c:\work\Jor\vol902_1 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90(2), Page 2014-2019

Comparative Study between Traditional Tonsillectomy and
Tonsillectomy by Coblation
Sabry Habashy Easa, Talaat Mahrous Farghaly, Ahmed Adel Elsherbeiny Abdelmawla
Department of Otorhinolaryngology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: Ahmed Adel Elsherbeiny, Mobile: (+20)1061576737, E-Mail: dr_alkashlan@yahoo.com

ABSTRACT

Background: One of the most frequent surgical operations carried out globally is a tonsillectomy. Tonsillectomy is
performed using a variety of methods that have been developed throughout time. In an effort to improve the procedure's
safety and reduce postoperative morbidity and complications, many procedures have developed over time.
Objective: The aim of the current study was to compare traditional tonsillectomy vs coblation tonsillectomy in terms
of operation time, intraoperative blood loss, postoperative pain, and postoperative healing.
Patients and methods: This prospective study included a total of 100 cases of chronic tonsillitis undergoing
tonsillectomy (50 cases by traditional tonsillectomy and 50 cases by coblation tonsillectomy), attending at Outpatient
Clinic, Department of ENT, Al-Azhar University Hospital, Assiut. This study was conducted between January 2021 to
June 2022.
Results: Considering operative time, there was statistically significant increase in the mean duration of operation (minutes)
among the traditional tonsillectomy (26.86±6.59) in comparison with the coblation tonsillectomy group (14.16±2.96). This
difference may be due to the immediate coagulation, and/or the immediate stopping of bleeding. Considering
intraoperative blood loss there was statistically significant decrease in intraoperative hemorrhage among the coblation
tonsillectomy group average (13 ml) in comparison with the traditional tonsillectomy group average (60ml). There was
one case with reactionary hemorrhage in traditional group and none in coblation group. Regarding the self-satisfaction
evaluation among the studied groups, the present study revealed a statistically non-significant difference in self-satisfaction
among patients of the coblation tonsillectomy group.
Conclusion: It could be concluded that coblation tonsillectomy is a safe technique. The traditional method still has its
advantages being less costly and having less incidence of secondary hemorrhage and availability and tools are present
almost in all hospitals primarily in the Egyptian Ministry of Health hospitals.
Keywords: Traditional tonsillectomy, Tonsillectomy by coblation, Postoperative pain, Blood loss.

INTRODUCTION

The two most popular methods for limiting bleeding
One of the most often carried out operations on
during and after tonsillectomy are electrocautery and
children across the world is a tonsillectomy (1). While
suture ligation, with varying degrees of success.
different procedures have developed throughout time,
Coblation reduces the amount of time needed to stop the
neither the criteria for tonsillectomy nor the post-
bleeding even though technique involves using one
procedure consequences have significantly altered (2).
hand to do both plasma coagulation and suction
Following the development of the "tonsillotome" by
simultaneously (10, 11).
Physick in the nineteenth century, the procedure gains
The aim of the current study was to compare
popularity (3).
traditional tonsillectomy versus coblation tonsillectomy
The ideal tonsillectomy is quick, bloodless, and
in terms of operation time, Intraoperative blood loss,
results in a quick, straightforward recovery (4). A variety
postoperative pain, postoperative healing, postoperative
of methods have been employed, but the two most
hemorrhage (primary and secondary), self-satisfaction,
popular methods are cold dissection and electro
postoperative mouth odor and dysphonia and the cost
dissection (5). However, none has been demonstrated to
for both patient and hospital.
be superior to the others (6).

Modern
procedures
have
revolutionized
PATIENTS and METHODS
tonsillectomy surgery, including the use of harmonic
This prospective study included a total of 100 cases of
scalpels, coblation, bipolar scissor dissection, radio
chronic tonsillitis undergoing tonsillectomy, attending
frequency excision with probes, microdebrider
at Outpatient Clinic, Department of ENT, Al-Azhar
endoscopic tonsillectomy, laser tonsillectomy, and
University Hospital, Assiut. This study was conducted
bipolar radio frequency ablation techniques (7).
between January 2021 to June 2022.
In an effort to improve the procedure's safety and

reduce postoperative morbidity and complications,
The age of the patients ranged from 5 to 18 years and
many procedures have developed over time (8).
their gender was male and female with slight female
Hemorrhage is still a serious complication during
predominance.
and after tonsillectomy, and roughly 5% of individuals

may experience this issue at any time from the first 24
The included subjects were divided into two groups
hours to 2 or 3 weeks following surgery (9).
according to the used technique.

2014
Received: 09/09/2022
Accepted: 12/11/2022

Full Paper (vol.902 paper# 1)


c:\work\Jor\vol902_2 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2020-2025

Macular Area Perfusion in Normal and Glaucomatous Eyes
Using Optical Coherence Tomography Angiography
Tarek Mahmoud Mostafa Radwan, Ahmed Hesham Salama Selim*, Mahmoud Ahmed Ali Ghonaim
Department of Ophthalmology, Faculty of Medicine, Suez Canal University, Egypt
*Corresponding author: Ahmed Hesham Salama Selim, Mobile: (+20)1033672700, E-Mail: drhishamahmad@gmail.com

ABSTRACT
Background:
The most common cause of blindness worldwide is glaucoma, a condition that progresses over time and
has the potential to permanently impair eyesight. The only glaucoma-related anomaly for which therapy stops the
disease from progressing is an increase in intraocular pressure (IOP).
Objective: The aim of the current work was to elucidate the differences of perfusion in macular area between normal
and glaucomatous eyes, and determine the correlation between the macular area vessel density (VD) and glaucoma
severity using optical Coherence tomography angiography (OCTA).
Patients and Methods:
This Cross sectional prospective analytic study included 20 participants with 20 glaucomatous
eyes and 20 normal eyes, attending at Outpatient Clinics, Department of Ophthalmology, Suez Canal University
Hospital, Ismailia, Egypt. Cases were scheduled for OCTA examination.
Results The changes macular vessel density (MVD) had strongly positive correlation with ganglion cell layer (GCL)
thickness and retinal nerve fiber layer (RNFL) thickness, had negative correlation with the severity of glaucoma, which
meant the more severe the glaucoma was, the lower MVD was. Compared to traditional glaucoma staging system judged
by visual field )VF(, the changes MVD obtained by OCTA might be a new method to grade the stage of glaucoma.
These findings theorize that the changes of MVD may be better facilitated for the observation and monitoring of
glaucoma progression.
Conclusion: It could be concluded that macular vessel density (MVD) has strongly positive correlation with ganglion
cell layer (GCL) thickness and RNFL thickness, has negative correlation with the severity of glaucoma, which mean
that the more severe the glaucoma is, the lower (MVD), (RNFL) and (GCL) are.
Keywords: Macular Area Perfusion, Glaucomatous Eyes, Optical Coherence Tomography Angiography

INTRODUCTION

correlation between the macular area vessel density
Glaucoma is the most common cause of blindness in the
(VD) and glaucoma severity using optical Coherence
world and is a progressive condition that can result in
tomography angiography (OCTA).
irreversible visual loss (1). The only glaucoma-related

anomaly for which therapy stops the disease from
PATIENTS AND METHODS
progressing is an increase in intraocular pressure (IOP)
This Cross sectional prospective analytic study included
(2).
20 participants with 20 glaucomatous eyes and 20
A technique called optical coherence tomography
normal eyes, attending at Outpatient Clinics,
angiography (OCTA) was created to examine the retinal
Department of Ophthalmology, Suez Canal University
and peripapillary microvasculature (3). OCTA research
Hospital, Ismailia, Egypt. Cases were scheduled for
showed alterations in the vascular density (VD) of the
OCTA examination.
optic nerve head (ONH) (4), while a different study

demonstrated a decline in peripapillary VD in
Inclusion Criteria:
glaucoma-affected eyes (5).
Adult patients aged above 35 years old.
According to a study, the diagnostic value of
Adult glaucomatous patients approved with visual
peripapillary VD in eyes with primary open-angle and
field test, IOP measuring, Optic nerve head, and
primary angle-closure glaucoma was equivalent to the
nerve fiber layer analysis.
thickness of the retinal nerve fiber layer (6). Macular and

optic nerve head vessel density (ONH-VD) measures,
Nonglaucomatous adult patients.
however, were revealed to have much lower diagnostic
Exclusion Criteria:
value than peripapillary VD readings (7,8).
Pre-existing ocular abnormalities.
Macular OCT measures that specifically target
Previous ocular inflammations or trauma.
the macular ganglion cell complex (GCC) can increase
Patients performed any previous ocular surgeries.
the glaucoma diagnosis accuracy since the lamina
Patients performed any anterior segment
cribrosa is made up of porous connective tissue. Studies
procedures during follow up.
have shown that the macula is home to a majority of

retinal ganglion cells and that the macula is affected by
Complete ophthalmic examinations were performed to
early glaucomatous damage (9, 10).
all patients including the following:

The aim of the work was to elucidate the
History: Personal Data: name, age, address,
differences of perfusion in macular area between
occupation and phone number, ocular history, and
normal and glaucomatous eyes, and determine the
2020
Received: 09/09/2022
Accepted: 12/11/2022

Full Paper (vol.902 paper# 2)


c:\work\Jor\vol902_3 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2026-2031

Assessment of Perinatal Outcomes in Pregnant Women with
Borderline Amniotic Fluid Index
Yousef Abo Elwan El-sayed, Mohammed El-Sayed Mohammed,
Ahmed Elsaied Abelrazik Kewan, Basem Mohammed Hamed
Department of Obstetrics & Gynecology, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding author: Ahmed Elsaied Abelrazik Kewan, Mobile: (+20)1061990252, E-Mail: magedkewan8@gmail.com

