c:\work\Jor\vol901_1 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1-9

Role of Gray Scale and Color Doppler Ultrasound in Diagnosis of
Parotid and Submandibular Gland Diseases
Marwa Samy1, Mostafa Thabet1, Galal M. Galal1, Mahmmed Hasan Osman2, Reham Sameeh1
1 Diagnostic Radiology Department, Faculty of Medicine, Assiut University Hospital, Egypt
2 Oral and Maxillofacial Surgery department, Faculty of Medicine, Assiut University, Egypt
*Corresponding author: Marwa Samy, Mobile: (+20) 01025260404, Email: Marwasamy@aun.edu.eg

Ultrasonography is considered as the primary imaging technique used for identification, diagnosis,
treatment, and follow-up of lesions affecting the major salivary gland. Both grey scale and color Doppler ultrasound
maneuvers are frequently used for assessment of various salivary gland infirmities. As well, it is used for classification
of the major salivary gland pathologies. This study aimed to assess the validity of ultrasound in the diagnosis and
prediction of the parotid and submandibular gland lesions.
Patients and Methods: Sixty-nine cases with salivary gland masses were investigated via using grey scale, color
Doppler and spectral Doppler. Grey scale was used for the morphological features of each tumor; color Doppler for the
blood vessel distribution and frequency; and spectral Doppler for determination of the peak systolic velocity, resistive
index and pulsatility index. Postoperative through histopathological examination was carried out for all cases after
excision of mass.
Results: According to the histopathological examination, 28 of 69 (40.6%) lesions were identified as benign, 13 of 69
(18.8%) as malignant, and 28 of 69 (40.6%) as inflammatory. Color Doppler revealed that malignant lesions had
significantly higher grade of vascularity and a mixed "scattered" pattern of distribution. Using spectral Doppler,
malignant masses had significantly higher Doppler ultrasound wave forms. Grey scale sonar showed that the rate of ill-
defined borders, heterogeneous structure, and irregular shape was significantly higher in Malignant than benign tumors.
Conclusions: Adding Doppler ultrasound (color and pulse wave) may grant better diagnosis for malignant salivary
gland tumors.
Keywords: Salivary gland, Malignant, Doppler, Grey scale, Color, Spectral.


index (PI)) are important for identification of malignant
Salivary glands (SGs) are susceptible for affliction
lesions [6].
by group of diseases either systemic, inflammatory,
Moreover, it was approved that the method of
obstructive or malignancy [1]. Most of SG tumors are
choice for obtaining biopsy for histopathological
benign with variable degree of liability for recurrence
examination is the USG guided Fine Needle Aspiration
and/or malignant transformation [2]. Hence, prompt and
Cytology (FNAC). This adds extra-advantage for the
proper diagnosis is crucial for disease management.
use of USG in discrimination between benign and
Clinical examination alone won't give the proper
malignant lesions [3]. Plain X-ray, sialography, CT, MRI
salivary gland disease diagnosis. Therefore, imaging
and PET-CT are other imaging modalities used for
techniques are fundamental for accurate diagnosis and
diagnosis and characterization of salivary gland
classification [3].
diseases [7].
The role of ultrasonography (USG) in the
Although USG is a good tool for diagnosis,
diagnosis and treatment of SG lesions is crucial and
sometimes full visualization of lesion might be
central. The final diagnosis may be suggested by the
impossible and this is because of the lesion position, its
USG examination alone, or significant differential
extension into the deep gland tissue or behind the bone
diagnostic information may be provided [4]. It can
of the mandible. Thus, further imaging with CT or MRI
differentiate between intraglandular from extra-
is necessary [4].
glandular lesions in 98% of cases i.e., it can
The current study aimed to assess the validity of
discriminate salivary gland lesions as focal or diffuse.
USG (grey-scale and Doppler) in the diagnosis and
Lesion edge outline may differentiate focal lesions into
prediction of SG lesions.
malignant and benign. High resolution transducers USG

is better than Computerized Tomography (CT) or
Magnetic Resonant Imaging (MRI) in detection of
The present study adopted an observational
lesions with irregular borders [5].
design and was conducted at the Radiology Department,
The findings of the Color Doppler are frequently
Assiut University, Egypt in the period from the 1st of
used for classification and characterization of lesions
January 2019 to the 1st of February 2021. Institutional
i.e., diagnosis of pleomorphic adenoma. Doppler
Ethical Committee permission was taken before starting
findings of intralesional vascularity, type and grade of
the study (IRB: 17100612) Trial registration was
vascularity, and Doppler ultrasound wave forms (pulse
prospectively undertaken in clinical trial.gov
wave velocity (PSV), resistive index (RI) and pulsatile
(NCT03746730) .The study was carried out in
accordance with the Helsinki Declaration guidelines.
Received: 20/5/2022
Accepted: 25/7/2022

Full Paper (vol.901 paper# 1)

c:\work\Jor\vol901_2 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 10-13

The Results of Meningitis/Encephalitis Panel in Children with
Suspected Central Nervous System Infections
Maha Zakariya Mohammed1*, Marwa Ramadan Mohamed Abdelhalim2,
Hoda Ezz Elarab Abdel Wahab Garrad2
Departments of Pediatrics1 and Clinical pathology2, Faculty of Medicine, Ain Shams University
Corresponding author: Maha Z. Mohammed, ORCID 0000-0002-6098-561X
, Email: mahazakariya@med.asu.edu.eg, Mobile:002 01124215285

Central nervous system (CNS) infection in pediatrics is a considerable cause of morbidity and fatality.
Objective: The aim of the current study was to evaluate the AllplexTM Meningitis Panel Assays (ME) as a rapid
diagnostic method for CNS infections.
Methods: The study included 329 cerebrospinal fluid (CSF) samples from pediatric patients with suspected CNS
infections. The samples were analyzed using the AllplexTM ME panel in the period between January 2020 and January
Result: Out of the 329 CSF samples, 21 (6.4%) cases were positive. The commonest viral pathogen detected was parvo
B19 (n=11), followed by human herpes virus 7 (n=3) and human herpes virus 6 (n=2). Streptococcus pneumoniae (n=1)
was the only bacterial pathogen detected in our cohort. One patient with parvo B19 encephalitis improved markedly after
receiving methylprednisolone. Another patient with parvo B19 was diagnosed consequently as anti-N-methyl-d-aspartate
(NMDA) receptor encephalitis.
Conclusion: The AllplexTM ME Panel test can rapidly detect 18 pathogens from CSF. In view of antibiotics misuse, ME
Panel aids in diagnosis of CNS infection helping the clinicians in early management and shortening the length of hospital
stay. Case by case clinical evaluation is mandatory to avoid unnecessary request of the ME panel test. Further testing -
specially for CSF autoantibodies- is warranted in case of worsening or unsatisfactory improvement of the condition.
Keywords: Encephalitis, Meningitis, PCR panel, Pediatric.

Nevertheless, it is anticipated that the yield of CSF
Pediatric meningitis and acute encephalitis are a
culture will be low in developing countries, where
large contributor to lengthy hospital stay, high
pretreatment with antibiotics is widespread (9).
mortality, significant morbidity and subsequent long-
In resource-limited setting, early diagnosis of CNS
lasting neurological sequelae (1).
infection is crucial to reduce mortality rate and avoid
The incidence of acute bacterial meningitis is
expenses needed for empiric antimicrobials and
estimated to be 5­7/100,000 in western countries (2,3),
isolation procedures in healthcare facilities. The aim of
while pediatric acute encephalitis syndrome in children
the current study was to evaluate the new multiplex
was reported to be around 10.5­13.8/100,000 (4).
PCR panel in determining the microbiologic etiologies
Regardless the causative organism, CNS infections
causing CNS infections in children.
can present with nonspecific symptoms including,

fever, neck stiffness, disturbed conscious level, nausea
and vomiting, headache, photophobia, cranial nerve
Study design
palsies, rash, behavioral changes, focal weakness, and
This retrospective observational study was
seizure (2,3).
conducted at Ain Shams University (ASU) Children
Therefore, the causative organism cannot be
hospital. The study included 329 pediatric patients who
determined based on clinical presentation only (5).
were admitted between January 2020 and January 2022
In case of clinical suspicion of CNS infection, a
with suspected CNS infection, where lumbar puncture
lumbar puncture (LP) is needed at the earliest
was performed as a part of the routine investigations.
opportunity -unless contraindicated- to reach a
Demographic data, clinical picture and CSF results
diagnosis. Results of cerebrospinal fluid (CSF)
were collected from patients' records.
microbiology are crucial for identifying the pathogenic

organisms, making an appropriate antimicrobial
treatment decision, determining the length of therapy,
CSF samples were collected and sent to ASU
and avoiding the use of empirical antibiotic therapy (6-
laboratory to analyze CSF protein, and glucose levels,
cytology and microbiological assessment.
CSF culture is typically positive in cases of
Bacteriological cultures were done on blood agar
bacterial meningitis that have not received treatment.
(BD) and chocolate agar (BD) for 72 hours.
Received: 13/3/2022
Accepted: 10/5/2022

Full Paper (vol.901 paper# 2)

c:\work\Jor\vol901_3 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 14- 18

Combined Intrauterine Lignocaine Injection and Paracervical Block Gives More Pain
Relief Than Either Method Alone in Dilatation and Curettage Procedure
Mohammed Ismail Sabry1, Alaa Masoud1, Israa Khedr2, Elsayed Elshamy*1, 3
1Department of Obstetrics and Gynecology, Menoufia University Hospital, Menoufia, Egypt.
2Department of Obstetrics and Gynecology, Quesna Central Hospital, Menoufia, Egypt
3Department of Obstetrics and Gynecology, King Abdul-Aziz airbase Hospital, Dhuhran, Saudi Arabia
*Corresponding author: Elsayed Elshamy, Mobile: (+2)01003071124, E-mail: s_shamy77@yahoo.com

Endometrial samples are typically obtained by the gynecological procedure known as dilatation and
curettage (D & C). Anesthesia is required for the surgery. Although paracervical blocks are frequently employed, the
pain they cause is mild to moderate.
Objective: The aim of this study was to compare the efficacy of intrauterine instillation of lidocaine, paracervical block,
and a combination of the two procedures for their ability to control intra- and post-operative pain during and after
endometrial curettage.
Patients and Methods: This research was conducted in Ob/Gyn Departments of Menoufia University Hospital and
Quesna Central Hospital. 90 women were scheduled for endometrial curettage were divided into three equal groups by
random selection: Group 1 (n=30): Lidocaine 2% was administered intra-uterine. Group 2 (n=30): Received
paracervical blockage. Group 3 (n=30): Received combined intrauterine lidocaine and paracervical block.
Results: The current study showed that mean VAS value of D and C time was statistically higher among lidocaine (4.9
± 0.76) than in combined intrauterine lidocaine and paracervical block (3.93 ± 0.83). Mean VAS value of D and C time
was statistically higher among paracervical block (4.6 ± 1.13) than in combined intrauterine lidocaine and paracervical
block (3.93 ± 0.83). Five minutes after the procedure, pain was least after the combined technique (group 3) then after
intrauterine lidocaine group (group 1) then after paracervical block (group 2), (VAS:2.6 ± 0.93, 2.9 ± 0.9 and 3.67 ± 0.96
respectively). Conclusion: Greater analgesia was provided by using intrauterine lidocaine in combination with
paracervical block than by using either lidocaine or paracervical block alone.
Keywords: Paracervical block, Intrauterine lignocaine injection, Pain relief; Endometrial curettage, Cervical dilatation.

Society of Anesthesiologists (ASA) (5) class I and II
The endometrium is sampled via dilatation and
were counselled and invited to participate in the study.
curettage (D & C). With adequate analgesia, can be

done in outpatient setting. Regional anesthesia is used
Exclusion criteria: Pregnant women, women with
when the procedure is used in the clinic saving time, and
systemic illness, Active pelvic infection, sever uterine
in addition, reducing hospital occupation, cost and
bleeding and women with known allergy to lidocaine
avoiding complications of general anesthesia (1, 2). The
were excluded from the study.
majority of patients can bear minor discomfort during
A computer-generated randomization software
and after surgery as long as it is not life-threatening (3).
randomly assigned 90 women scheduled for
Pain scoring using visual analogue scale during the
endometrial curettage into three groups: group 1, group
procedure is comparable to other popular outpatient
2, and group 3, based on the type of anesthetic used;
procedures such as cervical punch biopsy, intrauterine
Group 1 (n=30) received a 2% uterine injection of
device (IUD) insertion and hysteroscopy and the
lidocaine. Group 2 (n=30) received a paracervical block
optimal method for pain control during such procedures
and Group 3 (n=30) got combined paracervical block as
is still unclear (4).
well as intrauterine lidocaine. Only one anesthesiologist
The aim of this study was to compare the efficacy
prepared the experimental drugs. Endometrial curettage
of intrauterine instillation of lidocaine, paracervical
was performed by one gynecologist. The visual
block, and a combination of the two procedures for their
analogue scale (VAS) was used to record pain during at
ability to control intra and postoperative pain during and
five and 30 minutes after the treatment. In lithotomy
after endometrial curettage.
position, bimanual examination was carried out. The

cervix was then exposed using a bivalve speculum. A
single toothed vulsellum forceps were used to hold the
This prospective observational study was
cervical anterior lip. An endometrial cavity suction
conducted at Department of Obstetrics and Gynecology,
catheter (size 6 Fr) was used in group 1 and inserted 2­
Menoufia University Hospital and Quesna Central
3 cm distal to the cervix into the endometrial cavity. 5
Hospital between March 2021 and February 2022.
ml of 2 percent lidocaine solution was injected into the

catheter and then clamped for 5 minutes to reduce
Inclusion criteria: All women planned for endometrial
backflow and allow the anaesthetic to take effect before
curettage for diagnostic and/or therapeutic purposes
the catheter was withdrawn. With a 22 G spinal needle,
during the study period and fit according to American
5 ml of 1 percent lidocaine was administered at 1
centimeter depth at the 3 and 9 o'clock positions of the
Received: 12/7/2022
Accepted: 27/9/2022

Full Paper (vol.901 paper# 3)

c:\work\Jor\vol901_4 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 19- 23

Effect of Educational Intervention About Osteoporosis
Knowledge among Egyptian Women
Hanaa S. Said 1, Hanaa A. Nofal 2
1 Department of Family Medicine, 2 Department of Community,
Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Name: Hanaa Salah Said Elsayed, Telephone number: (+2) 01066175817,
Email address: drhanasalah@yahoo.com

Osteoporosis is generally known as a silent disease. Osteoporotic fractures lead to decrease the patient
quality of life and major burden on the individual and community. Educational intervention is suitable for osteoporosis as
many of its risk factors are modifiable.
Methods: An intervention study was carried out on 130 Egyptian women attending Belbeis Family Health Center using a
sociodemographic questionnaire and LOKS-19 scale to assess osteoporosis knowledge. This work passed through three
phases (preintervention- intervention- postintervention).
Results: 130 participants; mean of age was 50.4 + 5.6. About 55.4% were from low social class and 60% of the sample
were menopausal. 58.5 % had positive family history, 86.2% of the sample were drinking caffeinated beverages. There
was a statistically significant improvement in the total knowledge after intervention (from 1.3% to 82.3%). There was
direct correlation between total adequate knowledge and education and social class. On the other hand, there was indirect
correlation between total adequate knowledge and age.
Conclusion: Simple educational programs are successful in raising osteoporosis awareness among Egyptian patients.
Keywords: Egyptian, Educational intervention, Knowledge, Osteoporosis.


In Egypt, there were 21.9 percent of men and 28.4
Osteoporosis affects both sexes, however it affects
percent of women who had osteoporosis, as well as 53.9
women more than men (1). It is a skeletal disease causes
percent of women and 26 percent of men who had
porous bones result in bone mass reduction and bone

structure deterioration. The bone becomes more fragile,
osteopenia. The frequency of osteoporosis in women after
and the risk of fracture increases (2).
menopause was greater and reached 47.8% in Upper
Osteoporosis accounts for 1.5 million fractures every
Egypt's rural districts. Such a high incidence highlights
day, cause pain, increases cost of rehabilitation, disability,
the severity of the issue and the significance of having
quality of life becomes poor, and premature death due to
current recommendations for osteoporosis care in Egypt
decrease level of estradiol, decrease in osteoblastic
activity and a rise in osteoclastic resorption activity (3).

Although risk of osteoporotic fracture of women over
The study aimed to improve the knowledge regarding
the age of 50 is 50%, equivalent to the combined risk of
osteoporosis among Egyptian women.
developing breast, uterine, and ovarian cancers; less

developed nations are still ill-prepared to face the burden
Research Question
of the disease. Poor outcomes are caused by illiteracy, and
Does the educational intervention improve knowledge
a lack of knowledge about the risk factors and symptoms
regarding osteoporosis?

There are several known osteoporosis risk factors.
Sex, advanced age, a low body mass index, menopause
An intervention study was carried out on 130
before age 45, and a family history of osteoporosis or
Egyptian women assuming that the mean level of
fragility fractures, nulliparity, lactation for long time,
knowledge about preventive measures of osteoporosis is
prolonged amenorrhea unrelated to menopause,
(1.74±0.74 - 1.97±0.49) pre- and post-intervention
inadequate intake of calcium and vitamin D, decreased
respectively (7) using open epi online program at 95%
intestinal absorption of calcium, lactose intolerance,
confidence interval and adding 10% non-response rate.
excessive intake of caffeine or alcohol; smoking,
The study applied on Egyptian women attending
sedentary life style, and prolonged treatment with thyroid
the family medicine clinic at Belbeis Family Health
hormones, anticonvulsants, glucocorticoids, use of
Center asking for any medical service. Belbeis is the
anticoagulants and aluminum antacids (5).
second largest district in Sharkia Governorate, Egypt
regarding population density. Sample unites were
Received: 15/7/2022
Accepted: 20/10/2022

Full Paper (vol.901 paper# 4)

c:\work\Jor\vol901_5 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 24-30

UGT1A9 Gene Polymorphism in Egyptian Systemic Lupus Patients
Receiving Mycophenolate Mofetil
Amr Mohamed. Fathy1, Ahmed Shawky Hassan1, Farha Abdel Aziz El Chennawi1,
Dina Abd El-Halim Shahin2, Youssef Mohamed Mosaad1
1Clinical Immunology Unit, Clinical Pathology Department, 2 Department of Internal Medicine,
Rheumatology and Immunology Mansoura Faculty of Medicine,
Mansoura University, Dakahlia, Egypt.
Corresponding author:Amr M. Fathy, ORCID ID: https://orcid.org/0000-0003-0570-3015,Phone number:
+201006094696,Email: Amrfathy@mans.edu.eg

Mycophenolic acid (MPA), an efficient immunosuppressive medication used in SLE, is glucuronidated by
UGTs into an inert 7-O-glucuronide. Studies have shown that the -275T>A and-2152C>T SNPs in the UGT1A9 promoter
region are associated with greater hepatic production of UGT1A9 and higher MPA in vitro glucuronidation activity.
Subjects and Methods: patients were selected from outpatient Clinics of Rheumatology and immunology department,
UGT1A9 -275T>A and-2152C>T (SNPs) were genotyped in 50 SLE Egyptian patients and 100 healthy controls using PCR-
RFLP. In addition, MPA serum concentrations were measured in patients by homogeneous particle enhanced turbidimetric
inhibition immunoassay (PETINIA) technique.
Results: UGT1A9-2152C>T and -275T>A distribution of genotypic analysis in SLE patients and controls revealed that the
-2152C>T mutation is present in 14% patients and 21% of the control group (P = 0.3), whereas the -275T>A mutation is
present in 50% of patients and only in 11% of the control group (P = 0.001). In comparison to the (TT) genotype, the
combined (TA+AA) genotype exhibited significant correlation with greater GIT symptoms (68% versus 5%, respectively,
P = 0.001). In SLE patients taking MPA with CT+TT genotype against CC genotype, -2152C>T mutations revealed a higher
incidence of anemia (85.7% versus%, 30.2 respectively P =0.009). Both SNP genotype carriers had statistically lower C0
MPA values compared to non-carriers (1.25 umol/L (0.62-7.8) versus 4.68 umol/L (0.62-25.9), P = 0.028.
Conclusion: Carrier of both UGT1A9-2152C>T and -275T>A SNPS is associated with lower C0 MPA in comparison to
non-carrier in Egyptian SLE patients.
Keyw ords: UGT1A9, polymorphism, SLE, MPA.
MPA (Mycophenolic acid), SNPs (Single nucleotide polymorphisms), UGT (uridine diphosphate-

molecules(3), Numerous cells, including those in the liver,
SLE is a multiorgan autoimmune illness that
kidney, and gastrointestinal system, express this enzyme.
typically affects girls between the ages of 20 and 30. Its
A single nucleotide polymorphism (SNP) in the UGT1A9
etiology is unclear. SLE has remission and exacerbations
promoter (-2152C>T and -275T>A) affects the
and affects several organs, including the skin, CNS,
expression and activity of this enzyme, and it is believed
kidneys, lungs, heart, and blood cells. Positive antinuclear
that these SNPs have pharmacologic importance in terms
antibodies with a titer of 1/80 or above utilizing indirect
of MPA activity and concentration(4).
immunofluorescence on HEP-2 cells or any similar
This study sought to examine the distribution of
approach serve as the diagnostic characteristic(1).
An immunosuppressive medication known as
polymorphisms (SNPs) in the UGT1A9 promoter region
mycophenolic acid (MPA) is frequently used to avoid
in Egyptian patients with SLE as well as how these SNPs
acute rejection in kidney transplants. It is also utilized in
affected the pharmacokinetics of mycophenolic acid
several SLE patients, most notably Lupus nephritis, to

monophosphate dehydrogenase (IMPDH), a crucial
enzyme involved in the de novo synthesis of guanosine
The patients were selected from outpatient Clinics
nucleotides, is reversibly inhibited by MPA. This
of Rheumatology and immunology department,
prevents DNA replication and stops the proliferation of T
Mansoura university hospitals between January and
and B cells, which suppresses humoral and cell-mediated
august 2021. The present study included 150 patients
immunity and induces tolerance(2).
divided into two groups; the control group included 100
seemingly healthy subjects: 10 males & 90 females,
(UDP-glucuronosyl transferase) is an enzyme that
whose ages ranged from 18-50 years with a median age
transfers glucuronic acid to small hydrophobic
of 34 years. The patient group included 50 systemic lupus
Received: 9/5/2022
Received: 8/7/2022

Full Paper (vol.901 paper# 5)

c:\work\Jor\vol901_6 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89, Page 31- 36

The Effect of Surgical Salpingectomy versus Single-Dose Methotrexate on Ovarian
Reserve in Ectopic Pregnancy at Alzahraa University Hospital
Rania Mahfouz Abd El-Wahed*1, Alshaymaa Abdelbadie Abdelalim Nasr2
Departments of 1Obstetrics and Gynecology and
2Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
*Corresponding author: Rania Mahfouz Abd El-Wahed, Mobile: (+20) 01001131785, E-Mail: rania.mahfouz2@gmail.com


Background: Ectopic pregnancy (EP) is a major reason of maternal mortality and morbidity, affecting 1% to 2% of
pregnancies. Whether medically with methotrexate (MTX) or surgically with salpingectomy, managing EP could
seriously affect female sexuality and reproductive health. The impact of medication and surgical treatment for EP on
future fertility is currently unknown and has not been well explored. Objective: This study examines the future
reproductive effects of medication and surgical management for EP. Patients and methods: In this prospective study,
50 EP subjects were involved and randomly subdivided into two groups: (MTX) (Group A, n: 25) and salpingectomy
(Group B, n: 25). Anti-Mullerian hormone (AMH), beta-human chorionic gonadotropin (-HCG), liver enzyme levels,
and platelet count were evaluated before and after the treatment protocol. Hysterosalpingography (HSG) has also been
conducted three months after therapy for Group A to examine tubal patency. Results: Three months following therapy,
the AMH levels significantly decreased in Group A compared with Group B (p=0.04). Also, in Group A, AMH levels
after 3 months showed a statistically significant decline contrasted with those at the time of therapy. Conclusion: AMH
levels prior to and after medication with a single dose of systemic MTX and unilateral salpingectomy for EP were
positive signs. Present medical and surgical therapy methods have no detectable detrimental impact on ovarian reserve.
Keywords: Salpingectomy, Methotrexate, Ectopic, Pregnancy, Al-Azhar University.


still the best option for EP. Salpingectomy may
Ectopic pregnancy (EP) is a major reason of death
compromise OR due to the close physical closeness of
and illness in mothers and affects between 1% and 2%
the fallopian tube and ovary, as well as their shared
of all pregnant women [1]. Even though it can grow in
blood supply [3].
different places outside of the uterus, the fallopian tubes
Anti-Müllerian hormone (AMH) is synthesized by
are the most frequent where it happens. Diagnostic and
granulosa cells of antral follicles in the ovary of females.
imaging approaches have improved, making early
The hormone is then secreted into the follicular fluid
detection and management possible, leading to a large
and blood circulation. In health care settings, its
drop in maternal deaths [2].
concentration in peripheral circulation is monitored.
The level of AMH level is commonly associated with
pharmacological Methotrexate (MTX) and surgical
the number of primordial follicles, which could make it
(salpingectomy, salpingostomy, as well as milking)
the most precise hormonal monitor of the OR [5].
methods. MTX is a potent chemotherapeutic drug that
AMH levels correlated along with the count of
is frequently prescribed for various EPs [3].
recovered oocytes, the quality of embryos, fertility
However, MTX is considered a highly efficient
rates, as well as live birth percentages in patients
and non-invasive medication for EP, showing a
experiencing in vitro fertilization (IVF) [6]. AMH level
significant risk of infertility by targeting aggressively
is recognized as a more accurate and dependable
prognostic of OR, particularly in comparison to
Furthermore, MTX therapy is associated with a lengthy
period between both the cure of EP and the necessity to
stimulating hormone (FSH) and antral follicle count
wait several weeks before attempting again. There
(AFC) [7].
could also be a negative influence on ovarian reserve
Developing the capability of releasing AMH from
(OR) [4]. Surgical treatment, such as salpingectomy, is
a primordial follicle is considered to require at least
Received: 02/06/2022
Accepted: 09/08/2022

Full Paper (vol.901 paper# 6)

c:\work\Jor\vol901_7 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 37- 46
The Pattern of Cardiovascular Manifestations in Egyptian Patients With
Ankylosing Spondylitis and Its Relation to Disease Activity
Nashwa Aly Morshedy, Amina Badr Eldein, Mostafa Kamel Hassan, Mohammed Abd El Monem Teama*
Department of Internal Medicine, Rheumatology and Immunology,
Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Mohammed Abd El Monem Teama, Mobile: (+20)01277580006, Email: mohteama2009@yahoo.com

Cardiovascular manifestations are one of the most common extraarticular features of ankylosing
spondylitis (AS) patients. Objective: To characterize the cardiovascular symptoms of AS in a sample of Egyptian
patients and to establish a connection between these symptoms and disease activity.
Patients and Methods: Forty adults with Spondyloarthritis (SpA) were chosen at random from Ain Shams University
Hospital and diagnosed using Assessment of Spondyloarthritis International Society (ASAS) criteria for current cross-
sectional study. All patients underwent detailed history taking, full clinical examination, laboratory investigations
including (CBC, ESR, CRP, lipid profile) resting electrocardiogram, cardiac echo and carotid duplex to measure Carotid
Intima-Media Thickness (CIMT), and evaluate disease activity using the Ankylosing Spondylitis Disease Activity Score
(ASDAS)-C-reactive protein.
Results: The majority of patients (about 66%) experienced cardiac symptoms have had a valvular lesion, with tricuspid
regurgitation being the most common symptom (42.5%) then diastolic dysfunction (25%) followed by systolic
dysfunction (20%), intra cardiac mass (5%) and pericardial effusion (2.5%). Most of our patients had abnormal lipid
profile (hypertriglycerdemia 87.5%, hyperchlostremia in 80%, high LDL in 90%), 21 patients (52.5%) had abnormal
CIMT. The ASDAS-CRP score of the patients was ranged from 0.4-4.6. It was statistically significant correlated with
age, multiple cardiovascular lesions as systolic dysfunction, diastolic dysfunction (p<0.05), different forms arrhythmias,
and CIMT (p<0.05) although there is no statistically significant link to lipid profile (p>0.05).
Conclusion: Cardiovascular affection in AS patients is frequent, whether being clinical or subclinical and it is related
in a way to high disease activity.
Keywords: Cardiovascular manifestations, Ankylosing spondylitis, Lipid profile, Disease activity.

are all examples of cardiovascular involvement in AS.
Inflammatory illnesses of the sacroiliac (SI)
The most common problems are aortic insufficiency
joints and the rest of the axial skeleton are known as
and conduction abnormalities. Although uncommon,
axial spondyloarthropathies (axSpA). Patients have a
mitral insufficiency in AS can lead to life-threatening
wide range of negative symptoms, including pain,
heart failure (7).
exhaustion, restricted spinal motion, functional
The researchers in this study set out to do just
incapacity, and diminished mental health (1).
that by identifying and analysing the cardiovascular
Chronic inflammatory back pain is a hallmark
symptoms of AS in a sample of Egyptian patients and
of axSpA, which can be subdivided into two categories
determining how they relate to disease activity.
based on clinical and radiological characteristics: A).

Radiographic axSpA, which is characterised by
radiographic and structural alterations in the SI joints.
Forty adult patients were enrolled in the current
B) Sacroiliac inflammation revealed by MRI or the
cross-sectional study diagnosed with AS using the
presence of HLA-B27 in combination with classic
ASAS criteria (8). From May 2021 through January
spondylarthritis characteristics are the gold standards
2022, patients from the Ain Shams University hospitals'
for diagnosing non-radiographic axSpA(2).
outpatient clinic and the Internal Medicine and
In the United States, axSpA has an incidence of
Rheumatology Departments were enrolled. Patients
0.9­1.4% among adults, which is comparable to that of
with psoriasis, inflammatory bowel diseases (Ulcerative
rheumatoid arthritis (3).
colitis, Crohn's disease), other autoimmune diseases
AxSpA is often diagnosed and treated by
(SLE, RA, Scleroderma), diabetic, hypertensive, obese
patients (metabolic syndrome), and hypothyroidism
frequently miss the diagnosis because to a lengthy delay
were excluded from the study.
in making the determination (4).
One of the most prevalent extra articular
symptoms of AS is cardiovascular system involvement,
Clinical evaluation:
which is especially common in patients with long-term
A complete history was taken from all subjects
AS and peripheral joint involvement (5).
with focus on sex, age, duration of the disease, drug
Different studies showed that those with AS
history as well as full clinical, and rheumatological
have a higher chance of developing cardiovascular
examination with special emphasis on: axial spine
disease (6). Atrioventricular (AV) block, aortitis of the
(cervical, thoracic and lumbosacral regions) and
ascending aorta, aortic insufficiency and branch block
examination of sacroiliac joints.
Received: 16/7/2022
Accepted: 17/9/2022

Full Paper (vol.901 paper# 7)

c:\work\Jor\vol901_8 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 47-54
Calvarial Lesions: En-bloc Resection Is a Safe Surgical Procedure
Mohammed Mourad*, Mahmoud Wahdan, Ahmed R. Rizk
Department of Neurosurgery, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mohammed Mourad, Mobile: (+20)01558445071. Email: morademan@yahoo.de.
Calvarium could be a target site for either primary or secondary tumors. Calvarial tumors present usually
as painless palpable masses, which are asymptomatic neurologically. Objective: To perform a retrospective analysis of
the calvarial lesions operated in our departments of neurosurgery. Patients and Methods: We retrospectively reviewed
41 consecutive patients operated for calvarial masses between 2014 and 2020 at Benha University Hospital and Merciful
Brothers Hospital Trier. Clinical data were retrospectively analyzed. The diagnosis was confirmed by the
histopathological examination. Results: Calvarial lesions included in this series were divided into 3 categories: tumor-
like lesions, primary, and secondary tumors. The group of tumor-like lesions involved eosinophilic granuloma (3
patients), epidermoid cyst (3 patients), and fibrous dysplasia (5 patients). The primary tumors included hemangiomas
(5 patients), osteomas (5 patients), and meningiomas (11 patients). Nine patients had metastasis. Calvarial lesions mostly
presented with local swelling, sometimes local pain and rarely neurologic deficit. En-bloc resection was performed
followed by cranioplasty. Pain was improved postoperatively in cases presented with painful swelling. The only
postoperative complication was one case of wound infection. Conclusion: Although a thorough preoperative
radiological evaluation in cases of calvarial lesions could be helpful in narrowing the diagnosis spectrum of differential
diagnosis, en-bloc resection followed by cranioplasty could be considered as a valuable treatment option. The next step
in treatment of such patients vary widely according to the histopathological findings.
Keywords: Skull metastasis, calvarial tumors, cranioplasty, PMMA.

Calvarial lesions are usually asymptomatic and may
which was diagnosed through histopathology. No cases
be discovered incidentally(1). That's why such lesions
were excluded from the study.
carry less clinical importance than intracranial lesions(2).
The medical records of 41 patients were reviewed for
When becoming symptomatic they present themselves as
demographic data, the records of each patient were
a visible or palpable painless mass, which is sometimes
analyzed documenting pre- and postoperative clinical
painful(3). It is worthy to note that a wide variety of serious
symptoms and radiological as well as intraoperative
diseases can stand behind such a simple lesion and early
findings, surgery-related complications, and short-term
diagnosis is crucial for starting the optimum treatment(2).
Although CT scan is commonly considered a good tool
Ethical consent:
for the diagnosis of any boney lesion, MRI enables the
An approval of the study was obtained from Benha
screening for metastases in both skull and brain(4).
University Academic and Ethical Committee. Every
Differentiation of the imaging features of both benign and
patient signed an informed written consent for
malignant lesions is vital for establishing the radiological
acceptance of participation in the study. This work has
been carried out in accordance with The Code of
Histopathological examination is crucial in
Ethics of the World Medical Association (Declaration
of Helsinki) for studies involving humans.
postoperative staging is important not only for metastatic
Statistical analysis:

lesions but also for some other lesions like eosinophilic
The collected data were coded, processed and
granuloma and fibrous dysplasia. Our strategy in dealing
analyzed using the SPSS (Statistical Package for Social
with such lesions is to perform en-bloc resection with
Sciences) version 22 for Windows® (IBM SPSS Inc,
immediate reconstruction using polymethyl methacrylate
Chicago, IL, USA). P value < 0.05 was considered
(PMMA). Two-staged surgery is used very rarely in cases
with large skull lesions, where reconstruction is
performed in the second stage using a 3D-printed
This study included 41 patients (18 males, 23
The aim of our study is to perform a retrospective
females). The characteristics and presentations of the
analysis of the calvarial lesions operated in our
patients are shown in table 1. Accidental diagnosis was
departments of neurosurgery.
common in metastasis (56% accidentally diagnosed),

where the diagnosis was performed during routine
staging. An example of the accidental finding was a
A retrospective analysis was performed for all the
patient diagnosed for a frontal osteoma in whom a CT-
calvarial lesions operated upon between January 2014 and
brain was performed due to left-sided weakness, and
May 2020 at Benha University Hospital Egypt and
showed chronic subdural hematoma and the osteoma (Fig.
Merciful Brothers Hospital Trier- Germany. Preoperative
6). The patient characteristics, pathology and presenting
CT and MRI confirmed presence of a calvarial lesion,
symptoms are presented in Table 1. Table 2 shows the

number and location of the lesions in the presented series.
Received: 14/7/2022
Accepted: 12/9/2022

Full Paper (vol.901 paper# 8)

INTRODUCTION The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 55- 62

Early Outcomes of Glenn Shunt in Patients Aged 3 to 6 Months vs. above 6 Months

Ihab Mohamed Salah El Din Elsharkawy*, Ahmed Mohamed Abd Elmegeed El-Feky, Hossam Mahmoud
Hassanein, Tamer Farouk Siam, Mahmoud Saber Elsayed Singer
Lecturer of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Ihab Mohamed Salah El Din Elsharkawy, Mobile: (+20) 01222222213,
E-Mail: bebosharkawy@gmail.com
Bi-directional Glenn shunt is a well-established procedure performed as a part of the single ventricle
palliation pathway. The Bi-directional connection may also provide definitive palliation in certain patients. A major
advantage of the cavopulmonary connection is that it diminishes the extent of the inevitable pulmonary recirculation,
thereby resulting in a decrease in the workload of the functionally single ventricle.
Objective: To compare the short-term outcome of Glenn operation in patients aged between 3 to 6 months and
patients aged 6 months above. Patients and methods: Our study was a retrospective randomized trial, carried out in
Cairo University Hospitals, in the period between October 2018 and May 2020. Study Population had been
randomized into two groups. Group I: 20 patients who underwent Bi-directional Glenn aged 3 to 6 months & Group
II: 20 patients who underwent Bi-directional Glenn aged more than 6 months.
Results: There were significant differences between both groups regarding preoperative evaluation including age,
weight, sizes of RPA & LPA and McGoon index. Unbalanced AV canal and DILV are most common diagnoses after
tricuspid atresia as explained by their natural incidence in single ventricle diseases. There was significant increase in
the O2 saturation in each group. There was insignificant difference between both groups regarding post-operative
mortality and morbidity that met with many other similar studies.
Conclusion: This approach had a number of advantages where it eliminates the need for the traditional first-stage
procedures, such as systemic arterial shunting and PA banding, which minimizes PA manipulation and subsequent
distortion. The reduction in the number of procedures will also have a favorable impact on cost.
Bi-directional Glenn shunt, Outcomes, patients aged 3 to 6 months vs. above 6 months.


Bi-directional Glenn (BDG) shunt is a well-

established procedure performed as a part of the single
improve long-term diastolic function, decreasing the
ventricle palliation pathway. The Bi-directional
effective cardiac output required from the single
connection may also provide definitive palliation in
ventricle, avoiding potential pulmonary tree distortions
certain patients. A major advantage of the
seen with systemic to pulmonary shunts, and perhaps
cavopulmonary connection is that it diminishes the
preventing the development of pulmonary vascular
extent of the inevitable pulmonary recirculation,
obstructive disease (3). Despite increased reports in the
thereby resulting in a decrease in the workload of the
literature documenting the early BDG procedure, there
functionally single ventricle. Other advantages include
is continued controversy regarding the timing, with
the avoidance of pulmonary vascular disease, and also
some arguing little benefit in waiting beyond 6 months
major pulmonary arterial distortion (1). Univentricular
(4, 5). On the other hand, others are cautioning against
atrioventricular connection affects approximately 3 %
performing the procedure in those younger than 6
of infants born with congenital heart disease. Early
months. These cautions stem from concern with possibly
palliative procedure for such infants is mandatory with
increased mortality and morbidity with an early Glenn
the goal to relief cyanosis, prevent damage to
procedure; the possibility that the pulmonary arteries will
ventricular functions and pulmonary vasculature, and
not be as well developed with passive flow, and the
facilitate future definitive repair by preserving
potential adverse effects on cerebral circulation or long-
physiologic parameters. The cavopulmonary shunt
term candidacy for Fontan completion. The ideal age and
(superior vena cava to the right pulmonary artery)
age limits to perform the Glenn procedure remain
provides partial physiological correction for those
uncertain (6). The aim of the study was to compare the
infants. Its main advantage is to provide obligatory
short-term outcome of Glenn operation in patients
pulmonary blood flow, and avoid left ventricular
aged between 3 to 6 months and patients aged 6
months and above, to show whether it is safe to
pulmonary artery shunt (2).
perform Glenn operation before 6 months of age or
There have been numerous studies looking at
the timing of the BDG procedure, with many

highlighting the potential benefits of performing an
``early'' BDG procedure. These include removing a
This was analytical observational retrospective
volume load from the single ventricle that can benefit
study, 40 patients indicated for Glenn shunt were
atrioventricular (AV) valve insufficiency and perhaps
included after institutional and local ethical committee

approval. The study was done at Cairo University
Received: 16/06/2022
Accepted: 24/08/2022

Full Paper (vol.901 paper# 9)

c:\work\Jor\vol901_10 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 63- 70

Open Surgical Excision of Intracranial Arachnoid Cysts after
Initial Procedure Failure in Children
Mohamed M. Elmaghrabi*, Tamer M. Elsanadidy, Ahmed A. Arab
Department of Neurosurgery, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mohamed M. Elmaghrabi, Mobile: (+20)1222751406, Email: dr_elmaghrabi@yahoo.com

Intracranial arachnoid cysts (IAC) are pathological conditions that occur in 2.6% of children. Different
surgical procedures had significant failure rate. The objective of the current study is to evaluate the effectiveness of
open surgical excision in failed first-other surgery.
Patients and methods: A total of 23 patients with symptomatic arachnoid cysts, with radiological evidence who had
had one previous failed surgical intervention, shunting or endoscopic fenestration, underwent open surgical excision of
the arachnoid cyst at the Neurosurgery Department of Benha University and Benha Children Hospitals through the
period from January 2018 to January 2022.
Results: Children with IAC underwent open surgical excision, totalling 9 (39.1%) cases and partial in 14 (60.9%) cases.
In 13 cases, associated microscopic fenestration to basal arachnoid cisterns was done. The mean follow-up period is
28.36 (SD 3.97) months with 77.3% success and 22.7% failure with subsequent treatment by cystoperitoneal shunting.
Total excision success is 100%, but partial excision is 64.3%, with 88.9% of them being associated with microscopic
fenestration. Mild early transient complications were reported in only 3 cases and were conservatively treated, but late
complications occurred in 2 cases.
Conclusion: Open surgical excision of IAC has a very good success rate in the treatment of intracranial arachnoid cysts
after initial procedure failure; complete excision should be the main aim whenever possible for optimum results that
force us to ask: "Could it be the first line of surgical treatment in symptomatic untreated cases?"
Keywords: Open surgical excision, Intracranial arachnoid cyst, Cystoperitoneal shunting, Children.


radiological evidence who had a previous failed surgical
Intracranial arachnoid cysts (IAC) are pathological
intervention, either shunting or endoscopic fenestration
conditions that occur in 2.6% of children (either
were included in this study, and they underwent open
symptomatic or asymptomatic), with 90% of these
surgical excision of the arachnoid cyst at the
occur in the supratentorial area, with 60% in the middle
Neurosurgery Department of Benha University and
cranial fossa (1). The aetiology of although it is unclear,
Benha Children's Hospitals throughout the period from
a splitting or duplication of arachnoid membranes with
January 2018 to January 2022.
an accumulation of cerebrospinal fluid via a slit valve
A total of 23 patients were recruited; 13 boys, and
mechanism is mostly accepted (2-4).
10 girls, ranging in age from 1 year to 9 years (mean age
Most authors suggested surgical intervention as the
3.39; SD 2.25). It included one death case in the early
symptomatic arachnoid cyst had symptoms and signs
postoperative period due to electrolyte imbalance
related to cyst size and expansion with increased intra-
without radiological complications from surgery. The
cystic pressure (5, 6).
IAC was classified as Sylvian (12/23), Middle Cranial
Different surgical procedures were approached,
Fossa (5/23), Posterior Cranial Fossa (4/23), and Frontal
including aspiration, open surgical excision, endoscopic
fenestration, marsupilization, and cystoperitoneal

shunting (3,4, 7-8).
Preoperative Work-up:
All patients underwent routine physical
fenestration are good surgical options with good results.
examinations and received a thorough neurological
However, some cases with cystoperitoneal shunting
evaluation. Neuroimaging studies consisted of
complications and dependency and with ineffective
computerized tomography (CT) and magnetic
endoscopic fenestration may need open microscopic
resonance imaging (MRI).
surgery, aiming for effective fenestration to the basal
Clinically, these patients either presented with the
cistern, marsupilization, or more extensively to partial
same symptoms as before the previous intervention, or
or complete excision of the arachnoid cyst.
showed deterioration after an initial period of clinical
In our study, we evaluated the effectiveness of open
improvement. Symptoms included signs of increased
surgical excision of an arachnoid cyst in cases with
intracranial pressure (headache, drowsiness, vomiting,
bulging of fontanels, and an enlarged head), seizures,
hemiparesis, and visual obscuration. All patients had a

CT scan; those with no improvement or newly
developed problems, such as a large compressing
Study design: this is a prospective clinical cohort study
subdural hygroma were included in this study. For those
of 23 patients with symptomatic arachnoid cysts with
who participated in the study, magnetic resonance
Received: 17/06/2022
Accepted: 25/08/2022

Full Paper (vol.901 paper# 10)

c:\work\Jor\vol901_11 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 71- 78

Late onset Systemic Lupus Erythematosus: Different Clinical, Serological
Presentations and Damage Compared to Adult Lupus in Egypt
Samah A. El Bakry, Mariem Abd-Elrahman,
Marwa Mohamed Elsayed, Fatma Mohammed Badr*
Internal Medicine, Rheumatology and Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Fatma Mohammed Badr, Mobile: (+20)01274307978, Email: dr_fatma2020@yahoo.com


Background: Comparing cases of adult onset and late onset systemic lupus erythematous (SLE) reveals significant
differences in clinical, serological, disease activity, and damage score.
Objective: This study aimed to analyze clinical manifestations, laboratory data, serological markers, and prognosis of
late-onset SLE (L-SLE) and for comparing with adult- onset SLE.
Patients and Methods: One hundred fifty individuals with SLE were included in a cross-sectional study conducted at
Ain Shams University Hospital. They were divide into: Group 1 included 100 cases with adult-onset (age of onset 19
years and below 50 years). Group 2 included 50 Patients with L-SLE (age of onset 50 years). All patients were
subjected to medical history, physical examination, disease activity measured by the SLE disease activity index
(SLEDAI-2K) and a damage score. Laboratory investigations as complete blood count (CBC), blood urea nitrogen
(BUN), serum creatinine, anticardiolipin antibodies, lupus anticoagulant, protein creatinine ratio, serum complement
(C3, C4), anti-dsDNA antibody, and antinuclear antibodies (ANA).
Results: Mucocutaneous manifestations, frequency of hematuria, proteinuria, urinary cast, consumed C3, positive anti-
dsDNA antibodies, anti-cardiolipin antibody and lupus anticoagulant titers had considerably greater rates in-group 1
compared to group 2 (P-value <0.05) while group 2 had significantly more musculoskeletal symptoms (P-value <0.05).
The SLEDAI scores of the two groups were equivalent, however the damage index was greater in group 2 (P-value
0.00). Neuropsychiatric, cutaneous, renal, and skin damage were more frequent in group 1, while musculoskeletal,
endocrinal, pulmonary, cardiovascular and ocular damage were more frequent in- group 2.
Conclusion: late-onset SLE is different from adult onset SLE with more frequent damage.
Keywords: Adult SLE, L-SLE, SLEADI, Damage score.

Clinical and laboratory symptoms of the
Collaborating Clinics (SLICC) (6) who attended Ain
autoimmune illness as SLE can vary widely. Despite
Shams University Hospitals. They were divided into
lacking of understanding of its origin, we know that
two groups: Group 1 included 100 cases with adult-
genetic, hormonal, and environmental variables all play
onset SLE. Adult onset SLE was defined as age of onset
a part in the progression of this disease (1).
19 years and below 50 years. Group 2 included 50
Systemic signs of SLE include fever and
patients with L-SLE. L-SLE was defined as age of onset
arthritis, but it can also harm the kidneys and the central
50 years. Patients with other autoimmune diseases and
nervous system. The prognosis and quality of life of a
those with drug-induced lupus were excluded from the
patient can be improved by taking measures to prevent
permanent harm to vital organs (2). Both the intensity and

clinical manifestations of the disease are influenced by
II) Methods:
the age at which it first appeared. The onset and
Complete clinical evaluations were performed for
progression of L-SLE (50 years) are less obvious and
all patients, including a thorough history taking session
less severe. (3) that characterized by a reduced incidence
where age, sex, disease duration, and presenting
of nephritis and central nervous system involvement
symptoms were emphasized. A thorough physical
compared to the adult-onset type (4).
examination and a thorough musculoskeletal
Nonetheless, L- SLE has a worse prognosis
examination. Laboratory assessment including CBC,
because of age and prolonged exposure to vascular risk
urine analysis besides assessing active urinary
factors, which results in an increased prevalence of
sediments (white blood cells, red blood cells, as well as
concomitant disorders and increased organ damage (5).
casts or proteins), kidney function tests (serum
Our study aimed to analyze clinical
creatinine and BUN), protein creatinine ratio,
manifestations, laboratory data, serological markers,
erythrocyte sedimentation rate (ESR) by Westergren
and prognosis of L-SLE and for comparing with adult-
method, ANA and direct immunofluorescence with
onset SLE.

complements levels C3 and C4 by Cobas C6000
autoanalyzer, anticardiolipin (IgG & IgM) antibodies by
I) Patients:
enzyme-linked immunosorbent test (ELISA) and lupus
The current cross-sectional study recruited 150
anticoagulant by diluted Russell viper venom time
SLE patients diagnosed upon SLE classification criteria
(Roche Diagnostics GmbH, Mannheim, Germany). The
Received: 24/7/2022
Accepted: 25/9/2022

Full Paper (vol.901 paper# 11)

c:\work\Jor\vol901_12 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 79- 83

High Tumor Levels of Ki-67, VEGF and Endostatin are Associated with
Progression of Breast Cancer in Iraqi Women
Rana H. K. Al-Rubaye1& Rakad M. Kh AL-Jumaily2*
1Department of Biology, College of Education for Pure Sciences/ Ibn Al-Haitham, University of Baghdad, Iraq.
2Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq
*Corresponding author: Rana H. K. Al-Rubaye, E-mail: rana.h.k@ihcoedu.uobaghdad.edu.iq

Breast cancer (BC) is the most widespread cancer among women worldwide. Its incidence and mortality rates
have risen in the previous three decades as a result of changes in risk factor profiles, improved cancer registry, and cancer
detection. Objective: The study's goals were to establish if Ki-67 could be used as a potential marker in serum of cancer
disease patients as well as their interaction with vascular endothelial growth factor (VEGF) and ES in various stages of
breast cancer to assess their function in the progression of BC.
Materials and Methods: The levels of Ki-67, VEGF and endostatin (ES) in serum were assessed by commercial enzyme
linked immunosorbent assay (ELISA) kits in 60 women diagnosed with breast cancer (age range 33­80 yrs.) and 30 age-
matched healthy controls. Two groups of breast cancer patients: groups 1 consisted of stage II (Low level) and groups 2
consisted of patients in stage III and IV (High level).
Results: The results showed a significant increase of Ki-67 and VEGF in BC patients as related to healthy control with
increases in patients in advanced stage. The data revealed that the level of ES was much lower in patients with low-stage
(stage II) compared to the group of control, but it was significantly higher in women with advanced-stage of BC.
Conclusions: The Ki-67, VEGF, and ES levels in the serum of studied groups may be a good marker in the progression of
Ki-67, VEGF, Endostatin, Breast cancer.

placental growth factor (PlGF) are the most common
Breast cancer (B.C.) is a global problem, ranking top
members of the VEGF family (8). Angiogenesis is a key
among malignant neoplasms and affecting around 13% of
component of carcinogenesis, development, and metastasis
women in their lifetime (1). Breast cancer accounts for one-
in many human cancers. VEGF is regarded to be a key
third of all registered women's cancers in Iraq (2).
regulator of angiogenesis, promoting tumor cell
Ki-67 is a DNA binding protein that is found in most
proliferation as well as invasion and metastasis. Tumor
of vertebrates. It's commonly used as a proliferation mark
vascular density, particularly BC, has been shown to be
for tumor grading. It's expressed in every kinetic stage of
closely related to prognosis (9). However, pathologic
the cell cycle except G0. It is regarded as one of the most
angiogenesis can be caused by disturbances in the balance
dependable indices for determining the degree of
of pro- and anti-angiogenic factors (10).
malignant tumor cell proliferation (3). Ki-67 has recently
Endostatin is created by proteolytic cleavage of
received much attention as a promising prognostic,
collagen XVIII by a set of proteinases such as elastase,
predictive, and therapeutic target in malignant neoplasms
matrix metalloproteinases (MMPs) and procathepsin L (11).
such as bladder, lung, cervical, and breast carcinomas (4).
Endostatin suppresses angiogenesis by binding to VEGFR-
In some tumors' tissue, the expression of Ki-67 was used
1 and VEGF- 2 and preventing VEGF interaction with Flt-
as a clinical setting to study the state of tumor (5). However,
1 and Flk-1 and all downstream signaling proceedings (12).
it has suggested that Ki-67 have the ability to secrete or
This study aimed to identify the relationship between
leaked out of cancer cells and thus, it can easily be
VEGF-A, ES and Ki-67 to evaluate their potential roles in
measured in the serum of patients (6).
the progression of BC disease.
Angiogenesis is the formation of new vasculature

from pre-existing ones. Aangiogenesis process is tightly
maintaining by the interaction between pro- and anti-
Study design
angiogenic factors. Many potent promoter angiogenic
A total of 90 Iraqi women participated in this
factors are described since the identification of the master
study; 60 women were diagnosed with BC during their
role of growth factor in maintaining the balance of
attendance at Oncology Teaching Hospital /Medical
angiogenesis forming (7). VEGF-A is a key regulator of
City/Baghdad. The study extended from November 2020
vascular growth among pro-angiogenic factors, and the
till April 2021. Age of breast cancer women range from
VEGF family is regarded a key activator of vascular
(33­80) years. In addition, 30 apparently healthy women
development and angiogenesis. VEGF-A (commonly
also participated in this study whose ages ranged between
known as VEGF), VEGF-B, VEGF-C, VEGF-D, and
32-75 years. Patients with BC involved in this paper were
Received: 5/8/2022
Accepted: 6/10/2022

Full Paper (vol.901 paper# 12)

c:\work\Jor\vol901_13 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 84- 87

Mitral Valve Repair in Children with Mitral Insufficiency
Using Single Simple Technique
Ihab Mohamed Salah Eldin Elsharkawy*1, Hosam Fathy Ali Sayed1,
Mahmoud M. Elwakeel2, Ahmed H. Lamloom1
Departments of 1Cardiothoracic Surgery and 2Anasthesia Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Ihab Elsharkawy, Mobile: (+20) 01222222213, E-Mail: bebosharkawy@gmail.com
The multifactorial nature of pathologies causing mitral valve insufficiency in children along with the
anticipated child's growth make mitral valve repair in such age group a complex procedure. The main cardiac surgeon's
consideration in repairing insufficient mitral valve is to rgestore the valve's geometry and motility using the simplest
possible technique.
Objective: This study assessed mid-term feasibility and durability of mitral posterior annuloplasty using pericardial
patch in patients aged less than 18 years as a simple technique of mitral valve repair.
Patients and Methods: Data from Cairo University Hospitals on total number of 100 children who underwent
successful mitral valve repair (without need for valve replacement) were gathered from their records, including
postoperative and follow-up echocardiographic studies.
Results: there were no in-hospital mortalities nor early postoperative significant mitral regurgitation (MR). Follow-up
echocardiographic studies revealed moderate mitral regurgitation in 8 patients (8%) and only one patient (1%) required
re-operation for severe mitral regurgitation where mitral valve replacement (MVR) was done.
Conclusion: MV repair (MVr) in children using pericardial patch for posterior annuloplasty showed excellent survival,
acceptable re-operation rate and satisfactory valve function at short and mid-term follow-up.
Keywords: Mitral valve repair, Posterior annuloplasty, Pericardial Patch and para-valvular leakage.

Inclusion criteria: Patients between the ages of 1 and
Mitral valve replacement (MVR) in children
18 years who have a significantly regurgitant mitral
has several drawbacks and is linked to a high mortality
valve as shown by a preoperative echocardiographic
ranging between 10 to 36% (1). Additionally, the need
scan and clinical signs of pulmonary congestion despite
for prolonged anticoagulant medications and the
maximal drug therapy.
likelihood of repeat MVR as the kid gets older are
associated with greater morbidity (2). Thus, whenever
Exclusion criteria: Patients with complex congenital
possible, mitral valve repair is preferred over
heart anomalies, atrioventricular septal defects, atrio-
replacement especially in pediatric populations(3).
ventricular discordance, and those with bad
Over the past two decades, many mid- and
preoperative condition including high inotropic support
long-term publications have reported that pediatric
and mechanical ventilation due to suspected high
patients can infer the same benefits from mitral valve
morbidity and mortality postoperatively were barred
repair as grown-ups with respect to preserving valvular
from participating.
tissue, sub valvular apparatus, and ventricular
One hundred consecutive patients meeting the
geometry, driving to ideal valve and ventricular
above criteria were entered into the study. Intra
dynamics (3-6). For best results of repair in children,
operative Trans-esophageal echocardiography (TEE)
cardiac surgeon has to minimize tissue handling and
avoid usage of any synthetic materials including mitral
echocardiography data were analyzed.
rings as mismatches between the native annulus and the
All patients underwent routine preoperative
mitral prosthesis have been linked to both early and late
investigations including electrocardiogram, chest X-
mortality (7, 8).
ray, hemoglobin, urea, electrolyte, serum creatinine and
echocardiography. MVr was performed trans-septally
in 78 patients, while the left atriotomy approach was
We aims to assess whether the use of a strip of
used in the remaining patients with a sizable left atrium.
the patient's own pericardium for mitral posterior
annuloplasty is feasible and durable as a simple MVr
Ethical approval:
technique in children with leaky mitral valves.
An approval of the study was obtained from
Cairo University Academic and Ethical Committee.
Every patient's parent signed an informed written
This descriptive, retrospective, and record
consent for acceptance of the operation. This work
analysis study included 100 patients who underwent
has been carried out in accordance with The Code of
isolated surgical MVr carried out in the Department of
Ethics of the World Medical Association
Cardiothoracic Surgery, Faculty of Medicine, Cairo
(Declaration of Helsinki) for studies involving
University in the period from January 2015 to
December 2021 aimed to assess the effectiveness of
posterior mitral annuloplasty using pericardial strip.
Surgical Technique:
Received: 22/6/2022
Accepted: 30/8/2022

Full Paper (vol.901 paper# 13)

c:\work\Jor\vol901_14 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 88- 92

Evaluation of Interleukin-18 Serum Concentration and Gene Polymorphism
(Rs1946518) in A Sample of Type-2 Diabetes Mellitus Patients from Iraq
Zainab Abdul Hadi Hussein1, Dunya Fareed Salloom1
Department of Biology, Collage of Science, University of Baghdad,Iraq
*Corresponding author: Zainab Abdul Hadi Hussein, zainab.abd2102m@gmail.com, mobile: (+964)07729807897

Type two diabetes (T2DM) is characterized by insufficient insulin production and secretion. Additionally,
the body develops insulin resistance which affects 90­95% of diabetics. Complex cytokines, receptors, genetic pathways,
and the immune system are involved in T2DM. Interleukin-18 (IL-18) is one of the inflammatory cytokines associated with
Type 2 diabetes. Environmental and genetic variables, including genetic polymorphisms, can increase T2DM risk and its
consequences. Single nucleotide gene polymorphisms (SNPs) are important risk factors for diabetes that can be used to find
the disease early and treat it better.
Objective: This study aimed to determine the levels of IL-18 in the serum of Iraqi patients with Type 2 diabetes mellitus,
as well as the effect of IL-18 SNP rs1946518 (-607 G/T) in the etiology of T2DM.
Materials and Methods: This study involved 100 T2DM patients (52 males and 48 females) who visited Al-Karamah
Teaching Hospital and Baghdad Teaching Hospital. 52 Iraqi control subjects (26 males and 26 females) were included. A
sandwich enzyme-linked immunosorbent assay was used to quantify the IL-18 serum levels of 48 patients and 40 healthy
controls. The genotype of IL-18 was determined using Real-time (RT) Taqman PCR.
Results: According to age, the current study revealed a non-significant correlation (p-value > 0.05) among the studied
groups. IL-18 levels in the T2DM group were substantially greater than in the healthy control. In addition, the genotyping
frequencies revealed that the frequency of TT genotyping was higher in T2DM group than in healthy control (80% versus
66.7%, OR: 2.0), whereas the frequency of GT genotyping was lower in T2DM than in healthy persons (20% versus 33.3%,
OR: 0.5).
Conclusion: This Iraqi's novel study indicated that IL-18 and it's SNP(rs1946518) contributes to the pathophysiology of
Type 2 diabetes mellitus.
Keywords: T2DM, Interleukin-18, SNP, RT-PCR.

beta cells, resulting in insufficient insulin production and
According to the World Health Organization
hyperglycemia (T2D) (5).
(WHO), diabetes mellitus is a chronic metabolic
Patients with T2DM have elevated cytokine
condition characterized by high blood glucose levels,
expressions and immune cell infiltration of pro-
which overtime causes damage to the heart, blood vessels,
inflammatory macrophages in their pancreatic islets (6).
eyes, kidneys, and nerves. T2DM, which accounts for
The IL-1 cytokine family, a prominent class of
90% of diabetes mellitus cases, is characterized by
immunoregulatory agents, has key roles in endocrine
insufficient insulin secretion by pancreatic islet cells,
processes and the regulation of inflammatory stress
tissue insulin resistance (IR), and an inadequate insulin
responses, particularly in T2DM (7). IL-18, a member of
secretory compensatory response (1). Since T2D is known
the IL-1 family of cytokines, is a proinflammatory
as non-insulin-dependent diabetes, T2DM patients do not
cytokine with pleiotropic effects and a molecular weight
require insulin therapy to survive (2).
of 18 kDa and 157 amino acids (8).
The etiology of type 2 diabetes is complicated and
Interleukin-18 (IL-18) was found as an interferon-
involves numerous risk factors included age, genetic
gamma (IFN)-inducing factor in the late 20th century. IL-
inheritance, environmental variables, lifestyle, and
18 also contributes to the pathophysiology of atopic,
infections (3). The risk of developing T2DM is
autoimmune, and chronic inflammatory illnesses, in
significantly influenced by genetic predisposition, which
addition to its role in immunological protection against
includes genetic faults of IR and genetic defects in insulin
infectious pathogens (9). Causing inflammation and
secretion (4).
immune cell infiltration, IL-18 can cause pancreatic islet
An inflammatory reaction arises due to the immune
cell injury/death and dysfunction by inducing
response to elevated blood glucose levels and the
inflammation. Then the resulting insulin resistance or
presence of inflammatory mediators generated by
insulin sensitivity suppression leads to type 2 diabetes (10).
adipocytes and macrophages in adipose tissue. This
Numerous clinical studies have demonstrated that plasma
chronic and low-grade inflammation damages pancreatic
levels of interleukin-18 (IL-18) are positively linked with
the onset and progression of type 2 diabetes (11).
Received: 22/6/2022
Accepted: 30/8/2022

Full Paper (vol.901 paper# 14)

c:\work\Jor\vol901_15 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 90, Page 93- 98

Evaluation of Interleukin-9 Serum Level and Gene Polymorphism in A
Sample of Systemic Lupus Erythematosus in Iraqi Female's Patients
Marwah Mohammed Jasim 1, Dunya Fareed Salloom1
Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq
*Corresponding author: marwamohammed90n@gmail.com, mobile: +9647707373618

Immunological gene and serum level for interleukin- 9 rs 17317275 have been established to have linked
to predisposition systemic lupus erythematosus (SLE) and its severity. SLE is a severe, systemic autoimmune disease
characterized by autoantibody generation, complement activation, and immune complex deposition. In the
pathophysiology of SLE, cytokines have a pleiotropic function. Recently, IL-9 was discovered to mediate strong anti-
inflammatory effects in numerous cells or experimental autoimmune models.
Objective: This study aimed to determine the role of age, IL-9 serum level and genetic polymorphism, C-reactive
protein (CRP), Anti-nuclear antibody (ANA) and Anti- double-stranded DNA (anti-dsDNA) to recognize SLE
Materials and Methods: This case-control study was carried out in Baghdad Teaching Hospital and Typical
Rheumatology Unit through the period from October 2021 to January 2022.103 Iraqi patients with SLE illness and 50
healthy Iraqis were included. Blood samples were taken. Serum IL-9 levels measured using the sandwich enzyme-linked
immune-sorbent assay technology (ELISA) and cytokine genotyping by using allele-specific PCR technique
Results: SLE groups had greater levels of IL-9 than did healthy volunteer. Furthermore, both autoantibodies (ANA,
Ant-dsDNA) were positive in SLE patients. The findings indicated that CRP was much higher in SLE subjects than
those of healthy controls. On the other hand, the results showed that there was non-significance (p-value > 0.05) in age
of studied groups. Concerning genotyping frequencies, the GG and AG genotyping were greater in the SLE group
compared to the healthy subjects, while the AA genotyping frequency was significantly lower in the SLE group
compared to the healthy people.
Conclusion: This study indicated the major roles of the serum level and genetic polymorphism of IL-9, CRP, ANA and
anti-ds DNA in pathogenesis and severity of SLE.
Keywords: SLE, IL-9, Polymerase chain reaction, ANA.

tissues of target organs such as the skin, kidneys, and
SLE is a complex and heterogeneous autoimmune
synovia. Most of the cytokines promote inflammation,
condition that usually affects women throughout their
although some also have immunoregulatory or anti-
reproductive years. It is caused by a breakdown in
inflammatory activities (6).
immunological tolerance and the interaction of SLE
In SLE patients, the chronic inflammatory
susceptibility genes with diverse environmental
condition can cause mortality and morbidity. Many
variables, which results in the creation of pathogenic
immunological lineages' development, maturation, and
autoantibodies (1). SLE has an etiology that is unknown.
activation depend greatly on cytokines. These cytokines
Several potential factors have been identified and
accelerate the inflammatory process in several organs,
demonstrated to increase disease susceptibility or to
affect the immune cells' gene expression, and the
stimulate the immune system resulting in an
pathophysiology of SLE is influenced by many
inflammatory response that eventually causes the illness
cytokines (7).
to develop. Predisposition to SLE is influenced by
In this study, we aimed to understand the role of
interleukin-9 (IL-9) in the pathogenicity of SLE. It is a
inflammation, and endorgan damage emerge from a
144-amino acid protein with an 18-amino acid secretory
complex combination of genetics, environment, and
signal sequence that belongs to the gamma-chain
hormones that cause immunological dysregulation and
cytokine family. It was first identified as one of a
the lss of self-antigen tolerance (3).
growing number of cytokines that play critical roles in
Besides, immune dysfunction, inflammation, and
the growth, survival, proliferation, and differentiation of
organ damage are all caused by cytokine abnormalities.
various types of cells (8).
Cytokine production is increased when both the innate
Mast cells, NKT cells, Th2, Th17, Treg, and
and adaptive immune systems are disordered (4). They
ILC2 cells were among the cells that generated it,
are small, soluble proteins made by immune system
although Th9 cells are the main ones (9).
cells and mediate the activation or functional direction
The human IL-9 gene can be identified on
of neighboring cells by attaching to their surface
chromosome 5 long arm (10). A wide spectrum of
receptors. Communication between immune cells is
immunological functions has been attributed to IL-9 in
mediated by cytokines, which is essential for organizing
promoting cellular and humoral immune responses (11).
defenses against infections (5). Secreted cytokines can be
IL-9 has been linked to a variety of disease pathogenic
seen in the bloodstream, saliva, urine, as well as in the
processes, most notably allergic disorders such as
Received: 26/6/2022
Accepted: 2/9/2022

Full Paper (vol.901 paper# 15)

c:\work\Jor\vol901_16 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 89 (2), Page 99- 106

Downstaging of Rectal Cancer Following Neoadjuvant Chemoradiotherapy;
How Far Could Functional MRI Support Organ Preservation Approach
Roaa M Farahat1, Mohamed R Habba2, Ahmed F Elserafy2, Ahmed MM Gomaa3, Radwa A Noureldin2
1 Department of Radiodiagnosis, Ismailia Medical Complex
2 Department of Radiodiagnosis and 3 Department of Surgery, Faculty of Medicine, Suez Canal University
Address for Correspondence: Ahmed Mohamed Gomaa, Tel: 01002416360, E-mail: gomaaahmed@hotmail.com

Rectal cancer constitutes a distinct subset of colorectal carcinoma necessitating a dedicated multidisciplinary
approach through the journey of diagnosis and treatment. Neoadjuvant chemoradiotherapy (CRT) has the advantage of tumor
down staging, with a chance of pathologic complete response (pCR) with reflection on locoregional recurrence rates, and
increased overall survival. In this study we aim to assess the response to neoadjuvant chemoradiotherapy offered to patients
with locally advanced rectal cancer using functional MRI then to be validated through final pathological result following
standard surgical management.
Patients and Methods: This study included 29 patients with rectal cancer eligible for neoadjuvant therapy. Patients had
their MRI before and after neoadjuvant CRT, then they underwent surgical intervention in the form of anterior resection
with total mesorectal excision (TME) or abdominoperineal resection (APR). Final pathological results were compared to
post CRT functional MRI results. Results: We found that neoadjuvant CRT downstaged our patients to the extent that
rendered around 15 percent of patients with complete pathological response could have made benefit from organ
preservation approach with either `watch-and-wait' or local excision, a chance could be offered in regards to good
standardized functional multiparametric MRI assessment.
Conclusion: Response to neoadjuvant treatment in locally advanced rectal cancer could be assessed with multiparametric
functional MRI giving the patient good chances regarding the best tailored surgical options that influence disease control
and overall survival.
Keywords: Organ preservation, Watch and wait strategy, Functional MRI, Cancer rectum, Neoadjuvant chemoradiotherapy


Rectal cancer constitutes a special subset of
via examination of the primary tumor area histologically.
colorectal carcinoma and it comes second between all
Histological tumor response is estimated by applicating
female malignancies and third in male cancers worldwide.
what is recognized as "tumor regression grades". Most of
This raises the need to a dedicated multidisciplinary
these schemes identify proportions of residual malignant
approach through treatment journey (1).
cells as well as the surrounding fibrosis and inflammation,
Conventional MRI gained broad acceptance in
subsequently a final number is then assigned (4).
pretreatment evaluation of rectal cancer and local staging
Response to neoadjuvant CRT is variable. A work
via its prospect to assess and predict circumferential
carried out by Glynne-Jones in 2016 reported a cPR in
margins, extramural invasion and venous invasion with
nearly 25% of cases (4).
good accuracy by high resolution T2 TSE (2).
Many systems were developed for grading response
Nowadays, locally advanced rectal carcinoma is
to therapy, the first of which was the Mandard system (5),
given neoadjuvant chemoradiation therapy (CRT)
then came the Dworak method (6), which was widely
targeting reducing local recurrence and increasing disease
employed in Europe. Following the idea of these authentic
free survival (3).
systems, the College of American Pathologists designed a
Although numerous diagnostic methods proposed to
regression grade (Figure 1) (7) focusing on recording
assess the degree of tumor response to neoadjuvant CRT,
residual tumor and found to correlate with better
it is vital to emphasize that a definitive diagnosis of
outcomes (8).

Figure (1): AJCC and College of American Pathologists Regression Grade (7)

Received: 10/8/2022
Accepted: 10/10/2022

Full Paper (vol.901 paper# 16)

The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 107- 112

Combined Effect of Nanohydroxyapatite and Chitosan on
Remineralization of Initial Enamel Lesion in Vitro
Fatima Saeed J. Al-Ward1 *, Nada Jafer MH. Radhi
Pedodontic and Preventive dentistry department, Baghdad University, College of Dentistry
*Corresponding author: Fatima Saeed Al-Ward, Mobile: (+964)7901652676,
Email: fatima.yahya1901@codental.uobaghdad.edu.iq
The initial clinical manifestation of enamel caries is a white spot lesion (WSL). It is comprised of a porous
lesion body and a surface layer that is mostly unaffected. Dissolved calcium and phosphate ions that are somewhat trapped
in the adjacent dental plaque biofilm re-precipitate to form it. If remineralization mechanisms are undertaken, it is
anticipated that the WSL can be reverted when the process is still at an early stage.
Objective: This study aimed to examine the ex-vivo remineralization effectiveness of chitosan + nanohydroxyapatite
combination on artificially induced incipient lesion using Vickers microhardness tester.
Material and Methods: Artificial caries was created chemically by immersing 40 human teeth individually in
demineralizing solution for 72 hours. Then the teeth were subjected to a 10-day pH cycle. Samples were assigned to four
groups: (1) Control; (2) Chitosan (3) Nanohydroxyapatite and (4) Chitosan/nanohydroxyapatite complex. Surface
microhardness measurements were performed prior to lesion formation, after lesion formation and after treatment.
Diagnodent was used to assess mineral loss before and after demineralization. Results: The study's findings showed that
the sample from group 4 (combination of chitosan and nanohydroxyapatite) had the highest level of enamel remineralization,
and when compared to the control, there was a statistically significant difference(P0.05). The result of this study also
showed that DIAGNOdent was unable to detect mineral loss in vitro. Conclusion: We can state that the combination of
chitosan and nanohydroxyapatite promoted the remineralization of artificially induced incipient caries.
Keywords: Caries, Remineralization, Chitosan, Nanohydroxyapatite, Microhardness. Diagnodent.

early enamel decay under a pH cycle model has been
The initial clinical manifestation of enamel caries is
shown in several research using NANO- HA as a
a white spot lesion (WSL). It is comprised of a porous
biomimetic substance (9,10). If NANO-HA is paired with
lesion body and a surface layer that is mostly unaffected.
some other efficient non-fluoride compound that will not
Dissolved calcium and phosphate ions that are somewhat
affect Nano ­HAP, could have a co-operative benefit in
trapped in the adjacent dental plaque biofilm re-
promoting remineralization. Then, full remineralization
precipitate to form it (1). If remineralization mechanisms
could be expected (9).
are undertaken, it is anticipated that the WSL can be
For our knowledge, no previous studies had been
reverted when the process is still at an early stage (2). The
conducted to determine the combined impact of NANO-
deposit of mineral onto demineralized enamel within the
HA and chitosan. Therefore, the present study was aimed
enamel lesion is caused by the movement of calcium and
to assess how NANO-HA and chitosan together might
phosphate out of the tooth into the lesion., which is
affect the ex vivo remineralization of initial lesions, also
described as remineralization of carious lesions (3) .
to determine if the chitosan- NANO-HA mixture is more
An N-deacetylated chitin derivative substance is
efficient at enhancing subsurface mineral deposition in
chitosan, has gained a great deal of attention. Because of
WSL under a dynamic pH cycling and then to establish a
its action in encouraging enamel remineralization due to
strong base on which to apply these remineralizing
its readily available nature, bio - compatibility,
materials in dental treatments. Mechanical characteristics
biodegradability, and nontoxic nature, chitosan has been
as well as visible surface alterations following
employed in dental biomaterial (4,5) . Another compound
remineralization were evaluated using the Vicker surface
which has anti carious properties is hydroxyapatite, a
microhardness as well as the fluorescence technique by
substance that is both bioactive and biocompatible and is
DIAGNOdent. The null hypothesis has been stated that
frequently utilized in dental and medical procedures (6).
chitosan/ NANO-HA mixture has no additional effect on
Nano-hydroxyapatite (NANO-HA) is identical to dental
each of the material when applied separately on artificial
apatite in structure but it is more soluble, more bioactive
and has better surface energy than hydroxyapatite (7).
According to available reports, NANO-HA may act as a
Sample preparation
remineralizing agent (8,9,10). NANO-HA can defend teeth
40 human upper first premolars extracted for orthodontic
by adding a fresh coat of artificial enamel to the tooth's
purposes from individuals between the ages of 12 and 18
surface, rather than making the current layer harder by
years old were chosen. The study excluded any teeth
adding fluoride (11). This capability of remineralization of
having apparent or identifiable caries, fillings,
Received: 13/10/2022
Accepted: 13/12/2022

Full Paper (vol.901 paper# 17)

c:\work\Jor\vol901_18 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 113-120

Alternation in circARF3 (ADP-ribosylation Factor 3) and its Target Gene
miR-103 Activity Promotes Hepatocellular Carcinoma in Obese Patients with
Metabolic-Associated Fatty Liver Disease
Nearmeen M. Rashad*1, Abdalla M. Nawara1, Sherweet M. Ahmed2,
Hala Mosaad3, Amany Moheldin Sediq4, Ola M. Elfarargy5, Hassan Mahmoud Hassanin1
Departments of 1Internal Medicine, 2Tropical Medicine, 3Medical Biochemistry ,4Clinical Pathology and 5Medical
Oncology, Faculty of Medicine, Zagazig University, Zagazig 44511, Egypt.
*Corresponding author: Nearmeen M. Rashad, Mobile: (+20) 01224248642,
E-mail: nrashad78@yahoo.com & n.rashad@zu.edu.eg.

: Hepatocellular carcinoma (HCC) is the fourth most common cancer-related cause of death worldwide
and poses a severe threat to public health. In addition to being an underlying risk factor for HCC, obesity is one of the
common causes of metabolic-associated fatty liver disease (MAFLD). Objective: Therefore, the current study aimed to
investigate the expression levels of both circARF3 (ADP-ribosylation factor 3) and its target gene miR-103 in obese
patients with MAFLD and to assess their relations to susceptibility and clinicopathological features of HCC.
Patients and methods: The current study was conducted on 100 subjects (50 control groups and 50 obese patients with
MAFLD). The case group was subclassified to 39 patients without HCC and 11 patients with HCC. The expression
levels of circARF3 and miR-103 were investigated by RT PCR. Results Our results revealed statistically significant
higher values of circARF3 in MAFLD (1.89±0.614) compared to control (0.72±0.341). In addition, the level of miR-
103 was statistically significantly higher in MAFLD (2.41±0.82) compared to control (0.912±0.335), P 0.001. Also,
there were statistically significant higher values of circARF3 in HCC (4.67±1.63) compared to non-HCC (1.44± 0.74).
In addition, the level of miR-103 was statistically significantly higher in HCC (4.99±1.32) compared to non-HCC
(1.512±0.45), P <0.001. Interestingly, circARF3 and miR-103 significantly correlated with obesity indices and
metabolic and hepatic dysfunction biomarkers. Cut-off values 0.94, 1.2, 1.8, 2.98 were able to discriminate simple
steatosis, steatohepatitis, cirrhosis, and HCC with AUC 0.78, 0.64, 0.77, 0.81 respectively. Conclusions The current
study results detected upregulation of both studied epigenetic markers; circARF3 and miR-103 in obese MAFLD
patients especially patients with HCC. Thus, they could be used as diagnostic biomarkers of MAFLD-associated HCC.
Keywords: MAFLD, HCC, circARF3, obesity, miR-103 relative expression.


of fatty tissue, changes of gut microbiota, and
Hepatocellular carcinoma (HCC) is a major
dysregulated microRNA in increasing the relative risk
public health problem and the 4th leading cause of
of HCC among obese patients (10,11).
cancer related mortality worldwide (1). Recently, a
There is published data indicating that
report demonstrated that metabolic-associated fatty
circRNAs in adipose tissues can gain access to the
liver disease (MAFLD) is emerging as the main
circulation inside microvesicles and have functions in
etiology for chronic liver disease progressing HCC (2).
target organs. In support of this hypothesis, a recent
The diagnosis of MAFLD is based on the presence of
report indicated that adipose-derived exosomes,
hepatic steatosis plus one or more of other conditions
through regulating the deubiquitination-related miR-
such as overweight/obesity, type 2 diabetes mellitus
34a/USP7 axis, can mediate the delivery of circRNAs
(T2DM), or metabolic abnormalities with no additional
and promote the tumorigenesis of HCC (12).
exclusion criteria (3). Regarding metabolic dysfunction,
Risk factors for MAFLD-associated HCC
the definition includes at least two features from the
including obesity, diabetes, deposition of iron, genetic
following: increased waist circumference, arterial
and epigenetic factors, microRNA, and gut microbiota.
hypertension, elevated triglycerides, low high-density
The aim of this work is to investigate the expression
lipoprotein (HDL-C), prediabetes, insulin resistance,
levels of both circARF3 and its target gene miR-103 in
and subclinical inflammation (4).
obese patients with MAFLD and assess their relations
Of interest, increased prevalence of treatment of
to susceptibility and clinicopathological features of
hepatitis C virus (HCV) by antiviral therapy leads to a
decrease HCV-related HCC (5). Additionally, the
increased prevalence of western dietary pattern and
The current study enrolled 50 healthy subjects as a
decrease physical activity has accelerated the incidence
control group and 50 obese patients with MAFLD; both
rates of MAFLD (6,7). Obesity is one of the usual causes
groups were sex and age matched. For accurate
of MAFLD, which is also an underlying risk factor for
assessment of body fat, a dual energy X-ray
HCC (8). One must bear in mind that obesity is strictly
absorptiometry (DEXA) scan was done for estimation
associated with HCC (9). There is a lot of evidence
of fat mass index (FMI) and fat-free mass index (FFMI).
emphasizing the pathogenic role of increased reactive
The study design is shown in figure 1.
oxygen species, adipokines dysregulation, remodeling
Received: 14/08/2022
Accepted: 15/10/2022

Full Paper (vol.901 paper# 18)

c:\work\Jor\vol901_19 The Egyptian Journal of Hospital Medicine (October 2022) Vol. 89 (2), Page 121- 131

The prognostic Value of Cancer Stem Cell Marker, Cluster of
Differentiation 133 Expression in Stage III Colorectal Carcinoma
Mohamed Ali Alabiad1*, Warda M. M. Said2, Ibtesam Elhasadi2, Amany Mohamed Shalaby3,
Mohammed Alorini4, Ola M. Elfarargy5, Heba F. Taha5, Ahmed M.Yehia6 ,
Dina Ahmed Khairy7, Abla Sayed Mahmoud7
1Departments of Pathology, 5Medical Oncology and 6General Surgery,
Faculty of Medicine, Zagazig University, Egypt.
2Department of Pathology, Faculty of Medicine, University of Benghazi, Libya.
3Department of Histology and Cell Biology, Faculty of Medicine, Tanta University, Egypt.
4Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences,
Qassim University, Unaizah, Kingdom of Saudi Arabia.
7Department of Pathology, Faculty of Medicine, Beni-Suef University, Egypt
Corresponding author: Mohamed Ali Alabiad,Email: maabyad@medicine.zu.edu.eg,,
ORCID: https://orcid.org/0000-0002-6006-3711, Tel: 00201150509554

Colorectal cancer (CRC) is the 3rd most prevalent diagnosed cancer and the 4th leading cause of cancer-related
deaths globally. Nodal staging is significantly more essential in rectal cancer that detects most the therapy options.
Objectives: This study aimed to evaluate CD133 expression in the colorectal carcinoma stage III using immunohistochemistry
as well as its relationship to clinicopathological characteristics and patient outcomes.
Patients and Methods: The study includes 60 cases with stage III CRC five years after surgical removal of the tumor and
regular follow-up with the Departments of Medical and Clinical Oncology where clinicopathological and prognostic data are
collected from the archives. The patients were classified into two groups, GI includes 22 CRC patients with relapse, and GII
includes 38 CRC patients without relapse. Sixty archive paraffin blocks of primary resection and metastatic lymph nodes were
extracted from the archives of the Pathology Department processed for CD133 immunohistochemistry. CD133 expression
levels were assessed, analyzed, and correlated with clinicopathological and prognostic criteria.
Results: Positive CD133 expression was significantly linked with old age ( P=0.034 ), large tumor size ( p < 0.001), perineural
invasion (p = 0.0017), lympho-vascular invasion ( P < 0.001 ), high-grade ( p < 0.001 ), resistance to chemotherapy (p = 0.011),
lymph nodes metastasis and relapse (p = 0.005*) and DFS (p = 0.005)
Conclusion: CD133 expression in colorectal carcinoma is related to tumour progression and is considered a marker of poor
prognosis and a strong indicator of relapse and poor survival. Moreover, CD133 stem cell marker may act as a targeted therapy
in chemotherapeutic resistance patients with colorectal carcinoma.
Keywords: Cancer stem cell marker, CD133, Stage III, Colorectal carcinoma.


Colorectal cancer (CRC) is the 3rd most commonly
CRC patients are frequently treated with neo-adjuvant
diagnosed cancer and the 4th major cause of cancer-related
radiation-based therapy. The first appearance of LN
deaths worldwide. Its deadly consequences are anticipated
metastasis in CRC is stage IIIa, which has spread to 1 to 3
to rise by 60% to more than 2.2 million new cases and 1.1
nearby lymph nodes (N1) (5, 6).
million cancer deaths by 2030 (1).
This study aimed to assess CD133 expression in stage
Cancer stem-like cells (CSC) were discovered first by
III colorectal carcinoma using immunohistochemistry as
John Dick in acute myeloid leukemia (AML) in the late
well as its relationship to clinicopathological characteristics
1990s. They are a group of highly tumorigenic cells that can
and patient outcomes.
repopulate tumours following apparent curative treatment.

