an emotional level, and the
Adverse effects are mostly mild; nonsteroidal anti-
treatment they often require is drawn-out, tiresome, and
inflammatory drug-responsive flu-like symptoms (7).
unpleasant. Treatment progress is often followed by a
Due to the wide variety of immunotherapy
relapse (3).
options and the individuality of each patient's immune
Genital warts could only be treated until a few
system, selecting the most effective treatment can be
years ago with a combination of cryotherapy,
difficult. Several factors, such as the patient's age, sex,
5698
Received: 22/6/2022
Accepted: 30/8/2022
c:\work\Jor\vol891_248
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5702- 5709
Influence of Phototherapy on Urinary Calcium Excretion among
Full Term Neonates
Sahar Abdel Raouf El-Shaarawy1, Hadeel Mohamed Abdel Rahman1,
Arwa Attia Mohammed*1, Aml Saeed El-Shal2
Departments of 1Pediatrics and 2Biochemistry, Faculty of Medicine Zagazig University, Egypt
*Corresponding author: Arwa Attia Mohammed, Mobile: (+20) 01097190180, E-Mail: aatiakamel@gmail.com
ABSTRACT
Background: After 48 hours of phototherapy, the mean urinary Ca excretion is elevated in numerous neonates in
previous studies.
Objective: This study aimed to evaluate phototherapy effects on urinary calcium excretion among full term neonates.
Patients and methods: This Prospective-cohort study was conducted on 30 term neonates presented in NICU of
Pediatrics Department, Zagazig University Hospitals through the period from January 2018 to January 2019. They were
exposed to phototherapy. We assessed urinary calcium and sodium excretion post-phototherapy in term neonates.
Results: As regards urinary calcium, our results revealed an increment in urinary calcium excretion of about 8.76%
post-phototherapy exposure, which was significantly increased after phototherapy. A statistically significant increment
in serum sodium after exposure to phototherapy was found. Considering urinary calcium, there was statistically
significant increase in urine calcium after phototherapy in female patients aged 8 days born at gestational age less than
39 week and in those delivered by cesarean section. On the other hand, there was statistically significant decrease in
calcium/creatinine ratio after phototherapy in patients delivered by cesarean section only
Conclusion: Despite presence of an increment in urinary calcium excretion after phototherapy, no significant difference
was found in calcium/creatinine ratio after phototherapy, so no hypercalciuria to be considered, so it cannot cause
hypocalcemia.
Keywords: Phototherapy, Urinary calcium excretion.
INTRODUCTION
loss. Furthermore, bronze infant syndrome has been
Jaundice is the clinical manifestation of chemical
linked to phototherapy. Several hours after being placed
hyperbilirubinemia. Jaundice appears on newborns
in the phototherapy equipment, neonates with this
when serum bilirubin concentration exceeds 5.0 mg/dl.
syndrome will have a bronze coloration in their serum,
Although clinically among adults, jaundice manifests as
urine, and skin. Inadequate safety measures can lead to
a yellowing of the skin and sclera due to accumulation
additional problems like electric shock and burns (4).
of unconjugated bilirubin, and it only develops in adults
Hypocalcemia is a side effect of some
if the blood bilirubin level is above 2.0 mg/dl (1).
phototherapy treatments. It is possible that
During the first week after delivery,
phototherapy lowers melatonin levels, which in turn
hyperbilirubinemia affects 60% of term neonates and
decreases glucocorticoid release and increases calcium
80% of preterm neonates. Pigments of lipid-soluble,
(Ca) resorption, resulting in hypocalcemia (5). After 48
nonpolar, unconjugated bilirubin that have accumulated
hours of phototherapy, the average amount of Ca
in the skin are typically to occur (2). The condition
excreted in the urine of some newborns rose. First-week
known as icterus neonatorum, or newborn jaundice, has
urinary Ca excretion is proportional to urinary Na
been recognised since the nineteenth century. When
excretion and gestational age. Urinary excretion of
infants died of severe jaundice, doctors began using the
cyclic 3',5'-adenosine monophosphate and potassium
term "kernicterus" to describe the characteristic yellow
can also be influenced by glomerular filtration, which
staining of the basal ganglia (3).
can in turn alter Ca secretion (6).
Unconjugated hyperbilirubinemia is most often
In Hooman and Honarpisheh (7) study, the risk
treated and prevented by phototherapy. Total bilirubin
of hypocalcemia from phototherapy was assessed.
concentrations can be lowered by phototherapy in most
Seizures brought on by hypocalcemia could further
infants despite differences in age, skin pigmentation,
harm the central nervous system (CNS) and exacerbate
and hemolysis. Researchers have decided that
any damage caused by jaundice to the CNS. Asl et al. (8)
phototherapy is a safe therapeutic option that can lessen
measured the amount of calcium in the urine of full-
infants' need for exchange transfusion after reviewing
term infants after phototherapy. The researchers
the results of prior research on the effect of the therapy
concluded that, despite not causing hypocalcemia,
and finding no major problems (2). In rare cases,
phototherapy may promote calcium excretion through
phototherapy problems can arise. Long-term exposure
urination.
to phototherapy may cause retinal degeneration. The
This study's purpose was to evaluate
use of light in medical treatments can raise internal and
phototherapy effects on urinary calcium excretion
external temperatures. As a result, phototherapy may
among full term neonates.
cause dehydration, most notably by imperceptible water
5702
Received: 22/6/2022
Accepted: 30/8/2022
c:\work\Jor\vol891_249
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5710- 5716
Relationship between Maternal Infection with Helicobacter Pylori and
The Occurrence of Preeclampsia
Nadia Khairy Fathi Abou Elela*1, Amany Mahrous Seleem1, Sara Atef Zaki1, Ragab Alsayed Amin Ibrahim1,
Mostafa Gamal Abdelhaleem Mohammed2, Alshimaa Abd Elhakeem Hassan Mohammed1
1Obstetrics & Gynecology Department, Alahrar Teaching Hospital, Zagazig Al Sharqia, Egypt
2Obstetrics & Gynecology Department, Al GAlaa Teaching Hospital, Cairo, Egypt
*Corresponding author: Nadia Khairy Fathi Abou Elela, Mobile: (+20)01011140552, Mail: nadiakhairy056@gmail.com
ABSTRACT
Background: There is a tight association between preeclampsia and infection with H. pylori explained by in vitro studies.
Objective: To evaluate the relationship between maternal infection with Helicobacter pylori and the occurrence of
preeclampsia (PE) and the perinatal outcome.
Subjects and Methods: Ninety-two pregnant women were included in this comparative observational study. Serum
Immunoassay for H. Pylori IgG seropositivity was done for all patients.
Results: The preeclamptic group shows statistically significant higher values of liver transaminase enzymes, total
Bilirubin and decreased S. alb. These findings donate that liver is significantly affected in preeclampsia. There is
statistically significant association between maternal infection with H. pylori and the increased incidence of intrauterine
fetal death (IUFD), the need for neonatal intensive care unit (NICU) admission. And also, increased severity of
preeclampsia and the occurrence of hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. But the
association with eclampsia was insignificant.
Conclusion: There is association between PE and infection with H. pylori as H. pylori sero-positivity is higher among
women with preeclampsia and increased perinatal feto-maternal complications among patient with H. pylori infection.
Keywords: Helicobacter pylori, Preeclampsia, Pregnant women.
INTRODUCTION
invasiveness that helps to explain the strong association
Infections and haemorrhages are the other two
between PE and infection with H. pylori. Insight into the
leading causes of maternal morbidity and death, while
mechanism by which H. pylori infection harms the
hypertensive problems during pregnancy account for 5
placenta may be gained from this (5).
10% of all obstetric complications. About 3.9% of all
It's likely that this infection contributes to the
pregnancies are affected by preeclampsia syndrome, which
development of preeclampsia. An improper placentation is
includes both primary and secondary preeclampsia. In
caused by the auto-immune process that is triggered by an
addition, roughly half of pregnant women with
infection and acts detrimentally on the foetal side of the
hypertension develop preeclampsia (1).
placenta during its early stages of development (6).
The actual process of how the pregnancy-specific
The purpose of this research was to determine the
condition preeclampsia begins to manifest itself after the
relationship between maternal infection with Helicobacter
20th week of gestation is unknown. But it has been
pylori and the occurrence of preeclampsia and the
established that endothelial and trophoblast dysfunction,
perinatal outcome.
an
increased
inflammatory
response,
and
a
hypercoagulative condition all play critical roles in the
SUBJECTS AND METHODS
development of preeclampsia (2).
Subjects:
Higher rates of preterm delivery, respiratory
Ninety-two pregnant women were included in this
distress syndrome, NICU admission, and longer neonatal
comparative observational study; those were attending
stays are associated with preeclampsia compared to
High Risk Unit, Maternity Hospital, Zagazig University
normotensive pregnancies when examining neonatal
Hospitals.
outcomes (3).
The pregnant women, grouped into two groups as
H. pylori is a Gram-negative, microaerophilic
follows: Group A: Forty-six pregnant women with
bacteria that lives in the stomach and is a major contributor
preeclampsia, and Group B: Forty-six normotensive
to the development of a wide range of gastrointestinal
women free of any medical disorder (control group).
conditions, including asymptomatic chronic active
gastritis, peptic ulcer disease, and gastric cancer. This
Inclusion criteria: Age: 18 40 years, gestational age >
colonization of the gastric mucosa is aided by bacterial
34 weeks, and singleton pregnancy.
virulence factors such the cytotoxin-associated gene-A
protein (CagA) and vacuolating cytotoxin-A (VacA),
Exclusion criteria: Multiple pregnancies, gestational
which appear to regulate the host's immunological
age less than 34 weeks, fetus with apparent congenital
response (4).
anomalies, non-gestational hypertension, and pregnant
Anti-CagA antibodies have been demonstrated to
females with other medical disorders (Diabetes Mellitus,
cross-react with human trophoblast cells in in vitro studies,
history of having cardiac, liver or renal disease).
leading to a functional impairment in terms of cell
5710
Received: 23/06/2022
Accepted: 01/09/2022
c:\work\Jor\vol891_250
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5717- 5720
Prevalence of Celiac Disease Among Patients with Refractory
Iron Deficiency Anemia in North-Western Saudi Arabia
Rasha I. Ibrahim1, Omer B. Sulieman2, Mahmoud K. Mansour3,
Mahmoud R. Abdelmotaleb4, Noor K. ALJarba2
1 Department of Internal Medicine, Clinical Hematology and Oncology Unit,
Faculty of Medicine, Ain Shams University, Egypt.
2 Department of Internal Medicine, King Salman Specialist Hospital, Hail, Saudi Arabia
3 Department of Clinical Microbiology, Faculty of medicine, Suez Canal University, Egypt
4 Department of Gastroenterology, King Salman Specialist Hospital, Hail, Saudi Arabia
*Corresponding author: Rasha Ibrahim Ibrahim, Mobile: 00201126537107-00966533840914
, Email: rashaibraheem@med.asu.edu.eg, ORCID Id: 0000-0001-7118-8395
ABSTRACT
Background: Celiac disease (CD) is an immune-mediated intestinal disease caused by a hypersensitivity to gluten in
genetically susceptible people. The most frequent type of anemia in the world is iron-deficiency anemia (IDA), which is
also thought to be the most typical extra intestinal symptom of celiac disease.
Aim: This study aimed to determine the prevalence of CD in patients with unexplained refractory IDA by using anti-tissue
transglutaminase (anti-tTG) antibodies or by endoscopic biopsy in North-Western Saudi Arabia (Hail Province)
Design and Methods: This is a cross-sectional discipline that was done at the King Salman Specialist Hospital, Hail, Saudi
Arabia during the period from January 2019 to December 2021. We evaluated two thousand four hundred adult Saudi
patients with IDA for etiology. Of those, 270 patients (11.25%) were found to have refractory IDA. IgA and IgG tissue
transglutaminase (tTG) antibodies were tested in sera from patients with IDA of unknown cause using an ELISA test.
Intestinal endoscopic biopsies were taken from the second part of the duodenum in these patients. Histopathologic
examination results of patients categorized based on Marsh classification.
Results: In 16 patients (5.9%) with refractory IDA, anti-tTG antibodies were found to be positive; histopathologic evidence
of CD was seen in 15 patients (5.5%). The mean age of the diagnosed patients was 28.6 ± 8.1 years and all of them were
females.
Conclusions: Celiac disease was more common in patients with refractory iron deficient anemia. In individuals with
refractory iron deficiency anemia, we advise serological testing for early detection of celiac disease.
Keywords: Anti-tissue transglutaminase antibodies, Celiac disease, Iron Deficiency Anemia.
INTRODUCTION
anemia (IDA), has a significant negative influence on
Celiac disease (CD) is an autoimmune disorder that
health and quality of life. Increased iron loss or
affects small intestine. Exposure to dietary gluten worsens
inadequate iron absorption are the usual culprits (6).
CD in people with a genetic predisposition (1). The
Screening for CD, autoimmune gastritis, Helicobacter
pathophysiology basics of CD involve abnormal
pylori infection, and hereditary form of IDA is advised in
interaction between gluten, immune system and the gut
patients with unexplained or refractory IDA. Patients with
leading to destruction of villi that will lead to ineffective
refractory IDA had CD in between 4% and 6% of cases.
absorption of various nutrients. Iron, B12, folic acid and
In 100% of patients with CD, refractoriness to oral iron
fat-soluble vitamin deficiencies are particularly
therapy was discovered (7). Studies in the late 1990's
noticeable (2).
identified CD as a possible cause of IDA unresponsive to
Numerous serological techniques have been
oral iron treatment without other manifestations of
described for CD diagnosis, serum IgA-endomysial
malabsorption syndrome (8). It has been estimated that
antibodies (IgA-EMA) and tissue transglutaminase IgA
IDA is present in up to 80 - 90% of patients with CD (9).
(IgA-tTG) testing provide the best levels of diagnostic
Impaired absorption of iron and other minerals, such as
accuracy, with a sensitivity of 95% and a specificity that
folate and cobalamin, is the most obvious cause of anemia
is nearly 100% (3). Furthermore, CD patients frequently
in CD. It has been noted that there is also occult
exhibit IgA insufficiency. As a result, an IgG test against
gastrointestinal blood loss (10).
tTG is used for CD screening in patients who are at risk.
In our study, we sought to determine the prevalence
Furthermore, genetic testing can aid in the diagnosis (4).
of CD in adult Saudi patients with unexplained refractory
A third of the world's population is affected by
IDA in northwestern Saudi Arabia (Hail Province), who
anemia, which has several distinct etiologies and is a
had been identified by anti-tissue transglutaminase (anti-
major cause of morbidity globally (5). One of the most
tTG) antibodies and intestinal endoscopic biopsies.
prevalent nutritional issues worldwide, iron deficiency
5717
Received: XX/XX/2022
Accepted: XX/XX/2022
c:\work\Jor\vol891_251
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5721- 5727
Assessment of Nurses' Performance Regarding Care of
Patients with Spinal Cord Injury
Yasmin Korany Ali*1, Furat Hussein Mahmoud2, Sabah Nagah Hassan2
1Department of Critical Care Nursing, Faculty of Nursing, Fayoum University, Egypt
2Department of Medical-Surgical Nursing, Faculty of Nursing, Helwan University, Egypt
*Corresponding author: Yasmin Korany Ali, Mobile: (+20) 01066149661, E-Mail: yasminkorany123456789@gmail.com
ABSTRACT
Background: Spinal cord injury is a debilitating and irreversible injury leading to complete or incomplete loss of
sensory and motor function. Knowledge, practice and attitude of nurses can significantly affect the outcomes of patients.
Objective: This study aimed to assess nurses' performance regarding care of patients with spinal cord injury.
Patients and methods: Design: A descriptive exploratory design was utilized. Setting: The study was conducted at
Neurosurgical Intensive Care Unit and Neurology Care Department at Fayoum University Hospital. Sample: A
convenient sample of all available nurses (90 nurses). Tools: Three tools were used: I) Self-administered questionnaire.
It included two parts: demographic characteristics of the studied nurses and nurses' knowledge. II) Nurses' practices
observational checklist. and III) Nurses' attitude regarding care of patients with spinal cord injury.
Results: Demonstrated that the majority and the most of the studied nurses had unsatisfactory level of knowledge and
incompetent practices regarding care of patients with spinal cord injury respectively. While, the most of them had
positive attitude.
Conclusion: The current study concluded that there was a statistically significant positive correlation between total
knowledge scores of the studied nurses and their practices.
Recommendation: Providing a well-organized training program to improve nurses' knowledge and practices regarding
care of patient with spinal cord injury.
Keywords: Care, Nurses, Performance and Spinal cord injury.
INTRODUCTION
Early intervention seeks to restore physiological
Depending on the severity of the injury, a spinal
balance, reduce secondary injury, watch for signs of
cord injury (SCI) is a crippling and irreversible
developing neurologic impairments, and maintain
condition that results in the entire or partial loss of
neurologic function (5).
sensory and motor function underneath the injured area.
The greatest outcomes for patients should be
Tetraplegia is defined as SCI with loss of function in the
promoted by nurses working as a multidisciplinary team
cervical region; paraplegia is defined as SCI with loss
to deliver effective nursing care that can stop or lessen
of function in the thoracic, lumbar, or sacral regions.
future SCI. In addition to providing medical care,
Such injuries not only leave victims and their families
promoting
patients'
psychological
well-being,
with disabilities but also place a strain on healthcare
implementing nursing plans based on scientific nursing
systems and economies due to lost productivity and
theory and evidence-based practice, delivering
excessive medical costs (1, 2).
education, and evaluating appropriate medical services
The etiology of SCI can be classified as traumatic
for patients and their caregivers, nurses also play an
or non-traumatic. Traumatic injuries are often result of
important role in patient education (6).
motor vehicle accidents, sport-related incidences, falls
The nurse helps patients with SCI adjust to a
or violence leading to crushing, shearing or penetration
new way of life and develops and implements self-care
of the spinal cord. Non-traumatic injuries have a wide
strategies to support their physical, psychological, and
range of etiologies including infections, cancer and
spiritual well-being. With the help of these activities,
vascular disorders. The level and severity of injury
patients will be better able to accept their limitations,
determine the extent of paralysis and sensorimotor loss
return to their families and communities, and face the
(3).
future with optimism (7).
The resulting damage leads to a multitude of
sequel including bowel, bladder and sexual dysfunction,
Significance of the study:
pressure ulcers, neuropathic pain, pulmonary and
Patients with spinal cord injuries have severe
cardiovascular disease and osteoporosis. Strategies to
impairment. A SCI affects more than 500.000 persons
enhance neurorecovery are paramount to increase
annually worldwide. Traumatic reasons account for up
function and independence, reduce secondary
to 90% of these cases. According to a recent estimate,
complications as pressure injuries and urinary tract
there are around 17,810 new cases of SCI per year in the
infections (UTI), improve quality of life and reduce
United States, and there are currently an estimated
strain on the health care system (4).
294,000 people living with the condition. Less than 1%
The immediate care given to SCI patients can
of patients had fully recovered neurologically by the
have a big impact on their long-term neurological and
time they were discharged from the hospital. The first
functional outcomes, as well as their quality of life.
year following an injury has much higher mortality rates
5721
Received: 23/06/2022
Accepted: 01/09/2022
c:\work\Jor\vol891_252
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5728- 5732
Diosmin for Treatment of Menorrhagia in Women Using Copper IUD
Rahma Aly Mohammed
Resident of Obstetrics and Gynecology, El-Galaa Hospital, Egypt
*Corresponding author: Rahma Aly Mohammed, E mail: dr.rahmaaly@gmail.com, Mobile: 01021574302
ABSTRACT
Background: Many ladies deal with the difficulty of menorrhagia. Among women aged 30 to 49 years, one in twenty
suffers from menorrhagia, with 30% claiming their IUD is to blame for 10% to 15% of their bleeding.
Objectives: This study aimed to determine if diosmin is effective in lowering menstrual blood loss in IUCD-afflicted
women who have menorrhagia. Patients and methods: One hundred ladies were enrolled in this clinical trial
investigation. They were selected among the women who went to the Family Planning Clinic, Ain Shams University's
School of Medicine. They were complaining of heavy periods after switching to a copper IUCD. The study was
conducted during the period from October 2015 to August 2016.
Results: However, there was statistical significant difference between bleeding before therapy and after the first cycle
of treatment in both groups, but no difference in bleeding during the first, second, or third cycles of treatment.
However, there were notable differences in the groups' mean bleeding days before and after therapy. Conclusion:
Diosmin is a drug that is beneficial in reducing the increased menstrual blood loss in women who are using copper
IUDs, according to the study's findings.
Keywords: Diosmin; Menorrhagia; Copper IUD.
INTRODUCTION
PATIENTS AND METHODS
Numerous ladies suffer from menorrhagia. One
One hundred females, through the period from
from twenty women between the ages of 30 and 49
October 2015 to August 2016, participated in this
years suffers from menorrhagia, and roughly 30% of
investigation. They were chosen among the ladies who
these women attribute 10% to 15% of their bleeding to
presented to Ain Shams University Family Planning
their IUD (1). IUDs have the lowest failure rate of all
Clinic with complaints of heavy menstrual bleeding
forms of birth control, at less than 1% (1). This gadget
caused by the copper IUCDs they were now using. All
is used by over 100 million women worldwide (2).
women underwent the same processes, which included
IUD-related side effects including cramping and
a thorough clinical history that took into account
heavier periods are rather prevalent (3). In addition,
factors such as age, parity, IUCD usage length,
there is a risk that the bleeding will be severe enough
menorrhagia duration, and prior use of alternative
to cause iron deficiency anaemia (4). The cumulative
contraceptive methods.
net chance of removal of a Copper T380A IUD for
The following factors should be included in all of
bleeding after 12 years of usage was 36 per 100
the instances in this study: The data from this research
women in a big study funded by the World Health
were entered onto ClinicalTrials.gov with the identifier
Organization (5).
NCT02616731.
Oral tablets containing the flavonoid glycoside
diosmin (Daflon ®500, Servier Egypt, 6th October,
Inclusion Criteria: Those included in the study were
Egypt) were utilised in the current investigation.
between the ages of 20 and 40 years, had no history of
Diosmin preserves the microcirculation by preventing
systemic causes of abnormal uterine bleeding (such as
the process that damages the microcirculation. It fights
hypertension or hemorrhagic blood diseases), had no
venous inflammation by reducing leukocyte activation
other local causes of abnormal uterine bleeding (such
and, as a result, by suppressing the production of
as fibroid, adenomyosis, or polyps), did not take any
inflammatory mediators, primarily free radicals and
drugs that decreased blood coagulation, and had a
prostaglandins. For this reason, diosmin restores
properly fitted and non-misplaced IUD as determined
normal capillary permeability and fortifies capillary
by ultrasound.
resistance (6).
Prostaglandin E2 and prostaglandin F2 levels in
Exclusion criteria: Factors that increase the likelihood
the endometrium are higher in women who have heavy
of abnormal uterine bleeding include being between
menstruation. When cyclooxygenase is suppressed, as
the ages of 20 and 40, having irregular menstrual
it is by NSAIDs, prostaglandin levels decrease.
cycles, having a history of hemorrhagic blood diseases
Mefenamic acid, naproxen, ibuprofen, flurbiprofen,
or hypertension, having a uterine fibroid, adenomyosis,
meclofenamic acid, diclofenac, indomethacin, and
or polyps, or using blood-thinning medications or
acetylsalicylic acid were discovered to be more
having a missing intrauterine device (IUD).
efficient than placebo at reducing menstrual blood loss
The patients were divided into two equal groups:
in women with regular menstrual cycles, but less
1st group: used placebo as control group and 2nd group
effective than tranexamic acid, according to a
that received 500 mg t.d.s. of diosmin oral tablets
Cochrane review published in 2013 (7).
5728
Received:09/06/2022
Accepted:16/08/2022
c:\work\Jor\vol891_253
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5733- 5742
Prognostic Value of FDG PET/CT in Differentiated Thyroid Cancer Patients
Nadia Mohany1, Doaa Mahmoud*2, Jehan Ahmed Younis3, Khaled Elsaban3
1Department of Oncology and Nuclear Medicine, Faculty of Medicine, Assiut University, Egypt
2Department of Radiotherapy and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Egypt
3Department of Oncology and Nuclear Medicine, Kasr Al-Ainy Hospital, Cairo University, Egypt
*Corresponding author: Doaa Mahmoud, Mobile: (+20) 01026592162, E-Mail: doaamahmoud866@yahoo.com
ABSTRACT
Background: The most prevalent endocrine cancer is differentiated thyroid carcinoma, which accounts for 80%90%
of all thyroid malignancies as the most prevalent histologic subtype.
Objective: To evaluate the role of F18-FDG PET/CT in the prognosis and diagnosis of cases with differentiated thyroid
cancer who have high thyroglobulin levels and negative I131 WBS.
Materials and methods: This prospective study was conducted on 52 patients with pathologically proven differentiated
thyroid carcinoma. Those patients were under follow-up at Al Kasr Alaieny Hospital, Cairo University, between May
2018 and December 2020. We reviewed those patients; all patients had persistently elevated Tg levels after total
thyroidectomy and remnant ablation with RAI, with no thyroid residual tissue. The patients' follow-up was done by
measuring stimulated thyroglobulin level and anti-TG level, neck U/S, and DXWBS. Patients presenting no radiological
evidence of recurrence and elevated Tg values, are included for studying FDG-PET/CT was performed.
Results: The sensitivity and specificity of FDG PET/CT were 92% and 72% respectively compared to 43% and 71%
for I131 WBS. SUVmax cutoff point was at 1.5. On the other hand, DX WBS using I131 had sensitivity and specificity
of 43% and 71% respectively. Patients with lesions attaining avidity for both iodine and FDG have better OS than those
with lesions avid for FDG and lost iodine avidity.
Conclusion: FDG PET/CT provides additional information in the prediction of RAI therapy response and further
contributes to the establishment of a proper therapy strategy for metastatic DTC in the early period.
Keywords: Differentiated thyroid cancer, 18F-fluorodeoxyglucose (18F-FDG), PET/CT, SPECT/CT.
INTRODUCTION
Nowadays, tyrosine kinase inhibitor (TKI) medications,
The differentiated thyroid carcinoma is the most
such as sorafenib and lenvatinib, have been introduced
common endocrine cancer, and its incidence has
in these RAI-refractory patients with an expectation of
increased in recent decades it constitutes 80%-90% of
improved prognosis(11). Therefore, it is crucial to
all thyroid cancers as the most common histologic
identify RAI-refractory DTC patients early and
subtype (1-2). Although it usually has an excellent
establish appropriate treatment strategies from a long-
prognosis, it recurs in 20% of patients(3).
term perspective. Generally, high uptake of RAI in
Generally, thyroglobulin (TG) level and
metastatic carcinoma suggests an excellent therapeutic
radioactive iodine (RAI) diagnostic whole-body scan
effect, and several studies have reported a dose-
(dx-WBS) correlate well with each other in follow-up
response relationship(12).
studies for differentiated thyroid cancer (DTC) after
thyroid remnant ablation. Negative dx WBS despite an
Aim of the study was to evaluate the value of F18 FDG
elevated serum TG level occurs in 1015% of these
PET/CT in the prognosis of differentiated thyroid
patients(4). On the other hand, the presence of anti-TG
cancer cases.
antibodies in the systemic circulation interferes with the
measurement of serum TG(5).
MATERIALS AND METHODS
Loss of ability to trap RAI by metastatic DTC is
We reviewed the medical records of 52 patients
associated with worse survival, and such cases often
prospectively. Those patients were under follow-up at
present aggressive clinical behavior(6). Several studies
Al Kasr Alaieny Hospital, Cairo University, Clinical
have shown that fluorine-18-fluorodeoxyglucose
Oncology, and Nuclear Medicine Department
positron emission tomography (18F-FDG PET) and
(NEMROK) between May 2018 and December 2020.
18F-FDG PET/CT can detect recurrence or metastasis
33 women and 19 men; mean age 42.08 ± 15.7 years
with a high degree of sensitivity (80%-90%) in DTC of
with histological diagnosis of differentiated cancer
especially the non-trapping RAI cases [7], differentiated
thyroid. All patients had persistently elevated TG levels
thyroid cancer (DTC) sends metastasis in approximately
after both total thyroidectomy and remnant ablation
10% of all patients, and radioactive iodine (RAI)
with RAI; no residual thyroid tissue was included.
therapy is well-known to be the first line of therapy (8).
Follow-up of all patients was done by measuring
Around 33%-50% of metastatic patients
stimulated serum thyroglobulin level and anti-TG level,
eventually become refractory to RAI(9), and those
neck US, and DXWBS. Patients presenting no
patients generally have a poorer prognosis. The median
radiological evidence of recurrence and elevated TG
survival for RAI-refractory DTC patients with distant
values after four weeks of L-thyroxine withdrawal and
metastases is estimated to be 2.5-3.5 years(9,10).
low iodine diet are included for studying.
5733
Received: 23/06/2022
Accepted: 01/09/2022
c:\work\Jor\vol891_254
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5743- 5751
Evaluation Role of CXCL-8 levels and SARS-CoV-2 Variants in
Progression of Infection
Khadija Thair Salah*, Hula Younis Fadhil
Department of Biology, Collage of Science, University of Baghdad, Iraq
*Corresponding author: Khadija Thair Salah. E-mail: khadijath.salama@gmail.com., mobile: +9647718010592
ABSTRACT
Background: The SARS-CoV-2 virus underwent genetic alterations during viral genome replication, leading to the
development of numerous variations including Alpha, Delta, Delta plus, Omicron, and other variants. The chemokine
CXCL8 is known to directly restrict viral proteins by producing interferon as the antiviral efficacy.
Subjects and methods: A total of 137 nasal swabs and blood samples were collected from 89 positively corona virus
infection disease-19 (COVID-19) patients and 48 healthy individuals. RNA was extracted and real-time reverse transcriptase
polymerase chain reaction (rRT-PCR) was performed to variants detection by using special kits. CXCL8 levels were
determined in Enzyme linked immune-sorbent assay (ELISA) assay.