ABSTRACT
Background:
Antenatal testing is done to assess the health of the fetus and the likelihood of unfavorable consequences
throughout pregnancy. Amniotic fluid is a crucial component of pregnancy that aids in the fetus's healthy growth,
stimulates the development of its muscles and skeleton, and facilitates easier fetal movement.
Objective: The aim of this study was to assess the perinatal outcomes in pregnant women having borderline amniotic
fluid index (AFI). Patients and Methods: This prospective case control study was conducted on all pregnant women
who were enrolled from patients attending Zagazig university hospitals and Al-Ahrar teaching hospital for antenatal
care. Patients were divided into two groups: 1- Group A: included 42 patients with normal AFI (8-22cm). 2- Group B:
included 42 patients with borderline AFI (5-8 cm).
Results:
There was highly statistically significant difference between two groups regarding Amniotic fluid index and
the baby weight. Also, this study showed statistically significant difference between two groups regarding NICU.
Regarding the correlations of AFI, there was highly statistically significant difference between amniotic fluid index and
Gestational age (Week), Also, there were highly statistically significant differences between Amniotic fluid index and
LIQUOR, and fetal distress syndrome.
Conclusion:
It could be concluded that adverse perinatal outcome is seen in higher percentage of patients having
oligohydramnios than that of borderline AFI.
Keywords: Perinatal Outcomes - Borderline Amniotic Fluid Index

INTRODUCTION

Inclusion criteria:
Antenatal testing is done to assess the health of the
Pregnant women who were attending the
fetus and the likelihood of unfavorable consequences
assigned hospitals for antenatal care and having the
throughout pregnancy. Amniotic fluid is a crucial
following criteria: (1) Medically free. (2) Single intra
component of pregnancy that aids in the fetus's healthy
uterine viable pregnancy. (3) Gestational age more than
growth, stimulates the development of its muscles and
28w ± 0d. (4) AFI calculated to be between 5 and 8 cm.
skeleton, and facilitates easier fetal movement (1).
(5) AFI calculated to be between 5 and 8 cm. with
Measuring the amount of amniotic fluid is
normal AFI (8-22cm) or borderline AFI (5-8cm) was
essential for ensuring the fetus' survival, and the
involved in our study (5) Patient is sure of her dates.
Amniotic Fluid Index (AFI) is the most used

ultrasound-based technique for doing so (2).
Exclusion criteria:
Most studies describe oligohydramnios as having
(1) Any maternal medical disease as diabetes mellitus,
an AFI of 5 cm or less and demonstrating its related
hypertension, cardiac diseases, thyroid diseases
maternal and fetal problems. Regarding the borderline
etc. either chronic or pregnancy complicated.
AFI range, there are several opinions. Phelan et al. in
(2) Multiple gestations.
their study classified borderline AFI as being between 5
(3) Any evidence of active maternal or fetal
and 8 cm (3). A borderline AFI is also described by
infections.
Gumus and Miller as an AFI between 5.1 and 10 (4).
(4) Patients with AFI less than 5 cm or more than 22
The aim of the work was to evaluate the fetal
cm.
outcome of pregnancies with borderline amniotic fluid
(5) Complicated pregnancy as placenta previa or
index.
placenta accreta.

(6) Evident rupture membranes.
PATIENTS AND METHODS

This prospective case control study included a total
All patients were subjected to thorough clinical
of 84 pregnant women, 42 had borderline AFI (case
evaluation with emphasis on:
group) and 42 had normal AFI (control group),
1. Full medical and surgical history.
attending Zagazig university hospitals and Al-Ahrar
2. General clinical examination.
teaching hospital for antenatal care.
3. Ultrasound studies:
The included subjects were divided into two groups;
Trans-abdominal 2D ultrasound (GE Voluson
Group 1 (control) consisted of 42 pregnant women with
730 pro) at obstetric ultrasound unit at Zagazig
normal AFI (8 ­ 22 cm) and Group 2 (cases) consisted
University Hospitals.
of 42 pregnant women with normal AFI (5-8 cm).
Trans-abdominal 2D ultrasound (Medison ­
SonoAce R5) examination to assess for the
2026
Received: 09/09/2022
Accepted: 12/11/2022

Full Paper (vol.902 paper# 3)


c:\work\Jor\vol902_4 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2032-2040

Magnetic Resonance Imaging Compared to Magnetic Resonance Arthrography in
Assessment of Recurrent Meniscal Injury
Nermeen Ali Tawfik1, Tarek Hassan Khalil1, Ahmed Ali Toreih2, Waleed Mosallam Hussein1
Radiology department1, Orthopedic surgery department2, Suez Canal University
Corresponding author: Nermeen Ali Tawfik, Email: Nermeenalitawfik91@gmail.com
Tel: 00201010108687, ORCID 0000-0003-1069-8468
ABSTRACT
Background:
Arthroscopic knee surgery including partial meniscectomy & meniscal repair are of the world's most
performed surgical procedures. Magnetic Resonance arthrography is the cornerstone imaging modality in evaluating
postoperative symptomatic patients.
Objective: This study aimed to evaluate the diagnostic value of conventional MR compared to MR arthrography in the
diagnosis of recurrent meniscal tear.
Subjects and methods:
Our prospective cross-sectional study included 20 patients with postoperative meniscus surgery
admitted to Orthopedic Department, Suez Canal University Hospital through the period from April 2020 to September
2021. Results: In the meniscus surgery group (total 20 patients), 6 studied cases (30%) were treated with meniscal
repair, 13 studied cases (65%) had meniscectomy and one patient (5%) had meniscal transplants. Conventional MRI
showed 77% sensitivity, 58% specificity and 67.5% accuracy in the meniscal surgeries group. MRI and MRA showed
high agreement (K= 0.66) in meniscal transplant and meniscectomy less than 25%, while MRI has a low agreement
(K=0.1 &0.5) with MRA in meniscal repair and meniscectomy more than 25%.
Conclusions: Conventional MRI alone has low sensitivity and specificity in the assessment of recurrent tears in post-
meniscal surgeries where MR arthrography is essential in the detection of recurrent meniscal tears in cases of meniscal
repair and partial meniscectomy more than 25%. However, when meniscus resection is minimal (less than 25%)
conventional MRI is usually enough for diagnosis.
Keywords: MRI, MR arthrography, Meniscal repair, Partial meniscectomy.

INTRODUCTION
complicated and difficult; accordingly, an organized,
Arthroscopic knee surgery is one of the world's
systematic approach is necessary in differentiating
most done surgeries. Indications for performing this
between expected post-operative changes and new or
procedure include surgically correctable pathologies
already present pathology (9). Conventional MRI,
causing functional complaints and also persisting pain
indirect MR arthrography, direct MR arthrography &
(1). Pain is usually the major cause of surgery, and it is
CT arthrography are presently conducted to assess
also considered to be a critical post-operative
studied cases with recurrent postoperative knee (7).
complication (2, 3). The main purpose of meniscal
Direct MR arthrography implies intra-articular
surgery is to return the studied case to full function
injection of about twenty­fifty mL of mixture of diluted
without pain (4). The decision to perform either
gadolinium and saline into knee joint before undergoing
meniscectomy (partial or complete) or meniscal repair
MRI examination. Extension of contrast material into
accounts for various factors such as the patient's years
meniscus substance indicates recurrent tear or unhealed
old & general condition, the extent & severity of the
repair. Advantages of direct MR arthrography contain
injury, and probability of success (5). Associated injuries
distention of knee joint capsule, decreased viscosity of
including cruciate ligament injury, loss of cartilage, or
synovial fluid & great signal-to-noise ratio on T1-
fracture must be taken in consideration (5).
weighted sequences (7).
Magnetic resonance imaging of the knee after the
Aim & objective was to measure the diagnostic
meniscal repair is becoming increasingly common
value of conventional MR compared to MR
because of the growing number of knee arthroscopic
arthrography in the diagnosis of recurrent meniscal tear.
surgeries being done (6). Morphological changes in the

post-operative meniscus could mimic or obscure
METHODS
recurrent or residual meniscus tears (7).
This prospective cross-sectional research contained
Signs of post-operative knee in MRI include
twenty studied cases with postoperative meniscus
migration or obvious morphologic variations, circular
surgery admitted to Orthopedic Department, Suez Canal
or linear fine fibrous areas in infra-patellar fat, which
University Hospital from the period April 2020 to
are marks of trocar passage throughout arthroscopy, and
September 2021. The study was performed at the
it is seen on both parts of patellar tendon. Susceptibility
Radiology Department, Suez Canal University Hospital
artefacts produced by metallic particles, more
in Ismailia.
visualized on gradient echo sequences, are signs of
Inclusion criteria: Adult studied cases years old more
previous surgery too (8). Post-operative meniscus
than eighteen, patients with meniscal surgery either
surgery complications include meniscal re-tears (7).
partial meniscectomy or meniscal repair and patients
Postoperative imaging interpretation is often
with multi-ligamentous and meniscal injuries.
2032
Received: 13/08/2022
Accepted: 16/10/2022

Full Paper (vol.902 paper# 4)


c:\work\Jor\vol902_5 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2041-2044

Insulin Resistance, Resistin Hormone and Hepatocellular Carcinoma
Interplay: A Review Article
Mahmoud Abdou Ashour1, Fady Maher Wadea1, Nader Mohamad M. Hussein2,
Abd-Elhalim Mohamed A. Elnagar1
Departments of 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding author: Abd-Elhalim Mohamed A. Elnagar, Mobile: (+20) 01145857568, E-Mail: elnaggar202016@gmail.com

ABSTRACT
Background:
The incidence rate of hepatocellular carcinoma (HCC) has risen in the last ten years, increasing the
disease's burden in Egypt. Insulin resistance is a pathophysiological condition characterised by decreased insulin action
in peripheral target tissues such as skeletal muscle, liver, and adipose tissue. Insulin resistance is thought to play a key
role in the development of fibrosis as well as an increase in the risk of HCC. Objective: To assess the possible relation
between serum levels of resistin and HCC in patients suffering of liver cirrhosis.
Methods: PubMed, Egyptian Knowledge Bank, Google Scholar, were used to search for information on Hepatocellular
carcinoma, Insulin resistance and Resistin. The authors also analysed references from relevant literature, but only the
most recent or thorough study from May 2005 to October 2021 was included. Documents in languages other than English
were excluded because there were insufficient translation-related sources. Dissertations, oral presentations, unpublished
manuscripts, conference abstracts, and other works not related to major scientific research were removed.
Conclusion: In conclusion, serum resistin level may serve as a new diagnostic marker for HCC patients, however, its
accuracy in detection of early focal lesions and prognosis of these patients should be assessed in further larger studies.
Keywords: Hepatocellular carcinoma, Insulin resistance, Resistin.