They have characteristics similar to normal intestinal stem
cells, such as the ability to self-renew and long-term
The study includes 60 cases with stage III
repopulation, which leads to tumour heterogeneity. They
CRC(50colon ,and 10 rectal cancer) five years after surgical
can also give rise to all types of cells found in a cancer
removal of the tumor at the Department of General Surgery,
sample (2).
Faculty of Medicine, Zagazig University, and after
prominin-1, also known as CD133 is a transmembrane
receiving planned treatment according guidelines for stage
glycoprotein found in various tissues, including
III colorectal cancer they were on regular follow-up with the
hematopoietic cells, neuroepithelial cells, and endothelial
Departments of Medical and Clinical Oncology, Faculty of
cells. CD133 is a clear marker of primary colorectal cancer
Medicine, Zagazig University, where clinicopathological
stem cells (CSC), and its expression has been associated
and prognostic parameters were collected from their
with differentiation and tumour growth in colorectal cancer
archives, including ( age, sex, tumor type, tumor size, tumor
(3). CD133 could identify a group of tumor cells with
grade, drug resistance, and relapse after therapy).
characters of stem cells. Those CD133-positive tumor-
The patients were classified into 2 groups, the 1st
initiating cells can self-renewal, differentiate, regenerate,
group (GI) includes 22 patients with relapse, and the 2nd
and form tumors when injecting them into immunodeficient
group (GII) includes 38 patients without relapse. Sixty
mice. CD133 expression has a crucial influence in CRC
archive paraffin blocks of metastatic lymph nodes of
development (4).
primary resection were extracted from the Pathology
The proper preoperative staging of lymph nodes
Department's archives and processed for CD133
underpins several CRC therapeutic approaches. Nodal
immunohistochemistry. CD133 expression levels were
staging is vital in rectal cancer since clinically node-positive
assessed, analyzed, and correlated with clinicopathological
Received: 20/10/2022
Accepted: 22/12/2022

Full Paper (vol.901 paper# 19)

ABSTRACT The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 132-138

Prognostic Value of Pentraxin 3 and Procalcitonin in Late Onset Neonatal Sepsis
Mohamed Omar Abd El Aal1, Ibrahim Saad Abo Seif1,
Shimaa Ahmed Abd El Kareem1, Marwa Ali Abdel-Wahed*2
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Marwa Ali Abdel-Wahed, Mobile: +201065644724, Email: marrwa_ali3110@yahoo.com

High percentage of intensive care unit (ICU) admissions are due to sepsis. Some evidence suggests
procalcitonin (PCT) is a useful sepsis prognostic marker. Acute phase protein, which is called pentraxin3 (PTX3) may help
in sepsis screening.
Objective: To assess the prognostic value of the PTX3 and PCT in neonatal sepsis in comparison with other screening
Patients and Methods: A prospective study included 40 neonates with sepsis. The study had been conducted in the neonatal
ICUs of Ain Shams University, Children's Hospital during the period from January 2020 to May 2022. All neonates had been
subjected to clinical examination, anthropometric measurements and sepsis scoring by neonatal sequential organ failure
assessment (nSOFA). Laboratory investigations were performed including complete blood count, blood culture, assay of
serum levels of C-reactive protein (CRP), PCT and PTX3.
Results: The CRP levels were significantly lower in the deteriorated group compared to the better group, whereas PCT and
PTX3 levels were significantly higher with p-value=0.004, 0.016 and 0.019, respectively. After 3 days, CRP, PCT and PTX3
levels increased significantly in deteriorated group than improved group with p-value=0.002, <0.001 and <0.001, respectively.
The combination between baseline nSOFA score, CRP and PCT levels had a sensitivity of 84.62%, specificity of 92.59% and
AUC 0.906. While combination between baseline nSOFA CRP and PTX3 levels had the highest sensitivity of 100% and
AUC of 0.909 in prediction the poor outcome of the studied patients.
Conclusion: Serum levels PCT and PTX3 seem to be promising prognostic markers in neonatal sepsis.
C-reactive protein, nSOFA, procalcitonin, pentraxin 3, Late onset neonatal sepsis.


as much as 100-fold in 6-8 hours. For PTX3, IL-6 is
In low and middle-income nations, sepsis
only a marginal inducer (7).
continues to be a major contributor to newborn
Patients with sepsis can have detectable levels
mortality and morbidity. Due to the lack of specificity
of PTX3, PCT in their serum for a long time after the
in the symptoms of neonatal sepsis, testing is required
onset of sepsis, whereas other novel proinflammatory
to make a diagnosis. Better clinical outcomes and less
cytokines (like and tumour necrosis factor-a as well as
unnecessary antibiotic use can be achieved through
interleukin) have a short window of expression, despite
rapid and precise detection of infection(1).
showing good prognostic values for mortality. Because
Mild symptoms of neonatal sepsis can quickly
of this, multifactor assays are superior to those based on
deteriorate into life-threatening complications like
a single factor in identifying sepsis and measuring
organ failure and meningitis(2). Subclinical infection can
infection severity(8).
progress to severe local or systemic infection in the
There is a lack of neonatal-specific data, but
clinical setting(3). Therefore, it is crucial to identify
there is an established scoring system similar to the one
reliable early indicators of sepsis to improve diagnosis
used to determine sepsis in adults and it can be used in
and prognosis. Several potential biomarkers have been
neonates, called the neonatal sequential organ failure
presented recently(2).
assessment (nSOFA) (9).
Procalcitonin (PCT) could be an important
Our study's objective is to evaluate the PTX3,
prognostic marker for sepsis(4). Following bacterial
PCT for its predictive significance in newborn sepsis in
infection, the PCT level rises in 6 to 12 hours and drops
relation to other sepsis screens. Using a model that
by 50% after 24 hours with the help of appropriate
incorporates PTX3 and PCT, we can better predict
antibiotherapy and the work of the immune system. The
progression in these neonates.
level is not affected (does not decrease) by anti-

inflammatory drugs(5). PCT appears to be a useful
biomarker to differentiate bacterial infections from viral
During the months of January 2020 through
infections with high sensitivity and specificity rates.
May 2022, at Ain Shams University's Children's
One of these studies evaluating the rapid diagnosis of
Hospital, we analyzed data from a prospective study of
sepsis suggested that PCT could be used to differentiate
the NICU there.
severe clinical situations like sepsis and septic shock, as
Forty clinically suspected neonates with sepsis,
well as to help determine the type of microbe(6).
who were clinically free before this age were included
In response to activation by primary
in this study. The International Sepsis Definitions from
inflammatory signal proteins, the serum concentration
2001 were used to diagnose sepsis. In neonates, the
of pentraxin 3 (PTX3), an acute phase protein that
presence of sepsis can be suspected from the presence
represents the long pentraxin subfamily, can increase by
of inflammatory symptoms such as hyper or
Received: 26/08/2022
Accepted: 27/10/2022

Full Paper (vol.901 paper# 20)


Evaluation of Neutrophil to Lymphocyte Ratio in Patients with
Chronic Spontaneous Urticaria
Hossam Moustafa Elkady
Department of Internal Medicine, Allergy and Clinical immunology,
Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Corresponding Author: Hossam Moustafa Elkady, Mobile: (+2) 01090751701, E-mail: hossamelkady86@ymail.com

Chronic spontaneous urticaria (CSU) is an immune-inflammatory disorder. The urticaria activity score
(UAS 7) is used to assess urticaria activity. The neutrophil to lymphocyte ratio (NLR) is a reliable indicator for
inflammatory conditions. Parameters useful for the evaluation of patients with CSU are not currently available.
Objectives: To assess NLR in CSU patients and its correlation with urticaria activity score.
Patients and methods: Of the patients attending the allergy clinic of Ain Shams University Hospital, 200 patients
with CSU, including 62 patients with mild disease, 68 with moderate disease, and 70 with severe disease according to
urticaria activity score 7 (UAS7), and 200 controls, were included in this study. NLR values were compared among
various study groups.
Results: NLR values were significantly higher among CSU patients than controls (p<0.001), with no significant
correlation with urticaria activity score.
Conclusion: NLR is a rapid, simple, and low-cost blood marker that can be used to detect systemic inflammatory
processes in patients with CSU.
Keywords: Neutrophil to lymphocyte ratio, Chronic spontaneous urticaria, Urticaria activity score.


triggers or causes of chronic spontaneous urticaria were
Chronic urticaria (CU) is a mast cell-driven dermal
ruled out by history and proper investigations for all
disease, presented by at least 6 weeks of daily or
intermittent itchy wheals with or without angioedema
to EAACI/GA2LEN/EDF/WAO guideline (1).
(1). Chronic spontaneous urticaria (CSU) is the most
Each patient underwent the following investigations to
prevalent type of chronic urticaria. CSU occurs
exclude other causes of chronic urticaria: differential blood
spontaneously in the absence of any definite stimulus (1).
count, C-reactive protein (CRP), antithyroid antibodies,
The urticaria activity score (UAS 7) is a frequently used
thyroid function tests, and erythrocyte sedimentation rate
patient-reported CSU score based on symptoms, such as
(ESR). Patients with acute or chronic infection,
the number of hives and severity of pruritis, to assess
autoimmune disease, acute or chronic inflammation,
disease activity and therapy response (1).
tumors, any other dermatological or systemic disorder, or
Therefore, the UAS7 lacks objectivity, so different
pregnant women were excluded from this study.
markers have been studied to evaluate the activity of the
Also, patients on immunosuppressive drugs,
omalizumab, or corticosteroid treatment for CSU, as well as
Mast cells are the key cells in CSU pathogenesis.
smokers or alcoholic patients, were excluded. The body
However, various inflammatory cells, including
mass index (BMI) was within the normal range for all
basophils, eosinophils, T-lymphocytes, and neutrophils,
are essential in the pathogenesis of CSU (2)

The neutrophil-lymphocyte ratio (NLR) is the
Assessment of urticaria activity score (UAS7):
division of absolute neutrophil count by absolute
According to the EAACI/GA2LEN/ EDF/WAO
lymphocyte count. It is a simple, cheap, and easily
guideline (1), urticaria activity is determined by urticaria
accessible hemogram, which increases in a lot of
activity score 7. Itching and hives (wheals), the two
inflammatory disorders, such as diabetes mellitus,
main urticaria symptoms, are evaluated by the UAS7.
ulcerative colitis, and psoriasis (3-5). Correlations
Depending on the number of wheals and the level
between parameters of inflammation such as NLR and
of pruritis, the UAS7 values were assessed during the
disease severity or activity have been defined in other
previous 7 days. Then the scores of wheals and pruritis
skin disorders (6-7).
were summed up over seven days (minimum score 0-
The aim of the current study is to evaluate NLR in
maximum score 42). UAS7 6 is considered a
CSU patients and its correlation with UAS7.
controlled urticaria, UAS7 (7­15) is a mild urticaria,

UAS7 (16­27) is a moderate urticaria, and UAS7 (28­
42) is a severe urticaria (8).
A case-control study was conducted on 200 CSU
Assay of NLR:
patients presenting to the allergy clinic of Ain Shams
For all participants, blood samples were drawn and
University Hospital, and 200 healthy control volunteers
analyzed using (Sysmex XN-1000, Sysmex corp.,
without any dermatological or systemic disease, matched
Japan) hematology analyzer. Total and differential
for gender and age, were included in this study. Any
white blood cell counts were assessed in terms of the
Received: 26/8/2022
Accepted: 26/10/2022

Full Paper (vol.901 paper# 21)

c:\work\Jor\vol901_22 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 143-147

Association of Subclinical Hypothyroidism with Metabolic
Syndrome in Young Adult Egyptians
Hassan Mahmoud Hassanin*1, Usama A. Khalil1, Abdalla M. Nawara1, Amany Moheldin Sediq2,
Mayada M. Mousa1
Departments of 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Zagazig, Egypt

*Corresponding author: Hassan M. Hassanin, Mobile: (+20)1113657464, Email: drhassan_h99@yahoo.com,
ORCID: 0000-0002-9548-652X.
: Subclinical hypothyroidism (SCH) and metabolic syndrome (MetS) are two common medical conditions.
Thyroid dysfunction, prominently SCH has been described more frequently in MetS patients than general population.
SCH affect MetS parameters including high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), plasma
glucose and blood pressure. The relation between the two conditions looks like a bi-directional relationship.
Objectives: The aim of this study was to investigate the association between SCH and MetS in Egyptian young adults
and to study the prevalence of MetS and its components in SCH subjects.
Patients and methods: The study was conducted at Zagazig University Hospitals. 602 freshman-year students with no
history of medical disease were included in the study. General examination, anthropometric, and routine investigations
plus thyroid function tests were done for all.
: Diastolic hypertension (DBP) and impaired fasting glycaemia (IFG) showed significant differences between
SCH and EUT. Among the 602 participants, 23.9 % were diagnosed with MetS and 8.9 % with SCH. MetS was found
in 22.4 % in the euthyroidism (EUT) group and in 39 % in the SCH group. SCH was found in 14.6 % in subjects with
MetS and in 7.2% in non- MetS subjects. There was a significant association between MetS and SCH (2=7.3, p0.05).
Weight, BMI, and DBP were the significant predictors for SCH in patients with MetS.
Conclusions: It could be concluded that there is a significant association between MetS and SCH. DBP and IFG show
significant difference between SCH and EUT.
Subclinical hypothyroidism, Metabolic syndrome.


MetS appears to be a risk factor for subclinical
One of the most common medical issues,
hypothyroidism (4).
particularly in women, is thyroid dysfunction.
The relation between the two conditions looks like
Subclinical hypothyroidism (SCH), which is the initial
a bi-directional relationship.
biochemical aberration in hypothyroidism, is
The aim of this study was to investigate the
characterized by a rise in blood thyroid stimulating
association between SCH and MetS in young adult
hormone (TSH) concentration in conjunction with
Egyptians and to study the prevalence of MetS and its
normal serum free thyroxine (FT4) concentration (1).
components in SCH subjects.
The prevalence of SCH varies by gender and age,

with women over 60 years of age experiencing rates as
high as 20% in certain studies. Worldwide the
This cross-sectional study included a total of 602
prevalence ranges from 1 to 10% (2).
freshman-year students with no history of medical
The term "Metabolic Syndrome" (MetS) refers to a
disease, examined at Zagazig University Hospitals.
"constellation" of cardiometabolic risk factors that
All participants were new faculty students doing
together raise the risk of developing type 2 diabetes
medical examination as a part of undergraduate
mellitus (DM) and cardiovascular disease (3). Although
admission requirements. Data were collected from
it has been linked to coronary and carotid artery disease,
them, and they were subjected to history taking and
the link between SCH and MetS and each of its
physical examination.
components is still up for debate (4).
In relation to this topic, numerous researches have
circumference, WC (defined as the midpoint from the
shown a correlation between rising TSH levels and
lower costal margin to the iliac crest, standing and at the
increasing body mass index (BMI) and percentage of
end of normal expiration), and BMI (kg/m2) was done
body fat (5).
to all participants. Body weight was taken while
Although visceral obesity and insulin resistance are
wearing the less amount of clothes.
thought to be key factors in the etiology of MetS, an
Personal and family medical history was gathered,
imbalance of other hormones, such as thyroid and
with stress on endocrine, metabolic, and cardiovascular
glucocorticoids, may hasten metabolic problems and
diseases history. Blood samples were taken for routine
raise the risk of MetS (6).
checkup after 8 hours fasting plus TSH and FT4. The
On the other hand, thyroid dysfunction,
MetS was defined according to the International
prominently SCH is found more frequently in MetS
Diabetes Federation (IDF) by presence of WC > 94 cm
patients than general population (7).
(men) or > 80 cm (women) in addition to the presence
of two at least from the following: 1. Fasting blood
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.901 paper# 22)

c:\work\Jor\vol901_23 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 148-153

Breastfeeding Effect on The Genetic Variations of Primary Teeth Emergence in
Relation to Salivary Transforming Growth Factor-B 1 Among Iraqi Infants
Shaimaa Thabit Salih1 *, Ban Sahib Diab
Pedodontic and Preventive dentistry department, Baghdad University, College of Dentistry, Iraq
*Corresponding author: Shaimaa Thabit Salih, Mobile: (+964)7702547120,
Email: shaima.hamoudi1901@codental.uobaghdad.edu.iq
Mother`s milk has many necessary nutrients and cytokines, for instance transforming growth factor b1
(TGF-b1), which all are essential for teeth eruption and development. Additionally, human milk is considered as the best
source of nucleotides, hence it may have effect on genetic variations of infants.
Objectives: This study aimed to assess the effects of breastfeeding on timing of teething in relation to bone morphological
protein type 4 (BMP4) gene polymorphisms, and TGF-b1.
Patients and Methods: This study is cross sectional comparative study concerning salivary biochemical analysis with
prospective view concerning timing of eruption. Sample was composed of 100 breastfed infants compared to 100 infants
depending on formula milk. For the biochemical analysis including, saliva was collected only form subsample infants'
groups (40 from each group). While clinical examinations and follow up for teeth emergence was done for the whole sample.
Results: Findings showed that there were highly significant differences between breastfeeding and early eruption time.
While there were no significant differences between time of teething and both of salivary TGF-b1, and BMP4 gene by
feeding pattern. However, there was an antagonistic effect between BMP4 and TGF-b1, especially with AA genotype by
feeding pattern.
Conclusions: The current study confirmed the actual and pure effect of human milk on early primary teeth eruption in
comparison with formula-milk fed infants. However, there were no effects of other factors (salivary TGF-b1, and BMP4
gene) on the timing of teething. In addition, an antagonistic effect between BMP4 and TGF-b1 was confirmed in this study.
Keywords: Breastfeeding, BMP4 gene, Eruption time, Salivary TGF-b1.

underlying mechanisms are still unknown. Numerous

Infant feeding habits include the sorts of food the
research shed light on the actual impact of human breast
child consumes beginning at birth. The milk is basic
milk on genetic expression, particularly when it comes to
material of an infant's diet, and it can be either breast or
the risk of non-communicable diseases, with the potential
bottle milk (1). The WHO recommends starting weaning
to improve the health and long-term development of the
not earlier than 4 months old and exclusively
infant (8-10). On another hand, several animals and humans
breastfeeding until age of 6 months (2).
studies support the idea that genetic factors may be linked
In addition to its nutritional benefits, breastfeeding has
with early or delay teeth eruptions (11-13).
many other documented positive effects on baby's health.
Bone morphological proteins (BMPs) belong to
Human breast milk components shield breastfed
the secreted protein family known as the TGF-b
newborns from infections and inflammation. Breast milk
superfamily (14). One of the important routes controlling
has distinct nutritional advantages over formula because
craniofacial development is BMP signaling. It controls
its nutrient profile is tailored specifically for infants and it
the growth of its mineralized structures, including the
adapts over time to a child's changing demands (3, 4).
cranium, mandible, maxilla, palate, and teeth (15, 16).
Human milk is the best source of nucleotides for
Genome-wide association studies disclosed a linkage of
infants. Nucleotides are essential for encoding genetic
BMP4 in the SNP rs17101923 is likely to contain novel
information, controlling energy metabolism, signal
height-associated variants with earlier primary tooth
transduction, and enabling fast growth in early infancy.
eruption and craniofacial growth (11).
They are the monomeric units of ribonucleic acid (RNA)
Numerous non-syndromic and syndromic human
and deoxyribonucleic acid (DNA). Whereas, infants'
craniofacial abnormalities have been linked to gene
ability to produce the endogenous nucleotides required to
polymorphisms and mutations in the BMP pathway, as in
satisfy their increased metabolic demands for growth and
cleft palate, tooth agenesis and hypodontia (17, 18).
development is limited (5, 6).
Breast milk contains necessary nutrients for
Numerous studies have demonstrated that early in
healthy teeth development such as phosphate, calcium, and
development or during key times, the environment and
vitamins A, C, and D. For hydroxyapatite crystals to form
diet may have an impact on the expression of genes that
properly, calcium and phosphorus are necessary. So,
have both short- and long-term consequences on the
deficiency in the previous nutrients can have an effect on
organism (6, 7). Some elements of human breast milk may
tooth development (4, 19).
directly influence epigenetic alterations, while the
Received: 30/06/2022
Accepted: 06/09/2022

Full Paper (vol.901 paper# 23)

c:\work\Jor\vol901_24 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 154-161

Drug Use Indicators in Urban and Rural Primary Health Care Facilities in
Mansoura District, Dakahlia Governorate, Egypt
Mohamed Wahdan Elbrashy1, Abdel Hamied Mohamed Abdel Hamied2*, Mohamed Azmy Khafagy1
Departments of 1Public Health and Community Medicine and
2Industrial Medicine and Occupational Health, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Abdel Hamied Mohamed Abdel Hamied, Mobile: (+20) 01001257474,
E-Mail: abdelhamied_com @yahoo.com


Background: The WHO and International Network for Rational Use of Drugs (WHO/INRUD) developed a list of
indicators that are broadly used for evaluating irrational drug prescribing. The objective of the current study is to measure
drug use indicators in urban and rural primary health care facilitates in Mansoura district.
Patients and methods: A cross-sectional comparative study was carried out on 450 encounters attended urban and rural
primary health facilities in Mansoura district, Dakahlia Governorate during the period from October 1, 2016 to
September 30, 2017.
Results: Prescriptions of drugs with generic names and prescriptions with antibiotics were 51.9% and 40.9%
respectively. The average number of drugs prescribed per encounter was 1.9 (SD 0.41). The average consultation time
and the average dispensing time were 7.3 (SD 1.7) minutes and 32.2 (SD 6.9) seconds respectively. Drugs adequately
labeled were 57.6% and 52.4% of encounters knew the correct dosage. In addition, 14.7% of encounters were cured
without drugs. The average drug cost per encounter at the time of the study was 19.67 (SD 2.92) EGP. Regarding urban-
rural inequality concerning drug use indicators, the following were significantly higher in rural than in urban health care
facilities (prescriptions with antibiotics, average number of drugs prescribed per encounter, average consultation time,
average dispensing time, drugs adequately labeled, percentage of cure without drugs and the average drug cost per
encounter at the time of the study).
Conclusion: There is an irrational use of drugs in primary health care facilitates in Mansoura district when investigated
by the WHO/INRUD drug indicators.
Keywords: WHO, INRUD, Drug use, Indicators, Primary health care, Urban, Rural, Mansoura.

approaches for the quantification, understanding and
assessment of the process of prescribing, dispensing and
The World Health Organization (WHO) describes
consumption of drugs and for testing of interventions to
the rational utilization of drugs as "patients receiving
improve the quality of such processes (9). Different
medications proper to their clinical requirements, in
researches were conducted in different nations to access
dosages that match their own needs, for a proper period
the rationality of drug prescribing. Such researches aim
of time, and at the lowest cost to them and their
to follow up and assess and after that suggest
community" (1). Unluckily, the irrational usage of drugs
modifications in prescribing pattern to make the drug
is endemic, particularly in middle- and low-income
use rational and of minimal charge (10).
countries (2). Irrational use of drugs is common in all
nations but comparatively greater in developing ones, in
The regular evaluation of drug use pattern in a
which traditional supervision of medicine use is weak
healthcare facility could help to recognize the drug use
problems and as a result to encourage rational drug use
and assist policy makers to apply policies on drug
Rational drug prescribing participates in global
prescribing practices in the healthcare facility (4).
drops in population morbimortality with substantial
Essentially, drug utilization researches might provide
medical, social and economic advantages (4). Rational
insights to the pattern of drug use could evaluate the
prescribing is favored by the WHO/INRUD to evade
quality of use and identify predictors for use (11).
unwarranted extensive use of drugs and potential
adverse events on the cases (5). On the other hand, as
The use of generic name participates in cost
researches indicate, the majority of developing nations
reduction and offers more substitutions for drug
have a major gap from the WHO/ INRUD
purchases. Confusion over drug terminology could be
recommendations (6).
associated with adverse events. The use of non-
proprietary terminology in medicine must be promoted
Quality of life (QoL) could be enhanced by
to save charges, restrict commercial influences and
improving standards of medical management at all
decrease the likelihood for prescribing errors (12).
levels of the healthcare delivery system (7). Evaluation
of medicine use is of great importance for clinical,
The objective of the current study is to measure
educational and economic aims (8).
drug use indicators in urban and rural primary health
care facilitates in Mansoura district, Dakahlia
Drug utilization research could be described as an
Governorate, Egypt.
eclectic collection of descriptive and analytical

Received: 20/08/2022
Accepted: 20/10/2022

Full Paper (vol.901 paper# 24)

c:\work\Jor\vol901_25 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 162-165

COVID-19 Adult Patients Undergoing Cardiac Surgery: Early Outcomes
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


Background: COVID-19 illness is a major problem that has the possibility of resulting in morbidity and death. Research
on harmful outcomes of SARS-CoV-2 on the cardiovascular and circulatory systems have been documented,
complicating the therapy of these patients even more. Objective: The purpose of this research was to evaluate the safety
and consequences of heart surgery in COVID-19 previously infected patients. Patients and Methods: A retrospective
observational study on patients receiving open heart surgery was carried out at Elkasr Elaini Medical Center,
Cardiothoracic Surgery Department, Cairo University. Patients who tested positive for COVID-19 before surgery were
detected and included. Data from patient files were examined and evaluated in real time, complemented by telephone
following discharge. Results: Nineteen positive cases of COVID-19 underwent open heart surgery; June 2020-
September 2021in our center. Mean age of patients was 58±9 years old. Mean time from confirmed COVID-19 with
positive swab using PCR to surgery was 45±15 days. The vast majority of patients (94.7%) were extubated within 24
hours following operation. Acute renal failure developed in 10.5% of the patients, and one patient suffered severe heart
failure, seven patients (63.8%) required less than or equal to seven days in the hospital, whereas 11 patients (57.9%)
required between eight and fourteen days, one patient required more than 14 days. There were 2 mortalities one was
covid related while the other died from severe heart failure refractory to treatment. Conclusion: After a period of
convalescence, cardiac operation might be conducted successfully in individuals who suffered from COVID-19 illness
before undergoing surgery.
Keywords: Cardiopulmonary bypass, Heart surgery, CABG, COVID 19 mortality.

damage, coronary thrombosis, significant systemic
The extraordinary coronavirus (COVID-19)
inflammatory response, coronary plaque damage and
pandemic, driven by SARS-CoV-2, has had a
hypoxia. In a patient who has previously been infected
significant impact on the global population (1). With the
with COVID-19, there is an increased risk of surgical
introduction of vaccines in late 2020, numerous
complications such as pulmonary dysfunction, arterial
government initiatives encouraged, and in some cases
and venous embolism, difficulties weaning from
mandated, immunizations for certain segments of the
ventilators and residual neuromuscular weakness (9).
population. Increased immunization among the aged,

immunocompromised, and fragile patients resulted in
fewer viral infections, hospitalizations, and deaths.
The aim of our research is to assess the safety and
Governments that had adopted physical separation laws
consequences of heart surgery after a recovery period
to minimize transmission lifted these limits in part or
following COVID-19 infection.
whole (2). Due to their increased transmissibility and

capacity to elude vaccination protection, new
strains of concern have recently posed a fresh danger (3­
A retrospective observational study was conducted
on nineteen patients --- undergoing open heart surgery
Cardiac surgery is not without danger. The
in Elkasr Elaini Medical Center, Cardiothoracic Surgery
determination to undergo the surgery is dependent on
Department in Cairo University, Egypt, from June 2020
the patient and surgeon's risk assessment. Patient
to September 2021.
demographic data, as well as clinical urgency, surgical
Inclusion and exclusion criteria:
distresses and expected post-surgical recovery, are
Adult patients undergoing elective, emergency and
considered (6).
urgent open heart surgery, who were screened and
Ongoing COVID-19 illness is a major problem that
confirmedly diagnosed pre-operatively with COVID-19
has the possibility of causing morbidity and death.
infection via Polymerase Chain Reaction (PCR) as
Several studies have been published showing that
positive swab test, were included in our study.
SARS-CoV-2 has negative effects on the heart and
Vaccinated patients against COVID-19 were excluded.
circulatory system (7). Open heart surgery in COVID-19
patients causes coagulopathy, difficulties, weaning,
Data collection: Patients were determined using the
hypoxia, and vulnerability to subsequent bacterial
hospital's heart surgery database. Data from medical
infections. Beside operational damage, reduced
computerized patient records and records from patients
extracorporeal circulation (ECC) and poor cardiac and
were evaluated retrospectively. To augment the data,
chest reserve might result in weakened immune system
phone calls and interviews were conducted.
and coagulopathy, complicating these patients' care (8).

cardiovascular outcomes such as direct myocardial

Received: 02/07/2022
Accepted: 08/09/2022

Full Paper (vol.901 paper# 25)

c:\work\Jor\vol901_26 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 166-171

Distribution of Some Virulence Genes among Enterococcus Faecalis
Isolates from Urine Samples
Diyar A. Najm Al-shawi*, Ghadah M. S. Al-Quraishi
Department of Biology, Collage of Science, University of Baghdad, Baghdad, Iraq
*Corresponding author: Diyar A. Najm Al-shawi, E-mail: Diyarabd96@gmail.com, Mobile: +9647733518724

Enterococcus faecalis is one of the human and animal gastrointestinal flora. They are very robust so that
they can live in humid, salty, or acidic environments. Understanding the link between enteric and extra-enteric E. faecalis
strains is interesting as it is widely distributed throughout a variety of different habitats.
Objective: This research was carried out to investigate the percentage presence aggregation substance, cytolysin and
hyaluronidase genes (asa-1, cyl A, hyl) in the E. faecalis isolates from UTI samples via the method of Polymerase Chain
Reaction (PCR).
Materials and Methods: In the current study, collected 64 Samples during the period from November 2021 to January
2022 at Medical City Hospital in Baghdad city, included 18 men and 46 women. The patients ages were ranged from (17-
54) years. Urine samples cultured on Pfizer specific Enterococcus media, a selective medium for the isolation and growth
of Enterococcus spp, and then molecular detection was done to detect the E. faecalis gene and all three-virulence gene.
Results: Results demonstrated that the proportion of isolation for E. faecalis was 48%, while the percentage of cyl and
asa-1 genes was 100% and 97% respectively, although hyl gene was not detected in any isolates of E. faecalis isolated
from urine samples.
Conclusion: Virulence genes may be prevalent is some isolates and absent from other depending on many factors such as
the source of isolation.
Keywords: Virulence gene, PCR, Urinary tract infections.


hemolytic, with colonies on blood agar measuring around
Bacterial infections continue to be a serious issue
1-2 mm in diameter. Lactic acid is produced by
because of the considerable effects they have in public
Enterococci as a result of fermentation with no gas
and medical settings. Enterococci are one category of
production. Catalase and oxidase reactions in
microorganisms linked to opportunistic infections,
Enterococcus are negative. So capable of growing in
notably in medical settings. Urinary tract infections,
6.5% salt medium with a pH range of 4.8 to 9.6 and an
bacteremia, endocarditis, wound infections, and intra-
ideal temperature range of 35 to 37°C (3).
abdominal infections are only a few examples of
Infections of the urinary tract are among the most
enterococci-associated illnesses. Since enterococci
common diseases; 150 million people worldwide are
infections have significant negative effects on mortality,
affected by it each year. The most frequent cause of these
morbidity, and economic costs, they have been a growing
diseases is bacteria, the majority of cases (70­80%)
source of worry. According to estimates, enterococci
Uropathogenic Escherichia coli (UPEC) is the primary
infections, particularly those caused by vancomycin-
causative agent, followed by Staphylococcus, Klebsiella
resistant bacteria, increased by 1.4 to 3.5 times the
spp., Enterococcus spp., and numerous other pathogens
likelihood of death, major surgery, admission to the
critical care unit, length of hospital stays, and release to a
A UTI can occur anywhere in the Urinary tract. It
long-term care facility (1).
Enterococcus faecalis is one of the human and
epididymitis', prostatitis, per nephritis), and it is
animal gastrointestinal flora. They even reside in the
considered as one among the most common infectious
mouth and the vagina. They are very robust so that they
diseases that are widely seen among all age groups of
can live in humid, salty, or acidic environments.
individuals (5).
Additionally, E. faecalis frequently inhabits soil and
Virulence factors play a role in pathogenesis by
water. Understanding the link between enteric and extra-
mediating adherence colonization and invasion into host
enteric E. faecalis strains is interesting as it is widely
tissues, and the production of toxin and enzymes, all of
distributed throughout a variety of different habitats(2).
which can increase the severity of infection. There are
Enterococcus faecalis bacteria are often described
as Gram-positive bacteria that are seen individually, in
hyaluronidase, gelatinase, aggregation substance,
pairs, or in short chains under the microscope. That are
enterococcal surface protein, and others (6).
facultative anaerobes and non-motile and typically non-

Received: 15/10/2022
Accepted: 15/12/2022

Full Paper (vol.901 paper# 26)

c:\work\Jor\vol901_27 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 172-178

Multidrug Resistant Enterococcus Faecalis isolated from Root Canals and
Its Relationship with The Presence of Some Virulence Genes
Diyar A. Najm Al-shawi*, Ghadah M. S. Al-Quraishi
Department of Biology, Collage of Science, University of Baghdad, Baghdad, Iraq
*Corresponding author: Diyar A. Najm Al-shawi, Mobile: +9647733518724, E-mail: Diyarabd96@gmail.com

Enterococcus bacteria are normal flora found in the gut of different organisms, this bacterium has the potential
to become an opportunistic pathogen and harm the host's extra intestinal sites. Dental infections also associated with
Objective: In order to shed light on multidrug resistance E. faecalis in root canals infections and also this research was
carried out to investigate the percentage of asa-1, cyl genes A in the E. faecalis isolates from root canal samples by using
polymerase chain reaction technique (PCR).
Materials and Methods:
During the period of November 2021 to January 2022, root canal samples were collected from
(40) patients, (9) men and (31) women, and then were cultured on Pfizer specific Enterococcus media, a selective medium
for the isolation and growth of Enterococcus spp, after that antibiotic sensitivity test was done on all E. faecalis isolated.
And then molecular detection was done to detect the E. faecalis, asa-1 and Cyl A genes.
Results: The results showed percentage of E. faecalis isolates from root canal was 55% (22 isolates) and all isolates were
positive for E. faecalis gene, also 100% of isolates were positive for Cyl-A gene and 86.36% of isolates were positive asa-
1 gene. The antibiotics sensitivity result showed that 100% of E. faecalis isolates were sensitive to Imipenem and Linezolid,
whereas 100% of E. faecalis isolates were resistant to Tetracycline and Trimethoprim.
Conclusion: Most of isolates were multidrug resistant and also almost all the isolates had asa-1 and Cyl-A genes together.
Keywords: Virulence gene, PCR, Root canal, Antibiotic.

Antibiotic resistance affects pathogenicity, which
Enterococcus faecalis as Gram-positive bacteria
makes it more challenging to treat enterococcal
are often seen individually, in pairs, or in short chains
infections medically since there are fewer treatment
under the microscope. That have colonies on blood agar
options available (6).Virulence factors play a role in
that are about 1-2 mm in diameter and are facultative
pathogenesis by controlling adhesion and colonization,
anaerobes, non-motile, and often non-hemolytic. As a
invasion into host tissues, and the production of toxin
result of fermentation without gas generation,
and enzymes, all of which facilitate microorganism
Enterococci create lactic acid. The responses of catalase
adherence to root canal walls and surfaces, making it
and oxidase in Enterococcus are negative. So capable of
difficult to remove them even after instrumentation.
growing at an ideal temperature range of 35­37°C, pH
They can also harm the host in a number of different
4.8­9.6, and medium containing 6.5% salt(1).
ways by triggering the periapical tissue reaction to
Enterococcus bacteria has the capacity to develop
become more pronounced (7).
into an opportunistic pathogen and affect the host's extra
A pheromone-induced E. faecalis surface protein
intestinal locations despite being in the gut of many
called "aggregation substance" (AS) encourages the
organisms as normal flora(2).
formation of mating clumps during bacterial
Enterococci are linked to dental infections as well.
conjugation. As a component of the bacterial
Endocarditis, one of the most medically challenging
pheromone-responsive genetic exchange system,
diseases, might result from the oral infection if it
aggregate material aids plasmid transfers by promoting
develops into a bacteremia (3). The oral cavity may act
effective donor-recipient contact between Enterococcal
as a reservoir for superinfection microorganisms,
bacteria. Aggregation components facilitate adhesion to
including E. faecalis, E. faecium and E. coli, as assessed
a variety of eukaryotic cell surfaces in vitro and promote
by anti-biotyping studies (4).
uptake by human intestinal cells that have been cultured
E. faecalis has been associated to the occurrence
of several endodontic diseases, including primary and
Target cells such as erythrocytes, macrophages,
chronic endodontic infections. In original infections,
polymorphonuclear cells, and other eukaryotic cells can
asymptomatic chronic periradicular lesions are more
all be lysed by cytolysin. It has been demonstrated that
commonly seen than acute periradicular periodontitis or
cytolysin facilitates the invasion by harming the host
abscesses (5).
tissue (9). Together with Aggregation Substance (AS), it

will prevent the development of other bacteria (10).
Received: 15/10/2022
Accepted: 15/12/2022

Full Paper (vol.901 paper# 27)

c:\work\Jor\vol901_28 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 179-185

Mediastinal Goiter from the View of Thoracic Surgery
Tamer Eid Fouda*, Tarek Mohsen, Ahmed Sultan, Mahmoud Gamaleldin Ali, Ali Hetiba
Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding Author: Tamer Eid Fouda, Mobile: (+20)1113647910, Email: tamereidfouda@cu.edu.eg

Background: Several definitions were used to describe retrosternal goiter (RSG). The most accepted one describes
when 50% of the mass portion of the goiter is in the mediastinum. It is considered a surgical challenge because of the
difficulties faced during resection and the potential need for an extracervical approach.
Objective: It is to present some of the operated cases referred to our Thoracic Surgery Department after
multidisciplinary discussion and decision to operate such cases in combined team with ENT/General Surgery with
analysis of their data.
Materials and Methods: A retrospective analysis of 42 patients who underwent resections in a combined team for RSG
between 2018 and 2022 in the theater of Cardiothoracic Surgery, Cairo University Hospitals. The patients were
evaluated regarding their demographics, symptoms, level and side of extension in the mediastinum, approach,
pathology, and postoperative complications.
: The mean age was 57.1 years with male: female ratio 1:4.25. The most common symptom was dyspnea in 54%
of cases. History of previous thyroid surgery was found in 17(40%) patients. There were 15(36%) patients who had
extensions below the aortic arch. Sternal splitting was performed in 18 cases (43%) while thoracotomy was performed
in 3cases (7%). Morbidity occurred in 5cases (11.9%) in the form of RLN palsy, phrenic nerve palsy, need for
tracheostomy or Montgomery's tube with no postoperative mortality. The extension of RSG beyond the aortic arch and
history of previous thyroidectomy were significant calling for extracervical approach.
: Retrosternal goiter is an indication for surgery to avoid airway compression, malignancy and difficult
excision if the operation is delayed.
Keywords: Retrosternal, mediastinal, goiter, sternotomy, thoracotomy.

Several factors favor the downward extension
Substernal, retrosternal, intrathoracic, or
of the goiter into the mediastinum which are downward
mediastinal goiters are expressions used to describe a
traction caused by normal swallowing, negativity of
goiter extending below the inlet of the thoracic cavity.
intrathoracic pressure, and the force of gravity(2).
Albrecht von Haller in 1749 was the first one to describe
Others classified mediastinal goiters as follows;
retrosternal goiter (RSG) (1,2).
Type I (85%) into the anterior mediastinum, Type II
There have been many definitions of RSG since
(15%) into the posterior mediastinum and Type III (less
then till now. However, the most accepted definition of
than 1%) isolated mediastinal goiter(9).
RSG nowadays describes when 50% of the mass
Retrosternal goiters are closely related to
portion of the goiter is in the mediastinum(1,3,4). Other
thoracic surgery not only because of the potential need
different definitions have been also assumed for the
of endocrine surgeons during surgery for an additional
expression, e.g., goiter that extends beyond the thoracic
help by extending the operation into the thoracic cavity
inlet into the mediastinum for more than 2 cm is
but also due to the close relationship of the goiter to
considered retrosternal(1), or when the part of the goiter
nearby mediastinal structures and the potential,
in the mediastinum is larger than the cervical one and it
although rare, related complications in some cases, e.g.,
extends downwards beyond the thoracic inlet by two
fingers, or by at least 4 cm(4-6).
Some studies stated that RSG usually descends
In endemic areas for goiter, it is found that 20%
downwards to the right, because it takes the path of the
of the population over 70 have substernal goiter.
least resistance pathway and grow away from the aortic
However, diagnosis of RSG is most frequently made in
arch and its branches(11). However, other studies
the fifth or sixth decade of life, with female/male ratio
mentioned that retrosternal extension is more common
of 4:1(1,2). Mediastinal goiters are classified as primary
on the left than the right side due to a more capacious
or secondary. Primary mediastinal goiters (represent
anterior mediastinum on the left side, anterosuperior to
less than 1% of intrathoracic goiters) are those without
the aortic arch(12).
any direct vascular connection to the cervical part of the
Retrosternal goiter has always been considered
gland, whereas the blood supply comes from a
a surgical challenge because of the difficulties that may
mediastinal source, with no history of prior thyroid
be faced during surgical excision(1).
surgery and a lack of similar pathology in the other
In most cases, retrosternal goiters can be safely
portions of the thyroid gland. Secondary goiters are far
delivered and resected through the standard collar
more common, with a blood supply derived from
incision, but sometimes the resection is problematic to
cervical branches of the thyroid arteries(7,8).
the surgeon and necessitates an extra cervical incision

with the assistance by a thoracic surgeon(3,13).
Received: 08/07/2022
Accepted: 13/09/2022

Full Paper (vol.901 paper# 28)

c:\work\Jor\vol901_29 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 186-193

Early Outcome of Minimally Invasive Versus Conventional
Mitral Valve Replacement Surgery
Amr M. Eltonsy, Wagih S. Elborae, Hesham M. Elkay, Hosam Fathy Ali*
Department of Cardio-Thoracic Surgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Hosam Fathy Ali, Mobile: (+20) 01114567170, Email: amy.rh.209@gmail.com

Recent justifications for minimally invasive techniques include the desire to reduce surgical trauma,
enhance patient recovery, and lower costs without sacrificing the effectiveness of mitral valve repair or replacement.
The objective of the current study is to ascertain whether minimally invasive mitral valve surgery using lower mini-
sternotomies and mini-thoracotomies results in better postoperative outcomes than traditional surgery using a full
sternotomy. Patients and methods: A total of 60 patients were included in this study, of which 30 cases were operated
upon conventionally through full median sternotomy, 15 cases were operated upon through mini-sternotomy, and 15
cases were operated upon through right anterolateral mini-thoracotomy. Matched groups of patients were used.
Results: Statistical analysis of the basic data of patients before operations showed no statistical significance between
the groups. Minimally invasive mitral valve surgery was statistically associated with a significantly better outcome
regarding ventilation time, chest tube drainage, blood transfusion and postoperative pain in comparison to conventional
mitral valve surgery. These better results were not accompanied by significant increase in ICU stay, duration of inotropic
support, postoperative complications, hospital stay and in-hospital mortality. On the other hand, intra-operative time
parameters were shorter in conventional cases with statistical significance in total operative time when compared with
minimally invasive cases. Mini-thoracotomy as an approach showed superior results when compared with the mini-
sternotomy approach regarding chest tube drainage, and blood transfusion. However, mini-sternotomy cases showed
less intra-operative time parameters, ventilation time, duration of inotropic support and postoperative pain with
statistical significance in total operative time.
Minimally invasive mitral valve surgery improved significantly the early outcome regarding ventilation
time, chest tube drainage, blood transfusion and postoperative pain in comparison to conventional mitral valve surgery.
Keywords: Mitral valve replacement, Median sternotomy, minimally invasive mitral valve surgery, Mini-sternotomy,
Mini-thoracotomy, Comparative study, Clinical Trial, Cairo University.

of recuperation. However, this method has drawbacks,
Since the development of cardiac surgery in the
such as a longer learning curve required by the use of
1950s, the full median sternotomy has been the accepted
specialized long-shafted equipment and the non-
method for the majority of cardiac surgeries because it
standard approach to the mitral valve, as well as
provides the best opportunity for exposing and treating
lengthier CBP, cross-clamp, and overall treatment
the heart and surrounding structures. However,
times. Additionally, problems from peripheral
"surgical aggression" in the form of postoperative
cannulation are more likely when groyne vessels are
bleeding, wound infection, discomfort, and lengthy
cannulated [4].
scars compromises this strategy [1,2].
The aim of the current study is to determine
The need for minimally invasive techniques stems
whether minimally invasive mitral valve surgery
in part from the need to reduce surgical trauma, enhance
through lower mini-sternotomy and mini-thoracotomy
patient recovery, and lower costs without sacrificing the
improves postoperative outcome when compared to the
effectiveness of mitral valve repair or replacement.
conventional surgery through total sternotomy,
Access to all heart regions must be possible using a
minimally invasive technique with little to no need for
postoperative complications, intensive care unit and
highly specialized equipment. Additionally, better
hospital stays, in-hospital mortality and postoperative
cosmetic outcomes and reduced surgical discomfort
should be offered. Additionally, it must offer the benefit


of a patient's early recovery and quick return to work [2].
This is a comparative study, which included
A lower mini-sternotomy uses a smaller incision
retrospective data. It included 60 patients underwent
and well-known tools to expose the heart as is
Mitral valve replacement (MVR) surgery, of which 30
customary. Additionally, it keeps the shoulder girdle
cases were operated upon conventionally through full
continuous, which enhances postoperative breathing
median sternotomy (Group A), 15 cases were operated
mechanics. In addition, if difficulties arise or the
upon through mini-sternotomy (Group B), and 15 cases
exposure is insufficient, it enables quick and simple
were operated upon through right anterolateral mini-
conversion to a full sternotomy. Also, it is more prone
thoracotomy (Group C). Patients were operated upon in
to keloid formation than a full sternotomy and does not
Kasr Al-Aini Hospitals in the period from June 2012 to
produce significantly superior cosmetic effects than a
June 2018.
mini-thoracotomy [3]. Due to the preservation of the
Surgical techniques
entire sternum in its entirety, mini-thoracotomies have
A. Conventional mitral valve surgery:
the finest cosmetic outcomes and need the least amount
Received: 25/08/2022
Accepted: 26/10/2022

Full Paper (vol.901 paper# 29)

c:\work\Jor\vol901_30 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 194-199

Study of the Relationship between Insulin-Like Growth Factor 1,
Myostatin and Muscle Status in a sample of Egyptian Patients on Hemodialysis
Dina Ahmed Marawan Marawan*, Khaled Mahmoud Makboul,
Hanan Mahmoud Ali Mahmoud, Sayed Abdou Sayed Younis, Hany Khairy Mansour
Internal Medicine and Endocrinology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Dina Ahmed Marawan, Mobile: (+20) 01018086289, E-mail: dr_dina2010 @hotmail.com


Background: Sarcopenia is a common occurrence in people receiving hemodialysis. For hemodialysis patients, early
sarcopenia identification is essential since it can be treated with nutritional strategies and exercise. Measurement of
muscle mass and strength requires specialised equipment and takes time. Biomarkers are required to assist sarcopenia
screening and follow-up. Serum creatinine (SCr), which is impacted by residual renal function and the type of dialysis
being used, has been found to be the best biomarker too far for measuring muscle function in hemodialysis patients. In
the general population, new biomarkers relating to muscle function have appeared. The aim of the current study is to
evaluate the ability of insulin-like growth factor 1(IGF-1) and myostatin to assess muscle status in hemodialysis patients.
Patients and Methods: A case control study was conducted on 30 apparently healthy individuals as a control group
(Group A) and 30 Egyptian patients on hemodialysis (HD) with muscle wasting Group (B) recruited from Ain Shams
University Hospital.
Results: On comparing the studied groups, there were significant differences in the characteristics and parameters
between the HD patients and healthy control subjects reflect the sarcopenia and malnutrition status in our HD patients.
IGF-1 levels were found to be negatively correlated with sarcopenia status in HD patients according to correlation
analyses (p 0.05). On the other hand, in HD patients, myostatin levels were p/ositively correlated with the presence of
sarcopenia (all p 0.05). Conclusion: Our findings showed that in individuals undergoing HD, IGF-1 and myostatin
levels linked with the presence of sarcopenia. To verify these findings, however, additional research is required.
Keywords: Insulin-Like Growth Factor 1, Myostatin and muscle status, Hemodialysis.


Sarcopenia is a common sign in patients with
Group B (Patients) that included 30 patients on
chronic kidney disease (CKD), particularly those
hemodialysis (3 sessions per week) having muscle
receiving hemodialysis (HD) for end-stage renal disease
wasting recruited from the Hemodialysis unit at Ain
(1). Muscle mass, strength, and function loss is a chronic
Shams university Hospitals throughout six months.
condition that raises the risk of cardiovascular disease,

morbidity, and mortality. It also encourages sedentary
Inclusion Criteria: Adult (>18years), both sex (male
behavior and a lower quality of life (2).
and female) and patients with maintained HD for at least
Sarcopenia may result from a number of
reasons, such as an anabolic/catabolic imbalance. IGF-

1 is a hormone that promotes growth, differentiation,
Exclusion Criteria: Patients with acute diseases, such
and maintenance of skeletal muscle (3).
as infections or immunological disorders, patients with
The transforming growth factor (TGF)
history of primary muscle diseases and patients with
superfamily member myostatin, which acts as a
history of cerebrovascular stroke.
catabolic factor and a negative regulator of muscle

growth, is the alternative (4). Myostatin levels were
Study Procedures:
shown to be elevated and inversely linked with muscle
All patients in this study were subjected to the
atrophy in chronic illnesses (5). IGF1 levels were
discovered to be lower, which caused a decline in
1. Full medical history taking including (age,
muscle protein synthesis and concomitant muscle
dialysis vintage (the duration since the first day of
protein breakdown, aggravating catabolic disorders
dialysis), body mass index (weight and height).
such end-stage chronic renal disease (6).
2. Full clinical examination (pulse, blood pressure
The aim of the current study was to evaluate the
and muscle status tests as below).
relationship between Insulin-Like Growth Factor 1 and
3. Laboratory parameters including: (A) Complete
myostatin and Muscle status (strength and mass) in a
blood count, kidney function test (Urea and
sample of Egyptian patients on Hemodialysis.
Creatinine), serum sodium, potassium, phosphate,

Calcium and albumin were taken from the patients'
medical records. (B) Myostatin levels and IGF-1
A case control study that was conducted on 60 subjects
levels were measured using the Rayto tool with
divided into 2 groups matched for age and sex:
Enzyme-linked Immunosorbent Assay (ELISA)
Group A (Control) that included 30 apparently healthy
method before HD (USA).
Received: 12/07/2022
Accepted: 15/09/2022

Full Paper (vol.901 paper# 30)

c:\work\Jor\vol901_31 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 200-205

Safety and Tolerability of Sodium Glucose Co-Transporters-2
Inhibitors Among Elderly Patients with Type 2 Diabetes Fasting Ramadan
Hossam Arafa Ghazi
Department of Internal Medicine, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Hossam Arafa Ghazi, Mobile: (+20) 01006408074, Email: hossamghazi7@gmail.com

: One of the main five pillars of Islam is Ramadan fasting and it may carry some hazards on some patients
especially elderly patients. Sodium Glucose Co-Transporter-2 inhibitors (SGLT2i) is a new family which introduced in
the market few years ago and used to treat patients with Type 2 Diabetes (T2D).
Objective: The objective of this study is to investigate the safety and tolerability of SGLT2i among elderly patients
with T2D fasting Ramadan.
Patients and methods: The current study was conducted on 100 patients aged 60 years and more, both males and
females (Group 1: 50 patients on vildagliptin and metformin and Group 2: 50 patients on empagliflozin and metformin).
Glycated haemoglobin (HbA1c) and estimated glomerular filtration rate (eGFR) were measured before and 2 months
after Ramadan. Episodes suggesting hypoglycemia and/or volume depletion were estimated. Days to break fasting were
also compared.
Results: The mean age among group 1 was 65.34 + 2.9 years versus 66 + 3.4 years among group 2 [P value: 0.25].
Mean HbA1c before Ramadan was 7.26±0.46 among group 1 versus 7.28±0.53 among group 2 [P value: 0.84]. No
statistically significant difference was found regarding episodes suggesting hypoglycemia and/or volume depletion nor
days to break fasting.
Conclusion: The conducted study has addressed that SGLT2i may be used safely and well tolerated mong elderly
patients with T2D fasting Ramadan if patients were well prepared and educated before Ramadan.
Keywords: Elderly, Type 2 Diabetes, Ramadan Fasting, SGLT2 inhibitors.

higher among elderly in comparison to those younger
Ramadan is a holy month for Muslims and its
patients [2].
fasting is considered as one of the main five pillars of
Sodium Glucose Co-Transporter-2 Inhibitors
Islam. Often, Muslims fast 29 to 30 days from the sohor
(SGLT2i) are new family of oral antidiabetic drugs
(dawn) to iftar (sunset). Last few years; Muslims in
approved to treat T2D, they are recently introduced in
Egypt fasted for a duration ranging from 12 to 16 hours.
the Egyptian market few years ago. They act by
Although many elderly patients with diabetes have the
inhibition of Sodium Glucose Co-Transporter -2
permission not to fast, but most of them reject this and
(SGLT2) receptors in the proximal convoluted tubules,
insist on fasting [1]. On the other hand, Ramadan fasting
leading to glucosuria and subsequently lowering of the
may carry some hazards on few patients with diabetes
renal threshold of glucose reabsorption by about 50-60
especially elderly patients. First of these hazards is
% [5]. Furthermore, this family passed a long journey
fluctuation of blood glucose level that may occur during
from neutrality to benefits. Adding to its control of
fasting (hypoglycaemia and/or hyperglycaemia),
blood glucose, a lot of -well conducted- mega trials have
increased risk of thromboembolic manifestation and
shown that they have more advantages beyond the
increase the risk of ketosis [2].
glycaemic control like decreasing Major Adverse
In addition, Egypt is listed as one of the top ten
Cardiovascular Events (MACE) and progression of
countries having large number of people living with
Diabetic Kidney Diseases (DKD) [6].
diabetes. According to the International Diabetes
At the beginning of launching these drugs, there
Federation (IDF), 10.9 million people living in Egypt
was some worry from diabetologists regarding this
have diabetes (in the age range from 20-79 years) in
family to be prescribed among elderly population with
2021 and it is supposed to be doubled in 2045 by
T2D especially those aged above 70 years due to risk of
reaching about 20 million patients with diabetes [3].
hypovolemia especially during Ramadan fasting. Some
Also, in the last few years it was noticed that there is
trials were conducted to investigate the safety and
increase in the relative and absolute number of elderlies
tolerability of SGLT2i during Ramadan among general
in Egypt. Central Agency for Public Mobilization and
population with T2D like Canagliflozin in Ramadan
Statistics reported that elderlies represented about 7% of
Tolerance Observational Study (CRATOS) trial [7],
total Egyptian population in 2019 and expected to
which concluded that canagliflozin -which is one of
represent about 12% to the total population by the year
SGLT2i- could be used during Ramadan fasting.
2030 [4].
Nevertheless, some increased risk of hypovolemia
Prevalence of diabetes is increased with age,
during fasting was noticed. We previously studied the
subsequently total number of elderly patients having
use of SGLT2i among Egyptian patients with T2D and
type 2 diabetes (T2D) and willing to fast Ramadan will
we concluded that SGLT2i are effective, safe and well-
be increased. Complications of fasting are relatively
Received: 12/07/2022
Accepted: 15/09/2022

Full Paper (vol.901 paper# 31)


The Association of Serum Ferritin with Disease Severity in
Non-Alcoholic Fatty Liver Disease
Shaimaa Hussein GadAllah*, Zainab Ahmed Ali­Eldin, George Safwat Matta, Rafik Youssef Awad Youssef
Internal Medicine & Gastroenterology Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Shaimaa Hussein GadAllah, Mobile: (+20) 01020911390, E-mail: shaimaahussen2022@gmail.com

It is widely acknowledged that non-alcoholic fatty liver disease (NAFLD) is the most common chronic
liver disease in the West. It is associated with insulin resistance and frequently coexists with metabolic syndrome
symptoms. Ferritin is an acute phase reactant, though, thus its increase in a patient with fatty liver disease's serum could
perhaps be a sign of inflammation in addition to disease activity.
Objective: The aim of our study was to evaluate the association of serum ferritin with non-alcoholic fatty liver disease
in patients with normal and elevated lipid profile.
Patients and Methods: The study was cross sectional study, which conducted at Ain Shams University Hospital. This
study was conducted on 80 patients. They were divided in to 2 groups as following: Group I included: 40 NAFLD
patients with normal lipid profile. Group II included: 40 NAFLD patients with elevated lipid profile. Lipid profile and
serum ferritin were done.
Results: Our research showed that patients with increased lipid profiles and non-alcoholic fatty liver disease had
considerably higher serum ferritin levels than those with normal lipid profiles. However, there was no connection
between serum ferritin and the fibrosis score for NAFLD, hepatic steatosis index, or fatty liver index.
Conclusion: Serum ferritin may be promising adjuvant inflammatory marker of predication and prognosis in NAFLD
patients especially in those with elevated lipid profile. Also, serum ferritin level cannot alone reflect severity of NAFLD.
Keywords: Serum Ferritin; lipid profile, Disease Severity; Non-alcoholic Fatty Liver Disease.

research about the relationship between serum ferritin
The risk of diabetes mellitus, cardiovascular
and the severity of NAFLD.,
disease, and chronic renal disease is increased by non-

alcoholic fatty liver disease (NAFLD), which is
regarded as a multisystem disease (1). From basic
Our study objective is to determine the
steatosis through non-alcoholic steatohepatitis (NASH)
association of serum ferritin with non-alcoholic fatty
to cirrhosis and its associated complications such
liver disease in predication of severity and progression
hepatocellular cancer and mortality, there is a broad
in patients with normal and elevated lipid profile.
range of liver disease (2).

There is considerable evidence linking insulin
resistance to the development of non-alcoholic fatty
The study was cross sectional study, which
liver disease, even though the aetiology of the condition
conducted at Ain Shams University Hospital. This study
(non-alcoholic steatohepatitis/non-alcoholic fatty liver
was conducted on 80 patients of both sexes, with age
disease) is not yet fully understood (3).
(18years old - 60 years), duration of study was 6
One non-invasive marker, serum ferritin, has
months. Patients were divided in to 2 groups as
recently emerged as a potential predictor of the presence
following: Group I included: 40 patients with normal
of non-alcoholic steatohepatitis as opposed to simple
lipid profile (Triglyceride < 150mg/dl, Cholesterol <
steatosios. Iron excess can be found in up to one-third
200mg/dl, HDL = 60mg/dl, LDL < 100mg/dl). Group
of patients with non-alcoholic fatty liver disease.
II included: 40 patients with elevated lipid profile
Steatosis, insulin resistance, and inflammation all
(Triglyceride >150mg/dl, Cholesterol > 200mg/dl, HDL
contribute to an altered control of iron transport.
= 60mg/dl, LDL >100mg/dl).
Although ferritin is an acute phase reactant, its rise in

the blood of a patient with fatty liver disease may not
Exclusion criteria: Alcohol abuser, chronic or acute
only indicate the presence of the disease but also the
viral hepatitis patient (hepatitis A, B, C), patients with
presence of other inflammatory conditions and some
other chronic metabolic liver disease as Wilson disease,
cancers (such as lymphoma) (5).
hereditary hemochromatosis, auto immune hepatitis,
Numerous research have been interested in
primary sclerosing cholangitis, pregnancy and lactation,
examining the role of altered iron metabolism in the
onset and progression of non-alcoholic fatty liver
malignancy, immunocomprimised patients, anemia and
disease. The generation of reactive oxygen species,
the patients who refuse to be entitled in the study.
impaired insulin signalling, changed lipid metabolism

in hepatic tissue, and the harm they cause are only a few
All cases had underwent:
of the pathogenic pathways for iron that have been
Medical history taking according to pre-
identified (6). Since there is no consensus among
designed questionnaire.
Received: 12/07/2022
Accepted: 15/09/2022

Full Paper (vol.901 paper# 32)

c:\work\Jor\vol901_33 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 213-225

Gastroprotective and Healing Effect of Naringin and Quercetin in
Experimentally Induced Gastric Ulcer by Diclofenac Sodium in Adult Male
Albino Rat: A Histological and Immunohistochemical Study
Hend Ragab Mousa*, Nehal Fahmy Shaheen
Anatomy and Embryology, Benha Faculty of Medicine, Benha University
*Corresponding author: Hend Ragab Mousa, Mobile: (+20) 1222898035, E-mail: drhendragab@yahoo.com

Diclofenac (DFC) has been widely utilized as anti-inflammatory and analgesic medication. Naringin is
a natural flavanone glycoside that is found in citrus fruits. Quercetin is a natural flavonoid found in vegetables and fruits.
evaluation of the roles of naringin and quercetin in protection and recovery of rats' stomach ulcers caused by DFC.
Material and methods: Forty male albino adult rats were divided into 4 identical groups: Control group, (DFC) group:
rats were given 10 mg/kg b.w. /day DFC by oral gavage for 4 weeks, (DFC + Naringin) group: rats were given100
mg/kg/body weight naringin daily along with previous dose of DFC dose for 4 weeks and (DFC + Quercetin) group:
rats were given 50 mg/kg body weight quercetin daily along with previous dose of DFC. The stomach tissues were
examined grossly and processed for microscopic examination.
Results: DFC group revealed ulceration of mucosa resulting in detachment of fundic mucosa, inflammatory infiltration,
and wide lumen of fundic glands. There was a thin, sporadic PAS-AB mucous coating over the surface epithelium. It
showed extensive iNOS immunoreaction in the cytoplasm of gastric epithelial cell and strong PCNA immuno-
expression in the cells lining the fundic glands. Both naringin and quercetin exhibited a protective effect by prevention
of histopathological changes caused by DFC on gastric mucosa. There is a persistent, thick mucus coating covering the
surface epithelium, weak iNOS immunoreaction and moderate PCNA.
Conclusion: The intake of naringin during taking diclofenac protects the stomach mucosa but quercetin has more
protection than naringin.
Keywords: Diclofenac, naringin, Quercetin, ulcer.


The purpose of this study is to assess the roles of
One of the most prevalent gastrointestinal
naringin and quercetin on protection and curing of
disorders is gastric ulcer (1). It results from an imbalance
gastric ulcers in rats caused by DFC.
between the digestive factors, including prostaglandins

and blood flow, and the aggressive factors, including
gastric acid and pepsin (2). Due to their excellent
effectiveness against pain and inflammation,

nonsteroidal anti-inflammatory drugs (NSAIDs) are
Forty adult albino male rats that were 2 months old and
among the world's most frequently prescribed
weighed between 180 and 200 grams were used in this
medicines (3). Despite their ability to reduce
study. The laboratory animals' department at the faculty
inflammation, they have a variety of negative side
of veterinary medicine at Benha University in Egypt is
effects (4). Diclofenac, a member of this class of
where we obtained the rats. To prevent any metallic
medications, it is a phenylacetic acid derivative that has
contact, the rats were housed in plastic cages. The lab
long been used to treat a variety of illnesses as an
conditions were ambient, at a temperature of 20 ± 2°C
analgesic and anti-inflammatory medication (5).
with exposure to a planned illumination cycle
Diclofenac's adverse effects are brought on by oxidative
(light/dark 14 hours/dark 10 hours). Water and regular
stress and the suppression of the antioxidant defense
food were permitted.
system (6). Natural therapies are a key component in the

treatment and prevention of stomach ulcers (2).
Ethical approval:
Numerous plant species, particularly citrus fruits,
All aspects of this research approved from the
contain the flavanone glycoside naringin (NA), which is
Ethics Committee of the of Faculty of medicine, Benha
generated from the flavanone naringenin (7). NA has
University, Benha, Egypt.
actions against allergies, ulcers, inflammation, cancer,
The study conformed to "Guide for the care and
osteoporosis, and free radicals (8).
use of Laboratory Animals" for the use and welfare of
A flavonoid called quercetin (QU) is present in a
experimental animals, published by the US National
variety of plants, vegetables, and seeds (9).
Institutes of Health (NIH publication No. 85­23).
The antioxidant, anti-inflammatory and free

radical-scavenging capabilities of quercetin are partially

responsible for its anti-ulcer actions (10). The strong anti-
inflammatory actions of quercetin are primarily
-Diclofenac sodium was purchased from El Nasr
achieved via cytokine suppression (11).
Pharmaceutical Co. (ADWIC). It was obtained in the
Received: 25/10/2022
Accepted: 25/12/2022

Full Paper (vol.901 paper# 33)

c:\work\Jor\vol901_34 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 226-235

Factors Affecting the Outcome of Surgical Management of
Atypical Meningiomas
Shawky A. Elmeleigy*, Ahmed M. Deabes, Mohammed H. Eltantawy
Department of Neurosurgery, Faculty of Medicine, Benha University, Benha, Egypt
* Corresponding author: Shawky A. Elmeleigy, Mobile: (+20)1003495755, Email: elmelegyshawkey@gmail.com


Background: Atypical meningiomas differ from Grade I meningiomas in aspects of the higher rate of recurrence, more
postoperative complications, and shorter life expectancy postoperatively.
Objective: This study was aimed to evaluate the clinical course of atypical meningioma and prognostic factors affecting
its surgical outcomes.
Patients and Method: This retrospective study investigated the medical records of 45 patients who had surgical removal
of atypical meningiomas at Benha University Hospitals between January 2010 and December 2021. Patients average
age was (56.69± 11.11) ranged from 29 to 74 years. The follow-up period was 60 months. Analysis included multiple
factors such as patient age, gender, tumor size, location, and the extent of surgical resection based on (Simpson Grading
Results: There was significant relationship between recurrence and Simpson grade, size, and side. There was a
significant relationship between rate of recurrence and type of radiation used. The mean survival time was significantly
longer in Gamma knife group compared to radiotherapy. Rate of mortality was significantly higher in group radiotherapy
compared to gamma knife with hazard ratio (95% CI) (5.33(0.79-36.75%). Rate of recurrence was significantly higher
in group radiotherapy compared to gamma knife with hazard ratio (95% CI) (3.03(0.89-10.31%).
Conclusion: It could be concluded that atypical meningiomas in elderly patients with a large size especially more than
60cc, incomplete surgical resection; frequently have poorer prognosis following surgical intervention. Postoperative
radiotherapy could provide accepted local tumor control in patients with incompletely resected atypical meningioma.
Keywords: Atypical meningioma, Prognostic factors, Simpson grade, Recurrence, Cranial base, Stereotactic gamma


Meningioma is an intracranial tumor that arises
This study was aimed to evaluate the clinical course
from the meninges of the brain. It is the most common
of atypical meningioma and prognostic factors affecting
tumor of the central nervous system, accounting for
its surgical outcomes.
around thirty percent of CNS neoplasms. Meningioma

subtypes with aggressive and malignant features have
been found. The term (atypical meningioma of grade II)
This retrospective study investigated the medical
was created in 1985 [1].
records of 45 patients who had surgical removal of
In its most recent classification methods, the WHO
atypical meningiomas at Benha University Hospitals
classified meningiomas based on histological criteria as
between January 2010 and December 2021. Patients
atypical (Grade II) and anaplastic (Grade III) [2].
average age was (56.69± 11.11) ranged from 29 to 74
Since the adoption of the 2000 and 2007 WHO
years. The follow-up period was 60 months.
classifications, the percentage of atypical meningiomas

has increased [3]. Recent figures indicate that 20­30% of
We collected demographic information, including
meningioma patients are now diagnosed with atypical
the patient's age and gender. Patients had a pre-
meningioma [4, 5].
operative contrast-enhanced MRI; with a definitive
According to a recent study, atypical meningiomas
radiological description of extra-axial brain SOL as
are linked with a greater risk of recurrence and shorter
regard site, size, side, focal pathological edema and the
overall survival lengths than benign meningiomas
midline shift of the brain. The tumor size was
(Grade I). Atypical meningioma is linked with a 7­8-
determined in cubic centimeters based on the largest
fold higher risk of recurrence and a 2-fold greater risk
tumor length in all three dimensions.
of death 3­6 years after diagnosis [5, 6].
According to the tumor location, meningiomas
In addition, prior research identified the following
are classified anatomically into four categories.
potential prognostic markers for the recurrence of
Convexity meningioma including (frontal, parietal
atypical meningioma: cellular proliferating index, age,
temporal, occipital and that extending into more than
tumor site, preoperative tumor size, degree of surgical
one lobe of them), parasagittal meningioma including
resection, and early postoperative irradiation [7-9].
(falcine and parasagittal), sphenoid meningioma
However, these studies are debated, and the appropriate
(lateral sphenoidal, mid sphenoidal and medial or
treatment technique for atypical meningioma has not yet
clinoidal) and Tentorial and olfactory groove
been found.
Received: 06/09/2022
Accepted: 05/11/2022

Full Paper (vol.901 paper# 34)

c:\work\Jor\vol901_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.901 paper# 35)

c:\work\Jor\vol901_36 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 241-247

Effectiveness of Aerobic Exercise with Laughter Therapy on Functional,
Cognitive, and Psychological Well-Being in The Elderly:
A Randomized Controlled Clinical Trial
Marwa M. Elsayed*, Ebtesam N. Nagy
Department of Physical Therapy for Cardiovascular / Respiratory Disorder and Geriatrics,
Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Marwa Mahmoud Elsayed, Mobile: (+20)01156033818, Email: marwa.elsaid@cu.edu.eg.

Physical and mental abilities generally diminish with the natural process of aging. Exercise on a regular
basis is essential for everyone. Adequate physical exercise in older adults is associated with a better life.
Improvements in both physical and mental health are linked to laughter therapy. The aim of the current study was to
examine the unrecognized combined effects of aerobic exercise and laughter therapy on functional, cognitive, and
psychological well-being in the elderly.
Patients and methods: A total of 60 elderly individuals were divided into two groups; the experimental group (n=30),
which received aerobic exercise with laughter therapy, and the control group (n=30), which received the identical
experimental group's aerobic exercise program only, 3 times a week over 6 weeks. Body mass index, blood pressure,
functional capacity (assessed by the 6-minute walk test distance), functional activity level (evaluated by the Functional
Independence Measure), cognitive function (determined by the Mini-Mental State Examination), and psychological
status (estimated by the Geriatric Depression Scale) were all assessed at baseline and after 6 weeks. All participants
completed the study, and the outcome measure data were analyzed.
Results: By comparing the experimental group to the control group, all measured variables revealed a significant
change in both groups (p<0.001) but in favor of the experimental group rather than the control.
Conclusions: The elderly may benefit physiologically and mentally from laughter therapy combined with exercise.
Laughter therapy may be a powerful method for inspiring people to engage in physical activity and obtain greater
Keywords: Aged, Depression, Exercise therapy, Humor, Mental health, Walk test.


Aerobic exercise, which involves the use of
The global population is rapidly getting older,
oxygen and the action of large groups of skeletal
with an astounding 50% predicted increase in the
muscles over an extended period of time, may enhance
number of those 65 and older between 2015 and 2050,
executive function, speed of processing, cognition, and
reaching more than 1.4 billion (1).
memorization in healthy elderly persons (6).
Compared to other age groups, older
Also, the cardiovascular and neurological
individuals have the quickest rate of population
repairing processes, muscle endurance, improved
growth, the largest frequency of chronic diseases and
disorders, and the highest extensive care costs (2).
inflammatory, and antioxidant effects (4).
Certain factors, like physical disability, deficits in
Around the world, laughter therapy has been
seeing and hearing, cognition, and so forth, pose
employed in a variety of participant groups and
substantial barriers to the adoption of therapies that
programs as a non-pharmacological therapy, an easily
require deep intuition for issues of mental health
available, non-invasive, mental, and psychological
because of the various psychosomatic issues that older
rehabilitation (7).
individuals experience (3). Global lifestyle guidelines
It is a style of engagement that encourages
for older individuals are linked to a slower
smiles, radiant faces, and natural nonverbal
deterioration in mental, physical, intellectual, and
communication through an emotional pathway that
social attributes over time, ranging from 1.8% to
supports interpersonal communication. Unlike the
10.8% (1). The advantages of living a generally healthy
conventional forms of therapy, laughter therapy adopts
lifestyle were equally beneficial for men and women
a different strategy that has a favorable impact on body
of all ages, and occasionally they were even greatest, a
processes, the immune system, increases the activity of
healthy lifestyle is thought to be a key component of
natural killer cells, and lowers stress (8). The results
preventing chronic diseases (4).
from earlier studies indicated laughter therapy as a
Regular exercise is associated with improved
positive influence on both psychological and
sleep quality and mood. Aerobic exercise also benefits
physiological function, and it may be a useful
cardiovascular health by increasing cardiorespiratory
treatment to enhance the quality of life (QOL) of
fitness, which is associated with cognitive and mental
elderly adults whose daily living tasks and mental state
health (5).
have deteriorated due to depressive symptoms,
Received: 23/09/2022
Accepted: 21/11/2022

Full Paper (vol.901 paper# 36)

c:\work\Jor\vol901_37 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 248-254

Sexual Satisfaction; Prevalence, Cofactors and its Relation to
Mental Health of Egyptian Married Women
Reda Abdel Latif Ibrahem1, Shaimaa Sherif Soliman1, Wafaa Ahmed Shehata2, Ghadeer Maher Mohammad EL
1Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Egypt.

2 Dermatology, Andrology and STDs Department, Faculty of Medicine, Menoufia University, Egypt.
*Corresponding author: Ghadeer Maher El Sheikh, Mobile:01004039259, Email: ghadeer_maher@yahoo.com

Sexual satisfaction not only leads to one's marital satisfaction but also plays a crucial role in psychological
well-being and overall satisfaction with life of married individuals.
: The purpose of this study was to determine the prevalence and cofactors of sexual satisfaction, as well as its
relationship to mental health in Egyptian married women.
Participants and methods: An analytical cross-sectional study was carried out on 256 married females selected from
attendants of two healthcare centers in Menoufia governorate, Egypt. Sexual satisfaction among the participant women was
assessed using Married Women Sexual Satisfaction Questionnaire (MWSSQ) while their mental health was evaluated using
the 28-items General Health Questionnaire (GHQ-28).
Using MWSSQ revealed that 9.8%, 82% and 8.2% of participants were sexually dissatisfied, moderately satisfied
and highly satisfied respectively. Regarding mental status of participants, GHQ-28 scale showed that 48% of them were of
good mental health, 38.3% were of poor mental health and 13.7% were of very poor mental health. There was a significant
relationship between worsening mental status and decreased sexual satisfaction (P<0.0001). Multivariate regression analysis
showed that husband age, women education and socioeconomic standard were independent risk factors for sexual
Women's sexual satisfaction and their mental wellbeing are intimately related, so it is recommended to
implement effective and appropriate sexual education programs that will raise women's awareness and lessen the suffering
of those who are impacted.
: Sexual satisfaction, Married females, Mental health.

satisfaction have been related to improved mental health
According to one definition, sexual satisfaction is
(6), it has also been established that women's sexual
"an effective response coming from one's subjective
satisfaction influences their emotions and plays an
appraisal of all aspects of one's sexuality within a
important part in preventing dangerous sexual practices,
relationship". So, it is considered as a reliable measure of
major mental illness, and eventually divorce (7).
sexual health and sexual well-being (1).
In many countries, sexual dissatisfaction is an
Sexual satisfaction has a strong association with
increasingly frequent issue, and it affects females more
marital contentment, which is necessary for long-term
than males. The main contributing factors include
stability and healthy family bonds (2).
incorrect beliefs held by women about sexual activity and
Female sexual satisfaction is influenced by a
cultural taboos surrounding it, in addition to parenting
variety of factors, including length of marriage, age at
approaches that do not recognize their role in the
marriage, age at the time of marriage, number of
appreciation of sexual functions and sexual demands. As
marriages, number of children, employment status, and
a result, they are impacted by a variety of psychological
educational background (3). It is also impacted by a variety
problems such as depression, emotional instability, and
of intrapersonal and interpersonal elements, such as the
personality consequences including hostility and violence
strength of relationships, one's religious beliefs, gender
power, stress, life quality, mental health issues, chronic
In Egypt, there is limited research on sexual
disease, age gap between couples, and child-rearing
function and relationship satisfaction among females. So,
methods (4).
this study focused on the prevalence of sexual satisfaction
The lack of sexual satisfaction is attributed to
in women and how it is linked to their mental health.
many factors, which may include marital issues, partner

performance during the sexual activity, sexual
dysfunctions, and lack of emotional satisfaction (5).
An analytical cross-sectional study on 256
Sexual satisfaction and mental wellness are
married females who were selected from the attendants of
intimately linked. While mental health greatly affects
two healthcare centers (Shebin-Elkom and Batanon
women's sexual desires, and higher levels of sexual
Health Centers) in Menoufia governorate, Egypt. At the
Received: 23/09/2022
Accepted: 30/11/2022

Full Paper (vol.901 paper# 37)

ABSTRACT The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 255-261

Impact of Direct Acting Antivirals Therapy on Novel Fibrosis Index for
Assessment of Hepatic Fibrosis in Comparison with AST to Platelet Ratio and
Fibrosis-4 (FIB-4) Indexes in Egyptian Patients with
Chronic Hepatitis C Infection in Correlation with Fibroscan
Ahmed S. Allam, Khaled Z. Elkarmouty, Hany H. Kaisar,
Mahmoud M. Arafah, Shaimaa H. Gadallah*
Department of Internal Medicine, Gastroenterology and Hepatology Unit, Ain Shams University, Egypt
*Corresponding author: Shaimaa Hussein GadAllah, Mobile: (+2) 01020911390, E-mail: shaimaahussen2022@gmail.com

Scarring or progressive fibrosis and cirrhosis develop over time as a result of chronic viral infection,
which induces inflammation and tissue healing via deposition of extracellular matrix. There has been an increase in
the sustained virological response (SVR) and the rate of eradication of HCV because of the effectiveness of direct-
acting antiviral drugs (DAAs). Reduced hepatic fibrosis is associated with increased SVR rates. There are a variety of
non-invasive fibrosis imaging, scoring, and marker methods: transient elastography, aminotransferase platelet ratio
index (APRI), as well as fibrosis-4 (FIB-4) score.
Objective: The purpose of this research was comparing the novel fibrosis index to APRI, (FIB-4) score and fibroscan
in predicting the degree of hepatic fibrosis in Egyptian chronic HCV patients who were managed by DAAs.
Patients and methods: 100 Egyptians with chronic HCV infection participated in a our 3-month long prospective
Cohort research using the IFN-free DAA combination of Sofosbuvir and Daclatasvir ± Ribavirin.
Results: There was significant regression of fibrosis with DAAs treatment in all patients achieving SVR by fibroscan,
APRI and fib4. Novel fibrosis index is reliable and good tool in estimation of liver fibrosis in correlation to fibroscan,
with the cutoff value in prediction of hepatic fibrosis stage 4 was >3.1 and has sensitivity of 81.5% while the specificity
was 74.1%.
Conclusion Novel fibrosis index has been found to be good reliable marker for assessment of liver fibrosis with high
accuracy of predicting f4 fibrosis stage. There was significant marked reduction of fibrosis degree by fibroscan, APRI
and FIB4 after DAAs treatment.
Keywords: DAAs, SVR, NFI, liver fibrosis indexes.

deciding when to commence antiviral therapy in
Hepatitis C virus (HCV) infection is a prominent
patients with chronic HCV infection (5).
cause of chronic liver disease globally, and in certain
Liver biopsy has mostly been superseded by less
cases has been linked to liver cancer (1). Management
invasive methods, such as fibrosis scores, imaging
lines for chronic hepatitis C virus (CHC) infection have
methods, and novel blood fibrosis markers (3). The
shifted from the use of peginterferon and ribavirin
aminotransferase (AST)/platelet ratio index (APRI) and
(PegIFN/RBV, PR) to that of direct antiviral medicines
fibrosis-4 (FIB-4) scores are two of the most common
(DAAs) (2).
methods used to assess liver damage in individuals with
High ratios of sustained virological response
viral hepatitis C, especially those with advanced fibrosis
(SVR) are accompanied by a minimizing risks of
and cirrhosis (6). Rapid and noninvasive, transient
hepatic fibrosis as well as decreasing risky
elastography (TE) has found widespread application in
consequences such hepatic failure and portal
clinical practice due to its excellent sensitivity and
hypertension (3).
specificity for detecting advanced fibrosis (7).
Studies have demonstrated that patients with
Since the results of the novel fibrosis index
CHC who are managed with IFN and achieve SVR had
correspond with the expected fibrosis stages, F3 and F4,
a lower risk of advancing hepatocellular carcinoma
go with the FibroScan® test and are highly confirmed
(HCC) and other liver-related problems, and an
by clinical data in patients with chronic HCV infection,
enhanced health-related quality of life (4).
it is a valuable and reliable tool for predicting fibrosis
Liver fibrosis stage is a well-established predictor
progression (8).

of disease severity and problems in chronic HCV
infection; F4 fibrosis is most typically linked to ascites,
The purpose of this research was to compare the
hepatic encephalopathy, portal hypertension, and other
novel fibrosis index to APRI, (FIB-4) score and
implications. Proper staging of hepatic fibrosis in
fibroscan in predicting the degree of hepatic fibrosis in
chronic HCV infection is crucial for achieving timely
Egyptian chronic HCV patients who were managed by
treatment and optimal therapeutic outcomes. In
addition, in low and middle-income countries, where

complete eradication of virus in each instance is crucial,
a correct diagnosis of fibrosis is especially vital in
Received: 15/07/2022
Accepted: 18/09/2022

Full Paper (vol.901 paper# 38)

c:\work\Jor\vol901_39 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 262-267

Human Leucocyte Antigen A Alleles in The Prediction of Post-Kidney Transplant
Lymphoproliferative Disorders, A Single-Center Study
Raghda W. Magar(1) Manal I. Fouda (2), Osama Salama(2), Mohamed Sabry (2), Ayman F. Refaie(1)
(1)Urology and Nephrology Center, and (2)Clinical Pathology Department,
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Corresponding author: Raghda W Magar, Mobile no; +201000595951,
Email: rwmagar@gmail.com/ raghda_magar_unc@mans.edu.eg, ORCID iD 0000-0002-8582-7474

Post-transplant lymphoproliferative disorders (PTLPD) are frequently encountered after kidney
transplantation. Human leucocyte antigen (HLA)A alleles were shown to be a predictor of development of these disorders.
Objective: Study of prediction of human leucocyte antigen HLA-A alleles in the development of PTLPD.
This study included 50 Egyptian kidney transplant (KT) recipients who underwent live-donor kidney
transplantation, between 2010 to 2022. HLA-A alleles phenotyping was characterized by sequence specific oligonucleotide
probes (SSOP). Nondestructive form of PTLPD was diagnosed by presence of lymphocytosis followed by assessment of,
(CD45 and CD 19) mature B lymphocytes and blast cells (CD5 and CD10) with ratio of kappa/lambda by flow cytometry.
The association between the development of this form and different HLA-A alleles was studied.
Out of fifty recipients, five patients developed a non-destructive form of PTLPD in the median duration of 30
months (ranged, 15-50 months) post transplantation. A significant association was found between the expression of HLA-
A01 (P=0.002, OR=1.020), CI (0.996-1.045) and HLA-A02 (P=0.042, OR=1.019), CI (1.001-1.037) and the development
of PTLPD. Furthermore, HLA-A02 alleles were found to be a significant corelate with onset of development PTLPD.
Conclusion: Among Egyptian kidney transplant recipients, HLA-A01 and A02 alleles are good predictors of development
of early non distractive form of PTLPD.
: Post-transplant lymphoproliferative disorders, Human leucocyte antigen A alleles, Kidney transplant.

protection (1, 4-7). In this study, the role of HLA-A alleles
Human leucocyte antigens "HLA", which are
as predictive tool for development of non-distractive form
programmed in the major histocompatibility complex
of PTLPD among Egyptian live-donor kidney transplant
"MHC" on chromosome 6, influence the human immune
recipients was evaluated.
responses. HLA molecules are classified to class I and II.

HLA class I is heterodimer of polymorphic-polypeptide
chain and B2-microglobulin, which deliver peptides from
A total of 50 kidney transplant recipients who received
an endogenous source to cytotoxic T-cells and expressed
their renal allografts from live-related kidney donors
in somatic cells. HLA class II is heterodimer of alfa and
between 2010-2022 were enrolled in this cross-sectional
beta polypeptide chains, that deliver extracellular
study. The inclusion criteria were first-time kidney
peptides and presented them to helper T-cells (1,2).
transplantation, and age between 5 ­ 60-year-old. While
T-cells recognize HLA molecules as pathogen and
exclusion criteria were patients with another organ
tumour peptides, which activate adaptive immune
transplantation, history of previous transplantation, or
responses. With most polymorphic human genes, HLA
previous malignancy. All recipients were maintained on
haplotypes are greatly implicated in the causes and
tacrolimus-based immunosuppression. Tacrolimus doses
outcomes of immune conditions and hematopoietic
were adjusted to achieve a whole blood trough level
malignancy (1,2). Since a correlation between HLA and
between 4-8 ng/ml (8).
Hodgkin's lymphoma "HL" was first described in 1967, a
Ethical approval:
lot of studies found links between HL risk with single
The required ethical approval for this study was
nucleotide polymorphisms (SNPs) and HLA allele
obtained from the Ethical Committee of the University
variants. Stratification of the population and the number
of Mansoura (IRB: MD. 20.5.328). The study was
and complexity of linkage disequilibrium in the MHC, on
performed according to Helsinki standards and
the other hand, have made it hard to pinpoint causal
approval consent was obtained from each adult
signals (3). The associations between certain HLA
patient and from the caregiver of each child patient.
phenotypes and the development of post-transplant

lymphoproliferative disorders (PTLPD) have been
Clinical evaluation:
reported in many studies. They showed that the role of
Recipients were thoroughly examined with special
HLA with tumour antigen presentation could be involved
attention to any lymph node enlargement or
as either a genetic risk factors, prediction, or the disease
Received: 13/09/2022
Accepted: 06/11 2022

Full Paper (vol.901 paper# 39)

c:\work\Jor\vol901_40 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 268-274

Dermatology Life Quality Index and Work Limitation among Psoriasis Patients
Nashwa Nabil*1, Nader Nasr2, Eman Mahmoud Shebl3
Departments of 1, 3Community, Environmental and Occupational Medicine, 2Dermatology and Andrology
and Faculty of Medicine, Benha University, Egypt
*Corresponding author: Nashwa Nabil, Mobile: (+20) 01125923049, E-Mail: nashwa.nabil@fmed.bu.edu.eg


Background: Psoriasis is a long lasting immune-mediated disease that has a significant ferocious effect on quality of
life (QOL). It is often accompanied with social stigmatization, physical disability and psychological disorders that
may reach to suicidal ideation. All these effects of psoriasis have a significant negative impact at patients' work
productivity. Nevertheless, the effects of psoriasis on work-related factors have not been extensively studied.
Objective: The aim of the current study is to assess the relationship between the severity of psoriasis, dermatology life
quality index and work limitation among employed psoriatic patients. Patients and methods: A cross-sectional study
was conducted at Benha University Hospital Dermatology Clinic from 1st August 2022 till the end of October 2022.
The study included 180 of psoriasis patients using an interview questionnaire incorporating the Dermatology Life
Quality Index (DLQI) and Work limitation questionnaire (WLQ). An assessment of the disease severity was carried
out using the Psoriasis Area Severity Index (PASI). Results: The majority of studied group were males (64.4%) with a
median (IQR) age 45 (40-52) years old. Their median (IQR) disease duration was 12 years. About 48.9% of the
studied patients have degree PASI score. DLQI and WLQ score significantly increased among studied patients have
severe PASI grade [median 26 (IQR 23-27) and median 65 (IQR 50-75), respectively]. There were highly significant
positive correlations between DLQI and WLQ score, age and disease duration among the studied patients.
Conclusion: Psoriasis has a great impact on the workers, the organization and the society as a whole. So measures for
good psoriasis management are recommended.
Keywords: Psoriasis, Work limitation, DLQI, WLQ, PASI.


other chronic conditions as hypertension, congestive
Any area of the body can be affected by the
heart failure, type 2 diabetes, or depression. Patients
chronic inflammatory skin disease psoriasis, which has
may have severe physical discomfort and some
a pattern of remission or relapse (1). It happens when
handicap depending on the location and degree of
the immune system mistakenly perceives a healthy
outbreaks (9).
skin cell as a pathogen and sends out false signals that
Away from physical impact of itching, pain,
lead to an increase in the production of new skin
and scaling, the patients can also feel ashamed or
embarrassed because of their disease which affects
It affects 0.14-1.99% of persons worldwide,
their social life by avoiding social activities (10).
making it a very common condition (3). Psoriasis
Perceived discrimination, stigmatization and social
distresses 3 % of the American population, with
exclusion are psychologically devastating for
approximately 250,000 new cases every year (4). In
individuals suffering from psoriasis and their
Egypt, the prevalence of psoriasis ranges between
0.19% and 3% of the Egyptian people (5).
As a result, psoriasis has a massive negative
The most prevalent type of psoriasis, plaque
impact on people's lives.
psoriasis (PSO), often produces raised, scaly, and
The severity of the illness and its stigma are
erythematous lesions to emerge on the skin (2). Nearly
related to a negative impact on productivity at work.
30% of individuals experience pain and swelling in
Both the sick and society must pay a high price for this
their joints along with other symptoms, which
lost output (12). The projected annual economic impact
indicates the onset of psoriatic arthritis (6). PSO can
in the United States is $35.2 billion, of which 32% is
manifest at any age, but the majority of instances
due to lost productivity at work (13). According to one
happen before the age of 35, and women are frequently
study, 49% of psoriasis patients who were working
identified earlier than men (7).
frequently missed work due to their condition, while
Although there are several therapies available
92% of those who were unemployed cited psoriasis as
to decrease the symptoms of the disease, psoriasis is
the main reason for their situation. Additionally,
not curable (8). The patient's age, general health,
presenteeism (decreased productivity despite being
comorbidities, and severity all factor into these
present at work or school) contributes to patient
treatments (9). Psoriasis can range from minor to
productivity loss in addition to absenteeism (decreased
severe. How much of the body is affected by psoriasis
productivity as a result of absence from work or
determines the severity. Additionally, consider how
school); additionally, presenteeism makes up a larger
psoriasis affects a person's daily life (2). It has been
discovered that severe cases of psoriasis have an
impact on health-related quality of life comparable to
Received: 25/10/2022
Accepted: 25/12/ 2022

Full Paper (vol.901 paper# 40)

c:\work\Jor\vol901_41 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 , Page 275-281
Determination of miRNA -125b expression in Ankylosing Spondylitis
Hiba Haider Hashim1*, Reema Mohammed Abed2
1,2 Department of Biotechnology, College of Science, University of Baghdad, Baghdad, Iraq
*Corresponding author: Hiba Haider, Mobile phone: (+96) 47702622053, ORCID: 0000-0002-2550-645X,
Email: heba.haidar1206a@sc.uobaghdad.edu.iq

Background: The most prevalent kind of spondylo-arthropathies is ankylosing spondylitis (AS); >90% of those
who have it are HLA-B27 positive. AS may be influenced by non-HLA genes. MicroRNAs are 18-23 nucleotide
non-coding RNA molecules that gene expression control post-transcriptional.
Objective: The aim of the present study is to evaluate the expression profile of miRNA-125b and serum levels of
ESR, CRP in the control group and patients alike and find their association with disease progression in AS patients
and evaluate their significance as novel markers for AS.
Patients and methods: This case control study included 100 AS male patients and 100 healthy controls of matched
age with no history of infectious or autoimmune disorders. AS patients were recruited from the Hematology Clinic
in Medical City (Baghdad Hospital) and diagnosed with AS on the basis of complete blood picture (CBC), CRP,
along with MRI, and X-Ray. Clinical assessment, history of treatment administration, disease duration, and smoking
were taken into account for Disease Activity Indexes for AS patients. Disease was assessed using the Bath AS
Disease Activity Indicator (BASDAI), along with ESR (mm/h) and (CRP) (mg/l) to assess the mobility and
functional limitations. We investigate (miRNA-125b) expression in individuals with AS and in healthy individuals
by real-time quantitative polymerase chain reaction. Characteristic Receiver operating (ROC) in AS patients was
done to evaluate accuracy of diagnostic of miRNA-125b in patients with AS from control subjects.
Results: AS male patients had mean age of 40.56 (SD 10.19) and disease duration of 9.04 (SD 2.03) years. The age
of the male controls (38.78 ± 10.57 years) was not significantly different from that of AS patients (p=0.227). Both
AS Disease Activity Index (BASDAI) and AS Functional Index (BASFI) values were 3.45 (SD 2.03) and 3.84 (SD
2.62), respectively. It was observed that 57% of patients have HLA-B27positive and ESR and levels C-reactive
protein were 18.34 (SD 3.45) and 25.39 (SD 19.59) mm/h, respectively. Our results revealed a significant decrease
in (miRNA-125b) expression with fold change (0.133) in AS patients. The area under curve (AUC) was 0.962 and
cut off point was 8.94. Specificity and sensitivity of miRNA-125b were 92% and 91%, respectively.
Conclusion: Expression profile of miRNA-125b can be used as novel markers for AS.
Keywords: Non-coding sRNA, Disease duration, miRNA-125b, Disease activity, University of Baghdad.


