The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6051- 6055

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

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.
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.


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
without legal legislation controlling its purchasing (1).

The pill is composed of 56% aluminum
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
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).
hem component of hemoglobin (Hb)(3, 4).
Informed consent was taken from the patient's
The usual clinical picture of aluminum
relatives or the patient himself when he was still
phosphide intoxication are nausea, abdominal pain,
conscious with keeping the patients` records
vomiting, hypotension, severe metabolic acidosis,
confidential in all stages of the study. This work has
cardiac arrhythmia, hepatic necrosis and congestive
been carried out in accordance with The Code of
heart failure (5).
Ethics of the World Medical Association
The main cause of death is the cardiogenic
(Declaration of Helsinki) for studies involving
shock resistant to fluid therapy and inotropes followed
by complications as disseminated intravascular

coagulation (D.I.C) and multi organs failure (2).
Inclusion criteria: History of certain intake of wheat

pill within 24 hours. The cases presented with the
Received: 29/06/2022
Accepted: 05/09/2022

Full Paper (vol.892 paper# 1)

c:\work\Jor\vol892_2 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6056- 6061

Different Methods of Endovascular Techniques in Management of
Aorto-Iliac Occlusive Disease
Sherif Omar El Kerdawi1, Esmail Serageldin2, Ali Mahmoud Mohamed Galal3
1 Vascular Surgery Department, Faculty of Medicine, Helwan University
2 Vascular Surgery, Shebin Elkom Teaching Hospital
3 Vascular Surgery Department, Faculty of Medicine, Aswan University
Corresponding author: Ali Mahmoud Mohamed Galal, E-mail: a_mando76@yahoo.com
Mobile: +20 100 181 6078

AIOD (Aorto-Iliac Occlusive Disease) may affect any of the arteries from the distal aorta to the common
femoral arteries. CERAB (Covered Endovascular Reconstruction of Aortic Bifurcation) is a minimally invasive method
used to treat significant and/or recurring aortoiliac occlusive disease. Bare-Metal stents are both effective and safe for
treating AIOD. Bare-Metal stents had a statistically substantial greater risk of primary patency in both the general cohort
and more complicated TASC C/D lesions.
This was a comparative study done in Helwan University Hospital, Wadi Elnil Hospital, Shebin EL Kom
teaching hospital and Aswan University Hospital from June 2020 to June 2022. The study was conducted on 45 subjects.
Our study included 45 patients who were categorized into three groups in 1:1:1 ratio. Groups were covered stents,
Endovascular Aneurysm Repair (EVAR), and Bare-Metal groups. Patients were followed clinically and by duplex US
Results: There was no substantial variation among the three groups except in double barrel technique, Superficial
Femoral Artery (SFA) angioplasty and complications occurrence. Double barrel was mostly used in Bare-Metal group,
SFA angioplasty was significantly observed in Covered Stents group and complications frequently occurred in Bare-
Metal group. Bare-Metal group re-intervention was significantly increased compared to other groups (Less patency).
Conclusion: A covered Stents and EVAR technique has proven to be optimal endovascular treatment options for aorto-
iliac occlusive disease and is related to promising clinical outcomes. EVAR is more used with aneurysm occurrence.
Through-out time Bare-Metal Stents have low patency rate compared to CERAB and EVAR techniques.
Keywords: AIOD, Covered Stents, CERAB, EVAR, Bare-Metal Stent.


optimization is a critical component of effective AIOD
An inflow lesion known as AIOD may arise
management (3).
anywhere between the common femoral arteries and the
distal aorta. Stenoses may impact either the aorta or the
recommended for patients with severe lifestyle-
iliac arteries alone or both, and they can be short or long
restricting claudication, rest pain, a non-healing ulcer,
segmented, calcified or ulcerated, concentric or
gangrene, or tissue loss, iliac system stenosis preventing
eccentric, numerous or few, unilateral or bilateral.
other endovascular therapies, and reduced renal activity
Localized infrarenal aortic stenoses that do not affect
or hypertension in renal transplant recipients. In the case
the aortic bifurcation are infrequent. This is more
of complications, contraindications include a lack of
common in young persons who have less atherosclerotic
symptoms, incorrect anticoagulation, and operator
disease. The most frequent extension of distal aortic
inexperience with insufficient surgical assistance (4).
occlusive disease is into the common iliac arteries (1).
Angioplasty and/or stenting are examples of
The atherosclerotic consequences of smoking constrict
endovascular treatments. The absence of further
an already tiny aorta and iliac arteries, resulting in
treatment following endovascular intervention is
hypoplastic aortoiliac syndrome, which is more
referred to as primary patency. When the treated
frequent in female smokers. Intervention should only be
segment is not occluded, primary assisted patency is
used for patients with limb-threatening claudication or
defined; when the treated segment is occluded,
claudication that restricts their lifestyle since patients
secondary patency is produced (5).
with asymptomatic PAD are unlikely to benefit from
Because of the high frequency of AIOD, as well
endovascular or surgical therapies and may have
as the possibility of severe lifestyle-limiting
difficulties connected to treatment. In addition,
claudication, impotence, and/or tissue loss, proper
impotence is a common adverse effect among AIOD
diagnosis and therapy are required. The symptoms of
patients (2).
aortoiliac illness are alleviated by a combination of
Risk considerations for the establishment of
medical management of modifiable risk factors for
AIOD include non-white ethnicity, smoking, diabetes,
PAD, correct noninvasive and/or invasive diagnostic
dyslipidemia, high blood pressure, and age, and male
diagnosis for patients with claudication or CLI, and
sex, elevation of the C-reactive protein, hyper
endovascular and/or surgical revascularization, as
necessary (6).
and chronic renal impairment. Modifiable risk factor

Full Paper (vol.892 paper# 2)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6062- 6067

Comparison of the Effectiveness of Bosentan and Sildenafil in the
Management of Persistent Pulmonary Arterial Hypertension in Neonates
Hanan Elsayed Kamel Bakry
Pediatric Department, Damietta General Hospital, Ministry of Health, Damietta, Egypt.
Corresponding author: Hanan Elsayed Kamel Bakry.
E-mail address: Hananbakry10@ gmail.com. Mobile Phone: +201019089246
In newborns, persistent pulmonary hypertension (PPHN) poses a serious hazard to life. The principal
treatment, inhaled nitric oxide, is believed to be unavailable in developing nations, where mortality is predicted to be
between 10% and 20% higher. Objectives: This study aimed to assess the effectiveness, safety, and potential adverse
reactions of bosentan and sildenafil when used in newborns with PPHN.
Patients and Methods: Between July 2021 and August 2022, a double-blind clinical experiment was carried out at
Damietta General Hospital's Neonatal Intensive Care Unit. In newborns with PPHN, the effectiveness, safety, and
potential adverse reactions of bosentan and sildenafil were assessed. Comparisons were done between the two groups'
echocardiographic results, length of oxygen reliance, need for invasive ventilator assistance, duration of medication,
and short-term results such as: blood pressure, white blood cell, and haemoglobin counts. Results: Bosentan has
comparable PAP-lowering and cardiac output-improving effects to sildenafil. Bosentan had a considerably shorter
treatment period than sildenafil (P = 0.003). During 15 and 17 days, the oxygen need time was comparable between the
two groups (P = 0.175). Both groups required invasive breathing support, which was equivalent (P = 0.867). The third
echocardiographic research results, including pulmonic inadequacies (P = 0.183), tricuspid regurgitations (P = 0.357),
and ejection fractions (P = 0.159), were comparable in the bosentan and sildenafil groups, despite pulmonary artery
pressure (PAP) and the intensity of tricuspid valve inadequacy being higher before therapies. Conclusion: Neonatal
PPHN is successfully treated with bosentan, which decreased it more quickly. Comparing to sildenafil, it is more
effective at lowering PAP and lessens the degree of tricuspid valve dysfunction in a shorter period of time.
Keywords: Bosentan, Neonates, Persistent pulmonary hypertension, Pulmonary artery pressure, Sildenafil.

access to critical medications. The primary medication
Although persistent pulmonary hypertension
for treating this illness that produces pulmonary
(PPHN) was already recognised for more than thirty
vascular vasodilation by elevating CGMP (Cyclic
years, its cause and course of treatment are still
GMP) of pulmonary smooth muscles tissue is breathing
unknown. There are few research that examined the
nitric oxides (9). Additional typical medications for
etiology, risk factors, consequences, and treatment
PPHN include inotropes including intravenous
options of PPHN (1). In contrast, the usage of novel
dopamine, dobutamine, epinephrine, as well as
medications is restricted to experimental data or
norepinephrine. Dopamine raises the systemic blood
adults PPHN patients. The disease's physiopathology is
pressure and seems to have adrenergic consequences
caused by the pulmonary artery's inability to respond to
(10). Dobutamine enhances cardiac contractility while
increasing oxygenation, acute hypoxia, and persistent
decreasing left ventricular capacity. Norepinephrine
foetal hypoxia, all of which may be linked to thicker
and epinephrine raise peripheral blood pressure and
pulmonary artery smooth muscles (2, 3). As a
heart outputs, respectively (11, 12). Other class of
consequence of the pulmonary artery smooth
muscles contraction, it may also cause partial or total
phosphodiesterase inhibitors like milrinone and
failure of the lungs to dilate and ventilate properly,
sildenafil. Milrinone promotes pulmonary artery
which results in a reduction in lumen diameter, an
vasodilatation, which in turn lowers pulmonary artery
increase in pulmonary artery resistances, and an
pressures by raising CGMP (Cyclic GMP). It also
elevation in pulmonary artery pressure (PAP) (4).
enhances cardiac function by reducing afterload (13). It
Persistent PPHN frequently has an idiopathic
does, therefore, raise systemic blood pressure at greater
cause. Most term and post-term newborns experience it
dosages. By raising intracellular CGMP, the oral drug
(5). The condition affects 1.9 out of every 1000 live
sildenafil produces vasodilation of the pulmonary
babies. Early respiratory distress upon birth, that is
artery, which lowers PAP and widens blood vessels.
accompanied by tachypnea, grunting, cyanosis, and
This increases blood circulation to particular areas of
lower arterial oxygen levels, is one of the disease's signs
the body, which might lead to difficulties (14, 15).
(6). Even with 100% oxygenation, these signs are not
Endothelin A and B receptors are antagonised by
restored; nevertheless, hyperventilation may normalise
bosentan. It is helpful in treating pulmonary arterial
the arterial level of oxygen saturation. Depending on
hypertension, according to current data, but its impact
echocardiographic findings, the condition can be
on the pulmonary arteries is limited and specific,
definitively diagnosed (7, 8). The condition has a 10%­
avoiding major systemic effects. Bosentan studies have
20% death rate in newborns from underdeveloped
been limited in some nations since inhaling nitric
nations, but this incidence is higher in neonates without
oxides is readily available. None of those trials have
Received: 29/6/2022
Accepted: 5/9/2022

Full Paper (vol.892 paper# 3)

Out come of early tracheotomy in Comparison to prolonged endotracheal intubations in Severe traumatic The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6068- 6073

Outcome of Early Tracheotomy in Comparison to Prolonged Endotracheal
Intubation in Severe Traumatic Brain Injury Critically Ill Patients
Mohammed Abdel Monem Saeed*1, Ahmed Medhat El Shafae2,
Deyaa Mohamed Ibrahim3, Alaa Mohamed Hussein4
Departments of 1Critical Care Medicine and 2Ear, Nose and Throat, Faculty of Medicine, Helwan University, Egypt
Department of 3Critical Care Nursing, Helwan University Hospitals, Egypt
Department of 4Clinical Pharmacist, Faculty of Pharmacy, Helwan University, Egypt
*Corresponding author: Mohammed Abdel Monem Saeed, Mobile: (+20) 01099292999, E-Mail: mohammedicu1@gmail.com

In patients with severe traumatic brain injury, the goal of this study is to determine whether or not early
tracheostomy on day 5 lowers mechanical ventilation time, intensive care unit (ICU) stay, incidence of pneumonia, and
death compared to extended intubation. Our study aimed to determine the effects of early tracheostomy on mechanical
ventilation time, intensive care unit (ICU) stay, and nosocomial pneumonia.
Patients and methods: All patients who satisfied the following selection criteria were prospectively included in the
study: Patients with isolated traumatic brain injury with scores of 8 or below on the first and fifth days of the Glasgow
Coma Scale were randomly assigned to one of two groups: Total time of mechanical ventilation, ICU duration of stay,
incidence of pneumonia, days of mechanical ventilation after nosocomial pneumonia, and mortality were compared
between the early tracheostomy (T group, n = 400) and extended endotracheal (I group, n = 400) groups.
Results: ICU length of stay was 17.13 (SD 1.93) days in early tracheostomy versus 48.94 (SD 6.08) in the prolonged
intubation group, in terms of a p-value that is highly significant (P<0.001). Also, mortality was statistically highly
significant in comparison between both groups with only three patients in the early tracheostomy group versus thirty
eight patients in the prolonged intubation group.
Conclusion: Early tracheostomy in severe traumatic brain injury carries a great beneficial outcome regarding total
number of days requiring mechanical ventilation and post-nosocomial pneumonia days requiring mechanical ventilation,
incidence of pneumonia, complications either clinical or endoscopic and mortality when compared to prolonged
intubation patients.
Keywords: Early tracheostomy, Prolonged intubation, Traumatic brain injury.

(ARDS), sinusitis, cardiac dysfunction, bleeding,
Tracheostomy is a common procedure in the
sepsis, occurrence of granuloma, fibrosis and finally
intensive care unit. Because of the risk of significant
mortality when compared specifically, in individuals
oropharyngeal and laryngeal damage, prolonged
with isolated severe traumatic brain damage who
translaryngeal intubation is not suggested (1-7).
require extended intubation.
Despite the longevity of the tracheostomy

procedure, the current body of evidence is insufficient
to characterize the impact of early tracheostomy on
After receiving clearance from the Helwan University
mechanical ventilation and intensive care unit (ICU)
School of Medicine's Ethical Review Committee, this
length of stay (2-7).
randomized controlled clinical trial was conducted from
Many advantages come with tracheostomies for
January 2020 to May 2022.
patients on mechanical ventilation, including better

nursing care, more comfort, more safety, the ability to
Participants were patients who fulfilled the
speak, assistance with oral nourishment, and early
following criteria:
weaning from the ventilator (8-9).
- Traumatic brain injury (Glasgow Coma Score
Nosocomial pneumonia especially ventilator
[GCS] 8 or lower at admission) that occurred in
associated pneumonia was reported in some studies to
occur more with tracheostomy (10-12).
- If these conditions were satisfied on the fifth day of
This recommendation was given by the American
hospitalization, patients were randomly assigned to
consensus conference on artificial airways in 1989, and
get a tracheostomy (T) or continue with extended
the same conclusion was reached by the European
endotracheal intubation (I).
consensus in 1998: tracheostomy is the preferred option
- GCS <8 on fifth day without any sedation.
when an artificial airway is needed for duration of more
- CT scan shows brain contusion.
than 21 days (13-14).
- Patients in the T group (early tracheostomy group)
Our study's aim is to learn how early
had tracheostomies on days 5 or 6 after admission
tracheostomy affects the time a patient spends on
by a critical care physician using the conventional
mechanical ventilation and in ICU, nosocomial
procedure in the intensive care unit and low
pneumonia, other complications from intra-cranial
pressure tracheostomy tube cuffs.
hypertension, acute respiratory distress syndrome
Received: 29/06/2022
Accepted: 05/09/2022

Full Paper (vol.892 paper# 4)

c:\work\Jor\vol892_5 0The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6074- 6079

Angiogenic Biomarkers (sFlt / PLGF): An Approach for
Clinical Integration of Pre-eclampsia
Gehad Mohsen Mohamed El-Mazny1, Ekbal Mohamed Abo-Hashem1, Mona Abo Bakr El-Hussiny1,
Shereen Mamdouh Abdelwakil Mahammed2, Mostafa Mohamed Mansour1
1Clinical Chemistry Unit, Clinical Pathology Department and
2 Department of Obstetrics and Gynecology, Mansoura, Faculty of Medicine, Mansoura University, Egypt.
Corresponding author: Gehad M. El-Mazny, Phone number: +201007222319, Email: gehadmohsen422@gmail.com

One of the most important pregnancy problems is pre-eclampsia (PE). PE is caused by changes in the
circulating levels of angiogenic agents. Endothelial dysfunction is caused by elevated levels of antiangiogenic factors
like soluble fms-like tyrosine kinase-1(sFlt-1) and decreased levels of angiogenic factors like placental growth factor
(PlGF). Objective: This study's objective is to assess the significance of alternation of angiogenic balance as a pre-
eclamptic marker and their association to PE severity.
Patients and Methods: One hundred pregnant women in third trimester participated in this case-control study, with 40
having mild PE, 40 having severe PE, and 20 healthy pregnant ladies as control. It was done in Clinical Pathology and
Obstetrics and Gynecology Departments of Mansoura University Hospitals during a period from "November 2020 to
April 2022". Clinical and laboratory tests on all individuals were performed, including CBC, LDH, sFlt-1 in the serum,
PLGF, liver function tests, renal function tests.
Results: In comparison to the control group, greater levels of sFlt-1 and sFlt-1/PLGF and lower levels of PLGF were
present in all cases of mild and severe PE (p0.001 for each). Additionally, severe cases demonstrated significant high
levels of sFlt-1 and sFlt-1/PLGF and significant low levels of PLGF with superior AUCs when compared to moderate
instances (AUC=0.999).
Conclusion: sFlt-1, PLGF and sFlt-1/PLGF ratio may have a role in the prediction of severity of PE, and thus diagnosis
of PE, thus may be used in management of PE.
Keywords: Angiogenic biomarkers, Pre-eclampsia, PLGF, sFlt-1.

bloodstream, respectively. This lowers their free levels,
Around 5-8% of pregnancies worldwide experience
results in endothelial dysfunction, and exacerbates the
PE, a risky pregnancy condition characterised by
disease's clinical symptoms (3).
hypertension and harm to numerous maternal organs.
As a result, this study aims to assess the importance
Particularly the early onset variety is a major contributor
of angiogenic factor imbalance (sFlt-1/PLGF) "as a
to maternal and neonatal morbidity and mortality(1).
marker for PE" and assess their association to PE
The onset and development of the diseases brought
on by PE are significantly influenced by the placenta.

PE is caused by a combination of genetic,
immunological, and angiogenic factors. PE appears to
The current investigation, a case control study,
have its roots in the defective trophoblast cell invasion
was conducted in the Clinical Pathology Department
of the mother's spiral arteries during localised aberrant
and Obstetrics and Gynecology Department, Mansoura
immunological contacts between the fetoplacental unit
University Hospitals during a period from "November
and mother. Chronic hypoxia is brought on by placental
2020 to April 2022".
underperformance. The placenta experiences apoptosis
This study included 100 pregnant women in
and necrosis as a result of increased local oxidative
child bearing period (aged 19-44 years) with a
stress brought on by the reoxygenation that takes place
gestational age of 24-36 weeks and six days of
in conjunction with it. Apoptotic bodies released into
amenorrhea. They were classified into 3 groups:
the mother's circulation, pro-inflammatory and

antiangiogenic placental mediators, and dysfunctional
Group I: included forty pregnant patients (in 3rd
maternal systemic endothelial cells are all related to
trimester) with mild PE, which was divided into 14
systemic inflammation(2).
patients with GA <34 weeks and 26 patients with GA
Preeclampsia is caused by pathogenic changes in the
34 weeks.
circulating angiogenic factors. Angiogenesis, the
Group II: forty patients (in 3rd trimester) with severe
process by which existing blood arteries are used to
PE, which was divided into 7 patients with GA <34
create new ones, is carefully regulated by angiogenic
weeksand 33 patients with GA 34 weeks.
agents. Additionally crucial for maintaining healthy
Group III: twenty healthy pregnant ladies acting as
vessels, angiogenic factors serve as critical cues for
control with GA 34 weeks.
organ development. VEGF, PlGF, the antiangiogenic

factors sFlt-1 and soluble Endoglin (sEng), capture
Twin pregnancies, pregnancies with less than
transforming growth factor beta (TGFb) in the
twenty-four weeks of gestation, and pregnancies in
Received: 26/6/2022
Accepted: 2/9/2022

Full Paper (vol.892 paper# 5)

c:\work\Jor\vol892_6 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6080- 6084

Predictors of Mortality in Redo Aortic Valve Replacement for
Prosthetic Aortic Valve Endocarditis
Hisham Mohamed El Batanony1, Abdallah Samy Korany Gouda1, Ahmed Hussein Gaafar2, Hosam Fathy Ali*2
1Department of Cardio-Thoracic Surgery, Faculty of Medicine, Beni Suef University, Egypt
2Department of Cardio-Thoracic Surgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Hosam Fathy Ali, Mobile: (+20) 01114567170; Email: amy.rh.209@gmail.com

One of the most dreaded complications and a source of significant mortality after aortic valve surgery is
prosthetic aortic valve endocarditis. Many studies were done to address the risk factors for hospital mortality and
responsible for prolonged postoperative hospital stay.
Patients and Methods: Thirty patients underwent the study from September 2019 to March 2020 at Kasr Al-Aini
University Hospitals, Cairo, and Beni Suef University Hospital, Egypt. Preoperative, operative, and postoperative data
to determine the risk factors for hospital mortality were collected.
Result: The study included 16 (53.3%) males and 14 (46.7%) females. With mean age ±SD 38.5±7.7 years. The most
prevalent isolated organism was staph aureus (30%) followed by coagulase negative staph (20%) then enterococcus
fecalis and streptococcus bovis (13.3%). The hospital mortality was 26.7%. Pre-operative predictors of in-hospital
mortality were CHF (p value 0.011), DM (p value 0.012), NYHA III&IV (p value 0.014), preoperative need to inotropic
(p value 0.011), preoperative need to mechanical ventilation (p value 0.017), presence of aortic root abscess (p value
0.003). Intraoperative predictors of mortality were prolonged CPB time (p value 0.001), prolonged clamping time (p
value <0.001). While postoperative predictors were low COP (p value 0.027) and postoperative sepsis (p value 0.029).
Conclusion: Once infective endocarditis suspected in patient has prosthetic valve combined management should be
taken to minimize the perioperative complications and hence the operative mortality risk minimized.
Keywords: Prosthetic Valve, Aorta, Redo, Mortality, infective endocarditis.


Surgical treatment of prosthetic aortic valve
The increasing prevalence of valvular heart
endocarditis is particularly challenging due to
disease worldwide is a global clinical dilemma, where
destruction of the aortic root and the need for complex
the demand for interventions is expected to hit 850,000
repairs(8). Antimicrobial therapy for PVE should be
by 2050. Prosthetic heart valves have been used to
guided by the susceptibility profile of the causative
address this problem and the two commonly used basic
organism. Blood cultures should be drawn prior to
types are: surgically implanted mechanical heart valves
administration of any empiric antibiotics. Specific
(MHVs) and biological heart valves (BHVs) (1).
antimicrobial regimens depending on the causative
If a pathological heart valve is unrepairable,
microorganisms have been published by the American
valve replacement is now performed with low
Heart Association and European Society of Cardiology
morbidity and mortality. However, prosthetic valves
is the initial therapy for PVE should be initiated in a
are associated with some adverse effects, in particular
hospital setting under close observation, for any
infections, being a predisposing factor for the
symptoms or signs suggestive of a worsening condition
development of infective endocarditis (IE) (2).
where surgical intervention should be considered(9-11).
One of the most dreaded complications and a
The aim of this study is to detect the possible
source of significant mortality after valve surgery is
risk factors that may predict the occurrence of the
prosthetic valve endocarditis (PVE). PVE is the
hospital mortality in patients undergoing redo aortic
infection of a surgically implanted prosthetic valve or
valve replacement for prosthetic aortic valve
repaired native valve with an annuloplasty ring, with an
endocarditis to pave the way towards decreasing the
incidence of 3% to 6% over a patient's lifetime(3).
incidence rates of hospital mortality and their
The prevalence of PVE grows steadily and the
subsequent prolonged intensive care and hospital stay.
prognosis is worse than in cases of native valve

endocarditis (NVE) due to the excavating destruction of
periannular structures, which occurs in most cases
Patients: Thirty cases underwent redo aortic valve
(56% to 100%) lifetime (4,5). Surgical therapy is
replacement for prosthetic aortic valve endocarditis
essential for effective and successful treatment of IE
retrospectively reviewed and data analyzed at Kasr Al-
and requires clear guidelines for the optimal treatment
Aini University Hospitals, Cairo, and Beni suef
algorithm (6). In each individual case, the risks and
University Hospital, Egypt. In the period from
benefits of surgery need to be carefully weighed.
September 2019 to March 2020.
Surgical intervention is most beneficial when patients
Data collection: All patients were studied for age, sex,
present with complications of PVE, such as worsening
and detailed clinical examination with emphasis on the
heart failure, prosthetic valve dehiscence, worsening
presence of comorbidity e.g. diabetes, CVS and
regurgitation or perivalvular leak, valvular obstruction
associated medical diseases e.g. DM, renal failure.
and cardiac abscess formation(7).
Echocardiography was performed to assess the Size of
Received: 28/9/2022
Accepted: 4/6/2022

Full Paper (vol.892 paper# 6)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6085- 6090

Safe Thyroidectomy without Nerve Detector Stimulation. A Maneuver Adds
More Safety during Total Thyroidectomy, Comparative Study
Mohamed B. M. Kotb1*, Mostafa T. Ahmed2, Ibrahim A. Ibrahim3,
Abd-Elradi Abd-Elsalam Farghaly1, Mahmoud Thabet Ayoub1
Department of General Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
Correspondence to: Mohamed B. M. Kotb, Mobile: 01012127297, Email: kottb73@gmail.com

One of the most invasive procedures in endocrine surgery is the thyroidectomy. When the procedure is
carried out in the appropriate surgical settings, it is safe with little morbidity and zero fatality
We aimed to visualize the RLN and parathyroid and confirm it by staining with Diluted gentian violet for
safe total thyroidectomy.
Patients and Methods: At Assiut University Hospital, a quasi-experimental study was conducted on primary (not
recurring) complete thyroidectomy that was performed on 100 individuals with benign and malignant goitre diseases.
The patients were divided into two groups: 50 cases were operated on using the diluted gentian violet spraying approach
in group 1 (interventional group), and 50 cases were established using the traditional procedure in group 2 (control
group). The perilobe and thyroid lobe were covered with diluted gentian rinse. The recurrent laryngeal nerve and
parathyroids were discovered and assessed.
In all cases, the recurrent laryngeal nerve was left uncolored and remained white, while all other tissues were
coloured blue. The blue stain was washed out and the parathyroid glands' natural yellow hue appeared within three
minutes. The thyroid gland was washed out in about 15 minutes.
Conclusion: A new method called diluted gentian violet spraying makes it possible to recognise both parathyroid
glands and recurrent laryngeal nerves. This method is technically sound, reliable, and safe.
Intraoperative, Diluted gentian violet, Safe, Spraying, Thyroidectomy.


One of the most invasive procedures in endocrine
2 (control group) had 50 cases set up using the
surgery is the thyroidectomy. When the procedure is
traditional technique.
carried out in the appropriate surgical settings, it is safe

with little morbidity and zero fatality (1). The extent of
the excision and the surgeon's level of experience are
Investigation design: This quasi-experimental study
both directly connected with thyroid surgery
was conducted at the University Hospital of Assiut. All
complications (1, 2). As a result, thorough dissection
patients were subjected to: Serum T3, T4, and TSH
techniques, proper training, and an understanding of
levels estimation, vocal cord examination by direct
anatomy and pathology are the cornerstones of safe and
laryngoscope, serum calcium level determination (total
effective thyroid surgery. It is possible to use the
and ionized), neck ultrasound, and fine-needle
thorough dissection approach by properly exposing all
aspiration cytology. Follow-up was offered to all
fine anatomical features in a dry, bloodless operating
room. Additionally, a thorough understanding of the
hypoparathyroidism and monitoring of calcium level
three-dimensional topographic anatomy, common
was done every week until serum calcium level returned
landmarks, and potential anatomic deviations must
to normal.
underpin the dissection.

Procedures: Surgeons of Assiut General Surgery
Department performed operations and general
The Medical School of Assiut University uses the
anesthesia was used. Collar incision was made in the
hospital as its primary teaching facility. The research
skin, the subcutaneous tissue, and platysma muscle. The
was carried out from May 2017 to February 2020.
superior thyroid pole was dissected, the middle thyroid
Participants in the study, one hundred patients
vein was tied off, and the strap muscles split vertically
underwent complete thyroidectomy for benign and
in the midline and retracted laterally. When the superior
malignant goitre illnesses.
vessels are separated, which enables us to medially

rotate and anteriorly mobilise the gland, the critical
Exclusion criteria: People who had recent surgery, had
components in this region are best exposed. The thyroid
vocal cord dysfunction before surgery, or had mental
lobe and perilobe area were sprayed with diluted gentian
impairment were not included.
violet in 4 ml (0.1%) strength ampules. Both the
The patients were split into two groups: group 1
parathyroid glands and the recurrent laryngeal nerve are
(interventional group) had 50 cases operated on using
susceptible to damage in this area. Although, the wash-
the diluted gentian violet spraying approach, and group
out time for thyroid glands was longer than 15 minutes,

Received: 29/6/2022
Accepted: 5/9/2022

Full Paper (vol.892 paper# 7)

c:\work\Jor\vol892_8 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6091- 6100

Role of Perforator Flaps in Leg and Foot Reconstruction
Tarek Abdella El-Gammal1, Youssef Saleh Hassan*2, Tarek Raief2, Mohamed Elyounsi2, Mohamed Adel2
Departments of 1Orthopedic and Traumatology and 2Plastic and
Reconstructive Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
*Corresponding author: Youssef Saleh Hassan, Mobile: (+20)01001166118, E-mail: youssef66@aun.edu.eg

Lower extremity wounds have been always a challenge for reconstructive surgeons. Free perforator flaps
are considered to be the best option for this problem but require the complexity of microsurgery. So, pedicled perforator
flaps have emerged as an alternative option. The aim of the present study is the assessment of efficacy of perforator
flaps (either free flaps or pedicled flaps) regarding the coverage of traumatic soft tissue defects on the leg and foot.
Patients and methods: A prospective study was conducted upon 40 patients with traumatic soft tissue defects in the
leg and foot. The free flaps used were anterolateral thigh flap (ALT) and medial sural artery perforator flap (MSAP). In
pedicled perforator flaps group, 10 cases were designed as propeller flaps, while the other 10 flaps were designed as
perforator plus flaps. Results: Free flaps were mainly used for large sized defects; one case of partial flap loss and one
case of complete flap necrosis. MSAP flap was the first option for coverage of large sized defects on foot and ankle as
it's a thin and pliable flap, while ALT flap was used for coverage of larger defects on the leg. Pedicled perforator flaps
were used mainly for small to medium-sized defects especially in the lower third of the leg; we had 3 cases of flap loss
in propeller flap design while we had no cases of flap loss in perforator plus flap.
Conclusion: Perforator flaps have become a reasonable solution for soft tissue defects of the lower extremity. Careful
assessment of the dimensions, location, patient comorbidities, availability of surrounding soft tissue and presence of
adequate perforators are mandatory for proper perforator flap selection.
Keywords: Perforatr flap, Propeller flap, Perforaror plus flap, Anterolateral thigh flap, Medial sural artery peforator

Department, Assiut University Hospital, Assiut
Many severe lower extremity injuries that were
University, between September 2017 and August 2019.
formerly thought to be deadly can now be saved thanks
All polytraumatized patients with poor general
to advances in trauma management technology (1).
condition and disturbance of conscious level were
excluded from the study. Also, patients with chronic
struggled with instances involving soft tissue lesions in
debilitating diseases like chronic renal failure and liver
the lower extremity, especially in the distal section of
cell failure were excluded from the study.
the leg since local flaps in this area are unreliable (2).
The patients were divided into: Group I included
The angiosome was first described by Taylor and
20 patients were managed by free perforator flap, 14
Palmer (3) as a three-dimensional vascular region
patients were treated with anterolateral thigh flap (ALT)
supplied by an artery and a vein through branches for all
and 6 patients were treated by medial sural artery
the tissue layers between the skin and the bone, and
perforator flap (MSAP), and Group II included 20
showed that also demonstrated that there are numerous
patients managed by pedicled perforator flap, 10 flaps
choked and true anastomotic arteries between the
were designed as propeller flaps while the other 10 flaps
angiosomes (3). The era of perforator flaps has begun
were designed as perforator plus flaps. Anterior tibial
following this evolution and as a result of the
artery perforator flap, peroneal artery perforator flap,
publications made by Koshima and Soeda (4) and Kroll
and posterior tibial artery perforator flap were the
and Rosenfield (5) in 1989, respectively.
pedicled flaps.
Perforator vessels are the flaps where the blood
Personal and medical histories details were taken
vessel that supplies blood to the skin passes through the
from every patient. Careful local examination for any
fascia that lies on top and covers the muscles where the
vascular injury, neurological deficit, bone fracture, size
source artery is deep (6).
of the defect, and the condition of nearby soft tissues
The aim of the current study is the assessment of
was done.
efficacy of perforator flaps (either free flaps or pedicled
Surgical debridement with removal of all foreign
flaps) regarding the coverage of traumatic soft tissue
bodies, necrotic muscle and dead bone with subsequent
defects on the leg and foot.
regular dressing was done for heavily contaminated and

major sized wounds for successful control of infection,
while surgical debridement with primary coverage was
This prospective study was carried out on 40
done for mild contaminated and small sized wounds.
patients with traumatic soft tissue defects in the leg and
Skeletal stability and repair of any vascular insult
foot with or without bone injury who were admitted in
of the injured limb was achieved firstly. The type of flap
the Hand & Microsurgery Unit and the Plastic Surgery
was decided according to the site and size of the defect,
Received: 29/06/2022
Accepted: 05/09/2022

Full Paper (vol.892 paper# 8)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6101- 6105

Microscopic Identification of the Parathyroid Glands Feeding Blood Vessels:
A Method to Preserve Parathyroid Glands during Thyroidectomy
Mohamed Abdelmohsen Alnemr*, Ahmad Ramadan Lehni, Mohammed Kamal Mobashir
Otorhinolaryngology, Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Mohamed Abdelmohsen Alnemr, Mobile: (+20) 01225150427,
E-mail: dr.mabdelmohsen@yahoo.com, ORCID: 0000-0003-0340-5057

After a total thyroidectomy (TT), hypoparathyroidism may develop as a result of intraoperative stress,
injury to the vasculature supplying the parathyroid glands, or accidental loss of parathyroid tissue during surgery.
Depending on the cohort examined, the type of surgery utilized, and the diagnosis of hypoparathyroidism used, the
reported incidence of hypothyroidism after thyroidectomy varies greatly. The aim of the current study is to preserve the
parathyroid glands during total thyroidectomy operation by microscopic identification of their blood supply so
preventing post total thyroidectomy hypocalcemia due to hypoparathyroidism.
Patients and methods:
This study was conducted at Otorhinolaryngology, Head and Neck Surgery Department of
Zagazig University Hospitals. A total of 24 patients prepared for total thyroidectomy were included in this clinical trial.
The patients were randomly divided into two groups; Group I included 12 patients who underwent total thyroidectomy
with preservation of the parathyroid glands by microscopic identification of the arterial blood vessels of parathyroid
glands. Group II (control group) included 12 patients who underwent a traditional total thyroidectomy.
As regarding the postoperative hypocalcemia and hypoparathyroidism in our study, there was an increase in
their frequency among the traditional total thyroidectomy group (Group II) (25%) in comparison to microscopic
dissection group (Group I) (zero). Although that was not statistically significant "due to the small sample size" but we
can clearly notice that the use of microscopic identification technique led us to zero postoperative hypocalcemia and
hypoparathyroidism. Conclusions: Microscopic identification of the parathyroid feeding blood vessels as a method to
preserve parathyroid glands during total thyroidectomy is a safe procedure with low rate of complications and better
clinical outcome without exposure of the patient to toxic or allergic material as dye or specific light.
Keywords: Thyroidectomy, Parathyroid identification, Parathyroid, Hypocalcemia, Hypoparathyroidism.

reimplanted if inadvertently removed, is the most
The most frequent long-term consequence
crucial factor in preventing hypoparathyroidism (7).
following total thyroidectomy is hypoparathyroidism,
Thus, the current study aimed to preserve the
and with proper diagnosis and treatment, its morbidity
parathyroid glands during total thyroidectomy
and expense can be reduced (1). During thyroid surgery,
operation by microscopic identification of their arterial
it was crucial to keep the parathyroid glands (PGs)
blood supply, preventing post total thyroidectomy
functioning properly. For safe thyroid and parathyroid
hypocalcemia due to hypoparathyroidism.
surgery, it's crucial to recognise the parathyroid glands

and understand where their blood supply comes from (2).
According to various large series, the thyroidectomy's
This randomized controlled clinical trial was
mortality rate is almost 0%. However, the morbidity of
conducted at Otorhinolaryngology, Head and Neck
thyroidectomy remains a cause for concern (3).
Surgery Department of Zagazig University Hospitals. A
When the parathyroid hormone (PTH) is not
total of 24 patients prepared for total thyroidectomy
produced or is produced insufficiently, normal levels of
were included in this study.
calcium and phosphate are not maintained. As a result,
The patients were randomly divided into two
hypocalcemia, hyperphosphatemia, and low PTH are
groups; Group I included 12 patients who underwent
the biochemical manifestations of the disease.
total thyroidectomy with preservation of the parathyroid
Inadvertent injury to the parathyroid glands during
glands by microscopic identification of the arterial
thyroid surgery is the most frequent cause of
blood vessels of parathyroid glands, and Group II
hypoparathyroidism (4).
(control group) included 12 patients who underwent a
Since postoperative hypocalcemia can lead to
traditional total thyroidectomy.
extended hospital stays, frequent clinic visits, the
One case from group I was prepared for total
requirement for lifelong calcium and vitamin D
thyroidectomy for a 5 cm right thyroid lobe colloid
supplementation, and long-term complications like
nodule but intraoperatively the surgical team found no
cerebral, vascular, ocular, and renal damage, lowering
apparent macroscopic abnormality in the left thyroid
the rate of hypoparathyroidism is crucial for raising
lobe so they decided to perform only right
quality of life (5,6).
The preservation of the parathyroid glands' blood
thyroidectomy after definitive histopathological
supply, crucial to maintain their function and should be
examination which proved that it was a colloid nodule
Received: 28/06/2022
Accepted: 04/09/2022

Full Paper (vol.892 paper# 9)

c:\work\Jor\vol892_10 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6106- 6114

The Antioxidant Effects of Cerium Oxide Nanoparticles and Echinacea
Purpurea against Lead-induced Immunosuppression in Male Albino Rats
Amal H. Mahmoud*, Manal M. Abbas, Hanan A. AbdElmonem
Biological Application Department, Nuclear Research Centre, Egyptian Atomic Energy Authority, Cairo, Egypt
*Corresponding author: Amal H. Mahmoud, Mobile: (+20) 01112408081, Mail: dr.amalhanafi.1@gmail.com

Lead is an environmental pollutant has a negative effect on the immune system. Echinacea (E. purpurea)
is an immunostimulant. Also, cerium oxide nanoparticles (CeONPs) are potential antioxidant elements.
Objective: The current study was intended to assess the antioxidant and immunostimulant influences of CeONPs and
Echinacea against lead induced immune toxicity.
Methods: Forty nine male rats were allocated into 7 groups. Group1 served as the control group. Group2 rats were
orally treated with lead acetate 60 mg/ kg b.wt/day. Group3 rats were intraperitoneally (i.p.) injected with CeONPs 0.5
mg/kg b.wt/day. Group4 rats were orally treated with E.P. 150 mg/ kg b.wt/day. Group5 rats were given lead as group2
in addition injected i.p with 0.5 mg/kg b.wt/day CeONPs. Group6 rats gained the above mentioned dose of lead plus
150 mg/kg b.wt E.P orally. Group7 rats were given Lead & Echinacea and CeONPs by doses as mentioned above, rats
were treated for 2 weeks (5 days/week). Results: lead intake resulted in anemia with significant leukopenia and
lymphopenia. Additionally, lead injected rats showed a significant increase in interleukin-6, and tumor necrosis factor-
(TNF-). In contrast, sera-immunological parameters (interleukin-10, IgG, IgM) and testosterone levels were
significantly reduced. Moreover, lead-induced spleen oxidative injury was detected by a significant increase in
malondialdhyde level with notable reduction in reduced glutathione content and catalase activity. Treatment with
Echinacea and CeONPs improved the hematological, immunological and histological alterations induced by lead.
Conclusion: Echinacea. and CeONPs have antioxidant, anti-inflammatory and immunostimulatory effects and could
ameliorate the lead-induced immunotoxicity and oxidative stress.
Keywords: Lead, Immune system, Echinacea, Cerium oxide nanoparticles, oxidative stress, Spleen.


states; Ce+4 (oxidized form) and Ce+3 (reduced form). It
Lead is a heavy metal and one of the most
can alternate between the two in redox reactions with
harmful environmental contaminants in the world.
oxygen vacancies for acquiring or emitting electrons
Several evidences reported that lead causes different
during changing from Ce+3 to Ce+4 states [9]. Cerium
toxic biochemical effects on the liver, kidneys, nervous
activity resembles function of enzymes within the body,
system and the hematopoietic system [1]. Oxidative
superoxide dismutase [9] and catalase [10] in order to
stress is the main pathway implicated in lead-caused
counteract different reactive oxygen species (ROS)
toxicity [2]. The immune system which is the major
molecules including superoxide, nitric oxide and
contributor to inflammation has been demonstrated to
peroxinitrite [11]. Many researches have reported the
be adversely affected by lead [3].
anti-inflammatory, antibacterial and antioxidant effects
Globally, there is an increasing attention with
of CeONPs making them one of nanoparticles with
medicinal plants that can be considered as immune-
therapeutic potential [12].
modulators. Echinacea purpurea L. is a medicinal plant
Therefore, providing an approach for inhibiting
relates to the family Asteraceae recognized as
lead-immuno- toxicity is required. The study was
coneflower [4]. The US food and Drug Administration
conducted to assess the alleviating and modulatory
(FDA) identifies it as a food, whereas commission E
impacts of CeONPs and E. purpurea and their
(Task Force E of the Federal Bureau of Health of
combination on the hematological parameters,
Germany) authorized it as a medication. E. purpurea
contains active components involving polysaccharides,
histological structure of the spleen of the lead injected
polycetylenes, flavonoids, alkamides, caffeic acid
derivatives and cichoric acid, so it has antioxidant, anti-

inflammatory and immunomodulatory effects [5]. E.
purpurea also, has an interferon (INF) like effect
stimulating macrophages, increasing the production of
Cerium (IV) oxide (CAS Number: 1306-38-3), a
interleukin-1 and INF [6]. Among E. purpurea
nanopowder <25nm particle size obtained from Sigma-
components, echinacin, a particular glucose chain that
Aldrich Co., St.Louis USA. Cerium particles were
attaches to the T-cells and macrophages surface to
suspended in distilled water at dose (0.5mg/kg b.wt) and
activate them [7].
sonicated. Lead acetate was purchased from NATCO,
Nanomedicine has appeared as a desirable
Laboratory chemical reagents. Lead dissolved in
treatment strategy to combat diseases such as
distilled water at a dose of 50mg/kg b.wt. Echinacea
inflammation, cancer, diabetes and fibrosis [8]. Cerium
Purpurea was purchased from Puritan, as Pride's INC,
(Ce) is a rare chemical element present in two valence
(HoLbrook, NY 11741. USA.), as capsules each
Received: 27/6/2022
Accepted: 3/9/2022

Full Paper (vol.892 paper# 10)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6115- 6121

Associations of MicroRNA-34a Expression Profile; Serum Levels of Vascular
Endothelial Growth Factor and Disease Progression in Hepatitis C Patients
Amal M. Matta1, Reem R. Abd El-Galil1, Hala A. Tabl1, Heba-Allah F. El-Marakby*1, Ahmed S. Elgazar2
Departments of 1Medical Microbiology and Immunology, 2Hepatology, Gastroenterology and
Infectious Diseases, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Heba-Allah F. El-Marakby, Mobile: (+20) 01003659729, E-Mail: heba.elmarakby@gmail.com

Background: Hepatitis C virus (HCV) is a leading cause of liver cirrhosis, and hepatocellular carcinoma (HCC)
Noninvasive indicators for the diagnosis and follow-up of individuals with liver disorders may be found in circulating
microRNAs. One such miRNA is miR-34a, which has been linked to the development of HCC. Hepatocellular
carcinoma is a highly vascular tumor in which angiogenesis plays a critical role in its development. The best-known
angiogenic factor, vascular endothelial growth factor (VEGF), has been proven to have a pivotal role in the development
of HCC. Objectives: To evaluate the expression profile of miRNA-34a and the serum levels of VEGF both in patients
and control group and to find their association with disease progression in HCV patients and evaluate their significance
as novel markers for HCV induced HCC. Subjects and Method: Including 32 CHC, 23 CHC with liver cirrhosis (LC),
20 CHC with HCC patients, and 15 healthy controls, a total of 90 people participated in the study. Real-time PCR was
used to examine the miR-34a expression profile. ELISA was used to assess VEGF concentrations in serum. Results:
Serum miR-34a down-regulation was observed in patients' groups compared to control group, with lower expression in
HCV infection with HCC and HCV infection with LC groups than the HCV infected group. Also VEGF level increased
significantly in groups HCV infection with LC and with HCC compared to the control group, in groups HCV infection
with LC and with HCC groups compared to the HCV infected group and in group HCV infection with HCC compared
to HCV infection with LC group. Conclusion: Expression profile of miRNA-34a and serum levels of VEGF can be
used as novel markers for HCV inducing HCC with prediction of disease progression in CHC patients.
Keywords: Hepatitis C patients, Hepatocellular carcinoma, Vascular endothelial growth factor, miRNA-34a.

role in its development. The ratio of pro- to anti-

Viral hepatitis is a significant public health
angiogenic factors is a key regulator of angiogenesis,
concern; it is a key global cause of mortality as well as
which is controlled by the local environment (11).
morbidity. Hepatitis B and C are classified as identical
Vascular Endothelial Growth Factor (VEGF) is the
with the same types of liver infection, commonly spread
best-studied pro-angiogenic factor, and it has been
through the blood and blood products (1).
linked to tumor initiation, development, and metastasis
The prevalence of chronic hepatitis C virus (CHC)
via angiogenesis in a wide range of malignancies (12).
infection is high; it is estimated that 58 million persons
To determine the value of trustworthy serum
worldwide are infected with the virus (2). Egypt has a
indicators, we looked at their sensitivity and specificity
disproportionate share of the region's burden and has
for illness diagnosis and prognosis, as well as their
substantially greater prevalence rates than neighboring
capacity to be discovered early in the course of the
nations and even countries with similar socioeconomic
disease (13). The purpose of this study was to examine
conditions(3), with 92.5% of patients infected with
the blood VEGF and miRNA-34a levels in HCV
genotype 4 (4). Hepatocellular cancer, cirrhosis, as well
patients, as well as their connection with disease
as liver fibrosis, are all caused by the chronic
progression, to determine whether or not these factors
inflammatory disease response triggered by CHC
may serve as a potential marker for HCV-induced HCC.
infection (5). HCC is a major issue for public health in

Egypt. Here it causes 33.63 percent of male and 13.54
Seventy-five patients with chronic liver disease
percent of female malignancies (6). MicroRNAs
and fifteen healthy controls participated in this study,
(miRNAs) are short, single-stranded RNA molecules
who served as a control group, with normal routine
that typically range in length from 17 to 25
laboratory investigations and negative for HCV Ab.
ribonucleotides (7). It has been found that miRNAs play
Their age ranged from 26 to 72 years old. All
crucial roles in HCC growth by regulating the
individuals enrolled in this study were classified into 4
expression of a wide variety of proteins (8). It is possible
groups; group A: 32 patients with HCV infection, group
that blood miRNAs that are differentially expressed
B: 23 HCV patients with liver cirrhosis, group C: 20
between people with HCV and HCC might be employed
HCV patients with HCC and group D: 15 apparently
as non-invasive indicators for distinguishing between
healthy control group.
people with the two diseases and healthy people (9).
The Benha Faculty of Medicine's Medical
MicroRNA-34a (miR-34a) is a marker that is often
Microbiology and Immunology Department was the site
present in non-invasive human cancers(10). Topping the
of this investigation. Patients at Benha University
list of selective miRNAs linked to the HCC pathway, it
is one of the most widely seen miRNAs related with
Infectious Diseases Department were the subjects of the
cancer (7). Hepatocellular carcinoma (HCC) is a highly
vascular tumor in which angiogenesis plays a critical
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 11)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6122- 6126

Study of Serum Leptin Level in Children with Cyanotic and
Acyanotic Congenital Heart Disease
Mohamed B. Hamza1, Ahmed I. Harkan2
1 Pediatric Pulmonology Department, 2 Pediatric ICU Department, Faculty of Medicine, Tanta University, Egypt
*Corresponding author: Mohamed B. Hamza, E mail: mohamed.hamza@med.tanta.edu.eg
Mobile phone: +20 102 022 0271

Leptin balances body weight, but its role in the negative energy imbalance is unclear. Increased energy
expenditure reduces newborn with cyanotic congenital heart disease development.
Aim and objectives: The researchers wanted to see how much leptin was in the blood of kid's congenital heart disease
(CHD), both cyanotic and acyanotic, as well as to look into its involvement in their growth.
Subjects and methods: In this study, 38 Egyptian patients with congenital heart disease participated (18 with acyanotic
CHD and 20 with cyanotic CHD), as well as (20) seemingly normal youngsters of same age, gender, and socioeconomic
level as a control group.
Results: A total sample of 58 with mean age 7.7± 4.2, 8.3± 4.1 and 9.1± 3.8 in cyanotic, acyanotic and control groups.
Mean of serum leptin among control group was 3.7± 1.3. The mean of serum ghrelin among acyanotic group was 5.3±
1.8. There was positive correlation between age, BMI, O2 saturation, MAC, and serum leptin. But there was negative
correlation between age, BMI, O2 saturation, mid upper arm circumference (MAC), and serum ghrelin. There was
negative moderate statistically significant correlation between serum leptin and serum ghrelin.
Elevated leptin and reduced gherlin levels were found in children with congenital heart diseases, whether
cyanotic or acyanotic, suggesting a role for both hormones in regulation of nutrient intake, energy balance and
maintenance of body weight in those children.
Keywords: Congenital heart diseases, Serum ghrelin, Serum leptin


or increased energy requirements due to increased
Leptin is a newly discovered hormone that affects
metabolism, according to studies. However, the actual
energy balance and is encoded by the obesity gene. It
cause of this low growth is still unknown (7).
has both thermogenic and anorexigenic effects in mice,
Congenital cardiac disease causes growth delay
but its role in human energy balance is uncertain (1).
for a variety of reasons. Many patients with cyanotic
Leptin and ghrelin are hormones that have been
congenital heart illness have a noticeable decrease of
demonstrated to influence energy balance. Leptin is
fat. Leptin is a hormone produced by adipocytes that is
involved in long-term energy balance maintenance,
necessary for proper body weight management.
which reduces appetite and so promotes weight loss.
Although caloric consumption modulates its circulating
Ghrelin, on the other hand, is a fast-acting hormone that
levels, leptin regulates adipose tissue mass and
encourages people to consume more food (2).
corresponds with fat mass. In congenital heart diseases
Leptin is a hormone that is mostly produced by
the cyanotic group had lower weight, mid upper arm
adipose tissue, released into blood stream, and it binds
circumference (MAC), and Triceps Skinfold (TSF)
to hypothalamic leptin receptors after crossing the
standard deviations than the acyanotic group, although
blood-brain barrier. It sends and receives data about the
leptin levels were identical (8).
triglyceride content of adipocyte, as well as the
The purpose of this research was to see if blood
macronutrient and energy composition of recent food
leptin levels in newborns with cyanotic and acyanotic
intake (3).
congenital heart disease affected their growth.
Low circulating leptin levels have been found to

increase activity of hypothalamic neurons that secret
orexigenic peptides and decrease activity of in neurons
In this study, 38 Egyptians children with congenital
that secret anorexigenic peptides, thereby increasing
heart disease (18 with acyanotic CHD and 20 with
appetite and stimulate weight gain (4).
cyanotic CHD) were compared to a control group of 20
The most frequent congenital anomaly in children
seemingly normal children of the same age, gender, and
is congenital heart disease (CHD), which is a major
socioeconomic background. Patients were recruited
source of morbidity and mortality. CHD prevalence
from the University Hospital's Pediatric Cardiology
varies greatly amongst research around the world,
Clinic between February 2020 and January 2021.
however it was reported that 1.35 million babies are

born with CHD every year (5). Malnutrition is common
Inclusion criteria:
in children with congenital heart disease, regardless of
1) patients with acyanotic or cyanotic congenital heart
the kind of abnormality (6).
Growth retardation can be caused by inadequate
2) age from 2 months up to 18 years,
calorie intake due to anorexia, dyspnea, and tachypnea,
3) parental consent.
Received: 29/3/2022
Accepted: 28/5/2022

Full Paper (vol.892 paper# 12)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6127- 6131

Brief Treatment Modalities of Alopecia Areata: Review Article
Nermeen Mohamed Mahmoud Abd El Fattah*, Sahar Mohamed Abd El Fattah Al Mokadem,
Soheir Mohammed Ghonemy
Department of Dermatology, Venereology and Andrology, Faculty of Medicine,
Zagazig University, Zagazig, Egypt
*Corresponding author: Nermeen Mohamed Mahmoud Abd El Fattah, Mobile: (+20)01093801584,
E-Mail: mnermen220@gmail.com

Hair loss on the scalp and/or body due to Alopecia Areata (AA) is a frequent autoimmune, inflammatory,
nonscarring form of baldness. Hair loss can occur in a variety of patterns, from thinning in discrete areas to a complete
loss of hair from follicle. All treatments of AA are considered off-label. While these therapies may help stimulate hair
growth, they are not considered curative because they cannot alter the disease's normal progression. Age, general health,
and the severity of hair loss all play a role in determining the best course of therapy.
Objective: Assessment of current treatment modalities of alopecia areata.
Methods: Treatment, and alopecia areata 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 September 2007 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: Because of their low risk of adverse effects and simple administration, topical corticosteroids of varying
strengths are often the first line of defense in the treatment of AA in children. In more advanced cases of AA, systemic
therapies are performed. Most of these drugs work by modulating or suppressing the immune system.
Keywords: Treatment protocol AA, Alopecia Areata, Hair loss.


AA is equally likely to affect men and women of
Common hair loss on the scalp and/or body due
any age and any racial or cultural origin. Prevalence is
to an autoimmune, inflammatory, nonscarring condition
higher in kids than in grownups. In most cases, the
called alopecia areata. Hair thinning can occur in a
beginning of AA occurs before the patient is 40, with a
variety of patterns, from discrete bald spots to thinning
peak incidence in the twenties and thirties (2).
at every hair follicle (1).
The precise mechanisms by which this illness
After androgenetic alopecia, alopecia areata is
develops remain unknown. However, a combination of
the most frequent autoimmune disorder associated with
genetic and environmental variables has been proposed
hair loss. Globally, 2% of the population will have AA
to trigger an autoimmune reaction in the hair follicles,
at some point in their lives, with a 1%-2% lifetime risk
leading to AA (Figure 1)(3).
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 13)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6132- 6137

Anthropometric and Metabolic Parameters to Detect
Insulin Resistance in Children
Hanan Elsayed Kamel Bakry
Pediatric Department, Damietta General Hospital, Ministry of Health, Damietta, Egypt
Corresponding author: Hanan Elsayed Kamel Bakry. E-mail address: Hananbakry10@gmail.com.
Mobile Phone: +201019089246

The pathological state of insulin resistance (IR) is closely related to obesity. Insulin sensitivity, therefore,
could be permanently impacted by genetic disorders, steroids, or growth hormonal treatment.
Measuring the specificity and sensitivity of several cutoff points in order to determine insulin resistance in
pediatric community depending on anthropometric and metabolic characteristics.
Methods: 107 children between the ages of seven to eleven years participated in this cross-sectional survey, of whom
53 had obesity, 22 had overweight, and 32 had adequate nutrition as determined by body mass index (BMI) for age.
BMI, hip and waist circumference measurements, the conicity index, and the percent of body fat were all measured.
Fasting samples of blood had been used to assess the levels of triglyceridemia, glycemia, and insulinemia. Using the
90th percentage as the cutoff point, the glycemic homeostatic approach was used to assess insulin resistance.
Results: For such entire sample, the values were: insulinemia = 0.97 (0.97-0.98), 18.5 UmL-1; fat mass proportion =
0.86 (0.79-0.93), 41.1%; BMI = 0.88 (0.81-0.95), 23.67 kgm2-1; waist circumference = 0.86 (0.77-0.94), 76.0 cm;
glycemia = 0.69 (0.52-0.86), 86.0 mgdL-1; triglyceridemia = 0.76 (0.64-0.88). For the entire sample, triglyceridemia
was 114.0 mg/dL-1 and conicity index was 0.67 (0.48-0.85), 1.21; for the obese subgroup, these values were insulinemia
of 0.97 (0.96-0.98), 19.52 UmL-1, body fat percentage of 0.74 (0.62-0.87), 42.0%, BMI of 0.76 (0.62-0.90), 24.51
kg/m2-1, waist circumference of 0.75 (0.59-0.90).
Conclusions: Utilizing the cutoff points with the optimal specificity and sensitivity for the prediction method,
anthropometric and metabolic markers seem to have strong predictive potential for insulin resistance in children aged
between seven to eleven years old.
Keywords: Anthropometric, Insulin resistance, Metabolic parameters, Pediatrics.


the detection of insulin resistance in pediatrics showed
Reduced cellular glucose absorption as responding
it to be an intriguing idea. However, the HOMA
to a specific level of insulin characterizes the clinical
estimates need the fasting glycemia and insulinemia
condition known as insulin resistance that has recently
readings, which need invasive data gathering. These
been recognized as a public health issue (1), whereas the
techniques make it difficult to apply this index,
disease has also received attention in demographics
particularly when evaluating large population sampling
including children and teenagers. A problem in the
for diagnostic purposes (9).
insulin signaling pathways post-receptors is linked
It is evident that the development of diagnostics
towards the illness. This hinders the muscle glucose
with the goals of anticipating insulin resistance
transporter's (GLUT-4) translocation mechanism,
depending on risk variables necessitates their
which in turn plays a crucial role in glucose absorption
development. These tests must be simple to use,
(2, 3). Recently, numerous researchers have developed
accurate, and affordable. It is a proven truth that juvenile
this initial notion and put up a lipocentric theory to
obesity has detrimental effects on kids' health, and over
explain why there is insulin resistance, how the
the past few years, its incidence has been steadily rising
translocations of GLUT-4 to the plasma levels
(10, 11).
membranes may be inhibited by a buildup of
In this situation, having too much body fat is a
intramuscular lipids resulting from long-chain fatty acid
factor that may be capable of predicting a child's insulin
derivatives perforating cells, hence also providing a
resistance. For instance, it has been demonstrated that
potential alternative strategy of identifying insulin
waist circumference (WC) is a reliable indicator of
resistance by use of markers connected to the level of
hemodynamic and metabolic problems. The 90th
body fat (4-6).
percentile for a particular population was used in these
studies to determine cutoff points for the parameter;
measurement, which examines glucose metabolism
moreover, more researches are needed to imply
throughout mediated hyperinsulinemia, and other
diagnostic tests and their benefits, as well as to include
methods for identifying insulin resistance depending on
information depending on how sensitive and specific
biomolecular assessment of insulin receptors and
the offered methods are (12-14).
postreceptors are pricy and, for several medical
In context of the above, the objective of this
practitioners, are challenging to access (7, 8). Once
research was to assess the sensitivity and specificity of
opposed to the gold standard, Huang et al. validation's
cutoff points as well as the accuracy of predicted insulin
study of Homeostasis Model Assessment (HOMA) for
Received: 29/6/2022
Accepted: 5/9/2022

Full Paper (vol.892 paper# 14)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6138- 6144

Diagnostic Value of Biomarkers in Neonatal Sepsis at Neonatal Intensive
Care Unit at Minia University Hospitals
Ahmed Abdel Fadil Saedii1, Ayat Mostafa Mohamed Ahmed*1, Omima M. Mohamed1,
Mohamed Ahmed Bahaa El-deen2, Mohamed Abdel-Razek Abdel-Hakim1
Departments of 1Clinical Pathology and 2Pediatric, Faculty of Medicine, Minia University, Egypt
*Corresponding author: Ayat Mostafa Mohamed, Mobile: (+20) 01005651501, E-Mail: ayat42796@gmail.com

Due to the non-specific clinical manifestations, neonatal sepsis (NS), one of the major concerns with
considerable morbidity and mortality in newborn intensive care units (NICUs), poses a significant challenge for
clinicians and the laboratory. Blood culture, non-specific biomarkers, and clinical presentation are currently used to
diagnose newborn sepsis. Traditional biomarkers with low sensitivity and positive predictive value include total
leucocytic count (TLC) and C-reactive protein (CRP). The aim of the current study is to evaluate the value of apelin,
procalcitonin, and proadrenomedullin as biomarkers in the diagnosis of neonatal sepsis.
Patients and methods: This study was conducted, over a period of one year, at NICU in Minia University Hospitals
on 60 neonates diagnosed as sepsis representing Group-I who were further sub-grouped into Group I-a (Early Onset
sepsis) including 36 neonates and Group I-b (Late Onset Sepsis) including 24 neonates. A total of 30 apparently healthy
neonates represented Group-II (control group) with no manifestations or laboratory findings of sepsis. Samples were
collected from each neonate for CBC, CRP, blood culture and evaluation of serum procalcitonin, apelin and
proadrenomedullin by ELISA. Results: Significant correlations were found between serum procalcitonin, apelin and
proadrenomedullin with the routine investigations done (TLC, platelets count and CRP). Higher procalcitonin,
proadrenomedullin and apelin levels were observed in septic group (early onset sepsis and late onset sepsis) with positive
blood culture results. Staphylococcal infection was the most frequent type of infection.
: Measuring procalcitonin, apelin and proadrenomedullin levels are valid and can aid in the diagnosis of
NS, but alone cannot be dependable for accurate diagnosis.
Keywords: NICU, Apelin, Procalcitonin, Proadrenomedullin, Neonatal sepsis, Total leucocytic count.


diagnostic procedures as acute phase reactants were
Neonatal sepsis (NS) still represents a major cause
employed. These procedures included the use of cell
of neonatal death, affecting more than 2% of live births
surface markers, granulocyte colony-stimulating factor,
and about 16% of neonatal mortality at NICUs [1]. NS is
cytokines, molecular genetics, and molecular cell
challenging to diagnose because its manifestations are
proteomics [6].
non-specific (e.g. respiratory distress, hypotension, and
Acute phase reactants, such as haptoglobin, CRP,
apnea) which could be presented in non-infectious
fibronectin, lactoferrin, and procalcitonin, are
conditions. Furthermore, the time to administration of
collections of endogenous peptides made by the liver in
antibiotics affects its outcome; therefore, there are both
reaction to an infection or tissue injury [7].
clinical and submissive encourages for identifying and
Human monocytes and hepatocytes produce the
treating neonates with sepsis rapidly [2,3]. After the
hormone procalcitonin (PCT). After being exposed to
above facts, clinicians ordinarily use serum biomarkers
bacterial endotoxin for 4 hours, it starts to climb, peaks
to evaluate inflammation and infection and to assess the
after 6­8 hours, and stays elevated for at least 24 hours
risk of sepsis.
with a half-life of 25­30 hours. Procalcitonin cut-off
In contrast to late-onset sepsis (LOS), which refers
(2.3 ng/ml) has a poor sensitivity of around (48%) for
to infection diagnosed from day 4 onward, where the
NS diagnosis but good specificity and PPV of (97% and
source is either community-acquired or from the
96%, respectively). According to a report, even in cases
hospital environment, early-onset sepsis (EOS) refers to
when blood cultures come back negative, antibiotic
getting an infection in the first 72 hours of life with
therapy should be prolonged because a procalcitonin
pathogens most likely acquired through the birth canal
level of more than 2.3 ng/ml suggests a significant
[4]. As vital as ever, precise biomarkers are required to
likelihood of newborn sepsis. In most circumstances, it
aid in the quick and correct diagnosis of NS. The ideal
is not a simple tool to obtain for assay, albeit [8].
biomarker should reveal a consistent and foreseeable
Apelin is expressed on the surface of numerous
trend in both antibiotic response and diagnosis.
organs, including the endothelium, adipose tissue, GIT,
Additionally, it must be able to provide predictive
brain, kidneys, and liver. Adipocytes from both mice
information, be quick and simple to measure, and take a
and humans express and secrete apelin, a pro-
small amount of blood [5].
inflammatory protein involved in the inflammation of
The conventional and accurate way for diagnosing
arterial walls [9].
NS is the removal of the causative bacteria from blood.
Pre-proadrenomedullin is pre-prohormone of 185
The length of time it takes to arrive at a diagnosis is the
amino acids that is subsequently degraded into
biggest barrier to culture-based diagnosis. Recently,
proadrenomedullin (ProADM), a 164-amino acid-
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 15)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6145- 6149

Parent Stress in Relation to Activities of Daily Living and
Gross Motor Impairments in Children with Diplegic Cerebral Palsy
Ahmed F. Salman*1, Khaled A. Mamdouh2, Walaa A. Abd El-Nabie2, Hoda A. El Talawy2
1Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, May University in Cairo.
2Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University.
*Corresponding author: Ahmed F. Salman, Mobile: +201067873174, Email: ahmed.fekry@muc.edu.eg

: Cerebral palsy is the most common cause of motor disability in children. Parents of children with cerebral
palsy experience more stress than parents of typically developed children. The aim of the current study is to find out the
relation of parent stress between activities of daily living and gross motor limitation in children with diplegic cerebral
palsy; and investigate the relation between parent stress and their quality of life.
Patients and Methods: A cross sectional study of 107 children with diplegic cerebral palsy, aged from 2-4.8 years,
assigned to two groups; Group A included ambulant children on level I, II and III on gross motor function classification
system, while Group B included non-ambulant children on level IV and V. Parent stress and quality of life was assessed
by parenting stress index ­ short form and pediatric quality of life inventory family impact module respectively, while
activities of daily living and gross motor impairment were assessed by Wee functional independency measure and gross
motor functional classification system respectively.
Result: There was a positive correlation between parent stress and gross motor limitation in Groups A and B (r= 0.865
and 0.489, respectively). In addition, there was a positive correlation between parent stress and quality of life in Groups
A and B (r= 0.982 and 0.785, respectively). Negative correlation between parent stress and activities of daily living
(required total score) in Groups A and B (r= -0.911 and -0.811, respectively) also was found.
Conclusion: Activities of daily living and gross motor limitation may have an effect on parent stress.
: Activities of daily living, Cerebral palsy, Motor impairment, Parent stress, Quality of life.


and emotional demands and these family functioning
Cerebral palsy (CP) is described as a group of
variables are strong predictors of overall PS (8).
permanent disorders of the development of movement
The stress resulting from dealing with a child with
and posture, attributed to non-progressive injury or
CP is a primary risk factor for the development of
abnormal development occurring in the fetal or infant
psychosocial problems in both the affected child and
brain (1). Spastic diplegia is one of the most common
family members. These stresses may be the result of
clinical subtypes of CP, where motor impairment and
actual disease parameters, such as severity and as a
spasticity is more sever in the lower than upper
result of the child functional limitations (9).
extremities and a significant weakness in the trunk (2),
Caregivers of children with CP who had a
The worldwide incidence of CP is approximately 2
limitation in activities of daily living (ADL) are faced
cases per 1000 live births and 44 % of total incidence is
with ongoing difficulties and complications arising
spastic diplegic of CP (3).
from their children's impairment, they are often unable
Gross motor disorders are the main problem in
to provide for their own physical and mental needs, and
children with CP, seizures, as well as sensory,
are more likely to experience caregiver stress and low
cognitive, and communication issues, may accompany
quality of life (10).
these disorder (4). Moreover, children with CP always
Caring for a child, with a limitation in gross motor
have limitations in self-care functions, such as feeding,
activities, impacts many aspects of a parent's life
dressing, bathing mobility and locomotion. These
including physical, social, and emotional health,
limitations may lead to long-term care requirements that
wellbeing, marital relationships, employment, and
far exceed the usual needs of children during their
financial status. It requires a considerable amount of
development (5).
physical and mental effort and is associated with
Functional deficits in children with CP make it
physiological and psychological costs (11).
difficult for children to fulfill their roles in society and
Due to lacking of the research on measuring PS
thus affect their quality of life, besides the physical
and its relation to ADL and gross motor limitation in
limitations of the child; a life-long treatment process
children with diplegic CP, therefore the purpose of this
can affect psychosocial development and daily life
study is to explore the relation between these variables.
activities by isolating the child from family and society.

The functional level of the child with CP and the level
of proficiency in activities of daily life are crucial
factors in establishing and tracking rehabilitation goals
The current study was registered on one hundred
or in deciding the rehabilitation program's structure (6).
and seven children with diplegic CP aged from 2 years
Parent stress (PS) is a negative psychological
to 4.8 years old. All children were medically and
response to the obligations of being a parent (7), caring
clinically stable and represent all level of Gross Motor
for a children with CP entails high physical, financial
Function Classification System (GMFCS), children
Received: 29/06/2022
Accepted: 05/09/2022

Full Paper (vol.892 paper# 16)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6150- 6159

The Role of Cardiac MRI in Functional and Structural Assessment of
The Right Ventricle in Patients with Repaired Fallot Tetralogy
Ayman Mohamed Ibrahim*, Ali Haggag Ali, Naiad Medhat Elsaied
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University
*Corresponding author: Ayman Mohamed Ibrahim, Mobile: (+20)01000150157, Email: aymanibrahim_9@hotmail.com

Tetralogy of Fallot (TOF), the second most prevalent kind of complicated congenital heart disease (CHD),
accounts for 7-10% of CHD and affects 0.5/1000 live births. After surgical care, cardiac magnetic resonance imaging
(MRI) may be used to assess the right ventricle in TOF. The aim of the current study is to evaluate the role of cardiac
MRI in functional and structural assessment of the right ventricle in TOF patients after surgical management.
Patients and methods: The study was conducted on 30 patients of variable age groups that were collected from our
institute, who were referred to the radio diagnosis department after TOF operations and underwent cardiac MRI. Full
structural and functional assessment of the right ventricle could be done using various MRI pulse sequences as well as
the late gadolinium enhancement protocol.
Of the included 30 patients, 26 (86.6%) showed right ventricular dilatation. Right ventricular end diastolic
volume index: Left ventricular end diastolic volume index (RVEDVI: LVEDVI) ratio was 1.84:1. Four patients had
right atrium dilatation. Of the 30 participants, 8 (26.6%) had RV systolic dysfunction with mean ejection fraction (EF)
was 51.83% (SD 9.39). Out of 30 TOF cases, 29 (96.6%) had main pulmonary artery (MPA) regurgitation, and 18 (60%)
had right ventricular outflow tract obstruction (RVOTO).
Conclusions: MRI is an extremely useful imaging method for the functional and structural assessment of the right
ventricle after surgical repair of TOF.
Cardiac MRI, Right ventricle, Repaired fallot tetralogy.


pulmonary valve. Tricuspid regurgitation (TR) and RV
Tetralogy of Fallot (TOF), the second most
dysfunction may develop as a result of the volume
prevalent kind of complicated congenital heart disease
overload caused by PR, which also causes increasing
(CHD), accounts for 7-10% of CHD, occurring in
RV dilatation (4).
0.5/1000 live births. The four components of TOF are
Following TOF repair, residual or recurrent
(a) sub-pulmonary obstruction leading to (b) right
pulmonary stenosis is frequently observed. It ranges
ventricle (RV) hypertrophy, (c) malaligned ventricular
from distal branch pulmonary artery stenosis to
septal defect (VSD) leading to (d) apparent overriding
proximal RV outflow tract occlusion. The development
of the aorta over both ventricles. TOF is caused by
of pulmonary stenosis is either a complication of the
anterior deviation of the infundibular septum during
surgical procedure brought on by excessive internal
embryogenesis which separates the outflows of the two
endothelial proliferation or a kink resulting from patient
ventricles (1).
growth (5).
Primary repair, or a palliative temporary
Trans-annular patch repair that relieves RVOTO
procedure during the neonatal period that uses a shunt
is frequently followed by RVOT fibrosis and
(3.5 to 5mm prosthetic tube) between a large artery that
aneurysmal dilatation. RV-PA conduit obstruction and
branches off from the aorta (brachiocephalic or
palliative shunt complications such leakage and
subclavian) and the ipsilateral pulmonary artery usually
thrombosis are additional post-operative side effects (5).
via thoracotomy, typically a modified Blalock-Taussig
In addition to assessing ventricular size and
(mBT) shunt--has been used to increase pulmonary
function quantitatively, cardiac magnetic resonance
flow, reduce hypoxemia (2).
imaging (MRI) also assesses pulmonary and aortic size
Primary intracardiac repair entails widening of
and flow. It can be used to evaluate the volume and
the RVOTO. If the pulmonary annulus is hypoplastic, a
proportion of pulmonary regurgitation as well as
longitudinal incision is made across the major
pulmonary outflow blockage (6).
pulmonary artery (PA), the pulmonary annulus, and the
With the late gadolinium enhancement (LGE)
RV infundibulum, and a transannular patch is used to
technique, pictures are taken 10 minutes after
rebuild it. A sub-valvular muscle excision is performed
gadolinium contrast material has been administered and
in patients with a large enough pulmonary annulus. In
has accumulated in a tissue with increased extracellular
situations of pulmonary atresia, a valved RV-PA
space, such as a fibrotic ventricular segment. The seven
conduit is implanted in addition to RV muscle repair
segments RV LGE grading protocol is a scoring system,
and VSD closure (3).
where the right ventricle is divided into 7 segments,
The majority of patients who undergo
including 2 surgically manipulated segments (VSD
transannular patch repair of RVOTO experience the
patch region and the anterior wall of RVOT), and 5
postoperative complication known as pulmonary
remote LGE segments: anterior wall of RV, inferior
regurge (PR), which compromises the integrity of the
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 17)

The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6160- 6166

Intramedullary Fixation of Metacarpal Fractures Using
Headless Compression Screws
Ali Towfik Al-alfy, Waleed Mohammed Nafea, Basha Ahmed Basha Alkhadri*, Ahmed Mashhour Gaber
Orthopedic Department, Faculty of Medicine, Zagazeg University, Egypt
*Corresponding author: Basha Ahmed Basha Alkhadri, Mobile: (+20)01124122614, E-mail: alkhadrib@gmail.com

Metacarpal fractures represent about 1/3 of hand fracture, which represent 10% of all fractures, mostly in
the second and third decades of life. The purpose of this study was to evaluate the functional, radiological outcomes and
reducing rate of complications in patients suffering of metacarpal fractures, treated by closed reduction and internal
fixation by using headless compression screws.
Patients and methods: This prospective one-arm clinical trial included 18 patients presented by a total of 20 metacarpal
shaft fractures, who were managed surgically at Zagazig University Hospital (ZUH), Egypt. They were managed by
intra medullary headless compression screws (IMHS).
Results: No cases had malunion and 3 cases had superficial skin infection by 16.6%. Regarding Total Active Motion
(TAM) score, 83.4% of cases had satisfactory level, and 16.6% had unsatisfactory level.
Conclusion: Intramedullary screw fixation of metacarpal fractures is an efficient and safe procedure with a low
incidence of complications. The IMH screws appeared to require less casting and provide a quicker return to work.
Keywords: Metacarpal fracture, Intramedullary fixation, Headless compression screw.


provide a good results as Beck et al. (6) reported 100%
The metacarpal bones are the longest, closest
of patients achieved full radiological union with minor
bones to the hand, and they give the phalanges a secure
complication rate and full range of motion and early
foundation. Its head is cam-shaped and articulates as a
return to work with average 96% of grip strength (7,8).
condylar joint with the base of the proximal phalanx to
The purpose of this study was to evaluate the
allow for flexion, extension, and radial and ulnar
functional, radiological outcomes and reducing rate of
deviation. Its base articulates with the distal carpal row
complications in patients suffering of metacarpal
fractures, treated by closed reduction and internal
Hand fractures, which make up 10% of all
fixation by using headless compression screws.
fractures and are most common in the second and third

decades of life, account for around one-third of all
metacarpal fractures. It typically happens as a result of
This prospective one-arm clinical trial included 18
a direct blow to the hand's dorsum, as in an assault, a
patients presented by a total of 20 metacarpal shaft
boxing match, a fall, a car accident, crush injuries, and
fractures, who were managed surgically at Zagazig
workplace trauma. The most frequent metacarpal
University Hospital (ZUH) Egypt. They were managed
fractures were ring-finger shaft fractures and little
by intra medullary headless compression screws
finger neck fractures (Boxer's fractures) (2).
The majority of metacarpal fracture consequences

are stiffness at the carpometacarpal and metacarpo-
Inclusion criteria: Closed metacarpal fracture.
phalangeal joints and malunion, with surgery being an
Multiple metacarpal fractures in the same hand
effective treatment for malunion that includes
considered as single case.
angulation, rotation, and shortening (3).

There is a potential of shorting in numerous
Exclusion criteria included: Infection at site of
metacarpal fractures, which could lead to instability.
operation. Sever osteoporotic. Sever comminuted
Since the latter are linked to both sides of the metacarpal
fracture. Intra articular fracture. Skeletal immaturity.
head, instability is more frequently noted in the second
Neurovascular injuries.
and fifth metacarpals than the third and fourth.

Compared to a single metacarpal fracture, multiple
metacarpal fractures are typically accompanied by soft
All patients underwent Full history taking, Proper
tissue damage (4,5).
clinical examination, Routine plain radiographic images
Fixation of metacarpal fractures by intramedullary
were obtained for all patients, which include
headless screws has many advantages as it placed
anteroposterior (AP), and oblique views of the hand. In
percutaneously so minimal incision needed which
cases of phalangeal trauma, additional lateral views
reduce the infection risk, headless compression screws
were obtained. X ray images were used to identify the
also offer stable fixation. They can be placed through
site and shape of fractures and to evaluate their
the articular surface and, because of their small size and
displacement and angulation. Metacarpal fracture was
headless nature it can be buried in a sub-chondral
classified according to the morphological character.
location without interfering with joint motion. Also it

Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 18)

c:\work\Jor\vol892_19 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 667- 6173

The Relation between Vitamin D Deficiency and
Fetal Growth Restriction in Pregnant Women
Hanadi Salah Mahfod*, Manal Mohamed El Behery, Mai Mostafa Zaitoun, Hala Sherif El-sayed
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hanadi Salah Mahfod, Mobile: (+20)1066890232, E-mail: hanadymahfoud92@gmail.com

: Fetal growth restriction represents pathological inhibition of fetal growth and failure of the fetus to attain
its growth potential. There is a strong association between stillbirth and fetal growth restriction.
Objective: The aim of this study was to detect the relationship between Vitamin D deficiency in pregnancy and
intrauterine growth restriction (IUGR).
Patients and method: This case control study included a total of 56 pregnant women, attending for antenatal care at
Department of Obstetrics and Gynecology, Faculty of Medicine, Maternity Hospital, Zagazig University. The included
subjects were divided into two equal groups: Case Group (fetal growth restriction) and Control Group (healthy).
Vitamin D level was measured at 35 weeks of gestational age by electrochemiluminescence technique.
Result: All control group regularly consumed dairy products versus 78.6% within case group and 96% within control
group versus 60.7% within case group receive calcium supplementation. regarding serum vitamin D level, it was
significantly lower in case group than control group. Very severe vitamin D deficiency level (< 5 ng/ml) occurred in
10.7% within case group versus 3.6% in control group while sever vitamin D deficiency (5-10) occurred in 50% in case
group and 35.7% in control group while suboptimal level (20-30) in 14.3% case group and 25% in control group, optimal
level prevailed (30-50) in 3.6% and 14.3% within case and control groups respectively. The best cutoff value of serum
vitamin D in prediction of IUGR was considered as 11.5 ng/dl with area under curve 0.667, sensitivity 75%, specificity
53.6%, positive predictive value 61.8%, negative predictive value 68.2% and overall accuracy 64.3% (p<0.05).
It could be concluded that vitamin D deficiency could be a risk factor for the occurrence of fetal growth
Keywords: Vitamin D, Fetal Growth, Pregnant Women.


Intrauterine growth restriction is a prevalent
This case control study included a total of 56
disease in pregnancy in which placental insufficiency
pregnant women, attending for antenatal care at
leads to 5 to 10 times higher mortality and lifelong
Department of Obstetrics and Gynecology, Faculty of
morbidities (1).
Medicine, Maternity Hospital, Zagazig University.
Intrauterine growth restriction is associated
The included subjects were divided into two equal
with prenatal mortality and morbidity. A satisfactory
groups; Case Group (fetal growth restriction) consisted
definition of IUGR has been the rate of fetal growth that
of 28 pregnant women, and Control Group (healthy)
is less than normal considering growth potential of that
consisted of 28 pregnant women.
specific infant suggested by the American College of

Obstetricians and Gynecologists. Intrauterine growth
Ethical consent:
restriction is a multifaceted problem, that increases the
This study was ethically approved by Zagazig
risk of hypoxemia, acidemia, preterm deaths, and
University's Research Ethics Committee, and
maternal distress, and disposes the infant to several
submitted them to Zagazig University (ZU-IRB#
metabolic disorders, polycythemia, lung problems,
9409). Written informed consent of all the
intraventricular hemorrhage, cognitive dysfunction, and
participants was obtained. The study protocol
cerebral palsy, which occur in both term and preterm
conformed to the Helsinki Declaration, the ethical
infants (1, 2). Some of the effective factors for the
norm of the World Medical Association for human
occurrence of intrauterine growth restriction include the
history of chronic maternal diseases (high blood

pressure, renal diseases, diabetes, anemia, etc.)
Inclusion criteria: Women who accepted to participate
maternal weight gain during pregnancy, maternal age
in the study, aged above 18 years, women with viable,
during pregnancy, occupation, different types of fetal
single fetus, gestational age (28-39) weeks and women
infections and chromosomal abnormalities, birth rank,
with fetal growth restriction.
delivery interval, neonatal sex, placental abruption, and
Exclusion criteria: non-viable fetus, multiple
placenta previa (2).
pregnancies, fetal congenital anomaly, women with any
The aim of this study was to evaluate the
chronic diseases such as hypertension, diabetes
relationship between maternal vitamin D status and
mellitus, cardiac disease and renal disease and women
fetal growth and development. This may provide a basis
who did not accept to participate in the study.
for the prevention and intervention of maternal
All participants were subjected to full detailed
hypovitaminosis D.
medical history and thorough clinical examination.
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 19)

c:\work\Jor\vol892_20 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6174- 6180

Stress and Coping Strategies of Health Care Workers During Covid-19 Pandemic
Enas Elsherbeny*1, Ayman El-Saed2, Khadija Denewer1, Salwa El-Saka1
Departments of 1Industrial Medicine and Occupational Health, 2Public Health and
Community Medicine, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Enas Elsherbeny, Mobile: (+20)01097603888, E-Mail: enass75@ mans.edu.eg,

Since the onset of the current epidemic of COVID-19 infection among humans in Wuhan, China and it's
spreading around the globe causing heavy impacts on physical and mental health, especially health care workers.
Objective: To estimate the prevalence of stress among health care workers and their coping strategies during COVID-
19 pandemic. Patients and Methods: A descriptive, observational, cross-sectional study was conducted from July 1st
to August 30th, 2021. It included health care workers within Mansoura city dealing with confirmed or suspected cases
of COVID-19. An online self-administered questionnaire; 17 questions, Perceived Stress Scale (PSS-14) and Mini-
COPE Inventory (COPE-28). Results: A total of 227 health care workers responded the questionnaire with mean stress
score of 27.77±4.76SD. Prevalence of severe stress was 21.1% that appeared more among divorced or widow health
care workers (OR=4.75), working directly with COVID-19 patients, in primary health units, not satisfied with their
income with present history of comorbidity or psychiatric disease (OR=2.13, OR=5.9) and with minimal sleeping
duration. There was statistically significant positive correlation between total stress score and each strategy of adaptive
and maladaptive coping strategies.
Conclusion: High job demands, increased work responsibilities, fear from infection transmission and many other
stressors have put health care workers under unusual level of stress during COVID-19 pandemic.
Keywords: Job Stress; Coping Strategies; Health care workers; COVID-19.

corona virus cases have an additional source of fear;
Since the coronavirus disease 2019 (COVID-
transmission of infection among their beloved ones in
19) epidemic in China, the population has battled it with
addition to lack of manpower and decrease of resources.
resources. Health care workers (HCWs) are essential
Workplace aspects can play a crucial role on
assets in this fight, in addition to the efforts they make
moderating or worsening mental health of people facing
at every level. Researchers started to worry about their
this pandemic scenario (3).
mental health and how much they were able to cope
Numerous factors appear to have a detrimental
with all of this after acknowledging their work in the
effect on health care professionals' ability to function in
COVID era's fight against dynamic elements. It is
the face of the COVID-19 pandemic. From the
crucial to safeguard HCWs against the harmful
perspective of the managing staff, it's critical to
psychological consequences of the pandemic (1). People
understand these factors, effectively combat them, and
all across the world are affected by the COVID-19
plan future crisis management strategies. The
pandemic in terms of their social interactions and
psychological effects of COVID-19 among HCWs have
mental health. Global traumatic stress has resulted from
recently been discussed in some research papers (8). The
the virus's rapid spread due to globalization and human
Egyptian health care system is overcrowded, highly
mobility (2). The pandemic's sense of instability and
variable (public vs. private), and generally underfunded.
uncertainty, the necessity to alter our plans, the
In a situation with few resources, determining the scope
possibility of losing our jobs, financial instability, and
of mental health issues may be crucial to the ongoing
social isolation have all contributed to a sensation that
battle against the epidemic. There are very few studies
we are losing control of our lives (3,4).
that evaluate the pandemic's psychological effects on
The most frequent group that reacted to the
Egyptian health care workers.
COVID-19 crisis forcefully was the medical

community (5). Even though the pandemic has largely
faded and restrictions have been relaxed in many areas,
The researchers aims to estimate the prevalence
working in pandemic conditions has been particularly
of stress among health care workers and their coping
difficult for physicians, nurses, and other medical
strategies during COVID-19 pandemic.
workers. Medical personnel face significant daily stress

since they could lose their lives or health while doing
their regular duties (3, 6).
Study design: An observational, descriptive, cross-
As the pandemic progress there is a case of
section study.
general panic among people (7), because of a lot of
Study duration and setting: Different hospitals in
epidemiological features, fast transmission pattern and
Mansoura city during a two months period (from 1st July
deaths among health professionals. Health care workers
to 30th august 2021).
who are in direct contact with suspected and confirmed
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 20)

ASSESSMENT OF GIPS TECHNIQUE FOR MANAGEMENT OF PILONIDAL DISEASE The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6181- 6188
Assessment of Gips Technique for Management of Pilonidal Disease
Ali Ahmed Muhammad El Azzawy*, Gamal Galal Shemy, Abd El Kareem Elias Abd El Kareem
Department of General Surgery, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
*Corresponding author: Ali Ahmed Muhammad El Azzawy, Mobile: (+20)1207999916, E-Mail: alielazzawy93@gmail.com

Pilonidal sinus disease (PSD) is currently viewed as an acquired condition that develops abscesses and
typically several fistula tracts because of a continuous inflammatory response to the retention of hair follicles in the
intergluteal gap.
Objectives: The aim of the current work was to evaluate the outcomes of Gips technique for management of pilonidal
disease (PD) using minimally invasive surgery and following the impact of this procedure on the patients.
Patients and methods
: This study included a total of 40 patients with pilonidal disease, attending at Department of
General Surgery, Faculty of Medicine, Al-Azhar University Hospitals, Assuit. This study was conducted between
February 2021 and January 2022. All patients were treated by Gips method to assess this method in controlling of
pilonidal sinus.
Result: The duration of surgical procedures ranged 9-17 min (11.1±2.2), duration of health facility stays ranged 6-24
days (11±6.5), post-operative complications (contamination; 2.5%, wound dehiscence 0%, bleeding and recurrence;
5%). Patients have been discharged from health facility in brief time and fast recuperation to regular everyday
Conclusion: It could be concluded that the Gips approach is an easy procedure for the treatment of pilonidal disease
and is safe. It has a low complication and short recuperation and attractive aesthetic outcome.
Keywords: Gips, Technique, Management, Pilonidal Disease.


cleft. (5). Obviously, such large operations regularly
Pilonidal sinus disease (PSD) is a continual and
require hospitalization, fashionable or local anesthesia,
inflammatory sickness that regularly takes place on the
and variable use of stitches, drains, and antibiotics.
sacrococcygeal place. Although the etiology isn't
Pilonidal sinus operations are infamous for his or
always precisely known, it's far frequent that hair
her related morbidity, recurrence rate, and negative
boom penetrating into the subcutaneous cysts ensuing
beauty result (6). Few remedies, however, efficiently
overseas frame response and infection. The common
deal with the obtained overseas frame pathogenesis of
headaches of PSD are formation of cellulitis, abscess,
pilonidal sickness with out resorting to the typically
and fistulae (1).
used huge excisions (7). Despite the provision of
Pilonidal sinus is considered as an easy and
numerous strategies, the recurrent quotes are
regularly going on sickness localized on the sacro
nevertheless high, and the look for an excellent remedy
coccygeal area. However, on the inter gluteal place, it
continues to be on going. With new technical
can regularly become a continual and complex
improvements in current years, physicians are more
sickness. In a few cases, it can fistulize as much as the
and more more turning into attracted in the direction of
gluteal place and seem on the secondary orifices (2).
minimum surgical methods for the remedy of continual
Development of PSD necessitates surgical
PSD (8). Minimally invasive surgical strategies have
intervention, and there are numerous conservative and
become enormous in current years because of the
surgical remedies including excision and number one
multiplied enjoy and improvement of recent
closure, cryosurgery, marsupialization, and pores and
instruments (9).
skin grafting it's far a not unusualplace opinion that
In1965, Lord and Millar (10) cautioned a
PSD ought to be handled with massive excision and
minimally invasive operative approach, together with a
flap methods (3).
slim elliptical excision of pilonidal pits best and
Limited excision of the pilonidal sinus tract may
debridement and cleansing of the unroofed underlying
be a higher remedy choice as compared with massive
hollow space Small cylindrical brushes have been used
excisions in phrases of recuperation time and patient's
to cast off hair and smooth lateral tracts (11). In 1980,
comfort (4).
Bascom stated character excision of midline openings
Presently, many surgeons deal with pilonidal
and introduced a laterally located parallel incision to
sickness through huge excision of the pilonidal
higher discover and smooth the pilonidal hollow space
complex-containing tissue, right all the way down to
and to facilitate identity of diseased follicles. Bascom
the sacral fascia, leaving a lay open or a number one
additionally sutured midline operative wounds and
sutured midline wound. Other surgeons, even as
excised lateral tracts (12).
nevertheless dedicated to the equal huge excisions, use
This looks at describes an ambulatory surgical
extra state-of-the-art strategies including numerous
remedy for pilonidal sickness which integrates the
sorts of pores and skin flaps designed to hold the
standards cautioned through each Lord and Millar and
incision farfar from the midline or flatten the natal
Bascom and introduces using pores and skin trephines
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 21)

c:\work\Jor\vol892_22 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6189- 6197

Management of Diaphyseal Fractures of the Femur in
Children Using Flexible Intramedullary Nails
Mohamed Abdalla M. Abdelsalam, Ehsan Mosbah Emhemmed Shinber*,
Riad Mansour Megahed, Ahmed Hatem Farhan Imam
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ehsan Mosbah Emhemmed Shinber, Mobile: (+20)1116225490,
Email: ehsanshinber85@gmail.com

: Advantages of the elastic intramedullary nailing (EIN) in treating diaphyseal fractures of the femur
include the reduction of nearly all complications.
Objective: The aim of the current work was to evaluate the results of treatment of diaphyseal fractures of the femur
in children using intramedullary elastic nail.
Patients and Methods: This prospective clinical trial study included a total of 18 children with femoral diaphyseal
fracture treated with elastic intramedullary nails. They were admitted at the Department of Orthopedic Surgery,
Zagazig University Hospitals, Egypt and Abusalim Trauma Hospital, Libya. This study was conducted between
November 2021 to May 2022. All patients were followed up for six months.
Results: According to Flynn's score, the outcomes of the operation were excellent in 14 cases, satisfactory in 3
cases, and poor in 1 case. The 18 cases were united with radiological assessment. Only 1 case had superficial skin
infection and just one case had mild pain.
Conclusion: It could be concluded that if used appropriately, elastic stable intramedullary nailing (ESIN) is a
successful treatment for fracture femur in children with very few consequences.
Keywords: Diaphyseal Fractures, Femur, Flexible Intramedullary Nails.