INTRODUCTION
Insulin Resistance and Its Relationship with Liver
Primary liver cancer accounts for around 7% of
Cirrhosis and Malignancy:
all cancer diagnoses globally. It is the fifth most
Peripheral tissues such the liver, adipose tissue,
frequent cause of cancer in men and the seventh most
and skeletal muscle have decreased insulin activity is a
frequent in women (1). Hepatocellular carcinoma (HCC)
pathological illness known as insulin resistance. The
is the most frequent primary liver cancer and the third
main effects include insulin's diminished capacity to
highest cause of cancer-related deaths worldwide (2).
increase peripheral glucose clearance and inhibit
The prevalence of HCC is increasing globally. Its
hepatic glucose synthesis. As a result of insulin
prevalence gradually rises with age, peaking at
resistance, blood glucose levels are probably going to
approximately age 70. Regional variations in hepatitis
increase. But since glucose is the primary secretory
virus exposure and other environmental illnesses are
trigger for insulin, if cell activity is sufficient, bringing
reflected in the distribution of HCC (3).
blood glucose levels back to normal. The resulting
HCC development has been linked to several risk
"compensatory hyperinsulinemia" is a distinguishing
factors (Table 1). HCC is mostly brought on by chronic
feature of insulin resistance (6).
liver disease, alcoholism, chronic viral hepatitis, and
There are several variables associated with
liver cirrhosis. Even those with no known risk factors
insulin resistance, including ageing, obesity, central
are susceptible to this (4). Obesity and diabetes have
body fat distribution, metabolic syndrome, Type 2
been linked to the emergence of HCC and chronic liver
diabetes, liver disease, subclinical inflammation,
disease, respectively (5).
acromegaly, a high-glycemic-index diet, and a high-
Table (1): Etiology and hepatocellular carcinoma risk
saturated-fat diet, which is also linked to a increased
factors (4-5).
chance of cancer. The supporting records for this
- Chronic hepatitis B & C
- Hereditary tyrosinemia
relationship have been carefully examined (7).
infection with/without advanced "Type 1"
Chronic hyperinsulinemia may exacerbate cancer
fibrosis or cirrhosis
- glycogen storage
in people who already have it since insulin has the
- Alcoholic liver disease
disease "Type 1 & 2"
potential to induce it by improperly activating several
- Hereditary hemochromatosis - Hereditary ataxia-
cellular signalling cascades, cell metabolism alteration
- Porphyrias
telangiectasia
or direct stimulation of growth factor-dependent cell
- Wilson's disease
- Hypercitrullinemia
division (6).
- Alpha1-antitrypsin deficiency - Aflatoxin exposure
By increasing hepatic IGF-I production and
- Autoimmune hepatitis with
- Other carcinogens
reducing the insulin-like growth factor 1 and 2 binding
cirrhosis
- Thorotrast
proteins expression, insulin increases IGF-I bioactivity
- Fatty liver disease not caused - Polyvinyl choloride
(IGFBP-2). Many of insulin's mitogenic and
by alcohol
- Carbon chloride
- Primary biliary cirrhosis
antiapoptotic effects are thought to be arbitrated through
- Non-alcoholic
the IGF-I system since elevated circulation levels IGF-
steatohepatitis with
I have been linked to an increased risk of developing
cirrhosis
several malignancies, including breast and prostate
2041
Received: 14/09/2022
Accepted: 17/11/2022

Full Paper (vol.902 paper# 5)


c:\work\Jor\vol902_6 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2045-2048

Possible Role of Platelet -Rich Plasma for Striae Distensea
Management: Review Article
Hadeer Aladdin Ali El Nagdy*1, Enayat Mohamed Atwa1,
Hala Mohamed Morsi1, Kamal Ahmed El Qishishi2
Departments of Dermatology, Venereology & Andrology and
2Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hadeer Aladdin Ali El Nagdy, Mobile: (+20) 01119147527, E-Mail: hadeera30@gmail.com

ABSTRACT
Background:
Atrophic skin Strain scars, also known as striae or striae distensa, are a typical variety of atrophic dermal
scars that are covered by a thicker, less elastic layer of epidermis. While initially appearing pink (as striae rubra), striae
distensae eventually turn white (striae alba). Platelet-rich plasma (PRP) is an effective therapeutic option for striae rubra.
Objective: Assessment of possible role of platelet -rich plasma for striae distensea management.
Methods:
We looked for data on striae distensa and Platelet -Rich Plasma in medical journals and databases like
PubMed, Google Scholar, and Science Direct. However, only the most recent or extensive study was taken into account
between October 2006 and July 2021. References from related works were also evaluated by the writers. There are not
enough resources to translate documents into languages other than English, hence those documents have been ignored.
It was generally agreed that documents such as unpublished manuscripts, oral presentations, conference abstracts, and
dissertations did not qualify as legitimate scientific study. Conclusion: New and promising in the treatment of striae
distensa, platelet-rich plasma (PRP) poses no danger of hyperpigmentation or infection.
Keywords: Platelet -Rich Plasma, Striae distensea, Atrophic skin Strain scars.


INTRODUCTION

Striae distensa, also known as atrophic dermal
explored, but none have demonstrated significant
scars, are a common kind of striae atrophica that appear
benefit (1).
on the skin. Over time, striae distensae go from pink
Females are at a higher risk for developing striae
(striae rubra) to white (striae alba) (1). Stretch marks,
distensae due to hormonal changes during puberty,
also called strain scars, are linear lesions of atrophic
pregnancy, and obesity (2.5 times higher). Pregnant
skin characterised histologically by epidermal atrophy,
women have a prevalence of SD between 43% and
missing rete ridges, and abnormalities in architecture of
88%, and teenagers between 6% and 86%.
connective tissue. The precise pathophysiology of
A prevalence of 43% has been recorded among
striae distensae is not yet understood, however there is
those with a BMI between 27 and 51, who are
some indication that hormonal excess, mechanical
considered to be obese. There are also wide variations
stress, and genetic susceptibility all play a part in the
in reported prevalence across other patient populations,
formation of this illness. Several treatments have been
including adult males and women who are not pregnant

(1).

Figure (1): Features of striae distensae visible on the skin's surface. (a) Stria nigra, (b) stria alba, (c) stria rubra, (d)
stria cerulea (2).

2045
Received: 16/09/2022
Accepted: 17/11/2022

Full Paper (vol.902 paper# 6)


c:\work\Jor\vol902_7 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 2049-2054

Corneal Endothelial Cell Changes after Phacoemulsification with and without
Trypan Blue Anterior Capsule Staining
Khaled Salah Eldin Abdalkader, Alaswd M, Najah Salem H. Aldhabaa, Hani A Albialy
Department of Ophthalmology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Najah Salem H. Aldhabaa, Mobile: (+20)01021082582,
E-mail: n1318a.ns@gmail.com


ABSTRACT
Background:
phacoemulsification is the preferred surgical procedure in treatment of cataract nowadays. Its outcome can
be affected by health of the cornea, intra ocular pressure, manipulation and time of surgery in mature and white cataracts,
trypan blue staining of the anterior capsule improves capsule visibility.
Aim: To assess Trypan blue stain's effectiveness and safety after cataract surgery.
Patients and methods:
This prospective cohort study's was performed at Ophthalmology Department, faculty of Medicine,
Zagazig University hospitals. Patients with cataract (nuclear II III) or PSC, age group from (20-60) and patients with more
than 100 corneal endothelial cells per 2000 cells/mm2 were covered by the research. They were divided into the case group
and control group. All patients were subjected to history taking, complete slit-lamp examination including grading the
density of the cataract and an indirect ophthalmoscopy examination.
Results: There was significant decrease in ECD in both groups after one month of phaco surgery with statistically highly
significant decrease in group 2 compared to group 1. The same was observed in hexagonality and coefficient of variance.
Central corneal thickness showed no difference in change between both groups.
Conclusion:
There aren't significant alterations in the corneal endothelium one month postoperatively after staining anterior
capsule by trypan blue 1% in phacoemulsification surgery.
Keywords: Corneal Endothelium, Phacoemulsification, Trypan blue.