Results: Significant difference (p < 0.001) in the median levels of CXCL8 in patient higher than healthy control groups.
Highest median of CXCL8 levels was shown with severe infection 308.6 (IQR: 66.6 783.5). Receiver-operating
characteristic (ROC) analysis revealed that CXCL8 level was a good biomarker for immune response (Area under the curve
(AUC) was 0.707). CXCL8 showed a significant difference with variants of SARS-CoV-2 (p < 0.001), where Delta/Delta
plus variant patients had the highest median of CXCL8 level than other SARS-CoV-2 variant infections.
Conclusion: Patients infected with Delta/Delta plus and Omicron had higher level of CXCL-8. CXCL-8 had positive
relation with cardiac disease, renal failure, leukemia with COVID-19 infection.
Keywords: SARS- COV-2, CXCL8, rRT-PCR, TaqPath, ELISA.
INTRODUCTION
Since it started over two years ago, the severe acute
the first time in India. The prevalence of Spike's hallmark
respiratory syndrome coronavirus (SARS-CoV-2)
mutations (G142D, A222V, and T95I) was higher in the
pandemic has continued to spread (COVID-19). The virus
Delta Plus variety than the Delta variation. All three of
has harmed millions of people, hampered free travel,
Spike's mutations--K417N, V70F, and W258L--were
disturbed the global economy, and put a pressure on
detected only in the Delta Plus form. The Delta Plus
medical staff, leaving them emotionally vulnerable and
variant is the only one to include the new ORF1a mutation
physically and mentally spent (1). SARS-CoV-2 has
A1146T (5).
developed into a variety of variants, including Alpha,
As for Omicron (B.1.1.529) variant, the WHO
Delta, Delta plus, Omicron, and other variants. With the
classified a recently found, severely mutated viral strain
ongoing evolution of the viral genome, mutations may
as a VOC on November 26, 2021. The most mutated
modify the virus' ability to infect, the severity of the
SARS-CoV-2 variation is Omicron, which has over 50
disease, or interactions with the host immune system. To
mutations in its genome. Given that 15 of these
combat the pandemic, the World Health Organization
modifications are in the receptor-binding domain (RBD),
(WHO) has announced the specific variants of interest
which makes up 2632 of these mutations in the viral
(VOIs) and variants of concern (VOCs) by working with
spike (S) protein region, there is particular cause for
academics from around the world to analyze the rising
concern (6). There are roughly 30 mutations in the
risk of SARS-CoV-2 variations (2).
Omicron spike (S) protein, some of which are shared with
The Alpha variant (B.1.1.7) of the spike protein
the VOCs Alpha (del69/70, P681H), Beta (K417N,
contains a number of important modifications. Spike
N501Y), and Delta (G142D and T478K). One of these
protein had the following mutations: N501Y, P681H,
mutations known to be suspected to affect immune escape
D614G, and E484K. In September 2020, the B.1.1.7
or transmissibility is the del69/70 mutation (7).
strain of SARS-CoV-2 first appeared in England (3).
The Kappa (B.1.617.1) variant, which has significant
The Delta variant (B.1.617.2) genome has undergone
mutations (T95I, G142D, E154K, L452R, E484Q,
a number of mutations. In the delta lineage, there are eight
D614G, P681R, and Q1071H), was initially discovered in
spike mutations: T19R, G142D, del157/158, L452R,
India in December 2021 and is classified by the WHO and
T478K, D614G, P681R, and D950N. India was the first
the Centers for Disease Control and Prevention (CDC) as
country to report a delta variation toward the end of 2020,
a variant of interest (8).
and it has since spread throughout the world (4). In March
Chemokines represent a group of chemotactic
2021, the Delta Plus variant (B.1.617.2.1) was found for
cytokines secreted from a variety of cell types, following
5743
Received: 23/06/2022
Accepted: 01/09/2022
c:\work\Jor\vol891_255
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5752- 5757
Patients' Adherence to Capecitabine Treatment Is Affected by The Drug-Related
Adverse Effects Rather Than by Their Sociodemographic Characteristics
Shelan Amer Sabry 1, Mohammed Abdul-Hassan Jabarah AL-Zobaidy * 1, Mazin Jody 2
1 Department of Pharmacology, 2 Department of Medicine, University of Baghdad, College of Medicine, Iraq.
Corresponding author: Mohammed Abdul-Hassan Jabarah AL-Zobaidy. Mobile: 009647705982654,
Email: mohammed.a@comed. uobaghdad.edu.iq
ABSTRACT
Background: Colorectal cancer is the third most prevalent cancer worldwide as 1.80 million new cases of the cancer were
diagnosed, and 862,000 patients died in 2018. Depending on the stage, upfront surgery is the main form of treatment,
followed by adjuvant chemotherapy. Despite the importance of patients' adherence while they are on anti-cancer treatment,
there was no published data in the literature evaluating this vital parameter concerning Iraqi patients receiving anti-cancer
drugs, in general, or those on Capecitabine, in particular.
Methods: A cross-sectional, open-label prospective study was conducted at Al-Amal and Oncology Teaching Hospitals,
Baghdad during the period from November 2021 to June 2022. A convenient sampling method was adopted to enrol patients
in the current study. Assessment of adherence to capecitabine treatment was done using Morisky Medication-Taking
Adherence Scale (MMAS). Results: Generalized fatigue was the most common adverse event as it presented in 63.7% of
participants. Also, only 6.9% of participants had abnormal renal function tests. In addition, most of participants showed
low-moderate adherence to capecitabine treatment.
Conclusion: The extent of adherence to capecitabine treatment by colorectal cancer seems to be more sensitive to
capecitabine-related adverse effects rather than to patients' sociodemographic characteristics.
Keywords: Adherence, Adverse effects, Capecitabine, Colorectal cancer, Sociodemographic.
INTRODUCTION
Colorectal cancer (CRC) is the third most prevalent
Capecitabine, an oral prodrug, is a chemotherapy
cancer worldwide 1.
agent that was approved in 2001 and has been shown to
The causes of CRC play an important and effective
be effective in the treatment of CRC, gastric cancer, and
role in genetic and environmental factors 2, 3. Depending
breast cancer 5-7. The mechanism of action of the drug is
on the stage, upfront surgery is the main form of
presented in Figure (1).
treatment, followed by adjuvant chemotherapy 4.
Figure (1): Mechanism of action of Capecitabine 35.
CE, carboxyl esterase; CD, cytidine deaminase; TP, thymidine phosphorylase; 5-DFCR, 5-deoxy-5-fluorocytidine; 5-DFUR, 5-deoxy-
5-fluorouridine; DHFU, dihydro-5-fluorouracil; 5FU, fluorouracil; DPD, dihydropyrimidine dehydrogenase.
5752
Received: 23/06/2022
Accepted: 01/09/2022
c:\work\Jor\vol891_256
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5758- 5763
Comparative Study of Immunoglobulin G and Gender between COVID-19 Patients and
Vaccinated Iraqi Individuals with Pfizer, AstraZeneca and Sinopharm Vaccine
1Zoubaida Kh. Ibraheem *, 1Raghad H. AL-Azzawy
1Department of Biology, Collage of Science, University of Baghdad
*Corresponding author: Zoubaida kh. Ibraheem E-mail: zoubaidakhalil963@gmail.com
Mobile: +9647708371837
ABSTRACT
Background: The coronavirus 2 that causes severe acute respiratory syndrome is the source of the contagious sickness
known as coronavirus disease 2019, The first case was detected in Wuhan, China, in December of this year. Since then,
a pandemic has occurred due to the disease's global spread. The IgG antibody is a large, Y-shaped protein that aids in
the immune system's ability to identify and eliminate foreign substances like bacteria and viruses. The antibody detects
the antigen, a distinct molecular molecule of the virus.
Objective: This research aimed to know which were more infected males or females? and the levels of antibodies
produced when infected with the emerging virus as well as to compare the antibodies formed after taking two doses of
its vaccines, which include Pfizer, AstraZeneca, and Sinopharm vaccines that used in Iraq by measuring the level of
Serum IgG using enzyme-linked immune-sorbent assay technology.
Materials and Methods: In the current study, 100 Iraqi patients with covid-19 disease and 30 Iraqi healthy control were
included, and 20 previously uninfected individuals who received the vaccine, and 20 previously infected individuals who
took the vaccine (for each type of the three vaccines). Samples were collected 21 days after the second dose and also
from 3 to 6 months after the second dose by measuring the level of serum IgG using enzyme-linked immune-sorbent
assay technology. The study was conducted from September 2021 to February 2022. Blood samples were collected in
Baghdad Teaching Hospital (Corona patients' isolation center) in Baghdad, Iraq.
Results: The study showed that infection with COVID-19 increases the proportion of antibodies IgG, and it was also
found that the best type of vaccine is the AstraZeneca vaccine for raising IgG, and males are more susceptible for
infection than females.
Conclusion: Elevation of immunoglobulin G in blood depends on the severity of the infection and the Effect of vaccine.
Keywords: Antibodies, ELISA, Second dose.
INTRODUCTION
the body and provide long-lasting protection against the
Coronavirus 2 that causes severe acute respiratory
antigen (4).
syndrome is the source of the contagious sickness known
Adaptive immunity to viral infection heavily
as coronavirus disease 2019 (COVID-19) (SARS-CoV-
depends on humoral responses. COVID-19 patients'
2) (1) .
gamma
immunoglobulins
(Ig)
mediate
viral
The first case was detected in Wuhan, China, in
neutralization and may have various roles in immunity at
December of this year. Since then, a pandemic has
different stages of infection and at different anatomical
occurred due to the disease's global spread.
sites (5). IgG levels are said to diminish significantly 8
Coronaviruses are a group of closely related RNA
weeks after the onset of symptoms, but treated
viruses that infect both mammals and birds (2). The IgG
individuals have high spike proteinspecific IgG titers.
antibody is a large, Y-shaped protein that aids in the
immune system's ability to identify and eliminate foreign
MATERIALS AND METHODS
substances like bacteria and viruses. The antibody
Study Samples
detects the antigen, a distinct molecular molecule of the
A case study was conducted during September
virus (3).
2021February 2022 to determine the levels of IgG in
Antibodies, together with B and T cells, are the
Iraqi patients with SARS-COV-2, vaccinated people
most essential component of the adaptive immune
with Pfizer, AstraZeneca and Sinopharm vaccines, and
system. They come in two types: one that is linked i to a
control subjects who were not infected and not
B cell and the other, which is soluble and found in
vaccinated. The study samples included:
extracellular fluids like blood plasma i. All antibodies
start out as the first type, linked to the surface of a B cell,
1.Patients
these are known as B-cell receptors (BCR). When an
Consecutive 100 cases (62 males and 38 females) with
antigen binds to a BCR, the B cell activates and divides
positive PCR for SARS- COV-2 were randomly selected
into plasma cells, which make soluble antibodies against
and recruited from Baghdad Teaching Hospital (Corona
the same paratope, or memory B cells, which persist in
patients isolation center) that were diagnosed by PCR
technique.
5758
Received: 23/06/2022
Accepted: 01/09/2022
c:\work\Jor\vol891_257
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5764-5769
Nasoseptal Flap Versus Middle Turbinate Flap in Skull Base Reconstruction
Ahmed Ismail Yehia*, Abdelzaher Elsayed Tantawy, Atef Hamed Ali, Ismail Seddik Elnashar
Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Ismail Yehia, Mobile: (+20)1008282074, E-Mail: ahmed.ye7ia.1986@gmail.com
ABSTRACT
Background: The expanded endonasal approaches to the skull base are modular approaches that arise from the
sphenoidal sinus. The reconstructive techniques in these approaches are key to avoid postoperative complications.
Available flaps for reconstruction include the pedicled nasoseptal flap, the trans- pterygoid temporoparietal fascia flap,
and the posterior pedicle inferior turbinate flap (PPITF), among others. Recently, the middle turbinate flap and
nasoseptal flap have been described in a cadaveric study.
Objective: The aim of the current study was to compare results of using nasoseptal versus middle turbinate flaps in skull
base reconstruction. Patients and methods: This interventional cohort study was carried out on 24 patients in
Department of Otorhinolaryngology, Head and Neck Surgery, Zagazig University Hospitals. All patients with CSF leaks
of variable reasons (congenital, traumatic, spontaneous) who required surgical repair with either vascularized nasoseptal
mucosal flap or vascularized middle turbinate mucosal flap and fit for general anesthesia were included in the study.
Results: Incidence rate of operation failure that was temporary (8.3%) in NSF group while in MTF the success rate was
100%. Conclusions: There are no significant differences in results of using nasoseptal versus middle turbinate flaps in
skull base reconstruction.
Keywords: Middle turbinate flap, Vascularized flap, Endonasal expanded approach, Skull base reconstruction.
INTRODUCTION
posterior septal branches of the sphenopalatine artery
A dysfunctional communication between the
(12). The pedicled middle turbinate flap (MTF) is one of
subarachnoid space and the sinonasal cavity is known
the vascular nasal flaps used for reconstructing skull-
as cerebrospinal fluid (CSF) rhinorrhea. CSF leaks are
base defects after an expanded endonasal approach. The
often separated into traumatic and non-traumatic
middle turbinate receives most of its blood supply from
categories. Spontaneous or congenital CSF leaks, leaks
the middle tur-binate artery, which arises from the
brought on by intracranial or skull base malignancies,
posterolateral branch of the sphenopalatine artery (13).
and erosion of the skull base ahre examples of non-
So we aimed in this study to compare results of
traumatic causes (1). Traumatic leaks are more frequent
using nasoseptal versus middle turbinate flaps in skull
and can result from non-iatrogenic skull base trauma or
base reconstruction.
be caused by iatrogenic anterior skull base and
endoscopic sinus surgery (ESS). CSF rhinorrhea
PATIENT AND METHODS
complicates less than 1% of ESS cases, however it is a
This interventional cohort study included a total
major source of traumatic CSF leaks (2).
of 24 patients with CSF leaks of variable reasons,
The risk of meningitis, which has been reported
attending at Department of Otorhinolaryngology,
to vary from 10% to 37% under conservative care,
Head and Neck Surgery, Zagazig University
makes surgical intervention necessary once a persistent
Hospitals. during the period from Augustus 2019 to
leak has been verified and localised with the appropriate
Augustus 2021. The patients were 15 males and 9
diagnostic methods (3).
females; and their ages ranged from 12 to 67 years.
Endonasal endoscopic methods have essentially
replaced open intracranial approaches for the repair of
Inclusion criteria: All patients with CSF leaks of
cerebrospinal fluid leaks in recent years due to their
variable reasons (congenital, traumatic, spontaneous)
high success rate and minimal morbidity profile (4).
who required surgical repair with either vascularized
A variety of methods, such as fat grafts (5), fascia
nasoseptal mucosal flap or vascularized middle
lata (6), a multi-layered "gasket seal" closure (7), and a
turbinate mucosal flap and fit for general anesthesia
variety of locally harvested soft tissue flaps, which are
were included in the study.
often divided into free flaps or pedicled flaps, were
developed for endoscopic skull base repair (8-10).
Exclusion criteria: Previous posterior septectomy and
Non-vascularized procedures may be used to
involvement of septum &sphenoid rostrum by
treat smaller lesions and those without a clear
malignant tissue, previous MT resection and tumors
intraoperative cerebrospinal fluid (CSF) leak.
encroaching on MT, contraindications for general
Vascularized reconstruction may be advantageous for
anesthesia, cases which were repaired with grafts alone
more complicated defects and those with high-flow
whether single or multiple layers were excluded from the
intraoperative CSF leaks (11).
study.
The introduction of the nasoseptal flap (NSF)
All patients were subjected to:
provided a reliable technique for endonasal re-
Detailed history taking with stress on clear nasal
construction of complex skull base defects. The NSF is
discharge and headache, skull base surgery, skull base
a regional flap with blood supply pedicled on the
trauma. Clinical examination including endoscopic
5764
Received: 23/6/2022
Accepted: 1/9/2022
c:\work\Jor\vol891_258
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5770- 5777
Outcomes of Endoscopic Therapy in Patients with Peptic Ulcer Bleeding
Amany Mohamad Mohamad Ibrahim, Samira Mohamed Abdulqadir Alqanduz*,
Amir Abd-Elhameed Ahmed Barakat
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Samira Mohamed Abdulqadir Alqanduz, Mobile: (+20) 01017274020,
E-Mail: www.samiraqanduz02@gmail.com
ABSTRACT
Background: The use of endoscopy is crucial in the treatment of bleeding from peptic ulcers.
Objective: To evaluate the clinical, laboratory, and endoscopic findings related to poor prognosis and to analyze the
outcomes related to the treatment of peptic ulcer bleeding with different methods of endoscopic therapy.
Patients and Methods: Thirty patients who underwent endoscopic treatment and were diagnosed with peptic ulcer
bleeding at Zagazig University Hospitals (Intensive Care Units, Internal Medicine Departments, and Upper
Gastrointestinal Endoscopy Units) participated in our prospective observational cohort study stratified as follows:
adrenalin injection, argon plasma coagulation (APC), and adrenalin injection followed by argon plasma coagulation.
Results: Patients treated with adrenaline injection modality had a higher percentage of rebleeding 71.4%, more red
blood cell transfusion units with a median of 4 units, more hospital stay lengths with a median of 8.5 days compared
with argon plasma coagulation and combined (adrenalin plus APC therapy) as less rebleeding were observed (40% and
0%) respectively, and fewer units of red blood cell transfusion (2% and 2%) respectively. Hospital stay median was 3.5
days in APC and 4 days in combined therapy. According to univariate logistic regression, nonsteroidal anti
inflammatory drugs (NSAIDs) intake, large ulcer size, and high GBS were predictive factors of post-endoscopic
rebleeding.
Conclusion: Combining endoscopic adrenaline injection with argon plasma coagulation is more effective than either
method alone in stopping bleeding from peptic ulcers and identifying risk factors may help in improving the prognosis
of peptic ulcer bleeding.
Keywords: Peptic ulcer bleeding, Adrenalin, Argon plasma coagulation, Risk factors.
INTRODUCTION
vasoconstriction and the local tamponade action.
Upper GIT bleeding is the most common cause
Methods of applying heat can be broken down into two
of hospitalization. The majority of patients had
categories: those requiring physical touch and those that
esophageal varices and the second cause was found to
do not. Noncontact methods, such as argon plasma
be peptic ulcers (1). Age, comorbidities, shock,
coagulation, are safe and relatively simple to use
endoscopic diagnosis, hemoglobin level at bleeding
mechanically, while contact methods, such as a heater
episode, lesions' size and/or grade, and stigmata of
probe
or
bipolar
electrocoagulation,
provide
recent hemorrhage are all established risk variables that
appositional pressure, resulting in a heat-sink effect and
influence outcomes in the upper gastrointestinal
tissue coagulation with contraction of the blood vessels:
bleeding (UGIB) context (2).
clips placement and hemospray powder are all
Risk of upper gastrointestinal bleeding has been
endoscopic modalities for the treatment of non-variceal
stratified using a variety of scoring systems. The
upper gastrointestinal bleeding (NVUGIB) (7).
Glasgow-Blatchford score (GBS) and the Rockall score
The aim of the work was to evaluate the clinical,
are the most popular (both pre-and post-endoscopy) (3).
laboratory, and endoscopic findings related to poor
The GBS was developed to identify patients who would
prognosis and to analyze the outcomes related to the
benefit from no further care (such as endoscopy or a
treatment of peptic ulcer bleeding with different
transfusion). Mortality risk is measured by Rockall
methods of endoscopic therapy.
scores, although these ratings were never intended to be
used as decision aids (4).
PATIENTS AND METHODS
Stigmas of recent hemorrhage are typically
Thirty patients underwent endoscopic treatment and
defined using the Forrest classification, which is as
were diagnosed with peptic ulcer bleeding, at Zagazig
follows: (Forrest Ia-spurting bleeding, Forrest Ib-
University Hospitals. Intensive Care Units, Internal
oozing bleeding, Forrest IIa- non-bleeding visible
Medicine Departments, and Upper Gastrointestinal
vessel, Forrest IIb- adherent clot, Forrest IIc- hematin
Endoscopy Units, participated in our prospective
on ulcer base, Forrest III- clean ulcer base) (5).
observational cohort study.
First-line therapy for UGIB is endoscopic
hemostasis (6). Due to its ease of use, epinephrine
Inclusion criteria: Age 1870 years, both sexes,
injections are the most prevalent modality, however
patients who were diagnosed with peptic ulcer bleeding
sclerosants (absolute ethanol, polidocanol) and tissue
after initial endoscopy.
adhesives (thrombin/fibrin glues) are also commonly
injected.
Hemostasis
is
achieved
through
Exclusion criteria: Patients diagnosed other than a
5770
Received: 23/06/2022
Accepted: 01/09/2022
c:\work\Jor\vol891_259
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5778- 5783
Fatty Acid Binding Protein (1 & 2) as Markers of Diabetic Nephropathy in
Elderly Patients with Type 2 Diabetes Mellitus
Mohamed Mohamed Mohamed Hassaan1, Asmaa Mahmoud Elsayed Elsayed*1,
Hamed Abdelaziz Deraz1, Atef Goda Hussein2
Departments of 1Internal Medicine and 2Medical biochemistry, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Asmaa Mahmoud Elsayed Elsayed, Mobile: (+20)1013077533, E-Mail: asmaashady836@gmail.com
ABSTRACT
Background: The 15kDa cytoplasmic fatty acid-binding protein family (FABPs) is one of the most exciting novel
indicators for the diagnosis of renal damage.
Objective: The aim of this study was to investigate the relation of circulating FABP1 and FABP2 levels as clinical and
biochemical markers and varying stages of nephropathy in senior T2DM patients.
Patients and Methods: This case-control study included a total of 60 patients with Type 2 diabetes and 30 nondiabetic
controls, attending and followed up at Out-Patient Clinics, Department of Internal Medicine, Zagazig University
Hospitals. Patients were divided into 3 equal groups: Group I: healthy control group; Group II: diabetic group without
incidence of diabetic nephropathy; Group III: diabetic nephropathy group. All patients were tested for FABP1 and
FABP2. Results: FABP1 and FABP2 levels significantly varied among the study's three groups. The significance was
referred to the higher expression of FABP1 and FABP2 in group II and III than controls and higher expression in group
III than group II as illustrated in post-hoc analysis. There were significant positive Pearson correlations between
FABP1, FABP2 and serum creatinine, serum urea, urine albumin-creatinine ratio (uACR) while the correlation between
FABP1, FABP2 and eGFR was inverse correlation of significance.
Conclusion: It could be concluded that FABP1 and FABP2 may be novel biomarkers of diabetic nephropathy. FABP1
has an 87% sensitivity and an 83% specificity for the diagnosis of diabetic nephropathy at a cut-off value equal to 2.7
ng/dL. FABP2 has a 93% sensitivity and a 33% specificity for diagnosing diabetic nephropathy at a cut-off value equal
to 0.16 ng/dL.
Keywords: Fatty Acid Binding Protein, Diabetic Nephropathy.
INTRODUCTION
ileum (5).Acute intestinal ischemia, such as necrotizing
The process of ageing itself is a major
enterocolitis and nonocclusive mesenteric ischemia,
contributor to the high prevalence of many fatal
can be diagnosed with the use of the biomarker FAs-
illnesses among humans. About 100,000 individuals
associated peptide 2 (FABP2), which is released into
each day globally die from age-related illnesses (1).
the systemic circulation quickly in response to
Diabetic nephropathy (DN) is the most common
enterocyte damage. Similar to other FABP multigene
form of chronic kidney disease and the leading cause
family members, FABP2 is predicted to be swiftly
of end-stage renal disease (ESRD). Type 2 diabetes,
removed by the kidneys (half-life of around 11
which is often brought on by overeating, is mostly to
minutes)(6).
blame. Albumin excretion in the urine and the fall in
Tsai et al. (7) reported that FABP1 and FABP2
Glomerular Filtration Rate are used to categorize the
may be useful new biomarkers of diabetic nephropathy
clinical progression of diabetic nephropathy (2).
by examining their association with nephropathy in
A novel biomarker is required that would be
T2DM patients. FABP1 and FABP2 have been linked
part of the structural components of kidney. Many
increasingly to the onset and progression of chronic
renal biomarkers have been researched for early
renal disease. Almost no research was done on patients
prediction of renal damage. The 15kDa cytoplasmic
above 65.
fatty acid-binding protein family (FABPs) is one of the
The aim of this study was to investigate the relation of
most exciting novel indicators for the diagnosis of
circulating FABP1 and FABP2 levels as clinical and
renal damage (3). One of the proteins involved in fatty
biochemical markers and varying stages of
acid metabolism is fatty acid-binding protein 1
nephropathy in senior T2DM patients.
(FABP1), also known as liver-type fatty acid-binding
protein or L-FABP, a 14 kDa small molecule produced
PATIENTS AND METHODS
in the proximal tubules of the human kidney. This is
This case-control study included a total of 60 patients
because proximal tubule cell damage causes an
with Type 2 diabetes and 30 nondiabetic controls,
increase in the circulating proportion of FABP1 to be
attending and followed up at Out-Patient Clinics,
filtered by the glomeruli and then reabsorbed in the
Department of Internal Medicine, Zagazig University
proximal renal tubules (4).
Hospitals.
The second type of fatty acid-binding protein
Inclusion criteria: The geriatric population aged 65
(FABP2), also known as intestinal-type fatty acid-
years and above, male or female without diabetes.
binding protein (I-FABP), is a small, water-soluble
Elderly Type 2 diabetic patients without diabetic
protein with a molecular weight of 14-15 kDa that is
nephropathy, and elderly Type 2 diabetic patients with
expressed by enterocytes from the duodenum to the
diabetic nephropathy
5778
Received: 23/06/2022
Accepted: 01/09/2022
c:\work\Jor\vol891_260
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5784- 5788
Brain Natriuretic Peptide (BNP) Correlates Echo Finding of
Hemodynamic Patent Ductus Arteriosus
Ahmed Alaa Hamed*1, Lotfy Mohammed Elsayed2, Rania Diaa Eldin Aboushokka1,
Hesham Mohamed Abdallah1, Raafat Hassan Salama3, Sherief m. El Gebaly 2
1Department of Pediatric Cardiology, National Heart Institute, Giza, Egypt
2Department of Pediatrics, Faculty of Medicine - Zagazig University, Egypt
3Department of Pediatrics, Al-Ahrar Teaching Hospital, Zagazig, Egypt
*Corresponding author: Ahmed Alaa Hamed, Mobile: (+20) 01099808505, E-Mail: ahamed2080.ah@gmail.com
ABSTRACT
Background: When Doppler echocardiography is not readily available, a biomarker like NT-pro-Brain Natriuretic
Peptide (BNP) can be used to diagnose patent ductus arteriosus (PDA) in premature infants.
Objective: To evaluate the diagnostic accuracy of the cardiac biomarkers BNP for detection of hemodynamically
significant patent ductus arteriosus (hsPDA) in preterm newborns and their correlation to echocardiography results.
Patients and Methods: At tertiary care hospital at National Heart Institute, a total of 46 premature neonates (< 34 weeks
gestation) or those whose birth weight was less than 1200 g who were admitted to Neonatal Intensive Care Units
(NICUs) were included in this cross-sectional study. Patients with PDA were classified as having either hsPDA or non-
hsPDA based on a large ductal flow with left to right shunt on colour Doppler echocardiography, and all participating
neonates underwent this evaluation between 48- and 72-hours following birth.
Results: Serum brain-type natriuretic peptide was statistically significantly higher in cases with hsPDA. Serum brain-
type natriuretic peptide statistically had significant high diagnostic performance in predicting hemodynamically
significant patent ductus arteriosus. Serum brain-type natriuretic peptide at cut-off value of 108.0 pg/mL, had moderate
sensitivity, but high other characteristics in diagnosing hsPDA.
Conclusion: Preterm newborns at risk for poor outcome due to PDA may be identified by serum brain-type natriuretic
peptide in combination with echocardiography.
Keywords: Brain Natriuretic Peptide, Patent Ductus Arteriosus.
INTRODUCTION
it is released by ventricular myocytes in response to
The ductus arteriosus or fetal circulation vessel,
volume excess. Premature newborns may benefit from
often closes shortly after birth in full term newborns.
BNP measures for the diagnosis and evaluation of PDA
However, the prevalence of patent ductus arteriosus
(4). BNP has a half-life of 20 minutes; it produces diuresis,
(PDA) decreases with increasing gestational age, and it
natriuresis, and arterial dilatation. A corresponding
is known to stay persistent in a high proportion of
decrease in intravascular volume and ventricular preload
extremely low gestational age newborn newborns.
is anticipated as a result. Previous research has shown a
Infants born weighing less than 1,000 grammes or those
link between BNP and shunt volume size, suggesting its
born before 28 weeks of gestation have a 66% chance of
utility in assessing hemodynamically significant patent
developing a persisting PDA (1). Additionally, newborns
ductus arteriosus (hsPDA); however, its physiologic
with neonatal respiratory distress syndrome who require
relationship with blood flow indices has not yet been
mechanical ventilation and those who did not get prenatal
investigated (5).
corticosteroids are less likely to close. There are a number
When it comes to making a clinical diagnosis of
of serious complications that can arise from having a
PDA, echocardiography is unrivalled. In addition to
PDA that won't go away, including intraventricular
confirming a PDA diagnosis and ruling out or diagnosing
haemorrhage, pulmonary haemorrhage, necrotizing
a congenital heart defect, this test can be used to estimate
enterocolitis,
and
chronic
lung
the size of the shunt and evaluate its hemodynamic
disease/bronchopulmonary dysplasia, and an increased
significance, specifically the impact on the body's
risk of death (2).
circulation caused by the shunt's causing pulmonary
One cardiac peptide that rises in ventricular
over-circulation and systemic hypoperfusion (6).
dysfunction is B-type natriuretic peptide (BNP). After
being synthesized and secreted by the ventricle, this
AIM OF THE STUDY
molecule is converted enzymatically in response to
It was the goal of this study to evaluate the
myocardial strain to pro-BNP. Many studies have
diagnostic accuracy of the cardiac biomarkers BNP for
demonstrated that measuring serum levels of natriuretic
detection of hsPDA in preterm newborns and their
peptides is an accurate way to diagnose heart failure and
correlation to echocardiography results.
predict the patient's prognosis (3).