Because the periosteum is not damaged, the
One of the most common long bone fractures
fracture hematoma is not lost, blood loss is reduced,
is the thighbone, or femur (1). In youngsters, the
the growth plate is not compromised, early walking is
femoral diaphysis is the site of 1.4%-1.7% of all bone
possible, nail removal is painless, and the patient does
fractures and 7.6% of all long bone fractures. Males
not have to deal with a long scar, the elastic
experience 2.6 times as many diaphyseal femoral
intramedullary nail is a clear improvement over the
fractures as females (2).
previous methods (11). There are two potential problems
Injuries can be caused by a variety of factors,
with protruding elastic intramedullary nails: restricted
such as a slip and fall, a car crash, child abuse, an
knee motion and skin infections caused by the nail's
accident during a sporting event (3). Thigh edema,
sharp end (4).
shortening, and deformity along with extreme pain
The purpose of this research was to evaluate
were all immediate results of the fracture (4). Typically,
the results of treatment of diaphyseal fractures of the
the initial diagnosis can be made with just plain
femur in children using intramedullary elastic nail.
anteroposterior (AP) and lateral radiographs of the

affected femur (5). The Müller overall fracture
classification system includes a specific categorization
This prospective clinical trial study included a
for long bone fractures (6) , and it's been modified for
total of 18 children with femoral diaphyseal fracture
use with broken long bones in adults through the
treated with elastic intramedullary nails. They were
Orthopedic Trauma Association (OTA) as well as
admitted at the Department of Orthopedic Surgery,
Arbeitsgemeinschaft Für Osteosynthesefragen (AO) (7).
Zagazig University Hospitals, Egypt and Abusalim
Conservative methods, such as skin or skeleton
Trauma Hospital, Libya. This study was conducted
traction, are frequently employed in treatment. Surgical
between November 2021 to May 2022.
methods include open reduction and internal fixation

with a plate and screws, external fixation and closed
Ethical Consideration:
reduction and
This study was ethically approved by Zagazig
University's Research Ethics Committee, and
intramedullary nails under image intensifier (8).
submitted them to Zagazig University (#9005-11-10-
Transportation, hygiene, tolerance, malunion,
2021). Written informed consent of all the
as well as delayed union are just some of the issues that
participant parents was obtained. The study
come up in the context of Spica casting (9). Rigid
protocol conformed to the Helsinki Declaration, the
internal fixation with a plate, however, has the risks of
ethical norm of the World Medical Association for
a large incision, significant bleeding, and scarring, as
human testing.
well as the potential complications of re-fracture and a

growth disruption (10).

Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 22)

c:\work\Jor\vol892_23 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6197- 6200

Predictors and Outcome of Early Post Stroke Seizures

Alaa Ali Mohamed Abdel Ghani1, Tarek AbdelRahman Gouda1,
Hend AbdElhafez Al Basheir*2, Nancy Abdelhamid Mohammad1
1Department of Neurology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
2Department of Neurology, New Mansoura General Hospital, Mansoura, Egypt
*Corresponding author: Hend AbdElhafez Al Basheir, Mobile: (+20) 0102 138 5636, Mail: dr.hendhafez1234@gmail.com

In adults, stroke is the leading cause of epilepsy. Seizures that occur after a stroke are of two distinct
types; those that manifest early after the stroke and those that manifest much later the clinical course and occurrence of
late seizures can be considerably influenced by early seizures. The objective of the current study is to investigate the
predictors of early seizure after an acute ischemic stroke and the impact of these seizures on outcome of the patients.
Patients and methods:
A case-control study was conducted in the intensive care unit (ICU) of Neurology Department,
Zagazig University Hospitals and New Mansoura General Hospital. A total of 60 subjects were included: 30 patients
with acute ischemic stroke with early seizures (case group) and 30 patients with acute ischemic stroke without seizures
(control group). Evaluation of the severity of neurologic deficits was done by using National Institutes of Health Stroke
Scale (NIHSS). All patients' short-term outcomes were evaluated using a modified Rankin Scale.
There was a statistically significant higher mean NIHSS score and mean Modified Rankin scale among the
case group than the control group. The etiologies of ischemic stroke were 46.7% of the cases had cardio embolic stroke,
40% atherosclerotic and 13.3% lacunar. The distribution of the ischemic stroke according to infarction size was 56.7%
large, 30% medium and 13.3% small. Among the case group 53.3% had cortical involvement and 30% had hemorrhagic
transformation. Conclusion: Predictors of early post-acute ischemic stroke seizures were large infarction size, cortical
site, and patients with hemorrhagic transformation. Also, early post-acute ischemic stroke seizures were associated with
more severe disease and poor outcome.
Post Ischemic Stroke, Early Seizures, Late Seizures, National Institutes of Health Stroke Scale, Modified
Rankin scale.


an acute ischemic stroke and no other possible
Ischemic or hemorrhagic focal alteration of
explanations of their neurologic impairments (such as a
cerebral blood flow causes abrupt neurologic
tumor, trauma, infection, or vasculitis). Patients having
dysfunction, or stroke. Stroke can result in permanent
a known history of epilepsy and those who had suffered
brain impairment, incapacity, or death depending on the
a stroke, subarachnoid hemorrhage, or cerebral venous
severity of the cerebrovascular abnormality [1].
thrombosis were not included in the study.
One of the most prevalent causes of epilepsy in
All patients were subjected to history taking and
adults is cerebrovascular illness. Cardioembolic
proper general and neurological examination. The
infarction and cortical anomalies are frequently linked
National Institutes of Health Stroke Scale (NIHSS) was
to post-stroke seizures. Between 39% and 45% of all
used to assess the extent of neurological impairment [4].
elderly seizures occur after a stroke and can be further
All patients' short-term outcomes were evaluated using
subdivided into early and late stages based on the two-
a modified Rankin scale [5].
week post-stroke interval that is typically used to define

the onset of seizures following a stroke [2]. Seizures are
Ethical consent:
classified as either early (those occurring within the first
This study was ethically approved by the
week or two after a stroke) or late (those occurring more
Institutional Review Board of the Faculty of
than two weeks after the stroke)[3].
Medicine, Zagazig University (IRB approval #
The aim of this study was the prediction of patients
(6411-30-09-2020), and an enlightened written
who will have an early seizure after an acute ischemic
consent was taken from every patient in this study.
stroke and the impact of these seizures on outcome of
This study was executed according to the code of
the patients.
ethics of the World Medical Association

(Declaration of Helsinki) for studies on humans.

Statistical analysis
The present study was a case-control study
The collected data were coded, processed and
conducted in the intensive care unit (ICU) of Neurology
analyzed using the Statistical Package for Social
Department, Zagazig University Hospitals and New
Sciences (SPSS) version 20 for Windows® (IBM SPSS
Mansoura General Hospital, during the period from
Inc, Chicago, IL, USA). Data were tested for normal
October 2020 to October 2021.
distribution using the Shapiro Walk test. Qualitative
Patients with acute ischemic stroke with ages 18
data were represented as frequencies and relative
years who had seizures within one week from the onset
percentages. Quantitative data were expressed as mean
of stroke and patients with Computed tomography (CT)
and standard deviation (SD). Independent samples t-test
and /or Magnetic resonance imaging (MRI) evidence of
was used to compare between two independent groups
Received: 30/6/2022
Accepted: 6/9/2022

Full Paper (vol.892 paper# 23)

c:\work\Jor\vol892_24 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6201- 6208

Nurses' Adherence to Surgical Safety Guidelines for
Patients Undergoing Abdominal Surgery
Rehab Mohamed Kather Hassan*, Manar Fathy Hamza, Sabah Nagah Hassan
Department of Medical Surgical Nursing, Faculty of Nursing, Helwan University, Egypt
*Corresponding author: Rehab Mohamed Kather Hassan, Mobile: (+20) 01027726021, E-Mail: rehab22kather@gmail.com


Background: Patient's safety events at the operating room can be completely avoidable by adhering to surgical safety
practices that aims to improve adherence to evidence-based safety practices, communication and team work during
critical time points as during surgical procedure, before induction of anesthesia, before incision and before the patient
leaves the room. Objective: This study aimed to assess nurses' adherence to surgical safety guidelines for patients
undergoing abdominal surgery.
Subjects and methods:
Design: A descriptive exploratory research design was used to achieve the aim of this study.
Setting: This study was conducted at the Operating Departments affiliated to El-Saff General Hospital and Atfeh Central
Hospital. Study subjects: A convenient sample of all available nurses (75) from the previously mentioned departments
was included in the study. Tools of data collection: Structured interview questionnaire included two parts: demographic
characteristics of the studied nurses and surgical safety guidelines checklist.
This study presented that less than half of the studied scrub nurses and only minority of the circulating nurses
and anesthesia nurses had competent practices at the operating room respectively.
The study concluded there were statistically significant relations between competent practices of scrub
nurses and their attendance of training courses related to surgical safety and between competent practices of circulating
nurses, their age and years of experience, while, there were no statistically significant relations between competent
practices of anesthesia nurses, their gender and attendance of training course.
Ongoing staff development programs and continuing education are important for improving staff
performance and maintaining patients' safety.
Keywords: Abdominal surgery, Adherence, Surgical safety.

anesthesia, surgical skills and equipment, lack of
Surgery is one of the fundamental health care
readiness to manage unanticipated blood loss and non-
services given in the health care system. Over 234
sterile equipment and surgical items and sponges left
million surgical operations are performed annually
inside body cavities of patients resulting in sepsis and
worldwide, complications occur in 3­16 % of surgical
failure in non-technical skills such as communication
procedures. Surgical complications are major causes of
and teamwork. Patients' safety and measures to ensure
morbidity and mortality and also pose a major financial
optimal outcomes of surgery are particularly important
burden to patients and providers, but it has been
in Africa, where patients are twice as likely to die after
estimated that at least half of these complications are
surgery compared to the global average, and the risk of
avoidable. The importance of safety culture that
death following perioperative complications is
enhances patients' safety initiatives has been reiterated
significantly greater than in other regions (3).
for years in the health care system and the safety of
In 2008 the World Health Organization
surgical care therefore is a global concern (1).
developed the Surgical Safety Checklist (SSC) to
Patients undergoing surgical intervention are at
improve surgical patient safety. The SSC reinforces
increased risk for complications and death. Even routine
safety practices in surgery and fosters better
surgery requires the complex coordination of surgeons,
communication and teamwork between clinical
anesthesia providers, nurses and support staff to provide
disciplines. It' is designed to allow the surgical team,
timely and effective care. Heightened patient's acuity
anesthesia providers, nurses and others to discuss, agree
and time pressure increases the potential for critical
and check important details about each surgical case at
errors and omissions in established standards of care.
three key time-points in the normal flow of a surgical
Implementation of the World Health Organization's
procedure, namely, briefing phase before induction of
surgical safety checklist improved the process of care
anesthesia, time out period after induction and before
and was associated with one third decreases in
surgical incision and debriefing phase after wound
complications across all types of noncardiac adult
closure and before leaving the operating room (4).
surgery (2).
It's is essential that basic nursing care places an
There's evidence that a lack of safety protocols
emphasis on the safety of the patients. Nurses should be
in surgery could lead to a range of surgical adverse
responsible for educating patients about potential
events contributing to preventable deaths. Avoidable
dangers and strategies to minimize them, as well as,
complications during surgery commonly arise because
advocating for patient's safety and reporting any adverse
of factors such as: operating on the wrong patient, using
events that occur. From this vantage point, nurse safety
the wrong procedure or at the wrong site, inadequate
procedures are a critical aspect of operating room
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 24)

c:\work\Jor\vol892_25 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6209- 6213

Evaluation of The Serum Level of Osteocalcin in Breast Cancer Patients, and
Its Association with Estrogen and Progesterone Receptors
Mutaz Sabah Ahmeid*, Wafaa Nasser Hassan, Noora A. Awa
Department of Biochemistry, College of Medicine, Ibnsina University of Medical and Pharmaceutical Science, Iraq
*Corresponding author: Mutaz Sabah Ahmeid; Mobile: (+964)7703767320, E-mail: dr.mutaz@ibnsina.edu.iq

Breast cancer is the second leading reason of cancer-related deaths in women. Osteocalcin (OC) is
increased when bone metabolism is raised. Cancer cells with estrogen and progesterone receptors be determined by
estrogen and related hormones, such as progesterone, to grow.
To find the level of serum osteocalcin, and its association with estrogen receptors and progesterone receptors.
Methods: Study design: A cross-sectional study was designed; taking 45 patients with breast cancer and 22 controls
women whose ages were between 25-70 years old, from beginning of January 2021 to ending of June 2021. These
patients came to Kirkuk Teaching Hospital. Age, weight, length, and body mass index (BMI) were recorded.
Biochemical analysis: The serum osteocalcin, progesterone receptors (PRs), and estrogen receptors (ERs) levels were
measured by an automated immunoassay system.
Results: Mean of BMI of control group was (25.63 ± 1.93) kg/m2 and of the patients' group was (26.97±4.08) kg/m2.
There was a significant difference in osteocalcin between the control and patients' group. There was a significant
difference in ER between the control and patients' group. There was a significant difference in PR between the control
and patients' group.
Conclusion: Biochemical marker of bone metabolism may identify patients with bone disease who are at high risk for
skeletal-related events.
Keywords: Breast Cancer; Osteocalcin; ER; PR; BMI.

cell line express the essential parts in the
Breast cancer is one of the top causes of death due
microenvironment regulating metastatic scattering of
to cancer, and it is about one in every eight females in
metastatic bone, potential and growing, osteolysis, and
the USA country. Breast cancer cells are commonly
fudging of anti-cancer immunity 7.
metastasized to different parts of body such as bone,
In strictly, the spreading of tumor cells primary
where survival rate of 5-year is about less than 10% (1).
keeps of an osteoblastic position and then will be
The bone is frequently remodeling in adults.
capable to procedure a micro-metastatic tumor clusters
Beneath perfect conditions, the osteoclast bone-
closely to the endo-steal external as it will appear by
resorbing cell excavates cavities and osteoblast cell
several preclinical simulation's types and patient trial
bone-depositing yield matrix to procedure a new bone,
samples (8). Successively, in the early stage of the tumor
so the bone will not lose or gain. Exclusions to these
metastatic to the bone, the osteoblasts will be activated,
situations include the following: (1) bone destruction as
a consequence of mature and osteoporosis , (2) the bone
osteoclastogenesis, tumor progression, osteolytic
damage as physical activity or exercise and (3) Normal
effects, and also anti-tumoral immunity9.
bone makeover disconcertion by metastatic cancer bone
Osteocalcin (OC), which is a bone-specific protein
(2). The osteolytic feature is the common form of
that is produced via the osteoblasts cell and is the main
metastatic breast cancer to the bone, where the bone
non-collagen type protein in the bone matrix. The
deposition was lesser than bone resorption (3).
osteocalcin molecular weight is about 5,800 Da and
The osteolytic types of the bone lesions are
includes 49 amino acids, it contains three gamma
frequently associated with increased calcium level,
carboxyl residues that enable the connection of
severe bone pain, and skeletal-related events such as
hydroxyapatite to OC in bone. The level of serum OC,
spinal cord compression and bone fractures. On other
a subtle indication of bone production, and it is related
fact, metastases may cause a rise in bone deposition
to all bone revenue percentage and reduces the bone
were reflected by osteoblastic activity 4. Remarkably,
mineral density (BMD), and also it associates with
precise tools that provoke development of osteoblastic
histomorphometric indexes of the bone formation 10.
injuries in metastasis of breast cancer to the bone are not
The patients with breast cancer that have positive
completely identified 5.
estrogen receptor (ER) and/or positive progesterone
Bone destruction was associated with bone metastasis
receptor (PR) involve lesser threats of mortality rate
caused by the relations among osteoblasts, osteoclasts,
compared with females that had negative ER- and/or
and metastatic cancer cells 6.
Although osteoclasts have long been reflected the chief
The aim of this study was to calculate the serum level
effector cells and consequent the treatment goal of
of osteocalcin in patients with breast cancer patients,
and to find the correlation with estrogen and
recommendation that supports of mesenchymal stem
progesterone receptors.
Received: 29/06/2022
Accepted: 05/09/2022

Full Paper (vol.892 paper# 25)

c:\work\Jor\vol892_26 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6214- 6217

Tube Thoracostomy Outcomes in COVID-19 Patients
Mohamed Elkhouly*, Ahmed Fouad
Department of Cardiothoracic surgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding authors: Mohamed Elkhouly, Mobile: (+20) 01115551412, E-mail: elkhoulymohamed98@gmail.com

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is an extremely infectious virus causing
COVID-19 illness. Respiratory failure is a consequence of COVID-19 illness related pneumonia, in which mechanical
ventilation and endotracheal intubation are essential. Barotrauma is a chief complication due to mechanical ventilation,
in which pneumothorax was established in 25% of COVID-19 barotrauma patients. The majority of complicated
COVID-19 cases with a pleural effusion or pneumothorax require a thoracostomy.
To recognize and analyse tube thoracostomy consequences in COVID-19 complicated individuals through
this pandemic. Patients and Methods: A retrospective study was accomplished in Thoracic Surgery Unit of Elkasr
Elaini Medical Center, Cardiothoracic Surgery Department in Cairo University, Cairo, Egypt. We included fifteen
COVID-19 individuals entered the ICU in the period between June 2020 and September 2021 requiring thoracic surgery
consultation. Non-COVID-19 severe illness and iatrogenic pneumothorax were omitted from this study.
Nine pneumothorax cases (73.3%), two surgical emphysema associated with pneumothorax cases (13.3%),
three pleural effusion cases (20%) and one hydropneumothorax case (6.7%) as a total of fifteen patients needed thoracic
surgery consultation. After tube thoracostomy, there were no harm consequences. From the total number of patients, 12
well improved and discharged (80%) and three were dead (20%) within three days after tube thoracostomy who were
mechanically ventilated due to respiratory failure after ARDS.
Conclusion: COVID-19 complicated cases needed chest tube insertion is associated with good outcomes and
COVID-19, SARS-COV-2, chest tube, pleural effusion, tube thoracostomy, pneumothorax.

severely sick COVID-19 patients. Among these studies
A worldwide pandemic COVID-19 is the medical
on ARDS, one was done on minor number of SARS
state generated by SARS-CoV-2 infection and is linked
patients stated that a tube thoracostomy was received in
with considerable morbidity and death, involving acute
three out of six pneumothorax patients(11).
respiratory failure necessitating ICU admission and

sophisticated respiratory assistance (1).
Respiratory failure with profound hypoxemia is a
consequence of COVID-19 illness related pneumonia,
The aim of our research is to reveal the
in which mechanical ventilation and endotracheal
consequences of tube thoracostomy regarding
intubation are essential (2). An important complication
morbidity and death in these covid-19 patients who have
of mechanical ventilation is barotrauma. Barotrauma is
pneumothorax or pleural effusion.
a significant complication of mechanical ventilation (3).

Pneumothorax occurred in up to 25% of COVID-19
patients who experienced barotrauma, but only in 2% of
patients with certain other reasons of acute respiratory
A retrospective study was conducted in Thoracic
distress syndrome (ARDS) (3,4). Also, there is no
Surgery Unit of Elkasr Elaini Medical Center
agreement on how to manage ventilators and lung
Cardiothoracic Surgery Department in Cairo
relaxation in COVID-19 related ARDS, as well as
University, Cairo, Egypt. Fifteen COVID-19 cases
protecting additional lung injury. Mild COVID-19
(admitted in the time interval between June 2020 and
individuals with pleural effusion is only 8%, however.
September 2021) to ICU and needed thoracic surgery
It is occurred in 28% of severely ill covid 19 patients (5).
consultation, were included in our study.
Although controversial, it is presently suggested to

implant a tube thoracostomy in critically sick patients
Ethical approval:
on positive pressure ventilation when pneumothorax
The approval of this study was attained from
and pleural effusions are noted (6). These complications
Cairo University Academic and Ethical Committee.
are not rare, for example pneumothorax may occur by
Written informed consent was taken from all
5.9% through first day of intubation (7).
participants. The study was conducted according to
There have been several reports stated that in cases
the Declaration of Helsinki.
of pneumothorax and pleural effusion complicated

COVID-19 patients tube thoracostomy is required.
Inclusion and exclusion criteria:
However, these reports included individuals of limited
We involved all ICU entered COVID-19
sized and involved non-severely sick patients (6­10).
individuals who needed thoracic surgery intervention by
Furthermore, there is no data on the frequency and
a tube thoracostomy. Iatrogenic pneumothorax and
post-operative prognosis of tube thoracostomy in
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 26)

c:\work\Jor\vol892_27 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6218- 6225

The Relationship between Glycated Hemoglobin and Complexity of
Coronary Artery Lesions Among Middle-Aged Patients with Diabetes Mellitus
Ahmed Mokhtar El Kersh, Mohamed Abd Elmoneim Salama*, Hend Mohammed Abdo Eldeeb
Cardiology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Mohamed Abd Elmoneim Salama, Mobile: (+20) 01062804181, E-Mail: dr.salam2022@gmail.com

Microvascular angiopathies in DM patients are associated with elevated levels of glycated hemoglobin
(HbA1c). However, the connection between HbA1.c and the severity of CAD and coronary perfusion in DM patients
remains obscure.
Objectives: Evaluation if there is a correlation between HbA1c levels and the complexity of coronary artery lesions, as
measured by the Syntax score among middle-aged DM patients who have been referred for elective coronary
Patients and Methods: 50 patients with type 2 diabetes participated in this prospective, randomized clinical
investigation. Patients who voluntarily had coronary angiography at 6th October Insurance Hospital, Giza, Egypt
between April 2021 and January 2022 were evaluated for coronary artery blockage.
Results: Syntax score was highly statistically significant relation between Syntax score and HbA1c where Syntax score
significantly increased among patients in group III (29.70±5.14) than patients in group II (14.53±4.42) and patients in
group I (6.00±2.66), (P<0.001). Moreover, there were significant positive correlations between smoking and total
cholesterol with Syntax score (P<0.05). However, no significant correlations were found between Syntax score with
age, sex, HTN, serum creatinine, LDL, HDL, and triglyceride of the studied patients, (P>0.05). ROC curve analysis
shows that, the best cutoff value of HbA1c in detection of severity disease using syntax score was 6.95, with
AUC=0.705, sensitivity 86%, specificity 73%, with significant level p=0.016
Conclusion: The severity of coronary artery lesions in diabetic patients was significantly linked with their HbA1c levels.
Further, after accounting for other potential dangers, the HbA1c value was discovered to be a significant predictor of
coronary artery lesion complexity.
Keywords: Coronary artery lesions, Diabetes mellitus, Glycated hemoglobin.

The risk of microvascular problems rises not
High rates of coronary artery disease (CAD) and
linearly but exponentially with increasing HbA1c levels
poor outcomes are both associated with diabetes
(6). In contrast, research shows that a drop of just 1
mellitus (DM), a major risk factor for coronary heart
percent in HbA1c, the risk of microvascular
disease (1). Indicative of 2- to 3-month mean blood
complications decreases by 37%, and the risk of any end
glucose levels, glycated hemoglobin (HbA1c) is
point or mortality from diabetes decreases by 21% (7).
measured once a patient has been diagnosed with
Several prior researches have shown that HbA1c
diabetes. Several benefits set HbA1c apart from the
is positively correlated with mortality and even
fasting blood glucose test: its repeatability is improved
preclinical cardiovascular disease in individuals who do
(2). HbA1c can be measured even when the patient isn't
not have a history of diabetes (8). HbA1c was found to
fasting, and the panel specifically mentioned how much
be a significant predictor of future DM, CVD, and all-
more practical it is, increased stability and decreased
cause mortality by Selvin et al. (9). Diabetes mellitus is
biological variation (3). HbA1c, or glycated hemoglobin,
also a major problem among the elderly population. Age
is known to increase the likelihood that a person with
also influences both HbA1c and diabetes risk.
DM may get microvascular angiopathies. Yet, it is still
Iatrogenic hypoglycemia makes it challenging to
unclear how HbA1c relates to the degree of coronary
achieve optimal glycemic control and HbA1c levels in
perfusion as well as CAD in diabetic patients (2).
the elderly (9).
Clinically, an individual's HbA1c level is used to
This angiographic score, called the Syntax score,
evaluate the effectiveness of their long-term glucose
ranks coronary artery abnormalities according to their
management. Therefore, it is a reflection of how well
severity and complexity (10). Patients with a higher
diabetes people have managed their glucose levels over
Syntax score are at much higher risk for major adverse
time. An HbA1c cutoff of 7 percent has been suggested
cardiovascular events (MACE), and this system has
by the American Diabetes Association for optimal
been widely acknowledged as a CAD complexity
cardiovascular benefit (4), which represent potential
marker with shown prognostic utility in a variety of
predictive significance of HbA1c levels for
clinical settings (11).
cardiovascular disease risk assessment. Multiple prior
The greater risk of incapacitating and
research have shown that in those who have never had
unpredictable hypoglycemia in elderly patients with
diabetes, HbA1c is positively linked with death and
DM must always be taken into mind when
even preclinical cardiovascular disease (5).
contemplating intensive medication to reduce HbA1c
level. Clinical investigations have not conclusively
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 27)

c:\work\Jor\vol892_28 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6226- 6230

Protective Effect of Taurine Against Bisphenol A -Induced
Hepatotoxicity in Albino Rats
Esam Mohamed Abd- Allah, Maha Abd El Hameed Hilal,
Doha Saber Mohamed, Azza Omar Hassan*, Ahmed Mohamed Said
Department of Forensic Medicine and Clinical Toxicology and Histology,
Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Azza Omar Hassan, Mobile: 01000532969, Email: azzamahmoud559@yahoo.com


Background: Bisphenol A (BPA) is one of the most utilized industrial chemicals worldwide. It is commonly found in
a variety of consumer products. Taurine is a natural product; has been shown to protect cells against the cytotoxic
effects and inflammations associated with oxidative stress and provide anti-inflammatory effects.
: This study was designed to investigate the toxic effects of BPA on the liver and evaluate the possible
protective effect of taurine.
Methods: Forty adult male albino rats were divided equally into four groups (10 rats per group). Group I: Rats fed on
basal diet and distilled water. Group II: Received taurine orally (100 mg /kg /day). Group III: Rats treated orally with
bisphenol (130 mg /kg /day). Group IV received BPA and taurine. After one month, all animals were sacrificed and
blood was collected for analysis.
Results: There is increased serum AST& ALT level and histopathological changes in liver. Toxic effects declined
markedly with taurine co-administration.
Conclusions: The present study concluded that BPA has many toxic effects on liver, taurine has a potential protective
effect against such harmful effects.
Keywords: BPA, Taurine, Alanine transaminase (ALT), Aspartate transaminase (AST), liver.

mediated by: First, taurine is a proven anti-inflammatory
Bisphenol A (BPA) is one of the major materials
agent that neutralizes the neutrophil oxidant,
used to produce polycarbonate plastic, epoxy resin,
hypochlorous acid, also interferes with the inflammatory
health care products, and thermal resistant products (1).
process (10-11). Second, taurine diminishes the generation
BPA began to be predominantly used as a monomer to
of superoxide by the mitochondria (12).
manufacture polymers, such as Polycarbonates (PCs),
It also was found that taurine has emerged as an
epoxy resins, polysulfone and polyacrylate (2).
attractive therapeutic agent against liver injury as it is
Currently, PC plastics used to produce optical
actively involved in the reduction of hepatic oxidative
materials. Also used to manufacture electronic
burst, which is accompanied by a remarkable increase in
equipment, bottles, reusable plastic bottles, dishes,
anti-oxidant enzymes and by attenuation of
bowls, cups, microwavable utensils, and food containers
inflammatory injury (13).
(3). Epoxy resins are used to protect canned food and

beverages and as a surface coating on drinking water
storage tanks. Due to the broad application of BPA,
exposure of the general population to BPA can occur via
The experimental procedure was conducted in
a range of products (4).
accordance with the guide of the care and use of
Exposure to this chemical is ubiquitous, and
laboratory animals approved by the Medical
occurs mostly via the oral (approximately 90%),
Research Ethics Committee of Faculty of Medicine,
respiratory, and dermal routes in human and animals (5).
Sohag University. The study was conducted on 40 adult
Harmful effects of BPA in cells and tissues
male albino rats weighing (200± 20 gm). The animals
mostly mediated by increased oxidative stress associated
were housed in animal house, Faculty of Medicine,
with an elevated production of toxic free radicals (6).
Sohag University, in metal cages under ambient
Exposure to BPA is linked to cardiovascular disease,
temperature, 21± 3 °C. Animals were fed with standard
brain development abnormalities, obesity, hypertension,
pellet food and water. They were acclimatized to the
thyroid dysfunction, diabetes, breast cancer and
laboratory condition for one week before starting the
infertility (7). Oxidative stress is a condition that disturbs
treatment protocol. The study was performed at
the oxidant/antioxidant balance as a result of a
December 2020.
significant rise in reactive oxygen species (ROS) in cells

and a decline in antioxidant levels (8).
Experimental design:
Taurine is a sulfur-containing b-amino acid (2-
Animals groups: The rats were divided randomly into 4
aminoethane sulfonic acid) that is abundant in the cells
groups, 10 animals each:
of many tissues (9). The primary mechanisms of taurine
Group I (Control group): Rats fed on basal diet
cytoprotection is its antioxidant activity, which is
and distilled water.
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 28)

c:\work\Jor\vol892_29 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6231- 6238

Diffusion Weighted Magnetic Resonance Imaging in
Characterization of Different Pancreatic Masses
Islam Mahmoud Mahfouz*, Dalia Bayoumi, Salwa Mohamed Eteba
Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Islam Mahmoud Mahfouz, Mobile: (+20) 01116175457, E-Mail: islammahmoud5262@gmail.com

Diagnosis of variety of abdominal abnormalities could be easily done by diffusion-weighted magnetic
resonance imaging (DWI) with apparent diffusion coefficient (ADC) quantification. Several studies have
demonstrated that combining DWI with ADC measurement can aid in the detection and characterization of pancreatic
masses. The objective of the current study is the evaluation of diffusion weighted imaging role as a non-invasive
method in evaluation of pancreatic masses with histopathological correlation.
Patients and methods: The study included 59 patients performed at Radiology Department of Mansoura University
Hospital. The patients were between the ages of 30 and 71 years. This research was carried out using a 1.5 T Philips
Ingenia MRI scanner. All patients underwent history taking and MRI with DWI.
Results: Malignant lesions mean ADC was about 1.14 (SD 0.14) x 10-3 mm2/sec. Mean ADC of benign lesions was
about 2.38 (SD 0.73) x 10-3 mm2/sec. With a cutoff point of 1.36 x 10-3 mm2/sec for differentiating malignant from
benign lesions, the benign lesions' ADC value was statistically substantially higher than the malignant lesions', with
95.8% sensitivity, 90.9 % specificity, and 94.4% accuracy.
Conclusion: Combining qualitative and quantitative examination of DWI and ADC results could assist to distinguish
between malignant and benign pancreatic tumors. The evaluation of pancreatic masses can be aided by combining
DWI with conventional imaging, which has been demonstrated to be an easy, non-invasive procedure.
Keywords: Diffusion weighted imaging, apparent diffusion coefficient, MRI, pancreatic masses.


underwent an appropriate history taking, followed by
A tumor in the pancreas can be caused by a
clinical examination and MRI with DWI.
variety of benign and malignant disorders, some of

which may be completely benign (mass forming
Inclusion criteria:
chronic pancreatitis) or, more commonly, cancerous
Both gender, males and females, were included in
(like endocrine tumors as well as ductal
the study.
adenocarcinoma), or to be of cystic type (like
Patients who agreed to participate in the study.
pseudocysts as well as cystic neoplasms) (1).
Patients with a pancreatic mass, which was
Diffusion weighted imaging has yielded fruitful
histologically proven following a true cut or fine
results in the evaluation of pancreatic lesions through
needle biopsy/aspiration.
quantitative analysis of mean apparent diffusion
Cases who were diagnosed comfortably upon
coefficient (ADC) values (2).
clinical evaluation, laboratory studies and or
Thus, ADC reflecting the freedom of water
follow-up radiological examinations.
molecule motions serves to distinguish tissue regions

of varying cellular density and stromal composition (3).
Exclusion criteria:
The ADC map shows low signal intensity for
Patients who have a cardiac pacemaker.
tissues with water diffusion restriction while DW
Patients who have metallic foreign body in their
pictures show high signal intensity for these tissues; by
computing the ADC value inside particular regions of
Patients with severe claustrophobia to MRI
interest, diffusion restriction can also be measured (4).
This study aimed for the evaluation of diffusion
Patients with very bad general condition.
weighted imaging role as a noninvasive method in
Uncooperative patients with excessive motion.
evaluation of pancreatic masses with histopathological


Magnetic Resonance Imaging:
All cases in this study were processed using the
A total of 99 patients were included in this study,
Philips Ingenia 1.5 T MRI scanner located in the
referred from the Surgical Oncology Department and
Radiology Department of Mansoura University
Medical Oncology Unit at the Oncology Center
Hospital (with the same scanning parameters).
Mansoura University (OCMU) and the General

Surgical Department at Mansoura University Hospital,
I. Patient preparation: Patients were instructed to
during the period from November 2019 to May 2022.
avoid movement during the acquisition time. Before
Patients were 35 males and 24 females, and their age
entering the examination room, the patient was
ranged between 30 and 71 years. All patients
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 29)

c:\work\Jor\vol892_30 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6239- 6246

Relationship between C-MYC, BCL-2 and BCL-6 Genetic Abnormalities and
Bone Marrow Biopsy in B-Non-Hodgkin Lymphoma
Hanan M.Bedair, Olfat .M Hendy, Mona Wahba, Yasmin Mohsen, Soha Abuelela
Department Clinical and Chemical Pathology, National Liver Institute, Menoufia University, Egypt
*Corresponding author: Yasmin Mohsen, E-Mail: yasooo250@gmail.com, Mobile: (+20) 01005047478

C-MYC, BCL2 and BCL6 genes are the most commonly involved oncogenes detected in B-non-
Hodgkin's lymphomas (B-NHLs). Histopathology is the best method used to diagnose B-NHLs. However, the
cytological analysis of bone marrow smears and imprints could provide a chance for a precise diagnosis of these
This study aimed to evaluate bone marrow findings as an integral part of the staging workup in B-NHLs and
to study possible relationship to C-MYC, BCL-2, and BCL-6 gene abnormalities.
Patients and methods: This study was conducted as a cross-sectional study that included 51 adult B-NHL patients.
Each patient underwent careful history assessment, clinical examination, laboratory tests (e.g. complete blood count,
BM smears, BM biopsy, lymph node biopsy, immunophenotyping on bone marrow aspirates by flowcytometry and
interphase FISH dual color break-apart probes of C-MYC, BCL2 and BCL6 on bone marrow aspirates).
Results: Results of lymph node biopsy histopathological examination revealed that, FL, DLBCL, and MCL were
diagnosed in 43.1%, 39.2% and 17.6% of them respectively. Among 51 B-NHL cases, there were 35.29%, 31.37% and
23.53% positive cases for C-MYC, BCL2 and BCL6 respectively. Concurrent genetic aberrations showed double
C-MYC and BCL2 constituted 17.6% and triple expression of C-MYC, BCL2 and BCL6 that constituted 7.8% of the
cases. However, the FISH positive cases were more frequent in MCL than FL and DLBCL. The BCL2 was more
significantly associated with FL subtype and BCL6 with DLBCL subtype.
Conclusion: C-MYC, BCL2 and BCL6 gene aberrations frequently occurred in B-NHLs and could be considered as
independent prognostic factors that carry different impacts on BM marrow biopsy finding and BM infiltration which
affect clinical outcome of patients.
Keywords: BCL2, BCL6, C-MYC, B-Non-Hodgkin Lymphoma, FISH, Bone marrow.

functions as a pro-survival protein by inhibiting
B-NHLs are a diverse group of immune system
apoptotic cell death and protecting cells from a wide
malignancies that can affect any organ in the body.
variety of cytotoxic stimuli, including UV radiation and
They have a wide range of presentations that range from
cytokine deficiency. BCL2 translocation, t (14;18)
mild to extremely aggressive clinical behavior (1).
(q32;q21), results in its overexpression, which make the
Histopathology is the best method used to diagnose B-
cell resists dying (5).
NHLs. However, the cytological analysis of bone
When it comes to the growth of B-cell germinal
marrow smears and imprints could provide a chance for
centers, BCL6 is essential. In the regulation of cell
precise diagnosis of these disorders (2).
cycle, proliferation and differentiation, apoptosis, and
Bone marrow (BM) aspirate along with BM
DNA damage response, it serves as a transcriptional
trephine biopsy specimens are usually complementary
repressor. Loss of the normal controls leads to over
to each other, but bone marrow biopsy is critical and
BCL6 expression that results in a lymphoproliferative
more diagnostic in hematological disorders with focal
condition that resembles diffuse large B cell lymphoma
infiltration as in lymphomas and in bone marrow
(DLBCL) (6).
metastasis. Many patterns of bone marrow infiltration
Over the past 30 years, improvements in
in B-NHLs are documented and occur in any one or a
cytogenetic methods have increased the sensitivity of
combination of five different patterns: focal random,
chromosome abnormalities' identification. A revolution
focal para trabecular, interstitial, diffuse, and
in cytogenetic analysis and significant advancements in
intrasinusoidal (3).
the diagnosis and study of haematological malignancies
C-MYC functions as a transcriptional factor in
were particularly brought about by the development of
normal cell behavior to control cell cycle progression
FISH in the late 1980s (7).
from G1 to S phase beside the terminal differentiation
The goal of FISH is to locate specific nucleotide
inhibition. The C-MYC translocation t (8;14) (q24;q32)
sequences in tissues, metaphase spreads, or cell nuclei.
lead to MYC expression abnormalities. C-MYC over-
FISH works by annealing tagged probes into
expression in healthy cells makes them more
complementary sequences in situ on histological
susceptible to different apoptotic triggers, which makes
specimens as well as samples ready for karyotyping (8).
them resistant to cell death and causes cancer(4).
The aim of this study was to evaluate bone
A crucial part of the cell apoptosis cycle is played
marrow findings as an integral part of staging workup
by BCL2, a protein belongs to the BCL family. BCL2
Received: 14/06/2022
Accepted: 22/08/2022

Full Paper (vol.892 paper# 30)

c:\work\Jor\vol892_31 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6247- 6255

Exhaled Carbon Monoxide as a Marker of Inflammation in
Hospitalized COVID-19 Patients
Walid Elgendy1, Saad R. Samra1, Ahmed M. Tawfik2,
Huda Elsayed Mahmoud Said3, Ahmed Mohamed Said1*
Departments of 1Chest, 2Anesthesia and Intensive Care and
3Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Mohamed Said, Mobile: (+20)122708462, E-Mail: kingarmstrong100@yahoo.com

Coronavirus disease 2019 (COVID-19) is a virus that is quickly spreading and has heterogeneous clinical
features. Early identification of prognostic variables is necessary to coordinate treatment plans and accurately determine
patient severity.
Objectives: The aim of the current work was to evaluate the possible value of exhaled carbon monoxide (CO) as a marker
of inflammation in different severity categories of hospitalized COVID-19 patients.
Patients and Methods: A prospective cohort study was conducted on 39 confirmed COVID-19 nonsmoker patients
who admitted to isolation unit at Zagazig University isolation hospital from March 2021 to February 2022. They were
divided into two groups: Moderate COVID- 19 and severe COVID- 19. Exhaled carbon monoxide (eCO) was measured
on admission (day 1) and after seven days (day 7).
Results: It was revealed that there was high statistically significant difference between the studied groups regarding
eCO at day one and seven (the level was significantly higher among severe group) (p0.001). Also, there were high
significant positive correlations between eCO and CRP level in both moderate and severe groups through day one and
seven (p0.001).
Conclusion: It could be concluded that exhaled CO analysis can be viewed as a noninvasive inflammatory marker for
determining the level and severity of inflammation as well as forecasting the prognosis of COVID-19 patients.
Keywords: COVID-19, C- reactive protein, Exhaled carbon monoxide.


inflammation in different severity categories of
In Wuhan, Hubei, China, near the end of 2019,
hospitalized patients.
a cluster of cases complaining of severe respiratory

symptoms marked the emergence of an outbreak of an
unknown viral pathogen. Severe Acute Respiratory
This prospective cohort study included a total
Syndrome-2 (SARS-CoV-2) is the name of the virus
of 94 hospitalized nonsmoker confirmed COVID 19
that causing Coronavirus Disease 2019 (COVID-19)
patients who admitted to isolation unit in Zagazig
and World Health Organization (WHO) had deemed it
University Isolation Hospital from March 2021 to
a worldwide pandemic (1).
February 2022.
Septic shock, coagulation issues, and multiple
Fifty-five patients were excluded from this
organ failure are life-threatening consequences that
study according to the exclusion criteria as shown in
could affect close to 20% of COVID-19 patients.
figure (1).
Several earlier investigations have suggested that an
The remaining thirty-nine confirmed COVID
aberrant immune-inflammatory response and cytokine
19 patients were enrolled in this study based on
storm may promote COVID-19 progression (2).
positive polymerase chain reaction (RT-PCR) (samples
Carbon monoxide (CO) may have endogenous
were taken by nasopharyngeal swabs) and Chest CT.
or external origins in exhaled breath. Enzymatic heme

breakdown and nonheme-related release are the main
The included 39 patients were divided into two
sources of endogenous CO in exhaled breath (lipid
groups: moderate and severe according to MOHP
peroxidation, xenobiotic, and bacteria). Exhaled CO is
protocol (2021) (5).
produced endogenously in healthy nonsmokers and

rises in several inflammatory pulmonary diseases (3).
Group 1 (Moderate confirmed COVID- 19 patients)
consisted of 23 patients. These patients had (1) clinical
respiratory tract infections, bronchiectasis, lower
signs of pneumonia (fever, cough, dyspnea, tachypnea),
respiratory tract infections, interstitial lung disease,
& (2) Oxygen saturation 92% free air. and Group 2
cystic fibrosis, and critically ill patients have all
(Severe confirmed COVID-19 patients) consisted of 16
benefited from usage of exhaled CO in monitoring
various lung inflammatory disorders (4).
These patients had clinical and radiological signs of
Therefore, the aim of this research was to
pneumonia with oxygen saturation < 92% free air
quantify lung inflammation in hospitalized COVID
responding to oxygen therapy.
patients with pneumonia by measuring exhaled CO

levels to evaluate its possible role as a marker of
Inclusion criteria:
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 31)

c:\work\Jor\vol892_32 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6256- 6263

Study of Topical Potassium Hydroxide versus Candida Antigen
Immunotherapy for Molluscum Contagiosum Management
Doaa Shafik El-Hady*, Hend Darwish Gamil, Amin Mohamed Amin Amer
Department of Dermatology, Venereology and Andrology, Faculty of Medicine Zagazig University, Egypt
*Corresponding author: Doaa Shafik El-Hady, Mobile: (+20)1032551089, E-Mail: doaashafek59@gmail.com

Molluscum Contagiosum (MC) has no FDA-approved treatments as of yet. Although many other
treatments have been suggested, the majority of the efficacy evidence comes from modest case studies.
Objectives: The aim of the current work was to evaluate the safety as well as efficacy of intralesional candida Ag
immunotherapy versus topical KOH (10 %) in the treatment of MC.
Patients and methods:
A total of 40 patients (21females and 19 males) with multiple lesions of MC. They were divided
into two equal groups at random; group 1 treated by candida antigen at 2 weeks intervals with a maximum of five
injections or clinical cure. Group 2 subjected to topical 10% KOH twice daily for ten weeks.
Results: Complete clinical response was attained in 80% of MC patients who treated with candida antigen for 10 weeks
versus 85% of patients who treated with topical KOH for 10 weeks, while 20 % of patients showed no response in group
1 versus 5% in group 2 after the end of therapy. without recurrence after 3 months in all patients demonstrating complete
reaction. In group 1, most patients tolerated the side effects, which in 5% of cases manifested as erythema and
hyperpigmentation. While in group 2, hypopigmentation (15%), hyperpigmentation (10%), pruritus (10%) during
treatment were reported. There was significant reported burning sensation among 25% of patients treated with topical
potassium hydroxide (P = 0.047).
Conclusion: It could be concluded that both topically applied KOH10% and intralesional candida are dependable, less
expensive treatments for non-genital MC.
Keywords: Potassium Hydroxide, Candida Antigen Immunotherapy, Molluscum Contagiosum.


The molluscum contagiosum (MC) virus is the
therapy with cimetidine, and topical therapies using
source of the self-limiting cutaneous viral illness known
cantharidin, salicylic acid, podophyllotoxin, tretinoin,
as molluscum contagiosum (MC). Children and patients
imiquimod, or potassium hydroxide (KOH)(6).
with compromised immune systems are more
A dead yeast protein is injected intralesionally
susceptible to this virus. According to reports, 5.1-11.5
into the MC lesions as part of candida antigen
percent of pediatric patients have MC, with warm
immunotherapy. It is hoped that once the immune
climates accounting for the majority of cases (1).
system becomes active in this area, it will produce an
Beginning in the early nineteenth century,
immunological response against the wart or MCV in
Bateman first described MC and then gave it a name.
addition to the yeast protein. Instead of treating each
The intracytoplasmic inclusion bodies--also known as
lesion locally, this triggered immune response might
Molluscum or Henderson-Paterson bodies--were first
then result in the destruction of all lesions on the body(1).
characterized by Henderson and Paterson in 1841 (2).
Evaluation of the efficacy and safety of
Julinsberg (3), was able to extract filterable virus from
intralesional candida Ag versus topical KOH (10 %) in
lesions and demonstrate transmissibility at the
the treatment of MC. was the goal of this study.
beginning of the twentieth century. Later, Hanson and

Diven discussed the similarities between vaccinia and
molluscum (4).
The current study included 40 patients (21females and
Clinical images are characterized by 2­5 mm-
19 males) with multiple lesions of MC referred to the
diameter papules with a central umbilication that are
Outpatient Clinic, the Dermatology and Venereology
dome-shaped, smooth-surfaced, pearly, skin-colored, or
Department, Zagazig University Hospitals.
white. However, atypical MC presentations can make it

difficult for clinicians to make a diagnosis.
Inclusion criteria: Male and female patients,
Immunosuppressed patients are more likely to
determined clinically to have MC, aged 2-18 years.
experience immunotypical presentations, such as large,

cystic, ulcerated, or condyloma acuminatum-like
Exclusion criteria: Prior unfavorably susceptible
lesions (5).
reaction to candida antigen, pregnant and lactating
There are no FDA-approved treatments for MC as
female, acute febrile disease, asthma or a skin condition
of now. Although many other treatments have been
that makes them more sensitive, iatrogenic or essential
suggested, the majority of the efficacy data come from
immunosuppressed understanding, patient getting any
uncontrolled research and small case series (5).
treatment of MC amid the most recent month, any
Treatment options for MC include physical
summed up dermatitis, and genital MC.
eradication via curettage or cryotherapy, systemic
Every patient was subjected to:
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 32)

c:\work\Jor\vol892_33 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6264- 6267

Relation between Epicardial Fat Thickness and Acute Ischemic Stroke in
Patients with Atrial Fibrillation
Mohamed Hossam El-Din El Shaer, Ahmed Mohamed El-Zayat,
Moataz Abdelmonem Elkot, Mohammed El-Sayed Mohammed El-Sayed Zayed*
Department of Cardiology, Faculty of Medicine ­ Zagazig University, Zagazig, Egypt
*Corresponding author: Mohammed El-Sayed Mohammed El-Sayed, Mobile: (+20) 01010662920,
E-Mail: mohamed.zayed609@gmail.com
Cerebrovascular disease is the second most common cause of death after coronary artery disease (CAD)
and remains a major health problem worldwide. Cardioembolic stroke is the most common predicted cause of
cryptogenic stroke, and atrial fibrillation (AF) is the most frequent cause of cerebral cardio-embolism.
Objective: The aim of this study was to evaluate the performance of epicardial fat thickness (EFT) as a risk factor of
acute ischemic stroke in patients with AF.
Patients and Methods: This was a case-control study at Cardiology Department, Zagazig University Hospitals and
Nasser Institute for Research and Treatment, conducted on 60 patients: (20) AF patients with acute ischemic stroke
(AIS), (20) AF patients without AIS and (20) controls without AF or AIS.
Results: The current study showed that, AF patients with AIS have mean of age (66.15± 9.12). Our recent study
revealed that, males with AF with AIS were more than females (65.0%; 35.0% respectively). The current study showed
that, there were statistically significant difference between the studied groups regarding smoking and hypertension
(HTN). Regarding echo finding, mean value of EFT was statistically higher among AF patients with AIS than AF
patients without AIS. Mean value of EFT was statistically higher among AF patients with AIS than controls group.
Mean value of EFT was statistically higher among AF patients without AIS than controls group.
Conclusion: EFT is an independent predictor for the development of acute ischemic stroke in patients with AF.
Keywords: Epicardial Fat Thickness, Acute Ischemic Stroke, Atrial Fibrillation.

electrophysiological properties of the heart and ion
Accurate classification of stroke etiology is crucial
currents, causing higher arrhythmogenesis in left atrial
for optimizing stroke management. Cardio-embolic
myocytes, which contributes to an increased risk of AF
stroke is the most frequently predicted cause of
cryptogenic stroke; the most frequent cause of cerebral
Epicardial fat is a metabolically active tissue;
cardio-embolism is atrial fibrillation (AF), including
echocardiography is a useful technique for measuring
paroxysmal AF. AF is the most common etiology of
epicardial fat thickness (EFT). Previous studies have
ischemic stroke; the incidence of stroke in individuals
demonstrated associations between EFT and coronary
with non-valvular AF is estimated to be 5 times higher
artery disease, carotid atherosclerosis, metabolic
than in individuals without AF. The prevalence of AF
syndrome, and obesity. In addition, increased EFT has
in the whole stroke population has been reported to
been shown to be associated with the presence and
range from 17%-25.6%. The risk for stroke and
chronicity of AF (4).
thromboembolism in patients with AF has been shown
The aim of this study was to evaluate the
to escalate proportionally with combined vascular risk
performance of EFT as a risk factor of acute ischemic
factors (1). However, by routine arrhythmia screening
stroke in patients with AF.
methods, it is difficult to detect the short and usually

asymptomatic presentations of paroxysmal AF (also
called occult AF) (2).
This case control study was conducted in the period
There is evidence that abnormal levels of plasma
from January 2021 to January 2022. It included 60
free fatty acids (FFAs) are associated with an increased
patients and was done at Zagazig University Hospitals
risk of myocardial disease, including AF and heart
and Nasser Institute for Research and Treatment.
failure. Adipose tissue covers a significant portion of

the epicardial surface, and myocyte-adipocyte cross
Ethical consent:
linking is known to be important in the physiological
All patients gave an informed consent to
function of the normal myocardium. Myocardial injury
participate in the study. The study was approved by
and ischemia are followed by changes in the levels of
Ethical Committee of the Institutional Review Board at
adipocyte-derived biomarkers (FFAs and adipokines)
Faculty of Medicine, Zagazig University Hospitals.
and adipose deposition. Fat can accumulate around the
This work has been carried out in accordance with The
heart in epicardial adipose tissue or inside the heart as
Code of Ethics of the World Medical Association
lipid droplets. The mechanism by which fatty
(Declaration of Helsinki) for studies involving humans.
infiltration promotes arrhythmogenicity is not well

characterized. Recent studies have shown that increased
Study patients were divided into 3 groups: Group 1
epicardial adiposity can directly modulate the
(AF patients with acute ischemic stroke [AIS]): 20
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 33)

c:\work\Jor\vol892_34 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6268- 6273

Intrapleural Streptokinase in Complicated Parapneumonic Effusions and Empyema
Haytham Mohamed Abd El Moaty*, Khaled Mohammed Abdallah
Cardiothoracic Surgery Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
*Corresponding author: Haytham Mohamed Abd El Moaty, Mobil (+2)01007217084,
Email: drhaythmabdelmoaty@gmail.com
Catheter drainage and antibiotics were the standard therapy for parapneumonic effusions and/or empyema.
Streptokinase may aid tube drainage if it failed due to fibrinous adhesions.
Objective: This study aimed to identify the benefits of streptokinase in treatment of empyema by evaluating its efficacy
and safety.
Patients and Methods: 30 patients with parapneumonic effusions and/or empyema treated at Al-Azhar University
Hospitals between April 2020 and June 2022. The diagnosis was made using a frank pus aspiration from a pleura seen on
a chest radiograph (X-ray, ultrasonography, or CT), and it was later confirmed by the results of a bacteriological
examination of samples collected. Streptokinase was given 24 hours after insertion of intercostal tube by 250,000 IU diluted
in 50­100 ml of ordinary saline and given every 12 hours. The success of the technique was evaluated based on the volume
of pleural fluid removed, the treatment's impact on chest radiography, and the incidence of post-injection events.
Results: A complete improvement was seen in 21 patients (70%), a moderate effective response in 7 patients (23.3%), and
failure was shown in 2 patients (6.7%). Surgical decortication was scheduled in 3 patients who had little to no reaction.
Only 6 patients experienced temporary chest discomfort and cough, whereas fever and bleeding were less common.
Conclusion: With a lower rate of surgical referral in our study, the therapy of empyema with intrapleural instillation of
streptokinase was a safe and effective procedure.
Keywords: Empyema, parapneumonic effusion, streptokinase.

Therefore, current study aimed to investigate the
Parapneumonic effusion (PPE) is generally defined as
efficacy and safety of streptokinase in order to assess the
fluid accumulation in the pleural space secondary to
advantages of adding it to the conservative care of
pneumonia or lung abscess. It may progress to become
empyema (pus in the pleural space) (1) with a mortality rate

of 14% to 20%among them (2).
The optional management remains controversial
30 patients who reported PPE/empyema following
varied from antibiotics usage alone or in combination with
pneumonia between April 2020 and July 2022 at the
thoracocentesis, tube thoracostomy, fibrinolytic agents,
Cardiothoracic Surgery Department - Al-Azhar University
thoracoscopy, minithoracotomy, debridement and surgical
Hospitals were the subject of our prospective analysis. The
decortication (3). Despite the fact that surgical
diagnosis was made on the basis of the frank pus aspiration
interventions continue to have a high success rate (4), the
from the pleural collection seen on chest radiography (X-
morbidity and mortality are concerning, especially in a
ray, ultrasonography, or chest computed tomography
cohort of elderly patients or patients who have a lot of co-
(CT), which was later confirmed by bacteriological culture
morbid conditions. Therefore, less invasive treatments
and Gram staining of the aspirated fluid. These patients
that encourage pleural space drainage and the successful
had intrapleural injection of streptokinase.
treatment of pleural infection are expected to be very

useful in clinical settings (5).
Excluded patients were those with long-standing
In addition to chest tube drainage, several studies
empyema, a tendency to haemorrhage, recent trauma, a
found that intrapleural streptokinase decreased the
recent operation, and those taking anticoagulants.
requirement for surgery and increased the clinical
Participants were also excluded if they had streptokinase
treatment success in patients with PPE/empyema (6-11).
allergies, comas, severe hypertension, peptic ulcers, aortic
However, the American Association of Thoracic
aneurysms, aortic dissections, infective endocarditis, or
Surgeons (12) and British Thoracic Society (13) advise that
terminal malignancy.
surgical methods such as video-assisted thoracoscopic

surgery (VATS) or thoracotomy should be used if chest
Ethical approval:
tube drainage is inadequate. There hasn't been a set of
The study was approved by the Al-Azhar University
uniform management guidelines for empyema until today
Ethics Board, each participant gave their written consent
in accordance with the Declaration of Helsinki's Code of
Ethics for studies involving humans.
Received: 30/6/2022
Accepted: 6/9/2022

Full Paper (vol.892 paper# 34)

c:\work\Jor\vol892_35 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 236-240

Telerehabilitation of Temporomandibular Dysfunction Syndrome during the
COVID-19 Pandemic: A Pilot Study
Mohammed Safwat Shahine1, Safaa Ali Mahran2, Marwa Ahmed Abdel-Aziz Galal2
1Maxillofacial Surgery, 2Rheumatology, Rehabilitation, and Physical Medicine Department, Faculty of Medicine,
Assiut University, Assiut, Egypt
Corresponding author: Mohammed Safwat Shahine,Email: msafwat67@aun.edu.eg,
ORCID: 0000-0001-6527-4617,Mobile no.: +201025555420
To evaluate the efficacy of telerehabilitation presented in a well-designed home exercise program on the
manifestation of refractory TMD during the lockdown period of the current COVID-19.
Material and Method: Twenty Adult subjects with TMD were included in this pilot study. After a full medical history
taking and clinical examination of the TMJ, the pain level was assessed by a visual analog scale of 100. Assessment of
the severity of TMD was done using Fonseca's questionnaire.
Results: The age of our patients ranged between 15-58 years old, with female predominance (55%). On using paired t-
test and Wilcoxon Signed Ranks test, very high statistically significant differences (P=0.001) were found between the
results of pain at rest and with movement, the distance of mouth opening, and severity of TMD before and after the
rehabilitation program. Spearman's correlation test showed a weak inverse significant correlation (P= 0.032) between
TMD duration and pain at rest difference. Conclusion: This pilot study showed that, during the containment period of
the COVID-19 pandemic, telerehabilitation of chronic refractory TMD with no internal derangement, in the form of a
home-based well-chosen exercise program with the motivating follow-up of the patients through phone calls and other
smartphone applications, were effective in reducing the pain both at rest and with movement, improving the range of
motion and the severity of TMD manifestations.
Telerehabilitation, Temporomandibular disorder, home exercise program, COVID-


Temporomandibular joint dysfunction/Disorder
To investigate the effectiveness of a well-designed
(TMD) is characterized by pain in the joint itself that
home-based exercise program applied as a
radiates into the mandible, ear, neck, and tonsillar
telerehabilitation method for reducing pain and
pillars(1). The prevalence of TMD was stated to range
improving the function of temporomandibular
from 25% to 75% of the population and was reported to
dysfunction pain syndrome refractory to medical
be the second musculoskeletal condition causing pain
treatment during the containment period of the COVID-
after low back(2).
19 pandemic.
It is of multifactorial etiology including muscle

hyperactivity, malocclusion, and emotional stresses(3).
Pain and disability are the main drive of the patient to
Study design: A pilot clinical prospective study.
seek medical advice(4). Temporomandibular joint (TMJ)
Inclusion criteria: Twenty adult subjects with painful
dysfunction can be treated conservatively using
TMJ were included in this pilot study in March 2020.
medications, and a rehabilitation program or surgically
All patients were referred by an expert maxillofacial
through arthrocentesis, injection, arthroscopy, partial
surgeon to the Rheumatology and Rehabilitation
condylotomy, or open joint surgery. The effectiveness
outpatient clinics after establishing the diagnosis and
of the multidisciplinary approach has been affirmed and
excluding any intra-articular derangement by
conservative treatment can relieve pain and improve
panoramic x-ray and MRI on the painful TMJ. None of
function in up to 90% of TMD patients(5).
our patients had any manifestation suggestive of
During the lockdown period of the COVID-19
COVID-19 infection.
pandemic, the term telerehabilitation has been widely
Inclusion criteria were adult patients who were
used as an advisable method to deliver rehabilitation
diagnosed to have chronic TMD refractory to
care for patients in case of their inability to reach the
pharmacological treatment including muscle relaxants
rehabilitation institute for any reason. The best situation
and nonsteroidal anti-inflammatory medications
when telerehabilitation can be applied is during
(NSAIDS). Patients with a history of facial trauma or
infectious pandemics like the one we are passing
surgery and patients with rheumatic diseases were
through these days.
For the sake of our patient's safety, and following
the international recommendation of confining and
Ethical consideration:
social distancing, this pilot study aimed to investigate
The protocol was approved by the Ethics Review
the effectiveness of telerehabilitation in the form of a
Board of the Faculty of Medicine, Assiut University
home-based exercise program in improving the
(identification number 17300389), and according to
manifestations of chronic refractory TMD.
the Declaration of Helsinki. It was registered at

Received: 06/09/2022
Accepted: 05/11/2022

Full Paper (vol.892 paper# 35)

c:\work\Jor\vol892_36 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6279- 6281

24 Hours Pain-free after Combined Preoperative Gabapentin and
Intrathecal Opioid: A Case Report
Marwa Ahmad Mahrous, Elhaisam Mohamed Taha, Ahmed M.A. Ismail*
Department of anesthesia and intensive care, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Ahmed M.A. Ismail, Mobile: (+20) 01006774710, E-Mail: ahmed.aly25.aa@gmail.com

Gabapentin is used as an anti-epileptic and in chronic pain but can be used also in acute postoperative
pain by giving it preoperatively in a single or in two divided doses combined with intrathecal morphine.
Objectives: This study aimed to detect the role and value of gabapentin as analgesic in postoperative analgesia.
Presentation of the case: A case with orthopedic surgery that had no postoperative pain for 24 hours and needed no
analgesia with good (near normal) mobility after taking preoperative gabapentin and intrathecal morphine with spinal
anesthesia intraoperative. Results: It is a rare condition in which the patient is pain-free completely for 24 hours without
any postoperative analgesia, most researchers stated that patients who received preoperative gabapentin need less
postoperative analgesia or morphine but still there is pain.
Conclusion: Preoperative gabapentin has a great effect on postoperative pain, decreasing analgesic doses especially
morphine with good and early postoperative mobility.
Keywords: Gabapentin, Intrathecal opioid, Postoperative analgesia, Pain.


discomfort but also will increase patient morbidity and
Gabapentin is used originally as an anti-epileptic
mortality and so affect patient life quality (2).
and it is 1-(aminomethyl) cyclohexane acetic acid
In addition to the above chronic pain which is the
originating from a gamma-aminobutyric acid (GABA)-
pain lasting for 2 months or more will result
mimetic compound for management of spasticity with
postoperatively and not related to a previous illness (3).
the good anticonvulsant property. At first, it was
Most patients have good and rapid postoperative
approved to be used in partial seizures, but then had a
recovery and return to their normal wellbeing but others
good effect in treating chronic pain syndromes as
cannot and depend on opioid analgesia for longer
neuropathic pain (1). Gabapentin is an oral preparation
periods with resulting postoperative chronic pain (4).
only and its absorption is from the small intestine, it
Though opioids have an extremely good pain-relieving
occurs by diffusion and facilitated transport. An
effect on postoperative pain, it also has serious side
unidentified receptor which is related to a transport
effects such as bradycardia, hypotension, respiratory
mechanism by a saturable l-amino acid binds to
depression, decreasing level of consciousness, nausea
gabapentin in the gut after its oral intake to facilitate its
and vomiting, pruritus, and constipation (5).
transport. It is eliminated in the urine without change as
Postoperative opioid intake should be decreased as it
it doesn't expose to metabolism in the human body.
leads to opioid-related complications, increased
Elimination of gabapentin is by first-order kinetic so its
morbidity as well an increased period of hospital stay,
elimination is affected by kidney impairment strongly
so consequently increasing health care costs, all of that
correlated to creatinine clearance. Hemodialysis
means another method of pain-relieving is needed (6).
removes gabapentin. Gabapentin does not cause hepatic
Many institutions considered and used multimodal
microsomal enzyme system induction or inhibition
analgesia techniques in the standard treatment of
contrary to other anticonvulsants (1).
postoperative pain (7).
The aim of studying this case was to detect the
Multimodal analgesia is combining multiple
role and value of gabapentin as analgesic in
medications and therapies so there are different
postoperative analgesia.
mechanisms of action acting both on the central and

peripheral nervous system and offering individualized
targeted patient therapy considering pharmacogenetics
Though gabapentin is a (GABA)-mimetic
in the form of single gene allelic differences and
compound it is without GABAergic action and causes
responses to medications decreasing opioids intake and
no interference with GABA uptake nor its metabolism.
so decreasing their side effects (8-9). Gabapentin is a drug
It causes a block of the nociception tonic phase, which
with anti-hyperalgesic properties. These anti-
is induced by formalin and carrageenan and causes
hyperalgesic effects are caused by gabapentin effects at
inhibition of neuropathic pain, which is in the form of
the dorsal root ganglia and spinal cord (10). Gabapentin
mechanical hyperalgesia and mechanical/thermal
has few associated adverse side effects (11).
allodynia (1).
A review of four randomized control trials
It is of most significance to treat postoperative
(RCTs) with 190 patients having an abdominal
pain effectively. Inadequately treated postoperative
hysterectomy, reported a significant decrease in
pain has a negative effect on the patient's recovery and
morphine doses in cases using gabapentin. But there
the whole operative experience for the patient. Not only
was a good number of RCTs that demonstrated
pain not well managed will cause patient immediate
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 36)

ABSTRACT The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6282- 6288

Assessment of Serum Fetuin A level in Patients with NAFLD and Chronic Hepatitis C
Mohamed Ali Awadein1, Mohamed Ali Marie Makholof2, Shereen Abo Bakr Saleh2,
Mohamed Magdy Salama1, Roqaya Mohamed Hussein1, Amira R. El-Ansary*1
1Department of Internal medicine, Faculty of Medicine, Misr University for Science and Technology (MUST), Egypt
2Department of Internal Medicine and Gastroenterology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Amira R. El-Ansary, Mobile: (+20)01064457770, E-Mail: amira.elansary@must.edu.eg

It has been suggested that an association exists between elevated Fetuin A concentration, obesity, as well
as fatty liver.
Objective: Investigation of connection between NAFLD and Fetuin A in individuals with or without chronic hepatitis
C virus infection in of Egyptian population.
Patients and Methods: In a cross-sectional study, we conducted our trial at Misr University for Science and Technology
and the Gastroenterology and Hepatology Unit of Ain Shams University's Department of Internal Medicine. The study
included 90 patients and were subdivided into three groups, group I included 30 healthy people as control group, group
II included 30 patients with NAFLD (non-diabetic) and group III included 30 patients with hepatic steatosis on top of
HCV infection non cirrhotic and non-diabetic.
Results: Fetuin A level and blood triglyceride were positively correlated in all patients and patient subgroups, both
statistically significantly correlated (NAFLD, HCV). There was also highly statistically significant positive correlation
between serum cholestrerol and fetuin A level in all patients and in patient subgroups (NAFLD, HCV) and with a cutoff
point of >500, the serum level of fetuin A revealed a highly statistically significant difference between groups 1 and 2;
serum fetuin A showed a highly statistically significant difference between groups 1 and 3, with a cutoff point of >1800.
Conclusion: ROC curve showed the diagnostic performance of serum Fetuin A as a marker in fatty liver.
Keywords: Fetuin A, Non-Alcoholic Fatty Liver, HCC, HCV.


Embryogenesis produces fetal protein A. It modulates
A variety of steatosis diseases, such as basic
osteogenesis, prevents ectopic calcification, and
steatosis, more advanced steatosis, cirrhosis, and, in
encourages bone remodeling. Human Fetuin A is a
certain circumstances, hepatocellular carcinoma, are
naturally occurring inhibitor of the insulin receptor's
referred to as non-alcoholic fatty liver disease
tyrosine kinase activity. In the treatment of type 2
(NAFLD). Obesity and insulin resistance, which cause
diabetes, obesity, and other insulin-resistant disorders,
triglyceride and free fatty acid accumulation in the liver,
fetuin A may be a novel therapeutic target as it may play
are two factors contributing to the growing epidemic of
a significant role in postprandial glucose clearance,
NAFLD, which affects not just the western world but
insulin sensitivity, weight gain, and fat deposition (4).
the entire world (1).
It has been suggested that an association exists
Hepatocellular carcinoma (HCC), the main
between elevated Fetuin A concentration, obesity, and
cause of end-stage liver disease, liver-related death, and
fatty liver. Fetuin A promotes insulin resistance, which
chronic HCV infection in Egypt. After 20 to 30 years of
is the main defect causing both metabolic syndrome and
HCV infection, 10 to 20% of chronic hepatitis patients
fatty liver disease, which accounts for this. Adipocyte
go on to develop cirrhosis, which affects 60 to 80
accumulation of results in an increase in fetuin secretion
percent of people with HCV. In the 20 to 30 years that
follow, 3 to 6 percent of individuals with liver cirrhosis

and 1 to 5 percent of those with liver cancer may
experience decompensation. Between 15 and 20 percent
Our goal is investigation of connection between
of people who experience a decompensation episode
NAFLD and Fetuin A in individuals with or without
will pass away within a year (2).
chronic hepatitis C virus infection in of the Egyptian
The existence of adipokine secreting adipose
tissue as an active endocrine organ is now well

established. A relationship between illnesses associated
with obesity and adipose tissue dysfunction can be
established through altered adipokine secretion and
Gastroenterology and Hepatology Unit, Ain Shams
production. They are in charge of controlling the entire
University Hospital, and Misr University for Science
body's metabolism because they affect endothelial
and Technology Hospital participated in the study.
During the months of August 2017 and February 2018.
distribution, satiety, and appetite in addition to poor

insulin sensitivity or secretion (3).
Ninety cases included as the following:
Fetuin A is a glycoprotein that liver cells
Group I: involved 30 healthy persons as control class.
produce and secrete in large quantities into the blood.
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 37)

c:\work\Jor\vol892_38 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6289- 6296

Acute Kidney Injury Among Severe Trauma Patients in ICU
Aya Hassan Ibrahim Salama*1, Afaf Abdel-Hafez Abdel-Megeed2,
Mohamed El-Said Ahmed1, Samir Mohamed Attia3
Departments of 1Emergency Medicine, 2Internal Medicine, and 3Vascular Surgery,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Aya Hassan Ibrahim Salama, Mobile: (+20) 0 122 783 0258, E-Mail: ayotasalama93@gmail.com

Trauma is a major public health burble and is associated with a high mortality rate. Acute kidney injury
(AKI) has been demonstrated to be accompanied by adverse outcomes among trauma cases and development of AKI is
closely accompanied by increased mortality and length of stay (LOS).
Objective: To determine the incidence and the associated risk factors of AKI in severe trauma patients and its outcome
in the emergency intensive care unit (ICU).
Patients and Methods: This was a prospective study conducted on 104 patients with severe trauma at Mansoura
University Hospital. Entire cases were classified into 2 groups; AKI cases; patients who met the RIFLE criteria for AKI
and non-AKI cases. Entire cases were subjected resuscitation followed by physical examination and laboratory
investigations. In addition, trauma scores were assessed.
Results: Forty-six percent of patients developed AKI by RIFLE criteria. There were significant differences among AKI
and non-AKI in the context of sepsis, shock, coagulopathy and rhabdomyolysis. There were statistical significance
serum creatinine (S.cr) levels at emergency room (ER), S.cr peak level at ICU, PH value at ICU, comorbidities, sepsis,
shock, LOS, glomerular filtration rate (GFR) at ER and GFR with peak S.cr as independent predictors of AKI among
sever trauma patients.
Conclusion: Risk factors of trauma-associated AKI included rhabdomyolysis, coagulopathy, nephrotoxic drugs, shock
and sepsis. Development of AKI after severe trauma is closely accompanied by increased mortality and LOS. Early
detection of AKI and management of risk factors of AKI can improve the outcome.
Keywords: Acute kidney Injury, Trauma patients Intensive care unit Risk Factors.


Trauma has been considered the most frequent
reduction of its consequences and duration are
cause of death worldwide and remains the primary
important aspects of its management (6).
public health trouble in every country. On the other
The purpose of this study is to determine the
hand; international researches indicate that managing
incidence and the associated risk factors of AKI in
severely injured cases at trauma centers, which are
severe trauma cases and its outcomes in the emergency
better equipped to provide proper care, is accompanied
by reduction in mortality by about 22% (1).

Severe trauma might encourage a hyper-
inflammatory condition with a subsequent development
of multi-organ dysfunction syndrome (MODS). Organ
Study design:
dysfunction is still the third main etiology of death in
This was a prospective observational analytical
trauma cases, following hemorrhage and head trauma
clinical study carried out on 104 patients who were
presented by severe trauma to Emergency Department
Acute kidney injury (AKI) is described as the
(ED) in Mansoura University Emergency Hospital
abrupt loss of renal functions and a considerable drop in
(MUEH) from entrance to the Emergency Room (ER)
GFR with a subsequent retention of urea and other
and after admission to ICU over the period of one year
nitrogenous waste products and in the dysregulation of
(from December 2020 to December 2021). Entire cases
extracellular volume and electrolytes (3).
were classified into 2 groups according to AKI
AKI in trauma patient is complicated and its
development into; AKI cases: cases who met the -------
cause is diverse, renal ischemia being the commonest
---- (RIFLE) criteria for AKI and non-AKI cases: cases
etiology. Even though different researches have
who didn't meet the RIFLE criteria for AKI.
established that hypotension, rhabdomyolysis, venous

thromboembolism, acidosis, shock and infections have
Inclusion criteria:
been participating factors (4). AKI has been
Inclusion criteria involve cases of both genders
demonstrated to be accompanied by adverse outcomes
with all age groups with severe trauma admitted to ICU.
among trauma cases and development of AKI is closely

accompanied by increased mortality and length of stay
Exclusion criteria:
(LOS) (5). The keystone of AKI management is still
Exclusion criteria involve patients who refuse
supportive, with specific therapy reserved for the rarer
to be included in the study, chronic renal impairment,
etiologies. As a result, the prevention of AKI and
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 38)

c:\work\Jor\vol892_39 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6297- 6304

Hysteroscopy in the Evaluation of Postmenopausal Bleeding
Ahmed Mohamed AbdelHameed*, Noha Hamed Rabei, Mona Mosa Dikary, Laila Aly Farid
Departments of Obstetrics and Gynecology Department, Ain Shams University, Egypt
*Corresponding author: Ahmed Mohamed AbdelHameed, Mobile: (+20) 01095919811,
E-Mail: ahmedmohamedabdelhameed@med.asu.edu.eg

Menopause is the loss of ovarian follicular activity, which results in a permanent cessation of
menstruation. Postmenopausal bleeding (PMB) is defined as bleeding that starts twelve months following the last
menstrual period. Hysteroscopy enables (see and treat) approaches by allowing macroscopic diagnosis of benign lesions
and their excision, but histological samples must always be taken.
Objective: This study aimed to assess the accuracy of hysteroscopy use in the diagnosis of the causes of bleeding in
women with postmenopausal bleeding.
Methodology: The current prospective cohort study was carried out on 237 postmenopausal women with
postmenopausal bleeding recruited from Ain Shams University Maternity hospital (Hysteroscopy Unit) during the
period between December 2016 and October 2017.
Results: One of the difficulties that we have faced, there was no single operator assigned to perform the whole study
population. In this study we found that the mean age of the studied population was 56±6 years, while the mean body
mass index was 30±4 (kg/m²) also the mean duration of menopause was 7±5years. This study showed that the accuracy
of hysteroscopy in diagnosis of endometrial carcinoma was 97.9%, sensitivity of hysteroscopy in diagnosis of endometrial
carcinoma was (82.6%), and specificity was (99.5%).
Hysteroscopy is the fundamental tool for accurate identification of various endouterine diseases in women with
PMB. Hysteroscopy is useful in lowering the number of hospital visits, admissions, and overall expenses in older individuals
who are at high risk for any invasive operation like a hysterectomy.
Keywords: Hysteroscopy, Postmenopausal bleeding, Menopause.

bleeding was frequently left unidentified (8).
Menopause is the loss of ovarian follicular activity,
The introduction of intrauterine endoscopy has
which results in a permanent cessation of menstruation.
allowed clinician to evaluate an area of the body that was
Postmenopausal bleeding (PMB) is defined as bleeding that
previously accessible only by the procedure of blind
starts twelve months following the last menstrual period (1).
dilation and curettage (D&C). Many studies have shown
Up to 69% of postmenopausal women who are referred to
hysteroscopy to be superior to D&C, yet its use has yet to
gynaecological outpatient clinics for treatment have
be appreciated adequately (9).
postmenopausal bleeding as their primary gynecologic
Clinicians can now check a portion of the body
complaint (2). About 90% of endometrial cancer patients,
that was previously only accessible through the procedure
vaginal bleeding is the only complaint voiced (3).
of blind dilation and curettage thanks to intrauterine
Bleeding after menopause is a symptom that
endoscopy (D&C). Although its use has not yet been fully
requires careful examination. There are numerous less
understood, multiple studies have shown that
sinister explanations, but at worst it could indicate
hysteroscopy is superior to D&C (9).
malignant transformation (4). Menopause is the most
Hysteroscopy enables (see and treat)
common time for endometrial cancer to develop (5).
approaches by allowing macroscopic diagnosis of
In 90% of instances, postmenopausal bleeding
benign lesions and their excision, but histological
coexists with endometrial cancer. However, endometrial
samples must always be taken (10). To assess the
cancer only occurs in 10­15% of postmenopausal bleeding
women (6).
endometrial disease, a histological diagnosis is the gold

standard (6).
Histology provides a conclusive diagnosis for
This study aims to assess the accuracy of
postmenopausal hemorrhage. In the past, endometrial
hysteroscopy use in the diagnosis of the causes of
samples were collected using dilatation and curettage;
bleeding in women with postmenopausal bleeding.
today, dilatation and biopsy are the most common methods

Dilatation and curettage (D&C) is a blind
The current prospective cohort study was
operation that frequently yields non-representative
carried out on 237 postmenopausal women with
biopsies with diagnostic failure rates that range from 10
postmenopausal bleeding recruited from Ain Shams
to 25% and false-negative rates that range from 2 to
University Maternity Hospital (Hysteroscopy Unit)
10%. According to earlier findings, less than half of the
during the period between December 2016 and October
uterine cavity was sampled with the curette in 60% of
the women who underwent curettage, and the cause of

Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 39)

c:\work\Jor\vol892_40 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6305- 6312

Assessing Physicians' Knowledge, Attitude, and Practice Towards
Breaking Bad News: A Multicenter Study in Egypt
Azza. Elashiry1, Wafaa Y. Abdel Wahed2, Ghada W Elhady3
1 Family Medicine Department, 2 Public Health and Community Medicine Department,
Faculty of Medicine, Fayoum University
3 Public health and community medicine department, Faculty of Medicine, Cairo University
Corresponding Author: Wafaa Y. Abdel Wahed, Email: wya00@fayoum.edu.eg,
Telephone number: 00201003394785,ORCID Number: https://orcid.org/0000-0002-8524-6135


Background: Breaking bad news (BBN) is challenging for patients and physicians. Physicians are usually poorly
trained or untrained at all in BBN despite the existence of consensus protocols for BBN.
Objective: This study aimed to assess physicians' knowledge, attitude, and practice (KAP) regarding SPIKES protocol
for BBN.
Patients and Methods: This is a cross-sectional multicenter study carried out on 395 physicians of different specialties
and workplaces in Fayoum Governorate, Egypt. Data were collected through a self-administered questionnaire
consisting of three sections of questions about physicians: the background characteristics questions, questions assessing
their knowledge regarding BBN, and questions assessing their attitude regarding SPIKES protocol for BBN. The attitude
was assessed using the BBN attitude scale (BBNAS).
Results: Only 24% of physicians ever received training on BBN and 10% knew about SPIKES protocol. Bad experience
after BBN was reported by 52% of physicians. Most (75%) physicians preferred BBN to the patient's family rather than
the patient. Physicians' agreement level with the SPIKES strategy was very high (91.8%). Agreement to the SPIKES
protocol steps was statistically significantly higher among men, younger and older age groups ( 30 and > 40 years of
age) physicians, psychologists and oncologists, and those who received previous training on BBN.
Conclusion: The majority of physicians highly agreed with the SPIKES strategy for BBN, but they lacked essential
knowledge for BBN. Specific training and standardized protocols in this regard deem to be necessary during medical
school study and continuous professional development.
Keywords: Breaking bad news, Knowledge, Attitude, Physicians, SPIKES.