Ankylosing spondylitis is an inflammatory
RNAs having a length of 18 to 22 nt are known as
condition (AS), initially the spine joints and a
microRNAs (6).
characteristic backache. Permanent deterioration to the
Two-thirds of the human protein-coding genes
axial joints' structure and functionality gradually
seem to be under the control of miRNAs. Several
occurs as the disease progresses, causing a severe
findings claim that miRNAs play a crucial part in a
morbidity (1).
variety of physiological and pathological processes (7).
Despite the fact that there is no scientific test
Furthermore, miRNAs are highly stable, easy to
that can identify AS, 90­95% of AS patients in Central
quantify, and present in a several clinical samples,
Europe and North America carry the HLA-B27 gene
which makes them excellent diagnosis as invasive-free
(2). However, it is still largely unknown what other
biomarkers for the primarily diagnosis or prognosis of
genetic changes associated with AS exist outside of
a number of human diseases, involving Cancer, cardiac
HLA-B27. The main criteria for diagnosing AS often
disease, rheumatic-related disease, mass cell
include HLA-B27, markers of inflammatory,
carcinoma, and cancer of the colon (8) .
subjective symptoms, and imaging testing. To
MiR-125b controls biological processes
decrease the time, it takes to diagnose AS, diagnostic
important for both lymphoma and RA, such as
indicators with high specificity and sensitivity are
inflammation, B-cell differentiation, TNF production,
urgently needed (3).
and apoptosis, as it is an evolutionarily conserved
ESR and CRP values are only high in 50­70%
miRNA (9).
of patients with active illness (4). Studies have shown
The major regulators of innate immune and
that histone changes, DNA methylation, and
inflammatory reactions have been noted as miRNA-
microRNA are some of the epigenetic pathways that
125a and miRNA-125b. Nuclear factor Kappa b (NF-
support AS (miRNA) (5). Endogenous non-coding
KB) is activated by miRNA-125b in RA, which causes

inflammation (10).
Received: 15/7/2022
Accepted: 18/9/2022

Full Paper (vol.901 paper# 41)

c:\work\Jor\vol901_42 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 , Page 282-293

N- Acetyl Cysteine Versus Hesperidin as a Prophylactic Agent for
Lambda - Cyhalothrin Induced Hepatotoxicity in Adult Male Albino
Rats: Histological and Immunohistochemical Study
Nehal Fahmy Shaheen, Mai Hassan Ibrahim*
Department of Anatomy and Embryology, Faculty of Medicine, Benha University, Egypt
*Corresponding Author: Mai Hassan Ibrahim, Mobile: (+20)01145779734,
Email: may.ibrahim@fmed.bu.edu.eg, ORCID: 0000-0001-5999-2612

Lambda Cyhalothrin (LCT) is greatly used to manage a wide variety of pests present in farming and in
home procedures.
Aim: The current work was intended to demonstrate structural and functional alterations within the liver subsequent to
long-standing exposure to LCT. Protective effect of Hesperidin and N- acetylcysteine was also investigated.
Material and methods: 40 adult male albino rats were used in this experiment, and they were split into four equal
groups: control, LCT group, rats were received LCT at a dose 61.2mg/kg b. wt. per day by oral gavage for 28 days. LCT
+ Hesperidin group, rats were given the same dose of LCT with simultaneous oral dosage of HSP at a dose of 100mg/kg
b. wt., LCT + N-Acetyl cysteine group at which rats were received the same dose of LCT as the previous 2 groups with
simultaneous oral administration of N-acetyl cysteine 150 mg/kg b. wt. The liver underwent a number of biochemical,
histological, and immunohistochemical analysis.
Results: LCT induced oxidative stress which leads to liver damage (increases MDA / decreases GSH). LCT caused
degeneration of hepatocytes and increases inflammatory cells, this is followed by rise in liver markers (AST and ALT).
While concurrent administration of Hesperidin and N- Acetyl cysteine during LCT exposure period preserved the
architecture of the liver, prevents its damage, reduced oxidative stress and normalized liver function tests.
Conclusion: Administration of N ­Acetyl cysteine during exposure to the insecticide LCT has a protective effect on the
liver more than Hesperidin.
Keywords: Liver, Lambda- Cyhalothrin , N-Acetyl Cysteine, Hesperidin.

Lambda-cyhalothrin )LCT) is an artificial
Animals & experimental plan
pyrethroid which has wide-ranging insecticidal and
Forty male mature albino rats 2 months old and
acaricidal properties; it is usually used in applications
weighed 180 - 200 grams were used in this study. We
where it is able to control insects and pest invasions(1) .
get the rats from the laboratory animals' section of the
The liver is a crucial component of the body's
Veterinary Medicine Faculty at Zagazig University,
metabolic process, converting a variety of nutrients into
Egypt. Underneath environmental laboratory condition
proteins and secreting bile. It possess a chief purifying
at temperature 20± 2°C. Rats were retained in plastic
role by converting and removing toxins via hepatocyte-
cages to escape any metallic contact. Water and typical
facilitated enzymatic mechanisms (2).
diet were permitted. The rats were split into four equal
Metabolism of (LCT) occurs quickly in liver by
groups, each with ten rats after a week of lodging.
oxidative and cleavage of ester leading to production of
Group I (Control group): Three separate groups
ROS (3). Lipid peroxidation is a result of these ROS'
of ten rats were created:
direct interactions with cellular biomolecules leading to
Group Ia: four rats were given regular diet.
damage of DNA and protein oxidation (4).
Group Ib: three rats were oral gavaged with
Hesperidin (HSP) is an active flavonoid present
distilled water daily.
plentifully in citrus types as lemon, blood orange,
Group Ic : three rats were given 1%
orange and lime. It possesses antioxidant antiviral, anti-
carboxymethylcellulose (CMC) through oral
inflammatory, analgesic, and anticarcinogenic effect (5).
gavage daily.
The precursor of the amino acid L-cysteine is N-acetyl
Group II (Lambda-cyhalothrin treated rats)
cysteine (NAC). It is well recognised that L-cysteine is
(LCT): LCT was administered to the rats every day
essential for the production and replenishment of
at a dose 61.2mg/kg body weight (1/10 of LD50)
reduced-glutathione (GSH). As one of the most potent
through oral gavage after dilution with distilled
antioxidant molecules, GSH can guard tissues from the
water for 28 days (7).
damaging impacts of ROS under oxidative stress
Group III (LCT + Hesperidin ): Rats were given
situations (6).
LCT orally as in group II with simultaneous oral
The goal of the current study was to demonstrate the
administration of HSP for 28 days at a dose
potential safeguarding impact of Hesperidin and N-
100mg/kg b. wt. daily (8).
acetylcysteine against Lambda cyhalothrin effect on
Group IV (LCT + N-Acetylcysteine): Rats
were received 150mg/kg b. wt. of N-acetyl

Received: 27/10/2022
Accepted: 25/12/2022

Full Paper (vol.901 paper# 42)

c:\work\Jor\vol901_43 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 294-299

Effect of Blunt Extension of Myometrial Incision Versus Sharp
Extension during Cesarean Section on Isthmocele Development
Adel Atef 1, Mohamed Sayed 2, Akmal Nabil El-Mazny1, Hadeer Mashaal El Sayed 1
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Kasr Alainy Street,
Cairo 11562, Egypt, 2 Obstetrics and Gynecology, Ministry of Health and population of Egypt, Giza, Egypt
Corresponding author: Adel Atef, Email: dr.adel90@cu.edu.eg, Telephone: 01115241250, ORCID: 0000-0002-5220-5302

Isthmocele or cesarean scar defect/niche and its consequences are becoming more common worldwide, which
is unlikely to be because of improved diagnosis or rising cesarean rates.
Objective: This study aimed to see how the development of niche and maternal problems were affected by the method
of uterine incision extension.
Subjects and Methods: A total of 280 women from Kasr Alainy Teaching Hospital's Labor and Delivery section were
included in the study. Two groups were observed over 10 months: group A sharp extension group and group B blunt
extension group (1:1).
Results: There were no significant statistical differences between the two groups with respect to placental location,
presentation, amniotic fluid, incision extension, and the presence of niche 6 weeks or 3 months postoperatively by
transvaginal sonography. No significant differences were also found in scar thickness or surrounding myometrium
thickness between the two groups. However, there were statistically significant variations between the two groups with
respect to operational time, blood loss during closure, and uterine vascular damage.
Conclusion: There was no difference in the establishment of a cesarean scar niche or scar thickness between sharp and
blunt uterine incision extensions. Sharp incisions may be preferable to blunt incisions because they result in properly
aligned myometrial layers. More clinical trials with bigger sample sizes are needed to assess the impact of the technique
of extending the uterine incision on the establishment of cesarean niches.
Cesarean scar, Defect, Niche, Blunt extension, Sharp extension.


uterine incision during CS on the development of niche
The incidence of cesarean section (CS) is risen in
in comparison to sharp extension.
the Western world from an average of 14.5% to reach in

the last two decades to 27.2% (1). The rising prevalence
of CS has sparked curiosity in the deeply rooted
Study design and setting
consequences on the scar of cesarean section, including
An observational cohort study was conducted using a
abnormal placentation, a uterine scar disruption or
convenience sample of pregnant women undergoing
rupture uterus. Two other durable less severe but more
primary elective CS from May 2021 to March 2022. The
common effects are gynecological problems and
study was conducted at Kasr Alainy Teaching
infertility (2).
Hospital's Labor and Delivery section, which is part of
The niche in the uterine cesarean scar is a relatively
the Obstetrics and Gynecology Department.
recent long-term sequelae. After one or more CSs, a scar

niche is described as "a depression of the anterior
Ethical considerations:
myometrium at the level of uterine isthmus where the
The study was carried out following the World
uterine cesarean scar was previously done with at least
Health Organization's ethical standards for human
2 mm depth on ultrasonography" and is found in 56%­
studies and the Helsinki Declaration. The Research
84% of women (3).
Ethics Committee of Cairo University's Faculty of
The ways of performing CS and uterine closure
Medicine approved the study (IRB: MS-100-2021).
differ. Double-layer closure versus single-layer closure,
All potential participants signed informed written
unlocked sutures in contrast to locked sutures, and
consents after a thorough description of the study's
whole flap thickness in contrast to split thickness are
goal and potential advantages.
some of the differences (including or excluding the

decidual layer, respectively) (4).
Study population
Although a sharp scalpel is used to make the
All women who had their first CS were included in
incision, it can be expanded to either side with scissors
the study. Other requirements to be a part of the study
or by blunt dissection with hands (5). It was hypothesized
included a singleton pregnancy with a parity of fewer
that when a uterine incision is bluntly extended, the
than three, an age range of 18­35 years, and signed
resulting edge may be uneven or ragged, and hence the
informed permission. Women with a previous CS,
myometrium healing may be poor, as opposed to sharp
previous myomectomy either open or laparoscopic,
extension, which produces unique edges. Our work
known causes of abnormal uterine bleeding (e.g.,
aimed at studying the impact of blunt extension of
uterine anomaly, cervical dysplasia, or hormonal
Received: 15/7/2022
Accepted: 18/9/2022

Full Paper (vol.901 paper# 43)

c:\work\Jor\vol901_44 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 300-307

`Evaluation of Connecting a Fourth Ventricular Catheter with Y Connector to a
Previous Ventriculoperitoneal Shunt, as a Treatment Option for Patients with
Symptomatic Trapped Fourth Ventricle
Mohammed Hammad Eltantawy*, Shawky A. Elmeleigy, Ahmad Arab
Department of Neurosurgery, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mohammed H. Eltantawy, Mobile: (+20)01000221379, Email: hammad_neurosurg@yahoo.com

Trapped fourth ventricle (TFV) is a rare clinico-pathological syndrome, usually resulting from
inflammatory conditions (post-infective and post-hemorrhagic) that may present with serious brain stem compression
manifestations. Many treatment modalities have been described with varying degrees of success.
Objectives: To evaluate our results in managing the trapped 4th ventricle by inserting 4th ventricular catheter and
connecting it to the previously implanted ventriculoperitoneal (VP) shunt via Y connector.
Patients and Methods: A total number of 12 cases with TFV were diagnosed and treated surgically between 2014 and
2021 by a fourth ventricular catheter and connection to the pre-existing shunt via a Y- connector. Preoperative clinical
and radiological findings were reported. Postoperative improvement was evaluated during a mean follow-up of 4.3
years. Postoperative complications were reported
Results: 12 patients (6 males and 6 females), with a mean age of 3.3 years diagnosed with trapped fourth ventricles
were included. All patients had previous VP shunts. Headache, vomiting, abnormal movement, gait disturbance, and
nystagmus were the common symptoms. Trapped fourth ventricle was post-infectious in 6 (50%) patients, post-
hemorrhagic in 4 (33.3%) patients, and congenital in 2 (16.7%) patients. 6 (50%) patients had preoperative slit lateral
ventricles and 4 (33.3%) had multiloculated hydrocephalus. Postoperatively 10 (83.3%) patients had clinical
improvement while 2 (16.7%) remained as preoperative. All patients had a decrease in the 4th ventricular size.
Complications of surgery were minor.
Conclusion: Fourth ventricular shunting with a Y connector is a valuable and effective modality of treatment in TFV,
especially when other methods fail or in specific complex pathological situations, with fewer complications.
Keywords: Trapped fourth ventricle, Y-connector, Fourth ventricular shunt.

Trapped fourth ventricle (TFV) is an uncommon
ventriculocisternostomy with excision of the arachnoid
clinico-pathological syndrome that occurs when the
villi and endoscopic approaches for aqueductoplasty,
fourth ventricle loses its proximal communication to the
aqueductal stenting (anterograde or retrograde), and
third ventricle through the cerebral aqueduct of sylvius
cysto-ventricular fenestration. Literature till now is still
and loses its distal outlet drainage to foramina of
lacking a standard consensus for the treatment of such
Magendie and Luschka, with the continuation of CSF
condition favoring one treatment modality over the
production by the choroid plexus from the wall of the
other, probably due to the wide diversity of etiologies
fourth ventricle; leading to progressive dilation of such
and pathological pictures this condition may have. The
closed space (1).
only agreement between authors is to follow
Trapped 4th ventricle usually occurs as a sequela of
conservatively the asymptomatic cases with no
intraventricular hemorrhage or infection and less
progression of the fourth ventricular size. The selection
commonly with congenital conditions like Dandy-
of the treatment plan must be guided by a case-specific
Walker malformation or neoplastic like carcinomatous
understanding of anatomic, radiographic, and
meningitis. In most cases, it occurs after a variable
pathophysiologic factors (4). However, shunting of the
period from supratentorial shunting (2).
fourth ventricle has been considered by many authors as
The clinical presentations of trapped fourth
the less invasive and the mainstay method of treatment
ventricle may range from mild nonspecific symptoms
such as headache, nausea, and vomiting up to cerebellar
In this study, we tried to evaluate our results in
or brainstem symptoms; ataxia, diplopia, lethargy,
managing trapped 4th ventricle, due to different
nystagmus or cranial nerve neuropathies and deficits.
etiologies, by adding a fourth ventricular catheter and
The cerebellar and brain stem compression due to the
connecting it to the previously placed supratentorial
mass effect of the progressively dilated fourth ventricle
ventricular shunt with a Y connector.
is responsible for these clinical conditions. Although

some patients may be detected incidentally (3).
Multiple treatment options were suggested for the
A total number of 12 patients [six females, six
management of the trapped fourth ventricle, with
males] were diagnosed as symptomatic trapped fourth
variable success rates and with superiority to
ventricles due to variable etiologies with an average age
endoscopic procedures. Treatment modalities include
at the time of surgery ranging from six months to five
CSF diversionary procedures, direct microsurgical
years (mean 3.3 years).
Received: 22/10/2022
Accepted: 24/12/2022

Full Paper (vol.901 paper# 44)

c:\work\Jor\vol901_45 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 308-320

Therapeutic Role of Salivary Exosomes in Improving Histological and Biochemical
Changes Induced by Duct Ligation in the Submandibular Glands of Albino Rats
Nahla E. Ibrahem1, Noura H. Mekawy1, Samia Hussein*2, Heba M. Abdel-aziz1
Departments of 1Medical Histology and Cell Biology and 2Medical Biochemistry and
Molecular Biology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Samia Hussein, Mobile: (+20) 01062725981, E-Mail: samiahussein82@hotmail.com

Salivary gland diseases are induced by radiotherapy, autoimmune diseases, inflammation, trauma, and
obstructive lesions. They result in functional gland impairment which harms oral health and quality of life. Exosomes
are extracellular nanoparticles produced by a variety of cells including stem cells. Exosomes facilitate the paracrine
functions of the releasing cells, and they are easily absorbed and can integrate with target cells resulting in long-lasting
effects. Objective: To identify the therapeutic role of exosomes in the histological and biochemical changes in the
submandibular gland (SMG) of adult male albino rats after duct ligation.
Materials and methods: Forty adult male albino rats were included in this study. They were distributed in three main
groups: control, duct-ligated and treated groups. Exosomes were isolated from the saliva of healthy rats. The treated
group received salivary exosomes one week after duct ligation. At the end of the study, the SMG was removed from
all groups and two samples were obtained from each gland: one for antioxidant measurement and RNA extraction with
subsequent gene expression determination. The other was used for histopathological and immunohistochemical
Results: The ligated group revealed degenerative histological changes including vacuolated cytoplasm, apoptotic
nuclei, congested blood vessels and cellular infiltrate. Increased area percentage of both collagen fibers and S100
immunoreactivity was detected. The treated group showed an amelioration in the histological and
immunohistochemical picture. After treatment with exosomes, a significant increase in all antioxidants was recorded.
This was accompanied by an increase in both c-kit and cytokeratin-5 gene expression.
There were improved histological, immunohistochemical and biochemical alterations after treatment
with salivary exosomes. So, salivary exosomes could be a possible modality in treating SMG diseases.
Keywords: Therapeutic Role of Salivary Exosomes, Duct Ligation in the Submandibular Glands, Albino Rats.

contributing to organ crosstalk. Exosomes have been
Salivary glands have an important role in
used in clinical trials to diagnose or cure a variety of
maintaining the general health of the oral tissues by
disorders and understand their pathogenesis [5].
saliva. Saliva aids in digestion, enamel protection,
S100 protein family members are multifunctional
lubrication and pH buffering. Additionally, it has anti-
proteins that interact with several effector proteins in
inflammatory, anti-bacterial and anti-fungal properties.
About 60% of saliva is secreted by the second-largest
phosphorylation and synthesis, cell division, cell
salivary gland, the submandibular gland (SMG) [1].
growth and differentiation, transcription and protection
Radiotherapy, autoimmune disease, inflammation
from oxidative cell damage. S100 protein is mainly
and trauma to the salivary gland and obstruction of the
found in some neurons, glial and Schwann cells of
gland duct by calculi are all known to cause diseases
normal nervous tissues. Also, its expression was
of the salivary gland [2]. Duct ligation is a helpful
reported in oligodendrocytes and adipocytes.
experimental strategy for examining the mechanisms
Antibodies to the S100 protein are signs of salivary
behind salivary gland inflammation and regeneration
gland cellular damage [6]. Current treatments for
since the SMG can improve after inflammatory and
salivary gland diseases are palliative. Thus, how to
fibrotic changes caused by ligation [3].
effectively reverse atrophy and recover the function of
Exosomes are extracellular nanoparticles. They
the salivary gland is an urgent issue. So, this study was
have a lipid bilayer with a diameter range from 30 to
performed to clarify the therapeutic role of exosomes
150 nanometers, and they are secreted by several cells,
in the structural and biochemical alterations in the
including stem cells. Their composition reflects the
SMG of adult male albino rats following duct ligation.
composition of the parental cells and they facilitate the

paracrine functions of the releasing cells. They are
stable and relatively difficult to degrade. Also, they are
Study design:
easily absorbed and can integrate with target cells
In our study, 40 healthy adult male albino rats of
resulting in long-lasting effects [4].
weight 150­200g on average were included. Rats were
Exosomes are present in many body fluids
grown in sterile conditions (23±5° and 12 hours of
including saliva. They transport lipids, RNAs, and
darkness and light cycles). They were given a standard
proteins. They are also active carriers for target protein
pellet diet and an access to water. All rats received
delivery driving genetic and epigenetic changes and
human care in compliance with the guidelines of the
Received: 22/08/2022
Accepted: 23/10/2022

Full Paper (vol.901 paper# 45)

c:\work\Jor\vol901_46 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 321-327
Probiotic Characteristics of Enterococcus spp Bacteria Isolated from
Different Sources
Yaqeen Dheyaa Faris, Ahmed Khassaf Atya
College of Science, University of Thi-Qar, Thi-Qar, 64001, Iraq, Department of Biology
Corresponding authors: Yaqeen Dheyaa Faris, E-mail: yageen.far.bio@sci.utq.edu.iq

Probiotics are "live bacteria that, when provided in suitable amounts, impose a health benefit on the
host," according to the World Health Organization. Objective: This study aims to assess the probiotic properties of
Enterococcus bacteria and the safety and effectiveness of it as a probiotic agent.
Methods: Lactic acid bacteria, were isolated, using MRS media. Through biochemical tests, and PCR and
sequencing methods the isolates appeared to be members of the Enterococcus species. So blood agar was used to
grow them as a safety test. The presence of bacteriocin was then verified in the bacteria using a partial purification
process. Its autoaggregation, hydrophobicity, biofilm formation, and other probiotic characteristics of the bacteria
were investigated.
Result: When cultivated on blood agar media, the lactic acid bacteria were not hemolytic. The probiotics'
characteristics included substantial capacity for auto aggregation, hydrophobicity, and biofilm formation, The
results showed that the Etetrococcus employed in this study had bacteriocin, a pectocin variant effective against a
variety of dangerous bacterial species.
Conclusion: Although it is not hemolytic when growing on blood agar medium, Enterococcus spp. isolated from
conventional cheese and waterfowl intestines, in this study are unsatisfactory because of this safety trait. One of the
properties of bacteria that makes them advantageous is that they produce bacteriocin and inhibit the growth of gram-
negative bacteria.
Lactic acid bacteria, Probiotics, Enterococci, Bacteriocins, probiotic properties.


According to science, probiotics are non-
pathogenic bacteria that improve consumer health
16S rRNA sequencing for isolate identification
when consumed regularly and at recommended
samples was plated onto an MRS agar medium and
dosages. Probiotics mostly fall within the category of
cultivated for 48 hours at 37 °C to isolate the bacteria.
lactic acid bacteria (LAB). The probiotic strains from
DNA marker amplification for 16S rRNA and
the LAB category that are most widely used in food
representative isolates was found utilizing a primer
items include Bifidobacterium, Lactobacillus,
set and 16S rRNA sequencing on the isolates to be
Enterococcus, and Lactococcus(1).
identified on the countable plates (30-300
The member species of the genus Enterococci
CFU/plate). Amplicons were sequenced after being
are widespread and can be discovered in many
purified with a PCR purification kit. Using the
ecosystems, such as freshwater, soils, sediments, sea
BLAST algorithm, 16S rRNA sequences from
water, beach sand, and a variety of plants (2). The
isolates were compared.
typical gastrointestinal (GI) flora of both humans and

livestock frequently includes Enterococci species (3).
Probiotic properties
Despite being thought of as commensals in
1-Hemolytic Activity
humans, Enterococcus spp. is an important
Through inoculation on blood agar medium
opportunistic pathogen that can cause bacteremia,
containing 5% (w/v) human blood or sheep blood, 10
biliary and stomach infections, endocarditis, and
l of a 24-hour-old culture, the hemolytic activity of
urinary tract infections in addition to biofilms on
fresh cultures isolated from cheese and intestines of
catheters and implanted medical devices(4). The
ducks was examined. At 37 °C, the plates were
bacteriocins (enterocins) produced by the enterococci
incubated for 48 hours. Following this time, they
can increase the shelf life and safety of items by
were examined for hemolytic activity by looking for
acting as antibacterial peptides(5).
distinct haloes around the colonies.
The only food preservatives used nowadays are

bacteriocins produced by lactic acid bacteria, which
2-Biofilm Production through Micro titer Plate
offer significant advantages over chemically
Method (MTP)
produced food preservatives and antibiotics.
On a sterile 96-well microtiter plate, biofilm
Bacteriocin preparations such as propionicin,
development was carried out. Two ml of brain heart
acidocin, and nisin, as well as pure and mixed
infusion broth (BHIB) and a colony of each isolate
cultures of lactic acid-producing bacteria, are actively
were added to tubes, and the tubes were then
used as antibacterial agents against bacteria and
incubated at 37°C for 24 hours. 200 l of each broth
culture was put into microtiter plates and incubated at
Received: 22/08/2022
Accepted: 23/10/2022

Full Paper (vol.901 paper# 46)

c:\work\Jor\vol901_47 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 328- 334

Evaluation of the Quality of Life in Children with Haemophilia
Yasser Abdelrahman Ahmed1, Ahmed Mohammed Farid EL-Moazen1, Reham Adly Ahmed Abu-Rehab2*
1 Pediatrics and Neonatology Department, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
2 Resident of Pediatrics and Neonatology, El-Helal Health Insurance Hospital, Sohag, Egypt
*Corresponding author: Reham Adly Ahmed Abu-Rehab, Mobile: (+20) 01066596517, Email: drreham606@gmail.com

Congenital haemophilia primarily affects males. Haemophilia A or B is caused by mutation of clotting
factor genes on X chromosome.
Objective: The aim of the current study is to assess quality of life of children with haemophilia.
Patients and methods: A cross sectional comparative study was conducted at Hematology Clinic at El-Helal Hospital
and Sohag University Hospital on 50 children with haemophilia.
Results: Most patients had joint bleeding and most of them were satisfied about their quality of life (QoL). Most of
patients were able to do homework completely, work well and get around. Most of patients had difficulties annoyance
and difficulties effect on lifestyle. Most patients never had a depression due to the haemophilia. Most children like
school and had friends which made with future plans and never feared from the future. Most patients could perform
muscle activities but some of them felt upset going to hospital.
Conclusion: Haemophilia has effect on studied cases health-related quality of life (HRQOL). The severity of the
disease, bleeding frequency, rate of joint bleeding, financial burden, & therapy all have impact on haemophilia HRQoL.
Routine haemophilia care should contain psychological assessment & caregiver support, which should be measured
using result measures that account for both HRQoL and caregiver burden.
Keywords: Haemophilia, Quality of life, Children, Caregivers, Cross sectional study, Al-Azhar University.

therapy & healthcare. According to studies,
is congenital
hemophiliacs have a lower quality of life than healthy
impacts mostly men. It is caused by clotting factor gene
people (5).
mutation on X chromosome, which results in lack of
Soucie et al. discovered that hemophilia studied
factor VIII or -IX in haemophilia A or B (1).
cases of all years old have a lower quality of life because
Spontaneous bruising, mucosal and joint bleeding,
of arthropathy (6).
epistaxis, & severe bleeding events like intracranial
The goal of the QoL assessment is to identify
haemorrhage are all common symptoms (2). Repeated
children who are experiencing difficulties as a result of
joint bleeding results in severe joint damage and pain,
their hemophilia disease, estimate complications related
resulting in disability (3).
to hemophilia, & define comprehensive & satisfactory
The most common symptom of haemophilia is
bleeding, which occurs after trauma or surgery, with
As a result, it is essential to investigate & analyze
severity correlated with degree of clotting factor
whether degree of bleeding, severity of hemophilia,
deficiency. Bleeding can happen in muscles, joints, or
years old of diagnosis, & years old at which treatment
soft tissue, as well as in neck, throat, chest,
is initiated affect QoL in children with hemophilia
gastrointestinal system, or intracranially in life-
The aim of the current study was to analyze QoL of
threatening cases (1).
children with hemophilia.
Primary therapy aim is to prevent or treat

bleeding; bleeding is usually treated by on-demand
administration of specific factor concentrate to
A cross sectional comparative study was conducted
compensate for deficient clotting factor, and prevention
at Hematology Clinic at El-Helal Hospital and Sohag
has contained prophylaxis regimens of these factor-
University Hospital on 50 children with haemophilia.
replacement treatments, with non-replacement factors

becoming more widely available in recent years (4).
Inclusion Criteria:
Many studies have looked at the impact of
Patients diagnosed clinically and laboratory with
hemophilia on health-related quality of life (HRQOL).
hemophilia A, aged between 3-16 years, parents or
The disease is also linked to an increased risk of
caregivers (in case of children 4-8 years old) and
hepatitis, AIDS, anxiety, depression, & isolation, all of
children (8-16 years old) who can read, write and
which reduce patients' quality of life as they age.
understand all relevant aspects of research which will be
HRQoL is a multidimensional concept that describes an
explained and discussed with them, outpatients, aware,
individual's ability to function in terms of physical,
and have a good ability to fill out questionnaires and
psychological, and social health (2).
following up with Hematology Clinic at El-Helal
Quality of life (QoL) Evaluation is becoming
Hospital and Sohag University Hospital.
increasingly popular as guide to effective medical

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

Full Paper (vol.901 paper# 47)

c:\work\Jor\vol901_48 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 335-342

The Role of Absorbable Gelatin Sponge (Gel Foam) in Control of
Sternal Bleeding during Cardiac Surgery
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

Topical hemostatic agents based on gelatin have been shown to be successful in stopping bleeding
throughout open heart surgery, in conjunction with traditional methods.
Objective: To study the efficacy of gel foam for controlling postoperative bleeding in cardiac surgery.
Patients and Methods: A prospective randomized study was performed in Cardiac Surgery Unit of Elkasr Elaini
Medical Center, Cardiovascular Surgery Department in Cairo University, Cairo, Egypt. A total of 120 cases went
through heart surgeries were allocated in 2 groups, 60 cases in each. In group A, gel foam wasn't used but used in group
B under sternum on closure. Study endpoints were the rate of total blood drainage, reopening for bleeding, use of blood
products, tamponade and mediastinitis.
Results: Statistically higher rates of reopening for bleeding, total blood drainage, blood transfusion and tamponade in
group A comparing to group B, (p=0.015, < 0.009, <0.001 and 0.006 respectively). Rate of mediastinitis did not
statistically vary between both groups, but were lower in group B.
Conclusion: Gel foam is effective in reducing postoperative hemorrhage in conjunction with traditional surgical
procedures. Its thoughtful use is linked to lower rate of reopening for bleeding after cardiac surgery.
Keywords: Gel foam, Hemostatic agent, Cardiac surgery, Sternal bleeding.

visualization of the operational area and extends
Cardiac surgical procedure is closely correlated
operational processes (5). Excessive hemorrhage could
with perioperative hemorrhage and a serious potential
cause acidosis and hypothermia which could cause
of transfusion. Hemorrhagic complications in open
coagulopathy (lethal triad) (6).
heart surgery are linked to worse consequences and play
Blood products are used in approximately 21% of
a role to elevated total healthcare expenditure (1). The
all operational processes and 45.8% of cardiovascular
estimated incidence of all unselected patients
instances, but they are linked to a variety of
undergoing cardiac surgery is 5-9%, with limit values
complications and risks. Transfusions is also linked to
ranging from 0-16%(2). The requirement for
immunomodulation, bacterial infections and a lot of
intraoperative and postoperative blood transfusions is
non-infectious but significant health problems (7).
also linked to possible risks such as bad effects,
Systemic and local methods should be used to
transfusion-related harm, or pathogenic transmissions,
achieve hemostasis. The systemic treatment by blood
all of which are considerable morbidity or death
transfusions and pro-coagulant medication is critical,
attributes(1). Hemorrhage occurs as a consequence of
but it additionally carries significant potentials.
many components and steps in cardiac surgery,
Systemic medications, like anti-fibrinolytics and
including the placing of cardiovascular incision lines in
recombinant Factor VII, are commonly prescribed to
large vessels or cardiac chambers and the formation of
treat coagulation defects, but they are costly. Most
high-pressure anastomoses. Stainless steel wire used in
cardiac procedures do not have sufficient proof to
sternal closure is responsible for more than 20% of
support the administration of recombinant Factor VII(8).
causes of reopening (3).
Traditional strategies, such as suture applications
Massive microvascular hemorrhage upon heart
and vessel ligation, or electrocautery, were the initial
surgery can lead to re-exploration, which has been
local strategies of direct postoperative control of suture
linked to a number of adverse consequences, including
lines, anastomosis, and other topics of the operative
a three to four folds increase in operating room period,
area. There are numerous hemostatic manoeuvres,
blood and blood components transfusions, pulmonary
ranging from simple digital pressure management,
hypertension, renal failure, sepsis, atrial arrhythmias,
electrical tissue cauterization and wound irrigation with
long-lasting mechanical ventilation, extending duration
warm saline to topical administration of pro-coagulant
of stay, and causing death (4). Blood loss also impairs
substances (9) (Figure 1).
Received: 20/08/2022
Accepted: 21/10/2022

Full Paper (vol.901 paper# 48)

c:\work\Jor\vol901_49 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 343- 346

Psychological Distress of Home Quarantine during COVID-19
Outbreak in Baghdad City, Iraq
Hassan A. Hussein
Psychiatric-Mental Health Nursing Department, Psychiatric-Mental Health Nursing,
College of Nursing, University of Baghdad, Iraq
*Corresponding author: Hassan A. Hussein, Mobile: (+96) 47707850684, ORCID: 0000-0002-5142-5792, E-mail:

Between December 2019 and the beginning of 2020, the corona virus epidemic first appeared in Wuhan,
China, before its spreading to the rest of the country and subsequently to many other nations. Many people experience
severe psychological anguish, manifested as physical symptoms, anxiety disorders, sadness, and a sense of helplessness.
Objective: This study aims to identify the levels of psychological distress among Iraqi people and to find-out the
association between levels of psychological distress and some socio-demographic characteristics.
Patients and methods: A cross-sectional design was conducted on 291 persons of both sexes from the City of Baghdad.
Data were collected from the first to the 15th of April 2020 through online interview. The Kessler Psychological Distress
Scale was employed to measure the respondents' psychological distress.
Results: Almost 16.8% of the respondents experienced psychological distress. There was a significant association
between psychological distress and respondents' gender, occupation, monthly income, and level of education. Females
significantly demonstrated higher psychological distress than males.
Conclusion: COVID-19 epidemic has an impact on people's health, both psychological and physical health, which
requires follow-up and treatment by specialists. New studies are needed to determine the predicative factors for the level
of psychological distress.
Keywords: Coronavirus Disease, Quarantine, Psychological Distress.


of the virus (7), and issues related to managing universal
Coronavirus Disease 2019 (COVID-19) is a
health care (8). The general population of Iraq was never
global infectious disease which appeared in Wuhan,
the subject of research materials examining the
China, and then spread into many countries between
psychological and physical impacts of COVID-19.
December 2019 and the end 2020 (1). The COVID-19
Therefore, this study illustrates the first
pandemic causes a real risk to people's mental and
psychological impact survey and emotional health
physical health. It also causes a range of mental
survey on residents of the Baghdad City during the first
problems including anxiety disorder and major
two weeks of the COVID-19 outbreak. This study also
depression. This study seeks to measure the widespread
aims to assess the psychological symptoms and to
presence and intensity of these psychological effects,
determine the factors that contribute to psychological
and to determine the present psychological health
distress. This perhaps could help governmental agencies
burden on the general public, thus providing a tangible
and healthcare workers to protect the psychological
basis for designing and implementing pertinent mental
well-being of society in the face of the expanding
health interventions and/or policies to efficiently and
COVID-19 outbreak in Iraq and all over the world.
effectively address this defy (1).

Killing people everywhere is not limited to the
pandemic, but it is also stressing out healthy people and
A cross-sectional study was conducted to investigate
those with COVID-19 (2). In response to any form of
the psychological effects of the quarantine period on
anomalous circumstance, high degrees of stress and
COVID-19 asymptomatic patients.
anxiety are common reactions (3).
This study was conducted in Baghdad City. A total
In order to restrict infectious disease outbreaks,
of 291 responses were obtained via an online survey.
quarantine has been employed as a preventive measure
Data were collected for the period from April 1st, 2020,
for millennia. In the past, it has been successful to stop
to April 15th, 2020.
the spread of infectious diseases like cholera and plague
The Kessler Psychological Discomfort Scale (K10)
(4). According to studies, those in quarantine may feel
was employed to measure the psychological distress (9),
psychological distress in the form of anxiety, rage,
which includes 10 questions with 5-point Likert ratings.
hesitancy, and signs of severe stress (4). There are
The total score ranges from 0 (None at any time) to
currently no well-recognized research on the
5 (All times). Higher scores on each scale indicate
psychological consequences and general state of the
greater psychological distress. The K10 internal
people during the peak of the COVID-19 outbreak. The
consistency ranged from 0.80 to 0.86.
majority of studies that shed the light on this disease
Participants' approval to participate in this study was
have been on identifying the epidemiological and
confirmed through informed consent.
clinical traits of affected people (5,6), the genetic makeup

Received: 02/9/2022
Accepted: 1/12/2022

Full Paper (vol.901 paper# 49)

c:\work\Jor\vol901_50 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 347-352

Could peripheral Eosinopenia be Used as a Prognostic Biomarker for
Chronic Spontaneous Urticaria?
. , . and .
1. Internal Medicine Department, Benha Faculty of Medicine, Benha University, Egypt
2. Dermatology and Venereal Diseases Department, Benha Faculty of Medicine, Benha University, Egypt
Corresponding author: Medhat M. Elamawy, Mobile Phone: 01024443810, Email: m.elamawy@fmed.bu.edu.eg

Background: Chronic spontaneous urticaria (CSU) is a chronic, sometimes debilitating skin disorder characterized by the
appearance of wheals, angioedema, or both for a period of more than 6 weeks. Many biomarkers were explored for severity
evaluation such as d dimer and C Reactive Protein.
Objectives: The aim of the current study is to assess the usefulness of peripheral eosinopenia as a valuable and an applicable
biomarker for CSU severity.
Patients and methods: A case control study was conducted on 60 CSU patients. Patients were divided into 30 patients
with mild UAS7 score <15 representing the controls and 30 patients with severe UAS7 score >28 representing the cases.
Eosinophils count and other variables were compared.
Results: Severe cases demonstrated significantly higher age (median 34 vs. 29 years, P =0.043), CRP (14 vs. 2 mg/L, P
<0.001) and positive ASST (56.7% vs. 23.3%, P =0.008). In contrast, severe cases demonstrated significantly lower
eosinophilic count (median 21 vs. 123 cell/mm3, P <0.001), basophilic count (median 5 vs. 25 cell/mm3, P <0.001), and
total IgE (median 93 vs. 221.5 IU/ml, P <0.001). The eosinophilic count showed a significant-excellent AUC of 0.954. The
best cutoff point was 70, at which sensitivity and specificity were 96.7% and 86.7%, respectively.
Conclusion: Peripheral eosinophils are significantly lower count in severe urticarial patients (P value <0.001) and this could
be used as a simple and accessible tool for monitoring urticaria activity.
Keywords: Eosinopenia, chronic spontaneous urticaria, biomarker, case control study, Benha University.


Chronic spontaneous urticaria (CSU) is a chronic,
While eosinophils were considered a defense
sometimes debilitating skin disorder, characterized by the
against parasitic infection, they also had many other
appearance of wheals, angioedema, or both for a period
physiological and pathological properties as they regulate
more than 6 weeks (1).
body thermogenesis (11, 12) activate mast cells and share in
Although the advance in understanding the
allergic diseases development (13). Peripheral eosinopenia
is one of the important biomarkers that might be used as
spontaneous urticaria, there are still many patients who do
an applicable prognostic marker in chronic urticaria (14).
not respond efficiently to treatment, so their quality of life
The aim of the current study is to assess the
was greatly impaired (2).
usefulness of peripheral eosinopenia as a valuable and an
Many urticaria scores and questionnaires were
applicable biomarker for CSU severity.
developed to ensure optimum patient evaluation such as

Urticaria Activity Score (UAS7), Chronic Urticaria
Quality of Life Questionnaire (CU - Q2 OL) and some of
A case control study was conducted at Benha
them with translated Arabic version (3-7).
University Hospitals, Qalyubia Governorate, Egypt.
Urticaria can be classified according to its duration
Patient was recruited from June 2022 to October 2022.
into acute urticaria which lasts less than 6 weeks and
A total of 60 CSU patients were selected; Patients
chronic urticaria that extends beyond 6 weeks duration.
were divided into 30 patients with mild UAS7 score <15
Thereafter chronic urticaria is subdivided by its triggering
representing the controls and 30 patients with severe
factors into chronic spontaneous and chronic inducible
UAS7 score >28 representing the cases.
one. With advance in urticaria pathophysiology
Inclusion criterion was recently diagnosed CSU and
understanding, different CSU subsets were known. Of
exclusion criteria were patients with malignancy, active
them CSU type IIb which have the higher activity score,
autoimmune disease, or recent steroid use.
autoimmune diseases associated, longer persistence and
For each patient's file, the following variables were
lower responsiveness to 2nd generation antihistamines (8,9).
fulfilled; detailed medical history including demographic
Many biomarkers were explored for severity
data such as age and gender, medication use, duration of
evaluation such as d dimer, C reactive Protein and ESR
illness atopic diseases or associated induced urticaria.
Received: 20/08/2022
Accepted: 21/10/2022

Full Paper (vol.901 paper# 50)

c:\work\Jor\vol901_51 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 353-363

Correlation of Some Apoptotic Markers with Chronic Myelogenous
Leukemia in Iraqi Patients
Raghda Raisan Al-Omairi, Maha Fakhry Al-taee
Department of Biotechnology, College of Science, Baghdad University, Baghdad, Iraq
Corresponding author: Raghda Raisan AL-Omairi, E. mail: raghdarayssan9216@gmail.com, Mobile: +9647714547679

The BCR-ABL gene encodes an oncoprotein with abnormal tyrosine kinase activity affecting cellular
proliferation, survival, and apoptosis, is the cause of chronic myelogenous leukemia (CML). A type of programmed cell
death termed apoptosis works as a preventative measure against diseases like cancer.
Objective: This study aimed to assess four apoptotic players in CML patients as an attempt to provide new options for
targeted therapy, and to examine these proteins as potential predictors for the disease.
Methods: 140 participants were divided into two groups, healthy controls (CT) and people with chronic myeloid
leukemia. Healthy samples were 60, while 80 samples were taken from patients who had been diagnosed with CML in
the International Hematology Center, Baghdad, Iraq. Using ELISA approach, we measured serum levels of four critical
participants of apoptosis (TNFR1, BAX, CASP-9, and CYTO-C) in CML patients and controls.
Results: In comparison to patients, controls had higher median levels of BAX, CYTO-C, and CASP-9. While median
TNFR1 levels in patients were greater than in controls. Age-dependently, CT groups had significantly higher levels of
BAX, CYTO-C, and CASP-9 than CML groups in the age categories of < 40 years and 40­50 years, in contrast to
TNFR1 which was markedly down regulated in CT. According to gender, CT groups had significantly greater levels of
BAX, CYTO-C, and CASP-9 than CML, while TNFR1 was significantly higher in CML than CT groups in both
genders. BAX, CYTO-C, TNFR1, and CASP-9 are effective predictors in differentiating between CML patients and CT
groups according to the results obtained from receiver operating characteristic analysis. Correlation coefficient analysis
test revealed that BAX correlated with CYTO-C and CASP-9 in a positive-significant manner. While BAX had a
positive, although insignificant correlation with TNFR1. TNFR1 and CASP-9 had a non-significant positive correlation
with CYTO-C. Finally, TNFR1 and CASP-9 showed positive but non-significant correlation.
Conclusions: BAX, CYTO-C, TNFR1, and CASP-9, provide potential targets for diagnosis, prognosis, and treatment.
As they turned to be excellent predictors in CML.
Keywords: CYTO-C (cytochrome-c), TNFR1 (tumor necrosis factor receptor 1), CML (chronic myeloid leukemia),
CASP-9 (Caspase 9).


A translocation between the ABL (Abelson Murine
involves apoptosis. Either the intrinsic or the extrinsic
Leukemia) gene on chromosome 9 and the BCR
routes of apoptosis are triggered depending on the
(breakpoint cluster region) gene on chromosome 22
source of the apoptotic stimuli. A distinct intrinsic
results in the creation of the Philadelphia chromosome,
apoptotic mechanism dependent on mitochondria was
which is the main cause of chronic myeloid leukemia
identified by APAF1, the outer membrane of the
(CML), a myeloproliferative disease. In contrast to
mitochondria becomes permeable as a result of
ABL1, which encodes a non-receptor tyrosine kinase,
mitochondrial disruption, and several molecules are
BCR is a breakpoint cluster region. The 210-kDa
released, including cytochrome C. When APAF1
oncoprotein p210 BCR-ABL1 is translated and works
detects cytosolic cytochrome C (CASP 9) the intrinsic
as a faulty tyrosine kinase that is constitutively
apoptotic pathway's initiating caspase, and other
generated, influencing pathways including PI3K/AKT,
proteins come together to form the apoptosome (3).
JAK/STAT, and RAS/MEK and biological processes
This apoptosome splits CASP 9 into its mature form
like cell proliferation and apoptosis (1).
via an ATP hydrolysis-related mechanism. Mature
The majority of individuals have CML in its chronic
CASP 9 can activate effector caspases like CASP 3 that
phase, which is characterized by symptoms most
are downstream, several BCL-2 family proteins control
frequently related with anemia and splenomegaly as
the permeability of the mitochondria, which permits
fatigue and malaise, can have a cumulative effect that
cytochrome C discharge. (4).
results in pain or early satiety, thrombocytopenia or
The activation of the death-inducing receptors Fas
platelet dysfunction that can also be brought on by
and TNFR starts extrinsic apoptosis, through homotypic
CML. As CML enters the rapid or blast phase,
connections between their death effector domains
symptoms like headache, bone pain, fever, infection,
(DED), FADD engages the DD of the receptor and
bleeding, and lymphadenopathy become more prevalent
recruits CASP 8. When CASP 8 is activated, it cleaves
(2). Apoptosis is a methodical kind of energy-dependent
and activates CASP 3 and CASP 7 (5). One form of
cell demise that eliminates surplus cells. The
planned cell death is apoptosis (PCD) that acts as a
pathophysiology of numerous diseases, including
preventative measure inhibiting the growth of cancer. In
cancer, AIDS, and other immunological disorders
Received: 20/08/2022
Accepted: 21/10/2022

Full Paper (vol.901 paper# 51)

c:\work\Jor\vol901_52 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 364-371

Safety and Efficacy of Di-Peptidyl Peptidase-4 Inhibitors in The
Management of Inpatient Elderly with Type 2 Diabetes
Hossam Arafa Ghazi*, Ali H. Hegazy, Amira S. Nowara
Department of Internal Medicine, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Hossam Arafa Ghazi, Mobile: (+20) 01006408074, Email: hossamghazi7@gmail.com

: Hyperglycaemia in hospitalized elderlies with Type 2 Diabetes (T2D) is frequently seen and
increases rates of hospital stay, morbidity and mortality. Basal Bolus Regimen (BBR) is the corner stone in
management of hyperglycaemia among non-critically ill hospitalized patients. However, it is complex regimen
and associated with increased episodes of hypoglycaemia.
Objective: This study was conducted to explore the efficacy and safety of Di-Peptidyl Peptidase -4 inhibitors
(DPP-4i) with or without basal insulin for management of T2D among inpatient hospitalized elderly.
Patients and methods: We included 90 patients with T2D, both males and females, aged 60 years or more.
Participants were divided into 3 subgroups; Group 1 on BBR using glargine U100 and regular insulin, Group
on basal oral regimen using glargine U100 and vildagliptin, and Group 3 on vildagliptin only.
Results: Of all participants, 68 patients were females, and the mean age of the patients was 68.98 (SD 6.7)
years. Mean pre-hospital glycated haemoglobin was 8.09 (SD 1.04) gm%. Documented and severe
hypoglycaemia and hospital stay were significantly lower among groups 2 and 3. No serious adverse events
reported among all participants.
Conclusion: Using DPP-4i with or without basal insulin is safe, effective, less complex regimen associated
with lower episodes of documented and severe hypoglycaemia and hospital stay among elderly patients with
Keywords: Elderly, Type 2 Diabetes, Inpatient, DPP-4 inhibitors.

population. Three other categories each resulted in
Hyperglycaemia among non-critically ill
3-5% of all hospital stays in the elderly:
hospitalized patients was reported to be about 22%-
genitourinary disorders, endocrine disorders, and
46% [1]. Moreover, many cross-sectional studies
infections [6].
have reported an estimated prevalence of diabetes
Plenty of professional societies have
in elderly aged (65­75 years) and above 80 years
recommended insulin therapy as the cornerstone
about 20% and 40% respectively [2,3]. Hospitalized
for the inpatient management of hyperglycaemia
elderlies when compared to individuals less than 65
[8]. Nevertheless, insulin regimens -mainly multiple
years of age, hospital discharge rates related to
daily injections or Basal Bolus regimen (BBR)
diabetes among them are about 2 folds higher [1].
were associated with increased risk of
With increased age, with or without presence of
hypoglycaemia and complexity of the regimen for
diabetes, rates of hospitalization 3.1 times higher
health care providers [9].
among patients with diabetes compared to those
So, simple regimens with similar glycaemic
who has no history of diabetes [4].
efficacy to BBR and less episodes of
Several clinical trials have been conducted in
hypoglycaemia are needed to improve the care for
critically ill patients and have reported that
non-critically ill patients with diabetes. Data from
improved glycaemic control reduces length of
some Randomized Controlled Trials (RCT)
hospital stay, risk of multi-organ failure and
conducted among non-critically ill patients with
systemic infections. In addition, short term and
diabetes have reported that treatment with a Di-
long-term mortality rates were also decreased
Peptidyl Peptidase-4 inhibitors (DPP-4i) alone or
among patients with diabetes if blood sugar is well
in combination with basal insulin results in similar
controlled [5-7].
glycaemic control with less risk of hypoglycaemia
The commonest cause of hospitalization in
than BBR [6,10].
elderly was related to circulatory disorders, it was
DPP-4i are attractive drugs to be used as they
estimated that they represent about 28.4% of all
act by stimulating insulin and inhibiting glucagon -
hospital stays for elderly. Respiratory disorders
in a glucose dependent manner- with low risk to
were the second most common cause, representing
develop attacks of hypoglycaemia. Furthermore,
about 14.9%. Musculoskeletal and digestive
they are weight neutral and don't produce
disorders about 10.8% and 10.7%, respectively.
hemodynamic changes like Sodium Glucose Co-
Patients with nervous system disorders accounted
Transporter 2 inhibitors (SGLT2i) and they have
for 8% of all hospitalizations within this
no risk to develop euglycemic ketosis [11].
Received: 20/7/2022
Accepted: 22/9/2022

Full Paper (vol.901 paper# 52)

c:\work\Jor\vol901_53 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 372-378

Bone Mineral Density and Bone Markers in Juvenile Idiopathic Arthritis Patients
Samar G. Soliman1, Alaa A. Labeeb1, Reham S. El Zaiat2, Dalia A. Nofal*1, Dina S. Fotoh 1
Departments of 1Physical Medicine, Rheumatology and Rehabilitation and
2Clinical Pathology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Dalia Ahmed Nofal, Mobile: (+20)1007981362,
E-mail: doctor.dalia988@yahoo.co.uk, ORCID: 0000-0001-5673-2831

One of the most prevalent adolescent chronic inflammatory illnesses, juvenile idiopathic arthritis (JIA),
is linked to decreased bone mineral density (BMD) and an increased risk of osteopenia and osteoporosis, which raises
the risk of fractures.
Objective: The aim of the current work was to determine the relationship between disease activity and BMD and bone
turnover markers (serum osteocalcin for bone production and C terminal telopeptide of type 1 collagen (CTX) for bone
resorption) in patients with juvenile idiopathic arthritis.
Materials and Methods: This study included 50 patients with JIA (female: male 20:30). These patients were diagnosed
with JIA according to the criteria of classification of the International League of Associations for Rheumatology [ILAR].
BMD was measured by Dual-energy X-ray absorptiometry (DEXA) of the lumbar spine using the Z-score. The results
were correlated with juvenile arthritis disease duration, disease activity, serum level of bone turnover markers, and
serum level of vitamin D. Clinical disease activity was evaluated by juvenile arthritis disease activity score (JADAS-
There was a significant negative correlation between BMD (DEXA Z-score) and disease activity (P-value
<0.001), bone turnover markers (P-value <0.001), and duration of JIA (P-value <0.05). There was a significant
difference between vitamin D level and DEXA Z-score; DEXA Z-score was lower in vitamin D deficient patients.
Patients with JIA who have a more active condition are more likely to develop osteopenia and
osteoporosis. Osteoporosis incidence may be decreased, and bone health may be improved with timely and effective
JIA treatment and disease activity control.
Keywords: BMD, Bone turnover markers, Osteoporosis, Juvenile idiopathic arthritis.


A child's formative years are crucial for
The most accurate way to quantify BMD in
developing a robust musculoskeletal system. Genetic
children is using dual-energy X-ray absorptiometry
predisposition, organ function, chronic systemic
(DEXA) of the lumbar spine using the Z-score. As bone
illnesses, drug use, muscle abnormalities, and metabolic
density fluctuates with age, Z-score rather than T-score,
disorders are all known to affect bone structure and
which is often utilized in adults, is employed in the
quality [1]. One of the most prevalent chronic
pediatric population, and a Z score of -2 SD is
inflammatory illnesses affecting children and teenagers
considered osteoporosis [7]. Bone remodeling processes
under the age of 16 is juvenile idiopathic arthritis (JIA)
in terms of bone production and resorption can be
[2]. Both direct and indirect processes may prevent bone
detected using bone turnover markers [7]. The aim of the
accretion in JIA patients, as they do in other kids with
current work was to determine the relationship between
chronic disorders [3]. Reduced BMD in JIA patients is
disease activity and BMD and bone turnover markers
caused by the disease itself as well as a number of other
(serum osteocalcin for bone production and C terminal
variables, including limited physical activity, impaired
telopeptide of type 1 collagen (CTX) for bone
joint motility [4], delayed pubertal development,
resorption) in patients with juvenile idiopathic arthritis.
malnutrition, early onset of JIA, and JIA medications [5].

Reduced BMD is linked to a higher risk of osteopenia
and osteoporosis, both of which raise the possibility of
This observational cross-sectional study included 50
fracture [6].
patients diagnosed and assessed clinically as JIA. They
According to the WHO [7], osteoporosis develops
were randomly recruited from the Internal Medicine,
when the amount of bone resorbed exceeds the amount
Physical Medicine, Rheumatology, and Rehabilitation
of newly generated bone, resulting in a net loss of bone
Clinics, Menoufia University Hospitals during the years
Increasing awareness among pediatricians to
Patients were diagnosed with JIA according to the
identify risk factors and the clinical conditions or
criteria of classification of the International League of
diseases that could lead to the development of
Associations for Rheumatology [ILAR] [8], with a
osteoporosis made their screen for the possibility of
disease duration of more than one year, all patients are
under medical treatment for JIA.
rheumatological disease [7].

Received: 7/10/2022
Accepted: 7/12/2022

Full Paper (vol.901 paper# 53)

c:\work\Jor\vol901_54 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 379-385

Effects of Nano-Lipid Prostaglandin F2 on Synchronization
Buthina A. Abdullaha1 , Mohanad A. Al-Bayati2
1,2 Physiology and Pharmacology Department / Veterinary Medicine Collage, University of Baghdad/ Iraq.
Corresponding author: Buthina A.Abdullaha, Mobile: 09647701715129, E-Mail: buthinahameed@tu.edu.iq

: By modulating the estrous cycle, numerous oestrus-inducing or synchronising therapeutic hormones and
medicines are accessible for pharmacological use, allowing for rapid onset of estrus in the majority of animals.
Objective: The purpose of this research is to evaluate the efficacy of Nano-Lipid containing prostaglandin F2
nanotechnology in synchronising the estrous cycle.
Material and Methods: The strategy to induce and synchronise estrus75 in 4- to 8-week-old female mice was tested in an
animal investigation to establish its efficacy across three treatment groups: control, conventional, and SNLPGF2. The first
group received a saline injection as a control, the second group received conventional hormone injections at 5, 10, 15, 20,
and 25 IU g/kg body weight (I.P. ), and the third group received SNL PGF2 hormone injections at 5, 10, 15, 20, and 25 IU
g/kg body weight I.M.
: Nano-lipid Size The PGF2 ranged in length from 50 to 166.6 nm. whereas SNL PgF2 trapping efficiency is 84.11
(SD 5.55). As expected, autolysis and a rise in the estrus phase and an increase in the amount of estrogen were responsible
for the greatest degree of synchronisation in the group that received large doses of nano-treatment.
: results of this research demonstrate that Prostaglandin F2 f Nano-lipid has a high efficiency for synchronising
the estrous cycle..
Keywords: Synchronization, Estrus cycle, Nano-Lipid, Prostaglandin F2.


The cycle of estrous indicates the cycle of
(9,8). SLNs are solid lipids (e.g) triglycerides, complex
reproductive. Similar to the reproductive cycle in humans,
mixtures of glycerides or waxes) and stabilized by
the estrous cycle consists of four phases, namely,
surfactants (10).
proestrus, estrus, mesentery, and remission, and lasts for
The study was aimed at the reformulation and
4 to 5 days (1). both LH and FSH govern the estrous cycle
optimization of PGF2 based on the Nanostructured lipid
(2). There are two distinct times in a menstrual cycle: the
carriers' improved protocol of the estrous cycle
luteal and the follicular phases. (3).
The luteal phase is the period following ovulation

when the corpus luteum (CL), while the follicular phase
is the period following the demise of the corpus luteum
Preparation of Nano-Lipid PGF2
until ovulation (often further designated as pro-oestrus
Nano lipid was prepared by solvent diffusion method;
and oestrus), luteolysis by PGF2 (4). PGF2 is the
the formulation consisted.
treatment of choice to induce estrus by analyzing lutein

body profile (5). The use of PGF2 is one of the protocol
The lipid phase was comprised of two forms:
methods for synchronizing estrus by shortening the luteal
Lipid form: The lipid status formed by Stearic acid
phase (6).
100 mg dissolved by glycerine monostearate 100 mg
The synchronization of estrus allows the
and dispersing 800 rpm with Castor oil 2 ml to form
offspring to be increased, due to its inhibitory effect on
lipid dispersion by vortex 1500 rpm for 30 minutes.
the reproductive cycle and without dependence on the

season. It also unifies the estrus period. Hormonal
Dissolving form: At 800 rpm for 30 minutes, we
products are used in the synchronization of estrus for
loaded and disseminated the necessary quantity of
natural mating or artificial insemination, which further
hormones into the developing lipid phase and then
improves the reproductive performance of animals.
dissolved it in 100 mg of phosphatic acid. After
The use of prostaglandins is an alternative
adding the dissolved form to the lipid form and
method for controlling reproduction, which eliminates
mixing at 800 rpm for 1 hour, the mixture is chilled
corpus lutum and leads to a later follicular phase with
overnight at 8 °C before being utilised. You should
ovulation (7). Nanotechnology is a drug delivery system
stir for 30 minutes at 800 rpm before using (11). After
that can increase drug permeability by increasing their
collecting the supernatant, it was filtered via
solubility. As well as increasing issues of premature
membrane filters measuring 0.2 m. UV-Absorbance
removal associated with small particles, regenerative
spectrophotometer readings of supernatants and SNL
medicine will play a major role in treatment in the future
were used to detect the hormone.
Received: 20/7/2022
Accepted: 22/9/2022

Full Paper (vol.901 paper# 54)

c:\work\Jor\vol901_55 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 386-392

Serum Sphingosine 1-Phosphate as a Biomarker for
Post-Stroke Cognitive Impairment
Aya Shokry1, Ghada Saed Abdel Azim2, Sarah Younes Abozaid3, Marwa Abdellah Osman*2
Department of 1Neurology, Stroke Unit, Shebin El Koum Teaching Hospital,
General Organization for Teaching Hospitals and Institutes, Egypt
Departments of 2Neurology and 3Clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Egypt
*Corresponding Author: Marwa Abdellah Osman, Mobile: (+20)01000726854, Email: drmarwaosman@gmail.com

Stroke is a main cause of disability. Impaired cognition is an important aspect for stroke survivors. The
discovery of laboratory biomarkers for post stroke cognitive impairment (PSCI) may help identification of those who
are at risk of cognitive impairment and application of suitable therapeutic regimens.
Objective: This study aimed to measure S1P serum levels in a group of patients with severe ischemic stroke at admission
and to determine if they are associated with post stroke cognitive state.
Patients and Methods: The study has been applied on sixty patients who had acute ischemic stroke in addition to 40
apparently healthy. The mean of age and gender in subjects and controls were matched. Serum sphingosine -1 phosphate
(S1P) levels were analyzed by ELISA technique for all patients within 72 hours of admission and for healthy controls.
The severity of the stroke has been evaluated based on the scale of the National Institute of Health Stroke (NIHSS).
Patients also underwent cognitive assessment using Montreal Cognitive Assessment (MoCA) at admission and after 3
Results: The level of serum S1P was apparently reduced in acute stroke patients by comparing with the healthy controls
(p< 0.001). Furthermore, the decreased levels of the S1P serum were obviously with more disease severity as measured
by high NIHSS score at admission and with more post stroke cognitive impairment as assessed by MoCA scale three
months later after stroke onset.
Conclusions: The study came up with key findings that reported a clear step-down in the levels of serum S1P in the
patients with acute stroke as compared to the healthy control and the same obvious reduction in S1P levels in cognitive
impairment patients as compared to those with non-cognitive impairment.
Keywords: Post-stroke cognitive impairment, Sphingosine-1-phosphate, Montreal cognitive assessment scale.

give us better understanding of the pathophysiological
PSCI is common among stroke survivors.
mechanisms of the disease (4).
Previous studies identified that prevalence of PSCI is
Sphingosine 1- phosphate (S1P) is a lipid
53.4% within 1.5 years of stroke (1). Many cognitive
metabolite that mediates several physiological
domains are affected in PSCI; of these, impaired
processes, of which vascular endothelial cell function,
functions like attention appear to be the most prevalent.
coagulation thrombosis, angiogenesis and inflammation
Cognitive deterioration is usually obvious immediately
(4). S1P is a pleiotropic lipid mediator. Several studies
after stroke but most of these deficits resolve during the
demonstrated that endothelial cells, thrombocytes,
former recovery period. Nevertheless, longitudinal
neutrophils, macrophages and erythrocytes are the main
studies have demonstrated that long term-prevalence of
sources of S1P in blood (5).
impaired cognitive after stroke may be as high as 30-
About 50% of S1P in plasma is bound to high-
50% at 5 years (2). Cognitive impairment results in poor
density lipoprotein cholesterol (HDL-C), while about
long-term consequences on the daily activities and
40% is associated with albumin. S1P is a ligand of five
quality of life (QOL) and is associated with remote
G protein coupled cell surface receptors, S1PR1­
morbidity and disability. Therefore, finding a way to
S1PR5. These receptors are represented in different
help in former detection and effective treatment for
PSCI has become one of the priorities of modern
cardiovascular, hepatic, and neurological systems (6). By
neurological rehabilitation (3).
binding with different receptor subtypes, S1P regulates
Detection of post stroke cognitive impairment
many physiological and pathological functions, such as
depends basically on clinical manifestations,
blood flow, blood pressure, heart rate, vascular
However, these methods depend on the cooperation of
coagulation/thrombosis, and inflammatory responses,
patients and are not accurate enough for former
all of which play important roles in the pathogenesis and
diagnosis of post stroke cognitive impairment.
progression of stroke (4). In addition, S1P is shown to
Therefore, the identification of objective former
execute various functions in the cells of the central
biomarkers for PSCI would be of significant clinical
nervous system, such as differentiation, survival and
value in supporting the ability of physicians to tailor
excitability of neurons, activation of astrocyte-mediated
treatment regimens and improve outcome of PSCI, and
neuroinflammation, and processing of amyloid
precursor protein (7). Recently, serum S1P was found to
Received: 29/9/2022
Accepted: 1/12/2022

Full Paper (vol.901 paper# 55)

TF_Template_Word_Windows_2016 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 393-400
Pediatric COVID-19 Vaccine Refusal among Egyptian Parents:
An Online Survey Study
Hend Magdy Mohamed Gomaa* & Shymaa Mamdouh Mohamed Abdu
Public health and Community medicine department, Faculty of medicine, Mansoura University, Mansoura, Egypt
Corresponding Author: Hend Magdy Mohamed Gomaa, Email: hendmagdy86@hotmail.com,

Because COVID-19 pandemic is still ongoing, it is critical to immunize the majority of people, including
children, in order to achieve herd immunity.
Objective: The study aimed to estimate prevalence of pediatric COVID-19 vaccine refusal among parents and to explore
factors affecting it.
Methods: An online cross-sectional survey of 189 parents was conducted. Data were collected using a pre-structured
questionnaire about parents' socio-demographic characteristics, COVID-19 knowledge, level of concern about
reinfection, parents' willingness to vaccinate their children, and the importance of vaccine to their own and community
health. To identify predictors of vaccine refusal, binary logistic regression was used.
Results: The majority of parents (61.9%) refused the pediatric COVID-19 vaccine. Binary logistic regression analysis
showed that male parents (AOR= 10.18,95), those tested negative (AOR=26.27), those not worried from reinfection
(AOR= 15.23), those felt anxious more than half the days (AOR=10.64), nearly every day (AOR= 15) and those who
thought that the vaccine was not important for their own health (AOR=11.93) and for protecting health of other people
(AOR=4.05) were significantly more likely to refuse the pediatric COVID-19 vaccine. 73.5% and 63.2% of parents had
fear of vaccine side effects and thought that vaccine isn't effective, respectively.
Conclusion: Pediatric COVID-19 vaccines are opposed by two-thirds of parents. Fear of vaccine side effects and belief
that the vaccine is not effective are the most common reasons for vaccine rejection. As a result, health education for
those parents and future longitudinal studies exploring the factors influencing parents' refusal of the COVID-19 vaccine
are recommended.
Keywords: COVID-19 vaccines, Children, parents.

spread via social media channels (9), that is exacerbated
On March 11, 2020, the World Health
by widespread vaccine misinformation, which is
Organization (WHO) declared COVID-19 a pandemic
already very high (10).
and declared a global health emergency (1). The quick
The difficulty for a COVID-19 vaccine is that its
licensing of COVID-19 vaccinations serves as an
fast development contributed to the perception that the
essential preventative step against the pandemic with
vaccine hasn't been thoroughly vetted for safety and
unabated increase in new cases, achieve herd immunity,
efficacy, which is why the WHO now considers it to be
and avoid hospitalization and death. (2, 3). COVID-19
a severe global health hazard (11). Mild symptoms, few
vaccine trials illustrated encouraging results as regards
hospitalizations, and lower mortality rates among
safety and production of a good immune response and
children than adults may all contribute to hesitation in
shows effectiveness in disease control (4, 5). To combat
administering vaccines to younger individuals (12). As a
the pandemic, good awareness of vaccination needs to
result, 33.3% of Egyptians had received all
be done. The COVAX initiative was implemented
recommended vaccinations as of May 28, 2022(6).
among lower-income countries to make faster and more
Despite the Egyptian government's approval of Pfizer's
equitable distribution of the vaccines with the following
Covid-19 vaccination for youngsters aged 12 to 15,
achievements; 65.8% of the world population had
many families were still reluctant to vaccinate both
received at least one dose of a COVID-19 vaccine, of
themselves and their children (13). There are few studies
them 16.2% of people in low-income countries (6).
looking at how well the COVID-19 vaccine is received
With rates of uptake among the community
by children, particularly in low- and middle-income
enhancing the success of the immunization campaign,
countries (LMICs), despite the fact that there is a
more worry has been created over the expansion of
significant amount of research on adults' uptake of the
COVID-19 vaccination to youngsters. (7) . Some people
COVID-19 immunization (14, 15). The first study to use
are less confident in national safety monitoring systems
an online survey to highlight this crucial subject comes
due to possible side effects of vaccination, which cause
from Egypt.
them to put off getting vaccinated, delay getting

vaccinated, and strongly oppose vaccination. Younger
adults provide a challenge since they are less clinically
A descriptive cross-sectional study with analytical
impacted and may believe that receiving the COVID-19
components that was carried out through online survey
vaccine has less utility (8). Additionally, false
on accessible parents through year 2022.
information about the COVID-19 vaccine has been
Received: 20/9/2022
Accepted: 22/12/2022

Full Paper (vol.901 paper# 56)

c:\work\Jor\vol901_57 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 401-406

The Correlation Study between Rheumatoid Arthritis and
Obesity in Babylon Province
Karrar Salih Mahdi1, Duha Mahdi Hussein1, Mohammed A. Dabbi2, Mustafa Jawad Al-Imari1,
Raghad Obead AbdulAL-Abass2, Rusul Hamed Obaid4, Mohammed Hayder Hamad1,
Saafa Abaas Abd.Al-Kahdum1, Sarah Kamil Abbood1 and Hadi Sajid Abdulabbas3
1Medical Laboratories Techniques Department and 2Nursing Department, Al-Mustaqbal University College,
Babylon, Iraq, 3Continuous Education Department, Faculty of Dentistry, University of Al-Ameed, Karbala,
Iraq, 4No affilation
Corresponding author: Karrar a
S lih Mahdi, Karrar.salih@uomus.edu.iq / https://orcid.org/0000-0002 4
- 717-615 ,
Moblile : 009647807208910
Background: The prevalence of obesity has risen dramatically in recent years. History of obesity is a significant risk
factor for the development of rheumatoid arthritis (RA).
Objective: This study aimed to survy about obesity as a major threat for public health and attachment with other disease
such as RA, and because several research refer to association to each other in differnet patients around the world.
Subjects and Methods: It included 64 serum samples, classified as 16 from obese patients, 16 from rheumatoid patients,
16 from patients with both rheumatoid arthritis and obesity, and 16 from healthy individuals. All of these were recruited
between October 2021 and August 2022, from different government hospital laboratory and private labs in Babylon
Results: The results revealed significant differences (P>0.05) between control group and group of patients who had
rheumatoid and obesity regarding the level of rheumatoid factor (RF), also showed positive correlation between body
mass BMI and rheumatoid factor in the group of patients who had rheumatoid and obesity, but it revealed negative
correlation between body mass index and rheumatoid factor in the group of patients who had obesity.
Conclusion: Rehumatoid factor (RF) doesn't make important role in the obesity, and there is no association between
rehumatoid arthritis and body mass index.
Keywords: Rheumatoid arthritis, Obesity, BMI.

overweight is strongly linked to developing rheumatoid
The prevalence of obesity is quickly increasing,
arthritis (RA), perhaps because of the central role
making it a significant public health concern in many
obesity plays in the obesity of autoimmune and
nations throughout the world(1). Obesity and excess
inflammation conditions(1) .
weight significantly increases the danger of developing
Inflammation and hyperplasia of the synovial
several serious ailments, including diabetes, heart
membrane are the hallmarks of the chronic, generalized
disease, and cancer. They have recently begun to affect
autoimmune illness known as rheumatoid arthritis
emerging nations due to shifting dietary and physical
(RA). The degree of inflammation is connected with the
activity norms and rising fast food demand(2).
progression of structural disruption, which results in
The WHO (World Health Organization) defines
disability, musculoskeletal deformity, and a decrease in
overweight and obesity as abnormal or excessive fat
life expectancy(6).
accumulation that might have negative health
Obesity may start and maintain a low-grade systemic
consequences. When a child's body mass index (BMI)
inflammatory milieu that can exacerbate autoimmune
is more than one standard deviation over the recognized
diseases and the comorbidities that go along with them.
median in child development patterns, the youngster is
Autoimmunity has been observed to be aggravated by
considered overweight. In contrast, obesity is defined as
metabolic alterations and inflammatory substances
more than two standard deviations above the median.
generated by adipose tissue, which predisposes the
The intricacy of obesity stems from its "multi-systemic
patient to cardiovascular disease (CVD) and metabolic
character," which makes it challenging to treat(3). The
prevalence of overweight-obesity (BMI > 25 kg/m2)
Cutoff points for body mass index (BMI) show
was 39% in 2016 across adults aged 18 and older, while
substantial variation in the prevalence of obesity in RA.
the prevalence of obesity (BMI > 30 kg/m2) was 13%
Increased inflammatory activity, as measured by the
number of tenders and swollen joints, was linked to
The risk of hypertension, hyperlipidemia, and diabetes
being overweight or obese. Most measures of body fats
mellitus was shown to be higher in individuals with both
mass were found to be positively correlated with the
central obesity and compound obesity, as reported by
degree to which joints were swollen. Routine treatment
Zhang et al.(5). Another research found that being
for RA patients must involve assessing and working to
Received: 5/9/2022

Accepted: 1/12/2022

Full Paper (vol.901 paper# 57)

Liver Abscess The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 407-411

Gastric Staple Line Leaks After Laparoscopic Sleeve Gastrectomy,
Endoscopic Stent Insertion Versus Surgical Intervention Treatment
Yasser Baz1, Mohamed Abdelaal Mohamed2*, Mohammed M. Ezzat1
1 Department of General Surgery, Faculty of Medicine, Helwan University, Egypt
2 Department of General Surgery, Faculty of Medicine, 6th October University, Egypt
*Corresponding author: Mohamed Abdelaal Mohamed, Mobile: (+20) 01284500500,
E-Mail: Mohamed01284500500@gmail.com

Endoscopic stenting (ES) provides comfortable management of Gastric staple line leaks (GSLL); it is less
invasive than conventional surgery. Objective: The aim of the current study is to assess the efficacy of endoscopic
stenting versus surgical intervention in treating gastric stable line leakage following laparoscopic sleeve gastrectomy
(LSG). Patients and methods: In Helwan University Hospitals, 40 patients had GSLL post LSG between January 2018
and August 2022. We proceeded our management to either: ES placement (Group A) or surgical management (SM)
(Group B), 2o in each group.
Results: Regarding postoperative complications, there is a significant statistical difference regarding wound infection,
but no significant difference regarding chest infection, DVT, subphrenic abscess, severe vomiting, GERD, failure of
Roux-en-Y, stent migration, or stricture. There is a non-significant association between the type of participant
management and the outcomes of the intervention. However, there was a statistically significant association between
the type of participant management and the interval period between GSLL closure and its control (P value <0.001) and
patients' hospital stay (P= 0.001), as participants who underwent ES spent less time in the hospital. Conclusion:
Management of post-LSG leakage with ES is advocated as it is a minimally invasive technique that effectively manages
GSLL and has a comparable control success rate to definitive surgical treatment with a shorter hospital stay, early return
of function, fewer complications, and a well-tolerable safety profile. In stable patients, ES should be recommended as
first-line therapy.
Keywords: Gastric staple line leaks, Endoscopic stent insertion, Laparoscopic sleeve gastrectomy.


However, the outcome reports of ES are incomplete,
Obesity is a growing cause of death and has been
and the procedural aspects are not clearly defined (6).
linked to at least sixty chronic noncommunicable
Successful GSLL management requires rapid
diseases, including heart disease, hypertension,
leakage identification and effective source control.
cerebrovascular stroke, type 2 diabetes mellitus, sleep
Nevertheless, several treatment strategies have been
apnea, cancer, and chronic renal disease (1,2).
proposed but no definitive management regimen has
Since its initial description in 1988, laparoscopic
been recognized, a stepwise management escalation
sleeve gastrectomy (LSG) has gained popularity and is
approach is essential to improve patients outcomes (12-
now the most commonly performed bariatric surgery in
14). The lack of well-designed studies that included
the world because it is faster, easier, and more effective
at addressing comorbidities and promoting weight loss
standardization is a noteworthy obstacle to
(3-11). However, the operation is not without
determining the best treatment for GSLL. Because of
complications. In reality, the most common and
this, there is no solid data basis that can be relied upon
dangerous complication after LSG, gastric staple line
to definitively determine the optimal course of
leak (GSLL), occurs in up to 5% of patients, causing
treatment to take in order to achieve the best
significant morbidity, mortality, and additional
management results (8,15).
hospitalization, outpatient therapy, and follow-up costs
The study's objective was to assess the efficacy
(4, 8, 11).
of endoscopic stenting versus surgical intervention in
The following treatment challenges for GSLL that
treating gastric stable line leakage following LSG.
are influenced by the patient's clinical condition

include; Initial conservative management followed by
conventional surgical treatment of GSLL entails prompt
In Helwan University Hospitals, 40 patients had
reintervention to patch or close the site of the defect, but
GSLL post LSG between January 2018 and August
these procedures are accompanied by high patient
2022. We proceeded our management to either: ES
mortality and morbidity (5,6).
placement (Group A) or surgical management (SM)
Endoscopic stenting (ES) provides comfortable
(Group B), 20 in each group.
management of GSLL; it is less invasive than
Inclusion criteria: The study involved patients
conventional surgery, aiming to cover or exclude the
operated with LSG and had a radiologically proven
leak site to divert gastric contents, allowing patients
early enteral nutrition, and allowing a temporary return
Exclusion criteria: Patient's not fit for general
to home if the patient's clinical condition is appropriate.
anesthesia or unwilling to participate in the study.
Received: 01/09/2022
Accepted: 02/11/2022

Full Paper (vol.901 paper# 58)

c:\work\Jor\vol901_59 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 412-420

Production and Characterization of Nanostructured -Lipid Carriers as
Hormones PGF2and PMSG
Buthina A. Abdullaha1, Mohanad A. Al-Bayati2
1,2 Physiology and Pharmacology Department, Veterinary Medicine Collage, University of Baghdad, Iraq.
Corresponding author: Buthina A.Abdullaha, Mobile: 09647701715129, E-Mail: buthinahameed@tu.edu.iq

PGF2-PMSG is one of the hormones used to increase production and reproduction, but there are some side
effects regarding its use and the length of its effect. Thus, improvement of the action of hormones and reduction of their
side effects by reformulation and optimization of PGF2-PMSG based on the nano-lipid delivery system became the target.
This study aimed to reformulate and improve PGF2-PMSG based on the nano-lipid delivery system.
Materials and methods:
In this study, Nano-Lipid Carriers (NLCs) contained fatty acids to obtain nanoparticles with small
particle sizes. The hormone Nano lipid was prepared by solvent diffusion method, and has the characters and properties of
The results:
The results were optimized nanoparticle has a size of Nano-lipid Carrying PGF2 range between 50-166.6
nm and Nano-lipid Carrying PMSG 85.7-300 nm. The entrapment efficiency of hormone SNL PMSG was 79.04 ± 4.96
and SNL PgF2 was 84.11 ± 5.55. The results of characterization for the SLNs under transmission electron microscopy
were generally round and uniform in shape. FTIR and XRD analyzers indicate that the hormone is properly laden within
the amorphous nanostructure. It also proved that Nano-lipid formula has high stability at pH and Osmo-tolerance. The Nano-
Lipid structure PGF2 and PMSG formulas were represented max 450 nm in UV-visible.
The present study showed that the Nanostructured -Lipid Carriers had the ability in producing high-efficiency
of PGF2 and PMSG hormones.
Keywords: Nano-lipid preparation, PGF2, PMSG.


also increased the ability to incorporate drugs into Nano-
Nanotechnology is the branch of technology that is
carriers for rapid drug delivery that can be used in a wide
used in practical application (1). Nano-materials differ
variety of therapeutic goals (9).
from bulk materials in a number of ways, including their
Structure Nano-Lipid (SNL) has good chemical
high surface energy, extremely large surface area, and
stability, this is what the researchers confirm. It has
ability to customize their functions for varied applications
developed broad prospects for its use, and features of the
(2). Nano-delivery systems have the potency for
NLC structure that allow the inclusion of natural bioactive
simultaneous objective and diagnostic and therapeutic
lipids into the matrix of NLC that help creation of high-
action through nanotechnology-based delivery systems
performance drug carriers. Many drugs are available for
that have the potential to drug permeability, solubility,
stimulating as well as for superovulation such as
and early elimination issues associated with small
hormones and medicinal and pharmaceuticals for
molecules and biological materials (3, 4).
pharmacological use (10).
So targeted delivery systems and regenerative
The aim of the study was to reformulate and improve
medicine supported by nanotechnology have the
PGF2-PMSG based on the nano-lipid delivery system.
possibility to play a central role in future therapy (5, 6).