Biochemical indicators, in addition to clinical
PATIENTS AND METHODS
and echocardiographic examination, may aid in
Subjects:
determining the hemodynamic importance of a PDA. The
At tertiary care hospital at National Heart
brain-type natriuretic peptide (BNP) is a possibility since
Institute, a total of 46 premature neonates (< 34 weeks'
5784
Received: 26/6/2022
Accepted: 2/9/2022
c:\work\Jor\vol891_261
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5789- 5795
Prevalence of Fatigue and Risk of Fall Among Elderly with
Chronic Kidney Disease
Eman Mahmoud Abdelhamid, Salma Mohamed Samir Elsaid, Mohamed Shawky Khater, Suzan Mounir Ali*
Geriatrics and Gerontology Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Suzan Mounir Ali, Mobile: 01113001688, E-mail: futuresuzan@yahoo.com
ABSTRACT
Background: One of the most often reported symptoms in people with chronic kidney disease (CKD) is fatigue.
Additionally, fall is thought to be a marker of frailty and disability among them.
Objectives: To determine the prevalence of fatigue and risk of fall among elderly patients with CKD.
Subjects and methods: A cross sectional study included 100 elderly patients, Males and females aging 60 years or
more that were recruited from Ain Shams University Hospitals, 50 patients on regular hemodialysis and 50 patients
diagnosed with chronic renal impairment. All patients were subjected to Comprehensive Geriatric Assessment (CGA)
with assessment of cognition, depression, risk of fall, balance, fatigue, past medical history, associated comorbidities
and laboratory investigations. Results: The mean age among the studied population was 66.89±6.41 years, the prevalence
of depression was 66%. The most common comorbidities were hypertension (HTN) (84%), diabetes (DM) (66%). On
assessment of fall by Timed Up and Go (TUG) test, (45%) of the participants had risk of fall, which was more prevalent
in haemodialysis group (54%); whereas by one leg balance test (51%) of them had risk of fall, which was more prevalent
in haemodialysis group (72%), and on assessment of fatigue by Multidimensional Assessment of Fatigue (MAF) it was
found that (68%) of the participants were fatigue positive, which was more prevalent in haemodialysis group (82%).
Conclusion: Almost half of elderly patients with CKD had high risk of falls and about two third of them experienced
fatigue, which was more prevalent in patients on haemodialysis.
Keywords: Chronic Kidney Disease, MAF, Falls, Haemodialysis, Balance, TUG.
INTRODUCTION
with CKD, hospitalization and mortality (11). The
It is expected that in USA, the population aged
pathophysiology of fatigue in CKD has many factors
65-year-old and older will be more than double between
and includes decreased oxygen delivery to tissues,
2012 and 2060; rising from 43.1 million to 92 million
anaemia, lactic acidosis, chronic metabolic acidosis,
(1). Chronic Kidney Disease (CKD) is more prevalent in
sarcopenia, hyperphosphatemia, depression, and
the elderly population as reports indicate that one in
obstructive sleep apnea (12). So, the aim of our study was
three elderly patients will have estimated glomerular
to determine the prevalence of fatigue and risk of fall
filtration rate (eGFR) below 45 ml/min/1.73 m2 (2).
among elderly patients with CKD.
It was evident that patients with CKD, whether on
SUBJECTS AND METHODS
dialysis or not, are at risk of falls (3,4). In participants with
A cross sectional study included 100 elderly
CKD, falls are regarded as a critical source of injury and
patients, males and females aging 60 years or more that
morbidity (5), as they may be caused by physical
were recruited from inpatient ward and outpatient
function deficiencies, such as slowed gait and balance,
clinics in Ain Shams University Hospitals, 50 patients
that are common in this population (6). Additionally, it
on regular hemodialysis and 50 patients diagnosed with
has been found that slower gait speed was correlated
chronic renal impairment (serum creatinine2).
with the fear of falls in elderly (7). Even if there are no
Inclusion criteria included those with glomerular
fractures as a result of the fall, the patient may still
filtration rate (GFR) 60 mg/min/1.73m2. Exclusion
sustain other fall related injuries such as head injuries,
criteria included those with GFR more than 60
bruises or fall phobia which would eventually affect
mg/min/1.73 m2 and with severe cognitive impairment.
their mobilization (8). Fatigue can be defined as a
All patients were subjected to Comprehensive Geriatric
multiplex, multidimensional, subjective experience that
Assessment with history taking and clinical
binds both psychological and physical symptoms
examination, cognitive function assessment by Mini-
together. Patients describe it as severe and persistent
Mental Status Examination (MMSE) (13), assessment of
tiredness, lack of energy, exhaustion and weakness that
depression using Geriatric Depression Scale (GDS-15)
is counterintuitive to their degree of exertion, and it
(14), and assessment of balance by one leg balance test
interferes with physical functioning (9). Furthermore, it
(15). Assessment of fatigue was done by
is considered a usual symptom in patients with chronic
Multidimensional Assessment of Fatigue (MAF) [The
medical illnesses, including CKD patients requiring
MAF is a 16-item scale that assesses four aspects of
dialysis (10), and also an exhausting symptom in patients
fatigue: degree and intensity, discomfort it causes, time
with CKD not on dialysis (11).
of exhaustion (over the previous week, when it first
Approximately 66 to 75 % of patients with CKD
appeared, and any variations), and its effects on
experience fatigue, with almost quarter of them
different daily activities (household chores, cooking,
reporting severe symptoms (12), it differs in its
bathing, dressing, working, socializing, sexual activity,
prevalence according to the measurement instruments
leisure and recreation, shopping, walking, and
used and treatment modality. Not to forget that it is
exercising). We didn't finish the test if the person didn't
independently linked to dialysis initiation in patients
5789
Received: 26/06/2022
Accepted: 02/09/2022
c:\work\Jor\vol891_262
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5796- 5800
Thyroid Dysfunction in Pregnant Women Attending Antenatal Clinic
Manal Mohamed El Behery, Hoda Sibai AbdAlsalam,
Amany Aly Abdelhaleem Mohamed*, Ahmed Metwally El katawy
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Amany Aly Abdelhaleem Mohamed, Mobile: (+20)1067583125, E-mail: amany.ali90200@gmail.com
ABSTRACT
Background: Thyroid dysfunction in pregnancy may be accompanied by both maternal and fetal complications.
Hypothyroidism in pregnancy is associated with premature birth, fetal cardiac complications, low birth weight, increased
frequency of cesarean delivery, placental complications, preeclampsia and gestational hypertension, perinatal
morbidity-mortality, and cognitive dysfunction.
Objective: The aim of the current work was to study early diagnosis of thyroid dysfunction in pregnant women for
better health care.
Patients and method: A prospective cross-sectional study was conducted at Gynecology and Obstetrics Department,
Abukabir Central Hospital in co-operation with Gynecology and Obstetrics Department, Zagazig University hospitals
on 229 healthy pregnant women with uncomplicated singleton pregnancy and without history of previous thyroid
problems. Detailed medical and obstetrical history were taken from all selected participants, and they were subjected to
thorough clinical examination. Routine laboratory and ultrasonographic examination were also performed to all of them.
Results: Participants were divided into 4 groups including those with Euthyroid, subclinical hypothyroidism, subclinical
hypothyroidism was the most prevalent disorder (7.9%) followed by overt hypothyroidism (3.5%) and subclinical
hyperthyroidism (0.87%). No cases with overt hyperthyroidism were reported. There was no statistically significant
difference between the 4 groups as regard age. Regarding BMI, results showed that patients with overt hypothyroidism
had significantly higher BMI than those in the other groups. Also, there were no statistically significant differences
between different groups regarding gravidity, parity, and gestational ages.
Conclusion: It could be concluded that most pregnant women have normal thyroid functions (Euthyroid). The most
prevalent pattern of thyroid dysfunction in pregnant women is subclinical hypothyroidism.
Keywords: Thyroid, Pregnant Women, Zagazig University.
INTRODUCTION
Inadequate
maternal
thyroid
hormone
Thyroid disease commonly affects women of
production, particularly during the first stages of
childbearing age (1) and is the second most common
gestation when the fetus is reliant on maternal
endocrinological disorder diagnosed in pregnancy after
thyroxine, has been associated with multiple obstetric
gestational diabetes. It is four to six times more
and neonatal adverse outcomes. Mannisto and
common in women than in men, and prevalence
Mendola (7) including inadequate neuropsychological
increases with age (2).
development in the offspring (8).
Thyroid physiology plays a major role in
The physiological changes of pregnancy can
pregnancy. The thyroid gland adapts its structure and
simulate thyroid disease. Symptoms of heat intolerance,
function to satisfy increasing functional demands. It
sluggishness, fatigue, and constipation and examination
undergoes reversible physiological changes such as
findings of tachycardia, edema, and wide pulse pressure
increase in size (by 10%) and increased vascularization
are common to pregnancy and thyroid disease much in
due to the influence of human chorionic gonadotropin
same way.
(-hCG) (3).
During
pregnancy,
demands
on
the
Pregnancy is associated with profound
hypothalamic-pituitary-thyroid axis increases which
modifications in the regulation of thyroid function.
commonly leads to borderline thyroid abnormalities.
These changes are the result of various factors like an
Both hyper and hypothyroidism types of thyroid
increase of thyroxine-binding globulin (TBG) due to
disorders can occur during pregnancy and correction of
elevated estrogen and human chorionic gonadotropin
these disorders dramatically reduces the risk of adverse
(hCG), increased renal losses of iodine due to increased
fetomaternal outcomes (4).
glomerular filtration rate, modifications in the
The main obstetric complications are abortion,
peripheral metabolism of maternal thyroid hormones,
preeclampsia, eclampsia, abruption placentae and
and modification in iodine transfer to the placenta(4).
preterm labor and the fetal complications are
The developing fetus synthesizes thyroid
prematurity, low birth weight, whereas increased risk of
hormones only by the end of the first trimester and,
impaired neurological development in fetus still birth
hence, depends on the maternal thyroid hormone for
and perinatal death(9).
organogenesis, general growth, and development of the
The aim of the current work was to study early
central nervous system(5). Moreover, thyroid hormones
diagnosis of thyroid dysfunction in pregnant women for
are essential for the maintenance and successful
better health care.
completion of no rmal pregnancy (6).
5796
Received: 23/06/2022
Accepted: 01/09/2022
c:\work\Jor\vol891_263
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5801- 5807
Shear Wave Elastography of the Contralateral Apparently Normal Testis in
Patients with Unilateral Varicocele and Abnormal Semen Parameters
Khaled Mohammed Abdelwahab1, Esam A. Desoky1, Mohammed Abu Bakr1, Khaled Abd El-Samed1, Mostafa
Mohmmad Mohammad Ebraheem Rashed 2, Ashraf Elsayed Elnagar2, Mahmoud Saeed Mahmoud Ibrahem2
1Department of Urology, Faculty of Medicine, Zagazig University, Egypt
2Department of Urology, Ahmed Maher Teaching Hospital, Cairo, Egypt
*Corresponding author: Mohammed Abubakr Ali, Mobile: (+20)01097451878, Email: mo.abubakr.9@gmail.com
ABSTRACT
Background: Shear wave elastography (SWE) is extensively used in testicular pathology evaluation. Varicocele
subfertility complex associated with testicular fibrosis. Unilateral varicocele is not uncommon association in male
infertility. The aim of the present study is answering the question, why unilateral varicocele are fertile while others are
not, despite contralateral apparently normal testis?
Patients and methods: A case control study was carried out on 48 patients diagnosed with unilateral varicocele and
abnormal spermogram. Patients were collected from our urology outpatient clinics of Zagazig University Hospitals, in
the period between March and December 2019. A total 10 volunteers with unilateral varicocele and normal semen
parameters participate to know baseline SWE figures.
Results: In the case group, the mean age was 33.83 (SD 5) years. Mean sperm count, motility and normal forms among
the studied patients was 6.76 (SD 2.4 million/ml), 17.656 (SD 3.35) and 7.01 (SD 1.76) %, respectively with a negative
correlation with contralateral testicular stiffness. Mean value of the apparently normal contralateral testicular stiffness
was significantly higher than in control group as their mean results were 3.63 (SD 0.79) and 1.43 (SD 0.25) kpasc,
respectively. During our cases SWE mapping, ipsilateral testis stiffness SWE mean value was 4.81 (SD 1.03) kpasc and
insignificantly higher than control.
Conclusion: SWE data of normally apparent contralateral testis of unilateral varicocele patients with abnormal semen
parameters could reveal stiffer parenchyma that may reflect the presence of a harmful insult to the testis. Thus, it could
add a warning sign for surgeon to interfere in these unilateral cases, even with euspermic pattern and varicosities.
Keywords: Shear wave elastography, Varicocele, Abnormal semen, Ultrasound, case control study.
INTRODUCTION
Varicocele is a dilated and tortuous veins of the
waves spread across the stimulated tissue within the
scrotal pampiniform plexus. It presents in
region of interest. A more stiff tissue will resist the high
approximately 15% of the whole male population. It
frequency ultrasound wave (shear wave) and
reaches up to 39% and 81% of infertile men presenting
consequently show less resistance and adsorption to the
with primary and secondary infertility respectively (1).
spread of next ultrasound waves across and shows
Bilateral Varicocele is diagnosed commonly in
higher values of stiffness index, and vice versa
men seeking fertility with decline in semen quality.
regarding softer tissues (9).
However varicocele can present unilaterally in those
SWE ultrasound applications have enabled the
patients (2). Unilateral varicocele subfertility complex
assessment of new aspects in the structural and
occurs in the left side (17.6%), or right side (1.5%) (3).
functional analysis of testicular tissue by detecting
Varicocele has notorious pathophysiologic effect
tissue elasticity (9,10). SWE has been applied to
on testicular parenchyma with its seminiferous tubules.
differentiate testicular lesions nature (11).
This could be related to hemodynamic insults and their
Although spermogram is the initial gold slandered
effect on increased intra-testicular pressure or hypo-
method in evaluation of spermatogenic function in
perfusion and hypoxia. There are other factors palmed
varicocele-infertility complex, SWE can be used to
in varicocele pathologic and hypo-trophic changes like
assess testicular tissue stiffness both qualitatively and
disturbed countercurrent multiplier thermal regulator,
quantitatively. This supports the usefulness of the
gonad toxic metabolite reflux, anti-sperm antibody
technique for evaluating that aspect various aspect (12).
formation and or oxidative stress (4,5). Previous noxious
Despite the presence of contralateral apparently
changes are associated with histopathological
normal testis in unilateral varicocele patients, but their
interstitial tissue edema and fibrosis. Collagen fibril
spermogram profile is not uniform and a considerable
depositions are noted in both sides of extracellular space
percent of these cases need intervention for subfertility
of seminiferous tubules basement membrane
(13,14). Our primary end point is to investigate SWE
extracellular space of varicocele patients (6-8).
(fibrosis) of contralateral testis in unilateral varicocele
Shear wave elastography (SWE) ultrasound is
with semen parameter abnormalities. Our secondary
used to estimate tissue stiffness through delivery of a
end point was mapping of both testis using SWE. We
high frequency pulse into the tissue. That will create
aimed to early detect testicular insult of contralateral
energy inside the tissue. Then it followed by a usual B
apparently normal testis that could be considered as
mode pulse that measure the velocity of the ultrasound
5801
Received: 26/06/2022
Accepted: 02/09/2022
c:\work\Jor\vol891_264
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5807- 5812
Evaluation of TP53 Gene Mutation in Chronic Lymphocytic Leukemia Patients
Olfat M. Hendy1, Amal Abd ELHameed Mohamed2,
Yasmin Nabil Elsakhawy2, Asmaa Said Atta*1, Karema Abd Alhadi Diab1
1Department of Clinical Pathology, National Liver Institute, Menoufia University, Menoufia, Egypt
2Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Asmaa Said Shahat Atta, Mobile: (+20)01060599368, E-mail: asmaaatta8@gmail.com
ABSTRACT
Background: In chronic lymphocytic leukemia (CLL) disease, B cell heterogeneity and enhanced cellular proliferation
play major pathogenic roles. TP53 abnormalities namely, both 17p chromosome deletion (del 17 p) and TP53mutation
are considered gold standards for the clinical course of CLL and provide a better prognostic risk stratification.
Objectives: This was aimed to investigate TP53 mutations in patients with CLL and to assess their impact effect on the
clinical course and hematological characteristics of these patients.
Patients and methods: Forty newly diagnosed CLL adult patients were selected and subjected to full history taking,
clinical examination, peripheral blood & bone marrow examination, and immunophenotyping in addition to TP53
mutation by real-time PCR.
Results: TP53 gene mutation was positive in 20% of CLL cases, and this mutation was significantly associated with
hepatosplenomegaly, lymphadenopathy, short LDT (<12 months), CD38 expression, high-grade staging, and poor
response to therapy.
Conclusion: One of the most potent prognostic markers required to direct treatment decisions for CLL is the TP53
mutations, which were linked to rapid disease progression and poor outcomes.
Keywords: Chronic Lymphocytic Leukemia, 17p deletion, TP53.
INTRODUCTION
clinical course and hematological characteristics of
The majority of those who are affected by chronic
these patients.
lymphocytic leukemia (CLL) are elderly people,
PATIENTS AND METHODS
typically older than 70 years of age; it is also the most
The observational cross-section study was
prevalent leukemia among adults in the Western
conducted on 40 newly diagnosed CLL adult patients
world[1]. The median age of diagnosis may vary
attending Ain Shams Hospitals from October 2020 to
significantly between populations and geographical
October 2021. According to WHO recommendations,
areas due to its potential to affect younger persons as
the diagnosis of CLL was made using blood smears and
well [2].
counts, as well as immunophenotyping of circulating B-
CLL is caused by the clonal proliferation of
lymphocytes, which identifies a clonal B-cell
aberrant B cells that co-express T cell-specific antigens
population containing the CD5 antigen and
and B cell markers (CD19, CD20) (CD5) [3]. The
characteristic B-cell markers [8].
variability in the progression and treatment requirement
CLL patients in the Hematology and Oncology
results from chromosomal abnormalities present in
Departments are treated according to del(17p)/TP53
more than 75% of patients with CLL, including
mutation status. Del(17p)/TP53 mutation-positive
deletions of (13q14), del (11q23), del (17p13), and
patients are treated with (Ibrutinib 420 mg orally), while
trisomy 12 [4].
del(17p)/TP53 mutation-negative patients are treated
TP53 aberrations can come from gene mutations
with (Cyclophosphamide 500mg orally, Vincristine
that impair the function of wild-type p53 in CLL or
2mg injection day one, Fludrapine 50mg orally,
deletion of the TP53 locus on chromosome 17 (17p13.1)
Rituximab500mg injection and Dexamethasone 40mg
[5]. P53, a tumor-suppressor protein that regulates the
orally). The response definition after the treatment of
cell cycle and apoptosis as well as promotes DNA repair
CLL patients was based on iwCLL guidelines [9].
in response to cellular stress signals such as DNA
damage, is encoded by the gene TP53 [5].
Ethical consent:
Chemotherapy works by causing DNA damage,
All participants provided written consent, and
which activates the TP53 pathway and causes CLL cells
the study received Ethics Committee approval from
to apoptosis. Contrarily, chemotherapy fails to cause
the Faculty of Medicine at Ain Shams University.
apoptosis in CLL cells when TP53 is damaged, which
This work has been carried out following The Code
allows the disease to proceed and leads to clonal
of Ethics of the World Medical Association
evolution as the cells continue to multiply at a steady
(Declaration of Helsinki) for studies involving
rate [6, 7].
humans.
The following was done for all patients included: a
This was aimed to investigate TP53 mutations in
complete clinical history and thorough clinical
patients with CLL and assess their impact effect on the
examination. Complete blood picture using Sysmex
5807
Received: 26/06/2022
Accepted: 02/09/2022
c:\work\Jor\vol891_265
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5814- 5823
Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in
Evaluation of Inflammation and Nutritional Status in Chronic Kidney Disease Patients
Maha Abd El Moneim Behairy1, Sahar Mahmoud Shawky1 Somia Abd El hamid Bawady2,
Ghada Abd El Hahmed El Kezza1, Fatma Abdelrahman Ahmed1
Departments of 1Internal Medicine and Nephrology and
2Clinical Pathology, Faculty of Medicine - Ain Shams University, Cairo, Egypt
*Corresponding author: Fatma Abdelrahman Ahmed, Mobile: (+20) 01101216222,
Email: fatmagouda@med.asu.edu.egm ORCID: 0000-0002-8386-2241
ABSTRACT
Background: Malnutrition and inflammation have significant roles in chronic kidney disease (CKD), which causes
cardiovascular mortality and morbidity.
Objective: To evaluate the value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as
an inflammatory marker among CKD patients and their association with the nutritional status of the patients.
Patients and Methods: A case-control study included 60 adult patients' non-dialysis CKD stage G3-5, from Ain Shams
University Hospitals, and 30 healthy volunteers as a control group. Anthropometric measurements include body mass
index, mid-arm circumference, triceps skin fold thickness, mid-arm muscle circumference (MAMC), and modified
subjective global assessment (m-SGA). Laboratory parameters include complete blood count, NLR and PLR, hs-CRP,
routine blood chemistry, and urinary albumin/creatinine ratio. Results: The mean of NLR in patients' group was
significantly higher compared to healthy subjects. The mean of PLR in patients' group was higher than the control group,
but with no statistically significant difference. Both ratios PLR and NLR were positively correlated to high hs-CRP in
patients' group. The mean of hs-CRP among CKD patients was significantly higher than that in the control group. There
was a significant correlation of NLR with MAMC in patients' group. But there was no statistically significant correlation
between m-SGA score and NLR, PLR, or hs-CRP among patients' group.
Conclusions: Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio can be used as inflammatory markers
in chronic kidney disease patients with malnutrition.
Keywords: NLR, PLR, Inflammation and Nutritional Status, CKD Patients.
INTRODUCTION
significantly elevated under pathological conditions,
Even in the early stages of chronic kidney
like systemic inflammation or severe infection, and
disease (CKD), malnutrition is a common problem in
closely related to severity and clinical outcome of these
patients in pre dialysis stages, and it gets more
conditions; it is an easily determined and cost-effective
pronounced as kidney function declines (1). Nutritional
predictor of mortality in patients with heart failure and
status is evaluated using serum proteins. Patients with
myocardial infarction (7). In some research, NLR is
CKD frequently have hypoalbuminemia, which is
found to be associated with CKD and its progression (6)
linked to a high mortality rate, particularly in those who
and reported to be closely related to inflammation in
are receiving dialysis (2).
both hemodialysis (HD) and peritoneal dialysis (PD)
There are many factors related to the
with limited data regarding this association in pre-
development of sustained low-grade inflammation in
dialysis CKD patients. (6)
CKD patients, including increased proinflammatory
Platelet-to-lymphocyte ratio (PLR) is an
cytokines production, decreased clearance, metabolic
inflammatory marker that is reported as predictor for
acidosis and oxidative stress, chronic and recurrent
morbidity and mortality in various cardiovascular and
infection, altered metabolism of adipose tissue,
oncological diseases and associated strongly with
intestinal dysbiosis, and vitamin D deficiency because
inflammation in patients on maintenance HD (4). The
of its role in the regulation of immune system, in
role of these ratios in monitoring disease activity is
addition to the effect of genetic and epigenetic
mentioned in previous studies. Although hemodialysis
conditions (3).
(HD) patients are mostly investigated, the information
Inflammation and malnutrition are considered
related to predialysis patients is limited (8).
as a component of CKD that can lead to a poor outcome
(4). The relation of inflammation and malnutrition to
AIM OF THE STUDY
CVD is mentioned in previous studies, known as
We aims to investigate the clinical utility of
malnutrition, inflammation, and atherosclerosis referred
NLR and PLR as inflammatory markers and their
to as MIA syndrome, considered as a silent factor for
association with nutritional status of non-dialysis CKD
increased cardiovascular mortality rates in CKD
stage G3-5.
patients (5).
Neutrophil-to-lymphocyte ratio (NLR) is
SUBJECTS AND METHODS
introduced as an inflammatory marker in many cardiac
This was a pilot case-control study including 60
and noncardiac diseases (6). It was also reported to be
pre-dialysis CKD patients compared to 30 healthy
5814
Received: 26/06/2022
Accepted: 02/09/2022
c:\work\Jor\vol891_266
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5824- 5829
Functional and Radiological Outcomes after Screw Fixation in
Stable and Unstable Slipped Capital Femoral Epiphysis
Aymen Ahmed Bashir, Hosam Mohammed Khairy Tawfik,
Mohmed AbdAlla M. Abdel Salam, Yehia Tarek Elbromboly
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt
*Corresponding author: Aymen A. Bashir, Mobile: (+20) 01126549870, Email: aymenkrima55@gmail.com
ABSTRACT
Background: The hip condition known as slipped capital femoral epiphysis (SCFE), which affects adolescents
between the ages of 9 and 15, is frequent. The exact cause is still mostly unclear, but a mix of hormonal and
mechanical elements is most likely to be responsible.
Objective: The present study aimed to evaluate the functional and radiological outcomes of surgical treatment of stable
and unstable slipped capital femoral epiphysis with screw fixation.
Patients and methods: A prospective clinical study that included 18 cases (21 hips) with slipped capital femoral
epiphysis at Zagazig University Hospitals. Patients were classified as stable and unstable using the Loder criteria. All
patients were followed up in the outpatient clinic as follow: after 2 weeks to follow up on the wound and removal of the
sutures. After 3 and 6 months, patients were followed up clinically and radiologically.
Results: The SCFE was found on the left side in 50% of the cases, the right side in 33.3%, and bilateral in 16.7%. The
average weight of the studied group was (54.2±8.9) ranging from 43 to 69 Kg. According to the stability classification,
there were 15 patients are stable SCFE, and 3 patients are unstable SCFE. Regarding the severity 13 cases were mild
and 8 cases were moderate. The follow-up time ranged from 5 to 7 months. Our findings' satisfactory outcome was the
majority with 88.9%,12 cases (66,7%) obtained excellent results 4 cases (22.2%) had good results, and unsatisfactory
11.1% (2 cases one of them obtained fair results).
Conclusion: Treatment with screw fixation in stable and unstable slipped capital femoral epiphysis gives good results.
However, it highlights the fact that an unstable SCFE is more likely to generate a poorer outcome.
Keywords: Screw Fixation, Stable Slipped Capital Femoral Epiphysis, Radiological Outcomes.
INTRODUCTION
physeal stability, are more therapeutically applicable,
Adolescent hip disorders like slipped capital
and forecast the likelihood of avascular necrosis in the
femoral epiphysis (SCFE) are rather common. It is
future. There are two categories: a clinical one and a
known as the sliding of the proximal femoral epiphysis
radiological one. The child's capacity to walk will
through the growing cartilage concerning the femoral
determine the clinical classification. A stable SCFE is
neck. It is posteroinferior to the neck because the
one in which the child can walk, either with or without
epiphysis is still in the acetabulum at this point (1). The
the aid of crutches. A youngster who is unable to walk,
SCFE is now present in 0.33 to 24.58 out of every
using crutches or not, is said to have an unstable SCFE.
100,000 children. It typically affects children between
The hip effusion found on ultrasonography determines
the ages of 8 and 15, with a male-to-female ratio
the radiographic categorization. An unstable SCFE is
"between" 1.1:1 and 4.1:1, and is one of the most
defined as having no metaphyseal remodeling and an
frequently overlooked diagnoses in children (2, 3).
effusion, while a stable SCFE has metaphyseal
The etiology seems to involve multiple factors.
remodeling and no effusion. When opposed to stable
Obesity increased femoral retroversion, and increased
SCFEs, which have a nearly 0% incidence of avascular
physeal obliquity have all been identified as
necrosis, unstable SCFEs have an incidence of up to
biomechanical factors that contribute to greater shear
50% (4, 5).
stresses in the capital physis. The endocrine illnesses
Patients with SCFE frequently limp and complain
hypothyroidism, hypogonadism, and hypopituitarism
of hip, groin, thigh, or knee discomfort that is not well
have all been linked to SCFE. SCFE is more likely to
localized. Bilateral hip radiography, which should
occur in children with renal failure, osteodystrophy, or
include anteroposterior and frog-leg lateral views, is
a history of pelvic radiation (2).
used to confirm the diagnosis (1, 6).
Clinical, radio-morphological, and chronological
The aims of treatment for this condition, which is
classifications are used for SCFE. Based on the patient's
debatable, are to stop additional slippage and keep
medical history, physical examination, and x-ray, the
consequences like chondrolysis, avascular necrosis, and
traditional chronological classification was preslip,
femoroacetabular impingement at bay. Standard therapy
acute, chronic, and acute on top of chronic. Southwick
for stable SCFE involves in situ screw fixation. In situ
angle degree determines the radio morphological
fixation, inadvertent reduction and screw fixation, with
classification, which is divided into mild (0-30 degrees),
or without capsular decompression, and surgical
moderate (30-60 degrees), and severe categories (more
dislocation with reduction and fixation of the epiphysis
than 60 degrees). Newer classifications depend on
are other common treatments for unstable SCFE (7).