Unfortunately, the focus in medical education is usually
The term "bad news" means any information that
on technical and scientific skills rather than
is given to patients and/or their families, which directly
communication skills which may have led to
or indirectly reveals any negative or severe disorder that
alters the patient's view of his/her future drastically [1].
communication with patients and stressing treatment
Breaking bad news (BBN) is necessary for
without taking into account patients' feelings [4, 6].
physicians, particularly in the current era of pandemics
Therefore, physicians are usually poorly trained or
such as COVID-19, where healthcare professionals
untrained at all in BBN despite the existence of
regardless of their age, specialty, or experience level
consensus protocols for BBN [8].
may be redeployed for the end-of-life care of pandemic
One of the most popular communication
patients. BBN if performed improperly, negatively
protocols is the SPIKES protocol developed by
affects both patients and physicians. On the other hand,
Buckman [9].
well-developed communication skills establish a good
SPIKES protocol consists of six consecutive
physician-patient relationship that is associated with
steps. The first step is the "S" or setting up phase
better adherence to treatment, satisfaction, and health
meaning the preparation of the medical environment,
outcomes, in addition to helping physicians to overcome
which should preferably be a private, reserved, pleasant,
stress in delivering news to patients or their families [2].
and welcoming site. This is the right moment to
Furthermore, physicians are not allowed to mislead
establish a good physician-patient relationship. The
patients about their diagnosis and prognosis. Thus,
second step is the "P "or perception, which is to discover
physicians have a legal obligation to deliver bad news
what the patient already knows about his/ her illness by
to patients and their families [3].
using open-end questions. The third step is the "I" or
BBN is challenging for patients and physicians.
invitation, which is the moment to analyze the patient's
Physicians may fear causing suffering to their patients
willingness level to clarify the patient's doubts about the
or being blamed [4, 5]. A study on medical residents in
disease. The fourth step is the "K" or knowledge
the United States of America (USA) found that
meaning that everything in relation to the diagnosis
physicians consider BBN a very stressful event and are
must be announced in simple words, without medical
poorly prepared in this regard [4]. Other studies revealed
terms, in order to transmit the information. The fifth
that more than 80% of surveyed physicians had no
step is the "E "or emotion and this is the time to express
training in communicating any news to patients [6, 7, 8].
empathy, recognize the patient's emotions, and provide
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 40)

Review Of Literature The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6313- 6322

Comparison of Fractional CO2 Laser with Intralesional
Verapamil versus Fractional CO2 Laser with Intralesional
Triamcinolone for the Treatment of Keloid
Sahar Mahsoub Mohammed Soliman Fayed*, Hanan Fathy Mohammed, Moheiddin Fakhry Alghobary
Department of Dermatology, Andrology and STDs, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Sahar Mahsoub Mohammed, Mobile: (+20) 01155515220, E-Mail: smohaa100@yahoo.com

Background: Although keloids of unknown origin can also develop, keloids are a skin disease where the skin
expands past the borders of the initial incision. Intralesional triamcinolone (TAC) injections have been demonstrated
to lessen related scar pain and itching, decrease scar volume and height, and improve scar pliability. One of calcium
channel blockers; verapamil, causes the release of procollagenase, which speeds up the breakdown of scar tissue. As a
result, the morphology of fibroblasts changes, TGF-1 apoptosis is induced, the formation of extracellular matrix
(ECM) is decreased, and actin filaments are depolymerized.
Objective: comparing the efficacy and safety of fractional CO2 combined with intralesional verapamil versus
fractional CO2 combined with intralesional triamcinolone in the treatment of keloid.
Patients and methods: Twenty patients with keloids participated in this investigation. They were chosen from the
Dermatology Department's Outpatient Clinic at Mansoura University Hospital. Patients with two keloid were
recruited; one keloid was treated with fractional CO2 with intralesional verapamil (arm A) and the other was treated
with fractional CO2 with intralesional triamcinolone (arm B).
Results: In the fractional CO2 laser with intralesional triamcinolone and verapamil groups, there was a statistically
significant decrease in the height and surface area of keloid before and after treatment. The reduction of lesion height
was significantly higher in fractional CO2 laser with intralesional triamcinolone group in comparison with verapamil
group (P = 0.003).
Conclusion: Combined fractional CO2 laser with intralesional triamcinolone therapy showed better clinical
improvement compared to combined fractional CO2 laser with intralesional verapamil therapy, but with more adverse
Keywords: Treatment of Keloid, Fractional CO2 Laser, Intralesional Verapamil, Intralesional Triamcinolone


A benign fibroproliferative condition called a
It has been demonstrated that intralesional
keloid is characterized by aberrant collagen deposition
triamcinolone (TAC) injections can lessen related scar
within a wound. This cutaneous "tumor" spreads past
pain and itching while also reducing scar volume and
the edge of the initial lesion, grows over time,
height (7), as well as various rate of recurrency (8).
frequently returns after excision, and infrequently
Verapamil, a calcium channel blocker,
regresses on its own(1).
stimulates the release of procollagenase, which speeds
It is believed that increased collagen and ECM
up the breakdown of scar tissue. This modifies the
synthesis and decreased breakdown lead to the
morphology of fibroblasts, triggers TGF-1 apoptosis,
development of keloid lesions. The overexpression of
lowers the formation of ECM, and depolymerizes actin
inflammatory mediators, specifically TGF-1, is
filaments(9). Verapamil administered intralesionally for
thought to be responsible for the increased synthesis of
the treatment of keloid scars is risk-free (10).
ECM collagen(2).
In order to treat keloid lesions, this study
Although there are many ways to treat keloids,
compares the effectiveness and safety of fractional
none of them has been shown to be particularly
CO2 combined with intralesional verapamil with
successful(3). The use of a fractional carbon dioxide
laser has been the subject of more recent research(4).
Both keloids and hypertrophic scars were

treated in an early trial using CO2 laser monotherapy
(four treatments, six weeks apart). The findings were
Twenty patients with keloids were included in
conflicting. Although a statistically significant decline
this comparative interventional investigation. They
in Vancouver-Scar-Scale (VSS) scores was observed
were chosen from the Mansoura University Hospitals'
(primarily due to greater pliability), many patients did
Dermatology, Urology, and STD Outpatient Clinic.
not find this therapy to be effective(5). In a case study,
All studied patients had two keloid, one keloid
treatment with fractionated CO2 laser and laser-
was treated with fractional CO2 with intralesional
assisted medication administration of topical
verapamil (arm A) and other was treated with
triamcinolone resulted in scar shrinking and improved
fractional CO2 with intralesional triamcinolone (arm

Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.892 paper# 41)

c:\work\Jor\vol892_42 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6323- 6328

Relationship between Pain, Function, and Pressure Algometry in College
Students with Chronic Mechanical Neck Pain
Mohamed Abdelmegeed1*, Fatma Shewail2, Salwa Abdelmajeed1, Mohamed Farouk2
1Orthopedic physical therapy department, Faculty of physical therapy, Cairo University, Egypt
2Orthopedic physical therapy department, Misr University for Science and Technology, Cairo, Egypt
*Corresponding author: Mohamed Abdelmegeed, Phone: +201223631604,
Email. mabdelmegeed@cu.edu.eg; ORCID Id: 0000-0001-8664-3602

Chronic Mechanical Neck Pain (CMNP) is a common musculoskeletal disorder. The "new normal" during
the Corona Virus Disease-2019 (COVID-19) lockdown has forced schools to shift to online classes as a mitigation strategy.
Objectives: This study aimed to correlate pain, function, and pain pressure threshold (PPT) in college students with chronic
mechanical neck pain.
Patients and Methods: Thirty-three college students with a mean age of 21.33 ± 0.98 who were diagnosed with CMNP.
They were using online learning for more than three months during the COVID-19 lockdown. These students were recruited
from outpatient settings. The investigators measured their pain intensity using the visual analogue scale (VAS), functional
disability using the neck disability index (NDI), and PPT using a pressure algometer (PA). A correlation analysis was
conducted between these outcome measures using Pearson's correlation coefficient.
Results: There was a direct significant relationship between VAS and NDI scores (p < 0.05), while there was no significant
correlation between pain pressure threshold, VAS, and NDI scores (p > 0.05). Also, there was a significant difference
between males and females in NDI scores with a mean score of 23.0 ± 1.41 in males versus 32.6 ± 4.69 in females (p <
0.01). While there was no significant difference between both gender in the scores of VAS and pain pressure threshold (p
> 0.05).
Conclusion: The presence of pain in the neck significantly correlates with decreased function. While the presence of tight
muscles and/or trigger points may not correlate with pain intensity or functional disability in college students with chronic
mechanical neck pain.
Keywords: Neck pain, Outcome measures, Data correlation.

analogue scale (VAS) have been strongly recommended
It was reported that the prevalence of chronic
to be used in patients with cervical radiculopathy 11 (5).
neck pain is about 70% worldwide and about 20% of the
The original developer of the NDI (6) and a systematic
population could experience chronic neck pain at one
review concluded that the NDI has sufficient published
point in their lives (1).
data to support its usefulness as the most commonly used
Quantifying patients' findings is important in the
outcome measure in patients with neck pain (1).
realm of musculoskeletal physical therapy and the use of
Since the NDI has been cross-culturally adapted
validated outcome measures helps to accurately document
to many languages, the original and the translated
such findings. Most of the self-reported outcome
versions have a plethora of published psychometric
measures have been extensively studied in literature and
properties. The minimal detectable change (MDC) of the
their psychometric properties have been established. It is
NDI was reported to be 10.5 in patients with neck pain (7),
important to note, however, that discrepancies exist in the
internal consistency with a high Cronbach alpha between
reported psychometric properties given the fact that the
0.70- 0.96 (8-11), high correlation (more than 0.70) with
studied variables and/or the research design and the
other similar indices (12-15).
studied population are different (2).
Quantifying pain can be a challenging issue
The neck disability index (NDI) is used
considering the vague nature of pain in many disorders.
extensively in the literature and its psychometric
Studies have found that, however, self-reported pain
properties have been well established. It has been
status by the patient is the most representative way of
translated and cross-culturally adapted to many languages
reporting what a patient experiences with different health
(3). The index has 10 neck-related functional activities
disorders. Pain questionnaires and surveys can be
scored on a 0-5 likert scale for each item and a total raw
unidimensional, multidimensional, disease-specific, or
score of 50.
region-specific. Most of the used pain outcome measures
The higher the score, the greater the disability. It
are easy to use for a layperson to accurately report what
is reliable, valid, and responsive in patients with cervical
they feel (16).
radiculopathy treated non-operatively (4). NDI and visual
Received: 1/7/2022
Accepted: 7/9/2022

Full Paper (vol.892 paper# 42)

c:\work\Jor\vol892_43 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6329- 6335

Intact Bulla Technique versus Classic Technique as an
Endoscopic Approaches to Frontal Sinus
Magdy AbdAllah Ahmed Sayed El Ahl, Ismail Sedik Elnashar,
Ashraf Elsayed El-Malt, Mohamed Taha Mohamed Fareed*
Department of Oto-Rhino-Laryngology, Faculty of Medicine - Zagazig University, Egypt
*Corresponding author: Mohamed Taha Mohamed Fareed, Mobile: (+20) 01207993517, Mail: medofareed2020@gmail.com

The recent advances in imaging and endoscopic techniques have resulted in the resurgence of intranasal
procedures for the treatment of frontal sinus disease.
This study aimed to compare the following parameters in patients undergoing endoscopic frontal sinus
through intact bulla technique and classic technique regarding feasibility of the technique, operative time, success rate
and complications.
Subjects and Methods: At Oto-Rhino-Laryngology, Department, Zagazig University Hospital, fifty patients with
chronic frontal sinusitis resistant to medical treatment for a period not less than twelve weeks were included in this
prospective clinical trial. The patients were divided into two groups: The first (the frontal sinus) group was approached
by the classic approach from posterior to anterior, the second group, where the intact bulla technique was used to
approach the frontal sinus. All the patients underwent ESS addressing their frontal sinus pathology.
There was a statistically significant difference between the two surgical techniques regarding operative
duration. Recurrence of symptoms occurred in one patient with intact bulla technique and one patient with the classic
technique while frontal ostium restenosis occurred in one patient with intact bulla technique and two patients with the
classic technique. Nasal adhesions occurred postoperative between inferior turbinate and septum in 3 sides only that
were excised locally at outpatient clinic.
Conclusion: Addressing frontal sinus through intact bulla technique is less invasive and guards against anterior
ethmoidal artery accidental injury during surgery.
Keywords: Intact bulla technique, Classic technique, Endoscopic approaches, Frontal sinus.

adjuncts for chronic frontal sinusitis include saline nasal
As a result of its close embryological and
spray, antihistamines, leukotriene modifiers, mucolytics,
anatomical link to the ethmoid sinus, the frontal sinus has
and intranasal and systemic steroid medications (4).
been variously described as a "large ethmoidal cell" or as
In 1750, the first documented treatment for sinus
the "terminal" or "upper limit" of the complex ethmoidal
problems in the face was described. Intranasal operations
labyrinth. As a rule, there will be two sinuses in the
for the treatment of frontal sinus disease have recently
forehead. There is a thick anterior table and a thinner
seen a comeback thanks to recent advancements in
posterior table in each frontal sinus cavity, giving them
imaging and endoscopic techniques. The potential for
the appearance of a pyramid (1).
complications makes frontal sinus illness, and chronic
The infundibulum, ostium, and frontal recess make
frontal sinusitis in particular, an extremely morbid and
up the three main parts of the hourglass-shaped frontal
even life-threatening condition. Orbital and intracranial
sinus outflow system. Retained secretions, secondary
problems, such, intracerebral abscess, meningitis,
bacterial colonization, hypoxia, pH shifts, and ciliary
osteomyelitis as well as subdural abscess, continue to
dysfunction may all result from a failure to keep the
occur despite the overall decline in complication rates
frontal sinus outflow tract open (due to edema, fibrosis,
over time (5).
polyps, or tumors). Chronic rhinosinusitis can develop as
The purpose of this research was to compare the
a result of any one of these physiological alterations (2).
following parameters in patients undergoing endoscopic
Patients with persistent frontal sinusitis typically
frontal sinus through intact bulla technique and classic
also suffer from inflammation in the other sinuses of the
technique regarding feasibility of the technique,
face. In the case of a rhinologic patient, diagnostic nasal
operative time, success rate and complications.
endoscopy is the gold standard in terms of physical

examination. The presence of the following symptoms in
post-operative patients raises the possibility of frontal
sinus disease: Middle turbinate lateralization or
At Oto-Rhino-Laryngology, and Head and Neck Surgery
amputation, synechia, and polypoid edema in the front of
Departments, Zagazig University Hospital, fifty patients
the ethmoid cavity (3).
with chronic frontal sinusitis resistant to medical
At now, there is no frontal sinus treatment available
treatment for a period not less than twelve weeks were
in mainstream medicine. Selecting a course of treatment
included in this prospective clinical trial.
requires careful consideration and individualization.

Adjuvant therapy is often suggested as well, especially
These Patients were divided randomly into two
when it can help reduce inflammation. Therapeutic
groups: The first group where the frontal sinus was
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 43)

c:\work\Jor\vol892_44 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6336- 6340

The Arabic Patient-Rated Elbow Evaluation Questionnaire Has
No Floor or Ceiling Effect, and The Items Load on A Three-Factor Structure
Using Principal Component Analysis
Catherine Awad1, Nadia Fayaz2, Mohamed Kaddah3, Fathy Mostafa2, Mohamed Abdelmegeed2*
1Senior physical therapist at the Ministry of Health, Egypt
2Orthopedic Physical Therapy Department, Faculty of Physical Therapy, Cairo University, Egypt
3Orthopedic Surgery Department, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Mohamed Abdelmegeed, Phone: +201223631604;
E-Mail: mabdelmegeed@cu.edu.eg; ORCID Id: 0000-0001-8664-3602

The Patient-Rated Elbow Evaluation (PREE) is a commonly used self-reported outcome measure in patients
with elbow dysfunctions.
The purpose of this study was to conduct an exploratory factor analysis (EFA) of the newly translated and cross-
culturally adapted Patient-Rated Elbow Evaluation-Arabic version (PREE-AR). Also, to examine its floor and ceiling
Patients and Methods: An EFA using the principal component analysis (PCA) method was conducted on a sample of 88
participants with elbow pain. The oblique (nonorthogonal) rotation method was used. The Eigenvalue of 1.00 was used as a
cutoff point to retain a factor. A scree plot was produced to visually examine the eigenvalues. Item loading on factors with a
value greater than 0.4 was considered enough to show a satisfactory inclusion in the structure. A floor or a ceiling effect was
considered to be present if more than 15% of participants scored at the lowest or the highest scores respectively.
Results: The Kaiser-Meyer-Olkin (KMO) value of 0.891 with Bartlett's test of sphericity (P<0.001) justified the
appropriateness of running the factor analysis. The analysis produced a three-factor structure which accounted for 66% of
the total variance. Most of the "function" items loaded on factor number1 with less loading of the "pain" items of the three-
factor structure. All participants scored outside the 15% threshold of the highest and the lowest total score of the
The newly adapted PREE-AR items are loaded on a three-factor structure and the questionnaire does not have
a floor or a ceiling effect.
factor analysis, principal component analysis, floor effect, ceiling effect


classification scheme and to have a common functional
Quantification of pain and function is
language representing each disorder. It was reported that
increasingly important in musculoskeletal physical
the original English version of the PREE is aligned with
therapy practice. Patient-reported outcome measures
the framework of the ICF and with the core sets for elbow
provide an insight into the nature of the condition in the
conditions (7).
patient's own words which enables caregivers to
The English PREE had excellent test-retest
accurately address the patient's needs and make the
reliability (intraclass correlation coefficient (ICC)=0.95)
patient more actively involved in clinical decision-
and has been reported to be valid and reliable (6). There is
making (1-5).
no report, however, on the internal consistency of the
Self-reported outcome measures for the elbow
English PREE in patients with elbow conditions to the
joint are many with the patient-rated elbow evaluation
authors' knowledge.
(PREE) being more specific for elbow pathologies. The
Different versions of the PREE are available:
PREE was developed by MacDermid (6) in 2001 to fill the
German (8), French (9), Japanese (10), Persian (11), and
gap in the outcome measures for elbow pain and disability
Turkish (2), with some reports on its psychometric
and to quantify pain and function in patients with different
properties. Recently, the questionnaire was also cross-
elbow pathologies. It has 20 items; 5 items for pain and
culturally adapted and translated into the Arabic language
15 for function divided into two subsections: specific and
usual functional activities. The total score of the
Exploratory factor analysis (EFA) is a widely
questionnaire is 200 and the higher the scores, the worse
used statistical method of data reduction. In questionnaire
the outcome (6).
or self-reported outcome measure, it can be used to better
Since the International Classification of
show how multiple items of a questionnaire load or
Functioning, Disability, and Health (7) (ICF) was
unload on a shortened version of a structure (14). To the
introduced in the early 2000s, it was important to align
author's knowledge, factor analysis was performed only
outcome measures to the criteria outlined in the ICF
for the Japanese version of the PREE (15), but the type of

Full Paper (vol.892 paper# 44)

c:\work\Jor\vol892_45 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6341- 6347

Predictors of Post Covid Syndrome among Covid Survivors
Patients attending Post Covid Out-Patients Clinic
Alaa Edin Metwally Elgazzar, Mohamed El-Shabrawy, Abdulsalam Ali Mohamed Kot*, Tarek Hamdy
Chest Department, Faculty of Medicine- Zagazig University, Zagazig, Egypt
*Corresponding author: Abdulsalam Ali Mohamed Kot, Mobile: (+20) 01013824668, E-Mail: abdallsalamkat@gmail.com

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic remains a constant
challenge for healthcare systems and affects the well-being of many individuals. The objective of the current study is to
determine the parameters that can predict post COVID-19 sequale and incidence of post Covid sequale among Covid
survivor's patients attending post covid outpatient clinic.
Patients and methods
: This was a case control study carried out on 60 COVID-19 survivors whom were recovered
from the acute illness and discharged for follow-up at the post covid out-patient clinic at Zagazig University. The sixty
patients included in the study were divided to Group I: (Asymptomatic patients): include 30 patients whom were
discharged for follow-up and in whom no significant symptoms or signs were reported during the study. Group II:
(Symptomatic patients): include 30 patients whom were discharged for follow-up and in whom there were significant
symptoms or signs during the study.
Results: There is statistically significantly association between initial parameters high (CRP, D-dimer, ferritin, LDH,
IL6) and low Lymphocytes. Post covid degree of lung affection in chest CT scan where Grade 5 (severe lung affection)
prevailed in 63.3% and 20% in those with and without post covid syndrome, respectively, while Grade <2 (less sever
lung affection) was more dominant in those without post covid (30% vs. 6.7%).
Conclusion: Persistence of symptoms is common after the acute phase of COVID-19 infection. Post covid syndrome
occurs regardless of the disease severity. High CRP, LDH, ferritn, D-dimer, and IL6, low Lymphocytes and degree of
lung affection at diagnosis of acute covid19 may be good predictors for the occurrence of post covid syndrome.
Post covid Syndrome, COVID-19, COVID-19 Survivors.

seen in a large proportion of patients in a study in Italy.
Respiratory viral diseases are associated with both
The patients who were discharged from the hospital
were assessed, of whom 12.6% had no symptoms of
consequences in the survivors (1). Corona viruses are
COVID-19, 32% had one or two symptoms, and 55%
negatively stranded RNA viruses, which cause
had three or more. Also, 53% had fatigue, 43% dyspnea,
infections ranging from common colds to severe acute
27% joint pain, and 21% chest pain. According to this
respiratory syndrome. Coronavirus exposure has also
study, 87.4% had persistence of at least one symptom
been implicated in neuropsychiatric diseases during and
especially fatigue and dyspnea (6).
after Severe Acute Respiratory Syndrome (SARS) and
The aim of this study was to determine the
Middle East Respiratory Syndrome (MERS) outbreaks
parameters that can predict the post covid syndrome and
determine the spectrum of the post covid syndrome
SARS survivors reported psychiatric symptoms,
among COVID-19 survivors attending the post covid
including post-traumatic stress disorder (PTSD),
syndrome outpatient clinic at Zagazig University
depression, panic disorder, and obsessive-compulsive
disorder (OCD) at 1 to 50 months follow up (3).

Moreover, sero-positivity for corona viruses associated
with suicide and psychosis persisting one year after
This was a case control study carried out on 60 COVID-
SARS (4).
19 survivors whom were recovered from the acute
Despite passing months after the first case of
illness and discharged for follow-up at the post covid
cases at chest out-patient clinic at Zagazig University
complications. This disease can cause heart failure,
neurological diseases, such as stroke, and lung disease.

Symptoms include fatigue and brain fog, which may be
Inclusion criteria: Adults >18 years old. COVID-19
related to cytokines that cross the blood brain-barrier
survivors who met World Health Organization (WHO)
(BBB) and affect the brain. These symptoms should be
criteria for discontinuation of isolation (for
seriously considered because they may reflect the post-
symptomatic patients; 10 days after symptom onset,
viral syndrome associated with COVID-19. Moreover,
plus at least 3 additional days without symptoms), and
difficulty in reading, insomnia, general myalgia, dry
those symptomatic patients who have had COVID-19 at
skin, and increased anxiety are other common
least 3 months before.
symptoms (5).

Common symptoms, such as cough, fever, dyspnea,
Exclusion criteria: Pregnant and lactation women.
musculoskeletal symptoms, and anosmia have been
Patients refuse to complete their follow up.
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 45)

c:\work\Jor\vol892_46 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6348- 6355

Studying Sclerostin in Hemodialysis and after Kidney Transplantation in Egyptian
Populations and Its Relation to Vascular Calcification: A Single Center Study
Samir Kamal Abdul-Hamed1, Mahmoud Ali Mahmoud Ashry1, Nabeela Faiq Amin Mousa1,
Ahmed Faisal Mohamed Mohamed Saleh1*, Amal Abdel-Aziz Mahmoud Abdel-Ghani2
Departments of 1Internal Medicine and 2Clinical Pathology, Assiut University Hospital,
Faculty of Medicine, Assiut University, Egypt
*Corresponding author: Ahmed Faisal Mohamed Mohamed Saleh, Mobile: (+20) 01095066331,
Email: a-faisal-mm@hotmail.com

Vascular calcification has been shown as a critical indicator of cardiovascular diseases and all-cause
mortality in patients with chronic kidney disease. Patients with chronic kidney disease and vascular calcification were
suggested to be considered at the highest cardiovascular disease risk by the kidney disease. The current study aimed to
assess level of sclerostin in patients on haemodialysis and its association with vascular calcification.
Patients and methods: The current study included 29 patients received a renal transplant at least 12 months ago
(transplant group), 34 patients who diagnosed wth (end stage kidney disease) ESKD and receiving regular haemodialysis
(ESKD group) and 30 normal individuals (control group). All cases were subjected to laboratory data including
sclerostin level assessment. In addition, echocardiography and carotid intima media thickness was assessed by Duplex
in patient's group.
Results: The study found that majority of subjects was males. Also, frequency of diabetes mellitus was significantly
higher among dialysis group. Dialysis group had significtly higher level of sclerostin in comparison to other groups.
Vascular calcification was present in 31% of transplant group and 38.2% of dialysis group. Dialysis and transplant
groups had significantly higher intima media thickness but with significantly lower bone mineral density in comparison
to the control group. Sclerostin had negative significant correlation with glomerular filtration rate and serum calcium
and positive significant correlation with serum phosphate, parathermone hormone and intima media thickness.
Conclusion: Patients with chronic kidney disease are vulnerable to develop vascular calcification. This complication is
usually increasing the cardiovascular morbidity in those patients. Multi center future studies are warranted to confirm
the role of sclerostin.
Keywords: Vascular calcification, Sclerostin, Intima media thickness.


Abnormalities of mineral and bone metabolism
and ectopic calcification, especially vascular
This was a case-control study, conducted on 63 patients
calcification (VC), are common in chronic kidney
(29 renal transplant and 34 with ESRD on dialysis) and
disease (CKD), resulting in a specific class of disease
30 control subjects, in the period between January 2019
called chronic kidney disease-mineral and bone disorder
and March 2022. All participants were recruited from
(CKD-MBD). CKD-MBD, which promotes the
the Renal Transplant Clinic and Haemodialysis Unit of
development of cardiovascular disease and gives rise to
Internal Medicine Department, Assiut University
the increased risk of cardiovascular and all-cause
mortality, is an extremely important complication of

CKD, but it has often been neglected by clinicians (1).
Inclusion criteria:
Cumulative evidence implies that serum or
- Both genders.
circulating sclerostin is higher in uremic patients and
- Age 18 years-old.
serum sclerostin increases progressively across the
- Patients who received a renal transplant at least 12
CKD stages. However, the studies on the association of
months ago.
serum sclerostin with VC and mortality in renal disease
- Patients who diagnosed with ESRD-RD.
patients have yielded conflicting results (2,3).

The current work was designed to estimate the
Exclusion criteria:
relation between the level of sclerostin and
- Age <18 years-old.
atherosclerosis/vascular calcification in both end stage
- History of tertiary hyperparathyroidism, history
renal disease on regular dialysis (ESRD-RD) and renal
suggestive of osteoporosis, and other diseases that
transplant recipients. Also, to determine relation
might affect bone- mineral status as malignancy.
between serum sclerostin and calcium, phosphorus,
- Patients who received a renal transplant <12 months
parathyroid hormone (PTH), vitamin D levels, bone
mineral density.

Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 46)

c:\work\Jor\vol892_47 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6356- 6360

Detection of Carbapenem-Resistant Genes and Specific Biofilm Association
Genes in K. Pneumoniae Isolated from Medical Samples
1*Hussam Mahmood Hasan, 2Hameed M. Jasim, 1Ghada Mohammed Salih
1Department of Biology, Collage of Science, University of Baghdad, Iraq;
2Department of Molecular and medical Biotechnology, College of Biotechnology, Nahrain University, Iraq
Email: hussam.alammar@sc.uobaghdad.edu.iq, Mobile: +9647704537478
Background: Klebsiella pneumonia is a ubiquitous encapsulated bacterial pathogen which cause various types of
infections, this ability comes from the resistance gene and virulence factor genes.
Methodology: Fifty clinical isolates of Klebsiella pneumoniae was diagnosed and characterized according to their
chemical and molecular characteristics, then genomic DNA was extracted from each bacterial isolate to detect
carbapenem-resistant (NDM-1, and OXA-1), and biofilm association gene including (fimH, and mrkD) by amplification
of these genes using specific primers.
Results: Results showed that NDM-1 and OXA-1 were found to be frequent in bacterial isolates in a percentage of 54%
and 28% respectively. On the other hand, it was found that fimH is the most frequent in bacterial isolates (100%), while
mrkD was found in a percentage of 86% of the total isolates.
Conclusion: High prevalence of biofilm association genes and presence of carbapenem-resistant in varied isolates of K.
pose an important public health thing.
Keywords: Klebsiella pneumoniae, Antibiotic resistance genes, Virulence genes.


Klebsiella pneumoniae (K. pneumoniae), an
associate to the Enterobacteriaceae family, Gram-
Clinical bacterial isolates:
negative bacteria, is a pathogen for human and animal(1).
Fifty isolates of K. pneumoniae collected from
Increased mortality percent's are related with infection
different clinical environments from September 2019 to
with carbapenemase creating K. pneumoniae(2).
December 2020, were cultured on MacConkey agar at
Different carbapenemase genes, for instance: K.
35-37 ºC for 18-24 hours, then recognized by simple
pneumoniae carbapenemase (KPC), VIM, OXA-48,
microbiological experiments excluding: catalase, MR-
NDM-1, and IMP have been recognized in K.
VP (Methyl red­Voges Proskauer), urea agar, indole,
pneumoniae (3,4), several of which seem to be clone-
motility, blood agar, and MacConkey agar (12). The
specific and such clones are considered a pool for
isolates were stored at subzero (-20 ºC) in a broth
comprising glycerol for further examination.
The diseases of K. pneumoniae is interceded by

some virulence factors that mediate to avoid hast innate
Genomic DNA extraction:
immune reactions. The capsule, lipopolysaccharide,
Genomic DNA was extracted from each bacterial
adhesins, iron acquisition systems, resistance to serum,
by using the protocol of Geneaid for genomic DNA
and biofilm formation are considered as virulence
extraction, then purity and concentrations of DNA
factors responsible for K. pneumoniae pathogenecity (6-
solutions were determined by using Nano-drop
8). In addition to Types 1 and type 3 fimbriae are formed
and accumulated on the surface of experimental isolates

of K. pneumoniae. All above factors are considered
Amplification of carbapenem-resistant genes and
virulence factors (9). Type 1 fimbria is one of the
biofilm association genes. NDM-1, OXA-1, fimH, and
mrkD were detected in K. pneumoniae isolates
the Enterobacteriaceae family, contained the structural
amplified by PCR amplification (Biomolecular system,
subunits called FimA. FimH, an adhesin that gives the
Australia) using specific primers indicated in table (1).
capability for binding mannose (found at the tip of the
The PCR situations were as follow: Initial
fimbriae relating via FimA) (10).
denaturing at 94 ºC for 5 min followed by 30 cycles,
Type 3 fimbriae are responsible for the joining of
each cycle contained 1 min at 94 ºC for denaturation, 30
erythrocytes treated with tannic acid, result in bacterial
second for annealing and 60 S for extension steps and
adherence to endothelial and bladder cell lines and have
finally one cycle for final extension at 72 ºC for 10 min.
a role in biofilm creation on abiotic surfaces (6,11).
After amplification, PCR yields were investigated on
Therefore, this experiment aimed to examine the
agarose gel to confirm the presence of the examined
carbapenem-resistant genes and biofilm association
genes in the tested bacteria.
genes in KP isolated from clinical samples isolates from
cases admitted to hospitals in Baghdad, Iraq.

Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 47)

c:\work\Jor\vol892_48 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6361- 6366

Patterns of Superficial Cubital Veins in Sohag University Students
Salwa M. Ouies*, Abeer F. Abd El-Naeem
Anatomy Department ­Sohag University, Sohag-Egypt
*Corresponding author: Salwa Mohammed Ouies; Mobile: +20) 01002073124, E-mail: salwaouies@yahoo.com

Genetic and hydrodynamic factors have a very important role in the variation between individuals in
anatomical patterns of many structures like veins. Knowing of the different types of the superficial veins in the cubital
fossa could be a surgically important in performing safer manipulations like venipuncture, venesection, or any another
surgery at this region.
The aim of the present study: This study aimed to find out patterns of superficial cubital veins in Sohag University
Subjects and methods: The study was run on 310 participants (220 male and 90 females). A tourniquet was applied 10
cm proximal to elbow with active flexion and extension of fingers until the veins appear clearly.
Four patterns of superficial veins in the cubital fossa were noticed. From the total of 620 examined arms and
forearms; type 1, type 2, type 3, and type 4 were 30.1%, 26.6%, 22% and 21.3% respectively. The patterns on right
and left sides have no significant change, but there was significant change between males and females.
Conclusion: Four Types of superficial cubital veins were identified in Sohag University students with a close prevalence
of the 4 types with a significant difference between males and females.
Keywords: Patterns, Sohag, Cubital veins.


There is great importance of the superficial veins
Inclusion criteria
of cubital fossa in medical field and surgical maneuvers
o Students without any embryological anomaly or
due to their perfect location in the subcutaneous tissue.
vascular diseases.
Also, these veins are not paired with any artery, so they
o Students with prominent veins with applying of
are easy to be viewed and accessed (1). It is noticed that
these veins vary largely between genders and between

populations in their anatomical pattern. The study of
Exclusion criteria
this variation is important to medical and healthcare
o Students with thick skin.
professionals to perform safer venipuncture (2).
o Students with cut wound in the cubital region.
The major superficial veins of the upper limb
o Students with vascular diseases.
included in venipuncture are the Basilic, Cephalic,

Antebrachial and Median cubital veins and their
Data was collected after exposing both upper limbs
tributaries (3).
above the elbow joint in sitting position.
The vein of choice in medical field in doing venous
Tourniquet was applied above the elbow joint (for
catheterization is the basilic vein, because its diameter
persons with no prominent veins) with active flexion
increases in the region of cubital fossa until it reaches
and extension of fingers until veins become prominent.
the axillary vein. Also, it lies in direct contact with
Superficial venous arrangement were classified into 4
axillary vein .The median cubital vein is the second best
types (according to the most common).
choice as it is prominent in this region and in direct line

with the basalic vein (4) . Superficial venous system in
Ethical considerations:
the cubital fossa shows many variations and was
Study was ethically approved by the Scientific
classified by different researchers into several types
Research Ethics Committee of Sohag University
four, six and eight types (5-10).
(Sohag faculty of Medicine Ethical Committee under
The aim of the current work was to study the
IRB registration, number: Soh-Med-22-06-21).
different patterns of superficial cubital veins in Sohag
Participation in the study was voluntary and
University students.
investigators gave a complete full information about

the study to students and their role before signing
the informed consent with explanation of the
This study was done in Sohag University students.
purpose and nature of the study.
220 males and 90 females were randomly selected to
participate in this cross-sectional study. All subjects
This work has been carried out in accordance
were Egyptians aged between 18 and 22 years
with The Code of Ethics of the World Medical
(mean18.6 years) from November 2021 to February
Association (Declaration of Helsinki) for studies
2022. The participants were asked to view their right
involving humans.
and left arms and forearms and the patterns of

superficial veins were observed.

Received: 1/7/2022
Accepted: 7/9/2022

Full Paper (vol.892 paper# 48)

c:\work\Jor\vol892_49 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6367- 6372

Neurological Health Symptoms Associated with Pesticide Exposure among
Farmers in Sharkia Governorate Districts
Mryhan Ahmed Adel Hammouda
Community, Environmental, and Occupational Medicine Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mryhan Ahmed Adel Hammouda, Mobile: (+20) 01203876554, E-Mail: meryadel@yahoo.com


Background: Pesticides are widely utilized in agriculture, even pesticides have been outlawed in Western nations for
owing to safety concerns remain extensively utilized in Egypt. Even though there are few researches on the neurological
symptoms linked to pesticide exposure in Egypt. Recently, around 40% of the workforce in Egypt is worked in
agriculture, with a risk of exposure to pesticides.
This study's objective was to assess the neurological health effects of pesticide exposure among Egyptian
farmers in the districts of Sharkia governorate.
Patients and Methods:
A case control study was held on 95 farmers and comparable non-exposed controls from
different farms in four districts out of thirteen in Sharkia governorate were selected using multistage random sampling
technique. Then, during the period between March and July 2020, interviews were conducted to gather demographic
information, occupational history, and neurological health problems related to pesticide exposure. Blood samples
underwent to acetyl-cholinesterase test to assess the extent of pesticide exposure.
Ninety-four percent of pesticide users claimed to have contact with organophosphate insecticides. The most
common neurological symptom reported was a headache (69.5%), which was followed by poor attention (64.2%), a
short memory (57.9%), and fatigue (55.8 percent). There was a statistically significant higher depression of AChE
activity and its adjusted value (Q level) AChE/Hb level among farmers than their controls.
Conclusion: A high prevalence of neurological symptoms was reported among Egyptian farmers using pesticides, which
attributed to pesticide exposure causing severe depression in cholinesterase test. It`s recommended to conduct more
informative researches to assess risk factors and improve awareness.
Keywords: Agriculture, Pesticide exposure, Farmers and acetyl-choline esterase activity.

Due to improper application methods, outdated
Most of the young men who work as farmers
or completely unsuitable spraying equipment,
and apply pesticides have no training or awareness of
inadequate storage procedures, and frequent reuse of
how pesticides affect the environment and human
old pesticide containers for food and water storage,
health, and they lack the tools necessary to cope with
pesticide users are greatly at risk of exposure to harmful
exposures and their impacts. The adoption of protective
pesticides that are banned or restricted (6). When
measures during the use of pesticides depends on their
exposed to pesticides, one may experience a number of
accessibility, price, level of comfort, and the
negative health impacts, including transient acute
restrictions that are applicable in small-scale farming
symptoms including eye discomfort and excessive
regions. Additionally, without adequate protection, the
salivation. Central nervous system (CNS) side effects
danger of pesticide exposure and the likelihood of
such agitation, memory loss, seizures, and coma are
negative health effects rise (1).
also typical. It has been extensively documented that
In agriculture, pesticides--toxic chemicals that
several substances cause parasympathetic and
kill insects and plant pathogens--are frequently
sympathetic nervous system side effects, such as
utilized. However, they are also utilized in a number of
respiratory paralysis (7).
other procedures, including food preservation, sprays,
Additionally, persistent pesticide exposure has
and environmental tasks like the removal of undesired
been linked to a variety of health issues, including
aquatic plants and weeds. Pesticide use has protected
immunological, respiratory, cardiovascular, and
about one-third of global agricultural production (2).
reproductive system issues in addition to nervous
Occupational exposure happens at several phases of
system damage (5).
work, from formulating and combining with solvents to
Even pesticides that have been outlawed in
applying, like spraying. There are long-lasting
Western nations for a long time owing to safety
cumulative impacts on human health from these
concerns are extensively used in Egypt without any
chemical active components and their inert
safeguards. Currently, 40% of Egyptian workers work
counterparts (1).
in agriculture, which carries a significant risk of
Two to 5 million cases of pesticide poisoning
chemical exposure (8).
are reported annually globally, according to the World
Farmers who work in agriculture are at risk for
Health Organization (WHO) (3), 300 000 of the
neurological health issues because of pesticide use. In
instances have resulted in fatalities (4). Only poor
Egypt, nothing has been done about neurological health
nations account for almost 99 percent of pesticide
issues and the dangers of pesticide exposure (8).
poisoning deaths, although using 20 to 25 percent of the
Acetylcholinesterase (AChE) test, self-
world's pesticides (5).
reported neurological symptoms linked to pesticide
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 49)

c:\work\Jor\vol892_50 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6373- 6381

Detection of Some Virulence and Antibiotic Resistance Genes in
Campylobacter jejuni isolated from Poultry and Human
Mona Abdallah1, Mohmed Ahmed Abaza2 , Reda R. Fathy2, Asmaa Gahlan Youseef3,
Mona Sobhy4 , Hasnaa S. Abd Elhamid5 , Wedad Ahmed*6
Departments of 1Zoonoses, 2Avian and Rabbit Diseases, and Bacteriology,
6Immunology and Mycology, Faculty of Veterinary Medicine, Benha University, Qaliobia, Egypt
Department of 3Zoonoses, Faculty of Veterinary Medicine Qena, South Valley University, Qena, Egypt
Department of 4Reproductive Diseases, ARRI, Animal Reproduction Research Institute, Giza, Egypt
Department of 5Medical Microbiology and Immunology, Faculty of Medicine, Benha University, Qaliobia, Egypt
*Corresponding author: Wedad Ahmed, Mobile: (+20) 01063992369, E-mail: drwedad_2009@yahoo.com

Campylobacter species is a zoonotic pathogen and one of the most common causes of bacterial foodborne
Objective: To investigate the surveillance and differences in antibiotic drug resistance, in addition to tetracycline
resistance genes and virulence factors in C. jejuni isolated from both some poultry species and humans.
Materials and Methods: A total of 600 samples were collected from poultry species and humans, investigated by
bacteriological and biochemical methods, C.jejuni were confirmed by mapA gene using PCR. Antibiotic resistance was
assessed and 108 C.jejuni strains were tested for detection of tetO and tetA, and 6 virulence genes; flaA, virB11, cdt,
cdtA, cdtB, and cdtC.
Results: Our results revealed that the occurrence of C. jejuni was 23.67%, identified as 20.21 and 37.5 % in the
examined poultry and human samples, respectively. The evaluation of phenotypic resistance revealed that C.jejuni
isolates had high resistance rates to ampicillin, erythromycin, cloxacillin, amoxicillin, azithromycin, and tetracycline
81.69, 79.58, 77.46, 76.76, 76.06 and76.06%, respectively. The results of the molecular technique detected that
antimicrobial resistance genes in C. jejuni were tetO and tetA 27.78 and 100%, respectively. All isolates of C.jejuni in
poultry and humans possessed virulence genes involved in cytotoxin production (cdt, cdtA, cdtB, and cdtC). The genes
involved in invasion (virB11) and Motility, adherence colonization (flaA) were also widely dispersed between humans
and poultry with the following percentages of 74.07 and 64.81% for virB11 and flaA, respectively.
Conclusion: This study provided an overview of antimicrobial resistance, the presence of tetracycline resistance, and
virulence genes of C.jejuni isolates in poultry and human, which highlights the possible risk to consumer health in Egypt.
Keywords: Campylobacter jejuni, poultry, human, antibiotic resistance, virulence genes, resistance genes.

Fisher syndrome, can all be brought on by

Campylobacter species are considered the
campylobacters infection complications (3).
major known cause of foodborne bacterial zoonoses

Antimicrobial resistance of bacteria has
worldwide, with more than 200,000 cases reported each
emerged as a result of the wide use of antibiotics to treat
year in the European Union. According to estimates,
infectious diseases, and they now represent a major
400 to 500 million diarrheal cases per year are caused
public health concern on a global scale. Several studies
by Campylobacter spp., with C. jejuni being responsible
have mentioned this issue in C. jejuni strains in recent
for about 90% of infections. The most common bacteria
years. The evolution of the resistance profile for C.
that cause gastroenteritis in people worldwide is
jejuni is also related to veterinary procedures used to
C.jejuni (1).
control pathogens in domestic birds and animals. The

Campylobacter species are commensal in the
antibiotics that are released in environments of poultry
gastrointestinal tracts of birds and mammals, and it is
production can change the characteristics of bacterial
mainly spread to people through handling and eating
biofilms, hinder the development of resistance profiles,
contaminated meat of broiler chickens. Two to three
or help maintain sessile life forms like C. jejuni, which
weeks after hatching, Campylobacter is often
creates mature and highly stable biofilms when exposed
introduced to the production cycle of the broiler, and it
to the juice of chicken (4). Additionally frequently
quickly spreads throughout the flock (2).
exposure to antibiotics in animal husbandry situations,
Poultry meat and its products, contaminated
C. jejuni frequently inhabits the gastrointestinal tracts
water consumption or crops, raw or inadequately boiled
of animals used for food, which leads to resistance
milk, and contact with animals are the major routes for
against clinically significant antibiotics.
Campylobacter infection. Additionally, handling
The development of Antimicrobial-resistance in C.
poultry meat and its products with poor kitchen hygiene
jejuni occurs either by spontaneous point mutations on
is considered a main route of infection. Urinary tract
chromosomes that change the antibiotic target sites or
infections, sepsis, or some neuropathies, particularly
through horizontal gene transfer for the acquisition of
reactive arthritis, Guillain-Barré syndrome, and Miller-
antimicrobial resistance genes (5).
Received: 02/07/2022
Accepted: 08/09/2022

Full Paper (vol.892 paper# 50)

c:\work\Jor\vol892_51 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6382- 6392

Association of Mutations in The NPHS2 Gene and Nephrotic
Syndrome in Children and Adults in Middle East
Effat A. E. Tony1, Ahmed A. H. Aboushall2, Alwaheeb S.3, Alserri A.4,
Omima A. R. Mohamed5, Mohammad H. Mostafa1, Marwa K. Khairallah1
Departments of 1Internal Medicine, Nephrology Unite,
5Pediatric Nephrology, Faculty of Medicine, Assiut University, Egypt
Department 2Urology and Nephrology, National Institute of Urology and Nephrology, Cairo, Egypt, and
Farwaniya Hospital, Ministry of Health, Kuwait
Departments of 3Pathology and 4Human Genetics, Faculty of Medicine, Kuwait University-State of Kuwait
*Corresponding author: Ahmed Abd El-Kader Hammouda Aboushall, Mobile: (+965) 99379185, Email:
ORCID ID: 0000-0001-8893-776X

Background: Limited and contradictory pharmacogenetic studies of NPHS2 gene R229Q polymorphism in nephrotic
syndrome (NS) children and adults of different ethnicities steered us to investigate the genotype frequency and
associated risk of this polymorphism in Middle East NS children and adults.
Objectives: The present work aimed to study the effect of NPHS2 R229Q genetic variations on the susceptibility to
idiopathic NS and the treatment response in NS children and adults from Assiut University and major Kuwait Hospitals.
Patients and methods:
A prospective observational cohort study was conducted which comprised a total of 100
idiopathic NS patients (30 children and 70 adults). Mutation analysis was carried out by Taqman allele discrimination
of the NPHS2 gene R229Q polymorphism (rs61747728) using specific primers and probes.
Results: The results indicate the presence of R229Q polymorphism in 9% of our patients. Moreover, R229Q variant in
Steroid-resistant nephrotic syndrome (SRNS) adults was observed in a single heterozygous form. A total of 100 patients
were genotyped for the variant rs61747728. Ninety-one percent of patients carry the CC genotype (Homozygous), in
addition only 9% were carriers of the CT genotype (Heterozygous), whereas no patients were carrying the TT genotype.
The minor allele (T) frequency was 0.045, whereas the major allele (C) frequency was 0.955 in our population.
Conclusion: NPHS2 p.R229Q plays an important role in enhancing the susceptibility of minimal change disease
(MCD), focal segmental glomerulosclerosis/steroid-resistant nephrotic syndrome (FSGS/SRNS), especially in Middle
East population and age of late-onset patients. We recommend to screen for p.R229Q polymorphism in the diagnosis
of SRNS among our population.
Keywords: NPHS2 gene, Nephrotic Syndrome, Mutations, Middle East.

Nephrotic syndrome (NS) is characterized by
and tacrolimus), mycophenolate mophetil and rituximab
have been used with variable success rates in children
dyslipidaemia. Clinically, NS has been divided into two
and adults (4). Adult-onset SRNS is associated with
categories, based on the response to steroid therapy:
various NPHS2 mutations, mostly with R229Q (5). The
steroid-sensitive NS (SSNS) and steroid-resistant NS
NPHS2 gene mapped on chromosome 1q25.2 encodes
(SRNS). Approximately 10 % of children and 50 % of
podocin, which is an important protein expressed by the
adults with idiopathic NS have SRNS, fail to respond to
visceral glomerular epithelial cells (podocytes)(6).
immunosuppressive treatment and progress to end-stage
Podocin is a 383-amino acid lipid-raft-associated protein
renal disease (ESRD) within seven years. In these cases,
localized at the slit diaphragm, where it is required for
renal histology typically shows focal segmental
the structural organization and regulation of the
glomerulosclerosis (FSGS) or minimal change disease
glomerular filtration barrier(7).
(MCD) (1). Steroid-resistant nephrotic syndrome (SRNS)
Podocin mutations are apparently restricted to
is defined as NS resistant to steroid therapy, defined by
SRNS(8), they represent approximately 40% of familial
the absence of complete remission after four weeks of
SRNS patients and have also been found in 10-30% of
daily prednisone therapy at a dose of 60 mg/m2 per day
sporadic SRNS cases in groups from European and
(2). Despite representing a smaller proportion of nephrotic
Middle Eastern countries(9). The identification of NPHS2
syndrome cases, patients with steroid-resistant nephrotic
mutations in NS patients is important for therapeutic
syndrome (SRNS) have proven more difficult to treat,
decisions and genetic counseling, and according to
with 36%­50% progressing to end-stage renal disease
several authors, patients should be tested for mutations
within 10 years(3).
in this gene before receiving immunosuppressive
The treatment of SRNS is a challenging task for
therapy(10). Inter-ethnic differences have also been
the nephrologists due to its poor response to
suggested to play a role in the incidence of NPHS2
cyclopsphamide, calcineurin inhibitors (cyclosporine
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 51)

c:\work\Jor\vol892_52 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6393- 6398

Serum Copeptin as a Predictor for Hepatorenal Syndrome in
Advanced Liver Cirrhosis Patients: A Single-Center Study
Medhat Ibrahim Mahmoud1, Khaled M. Talaat1, Magda M. Sherif1,
Osama A. Mahmoud2, Saher S. Abdel-Samih1, Niveen S. S. Sakla1*
1Internal Medicine and 2Biochemistry Departments, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Niveen Shafik Shokry Sakla, Mobile: (+20) 01285031953, Email: drniveen.shafeek@yahoo.com

Hepatorenal syndrome (HRS) may result from decreased renal perfusion in advanced liver cirrhosis
patients. Copeptin is co-secreted with the arginine vasopressin (AVP) and is increased in patients with decompensated
liver cirrhosis, however, limited studies associated Copeptin with HRS.
Objective: This study aimed to evaluate serum Copeptin as a predictor of HRS in advanced liver cirrhosis patients.
Patients and Methods: A case-control study had been carried out on a total of 40 subjects divided into; Group 1: 20
decompensated cirrhotic patients with HRS, Group 2: 10 decompensated cirrhotic patients with normal kidney function,
and Group 3: 10 healthy controls. The following had been made; history taking, clinical examination, laboratory
investigations: complete blood picture, liver function tests, coagulation profile, serum sodium, and creatinine. Serum
Copeptin was measured using an enzyme-linked immunosorbent assay (ELISA).
Results: Serum Copeptin levels; mean ±SD in pmol/L were significantly increased in group 1 (HRS) (7.3±1.11)
compared to group 2 (3.6±0.99) and group 3 (2.3±0.31) (P0.001). Serum Copeptin levels positively correlated with
serum creatinine, prothrombin time, total bilirubin (P0.05), and negatively correlated with serum albumin (P0.05), and
sodium (P0.001), with no correlation with other parameters. The receiver operating characteristic (ROC) curve for serum
Copeptin validity as a predictor of HRS in advanced liver cirrhosis patients, at a cutoff of 3.99 pmol/L showed 95.1%
sensitivity, 70.2% specificity, and 85.1% accuracy.
Conclusion: Serum Copeptin may predict HRS in advanced liver cirrhosis with high sensitivity and specificity.
Keywords: Hepatorenal syndrome (HRS), Serum Copeptin, Arginine vasopressin (AVP), Advanced liver cirrhosis;

serum creatinine alone in estimating the glomerular
Hepatorenal syndrome (HRS) is characterized
filtration rate (GFR) (10).
by the deterioration of renal function in patients with
This study had been carried out to evaluate the
severe chronic liver disease, advanced cirrhosis, or
role of serum Copeptin as a predictor for HRS in
acute liver cell failure, in the absence of other causes of
advanced liver cirrhosis patients.
renal failure (1). Regardless of the cause of acute kidney

injury (AKI), HRS type-1 is considered a type of AKI,
and HRS type-2 is considered a type of CKD (2). With a
Study Design:
rise in serum creatinine to more than 2.5 mg/dL in less
A case-control study that included a total of 40
than two weeks, type 1-HRS develops suddenly and
subjects; 30 patients with advanced liver cirrhosis,
quickly (3). The only effective treatment for HRS is liver
subdivided into; Group 1: 20 decompensated cirrhotic
transplantation, while early diagnosis, the use of
patients with hepatorenal syndrome (12 males & 8
vasopressors, and the use of albumin may improve the
females), (age mean ±SD; 53.2±5.4 years), and Group
prognosis (4).
2: 10 decompensated cirrhotic patients with normal
Reduced blood flow to the kidneys triggers the
kidney function (6 males & 4 females), (age mean ±SD;
release of arginine vasopressin (AVP), the sympathetic
52.3±4.8 years), in addition to Group 3: 10 healthy
nervous system, and the renin-angiotensin-aldosterone
controls (5 males & 5 females) (age mean ±SD;
system (RAAS), which results in vasoconstriction of the
52.3±1.7 years). Patients with decompensated liver
renal arterioles, a reduction in renal perfusion and
cirrhosis were Child-Pugh classification B (13 patients)
glomerular filtration rate (GFR), and the emergence of
(9 in group 1 and 4 in group 2), and C (17 patients) (11
HRS (5).
in group 1 and 6 in group 2). It was conducted in the
AVP secretion from the neurohypophysis
Intensive Care Unit (ICU), Internal Medicine
increases with the progression of hepatic cirrhosis and
Department, Zagazig University Hospitals, Egypt, in
circulatory dysfunction and plays a role in
the period from October 2018 to September 2019.
(6). Copeptin, a 39-amino-acid

glycopeptide, is co-secreted with the AVP, with more
Inclusion Criteria:
stability in plasma and serum (7). Serum copeptin is
Patients included in this study were admitted to
independently related to markers of kidney injury in
ICU with advanced liver cell failure, their age was >18
type-2 diabetes mellitus (8) and preeclampsia (9).
years. Diagnostic criteria of hepatorenal syndrome
Evaluation of kidney functions in hepatic
included patients with cirrhosis and ascites, with AKI;
cirrhotic patients is difficult due to the limitations of
as per the International Club of Ascites (11) (ICA)
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 52)

c:\work\Jor\vol892_53 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6399- 6409

Influence of Low Dose Intrathecal Naloxone on Bupivacaine - Fentanyl Spinal
Anaesthesia for Lower Limb Orthopedic Surgery in Elderly Patients
Hanaa M. ElBendary1, Amr M. Elhawary2, Mohamed Y. Makharita1, Maha A. Abo-Zeid*1
1Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
2Department of Anesthesia and Surgical Intensive Care, Damietta Cancer Institute, Egypt
*Corresponding author: Maha Ahmed Abo-Zeid, Mobile: (+20) 01019216192,
E-mail: mahzed@yahoo.com, ORCID: https://orcid.org/0000-0002-6389-406X

: Fentanyl as an adjuvant in spinal anesthesia is known to potentate postoperative analgesia. However, its
adverse effects decrease patient satisfaction.
Objectives: This study evaluated the effect of adding low-dose intrathecal naloxone to bupivacaine-fentanyl spinal
anesthesia on the incidence of pruritus.
Patients and Method: In total, 92 patients who underwent lower limb orthopedic surgery under spinal anesthesia were
randomly allocated into two equal groups. In the bupivacaine-fentanyl (BF) group, patients received spinal anesthesia
with 12.5 mg hyperbaric bupivacaine 0.5% plus 25 µg fentanyl, whereas in the bupivacaine-fentanyl-naloxone (BFN)
group, 12.5 mg hyperbaric bupivacaine 0.5% plus 25 µg fentanyl and 20 µg naloxone was administered. Postoperative
Mini-mental state examination (MMSE), arterial blood gas analysis, analgesia, and sedation were recorded
Results: The incidence of postoperative pruritus and other fentanyl-induced side effects was significantly lower in the
BFN group than in the BF group in the first 4 hours postoperatively. The onset of sensory and motor blockade was not
statistically significant between the two groups. In the BFN group, the duration of sensory blockade, motor blockade,
postoperative analgesia, and the total postoperative analgesic requirements with no significant difference in MMSE scores
between the two groups.
Conclusions: The addition of low-dose naloxone to intrathecal BF in lower limb orthopedic surgeries in older adults is
associated with fewer incidences of fentanyl-induced side effects and more analgesic efficacy with no influence on
cognitive function.
Keywords: elderly, intrathecal, fentanyl, naloxone, pruritus.

effectively manage postoperative pain while also
The most popular anesthetic method for lower limb
controlling pruritus, nausea, and vomiting(9).
surgeries is spinal anesthesia(1). It is well renowned for
We hypothesized that using intrathecal naloxone as
offering a quick start and powerful sensory and motor
an adjuvant to opioids during spinal anesthesia in older
block. As blood loss, thromboembolic event risk, ileus
persons could lessen the adverse effects of the opioids,
length, and postoperative morbidity are all reduced,
maintain or perhaps improve postoperative analgesia, and
surgical results are improved(2).
possibly even lower the risk of postoperative cognitive
With sustained postoperative analgesia and limited
dysfunction (POCD).
potential side effects on sympathetic pathways, low-dose
Therefore, this study was conducted to evaluate the
local anesthetic coupled with opioids in spinal anesthesia
effect of adding low-dose intrathecal naloxone to
provides significantly superior hemodynamic stability
bupivacaine-fentanyl spinal anesthesia in older adults
and a more potent synergistic nociceptive analgesic
scheduled for unilateral lower limb orthopedic
effect(3). Local anesthetic solutions that are injected
procedures. The primary outcome was the incidence of
intrathecally can have different opioids added to them(4).
fentanyl-induced pruritus within 4 hours postoperatively.
The clinical profile of lipophilic opioids is more favorable
The secondary outcomes were the influence of low-dose
because of their quick onset, short duration of action, and
intrathecal naloxone on the time until the first
little risk of delayed respiratory depression. The most
postoperative analgesic dose, the incidence of other
widely used lipophilic spinal opioid is fentanyl(5).
fentanyl-induced side effects, and the change in
Pruritus, nausea, and vomiting are among the side effects
postoperative cognitive function within 4 hours
of intrathecal fentanyl administration that might lower
patient satisfaction with anesthesia, delay post-anesthesia

care unit release, and raise costs (6-7).
Older folks need orthopedic operations because they
This prospective, randomized, double-blinded
are more prone to fractures. Unfortunately, a high
comparative study was carried out from December 2020
incidence of pruritus ranging from 30% to 60% has been
to April 2021 at Mansoura University Hospitals after
linked to the use of intrathecal fentanyl in orthopedic
obtaining approval from the Mansoura Faculty of
surgery (8). According to a recent study, intrathecal
Medicine Institutional Research Board (code number
opioids combined with low-dose intrathecal naloxone
MS/19.09.830). This study was registered at
ClinicalTrials.gov with a trial ID NCT04673812.
Received: 02/07/2022
Accepted: 08/09/2022

Full Paper (vol.892 paper# 53)

c:\work\Jor\vol892_54 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6410- 6418

Role of MRI in Evaluation of Injuries of Posterolateral Corner of the Knee
Eman Abd Elwahab Mosilhy*, Ayman Fathy Zaid, Rania Mostafa Almolla, Ahmed Mostafa Elmaghraby
Radiodiagnosis Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Eman Abd Elwahab Mosilhy, Mobile: (+20) 01024396651, E-Mail: emanmosilhy99@gmail.com

In particular during extension, the posterolateral corner of the knee (PLC) acts as a substantial rotational
and transitional stress resistor. The interplay of numerous overlapping structures creates the multi-compartment
complicated sector known as the posterolateral corner.
Objective: Assessment of conventional MRI role in posterolateral corner of the knee.
Patients and Methods: The study was a cross-sectional study. It was conducted at the Radiodiagnosis Department,
Zagazig University Hospitals during six months. It included 36 symptomatic patients with knee trauma before the MR
examination. Their ages ranged from 21 to 53 years.
Results: According to LCL pathology among the studied cases there were 16.7% intact, 33.3% with sprain, 25% with
partial tear and 25% with compete tear. According to PT pathology there were 19.4% intact, 66.7% with sprain, 5.6%
with partial tear and 8.3% with compete tear. According to BF pathology there were 94.4% intact and 5.6% with compete
tear. According to ITB pathology; 94.4% intact and 5.6% with ITB friction syndrome. According to PFL pathology,
50% intact, 25% with sprain, 16.7% with partial tear and 3 (8.3%) with compete tear. There was remarkable variation
between patients and healthy persons in LCL, PT, BF, ITB, and PFL lesions.
Conclusion: We came to the conclusion that MRI offers a superb, in-depth assessment of the knee's posterolateral
corner structures and lesions. Chronic posterolateral instability can be caused by an unsuspected posterolateral corner
injury. To improve surgical care, suggestive imaging results should be quickly communicated with the orthopedic
Keywords: MRI, Posterolateral Corner, Lateral collateral ligament, Popletius tendon, Biceps femoris, Iliotibial band,
Popliteofibular ligament.


intensities. Sprains are classified as injuries with fibular
An important rotational and transitional stress
collateral ligament, popliteus muscle, patellofemoral
resistor, particularly in extension, is the posterolateral
ligament, fabellofibular ligament, or arcuate ligament
corner of the knee (PLC). PLC is made up of several
thickening and hyperintensity signal alterations. Only
overlapping components that interact to generate a
when the structure is damaged and there is an obvious
multi-compartment complex sector. In post-traumatic
space should a tear be reported (5-7).
MRI evaluation, it is critical to identify these injuries
The aim of the work is to assessment of
because missing untreated injuries in this area can have
conventional MRI role in posterolateral corner of the
long-term weakening effects (1,2). The majority of PLC
injuries happen along with damage to other significant

knee stabilising tissues, like the anterior cruciate
ligament (ACL) and posterior cruciate ligament (PCL).
This study was conducted on (48) people at the
Recognition of PLC injuries is crucial since the
Faculty of Medicine at Zagazig University Hospitals. It
diagnosis will frequently alter or require surgical
comprised 36 patients who were sent to the Radiology
therapy, and untreated PLC injury is one of the causes
Department at Zagazig university hospitals from the
of ACL and PCL transplant failures (3).
Emergency Room and Orthopaedic Outpatient Clinic
Anatomically, the PLC's constituent structures
between October 2020 and July 2021.
are grouped in three layers. Iliotibial band (ITB)
The studied group included 10 females and 26
anteriorly and biceps femoris (BF) posteriorly combine
males; their age group ranged from 21 to 53 years.
to produce the superfacial layer. The patellofemoral
Twelve healthy volunteers of similar ages who had had
ligament and lateral patellar retinaculum make up the
no apparent stress and had no symptoms were included
intermediate layer. The popliteus muscle and its tendon
as a control group for comparison. This group contained
(PT), which go through the popliteushaiatus, popliteus
persons chosen from this area to serve as the case
fibular ligament (PFL) and tendon (PFT), and
subjects; the majority were friends or acquaintances of
fabellofibular ligament, make up the deep layer. These
the case subjects; they were healthy, age-matched adults
PLC stabilising elements could potentially be split into
whose ages ranged from 21 to 50.
scaffolds that are static and dynamic (4).

Fibular collateral ligament, PT, and PFT are
Ethical consent:
significant static stabilizers of the posterolateral knee (5).
An approval of the study was obtained from
On an MRI scan, injuries to these various PLC
University Academic
components might be seen as aberrant thickening,
Committee (IRB Approval of Research Ethics
interrupted contours, and/or abnormally high signal
Committee was (ZU-IRB# 6087/5-10-2020)). Every
Received: 02/07/2022
Accepted: 08/09/2022

Full Paper (vol.892 paper# 54)

c:\work\Jor\vol892_55 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6419- 6421

Serum Connective Tissue Growth Factor in Children with Pulmonary Arterial
Hypertension Associated with Congenital Heart Disease: Review Article
Beshier Abdallah Hassan 1, Hanan Samir Ahmed2,
Sherief Mohammed El-Gebaly1, Ahmed Fawzy Fahmy Mahjoub1*
1 Pediatrics Department, 2 Clinical Pathology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Fawzy Fahmy Mahjoub,
E mail: Dr.ahmed7fawzy@gmail.com, Mobile phone: +20 100 093 3643

The significant pulmonary vascular resistance can result in right-sided heart failure, elevated pulmonary
vascular resistance, and even mortality, a progressive condition known as pulmonary arterial hypertension (PAH), which
also has a high mortality and morbidity rate.
Objectives: we aimed investigate plasma connective tissue growth factor (CTGF) levels in pulmonary arterial
hypertension (PAH) associated with congenital heart disease (CHD) (PAH-CHD) in children and the relationships of
CTGF with hemodynamic parameters.
Material and methods: A review of MEDLINE, Cochrane Library, ClinicalTrials.gov, indexed through 31 October
2022, utilizing the following searches: connective tissue growth factor OR/AND one of the following: Biomarker;
Children; Congenital heart disease; Pulmonary arterial hypertension [MESH], was conducted. Additional studies were
identified through review of references. English-language epidemiological studies, clinical studies, and case
reports/series of connective tissue growth factor was included. The authors reached consensus regarding study inclusion
after full-text review. The body of literature was assessed for bias qualitatively.
Conclusion: Children with PAH-CHD had considerably higher serum connective tissue growth factor (CTGF) levels,
which were inversely linked with oxygen saturation. The parameters of the echocardiograph and CTGF did not correlate.
A possible diagnostic biomarker for PAH-CHD in children may be found in serum CTGF levels.
Keywords: Children's serum CTGF, Pulmonary arterial hypertension, heart disease.


adulthood. The costs for supporting those individuals
The severe pulmonary arterial hypertension
with long-term, competent medical care are significant.
(PAH) condition has a high mortality and morbidity
As a result, the burden of CHD on world health grows
rate. It can cause right-sided heart failure, increased
rapidly (7). Additionally, there is expanding
pulmonary vascular resistance, and even death (1).
acknowledgement of neuro-developmental issues in
Congenital heart disease (CHD) with left-to-right
adolescent among CHD survivors (8).
shunts causes increased pulmonary blood flow that
CHD, inborn heart defects is defined as the structural
harms endothelial cells, triggers apoptosis, and raises
malformation(s) of one or more heart chambers and/or
pulmonary arterial pressure. All of which lead to the
deformities of the major intra-thoracic blood vessels
eventual development of neointima and pulmonary
and the ensuing deformities that occurs during
vascular remodelling. Children with CHD are hence
embryonic development (9).
more susceptible to PAH development (2).

Even if several PAH-targeting medications have
Incidence of CHD:
increased life expectancy and quality of life by avoiding
The frequency of CHD is estimated to be 40/1000 if the
pulmonary vascular remodelling (3). The prognosis for
bicuspid aortic valve is taken into account. The
PAH in children with CHD was not good (4). Blood
incidence is approximately 4-6/1000 live births (10).
biomarkers for PAH have been used for diagnosis and
Approximately 33% to 50% of these abnormalities are
prognosis over the years, but none of them have proven
serious and necessitate treatment during the first year of
to be very successful. These include NT-proBNP (B-
life (11).
type natriuretic peptide), N-terminal pro B-type

natriuretic peptide (BNP), endothelin-1 and growth
Pulmonary hypertension of newborn
differentiation factor (5).
The failure of the typical circulatory transition that takes
CCN2, or connective tissue growth factor, is a
place after birth is referred to as hypertension of the
cysteine-rich matricellular protein that controls a
newborn (PAH). It is a sickness that is defined by severe
number of illnesses, including the formation of tumours
pulmonary hypertension that results in hypoxemia and
and tissue fibrosis, as well as biological processes like
decrease of blood flow from the right side of the heart
cell proliferation, differentiation, adhesion, and
to the left side (12).
angiogenesis (6).
Since a patent foramen ovale and patent ductus

arteriosus are frequently present at a young age,
Congenital heart disease
extrapulmonary blood shunting in newborns is brought
Individuals with grown-up congenital heart disease
on by the increased pulmonary vascular resistance. As a
(GUCH) are those patients who have reached
result, there is severe hypoxemia, which could last
Received: 30/6/2022
Accepted: 1/9/2022

Full Paper (vol.892 paper# 55)

c:\work\Jor\vol892_56 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6422- 6431

Immunohistochemical Expression of Claspin and TopBP1 in
Prostatic Adenocarcinoma: Correlation with Clinicopathological
Parameters and Prognostic Significance
Samah S. Elbasateeny*1, Mai M. Abdelwahab1, Asmaa A. Mahmoud2,
Mahmoud M. Malek3, Mahmoud Abdou Yassin4, Adel Mohamed Ismail5, Hanaa M. Ibrahim1
Departments of 1Pathology, 2Medical Oncology, 3Urology and Andrology and
4General surgery, Faculty of Medicine, Zagazig University, Egypt
Department of 5Surgical Oncology at Ismailia teaching oncology hospital, Ismalila, Egypt
*Corresponding author: Samah S. Elbasateeny, Mobile: (+20)01060332800, E-mail: samah_elbasateeny@yahoo.com

Understanding the molecular basis of prostate cancer development is essential to improve the
therapeutic efficacy and to determine the clinical behavior of different cases. Genome protective mechanisms
investigations is a mainstay of cancer research.
To study the immunohistochemical expression of Claspin and TopBP1 in cases of prostate cancer to assess
their relationship with clinicopathological and prognostic features of the disease.
Patients and Methods:
Claspin and TopBP1 expression was assessed immunohistochemically in eighty-four (84)
prostate cancer patients and their prognostic significance was evaluated.
Results: Positive Claspin expression and high TopBP1 score were strongly correlated with high pre-treatment level of
PSA, groups of Gleason grade, higher Gleason score and advanced stage of tumor (P<0.001) for each. Positive
Claspin expression was correlated with LN and distant metastasis (P<0.001). High TopBP1 score was strongly
correlated with distant and LN metastasis (P=0.002, P=0.007 respectively). No association was found between both
markers and age. A significant association was found between higher TopBP1 expression score & positive Claspin
expression (P<0.001) and also shorter progression free survival. Upregulation of Claspin was associated with worse
overall survival (p=0.045), but no association was detected among the expression of TopBP1 and overall survival
Conclusion: Claspin and TopBP1 expression have an important prognostic value in prostate cancer. Using them may
help to identify high risk patients who will benefit the most from treatment. Besides, both markers can aid in the
creation of improved methods that are useful against the therapy-resistant cancer.
Keywords: Claspin, TopBP1, Prostate cancer, Genomic instability.

After DNA damage, checkpoint activation
Prostate cancer (PCa) is a common solid
gives cells a period to repair before continuing the cell
neoplasm among males in the developed nations. In
cycle. Otherwise, checkpoints are disabled and cells
2019, PCa was the cause of about 20% of the newly
undergo apoptosis. Chk1 is a chief mediators of
diagnosed cancers and about 10% of cancer related
checkpoint stimulation (7). Claspin is essential for Chk1
death in American men (1). The frequency and death of
PCa in developing countries also increasing(2).
phosphorylation of Chk1 Via ATR, Claspin
Prostate cancer is a multifactorial neoplasm
upregulation in neoplastic cells guards them from
with variable clinical spectrum and prognosis.
stress of proliferation in a checkpoint-independent
Unfortunately, the important factors in prognosis
mode (8). Claspin upregulation is triggering
including Gleason score and TNM staging, don't
proliferation of many neoplasms such as carcinomas of
clarify the variability in the treatment outcomes (3).
the stomach and kidney (9, 10).
Furthermore, stratification of PCa patients into
Interestingly, Claspin may have neoplasm
prognostic subgroups according to PSA kinetics cannot
suppressive behavior (11). In PCa, the biological
sufficiently differentiate indolent from aggressive
behavior and function of Claspin is unclear and need
cases, there are still key questions to answer (4).
further clarification (12). An important triggering of
A cornerstone of neoplastic transformation is
Ataxia telangiectasia and Rad3 related (ATR) is
instability of the genome that occurs due to
Topoisomerase II-binding protein one (TopBP1) (13).
deficiencies in maintenance mechanisms of genome
Suppressors of ATR, a cheif protein kinases working
integrity, including the checkpoints of the cell cycle,
in DNA damage response (DDR), are striking as
DNA repair and DNA proliferation control.
sensitizers in treatment with chemotherapy (14).
Accordingly, a mainstay of cancer research is genome
TopBP1 upregulation is related with genome
protective mechanisms investigations (5). Throughout
instability in neoplasia (13).
proliferation stress, to keep the integrity of the
In vitro, TopBP1 encourages the cellular
genome, the proliferation checkpoint pathways ATR-
replication of PCa by inhibition of apoptosis mediated
Claspin-Chk1 is triggered (6).
via ATR-CHK1. Still, the exact clinical behavior of
TopBP1 in PCa is obscured (15). In response to
Received: 1/7/2022
Accepted: 7/9/2022

Full Paper (vol.892 paper# 56)

c:\work\Jor\vol892_57 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6432- 6437

Optical Coherence Tomography Angiography of The Retina in
Diabetic Patients before and after Phacoemulsification
Asaad Nooreldin Ahmed, Esam Ghanem Abu-Elwafa, Mohammed Atya Ahmed*

Ophthalmology department, Faculty of Medicin, Al Azhar University, Assuit, Egypt
Corresponding author: Mohammed Atya Ahmed, Email: Atya5710 @gmail.com
Mobile: 01129267823
With optical coherence tomography angiography (OCTA), blood circulation in the retina and choroid
may be examined non-invasively by means of motion contrast imaging.
Objective: This study aimed to investigate the usage of OCTA to look at how the blood vessels in the retina of diabetic
patients are changed before and after phacoemulsification that didn't go wrong.
Methods: This controlled prospective not randomized study was conducted through the period from February 2021 to
February 2022 in Al-Azhar University hospital.
Results: All of the OCTA measurements of the microvasculature were done before, and after one week, one month, and
three months following phacoemulsification for cataract. After three months, the average macula thickness (MT) was
329.68 ± 24.56 micrometer, up from 275.48 ± 14.93 micrometer at the start of the research. The SCP% increased
significantly from 40.28 ± 1.09 at baseline to 42.34 ± 1.44 at one-month post-operative, to 43.59 ± 1.72 at 3 months
post-operative (P < 0.05). This rise was statistically significant (P < 0.05).
Conclusion: According to the findings of our research, OCTA helped to diagnose and keep track of DM patients with
early diabetic retinopathy (DR). It gave detailed images and data about microvascular changes in the retinal layers that
could not be seen with other investigation tools.
Keywords: Optical coherence tomography, Angiography, Retina, Diabetic, Phacoemulsification.


and blood flow (TD OCT). OCT-derived methods, such
One of the most popular surgical treatments
as phase-variation optical coherence tomography (PV
performed by ophthalmologists is phacoemulsification,
OCT), phase contrast optical coherence tomography
which removes cataracts using ultrasonic waves. This
(PC OCT), and split-spectrum amplitude decorrelation
process enhances patients' eyesight following cataract
angiography (SSADA), have been successfully
removal and is crucial for raising quality of life. A split-
employed to study in vivo human ocular
microcirculation (5). This study's objective was to find
algorithm was combined with high-speed optical
retinal vascular changes.
coherence tomography (HS-OCT) in a recent study by

Jia and colleagues to create a novel technique for
performing quantitative angiography of the retina.
Clinical prospective and controlled but not randomised
Previous research has demonstrated that split-spectrum
trial that took place at the Al-Azhar University Hospital
amplitude-decorrelation angiography
between February 2021 and February 2022. Before any
coherence tomography yields accurate findings (1).
surgeries were done, all patients had their questions
answered and given a detailed explanation of the
parenchymal neuroglial tissues to become hypoxic,
procedures' symptoms and likely consequences. The
resulting in increased angiogenic responses and
actual work was always done by the talented surgeons
vascular permeability that promotes vascular
(Azhar University's medical staff).
endothelial growth factor (VEGF). Both inflammatory

mediators and VEGF-mediated factors contribute to the
Inclusion criteria: IOP of 21 mmHg or below, nuclear
progression of diabetic macular edema (2). Fluorescein
cataract of grade 2 or 3 or cortical cataract and lack of
angiography is widely acknowledged to play an
posterior subscapular or posterior polar cataract.
important role in both DR diagnosis and therapy.

However, venipuncture is required, and although rare,
Exclusion criteria: Axial length (AL) larger than 25.0
cases of allergy and death due to contrast injections have
mm or less than 20.0 mm, an intraocular pressure (IOP)
been reported. The method is both costly and time-
greater than 21 mm Hg, history of ocular trauma or
consuming, with a suitable frame taking up to 10
intraocular surgery, and any aberrant intraocular
minutes to obtain. Nonetheless, it remains the preferred
findings. Also, eyes with poor OCT images because of
method for analysing DR components (3).
substantial cataracts, unstable fixation, and any other
Retinal and choroidal blood vessels may be seen
postoperative or surgical challenges.
non-invasively using OCTA thanks to motion contrast
In the course of the research, there were a total
imaging. This cutting-edge imaging method rapidly
of fifty eyes with cataracts taken from fifty different
produces angiograms from high-resolution volumetric
blood flow data (4). Time-domain OCTA is slower than
phacoemulsification and intraocular lens (IOL)
SD OCT, allowing for faster imaging of both structure
implantation. Despite the fact that a patient could have
Received: 30/6/2022
Accepted: 6/9/2022

Full Paper (vol.892 paper# 57)

c:\work\Jor\vol892_58 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6438- 6444

Antibiofilm Activity of Fructophilic Lactic Acid Bacteria filtrate against
Klebsiella Pneumoniae Virulence Gene Expression

Hussam Mahmood Hasan, Ghada Mohammed Salih, and H
ameed M. Jasim
1Department of Biology, College of Science, University of Baghdad, Iraq; 2Department of Molecular and
Medical Biotechnology, College of Biotechnology, Nahrain University, Iraq
Email: hussam.alammar@sc.uobaghdad.edu.iq, Mobile: +9647704537478

Fructophilic lactic acid bacteria (FLAB) are a group of LAB with unique growth features and are regarded
as potential bioactive compound manufacturers. FLAB is discovered in D- fructose rich niches that favors D-fructose
as a growth substrate triumphs over D-glucose. On D-glucose, they require electron acceptors to proliferate. The
organisms have similar metabolic processes for carbohydrates. Fructobacillus spp. are Lactobacillus kunkeei, are
members of this unique group.
Methodology: Inhibitory effect of filtrate from four FLAB isolates from honeybee was detected against the growth of
pathogenic Klebsiella pneumoniae isolates. Biofilm formation, and the expression of fimH, mrkD, and NDM-1, and
OXA-1 virulence genes were also tested.
Results: It was found that FLAB has antibacterial and antibiofilm effect. The incubation of K. pneumoniae with FLAB
suspension at different three-time intervals (3, 6, and 9 hrs.) decreased expression of fimH, mrkD, NDM-1, and OXA-1
virulence genes compared with the expression of the same genes in the absence of FLAB.
Conclusion: all FLAB filtrate isolates tested, K. pneumoniae fimH, mrkD, NDM-1, and OXA-1 virulence gene
expression was down-regulated, when compared to the control culture.
Fructophilic lactic acid bacteria, Klebsiella pneumoniae, Virulence genes, Gene expression, Antibacterial

Honey is a promising candidate to be used as a further
Fructophilic lactic acid bacteria (FLAB) are
aid in the therapy of wounds against various human and
cultivated in D-fructose-rich environments, including
animal illnesses because it contains bioactive,
flowers, fruits, fermented fruits, and insects'
antimicrobial compounds manufactured by FLAB and
gastrointestinal tracts (1-3). They demonstrate relatively
other LAB (6).
little growth on D-glucose as a growth substrate, but
Two types of antigens are typically expressed on the
they actively metabolize D-fructose. Their growth on
cell surfaces of members of the Klebsiella genus. The
D-glucose is clearly improved by external electron
lipopolysaccharide (LPS), which comes in nine
acceptors, and O2, pyruvate, and D-fructose are
different types, contains the first antigen, known as O.
employed as electron acceptors.
The second is K antigen, a polysaccharide capsular with
Metabolically, FLAB belongs to a class of
over 77 different variants. Both support sero-grouping
heterofermentative lactic acid bacteria (LAB), however
and contribute to pathogenicity(7). According to the
end-product profiles from D-glucose metabolism
diseases they caused, the genus Klebsiella can be
classified into three species: K. pneumoniae, K.
heterofermentative LAB. The main byproducts of the
ozaenae, and K. rhinoscleromatis. The Klebsiella
heterofermentative pathway of LAB are lactate,
species' most well-known and significant rod is K.
ethanol, and CO2. When using FLAB, acetate replaces
pneumoniae and it accounts for 75-86% of all Klebsiella
ethanol (2,4). The fructophilic bacteria in honeybee guts
species(8). K. pneumoniae is responsible for initiating
have a positive effect on their hosts' health and length
enteritis, pneumonia, meningitis, and urinary tract
of life and are intriguing candidates for probiotics.
infections that are recognized as pathogenic to humans.
These honeybee symbionts are abundant in fresh honey
K. pneumoniae are also a common opportunistic
and play a crucial part in the production of honey by
pathogen in humans chiefly in immunocompromised
bees. Fresh honey is the best alternative for future
and/or postoperative patients. In addition, K.
wound healing because of its combination of osmolality
pneumoniae is one of the most important pathogens that
and these bacteria's antibacterial and therapeutic
can product extended-spectrum -lactamases, leading to
characteristics (5). The importance of FLAB as
its resistance to utmost antibiotic (6).
probiotics to enhance honeybee health has drawn
K. pneumoniae has a variety of strategies to thrive
considerable attention. These bacteria live in the
and protect itself from the host's immune due to its
digestive tracts of honeybees, shielding them from
many virulence factors. The formation of hypercapsule
harmful infections and helping to maintain the good
in HV strains is one of the four main classes of virulence
health of beehive colonies. FLAB indicates that bees'
factors that have been thoroughly documented in K.
production of honey plays a significant influence. They
pneumoniae. Other virulence factors include
support honey's medicinal and antibacterial qualities.
lipopolysaccharide (LPS), siderophores, and fimbriae,

Full Paper (vol.892 paper# 58)

c:\work\Jor\vol892_59 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6445- 6453

Elevated Serum Dickkopf-1 Levels as a Biomarker for Disease Activity and
Severity in Psoriatic Arthritis Patients
Hasnaa S. Abd el Hamid*1, Noha Hosni Ibrahim2, Maha Hosni Morsi3,
Al-Shaimaa M. Al-Tabbakh1, Marwa S. EL-Melouk1
Departments of 1Medical Microbiology and Immunology and
2Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Benha University, Egypt
Department of 3Clinical Pathology, Misr University for Sciences and Technology, Egypt
*Corresponding author: Hasnaa S. Abd El Hamid, Mobile: (+20)01228623506, E-mail: ahmed_sayedb@yahoo.com

Psoriatic arthritis (PsA) is distinguished by spondylitis, dactylitis, peripheral arthritis, and skin psoriasis.
Dickkopf-1 (DKK-1) is thought to be the primary suppressor of the Wnt signaling pathway, resulting in decreased
osteoblast proliferation.
Objective: This study determined DKK-1 serum levels and its relationship with disease severity and activity in PsA

Patients and Methods: Enzyme-linked immunosorbent assay (ELISA) was used to measure serum DKK-1 levels in 45
patients with PsA and 45 healthy age and gender harmonized people as a control group. All patients were recruited from
the Rheumatology, Rehabilitation, and Physical Medicine Outpatient Clinic and Inpatient Department at Benha
University Hospitals. PsA Disease Activity Score (PASDAS) was utilized to assess disease activity, while Simplified
Psoriatic Arthritis Radiographic Score (SPARS) and PsA Impact of Disease (PsAID) were used to assess disease
Results: The mean serum DKK-1 levels in PsA patients was significantly higher than in control group [p<0.001]. In
addition, it increased gradually in remission, low, moderate then high activity cases (p<0.001). As regards disease
severity, unacceptable status showed significantly higher DKK-1 level when compared to acceptable status. Also, a
statistically significant correlations between serum levels of DKK-1 and PASDAS, PsAID, and SPARS was discovered.
Conclusion: DKK-1 serum levels were abnormally high in PsA patients. Elevated DKK-1 levels had a significant role
in the process of structural radiographic alterations, as well as disease severity and activity in PsA patients.
Keywords: Psoriatic arthritis, Dickkopf-1, Disease activity, ELISA.

been shown to contribute to the pathophysiology and
Psoriasis is a widespread inflammatory chronic
increase the production of Wnt proteins. Interleukin
skin condition defined by aberrant keratinocyte
(IL)-1, the epidermal growth factors TGF- and
proliferation, differentiation, and death(1).
vascular endothelial growth factor (VEGF), as well as
Psoriatic arthritis (PsA) is a comorbidity of
other cytokines generated by the Th17 fraction of T
psoriasis that affects 20­30% of psoriatic patients and
cells, have also been linked to increase expression of
is distinguished by isolated bone erosions and aberrant
Wnt proteins(6).
bone growth, which may imply an uncoupling of
The Wnt family of signaling proteins is a set of
osteoblast-osteoclast homeostasis. The typical lag time
tiny, cysteine-rich, secreted glycoproteins that regulate
for the onset of PsA is 10 years(2).
and govern cell proliferation, fate determination, and
PsA typically manifests in young adults
between the ages of 30 and 50. It affects both axial and
Wnt proteins interact with a membrane-bound
peripheral joints, causing bone loss, irreversible joint
receptor complex comprised of the Frizzled (Fz)
damage, increased functional disability, and an
receptor and its low-density lipoprotein receptor-related
impaired wellbeing's(3).
protein 5 and 6 (LRP5/6) co-receptors in order to
activate multiple signaling pathways(8). The production
characterized by an aberrant immune response in
of IL-12p40 (the common subunit of IL-12 and IL-23)
genetically susceptible individuals that is brought on by
and IFN- increases as a result of this interaction.
additional environmental factors; the etiology and basis
Through the maintenance of Th1 and Th17 cells and
of these physiologic changes are not fully understood(4).
effector functions, IFN- and IL-23 play essential roles
It has been established that the immune
in the progression of psoriasis. Wnt proteins may work
infiltrate within psoriatic lesions is crucial for the
in concert with type I interferons, which are thought to
emergence of psoriasis and that T cells are triggered to
be responsible for the development of psoriasis(6).
start producing the cytokines that cause epidermal
PsA is distinguished by a large influx of
hyperplasia, acanthosis, hyperparakeratosis, and
fibroblasts and activated CD4+ T cells into the synovial
membrane, similar to the immune infiltrate of dermal
Several cytokines, including IL-17 and IL-22,
cutaneous psoriatic eruptions. By interacting with
generated by the Th17 subset of T lymphocytes have
receptor activators of nuclear factor -B (RANK), its
Received: 2/7/2022
Accepted: 8/9/2022

Full Paper (vol.892 paper# 59)

c:\work\Jor\vol892_60 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6454- 6459

Circulating CD19 CD24hi CD38hi Regulatory B Cells Percentage in
Lupus Nephritis Patients: Does It Differ?
Nihal Fathi1, Rania M. Gamal1, Eman M. Shawky1*, Helal F. Hetta2,
Asmaa M. Zahran3, Marwa Mahmoud Abdelaziz1
Departments of 1Rheumatology and Rehabilitation, 2Medical Microbiology and
Immunology and 3Clinical Pathology, Assiut University, Assiut, Egypt
*Corresponding Author: Eman M. Shawky, Mobile: (+20)01063489998, Email: eman202@aun.edu.eg

: There is a debate about the functional role of regulatory B cells in the lupus nephritis (LN) pathogenesis.
Objective: The aim of the present study was to analyze total B lymphocytes and their subtype regulatory B lymphocytes
(Breg) % in systemic lupus erythematous (SLE) patients, in addition to assess their association with LN activity.
Patients and Methods:
The present study included 19 lupus nephritis (LN) patients, 11 SLE patients without lupus
nephritis (non-LN). They were matched with 20 healthy individuals as a control group. LN activity was evaluated by
Renal SLEDAI (rSLEDAI), nephritis patients were divided into active lupus nephritis (renal SLEDAI4) and non-active
lupus nephritis patients (renal SLEDAI = 0). Full history taking, clinical examination and baseline laboratory
investigations were done for all participants. Total B lymphocytes and their subtypes Breg were measured by flow
Results: SLE diseased patients have significantly higher total B lymphocytes compared to matched controls; also, SLE
diseased patients (LN and non-LN) have significantly lower CD19+ CD24hi CD38hi compared to matched controls,
regardless of LN activity.
The present study supports B cell and Breg role in aetio-pathogenesis of SLE and also contributes to the
onset of LN which indicates a dysfunctional regulatory mechanism.
Keywords: Systemic lupus erythematous, Lupus nephritis, B lymphocytes and regulatory B lymphocytes.

are involved in the pathophysiology of lupus [7, 9].
Systemic lupus erythematous is a chronic
However, there is a debate on how Bregs function in
autoimmune disease associated with multiple organ
SLE, the Bregs percentage in SLE diseased patients is
manifestations [1]. Patients with SLE frequently exhibit
either increased or decreased [1, 10-13]. Therefore, the aim
renal involvement, and despite modern available
of the current study was to evaluate the role of B
therapeutic options, the development of LN greatly
lymphocytes and Breg in patients with SLE, especially
raised the risk of renal failure and patient mortality [2].
in patients with LN.
However; the possible aetio-pathogenesis of LN is not

well understood but B cells play an essential role [1].
B cells play a pathogenic role in LN which could
Study design:
be contributed to the production of cytokine and
The present study was an observational cross-sectional
autoantibodies, their ability to activate T cells through
study conducted on 30 SLE diseased patients (LN
co-stimulatory molecules, and their function as antigen-
patients, n=19), (non-LN patients, n=11). They were
presenting cells [3].
matched with 20 healthy individuals as a control group.
Bregs are a sub-set of B cell lymphocyte which

have the ability to adversely inhibit the immune
Inclusion criteria:

response [4], primarily by secreting transforming growth
All recruited patients were diagnosed with the revised
factor (TGF)­, regulatory cytokines like interleukin
and validated classification criteria of the Systemic
(IL)-10 and by expressing inhibitory antibodies that
Lupus Collaborating Clinics (SLICC) and the American
block T cells and auto-reactive B cells, which are
College of Rheumatology (ACR) SLE [14]. Patients
ultimately connected to the SLE pathogenesis and
recruited from outpatient clinics and inpatient of
disease activity [5]. Also there is a proof that Bregs are
Rheumatology, Rehabilitation and Physical Medicine
crucial in numerous animal models of autoimmune
Department, Assiut University Hospitals, Egypt in the
disease and inflammation. Bregs are an undeniably
period from 1st of May 2018 up to the end of May 2019.
significant part of the immune system, even if their
The control group included volunteers with similar ages
definition and mechanism of action are still being
and sexes.
recently investigated [4, 6].