Nano-particles are classified according to their size,
shape, and physical and chemical properties. There are
Preparation and standardization of Nano-Lipid
carbon nanoparticles, metallic nano-particles, ceramic
nano-particles, polymeric nanoparticles, and lipid
Nano lipid was prepared by solvent diffusion
nanoparticles (7). Lipid nanoparticles are generally
method (11). The lipid phase comprised of two forms:
spherical, with a diameter of 10 to 100 nm. It contains

lipophilic and soluble particles. Its structure consists of a
1-Lipid form: The lipid status formed by stearic acid 100
solid core made of lipids matrix, and by means of
mg dissolved by glycerin monostearate 100 mg and
surfactants and emulsifiers the outer core is stabilized (8).
dispersing 800 rpm with castor oil (2 ml) to form lipid
The rapid development of science regarding the ability to
dispersion by vortex 1500 rpm for 30 minutes.
produce nanoparticles of uniform shape, structure, and

size has revolutionized pharmaceutical science.
2-Dissolving form: The forming lipid phase was
With their size-dependent properties, nanoparticles will
dissolved in phosphatidic acid 100 mg and the amount of
offer the potential for new and advanced treatments. It
loaded and dispersed hormone requirements was 800 rpm
Received: 20/07/2022
Accepted: 22/09/2022

Full Paper (vol.901 paper# 59)

c:\work\Jor\vol901_60 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 421-432

Detection of Important Compounds from The Aerial Part of
Callistemon viminalis Plant Cultivated in Iraq
Anas Yasir Asaad1
1 Bc.S. Pharmacy, Department of Pharmacognosy, College of Pharmacy, University of Baghdad, Baghdad, Iraq
*Corresponding author: Anas Yasir Asaad, E-mail addresses: onos.yaser1200m@copharm.uobaghdad.edu.iq
Tel. no.: mobile; +9647730115700

Background: Medicinal plants are a generous source of our drugs and remedies, coming from their fabulous secondary
metabolites, which involve different classes such as alkaloids, glycosides, essential oils, phenolic compounds, and
steroids. Callistemon viminalis is a small tree cultivated in Iraq, that owns very interesting bioactive compounds
especially, essential oils, phenolic derivatives, and terpenoids.
Objective: To investigate the bioactive compounds from the aerial part of the Iraqi Callistemon viminalis plant.
Material and methods:
The plant was extracted by Soxhlet apparatus and fractionated with solvents that differ in
polarity, the n-butanol and ethyl acetate fractions were applied to Liquid Chromatography-Tandem mass spectrometer,
while the hexane defatting extract was applied to Gas Chromatography-Mass spectrometer analysis to discover to
components of the plant.
Results: The results show the presence of many glycosides, flavonoids, terpenoids, and alkaloids like Kaempferol,
Astragalin, Quercitrin, Scutellarin alpha-Phellandrene, 3-Carene, (-)-Spathulenol and, Dihydroepinatalensine.
Conclusion: Callistemon viminalis aerial part involves diverse types of important that own important medical activity,
they are mostly flavonoids, phenolic derivatives, terpenoids, terpenes, and glycosides. Also, the study supports the
presence of powerful anti-inflammatory flavonoids and terpenoids that are involved in the traditional use of the plant in
the relief of tissue inflammations.
medicinal plants, phenolic compounds, flavonoids, liquid chromatography.

primarily involves essential oils as well as phenolic
Natural surround is always a very attractive
acids, phloroglucinol derivatives, tannins, flavonoids,
field to explore new treatments and remedies. The
and triterpenoids. Active molecules in plant extraction
plants are mostly revealed as the premier source for our
show exceptional applications in nanoparticle drug
drug discoveries. Deeply, when we take a look at the
manufacturing, medical solutions, and cosmetic
plant, we see the primary and the secondary
concepts (8,9).
metabolites, the primary metabolites are proteins,
Plant phenolic compounds are a very broad
sugars, fatty acids, and whatever plants need to grow,
class of secondary metabolites, which obtain more
they also act as a food source for both humans and
deliberation in the last years due to their high
animals. Secondary metabolites are what plants use to
occurrence in the plant kingdom in addition to their
survive in their environment, just like protection from
powerful antioxidant activity. Natural roles may be
insects; they are also considered to have the role of
diverse from securing the plant from predators to
appreciable pharmaceutical activity (1). Secondary
sensorial, structural, and reproductive functions.
metabolites are versatile in their structure and activity.
Chemically, plant phenolics involve an aromatic ring
Also, many biosynthetic pathways give rise to different
bonded with at least one hydroxyl group that is
natural products. Alkaloids, glycosides, terpenes,
generally derived from the shikimic acid pathway and
essential oils, and phenolics are some examples of these
acetate coenzyme A or its active forms. With their
hopeful bioactive compounds (1,2).
obvious radical scavenging ability, they play an
Ancient history reveals many medicinal plants
important role in protection from degenerative diseases
that were used by people, the oldest evidence was a
as well as the strong ability to suppress tumor formation
Sumerian clay slab found in Nagpur about 5000 years
and inflammatory response (10).
in old. It involved 12 preparations from 250 different

plants which include poppy and henbane alkaloids (3).
Also, Indian Vedas holy books have mentioned
Ethical approval: The study was approved by the
numerous treatments from plants that grow in nature (4).
Ethics Board of Baghdad University.
Even in this time we use treatments with plant parts like

ginseng and camphor written in "Pen T'Sao", the
Plant material:
Chinese book on roots and grasses, that listed 365 drugs
Callistemon viminalis aerial part was collected
from plants and belonged to 2500 BC (5,6).
from Baghdad city on separate periods extended from
Medicinal plant products not only can treat and
the end of October 2021 AD to February 2022 AD. The
prevent diseases but also give template structures that
plant was identified and authenticated by the
can be modified and developed as active molecules
Department of Biology / College of the Science /
against existing illnesses (7). Callistemon viminalis
University of Baghdad. The plant component was
Received: 04/09/2022

Accepted: 01/12/2022

Full Paper (vol.901 paper# 60)

c:\work\Jor\vol901_61 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 433-445

Protective Effects of Alfa Lipoic Acid on Amiodarone Induced
Hypothyroidism in Adult Male Albino Rats
(A Biochemical, Histopathological and Immunohistochemical Study)
Amal Mahmoud Elshazly1*,Bodour Baiomy1,Yasmeen Mohammed Ismail El Sayed2 ,
Asmaa Y.A. Hussein 3*, Neama Mahmoud Taha 4, and Ali Mohamed Ali 1.
1Department of Anatomy and Embryology,2Department of Clinical Pharmacology,
3Department of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Benha University, Egypt
4 Physiology Department, Umm Al-Qura University, KSA.
Corresponding author: Amal Elshazly, Mobile:(+20)1222924128, Email: amal.elshazly79@yahoo.com

Amiodarone (AMD) is a highly effective antiarrhythmic agent. Its utilization is associated with toxic
effects on thyroid gland. The aim of this research to evaluate the AMD chronic administration potential toxic impact on
the thyroid gland and evaluate Alfa lipoic acid ( LA) possible protective impact.
Materials and methods: 40 adult male albino rats were equally separated into 4 groups, group I (control) given 1ml
distilled water for 12 wks., group II (AMD tested group) received a single dose of 40 mg/kg /day AMD for 12 wks.
Group III (AMD+ -LA), where AMD was given as group II and a dose of 100 mg/kg of -LA for 12 weeks, group IV
received AMD in doses similar to group II, then the drug was withdrawn and the rats took no treatment for additional 4
weeks. All groups were sacrificed after 12 weeks except group IV after 16 weeks from the beginning of the experiment.
Results: In AMD treated group; the T3, T4 and catalase [CAT] serum levels were significantly reduced along with
significant elevation in TSH, IL6 and malondialdehyde [MDA] level, light microscopic examination of AMD group
showed cellular degeneration of follicles and colloid peripheral vacuolation along with strong positive immune reaction
for Ki-67 declared in AMD group as compared to those of other groups. Additionally, electron microscopic studies
supported these results. Conclusion: Chronic administration of AMD induced thyroid damage which could be improved
by Co-supplementation of -LA.
Keywords: Amiodarone, Alfa Lipoic Acid, thyroid gland, hypothyroidism.


these factors include age, sex, the dose and duration of
Being a benzofuran derivative, amiodarone
AMD therapy, absence or existence of underlying
(AMD) is a class III effective antiarrhythmic agent with
thyroid disease and the level of body iodine. However,
non-competitive - and adrenergic blocker and
most studies attributed the potential ability of AMD
multichannel blocker properties. Due to its little
problems to the high iodine content of the drug; as every
negative inotropic impact, it is frequently utilized, even
AMD molecule contains 2 atoms of iodine making it
in heart failure cases (1,2).
closely similar to the structure of thyroid hormones (6,8).
The long-term administration of AMD may be
An adaptive blockade of additional thyroidal
accompanied with direct and/or indirect organ
iodide uptake and subsequent production of thyroid
hormone, known as the effect Wolff-Chaikoff occurs
dysfunction, corneal microdeposits and lung toxicity
during AMD therapy, due to the significant amount of
(3,4). AMD has numerous impacts on physiology of the
iodide liberated from its metabolism. Although the
thyroid and peripheral metabolism of thyroid hormones.
effect is noticeable through the first 2 wks. of treatment,
In fact, greater than 50% of patients receiving prolonged
normal thyroid hormone production is restored due to
treatment of AMD have abnormal thyroid function test
continued exposure to iodine. As a result of failure of
results. The pathogenesis of AMD is multifactorial, and
thyroid to escape the Wolff-Chaikoff effect,
may be related to its lipophilic nature, presence of 2
amiodarone-induced hypothyroidism (AIH) is induced.
iodine atoms, a high propensity for deposition in various
Because of the prolonged blockage of intrathyroidal
tissues, high bio-distribution potential, and long half-
iodine organification, thyroid hormone production is
life in plasma (13­30 days) (5).
hindered (9).
Several clinical and experimental studies
Characteristic destructive thyroiditis associated
revealed many thyroidal disturbances associated with
with AMD chronic administrations occurs due to its
AMD therapy such as hypothyroidism, thyroiditis,
direct toxic effect with its iodide content that induced
follicular cell hyperplasia & follicular cell tumors. Long
oxidative stress, characterized by generation of reactive
term administration of AMD is highly affecting thyroid
oxygen species (ROS) and a significant rise in the levels
hormones metabolism and causes direct toxic effect on
of lipid peroxide on normal thyroid cells and follicles
the thyroid (6,7).
with subsequent thyroid gland degeneration. Also,
Varying degrees of thyroid gland abnormalities
AMD was found to be concentrated in the thyroid, and
were detected in response to AMD treatment related to
when its concentration exceed certain limit, damage and
certain factors in each specific case. Some examples of
destruction occurs in thyroid cells. This results in the
Received: 05/09/2022

Accepted: 06/12/2022

Full Paper (vol.901 paper# 61)

c:\work\Jor\vol901_62 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 446-452

Study of Erythroferone Hormone in Children with Beta Thalassemia Major
Hend T. Elmazain1*, Rasha A. Elkholy1, Abd El-rahman M. Elmashad2, Sahar A. Hammodah1
Clinical Pathology Department1, Pediatrics and Neonates Department2,
Faculty of Medicine, Tanta University, Egypt
*Corresponding author: Hend Tawfik Elmazain, Mobile: 01115311874, E-mail: hendtawfik52@gmail.com

Iron overload is a principal reason for morbidity and death in transfusion-dependent beta-thalassemia
cases. Erythroferrone hormone (ERFE), a member of tumor necrosis family- alpha (TNF-) superfamily produced by
erythroblasts and stimulated by endogenous or exogenous erythropoietin (EPO), Under these conditions, ERFE inhibits
the formation of hepcidin, restoring the functionality of ferro-portin, that is accountable for enhancing intestinal iron
absorption and mobilizing iron reserves. Objective: The aim of the currents study is to analyze the role of ERFE in
children suffering from beta thalassemia major.
Patients and methods:
A prospective case-control study was conducted at Tanta University Hospital during the period
from March 2021 to November 2021. The study included 40 children previously diagnosed with beta thalassemia major,
and 40 healthy children matched in sex and age as a control group. Serum ERFE was calculated utilizing enzyme linked
immunosorbent assay (ELISA) technique. Results: Serum ERFE level was significant increase in the beta thalassemia
patients' group than control group. In the patients group, serum ERFE was higher in non spleenectomized patients, and
in patients receiving blood transfusion more than once/ month, also, ERFE was higher in those with serum ferritin >1000
ng/ml. There is significant positive correlation between ERFE level and serum levels of ferritin and transferrin saturation
(T.SAT %). Receiver Operating Characteristic (ROC) curve analysis demonstrated that ERFE level above 1.6 ng/ml is
the cutoff value indicating iron overload with high diagnostic efficacy. Conclusion: ERFE is a possible diagnostic tool
in predicting iron overload with sensitivity 95%, specificity 62 %, and accuracy 78%.
Beta thalassemia major, Erythroferrone, Iron overload, case control study, Tanta University.


Thalassemia is a heterogeneous hereditary
completely standardized, and because inter-laboratory
variation is significant, the publicly available T.SAT
abnormalities and autosomal recessive inheritance.
percent is frequently used to infer the likelihood of
Homozygous or compound heterozygous formulae
higher concentrations of these two iron-toxic chemicals.
have a disturbance in the formation of - and non-globin
T.SAT percentage values should be interpreted with
chains, leading to inefficient erythropoiesis and a
caution during chelation therapy or inflammations (6).
decrease in normal hemoglobin A production (1).
Erythroferrone (ERFE) was suggested to be an
Iron overload is the primary cause for morbidity
erythroid hormone that FAM132B encodes a protein
and mortality in transfusion-dependent -thalassemia
that regulates iron metabolism in humans. It is the most
cases. As the body doesn't have action for excreting
important negative mechanism of hepcidin under
extra iron, iron accumulation leads to organ
stressing condition or inadequate erythropoiesis, being
malfunction, especially in the heart, liver, and the
formed by erythroid precursors in the bone marrow and
endocrinal system, if left untreated (2).
spleen under the control of renal erythropoietin (EPO)
The role of laboratory investigations in expecting
(7). Under these conditions, ERFE inhibits the formation
the incidence of tissue iron accumulation, as determined
of hepcidin, restoring the role of ferro-portin, that is
by measurement of hepatic iron content using biopsy or
accountable for enhancing the absorption of iron in the
noninvasive imaging techniques, was exhaustively
intestines and mobilising iron reserves. In settings
investigated. Some investigations have identified serum
needing an increase in erythropoietic activity, ERFE
ferritin as an acceptable prediction factor of the severity
could be reasonably seen as playing a crucial function
of iron overload, and its predictive value has been
in enhancing iron accessibility for haemoglobin
demonstrated in thalassemia and is connected with
production (8).
cardiac-related death (3). However, its ability to forecast
There are two components to the raised ERFE
iron accumulation has been deemed inadequate by other
synthesis because of anemia: as erythropoietic cells are
researchers. Moreover, its benefit was reduced because
activated by the effect of EPO, the number of erythroid
of being an acute phase reactant increasing in some
precursor cells increases. Second, each individual cell
concomitant conditions like inflammatory states,
in this population produces more ERFE. In anemias
hepatic disorder, rapid cell turnover, and deficiency in
accompanied by inefficient erythropoiesis, EPO
vitamin C (4,5).
dramatically expands and stimulates the erythroid
Transferrin saturation (T.SAT %), labile plasma
precursor population, but the majority of these cells do
iron (LPI), and non-transferrin-bound iron (NTBI) are
not produce mature erythrocytes. These deadend
shown indicators of iron toxicity risk. Though, since
erythroid precursors secrete elevated quantities of
NTBI and LPI assays aren't generally accessible or
ERFE, which persistently suppresses hepcidin and
Received: 05/09/2022

Accepted: 06/12/2022

Full Paper (vol.901 paper# 62)

c:\work\Jor\vol901_63 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 453-458

The X-Ray Repair Cross Complementing 1(XRCC1) Rs25487 Variation and
Susceptibility to Cirrhosis in Patients with Chronic Hepatitis C Virus
Dalia Hamed1, Badawy El Kholy1, Hadeel Gamal El Deen2,
Samar Mahmoud Mohammed Momen1, Nora Mahmoud Selim1*
Clinical & Chemical Pathology1Endemic Medicine2, Faculty of Medicine, Cairo University
Corresponding author: Nora Mahmoud Selim, Tel: 01100227772, Email: nora.selim@hotmail.com

Around 130­170 million individuals are thought to be affected with the hepatitis C virus (HCV), which
is a viral pandemic and the leading cause of persistent liver illness. The frequency of HCV infections is greatest in
Egypt, where more than 10% of the general population is affected. Objective: The purpose of the current study was to
confirm any potential associations between cirrhosis and the XRCC1 rs25487 variant in chronic HCV patients.
Patients and methods: A fibroscan was conducted on 80 HCV +ve patients and 40 control participants for a total of
120 people to determine the extent of hepatic fibrosis. Real-time PCR was used to examine the SNP genotyping in the
XRCC1 gene (rs25487). Results: There were no substantial variation in the prevalence of different genotypes in XRCC1
A > G (GG and AG) between non cirrhotic and cirrhotic in chronic HCV Egyptian patients. Conclusion: By comparing
the incidence of the various genotypes (AA, AG, and GG) in the analyzed groups, no clear pattern of relationship could
be seen (p=0.225). (P = 0.410) There was no distinguishable pattern of connection between the AA genotype and the
other genotypes (GG and AG). Comparing the frequencies of the two alleles (A and G alleles) in the three groups under
study revealed no evidence of a connection.
X-ray repair, rs25487 Variation, cirrhosis, chronic hepatitis C virus, case control study, Cairo University.


The hepatitis C virus is acknowledged as posing
Between August 2016 and November 2016, a case
a serious risk to public health worldwide. As per to the
control study including HCV patients at the Cairo
most current estimates of disease burden, seropositivity
University Center for Hepatic Fibrosis, Endemic
has climbed to 2.8% during the last 15 years, translating
Medicine Department, Kasr Al-Ainy Hospital, and age-
to more over 185 million infections globally (1).
and sex-matched healthy participants was conducted.
In 2008, Egypt had the largest proportion of HCV
A total 120 participants were recruited in the
infections in the world, with 10% of the population
present research, who were split into two groups; Group
having a chronic infection and 90% of patients having
I (Control Group) had 40
genotype 4 infections (2). With an overall projected 30%
healthy, age and sex matched controls with normal
fall in HCV occurrence in Egypt between 2008 and
liver biochemical profile, HCV Ab -ve and HBs Ag -ve.
2015, the seropositivity of HCV infection in that
Group II (Patient Group) had 80 HCV patients.
country has reduced to 6.3% among the population
Patient Group was split into groups depending on
under study in 2015 (3).
the degree of hepatic fibrosis found by fibroscan; Group
Hepatocellular carcinoma (HCC) and cirrhosis
IIa included 40 chronic HCV non cirrhotic patients (f0-
are two conditions that are mostly brought on by HCV
f2), and Group IIb included 40 chronic HCV cirrhotic
infection. HCC is more likely to occur in people with
patients (f3-f4).
liver cirrhosis than in those with less severe fibrosis (4).

A multi-protein complex called XRRC1, one of
Patient's Inclusion criteria:
: Patients diagnosed
the most important molecules in base excision
with chronic HCV (HCV Ab +ve > 6 months, male or
female, and subsequently validated by PCR testing for
polymerase and poly (ADP-ribose) polymerase to fix
the existence of HCV RNA in blood) must be between
the single strand break brought on by the cleaving of the
the ages of 18 and 65.
DNA backbone at a basic site, which occurred in an

initial phase of the DNA restoration technique (5).
Patient's exclusion criteria: Combined HCV and
An A to G transition at codon 399 (exon 10) of
HBV (HBs Ag positive) and other causes of liver
the XRCC1 gene causes a shift from the amino acid
arginine (Arg) to the amino acid glycine (Gln) in the

XRCC1 protein (XRCC1 rs25487). The addition of Gln
Patients underwent the following:
may change the protein's function, making DNA repair
- History taking including, medical history and
less successful (6).
possible routes of acquiring HCV infection, as blood
The study's objective was to determine if there
transfusion, surgeries, dental care, needle pricks and
was any connection between the dispersion of the
XRCC1 rs25487 A > G variant in chronic HCV patients
- Clinical assessment including general examinations
from Egypt and hepatic cirrhosis.
especially jaundice, lower limb edema, and local

Received: 10/10/2022

Accepted: 10/12/2022

Full Paper (vol.901 paper# 63)

c:\work\Jor\vol901_64 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 459-464

Linear Analysis of ECG Data Variability to Assess The
Autonomic Nervous System in Two Different Body Positions
Amr Farhan1,2,3*, Aissam Lyazidi1,2, Said Elkettani4, Badreddine Labakoum1,2,
Mourad Rattal1,2, Azeddine Mouhsen1
1Hassan First University of Settat, Radiation-Matter Instrumentation Laboratory (RMI), Settat, Morocco.
2Hassan First University of Settat, Higher Institute of Health Sciences (ISSS), Laboratory of Health Sciences and
Technologies, Settat, Morocco.3Authority of Al-Thawra Hospital Taiz, Yemen
4Médecine Interne Libérale, Settat. Maroc
Corresponding author: Amr Farhan, Mobile: +212633280045, ORCID: 0000-0003-1492-3837, E-mail: a.farhan@uhp.ac.ma
Heart rate variability (HRV), generated from an electrocardiogram (ECG), can be used to evaluate the
autonomic nervous system (ANS). Heart rate changes during different physical activities are due to changing
involuntary regulation. Objective: The main aim of the current study is to explore the ANS by analyzing linear HRV
parameters, so that clinicians can preliminarily explore ANS function using ECG analysis with their patients.
Patients and methods: A total of 15 student volunteers were recorded. Data was collected for 5 minutes for each
supine and standing position. The R-peak obtained from an ECG is used to assess the RR-peak, which is also required
for HRV analysis. Linear HRV parameters with different time-domain indices and frequency-domain indices are
interpreted in 2 body positions.
Results: We discovered that the RR interval is longer in the supine position than in the standing position (952.8±181.6
vs. 771.9±164, respectively; P<0.05), and that in comparison to supine position, when standing as opposed to when
lying down, the heart rate is higher (81.7±10.2 vs. 65.8±9.1, respectively; P<0.05), where the body is more relaxed.
This affects ANS, and stress index values, which are low before increasing in the standing position, starting in the
supine position (5.7±2.4 vs. 9.5±2.7, respectively; P<0.05).
Conclusion: We conclude that there is a relationship between HRV and the sympathetic system in different positions,
where when moving from supine to standing, the values of HRV changes (increases) and, therefore, the stress index
changes (increase) and, from this, we note the change (value increase) in ANS.
Keywords: Autonome Nervous System, Heart Rate Variability, Electrocardiogram, Heart Rate, Case series,

(5). External heart rate regulation regulates the RR
intervals, which are the
Electrocardiogram (ECG) signals can be acquired
intervals between successive heartbeats (HR). HRV
by putting disposable electrodes on legs, arms, and
exhibits the heart's capacity to adapt to changing
chest skin surfaces (1). Electrical impulses from various
circumstances by quickly detecting and reacting to
areas of the heart are detected by these electrodes. The
stimuli (6). Additionally, HRV measurements enable the
heart's rhythm and heart rate are displayed on the ECG,
evaluation of nonlinear dynamic processes in the ANS
which might be irregular or constant (2).
and neurocardiac function brought on by interactions
Each participant's ECG signal pattern may change
between the heart and brain (7). There are several
over time as a result of body posture and physical
parameters used for R­R interval time series analysis,
activity. By measuring heart rate variability (HRV), the
including time domain and frequency domain as the
variation in heart rate or period may indicate the
standard analysis for HRV by the European Society of
function of the autonomic nervous system (3).
Cardiology Parameters Task Force (8,9).
The parasympathetic nervous system (PNS),
In recent years, numerous studies have used HRV
generally known as the relaxation response, and the
as a suitable ANS modulation biomarker (10). Examine
sympathetic nervous system (SNS), sometimes referred
the ANS in different positions: supine, sitting, and then
to as the fight-or-flight reaction, respectively, make up
standing, Also, (6) supine and standing positions were
the autonomic nervous system (ANS). In response to a
used to investigate the ANS. The ANS regulates
stressful situation, such as the fight-or-flight response,
heartbeats through its SNS and PNS divisions. An
the body experiences physiological changes known as
increase in SNS activity or a decrease in PNS activity
stress. The hypothalamic-pituitary-adrenal axis is
causes heart acceleration. Conversely, slowed heartbeat
stimulated by the SNS mechanisms that generate stress
is a result of both high PNS activity and low SNS activity
and anxiety, and this increases the hypothalamic release
of corticotropin-releasing hormone. The adrenal gland
As stated by (12,13), the variability function of the
tissue is where corticotropin-releasing hormone enters
heartbeat enables an organism to adapt efficiently to both
to trigger the release of cortisol, the main hormone
internal and external demands. Additionally, a variety of
associated with stress (4). HRV is the term used to
elements, including genetic, environmental, and clinical
describe the variation in heartbeat frequency over time
circumstances, may affect an organism's patterns of
Received: 10/10/2022

Accepted: 10/12/2022

Full Paper (vol.901 paper# 64)

c:\work\Jor\vol901_65 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 465-470

Neck Masses as The First Presentation of Occult Papillary Thyroid Carcinoma: Case Series
Mohammed Salih Abedulla Ali 1, Layth Alharbawi 2*, Ziyad Ahmed Abed 3, Nazar M.T. Jawhar3
1. Dijlah University College of Medicine, Iraq. 2. Al Kitab University, Iraq.
3. Department of Pathology, Ninevah Medical College, Iraq.
*Corresponding author: Layth Al harbawi, Mobile: (+964)7722020117, Email: Laythqassid@yahoo.com,

Papillary Thyroid Carcinoma (PTC) is the most common thyroid cancer. It can be found incidentally
during thyroidectomy or can present as an enlarged cervical lymph node which is difficult to be diagnosed unless
confirmed by ultrasonography and fine needle aspiration cytology (FNAC).
The aim of the current study is to report our experience in diagnosing Occult PTC (OPTC) presenting as a
cervical mass without any evident thyroid enlargement.
Patients and methods:
Retrospective reviews of reports of all patients presented to our hospital complaining of a mass
in the neck were enrolled in this study. Data regarding their history, investigations, ultrasound and Fine Needle
Aspiration Cytology (FNAC) were reviewed. Cases investigated and diagnosed initially as OPTC were included.
Diagnosis was confirmed by histopathological examination of the resected specimens.
Results: Eleven out of 62 (17.7%) cases with cervical masses were diagnosed as OPTC based on ultrasound and FNAC
findings later confirmed by histological examination of their specimens. Six of them were females and 5 were males
with a mean age of 36.9 years. The mean duration of these masses was 2.3 months. Hemithyroidectomy was done for 2
patients for unilateral small masses in the thyroid with the remainder undergone a total thyroidectomy with modified
lymph node dissection.
Conclusion: OPTC can present for the first time as a neck mass without clinically apparent thyroid enlargement.
Physicians should keep the possibility of OPTC in the differential diagnosis of all adult neck masses in order to avoid
any delay in diagnosis and to achieve the proper management plan.
Cervical mass, FNAC, Ultrasound, Papillary thyroid carcinoma, Retrospective reviews, Case series, Dijlah

ultrasound of the soft tissues of the neck7. Thick and
irregular lining of a cyst are the ultrasound features
Neck masses commonly present to general
highly suggestive of metastasis. The origin of these cysts
practitioners (GPs) and could be the single presenting
is still controversial; some researchers proposed that it
complaint in a patient with head and neck malignancy
could represent a malignant change of ectopic thyroid
notably for those over 40 years of age 1. There are often
tissue. Others believe that it signifies metastasis from
no associated symptoms other than the recognition of a
an occult thyroid lesion to the LN which in turn, suffered
new lump noted incidentally on palpation or noticed by
central liquefaction and cystic generation8,9.
another individual. Evaluation of the neck mass can be
Fine Needle Aspiration Cytology (FNAC) is a safe
difficult because of the wide differential diagnosis
and cost-effective investigation with an overall accuracy
ranging from infection to malignancy. Therefore,
of 93.1% (73.3­98.0%), henceforth, it is considered as a
thorough history and physical examination are essential
first-line diagnostic test for patients at increased risk of
to decide the proper management.
malignancy10,11. Other modalities like contrast-enhanced
Papillary thyroid carcinoma (PTC) is an epithelial
CT or Magnetic Resonance Imaging (MRI) are
malignant tumor of the thyroid gland and accounts for
extremely valuable for the management of patients with
almost 80% of thyroid cancers2,3. About 21.5% of PTCs
cystic neck lesions, especially where the diagnosis
present with lymph node (LN) metastasis at the time of
remains uncertain after standard investigations have
diagnosis4, however, even with LN metastasis, PTC has
been performed12,13.
the best prognosis5,6. Occult papillary thyroid carcinoma
The aim of the current study is to report our
(OPTC) that is less than 1.5 cm size is difficult to be
experience in diagnosing OPTC presenting as a cervical
diagnosed by only palpating the LN unless assisted by
mass without any evident thyroid enlargement.
Received: 10/09/2022

Accepted: 01/12/2022

Full Paper (vol.901 paper# 65)

c:\work\Jor\vol901_66 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 471-474

Evaluation of Students- Instructor Relationship in Nursing
Education at the University of Baghdad, Iraq
Qahtan Q. Mohammed
Psychiatric and Mental Health Nursing Department, College of Nursing, University of Baghdad, Iraq
*Corresponding author: Qahtan Q. Mohammed, Mobile phone: +9647713745870,
ORCID ID. 0000-0002-0251-2064, E-mail: qahtan@conursing.uobaghdad.edu.iq

Background: The student-instructor relationship as well as effective learning strategies is an important component of
an academic program that magnifies the feeling of trust and respect between the students and instructor. Therefore,
evaluation of the student-instructor relationship provides crucial understanding to reach a good academic environment.
The study aims at assessing the students - instructor relationship within the educational environment and
evaluating the emotional perception toward relationships among nursing students and their instructors.
Subjects and Methods: The study was conducted on Nursing Collegians of Morning and Evening Studies at the
Nursing Faculty, at Baghdad University. The assessment approach was used over six months (from January 2018 to
June 2018) to achieve the study objectives. A sample of 200 Nursing Collegians was recruited. Student-Instructor
Scale was adopted and used for the current study. The scale consisted of 36 items. The scale defines two domains
regarding instructor relationships; the first domain is regarding the connectedness with an instructor, and the second
domain of the scale is concerned with instructor anxiety.
Results: The students show higher scores of instructor connectedness and anxiety (89% and 83%) which means they
perceive a strong feeling of connectedness with an instructor and show generalized anxiety regarding this relationship
at the same time.
There is a strong positive relationship between students and instructors in nursing education, and this
positive relationship is an important moderator for improving the student's academic performance.
Keywords: Student-Instructor, Relationship, Nursing Education, Student-Instructor Scale, University of Baghdad.


The efficacy of the student-instructor relationship
five components for understanding the student-
can be a contributing factor to students' achievements
instructor relationship which is "providing information,
and resilience. As reported by previous studies factors
instructing, facilitating, guided participation and
concerning the protection of students such as "caring
mentoring" (11).
relationships, higher expectations and opportunities"
Developing effective learning practices requiring
have an influence on the improvement of students'
focusing on the student-instructor relationship. Creating
achievement and performance (1,2).
a positive supportive environment based on building
The identification of learning strategies and
trust and respect between the student and instructor has
learning assignments has been devoted to various
been shown essential for a relationship as maintaining
theories and research as affecting factors to students'
the sense of caring in that relationship and learning
academic achievement and orientation (3,4). And also
environment to be understood. The instructors should
there is a study that examines the effect of student-
exhibit positive perspectives, convictions, and
instructor association on learning outcomes. The
anticipations for the students as learners. An academic
nursing collegians who show a positive connectedness
setting aims to improve the student's abilities related to
with the instructor have higher achievement levels (3,5).
social, ethical, and intellectual aspects by creating a
The most ineffective instructor does not link the
supportive relationship between the student and
student's background to the nature of the educational
instructor (12).
and academic program, so students feel that the
Griffith and Bakanauskas (1983) studied the
instructor is unfaithful and untrustworthy. They show
student-instructor relationship in nursing education,
characteristics of cultural destruction and inability that
they stated that the instructor is significant in facilitating
seek to diminish the student's cultural values and
the role of students by helping them to learn and develop
scientific background (6,7). The student-instructor
personal and professional competencies. They see that
relationship as well as effective learning strategies is an
in terms of power, female instructors may show power
important component of an academic program that
over the students causing them to feel more threatened
magnifies the feeling of trust and respect between the
and incompetent. It has found a positive correlation
students and instructor (8).
A study conducted in
between self-concept and academic performance based
2016 reported that the three important components of
on the instructor showing open communication to
the student-instructor relationship: are "the teaching-
facilitate positive self-concepts (13).
learning environment, exchange of information, and
The study aims at assessing the student-instructor
mentor-peer association" (9,10). Beutel also categorizes
relationship within the educational environment and
Received: 10/09/2022

Accepted: 01/12/2022

Full Paper (vol.901 paper# 66)

c:\work\Jor\vol901_67 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 475-482

Colistin Susceptibility among Carbapenem Resistant Klebsiella pneumoniae
Isolated from Menoufia University Hospitals
Shymaa A. Elaskary1*, Hanem Mohamed Badawy2
1Medical Microbiology and Immunology Department, Faculty of Medicine, Menoufia University, Egypt.
2Clinical pathology, Faculty of Medicine, Menoufia University, Egypt.
Corresponding author: Shymaa A. Elaskary, ORCID: 0000-0003-0588-9761, Email: dr.shaimaaelaskary@yahoo.com


Background: Infections by CRKp represents a major health problem. Carbapenemases have been frequently reported
in CRKp. Limited antimicrobials are still effective for CRKp like tigecycline, ceftazidime/avibactam, as well,
polymyxins including colistin. With the increased use of colistin, Col R k. pneumoniae carbapenemase (KpC)-
producing isolates are documented worldwide.
Objectives: The aim of the current study is to investigate carbapenemases and to determine colistin susceptibility and
mcr genes among CRKp.
Material and methods: k. pneumoniae were identified by conventional methods and API20E. Carbapenem and colistin
resistance were screened by disc diffusion method. Confirmatory combined mCIM/eCIM testing was used for
carbapenemases detection. BMD and CBDE tests were used for colistin susceptibility detection. Multiplex PCRs were
done for carbapenemases genes (blaNDM-1, blaOXA48, blaIMP blaVIM, blaKPC) and colistin resistance genes (mcr1, 2, 3, 4
and 5 genes) detection.
Results: Out of CRKp, 68.9% were positive carbapenemases by mCIM/eCIM testing, 33.3% of them were MBLs and
66.7% were serine carbapenemases. the most frequent carbapenemases genes were blaKPC and blaOXA-48. About 16.3%
of CRKp were colistin resistant by BMD test. There was fair agreement of CBDE test in relation to BMD for colistin
susceptibility detection. The mcr1 gene was detected in 9.1% of CRKp.
Conclusions: The increase detection of carbapenemases and colistin resistance among k. pneumoniae isolates obligate
us for efficient use of prevention and control protocols to decrease the multidrug resistance in hospital and community
Keywords: Carbapenemases, Colistin, BMD, CBDE and MCR, Experimental study, Menoufia University.


colistin with other antibiotics including tigecycline,
Infections by carbapenem-resistant Klebsiella
meropenem, gentamicin, or fosfomycin can manage
pneumoniae (CRKp) that usually shows multidrug
them properly8. With the increased use of colistin,
resistance pattern to all -lactams, fluoroquinolones,
and aminoglycosides stay a major health threat
carbapenemase (KpC)- producing isolates are
documented worldwide8. Which were initially
The carbapenem resistance is mainly due to
considered to be chromosomally mediated only until
reduced expression and/or mutation of porins that allow
Liu et al., 20169 stated the development of the first
carbapenem entry into the bacterial cells3. Moreover,
plasmid-mediated polymyxin resistance mechanism,
the presence of carbapenemase genes on conjugative
mcr-1 in enterobacteriaceae2. The occurrence of
plasmids is correlated with the high incidence of
colistin-resistance (ColR) in CRKp generates a warning
carbapenem resistance4.
alarm for both clinicians and patients to return them to
Carbapenemases are either non-metallo--
the pre-antibiotic era8.
lactamases (serine carbapenemases, classes A and D)
and metallo--lactamases (MBL, class B)3. MBL genes
carbapenemases and determine colistin susceptibility
such as blaNDM, blaIMP, blaVIM, and non-metallo-
and mcr genes among carbapenem resistant Klebsiella
carbapenemase genes like blaOXA (class D) and blaKPC
pneumoniae isolated from Menoufia University
(class A), have been frequently reported in carbapenem-
resistant Klebsiella pneumoniae (CRKp)5.

Some limited antimicrobials are still effective for
CRKp like tigecycline, and the newly approved
Collection of Samples:
ceftazidime/avibactam6. As well, polymyxins including
Out of 984 patients admitted to different wards of
colistin are a valuable therapeutic choice that can bind
Menoufia University Hospitals during the period of
lipopolysaccharides and disrupt the outer membrane2,6.
February 2021 to July 2022, 334 (33.9%) Klebsiella
Although in 1970s, polymixins were largely
pneumoniae C.I.s were isolated as one isolate per
neglected because of their toxicity. These cationic
patient in the Medical Microbiology and Immunology
antimicrobial peptides have come back as a "final-
Department, Faculty of Medicine, Menoufia University.
resort" alternative therapy for numerous multidrug-

resistant organisms7. In critical cases caused by CRKp,
Received: 01/10/2022

Accepted: 15/12/2022

Full Paper (vol.901 paper# 67)

c:\work\Jor\vol901_68 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 483-490

Sirtuin-1 in Rheumatoid Arthritis Patients, Relation to Disease
Activity and Interleukin-17A
Rasha I Noreldina, Heba A Esailyb, Samar M Kamal Eldina
Departments of a Clinical Pathology and b Physical Medicine, Rheumatology and Rehabilitation,
Faculty of Medicine, Menoufia University, Menofia Governorate, Egypt
Corresponding author: Heba A. Esaily, MD, Mobile: +20 109 272 2125, ORCID: 0000-0002-8660-6817,
E-mail: hebaesaily@yahoo.com

A systemic condition with a very complex pathophysiology is rheumatoid arthritis. It has been discovered
that IL-17A has strong pro-inflammatory characteristics. Sirtuin-1 contributes to chronic inflammation, and its levels in
chronic inflammatory illnesses are still under investigations. Up to our Knowledge, the relation between such two markers
not yet studied in rheumatoid arthritis patients.
Objectives: The aim of the current study is to evaluate sirtuin-1 in rheumatoid arthritis patients and analyze the potential
association between sirtuin-1 level and serum IL-17A levels and their relations to disease activity.
Patients and methods: A cross-sectional study was conducted on 60 Rheumatoid Arthritis (RA) patients and 30 healthy
volunteers. Every participant was subjected to history taking, clinical examination, and laboratory evaluation.
Results: both IL-17A and sirtuin-1 were substantially more in RA patients and significantly correlated to most of measured
variables. IL-17A and sirtuin-1can be diagnostic indicator of RA with sensitivity (96.67% and 96.67%, respectively) and
specificity (96.67% and 86.67%, respectively) and can be indicators of high disease activity with sensitivity (90% and 80%,
respectively) and specificity (94% and 94%, respectively), while combined sirtuin-1 and IL-17A diagnostic performance
adds much to specificity to discriminate those with high active disease; Sirtuin-1 (Coefficient B= 0.249, P<0.006) and IL-
17A (Coefficient B= 0.043, P<0.012) were independent predictors of disease activity.
Conclusion: Compared to healthy individuals, RA patients had considerably greater levels of IL-17A and sirtuin-1. IL-17A
has better sensitivity and specificity than situin-1 in discriminating patients, remission and high disease activity states.
Sirtuin-1 combined with IL-17 is beneficial in improving the discriminative power for high disease activity, therefore, both
might be thought of as potential biomarkers for RA disease activity.
Keywords: IL-17A; Sirtuin-1; disease activity; rheumatoid arthritis, case control study.

Retinoic acid receptor-related orphan receptor t (RORt),
One of the most prevalent autoimmune illnesses,
a key transcription factor, is required for Th17 cell
rheumatoid arthritis (RA), affects about 1% of people
development (7).
worldwide. Systemic loss of self-tolerance and immune-
A histone deacetylase known as Sirtuin1 is
mediated inflammation are its defining characteristics (1).
involved in a variety of physiological processes, including
oxidative stress, glucose metabolism, DNA integrity,
synoviocytes (FLSs) is the pathogenic aspect of RA; they
aging, and cancer. Sirtuin1 is nicotinamide-adenine
form invasive synovial pannus, emit a number of pro-
dinucleotide (NAD)+-dependent (8). The sirtuin family of
inflammatory cytokines, and make proteases that damage
proteins includes sirtuin-1, which has the greatest
bone and cartilage (2).
molecular mass (120 kDa). SIRT-1, which has 8 introns
Macrophages, mast cells, dendritic cells (DCs), T
and 11 exons, is found on chromosome 10q21.3 (9).
cells, B cells, and fibroblast-like synoviocytes (FLSs) are
Sirtuin-1 suppression lowers the expansion of Th1,
only a few of the cell types implicated with RA (FLSs) (3).
Th17, and dendritic cells as well as the production of
Helper T cells are the most crucial immune cells in
inflammatory cytokines, matrix metalloproteinase, and
adaptive immunity and are often referred to as the "master
RORt (10). Sirtuin-1 contributes to chronic inflammation,
of immunity" since they are essential for practically all
and its protein levels in numerous chronic inflammatory
immunological responses, including those that control the
illnesses including RA are still under investigations.
actions of other lymphocytes and a large portion of the
Therefore, the aim of the current study is to evaluate
innate immune response (4).
sirtuin-1 in rheumatoid arthritis patients and analyze the
T cells are the primary source of IL-17A. IL-17, IL-
potential association between sirtuin-1 level and serum
22, and other cytokines are released by TH17. When
IL-17A levels and their relations to disease activity.
TGF-, IL-6, and IL-l are present, antigen stimulates their

differentiation from TH0, which is then blocked by IFN-
or IL-4 (5). A novel subclass of cytokines with strong pro-
The 60 rheumatoid arthritis patients who addressed the
inflammatory characteristics was founded by IL-17 (6).
Received: 01/10/2022

Accepted: 12/12/2022

Full Paper (vol.901 paper# 68)

c:\work\Jor\vol901_69 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 491-497

Red Blood Cell Distribution Width Association with Resistance to
Erythropoietin Stimulating Agents in Hemodialysis Patients
Islam Elshazly*1, Ayman Seddik1, Ahmed Samir Abo Halima2, AbdelRahman Khedr1
Departments of 1Internal Medicine and Nephrology and 2Internal Medicine and Gastroenterology,
Faculty of Medicine Ain Shams University, Egypt
*Corresponding author: Islam Omar Elshazly, Mobile: (+20)01142497699,
Email: Islam.Omar@med.asu.edu.eg, Islamomarelshazly@gmail.com


Background: Red blood cell distribution width (RDW) is a quantitative marker of heterogeneity of circulating
erythrocytes size and a marker of malnutrition, inflammation and mortality. Erythropoietin resistance index (ERI) is
considered as an effective way to check erythropoietin resistance. ERI is related to all-causes of morbidity & mortality
in hemodialysis patients. Association with aging and gender have also confirmed progressive increase in RDW with
aging and in female gender.
Objective: this study aimed to check the relation between RDW & ERI in iron replete hemodialysis patients.
Patients and methods:
89 patients matched inclusion criteria followed up for 12 months and data analyzed including
age, gender, diabetic status, serum iron, serum ferritin, red blood cell width, Erythropoietin dose per week per kg body
Patients included were 36 (40.5%) females and 53(59.5%) males with mean age of 42.7 ± 15.2 years old.
Diabetic patients were 51 (57.3%) and non-diabetic were 38 (42.7%). All patients were iron replete as per inclusion
criteria with serum ferritin 200-800 ug/dl and transferrin saturation 20-40%. Hemoglobin, RDW & ERI were repeated
at 4 checkpoints during the 12-months follow-up period. The average of all (4) readings then processed for Pearson
correlation logistic regression to identify the relation between RDW and ERI and we found linear correlation between
RDW and ERI. R-square 0.158, P-value < 0.001, this relation was independent of age, gender, hemoglobin level,
erythropoietin dose and diabetic status.
Conclusion: Our results confirmed the independent relation between RDW and resistance to erythropoietin in iron
replete hemodialysis patients.
Keywords: Red blood cell distribution width, Erythropoietin resistance index, Anemia, Hemodialysis.

causes of morbidity & mortality in maintenance
RDW is a quantitative marker of heterogeneity
hemodialysis patients (11).
of circulating erythrocytes size. It is routinely reported
Although RDW has been shown to closely
in a complete blood count and does not require an
correlate with kidney function (12-13). There is a limited
additional cost. It is measured by dividing the volume
data about RDW and other lab parameters in
of red blood cell to mean corpuscular volume (MCV)
maintenance hemodialysis patients. In this study we
and the result given as a percentage. It was used to
hypothesized a relation between RDW and ERI in
narrow the differential diagnosis of nutritional anemia
maintenance hemodialysis patients. Aim of the study
(iron, vitamin B12 and folate) in combination with
was to determine relation between RDW and ERI in
MCV (1-3).
iron replete hemodialysis patients.
RDW has been implicated as a marker of

malnutrition and inflammation. It has also been found to
be an important marker for mortality independent of
Inclusion criteria:
anemia across general population and in several
Patients undergoing hemodialysis in Ain Shams
conditions as heart failure, pulmonary embolism,
University Hospitals Outpatient dialysis facility for at
pancreatitis, sepsis, acute kidney injury and renal
least 3 months prior to study starting and having iron
transplantation but the association remains unexplained
profile within target as per KDIGO anemia management
(4-8). Association with aging and gender have also
guidelines serum Ferritin 200-800 ng/dl and transferrin
confirmed progressive increase in RDW with aging and
saturation 25-50% .
in female gender (9).

Anemia is a common complication in patients
Exclusion criteria: Patient not matching eligibility
on maintenance hemodialysis and usually it is managed
by erythropoietin (EPO) injection with good response in

most of the patients. Some do not respond well to EPO
Study design:
or need higher than average doses and this is defined as
89 patients were included as per inclusion criteria,
EPO resistance. ERI has been considered as an effective
data collected including gender, age, duration on
way to check EPO resistance (10). ERI is related to all-
dialysis, dialysis modality, iron profile (serum ferritin,
Received: 16/09/2022
Accepted: 18/11/2022

Full Paper (vol.901 paper# 69)

c:\work\Jor\vol901_70 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 498-506

Erector Spinae Plane Block: An Analgesic Technique as an Alternative to
Transversus Abdominis Plane Block in Abdominoplasty Surgery
Tamer Elmetwally Abdallah Farahat, Ayat Ebrahim Eid*, Mona Hasheesh, Hanaa M. El Bendary
Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ayat Ebrahim Eid, Mobile: (+20) 01064451903, E-Mail: ayatebrahimeid@gmail.com

Managing post abdominoplasty pain can be quite challenging. Multimodal analgesia strategies have been
used to provide maximum benefit with less side effects. Combining regional anaesthetic techniques with multiple non
opioid analgesics can provide efficient postoperative analgesia. Objective: This study aimed at comparing the analgesic
efficacy of ultrasound guided erector spinae plane block (ESPB) and ultrasound guided transversus abdominis plane
block (TAPB) in abdominoplasty surgery when given as a part of multimodal analgesic strategy.
Patients and methods: A total of 69 females ASA I & II physical status patients aged between 25 and 65 years who
were scheduled for abdominoplasty surgery under general anaesthesia were included in this study. Patients were
allocated to three groups; Control group received only standard general anaesthesia, TAPB group received standard
general anaesthesia in addition to TAPB, while ESPB group received standard general anaesthesia and ESPB. We
recorded total opioid consumption, time of first analgesic request, visual analogue score and hemodynamic changes in
first 24h postoperatively. Results: ESPB and TAPB reduced postoperative opioid consumption and prolonged time till
analgesic request than the control group. ESPB prolonged duration of analgesia and reduced postoperative heart rate,
while TAPB block was relatively easier and less time consuming.
Conclusion: ESPB and TAPB can provide considerable postoperative analgesia following abdominoplasty surgery
when being incorporated in a multimodal analgesia regimen. Therefore, we recommend using either technique to lessen
pain in patients subjected to abdominoplasty surgery.
Keywords: Erector Spinae plane block, Analgesic technique, Transversus Abdominis plane block, Abdominoplasty


Abdominoplasty is a popular body reshaping
Patients excluded from this clinical trial are those who
surgery that often results in great amount of pain. Post
have contraindications for regional anaesthesia in
abdominoplasty pain usually originates from the long
general such as patient's refusal, local skin infection at
incision and facial plication meaning it is a somatic pain
the puncture site, hematological diseases, bleeding, or
component (1). Improperly managed postoperative pain
coagulation abnormality, also patients who have
can delay patient recovery increase incidence of
psychiatric disorders and allergy to the local anesthetics
complications and delay ambulation which carries the
risk of venous thromboembolism (2).w Opioids have
Sample size calculation:
been the go-to drugs for decades, but nowadays its use
The primary outcome was the mean amount of opioids
is being devalued in consequence of its multiple side
consumed on the first postoperative day, and the sample
effects (3). Regional anaesthetic techniques is a valuable
size was calculated using the Power Analysis and
alterative that has proven its efficacy in preventing
Sample Size software programme (PASS) version
nociception following Abdominoplasty surgery (4).
15.0.5 for Windows (2017) based on earlier findings (12,
An effective face plane block known as the
13). To attain 90% power, sample sizes of 23 patients in
erector spinae plane block (ESPB) has been
each group are required (1- ).
demonstrated to do so after a variety of procedures (5).
For somatic analgesia during abdominal
procedures, the transversus abdominis plane block
Eligible 69 patients were randomly allocated by closed
(TAPB) is a well-known abdominal wall block (6).
envelop method according to the anesthetic technique
This study aimed at comparing the analgesic
used into 3 equal groups:
efficacy of ESPB and TAPB in abdominoplasty surgery
Control group (Control) (N= 23): Which received
when given as a part of multimodal analgesic strategy.
only standard general anesthesia.

Transversus abdominis plane block group (TAPB)
(N= 23): which underwent bilateral transversus
This prospective randomized controlled clinical trial
abdominis plane blockade; the total volume of local
was conducted in Mansoura University Hospitals
anaesthetic utilised was 25 ml on each side; 15 ml
(MUH) for patients subjected to abdominoplasty
of 0.5% + 5 ml of 2% lidocaine HCL plus 5 ml of
surgery. A total of 69 ASA I & II physical status
patients aged between 25 and 65 years of either sex who
Erector spinae plane block group (ESPB) (N= 23):
were scheduled for abdominoplasty surgery under
It underwent bilateral erector spinae plane blockade
general anaesthesia were included in this study.
and got a total amount of 25 ml of local anesthetic
Received: 21/09/2022
Accepted: 22/11/2022

Full Paper (vol.901 paper# 70)

c:\work\Jor\vol901_71 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 507- 517

Comparative Protective Effects of L-Ascorbic Acid and Crude Honeybee Extract
Supplements Against Toxic Effects Induced by Sodium Nitrate in Male Rats
Eman Mohamed Kamel*1, Hany Salah. Mahmoud2, Heba Nageh Gad EL-Hak3,
Heba M.A. Abdelrazek4, Noha E. Shebl5, Yousra Reda Arafa Mohamed6,
Ghada Mohamed Gad Abd Elghany3, Ranwa Ahmed Abdou Elrayess3
1Anatomy and Embryology Department, Faculty of Medicine, Suez Canal University, Egypt
2Center of Scientific Foundation for Experimental Studies and Research, Ismailia, Egypt
3Zoology Department, Faculty of Sciences, Suez Canal University, Egypt
4Physiology, 5Pathology and 6Forensic Medicine and Toxicology Departments,
Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
*Corresponding author: Eman Mohamed Kamel, Mobile: (+20) 01017209608, E-Mail: emanalshareef79@gmail.com

Sodium nitrate has been used extensively as a meat additive to keep meat products fresh. Several
strategies have been implemented in counteracting such toxicity.
Objective: The goal of the current investigation was to determine if ascorbic acid and crude honey extract can protect
male rats from the harmful biochemical and histopathological effects of sodium nitrate.
Materials and methods: 36 male Albino rats were alienated into 6 groups; control was given saline, honey group was
given (2.5g/kg/day honey, ascorbic group was given (200mg/kg /day) L-ascorbic acid, NaNO3 group was given
200mg/kg/day, honey/ NaNO3 group rats given honey and nitrate with the former doses, and Ascorbic/ NaNO3 group
was given L-ascorbic acid and NaNO3 with the former doses. Organs' relative weight, liver and kidney blood
biochemical determinants, serum tumor necrosis factor alpha (TNF-) and interleukin 6 (IL-6), histology and
histochemistry were determined.
Results: The sodium nitrate had significantly increased liver, kidney and spleen relative weights while decreased thymus
weight. Higher levels of AST, ALT, urea, creatinine, IL-6 and TNF- were observed in NaNO3 treated group. Liver,
kidney, and spleen of rats treated with NaNO3 revealed histological and histochemical alterations. The treatment with
L-ascorbic acid and crude honeybee improved the later dysfunctions with more palliative effect for L-ascorbic acid.
Conclusions: We can conclude that sodium nitrate has to be limited in use. L-ascorbic acid was therefore recommended
to be used in reducing the harmful metabolic alterations induced by sodium nitrate better than the honeybee.
Keywords: Ascorbic acid, Honey, Kidney, Liver, Sodium nitrite, Spleen.


recently been discovered to be effective antioxidants[6].
Sodium nitrate and sodium nitrite are
Ascorbic acid and honeybee are considered potent
preservatives found in treated meats like sausage,
antioxidants, they play a vital role in diminishing
bacon, and ham, as well as some cheeses [1]. Nitrate can
oxidative stress through reactions with different free
be transformed to nitrite in the food byproducts, as well
radicals and inhibition of lipid peroxides formation [7].
as in the gastrointestinal tract or mouth, both nitrate and
Ascorbic acid can enter mitochondria through
nitrite must be taken into consideration when evaluating
facilitated glucose diffusion via transporter and
any potential hazard [2].
deliberates mitochondrial shield in contradiction of
Adding nitrite and nitrate to food byproducts is
oxidative injury. Ascorbate has been concerned in
just one of the various sources of nitrogenous
various biological processes. It is considered a cofactor
compounds to which human beings are exposed.
for various enzymatic phases in the monoamines',
Smoked foods and salt-preserved fish are other sources
collagen, peptide hormones, amino acids, and carnitine
of nitrogenous compounds in the human diet[3]. It is
synthesis. Moreover, it plays a significant role in the
believed that low levels of Na nitrate consumption for
antioxidative defense at several stages [8].
long period are associated with several health problems
The honeybee is a nutrient used for centuries as
with many harmful side effects like carcinogenicity,
a disease fighter and health improver[9]. Honey consists
histopathologic tissue alterations, nitrative tissue injury,
of a mixture of carbohydrates, minerals, proteins, and
and hepatic as well as renal lipid peroxidation, as well
water [10]. It has been reported that honey has antioxidant
as encouraging chromosomal aberrations [4]. The liver,
properties as it can decrease lipid peroxidation [11]. This
kidney and spleen are one of the potential targets of
goes back to its component of flavonoids and
toxicity after exposure to Na nitrate, through induction
antioxidant trace elements [12].
of oxidative stress [5].
Ascorbic acid and Honeybee exert benefits
Animals' ability to withstand the toxic
against liver, kidney and spleen injury in experimental
influences of environmental toxicants is reliant on their
impairment by exerting anti-inflammatory and
detoxifying capability and antioxidant schemes.
antioxidant influences. Therefore, this study intended to
Vitamins, amino acids and their byproducts,
estimate the possible positive effects of ascorbic acid
trace elements, plant phenolics and fatty acids have
and honey against Na nitrate-induced liver, kidney and
Received: 22/7/2022
Accepted: 24/9/2022

Full Paper (vol.901 paper# 71)

c:\work\Jor\vol901_72 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 518-521

Epidemiological Study on Toxoplasmosis in Cat, Healthy and
Contact Human in Al-Anbar Governorate
Salaah Aldeen M. Sadeq Alkubaisi1*, Ibrahim Abdul-Hussein Swear Al-Zubaidy2
1,2College of Veterinary Medicine, Department of Public Health, Zoonotic Diseases Unite, University of Baghdad, Iraq
*Corresponding author: Salaah Aldeen M. Sadeq Alkubaisi. Mobile (+964)7707592904,
Email: salahaldeen.mohammed1204@covm.uobaghdad.edu.iq

Introduction: One of the most typical illnesses in women is toxoplasmosis, and considered a transmissible disease between
humans and animals. Cats show a major part in contributing to the spread of toxoplasma, so they stay the final host, which
shed their eggs with feces to the environment, which leads to contamination of water and food. Objective: The purpose of
the current research is to determine if keeping cats at home contributes to the spread of toxoplasmosis or not, and what is
the difference between stray and pet cats in the spread of the disease. Patients and Methods: An epidemiology research on
toxoplasmosis was undertaken in Anbar province. A total 120 human blood samples were collected from people attending
veterinary clinics in Anbar Governorate and 62 fecal samples of cats, from November 2021 to April 2022. Human's samples
were tested by Latex agglutination, while cat's samples were tested by direct detection of oocyst.
Results: The result showed that 33 of 120 (27.5%) blood sample of female human were positive by (latex test IgM, IgG)
and 87 of 120 (72.5%) were negative. These samples were divided into woman having cat (51.67%) and woman don't have
cat (48.33%). The result of cats showed oocyst (9.67%) positive result fecal samples of cats, using feces flotation method.
Conclusion: Toxoplasmosis infection does not only occur in people who own cats, because many infected people did not
have direct contact with cats, but may be infection by undercooked meat or by the soil that holds the eggs.
Keywords: Toxoplasmosis, Epidemiological Study, Human, Cats, Cross sectional study, University of Baghdad.

blood transfusions and organ replacements in
Toxoplasmosis is composed of intracellular obligate
individuals who
were 90%
protozoan organism Toxoplasma gondii (T.gondii), that
asymptomatic when they contracted toxoplasmosis (10).
able to infected people and other warm blood animals.
Symptomatic diseases commonly cause few mark fever,
Toxoplasmosis had a world-wide propagation with almost
headache, malaise, cervical Lymphadenopathy. Severe
one third of the world-wide people expected to have
and pneumonia are rare but can complicate severe (10),
infection with that organism (1). Toxoplasmosis is an
lead to death in immunocompromised patient (11).
expanded infectious disease caused by T.gondii. Human,
Diagnosis of toxoplasmosis infectivity may be recognized
veterinary, and environmental health all have economic
by serologic checks, molecular techniques, histological
value (2). Toxoplasmosis is a cause of fetus dead
validation of the parasite, a toxoplasmin skin experiment
because T.gondii can be transferred to the fetus across the
and by isolation of the parasite (12,13). Molecular
placenta (trans-placental) from an infested mother or at
techniques trust on PCR for the exclusive detection or
vaginal liberation (3).
examination of T. gondii DNA. From humans and animals
Recently, Asal revealed the highest infection rate
(14, 15). Real-time PCR remains to amplify DNA of
reported among younger animals while it was the lowest
T.gondii B1 gene (16). Real-time PCR utilizes the 59-
in older animals (4). However, Bisson et al. concluded that
nuclease activity of Taq DNA polymers (17).
health then ingesting of infected milk and meat can enable

zoonotic diffusion of toxoplasmosis has a large variation
of hosts (5), as approximately each warm-blooded
Sampling: Samples were collected from 120 female
domestic animal can be infested. Sexual reproduction of
human blood from different areas in Al-Anbar
parasite that cause by only happening cat and Felids (final
governorate (52) in Ramadi city center of Al-Anbar and
host), while asexual reproduction occurs in together final
(43) Jazert Alramadi, Falluja (19) and (6) from Heet.
and intermediate host (6,7). Oocyst remain transit in the
Serological test: The sample of all cases survived
fecal of cats and be transmissible within 21 days of
examined for the existence of exclusive IgG, IgM anti-
actuality shed. Tachyzoites escape and reproduce only in
Toxoplasma antibodies. The kit was used concurring to
an intracellular site but tissue cysts having many nor do
the company's orders but can briefly illustrated by adding
limited bradyzoites take place in the tissues of infested
50l of Toxo-latex substance was additional to 50l of
animals during a week of infectivity (8). Consumption of
blood samples on slid, mixed and revolved on involuntary
tissue cysts in infested meat or oocyst from water, food,
rotator (100 rpm) for 5 min. After mark of agglutination
or soil infective by feline feces are the two main ways of
showed mean positive sensitive. Positive and negative
diffusion (9). Rarely, T.gondii transmission occurs after
controls were involved.
Received: 02/10/2022
Accepted: 02/12/2022

Full Paper (vol.901 paper# 72)

INTRODUCTION The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 522-527

Role of 17- Estradiol and Ramipril in OPG/RANKL Pathway in a
Rat Model of Post-Menopausal Osteoporosis
Hemmat Mohamed Khloussy1, Ahmed Desouky Badawy2,
Yara Sayed Ibrahim Eldesouki Mohamed2, Muhammad Maher 1
1 Medical Physiology, Faculty of Medicine, Cairo University
2 Medical Physiology, Faculty of Medicine, October 6 University
Corresponding authors: Yara Sayed Ibrahim Eldesouki Mohamed, Mobile: (+20) 01065275241,
Email: Yara.Sayed@o6u.edu.eg

Primary osteoporosis and other metabolic bone disorders have been linked to the proteins osteoprotegerin
(OPG) and receptor activator of nuclear factor-kappa B ligand (RANKL).
Aim and objectives: Our study's goal was to examine the effects of co-administering estradiol (E2) and ramipril (ACEI)
on bone markers in ovariectomized rats and to assess the potential interactions between these medications in order to
address the function of the OPG/RANKL system as a potential mechanism of action.
Materials and methods: 40 female rats, randomly divided into 5 groups, each group included 8 rats. Group 1: Control
group (sham operated). Group 2: Ovariectomized rats (OVX). Group 3: Ovariectomized rats (OVX)+E2. Group 4:
Ovariectomized rats (OVX)+ACEI. Group 5: Ovariectomized rats (OVX)+E2+ACEI.
Results: OVX rats showed a significant decrease in serum Ca2+ and OPG levels with significant increase in serum
RANKL, osteocalcin, alkaline phosphatase activity and urinary hydroxyproline levels compared to control group.
Treatment with ramipril as well as E2 led to a significant improvement in bone markers levels with a significant increase
in serum OPG level with a significant reduction in serum RANKL level compared to OVX group.
Conclusion: Ramipril as ACEI had more significant effect on decreasing serum bone markers level than 17- estradiol
in ovariectomized rats. So, we can draw the conclusion that altering OPG/RANKL signalling may be a possible
mechanism by which E2 and ACEI prevent osteoporosis.
Keywords: 17- Estradiol; Ramipril; OPG/RANKL; Rat Model; Post-Menopausal Osteoporosis.


formation (5). One accurate measure of the differentiation
Osteoporosis, a systemic skeletal disorder
status of the osteoblast and osteoclast is the
characterised by decreasing bone mass, is one of the
most significant issues impacting postmenopausal
system has been related to a range of skeletal and immune-
women, deteriorated bone tissue, and increased fragility
mediated illnesses, including numerous types of
and fracture susceptibility (1).
osteoporosis, which are characterised by accelerated bone
Bone is a dynamic tissue that undergoes ongoing
resorption and bone loss (postmenopausal, glucocorticoid-
remodelling as a way to integrate external chemical,
induced, and senile osteoporosis (6).
hormonal, and biomechanical cues as well as its own
In order to assess the potential effects of ramipril
internal mechanism for self-regeneration. At the cellular
(ACEI) and estradiol on bone markers in oestrogen
level, bone remodelling occurs in a series of recurrent
deficiency-induced bone loss in ovariectomized rats,
cycles of bone production by osteoblasts, which are
our study set out to compare the two drugs, to discuss
descended from pluripotent mesenchymal stem cells,
the role of OPG/RANKL system as a possible
and bone resorption by osteoclasts, which are derived
mechanism of action, also to compare the effect of co-
from the monocytic/macrophagic lineage (2).
administration of estradiol and ramipril on bone
The majority of metabolic bone illnesses are
markers in ovariectomized rat.
brought on by disturbances in osteoclast quantity or

activity, which lead to abnormally high levels of bone
resorption that are greater than osteoblasts' ability for
The goal of the current investigation was to assess the
compensation (3). The most common option for
potential effects of ramipril (ACEI) and estradiol on
simulating some of the most crucial clinical aspects of
bone markers in rats with estrogen deficiency-induced
postmenopausal bone loss is the ovariectomized (OVX)
bone loss as well as to discuss the potential relevance of
rat model (4).
the OPG/RANKL ratio as a mechanism of action.
It's well known that the estrogen exerts a direct

protective effect on the bone through its receptors; it
Ethical consideration:
decreases the rate of production of osteoclasts, their
The experimental techniques and animal care were
activity and their survival and exerts an anabolic effect
approved by Institutional Review Boards (IRB) at
on osteoblasts. Additionally, oestrogen is known to
Faculty of Medicine's Research Ethics Committee,
control the development and activity of various pro-
Cairo University. Code: MD- 252-2020. Rats were
inflammatory cytokines, including RANKL, which has
handled according to National Institutes of Health
been shown to increase bone resorption and limit bone
(NIH) guidelines for animal experimentation. This work
Received: 19/07/2022
Accepted: 21/10/2022

Full Paper (vol.901 paper# 73)

c:\work\Jor\vol901_74 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 89 (2), Page 528-535

Quality of Life in Rheumatoid Arthritis: Influence of Personality Traits and
Disease Related Variables. An Egyptian Study
Abeer Allam a, Heba A Esaily b, Eman G. Saleh a
Departments of a Neuropsychiatry, and b Physical Medicine, Rheumatology and Rehabilitation,
Faculty of Medicine, Menoufia University, Menofia Governorate, Egypt
Corresponding author: Heba A. Esaily, MD, e-mail: hebaesaily@yahoo.com
Mobile: +20 109 272 2125, ORCID ID: https://orcid.org/0000-0002-8660-6817

Quality of life (QoL) in rheumatoid arthritis patients may be greatly affected by their personality, which
shape their perception of illness, their attitude, and behavior. Up to our knowledge, none has discussed personality traits
in Egyptian RA patients.
Objectives: To study personality traits in Egyptian RA patients and its impact on health-related quality of life together
with its relation to severity of illness.
Methods: A cross-sectional study was conducted on 150 Rheumatoid arthritis female patients and 50 healthy
voluntaries. All participants completed the following: socio-demographics, SF-36, Eysenck personality questionnaire,
hospital anxiety and depression scale, DAS-28, Pain VAS, and laboratory investigations.
Results: Neuroticism traits were substantially more in RA patients and significantly correlated to most of measured
variables. QoL deteriorated in RA patients. Pain severity (coefficient B= -0.31, p 0.002) and depression severity
(coefficient B= -0.25, p 0.01) were an independent negative predictor of life quality related to physical health, followed
by higher disease activity (coefficient B= -0.20, p 0.02), disease span (coefficient B= -0.19, p 0.02). Depression was an
independent negative predictor of quality of life related to mental health (coefficient B=-0.42, p< 0.001) followed by
anxiety (coefficient B=-0.38, p< 0.001), then disease span (coefficient B=-0.17, p 0.03) and Pain severity (coefficient
B=-0.34, p0.04)
Conclusion: Personality traits specially neuroticism was significantly correlated with most of measured variables and
affect QoL in Egyptian RA patients, indirectly.
Anxiety, Depression, Personality traits, Quality of life, Rheumatoid arthritis.


impact on health-related quality of life together with its
The autoimmune disorder rheumatoid
relation to severity of illness.
arthritis (RA), is one of the most prevalent conditions.

Prevalence of RA ranges from 0.6 to 1.3 % based on
data of World Health Organization (WHO) records. It
The study enrolled 150 patients in a cross-
causes severe limitations in patients' life despite many
sectional design (both sexes, ages from 20 to 50 years).
advances in its treatment. Higher rates of disability were
They were diagnosed with RA using the 2010
found to be related to older age, female sex and higher
ACR/EULAR indicators of classification (8). Patients
disease activity variables (1). Impairments in HR-QoL in
RA have been reported (2). QoL greatly influenced by
Rheumatology, and Rehabilitation department's
personality traits as evaluation of HR-QoL items
Outpatient Clinic at Menoufia University Hospital
depends on subjective assessment of its items (3).
between July 2019 and February 2020. As a control
Neuroticism subtype of personality traits in RA patients
group, 50 healthy volunteers with similar ages were
was found to contribute to their psychological distress
even to their disease adjustment (4).

Depression rates in RA ranges from 13% to
Exclusion criteria: Patients who were uncooperative
20% and even above. Studies that used self-report
for psychiatric evaluation, or with positive history of
measurement gives higher rates of depression despite
psychiatric disorders or receiving psychotropic
symptomatology levels is subclinical (5). In a
medication. Also, patients with any other physical
longitudinal study, depression risk in RA was found to
illness, or with extra-articular manifestations were
be 40% over 9 years. Depression occurrence in RA
patients found to be related to pain, fatigue, more

disease activity, greater use of health services, more
Socio-demographic information were gathered.
work disability even to higher suicidal risk and
The Disease Activity Score (DAS-28) was employed
mortality (6). Higher levels of anxiety (21% to 70%)
to evaluate the illness severity. It included the first hour
were also reported in previous studies (7). Up to our
Erythrocyte Sedimentation Rate (ESR), joint swelling
Knowledge, none has discussed personality traits in
and tender counts, and personal evaluation of patients
Egyptian RA patients. Thus, the aim of this work was to
on a visual analogue scale. The total DAS-28 score was
study personality traits in Egyptian RA patients and its
computed using the standard method. RF titre was

obtained using the latex agglutination method (RF
Received: 25/09/2022
Accepted: 10/12/2022

Full Paper (vol.901 paper# 74)

c:\work\Jor\vol901_75 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 536-541

Prevalence of Covid-19 Vaccine Hesitancy among Chronically-ill
Egyptian Patients in Tertiary Care Centers
*Hend A Elsheimy1, Ahmed Yamany Ali1, Rajia A Tawfik2, Farah M Ezzat2, Abeer Attia3, Shereen Esmat3
1 Internal Medicine Department, 2House Officers, 3 Public Health and Community Medicine Department, Faculty of
Medicine, Cairo University, Cairo, Egypt
*Corresponding author: Hend A Elsheimy, Email: hendaelshemy@gmail.com,
Mobile: +201091648680, https://orcid.org/0000-0001-8790-9804

COVID-19 caused a high level of morbidity and mortality. All age groups are at risk to acquire infection,
especially chronically-ill patients; however, there is a hesitancy toward vaccines among them.
Aim of the work: The study aims to assess the prevalence of Covid-19 vaccine hesitancy and to identify the underlying
factors among chronically-ill patients. Methods: An analytical cross-sectional study was conducted at the outpatient
clinics of the Internal Medicine Department at Kasr Al-Ainy Medical school. A self-administered Arabic questionnaire
was distributed by the researchers to the patients surveying the acceptance rate of vaccination.
Results: A total of 587 participants ruled in the study, and their response rate was 78.2 %. The prevalence of COVID-
19 Vaccine hesitancy was 29.8%, and the main underlying causes of vaccine hesitancy were fear of the complications
of vaccination and fear of the deterioration of chronic diseases (36.4% & 25.5 %) respectively. A statistical significance
was detected between vaccine hesitancy and many factors such as (gender, educational level, smoking status, type of
chronic disease, and attitude toward the safety of vaccine) P 0.001. Multiple logistic regression models yielded that
significant predictors for vaccine hesitancy were females (OR 2.119), Illiterate (OR 1.73), not working in medical field
(OR 2.311), using sources of knowledge other than Ministry of Health Website (OR 3.716), non Hypertensive (OR
1.45), having autoimmune diseases (OR1.68).
Conclusions: Relatively significant Covid-19 vaccine hesitancy among chronically-ill patients is influenced by gender,
educational level, smoking status, attitude toward safety of vaccine, and source of knowledge regarding the vaccine.
Keywords: COVID-19, Vaccine hesitancy, Chronically-ill, Morbidity, Mortality


influenced by the perceived threat of this pandemic,
The COVID-19 pandemic has been a major public
perceived benefits, barriers to vaccination, presence of
health problem all over the world since 2020 as it causes
comorbidities, and low educational level (18,19,20).
high-risk morbidities and mortalities (1,2,3). All age
It was also reported that chronic patients have a high
groups are at risk for infection, however, chronically ill
hesitancy regarding the vaccine in lower-income
patients are five times more likely to acquire infection
countries which may be related to a lack of
and develop more serious complications (4,5).
communication and false information regarding the

vaccine (21,22).
Since the emergence of the pandemic, no definite

treatment has been identified (6), which mandated that
There is a paucity of studies that assess vaccine
global health organizations find a way to prevent and
hesitancy among chronically ill patients in Egypt. So the
protect from such a disease. In this context, many
study aims to identify the acceptance degree towards
vaccines have been developed (7).
COVID-19 vaccination and underlying factors for

vaccine hesitancy among chronically ill patients.
Vaccination is considered one of the best preventive

measures to control infectious diseases (8), also
vaccination reduces the transmission of infection among
Study design and allocation:
people. So, it was declared that vaccination plays a role
The study is an analytical cross-sectional study that
in controlling the spread of the disease (9,10,11). Many
was implemented among chronically ill patients
types of vaccines against (SARS-CoV-2) have been
attending outpatient clinics and /or admitted to the
developed and distributed to reduce the risk of infection
Internal Medicine wards, of Kasr Al Aini Hospital,
with COVID-19 (12,13 ).
Cairo, Egypt.

All patients suffering from chronic illness such as
The acceptance rate of vaccination against COVID-19
diabetes mellitus, hypertension, chronic kidney, chronic
is variable from one country to another. Whilst most
rheumatic, autoimmune, or respiratory diseases, and
developed countries have an impacted response to the
also those who have concurrent malignancy whether
vaccination (14,15), in Egypt, there is still a lack of
catching COVID-19 infection or not, were included in
accomplishment of across-country vaccination.
the study.
Overall the acceptance rate of vaccination has been
Those who refused participation were ruled out.
estimated to be very low in Africa. (16,17) This might be

attributed to the individual's behavior which is

Received: 08/08/2022
Accepted: 09/12/2022

Full Paper (vol.901 paper# 75)

c:\work\Jor\vol901_76 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 542-546

Laparoscopic Cholecystectomy within 24 Hours Following Endoscopic Retrograde
Cholangiography as a Good Option for the Treatment of Cholecysto-Choledocholithiasis
Ibrahim Sabry Bakr 1*, Ahmed Alwaseif 2, Alshimaa Alaboudy 3, and Yasser Hussein Metwally 1
1. Assistant Professor of General Surgery, Faculty of Medicine, Al-Azhar University, Egypt
2. Consultant of Gastroenterology, Sultan Qaboos University Hospital, Muscat, Oman
3. Lecturer of Tropical Medicine and Gastroenterology, Sohag University, Sohag, Egypt
Corresponding author: Ibrahim Sabry Bakr, Mobile: +966566454748,
ORCID: 0000-0001-7226-3684, Email: Isb11117777@gmail.com

Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC)
is a preferred treatment option for combined cholelithiasis and choledocholithiasis. Numerous studies have investigated the
optimal timing of LC after ERCP, which can be early (within 72 hours) or delayed for 6 to 8 weeks.
Objective: The aim of the current study is to evaluate the laparoscopic cholecystectomy within 24 hours following ERCP,
as an option for the treatment of cholecysto-choledocholithiasis.
Patients and methods: A total of 200 consecutive patients with combined cholelithiasis and choledocholithiasis, diagnosed
by abdominal ultrasonography and magnetic resonance cholangiopancreatography, were included in our study. All patients
underwent therapeutic ERCP, with sphincterotomy and stone extraction, followed by LC within 24 hours. The post-ERCP
complications, the operative time, intraoperative blood loss, intraoperative severity of gall bladder adhesion, postoperative
complications, and hospital stay were recorded and studied.
: Among the 200 patients included, their mean age was 34 years. Of them 120 (60%) were females. Only 60 (30%)
patients originally presented with biliary pancreatitis. Post-ERCP pancreatitis was recorded in 20 (10%) patients. The mean
duration of laparoscopic cholecystectomy was 40 minutes (range 30-60) with minimal blood loss. Moderate to severe gall
bladder adhesion was detected in 60 (30%) patients. In addition, intraoperative moderate to severe cholecystitis was
detected in 80 (40%) patients. The post-cholecystectomy complications included ileus (N=10; 5%) and superficial wound
sepsis (N=8; 4%). The mean hospital stay was 4 days (range 3-5).
ERCP followed within 24 hours by laparoscopic cholecystectomy appears to be an effective choice for treating
ERCP, CBD stone, Laparoscopic cholecystectomy, Choledocholithiasis, Cholecystolithiasis, Case series, Al-
Azhar University.

early LC after ERCP, can reduce recurrent biliary
Gallbladder stone is one of the most common diseases
complications and post-LC complications [6].
worldwide. It is commonly seen in middle-aged females.
The timing between the ERCP and LC, as well as the
It is the main cause of at least one million hospitalizations
order in which the two procedures should be performed,
[1]. Despite the low mortality rate (0.6%) associated with
is debatable. Liu et al. advocated that ERCP should be
this disease, there are a variety of complications that may
followed immediately by LC. The majority of biliary
arise from it. Concomitant bile duct stone occurs in 10­
occurrences in the interval following ERCP may be
18% of patients with gallbladder stones and varies
avoided by early LC, according to their findings and early
according to age. About 55% of patients are symptomatic,
LC appears to be generally safe [7]. Yet, other studies
and half of those experience complications [2]. Many
favor delayed LC [8].
treatment options are currently available for combined
In the current study, we aimed to evaluate the LC within
cholelithiasis and Choledocholithiasis. This included
cholangiopancreatography (ERCP), as a treatment option
(ERCP) followed by laparoscopic cholecystectomy (LC),
for cholecysto-choledocholithiasis.
LC with intraoperative ERCP, laparoscopic common bile

duct exploration, and open common bile duct exploration.
Among those treatment options, ERCP followed by LC
A total 250 consecutive patients with combined
appears to be the safest and the least invasive [3,4].
cholelithiasis and choledocholithiasis were studied. This
Manes et al. mentioned that there is a 4% to 24% risk of
study was conducted at Al-Dar Private Hospital in Saudi
biliary complications following ERCP if the LC is not
Arabia, from January 2013 to January 2020. All patients
performed early after the surgery. Additionally, they
underwent full clinical assessment, full laboratory
noted that LC difficulties and the rate at which
investigations, and abdominal ultrasonography. In
laparoscopic cholecystectomies are converted to open
patients with doubtful etiology of CBD dilatation CT
procedures both increased after a 6- to 8-week post-ERCP
and/or MRCP were done mainly to roll out malignancy.
interval [5]. On the other hand, it had been advocated that
Received: 20/09/2022
Accepted: 20/10/2022

Full Paper (vol.901 paper# 76)

c:\work\Jor\vol901_77 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 547-554

Silent Brain Changes in Children with Sickle Cell Disease
Al Shaimaa Mahfouz Abdel Rahman1, Tamer Elzaeem Ismail1,
Mohamed Hashim2, Ebtihal Mokhtar2, Mohammad Fouad Abdel-Baki Allam1
Departments of 1Diagnostic Radiology and 2Pediatric, Faculty of Medicine, Minia University, Egypt
*Corresponding author: Mohammad Fouad Abdel-Baki Allam, Mobile: (+20) 201005695624, E-Mail: mfallam@mu.edu.eg

Cerebrovascular steno-occlusive disease constitutes one of the most dangerous complications of sickle cell
disease (SCD). It could result in overt or silent cerebral infarctions (SCI).
The aim of this study was to demonstrate silent parenchymal and vascular brain changes that are incidentally
observed in neurologically free SCD children using screening MRI and MRA.
Patients and methods: This prospective cross-sectional study was conducted on 78 children diagnosed with SCD who
were neurologically free. Magnetic resonance imaging (MRI) and Magnetic Resonance Angiography (MRA) were done to
all the participant children. Results: Thirty (38.4%) of our children demonstrated pathologic parenchymal features on their
MRI. There were 29 (37.17%) patients had pathologic changes in MRA; 6 of them had isolated vascular abnormality,
whereas the remaining patients had concurrent parenchymal abnormalities. There was significant high positive correlation
between low hemoglobin and presence of silent cerebral infarction (SCI). Moya-moya vasculopathy showed significant
positive correlation with arterial occlusion and old SCI. HB SS phenotype was significantly correlated with moya-moya
vasculopathy, arterial occlusion and old SCI. Conclusions: Silent cerebral and cerebrovascular changes in SCD children
are frequent abnormalities requiring utilization of MRI and MRA to find out their exact prevalence and their risk factors.
Keywords: Sickle cell disease, Silent brain infarction, Moya-moya vasculopathy, Screening MRI, Screening MRA.


Sickle cell disease (SCD) is an inherited
incidentally or through screening magnetic resonance
haemoglobinopathy, which is a severe monogenic
imaging (MRI). Furthermore, cerebrovascular steno-
condition that affects millions of people worldwide, and
occlusive disease could result in moya-moya
characterized by formation of abnormal hemoglobin
vasculopathy, which could be considered as another
called Hb S, repeated cycles of sickling and unsickling,
silent change developed when the arterial narrowing
multiple episodes of vascular obstruction, and hemolytic
occurs over a long period of time allowing for formation
anemia (1). During sickling process, interaction between
of collateral pathways (6, 9). The aim of our study was to
the rigid sickle cells and the vascular wall leads to,
screen silent parenchymal and vascular brain changes in
intravascular thrombosis and subsequent end-organ
neurologically free children diagnosed with SCD using
ischemia (1, 2). Stroke caused by vaso-occlusion is a
MRI and MRA.
major complication of SCD. Its risk is greatest early in
childhood during the first decade and is most significant
This was a prospective cross-sectional study
at the age of two to five years. Children with sickling are
that was conducted from May 2022 to November 2022
more susceptible to have stroke 250 times than for those
after being ethically approved by the institution
without SCD (3). Silent cerebral infarction (SCI) could be
committee (Approval no: 512/2022).
seen in some cases, which often go unnoticed but may
cause significant neurological damage and disability up
Study participants
to 17% to 25% of SCD patients (4).
Seventy-eight children diagnosed with SCD
Silent stroke is much more common than
were included in the study, all of them had regular
manifested one, which has declined in the last decade
follow ups in the Pediatric Hematology Outpatient's
with the use of chronic transfusion therapy and
Clinic, Minia University Children Hospital, Egypt. All
transcranial Doppler (TCD) ultrasonography (5, 6). It is
patients underwent thorough medical history tacking,
believed that SCI may increase the risk of overt stroke.
complete clinical and neurologic examination as well as
In brief, the major hypothesis is that prophylactic blood
laboratory tests including CBC, differential white blood
transfusion therapy in children with SCD with silent
cell count, serum ferritin, and renal function tests. MRI
cerebral infarcts will result in at least 86% reduction in
and MRA were done to all the participant children.
the rate of subsequent overt strokes or new or enlarging
Informed written consent was obtained from the parents
cerebral infarcts as defined by MRI of the brain (6-8).
of each patient prior to participating in the study.
By definition, SCIs are clinically silent, they
Inclusion criteria: SCD children below 18 years who
have normal neurologic examination and, in some cases,
were neurologically free with no history of neurological
normal TCD study, subsequently. SCI are identified
Received: 21/07/2022
Accepted: 23/09/2022

Full Paper (vol.901 paper# 77)

c:\work\Jor\vol901_78 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 555-560

Correlation of Retinal Sensitivity in Psoriasis and Psoriatic Arthritis with
Tumour Necrosis Factor Alpha and Pigmented Epithelium Derived Factor
Ghada A. Abd El-Aziz1, Sawsan A. Shalaby2, Amal A. Morsy3, Naglaa A. Ahmed 4,
Marwa S. Mahmoud5, Eman M. El Mahdy6, Jihan A. Mohamed7*
1,4.5,6 Department of Dermatology, 2,7 Department of Ophthalmology,
3Department of clinical Pathology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
* Corresponding author: Jihan A. Mohamed, Mobile: (+20)1005282408, E-mail: Jihan.Abdallah@azhar.edu.eg

Early recognition is crucial because the natural course of psoriasis (Ps) may result in vision loss. Psoriatic
arthritis (PsA) patients with ophthalmological manifestations of psoriasis (Ps) account for 30% of cases. Assessment of
visual functions and correlation with blood levels of tumour necrosis factor-alpha (TNF- ) and pigmented epithelium
derived factor (PEDF) were the study's main goals in Ps and PsA patients.
to assess visual functions in Ps and PsA patients and correlate them with serum levels of tumour necrosis
factor-alpha (TNF-) and Pigmented Epithelium Derived Factor (PEDF).
Subjects &Methods: This case-control study involved 60 Ps patients, 30 of whom had Ps without arthritis and 30 of
whom had PsA, 30 age and sex-matched healthy individuals were included, representing the control group. Serum levels
of both TNF- and PEDF were measured by enzyme-linked immune sorbent assay and complete ophthalmological
examination of the anterior and posterior segment by slit-lamp Biomicroscopy, best corrected visual acuity, intraocular
pressure, and visual field using automated perimetry.
Results: Visual affection in PsA patients was affected more than psoriatic patients with positive correlation with serum
TNF- level and negative correlation with PDF. High statistically significant increase in serum TNF- level with the
severity of both Ps and PsA P= 0.000. Also, high statistically significant increase in mean deviation (MD) and increase
the negativity of PSD. High statistically significant increase in TNF and decrease in PEDF levels were found between
patients and control (p = 0.001) with a higher significant difference (p =0.000) in PsA patients
Conclusion: To prevent vision impairment, patients with Ps and PsA should receive routine ophthalmological tests to
evaluate their visual functions and spot potential ocular involvement.
Keywords: Visual affection, Ps Vulgaris, Psoriatic Arthritis, TNF-, PEDF.


In particular, ocular manifestations of psoriasis,
This case-control study included 60 patients (30
which is an immune-mediated, chronic inflammatory
patients with Ps Vulgaris) and the patient group (which
disease with genetic underpinnings, have been noted.
included 30 people with psoriatic arthropathy) was
These manifestations include reduced retinal
chosen. A control group of 30 healthy people who were
sensitivity, retinal disorders, blepharitis, dry eye,
matched for age and sex was also included. The study
conjunctivitis, keratitis, uveitis, and birdshot
was conducted between January 2020 and January
chorioretinopathy (1). The severity of Ps vulgaris has an
2022, all patients were drawn from Al-Zahraa
impact on the retinal sensitivity (2).
University Hospital's Outpatient Clinic.
TNF- is essential for a healthy immune response.

The immune system can be activated to regulate by
Inclusion criteria: This study included patients with Ps
TNF-, but excessive or improper TNF- production
Vulgaris and PsA who were diagnosed using the
can be damaging and can result in Ps and PsA (3). Bone
CASPAR criteria for PsA and were aged from 20 to 50
increasing the frequency of osteoclast precursor cells
Exclusion criteria: Other autoimmune diseases such
and upregulating receptor activator of nuclear factor
systemic lupus erythematosus, rheumatic, high uric
kappa-B ligand (RANKL) in synovial tissue, which
acid, vasculitis, neurological diseases, and space-
causes increased bone resorption. TNF- is a dominant
occupying lesions). Systemic or ocular disease,
cytokine in PsA (4).
hypertension, diabetes mellitus, and other autoimmune
One of the most prevalent adipokines, PEDF is
diseases. Color vision issues, cataracts, uveitis, the use
found in a variety of human tissues (5).
of systemic topical retinoic acid or immunosuppressive
It is a secreted protein with multiple activities,
medications, and UV therapy. Optic neuropathy, high
including anti-angiogenic, anti-metastatic, anti-
refractive errors, glaucoma, retinal detachment, retinal
inflammatory, antioxidative, and neurotrophic. It has
pigment changes, and active or past retinol choroiditis.
primarily been investigated in the eye, where disorders

like age-related macular degeneration and diabetic
Ocular examination: Best corrected visual acuity
retinopathy cause changes in its levels there (6).
(BCVA) at a distance using Landolt's C chart and

assessment of the refractive status using an auto
Received: 18/07/2022
Accepted: 20/09/2022

Full Paper (vol.901 paper# 78)

c:\work\Jor\vol901_79 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 561-568

Association of GATA3 Rs3824662 Gene Polymorphism with Response to
Induction Therapy in Acute Lymphoblastic Leukemia
Amna Muhammed Salih 1, Jaffar Nouri Jaffar Alalsaidissa 2
1 Ibn Al-Bitar Center for Cardiac Surgery, Baghdad, Iraq
2 Department of Pathology and Forensic Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
Corresponding Author: Amna Muhammed Salih, Email:amnamuhammed485@gmail.com, Mobile: 07814957600

The malignant transformation and multiplication of lymphoid precursor cells in the bone marrow, blood,
and extramedullary tissues is known as acute lymphoblastic leukemia. ALL susceptibility has been linked to the GATA3
SNP rs3824662. Numerous studies have found a link between the rs3824662 risk allele and a worse prognosis and
Aim: To evaluate the frequency of GATA3 gene single nucleotide polymorphism (SNP rs3824662) in newly diagnosed
Iraqi patients with acute lymphoblastic leukemia and its correlation to response to induction therapy.
Patients and methods: A cross-sectional study was conducted on 53 patients (33 adult and 20 pediatric patients) with
newly diagnosed acute lymphoblastic leukemia. Sanger sequencing polymerase chain reaction-based techniques have
been employed by us to enable the detection of GATA3 rs3824662 gene polymorphism.
Results: For the adult group genotype frequency of GATA3 rs3824662 wild type (CC) was 19 (57.6%) of patients, and
heterozygous state (CA) genotype was detected in 14 (42.4%) of patients while the homozygous state (AA) genotype
was not detected in the adult group of this study. In the pediatric group of ALL patients wild type (CC) was detected in
11 (55%) of patients, the heterozygous state (CA) genotype was present in 6 (30%) of patients, while the homozygous
state (AA) genotype was detected in 3(15% ) of patients. There was no significant association between the GATA3
rs3824662 genotype and response to induction therapy, p-value = 0.54.
Conclusion: The GATA3 rs3824662 AA genotype and A allele could be risk factors for childhood and adult acute
lymphoblastic leukemia. There was a nonsignificant association between the GATA3 rs3824662 genotype and response
to induction therapy
Keywords: GATA3 rs3824662, Acute lymphoblastic leukemia, Single nucleotide polymorphism.