INTRODUCTION

The leading global contributor to reversible
(nuclear II, III) or PSC, age group from (20-60) and
blindness is cataract. Over the past two decades, new
patients with a corneal endothelial count more than 2000
methods for removing cataractous lenses have developed
cells/mm2 were covered by the research.
quickly today, phacoemulsification is the most popular
Patients with a history of corneal diseases like
surgery with more safety and better postoperative
corneal opacity interstitial keratitis or Corneal
outcome (1).
dystrophies; those whose corneal endothelial count was
It was well known that anterior segment surgery
less than 2000 cells/mm2; patients with extracapsular or
lowers the number of corneal endothelial cells, which,
intracapsular cataract extraction during surgery; patients
when combined with long surgery time and hazardous
who have undergone intraocular surgery in the past such
manipulation, might resulted in irreparable corneal
as vitrectomy, glaucoma filtering surgery, corneal
deterioration (2). Anterior capsule staining aided in greater
transplant, or trauma;.patients with retinal or optic nerve
visibility and enhances surgical results when continuous
diseases (e.g., glaucoma), high myopic patients or
circular capsulorhexis (CCC) was successfully completed
systemic disease that might affect corneal endothelium
during cataract surgery (1).
(e.g., DM) were excluded from the study.
Historically Trypan Blue (TB) is less harmful to the
Patients were divided into the case group and the
corneal endothelium than Indocyanine Green (ICG),
control group. All patients were subjected to: history
which was the first dye created for anterior capsule
taking, complete slit-lamp examination including grading
staining in white cataracts (3). Trypan blue is a crucial dye
the density of the cataract, an indirect ophthalmoscopy
utilised in both anterior and posterior segment surgery (2).
examination.
When there are mature or white cataracts, it is mostly

utilized to stain the anterior capsule. However, there
Investigations:
weren't many studies that look at its effectiveness and
Corneal endothelial cell analysis was carried out by
potential cytotoxicity following cataract surgery (1).
using the noncontact an optical microscope (NIDEK

CEM -530, Hiroishi Gamagori, Aichi, Japan). The
PATIENTS & METHODS
patient's information was entered to the computer
This prospective cohort study is carried out in
including name, gender and birth date.
Ophthalmology Department, Faculty of Medicine
Patient was asked to focus on internal fixation point
Zagazig University hospitals. Patients with cataract
inside the device as non-contact specular microscopy uses
2049
Received: 12/09/2022
Accepted: 14/11/2022

Full Paper (vol.902 paper# 7)


c:\work\Jor\vol902_8 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 2055-2063

Quality of Life for Family Caregivers of Patients with Lymph Nodes Cancer
Hesham Shaban Abd El-Latif Abd El-Hamid1*, Sahar Ahmed Shafik2, Amany Mohamed Saad1
1 Department of Community Health Nursing, Faculty of Nursing, Helwan University, Egypt
2 Department of Community Health Nursing, Faculty of Nursing, Fayoum University, Egypt
*Corresponding author: Hesham Shaban Abd El-Latif, Mobile: (+20) 01095922018, E-Mail: hesham.bosaat123@gmail.com

ABSTRACT
Background:
Lymph nodes cancer is one of chronic diseases that require long-term care. Family caregivers as the
closest one who lives with the cancer patient takes a significant role in providing care. This causes an important burden
on caregivers and decreases their quality of life. Objective: The aim of the current study is to assess the quality of life
for family caregivers of patients with lymph nodes cancer.
Subjects and methods: A descriptive study was conducted in outpatient Cancer Clinic of General Fayoum Hospitals.
Purposive sample was used and included 240 family caregivers. Tools of the study included: (1): Interviewing
Questionnaire sheet that included two parts, Part I: Demographic characteristics, Part II: Knowledge Assessment Sheet,
(2): Caregiver Quality of Life Index.
Result: Up to 80% of the sample under investigation knew too little overall about lymph node cancer. There were
statistically significant associations between the total knowledge scores of family caregiver of lymph node cancer
patients and their age, educational attainment, and monthly income, as well as statistically significant associations
between some socio-demographic data and their quality of life. Additionally, there was a highly statistically significant
positive correlation between the total knowledge scores and the total quality of life. Conclusion: Majority of family
caregivers with cancer patients had poor quality of life and unsatisfactory knowledge. Implementation of educational
programe for family caregivers with cancer patients to enhance their quality of life is needed.
Keywords: Quality of life, Family caregivers, Lymph nodes cancer.

INTRODUCTION

lymph nodes. Secondary lymph node malignancies start
Lymph node cancer is a kind of cancer that
in other parts of the body before metastasizing to the
develops in the immune system's lymphocytes, which
lymph nodes. The lymphocytes are the site of genesis
are responsible for battling infections. These cells can
for lymphoma, the most prevalent kind of blood cancer.
be found in the bone marrow, lymph nodes, spleen,
These cells can travel to the lymph nodes, spleen, bone
thymus, and other organs. During lymphoma,
marrow, and other organs after they have mutated and
lymphocytes alter and proliferate uncontrollably (1).
became malignant. Hodgkin lymphoma and non-
Infections, damage to the lymph nodes, drugs,
Hodgkin lymphoma are the two main categories of
immune system abnormalities, and cancer are some of
lymphoma (4).
the causes of lymphadenopathy. Lymphoma and
An adult family member or other person who
leukemia are the tumors that most frequently cause
provides unpaid in-home and out-of-community care to
larger lymph nodes. The following are warning signs
an elderly Vermonter or a person with a condition is
and symptoms of cancerous lymph nodes: lumps under
referred to as a family caregiver. Symptoms of
the skin, especially in the neck, under the arm, or in the
deteriorating health, anxiety, anger, sadness, social
groyne; fever (which may come and go over several
disengagement, changes in food and weight, and an
weeks); night sweats; unintentional weight loss; itchy
excessive dependence on drink and drugs are all
skin; fatigue; loss of appetite; cough; difficulty
experienced by family caregiver. They carry out duties
breathing; and chest pain. Numerous issues can result
akin to those they did at the care recipient's home,
from enlarged lymph nodes: Pain, coughing or
including feeding, grooming, managing money,
hoarseness due to chest lymphadenopathy, tingling and
shopping, and providing transportation. They also offer
numbness for lymphadenopathy damaging the spinal
companionship and emotional support (5).
cord's nerves (2).
Community
health
nurses
are
medical
Incidence and death rates for cancer of the lymph
professionals who play crucial roles in the lives of
nodes were 0.98 and 0.26 per 100,000 in 2020. High-
lymph node cancer patients and the people who care for
income nations showed a greater incidence, whereas
them in their families. The nurse uses their clinical
low-income nations showed a higher mortality. At the
knowledge and technological experience to ensure that
population level, smoking, obesity, and hypertension
the family caregiver understand what is happening with
prevalence were linked to incidence and death.
their body throughout each step of treatment. They also
Incidence increased despite the trend toward declining
assist in understanding the disease and the treatment
mortality, particularly among females, the younger
process. Nurses tend to patients' emotional needs as well
population, and patients from Asian nations (3).
as their physical ones, listening to their worries as well.
The likelihood of lymph node cancer occurring is
The nurses can assist patients find outside services that
double. First, primary lymph node malignancies, also
can lessen the emotional, financial, and familial strain
known as lymphomas, are tumors that originate in the
that comes with receiving a cancer diagnosis (6).
2055
Received: 28/08/2022
Accepted: 02/11/2022

Full Paper (vol.902 paper# 8)


RELATIONSHIP BETWEEN SLEEP DISORDERED BREATHING AND PRO-INFLAMMATORY MARKERS IN ACUTE ISCHEMIC STROKE The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 2064-2070

Comparative Study between Matrix Rotation Technique versus
Wide Local Excision of Carcinoma of The Breast Located in
The Upper/Upper Outer Quadrant
Ahmed Mahmoud Galal, Mohamed Ahmed Mohamed Khalaf Abotaleb,
Ahmed Gamal El Din Osman, Mohamed El azazy*
General Surgery Department, Faculty of Medicine, Ain Shams University, Egypt
Corresponding Author: Mohamed El azazy, Mobile: (+20) 01119972275, E-mail: mohamedelazazy1984@gmail.com

ABSTRACT
Background:
The breast is a cornerstone image of femininity, and the heart of womanhood, as nourisher and
comforter. The term "oncoplastic surgery" (OPS) refers to more than only the fusion of plastic and oncologic concepts.
Surgeons can do wider excisions with free margins by modifying the residual breast tissue using different
mammoplastic techniques, which lowers the incidence of re-excision.
Objective:
To assess and evaluate wide local excision technique as an oncoplastic procedure for management of
breast carcinoma in the upper/upper lateral quadrant with matrix rotation technique regarding cosmetic, surgical
outcomes, and patient satisfaction
Patients and Methods: This prospective randomized controlled study included 30 patients with cancer breast
scheduled for oncology breast surgery. They were divided to two equal groups: Group I: wide local excision
technique. Group II: matrix rotation technique.
Results: When testing the postoperative outcomes for all included patients, we found that 63.3% of patients had good
cosmetic outcome postoperatively. 16.7% of patients had very good cosmetic outcome. Concerning patients' point of
view, 80% of patients (24 patients) were totally satisfied about their postoperative outcome. 63.3% of them (19
patients) thought they had equal breast sizes while 36.7% of them (11 patients) thought they had a better breast shape
as shown in table 3.
Conclusion: Wide local excision is a safe oncoplastic technique, causing significantly less post-operative hematoma,
mild seroma, minimal blood loss, less areolar deviation and better breast symmetry than matrix rotation technique.
Keywords: matrix rotation technique, wide local excision.