Human Bregs are primarily divided into memory
Exclusion criteria:
Patients, who were pregnant, aged less than 18 years old
(CD19+CD24highCD38high) types [7, 8]. Bregs are
or those with other systemic autoimmune disorders
functionally compromised in SLE patients, according to
were excluded.
earlier research, which raises the possibility that they

Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 60)

c:\work\Jor\vol892_61 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6461- 6466

Transvaginal versus Transperineal Ultrasound Examination in
Diagnosis of Placenta Previa in Late Pregnancy
Amany Mahrous Seleem Esawy
Obstetrics & Gynecology Specialist, Al-Ahrar Teaching Hospital, Zagazig, Alsharqia, Egypt
*Corresponding author: Amany Mahrous Seleem Esawy, Mobile: (+20) 01111614270, E-Mail: amanyyswy10@gmail.com

: A low placenta may now be located with absolute accuracy using transvaginal scanning. The procedure
known as transperineal sonography (TPS) is quick, easy, safe, and gives the patient very little pain. The objective of the
current study is the determination of the accuracy of transperineal ultrasound versus transvaginal ultrasound (TVS) in
the diagnosis of placenta previa in late pregnancy.
Patients and methods: In a prospective comparative study at Ain Shams University Maternity Hospital at Ultrasound
Special Care Unit for the fetus using Medison sonoace R5 ultrasound 67 cases suspected to have placenta previa by
trans-abdominal US were enrolled. Comparison between transperineal versus transvaginal US for having placenta previa
diagnosis was judged by intraoperative visualization.
Results: There was significant moderate agreement between intraoperative observation (golden test) and both
transperineal ultrasound and tranvaginal ultrasound. The diagnostic accuracy was 92.5% (95%CI: 90.4-93.1) for
tranperineal versus 97% (95%CI: 96.1-97.3) for the transvaginal. Mean "Verbal Descriptor Scale" assessment was
significantly higher in transvaginal than in transperineal US (3.3±0.4 versus 1.3±0.4 respectively, p value <0.001).
: TPS and TVS are also useful methods that can be used in addition to transabdominal sonography to
diagnose placenta previa. However, TPS proved to be superior than TVS due to reduced discomfort, the lack of
specialist equipment, and the avoidance of vaginal penetration, particularly in situations where there is a danger of
Keywords: Transvaginal Ultrasound, Transperineal Ultrasound, Transabdominal Ultrasound, Placenta Previa.

quick, safe, and well-accepted. Along with being a
The condition known as placenta previa occurs
beneficial therapy to support transabdominal sonography
when the placenta is entirely or partially implanted into
(TAS) for evaluating of suspected placenta previa cases,
the lower section of the uterus. Ultrasonic imaging is
Although it can't totally replace transabdominal
classed according to what is significant clinically: When
sonography, transperineal sonography can assist weed out
the leading edge of the placenta does not cover the
false positives and determine the delivery route and
internal cervical os, it is known as mild or partial previa.
should be used regularly when transabdominal
When the placenta covers the internal cervical os, it is
sonography's placenta visualization is poor (4, 5). When
known as placenta previa major (1).
transabdominal sonography's placenta viewing is
Placenta previa occurs 0.5-2 percent of the time at
insufficient, it should be regularly employed even if it
term. Placenta previa is significantly more common
cannot totally replace it (5).
earlier in pregnancy, but most occurrences of it resolve,
The purpose of this study was to compare
especially if they are discovered in the first or second
transvaginal and transperineal ultrasounds for the
trimester (1).
identification of placenta previa in late pregnancy.
A prior caesarean delivery, spontaneous abortion, or

artificial inseminations all significantly increase the risk
of developing placenta previa. With more past caesarean
Study design and setting:
deliveries, the danger rises. Pregnant women having a
A total of 67 patients were recruited for this prospective
history of an abortion or caesarean delivery should be
comparative study from Ain Shams University Maternity
treated as high-risk cases for placenta previa and closely
Hospital from the causality and the antenatal care clinic
monitored (2).
with suspected placenta previa (major or minor) during
Accurate placenta previa diagnosis lowers maternal
the third trimester which were diagnosed by 3rd trimester
and fetal morbidity and death. Diagnostic error has been
abdominal ultrasound.
significantly decreased because to sonography and

placenta previa detection accuracy has risen. To identify a
Inclusion criteria:
placenta previa, sonography is utilized transabdominally,
1. Gestational age >20 weeks.
transvaginaly, and transperineally (3).
2. Absence of labor pains.
Despite being a straightforward and secure
3. Absence of active vaginal bleeding.
procedure for locating the placenta, transabdominal
4. Vital data are stable.
sonography (TAS) has a high rate of false positives and

false negatives (3).
Exclusion criteria:
The procedure known as transperineal sonography
1. Gestational age less than 20 weeks.
(TPS) is painless for the patient and is straightforward,
2. Presence of labor pains.
Received: 06/07/2022
Accepted: 11/09/2022

Full Paper (vol.892 paper# 61)

c:\work\Jor\vol892_62 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6467- 6472

Value of Transvaginal Ultrasonographic Assessment of Cervical Length in
Predicting Duration of Second Trimester Pregnancy Termination
Amany Mahrous Seleem Esawy*, Tharwat Ahmed Elsayed Ibrahim,
Mahmoud Negm Abd Elgafar Mohamed, Alshimaa Abd Elhakeem Hassan Mohammed
Obstetrics & Gynecology Department, Al-Ahrar Teaching Hospital, Zagazig, Alsharqia, Egypt
*Corresponding author: Amany Mahrous Seleem Esawy, Mobile: (+20) 01111614270, E-Mail: amanyyswy10@gmail.com

: Cervical length can be measured transvaginally to help determine whether vaginal delivery will occur
within 24 hours following induction. The objective of the current study is to investigate the accuracy of transvaginal
ultrasound measurement of cervical length as a prediction of the time needed for a medically assisted pregnancy
termination in the second trimester that occurs within 24 hours.
Patients and methods: In a case series at Ain Shams University Maternity Hospital, Transvaginal ultrasonography was
used to measure the cervical length in 100 women between 14 and 24 weeks of gestation, who had singleton pregnancies
that were recommended for elective pregnancy termination. All participants received the same regimen of medical
termination of second trimester pregnancy by misoprostol.
Results: A positive correlation was found between cervical length measured by transvaginal ultrasound and duration of
termination of second trimetric abortion. Results revealed an equation (Cervical length ­ Parity + Fetal demise ­
Rupture of membranes) that can predict duration of termination Conclusion: Transvaginal ultrasonographic cervical
measurements has a significant correlation with duration of termination of second trimetric abortion and can be used as a
predictor of time of induction of abortion by misoprostol in the second trimester termination of pregnancy.
Keywords: Transvaginal Ultrasound, Cervical Length, Termination of Pregnancy, Misoprostol.


misoprostol for inducing abortion in the second trimester
As the pregnancy progresses, abortion-related
is 800 mcg given after the initial dose (3).
morbidity and death considerably rise. Abortions beyond
Cervical length can be measured transvaginally to
14 weeks of pregnancy account for ten to fifteen percent
help determine whether vaginal delivery will occur within
of all abortions, but they also account for two-thirds of all
24 hours following induction (4).
complications and fifty percent of all abortion-related
The supravaginal part of the cervix typically
fatalities (1).
accounts for around 50% of cervical length; however this
A significant clinical problem is the development of
is extremely variable across people, making transvaginal
safe and efficient abortion methods for second-trimester
ultrasonographic measurement theoretically a more
pregnancy terminations and fetal death. The primary goal
reliable evaluation of the cervix than digital examination.
of inducing an abortion is the quick, painless, and
This area is challenging to digitally measure, especially if
successful delivery of the fetus. Several methods,
the cervix is closed. Additionally, effacement is
including as prostaglandin analogues, hydroscopic
subjective and can vary greatly across examiners (4).
dilatators, and Foley balloon traction, can end second-
The purpose of this study was to assess the efficacy
trimester pregnancies. Due to uterine unresponsiveness
of transvaginal ultrasound assessment of cervical length
and an unfavorable cervix, the time between the start of
as a predictor for the time required for a medically
induction and the birth of the products of conception
assisted second trimester pregnancy termination within 24
might be prolonged during the second trimester of
pregnancy (2).

The lady experiences discomfort and increased
anxiety as a result of the prolonged administration of
Study design and setting:
various ways and the reduced response rate to oxytocin
In a case series study at Ain Shams University Maternity
infusion. Cervical priming is therefore a crucial
Hospital 100 participants between 14 and 24 weeks of
component of second trimester pregnancy termination.
gestation, with singleton pregnancy indicated for elective
The administration of the prostaglandin analogue
pregnancy termination were examined by transvaginal
misoprostol is the most often used technique of
ultrasonography to assess the cervical length before
termination of pregnancy (TOP). The term "medical
medical second trimester pregnancy termination.
induction of abortion" refers to the process of terminating

a pregnancy using methods other than surgery. It
Inclusion criteria:
frequently involves the use of abortion-inducing
Age: 17-40 years old.
substances (prostaglandins, RU486, Methotrexate). A
Non-scar uterus (primigravida or multipara).
total of 400 mcg of misoprostol can be injected vaginally
Singleton pregnancy.
and repeated after 4 hours. The recommended dose of
14-24 weeks GA according to WHO
classification (5).
Received: 02/07/2022
Accepted: 08/09/2022

Full Paper (vol.892 paper# 62)

c:\work\Jor\vol892_63 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6473- 6479

Risk Factors and Outcomes of Hyperglycemia in Low Birth
Weight Infants: A Prospective Observational Study
Mohamed Samy El-Shimi, Passant M. Abu El-Saoud, Rania I. H. Ismail*
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Rania Ibrahim Hossni Ismail, Mobile: 002-01144447769,
Email: raniaibrahim@med,asu,edu,eg, ORCID account: 0000-0002-6389-4449

Low birth weight (LBW) babies frequently have hyperglycemia, which is linked to greater mortality as
well as morbidity. The threshold intervention and management protocols are controversial.
Objectives: To define the incidence of neonatal hyperglycemia, associated risk factors, and the outcome in LBW
infants in tertiary Neonatal Intensive Care Units in Ain Shams University, Cairo, Egypt.
Patients and Methods: In a prospective observational trial, 125 low birth weight neonates were included in this
study. Blood glucose concentration was monitored daily in all infants for 7 days. Insulin therapy was initiated if
hyperglycemia >200 mg/dL despite reductions in glucose infusion rate. Outcomes were reported till 28 days of life.
Results: Twenty-four percent of the cohort developed hyperglycemia. Mortality and intraventricular haemorrhage
(IVH) were significant outcomes and higher in the hyperglycemia group compared to euglycemia group. This could be
related to the higher glucose levels and not to the duration of hyperglycemia. Twenty-three infant (76.7%) among the
hyperglycemia group responded to decreasing glucose infusion rate (GIR) while 7 infants (23.3%) needed insulin; 3
(42.9%) improved, 4 (57.1%) had hypoglycemia attacks and died.
Conclusions: Among low birth weight infants' hyperglycemia was associated with morbidity and death. Using insulin
as a line of treatment for hyperglycemia may be associated with hypoglycemic attacks and mortality.
Keywords: Insulin, Low birth weight babies, Hyperglycemia.


During the first week of life, due to interrupted
placental glucose transfer and disturbed glucose
The study included 125 LBW infants weighing
homeostasis most preterm neonates need glucose
less than 2500 grams at birth consecutively admitted to
infusion to maintain the glucose level. Hyperglycemia
the NICU. All of the infants who were included
eventually develops as a result of improper proinsulin
underwent a full clinical examination, comprehensive
processing by -islet cells, partial insulin resistance,
history taking, and standard neonatal care. Prenatal
and a lack of inhibition of glucose synthesis during
trans-abdominal ultrasound and the modified Ballard
parenteral glucose infusion(1).
scoring method(9) were used to confirm the gestational
Although chronic neonatal hyperglycemia is
age, which was determined from the date of the most
linked to considerable morbidity and mortality, it may
recent menstrual cycle.
be a normal reaction to stress. It has been classified

according on the absolute blood glucose level, the
Exclusion criteria: Infant of diabetic mothers,
length of exposure, and whether or not glycosuria was
neonates with endocrinal diseases, congenital
anomalies, or suspected chromosomal aberrations were
Depending on how the threshold is defined,
excluded from the study. Hyperglycemia outcomes
the prevalence of hyperglycemia in preterm infants
were reported till 28 days of life.
ranges from 15% to 30% (3). It has an opposite
Blood glucose concentration was monitored
relationship to birth weight(4).
for 7 days using the Bionime rightest blood glucose
In babies born very prematurely with very low
monitoring system GM300.
birth weights, hyperglycemia can increase mortality,
Blood glucose concentration was monitored
cause intraventricular haemorrhage (IVH), retinopathy
daily in all infants receiving intravenous glucose
of prematurity, necrotizing enterocolitis (NEC),
infusions. Monitoring every 3-6 hours for newborns
increase oxidative stress, cause sepsis, prolong hospital
with stress, septicemia, or cases of extremely low birth
stays, and impair physical growth until 2 years
weight (ELBW). The blood glucose level was
corrected age(5-8).
measured within 30 minutes to 1 hour of the start of
Recent research has shown that continuous
the insulin infusion and whenever the rate of glucose
glucose monitoring (CGM) can aid with glucose
or insulin infusion varied. After becoming steady,
control and lower the risk of hypoglycemia in preterm
glucose levels was checked every hour for the next 3-6
The aim of this work is to define the incidence
Hyperglycemia was defined according to
of neonatal hyperglycemia, associated risk factors and
blood glucose; mild (151 mg/dL to 180 mg/dL),
the outcomes for low birth weight (LBW) babies in
moderate (181 mg/dL to 210 mg/dL) or severe (>210
Tertiary Neonatal Intensive Critical Care Units, Ain
Shams University, Cairo, Egypt.

Received: 1/7/2022
Accepted: 7/9/2022

Full Paper (vol.892 paper# 63)

Oral and maxillofacial lesions The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6480- 6487

Oral and Maxillofacial Lesions Algorithm in Nineveh Province,
a Clinicopathological Study
Nazar M.T Jawhar1, Karam Turath Tawfeeq2, Ziyad Ahmed Abed1,
Rawaa Y. Al-Rawee3*, Safwan Abd ALHammed Salih3
1. Department of Pathology, College of Medicine, University of Nineveh, Iraq.
2. Department of Pathology, College of Medicine, University of Mosul, Iraq.
3. Department of Maxillofacial surgery, Al-Salam Teaching Hospital, Nineveh Health Directorate, Iraq.
Corresponding Author: Rawaa Y. Al-Rawee. Phone: 009647726438648,
ORCID: 0000-0003-2554-1121. E-mail: dr.rawarawi@yahoo.com.

Oral and maxillofacial lesions include a wide variety of lesions. They could be either neoplastic or non-
neoplastic, furthermore; the non-neoplastic lesions can be cystic, inflammatory, or they can also represent a reaction to
some kind of irritation or mild injury.
To analyze the frequency and distribution of the various types of oral and maxillofacial lesions in Nineveh
province. Patients and methods: This retrospective study was conducted on 763 cases from May 2021 to April 2022.
Data was retrieved from the Oral Pathology Department at Al-Jumhori Teaching Hospital, Al-Salam Teaching Hospital
and some private laboratories in Nineveh province (Iraq). Lesions were classified into four categories: Inflammatory
and reactive benign lesions, cystic lesions, benign and malignant lesions. Statistical analysis was done using chi-square
test and F test, with p-value <0.05 a significant level.
Results: The most commonly affected age was between 11 and 20 years. There were four diagnostic groups; (46.79%)
inflammatory and reactive benign lesions, (16.77%) cystic lesions, (22.81%) benign tumors and tumor­like lesions, and
(13.63%) malignant tumors. The most frequently encountered inflammatory and reactive benign lesion was non-specific
inflammation (11.27%). The most frequently encountered cystic lesion was epidermoid cyst (7.34%). On the other hand,
the most frequently encountered benign tumor and tumor-like lesion was nevi (4.33%).
Conclusions: Non-specific inflammation is the most common oral and maxillofacial lesions, followed by fibroepithelial
Oral lesions, maxillofacial lesions, benign tumors, malignant lesion, retrospective study, Iraq.


Oral and maxillofacial lesions (OMLs) include a
among Iraqi population and none of them was
wide variety of lesions (1).
conducted in Nineveh province (9).
They could be either neoplastic or non-neoplastic,
The aim of this study is to analyze the frequency
furthermore; the non-neoplastic lesions can be cystic,
and distribution of the various types of OMLs found in
inflammatory, or they can also represent a reaction to
biopsy specimens in Nineveh province (north of Iraq),
some kind of irritation or mild injury (2). The diagnoses
and to correlate the results with different age groups
of oral and maxillofacial pathologies are established by
and gender of population and with the anatomical
some clinical and radiological features, but the final
location of the lesion.
diagnosis is based mainly on histopathological

examination of the lesion (3-6).
Although oral neoplasms can be either benign or
Study setting and design:
malignant, most of them have a benign nature, clinical
This retrospective study was conducted in Nineveh
differential diagnosis of oral lesions is often dependent
province from May 2021 to November 2021, Clinical
on some clinical features like obvious changes in color,
data and
histopathological information were
size, consistency, and relation to neighboring structures,
sequentially submitted for 763 cases. Clinical data
knowledge of the frequency and distribution of such
included endodontic status, age and sex of patient,
lesions is also essential when establishing a diagnosis
frequency and location of lesion, and submitting
and putting forward a proper treatment plan (7).
It is also important to find out the distribution of

each lesion in the countries in order to link their
Data collection:
occurrence with the habits, foods type, and genetic
Data was obtained from the histopathological
background of populations with these lesions in order to
reports that accompanied biopsy request forms, which
decrease them (8).
were retrieved from the files of the Oral Pathology
Despite a considerable volume of literature
Department at Al-Jumhori Teaching Hospital, Al-
written about benign and malignant oral soft tissue
Salam Teaching Hospital and some private laboratories
masses in people from different countries, there is very
in Nineveh province for the last decade (2010-2020).
little documentation of the prevalence of such lesions
The records of patients with biopsied oral soft tissue
Received: 2/7/2022
Accepted: 8/9/2022

Full Paper (vol.892 paper# 64)

c:\work\Jor\vol892_65 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6488- 6495

Molecular Detection of Plasmid-Mediated AmpC in Gram Negative Bacteria
Isolated from Intensive Care Unit Patients in Wasit Province, Iraq
Rana Essa Muslem1*, Rana H. Raheema1, Qasim Dawood Yasir2
1Departments of Medical Microbiology and 2Pediatric
Faculty of Medicine, University of Wasit, Iraq
*Corresponding author: Rana H.Raheema, Mobile: 07811552129,
Email: rraheema@uowasit.edu.iq, https://orcid.org/0000-0002-1360-1716

The intensive care unit (ICU) plays a crucial role in managing and treating some of the most complex
and serious disorders that affect the human body.
Patients and Methods: A total of 100 clinical specimens (urine, sputum and pus) were collected from patients admitted
to the ICU. in this study admitted to the intensive care units (ICUs) of Alzahraa and Alkarama hospitals for more than
48 hours between 3rd October 2021 to 20th February 2022. Each patient's name, age, gender, underlying clinical
condition, ICU admission date, indoor admission date, previous antibiotic intake history, current ICU therapy, and
clinical outcome were recorded.
Results: Thirty (36.5%) female and 52 (63.5%) male patients were admitted to the ICU. They were distributed 69
(84.1%) gram-negative bacteria. Gram positive 13 (15.9%). Nitrofurantion was most active against E. coli. Piperacillin-
tazobactam was most active against Proteus mirabilis. AmpC ß-lactamase was detected by phenotypic and genotypic
procedures, phenotypically AmpC producers for klebsiella pneumoniae 13 (68%). Genotypically isolates blaEBC 4
(30.7%), blaCIT 13 (53.8%). However, phenotypically survey of AmpC pseudomonas aeruginosa was 9 (45%).
Genotypically isolates blaEBC was 6 (50%). Phenotypically survey of AmpC producers for E. coli was 9 (52%) and
genotypically isolates blaEBC 3 (30%), blaCIT 1 (10%). While, DHA, MOX ACC, FOX genes were absent among all
isolates. Conclusion: klebsiella pneumoniae showed AmpC ß-lactamase comprised (blaEBC and blaCIT. while no isolate
have DHA, MOX ACC, FOX genes). As for E.Coli AmpC ß- lactamase comprised (blaEBC and blaCIT, while no isolates
have AmpC DHA, MOX ACC and FOX.
Keywords: Intensive care unit, Bacteria characterization, Antibiotic susceptibility, Phenotypes, genotype, Plasmic
AmpC, Gram-negative bacteria.

exposed to certain -lactam antibiotics, AmpC -
The intensive care unit (ICU) plays a crucial
lactamase synthesis increases and wide spectrum
role in managing and treating some of the most complex
cephalosporin resistance is induced Meini et al (5).
and serious disorders that affect the human body.
However, certain genetic mutations result in
Despite the ICU's are crucial and well-established role
overexpression and production of AmpC -lactamase.
in patient care, ICU-acquired infections raise

expenditures significantly, while also increasing
morbidity and death for patients are found there. Large
The aim was presented to detect spread of
multicenter research conducted in the United States and
bacterial isolates from patients in ICU in Kut City,
Europe have shown that hospital infection rates in ICUs
Wasit Province, Iraq and to characterize it at the level
are the worst of all hospital-acquired infections
of molecular analyses of its phylogenic and
Iwashyna and Viglianti (1). Intensive care unit (ICU)
antimicrobial resistance genes.
patients frequently have consequences from healthcare-

associated infections (HAIs), which include bacteremia,
pneumonia, urinary tract, skin, or soft tissue infections
A total of 100 clinical samples including: urine,
Salonia and Sotelo (2).
sputum and pus culture media such as mannitol salt
The ICU personnel and doctors may act as
agar, MacConkey agar, blood agar, and chocolate agar
conduits for the transfer of germs from other inpatient
were collected in this study admitted to the intensive
units to ICUs Amaan et al (3). Some Gram-negative
care units (ICUs) of Alzahraa and Alkarama hospitals
bacteria include chromosomal genes that encode ampC
for more than 48 hours between 3rd October 2021 to
-lactamases, which are significant resistance
20th February 2022. The growth showed different
mechanisms. With the exception of carbapenem and
cefepime, these enzymes are resistant to all -lactam
biochemical characteristics were tested. Then DNA was
antibiotics, and atypical extended spectrum -
extracted; purity and concentration were confirmed
lactamases (ESBLs), they act as cephamycins
with Nanodrop. The purity of gram-negative bacteria
hydrolyzer so the commercially available -lactamase
was (1.8-2), and the concentration was between 50-360
inhibitors does not suppressed them. Substrate profile
ng/µl. Primers were mentioned as Dahwash et al. (7)
such as monobactam, penicillins, cephalosporins were
belong these enzymes Castanheira et al (4). When
Received: 1/7/2022
Accepted: 7/9/2022

Full Paper (vol.892 paper# 65)

c:\work\Jor\vol892_66 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6496- 6501

Clinical and Radiological Outcomes of Endoscopic Endonasal
Transsphenoidal Surgery for Pituitary Adenomas
Abdulrahman Mohammed Ali Abeedah*, Adel Saad Ismaeil,
Mohamed Salah Mohamed Ahmed, Hassan Ahmed Ibrahim Abaza
Neurosurgery Department, Zagazig University, Zagazig, Egypt
*Corresponding author: Abdulrahman Mohammed Ali Abeedah, Mobile: (+20)1008853873,
E-Mail: optimistic.surgeon@gmail.com

: Pituitary adenomas may cause problems because of hormonal hypersecretion, pituitary hormonal failure,
vision loss, headaches and/or bleeding into the tumor (apoplexy).
Objectives: The purpose of this study was to evaluate the efficacy of the endoscopic endonasal approach in managing
pituitary adenoma concerning the resection rate and other clinical outcomes. Also, to assess the safety of the approach.
Patients and methods: A prospective cohort study was conducted on twenty-four patients undergoing endonasal
transsphenoidal approaches for pituitary adenomas at the Department of Neurosurgery, Zagazig University Hospitals
during the period from March 2022 to October 2022. All patients were subjected to complete clinical examination,
hormonal assessment, and neuroimaging.
: This study demonstrated that among cases with hypopituitarism (66.7% became normal after treatment and
33.3% remained suffering from hypopituitarism) with statistically significant difference between pre & post treatment
(p=0.03). For cases with normalized hormonal level pre-operative change to 5 cases hypopituitarism (4 transient diabetes
insipidus and one case permanent Diabetes insipidus at one or more axis) and 13 cases remained normalized with
statistically significant difference between them (p<0.001). All cases of increased GH, ACTH and prolactin showed
complete improvement after treatment and 90% of prolactinoma improved after treatment.
Conclusion: It could be concluded that the minimally invasive endoscopic endonasal transsphenoidal approach is an
effective and safe approach for the management of pituitary adenomas.
Keywords: Pituitary Adenomas, Endoscopic, Endonasal


of pituitary adenoma (typically a macroadenoma).
Pituitary adenomas are benign clonal
Symptoms may include Headache, Nausea, Visual loss,
neoplasms of the neuroendocrine epithelial cells of the
Double vision and Confusion.
adenohypophysis. It is considered the most common
Pituitary adenomas are best diagnosed by
type of pituitary disorder (1). It accounts for 10-15% of
imaging studies and hormonal testing. The imaging
all intracranial masses (2).
study of choice is an MRI of the pituitary gland without
Pituitary adenomas are classified by size and
and with gadolinium (a contrast agent). A brain MRI or
CT scan paranasal will also reveal most pituitary
microadenomas are less than 1 cm in diameter and
macroadenomas but may not reveal smaller
macroadenomas are over 1 cm in diameter (3).
microadenomas. Beside imaging there is Pituitary
Pituitary adenomas may cause problems
Hormonal Testing, Evaluation, and interpretation of the
because of hormonal hypersecretion, pituitary hormonal
pituitary gland function either for hormonal deficits or
failure, vision loss, headaches and/or bleeding into the
inappropriate hormonal secretion is performed full
tumor (apoplexy) (4).
hormonal profile. Also, Neuro-Ophthalmological
Endocrine-active adenomas that make excess
Evaluation Patients with visual complaints or those
hormones (endocrine-active adenomas) include
whose tumors that contact the optic nerves or optic
prolactin-secreting adenomas known as prolactinomas,
chiasm should receive a full ophthalmological
adrenocorticotropic hormone (ACTH) secreting
evaluation. An evaluation with our neuro-
adenomas causing Cushing's disease, growth hormone
ophthalmologist should include acuity (vision quality)
(GH) secreting adenomas causing acromegaly, and
testing of each eye and formal visual field testing to
thyroid stimulating hormone (TSH) secreting adenomas
determine if there is loss of peripheral vision (2,7).
causing hyperthyroidism. Endocrine-inactive Adenoma
This study was aimed to evaluate the efficacy
Adenomas that do not make excess hormones are called
of the endoscopic endonasal approach in managing
endocrine-inactive or Non-Functional Adenomas (5).
pituitary adenoma concerning the resection rate and
other clinical outcomes. Also, to assess the safety of the
(Hypopituitarism) typically occurs only in larger tumors
(macroadenomas) and results from compression and

damage to the normal pituitary gland from the enlarging
adenoma (6).
This prospective cohort study included a total of
Bleeding (pituitary apoplexy) develops over
hours to several days from hemorrhage and/or infarction
transsphenoidal approaches for pituitary adenomas,
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 66)

c:\work\Jor\vol892_67 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6502- 6508

Predictors of Mortality in Complicated Intra-abdominal Infections:
A Comparative Study between International Scores
Mohamed Shetiwy, Ayman Shemes, Ashraf Abbas, Ahmed Negm
General Surgery Department, Faculty of Medicine, Mansoura University, Egypt
Corresponding author: Mohamed Shetiwy, Mobile: (+20)1223276246, Email: mshetiwy@mans.edu.eg

Due to the known poor prognosis of complicated intra-abdominal infections (cIAIs), a clinically usable
predictive model of cIAI outcomes may be used to identify the high-risk patients and encourage appropriate
The aim of the current work was to evaluate and compare Mannheim Peritonitis Index (MPI) and Sepsis
Severity Score (SSS) validity in predicting the cIAIs related mortality based on score parameters.
Patients and Methods: This observational prospective study included a total of 143 patients with acute abdomen caused
by intra-abdominal sepsis, attending at Department of General Surgery, Zagazig University Hospitals. during the
period from December 2018 to December 2019. The enrolled patients were evaluated by two different scores (SSS and
MPI) without any interference in management decisions or a plan and comparing each score.
Results: For SSS and MPI, respectively, the optimal cut-off points discovered from the curve were 9.5 and 24.5. Both
scores according to the ROC curve demonstrated an excellent mortality prediction, with the area under the curve being
outstanding for both scores (AUC > 0.7). The MPI total accuracy (67.13%) was lower than that of SSS (75%), but MPI
produced true positives indicating higher sensitivity than SSS, which produced more specificity (true
negative). Between MPI and SSS, there was a fair degree of agreement (kappa agreement = 0.603) and a statistically
significant moderately positive correlation (r=o.562).
It could be concluded that MPI score is more sensitive than WSES-SSS in the prediction of mortality,
however, WSES-SSS is more specific for the prediction of intra-abdominal sepsis related mortality.
Intra-abdominal infections, Sepsis, MPI score.


this requires validity and investigations of such scores.
Intra-abdominal infections that are complicated
Accordingly, this comparative study aimed to assess the
(cIAIs) are associated with a poor prognosis and
two-scoring systems validity in mortality prediction of
represent an important cause of morbidity. The
cIAIs based on parameters for scoring.
infectious process in cIAIs spreads outside of the organs
The aim of the work was to evaluate and compare
and results in either localized or generalized peritonitis
Mannheim Peritonitis Index (MPI) and Sepsis Severity
(abdominal sepsis) (1, 2).
Score (SSS) validity in predicting the cIAIs related
To provide adequate care while making the
mortality based on score parameters.
greatest use of available resources and give an

affordable prognostic evaluation, a cIAIs related
outcome model of prediction may be therapeutically
This observational prospective study included a
valuable. This could even lead to a decrease in the death
total of 143 patients with acute abdomen caused by
rate (3).
intra-abdominal sepsis, attending at Department of
The Mannheim Peritonitis Index (MPI) was
General Surgery, Zagazig University Hospitals.
created in a retrospective assessment of peritonitis
during the period from December 2018 to December
patients treated in two surgical departments in Germany
in the 1980s, and it was subsequently confirmed in a

multi-institutional study. The MPI, also known as
Exclusion criteria:
"empirically deduced first risk score," was created with
Patients under 18 years, pregnant women, and
the aim of classifying the cIAIs severity and identifying
patients presented to the ER without having any clear
patients who needed quick and aggressive treatment
signs of sepsis.
using data that could be easily gathered during clinical

examination and surgical exploration (4).
Enrolled patients were evaluated by two different
The World Society of Emergency Surgery
scores (WSES-SSS and MPI) based on a collection of
(WSES) developed the Sepsis Severity Index (SSS),
the data about their parameters without any interference
which is regarded as a novel useful clinical severity
in management decisions or a plan and comparing each
measure for patients with cIAIs. Even during surgery, it
is specific for cIAIs and simple to compute. It can be

important to adjust the intensity of the treatment course,
The chosen patients had extensive history taking,
especially for individuals at higher risk (5).
which included personal information, current illness
As the monitoring scores are essential to identify
history, and information about previous medical
the risky patients to promote aggressive management,
history. This information was obtained from the patients
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 67)

Discussion The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6509- 6517

Incidence of Substance Abuse Related Medical Disorders among
Patients Presented to Mansoura, Emergency Hospital
Mohammed Naeem Ramadan Ali*1, Samir Mohamed Attia2, Ahmed Refat Ragab Ali3,
Hesham Khairy Ismail4
Departments of 1 Emergency Medicine and Traumatology, 2 Vascular Surgery,
3Forensic Medicine & Clinical Toxicology and 4 Critical Care Medicine,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Mohammed Naeem Ramadan Ali Mobile: (+20)1097090484,
E-Mail: Mohamed.naeem@std.mans.edu.eg
Substance abuse is rapidly growing with changing patterns of substance use. There is a substantial
amount of data as regards the correlation between drug abuse and injuries managed in the emergency department
Objective: The aim of the current work was to estimate the incidence of substance abuse related medical disorders
among patients presented to Mansoura Emergency Hospital and the outcome of management of those cases
Patients and methods: This prospective observational clinical study included a total of 250 patients arrived at ED,
Emergency Hospital-Mansoura University with positive history of drug abuse and verified by Urine drug screening.
Results: The incidence of substance use disorders (SUDs) among the studied cases was 11.2%. There were
statistically significant correlations between toxicological screening results and studied cases presentation to
emergency department. Male gender, single status, younger age and low income were the most frequently involved
factors. Drug abusers were significantly increased among smokers.
Conclusion: Of all adult patients presented to ED at Emergency Hospital-Mansoura University, about 10% of them
had SUD. They were mostly male, single, younger age with unsatisfactory income. The outcomes focus on the
significance of the potential roles of the ED as a site for interventions aimed at reducing harm from SUDs.
Keywords: Substance abuse, Emergency, alcohol, Tramadol, cannabis.


An ED visit for an acute change in health,
Substance abuse is a patterned use of a drug
whether from SUDs associated injury, pneumonia,
where the user consumes the substance in amounts or
infections or overdose, offers an opportunity for
with approaches that are hazardous to themselves, and
clinicians to involve cases in discussion in an active
is a form of substance associated disorder (1).
manner, to aid them to make the association between
Substance abuse is rapidly growing with
SUDs and their medical state, that might help offer
changing patterns of substance use. In Egypt, we aren't
motivation for behavior alterations (7).
away from the problem. A lot of researches revealed
Gradually, the practice of actively screening,
increases in the prevalence of the use of tobacco and
illicit drugs, in particular between youth (2).
interventions, and linking cases with SUDs to effective
Alcohol and drug abuse are main healthcare
management has become very common, but for several
problems often associated with ED admission. The
reasons, several EDs haven't comprised the critical
causes for such admissions are several: overdose,
part they could play in this process (8).
The aim of this study was to estimate the
psychosocial troubles, traumas (3).
incidence of substance abuse related medical disorders
Over 20 million Americans experience SUDs
among patients presented to Mansoura Emergency
annually (4). In Middle Eastern Arab nations, in
Hospital and the outcome of management of those
particular Egypt, there is limited data on the problem
of patients with SUDs attending ED in general

hospitals (5).
It has been demonstrated that; there have been
This prospective observational clinical study
a lot of research that discussed the association between
included a total of 250 patients arrived at Department
alcohol and injuries managed in ED. On the other
of Emergency, Emergency Hospital, Mansoura
hand, the majority of ED research comprising
University. This study was conducted between
representative samples of injured patients haven't
February 2021 and January 2022.
considered the use of different drugs. However, a
Emergency Hospital, Mansoura University is a
considerable number of records on alcohol use 6h
level one emergency center with about 250,000 visit
before injury have also demonstrated that other
and 25,000 cases per year.
(illegal) drugs were utilized throughout the same 6-

hour period, although SUDs isn't systematically
Inclusion criteria involved patients of both genders,
comprised in all questionnaires (6).
aged 18 years, with directly related to drug abuse.
Patients with acute intoxication, and direct adverse
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 68)

c:\work\Jor\vol892_69 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6518- 6522

Medical Consultation and Communication with A Family Doctor from
The Patients' Perspective: A Review Article
Mohanad Omar Darwish Alhelo
The Primary Health Care Corporation (PHCC) Qatar
Email: m_alhelo79@hotmail.com,Tel: +46 76 088 23 00, Orcid no.: 0000-0003-4390-8185

The ability for patients to evaluate healthcare based on their experiences is one of the new responsibilities
that have been accorded to them in the current concept of healthcare quality. A survey of the literature reveals that
communication-related difficulties are crucial among the fundamental factors used to gauge patients' happiness.
Objectives: The study's goal was to identify the elements of patient contact with a family doctor that are of particular
Materials and methods: A review of the literature from the years 2018­2022 on communication with family doctors
was performed, including articles based on both quantitative and qualitative studies. The main source of the data was
the English-language online database PubMed, in which articles were searched for based on such key words as: "medical
consultation", "family doctor", "general practitioner", "communication", "patient's perspective". Furthermore,
information was searched for in Polish-language journals, books and textbooks for physicians, using a method of manual
Conclusion: Building a therapeutic doctor-patient relationship, which is the essence of medicine, depends on effective
doctor-patient communication. This is crucial for the provision of high-quality medical treatment. The breakdown in the
doctor-patient connection is the cause of a great deal of patient discontent and complaints. However, many medical
professionals prefer to exaggerate their communication skills. Numerous articles on this significant subject have been
written in the literature throughout the years. Doctors with stronger interpersonal and communication skills are able to
identify issues early, avoid medical emergencies and costly interventions, and provide their patients more assistance.
This might result in improved results, increased patient comprehension of health concerns, and better adherence to the
prescribed course of action, as well as cheaper healthcare expenditures. Currently, there is a higher expectation for joint
decision-making between doctors and patients in order to reach the set objectives and improve quality of life.
Keywords: Benefits, Communication, Doctor-patient relationship, Review, Strategies.

just 21% of patients said they had good contact with
The interpersonal aspects of the patient-
their physicians, despite the fact that 75% of
physician connection are where medicine, as an art,
orthopaedic surgeons polled thought they did. Patients
finds its charm and creative potential. A doctor's
frequently express a desire for improved contact with
interpersonal and communication abilities include the
their physicians in polls.
capacity to interview patients in a way that facilitates
The ancient Greek Cos School is where the
correct diagnosis, advise them effectively, provide them
foundational ideas of patient-centered care were first
with treatment instructions, and build trusting
developed. Patient-centered care hasn't always been the
relationships with them. These are the fundamental
norm in medicine, however. For instance, due to the
clinical abilities required for the successful provision of
poor prognosis for cancer treatments in the 1950s to
medical treatment, with the ultimate objectives of
1970s, the majority of physicians felt it was cruel and
getting the greatest results and elevating patient
harmful to patients to share terrible news. More
happiness (1).
recently, the medical approach has moved away from
To establish and maintain a good therapeutic
paternalism and toward individuality. The predominant
doctor-patient relationship that is comprised of shared
type of communication is information sharing, and the
views and sentiments about the nature of the issue,
present shared decision-making and patient-centered
treatment objectives, and psychological support, basic
communication models are products of the health
communication skills alone are inadequate. This
consumer movement (4).
fundamental ability to communicate builds on
For all patients, but particularly for those with
interpersonal abilities. Appropriate communication
chronic illnesses who must get ongoing, long-term
combines patient- and physician-centered strategies (2).
treatment, effective communication with doctors is
Any contact between a doctor and patient
crucial. According to studies, good communication
should always aim to enhance the patient's health and
helps patients achieve better physical health outcomes
level of medical treatment. Even when many physicians
and manage their own self-care. The Centers for
thought the communication was good or even great,
Disease Control and Prevention estimate that 40% of
studies on doctor-patient interactions have shown
American adults and 60% of people in general have two
patient dissatisfaction. Doctors often overestimate their
or more chronic diseases. 90% of the $3.3 trillion in
communication skills. According to Tongue et al. (3)
yearly health care expenses in the US are attributable to
Received: 1/7/2022
Accepted: 7/9/2022

Full Paper (vol.892 paper# 69)

c:\work\Jor\vol892_70 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6523- 6531

Assessment of Cesarean Section Uterine Scar by Transvaginal
Ultrasound after Single Versus Double Layer Closure Techniques
Hanan Abdelwahab Meselhy Mousa*, Azza Abdelmageed Abdelhamed,
Somayya Magdeldin Sadek, Abdallah Hassan Gad
Obstetrics & Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Hanan Abdelwahab Meselhy Mousa, Mobile: (+20)01004410720,
E-Mail : hananabdelwahab9992@gmail.com

: The best way to show a caesarean section (CS) scar is using transvaginal ultrasound, which has better
detection rates. The objective of the current study is to detect sonographic features of CS scar after single layer and double
layer closure techniques and determine those of better healing and niche development.
Patients and methods: A clinical trial was conducted on 74 pregnant at 39 weeks with single-tone pregnancies.
Participants were divided into 2 equal groups. Group SL included 39 primigravidae who underwent single layer closure
of the uterine incision during CS, and Group DL included 37 primigravidae who underwent double layer closure of the
uterine incision during CS. Participant women were subjected to thorough medical and obstetrical examination, and
ultrasound check 3 months following their operations.
Results: Niche features revealed that patients in the double layer group had a significantly larger niche depth than those
in the single layer group. Additionally, they had significantly greater residual myometrial thickness as compared to the
single-layer group. No statistically significant difference in niche length, breadth, or neighboring myometrial thickness
existed between the two groups. The residual myometrium thickness (RMT)/ adjacent myometrium thickness (AMT) ratio
was utilized as a marker of uterine scar healing, and our findings indicated that patients in the double layer group had
considerably higher healing "RMT/AMT" ratios than those in the single layer group.
Conclusion: With closure of CS incision by double layer, better outcomes have occurred, including incidence of niche
development, residual myometrial thickness and healing ratio than the single layer closure.
Keywords: Cesarean Section, Uterine Scar, Transvaginal Ultrasound, Residual myometrium thickness, Adjacent
myometrium thickness.

However, as ultrasonography is a less invasive imaging
The majority of births are carried out through
technique and is more widely available in clinical settings,
caesarean section, one of the most popular medical
it is typically the first diagnostic resource that most medical
procedures in the world. Although it frequently makes
professionals have at their disposal when examining a
delivery safe, there is still a chance that something bad may
patient who has unexplained uterine hemorrhage.
According to research, in 50% of women who have
thromboembolism as well as hemorrhage are some of the
previously had a caesarean section, transvaginal
short-term consequences of caesarean delivery (1).
sonography (TVS) can, on average, identify the caesarean
Although caesarean delivery's obstetric consequences are
niche (6).
widely known; potential long-term gynecological diseases
In a contemporaneous study, Glavind measured
have received less attention (2).
the residual myometrial thickness, scar defect, depth,
More focus has lately been placed on the
width, and length in 68 women who had single layer
implications of single-layer vs. double-layer uterine
closure and 81 women who had double layer closure using
incision closure after caesarean sections. Single-layer
2D TVS (Transvaginal sonography). The results of the
closure was shown to carry a higher risk of issues than
study showed that double layer closure greatly improves
double-layer closure in a number of instances. However,
scar quality, reduces the length of scar defects, and
most studies on this subject were retrospective (3).
thickens the myometrium. For superior long-term results,
Although clinical results are sparse, double-layer closure is
he also supports two-layer closure (7).
linked to a decreased frequency of big niches and thicker
In 1990, four important sonographic results were
remaining myometrium (4).
described: a wedge defect, an inwardly projecting scar, an
According to the European Niche Taskforce, a
outwardly protruding scar with hematoma, or a retracted
caesarean section site depression that is at least 2
scar. Others have characterized the caesarean scar on
millimetres deep constitutes a niche. The same issue has
transvaginal ultrasound (TVUS) as an anechoic triangular
gone by a number of other names, including caesarean
region with the apex pointing anteriorly or a filling defect
niche, isthmocele post-caesarean section scar defect
on the anterior isthmus. The defect can occasionally be
(PCSD), caesarean delivery scar pouch, and caesarean scar
partially filled with debris and can also resemble a cystic
defect (5).
tumor between the bladder and lower uterine portion (8).
Saline infusion sonohysterography, which has
The objective of this study was to detect
greater detection rates than transvaginal ultrasonography,
sonographic features of CS scar after single layer and
is the best method for showing the c-section niche.



Full Paper (vol.892 paper# 70)

c:\work\Jor\vol892_71 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6532- 6540

Socio-economic Status in Egyptian Patients with Autism Spectrum
Disorder. Does it affect Autism Severity?
Sally S. Zahra, Rana A. Mahmoud, Rania Khedr Abdel Lateef, Batoul M. Abdel Raouf*
Pediatrics Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Batoul Mohamed Abdel Raouf, Mobile: (+20) 01113778353, E-mail: drbatoul@med.asu.edu.eg


Background: Socioeconomic status (SES) exerts a crucial impact on the prevalence of chronic non-communicable
diseases worldwide. The objective of the current study is to assess the SES in children with autism spectrum disorder
(ASD) and its relation to clinical characteristics and disease severity.
Patients and methods: This was a cohort including 200 children diagnosed with ASD, using the Diagnostic and
Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Severity was assessed using the Childhood Autism
Rating Scale (CARS). SES was determined using the scoring system for measurement of socioeconomic status (SES)
in health research in Egypt which was originally developed by Fahmy and El Sherbini in 1983 and then updated by El
-Gilany in 2012. Results: In the studied patients, 57% of the children with ASD belonged to the middle SES group,
compared to 21% and 22% in the low and high SES groups, respectively. Children with lower SES scores were more
likely to experience a delayed diagnosis (p = 0.016). Those with higher SES scores fared better, with lower CARS scores
and higher non-verbal IQ scores (P values 0.034 and 0.003, respectively). The SES and ASD severity groups differed
in a few ways, but the values did not reach statistical significance level. Conclusion: Targeting certain socioeconomic
and demographic factors involved in autism could help to implement tailored preventive and management strategies.
Keywords: ASD, Children, Socioeconomic status, Childhood Autism Rating Scale, DSM-5.

These findings occasionally became less significant
Autism spectrum disorder (ASD) places an
after controlling for additional risk variables, such as
increasingly emotional and financial strain on the
perinatal factors (7), or they were limited to a small
family and the community, particularly in low-income
number of categories, such as ASD with low genetic
nations. It has a complex etiology with risk factors that
predisposition (9). Even after accounting for all
can be changed and those that cannot. For a better
contributing factors and for all cases with ASD
prognosis, efforts should be focused on prevention,
investigated, i.e. with or without accompanying
rapid case detection, and treatment (1). There is growing
intellectual disability (ID), a Swedish study found a
evidence that health symptoms and outcomes may be
definite increase in prevalence in the most impoverished
influenced by socioeconomic status (SES). SES
homes (8).
classification is based on resources available for
The Arab communities have gone through
education, employment, finance, culture, and healthcare
fundamental societal changes during the past ten years
(2). It has been demonstrated that prenatal and
on a variety of fronts, including parental ages, female
developmental variables that may alter the
employment, economic, political, and lifestyle changes.
susceptibility to neuro-developmental diseases are
The incidence of ASD may change due to any of this
influenced by parental SES (3). Additionally, it was
causes (10). Egypt is a developing nation with a low
discovered that SES had a significant impact on
income. The Ministry of Health, which oversees a
disparities in health care services, problem perception,
comprehensive network of healthcare services, is the
age at diagnosis and intervention, ASD severity, and
main supplier of care. All citizens have access to
clinical presentation (4).
subsidized and generally free MOH services. Twenty
Results on SES's effect on autistic spectrum
university hospitals are supported by the budget of the
diseases are contradictory. The underlying mechanisms
Ministry of Education. Compared to MOH institutions,
are intricate and probably have something to do with the
these offer higher-quality care. Egyptians heavily rely
health system. There is a trend for the frequency of ASD
on private healthcare, even though state provision
to be higher in homes with higher SES, as determined
dominates inpatient care services. Most of the doctors
by the parental educational level or ecological measures
working in private clinics and hospitals are employed
of household income, according to numerous studies,
by the government. All of these private services are paid
primarily American and Australian studies. These
for out of pocket by individuals (11).
correlations may mostly be explained by a case
Along with academic hospitals, private clinics
detection bias, with artificially elevated prevalence in
and hospitals primarily provide services for kids with
backgrounds with more favorable demographics (5).
autism. Mendoza and his colleagues (12) compared the
Contrarily, the bulk of research that discovered
costs of ASD in Egypt to those in wealthy nations in an
an elevated risk of ASD in individuals from
effort to determine the economic impact of ASD there.
underprivileged families was conducted in European
They discovered that care and support for ASD are
nations (6-7). Studies revealed an increase in prevalence
frequently based on a household-provider paradigm, in
linked to lower parental occupational class, lower
contrast to western, institution-centered paradigms.
mother education level, or lower household income (8).
Costs associated with ASD in Egypt are mostly the
Received: 07/07/2022
Accepted: 12/09/2022

Full Paper (vol.892 paper# 71)

c:\work\Jor\vol892_72 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6541- 6544

Computed Tomographic (CT) Study of The Pneumatization Pattern of
The Maxillary Sinus Prelacrimal Recess and Its Impact on Endoscopic Access
Mohamed Omar A. Gad1, Omran Khodary2, Mohamed Gaber Taha2
Department of 1Otorhinolaryngology, Head & Neck Surgery and
2Diagnostic Radiology, Faculty of medicine, Assiut University, Assiut, Egypt
*Corresponding author: Mohamed Omar A. Gad, Mobile: (+20) 01227006258, E-Mail: omargad81@aun.edu.eg

The maxillary sinus is the most one vulnerable to lesions. It has a great variation in size, shape, position,
and pneumatization, not only in different persons, but also in different sides of the same person.
Objective: The aim of this study was to define the pneumatization pattern of the maxillary sinus prelacrimal recess and
its impact on endoscopic access.
Patients and methods: A series of 99 paranasal CT scans were analyzed retrospectively to define the pattern of
pneumatization of the maxillary sinus prelacrimal recess. In a total of 198 maxillary sinus, the distance between the
maxillary sinus anterior wall and the anterior margin of the nasolacrimal duct were measured in a millimeter (mm).
Results: A total of 99 patients, 54 (55%) were males and 45 (45%) were females with age ranged from 18 ­ 69 years,
with 198 maxillary sinus prelacrimal recess were measured. There are 3 types of pneumatization: Type I (0­3 mm),
Type II (>3­7 mm) and Type III (>7 mm). In our study we found that type III was found in 24 maxillary sinus (12 %),
type II was present in 156 maxillary sinus (79 %) and type I was present in only 18 maxillary sinus (9 %).
Conclusion: In 12 % of maxillary sinuses there was a widely pneumatized prelacrimal recess, which allow easy
endoscopic access, while in 79 % there was a narrow recess so, temporary lacrimal duct dislocation is required to allow
endoscopic access and in 9 % there was a very narrow recess so, lacrimal duct dislocation is always needed with bone
removal to enable endoscopic access.
Keywords: Maxillary sinus, Lacrimal duct, Prelacrimal recess.

exposure to the anterior wall, alveolar recess and the
The maxillary sinus is the most approached
prelacrimal recess of the maxillary sinus, it became
sinus in endoscopic sinus surgery. Endoscopic access to
possible to preserve the sinus by skeletonizing the
the lesion inside the maxillary sinus may be difficult
lacrimal system before entering anterolateral to it. Also,
particularly if the pathology is located at the floor or the
it is possible to resect the remaining of the medial wall
anterior wall (1).
to allow good exposure to the anterior compartment of
Wide endoscopic middle meatal antrostomy
the maxillary sinus. The amount of bone removal can be
allow excellent access to the posterior and medial walls
tailored according to the extent of the lesion (2).
of the maxillary sinus (2). By endoscopic medial
The goal of this research was to define the
maxillectomy the entire medial wall can be resected.
pattern of pneumatization of the maxillary sinus
The exposure of the lesions along the floor and the
prelacrimal recess and its impact on endoscopic access.
anterior wall are much more difficult. The exposure

may be possible after a type III sinusotomy by using a
70° endoscope, or after an endoscopic medial
A retrospective study that was done in Assiut
maxillectomy (3).
To help excellent visualization of the maxillary
Otorhinolaryngology between December 2019 and
sinus, some endoscopic sinus surgeons do another
March 2021 after receiving institutional ethics
approach at the same time via the canine fossa (4).
committee permission and informed consent.
Lateral rhinotomy or midfacial degloving are external

approaches also provides good access and exposure to
Inclusion criteria: Patients admitted in the
the maxillary sinus and lateral nasal wall, but the
Otorhinolaryngology department Assiut University
morbidity is greater than with an endoscopic modified
Hospital for a non-rhinogenic problem & patients with
medial maxillectomy (5).
rhinogenic problems not destroying the prelacrimal
With the advancement of endoscopic sinus
surgery and the increasing usage of nasal endoscopy for

performing middle meatal antrostomy and endoscopic
Exclusion criteria: Patients with age less than 18
transnasal dacryocystorhinostomy, the relationship
years, nasal trauma, lesions in lacrimal canal, and
between the nasolacrimal pathway and the maxillary
pregnant woman.
sinus became an area of endoscopic research (6, 7).

With the description of the prelacrimal recess
After fulfilling all inclusion and exclusion criteria all
approach (PLRA) by Zhou et al. (8) by preserving the
patients were subjected to:
integrity of the nasolacrimal pathway and keeping the
I- Full history taking including:
inferior nasal concha intact and obtaining good
1- Personal History.
Received: 06/07/2022
Accepted: 11/09/2022

Full Paper (vol.892 paper# 72)

c:\work\Jor\vol892_73 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6545- 6547

Ultrasonography in Early Stage of Rheumatoid Arthritis and
Psoriatic Arthritis: Review Article
El-Sayed Ahmed Hassan Fahmy El-Sayaad1, Ahmed said Abdelshafy2,
Elham Ali Abdo Ali*1, Mohamed Atia Mortada1
Departments of 1Rheumatology Rehabilitation and Physical Medicine and
2Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Elham Ali Abdo Ali, Mobile: (+20) 01066100625, E-Mail: elhamali9296@gmail.com

Musculoskeletal ultrasound (MSUS), which is also known as the rheumatologist's third eye, stethoscope, or
extended finger, is now widely regarded by rheumatologists as an extension of their clinical examination and a crucial tool
in their diagnostic collection.
Objective: Assessment of ultrasonography in the early stage of rheumatoid arthritis and psoriatic arthritis.
Ultrasonography, Early stage, Rheumatoid arthritis and Psoriatic arthritis 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 November 2001 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: As there is no ionizing radiation or claustrophobia risk, US is a reasonably affordable and patient-friendly
imaging technique. Due to MSUS's great sensitivity in identifying inflammatory and structural lesions, this imaging
technique may definitively identify the pathology behind symptoms including pain, stiffness, and restricted range of
Keywords: Ultrasonography, Early Stage, Rheumatoid Arthritis, Psoriatic Arthritis.

compared to those who are seropositive, and may thus need
The area of musculoskeletal ultrasound (MSUS) has
delayed diagnosis (5). Early diagnosis is essential for
expanded rapidly since Dussik initially wrote on the use of
seronegative individuals as well since early therapy
ultrasound (US) to scan articular and periarticular tissues
benefits all patients (6).
in 1958 and the first in-depth US imaging of a human joint
Early polyarticular psoriatic arthritis is frequently the
in 1972 (1).
predominant differential diagnosis for seronegative early
This growth has been fueled by rheumatologists'
RA types. Its diagnosis may be challenging when dealing
increased interest in and use of the technology, as well as
with modest or unusual cutaneous or nail symptoms (7).
technological advancements that have resulted in the

development of high resolution transducers that can image
MSUS Advantages:
superficial structure (2). Musculoskeletal ultrasound
Due to the lack of ionizing radiation or claustrophobia
(MSUS), which is also known as the rheumatologist's third
concerns, US is a very affordable and patient-friendly
eye, stethoscope, or extended finger, is now widely
imaging technique (8).
regarded by rheumatologists as an extension of their
MSUS is more accurate than conventional
clinical examination and a crucial tool in their diagnostic
radiography for identifying joint structural deterioration.
collection (1).
This imaging approach can successfully identify the
Early seronegative rheumatoid arthritis diagnosis can
pathology underlying symptoms such as pain, stiffness,
be difficult, potentially leading to incorrect treatments and
and limited range of motion because to MSUS's superior
diagnostic blunders. This is probably caused by the lack of
sensitivity in identifying structural and inflammatory
precise indicators for seronegative RA as well as the more
lesions. MSUS can be used to identify the disease, monitor
challenging early-stage RA categorization (3).
the illness' development, and evaluate the efficacy of
Disease-modifying anti rheumatic drug (DMARD)
treatment. It may also be used to evaluate the degree of
treatment and diagnosis of patients with seronegative RA
structural damage and anatomical inflammation in early
were delayed, according 2010 categorization criteria.
arthritis. It may be used to spot early erosions, enthesitis,
Additionally, seronegative RA patients had a lower
and subclinical synovitis. It can also help articular and
remission rate, indicating that they may be more likely to
periarticular procedures work better (9). Additionally, US
miss the window of opportunity for intervention (4).
is simple to repeat and may be used to evaluate many joints
Despite often being thought of as having a less
at once (unlike MRI). Additionally, dynamic tests may be
inflammatory and damaging version of RA, according to
carried out while the joints and tendons are moving (10).
2010 (American College of Rheumatology) ACR/EULAR

(European League Against Rheumatism) criteria,
RA and psoriatic arthritis (PsA) US findings:
individuals who are seronegative need to exhibit more
Studies appear to support the hypothesis that
clinical symptoms before being diagnosed with RA,
significant extra-synovial involvement might help identify
Received: 06/07/2022
Accepted: 11/09/2022

Full Paper (vol.892 paper# 73)

c:\work\Jor\vol892_74 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6548- 6555

Impact of Estrogen Receptor 2 Gene Polymorphisms and Expression, on
Risk and Progression of Hepatocellular Carcinoma among Women with
Nonalcoholic Fatty Liver Disease
Nearmeen M. Rashad1*, Abdelmonem Mohamed Elshamy2,
Marwa H.S. Hussien3, Ola M. Elfarargy4, Amira M. El-Helaly5, Ahmed F. Gomaa1
Departments of 1Internal Medicine, 2Tropical Medicine, 3Medical Biochemistry, 4Medical Oncology, and 5Clinical
Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Nearmeen M. Rashad, Mobile: (+20) 01224248642,
E-mail: nrashad78@yahoo.com & n.rashad@zu.edu.eg.
: Given that risk for hepatocellular carcinoma (HCC) is linked to liver cirrhosis. There is accumulating
evidence that estrogen influences liver function via estrogen receptors (ERs), which are dysregulated in many cancers
all over the body. Objective: We aimed to investigate the ESR2 genes (rs1256049 and rs-4986938) polymorphism and
mRNA expression in patients with nonalcoholic fatty liver (NAFLD), in correlation with the risk and progression of
HCC among Egyptian women with NAFLD. Patients and Methods: Case-control study enrolled fifty women with
NAFLD and fifty healthy women. Serum E2 level was determined using ELISA. Genotyping of ESR2-SNPs
(rs1256049 and rs4986938) was performed by PCR-RFLP. ER2 mRNA values were explored by RT- PCR.
Results: There were non-significant differences concerning ER2 mRNA expression levels among studied groups.
Concerning genotype of ESR2 (rs1256049), in NAFLD group the frequencies of the AA, GA were higher than in
controls (OR = 22.62,95% CI = 2.8- 182.6, P 0.001 and OR = 8.7,95% CI = 1.77- 42.69, P 0.001 respectively).
Additionally, A allele OR = 13.5,95% CI = 4.58- 39.76, P 0.001). There were non-significant differences in frequencies
of GG, GA, and A allele between case and control groups P >0.001. Regarding ESR2 (rs1256049), the only significant
parameter was A allele OR = 4.71,95% CI = 1.96-11.33, P 0.001 in cirrhotic NAFLD compared to non-cirrhotic
NAFLD. ESR2 (rs1256049) polymorphism was significantly higher in HCC. Thus, it could be a predictor of HCC
among NAFLD patients. BMI, HOMA-IR, E2, and FIB-4 scores were highly correlated with HCC in both cirrhotic and
non-cirrhotic NAFLD groups by applying a logistic regression test.
Conclusion: ESR2 (rs1256049) polymorphism was significantly higher in HCC. Thus, it could be a predictor of HCC
among NAFLD patients.
Keywords: NAFLD, HCC, Cirrhotic, ESR2 genes, Genotype.

Estrogen Receptors 2 (ERs) are expressed in
Consistent evidence indicates that the
many tissues and organs all over the body. Intriguingly,
prevalence of nonalcoholic fatty liver disease (NAFLD)
ER dysregulation over or under-expression could be led
is increasing and is supposed to be the most indicator
to many diseases and cancer [9]. Overall, there is modest
for liver transplantation [1]. Emerging evidence indicates
evidence to support the association of ER (ESR1 and
that about 40% of the population had NAFLD [2].
ESR2) with risk, clinicopathological features, and
Furthermore, steatohepatitis affects around 1.5%­6.5%
progression of cancers [10].
of the general population worldwide. Nowadays, it is
Nonetheless, there is evidence that ESR2
influences the precancerous genes [11]. There is
inflammation, and hepatocyte ballooning, which is the
convincing evidence that under-expression of ESR2 is
main histopathological criterion of steatohepatitis is
related to susceptibility and severity of gall bladder
associated with the rapid progression of liver fibrosis[3].
cancer [12-13].
Several pieces of evidence have shown that
Remarkably, HCC etiology varies according to
cirrhosis is a precancerous disorder [4]. There is
the different epigenetic and genetic dysregulations.
convincing evidence that the current pandemic of
Even though the understanding of the pathogenesis and
obesity and its associated NAFLD led to cirrhosis.
etiology of the disease has improved, still we needed
Nowadays, it is widely recognized that the prevalence
further studies. Thus, we aimed to investigate whether
of HCC-related NAFLD is growing and about 15­20%
polymorphism of ESR2 genes rs1256049 and rs-
of NAFLD patients have HCC in Western countries [5].
4986938 are associated with NAFLD and to determine
From a clinical perspective, the currently well-
a possible impact of this polymorphism on the risk and
documented diagnosis of HCC depends on noninvasive
progression of HCC of Egyptian women with NAFLD.
diagnostic markers [6]. In recent years, considerable

attention has focused on liver function regulations and
The current study was conducted on one
the role of sex hormones, in particular estrogen, in liver
hundred participants; 50 women with NAFLD and fifty
growth and function regulations [7]. Additionally,
healthy volunteers without liver disease, were included
estradiol prevents lipid accumulation and liver steatosis
as the control group. The flowchart of the study is
by decreasing lipogenesis and enhancing lipolysis [8].
demonstrated in figure 1.
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 74)

c:\work\Jor\vol892_75 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6556- 6560

Vit D Deficiency Among Patients with Lichen Planus in Najran KSA
Abdul Hakeem Mohammed Saeed1, Mahdi Turki Bin Ali Alfataih2, Bader Maiedh Mohsen Al Adainan2
1 Dermatology Department, Faculty of Medicine, Najran University, Saudi Arabia
2 Medical intern, Najran University, Saudi Arabia
*Corresponding author: Mahdi Turki Bin Ali Alfataih. Email: Alfataih.Mahdi@gmail.com
Mobile: 0966558948601
Lichen planus (LP) is a chronic inflammatory autoimmune skin disorder that commonly affects the skin,
oral mucosa, genital mucosa, scalp, and nails. Vitamin D has properties of anti-inflammatory with immunomodulatory
effects and some antioxidant effects.
Objectives: This research aimed to assess the level of serum vitamin D among patients with Lichen Plans and also to
do a comparison with the healthy control group
Subjects and Methods: A case-control study was carried out. Thirty-three patients with Lichen planus and 30 normal
healthy controls were involved in this study. The blood samples were taken and collected to assess the serum levels of
25-hydroxy vitamin D, from all the patients and the control subjects.
Results: The Mean serum level of Vitamin D in patients with LP was 16.7 ± 6.0, which was significantly lower than
that of normal subjects (21.4 ± 8.9), with P value = 0.029.
Conclusion: Our research showed a lower level of Vit D among patients with LP. Also, there may be other factors that
play roles in provoking LP and its immunopathogenesis.
Keywords: Lichen planus, Vitamin D, Etiology, Pathogenesis, Oral lichen planus.

procedure in the skin [6, 7]. Vitamin D also has a clear
Lichen planus (LP) is a chronic skin disorder
role in the way of the response of immune reaction with
characterized by inflammatory processes involving the
some anti-inflammatory possessions [8, 9, and 10]. Vitamin
skin and to some extent, the mucosal membrane, nails,
D also has effects on embarrassment of T-helper 1
and hair with the prevalence of one percent of the whole
explosion, motivation of adjusting T cells, with some
population. The onset of the disease can occur at any
conquest of B lymphocyte diversity, and also shares in
age, but the disease usually starts in middle-aged adults.
reserve of the proclamation of immunoglobulin. It
The precise etiology of Lichen Planus and its
likewise inhibits the antigen exhibition and leads to
pathophysiology is still not fully understood. An
modulation of dendritic cells maturation [11].
immunological mechanism including activated CD8+ T
On the other hand, Vitamin D also down-
cells, directed against the lowermost layer (basal
regulates the construction of cytokines, such as
keratinocytes) of the epidermis, which leads to changes
interleukin (IL)-1, TNF-alpha, IL-6, and IL-8 [12]. For
in keratinization of the skin has been proposed.
these factors, the immunomodulatory properties, and
Regarding the Previous reports which elicited
decreased vitamin D level may affect the regulatory T
upregulation of ICAM-1 with the association of helper
cell numbers, and other T lymphocytes, such as T-h1
T cell cytokines and type 1 (Th1) - driven immune
that play a role in a number of inflammatory diseases,
response [1, 2].
notably LP. Consequently, lack of vitamin D could put
The T-helper1/T-helper2 ratios in patients with
people at risk for developing Th1-dominant
LP are high, this supports the idea that T-helper1 may
immunological diseases as LP [13, 14].
have a dominant role in the pathogenesis of LP [3].
Limited research has examined the amount of
The effect of cytotoxic CD8+ T lymphocytes that
blood vitamin D in individuals experiencing lichen
are provoked during MHC class II antigen presentation
planus to yet, and indeed the results are conflicting [15,
of Langerhans cells to CD4+ T-helper cells is
16, 17].
responsible for the toxicity toward keratinocyte antigens
The aim of this study was to investigate the
in the lower layer of the epidermis (basal layer), which
association between lichen planus and Vitamin D
lead to degeneration of this layer [4].
deficiency. We measured the level of vitamin D in the
Vitamin D is a hormone that mainly controls the
serum of lichen planus patients and to do a comparison
regulation of calcium and phosphorus homeostasis [4, 5].
with that of the control group.
It is also responsible for some antiangiogenic properties

in addition to pro-differentiating, anti-proliferative, and
pro-apoptotic effects. Vitamin D receptor (VDR) which
Study design and groups
is a specific nuclear hormone receptor is the main
A case-control study design was conducted. We
responsible part of vitamin D's biological function [6].
involved all patients with lichen planus diagnosed at the
Regarding the physiological effects, vitamin D is
Dermatology Clinic in Najran University Hospital over
responsible for the regulation of proliferation and
the past two years from Feb. 2019 to Dec. 2021. All the
differentiation of keratinocytes, also to some extent for
cases with the typical presentation were diagnosed
skin immune system homeostasis, besides the apoptotic
clinically while in the suspected cases the diagnosis was
Received: 01/07/2022
Accepted: 07/09/2022

Full Paper (vol.892 paper# 75)

c:\work\Jor\vol892_76 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6561- 6567

Comparison between Soft and Conventional Antagonist protocols for Estradiol
Level and Number of Growing Follicles in Women of Poor Ovarian Response
Nidhal Salim Alwan*, Manal Taha Al-Obaid , Lubna Al-Anbari
High Institute for Infertility Diagnosis and Assisted Reproductive Technologies,
Al-Nahrain University, Baghdad, Iraq
Corresponding author: Nidhal Salim Alwan, Mobile: 009647901749879, Email: Nalooly@yahoo.com


Introduction: Poor ovarian responders (PORs) are defined as the group of infertile women who are characterized by
decreased response of the ovaries to stimulation. Recently using soft protocol with low doses of Gn with/without oral
compounds like letrozole seems superior to the conventional high doses since it is less cost-effective.
Objective: Comparing of soft versus conventional GnRH-antagonist protocol in POR for estradiol level and number of
growing follicles.
Patients and Methods: This was a prospective randomized controlled trial including eighty infertile POR according to
Bologna criteria that were divided into two equal groups and undergoing IVF (In vitro fertilization)/ICSI
(Intracytoplasmic sperm injection) antagonist protocols. One group underwent soft protocol by using letrozole 2.5 mg
twice daily for 5 days starting from cycle day 2-3 overlapped low-dose Gn 225 IU from cycle day 4-5. Other group
received high dose Gn only 450 IU from cycle day 2-3.
Results: Basal demographic characteristics and hormones, comparison showed no significant difference. The mean
AFC was not significantly different (P > 0.05) between the two groups with the number of the growing follicles at day
of starting antagonist and at day of trigger. There is a significant difference in the total units of Gn used.
Conclusion: Soft protocol is a good option for POR since obtaining the same ovarian response with less cost.
Poor ovarian responders, Soft stimulation, Conventional stimulation, Letrozole, Gonadotropins.


The live birth of a single and healthy infant is
standardizing the description of POR. These criteria
the aim of the recent assisted reproduction technology
consist of the following:
(ART). This aim is intended to be accomplished with
(1) The age of women (more than 40 years old) or any
less time and cost to increase patient satisfaction and
other factor that increases the risk of POR.
safety. In spite of the rapid progress that has been made
(2) The women had prior experience with IVF or ICSI
in ARTs over the period of the past 40 years, there are
and were able to collect at least three (or less than 3)
still several issues that have not been resolved like the
oocytes using a conventional stimulation procedure.
problem of managing clinically the women who have
(3) An abnormal ovarian reserve test, which is defined
POR, which is still a matter of debate and disappointing
as an antral follicle count that is lower than 5­7 follicles
for the women and the clinician (1). The percentage of
or an AMH level that is lower than 0.5­1.1 ng/ml (6).
women who have a poor ovarian response ranges from
After the age of 35, the chance of getting
5.6% to 35.1%, depending on how the term "poor
pregnant and having live birth begins to reduce
response" is defined (2).
dramatically and providing successful treatment for
The etiology and pathogenesis of POR is
these patients continues to be an important issue for
complex and only parts of it have been understood and
ART programs (7).
recognized like the effect of age and its relation to
Poor ovarian response (POR) is characterized by
decrease the number and quality of ovarian follicles,
a decline in ovarian function that is substantially greater
chromosomal and genetic abnormalities and advanced
than what is considered to be within the normal range
endometriosis (2). The technologies of assisted
for the woman's age (8). The oocyte donation is now
reproduction have shown progressive development in
regarded the most effective and reliable option for POR
the field of clinical knowledge and technology in order
but the vast majority of patients are insisting to use their
to increase the success rate of pregnancy, which is still
own oocytes even though doing many trails of ART
in relation to the number of eggs obtained after
cycles in order to be pregnant (9).
ovulation induction by Gn (3).
Many of the procedures that are employed for
There have been numerous trials done for
patients who are POR are concentrating on reducing the
management of POR using different protocols, but these
amount of gonadotropins they received (10).
efforts have not been successful in identifying the exact
They are prone to longer and more expensive
protocol, which is most effective (4). The heterogeneity
cycles because of the higher cancellation rates that are
of this group of women may be the reason behind the
experienced. In addition to the financial burden that
difficulty in identifying the most effective strategies in
results from limited working days and expensive
management of POR (5). In 2011, the European Society
treatment, they also face with the emotional load that
of Human Reproduction and Embryology (ESHRE)
result from repeated failed cycles (11).
developed the Bologna criteria with the intention of

Received: 1/7/2022
Accepted: 7/9/2022

Full Paper (vol.892 paper# 76)

c:\work\Jor\vol892_77 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6568- 6573

Effect of Visceral Mobilization on Abdomino-Phrenic Dyssynergia in
Irritable Bowel Syndrome Patients
Eman Essam EL-Din Hammam*1, Akram Abdelaziz Sayed1,
Fatma Abdelkader2, Alaa Mohamed El-Moatasem1
1Department of Physical Therapy for Cardiovascular/Respiratory Disorders and
Geriatrics, Faculty of Physical Therapy, Cairo University, Egypt
2Department of Internal Medicine, Faculty of Medicine, Al-Azhar University, Egypt
*Corresponding author: Eman Essam EL-Din Hammam, Mobile: (+20) 01025211326, E-Mail: eman.essam49@gmail.com

Irritable Bowel Syndrome (IBS) is among the highest debilitating, commonly diagnosed gastrointestinal
disorder. Considering its chronic nature, it would be more beneficial to resort to a treatment option that doesn't have a
long-term drug effect.
Objective: This research assessed the impact of visceral mobilization on abdomino-phrenic dyssynergia in IBS patients.
Patient and Methods: 60 female IBS patients (constipation subtype), equally split into two groups, were recruited from
Boulak Al Dakror General Hospital outpatient clinics. Subjective distention feeling and girth measurement were
assessed for all participants, as well as psychiatric assessment was done by two scales; Beck Depression Inventory and
Spielberger State-Trait Anxiety Inventory. Both groups followed a low fermentable oligosaccharides, disaccharides,
monosaccharides and polyols (FODMAP) diet with their prescribed medications. Group A received visceral
mobilization, while group B received medical care only.
Results: Post 6 weeks of intervention, the study group had a significant lowering in median subjective distension feeling
score by (1.50 (1.00-2.00)) contrasted to the control group (3.00 (2.00-4.00)) (P<0.001). The mean girth measurement
was significantly decreased by 8.00±3.22 cm in the study group contrasted to 2.60±0.93 in the control group (P< 0.001).
The study group had a significant reduction in depression score by 14.80±8.11 points compared to the control group by
2.97±3.66 points (p<0.001). Furthermore, the study group showed a significantly lower mean trait anxiety score by
22.57±10.67 points than the control group by 3.83±2.44 points (P<0.05).
Conclusion: Visceral mobilization effectively normalizes mechanical, vascular, and neurological bowels dysfunctions
in IBS patients.
Keywords: Visceral mobilization; Irritable bowel syndrome; Abdomino-phrenic dyssynergia.

sudden and unexpected death if a potential medicine
Irritable bowel syndrome (IBS) is a chronic,
might eliminate their IBS symptoms [1].
frequently debilitating, and widespread illness of gut-
Abdomino-phrenic dyssynergia occurs when
brain interaction (formerly known as functional
some patients with abdominal distension have a
gastrointestinal [GI] disorders) [1].
paradoxical abdomino-phrenic response to elevated
IBS is a widespread and potentially severe
intraluminal gas. The diaphragm contracts (descends)
gastrointestinal illness characterized by abdominal pain,
while the anterior abdominal wall muscles relax during
distention, and alterations in bowel routines, excluding
this action. This is in contrast to the normal physiologic
organic pathology [2]. IBS is linked to a significant drop
reaction to rising intraluminal gas, in which the
in health-related quality of life, higher rates of
diaphragm relaxes and the anterior abdominal muscles
somatization, increased risk of psychological
contract to enhance the craniocaudal capacity of the
comorbidity, including depression and suicidal
abdominal cavity while avoiding abdominal protrusion
thoughts, and work impairment, as well as higher
[5]. Findings of previous studies showed that visceral
annual medical and prescription medicine [3].
mobilization was useful for improving intestinal
The onset is triggered in a genetically
symptoms significantly (bowel movement frequency,
predisposed person. Changes in the gut, those brought
stomach pain or distress, difficulty eliminating stools
on by diet or gastrointestinal tract (GIT) dysfunction,
and gas, feeling of distention and incomplete bowel
reflect on the brain and negatively affect psychological
movement, and anal pain) [6].
health. Greater dysbiosis response from the gut
Accordingly, we sought to investigate the
microbiota may have a role in mediating these effects.
impact of intestinal motility on abdomino-phrenic
Similarly, the CNS may impact GIT physiology by
dyssynergia in irritable bowel syndrome female
changing motility or GIT sensitivity. Shifts in intestinal
transit with the experience of pain can result in

alteration in bowel habits [4].
IBS mostly targets women and people under the
This research involved 60 female patients with
age of 50. IBS has a significant negative influence on
moderate IBS (constipation subtype) from October
the quality of life of patients. Moreover, patients might
2021 to September 2022. They were recruited from
sacrifice 10-15 years of life span for quick treatment. In
outpatient clinics of Boulak Al Dakror General
contrast, patients with IBS might tolerate a 1% risk of
Hospital. Equally split into two groups, Subjective
Received: 06/07/2022
Accepted: 11/09/2022

Full Paper (vol.892 paper# 77)

c:\work\Jor\vol892_78 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6574- 6580

Predictors of LV Recovery after Proximal Left Anterior Descending Artery Stenting
Rana Mohammed El Helf, Ahmed Ahmed Wafa, Mohammed Salah A. Hussein*
Cardiovascular Medicine Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
*Corresponding author: Mohammed Salah Ahmed Hussein, Mobile: (+20) 01064099487,
Email: dr_mohammed_salah@yahoo.com
The presence of proximal left anterior descending artery (LAD) stenosis is an important independent
predictor of mortality & major adverse cardiovascular events (MACE). Speckle tracking is highly sensitive for the
detection of subclinical impact of both ischemia and revascularization on global and regional myocardial function.
Objective: The study aims to assess global and regional left ventricular strain, in patients with significant proximal left
anterior descending coronary artery stenosis, before and after percutaneous revascularization, and its relation with
Methods: A total of 53 patients were admitted to Mansoura University's Cardiovascular Department between December
2017 and November 2018 for elective proximal left anterior descending artery (LAD) stenting. 2D echocardiography
and speckle tracking were done before and one month after percutaneous coronary intervention (PCI), assessing left
ventricular ejection fraction (LVEF). Global Longitudinal Strain (GLS), mean LAD territorial strain & left ventricular
(LV) function with clinical follow-up for cardiovascular MACE after one year.
Results: There was presenting significant impaired GLS and mean LAD strain even with normal EF (median -13.5 /-
11.9) respectively with significant recovery The mean LAD territorial strain one month after PCI than GLS, with p-
value <0.001/ <0.01 respectively. However, GLS recovery was found to be the most valuable predictor for the
occurrence of MACE one-year follow-up (p-value: 0.019).
Conclusion: GLS & mean LAD territorial strain provided a more precise objective quantification of successful global
and regional recovery of LV function after proximal LAD revascularization & predictor for MACE.
Keywords: Proximal LAD stenosis, GLS, mean LAD territorial strain, LV recovery.

guidelines on myocardial revascularization recommend
Proximal left anterior descending coronary artery
a "heart team" discussion in both chronic and acute
stenosis (P-LAD) is known to be a high-risk lesion due
coronary syndromes with proximal LAD stenosis >50%
to long-term morbidity and decreased survival as
with a class I recommendation and level of evidence A
compared to distal lesions or other territories (1).
to both, PCI and CABG (7).
Proximal LAD stenosis alone is a significant
The choice between conservative therapy, PCI, or
predictor of cardiac deaths because its related
CABG for P-LAD stenosis should depend on the cost-
myocardial infarction is commonly fatal (2), moreover
benefit ratios of these treatment strategies, comparing
autopsy for 86% of acute myocardial infarction deaths
the possible complications (e.g., stroke, bleeding, renal
were related to proximal LAD culprit (3).
insufficiency, arrhythmias, or sepsis) with the
Stable coronary artery disease with high-grade
refinement of the quality of life, in addition to long-term
proximal LAD lesions is at higher risk for LV
freedom from MACE as mortality, infarction, or repeat
dysfunction with poor prognosis owing to the large area
revascularization (8).
of involved myocardium that considers an early
Kinnaird et al. (9) reported no differences
invasive approach than conservative medical therapy (4).
between surgical LIMA graft or percutaneous DES
Percutaneous revascularization of proximal LAD
implantation for isolated P-LAD stenosis as regards
lesions has managed to improve short- and long-term
deaths, myocardial infarction, and cerebrovascular
physical activity and quality of life in comparison with
events; however, there was a significant decline in
the medical conservative strategy (5).
repeat revascularization rated in CABG patients.
The proximal LAD stenting is a challenging high-
Additionally, Kapoor et al. (10) reported that
risk procedure due to concern about the left main artery
CABG was Superior to PCI as regards symptom relief
or major side branches injury. Therefore, coronary
and repeat revascularization with no differences as
artery bypass grafting (CABG) is usually considered,
regards death, stroke, or MI.
even in patients with a sole P-LAD lesion (4).
However, studies on newer-generation DES
The 2011 American Heart Association/American
compared with first-generation DES for P-LAD
College of Cardiology (AHA/ACC) and 2012
reported that; at >3 years follow-up, death rates declined
AHA/ACC stable angina guidelines both reported the
by 35%, cardiac death and infarctions decreased by
superiority of surgical strategy with LIMA graft in P-
30%, and instant thrombosis reduced by >50% (11).
LAD lesions (>70% stenosis) (indication IIa, level of
Despite being the most commonly used tool in
evidence B), to PCI (class IIb, level of evidence B)
daily clinical practice for the evaluation of LV function,
regards survival rate (6).
echocardiographic LVEF has many limitations such as
While, the latest European Society of Cardiology
intra and interobserver variability, affected by preload
ESC/European Association of Cardio-Thoracic Society
Received: 06/07/2022
Accepted: 11/09/2022

Full Paper (vol.892 paper# 78)

Full Paper (vol.892 paper# 79)

c:\work\Jor\vol892_80 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6589- 6595

Role of Hydroxychloroquine in Rheumatoid Arthritis and Systemic Lupus
Erythematosus Patients during COVID-19 Pandemic
Noha H. Elnagdy1, Ali Sobh2, Mohamed Elegezy3, Mohamed Mofreh4, Ahmed Hazem El-nagdy5, Mohamed
Tohlob6, Marwa H. Elnagdy7, Ahmed E. Abdulgalil8
1Department of Physical Medicine, Rheumatology and Rehabilitation,
2Department of Pediatrics-Mansoura University Children's Hospital,
3Department of Endemic medicine, 4Department of Clinical Pathology,
6Department of Chest Medicine, 7Department of Medical Biochemistry and Molecular Biology,
8Mansoura nephrology and dialysis unit, Faculty of Medicine, Mansoura University, Egypt.
5Department of Microbiology, Faculty of Dentistry, Horus University, Damietta Elgadeda, Egypt
*Corresponding Author: Noha H. Elnagdy, Email: n.elnagdy86@mans.edu.eg,
Phone no:00201116118771, Orcid id: 0000-0002-2135-3599

Antimalarial drugs including Hydroxychloroquine (HCQ) and chloroquine have been demonstrated to be
associated with anti-inflammatory actions in different connective tissue diseases (CTD) as rheumatoid arthritis (RA)
and Systemic Lupus Erythematosus (SLE). One of the points of interest was the emergent antiviral effect of these drugs
against Covid-19 infection. However, this antiviral effect is still debatable. Objective: The objective was to study HCQ
effects on the severity and outcome of COVID-19 infection in patients with RA and SLE.
Patients and Methods: A total of 94 cases diagnosed as RA and SLE with COVID-19 infection were comprised in the
study and were categorized into 2 groups: the first group included patients who were receiving HCQ treatment before
infection, and the second group included patients who were not receiving HCQ before. Clinical, laboratory, and
radiological findings as well as the outcome of patients were assessed to compare the severity of COVID-19 infection
in both groups. Results: Demographic data showed higher female predominance. Fever, cough, rhinorrhea, and myalgia
were observed in both groups with no significant variation except for rhinorrhea. D-dimer was significantly increased
in the first group. Decreased oxygen saturation, need for mechanical ventilation, radiological changes suggestive of
COVID-19 infection, and acute kidney injury (AKI) were more observed in the HCQ group with statistical significance.
Conclusion: HCQ administration was not associated with less severe infection or better outcomes in RA and SLE
patients infected with COVID-19.
Keywords: Hydroxychloroquine, Rheumatoid Arthritis, Systemic Lupus Erythematosus, COVID-19.