Acute lymphoblastic leukemia (ALL) is a clonal
T cells. The thymus's functions in the CD4 versus CD8
hemopoietic stem cell condition that is defined by the
lineage option and at the - selection checkpoint during
growth of blasts with little to no differentiation, which
T-cell development are best understood (5). Early B-cell
are typically B-cell or T-cell precursors. Assessing
commitment requires transcriptional regulation of
disease prognosis and choosing current and better
GATA3, a crucial early regulator of innate lymphoid
treatments to require an understanding of blast lineage
cells (6).
GATA3, which has been demonstrated to be
It was characterized by somatically acquired
expressed in multipotent hematopoietic stem cells,
genomic alterations, but research over the past ten years
regulates the equilibrium between self-renewal and
has revealed that genetic polymorphisms that are
differentiation in hematopoietic stem cells (HSCs) (7,8).
inherited (germline) have a significant role in the

variability in susceptibility between patients to ALL,
drug action, and side effects of treatment. Germline

variants strongly linked to ALL susceptibility have been
A cross-sectional study was done on 53 patients
discovered using genome-wide association studies(
(33 adult and 20 pediatric patients) who are newly
GWAS), which has led to a new understanding of the
diagnosed with acute lymphoblastic leukemia. The
driving forces behind leukemogenesis and evidence of
collection period was from December 2021 to May
the intricate correlation between inherited and acquired
2022. The patients were seen and followed up in the
genetic variants in ALL (2).
Hematology Unit at Baghdad Medical City and Central
The GATA3 gene is situated at location p14, close
child's hospital.
to the end of the short arm of chromosome 10. The
For each patient, a questionnaire form was done
GATA3 SNP rs3824662 corresponds to 10p14 and is
including the patient's general information, past and
located in intron 3 of the transcription factor (3). A
recent medical history, and results of blood and flow
transcription factor required for early T-cell
cytometry tests.
development and lymphoid cell lineage commitment is
Bone marrow and peripheral blood were used to
encoded by GATA3 (4).
monitor patients following the induction therapy to see
GATA3 has been referred to as a vital regulator
their response to treatment.
of T-helper 2 (Th2) cell development in matured CD4+

Received: 05/12/2022
Accepted: 07/12/2022

Full Paper (vol.901 paper# 79)

c:\work\Jor\vol901_80 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 569-574

Ratio of Tricuspid Annular Plane Systolic Excursion to Systolic Pulmonary
Artery Pressure in Patients with Heart Failure with Preserved Ejection Fraction
Ragab A Mahfouz, Haitem Najmeddein Ali, Alaa Salama, Mohamed Salah Abdelbasit*
Cardiology Department, Faculty of Medicine, Zagazig University, Egypt
*Correspondence author: Mohamed Salah Abdelbasit, Mobile: +2 01092791494, Email: msa_20122002@yahoo.com


Background: Tricuspid annular plane systolic excursion (TAPSE) connected to pulmonary artery systolic pressure
(PASP) may enhance prognosis in heart failure with an adequate ejection fraction.
Objective: The aim of the current study is to evaluate the applicability of TAPSE in cases with heart failure and
preserved ejection fraction (HFpEF), which is indexed to PASP.
Patients and methods: The present study included 75 patients with HFpEF. They were divided into 2 groups depend
on the results of 6-minute walking test. Group I included 49 patients with good exercise tolerance and Group II included
36 patients with reduced exercise tolerance.
Results: The TAPSE/PASP ratio has a sensitivity of 83.5% and a specificity of 79.3% for detecting individuals with
reduced exercise intolerance, with an area under the curve (AUC) of 0.834 (95%CI: 0.753-0.916, P <0.001).
Conclusion: A relevant clinical indicator of the length/force relation may be the correlation between longitudinal RV
fibre shortening (TAPSE) and developed pressure (PASP), and the ratio of 2 variables may be more reliable than either
of the two measures alone in predicting the severity of disease.
Keywords: TAPSE, Right ventricular function, Heart failure, Case control study, Zagazig University.


A crucial indicator of prognosis for certain
A cross-sectional study was conducted at
cardiovascular diseases, right ventricular (RV)
Cardiology Department, Zagazig University Hospital,
malfunction is one of the heart failures that include the
from Heart Failure Clinic. Included patients were
left side. Maladaptive RV remodel ing is connected to
diagnosed with HFpEF (EF more than 50%, Symptoms
RV myocardial dilatation, sarcomere changes, fibrosis,
of HF, Signs of HF, Evidence of diastolic dysfunction)
capil ary rarefication, and metabolic problems, is a
and functioning classes I through III of the New York
common complication of ischemia and non-ischemic
Heart Association (NYHA) were included.
cardiomyopathy. These alterations result in right side
Cases with greater mild mitral regurgitation, severe
heart failure (HF) and progressive RV dysfunction (1).
arrhythmias, limited physical activity caused by

conditions other than cardiac symptoms, such as
With rising prevalence and morbidity, on a global
arthritis, and those with clinical signs of cardiac
level, a significant public health issue is HFpEF.
decompensation were excluded from the study.
Despite the fact that modern medicinal methods have
Every patient had a thorough medical history
increased life quality, mortality rates are stil high (2).
Determinants of functional ability in individuals with
review and physical assessment. Thereafter, laboratory
tests included lipid profile, kidney profile, hemoglobin,
HFpEF have not been thoroughly studied. The 6-minute
fasting blood glucose levels, brain natriuretic peptide.
walk test (6-MWT) has been utilized to objectively
Al patients underwent standard 12-lead ECG
assess activity ability in the context of HF. For
recordings during both rest and stress.
echocardiographic indicators indicated limited exercise
Echocardiography was performed for al
ability; however, none of these markers are related to
participants: The apical 2 and 4 chamber photos were
functional ability in people with HFpEF (3).
utilised to determine the LV volumes and EF utilizing a

modified Simpson's technique. The M-mode cursor was
People with HF and reduced left ventricular (LV)
placed at the lateral, septal, and tricuspid ring angles to
ejection fraction (HFrEF) as wel as those with HF and
track the movement of the ventricles along their long
retained LV ejection fraction (HFpEF) have revealed
axis. Like I said previously, peaks from the inside to the
that the TAPSE/PASP ratios can predict serious adverse
outside were used to calculate the long axis motion's
outcomes (4).
overal amplitude (5). The M-mode cursor was put at the

position of the aortic valve leaflets to estimate the left
The aim of the current study is to evaluate the
atrial diameter from recordings of the aortic root.
applicability of TAPSE in cases with heart failure and
Area-length measurements of LA volumes were
preserved ejection fraction (HFpEF), which is indexed
made from the apical four chamber images. Left atrial
to PASP.
maximal volume (LAV max) and left atrial minimal

volume (LAV min) were assessed at the conclusion of
Received: 20/10/2022
Accepted: 20/12/2022

Full Paper (vol.901 paper# 80)

c:\work\Jor\vol901_81 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 575-584

Impact of Home-Based Self-Isolation Abiding on Outcome of
COVID-19 Patients: An Exploratory Study in Egypt
Eman Hany Elsebaie1, Amany Ahmed Salem1, Mennatallah Said Hosney Shehata1,
Mohamed Tharwat Hegazy2, Ibrahim Naguib El Ebrashi3, Ahmed Sayed Kotb3,
Mariam Amr Amin3, Yousra Elsayed Diab3, Fady Nagy3, Sobhi Eid Rizk3, Christina Samir Ragheb3,
Alaa Abdallah Salah3, Hadeel Abd El Wahab4, Maha Hossam Al-Din Ibrahim3, Mohamed Abdelkader Morad5
1Public Health & Community Medicine Department, 2 Rheumatology and Clinical Immunology Unit, Internal Medicine
Department, 3 Internal Medicine Department, 4 Department of Chest diseases, 5 Clinical Haematology Unit, Internal
Medicine Department, Kasr Alainy, Faculty of Medicine, Cairo University, Cairo, Egypt
Corresponding author: Eman Hany Ahmed Elsebaie Email: eman.elsebaei@kasralainy.edu.eg Tel: 01005645129

The ongoing Coronavirus Disease 19 (COVID-19) pandemic has caused an increased burden on healthcare
organizations and public health resources.
Objective: This study aimed to examine the potential impact of home-based self-isolation on health-related outcomes of
patients suffering from COVID-19, to assess patients' and household contacts' compliance to physicians' instructions while
isolated at home, and to explore predictors affecting home-based self-isolation compliance.
Methods: A cross-sectional analytical study of 393 mild/moderate adult cases of COVID-19 patients referred to home
isolation by Cairo University Hospital through the period from June 1st to September 30, 2020.
Results: The proportion of patients admitted to the hospital while isolated at home was 76 (19.3%). When examining the
factors contributing to hospital admission among the home isolation instructions measures, we found that 74.5% of those
who abide by the home isolation rules were not hospitalized compared to 25.5% hospitalized (P-value<0.001; OR= 11.8;
95% CI: 3.65­38.59). The infection rate among household contacts while patients isolated at home was 38.42%. About
66.8% of those who abided by the home isolation instructions did not infect contacts compared to 33.2% who got infection
(P-value=0.001; OR= 2.207; 95% CI: 1.404­4.807). Significant predictors for compliance with home-based isolation
instructions were the presence of hypertension, previous hospitalization, and absence of chronic liver diseases.
Compliance with isolation instructions and conforming to infection and control procedures are important
factors to decrease hospital visits and infection rates among household contacts.
COVID-19, Home isolation, Outcome, Egypt, Impact, Feasibility, Follow-up.


Coronavirus disease-2019 (COVID-19) is an
resources limited, home-based self-isolation is a key
infectious disease of pandemic proportions, with more
public health strategy to curb the spread of the pandemic
than 85,000,000 cases and approximately 1,800,000
under the country's coronavirus treatment protocol, mild
deaths reported worldwide as of January 3, 2021 (1).
and moderate COVID-19 patients are treated at home or
COVID-19 is a public health emergency of
at the university hostels, to free up beds for critical cases
international concern (2), and as such, it requires
at isolation hospitals. The total number of home-isolating
coordinated, protective responses from national and
coronavirus patients in Egypt has so far reached 10,168
supranational entities around the world. The absence of
cases since the health ministry launched its program for
specific preventive or therapeutic medical interventions
non-hospitalized cases in July 2020 (5).
for COVID-19 infection, alongside its rapid transmission
Home-based self-isolation, however, has several
important limitations. For one, home-based isolation is
contamination and transmission numbers, has led to the
not effective in preventing transmissions within
scientifically sound recommendation that individuals
households. In China, before the implementation of
must stay home to avoid social interactions and restrain
facility-based isolation, more than half of COVID-19
the disease spread, thereby reducing pressure on health
patients had at least one family member with the disease,
systems worldwide. Therefore, physical distancing,
and 75-80% of all clustered infections occurred within
intensive contact tracing, and case isolation remain
families (6,7). In New York City, 66% of COVID-19 cases
frontline measures in controlling the spread of COVID-
were people who had stayed in their homes (8), suggesting
19 infection (3).
high rates of intra-family transmission of COVID-19.
In Egypt, with a population of over 100 million,
Furthermore, it is difficult to achieve high compliance
since most cases of COVID-19 are mild (4) and health care
with home-based isolation (9).

Received: 20/07/2022
Accepted: 22/09/2022

Full Paper (vol.901 paper# 81)

c:\work\Jor\vol901_82 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 585-589

Effect of Covid19 Vaccination on Semen Parameters in Sample of
The Egyptian Male in Upper Egypt
Ali Mahram, Hatem Kamal, Mohamed Elmahdy Abdelmotaleb*
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University Hospital, Assiut
*Corresponding author: Mohamed Elmahdy Abdelmotaleb, Mobile: (+20) 0109 866 5809,
E-mail: m_mahdy_teama@yahoo.com,

Despite the safety and efficacy of mRNA COVID-19 vaccines against SARS-CoV-2, immunisation rates
have stalled.
Objective: This study aimed to assess the effect of the COVID-19 immunisation on semen parameters in comparison
with unvaccinated males.
Patients and Methods: Semen analysis was used to survey adult males in Egypt between March and October 2022
before and 3 and 6 months after immunisation.
Results: Regardless of immunisation status or prior COVID-19 medical history, 220 men who are now above the age
of 18 and reside in Upper Egypt are eligible to participate in the survey. Respondents have to be at least 18 years old
and have never had main or secondary infertility identified by a doctor. The results of the multivariable adjusted analysis
showed that semen parameter affliction was not linked to COVID-19 immunisation.
Conclusion: Overall, this cross-sectional study revealed that males 18 years of age and older did not have an elevated
risk of alteration of semen parameters following COVID-19 immunisation.
Keywords: Coronavirus disease-19, Semen, Vaccination.


patients have a higher risk of COVID-19-induced
As of December 5, 2022, there have been over
testicular injury than older ones (5).
650 million confirmed cases of the COVID 19
pandemic, which is brought on by the severe acute
inflammatory response, which is increased during the
respiratory syndrome coronavirus 2 (SARS CoV 2).
severe viral infection in the testicles due to the high load
This has been a huge public health issue throughout the
of virus in the blood stream going to testicles, has also
world. Despite the fact that the condition mostly attacks
been theorised as a potential cause of testicular injury
the lungs, it can also harm the heart, kidney, liver, and
testicles (1). The global SARS-Cov-2 epidemic caused a
Through a variety of pathogenic pathways, such
significant blow to sexual relations (1). Due to the limits
as increased oxidative stress and increased DNA
imposed by the various states and the general public's
methylation and fragmentation, COVID-19 infection
perception of the virus as a threat. COVID-19 has
may also reduce male fertility (2). The ace enzyme has
altered social connections around the world. These
the potential to directly harm spermatocytes and Leydig
changes completely overcame us in a short amount of
cells. In addition, persistently elevated blood
time, giving little time for our bodies and minds to
temperatures during active viral infections might harm
adjust to the new situation. The mental stability of each
the blood-testis barrier (BTB), allowing viruses to enter
person has been put to the test by their distress over the
seminiferous tubules (6). This demonstrates how
state of the world and their constant exposure to pictures
testicular infection brought on by SARS-CoV-2 induce
of illness and death (2).
orchitis that may harm BTB and cause virus to leak into
Numerous studies have demonstrated that
semen. Therefore, hypothetically, it is possible that
COVID 19 vaccines have no impact on a man's ability
COVID-19 infection might harm the testicular cells,
to engage in sexual activity after being exposed to
which are the virus's potential target, and ultimately
various vaccines in various regions throughout the
result in infertility (7).
world (3). Due to the fact that ACE2 receptors are crucial
The safety of these vaccinations has been
in the pathophysiology of COVID-19 (4). Therefore, the
established via a number of clinical trials, but their
virus may directly harm cells that express ACE2 at high
effect on male fertility has not yet been examined.
levels. Numerous studies have demonstrated that
Studies have revealed that SARS-CoV-2 infection has a
testicular cells such as seminiferous duct cells,
considerable deleterious influence on sperm parameters
Spermatogonia, Leydig cells, and Sertoli cells have
(7, 8, 9). According to a Chinese research, 37% of
significant levels of ACE2 expression (3). Age is
individuals assessed had less sexual activity in the early
associated with this expression of ACE2 in testicular
stages of the epidemic. In that research, 44% of
cells. In a study, it was discovered that the expression
participants reported having fewer sexual partners (9).
was highest in patients aged 30 years, higher than
Holtmann and coworkers (10) provided the
people in their twenties, and lowest in patients 60 years
initial report on the effects of SARSCoV-2 infection on
of age and older. This may suggest that younger male
semen parameters. They discovered that individuals
with severe infections had impaired semen parameters,
Received: 20/07/2022
Accepted: 22/09/2022

Full Paper (vol.901 paper# 82)

c:\work\Jor\vol901_83 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 590-594

Response of Immune System and Wound Healing to
Laser Puncture in Burned Patients
Mohamed Maher Elkeblawy1, Amany Gomaa Atiaa Farag2*,
Salah El-Din Abdel-Ghani Mohamed3, Khadraa Mohamed Ali4
1- National Center of Research, Egypt,
2-Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Heliopolis University, Egypt,
3-Department of General and Plastic Surgery, Faculty of Medicine, Kasr Al-Aini, Cairo University, Egypt,
4-Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt.
Corresponding author: Amany Gomaa Atiaa Farag,Email: dr.mony_555@yahoo.com, Mobile: +201223002855

laser acupuncture due to its anti-inflammatory and immunocorrection action has great role in improving
immunity parameters (neutrophils and total lymphocytes) and accelerate wound healing in patients with depressed
immune system after burn.
Aim: This study aimed to investigate the response of immune system and wound healing of laser puncture in burned
patients through comparing the impact of laser puncture and routine medical treatment on treatment of burned patients.
Subjects and Methods: After one week of burn injury, sixty patients (31 males and 29 females) suffering from thermal
burn injury (second degree) were randomized into two groups: laser puncture group (A) (n = 30) as well as control group
(B) (n = 30). The intervention was performed 3 sessions each week for two months. Wound measurement ­ working
out surface area in cm² and complete blood cell counts (Neutrophils, total lymphocytes) were evaluated pre- and post-
Results: In groups A and B, there was a significant decrease in wound surface area and a substantial increase in
lymphocytes as well as neutrophils post-treatment compared to pre-treatment (p > 0.001).
Conclusions: laser puncture is an effective technique to increase the immunity parameters and wound healing in burned
Keywords: Immune, Wound Healing, Laser puncture, Burn.


excitation, tissue regenerative, antimicrobial, anti-
Burns are the 4th most common type of injury
inflammatory, and analgesic properties )6(. To the
worldwide, following car accidents, falls, and acts of
author's knowledge, there is no previous study on the
violence )1(. The systemic inflammatory reaction
response of immune system and wound healing of laser
syndrome is triggered by burn injuries and can lead to
puncture in burned patients.
tissue and organ destruction throughout the body )2, 3(.

Neutrophils as well as macrophages are the initial
immune cells that reach at the wound site
Randomization and study design
following burn injury that triggers the acute phase of the
A cluster randomised-controlled trial with two
immune reaction )4(. The bone marrow is responsible for
arms was carried out. When patients were admitted,
producing and renewing the blood's neutrophils as well
they were given an identification number. Group 1 was
as macrophages. These innate immune cells clear the
assigned odd numbers, while group 2 was assigned even
body of infections and necrotic tissue through processes
numbers. Before beginning treatment, participants'
called phagocytosis and the generation of reactive
consent was obtained after a thorough explanation of the
oxygen species )5(.
study's details.
Acupuncture (ACU) is an integral part of the initial

response in the multifaceted treatment of burn trauma
(BT). The anti-inflammatory, analgesic, and immune-
From the Burn Department of Hehia Hospital in
stimulating effects of ACU, as well as its influence on
Sharqia, Egypt, 60 patients who fulfilled the inclusion
the veins and lymphatic system, all contribute to its
criteria were chosen for this study. Total of sixty
ability to reduce the symptoms of post-traumatic stress.
patients (31 males and 29 females), their ages ranged
When it comes to healing wounds, ACU is crucial,
from 25 to 55 years with thermal burn injury (second
especially for avoiding hypertrophic scarring )6(. All
degree). After one week of burn injury, they were
burn patients, but especially those in mass disasters and
randomized into two groups: laser puncture group (A)
medium and low-income countries, can benefit from
(n = 30) and control group (B) (n = 30).
ACU's easy and inexpensive application. The use of

ACU in BT complex therapy has several benefits,
Inclusion criteria: Patients with ages ranged from 25
including those in the fields of medicine, economics,
to 55 years old, both genders, patients were diagnosed
and psychology, as well as the avoidance of medical-
with 20 to 30% TBSA, and able to follow instructions
law conflicts. Laser acupuncture therapy has bio
or complete self-report scales.
Received: 19/07/2022
Accepted: 21/09/2022

Full Paper (vol.901 paper# 83)

c:\work\Jor\vol901_84 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 595-600

Assessment of Maternal Contributing Factors of Preterm Birth in
Soran Maternity Hospital
Fatima Mohammed Azo1, Magroom Esmail Seniar1*, Safiya Sabri Piro2
1 Soran Technical College, Erbil Polytechnic University, Kurdistan Region, Iraq
2 College of Nursing, Dohuk University, Dohuk, Kurdistan Region, Iraq
*Corresponding Author: Magroom Esmail Seniar, Tel.: +9647504473776, ORCID: 0000-0003-2192-5697,
Email: Magroom.seniar@epu.edu.iq

Preterm birth has become a global issue owing to its high morbidity and mortality rate. It accounts for
significant medical expenses and places a considerable economic strain on children, families, and healthcare systems.
Objective: This study aimed at determining the maternal risk factors related to preterm birth.
Patients and methods: This cross-sectional study was conducted in Soran Maternity Hospital from 15th November 2019 to
25 th October 2020; the time of data collection was from 20th December 2019 until 30th September 2020. A total of 130
pregnant women with 24-37 gestational weeks and painful uterine contractions admitted to the labor room during the time
of data collection were included in the present research. A self-structured questionnaire was utilized to collect information
from participants. The data were analyzed utilizing SPSS version 20.
Results: The highest percentage, 66.2%, was multiparous, and the commonest maternal contributing factors for preterm
birth were urinary tract infection, vaginal infection, anemia, and hypertension during pregnancy. There was a significant
association between parity, urinary tract infection, pregnant women's age, and risk for preterm birth by gestational age.
Urinary tract infection, vaginal infection, anemia, and hypertension during pregnancy were the most prevalent risk factors
for preterm birth. Conclusions: Early recognition of preterm risk factors can benefit healthcare workers and medical staff
to identify high-risk pregnant women to adopt preventive measures against preterm birth.
Keywords: Preterm birth, Risk factors, Parity, Cross sectional study, Erbil Polytechnic University.


Across 184 countries, its prevalence varies from 5 % to
Preterm birth (PTB) is among the main
18%. The highest preterm birth percentages are in Sub-
complications in pregnant women, affecting 10% of all
Saharan Africa and Asia, accounting globally for half of
pregnancies. One million neonatal deaths happen
the births, over 60% of preterm babies, and over 80% of
annually due to preterm birth. It accounts for significant
neonatal deaths annually (8).
medical expenses and places a considerable economic
Al-Diwan (2006) reported the preterm birth
strain on children, families, and healthcare systems (1).
frequency as 31% in the west (Al-Anbar), 51.8% in the
PTB, the birth of an infant before 37 post-menstrual
east (Diyala), and 50% in the center (Baghdad) of Iraq (9).
weeks (and after 20 weeks gestation), is a dreadful
Preterm birth causes are not known in more than
pregnancy complication with long-term medical and
50% of spontaneous preterm labor, while preterm labor
financial burdens on children, families, and healthcare
mechanisms remain poorly understood. (9) Potentially,
systems (2).
recognizing and understanding the preterm birth risk
In developed countries, preterm labor is the main
factors helps address this issue. Similar to most
cause of perinatal morbidity and mortality, with most
developing countries, Iraq lacks reliable data on the
deaths occurring in neonates with a gestational age
preterm delivery burden. Despite this, few studies have
<32 weeks (3). Recently, the care offered in Neonate
been published locally on the preterm birth burden and its
Intensive Care Units (NICU) has increased the survival of
associated factors. This research aims to determine the
premature neonates while increasing the hospitalization
maternal factors associated with preterm birth.
stay and cost. Accordingly, the care of premature infants

now accounts for a large share of the total in-hospital
costs globally (4). Overall, 15 million premature births are
This cross-sectional study was conducted in Soran
reported globally per year, (5) about 90% of which happen
Maternity Hospital from 15th November 2019 to 25th
in developing countries in Asia and Africa, even though
October 2020; data collection time was from 20th
preterm labor frequency differs significantly between
December 2019 to 30th September 2020. A total 130
them (6).
pregnant women with a gestational age of 24-37 weeks
Preterm birth has become a global issue owing to
and painful uterine contractions admitted to the labor
its high morbidity and mortality rate. According to World
room during data collection time were included in the
Health Organization (WHO), in 2018, the preterm birth
research. The gestational age was obtained on the basis of
rate in Africa and South Asia was more than 60% (7). LMP (first day of the last menstrual period) or/and early
Received: 22/7/2022
Accepted: 24/9/2022

Full Paper (vol.901 paper# 84)

c:\work\Jor\vol901_85 The Egyptian Journal of Hospital Medicine (January2023) Vol. 90, Page 601- 606

Comparison of Anti-inflammatory Effect between Intracameral Triamcinolone
Acetonide and Topical Dexamethasone after Phacoemulsification
Nashwa Mohamed Mohamed Elkhodary*, Zeinab Sayed Hasan, Nermin Salah El-Din Mohamed
Department of Ophthalmology, Faculty of Medicine (for Girls), Al-Azhar University, Egypt
*Corresponding author: Nashwa Mohamed Mohamed Elkhodary, Mobile: 01016976242,
Email: Nashwa_kh90@yahoo.com

Despite better surgical methods and intraocular lenses, phacoemulsification has emerged as the most
widely used and gold standard in cataract surgery today. One of the most typical surgical consequences is
postoperative inflammation. Surgical trauma damages the blood aqueous barrier, allowing proteins and inflammatory
cells to flow into the anterior chamber. Objective: The aim of the current study is to compare the effectiveness of a
single intracameral dose of triamcinolone and topical dexamethasone in controlling inflammation following
Patients and methods:
The current clinical trial included 60 eyes divided into two equal groups; Group A included 30
eyes which received single intracameral injection of triamcinolone acetonide (ICTA) 1 mg at the end of surgery, and
Group B included 30 eyes which was given topical dexamethasone eye drops 5 times per day for 1 week and the dose
decreased gradually. Results: It is found that there was no statistically significant difference between the two studied
groups regarding corneal edema, anterior chamber (AC) cells at 1 day and 1 week after surgery. All cases of the two
groups were found negative for corneal edema, AC cells at 1 month and 3rd month postoperative. There was no
significant difference between the two groups in terms of mean BCVA or intraocular pressure (IOP) at any time point
(P >0.05) postoperatively. Our results show that there was highly significant difference between the two studied
groups regarding conjunctival irritation at 1 day, 1 week and 1 month and there is non-significant difference at 3rd
month. No significant complications like endophthalmitis were observed.
Conclusion: Intracameral triamcinolone injection was demonstrated to be a promising safe alternative to topical
dexamethasonen with comparable efficacy in terms of the management of postoperative inflammation after
phacoemulsification and was associated with minimal complications and higher compliance.
Keywords: Cataract, Inflammation, Phacoemulsification, Triamcinolone.

The aim of this study was to compare the
The most common form of curable blindness
effectiveness of a single dose intracameral
worldwide is cataract (1). The most frequent treatment
triamcinolone injection and topical dexamethasone in
performed by ophthalmologists globally is cataract
surgery, which is carried out on about 18 million
patients per year and is predicted to rise as the world's

population and life expectancy rise (2). Although better
surgical methods and intraocular lenses have made
This study was a prospective, non-randomized,
phacoemulsification the most widely used and gold
controlled clinical trial. This clinical trial was
conducted on 60 patients admitted from Al Zahraa
inflammation remains one of the most frequent
University Hospitals in the period from January 2019
postoperative consequences (3).
to April 2021 with age ranging from 30 years to 70
Surgical trauma damages the blood aqueous
barrier, allowing proteins and inflammatory cells to
Inclusion criteria were participants with age 30-
flow into the anterior chamber. Increased recovery
70 years old, both sexes, clear ocular media and
time, increased intraocular pressure (IOP), synechiae
catractous lens.
development, and cystoid macular edoema are all
Exclusion criteria were previous intraocular
surgical intervention, history of trauma, anterior
inflammation (4). After cataract surgery, topical
uveitis, glaucoma, complications during surgery, and
steroids are frequently used to reduce postoperative
presence of systemic diseases or conditions as diabetes
inflammation. Injections into the anterior chamber,
sub-tenon, sub-conjunctiva, also intravitreal injections
All subjects in our study were subjected to
are other methods of administering steroids to the eye
demographic data as age, gender, history of presence
(5). Although topical steroids are useful for reducing
of systemic diseases and history of trauma or previous
postoperative inflammation, they have several
ophthalmic interference, and full ophthalmological
drawbacks, such as poor compliance from daily
preoperative examination including slit lamp
dosages that must be repeated, disturbance of the tear
examination for anterior chamber cells, corneal edema,
film, and discomfort (6).
visual acuity by Snellen chart, IOP measurements by

air-puff and fundus examination.
Received: 15/10/2022
Accepted: 15/12/2022

Full Paper (vol.901 paper# 85)

c:\work\Jor\vol901_86 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 607-609

Assessment of Role of Latanoprost in Management of Vitiligo: Review Article
Laila Ismail Mohamed Ismail*, Abdulla Hassan Kandil, Abdulla Mohamed Essawy
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Laila Ismail Mohamed Ismail, Mobile: (+20) 01006484160, E-Mail: lailaismail294@gmail.com

One of the PGF2 analogues, latanoprost solution is applied topically to the eye to lower intraocular
pressure and treat glaucoma. Latanoprost has been examined for the treatment of cutaneous hypopigmentation since
evidence of its periocular and pigmentation adverse effects emerged. It has been found to be useful, especially when
combined with other medications. It has been reported that topical latanoprost is effective as a monotherapy for vitiligo.
Objective: This study aimed to assess the possible role of latanoprost in management of vitiligo.
We searched PubMed, Google Scholar, and Science Direct for information on vitiligo with latanoprost.
However, only the most current or comprehensive study from November 2001 to May 2021 was 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: According to some studies, using latanoprost in conjunction with other treatments for vitiligo is more
beneficial than using latanoprost alone.
Keywords: Latanoprost, Management of vitiligo.


advances to whole or nearly total skin and hair
Milky white macules and patches appear on the skin
depigmentation (5).
and mucous membranes of people with vitiligo, an
Regarding focal vitiligo, a little, single, depigmented
inherited, progressive depigmenting illness that results
lesion that hasn't spread or changed much over the course
from a significant loss of epidermal and, in some cases,
of two years. Possible future states include SV and NSV
hair follicle melanocytes (1). Between half a percent and
one percent of the population may have vitiligo (2).

The exact aetiology is not well understood, but it is
In Mixed vitiligo, simultaneous presence of both SV and
known to be complex and include the interaction of
NSV. Wood lamp examination rules out nevus
several variables. Most notably, the autoimmune process
depigmentosus at birth and within the first year of life;
has been thoroughly documented. Anyone of either
(2) SV is followed by NSV with a delay of at least 6
gender can develop vitiligo at any time (3).
months; (3) SV affects at least 20% of the dermatomal

segment or presents a definite Blaschko linear
Generalized vitiligo:
distribution; (4) SV responds poorly to conventional
Macules or patches of skin without pigmentation
narrow-band ultraviolet B (NB-UVB) treatment
that appear at random locations all over the body and are
compared to NSV (good response). Patients with SV who
usually bilateral and symmetrical. This condition
present with leukotrichia or halo nevi at presentation are
typically manifests in parts of the body that are frequently
at increased risk of developing MV (4).
subjected to stressors including rubbing, squeezing, and

bruising. It can start at any age, from childhood to young
In Punctate vitiligo, macules that are between 1 and 1.5
adulthood (4).
millimeters in diameter and are completely depigmented
In acrofacial vitiligo, macules with missing
at their borders. In the absence of conventional vitiligo
pigmentation that appear only on the hands, feet, and/or
macules, these spots should be called leukoderma
face. Depigmentation of the extremities, such as the
punctata (6).
fingers and the orifices of the face, is a defining

characteristic. As time goes on, it could spread to other
Hypochromic vitiligo or vitiligo minor, indicated by
parts of the body, at which point it would be more
the appearance of hypopigmented macules across the
accurately described as systemic or even global (5).
trunk and scalp, as well as a seborrheic distribution of
In mucosal vitiligo, normal mucosal surfaces, such
these lesions across the face and neck. It appears to affect
as those in the mouth and genitalia, are frequently
only those with dark complexion (7).
affected. It might be an isolated occurrence or part of a

more widespread case of vitiligo. Unclassified mucosal
Follicular vitiligo, manifests as leukotrichia without
vitiligo is characterized as persistent, isolated vitiligo that
accompanying epidermal depigmentation (8).
has been present for at least 2 years (5).

In vitiligo universalis, full or near-full
Segmental vitiligo, fast onset and segmental distribution
depigmentation (80-90% of the body's surface).
of depigmented macules are hallmarks of leukotrichia.
Typically, it begins with widespread vitiligo and
The macule-like lesion is a clinical hallmark of NSV. A
macule that is completely devoid of melanin and is white,
Received: 22/7/2022
Accepted: 24/9/2022

Full Paper (vol.901 paper# 86)

c:\work\Jor\vol901_87 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 610-620

Acceptability of The Flu Vaccine among The General Population in
Tabuk, Saudi Arabia, 2021-2022
Rofayda Mansour Ahmed Mohamad1*, Khalil Ibrahim Abu Jamileh2,
Mohammad Radwan Abdelhak Ali2, Khalid Hassan Ali Makki2, Waheed Ali Alshehri1,
Safa Salih Ahmed Fadul3, Samir Salah Eldin Mohamed Buraei2, Wareef Abdullah Saleem Al-lahim1,
Haytham Abdullah Amin Abosalamh2, Abdulla Saeed Hassan Althobaiti1, Mohammed Ali Abdullah Khubrani1
1 Preventive Medicine Department,
2 Family Medicine Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
3 Ministry of Health, Tabuk, Saudi Arabia
*Corresponding author: Rofayda Mansour Ahmed Mohamad, Phone: +966545450874,
Email: rofayda.mohamad22@gmail.com

Vaccine hesitancy and ignoring prevents reaching the desired rates of vaccine coverage.
Objectives: The present study was conducted to identify factors for the acceptability of the seasonal flu vaccination in
the 2021-2022 season.
Patients and methods: A cross-sectional study was conducted between December 2021 and February 2022 among the
general population of Tabuk, KSA. A structured, self-administered, web-based questionnaire was distributed to a sample
of adult residents of Tabuk, Saudi Arabia. The questionnaire included: 1) demographic data; 2) information about
contracting COVID-19 and/or getting COVID-19 vaccination; and 3) acceptance or refusal of flu vaccination and
reasons for either.
Results: Most respondents (73%) believed that the flu vaccine was important, but only 45% received the vaccine during
the years 2021-2022. Independent predictors for believing the vaccine's importance were having good knowledge about
the vaccine, thinking that influenza is dangerous, hearing about the vaccine or taking it before, and believing that it
reduces susceptibility to the disease. The independent predictors for vaccine acceptability were the male gender, the
medical profession, perceiving influenza as a dangerous disease, believing the importance of the vaccine, uptake of the
vaccine, and believing that the vaccine could reduce susceptibility.
Conclusion: A considerable proportion of the Tabuk adult population holds misconceptions about influenza and its
vaccines. These misconceptions reduce the rate of vaccination coverage. COVID-19 infection or vaccination did not
significantly contribute to flu vaccine acceptability. Health education about the flu vaccine's safety and efficacy can
increase vaccine acceptability.
Keywords: COVID-19, Immunization, Influenza vaccine, Seasonal influenza, Vaccination uptake, Cross sectional
study, King Salman Armed Forces Hospital.

addition, the Saudi Ministry of Health launched a 5-year
The global annual incidence of influenza
strategic project in 2014 to increase vaccination
approximates one billion cases, out of which 3­5
coverage among high-risk groups (7). During the
million cases develop severe disease, and 290,000­
COVID-19 pandemic, concerns have been raised
650,000 cases end in death. Most deaths occur in
regarding the co-occurrence of the influenza epidemic
children younger than 12-years-old or elderly people
and the resultant aggravated respiratory morbidities and
aged over 65 years (1).
mortalities (8). The WHO has recommended influenza
Influenza leads to hospital admissions and absence
vaccination for high-risk groups during the COVID-19
from work, resulting in increased health expenditure
pandemic. The Saudi Ministry of Health stated the role
and reduced productivity, which in turn account for
of the influenza vaccine in reducing influenza-related
massive economic costs (2). Vaccination represents the
mortality and morbidity during the COVID-19
main strategy for reducing the incidence of seasonal
pandemic (9).
influenza. The WHO and the Centers for Disease
Understanding the factors that increase the
Control and Prevention in the United States have
acceptability of influenza vaccination is essential to
emphasized the safety and efficacy of the seasonal flu
designing effective strategic projects to increase
vaccine to protect against the disease and prevent the
vaccination coverage and rate with the goal of reducing
development of severe complications and hospital
seasonal influenza-related morbidity and mortality (10).
admissions (3-5). The Kingdom of Saudi Arabia (KSA) is
The present study aimed to assess knowledge, beliefs,
particularly susceptible to outbreaks and epidemics of
and attitudes regarding flu vaccination and to
influenza as the Kingdom receives millions of Muslims
investigate the association between participants'
from around the world to perform Umrah and
demographic and professional characteristics, COVID-
pilgrimage (6). Influenza vaccination is free of charge in
19 exposure and/or vaccination, and the acceptability of
Saudi Arabia and is indicated for any individual over 6
seasonal flu vaccination in the 2021-2022 season.
months of age in the absence of any contraindication. In

Received: 22/7/2022
Accepted: 24/9/2022

Full Paper (vol.901 paper# 87)

c:\work\Jor\vol901_88 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 621-627

A Comparison Between Pregabalin and Gabapentin as Adjuvants to
Opioids in Elective Lumbar Microdiscectomy to Control Postoperative Pain:
A Randomized-Controlled Study
Mohamed S. Arafa1, Abeer S. Salem2*, Ahmed Kadry1, Gomaa Zahry Hussien1,
Mohamed Mahmoud Mohamed1
1Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
2Anesthesia Department, Research Institute of Ophthalmology, Giza, Egypt
*Corresponding author: Abeer S. Salem, Email: abeer.samir.salem@gmail.com, Mobile: +201125666006

Although pregabalin and gabapentin have been used to control pain after spinal surgery, there is little
evidence comparing their analgesic advantages to opioids.
Objective: The current study aimed to assess efficacy and safety of analgesia with pregabalin versus gabapentin
compared to opioids in patients undergoing elective lumbar microdiscectomy.
Methods: This randomized-controlled trial included 72 patients scheduled for elective lumbar microdiscectomy. The
patients were randomly allocated to three groups. Each group enrolled 24 patients who received 0.1 mg/kg of morphine
intramuscularly 30 minutes before the surgery. One hour before the surgery, 150 mg of pregabalin was given orally for
the pregabalin (P) group, meanwhile, in the gabapentin (G) group, 400 mg of gabapentin were given orally, and in the
control (C) group, 100 micrograms of vitamin B12 were given orally. The primary outcome was the time to first rescue
analgesia. The secondary outcomes were the intraoperative hemodynamics, visual analogue score, total consumption of
morphine during the first postoperative 24 h, and morphine complications.
Results: Groups P and G had significantly longer time to first analgesia and significantly lower total morphine
consumption during the first 24 h and visual analogue scores at 10, 12, 16, 20, and 24 hours postoperatively. All groups
had comparable hemodynamic parameters and postoperative complications.
Conclusion: In elective lumbar microdiscectomy, preoperative administration of pregabalin provided longer time to
first rescue analgesia with better acute pain control and lower total analgesic consumption compared to gabapentin and
opioid analgesia.
lumbar discectomy, Pregabalin, Gabapentin, Analgesia, Opioid.

inflammatory hyperalgesia, gabapentin and pregabalin
Acute postoperative pain is a common problem
found to
exhibit antinociceptive
after spine surgery. Eighty percent of these patients rate
their pain as severe (1). Postoperative pain can be
pregabalin decreases several neurotransmitters' (e.g.,
damage, inflammatory,
serotonin, glutamate, dopamine, and substance P)
neuropathic, or visceral in nature. Both peripheral and
release by interacting with the calcium channel's 2-
central sensitization has a role in the development of
subunit (8).
pain (2). Thus, preemptive analgesia aims to prevent
Pregabalin is approximately 2.5 times the potency
central sensitization brought on by surgical incisional
of gabapentin (9). Over the past ten years, the off-label
injury and other inflammatory reactions to surgery.
use of gabapentinoids for managing acute nociceptive
Preemptive analgesia is a form of treatment that begins
pain, postoperative analgesia and to reduce opiate use
before surgery (3).
has dramatically increased (5, 10). However, the scientific
Morphine is the first treatment option for
evidence for the growing gabapentinoids use is
postsurgical pain. However, its use has been restricted
contradictory, which may indicate clinical agnosticism
because of several side effects including nausea and
instead of additional proof of clinical efficacy (11).
vomiting, respiratory depression, itching, constipation,
As the possibility of opioid-induced respiratory
and urine retention. Furthermore, some forms of pain do
depression was raised by gabapentinoids, an increased
not respond well to opioids (1). Thus, using a variety of
rate of naloxone administration was linked to continued
pharmacologic medications could improve early
usage of chronic gabapentin after surgery (12). Thus, the
ambulation, early release, and a lower incidence of pain
current study aimed to assess efficacy and safety of
(4). Gabapentinoids are anticonvulsant drugs including
preoperative administration of pregabalin versus
pregabalin and gabapentin. Food and Drug
gabapentin as adjuvants to opioids for postoperative
Administration has licensed gabapentinoids to treat a
pain in elective lumbar microdiscectomy.
number of ailments, such as partial seizures, nerve pain

from spinal cord injuries, shingles, and diabetes (5).
Pregabalin and gabapentin have a well-established
Study design: This randomized trial was carried out at
place in the treatment of neuropathic pain (6, 7). In
the Neurosurgery Unit, Kasr Al-Ainy Hospital, Egypt
experimental research on neuropathic pain and
between September and November 2022.
Received: 20/07/2022
Accepted: 22/09/2022

Full Paper (vol.901 paper# 88)

c:\work\Jor\vol901_89 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 607-614

Cytokine Dependent Hematopoietic Cell Linker and Anemia in
Liver Cirrhosis Patients
Mohammed Sayed Mostafa1, Mona Mahmoud Hassouna1, Hanaa Nagy Ibrahim Heikal1*,
Mostafa Gamal El Din El Helbawy2, Heba Mohamed Ibrahim Abdallah1
Department of 1Clinical Pathology and 2Internal Medicine,
National Liver Institute, Menoufia University, Menoufia, Egypt
*Corresponding author: Hanaa Nagy Ibrahim Heikal, Mobile: (+20) 01093889877, E-mail: hanaaheikal972@gmail.com


Background: About 75% of people with liver cirrhosis have anemia. It significantly lowers their quality of life and
raises mortality. Additionally, several etiologies may be involved. A tyrosine-phosphorylated polypeptide called
cytokine dependent hematopoietic cell linker (CLNK) controls immunological receptor signalling and controls the
receptor signalling of T-cells and natural killer T-cells. Tyrosine of the cytoplasmic domain band-3 is phosphorylated
by oxidative stress, which is a significant factor in the development of liver cirrhosis. Tyrosine phosphorylation thus
triggers the release of microparticles, local red cell membrane instability, and major changes in erythrocyte shape. It has
not been previously investigated how CLNK affects liver cirrhosis and anemia caused by cirrhosis.
Objectives: The aim of the current study was to evaluate serum level of CLNK in cirrhotic patients compared to healthy
controls, and its level was correlated with various hematological parameters.
Patients and methods: A case­control study was conducted on 60 liver cirrhotic patients (30 anemic and 30 not anemic)
and 30 age and sex-matched healthy individuals. All patients were subjected to full history taking, complete medical
examination, and thorough radiological and laboratory investigations as complete blood counts, ferritin, CRP, liver
function tests, kidney function tests, and serum CLNK using enzyme-linked immunosorbent assay were done.
Results: Serum CLNK levels were significantly higher in anemic [178.86 (IQR 68.25)]) and nonanemic cirrhotic
patients [138.17 (IQR 170.55)] than in controls [90.28 (IQR 10.61) with a P-value <0.001. There was no significant
difference between anemic and non-anemic groups compared with each other. CLNK serum levels showed a statistically
significant positive correlation with ferritin and reticulocyte count in anemic patients' groups.
Conclusion: Serum CLNK is significantly elevated in patients with liver cirrhosis and there is still some debate
regarding the association between CLNK levels and the incidence of anemia in cirrhotic patients.
Keywords: CLNK, Liver cirrhosis, Anemia, Case control study, Menoufia University.

An overabundance of iron, which may be identified by
The pathophysiological effects of cirrhosis have a
higher blood ferritin levels, increases the risk of HCC (5,
major impact on the liver's immunological and synthetic
6). The liver produces crucial mediators known as acute
activities. Hematological dysfunctions, such as anemia,
phase reactants during acute and chronic inflammatory
are how this manifests (1).
diseases, which lead to a number of negative outcomes
Anemia may develop in 66% to 75% of liver
such as fever and anemia of chronic illness. Interleukin-
cirrhotic patients. Notably, the cause of anemia is still
6 is the main cytokine that stimulates the liver to make
unknown in the majority of cases. 53% of all cases of
more (IL-6). Acute-phase reactants can also be induced
anemia were unknown in etiology, hemorrhage (25%)
by IL-1, tumor necrosis factor-alpha (TNF-alpha), and
and iron deficiency (9%). Unfortunately, the high
interferon-gamma (IFN-gamma) (7).
occurrence of anemia can lead to a misperception that it
In addition to the cytokines generated in response
is a necessary component of liver disease (2).
to various stimuli and immune system dysregulation, a
Anemia brought on by cirrhosis is linked to higher
different class of proteins known as adaptor proteins is
mortality and morbidity rates. There may be many
an essential part of signaling pathways both inside and
etiologies at play as well. Therefore, it is crucial to have
outside the immune system (8).
a straightforward, simple to use, but informative
Different hematopoietic cell types have a variety
diagnostic procedure to help with the identification and
of adaptors, which refers to hematopoietic stem cells,
subsequent treatment of the primary cause of anemia in
which includes all mature cell types as well as their
cirrhosis (3).Hepatocytes primarily generate ferritin, a
immature progenitors (9).
sign of iron homeostasis and an acute phase reactant. A
In cytokine-dependent lymphoid and myeloid cell
systemic review of the accuracy of ferritin analysis in
lines, including neutrophils, mast cells, macrophages,
cirrhotic patients showed that levels of <15 g/dL were
platelets, T cells, and natural killer (NK) cells, CLNK,
essentially diagnostic of iron deficiency anemia (IDA)
an adaptor protein, has been found to be expressed. It
in cirrhosis whereas values of >100 g/dL practically
seems that persistent exposure to cytokines like IL-2
ruled it out (4).
and IL-3 is the only factor that influences its expression.
Even without particular genetic defects, iron
It possesses a leukocyte protein of 76 kD (SLP-76)-
overload has been discovered in 8% of people with an
related molecule with a Src homology 2 domain (10). The
advanced liver illness comparable to hemochromatosis.
Src family of protein tyrosine kinases (SFKs) is a group
Received: 23/07/2022
Accepted: 25/09/2022

Full Paper (vol.901 paper# 89)

c:\work\Jor\vol901_90 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 636-654

Composition and Development of the Intestinal Microbiome in
Children and Its Changes with Certain Pathologies (Cystic Fibrosis,
Multisystem Inflammatory Syndrome, Type 1 Diabetes, and Autism): Meta-Analysis
Abduladeem G.M. Al-Selwi1,2,4* and Amina Barkat1,3
1. Department of Clinical Epidemiology and Medico-Surgical Sciences,
2. Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
3. Medical Research Laboratory, Children's Hospital, Ibn Sina University Hospital, Rabat, Morocco
4. National Reference Center for Neonatology and Nutrition, Rabat Children's Hospital Ibn Sina, Rabat, Morocco
5. Taiz University in Yemen
Corresponding author: Abduladeem G.M. Al-Selwi, Mobile: + (212) 639604766, ORCID: 0000-0003-4211-6223,
E mail:
abdualadeem12@gmail.com, abduladeemgazemmoq_thabet@um5.ac.ma

Establishment of the intestinal flora in childhood is a critical window for growth and development. Objective:
The aim of the current meta-analysis is to investigate the composition, development of intestinal flora in children and its
change with certain pathologies.
Material and methods: A comprehensive search was conducted in Scopus, PubMed, Google Scholar and Other engines.
A total of 603 articles were identified of them only 11 fulfilled our inclusion criteria.
Results: Composition of the intestinal flora in children: Firmicutes (51.1%) and Bacteroidetes (36%) at the phylum level.
Bacteroidaceae, Lachnospiraceae (17.5%) and Ruminococcaceae (13.9%) at family level. Bacteroides, Prevotella,
Faecalibacterium and Bifidobacterium (16%, 8.69%, 7.51%, and 5.47%, respectively) at genus level. Children with cystic
fibrosis had different intestinal microbiota structures compared to healthy children. Alterations of the intestinal microbiota
could be a predisposing factor for the multi-systemic inflammatory syndrome. In SARS CoV-2: Firmicutes, Bacteroidetes,
Proteobacteria, Actinobacteria, and Verrucomicrobia (51%, 25%, 12%, 9%, and 2%, respectively). In non-diabetic
children: Enterococcus 28.4%, and in children with type 1 diabetes Enterococcus 22.8%. The diversity and stability of the
microbial composition: Bacteroidetes, Proteobacteria, Firmicutes, Actinobacteria, Fusobacteria, and Verrucomicrobia are
different in diabetic and non-diabetic children. The percentage of microbiota species in children with signs of constipation
varies compared to children without constipation. In children and adults, there is variation in species composition at the
family, phylum, and genus level. Bacteroidetes raised in the severe autistic group. Dysbiosis was elevated in autistic children
compared to healthy children. Sutterella sequences were absent in healthy children. Conclusion: It is a very important to
know the influence of the change in the microbiota predisposition to develop different pathologies or the opposite, which
opens a wide range in this subject, hence the importance of carrying out more in-depth studies and research, especially in
Keywords: Intestinal microbiota, children, pathologies, meta-analysis, University Mohammed V.

Breast milk can encourage the proliferation of
The intestinal microbiota is an important set of
Lactobacillus and Bifidobacterium strains, whose
bacteria distributed along the intestinal tract and whose
function is to provide an acidic environment rich in short
overall composition varies according to the location, the
chain fatty acids with an intestine protective and
individuals, the age, the periods of the life of a same
nutritional function. Additionally, breastfeeding has been
individual, the human intestinal microbiota is composed
shown to provide a balanced gut microbiota to infants,
of about 1014 bacteria as well as other microorganisms
which positively impacts their health (2).
such as viruses, fungi and archaea.
The intestinal microbiota is composed in a very large
Intestinal microbiota research has revealed the
majority of anaerobic bacteria, 95% of the microbiota is
fundamental role it plays in intestinal physiology but also
represented by four bacterial phyla: Firmicutes (Firmus
in human health in a more general way, as a real "hidden
cutis: hard skin) are bacteria traditionally Gram-positive
organ", after bacterial colonization of the digestive tract,
but of which certain classes are Gram-positive (we find in
this transient microbiota is crucial for the growth of each
particular the genera: Ruminococcus, Clostridium,
person's unique intestinal microbiota and actually has a
Lactobacillus (of which several strains are used as
significant impact on how a newborn develops. We
probiotics), and of Eubacterium, Faecalibacterium and
explain the structure and role of the intestinal microbiota
Roseburia (producers of butyrate), Bacteroidetes is Gram
as well as its implications in human pathology (1).
negative with a phylum consisting of three major groups
Received 23/07/2022
Accepted 25/09/2022

Full Paper (vol.901 paper# 90)

c:\work\Jor\vol901_91 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 655-659

Results of Dynamic Hip Screw with Trochanteric Stabilizing Plate in
Treatment of Unstable Trochanteric Hip Fractures
Mohammed Mazher Mohammed Saif *, Mohamed Omar Soliman,
Mohamed Said Abd El Maksoud, Mohamed Ahmed Abd El Moneim, Mahmoud Fahmy Tayel
Orthopedics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Corresponding author: Mohammed M M Saif, Mobile: +966532902112, Email: dr_m_seif@yahoo.com

: Trochanteric hip fractures are common among elderly patients. They are categorized as stable and
unstable fractures depending on integrity of postero-medial cortex. Integrity of lateral wall is important to prevent
excessive fracture collapse and poor outcome.
Objective: This study aimed to assess the results of using dynamic hip screw with trochanteric stabilizing plate (TSP)
in management of unstable trochanteric fractures (A2 and A3 patterns in AO classification).
Patients and methods: Forty patients with unstable hip fractures were operated in Kasr Alainy Hospital using dynamic
hip screw (DHS) with TSP. The study had a minimum follow up of 18 months.
Results: In this study, operative time ranged from 90 to 180 minutes with mean of 105.5 ± 24.06. Six patients (15%)
had 500 cc packed RBCs transfusion and only one case (2.5%) needed 1000 cc of packed RBCs. At 6 weeks HSS ranged
from 20 to 80 points, the mean was 54.94 ± 16.17 points. At 3 months the HSS ranged from 43 to 89 points, the mean
was 70.22 ±12.65 points. At 6 months the HSS ranged from 50 to 100 points, the mean was 82.81 ±10.37 points. At 12
months the HSS ranged from 55 to 100 points, the mean was 89.09 ±9.20 points. At 18 months the HSS ranged from 62
to 100 points, the mean was 93.84 ± 7.95 points.
Conclusion: TSP is a good option in management of unstable trochanteric fractures. We recommend making more
studies on TSP to reveal its efficacy.
Keywords: Dynamic, Hip, Screw, Trochanteric, Hip fractures.

excessive fracture collapse, limb shortening and
Hip fractures are those which occur between the
fixation failure (4).
articular margins of the femoral head to 5 cm below the
The purpose of this study is to assess the results of
lesser trochanter. They are divided into extracapsular
using dynamic hip screw with trochanteric stabilizing
and intracapsular hip fractures. The extracapsular hip
plate in management of unstable trochanteric fractures
fractures are subdivided into pertrochanteric and
(A2 and A3 patterns in AO classification).
subtrochanteric fractures (1).

Hip fractures occur most commonly in elderly
patients. Decreasing bone mass with age increases the
This prospective study was conducted in Kasr Alainy
risk of hip fractures. That is why hip fractures in elderly
Hospital in the period from June 2018 to June 2020. It
included patients with unstable type of trochanteric
fractures AO/OTA classification 31-A2 and 31-A3.
approximately 50% of all proximal femur fractures.

Based on the integrity of the postero-medial cortex,
Inclusion criteria:
the Evan's classification system divides the
1. Skeletally mature patients which have diagnosed
intertrochanteric fractures into stable and unstable
unstable trochanteric fractures AO/OTA classification
fractures (2).
31-A2 and 31-A3 types.
The conservation of the side trochanteric wall was
2. Both genders.
significant in reducing a planned fracture influence.
3. Age from 50 to 90.
Disruption of the lateral wall, after miniaturization and

fixture progress to excrescent fracture breakdown and
Exclusion criteria were polytrauma patients,
less results. Integrity of the lateral cortex considered the
pathological fractures, open fractures, bed ridden
most common factor leading to post-operative failure
patients, patients below 50 years or above 90 years, and
and reoperation (3). The operative management of
patients with dementia.
intertrochanteric fractures can be done with different

implant choices. Dynamic compression hip screw,
Sample size calculation:
proximal femoral nail, fixed angle blade plate and
The size of the sample was obtained by IBMª SPSSª
locked plate proximal femur are examples of implant
Sample Powerª version 3.0.1 (IBMª Corp., Armonk,
choices in such fracture pattern (4).
New York, United States). A previous study by Patil
Trochanteric stabilizing plate over dynamic hip
and Srinivas (5) reported that the Harris Hip Score at 6
screw provides lateral buttress for the proximal
months was 85.45 (SD 6.04). A minimal sample size of
fragment. This buttressing for the lateral cortex prevents
40 cases will have 80% power to detect an expected

difference of 3 in the Harris Hip Score at 6 months, at
Received: 01/09/2022
Accepted: 02/11/2022

Full Paper (vol.901 paper# 91)

c:\work\Jor\vol901_92 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 660-661

Sensitive Uterus Post Bariatric Surgery (Case Report)
Latteefah Saleh Alnaeem*
College of Medicine, Obstetrics and Gynecology Department, King Faisal University,
AI Hfouf, Kingdom of Saudi Arabia.
*Corresponding author: Latteefah Saleh Alnaeem, Mobile No.: +966504935792,
ORCID: 0000-0002-3677-2454, E-mail: Latifa_alnaeem@hotmail.com

This female case highlights the effect of bariatric surgery in modifying the physiology of the patient and
her irregular hormonal response to stress.
Case summary: The reported patient had an uneventful menstrual history prior to performing her gastric sleeve till
two years post-surgery, started to become sensitive to any stressful event with intermenstrual bleeding, all
investigations suitable to her case were within the standard limits and despite trial of variable hormonal and non-
hormonal treatments were ineffective, while relaxing techniques and cognitive behavioural therapy were applied with
positive results.
Conclusion: Bariatric surgery could change the physiological stress response; after the exclusion of other known
causes, behavioural therapy could improve the treatment outcome. Further studies need to support these findings.
Keywords: Intermenstrual, Vaginal bleeding, Bariatric surgery, Obesity, Case report, King Faisal University.


Thirty-three years old female patient presented to
cervical motion tenderness was noted. Investigations
the outpatient clinic with a history of recurrent onset of
included transvaginal ultrasound showing thin
intermenstrual bleeding, which was characterized to be
endometrium 0.1 mm, no myometrial pathology noted,
mild, dark coloured blood with mucus that started on
and ovaries were average size with no cysts.
her twelfth day of the period after five days being dry .
Pregnancy was excluded, and laboratory tests
It continued for ten days then stop spontaneously
results were within normal limits of lab reference,
without any interventions. The events were recurrent
including haemoglobin 13.2 g/dl , haematocrit 39%
irregularly through the year.
platelets 319 thousands/cmm, total leukocytes count 8
The patient claims that this complaint started after a
thousands/cmm, coagulation profile including PT 12
serious psychological accident in her life two years ago,
seconds, a activated PTT 27seconds , fibrinogen 133
the death of her dearest friend. She described this
mg/dl , liver functions tests including (ALT) Alanine
bleeding happened to her later with the stressful events.
aminotransferase 15, (AST) Aspartate aminotransferase
She delivered three times with no history of previous
25, and TSH (thyroid stimulating hormone) 1.25
miscarriages or other abnormal pregnancies. Regarding
mIU/L, Calcium 9.7 mg/dl, total vitamin D 47.4 ng/ml.
her previous deliveries, all were spontaneous vaginal
As a management strategy plan, the patient was
delivery; she is not known to have any medical illness
instructed to use nonsteroidal anti-inflammatory drugs
with a history of gastric sleeve four years ago with a
combined with antacids in doses suitable to her history
gradual loss of thirty-five kilograms during the first two
of bariatric surgery and to change the pills market
years, then her weight stabilized. She is not on
company for twelve months; unfortunately, in a follow-
medications except for combined oral contraceptive
up visit, no benefits were achieved especially after a
pills for six years after her last delivery and vitamins.
stressful episode. The patient was counselled about
She had a regular period with combined oral
behavioural therapy and relaxation techniques. Six
contraceptives, average blood loss for five to six days,
months later, the patient reported improvement in her
and no vaginal discharge or itching. She had no post-
symptoms, decreasing the duration of bleeding while
coital bleeding or dyspareunia. There was no family
practising relaxing techniques.
history of endometrial, ovarian, or breast cancer.

The patient is a teacher and has an average income
and stable family bonds. She had been screened for the
Irregular uterine bleeding (AUB) is the coordinated
psychological disorder during her annual women's
cause of a critical healthcare burden for females, their
health visit and was never diagnosed with any disorder
families, and society. Up to 30 percent of ladies will
and mentioned that it was not the first emotional
look for medical advice for this issue throughout their
accident in her life; however, it was the first one after
reproductive years (1).
her surgery. The patient underwent assessments,
Intermenstrual bleeding means AUB that happens
including a general examination and speculum
between well-defined patterned menses. It can be
examination, which showed no signs of infection or
cyclical or acyclical. Recurrent midcycle intermenstrual
ectropion. The PAP smear was obtained, and the result
bleeding refers to a small amount of bleeding emerging
was normal. Bimanual examination showed a pelvic
from the endometrium around midcycle and happens in
anteverted uterus with unpalpable ovaries with no
roughly 9 percent of all reproductive-age females. This
Received: 7/7/2022
Received: 12/9/2022

Full Paper (vol.901 paper# 92)

c:\work\Jor\vol901_93 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 662-667

Predictive Value of Cervical Dilatation at Initial Presentation in
Labor and Subsequent Intervention
Essam A. Amin1, Tarek Mohammed Sayed1, Rasha Zaki Abd Al-Aziz2*, Hesham Ammar1
1 Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt
2 Department of Obstetrics and Gynecology, Qwesna General Hospital, Menoufia, Egypt
*Corresponding author: Rasha Zaki Abd Al-Aziz, Mobile: (+20) 01007004976, E-mail: rashazaki913@gmail.com

The development of initiatives to lower caesarean section rates requires a fundamental understanding of
the dynamics of normal and atypical labor, as well as women's behavior.
Objective: The aim of the current study is to assess the predictive value of initial cervical dilatation at the time of
hospital admission in nulliparous women in labor and its relation to subsequent intervention, mode of delivery, and
maternal, fetal outcomes.
Patients and methods: This cohort study was conducted at the Department of Obstetrics and Gynecology of both
Menoufia University Hospital and Quesna General Hospital included 60 nulliparous pregnant women with singleton
cephalic deliveries at 36-42 weeks who were admitted in spontaneous labor at various grades of cervical dilatation <
or equal 6 cm. Results: There was a significant difference between the Average Dilatation Rate (ADR) and Initial
Dilatation Rate (IDR) and the number of vaginal examinations and duration of 1st stage and a highly significant
difference in the duration of 2nd stage. While correlating with the mode of delivery, we found that ADR is 1cm/h or
more 100% in the spontaneous vaginal group and 80% in the assistant vaginal group while it is 100% less than 1cm/h
in the cesarean group. IDR is 1cm/h or more in 88.6 % of the spontaneous vaginal group and less than 1cm/h in 100%
of assistant vaginal and 100% of cesarean groups.
Conclusion: The IDR appears to be an accurate indicator and predictor of the course of labor. When IDR was
1cm/hour or more percentage of vaginal delivery was more and if less than 1cm/hour percentage of CS was more.
Keywords: Average dilatation rate, Cervical, Initial dilatation rate, Labor, Pregnancy.


Cervicographs are the primary component of
The physiological progression of labor and the
Partograms, according to Philpott and Castle. Their
differentiation between physiological and non-
alarm line notifies the obstetrician to provide the
physiological labor have recently received attention in
patient with prompt treatment, such as moving to
obstetrical research, particularly to minimize
another well-equipped hospital or initiating an
caesareans and improve labor management [1].
oxytocin drip, among other things. Active management
These efforts led to the creation of the
is typically needed when the cervicographs pass the
Partographs by Friedman, Hendricks, and Philpott. An
action line. Obstetricians in practice get the ability to
established instrument for monitoring labor progress is
spot the early indicators of atypical labor via practice
a partogram. A partogram's usage is linked to better
treatment quality and labor outcomes, according to a
Initial dilatation rate (IDR) measures' main
number of studies [2-4].
benefit is their ability to accurately identify births that
Friedman's work from the 1954s served as the
might pose a concern. 100% of pregnancies ended in
foundation for the widely used WHO partogram,
vaginal births, either naturally or with some help, when
which has since been updated and updated labor curves
the lDR was 1 cm/hr or above. With an IDR of 1
evaluated. Friedman created a cervical dilatation time
cm/hour or more, 96% of primiparas spontaneously
curve that allowed for important labor progression
gave birth, whereas 60.5% needed assistance or a
monitoring [2,5].
caesarean section with an IDR of less than 1 cm/hour
Hendricks, however, sparked resurgence in
interest for partograms, notably with cervicograms.
Therefore, examining the cervix during labor
Cervicograph upkeep throughout labor is very
might reveal important details about how labor is
beneficial in the treatment of challenging patients [6].In
developing and what is likely to happen next.
the early detection of slowly progressive labor
Together, the pace of cervical dilatation and the
dystocia, partograms are particularly helpful. By
descent of the presenting section provide the most
retrospectively evaluating the nomograms of a
reliable indicator of labor productivity. It appears that
primigravida in labor, the study discovered that
the early rate of cervical dilatation is a reliable
nomograms are helpful in discriminating between
indicator of how labor will progress. The first
normal and abnormal labor [1]. Ledger claims that an
dilatation rate provides an early indicator of potential
aberrant cervical dilation pattern suggests the necessity
labor complications [5].
for a clinical examination and potential intervention,
Thus, we aimed to assess the predictive value of initial
but does not define the course of treatment [7].
cervical dilatation at the time of hospital admission in

nulliparous women in labor and its relation to

Received: 24/07/2022
Accepted: 26/09/2022

Full Paper (vol.901 paper# 93)

c:\work\Jor\vol901_94 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 668-678
Histological and Ultrastructural Changes of Cefepime on the
Kidney in The Adult Albino Rats
Mohammed Hegazy Hassan Ali ¹,*; Mohamed Al-Hady Zahran ²; Gamal M. Aboul-Hassan¹
¹ Departments of Anatomy, Faculty of Medicine, Al-Azhar University, Assuit, Egypt
² Departments of Anatomy, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
*Corresponding Author: Mohammed H. H. Ali, Mobile: +201550624531, E-mail: drhegazy2008@gmail.com

The cephalosporins are -lactam antibiotics that, in terms of both structure and function, are very similar to
penicillin. Cefepime is one of the most widely used parenteral fourth generation cephalosporins with broad-spectrum action.
The administration of a high dose of cefepime can exert a direct cytotoxic effect which accumulated in the tubular epithelial
Objective: The present work aimed to reveal the histological and ultrastructural alterations in the kidney of the adult albino
rats in relation to the dose of cefepime given. That's may give a new insight into the prophylaxis of cefepime nephrotoxicity.
Material and methods: 25 adult albino rats were divided into five equal groups. In group I (control group) each rat was
injected intramuscularly with 1 ml isotonic saline solution /day for one week. Each rat of group II, III, IV and V was injected
by cefepime intramuscularly in doses 50, 75, 100 and 125 mg/kg/day respectively for one week. After 2 months kidneys of
rats were excised for routine histological and electron microscopic studies. Results: Intramuscular injection of cefepime led
to histological and ultrastructural alterations of the cortex and medulla which were marked with increasing its concentration.
Cytotoxic damage to the renal tubules, glomeruli and interstitium was obtained. The histological and ultrastructural changes
in the kidney caused by cefepime were marked in group III, IV and V.
Conclusion: Cefepime nephrotoxicity were marked with increasing its concentration which proves that, cefepime
nephrotoxicity in rats were dose related.
Keywords: Cefepime; cephalosporins; nephrotoxicity; kidneys.


Various drugs or their metabolites are excreted by the
A rat model has been used to describe the dose-
kidney. Modifications in glomerular nephropathy, tubular
dependent feature of cefepime nephrotoxicity. As this
damage or obstruction, kidney hemodynamics, and
antibiotic's concentration rises, it directly causes injury of
manifestations of
the renal tubules, resulting in manifestations as
nephrotoxicity (1).
proteinuria, glycosuria, and an increase in the urine salt
The onset of many acute and chronic renal disorders
excretion (4). There have been reports of interstitial
is usually correlated with drug use. The two most
nephritis in association with cefepime (5).
common forms of tubulointerstitial compartment injury
This work aimed to investigate the histological and
either acute tubular necrosis (ATN) or acute interstitial
ultrastructural alterations in the kidney of the adult albino
nephritis (AIN) are linked to nephrotoxicity.
rats in rel/ation to the dose of cefepime administration.
Additionally, the possibility of drug-induced glomerular

diseases has been brought up in an increasing number of
publications, including immune-mediated injury or even
Experimental animals:
direct cellular injury. It is believed that an immune
Twenty-five adult albino rats with average body weight
response is a part of the pathogenesis of AIN. Frequently,
150 ± 40 g were purchased from the breeding unit of
the development of that hypersensitive reaction involves
"Helwan Farm of experimental animals - VACSERA,
cephalosporins, especially cefepime (2).
Egypt". The study was done at faculty of medicine, Al-
The development of cefepime was in 1990. Its
Azh ar University. The rats were kept for one week in
antibacterial activity is close to that of third generation
standard cages with clear sides, controlled temperature
cephalosporins, however it has a significant level of beta-
(23± 3°C), humidity (approximately 60%), 12 hours of
lactamase resistance. Furthermore, due to its high potency
light and 12 hours of darkness, and access to food and
and broad spectrum, it is useful in treating a variety of
water. Strict cleaning and care procedures were crucial for
serious illnesses, including septicemia, bacteremia,
maintaining animals in good health.
febrile neutropenia, and hospital-acquired pneumonia (3).

For an average adult with normal renal function, the
Chemical material:
recommended therapeutic dose of cefepime is 1-2 g/day
Cefepime 500 mg vial was obtained from "Pharco B
intravenously. In child with febrile neutropenia, the dose
International, Egypt". Its commercial name is
is 50 mg/kg/day intravenously (3).
"Cefepime". Each 1 ml contains 100 mg of cefepime. The
Received: 6/7/2022
Accepted: 11/9/2022

Full Paper (vol.901 paper# 94)

c:\work\Jor\vol901_95 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 679-688

A Prospective Study Comparing Three-Dimensional Ultrasonography versus
Hysteroscopy in Evaluation of Uterine Cavity in Infertile Women
Mohamed Ahmed Fekry*, Mohamed Mohamed El Toutongy, Yasser Abd El Dayem Elmorsy
Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Mohamed Ahmed Fekry, Mobile: (+20) 01006322127, E-Mail: mohafekry@gmail.com


Background: Hysteroscopy (HS) is a frequently utilized procedure for diagnosing and treating intracavitary pathologies
in gynecological practice. It is a favored procedure for assessing of infertile women. While different types of ultrasounds
scanning for infertility such as baseline or screening ultrasound, follicular monitoring ultrasounds, saline infusion
sonograms (SIS) with or without three-dimensional transvaginal ultrasonography (3D-TVS) evaluation are utilized to
evaluate uterine cavity. Abdominal ultrasound might be required with any of the above scanning modalities for better
assessment of pelvic structures.
Objective: The current study aimed to evaluate the diagnostic accuracy of 3D ultrasonography versus hysteroscopy for
assessment of uterine cavity in infertile females.
Patients and methods: The diagnostic study included 139 infertile patients. All cases were subjected to detailed history
taking with special focus on age, parity, age of menarche, past history of obstetric problems or surgeries. All patients
had pelvic 3D TVS assessment and then reassessed by hysteroscopy.
Results: The 3D TVS showed perfect performance characteristics for detection of uterine abnormalities in relation to
hysteroscopy as a standard method, with sensitivity of 96.9%, specificity of 85.7%, positive predictive value (PPV) of
94%, negative predictive value (NPV) of 92.3%, and accuracy of 93.5%. The 3D TVS showed perfect performance
characteristics regarding any Mullerian abnormality, septate uterus, subseptate uterus, bicornuate uterus, unicornuate
and arcuate uterus.
Conclusion: 3D TVS is a cost-effective, non-invasive modality without complications in comparison with HS, must be
considered as a first-line investigation in infertility.
Keywords: Hysterosalpingography, Three-dimensional TVS, Hysteroscopy.


Infertility is failure to achieve a pregnancy after
This study aimed at assessing the diagnostic
one year or more of regular unprotected intercourse (1).
accuracy of 3D-TVS versus HS for assessment of
Uterine cavity evaluation is mandatory in infertile
uterine cavity abnormalities among females with
females. Pathologies including fibroids, polyps as well
as Müllerian anomalies can cause infertility, recurrent

miscarriages and poor outcome of gestation. Thereby,
their diagnosis and treatment are significant to achieve
Study Design:
pregnancy in natural and ART cycles (2).
This study was a prospective diagnostic study, and
Hysteroscopy (HS) has now become a gold-
was carried out from November 2018 to November
standard method to assess uterine cavity in infertile
2021 at Obstetrics and Gynecology Department in
females (3). Apart from direct endometrial visualizing by
Mansoura University Hospitals. This study included
the naked eye, any pathology missed by other methods
infertile women (primary or secondary) with age
can be detected and treated (3,4). Unfortunately, HS can
ranging between 18- 40 years old. Female patients less
have complications e.g. perforations, cervical
than 18 years or more than 40 years old, females with
lacerations, hemorrhage, inadequate access in cases of
pelvic inflammatory diseases, or females with active
cervical stenosis and considered as an invasive method
uterine bleeding were excluded.
(5).Two-dimensional transvaginal ultrasonography (2D-

TVS) and three-dimensional TVS (3D-TVS) are non-
invasive procedures used to evaluate uterine cavity. The
A full history was obtained from each participant.
3D-TVS is better than 2D-TVS in diagnosing uterine
Thorough clinical examination (including general,
cavity abnormalities as it obtains a view of 3 uterine
abdominal examination and local examination) was
planes (6).
performed. Basic infertility workup including a semen

Reports vary concerning the diagnostic accuracy
hysterosalpingogram was revised. All patients were
of 3D-TVS which was found to have 41.3-81.5%
subjected during the proliferative phase to two
sensitivity and 94.6-98.7% specificity (7,8). Thus, 3D-
diagnostic techniques for evaluating the uterine cavity.
TVS is considered a non-invasive and safe tool for

assessment of uterine cavity abnormalities however its
1. The 3D-TVS:
sensitivity, specificity and accuracy remain a matter of
The uterine cavity was evaluated by obtaining a mid-
coronal render image. Evaluation of mullerian
Received: 23/7/2022
Accepted: 25/9/2022

Full Paper (vol.901 paper# 95)

c:\work\Jor\vol901_96 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 689-694

Histopathological Artifacts in Skin Biopsies: Types, Frequencies and
Its Impact on Final Diagnosis
Mohammed J E Ahmed1*, Sajid Saad Mohammed2
1Department of Dermatology and Venereology,
2Department of Histopathology, Al-Yarmouk Teaching Hospital, Baghdad, Iraq.
Corresponding author: Mohammed J E Ahmed, Mobile: (+964)7848771871, *E mail: mohammedjasimessa@gmail.com

Generally, in practical dermatology, the term artifacts is used to describe what is called pathomimia which
means self-inflicted lesions or that lesions induced accidentally on oral mucosa and skin. Regarding dermatopathology, the
word, `artefact' comes from the Latin term, `Ars' = art and `factum' = made. This study evaluates types of artifacts,
frequencies, and their impact on final diagnosis.
Patients and method:
This observational, cross-sectional study. The study worked on 590 dermatological slides, that
stained with hematoxylin and eosin stain. Slides evaluated from archive and that collected during time of study which occur
from June 2022 to November 2022, in Al-Yarmouk Teaching Hospital, Baghdad, Iraq, analyzed for artifacts under light
Results: Totally 590 slides were evaluated, only 69 (11.695%) show no artifacts. Slides with artifact(s) counting
521(88.305%). Histopathological artifacts were accounted for 931 because more 45% of total examined slides show two or
more artifacts. Folding artifacts were the most common type, while artefacts related to fixation were the least 307(32.975%),
6(0.644%) respectively.
Conclusion: Histopathological evaluation of skin biopsies had long, and multiple stages done by the dermatologist, assistant
pathologists, and lab technicians. That led to increased incidence of errors and artifacts. Artifacts invariably occur in the
majority of dermatopathological slides and may interfere with the interpretation of histopathological diagnosis. These
artefacts should be recognized and do all effort to avoid or at least, minimized them, which yet defied even with soft tissue
handle and wrong techniques avoidance.
Keywords: Histopathological artifacts, skin biopsies, impact on final diagnosis.


Generally, in practical dermatology, the term
embedding stage, microtomy stage, staining stage and
artifacts used to describe what call it pathomimia which
mounting process (8).
mean self-inflicted lesions or that lesions induced

accidentally on oral mucosa and skin (1).
Artifacts can be categories as below according to
Regarding the dermatopathology, term biopsy
known stages of dermatopathology processing:
derived from Greek word bios = `life' and opsis = `sight'
· Surgical removal of specimen related artifact
(2,3). The word, `artefact' comes from the Latin term, `Ars'
· Fixation artifact
= art and `factum' = made (4). Skin biopsy remains the
· Tissue processing artifact
paradigm procedure for obtaining sufficient tissue for
· Embedding artifact
histological assessment and subsequently for obtained
· Microtomy artifact
final diagnosis (5).
· Staining artifact
Artefact refers to "an artificial structure or tissue
· Mounting and Coverslipping artifact.
alteration on a prepared microscopic slide caused by some

extraneous factors" (6). Artifacts may lead to changing of
Surgical biopsy procedure:
normal morphology or even cytology of tissue, and with
multiple artifacts of same slide may give fully non useful
dermatopathology are occur in this stage, like epithelial
tissue specimen, which may lead to major errors and mal-
vacuolation and connective tissue separation along with
diagnosis histopathological picture (7). Regarding the
hemorrhage (Fig. 1) all may cause by injection of
artifacts influence on final histopathological diagnosis,
anesthesia (9). That can be avoided by prelesional injection
artifacts may be minimally affected or may lead to totally
of anesthesia. Crush (Fig. 2) and hole artifact (Fig. 3) may
distrusted prepared stained tissue (4).
cause by using of forceps with over-force before the stage
Because of histopathological evaluations are multi-
of fixation and produced by syringe needle that use for
stages process, so many artifacts may happen through
separation of biopsy, respectively (10,11,3) which can be
these stages which includes; surgical removal of
avoid by gently holding the biopsy and use Terson lens
specimen, fixation of obtained tissue, processing stage,
capsule forceps (12). During obtaining of biopsy,

electrocautery may be used to cutting or for hemostasis


Full Paper (vol.901 paper# 96)

c:\work\Jor\vol901_97 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 695-700

Detection of Fungal Infection in Patients on Hemodialysis with
Double Lumen Catheter by Conventional and Molecular Methods
Rusul Jabbar Abdulzahra*1, Alaa kassar Salih2, Azhar A. F. Al-Attraqchi3, Shatha Hussain Ali4
1 College of Medicine, Al-Nahrain University, Baghdad, Iraq
2 Department of Surgery, College of Medicine, Al-Nahrain University, Baghdad, Iraq
3 Department of Microbiology, College of Medicine, Al-Nahrain University, Baghdad, Iraq
4 Department of Pediatrics, College of Medicine, Al-Nahrain University, Baghdad, Iraq
*Corresponding author: Rusul Jabbar Abdulzahra, Moblile: 009647705341439
Email: rusulrusul1996@gmail.com
In hemodialysis patients, tunneled, cuffed, double-lumen catheters are frequently used for long-term venous
access. Infections associated with these catheters are one of the major causes of morbidity and resource usage in the
hemodialysis population. Objective: The aim of the current study is to investigate the frequency and types of fungal
infection in patients on hemodialysis with double lumen catheter in Imamein Kadhimein Teaching Hospital and Al-Karama
Teaching Hospital, Iraq.
Material and methods: For the purpose of detecting a fungal infection, 19 blood samples from hemodialysis patients with
double lumen catheters were subjected to both BacT/ALERT system (Blood Culture) and molecular approaches (Multiplex
Real Time PCR). Results: By using traditional techniques, the fungi Candida spp. (2%), and Cryptococcus spp. (1%) were
detected. The following fungi were identified using molecular techniques: (2%) R.oryzae.
Conclusion: The nephrologist should be aware of the many fungal infections that patients receiving hemodialysis with
double lumen catheters may acquire, including R.oryzae, Candida spp., and Cryptococcus spp. The fungi mentioned above
may be acquired during hemodialysis or may already be present as underlying illnesses. This study established that
hemodialysis patients with renal impairment who use double lumen catheters could have several complications.
Keywords: Fungal Infection, Hemodialysis, Double lumen, M-RTPCR, BacT/ALERT, Case series, Al-Nahrain University.

culture should be taken from a catheter and a peripheral
With a rising worldwide burden among solid organ
vein from patients in whom CRI is suspected (6).
and bone marrow transplant recipients, cancer patients,
Molecular methods for the precise detection of certain
people living with HIV and those receiving
genera or species, as well as broad range (or pan-fungal)
immunomodulatory therapies, invasive fungal diseases
assays to capture "all fungi," are available for the direct
(IFDs) represent a serious hazard to human health,
detection of fungal DNA in clinical specimens (7).
especially in the immunocompromised. The pathogens
Initially, the detection of mucorales DNA from clinical
Candida spp. and Aspergillus spp. are the most frequent
specimens was primarily established for tissue samples as
causes of IFDs, followed by Pneumocystis and the
an adjunct to histopathological and microbiological
Mucorales, with the prevalence of IFDs varied by
diagnosis (8,9). However, recently, molecular blood and
geographic location and patient population from pathogen
even urine tests were developed (10). The load of
to pathogen (1). /For hemodialysis and IV medicine,
circulating mucorales species DNA in serum was shown
central venous catheterization with a double-lumen
to be extremely high compared to invasive aspergillosis,
catheter is frequently used (2). As more permanent
possibly due to the angioinvasive character of mucorales
vascular access, arteriovenous fistulas, is used usually,
infections (11). As a result, blood samples are suitable for
but tunneled and cuffed double lumen catheters are being
therapeutic monitoring and suspicion-free screenings of
utilized more frequently for acute procedures (3).
high-risk patients (12).The aim of the current study is to
Infections associated with catheters are a frequent
investigate the frequency and types of fungal infection in
problem and a significant source of morbidity and death
patients on hemodialysis with double lumen catheter in
in these individuals (4).
Imamein Kadhimein Teaching Hospital and Al-Karama
Fever, localized redness, and discomfort at the
Teaching Hospital, Iraq.
insertion site are less sensitive and specific indicators of

catheter-related infection. The most accurate way to
identify fungi is by culture, which also enables the
A total of 19 patients aged between 13 and 70 years, who
assessment of an antifungal's susceptibility (5). To identify
were receiving hemodialysis with double lumen catheters
a catheter-related infection, a quantitative blood culture
in Imamein Kadhimein Teaching Hospital and Al-
collected from a peripheral vein and a culture of the
Karama Teaching Hospital were included in our study.
central venous catheter tip can be employed. Samples for
Blood samples from participants were collected from
December 2020 to February 2021.
Received: 23/07/2022
Accepted: 25/09/2022

Full Paper (vol.901 paper# 97)

c:\work\Jor\vol901_98 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 701-705

Cytokines in Chronic Hepatitis C Liver Diseases: Interleukin 20
Nabila Hassan Ahmed1, Heba Fouad Pasha2, Mohamed Nagiub El-khashab1, Rania Mostafa Mohamed3
Departments of 1Tropical Medicine and 2Biochemistry, Faculty of Medicine, Zagazig University, Sharkia, Egypt
Department of 3Tropical Medicine, El-Ahrar Teaching Hospital, Zagazig, Sharkia, Egypt
*Corresponding author: Nabila Hassan Ahmed, Mobile: (+20) 01224892292, Email: nabilaahassanahmed@gmail.com

The Interleukin (IL-20) cytokine subfamily is a major IL-10 cytokine subfamily that is thought to produce
a role in the response to hepatic injury. The IL-22 cytokine is the most studied of this family to the inflammatory
imbalance of the liver, and it primarily serves bi-role, it is supposed to increase the susceptibility to HCC development.
Objective: We aimed to study the relationship between IL-20 serum levels and the clinical parameters of chronic HCV-
associated diseases.
Patients and Methods: In this case-control study, a total of 3 groups included Chronic hepatitis C, liver cirrhosis, and
HCC post HCV patients (15 in every group) compared by a healthy group concerning serum IL-20 assay. Clinical
features, laboratory, radiological elements, and CLD scoring were evaluated and compared with IL-20.
Results: The April and FIB-4 scoring show a significant difference (p-value < 0.001) between the chronic hepatitis c
patients and both the cirrhosis and HCC group, with no significant difference between cirrhosis and HCC groups. There
was a significant difference between the three groups regarding the child. Pugh classification (HCC group by 40% as
both child B and C, while 20% child A). In both HCC and cirrhosis groups, the IL-20 level is not related significantly
to the first presenting symptom.
Conclusions: Newly studied cytokines such as IL-20 are easy, cheap ELISA tests that can be useful in assessing the
related clinical parameters of chronic liver diseases.
Keywords: Cytokines, Interleukin, IL-20, Hepatitis C, Liver cirrhosis, Hepatocellular carcinoma.

injury, promoting survival, and inhibiting apoptosis of
Hepatocellular carcinoma (HCC) accounts for the
epithelial cells [5].
common cause of primary liver cancers and is the
The work aims to study the relationship between
principal cause of cancer-linked death worldwide.
IL-20 serum levels and the clinical parameters of
Infections with the HBV or HCV and alcohol use are
chronic HCV-associated diseases.
the most important risk factors [1].

Unsettled chronic inflammation is a leading
feature of HCC, regardless of the etiology. Local
The study design
activation of cell populations in the liver in response to
This case-control study was carried out at Zagazig
organisms and/or tissue injury may initiate a linked and
University Hospitals at the Department of Tropical
coordinated cascade process, followed by immune cell
Medicine from March 2020 to July 2021. Three
infiltration, and eventually repair of the organ. The
diseased groups related to HCV infection 15 patients in
release of soluble factors, such as cytokines, occurs as a
each group (HCC, Cirrhosis, and Chronic hepatitis)
result of this fine coordination of events [2].
compared to 15 healthy participants in a controlled
Cytokines have been studied as potential
biomarkers for predicting different stages of HCC and
The study included patients of HCV infection with
for additional understanding of HCC formation
age more than 18 years old (positive antibody by ELISA
mechanisms. The initial inflammatory response in the
and quantitative PCR) and excluded other causes of
liver is unresolved in the presence of HCC-promoting
chronic liver diseases as autoimmune, other chronic
risk factors, and so, the unbalanced expression of
liver viral diseases HBV (excluded by HBV surface
cytokines promotes a persistent healing response [3].
Antigen), known metabolic, autoimmune diseases
By enhancing hepatocyte proliferation and
(excluded by autoantibodies were negative), and known
regeneration, which can lead to mutagenesis and set the
vascular diseases (Ultrasound Doppler).
stage for HCC development, this response may lead to
Liver cirrhosis was confirmed by history, clinical,
the sequential development of inflammation and
laboratory, and radiology evaluation. HCC was
eventually HCC. Once HCC has formed, cytokines
evaluated by alpha-fetoprotein and tri-phasic CT, and
released by the tumor or immune cells can act on the
extra-hepatic malignancy or metastases were excluded.
malignant lesion to promote tumor survival through a
Pregnant and lactating females were also excluded.
variety of mechanisms [4].

Other interleukins in the IL-20 subfamily have the
common function of communicating with leukocytes
Complete history, detailed clinical examination,
and epithelial cells in different tissues such as the liver.
routine investigations, radiological assessment (US
They are crucial in controlling tissue regeneration after
(Sonoscape c11) and tri-phasic CT scanning (Philips

Ingenuity 128)) and the studied interleukin-20 assay (3-
Received: 10/06/2022
Accepted: 17/08/2022

Full Paper (vol.901 paper# 98)

c:\work\Jor\vol901_99 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 706-715

What Does 3/4D Ultrasound Add to 2D Examination in The
Assessment of Fetal Neural Anomalies: Tertiary Center Experience
Nashwa Mohamed Adel*1, Ahmed Kodb Ebd El Hakeem2,
Mohamed Ali AbdelKader3, Mohamed Ahmed Amin1
Departments of 1Radiodiagnosis and 2Obstetrics and Gynecology,
Faculty of Medicine, Minya University, Minya, Egypt
Department of 3Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Nashwa Mohamed Adel, Mobile: (+20) 01005651501, E-Mail: nashwaadelrad80@yahoo.com

Central nervous system (CNS) malformations are the most common congenital abnormalities.
The detection of fetal anomalies was one of the earliest uses and remains a pivotal application of prenatal ultrasound.
Objective: This prospective study aims to clear out the value of 3/4D examination with advanced techniques (TUI, MIP
& surface mode) over 2D in the evolution of fetal neural anomalies.
Patients and methods:
120 pregnant women with suspected CNS fetal anomalies by 2D US were examined over a
period starting from January 2015 until October 2017. Fetal gestation ranged from 8-39 weeks with a 24-week mean
age. In all patients, 2D and 3/4D ultrasound as well as fetal Doppler were performed.
3/4D ultrasound shows higher sensitivity in the detection of neural anomalies such as anencephaly, Chiari
malformation, Hydranencephaly, holoprosencephaly, encephalocele, meningocele (spina bifida with no brain changes),
Iniencephaly and Dandy-Walker variants, 3/4D ultrasound of 100% deletion rate over 85% for the 2D ultrasound. 3/4d
& 2D ultrasound had the same detection rate of anomalies like hydrocephalus (communicating & non-communicating),
microcephaly, and Dandy-Walker malformation.
3/4D ultrasound had a higher sensitivity in the detection of fetal neural anomalies over 2D which allows
early interference or decision-making to save fetal or material life.
Prenatal ultrasound, 3D/4D ultrasound, Congenital brain anomalies, Fetal CNS.