5824
Received: 26/06/2022
Accepted: 02/09/2022
c:\work\Jor\vol891_267
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5830- 5839
Artemisia annua Has Anti-Psoriatic Effects Comparable to Those of
Clobetasol in Imiquimod-Induced Animal Model of Psoriasis
Noor M. Badea Abdulrahman AL-Badri 1, Mohammed Abdul-Hassan Jabarah AL-Zobaidy * 1
1 Department of Pharmacology/ College of Medicine/ University of Baghdad- Iraq.
*Corresponding author: Mohammed Abdul-Hassan Jabarah AL-Zobaidy,Mobile: 009647705982654;
Email: mohammed.a@comed. uobaghdad.edu.iq
ABSTRACT
Introduction: Psoriasis is a complex, common, chronic, non-contagious. The etiology of psoriasis remains poorly
understood, but it is thought to be a complex of genetics, skin disruption, environmental, and immune dysfunction.
Methods: This study extended from December 2020 to July 2021. Plant extraction was done at Baghdad Collage of
Pharmacy (a private College) while animal experiments were done at College of Pharmacy, Baghdad University. The study
involved 60 apparently healthy BALB/c male mice, which were divided into 6 groups where each group contained ten
animals. Results: Psoriasis was induced on back skin of mice by the application of imiquimod cream, revealing significant
histological and morphological changes in the skin in addition to the elevated levels of skin homogenate TNF-, IL-17, IL-
23 and VEGF, and elevated levels of circulated TNF-, IL-17, and IL-23. Additionally, there was an increase in spleen
index. The current study showed that using Artemisia annua extract ointment as prophylactic resulted in lower levels of
inflammation, spleen index, skin homogenate TNF-, IL- 17, IL- 23 and VEGF as well as lower levels of circulating TNF-
, IL- 17, and IL- 23.
Conclusion: Both Artemisia annua extract ointment and Clobetasol showed an improvement in induced psoriasis, by
decreasing the histological changes in skin, lowering cytokines level and in decreasing spleen index.
Keywords: Artemisia annua, Ethanolic extract, Imiquimod, Interleukins, Psoriasis.
INTRODUCTION
Psoriasis is a complex, common, chronic,
Among medicinal plants, Artemisia annua is
noncontagious, recurrent, multisystem, immune-mediated
considered as one of the most common plants that is
inflammatory disease of skin (1-5). On the other hand, the
prescribed in traditional Chinese medicine for more than
histopathological findings in psoriasis are generally
two thousand years. Also, studies have been done to
characterized by three features; epidermal hyperplasia,
evaluate the potential effects (24) of the plant to cure
increase vascularity in the dermis and infiltration of
variety of ailments. These include antihypertensive,
inflammatory leucocytes (6-8). Individuals with psoriasis
antimicrobial,
anti-inflammatory,
antioxidant,
have a high prevalence of developing several distinct
immunosuppressive and antiparasitic effects. Despite the
comorbidities such as metabolic syndrome (9), insulin
broad spectrum of pharmacological therapies available
resistance (10) and/or Hypertension (11).
for treatment of psoriasis, they are associated with a wide
Traditional pharmacological treatment of psoriasis
range of adverse effects. Taken together, current study
includes topical agents such as retinoids, vitamin D,
aimed to evaluate the possible prophylactic and
topical corticosteroids, topical keratolytics and topical
therapeutic effects of Artemisia annua extract on
calcineurin inhibitors (12,13). Moreover, systemic agents
imiquimod-induced psoriasis in mice.
can also be useful in treatment of psoriasis, these may
include phosphodiesterase 4 inhibitors, cyclosporine A
METHODS
and methotrexate (12,14,15).
This study extended from December 2020 to July
Nonetheless, modern pharmacological treatments
2021. Plant extraction was done at Baghdad Collage of
(such as phototherapy and biologics) have been
Pharmacy (a private College). The plant Artemisia annua
successfully employed in treatment of psoriasis. These
was purchased from the local market in Baghdad and
include, but not limited to, ultraviolet B (16), Psoralin
authenticated at Al-Razi center, which is an authorized
ultraviolet A (PUVA) [17], TNF- inhibitors [18], IL-17
center for alternative medicine in Baghdad, Iraq. after
inhibiters [13] and IL - 23 inhibitors (19). Interestingly,
extraction of the leaves, numerous qualitative
complementary and alternative medicines are nowadays
phytochemical screening studies were conducted to
used to supplement or replace traditional treatment and
determine the chemical composition of the extract. Then,
they include dietary supplements, traditional Chinese
the extract was formulated into an ointment by trituration
medicines, herbal/botanical therapy, mind body
method. Moreover, the study involved 60 apparently
intervention and climatotherapy [20]. Throughout the
healthy BALB /c male mice, which were divided into six
history, three herbal medicines were commonly used for
groups (normal control, prophylaxis, induction, treatment
treatment of psoriasis; Aloe Vera (21), Mahonia
with Vaseline, treatment with clobetasol and treatment
Aquifolium (22) and Indigo Naturalis (23).
with Artemisia annua extraction) where each group
5830
Received: 19/6/2022
Accepted: 27/8/2022
c:\work\Jor\vol891_268
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5840- 5846
Red Blood Cell Distribution Width Level as Reliable Diagnostic and
Prognostic Biomarker in Septic Patients: A Case-Control Study
Ashraf Khalifa Elnagar*1, Azza Moustafa2
Departments of 1Internal Medicine and 2Clinical Pathology,
Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Ashraf Khalifa Elnagar, Mobile: (+20)01062137110, Email: khalifamd1000@yahoo.com
ABSTRACT
Background: Sepsis is one of the leading causes of death, with 4050% mortality rates. The red blood cell distribution
width (RDW) is an emerging, novel, and inexpensive marker for sepsis.
Objective: This study aimed to evaluate RDW levels as a reliable diagnostic and prognostic biomarker in septic patients.
Patients and Methods: A prospective case-control study was carried out in the Medical Intensive Care Unit (MICU),
Zagazig University Hospitals on 46 patients, equally divided into two groups (n=23): the septic group and those who
didn't develop sepsis (control group). All participants underwent a C-reactive protein (CRP, mg/ml) and a complete
blood count (CBC) analysis, including RDW, on the first, third, and seventh days after admission. Procalcitonin (ng/ml)
was determined using an enzyme-linked immunosorbent assay.
Results: Diabetes was the most common chronic disease, while lung infections were the most common source of sepsis.
Septic patients had significantly higher RDW values compared to control patients on the first (18.9 vs. 13.8), third (20.4
vs. 14.3), and seventh day (25.7 vs. 16.0) after admission, p <0.05. RDW >14.8, CRP >38.7mg / l, or CRP >38.7mg/l,
or procalcitonin >2.2 mg/l were correlated with development of sepsis. On the seventh day of admission to the ICU, the
mortality rate was 43.5% and 13.1% in the septic and control groups, respectively. A positive correlation was detected
between RDW and Sequential Organ Failure Assessment (SOFA) score on the seventh day of hospitalization
(P<0.0001).
Conclusions: RDW is significantly higher in septic and dead patients; hence, it may be considered an effective
biomarker for early sepsis detection and reliable predictor of mortality in septic patients.
Keywords: Sepsis, Red blood cell distribution width, CRP, RDW.
INTRODUCTION
The red blood cell distribution width (RDW) is a
Sepsis is a state of life-threatening organ
numerical measurement of the size, variability, and
dysfunction resulting from an improperly controlled
heterogeneity of the red blood cells (RBCs). In most
host response to infection. Typically, a bacterial
patients with sepsis admitted to emergency rooms,
infection is a cause. Sepsis and septic shock are
automated analyzers perform a complete blood count
significant global health issues, affecting millions of
(CBC), and RDW is routinely provided as part of the
people annually and causing deaths between one-third
CBC. RDW is simple, cost-effective, frequently
and one-sixth of those affected(1).
accessible, and quickly quantifiable(8). RDW is
Sepsis continues to be the primary cause of death
calculated by dividing the standard deviation of the
in non-coronary intensive care units (ICU) worldwide,
erythrocyte by the average corpuscular volume and
with an estimated mortality rate of 30% in sepsis and
multiplying the result by 100 to express as a
80% in septic shock in the United States(2) and 12.8% in
percentage(9).
sepsis and 45.7% in septic shock in Europe(3).
Any disease involving the breakdown or
Unfortunately, data on the prevalence of sepsis in Egypt
synthesis of RBCs could increase the variability of the
are limited.
size of RBCs and RDW. Both erythropoiesis and
Early diagnosis and effective treatment
erythrocyte maturation can be altered by sepsis. A
administered in the first few hours after the onset of
subsequent acute increase in RDW can reflect the
sepsis development improve patient outcomes(4).
severity of the underlying inflammatory state and
Prognostic factors such as age, sex, comorbidities,
provide important prognostic information on the
biomarkers (C-reactive protein and procalcitonin), and
intensity of resource use and the risk of mortality(10).
severity of the disease score [Acute Physiology and
Although the mechanism of increased RDW in
Chronic Health Evaluation (APACHE)] have been
septic patients has not yet been determined, it has been
associated with the outcome of severe sepsis(5).
postulated that inflammation and oxidative stress are
There are no gold standards for the diagnosis of
associated with elevated RDW(10). Electronic
infection; however, procalcitonin is regarded as one of
microscopy shows RBC shape changes during shock's
the most potential sepsis indicators in critically ill
refractory phase. Sepsis affects the morphology and
patients(6), complementing clinical symptoms and
function of RBC. Therefore, changes in RBC during
routine laboratory variables that predict sepsis but
sepsis and shock can contribute to multiple organ
remain costly(7).
dysfunction syndromes. Septic shock bacteria
endotoxins may reduce the elasticity of RBC, reduce the
5840
Received: 26/6/2022
Accepted: 2/9/2022
c:\work\Jor\vol891_269
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5847- 5851
Operative Treatment of Displaced Both Bone Forearm Diaphyseal
Fractures in Children by Elastic Intramedullary Nail
El Sayed Eletwy Soudy, Ahmed El Sayed El Malt, Mousa Abdulrasul Mousa*, Ehab Mohamed Shehata
Department of Orthopedic, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mousa Abdulrasul Mousa, Mobile: (+20)01030520388, E-mail: musabm49@gmail.com
ABSTRACT
Background: Injuries to the shafts of radius and ulna are one of the most common reasons for children to receive
orthopedic care. The purpose of this study was to evaluate the radiological and clinical outcome of fracture both bone
forearm in children treated by elastic nail.
Patients and methods: This clinical trial was conducted on 18 patients with fracture shaft of both bone forearm treated
by elastic stable intramedullary nail (ESIN) in Zagazig University Hospital, Egypt, and Emhamed Almaqrif Hospital
Educational Center, Ajdabia, Libya. It was conducted to evaluate the radiological and clinical outcome of fracture both
bone forearm in children treated by elastic stable intramedullary nail.
Results: The mean time to union was 9.94 (SD 2.01) weeks with minimum 7 and maximum 14 weeks. According to the
Mayo score majority were excellent 61.1%, then good 27.8% and finally fair 11.1%, and only 4 cases 22.2% had
complication (2 surgical site infections, 1 superficial radial nerve injury, and 1 nonunion).
Conclusion: ESIN is secure and suitable for young children for the treatment of displaced forearm fractures.
Keywords: ESIN, Forearm Diaphyseal Fractures, Children.
INTRODUCTION
treatment of unstable both bone forearm fractures in
Diaphysis fractures of the forearm are among the
pediatric population (9). Recently, however, there has
most frequent fractures in children, accounting for up to
been a trend towards increased surgical management of
1440% of all pediatric fractures. The most frequent
these fractures in an effort to improve clinical outcomes.
cause of this sort of fracture is falling on an extended
So, the purpose of this clinical trial was to evaluate the
hand (1-3). The most effective method of treating juvenile
radiological and clinical outcome of fracture both bone
forearm fractures with little displacement and stability
forearm in children treated by elastic nail.
is still closed reduction and immobilization with a cast
(4,5). In earlier trials, surgical intervention was advised
PATIENTS AND METHODS
for angulation >10°, malrotation >50%, and
This clinical trial was conducted on 18 patients
displacement >60% (6).
with fracture shaft of both bone forearm treated by
The possible surgical treatments are closed
intramedullary elastic nail in Zagazig University
reduction and internal fixation with titanium elastic
Hospital, Zagazig, Egypt, and Emhamed Almaqrif
nailing, open reduction and plate osteosynthesis, and
Hospital Educational Center, Ajdabia, Libya.
kirschner-wire pinning. Metaizeau and Ligier(7) were
the first to report the surgical therapy of pediatric both
Inclusion criteria: Children aged 5-15years with
bone forearm fracture using an elastic intramedullary
unaccepted displaced diaphyseal forearm fracture.
nail.Elastic Stable Intramedullary Nail (ESIN) nails
Children aged 5-15years with compound forearm
have become more common for fixing forearm
fracture (Grade 1 and Grade 2).
fractures, with supporters claiming that nailing reduces
surgical dissection and preserves biologic variables at
Exclusion criteria included: Children older more than
the fracture site (8).
15 years age. Children younger than 5 years of age.
The use of ESIN to fix the two forearm bone
Pathological fractures, malunion, nonunion, and patient
fractures had numerous benefits, including a smaller
unfit for surgery.
incision, minimal soft tissue interference with the
fracture fixation process, prompt osseous healing,
Pre-operative:
maximum range of motion at the earliest possible time,
Detailed history was taken to know the age, sex,
a decrease in the complication rate, and excellent
type, and mode of trauma mechanism and time of injury.
clinical and radiological outcomes (9).
Proper clinical examination, Forearm radiographs were
Early forearm mobilization and less invasiveness
examined to determine fracture pattern (complete or
compared to plate osteosynthesis are the main
greenstick), location (proximal, middle, or distal third),
advantages of ESIN treatment over conservative
displacement, angulation, and rotation. Displacement
treatment (9). About 34 weeks of post-operative
and angulation are fairly easy to document on AP and
immobilization by back slapping above the elbow, then
lateral views. Laboratory evaluation included Complete
early mobilization. The quantity of callus is equivalent
blood count (CBC), Liver function tests (SGOT, SGPT,
to callus formation following conservative therapy after
and Albumin), Coagulation profile, Serum creatinine,
3 weeks (8,9). Thus, titanium elastic nailing used
Random serum glucose (RSG), Virology tests (HBV,
intramedullary is an effective treatment option for the
HCV, and HIV).
5847
Received: 26/6/2022
Accepted: 2/9/2022
c:\work\Jor\vol891_270
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5852- 5859
Impact Of Treadmill Training on Immunoglobulin G And C- Reactive Protein in
Obese Adolescent Girls: Randomized Controlled Clinical Trial
Omnia Gamal Ali*1, Eman Ibrahim El Hadidy2, Sahar Abd El-Aziz Khairy3, Samah Attia El Shemy2
1 Department of Physical Therapy, Matria Teaching Hospital, Cairo, Egypt
2Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
3Department of Growth and Nutrition Requirements, National Nutrition Institute, Giza, Egypt
*Corresponding author: Omnia Gamal Ali, Mobile: (+20) 01121767571, E-Mail: dr.omniagamal90@gmail.com
ABSTRACT
Background: Obesity is linked to metabolic disorders that result in tissue damage and malfunction. In addition to
impairing immunity, obesity is associated with low-grade chronic inflammation. Objective: The aim of the current
study is to assess the effect of treadmill training on immunoglobulin G and C-reactive protein (CRP), body mass index
(BMI) and waist circumference (WC) in obese adolescents' girls. Patients and methods: A total of 60 obese adolescent
girls were selected from National Nutrition Institute aged from 12 to 18 years old. All girls were randomly assigned into
two groups. Control group included 30 girls who received diet control therapy only. Study group included 30 girls who
received treadmill gait training (3 sessions/per week) in addition to diet control therapy. All girls in both groups were
assessed before and after three successive months as Immunoglobulin G and CRP were measured using blood analysis,
BMI calculated by weight in kilograms (Kg) divided by the girls' height in meter squared (m2) while waist circumference
by Graduated measuring tape. Results: There was a statistically significant increase in IgG level, and a statistically
significant decrease in CRP, BMI and WC in both groups; these changes were more in the study than the control, but
there was no statistically significant difference in IgG, CRP, BMI and WC when comparing post-treatment results of
both groups. Conclusion: Treadmill gait training is an effective modality that can be used in the rehabilitation program
in obese adolescents for improving their immune functions and reducing inflammatory reactions.
Keywords: Treadmill training, Obese adolescent girls, Immunoglobin G, C-reactive protein.
INTRODUCTION
Obesity and related metabolic disorders have
been associated with changing in consistency of serum
become a major global health concern. It is a state
immunoglobulin IgG, IgA and IgM, levels [6].
defined by a pathological increase in adipose tissue that
The concentrations of adrenaline and cortisol rise
can lead to a variety of metabolic disorders, including
during exercise when the VO2max is greater than 60%
[7]
type 2 diabetes, cardiovascular disease, non-alcoholic
. Exercise has anti-inflammatory effects, therefore
fatty liver disease, and some cancers [1].
moderate amount of exercise improves immune
Since the 1980s, the prevalence of obesity has more
function and reduce resting C-reactive protein (CRP)
than doubled worldwide, and in 2014, 13% of adults
levels [8]. Therefore, this study aimed to determine the
were classified as obese and over 39% as overweight.
effect of treadmill gait training program on
1.9 billion adults are predicted to be overweight, with
immunoglobulin G and C-reactive protein, body mass
more than 600 million of them being obese. Globally,
index and waist circumference in obese adolescent girls.
childhood obesity is on the rise. Overweight/obesity
PATIENTS AND METHODS
affects 200 million school-age children, of which 4050
Study design and sample: A total of 60 obese
million are obese. Seventy percent of obese adolescents
adolescent girls participated in this randomized
will go on to become obese adults [2].
controlled clinical trial.
There is evidence that childhood obesity can persist
Inclusion Criteria:
into adulthood. Obesity in adults is associated with a
1. Age ranged from 12 to 18 years.
significantly increased risk of morbidity, such as type 2
2. Body mass index (BMI) equal or greater than 95th
diabetes, cardiovascular disease (CVD), and cancer [3].
percentile according to CDC growth curves [9].
Adolescent obesity has psychosocial consequences
3. All girls were clinically and medically stable.
such as body dissatisfaction and lower educational
Exclusion Criteria
attainment, as well as medical complications such as
1. Autoimmune diseases.
cardiovascular disease, colon cancer, and diabetes
2. Metabolic disorders.
mellitus [4]. Obese people have a poorer immune
3. Neurological or genetic disorders (e.g. Down
response to the hepatitis B vaccine than people of
syndrome, hypothyroidism, endocrinal cause of
normal weight and compared to children of normal
obesity).
weight, the anti-tetanus IgG antibodies in the
4. Cardiac disease, liver or kidney problems.
overweight children were considerably lower [5].
5. Severe visual or hearing problems.
Regular physical activity has been shown to improve
6. Respiratory disorders.
physiological, psychological, and immune functions.
All girls were randomly assigned into 2 groups using
Exercise-induced changes in immunological responses
sealed envelopes. Control group included 30 girls who
have been linked to increased levels of cortisol,
received diet control therapy only. Study group included
catecholamine, and neuropeptides. Also, exercises have
30 girls who received treadmill gait tanning in addition
to diet control therapy.
5852
Received: 27/06/2022
Accepted: 03/09/2022
c:\work\Jor\vol891_271
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5860- 5864
The Link between an Epidermal Growth Factor Gene Functional Polymorphism and
Hepatocellular Carcinoma in a Cohort of Hepatitis C Egyptian Patients
Bothaina A. Madkour1, Ola M. Mahmoud1, Ola B Abo El Nil1*,
Mohamed A. Aboul-Ezz2, Shereif A. Morsy2, Ahmed R. Mashaal2, Omar M. Sabry1
1Hematology Department, 2Hepato-gastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt.
*Corresponding author: Ola B Abo El Nil, Mobile: (00201005071442), E-mail: olabadr81@gmail.com
ABSTRACT
Background: Chronic hepatitis C (HCV) infection is implicated in hepatocarcinogenesis. Hepatocellular carcinoma
(HCC) progression is influenced by a number of genetic and epigenetic mechanisms. One of the most critical variables
in early hepatocarcinogenesis is the dysregulation of the epidermal growth factor receptor (EGFR) or the epidermal growth
factor (EGF) signaling pathway. This study aimed to assess the association between the incidence of HCC and the EGF
61A/G polymorphism in chronic HCV Egyptian cases.
Patients and methods: A comparative study was carried out with a total of 165 single ethnic Egyptian. They were
classified into 3 groups: Chronic HCV (n = 55), HCC (n = 60), and healthy cases (n = 50). Genotyping was performed for
all participants using RT-Multiplex PCR.
Results: The frequencies of genotypes were in HCV G/A 32.7%, G/G 60.0%, and A/A 7.3%, and in HCC G/A 51.7%,
G/G 30.0%, and A/A 18.3%. The control group was G/A 52.0%, G/G 20.0%, and A/A 28.0%. The alleles frequencies in
HCV were G 76.4%, and A 23.6%, in HCC were G 55.8% and A 44.2%. In the control group were G 46.0% and A 54.0%.
The difference regarding the genotype and allele frequency among studied groups was highly significant. The G/G
genotype (P-value 0.006) were protective against HCC development. However, HCV patients with the A/G genotype
(P-value 0.04) might be at a higher risk to develop HCC.
Conclusion: The indications for EGF 61A/G gene polymorphism's correlation with susceptible threat for HCC
development in HCV patients in Egypt.
Keywords: EGF 61A/G gene polymorphism; HCC; HCV; Comparative study; Theodor Bilharz Research Institute.
INTRODUCTION
HCC is cancer affects the liver and considers
infection, group (B) comprised 60 patients diagnosed
primary malignant tumor in liver tissue mainly affects
with HCC on top of chronic HCV infection, and group
people have cirrhosis and chronic liver disease (CLD) (1).
(C) who constituted 50 healthy individuals to serve as the
It's Egypt's fourth most prevalent cancer (2).
control group.
During chronic inflammation, inflammatory
Group A included 27(49.1%) males besides
process continues for extended length of time, and
28(50.9%) females with their age ranged from 34 to 67
constant apoptosis/regeneration occurs as a result of the
years (mean ± SD = 44.3 ± 13.9). While in group B
process known to increase possibility of malignancy,
comprised 42(70%) males as opposed to 18(30%)
particularly HCC (3, 4).
females with age ranged from 48 to 60 years (Mean ± SD
The EGF gene, 110 kb, has 24 exons and 23 introns,
= 46.8±15.9) were enrolled. Finally, group C comprised
is localized at chromosome 4q25-27. The EGF 61A/G
36 (72.0%) males and 14 (28.0%) females with their age
polymorphism (rs4444903) is single nucleotide
ranged from 32 to 57 years (Mean ± SD= 46.7±13.3).
polymorphism (SNP) that affects the expression of EGF
identified in the EGF gene's 5-untranslated region (5-
Sample size calculation:
UTR) (5,6).
A Cohort (Longitudinal) study of subjects in which
The aim of the present study is to assess the
we will regress their values of the patients against
association between the incidence of HCC and the EGF
control. Prior data indicate that the standard deviation of
61A/G polymorphism in chronic HCV Egyptian cases.
control is 0.8 and the standard deviation of the regression
errors will be 1.9. If the true slope of the line obtained by
PATIENTS AND METHODS
regressing patients against control is 1.0, we will need to
Study Design: Cohort Study
study 50 subjects for each group to be able to reject the
Study Setting: Theodor Bilharz Research Institute
null hypothesis that this slope equals zero with
Study Period: One year.
probability (power) 90%. The Type I error probability
associated with this test of this null hypothesis is 0.05.
Data collection:
Sociodemographic data of the participants like age
Study population and demographic information:
and gender should be comparable? 165 subjects
The study was executed at Theodor Bilharz
categorized into 3 groups group (A) comprised 55
Research institute (TBRI) where 165 subjects were
patients with established diagnosis of chronic HCV
involved and categorized into 3 groups; group (A)
comprised 55 patients with established diagnosis of
chronic HCV infection, group (B) comprised 60 patients
5860
Received: 9/6/2022
Accepted: 16/8/2022
c:\work\Jor\vol891_272
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5865-5870
Comparative Study between Chandlier Assisted 23, 25 and 27 Gauge Bimanual
Vitrectomy for Diabetic Tractional Retinal Detachment and Vitreous Hemorrhage
Mahmoud Abd El-Badie Mohamed, Ahmed Mahmoud Abd EL-Hady,
Ashraf Mohammed Gad Elkareem, Khaled Ibrahim Ali*
Department of Ophthalmology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: Khaled Ibrahim Ali, Mobile: (+20) 01006291987, E-Mail: khaledhaikel1987@gmail.com
ABSTRACT
Background: Hematogenous retinal detachment is just one of many surgical indications where the 27G system has
been shown to be both safe and useful. Objective: This study aimed to compare the results of chandelier assisted 23,
25, 27 gauge bimanual vitrectomy in diabetic vitreous hemorrhage and diabetic tractional retinal detachment.
Patients and Methods: There were a total of 30 eyes from 30 diabetic individuals in this prospective research of pars
plana vitrectomy. The study was conducted throughout 18 months (January 2018 to June 2019) in two private eye centers
in Alexandria (El-Safwa and Ebsar centers). Patients were divided into three groups according to the used vitrectomy
system (10 eyes per group): Group (I, II & III), each included 10 patients underwent vitrectomy surgery using 23-gauge
system, 25-gauge system and 27-gauge system respectively.
Results: The 27 gauge group took the highest operative duration (40.2 ± 7.5 min). However, at 6 months follow-up, the
27 gauge group had significantly improved Best Corrected Visual Acuity (0.39 ± 0.13 logMAR) compared to the 23
gauge group (0.76 ± 0.37 logMAR), (p< 0.01). The 23 gauge group had the highest mean time of exit (9.5 ± 1.3 min.).
Conclusion: When comparing the varied incision sizes associated with the 25-G and 23-G vitrectomy systems, the 27-
G system yielded comparable results when done on a variety of conditions. Smaller-gauge vitrectomy systems have
several advantages, but they also have some drawbacks, including as weaker instruments and a less effective treatment.
Keywords: Chandlier, 23 Gauge, 25 Gauge, 27 Gauge, Bimanual vitrectomy, Diabetic tractional retinal detachment,
Vitreous hemorrhage.
INTRODUCTION
addition, numerous vitreo-retinal surgical indications,
After the introduction of wide-angle viewing
including rhegmatogenous retinal detachment (RRD),
equipment, transconjunctival microincision vitrectomy
have been reported to have positive clinical outcomes
surgery (MIVS) employing 23-, 25-, or 27-gauge
with 27G transconjunctival sutureless vitrectomy
instrumentation has become increasingly common (1).
(TSV), along with a favorable short-term safety profile
Microincision phacoemulsification surgery (with 25- or
(9). The aim of the work was to compare the results of
23-gauge "25G" or "23G" instruments) has various
chandelier assisted 23, 25, 27 gauge bimanual
advantages, including a low rate of intraoperative and
vitrectomy in diabetic vitreous hemorrhage and diabetic
postoperative sequelae, such as early postoperative
tractional retinal detachment.
hypotony and endophthalmitis (2). A number of other
benefits have also been observed, including expedited
PATIENTS AND METHODS
wound healing, shorter surgery times, increased patient
There was a total of 30 eyes from 30 diabetic
comfort, decreased postoperative inflammation,
individuals in this prospective research of pars plana
reduced medically-induced astigmatism, and stable
vitrectomy. The research covered 18 months (January
postoperative intraocular pressure with early visual
2018 - June 2019) and took place at two Alexandria
recovery (3). It has been claimed that postoperative
private Eye Medical Centres (El-Safwa and Ebsar
intraocular pressure (IOP) stabilization can be achieved
centers). Patients were recruited randomly and were
by the use of angled incisions rather than straight ones
divided into three groups according to the vitrectomy
while performing sclerotomy, and through the use of air
system used (10 eyes in each group): Group (I): Patients
or gas exchange rather than fluid exchange (4). The
in the study had vitrectomies performed with a 23-
primary focus of technology development is still on
gauge system, Group (II): Patients were operated on
patient care and treatment compliance, even though
with a 25-gauge vitrectomy system and Group (III):
these advancements make surgery safer. The 27G
Patients in the study had vitrectomies performed with a
instrumentation system has just been released. First
27-gauge system.
presented by Oshima and colleagues in 2010 (5), the
In each group five eyes had diabetic vitreous
revolutionary 27-G MIVS system has been shown to be
hemorrhage and five eyes had diabetic tractional retinal
feasible and safe in early trials.
detachment (RD) were included in our study.
Indications for 27-G vitrectomy have broadened to
Inclusion criteria: Diabetic tractional RD involving or
encompass a wider range of conditions, such as
threatening macula, chronic diabetic vitreous
proliferative vitreoretinopathy, retinal detachment as
hemorrhage,
combined
tractional
RD
and
well as proliferative diabetic retinopathy (6, 7). Even
rhegmatogenous RD, sever premacular diabetic
though 27-G vitrectomy has been around for a while,
hemorrhage, diabetic tractional papilopathy and case
the quantity of studies on it is still rather low (8). In
of neovascular glaucoma with vitreous hemorrhage.
5865
Received: 22/10/2020
Accepted: 10/12/2020
c:\work\Jor\vol891_273
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5871- 5874
Comparative Study between Traditional Dissection with Electrocautery Versus
Ultrasonic Dissection of The Gall Bladder in Laparoscopic Cholecystectomy
Emad A. Ibrahim, Mohammed H. Alsayed
Lecturer of general surgery department at Al - Azhar faculty of medicine Assiut
Corresponding Author: Emad A. Ibrahim,E mail: demad1975@gmail.com, Mobile phone:01559355254
ABSTRACT
Background: Twenty percent to forty percent of those who have laparoscopic cholecystectomy experience perforation
of the gallbladder. The incidence of gallbladder perforation and its intraoperative implications may be reduced by using
ultrasound to dissect the gallbladder bed during laparoscopic cholecystectomy, which might enhance surgical quality.