Therefore, the US Food and Drug Administration
Coronaviruses are viruses that can affect both
emergently approved it for the management of cases of
animals and humans. They may be associated with a
variety of respiratory disorders such as severe acute
SOLIDARITY trial, demonstrated that the usage of
respiratory syndrome (SARS), Middle East respiratory
HCQ wasn't accompanied by either benefit or harm in
syndrome (MERS), and COVID-19 which is induced by
the management of COVID-19- infected patients. Also,
SARS-CoV-2 (1). Although the infection with SARS-
results from later randomized controlled trials, such as
CoV-2 might be without manifestations, multiple vital
the RECOVERY trial, showed that HCQ wasn't
organs have been proven to be affected. The respiratory
beneficial in hospitalized COVID-19 patients (9). It has
system is the most common site to be affected (2).
been concluded that the evidence about the efficacy and
Pneumonia is one of the most serious manifestations of
safety of HCQ regarding COVID-19 management was
this viral infection and may be life-threatening (3).
feeble and conflicting (10).
Various treatment strategies have been used
Infection with COVID-19 might be very
since the beginning of the pandemic including HCQ
extensive in cases with CTD. Despite the lower
which is a commonly utilized DMARD in the context
possibility of severe COVID-19 infections in patients
of RA and SLE management (4,5). The use of HCQ was
receiving HCQ and/or glucocorticoid therapy with low-
based on its different mechanisms of action including
to medium-dose, immunosuppressive agents should be
decrement of replication of the virus in vitro, inhibition
used with extra caution due to their dysregulated
of production of cytokines and costimulatory
immune response (11).
molecules, alteration of cell pH, affecting the lysosomal
The beneficial role of HCQ in CTD patients
activity and signaling pathways as well as autophagy (6).
infected with COVID-19 is questionable (12). Also, the
The fact that HCQ has a very high
effect of HCQ on the severity of infection and its effect
concentration in the lung that it may reach a hundred
on outcome in this group of patients is controversial. We
times more than its concentration in the blood, led to the
carried out the present study to assess whether HCQ use
belief in its possible therapeutic effect concerning
influences the severity and outcome of COVID-19
COVID-19- associated pneumonia management (7).
infection among cases with RA and SLE.
Received: 1/7/2022
Accepted: 7/9/2022

Full Paper (vol.892 paper# 80)

c:\work\Jor\vol892_81 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6596- 6604

Role of Aortic Isthmus Doppler Ultrasound in Fetuses with
Intrauterine Growth Restriction
Hesham Ahmed Abdelsalam*, Ibrahim Abdul -Aziz Libda,
Ahmed Abdelhameed Mohammed, Marwa Elsayed Abdelhamed
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hesham Ahmed Abdelsalam, Mobile: (+20) 0111348 6747, Email: hetshoahmed92@gmail.com
Poor perinatal outcome and cerebral palsy have been linked to intrauterine growth restriction (IUGR).
New Doppler metrics, like the aortic isthmus (AoI), can be used to detect and assess the severity of IUGR in fetuses.
The aim of the current study is to investigate the better diagnosis of intrauterine growth Restriction using the aortic
isthmus Doppler. Patients and methods: A cross-sectional study was conducted on 74 women with a singleton
pregnancy between 24-34 weeks, with fetal growth restriction and placental insufficiency, between September 2021 and
March 2022. Repeated Doppler evaluation of umbilical artery, middle cerebral artery and aortic isthmus artery were
assessed until one day before pregnancy termination by 37 weeks. Correlation of Doppler findings with perinatal fetal
outcomes was done. Results: As regard aortic isthmus artery resistance index (RI), it differed significantly between
both groups as first visit, before termination, decrease and % decrease, as well as regard perinatal outcome as general
anesthesia at delivery and neonatal ICU admission. Validity (area under the curve (AUC), sensitivity, specificity) for
aortic isthmus, middle cerebral artery as well as umbilical artery at RI First visit to prognoses birth weight 2 kg where
there was statistically significant difference between aortic isthmus, middle cerebral artery as well as umbilical artery
(RI) first visit to prognoses birth weight 2 kg.
Conclusion: Using Doppler imaging of the aortic isthmus to assess the clinical state of fetuses with fetal growth
restriction (FGR) is possible, and even to decide when to terminate the pregnancy in preterm fetuses. Aortic isthmus
(AI) Doppler measurements are useful to identify fetal growth restriction (FGR).
Keywords: Aortic Isthmus, Doppler Ultrasound, Intrauterine Growth Restriction, Zagazig University.


middle cerebral artery (MCA) is divided by that of the
To be classified as having intrauterine growth
umbilical artery (UA) to arrive at the CPR value [4].
restriction (IUGR), a pregnant woman must be
In early-onset FGR, ductus venosus (DV) is the
less than 10 percent of the 10th percentile which
most reliable Doppler measure for predicting the short-
corresponds with fetal gestational age [1].
term risk of fetal mortality. DV flow waveforms
Even though they are frequently used
become abnormal only at the most severe phases of fetal
interchangeably in the medical community, IUGR and
impairment, according to long-term investigations [5].
small for gestational age (SGA) have a distinct
Regardless of the gestational age at birth, atrial
meaning. No matter how close they are to the 10th
contractions with absent or reversed velocities are
percentile for their gestational age when it comes to
related with perinatal death [6].
anticipated birth weight, SGA just considers the weight
The Doppler waveform of isthmus of the aorta is
at birth, but IUGR considers other signs of malnutrition
used to find the right amount of brain-to-systemic
as well [2]. Ultrasound measurement of fetal tone,
circulation impedance balance. Diastolic aortic isthmus
respiratory movements, and body movements, along
AoI flow reversed indicates substantial fetal hypoxia
with amniotic fluid and traditional cardiotocography
degradation; this usually occurs after abnormalities in
(CTG), are used to create a biophysical profile (BPP).
the umbilical artery (UA) Doppler indices, but before
For the time being, performing a biophysical profile
abnormalities in the DV Doppler indices, by an average
BPP to keep an SGA premature baby under control is
of one week. Poor neurodevelopmental outcomes are
not suggested [3]. An index of amniotic fluid (AFI) is a
linked to aberrant aortic isthmus (AoI) recordings. In
component of the BPP. Due to the lack of evidence
spite of this, the sensitivity was modest, and its genuine
supporting oligoamnios' relevance as a predictor of
relevance in daily clinical practice is still unclear [7].
postnatal problems in in-vitro fertilisation (IVF) babies
Longitudinal studies reveal that aortic isthmus
with Doppler monitoring, its inclusion in treatment
AoI changes occur 1 week before DV changes in
guidelines is debatable [3]. High-risk pregnancies,
patients [8], and as a result, it is a poor indicator of the
particularly fetal growth restriction (FGR), have been
likelihood of a future stillbirth. The opposite appears to
shown to reduce perinatal morbidity and death by using
be true: aortic isthmus AoI appears to improve the
Doppler velocimetry of the umbilical artery (UA) and
prediction of neurological morbidity [9]. The aim of the
middle cerebral artery. When blood flow to the brain of
study is the better diagnosis of intrauterine growth
a fetus is concentrated in the fetal cerebral hemisphere,
restriction IUGR using the aortic isthmus Doppler.
this is known as cerebroplacental ratio (CPR). The
Doppler index (pulsatility index [PI]), resistance index,
A cross sectional study was conducted between
or systolic/diastolic ratio) of the middle cerebral artery
September 2021 and March 2022 at Radiology
Received: 08/07/2022
Accepted: 13/09/2022

Full Paper (vol.892 paper# 81)

c:\work\Jor\vol892_82 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6605- 6611

3D Echocardiographic Evaluation of Right Ventricular Functions:
A Prognostic Study in Pediatric Population with Critical Pulmonary Stenosis
Undergoing Balloon Pulmonary Valvuloplasty
Amira Nour*, Mostafa Zidan, Ghada Elshahed, Dina Ezzeldin
Congenital and Structural Heart Disease Unit, Cardiology Department, Ain Shams University, Egypt
*Corresponding author:
Amira Nour, Mobile: (+20)1001486012, E-Mail: princess_cardiology@hotmail.com
Critical pulmonary stenosis has been associated with severe right ventricular outflow tract obstruction
(RVOTO) leading to severe right ventricular hypertrophy (RVH), impaired both systolic and diastolic functions, changes
in RV shape and geometry, hence further assessment by 3D echocardiography (3D Echo) is recommended.
Objective: The aim of the current work was to evaluate RV (Right Ventricle) functional indices using 3D
echocardiography in infants with critical pulmonary stenosis undergoing balloon pulmonary valvuloplasty and to
evaluate RV (Right ventricle) indices as follow up parameters in infants with critical pulmonary stenosis (PS).
Patients and Methods: This prospective study included a total of 60 infants with critical pulmonary stenosis, their
median age was 8.5 (range 2 - 12) months referred for urgent balloon pulmonary valvuloplasty to Pediatric Cardiology
Unit, Department of Cardiology, Ain Shams University Hospitals.
Results: 3D echo revealed lower RV (Right ventricle) volumes (P <0.001), higher FAC (fractional area change) (P<
0.001), higher TAPSE (tricuspid annular plane systolic excursion) (P< 0.001), higher EF (Ejection fraction) (P < 0.001),
lower basal, mid and longitudinal RV dimension (P< 0.001). FAC (fractional area change), TAPSE (tricuspid annular
plane systolic excursion) and RV basal and longitudinal diameter were significantly larger by 3-dimensional
echocardiography (3D Echo) than by 2-dimensional echocardiography (2D Echo) (P=0.01).
Conclusions: It could be concluded that in patients with critical pulmonary stenosis undergoing balloon pulmonary
valvuloplasty, assessment of RV indices using 3 D echo is more reliable and effective method to assess RV volumes
and function in comparison with conventional 2D echocardiography.
Keywords: 3D echo, Critical pulmonary stenosis, Balloon pulmonary valvuloplasty, RV functions.


and circumferentially (RV outflow). Because of this
Critical Pulmonary Stenosis (CPS) is a life
unique RV morphology, 2D echo has several limitations
threating condition due to severe RVOT obstruction
in the evaluation of RV (4).
with RV pressure that exceeds systemic pressure,
Three-dimensional echocardiography (3DE)
commonly presents in the neonates and infants with
provides wide gated complete acquisition which enables
cyanosis due to reversal of flow across the patent
complete assessment of RV volumes, morphology and
foramen ovale (PFO) or atrial septal defect (ASD),
ventricular functions. 3D echo has the ability to display
patients usually have PDA dependent pulmonary
the surfaces of entire RV including the inflow,
circulation and urgent catheter intervention is needed (1).
trabecular and outflow portion. 3D echo allows us to
Critical pulmonary stenosis has been associated
measure RV enddiastolic volume, RV end-systolic
with severe RVOT obstruction leading to severe RV
volumes and ejection fraction (RVEF) regardless of its
hypertrophy, impaired both systolic and diastolic
shape and evaluate the morphologic and functional
functions, changes in RV shape and geometry. After
remodeling of the RV in patients with critical PS (4).
balloon pulmonary valvuloplasty, early removal of
Several clinical studies have shown a good correlation
RVOTO helps in reverting the unfavorable effects of
between cardiac magnetic resonance (CMR) and 3DE
pressure overload on RV (2).
derived volumes and ejection fraction of the RV in
Accordingly, echocardiography plays a major
selected population with most studies showing slight
role in diagnosis, assessment and management of
underestimation of volumes when compared with those
critical pulmonary valve stenosis. It is helpful for
measured by CMR. The aim of the current work was to
detecting the degree of stenosis (pressure drop across
evaluate RV (Right Ventricle) functional indices using
the pulmonary valve), level of obstruction (sub-
3D echocardiography in infants with critical pulmonary
valvular, valvular or supravalvular), associated
stenosis undergoing balloon pulmonary valvuloplasty
intracardiac anomalies and the proper management
and to evaluate RV indices as follow up parameters in
strategy. Assessment of RV volumes and systolic
these infants.
functions are important determinants of the outcome of
the intervention, which cannot be assessed accurately by
This prospective study included a total of 60 infants
2D echo using Simpson's method due to the triangular
with critical pulmonary stenosis, their median age was
shape of the RV which makes it difficult to visualize it
8.5 (range 2 - 12) months, referred for urgent balloon
all in one view and hence limits the role of 2D echo (3),
pulmonary valvuloplasty to Pediatric Cardiology Unit,
the RV is heavily trabeculated with prominent
Department of Cardiology, Ain Shams University
moderator and peculiar arrangement of its fibers in two
perpendicular directions: longitudinally (RV inflow)
Received: 02/07/2022
Accepted: 08/09/2022

Full Paper (vol.892 paper# 82)

c:\work\Jor\vol892_83 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6612- 6616

Validity And Reliability of a Smartphone Application in Measuring
Surface Area of Lower Limb Chronic Wounds
Pakinam H. M. Younis, Ashraf E. M. El Sebaie, Intsar S. Waked, And Mohamed B. I. Bayoumi
Department of Physical Therapy for Surgery, Faculty of Physical Therapy
*Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Mohamed Bayoumi Ibrahim, Mobile: (+20) 01005238554, E-Mail: mohamed.forever@yahoo.com

As the population ages, chronic wounds also raised, creating a load on the health system. Accurate
documentation and continuous measurement of wounds have become critical.
Aim of the study: It was to determine the validity and reliability (VAR) of a smartphone application in measuring the
surface area of lower limb chronic wounds.
Patients and Methods: A study of 61 patients (46 males and 15 females) with lower limb chronic wounds, aged from 40
to 70 years were selected from Cairo University Hospitals from March 2022 to August 2022. Patients were assessed by the
manual planimetry method and a smartphone application (Imito AG, Switzerland). Wound evaluation using the Imito-
measure application was performed twice by the principal investigator and by a co-investigator to test Inter-rater reliability
(Inter-RR), intra-rater reliability (Intra-RR), and validity. Concurrent validity was investigated by determining the
correlation between a smartphone application and the metric graph sheet by Pearson Product Moment Correlation
Coefficient. Intra-RR and inter-RR were expressed in Intra-class Correlation Coefficients (ICCs).
Results: The validity, intra-RR, and inter-RR of the Imito-measure application were excellent with a strong positive
significant correlation (r = 0.998, p = 0.001), ICC was 0.999, with 95% CI 0.998-0.999 and standard of measurement (SEM)
of 1.83; ICC for measurement wound surface area was 0.999, with 95% CI 0.998-0.999 and SEM of 1.85, respectively.
Conclusion: The Imito-measure application showed excellent VAR for wound measurement, and it could be a selection to
be used as an assessment tool in clinical practice.
Keywords: chronic wounds, wound assessment, Smartphone application, Validity, Reliability.

paper or film is placed on a milli-metric grid paper and
A chronic wound is an unhealed wound that
then milli-meter squares inside the marked region are
undergoes an organized and proper reparative process to
calculated (7). Using a smartphone mobile application
maintain long-term anatomical and functional integrity. It
shows good feasibility when utilized as a point-of-care
can last from four weeks up to three months (1).
tool. Reliability and interrater agreement will be ensured
Worldwide, chronic lower limb ulcers found to affect
when compared with a previously validated method (8).
nearly 3% over the age of 60 years and more than 5% of
In clinical trials, the utilization of the Imito-
people aged above 80 years (2).
measure application has the advantage of overcoming the
Chronic lower limb wounds are classified into
difficulties associated with the manual tracing method
vascular ulcers (venous and arterial ulcers), pressure
such as the material availability, problems with storing
ulcers, and diabetic foot ulcers (3). Lower limb chronic
data, and the time required to calculate the wound surface
ulcers are difficult-to-heal wounds on the foot or lower
area, and it is easily accessible since medical practitioners
leg usually caused by diabetes mellitus, venous
frequently use smartphones (9).
insufficiency, and arterial insufficiency (4).

There are many reasons why a wound should be
evaluated so that measurements will indicate whether the
The aim of this study is to determine the validity
wound is healing, getting worse, or remaining static (5).
and reliability (VAR) of a smartphone application in
Although measurement methods overestimate or
measuring the surface area of lower limb chronic wounds.
underestimate the surface area of a wound or its volume,

even so, they are useful in assessing wound healing.
Wound area measurements need to be reliable, but not
certainly accurate in assessing wound healing (6).
Sixty-one patients were diagnosed with chronic
Tracing wound boundaries is one of the most
leg ulcers by a physician, they suffered from partial-
popular methods for measuring the surface area of a
thickness and full-thickness pressure ulcers, diabetic
wound. Sterile acetate paper or a transparent film is
ulcers, and venous ulcers based on clinical investigations,
placed above wounds. The margins of the wound are then
they were selected from Cairo University Hospitals. Their
marked on sterile acetate paper or a transparent film. Then
age ranged from 40 to 70 years. They were evaluated by
Received: 7/7/2022
Accepted: 12/9/2022

Full Paper (vol.892 paper# 83)

c:\work\Jor\vol892_84 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6617- 6621

Relative Motion Protocol Versus Place and Hold Protocol After
Hand Zone II Flexor Tendon Repair: A Prospective Randomized Controlled Trial
Ahmed M. Zarraa1, Emad T. Ahmed1, 2, Ashraf A. Khalil3, and Amal M. Abd El Baky1
1Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University; 2Faculty of Physical
Therapy, Heliopolis University; and 3Department of Plastic Surgery, Faculty of Medicine, Cairo University
*Corresponding author: Ahmed Mahmoud Ali Gabr Zarraa, Mobile: (+20) 01007580084, E-Mail: dptahmedzarraa91@gmail.com

Flexor tendon injuries in zone II are very challenging and till now there no consensus on a particular therapy
protocol to provide the best outcomes postoperatively.
: The present study was introduced to explore the effect of a relative motion protocol and compare it to those of a place
and hold protocol on the outcomes after zone II flexor tendon repair.
Patients and Methods:
Sixty patients who underwent zone II flexor tendon repair participated in this study. Their ages
were between 20 to 35 years. They were collected from Cairo University Hospitals and distributed randomly into two
groups: Group (A) contained 30 patients who received a relative motion protocol, and Group (B) contained 30 patients
who received place and hold protocol. At 12th postoperative week, finger goniometer; hand dynamometer; and Michigan
Hand Questionnaire (MHQ) were used to evaluate outcomes.
Results: Relative motion protocol showed significant improvement over place and hold protocol in terms of IP joints active
ROM of the operated fingers, operated hand grip strength, and all scales of MHQ.
Relative motion protocol is superior to place and hold protocol in improving the outcomes after zone II flexor
tendon repair.
Key words: Relative motion, Place and hold, Flexor tendon repair.


A formidable challenge faces hand surgeons and

therapists in repair and rehabilitation of tendons in zone
II. Adhesions are highly anticipated to occur there leading
The need for this study has been developed to be, up
to limited tendon excursion that causes a limitation in the
to our knowledge, the first prospective study to
ROM and a reduction in hand strength and function (1, 2).
investigate the effect of a relative motion protocol post
One of the major purposes in rehabilitation is to
flexor tendon repair.
achieve better tendon gliding by inhibiting the adhesions

and an Early Active Mobilization (EAM) protocol can
clearly achieve that (1-3).
Relative motion protocol is firstly described for
Sixty patients, who underwent zone II flexor tendon
rehabilitation after extensor tendon repair. Its concept is
primary direct four-strand repair with ages between 20 to
simple, it depends on the presence of a single muscle that
35 years, participated in this study. They were collected
has multiple tendons through which it transmits its force
from Cairo University Hospitals. Participants were
to the four medial fingers. By placement of the digits with
excluded if they had more than one operated finger,
concurrent major vascular injuries, crush injuries, nerve
Metacarpophalangeal (MCP) joints angle than the
injuries, fractures, tendon injuries in other zones or the
adjacent digits, the repaired tendons will receive less force
other hand, flexor pollicis longus repair, previous post-
from the muscle which encourages immediate
repair tendon rupture, or reduced cognitive capacity.
postoperative active fingers movement resulting in earlier

use of the hands in the Activities of Daily Living (ADL)
Ethical Approval:
without risk of tendon rupture (4-6).
After explanation of the all rights, an informed
Place and hold protocol is one of the most evident
consent was signed by each patient before participation in
protocols but seeking for better outcomes, a start to study
this study. Before conducting the study, an ethical
relative motion protocols post flexor tendon repair has
approval (No. P.T. REC/012/002689) was provided by
been recently developed due to their advantageous nature
the Institutional Review Board of Faculty of Physical
and promising effects (7,8).
Therapy at Cairo University. The conduction of the
Depending on the conclusions of recently published
current study was matched with the Declaration of
studies, it was recommended to prospectively investigate
Helsinki Guidelines for Human Research (Ref).
the effects of a relative motion protocol (4,9).

Received: 7/7/2022
Accepted: 12/9/2022

Full Paper (vol.892 paper# 84)

c:\work\Jor\vol892_85 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6622- 6629

Breakthrough Seizures in Patients Switched from Brand to
Generic Antiseizure Medications
Abdulsalam Mohammed Ali Abu Sayf*, Mahmoud Mohamed Elebyary,
Tarek Goda, Mohammed Elsayed Mahdy
Department of Neurology, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Abdulsalam Mohammed Ali Abus Sayf, Mobile: (+20) 01068298951,
E-Mail: aabdalssalam@gmail.com

Despite the fact that generic drugs are less expensive than brand-name drugs, the healthcare system still
does not employ enough generic drugs to treat seizures. The objective of the current study is to evaluate the relation
between seizure-related outcomes and switching between brand name antiseizure medications (ASMs), and a different
generic ASMs manufacturer.
Patients and methods:
In a prospective cohort study conducted in Outpatient clinic of Neurology Department, Zagazig
University Hospitals, 380 known epileptic patients were included. Cases were divided into 5 equal groups (76 cases in
each group): Group I carbamazepine, Group II levetiracetam, Group III topiramate, Group IV valproic acid, and Group
lamotrigine. All included patients were evaluated for the effect of switching from a brand to generic ASMs.
Results: Mean duration of treatment with ASMs among study population was 13.72 (SD 6.52) years and ranged from
1 to 38 years. Only 19.2% of our study population had switched from brand-name to generic formulations under patients'
their free will, due to unavailability of brand drugs, increase adverse effect, or financial issues. Regarding studies ASMs
(carbamazepine, levetiracetam, topiramate, valproic acid and lamotrigine), we found statistically significant increased
total seizure frequency after 6 months treatment, and breakthrough state among group shifted to generics. Conclusion:
There is a potential association between the risk of breakthrough seizures and switching from brand to generic ASMs.
Keywords: Breakthrough seizures, Antiseizure Medications, Carbamazepine, Levetiracetam, Topiramate, Valproic
acid, Lamotrigine, Generic drugs.


generics. Patients also think older drugs are safer than
In order to qualify as having epilepsy, a person
newer ones since they have been on the market longer.
must have at least two unprovoked (or reflex) seizures
Additionally, patients who are in better condition are
that happen more than 24 hours apart. one unprovoked
more worried about the effectiveness of generic drugs,
(or reflex) seizure and a likelihood of additional
much as older individuals who prefer brand-name drugs
seizures equal to the general recurrence risk (at least
to generic ones (4).
60%) following two unprovoked seizures occurring
The aim of this study is to evaluate the relation
over the course of the following 10 years, or the
between seizure-related outcomes and switching
identification of an epilepsy syndrome (1).
between brand name antiseizure medications (ASMs),
After stroke and dementia, epilepsy is the third
and a different generic ASMs manufacturer.
most prevalent neurological condition, affecting over 70

million people globally, or 0.5-1% of the population (2).
According to the FDA, a generic medicine is one
In a prospective cohort study conducted in
that has the same dosage form, safety, strength,
Outpatient clinic of Neurology Department, Zagazig
administration method, quality, performance attributes,
University Hospitals, 380 known epileptic patients were
and intended use as a brand-name drug (3).
included. Cases were divided into 5 equal groups (76
Generic medications often cost between 20% and
cases in each group): Group I carbamazepine, Group II
90% less than their brand-name counterparts. For
levetiracetam, Group III topiramate, Group IV valproic
patients who are without health insurance or who are
acid, and Group V lamotrigine. All included patients
economically disadvantaged, the cost of generic ASMs
were evaluated for the effect of switching from a brand
is crucial. Generic drugs and go into a distinct tier that
to generic ASMs.
is more patient-affordable, while brand drugs fall into a

tier that raises expense to patients (3).
Inclusion criteria:
Although brand-name vs generic drugs are
Adult patients 18years or older, both genders.
thought to be more cost-effective, the US healthcare
Patients known case of epilepsy (of any type)
system still does not encourage consumer usage of
on monotherapy ASMs.
generic drugs. There are several factors at play when
Patients on only one of the following ASMs;
customers decide whether to utilize generic drugs
carbamazepine, levetiracetam, topiramate,
instead of name brands. The main concern is the notion
valproic acid, and lamotrigine. All selected
that generic medications are less reliable or efficient
ASMs have generic products available in
than their brand-name counterparts. Other studies
Egyptian pharmaceutical market, using
showed that most patients just don't like to utilize
immediate release form of the drug.
Received: 08/07/2022
Accepted: 13/09/2022

Full Paper (vol.892 paper# 85)

c:\work\Jor\vol892_86 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6630- 6636

Baseline Peripheral Blood Monocytosis Carries Worse Leukemia-Free Survival
in Acute Myeloid Leukemia Without Monocytic Differentiation
Doaa M. AbdElmonem*1, Ahmed Embaby2, Ayman Fathy2, Ahmad Baraka1, Yousef Nosery3, Heba F. Taha4,
Amira Elwan5, Ahmed El-Sayed Hassan6, Mohammad Al-Akkad2, Omnia Awwad7, Haitham Elsheikh2
Departments of 1Clinical Pathology, 2Clinical Hematology Unit, Internal Medicine, 3Pathology, 4Medical Oncology,
5Clinical Oncology and 6Medical Physiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
7Family Medicine Fellowship, Egyptian Ministry of Health, Egypt
*Corresponding author: Doaa M. AbdElmonem, Mobile: (+20)1226391406,
E-Mail: doaametwaly2005@yahoo.com, ORCID ID: 0000-0003-2738-2734
: The growth of acute myeloid leukemia (AML) cells not only depends on cell-intrinsic factors but is also
supported by tumor microenvironment (TME), which can be reflected by Peripheral blood monocytes. This study
was aimed to assess the role of peripheral blood monocytes as a marker for TME on the AML outcome exclusively in
the non-M4/M5 subtypes to limit the confounding effect of the accompanying monocytosis. Patients and Methods:
We prospectively analyzed the impact of absolute monocyte count (AMC) on the outcome of 44 adults with de novo
non-M4/M5 AML. The AMC values were obtained at diagnosis by hematology automatic analyzer and patients were
classified based on their AMC level generated by the ROC curve into two groups: low (0.4x10 9 /L) and high
(>0.4x10 9 /L); including 16 (36.4%) and 28 (63.6%) patients, respectively. Results: The Median duration for follow-
up was 8.2 (range 0.8-34.9) months, death, and relapse rates were significantly higher in the high AMC group,
(P=0.028 and 0.001, respectively). There was no significant difference as regards complete remission, primary
induction failure, or early death rates between both groups. Moreover, no statistical difference in 3-year Overall
survival (OS) between low and high AMC groups except after ruling out early deaths (P=0.366 and 0.008,
respectively). However, a statistically significant better Leukemia-Free Survival (LFS) was found in the low AMC
group, (P=0.026). Conclusion: Peripheral blood monocytosis at the time of diagnosis, carries worse LFS and OS
(only in patients without induction-related mortality) rates in non-M4/M5 AML patients.
Keywords: Monocytosis, Acute Myeloid Leukemia, Tumor Microenvironment, Survival, Outcome.

Clinical Hematology Unit, Zagazig university
Despite the marked improvement of survival,
Hospital, Egypt, from January 2017 to February 2020.
acute leukemia is associated with significant mortality
Ethical consent:
risk (1). The growth of AML is supported by tumor
This study was ethically approved by the
microenvironment (TME), among them Leukemia-
Institutional Review Board of the Faculty of Medicine,
associated Macrophages (LAMs) which are involved
Zagazig University (ZU- IRB #2899). Written informed
in the progression of leukemia (2).
consent was taken from all participants. The study was
Peripheral blood monocytes are reflective of the
conducted according to the Declaration of Helsinki.
TME status, particularly the immune status which
Enrollment criteria also included good performance
facilitates immune evasion and affects patient clinical
status (PS) according to the Eastern Cooperative
outcome (3). Moreover, Absolute monocyte count
Oncology Group (ECOG) criteria, French American-
(AMC) was found to be linked with survival in acute
British (FAB); M0-2 with ruling out acute
myeloid leukemia with monocytic differentiation (4),
promyelocytic and monocytic differentiation AML.
various types of lymphoma (5-7) and chronic
The diagnosis of AML and its subtypes was based on
lymphocytic leukemia (8).
Conversely, their relationship with myeloid
cytogenetic features of leukemic blast cells as stated in
malignancies including acute myeloblastic leukemia
FAB (9), the WHO 2016 criteria (10) and the
remains under-studied and controversial. So, this study
International System for Human Cytogenetic
was conducted to assess the impact of monocytosis as
Nomenclature (11). We used the clinico-laboratory
a marker for TME on the AML outcome exclusively
information to determine age, sex, white blood cell
on non-M4/M5 subtypes to evaluate the extreme
(WBC) count with AMC, hemoglobin level, platelet
monocytosis in these subtypes.
count, and the percentage of peripheral and bone
This study was aimed to assess the role of
marrow blast cells. The WBC as well as AMC values
peripheral blood monocytes as a marker for Tumor
were obtained by either manual differential method (in
Microenvironment on the AML outcome exclusively
cases flagged for abnormal values) or the hematology
in the non-M4/M5 subtypes to limit the confounding
automatic analyzer Sysmex XN-2000 (Sysmex, Kobe,
effect of the accompanying monocytosis.
Japan). A monoclonal mouse anti human CD34

antibody (Thermo Fisher Scientific Invitrogen: Catalog
# MA1-19119) was used for I immunohistochemical
This prospective cohort study included a total of
detection of CD34 in the bone marrow biopsy (BMB)
44 patients with primary AML, aged 18 years, and
on certain cases. Immunostaining was conducted on an
all of them were chemotherapy naïve, treated at
automated immunostainer (Tec mate 500 plus, DAKO)
Received: 02/07/2022
Accepted: 08/09/2022

Full Paper (vol.892 paper# 86)

c:\work\Jor\vol892_87 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6637- 6645

Developing Gold-Resveratrol Nanoconjugates for Management of
Rheumatoid Arthritis (RA)
Marwa Dawood Jaaffer1*, Israa Ali Zaidan Al-Ogaidi2
1,2Department of Biotechnology, College of Science, University of Baghdad, Bagdad, Iraq
Corresponding auther: Marwa Dawood Jaaffer, Moblie: +9647708214513, Email: Marwa.Jaafer1106@sc.uobaghdad.edu.iq

The development of nanotechnology, due to the unique physical and chemical features of nanomaterials.
Nanomaterial therapy for RA can increase bioavailability and target damaged joint tissue
Objective: This study aimed to check the effect of gold nanoparticles (AuNPs) with resveratrol by polyethylene glycol to
manage the levels of ten immune markers of rheumatoid arthritis patients.
Patients and Methods: Gold nanoparticles (AuNPs) were functionalized with resveratrol by polyethylene glycol and
utilized to manage the levels of 10 immune markers of 84 rheumatoid arthritis patients and 20 healthy volunteers ranging
in age from 18 to 80 years.
Results: The synthesized gold nanoparticles, before and after functionalization, were characterized by UV-Vis
spectrophotometer, Fourier-transforms spectroscopy, zeta potential, and FE-SEM. The levels of 10 immune markers in the
sera of RA patients (IgA, IgE, IgG, RF, ANA, anti-dsDNA, C3, C4, IL-6, and IL-33) were tested by ELISA kits to study
the in vitro effects of treatment with functionalized and non-functionalized AuNPs on their immune response.
Conclusion: The levels of all markers were decreased significantly in RA patients after exposure to AuNPs or AuNPs-
PEG-Res. However, the levels of IgE, RF, ANA, dsDNA, C3, C4, and IL-33 showed significantly higher reduction in the
presence of AuNPs as compared to AuNPs-PEG-Res, whereas the opposite was observed for the levels of IgA, IgG, and
Keyword: Nanotechnology, Gold nanoparticles (AuNPs), Resveratrol (Res), Rheumatoid arthritis (RA), ELISA.


Rheumatoid arthritis (RA) is a chronic
that resveratrol also affects immunity by messing with the
autoimmune systemic disease that primarily damages the
way immune cells work, how proinflammatory cytokines
lining of synovial joints. It causes progressive disability,
are made, and how genes are expressed.
premature death, and has a significant economic impact
Nanotechnology is becoming increasingly
(1). It is critical to understand how pathologic mechanisms
essential in modern research. Nanotechnology is
lead to the deterioration of RA progression in individuals
concerned with the development and utilization of
in order to design medicines that effectively treat patients
materials with dimensions smaller than 100 nm, which are
at each stage of their disease (2). The mainstay of RA
referred to as nanomaterial (8). Nanomaterial has a greater
treatment is still pharmacologic therapy, which includes
surface-to-volume ratio, allowing them to perform well in
traditional, biological, and cutting-edge potential small
a variety of applications such as Nano sensors, Nano-
molecular disease-modifying anti-rheumatic drugs.
sorbents, and fuel cells (9). Gold compounds have been
Significant progress has been made toward disease
used to treat RA for more than 50 years, dating back to
recovery without joint deformity. However, a sizable
Jacques Forestier's (10) discoveries in the early 1930s.
minority of RA patients do not respond well to currently
Recently, AuNPs have been used to carry materials like
available treatments. The available medication
DNA, peptides, anticancer drugs, and antibody products
specifically targets macrophage proliferation and the
(11). It is known that the properties vary according to the
production of pro-inflammatory cytokines. The
size, shape, medium, cell type, charge, and nanoparticle
therapeutic effectiveness of current treatment options at
synthesis reduction agent (12). It's important to study the
the targeted site is limited. Therefore, there is a pressing
effects of AuNPs on their own before putting them
need to develop a new therapeutic method that could give
together with other drugs. This will help find the best way
more targeted drug delivery and make it safer (3).
to use them in therapy.
Resveratrol (Res) is a plant polyphenol molecule
Some previous studies of nanoparticles trying to
that has trans-Res capability for cancer protection (4). The
control the RA disease. GNPs/MTX-Cys-FA Nano-
most well-known polyphenolic stilbenoid is resveratrol,
conjugates for RA targeted therapy methods are studied
which can be found in raisins, mulberries, peanuts, and
by Li et al. (13). By decreasing the expression and secretion
rhubarb (5). Resveratrol may be beneficial for preventing
of inflammatory factors, GNPs/MTX-Cys-FA can
the progression of chronic inflammatory diseases such as
drastically reduce rheumatoid synovitis and successfully
protect articular cartilage. Yang et al. (14) found that
neurodegeneration, and cancer (6). Yahfoufi et al. (7) found
resveratrol had anti-inflammatory properties reducing
Received: 2/7/2022
Accepted: 8/9/2022

Full Paper (vol.892 paper# 87)

c:\work\Jor\vol892_88 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6646- 6652

A Comparative Study of Analgesic Effect of Ultrasound Guided Erector
Spinae Plane Block Versus Serratus Anterior Plane Block for
Thoracoscopic Sympathectomy Surgeries
Mohamed Younes Yousef Abd-Allah, Doaa Galal Diab,
Ahmed Mohamed Hamed Abozeid1*, Mohamed Younis Makharita
Department Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Mohamed Hamed Abozeid, Mobile: (+20) 01065217484, E-Mail: ahmedabozeid37@gmail.com

In the realm of thoracic surgery, video-assisted thoracoscopic surgery (VATS) is a well-established
minimally invasive approach. The objective of the current study is to compare the analgesic effects of erector spinae
plane blocks guided by ultrasound vs serratus anterior plane blocks guided by ultrasound in patients undergoing
thoracoscopic sympathectomy for palmer hyperhidrosis.
Patients and methods: A total of 110 patients, aged between 21 and 40 years old planed for sympathectomy, were
randomly allocated into 55 patients who were subjected to erector spinae plane block (ESPB) and 55 patients who were
subjected to serratus anterior plane block (SAPB). All patients with VAS more than 30 were received i.v. ketorolac 30
mg every 8 hours. Up to the end of the first 24 hours following surgery, the total amount of fentanyl and paracetamol
used was tracked, along with the length of analgesia, the occurrence of side effects during the first 24 hours following
surgery, and the patient satisfaction score after 12 and 24 hours.
Result: The total analgesic (fentanyl) consumption in 24 h was significantly lower in ESPB group compared with SAPB
group. Significantly lower VAS was observed with ESPB. Significantly longer time for the first request to rescue
analgesia was recorded with ESPB. Significantly longer time of block performance was observed in ESPB group.
Significantly delayed onset of sensory block and less number of fentanyle doses were recorded in ESPB group. No
significant difference between ESPB and SAPB as regards to patient satisfaction score and side effects.
Conclusion: ESPB shows superior analgesic effect to SAPB in sympathectomy surgeries
Keywords: Analgesic, Serratus anterior plane block, Thoracoscopic sympathectomy, Ultrasound guide, Erector spinae
plane block.

hemorrhage, no response to the procedure, and
In the realm of thoracic surgery, VATS, or video-
compensatory hyperhidrosis in non-denervated areas (5).
assisted thoracoscopic surgery, is a well-known
In the current study, patients undergoing thoracoscopic
minimally invasive technique. Chest drains are clearly
sympathectomy for palmer hyperhidrosis were
superior to open surgery and other minimally invasive
compared to the effects of ultrasound guided erector
procedures in terms of discomfort, length of stay (LOS),
spinae plane block (ESPB) and ultrasound guided
duration, and morbidity, according to comparative
serratus anterior plane block (SAPB).
studies and meta-analyses (1). It is indicated in several

diseases either they were malignant or benign,
esophageal operations, major as well as minor thorax
A prospective randomized controlled clinical trial was
surgeries, distal airway operations as cranial resections,
conducted at Mansoura University Hospital from May
pleural causes like empyema as well as sympathectomy
2020 to 2021. This single blind clinical trial was carried
for managing hyperhidrosis (2).
out after being approved from Anesthesia, ICU and Pain
Primary palmar hyperhidrosis (PPH), which is
Management Department then the Institutional Review
frequently accompanied with head, face, or plantar
Board (IRB).
hyperhidrosis, is the excessive production of exocrine

glands on the palms. PPH has no clear organic etiology,
Study Design and Patients: The current study
although some patients may experience significant
comprised adult American Society of Anesthesiologists
psychologic, social, and vocational dysfunction because
(ASA) I­II patients who were scheduled to have
they feel anxious and experience excessive palm
thoracoscopic sympathectomy procedures and who
sweating (3).
consented to sign the informed consents. The research
Treatment for palmar hyperhidrosis focuses mostly on
excluded patients with coagulopathies, local infections,
symptoms. Injections of botulinum toxin, aluminum
neuropathies, neuromuscular diseases, mental illnesses,
and a history of thoracic surgery. Patients who had a
radiofrequency ablation, and endoscopic thoracic
history of local anesthetic allergies, were on chronic
sympathectomy are a few of the therapy options (4).
pain medications, were drug users, or refused treatment
Endoscopic thoracic sympathectomy eliminates eccrine
were also eliminated.
sweating in all regions supplied by the postganglionic
A total of 110 patients were randomly allocated by a
fibres, but it comes with a number of risks, including
computer-generated randomization table and group
post-sympathetic neuralgia, which is the most serious,
assignment will be concealed in sealed opaque
wound infection, pneumothorax, Horner syndrome,
envelopes into ESPB group (55 patients) and SAPB
Received: 08/07/2022
Accepted: 13/09/2022

Full Paper (vol.892 paper# 88)


Serum Resistin Level as a Novel Marker of Disease Activity
in Patients with Ulcerative Colitis
Mohamed Gamal Youssef, Khalid Abd El-Hamid, Omnia Samir Mohamed Sayed, Ahmed Samir Allam
Internal Medicine, Hepatology and Gastroenterology Department,
Faculty of Medicine, Ain Shams University
Corresponding Author: Mohamed Gamal Youssef,Phone No.: (+2) 01146802018, E-mail: mohamedazz3@yahoo.com

IBD, occasionally referred to as "chronic inflammatory bowel disease" including Crohn's disease,
ulcerative colitis (UC), and other gastrointestinal disorders are included in this group.
Aim of the Work:
The aim of our study was to assess serum resistin level in disease activity and remission in patients
with ulcerative colitis disease.
Patients and Methods:
A cohort study for 6 months on 40 Egyptian patients presented with ulcerative colitis disease
over 18 years old visiting the Outpatient Clinics or admitted in Ain Shams University Hospitals.
The present study revealed a highly significant elevation of serum resistin in active ulcerative colitis patients
(p-value <0.001). There was direct relationship between the activity of ulcerative colitis and serum resistin. Resistin was
positively correlated with inflammatory markers (CRP and ESR) in UC patients. And there was negative relation
between resistin and Hb, fecal calprotectin.
Serum resistin is a useful non-invasive test that was used to monitor disease activity in patients with
ulcerative colitis. It positively correlated with inflammatory markers (CRP and ESR). Other studies should be done on
larger size of participants to determine the the role of serum resistin as a marker of disease activity in patients with
inflammatory bowel disease.
Serum resistin level, Ulcerative colitis.


predisposition, and immunological abnormalities in the
IBD, or chronic inflammatory bowel disease, is a term
aetiology of IBD (5).
that is used to describe a variety of gastrointestinal
Combinations of clinical symptoms are necessary for
disorders, including Crohn's disease and ulcerative
the diagnosis of inflammatory bowel disease (IBD),
colitis (1). IBD symptoms include episodes of abdominal
imaging results, inflammatory indicators in the lab, and
pain, diarrhoea, bloody stools, weight loss, and an
endoscopic samples. Microcytic anaemia, leukocytosis,
influx of neutrophils and macrophages that create
and thrombocytosis are among the hematologic
cytokines, proteolytic enzymes, and free radicals that
abnormalities. Two indicators of inflammation, the high
cause inflammation and ulceration (1).
sensitivity C-reactive protein (hs-CRP) and erythrocyte
IBD is a chronic condition that develops early in both
sedimentation rate (ESR) are frequently enhanced (6).
males and girls. IBD has been recognised as one of the
Our study's objective was to measure the level of serum
most common gastrointestinal diseases since the start of
resistin in ulcerative colitis patients to assess for disease
the twenty-first century, with an accelerated occurrence
activity and remission.
in newly industrialised nations. Over the second half of

the 20th century, there was a remarkable increase in
both the incidence and prevalence of IBD (2).
A cohort study for 6 months on 40 Egyptian patients
Crohn's disease often affects the colon, perianal region,
presented with ulcerative colitis to assess for disease
terminal ileum, and cecum, although it can also affect
activity and for follow up during disease remission.
any part of the intestine in an erratic manner. In contrast,
They were over 18 years old visiting the Outpatient
ulcerative colitis affects the rectum and has a
Clinics or admitted in Ain Shams University Hospitals.
continuous pattern that might affect either the entire

colon or only a portion of it (3).
Inclusion criteria: Patients presented with ulcerative
The only sites of ulcerative colitis are those in the
colitis disease during activity and remission, patients
mucosa and submucosa with cryptitis and crypt
more than 18 years old and newly diagnosed patients
abscesses where inflammation is observed, in contrast
with ulcerative colitis.
to what histologically seen in Crohn's disease, there are
Exclusion criteria: Pregnant nursing females, patients
granulomas, transmural inflammation, thickened
less than 18 years old, patients who refuse to participate
submucosa, and fissuring ulceration (4).
in the study and patients with chronic diseases as DM,
Despite the fact that the origin of IBD is still unknown,
heart failure and renal failure.
significant work has been achieved in recent years to

understand its pathophysiology. Studies have shown
All patients were subjected to: Full history,
correlations between intestinal microbiota, other
performing a physical exam, and performing laboratory
tests such as ELISA test to measure serum resistin
Received: 26/6/2022
Accepted: 5/9/2022

Full Paper (vol.892 paper# 89)

c:\work\Jor\vol892_90 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6659- 6666

Morbidly Adherent Placenta: Clinical, Sonographic and Doppler Predictors
Abd El Aziz Galal El din Thabet Darwish1,
Mahmoud Sayed Mohamed Ali Zakhera2, Ahmed Kamel Ahmed Bakry1*
1 Obstetrics and Gynecology Department, Faculty of Medicine, Al-Azhar University, Egypt, 2 Obstetrics and
Gynecology Department, Faculty of Medicine, Assiut University, Egypt
*Corresponding author: Ahmed Kamel Ahmed Bakry, E mail: drahmedkamelahmed@yahoo.com

Placenta accreta, which complicates 0.9% of all pregnancies, is the improper implantation of the placenta
into the uterine wall. Placenta previa and past uterine surgery, including caesarean delivery, are clinical risk factors.
Aim and objectives: This study aimed to evaluate the effectiveness of a novel, straightforward scoring method for
identifying placenta accreta risk in low- and high-risk pregnant women based on sonographic markers and to identify
prenatal imaging results that indicate whether a placenta previa will adhere.
Subjects and methods: By reviewing 150 cases of placenta previa, we created "Al- Azhar placenta accreta scoring
system" and showed how it may be used to predict placenta accreta. Their clinical information and ultrasound images
were gathered. , and we assessed them using the scoring technique.
78.4% of total accreta cases that were diagnosed initially by ultrasound as total accreta were diagnosed by
laparotomy and histopathology as total accreta, while 21.6% of total accrete cases finally were diagnosed as focal
Conclusion: In order to better prepare for birth and lower the risk of morbidity and mortality in patients with morbidly
adherent placentas, the assignment of a scoring system for placenta accreta prediction throughout pregnancy may be
Keywords: Adherent placenta, Placenta accreta, Clinical and sonographic predictors.

When a normal gestation is routinely evaluated,
In a prospective cohort study, we developed "Al-
the placenta is frequently disregarded, it only receives
Azhar placenta accreta scoring system". We
attention when an anomaly is found. Despite being rare,
retrospectively examined 150 cases of placenta previa
placenta abnormalities must be recognised due to the
to establish its viability in the prediction of placenta
risk of maternal and foetal morbidity and mortality (1).
accreta. Their clinical information and ultrasound
When chorionic villi enter the myometrium improperly,
images were gathered, and they were then scored using
placenta accreta develops. The placenta is divided into
the scoring system.
three grades based on histology: placenta accreta

(chorionic villi in touch with the myometrium), placenta
Inclusion criteria:
increta (chorionic villi invade the myometrium), and
After 28 weeks of pregnancy, abdomen
placenta percreta (chorionic villi enter the uterine
ultrasonography is used to diagnose all women with
serosa) (2).
placenta previa anterior.
Age, pregnancy and placental attachment

disorders (PAD) are the most common risk factors.
Exclusion criteria: Low lying placenta diagnosed
Also, prior caesarean section, and placenta previa.
before 28 weeks gestation and placenta previa posterior.
Asherman syndrome and endometrial ablation are risk

factors that are more rarely present. Pregnancies
Data collection: the patient's hospital case number, age,
resulting from in vitro fertilisation have also increased
consanguinity, gravidity, parity, prior problems of
Although vaginal bleeding and discomfort might
pregnancy, gestational age, height, weight, and history
happen, placenta accreta patients are typically
of drug use, employment, education, and the husband's
asymptomatic. A potentially fatal presentation is acute
unique habits were all noted on a page.
abdominal pain and hypotension brought on by

hypovolemic shock following uterine rupture associated
Test methods: The study included all pregnant women
with placenta percreta, despite being uncommon. In the
seeking care at the Obstetric Outpatient Clinic or the
absence of labour, this serious scenario might happen at
Inpatient Obstetric Department at Assiut University
any point during pregnancy, from the first trimester to
Hospital who had placenta previa detected by
full term gestations (4). The caring doctor should have a
abdominal ultrasound after 28 weeks of pregnancy.
high index of suspicion because the majority of patients
Women who were deemed to be research candidates and
are asymptomatic. The patient's risk indicators suggest
had placenta previa underwent abdominal ultrasounds,
a potential diagnosis of a morbidly adherent placenta,
where the entire placenta was systematically scanned
which should be investigated further with targeted
using both two-dimensional ultrasound and 2D
sonography (5).
Doppler. The angle of insonation was kept as low as
Received: 17/5/2022
Accepted: 24/7/2022

Full Paper (vol.892 paper# 90)

TF_Template_Word_Mac_2011 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6667- 6671

Reattachment of Recessed Superior Rectus Muscle Using Fibrin
Glue Versus Vicryl: An Experimental Study in Rabbits
Zeinab A. Saad1*, Ayman Elghonemy1, Enas A. Mourad1, Hala A. Elsayed2
1 Department of Ophthalmology, 2 Department of Anaesthesia,
Giza Memorial Institute of Ophthalmic Research, Giza, Egypt
Corresponding author: zeinab Ahmed Saad, Email: dr.zynabsaad@outlook.com
Mobile Number: +201013843855

During the reinsertion of extraocular muscle to the sclera, the risk of scleral perforation is possible.
Endophthalmitis may also result in sequelae of scleral perforation. Reattachment of extraocular muscles using fibrin
glue is an alternative option in muscle recession surgeries.
Aim of the study: to evaluate the efficacy of fibrin glue as an adhesive agent and to compare it with muscle suturing.
Materials and methods: In this prospective comparative experimental study, fifty-six eyes of twenty-eight rabbits of
the same species (white New Zealand) weighing approximately 2.240 to three kg. All the superior rectus muscles (SRM)
were disinserted and recessed 5 mm from the insertion and then reattached to the sclera either by fibrin glue (group 1)
or sutures 6/0 vicryl (group 2).
Results: After two weeks, of surgical exploration of SRM in the glued group (28 eyes); 23 eyes (82.14%) the SRM
was found in the same location of insertion (5mm recession). While the SRM in the remaining five eyes (17.86%) was
slipped with posterior displacement of the muscle. on the other hand, surgical exploration of SRM in the control group
was found in the same location of insertion. The correlation between inflammation and slippage was significant.
Conclusion: we concluded that fibrin glue was effective as an alternative to sutures to re-attach rectus muscles during
recessions (even in small muscle recession) in strabismus surgery, however postoperative slippage of the muscles and
inflammation are considerable complications.
suture-less squint surgery; fibrin glue; muscle recession; muscle reattachment; vicryl


guidelines (Animal Research: Reporting of In
Scleral perforation may happen during the
Vivo Experiments). All rabbits were middle-aged,
reinsertion of a muscle into the sclera. Incidence of
white New Zealand, weighing approximately 2.250- 3.0
scleral perforation is highly variable ranging from 0.3%
kg. The animal husbandry was in the experimental
to 7.8 % (1). Such risk of scleral perforation during the
animal facility of the Research Institute of
recession would be much greater if the sclera is thinner
Ophthalmology, Giza, Egypt. The experiment was
(2). Endophthalmitis may also result in sequelae of
approved by the Memorial Institute of Ophthalmic
scleral perforation. Reattachment of extraocular
Research Ethics Committee. All procedures followed
muscles using fibrin glue is an alternative option in
the Institutional Guidelines and the Statement for the
muscle recession surgeries.
Use of Animals in Ophthalmology and Vision Research
Fibrin glue is a blood product that is easy to apply
and observed the essential ARRIVE guidelines for
(3). Fibrin glue was used instead of sutures in squint
animal research. Healthy litter cage animals were
surgery during the closure of conjunctiva incisions (4).
included and divided into single-cage animals which
Graham et al. (5) reported that usage of fibrin glue
were provided with food, water, and veterinary
(autologous= prepared from patient's blood) has proven
supervision. Randomization and blinding were initially
to be an effective way compared to suturing in case of
applied to minimize the confounder bias.
leaking from fornix-based conjunctiva incisions after
The experimental study was conducted on Fifty-
subscleral trabeculectomy (5). Fibrin glue was proven to
six eyes of twenty-eight rabbits. They were divided into
be useful in the reinsertion of muscle recessions, but it
2 groups: Group 1 (glued group): the recessed superior
was found that it was more effective in large-angle
rectus muscle of the right eye of 28 rabbits is reattached
recessions than in small-angle recessions (6).
using fibrin glue (consisting of twenty-eight eyes of
In this study, we aimed to re-evaluate the
twenty-eight rabbits). Group 2 (control group): the
reattachment of extraocular muscles in small muscle
recessed superior rectus muscle of the left eye of 28
recession using fibrin glue in strabismus surgery, to
rabbits is reattached using 6/0 vicryl (consisting of 28
detect its stability against contractile muscle strength
eyes of 28 rabbits); the sample size was decided based
and investigate whether it could replace the classic
on the outcome measures.
stitches, hence avoiding perforation of the globe and its


The animals were anesthetized with intramuscular
ketamine (30mg/kg) and Xyla-Ject 20 mg/mL (xylazine
This is a prospective comparative experimental
hydrochloride). Xyla-Ject 20 mg/ml is a sedative and
study in rabbits that was reported following ARRIVE
analgesic. It is administered /subcutaneously 1mL/ 20
Received: 8/7/2022
Accepted: 13/9/2022

Full Paper (vol.892 paper# 91)

review of literature The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6672- 6677

Prognostic Significance of Echocardiographic and ECG Changes in
Patients with Acute Pancreatitis
Muhammad Abbas El-Masry, Mahmoud Aly Mahmoud Ashry,
Alaaeldin Abdelrahman*, Lobna Abdel-Wahid
Internal Medicine Department, Assiut University Hospitals, Assiut University, Assiut, Egypt
Corresponding author: Alaaeldin Abdelrahman, Mobile: (+20) 01144780935, Email: aladdinmahmoud@aun.edu.eg

Acute pancreatitis is a primarily noninfectious inflammatory disease of the pancreatic gland. The
cardiovascular system involvement has been described before, in the form of electrocardiogram (ECG) changes and
echocardiographic findings (diastolic, systolic or combined dysfunction, wall motion abnormalities and pericardial
effusion). The current study aimed to detect echocardiographic and ECG changes in acute pancreatitis and investigate
the significance of these changes on prognosis. Patients and methods: A prospective observational study was conducted
on 54 patients with acute pancreatitis (according to Atlanta score) admitted to Internal Medicine Department, Assiut
University, Egypt. All patients were subjected full clinical and laboratory evaluation in addition to assessment of ECG
changes and echocardiographic findings. Results: The mean age of patients was 45.72 (SD 12.3) years and ranged from
19 to 70 years, with 51.9% of them were females. The probable cause in the majority of the study patients was gall stone
(42.6%). The present study showed several possible ECG changes; T-wave Changes and Prolonged Q-R Interval had
significant impact on the rate of complications. Also, left ventricular (LV) diastolic dysfunction and pericardial effusion
at discharge had significant impact on the rate of complications. At discharge echo changes had no impact on the rate of
complications. Poor R-wave progression (PRWP), ST segment elevation and T-wave changes had significant association
with mortality. Female sex, comorbidity, Ranson Severity Score, white blood cells (WBCs), blood urea nitrogen (BUN)
follow up, calcium Level, albumin, Basal deficit, ST segment elevation, regional wall motion abnormality (RWMA)
baseline, left ventricular diastolic dysfunction (LVDD) on discharge and right ventricular systolic dysfunction (RVSD)
on discharge could significantly predict mortality among cases.
Conclusion: Echocardiographic and ECG changes in patients with acute pancreatitis could predict the outcome of those
patients. Future studies on larger sample sizes are warranted to confirm such findings.
Keywords: Acute pancreatitis, echocardiography, Ranson Severity Score, Atlanta score.


Although gallstones and alcohol consumption are
the most common causes of acute pancreatitis (AP),
Study design
A prospective observational study was conducted on
cholangiopancreatography (ERCP), trauma, obesity,
54 patients who were admitted to Al-Rajhi Intensive
diabetes are also well-known triggers of local and
Care Unit (ICU) and at Internal Medicine Department,
systemic inflammation (1,2).
Assiut University Hospital, Assiut University, in the
The Atlanta classification of AP has been used to
period from 2019 to 2022.
differentiate between severe and mild cases of acute
Study Setting
pancreatitis, according to this classification, patients are
Gastroenterology & Hepatology Unit and ICU at Internal
diagnosed with severe acute pancreatitis (SAP) if they
Medicine Department, Assiut University Hospital,
show evidence of organ failure, local complications (e.g.,
Assiut University.
necrosis, abscess, pseudocyst), Ranson score of 3 or

higher or acute physiology and chronic health evaluation
Inclusion criteria: All patients with acute pancreatitis
II (APACHE II) score of 8 or higher (3).
aged more than 18 years admitted to Al-Rajhi ICU of all
SAP has a wide range of affection on nearly all
body systems with various degrees of affection than
Exclusion criteria: Patients with known cardiac
affect both the clinical picture and the prognosis of the
disease (4).
All patients were subjected to:
The cardiovascular system involvement has been
1. Full history taking including age, gender, special
described before, in the form of electrocardiogram
habits of medical importance, comorbidities,
(ECG) changes (sinus tachycardia, arrhythmias,
previous operations.
conduction abnormalities) and echocardiographic
2. General examination: Blood pressure, temperature,
findings (diastolic, systolic or combined dysfunction,
respiratory rate, pulse.
wall motion abnormalities, pericardial effusion (5).
3. Local examination: Abdominal examination
In the current study our aim was to detect
including inspection, palpation, percussion and
echocardiographic and ECG changes in acute
pancreatitis and investigate the significance of these
4. Laboratory investigations: Complete Blood Count.
changes on prognosis.
Kidney function tests (creatinine, urea, blood urea
Received: 08/07/2022
Accepted: 13/09/2022

Full Paper (vol.892 paper# 92)

c:\work\Jor\vol892_93 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6678- 6685

Early Detection of Myocardial Contusion and Its Outcomes in
Patients with Blunt Chest Trauma
Mohammed Ahmed Mohammed El-Oraby*1, Samir Mohamed Attia2,
Tarek Elsayed Gouda3, Hesham Khairy Ismail4
Departments of 1Emergency Medicine, 2Vascular Surgery, 3Internal Medicine,
4Critical Care Medicine, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Mohammed Ahmed Mohammed, Mobile: (+20) 01014537098, E-Mail: mohammedorabi52@gmail.com

Polytrauma has a significant impact on the wellbeing and provided healthcare for the populations. More
than fifteen percent of emergency room admission worldwide are due to blunt chest trauma (BCT), which comes in
second most common cause of death in vehicle collisions after head injuries. Exposure of anterior chest wall to an abrupt
high-speed deceleration injury results in thorax compression, which is a common cause of BCT. The trauma may cause
damage to all thoracic structures.
Objective: In patients with acute chest injuries, the goal of this study was to identify the early onset of myocardial
contusion and its consequences.
Patients and methods: This study was carried out over the course of a year in the Emergency Department of the
Mansoura University Hospital. The research comprised 153 individuals who presented with solitary BCT.
Results: When compared to patients without myocardial contusions, the mean heart rate was statistically significantly
greater in the cases with myocardial contusions. The global circumferential strains (GCS) and the mean arterial pressure
(MAP) were statistically significantly lower in the cases with myocardial contusions as compared with the cases with
no myocardial contusions. In patients with myocardial contusions, the length of hospital as well as the length of intensive
care unit (ICU) stays were statistically significantly longer.
The diagnosis of blunt chest trauma is exceedingly difficult since it can result in a broad variety of clinical
manifestations and damage. Patients may arrive at the hospital with stable hemodynamics and no symptoms.
Myocardial Contusion, Blunt Chest Trauma, Electrocardiograms, ICU.


The term "myocardial contusion" refers to
identifying those who are at risk of experiencing a
bruising or microscopic bleeding into the heart muscle
severe thoracic trauma (traumatic contusion) on the
brought on by forceful thoracic trauma. Myocardial
contusion incidence among individuals with blunt
Major thoracic trauma includes multiple rib
thoracic trauma extends from zero to seventy six percent
fractures, concomitant pulmonary contusions, and
varying according to which diagnostic criteria was
hemothorax. It is highly advised avoiding adding
biomarkers to the ECG under these circumstances.
The severity of a myocardial contusion may
However, by assessing biomarkers at the start of the
vary depending on the injury's scope and when it
hospitalization and again 4-6 hours later, the negative
occurred. When it affects individuals who have
predictive value of this approach alone in situations with
experienced acute thoracic trauma, it can be fatal. The
an irregular ECG will be enhanced. A component of the
diagnostic strategy is still up for discussion. It should be
class II predictive negative value is biomarker
suspected during triage in the emergency room as a
measurement (4).
primary cause of sudden mortality following traumatic
Stages 1 and 2 test findings that are abnormal,
chest injuries. The ability to safely release patients with
the patient being in shock, or cardiac factors being taken
suspected myocardial contusions who have normal
into consideration call for an echo or long-term
electrocardiograms (ECGs) and biomarker testing has
monitoring (twenty-four to forty-eight hours).
been proven (2, 3).
Investigations have reduced the requirement for
Because the patient's symptoms are vague and
echocardiography in sternal fractures. Therefore,
there is no optimum diagnostic test, diagnosing
recommending regular echocardiograms is of very little
myocardial contusion is highly challenging. For
use(5, 6).
detection, cardiologists use cardiac biomarkers,
In the emergency room, diagnosing myocardial
echocardiography, nuclear cardiac imaging, as well as
contusion in trauma patients is still difficult, and the
electrocardiography (ECG); although none of these is
used procedures are the most expensive diagnostic
hundred percent sensitive(2).
procedures (2).
Suspected myocardial contusion approach will
In patients with acute chest injuries, the goal of
be very helpful in reducing the number of trauma
this study is to identify the early onset of myocardial
patients admitted to hospitals and the frequency of
contusion and its short-term consequences.
unnecessary diagnostic procedures. Research indicated

that the diagnostic tests, e.g. ECG, are useful in

Received: 8/7/2022
Accepted: 13/9/2022

Full Paper (vol.892 paper# 93)

c:\work\Jor\vol892_94 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6686- 6692

The Use of Three-Dimensional Power Doppler Ultrasound in Assessment of Placental
Blood Flow and Volume and Its Correlation with Severity of Preeclampsia
Hisham Mamdouh Haggag 1, Sherif Mohamed Mahmoud 1, Mennatallah Mohamed Elsayed2, Adel Farouk
Ibrahim 1, Omneya Mostafa Helal 1, Mohamed Faisal Ahmed 3, Manal Moussa 1
1 Obstetrics and Gynecology Department, 2Radiology Department,
3 Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt,
Corresponding author: Sherif Mohamed Mahmoud, Mobile 002010002366718,
E-mail: sherif.elsayed@kasralainy.edu.eg

Hypertensive disorders in pregnancy, especially preeclampsia are among the commonest medical disorders
encountered in pregnancy and major contributors to maternal & fetal morbidity and mortality.
Objective: Assessment of the efficacy of 3rd trimester three-dimensional power Doppler (3D PD) ultrasound of placental
volume and vascular indices in determining the severity of preeclampsia.
Subjects and Methods: A cross-sectional analytic study involving 200 women from 18 to 35 years old, with singleton
pregnancies in the third trimester complicated with preeclampsia. The subjects were further divided into two groups of
100 patients stratified by disease severity; severe group and non-severe group.
Results: The non-severe and severe preeclamptic groups had a significant decrease in placental volume. No significant
correlation was found between gestational age and placental volume regarding severity of preeclampsia. The non-severe
group had significantly higher values for each of the 3 indices: Vascularization index (VI), Flow index (FI), and
Vascularization Flow index (VFI) (16.9 versus 8.5), (36 versus 26), and (4.9 versus 2.6), respectively, compared to the
severe group. Both the non-severe and the severe groups had a significant negative correlation between gestational age
(GA) and VFI. Additionally, neither the severe nor the non-severe groups showed any correlation between VI and GA,
while FI showed a non-significant inverse correlation with GA. Conclusion: The 3D Power Doppler ultrasound may
provide alternative methods for assessment of placental blood flow and provide insights on pathophysiology of placental
disease. Additional studies are required for verification of its accuracy and applicability in clinical practice.
Keywords: Three-dimensional power Doppler, Placental vascular indices, Placental volume, Preeclampsia.


(4). By assessment of the power Doppler signal within the
complications encountered in pregnancy with a range of
desired organ as a whole as defined by the volume of
consequences including intrauterine fetal growth
interest, 3D ultrasonography, in contrast, allows
restriction, eclampsia and reaching fetal and maternal
examination and quantification of overall blood flow
mortality. The condition is associated with marked
through an organ. Three indices are used to evaluate the
reduction of uteroplacental blood flow (1).
vascular perfusion of the placenta, including the VI,
Preeclampsia is a disease unique to pregnancy and
which is the percentage of a target volume with
is marked by the presence of elevated blood pressure and
detectable moving blood, the FI, which is the mobile
significant proteinuria at or beyond the 20th week of
blood's mean value in the target volume, and the VFI,
pregnancy. The worldwide incidence is around 28%.
which signifies the relative quantity of moving blood in
The current view of hypertensive disorders complicating
the target volume (5). Measurement of placental volume
pregnancy (HDCP), including pre-eclampsia, is as a
alone or combined with uterine artery Doppler has been
chronic placental pathology. Pathophysiology and
suggested for early prediction of both preeclampsia and
subsequent pregnancy outcomes are significantly
fetal growth restriction. The usage of 3D PD and
influenced by abnormal placental function and
VOCAL techniques to assess placental volume and
diminished vascular perfusion (2).
vasculature can prove to be a useful modality for
Gross pathological changes are most evident in
adequate identification of FGR pregnancies and
placental specimens retrieved from cases of severe
evaluation of preeclampsia severity (6).
This study's goal was to examine the placental
preeclampsia are those reflecting placental ischemia,
volume and placental vascularization using 3D power
including diminished size and presence of infarctions.
Doppler ultrasound (3DPD) in third-trimester
These findings are also often encountered in cases of
pregnancies complicated by preeclampsia, combined
fetal growth restriction (FGR) (3).
with pathological examination of such placentae for
In conventional 2D sonography, blood flow
signs of hypoperfusion.
assessment is done by application of Doppler to a single

vessel of interest and measurement of vascular flow
velocity and resistance indices. This technique is limited
by the ability to examine only portions of an organ or
A cross-sectional analytic investigation including
tissue blood flow
200 women aged from 18 to 35 years old with singleton
Received: 08/07/2022
Accepted: 13/09/2022

Full Paper (vol.892 paper# 94)

c:\work\Jor\vol892_95 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6693- 6701

Ultrasound Elastography Role versus Liver Biopsy in Diagnosing and
Staging of Hepatic Fibrosis in Chronic Liver Disease Patients
Rehab M. Shimy1, Asmaa Monir Ali1, Ahmed Abd Elsattar1, Amir Hanna1,
Shimaa H. I. Desoukey1, Mona H. Hassan1, Mohammed Moharam M. Hussein1, Kholoud Morad2
1Department of Radiology, Theodor Bilharz Research Institute, Giza, Egypt
2Department of Radiology, National cancer Institute, Cairo, Egypt
*Corresponding author: Amir Hanna, Mobile: (+20)1114086980, E-Mail: amirelhamy84@gmail.com

Ultrasound elastography is a novel and promising noninvasive method based on sonography for assessing
liver fibrosis in persons with chronic viral hepatitis.
Objective: The aim of the current work was to assess the effectiveness of ultrasound elastography as a non-invasive
alternative method of liver biopsy for the diagnosis and staging of hepatic fibrosis in people with chronic liver disease.
Patients and methods:
This study included a total of 50 patients with chronic HCV who had been identified by using
PCR testing for HCV RNA and seropositivity for HCV antibodies, attending at Theodor Bilharz Research Institute
(TBRI). Prior to starting treatment, patients were referred for evaluation and underwent abdominal ultrasonography,
ultrasound-guided liver biopsies, and real-time elastography (RTE) to quantify the stiffness of the liver.
Results: liver fibrosis index (LFI) and stage of liver fibrosis identified by very sensitive liver biopsy showed a
significantly positive connection (ranging of sensitivity from 86.36 % to 100%) and high specificity ranging from (78.57
% to 89.36%). High sensitivity and specificity was observed specially in high grades of fibrosis F3 and F4. For
determining the extent of liver fibrosis in CHC patients, RTE shown a high level of performance utilizing LFI, and it
proved to be notably helpful for the identification of early cirrhosis and advanced hepatitis, both of which are issues in
clinical practice. Additionally, it contrasted well with the reported pooled TE performance.
Conclusion: It could be concluded that the future of elastography imaging is optimistic, and RTE appears to be a
promising method since it can yield a good diagnostic performance to predict advanced fibrosis in CHC, and to detect
hepatic fibrosis staging.
Ultrasound Elastography, Liver Biopsy, Hepatic Fibrosis.


biological tissues non-invasively (3).
Inflammation, necrosis, which causes hepatocyte
Given that measures of liver stiffness are closely
lysis, and a reparative tissue response all contribute to
associated to fibrosis METAVIR stages, transient
the complicated dynamic process that leads to liver
elastography is one of the techniques that may be
fibrosis. The result of acute and chronic liver illnesses,
utilized to non-invasively quantify mean tissue
such a condition includes non-alcoholic steatohepatitis,
stiffness. Additionally, transient elastography offers the
autoimmune hepatitis, chronic hepatitis B and C, and
advantages of reproducibility, not requiring a highly
alcoholic liver disease (1).
skilled operator, and having a low risk of unfavorable
The chronic liver illnesses cirrhosis, fibrosis, and
results (4).
inflammation are all brought on by HCV, which is one
A relatively new technique for measuring tissue
of the main causes of these conditions globally. With
elasticity is real-time tissue elastography. It employs a
between 15% and 25% of residents in rural regions
B-mode US scanner, a hybrid of the conventional US
infected, Egypt has the highest adult hepatitis C virus
scanner and elastography. The body is gently pressed or
(HCV) infection rate in the world. HCV has also been
released as the echo signals are recorded in real-time
related to an increased risk of morbidity and mortality
using a US Probe. This method estimates the relative
in cases of hepatocellular carcinoma (2).
hardness of tissue using standard B-mode photos and
The best method for determining the extent of
images of tissue elasticity and displays that information
liver fibrosis is still liver biopsy. Important information
as real-time color graphics (4).
on necrosis, inflammatory grading, and iron
The examination of liver fibrosis in people with
accumulation is provided by liver biopsy, in addition to
chronic viral hepatitis using ultrasound elastography is
fibrosis and its structure. On the other side, it is an
a unique and promising noninvasive sonography-based
intrusive technique that causes discomfort for the
technique that is unaffected by the test sites or the
patient, and there can occasionally be catastrophic
observer. When combined with foundational laboratory
problems. Additionally, high intra- and interobserver
data, ultrasound elastography can further improve the
variability as well as sampling errors restrict the
separation of different fibrosis stages, which is essential
accuracy of liver biopsy (2).
for treating patients with viral hepatitis (5).
With the aid of adapted software and standard
This study's goal was to assess the efficacy of
ultrasound equipment, a new imaging technique called
ultrasound elastography as a non-invasive method
ultrasound elastography makes it possible to image and
against liver biopsy for detecting and staging hepatic
estimate the distribution of tissue elasticity within
fibrosis in people with chronic liver disease.
Received: 02/07/2022
Accepted: 08/09/2022

Full Paper (vol.892 paper# 95)

c:\work\Jor\vol892_96 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6702- 6706

Toxicity and Complications of Long Term Use of Methotrexate in Sohag University
Hospital: A Retrospective, Record Based Epidemiological Study
Ahmed M. Said1, Ahmed R. Alagamy2, Meray M. Shokry1
Departments of 1Forensic Medicine and Clinical Toxicology,
2Rheumatology, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Ahmed M. Said, Mobile: (+20) 01002663856, E-Mail: ahmedabostate1981@gmail.com

Methotrexate (MTX) is used as an anti-cancer drug in higher doses. However, lower doses of
methotrexate have been used in the treatment of rheumatic diseases due to its immunosuppressant effects such as
rheumatoid arthritis, psoriatic arthritis, inflammatory myopathies, asthma, and other inflammatory conditions.
Objective: The current study aimed to estimate the prevalence and severity of methotrexate toxicity among patients
receiving low-dose methotrexate and followed up in the Rheumatology Department, at Sohag University.
Patients and Methods: A retrospective, record-based study. All cases with rheumatoid arthritis were treated with low-
dose methotrexate for at least 3 months and were recorded in the files of the Rheumatology Department, Sohag
University Hospitals, in the period from 1 Jan 2012 to 31 December 2021. The files of the selected cases were revised
carefully regarding details of the demographic data, clinical history, comorbidities, and side effects and toxicities
supposed to be due to methotrexate.
Results: The study included the files of 1077 rheumatoid arthritis cases. 849 cases (78.8%) were chronic MTX users,
and 228 cases (21.2%) were non-chronic MTX users, taken as the control group. The comparison between MTX users
and non-users as regards the clinical data revealed that MTX users had less disease duration, more morning stiffness,
and less hypertension. MTX use was significantly associated with a higher incidence of gastritis, blurred vision, anemia,
pneumonitis, and hepatotoxicity.
Conclusion: Although generally tolerable in low doses, MTX is sometimes associated with some toxicities including
gastritis, blurred vision, anemia, pneumonitis, and hepatotoxicity.
Keywords: Methotrexate, Rheumatoid arthritis, Hepatotoxicity, Pneumonitis.

but these side effects mainly do not threaten the life of
Methotrexate (MTX) is used as an anti-cancer
the patient as described by many authors. Examples of
drug in higher doses such as acute lymphoblastic
these side effects: Skin lesions such as skin rashes and
leukemia, lymphoma, carcinoma of the breast,
alopecia. Neurological symptoms such as headache,
osteogenic sarcoma, and cancer of the head and neck
lack of concentration, and confusion. As well as
region (1). The doses of MTX for anti-cancer purposes
gastrointestinal tract (GIT) symptoms like gastric
may reach up to 1 gram per cycle and is especially
inflammation, nausea, diarrhea, and difficulty in
effective against child onset acute lymphoid leukemia,
digestion (12-14).
also malignancies as trophoblastic and hematologic
On the other side low dose of methotrexate can
types as well as cancer bladder and osteosarcomas (2, 3).
lead to severe harmful side effects as described by many
However, lower doses of methotrexate have been
authors for example liver toxicity, lung toxicity,
used in the treatment of rheumatic diseases due to its
mucositis and bone marrow depression and these side
immunosuppressant effect (4), for example used for an
effects lead to patients who can't tolerate treatment (15,
asthmatic patient, psoriatic arthritis disease (PsA),
rheumatoid arthritis disorder (RA), also inflammatory
About the renal system it is noticed that high dose
myopathies diseases, as well as used in prophylaxis in
methotrexate can cause renal toxicity in form of tubular
case of graft against host disorder and inflammatory
toxicity which mainly leads to renal impairment, but in
case of low dose methotrexate; it can't lead to renal
MTX depletes folic acid thus affecting the purine
impairment but renal impairment leads to more
metabolism, which leads to either beneficial therapeutic
susceptibility and toxicity to low dose methotrexate for
or harmful toxic effects of MTX. The use of MTX is
other systems (17, 18).
associated with deleterious effects on different organs
Many studies as case reports and small case series
such as the kidney, liver, testis, and bone marrow. As
about low dose methotrexate toxicity have been done by
MTX is mainly eliminated through the kidneys
many authors. But the largest case series up till now
nephrotoxicity is more common to occur more than
studied 70 cases of rheumatoid arthritis who developed
other side effects, which limit its therapeutic uses in
side effect as pancytopenia in 17% of cases that did not
many conditions (11).
recover from bone marrow suppression and
Even a therapeutic low dose of MTX is accepted
unfortunately died (19-21).
and tolerated by the patient, but minimal side effects,
Another case-series study described 25 cases that
mainly starting 24­48 h after a regular dose each week,
Received: 06/07/2022
Accepted: 11/09/2022

Full Paper (vol.892 paper# 96)

c:\work\Jor\vol892_97 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6707- 6715

Evaluation of Intravenous Maternal Hydration Therapy in
Isolated Oligohydramnios: A Randomized Controlled Clinical Trial
Mostafa Mahmoud Alkhiary1, Mohamed Hassan hussein1*, Mona Gad Elebiedy2 , Yasmin Ahmed Elsaid
Department of 1Obstetrics and Gynecology and 2Anaesthesia and Intensive Care Unit,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Mohamed Hassan Hussein, Mobile: (+20) 01062106155, E-Mail: mbedairy71@yahoo.com
Background: Oligohydramnios has invariably been associated with adverse perinatal outcome such as fetal distress
(ante/intra-partum fetal heart rate decelerations, meconium passage and cord compression). The current study aimed to
determine the effects of intravenous maternal hydration on amniotic fluid volume in pregnancies above 34 weeks
manifested with decreased amniotic fluid index (AFI).
Patients and methods: A randomized controlled clinical trial included 42 pregnant women who were diagnosed to
have oligohydramnios by ultrasound. They attended Obstetrics and Gynecology Department at Mansoura University
Hospitals from November 2019 to December 2021. The participants were divided into 3 groups: Group A with 14
women allocated to infusion of normal saline and Ringer's solution for 1liter/day for 1 week, Group B with 14 women
allocated to infusion of normal saline and Ringer's solution for 3liter/day for 1 week, and Group C with 14 Fourteen
women as a control group.
Results: The mean AFI in Group A before treatment was 4.54 (SD 0.58), in Group B was 4.46 (SD 0.54) and in Group
was 4.72 (SD 0.375), with no significant difference between the three groups (P1=0.692, P2=0.344 and P3=0.183),
as P1: difference between group A and B, P2: Between group A and C and P3: difference between group B and C.
There were statistically significant increases in AFI in Group A and Group B in comparison with the control group
(P<0.05) after 48 hours and 1 week of hydration. However, no significant difference was recorded among Groups A
and B as regards AFI.
Conclusion: Applying normal saline and Ringer's solution is safe and effective method on mothers with isolated
oligohydramnios and gestational age above 34 weeks, and could eliminate the need to terminate the pregnancy before
term, which has terrible consequences on the mother and the fetus.
Keywords: Amniotic fluid, Intravenous maternal hydration therapy, Isolated oligohydramnios.


pulmonary hypoplasia, fetal heart rate deceleration,
Amniotic fluid (AF) is an important part of
increased chance of caesarean section (CS), non-
pregnancy sac and helps fetal development. It has a
reactive non-stress tests, intrauterine growth restriction
number of important functions like the development of
(IUGR), congenital abnormalities, post-date pregnancy,
gastrointestinal tract, musculoskeletal system, and lung
and low Apgar scores (6).
development, providing essential nutrients to the fetus
In some cases, it may even be reduced to a few
and it has bacteriostatic properties (1).
milliliters of viscous fluid which results in an increase
It also acts as a protective cushion for the fetus
in fetal death to 40-50 times of the rates among normal
against the pressures placed on the abdomen, prevents
pregnancies (7).
attachment to the fetal membranes, and keeps the fetal
Thus, researchers have been prompted to study
temperature stable. In addition, it facilitates the fetal
the basic mechanisms and treatment options of the
symmetrical growth and movement (2).
condition. Among a number of interventions that have
Many factors may affect the amniotic fluid index.
been tried to improve the AFV are bed rest, and
The mothers' blood volume plays an important role in
intravenous hydration therapy. Which are cost-
maintaining the amniotic fluid volume. Hydration status
effective, simple to accomplish, with fewer side effects,
and maternal plasma osmolarity can also alter amniotic
and do not require special techniques with successful
fluid volume (2,3). AFI is assessed by ultrasound where
outcome (1,8).
an AFI of 5.0 cm or less is defined as oligohydramnios.
General fluid needs increase during pregnancy, in
It was added to antepartum testing, to better identify
order to support fetal circulation, amniotic fluid, and a
fetuses at higher risk of poor perinatal outcome (1).
higher blood volume. Individuals normally need 1­1.5
Oligohydramnios, in the absence of premature
ml of water for each calorie consumed (e.g., a person
rupture of membranes and fetal anomalies, is considered
eating a 2000-calorie diet would need 2000­3000 ml of
as a symptom of chronic reduction in placental function,
fluid each day). Most pregnant women are advised to
which results in the reduction of fetal urinary output (4).
increase their caloric consumption by about 300 calories
It occurs in 3% to 5% of pregnancies at term (5). Sequel
(9). Therefore, they would need at least 300 ml of
of chronic oligohydramnios may be responsible for
additional fluid intake, so the current recommendation
problems such as Malpresentation, umbilical cord
for water intake is drinking 8­10 glasses of water each
compression, concentration of meconium-stained
day. Maternal hydration, above the recommended daily
liquor, difficult or failed external cephalic version,
oral intake, may theoretically increase amniotic fluid
difficult ultrasound visualization of fetal parts,
volume by causing fetal diuresis and by improving
Received: 12/07/2022
Accepted: 15/09/2022

Full Paper (vol.892 paper# 97)

c:\work\Jor\vol892_98 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6716- 6725

Conventional Fluid Management Versus Goal-Directed Fluid
Management In Elective Colorectal Surgery
Abdelrahman Mahmoud Abdelrahman, Aboelnour Elmorsy Badran,
Amgad Abdelmageed Zagloul, Rania Elmohamady Elbadrawy*
Department of Anesthesia and Surgical Intensive Care, Mansoura University, Dakahlia, Egypt
*Corresponding author: Rania Elmohamady Elbadrawy, Mobile: (+20) 01128819560, E-Mail: raniaelmohamady@gmail.com

Optimum perioperative fluid therapy is important to improve the outcome of surgical patients, so the
assessment of a patient's volume status accurately is an important goal for the anesthesiologist to achieve hemodynamic
stability and adequate tissue oxygenation.
This study compared intraoperative goal-directed fluid therapy (GDFT) versus conventional fluid therapy
(CVFT) using noninvasive electrical cardiometry with measuring serum lactate, serum creatinine levels, stroke volume
optimization, and postoperative complication.
Methods: One hundred patients ASA I -II, both sexes, aged 21-65 years scheduled for elective colorectal surgery were
randomized into 2 groups (50 subjects each). GDFT group used Stroke volume optimization, and CVFT used the
conventional method of fluid administration. Hemodynamic variables, amount of fluid given, serum lactate, serum
creatinine, and postoperative complication were noted.
Results: Serum lactate levels were insignificant intra& postoperative except at 6 hrs. postoperative was higher in GDFT
1,79±0.21 than CVFT 1.68±0.23with p value=0.02 but still within normal limits. CVFT received significantly more
crystalloids 2750(1500-4000) than GDFT 2250 (1000-3350) with p value=0.002, whereas GDFT received more colloids
350(200-1000) than CVFT 250(0-1000) with p value=0.024. Total fluid received were higher in CVFT 3550(2000-
5600) than GDFT 2750(1500-5000) with p-value=0.005.
Conclusions: GDFT results in a decreased total volume of crystalloids and fluid given to patients. However, both groups
didn't alter organ perfusion inspite of serum lactate being higher in GDFT and with no differences in postoperative
complications in both groups.
Keywords: Fluid therapy, Conventional, Goal-directed, Cardiometry, Colorectal surgery.


During the perioperative period, fluid therapy
force and rate of left ventricle contraction. Stroke
and gastrointestinal function may aid or hinder each
volume, COP, SVR, and other hemodynamic
other. To prevent delayed gastrointestinal function and
parameters are also deduced from that curve in addition
promote early oral intake, fluid therapy should be
to heart rate and blood pressure (5).

carefully maintained (1).
This study aimed to compare intraoperative goal-
To establish hemodynamic stability and
directed fluid therapy (GDFT) versus conventional fluid
sufficient tissue oxygenation, the anesthesiologist must
therapy in patients undergoing elective colorectal
accurately monitor the patient's volume status. For this
surgery using noninvasive electrical cardiometry.
reason, various intraoperative fluid management
We hypothesized that GDFT is better than
techniques are used. The most typical is conventional
conventional fluid therapy to provide sufficient
fluid management (CFM). Clinical evaluation, heart
intravascular fluid volume for adequate perfusion
rate (HR), arterial blood pressure (ABP), and central
without destructing glycocalyx function with fluid
venous pressure (CVP) monitoring are used to control
fluid replacement (2).
The primary outcome was to compare the effects of both
While goal-directed fluid therapy (GDFT) is a
fluid management protocols on organ perfusion
perioperative strategy that uses fluid administration to
regarding Serum lactate, and serum creatinine levels.
target continuously measured hemodynamic variables
Stroke volume optimization, Hemodynamic stability,
like cardiac output, stroke volume, stroke volume
amount of fluid &vasoactive agent administered, and
variation, pulse pressure variation, and other factors to
postoperative complication [Wound dehiscence and
direct intravenous and inotropic therapy to maximise
acute kidney injury (AKI)] were secondary outcomes of
tissue perfusion and oxygen delivery (3).
this study.

Direct measurement of SV using noninvasive

techniques has become an accepted tool for stroke
volume optimization and guiding fluid administration in
This randomized, controlled study was
high risk surgical patients (4).
conducted at Mansoura Oncology Center. Written
informed consent was obtained from all 100 patients
Cardiography (ICG) uses electrical impedance changes
and the duration of the study would be 24 months
to produce waveforms that depend on the volume and
starting from January 2020- January 2022.
velocity of blood injected into the aorta as well as the

Received: 9/7/2022
Accepted: 14/9/2022

Full Paper (vol.892 paper# 98)

c:\work\Jor\vol892_99 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6726- 6733

A Comparative Study between Conventional and
Recent Anticoagulant Therapies in Atrial Fibrillation
Ekhlas Mohamed Hussein, Mohamed Wafaie Morsi Aboleieneen,
Mohammed Mostafa Al-Daydamony, Ali Abd El-fatah Morsi Atwa
1Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
*Corresponding author: Ali Abd El-fatah Morsi Atwa, Mobile: (+20)1007169349, Email: ali_atwa@ymail.com

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in 1-2% of the
general population. With an aging population, its prevalence is estimated to increase two-fold in the next 50 years. The
prevalence of AF increases remarkably with age, being 0.5% at 40-50 years of age and 5-15% at 80 years of age. Men
are more often affected than women.
Objective: This study was aimed to evaluate and compare the healthcare effect and safety of nonvalvular atrial
fibrillation (NVAF) patients using novel oral anticoagulants (NOACs) with patients using warfarin.
Patients and Methods:
This study included a total of 124 patients with non-rheumatic atrial fibrillation on their
anticoagulation drug, attending at Department of Cardiology, Zagazig University Hospitals, and Cardiology Clinic,
Ministry of Civil Aviation, during the period from 2015 to 2016. Patients were divided into two groups NOACs, group
I and warfarin, group II. Results: revealed that there was a statistically significant difference between both groups
regarding hemorrhagic complications. The rate of occurrence of hemorrhage among the warfarin group was 8.3% per
year compared to 3.3% of the NOACs group. Results revealed also that there was a statistically significant difference
between both groups regarding thrombotic complications. The rate of thrombosis among the warfarin group was 25%
per year compared to 8.2% of the NOACs group.
Conclusion: It could be concluded that the overall evidence indicates that NOACs could be considered a safe and
efficacious alternative to warfarin as a treatment option for atrial fibrillation.


carefully selected and monitored patients, the
The most prevalent persistent heart
proportion of time in therapeutic range (TTR), defined
arrhythmia, atrial fibrillation (AF), affects 1-2 % of the
by the international normalized ratio (INR) of 2 to 3,
general population. With age, the prevalence of AF
varied from 44% to 77%, depending on the study or
dramatically rises, from 0.5% at 40 to 50 years of age to
clinical center (7).
5 to 15% at 80 years of age. In the next 50 years, its
Hemorrhage or thrombosis due to over- or
prevalence is predicted to double due to an ageing
under-dosing may have devastating consequences. Poor
population (1). Men are impacted more frequently than
coagulation control may increase the risk of
women (2). Numerous diseases and cardiovascular risk
thromboembolic events, warfarin-related bleeding, and
factors are linked to AF, which may result in structural,
thrombotic events. Also, a recent study shows the
electrical, or both types of (ion-channel) remodeling (3).
importance of identifying the patient with atrial
One in five strokes is due to the arrhythmia
fibrillation with a higher risk of stroke and
atrial fibrillation, which is linked to a 5-fold increased
administering proper anticoagulation. New oral
risk of stroke. Particularly lethal strokes in people with
anticoagulants (NOACs), i.e., dabigatran, apixaban,
AF are ischemic strokes. Compared to individuals who
rivaroxaban, and edoxaban, are not inferior to warfarin
suffer from stroke or other reasons, those who survive
in preventing ischemic stroke systemic embolism in
become more impaired and are more likely to
patients with non-valvular AF (8).
experience a recurrence. As a result, stroke caused by
For all vascular events, non-hemorrhagic
AF doubles the chance of death and quadruples the
events, and mortality. However, no consensus exists
expense of care (4).
regarding the indication for the use of these agents in
Vitamin K antagonists (VKAs), such as
patients with AF. The quality of anticoagulation control
warfarin used to be the standard of care for stroke
may depend on genetic factors, notably CYP2C9 and
prevention in patients with non-valvular AF (NVAF) (5).
VKORC1 polymorphisms, and on non-genetic patient-
The advent of the non-vitamin K antagonist OACs
related factors, such as gender, race/ethnicity, and
(NOACs) apixaban, dabigatran, edoxaban, and
paroxysmal vs. permanent AF. Dr. Lip and colleagues
rivaroxaban has provided a convenient, efficacious, and
recently introduced a validated assessment scheme
tolerable alternative to anticoagulation with warfarin.
based on clinical variables to aid in distinguishing
Unsurprisingly, the NOACs are increasingly used in
patients with AF who are likely to do well on warfarin
everyday clinical practice (6).
from those who are likely to have poor anticoagulation
Although anticoagulation with warfarin may
control. This appears to provide valuable information
effectively reduce the risk of cardioembolic stroke in
relevant to the safety and effectiveness of treatment
patients with atrial fibrillation (AF), warfarin has a
while avoiding the time and expense of a
narrow therapeutic window. In the RE-LY trial with
pharmacogenetics study (7).
Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 99)

c:\work\Jor\vol892_100 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6734- 6742

Acute-on-Chronic Liver Failure in Zagazig University Hospital: A Single
Center-Based Study
Ayman Yousef Ahmed Mohamed Eltaweel*1, Emad Abdullatif Emam2,
Salem Youssef Mohamed2
1Internal Medicine Department, Fakous General Hospital, Sharqia Governorate, Egypt
2Internal Medicine Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ayman Yousef Ahmed Mohamed Eltaweel, Mobile: (+20) 0 109 758 2281, Email:

Background :
Chronic or acute liver failure is a common condition that has a number of contributing variables; a high
death rate and a dismal prognosis. The mainstay of these individuals' survival chances is liver transplantation.
Objectives: To identify the prevalence of acute-on-chronic liver failure (ACLF) and to characterize patients admitted
with ACLF according to the European association for the study of liver (EASL) definition of ACLF to determine the
possible risk and precipitating factors and show the outcomes.
Patients and Method: Prospective study in a single tertiary University hospital was conducted for 1 year duration,
comparing cirrhotic patients with or without ACLF according to EASL-ACLF criteria.
Results: The prevalence rate of ACLF was 57.9% of the studied populations. GIT bleeding, HE, and active infections
were the most frequent precipitating factors. Patients who have ACLF had a high 28-day mortality rate (67.3%). The
rate of mortality was significantly greater with the grade of ACLF. Chronic liver failure (CLIF) score of more than 5
was associated with 86.84% sensitivity, 45.95% specificity, 63% negative predictive value, 76.7% positive predictive
value as well as 0.661 AUC.
Conclusion: A common illness with a high death rate is ACLF. The primary triggering causes include GIT hemorrhage,
HE, and active infection. High sensitivity and positive predictive value, but low specificity and negative predictive value
are associated with a CLIF score of more than five for mortality in ACLF patients.
Keywords: ACLF, Decompensated cirrhosis, Mortality.