The most frequent developmental abnormalities
Following 2D ultrasonography, 3D/4D ultrasound
identified at birth and in conceptuses that spontaneously
has been employed as an imaging modality. Thus, the
abort are those affecting the central nervous system
(CNS) (1). There are 1 to 65 cases for every 1,000 births
ultrasonography to do a target scan after 2D
(2). Embryos from spontaneous abortions have a rate of
ultrasonography has formed an initial diagnostic
neural tube abnormalities that is around ten times
impression (5,6).
greater than that of newborns. CNS abnormalities are
So, this study aimed to clear out the value of 3/4D
typically found in early-death chromosomal syndromes
examination with advanced techniques (TUI, MIP &
in aborted embryos and less frequently in aborted babies
surface mode) over 2D in the evolution of fetal neural
with fewer chromosomal abnormalities (2,3).
Ultrasound has a major role in the evaluation of

fetal anomalies, one of them being central nervous
system anomalies, 2D ultrasound alone is helpful to
A prospective study was conducted at Minya
evaluate several conditions but it lakes advanced
University and OBST/GYN tertiary center, 120
capabilities to evaluate some structures as mid-line
pregnant women with suspected CNS fetal anomalies
structures such as lakes of the general overview of the
by 2D US were examined over a period starting from
head and spine unlike volumetric assessment (3).
Jan 2015 until Oct 2017. Fetal gestation ranged from 8-
The rising of advanced ultrasound machines and
39 weeks with a 24-week mean age. In all patients, 2D
their technologies to create volumetric examination of
and 3D/4D ultrasound as well as fetal Doppler were
the fetus parallels the wider availability of 3/4D
machines, and the assessment of the fetal body and CNS

anomalies becomes easier, more efficient, and lesser
Inclusion criteria:
time consumer (4).
1. Previous history of congenital anomalies.
3/4D ultrasound allows examination of the fetus
2. Family history of congenital or chromosomal
in three orthogonal planes by taking one volume saving
time and effort. It is considered also a quick way to
3. Diabetic patients with polyhydramnios.
image the mid-line structures in the brain, especially the
4. The patient who referred with a sonographic
corpus callosum & vermis. The surface mode helps to
report showing or suspecting fetal anomalies.
obtain a fully detailed image of any associated facial
5. Patient with +ve TORCH screen.
defect (2,4).
6. Ultrasound

Received: 21/7/2022
Accepted: 23/9/2022

Full Paper (vol.901 paper# 99)

c:\work\Jor\vol901_100 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 716-720

Molecular Detection of (Urec , Mrpa , Hpma) Genes in Proteus mirabilis Bacteria
Isolated From Patients with Urinary Tract Infection
Somaya A. J. Al-obaidi1* and Ashwak B. J. Al-Hashimy2
Institute of Genetic Engineering and Biotechnology for Post Graduate Studies, Baghdad University, Iraq
*Corresponding author: Somaya A. J. Al-obaidi Mobile: 0096 47706293099, E-mail: somaia.ali1200a@ige.uobaghdad.edu.iq

Urinary tract infection (UTI) is the term for bacterial colonization or infection of the urinary bladder, ureters
and tract. Objective: This study aimed to detect specific virulence genes in Proteus mirabilis isolated from urine samples
of Iraqi patients with urinary tract infection.
Patients and methods: During the study period from early December 2021 to late April 2022, urine specimens (103
specimens) were collected from patients with symptoms and signs of UTI from various hospitals in Baghdad and private
laboratories in Baghdad. Samples were collected from men and women of different age groups (4-75 years) with clinically
suspected UTI.
Results: All specimens were identified based on their properties on media (blood agar and MacConkey agar). Colonies on
blood agar were identified as P.mirabilis due to their colonization, also had a characteristic fishy smell and appeared to form
smooth, pale or colorless colonies on Macckongy agar instead, further diagnosed by using VITEK 2 system and molecular
diagnosis by urec gene also gave positive results for 22 isolates of P. mirabilis. (mrpA, hpmA) genes detection results: mrpA
presence percentage was 100%, while hpmA was 22.72%.
Conclusion: The molecular technique showed that the mrpA, hpmA and urec genes associated with virulence factor include:
adherence activity, produce Alpha () hemolysin and urease.
Keywords: Proteus mirabilis, Urinary tract infections, PCR, Gene.


This study aimed to detect specific virulence genes
Urinary tract infections (UTIs) occur when harmful
in Proteus mirabilis isolated from urine samples of Iraqi
microscopic organisms enter your urinary tract, most
patients with urinary tract infection.
UTIs are caused by bacteria. This condition can affect the
urinary tract, which is referred to as urethritis; the
1. Samples collection:
kidneys, which is referred to as pyelonephritis; and the
In this study, 103 urine specimens were collected
urinary bladder, which is referred to as cystitis (1).
from patients with signs and symptoms of urinary tract
Escherichia coli, Proteus mirabilis, Pseudomonas
infection from different age groups (4-75 years) of both
aeruginosa, Klebsiella pneumoniae, Staphylococcus
sex in different hospitals and private laboratories in
saprophyticus, Enterococcus faecalis and Enterobacter
Baghdad from the beginning of December 2021 to the end
cloacae are the most common bacterial UTIs (2).
of April 2022.
Risk factors of UTIs are female anatomy, sexual

activity, diabetes, family history, and obesity (3). Some
2. Isolation and identification of P. mirabilis:
groups of people are more prone to UTI than others, for
In the laboratory, under sterile conditions, all urine
example diabetic patients and female. Females have
samples (103) were cultured on (blood, nutrient agar, and
fourteen times more chance to develop UTI than men due
MacConkey agar) at 37 °C for 24-48 hours, and further
to several factors. Such as they has a shorter urethra
diagnosis was made for suspected colonies based on
compare to men, which open nearer to the anus so that the
morphological characteristics and biochemical tests, and
lower third of urethra is continually contaminated with
the molecular approach of the ureC gene with specific
pathogens from vagina and rectum (1).
Uncomplicated UTIs usually affect the bladder only.

Cystitis occurs when bacteria invade the lining of the
Molecular methods
bladder. Most organisms that cause UTIs are enteric
Genomic DNA extraction
coliforms that normally inhabit the vaginal opening
DNA extraction was performed; Proteus mirabilis
around the urethra. These microorganisms travel through
isolates were cultured in brain heart broth for 24 hours at
the urethra into the bladder and cause UTIs. People who
37°C. Genomic DNA was isolated from bacterial growth
urinate frequently and void their bladders have a lower
according to the Favour Prep Blood/Cultured Cell
risk of UTIs (4).
Genomic DNA Extraction Mini Kit protocol. A Quantus
Fluorometer is used to determine the concentration of
extracted DNA to determine sample quality for
Received: 23/07/2022
Accepted: 25/09/2022

Full Paper (vol.901 paper# 100)

c:\work\Jor\vol901_101 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 721-726

Acid-Base Disturbances in Pediatrics Infected With COVID-19,
A Cross Sectional Study
Hoda Atef Abdelsattar Ibrahim1*, Abeer Mostafa 2, Eatematd Helmy3,
Aya Ahmed Amin4, Sally kamal Ibrahim Ishak1
1 Pediatric Department, 2 Medical Biochemistry and Molecular Biology Department,
Faculty of Medicine, Cairo University, Egypt
3 Pediatric Department, El-Matria Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Egypt
4 Cancer Epidemiology and Biostatistics, National Cancer Institute, Cairo University, Egypt
*The corresponding author: Hoda Atef Abdelsattar Ibrahim
ORCID: 0000-0001-5399-8861, E-mail: hodaibrahim424@cu.edu.eg

Data on the pathophysiology and clinical spectrum of COVID-19 in children are few. The dominant
respiratory outcome of COVID-19 is arterial hypoxaemia. Arterial Blood Gas (ABG) analysis helps detect early acid base
balance alternations. Acid­base imbalance hasn't been outlined well in children with COVID-19.
Objective: The aim of the current study is to evaluate the blood gas levels as a reflection to the acid-base status among
COVID19 children at admission and to detect the pattern of acid-base disorders.
Patients and methods: A total of 62 children with positive nasopharyngeal swabs were assessed for ABG at the time of
admission in ElMatria Teaching Hospital from February 1, 2021 to the end of July 2021. Results: Among the study subjects,
53% were males and 47% were female. Most affected age group was <2 years. 53% presented by GIT manifestation (fever,
nausea, vomiting, diarrhea), 37% presented by respiratory manifestation (fever, cough, dyspnea). Most common ABG
finding was hypoxemia in 90.3% (P<0.001). PH (potential hydrogen) of about 50% was within the normal range, while
37.1% had acidosis and 12.9% had alkalosis (P<0.001). Base deficit was significantly found in 53.4% (P=0.004), while
lactic acid was only elevated in 32.3% (P=0.005).
Conclusion: ABG should be evaluated in all COVID-19 patients at admission. Children may present with atypical COVID
symptoms as diarrhea, and children may resist changes in acid-base balance.
Coronavirus, ABG, Acidosis, Alkalosis, Cross sectional study, ElMatria Teaching Hospital.


On March 2020, the Coronavirus disease of 2019
One of the most major complications of COVID 19
(COVID-19) was declared by the World Health
is the arterial hypoxemia, thus affecting the lung
Organization (WHO) as a pandemic (1). A worldwide
compliance which could require mechanical ventilation
regular attempt is needed to prevent the more unfold of
(6,7). Acid base imbalance is a frequent association with
the virus. During the COVID-19 outbreak, many studies
patients who suffer from serious viral illnesses including
have investigated laboratory biomarkers used to treat and
COVID-19(8). Tropism of the virus for kidneys and lungs
determine the prognosis of COVID-19 patients, but none
might hypothetically result in frequent acid­base changes
have investigated arterial blood gas and acid-base
due to kidney injury and pneumonia (9,10). To monitor acid
changes in infected children. Very few studies have done
base balance of COVID-19 patients, ABG should be
so. As COVID-19 becomes more severe, many patients
carried out. Most cases of acid­base changes are mild and
require admission to the intensive care unit (ICU),
rarely symptomatic and may have a low tendency to affect
resulting in frequent arterial blood gas (ABG) analysis.
organ homeostasis. Contrariwise, severe changes of acid­
Various test results have been identified as risk predictors
base balance can have severe multi-organ significances.
that may help in staging, monitoring, prognosis, and
The prevalence and impacts of acid­base disorders in
treatment of COVID-19 patients (2,3).
COVID-19 patients have been poorly assessed until now
What is currently known is that children may have
milder symptoms and require hospitalization less
As angiotensin-converting enzyme 2 (ACE2) is the
frequently than adults. Nonetheless, on May 14, 2020, the
entry pathway for SARS-CoV-2 (12), the renin-angiotensin
US Centers for Disease Control and Prevention (CDC)
system (RAS) is affected by COVID-19. When SARS-
reported pediatric multisystem inflammatory syndrome
CoV-2 enters cells, it downregulates ACE2, upregulates
(MIS-C) associated with COVID-19 (4,5). This statement
RAS signaling, and produces angiotensin II and
is from a subset of pediatric patients who presented with
aldosterone. Both angiotensin II and aldosterone affect
multiple organ failure and severe inflammation and were
renal processing of hydrogen (H+) and bicarbonate
diagnosed as SARS-CoV-2 positive.
(HCO3) and can cause acid-base disorders. (13). Reports on

the clinical picture of COVID-19 in children are missing
Received: 02/08/2022
Accepted: 22/09/2022

Full Paper (vol.901 paper# 101)

c:\work\Jor\vol901_102 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 727-732

Impact of Titanium Tetra Flouride Material and 810nm Diode Laser on
Demineralized Human Enamel (In Vitro Study)
Amjed Kamel Al-Hassnawi1, Nada Jafer MH. Radhi2*
(1) Ph. D. student, Department of Pediatric and Preventive Dentistry, College of Dentistry/University of Baghdad,
Iraq.Specialist dentist in specialized dental center.Dewanyiah governorate.
(2) Department of Pediatric and Preventive Dentistry. College of Dentistry/University of Baghdad, Iraq.
*Corresponding author: Nada Jafer MH. Radhi, Phone: (+964)7806314951, Email: nada.radhi@codental.uobaghdad.edu.iq

Dental enamel was treated with laser irradiation and fluoride compounds as a method to enhance fluoride
absorption by the enamel, which resulted in a rise in the mineral content of the enamel and a significant boost in its resistance
to acid demineralization. Objective: The purpose of this research was to look into the effects of Titanium tetra Fluoride
(TiF4) with or without diode laser on the demineralized enamel.
Material and methods: The sample consisted of 65 premolars teeth: 5 teeth remained sound for energy dispersive
spectroscopy (EDS) analysis where 60 teeth were divided into 6 groups by treatment (N=10): (1) control negative (deionized
water), (2) control positive (acidulated phosphate fluoride gel (APF)), (3) 6% Titanium tetra fluoride (TiF4) solution, (4)
diode laser (810 nm, 0.5W, 60 s), (5) Laser then TiF4, and (6) Tif4 then Laser. Microhardness was measured before and
after demineralization then after treatments. Five samples from each group were selected randomly for EDS analysis.
Results: Microhardness increased significantly after all treatments (p<0.05). Results revealed a significant difference for
all treatment groups (p<0.05). EDS analysis revealed that fluoride content was greater in 6%TIF4 then Tif4 with Laser
groups, while the calcium content was greater in control positive followed by TiF4 groups.
Conclusion: TiF4 alone or in combination with laser enhancing demineralized enamel microhardness and fluoride content.
Diode laser before or after TiF4 had minimal extra impact on remineralization.
Keywords: TiF4, Demineralized Enamel, Diode laser, Microhardness, Experimental study, University of Baghdad.


Dental caries is one of the most common oral health
impact on caries therapy and lowers enamel solubility and
issues, resulting in tooth demineralization caused by
permeability (4).
organic acids produced by biofilm bacteria from the
Diode lasers, which are semiconductor lasers,
metabolism of dietary fermentable carbohydrates,
produce coherent light of a single wavelength. Due to its
primarily sugars. The increase of resistance of teeth to
compact size, low power consumption, and cheap cost of
acid attack can be achieved by fluoride that gives hardness
manufacture, diode lasers have become the most
and durability to the tooth enamel and protect against
prevalent kinds of lasers in the world, being utilized in a
caries (1).
wide range of components and disciplines of medical and
Titanium tetrafluoride (TiF4) has been studied since
dental operations (5).
1972 and has indicated promising preventive and

therapeutic properties. It is reported as a stronger
When tissues interact with laser energy, the impact
cariostatic agent compared to other fluoride compounds
is affected by emission wavelengths, tissue optical
via formation of an acid-resistant coating composed of
characteristics, exposure period, laser intensity, and laser
titanium dioxide or other organo-metallic complexes, and
energy absorption into tissues. The absorptive effect
increased fluoride uptake due to the acidic nature of the
governs how the atoms and molecules of the target tissue
compound (2).
convert laser light energy into heat, chemical, acoustic, or
Titanium tetra fluoride is metal fluorides, a nontoxic
non-laser light energy (6).
element, and no side effects have been reported with it.

The benefit has been attributed to the compound's
Laser irradiation is among the new techniques that
titanium group, which synergizes the impact of fluoride
might be promising in the field of remineralization (7)
especially when applied with fluoride (2).
Laser irradiation has been used in the area of
The impact of diode laser in conjunction with
preventative dentistry for its potential to enhance tooth
titanium tetrafluoride on demineralized enamel
structure. Low-power red and near-infrared lasers seem to
remineralization had not been explored before; hence the
be a more appealing option for caries inhibition than high-
purpose of this research was to compare the potential
power lasers. It has been shown that combining topical
effect of TiF4 alone or in combination with diode laser on
mineral treatments with laser irradiation has a synergistic
demineralized enamel.

Received: 23/07/2022
Accepted: 25/09/2022

Full Paper (vol.901 paper# 102)

c:\work\Jor\vol901_103 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 733-737

Free Flank Modified Supine Percutaneous Nephrolithotomy for
Management of Primary Renal Stones
Esam Abdelgawad1*, Khaled M. Abdelhalim1, Hassan A. Abdelwahab1, Mohamed Bakr2, Ahmed M. Kadry1
1. Urology Department, Faculty of Medicine, Suez Canal University, Egypt
2. Urology Department, Faculty of Medicine, Port Said University, Egypt
Corresponding author: Esam Abdelgawad, Telephone: +201501599744,
ORCID: 0000-0003-2055-4791, E-mail: esam76u@gmail.com

Prone percutaneous nehprolithotomy (PCNL) is associated with patient inconvenience, circulatory and
ventilatory impediment. Objective: The aim of the current study is to evaluate the outcome of percutaneous
nephrolithotomy in the free flank modified supine position (FFMSP) regarding the operation duration, hospitalization time,
and the effectiveness and safety.
Patients and methods: From January 2020 to June 2021, 60 patients (36 males and 24 females) with renal stones underwent
PCNL procedure in FFMSP. Descriptive statistics, puncture site, numbers of punctures, operative time, stone free rate,
bleeding, modified Clavien grade of complication, re-treatment rate, additional procedures and hospitalization time were
presented. Results: Multiple stones were in 53% of the cases, the stone distribution was mainly in the inferior calyces and/or
the pelvis of the kidney. Positive history of renal surgery was reported by 70% of cases. The site of puncture was mainly
through the inferior calyx in 83% of cases, 23% of the cases were in need for two punctures, 26% were in need for re-
treatment, mean duration of operation was 89.67 (SD 25.2) minutes, mean hospitalization time was 8.3 (SD 6.32) days and
the patient's ratio who were free from stones was 86%. The average need for an additional procedure was 20%. The
complication grade according to Calvien Dindo classification is mainly grades 2,3A and 4B. Conclusions: The supine
position is effective with average operation duration; however, it has a high complication rate, an increased need for
additional procedures, a re-treatment rate, a long hospital stay and an increased rate for blood transfusion.
Keywords: Supine position, free flank modified supine position, Stone free rate, Descriptive study, Suez Canal University.


the prone position to get better results and conquer these
After Goodwine et al., firstly described the
difficulties (10).
percutaneous kidney access in the prone position, the
In 1998, Valdivia et al., was the first urologist to
earliest case of percutaneous extraction of stone was
perform supine PCNL, reporting many advantages for the
reported. Since then prone percutaneous nehprolithotomy
patients at high anesthetic risk (11).
(PCNL) has been popularly recognized procedure and its
There are many benefits for positioning the patients in
indications were well described (1,2). Recently, PCNL is
supine position, which is easier and less time consuming
best indicated for management of bulky kidney stones,
because there is no need to convert the patient position from
hard stones difficult to crash, or stones occurring in
lithotomy to prone. The supine position gives easy control
anomalous kidneys (3,4).
and accessibility to the airway and is safer for patients with
Historically, PCNL has been carried out in the prone
impaired function of the cardiopulmonary system and
position since it was believed to be a harmless access to
patients with morbid obesity who need long procedure (12).
the kidney allowing puncture of the posterior calyces
The intrarenal pressure is maintained low due to the
through Brodel's line with minimal parenchymal
fact that the tract is horizontal or inclined downwards,
bleeding and avoiding peritoneal and visceral injuries
which may enhance the natural clearance of stone
(5,6). The prone PCNL position causes limitation of the
particles. Both Le Roy et al. and Hopper et al. found only
respiratory movement therefore, is not suitable for all
2% of the patients to have a retro renal colon in supine
patients (7). In the prone position during PCNL, there is
position, which elevated to 10% when prone (13,14). Shoma
reduction of the lung compliance caused by limitation of
et al. studied a total of 130 patients who were operated by
the chest and diaphragmatic movement due to increased
PCNL in a prospective and nonrandomized study in both
abdominal pressure. There is also a lowering of cardiac
prone and supine; found that the stones were cleared in 84
output. All of these make difficult challenges to the
and 89% of patients respectively (15). PCNL in the supine
anesthetist (8).
position can be used safely and effectively as the prone
Marked increased body weight, impaired status of the
procedure (15).
cardiopulmonary system, and skeletal deformities may
Supine PCNL is a head to head alternative to the
cause great challenges to the operator and the anesthetist
standard prone position (16). More prospective, randomized
(9) .The increasing rate of PCNL maneuvers together with
multi-institutional studies are needed to prove the efficacy
increased experience has encourage the urologists to alter
and safety of both procedures. Moreover, recognition and
Received: 23/07/2022
Accepted: 25/09/2022

Full Paper (vol.901 paper# 103)

c:\work\Jor\vol901_104 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 738-742

Flu vaccination effectiveness in Tabuk City, Saudi Arabia
Rofayda Mansour Ahmed Mohamad1*, Salem Khalil Adhahi2, Intisar Alwadai1,
Waheed Ali Alshehri1, Shatha Talal Alhakami1, Manal Muhsen Alatawi1, Nadia Salaman Atawi1,
Mona Salem Atawi1, Abdulla Saeed Althobaiti1, Mohammed Ali Khubrani1, Sakeina Saleem Haroon Mohammed3
1Preventive Medicine Department, 2Department of Home Health Care, and
3Family Medicine Department, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
*Corresponding author: Rofayda Mansour Ahmed Mohamad, Phone: +966545450874; Email: rofayda.mohamad22@gmail.com


Background: There are controversies about vaccination effectiveness of seasonal influenza and its wide variation across
seasons and countries. Objectives: This study aimed to estimate the effectiveness of seasonal influenza vaccination among
adult population in Tabuk City, Saudi Arabia.
Methods: This prospective cohort study included residents aged 18 years or older. 532 participants were divided regarding
vaccination status into two equal groups: the first (vaccine group) received the current influenza vaccine, and the other
(control group) received nothing. Data were collected through a structured questionnaire. The vaccine effectiveness was
estimated based on self-reported data regarding the incidence of chest infection or flu-like illness (FLI) after the vaccination,
duration of the FLI, ability to do the normal daily activity, seeking medical care, need for visiting a clinic, taking
medications, and hospital admissions.
Results: The rate of chest infection after vaccination showed no significant difference between the two groups (p=0.879).
The incidence of FLI in winter following vaccine intake was significantly higher in the vaccine group compared to the
control (p=0.038). The FLI affected the daily life activities of 36 subjects (13.5%) belonging to the vaccine group compared
to 28 subjects (10.5%) in the control group (p=0.286). Seeking medical service for the FLI was recorded in 7.5% and 4.5%
of the vaccine and the control groups, respectively, with no significant difference (p=0.145).
Conclusions: The seasonal flu vaccine lacked significant effectiveness among adult population in Tabuk City, Saudi Arabia.
Regularly improving the immunogenicity and efficacy of influenza vaccines seems a necessity.
Keywords: Effectiveness; Influenza; Saudi Arabia; Seasonal influenza; Vaccination; Tabuk


recommends the annual vaccine intake by healthcare
Seasonal influenza is a highly infectious acute
professionals as well as the public to prevent influenza
disease. It causes inflammation of the upper respiratory
pandemics (7-10). Concerns have emerged regarding the
tract leading to a variety of symptoms, such as high fever,
impact of influenza vaccination on the burden and
sore throat, coryza, body aches, and possibly lower
severity of influenza. There are controversies about the
respiratory tract illness (1). It is caused by influenza A and
vaccination effectiveness and its wide variation across
B virus subtypes. Influenza A is the most common type in
seasons and countries (11-13).
humans, and it has a characteristic high mutation rate,
There is a necessity for monitoring the direct
which is over 300 times faster than influenza B. The
protective effect of the vaccine each season. Therefore,
mutations in the virus antigenic proteins are attributed to
this study was conducted to estimate the effectiveness of
antigenic drift and antigenic shift (2).
seasonal influenza vaccination among adult population in
Globally, seasonal influenza affects about five
Tabuk City, Saudi Arabia.
million people, with approximately 500,000 deaths

annually, particularly among young children and the
elderly (3). Also, it causes a substantial economic burden
Study design and settings
because of the associated complications, hospital
This prospective cohort study was conducted in Tabuk
admissions, and loss of productivity (4).
City, which is located at the North-Western area of Saudi
Vaccination can reduce the incidence of flu and
lessen the severity of infection by eliciting strain-specific
Sample size calculation
immunity. It constitutes the primary approach for
The study sample size was calculated based on an
controlling influenza and is recommended by most
expected incidence in the unexposed of 0.03, an assumed
healthcare providers (5, 6).
relative risk of 3, a confidence level of 95%, and a desired
In Saudi Arabia, seasonal influenza remains a threat
power of 80. The total sample size was 532.
with widespread cases and deaths. The prevalence of
Eligibility criteria
influenza-like illnesses during the holy pilgrimage in
Residents of Tabuk City aged 18 years or older were
Saudi Arabia ranges from 8 to 78.2%. The Ministry of
included in the study. The criteria for exclusion included
Health keeps the seasonal influenza vaccine available,
history of immediate hypersensitivity reactions to eggs
free of charge to all Saudi citizens and residents, and it
Received: 23/07/2022
Accepted: 25/09/2022

Full Paper (vol.901 paper# 104)

c:\work\Jor\vol901_105 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 743-753

Role of Neoadjuvant Chemotherapy Followed by Interval Cyto-Reductive
Surgery in Reducing Progression and Recurrence of Patients with
Advanced Endometrial Cancer
Ahmed Mahmoud Abdou1, Rehab Hemeda2, Doaa Mandour2, Ola A. Harb3,
Mohamed Ali Alabiad*3, Mohamed M. Alkilany4, Loay M Gertallah 4,
Amany Mohamed Shalaby5, Mohamed El-Bakry Lashin1 , Mohamed Moustafa Zaitoun1
1Department of Gynecology and Obstetrics, 2Department of Clinical Oncology and nuclear medicine,
3Department of Pathology, 4Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
,5Department of Histology and Cell Biology, Faculty of Medicine, Tanta University, Egypt.
Corresponding author: Mohamed Ali Alabiad, Email: maabyad@medicine.zu.edu.eg,
ORCID: https://orcid.org/0000-0002-6006-3711, Tele: 00201150509554

Cytoreductive surgery (CRS) roles in advanced EC are not fully defined and there are few published data
about role of neoadjuvant chemotherapy followed by cytoreductive surgery in advanced endometrioid endometrial
adenocarcinoma which is the commonest histopathological subtype of EC.
Objective: The aim of the study was to evaluate the roles of neoadjuvant chemotherapy followed by interval cyto-reductive
surgery in reducing progression improving survival and prognosis of patients who were initially diagnosed with advanced
stage EC. Patients and Methods: we collected 50 patients of advanced endometrial carcinoma stage III and divided them
into 2 groups the first group included 36 (72%) patients who underwent cytoreductive surgery after neoadjuvant
chemotherapy and remaining patients who have not undergone surgery.
Results: Patients who underwent interval cytoreductive surgery after neoadjuvant chemotherapy had longer progression-
free survival rate (12.53 vs. 5 months, p = 0.001) and longer overall survival rate (25 vs. 8 months, p = 0.002) in comparison
with patients who have not undergone surgery.
Using neo-adjuvant chemotherapeutic agents followed by cyto-reductive surgery in cases of advanced
endometrial carcinoma reduces rates of disease recurrences and improving patients' survival rates.
Keywords: Neo-adjuvant chemotherapy, Cyto-reductive surgery, Recurrence, Endometrial cancer.


there are few published data about roles of neoadjuvant
Endometrial cancer (EC) is considered the
chemotherapy followed by cytoreductive surgery in
commonest gynecological cancer in developed countries,

which has a relatively good prognosis. Advanced EC has
endometrioid endometrial adenocarcinoma, which is the
a poor prognosis and a high incidence of progression with
commonest histopathological subtype of EC (11, 12).
the 5-year OS of stage III EC about 36%­57% (1). About
The aim of the study was to evaluate the roles of
13% of female patients with EC were found to have stage
neoadjuvant chemotherapy followed by interval cyto-
III or IV disease (2), at initial diagnosis and have a dismal
reductive surgery in reducing progression improving
outcome (3, 4).
survival and prognosis of patients who initially diagnosed
Management of those patients includes many
with advanced stage EC.
combined lines of therapy, which includes chemo-

radiotherapy in addition to surgery (5). Cytoreductive
surgery (CRS) roles in advanced EC are not fully defined
We collected all cases with EC who admitted to
(6). In the past adjuvant chemotherapy (CT) was found to
Gynecology and Obstetrics Department and General
reduce incidence of distant recurrence but CT could not
Surgery Departments, Faculty of Medicine, Zagazig
prevent occurrence of local or pelvic recurrence, which
University in the period from May 2015 to May 2020. All
happens in about 18% of cases presented with advanced
specimens were sent to the Pathology Department, where
EC (7).
they processed for routine H & E staining, and
It was found that using multimodality treatment,
immunohistochemistry for diagnoses of EC, classification
which include neoadjuvant chemotherapy followed by
into subtypes and grading.
cytoreductive surgery could improve prognosis, decrease

morbidity and mortality in ovarian carcinoma patients (8).
Histopathological study:
This approach was suggested to be beneficial in uterine
For initial carcinoma diagnosis most patients
papillary serous carcinomas (9) due to its histopathological
underwent endometrial biopsy or a paracentesis for
similarity to papillary serous ovarian carcinoma (10). But
cytology. All patients underwent comprehensive imaging
after initial diagnosis and all patients were confirmed to
Received: 23/07/2022
Accepted: 25/09/2022

Full Paper (vol.901 paper# 105)

c:\work\Jor\vol901_106 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 754-756

Outcome of On-Demand Tadalafil in Premature Ejaculation
Mohammad Sayed Abdel-Kader, Ahmed Mahmoud Hasan,
Mahmoud Mohsen Mohammed*, Gamal A. Alsagheer
Department of Urology, Qena Faculty of Medicine, South Valley University
*Corresponding author: Mahmoud Mohsen Mohammed,
E mail: dr.ma7moud.mo7sen@gmail.com , Tel: 01112040604

One of the most prevalent sexual diseases among men is premature ejaculation (PE). Phosphodiesterase type-
5 (PDE5) inhibitors used on-demand were successful in treating PE, according to several studies.
Aims: To evaluate the safety and the efficacy of tadalafil in treatment of patients with premature ejaculation.
Patients and methods:
This study was conducted on 30 patients with at least a 3-month history of PE. All patients were
submitted to clinical examination with stress on genital examination, laboratory testing for complete blood picture, and
hormonal profile. Patients were received on-demand 20 mg tadalafil 2 hours before intercourse. Intravaginal ejaculatory
latency time (IELT) was measured in all patients before and after the treatment (at 4, 8, and 12 weeks).
Results: The mean age was 33.03 ± 7.5 years, with mean body mass index (BMI) of 28.8 ± 2.9 kg/m². The baseline IELT
score was 39.4 ± 10. There was highly statistically significant (p-value < 0.001) increased 4 weeks IELT score (186.6 ±
24.4), 8 weeks IELT score (188.5 ± 21) and 12 weeks IELT score (187.2 ± 20.5) when compared with baseline IELT score
(39.4 ± 10). Conclusion: Tadalafil 20 mg on demand is thought to help PE patients with good levels of safety and
Keywords: Tadalafil, Premature ejaculation, IELT score.


intercourse enjoyment. In PE patients, using dapoxetine
A male sexual disease known as premature
and PDE5i together is therefore associated with greater
ejaculation (PE) is distinguished by the inability to control
efficacy (6). The study's objectives are to evaluate the
or delay ejaculation and a short intravaginal ejaculatory
efficacy and safety of tadalafil in treating patients with
latency time (IELT), and unfavourable personal effects.
premature ejaculation.
PE causes psychological pressure on both men and their

spouses, having a significant negative impact on the
marriage (1). The preferred medications for treating PE
This study was an observational prospective study
over the past 20 years have changed from psychotherapy
done on thirty patients having at least a 3-month history
to medications, mainly phosphodiesterase type-5 (PDE5)
of PE.
inhibitors and selective serotonin reuptake inhibitors
PE is characterised by (1) ejaculation that always or
(SSRIs) (2).
almost always happens prior to or within 1 minute of
The only pharmaceutical approved to treat PE,
vaginal penetration, either present from the first sexual
additional off-label medications, such as long-acting
experience or following a new unpleasant shift in
selective serotonin reuptake inhibitors, or dapoxetine on
ejaculatory latency, according to the International Society
demand (OD) (SSRIs), topical anaesthetics (TAs), and
for Sexual Medicine (ISSM). Patients were given a PE
phosphodiesterase type 5 inhibitors (PED5is), and
diagnosis if they fulfilled these criteria (2) Being unable
tramadol are the most popular therapeutic strategies for
to delay ejaculation throughout all or nearly all vaginal
PE management (3).
penetrations (3) Bad psychological outcomes, such as
Dapoxetine on demand therapy for PE has been
avoidance of sexual activity or feelings of worry,
approved in Europe per The European Association of
irritation, or dissatisfaction (2). All patients received on-
Urology's suggestions. Lifelong and acquired PE may
demand 20 mg tadalafil two hours before to sexual
both benefit with dapoxetine (4).
The effectiveness of PDE5i in the management of PE

has been supported by numerous researches. Central and
Setting: Outpatient Clinic of Urology Department, Qena
peripheral responses are a few of the mechanisms that
University Hospital.
have been proposed for PDE5i's involvement in PE
Inclusion criteria: All married patients verified as having
treatment (5). The vas deferens, seminal vesicle, and
at least a 3-month history of PE and aged older than 18
prostate smooth muscles, and urethra could be mostly
relaxed by PDE5i. Other possible outcomes include
lengthening erections, decreasing sympathetic tone in the
Exclusion criteria: Patients with diabetes mellitus (DM),
central nervous system, and more, and raising overall
chronic prostatitis, patients with erectile dysfunction
Received: 23/07/2022
Accepted: 25/09/2022

Full Paper (vol.901 paper# 106)

c:\work\Jor\vol901_107 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 757-762

Validation of Specimen Pooling Versus Individual Samples for Screening of
Viral Markers and Syphilis in Blood Bag Strategy Single-Center Study
Rania M. Saleh1*, Ahmed Mohamed Farouk2, Maha Anani1, Fadia M. Attia1
1 Clinical Pathology Department, Faculty of Medicine, Suez Canal University Hospital, Ismailia, Egypt.
2 Clinical Pathology Department, Military medical academy
*Corresponding author: drrania82@yahoo.com OR drrania82@med.suez.edu.eg, Mobile: 01224428993

Blood safety is a crucial health concern, and it is still a problem on a worldwide scale. Pool-testing approach
is to combine multiple samples and test them as one pool. A pool-testing strategy can shorten the screening time and
increase the test rate, especially during times of inadequate reporting speed and limited test availability.
Aim: This research aimed to assess the effectiveness of the pool-testing strategy in Egyptian blood banks and to develop
a pooling test to be used in the routine screening of blood donors. We suggest that the use of pooling for blood screening
is beneficial, especially in our country, which has a high rate of hepatitis infection and recent extensive government control
measures, as well as the importance of potential cost savings in Egypt.
Subjects and methods: Sera from 619 volunteer blood donors approaching Suez Canal University Hospital's Blood
Transfusion Department, were screened individually for Syphilis and viral infectious markers HBV, HCV, and HIV by
ELISA, then pooled into pools of five and retested.
The results showed sensitivity, specificity, and accuracy of syphilis and HBV tests were 100% on pooled samples
while HCV test showed sensitivity 71%, specificity 100%, and accuracy 99.68%.
Our present study demonstrated the importance of a pooling protocol and that a pooling scheme of five
samples is helpful for mass screening for syphilis and viral markers in subjects from large populations as blood donors
without loss of accuracy.
Keywords: Syphilis- HBV- HBV- HIV- Pooling- Screening- Transfusion.

blood donations screening for any newly (re)-emerging
For decades, it has been known that transfusion
viruses. In addition to the increased running expenses for
of blood products and plasma derivatives can transmit
instruments and reagents, as well as the requirement for
viral infections, even though it has to be an inevitable
cold-chain transport and reagents storage (5). So,
result of a life-saving procedure. A viral infection can
decreased cost-effectiveness encouraged the advent of
potentially be transmitted by transfusion when it has a
a number of cost-cutting strategies.
long or brief asymptomatic blood-borne stage, as well as
funding to gain trust in the blood supply safety has led to
having the ability to remain in collected blood products
a distinct issue: the discrepancy that the health care yield
and causing infection intravenously (1). The potential of
is usually extremely poor, and the resources could be
viral transfusion-transmitted infections (TTI) has
more effectively used elsewhere (6).
consistently decreased during the previous forty years
Blood safety at all costs comes with risks that
with the development of laboratory investigations for
might affect sustainability and ability to face new
hepatitis B virus (HBV) surface antigen (HBsAg) in the
problems (7). The technique of sample pooling was
1970s (2). Alanine aminotransferase (ALT) and HBV core
demonstrated to be practical for extensive sero-
(anti-HBc) antibodies testing started in the 1980s to
epidemiological research for years ago (8). This technique
decrease the spread of non-A non-B viral hepatitis. Then,
utilizes enzyme-linked immunosorbent assays (ELISAs)
the emergence of the human immunodeficiency virus
to screen samples from multiple demographic groups,
(HIV) and the subsequent rapid identification of hepatitis
which minimizes resources in terms of time, work, and
C virus (HCV) resulted in extraordinary attempts to stop
supplies (9).
the spread of these new blood-borne viruses and the
Transfusion safety continues to be the main
introduction of antibody tests for both of these agents (3).
driver for the invention of technically advanced
To rule out those who are susceptible to transmit
technologies that can be applied for blood screening for
viral infection, a donor screening procedure has been
facing the ongoing (re)emergence of novel viruses and
established and implemented. This procedure involves the
variations of existing viruses (10). Our research was
donor's medical history and a short physical examination.
planned to assess the detection of Syphilis and viral
The following critical step in lowering viral TTI was
infectious markers HBV, HCV, and HIV by using ELISA
accomplished with the establishment of serologic testing
in plasma pools in blood donors rather than in individual
(4). Blood banks are under increasing economic pressure
samples to lower the time of screening and cost burden on
regarding the addition of any costly molecular testings for
blood banks in Egypt as a developing country.
Received: 23/07/2022
Accepted: 25/09/2022

Full Paper (vol.901 paper# 107)

c:\work\Jor\vol901_108 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 763-767

Polyglycolic Acid Sheets and Fibrin Glue Versus Nasolabial Flap for
Reconstruction of Oral Mucosal Defects
Tarek Elsayed Ftohy Abdelrahman*1, Kamal A. A. Hassanein1, Islam A. Elzahaby2,
Ahmed Gaber Hassanein1, Islam A. Amer1, Ahmed Gaber Mahmoud1
1Department of Surgery, Faculty of Medicine, Sohag University, Egypt
2Department of Surgery Oncology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Tarek Elsayed Ftohy Abdelrahman, Mobile: (+20) 01062062481, E-Mail: tarekftohy2@gmail.com
Background: Early-stage oral cancers are usually treated with surgical resection and in most of cases the resulting
defects are too large to be primarily reconstructed. There are many modalities of reconstruction as nasolabial flap, buccal
bad of fat, polyglycolic acid sheets. Objective: This work aimed to evaluate the reconstruction of oral mucosal defects
using either polyglycolic acid (PGA) sheet or nasolabial flap.
Material and Methods: 51 patients of them 26 were reconstructed using (PGA) sheet, and 25 using nasolabial flap
retrospectively. The tumors' location, perioperative situation, postoperative aesthetic and functional results were
assessed. Results: There was no significant difference between the 2 groups regarding the early start of oral feeding or
hospitalization time. While, the PGA group had significant shorter operative time. In cases with exposed bone surface,
the PGA sheet was more feasible for reconstruction. There was no significant difference between the 2 groups in speech
intelligibility in lingual cases. In buccal reconstruction the PGA sheets were more suitable for larger defects.
Conclusion: The optimal choice of nasolabial flap or PGA sheet depends on tumor location, mucosal defect size, the
general condition of the patient and tolerability for surgery.
Keywords: Oral mucosal defect, Polyglycolic acid sheet, Nasolabial flap.


polyglycolic acid (Neoveil) sheets and fibrin glue for
Early-stage oral cancers are usually managed with
the restoration of oral mucosal lesions.
surgical excision and in most of cases the resulting

mucosal defects are too large to be primarily
reconstructed. Extensive mucosal defects are usually
A retrospective study included patients who had
managed with free vascularized grafts. While, in
surgery for oral cancer resulting in mucosal defects and
intermediate ones, there are many modalities for
were reconstructed by PGA sheets or nasolabial flap at
reconstruction such as nasolabial flaps or submental
Maxillofacial Surgery Unit, General Surgery
flaps and recently polyglycolic acid (PGA) sheets and
Department, Faculty of Medicine, Sohag University,
fibrin glue were used (1).
Egypt. The study was conducted between April 2014
The nasolabial flaps are perfect for reconstructing
and June 2020.
the mouth. It is straightforward and appropriate for the
Ethical consent: The Academic and Ethical Committee
closure of oral deformities in the tongue, cheek, and
of Sohag University granted its clearance for the study.
mouth floor (2, 3). The inferiorly based flap is used to
Each patient signed a written informed consent form to
reconstruct the lip, oral commissure, and anterior region
agree to participate in the study. The Declaration of
of the mouth floor. It can be superiorly or inferiorly
Helsinki, the World Medical Association's code of
based (3, 4). The flap's thickness is determined by the
ethics for studies involving humans, guided the conduct
thickness of the donor tissues and the requirement for
of this study.
the defect. A nasolabial flap is a straightforward
operation with little risk of complications and donor
Inclusion criteria: All patients with oral mucosal
defect (2-4).
defects beyond primary repair and not too large defects,
A polyglycolic acid nonwoven membrane makes
which is usually reconstructed with free vascularized
up PGA sheets (a homopolymer with a molecular
weight of 100,000 Dalton). Through a unique
Exclusion criteria: Cases presented with recurrent
procedure, the cloth acquires its elastic and soft
lesions associated with marked fibrosis and severe
qualities. Fibrin glue is utilized to adhere the PGA sheet
limited mouth opening.
(Neoveil, Gunze Co., Ltd., Tokyo, Japan). Recently,
Polyglycolic acid sheet and fibrin glue technique
oral mucosal lesions have been repaired using PGA
According to Takeuchi et al. (1), following effective
sheets (4).
hemostasis, the mucosal defect was treated with a small
To our knowledge, there are no papers that
quantity of fibrin glue spray (fibrinogen). The defect
compared PGA sheets with nasolabial flaps for the
was then covered with a PGA sheet that had been cut
repair of oral mucosal lesions in a sufficient number of
into pieces the same size as the remaining region, and
instances. Therefore, we undertook this study to
the sheet and surrounding area were sprayed with a
evaluate the effectiveness of nasolabial flaps vs
solution of fibrin glue and thrombin using a specialized
Received: 24/07/2022
Accepted: 26/09/2022

Full Paper (vol.901 paper# 108)

c:\work\Jor\vol901_109 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 768-774

Management of Complicated Acute Appendicitis in Adults:
Laparoscopic versus Open Appendectomy
Yasser Baz1, Yasser A. Orban*2, Ibrahim A. Heggy2
1Department of Surgery, Faculty of Medicine Helwan University, Egypt
2Department of Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Yasser A. Orban, Mobile: (+20)01002428734, Email: yasser_ali_orban@yahoo.com

Nowadays laparoscopic appendectomy (LA) is the management of choice for acute appendicitis (AA) in
simple, uncomplicated cases. For complicated acute appendicitis (CAA), laparoscopic or conventional open
appendectomy (OA) is still in debate.
Objective: This study aimed to compare minimally invasive LA and traditional OA in CAA cases.
Methods: In this study, 44 patients with CAA (22 for LA and 22 for OA) with 18 years of age or older were enrolled.
It was conducted in General Surgery Department, Helwan University Hospital.
The operative time difference between the LA and OA groups was statistically significant (18.5 minutes shorter
in the OA group, (p<0.001). The median length of hospital stay, return to normal activity, and patient satisfaction were
significantly better in the LA group (p-values of 0.001, 0.00, and 0.14 respectively). The need for analgesics in the LA
group was significantly lower than in the OA group. There were no detectable statistically significant findings
concerning the occurrence of surgical findings, postoperative vomiting, postoperative ileus, wound infection, wound
dehiscence, or postoperative intra-abdominal collection.
Conclusions: Laparoscopic appendectomy management of CAA is feasible, safe, and has numerous advantages over
the traditional open procedure in terms of reducing postoperative pain, requiring fewer analgesics, shortening the
postoperative hospital stay, having a low incidence of postoperative infectious complications, and allowing a rapid
return to daily activities with improved comfort and satisfaction.
Keywords: Laparoscopic appendectomy, Complicated appendicitis, Open appendectomy.

randomized-controlled study comparing laparoscopic
Acute appendicitis (AA) is among the most
and open appendectomy in adults (18 and older). Using
prevalent abdominal surgery emergencies worldwide (1).
the closed-envelope randomization approach, the
It is most often seen in patients between 10 and 30 years
patients were divided randomly into 2 groups, with 22
old (2). If neglected, AA ultimately complicates (20­
participants in the LA group and 22 in the OA group. It
30%), leading to gangrene, perforation, local peritonitis,
took place at General Surgery Department, Helwan
or diffuse peritonitis, among other potentially serious
University Hospitals.
problems (3-7). The diagnosis of complicated acute
Criteria for inclusion: The study included adult
appendicitis (CAA) is primarily built on a combination
patients with CAA, defined as perforated AA,
of clinical suspicion of AA progression of severity,
gangrenous AA, and a walled-off abscess of localised
inflammatory laboratory blood markers, and pelvi-
peritonitis or diffuse peritonitis, by either preoperative
abdominal imaging such as ultrasonography (US) and
or intraoperative diagnosis. Preoperative diagnosis was
computed tomography (CT) (6-9).
built on history, thorough clinical examination,
The optimal treatment of CAA remains
participants' laboratory findings, and abdominal US,
indeterminate (10). CAA is associated with more risk of
whereas an abdominal CT scan was saved only for
postoperative morbidity and mortality and has been
selected cases. However, the intraoperative gross
delineated as a relative contraindication for LA.
appearance was the basis for the intraoperative
Nevertheless, this conception has been faced by some
authors. There is a lack of good evidence-based support
for the LA approach for CAA (11-13). On review of the
Criteria for exclusion: Non-CAA patients, patients
literature, most research studies were retrospective and
with CAA aged less than 18 years, pregnant females and
involved heterogeneous groups of cases (7). We assumed
patients with prior abdominal surgeries. Patients who
that laparoscopy is superior to traditional OA in the
are unfit or unwilling to participate in the study, or who
management of CAA, and our purpose of this
had their LA converted to open.
investigation was to compare the outcomes of LA
Preoperative evaluation: All participants were
versus OA in cases with CAA in terms of the operative
exposed to complete history taking, general and local
time, perioperative morbidity, hospital stay, time to
clinical examinations, required laboratory tests, and
return to daily activities, and patients' satisfaction.
imaging investigations, including abdominal US and
CT. Preoperatively, all participants received 1 gram of
Between January 2021 and March 2022, 44
third-generation cephalosporin and 0.5 gram of
participants were involved in this prospective,
Metronidazole intravenously.

Received: 01/09/2022
Accepted: 02/11/2022

Full Paper (vol.901 paper# 109)

c:\work\Jor\vol901_110 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 775-779

The Effect of Surgical Wound Infection on Postoperative Hospital Stay
Ahmed Mohamed Saeed1, Ahmed Osama Abdelmotaal Abdelmeguid1, Wael abd Elatief Khafagy2*
1 Obstetrics and Gynaecology Department, Faculty of Medicine, Al-Azhar University, Egypt
2 Obstetrics and Gynaecology, International Islamic institute, ART Unite
Corresponding Author: Wael abd Elatief khafagy,
Mobile phone: 01005828758, Email: Waelkhafagy2019@gmail.com

Patients who experience any postoperative complication have longer hospital stays. Infection at the
surgical site is the major cause of postoperative problems and lengthening of hospital stays. However, numerous
variables contribute to the development of surgical site infections.
Objective: The present study is aimed to investigate the effect of surgical wound infection on postoperative hospital
stay. Patients and methods: This study was conducted in Al Hussein and Al Mokatam General Hospital from February
to August 2022 on 20 cases. Complete history and demographic data were obtained along with complete physical
examination from all participants. All data regarding characters of the surgical wound and time of discharge was
recorded. Results: Mean age in the included patients was 42.22 (SD 10.94) years. Mean weight was 87.72 (SD 13.5)
kg. Mean height was 166.56 (SD 5.88) cm. Postoperative Hb reached 11.36 (SD 0.54) g/dl. Among 20 patients included
in the study lower segment cesarean section (LSCS) was reported in 4 (20%) of cases, myomectomy was in 3 (15%)
and total abdominal hysterectomy (TAH) was in 13 (65%) cases. Mean time to discharge in gapped wound was 2.5 (SD
2.1) days. Time to discharge was significantly increased in cases with gapped wound. There was significant negative
correlation between hospital stay and good wound.
Conclusion: Depending on the surgical category, the length of hospital stays and wound characteristics related to
surgical site infection (SSI) vary greatly by identifying the surgical techniques that have a SSI unfavourable effect that
is more severe. A strong inverse relationship exists between hospitalisation and healing wounds.
Keywords: Surgical site infection; Length of hospital stay, Time to discharge, Case series, Al-Azhar University.

the release of new medications (4). The prevention of
Patients who encounter any postoperative
SSIs has received more attention since the U.S. Centres
difficulties often stay in the hospital for 3 to 11 more
for Disease Control and Prevention (CDC) released the
days than those who do not. According to a recent study,
Guidelines for Prevention of Surgical Site Infection in
regardless of preoperative patient risk, complications
1999.There have been several reports released about
that lasted 30 days or more decreased median patient
how to prevent SSIs and how common they are (5).
survival by 69% (1).
The present study is aimed to investigate the effect of
The third most common type of infection
surgical wound infection on postoperative hospital stay.
connected with healthcare is surgical site infection

(SSI), which makes about 14%­16% of all such
illnesses. According to reports, patients who experience
This was a study conducted in Al Hussein and Al
SSIs have a 2- to 11-fold increased chance of dying,
Mokatam General Hospital from February to August
making them one of the clinically significant post-
2022. The study was conducted on 20 cases. All were
operative consequences. An average of 2 to 5 percent of
followed at the Obstetrics and Gynecology Units.
surgery patients is predicted to experience SSI (2).
The study population consisted of female patients >20
According to estimates, SSI was directly
years. Patients underwent one of the following 3
responsible for 0.64% of hospital mortality in the USA.
categories of surgery: Lower segment cesarean section
According to a recent study from Europe, the infection
(LSCS), Myomectomy, and Total Abdominal
was to blame for 38% of patient deaths with SSI,
Hysterectomy (TAH) were enrolled in the study.
translating to an attributable mortality of 0.9%.
Emergency cases in all categories were excluded.
Furthermore, patients with SSI spend longer in the

hospital, which increases the overall cost of
The following data were collected from all
hospitalisation. The severity of these negative effects
varies depending on the type of surgery, the country of
Complete history taking: Personal history, any
investigation, and the methods employed (3).
complaint, Obstetric history, menstrual history, past
medical and past surgical history, and family history.
development, medical co-morbidities, and preoperative
Complete physical examination including General
antibiotic selection are only a few of the many factors
examination: Vital signs (Blood pressure, Temperature,
that affect SSIs. Despite being a well-established
Heart rate, Respiratory rate).
Every patient receiving surgery in any of the selected
administration during elective colorectal surgeries has
surgical categories, information on their demographics,
recently changed due to changes in drug availability and
discharge, and potential risk factors were recorded.

Full Paper (vol.901 paper# 110)

c:\work\Jor\vol901_111 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 780-786

The Role of Some Organic Acids in The Eradication of Antibiotics
Resistance of E. Coli Isolated from Urinary Tract Infections
Noor Saad latteef1, Warqaa Y. Salih 2, Ali Abdulmueen Al-lawi3
1,2,3 Biotechnology Department Genetic Engineering and Biotechnology Institute for postgraduate,
University of Baghdad, Baghdad, Iraq
Corresponding author: Noor Saad Latteef, Mobile: 0096 47711170239, Email: noorsaad@ige.uobaghdad.edu.iq

The organic acids like succinic acid and malic acid have an antibacterial impact on E.coli infection.
Objective: The aim of the present study is the detection of E.coli in urine samples using PCR and antibiotic susceptibility
testing of strains obtained from people and food using ampicillin and erythromycin, in addition to testing malic and
succinic acids against uropathogenic E.coli.
Material and methods: This study describes a biochemical and polymerase chain reaction E.coli test. PCR can
accurately verify E.coli colonies on culture plates. The Minimum Inhibitory Concentration (MIC) method assessed
organic acids and antibiotics for bactericidal action.
Results: The study showed that malic acid has a higher ratio of inhibition that increase from 0.06 to hit 0.14 in
concentration 0.3 mg/ml, while Ampicillin's ratio of inhibition fluctuates the same level until rise gradually to reach 0.04
in concentration 0.09 mg/ml. Succinic acid's ratio increased to 0.35 in concentration 0.4 mg/ml, while in 0.5 mg/ml hit 0.4
and dropped to 0.1 in the concentration of 0.6 mg/ml, in contrast to Erythromycin that have a higher ratio of inhibition
increased gradually to reach 1.5 in concentration 0.7 mg/ml.
Conclusion: Urinary tract infections caused by E.coli may be challenging to treat empirically in Ile-Ife due to antibiotic
resistance. In order to reduce the selection pressure that could lead to the spread of E. coli in the environment and to
increase the likelihood of a successful treatment, culture and susceptibility tests must be performed prior to administering
any antibiotics.
Keywords: Urinary tract infection, Escherichia coli, Succinic acid, Malic acid, Antibiotic resistance, University of Baghdad.


One of the most prevalent bacterial diseases in
Before beginning treatment, it is important to do
humans is urinary tract infection (UTI), which is most
susceptibility and culture tests on the bacterium that is
usually brought on by E.coli (1); The main source of
causing the infection in order to determine whether or
nosocomial and community-acquired diseases (2).
not it is susceptible to the antimicrobial agents that will

be used (10).
When exposed to antimicrobials, commensal E.coli

in the gastrointestinal system is particularly capable of
For severe UTIs such pyelonephritis, amoxicillin-
passing on its genes for resistance to antibiotics to a
clavulanic acid is the treatment of choice. Amoxicillin-
variety of other microorganisms, including pathogenic
clavulanic acid resistance rates among UPEC vary
bacteria (3). This is supported by the findings of a great
greatly between regions. In the European countries, the
deal of study that has been carried out over the years (4,5).
levels of resistance to this antimicrobial range from
Colonization and/or infection of humans is possible
5.3% (Germany) to 37.6% (France) (11).
through unintentional or occupational contact, as well as

through the intake of food that has been tainted with
Seven distinct antibiotics were evaluated, and each
pathogens. There is a widespread dissemination of
one was shown to be effective against a different isolate.
antibiotic-resistant microorganisms throughout the food
Each of the isolates that was examined had some level of
chain, most notably in animal products (6).
resistance to the various antibiotics that were utilized in

the examination process. The majority of bacteria tested
There has been an increase in the number of E.coli
positive for resistance to ampicillin, but just a small
isolates that are resistant to treatment, and a number of
percentage of bacteria tested positive for resistance to
studies have discovered epidemiological linkages
gentamicin (12).
between these strains and humans as well as food (7,8,9).

Researchers discovered that the organic acids in
Urinary tract infections that are brought on by E.coli
cranberry juice can prevent E.coli from colonizing the
in Ile-Ife may be difficult to treat empirically with only
bladder in a mouse model of a urinary tract infection
nitrofurantoin as a treatment due to the extensive
(UTI). The study was conducted on mice (13).PCR
resistance to regularly used antibiotics in the region.
Received: XX/XX/2022
Accepted: XX/XX/2022

Full Paper (vol.901 paper# 111)

c:\work\Jor\vol901_112 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 787-790

Impact of Covid-19 Disease on Tuberculosis in Kuwait:
Study from TB Referral Center
Mohammed Abdalla Rakha*1, 2, Asmaa Ali3, Mohmod Omer1, Ahmed Alsyed1, Eman Al- Anbay1
1Department of Pulmonary Rehabilitation Center- Chest Hospital- Kuwait City, Kuwait
2Department of Chest Diseases, Al-Azhar University, Cairo, Egypt
3Department of Pulmonary Medicine, Abbassia Chest Hospital, MOH, Cairo, Egypt
*Corresponding author: Mohammed Abdalla Rakha, Mobile: 0096598847662, E-Mail: drrakha41@gmail.com

Tuberculosis is an endemic disease in various regions of the world like South East Asia. The State of
Kuwait compromises a diverse population of non-Kuwaiti expatriates mostly from India, Bangladesh, and Egypt. The
Pulmonary Rehabilitation Centre (PRC) in Kuwait is a referral center for all diagnosed cases that have tuberculosis
either active or latent.
Objective: To study the impact of covid 19 disease on tuberculosis during its pandemic within the period from March
2020 to March 2021 and to compare it with the previous 1 year from January 2019 to February 2020.
Patients and Methods: Data were collected from our system for comparison of the rate of diagnosis and treatment each
month over two years from January 2019 to the end of 2020, which was done during the period of lockdown (total
Results: Before COVID-19 disease, the annual number of active TB was 534, which decreased during the pandemic
without reaching the critical difference; mean±SD= 423.3±103.4, P> 0.05. On the other hand, the annual number of
latent TB cases was 438 before the pandemic, which showed a significant increase with a mean of ±SD= 624.5±154.5,
P=0.007. Additionally, Latent TB cases in the COVID-19 era showed significantly higher reports than active TB, P <
0.05. Moreover, we found a considerable double number of multi-drug resistance pulmonary tuberculosis and one case
suspected extensive drug resistance.
Conclusion: Covid 19 pandemic had a significant impact on tuberculosis care as regards diagnosis and treatment as
well as follow-up.

Keywords: Tuberculosis active, Latent covid 19 pandemics, Drug resistance tuberculosis.


Coronavirus disease (COVID-19) is a highly
Patients and study type
infectious disease caused by novel coronavirus named
A retrospective cohort study was done for all
as SARS Cov-2. It originated in the big city of Wuhan,
tuberculous cases, referred to Pulmonary Rehabilitation
the capital of the Hubei province of China in December
Center and it compared the pre-lockdown during the
2019 and has been announced pandemic by the World
period from March 2019 to March 2020 with the
Health Organization. It has a serious impact on people
lockdown and post-lockdown periods through the
with pre-existing health conditions and has many side
period from March 2020 to March 2021.
effects in the management of other diseases [1, 2].

Data collection:
Tuberculosis (TB) is the world's greater killer
The study used patient records and digital
among infectious diseases, claiming more than 4000
laboratory results in addition to radiological reports
lives each day. India has the biggest number of both
among pulmonary and extrapulmonary as well as latent
drug-sensitive and drug-resistant TB [3]. Kuwait is one
of the biggest countries for the recipient of Asian
In pulmonary tuberculosis, the data collected
workers mainly from India.
included AFB smear status, Xpert DNA load, culture
Patients who are on treatment from tertiary care
status, time to culture positivity, hospital admission rate,
hospitals are severely affected due to the lockdown
outpatient follow-up rate, sputum time, AFB conversion
implemented to control coronavirus infection. Almost
to negative, rate of defaulters, as well as the rate of
every country has established national TB programs,
resistant cases.
whereas national programs for COVID-19 are urgently
In extrapulmonary tuberculosis, the data included
required [4, 5].
AFB status, Xpert DNA load, culture status, outpatient

follow-up rate, rate of defaulters, and rate of resistant
However, in March 2020 a rapid analysis
conducted by the Stop TB Partnership brought attention
In latent tuberculosis, the data included the
to s major impacts of COVID-related lockdowns on TB
proportion of screened contacts identified with latent
care in different countries [6].
tuberculosis infection (LTBI), the outpatient follow-up

rate, and the rate of defaulters.
Received: 14/7/2022
Accepted: 17/9/2022

Full Paper (vol.901 paper# 112)

c:\work\Jor\vol901_113 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 791-795

Chest CT Scan Findings in A Sample of Patients with COVID19 Infection
Karim Mahmood Hussein1*, Ali Khalaf Salim2, Sawsan Sahib Hamzah3
1 Department of Anatomy, College of Medicine, University of Kirkuk, Iraq.
2 Kirkuk Oncology and Hematology Center, Kirkuk health directorate, Kirkuk, Iraq
3College of Dentistry, Al-Farahidi University, Baghdad, Iraq.
*Corresponding author: Karim Mahmood, Mobile: +964 770 124 0295, E-mail: karimazaw@uokirkuk.edu.iq

: Coronavirus disease 2019 (COVID-19) or severe acute respiratory syndrome coronavirus 2 (SARSCoV-2)
on January 7, 2020, was established as a source of the discovered cases, previous name was "2019-NOVAL" corona-virus
"2019 nCoV", then the epidemic was termed COVID-19; Fever, fatigue, dry cough, and dyspnea, as well as a variety of
chest imaging features are what COVID-19 is characterized by.
Objective: This study focuses on critical imaging chest CT scan characteristics in COVID-19 patients with positive PCR
to aid in accurate diagnosis and therapy.
Patients and methods: This study concentrated on the most recognizable CT-scan features in established cases of (COVID-
19) to distinguish the various CT-scan appearance that aid in effective diagnosis as well as proper management.
Results: Ground-glass patchy opacities (33.3%) then ground-glass opacities with consolidations (24.4%), then ground-glass
opacities with subpleural linear fibrotic bands abnormality (14.4), crazy-paving pattern (13.3%), single air bronchogram
(10.0%), and consolidation patches only (4.4%) were the most prominent chest CT scan findings in COVID-19 patients. In
the examined patients, no cavitary-like lesions or sizable lymphadenopathy were detected. The lesions in the lung displayed
distinctive bilateral predominantly right side, mostly all lobes affected, especially basal, and peripheral subpleural in
Conclusion: The CT-scan imaging features seen in (COVID19) cases may aid a rapid and precise diagnosis of COVID19
then detailed evaluation of pulmonary parenchymal affection and disease severity.
Keywords: Coronavirus infections, COVID-19, Computed tomography, ground glass opacity, Case series, University of

scan of the chest; In the context of diagnostic CT-scan
The first four reported cases were detected by
results, the polymerase chain reaction (PCR) as a
screening test may be false negative initially (8).
measurements for pneumonia of unknown origin which
It was applied in some local studies for diagnosis of
was established during the 2003 SARS pandemic )1(.
COVID among infected pregnant women (9).
On (31 December 2019) WHO reported several
However, with the COVID19 outbreak and the fast
instances of unknown cause type of pneumonia in
growing world-wide pandemic that has resulted in
Wuhan-China (2) on (7-January-2020), corona-virus
catastrophic mortality, accurate patient diagnosis and care
disease 2019 (COVID19) or severe acute respiratory
requires a detailed understanding and description of
syndrome coronavirus 2 (SARSCoV-2) verified the
diagnostic imaging characteristics, differential criteria,
etiology of such discovered cases (at previous time
and chest imaging findings (10). This study focuses on
identified as 2019 new corona-virus 2019-n CoV), and the
critical imaging chest CT scan characteristics in COVID-
epidemic was dubbed COVID19 (3). The World Health
19 patients with positive PCR to aid in accurate diagnosis
Organization declared a global health emergency on
and therapy.
January 30, 2020. On 20/Feb/2020, 75,761 cases and

about 2130 fatalities were reported in more than 30
countries (4).
This was a retrospective research in which 90 cases
Because the COVID-19 largely affects the respiratory
that test result positive for newly discovered corona-virus
system, chest imaging is strongly recommended for both
by naso-pharyngeal exchange received a CT-scan of the
initial screening and follow-up in suspected patients (5),
chest in July 2020. The patients' ages ranged from 20 to
while chest radiographs are ineffective in the early stages
80 years old. There were 55 men and 35 females, for a
of illness, CT lung alterations may be detected even
male to female ratio of 1.6:1.
before clinical symptoms arise. Chest radiographs with
All pictures were taken while the patients were in the
symptoms of acute respiratory distress syndrome (ARDS)
supine position, using CT-Scan Chest procedures. Scans
may be beneficial in the mild to severe types of COVID-
were performed from the proximal thoracic intake to the
19 (6,7), the chest imaging findings are the consequence of
lower costophrenic angle level, with the following scan
COVID-19 overlapping with other viral pneumonias CT-
settings utilized voltage of the CT tube (120 kVp), (250
Received: 24/07/2022
Accepted: 26/09/2022

Full Paper (vol.901 paper# 113)

c:\work\Jor\vol901_114 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 796-802

Assessment of The Effect of Lyophilized Platelet-Rich Plasma on
Superficial Wrinkles
May H. El-Samahy, Tabarak R. M. Alwaheely, Mona A. Ibrahim*
Department of Dermatology, Venereology, and Andrology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Mona Abdel-Halim Ibrahim, Mobile: (+20) 01006228698,
E-mail: monaabdelhalim@med.asu.edu.eg

Lyophilized platelet-rich plasma (L-RPR) is considered a simple and effective comparable method
to fresh preparations of platelet-rich plasma (PRP). It is prepared using platelets concentration derived from
different donors. It is ubiquitously available and enables medical professionals to inject a specific volume of
growth factors. Objective: The aim of the current study is to assess the effect of L-PRP in treating superficial
Patients and methods:
The present one-arm clinical trial was performed on 20 adult females (age range between
30 and 50 years old) with Type I and II superficial wrinkles (Glogau classification). The entire face was injected
with a 2 cm reconstituted vial of sterilized L-PRP (L-GF®) for 3 treatment sessions at 2-week intervals. The
evaluation was done before each treatment session and 2 weeks after the last session with 8 megapixels and Antera
3D® cameras. The wrinkles indentation index, the texture (roughness) score, the average melanin level, and the
melanin variation were calculated.
Results: The mean duration of wrinkles was 5.8 (SD 2.9) with a range of 2-12 years. Most cases (95%) had skin
type III and Glogau classification type II (75%). A statistically significant difference was found before and after
treatment in the average melanin level using Antera 3D® camera assessment. However, no significant difference
was found before and after treatment regarding the roughness score, melanin variation level, and wrinkle
indentation index. Treatment was well tolerated with minimal local side effects.
L-PRP is a safe, simple, and cost-effective treatment modality for aging-related hyperpigmentation.
Keywords: L-PRP, wrinkles, PRP, Pigmentation, Aging, One-arm.


PRP as it has a much longer shelf life (12 months in
Skin aging is a physiological process that poses
L-PRP vs 8 hours in fresh preparations). In order to
significant distress to many people, especially
achieve standardization, apheresis and platelet
females. Skin aging occurs by combined
processing were obtained from different volunteers,
mechanisms; intrinsic as hereditary or hormonal
thereby eliminating variations in the concentrations
factors and extrinsic as ultraviolet rays (UVR) and
of platelets and growth factors between individual
smoking. The combination of these factors leads to
donors (4).
the appearance of signs of aged skin clinically in the
On the other hand, leukocyte depletion, gamma
form of atrophy, laxity, sagging, dryness,
irradiation, or lyophilization have no deleterious
dyspigmentation, telangiectasia, and wrinkles (1). The
effects on growth factor concentrations (5,6).
increased desire to look younger led to the
L-PRP powder contained a variety of growth
development of novel dermatological techniques for
factors, such as transforming growth factor ß1 (TGF-
treating skin aging. Recently, a greater emphasis has
ß1), platelet-derived growth factor-AB (PDGF-AB),
been placed on minimally invasive treatments and
vascular endothelial growth factor (VEGF), basic
approaches for treating skin elasticity, wrinkles,
fibroblast growth factor (bFGF), insulin-like growth
dyspigmentation, roughness, and skin photodamage
factor 1 (IGF-1), epidermal growth factor (EGF),
interleukin (IL)-1a, IL-1b, and IL-1 receptor agonist
Platelet-rich plasma (PRP) has gained interest as
(IL-1RA) (7). These various growth factors can have a
a minimally invasive technique in treating the signs
beneficial effect in reducing skin aging. Scarce data
of skin aging. PRP stimulates the body's natural
is available on the role of L-PRP in skin
healing process and tissue regeneration by releasing
rejuvenation. The aim of the current study is to assess
platelet-derived compounds at the treatment site in a
the effect of L-PRP in treating superficial wrinkles.
hyperphysiologic manner. It may result in the

reduction of a number of age-related skin aging
symptoms (3).
The study groups:
Lyophilized PRP (L-PRP) is a novel and refined
The present one-arm clinical trial included 20
form of PRP. It shares the same first preparation
adult females (30-50 years old) with superficial
steps, benefits, and uses of PRP. However, L-PRP
wrinkles (Type I and II by Glogau classification) (8).
uses allogenic, pathogen-free platelets as a source of
Exclusion criteria include patients who had
growth factors as opposed to autologous platelets. It
received facial dermabrasion procedures, topical or
offers many advantages over fresh preparations of
systemic retinoid use, facial botulinum toxin
Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 114)

c:\work\Jor\vol901_115 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 803-805

Musculoskeletal Diagnoses for Patients with Non-cardiac Long-Standing Chest Pain
Sheerwan Bahaa Assim1, Zainab A. Mahmood 2, Ammar Salih Abbood3, Haider Kadhem Saeed4*
1Cardiologist. Department of Medicine, 2Rheumatologist. Department of Medicine,
3Cardiologist. Department of Medicine, College of Medicine, University of Basrah, Basrah, IRQ
4Otolaryngologist, Department of Surgery, Alzahra College of Medicine,
University of Basrah, Alsadar Teaching Hospital, Basrah Health Directorate, Basrah, IRQ
*Corresponding author: Dr. Haider Kadhem Saeed, Mobile: (+96) 47705757688, Email: haider.kadhem@uobasrah.edu.iq

Three quarters of patients with non-diagnosed chest pain after a normal cardiac evaluation continue to
complain from residual pain. By careful history taking and physical examination, number of those patient diagnosed to have
musculoskeletal pain. The proper management will help to reduce the socio-economic consequences due to fear and anxiety
of undiagnosed coronary artery diseases.
Aim: To highlight one of the other differential diagnoses of ischemic chest pain.
Patients and Method: Fifty patients with chest pain were involved. All these patient had chronic chest pain and normal all
cardiac evaluations. These patients were examined by rheumatologist to reach the final diagnosis.
Results: The mean age was 46.6±14 standard deviation. About 40% of the patients were complained from left side chest
pain. The final diagnosis was either muscular pain, shoulder problem, cervical radicular pain, costochondritis, or
Conclusion: Musculoskeletal chest pain is not uncommon and an important differential diagnosis of chest pain for patients
presented to cardiac clinic. After exclusion of cardiac causes, a high index of suspension and an appropriate approach is
recommended to diagnose and treat these conditions to improve patients' quality of life.
Keyword: chest pain, ischemic heart disease, musculoskeletal pain, shoulder diseases.


Patients who present to the office with chest pain
The likelihood of chronic coronary syndrome
are a diagnostic challenge due to many possible
decreases by a normal ECG exercise test or normal
etiologies, including life-threatening conditions (1).
calcium score by CT, keeping in mind false negative ECG
The key for a definitive diagnosis is a precise and
exercise test especially in the absence of a diagnosis that
a detailed clinical history. The diagnosis can be achieved
explains patients' symptoms (6).
by history alone in substantial number of patients. A
If clinical assessment alone cannot exclude
careful physical examination and special tests should be
coronary artery diseases, the diagnosis can be established
done to confirm the diagnosis and to exclude other
by non-invasive tests. The current Guidelines recommend
diagnoses. Almost 70 - 75% of patients with non-
the use of functional imaging or anatomical imaging by
diagnosed chest pain next to normal cardiac assessment
CT coronary angiography as an initial test for coronary
remain suffering from residual discomfort with
artery diseases diagnosis (7).
significant individual and socioeconomic concerns due to
An anatomic assessment by CTCA or invasive
fear and anxiety of undiagnosed coronary heart diseases,
coronary angiography should be considered in cases of
loss of working capability, and repeated hospitals'
non-diagnostic findings or a strong suspicion conflicting
admissions (2).
with stress tests findings.
Differential diagnoses of chest pain include

cardiac, pulmonary, musculoskeletal, gastrointestinal or
psychological disorders. Musculoskeletal causes accounts
To highlight one of the other differential diagnoses of
for 5­20% of consultations to chest pain clinics (3).
ischemic chest pain.
The ECG is the initial test for evaluation of a

patient presents with a chest pain. An echocardiography
is an essential study to assess cardiac function and
Study design:
anatomy (4). ECG stress test is a useful test to exclude
This was a cross-sectional descriptive study
ischemic heart disease in patients with low and
conducted in the Cardiac and Rheumatological clinics in
intermediate pre-test probably. In addition to the classic
Al Sadar Teaching Hospital in Basrah (Iraq), from
Diamond and Forrester classes (5).
January 2021 till June 2022.

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

Full Paper (vol.901 paper# 115)

c:\work\Jor\vol901_116 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 806-810

Prevalence of Catheter Related Blood Stream Infection among Patients on
Maintenance Hemodialysis, Causative Organism and Catheter Outcome
Ayman Seddik1*, Abdelrahman Khedr1, Ayman Asaad2, Islam Elshazly1
Departments of 1Internal Medicine & Nephrology and 2Medical Microbiology & Immunology,
Faculty of Medicine, Ain Shams University, Cairo Egypt
*Corresponding author: Ayman Seddik, Mobile: (+20) 01142497699, E-mail: aymanseddik@med.asu.edu.eg

Hemodialysis (HD) patients are at risk of several causes of morbidity and mortality especially
cardiovascular related complications and Infection. In patients on maintenance HD infection and sepsis are major
hospitalization cause and the second most common cause of mortality. Objective: The aim of the current study is to
investigate the incidence of catheter related blood stream infection among HD patients.
Patients and methods: A total of 161 patients on maintenance HD at Ain Shams University Hospital Dialysis Unit for
at least 3 months prior to start of study, and followed up for 12 consecutive months.
A total of 161 patients were included in our study; mean age was 55.2 (SD 17.1) years old, and mean follow
up was 10.9 (SD 2.7) months. Patients were observed for 12 months on maintenance HD, 102 (63.4%) of the patients'
vascular access was arteriovenous fistula and 59 (36.6%) patients with dialysis catheter (tunneled or non-tunneled
catheter). Patients older than 65 years old were independently associated with increased risk of CRBSI relative risk 1.13
(95%CI: 1.57-2.24) [P-value <0.001]. Prolonged of catheter indwelling was independently associated with higher
CRBSI relative risk in patients with >12 months catheter indwelling time relative risk 1.75 (95%CI: 1.0-2.0) [P-value
<0.001]. Diabetes is independently associated with higher relative risk of CRBSI 1.94 (95%CI: 1.15-3.26) [P-value
<0.001]. Most common causative organism was gram-positive bacteria (65) %, followed by gram-negative bacteria
(35%). gram negative CRBSI is independently associated with higher risk of catheter loss compared to gram positive
organisms' relative risk 5.18 (95%CI: 1.76-15.18) [P-value <0.001].
Conclusion: CRBSI is common among patients on maintenance hemodialysis maximizing prevention strategies and
tailoring treatment approaches is vital for the reduction of rate of CRBSI and appropriate catheter management.
Hemodialysis, Catheter related blood stream infection, Bacteremia.

Bacteremia had a high incidence among HD
End stage renal disease (ESRD) is a major public
patients using tunneled catheters as compared to those
health problem and a significant financial burden (1).
an arteriovenous fistula (AVF) or even with a graft
Hemodialysis (HD) patients are at risk of several causes
(AVG). Tunneled catheter is associated with an 8-fold
of morbidity &mortality especially cardiovascular
greater bacteremia risk compared to AVF. CRBSI, exit-
related complications and Infection. In HD patients'
site infection and tunnel infection or colonization are
infection and sepsis are major hospitalization cause and
common central venous catheter complication in HD
the second most common cause of mortality (2,3).
patients (7,8). There are 1.1 to 5.5 occurrences of
The exact definition of catheter-related blood
catheter-related bloodstream infection per 1000 catheter
stream infection (CRBSI) lacks consistency. In 2018,
days, and these episodes are more likely to result in
the Kidney Health Initiative's Catheter End Points
hospitalization, morbidity, and fatality (9).
Workgroup was performed by a multidisciplinary group
of experts to establish a standardized definition of
catheter-related bloodstream infection (CRBSI) in HD
staphylococci, account for 40% to 80% of CRBSIs
patients. The definition criteria for CRBSI diagnoses in
whereas gram-negative organisms account for 20% to
HD patients: 1) Clinically (temperature more than 37.5
40%, polymicrobial infections account for 10% to 20%,
C or rigors or new predialysis hypotension or altered
and fungal infections account for 5%. Endocarditis,
mental status), 2) Bacteremia confirmation (the same
septic pulmonary emboli, osteomyelitis, spinal epidural
organism growing in the blood cultures from the HD
abscess, septic arthritis, and brain abscess are possible
catheter and a peripheral vein or dialysis bloodline), and
CRBSI complications (10).
3) exclusion of any alternate infection (4).
Management of CRBSI depends on the catheter
The accurate diagnosis of CRSBI in HD patients
type and the infection severity. As soon as a diagnosis
face challenges as peripheral blood cultures are not
is made, empirical systemic antibiotics should be given
obtained either because an existing vein is preserved for
until the results of the culture and sensitivity test are
arteriovenous fistula (AVF) creation or veins cannot be
available (11). Decision for catheter removal depends on
accessed. Symptomatic HD patients with fever usually
infection severity and the organism involved. Whenever
will go the hospital and not to the HD facility with
catheter salvage is attempted, a systemic antibiotic and
antibiotics prescribed without taking blood cultures.
an antibiotic lock should be provided (12).
Catheter tips are not routinely sent for culture due to
The objective of the current study is to study the
catheter salvage (5,6).
incidence of catheter related blood stream infection
Received: 03/08/2022
Accepted: 04/10/2022

Full Paper (vol.901 paper# 116)

c:\work\Jor\vol901_117 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 811-814

The Subclinical Hypothyroidism and Cardiovascular System
Muhamad Hossam El Den Maghrapy1, Manal El Sayed Ez EL Deen1,
Randa Mahrous Roushdy1, Sara Mahmoud Ahmed Hassanein1
Internal Medicine Department, Faculty of medicine, Assiut University, Assiut, Egypt.
Corresponding author: Randa Mahrous Roushdy, Tel: +201021584548, Email: randama7rous@yahoo.com

Because of its high prevalence, subclinical hypothyroidism (SCH) has clinical significance as it is
associated with many of the risks of atherosclerotic cardiovascular disease (CVD) due to its direct and indirect effect
on lipid profile, diastolic function, and endothelial dysfunction. However, the link between SCH and CVD is still
Objectives: This study aimed to evaluate the carotid intima media thickness (CIMT) and the lipid profile as evidence
of endothelial dysfunction and atherosclerosis on patients with SCH.
Patients and methods: The current study was a cross-section study carried out on 50 patients with SCH who were
enrolled from the Outpatient Clinics of Diabetes and Internal Medicine Department, Assiut University Hospitals,
Assiut, Egypt in the period from the 1st of September 2019 up to the end of December 2021. Also, 50 healthy matched
participants who served as control group. All participants underwent full history taking, a thorough clinical
examination, and routine lab investigation, in addition to thyroid function tests, lipid profile, echocardiography, and
estimation of CIMT.
Results: Patients with SCH had significantly higher waist to hip ratio (W/H), higher triglycerides, cholesterol, low-
density lipoprotein cholesterol (LDL-c), and increase in CIMT. Seven patients (14%) in the study group had diastolic
dysfunction versus no one in the control group. In addition, SCH patients showed that significant positive correlations
were founded between CIMT and thyroid-stimulating hormone (TSH), cholesterol and LDL levels.
Conclusions: The study found that various cardiovascular risk factors were prevalent in patients with SCH and should
be considered.
Keywords: Subclinical hypothyroidism, Cardiovascular system.


Subclinical hypothyroidism is a biochemical
disorder marked by elevated serum level of TSH
Study participants:
while the thyroid hormone concentrations still within
The current study was a cross-sectional hospital-
their normal reference values[1]. The prevalence rate
based study at one of major Tertiary Health Care
ranges from 12 to 18%, being more common with
Hospitals, Assiut University Hospital, Assiut, Egypt
increased age and among women[2].
through the period from the 1st of September 2019 to
Autoimmune thyroiditis is one of the main
the end of December 2021. Fifteen patients with SCH
causes of SCH, but it can also be caused by other
were recruited from the Outpatient Clinics of
Diabetes and Internal Medicine Department of Assiut
accompanied by cardiovascular hazards such as
University Hospitals, in addition to 50 healthy
hyperlipemia, diastolic hypertension, increase arterial
matched individuals with normal thyroid function
stiffness, an elevated C- reactive protein, and
who serve as control group. All patients had a
endothelial dysfunction[4, 5].
thorough medical history taking, including their body
Hyperlipidemia is a significant risk factor for
mass index (BMI) and W/H ratio, presence of other
atherosclerosis; elevated TSH is linked to higher
comorbidities (as hypertension, diabetes mellitus),
LDL, higher serum triglycerides (TGs), and reduced
and current use of medications. Assessment of vital
breakdown of cholesterol. This could contribute
signs was done for all studied participants. 3 ml of
to the dyslipidemia observed with SCH[4, 5].
venous blood samples were collected from all studied
Endothelial dysfunction is the centerpiece in the
participants to assess the thyroid stimulation hormone
onset and progression of atherosclerotic CVD, which
(TSH), lipid profile, blood glucose, and CRP. All
leads to increase carotid artery intima media thickness
(CIMT) [4, 5].
Echocardiography, and measurement of CIMT.
The association between SCH, atherosclerosis

and CIMT has been reported but the exact
Exclusion criteria:
mechanisms have not entirely cleared[6].
Patients aged less than 18 years old, those with
The main goal of this study was to estimate the
thyroid dysfunction (either hypo or hyperthyroidism),
correlation between SCH and cardiovascular risk
diabetics, hypertensives, pregnant or lactating
factors by assessment of lipid profile and CIMT as
women, smokers, those who received antithyroid
evidence of atherosclerosis and endothelial
medications or any drug that had an effect on thyroid
functions, patients with a history of receiving
Received: 24/7/2022
Accepted: 26/9/2022

Full Paper (vol.901 paper# 117)

c:\work\Jor\vol901_118 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 815-820

Study of Morbidity and Mortality of The Cardio-Renal Syndrome in
The Pediatric Intensive Care Unit
Sameh E Z Abdulsamea*, Ahmed Attia
Pediatrics department, Faculty of Medicine, Benha University, Benha.
*Correspondence author: Sameh Abdulsamea, Mobile: 00447943109130,
E-mail: samoha779@gmail.com, ORCID: 0000-0002-7478-5037
Background: Cardio-renal syndrome (CRS) is a term that describes the acute or choric comorbid state of the heart and
kidney. Cardio renal axis is of significant importance in pediatric patients in acute conditions as identification and optimum
management of this condition improves the survival in the PICU.
Objectives: This study aimed to describe the pattern of CRS in our unit and to compare it with other PICU centers and to
highlight the impact of this condition on PICU-admitted children.
Patient and methods: This study was carried out in Benha University Hospital, Egypt on 321 critically ill patients aged
from 1 month to 18 years.
Results: In this study, we described 321 children patients admitted to the PICU, out of which 79 (24.9%) acquired cardio-
renal syndrome. The primary diagnosis leading to admission to PICU was attributed to CVS causes like heart failure and
arrhythmia in 51 patients (15.9%), CNS in 109 cases (34%) with the predominance of CNS infection being the commonest.
There was no significant correlation between the severity of kidney injury and the stage of the heart failure in all types of
CRS expect in type III. PICU stay significantly longer with CRS III (mean 10.4 ± 5.1 days) compared to other types. The
mortality was the highest in type 5 (72.8% compared to other types).
Conclusion: CRS is an important PICU phenomenon that needs to be early recognized and managed to improve the survival
of PICU patients and to reduce the mortality.
Keywords: Cardio-renal syndrome, AKI, CKD, PICU, Heart failure.


addition to old well-known theories of abnormal
Acute or chronic malfunction in one organ may
hemodynamics, anemia, hypoxia and hypertension (7).
cause acute or chronic malfunction in the other organs. In
Although the link between the kidney and heart was
the illness known as CRS, which affects both the heart
studied thoroughly, the CRS is introduced in pediatric
and the kidneys (1,2).
literature in 2008 following a cohort study at Cincinnati
Heart failure is a clinical illness characterized by
children hospital in the USA between 2003 and 2005 on
elevated venous pressure, early myocardial cells loss, and
children admitted with acute decompensated heart failure
diminished cardiac output. Acute kidney injury (AKI) is
a severe clinical condition characterized by abnormal

kidney functioning, with or without testing evidence
(often within 48 hours of bilateral renal affections of any
This was a prospective cohort study that was
degree) (3-5).
conducted over a period from 1/10/2013 till 30/9/2017.
CRS was divided into five categories: Acute cardiac
The study was approved by the ethical committee of
failure that results in acute renal damage is a characteristic
Benha University. All admitted cases to the PICU during
of type I. Chronic cardiac dysfunction of type II results in
the aforementioned period who met PICU admission
chronic renal disease. Acute renal injury that results in
criteria were included in the study. The total number of
heart failure or an arrhythmia as a result of acute cardiac
patients was 321 cases (169 male and 152 female).
dysfunction characterizes type III. Type IV describes

chronic kidney disease leading to chronic cardiac
Inclusion criteria (PICU admission criteria):
abnormality, while type V is the presence of combined
Patients with severe or potentially life-threatening
cardiac and renal dysfunction due to systematic disorder
pulmonary or airway disease such as those requiring
(6). There are many mechanisms explaining the heart-
endotracheal intubation and those with rapidly
kidney interaction including neuro-hormonal activation
progressive pulmonary lower or upper airway disease.
of renin-angiotensin-aldosterone axis, high abdominal
Those with life-threatening or unstable cardiovascular
pressure, increased venous pressure and endothelial
disease and those with acute or unstable neurological
Free radical production and cytokine-induced
hematologic/oncologic emergencies like those with
apoptosis are also contributing mechanisms. Defects in
severe coagulopathy. Those with GIT, renal, metabolic or
perfusion autoregulation pathways contribute to CRS in
multisystem affection were also included (9).
Received: 23/07/2022
Accepted: 25/09/2022

Full Paper (vol.901 paper# 118)

c:\work\Jor\vol901_119 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 821-823

Implications of Antimicrobial Resistance during Acne Treatment:
Review Article
Hend Darwish Gamil1, Sara Ahmed Gouda Mustafa*1,
Rania Mohammed Mohammed Amer2, Shrook Abd Elshafy Khashaba1
Departments of 1Dermatology, Venereology and Andrology and
2Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Sara Ahmed Gouda Mustafa, Mobile: (+20) 01060140667, E-Mail: sea.friends1994@gmail.com

P. acnes is a pleomorphic rod that is aerotolerant, anaerobic, Gram positive, non-spore-forming, and a
member of the class Propionibacteriales in the phylum Actinobacteria. Antibiotic therapy for acne is widely recognized as
an effective strategy for managing this common skin condition. P. acnes skin colonization can also lead to Pseudomonas
folliculitis, a Gram-negative folliculitis. By stimulating a regional upsurge in keratinocyte autophagic activity, P. acnes
strains may play a role in antimicrobial defence pathways.
Objective: This review article aimed to assess the antimicrobial resistance during acne treatment.
We searched PubMed, Google Scholar, and Science Direct for information on Antimicrobial Resistance with
Acne Treatment. However, only the most current or comprehensive study from January 2000 to May 2021 was
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: Antibiotic resistance in P. acnes could compromise the success of acne treatments. Extensive use of
antibiotics to treat acne may have consequences in other illnesses where P. acnes may be the etiological culprit. Recent
research has shown that the phylotype IA1 is the most common among resistant strains. Variants of this genotype that
are resistant to antibiotics have been discovered all over the world, including on the skin of otherwise healthy people.
Keywords: Antimicrobial Resistance, Acne Treatment.