Objectives: This study aimed to compare between the conventional electrocautery dissection technique and the
ultrasonic gall bladder dissection.
Methods: The research included 120 adult patients with symptomatic gallstone disease who were candidates for
laparoscopic cholecystectomy. Each patient's demographic information, as well as clinical, radiological, and laboratory
data, were evaluated. Study was conducted in Safa Almadinah Hospital in Saudi Arabia between June 2019 and May
2022.
Results: There was no major difference between the two groups in terms of baseline characteristics and demographic
data. Before surgery, ultrasonography data showed no major differences between the two groups. There was significant
increase in the incidence of complications in Electrocautery group except for the need to insert hemostatics and stone
leakage there was no significant difference between the two groups.
Conclusion: In order to improve the surgical course of laparoscopic cholecystectomy, ultrasonic dissection is used. This
is because ultrasonic dissection is both safe and effective in minimizing the risk of gallbladder perforation, as well as
the time needed and the possibility for complications.
Keywords: Dissection, Electrocautery, Ultrasonic, laparoscopic cholecystectomy.
INTRODUCTION
radiological, and laboratory data, were evaluated. Study
When symptoms of gallstones are evident, the
was conducted in Safa Almadinah Hospital in Saudi
"gold standard" therapy is a cholecystectomy performed
Arabia between June 2019 and May 2022. Before the
using a laparoscope. Bile leakage and stone loss my
conduction of the study, the Local Ethical Committee
happen due to gallbladder rupture during dissection
approved the work. All gave consent to participate in
from the liver bed (1).
the work.
Gallbladder perforation has been observed in
20%-40%
of
patients
after
laparoscopic
Exclusion criteria: Patients with common bile duct
cholecystectomy. Perforation of the gallbladder, which
stones, suspected gallbladder cancer based on
causes bile leakage and stone loss, interrupts and
ultrasound and subsequent computed tomography
prolongs the therapy. The most often utilized cutting
results, and patients unable to undergo laparoscopic
technique for removing the gallbladder from the hepatic
surgery were excluded.
bed is monopolar electrocautery (2). It has been linked to
Patients were randomly allocated to either monopolar
both local and remote tissue injury, which might result
electrocautery or ultrasonic dissection soon before
in gallbladder perforation during gallbladder bed
surgery using the envelope approach. They were
dissection (1). Ultrasonic dissection has been shown to
distributed in a one-to-one proportion.
reduce gallbladder perforation during laparoscopic
cholecystectomy
in
contrast
to
monopolar
Electrocautery group: included 60 patients treated
electrocautery (3).
with electrocautery dissection.
One way in which ultrasonic dissection may
improve the quality of laparoscopic cholecystectomy by
Ultrasonic group: included 60 patients treated with
reducing the risk of gallbladder perforation and the
ultrasonic dissection.
complications that come with it during surgery (4). We
In the ultrasonic dissection group, the gallbladder
compared standard electrocautery dissection against
was dissected using Harmonic Ace curved shears.
ultrasonic gall bladder dissection during laparoscopic
Before enrolling patients in this study, we obtained
cholecystectomy.
written informed consents from them. All patients had
successful laparoscopic cholecystectomy utilizing one
MATERIAL AND METHODS
of the dissection approaches, according to the random
The research included 120 adult patients with
assignment.
symptomatic gallstone disease who were candidates for
Before any procedures were conducted, thorough
laparoscopic
cholecystectomy.
Each
patient's
patient histories were documented. This included the
demographic information, as well as clinical,
patients' ages, genders, body mass indexes, symptoms,
5871
Received: 27/8/2022
Accepted: 3/9/2022
c:\work\Jor\vol891_274
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5875- 5881
The Pattern of Soluble Urokinase Plasminogen Activator Receptor (suPAR)
Levels in Lupus Nephritis and Its Correlation with Renal Biopsy
Nafesa M. Kamal1, Salem Aly El Deeb1, Ahmed Mohamed Gaballah2,
Sara Ghwnimy Bayomy El Said Eissa*1, Salama E. Farag1
Departments of 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Sara Ghwnimy Bayomy El Said Eissa, Mobile: (+20) 01145605011, E-Mail: drsara.eesa@gmail.com
ABSTRACT
Background: Systemic lupus erythematosus (SLE) is systemic autoimmune disease with variable clinical presentations.
Lupus nephritis (LN) is type of glomerulonephritis that affect SLE patients and considers one of the most serious organ
manifestations of SLE. SLE patients may develop LN within 5 years of SLE diagnosis and, in many cases, LN is the
presenting manifestation.
Objective: Our study aimed to determine the value of suPAR levels in lupus nephritis patients and its correlation with
renal biobsy.
Patients and Methods: This study was conducted in the Outpatient Clinics of Internal Medicine of Zagazig University
Hospitals, Egypt, on 90 subjects both females and males. These participants were divided into three groups: Group (A):
Comprised 30 SLE patients according to the 2019 EULAR/ACR classification criteria for SLE, without LN. Group (B):
Included 30 SLE with LN patients. Group (C): Involved 30 healthy individuals were chosen with age and sex matching
previous groups. Soluble urokinase plasminogen activator receptor (suPAR) was measured for all groups.
Results: Our study revealed there was statistically significant increase suPAR in LN and SLE patients compared to
control participants and also in LN patients compared to SLE patients. There was a statistically significant positive
correlation between suPAR and LN class in LN patients as suPAR level increased with increased degree of LN class.
Our results show suPAR had sensitivity 93.3%, specificity 90% and accuracy 91.7% in diagnosis of LN.
Conclusion: Circulating suPAR can be considered a good marker to identify high risky patients with disease progression
especially LN.
Keywords: Soluble Urokinase Plasminogen Activator Receptor, Lupus Nephritis, Inflammatory Biomarker, Immune
Disease, Systemic Lupus Patients.
INTRODUCTION
as the classic parameters such as GFR, urine sediment,
Systemic Lupus Erythematosus (SLE) is a
proteinuria, anti-dsDNA and complements level are not
worldwide autoimmune disease which causes
sensitive or specific enough in detection and follow up
significant morbidity and mortality rates. It is
of LN (4).
characterized by the loss of self-tolerance and formation
of nuclear autoantigens and immune complexes, which
AIMS OF THE STUDY
results in systemic inflammation involves multiple
This study aims to determine the value of
organs such as skin, joints, kidneys and nervous system
suPAR levels in SLE patients and its role in prediction
(1).
of LN.
Lupus nephritis (LN) is a common sever organ
manifestation of SLE which affects about 40% of SLE
PATIENTS AND METHODS
patients within 5 years of onset of the disease. Despite
A prospective, comparative, case-control
of ever-evolving diagnostic and therapeutic methods,
study was conducted in the outpatient clinics of Internal
LN still causes high rates of end-stage renal disease
Medicine of Zagazig University Hospitals, Egypt (from
(ESRD) development and high mortality rates (2).
30/6/2021 to 30/3/2022).
Soluble urokinase plasminogen activator
receptor (suPAR) is an emerging inflammatory
Ethical consent:
biomarker generated from shedding of urokinase
Approval for performing the study was
plasminogen activator receptor (uPAR), which is a
obtained from Internal Medicine Department and
membrane-bound receptor acts as biological mediator
Zagazig
University Hospitals after taking
of inflammation and host immunological response.
Institutional Review Board (IRB) approval. All the
Circulating suPAR is upregulated in cases of chronic
procedures used in the present study were in keeping
inflammation and consequent immune response, and it
with the current revision of the Helsinki Declaration.
is less likely to be affected by acute changes, unlike C-
All participants were informed of the various aspects
reactive-protein (CRP). Therefore, suPAR acts as a
of the study, and they were enrolled only after
prognostic inflammatory marker which can predict the
providing a signed consent form.
prognosis and mortality of several diseases (3).
Despite the improvement in diagnosis and
This study involved 90 subjects both females
treatment of SLE, still there is a need for new
and males, their ages ranged from 18 to 58 years old.
biomarkers in LN prediction, diagnosis and follow up,
Sixty patients were diagnosed to have SLE according to
5875
Received: 27/06/2022
Accepted: 03/09/2022
c:\work\Jor\vol891_275
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5882- 5885
Evaluation of Surface Hardness and Color Stability of Two Different Glass Ionomer
Cements After Treatment with Calcium Chloride: An In-Vitro Study
Yasmeen Khallaf Ahmed, Basma Gamal Awad, Amr Mahmoud Abdelaziz
Department of Pediatric Dentistry, Faculty of Dentistry, Ain Shams University.
*Corresponding author: Yasmeen Khallaf Ahmed, Mobile: (+20) 01007087258, Email: yamena.kh@gmail.com
ABSTRACT
Background: Glass ionomer cements (GICs) is one of the materials of choice for restoring carious teeth in children due
to its good qualities. Some modifications were made on GIC to improve its properties such as calcium chloride (CaCl2)
solution application.
Objective: The purpose of this study was to evaluate the effect of 42.7 weight percent (wt%) CaCl2 solution on two
GIC restorations in relevance to color stability and surface hardness.
Methods: Forty GIC specimens were prepared for each of the two tests and grouped according to the type of GIC into
Fuji II light cure (Fuji II) group (n=20) and Fuji IX group (n=20). Each group was further subdivided into two subgroups:
control (n=10) and experimental (n=10). Control specimens were left to set without treatment for five minutes.
Experimental specimens were left to set for five minutes and then each specimen was immersed in ten milliliters (ml)
of 42.7 wt% CaCl2 solution for 60 seconds.
Results: Fuji II group showed significant change in color after seven days while Fuji IX group showed no change in
color at different time intervals. For surface hardness test, Fuji IX showed increase in surface hardness while Fuji II
showed no change in surface hardness.
Conclusion: Treatment of GIC with CaCl2 solution does not affect the color stability of Fuji IX GIC but it might affect
that of Fuji II GIC. CaCl2 application on GIC improved the surface hardness of Fuji IX GIC however surface hardness
of Fuji II had not changed.
Keywords: Calcium chloride solution, Glass ionomer cements, Color Stability, Surface hardness.
INTRODUCTION
GICs are widely used restorative materials in
MATERIALS AND METHODS
dentistry especially in pediatric dentistry. GIC has some
Two types of GIC were used in this study: Fuji
advantageous properties, it has similar thermal
II LC capsule (GC Corp., Tokyo, Japan) and Fuji IX GP
expansion coefficient to that of dentin [1], chemical
capsule (GC Corp., Tokyo, Japan). Calcium Chloride
adhesive properties [2], and fluoride release property [3].
salt (CaCl2; Calcium Chloride Anhydrous, Alpha
In spite of the advantageous properties of GIC, it has
Chemika, India, batch no.cc062) will be dissolved in
some drawbacks. GICs has early water sensitivity and
deionized water at concentrations of 42.7 wt%. All
has slow setting process, which affects and delay its
materials were manipulated according to manufacturer
final strength [4].
instructions.
Some modifications were made on GIC
composition to improve its properties such as laser
Sample size:
system [5] and radiant heat transfer, or ultrasonic energy
A power analysis was designed to have
application on restoration surface [6]. Calcium Chloride
adequate power to apply a two-sided statistical test of
application is one of the modifications that was made on
the null hypothesis that there is no difference would be
GIC. It has been found that application of CaCl2 on GIC
found between tested groups. By adopting an alpha ()
improve its setting reaction, its physical and its
level of 0.05, a beta () of 0.2 (i.e. power=80%), and an
mechanical properties [7].
effect size (d) of 1.32 calculated based on the results of
Finally, there is considerable support in literature
a previous study [8]. The total sample size was 80
that favors using CaCl2 solution for improving some
samples: 40 for Fuji IX group and 40 for Fuji II LC
mechanical properties but there were no studies done to
group. The 40 disks for each type of GIC were further
test its effect on color stability. Accordingly, this study
divided into 20 disks for each of the two tests. Each
was formulated to test the effect of CaCl2 solution on
group was further subdivided into two subgroups:
two types of GIC; a high viscous GIC (Fuji IX) and a
control subgroup (n=10) and experimental subgroup
resin modified GIC (Fuji II). Regarding surface
(n=10). Sample size calculation was performed using
hardness and color stability since there was no adequate
G*Power version 3.1.9.7
research conducted in this sector upon reviewing
literature.
Steps for disk shaped specimens' preparation for
The purpose of this study was to evaluate the effect
both groups:
of 42.7 weight percent (wt%) CaCl2 solution on two
For preparation of disk-shaped specimen
GIC restorations in relevance to color stability and
measuring a specially designed custom-made split
surface hardness.
Teflon mold was fabricated with 7 mm diameter and 2
5882
Received: 27/06/2022
Accepted: 03/09/2022
c:\work\Jor\vol891_276
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5886- 5894
Comparing Intramedullary Nailing and Plate Fixation in Management of
Displaced Extra-Articular Distal Tibia Fractures
Rabeea Faraj Mohammed Almishri*, Omar Abdelwahab Kelany,
Amr Mohammed Aladawy, Mohammed Khalid Saleh
Department of Orthopedic Surgery Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Rabeea Faraj Mohammed Almishri, Mobile: (+20) 01069260182, E-Mail: rabeafarj943@gmail.com
ABSTRACT
Background: Locked plating and intramedullary (IM) nailing are 2 used common modalities in treating distal tibia
extra-articular fractures.
Objectives: To study and compare between techniques regard outcome and complication therefore, to improve outcome
of patients with displaced extra-articular distal tibia fractures.
Patients and Methods: The current trial was a non-random controlled clinical trial conducted on 18 patients with tibial
fracture at the Orthopedic Department, College of Medicine, Zagazig University. A total of 18 patients were divided
into 2 groups of 9, with 9 patients in Group (I) receiving an intramedullary nail and 9 patients in Group (II) receiving a
plate.
Results: Operation duration and hospital stay were longer among plate group. Majority of both groups were excellent
and good. We found that nail group has better outcome. The postoperative Teeny and Wiss score's did not differ
significantly across the groups. In terms of postoperative complications, there was no significant difference between the
groups.
Conclusion: Both techniques can provide effective treatment and fixation for closed extra-articular fractures.
Intramedullary nailing showed lower infection rate and faster time to healing but with more mal-alignment reduction.
Keywords: Extra-articular Distal Tibia Fractures, Intramedullary Nailing, Plate Fixation.
INTRODUCTION
In terms of long bone fractures, distal tibial
Although a ' locking' tibial plate can help with
fractures are the most prevalent. 17 per 100,000 years(1),
reduction, the increased soft tissue dissection that is
while newer research suggests that this number may be
required raises the danger of infection, wound collapse,
on the reduction (2).
and collateral injury (6). Until the proximal two-thirds and
Most of the time, these injuries occur as a result
distal thirds of the tibia join, the medullary cavity is very
of a high-energy traumatic incident, such as a fall from a
homogeneous across the bone. At that point, the cavity
great height, car accident, motorbike accident, or sporting
begins to enlarge until it reaches the subchondral area of
event (2).
the ankle. Because of this, you can see why nails tend to
Fractures of the distal tibia are often classified as
pull out of such fractures. However, open reduction with
either intra-articular or extra-articular (42A1 and 43A1)
internal fixation employing plate fixation remains
classification by AO and OTA. Extra-articular fractures
challenging due to the restricted soft tissue envelope at
are further subdivided into three categories based on their
this location. Nonunion and other soft tissue problems are
morphology and degree of comminution: 43-A1 refers to
common results of this (7).
non-comminuted fractures, 43-A2 refers to wedge
Patients with extra-articular distal tibial fractures
fractures, and 43-A3 refers to comminuted fractures.
treated with either nail or screw fixation had comparable
Fractures that simply extend into the joint without
rates of deep infection, delayed union, and implant
depressing the joint surface are classed as 43-B1, and are
removal, but nail fixation was linked to considerably
often treated in the same way as 43-A fractures (3,4).
more malunions, as described by Mao et al. (8). By
The mechanism of damage, treatment, and
contrast, Zelle et al. (9) discovered that the rates of
prognosis for these breaks are distinct from those of pilon
malunion were comparable between the two groups.
breaks (intra-articular distal tibial breaks). In comparison
to diaphyseal or mid-thigh fractures, the consequences
AIMS OF THE STUDY
that arise from being so close to the ankle joint are much
The purposes of this research are to study and
higher. As a result, there are still challenges in treating
compare between techniques regard outcome and
distal tibia fractures (5).
complication therefore, to improve outcomes of
Although there are several options for treating
displaced extra-articular distal tibia fractures.
these fractures, including locking plates and
intramedullary (IM) nails, each has its own set of
SUBJECTS AND METHODS
drawbacks. Intramedullary nailing has a higher risk of
Subjects:
anterior knee discomfort, a broken bolt or screw across
At Orthopedic Surgery Department of Zagazig
the nail, and bone malalignment (5).
General Hospital 18 patients who had extra-articular
distal tibial fractures as intramedullary nailing, or plating
5886
Received: 27/06/2022
Accepted: 03/09/2022
c:\work\Jor\vol891_277
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5895- 5896
Anesthetic Management of Cesarean Section for A Covid-19
Positive Patient: Case Report
Elhaisam Mohamed Taha, Omima Emad Eldin*, Asmaa Saad, Marwa Ahmad Mahrous
Department of Anesthesia and Intensive Care, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Omima Emad Eldin, Mobile: (+20) 01093181802, E-Mail: omimaemad2008@yahoo.com
ABSTRACT
Background: Covid19 infection became one of the most widespread respiratory tract infections worldwide. The
pandemic lastly spreading in Egypt made a great challenge for the health workers of different specialties. Anesthetists
had to solve difficult problems related to the infected patients requiring surgical interventions and to make the balance
between patient safety and medical team protection during the procedure. Objective: This study aimed to check for
clear guideline protocol for anesthetic management of Covid-19 cases undergoing cesarean section, here is a case
presentation for a twins pregnant patient.
Case presentation: Female patient 32 years old diagnosed as covid-19 positive prepared for cesarean section for
delivery of preterm twins with CT finding corads 5, clinically presented by acute respiratory distress syndrome (ARDS).
The patient received spinal anesthesia associated with tap block, oxygenation was done by closed circuit system of the
anesthesia machine with partial closure of adjustable pressure limiting (APL) valve and hypotension was managed by
noradrenaline infusion during the procedure.
Conclusion: Combined spinal anesthesia with tap block was the most successful modality for anesthesia for cesarean
section (CS) in severe cases of covid-19 infected patients.
Keywords: Anesthetic management, Cesarean section, Covid-19.
INTRODUCTION
Fully conscious, irritable with facial look of respiratory
In spite of the theoretical expectation of increased
distress (working Ala Nasi), HR130 beat/minute,
risk of infection with covid-19 among pregnant females
regular, average pulse volume, BP = 110/80 mmHg, RR
in comparison with non-pregnant females, there is no
= 30/minute, temperature = 39C and SPO2 = 75% on
enough data to prove this (1-3). On the same side, there is
room air.
no enough data to prove that a worse clinical picture will
CT chest showed bilateral lung infiltrate (corads
be found in a pregnant woman compared to non-
5), arterial blood gas (ABG) was PH 7.42, PCO2 = 30
pregnant one if both got the infection at the same time.
mmHg, PO2 = 40 mmHg and HCO3 = 21 mEq/L.
Pregnant females with covid-19 infection are more
Patient was immediately admitted to intensive care
liable for obstetric complications involving CS,
unit (ICU) on isolation unit that was noninvasive
eclampsia, preterm labor and intrauterine fetal death (4,
ventilation using continuous positive airway pressure
5). There is no clear guideline protocol for anesthetic
(CPAP) mask started to find good response and marked
management of covid-19 cases undergoing cesarean
improvement of oxygenation and respiratory distress.
section, here is a case presentation for a twins pregnant
Three days later after admission, obstetricians decided
patient.
to terminate pregnancy based on the bad general
CASE REPORT
condition of the mother and the babies.
A female patient 32 years old with history of
Patient was then referred to the operative room
primary infertility for seven years for gynecological
for purpose of cesarean section and termination of
causes presented by fever, myalgia, and respiratory
pregnancy.
distress during the third attacking wave of covid-19
Medical team protection was in the form of n95
infection in Egypt. Nasopharyngeal and oropharyngeal
respirator, face shield, gown, overhead and gloves
swabs were done to ensure the suspected diagnosis of
according to international protection guidelines against
covid-19. The CT findings were corads 5 with bilateral
covid-19 infection.
lung infiltration (Figure 1). On arrival to hospital the
The challenge was the choice of anesthetic
patient condition was as the following:
modality in her condition as regards hypoxia, lung
affection and respiratory distress.
Oxygenation started by the bag and mask of the
anesthesia machine and partial closure of the APL valve
was done to maintain peep on 10 cm H2O, oxygen
saturation after this maneuver was 88%.
Monitoring was in the form of pulse oximetry,
non-invasive
blood
pressure
(NIBP),
electrocardiography (ECG), Capnography and invasive
blood pressure (BP) monitoring system.
500 cc of normal saline were give as a bolus over
Figure (1): CORADS (5) CT chest findings.
30 minutes-duration to maintain a normo-volemic state.
5895
Received: 27/8/2022
Accepted: 3/9/2022
c:\work\Jor\vol891_278
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5897- 5904
Retracted article
1
Received: 27/06/2022
Accepted: 03/09/2022
c:\work\Jor\vol891_279
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5905- 5913
Effect of Early Introduction of Calcium Carbonate on Fibroblast
Growth Factor 23 (FGF23) Levels in Children with Normophosphatemic
Early Chronic Kidney Disease (CKD)
Samuel Helmy Makar1, Balsam Sherif Fahmy2, Bahaa Kamal Elsakhawy3, *Eman Abobakr Abd Alazem1
Departments of 1 Pediatrics and 2 Clinical and Chemical Pathology, Kasr Alainy Faculty of Medicine, Cairo University,
Cairo, Egypt, 3 Department of Pediatrics, Alagouza Hospital, Ministry of Health, Cairo, Egypt
*The corresponding author: Eman Abobakr Abd Alazem
Email: emanabobaker363@yahoo.com/emanabobaker363@cu.edu.eg
Mobile: +02 01005574801/ +02 01205551851, ORCID: 0000-0003-2247-2183
ABSTRACT
Background: Fibroblast Growth Factor 23 (FGF23) is considered as a marker of progression of kidney disease. Objective:
the aim of the study: is to assess the effect of administration of calcium carbonate on serum FGF23 in normophosphatemic
children with early stages CKD.
Patients and Methods: Forty children with early CKD were enrolled in this case-control study. The patients were randomly
divided equally into two groups A and B. Group A (received daily oral calcium-carbonate as a phosphate binder) over a
period of 6 months, and group B (did not receive oral phosphate binder or calcimimetics). Baseline and follow up urea,
creatinine, serum phosphate, serum calcium, alkaline phosphatase, 25 hydroxy vitamin D, parathormone (PTH) and serum
FGF23 were obtained at the start and at the end of the study period.
Results: Group A showed a significant decrease in serum levels of P, ALP and 25 hydroxy vitamin D (p-values: <0.001,
0.003, 0.0001 respectively). Also, there was non-significant decrease of PTH and serum FGF-23 (p-values: 0.39 and 0.396
respectively). While in group B there was a significant increase in levels of phosphate, PTH and FGF23 (p-values: 0.012,
<0.001, <0.001) respectively, in contrast to significant decrease in levels of serum calcium and 25 hydroxy vitamin D (p-
values: 0.033 and <0.001 respectively).
Conclusion: Oral calcium-based phosphate binder has a role in decrease production of FGF23 and control secondary
hyperparathyroidism in early CKD children.
Keywords: CKD, FGF23, Phosphate binders and PTH.
INTRODUCTION
In children, chronic kidney disease (CKD) became a
binder on serum FGF23 in normophosphatemic children
serious health issue as it became more frequent and
with early stages CKD.
related co morbidities(1). Fibroblast Growth Factor 23
(FGF23), along with parathormone (PTH) and
PATIENTS AND METHODS
1,25(OH)2D3, is one of three hormones that regulate
This case control study was conducted on 40
phosphate homeostasis and is released by osteocytes in
children with normophosphatemic, CKD stages 2 (eGFR:
the bone (2).
60-89 mL/min/1.73 m2), 3a (eGFR:45-59 mL/min/1.73
Bone mineral disease is one of the consequences of
m2) and 3b (eGFR: 30-44 mL/min/1.73 m2) (KDIGO
chronic renal disease (CKD-BMD), this results from
2012) 9 aged from 2 to 18 years old following at
hyperphosphatemia and an increase in serum FGF 23
Outpatient Nephrology Clinic, Cairo University Children
level (3).
Hospital.
Serum FGF23 level rises in early CKD to control
Patients that fit the following criteria weren't included in
phosphate retention by reducing phosphate reabsorption
the study: patients with hyperphosphatemia 10, marked
by renal tubules. With the progression of the renal disease,
hypocalcemia (total serum calcium <7 mg/dl) 11, previous
blood FGF23 levels rise and inhibit 25(OH) 2D3
or current treatment with phosphorus binders or active
production, resulting in hypocalcemia and secondary
vitamin D, malnutrition (serum albumin<3.0 mg/dl) 12,
hyperparathyroidism 4.
use of phenytoin (may induce vitamin D deficiency) and
There is conflicting evidence from earlier studies that
primary
parathyroid
disease,
or
previous
suggests using calcium-based oral phosphate binders can
parathyroidectomy.
either have no effect on FGF23 levels 5 or cause them
decrease (6-8).
Ethical Consideration:
The purpose of this research is to evaluate the effect
Research Ethics Committee at Cairo University,
of administration of calcium carbonate as oral phosphate
Egypt, approved this research. The Ethical Committee
approval number is MS-176-2019. Participants' legal
5905
Received: 26/6/2022
Accepted: 2/9/2022
c:\work\Jor\vol891_280
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5914- 5922
QT Interval and P Wave Dispersion in Slow Coronary Flow
Phenomenon in Patients with Acute Coronary Syndrome
Mohamed Elawady, Tamer M. Moustafa, Mohamed Safwat, Basem N. Amin*
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Basem N. Amin, Mobile: (+20) 01003481570, E-Mail: dr.basem.nagy@gmail.com
ABSTRACT
Background: When there is minimal epicardial coronary stenosis, the coronary slow flow phenomenon (CSFP) is
characterized by delayed distal artery opacification. The sluggish velocity of dye in coronary arteries is known as the
slow coronary flow (SCF) phenomenon. Dispersion in QT interval and P wave are 2 electrocardiographic findings which
can predict predisposing of individuals for developing fatal arrhythmia. The aim of this study was to find association
between QT interval and P wave dispersion in acute coronary syndrome patients with CSFP.
Patients and methods: This cross-sectional study was carried out on 200 cases undergoing diagnostic coronary
angiography; Group 1 included 100 patients with acute coronary syndrome and CSFP, and Group 2 included 100
patients with acute coronary syndrome without CSFP.
Results: We found no statistically significant differences between Group 1 and Group 2 according to demographic data,
diabetes mellitus, hypertension, dyslipidemia and smoking. QTD, PWD, CTFC LAD, CTFC LCX, CTFC RCA and
CTFC were significantly higher among Group 1. QTD showed AUC of 0.996. At best cutoff value of 46.5, sensitivity
was 99.75% and specificity was 99.8%. PWD showed AUC of 0.99. At best cutoff value of 23.5, sensitivity was 96.55%
and specificity was 98.3%. QT interval showed significant positive correlations with PWD and CTFC. Otherwise, QT
interval showed non-significant correlations with other parameters in all studied cases. Conclusion: There is an
association between QT interval and PWD in acute coronary syndrome patients with slow coronary flow phenomenon.
Keywords: Acute Coronary Syndrome, Slow Coronary Flow Phenomenon, QT interval, P wave dispersion.
INTRODUCTION
understanding about measurement and significance of
Most fatal myocardial infarctions were brought
QT interval (3).
on by plaque rupture, which is occasionally referred to
P-wave dispersion, which is the difference
as a fissure. These discoveries gave rise to the idea of
between the highest P-wave duration and the shortest P-
the high-risk or susceptible plaque, which is
wave duration measured from numerous separate
distinguished by a thin fibrous cap, a big central lipid
Electrocardiographic (ECG) leads, is a contribution to
core, a surplus of inflammatory cells, and a dearth of
the study of noninvasive electrocardiology. The method
smooth muscle cells (SMCs). These findings gave rise
for recording and analyzing P-wave inscriptions has
to the now-accepted theory that the fissuring of a thin-
been improved, which may lead to the widespread use
capped fibroatheroma occurred from an inflammatory-
of this ECG marker in clinical settings, particularly in
induced weakening of its collagen structure, which led
the determination of atrial fibrillation (AF) risk (4).
coronary atheromata to become unstable. A measure of
Eshraghi et al. (5) evaluated the relation between
inflammation called C-reactive protein (CRP) was
SCF and presence of P-wave and QT-interval dispersion
present in about half of acute coronary syndromes
in electrocardiography. They showed that TIMI Frame
(ACS) cases (1).
Count (TFC) TFC among patients with SCF will result
In the absence of substantial epicardial coronary
in P wave and QT interval dispersion and therefore this
stenosis, the coronary slow flow phenomenon (CSFP) is
finding can be considered as an indicative marker for
an angiographic clinical entity defined by delayed distal
cardiac events. Therefore, this study aimed to find the
artery
opacification.
Although
interventional
association between QT interval and P wave dispersion
cardiologists have been aware of it for around 40 years,
in ACS patients with slow coronary flow phenomenon.
the pathogenic mechanisms are still not fully
understood. Since CSFP has been connected to clinical
PATIENTS AND METHODS
signs of myocardial ischemia, life-threatening
Our cross-sectional study included patients with
arrhythmias, sudden cardiac death, and recurring acute
unstable angina, non-ST-segment elevation myocardial
coronary syndromes, it has direct clinical consequences
infarction (NSTEMI) and ST-segment elevation
rather than being only an angiographic curiosity (2).
myocardial infarction (STEMI) candidate for coronary
QT interval extends from the beginning of QRS
angiography at Cardiology Department, Zagazig
complex to the end of T wave. Thus, it includes the
University Hospitals.
duration of ventricular depolarization (QRS) and
repolarization (J point to end of T wave). It corresponds
The patients were divided into:
to the duration of cellular action potential. "long-" and
Group 1 included patients with acute coronary
"short"-QT intervals are considered as risk markers for
syndrome and slow coronary flow, and Group 2
cardiac arrhythmias and sudden death. In the last
included patients with acute coronary syndrome without
decade, there have been significant advances in our
slow coronary flow.