INTRODUCTION

paradoxical that seems. Without the right surgical
Since 1996, the World Health Organization
approach, deformity can frequently develop in
Committee of Investigations for Evaluation of
medium- to large-sized breasts, and this might lead to
Methods of Diagnosis and Treatment of Breast Cancer
the patient being advised to have a mastectomy.
has approved breast-conserving surgery (BCS),
Additionally, 5% to 18% of typical BCS patients had
providing an option to radical mastectomy for the
positive margins, which resulted in significant re-
treatment of early-stage breast cancer (1).
excision rates. Re-excision rates this high can result in
Malignant illness surgical treatment involves a
substantial problems, morbidity, and deformity (3).
multidisciplinary
strategy.
Primary
surgical
The leftover lower breast tissue from tumours
intervention, radiation therapy, and chemotherapy are
in the upper and middle area may be placed into the
all part of the management process, and careful
defect as a glandular flap using the inferior
balancing and synchronisation of these modalities with
dermoglandular pedicle (IDP) mammaplasty procedure
cutting-edge reconstructive breast cancer surgery
(4).
procedures is required (1).
The nipple-areola complex zone was reliably
Additionally, oncoplastic breast surgery
preserved by the inferior pedicle surgical method in
improved quality of life by lessening the negative
breasts of nearly any size and shape. It is an easy
effects of mastectomy on psychosocial adjustment,
process to learn and use in real-world situations. In
body image, and sexual function. The removal of the
most surgical case circumstances, it requires some flap
tumour with sufficient margins and post-operative
undermining and the wise pattern, although it can still
radiation are the cornerstones of BCS success. BCS
be completed in 2 to 3 hours. Because the inferior
has emerged as the go-to therapy for breast cancer in
position removes dead space inside the dependent area
its early stages because it produces positive clinical
of the breast, some surgeons believe the inferior
results. The ultimate objectives of BCS for breast
pedicle approach has a reduced risk of problems (5).
cancer are to totally remove the breast tumour with
Cases with breast cancer who want to maintain
sufficient margins while still maintaining the breast's
their breasts but have moderate- to large-sized breasts
natural form (2).
and ptosis are indications for an inferior pedicle
The removal of a tumour that is huge in
oncoplastic reduction. Radiation therapy is more easily
relation to the size of the breast without losing
tolerated by smaller breasts than by larger breasts, and
aesthetics might be challenging, notwithstanding how
smaller breasts often provide more attractive results (6).
2064
Received: 12/09/2022
Accepted: 14/11/2022

Full Paper (vol.902 paper# 9)


c:\work\Jor\vol902_10 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2071-2073

Association of Interleukin-12B Polymorphism and Serum Level of
Interleukin-12 in a Sample of Iraqi Patients with Rheumatoid Arthritis
Layla Hassan Khayon, Abbas Aboud Farhan, Dunya Fareed Salloom
Department of Biology, College of Education for Pure Sciences, University of Diyala, Diyala, Iraq.
Department of Biology, College of Sciences, University of Baghdad, Baghdad, Iraq.
*Corresponding author: layla.hassan.khayon@uodiyala.edu.iq, Mobile: +9647723220927

ABSTRACT

Background: In rheumatoid arthritis, your immune system attacks the tissue lining the joints on both sides of your body.
Other parts of the body may also be affected. Unsure of the exact cause. Two separate genes termed IL12A (p35) and IL12
encode the heterodimeric cytokine known as IL12 (p40). Several different hematopoietic cell types can have several
different hematopoietic cell types that can generate antigen-presenting cells (APCs), including DCs and macrophages.
Objectives: This study aimed to investigate if the interleukin IL-12B gene's common polymorphisms in an Iraqi population
were associated with RA.
Material and methods: Blood samples were taken from 70 Iraqi patients with RA illnesses and 30 Iraqi controls during
the periods from April 2022 to June 2022 at Baghdad Teaching Hospital and Typical Rheumatology Unit. IL-12 level was
determined by ELISA, and the IL-12B gene SNP was investigated through RT-PCR.
Results: Between the sick and the healthy group, there was no statistically significant difference in the levels of IL-12. The
allele G was more prevalent, and the genotype GG was more noticeable in patients compared to healthy people. As a result,
the pattern represents a risk factor for RA (OR (95% CI, 1.55, (0.47 - 5.12), P=0.523).
Conclusion: We concluded that the IL-12B gene SNP rs3212227 GG was linked to the onset of RA, and that people carrying
the G allele had a greater probability of doing so.
Keywords: Rheumatoid arthritis, IL- 12, SNP.

INTRODUCTION

The lining of the joints throughout the body is
bridge between the innate and adaptive immune system
attacked by the immune system in the autoimmune
(2). IL-12 cytokines govern the immune system's cellular
disease rheumatoid arthritis (RA) (1). Inflammation of the
pathways, some of which stimulate pro-inflammatory
joints brought on by rheumatoid arthritis can, in extreme
responses that defend against infection while others
circumstances, lead to lifelong joint damage and
regulate unregulated immunological responses that cause
disability. The lungs, heart, blood vessels, skin, and eyes
autoimmune disorders. These cytokines also affect the
are just a few of the many organs that RA may impact.
choices made by differentiating lymphocytes about their
Rheumatoid arthritis affects around 1 in 200 persons
cell destiny (3).
globally, and women are often affected 2 to 3 times more
In the rheumatology unit, there were 53786 total
often than males. Although it can affect anyone at any
patients, 1039 of them had rheumatoid arthritis. 50.1% of
age, the peak onset is between the ages of 50 and 59 (1).
people live in urban areas, while 49.9% do so in rural
Joint discomfort, especially in the hands and feet, and
ones. Incidence was 1.60 in 2001 and 3.02 in 2011 for the
stiffness that lasts longer than 30 minutes in the morning
same group (4).
are the earliest symptoms of RA. Joints afflicted by RA

become swollen and challenging to move as the condition
MATERIALS AND METHODS
worsens. Times of greater inflammation (flares) are
Blood samples of 70 cases with a recognized
frequently followed by periods of relative improvement
diagnosis of RA based on the information about clinical
as the pain and swelling frequently come and go. Patients
symptoms and laboratory tests that were obtained from
may also have flu-like symptoms during flares, including
Baghdad Teaching Hospital and Typical Rheumatology
exhaustion and muscular pains (1).
Unit. In addition, a control group included 30 apparently
Interleukin 12 (IL-12) family consists of the four
healthy subjects in term of non-RA; their age range was
proteins IL-12, IL-23, IL-27, and IL-35. When an antigen
20-67 years. Also, age demographic data were similar in
is presented to naļve T cells by activated antigen-
the both subject groups.
presenting cells (APC), IL-12, IL-23, and IL-27 are

produced, but IL-35 is a consequence of regulatory T and
Measurement of serum IL-12 levels
B cells. They achieve this by promoting the transition of
Both the RA patients and the healthy controls had
immature CD4+ T cells into memory T cells and
their blood drawn. ELISA kits (Al-shkairate, Jordan)
cytokine-producing T-helper subsets, which serve as a
according to the manufacturer's instructions, were used to
2071
Received: 17/08/2022
Accepted: 20/10/2022

Full Paper (vol.902 paper# 10)


c:\work\Jor\vol902_11 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2074-2079

Predictive Value of Sepsis Markers in Diabetic Ketoacidosis
Patients Admitted to Intensive Care Unit
Afaf Abdel Hafez1, El-Said Kedra*2, Hesham Khairy Ismael3, Medhat Mikhail Messeha4
Departments of 1Internal Medicine, 2Emergency, 3Critical Care Medicine, and
4Anesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
*Corresponding author: El-Said Kedra, Mobile: (+20) 01015910745, E-mail: alsaeedkedra@gmail.com

ABSTRACT
Background:
Diabetic Ketoacidosis is one of the leading causes of intensive care unit (ICU) admissions. Recently,
evidence suggests that procalcitonin (PCT) and lactate levels are helpful prognostic markers for diabetic ketoacidosis.
Objective: To assess the PCT and serum lactate levels as predictors for morbidity and mortality in DKA patients
admitted to the ICU.
Patients and Methods: A prospective study included 180 patients conducted at Mansoura University Hospitals,
Mansoura, Egypt, for a duration of 1.5 year-duration from January 2021 to June 2022. All patients had been subjected
to clinical examination and medical history. Laboratory tests, comprising a complete blood count, PCT, and serum
lactate levels were reported.
Results: The median PCT level in the DKA group was 7.18 ng/ml, the median PCT level in the diabetic group without
DKA was 5.8 ng/ml and in the control group, the median level was 0.7 ng/ml. The mean serum lactate level in the DKA
group was 7.66 ± 0.86 mmol/L, the mean serum lactate level in the diabetic group without DKA was 4.11±0.77 mmol/L
and in the control group, the mean serum lactate level was 2.01 ± 0.39 mmol/L.
Conclusion: PCT and lactate levels were significantly higher in the DKA group in comparison to the diabetic without
DKA group and the control group.
Keywords: Diabetic ketoacidosis, Sepsis, Lactate, Procalcitonin, and ICU.