In normal skin, the cutaneous microbiome is in a
cutaneous group Propionibacterium within the field of
delicate balance that can be thrown off by external
dermatology (5).
factors, potentially leading to a number of inflammatory

skin illnesses. Corynebacteria, Propionibacteria, and
Microbiology of P. Acnes:
Staphylococci are the top three genera of cutaneous
P. acnes is a pleomorphic rod that is aerotolerant,
bacteria (1).
anaerobic, Gram positive, non-spore-forming, and a

member of the class Propionibacteriales in the phylum
Structure of P. Acnes:
Actinobacteria. This bacterium is nonpathogenic and is
Acne-causing, Propionibacterium acnes is a
found as a component of the normal flora of the skin,
commensal of human skin that is Gram-positive, does not
mouth and digestive and urine systems. Rather of
form spores, and thrives in anaerobic environments (2).
flourishing in an acidic or alkaline environment, P. acnes
Like Propionibacterium avidum, Propionibacterium
thrives in the more neutral pH range of 6.0 to 7.0. Aerobic
granulosum, and Propionibacterium humerusii, it is part
blood culture bottles are ideal for P. acnes because they
of the typical skin microbiota. The entire P. acnes
lack the anaerobic microenvironment that occurs at the
genome, at a size of 2.5 Mb has been sequenced. Lipases
bottom of nonshaken bottles. The optimal growth
that degrade pilosebaceous follicle lipids give the
temperature lies between 30 and 37 degrees Celsius (6).
bacteria energy, and the genes that code for these
Acne pathology can't start until P. acnes has
enzymes allow the bacterium to survive in
colonized the skin, but that's not enough on its own.
microaerophilic conditions (3).
Patients with acne have P. acnes make up more than
After the discovery of the lipase genes
30% of the face microbiota, and this bacterium is
triacylglycerol lipase and lysophospholipase, which are
present in 87% of clones in both acne and non-acne
specific to the breakdown of sebum lipids, a proposal was
patients (7).
made to rename P. acnes to Cutibacterium acnes in order
Conversely, P. acnes may reduce the expansion of
to reflect the genomic adaptation changes and to
S. aureus and S. pyogenes by boosting triglyceride
differentiate it from other Propionibacteria species (4).
hydrolysis and propionic acid generation. The
Some have advocated, however, that the name
pilosebaceous follicle, as a result, has a constantly
should be changed back to "Cutibacterium acnes" for a
acidic pH. Damage to the skin's protective barrier and
number of reasons, including the potential for
inflammation could result from a shift in the
misunderstanding with the old name. As far as taxonomy
microbiome's composition (8).
is concerned, it is acceptable to keep calling the
Acne is associated with a different phenotype of P.

acnes, and distinguishing phylotypes in patients with
Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 119)

c:\work\Jor\vol901_120 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 824-832

Study of Risk Factors Leading to Conversion of Laparoscopic Simple
Closure to Open Surgery in Perforated Peptic Ulcer
Emad Mohammed Salah, Tamer Alsaied Alnaimy, Atwa Arafat Atwa, Gamal Mohamed Osman
Department of General Surgery, Faculty of Medicine - Zagazig, University, Egypt
*Corresponding author: Atwa Arafat Atwa, Mobile: (+20) 01024455270, E-Mail: atwa.arafat@medicine.zu.edu.eg

When compared to open surgery for perforated peptic ulcers, laparoscopic treatment has many
advantages, including less pain, a quicker recovery time, and less consequences. Objective: This study aimed to assess
the risk factors that lead to conversion of laparoscopic simple closure of perforated peptic ulcer to open procedure in
Zagazig University Hospitals.
Subjects and Methods: Our study is prospective randomized clinical trial was done in the General Surgery Department
at Zagazig University Hospital on a study sample of 24 patients who visited an emergency room complaining of severe
stomach discomfort and were told they had a perforated peptic ulcer. Those patients underwent laparoscopic repair at
first. The steps of laparoscopic repair were performed after the perforation site was located laparoscopically, assuming
that the initial diagnosis was correct.
Results: Studied groups differed significantly regarding duration of perforation and its size, hospital stay and duration
of operation. These variables were higher among conversion group than laparoscopic group. The average laparoscopic
simple closure (LSC) conversion rate was 12.4% (range: 0% to 28.5%). The size of the perforation was the primary
factor in most cases of conversion, however the location of the perforation was also a typical contributing factor. Only
4 of the total 24 instances in the research were converted, at a percentage of (16.7%).
Laparoscopic management of perforated peptic ulcer is safe and practicable for the well-trained surgeon.
It causes less pain postoperatively, and the rate of complications is less than an open approach.
Keywords: Laparoscopic simple closure, Open surgery, Perforated peptic ulcer.


Medical advances like H2 receptor antagonists,
proton pump inhibitors (PPIs), and the elimination of
Our study is prospective randomized clinical trial
Helicobacter pylori have led to a decline in the incidence
that was done in the General Surgery Department at
of peptic ulcer disease in recent decades (1). However,
Zagazig University Hospital on a study sample of 24
complications from peptic ulcers have not decreased in
patients who were presented with acute abdominal pain
tandem with the decline in peptic ulcer disease (2).
and diagnosed with perforated peptic ulcer.
However, the prevalence of perforated peptic

ulcers (PPUs) has stayed relatively constant over the
Methods of the study:
previous few decades despite their high mortality rate (3).
Perforated peptic ulcer was diagnosed based on:
Many studies have been conducted since the first
Proper history and examination: History of
report of laparoscopic management of PPU in 1990 to
smoking and intake of NSAIDs. Perforation
assess its efficacy and safety (4). When comparing
symptoms present themselves with a sudden onset of
laparoscopic repair of PPU to open surgery, laparoscopic
severe stomach discomfort, nausea, and vomiting.
repair is preferable since it results in less pain, a shorter
Abdominal rigidity, discomfort, and rebound
hospital stay, and less overall damage to the body. As
tenderness are all symptoms of a perforation.
medical care for PPU has advanced and laparoscopic
surgery has become more widespread, a new trend has
Lab investigations: Testing for initial evaluation
emerged: the use of laparoscopic simple closure (LSC)
and resuscitation purposes, including complete blood
instead of open repair. On the other hand, laparoscopic
count, serum electrolytes (Na, K), serum amylase,
surgery isn't a good option for everyone (5).
kidney, and liver functions.
Compared to open surgery, reoperation rates
Radiology: Most commonly in the form of an upright
following laparoscopic repair have been shown to be
abdominal X-ray and a plain chest X-ray to detect the
much higher in several studies (4-6). While many studies
presence of free air in the belly and verify a
have shown laparoscopic and open repair to be effective
perforation. However, other tests, such as pelvic-
for PPU. Surgeons still sometimes have complications
with the procedure (7).
intraperitoneal turbid fluid or collections, are also
It was the goal of this study, to assess the risk
performed and when the diagnosis was uncertain,
factors that lead to conversion of laparoscopic simple
patients underwent a CT of the abdomen and pelvis
closure of perforated peptic ulcer to open procedure in
with oral and intravenous contrast since free air under
Zagazig University Hospitals.
the diaphragm is not always visible on a standard X-

Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 120)

c:\work\Jor\vol901_121 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 833-836

Immunotherapy Growing Role in Warts Management: Review Article
Aml Ibrahim Mohamed Ismael*, Ayman Elsayed Yousef, Basma M. Elkholy
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aml Ibrahim Mohamed Ismael, Mobile: (+20) 01115387163,
E-Mail: amlelshorbagy47@gmail.com

Common dermatological disorders induced by the human papillomavirus (HPV) include warts (both
cutaneous and genital). It's not dangerous, but it's unpleasant to look at, can spread to others, and sometimes koebnerizes.
So, it's crucial to get the right care at the right time. Several conventional therapies are available, although their efficacy
varies. Noninvasive, user-friendly, and showing great promise, topical and systemic immunotherapy has quickly become
a mainstay in the treatment of warts.
Objective: Assessment of Growing role of immunotherapy in treatment of warts.
We searched PubMed, Google Scholar, and Science Direct for information on Immunotherapy with Warts
and human papillomavirus. However, only the most current or comprehensive study from April 2005 to July 2022 was
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: Intralesional immunotherapy using Candida antigen has the benefits of being inexpensive, showing
promise, being simple and easy to inject into a single wart. A promising immunotherapeutic strategy is intralesional
injection of the Candida antigen. In both injected and non-injected lesions, this modality is related to Th1 cytokines
Keywords: Immunotherapy, Warts, Human papillomavirus.


following infection, at which point it may vanish on its
epitheliotropic, double-stranded DNA viruses called
own. In children, cleaning often begins within a few
human papillomavirus (HPV) is responsible for a variety
months, with around 50% clearing by one year and 2/3
of human malignancies. Infection causes enhanced
clearing by two years. While childhood warts often
epithelial proliferation in particular areas, which might
disappear after a year or two, adult ones can linger for
lead to cancer in some cases (1). Double-stranded DNA
five to 10 years (5).
viruses, human papillomaviruses (HPV) are about 8
Two main therapeutic approaches are used to treat
kilobases in length and 50-55 nm in diameter. The viral
warts: immunotherapy, which is based on immune
DNA is enveloped in an icosahedral spherical capsid
system activation, and the traditional aggressive and
that has a preference for epithelial cells and infects the
destructive strategy,
laser ablation, chemical
skin and mucous membrane (2).
cauterization, cryotherapy, electrocautery, surgical
Abrasion to the skin or mucous membranes
excision, and surgical excision all fall under this
frequently results in HPV infection. Through contact
category (6).
with contaminated surfaces like gym floors or the area

around swimming pools, cutaneous forms can also
Immunotherapy in Warts Management (Figure 1):
spread inadvertently (3).
Immunotherapy is a biological therapy that employs
The ability of HPV to elude the immune system is
medicines that stimulate or suppress the immune system
unique. Three fundamental viral characteristics allow
to combat cancer, infections, and other diseases. Topical
for this ability. Since there is no viremic phase, immune
and systemic immunotherapy has now assumed a
cells in circulation have difficulty accessing the virus.
pivotal position in the treatment of warts because of its
Despite the abundance of Langerhans cells on the
non-invasive nature, ease of use, and promising results
mucosal surface, infections typically begin at the
basement membrane. Second, HPV is able to replicate
Growing evidence of the importance of cell
"silently" because it does not cause significant harm to
mediated immunity (CMI) in wart elimination,
the host cells, such as lysis of the infected cell, hence
particularly in patients with many and persistent warts,
reducing inflammation and the accompanying signaling
has justified the use of a variety of immunomodulatory
alternatives to eliminate warts on the skin. These
The inflammation associated with warts is not
include topical sensitizers like diphenylcyprone, pro-
always present, and they might persist for years. The
inflammatory cytokines like interferons, intralesional
wart may first shrink in size a few months to years
antigen therapies like Candida antigen therapy, and

others (8).

Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 121)

c:\work\Jor\vol901_122 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 837-842

Study of Risk Factors of Diabetic Foot and Role of Hypoxia- Inducible
Factor I Alpha in Egyptian Type 2 Diabetic Patients
Sahar Hossam ElHini1, Hala Elsayed Mohamed1, Ahmed Abdelfadil Saedii2,
Tamer El Zaeem Esmaeel3, Mostafa Mahmoud Hussein4, Hatem Ahmed Hassan5*
Departments of 1Endocrine and Diabetes Unit, 2Clinical Pathology, 3Radio-Diagnosis,
4Vascular Surgery and 5Internal Medicine, Faculty of Medicine, Minia University, Egypt
*Corresponding author: Hatem Ahmed Hassan, Mobile: (+20) 01008199481, Email: Dr.Hatem.ahmed@mu.edu.eg

Diabetes mellitus (DM) causes elevated blood sugar levels and over time can cause problems of the heart,
blood vessels, kidneys, retina, and nervous system. One of the most severe complications of diabetes, diabetic foot ulcers
(DFU) are a major factor in the majority of non-traumatic lower-limb amputations. A heterodimer of HIF-1 and HIF-
1 , hypoxia-inducible factor I (HIF-1) is a transcription factor that is stabilized by hypoxia and acts as a fundamental
regulator of oxygen homeostasis and adaptive cellular responses to hypoxia. Objective: The current study aimed to
evaluate the risk factors of DFU and investigate the serum level of hypoxia inducible factor 1 alpha as biomarker for
incidence of DFU. Patients and methods: The study was conducted on 80 patients. Participants were divided into two
groups: Group I (diabetic foot) subdivided according to Wagner Meggitt 1987 Classification into grade (0), grade (1),
grade (2) and grade (3). Each group included 10 patients. Group II patients (control group) included 40 healthy subjects.
Patients were subjected to detailed history and complete examination, and complete laboratory evaluation which
included serum Hypoxia- inducible factor I alpha. Results: The associated risk factors of DFU identified in our study
were peripheral neuropathy, peripheral vascular disease, diabetic nephropathy, age, duration of DM, lack of education
about care of diabetic foot and male gender. There was higher level of serum hypoxia inducible factor 1 alpha in diabetic
patients than control subjects with significant increase in DFU patients.
HIF-1 may have a role in pathogenesis of DFU.
Keywords: Diabetic foot, Hypoxia- inducible factor I alpha, Egypt, type 2 diabetes mellitus.

factor-1 (HIF-1, a heterodimer of HIF-1 and HIF-1 ),
The World Health Organization (WHO) describes
which is stabilized by hypoxia and controls
diabetes mellitus (DM) as a chronic metabolic disorder
angiogenesis, erythropoiesis, metabolic changes,
characterized by high blood sugar that eventually leads
proliferation, migration, proliferation, and cell survival
to issues with the heart, arteries, kidneys, retina, and
(5). The increased cytosolic ratio of free NADH to
nervous system (1).
NAD+ in hyperglycemia might create metabolic
According to the International Diabetes Federation
abnormalities despite appropriate tissue oxygenation.
(IDF), 700 million people between the ages of 20 and
This high ratio was the root cause of pseudohypoxia (6).
79 were estimated to have diabetes in 2045, up from an
The current study aimed to evaluate the risk factors
estimated 463 million in 2019. Worldwide, diabetes
of DFU and investigate the serum level of hypoxia
claimed 4.2 million lives in 2019. Around 90% of
inducible factor 1 alpha as biomarker for incidence of
occurrences of diabetes worldwide are of type 2,
DFU among Egyptian type 2 diabetic patients.
making it the most common kind of the condition (2).

The main pathophysiological factor driving type 2
diabetes, in addition to cell failure, is insulin resistance,
The study was conducted on 80 patients selected
which is frequently correlated with abnormal insulin
from DM Outpatient Clinic at Minia University
production (3). Diabetic foot ulcer (DFU) is one of the
Hospital in the period from May 2020 to December
most severe complications of diabetes based on the two
primary etiological factors of diabetic peripheral
All subjects were divided into two groups:
neuropathy and peripheral arterial disease (PAD),
Group I (diabetic foot) patients which included 40
which together account for the majority of causes of
diabetic foot patient with type 2 diabetes subdivided
non-traumatic lower-extremity amputations (LEA) and
according to Wagner Meggitt 1987 Classification (7)
raise mortality rates. The long-term outlook is rather
into grade (0) 10 diabetic patients with intact skin, grade
bleak following LEA's revelation, which is highly
(1) 10 patients with superficial skin ulcer, grade (2) 10
related to DFU, with a 3-year mortality rate ranging
patients with deep skin ulcer and grade (3) 10 patients
from 35% to 50%. The total 5-year death rate was
with deep skin ulcer associated with abscess or bone
considerably greater over the longer term, ranging from
involved. Group II patients (control group) included 40
53% to 100% for those who had any amputations to
healthy subjects (free of any acute or chronic medical
52% to 80% for those who had severe amputations (4).
Adaptive cellular responses to hypoxia are
Patients with type 2 DM with and without
governed by the transcription factor hypoxia inducible
diabetic foot were included in the study. Patients were
Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 122)

c:\work\Jor\vol901_123 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 843-851

The Utility of Serum Procalcitonin Level as an Early Diagnostic Biomarker for
COVID in Patients Presenting with ST-Elevation Myocardial Infarction
Post Primary Percutaneous Coronary Intervention
Mostafa Ibrahim Ibrahim, Yara Mostafa Mohamed,
Mohamed Awad Taher, Mohamed Ahmed Abdelrahman
Department of Cardiology, Facutly of Medicine, Ain Shams University, Egypt
*Corresponding author: Mostafa Ibrahim Ibrahim, Mobile: (+20)01006682917, Email: dr.mostafaibrahim86@gmail.com


Objectives: The aim of the study was to detect if serum procalcitonin could be used as an early diagnostic marker for
COVID in asymptomatic patients presenting with ST-segment elevation myocardial infarction and if procalcitonin is
related to the extent of myocardial injury after the infarction.
Patients and Methods: The study was carried out on 150 patients (age 53.39 ± 13.16) presenting to Ain Shams
University Hospitals with ST-segment elevation myocardial infarction (STEMI) and received the standard of care
management, which is primary percutaneous coronary intervention (PCI). The patients were assessed regarding the
demographic data, presence of any symptoms and signs of infection, risk factors, echocardiography and laboratory
measures. COVID PCR and procalcitonin were assessed for all patients.
Results: Out of all the asymptomatic patients presenting with STEMI whose COVID PCR turned out to be positive,
the procalcitonin was positive 24 and 48 hours post presentation with P value <0.001. There was high statistically
significant relation between positive procalcitonin and total leucocytic count (TLC) where there was a drop from a
median of 11/mm3 with range (4.5­ 19) /mm3 in negative procalcitonin to a median of 3.7 /mm3 with range (1.4 ­12)
/mm3 in procalcitonin positive patients. There was high statistically significant relation between positive procalcitonin
and rise of C-reactive protein (CRP) value where there was a rise from CRP median value from 12 mg/dL range (2­
40) mg/dL in negative procalcitonin patients to 47 mg/dL range (14­ 163) mg/dL in positive procalcitonin patients.
Conclusion: There was a strong relationship between procalcitonin and COVID infection in asymptomatic patients
thus procalcitonin can be used as an early diagnostic biomarker for COVID infection in patients presenting with
myocardial infarction.
Keywords: STEMI, COVID, Procalcitonin.

It is standard procedure to classify patients with
The most prevalent type of cardiac illness is
persistent chest pain or other symptoms indicative of
coronary artery disease (CAD). It arises from
ischemia and ST-segment elevation in at least two
atheromatous modifications in the blood arteries
contiguous leads as STEMI in order to facilitate rapid
feeding the heart. Acute coronary syndrome (unstable
treatment measures such reperfusion therapy [4].
COVID cases have been increasing significantly
atherosclerosis, and stable angina are all clinical
and it was associated with a lot of CAD cases. Most of
diseases referred to as CAD [1].
the patients present asymptomatically but it's related to
One of the biggest causes of death globally is
increased risk of morbidity and mortality in these
coronary artery disease. According to the World
Health Organization (WHO), ischemic heart disease
In critically unwell patients, procalcitonin (PCT) is
caused almost nine million fatalities in 2016. The
recognised as a biological diagnostic sign for severe
mortality rate from CAD shows contrasting patterns in
sepsis or septic shock. The significance of
developed and developing nations. Ischemic heart
procalcitonin in patients with acute myocardial
disease-related death rates are declining in wealthy
infarction and those with acute coronary syndromes,
nations like the U.S. and the UK. Nevertheless, 16.5
that is, non-ST-elevation myocardial infarction or
million Americans over the age of 20 had coronary
unstable angina, is still controversial due to conflicting
artery disease in 2018, with 55% of those affected
evidence. There are conflicting findings regarding
being men. With rising mortality trends, the condition
procalcitonin rise in COVID-19 subjects [5].
of CAD is getting worse in emerging nations [2].

The presence of acute myocardial injury indicated
by abnormal cardiac biomarkers in the presence of
Primary objective: To investigate the utility of serum
evidence of acute myocardial ischemia indicated by
procalcitonin as an early diagnostic biomarker for
the detection of an elevated cardiac troponins (cTn)
COVID in asymptomatic patients presented with
value above the 99th percentile is what is referred to as
myocardial infarction in clinical terms. If the values of
Secondary objective: To evaluate the association
cTn increase or decrease, the damage is deemed acute.
between procalcitonin release in the acute setting of
Provided the fourth accepted definition of myocardial
STEMI with the size and extent of myocardial
infarction (2018) [3].
Received: 10/6/2022
Accepted: 11/8/2022

Full Paper (vol.901 paper# 123)

c:\work\Jor\vol901_124 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 852-856

Evaluation of The Outcomes of Intra-Operative Colonic Lavage in
Non-Elective Colonic Resection and Primary Anastomosis for Sigmoid Volvulus
Sherif Albalkiny, Mohamed Elsayed Seifalyazal, Gamal Fawzy*
Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Gamal Fawzy, Mobile: (+20) 01220495554, E-Mail: dr.gamalfawzy@yahoo.com

Management of acute sigmoid volvulus was documented using a variety of surgical techniques. It has
been established that mechanical bowel preparation is not required for elective colorectal surgery. To lower the risk of
post-operative infectious complications and anastomotic dehiscence, one-stage primary resection and anastomosis of
left sided colon blockage with on-table antegrade colonic lavage are becoming more and more popular.
Objective: The aim of the current study was to assess the safety of single stage resection and anastomosis in the
treatment of acute left sided colonic blockage brought on by acute sigmoid volvulus without intraoperative colonic
lavage. Patients and methods: This study was conducted in the Department of Surgery, Ain shams University
Hospitals (Cairo, Egypt) between June 2018 till June 2021. It included 37 patients who presented with acute sigmoid
volvulus and managed by colonic resection and primary anastomosis then furtherly classified into two groups based
on the usage of antegrade colonic lavage to evaluate their outcome. Results: Preoperative characteristics of the 2
studied groups were comparable. In terms of mortality, general morbidity, or significant morbidity, there was no
difference between the 2 studied groups. Operative time was significantly higher in Group I where Intra-operative
Antegrade Colonic lavage (IOACL) took place, which could be attributed to the extra step of setting the lavage system
and colonic irrigation time. Of the studied 37 patients, superficial wound infection occurred in 12 patients and 3 of
them progressed to develop complete wound dehiscence, however; neither required further surgery as no disruption
and managed conservatively with antibiotics and wound dressing. Conclusion: Colonic resection and primary
anastomosis can be used to safely treat left-sided colonic blockage brought on by acute sigmoid volvulus without the
need for mechanical bowel preparation.
Keywords: Left sided colonic obstruction, Sigmoid volvulus, Resection, Primary anastomosis, Intraoperative colonic

The majority of patients are very young and
The sigmoid colon twisting around its mesentery
healthy, which increases the likelihood that they will
is known as a sigmoid volvulus and could be attributed
be able to recover from the condition and its surgical
to abnormal narrow attachment of its root to the
side effects. This is reflected in the low mortality rates
posterior abdominal wall which in turns results in
following emergency surgery for acute volvulus (4-6).
close approximation of its two limbs and predispose to
As long as patient does not have features
its twist around its mesenteric axis. In these vulnerable
suggestive for peritonitis, endoscopic detorsion is the
patients, lack of dietary fibers and chronic constipation
preferred initial approach for sigmoid volvulus.
could be precipitating factors for volvulus. Twisting
Endoscopic reduction is being effective in reducing the
usually occurs counterclockwise with variable degree
volvulus in about 77­98% of patients. Additionally, it
of torsion ranging from 180º to 540º (1-3). The most
is less invasive procedure than emergent colectomy
frequent type of volvulus often occurs around the
with lower mortality rate. Even so, endoscopic
mesenteric axis and is located 15­25 cm away from
detorsion has recurrence rates ranging between 7 and
the anus, making sigmoidoscopic inspection possible
67% (3,15,17-19).
Moreover, emergency endoscopic decompression
Elderly people older than 70 who have a history
could not be an available facility out of hours in most
of persistent constipation or who have underlying
of the developing countries. Therefore, it is advised to
neuropsychiatric illnesses are the most often afflicted
think about a colectomy following a successful
group (4-15), if prompt intervention is not done, serious
endoscopic reduction (3,12,17,19), which may be followed
complications such as intestinal gangrene and
by a primary anastomosis with or without proximal
peritonitis might progress and result in death.
diversion or resection with end colostomy (Hartman's
Around 10-50% of bowel blockages worldwide,
Procedure) (11). There is insufficient high-quality
including in Latin America, Africa, Eastern Europe,
evidences to favor one operational strategy over
Russia, the Middle East, and India, are caused by
sigmoid volvulus, compared to only 2-3% in the
Most surgeons would like to conduct initial
United States (11-14).
anastomosis on mechanically cleansed bowel as a
It was shown that sigmoid volvulus patients tend
general, established criterion for safe colonic resection
to be younger and have less morbidities than what was
and anastomosis. On-table antegrade colonic lavage is
previously suggested in previous reports, in a sizable
intended to clear and decompress the proximal blocked
population-based analysis of individuals who
colon in order to reduce abdominal distension,
underwent surgery correction for the condition (16).
promote abdominal closure, and enhance colonic blood
Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 124)

c:\work\Jor\vol901_125 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 857-862

Assessment of Motor Skills in Autism Spectrum Disorders
Eman Fathalla Gad1, Samia Attwa2, Dina Tharwat Mohammed Ali3*
1Associate Professor of Pediatrics, 2Professor of Pediatrics, 3M.B.B.CH, Faculty of Medicine, Assuit University
Corresponding authors: Dina Tharwat Mohammed Ali, E-mail: dfouad973@gmail.com

Motor deficits are common and extensive in neurodevelopmental disorders, autism spectrum disorder in
particular (ASD). Additionally, motor deficiencies are probably the cause of difficulties with social communication,
which may be the first sign of atypical development in ASD.
Objective: The purpose of this study was to examine the degree of mobility impairment in kids with autism spectrum
disorders (ASD).
Patients and methods:
A cross-sectional study was carried out in Assiut University Child Hospital. All children with
autism from the age of 3 years to 18 years in Neurological Outpatient Clinic in Assiut University Pediatric Hospital
diagnosed using the Movement Assessment Battery for Children (M-ABC) were included.
: There was significant difference between improvement after physiotherapy (Not yet, No improvement and
Improved) and Medical treatment (Antipsychotics). There was highly significant difference between improvement after
physiotherapy (Not yet, no improvement and improved) and compliance, and there is no significant difference between
improvement after physiotherapy (Not yet, no improvement and improved) and outcome.
Conclusion: The physical health of children with ASD improved as a result of the physiotherapy sessions, including
agility, coordination, usable skills, and powerful, quick legs. Additionally, it became simpler to exercise in a group, at
home, or in private sessions with a professional.
Autism spectrum disorder, motor control, motor function, cross sectional study, Assuit University.


Motor deficits are common and extensive in
The purpose of this study was to examine the degree of
neurodevelopmental disorders, particularly autism
mobility impairment in kids with autism spectrum
spectrum disorder (ASD). In contrast to the other
disorders (ASD).

behaviours including feeding, dressing, and using the
restroom and sensori-motor development are still
A cross-sectional study was carried out in Assiut
understudied, daily living abilities, which we shall refer
University Child Hospital. Patients with autism from
to as self-care abilities, can be challenging for some
the age of 3 years to 18 years in Neurological Outpatient
ASD youngsters (1).
Clinic in Assiut University Pediatric Hospital were
Autism is a complicated neurobehavioral illness
marked by inflexible, repetitive behaviours as well as

Inclusion criteria: All children with autism from the
development, and communication. ASD is the name
age of 3 years to 18 years diagnosed using the
given to this ailment nowadays due to the wide range of
Movement Assessment Battery for Children (M-ABC).
symptoms. It covers a wide range of signs, abilities, and
Exclusion criteria: Children younger than three years
degrees of impairment. The degree of ASD can range
old, those with neurological diseases, and those who
from a minor impairment that only slightly restricts
have cerebral palsy.
otherwise normal life to a catastrophic disability that

may necessitate institutional care (2).
The best reasons for these problems are not
Full clinical history: including age, sex, residence,
intellectual disability (intellectual developmental
consanguinity, similar conditions in family.
disorder) or general developmental delay.Intellectual
handicap and autism spectrum condition frequently co-
occur, therefore social communication must be below
anthropometric measures, systematic examination.
the level anticipated for general developmental maturity

in order to identify both illnesses (3).
Movement skills measured their movement using the
Independent living depends on daily living skills
Movement Assessment Battery for Children (MABC).
(DLS), which cover matters like maintaining personal
Exam taking is advised by the European Academy of
hygiene, preparing meals, and managing money. In
Childhood Disability. The Movement Assessment
contrast to their cognitive talents, many people with
Battery for Children (MABC-2) standard exam was
autism spectrum disorder struggle with everyday living
used to collect data, which is the most complete
skills, according to research (4).
diagnostic tool yet developed for evaluating motor

activity and identifying developmentally conditioned

Full Paper (vol.901 paper# 125)

c:\work\Jor\vol901_126 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 863-868

Outcome of Infant Regurgitation Diagnosed by Rome Criteria
Yosra M Awad1, *, Mostafa EL-Hodhod1, Marwa El Deeb1, Nehal Soliman2 and Yasmin AF Aly1
1Department of Pediatrics, Faculty of Medicine, Ain Shams University.
2Ministry of Health and Population, Egypt
*Correspondence: yosraawad@med.asu.edu.eg. Egypt. Mobile number: (+20)1001831590, ORCID: 0000-0002-5315-9774


Background: Infant regurgitation is the most prevalent functional gastrointestinal disorder in infancy. Knowing the
benign outcome of such condition helps to decrease the anxiety of parents and unnecessary prescriptions by physicians.
Objectives: The aims of the current work were to detect the outcome of infant regurgitation among Egyptian infants
diagnosed by Rome criteria and to detect its prevalence among the surveyed population.
Patients and Methods: A prospective cohort study enrolling 280 healthy infants 1-4 months diagnosed as infant
regurgitation according to Rome criteria by fulfilling a questionnaire and undergoing examination. Parents were
reassured and educated then both were repeated after 3 months. According to the outcome, infants were divided into
symptomatic infants, who were either partially improved or not- improved at all and asymptomatic infants who had
stopped regurgitation.
Results: The prevalence of regurgitation was 20.3% among the surveyed 1380 infants. On follow up 42.9% of infants
became asymptomatic while 49.6% partially improved and only 7.5% didn't improve. Weight was properly gained for
all patients except 3 who had failure to thrive, however that was not correlated with the outcome of regurgitation. Proton
pump inhibitors were prescribed for 7.7% of cases, however, increasing age was the only predictor of total improvement
after 3 months follow up with odds ratio=2.45 and confidence interval (1.57-3.84).
Conclusion: Infant regurgitation diagnosed according to Rome criteria seems to be normal behavior in early infancy
which resolves by time, just requiring parental, reassurance, and follow up, while no interventions are needed.
Keywords: Infants; Regurgitation, Proton pump inhibitors, Gastrointestinal diseases; Functional; Gastroesophageal


Infant regurgitation must meet the following
Regurgitation is defined as the flow of refluxed
two requirements, according to the Rome
gastric content into the oropharynx. In infants, it is
diagnostic criteria, in otherwise healthy infants between
crucial to differentiate between the physiologic and
the ages of three weeks and twelve months:
pathologic reflux. Most infants with physiologic
regurgitation occurring twice daily for three weeks or
regurgitation are healthy, happy (happy spitters), and
longer without any feeding or swallowing issues, failure
having normal growth and development without
to thrive, abnormal posturing, apnea, retching, or
underlying predisposing factors and no pharmacologic
hematemesis, and the absence of any other signs (10).
treatment is typically necessary (1).
It is crucial for healthcare professionals to
On the other hand, the movement of gastric
understand the natural history of infant regurgitation to
contents into the esophagus, either with or without
manage infants and offer parents evidence-based
guidance (5).
gastroesophageal reflux (GER) (2). Reflux is the most
The primary objective of the current study was
prevalent functional gastrointestinal disorder in the first
to detect the outcome of infant regurgitation among
year of life, accounting for 25% of the appointments
Egyptian infants diagnosed by Rome criteria and
with pediatricians and other health professionals (3,4).
secondary aim was to detect the prevalence among the
The natural progression of reflux in infants is
surveyed population.
between birth and 4 months of age (5). Then usually

outgrow this phenomenon by their first birthday (6),
however a small proportion (5-9%) of all infants with
This prospective cohort study included a total of
regurgitation have gastroesophageal reflux disease
280 infants with regurgitation that were diagnosed
(GERD) (5,7).
based on Rome IV criteria, visiting the General
GERD develops when GER leads to
Pediatric Outpatient Clinic, Ain Shams University
troublesome symptoms that interfere with daily
Hospitals. This study was conducted between
functioning and/or the occurrence of complications; as
December 2021 to May 2022.
discomfort/irritability - failure to thrive - feeding refusal
Legal guardians/parents were asked to fill in a
- dystonic neck posturing (Sandifer syndrome),
questionnaire to assess infant regurgitation according to
hematemesis - dysphagia/odynophagia, apnea spells -
Rome criteria and infants were included if they were
brief resolved unexplained events - asthma ­ recurrent
1-4 months old, full term, healthy and fulfilling Rome
otitis media and recurrent pneumonia linked with
criteria for infant regurgitation defined as presence
aspiration (2). Additionally, others have added choking,
of regurgitation at least 2 times per day for at least 3
gagging, and coughing with feeds (8,9).
weeks (10).

Full Paper (vol.901 paper# 126)

c:\work\Jor\vol901_127 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 869-874

Assessment of Heat Stress Exposure among Outdoor
Cleansing Workers in Helwan University
Kholod Sayed Mohammad1, Sahar Ahmad Shafik2*, Mayada Taha Mahmoud1
1 Department of Community Health Department, Faculty of Nursing, Helwan University, Egypt
2 Department of Community Health Department, Faculty of Nursing, El-Fayoum University, Egypt
*Corresponding author: Sahar Ahmad Shafik, Mobile: (+20) 01062225020, ORCID: 0000-0003-3247-4823,
E-Mail: Sas19@fayoum.edu.eg


Background: Heat stress is considered a well-established phenomenon from extreme heat exposure for long time
without taking safety measures. Heat stress is determined by various symptoms, such as fatigue, nausea, vomiting,
dizziness, and giddiness. Objective: The current study aimed to assess heat stress exposure among outdoor cleansing
workers in Helwan University.
Patients and methods: Design: Descriptive research design. Sample: A convenience sample for consists of 100
outdoor cleansing workers that had been worked outdoor in Helwan University, Egypt. Setting: The study was
conducted in outdoor at Helwan University. Tools: Data were collected by two tools; the 1st tool included
demographic characteristics, workers` knowledge about heat stress, and workers` reported practice regarding heat
stress, and the 2nd tool included standardized observational checklist for heat stress risk assessment.
Results: Up to 80% of workers were exposed to sun burn and 90% of them were exposed to sun stroke in the last 12
months. Also, they had poor level of knowledge, inadequate reported practices regarding heat stress with highly
statistically significant differences between correlation of total knowledge, total reported practice and standardized
observational checklist for heat stress risk exposure. There was a highly significance correlation between workers`total
knowledge and workers` total reported practice, together with a highly significance correlation between workers` total
knowledge, workers` total reported practice and standardized observational checklist for heat stress risk exposure.
Conclusion: Continuous health education program for outdoor cleansing workers regarding prevention of heat stress
is essential.
Keywords: Heat stress, Outdoors workers, Cleansing workers.


reaction to occupational heat stress exposure is thought
Heat stress is regarded as a well-known
to be influenced by personal factors, including age.
phenomenon that results from prolonged exposure to
According to research, older adults are less able to
excessive heat without taking appropriate precautions.
adjust to fluctuations in body temperature than
The effects of heat stress, which are considered a
younger adults, which renders them more susceptible
worldwide problem that transcends socioeconomic
to heat exhaustion. This is attributed to a number of
level, include lower worker productivity on seasonal
factors that affect their capacity to regulate their body
timeframes, incapacitation, illness, and death, and
temperature, such as decreased aerobic capacity,
weekly to sub-daily timescales. It happens when the
decreased sweating rate, decreased stroke volume,
body is unable to naturally release extra heat into the
decreased cardiac output, decreased skin blood flow,
environment and the thermal balance cannot be
as well as potential changes in body fluid distribution
maintained. In 2021, the American Conference of
and thirst perception (4).
Governmental Industrial Hygienists (ACGIH) warned
Inadequate health care, a lack of safety training
employees that they shouldn't be allowed to operate in
regarding the use of semipermeable or impermeable
hot surroundings if their interior temperature is more
protective clothing, poor supervision, limited access to
than 38 °C (1).
cooling techniques and hydration supplies, inadequate
There has been prior research linking working
on-site restroom and resting facilities, a lack of rest
people's exposure to hot environments to heat-related
periods, and productivity incentives are organizational
health effects such respiratory, heart, and renal
factors that may increase the risk of occupational heat
illnesses. Even in healthy people, heat stress has the
stress (piece-rate pay, or payment per amount of work
potential to produce acute kidney damage through
done). Other variables include social/economic ones
volume depletion. Numerous heat-related symptoms,
including low levels of education and decreased
including exhaustion, headaches, muscle cramps,
knowledge, poverty and low incomes, a lack of health
insurance, subpar housing, and a lack of job
hyperventilation, and chest pain that may be mild or
opportunities. Conditions related to the job, such as
severe depending on severity, ataxia, hypotension,
extreme temperatures, a lack of shade or air
syncope, and momentary changes in mental status, can
conditioning, exposure with nephrotoxins, and hard
all be signs of heat stress (2,3).
exercise while assuming the wrong posture. Climate
It is well known that depending on individual
elements include droughts, heat waves, high humidity,
circumstances, outdoor workers' tolerance or reaction
and rising temperatures (5).
to heat exposure varies. An individual's physiological
Received: 03/08/2022
Accepted: 04/10/2022

Full Paper (vol.901 paper# 127)

c:\work\Jor\vol901_128 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 875-878

Role of Topical Brimonidine in The Treatment of
Dermatological Diseases: Review Article
Heba Hassan Ali Muhammad*, Manal Mohamed Elsayed, Mohamed Ibrahim Elghareeb
Department of 1Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Heba Hassan Ali Muhammad, Mobile: (+20) 0115 308 9855, E-Mail: dr.hebahassan91@gmail.com

Topical Brimonidine is approved by FDA for the treatment of rosacea-associated erythema. It has anti-
inflammatory action, in additional to its vasoconstrictive activity, it preventes leucocyte recruitment via inhibition of
transendothelial cells migration. Briominidine has been studied for many indications rather than rosacea with positive
results. Objective: Review of the literature on the effectiveness of topical brimonidine in the treatment of various
dermatological diseases.
Methods: A comprehensive search was conducted in PubMed, Google Scholar, and Science Direct for information
on Topical Brimonidine dermatological diseases. However, only the most current or comprehensive study from May
2011 to November 2022 was considered. The authors also assessed references from pertinent literature. Documents
in languages other than English have been disregarded since there are not enough resources for translation.
Unpublished manuscripts, oral presentations, conference abstracts, and dissertations were examples of papers that
were not considered to be serious scientific research.
Results: Mild, temporary skin-related adverse effects have been reported with 0.33 percent brimonidine topical gel.
Maximum erythema reduction may occur 3­6 hours after application, while some patients report seeing results as
early as 30 minutes. Conclusion: Combination therapy with brimonidine gel and other treatments for face papules
and pustules is safe and does not enhance the risk of adverse outcomes.
Keywords: Topical Brimonidine, Seborrehic Dermatitis, Combined Therapy.

of participants in the two pivotal studies lasting one
Rosacea is a chronic skin disorder that causes
month and up to nine point one percent of participants
redness, dilated blood vessels, papules, pustules,
in the long-term safety study lasting one year reported
phymatous changes, and sometimes even eye
an increase in the severity of their erythema and/or
involvement. Common signs and symptoms are
flushing (3).
divided into four categories by the National Rosacea
Rosacea patients with moderate to severe
Society (NRS) Expert Committee in 2002:
erythema had an optimal dosing regimen of
brimonidine that was identified after two randomized,
(PPR), phymatous (PHY), and ocular (1).
double-blind, vehicle-controlled investigations were
Rosacea causes face redness in more than 40
conducted. The effectiveness of three different topical
million people throughout the world. The NRS
brimonidine gel doses was studied. For 12 hours,
estimates that 16 million American adults have rosacea
brimonidine was able to significantly reduce the
symptoms at some point in their lives. It is believed
redness. At 0.5% concentration, researchers saw the
that the incidence of rosacea is on the rise in the United
most benefit; it was also well tolerated (4).
States, but this may be due to the country's ageing
The FDA has approved BT for topical use in the
population (1).
treatment of erythema associated with rosacea (5).
Facial erythema, papules, and pustules are just
The objective of the current study was to review
some of the symptoms that can appear at the same
the effectiveness of topical brimonidine in the
time, making rosacea treatment more complicated. The
treatment of various dermatological diseases.
best results for a patient with several rosacea
A comprehensive search was conducted in
symptoms can be achieved with a multimodal
PubMed, Google Scholar, and Science Direct for
approach (2).
information on Topical Brimonidine dermatological
In order to decrease vasodilation and edema,
diseases. However, only the most current or
brimonidine, a highly selective alpha 2 agonist, binds
comprehensive study from May 2011 to November
to alpha 2 receptors on the vasculature and induces
2022 was considered. The authors also assessed
direct vasoconstriction of both small arteries and veins.
references from pertinent literature. Documents in
With this review, we hope to sum up the research on
languages other than English have been disregarded
brimonidine topical gel for the treatment of rosacea-
since there are not enough resources for translation.
related facial erythema in terms of its safety,
effectiveness, and patient acceptability (3).
conference abstracts, and dissertations were examples
Clinical investigations with brimonidine tartrate
of papers that were not considered to be serious
(BT) found it to be effective and safe for the treatment
scientific research.
of facial erythema associated with rosacea for up to 1
Mechanism of action of Brimonidine:
year, with a rapid onset. Three percent to seven percent
Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 128)

c:\work\Jor\vol901_129 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 879-886
Hysteroscopy in the Evaluation of Recurrent First Trimesteric Miscarriages
Ahmed M. Abd El-Hamed*, Abd El-Mageed I. Abd El-Mageed,
Wasan Y. Alsaleem, Mohammed M. Al-Sherbiny
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Ahmed Mohamed Abd El-Hamed, Mobile: (+20) 01095919811,
E-Mail: research.sh.2022@gmail.com

Recurrent pregnancy loss (RPL) is one of the most painful and difficult areas of reproductive medicine
since the explanation is often unknown. RPL is caused by uterine factors (both acquired and congenital). Hysteroscopy
is the gold standard for evaluating the endometrial cavity because it allows direct sight of the endometrium.
Objective: This study aimed to evaluate the role of hysteroscopy in the assessment of cases with recurrent first
trimesteric miscarriage.
Methods: This prospective cohort study was conducted on 164 women with recurrent first trimesteric miscarriages,
who were referred to Early Cancer Detection Unit (ECDU) to undergo diagnostic hysteroscopy for various complaints.
Women were asked to attend postmenstrual within 3-6 months following abortion. Hysteroscopy was done under local
anesthesia. Before operation, all cases were subjected to full history taking, clinical examination and laboratory
investigations as random blood glucose level, serum thyroid stimulating hormone (TSH), serum prolactin,
anticardiolipin (IgG, IgM), follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Results: Abnormal hysteroscopic study was found in 53.0% of cases with recurrent first trimesteric miscarriages.
Acquired uterine abnormalities were found in 27.4% of cases and it was more common than congenital uterine
anomalies that were found in 25.6% of cases. The most common congenital uterine anomaly was uterine septum that
was found in 20% of cases, while the most common acquired abnormality was uterine polyp (s) that was found in 11%
of cases. 20% of these anatomical abnormalities were corrected hysteroscopically.
Conclusion: Hysteroscopy is safe, sensitive and reliable tool of diagnosis and could be performed at outpatient bases
without anesthesia.
Keywords: Hysteroscopy, Pregnancy loss, Recurrent first trimesteric miscarriages.

adhesion) or congenital (such as Mullerian anomalies)
When a pregnancy spontaneously ends three times
(5). Eight to ten percent of women who experience
in a row, either before 20 weeks of pregnancy or before
recurrent miscarriage have Mullerian defects, with
the foetus weighs 500 g, the condition is known as
uterine septum being the most frequent. The majority
recurrent miscarriage (1). Recurrent pregnancy loss has
of the flaws can be fixed (6).
a significant impact on a couple's psycho-social status.
High rates of conception are reported following
Recurrent pregnancy losses can occur in up to 3% of
hysteroscopic metroplasty in septate uteri or
women, and in about 50% of those cases, the
hysteroscopic cutting of intrauterine adhesion, with a
underlying cause is idiopathic (2).
postoperative conception rate of 87% (7). This work
The aetiology of recurrent pregnancy loss can be
aimed to evaluate the role of hysteroscopy in the
divided into potentially treatable and currently
assessment of cases with recurrent first trimesteric
untreatable etiologies based on their treatment
potential. There are several possibly curable causes,

including structural flaws, endocrine issues (luteal
This prospective cohort study was carried out on
(thrombophilia or autoantibodies), and immunological
164 women with recurrent (3 or more), first trimester
miscarriage planned to undergo office (diagnostic)
Idiopathic etiologies and genetic anomalies are the
hysteroscopy to assess the uterine cavity. They
situations that are now incurable (3).
attended to Ain shams University Maternity Hospital
Hysteroscopy is quite helpful in interpreting
Early Cancer Detection Unit through the period from
ambiguous results from other diagnostic modalities.
July 2018 to December 2018.
Additionally, it improves accuracy in the evaluation of

intrauterine anomalies and allows direct visualisation
Inclusion criteria: Women with normal transvaginal
of the cervical canal and uterine cavity (4).
ultrasound scan, lupus anticoagulants, anticardiolepin
Uterine malformations can be acquired (such as
antibodies, complete blood count, sedimentation rate,
submucous myomas, endometrial polyps, and
progesterone level in the luteal phase were enrolled in
Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 129)

c:\work\Jor\vol901_130 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 887-893

Novel Study of the Effect of Bilobetein Compound and Silver Nano Particles of
Ginkgo Biloba as Folate Antagonists by Inhibiting Enzyme Dihydrofolate
Reductase in Iraqi Patients Serum of Small Cell and Adenocarcinoma Lung Cancer
Hiba J. Hussein and Nijoud F. Yousif AL-Saarag
Department of Chemistry / Biochemistry Laboratory, College of Education for Pure Science,
Ibn Al-Haitham,University of Baghdad, Iraq
Corresponding author: Nijoud F. Yousif AL-Saarag, Email: nijud.f.y@ihcoedu.uobaghdad.edu.iq, Mobile: +9647905158320


Background: The most common and deadly cancers are lung cancer. There are no symptoms or indicators in its early
stages. In study silver nanoparticles of Ginkgo biloba herb were synthesized and prepared solutions of different
concentration of this nanoparticles compound, solution of different concentrations of the bilobetein compound which is
the main compound in the ginkgo biloba herb.
Objective: The purpose of this study was to prepare silver nanoparticles of ginkgo biloba herb and to study the effect of
this compound at different concentration as an antifolate, through its reduction of the enzyme DHFR concentration
Patient and Methods:
This study was divided into three groups as following: thirty samples of blood serum from men
and women as a control group with age range 23-45 years, thirty samples of blood serum from men and women of small
cell lung cancer patients with age range 45-80 years and finally, thirty samples of blood serum from men and women of
adenocarcinoma lung cancer patients with age range 45-80 years.
Results: The 4 ppm concentration of the nanoparticles solution gave the best reduction in enzyme concentration in patients
of small cell and adenocarcinoma lung cancer compared to control (465.94 ± 238.74 and 700.09 ± 324.59 vs 1680.38 ±
345.51 pg/ml). 8 ppm concentration showed reduction of enzyme concentration in small cell and adenocarcinoma lung
cancer compared to control of 586.62 ± 225.57 and 1131.23 ± 415.33 vs 1860.06 ± 163.22 pg/ml.
Conclusion: This study concluded the bilobetein and silver nanoparticle of Ginkgo biloba had the ability in preventing
growth of cancer cells by reducing the DHFR concentration in sera of small and adenocarcinoma lung cancer patients.
Keywords: Lung cancer, DHFR, Bilobetein, GinkgoBiloba.


Dihydrofolate reductase (DHFR) (EC is a
Cancer is a fatal illness in which normal body cell
vital enzyme in biochemistry and pharmaceutical
proliferation is constrained and aberrant alterations
science (9). The importance of this family of drugs is
occur at an uncontrolled rate (1). At this time, lung cancer
shown by the fact that dihydrofolate reductase inhibitors
in the globe, accounts for 23% of all cancer-related
are utilized as antibacterial, antimalarial, antifungal, and
fatalities (2, 3). Squamous-cell lung cancer (15 %­20 %)
anticancer drugs.? The maintenance of tetrahydrofolate
together with non-small cell lung cancer are the most
(THF) and its derivatives, which results in the production
common kinds of lung (NSCLC, 80%­85%). Primary
of purine and thymidylates, is regulated by DHFR, which
lung cancer is mostly treated clinically by chemotherapy,
is essential for healthy cellular development and
surgery, and radiation (4, 5).
proliferation (10). The folate pathway, which uses the
An ancient plant species known as ginkgo biloba is
enzyme dihydrofolate reductase (DHFR) to catalyze the
regarded to have a number of health advantages for
conversion of dihydrofolate to tetrahydrofolate utilizing
living things (6). It is chemically diverse and includes a
NADPH- a crucial cofactor for the manufacture of
lot of bioactive components. Ginkgo biloba has been
purines, thymidylate, and a number of amino acids- has
shown to have a wide range of therapeutic and
been a key target in the fight against cancer (11). The
pharmacological properties, including anticancer,
success of antifolate drugs used to treat cancer by
antidementia, antidiabetic, antiobesity, antilipidemic,
blocking DHFR, so depleting THF and decreasing DNA
antimicrobial, antioxidant, antilipid peroxidation,
synthesis and cell proliferation, highlights the
significance of this response (12).
In the past, methotrexate (MTX) has been used to
antihypertensive, and neuroprotective effects (7).
target the folate metabolic pathway and is a crucial part
Bilobetin, a naturally occurring chemical obtained
of the therapy of cancer, including lung, breast, head and
from Ginkgo biloba, has a wide range of
neck, and osteosarcoma. Inhibiting de novo pyrimidine
pharmacological actions, including those related to anti-
and purine production, which leads to cell death, is how
oxidation, anti-cancer, antibacterial, antifungal, anti-
anti-folate medicines combat folate-dependent enzymes.
inflammatory, antiviral, and promoting osteoblast
MTX is now utilized in chemotherapy (13). The purpose
formation (8).
of this study was to prepare silver nanoparticles of
Received: 19/09/2022
Accepted: 26/11/2022

Full Paper (vol.901 paper# 130)

c:\work\Jor\vol901_131 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 894-900
Serum Vitamin D Deficiency in Idiopathic Preterm Labor: Case Control Study
Ahmed M. Zeinhom1, Ahmed F. Kamal*2, Mohamed H. Mostafa1, Mai Magdy Abdel Wahed3, Laila A. Farid1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2Department of Obstetrics and Gynecology, Al Fayoum General Hospital, Egypt
3Department of Clinical and Chemical Pathology, National Research Center (NRC), Giza, Egypt
*Corresponding author: Ahmed Fouad Mohamed Kamal, Mobile: (+20) 01222148471, E-Mail: drfouad8585@gmail.com

Preterm labor (PTL) is the most common cause of neonatal death worldwide. In Egypt, the average rate
of preterm labor is estimated to be 14.7%. Objective: This study aimed to evaluate the relation between maternal
vitamin D deficiency and idiopathic preterm birth.
Patients and Methods: This case-control study was conducted on 160 pregnant women; 80 women with PTL as cases
and another 80 women with term birth as controls, who were admitted to the Obstetrics and Gynecology Department
in Ain Shams University Maternity Hospital.
Results: Using ROC curve, serum 25(OH) D level 32 ng/ml was significantly associated with PTL (p = 0.001), with
moderate sensitivity of 80% and low specificity of 47.5%.
Conclusion: Preterm delivery was significantly associated with vitamin D 32.0 ng/ml. Although serum 25(OH) D
deficiency is a significant risk factor, but it cannot be considered a diagnostic tool in predicting PTL.
Keywords: Preterm labor, Vitamin D deficiency, Pregnant women.

production of inflammatory cytokines that contribute
Every year, 15 millions of infants are born
to spontaneous preterm delivery, such as tumour
preterm, worldwide (1). Unknown factors that increase
necrosis factor-alpha (TNF- ) and Interleukin-1, 6
the chance of spontaneous preterm labour include low
(IL-1, 6) (10). Additionally, several research revealed
socioeconomic status, little education, genitourinary
that pregnant women with vitamin D deficiency
produced more inflammatory cytokines like TNF-
incompetence, intense manual labour, prior abortion,
(11). In order to preserve myometrial quiescence,
and prior preterm labour (2).
vitamin D may also lower the chance of premature
Some studies stated that intra-amniotic microbial
delivery (10).
infections or inflammation and premature cervical
Preeclampsia, gestational diabetes, preterm
changes are the most important causes of preterm
delivery, intrauterine growth restriction, spontaneous
labor. The mechanism of preterm labor may be due to
abortion, caesarean section, maternal depressive
complement activation caused by micro-organisms
symptoms, and low birth weight babies are just a few
invasion (3).
of the harmful outcomes for mothers and their unborn
Due to changes in the vagina's microbial habitat
children that have been linked to vitamin D deficiency
during pregnancy, ascending vaginal or cervical
in numerous studies (12). However, other research has
infections are believed to be the primary cause of the
not discovered a connection between low vitamin D
majority of intra-amniotic infections (4).
level and preterm labour or premature membrane
Maintaining appropriate blood levels of calcium
rupture (13).
and phosphate, which are necessary for bone

mineralization, muscle contraction, nervous system
activity, and cellular function, is facilitated by vitamin
This case-control study was conducted on 160
D (5). Additionally, vitamin D has potent immuno-
pregnant women who were admitted to the Obstetrics
modulating characteristics that may support the
and Gynecology Department in Ain Shams University
development of a healthy maternal immune response
Maternity Hospital during the period from December
to the placenta. Studies examined its function in
2019 to January 2021, allocated into 2 groups:
ensuring normal placenta implantation by controlling
- Cases: 80 pregnant women who delivered their
particular target genes (6, 7). Vitamin D is also found to
babies between 28 weeks and 37 weeks of
have a role in production of sex steroids during
gestation (preterm labor).
pregnancy (8).
- Control: 80 pregnant women who delivered their
Vitamin D is well recognized for its antioxidant
babies at term, with no obstetric complications.
activity, immune-modulatory, anti-fibrotic and anti-

inflammatory effects, as it regulates the production and
Inclusion criteria: Primigravida women aged between
function of cytokines, neutrophil degranulation
20 and 35 years old with BMI between 5th percentile
products and antimicrobial peptides such as
and 95th percentile for age.
cathelicidin, preventing microbial invasion, reducing
Exclusion criteria: Multigravida. Rupture of
the risk of infection (9). It works by lowering the
membranes. Maternal vaginal bleeding in 1st or 2nd
Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 131)

c:\work\Jor\vol901_132 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 901-903

Impact of Physiotherapy on Vital Signs and Blood Gases in COVID-19 Patients
Marwa Elhelali Elsherbeni1*, Saad Elsayed Flefil2, May Elsherbiny Badr3, Mona Elhelaly Elsherbeny4
1 Department of Physical Therapy for Internal Medicine and Geriatrics,
Faculty of Physical Therapy, Horus University, Egypt
2 Department of Topical Medicine, 3 Department of Anesthesiology, Surgical and Pain Management, 4 Department of
Medical Biochemistry and Molecular Biology, Faculty of Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Marwa Elhelali Elsherbeni, Mobile: (+20) 01100031764, E-Mail: marwahelali@ymail.com

The severe acute respiratory syndrome (SARS), the Middle East respiratory syndrome, and the common
cold are all diseases that can be brought on by the coronavirus family of viruses (MERS). A disease epidemic that began
in China was linked to a novel coronavirus in 2019. A person's quality of life is impacted by Corona Virus Disease 2019
(COVID-19), which also raises the rate of morbidity and mortality. The chance of developing a major disease from
COVID-19 rises with age in older adults. A major sickness may be more likely to strike those who already have
underlying medical issues.
Objectives: The purpose of the current study is to objectively evaluate the effect of physiotherapy therapy on COVID-
19 patients.
Patients and methods: A total of 60 COVID-19 patients were included, with ages ranging from 46­55 years, and were
divided into two age-and-sex-matched groups. They were divided into two groups; A and B (intervention and control),
of an equal number of patients, each 30. Both groups received their COVID-19 medical treatment. In addition, group A
received a physiotherapy protocol, 3 times per week for 2 weeks as a total period of treatment. Vital signs and blood
gases were measured before and after the study. Results: There was a statistically significantly higher post-intervention
O2 saturation and PaO2 in group A vs. group B, and a statistically significantly higher post-intervention PaCO2 in group
B vs. group A. There was no statistically significant difference in all other parameters (systolic blood pressure, diastolic
blood pressure, HCO3, PH, heart rate, or respiratory rate).
Conclusion: For COVID-19 patients, the physiotherapy therapy PT protocol is an effective, noninvasive, and safe
COVID-19, Physiotherapy therapy, Blood gases, Vital signs.


cytokine storm, and with early detection comes early
Hospitalizations for pneumonia with multi-organ
care that can save many lives (5).
illness brought on by the coronavirus disease 2019

(COVID-19) pandemic have been reported to have
Due to the persistent and severe inflammation seen
increased significantly over night (1). Due to its
in COVID-19, sedentary lifestyles and inactivity are
widespread infectivity and high rate of contagion, the
associated with a higher risk of hospitalization and
disease was given the designation coronavirus disease
mortality. People are more susceptible to the most
2019 (COVID-19) by the World Health Organization (2).
severe types of COVID-19 when they have certain
Coronavirus, which is a member of the Nidovirales
diseases (6).
order of the Coronaviridae family, is divided into four
Many evidence-based care strategies for chronic
genera: -, -, -, and - CoV. - and - CoVs. Only
illnesses, especially those involving cardiac issues,
mammals can contract - and CoVs, yet CoVs mostly
include physical therapy as a crucial component.
infect birds. The Middle East respiratory syndrome-
Therefore, it would make sense to provide long-
related coronavirus (MERS-CoV), SARS-CoV, -
COVID-19 patients who have other chronic diseases
CoVs (229E and NL63), -CoVs (OC43 and HKU1),
physiotherapy (7).
and CoVs (229E and NL63) are among the human
Pre-post treatment aerobic capacity and
coronaviruses (5). The COVID-19-causing CoV is -
endurance, health status, dyspnea-related impairment,
CoV in the same subgenus as the SARS virus, but in a
and cardio-respiratory function all benefit with physical
distinct clade, according to the genomic and phylogenic
therapy. Additionally, all post-COVID-19 patients saw
analyses (5). The virus was identified on January 7 as a
an improvement in health status and a general decrease
CoV with >95% similarity to the bat CoV and >70% (3).
in impairment brought on by dyspnea at the 2-year
The admission oxygen saturation, respiratory rate,
follow-up (8).
glucose, and diastolic blood pressure (with/without age)
The purpose of the current study is to objectively
multivariate regression model showed promising
evaluate the effect of physiotherapy therapy on COVID-
predictive capacity and may offer a practical, affordable
19 patients.
method for early prognostication of patients admitted

with COVID-19 in resource-constrained settings (4).
Regular arterial blood gas monitoring can aid in the
A total of 60 patients were chosen from the
early discovery of respiratory injury, silent hypoxia, and
Mansoura Chest Hospital and Mansoura University
Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 132)

c:\work\Jor\vol901_133 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 904-913

Determination of Neopterin and Biopterin in Dried Blood Spot by Tandem
Mass Spectrometry in Classic and Atypical Hyperphenylalaninemia
Nadia Salama*1, Radwa Gamal2, Osama Zaki2, Ashraf Khalil1, Manar Obada1, Gamalat El Gedawy1
1Department of Biochemistry and Molecular Diagnostics,
National Liver Institute, Menoufia University, Menoufia, Egypt
2Department of Human Genetics, Ain Shames University, Cairo, Egypt
*Corresponding author: Nadia Salama, Mobile (+20)01009711622, Email: nadia_salama2@yahoo.com

Tetrahydrobiopterin is a coenzyme of phenylalanine hydroxylase and other enzymes essential for the
synthesis of tyrosine and other neurotransmitters. Despite proper nutritional regulation of blood phenylalanine levels,
tetrahydrobiopterin deficiency results in progressive neurologic illness.
Objective: The study aims to optimize a mass spec-dependent assay for quantitative measurement of biopterin and
neopterin as distinctive markers of the atypical phenylketonuria due to tetrahydrobiopterin deficiency.
Patients and methods: The study enrolled 46 patients with typical hyperphenylalaninaemia, 14 atypical cases, and 50
healthy children as a control group. Quantitative measurements of biopterin, neopterin, phenylalanine, and tyrosine
were performed by ultra-performance liquid chromatography-mass spectrometry in the dried blood spots of patients
and control samples.
Validation of the analytical protocol was performed at a biopterin and neopterin concentration range from 0
to 100 nmol/l. The regression coefficients for the linearity of the calibration curves exceeded 0.98. The lower limit of
detection of biopterin and neopterin ranged from 1.5 to 2.5 nmol/l. The intra-day and inter-day precision and accuracy
ranged from 96% - 105%, and from 97% - 110%. The mean recoveries were 105 ± 7% for biopterin and 106 ± 9% for
neopterin. The short and long-term stability of the stored samples was seven days at room temperature and 12 weeks
at -20 °C. Biopterin and neopterin were significantly higher in the classic group compared to the atypical and control
group (p < 0.05), with their level being in the order classic > control > atypical group. Phenylalanine levels had a
significant positive correlation with biopterin and neopterin levels in classic phenylketonuria (p < 0.05).
Conclusions: The performance of the developed assay for biopterin and neopterin in the dried blood spot by ultra-
performance liquid chromatography-mass spectrometry was accurate and precise thus, provide a legitimate diagnostic
tool for cases of atypical phenylketonuria.
Keyword: Tetrahydrobiopterin, Neopterin, Biopterin, Hyperphenylalaninemia, Liquid chromatography-mass

(plasma Phe 600-1200 mol/l), and mild PKU (plasma
Phe 120-600 mol/l). About 50% of instances of PKU
neurotransmitters dopamine and norepinephrine in the
are classified as classical, 30% as moderate, and 20%
central nervous system, is in insufficient supply if
as mild. Only 2% of those with hyperphenylalaninemia
phenylalanine (Phe) cannot be converted to tyrosine
had a PAH gene mutation rather than a deficiency in
(tyr). Because of a shortage or absence of the essential
BH4 production or recycling [7].
amino acid phenylalanine (Phe), phenylketonuria
Five separate hereditary disorders that mirror
PKU with increased phenylalanine levels and the
Tetrahydrobiopterin (BH4), a cofactor for the enzyme
potential for neurological damage despite early
phenylalanine hydroxylase (PAH), causes the
treatment are caused by the inability to synthesis or
condition known as atypical PKU [1].
renew the PAH cofactor BH4. Without the requirement
If PKU is not treated, it leads to gradual and
for a Phe-restricted diet, the administration of synthetic
permanent brain damage. During the first few years of
BH4 quickly returns plasma Phe levels to normal [8].
life, the brain is particularly vulnerable to the
Patients with hyperphenylalaninemia (HPA)
neurotoxic effects of increased Phe. Elevated Phe
experience a depletion of catecholamines and serotonin
disrupts brain tissue's myelination, synaptic sprouting,
because BH4 is a necessary cofactor for PAH, tyrosine-
and dendritic pruning [2]. Preventing mental retardation
3-hydroxylase, and tryptophan-5-hydroxylase in
and serious neurological consequences such seizures
addition to all three isoforms of nitric oxide synthase
and spasticity is possible with PKU screening,
(NOS), the key enzymes in the biosynthesis of
diagnosis, and therapy during the newborn period [3-6].
dopamine and serotonin [9­12].
The most prevalent inborn metabolic mistake,
Although sufficient dietary control of blood
PKU, is most prevalent in Ireland, Eastern Europe, and
phenylalanine levels is maintained, BH4 deficiency is
North America [1]. Based on the plasma Phe level upon
a serious condition that causes gradual neurologic
diagnosis, PKU is divided into three categories: classic
deterioration. BH4 is a possible therapeutic target for
PKU (plasma Phe >1200 mol/l), moderate PKU
Received: 01/08/2022
Accepted: 02/10/2022

Full Paper (vol.901 paper# 133)

c:\work\Jor\vol901_134 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 914-919

Prevalence of H. Pylori Infection among Patients with
Acute Myocardial Infarction
Amira K. El-Alfy1, Noha Abdelrazek Eldeeb*1, Ahmed Bendary2,
Asmaa A. Elfallah3, Ahmed R. Mohamed1
Departments of 1Internal Medicine, 2Cardiology and 3Clinical Pathology,
Faculty of Medicine, Benha University, Qalyubia, Egypt
*Corresponding author: Noha Abdelrazek Eldeeb, Mobile: (+20) 01274440453, Email: noha.eldeeb2050@gmail.com

Infection with Helicobacter pylori (HP) is the most prevalent infection worldwide, particularly in
underdeveloped nations. It is reported to be associated with many extra gastrointestinal manifestations.
The current work aimed to study the prevalence of HP infection among patients with acute myocardial
infarction (AMI). Patients and Methods: This cross-sectional study included STEMI and NSTEMI patients admitted
with AMI in the CCU of the Cardiology Department at Benha University Hospital, Egypt.
The prevalence of HP among the studied patients was 72%. Our study showed that those with positive HP
Ig-G had considerably lower triglycerides than those with negative HP Ig-G. No significant differences were observed
regarding hemoglobin, TLC, platelets, serum creatinine, blood urea, ALT, AST, total cholesterol, HDL, and LDL. In
patients with positive HP Ig-G, significant negative correlations were observed between ejection fraction (EF) and
blood urea, serum creatinine, and AST.
Conclusion: In this study, HP is related to the incidence of MI. The elimination of HP prevents the onset of CAD and
associated consequences.
Keywords: Prevalence, HP, Infection, Acute Myocardial Infarction.

Currently, the most prevalent risk factors for
This cross-sectional study included STEMI and
NSTEMI patients admitted with AMI in the CCU of
atherosclerosis are dyslipidemia, diabetes, smoking,
the Cardiology Department at Benha University
and hypertension [1]. For many years, monocytes and
Hospital, Egypt.
macrophages have been recognized as components of
The study was done after being approved by the
atheromatous plaque. The involvement of an active
institutional ethical committee and informed consent
inflammatory process in the etiology of atherosclerosis
was obtained from all participants included.
in coronary circulation is developing rapidly [2].
The inclusion criteria were patients with age 18
The Helicobacter pylori (HP) infection is the
years old, who were admitted with acute myocardial
most prevalent infection worldwide, especially in
infarction (STEMI and NSTEMI).
The exclusion criteria included severe renal failure
symptoms have been linked to HP infection, according
(creatinine >2 mg/dL), anemia, hepatic failure,
to Yokota et al. [3]. Several signs point to a connection
neurological or endocrine diseases, previous HP
between persistent infections, atherosclerosis, and
infection treatment, and malignancies.
vascular disease. The prevalence of inflammation as a

cardiovascular risk factor and the existence of HP in
All participants were subjected to full history
extra-digestive illnesses motivated researchers to study
taking including [Age, gender, BMI, HTN history,
the role of HP in atherosclerosis progression. There
Stroke, Cardiac diseases and cardiac failure, DM,
was a significant incidence of active HP infection
smoking (Patients who had quit smoking for fewer
among patients with myocardial infarction, which may
than 10 years were categorized as smokers), CCU
be a modifiable risk factor for upper gastrointestinal
admission, and renal insufficiency].
bleeding [4].

Given that HP infection has emerged as a
Clinical examination including [Biochemical
potentially modifiable risk factor for UGIB and early
parameters, thorough Complete blood picture, ESR,
termination of DAPT in patients with AMI, we
CRP, Total cholesterol, LDL, HDL, TG, liver, and
believed that examining the incidence of HP infection
kidney function tests, ECG, and ECHO].
in a group of patients with AMI would be of
considerable interest. This might be considered a step
demographic information and the use of medicines
forward in proving the feasibility of Hp testing as part
having known effects on atherogenesis.
of the standard therapeutic therapy for AMI patients.
STEMI was defined according to the 2017 ESC
This may stimulate the continued use of DAPT, so
STEMI guidelines [6], and NSTEMI was defined
optimizing its advantages [5].The present work aimed
following the 2020 ESC guidelines [7]. The evaluation
to study the prevalence of HP Infection among patients
of a MI is comprised of three components: clinical
with acute myocardial infarction.
Received: 21/07/2022
Accepted: 23/09/2022

Full Paper (vol.901 paper# 134)

c:\work\Jor\vol901_135 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 920-927
Interaction Between Maternal Chrysin Intake and Development of
Adrenal Gland in Rat Fetus during Organogenesis
Sahar A. Sabry
Department of Biological and Geological Sciences, Faculty of Education, Ain Shams University, Cairo, Egypt
Corresponding author: Sahar A. Sabry, Mobile: (+20) 01204427241, E-Mail: sahar_ahmed@edu.asu.edu.eg

Chrysin is a flavone that occurs naturally in plants and possesses antioxidant and anti-inflammatory
effects. Objective: This study was carried out to examine the effect of chrysin on the adrenal cortex of maternally
treated rat fetuses. Material and methods: Twelve pregnant rats were assigned into two groups (6 rats each). The first
group acted as a control and received a vehicle 1% w/v Tween 80 (the drug's solvent) (GDs 7-14), whereas rats of the
second group were treated orally with chrysin (50 mg/kg body weight/day) daily from day 7 till day 14 of gestation.
Animals were sacrificed, and samples of the adrenal glands were taken, processed, and prepared for the histological
and ultrastructural examination. Results: The three cortical zones, Zone glomerulosa, Zone fasciculata, and Zone
reticularis in the cells of the adrenal cortex sections from maternally treated rat foetuses showed cytoplasmic
vacuolation. Some of these cells' nuclei showed indications of karyolysis. Cortical cells had clear alterations at the
ultrastructural level, including cavitated and deformed mitochondria as well as dilated smooth and rough endoplasmic
reticular membranes. Accumulation of lipid droplets and lysosomes was seen in the vacuolated cytoplasm. These cells'
nuclei had karyolysis visible. Conclusion: It appears that oral administration of chrysin caused damaging effects on
adrenocortical cells of maternally treated rat fetuses. Therefore, it should be taken into mind and viewed with great
worry that chrysin, although one of the flavonoids, should be utilized with caution during pregnancy.
Keywords: Fetus, Estrogen, Adrenal cortex, Chrysin, Histology, Ultrastructure.

their fetuses; nevertheless, antioxidants may harm the
Plant flavonoids have recently piqued both scientif
ic and public attention due to claims that they provide
The adrenal cortex is a crucial mammalian
health benefits (1). Chrysin is a naturally occurring
endocrine organ that produces a variety of hormones.
flavone that is frequently present in plants. Its anti-
Pregnancy must be maintained to encourage fetal
inflammatory and antioxidant properties have been
growth and nervous system development (10).
researched (2).
Additionally, it is crucial for the fetus's growth and
Most research indicated that chrysin inhibits
development after delivery. The adrenal cortex's
aromatase activity. Aromatase, also known as
improper functional growth will result in an abnormal
cytochrome P450, had a significant influence on cell
production of steroid hormones, which will lead to the
growth and the cell cycle and allowed for the
development of associated disorders (11).
production of excess estrogens from testosterone.
Despite the previously mentioned therapeutic
Because of their enhanced protein stability and lower
benefits of chrysin, the developmental period at which
bioavailability, chrysin solid lipid nanoparticles allow
exposure takes place is a significant matter; for
for long-term therapeutic delivery (3). According to a
example, its usage during pregnancy is an important
study by Balta et al. (4) chrysin has a therapeutic
subject that requires further investigation. So, the study
impact on liver fibrosis brought on by carbon tetra
tried to illustrate whether the beneficial impacts of
chloride (CCl4). Also, Chrysin has high bioavailability
chrysin as proven in adults extend to fetuses or not by
in the low gastrointestinal tract so it is effective in
focusing on the embryonic development of one of the
treating conditions affecting the ileum and colon such
most essential organs, the adrenal glands of the
as cancer and local infections (5). Chrysin not only
fetuses. To our best knowledge, there were scarce
provides a defense against interstitial fibrosis and renal
studies that demonstrated the possible harmful effects
impairments brought on by Cyclosporine A (CsA) (6),
of chrysin exposure during pregnancy. Therefore, this
but also inhibits D-gal-induced oxidative stress,
investigation aimed to explore the potential
inflammation, apoptosis, and ovarian damage (7),
undesirable outcomes of chrysin exposure during
suggesting that chrysin may play a role in the
pregnancy on the histological and ultrastructural
prevention of premature ovarian failure.
characteristics of the adrenal gland of maternally
Physiological changes during pregnancy, along
treated rat fetuses.
with the demands of a growing human fetus, such as

increased metabolic demands, and lack of essential
vitamins and minerals might be harmful to both
Mature Wistar albino rats (Rattus norvegicus) utilized
parties' health (8). There is a strong correlation between
in this study were obtained from Theodor Bilharz
maternal malnutrition and the mortality and morbidity
Research Institute (TBRI), Imbaba, Giza, A.R. Egypt.
of fetuses (9). Pregnant women may turn to consume
The Wistar rats were 150­160 g in weight on average.
nutritional supplements, vitamins, and antioxidants in
Males and females were maintained in separate plastic
an attempt to enhance their health and the health of
cages, each containing two rats, to avoid
overpopulation. They were kept in the laboratory for
Received: 21/07/2022
Accepted: 23/09/2022

Full Paper (vol.901 paper# 135)

c:\work\Jor\vol901_136 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 928-936

Study on The Bioactive Components of Atriplex halimus L. and Evaluation of
Their Anticancer Effect on Liver Cancer Cells
Ali Hasanain Alhamadani 1 , Enas abdul Kareem jabbar 2 , Alla N.Al-Waheeb 1
1 Department of Biology, College of Science, University of Thi-Qar, Thi-Qar, Iraq.
2 Basic Medical Science, College of Nursing, University of Thi-Qar, Thi-Qar, Iraq.
Corresponding author: Ali Hasanain Alhamadani, E-mails: Ali.hasanen@mu.edu.iq
Mobile: 009647813318533 , ORCID ID: 0000-0002-9704-7862

Liver cancer is one of the most prevalent and fatal malignancies in the human digestive system, killing
over 500,000 people each year worldwide.
Aim of the work: This study was to analyze for the first time the phytochemical composition of Atriplex halimus L.
by High-Performance Liquid Chromatography technique and to evaluate its anticancer activity on primary cell culture
of human liver carcinoma by MTT assay and compared it with a chemotherapy drug.
Method: Cancer cells were treated with a concentration of AHE, Cisplatin, and a combination of them. Also, cell
viability and morphological changes, Superoxide Dismutase, and Catalase enzyme activity were measured.
Results: The results showed two types of flavonols, quercetin, and kaempferol identified. The MTT assay shows the
highest cytotoxicity on cancer cells at concentrations of 100 and 200 µg/ml for all treatments. Superoxide dismutase
enzyme showed an increased level (P = 0.001) while catalase enzyme showed decreased level (P = 0.032) in treated
cells compared to the untreated cell.
Conclusion: Our findings suggest that A. halimus possesses antioxidant and anticancer properties, which are possibly
due to flavonoids existing in this plant, and could be a potential candidate for the development of drugs for the
management of liver cancer cells.
Keywords: Atriplex halimus, Liver Cancer cell, HPLC, SOD, Catalase.

Some studies highlight the cytotoxic activity
The liver is the largest glandular organ that
of the methanolic extract of A. halimus, which had an
performs several crucial functions to keep the body
antiproliferative effect and was highly cytotoxic on
free from toxins and harmful substances. (1,2)
cell lines (MCF-7) and (HepG2) Neima and Abou-
75% of occurrences of liver cancer globally
Eisha (10). On the other hand, this extract did not
are of the most frequent kind, hepatocellular
impair the proliferation of normal cell lines.
carcinoma (HCC). The second leading cause of cancer
Numerous studies have found plant species utilized in
death worldwide and the seventh most prevalent
traditional medicine in developing nations that have
cancer overall is primary liver cancer Ferlay et al. (3) .
shown anticancer effects .(11,12,13,14)
Asia and Africa have the highest rates of incidence in
The present study is a novel study of
the world. China has the most cases due to a high rate
phytochemical analysis of A. halimus by HPLC
(18.3 per 100,000) and the largest population in the
technique to evaluate its cytotoxic effect on the
world, However, Mongolia has the highest incidence
primary cell culture of human liver carcinoma and
of liver cancer at 93.7 per 100,000 people (4).
assess the anticancer activity of A. halimus extract.
Chemotherapy and radiotherapy are among

the current treatments. Chemotherapy can put patients
under a lot of stress and damage their health. As a
Plant Collection and Extraction
result, there is a focus on using alternative cancer
Fresh plants of Atriplex halimus L. were
treatments and therapies. (5)
collected as a whole plant in April 2022 from the west
Atriplex halimus is a perennial shrub that is
of Al-Samawa City, Iraq. The plant was identified in
halophytic and thrives in dry and semi-arid climates.
the Biology Department, Thi-Qar University, Iraq.
It is an excellent species for landscaping in arid and
The Powder of the whole plant (50gm) was macerated
salt-affected areas because of its resilience to severe
with 250 ml of 80 % methanol using an ultrasonic
salinity and drought, where it provides valuable feed
extractor (20 kHz, power 100w) for 30 min, followed
for livestock. Heuzé et al. (6) , OEP (7). It can grow
by putting it in a shaker incubator for 24 hours at room
from Europe to Northern Africa, western Asia, and W.
Iraq and the NE, as well as the Arabian Peninsula
Flavonoids Isolation from A. halimus
Ghazanfar (8). Depending on how well it has adapted
The methanol soluble fraction (Fr I) was then
to the extreme climatic conditions through
extracted with second fractionation (Fr II) by adding
morphological, anatomical, and physiological
an equal volume of hexane (100 ml) to the methanol
changes. The leaves of the plant are used by native
extract and shaking it in a Buchner funnel for four
herbalists in Arabic countries to cure rheumatism,
hours. However, the lower layer of the solvent was
diabetes, and heart conditions Said et al. (9)
isolated, and then an equal volume (100 ml) of ethyl
Received: 21/07/2022
Accepted: 23/09/2022

Full Paper (vol.901 paper# 136)

c:\work\Jor\vol901_137 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 937-942

Detection of Main Barriers for Adverse Drug Reactions Reporting in
The Middle East Countries: Review article
Mohammed Mahdi H. Abdul Hussein*, Jubran K. Hassan
Department of Clinical Pharmacy, College of Pharmacy, University of Basrah, Iraq
*Corresponding author: Mohammed Mahdi H. Abdul Hussein, Mobile: 009647725579153, E-mail: smmh91@gmail.com

Background: For years, specialists have been interested on the verge of documentation of adverse drug reactions
because of its great importance. The countries of the Middle East have also kept pace with this mission and developed
in the past years. Like any other project, this documentation process is accompanied by several problems that will
negatively affect the objectives set in this area.
Objective: The aim of the current study is to know the main barriers regarding the process of adverse drug reactions in
the Middle East area.
Patients and methods: In October 2022, a manual search of the literary databases PubMed and Google Scholar has
done. The 102 articles were manually screened. Studies that have been published between 2012 and 2022 were eligible.
Results: From the 102 publications that underwent manual screening, 26 research articles from 12 different countries
qualified for inclusion in the study. Lack of enthusiasm, a professional atmosphere for the conduct of
pharmacovigilance, a general lack of knowledge and awareness concerning pharmacovigilance and not enough time for
reporting are the main barriers for adverse drug reactions.
Conclusion: According to the results, the lack of knowledge or awareness of pharmacovigilance practices and the
absence of mechanisms that assist recording in terms of enough time, motivation, or the environment as a whole are the
two most significant causes of underreporting.
Keywords: Adverse drug reaction, Barriers, Pharmacovigilance, health care providers, Review, University of Basrah.

as a result of the numerous evident morbidities and the
The use of medicines is an inextricable part of human
deaths they produce. If pharmacists and other healthcare
life and we see clearly with the development of new
workers pay great attention to the information on the
diseases and health problems, the indications for the use
side effects of the medications given to patients, we can
of medicines have become more important and besides,
prevent ADRs. Understanding ADRs helps reduce the
the use and discovery of therapeutic substances to be in
irrational usage of unsuitable medication. Consequently,
line with the need of humans to fight these diseases.
there is a critical need to raise pharmacists' and
Accordingly, with the widespread use of medicines in
prescribers' understanding of ADRs and medication
the world, also there has been a proliferation of adverse
monitoring Omer et al. (4).
drug reactions (ADRs) associated with the use of those
Healthcare providers need to be particularly aware of
drugs. World Health Organization (WHO) has provided
pharmacovigilance. Pharmacy and medicine students
a definition of ADR, which is as follows: "a negative,
must get thorough instruction on how to recognize,
unanticipated reaction to a medicine that happens at
avoid, and report ADRs. The healthcare providers'
dosages typically used in humans for illness prevention,
undergraduate training is the ideal period to increase
diagnosis, treatment, or altering physiological function".
Edwards (1).
pharmacovigilance Omer et al. (5).
The term of pharmacovigilance (PV) is another
The under-reporting of ADRs by them, however, is
important concept has taken a documented association
a concern in many nations, including the middle-east
with the ADRs since years ago and it is mean: "the
nations. Lack of awareness and expertise of methods to
science and actions related to the evaluation, detection,
recognize and report ADRs may be used to explain this.
comprehension, and prevention of negative drug-related
The aim of the current study is to know the main barriers
effects or any other issues Adheed et al. (2).
regarding the process of adverse drug reactions in the
Due to the importance of the topic, the study of PV
Middle East area.
at the levels of knowledge, attitude and practice is very

useful. To find out more about the importance of
documentation of adverse drug reactions it is enough to
Search protocol
know that ADRs appear in 10% of outpatients, causing
A manual search was conducted on the literature
approximately 5-10% to be admitted to hospital
databases PubMed and Google Scholar in October 2022,
Aljadhey et al. (3).
ADRs are regularly seen in the routine operations of
Pharmacovigilance, adverse drug reaction, adverse drug
pharmacies and hospitals, both privately and publicly
reactions, barriers, marries to pharmacovigilance,
held. The healthcare system faces financial difficulties
Middle East.
Received: 21/7/2022
Accepted: 23/9/2022

Full Paper (vol.901 paper# 137)

c:\work\Jor\vol901_138 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 943-947

The Association of Leptin Levels in Iraqi Women with
Newly Diagnosed Thyroid Dysfunction
1 Haider Ridha Mohammed Saeed, 1 Sura A.Abdulsattar, 2 Abdilkarim Y.Al-Samarriae
1 Mustansiriyah University/ College of Medicine /Department of chemistry and Biochemistry
2 National Diabetic Center for Treatment and Research/Mustansiriyah University.
Corresponding authorl: Haider Ridha Mohammed Saeed
Email: haidersaeed@uomustansiriyah.edu.iq. Phone: +9647712321428


Background: Leptin changes were observed in thyroid dysfunction patients, yet the evidence is inconsistent.
This study aimed to find the correlation between leptin and thyroid hormone with lipid profile in Iraqi
women who have recently been diagnosed with thyroid dysfunction.
Subjects and Methods: A case-control study that was conducted at Chemistry and Biochemistry department, Medicine
College in cooperation with National Diabetes Center (NDC), Mustansiriyah University during the period from January
2021 to February 2022. One hundred thirty two (132) samples were included in this study. All participants were women
and aged between (21-54) years. They were divided into three groups: (44) subjects served as a control group, (44)
patients with newly diagnosed hyperthyroidism and (44) patients with newly diagnosed hypothyroidism.
Results: The levels of serum leptin have been elevated in the patients who have newly diagnosed hypothyroidism (p
0.001) and declined in patients that had newly diagnosed hyperthyroidism (p 0.0010) when compared to control group.
Patients with hyperthyroidism had low levels of triglycerides, cholesterol, high density lipoprotein, very low density
lipoprotein and low density lipoprotein, while patients with hypothyroidism had high levels of triglycerides,
cholesterol, high density lipoprotein, very low density lipoprotein and low density lipoprotein. No correlation between
leptin and thyroid hormones with lipid profile in both hypothyroidism and hyperthyroidism. Conclusion: Leptin levels
were high in patients with hypothyroidism, while were low in hyperthyroidism. No correlation between leptin and
thyroid hormones with lipid profile.
Keywords: Hyperthyroidism, Hypothyroidism, Leptin.


adipose tissue interchange (6). Adipose tissue function
A hypermetabolic state that is characterized by
could be affected by thyroid dysfunction, which
the increase in the expenditure of resting energy, loss
contributes to the growth of metabolic diseases.
of weight, lower levels of cholesterol, elevated
Additionally, people with thyroid dysfunction have
gluconeogenesis, and improved lipolysis, is aided by
changes in their lipolysis (7).
hyperthyroidism, a condition in which there is too much
Previous studies point to a connection between
thyroid hormone. Conversely, hypothyroidism, or low
leptin and thyroid hormones. TSH could induce leptin
levels of the thyroid hormone, has been related to the
release from adipose tissue while leptin can stimulate
hypometabolism, which is distinguished by low resting
thyroid-stimulating hormone secretion (8, 9).
weight, low
According to studies, hyperthyroidism patients
gluconeogenesis, elevated levels of the cholesterol, and
also have altered profiles of adipokines (such as resistin,
low lipolysis (1).
adiponectin, and leptin, among others) in addition to
Thyroid hormones and adipokines have
aberrant circulating levels of TSH and TH (10).
physiological effects in addition to glucose and lipid
Additionally, adipocytes show high numbers of
metabolism, like controlling energy expenditure (2).
TH and TSH receptors that operate similarly to thyroid
Adipokines are a diverse of biologically active
receptors, indicating that TH could play a role in
materials that are released by adipose tissue in
controlling adipocyte functions (11).
paracrine, autocrine, and endocrine processes (3).
Therefore, adipokine secretion, which contributes
Adipokines, including resistin, adiponectin, leptin, and
to lipid metabolic disorders, could be impacted by
fibroblast growth factor 21, among others, have been
thyroid dysfunction.
demonstrated to play a significant role in
Leptin elevates levels of thyroid hormone (12). It
controlling energy expenditure and lipid metabolism in
impacts on metabolism of thyroid by adipocytes; leptin
some ways (4). Leptin is a protein with 146 amino acids
and thyroid stimulating hormone had a positive
that adipocytes excrete when there is an increase in fat
association could occur due to this direct effect of TSH,
mass. It is a crucial atom in feed-in circle that controls
it might also affect thyroid- axis in acute way.
balance of energy. Leptin has two functions: it reduces
Leptin taking inverts the fasting-induced
appetite and increases fat burning by improving energy
suppression of hypothalamus pituitary- thyroid axis at
utilization (5). As adipokine that is released by the
the central level by expression of upregulating TRH in
adipose tissue, leptin regulates glucose and lipid
the hypothalamus (13). This study aimed to find the
with energy
correlation between leptin level and thyroid hormone
Consequently, it appears that thyroid function and
Received: 26/7/2022
Accepted: 28/9/2022

Full Paper (vol.901 paper# 138)

c:\work\Jor\vol901_139 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 948-952

Harmonic versus Cold Steel Dissection Tonsillectomy, A Comparative Study
Nawres Jawad Alshlah 1, Mohammed Fadhil Mohammed 2, Muthanna Saleem Abdulameer3
1. Imam Alsadiq general teaching hospital, Babylon, Iraq.
2. Al Najaf teaching hospital, Najaf, Iraq.
3. Hammurabi College of Medicine, University of Babylon.
Corresponding author: Nawres Jawad Alshlah, drnawrasalshalah@gmail.com,
ORCID: 0000-0002-3150-8953. Tel: 009647716229835

Tonsillectomy is one of the most common operations performed in otolaryngology departments, various
techniques used for this purpose including dissection method and powered instrumentation like electrocautery, harmonic
scalpel, radiofrequency techniques, laser technique and coblation technique.
Objective: This study aimed to compare the intraoperative time, intraoperative bleeding and post. Operative pain among
patients underwent harmonic and cold steel dissection techniques.
Patients and Method:
This was prospective randomized study p erformed in AL-Hilla Teaching Hospital. It included fifty
patients scheduled for tonsillectomy for chronic tonsillitis from July 2016 to October 2017. Harmonic tonsillectomy (HT)
was done on right side and traditional tonsillectomy on left side by same surgical team.
Patients reported significantly less intraoperative bleeding (HT mean was 4.8 ml, while CDT mean was 64.7), less
operative time (HT mean was 4.76 min., while CDT mean was 10.1 min) and less postoperative pain (from 0,3,7 and 14
postoperative days HT means pain score were 1.68, 3.6, 1.64 and 0.65 respectively and CDT means pain score were 5.8,
4.5, 2.4 and 0.78 respectively) on the harmonic scalpel tonsillectomy side compared with the Cold steel dissection
tonsillectomy side. In the day 11 to 14 pain difference disappeared and reached plateau phase. There was no post
tonsillectomy bleeding among the 50 patients.
Conclusions: Harmonic scalpel tonsillectomy reduces discomfort, intraoperative hemorrhage, and postoperative morbidity.
Harmonic scalpel tonsillectomy is effective, although the handpiece is disposable.
Keywords: Harmonic, Cold steel, Dissection, Tonsillectomy, Comparative study.