We aims in this study to identify the prevalence
associations offered numerous different criteria for
of ACLF and to characterize patients admitted with
acute on chronic liver failure (ACLF) in cirrhotic
ACLF according to the EASL definition of ACLF to
individuals in various geographic locations, although
determine the possible risk and precipitating factors and
every definition identifies that ACLF is a separate
show the outcomes.
clinical entity. The majority of these definitions

consider ACLF as a serious type of acutely
decompensated cirrhosis (1). The clinical entity will
At the Internal Medicine Department's
change based on the etiological cause of underlying
gastroenterology and hepatic departments, as well as the
liver illnesses, the nature of various precipitating events,
Zagazig University hospitals, we conducted this
and the patient outcome and prognosis depending on the
prospective observational study during 1 year period
many types of precipitating events and organ failures
from 2018-2019.
covered in each description (2).
There were 254 patients hospitalized for
The frequency and mortality of patients with
decompensation of cirrhosis. The following conditions
ACLF are significant on a global scale. The greatest 90-
or combinations of conditions led to the exclusion of 59
day death rate worldwide was in South America at 73
patients (19 with hepatocellular carcinoma outside
percent, therefore region-specific variances might be
Milan criteria, 15 people were admitted for an
explained by the kind of distinct chronic liver disease
appointment or treatment), 11 had insufficient data, (8
(CLD) triggers or grade-related etiological factors (3).
had ESRD, and six had chronic obstructive pulmonary
Typically, it is impossible to pinpoint a precise
disease (COPD)).
triggering event. Uncontrolled inflammatory responses
One-hundred ninety-five participants signed up
are believed to be a major contributing factor in
and were counted in the sample population. 82 had no
inducing ACLF in cirrhotic individuals, despite the fact
ACLF, whereas 113 had ACLF. Inclusion criteria:
that the precise pathophysiological pathways of its
Patients who were hospitalized to the liver intensive
development are still unclear (2).
care unit and who meet the criteria for ACLF as defined
In Egypt, the burden, the precipitating factors,
by the EASL. The study excluded patients with
the outcome, and mortality of ACLF have not been
hepatocellular carcinoma or other malignancies, portal
vein thrombosis, patients with COPD or renal failure.

All patients were subjected to the following:

History, clinical examination, laboratory evaluation:
Received: 9/7/2022
Accepted: 14/9/2022

Full Paper (vol.892 paper# 100)

c:\work\Jor\vol892_101 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6743- 6749

Assessment of the Efficacy of Verapamil to Prevent Radial Artery Occlusion
during Cardiac Catheterization Procedures: A Randomized Study
Comparing Verapamil VS Placebo
Shehab Adel El Etriby*, Ahmed Yehia Ramadan Salama,
Sherif Mohamed Kamel Sharaf, Ahmed Fathy Tamara
Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Shehab Adel El Etriby, Mobile: (+20) 01001717943, E-mail: etribyz@gmail.com

During the transradial approach, radial artery spasm is common complication that might make the patient
uncomfortable or make it impossible to complete the treatment for patients over 40years old.
Objective: It was to compare the conventional spasmolytic drug (verapamil) with a placebo.
Patients and Methods: We conducted a randomised, double-blind, prospective study at two-center. After being
randomly assigned to receive 2.5mg verapamil after sheath insertion and another 2.5mg before sheath removal at the
end of the cardiac procedure (each diluted in 5ml normal saline) or placebo 5ml of normal saline after sheath insertion
and before removal, 150 patients (75 in each group) who underwent a transradial cardiac catheterization were
subsequently included.
The rate of radial occlusion was nearly the same in both groups (10% vs. 15% in verapamil and placebo treated
patients, respectively) at the 24-hour follow-up evaluation of the radial artery patency by pulse oximetry and radial
arterial duplex. The rate of radial artery blockage was essentially the same in both groups, with insignificant p-
value=0.273. There was no statistically significant differences between the two agents in lowering of the radial
occlusion rate when verapamil was used (65% had patent arteries with normal flow) or normal saline (60% had patent
arteries with normal flow).
Conclusion: Verapamil might not be even required as a preventative measure during transradial treatments. Absence
of verapamil might not only lower the drug-related problems, but also enable the safe application of transradial
technique to patients who are verapamil-incompatible.
Key words:
Verapamil; Radial artery occlusion; Coronary angiography.

administration of vasodilating drugs with various
Because of its safety and cost-effectiveness,
mechanisms of action, such as verapamil 2.5mg and
transradial access has become the preferred route for
nitroglycerin 200mg(7). There is currently no proof that
injecting vasodilators such verapamil at the end of the
interventional procedures(1). This approach has fewer
surgery can lessen the likelihood of RAO.
access site complications, a shorter hospital stay, and

improved patient comfort over the traditional
transfemoral approach(2). A meta-analysis found that the
It is to determine the effectiveness of both
transradial approach (TRA) reduced major bleeding
agents; verapamil versus placebo (normal saline) by
complications by 78% when compared to the
measuring radial vasodilator power and preventing
transfemoral approach(3). In the RIVAL trial, the
incidence of major vascular complications was 1.4%
catheterization. To evaluate radial artery patency
with radial access and 3.7% with femoral access. The
because of the possible link between radial trauma
most common vascular complication following
caused by spasm and subsequent vessel occlusion.
transradial coronary interventions was radial artery

Over the past ten years, TRA has gained
Study Population:
popularity and is regularly employed in a variety of
In a prospective, randomised, placebo-
patients. Radial artery occlusion (RAO), a drawback of
controlled, double-blinded trial. It was done from June
transradial access despite its widespread use, may
to December 2019, on 150 patients who had transradial
restrict its use as an access site in the future(5).
catheterizations in two reputable radial catheter
facilities (Ain Shams University hospital and Souad
nitroglycerine, the use of a smaller sheath, maintaining
Kafafy hospital) were enrolled in the current study.
patency during hemostasis, and cutting the compression
They were sequentially randomised to have elective
time are a few strategies that had been used to lower the
coronary angiography (CA) or percutaneous coronary
incidence of RAO(6).
intervention (PCI). The two groups of patients were
The incidence and severity of RAO during the
created; the first group received 2.5mg of verapamil pre
process are known to be decreased by intra-arterial
and post operation (n = 75), while the other group
Received: 12/7/2022
Accepted: 15/9/2022

Full Paper (vol.892 paper# 101)

c:\work\Jor\vol892_102 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6750- 6755

Early versus Delayed Oxytocin Administration during Caesarean
Section: A Randomized Controlled Clinical Trial
Heba Mohamed Hamdy*, Hend AbdElrahman Shalaby,
Yasser Mohamed Mosbah, Mohamed Elsayed Taman
Departments of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Heba Mohamed Hamdy, Mobile: (+20) 01099761801, E-Mail: hebahamdy1481992@gmail.com


Background: Cesarean delivery (CD) is commonly performed operation in modern obstetrics. The risks of cesarean
section (CS) include maternal mortality, hemorrhage, venous thrombosis, infections, and anesthetic complications.
Oxytocin is the most commonly used ecbolic agent during management of atonic postpartum hemorrhage. The aim of
the current study was to compare between the influence of early IV oxytocin infusion early and the standard
administration on intraoperative blood loss during caesarean section.
Patients and methods: A randomized controlled clinical trial was conducted at Obstetrics and Gynecology Department
of Mansoura University Hospitals. This clinical trial included women aged between 18 and 40 years old admitted for
elective CS (low risk). The study population consisted of 80 women who were randomly divided into 2 groups.
Intervention group included 40 women who received oxytocin infusion immediately after incision of pelvic peritoneum.
Control group included 40 cases who received oxytocin after clamping the umbilical cord.
Results: There was no significant difference between both groups in terms of primary post-partum hemorrhage or the
need for blood transfusion. However, the mean intraoperative blood loss was significantly lower among females who
received early oxytocin prior to uterine incision as compared to the control group who received oxytocin after fetal
Conclusion: Early administration of oxytocin (before uterine incision) compared to late oxytocin (after clamping of
umbilical cord) is associated with significantly lower mean intra-operative blood loss.
Keywords: Caesarean section, Placenta accreta, Primary postpartum hemorrhage, Oxytocin.

prophylactic use of ecbolics as oxytocin,
The rate of caesarean deliveries increased from
methylergonovine, prostaglandin E1, and prostaglandin
5.5% in 1970 to 16.5% in 1980, and continued to rise
F2-alpha in the third stage of labor diminishes the risk
till appearing to have steadied around 31-32% in the US
of PPH by nearly 60% (9).
in 2019 (1).
Oxytocin is considered as the first-line agent for
Caesarean section (CS) is considered the most
PPH prevention. Some treatment protocols of oxytocin
common major surgical procedure in Egypt with a rate
have been measured during CS, however its ideal dose
of 51.8%, making Egypt graded the third top country
and infusion rate have not yet to recognized in the
with the supreme CS rate worldwide (2,3).
literature (10).
CS is considered one of the major abdominal
Notably, this wide use of oxytocin is due to its
surgeries that caries medical hazards to woman's health
lesser cost and rapid onset of action. The advantage of
including; hemorrhage, need for transfusion, injury to
oxytocin infusion is in maintaining uterine contraction
other organs, and infections (4).
during CS and immediate post-partum period, and thus
Despite considerable improvements of modern
decreases the incidence and amount of intra-operative
obstetrics care, hemorrhage remains the most important
bleeding and PPH (11).
cause of maternal mortality, specifically in developing
The aim of this work was to compare between
countries (5). Though post-partum hemorrhage itself
the influence of early IV oxytocin infusion early (just
might not be preventable, early recognition of blood
prior to uterine incision) and the standard administration
loss, and enlistment of resources might prevent poor
(following clamping the umbilical cord) on
outcome. Multidisciplinary planning at the system
intraoperative blood loss during elective CS.
level, confirming that hemorrhage protocols are

available, as well as for management of high-risk
women is significant to improve the outcome (6).
Study design
Approaches decreasing the intra-operative blood
A randomized controlled clinical trial was
loss are necessary for reducing the risks of blood
conducted at Obstetrics and Gynecology Department of
transfusion and the post-operative complications (7).
Mansoura University Hospitals. This study included
Primary postpartum hemorrhage (PPH) related to CS
women aged between 18 and 40 years old admitted for
(incidence 3-15%) is demarcated as vaginal
elective CS (low risk) during the study period
bleeding 500mL within 24 hours after CS in mild
cases and 1000 ml in severe cases (8). Most of
We excluded patients who refused to be included
complications of CD could be prevented. The
in the study, patients with uterine overdistension,
Received: 12/7/2022
Accepted: 15/9/2022

Full Paper (vol.892 paper# 102)

c:\work\Jor\vol892_103 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6756- 6761

Evaluation of the Efficacy of Fentanyl versus Dexamethasone as an Adjuvant to
Isobaric Bupivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block
Hatem Saber Mohamed1, Moustafa Ahmed Saad*1, Marwa Nasrelden elansary1
1Department of Anesthesia, ICU and Pain management, Faculty of Medicine, South Valley University, Qena, Egypt
*Corresponding author: Mustafa Ahmed Saad Abd El-Hameed
E mail: masa201010@yahoo.com, Mobile phone: +20 106 704 6710

Changed adjuvants have been used to extend regional blockage, shorten onset times of blocks and prolong
time of post-operative analgesia.
Objectives: This study aimed to compare the effect of dexamethasone plus bupivacaine versus fentanyl plus bupivacaine
in ultrasound guided supra-clavicular approach of the brachial plexus block for upper limb surgeries.
Subjects &Methods: A prospective randomized double-blind research that was conducted in the South Valley
University Hospital, Qena, Egypt. The study included 90 patients of both sexes, scheduled for upper limb surgeries
(Orthopedic and plastic surgeries). Result: Regarding onset of sensory block (min) it was minor in fentanyl category
followed by dexamethasone category & longer in control category with important differences. Complete sensory block
(min) occurred in shorter period in fentanyl group then in dexamethasone group and took longer period to occur in
control group with significant difference. Time of sensory block (hr) was longer among dexamethasone group followed
by fentanyl group and less period in control with significant difference. Conclusion: The addition of dexamethasone or
fentanyl to bupivacaine in supraclavicular brachial plexus block was safe in terms of hemodynamic stability and side
effects, and significantly prolongs time of sensory & motor block & reduces VAS scores.
Keywords: Dexamethasone, Fentanyl, Isobaric bupivacaine, Ultrasound.

After many surgeries, inadequate postoperative
This prospective randomized double-blind
pain management remains major issue. Optimal
research was done in South Valley University Hospital
postoperative pain management necessitates thorough
through the period from April 2021 to June 2022.Ninety
understanding of pain pathophysiology, surgical
patients according to American Society of
procedure invasiveness, & studied case factors related
Anesthesiologist Grade 1 & 2 were studied of both
to increased pain, such as anxiety & depression. Use of
genders with age ranged from 20 to 60 years. They were
undergoing numerous bony orthopedic or plastic
provided rational basis for better postoperative pain
surgeries on upper limb under supraclavicular brachial
control, fewer adverse impacts, & higher studied
plexus block. The study included three categories of
case satisfaction (1).
thirty studied cases each. Studied cases have
Different adjuvants were used to prolong
beenhaphazardly allocated into 3 groups: Group A:
regional blockage, shorten the onset times of blocks &
Bupivacaine 0.25% + dexamethasone 0.1mg/Kg, group
prolong time of post-operative analgesia. Adjuvants
B received bupivacaine 0.25% + fentanyl 1g/kg and
such as fentanyl, midazolam, magnesium sulphate,
group C received bupivacaine 0.25% + normal saline
dexamethasone, & neostigmine were added to local
anaesthetics in attempt to prolong block time &

postoperative analgesia (2).
Inclusion criteria:
Steroids cause vasoconstriction, acting similarly
Patients recruited for elective upper limb
to epinephrine by reducing local anaesthetic absorption.
orthopedics or plastic surgeries according toAmerican
Another theory is that dexamethasone can act locally on
Society of Anaesthesiologist class 1 & 2 & aged from
nociceptive C-fibers to raise activity of inhibitory
20 to 60 years of both sexes.
potassium channels, thus reducing their activity (3). We
hypothesized that peri-neural dexamethasone added to
Anesthesiologists3- 4 status patients, morbid obesity
bupivacaine vsfentanyl added to bupivacaine and their
(BMI > 40), severe & systemic bacterial infection,
allergy to amide local anesthetic & morphine sulphate,
supraclavicular brachial plexus block would prolong
case with seizure
time of sensory analgesia & delay necessity for
case with history of atrial & ventricular arrhythmia,
postoperative analgesia.
studied case with history of autonomic dysfunction,
This research aimed for comparing impact of
studied case with history of renal dysfunction, liver
dexamethasone plus bupivacaine versus fentanyl plus
dysfunction, congestive heart failure.
bupivacaine in ultrasound guided supra-clavicular

approach of brachial plexus block for upper limb
Trial drugs: Dexamethasone (Dexamethasone-
MUP) R 8mg/2ml ampoule; MUP Egypt), Fentanyl


Full Paper (vol.892 paper# 103)

c:\work\Jor\vol892_104 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6762- 6766

Study of Selenium Status in Grave's Disease Patients
Mohamed Reda Halawa, Manal Mohamed Abo-Shadi,
Mai Ahmed Abdel-Maksoud Moustafa Elkateb, Dina Ahmed Marawan*
Department of Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Dina Ahmed Marawan Marawan, Mobile: (+20) 01018086289, Email: dr_dina2010@homail.com

Grave's disease (GD) is an autoimmune disorder caused by the thyroid receptor antibodies (TRAb),
resulting in hyperthyroidism and goiter with extrathyroidal manifestations as; Grave's ophthalmopathy,
dermopathy and acropachy. Selenium: the essential trace element found to have a crucial role in the maintenance of
thyroid physiology and function. Thus, selenium deficiency reported to be linked in the start and progress of autoimmune
thyroid diseases in genetically predisposed individuals. The aim of the current to evaluate the selenium status by
measuring serum selenoprotein P (SEPP) level in GD patients, in comparison to healthy subjects and assess the linkage
between selenium status and Grave's ophthalmopathy (GO).
Patients and methods:
A case control study that was conducted on 80 subjects; Group (A): 40 patients with GD and
Group (B): 40 healthy control subjects recruited from endocrinology clinic at Ain Shams University Hospitals in the
period between December 2020 and June 2021. All the included GD patients suffered from GO.
SEPP levels "as a marker of selenium status" were significantly lower in GD patients than control subjects. No
significant correlation was found between selenium status and GO severity or activity.
GD patients are markedly selenium deficient. There is lack of association between selenium status and GO
severity and activity.
Keywords: Grave's disease, Ophthalmopathy, Selenium, Selenoprotein P.


Grave's disease (GD); the autoimmune disorder
The current study aims to evaluate the selenium
that affects mainly the thyroid gland with extrathyroidal
status by measuring serum selenoprotein P (SEPP) level
in GD patients, in comparison to healthy subjects and
dermopathy and acropachy in less common cases, is the
assess the linkage between selenium status and Grave's
most common cause of hyperthyroidism in iodine-
ophthalmopathy (GO).
sufficient countries (1). It is characterized by the

circulating autoantibodies
resulting in hyperthyroidism and goiter. GD has multi-
This is a case control study that was conducted on
factorial etiology; affected by gender, age, iodine and
80 subjects; Group (A): 40 patients diagnosed with GD
selenium supply, smoking, infections, stress and other
and Group (B): 40 healthy control subjects recruited
auto-immune diseases (2).
from Endocrinology clinic at Ain Shams university
Selenium; the essential element that has several
hospitals in the period between December 2020 and
biological effects depending on the level of its intake, is
June 2021. All the included GD patients suffered from
integrated into 25 selenoproteins, important for
endocrinal functions, immunity, metabolism, and

cellular homeostasis. Selenium has a vital role in the
Inclusion criteria:
metabolism of thyroid hormones (3). Selenium
1. Age: from 18 to 55 years old, both sexes will
deficiency was found to be associated with many
be included.
thyroid diseases especially that of autoimmune
2. Confirmed Grave's patients with GO
pathogenesis, cellmediated and the humoral immune
Exclusion criteria:
response may be impaired in selenium deficiency (4).
1. Patients less than 18 years old and more than
Selenium status is of increasing concern to
55 years old.
define the risk of nutritional deficiency of selenium, to
2. Subjects on selenium supplementation.
estimate its role in decreasing cancer risk, assess public
3. Pregnant and lactating females.
health and to consider the pros and cons of excess
4. Major organ failure.
selenium (5). It is essential to study selenium status in
5. Psychiatric illness.
different countries of the world, due to the variability of

selenium status and the variability of its correlation with
The following data was recorded and analyzed:
thyroid diseases (6).
Group (1) "GD patients" were subjected to:
Selenoprotein P represents 50% of selenium in
1. History taking and clinical examination.
blood (7). Accordingly, serum selenium is mirrored by
2. Confirmation of Grave's disease diagnosis
circulating selenoprotein P concentrations especially in
clinically and laboratory thyrotoxic lab profile
marginally supplied individuals (8).
and evidence of GO.

Received: 12/7/2022
Accepted: 15/9/2022

Full Paper (vol.892 paper# 104)

c:\work\Jor\vol892_105 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6767- 6770

Evaluation of Interleukin-10 -1082 G/A Gene Promoter Polymorphism among
Hematologic Malignancies in Children
Elhamy Rifky Abdel Khalek1, Tamer Hasan Hassan1, Wafaa Abdel Latif2,
Hala Mossad Yousef2, Arwa Arafa Ramadan Ahmed*1
Departments 1Pediatric and 2Medical Biochemistry, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Arwa Arafa Ramadan Ahmed, Mobile: (+20)1092721490, Email: arwa.arafa27@gmail.com

Hematological malignancies are forms of cancer that begin in the cells of the blood-forming tissue, such
as the bone marrow. Childhood blood cancers are relatively rare but are still found to be the major cause of death in
children aged 1-14years. Objective: The aim of the current work was to evaluate IL-10 (1082G/A) gene promoter
polymorphism as a risk factor in children with hematological malignancies.
Patients and Methods:
This study included a total of 30 patients with newly diagnosed hematologic malignancies and
30 healthy children served as a control, attending at Oncology Unit, Department of Pediatrics, Zagazig University and
Department of Pediatrics, Mansoura Cancer center, Mansoura University Hospitals. All patients and controls were
subjected to the detection of IL-10-1082G/A gene promoter polymorphism using ARMS-PCR.
Results: There was no significant difference between patients and controls as regards age and sex. Fever was the most
common presentation in patients followed by anorexia, pallor, lymph node enlargement, and bone pain. There was no
significant difference between patients and controls as regards the genotype of the IL10 (1082) gene.
Conclusion: It could be concluded that no significant association between hematologic malignancies in children and
controls as regards the genotype of the IL-10 (1082) gene.
Interleukin-10, 1082 G/A gene promoter polymorphism, Hematologic malignancies, children.


growth factors, and matrix Metalloproteinases (MMPs)
Childhood cancer mortality rates were higher 50
and stimulation of the production of inhibitors of
years ago, but can now, fortunately, be successfully
angiogenesis. Based on this, several investigators have
treated in approximately 80% of cases where there is
suggested the therapeutic use of IL-10 in cancer
access to modern treatments and robust supportive care
patients, but at present no clinical trials have been
(1). Hematologic malignancies (HMs) are the most
performed (5).
common neoplasms in childhood representing about
In recent years a considerable number of genetic
45% (30.6% leukemias, 14.2% lymphomas) of all
polymorphisms have been identified within the IL-10
newly diagnosed pediatric cancers. The treatment of
gene, particularly within the promoter region of the
childhood leukemia has undergone dramatic change in
gene. Some of these polymorphisms are associated with
the last 50 years. Recently, about 90% of children are
differential levels of IL-10 expression. A considerable
cured of this once nearly uniformly fatal disease.
number of studies have been performed to determine
Lymphomas make up a large category of childhood
whether IL-10 polymorphisms are associated with
cancers. Chief among these cancers are the NHLs,
susceptibility to many immune-mediated diseases (6).
which are responsible for 6% of all pediatric cancers (2).
This study was aimed to evaluate IL-10-
Interleukin-10 (IL-10) is a multifunctional
1082G/A gene promoter polymorphism as a risk factor
cytokine with both immunosuppressive and anti-
in children with hematologic malignancies and its
angiogenic functions. In consequence, IL-10 can have
association with other well-known risk factors.
both tumor-promoting and tumor-inhibiting properties.

Raised levels of serum and peri-tumoral IL-10
production have been reported in many malignancies,
This study included a total of 30 patients with newly
which have been interpreted in support of a role for IL-
diagnosed hematologic malignancies and 30 healthy
10 in tumor escape from the immune response.
children served as a control, attending at Oncology
However, gene studies in several malignancies argue
Unit, Department of Pediatrics, Zagazig University and
more convincingly for an anti-tumor function of IL-10,
Department of Pediatrics, Mansoura Cancer center,
possibly via inhibition of pathways of angiogenesis (3).
Mansoura University Hospitals. This study was
There are some reports describing elevated
conducted between September 2020 to July 2022.
levels of IL-10 expression in patients with particular

cancers, including malignant melanoma, ovarian
Children were divided into 2 groups: Patients
cancer, and other carcinomas, lymphoma, and myeloma
group: It included 30 patients with newly diagnosed
(4). While the mechanisms remain unclear, there is a
hematologic malignancies. They were 16 males and 14
considerable and growing body of evidence for the
females. Their age ranged from 2 years to 15 years with
antitumor properties of IL-10 and this may result at least
a mean age of 7.4 years, and Control group: It included
in part from inhibition of angiogenesis, possibly by
30 healthy children. They were 14 males and 16
inhibition of production of angiogenic cytokines,
females. Their age ranged from 3 years to 15 years with
Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 105)

c:\work\Jor\vol892_106 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6771- 6778

Role of Ultrasound in Evaluation of Pulmonary Manifestations of
COVID-19 Using Computed Tomography as A Gold Standard
Rania Mostafa Al-Molla, Ashraf Ali Mohamed Ali Mansour*,
Osama Abd Allah Dawoud, Marwa Elsayed Abd Elhamed
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ashraf Ali Mohamed Ali Mansour, Mobile: (+20)1025353752,
E-Mail : ashrafmansour192@gmail.com

In critical care medicine, lung ultrasonography (LUS) has become more widely utilized as a trustworthy
method for assessing lung diseases. Since COVID-19 pneumonia lesions have a predominant peripheral distribution,
LUS detection is more appropriate.
Objective: This study was aimed to assess the role of LUS in early diagnosis of COVID-19, as well as severity
assessment of COVID-19 patients using CT chest as a gold standard.
Patients and methods: Patients in this prospective cohort study were complaining of symptoms raising suspicion of
SARS-CoV-2 infection and referred from chest emergency departments. Ultra-sound and CT were done for all patients
and finding were correlated in the two modalities with estimation of the severity score.
out of 242 patients with CT chest findings positive for COVID-19 infection, 232 patients demonstrated positive
LUS findings for COVID-19. Our study revealed the sensitivity of LUS up to (99.15%), specificity (100%), PPV
(100%), NPV (80%) and accuracy (99.17%).
It could be concluded that LUS could show pulmonary manifestations indicative of COVID-19 in
symptomatic patients with high diagnostic accuracy comparable to CT chest.
Keywords: CT, US, COVID-19, Diagnosis.


clinical phenotype at the time of emergency department
By the end of 2019, China had become a global for
presentation. Lung ultrasound (LUS) has therefore been
the SARS-CoV-2 virus, which causes severe acute
suggested as a substitute imaging tool for suspected
respiratory syndrome, causing a unique interstitial
COVID-19 pneumonia patients (3).
pneumonia outbreak. Even in the most developed and
In symptomatic COVID-19 patients who reported
wealthy nations, the COVID-19 outbreak is causing the
to the emergency department (ED) in the spring of
healthcare systems a great deal of trouble.
2021, when the COVID-19 pandemic was at its worst,
The SARS-CoV-2 infection's most common
this research was outlined to evaluate the accuracy and
negative effect, interstitial pneumonia, must be swiftly
diagnostic rule of ultrasound (US) compared to
diagnosed during the pandemic surge. New patients
computed tomography (CT) in detecting lung affection.
must be isolated. The frontline relies heavily on chest

imaging. Lung CT was deemed the gold standard chest
imaging method and is highly advised in suspected
This prospective cohort study was carried out at the
instances among the commonly used chest imaging
Radiodiagnosis Department, Zagazig University
technologies (1, 2).
Hospitals, Radiodiagnosis Center, Suez General
Investigations have shown that CT is very sensitive
Hospital and Radiodiagnosis Department, El-Mouneera
in detecting the early stages of interstitial pneumonia,
General Hospital. It included a total of 242 patients with
even in COVID-19 patients who are asymptomatic and
clinically suspected SARS-CoV-2 infection, referred
in patients whose first rapid test (RT-PCR) swab results
from chest emergency Departments.
were negative. A systematic use of CT during the

pandemic surge is impossible due to the biological and
The included 242 patients were 143 men and 99
monetary costs, the lack of availability in areas with low
women, their average age was (47.94 ±13.47) years
resources, and the increased risk of in-hospital cross-
ranged from 20 to 78 years.
infections when infected patients referred to the

radiology units. Social norms concur with the proposal
Inclusion Criteria: All genders, any patient with
to restrict the use of CT scans during a pandemic spike
clinically suspected COVID-19 infection, and
(3). Chest radiography (CXR) and lung ultrasonography
individuals who presented to the emergency department
(LUS) are reliable alternatives that may be used in this
(ED) with symptoms raising suspicion of SARS-CoV-2
field. LUS demonstrated good feasibility and sensitivity
for COVID-19 pneumonia, with a specificity that

increases during the peaks of occurrence. When
Exclusion Criteria: Women who were pregnant, and
utilizing LUS properly, it's also crucial to take into
patients who dropped out of the trial (US or CT not
account the different COVID-19 pneumonia risk
categories and correlate LUS patterns with the patient's

Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 106)

c:\work\Jor\vol892_107 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6779- 6785

Plasma Pentraxin-3 as a Predictor for Peripheral Arterial Disease in
Maintenance Hemodialysis Egyptian Patients: A Single-Center Study
Niveen S. S. Sakla*1, Mohamed A. Arafat1, Magda M. Sherif1, Samar M. Sharaf2,
Rania M. Al-Molla3, Mai Z. Abd El-Halim1, Medhat Ibrahim Mahmoud1
Departments 1Internal Medicine, 2Clinical Pathology and 3Radio-Diagnosis,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Niveen S. S. Sakla, Mobile: (+20) 01285031953, Email: drniveen.shafeek@yahoo.com

Peripheral arterial disease (PAD) is a common risk factor for mortality in hemodialysis (HD) patients.
Pentraxin-3 (PTX3), an inflammatory mediator, is widely expressed in peripheral tissues and may have a predictive
value for PAD.
To evaluate the role of plasma PTX3 as a predictor for PAD in maintenance HD patients.
Patients and Methods: 84 subjects were included; Group 1: 42 End-stage renal disease (ESRD) patients on
maintenance HD, and Group 2: 42 Healthy controls. After history taking, examination, and routine laboratory
investigations, the following was done; Assessment of lower limb arteries by Color and Pulsed Doppler Ultrasound,
ankle-brachial index (ABI), measurement of high-sensitivity C-reactive protein (HS-CRP), and plasma Pentraxin-3
(PTX3) by ELISA. Results: The ABI in HD patients (0.67 ± 0.13) was significantly lower than controls (1.1±0.16),
(P<0.001). HS-CRP levels in ng/ml in HD patients (10.5 ± 2.3) were significantly higher than controls (1.48 ± 0.34),
(P<0.001). Plasma PTX3 levels in ng/ml in HD patients (6.87 ± 1.36) were significantly higher than controls (1.47 ±
0.25), (P<0.001). Plasma PTX3 had a significant negative correlation with ABI, and Hb% (P<0.001), and a significant
positive correlation with cholesterol and triglycerides (P<0.001), whereas HS-CRP did not have correlation with ABI.
Plasma PTX3 at a cutoff of 2.35 ng/ml showed a higher predictive value for PAD than HS-CRP at a cutoff of 2.25 ng/ml
regarding sensitivity (95.2% vs 88.1%), and specificity (92.0% vs 86.7%) respectively, (P<0.001).
Plasma PTX3 maybe used as a predictor for PAD in maintenance HD patients, with a high sensitivity and
Keywords: Plasma Pentraxin-3 (PTX3), High-sensitivity C-reactive protein (HS-CRP), hemodialysis (HD), peripheral
arterial diseases (PAD), ankle-brachial index (ABI), Pulsed Color Doppler Ultrasound.

possible need to start a secondary preventive therapy
Peripheral arterial disease (PAD) includes all
with statins or platelet inhibition (9).
arterial diseases; carotid, mesenteric, renal, and lower
This study was conducted to assess the validity of
extremity artery disease, other than the aorta and
plasma pentraxin-3 (PTX3) as a predictor for peripheral
coronaries (1). End-stage renal disease (ESRD) patients
arterial disease (PAD) in maintenance HD patients.
on hemodialysis (HD) are more prone to PAD due to

systemic inflammation, hypercoagulability, oxidative
This case-control study was carried out in collaboration
hyperparathyroidism, atherosclerosis, and vascular
between Internal Medicine, Clinical Pathology, and
calcification (2). The normal ankle-brachial index (ABI)
Radio-Diagnosis Departments, Faculty of Medicine,
varies from (1.0-1.4), and individuals with ESRD who
Zagazig University, Egypt, during the period from April
need dialysis have much higher incidence of PAD (46%
2018 to March 2019. It included 84 age and sex-
in the USA) (3). Intermittent claudication and critical
matched subjects: 42 ESRD patients on maintenance
limb ischemia are two symptoms of PAD that are linked
HD, age mean±SD (38.24 ± 12.92) years, (20 females
to greater mortality in HD patients (4). Short pentraxins,
and 22 males), and 42 healthy controls (37.4.5±11.37)
like C-reactive protein (CRP) and serum amyloid P, are
years, (23 females and 19 males).

structurally related to long pentraxin, an inflammatory
Inclusion criteria: Patients included were HD patients
mediator. Pentraxin-3 (PTX3) is expressed in a variety
(age >18 years). presenting with symptoms and/or signs
of peripheral tissues, including endothelial cells and
suggestive of PAD (intermittent claudication and
mononuclear phagocytes, and it is increased in
diminished walking ability) (10); that were referred for
atherosclerotic plaques (5).
diagnosis of PAD by Doppler ultrasound from different
Higher PTX3 levels independently predict
hemodialysis units in Sharkia Governorate (from our
chronic kidney disease (CKD) in elderly persons and are
dialysis unit and other dialysis units).
linked to reduced glomerular filtration rate (GFR) (6).

Exclusion criteria:

Plasma PTX3 levels are higher in people with vascular
Patients with diabetes mellitus, malignancy, auto-
disorders and atherosclerotic plaques, and they are
immune diseases, active infection, amputation, and age
related with an increased risk of mortality in HD
patients (7, 8). Assessment of PAD is indicated in both
< 18 years.

symptomatic and asymptomatic CKD patients for
Ethical Approvals:
Received: 8/7/2022
Accepted: 13/9/2022

Full Paper (vol.892 paper# 107)

c:\work\Jor\vol892_108 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6786- 6794

Dentists Perception to Personal Protection Equipment Use during the
COVID-19 Pandemic (Analytical Study)
Rawaa Y. Al-Rawee1*, Karam Ibrahim Al-Saidi2,
Abdulmohsen A. Mohammed3, Bashar Abdul-Ghani Tawfeeq4
1Department of Maxillofacial Surgery, Al-Salam Teaching Hospital, Nineveh Health Directorate. Iraq.
2Department of Oral Surgery, Al-Noor Specialized Dental Center. Nineveh Health Directorate
3Department of Maxillofacial Surgery, Al-Jamhory Teaching Hospital, Nineveh Health Directorate. Iraq.
4Department of Oral and Maxillofacial Surgery,Al-Noor University College. Mosul, Iraq
*Corresponding Author: Rawaa Y. Al-Rawee. 009647726438648, 0000-0003-2554-1121. E-mail: dr.rawarawi@yahoo.com.

It has been demonstrated that the use of personal protective equipment (PPE) by health care workers,
including dentists, reduces the transmission of COVID-19. PPE lowers patient morbidity and death as well as illness
and absenteeism.
The purpose of the study was to evaluate the impact of dentists' perceptions of personal infection control and their
level of trust in PPE as part of the dental profession's response to the COVID-19 pandemic.
Materials and Method: The sample size was (388) participants distributed as specialist, general dental practitioners,
dental branch practitioners, and rotators. Google form prepared with specific questions; demographical and knowledge
questions translated to the mother language (Arabic Language). Structured and distributed online by sharing the link
through electronic platforms. Two responses were used in a statistical analysis using the SPSS version (SPSS Package
version (21). Significant p value of 0.05 or less was used. Descriptive statistics were used in the data analysis to analyze
the percentage, and mean values. All questions employ the spearman test to determine correlations. Kruskal-Wallis for
comparing differences between groups including qualification and experience period between participants.
Result: Significant results were shown in both rotators and general practitioners for comparison of different
qualification levels between dentists. All dentists had good knowledge regarding the PPE.
Overall, dentists in the current study had good knowledge of the PPE used for COVID-19 protection.
However, it was discovered that knowledge is important for rotators and general practitioners in the majority of the PPE
Keywords: Dentist Perception, Covid 19, Personal Protection Equipment, Analytical Study, Knowledge


million reported illnesses and almost 1.7 million deaths
Everywhere in the world, the year 2000 was
on December 29, 2020, which was one year later(8).
exceptional. The worst health issue affecting humanity is
Consequently, at the height of an attack, dental clinics
COVID-19, which has claimed numerous lives. The
were obliged to close( 9).
epidemic attacks presented a variety of difficulties for
Hospitals, basic care clinics, and even private
people at many stages of life (social, economic, health,
clinics are getting ready and being urged to try their
political). Leaders made every attempt to shield the
maximum best to stop the spread of COVID-19. One
populace from the epidemic's wide spread. The symptoms
goal of these initiatives was to increase the preparedness
of COVID-19 infection had been identified as fever, cough,
of healthcare workers (HCWs) by educating them about
exhaustion, anorexia, shortness of breath, and myalgia, in
the illness and the steps needed to stop its spread,
addition to odor and test loss (1,2), which have a high death
primarily through the use of personal protective
rate (3,4).
equipment (PPE)(9). In fact, effective PPE use which
However, some people exhibit symptomless
includes gloves, dressing gowns, masks, and protective
attacks, occurring at a rate of between 1.5 and 2.8% in
eyewear can reduce infection control and transmission.
the initial studies of COVID-19(5). People who are
It has been demonstrated that the use of PPE by HCWs,
asymptomatic present a special risk to dental
including dentists, reduces the transmission of COVID-
professionals since they might unwittingly attend their
19, which lowers patient morbidity and death as well as
appointment while carrying the COVID-19 virus.
illness and absenteeism (10).
Dental professionals are not exempt from these
Dental professionals may not be fully aware of
difficulties because saliva is thought to be a source of
PPE's demonstrated effectiveness and relevance of use,
the COVID-19 virus(6). The dental team is in a risky
and reports of misuse and compliance are common(11).
position for infection because of their close proximity to
With improved personal protective equipment (PPE),
their patients(7).
new protection protocols are upheld for the performance
The World Health Organization (WHO) first
of harmless dental treatments(12).
reported and issued cautions about this virus in the
The WHO reported in March 2020 that the cost
weekly updates on January 12 after China provided the
of surgical masks had climbed six-fold, that the price of
virus' genetic sequence (7). The WHO recorded 79
N95 masks had increased threefold, and that the price of
Received: 12/7/2022
Accepted: 15/9/2022

Full Paper (vol.892 paper# 108)

c:\work\Jor\vol892_109 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6795- 6802

Evaluation of Right Ventricular Performance in Ischemic
Patients with or without Significant Right Coronary Artery Disease
Taghreed A. Ahmed 1, Shaimaa A. Habib 1, Bassem M Abdel Hady 1, Taher Said2
1 Cardiology department, faculty of Medicine for girls, Al-Azhar University, Cairo, Egypt.
2 Islamic Center of cardiology, Al Azhar University, Cairo, Egypt.
Corresponding Author: Taher Said Abd-Elkareem, Islamic Center of cardiology, Al Azhar University, Cairo, Egypt.
Tel: 002-01120313136 Email: Tahersalman2017@gmail.com

Optimal cardiac performance relies on integrity between left ventricle (LV) and right ventricle (RV)
owing to variety of factors as shared coronary circulation. RV systolic dysfunction identified as a poor prognostic
factor. Objectives: We aimed at assessing the impact of LV ischemia on RV performance in occurrence or absence
of right coronary artery (RCA) disease. Subjects and methods: We enrolled 40 patients with proven LV ischemia.
All patients were subjected to myocardial perfusion imaging and coronary angiography. LV and RV functional
parameters were assessed in all individuals using conventional echocardiography, tissue Doppler imaging (TDI), two-
dimensional speckle tracking echocardiography (2D-STE) and 4-dimensional echocardiography (4DE).
Results: We divided our patients based on presence or absence of angiographic significant RCA disease into two
groups. Group I with RCA involvement (22 patients) and Group II without significant RCA involvement (18 patients).
Group I was older, predominantly men and more hypertensive (HTN) compared to Group II, however it did not reach
statistical significance. Our study demonstrated reduced RV performance in both groups however, it didn't reach the
statistical significance.
Conclusion: RV performance was impaired in ischemic heart disease (IHD) but not significantly affected by the
presence or absence of RCA affection, denoting that the right ventricular performance is directly interdependent on
the left ventricular function in ischemic heart disease.
Keywords: Left ventricle, Right ventricle performance, Ischemia, Echocardiography, Myocardial perfusion imaging.

occlusions show minor acute RV abnormalities, the
For a very long time, the RV was viewed as the
location of RCA occlusions could be distal or proximal
forgotten or neglected chamber of the heart since it was
with different degrees of RV dysfunctions unrelated to
thought to be less important in cardiac disorders than
the site of affection. RV dysfunctions may vary in
its left counterpart. Therefore, the significance of the
severity from modest to severe RV performance
RV in the treatment and prognosis of numerous cardiac
depression (5).
disorders is being acknowledged more and more (1).
The cost of echocardiography is lower than that
Common coronary arterial blood supply among
of other methods used to assess RV function and it is
other factors closely linking the RV and LV
readily accessible. It is a helpful instrument for a
performance. In extreme cases of myocardial infarction
thorough assessment of RV dimensions and functions.
with LV injury, RV dysfunction develop, where LV
Echocardiography evaluation of the RV is difficult
infarction pattern affects the risk for RV insufficiency
because of its complicated structure, location, and
anatomy. New echocardiography techniques, such
Extending LV ischemia may have an effect on
4DE and STE myocardial deformation imaging, offer
RV function both directly by changing RV
prospective solutions to most of the problems with
perfusions and indirectly by raising RV afterload. The
traditional echocardiography (1).
RV and LV are very different from each other

anatomically and physiologically. Once RCA
occlusion happens, the RV becomes less susceptible to
Study population
ischemia and less likely to sustain myocardial damage
Our study was a prospective observational study
than when left coronary artery (LCA) obstruction
that enrolled 40 consecutive patients diagnosed as IHD
happens due to the amount of LV dysfunction (3).
who were candidate for myocardial perfusion imaging
Because proximal RCA blockage is typically
(MPI) and elective coronary angiography (CA) plus or
the responsible for acute RV infarction (RVI), inferior
minus intervention. The study was conducted through
MI is frequently linked with RVI (4).
the period from November 2018 to November 2019.
The RV free wall, which is largely in charge of

overall RV efficiency, is fueled by the RCA's RV
Ethical consent: This study was ethically approved
branches. As some cases with proximal RCA
by Al-Azhar University's Research Ethics
Received: 8/7/2022
Accepted: 13/9/2022

Full Paper (vol.892 paper# 109)

c:\work\Jor\vol892_110 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6803- 6808

Synthesis, Evolution Anticancer and Microbial Activity of
Some 1,3,4-Oxadiazoles Analogues
Esraa Mohammed Jawad Mohsen, Israa Sami Hadi
Department of Pharmaceutical Chemistry, College of Pharmacy, University of Kufa
Corresponding author: Esraa M. J. Mohsen, Mobile: +9647810415661, Email: israam.jawad@uokufa.edu.iq

The need to develop anti-cancer drugs and the increasing bacteria resistance towered many antibiotics have
made researchers more interested in testing the ability of synthetic derivatives to inhibit different types of microorganisms,
although studying the cytotoxicity effect on various species of cancer cells.
Aim: synthesis methyl nicotinate derivatives and evolution their anti-microbial and anti-cancer ability.
Material and methods: a series of 1,3,4-oxadiazole heterocyclic compounds were synthesized, a nicotinoyl hydrazine was
synthesized by refluxed methyl nicotinate and hydrazine hydrate. a good yield of Schiff bases was isolated by a reaction
equimolar quantity of nicotinoyl hydrazine with several aromatic aldehydes. Up on Schiff bases acylation, heterocyclic
compounds were collected, and synthetic derivatives were identified using Infra-Red (IR), Hydrogen Nuclear Magnetic
Resonance (1HNMR). The methyl thiazolyl tetrazolium (MTT) Method was used for the Evolution of anti-cancer activity.
Well diffusion method over agar was used to determine antibacterial activity, gram-positive and gram-negative bacteria
were used to test the strength of inhibition for synthesis derivatives.
Results: a white solid of nicotinoyl hydrazine was isolated, different Schiff bases were separated in a high yield, and 1,3,4-
oxadiazole analogues were collected. The inhibition values of the prepared derivatives towards bacterial growth were
measured. Cytotoxicity was an accounted for Schiff bases and 1,3,4-oxadiazole analogues.
Conclusion: Three oxadiazole heterocyclic compounds show moderate activity. In contrast, two showed excellent
inhibition toward cancer cell and bacteria growth greatly depending on the type and position of substituent groups in
different hetero cyclic compounds.
Keywords: 1,3,4-Oxadiazole, Schiff bases acylation, Methyl nicotinoyl hydrazine.

hydrophobic properties, and the cell wall is a barrier for
From many decades 1,3,4-oxadiazoles have been
different various of antibiotics which causes antibiotic
proven their synthetic and biological importance against
resistance; on the other hand, gram positive bacteria have
various species of microorganisms and introduced
alack in this ability (11,12) .several 1,3,4-oxadiazole have
hundreds of products as antibacterial, anti-fungi, anti-
been reported to possess good anticancer potential against
tuberculosis, antitumor, anti-virus, anti-septic, and anti-
various types of cancer cells. Although the anticancer
Arteriosclerosis(1,2,3,4,5). It has well known the wide ring
activity of oxadiazoles is well documented, a
application of methyl nicotinate in synthesis. It has been
comprehensive study on their putative targets and
used as a starting material in nucleophilic displacement
mechanism of action has not been reported so far (13).
reactions (6,7); hydrazine hydrate shows excellent activity

in the synthesis of isoniazid derivatives (Ar-NH-NH2),
which have many implementations in therapeutic,
The work aims to synthesise methyl nicotinate
especially inhibition of a wide series of tuberculosis (8).
derivatives as 1,3,4-oxadiazole heterocyclic in mild
The direct cyclisation of methyl nicotinoyl hydrazone to
conditions. Evolution of their anticancer and antibacterial
1,3,4- heterocyclic compounds were completed by using
activity and no further reagents were used, lead to less
various reagents such as acetic anhydride, phosphorus
contamination and high purity of isolate products.
penta oxide, thionyl chloride, and polyphosphoric acid.

Increasing bacterial resistance against antibiotics, leading
to many drugs interaction and reducing the drug efficacy,
The melting points of the synthetic derivatives
such as local tissue irritation, narrow antimicrobial
were measured using a capillary tube method with no
spectrum and Interference with wound healing processes
further correction. The IR measurements were recorded
(9,10). For this reason, there is always a need to develop
on a Shimadzu spectrometer using a KBr pellet, and
new types of synthetic agents and reduce the toxic effect
1HNMR measurements were done using the DMSO. No
by modifying the chemical structure. Many researchers
further purification of starting materials (Methyl
have reported that gram positive is fewer resistances to
nicotinate, hydrazone hydrate, absolute ethanol and
antibiotics than gram negative due to the outer membrane
aromatic aldehydes), while the purification of synthesis
of gram negative bacteria, which can alter the
derivatives was achieved by using a recrystallisation

Full Paper (vol.892 paper# 110)

c:\work\Jor\vol892_111 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6809- 6815

Microsurgical Decompression of C2 Nerve and Ganglion as a
Treatment Option for Occipital Neuralgia with Migraine
Mohammed Hammad Eltantawy*, Ahmad Arab, Shawky A. Elmeleigy
Department of Neurosurgery, Faculty of Medicine, Banha University, Egypt
*Corresponding author: Mohammed H. Eltantawy, Mobile: (+20)01000221379, Email: hammad_neurosurg@yahoo.com

Occipital neuralgia associated with migraine or cervicogenic headache is not uncommon clinical
syndrome. It's still a debatable issue regarding the pathogenesis and treatment options in the literature.
Objective: It was to study and analyze the rule of microsurgical decompression of C2 nerve and it's ganglion in
management of intractable occipital neuralgia with migraine.
Patients and Methods: Thirty-six patients with this syndrome had been subjected to full clinical assessment to fulfill
the clinical criteria of having occipital neuralgia with migraine (cervicogenic headache). All patients were subjected to
image guided C2 ganglion anesthetic block and corticosteroid administration as a therapeutic test.
Results: Among the 10 patients who had surgery and during a mean full up period of 28.1 months, 6 patients 60% (7
sides) were totally free of pain. Three patients (30%) showed moderate degree of improvement with less frequent attacks
and controlled with minor medication. Only one patient (10%) showed no improvement but still without worsening of
his preoperative symptoms. In nine patients (90%) the main pathology was vascular compression by vertebral venous
plexus around the root and ganglion, while in six (60%) patients we found the hypertrophied dorsal atlanto-epistrophic
ligament is the main pathology. Osteoarthritic sharp lower border of C1 vertebrae and lateral mass were found in three
patients (30%). Conclusion: Good selection of patients with typical clinical presentation together with C2 ganglion
anesthetic block were the key of success of microsurgical decompression of C2 nerve and ganglion as a valid treatment
option in intractable occipital neuralgia with migraine.
Keywords: Occipital neuralgia, Cervicogenic headache, Migraine, C2 nerve decompression.

The term occipital neuralgia describes clinical
Thirty-six patients had been diagnosed as
syndrome of headache that has been defined by the
cervicogenic headache (20 females and 16 males), after
International Classification of Headache Disorders(1)
fulfilling the diagnostic criteria, from June 2017 to
(3rd edition) as sharp shooting pain radiating from the
March 2022. All of them had been treated as intractable
occipital area into the distribution of the greater, lesser,
cervicogenic headache with long history of medical
and or 3rd occipital nerves, to the temple and the
treatment by other doctors (Table 1).
forehead. Sometimes it can be associated with constant
Different modalities of treatment had been
dull aching pain between the attacks. This type of
given to all patients; 20 patients decided to go with
headache is usually difficult to distinguish from
conservative treatment only in spite of unsatisfactory
migraine headache and maybe associated or
results, six patients get benefit from repeated local
precipitated by it forming a clinical syndrome called
injection with corticosteroid during a mean follow up of
cervicogenic headache. Concomitant presence of the
18.4 months.
term occipital neuralgia and migraine headaches has
Full history and clinical examination has been
been noted in the literature (2-5). Neck pain has been
taken on all patients to confirm the diagnostic criteria of
found to be a predominant symptom in up to 68% of
this type of headache according to the ICHD 3 (6).
patients with migraine the pain usually relieves by
All patients had MRI brain, cervical spine, and
occipital nerve block or C2 nerve and ganglion
fundus exam to exclude other pathologies that may
explain their headache. Cervical disc disease or
Different modalities of treatment has been
advanced cervical spondylosis has been excluded.
proposed to manage properly cervicogenic headache (6).
All patients underwent a diagnostic image
Some studies had focused on the role of C2 nerve and
guided C2 ganglion anesthetic blockade with
ganglion entrapment by different pathologies as a
corticosteroid administration as a therapeutic test. All
causative agent of this type of headache (2,7,8).
patients showed positive response.

The technique has been done with the spinal
needle introduced to the anatomical site of C2 below C1
It is to review our results of microsurgical
arch, and against lateral C1-C2 joint under C arm image
decompression of C2 nerve and its ganglion for
Control. Injecting 5CC's of light Marcaine and confirm
treatment of intractable occipital neuralgia with
the disappearance of symptoms, followed by one vial of
migraine or the so-called (cervicogenic headache).
long-acting corticosteroid injection. Temporary relief of

symptoms is strong evidence of involvement of C2
nerve and ganglion in the etiology of this type of
headache (Fig. 1).
Received: 12/07/2022
Accepted: 15/09/2022

Full Paper (vol.892 paper# 111)

c:\work\Jor\vol892_112 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6816- 6822

Impact of Different Right Ventricular Lead Positions on QRS Complex
Duration Post Cardiac Resynchronization Therapy Device Implantation
Ahmed Reda*, Hassan Shehata, Hesham Tarek, Haitham Badran
Cardiology Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Ahmed Reda, Mobile: (+20) 01148843202, E-Mail: profdark2009@yahoo.com

Undoubtedly one of the most successful recent developments in the treatment of heart failure (HF) is
cardiac resynchronization therapy (CRT). CRT aims to provide the failing heart with a mechanical advantage that can
significantly reduce symptoms and mortality by treating ventricular dyssynchrony, a problem that affects up to one-
third of patients with highly symptomatic systolic HF. Objectives: The aim of the current study was to evaluate the
effect of different right ventricular (RV) lead positions on QRS complex duration post CRT device implantation in
patients indicated for CRT as a treatment of chronic heart failure. Patients and methods: This clinical trial included
100 patients who underwent CRT device implantation as a treatment for heart failure, divided into 2 groups according
to the site of RV lead implantation after confirmation of the RV lead position; 54 patients had the RV lead implanted in
the RV Apex (RVA n=54) and 46 patients had the RV lead implanted in the RV Septum (RVS n=46).
Results: There was no significant difference between the two groups regarding clinical response (NYHA Class) (P-
value = 0.583), left ventricular ejection fraction (LVEF) ( EF 6.26 ± 1.64 in RVS group vs. 6.07 ± 1.43 in RVA group,
P-value = 0.575) LVES diameter (47.70 ± 8.03 in RVS group vs. 45.39 ± 7.48 in RVA group, P-value = 0.141) or QRS
complex narrowing ( QRS 60.93 ± 14.68 in RVS group vs. 54.07 ± 13.12 in RVA group, P-value = 0.182). Conclusion:
Our results demonstrate that septal RV pacing in CRT is non-inferior to apical RV pacing regarding the primary
objective of the study regarding clinical outcome, narrowing of QRS complex ( QRS) or LV reverse remodeling.
Keywords: RV pacing, Heart failure, Non responders, CRT, Pacemaker, QRS complex.


patients having the RV lead positioned in RV apex and
Patients with symptomatic heart failure (HF),
the second group included 54 patients having the RV lead
reduced left ventricular ejection fraction (LVEF), and
positioned in RV septum, the outcomes regarding QRS
broad QRS are advised to undergo cardiac
complex duration, Echocardiography and clinical
resynchronization therapy (CRT) (1). Pacing the right and
response were compared between the two groups.
left ventricles simultaneously or sequentially results in
The study protocol was approved by Ain Shams
cardiac resynchronization treatment. Even though such
University Faculty of Medicine Scientific and Ethical
implantation is technically successful in 90% of patients
(2) only 2/3 of individuals have clinical improvement or
Inclusion criteria: Patients underwent CRT device
reverse remodeling of the left ventricle (LV). Several
implantation as a treatment for HF with reduced ejection
factors could account for this insufficient response:
fraction after at least 3 months post implantation based
inadequate patient selection (1,3).Poor programming and
on ESC guidelines of Heart failure published in 2016
insufficient left ventricular (LV) lead position (4,5). There
with biventricular pacing >95%.
is disagreement about whether the right ventricular (RV)
Exclusion Criteria: (1) Patients with multiple co
lead position can enhance the response to CRT. Although
morbidities that may underestimate the clinical
the apical position is customary, particularly for patients
improvement including patients with COPD, interstitial
receiving a CRT-defibrillator (CRT-D), long-term RV
pulmonary fibrosis, bronchial asthma, cerebrovascular
apical pacing may negatively impact cardiac function in
disease, skeletomuscular abnormalities or sever CKD.
intracardiac cardioverter defibrillator (ICD) receivers (6).
(2) Patients with heart block. (3) Documented AF within
Recent proposals for alternative RV pacing sites in
1month prior enrolment.
CRT patients, suggest primarily the RV septum. With the

limitations of either retrospective analysis of large
prospective trials (7), prospective non-randomized trials,
All patients after written informed consent were
or single-Centre randomized studies, no discernible
subjected to the following at baseline:
effect of these various RV pacing sites was shown (8,9).
1. Full history taking including: Age and sex, risk
The aim of present study was to evaluate the effect
factors, etiology of chronic heart failure (ischemic
of different RV lead positions on QRS complex duration
vs dilated non-ischemic cardiomyopathy), co-
and morphology post CRT device implantation in
morbid conditions including COPD, bronchial
patients indicated for CRT based on ESC guidelines of
heart failure published in 2016.
cerebrovascular disease, Skeletomuscular diseases,

or (CKD), symptoms including New York Heart
Association (NYHA) classification.
A total of 100 patients at least 3 months post CRT
2. Resting 12 leads surface electrocardiogram: Prior to
device implantation were enrolled in this study and
CRT, surface ECGs were retrospectively examined.
classified into two group, the first group included 46
The following measurements were taken from a
Received: 14/7/2022
Accepted: 17/9/2022

Full Paper (vol.892 paper# 112)

c:\work\Jor\vol892_113 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6823- 6830

Differentiation Between Hepatic Hemangioma and
Metastasis by Diffusion Weighted MRI
Ahmed Mohamed Helmy*, Mahmoud Abdel Latif, Amina Ahmed Sultan
Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Mohamed Helmy El Diasty, Mobile: (+20) 01067705006,
E-Mail: ahmedabouhelmy@gmail.com

Diagnosis of hepatic focal lesions could be done by magnetic resonance imaging (MRI) study especially
when diffusion-weighted magnetic resonance imaging (DWI) is included in the imaging protocol with apparent diffusion
coefficient (ADC) quantification. Several studies have demonstrated that combining DWI with ADC measurement plays
an important role in the detection and characterization of hepatic focal lesions and differentiating hemangioma from
hepatic deposits.
Objective: The current study aimed at evaluation of the role of diffusion weighted imaging differentiating between
hepatic hemangioma and metastasis (1-4 lesions in number) by diffusion weighted MRI in patient pathologically proved
to have primary malignancy.
Patient and methods: Fifty cases were included; patients referred to Radiology Department of Mansoura University
Hospital. There were 33 females and 17 male patients with age ranged from 26 to 82 years. All patients were subjected
to proper history taking and DWI MRI. This study was using a 1.5 T Philips Ingenia MRI scanner.
Results: ADC had significantly lower values in patients with metastatic hepatic lesions with mean ADC 0.93 (SD 0.21)
x10-3 mm2/sec. ADC had significantly higher values in patients with hemangioma with mean ADC 1.96 (SD 0.31) x10-
3 mm2/sec. The mean ADC value in the metastatic group was statistically significantly lower compared to the
hemangioma group. ADC had sensitivity and specificity of 100 % and 95.8% respectively, and an accuracy of 97.4% in
differentiating between hemangioma and metastasis cases, when a cut-off value of 1.55 x 10-3mm2/s was applied.
Conclusion: Combined qualitative and quantitative analysis of DWI and ADC values respectively can help in
differentiation between hepatic hemangioma and metastatic deposits. Using DWI and ADC in conjunction with
conventional imaging found to be a simple and non-invasive tool that aid in differentiation between hepatic hemangioma
and metastatic deposits.
Keywords: Diffusion weighted imaging, Apparent diffusion coefficient, MRI, Hepatic hemangioma, Hepatic


With an incidence of up to 20% of the population,
The standard liver imaging protocol includes DWI.
hepatic hemangiomas are not only the most frequent
For the assessment of localized and diffuse liver
benign liver lesion but also the most frequent primary
disorders, DWI is becoming more important (4).
hepatic tumors overall. With a female-to-male ratio that
The aim of the current study was to evaluate the
can approach 5:1 (1).
role of diffusion weighted imaging differentiating
One of the organs that is most frequently affected
between hepatic hemangioma and metastasis (1-4
by metastatic disease is the liver. Primary liver tumors
lesions in number) by diffusion weighted MRI in patient
are 18 to 40 times less frequent than secondary lesions.
pathologically proved to have primary malignancy.
Because of its abundant blood supply, the liver serves

as a favorable "soil" for the spread of metastatic disease
(2). Magnetic resonance imaging (MRI) is a non-
A total of 50 cases were included; patients
invasive imaging technique that has superior soft tissue
referred from General Surgery Department and
contrasts and potential physiological and functional
Oncology Centre Mansoura University (OCMU) with
application. Due to its superior contrast resolution and
clinical or radiological proven to have primary
lack of ionizing radiation, MRI is frequently used to
malignant tumour with hepatic focal lesions (1-4 in
diagnose liver lesions (3).
number) suspected to be hepatic haemangioma or
Diffusion-weighted magnetic resonance imaging
metastatic during the period from December 2019 to
(DWI) is integrated into the routine liver imaging
July 2022.
protocol. DWI plays an emerging role for the
There were 33 females and 17 male patients with
assessment of focal and diffuse liver diseases (4).
age ranged from 26 to 82 years. All patients were
A non-invasive imaging method with superior soft
subjected to proper history taking and DWI MRI.
tissue contrasts and potential physiological and

functional applications is magnetic resonance imaging
Inclusion criteria:
(MRI). MRI is commonly used to diagnose liver

Patients who agreed to participate in study.
abnormalities due to its higher contrast resolution and

Patients already diagnosed with primary
lack of ionizing radiation (3).
malignancy and present with hepatic focal
lesion (1-4 in number) detected by
Received: 14/07/2022
Accepted: 17/09/2022

Full Paper (vol.892 paper# 113)

c:\work\Jor\vol892_114 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6831- 6838

Validity of Modified Vienna-CATS Score for Prediction of
Venous Thromboembolism in Egyptian Cancer Cases
Hanaa Ali EL-Sayed1, Mohamed Awad Ebrahim2, Hayam Rashad Ghoneim1,
Mohammed Ahmed Mohammed Abdallah Elagdar1, Tarek El-sayed Selim1
1Hemeostasis and Thrombosis Laboratories, Hematology Unit, Clinical Pathology Department and
2Oncology Center, Faculty of Medicine, Mansoura University, Dakahlia, Egypt.
Corresponding author: Hanaa Ali EL-Sayed, Phone number: +201091193063, Email: hanaaali269@gmail.com

Modern oncology has a compelling problem in predicting the hazards of venous thromboembolism (VTE)
linked with chemotherapy. Although thromboprophylaxis is not now advised for primary prevention, it is typically advised
that cases' risks of VTE be evaluated before treatment. Great interest was given to establishing effective predictive methods
for VTE in cancer cases.
The aim of this study: The study aimed to detect whether Egyptian cancer cases' VTE risk could be predicted using the
modified Vienna Cancer and Thrombosis Study (CATS) score. Methods: 214 newly diagnosed cancer cases participated
in a prospective cohort study completed before receiving chemotherapy. Cases who received chemotherapy were monitored
for VTE episodes for six months. The Khorana score was determined. D dimer and soluble P-selectin (sP-selectin) levels
were assessed, followed by a modified Vienna CATS score. For each example, the Vienna CATS score was determined.
Results: Only 24 (11.2%) of the 214 cases who had follow-up experienced VTE episodes, and 5 of these (2.3%) were lost.
Conclusion: When compared to the Khorana score, the modified Vienna CATS score was more sensitive in identifying
cancer cases at risk for VTE. Implementation of modified Vienna CATS in the clinical workup of cancer cases could help
physicians to tailor antithrombotic therapy and lead to the perfect use of thromboprophylaxis.
Keywords: Cancer, Egypt, Vienna CATS.
Abbreviations: venous thromboembolism (VTE), Cancer and Thrombosis Study (CATS), soluble P-selectin (sP-selectin).


VTE is the second cause that leads to death in
cancer cases and causes morbidity. In comparison to the
214 newly diagnosed cancer cases participated in
general population, a cancer case has more than 4 times
this prospective cohort study before starting
the risk of thrombosis. A case with both cancer and VTE
chemotherapy in February 2021 and February 2022. The
has up to 8 times the risk of death from thrombosis
Outpatient Hematology and Oncology Clinics at
compared to cases without cancer (1).
Mansoura University Oncology Center were used to
By helping to select cancer cases that are at high
select newly diagnosed cancer cases during 6 months of
risk for VTE, risk stratification methods can help in
case monitoring for VTE episodes while they were on
decreasing the number of cases that need treatment. The
ideal risk score enables physicians to distinguish between
Cancer cases starting chemotherapy, receiving
low-risk cases and those at very high risk who require
anticoagulant or thromboprophylaxis therapy, with
intervention (2).
missing or inadequate data, with a past history of VTE, or
The Korana score is the most well-known risk
with inherited thrombogenic tendency were kept away
classification measure. Although the Khorana score is a
from the study.
reliable predictor, it is highly dependent on tumor type
Age, gender, past VTE, therapy history, and
and does not take into account many elements that may
concomitant other diseases were all given particular
influence the occurrence of VTE in a cancer case. As a
consideration when taking the case's history. Pathology
result, its external validation was not entirely conclusive.
biopsies were used to determine the location, condition,
The main drawback is the sub-average clinical use due to
and stage of malignancy.
that more than fifty percent of cases were in the
Calculations included body mass index (BMI),
intermediate-risk group (3).
the Khorana score, the neutrophil-lymphocyte (N/L) ratio,
Other scores have been thought to increase the
and the platelet lymphocyte (P/L ratio). Five clinical and
ability of the Khorana score to predict the outcome by
before-therapy lab parameters are given points according
adding new variables such as soluble biomarkers (like the
to the Khorana score: the primary tumor site (+1 or 2
CATS score) (4). Therefore, the goal of this research was
points), the platelet count of 350x109/L or more, the
to assess the reliability of the modified Vienna CATS
hemoglobin level 100 g/L or lower, the use of
scores in predicting VTE in Egyptian cancer cases.
erythropoiesis-stimulating agents, the leukocyte count of
Received: 12/07/2022
Accepted: 15/09/2022

Full Paper (vol.892 paper# 114)

Effects of aerobic exercises on immune parameters following the inguinal lymphnodes dissection The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6839- 6844

Kinesiotaping versus Wrist Wheel on Upper Extremity Functions in
Children with Unilateral Cerebral Palsy
1*Mohamed A. El-Fatah A. El-Karim, 2Manal S. Abd.El-Wahab,2 Nahla M. Ibrahim
1 Al Shahid Fikri Health Unit, Birket El-Sabaa, Menoufia Governorate.
2Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University.
*Corresponding author: Mohamed A. El-Fatah A. El-Karim, Mobile: (+20) 01025140047, E-Mail: mohafh92@gmail.com

Children with Unilateral Cerebral Palsy (UCP) usually have obvious impairment of hand function and limited
active supination, which causes restrictions of upper extremity functions.
This aimed to compare between Kinesiotaping and wrist wheel effect on forearm supination range of motion
and its reflection on functions of upper limb in children with UCP.
Patients and Methods:
Forty-eight children with UCP their age from 6 to 8 years were divided randomly into 2 groups
with twenty-four in each, Kinesiotaping (KT) and Wrist Wheel (WW). KT group children were treated by a designed
physical therapy program after forearm Kinesiotaping application, while children in WW group were treated by the same
designed physical therapy program while using wrist wheel. Treatment program was conducted for three successive months
at frequency of 3 sessions per week. Before the commencement and after the study completion forearm supination range of
motion was measured using digital goniometer and Shriners Hospital Upper Extremity scale was used to evaluate upper
extremity functions in the affected upper limb.
A statistically significant change was observed in each group after treatment application when comparing before
and post treatment mean values (P < 0.001). Also, a statistically significant change was noticed when comparing after
treatment results between both groups in favor to wrist wheel group.
Conclusion: Both Kinesiotaping and Wrist Wheel can improve supination ROM and upper extremity functions of children
with UCP, with more effectiveness to Wrist Wheel.
Keywords: Cerebral palsy, Hemiparesis, Kinesiotaping, Wrist Wheel.


Wrist Wheel (WW) is a therapeutic tool that works
Most daily activities, including eating, brushing, as
the muscles of the wrist, forearm, and shoulder, it enables
well as drinking needs the free supination. Washing face
the patient to easily roll his/her wrist in and out while
and hands, combing hair also depends on the ability to
concentrating on their wrist and arm. It is considered as
supinate forearm. Holding pencil to write and using a
one of the simple easy devices for assisting children in
walker to assist gait, all depend on forearm supination and
performing a function (7).
pronation movements (1). The pronator teres, pronator

quadratus, and supinator muscles cooperate to perform
upper limb daily functions. However, the contracture of
pronators that characterizes UCP children impairs these
functions, which may lead to social and functional
enrolled in the study that was carried out from
limitations. These limitations also impair the ability of
October 2021 to March 2022 at the Outpatient
children to communicate with the surroundings within
their environment, which challenge them to be
Physical Therapy¸ Cairo University. Children were
functionally independent in daily activities (2).
selected with age ranged from six to eight years,
There is a compensatory relationship between
diagnosed as Unilateral CP with upper extremity
shoulder range of motion (ROM) and the forearm rotation
spasticity grades 1 and 1+ in according to Modified
in different activities of daily living (ADL) that require
Ashworth scale (MAS) (8). They had level II and III
forearm pronation and supination, forearm rotation could
impaired hand functions as described by Manual
expose the shoulder to overuse, which could be more
Ability Classification System (MACS) (9). All
disabling (3).
participants had the ability to follow simple verbal
Kinesiotaping is a widely used technique in the
commands given during assessment and treatment
treatment of CP children to improve ROM, individual
finger movements, and enhance fine motor manipulation

of the hand. Some studies show an improvement in upper
Exclusion criteria: Children with severe visual or
limb stability as well as segment alignment during
auditory problems, skin diseases at forearm and
reaching and grasping (4, 5, 6).
recent surgical interference (Tenotomy or muscle

Full Paper (vol.892 paper# 115)

c:\work\Jor\vol892_116 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6845- 6850

Tracheal Resection and Reconstruction: Predictors of
Postoperative Tracheal Restenosis
Gamal M. Shalaby*1, Ahmed K. Abdallah2, Mohamed-Adel F. Elgamal2, Rami A. Sabri2
Departments of Cardiothoracic Surgery, 1Faculty of Medicine, Helwan University and
2Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Gamal Mansour Shalaby, Mobile: (+20) 01010585804, E-mail: gmansour-cts@med.helwan.edu.eg

Tracheal resection and reconstruction (TRR) is a highly challenging mission to any tracheal surgery
group. New advances in tracheal surgery declared by Barclay when first trial of tracheal resection and reanastomosis
was performed. After that, trials began to allow more tracheal segment to be resected.
Aim: It was to determine predictors of postoperative tracheal restenosis.
Patients and Methods:
This retrospective study was conducted on twenty-four patients who underwent TRR that done
in Cardiothoracic Surgery Department, Mansoura University Hospital from January 2014 till July 2022. Inclusion
criteria included patients with tracheal stenosis of any age, of both sexes, and patients with benign or malignant tumors.
Exclusion criteria included immunocompromised patients, diffuse tracheal stenosis, and autoimmune tracheal lesions
or tracheal stenosis less than 50% of normal tracheal diameter.
Results: Restoration of normal airway continuity was succeeded in 20 cases (83.3%) and failed in 4 cases (16.7%); 3
cases (75%) due to restenosis and one case (25%) due to anastomotic dehiscence due to epileptic fit. Three cases needed
postoperative stenting; one (33.3%) showed good result, one (33.3%) complicated by stent migration, and the last case
(33.3%) needed stent removal through anterior tracheotomy and permanent tracheostomy.
Conclusion: Early and regular follow-up visits for patients with prolonged mechanical ventilation after discharging
home, ensuring good preoperative preparations for patients with epilepsy with 6 months convulsion free period before
surgery and avoiding usage of unipolar diathermy for lateral tracheal dissection could decrease postoperative tracheal
restenosis for patients' undergone tracheal resection and reconstruction.
Keywords: Trachea, Tracheal Resection and Reconstruction, Tracheal Stenosis, Anastomotic Complications.

Tracheal resection and reconstruction (TRR) is
This was a retrospective, record analysis,
a highly challenging mission to any tracheal surgery
descriptive study conducted on all patients who
underwent TRR that done in Cardiothoracic Surgery
Tracheal surgery was started by Aretaeus and
Department, Mansoura University Hospital from
Galen in the second Century. New advances in tracheal
January, 2014 till July, 2022 (24 cases). Collected data
surgery was declared by Barclay when first trial of
tracheal resection and reanastomosis was performed
symptoms, comorbidities, stenosis characteristics, and
but was limited by removal of not more than 2 cm of
vocal fold mobility was studied as well. All patients
the whole tracheal length. The fact that we can't resect
were primarily evaluated by bronchoscopy and
more than 4 tracheal rings inhibited more advanced
computed tomography (CT) scan.
tracheal surgery(2).

After that, trials were done to mobilize the
Ethical approval:
thoracic tracheal segment. That trials found that
Ethics approval was granted by the
division of the inferior pulmonary ligament and right
Institutional Review Board in Faculty of Medicine,
hilar mobilization facilitate resection of more than 4
tracheal rings and its re-anastomosis found to be
applicable, but this also can be achieved by cervical
Patients' consents were waived due to it was
flexion that deliver extrathoracic tracheal segment into
a case record study and with a retrospective nature.
the mediastinum(3). Later, Grillo(3) started the new era
All authors had read the author rules and gave their
of the tracheal surgery by using of different types of
agreement for this work to be published.
tracheal release maneuvers that allowed resection of
Inclusion criteria: included patients with tracheal
longer tracheal segment. So, outcome of TRR became
stenosis of any age of both sexes and patients with
gradually improving with reduction in postoperative
benign or malignant tumors.

Exclusion criteria: included immunocompromized
patients, diffuse tracheal stenosis, autoimmune tracheal
It is to determine predictors of postoperative
lesions or tracheal stenosis less than 50% of normal
tracheal resection.
tracheal diameter.


Full Paper (vol.892 paper# 116)

c:\work\Jor\vol892_117 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6851- 6858

Characterization of Anemia among Hospitalized Patients with
Psychiatric Disorders
Eman Ali1, Nahla Zaitoun2, Ahmed Embaby3, Nermeen Zaitoun4, Doaa Ibrahim5
Departments of 1Psychiatry, 2Family Medicine, 3Clinical Hematology Unit, Internal Medicine and
4Physiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Department of 5Psychiatry, Faculty of Medicine, AlAzhar University for Girls, Cairo, Egypt
*Corresponding author: Eman Ali, Mobile: (+20) 1011361522, Email: dremanmandour77@hotmail.com


Background: Anemia is associated with many psychiatric problems, including depression, bipolar disorder,
schizophrenia, and other mental disorders. Moreover, anemia affects brain neurotransmitters, which affect learning,
memory, and behavior.
Objective: The current study aims to shed light on the prevalence of anemia and its associated factors among
hospitalized psychiatric patients.
Patients and Methods: A total of 143 admitted patients who had been diagnosed with psychiatric disorders with an age
> 14-year-old who fulfilled the study criteria were enrolled in this cross-sectional study over six months in 2022. A
structured clinical interview for the DSM-5 was used to settle the diagnosis of psychiatric disorders. Patients' data and
blood samples were collected.
Results: About 27.27% of the psychiatric patients had anemia, with the highest frequency in schizophrenia (46.2%),
followed by other disorders (33.3% bipolar, 10.3% schizoaffective, 5.1% depression, and 5.1% psychotic depression).
Moreover, a higher frequency was found among adolescents and young adults than among older adults (76.9% vs.
23.2%). Normocytic normochromic morphology was the commonest subtype (59.0%).
Conclusion: Anemia could cause psychiatric symptoms or deteriorate an existing psychiatric condition when left
untreated. So, it would be beneficial to catch up with the diagnosis of anemia in psychiatric patients and change the
negative lifestyles and malnutrition habits of this population.
Keywords: Anemia, Psychiatric Disorders, Hemoglobin.


However, the clinical manifestation of DD is affected
Anemia is a medical disorder characterized by
by iron deficiency anemia (IDA) (7).
decreasing the hemoglobin (Hb) level and red blood cell
Thus, correction of nutrients deficient helps in
(RBC) count. Male and non-pregnant females are
prevention and treatment of DD as it causes recovery to
diagnosed when their Hb falls below 13 g/dL and 12
the neurotransmitter and enzymes level (8). However, the
g/dL, respectively (1). In 2019, an estimated 1.8 billion
evidence for this relationship was addressed. Limited
individuals had anemia with various health
studies had investigated the characterization of anemia
consequences, including the immune system,
and its correlation with different clinico- demographic
neurocognitive function, and other diseases and other
factors in psychiatric patients. Thus, the current study
psychiatric problems (2).
aims to study the prevalence of anemia and its
Recent evidence links anemia with many
associated factors among hospitalized psychiatric
psychiatric problems, including depression, bipolar,
schizophrenia, and other mental disorders (3). A previous

study revealed that anemia influences brain
neurotransmitter homeostasis, including dopamine,
Study design and participants
serotonin, and norepinephrine, which particularly
This hospital-based cross-sectional study that was
affects learning, memory, and behavior (4).
conducted over six months in 2022 in the Psychiatry
Decreased iron level leads to significantly
Department of a University-affiliated Hospital in Egypt.
reduced concentration, expression and transport of
A total of 143 admitted patients diagnosed with
norepinephrine, in addition to alteration to the level of
psychiatric diseases as bipolar, schizophrenia,
norepinephrine protein receptors in the basal ganglia (5).
schizoaffective, depression and psychotic depression
Moreover, patients with anemia experience symptoms
with an age > 14-year-old who fulfilled the study
like depression with mood and behavioral signs,
criteria were enrolled in the current study after the
especially those with microcytic anemia, and iron
exclusion of patients with substance use disorders,
supplementation can cause recovery of brain
active bleeding, recent blood transfusion, pregnancy,
neurotransmitters (6).
lactation, comorbid condition like infections, chronic
Nutritional deficiency as deficiency of folic acid
hepatic or kidney disease, inflammatory, autoimmune
and vitamin B12 had been linked to the severity of
and endocrinal disorders additionally patients unwilling
depressive disorder (DD) and there is no relation had
to participate in the study (Figure 1).
been established between iron deficiency and DD.

Full Paper (vol.892 paper# 117)

c:\work\Jor\vol892_118 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6859- 6866

The Role of Ultrasound and CT in Diagnosis of Acute Appendicitis &
Its Impact on The Surgical Outcome
Marwa Shaker Abd ElFatah1, Mohamed Hamdy Khattab1, Marina Ishac Iskandar Ibrahim1,
Shimaa H. I. Desoukey*2, Amir Hanna2, Marie Nader Grace1
1Department of Radiology, Faculty of Medicine, Cairo University, Cairo, Egypt
2Department of Radiology, Theodor Bilharz Research Institute, Giza, Egypt
*Corresponding author: Shimaa H. I. Desoukey, Mobile: (+20) 01114086980, E-Mail: sh.hamed85@gmail.com

The emergency room's most dependable and accessible diagnostic imaging tools for detecting
appendicitis early and averting catastrophic complications by ultrasound (US) computed tomography (CT) imaging.
Objective: To evaluate the role of ultrasound and CT in the diagnosis of acute appendicitis and their impact on surgical
Patients and Methods:
This study was carried out as a prospective cross-sectional in collaboration between Surgery
and Radiology Departments, Faculty of Medicine, Cairo University, Cairo, Egypt. We included 45 patients who were
presented by symptoms of acute appendicitis, examined by pelvi-abdominal US then contract enhanced CT. The results
of both Ultrasound and CT were correlated with the surgical outcome aiming of the study for diagnosis of acute
Results: A total of 45 patients were included in the final analysis of our cohort research. The average age of the patients
was 25 years with a standard deviation of 9 years. Males represented 53.3% while females represented 46.7% of the
included patients. Our analysis revealed that CT exhibited a higher sensitivity than US if we used a cutoff point 2
findings by CT 100% versus 60.4% in US, while both were equal in specificity 85.7% in both modalities. CT and US
can significantly predict positive surgical outcome.
Conclusion: Detection of acute appendicitis by Ultrasound and CT were prior to any surgical intervention, reduces the
negative appendectomy rate and the complications that may occur due to either improper diagnosis or unnecessary
Keywords: Ultrasonography, Computed tomography, Appendicitis, Surgical intervention.

low cost although still operator-dependent, ultrasound
With an annual incidence of about 1 per 1000
is currently regarded as the first line of diagnostic
persons and a lifetime risk of 7 to 9 percent in developed
imaging for any abdominal emergency (2).
countries, acute appendicitis is a prevalent cause of
A normal appendix is removed during a
abdominal discomfort. Appendicitis is the term for the
negative appendectomy, a surgical problem. Patients
inflammation of the vermiform appendix; nevertheless,
are put at risk for needless hospital expenses,
the aetiology and progression of the condition remain
anesthesia, and surgical side effects include wound
unclear. A tumor blocking the appendix lumen can
infection, bleeding, damage to surrounding organs, and
cause appendicitis, as can fecoliths, or caecum
intestinal blockage (3).
obstructions, but it also appears that genetic and
With growing ultrasound and CT (computed
environmental factors play a role in the development of
tomography) technology knowledge and accessibility,
appendicitis (1).
In order to reduce the complications of appendicitis and
The most typical first symptom is central
the percentage of unsuccessful appendicectomy, there
abdominal discomfort; other symptoms include
are now additional diagnostic tools accessible to the
anorexia, nausea, vomiting, and pain migration to the
treating physician for monitoring patients with a
right iliac fossa. The most effective treatments for acute
suspicion of acute appendicitis before any surgical
appendicitis are early detection and surgical
intervention (3).
intervention (1).