INTRODUCTION

The most frequent acute hyperglycemic
Recently, serum procalcitonin (PCT) is a
emergency in persons with diabetes mellitus (DM) is
calcitonin precursor with no hormonal activity that has
diabetic ketoacidosis (DKA). DKA is more common in
been suggested for the diagnosis of bacterial infections
cases with uncontrolled type I DM (TIDM), although it
and was hypothesized to be used in the diagnosis of
can also happen in adults with poorly controlled type II
DKA (6). Furthermore; DKA is a significant acute
DM (TIIDM) under stressful circumstances, such as
consequence that induces extensive dehydration and
acute medical or surgical disorders, and in adolescents
raised blood lactate levels; excessive lactate levels
with new-onset TIIDM (1).
frequently imply hypovolemia and microcirculation
The most common causes of DKA are infections,
abnormalities (7). Leading to that, the serum lactate
in particular gastrointestinal infections as well as
levels and PCT may play a crucial role as predictive
urinary tract infections (UTIs). The incidence of DKA
biomarkers in DKA diagnosis.
is approximately 2 episodes per 100 patients per year,
In our study, we aim to discover the role of PCT
with approximately 3% of T1DM patients initially
and lactate level as biomarkers for mortality in DKA
presenting with DKA (2).
patients admitted into the ICU department of Mansoura
The American Diabetes Association (ADA),
University Hospitals.
2001 redefined DKA to involve mild metabolic

acidosis, hyperglycemia, and positive ketone testing. In
PATIENTS AND METHODS
affluent nations, the mortality rate from DKA in
The study comprised one hundred twenty diabetic
pediatrics and adults is 1%. In contrast, mortality rates
patients, sixty patients were admitted to ICU due to
among impoverished nations are substantially higher,
moderate and severe DKA, while the other sixty
with recorded death rates in youngsters as high as 3-
patients were admitted because of medical emergencies
13%. In addition, DKA-related mortality in adults is
other than DKA to ICU, at Mansoura University
most common in older people (>60 years old) or those
Hospitals, Mansoura, Egypt, for a duration of 1.5 year-
with extensive precipitating diseases (3).
duration from January 2021 to June 2022.
DKA can develop in T1DM or T2DM when there
In our included population, the presence of DKA
is absolute or relative insulin insufficiency or during
can be based on the presence of inflammatory
acute illness, and it is related to a rise in the regulation
symptoms such as respiratory tract infection, UTI, soft
of the cortisol, growth hormone, glucagon, and
tissue infections, and other factors, including renal
catecholamines (4).
failure, hepatic encephalopathy, and missing insulin
The pathophysiological mechanisms implicated
doses.
in DKA are based on changes in hormone levels and the
The inclusion criteria of our study include patients
associated inflammatory response (5).
with, insulin-dependent DM (Type 1), complicated with
2074
Received: 15/09/2022
Accepted: 18/11/2022

Full Paper (vol.902 paper# 11)


ž’'D3J/ The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2080-2087

Sohag University Students Are They Active or Not?
Dina Abdelnaby Ahmed*, Fouad Metry Atia Yousef, Rasha Abdelhameed Ali
Department of Public Health and Community Medicine, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Dina Abdelnaby Ahmed, Mobile: (+20) 01008118057, E-Mail: abdelnabydina@gmail.com

ABSTRACT
Background:
Physical activity (PA) is such movements that resulted from any muscular or skeletal movements that
require energy expenditure. This includes all types of human movements such as competitive sports and exercise or
the daily activities. PA is a key factor in reducing the risk of many chronic diseases and promotes psychological well-
being; only if practiced throughout the life span. Objectives: The current study aimed to determine the prevalence
of PA and its predictors among Sohag University students.
Patients and Methods: A cross- sectional study was conducted among 536 students of Sohag University in four
randomly chosen faculties during the academic year 2020/2021. A self- administered questionnaire was used for
collecting data about socio-demographic characteristics; the second section was the International Physical
Activity Questionnaire (IPAQ).
Results: Most of the participants (95%) were physically active. Most females (99.2%) were physically active
compared to males (91.3 %). Students enrolled Faculty of Literature and Faculty of Law were more active (98.4% and
955%, respectively) than others in Faculty of Engineering and Faculty of Medicine (90.4% and 81.5%, respectively).
The studied students in the fourth grade were the most physically active (97.4%). Females spent more time in
domestic activities than males. Regarding work while studying, the studied students who work were physically active
(99.2%) much more than those who didn't work (93.8%). Predictors of PA among Sohag University students were
being a female and student in Faculty of Literature and Faculty of Law.
Conclusion: High prevalence of PA is present among students in Sohag University. Females were more active than
males.
Keywords: Physical activity, Sohag University students, International Physical Activity Questionnaire.

INTRODUCTION

in order to assess the existing situation and create a set
Physical activity (PA) is crucial in the prevention
of suggestions for interventions to assure a high level
of several chronic diseases and is vital for reducing the
of PA in university life (3).
incidence of cardiovascular diseases. Regular PA
Reduce your use of mobile devices, television,
reduces the incidence of ischemic heart disease, stroke,
and video games (4). Families are a crucial source of
diabetes, and breast and colon cancer. Regular PA is
influence for kids in modelling healthy habits since
also necessary for energy balance, maintaining a
many illness risk factors (physiologic and
healthy weight, and preventing obesity since it plays a
behavioral) congregate there (5). A lower risk of
critical role in determining energy expenditure (1,2).
early death, cardiovascular disease, type 2 diabetes,
Insufficient
moderate-to-vigorous
PA
is
hypertension, obesity, and several forms of cancer
referred to as physical inactivity (PI). It is different
is linked to PA.
from sitting down all day (1). With cigarette use,
The current study aimed to determine the
hypertension, and high blood sugar levels as the top
prevalence of PA and its predictors among Sohag
three risk factors for non-communicable illnesses,
University students.
PI was ranked as the fourth most dangerous factor,

accounting for roughly 3.2 million fatalities
PATIENTS AND METHODS
annually.
A cross- sectional study was conducted among
According
to
the
WHO,
the
Eastern
students of Sohag University in 4 randomly chosen
Mediterranean and the Americas had the highest rates
faculties, 2 theoretical (Faculty of Law and Faculty of
of PI as of 2008. About 40% of males in the Americas
Literature) and 2 practical (one medical, Faculty of
and 36% of men in the Eastern Mediterranean were
Medicine and one non-medical, Faculty of
physically inactive, making up almost half of all
Engineering), in a 4 months duration (from April 2021
women in each of these locations. Southeast Asia, in
to July 2021 during the academic year of 2020/2021.
contrast, has the lowest frequency of PI. Physical
The sample size was calculated using Danial
inactivity is seen there among 19% of women and 15%
sample size formula based on the following
of men (1).
assumptions: Prevalence of PA of the last previous
At Al-Mansoura University in Egypt, a cross-
study conducted in Egyptian University was 86.7%,
sectional survey found that 11.3% of students were PI,
with a confidence level of 95%. It was estimated that
with female students being more inactive (14.4%) than
536 samples were the minimum needed.
male students (8.2%) (3). The setting of a university is
The participant students were chosen using a
great for promoting PA and other healthy living
stratified random sample method. Based on the
activities. Therefore, it is crucial to perform this study
percentage of the total number of students in this
2080
Received: 28/08/2022
Accepted: 01/11/2022

Full Paper (vol.902 paper# 12)


c:\work\Jor\vol902_13 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2088-2092

Minimally Invasive Approach in the Treatment of
Benign Parotid Gland Tumors
Zainab Hussein Ali, Ayad Abdulkhalik Hasan
Department of Maxillofacial Surgery, Al-Imamain Al-Kadhemain Medical Center,
Baghdad Health Directorate, Baghdad, Iraq.
Corresponding Author: Zainab Hussein Ali. Telephone: 009647709177174,
ORCID: 0000-0003-4386-7977. E-mail: zainabhusseinaliibrahim@gmail.com

ABSTRACT
Background:
Conventional incisions for parotidectomy heal with a hardly discernible scar, which can cause long-term
psychosocial difficulties for patients. A minimally invasive method was the best option, when the parotid tumor was
mobile, superficially and small in size, contain the preauricular and postauricular incisions without upper cervical or
hairline incisions, which shorten the scar, dissection and improves the aesthetic results.
Aim of the study: To evaluate a minimally invasive approach of parotidectomy for benign parotid tumors regarding
aesthetics, facial nerve weakness, numbness of the ear, and time of operation.
Materials and Methods: This prospective clinical study included 10 patients with benign parotid lesions treated with a
minimally invasive approach via V-shape incision. Age, gender, histological type of the tumor, facial nerve assessment,
the sensation of the posterior auricular nerve, operative time, and patient satisfaction were analyzed. Followed-up interval
include 1, 2, 4, 12and 24 weeks.
Results:
Visual analogue scale for cosmetic satisfaction revealed 8 patients (very satisfied), and two patients (satisfied).
Facial nerves were intact in 9 patients, while one patient's forehead wrinkles showed a slight weakening. PAN sensation
showed hypoesthesia in 2 patients only. Mean operative time was relatively about 90 minutes.
Conclusions: Minimally invasive approach, is safe and practical for preserving the facial nerve and posterior auricular
nerve, produce no scar on the face or neck marking a significant step forward in the cosmetic evaluation of parotidectomy
with no significant complications. So, it turned out to be reasonable for the surgeon and satisfactory for the majority of
the patients.
Keywords: Minimally invasive, Parotidectomy, Superficial parotidectomy.