5914
Received: 26/06/2022
Accepted: 02/09/2022
c:\work\Jor\vol891_281
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5923- 5927
Changes in Substance P and Calcitonin Gene-Related Peptide Serum Levels in
COVID-19 Patients- For Better Understanding of Disease Biology
Osama M. Mehanna1*, Noura F. Elmongy1, Ahmad A. El Askary2,3
1Department of Medical Physiology, 3Department of Medical Biochemistry,
Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
2Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, KSA
*Corresponding author: Osama M Mehanna, Email: osama.mahanna@domazhermedicine.edu.eg,
Mobile: (+20) 1027587586, Orcid iD: 0000-0002-3076-5130
ABSTRACT
Background: To win the ongoing battle against the emerging coronavirus, new strategies are needed for reliable
diagnosis and more effective treatment, which requires a better understanding of disease biology. This study aimed to
determine the changes in Substance P (SP), and Calcitonin Gene-Related Peptide (CGRP) serum levels as a result of
SARS-COV-2infection, and to correlate these changes with the pathophysiological events affecting the severity of the
disease.
Patients and Methods: Serum levels of SP and CGRP were measured for 20 healthy volunteers assigned as controls, and
64 COVID-19-positive patients, subdivided according to disease severity, into 3 groups assigned as asymptomatic (n = 19),
hospitalized (n = 24), and ICU admitted (n = 21) groups. The results were statistically compared between the studied groups.
Results: The serum levels of SP were significantly elevated in COVID-19 patients (P<0.001) when compared to the control
samples, with significant increases between COVID-19 groups due to disease severity. On the other hand, serum levels of
CGRP in COVID-19 patients, were greatly decreased (P<0.001) as compared to normal controls, with no effect driven by
disease severity
Conclusion: SP and/or CGRP can be measured as diagnostic and prognostic biomarkers in SARS-COV-2 infection.
Adjusting CGRP level in COVID-19 patients is very important for proper angiogenesis, powerful immune response, and
good epithelial repair, so may represent a novel therapeutic approach. Also, targeting NK-1Rs or TRPV-1, could modulate
the inflammatory and immune responses in COVID-19, leading to better disease outcomes.
Keywords: Substance P, Calcitonin Gene-Related Peptide, COVID-19, Cytokine Storming
INTRODUCTION
airways, lung parenchyma, and lymphoid organs, where
As the world is (hopefully) emerging from the
SP is released as a neurotransmitter (NT), for
Covid-19 pandemic, which represented the world's
neuroimmunoregulation (i.e., coordinates between the
biggest challenge in the past few years, that killed
nervous and the immune systems)6. Several studies have
millions of people, along with its enormous impact on
reported elevated serum levels of SP with cancers and
nations' economies, safety and religious practices1, new
several viral infections including HIV/AIDS and
strategies are needed for reliable diagnosis and conclusive
respiratory syncytial virus (RSV)7.Recent studies
treatment, which requires a good understanding of
investigating the novel SARS-CoV-2, accuses the SP of
pathophysiology, and inflammatory pathways of the
being the main trigger of many inflammatory pathways in
disease and its complications. This study attempted to
the course of the COVID-19 pandemic caused by this
correlate the neuroimmune functions of 2 neuropeptides
damn virus8, as it is over secreted to direct the immune
(SP and CGRP), with the pathophysiology of COVID-19,
cells and other cells in the respiratory tract to release
and to investigate whether the cytokine storming (the
cytokine storming mediators responsible for many serious
actual killer in COVID-19)2, is directly related to the
complications of the disease6. So, we can conclude that
changes in their serum levels subsequent toSARS-CoV-
NK-1Rs may be a target for those interested in developing
2infection.
new therapeutic approaches for COVID-19.
Substance P (SP):
Calcitonin Gene-Related Peptide (CGRP):
Substance P (SP), the first inflammatory neuropeptide
Calcitonin gene-related peptide (CGRP) is a potent
(11 amino-acids), discovered by Euler and Gaddum in
vasodilating, angiogenic and immune modulating peptide
19313, is the most common modulator of
(37 amino-acids)9, primarily localized to C and A
neuroimmunoregulation in the lungairways4. In addition
sensory fibers, which have a dual sensory and motor
to their abundant expression in central nervous system,
functions, and displayed widely throughout the body,
peripheral nervous system, and gastrointestinal tract5, SP
with extensive perivascular localization10. At present,
and its selective receptors Neurokinin 1 (NK-1Rs), are
little is known about its nonneuronal localization, as well
widely expressed in the sensory neurons innervating the
as its role, despite excellent previous studies11. In the
5923
Received: 26/6/2022
Accepted: 2/9/2022
c:\work\Jor\vol891_282
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5928- 5934
Prevalence of Hepatitis E Virus Infection in Hemodialysis Patients
Mohamed Shemis1; Omar Sabry2, Tamer Abdel Tawab3, Samia El-Shishtawy3, Ahmed R. Mashaal4,
Ali Abdel Rahim4*, Hanem Hassan1, Samah Mamdouh1, Shereif A. Morsy4, Hany Elghobary5, Nevine Sherif3
1Biochemistry &Molecular Biology Department, 2 Hematology Department, 3 Nephrology Department, 4Hepato-
Gastroenterology Department, Theodor Bilharz Research Institute, Giza, Egypt
5 Clinical & Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
*Corresponding author: Ali Abdel Rahim, Mobile: (00201225884450) E-mail: ali_tbri_1982@yahoo.com
ABSTRACT
Background: There are many studies about the epidemiology of hepatitis E virus (HEV) in the general population, but the data
about HEV infection among patients with end-stage renal disease (ESRD) give conflicting results. Although the parenteral route
may be involved in the transmission of HEV infection, several investigators have suggested that fecal-oral transmission is the
primary transmission mode. We aimed to identify the seroprevalence of HEV in hemodialysis (HD) patients compared to the
seroprevalence of HBV and HCV infection, and examine the role of parenteral transmission. Methodology: Eighty-four patients
from TBRI's HD unit who had been receiving dialysis for more than six months were involved in the study. All the patients
were subjected to detailed medical history, full clinical examination, and routine investigations, including virology screening
and abdominal ultrasound. HEV seropositivity was investigated by ELISA for HEV-Ab (IgG), while active viremia was
assessed by RT-PCR for HEV RNA. Results: Out of the 84 patients, anti-HEV IgG antibodies were detected in five cases
(6.0%). A minor (P=0.001) and a moderate (P=0.01) increase in liver echogenicity by ultrasound were significantly correlated
with HEV seropositivity. Blood transfusion and HEV seropositivity did not significantly correlate (P=0.6). Neither HBsAg nor
HCV-Ab was related to anti-HEV antibody seropositivity. HEV RT-PCR was only positive in one case.
Conclusion: Compared to HCV (34.5%), the prevalence of HEV seropositivity was low (6%) in our patients. Parenteral
transmission of HEV was less likely. HEV routine screening may help lower the related morbidity and mortality in HD patients.
Keywords: HEV-IgG, Non-A Hepatitis, Hemodialysis, HEV prevalence.
INTRODUCTION
remarked on the great level of anti-HEV antibodies in those
Enteric non-A Hepatitis is commonly caused by HEV.
patients and considered other transmission modes by
It was believed until recently that HEV exists only in
nosocomial in addition to the fecal-oral route (10-12). Other
developing countries, where it was associated with
authors reported low rates of anti-HEV-positivity in their
outbreaks through contaminated water supplies(1).
HD patients (13, 14). This study aimed to identify the
However, recent data have defined the virus as a worldwide
seroprevalence of HEV in HD patients compared to the
infection, probably related to either parenteral/vertical
seroprevalence of HBV and HCV infection and examine
transmission or zoonotic fecal-oral infection. In addition, it
the role of parenteral transmission.
has recently been discovered that a changing rate of blood
and/or solid organ donors was positive for HEV-RNA (2, 3).
PATIENTS AND METHODS
In most cases HEV infection presents with an acute
A- Patients
self-limited disease; however, people who already have
The current work was performed at the
chronic liver disease are more likely to get acute on top of
Hemodialysis Unit in the Nephrology Department and
chronic liver failure. (4). The same applies to people with
Biochemistry & Mol. Biology Dep., Theodor Bilharz
impaired immune systems (like HIV-positive cases, organ
Research Institute. Eighty-four patients with ESRD on
transplant recipients, and cases with hematological
maintenance hemodialysis for more than six months
malignancies) (5,6).
were listed in the work.
These groups of cases have a greater incidence of
The patient's ages ranged between 19 and 76 years,
chronic infection progression; the incidence may reach up
33 (39.3%) were females and 51(60.7%) were males. All
to 50% in solid-organ transplant recipients (7). When an
were subjected to full medical history and clinical
infection becomes chronic, the liver may rapidly get fibrosis
assessment for signs of liver cell failure. Abdominal
and decompensates, which can sometimes result in
Ultrasonography (U/S) was performed for all patients.
mortality(8).
The causes of ESRD were as follows: hypertension
Patients with End-Stage Renal Disease (ESRD) have
(HTN) in 44 (52.4%), diabetes mellitus (T2DM) in 16
been acknowledged as a severe challenge in global public
(19.0%), congenital in 4 (4.8%), nephrocalcinosis in 4
health. All over the world, hemodialysis (HD) is still the
(4.8%), obstructive uropathy in 4 (4.8%), Non-steroidal
main therapy method used to treat ESRD patients. It is well-
anti-inflammatory drug (NSAID) in 4 (4.8%), chronic
recognized that HD cases are more likely to contract viral
glomerulonephritis (GN) in 2 (2.4%), and other causes
infections because they share dialysis machines, receive
which
include
(amyloidosis,
Systemic
lupus
blood transfusions frequently, require repeated hospital
erythematosus (SLE), and tubulointerstitial renal
stays, and have poor cellular immunity, making them
disease) in 6 (7.1%) cases.
especially susceptible to blood-borne viruses(9). Conflicting
The age (mean ± SD) of patients with HEV positive
data were published in the last two decades about the real
and negative serology was 53.4±12.5 and 55.9±14.4
prevalence of HEV in HD cases. Some investigators
respectively, with no significant difference (Table 1).
5928
Received: 27/6/2022
Accepted: 3/9/2022
RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5935- 5940
Effect of Direct-Acting Antiviral Therapy on Lipid Profile in
Egyptian Patients with Chronic Hepatitis C Infection
Shaimaa Hussien Gad Allah*, Emad Ahmed Awed, Hossam Samir Ebrahim AL Baz, Shimaa Adel Mahdy Ahmed
Internal Medicine & Gastroenterology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Shaimaa Hussein Gad Allah, Mobile: (+20) 01020911390, E-mail: shaimaahussen2022@gmail.com
ABSTRACT
Background: Widespread metabolic disturbances are linked to chronic hepatitis virus infection. Steatosis is caused by
HCV's interference with lipid metabolism. Low lipid profiles and the development of chronic liver disease are both
associated with hepatitis C virus infection.
Objective: We aimed to evaluate the effect of direct-acting antiviral therapy on serum lipid profile among Egyptians
with chronic hepatitis C infection.
Patients and Methods: Sixty individuals with chronic hepatitis C infection who were given direct-acting antiviral
treatment were analyzed in this study. 30 naïve patients received (sofosbuvir + daclatasvir) during 12 weeks and 30
naïve Patients received (sofosbuvir + daclatasvir + ribavirin) during 12 weeks, lipid profile was done before and after
treatment.
Results: In our results, the lipid profile regarding triglyceride and cholesterol, before treatment and throughout the entire
follow-up, neither group differed significantly from the other, but after three months, The levels of triglycerides and
cholesterol were significantly high in both group with much more higher in group I. Regarding LDL and HDL no
significant difference pretreatment was detected, but the increase in LDL and decrease in HDL were found in both
groups and in group I was significantly higher than group II after one and three months.
Conclusion: we conclude that Direct acting antiviral drug treatment for chronic HCV infection resulted in a dramatic
increase in lipid profile in these patients.
Keywords: Lipid Profile; Chronic Hepatitis C Infection; Direct-acting antiviral therapy.
INTRODUCTION
eliminated. On the other hand, a post-treatment rise in
Two and a half percent of the world's
lipid levels is influenced by the presence of advanced
population has HCV infection, making it a major threat
fibrosis (8).
to public health around the world. This amounts to
The serum lipid profile during DAA therapy
roughly 177.5 million people (1). The Egyptian
may represent not only the pharmacological effect of
population has a greater incidence of serum anti-HCV
DAAs but also recovery from the disturbance of lipid
(2). Several studies have linked HCV to poor lipid
metabolism caused by HCV (9). As the changes in these
profiles, making people more susceptible to conditions
parameters after HCV infection cure is of interest but
like dyslipidemia, liver steatosis, and progressive
are not well-documented, the current study intends to
fibrosis (3). It is believed that lipids may play a structural
analyze the influence of antiviral medicine on lipid
or regulatory role in the HCV life cycle. However,
profiles and explore the factors connected to changes in
hypobetalipoproteinaemia due to HCV binding to
lipid profiles in CHC patients.
lipoprotein has been observed and may be a major
The goal of this research was to determine how
avenue for decreasing lipid profiles during HCV
the administration of direct-acting antiviral medication
infection (4).
affected lipid profiles in the blood of Egyptians who
Dysregulated blood lipid levels, specifically
were suffering from chronic hepatitis C.
low levels of low-density lipoprotein cholesterol, have
been found by multiple investigations with HCV
PATIENTS AND METHODS
infection (5), and the levels of blood triglycerides (TG)
The Antiviral Therapy Center at Aswan Fever
in HCV infection are poorly understood. Deposition of
Hospital was the site of this prospective cohort study.
TG and liver steatosis have been linked to liver fibrosis
Sixty Egyptians with chronic hepatitis C infection were
in another investigation (6). The affection of chronic
studied; all were adults older than 18 and all were
HCV infection's fibrosis stage by lipid profiles has only
receiving direct-acting antiviral medication. According
been studied in a small number of cases.
to the April 2019 modification to the National
Despite the widespread use of direct-acting
Committee for the Control of Viral Hepatitis protocol,
anti-viral medications like protease inhibitors in the
patients were randomly assigned to one of two groups.
West, Despite this, many nations' primary treatment for
Group I: Included 30 naïve patients who received
HCV infection is still the combination of ribavirin
(sofosbuvir + daclatasvir) for 12 weeks. Both
(RBV) as well as Pegylated interferon-alpha (PegIFN)
sofosbuvir (400 mg) and daclatasvir (60 mg) are taken
for chronic hepatitis C (CHC)(7). The degree to which
orally once a day. Group II: Included 30 naïve Patients
lipid levels rise after PegIFN/RBV therapy is largely
received (sofosbuvir + daclatasvir + ribavirin) for 12
determined by how quickly the HCV RNA is
weeks. Both sofosbuvir (400 mg) and daclatasvir (60
5935
Received: 27/06/2022
Accepted: 03/09/2022
ABSTRACT
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5941- 5948
Ascitic Calprotectin, as a Potential Diagnostic and Prognostic Marker of
Spontaneous Bacterial Peritonitis
Hany Samir Rasmy1, Kadry Mohamed El Saeed1, Engy Yousry El Sayed1,
Fatma Badawy Mansour Al Hajajy2, Amira R. El-Ansary*2
1Department of Gastroenterology and Hepatology, Faculty of Medicine, Ain Shams University, Egypt
2Department of Internal Medicine, Faculty of Medicine, Misr University for Science and Technology (MUST), Egypt
*Corresponding author: Amira R. El-Ansary, Mobile: (+20)1064457770, Email: amira.elansary@must.edu.eg
ABSTRACT
Background: The presence of an elevated absolute polymorphonuclear leukocyte count in the ascitic fluid (>250
cells/mm3) in combination with a positive ascitic fluid bacterial culture is diagnostic of spontaneous bacterial peritonitis.
Among the families of calcium-binding proteins known as S100, calprotectin belongs to the subfamily known as
calgranulins. Objective: The aim of the current work was to examine the value of ascitic fluid calprotectin for the
diagnosis and prognosis of spontaneous bacterial peritonitis in people with liver cirrhosis.
Patients and Methods: Between April 2018 and May 2019, 50 Egyptians with liver cirrhosis and ascites were recruited.
Forty individuals with spontaneous bacterial peritonitis (SBP) and 10 patients with ascites without SBP were studied.
Biochemical, bacterial, and ascitic calprotectin level, as well as diagnostic paracentesis, were performed to all patients.
Results: When comparing individuals with cirrhosis and SBP to those without SBP, the level of calprotectin in the
ascitic fluid was significantly higher in SBP patients (P= 0.000). Its mean values were statistically significantly reduced
after treatment of SBP in comparison to its level before treatment [reduced from 626.75 ± 188.05 to 251.25 ± 223.13
ug/l] with p value 0.000. At a cutoff value of >320 ug/l, ascitic calprotectin may be a possible marker of development
of SBP among cirrhotic patients with ascites with 95% sensitivity and 90% specificity.
Conclusion: It could be concluded that ascitic fluid calprotectin may be useful in the diagnosis and prognosis of
patients with liver cirrhosis and spontaneous bacterial peritonitis.
Keywords: Liver cirrhosis, Spontaneous bacterial peritonitis, Calprotectin.
INTRODUCTION
Spontaneous bacterial peritonitis (SBP) is the
fluids are known to rise dramatically in many forms of
most prevalent bacterial illness in people with liver
inflammation. Excessive levels of calprotectin have
cirrhosis, and it accounts for ten to thirty percent of all
been seen in extracellular fluid in inflammatory diseases
bacterial infections diagnosed in hospitals (1).
such as: Cystic fibrosis, temporal arthritis, rheumatoid
SBP is diagnosed in cirrhotic patients with an
arthritis and abscesses (8).
ascitic polymorph nuclear leucocytic count (PMNL) of
The ascitic fluid levels of calprotectin in
250 cell/mm3, regardless of whether bacteria are
individuals with liver cirrhosis who have SBP are much
isolated from the ascitic fluid (2). Abdominal pain, fever,
higher than those of patients without SBP (7). Lutz et al.
as well as worsening of pre-existing ascites are the most
(6) stated that the ascetic fluid calprotectin to total
common symptoms, though up to one-third of cases are
protein ratio was an independent predictive predictor of
asymptomatic (3). Some people with SBP don't have any
30-day mortality and showed better diagnostic value for
symptoms, therefore finding a good marker is crucial.
SBP than calprotectin alone. Insufficient study has
Severe side effects of SBP include hepatorenal
made it difficult to determine how effective calprotectin
syndrome (HRS), hypovolemia, fluid and electrolyte
levels are in distinguishing between SBP and sterile
changes that can lead to shock or abrupt renal failure,
ascites (9).
and peritoneal abscess. Early detection of SBP requires
In this study we aimed for examining the value
a paracentesis, however this isn't always feasible and
of ascitic fluid calprotectin for the diagnosis and
may take too much time (4). It is therefore desirable to
prognosis of spontaneous bacterial peritonitis in people
discover new and relevant biomarkers for the early
with liver cirrhosis.
detection of SBP. Also desirable are laboratory tests that
can anticipate how a patient will respond to the first
PATIENTS AND METHODS
treatment as failure to respond to the initial treatment is
This study included a total of fifty Egyptian
associated with an increased risk of death and/or severe
patients with liver cirrhosis and ascites admitted to Ain
bleeding (5).
Shams University Hospitals during the period from
A noninvasive biomarker for gastrointestinal
April 2018 to May 2019.
inflammation, calprotectin, has emerged in the last two
They were divided into two groups, one
decades (6). In neutrophils, the antibacterial and anti-
comprising 40 patients who had ascites and SBP
proliferative protein calprotectin is found nearly
detected by the existence of 250 PMNL/mm3 in
exclusively; the number of neutrophils present is
ascitic fluid and/or positive culture with a single
inversely proportional to the amount of this substance
causative organism, and the other comprising 10
found in body fluids (7). Calprotectin titers in bodily
patients with ascites without SBP.
5941
Received: 27/06/2022
Accepted: 03/09/2022
c:\work\Jor\vol891_285
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5949- 5954
Glucose-Lowering Drugs and Fracture Risk among Diabetics:
Review Article
Nema Abd El-Wanees Abd El-Shafy*1, Hamed Abd El-Aziz Deraz2,
Atef Goda Hussin3, Mostafa Mohamed Assy4
1Department of Nephrology, Minya El-Qamh Central Hospital, Sharkia, Egypt
Departments of 2Internal medicine, 3Biochemistry and 4Radiology,
Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Nema Abd El-Wanees Abd El-Shafy, Mobile: (+20)128 196 4512, E-Mail: nonamobark71@gmail.com
ABSTRACT
Background: Diabetic patients have an increased risk of bone fractures. Patients with type 1 DM are seven times more likely
to suffer a fracture than those without DM, whereas those with type 2 DM are 1.3 times more likely to do so. Patients with
T2DM have an increased risk for fractures, despite having a normal to increased bone mineral density, suggesting that other
factors besides bone quantity must account for increased bone fragility.
Objective: The aim of the current work was to assess fracture risk among diabetics who use glucose-lowering drugs.
Methods: Fracture Risk, Glucose-Lowering Drugs, and diabetics were all looked for in PubMed, Google scholar, and
ScienceDirect. References from relevant literature were also evaluated by the authors, but only the most recent or complete
study from February 2016 to August 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: Some of the newer glucose-lowering therapies for type 2 diabetes have been shown to improve renal and
cardiovascular outcomes. However, treatments aimed at reducing glucose levels may potentially influence fractures risks.
Keywords: Fracture Risk, Glucose-Lowering Drugs, Diabetics.
INTRODUCTION
Chronic hyperglycemia and abnormalities in
cannot account for the elevated risk of fracture in T2D
carbohydrate, lipid, and protein metabolism define
patients (1).
diabetes mellitus, a multifactorial metabolic illness.
It has been shown that micro-fractures caused by
Caused by either a lack of insulin production (Type 1
inadequate bone turnover, which can occur despite a
Diabetes) or a failure of insulin action (Type 2 Diabetes),
healthy bone mineral density (BMD), are responsible for
or often both, this disease affects a person's blood sugar
the degeneration of bone in DM. This includes an increase
levels, defined by high levels of sugar in the blood and
in cortical porosity and modifications to the bone collagen.
urine, and weight loss (1).
The diabetes symptoms and severity have also been
According to the data, 43% of diabetic patients and
studied. Even in the absence of other medical conditions,
most pre-diabetic patients in Egypt are undiagnosed. The
those with diabetes are at a higher risk of fractures. Studies
significant rise in diabetes incidence in Egypt from 4.4
have linked the duration of diabetes to an increased risk of
million cases in 2007 to 7.5 million in 2013 has occurred
fracture; however, research designed to investigate T2D
within a very short time frame. It is anticipated that by
specifically have not found this association, possible
2035, this figure would have increased to 13.1 million (1).
inclusion of some individuals with type 1 diabetes.
The incidence of type 2 diabetes has nearly tripled in
Underreporting and information bias contribute to a lack of
Egypt over the past two decades. This dramatic increase
research on falls and hypoglycemia in DM. However, the
may be attributable to an upward trend in the prevalence of
high prevalence of fractures in people with type 1 and type
traditional risk factors, such as obesity, inactivity, and
2 diabetes cannot be explained solely by falls and
dietary shifts, or to risk factors unique to Egypt, such as the
hypoglycemia (2).
country's heavy reliance on pesticides and its endemic
Loss of bone mineral, mostly calcium, and the
hepatitis C virus (1).
natural architecture of the skeleton bring to osteoporosis.
The probability of breaking a bone increases with the
Bone mineral density loss refers to the gradual depletion of
presence of diabetes mellitus. Patients with type 1 DM
bone tissue's mineral content. Two hundred million people
have a risk of fracture that is seven times higher than that
all over the world suffer from osteoporosis, making it the
of persons without DM, while patients with type 2 DM
most prevalent metabolic bone ailment. It's becoming more
have an elevated risk of fracture that is only 1.3 times that
common, yet doctors still miss most cases and offer
of people without DM. People with type 2 diabetes (T2D)
inadequate care. Part of the reason for this is that the illness
are often said to have higher bone mineral density (BMD)
shows no signs of existence until it causes a fracture. This
than those without the disease; however, BMD alone
can lead to higher morbidity and mortality as well as severe
pain and deformity (2).
5949
Received: 28/06/2022
Accepted: 04/09/2022
c:\work\Jor\vol891_286
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5955- 5960
Treatment of Bony Defects in Anterior Shoulder Dislocation-Latarjet
Procedure: Short-Term Results
Sherif Mohamed Mohamed Ashour*, Mohamed Abd Allah Abd El-Aziz El-Soufy,
Mohamed Hamed Fahmy Afifi, Ahmed Hatem Farhan Imam
Department of Orthopedic, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Sherif Mohamed Mohamed Ashour, Mobile: (+20)1063825538, E-mail: sherifashour94@gmail.com
ABSTRACT
Background: Anterior glenohumeral dislocation is a widespread problem among young athletic populations.
Objective: This study was aimed to evaluate the clinical and the radiological results of patients with recurrent traumatic
anterior shoulder instability treated with Latarjet procedure.
Patients and Methods: A clinical trial study was conducted on 18 patients with recurrent traumatic anterior shoulder
instability treated at the Department of Orthopedic, Faculty of Medicine, Zagazig University Hospitals. Pre- and post-
operative clinical evaluation and radiological assessment was applied.
Results: The average glenoid bone loss was (24.1±2.3 %) ranging from 20 to 27. All cases showed postoperative union
and most of them (94.4%) had bony union and only (5.6%) had a fibrous union. Regarding range of motion and the
shoulder functional evaluation there was a highly statistically significant improvement in all examined items (p-
value<0.001). 123.0 % improvement postoperatively with a highly statistically significant increase in the constant score
from (48.1±6.2) to (91.4±3.7) (p-value<0.001). 93.6 % improvement postoperatively with a highly statistically
significant increase in the ULCA score from (14.6±2.9) to (31.3±1.8) (p-value<0.001). Most of the studied group (16
cases, 88.8%) didn't have any postoperative complications, one case had a hematoma (5.6%) and one case had a
superficial infection (5.6%).
Conclusion: It could be concluded that the open Latarjet procedure has confirmed to be an effective and efficient
procedure for shoulder stabilization.
Keywords: Anterior Shoulder, Glenohumeral joint, Latarjet, dislocation.
INTRODUCTION
least in circumstances with severe glenoid bone loss,
The glenohumeral joint, which accounts for
among the numerous surgical procedures that have been
50% of all major joint dislocations, is the one that
reported for the treatment of recurrent anterior shoulder
dislocates most frequently. A glenohumeral dislocation
dislocation (4).
affects 1% to 2% of the general population at some point
For the treatment of traumatic and nontraumatic
in their lives. Because of its large range of motion and
anterior shoulder subluxations and dislocations, latarjet
shallow glenoid cavity, which only articulates with a
surgery is recommended. When there are bone defects
small portion of the humeral head, the shoulder is an
that account for more than 25% of the glenoid surface
unstable joint and is therefore more prone to injury (1).
area, it is a reliable surgical option. It can also be used
The
glenohumeral
joint
capsule,
the
as the primary treatment for recurrent instability in high-
cartilaginous glenoid labrum (which expands the
risk contact athletes, even when there is just a little bony
shallow glenoid fossa), and the rotator cuff muscles all
deficit (5).
work together to keep the shoulder stable. With a rate of
This study was performed to evaluate the
over 95%, anterior dislocation accounts for the majority
clinical and the radiological results of patients with
of shoulder dislocations; however, posterior, inferior
recurrent traumatic anterior shoulder instability treated
(luxatio erecta), superior, and intrathoracic dislocations
with Latarjet procedure.
are also conceivable (2).
Both structural and functional instability, as
PATIENTS AND METHODS
well as both, can contribute to shoulder instability.
This prospective clinical randomized trial study
Successful therapy depends on determining the source
included a total of 18 patients with recurrent traumatic
and eliminating it, either surgically in the case of
anterior shoulder instability treated at the Department of
structural instability or physiotherapeutically in the case
Orthopedic, Faculty of Medicine, Zagazig University
of functional instability. Patients can experience low
Hospitals.
incidence of problems, good range of motion, stable
The 18 patients were 16 males and 2 females, and their
repairs, and minimal incidence of recurrence if these
average age was (24.3±4.2) ranged from 18 to 35 years.
crucial parameters are taken care of (3).
Trauma and a number of predispositions can
Ethical consent:
disrupt the shoulder joint's ability to function
This study was ethically approved by Zagazig
harmoniously, resulting in the loss of the joint's
University's Research Ethics Committee. Written
congruence. The Latarjet procedure, one of the most
informed consent of all the participants was
successful methods, has been proven to be superior, at
obtained. This Work was performed according to
5955
Received: 28/06/2022
Accepted: 04/09/2022
c:\work\Jor\vol891_287
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5961- 5965
Study on Viral Infection and Related Parameters in A Sample of
Diabetes Mellitus Type 2
Zainab Abdul Hadi Hussein1, Dunya Fareed Salloom1
Department of Biology, Collage of Science, University of Baghdad,Iraq
*Corresponding author: Zainab Abdul Hadi Hussein, Email: Zainab.abd2102m@gmail.com, mobile: (+964)07729807897
ABSTRACT
Background: High levels of blood glucose brought on by insulin resistance or deficiency characterize diabetes mellitus
type 2, a metabolic condition. One of the main factors contributing to diabetes is viral infection. One of the viruses connected
to T2DM is the cytomegalovirus (CMV). Analysis of viral infection and associated factors in a type 2 diabetes sample.