A delayed diagnosis of appendicitis can result
in significant consequences, such as pylephlebitis, an
This study's goal is to evaluate of the role of
infective thrombophlebitis of the portal circulation, and
ultrasound and computed tomography (CT) in the
perforation leading to widespread peritonitis, which is
diagnosis of acute appendicitis and their impact on
regarded as a dangerous and deadly disease.
surgical outcomes.
Consequently, the necessity of imaging diagnostic tests

is significant. The emergency room's most dependable
and accessible diagnostic imaging tools for detecting
Forty-five cases with suspected acute
appendicitis were admitted to the Trauma and Surgical
complications are ultrasound and CT imaging. Due to
Emergency Unit of Kasr El-Aini Hospital, Faculty of
its ease of use, lack of radiation exposure, and relatively
Medicine, Cairo University, Cairo, Egypt, in the period
Received: 12/07/2022
Accepted: 15/09/2022

Full Paper (vol.892 paper# 118)

c:\work\Jor\vol892_119 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6867- 6873

Validity of Internal Iliac Artery Ligation with Cervico-Isthmic Compression Suture
During Conservative Management of Placenta Accreta Spectrum
Salsabeil Hamdi Rizk*, Mostafa Mahmoud Al-Khiary, Mohamed Elsayed Taman
Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
*Corresponding author: Salsabeil Hamdi Rizk, Mobile: (+20) 01098821853, E-Mail: salsabeilhamdi92@gmail.com


Background: Placenta accreta is becoming a common complication of pregnancy. Hysterectomy has been considered
the best therapeutic modality in the context of it, but this represents a problem for patients desiring to preserve the uterus
for future fertility. Surgical internal iliac artery ligation (IIAL) is usually utilized to attempt to control obstetric
hemorrhage. Ligation of the internal iliac arteries has restricted effectiveness. Either ligation of the anterior division of
the internal iliac or uterine artery is often employed in a trial to control postpartum hemorrhage (PPH) before resorting
to hysterectomy.
Objective: To assess the efficacy of IIAL before bladder dissection during conservative management of cases of the
morbidly adherent placenta (MAP) using a cervico-isthmic compression suture.
Patients and methods: This randomized control study comprised 42 patients with placenta previa (major and minor);
divided into two groups; group A (21 patients with bilateral ligation of IIA) and group B (21 patients without ligation
of IIA).
Results: The amount of blood loss in group A was more than in group B. There was a statistically significantly higher
number of packed RBCs transfused units, total estimated blood loss (liters) in group A vs group B. The rate of
hysterectomy was statistically higher among group A than Group B.
Conclusion: This study demonstrated that bilateral IIAL, as an intervention to reduce blood loss during conservative
management for AIP using cervico-isthmic compression suture (CIC), is not beneficial.
Keywords: Abnormally invasive placenta, Placenta accreta spectrum, Postpartum hemorrhage, Loss retroplacental
hypoechoic zone.

subtypes defined as accreta (adhere to the
The incidence of placenta accrete increta and
myometrium), increta (invade deep to the myometrium)
percreta, collectively called placenta accreta spectrum
and percreta (reach to the uterine serosa and beyond) (3).
(PAS) disorders, has been rising considerably over the
Strategies of traditional management of placenta
last decade globally, mostly owing to arising cesarean
accreta with promising outcomes have been employed
delivery (CD) rate accompanied by a lot of adverse
to evade peripartum hysterectomy and preserve fertility.
events comprising extensive blood transfusion,
These approaches might be appropriate as long as the
disseminated intravascular coagulopathy (DIC), high
bleeding is still mild. The key to the success of non-
morbimortality rates as antepartum and PPH, nearby
surgical intervention rests mainly on early diagnosis or,
pelvic organs injury, infections and psychological
more precisely, on early suspicion of placenta accreta.
sequel owing to the loss of femininity and fertility (1).
The primary components of efficient conservative non-
There are methods to manage PAS such as
surgical management are leaving the placenta
cesarean hysterectomy (CS hysterectomy) and
undisturbed, interval placental removal, and different
conservative treatment which includes a stepwise
plans (5). Hence, the current study was done to evaluate
approach, cervico isthmic compression suture, and
the efficacy of IIA suture ligation before bladder
Triple-P procedure (2). Vessels' ligation could be
dissection through traditional management with
utilized as a part of traditional management concerning
cervico-isthmic compression suture in patients of
PAS management to reduce blood loss as uterine artery
morbidity adherent placenta.
ligation (UAL) and IIAL. Surgical ligation of the

anterior divisions of the IIA is practiced by a lot of
tertiary care centers throughout the management of
Study design
women with PAS disorders (3). On the other hand, there
This was a randomized control study that had
is no recommendation for the traditional usage of IIAL
been carried out at the Obstetrics and Gynecology
before bladder dissection during conservative
Department, Mansoura University Hospitals, through
management of PAS. The retroperitoneal space was
the period from September 2020 to September 2021
dissected and bifurcation of common iliac vessels was
after obtaining approval from the Local Ethics
recognized, following identification of the ureter, the
Committee of Mansoura Faculty of Medicine.
IIA was dissected on both sides away from nearby
The study included 42 pregnant women. The
tissues and iliac vein (4).
comprised cases were divided into two groups in a
Placenta accrete spectrum (PAS) could be
random manner (Group A: with IIAL:21 patients) and
described as pathologic invasion of the placental
(Group B without IIAL:21 patients) with the use of
trophoblasts to the myometrium and beyond with
opaque sealed unlabeled envelopes, each containing a
Received: 09/07/2022
Accepted: 14/9/2022

Full Paper (vol.892 paper# 119)

Non-metallic implant for patellar fracture fixation: A systematic review The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6874- 6881

Metallic Implants for Patellar Fracture Fixation:
A Systematic Review
Assaf Mahmoud, Farag Hossam, Elsheikh Ahmed
Department of Orthopaedic Surgery, Benha University, Qaliobia, Egypt
*Corresponding author: Assaf Mahmoud, Mobile: (+20) 01062333602, Email: moud.assaf88@gmail.com,

Although tension band wiring is the traditional method to fix the transverse patellar fracture, there are
many published studies regarding the use of other metallic implants to fix the patellar fracture. This study aims to
find out the good choice of fixation by performing a systematic review of the literature to compare clinical and
radiological outcomes of the studies that use metallic implants to fix transverse patellar fractures.
Methods: The following keywords (patella cerclage, patella wire, patella plate, patella fixation, tension band) were
used to perform a systematic search of literature until 2021. All abstracts were reviewed, and the selection of these
abstracts was then performed based on the inclusion and/or exclusion criteria.
Results: A total of 19 studies involving 1264 patients were included (623 males and 641 females). The tension band
with K wires method was the most used method in the studies followed by tension with cannulated screws, plates,
and lag interfragmentary screws respectively. 95.4 % of patients had a complete union. TBCS had lower
postoperative complications, less hardware failure, and short healing time, but no significant difference between
TBCS and TBKW regarding the range of motion and operative time.
Conclusion: TBCS technique had a low risk of hardware failure and complication in comparison to the TBKW
technique while no superior method regarding ROM and operative time. On the other hand, plate osteosynthesis and
isolated interfragmentary screws may provide other choices for the fixation of transverse patella fractures but it needs
more trials and studies to be confirmed to be effective.
Keywords: patella cerclage, patella wire, patella plate, patella fixation, tension band.

technique providing good rigid fixation small
The patella is a crucial component of the
incisions (6). Another minimally invasive technique
extensor mechanism of the knee, with one of the
using arthroscopy was reported for a good vision of
thickest articular cartilages in the human body. Its
the articular surface (7, 8).
primary function is to increase the moment arm of the
Implants are numerous and can be divided into
extensor mechanism of the quadriceps by 30%.
two main categories metallic and non-metallic.
Fractures of the Patella account for about 1% of
Metallic implants include tension band wiring, tension
skeletal injuries. Patellar fractures are classified
band on cannulated screws, interfragmentary screw
descriptively as transverse, vertical, comminuted,
fixation, and cerclage (9), (10). Non-metallic implants
marginal, or osteochondral. Patellar fractures may be
include suture materials and bio-absorbable
displaced (step-off >2 to 3 mm and fracture gap >1 to
cannulated screws (11). Combined techniques and plate
4 mm) or non-displaced (1).
osteosynthesis were also described (12, 13).
Most non-displaced fractures are managed
This systematic review aimed to provide a
conservatively. Surgical management is indicated
piece of evidence about the best metallic implant to fix
when the extensor mechanism of the knee is disrupted
simple transverse patellar fractures. We have analyzed
or the articular congruity is affected (2). Because of the
and compared the clinical, radiological, and functional
high tensile and compressive forces subjected to the
outcomes and complications of patients treated with
patella, adequate and rigid fixation and anatomical
different techniques of fixations using metallic
reduction by implants are mandatory (3).

Surgical approaches are variable and could be
longitudinal, transverse, or minimally invasive. A
This systematic review was conducted according
longitudinal midline incision is the most preferred
to the guidelines presented in the PRISMA Statement
approach for good exposure for the patella allowing
(Preferred Reporting Items for Systematic Reviews
good confirmation of reduction. In contrast, the
and Meta-Analyses) (figure 1) (14). An initial search in
transverse approach provides reasonable exposure for
the following databases: Google Scholar, EKB (web
patella and extensor mechanism ligaments and good
of science, Elsevier), and PubMed. The following
cosmetic results (4,5). Zhou describes a percutaneous
Mesh entries were used for research articles patella
Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 120)

c:\work\Jor\vol892_121 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6882- 6888

Effect the Natural Efflux Pump Inhibitor (Berberine) in Multidrug Resistant
Kleibsiella pneumoniae Isolated from Urinary Tract Infections in
Several Baghdad Hospitals
Tamara Walid Basil M. Khalid*1, Kais Kassim Ghaima1
1 Institute of Genetic Engineering and Biotechnology for Postgraduate Studies,
University of Baghdad, Baghdad, Iraq
*Corresponding author: Tamara Walid Basil M. Khalid, Mobile: 07733766300,
Email: tamarah.walidbasil20@gmail.com

Kleibsiella pneumoniae in urinary tract infections (UTIs) have grown for years. Antibiotic-resistant
microorganisms make infection control and treatment difficult for clinicians. Efflux pumps contribute to K.
pneumoniae's multidrug resistance.
Objective: This study aimed to test Phenylalanine-Arginine -Naphthylamide (PAN) and Berberine as antibacterial
agents against multidrug-resistant bacteria (UTI K. pneumonia isolates).
Subjects and Methods:
Between December 2021 and April 2022, five Baghdad hospitals collected 260 urine
samples from outpatients and inpatients with urinary tract infections, both genders, aged 15 to 72.
Results: We isolated 76 of the cultures (65.5%) and employed selective media, biochemical assays, and the VITEK2
system to identify bacteria as K. pneumoniae. Using the disc diffusion technique, it was demonstrated that clinical
isolates of K. pneumoniae were moderately resistant to the majority of drugs. K. pneumoniae isolates were extremely
resistant to Amoxicillin (96.1%), Trimethoprim (80.3%), Gentamicin, Amikacin and Meropenem (55.1%), and
Ciprofloxacin (53.9%). The efflux pump inhibitor (PAN) greatly boosted strain susceptibility to Ciprofloxacin.
PAN lowered MICs by 4­64-fold. The minimum inhibitory concentrations (MICs) of Berberine against ten
multidrug-resistant K. pneumoniae isolates ranged from 3.9 to 500 g/ml, indicating that Berberine affects K.
growth at very low doses.
Conclusion: In this work, Berberine was found to be an efflux pump inhibitor (EPI) and antibacterial drug that could
overcome bacterial resistance mechanisms.
Keywords: UTIs infections, Multidrug resistance, Berberine, Kleibsiella pneumoniae.


Hospitals are struggling with Kleibsiella
pneumoniae-related UTIs (1). Due to the lack of
Isolation and identification of K. pneumoniae:
treatments for this pathogen, its high multidrug
Between December 2021 and April 2022, this
resistance (MDR) causes clinical issues (2, 3).
study was conducted at various hospitals located in
K. pneumoniae, a Gram-negative, rod-shaped,
Baghdad, Iraq. Patients suffering from burn diseases
capsulated Enterobacteriaceae bacterium; a common
generated 76 isolates of K. pneumoniae out of a total of
nosocomial pathogen in this species can cause urinary
260 urine samples. In order to isolate K. pneumoniae,
tract, respiratory, and blood infections (4, 5). Gram-
blood agar, macConkey agar, and CHROM agar
negative bacteria evade drugs via multidrug efflux
orientation were utilized as media. The typical
pumps. Efflux systems make microorganisms more
bacteriological methods as well as biochemical testing
resistant (6). K. pneumoniae use resistance-nodulation-
with the VITEK 2 system were used in accordance with
division (RND) efflux pumps OqxAB and AcrAB to
the guidelines provided by the manufacturer in order to
become antibiotic-resistant (7).
determine the identities of these isolates (bioMerieux,
Blocking efflux pumps may function when
antibiotics fail. EPIs and natural substrates allow drug

accumulation inside the bacterial cell, where it can do
Antibiotic Susceptibility Test:
the most benefit. Berberine and reserpine are plant-
An antimicrobial disc diffusion technique test
derived EPIs (8). Considerably used synthetic efflux
was carried out for the susceptibility evaluation. In a
inhibitors to detect the efflux activity in K . pneumoniae
nutshell, an overnight culture of K. pneumoniae was
are carbonyl cyanide-chlorophenylhydrazone (CCCP)
grown on MacConkey agar, and it was afterwards
and phenylalanine-arginine -naphthylamide (PAN)
suspended in Mueller-Hinton broth (Himedia). The
(9). The present study aimed to investigate the efficacy
turbidity of the suspension was adjusted to an
of Berberine against clinical K. pneumoniae isolates
equivalent of 0.5 McFarland so that it could be
and evaluate the role of this natural efflux pump
inoculated onto plates made of Mueller-Hinton agar
inhibitor as an alternative therapeutic agent for
(Himedia). In the course of this research, antibiotic
multidrug resistant strains in patients with UTIs.
discs bearing the following designations were utilized:
Received: 6/7/2022
Accepted: 11/9/2022

Full Paper (vol.892 paper# 121)

c:\work\Jor\vol892_122 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6889- 6894

Comparing The Efficacy and Safety of (Ombitasvir/ Paritaprevir/ Ritonavir) in
Management of Chronic HCV Patients Among Haemodialysis Patients and
Those with Normal Renal Functions
Alaa Ahmed Mahmoud*, Hussein El Ameen, Nashwa Mostafa
Department of Internal Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt
*Corresponding author: Alaa Ahmed Mahmoud, Mobile: (+20)01113145388, E-mail: brokenheart26120@gmail.com

In the past, interferon use made it challenging to treat hepatitis C virus (HCV) infection in people with
chronic renal disease (IFN). Due to decreased renal clearance of IFN, it was linked to IFN-related adverse events with
a significant risk.
Objective: This study aimed to evaluate the antiviral efficacy, safety, and tolerability of
ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) in chronic kidney disease patients infected with chronic HCV.
Patients and Methods: This study was conducted on HCV patients who undergo haemodialysis and patients with
normal renal functions who had taken OBV/PTV/r. The study was done at the period from May 2017 to May 2018. The
study included 47 patients with chronic HCV infection on regular dialysis (study group) and 50 patients with chronic
HCV infection (control group).
Results: In our cohort, the mean age of the study group was 43.43 ± 10.56 years while mean age of the control group
was 46.80 ± 6.86 years. The majority of the studied groups were males. It was noticed that all enrolled subjects enrolled
in the study achieved sustained virological response (SVR) at 12 weeks and 24 weeks. The most frequent adverse effects
were fatigue, myalgia and epigastric pain.
Conclusion: Paritaprevir/ritonavir and ombitasvir for 12 weeks were considered to be safe and effective in the treatment
of chronic HCV infected patients with end stage renal disease.
Keywords: End-stage renal disease, Hepatitis C virus, Renal impairment, Sustained virological response.

Hepatitis C virus (HCV) is a prominent cause
Study setting and design:
of liver damage among individuals with chronic renal
A cross sectional study was conducted at
failure and end-stage renal disease (ESRD) receiving
Outpatient Clinics of Internal Medicine Department of
frequent haemodialysis (HD), leading to morbidity and
Assiut University Hospital. This study was performed
mortality (1).
between May 2017 and May 2018.
It is challenging to treat hepatitis C virus (HCV)

infection in ESRD patients. In the past, adding ribavirin
Ethical consideration:
to pegylated-interferon (peg-IFN) might be used as a
This study was ethically approved by the
treatment, but it had poor tolerability and efficacy (2).
Institutional Review Board of the Faculty of
The virus's non-structural proteins are the
Medicine, Assiut University. Written informed
primary target of recent direct antiviral drugs (DAAs),
consent was taken from all participants. The study
which also hinder the virus's ability to replicate. These
was conducted according to the Declaration of
medications successfully elicit a long-lasting virologic
response (3). When combined with ribavirin, Qurevo

(Ombitasvir + Paritaprevir + Ritonavir) can be used to
Study participants
treat chronic genotype 4 hepatitis C virus infection (4).
This study was carried out on 97 patients with
Egyptian patients with chronic HCV genotype 4
chronic HCV infection divided into 2 groups:
infection who received ombitasvir/paritaprevir/ritonavir
Group (I): 47 HCV patients on Haemodialysis.
(Qurevo) plus ribavirin for 12 or 24 weeks experienced
Group (II): 50 HCV patients with normal renal
high sustained virological response rates at 12 weeks
post-treatment. Patients with chronic HCV genotype 4

infection without cirrhosis or with compensated
Inclusion criteria:
cirrhosis often tolerated ombitasvir/paritaprevir/
1- Patients with chronic HCV infection.
ritonavir (Qurevo) well (5).
2- Age from 18-60 years old.

3- Compensated liver cirrhosis.
4- Treatment-naïve patients.
The current study aims to assess the percentage

of complete recovery or clearance of the virus between
Exclusion criteria:
HCV patients on HD versus HCV patients with normal
1- Decompensated liver cirrhosis.
renal functions. Also, to assess sustained viral response
2- Co-infection HCV positive in hepatitis B virus
(SVR) in HCV patients on HD versus HCV patients
with normal renal functions.
3- Prior anti-viral therapy.
Received: 13/07/2022
Accepted: 16/09/2022

Full Paper (vol.892 paper# 122)

c:\work\Jor\vol892_123 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6895- 6901

Value of Serum NGAL Combined with Serum Cystatin C for Predicting
Acute Kidney Injury in Preterm Neonates with Respiratory Distress Syndrome
Aliaa M. Diab1, Ghada S. Abdelmotaleb1, Mosad Fatouh Rashed3,
Waled Abd Elateef2, Fatma S. Elshaarawy1, Wesam E. Affi1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Benha University, Egypt
Department of 3Public Health, Faculty of Medicine, Al-Azhar University, Egypt
*Corresponding author: Wesam E. Affi, Mobile: (+20) 01064218197, E-Mail: Dr.elmenshawy2007@gmail.com


Background: The most frequent cause of respiratory failure in preterm newborns, as well as the most frequent cause
of mortality and long-term morbidity associated with prematurity, is respiratory distress syndrome (RDS). RDS affects
half of newborns with birth weights (BW) under 1.5 kg, and a sizable portion of those newborns also experience acute
kidney injury (AKI). Objective: The purpose of this study was to identify useful biomarkers (serum cystatin C and
Neutrophil gelatinase-associated lipocalin (NGAL) to predict AKI in premature infant with RDS.
Patients and Methods:
This was a prospective (case-control) study was conducted on 90 preterm neonates between
28 and 36 gestational weeks (GW) from the neonatal intensive care unit (NICU) of Benha University hospitals. Serum
creatinine, Blood urea nitrogen Levels, Serum cystatin C and Serum NGAL were measured for all included neonates.
Results: Serum creatinine showed no significant difference between the studied groups at day 3 (P = 0.273). At day 5
and day 7, it was significantly higher in group I (1.4 & 1.8 mg/dl, respectively) than groups II (0.7 & 0.6 mg/dl,
respectively) and III (0.6 & 0.5 mg/dl, respectively). Also, it was significantly higher in group II (0.7 & 0.6 mg/dl,
respectively) than group III (0.6 & 0.5 mg/dl, respectively). Serum cystatin C and serumNGAL showed an overall
significant difference between the studied groups at day 3 (P < 0.001). In post hoc analyses, it was significantly higher
in group I (1.7 mg/l) than groups II (1.1 mg/l) and III (01 mg/l). Conclusion: NGAL and sCys C levels were found to
have a statistically significant association with development of AKI in preterm neonates with RDS and they were
elevated earlier than sCr which makes NGAL and sCys C a good predictive marker for AKI in preterm neonates better
than sCr.
Serum NGAL, Serum Cystatin C, Acute kidney injury, Respiratory Distress Syndrome.


evaluate kidney function in premature newborns
Hyaline membrane disease, also referred to as
because they mimic maternal levels during the early
neonatal respiratory distress syndrome (NRDS), is
postnatal period and decline over days to weeks rather
primarily brought on by a deficiency in pulmonary
than remaining constant. On the other hand, because
surfactant (PS), which raises the alveolar wall surface
non-oliguric AKI frequently occurs in preterm infants,
tension and decreases pulmonary compliance. As a
oliguria is an insensitive diagnostic for the early
result, the newborn experiences dyspnea soon after birth
identification of kidney injury (5).
and may even develop clinical respiratory failure
It is advised to employ alternative indicators
syndromes. Infants born prematurely frequently
that do not fluctuate with changes in muscle mass or
develop NRDS, particularly those born before 34
tubular secretion and reabsorption. As biomarkers for
weeks. Up to 80% of premature infants with gestational
determining the location and extent of renal damage,
ages within 28 weeks have a chance of developing
certain proteins that are secreted in the urine following
NRDS (1).
harm to particular nephron segments can be identified.
Preterm births account for about 11% of all
Many specialists and academics have suggested various
births worldwide, and as overall survival rates rise
biomarkers for the early detection of AKI in both adults
within this patient population, the best possible early
and children, including Neutrophil Gelatinase-
care for these newborns is anticipated to have positive
Associated Lipocalin (NGAL) and Cystatin C.
effects on their long-term health (2).
However, there has been very little published studies on
The illness known as acute kidney injury
premature infants. NGAL, a 25-kDa protein that is a
(AKI), formerly known as acute renal failure (ARF),
member of the lipocalin group and is abundantly
affects the structure and function of the kidneys.
expressed in proximal tubular epithelial cells, plays a
Currently, the term "AKI" refers to a decline in kidney
role in the growth and repair of renal tubular epithelial
function, including renal failure and a decreased
cells. It is expressed in neutrophils and in trace amounts
glomerular filtration rate (GFR) (3). AKI affects 12% to
in the kidney, prostate, and gastrointestinal and
40% of premature newborns and is linked to poor
respiratory tract epithelia. Tubular epithelial cells are
outcomes (4).
harmed during AKI, and NGAL is highly expressed in
AKI is currently diagnosed using a higher
both blood and urine (6).
serum creatinine (Cr) level and/or a decreased urine
Nucleated cells produce cystatin C, a 13-kDa
output. Neonatal blood Cr levels cannot be used to
cysteine proteinase inhibitor that can freely pass
Received: 16/08/2022
Accepted: 17/10/2022

Full Paper (vol.892 paper# 123)

c:\work\Jor\vol892_124 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6902- 6907

Utility of Neonatal Pain, Agitation and Sedation Scale and Amplitude
Integrated Electroencephalogram to Differentiate the Different Levels of
Sedation in Neonatal Intensive Care Units
Mariam Ibrahim *, Nehal El Raggal, Mohamed Dawoud, Bassem Mohamed, Maha Mohammed
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Corresponding author: Mariam Ibrahim, ORCID 0000-0002-4936-8303. Mobile: 002 01124215285, mariam.john@med.asu.edu.eg

Neonates admitted in any Neonatal Intensive Care Unit (NICU) are constantly subjected to several stressful
and painful conditions and require pain and sedation management. Ineffective sedation has severe consequences. Excessive
sedation can prolong the duration of mechanical ventilation. On the other hand, inadequate sedation may lead to
asynchronization with the ventilator and inability of adequate ventilation. The objective of the current study is to evaluate
the use of Neonatal Pain, Agitation and Sedation Scale (N-PASS) parameters and double channel amplitude integrated
electroencephalography (aEEG) to differentiate between light and deep sedation in neonatal patients.
Patients and methods: A total of 30 full term neonates mechanically ventilated with congenital pneumonia were recruited
for the current study. Neonates of the study were divided into 2 groups according to the dose of sedative received into
Lightly sedated group and Deeply sedated. All studied neonates were subjected to N-PASS and aEEG monitoring before
starting sedation and after 2 hours of sedation. Results: Parameters of Burdjalov score (Continuity, Cycling, bandwidth
span) and its total score showed a statistically significant decrease after sedation with median in the in non-sedated patients
than deeply sedated patients (12 (11 - 12) vs. 8 (8 - 9), respectively (p<0.001).There was also a difference which was
statistically significant between deeply sedated patients than lightly sedated patients [8 (7 - 8) vs. 9 (9 - 9), respectively
(p<0.00)]. When applying ROC analysis, aEEG total (Burdjalov) score at a cut-off value of 8 was predictive of deep
sedation with 100% sensitivity and specificity. Conclusion: aEEG can be used to differentiate between states of awake and
sedation, and can also be used to differentiate the different sedation levels.
Neonate, Sedation levels, Amplitude integrated electroencephalogram, NICU, aEEG, Pain, Burdjalov score,
Ain Shams University.

be established by using standard protocols that should be
Neonates in many Neonatal Intensive Care Units
based on objective methods.
(NICU)s often experience many painful interventions and
Sedation scores and sedation-measuring devices
situations that require analgesics and sedative drugs such
have been used to reduce the risks of over-sedation,
as mechanical ventilation, diagnostic, as well as
especially excess drug given and drug withdrawal
therapeutic procedures and therefore are in need of pain
reactions [5]. The use of different itemized scales has
and sedation management [1,2]. The utilization of
improved the sedative and analgesic management in
analgesics and sedative drugs is often difficult and
neonates and children [6]. However, scales based on
complicated by the inability of neonates to express their
clinical parameters are not often objective, and they often
sensation of pain, and therefore is completely dependent
have a subjective element which may lead to bias that
on the subjective judgment of their care givers [3].
could affect a patients proper assessment. Among the
Inappropriate sedation has serious consequences.
variety of scales that have been published in the literature,
Excessive sedation can prolong the duration of
the Neonatal Pain, Agitation and Sedation Scale (N-
mechanical ventilation as a result of prolonged recovery
PASS), has been proven to be an effective scale, and is
from sedation and this can lead to ventilator associated
proposed to be able to differentiate different sedation
pneumonia and lung injury. On the other hand, inadequate
levels. It includes five items (crying, behavior state,
sedation may lead to asynchronization with the ventilator
irritability, facial expression, vital signs and extremities
and prolonged duration of ventilation. It can also lead to
tone) [7].
severe agitation and stress leading to cardiac ischemia [4] .
Amplitude integrated electroencephalography
Therefore, the proper titration of sedation is very useful.
(aEEG) is used for continuous long-term brain monitoring
Trying to avoid over and under sedation, would ensure the
that has been proven effective and useful in neonates of
neonates comfort and would decrease the response to
all gestational ages and is gaining a more wider role in
stress related to trauma or inflammation. This is a
NICUs recently. This is due to the handiness of
challenge for the whole NICU teams worldwide.
application of the electrodes and even a simpler way of
Therefore, sedation targets and levels should be regularly
interpretation which facilitates its application by the
defined and maintained within optimal ranges. This can
neonatal staff, and the interpreter reliability is mostly
Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 124)

c:\work\Jor\vol892_125 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6908- 6914

Evaluation of Immunohistochemical Expression of Matrix
Metallo-Proteinase14 (MMP14) in Endometrial Carcinoma Type I:
Relation with 1- Integrin & Yes-Associated Protein 1(YAP1)
Heba M. Rashad*1, Samy A. Mohamed2, Eman M. Said1
Department of Pathology, Faculty of Medicine, 1Benha University, Benha and 2Al-Azhar University, Damietta, Egypt
*Corresponding author: Heba Mohammed Rashad, Mobile: (+20)01281855757, Email: heba_massoud@yahoo.com.


Endometrial carcinoma (EC) is a common gynecological malignancy, yet the mechanisms that lead to
tumor development and progression are still not fully known.
We aimed to evaluate immunohistochemical (IHC) expression of MMP14, 1 integrin and YAP1 in EC
type I and its relation to clinic-pathological parameters.
Subjects and Methods:
IHC expression of MMP14, 1-integrin & YAP1 in 52 cases of EC type I (endometrioid type)
were studied. The association of these markers with each other as well as with clinic-pathological parameters were
evaluated. Results: Positive membranous and cytoplasmic IHC expression of MMP14 was detected in 36 (69.2%) of
studied EC cases. Comparison of MMP14 IHC expression with the clinic-pathological data revealed higher expression
of MMP 14 in high grades EC (II & III) and higher stages (II& III), compared to lower grades and stages but did not
reach significant difference (P=0.077, P=0.925 respectively). No significant statistical difference with other variables
(P>0.05 for all) were detected. Cytoplasmic localization of 1 integrin was detected in 33 (63.5%) of studied EC cases.
Significant statistical difference with grade, depth of invasion (p<0.001 for both), LVI (P=0.001) and LNs metastasis
(P=008) were detected. No significant statistical difference with other variables (P>0.05 for all). Nuclear IHC expression
of YAP1 was detected in 34(65.4%) of studied EC cases. There was significant statistical difference with grade & depth
of invasion (p=0.001 for both), mean tumor size (P=0.033), LVI (p<0.001), LN metastasis (P<0.001) and TNM stage
Conclusion: MMP14, 1-integrin and YAP1 were upregulated in EC and associated with malignant potential. This
pattern of expression may represent promising markers for tumor development and progression and may be used as
therapeutic targets.
: Endometrial carcinoma, Immunohistochemistry, MMP14, 1-integrin, YAP 1.


cancer, colorectal cancer, pancreatic cancer, and oral
Endometrial cancer (EC) worldwide represents
squamous cell carcinoma (7).
the seventh common malignancy among females.
Many studies revealed that there is a relation
Developed countries have increased incidence of EC (1).
between MMP14 and 1-integrin. MMP14 accumulates
In United States, EC is the commonest gynecologic
at the bud tip of the invasive mammary gland, so
cancer, and the fourth most frequently diagnosed cancer
activate 1-integrin to promote cell invasion to regulate
in female (coming after breast, lung and colorectal
the invasion to interstitial tissue (8). YAP1 is a main
cancers) (2).
effector downstream of the Hippo signaling pathway,
In Egypt, it comes in the 14th rank among all
which activated during the development of many solid
cancers representing 1.5%. At NCI it is the third most
tumors. Also it is a driving factor to increase the
common gynecological cancer after ovary and cervix
proliferation and invasion of tumor cells(9).
(1,3). EC is divided into two entities: type 1 cancer (80%),
The regulation of this pathway occurred by
which occur in young and obese patients, is associated
phosphorylation and subcellular localization of YAP1.
with excess estrogen, a favorable prognosis, and
Activation of the Hippo signaling pathway induces
endometrioid histology, and is often accompanied by
phosphorylation of YAP1, which prevents translocation
and/or following endometrial hyperplasia (EH). Type 2
to the nucleus. When this pathway is inactivated,
cancers (10-20%), which represent tumors that arise in
dephosphorylated YAP1 translocate to the nucleus and
older and non-obese patients, are related to poor
interacts with transcription factors, resulting in cell
prognosis and non-endometrioid histotypes, and are
proliferation in many organs (10).
typically of serous histology, without associated
Many studies have shown that upregulation of
hyperplastic lesions (4).
The development and progression of EC are
transformation (EMT), inhibit apoptosis and promote
related to its secretion of a variety of matrix
the production of tumor stem cells (11-12). These concepts
metalloproteinases (MMPs) involving the degradation
inform possible strategies for effectively inhibiting
of extracellular matrix (ECM) components (5,6).
YAP1 activity in cancer patients, such as conventional
MMP-14, one of the members of thin-film
chemotherapy, radiotherapy or immunotherapy.
MMP, not only reduces a variety of ECM components
However, there are a few studies on the expression of
but also, activates matrix metalloproteinase-2 (MMP-
YAP1 in EC and its correlation with MMP and 1-
2). In addition, MMP14 plays an important role in the
development and invasion of cancers such as breast

Received: 13/7/2022
Accepted: 16/9/2022

Full Paper (vol.892 paper# 125)

c:\work\Jor\vol892_126 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6915- 6922

Assessment of Physicians' Attitude Towards Mental Illness and
Integrating Mental Health in Primary Health Care in Fayoum, Egypt
Nashwa Sayed Hamed1, Wafaa Y. Abdel Wahed1, Shimaa Elsayed Mabrouk1
1Public Health and Community Medicine Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt
Corresponding Author: Wafaa Y. Abdel Wahed,Email: wya00@fayoum.edu.eg, Telephone number: 00201003394785,
ORCID Number: https://orcid.org/0000-0002-8524-6135

Physicians' attitude towards mental illness is crucial in providing the service and in the feasibility of
integrating mental health in primary health care (PHC).
Objective: This cross-sectional study aimed to assess PHC physicians' attitudes toward mental illness and integrating
mental health services into PHC facilities
Material and Methods: This is a cross-sectional study conducted on 105 primary health care physicians in Fayoum
governorate, Egypt. For data collection, a self-administered questionnaire was used. It covers three themes: the basic
characteristics of the physicians, their attitude towards mental illness using the Mental Illness Clinicians' Attitudes Scale
version 4 (MICA 4). and their attitude towards integrating mental health into PHC.
Results: The mean MICA score was 44.4 ± 8.1 out of 96. A significant positive attitude was found among those younger
than 40 years, females, urban residents, those with no postgraduate degree, and those working in an urban PHC facility.
The mean score of attitude towards integrating mental health in PHC was 7.02 ± 2.03 out of 15. The majority of
respondents (87.6%) believe in the necessity of integrating mental health in PHC.
Conclusion: Physicians' attitude was generally positive regarding mental illness and mental health integration in PHC.
Further research is required to identify obstacles in integrating mental health in PHC.
Keywords: Primary health care, Integration, Mental illness, Physicians, MICA.

to healthcare professionals [7]. Stigma toward
Mental disorders are common representing 15%
individuals with mental health problems has a severe
of the global disease burden [1]. It is estimated that
social impact as well as a heavy burden for affected
mental disorders are affecting around 450 million
people [8]. The constant exposure to this stigmatizing
persons worldwide, with around 25% of people
attitude may lead to lack of access to care, poor
suffering from some type of ill mental health in their
compliance to treatment, as well as social
lifetime [2], 75% of affected people in many low-income
marginalization, and can undermine the relationship
countries do not have access to needed treatment
between the patient and the healthcare provider [9].
because of lack of fund and interest by most health
Further investigations to explore PHC physicians'
policymakers [1].
attitudes toward mental illness are required as most
It is common for non-specialists to be involved in
previous studies were conducted in the general
the detection, treatment, and management of mental
population and little is known about the attitudes of
health issues in settings with limited resources where
PHC providers [10].
there is a shortage of mental health providers and/or
In the current study, we aimed to assess attitudes
they are unevenly distributed. For this reason, WHO
towards mental illness in a sample of PHC physicians
encourages and reinforces the use of non-specialists in
and their attitudes towards integrating mental health
mental health care [3]. Because it improves health
care in PHC facilities.

incorporating mental health services within PHC is
essential. Additionally, it is the most practical method
Study design and setting
to close the treatment gap and guarantee that mental
A cross-sectional study was conducted in Fayoum
health is covered by universal health care [3].
Governorate, Southwest of Cairo, with an area of 1827
In Egypt, hospitals are primarily responsible for
km² and a population reaching 4 million [11]. Fayoum
providing mental health services, and PHC is not given
Governorate is divided into seven districts that have
enough consideration in this regard [4]. Thus
urban and rural areas.
transformation from hospital-based to community-

based mental health and the provision of accessible
services are necessary [5].
The study population was physicians working in
However, the attitude of healthcare providers is
PHC facilities in Fayoum Governorate. The inclusion
not always positive or encouraging [6].
criteria were: working full-time for more than one
Studies have shown that the healthcare system
month and being in direct contact with patients. A total
creates a stigmatizing environment for those who have
of 120 physicians working in PHC facilities at the end
mental health issues. Part of these unfavorable
of July 2022 were targeted. The authors contacted them
experiences in the healthcare system might be attributed
and sent them the questionnaire. One hundred and five
Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 126)

Full Paper (vol.892 paper# 127)

c:\work\Jor\vol892_128 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6928- 6936

Study of Anti-nucleosome Antibodies as A Predictor of Early Renal
Affection in Systemic Lupus Erythematosus Patients
Tamer M. Goda, Reda A. Kamel, Ayman Riyadh Abd El-Hameed*
Internal medicine department, faculty of medicine, Zigzag University, Egypt
*Corresponding author: Ayman Riyadh Abd El-Hameed, E-mail Address: arelsayed@medicine.zu.edu.eg,
Mobile: 010192192223, ORCID no: 0000-0001-9237-1420

Anti-nucleosome antibodies are a wide group of autoantibodies targeting the native nucleosome, which
contribute to systemic lupus erythematosus (SLE) development.
Objective: This study aimed to assess the anti-nucleosome antibodies as a diagnostic predictor to lupus nephritis (LN),
to evaluate its sensitivity and specificity, and changes in titers with LN treatment.
Patients and methods: The current research was conducted at Zagazig University Hospitals, Internal Medicine
Department. A total of 60 SLE patients were involved in this survey. They were split into two groups: Group I consisted
of 30 SLE patients without renal disease, and group II comprised of 30 individuals with lupus nephritis (LN). Group I
was subdivided according to results of renal biopsy into (group Ia) with free kidney biopsy (n=17) and (group Ib) with
class II/III LN (n=13).
Results: SLE cases with pathological abnormalities in kidney biopsy, including those with (group II) and without
clinical LN (group Ib or silent LN) showed significantly higher anti-nucleosome antibody titers. After therapy, there
was a significant drop in group II's anti-nucleosome antibody titer and 24-hour urine proteins. Anti-nucleosome
antibodies sensitivity for prediction of abnormal renal biopsy was 95.3%, specificity was 94.5%, while for prediction of
proteinuria sensitivity was 80%, and specificity was 80%.
Conclusion: Anti-nucleosome antibodies were more specific and sensitive than anti-dsDNA antibodies for diagnosing
LN and early prediction of renal affection. Anti-nucleosome antibodies have valuable importance in following the
response to treatment in LN.
Anti-dsDNA antibodies, Anti-nucleosome antibodies, Systemic lupus erythematosus, Lupus nephritis.


Systemic lupus erythematosus (SLE) is an
Nucleosomes are thought to be the primary antigens in
autoimmune disorder due to abnormal immune system
the pathophysiology of SLE (8). These nucleosome-
that induced the generation of harmful autoantibodies,
specific antibodies show up earlier in the course of the
which have a role in diagnosis and are linked in
disease than anti-dsDNA and anti-histone antibodies (9).
systemic affection (1).

Lupus nephritis (LN) is common reason for death
and morbidity. LN patients have mortality rates that are
This current work was done at Nephrology Unit,
nearly six times greater (2). Abnormal activation of self-
Internal Medicine Department, Zagazig University
reactive T and B cells, auto-antibodies, and immune
Hospitals to evaluate the anti-nucleosome antibodies as
complex production were detected in SLE (3).
a diagnostic marker in LN and to evaluate its sensitivity
Although, clinical evaluation is the cornerstone of
and specificity in comparison with anti-dsDNA
managing SLE, this evaluation has limitations and need
antibodies, and evaluate changes in anti-nucleosome
to be supplemented with other tests in order to confirm
antibodies titer with treatment of LN.
the diagnosis and assess the severity of the disease.
This study comprised a total of 60 SLE patients.
Serological biomarkers are essential for SLE patient
They were divided into 2 groups, group I involved 30
treatment (4).
SLE individuals without manifestations of renal
Autoantibodies have been implicated with an
affection and group II contained 30 LN individuals.
increased risk of organ involvement in SLE (5).
Group I was subdivided according to results of renal
Antinuclear antibodies (ANA) are the most important
biopsy into group Ia with free kidney biopsy (n=17) and
diagnostic serology marker for SLE, however because
group Ib with class II/III LN (n=13). SLE cases were
they are present in the majority of systemic autoimmune
diagnosed using the European League Against
illnesses and even in healthy people, they have low
Rheumatism (EULAR) and the American College of
specificity for SLE diagnosis (6).
Rheumatology (ACR) (EULAR/ACR) criteria for the
Fundamental components of chromatin are
classification of SLE (10).
nucleosomes. Histones are an essential component of
LN was diagnosed according to the American
double-stranded DNA (dsDNA), yet they are made of
College of Rheumatology (ACR) criteria (11). All
about 146 base pairs of DNA that are twice wrapped
participants were submitted to thorough history taking
around a protein core that is an octamer made of two
with stress on arthritis or arthralgia, fever, vasculitic
molecules. Histone H1 is connected to the outside of the
changes, loin pain, dysuria, seizures, headache or
complex to further bind the molecules together (7).
Received: 12/7/2022
Accepted: 15/9/2022

Full Paper (vol.892 paper# 128)

c:\work\Jor\vol892_129 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6937- 6946

Incorporation of Curcumin in Bilayer Matrices to Reduce the Toxic Effects to
Be Used for Wound-Healing Application
Noor Abd-Ulamer Oda, Maryam Mansoor Mathkoor, Zainab Abdul Kareem Abbas
College of Pharmacy, University of Ahl Al Bayt, Karbala, Iraq
Corresponding author: Noor Abd-Ulamer Oda, Mobile: (+964)07723997291,
Email: abdalamernoor@gmail.com. https://orcid.org/0000-0002-5430-6940

The self-assembly of hydrophobically modified polymers has become a research hotspot. Chronic, non-
healing wounds place a significant burden on patients and healthcare systems.
Objective: The present work aims to create a poly (3hydroxybotyrate) (PHB) composite film containing curcumin that
would effectively improve skin wound healing by antibacterial activity.
Methods: The PHB/curcumin films are devised using a solution casting method, and Chloroform is the main solvent in
the work. FTIR spectroscopy analysis is used to prove the success of the insertion process between Cur and the PHB
matrix. Results: The PHB/Curcumin film product is smooth and flexible without any defects. Long-term protection is
provided by the composite film's sustained curcumin release. Within 15 hours, almost 90% of the curcumin in
PHB/Curcumin films is released in a sustained way. Results from the MTT assay show that PHB/Curcumin film has lower
cytotoxicity than that of free curcumin. Furthermore, Vivo experiments reveal that the PHB/Curcumin Films have a 95%
healing rate and mature epithelialization on day 14 following surgery.
Conclusion: Due to the success of loading curcumin in a PHB film and proving the growth in the effectiveness of the
method by increasing and prolonging the effect of the biological activity as an antibacterial and in helping tissues to heal
wounds in addition to its rapid wound-healing effects, it could be concluded the study considers PHB/Curcumin films
promising as a wound dressing agent in wound management.
Keywords: Poly (3-hydroxybutyrate), Curcumin, Wound Healing, Staphylococcus aureus, Antibacterial effect, Bio-films


hospitalization, increased morbidity, and mortality, and
Skin is a flexible exterior tissue that covers the
increased healthcare costs(5).
body of a vertebrate animal and performs activities such
That is to say, wounds must be carefully dealt
as controlling body temperature, receiving external
with to prevent the spread of microbes, consequently
stimuli, defending against harm, and excreting excessive
helping the patient recover and reducing healthcare costs
water(1). However, the skin may be wounded by
through resorting to the use of medicinal plants to
scratching, bruising, or during surgery, in addition to
eliminate antibiotic-resistant bacteria and contribute to
immunodeficiency disease conditions such as diabetes
the repair of damaged skin tissues(6). (7) state that
mellitus. Regardless of whether the wound is acute or
curcumin is the main phytochemical of Curcuma longa
chronic, it may cause a wound, loss of body fluids,
L. rhizome with the common name of turmeric.
nutrients, and electrolytes, which may severely threaten
Furthermore, turmeric is used as a spice in food and
the health of individuals (2)
medicine to treat various diseases and kill antimicrobial-
. Thus, it is essential to promote wound-healing
resistant bacteria. Turmeric inhibits bacterial biofilm
and restore skin functions through adopting diverse
formation. It blocks bacterial growth and prevents
clinical treatment measures. Moreover, wounds can be
bacterial adhesion to host cell receptors through the
colonized by many types of bacteria that cause
bacterial quorum-sensing regulation system (8). Besides,
inflammation and destruction of the surrounding tissues,
it can exert a synergistic antibacterial effect alongside
and affect healing. Staphylococcus aureus and
other antibacterial substances. Although curcumin has
Pseudomonas aeruginosa are the most commonly
high clinical applicability, it has low water solubility,
isolated organisms from wounds, for their capacity to
absorbability, and metabolism have constrained its direct
acquire antibiotic resistance, colonization by these
use in biomedicine (9). Yet, it has been used to produce
organisms which necessitates cautious treatment, and
functional films mixed with various polymers such as
their connection with nosocomial infections(3).
cellulose, carrageenan, pecti, gelatin, and more for
Wounds are a risk factor for colonization with
biomedical and food packaging applications. Bio-film,
methicillin-resistant S. aureus (MRSA) as well as other
as (10) argue, is an emerging field that is possibly altering
multidrug-resistant organisms, especially in hospital
the treatment of diseases through drug delivery with
environments (4). On the other hand, Infections with
curcumin. Moreover, the use of biodegradable polymers
antibiotic-resistant bacteria are related to prolonged
film, as a base for drug formulations, may only eliminate
many side effects of the current compounds used in the
Received: 2/7/2022
Accepted: 8/9/2022

Full Paper (vol.892 paper# 129)

c:\work\Jor\vol892_130 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6947- 6955

Effect of Nutritional Rehabilitation on Osteocalcin and Insulin
Resistance in Pediatric Obesity
May Fouad Nassar1, Enas Mokhtar Abd-Alhamid2, Eman Ahmed Elghoroury3,
Bassma Abdelnasser Abdelhaleem1, Shaimaa Adel Elsayed2, Heba E. Elkholy1
1 Pediatrics department, Ain Shams University, Cairo, Egypt
2Pediatrics Department, 3 Clinical Pathology Department, National Research Centre, Giza, Egypt
Corresponding author: Heba E. Elkholy, 01223339160, ORCID 0000-0002-5736-3203. dr_hebaessam@yahoo.com

Children's obesity and overweight are new health issues and are associated with insulin resistance. Oste-
ocalcin level is inversely correlated with obesity and has a metabolic role in insulin resistance.
Aim of work: The study aimed to detect the effect of nutritional intervention on serum osteocalcin and HOMA-IR in
obese children. Patients and Methods: This interventional study was conducted on 40 obese children and 20 control
recruited from Clinical Nutrition Unit, Ain Shams University. The participants were subjected to nutritional analysis,
body composition, anthropometric measurements, and laboratory parameters including a full lipid profile, osteocalcin,
fasting insulin, fasting glucose, and HOMA-IR calculation at baseline and 3-month intervals after being subjected to a
nutritional weight loss and exercise program.
Results: In contrast to the controls, the patients' serum levels of triglycerides, LDL, fasting glucose, fasting insulin, and
HOMA-IR were all significantly higher, while HDL and osteocalcin were lower. BMI, waist-hip ratio, and waist-height
ratio significantly decreased after the nutritional intervention. Also, fasting insulin and HOMA-IR were dramatically
decreased, Osteocalcin increased, and fasting glucose level did not significantly alter. The anthropometric measures,
fasting blood glucose, insulin, and HOMA-IR had notable negative relationships with osteocalcin, but these were non-
significant. Conclusion: Insulin resistance is demonstrated in pediatric obesity and correlates with osteocalcin levels.
Early nutritional intervention and exercise programs causing weight loss results in elevation of osteocalcin level coupled
with improvement in IR suggesting osteocalcin's role as a prognostic marker.
Keywords: Pediatric Obesity; Osteocalcin; Insulin resistance; Nutritional intervention.


bones, plays a crucial function in bone development and
Overweight and obesity, as defined by the
metabolism control. These functions include improving
World Health Organization (WHO), are conditions
mitochondrial function and proliferation, lowering body
where there is an excessive buildup of body fat that has
fat, and stimulating insulin secretion and sensitivity (9).
a negative impact on health (1). According to the CDC,
Obesity and osteocalcin are adversely associated (10) and
BMI at or above the 95th percentile for children and
their levels are lower in overweight and obese children.
teens is the cutoff threshold for diagnosing obesity (2).
It is also hypothesized that it contributes to insulin re-
In comparison to the Middle East and Sub-Sa-
sistance in obese children (11).
haran Africa, North Africa is one of the regions of the
To treat childhood obesity, behavior-changing
world where there is a higher prevalence of obesity and
therapies that aim to boost physical activity, improve
overweight. One of the nations reportedly exhibiting
nutritional intake, and reduce sedentary behavior are
this rising occurrence is Egypt (3). Seventeen percent of
prescribed and advised (12). The recommended dietary
school children in Sohag were overweight, and 15%
strategy consists of calorie restriction along with a de-
were obese, according to a recent survey (4).
crease in the consumption of carbohydrates with a high
Childhood obesity and overweight are linked to
glycemic index. Exercise increases calorie expenditure
a higher frequency of various short- and long-term con-
and muscle insulin sensitivity (13). Osteocalcin levels
sequences, such as diabetes, impaired insulin sensitiv-
rise after weight loss in overweight people (14)
ity, respiratory and musculoskeletal issues, elevated
The current study sought to determine the impact
blood pressure, stroke, and a higher likelihood of be-
of a weight-loss exercise program and nutritional inter-
coming adult obesity (5), moreover, causing death and
vention on blood markers of insulin resistance and os-
affecting mental health (6).
teocalcin in obese children.
Insulin resistance (IR) is the inability of a given

insulin dose to promote the absorption and utilization of
glucose (7).
At the Clinical Nutrition Clinic, Children's Hospi-
In children, increased adiposity and obesity are
tal, Faculty of Medicine, Ain Shams University, an in-
the main risk factors for impaired insulin sensitivity,
terventional study on obese children aged 5 to 12 years
and the association between obesity and the develop-
was undertaken from August 2021 to February 2022.
ment of metabolic and cardiovascular problems is made
It compared 40 obese children who met the inclu-
by insulin resistance/hyperinsulinemia (8). Osteocalcin
sion criteria to 20 controls who were of a similar age
(OCN), a hormone produced by osteoblasts in the
and gender.

Received: 12/7/2022
Accepted: 15/9/2022

Full Paper (vol.892 paper# 130)

c:\work\Jor\vol892_131 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6956- 6960

Potential Role of Peroxisome Proliferator-activated Receptor Gamma Coactivator-1
Alpha (PGC-1) Gene Polymorphism in Patients with Type 2 Diabetes Mellitus
Abdallah S. Abdelazem1, Atef Gouda Hussein2, Mayada M. Mousa3,
Shaden A. F. Mohammed Assaf 1, Samia Hussein*2
Department of 1Medical Biochemistry and Molecular Biology, Faculty of Medicine, Suez University, Egypt
Departments of 2Medical Biochemistry and Molecular Biology, 3Internal Medicine,
Endocrine and Diabetes Unit, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Samia Hussein, Mobile: (+20) 01062725981, E-Mail: samiahussein82@hotmail.com


Background: Peroxisome Proliferator-activated Receptor Gamma Coactivator-1 Alpha (PGC-1) is a cellular
modulator of oxidative and lipid metabolism. It has a vital role in the regulation of mitochondrial activity. Patients
with type 2 diabetes mellitus (T2DM) have mitochondrial abnormality and reduced mitochondrial numbers within the
cells of skeletal muscles.
Objective: To evaluate the correlation between PGC-1 gene polymorphism and T2DM in Egyptian patients attending
Zagazig University Hospitals.
Patients and Methods: This was a case-control study including 136 participants of both sexes recruited from the
Zagazig University Hospitals. The participants were divided into two equal groups: control group with normal
individuals and T2DM group with 68 participants in each group.
Results: The incidence of A allele was significantly higher in T2DM group. Also, there were statistically significant
elevations in waist hip ratio (WHR) and fasting blood sugar (FBS) among carriers of GA and AA genotypes. However,
there was no significant correlation between gene polymorphism and lipid profile in T2DM group. After applying
multivariate analysis, A allele carriers and increased values of WHR, FBS, HOMA-IR and low-density lipoprotein-
cholesterol (LDL-c) were detected in T2DM.
Conclusion: We concluded that A allele of PGC-1 polymorphism was a possible predictor of T2DM occurrence in
Egyptian patients. Additionally, WHR and FBS were significantly higher among carriers of GA and AA genotypes
Keywords: PGC-1, polymorphism, Type 2 diabetes mellitus.


Diabetes mellitus is defined by the World Health
including glucose production and utilization, hepatic
Organization as a metabolic abnormality accompanied
gluconeogenesis, and glucose uptake in skeletal muscles
with alteration of glucose, protein, and lipid metabolism
accompanied by increased glucose level, and insulin

resistance. The most prominent type is type 2 diabetes
mellitus (T2DM) representing nearly 90% of all cases
The present study aims to evaluate the
with diabetes mellitus (1).
correlation between PGC-1 gene polymorphism and
T2DM affects nearly 300 million people
T2DM in Egyptian patients attending Zagazig
worldwide nowadays, and more than 590 million
University Hospitals.
individuals are expected to develop T2DM by 2035 (2).

Egypt comes 10th in the countries with high diabetes
mellitus incidences with 7.5 million diabetic cases
estimated by the International Diabetes Federation with
participants of both sexes (68 participants in each group)
expected elevation by 2035 up to 13.1 million cases (3).
recruited from the Internal Medicine Department,
Peroxisome proliferator-activated receptor-
Zagazig University Hospitals.
gamma coactivator-1 alpha (PGC-1) is a potential

coactivator of multiple transcriptional factors that has a
Ethical consent:
variety of biological activity in various tissues. It has an
The study design was approved by the
oxidative metabolism regulator activity especially in
Institute Review Board of the Ethical Committee of
reactive oxygen species production. Any alteration in
Faculty of Medicine, Zagazig University (ZU-IRB
PGC-1 expression may alter the metabolic processes,
which influence thermogenesis, adipogenesis, and
Every patient signed an informed written
gluconeogenesis which could result in insulin
consent for acceptance of participation in the study.
This work has been carried out in accordance with
PGC-1 is a key regulator of metabolic
The Code of Ethics of the World Medical Association
adaptations as it regulates the expression of key enzymes
(Declaration of Helsinki) for studies involving
involved in -oxidation, cellular energy metabolism
regulation, and various aspects of glucose metabolism,

Received: 16/08/2022
Accepted: 17/10/2022

Full Paper (vol.892 paper# 131)

c:\work\Jor\vol892_132 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6961- 6969

Antibiofilm Activity of Conocarpus erectus Leaves Extract and Assessment Its
Effect on pelA and algD Genes on Multi-drug Resistant Pseudomonas aeruginosa
Laith F. Mahdi*1 and Ahmed H. AL-Azawi2
1 Baghdad Health Al-Karkh Directorate, Ministry of Health, Baghdad, Iraq
2Biotechnology Department, Genetic Engineering and Biotechnology Institute for Post
Graduate Studies, University of Baghdad, Baghdad, Iraq
*Corresponding author: Laith F. Mahdi, Email: lias93@yahoo.com, Mobile: +9647733766300

Due to its various resistance mechanisms, Pseudomonas aeruginosa is the most prevalent opportunistic
infection that kills hospitalized patients. Thus, therapeutic options become limited.
Objective: The study aimed to estimate the antibiofilm effectiveness of Conocarpus erectus leaf extracts against MDR
P. aeruginosa isolates and examines pelA and algD gene expression.
Subjects and Methods: One hundred-fifty clinical samples were collected from five Baghdad hospitals between
September 2021 and January 2022. Samples were grown on different mediums. Despite cetrimide agar's ability to detect
P. aeruginosa, only 83 isolates developed at 42°C. VITEK 2 compact system identification followed. This study
examined 83 of P. aeruginosa isolates for resistance vs 10 medications. Disk diffusion was used for this investigation.
Results: The results showed that P. aeruginosa isolates were most resistant to Ceftriaxone, Amoxicillin-Clavulanic acid,
and Trimethoprim. Microtiter plate biofilm detection is done with 10 multi-drug-resistant isolates. All isolates produced
significant biofilm. Maceration and Soxhlet equipment produced methanolic and aqueous extracts. The phytochemical
screening of Conocarpus erectus revealed flavonoids, phenols, alkaloids, tannins, glycosides, and saponins in methanolic
and aqueous extracts. 32 mg/ml Conocarpus erectus methanolic leaf extract prevented clinical P. aeruginosa biofilm
development. After treatment with the sub-MIC of the methanolic extract, P. aeruginosa's biofilm-forming genes pelA
and algD had minimal expression. Conclusion: This study demonstrated that Conocarpus erectus methanolic extracts
contain significant phytochemical content, making them therapeutic. The antibiofilm compound in Conocarpus erectus
extract downregulates the algD and pelA genes in P. aeruginosa despite antibiotic resistance.
: Pseudomonas aeruginosa, Conocarpus erectus, antibacterial, antibiofilm, MIC, pelA and algD genes.

flavonoids, terpenoids, essential oil, tannins, lignans,
Clinically and epidemiologically, Pseudomonas
glucosinolates, and others. Some secondary metabolites
aeruginosa ranks high prevalence of MDR. Non-
are also involved (5). Conocarpus wood might have been
fermenting Gram-negative bacilli cause most
in the past utilized for fire, furniture, and charcoal, as it
is very hard and strong wood (6).
immunocompromised patients (1). Its virulence factors
Because of their low rate of combustion, the
wood and bark of this tree are often used in the smoking
lipopolysaccharide, flagellum, type IV pili, type III
process, particularly for red meat and fish. Orchitis,
secretion system, exotoxin A, proteases, alginate,
prickly heat, headache, anemia, bleeding, catarrh,
quorum sensing, biofilm formation, type VI secretion
diabetes, diarrhea, conjunctivitis, tumors, gonorrhea,
systems, and airspace oxidant production are virulence
and syphilis are just some of the many conditions that
factors (2).
have traditionally been treated with this species. It has
When bacteria stick to a surface and build a
also been used as an antipyretic and anti-inflammatory
polysaccharide matrix, they produce biofilms. They do
in the treatment of fever (Decoction of leaves) and
this to protect their microorganisms from outside
swellings (7).
threats. Biofilms can cover biotic and abiotic surfaces

(EPS). Stress allows P. aeruginosa's biofilm form to
avoid the host immune response and have better
The study aims to estimate the antibiofilm
antimicrobial resistance than its planktonic form (3).
effectiveness of Conocarpus erectus leaf extracts
In therapeutic plants, one can discover a great
against MDR P. aeruginosa isolates and examines
deal of material that possesses antibacterial properties.
pelA and algD gene expression.
Because of the potential antibacterial activity that they

possess, the extracts of numerous medicinal plants are
utilized in the treatment of a wide variety of ailments.
Collection of plant:
The screening and subsequent market trading of
The expert from the Department of Biology in
particular bioactive components is essential to the
the College of Science at the University of Baghdad
success of a large number of herbal firms (4).
identified the plant leaves seen in Iraqi marketplaces as
The existence of active compounds in plants is
belonging to the species Conocarpus erectus L. After
what causes them to have antimicrobial effects. These
being washed and dried at room temperature, the leaves
chemicals include quinones, phenols, alkaloids,
are then ground and placed in an airtight container to be
Received: 7/7/2022
Accepted: 12/9/2022

Full Paper (vol.892 paper# 132)

c:\work\Jor\vol892_133 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6970- 6978

Assessment of the Pectoralis Major Myocutaneous Flap in Closure of
Orofacial Defects After Excision of Oral Cancer
Mohammed H. Osman1, Salah El-Dein G. Shaltout1, Dalia A. Elsers2,
Hamdan S. Abbas1, Mohammed S. Shahine1*
1Maxillofacial Surgery, General Surgery Department, Faculty of Medicine, Assiut University, Egypt
2 Departement of Pathology, Faculty of Medicine, Assiut University, Egypt
* Corresponding author. Mohammed S. Shahine
Tel: 002/ 01025555420 Fax: 002/ 0882333327 Postal code: 71515, E-mail: msafwat67@aun.edu.eg

Oral cancer is one of the main causes of orofacial defects that need reconstruction after resection to restore
cosmetic appearance and function, especially after glossectomy and cancer cheek resection.
Patients and methods:
The study was done on 17 cases with oral squamous cell carcinoma (OSCC) who were evaluated
for choice of the reconstruction method with pectoralis major myocutaneous flap (PMMF) according to tumor size (T).
They were admitted to the General Surgery Department (Maxillofacial Unit), Assiut University Hospital, Egypt from
March 2016.
We observed that 58.8 % of the cases which reconstructed with PMMF were females and 41.2% of the cases
were males. Most cases were from age group 50 years (82.4%) while 17.6% of cases were from the age group < 50
years. As regards smoking, 29.4% of the reconstructed cases were smokers and 70.6% of the cases were non-smokers.
Our study' findings showed the safety, dependability, and adaptability of the pectoralis major
myocutaneous pedicle flap as a reconstructive technique, with a manageable incidence of postoperative problems and
related morbidity.
Orofacial defects ­ PMMF ­ Smoking - Oral cancer.


collected: patient's age, sex, site of the tumor, TNM
Oral cancer is one of the main causes of orofacial
staging, and morphological differentiation of the tumor.
defects that need reconstruction after resection to
After preoperative assessment, patients who were
restore cosmetic appearance and function, especially
medically fit for surgical resection and reconstruction
after glossectomy and cancer cheek resection (1). The
had prepared well for the operation by raising the
location of the defect, the type of tissue needed, the
albumin level, hemoglobin level and good nutrition by
functional and cosmetic effects of the defect, any
Ryle feeding or even gastrostomy if needed. Under
accompanying comorbidities, and the availability of
resources all have a role in the reconstruction method
positioning, block neck dissection, and removal of the
that is chosen. Pectoralis major (PM) flap is described
main tumour with safety margin. The costal border and
by Ariyan (1979) as a substitute for microvascular
the midline of the chest were exposed. To reveal the
repair in the context of head and neck reconstruction (2).
lateral chest wall and anterior axillary fold, the upper
The primary outcome of the current study is to
arm is gently abducted. The surface marks of the
assess the surgical outcomes of PMMF in
vascular pedicle can be determined by drawing a line
reconstruction of orofacial defects after oral cancer
from the shoulder to the xiphisternum and another line
resection (cosmetic and functional outcome) and to
vertically from the midline of the clavicle to intersect
study the possible complications that result from its uses
the first line. Along the pectoral branch of the
e.g. infection, tissue loss and fistula.
thoracoacromial artery, the skin paddle is positioned

across the pectoralis major muscle. The flap's outline is
drawn onto the skin to make sure the pedicle is the right
The study was done on 17 cases with oral squamous cell
length. To mould the flap to the shape of the defect, the
carcinoma who were evaluated for choice of the
distal dark portion of the flap will be removed.
reconstruction method with PMMF according to tumor
The location, size, and form of the surgical defect
size (T). They were admitted to the General Surgery
dictate the size and shape of the skin island of the
Department (Maxillofacial Unit) at Assiut University
myocutaneous flap as well as the length of its pedicle.
Hospital, Egypt.
The midclavicular region serves as the flap's pivot point.

Measure the distance from this point up to the farthest
Inclusion criteria:
part of the surgical defect using tape or thread. This
Patients that were not candidate for free flaps
measurement reveals the distance between the mid-
reconstructions, due to medical problem that cannot
clavicular point and the distal tip of the flap.
tolerate the long-time of the operation, patients that
If more pedicle length is required, the flap may be
refuse free flaps or after failure of free flap.
extended inferiorly up to 2.5 cm beyond the pectoralis
Clinical information of cases were obtained from
major muscle, but do so with the understanding that the
the medical charts. The following information were
flap will then have a random pattern and a weaker blood
Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 133)

c:\work\Jor\vol892_134 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6979- 6985

Hypovitaminosis D and Hepatocellular Carcinoma
in Patients with Liver Cirrhosis
Mahmoud Rizk, Ahmed Refaat Mohamed, Amira K. El-Alfy,
Ahmed Ramadan Masry, Mohamed Abd Ellatif Afifi*
Department of Internal Medicine, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mohamed Abd Ellatif Afifi, Mobile: 00201001588752, Email: dr_malatif82@yahoo.com

The most frequent primary liver cancer in those with cirrhosis and chronic liver disease is
hepatocellular carcinoma (HCC). Anti-infective and immune-modulating capabilities have been discovered for the
multifunctional steroid hormone known as vitamin D. Vitamin D deficiency was found to be linked with advancement
of Chronic liver disease (CLD) as non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), as well
as the hepatitis C virus (HCV). Objective: The aim of the current work was to investigate the association between
vitamin D deficiency and HCC in patients with liver cirrhosis. Patients and Methods: Ninety individuals with liver
cirrhosis (LC) participated in this trial. The included subjects were divided into two groups; Group A consisted of 45
cirrhotic patients without HCC, and Group B consisted of 45 cirrhotic patients with HCC. Results: Liver function
tests: INR, ALT, AST, total bilirubin were all statistically substantially higher in group B than in group A (P=0.001,
0.001, 0.001, and 0.011, respectively). However, group B's serum albumin and platelet count were considerably lower
than group A's (P=0.003 and 0.001, respectively) compared to each other. In comparison to group A's alpha-
fetoprotein (AFP) of 8.69±1.84, group B's AFP of 254.33±32.69 was statistically substantially higher (P =
0.001).Vitamin D levels in group B were substantially lower (19.33±4.68) than in group A (26.31±4.95) (P= 0.00).
With an area under the curve (AUC) of 0.802, vitamin D was significant at a cutoff level of 20.5 ng/ml with a
sensitivity of 80.3% and a specificity of 75% for increasing the risk of HCC. Conclusion: It could be concluded that it
is crucial to maintain an optimum blood level of vitamin D in cirrhotic individuals since our findings indicate a
substantial correlation between vitamin D levels and HCC risk.
Cirrhosis; Hepatocellular Carcinoma; Vitamin D.


levels in the blood is a common method of assessing
People all over the world are affected by
vitamin D status[4].
hepatocellular carcinoma (HCC). It comes in 2nd place
Vitamin D deficiency was found to be linked
in prevalence among mortality causes of cancer related
with advancement of chronic liver diseases as non-
diseases while it comes in 6th place as a factor
alcoholic fatty liver disease (NAFLD), alcoholic liver
predisposing to malignancy globally. This tumor is
disease (ALD), as well as the hepatitis C virus (HCV).
aggressive and has a bad prognosis, as seen by the
New evidence suggests vitamin D has antimicrobial
discrepancy between its incidence and mortality rates.
and immune-boosting properties [5].
Development of HCC could be attributed to various
As liver function declines, levels of 25-OHD,
predisposing factors including chronic viral hepatitis,
which is created as the first phase of vitamin D
non-alcoholic, and alcoholic fatty liver diseases, as
hydroxylation, decrease with time. At least one-third
well as other chronic inflammatory liver diseases [1].
of those with chronic liver disease have a significant
Calcium homeostasis and bone metabolism,
lack of vitamin D (25-OHD insufficiency), and studies
among other biological processes, are regulated by
suggest that up to 92% of those with the condition are
vitamin D receptors (VDR), that can be found in more
vitamin D deficient [6].
than 30 tissues involving pituitary, brain, prostate,
Wu et al. [7] revealed that DBP as well as VDR
kidneys, intestine, parathyroid gland, skeletal and
play important functions in the development of HCC
cardiac muscle, mammary glands, non-parenchymal
tumors and that people with chronic liver disorders
liver endothelial cells, as well as the immune system[2].
who have polymorphisms in these genes have an
Vitamin D is mostly obtained either from sun
increased chance of developing HCC in patients with
exposure or food sources. In the first step of activating
CLDs. They have partially demonstrated vitamin D's
vitamin D, the liver converts cholecalciferol to 25-
anti-tumor properties. Thus, vitamin D and its
hydroxyvitamin D (25-OHD). With a half-life of 15 to
analogues may provide new treatment targets and HCC
21 days, the primary vitamin D circulating metabolite
prognostic biomarkers, which may be crucial for
is related to the carrier protein; vitamin D binding
primary and secondary HCC prevention and the
protein (DBP) [3].
tracking of its development.
The kidney is where 25-OHD undergoes its
This research aims to investigate the association
second activation to 1,25-dihydroxyvitamin D, with
between vitamin D deficiency and HCC in liver
the bone, parathyroid gland, monocytes, placenta,
breast, as well as brain, being less involved. This

metabolically active compound has a half-life of just

ten to twenty hours. Consequently, evaluating 25-OHD
Received: 14/7/2022
Accepted: 17/9/2022

Full Paper (vol.892 paper# 134)

c:\work\Jor\vol892_135 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6986- 6992

Efficacy of Hydroxychloroquine in Rheumatic Diseases and
Associated Co- morbidities
Eman Ahmed Hamed Omran1, Safaa A. Mahran1, Mohamed G. A. Saleh2,
Mohamed Salem Hareedy3, Helal F. Hetta4, Nesreen I. Ibrahim*1, Manal Hassanien1
Departments of 1Rheumatology and Rehabilitation, 2Ophthalmology,
3Pharmacology and 4Medical Microbiology and Immunology, Assiut University, Assiut, Egypt
*Corresponding Author: Nesreen I. Ibrahim, Mobile: (+20)1096594921, Email: nesreen.ismail1988@gmail.com

In the treatment of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), the antimalarial
drug hydroxychloroquine (HCQ) is frequently used. It reduces the risk of illness flare-ups, prevents thrombosis, and
lowers the possibility of long-term organ damage. HCQ's advantageous impact on cholesterol levels and diabetes risk
The aim of the present study was to identify the efficacy of HCQ in rheumatic diseases and associated
Patients and method: This cross-sectional study included a total of 71 RA and 9 SLE patients, attending at Department
of Rheumatology, Rehabilitation and Physical Medicine, Assiut University Hospitals. University Hospitals. All
patients subjected to complete history taking including medication history [HCQ dose (daily, cumulative) and duration],
clinical examination, disease activity of RA was defined by DAS 28 (Disease activity scale) and disease activity of SLE
by SELDAI-2K (Systemic Lupus Erythematosus Disease Activity Index). Laboratory assessments were performed
including: routine investigation, autoantibodies
Results: HCQ has a role in control diabetes mellitus (DM) of our diabetic patients and had role in reducing the risk for
atherosclerosis and a significant reduction in the lipid profiles as well as AI has been observed.
Conclusion: It could be concluded that HCQ is associated with a reduced risk of rheumatic diseases and its associated
Keywords: Systemic lupus erythematosus, Antimalarial drugs, DM, HCQ.


The aim of the present study was to identify the
Disease-modifying antirheumatic medicines
efficacy of HCQ in rheumatic diseases and associated
medications hydroxychloroquine and chloroquine, were

accidentally and irrationally introduced to treat a variety
of rheumatic diseases (1)
This cross-sectional study included a total of 71
. Hydroxychloroquine (HCQ) is
the go-to medication for inflammatory rheumatic
RA and 9 SLE patients, attending at Department of
disorders like SLE, rheumatoid arthritis (RA), and
Rheumatology, Rehabilitation and Physical Medicine,
others (2). They have recently been proposed as a form
Assiut University Hospitals. University Hospitals.
of treatment for COVID-19 sufferers (3).
Patients were 72 females and 8 males. Their
HCQ has been shown to decrease SLE activity
average age was (48.2 ± 10.9) ranged from 20 to 75
and increase damage-free survival (4), improves target
years. All RA patients were diagnosed and fulfilled
organ damage and survival in SLE patients (5). Although
2010 ACR/EULAR classification criteria for RA (10).
some studies have suggested that HCQ therapy for SLE
All SLE patients were diagnosed and fulfilled SLICC
patients may have cardiovascular beneficial effects,
classification criteria for SLE (11).

other studies have failed to show any significant effect
Inclusion criteria: Adult rheumatoid arthritis (RA) and
of HCQ on cardiovascular disease (CVD) (6). HCQ
systemic lupus erythematosus (SLE) patients who
could reduce disease activity of preeclampsia and may
received HCQ treatment.
play a protective function to avoid SLE flare-ups during

pregnancy, fetal growth restriction, and prematurity (7).
Exclusion criteria: Patients < 18 years, individuals
HCQ has also some metabolic effects by lowering
experiencing renal failure (creatinine clearance 30
fasting glucose, protection against diabetes, and
ml/min), patients with ocular disorders include
improvement of the lipids profile (8). HCQ has been
glaucoma, hereditary fundus dystrophies, dense media
demonstrated to improve clinical and laboratory results
opacity preventing fundus visibility, optic neuritis, and
in RA, especially in moderate and early disease, even
uveitis that may cause anomalies in screening tests used
though it had no protective effect on radiographic
to detect HCQ toxicity.
progression. Most of the effects, such as an

improvement in lipid profile and insulin resistance, are
Ethical Consideration:
comparable to those felt by lupus patients (9).
This study was ethically approved by Academic and
Ethical Committee at Assiut University (No.
17200029). Written informed consent of all the
participants was obtained. The study protocol

Received: 14/7/2022
Accepted: 17/9/2022

Full Paper (vol.892 paper# 135)

c:\work\Jor\vol892_136 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 6993- 6999

Study of Extended Focused Assessment Sonography Accuracy versus
Computed Tomography in Multiple Trauma Patients
Alaa Mostafa Abdel-Khalik El-Gendy*, Tarek Mohamed Sobhy,
Maged Abdel-Gleel Hamed, Hanan Abdel-Hameed Esmail
Department of Radiodiagnosis, Faculty of Medicine Zagazig University, Egypt
*Corresponding author: Alaa Mostafa Abdel-Khalik El-Gendy, Mobile: (+20) 01002524543,
E-Mail: alaaelgendy670@gmail.com
Focused assessment with sonography for trauma (FAST), a technological advancement, allowed
radiology residents to quickly check patients for injuries at their bedsides. Extended FAST (EFAST) is a recent
procedure that scans the lower chest region to detect pneumothorax.
Objective: This study aimed to evaluate the accuracy of E-FAST compared with the results of CT as a gold standard in
multiple trauma patients.
Patients and methods:
During the six-month period from June 2021 to December 2021, our prospective, observational,
and diagnostic accuracy study, which included 53 patients with multiple trauma and for whom CT scans were performed
at the time of arrival in the emergency room, at the Radiodiagnosis Department, Zagazig University Hospital.
Results: FAST results in comparison to CT results among the participants indicated that there were 26 true positive
diagnosis of hemothorax and pneumothorax, while 3 were false negative. There were 25 had true positive diagnosis of
hemoperitoneum among them 18 had true positive solid organ injury while 3 had false negative diagnosis of
hemoperitoneum among them 1 had false negative diagnosis of solid organ injury
Conclusion: E-FAST examination has an excellent specificity as considered as a useful diagnostic procedure for the
primary assessment of trauma patients in ED. However, the sensitivity detected is not high enough to rule-out thoraco-
abdominal injuries in multiple trauma patients. It is also a portable and non- invasive procedure but is operator
Keywords: Extended focused assessment sonography, Computed tomography, Multiple trauma.

Extended-focused evaluation with sonography in
Accidents of Motor vehicles are a significant
trauma has been established as a technique for finding
source of health concerns. These accidents have caused
free fluid in the abdomen and is now used similarly to a
blunt abdominal injuries, which has increased
stethoscope (5).
morbidity and mortality (1).
For the investigation of blunt abdominal injuries,
Focused assessment with sonography for trauma,
computed tomography has emerged as the industry
a development, let radiological residents to rapidly
standard. Imaging time has been drastically shortened
examine patients for injuries at the bedside,
thanks to the introduction of multi-detector CT
particularly those who were hemodynamically unstable
scanners, which have improved diagnostic capabilities
and couldn't be moved to a computed tomography
with high intra-abdominal injury detection with
machine (CT). When a patient arrives at the hospital, it
sensitivity and specificity of over 95% and strong
is possible to immediately determine whether there is
negative predictive value of almost 100% (6).
any free fluid present in the peritoneal cavity,
However, it is inappropriate for patients with
pericardium, or pleural spaces. FAST can also be used
hemodynamic instability because the patient must be
to detect solid organ damage as well as pneumothorax
transferred from the emergency room to the scanner.
(2). In addition, it can detect any free fluids in
Additionally, some patients' CT evaluations may be
hepatorenal recess, perihepatic region, or Morrison
slowed down or prohibited by worries about radiation
pouch, upper right quadrant, peri-splenic view, upper
and contrast. Because ultrasonography is rapid and can
left quadrant, the suprapubic area (the Douglas pouch),
be done at the patient's bedside, it is still beneficial in
and the sub-xiphoid region (pericardial view) (3).
trauma patients where time is of the essence. Its
The "extended FAST" (EFAST) procedure is a
usefulness as a screening test has been demonstrated in
new invention that scans the lower chest to look for
numerous investigations, but only a small number of
pneumothorax. A FAST scan's accuracy is found to be
research have linked its diagnostic abilities to the
correlated with and influenced by the severity of the
underlying seriousness or grading of solid abdominal
injury, the patient's build (obesity) and condition
visceral injuries (7).
(hemodynamic stability), the machine's features and
Evaluation of the accuracy of E-FAST compared
resolution, and the operator's level of training and
with the results of CT as a gold standard in multiple
experience, despite the apparent accessibility and ease
trauma patients was the goal of this study.
of use. FAST can also be problematic and commonly

fails to detect the existence of blunt mesenteric,
intestinal, diaphragmatic, or retroperitoneal injuries (4).
During the six-month period from June 2021 to
Received: 13/7/2022
Accepted: 16/9/2022

Full Paper (vol.892 paper# 136)

c:\work\Jor\vol892_137 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7000- 7008

Study the Effect of Intravenous Infusion of Dexamethasone versus
Magnesium Sulphate on Incidence and severity of Post Dural Puncture
Headache in Parturient Undergoing Caesarean Section
Hala Abdel- Sadek Elattar, Amany Fouad Ahmed, Hadeer Emad Ali Elmahallawy*,
Reham Mohamed Mohamed Aamer
Anaesthesia, Intensive Care and Pain Management Department, Faculty of Medicine,
Zagazig University, Sharkia, Egypt
*Corresponding author: Hadeer Emad Ali Elmahallawy, Mobile : (+20)01110434697, Mail : hadeeremad262@icloud.com

: Cerebrospinal fluid (CSF) leaks from the subarachnoid space, causing the CSF volume and pressure to
drop which exerts traction on the intracranial pain-sensitive structures and leads to post-dural puncture headache
(PDPH). Objective: Modulation of PDPH in parturient undergoing cesarean section using intravenous infusion of
dexamethasone versus magnesium sulfate. Subjects and Methods: Prospective, randomized, controlled, double-blind,
clinical study included 72 pregnant women undergoing spinal anesthesia for elective cesarean sections and were
allocated into three groups at random. 24 patients per group: Group C: patient received 100ml IV infusions of normal
saline over 20 minutes after clamping of the umbilical cord, Group D: patient received dexamethasone 0.1 mg/kg IV
infusion diluted in normal saline with a total volume of 100 ml over 20 minutes beyond clamping of the umbilical cord,
Group M: cases received 50mg/kg magnesium sulfate IV infusion diluted in normal saline with total volume 100ml
over 20minutes beyond umbilical cord clamping. Incidence and severity of PDPH were recorded at
6,12,24,36.48,60&72 postoperatively. Results: In comparison to the control group dexamethasone significantly reduce
the incidence of PDPH. Both dexamethasone and magnesium sulfate significantly lowered the severity of PDPH in
comparison to the control group without any significant difference between the two groups without side effects.
Conclusion: It has been demonstrated using intravenous dexamethasone in pregnant women who have undergone
cesarean section with spinal anesthesia reduces the frequency and severity of PDPH. While intravenous magnesium
sulfate just reduces the intensity of headache with no adverse effects.
Keywords: Dexamethasone, Magnesium Sulphate, Post Dural Puncture Headache.

explains the analgesic effects (9). It also affects how
A common side effect of spinal anesthesia is
much intracellular calcium is present (10).
post-dural puncture headache (PDPH). The prevalence

of PDPH following neuraxial procedure ranges from 6
to 36% (1). The incidence of dural puncture varies
At 6 months duration from January to June 2022,
depending on a variety of parameters, including age,
we conducted our prospective, randomized, controlled,
gender, the kind and size of the needle, the type of
double-blind, clinical study. Using a computer-
procedure, and the number of tries (2).
generated randomization table, 72 expectant mothers
The headache is usually intense and throbbing,
undergoing elective cesarean sections were divided into
starting from the front of the head and radiating to the
three equal groups at random.
occiput, it gets worse when you sit or rise (3). The
Inclusion criteria:
standard diagnostic criteria for PDPH include the
Acceptance of the participant who was admitted to
positional nature and dramatic alleviation after
the hospital for a planned cesarean section with spinal
resuming the supine position (4). Following intraspinal
anesthesia, ASA physical status II, the age ranged from
puncture, CSF loss and a decrease in intracranial
21 to 40, and Body Mass Index (BMI) ranged from 25 to
pressure are connected to PDPH. The usefulness of
30 kg/m2.
intravenous infusion of dexamethasone and magnesium
Exclusion criteria:
sulfate in avoiding PDPH was demonstrated in certain
uncontrolled hypertensive or diabetic, absolute
double-blind and placebo-controlled studies (6, 7).
contraindication to spinal anesthesia, history of headache
Corticosteroids' suppressive effect on the
or adverse reactions to study drugs, woman who had
synthesis of inflammatory mediators in immune cells at
taken any form of pain medication in the 24 hours before
the puncture site may play a role in the prevention of
surgery, more than one attempt for spinal anesthesia,
PDPH as these mediators will be released less
severe intraoperative hypotension [when systolic blood
frequently into CSF and subsequently decrease the
pressure (SBP) is lowered more than 25% from baseline]
number of stimulated pain receptors in CNS (8).
or required more intraoperative vasopressor drugs than
Although the precise mechanism is uncertain,
magnesium sulfate's ability to function as a non-
Preoperative preparation:
competitive antagonist of (NMDA)receptors among
All cases were visited before surgery, the goal of the
peripheral tissues as well as the central nervous system
study and the anesthetic procedure was explained in
Received: 13/07/2022
Accepted: 16/09/2022

Full Paper (vol.892 paper# 137)

c:\work\Jor\vol892_138 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7009- 7018

Urinary and Tissue Immunohistochemical Expression of Complement Activation
Products among Diabetic Nephropathy Patients in Different Stages
Mai Mohamed Abdelwahab1, Ezzat Mostafa Mohammed2, Samia Hussein3,
Ruaya Ibrahim Ibrahim Elsisy*4, Hayat Mahmoud Mahmoud2
Departments of 1Pathology, 2Internal Medicine and Nephrology, 3Medical Biochemistry and
Molecular Biology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
Department of 4Nephrology, Al-Ahrar Teaching Hospital, Zagazig, Sharkia, Egypt
*Corresponding author: Ruaya Ibrahim Ibrahim, Mobile: (+20) 01022182227, E-Mail: ruayaibraheem@gmail.com

It is currently unclear what role of urinary complement activation products (CAPs) play among diabetic
nephropathy (DN) patients. Objective: To assess complement activation products (C5a) contribution to diabetic
nephropathy development in urine and tissue. Patients and methods: A cross-sectional study was conducted at the
Nephrology Unit and Pathology Department of Zagazig University Hospitals. This study included sixty-two diabetic
patients who had diabetic nephropathy. Urinary C5a levels by ELISA and tissue immunohistochemical expression of
C5 a receptor (C5aR) were assessed among all patients. Results: Statistically significant difference was found regarding
C5a level and its tissue receptors which was higher among the grade IV group and lower among the grade IIa group.
Age, HDL, and albumin/ creatinine ratio showed statistically significant correlations with C5a and its receptors.
Diabetic duration, nephropathy classes, and C5a, C5aR showed statistically significant correlations with albumin/
creatinine ratio. Age, diabetic duration, HDL, fasting blood glucose level, albumin creatinine ratio, and C5a showed
statistical significance as predictors for diabetic nephropathy grades III or IV. At a cutoff value equal to 74.4, C5a had
80.8% sensitivity and 66.7% specificity in the prediction of diabetic nephropathy grade III and IV.
Conclusion: Since urinary and tissue CAPs and the severity of DN are closely correlated, doctors may utilize them as
markers to assess the disease's severity and development, particularly in cases when renal tubules are injured.
Keywords: Diabetic nephropathy, Complement Activation Products.


and Pathology Departments of Zagazig University
Pathologically, diabetic nephropathy (DN) is
Hospitals was performed on sixty-two diabetic patients
frequently marked by glomerular nodular sclerosis
who had diabetic nephropathy.
formation, expansion of glomerular mesangial matrix,
Ethical consent:
and glomerular basement membrane thickening, in the
The research ethics council at Zagazig
stages of advanced cases. It is typically characterized by
University approved the study (ZU-IRB#6644/5-1-
the presence of proteinuria or declining renal function,
2021). Every patient signed an informed written
such as a lower glomerular filtration rate (1). Multiple
consent for the acceptance of participation in the
factors contribute to DN's pathophysiology. Recent
study. The Helsinki Declaration of the World
research revealed that supplements may contribute to
Medical Association was followed when it came to
the development of DN. But it's not entirely apparent
ethical standards for human research.
what the implications are or what the underlying
mechanism is. Proteinuric kidney disorders, including
Inclusion Criteria:
DN, have been linked to increased CAP s levels in urine
Patients who had one of the study's inclusion
and tissue. Changes in CAPs, such as C5a, C3a, and
criteria were as follows:
C5b-9, were seen in individuals with various DN stages
Above 18 years.
and were linked to renal tubular injury (2).
Both sexes.
Because it triggers the release of TNF-alpha, IL-
Based on clinical and laboratory data,
6, IL-8, and CCL, C5a complement is the most powerful
individuals with diabetes mellitus (type II).
inflammatory mediator among the complement systems
Exclusion criteria:
C5aR and C5L2 are two distinct receptors that
Patients who met one of the following requirements will
interact to initiate C5a signaling. The bulk of C5a's
not participate in the trial:
functional effects is mediated by C5aR, which is
Patients with other diabetes mellitus types
expressed on cell membranes since C5L2 is mainly
including type 1 diabetes, gestational diabetes,
intracellular and may work as a C5aR negative
and young-onset diabetes with maturity,
modulator of signal transduction (4).
Patients suffering from any inflammatory or
The study aimed to investigate the role of urinary
infectious disorders.
and tissue complement activation products (C5a and C5
Patients with abnormal renal biopsy results or
a receptor) in diabetic nephropathy development.
concurrent additional renal disorders.
All patients were submitted to:
A cross-sectional study at the Nephrology Unit
(A) Clinical examination and history taking.
Received: 13/07/2022
Accepted: 16/09/2022

Full Paper (vol.892 paper# 138)

c:\work\Jor\vol892_139 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7019- 7024

Radiocephalic Arteriovenous Fistula as A Possible Efficient Hemodialysis
Access in Elderly Patients Above 60 Years
Hamdy AbdelAzeem AboElNeel*, AbdulRahman Mohamed Salem,
Mohamed Emam Fakhr, Karim Shalaby Mohamed Elawady
Department Vascular Surgery, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Hamdy AbdelAzeem AboElNeel, Mobile: (+20) 01111230823, E-Mail: dr_hamdy2009@hotmail.com


Background: Although there is debate about the best initial vascular access for elderly patients, Kidney Disease
Outcomes Quality Initiative guidelines do not take age into account when deciding the location of autogenous
arteriovenous hemodialysis access.
Objective: The purpose of this study was to study the outcome of the radiocephalic arteriovenous fistulae in elderly
patients, above 60 years of age, as regard primary failure, maturation and non-maturation.
Patients and Methods: A single-center prospective cohort study of elderly patients above age of 60 years who were
planned for permanent hemodialysis set for primary radiocephalic arteriovenous fistula after fulfilling the inclusion and
exclusion criteria during the period from March 1, 2021, to February 28, 2022.
Results: During the study period, 83 patients (42 males and 41 females) were included who presented with chronic renal
failure (CRF) and were planned for permanent vascular access for the first time. Functional maturation at 6 months was
achieved in 66 patients (81.48%). They were significantly younger than those without functional maturation, and the
diameter of their radial artery and cephalic veins was, 2.10 mm and 2.50 mm respectively. Also, patients with functional
maturity in relation to gender and comorbidities, were not significantly different from those without functional maturity.
In the patients, primary, assisted primary and secondary patencies at 6 months were 75.3%, 88.9% and 92.6%
Conclusions: Age has a substantial impact on the functional maturation of radiocephalic fistula in elderly patients,
according to this study. This impact should be taken into account when arranging a vascular access in incident elderly
patients if they are supported by additional prospective research.
Keywords: Radiocephalic arteriovenous fistula, Possible efficient hemodialysis, Elderly patients, Arteriovenous.