INTRODUCTION

been performed using the Blair incision. In patients,
Of all head and neck neoplasms, salivary gland
especially those with skin hues like yellow, brown, or
tumors represent 3% to 10% of the total. The parotid
black, this classic incision has a negative cosmetic result
gland is the source of about 80% of these tumors, and
of a lengthy visible permanent scar on the face and neck
80% of them are benign. Guidelines for the surgical
and may heal with a little visible scar. Long-term
removal of benign parotid tumors have evolved (1).
psychosocial difficulties for patients are a possibility
Parotid gland tumors have a high degree of anatomical
because of the long visible scar (6). According to
heterogeneity and are difficult to diagnose and treat.
Ciuman et al., cosmetic dissatisfaction with the
Their wide spectrum of biological behavior and relative
surgical scar and post-parotidectomy deformities
rarity make diagnosis and treatment challenging (2).
harmed quality of life ratings for both particular
Approximately 75% of all benign tumors of the major
symptoms and as a whole. Patients may decline surgery
salivary glands are pleomorphic adenomas (PAs), also
because of the unsightly facial scar before the tumors
known as benign mixed tumors. In most cases, PAs
have become large or displayed clinical indications of
occur as isolated, symptomless, slowly growing tumors
malignancy (6). The minimally invasive parotidectomy
(3). Although superficial parotidectomy is still regarded
procedure reduces the drawbacks of standard treatment
as the gold standard parotid gland surgery for
and improves the surgical result (8). It is suggested to
pleomorphic adenomas, parotid surgery has advanced
make a pre- and retro-auricular incision that is not long
significantly over the past century (4).
enough to reach the area that bears hair. This improves
Fear of causing facial nerve damage may result
the aesthetic results by reducing the extent of dissection
in inadequate surgery and a high likelihood of
and the size of the scar (7). This modified procedure
recurrence (2). To precisely identify the facial nerve and
involved an incision, flap elevation, facial nerve
prevent facial paralysis, a potentially fatal disease that
dissection while keeping the great auricular nerve intact,
has a significant influence on the patient's quality of life,
and postoperative removal (8).
a suitable incision and the identification of certain

anatomical landmarks are required. The majority of the
PATIENTS AND METHODS
time, benign and malignant tumors of the primary
This prospective clinical study included 10 patients
salivary glands are the reason for parotid surgery (5).
presented to Al- Al-Imamain Alkhademain Medical
Parotidectomy, which entails creating a sizable S-
center with benign parotid lesions. They were treated
shaped incision that runs from the lateral face across the
with a minimally invasive approach via V-shape
parotid gland and up to the upper neck, has commonly
incision. The variables that were analyzed included age,
2088
Received: 07/08/2022
Accepted: 10/10/2022

Full Paper (vol.902 paper# 13)


c:\work\Jor\vol902_14 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2093-2096

Reliability of The Post-Operative Recovery Index for
Measuring Quality of Recovery after Surgery
Dara Abdulla Al-Banna 1,2
1. Department of Nursing, Faculty of Nursing, Tishk International University, Erbil, Kurdistan Region, Iraq,
2. Department of Nursing, College of Nursing, Hawler Medical University, Erbil, Kurdistan Region, Iraq
*Corresponding author: Dara Abdulla Al-Banna, E-mail: daraaq@yahoo.com,
Mobile phone: 009647504488180, ORCID iD 0000-0003-1514-659

ABSTRACT
Background: Postoperative recovery is a crucial component of the patient experience, regardless of the kind of treatment.
There has been a lot of research done in this field, including studies using post-operative recovery as an end measure.
Objectives: This study aimed to evaluate the consistency of the Quality of Recovery (QoR-40) index among post-operative
patients in the hospitals of Erbil city. Subjects and methods: A descriptive study was designed among 166 participants of
patients, physicians, nurses, and medical assistants in four surgical wards of Hawler, Rizgary, Maternity, and Raparin
(Pediatric) Teaching Hospitals in Erbil City in the Kurdistan Region of Iraq. The data were collected through self-report
and direct interview face-to-face techniques from January to July 2022. A questionnaire was designed, and It is divided into
two main sections: the sociodemographic information about the participants is presented in the first section, and the second
section contains a ready-made scale question about the QoR-40 index, which consists of 40 items concerning five different
items and is used to assess the quality of recovery following surgery dimensions.
RESULTS: The study results showed that all the participants believed that the items of all dimensions were applicable and
can be used in measuring the level of recovery for post-operative patients and the correlation coefficient was 0.746 which
considered that this index has a Good Agreement among the participants.
Conclusion: This study concluded that the QoR-40 index is reliable among the different peoples of patients, nurses,
physicians, and medical assistants, and it's considered that this index has a positive agreement among people with very
highly applicable for post-operative patients in measuring the quality of the recovery after surgery.
Keywords: Reliability; Correlation Coefficient; Post-operative Recovery Index; Quality of Recovery; Surgery.

INTRODUCTION


Surgery aims to alter the structure of the human
Following surgery, patients receive postoperative
body. This method, which involves cutting or destroying
care. The surgery and the patient's medical history
tissue, will entail the use of any instrument that produces
influence the type of postoperative care required. Pain
local displacement or transfer of living human tissue, such
management and wound care are commonly included.
as lasers, ultrasound, ionizing radiation, scalpels, probes,
Postoperative care begins after surgery. It continues
and needles. Additionally, it can be utilized to diagnose
during your stay in the hospital and may do so even after
or treat illnesses or disease processes. Tissue can be
you depart. The procedure may have drawbacks and side
altered by any mechanical, thermal, optical,
effects that call for after-treatment (3). Preventing issues
electromagnetic, or chemical method. Additionally, it can
like infections, promoting wound healing, and restoring
be evaluated, and processed by closed reduction of severe
the patient's health are the objectives of postoperative
dislocations and fractures, burned, steamed, frozen,
care. Recovery from surgery is a difficult process that
sutured, burned, and changed. Any invasive surgical
affects many different outcomes. Prior research on post-
procedure referred to as a "major surgery" entails a more
operative recovery has mostly examined physiologic
substantial excision. In general, major surgery is
endpoints such as the frequency of adverse events
considered when a mechanical septum (pleural cavity,
including severe morbidity and mortality (3).
peritoneum) (1). The process of recovering after surgery is
The most widely used rating scale among those
characterized by an increase in functional status and a
developed to evaluate the quality of recovery following
sense of well-being. Theoretically, the idea that has been
surgery is the Quality of Recovery (QoR-40), a 40-item
developed states that healing from surgery is a process
questionnaire on the quality of recovery from the
that requires energy to complete in order to return to
postoperative period that has been proven to be a measure
normal and whole. It is determined using comparison
of health status after surgery. a 40-item questionnaire with
criteria, which is achieved by regaining control over
subscores for each of the five pain, support for the patient,
physical, psychological, social, and normal functions.
comfort, emotions, and bodily independence categories
This results in a return to a preoperative level of
(5). The clinical value and overall psychological qualities
independence or dependence on day-to-day activities as
of QoR-40 (validity, reliability, ease of administration,
well as an ideal level of psychological well-being (2).
and interpretation) have been studied in many contexts.

For the above reasons, the researcher wanted to determine
2093
Received: 08/08/2022
Accepted: 11/10/2022

Full Paper (vol.902 paper# 14)


c:\work\Jor\vol902_15 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2097-2101

Platelet Rich Plasma in Treatment of Plantar Fasciitis
Mohammed Osama Hegazy1, Hazem Mahmoud Hamdy2, Ahmed Saad Abdel-Hameed Elfar*2
1Department of Orthopedic Surgery, Faculty of Medicine, Banha University, Egypt
2Department of Orthopedic Surgery, Faculty of Medicine, Helwan University, Egypt
*Corresponding author: Ahmed Saad Abdel-Hameed, Mobile: (+20) 01094269080, E-Mail: drahmed4761@gmail.com

ABSTRACT
Background:
Using platelet rich plasma (PRP) was associated with more improvement in activity limitation and
physical disability when compared with corticosteroids and even with surgical management.
Objective: The aim of the study is to evaluate the effect of local PRP injection on chronic plantar fasciitis resisting the
conservative modalities of treatment.
Patients and Methods: This is a prospective interventional study of 30 patients for 6 months. 18 males and 12 females
with planter fasciitis were included in this study. Their ages ranged from 35 to 62 years with a mean age of 44.5 years.
Patients with widespread inflammatory arthritis, any wound or skin lesion on the plantar aspect of the foot, previous
surgery for heel pain, and other local pathologies for heel pain were excluded. Their improvement was measured by
Ankle Hindfoot Scale.
Results: The Ankle Hindfoot Scale showed a statistically significant (p-value 0.02) improvement over time. Acceptable
results were obtained in 70% (n=21) of patients from a single injection and 30% (n=9) needed a second injection.
Chronic plantar fasciitis that is resistant to conventional treatment techniques can be effectively treated with local PRP
injection.
Conclusion: For severe plantar fasciitis that is resistant to conservative treatment approaches, local PRP injection is an
effective therapy.
Keywords:
Platelet Rich Plasma, Plantar Fasciitis, Conservative modalities of treatment.