Objective: The aim of this study is to measure levels of anti-CMV virus IgG in serum of Iraqi patients with Type 2 diabetes
mellitus disease and measure the levels of some markers including age, gender, FBS, HbA1c, s. creatinine, blood urea and
lipid profile (cholesterol, triglyceride, HLD, LDL, and VLDL).
Materials and Methods: This study involved 100 T2DM patients (52 males and 48 females) who visited Al-Karamah
Teaching Hospital and Baghdad Teaching Hospital, and 52 healthy Iraqi subjects (control) (26 males and 26 females).
In addition to the measures used in this investigation, which also included the lipid profile, HbA1c, FBS, serum creatinine,
and blood urea, Anti-CMV IgG was also measured for 48 patients and 40 controls.
Results: In comparison with the control group, B. urea, S. creatinine, Anti-CMV IgG, and lipid profile (excluding HDL)
were considerably higher in the patient group. While there was no statistically significant difference between groups in
terms of age and HDL levels, there was a difference.
Conclusion: As indicators and cofactors for type 2 diabetes mellitus, particular laboratory tests and Anti-CMV viral IgG
might be utilized.
Keywords: Type 2 diabetes mellitus, Cytomegalovirus.
INTRODUCTION
matches that of the herpes virus, and its replication cycle
One of the most widespread metabolic problems
consists of a fully regulated cascade of genes capable of
globally is Type 2 diabetes mellitus (T2D) that occurs as
expression (10). Multiple findings suggest that chronic
a consequence of a pair of critical indicators: defective
CMV infection may have a role in the development of
insulin responsivity of tissues and hypoinsulinemia
type 2 diabetes. CMV may expedite immunosenescence
production by pancreatic islets (1). Hyperglycemia, a
by promoting the development of late-differentiated
hallmark of type 2 diabetes, is often brought on by the
CD4+ and CD8+ T-cells that generate pro-inflammatory
concomitant presence of insulin resistance and decreased
cytokines and hence create a more pro-inflammatory
beta cell function (2).
environment (11).
About 382 million individuals worldwide had
Eye, renal, and neurological system issues are
diabetes mellitus in 2013, according to statistics, with
caused by diabetes. Diabetes is a leading cause of
type 2 diabetes accounting for 90% of all cases (3). It is
blindness, renal failure, amputation, cardiovascular
anticipated that the prevalence of diabetes would increase
disease, and stroke (12).
by 110 percent between 2017 and 2045, reaching 629
Diabetes is diagnosed using glycated hemoglobin
million worldwide in 2045 (4). The risk factors for T2DM
(HbA1c), a crucial measure of long-term glycemic control
are genetic, obesity, family history for disease, sedentary
that might reflect the cumulative glycemic history of the
lifestyle, ethnicity and other (5).
previous two to three months, which is the predicted half-
Age, genetic inheritance, environmental variables,
life of red blood cells (13). FBG is also utilized for the
lifestyle choices, infections that increase the likelihood of
diagnosis of impaired fasting glucose (IFG) and diabetes.
developing T2DM, and others make up the likely
FBG 100 mg/dl is often considered normal in humans,
etiology. Since viruses and T2D may coexist in an
with 126 mg/dl or more indicating diabetes (14). Blood
individual through direct or indirect viral-mediated
urea and serum creatinine, which are simple tests for
pathways, viral infections appear to be highly related with
evaluating kidney function in poorly controlled diabetics,
non-autoimmune diabetes (6-7).
are used to diagnose diabetes (15).
Numerous viral illnesses, such as rubella, mumps,
Moreover, increases in cholesterol, triglyceride,
Epstein-Barr, and CMV, have been linked to T2DM (8).
VLDL, and HDL levels are associated with an increased
Human herpes virus 5 (HHV 5), often known as
risk of type 2 diabetes in first-degree relatives (16).
cytomegalovirus (CMV), is a double-stranded DNA virus
Our study's objective is to determine the anti-
that belongs to the family Herpesviridae and can cause a
Cytomegalovirus IgG levels in the blood serum of Iraqi
variety of disorders in humans (9). CMV's virion structure
T2DM patients as well as other parameters including
5961
Received: 23/6/2022
Accepted: 1/9/2022
c:\work\Jor\vol891_288
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5966- 5970
Heat Shock Protein-72 as a Novel Biomarker to Predict Acute Kidney
Injury in Critically Ill Patients
Safaa Hamdy Ahmed1, Ezzat Kamel Amin1, Naglaa Ali Khalifa2, Yaser Mohammed Ali1*
1Pediatrics department, 2Clinical Pathology department, Faculty of medicine, Zagazig University, Egypt
*Corresponding author: Yaser Mohammed Ali. E mail: yaserkolip85@gmail.com
ABSTRACT
Background: Acute kidney injury (AKI), also known as transient renal failure, is characterized by a sudden loss in
kidney function and a reversible acute rise in nitrogen waste products. A measurable decrease in urine output can be
used to identify renal function decline. Blood tests for the kidney's typical excretion products, urea and creatinine, are
frequently used to identify it. AKI in rats and people can be detected early by using a sensitive biomarker called heat
shock protein-72 (Hsp 72). The biomarker Hsp-72 has sufficient sensitivity and specificity to identify the AKI up to 3
days before the diagnosis in severely sicked individuals.
Aim: This study aimed to assess the sensitivity, specificity, and predictive values of Hsp-72 in the early prediction of
AKI in severely diseased candidates.
Subject and Methods: This study was done in PICU, Pediatrics Department, Zagazig University. Participants were
split into 2 collections according to development of AKI.
Results: There was significance elevation in neutrophil gelatinase-associated lipocalin (NGAL), KIM-1 and Hsp-72
levels at 3rd day compared to levels on admission. Urinary output showed significant decrease in AKI group compared
to no AKI group. There were no statistical significance variations among the double collections as regards nephrotoxic
drug. Conclusion: Even though most of the investigated biomarkers had comparable capacities to inspect the AKI 24-
h before the AKIN features was met, Hsp-72 was much utmost due to it was the initial discoverable AKI biomarker and
was remarkably sensitive and specific. HSP-72 was the most popular diagnosis at day 3. AKI in severely sicked
individuals can be accurately and specifically predicted by the biomarker HSP-72 up to three days before the diagnosis.
Keywords: Heat shock protein-72, Acute kidney injury, Pediatric AKI.
INTRODUCTION
Acute kidney injury (AKI), also known as acute
Study population:
renal failure (ARF), is a medical disorder that manifests
This study included 50 critically ill patients who
as an hour-to-week-long reversible acute rise in
were admitted to PICU exhibiting two or more organ
nitrogen waste products as evaluated by serum
failures and were investigated at day 1, 3 according to
creatinine and blood urea nitrogen (BUN) (1).About 5%
the increase of serum creatinine and decrease urinary
of kids admitted to paediatric intensive care units and
output. Candidates were split to double collections:
those undergoing cardiac procedure for congenital
cardiac disease experience acute renal damage. The
AKI group: included 21 cases.
showed incidence between 30 to 40%, and in children
No AKI group: included 29 cases.
receiving bone marrow transplantation the incidence
ranges from 15 to 34% (2).
Inclusion criteria:
Heat shock protein-72 (Hsp 72) has been
Children attended to the pediatric intensive care
demonstrated by Sanchez-Pozos et al. (3) to be an earlier
unit who had at least 2 or more dysfunctional organs.
and specific biomarker for AKI in mice and individuals.
With mechanical ventilation, one of the organ failures
Additionally, this original biomarker was useful at
is the glomerular filtration rate (GFR), which is studied
observing a reno-protective approach in an
by means of the Schwartz equation:
investigational mice sort of AKI as well as stratifying
eGFR= k
×
various levels of tubular injury and recovery.
It is recommended to use presumed baseline of 120
PATIENTS AND METHODS
ml/minute/1.73 m2, with no AKI at the time of
This study was a prospective cohort research made in
admission.
PICU, Department of Pediatrics, Zagazig University
Hospitals in 6 months from October to March 2022.
Exclusion criteria:
Patients with chronic kidney disease under renal
Sample size:
replacement therapy (patients on renal dialysis were
Assuming that the total population size of children
excluded) or under conservative treatment.
in Pediatric Intensive Care Unit (PICU) in 6 months
duration is 160 patients and the positive predictive value
Acute Kidney Injury: AKI is defined as a rise in serum
of Hsp-72 in detection of AKI is 95%. So, the sample
creatinine of 0.3 mg/dl within 48 hours or a rise of 50%
size was 50 patients using open Epi program with
from the level at admission while hospitalised
CI95%.
5966
Received: 28/6/2022
Accepted: 4/9/2022
c:\work\Jor\vol891_289
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5971- 5977
Significance of Immunohistochemical Expression of Fascin-1 in Colorectal Carcinoma
Maisa Hashem Mohammed*, Emad Ali Ahmed**, Tasneem Mohammed Bakheet***, Nagwa Abd El-Sadek
Ahmed*
* Department of Pathology, ** Department of General Surgery,
*** Department of Public Health and Community Medicine, Faculty of Medicine, Sohag University, Egypt
Corresponding author: Maisa Hashem Mohammed, E-mail: maisaahashem@med.sohag.edu.eg,
Tel. 01060260461, Orcid Id: 0000-0002-0939-7097
ABSTRACT
Introduction: Colorectal carcinoma (CRC) is the third most prevalent cancer and the second leading cause of cancer-
related mortality. The high morbidity and mortality rates associated with CRC are attributed to the ability of the
neoplastic cells to metastasize to distant sites. Fascin actin-bundling protein-1 (FSCN-1) is a member of Fascin family.
Its expression is up regulated in various types of neoplasms. Previous studies reported that Fascin-1 is responsible for
enhancing both invasive and metastatic potentials of neoplastic cells by modulating cellular and extracellular properties.
Fortunately, FSCN-1 can be blocked by new therapeutic agents.
Objectives: This study aimed to evaluate expression of FSCN-1 in colorectal carcinoma (CRC) and to correlate its
expression with the available clinicopathological parameters to assess its prognostic value.
Methods: Paired formalin-fixed, paraffin embedded tissue blocks of 60 cases of CRC and their adjacent normal colonic
mucosa were included in this study. FSCN-1 expression was evaluated by immunohistochemistry (IHC). Correlation of
different levels of Fascin-1 expression with different clinicopathological parameters were statistically analyzed.
Results: All cases of CRC showed immunohistochemical expression of FSCN-1 with variable staining intensities and
extents. FSCN-1 expression showed positive statistically significant correlations with tumor grade (p = 0.002),
pathological T stage (p< 0.005), nodal metastasis (p<0.006), and vascular invasion (p = 0.001).
Conclusion: FSCN-1 is an independent adverse prognostic factor in CRC. Its overexpression could be used as an
indicator of tumor progression and metastasis. It could be targeted in future therapeutic approaches to decrease CRC
progression and spread.
Keywords: Fascin-1, Colorectal carcinoma, Metastasis, Cytoskeleton, Vascular invasion.
INTRODUCTION
protrusions and subsequent different cellular changes as
Colorectal carcinoma (CRC) is the third most
filopodia, lamellipodia and microspikes (5).
prevalent globally distributed malignant neoplasm. It
Detection of genetic aberrations involved in
represents the second leading cause of cancer-related
different stages of CRC progression is considered as a
mortality. CRC is a major public health problem. In
major obstacle. Strenuous efforts have been spent to
Egypt, it is the 7th most prevalent cancer in the Egyptian
detect metastasis-related biological molecules that can
population (1). The high morbidity and mortality rates,
be used either as prognostic markers to predict the risk
which accompany CRC are assigned to the ability of
of tumor progression, or can be blocked to inhibit
these neoplastic cells to metastasize to distant sites,
metastasis (6). Fascin actin-bundling protein 1 (FSCN-
approximately 50% of CRC are associated with
1), also known as Fascin-1 or Fascin, is a member of
metastasis. Histologically, adenocarcinoma constitutes
Fascin family. There are three isoforms of Fascin
more than 90% of all CRC cases. Other
protein family. Fascin-1, is more widely distributed in
histopathological variants of CRC include mucinous,
different
human
tissues.
It
stabilizes
actin
Signet ring, medullary, micropapillary, and cribriform
microfilaments into tight and parallel bundles, creating
phenotypes (2).
different cellular shapes as microspikes, filopodia and
Metastasis is a multistep process which is initiated
lamellipodia, all of these cellular morphological
at the molecular level in the form of cumulative
changes are involved in cell migration, adhesion and
acquisition of intracellular genetic mutations. These
cell-cell interactions (7).
genetic mutations produce a series of dynamic changes
Physiologically, FSCN-1 is restricted to neural,
in both neoplastic cells and surrounding tissues.
endothelial, dendritic and mesenchymal cells, while it is
Neoplastic cells separate from the primary sites,
absent or minimally expressed in normal epithelial cells
degrade and invade through basement membranes and
(8). In human neoplasms, expression of FSCN-1 is
extracellular matrix (ECM), invade a vascular channel
increased, especially in malignant tumors, which show
and/or a serous sac and lastly get arrested in a target
epithelial-mesenchymal transition (EMT). The latter
organ (3). At these secondary sites, neoplastic cells must
gives the malignant epithelial cells both the migratory
adapt themselves in the new microenvironment, evade
and invasive properties (7, 9). FSCN-1 was detected in
apoptosis and immunological surveillance, and induce
different human cancers as esophageal squamous cell
angiogenesis for their survival (4). Initiation of the cell
carcinoma, non-small cell lung cancer, mammary,
movement is achieved by polymerization of actin into
gastric and pancreatic duct adenocarcinoma (10-14).
filaments. The actin filaments are packed and bundled
Fortunately, FSCN-1 can be blocked by new therapeutic
at the leading edge of the cell to create membrane
5971
Received: 28/6/2022
Accepted: 4/9/2022
RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5978- 5983
Nutritional Assessment in Patients with Inflammatory Bowel Disease
Shaimaa Hussien Gad Allah*, Amal Shawky Bakir, Hany Haroun Kaiser, Ahmed Kamal Abd El Wahab
Internal Medicine & Gastroenterology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Shaimaa Hussein Gad Allah, Mobile: (+20) 01020911390, E-mail: shaimaahussen2022@gmail.com
ABSTRACT
Background: Several illnesses, including Crohn's disease and ulcerative colitis, share the clinical category of
"inflammatory bowel disease," which is characterized by chronic inflammation of the gastrointestinal system. Symptoms
of inflammatory bowel disease include colonic pain, diarrhea, bloody stool, and loss of appetite.
Aim of the Work: Our research tries to determine whether or not people with CD and UC are getting enough of certain
nutrients by comparing their consumption to dietary guidelines, measuring their body composition, and looking at
molecular markers of nutrition.
Materials and Methods: Ninety patients with inflammatory bowel disease (IBD), including Crohn's disease (CD),
ulcerative colitis (UC), and indeterminate colitis (UD), were enrolled in this cross-sectional study at the IBD outpatient
clinic in the Department of Internal Medicine at Ain Shams University Hospital. Patients filled questionnaires regarding
their backgrounds, treatments, and diets.
Results: Our study showed that the majority of the chosen patients had normal body mass indexes, suggesting that
malnutrition especially underweight is not widespread. There was an unfavorable ratio of essential fatty acids (FA) in
our study groups compared to the most up-to-date recommendations. However, due to the widespread usage of
margarine, the ratio of n-6 to n-3 fatty acids, linoleic acid (LA) to -linolenic acid (ALA), was significantly higher than
the recommended 5:1.
Conclusion: Increases in IBD prevalence coincide with the "Westernization" of eating patterns in underdeveloped
nations. Suboptimal energy intake, malabsorption, enteric nutrient loss, elevated basal energy expenditure, and
medicines all contribute to IBD patients' impaired nutritional status.
Keywords: Nutritional assessment - Inflammatory bowel disease.
INTRODUCTION
countries has been steady or declining since 1990,
Crohn's disease, ulcerative colitis, and other
whereas it has been rising in newly industrialized
disorders are all included in the clinical category of
countries in Asia, Africa, and South America (2).
inflammatory bowel disease (IBD), which is a chronic
Although Crohn's disease most frequently
inflammatory illness of the gastrointestinal system. IBD
affects the terminal ileum, cecum, peritoneum, and
is characterized by periods of abdominal pain, diarrhea,
colon, it can manifest itself in any part of the intestine
bloody stools, and weight loss, as well as the infiltration
in a patchwork fashion. In contrast, ulcerative colitis is
of neutrophils and macrophages that generate cytokines,
characterized by the involvement of the rectum and, in
proteolytic enzymes, and free radicals, all of which
a continuous pattern, can affect all of the colon (3).
contribute to inflammation and ulceration of the
Inflammatory bowel disease (IBD) patients are more
intestinal mucosa (1).
likely to become malnourished when their disease is
Both men and women are equally at risk for
actively progressing. Between 6 and 16 percent of
developing IBD in early childhood, and it is a condition
people with IBD are malnourished, which is a risk
that lasts a lifetime once it sets in. Since the turn of the
factor 5-fold higher than in people without IBD (4).
21st century, IBD has been recognized as one of the
Our research objectives were to determine
most common gastrointestinal disorders, and its
whether or not people with CD and UC are getting
prevalence is expected to rise even further in newly
enough of certain nutrients by comparing their
industrialized countries, where it was already at an
consumption to dietary guidelines, measuring their
alarmingly high rate in the second half of the 20th
body composition, and looking at molecular markers of
century (2).
nutrition.
Some of the highest rates of inflammatory
bowel disease (IBD) prevalence were found in Europe
PATIENTS AND METHODS
(ulcerative colitis, 505 cases per 100,000 people in the
Patients and study design:
southeast of Norway; Crohn's disease, 322 cases per
Patients with inflammatory bowel disease (IBD)
100,000 people in Hesse, Germany) and North America
were recruited from January 2020 to July 2020 in the
(ulcerative colitis, 286.3 cases per 100,000 people in
outpatient clinic for IBD in the Department of Internal
Olmsted County, USA; Crohn's disease, 318.5 cases per
Medicine at the University Hospital of Ain Shams
100,000 people in Nova Scotia, Canada) (2). It has been
University. There were a total of 90 people with IBD
established that the incidence rate of IBD in Western
(65 with UC, 22 with CD, and 3 with UD colitis).
5978
Received: 27/06/2022
Accepted: 03/09/2022
c:\work\Jor\vol891_291
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5984- 5990
Surgical Management of Patients with Aortic Root Abscess: An Interventional Study
Ahmed H. Lamlom, Wageih Saad Elboraey, Alaa Eldin Farouk, Hossam Fathy Aly
Department of Cardio-Thoracic Surgery, Faculty of Medicine, Cairo University, Egypt
Corresponding Author: Hossam Fathy Aly, email: amy.rh.209@gmail.com;
Mobile: +20 111 456 7170; https://orcid.org/0000-0002-6794-5522
ABSTRACT
Background: It is still challenging for cardiovascular surgeons to treat aortic root abscess, a severe type of infective
endocarditis (IE) of the aortic valve and the surrounding tissues.
Objectives: We aimed to assess the proper timing for surgical intervention, the rate of hospital mortality and recurrence,
and mid-term survival in patients with active IE of the aortic valve.
Patients and Methods: Thirty patients with aortic root abscesses were subjected to isolated aortic root surgery between
March 2016 and September 2017 at the Department of Cardio-thoracic Surgery at Kasr El-Ainy hospital, Cairo University,
Egypt.
Results: Out of the 30 patients, 19 were females (63.33%), and 11 were males (36.67%), with a mean age of 39.5 ± 15.5
years. The mean diameter of the abscess cavities was 1.85 ± 0.82 cm, most commonly located in the non-coronary sinus
(63.33%). The common causative microorganisms were Staphylococcus spp. (36.67%), followed by Streptococcus spp.
(23.33%), Pseudomonas aeruginosa (16.67%), and Candida sake (6.67%). The mortality rate was 23.33% and 16.67% were
early, and 6.67% were late. Patients with prosthetic valve endocarditis (PVE) were associated with larger vegetation size,
the abundance of Staphylococcus infection, a higher proportion of AV dehiscence, longer operative, aortic cross-clamp and
bypass times, and longer ICU stay. The overall recurrence rate was 16.67%.
Conclusion: Early outcomes of AIE of the aortic valve could be enhanced through proper diagnosis, earlier referral to
surgery, radical excision of infected tissue, at least a one-month course of intravenous antibiotics according to the culture
and sensitivity, or broad-spectrum empirical agents in culture-negative cases.
Keywords: Infective endocarditis, Prosthetic valve endocarditis, Aortic root abscess, Native valve endocarditis.
INTRODUCTION
aortic root abscess, making early and extensive surgical
Infective endocarditis (IE) is a disease
reconstruction of the aortic root mandatory (7).
characterized by high morbidity and mortality (1). Among
There is a high risk of serious tissue damage if
those who have had a prosthetic valve implanted, the
surgery is delayed.
incidence of IE is between 0.3% and 1.2% annually,
A paravalvular abscess should raise red flags for
accounting for between 1% and 5% of all IE cases (2).
physicians to send patients for emergency surgery.
Treatment mostly consists of antibiotics.
Debridement of diseased and necrotic tissues around the
However, surgery is required for around a third of patients
aortic root is a standard part of surgical therapy, as is
with active IE and a much higher percentage of patients
aortic root reconstruction by patching or plicating the
with prosthetic valve endocarditis (3). Prosthetic valve
resected region and aortic valve replacement (AVR) with
endocarditis (PVE) is more likely to cause periannular
a prosthesis (8). Aortic root replacement (ARR) is
problems than native valve endocarditis (NVE), while
accomplished via radical debridement and the
Staphylococcal infections are more likely to cause
implantation of a biological or prosthetic composite graft
periannular complications than infections caused by other
into the aortic root (9). Our study aimed to assess the
species (4). Patients with total aortic root destruction and
proper timing for surgical intervention, the rate of hospital
involvement of the intervalvular fibrous body and mitral
mortality and recurrence, and mid-term survival in
valve provide a special surgical challenge because they
patients consecutively referred to Kasr Al Aini Hospitals
lack clarity around their present risk and long-term
for surgical treatment of active IE (AIE).
prognosis (5).
It is still challenging for cardiovascular surgeons
PATIENTS AND METHODS
to treat aortic root abscess, a severe type of IE of the aortic
Study Design
valve and the surrounding tissues. When left untreated, an
Between March 2016 and September 2017, ARR
aortic root abscess may cause cardiac arrhythmias,
and AVR with patch repair of the aortic root were
pseudoaneurysms, cardiac fistulas, and burrowing
performed for patients who had aortic root abscess at the
abscesses (6). However, antibiosis alone is frequently
"Department of Cardio-thoracic Surgery, Kasr El-Ainy
insufficient to prevent the damaging impact of a severe
hospital, Faculty of Medicine, Cairo University, Egypt."
5984
Received: 22/10/2020
Accepted: 10/12/2020
c:\work\Jor\vol891_292
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 5991- 5999
Ventilatory and Auditory Findings among Workers in Asal's Furniture
Factory at New Damietta City, Damietta Governorate, Egypt
Asmaa Fayez Ibrahim1, Mona Abo Bakr El-Hussiny2, Adel Al Wehedy1,
Sohair El-Bestar1, Abdel Hamied Mohamed Abdel Hamied*1
Departments of 1Industrial Medicine and Occupational Health and 2Clinical Pathology,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Abdel Hamied Mohamed Abdel Hamied, Mobile: (+20) 01001257474,
E-Mail: abdelhamied_com @yahoo.com
ABSTRACT
Background: Wood furniture production is one of the most hazardous industries. The workers are subjected to several
hazards involving exposure to wood dust, solvents, isocyanates, finishes and noise.
Objective: To determine ventilatory and auditory findings among workers in Asal's furniture factory at New Damietta
City, Damietta Governorate, Egypt. Patients and Methods: A descriptive comparative cross-sectional study was carried
out on 183 wood furniture workers in Asal's furniture factory at New Damietta city, Damietta governorate and a matched
comparison group, during the period from February 1, 2018 to November 24, 2018.
Results: The averages of the measured wood dust concentrations and noise levels were within the Egyptian maximum
permissible limits, except for the noise levels in the woodworking building which were higher than the maximum
permissible limits [90.8±7.1dB(A)]. As regards the ventilatory lung functions measurements among both woodworkers
and finishing group, the means± SD of both measured and percent predicted values of FEV1/FVC, peak expiratory flow
rate (PEFR) and FEF 25-75% were lower than those of the comparison group with a statistically significant difference
(p0.05). Finishing workers had a statistically significant (p0.001) higher prevalence of obstructive ventilatory pattern.
Sensorineural hearing loss was significantly (p0.005) prevalent among both woodworkers (26.2%) and the finishing
workers (18%) compared to the comparison group (2.4%). Criteria of NIHL were met in 81.3% of woodworkers with
sensorineural hearing loss, who accounted for 21.3% of all woodworkers.
Conclusion: The workplace environment in Asal's furniture factory adversely affects the ventilatory and auditory
functions of their workers.
Keywords: Ventilatory, Auditory, Woodworkers, Finishing workers, Asal's furniture factory.
INTRODUCTION
(5). Moreover, Batkus et al. (6) found that noise levels
Wood furniture production is one of the most
exceeded the permissible limits in 77% of the surveyed
hazardous industries. The workers are subjected to
wood furniture workplaces in Lithuania. Masterson et
several hazards involving exposure to wood dust,
al. (7) observed that the prevalence of NIHL among
solvents, finishes and noise (1).
woodworkers in USA was 20.8%, which ranked the
Wood furniture industry has been reported to be
second among all studied industries.
one of the industries with heaviest wood dust exposure.
Wood furniture industry adversely affects the
High levels of wood dust are emmitted throughout the
ventilatory and auditory functions of their workers.
machining processes, such as chipping, sawing, drilling
Thus, it requires effective prevention and control (8). For
and sanding. Wood dust generated occupationally
wood dust, Health and Safety Executive (HSE) (4)
consists mainly of >5µm particles, that's is trapped in
suggested local exhaust ventilation, fans and respiratory
the upper respiratory tract. The particles with sub-5µm
protective equipment. For noise exposure, occupational
diameter, that range from 6% to 75% of the total wood
hearing conservation program is carried out in the
aerosol (2), are particularly hazardous as they infiltrate
workplace and must include periodic noise exposure
into the lower respiratory tract through sedimentation
monitoring, engineering and administrative control
and diffusion (3). Wood dust may give rise to allergic
measures, hearing protection devices and annual
rhinitis, chronic bronchitis, occupational asthma (OA),
audiometric evaluation (9). In Egypt, there were 84
External allergic alveolitis (EAA) and Chronic
establishments engaged in furniture manufacturing with
Obstructive Pulmonary Disease (COPD) (3).
about 10,825 workers (10). Damietta alone, accounts for
It is in the top ten causes of occupational
over 1/4th of the enterprises working in wood furniture
asthma in the United Kingdom. Respiratory health
manufacturing (11).
effects associated with wood dust exposure, are directly
affected by the wood type, wood dust concentration,
Objectives:
duration of exposure, other chemical exposures,
The specific objectives of this study are (1)
individual sensitivity, use of PPE and air ventilation
Determine ventilatory and auditory findings among
system (4).
workers in Asal's furniture factory at New Damietta
Wood furniture industry is considered one of
City, Damietta Governorate, Egypt (2) Measurement
the noisiest working environments. Hearing could be
the total and respirable wood dust concentrations and
adversely affected due to exposure to noise and solvents
noise level in the workplace.
5991
Received: 28/6/2022
Accepted: 4/9/2022
c:\work\Jor\vol891_293
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 6000- 6005
Intratympanic Gentamicin Injection for Treatment of Vertigo in
Intractable Meniere's Disease
Mohamed Abdelmohsen Alnemr, Amira Selem Abdelazem Selem*,
Ezzeddin Mohamed Elshiekh, Alaa Eldin Mohamed Elfeky
Department of Oto-Rhino-Laryngology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding Author: Amira Selem Abdelazem Selem, Mobile : (+20) 01000016528, Mail : amiraselem25@gmail.com
ABSTRACT
Background: Vertigo is being treated by Intratympanic Gentamicin (ITG) among Ménière's Disease (MD) patients,
but its effectiveness and safety remain controversial.
Objective: To know the optimal dose and duration of intratympanic gentamicin needed to cease vertigo attacks in
Ménière's disease.
Patients and Methods: At Oto-Rhino-Laryngology, and Head and Neck Surgery Departments of Zagazig University
hospital, eighteen consecutive patients with disabling unilateral Ménière's disease were included in this randomized
controlled trial. The patients were divided randomly into 2 groups; Group A: 9 patients were injected with 20mg/ ml
every 3 days for 6 injections, until vertigo completely controlled or presence of complications & Group B: 9 patients
were injected with 40mg/ ml every 1 month for 4 injections, until vertigo completely controlled or presence of
complications.
Results: Twenty mg/ml ITG every 3 days in group A & 40mg/ml ITG every 1month in group B; Both doses can control
vertigo, Group A: there was no significant hearing impairment but need repeated rounds of injections, Group B: there
was significant hearing impairment and need less rounds of injections.
Conclusion: Considering the results of using 20mg/ml ITG every 3 days in group A & 40mg/ml ITG every 1month in
group B; Both doses can control vertigo. Group A: there was no significant hearing impairment but need repeated
rounds of injections. Group B: there was significant hearing impairment and need less rounds of injections. Using
20mg/ml ITG every 3 days is better and safer than using 40mg/ml ITG every 1 month.
Keywords: Intratympanic Gentamicin, Vertigo, Meniere's Disease.