The autogenous arteriovenous fistula (AVF)
be the best economical option for all patient groupings,
has been indicated as the ideal vascular access for
notwithstanding recent challenges to this popular
chronic hemodialysis patients by current treatment
technique. On the other hand, the challenging elder
guidelines (1). According to recent guidelines,
population with a higher late referral rate makes it
radiocephalic arteriovenous fistula (RCAVF) is
impossible to always implement the "all autogenous"
specifically advised as the first in the order of choice for
approach (11).
patients who begin hemodialysis (2).
There aren't many statistics about access
outcomes in elderly patients, and those that exist have
The RCAVF at the wrist is typically the initial
mixed findings despite the fact that more than half of all
option for vascular access; however, a recent meta-
patients commencing hemodialysis are over 60 years
analysis has found a high primary failure rate and
moderate patency rates at 1 year. Despite having a high
In a recent report, 12% of elderly patients
primary failure rate due to early thrombosis or inability
achieved RCAVF adequacy, which was defined as the
to mature, RCAVFs have excellent long-term patency
ability to use the fistula for hemodialysis with two
and a low complication rate after they are established .
needles and a flow of 350 mL/min on at least 6 sessions
Compared to catheters and arteriovenous grafts (AVG),
per month (13). This was despite the optimal results of
which have higher rates of morbidity and death, it has
access salvage of RCAVF using percutaneous
greater patency rates, fewer problems, and reduced
transluminal angioplasty (14). A distal AV fistula is more
health care expenditures (4-8).
likely to fail due to inadequate vasculature in elderly
For natural autologous arteriovenous (AV)
patients due to their severe comorbidities, such as
fistulas, the annual failure and thrombotic event rate is
uremic or ischemic cardiomyopathy, peripheral
0.2 per patient, compared to 0.8 per patient for synthetic
vascular disease, and diabetes mellitus (15). Growing
AV grafts (9).
older is a big element that negatively affects their result

On the other hand, 19% of patients have AVFs
for these reasons (16).
that have not fully matured, which is characterised as an
In spite these factors, neither the American nor
inability to achieve a sufficient flow for optimal
the European guidelines for older people with end-stage
hemodialysis after a 6-week maturation period (10).
renal disease contain any particular recommendations

The "fistula first at all costs" method may not
. If these recommendations are followed, choosing
Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 139)

c:\work\Jor\vol892_140 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7025- 7030
Human Adenoviruses 40/41 and Cytokines Response in Children with Diarrhoea
Layla Maki AL-Nasrawy1*, Sahar Mohammed Jawad2, Waleed Dakil AL-Nasrawy3
1 The General Directorate of Education Al-Najaf, Almutafawiqat Students School,iraq
2 Department of Physiology and Pharmacology, College of Nursing, Altoosi University College, Najaf, Iraq
3 Department of Biology, Faculty of Sciences, University of Kufa, Iraq
*Corresponding author: Layla Maki AL-Nasrawy, Mobile: 009647802424957, E-mail: alnasrawylaila@gmail.com

: One of the most significant etiologic factors in acute gastroenteritis in children is adenovirus types 40/41.
Objective: The aim of this research was to diagnosis of adenovirus type 40/41 in children with diarrhoea in three Cities
in Iraq; Babylon, AL-Najaf and Karbala, and evaluation of serum concentration of Interferon gamma (IFN-),
Interleukin (IL) 6 and 10. Patients and methods: A total of 450 stool samples were collected from children with
diarrhoea, age range from 1 to 36 month. Adenovirus 40/41 has been detected in stool using Polymerase Chain Reaction
(PCR) method. Serum concentration of IFN-, IL-6 and 10 have been measurement using Enzyme-linked
Immunosorbent Assay (ELISA) technique.
Results: Out of 450 stool samples, there were 150 Children (33.3%) infected with adenovirus 40/41, the highest rate of
infection was in the Karbala City with 73 infections (16.2%) followed by Najaf and Babylon were recorded 55 (12.2%)
and 22 (4.8%) respectively. Cytokines profile revealed a significantly substantial rise in viral patients compared to
controls. IFN-, IL-6 and IL-10 levels in the age range of 1 to 36 months were higher than those in the control group at
69.5, 61.3 and 112.3 pg/ml respectively.
Conclusions: There were high infections with adenovirus type 40/41 in Karbala City. Interferon-, IL-6 and IL-10 play
an important role in infection which can be used in immunotherapy.
Keywords: Adenovirus, 40/41, PCR, IFN-, IL-6, IL-10, case control study, University of Kufa.

(CTLs) (8). Children and infants who live in areas with
Adenovirus types 40 and 41, which cause 3.2 to
poor healthcare access are particularly vulnerable to
12.5% of all cases of acute diarrheal illnesses in children
diarrheal disease and the growth faltering, impaired
and infants worldwide and have a higher detection rate
neurocognitive development, and increased mortality
in underdeveloped nations, have been linked to acute
are linked to repeated episodes of moderate-to-severe
diarrheal diseases (1). Children under the age of two are
diarrhoea and high rates of enteric pathogen infection
most commonly affected by adenovirus types 40 and 41,
lead to defect in immune system due to increase
which specifically infect the enterocytes of the small
cytokines production (9,10).
intestine and produce chronic watery diarrhea that, if
Therefore, the aim of this research was to diagnosis
ignored, can result in serious dehydration (2). In cell
of adenovirus type 40/41 in children with diarrhoea in
culture, these viruses do not or do not grow well. By
three Cities in Iraq; Babylon, AL-Najaf and Karbala,
virtue of their pathogen-associated molecular patterns
and evaluation of serum concentration of Interferon-
(PAMPs), such as capsid or DNA, adenovirus is well
(IFN-), Interleukin (IL) 6 and IL-10.
known to activate innate immunity, which results in the

generation of IFN- and other cytokines such as IL-6
and IL-10 (3).
This case control study was performed in 3
A cytokine with a variety of functions, IL-6 has
cities; Babylon, AL-Najaf and Karbala during period
been demonstrated to be essential for the
from 1st March 2021 to the end of August 2021. A total
immunological and host defense systems. In addition,
of 450 stool samples were collected from children with
endogenous IL-6 has been demonstrated to work in
diarrhoea age range 1 to 36 month attending to the Al-
concert with other cytokines and growth factors to
Jerahi Hospital (Babylon City), Al-Furat Al-Awsat
prevent programmed cell death brought on by cytotoxic
Hospital (AL-Najaf City) and AL-Zahra teaching
drugs in viral infections (4,5).
Hospital (Karbala City). In contrast, 60 healthy children
One of the most powerful and promising
age range 1 to 36 month have been considered as control
anticancer cytokines is IL-10. It is a heterodimeric
group (11,12).
cytokine that is mostly generated by activated
D i a g n o s i s o f a d e n o v i r u s :
macrophages and dendritic cells and is made up of two
Five gram of stool has been collected from each
distinct disulfide-linked subunits known as p35 and p40.
children suffering from diarrhoea in disposable
The production of interferon by natural killer cells, T
containers (13,14). Monoplex PCR was done to detect
cells, dendritic cells, and macrophages is stimulated by
number of genes that encode for adenovirus type 40/41
IL-12 (6,7). In the same way, it promotes T helper type 1
to detect Penton base and Fiber genes (15,16) using
development and increases the cytolysis activity of
primers provided from (Bioneer Company /Korea)
Natural killer (NK) cells and cytotoxic T lymphocytes

Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 140)

c:\work\Jor\vol892_141 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7031- 7036

Methylglyoxal in Correlation with Persistent Pulmonary Hypertension of Neonates
Eman R. Youness 1, Mones M. Abu Shady 2, Hisham W. Bader 2, Mohamed EL-Sonbaty2,
Shaimaa A Hashem 2, WalaaAlsharanyAbuelhamd,3Hanan Hanna4 *
1 Medical Biochemistry Department and 2Child Health Department, Medical Research and Clinical Studies Institute,
National Research Centre, Cairo, Egypt, 3 Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt,
4Chemical Pathology, Faculty of Medicine, Delta University for Science and Technology, Gamassa, Egypt.
*Corresponding Author: Hanan H Hanna, Email: hananagm@hotmail.com
Mobile: 01014510667, ORCID NO.:0000-0003-4796-8919


Background: Methylglyoxal has been documented to increase in circulation and at tissue level not only in diabetes but also
in hypertension.
Objective: Our objective was to report the association between methylglyoxal (MG) levels in the blood and newborn
persistent pulmonary hypertension.
Subjects and Methodology: Forty near-term and term neonates with evidence of persistent pulmonary hypertension
(PPHN); were further alienated into two groups, Group (1):20 cases with PPHN with hypoxia and Group (2):20 cases with
PPHN without hypoxia,40 healthy cross-matched controls with normal hearts were included in the study. Echocardiography
was done to establish the diagnosis of PPHN, APGAR score, and methylglyoxal (MG) levels, random blood sugar,complete
blood picture, serum creatinine, blood urea and oxygenation index were measured.
Results: A highly significant increase in the mean levels of MG was found in cases (whether with or without hypoxia)
compared to controls (31.15± 19, 18.6 ± 10.01 ng/uL versus 12.8 ± 6.2respectively).
Conclusion: Methylglyoxal initiates pulmonary hypertension either by suppressing the production of nitric oxide
(vasodilator) or by releasing vasoconstrictors. Furthermore, there was strong evidence that systolic blood pressure,
hemoglobin, blood sugar, and pulmonary hypertension were the main predictors of MG
Keywords: Methylglyoxal, Pulmonary hypertension, Neonates, Hypoxia.


Methylglyoxal (MG) is a reactive carbonyl species. It
across the patent foramen ovale and the patent ductus
is generated endogenously during glycolysis in the cell.
arteriosus, causing hypoxemia8.
Furthermore, endogenous exposure to MG occurs as a
At the cellular level, it is characterized by noticeable
result of glycated protein catabolism(1). MG is produced
endothelial dysfunction with a constrictor excess over
exogenously during the Maillard reaction, sugar
vasodilator ingredients (9).
autoxidation, and liberation of lipids during processing
As a result of chronic exposure to hypoxia, pulmonary
and storage(2).
vessel wall thickening with augmented depositionn of
MG is augmented three-fold to five-fold in diabetic
connective tissue and neomuscularization occur, which is
patients due to leak out of cells (3) and circulating at a
termed pulmonary vascular remodeling. That remodeling
concentration as high as 8umol/L. At this level, MG
affects right ventricle (RV) after load, reduces left
significantly reinforces apoptosis caused by induction of
ventricle (LV) preload (owing to the diminished
DNA damage and oxidative stress4. Direct alteration of
pulmonary venous return), and compromises the function
heat shock protein 27 (HSP 27) at amino acid Arg-188
left and right ventricular in PPHN10.
permits HSP 27 to suppress cytochrome c-mediated

caspase activation and may allow MG to act as an anti-
The effects of dilated right heart pressure loading
apoptotic modulator5.
included left ventricle compression and a shift in the
Methylglyoxal has been documented to increase in
interventricular septum, both of which caused diminished
circulation and at tissue level not only in diabetes but also
LV filling and thus LV cardiac output (LVO). This could
in hypertension6.
lead to a reduction in blood pressure with PPHN,
Persistent pulmonary hypertension of newborns
demanding the use of vasoactive inotropes as adrenaline
(PPHN) is a comparatively usual state that occurs in 0.5
and dopamine11.
to 7 per 1000 live births causing mortality ranging from 4

to 33 %.7 It is characterized clinically by hypoxemic
Numerous studies have revealed the relationship
respiratory failure owing to privation of transition of the
between low cardiac output in the setting of PPHN with
pulmonary vasculature from a high-resistance fetal to a
mortality and morbidity (12,13).
low-resistance extra uterine circuit. High pulmonary

vascular resistance (PVR) results in right-to-left shunting

Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 141)

c:\work\Jor\vol892_142 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7037- 7042

Impact of Vitamin D Status on Pregnant Women and Their Neonates:
A Cross-Sectional Study
Zahraa Muhmmed Jameel Al-Sattam1, Razzaq Kaream abdullah2, Areej Kazim Shareef3
1 Obstetrics and Gynecology Department, Al Kindy College of Medicine, University of Baghdad, Iraq
2 Pediatrician, 3 Obstetrics and Gynecology Department, Al-Elwiya Maternity Teaching Hospital, Iraq
Corresponding author: Zahraa Muhmmed Jameel Al-Sattam,, Mobile: +9647819699079,
E-mail: Zahraamjameel@kmc.uobaghdad.edu.iq

Vitamin D deficiency or insufficiency is very prevalent, but it is most common in pregnant women and
infants, where it is related to a wide range of unfavorable consequences, for example, preeclampsia and premature birth.
This study aims to: (1) Evaluate the negative implications of low levels of vitamin D on neonates; (2) Analyze the prevalence
of Vitamin-D insufficiency/deficiency amongst mothers and their newborns, as well as the features associated with it.
Patients and methods: Between July 2 and October 31, 2021, researchers at Baghdad's "Al-Elwiya teaching hospital"
surveyed 100 pregnant Iraqi mothers and their neonates in a cross-sectional study. Age, delivery method, gender, weight,
adequate sun exposure, and time in utero were all determined for the mother. Enzyme-Linked Immunosorbent Assay is used
to assess Vitamin D in both mothers and infants (ELISA).
Results: Among a sample of 100 mothers and their children, researchers discovered that 95% of moms and 86% of newborns
had insufficient or deficient Vitamin D. Vitamin D of parents and newborns was found to be different. Infant Vitamin D is
favorably associated with maternal Vitamin-D status. Birth weight is strongly associated with maternal Vitamin D. Vitamin
D in women was (5.1-19.1) ng/ml whereas in neonates was (9.28-31.22) ng/ml, on average.
Conclusions: Vitamin D deficiency or insufficiency is widespread, particularly among mothers, but it is also present in a
considerable percentage of babies. There is a link between the mother's Vitamin D level and that of their babies.
Keywords: ELISA, pregnant, Vitamin-D, cross-sectional study.


vitamin D insufficiency (5, 6). Even under ideal
Pregnancy-related vitamin D insufficiency is a
circumstances, the amount of Vitamin D gained from
global health concern. Miscarriages, hypertension,
dietary sources is less than 10% of what is required by the
intrauterine growth restriction, a greater risk for
body. In the summer, a person with lighter skin may
gestational diabetes, premature delivery, and Children
create between 10,000 and 20,000 IU of vitamin D3 in
with a low birth weight are among the negative pregnancy
only 10 to 15 minutes of sun exposure, whereas a person
consequences that have been linked to vitamin D
with darker skin may need as much as 10 times as much
insufficiency (1).
sun exposure to get the same result. Factors other than
Vitamin D is synthesized by the skin when it is
time spent outdoors affect how much ultraviolet radiation
exposed to sunlight; this accounts for the vast majority of
(UV) is absorbed by the skin for Vitamin-D synthesis (6).
vitamin D in the body. Deficiency of vitamin D is unusual
Increased rates of asthma, respiratory-distress-
in tropical places where the sun is overhead for most or
syndrome, food allergy, type-I diabetes, autism, and
all of the year, such as India, the Middle East, and Africa
schizophrenia have all been associated with vitamin D
(particularly Iraq). However, a significant frequency of
insufficiency in neonates (7-10). The vitamin D status of the
vitamin D insufficiency in pregnancy, ranging from 26-
mother has a major impact on the vitamin D status of the
95%, was documented in nations around the equator
developing fetus and baby. Maternal vitamin D
despite steady and ample sun exposure (2). Women have
insufficiency is the primary risk factor for neonatal
traditionally been considered to have a "high risk" for
vitamin D deficiency. The benefits of vitamin D
vitamin D insufficiency in sub-Saharan Africa, Asia, and
supplementation, as well as what constitutes adequate
the Middle East. All areas had a high incidence of
vitamin D consumption, are up for debate (11). Among
hypovitaminosis when its level is lesser than 30 ng/ml (75
pregnant women and their babies, vitamin-D deficiency
nmol/L), although South Asia and the Middle East had the
or insufficiency is common. The current study aimed to
highest incidence of values below 10 ng/ml (25 nmol/L)
determine how common is vitamin-D deficiency among
(3, 4). Vitamin D level is affected by several external and
pregnant women and what negative impacts this condition
internal factors, including but not limited to exposure to
has on babies.
sun, season, skin color, clothing type, latitude, diet, and

Vitamin-D supplementation. Poor sun exposure,
inadequate vitamin D dietary intake, obesity, and poor
We have conducted a cross-sectional research
socioeconomic situations are the most prevalent causes of
study with convenience sampling of 100 pregnant women
Received: 13/7/2022
Accepted: 16/9/2022

Full Paper (vol.892 paper# 142)

c:\work\Jor\vol892_143 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7043- 7049

Prevalence and Determinants Affecting Breast Feeding among
Mothers Attending Meet Mazah Outpatient Clinic
Nermeen A. Niazy, Aya Ahmed Fathy
Department of Public Health and Community Medicine, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Nermeen A. Niazy, Mobile: (+20) 01006514544, E-Mail: nermeenniazy@yahoo.com

Promotion of exclusive breastfeeding (EBF) has been considered as an efficient strategy for reduction of
infant morbimortality for the first 6 months of the infant's life. Several factors have been considered as determinants of
breastfeeding (BF) among a rural community.
Objective: To determine the prevalence of BF in the studied group, assess maternal factors affecting breastfeeding and
find out determinants of BF among a rural community in the village of Meet Mazah, Dakahlya, Egypt.
Patients and Methods: This study was carried out on a total of 200 breast-feeder mothers to determine the prevalence
of breastfeeding in the studied group, assess maternal factors affecting BF and find out determinants of BF among a
rural community in the village of Meet Mazah, Dakahlya, Egypt.
Results: The prevalence of breastfeeding was 71%. BF was significantly higher among younger age, lower
educational level and lower income mothers. BF mothers were significantly more knowledgeable about the
importance of breastfeeding compared to non-BF. BF women were associated with a higher attitude of breastfeeding
compared to non-BF ones
Conclusion: Despite mothers' knowledge and attitudes towards EBF were favorable, practice of EBF was not optimal.
The current study adds further evidence that knowledge of EBF, mother's age, maternal income and maternal level of
education are essential determinants in the context of EBF practice.
Keywords: Prevalence, Breastfeeding, Determinants, Maternal factors.

perpetuating health and socioeconomic inequalities
Breastfeeding (BF) has been considered as an
across generations. For instance, stunting among
essential component of a newborn's life. BF or lactation
women of reproductive age has been accompanied by
offers total nutritional and emotional dependency of the
an increase in the possibility of poor perinatal outcomes
baby on the mother. The powerful emotional bonding
in their children, and lower intelligence is known to
between the mother-child dyad is required for
impact school and labor market performance, which
effectively prolong BF. Breast milk is suggested as the
affects the individual's socioeconomic condition and
optimal and exclusive source of early nutrition for
that of his/her offspring (8, 10).
whole infants from birth to at least 6 months of age.
As a result, a health promotion program for EBF
Maternal milk is essential for development (1, 2).
throughout antenatal health visits, in association with
In spite of the marvelous efforts to raise BF
initiating health policies in maternal hospitals favor BF
globally, the frequencies remain not optimal in a lot of
initiation during the first hour of birth and the
nations, comprising Egypt (3). In terms of infants below
introduction of skin-to-skin contact during the first five
the age of two months, 79% were recorded to have
min of birth are highly suggested (11).
received only breast milk. On the other hand, the ratio
The aim of the present study was to determine the
of EBF markedly reduced among older infants by the
prevalence of BF in the studied group, assess maternal
age 4-5 months. About seven out of ten babies are
factors affecting breastfeeding and find out
receiving some form of supplementation, with
determinants of BF among a rural community in the
somewhat more than three in ten given complementary
village of Meet Mazah, Dakahlya, Egypt.
foods (4).

Suboptimum BF practices have adverse events
especially in low-and middle-income countries. They
The present study is a cross-section, (case-nested)
have been accompanied by an increase in the possibility
study conducted in a rural district, outpatient clinics of
of neonatal and under-five mortality, representing more
Meet Mazah, Dakahlya Governorate, Egypt during the
than 0.8 million deaths among children in lower middle-
period from start of January till end of October 2019.
income countries (LMICs) every year (5, 6).
This center was chosen because it typically represents
In addition, they have been associated with
the Egyptian rural life, available to the researchers and
minimal intelligence and poor health outcomes later in
near from their residence.

morbimortality, diabetes mellitus and stunting, leading
Inclusion criteria: A mother at the reproductive age,
to economic costs of about 302 billion US dollars
raring a child aging 2 years or less, and accept to
annually worldwide (7-9).
participate in the study.
Such adverse events of suboptimum BF might

persist and have main roles in the context of
Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 143)

c:\work\Jor\vol892_144 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7050- 7055

Lack of Association of FOXP3 Gene with Risk of Asthma in Children:
A Case-Control Study
Khalid Mohamed Salah1, Samar Almohamadi Abdel Wahed1*,
Ahmad Mohammed Baraka2, Dina Tawfeek Sarhan1
Departments 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Samar Almohamadi Abdel Wahed, Mobile: 01063644016, E-Mail: Samaromar922@gmail.com

Loss of Treg cell suppressive activity due to FOXP3 gene disruption is the leading hypothesis for the
development of allergy disorders. Thus, asthma susceptibility appears to be determined by host genetic variables
affecting FOXP3. A number of research have looked at the role of polymorphisms in the FOXP3 gene in relation to
allergy susceptibility.
Objective: We aimed at studying the association between FOXP3 gene single nucleotide polymorphism (SNP) and
bronchial asthma, asthma severity as well as atopy in Egyptian children.
Patients and Methods: The study comprised 101 children with asthma and a control group of 101 children without
asthma. Subgroup analyses revealed that there were 44 "atopic" a nd 57 "non-atopic" asthmatics in the total asthmatic
group. Polymerase chain reaction sequence specific primers (PCR-SSP) were used to investigate the FOXP3 genotypes
(rs3761548, rs2232365).
Results: There was no significant difference in the genotypes tested between the asthmatic group and the control group.
The AC of rs3761548 and the GG (rs2232365) polymorphisms were the most frequent genotype among the studied
children. And only C allele of (rs3761548) was more frequent among asthmatic cases compared to control group.
Moreover, no statistically significant difference was found among atopic asthmatic children as regards FOXP3
genotypes (rs3761548, rs2232365) and degree of asthma severity.
Conclusions: No link between FOXP3 gene polymorphism (rs3761548 and rs2232365) and asthma susceptibility was
found in Egyptian children with asthma. The severity of atopic asthma in children was not shown to be correlated with
FOXP3 polymorphism in the present study.
Asthma, FOXP3, Polymorphism, Atopy.


alterations in FOXP3 expression and stability [7].
Atopy and non-atopy are the two basic categories
Although FOXP3 gene polymorphisms have been
used to classify asthma phenotypes [1]. Multiple
connected to a number of allergy diseases, their role in
immunological processes (endotypes) determine the
the onset of allergic asthma remains unclear [8].
variety of clinical manifestations associated with this
The purpose of this research was to examine the
disease (phenotypes). It is essential to understand
connection between two significant SNPs in the FOXP3
endotypic processes in order to more accurately
gene and the development of asthma.
categorise individuals and develop more effective,

individualized therapy strategies [2].
Therefore, phenotypes are the observable traits of
The research was conducted in the Clinical Pathology
an organism that emerge from the interplay between its
Department and the Pulmonology Unit of the Children's
genotype and its environment [3]. Tolerance against
Hospital Faculty of Medicine, Zagazig University. The
allergens is maintained or acquired by the help of CD4+
study was conducted through the period from October
CD25+ regulatory T cells (Treg). Therefore, a lack of
2019 to March 2020.
Tregs or impaired Treg function may play a role in the

onset and maintenance of atopic eczema and asthma.
Type of the study: Our study was designed as a case-
Further evidence that FOXP3 may have a role in atopic
control study.
illness comes from the association between the Xp11.23

FOXP3 chromosomal locus and asthma and atopy [4].
Subjects: Subjects included in the study were 2 groups:
Variations in a single nucleotide's base pair the
The asthmatic group included 101 children aged 5 to 15
vast majority of phenotypic diversity among humans
years (mean age 7.30 ± 2.02 years) diagnosed as
may be traced back to single-nucleotide polymorphisms
bronchial asthma according to The Global Initiative For
(SNPs). Further, it has been hypothesized that genetic
Asthma (GINA) guidelines, 2019 [9]. They were 50
variants in the FOXP3 gene are linked to T cell
males and 51 females. Asthmatic group was subdivided
dysfunction [5, 6]. By generating the necessary cell
into 2 subgroups according to the presence and evidence
programme, FOXP3 can promote Treg cell growth and
of atopy into 44 atopic and 57 non-atopic. The control
function. Several studies showed that Treg cells could
group included 101 children, 52 males and 49 females
lose their phenotypic features and be transformed into
with a mean age of 7.71 ± 2.31 years, who had no
effector T cells during inflammation due to the
evidence of bronchial asthma, allergy or atopy and also
Received: 09/07/2022
Accepted: 14/09/2022

Full Paper (vol.892 paper# 144)

c:\work\Jor\vol892_145 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7056- 7060

Immunological Indicators in Aborted Women Infected with Human
Cytomegalovirus in Karbala City, Iraq
Noor H. Alkharsan*, Alaa A. Aljanabi, Zahraa M. Alshammari
Department of Medical Laboratory Technologies, AlSafwa University Collage, Karbala, Iraq
*Corresponding author: Noor H. Alkharsan, Mobile: (+964) 771 903 4809, Email: noorh.alkharsain@alsafwa.edu.iq

In affluent countries, human cytomegalovirus (CMV) is the most common cause of congenital malformations
caused by viral intrauterine infection. HCMV infection is the infectious cause of deafness, visual loss, mental retardation,
and other neurodevelopmental disorders in children, causing significant morbidity and mortality in infants.
Objective: The work was conducted to identify the rates of spontaneous abortion occurrence among the age groups, stages
of pregnancy, and detection of the type of abortion that most frequently occurred in the pregnant women community.
Patients and Methods: 65 Blood samples were collected from abortifacients women at the moment of miscarriage. Each
pregnant woman had five milliliters of blood collected to separate the sera. The CMV-IgM and CMV-IgG antibody levels
in the patient's serum were determined using an ELISA assay.
Results: The outcome of antibodies against CMV were found in 50 of 65 (76.92%) aborted mothers, while 15 (23.07%) of
65 women had abortions for unknown reasons. Meanwhile, most pregnant women who had abortions tested positive for
CMV-IgG, with 36 (72%) of them being positive, the number of people who tested positive for CMV-IgM was 14 (28%).
The age group 25­34 years old was the most infected with CMV infection, accounting for 25 (50%) of the cases. 96% and
4% of patients were infected in urban and the countryside regions, respectively.
Conclusion: Based on this research, spontaneous abortion rates are increasing within young age groups, particularly for
missed abortions during the first trimester of pregnancy.
Keywords: Human Cytomegalovirus, CMV, Congenital infection, HCMV

parity, gynecologic and medical history of abortion, and
The prototypical member of the Betaherpesvirinae
domicile were all covered in a structured interview
subfamily Herpesviridae is Cytomegalovirus (CMV) (1).
utilizing a standard mother questionnaire. The research
In most parts of the world, CMV is endemic. The
participants had a clinical examination and laboratory
seroprevalence of HCMV varies by geographic region,
tests to rule out other reasons for fetal loss, such as
ranging from 30 to 100 percent(2).
hypertension, diabetes mellitus, syphilis, Rh (rhesus)
This virus is transmitted by sexual intercourse, organ
incompatibility, and physical causes of abortion.
transplantation, or blood transfusion in the perinatal

period and infancy, as well as in adults (3). HCMV, like
2. Immunological Assays:
other herpesviruses, causes a long-term infection, and its
Immunological Assays: The ELISA method was used to
reservoir is primarily monocytes and polymorphonuclear
detect CMV-IgM and CMV-IgG utilizing kits. Sigma
leukocytes, from which the virus is shed many years later
Diagnostics USA provided the kits, and the methods
(present in the throat and urine). The appearance of so-
were done according to the manufacturer's instructions.
called "Owl-eyes" is caused by the presence of distinctive

intracellular inclusions surrounded by a halo of poor
Principle of the assay
reflection. The virus infects the salivary gland, the breast
The surface of tiny wells is covered with purified
epithelium, the prostate, the endometrium, the kidney
CMV antigen. The wells are filled with diluted patient
tubules, and other organs such as the bone marrow and the
serum, and the Cytomegalovirus IgG specific-antibody, if
present, attaches to the antigen. Everything that isn't
Milk, sperm, cervical secretions, blood products,
bound is washed away. The HRP-conjugate is introduced
and urine can all be used to isolate it. HCMV infection
to the Ab-Ag complex and binds to it. The remaining
can be latent (non-productive), lytic (productive),
HRP-conjugate is rinsed away, and a TMB reagent
asymptomatic (non-symptomatic), or symptomatic (4).
solution was then added.

The catalytic process of the enzyme conjugate is
halted at a particular time. The quantity of CMV IgG-
1. Patients:
specific antibodies in the sample determines the intensity
The research included 50 pregnant women who had
of the color generated. The findings are read using a small
an abortion and were between the ages of 15 and 45. Age,
well reader in tandem with calibrators and controls.

Received: 2/7/2022
Accepted: 8/9/2022

Full Paper (vol.892 paper# 145)

c:\work\Jor\vol892_146 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7061- 7070

Epidemiology of Colorectal Cancer, Incidence, Survival, and Risk Factors: Cairo
University Center of Oncology and Nuclear Medicine Experience
Ashraf Mounir, Mohamed Abdulla Hassan, Mahmoud Ahmed Selim, Inas Abdou Mahmoud*
Department of Clinical Oncology, Kasr El Ainy University Hospital, Cairo University, Cairo, Egypt
*Corresponding Author: Inas Abdou, Mobile: 00201224407766, Email: inasabdou_onco@hotmail.com

Colorectal cancers are amongst the most common cancers to occur. They are 3rd most prevalent and
mortality causing cancers. Colorectal cancers incidence has been rising in developing countries.
Objective: This study aimed to analyze deeply survival rates in correlation with different epidemiological and
pathological factors as well as investigation of patterns of disease failure and relapse.
Subjects and Methods: This was a retrospective study of 141 patients of all stages of colorectal cancers being treated
at Cairo University Cancer Center (NEMROCK), through the period from 2014 to 2020. Data were followed up until
June 2021. Assessments were made according to individual clinicopathological, and clinico-epidemiological specific
Results: Histopathological evaluation revealed that T3 disease was commonest presenting pathology in 40, while nodal
stage N1 was commonest in 17%. The most common disease stage at diagnosis was stage 3 in 43% of patients, while
17% were metastatic at time of diagnosis. Initial pathological staging was the most significant factor to affect DFS with
patients from stage 1 had significant longer disease free survival (DFS) 45 months VS stage 2 26 months Vs 3 months
for stage 4 p value 0.009. Overall survival was also significantly correlated with pathological stage with difference in
median OS 60 months VS 10 months between stage 1 and stage 4, respectively p value 0.002 HR 3.3.
Conclusion: Pathological staging was the most significant factor affecting survival, while patients with locally advanced
rectal cancers were potentially curable and had extended survival rates after receiving full multimodality treatments.
Cancer rectum, Clinicopathological, Clinicoepidemiological, Neoadjuvant ccrth, Total neoadjuvant
treatment, Lower anterior resection, Disease free survival, Overall survival.

high risk: 1. First-degree relatives of patients with
CRC is the fourth most common diagnosed
common colorectal cancer or with a large adenoma (>1
cancer and third most common cause of death (1).
cm) have an increased risk of colorectal cancer when
Although Egypt does not have high rates of incidence
occurred before 60 years, or two first-degree relatives
like in developed world (2), there are increasing trends
of patients with common colorectal cancer or with a
of developing CRC at younger age in Egypt and other
large adenoma (>1 cm) have an increased risk of
parts of the world, partly due to westernized lifestyle (3).
colorectal cancer irrespective of age. 2. History of
It is still constitute an important cause of mortality
colorectal cancer or large adenoma. 3. Personal history
especially rectal cancers being mostly advanced at
of chronic gastrointestinal inflammatory bowel disease
presentation (4). CRC caused nearly 881,000 deaths in
(ulcerative colitis and Crohn's disease). Individuals
2018, where cancer of the colon being the fifth most
with very high risk: familial adenomatosis polyposis
deadly cancer accounting for 5.8% of all cancer deaths,
and hereditary nonpolyposis colorectal cancer (Lynch
and cancer rectum being tenth with 3.2% of all cancer
deaths (5).
Environmental risk factors include excessive
CRC affect various races and ethnicities at
alcohol intake, smoking, and excess body weight. A
different age groups differently. The proportion of CRC
sedentary behavior has been also associated with an
amongst patients younger than 50 years old is almost
increased risk of colorectal cancer (9,10). Other
double for blacks (16%) than for whites ( 9%), and
modifiable risk factors that have been convincingly
Hispanics (6%)(6). CRC ranked seventh after lung,
associated with higher colorectal cancer risk are the
breast, prostate, liver, and bladder in Egypt with
consumption of red and processed meat (11).
approximately 5,000 patients in 2015 with almost

3.24% of all cancer cases. It has average incidence ASR
of 6/100,000 in males, and 4.9/100,000 in females(2).
This is a retrospective cohort study of all
Three risk's levels are identified for colorectal
colorectal cancer patients treated at Cairo University
cancer according to personal or familial history:
Center of Oncology and Nuclear Medicine. They
Individuals with middle risk: men and women aged 50
presented with stages 1-4 who received their
and more. More than 90%of colorectal cancer cases are
multimodality treatment starting from January 2014 and
diagnosed after this age (7).
kept under thorough follow up until June 2021.
The median age diagnosis for colon cancer, 69 in
A Total of 340 records were registered of
men and 73 in women, is older than that of rectal cancer,
which total of 141 patients were studied according to
which is 63 in men and 65 in women (8). Individuals with
eligibility criteria. This retrospective analysis was
Received: 13/7/2022
Accepted: 16/9/2022

Full Paper (vol.892 paper# 146)

c:\work\Jor\vol892_147 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7071- 7081

Perception of Female Health Care Providers Regarding Breast Cancer at
El Minia Oncology Center
Amany Mohamed Saad, Marwa Ahmed Hussein*, Aliaa Mohammed Osthman El- Afandey
Department of Community Health Nursing, Faculty of Nursing, Helwan University, Egypt
*Corresponding author: Marwa Ahmed Hussein, Mobile: (+20) 01143002815, E-Mail: marwaelhady500@gmail .com


Background: Breast cancer is the most common occurring cancer in women worldwide. To guide current breast cancer
screening program, the level of knowledge about breast cancer should be evaluated .A high level of knowledge and
practice among female health care providers regarding risk factors for breast cancer and screening methods are important
in increasing awareness in the general population.
Objective: This study aims to assess perception of female health care providers regarding breast cancer at El-Minia
oncology center.: Design: Descriptive research design was used for conducting the study. Sample: A convenience sample
was used to choose 148 female health care providers. Setting: The study was carried out at oncology center at Minia city,
Egypt. Tools: It consisted of 4 parts: part I: Concerning with demographic characteristics of female health care providers.
Part II: female health care providers' knowledge questionnaire. Part III: female health care providers attitude toward
breast cancer. Tool VI: female health care providers' reported practice regarding breast self-examination.
Results: The study result revealed that, 89.9% of female health care providers have satisfactory levels of total knowledge
regarding breast cancer. 98.6% of female health care providers have positive attitude toward breast cancer and 97.3% of
female health care providers have adequate level of reported practice.
Conclusion: there's highly statistically significant between female health care providers' total perceived breast cancer
include total knowledge, total practice and attitude toward breast cancer. Recommendations: continuous education
program to improve knowledge and practice of female health care providers through carrying out continuing educational
programs about how to prevent breast cancer with other organizations and institutions.
: Female, Health care providers, Breast cancer, Perception of knowledge.


rates as high as 32.4% in Egypt, 32% in Jordan, 36% in
As the most frequent tumor of the breast, breast
Kuwait, and 25% in Saudi Arabia (3).
cancer can affect either sex. Cancer of the breast, the
Female health care workers are one that consists
most prevalent cause of death in women, develops from
of professionals with different skills, information and
cells within the breast that have grown improperly and
experiences, additionally known as breast care team as
multiplied to form a lump or tumor. Women over the age
(medical doctor, nurse, breast surgeon, social worker).
of fifty, many of whom have already gone through
The perception of female health care providers about
menopause, have the highest risk for developing breast
breast cancer prevention is essential importance that
cancer. Men can get breast cancer too, but it's extremely
assist in explaining how such beliefs interfere with breast
rare and accounts for only a small fraction of all breast
cancer treatment, however, there are a large number of
cancer diagnoses. Women, of any age after puberty, are
women health care providers didn't know about breast
at risk for developing breast cancer, while the incidence
cancer. Female health care providers can accurate look
rate rises with age (1).
at her breasts by using breast self- examination (BSE)
It is projected that by 2020, the global incidence
which is useful tool for detect any abnormality especially
of breast cancer will be highest in industrialized nations,
tender or swollen within side the breasts and must be
thanks to screening and earlier identification, and lowest
evaluate technique periodically (4). Perception is a
in developing countries, with death highest due to
subjective assessment of knowledge that enables
limited diagnostic and treatment capacities. Worldwide,
individuals to make sense of their vulnerability and reach
2.3 million women are diagnosed with breast cancer each
decisions about fitness behavior. Sources of beliefs
year, leading to 685,000 deaths; in addition, 7.8 million
inaccuracy were related to a variety of elements which
women are now alive and have been diagnosed with
include misinformation or a lack of knowledge, personal
breast cancer during the past five years, making the
experiences and perception. Females usually misjudge
world the most prevalent region for breast cancer (2).
their breast cancer risk, in order that the perception may
By the year 2020, it is expected that 276,480
be vital motivator for female health care workers
new cases of invasive breast cancer in women would be
concerning breast cancer to adapt healthy behaviors to
identified in the United States, and that between 3-5
understand perceived threats of breast cancer and early
million people will have survived the disease. Pakistan
diagnosis to prevent any occurrence of disease (5).
has the highest breast cancer mortality rate in Asia, with
Community health nurses play an essential role
an estimated 40.000 women succumbing to the disease
in coordinating the care through collaborating with
each year. Breast cancer accounts for between 17.7 and
different team members and performing as central point
19% of all new cancer diagnoses in the Arab world, with
of contact among physician and client or her family .The
nurses have experience in the management, make
Received: 14/07/2022
Accepted: 17/09/2022

Full Paper (vol.892 paper# 147)

c:\work\Jor\vol892_148 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7082- 7090

Impact of Ablative Low Dose Radio-Active Iodine after Thyroidectomy in
Low­Risk Differentiated Thyroid Cancer
Lamiaa Ahmed Elsaeed Elrefai1*, Magda Elsayed Hassan Allam1,
Mohamed Saad El-deen El-zahi1, Fatma Mohamed Farouk Akl1
1 Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Lamiaa Ahmed Elsaeed Elrefai, Mobile: (+20) 1009682247, E-Mail: l.elrefai@icloud.com

Thyroid cancer (TC) is the most frequent endocrine cancer, comprising for 3-4% of all tumors.
Objective: The aim of the current study was to assess the efficacy, safety, and disease-free survival of low-dose RAI
(iodine-131) in patients with low-risk differentiated thyroid cancer (DTC) who had low-dose RAI for thyroid residual
ablation after full or near-total thyroidectomy.
Patients and methods: Between January 2013 and July 2019, 35 patients with low-risk well-differentiated thyroid
cancer were investigated by the Clinical Oncology and Nuclear Department at Mansoura University Hospitals.
The majority of our patients (94.3%) were females. A total of 34 (97.1%) patients had papillary thyroid cancer
and 1 (2.8 %) patient had follicular thyroid carcinoma. All patients were Stage I; 13 (37.1%) patients were T1, and 22
(62.9%) patients were T2 thyroid carcinoma. All patients had pathologically negative lymph nodes and 8 (22.8%)
patients had complete thyroidectomy with block neck dissection (BND), whereas the remaining 27 (77.1%) patients had
total thyroidectomy without BND.
Conclusion: Low-dose radioactive iodine ablation following surgery is an effective approach for treating low-risk DTC,
because it decreases the side effects while preserving a good quality of life.
Keywords: A
blative low dose radio-active iodine, Thyroidectomy, Papillary thyroid cancer, Follicular thyroid
carcinoma, Thyroid cancer, Case series, Mansoura University.


The most common endocrine malignancy,
accounting for 3-4% of all cancers, is thyroid carcinoma
We included in this retrospective analysis 35
(TC). The prevalence is increasing globally, primarily
patients with low-risk DTC who were treated between
due to the increased use of advanced diagnostic
January 2013 and July 2019 at the Clinical Oncology
methods that enable the finding of more papillary
and Nuclear Medicine Department, Mansura University
thyroid tumors (PTC) (1).
Hospitals. Data collected of medical records were
Differentiated thyroid carcinoma (DTC) is a
reviewed, and information was obtained using a
histologic subtype with papillary and follicular
standard form; identifying information, such as sex,
characteristics. They make up the majority of cases, are
age, location, marital status, and profession. Medical
typically given a great prognosis (90­95%), and have a
history included any coexisting diseases, risk factors,
good 5-year survival rate (2).
previous neck irradiation, drug history, and family
Low-risk thyroid cancer refers to cancers that
history. Thyroid enlargement, cervical lymph nodes
have a low chance of recurrence, causing morbidity and
(LN) enlargement, symptoms, and indications of distant
death. In the last 30 years, the prevalence of low-risk
metastases are all present. Histopathology, initial tumor
DTC has tripled in the United States, the frequency of
size, the number of metastatic lymph nodes, and the
tumors 2 cm has increased. Worldwide, a comparable
presence of capsular or vascular invasion are all
increase in occurrence has been seen (3). The post-
examples of pathological data. The following laboratory
operative thyroid residual in patients with low-risk DTC
results were obtained; serum TSH, T3, T4, alkaline
can be eradicated using radioactive iodine (RAI), which
phosphatase, SGOT, SGPT, serum bilirubin, blood
is highly concentrated in the thyroid follicular cells. The
urea, serum creatinine, uric acid, total blood count,
conventional treatment for people with DTC has been
either a whole or near-total thyroidectomy followed by
antithyroglobulin antibodies. Radiological tests include
radioactive iodine treatment (4).
a whole-body iodine scan and neck ultrasonography.
After a near-complete or total thyroidectomy,
Treatment details: Surgery (total or near-total
low-dosage RAI is an appropriate treatment for patients
thyroidectomy with or without block neck dissection).
with low-risk DTC. There is no discernible difference
All patients were given levothyroxine after their first
in the recurrence risk between these patients and those
RAI ablation dose in order to maintain TSH levels at or
who received high-dose RAI (5).
below the lower limit of the standard range. Radioiodine
This retrospective study aims to assess the
(I-131) ablation was performed in all patients (treatment
efficacy, safety, and disease-free survival of low-dose
doses, day of therapy). All patients had pre-ablation
radioactive iodine (RAI-131) therapy for patients with
TSH concentrations more than or equal to 30 mIU/L.
low-risk DTC who have undergone low-dose RAI
The American Thyroid Association (ATA)
following complete or near-total thyroidectomy.
criteria were used to analyze the outcomes. Effective
Received: 14/07/2022
Accepted: 17/09/2022

Full Paper (vol.892 paper# 148)

c:\work\Jor\vol892_149 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7091- 7097

Correlation of Some RBCs and Platelets Indices with Outcome of
Critically Ill Children Admitted to Pediatric Intensive Care Units
Aliaa Mohammed Diab*1, Reda Sanad Arafa1, Yasser Mahmoud Ismael2,
Rana Ashraf Elnoury1, Effat Hussein Assar1
Departments of 1Pediatric and 2Clinical and Chemical Pathology, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Aliaa Mohammed Elhady Diab, Mobile: (+20) 01008391980, E-Mail: aliaadiab@yahoo.com

Platelet and Red blood cell indices ratios serve as a simple and convenient stratification tool for illness
severity predictors in pediatric intensive care unit (PICU) mortality. The aim of the current study was toevaluate the
ability of red cell distribution width (RDW) and platelet indices and ratios to predict mortality.
Patients and methods: A prospective, observational study was conducted on 99 critically ill children of both sexes
admitted to PICU of Benha University Hospitals and Benha Children Hospital (BENCH). All children incorporated in
this study were subjected to careful history taking, clinical examination, complete blood count (CBC) and scoring by
the third-generation pediatric index of mortality (PIM-3).
Results: Our results showed that RDW, platelet counts and platelet indices ratios independently predicted PICU
mortality. RDW measured within 24 hours of PICU admission was independently associated with mortality (p=0.001).
Although RDW demonstrated high sensitivity (94.8 %) but low specificity (37.1%) as an independent predictor of
mortality, it corresponded fairly to sensitivity and specificity of PIM-3 score in the present study. This is an important
observation as a low-cost test of RDW performed nearly at par with more complex index of mortality. Regarding platelet
indices, our study found that the platelet ratios [Mean platelet volume (MPV)/ plateletcrit (PCT), MPV/ platelet count,
platelet differential width (PDW)/PCT, PDW/Platelet count] were better predictors of mortality than platelet indices by
themselves. All the ratios of platelet indices were statistically significant (p-value <0.05).
Conclusion: RDW, platelet count, and platelet indices ratios were independent predictors of PICU mortality. The
predictive power of these indices was comparable to the PIM-3 score.
Keywords: Red cell distribution width, Platelet indices, Pediatric index of mortality, Critical illness, Mortality, Pediatric
intensive care unit.


reactive protein (CRP) levels are closely connected,
The total care provided to children has
suggesting that RDW may reflect the degree of
improved as a result of technological improvements.
inflammation (7).
Despite these advancements, many sick children pass
The most significant and vital component of blood
away in PICU each year. Predicting the death of kids
are the platelets. The severity of the sickness is thought to
admitted to PICUs could lead to better future results (1).
be predicted by thrombocytopenia. Both the platelet count
The pediatric risk of mortality (PRISM) and pediatric
and morphology are altered in critically ill patients, and
index of mortality (PIM) are the primary ratings
this is reflected in alterations in the platelet indices.
designed for the pediatric population; the most recent
Automated blood analyzers frequently measure platelet
iterations of these scores are PRISM III and PIM-3.
indices. As they age, platelets get smaller, and a greater
Following a multivariate statistical study, these scores
mean platelet volume (MPV) suggests that there are more
were created by identifying variables related to
young platelets in circulation. Increased MPV indicates
mortality risk and ranking them (2). It is crucial to
that either platelet production or platelet breakdown is
remember that PIM employs 10 variables recorded at
increasing (8).
the time of ICU admission, whereas PRISM takes the
Platelet count (PC) and platelet volume are added
worst value of physiological variables gathered over the
together to form plateletocrit (PCT). When there is a
first 12 or 24 hours for deciding whether to adopt PIM
difference in the size of the cells in circulation, the platelet
or PRISM (3).
distribution width (PDW) increases, indicating that
Elevated RDW has reportedly been a reliable
mature and immature cells are present in circulation at the
indicator of death in persons with critical illnesses,
same time. Studies have shown that MPV and PDW rise
cardiovascular conditions, pneumonia, and sepsis (4).
in the early stages of sepsis whereas PC and PCT fall (9).
Similarly, recent restricted investigations discovered
We propose that, intuitively, as MPV and PDW
that in pediatric critical patients who weren't chosen, a
increase and platelet count and PCT decrease, the ratio of
high RDW number was linked to worse outcomes (5).
MPV to PCT, MPV to platelet count, PDW to PCT, PDW
However, the reporters in non-cardiovascular critical
to platelet count, and the ratio of the product of MPV and
disease have ignored the significant relevance of
PDW to the product of PCT and platelet count may be
prognosis. There aren't many researches looking at
useful in predicting mortality in sick children. Two recent
RDW as a crucial marker in the pre- and postoperative
researches looked into these ratios in children(1, 9).
period of pediatric congenital heart surgery to predict
mortality (6). Studies have shown that RDW and C
Received: 15/07/2022
Accepted: 18/09/2022

Full Paper (vol.892 paper# 149)

c:\work\Jor\vol892_150 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7098- 7102

Serum Level of Galactin-1 Association with Disease Activity of
Rheumatoid Arthritis Patients under Conventional Treatment
Samia M. Abdel Rahman1, Rasha N. Thabet2, Mohamed M. Metwely*1
Departments of 1Physical Medicine, Rheumatology and Rehabilitation and 2Internal Medicine and
Rheumatology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Mohamed Mostafa Metwely, Mobile: (+20) 01146163682,
Email: drmohamed.metwaly@med.asu.edu.com
The small joints of feet, hands and wrists are particularly vulnerable to impacts of Rheumatoid Arthritis
(RA), the most prevalent auto-inflammatory disorder. The pathogenesis of RA is still unknown which leads to the on-
going studies for further understands the pathogenesis and find new treatment targets. Galectin family includes Galectin-
1 (Gal-1). It could be found in a large number of tissues with pro-inflammatory as well as anti-inflammatory effects
relying on the cellular microenvironment. Objectives: The aim of the current study is to evaluate the relation between
the disease activity of active rheumatoid cases under conventional medical treatment, and the level of Gal-1 in serum.
Patient and methods:
A total of 50 healthy controls and 50 RA patients; at least 18 years old using conventional
medical treatment, were included in this case control study. Clinical evaluation, laboratory testing, serum Gal-1 levels,
and evaluation of disease activity, was performed to all participants. Results: At a cutoff of >15 (ng/ml), the serum Gal-
1 level in the RA group was significantly higher compared to the healthy control group. Serum Gal-1 was not
significantly correlated with the activity of RA. Conclusion: Our results demonstrated the usefulness of measuring the
serum levels of Galectin-1 in patients with RA with high validity. This proves the pro-inflammatory effect of Galectin-
1 in RA patients.
Keywords: Galectin-1, Rheumatoid arthritis, Disease activity, Conventional treatment.


decades has led to a more sophisticated approach to
Most cases of rheumatic autoimmunity are due
disease management (DMARDs). Methotrexate, the
to rheumatoid arthritis (RA). The exact cause of RA is
most often prescribed DMARD, has revolutionized the
still unknown, but it is may be a result of multiple
treatment of this disease by blocking enzymes necessary
variables, including genetics and environmental factors.
for the production of purines and pyrimidines. Many
This results in the continuous infiltration of the synovial
people feel better after using this medication (9).
membrane by different immune cells (1). Joint
However, a deeper understanding of the function of
degeneration resulted from cartilage and bone erosion is
each immune system component can lead to more
caused by the infiltrating inflammatory cells and
effective treatment plans, including when to administer
persistent production of proinflammatory cytokines
them and in what doses. In spite of the fact that there are
(such as, IL-6, IL-1as well as TNF-) (2).
those who advocate for aggressive treatment of arthritis
Carbohydrate recognition domains (CRDs) in
in order to reduce inflammation (10), It seems sense to
galectins allow them to bind -galactoside (3). Up to 15
not over-treat those who aren't at high risk for
mammalian galectins have been discovered and
developing a serious illness.
characterized so far; each one has 1 or 2 CRDs totaling
Aside from the effects of Gal-1 on T cells, very
roughly 130 amino acids. Galectins are involved in
little work has been conducted on the role of Gal-1 on
many different biological processes, including as
disease activity and its serum level usefulness in
immunological control, because to their broad
differentiating RA patients from normal healthy
dispersion and many binding partners (4). The protein
population. Therefore, the current study aimed to
galectin-1 (Gal-1) can self-assemble into homodimers.
evaluate the relation between the disease activity of
Extremely abundant in immune cells, its expression
active rheumatoid cases under conventional medical
changes with differentiation as well as cell activity (4).
treatment, and the level of Gal-1 in serum.
There is a correlation between Gal-1 pro-apoptotic

activity in activated lymphocytes and its anti-
inflammatory and immunosuppressive properties (5).
A total of 50 patients with RA (according to the 2010
It has an enhancing effect to shift Th1 responses
ACR/EULAR criteria) and 50 healthy controls took part
to the regulatory T cell (Treg) and Th17 responses away
in this study. After being apprised of the study's
from the Th1 cell (6), as well as preventing the
procedures, all participants voluntarily supplied written
production of inflammatory cytokines (like TNF-,
IFN- as well as IL-2) in vitro (7). The Gal-1 serum
Inclusion criteria: 1. Patients diagnosed as RA; by
levels of RA patients and healthy controls have been
American College of Rheumatology and European
reported to be similar in various research (8).
League Against Rheumatism (ACR/EULAR) in 2010,
Incorporating disease-modifying antirheumatic
2. Above 18 years old, and 3. Under conventional
medications into RA treatment over the past two
Received: 14/07/2022
Accepted: 17/09/2022

Full Paper (vol.892 paper# 150)

c:\work\Jor\vol892_151 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7103- 7111

Comparison between Serological and Molecular Diagnosis of Epstein Barr
Virus Infection among Egyptian Renal Transplant Recipients
Mary S. Karras1*, Noha El Mashad2, Ayman Refaie1, Mohamed Mofreh2, Hazem H. Salah1, Mayssa Elsayeed Zaki2
1 Urology and Nephrology Center and2 Microbiology Unit, Clinical Pathology Department,
Mansoura, Faculty of Medicine, Mansoura University, Egypt.
Corresponding author: Mary Samy Karras, Phone Number: 01224579990, ORCID: 0000-0002-7042-615,
Email: mary_samy_unc@mans.edu.eg
Background: Kidney transplantation is the best treatment for end-stage kidney diseases. Lifelong immunosuppression
preserves graft function. However, they usually lead to severe viral infections; as Epstein Barr Virus (EBV) which lead to
development Post Transplant Lymphoproliferative Disorders (PTLD). Objectives: The aim of this study is to compare
between serological and molecular assays as methods of detection of EBV infection. Presumed risk factors for development
of EBV infection and its impact on transplant outcome were studied. Patients and Methods: A total of 50 Egyptian kidney
transplant recipients received their renal allografts from living-related donors were studied. Recipients were tested for EBV
infection by serological markers; anti-EBV viral capsid antigen (VCA) IgM and molecular assay by detection BamHI region
by PCR. Different co-morbid risk factors for development of EBV infection (pre-transplant hemodialysis & blood
transfusion, diabetes mellitus, CMV, and HCV infection) were studied. Likewise, the impact of EBV infection on transplant
outcomes was evaluated. Results: Of the 50 patients, 66% were positive for VCA IgM and 42% were positive BamHI
region of EBV. BamHI positivity was significantly correlated with duration of transplantation, and severity of rejections
episodes. On the other hand, none of these risk factors were correlated with the positivity of VCA IgM. Among the studied
recipients, EBV infection detected by either serological or molecular assay has no impact on the transplant outcome.
Conclusions: Although serological diagnosis for EBV infection is a simple method for screening and follow-up. Yet,
molecular diagnosis seems to be more accurate diagnostic test.
Keywords: Epstein Barr Virus, Kidney transplantation, Serological Diagnosis, Molecular Diagnosis, Case series, Mansoura


at various stages of EBV life cycle, however,
Renal transplantation is the best treatment option
either for adults & children with chronic kidney disease
interpretation of this test as they inhibit recipients'
(1). Unfortunately, opportunistic infections such as EBV
immune response. Therefore, molecular diagnosis is
and cytomegalovirus (CMV) are major complications to
made to detect EBV DNA such as PCR (6). The
patients after transplantation, which have a negative
classification of the EBV genome was designed according
impact on transplant outcomes and increase the risk of
to a BamHI-restriction fragment map according to their
rejection. EBV infection occurs in more than third of
sizes (7). The current study aimed to compare serological
renal transplant recipients and accounts for high
and molecular assays as methods for detection of EBV
morbidity and mortality rate, it was established after 1-6
infection and studied the possible risk factors and impact
months post-transplantation, after receiving high doses of
on transplant outcome.
immunosuppression (2).

EBV is a viral DNA belongs to herpesvirus family.
It represented as a latent, asymptomatic infection in most
The study was conducted on 50 Egyptian kidney
cases (3). Most children in developing countries become
transplant recipients who received their renal allograft in
positive at the age of 5, while it delayed in developed
the period between 2010 and 2021. The selected
countries with high socioeconomic state. The main way
recipients were having their first renal transplantation.
of EBV spread is orally through the saliva. But it may be
Any recipients who had previously received a kidney
transmitted through many routes, such as blood
transplant, another organ transplant or had cancer were
transfusion, organ transplantation, sexual contact, and
excluded. They were subjected to pre- and post-
sharing infected personal objects (4).
transplantation evaluation as follows:
After organ transplantation, the rate of infection
I) Pretransplant evaluations: age, sex, previous
increased in children compared to adults as the recipient
is immunocompromised and exposed to seropositive
associated comorbidities as diabetes mellitus, the
donor leukocyte. The symptoms of infection include
degree of matching between recipient and donor,
fever, enlarged lymph nodes, and hepatosplenomegaly (5).
and history of CMV and HCV infections.
EBV serological diagnosis is common diagnostic test to
evaluate EBV infectious state by detecting antibodies in
transplantation, laboratory investigations include
Received: 15/07/2022
Accepted: 18/09/2022

Full Paper (vol.892 paper# 151)

c:\work\Jor\vol892_152 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7112- 7119

Effect of Adding Magnesium Sulphate as An Adjuvant to Bupivacaine in
Ultrasound Guided Transversus Abdominis Plane (TAP) Block for
Postoperative Analgesia After Inguinal Hernia Repair in Adults
Mohamed Mohamed Abo Elenain, Emad El-Din Abd El-Khalek El-Fadali*,
Osama Helal Ahmed, Mahmoud Farouk Mahmoud
Anesthesiology and Intensive care department, Faculty of medicine, Al-Azhar University (Assiut), Egypt
*Corresponding author: Mohamed Mohamed Abo Elenain, Email: aboelenainmohamed@gmail.com

One of the surgical techniques that is most frequently utilised in the globe, particularly in day-case
settings, is inguinal hernia repair.
Aim and objectives: The goal of the study was to ascertain how patient outcomes can be affected by postoperative
analgesia following adult inguinal hernia surgery with bupivacaine and magnesium sulphate in transversus abdominis
plane (TAP) block.
Subjects and methods:
Between March 2021 and January 2022, at Al-Azhar University Hospitals (Assiut). According
to Class I or II American Society of Anesthesiologists (ASA), and planning for a main unilateral open elective inguinal
hernia repair we recruited 60 adult male patients between the ages of 21 and 60 years old for the current study
Group II had significantly lower VASr and VASm than group I. Mean VASr at 4 and 8 hours postoperatively
were 3.43 and 3.87 respectively for group I and 2.33 and 3.37 respectively for group II. Mean VASm at 4 and 8 hours
postoperatively were 4.72 and 5 respectively for group I and 2.78 and 3.52 respectively for group I.
Conclusion: Pre-emptive magnesium sulphate added to plain bupivacaine during a transversus abdominis plain block
(TAPB) performed on patients under ultrasonographic guidance to treat an inguinal hernia lengthens the time until the
first opioid administration is necessary and lengthens the duration of the block.
Keywords: Magnesium sulphate, Adjuvant, Bupivacaine, Ultrasound guided, Transversus abdominis plane block, TAP,
Postoperative, analgesia, inguinal hernia repair.


anaesthetics. But its use is constrained by side effects
Inguinal hernia repair is one of the most frequently
such nausea, vomiting, and urticaria (5).
carried out surgical procedures globally, particularly in
The development of the NMDA antagonist
the day-case scenario (1).
magnesium sulphate (MgSO4), which thanks to the
The Lichtenstein "tension-free" hernioplasty
discovery of NMDA receptors in the skin and muscles,
surgery is currently one of the most popular ways to
is used in a variety of methods for brachial plexus
treat inguinal hernias and uses mesh prosthesis (2).
blocking as well as via neuraxial pathway. The
Although the Lichtenstein technique is the go-to
contribution of MgSO4 to TAP inhibition as an adjuvant
surgical procedure for unilateral or bilateral hernia
has not yet been properly analysed (6).
repair and has a low recurrence incidence, it is linked to
The goal of the study was to determine whether
moderate to severe postoperative discomfort that may
improving patient outcomes following adult inguinal
delay return to regular activities or lead to the
hernia surgery involved using TAP block that combined
emergence of chronic pain (3).
magnesium sulphate and bupivacaine under ultrasound
Uncontrolled postoperative pain causes a surgical
stress response that adversely impacts several

physiological processes, even increasing perioperative
morbidity and mortality. Consequently, providing
Between March 2021 and January 2022 at Al-
surgical patients with good post-operative analgesia is
Azhar University Hospitals (Assiut), 60 adult male
crucial to their overall care (4).
patients between the ages of 21 and 60 were recruited
The ilioinguinal, iliohypogastric, and lower
for the current study. The patients were Class I or II
intercostal (T7-T11) nerves are blocked by an efficient
American Society of Anesthesiologists (ASA), and
peripheral abdominal field block called the transversus
planning for a main unilateral open elective inguinal
abdominis plain (TAP) block that is guided by
hernia repair.
ultrasound as a component of a multimodal strategy for

post-operative pain relief. TAP block has been
Exclusion criteria:
employed in a range of surgical procedures involving
Preoperative use of opioids or NSAIDs, allergies to
lower abdominal wall incisions. While producing
researched medications or anaesthetic agents, or other
adequate operating circumstances for localised
contraindication, emergency hernia repair, BMI 30
anaesthesia, local anaesthetics alone have a shorter
kg/m2, patients with diabetes mellitus and those who are
duration of post-operative analgesia. To create a quick,
unable to adequately describe postoperative pain to the
dense, and long-lasting block, opioids, clonidine, and
researcher (because of dementia, delirium, psychiatric
ketamine are some of the adjuvants utilised with local
Received: 15/07/2022
Accepted: 18/09/2022

Full Paper (vol.892 paper# 152)

c:\work\Jor\vol892_153 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7120- 7124

Serum Level of Vitamin B12 And Folic Acid in Egyptian Children with
Idiopathic Nephrotic Syndrome
Eman R. Youness1*,Nabila A.El- Laithy1, Ahmed S. El-Gayed2, Mones M. Abu Shady3, Mohamed EL-Sonbaty3
1Medical Biochemistry Department, 3Child Health Department, Medical Research and
Clinical Studies Institute, National Research Centre, Cairo, Egypt.
2 Pediatrics Department, Faculty of Medicine, October 6th University, Egypt
Corresponding author: Eman R. Youness, Mobile: 01118902966, ORCID:0000-0002-6492-1680,

Nephrotic syndrome (NS) is one of the most widespread chronic renal illnesses in childhood. Homocysteine
(Hcys) metabolism uses vitamin B12 and folic acid as a cofactor.
The current study investigated the probableassociationamongvitamin B12 and folic acid with nephrotic patients
in various stages comparing to healthy ones among Egyptian children.
Patients and methods: The current researchwasdone on 60 patients in relapse and remission compared to 30 healthy
children.Folic acid, vitamin B12, albumin and cholesterol in serum were measured in all patients and controls.
Results: Level of vitamin B12 was significantly lower in relapse than controls. Mean vitamin B12 was significantly higher
in relapse group than in the remission one. Vitamin B12 was significantly lower in remission group than in the control group.
No majorvariation was found among patients in relapse and controls as regard serum folic acid level. No significant
alteration was found amongst patients in remission and relapse as regard serum folic acid level. Same results were found
between patients in remission and control as regard to folic acid. Conclusions: Decreased levels of B12 were associated
significantly with NS in relapse. Understanding the correlation of vitamin B12 and folate supplementation in childrenwith
NS mightputphysicians and scientists in preferable situation to create informed remediation policy and decisions.
: Nephrotic syndrome, B12, Folate, Children, National Research Centre, October 6th University.


In the bowel,folate is resulting from
Nephrotic syndrome (NS) is the prevalent chronic
polyglutamateswhich are changed into monoglutamates,
kidney diseases (CKD) in babyhood(1)with aprevalence of
and folic acid carried by a specific carriertransport it
2-16.9 per 100.00 childrenuniversally (2).Idiopathic NS is
across mucosal epithelia and produced another
the suprememutual form of NS in babyhood is
component called 5-methyltetrahydrofolate (5-MTHF)(11).
representing approximately 90% of all cases.Itconsidered
In the duodenum, vitamin B12is taken with
a primary glomerular disease without an identifiable
nutrients as cobalamin, complexes with salivary
causative disease or infection(3).About 85%-90% of
haptocorrin. Pancreatic proteases liberates this complex
children with idiopathic NS are steroid sensitive, and the
abruptly from cobalamin. After thatcobalaminfastens to
majority of cases follow a relapsing and remitting
an intrinsic factor released from the stomach parietal cells.
course(4). About half of relapsed patients, show frequently
In the distal ileum this compound is endocytosed from the
relapsing or steroid dependent course(5).
enterocytes through cubilin. In plasma, plasma transport
As reported in 2012, NS is a major health trouble
protein named transcobalamin carry cobalamin(12).
Urinary excretion of vitamin B12 is minimumbecause of
increasingoccurrence of recently diagnosed cases through
reabsorption in the proximal tubule(13).
years and increasing inincidence of steroid-resistant cases
Several metabolic alterations have been occurred
that are relatedtouse of multiple immunosuppressive
in CKD patients, comprising hormonal dysregulation,
drugs, complications, recurrent hospital admission, and
acidosisand systemic inflammation, together with co-
morbidities and multi-drug remedies, could lead to
complications in patients with NS is a serious problem its
malnutrition with subsequent deficiency of vitamin B12
frequency about 3%. Venous thrombosis is threefold
and folate. Also there are other factors such
more commonin comparison to arterial thrombosis(8).
asgastroparesis, anorexia, diarrhea,or slow intestinal
Abnormality inHomocysteine (Hcys) metabolism by
transit, augmentedgut microbiota impairment and gut
increasing in its level has been independent risk factor for
mucosal permeability might represent deterioratethe
both arterial and venous thrombosis (9).
Vitamin B12 and folate have an essential role in
homocysteine metabolism. Not only as cofactors
theprobableassociation between vitamin B12 and folic
howevermight their homeostasis disturbance be directly
acid withidiopathic NS patients in different stages
related to cardiovascular risk and CKD progression(10).
comparing to healthy onesamong Egyptian children.
Received: 15/07/2022
Accepted: 18/09/2022

Full Paper (vol.892 paper# 153)

c:\work\Jor\vol892_154 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7125- 7131

Cervical Vestibular Evoked Myogenic Potential (Cvemp) in
Children With Sensorineural Hearing Loss
Abeer Abdellatif E. Mousa*, Shimaa Abdelazim A. Metwally, Mostafa Adly Tantawy,
Nadia Lotfy Hussieny, Israa Taha H. Ibrahim, Mona Taha A. Hegazy, Noha Nabil Abdelaziz
Ear, Nose, and Throat Department, Audiovestibular Unit, Al Ahrar Teaching Hospital, Zagazig, Sharkia, Egypt
*Corresponding author: Abeer Abdellatif E. Mousa, Mobile: (+20)01220353859, E-Mail: dr.abeer_elenany@yahoo.com


Background: Sensorineural Hearing Loss (SNHL) has a detrimental effect on children's development, it makes a
thorough examination of the inner ear crucial.
Aim of the work:
To assess the saccular function in children with different degrees of SNHL by using cervical vestibular
evoked myogenic potential (cVEMP) in comparison to normal children.
Patients and methods:
Forty-five children were included in this study (fifteen normal children as a control group and
thirty children with SNHL as a study group). Children in the study group were divided according to the degrees of
hearing loss into mild, moderate, moderately severe, severe, and profound. cVEMP was done at a supra-threshold level
of 95 decibels (normal Hearing Level dBnHL) using 500 Hertz (Hz) tone-burst to evaluate the vestibular system in both
groups. cVEMP P13, N23 amplitude, and latency results were recorded.
Results: there was a statistically significant difference regarding latency of P13 & N23 among the two groups with
increased mean in the study group, a statistically significant difference as regards absolute amplitude of P13 & N23 with
decreased mean in the study group and a statistically significant difference regarding P13-N23 amplitude. But there is
no statistically significant difference as regards asymmetry ratio, the interaural level difference (ILD), and P13-N23
interpeak latency (IPL).
Conclusion: A significant portion of kids with SNHL experience vestibular impairments. The largest percentage of
aberrant cVEMP results were seen in children with severe or profound hearing loss. Cochlear implantation (CI) may
affect the vestibular otolith organs, and the cVEMP waveform alterations can reveal how surgery affects the otolith
Cervical vestibular evoked myogenic potential, Sensorineural Hearing Loss.


Those kids' vestibular systems did not receive adequate
The vestibule and cochlea, which belong to the
consideration. The otolithic injury occurs often in
vestibular and auditory systems, respectively, are the
children with severe SNHL. According to reports,
peripheral sense organs. Because the vestibule and the
children with SNHL have a maximum chance of
cochlea are connected by a continuous membrane
detecting vestibular dysfunction of around 70%, but
labyrinth in the inner ear, disturbances of functions of
doctors haven't paid enough attention to this problem.
the cochlea, which can induce sensorineural hearing
Therefore, it is crucial to comprehend how children with
loss (SNHL), may occur with vestibular dysfunction (1).
SNHL's vestibular system is functioning (4).
Pediatric patients can benefit from early
This study aimed to assess the saccular function in
identification of peripheral vestibular dysfunction since
children with different degrees of SNHL by using
it not only helps doctors and parents understand why
cVEMP and to compare cVEMP findings between them
children have balance problems but also makes it easier
and normal children.
for kids to acquire compensatory balance control

techniques. The lack of routine vestibular testing in the
pediatric population is due to many factors. One of them
A total of 45 kids attending AL-Ahrar Teaching
is the dearth of workable and efficient healthcare
Hospital's Audiology Unit between December 2016 and
methods. When performed on young children, the
August 2017 were randomly recruited in this study, they
traditional techniques for vestibular assessment in
split up into two groups:
adults, such as videonystagmography (VNG) and the

caloric test, are difficult, if not impossible (2).
1- Control Group:
The development of kid-friendly vestibular
It consists of 15 normal healthy control children,
assessment techniques has made significant strides.
aged between 6-17 years with the following inclusion
Cervical vestibular evoked myogenic potentials
(cVEMP) are one such test for determining vestibular
1. Absence of any background history of systemic
problems. It is a thorough, painless, quick, and well-
disorders affecting the vestibular system.
tolerated exam to determine how effectively the saccule
2. No history of ear disease.
and inferior vestibular nerves operate (3).
3. Neither acoustic nor physical trauma history.
A decrease in hearing sensitivity is typically the
4. No ototoxic drug history.
main complaint from parents and children with SNHL.
Received: 15/07/2022
Accepted: 18/09/2022

Full Paper (vol.892 paper# 154)

c:\work\Jor\vol892_155 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7132- 7136

Updated Treatment Modalities of Systemic Sclerosis: Review Article
Manar Ibrahim Abd El-Fattah Ibrahim*1, Enass Abdel-kader Eliwa1,
Sohair Atia Ahmed2, Samah Mahmoud Alian1
Departments of 1Rheumatology and Rehabilitation and
2Community Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Manar Ibrahim Abd El-Fattah Ibrahim, Mobile: (+20) 01066703898,
E-Mail: dr.manar29490@gmail.com

The three defining characteristics of systemic sclerosis (SSc), a chronic connective tissue condition, are
fibrosis of the internal organs, joints as well skin, autoimmunity, and vasculopathy. New therapeutic targets are urgently
required because there is currently no medication that alters the fibrosis components. This review looks at the state of
therapies now and new medicines.
Objective: This review article aimed to assessment of updated treatment modalities of systemic sclerosis.
We searched PubMed, Google Scholar, and Science Direct for information on Systemic Sclerosis with its
treatment. However, only the most current or comprehensive studies from April 2007 to May 2021 were considered.
The authors also assessed references from pertinent literature. Documents in languages other than English have been
disregarded since there aren't enough resources for translation. Unpublished manuscripts, oral presentations, conference
abstracts, and dissertations were examples of papers that weren't considered to be serious scientific research.
Conclusion: The development of progressive pharmacological therapy strategies in conjunction with non-
pharmacological procedures is the foundation for the treatment of SSc and is established on the regular and routine
examination of any possible organ injury. Based on unique traits of the patient and the SSc, several advancements have
been accomplished, particularly in the fields of targeted treatments and customized medicine.
Keywords: Systemic sclerosis, Pharmacological therapy strategies, Quality of life.


A chronic connective tissue illness called systemic
Clinical Manifestation:
sclerosis (SSc) is distinguished by fibrosis of joints and
Diffuse cutaneous systemic sclerosis (dcSSc) and
skin as well as internal organs, blood vessels as well as
restricted cutaneous systemic sclerosis (lcSSc) are the
autoimmune impact. It has a higher mortality rate than
two primary subtypes of systemic sclerosis, and they
would be predicted from the general population and when
differ in the location of skin involvement. Calcinosis,
compared to some of the other rheumatic diseases (1).
The multisystem condition SSc is rare, clinically
sclerodactyly, and telangiectasis, or CREST syndrome, is
diverse, and has a significant impact on the physical and
the previous term for restricted cutaneous systemic
psychological functioning of patients as well as their
sclerosis (3).
capacity to engage in social and occupational activities.
Both systemic sclerosis and morphea (localized
To reduce symptoms and impairment, as well as to
scleroderma) are frequently referred to under the
enhance functional capacity and health-related quality of
umbrella term "scleroderma" (systemic scleroderma). It's
life (QoL), is one of the most difficult aims of treatment
crucial to distinguish between the two since they have
extremely distinct symptoms and treatment requirements
Inflammation, fibrosis, and vasculopathy all share
a number of pathogenic pathways with systemic sclerosis

(SSc), a complicated rheumatologic autoimmune disease
The key features of systemic sclerosis are:
that causes damage to internal organs. Now that the
Sclerodactyly, the thickening of the skin of the
disease's pathophysiology has been clarified, and new
fingers and toes blood levels of certain autoantibodies
therapeutic targets have been found. Many of these
(such as anti-Scl70 or anti-centromere antibodies),
targets have been tested in preclinical and clinical trials
abnormal capillaries in the nail fold (Figure 1), Internal
with varying degrees of success. New therapeutic targets
organ fibrosis as well as vascular damage affecting the
have also been found as a result of recent research on the
kidneys, heart, lungs, and/or digestive system (3).
participation and interplay of the innate and acquired
immune systems (2).
Received: 14/07/2022
Accepted: 17/09/2022

Full Paper (vol.892 paper# 155)

c:\work\Jor\vol892_156 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7137- 7146

The Role of Vitamin D, DKK1, Hepcidin and Oxidative Stress Biomarkers in
Type 2 Diabetes Mellitus Patients With and Without Diabetic Nephropathy
Amira A. Kamel*1, Mohamed G. Elnaggar2, Dina Ali Hamad3, Madeha M. Zakhary1, Sally M. Bakkar1
Departments of 1Medical Biochemistry and Molecular Biology, 2Clinical Pathology
South Egypt Cancer Institute, and 3Internal Medicine, Critical Care Unit,
Faculty of Medicine, Assiut University, Assiut, Egypt
*Corresponding author: Amira A. Kamel, Mobile: (+20) 01068345861, Email: amirakamel@aun.edu.eg,
ORCID: 0000-0001-7567-7022
Background: Type 2 diabetes mellitus (T2DM) is a widespread disease. Diabetic nephropathy (DN) is one of the most
prevalent and harmful effects of T2DM.
Objectives: We aimed to assess blood levels of vitamin D, dickkopf1 (DKK1), hepcidin, and oxidative stress biomarkers
in T2DM patients who have and do not have DN.
Subjects and methods:
The study comprised 55 T2DM patients, of which 35 had DN, 20 did not, and 30 were healthy
controls. ELISA was utilized to estimate serum concentrations of vitamin D, DKK1, and hepcidin, while
spectrophotometry was used to detect the oxidative stress indicators.
Comparing T2DM patients to controls and DN patients to patients without DN, serum levels of DKK1,
hepcidin, lipid peroxide (LPER), and nitric oxide (NO) were considerably greater, whereas vitamin D, glutathione
peroxidase (GPx), and superoxide dismutase (SOD) were significantly lower. DKK1, hepcidin, LPER, and NO levels
were considerably higher in T2DM patients with prolonged duration and inadequate glycemic control, but vitamin D,
GPx, and SOD levels were significantly lower. Vitamin D, DKK1, and SOD showed the highest predictive value for
T2DM. Vitamin D and hepcidin, meanwhile, demonstrated the strongest predictive value for DN. In T2DM patients,
elevated hepcidin levels were strong predictor of DN. Vitamin D correlated positively with GPx and SOD and negatively
with DKK1, hepcidin, LPER and NO.
We can deduce that in T2DM patients, especially those with DN, long duration, and poor glycemic control,
high levels of DKK1, hepcidin, LPER, NO, and low concentrations of vitamin D, GPx, and SOD are detected. Hepcidin
may be useful in diagnosis and predicting DN in T2DM patients. This emphasizes the role of these biomarkers in
pathogeneses of T2DM and DN in an effort to have potential therapeutic implications in the future.
Keywords: Type 2 diabetes mellitus, Diabetic nephropathy, Vitamin D, DKK1, Hepcidin, Oxidative stress.

DKK1/Wnt/-catenin signalling pathways in the
Diabetes mellitus (DM) is a metabolic disease
pathophysiology of glomerular diabetic lesions is being
marked by hyperglycemia brought on by deviations in
increasingly supported by research (7).
insulin effect, synthesis, or both. T2DM is the most
Hepcidin is the principal iron regulator. The liver
common type of diabetes, makes up for 90% of diabetes
increases hepcidin synthesis in response to increased
(1). One of the most prevalent and harmful effects of DM
iron levels, and this action on the sites of absorption,
is DN. It is the primary contributor to end-stage renal
storage, or recycling causes a reduction in the release of
disease (ESRD) (2). It may be advantageous to use
iron from these tissues (8). Erythropoiesis, inflammation,
biomarkers that are indicative of the incidence and
and levels of both circulating and stored iron all
progression of T2DM and its consequences in order to
influence hepcidin levels (9). Hepcidin may have a role
diagnose and treat patients earlier in the course of the
in the aetiopathogenesis of T2DM because T2DM is
illness (3).Having hormonal effects, vitamin D is a fat-
one of the consequences of having too much iron in the
soluble vitamin. Reactive oxygen species (ROS) and
body. Excessive systemic iron can damage hepatocytes
Ca2+ levels are maintained at normal resting levels by
and pancreatic cells owing to oxidative stress (10).
vitamin D in both insulin-responsive tissues and
Oxidative stress (OS) is imbalance between the
pancreatic -cells (4). The body's sensitivity to insulin is
production of reactive oxygen species (ROS) and
thought to be enhanced by vitamin D, which lowers the
antioxidant defence mechanisms (3). OS has been
likelihood of developing insulin resistance. However,
regarded as a key indicator of the pathophysiology and
the connection between vitamin D levels and T2DM is
occurrence of T2DM and related consequences (11).
unknown. A serious global public health problem is
Pancreatic -cells experience oxidative damage as a
vitamin D deficiency. It substantially contributes to the
result of chronic hyperglycemia. ROS are capable of
development of T2DM (5).
causing DNA, protein, and lipid damage, which results
Dickkopf1 (DKK1) is a small molecular weight
in -cell malfunction and death (3).
soluble secreted protein. DKK1 is a powerful inhibitor
Given the foregoing, the current research was
of Wnt signalling and implicated in the control of
carried out to assess the serum levels of vitamin D,
glucose metabolism (6). In T2DM, circulating DKK1 is
DKK1, hepcidin, and biomarkers of oxidative stress in
elevated. Dysfunction of podocyte and mesangial cell is
T2DM patients and to examine their relationship with
a factor in DN. The relevance of dysregulated
DN with the purpose of better grasping their potential
Received: 14/07/2022
Accepted: 17/09/2022

Full Paper (vol.892 paper# 156)

c:\work\Jor\vol892_157 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 7147- 7157

Acne Vulgaris Severity Correlation with Serum Calprotectin: A Prospective Case-
Controlled Study
Mohammed Fawzy El Kamel, Laila Ahmed Sharaf, Mohammed Samir Sultan, Sara Hossam Mohammed*
Department of Dermatology, Andrology & STDs, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Sara Hossam Mohammed, Mobile: (+20) 01098477262, E-Mail: dr.sarahosaam2017@gmail.com

Acne vulgaris is an inflammatory skin disease which is extremely common. Acne affects around 85% of
teenagers, and its effects can persist into adulthood for some. It has been hypothesized that calprotectin plays an
inflammatory function in acne vulgaris, and so contributes to its etiopathogenesis.
Objective: The aim of the current study was to measure serum calprotectin in patients with acne vulgaris and finds any
links between that measure and the severity of the underlying condition.
Patients and methods: A total of 45 people with a diagnosis of acne vulgaris and 45 controls of the same age and sex
participated in the study. They were selected from the Dermatology, Andrology, and STDs outpatient clinic at Mansoura
University Hospitals between May 2021 and May 2022.
Results: Acne vulgaris patients had considerably higher serum calprotectin levels with median of 18.9 compared with
a median of 11 of the healthy volunteers (P <0.001). The GAGS (Global Acne Grading System) score was positively
correlated with age (r= 0.341, P =0.022), body mass index (r= 0.538, P <0.001), acne duration (r= 0.461, P <0.001), and
serum calprotectin (r= 0.874, P <0.001). GAGS scores was also positively correlated with serum calprotectin (r= 0.943,
P <0.001), acne duration (r= 0.523, P <0.001), and age (r= 0.392, P =0.008).
Conclusion: Acne vulgaris patients had increased serum calprotectin levels compared to control subjects, and they have
a statistically significant relationship with disease severity, suggesting that calprotectin may be used as a chemical
biomarker to determine disease severity.
Keywords: Acne Vulgaris, Serum Calprotectin, GAGS score.

antibacterial impact by binding to zinc and manganese,
Pilosebaceous unit inflammation is chronic and
two metals that are essential for bacterial growth (1).
widespread in acne vulgaris (AV). The precise pathology
Serum calprotectin level increases in various
of AV is unknown, despite the fact that different
diseases as inflammatory diseases, autoimmune diseases
pathways have been implicated in its etiopathogenesis (1).
and cancers (9,10).
The etiopathogenesis of AV involves a number of
It has been hypothesized that calprotectin plays an
variables. Increased sebum production, aberrant
inflammatory function in acne vulgaris, and so
hyperkeratinization, altered microbial flora, and
contributes to its etiology. Patients with moderate-severe
inflammation are the primary causes (2).
acne had higher serum calprotectin levels than those with
While the precise timing of these occurrences is
mild acne, while AV patients had higher serum
yet unknown, inflammation has been hypothesized to be
calprotectin levels than controls overall (1).
the first cause. Propionibacterium acne plays a crucial
The aim of the current study was to measure serum
part in the mechanisms that initiate and sustain the
calprotectin in patients with acne vulgaris and finds any
inflammatory response, but these mechanisms are not yet
links between that measure and the severity of the
fully understood (3,4).
underlying condition.
Acne-causing Propionibacterium can cause


inflammation in two ways. The production of
A total of 90 subjects were recruited for this case
inflammatory cytokines and antimicrobial peptides is
control study. They were selected from the Dermatology,
boosted. Toll like receptor 2 activation by
Andrology, and STDs outpatient clinic at Mansoura
Propionibacterium acnes also triggers the innate immune
University Hospitals between May 2021 and May 2022.
response (TLR2) (5). The pilosebaceous unit consists of
Recruited participants were divided into 2 groups; Case
the sebaceous gland, the hair follicle, the arrector pili
group: 45 acne vulgaris patients, and control group: 45
muscle, and the sebaceous duct. Together with
healthy controls of matched age and sex.
keratinocytes, sebocytes play a role in immunity(6).

S100A8 and S100A9, both members of the S100
Sample Size:
protein family, heterodimerize to generate calprotectin, a
IBM SPSS SamplePower version 3.0.1 (IBM a Corp.,
protein involved in a wide range of inflammatory
Armonk, NY, USA) was used to determine the minimum
responses (7). The proinflammatory response may be
sample size needed for the study.
amplified by epithelial calprotectin secretion (8).

Leukocyte migration, infection as well as

cytoskeleton modulation are all areas where calprotectin
Korkmaz and Fiçiciolu(1) conducted a comprehensive
comes into play. In addition, calprotectin has a direct
literature search and determined that the mean GAGS
(Global Acne Grading System)
score in the cases of
Received: 15/07/2022
Accepted: 18/09/2022

Full Paper (vol.892 paper# 157)


Serum IL-22 as a Novel Non-Invasive Biomarker in Diagnosis and
Assessment of Activity in Ulcerative Colitis Patients
Abdelrahman Khedr*, Sherif Mounir Mohamed Farag, Ahmed Samir Abo Halima,
Heba Ahmed Faheem, Mohamed Sayed Mohamed Ali Kortam, Ayman Seddik
Internal Medicine Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Abdelrahman Khedr, Mobile: (+20) 01005412601, E-mail: khedr76@hotmail.com

A chronic inflammatory illness with a relapsing remitting course is ulcerative colitis (UC). The primary
test for UC diagnosis is a colonoscopy, however there is a chance that anything could go wrong. Inflammation of the
mucosa has a lower correlation with UC indicators than colonoscopy. Interleukin 22 (IL 22), a member of the IL-10
family of cytokines, has only lately been linked to the pathogenesis of UC.
Objective: The aim of this study was to evaluate the role of serum IL-22 as a novel non-invasive biomarker in diagnosis
and assessment of activity in ulcerative colitis patients.
Patients and Methods: This was a case control study that was conducted on 40 UC patients and 15 healthy controls at
Ain Shams University Hospitals, throughout 6 months. Patients with ulcerative colitis were divided into 20 patients in
clinical, laboratory and endoscopic remission and 20 patients in clinical, laboratory and endoscopic activity.
Results: Statistical analysis revealed the following: For Interleukin 22, there was highly statistically significant
difference found between the three groups. There was highly statistically significant correlation found between IL-22
(Pg/ml) and endoscopic activity, and there was statistically significant correlation found between IL-22 (Pg/ml) and
Histological activity, and there was no statistically significant correlation found between IL-22 (Pg/ml) and Extent of
the disease. IL 22 levels showed statistically significant correlations with erythrocyte sedimentation rate (ESR), C
reactive protein (CRP) and Mayo score of severity of UC. Receiver operating characteristic curve (ROC) showed that
the best cut off point of IL-22 (Pg/ml) to detect Patients was found > 4.7 with sensitivity of 90.0%, specificity of 100%,
PPV of 100.0%, NPV of 78.9% and total accuracy of 0.95%. (ROC) shows that the best cut off point of IL-22 to detect
patients with activity was found > 10.2 pg/ml with sensitivity of 95.0%, specificity of 75.0%.
Conclusion: It is concluded that IL22 is an important marker of ulcerative colitis activity as it shows significant
correlation with endoscopic and histological activity.
Keywords: Serum IL-22, Crohn's disease, Ulcerative colitis.

The ideal inflammatory marker would have a
Inflammatory bowel illnesses, such as Crohn's
high predictive value, be sensitive and specific, simple
disease (CD) and ulcerative colitis (UC), are
to use, and not require invasive procedures.
characterised by relapses and remissions over time. Its
Additionally, it should be replicable in both individual
multifaceted aetiology includes genetic, environmental,
and laboratory settings (4).
gut microbiome, and improper immune response factors
Interleukin 22 (IL 22) is a cytokine of interleukin
(1). Affection of intestinal barrier integrity plays an
10 family. IL 22 is secreted by various immune cells
important role in the pathogenesis of inflammatory
especially T helper lymphocytes, it is also secreted by
bowel disease. As increasing barrier permeability leads
natural killer cells. Myeloid cell lineage (neutrophils)
to enhanced exposure to microbial and protein antigens
can also secrete IL 22. IL 22 is involved in various
and thus triggering immune system and causing marked
inflammatory diseases like psoriasis, rheumatoid
mucosal inflammation (2).
arthritis and IBD (2).
The diagnosis and evaluation of severity of IBD
The control of the expression of IL 22 is
is best confirmed by endoscopy. Valid and widely used
significantly influenced by T cells, transcription factors,
scoring systems for endoscopy include Mayo
and certain cytokines, such as IL 23 (5). In animal
endoscopic sub score for UC and the simple endoscopic
models, IL-22 promotes proliferation, improves barrier
score for Crohn's disease (CD) (1). Although endoscopy
is the standard investigation to diagnose and evaluate
inflammation (2). Patients with ulcerative colitis and
severity of IBD, it is costly and carries a risk of serious
Crohn's disease have elevated IL-22 levels (2).
complications, so it is difficult to use it to monitor the
IL 22 gene is proved to be involved in the
disease activity (3).
pathogenesis of ulcerative colitis in many genetic
Fecal calprotectin and CRP are used universally
studies. IL 22 appears to have a defensive role in UC by
as clinical biological markers to monitor IBD activity
improving mucous production, preventing tissue
but its correlation with mucosal inflammation is far less
damage and enhancing epithelial cell proliferation (6).
than endoscopy, so it is essential to discover a new
IL 22 appears to be beneficial in intestinal
biological marker that has the ability to differentiate
inflammation. It is proved to enhance regeneration of
between severe activity, subclinical activity and
damaged epithelial layers and improve intestinal wound
remission of the disease based on a better correlation