Infectious and inflammatory diseases of the
Neck Surgeons developed SIGN recommendations
pharynx, tonsils, and adenoids are a major cause of illness
that advocate tonsillectomy in children and adults based
and medical costs in children. Tonsillectomy and
on current information, clinical observation, and clinical
adenoidectomy are common surgeries done on children.
audit. Tonsillitis causing painful throats, a year of
Clinical research has shed light on many parts of
symptoms and sore throats that inhibit proper functioning
paediatric otolaryngology, such as the effects of
(6-8). The risks and benefits of surgery must be weighed.
adenotonsillar hypertrophy on obstructive sleep apnea
The frequency of episodes should be considered. US
and its effects, the microbiologic flora of the tonsils and
health insurance companies recognize AAO HNS
adenoids and their role in chronic adenotonsillar
guidelines. Guidelines propose tonsillectomy for children
hypertrophy, and the relationship between adenotonsillar
with 'three or more tonsil and/or adenoid infections per
hypertrophy and craniofacial growth (1). Tonsillectomy is
year despite acceptable medical care (9), tonsillectomy
a common head-and-neck treatment.
procedures constantly evolve. Before about ten years ago,
Surgery helps children with persistent sore throats.
the most common surgery was a dissection tonsillectomy,
Fewer get tonsillectomy with adenoidectomy for airway
which was first described by Edwin Pynchon in 1890. To
congestion (2). Celsus wrote in De Medicina that tonsil
stop bleeding, ties or diathermy were used. Since then,
'induration' may be eliminated with a fingernail. If this
there have been a lot of new ideas about how to use
wasn't practicable, they may be hooked and dragged out
dissection tools to reduce pain and bleeding after surgery.
using a "bistoury." Once Morrel McKenzie 2's snares and
The basic ideas behind a tonsillectomy haven't changed.
'guillotines' popularised the operation in Victorian
Current trials don't show that any of these
England. Sir Felix Semon (1849-1921) removed the
procedures is clinically better than the others, so we
tonsils of numerous of Queen Victoria's grandchildren (3-
definitely need a large multicenter trial. Before these
5). Tonsillectomy may prevent recurring acute tonsillitis,
procedures are extensively used, cost-effectiveness must
but not other sore throats. Before tonsillectomy, history
be addressed (10).
and clinical exam should confirm recurrent tonsillitis and,
Post-tonsillectomy analgesia lacks evidence. In
if possible, differentiate it from widespread pharyngitis.
multiple trials, 70% of children given postoperative
The British Association of Otolaryngologists Head and
analgesics suffered pain. Two hours preoperatively, they
Received: 26/07/2022

Full Paper (vol.901 paper# 139)

c:\work\Jor\vol901_140 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 953-956

Assessment of Serum Copper in Patients with Anemia after Bariatric Surgery
Ayman Fathy1, Esam N. Mohammed1, Aliaa A. Y. Ateya1, Samia Hussein*2
Departments of 1Internal Medicine, Hematology Unit and 2Medical Biochemistry and
Molecular Biology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Samia Hussein, Mobile: (+20) 01062725981, E-Mail: samiahussein82@hotmail.com

Bariatric surgery interferes with food absorption, which may cause deficiencies in certain elements and
complications. Copper deficiency after bariatric surgeries may be misdiagnosed, which may cause serious diseases.
: The current study aimed to investigate the significance of serum copper level in the early detection of
anemia related to bariatric surgery.
Patients and methods:
This study included 50 participants from both sexes divided into 25 anemic patients after
bariatric surgery and 25 healthy individuals. Full history taking and complete clinical examination were performed for
all participants. Laboratory investigations included hemoglobin (Hb) measurement, serum copper measurement, and
iron parameters including serum iron, ferritin, total iron binding capacity (TIBC), and transferrin saturation.

Results: There was a highly statistically significant decrease in Hb, serum iron, copper, and ferritin levels after
bariatric surgery while transferrin level and TIBC were significantly higher in cases than their controls (P <0.001 for
each), while transferrin level and TIBC were significantly higher after bariatric surgery compared to controls (P
<0.001 for each). There were highly statistically significant positive correlations between copper level and each of
serum hemoglobin (r= 0.726, P=0.03) and iron level (r=0.986, P <0.001), while there were significant negative
correlations between copper level and each of transferrin level (r=-0.617, P=0.005) and TIBC (r=-0.520, P=0.008).
Conclusion: Copper deficiency after bariatric surgery is associated with iron deficiency anemia. So, copper
supplement in addition to iron supplement after bariatric surgery is necessary to avoid the occurrence of anemia.
Keywords: Serum Copper, Anemia, Bariatric Surgery.


Treatment with copper rapidly improved the
Copper is an essential trace element and a
hematological abnormalities. Thus, copper deficiency
component of multiple proteins and metalloenzymes
after bariatric surgeries may be misdiagnosed resulting
which perform important metabolic functions [1]. It is
in serious diseases [8].
involved in the formation of RBCs, absorption, and
The current study aimed to evaluate the
utilization of iron. So, hypocupremia is considered a
significance of serum copper level in the early
cause of hematological problems like anemia, and
detection of anemia related to bariatric surgery.
bone and neurological manifestations [2]. Copper

deficiency can be represented as microcytic,
normocytic, or macrocytic anemias [3].
This case-control study was conducted in the
The main sites of absorption of copper in humans
Clinical Hematology Unit, Internal Medicine
are the stomach and proximal part of the small
Department, Zagazig University, and the Medical
intestine, but absorption can be impaired after upper
Biochemistry and Molecular Biology Department,
gastrointestinal surgery [4]. Bariatric surgery became a
Faculty of Medicine, Zagazig University.
popular solution for morbid obesity [5]. Bariatric
The study included 50 participants from both sexes
surgery includes multiple procedures such as gastric
divided into 25 anemic patients after bariatric surgery
bypass surgery, biliopancreatic diversion with
and 25 healthy individuals.
duodenal switch, and sleeve gastrectomy. All of them
The age of the included participants was more than
aimed to reduce stomach size, and decrease the
18 years. Patients with known hematological diseases
absorption of food in obese patients [6].
were excluded from the study.
Unfortunately, Bariatric surgery interferes with the
Complete history taking including drug history and
absorption of certain nutritional elements, causing
complete clinical examination was performed for all
serious nutritional deficiencies and complications.
participants. Measurement of hemoglobin (Hb), serum
Some of these nutritional elements are already
copper, serum iron, ferritin, total iron binding capacity
screened for after surgery, including protein, vitamin
(TIBC), and transferrin saturation was performed.
B12, vitamin D, calcium, and iron. Others that are not

routinely screened for include B vitamins, fat-soluble
Ethical consent:
vitamins, and minerals such as copper and zinc [7].
The study got approval from the Institute
In many cases of copper deficiency with
Review Board, Faculty of Medicine, Zagazig
documented hematological abnormalities (anemia),
University (ZU-IRB#4740\25-7-2018). All study
symptoms were related to iron or vitamin B12
participants provided written informed permission
deficiency. If patients failed to respond to ordinary
after being informed of our research's goals. The
treatments, severely low copper levels were detected.
Declaration of Helsinki for human beings, which is
Received: 25/07/2022
Accepted: 27/09/2022

Full Paper (vol.901 paper# 140)

c:\work\Jor\vol901_141 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 957-964

A Health Education Program for Mothers to Prevent Burn in Early Childhood
Hagar Marzouk Abo El Enin Elsayed1, Sahar Ahmed Shafik2*, Mayada Taha Sabea1
1 Department of Community Health Department, Faculty of Nursing, Helwan University, Egypt
2 Department of Community Health Department, Faculty of Nursing, El-Fayoum University, Egypt
*Corresponding author: Sahar Ahmad Shafik, Mobile: (+20) 01062225020,
ORCID: 0000-0003-3247-4823, E-Mail: Sas19@fayoum.edu.eg
Burn is considered one of the most dangerous domestic home injuries in early childhood stage that
causes different harmful effects. Objective: The current study aimed to evaluate the effect of health education
program for mothers to prevent burn in early childhood.
Subjects and methods: Design: A quasi experimental design was conducted. Setting: The study was conducted at
Maternal and Child Health Center in Menouf City. Sample: Convenience sample of 167 mothers from the previously
mentioned Maternal and Child Health Center. Tools: Structured interview questionnaire composed of three parts;
mothers demographic Characteristics, mothers' knowledge about burn, and mothers' reported practices to prevent
burn at early childhood. Results: Before program implementation about 60% of mothers had poor knowledge score
about burns. On the other hand, 90% of mothers have good knowledge score at immediate post health education
program implementation (P= 0.001). Only 30% of mothers reported done practice before program, and improved to
70% after the health educational program (P= 0.001). Conclusion: Continuous health educational programs for
mothers to enhance their knowledge and practice about burn prevention are needed.
Keywords: Health Education Program, Mothers, Burn, Early childhood.
how to care for their child, improving mothers'
Burns are tissue damage caused by heat,
knowledge of home injuries, particularly burn
overexposure to sunlight or other radiation, chemical
definition, causes, risk factors, ways of prevention, and
or electrical contact, or other reasons. Burns might
safety measures, and it's essential to teach them the
result in minor medical difficulties or significant
proper first aid after burn. The availability of health
medical problems. The burn therapy is determined by
services helps the community health nurse do her duty
the site and extent of the damage. The majority of
efficiently, and community home visits might
sunburns and mild burns may be treated at home.
contribute to the promotion of health and the
Severe or extensive burns necessitate immediate
avoidance of sickness (4).
medical attention. Some patients will need follow-up
Because bacteria can enter any broken skin, burn
care as well as therapy at specialized burn centers.
injuries can result in complications of any degree.
First aid after a burn improves results and decreases
However, third- and fourth-degree burns have the
issues (1).
highest risk of complications, including scarring,
Early childhood burn injuries are common due to
infection, dehydration, low body temperature
young children's limited understanding of burn
(hypothermia), contractures, muscle and tissue
protection, first aid, and injury recognition. In addition,
damage, low self-esteem, emotional distress, and
because young children's visceral organs, particularly
psychological distress because burn scars can
their immune and respiratory systems, are still
negatively impact a person's self-confidence or self-
developing, this may cause more severe symptoms and
esteem, especially when they are present (5).
outcomes than in older children. According to the
Burn injuries are a leading cause of mortality and
World Health Organization (WHO), burns and scalds
disability worldwide. To better study burn injuries
are the sixth most common cause of sickness and death
globally, the World Health Organization (6) established
in young children worldwide, particularly in
the Global Burn Registry (GBR). There were 800.640
impoverished nations (2).
pediatric and adult patients from 20 different countries,
Because they create and shed heat more quickly
of which 42 percent were children (0­18 years old)
than adults, young children are considerably more
from middle-income nations. Scald burns accounted
sensitive to changes in the weather. Because they are
for 62% of childhood injuries, whereas flame burns
usually too busy playing and having a good time to
accounted for 14%. Despite the fact that more than half
notice when they are getting too hot before issues
of pediatric patients (52% of whom had significant
arise. Mothers must shield their children from the sun's
burns with 15% or more of their total body surface
rays, from heat, and from hot objects that may burn
area) and 48% of whom underwent surgery for wound
them. Educating and educating moms in burn first aid
healing while they were hospitalized, 23% of pediatric
helps to lessen the negative consequences and
patients had critical care capability that was
problems associated with burns (3).
"restricted" (6).
The community health nurse (CHN) plays a
Around 250,000 individuals in Egypt get severe
significant role in the prevention of burns in young
burns annually, and around 90,000 of them pass away
children by focusing on a number of key areas,
within the first six hours of their injuries due to
including health education for first-time mothers on
inadequate first assistance, making Egypt the country
Received: 02/08/2022
Accepted: 03/10/2022

Full Paper (vol.901 paper# 141)

c:\work\Jor\vol901_142 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 965-970
Ovulation Induction Techniques in Women with Polycystic Ovary
Syndrome: A Review of literature
Gamal Abo El Serour, Amal Mohammed El Shahat,
Mariam Lotfy Mohammed, Mohammed Mamdouh Youssef Saleh*
Obstetrics and Gynecology Department, Faculty of Medicine, Suez Canal University, Egypt
Corresponding author: Mohammed Mamdouh Youssef Saleh, Mobile: 01101199222
ORCID: https://orcid.org/0000-0001-8370-4772, Email: dr.moh.saleh.89@gmail.com

Amenorrhea, oligomenorrhea, and irregular uterine bleeding are a few of the many clinical signs of
anovulation, which is fairly prevalent. Anovulation can result from a number of mechanisms. Polycystic ovarian
syndrome (PCOS), which has clinical repercussions and is the most prevalent chronic anovulatory illness, affects 6 to
10% of people worldwide. While a variety of factors may eventually lead to PCOS, a number of therapeutic strategies
have been documented in the literature, frequently without addressing the underlying reason. Ovulation Induction (OI)
is a series of methods used by PCOS-afflicted women who want to get pregnant but are unable to do so naturally.
Aim: The current review discusses OI in PCOS-affected women, with an emphasis on their effectiveness and
application. Development: Cochrane Central Register of Controlled Trials, PubMed/MEDLINE, and EMBASE, up to
November 2022, search by keyword of "Polycystic Ovarian Syndrome" and "Ovulation Induction".
Conclusion: The likelihood of a good pregnancy outcome in PCOS patients receiving OI should be able to be
determined by clinicians, taking into account age, body weight, the various protocols employed, and the length of
infertility. A recommendation to a specialised fertility clinic for in vitro fertilisation would be a good backup plan if the
aforementioned therapies don't succeed in conceiving a child. Future research should evaluate the results of the various
OI techniques outlined above and stratify the efficiency of laparoscopic ovarian drilling in comparison to current medical
Ovulation, Anovulation, Induction, Clomiphene, Letrezole, PCOS, laparoscopic ovarian drilling, Review.

Women with PCOS who are seeking fertility
The inability to get pregnant after six months for
treatment should first consider changing their lifestyles
women over 35 and after a year for women under 35
and losing weight. Up to 70% of obese women fit the
who are not using contraception is referred to as
criteria for PCOS, compared to 9­18% of all women of
infertility. Epidemiological data show that 10% to 15%
reproductive age (4).
of all couples will struggle to conceive the optimal
When compared to PCOS patients who are not
number of children (secondary infertility) or have
obese, obese PCOS patients have an increased risk of
primary infertility (1).
the disease's metabolic and psychological side effects in
Over 70 million couples experience infertility
addition to its impact on fertility. With a delivery rate
globally, with most of them living in underdeveloped
per initiated cycle of about 22%, intracytoplasmic
nations. When compared to Western society, emerging
sperm injection (ICSI) is becoming more widely used
nations endure the negative effects of childlessness to a
worldwide. Data from almost 2,500 ART clinics from
greater extent. The most frequent cause of infertility in
58 to 61 countries between the years 2008, 2009, and
poor nations is bilateral tubal blockage brought on by
2010 are included in the report. More than 4,461,300
sexually transmitted diseases and infections contracted
ART cycles were performed over the course of the three
during pregnancy, a condition that may be treated by
years, leading to an estimated 1,144,858 births globally
assisted reproductive technology (ART). In developing
nations, new reproductive technologies are either
The aim of this study is to review the ICSI
unavailable or extremely expensive (2). The World
outcome among PCOS patients treated with letrozole-
Health Organization (WHO) reports that female
gonadotropins, clomiphene citrate-gonadotropins, or
infertility accounts for 37% of reasons for infertile
gonadotropins only for controlled ovarian super-
couples, male infertility for 18%, and both male and
female for 35%, according to a survey conducted in

wealthy countries. 5% of couples experience
unrecognised infertility. Ovulatory disorders (25%),
A healthy preovulatory oocyte is released, sufficient
endometriosis (15%), pelvic adhesions (11%), tubal
spermatozoa are produced, the gametes are transported
obstruction (11%), other tubal abnormalities (11%), and
normally to the ampullary region of the fallopian tube
hyperprolactinemia (7%) were the most often
(where fertilisation takes place), and the cleaving
discovered contributing variables. According to certain
embryo is then transported into the endometrial cavity
studies, ovulatory abnormalities account for more than
for implantation and development. These events are all
half of the causes (3).
necessary for reproduction to occur (6). The causes of
infertility might be either male or female. Aproximately
Received: 02/08/2022
Accepted: 03/10/2022

Full Paper (vol.901 paper# 142)

In vivo antimicrobial activity of Matricaria chamomilla extract against Pathogenic Bacteria induced skin infections in Mice The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 971-976

GC-MS Analysis and Antimicrobial Activity of Essential Oil from
(Cymbopogon citratus) against Pathogenic Bacteria
Atheer A. Khashan *, Sawsan Qahtan Taha, Mohammad Jadaan Saad
College of Pharmacy university of Anbar, College of Medicine university of Anbar,
College of Medicine, university of Anbar
*Corresponding author: Atheer Abdulhameed Khashan, Mobile: (+964)7906655477,
Email: ph.alatheernet@uoanbar.edu.iq
Introduction: Our plant under research, Cymbopogon citratus, commonly referred to as lemon grass and a member of
the family fabaceae, is one of those potential medicinal plants. It is known as a medicinal plant and is significant in
various uses, particularly pharmaceutical usage due to the presence of the active compounds represented by terpens,
phenols, alkaloids, etc. Our plant under study is one of these significant medicinal plants. Objective: In this work,
lemongrass was harvested from the desert of the Anbar Region and then extracted using a Clevenger device to produce
oil. To identify the phytoconstituents found in the Cymbopogon citratus plant, this study was done.
Materials and Methods: The sample was identified by GC-Mass, which indicated the presence of 2-Methyl-Z, 13-
octadecadienol with percentage 39.86%. Alkaloids, phenols, tannins, and flavonoids were also present, however cardiac
glycosides and saponins were not. Results: We isolated certain pure phytopharmaceuticals, which may then be employed
as a lead molecule to create a new drug with potent therapeutic effects. The antibacterial activity of lemon grass oil on
microorganisms has been investigated utilising the well diffusion method to battle pathogenic bacteria and zone of
inhibition of growth with widths of 22 mm.
Conclusion: Using the well diffusion method, the antibacterial activity of lemongrass oil on microorganisms has been
investigated in order to battle pathogenic bacteria and zones of inhibition of growth with diameters of 22 mm.
Keywords: Cymbopogon citrates, Clevenger apparatus, Antibacterial activity, GC-Mass.


Natural products, primarily from plants, were
(Southwest Asia) is native to South India, but is grown in
explored by people in the treatment of different diseases
dense crops in many parts of the world (9).
for thousands of years (1). Trado-medicine has been a
global topic in the last decade and plays an important role
Collection: Dry Cymbopogon citratus leaves were
both in healthcare and the global economy (2).
purchased from a local market in Anbar.
It is a matter of global significance. Medicinal
Clevenger apparatus method (Hydrodistillation):
plants have recently held their pivotal position in many
The Clevenger apparatus was named for its inventor,
people's universal health care schemes. In developed
Joseph Franklin Clevenger, who had printed it in 1928.
nations where commercial medication has a lengthy and
There are a few versions. The most famous is a part of a
continuous tradition of use (3). Due to increased demand
particular glassware, as can be seen above the rotund
worldwide for medical products from medicinal plants,
bottom flask. The flask, of an inconstant dimension,
herbal plants manufacturers have been using the best
contains both the heated water and the plant to be
extraction process to see and unlock their chemical
harvested. Steam rises in the mixture of the condenser and
compounds (4). The main aims of this research were to
the condensate fall into the narrow burette on the right.
evaluate the quality of active substances and to determine
Oil floats on the bath, and is eventually extracted to the
the chemical composition of essentials lemongrass oils
hot flask over the diagonal conduit. After a few hours of
grown in southern Delta conditions in the Nile region
extraction, the amount of the oil can be determined
(Bilbeis, Sharqia, Egypt). Cymbopogon citratus is the
directly together in the burette (10).
scientific name of lemongrass. The name Cymbopogon
derives from the Greek phrases 'kymbe' (boat) and 'pogon'
Culture preparation:
(barley), which refer to a flower spike arrangement (5), a
Streptococcus sp. was obtained from Al-Ramadi Hospital
genus of approximately 55 grass species (6). Whereas the
and centrifuged at 3000 rpm, twice washed and re-
term lemon-scented leaves derive in the ancient Latin (7).
suspended in 0.1 per cent pepton water, loop of 24-hour
Lemongrass is a genus of Poaceae grass. It is a
surface development on NA slope of bacterial isolate,
herb with a fragrance that is known in Egypt, the Arab
which is transported individually to 5 ml of brain heart
Peninsula, and tropical Africa of the North and West (8).
infusion broth (PH 7.6) and incubated for 24 hours at 37
Tropical perennial herbs with green, long and slates
°C. The turbidity was changed to meet that of the
leaves from 60-120 cm high with a good fragrance and
Mcfarland tube (108 CFU/ml).
flavor, spontaneously emerging worldwide, mostly in
Antibacterial screening test of extracts using disk
tropical and savannan areas. Lemongrass, barbed wire
diffusion method:
grass, silky heads, lemongrasses, chadedartigalongue,
The disk diffusion check was conducted by normal
tanglad, hierbaluisa or gavatichaha, and many others are
protocol. On the entire surface of Muller-Hinton agar
the common names of this grass. Cymbopogon citratus
(MHA), the inoculum suspension of bacterial insulates
Received: 26/07/2022
Accepted: 28/09/2022

Full Paper (vol.901 paper# 143)

c:\work\Jor\vol901_144 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 977-982

Expiratory Muscle Training Versus Functional Electrical Stimulation on
Pulmonaryand Swallowing Functions in Covid-19 Patients
Samia W. Diab*1, Nagwa M. Badr1, Eman K. Ibrahim2, Asmaa M. Mohamed1
1Department of Physical Therapist, of Physical Therapy for Cardiovascular /
Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
2Department of Chest Diseases, Faculty of Medicine, Cairo University, Giza, Egypt
*Corresponding author: Samia W. Diab, Mobile: (+20)01094762028, E-Mail: soodiab1994@gmail.com


Background:Coronaviruses are viruses that cause reductions in pulmonary and swallowing functions. The need for this
study has been developed to apply a comparison between expiratory muscle strength training and functional electrical
stimulation for the abdomenandneck in acute COVID-19 patients with dysphagia, aiming to determine the most effective
technique to improve cough peak flow, peak expiratory flow, swallowing, and arterial blood gases. Objective:To
determine the impact of electrical stimulation and expiratory muscle strength training on the pulmonary and swallowing
functions in individuals with COVID-19. Methods:This clinical trial study included sixty patients with COVID-19, of
both sexes, aged from 20 to 45 years,from El-Menshawy General Hospital, Tanta, Gharbia Governorate, Egypt, who
were randomly chosen and divided into two equal groups equal. Expiratory muscle strength training was given to group
A as one session per day, 30 minutes for each session, five times a week for four weeks.Group B received neck and
abdominal functional electrical stimulation. Traditional dysphagia therapies, as well as chest physiotherapy, are
administered to both groups. Results: After treatment, there was a significant difference between the two groups in
terms of pH and PCO2 (p< 0.001). Additionally, there was a significantly higher SaO2, PEF, and GUSS in group B
following therapy compared to group A (p< 0.001). Conclusion:Functional electrical stimulation had a greater impact
on pulmonary and swallowing functions in COVID-19 patients than expiratory muscle strength training.
Keywords: Covid19, EMST 150, Dysphagia,Electrical stimulation,Pulmonary function.

swallowing function. EMT can be expected to be used
More than 24 million people globally have been
as a therapeutic strategy to lessen respiratory difficulties
impacted by the coronavirus that causes severe acute
because it improves airway clearance and lowers the
risk of aspiration(5).
individuals with the COVID-19 virus may develop
Pharyngeal electrical stimulation (PES) is a
severe acute respiratory syndrome and other multi-
organ system disorders, necessitating extended periods
Neuromuscular stimulation is used to treat the sensory
of recuperation. Although many COVID-19 patients
afferent pathways that are causing pharyngeal
present in acute care hospitals with dysphagia, the
dysfunction to enhance swallowing function. PES has
importance of swallowing rehabilitation in these
been shown to help people with dysphagia recover safe
patients has not been reported(1).
swallowing following severe COVID-19(6). For
Variable levels of swallowing impairment may
pharyngeal electrical stimulation, an electrode catheter
occur in non-intubated patients, and these impairments
that resembles a nasogastric feeding tube is employed
are probably closely related to changes in pulmonary
(PES) (7).
respiratory function and virus-direct neural damage.
The study aimed to determine the impact of
Patients' ability to recover from COVID-19 may be
electrical stimulation and expiratory muscle strength
hampered, which could have an impact on their health
training on the pulmonary and swallowing functions in
outcomes(2).After a protracted stay in the intensive care
individuals with COVID-19.
unit (ICU), endotracheal intubated patients have

complained about swallowing problems. However, it is
still unknown if the intubation, the viral infection itself,
or both are to blame for the dysphagia(3).
This clinical trial study included sixty patients with
Dysphagia is one of the many signs and
COVID-19, of both sexes, aged from 20 to 45 years,
symptoms that COVID-19 may produce. However,
from El-Menshawy General Hospital, Tanta, Gharbia
swallowing impairment can occur in varying degrees in
Governorate, Egypt, who were randomly divided into
non-intubated patients as well. These impairments are
two equal groups.
most likely caused by alterations in pulmonary
Expiratory muscle strength training was given to group
respiratory function and virus-directed neuronal
A as one session per day, 30 minutes for each session,
lesioning activity. There is a significant possibility that
five times a week for four weeks. Group B received
patients receiving invasive ventilation will develop
neck and abdominal functional electrical stimulation.
swallowing problems(4).Expiratory muscular training
Traditional dysphagia therapies, as well as chest
(EMT), which increases pharyngeal muscle contraction,
physiotherapy, are administered to both groups.

enhances not only the coughing function but also the
Ethical consent:
Received: 26/07/2022
Accepted: 28/09/2022

Full Paper (vol.901 paper# 144)

c:\work\Jor\vol901_145 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 983-993

The Predictive Role of Serum C16 Ceramide and C24
Dihydroceramide in Patients with Hepatocellular Carcinoma
Amira Gamal1, Manar Obada1, Maha Elsabaawy2, Ashraf Khalil1*, Marwa Helal1
1 Department of Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Egypt
2 Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Egypt
*Corresponding author: Ashraf Khalil, Mobile: (+20) 483352455, Email: ashkalil2010@gmail.com

Ceramides are structural long-chain lipid molecules essential for cell architecture, with many biological
functions involving cell proliferation, inflammation, apoptosis, and cell death. Ceramides have a diverse role in
carcinogenesis depending on their chain length, metabolism, and localization. Disturbance in ceramide metabolism has
been observed in many cancers such as head and neck, colorectal, lung, and liver. Objective: The current study aimed
to use a high-performance liquid chromatography-tandem mass spectrometry analytical method for the measurement of
C16 ceramide and C24 dihydroceramide in the serum of patients with hepatocellular carcinoma and chronic liver
cirrhosis and to verify their potential role as markers of hepatocellular carcinoma.
Patients and methods: This case control study enrolled 100 patients diagnosed with hepatocellular carcinoma and
chronic liver cirrhosis (n= 50 each) and 50 healthy subjects as a control group. Serum samples were subjected to
separation of ceramides by ultra-performance liquid chromatography and quantitative detection and measurement by
tandem mass spectrometry. The assay method allowed accurate measurement of C16 ceramide and C24
dihydroceramide at a serum concentration <2.5 ng/ml. Results: The calibration curves' linearity had regression
coefficients >0.98, with intra-day and inter-day precision and accuracy ranging from 89%-102%. C16 ceramide and
C24 dihydroceramide were significantly higher in hepatocellular carcinoma and chronic liver cirrhosis patients than in
healthy subjects (P<0.05). Their serum levels were not different in liver cirrhosis and hepatocellular carcinoma (P>0.05)
but showed an increasing trend to be higher in hepatocellular carcinoma. Both ceramides did not correlate with the
clinical parameters of hepatocellular injury as Child-Pugh score, BCLC stage, or the burden of tumor of all
P>0.05. Conclusion: Quantitative measurement of C16 ceramide and C24 dihydroceramide by tandem mass
spectrometry is an accurate and precise method for laboratory workup in patients with chronic liver cirrhosis.
Keyword: C16 Ceramide, C24 Dihydroceramide, High-performance liquid chromatography-mass spectrometry,
Hepatocellular carcinoma, Chronic liver Disease, Case control study, Menoufia University.


mechanism that leads to the production of ceramides.
The development of hepatocellular carcinoma
This pathway is more complicated and contains a
(HCC) is a multistep, complex process associated with
genetic modifications and genomic alterations
dihydroceramide synthases, and sphingomyelinases.
presumably related to the underlying risk factors [1,2].
Complex sphingolipids are broken down in the
The risk factors for developing HCC vary with the
lysosomes and plasma membrane into sphingosine,
geographic distribution, e.g., in Egypt and Japan are
which can then be converted back into ceramide by
infection with hepatitis C virus (HCV), in China are
ceramide synthases [9,10].
hepatitis B virus (HBV) infection, in Europe and USA
The pathway that is chosen to be engaged in
is infection with HCV, non-alcoholic fatty liver disease
order to produce ceramide may be influenced by a
(NAFLD), and alcoholic liver disease (ALD) [3].
variety of stimuli, for example, heat shock proteins and
Cirrhosis of the liver, consumption of aflatoxin
certain chemotherapeutic drugs can both activate the de
B1, smoking, and diabetes mellitus are additional risk
novo pathway [11]. Ceramides play a variety of
factors [1,2]. Patients who have underlying liver disease,
biological roles in cellular differentiation, proliferation,
disturbance in ceramide metabolism have been reported
trafficking, cell cycle arrest, autophagy, and apoptosis
[4]. Ceramides (Cer) are a class of molecules with more
[12-14]. Depending on the length of their fatty acid chains,
than 200 species of different chain lengths identified in
ceramides may either promote or prevent tumour
various tissues [5]. Ceramides can be synthesized de
growth [15]. In preclinical models, the ceramide
novo in the endoplasmic reticulum from serine and
pathways develop into a viable target for several
palmitoyl-Co A via a multistep process involving the
anticancer medications due to their capacity to trigger
apoptosis [6,16].
palmitoyltransferase, dihydroceramide synthases, and
Long-chain ceramides have been linked to
dihydroceramide desaturase [6,7].
advanced carcinogenesis often, and it has been
Sphingomyelinases, which are triggered by
proposed that they may serve as cancer biomarkers for
TNF-, Fas ligands, and oxidative stress, may
early diagnosis [16]. Depending on the fatty acyl chain
hydrolyze sphingomyelin in the endo-lysosome to
they possess, the members of the ceramide and
generate ceramides [8]. The salvage process, also known
dihydroceramide families differ from one another. High
as the sphingolipid-recycling pathway, is the third
serum concentrations of C16Cer, C18Cer, C18:1Cer,
Received: 28/07/2022
Accepted: 30/09/2022

Full Paper (vol.901 paper# 145)

c:\work\Jor\vol901_146 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 994-1000

Age-Dependent Computer-Assisted Sperm Analysis of
Buck Semen Supplemented with Different Antioxidants
Norhan Hamdy Nasr1, Nehal A. Abu Elnaga1, Mervat Ahmed AbdRabou2, Nasser Ghanem 3*
1Zoology and Entomology, Department, Faculty of Science (Girls), Al-Azhar University, Cairo, Egypt
2Biololgy Department, College of Science, Jouf University, P.O. Box: 2014, Sakaka, Saudi Arabia
3 Animal Production Department, Faculty of Agriculture., Cairo University, Giza, Egypt.
*Corresponding author: Nasser Ghanem, Email: nassergo@agr.cu.edu.eg,
Mobile Phone: +01002986157.

: Sperm cryopreservation is necessary for genetic sharing on a national and international scale.
Objective: This study aimed to examine, after treatment with various antioxidants, the link between buck age and sperm
quality using the computer-assisted sperm analysis (CASA) method.
Material and methods: Collected semen from 16 younger and 14 older New Zealand rabbit bucks. The obtained semen
was assessed by the CASA system using ejaculates with at least 70% progressive motility. Separated semen samples
into eight liquors and diluted (1:1 v/v) with rabbit semen extender supplemented with all antioxidant combinations
(melatonin (M), L-carnitine (LC), cysteine (Cys), LC+M, M+Cys, LC+Cys, and LC+Cys+M) and untreated group.
Results: The casa's characteristics were higher in young than older bucks. In comparison to controls, which recorded
the lowest values, the addition of antioxidants increases total and progressive sperm motility in all experimental groups
significantly. All experimental group's antioxidant supplementation levels and the control group were significantly
lower than fresh pooled semen. Additionally, all CASA parameters increased compared to the control group when buck
semen was supplemented with different antioxidants.
: In contrast to younger bucks, administering several antioxidants (LM, LS, MS, and LMS) has a more
substantial positive effect on sperm motility and CASA parameters in older bucks. Thus, age has a substantial role in
defining semen's quality. Additionally, treatment with either a single (L, M, and S) or a combination of antioxidants
enhances buck semen's motility and CASA properties (LM, LS, MS, and LMS).
Keywords: Bucks; CASA; Antioxidants; Melatonin; L-carnitine; Cysteine.

sperm damage, significantly lowering its fertilization
Because commercial hybrid lines account for the
ability [11].
majority of the world's rabbit meat output, the relevance
Deterioration of the cell membrane may be
of rabbit breeds chosen for their ability to provide meat
due to both short-term (liquid) and long-term (frozen)
has considerably declined [1]. FAO recommendations
storage of semen [12]. The mature sperm cells lack a
have incorporated most rabbit breeds into national
major cytoplasmic component carrying antioxidants to
strategies to safeguard genetic resources [2]. Semen
combat the harmful effects of lipid peroxidation (LPO)
cryopreservation is a helpful tool for protecting animal
and reactive oxygen species (ROS). Their membranes
species when it comes to assisting the storage of
include a high concentration of unsaturated fatty acids.
gametes in a gene bank using the ex-situ in vitro
Therefore, during the freezing and thawing processes,
procedure [3,4].
free radicals such as hydrogen peroxide, superoxide
Rabbit cryopreserved sperm has primarily been
anion, and hydroxyl radicals can cause structural
employed for experimental purposes due to reduced
damage to sperm membranes, making sperm cells
fertility/prolificacy outputs [5]. In contrast, rabbit
extremely vulnerable to LPO [12,13].
artificial insemination (AI) is often performed for a
Increased ROS generation during cryopreservation
short period with fresh or cooled semen [6,7]. Changes in
is related to lower post-thaw viability, sperm function,
motility, and fertility [10]. The term "responsibility"
cryopreservation and are ascribed to intracellular ice
refers to the act of determining whether or not a person
formation, and cry-protectant[8].
is responsible for his or her actions. They found that the
One of the critical structures altered by
quality of post-thaw spermatozoa improved when
cryopreservation is the sperm plasma membrane [9],
compared to controls using standard andrological
where reactive oxygen species (ROS) formation rises,
testing [14, 15].
and antioxidant levels decrease during sperm
Antioxidants applied before freezing may
cryopreservation and thawing. The water volume of
prevent the harmful impacts of oxidative stress [16]. The
cells was dramatically affected by freezing and thawing.
scavenging of free radicals, which can result in the lipid
Furthermore, spermatozoa lose most of their cytoplasm
peroxidation of sperm plasma membranes, is a crucial
at the end of development and lack significant
role of antioxidants [17]. Furthermore, antioxidants have
been shown to improve the viability and motility of
Therefore, the cryopreservation procedure has severe
cryopreserved and liquid-stored sperm cells [18].
Received: 24/7/2022
Accepted: 26/9/2022

Full Paper (vol.901 paper# 146)

c:\work\Jor\vol901_147 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1001-1002

Atypical Presentation of Nursemaid's Elbow: A Case Report
Ahmed Kamal Mohamed1*, Hakim Ebrahim Mohammed Ali2, Ali Nawaz1
1 Emergency Department, NMC Royal Hospital Khalifa City, Abu Dhabi, UAE
2 Emergency Department, King's College Hospital London, Dubai, UAE
*Corresponding author: Ahmed Kamal Mohamed, Phone: +971508892247, Email: ahmed.kamal.ed33@gmail.com

Nursemaid's elbow is a known orthopedic pediatric emergency that occurs between one and four years of
age. Axial traction of the extended arm when the forearm is pronated is the most frequently reported mechanism of infliction.
However, other mechanisms are mentioned in the literature.
Cases report: We report a case of pulled elbow in a four-month-old child. The mother reported that the child only rolled
over to her side. Conclusion: A high index of suspicion for pulled elbow should be kept in younger infants despite the
absence of the usual presentation.
Keywords: Nursemaid's elbow, Pulled elbow, Radial head subluxation, Axial traction, Case report.


Nursemaid's elbow (radial head subluxation) is a well-
Based on the history, the suspicion of non-accidental
known pediatric orthopedic injury. Temper tantrum
injury was excluded.
elbow and pulled elbow are other names used for this
On examination, the child was sitting comfortably
condition (1). It commonly affects children aged between
in her mother's lap. She had her left arm in a partially
1 and 4 years old. The highest incidence of this injury is
pronated position with her elbow slightly flexed (15-20
among children aged two and three years (2,3). It is
degrees). The child's peripheral forearm circulation,
classically caused by axial traction on the extended arm
sensation, and motor activity \were not affected. When we
while the forearm is in a pronated position, causing the
tried to move her left elbow, the child cried. She also
radial head to be slipped under the annular ligament (1,4).
resisted supination, pronation, flexion, and extension of
The affected child typically presents keeping the injured
the affected extremity. No visible bruising, deformity,
arm in a semi flexed and/or pronated position (5) without
swelling, or discoloration of the arm was seen. No
evidence of swelling or deformity (4).
crepitus was detected. Tenderness was only detected over
The typical history for the axial traction mechanism of
the radio-humeral joint.
infliction is when the child is pulled by the outstretched
Despite the very young age of the child and the lack
arm to be lifted or to be prevented from falling. As long
of typical history, the diagnosis of a pulled elbow was
as there is no clinical symptoms and signs suggesting a
suspected. The manipulation maneuver was discussed
fracture, the patient history is often satisfactory to
with the parents, and a formal consent was taken
diagnose nursemaid's elbow without the need for
beforehand. The supination and flexion technique was
performed with the baby's elbow at 90° with one hand,
mechanisms other than axial traction were also reported
and the other hand supinated the wrist and flexed the
including falls (6), playing rough, getting dressed, and
elbow. We got an audible click during the maneuver. The
accidentally having the hands get stuck in fixtures (5,7).
child was more comfortable, and she started mobilizing
Here, we report a case of a pulled elbow in a four-month-
her elbow actively within 2 minutes. She was observed
old child with atypical history and presentation.
for a period of 15 minutes, and she was subsequently

discharged from the emergency department with
appropriate advice to her mother regarding mobilization.
A four-month-old baby girl's mother noticed that
A telephone follow-up was done after 2 weeks.
after the baby rolled over to her side, she started crying

and then she was unable to move her left arm. She held
Ethical Approval
that arm not wanting to move it. The mother did not know
An approval of the study was obtained from King's
what the precise site of the injury was. She thought it
College Hospital London, Dubai, UAE. The patient's
might be the shoulder or the wrist. The mother did not
guardians were informed that the case would be
give history of trauma, fall, or forced-pulling of the
published as case report, and this was accepted. This
affected arm. There was no delay in seeking medical help,
work has been carried out in accordance with The
and the child was brought within an hour of the
Code of Ethics of the World Medical Association
occurrence of the injury. There were no other reported
(Declaration of Helsinki) for studies involving
health problems or history of similar injuries in the past.

Received: 27/7/2022
Accepted: 29/9/2022

Full Paper (vol.901 paper# 147)

c:\work\Jor\vol901_148 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1003-1006

Remember Kounis in the Emergency Department: A Case Report
Hakim Ebrahim Mohammed Ali1*, Ahmed Kamal Mohamed2, Ali Nawaz2
1 Emergency Department, King's College Hospital London, Dubai, UAE
2 Emergency Department, NMC Royal Hospital Khalifa City, Abu Dhabi, UAE
*Corresponding author: Hakim Ebrahim Mohammed Ali, Phone: +971503716210, Email: hakim.ali.ed@hotmail.com

Anaphylaxis is a life-threatening allergic reaction. Epinephrine is the first-line treatment of this condition.
Kounis syndrome indicates the occurrence of acute coronary syndrome in a patient of hypersensitivity, allergy, or
anaphylaxis associated with mast cells and platelets activation. Epinephrine can be the etiology of myocardial infarction in
this setting.
Cases report: This report represents a case of a 58-year-old female who had myocardial infarction while being treated of
anaphylaxis in response to cefuroxime intake.
Conclusion: Emergency physicians should be aware of the possibility of myocardial infarction in anaphylactic patients to
properly manage it.
Keywords: Anaphylaxis, Kounis syndrome, Hypersensitivity, Case report.


Anaphylaxis is an acute, serious, systemic allergic
The second possible etiology behind MI in the setting
reaction related to a variety of triggers, mechanisms,
of anaphylaxis is epinephrine. It is considered the first line
clinical presentations, and grades of severity (1). Several
of treatment in anaphylaxis (9). The different mechanisms
risk factors have been recognized for myocardial
suggested included coronary vasospasm, promotion of
infarction (MI); however, the differential diagnosis of this
platelet aggregation, and increase of thrombin-induced
condition in an anaphylactic patient is either an allergic
platelet fibrinogen binding (3).
acute coronary syndrome (ACS) known as Kounis
The time interval between epinephrine administration
syndrome or the effect of epinephrine treatment (2,3).
and the occurrence of acute MI is the main determining
Kounis syndrome refers to the occurrence of ACS
factor in the differential diagnosis. If the cardiac
including coronary spasm, acute myocardial infarction,
symptoms occur at the same time or shortly after
and stent thrombosis with mast cells and platelets
epinephrine administration, an epinephrine-related
activation in a patient experiencing hypersensitivity,
etiology is highly suspected. Kounis syndrome is more
allergy, or anaphylaxis (4).
likely if MI symptoms and ECG changes happened before
The pathophysiology behind Kounis syndrome
epinephrine administration (3).
involves mediators as histamine causing coronary
The challenging aspect of Kounis syndrome is that
vasoconstriction, platelet activation, inflammatory cell
managing ACS in the setting of anaphylaxis differs from
activity modulation, and cytokine production. Another
that of a standard acute MI. Treatment requires
suggested mechanism is activation of matrix-degrading
harmonizing the management of coronary vasospasm or
metalloproteinases by chymase and tryptase enzymes
thrombosis with allergy at the same time (8).
eventually leading to atherosclerotic plaques. There are

three described variants of Kounis syndrome: Type I that
involves coronary vasospasm in patients without pre-
A 58-year-old female attended the emergency room
existing coronary problems, type II that includes patients
complaining of sudden itching all over her body,
with pre-existing coronary plaques, and type III that
dizziness, vomiting and a fainting episode, one hour
involves coronary stent thrombosis (5).
following cefuroxime intake.
Kounis syndrome diagnosis is based on symptoms,
The patient had type 2 diabetes mellitus and
hypertension. On examination, the patient was sweaty,
echocardiography, and coronary angiography. It should
dyspneic, and with urticarial rash. Her vital data were as
be suspected in patients who present with chest pain or
follows: blood pressure 80/50 mmHg, pulse 105
angina-like symptoms in the presence of symptoms of
beats/minute, oxygen saturation 96% on room air, and
systemic allergic reaction (5).
temperature 36.8 C. Anaphylaxis was suspected, and the
Elevation of serum tryptase, histamine, cardiac
patient was given intramuscular epinephrine (0.5 mg),
biomarkers, and troponins is a clue for diagnosis (6). Till
intravenous hydrocortisone (200 mg), and one liter of
now, there are no guidelines for its management (7,8).
intravenous normal saline. The initial ECG showed
nonspecific changes (Figure 1).

Received: 27/7/2022
Accepted: 29/9/2022

Full Paper (vol.901 paper# 148)

c:\work\Jor\vol901_149 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1007-1013

Short Segment with Index Vertebra Fixation versus Long Segment Fixation in the
Management of Thoracolumbar Fractures
Essam Mohamed Youssef, Samy Hassanin Mohamed, Asel Ali Alsadek*, Ahmed Ali Morsy
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Asel Ali Alsadek, Mobile: (+20) 01014260617,
E-mail: Aselalialsadg@gmail.com
The majority of musculoskeletal injuries around the globe are spine fractures. The thoracic and lumbar spine
account for 75­90% of fractures of the spine.
Aim of study:
To compare the radiological and clinical results of short segment with index vertebra fixation with those of
long segment fixation, in the cases of thoracolumbar fractures.
Patients and methods: This interventional comparative study included 40 patients with traumatic thoracolumbar fractures,
of these 20 patients underwent short segment open transpedicular posterior with index vertebral fixation and 20 patients
underwent long segment open transpedicular posterior fixation.
Results: The operative time in Short Segment with Index Vertebra Fixation (SSIVF) was 149 minutes taking considerably
less time than Long Segment Fixation (LSF) (195 minutes). Blood loss was significantly less in SSIVF (290.5 ± 94.88 mL.)
than in LSF (495.5 ± 110.76 mL). Regarding postoperative visual analogue scale (PVAS) pain was significantly lower in
SSIVF (2.25 ± 1.45) group than in LSF group (4.6 ± 1.79) and Oswestry Disability Index (ODI) was significantly lower in
SSIVF group (20.4 ± 12.1) than in LSF group (26.05 ± 13.45) follow-up after 12 weeks postoperatively. Angl of Kyphosis
measured by Cobb angle in LSF group (7.7 ± 2.030) correction was significantly best than in SSIVF group (9.3 ± 2.25)
Follow-up after 12 weeks postoperatively.
Conclusion: In comparison with LSF technique, the SSIVF technique yielded significantly better clinical and functional
outcomes for PVAS and ODI. Compared to the SSIVF procedure, the LSF technique greatly outperformed of radiological
correction of Cobb's angle at the most recent follow-up.
Spine, Short Segment, Long Segment Fixation, Thoracolumbar Fractures.


combination therapy using anterior and posterior spinal
A frequent type of spinal injury is thoracolumbar
techniques (7-9).
vertebral body fractures, with "burst type" fractures
Fixation with a long segment pedicle screw was
accounting for between 21% and 58% of all fractures of
historically the most popular technique, encouraging early
the thoracolumbar spine. Thoracolumbar burst fractures
ambulation and reducing kyphosis (a damaged vertebra
are particularly common in younger patients and may
and at least two levels above and below it). SSF
significantly affect their everyday physical activity. They
increasingly took its place because to concerns voiced
are commonly accompanied by neurological deficiencies
regarding the loss of motion segments with long-term
and kyphotic deformities. However, there is still
fixation of segments (the broken vertebra and one level
disagreement over the best way to treat this injury (1, 2).
above and below it) (10).
One of the therapeutic goals of the most effective
Many publications(9­15) did, however, observe
technique to treat thoracolumbar burst fractures is to open
substantial rates of early implant failure and corrective
up the spinal canal. Other treatment goals include
loss when using this fixation technique. Some authors [12,
correcting the kyphotic deformity, restoring spinal
13] made the claim that installing pedicle screws at the
stability and alignment, and correcting the kyphotic
fracture location would improve load distribution and,
deformity. The majority of authors feel that surgical
consequently, construct stability. Therefore, this study's
intervention is necessary to accomplish these desired
objective was to examine the radiological evaluation and
objectives in cases of burst fractures; nonetheless, there is
clinical results contrasted with long segment fixing in
ongoing debate about the best course of action (2-4).
patients with such broken thoracolumbar vertebrae. The
Roy-Camille et al. (5) first used pedicle screws to treat
use of short segment fixation in patients with such
thoracolumbar fractures. Transpedicular Short Segment
fractures has been shown to be more effective in treating
fixation was first described in 1963 and further developed
the fractures.
by Dick et al. (6) in 1985. Since then, other surgical

decompression through corpectomy and thoracolumbar
The study was performed in the Neurosurgery
burst fractures can be treated with posterior short segment
Department, Zagazig University Hospital during the
or long segment pedicle screw fixation, as well as
period from November 2021 to August 2022. This
interventional comparative study was conducted on 40
Received: 27/7/2022
Accepted: 29/9/2022

Full Paper (vol.901 paper# 149)

c:\work\Jor\vol901_150 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1014-1018

Compliance with Standard Protocol for the Diagnosis of Barrett's
Oesophagus: Significance of The Complete Audit Cycle
Ahmed Elnabil-Mortada*1, Sherif Shabana2, Sherif Albalkiny1, Mohamed Elsayed Seifalyazal1
Departments of 1General Surgery and 2Gastroenterology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Ahmed Elnabil-Mortada, Mobile: (+20) 01140509696,
E-mail: ahmedelnabil@med.asu.edu.eg
The key to effective therapeutic endoscopic therapy is early dysplastic Barrett's oesophagus (BO)
alteration detection. Oesophago-gastro-duodenoscopy (OGD) technical proficiency is quickly attained, but the
diagnosis accuracy is still quite variable, especially in non-specialized endoscopic facilities.
Objective: We aimed to evaluate the quality of endoscopic diagnosis and the adherence to guidelines of BO in our
unit. Patients and Methods: A retrospective cohort analysis was done for 436 eligible endoscopic reports after
independent review for confirmation of BO. Cohorts represent the complete audit cycle during the period from
01/01/2018 till 01/07/2022. Group A represented first audit data, and group B represented re-audit data.
Results: A total eligible reports of 256 of BO in group A, and 180 reports in group B were reviewed. There was no
significant difference between the groups regarding the age (62.7 ± 13.5 and 60.1 ± 15.1 years), male sex (68% and 70
%), and endoscopist specialty respectively. Surveillance was the most common indication (32.4% vs 35.5%), followed
by Reflux (16.7% and 15%) in both groups respectively. Compliance with Prague, Paris, and Seattle protocol was
significantly higher in group B (P value 0.05). Lack of awareness of the new guidelines, surgeon specialty, older age
of the endoscopist, long segment of BO were the main factors of poor results in group A.
Conclusions: In the absence of local standard protocol for endoscopic diagnosis of BO, the adherence to the
guidelines was poor. Compliance with the guidelines after implementing new recommendations results in better
outcomes. It is important to complete the audit cycle to ensure that the quality improvement was achieved.
Keywords: Barrett's oesophagus, Barrett's surveillance, Prague Criteria, Seattle protocol, Paris classification,
Adherence guidelines.


Table (1): PICOS criteria for the study
The most significant risk factor for the emergence
of adenocarcinoma is Barrett's oesophagus (BO),
A total of 436 reports, which
which is characterized as the presence of metaplastic
mentioned word Barrett's weather
columnar epithelium, which endoscopically manifests
as indication, findings, or final
as salmon pink mucosa. Intestinal metaplasia (IM) is
diagnosis were included in our
not necessary for the diagnosis of Barrett's oesophagus
according to current British recommendations [1].
Diagnostic OGD.
Group A: first audit data. Group B:
Current management of Barrett's oesophagus
re-audit data.
focuses mainly on surveillance to detect early low-risk
Demographic data, indication for
neoplastic lesions suitable for advanced endoscopic
therapies, Oesophagectomy is only still used in cases
compliance with Prague Criteria,
of high-risk and advanced carcinomas [2].
Paris classification, and Seattle
While it takes little time to become technically
proficient in OGD, the grade of high-quality
statistically analyzed.
examination varies, and an unacceptable amount of
Study design
Retrospective cohort study between
endoscopies fail to detect cancer [3].
01/01/2018 till 01/07/2022.
In a recent systematic review and meta-analysis by

Roumans et al. [4] there was large variance between
Population: A total of 436 reports which mentioned
the studies regarding the adherence to Barrett's
the word Barrett's weather as indication, findings, or
esophagus surveillance guidelines worldwide?
final diagnosis were included.
We noted a great variability between endoscopists
Intervention: Diagnostic OGD.
in the description and reporting of BO in our unit, so
Comparators: Group A: represented first audit data
we aimed to evaluate the quality of endoscopic
between 01/01/2018 and 31/03/2020. We chose this
diagnosis and the adherence to guidelines of BO in our
period as 6 months after the standards of the British
Society of Gastroenterology (BSG) and Association of

Upper Gastrointestinal Surgeons of Great Britain and
Ireland (AUGIS) were published in 2017 till the first
COVID 19 national lockdown in March 2020. Group
outcomes, and study design (PICOS) framework were
B: represented re-audit data between 01/04/2021and
used to plan this study (Table1). We conducted our
01/07/2022, started 6 months after first audit to give
study between 01/01/2018 till 01/07/2022.
Received: 13/08/2022
Accepted: 14/10/2022

Full Paper (vol.901 paper# 150)

c:\work\Jor\vol901_151 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1019-1025

The Role of Chest Ultrasound Combined with Plasma Brain
Natriuretic Peptide in The Differentiation between Cardiogenic and
Noncardiogenic Pulmonary Edema
Magdy Mohammed Omar1, Mohammed Hussein Kamel1,
Shaimaa Mostafa El-Nahhas Wahdan*1, Asmaa Adel El-Fallah2, Shaimaa Magdy AboYoussof1
Departments of 1Chest Diseases and 2Clinical Pathology,
Faculty of Medicine- Benha University, Qalyoubia, Egypt
*Corresponding author: Shaimaa Mostafa El-Nahhas Wahdan, Mobile: (+20) 01025611515, E-Mail: shimaalnahas @gmail.com


Background: Pulmonary edema is a medical emergency that threatens life, and requires urgent management and
immediate hospitalization. Since there is no definite "gold standard" for diagnosing ALI/ARDS or cardiogenic
pulmonary edema (CPE), there is no technique or known biomarker that can be used to distinguish between the two
conditions. Combining clinical criteria with other proven diagnostic methods, such as BNP and chest ultrasonography,
can increase the predicted accuracy, assist in therapy, and enhance the results.
Objective: The purpose of this study is to assess how wel plasma brain natriuretic peptide (BNP) and chest
ultrasonography can distinguish between cardiogenic and noncardiogenic pulmonary edema.
Patients and methods: Lung US was applied to respiratory distressed patients In Benha University Hospital Chest ICU
and Emergency Department on 50 subjects through a cross-sectional prospective study. They were divided into CPE
group 20 cases) and NCPE group (20 cases) as wel as the control group (10 cases). Alveolar-interstitial syndrome
(AIS), absence or decreased lung sliding, sparing regions, subpleural consolidation, pleural line abnormalities, and
pleural effusion were among the pleuropulmonary symptoms that were targeted for detection by the LUS scan in both
groups. Plasma BNP levels were assessed in al groups.
Results: Consolidation is another sonographic finding in the Non-CPE group which represents 80% of cases and is
present in 5% only in the CPE group in our study. Pleural effusion is not a specific finding between the two groups but
it was higher among the cardiogenic group representing 65% while was 25% only among the non-cardiogenic group.
BNP was significantly higher in the CPE group (1031 pg/ml) than in the Non-CPE group (346.5 pg/ml) and controls
(63.5 pg/ml) (P <0.0001). BNP was valid for differentiation between CPE and non-CPE with a Cutoff point of >740
pg/ml (70% Sensitivity and 100% Specificity).
Conclusion: CUS in combination with BNP represents a useful tool for differentiating CPE from non-CPE. In
emergency settings, the benefits of their use outweigh the presence of limitations.
Keywords: CPE, non-CPE, Lung ultrasonography, Chest ultrasound, Brain natriuretic peptides.


and hypoxemic respiratory failure brought on by cardiac
Pulmonary edema is a health emergency that
reasons in the emergency room and intensive care unit.
threatens life and needs urgent management and
Therefore, in these conditions, it might be the most
immediate hospitalization (1).
useful for excluding CPE (5).
It happens when one or more of Starling's forces
Transthoracic ultrasound is an easy, bedside, low-
change, which causes more fluid to migrate into the
cost, and lacks radiation tool that has proved its worth
alveoli. High pulmonary capil ary pressure is what
as a strategic instrument to be used directly after the
causes the aberrant fluid flow in cardiogenic pulmonary
clinical investigation in the emergency room, intensive
edema. Contrarily, noncardiogenic pulmonary edema is
care unit, operating room, and clinical routine (6). It has
brought on by many diseases in which alveolar protein
developed into an important point-of-care (POC) tool
and fluid buildup are due to causes other than increased
for the evaluation of a range of pulmonary and pleural
pulmonary capil ary pressure (2).
disease states, including pleural effusion, empyema,
History, signs, and symptoms may be enough to
pneumonia, pneumothorax, lung cancer, and pulmonary
determine the origin of edema clinical y, but in many
embolism (7).
other situations, particularly in a critical care scenario,
Since there is no definite "gold standard" for
the distinction between cardiogenic and noncardiogenic
diagnosing ALI/ARDS or CPE, there is no technique or
causes may be difficult. Because different treatments
known biomarker that can be used to distinguish
are available
the underlying
between the two conditions. Combining relevant
pathophysiologic mechanisms, the diagnosis is crucial
biomarkers with clinical criteria and other techniques
(3). Brain Natriuretic Peptide (BNP) was the most often
may increase the prediction power, facilitate the
examined serum and pulmonary biomarker used to
management, and enhance results (4).
distinguish ALI/ARDS from CPE (4).
The purpose of this study was to assess the
BNP is released from the cardiac ventricles in
contribution of plasma brain natriuretic peptide (BNP)
response to an increase in heart wal tension. Rapid
and chest ultrasonography to the distinction between
measurement of BNP is a sensitive indicator of dyspnea
cardiogenic and noncardiogenic pulmonary edema.
Received: 26/07/2022
Accepted: 28/09/2022

Full Paper (vol.901 paper# 151)

c:\work\Jor\vol901_152 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1026-1032

Levels of Serum Procollagen Type1 Amino Terminal Propeptide and
Cterminal Crosslinked Telopeptide of Type1 Collagen in Children and
Adolescents with Type 1 Diabetes Mellitus
Mohamed A. M. Afify, Alaa Hassanin, Rasha Eladawy*
Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
Corresponding author: Rasha Eladawy Shaaban Elmetwally, E-mail: dr.rashaeladawy@med.asu.edu.eg

In patients with type 1 diabetes mellitus (T1DM), accelerated bones turnover and bone loss are caused by
increased inflammation. The serum levels of the bones turnover markers (BTM), serum procollagen type 1 N-terminal
propeptide (P1NP) and serum C-terminal telopeptide of type I collagen (CTX), can help identify increasing bones fragility
in T1DM earlier on. Objective: The aim of the study is to measure the levels of BTM in children with T1DM, specifically
serum P1NP and serum CTX, and to look into the relationships between BTM and indicators of glycemic control and
diabetics micro-vascular problems.
Patients and methods:
A total of 40 pediatric and adolescent T1DM children were compared with a control group of
healthy control, age- and sex-matched participants. HbA1c, fasting lipids profiles, microalbumin in urine, fasting serum
P1NP, and serum CTX concentrations were measured in the laboratory.
P1NP and CTX concentrations in the sick group were statistically significantly higher than those in the control
group (p<0.001), according to the findings of our research. LDL-C and TDD of insulin, which rose in the uncontrolled
sample, were determined to differ significantly between participants with HbA1c 7% and participants with HbA1c 7%
(p<0.001 and p=0.008, respectively), although there was no differences in the levels of serum P1NP and CTX between the
two samples. Conclusion: In younger T1DM children, serum concentrations of P1NP and CTX may offer predictive
information on bones health. To demonstrate that oxidative stress causes major changes in the activities of bone production
and resorption, more research should be conducted.
Keywords: BTM, P1NP, CTX, bone turnover, diabetes complications, type 1 diabetes, case control study, Ain Shams


Another possible mechanism is that poorly
A metabolic disorder known as type 1 diabetes
controlled T1DM is associated with ongoing cellular
mellitus (T1DM) is defined by the autoimmune
oxidative stress. Previous studies have shown that
destruction of pancreatic beta-cells, which results in a lack
exposure to chronic state of oxidative stress due chronic
of insulin release and the emergence of hyperglycemia (1).
hyperglycemia could result in tissue damage and
It is one of the most prevalent autoimmune
abnormal responses in the body's antioxidant defenses (5).
illnesses among children and teenagers, and its prevalence
is growing globally (2).
malondialdehyde, high total serum cholesterol, and
Patients with diabetes either type 1 or 2 diabetes
reactive hydrogen peroxides are responsible for the
were found to have an increased bone fragility despite
pathophysiology of several micro-vascular complications
higher or even normal bone mineral density (BMD) (3).
of T1DM through lipid peroxidation, DNA damage, and
For type 1 Diabetic patients, the higher risk of fractures
mitochondrial malfunction. Presence of free oxygen
has been attributed to a number of factors, notably
radicals result in oxidation of proteins, lipids, and nucleic
alterations in bones microarchitectures, bones marrow
acids and production of toxic products leading to tissue
features, and the balancing of bone turnover. In order to
damage and dysfunction. Moreover, oxidative stress can
produce an unbalance between proteolytic enzymes and
bones turnover indicators are examined. Serum
their inhibitors that results in progressive osteoporosis in
procollagen type 1 N-terminal propeptide (P1NP) is a
patients with T1DM. Previous studies on bone function in
significant marker included in our analysis that is
the presence of diabetes have shown that osteoblastic
recognized to be effective for estimating bones turnover,
differentiation was inhibited and osteoblasts damage and
while serum C-terminal cross-linked telopeptide of type 1
apoptosis were evident. Eventually therefore, oxidative
collagen (CTX) is a marker for bones resorption (4).
stress may be related to the pathogenesis of bone disorders
Chronic inflammation and increased levels of pro-
associated with diabetes (6).
inflammatory cytokines are responsible for bone turnover
In earlier clinical trials on bones turnover,
acceleration and bone loss in patients with T1DM.
fractures risks, and osteoporosis, the usage of P1NP and
CTX was advised. Variations in serum P1NP and serum
Received: 24/7/2022
Accepted: 26/9/2022

Full Paper (vol.901 paper# 152)

c:\work\Jor\vol901_153 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1033-1039

Comparative Review of Outcomes between Enhanced View Totally
Extraperitoneal Technique with Inherently Divided Douglas' Line and
Totally Extraperitoneal Technique for Repairing Inguinal Hernia
Mohamed Elsayed Seifalyazal*, Mohamed Elnagar, Sameh Said Mohamed, Ahmed Elnabil-Mortada
Department of General Surgery, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Mohamed Elsayed Seifalyazal, Mobile: (+20) 01157327366,
E-mail: seifalyazl1976@gmail.com, seifalyazl1976@med.asu.edu.eg
The inguinal hernia can be repaired using a variety of laparoscopic methods. The most popular
procedures are transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP). TEP technique is regarded
closet to ideal. However, it has limitations that inspired the evolution of e-TEP. This small e stands for enhanced or
extended view. Although the division of Douglas' line is not inherent to e-TEP technique, it offers a wider working
place for secondary ports. Objective: To compare extended view totally extraperitoneal repair with inherently divided
Douglas' line to totally extraperitoneal repair of inguinal hernia concerning operative time, ease of the procedure and
postoperative complications. Patients and Methods: This prospective cohort study enrolled 55 patients diagnosed
with inguinal hernia underwent laparoscopic repair between January 2019 and November 2021. Thirty-one patients
(56.4%) underwent e-TEP technique with inherently divided Douglas' line (group I) and twenty-four patients (43.6%)
underwent TEP technique (group II). Results: No significant difference was found between the two groups regarding
age, sex and body mass index. Overall complication rate was higher in TEP group than in e-TEP group. Mean
operative time, hospital stay, and pain score were less in e-TEP technique with inherently divided Douglas' line.
The number of used tacks, and early return to work were significantly different for favor of e-TEP group.
Conclusion: Enhanced view TEP technique with inherently divided Douglas' line is superior to TEP technique for
repairing inguinal hernia in providing a better visual angle and ergonomics with lower complication rates and shorter
operative time
Hernia, Douglas' line, TEP, e-TEP.

e-TEP technique has outstanding features such as:
Since the first published laparoscopic hernia
fast and easy creation of large extraperitoneal space,
surgery by Dr. Ralph Ger in 1982, many
flexible port placement, more tolerance to
endolaparoscopic techniques to repair inguinal hernia
pneumoperitoneum and better ergonomics (6).
have gained more advances in recent years (1), as
Although the division of Douglas' line is not inherent
to e-TEP technique, it allows wider access to both
extraperitoneal (TEP), extended totally extraperitoneal
Retzius and Bogros spaces and provides more
comfortable dissection of the critical view of
mesh (IPOM)
myopectineal orifice (5). e-TEP technique has its
preperitoneal (r-TAPP). Numerous research has
specific indications as short umbilicus-pubis distance,
compared TAPP with TEP methods. There was no
previous pelvic surgery, complicated hernia cases
discernible difference between the two procedures in
(sliding or large inguinoscrotal one), obese patient or
terms of perioperative complication rates, according to
post bariatric surgery. Finally, mastering e-TEP
the German hernia registry (2). Contrarily, register-
technique will open the door to encompass the repair
based studies conducted in Japan and Switzerland
of more complex cases of inguinal, incisional, ventral
revealed that the TEP group experienced greater
and lumbar hernias (8).
perioperative problems than the TAPP group (3).
The aim of the study was to compare extended
TEP technique has many advantages over TAPP as
view totally extraperitoneal repair with inherently
no penetration of the abdominal cavity, low risk of
divided Douglas' line to totally extraperitoneal repair
visceral or vascular injury and minimal risk of trocar
of inguinal hernia concerning operative time, ease of
site hernia. However, it has challenges such as field
the procedure and postoperative complications.
restriction caused by pneumoperitoneum due to


peritoneal tears. In addition to bleeding, it is the

conversion factor that leads to e-TEP growth (4).
Enhanced or extended view TEP concept was first
We conducted a prospective cohort study. Fifty-
developed in 2009 at Clinica Bautista, Colombia by
five eligible patients aged between 18 and 66 years
Dales for inguinal hernia repair (5). It is based on the
diagnosed with unilateral non-complicated inguinal
anatomical tenet that practically every point along the
hernia between January 2019 and November 2021 at
front abdominal wall can access the extra-peritoneal
Al-Jedaani Hospitals, KSA were included and divided
area (6). Later, Belyansky et al. (7) employed this
between two groups. We excluded any patients who
method in laparoscopic ventral hernia surgery.
were unfit for general anesthesia, diagnosed with
Received: 13/08/2022
Accepted: 14/10/2022

Full Paper (vol.901 paper# 153)

Comparison between Torsemlde infusion, versus intermittent boluses and their impaction thoracic fluid Content in acute decompensated Heart failure critically ill patients The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1040-1048

Comparison between Torsemide Infusion Versus Intermittent Boluses and
Their Impact-On Thoracic Fluid Content in Acute Decompensated
Heart Failure Critically Ill Patients
Mohammed Abdel Monem*1, Tamer Waheed2, Alaa Hussein3, Deyaa Mohammed4
1Department Critical Care Medicine, Faculty of Medicine, Helwan University, Egypt
2Department of Nephrology, Faculty of Medicine, Helwan University, Egypt
3Department of Clinical Pharmacist, Faculty of Pharmacy, Helwan University, Egypt
4Department of Critical Care Nursing, Faculty of Nursing, Helwan University, Egypt
*Corresponding author: Mohammed Abdel Monem Saeed, Mobile: (+20) 01099292999, E-Mail: mohammedicu1@gmail.com

It is still debatable whether loop diuretics should be given intravenously as boluses or continuously by
infusion while treating acute decompensated heart failure (ADHF).
Objective: We aimed to evaluate the differences between the two administration routes on the thoracic fluid content
(TFC), renal functions, urine output, electrolytes, haemodynamic parameters, echo cardiographic parameters,
incidence of atrial fibrillation and NYHA class.
Patients and methods: Eight hundred thirty patients admitted to the Critical Care Medicine Department, Faculty of
Medicine Helwan University, Egypt with acute decompensated heart failure (ADHF) were enrolled in the study; thirty
patients were excluded due to EF>40%, myocardial infarction within 30 days and baseline creatinine level > 4 mg/dl.
Torsemide 200 mg per day was given to the remaining 800 patients who continued in the study after 1:1
randomization to either continuous intravenous infusion (group I, 400 patients), or twice equal intermittently daily
doses (group II, 400 patients). No subsequent dose titration done all over the first 4 days.
Results: The delta TFC all through the four days were all statistically significant giving the superiority of the infusion
route over the twice daily regimen. While urine output was increased all through the four days, with significant
statistical difference in favor of the infusion group but creatinine level, urea level, creatinine clearance were all non-
significant statistically when comparing the two groups. The NYHA class started to be significant statistically from
the third and fourth days in favor of infusion group.
Conclusions: We concluded that torsemide infusion when compared to the torsemide twice equal dose in ADHF,
causes more decrease in TFC, symptomatic improvement with non-significant nephrotoxic effects.
Keywords: Torsemide, ADHF, TFC.

that is more closely linked to intravenous boluses,
Heart failure is a major public health issue
along with enhanced neuro-hormonal activation and
across the world, with high morbidity, value, and
lower cardiac parameters (6). Continuous loop diuretics
expense. In affluent nations, it affects 1-2% of
infusion increases diuretic effectiveness and reduces
individuals, with the frequency rising to roughly 8.4%
diuretic toxicity by utilising lower dosages in post-
in the population over 70 (1).
cardiac surgery patients with heart failure. According
Patients with heart failure frequently take loop
to Felker et al. (7) there is no discernible difference
diuretics to treat congestion symptoms, increase
between continuous infusion and boluses in terms of
exercise tolerance, and lower mortality risk (2). As one
effectiveness and change from baseline renal
of the many negative effects of using diuretics,
hypotension (3), may develop as a result of the fast
Impedance cardiography (IC) is a non-invasive
technique for ongoing hemodynamic monitoring that is
venodilatation brought on by diuresis (4). The use of
secure, repeatable, and appropriate for a variety of
loop diuretics results in the activation of the
heart failure patients (8). One of the important
sympathetic and renin-angiotensin-aldosterone nerve
hemodynamic characteristics that IC evaluates is
systems. Loop diuretics can cause hypokalemia as a
thoracic fluid content (TFC). TFC and chest wall
side effect that is associated with the use of loop
impedance are inversely correlated, meaning that when
diuretic administration, and neurohormonal activation
TFC rises, chest wall impedance falls. Chest
can trigger cardio-renal syndrome and renal hypo-
intravascular and extravascular fluid components and
perfusion caused by hypotension (5).
TFC are correlated (9).
The most effective way to provide intravenous
Regarding lowering TFC, clinical improvement,
loop diuretics is still up for debate, however standard
and safety, we aimed to evaluate intravenous
delivery methods include intravenous boluses or
torsemide treatment as a continuous infusion with
continuous infusions. Theoretically, the use of
intermittent boluses in patients with acute
continuous infusion may be more advantageous in the
counterintuitive rise in systematic vascular resistance

Received: 21/07/2022
Accepted: 23/09/2022

Full Paper (vol.901 paper# 154)

c:\work\Jor\vol901_155 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1049-1052

Association of Microrna-153-3p Expression in Response to
Treatment with Imatinib in Patients with Chronic Myeloid Leukemia
Duaa Dhahir Abbas1, Haithem Ahmed Al-Rubaie2
1Al-Yarmouk Teaching Hospital, Al-Karkh, Baghdad, Iraq
2Department of Pathology, Col ege of Medicine, University of Baghdad, Iraq
Corresponding author: Duaa Dhahir Abbas, Email: duaa.dahir1986@gmail.com, Phone: 9647711609169


Background: It is thought that the susceptibility of chronic myeloid leukemic (CML) cel s to imatinib (IM) is increased
by high miR-153-3p expression.
Aim: To establish the association of miR-153-3p expression with treatment response to IM in CML patients.
Methods: Sixty CML patients were included and divided into two groups consistent with their response to treatment
whether sensitive or resistant to IM. Ten healthy normal participants were enrol ed as control group. RNA was extracted
from serum to work out miR-153-3p expression utilizing real-time quantitative reverse transcription polymerase chain
reaction. The primers were supplied by Macrogen Inc.
Results: 27 patients were sensitive to imatinib and 33 were resistant to imatinib. The ratio of male to female was
1.14:1. The bulk (58%) of patients were within the age range of 41-60 years. Weight and gender did not significantly
differ between the two patient groups. The mean patients' CT of miR-153-3p was significantly above the control group
and the sensitive group. The mean DCT value in resistant group was significantly above that of the sensitive group while
insignificantly above that of the control group. The mean DDCT in resistant group was significantly higher than that of
the sensitive group. The miR-153-3p expression showed significantly lower fold change than the sensitive group.
Conclusion: There is miR-153-3p expression downregulation in resistant CML patients indicating unresponsiveness to
treatment with imatinib.
CML, Imatinib, MiRNA-153-3p, Response to treatment.


been discovered that IM-resistant CML cel s exhibit
Thirteen percent of al leukemia cases are caused by
downregulation of the miR-153-3p, which has been
a malignant proliferative disorder cal ed chronic
linked to many different sorts of malignancies. By
myeloid leukemia (CML). Condition that developed
blocking the autophagy mediated by B cel lymphoma 2
from hematopoietic stem cel s and is identified by the
that is caused by up-regulation of miR-153-3p. IM
Philadelphia (Ph) chromosome and the presence of the
sensitivity was considerably boosted. Whereas down-
fusion gene BCR-ABL (1, 2). Tyrosine kinase inhibitors
regulating miR-153-3p mitigated these effects in IM-
(TKIs), such as imatinib (IM), are utilized as first-line
resistant CML cel s, and lowered the survival rate of
therapy since chemotherapy is considered the most
IM-resistant CML cel s (8).
effective treatment for CML (3). But the main obstacle

to successful treatment of the il ness is chemotherapy
resistance (4).
This cross-sectional analysis examined 60 CML
Since blood cancers cannot be surgical y treated,
patients were enrol ed. Two groups of patients were
unlike solid tumors, as a result, it is vital to research the
selected sequential y according to their response to
mechanisms underlying treatment resistance in blood
treatment with IM according to the fol owing criteria:
malignancies and figure out how to combat it.
CML patients who are sensitive to IM after a
Approximately 22 nucleotides in length, microRNAs
minimum of 3 months without interruption of
(miRs) are a category of a short single-stranded non-
treatment, with their BCR-ABL1 transcript levels
coding RNAs that regulate the epigenetic state of certain
targets by modifying the translation of target genes or
CML patients who are resistant to IM and failed to
by cleaving mRNA (5). BCR-ABL1 expression is the
achieve complete hematologic response and BCR-
distinguishing molecular feature of CML and is hence
ABL1 transcript levels > 10% (IS) after three to six
the target for TKI treatment (6). Since some of the IM-
months of therapy or partial cytogenetic response
resistant patients had no mutations on the BCR-ABL1
after 3 to 6 months into a therapeutic regimen.
oncogene, resistance to IM and other TKIs has been

acknowledged as the main problem for CML treatment
Exclusion criteria:
and monitoring (7).
Patients who stopped or interrupted imatinib for any
Since miRs are powerful regulators, they may
reason, or taking drugs other than IM.
contribute to the emergence of drug resistance because
Ten normal healthy people were recruited as a
they regulate other genes involved in drug transport or
control group. From each patient and control, a sample
the activation of essential signal ing pathways in
of three mL peripheral blood was withdrawn and
addition to the gene's expression BCR-ABL1 (8, 9). It has
col ected in gel tube. Serum was separated by
Received: 2/9/2022
Accepted: 28/11/2022

Full Paper (vol.901 paper# 155)

c:\work\Jor\vol901_156 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1053-1056

Study of The Effect of Metformin on Plasminogen Activator Inhibitor-1
(PAI-1) and Some Biochemical and Blood Parameters in Patients with
Type 2 Diabetes in Samarra City
Khalilda Khaleel Abdullah1, Muzayyan Fadhly Namik2, Iman Ismael Khaleel3
1Department of Biology, College of Education, University of Samarra, Samarra, Iraq
2Department of Biology, College of Education for Pure Sciences Tikrit University, Tikrit, Iraq.
3Department of Education Samarra, General Directorate of Salah al-Din Education, Ministry of Education
Corresponding Author: Khalilda Khaleel Abdullah, Email: khaleda.kh@uosamarra.edu.iq, Phone No: 009647731823466

Metformin, an anti-hyperglycemic drug, treats type 2 diabetes with diet. It increases muscle glucose
consumption, maintains blood levels, and does not cause severe hypoglycemia.
Aim: To evaluate the effect of metformin on some plasminogen and cortisol variables and some hematological variables
represented in the percentage of compact red blood cells, hemoglobin concentration, total number of red blood cells,
and white blood cells in patients with type 2 diabetes.
Subjects and Method: 90 patients with type 2 diabetes and patients who used metformin treatment twice a day
continued for three months, six months, and one year were included, according to a questionnaire. After confirming the
status of type 2 diabetes through laboratory tests, samples were taken. They were divided into four groups according to
the period used in the treatment.
The results indicated that treatment with metformin led to a significant decrease in the level of Plasminogen
Activator-1 (PAI-1) and cortisol hormones, in addition, to the decline in hematological indices, packed cell volume
(PCV), hemoglobin (Hb), red blood cells (RBCs) and white blood cells (WBCs) within works 2, 3 and 4 compared to
the control group.
Conclusion: Metformin may improve the risk of atherosclerotic disease that may occur due to diabetes by lowering
blood glucose, such as improving endothelial function, decreasing inflammatory activity, and decreasing blood
parameters during treatment, which may be related to anemia.
Keywords: Diabetes, Metformin, Plasminogen, PCV, Hb, WBC, RBC.


number of erythrocytes increases or when the plasma
The number of oral agents used to treat patients with
volume decreases (5).
type 2 diabetes has increased significantly in recent

years, as these agents mainly reduce peripheral insulin
Hemoglobin (Hb): (Hb) has an essential effect on the
resistance (1).
transport of respiratory gases and is one of the main
The sugar regulator Metformin belongs to the
compounds that make up most of the components of
Biguanide group. Metformin has a strong and practical
erythrocytes (12 g/milliliter) in females. The decrease
effect on the treatment of diabetes. Its mechanism of
in Hb is an indicator of anemia. The increase in
action is to lessen blood glucose degrees by reducing
hemoglobin concentration usually occurs due to loss of
glucose manufacturing with the aid of the liver and
body fluids in cases of vomiting and acute diarrhea (6).
reducing the intestinal absorption of glucose. In
Erythrocytes contain between (200-300) hemoglobin
addition, it was found that metformin increases insulin
molecules. Hemoglobin transports 98.0% of oxygen (7).
sensitivity by increasing cell uptake of glucose and its

utilization. In addition, it also inhibits the activity of
White Blood Cells (WBC): Leukocytes represent the
mitochondria complex I and strongly affects the
essential elements in the body's integrated protective
treatment of diabetes (2).
system and are characterized by their ability to self-
Diabetes type 2 has normal insulin levels, but there
move as they migrate through tissues and have many
may be a harmful decrease in insulin levels or insulin
immune functions, and their number in a healthy adult
resistance (3). Since 2019, the World Health
human being ranges from 4000-11,000 cells per
Organization has indicated that there are 463 million
microliter (8).
people with diabetes worldwide, with type 2 diabetes

accounting for about 90% of cases and the same in
Red Blood cells (RBC): The function is to transport
women and men. In 2019, diabetes resulted in
respiratory gases (O2 and CO2) by attaching these gases
approximately 4.2 million cases of deaths worldwide (4).
to hemoglobin. The number of red blood cells in

females is 4-4.5 million cells/m3, and in males, 4-5
Packed cells Volume (PCV %): The volume of
million cells/m3; their number varies according to the
compacted blood cells in a healthy organism is
physiological conditions a person may go through. Red
proportional to the amount of hemoglobin and the
blood cells are formed in the adult in the red bone
erythrocytes, as the PCV value increases when the
marrow by the action of the hormone erythropoietin (9).
Received: 27/7/2022
Accepted: 29/9/2022

Full Paper (vol.901 paper# 156)

c:\work\Jor\vol901_157 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1057-1062
Results of Using Modular Mega Prosthesis after
Proximal Femoral Tumor Resection
Wael Mansour Wafa*, Yasser Youssef Abed, Sallam Ibrahim Fawzy,
Mohamed Fathi Mostafa, Abed Abd El-Latif El-Negiry
Department of Musculo-Skeletal Oncology Unit, Orthopedic, Mansoura University, Dakahlia, Egypt
*Corresponding author: Wael Mansour Wafa, Mobile: (+20)01067565200, Email: drwaelmansour@gmail.com

Proximal femoral replacement (PFR) is a commonly performed procedure to restore extensive bone
defects for different indications with variable reported outcomes.
Objective: This retrospective study aimed to assess the functional outcomes and complication rates of PFR with
MUTARS or Hipokrat modular femoral mega prosthesis after oncological resections and to highlight the overall
patient, limb, and implant survivorship.
Patients and methods: A total of 18 patients had PFR after oncological resection. 14 patients had bipolar
hemiarthroplasty (BHA) and 4 patients had total hip arthroplasty (THA). At the final follow-up, the patient's
functional outcome was assessed by Muscloskeletal Tumor Society score (MSTS) and Toronto Extremity Salvage
Score (TESS). Complications were recorded and classified according to the Henderson classification.
Results: The mean follow-up was 87.74 months (14-103 months). The mean MSTS and TESS score was 65.7 (range
23-97%) and 81 (range 56-98) respectively. Overall limb, implant, and 5-year patient survival were 94%, 94%, and
66% respectively. The overall complication rate was 39%; 11% instability, 17% periprosthetic fracture, 5.6%
infection, and 5.6% local tumor recurrence. Conclusion: PFR is a valid option for reconstruction of huge bone loss
after oncological resection of the proximal femur with acceptable longevity, functional outcome, and complication
rate with better BHA over THA reconstructive option for stability issues.
Keywords: Proximal femur, Tumor, Endoprosthesis, Sarcoma, Metastasis.

most frequent cause of failure in multiple datasets(4).
Primary malignant and benign lesions as well
This study concentrates primarily on clinical,
as metastatic illness frequently occur in the proximal
oncological, and functional outcomes of PFR after
femur. It is the primary site for metastases after the
oncological resection with implant longevity and
spine and the third location for bone sarcoma after the
patient survivorship as secondary outcomes.
distal femur and proximal tibia (1).

Amputation was once the standard of care for
bone sarcoma, but now, because of improvements in
A retrospective study was conducted, from
surgical skills and adjuvant therapies, limb salvage is
2014 to 2022, targeting patients who had proximal
possible. The gold standard for limb salvage now is
femoral modular mega prosthesis for oncological
broad local excision followed by reconstruction(2).
indications using prospectively collected data from the
Large defects in bone and soft tissue may be
registry for patients and their follow-up for a minimum
left behind after surgical removal of proximal femur
of one year at the outpatient clinic.
bone cancers. Following such excision, three main
Preoperative evaluation included radiographs
reconstructive alternatives are viable: a composite
and magnetic resonance imaging of the pelvis and the
biological reconstruction, an osteoarticular allograft,
proximal femur and computed tomography (CT) of the
and the use of a tumor prosthesis. The most common
lungs. CT-guided or open biopsy was obtained to
technique nowadays is endoprosthetic reconstruction,
confirm the pathological diagnosis. Pre and post-
which can be either modular or custom constructed.
chemotherapy and or radiotherapy regimens were
The femoral neck length, angle, and anteversion angle
decided by a multidisciplinary team, which included
may all be adjusted with the modular prosthesis. As a
an orthopedic surgeon, a histopathologist, a medical
result, it enables intraoperative adaptation to the
oncologist, and a radiation oncologist. Two patients
patient's specific defect(3).
(11%) were presented with pathological fractures.
Despite recent developments in the prosthetic
Surgical technique
PFR, there are still numerous obstacles to overcome
All patients were operated, under spinal
and conflicting data concerning implant failure. To
anesthesia enhanced with epidural catheterization,
achieve a large margin, it is frequently necessary to
using the posterolateral approach in the lateral
sacrifice crucial components including the joint
position, including the biopsy track. The gluteus
capsule, the greater trochanter where the gluteal
maximus was detached from its osteo-facial insertion
muscles attach, and the lesser trochanter where the
and reflected posteriorly exposing the sciatic nerve and
ileo-psoas muscle inserts, leading to joint instability(2).
short rotators of the hip, then the Gluteus Medius and
Between 1% and 37% of patients who have had
Minimus detached with a safety margin away from
proximal femoral replacement (PFR) with an
their tendinous insertion, except in a single patient the
endoprosthesis experienced hip instability, which is the
greater trochanter was preserved. The hip joint capsule
was opened longitudinally along its anterolateral
Received: 01/08/2022
Accepted: 02/10/2022

Full Paper (vol.901 paper# 157)

c:\work\Jor\vol901_158 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 1063-1068

Effect of Low-Level Laser with and without Shoulder Mobilization in
Treating Shoulder Impingement
Hind Mohammed El Mahdy Nasser Alsharief1,2, Osama Fekry Ahmed Al Balah1, Nader Ibrahim Elsayed3
1. Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences,
Cairo University, Giza, Egypt.
2. Department of Basic Science for Physical Therapy, Faculty of Physical Therapy,
Heliopolis University, Cairo, Egypt.
3. Department of Orthopedic Physical Therapy, Faculty of Physical Therapy,
Alhayah University in Cairo (AHUC), Cairo, Egypt.
Corresponding author: Hind Mohammed El Mahdy Nasser Alsharief,
Email: Hammarh.19@g mail.co m, Mobile: +201025050698

Background: Besides the traditional physical therapy interventions (infrared and strengthening exercises for scapular
and shoulder muscles), recently, low-level laser (LLL) and mobilization with movement (MMM) gained more attention
in the management of shoulder impingement syndrome (SIS).
: To examine the effects of adding LLL to MMM in patients having SIS.
Design: A prospective double-blinded randomized trial.
Settings: Physical therapy outpatient clinic of Heliopolis University.
Participants: Forty patients complaining of unilateral shoulder impingement syndrome for not less than three months
and not more than twenty-four months were included.
Methods: The patients were randomly assigned to group A (n=20, received the active LLL, MMM, and the above-
mentioned traditional physical therapy interventions), and group B (n=20, received the same treatments as group A but
the LLL was sham). Al treatments were applied 3 times per week, for 6 successive weeks. The