INTRODUCTION
and type 1 vestibular cells are particularly vulnerable to
The symptoms of Ménière's disease (MD)
its effects and are wasting away (1).
include vertigo attacks, hearing loss in the affected ear
With intratympanic gentamicin, there is no
that fluctuates at low frequencies, tinnitus, and a fullness
agreed-upon standard for dosing, concentration, time
in the ear. Issues like stumbling and toppling over are
between injections, or length of treatment (ITG)(4).
possible side effects. Comorbidities in Ménière's disease
Using ITG to treat vertigo in MD is
include autoimmune diseases and migraine (1). Dilation
controversial due to disagreements regarding optimal
of the membranous labyrinth is a closely connected
dosage and administration technique. Some doctors
result on postmortem examinations, but the exact cause
favour high-dose intratympanic gentamicin (HD-ITG),
of Ménière's disease is still unknown(2).
also known as titration or continuous administration, in
Patients with Ménière's disease should take
which the drug is injected at increasingly higher doses
advantage of the various available treatment choices and
until vestibular weakness is achieved, while others
tailor their care to their own needs. A patient should also
favour low-dose intratympanic gentamicin (LD-ITG), in
be treated for any coexisting conditions they may have,
which the drug is injected once and further injections are
such as allergies, migraines, or autoimmune arthritis (1).
performed only if vertigo attacks recur (3).
Clinicians might recommend a wide variety of
Clinical symptomatology was used to evaluate
treatments, including dietary changes, pharmacological
the effectiveness and safety of LD-ITG for treating
management with diuretics, steroids, or betahistine, and
vertigo attacks in MD; in this trial, ITG was
operations like decompression of the endolymphatic sac
administered up to five times, with a 2-week gap
(2).
between injections, and only if the vertigo attacks
Medication and avoiding triggers like too much
returned (3).
salt or coffee may not be enough to control vertigo
In their study, Patel et al.(5) used 40 mg/ml at a
attacks in some people with Ménière's disease. Since the
frequency of 2 weeks. Patients of Kaplan et al. (6) were
last two decades, intratympanic treatment has gained a
injected thrice daily for four days. Patients were injected
lot of popularity due to the fact that it is easy to
with 0.4 ml of 26.7 mg/ml by Carey et al. (7) once
administer even in an office setting and has a high rate
weekly.
of patient acceptance. The cochleotoxic and
The purpose of this research was to determine
vestibulotoxic effects of aminoglycoside medicines
the best dosage and treatment schedule for
have been studied extensively (3). The aminoglycoside
intratympanic gentamicin in patients with Ménière's
antibiotic gentamicin is more harmful to the vestibular
disease suffering from vertigo attacks.
system than the auditory system. The neuroepithelium
6000
Received: 28/06/2022
Accepted: 04/09/2022
c:\work\Jor\vol891_294
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 6006- 6010
Assessment of Serum Leptin in Patients with Chronic Spontaneous Urticaria
Mohamed Nazmy Farres, Mayada Moneer Mahmoud, Nouran Mohamed Eissa, Hossam Moustafa Elkady*
Department of Internal Medicine, Allergy and Clinical immunology,
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
*Corresponding author: Hossam Moustafa Elkady, Phone: (+2) 01090751701, E-mail: hossamelkady86@ymail.com
ABSTRACT
Background: Chronic spontaneous urticaria (CSU) is an inflammatory skin disease. The pathogenesis of CSU is still
not completely understood in most cases. The association between CSU and obesity suggests a potential role for
adipokines, mainly leptin, which have variable proinflammatory function.
Objective: To assess serum leptin levels in CSU patients and their relation to disease activity.
Patients and Methods: A case-control study, involving 60 patients with chronic spontaneous urticaria and 30 controls,
was conducted at the Allergy Clinic of Ain Shams University hospital. CSU patients were graded as mild, moderate,
and severe according to urticaria activity score 7(UAS7). The serum leptin levels were compared among different study
groups. Results: Serum leptin levels were significantly higher among CSU patients than control group (p<0.001), with
a positive correlation with urticaria activity (P value <0.001 and r = 0.691).
Conclusion: Serum leptin levels are increased in CSU, leptin could have an important role in the pathogenesis of CSU.
Keywords: Serum leptin level, Chronic spontaneous urticaria (CSU), Urticaria activity score (UAS).
INTRODUCTION
having chronic spontaneous urticaria according to the
Chronic urticaria (CU) is a mast cell skin
EAACI/GA2LEN/EDF/WAO guideline (1) and 30
disease, presented by at least six weeks of continuous or
disease-free controls who were group-matched with
recurrent urticaria. CU is classified into chronic
patients for age and sex, with no co-morbidity or
inducible urticaria and chronic spontaneous urticaria
allergic diseases. The body mass index was within the
(CSU). CSU occurs in the absence of any exogenous
normal range for all participants.
trigger (1).
The urticaria activity score 7 (UAS 7) depends on
Inclusion criteria: Patients aged 18 to 60 years with
symptoms documented by the patients, such as the number
chronic spontaneous urticaria with normal body mass
of wheals and severity of itching, to evaluate the disease
index.
activity (1).
CSU may be associated with overweight and
Exclusion criteria: Physical (inducible) urticaria, other
obesity. Increased body mass can cause urticaria
possible causes of chronic urticaria, and acute urticaria,
symptoms to develop later onset (2). Also CU patients
patients on medication for the previous three months
may exhibit one or more unidentified elements of the
prior to recruitment (other than antihistamines), or
metabolic syndrome (3). Mast cells which are the key
patients on steroids or immunosuppressive drugs,
cells in pathogenesis of CU (4), are involved in the
pregnant women or patients with amenorrhea, patients
metabolic syndrome (5, 6). In metabolic syndrome, a lot
with co-morbidity such as endocrine disorders (thyroid
of pro-inflammatory adipokines are overproduced (7).
disorders), chronic infection, diabetes mellitus,
This raises the possibility of a connection between
hypertension, ischemic heart disease, malignant tumors,
adipokines and the pathophysiology of CU.
hepatic and renal disease, and other inflammatory skin
Adipocytes
produce
numerous
diseases and patients who are overweight or obese
proinflammatory adipokines such as leptin. Leptin not
(body mass index 25 kg/m2) or have a history of
only regulates fat metabolism and appetite but also has
eating disorders.
immunomodulatory function. A lot of immune cells
react to leptin through leptin receptors, resulting in
All patients with chronic spontaneous urticaria were
proinflammatory status. Leptin also promotes the T
subjected to the following:
helper 1 phenotype in T lymphocytes (8-11).
Full history taking and clinical examination,
laboratory tests to rule out any possible causes of CU:
AIMS OF THE STUDY
Thyroid function tests, antithyroid antibodies, complete
In this study, we aimed to evaluate leptin levels
blood count, erythrocyte sedimentation rate (ESR), C-
in patients with chronic spontaneous urticaria and to
reactive protein (CRP), and antinuclear antibody
outline the relationship between serum leptin and
(ANA).
urticaria severity.
PATIENT AND METHODS
A case-control study was conducted at the
Evaluation of urticaria activity score (UAS 7):
Allergy and Immunology Outpatient Clinic at Ain
Disease activity was defined according to
Shams University hospital on 60 patients diagnosed as
EAACI/GA2LEN/EDF/WAO guidelines (1) by urticaria
6006
Received: 28/06/2022
Accepted: 04/09/2022
c:\work\Jor\vol891_295
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 6011- 6015
Use of Bedside Laryngeal Ultrasound to Predict Post-extubation
Stridor in Critically Ill Mechanically Ventilated Children
Ola Soliman1, Mona Mohsen1, hafez Bazaraa1, HebatAllah Fadel Algebaly*1, Maha Shiba2 Radwa iraqy2.
Department of Pediatrics, Cairo University, Cairo, Egypt.
Department of Pediatric Ultrasound, Cairo University, Cairo, Egypt.
*Corresponding author: HebatAllah Fadel Algebaly, Mobile:(00201009331670),
E-mail: HebatAllah.gebaly@kasralainy.edu.eg
ABSTRACT
Background: the frequency of post extubation stridor (PES) may range between 215% in critical children and is a
significant cause of reintubation with a higher degree of mortality. The laryngeal US to measure the air column width
was described to be a possible method to PES and laryngeal edema.
Objectives: We aimed to investigate the reliability of laryngeal ultrasound for the prediction of PES.
Patients and Methods: A prospective observational study that was conducted at the PICU of Cairo University Hospital
on 50 ventilated children between January 2020 and January 2021. The children underwent laryngeal ultrasound during
the first 24 hours of admission and after passing the spontaneous breathing trial and preparing for extubation.
Results: the incidence of stridor was 18% and the main risk factors were the longer duration of ventilation and the
repeated intubation attempts, the stridor group had a median of 12 days while the non-stridor group had a median of 6
intubation days (p-value = 0.023). The PES had a statistically significant variation in air column width ratio in stridor
children compared to the non-stridor group (p- < 0.001). A cut-off point < 0.86 could predict PES with sensitivity of
100% and specificity of 97%. Conclusion: laryngeal air column width ratio is a safe, easy, and reliable method for the
prediction of PES in critically ill mechanically ventilated children.
Keywords: Critical patients, Mechanical ventilation, Laryngeal ultrasound, Stridor.
INTRODUCTION
January 2021 after receiving approval from the Ethical
The frequency of post-extubation stridor (PES)
Committee and informed consents from the child's
may range between 215% in critical children and is a
carers.
significant cause of reintubation with a higher degree of
Data collection
mortality. Methods for vocal cords examination were
Fifty children aged from 1 month to 13 years were
proposed as direct or indirect laryngoscopy, but this may
included, and all children were ventilated more than 48
be difficult and sometimes risky in intubated patients (1).
hours.
It is believed that there are numerous
contributing factors in the emergence of PES. There are
Exclusion criteria: Patients known to have congenital
a few predicted clinical characteristics that have been
anomalies of the larynx, neonates; patients with an
established, such as the length of the intubation, the
expected duration of ventilation fewer than 48 hours or
number of times it was attempted, and infection (2-4). Age,
stridor as a cause of ventilation.
gender, small tube size, gastro-esophageal reflux, narrow
Laryngeal ultrasonography was done to all patients
larynx, low birth weight, and low gestational age are
within 24 hours after ventilation and again before
additional risk factors. However, literature is variable
extubation and upper endoscopy was performed for
with differing results (5, 6).
those who developed stridor. Patients were followed for
The air column width (LACWD) measured by
their course of ventilation, extubation success or failure,
the US was described to have a considerable ability to
intensive care unit (ICU) complications, and survival.
pre-post-extubation stridor in intubated mechanically
Laryngeal ultrasound examination was carried out within
ventilated patients (7). The laryngeal US to measure the
24 hrs after intubation and again before extubation after
air column width was described as a non-invasive
testing for the visibility of weaning after successful SBT
method to better predict PES and laryngeal trauma from
and measurement of ACWR were performed after passing
intubation and inflammation (8, 9). Previous studies
the trial successfully. Measurements were performed with
evaluated the use of LACWD in the prediction of PES in
a 13 MHz linear probe Vivid 5 GE machine made while
adults (1, 9, and 10). Laryngeal air column width ratio may
patients were lying supine with their necks extended. The
be a very effective for prediction of PES in children
instrument was positioned on the cricothyroid membrane,
without any negative effects, according to a pediatric
and the air column diameter was measured (defined as the
study of El Amrousy et al. (11). We aimed to evaluate the
air passed through the VC). Three readings were taken, and
ability of laryngeal ultrasound to predict PES in a group
the average was calculated. Before the measurements, oral
of mechanically ventilated children.
and pharyngeal secretions were suctioned. Then air column
width ratio measured (before extubation/after intubation)
PATIENTS AND METHODOLOGY
according to Venkategowda et al. (1). Patients with
Study design
clinical stridor were subjected to flexible bronchoscopy
This is a cohort study conducted on mechanically
(FFB) size 2.1 (manufactured by PENTAX). The findings
ventilated critically ill children from January 2020 to
were classified according to the CALI classification
6011
Received: 29/6/2022
Accepted: 5/9/2022
c:\work\Jor\vol891_296
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 6016- 6023
Clinical Significance of Urine Podocyte Messenger Ribonucleic Acids in
Idiopathic Nephrotic Syndrome and Lupus Nephritis Patients
,
1
Amir Mohamed Elokely
,
2
Emam Waked
,
3
Mohamed A Shemis
,
1
Sameh Abdel Azeem Soliman
2
Mal
ak Nabil
,
*
2
A
and
2
Manar Raafat
nas Hassan
I
1
nternal Medicine and Nephrology Department Faculty of Medicine, Zagazig University, Zagazig, Egypt
2Nephrology Department Theodor Bilharz Research Institute, Cairo, Egypt
3Biochemistry &Molecular Biology department Theodor Bilharz Research Institute, Cairo, Egypt
*Corresponding author: Malak Nabil, Mobile: (00201222158622) E-mail: nabil.malak59@yahoo.com
ABSTRACT
Introduction: Podocytes are specific epithelial cells that surround the outside of the glomeruli's basement membrane
(GBM). They play a significant role in glomerular function. This study aimed to detect the presence of podocyte in
idiopathic nephrotic syndrome and lupus nephritis patients, and to correlate them with the proteinuria levels.
Methods: Patients were divided to three groups (patients with idiopathic nephrotic syndrome, patients with lupus
nephritis and, healthy controls. Quantification of podocyte mRNA proteins in urinary sediment by real time PCR was
performed to all groups. Results: For those who had nephrotic syndrome showed significant increase in the alpha actin
4 value (p= 0.001) and significant decrease in the value of synaptopodin and podoclyxin in relation to controls (p= 0.001).
The level of urinary expression of mRNA of podocytes correlated positively to renal function tests and estimated
glomerular filtration rate between nephrotic and control groups. The reverse occurred with proteinuria. A significant rise
in the alpha actin 4 value, podocin and synaptopodin in comparison with control (p= 0.001). Podocalyxin was decreased
significantly (p=0.021). There was a statistically significant difference, when comparing renal function tests and
estimated glomerular filtration rate between LN and control group. Also, an increase in the value of podocin in active
group relative to control and non-active groups (p= 0.001 and p= 0.007, respectively).
Conclusion: Significant increase in level of mRNA of alpha actin in nephrotic syndrome, while mRNA podocin,
synaptopodin and alpha actin were increased in LN, with podocin could mark increased activity of the disease.
Keywords: Synaptopodin, Podocalyxin, actin-4, Podocin, Idiopathic nephrotic syndrome, Lupus nephritis.
INTRODUCTION
Podocytes are specific epithelial cells that surround
and establish prognostic subgroups in every disease type,
the outside of the glomeruli's basement membrane
that predict the reaction to therapy and/or relapses, is one
(GBM). They play critical role in glomerular functions.
of the pending challenges in the modern nephrology (10).
Decrease podocytes number and effacement of foot
Screening of slit diaphragm proteins as synaptopodin,
procedures have been documented in various glomerular
podocalyxin, actin-4 and podocin might be a unique
diseases. This may stimulate a sequence of events, which
technique in examining the glomerulopathy progression
end in decline of renal function and glomerulosclerosis
(11). When glomerular injury arises, the slit diaphragm is
(1). Podocytopathies are considered essential in various
damaged and the slit diaphragm proteins in urine could
types of human glomerular diseases (2, 3).
be used as a tool for monitoring the renal disease
Proteinuria with nephrotic syndrome (> 3.5 g/day)
progression (12). Screening of podocyte proteins and
due to loss of glomerular filtration barrier selectivity is a
related molecules in the urine pellet by real time PCR is
common complication in each renal disease of this
sensitive and accurate. It has the ability to measure low
syndrome (4). Lupus nephritis (LN) is considered one of
abundance genes (13). Urine pellet podocyte mRNAs
the most serious organ involvements in systemic lupus
could be effective in observing the progression of various
erythematosus (SLE) (5). About 40 to 60% of SLE
glomerular diseases and response to therapy (3).
patients have LN (6), and about 1030% of patients
The objective of the current study was to detect
develop end-stage kidney disease depending on the
podocyte presence in idiopathic nephrotic syndrome and
disease severity (7). The immunopathogenesis of LN is
lupus nephritis patients, and to correlate them with the
complicated and incompletely understood. It shows
proteinuria levels.
autoantibodies deposition in the complement,
glomerulus, and macrophages activation, leading to
PATIENTS AND METHODOLOGY
release of pro-inflammatory chemokines and cytokines
The work was performed on 30 cases from the
(8). Recently the crucial role of podocytes has been
Department of Nephrology, Theodor Bilharz Research
defined in the glomerulosclerosis pathogenesis (2).
Institute in addition to 15 healthy control subjects of
Recently, the urinary sediment as emerging
comparable age and sex.
modality for studying renal glomerulopathies showed a
Inclusion criteria: Patients according to clinical history,
promising role instead of the renal biopsy which is
investigations and renal biopsy proving the etiology of
considered difficult and invasive tool (9).
proteinuria were divided to two groups:
The identification of biological markers that can lead
to pathogenic mechanisms or histopathological patterns,
Group A: Idiopathic nephrotic syndrome patients.
Group B: Lupus nephritis patients.
6016
Received: 27/6/2022
Accepted: 3/9/2022
c:\work\Jor\vol891_297
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 6024- 6029
Effect of Interactive Virtual Reality Device on Cervical Pain and
Neck Function in Forward Head Posture
Haytham M. Elhafez1, Shaimaa N. Abd Elmageed2, Ebtesam A Ali3
Department of Physical Therapy, Basic Science Department, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Shaimaa N. Abd Elmageed, Mobile: (+20) 01221792786, E-Mail: shaimaafayedg33@gmail.com
ABSTRACT
Background: One of the most prevalent postural abnormalities, forward head posture (FHP), is affecting 66% of the
population of patients. Bad interaction between bodily components results in poor posture. These can result in muscle
tightening and tension that will make it harder to move your joints properly and may even hurt.
Objective: This study was conducted to evaluate the impact of interactive virtual reality device on cervical pain and
neck function in symptomatic forward head posture.
Patients and Methods. In this study, 30 patients of both sexes with symptoms of forward head posture, body mass
index (BMI) between 18 and 25 kg/m2, and ages between 20 and 24 years were enrolled in this study. They were
randomized into two groups of equal number. Group A received taditional treatment (chin tuck exercise for posture
correction); three sets of ten repetitions were carried out for three minutes each day for four weeks, with each repetition
lasting five seconds. Group B obtained the same as group "A" in addition to VR training by Xbox Kinect 360 (15 min
each session three times each week) for 4 weeks. Cervical pain "VAS" and neck disability "NDI" were measured pre
and post treatment. Results. There was a substantial decrease in the VAS post treatment and there was a substantial
decrease in the NDI among the two groups in favor of group B.
Conclusion Combining virtual reality with the chin-tuck exercise is an efficient way to treat cervical pain and neck
disability in forward head posture.
Keywords: Forward Head, Virtual Reality, Neck disability, Xbox Kinect 360.
INTRODUCTION
Alignment of the body's parts at a given
This study was conducted to evaluate the impact
moment in time is known as posture, and it may provide
of interactive virtual reality device on cervical pain and
you with valuable information about your overall
neck function in symptomatic forward head posture.
health. It needs to be in line with a spatial posture of the
body that reduces the negative effects of gravity on the
PATIENTS AND METHODS
tissues. Poor posture results from faulty connections
Design
between the body's components. Tense and contracted
This study included 30 patients of both sexes with
muscles restrict range of motion in the joints, causing
symptoms of forward head posture. The study was a pre
pain and difficulty in performing daily tasks (1).
and post randomized experimental trial.
One of the most prevalent postural abnormalities
is forward head position (FHP), which affects 66% of
Ethical considerations:
the patient population (2) with high prevalence among
Every patient signed an informed written consent
university students due to prolonged usage of computer,
for acceptance of participation in the study. The
smartphones and faulty posture during lectures with
Helsinki Declaration's guidelines for research involving
lack of awareness about proper posture among them(3).
human participants were followed. Clinical trials
Musculoskeletal issues in the neck maybe
registration
database
with
identifier
attributed to improper forward head position in a large
P.T.REC/012/003549; Research Ethics Committee,
percentage of the population. FHP is prevalent postural
Faculty of Physical Therapy, Cairo University and the
abnormality noted in the literature and is thought to
clinical trials registering database under the
contribute to the onset of neck pain. According to a
identification number NCT05579613.
recent study, over 61.3% of individuals who have neck
pain while using a computer for work have FHP. Also,
Randomization
when individuals with chronic neck pain were
Participants were randomly assigned to one of two
distracted, they exhibited FHP and showed signs of
equally sized groups (A, B) by an independent observer
weakening in their deep neck flexors (4).
who performed the randomization process by opening
Rehabilitative professionals have conducted
sealed envelopes enclosing index cards with sequential
evaluations and administered treatments using VR
numbers created by a computer utilizing the statistical
systems. Virtual reality (VR) can enable simulated
package for the social sciences (SPSS) program
practice of functional activities at larger doses than in
(version 25 for Windows; SPSS Inc., Chicago, Illinois,
traditional treatments, whether it is on a screen or
USA). After initial randomization, there weren't any
through Head-mounted display for virtual reality
participant dropouts.
(HMD- VR) (5).
6024
Received: 29/06/2022
Accepted: 05/09/2022
c:\work\Jor\vol891_298
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 6039- 6035
The Role of Serum Midkine and Secretory Leucocyte Protease
Inhibitor in Diagnosis of Thyroid Cancer
Hanan G. Abdel-Azeem1, Amal M. Abdel-aal1, Mohamed H. Mahran2, Marwa H. Thabet*
1Clinical Pathology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
2Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
Corresponding author: Marwa H. Thabet, Email: meromoro1010@gmail.com,
Telephone: +20 100 474 8373
ABSTRACT
Introduction: The most frequent endocrine cancer is thyroid cancer. 95% of thyroid cancer cases are papillary thyroid
carcinomas (PTC) and follicular thyroid carcinomas (FTC).
Aim: The study aimed to assess the value of serum midkine and secretory leucocyte protease inhibitor as noninvasive
diagnostic markers for thyroid cancer. Serum levels of these markers concerning different thyroid cancer stages were
also studied.
Patients and methods: This study included fifteen healthy controls with age and sex-matched thyroid cancer, and
benign thyroid problem patients. Serum Midkine and secretory leucocyte protease inhibitor levels were measured by
ELISA technique.
Results: Individuals with thyroid cancer had considerably greater midkine levels than patients with benign thyroid
disorders and the control group. The SLPI was significantly higher in thyroid cancer patients compared to the control
group. it was found that midkine had 88.4% accuracy with the area under curve 0.95 at cutoff point 895 pg/ml while
SLPI had 61.2% accuracy with the area under curve 0.64 at cutoff point 1275.5 ng/ml.
Conclusion: Serum Midkine level and secretory leucocyte protease inhibitor are good markers for the detection of
thyroid cancer with correlation with tumor stage.
Keywords: Thyroid nodule, Biomarker, Thyroid cancer, midkine, secretory leucocyte protease inhibitor.
INTRODUCTION
The most common endocrine cancer is thyroid
This study aims to evaluate the role of midkine and
cancer, and during the past few decades, its prevalence
secretory leucocyte
has grown (1). It is one of the 10 most common
protease inhibitor in differentiating malignant from the
malignancies. 95% of thyroid cancer cases are papillary
benign thyroid nodule. Studying serum levels of these
thyroid carcinomas (PTC) and follicular thyroid
markers with different thyroid cancer stages and
carcinomas (FTC) (2). When found in their early stages,
histopathological types.
PTC and FTC are frequently treatable, however, the
chances of survival may drop from 100% in stages I and
PATIENTS AND METHOD
II to 50% in stages IV (3).
This study was conducted on: a malignant group
Therefore, the secret to effective therapy and a
that included thirty patients diagnosed with thyroid
decrease in mortality is early identification. The results
cancer. (8 males and 22 females) their age ranged from
of
pre-operative
diagnostic
procedures
like
25 to 77 years. Another benign group included thirty
ultrasonography, CT scans, and fine-needle aspirates
patients with benign thyroid diseases (3 males and 27
(FNA) are frequently inconclusive. Up to 75% of
females), and their ages ranged from 19 to 63 years.
patients who undergo diagnostic hemithyroidectomy
Also, twenty-five apparently healthy individuals were
surgery in these undetermined circumstances have a
studied as a control group.
benign illness (4).
They included 6 males and 19 females. Their age
Consequently, biomarkers are required for
ranged from 30 to 55 years. The study was conducted
diagnosis. Low molecular weight basic heparin-binding
during the period from December 2020 to November
growth factor known as midkine (MK) (5). MK affects
2021, the patients were chosen from the General
cell proliferation, survival, migration, angiogenic, and
Surgery Department of Assiut University Hospitals and
antiapoptotic actions and is highly expressed
South Egypt Cancer Institute. Patients and controls gave
throughout embryogenesis (6). A frequent characteristic
their formal consent. The Assiut University Faculty of
of cancer is the overexpression of the MDK gene and
Medicine's Ethical Committee gave its approval to the
the MK protein within the tumor.
study.
SLPI is a newly developed serine protease inhibitor
that promotes tumor growth and is overexpressed in
Ethical Approval:
several cancers (7). Protease inhibitors help initial tumor
Each participant in the study provided written
cells create networks resembling blood vessels and
informed consent, which was obtained after the project
enhance perfusion. They are typically overexpressed in
was given the go-ahead by the Assiut University Ethics
a variety of cancer tissues, such as those in the head and
Board. The Declaration of Helsinki, the code of ethics
neck, breast, lung, and brain. (8).
of the World Medical Association, was followed when
conducting this research.
6039
Received: 29/06/2022
Accepted: 05/09/2022
c:\work\Jor\vol891_299
The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 6036- 6040
Oxidative Stress Parameters, Can They Predict Mortality in
Acute Aluminum Phosphide Poisoning?
Shymaa M. N. Abdulrhman*, Raghda H. Deraz, Laila M. E. Sabik
Department of Forensic Medicine and Clinical Toxicology,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Shymaa M. N. Abdulrhman, Mobile: (+20) 01140292959, Email: shymaanasrallah93@gmail.com
ABSTRACT
Background: Aluminum phosphide (AlP) is used excessively in Egypt as a fumigant and preservative for the grains.
Recently, the suicidal accidents due to AlP poisoning are uprising as it is highly toxic and easily available for vulnerable
groups as uneducated individual and teenagers.
Objective: This study aims to evaluate the ability of oxidative stress parameters including malondialdehyde (MDA),
catalase activity and superoxide dismutase (SOD) to predict the outcome of AlP acute intoxication.
Patients and methods: This was a prospective cohort study on 50 cases of AlP-intoxicated cases who presented to
Zagazig Poison Control Center, Emergency Department and Intensive Care Units of Zagazig University Hospitals from
January 2021 to June 2021, forty-two of them were eligible to be included for age group (20-45). Serum samples were
collected within 24 hours post ingestion.
Results: serum level of malondialdehyde (MDA) was significantly elevated and catalase activity was markedly declined
in the non-survivors compared to the survivors, while SOD had no statistical value.
Conclusions: MDA and catalase activity showed good prognostic potential using statistical tests of comparison,
although by receiver operating curves, they showed low specificity (41.2% and 76.5% respectively) with possibility of
high false positive, while SOD was of no value.
Keywords: Oxidative stress parameters, Predict mortality in acute aluminum, Phosphide poisoning, Malondialdehyde.
INTRODUCTION
Aluminum phosphide "The wheat pill" is a
With absence of specific antidote for aluminum
fumigant which used to preserve grains widely in
phosphide poisoning the treatment of the AlP poisoning
several developing agricultural countries, like Egypt, to
only is supportive and symptomatic (6).
protect wheat and rice from any infestation. The
This study aims to evaluate the ability of
aluminum phosphide poisoning, whether accidental or
oxidative stress parameters including MDA, catalase
suicidal, is considered a health hazard in Egypt
activity and SOD to predict the outcome of AlP acute
nowadays; as it is a cheap and easy available poison
poisoning.
without legal legislation controlling its purchasing (1).
The pill is composed of 56% aluminum
SUBJECTS AND METHODS
phosphide and the rest are inactive ingredients. One pill
Prospective cohort study on fifty cases of AlP
contains about 1500 milligrams of aluminum
intoxicated cases who presented to Zagazig Poison
phosphide(2).
Control Center, Emergency Department and Intensive
The fatal dose for an average-sized individual is
Care Units of Zagazig University Hospitals from
believed to be 150-500 milligrams; so less than half pill
January 2021 to June 2021, forty-two of them were
is enough to kill an adult individual as it is believed that
eligible to be included in represented inclusion age
aluminum phosphide is fatal when consumed from a
group (20-45).
recently opened container. Because of the immediate
release of lethal amount of phosphine gas (PH3) when
Ethical consent:
it comes in contact with the moisture or stomach
The research was conducted with approval from
content; then, phosphine gas is rapidly absorbed through
a scientific research ethics commission Zagazig
lungs and stomach causing severe poisoning as it binds
University (Institutional Research Board "IRB"
cytochrome oxidase and changes the valences of the
number ZU-IRB #6665/13-1-2021). Informed
hem component of hemoglobin (Hb)(3, 4).
consent was taken from the patient's relatives or the
The usual clinical picture of aluminum
patient himself when he was still conscious with
phosphide intoxication are nausea, abdominal pain,
keeping the patients` records confidential in all
vomiting, hypotension, severe metabolic acidosis,
stages of the study. This work has been carried out
cardiac arrhythmia, hepatic necrosis and congestive
in accordance with The Code of Ethics of the World
heart failure (5).
Medical Association (Declaration of Helsinki) for
The main cause of death is the cardiogenic
studies involving humans.
shock resistant to fluid therapy and inotropes followed
by complications as disseminated intravascular
Inclusion criteria: History of certain intake of wheat
coagulation (D.I.C) and multi organs failure (2).
pill within 24 hours. The cases presented with the
clinical findings of acute aluminum phosphide
6036
Received: 29/06/2022
Accepted: 05/09/2022