INTRODUCTION
PATIENTS AND METHODS
The most frequent cause of heel discomfort is
This is a prospective interventional study of 30
chronic plantar fasciitis, which can afflict both active
patients for 6 months. Through using Z score table with
young people and sedentary middle-aged adults (1-3).
confidence interval (95%) with consideration of
The disease is diagnosed based on the usual history and
estimated prevalence ratio of the disease in Egypt and
the presence of localised soreness in the medial
census; 30 patients with chronic heel pain diagnosed
calcaneal tubercle, which are both signs of a
with plantar fasciitis not responding to conservative
degenerative pathology (4), as opposed to an
treatment for 3 months or injection by corticosteroid
inflammatory process (5-8).
and ages between 18 and 65 years were enrolled in this
A variety of conservative treatments for plantar
study, while patients with any wound or skin lesion on
fasciitis are now widely used, including physiotherapy,
the plantar area of the foot, previous surgery for heel
stretching exercises for the plantar fascia, ice packs,
pain, and any other local pathologies for heel pain were
night splints, shoe modifications, and non-steroidal
rejected.
anti-inflammatory medicines (NSAIDs) (9). Following

conservative therapy, local injections of corticosteroids
Platelet Rich Plasma preparation:
are frequently utilised to treat individuals with
The antecubital vein was punctured using
recalcitrant plantar fasciitis (10-12).
aseptic approach to get between 30 and 60 cc of venous
PRP is platelet-rich plasma that promotes bone
blood. In an effort to prevent agitation and damage to
and muscle repair. PRP is often employed in tissue
the platelets, which were in a resting condition, an 18 or
healing processes that are mediated by various
19 g butterfly needle was indicated. After that, the blood
cytokines and growth factors (13, 14). In medicine, PRP is
was put into a specialised kit that has received FDA
frequently utilised to treat osteoarthritis, tennis elbow,
approval and centrifuged for 15 minutes at 3,200 rpm.
Achilles tendonitis, and plastic surgery (15, 16).
The blood was then divided into RBC, PRP, and platelet
For the treatment of plantar fasciitis, platelet
deficient plasma (PPP). The PPP was then removed
rich plasma (PRP) has recently been evaluated in
from the device via a unique port and discarded. The
contrast to other therapies and drugs. When compared
device was shaken for 30 seconds to resuspend the
to corticosteroids and even surgical therapy in certain
platelets while the PRP was in a vacuumed
trials, utilising PRP was linked to greater improvement
environment. After that, the PRP was removed. There
in activity restriction and physical handicap (11, 12).
were around 3 or 6 cc of PRP accessible, depending on
Aim of the work was to evaluate the effect of
the size of the first blood pull (17).
local PRP injection on chronic plantar fasciitis resisting

the conservative modalities of treatment.




2097
Received: 14/09/2022
Accepted: 17/11/2022

Full Paper (vol.902 paper# 15)


c:\work\Jor\vol902_16 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2102-2107

Study of Lipid Profile of Patients with Chronic Coronary Syndromes at
Sohag University Hospital
Eslam Mohamed Farrag*, Ali Mahmoud Ahmed Kassem, Amal Khalifa Ahmed, Alaa Ahmed Ghaleb
Department of Internal Medicine, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Eslam Mohamed Farrag, Mobile: (+20) 01005842407, E-Mail: eslamfarrag753@gmail.com

ABSTRACT
Background:
Coronary artery disease (CAD) has been proven to be causally associated to genetically defined and
metabolically produced changes in lipid metabolism, as seen in numerous kinds of dyslipidemia.
Objective: The aim of the present study was to assess the lipid profile in patients with chronic coronary syndrome.
Patients and Methods: A hospital based cross-sectional study was conducted at Sohag University Hospital and
included 100 patients with chronic coronary syndrome. The examined if our patients could achieve the target lipid
profile level of their group according to 2019 ESC/EAS Guidelines for the management of dyslipidaemia. History of
CAD and family history were taken. Clinical presentation and body mass index (BMI) were assessed. Finally, lifestyle,
drug history (lipid lowering drug, anti HTN drug and anti-platelets drugs), dietary intake assessment and physical
exercise were evaluated.
Results: Patients had a mean HDL-C level of 39.4 91mg/dL, a mean total cholesterol level of 188.91mg/dL, a mean
LDL-C level of 119.67mg/dL and a mean triglyceride level of 149.15mg/dL. HDL-C was significantly lower for non-
statin therapy group compared to statin therapy group (P<0.001), while triglycerides and vLDL were significantly higher
non-statin therapy group compared to statin therapy group (P<0.001). Only 8% of patients achieved target LDL-C
according to 2019 ESC/EAS guidelines.
Conclusion: Most of patients at Sohag University Hospital are not reaching the target LDL-C. Thus, more strict
application of guidelines and investigating the predisposing factors for uncontrolled lipid profile, especially in patients
with CAD, are urgently needed.
Keywords: Lipid Profile, Chronic Coronary Syndromes, LDL-C.

INTRODUCTION

commencement of an acute coronary event is
From 1970 to 2015, it was predicted that
determined by the kind of plaque, not the degree of
cardiovascular disease deaths will decrease in wealthy
coronary artery constriction. Dyslipidemia is reported to
nations while nearly doubling in underdeveloped ones.
raise fibrinogen levels, platelet activation inhibitor, and
According to the Global Burden of Disease research,
platelet aggregation. Increased LDL oxidation (free
cardiovascular illnesses were responsible for 2.3 million
radical damage), increased platelet aggregation
fatalities, or 25%, of the 9.4 million total deaths
(clumping), increased plasma fibrinogen, coagulation
recorded worldwide in 1990. There will likely be a
factors, hypertension, changes in glucose metabolism,
111% increase in cardiovascular fatalities in India by
smoking, hereditary and environmental variables are
2020, according to predictions. This surge exceeds
only a few of the causes linked to CAD (3).
China's 77%, other Asian nations' 106%, and
It is generally established that statins help people
economically developed nations' 15% increases (1).
with coronary artery disease or who are at high risk of
Any community's relative changes in biological
developing cardiovascular disease by lowering
features such serum lipids, blood pressure, blood
cardiovascular events and death. Statins have
glucose, insulin, and thrombogenic variables are related
pleiotropic benefits that include better endothelial
to the prevalence of coronary heart disease in that group.
function, decreased inflammation, and decreased
This theory is based on Key's postulation of ill
thrombus formation in addition to decreasing low-
individuals and sick groups as well as Pickering's
density lipoprotein (LDL) cholesterol. Numerous recent
observation that sick people are just the extreme of a
studies have shown that statins are effective for treating
continuous distribution. Changes in lifestyle, such as
coronary artery disease in people (4).
quitting smoking, getting more exercise, drinking
Current recommendations emphasize using statins
alcohol, and eating a rich diet, as well as psychological
to reduce low-density lipoprotein cholesterol (LDL-C)
factors that accompany economic change, are the cause
for both primary and secondary prevention. Low levels
of these adjustments (2).
of high-density lipoprotein cholesterol (HDL-C) and
A significant biochemical change in the arteries
increased triglycerides are two additional significant
occurs during dyslipidemia as a result of an
lipid abnormalities that both independently indicate a
accumulation of lipids, either in the form of free
high residual risk for future cardiovascular events (5).
cholesterol or its ester, which results in the development
There is no discernible link between serum HDL-
of plaques in the inner wall of the artery. No new
C and the prevalence of CVD. According to a
plaques will develop if the total cholesterol level is less
systematic review and meta-analysis, higher HDL-C
than 150 mg/dl. When the plaques with thin fibrous caps
levels were not linked to a lower risk of CVD or CVD
break, an acute coronary event is anticipated. The
death (6).
2102
Received: 28/08/2022
Accepted: 01/11/2022

Full Paper (vol.902 paper# 16)


c:\work\Jor\vol902_17 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2108-2113

Efficacy of Ultrasonography and Fibroblast Growth Factor 21 for
Early Diagnosis of Non-Alcoholic Fatty Liver Disease
Said Abdel Baky Gad1, Samia Hussein*2, Aliaa Talaat2, Sameh Saber3, Ahmad I. Elagrody1
Departments of 1Internal Medicine, Gastroenterology and Hepatology, 2Medical Biochemistry &
Molecular Biology and 3Radiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Samia Hussein, Mobile: (+20) 01227517689, E-mail: samiahussein82@hotmail.com

ABSTRACT
Background:
Non-alcoholic fatty liver disease (NAFLD) is a worldwide public health problem. It ranges from simple
steatosis to steatohepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). Ultrasonography is a noninvasive tool
to examine the liver parenchyma. The aim of the current study is to evaluate the accuracy of ultrasonography in
combination with fibroblast growth factor 21 (FGF21) in early detection and diagnosis of NAFLD, especially early
stages (mild NAFLD).
Patients and methods: A total of 340 eligible obese subjects were included in the study. They performed
ultrasonographic examination with serum levels of FGF21 together with fasting blood glucose, insulin, glycated
hemoglobin, total lipid profile, liver function tests and HOMA-IR.
Results: There were significant differences in ultrasonographic findings and FGF21 serum levels between NAFLD
group and non-NAFLD group. Roc curve showed a significant area under curve with a significant cutoff for FGF21
serum levels (>160 pg/mL) and intrahepatic triglyceride content (IHTC) (>5.79%). The sensitivity was 83.3% for FGF21
serum levels and 87.8% for IHTC and the specificity was 80% for FGF21 serum levels and 85% for IHTC. After
combination of both FGF21 serum levels and IHTC, the sensitivity increased to 88.3% and the specificity was 80%.
Conclusion: The combined use of ultrasonography and serum FGF21 has a higher sensitivity in the early diagnosis
of NAFLD compared to either method alone.
Keywords: Nonalcoholic fatty liver disease, FGF21, Ultrasonography, Comparative study, Diagnostic Test.

INTRODUCTION


Nonalcoholic liver disease (NAFLD) is the most
Fibroblast growth factor 21 (FGF21) is a plasma
common worldwide emerging public health problem
biomarker which is positively correlated with
representing approximately 25% of the general
intrahepatic triglyceride content (IHTC). Elevations of
population. It ranges from benign simple steatosis to
FGF21 are correlated with liver triglycerides, which
malignant
steatohepatitis,
liver
cirrhosis
and
may progress to end-stage steatosis [7].
hepatocellular carcinoma (HCC) [1].
Also, plasma levels of FGF21 are correlated with
Hepatic steatosis is graded as minimal (< 5%),
age, dietary interventions, liver weight and body weight.
mild (5%-33%), moderate (33- 66%), and severe (
So, FGF21 is an emerging plasma biomarker to
66%) [2]. Owing to the nonspecific presentation and mild
diagnose NAFLD [8]. So, we investigated the combined
symptoms of NAFLD, early diagnosis and search
effect of ultrasonography and FGF21 for diagnosis of
workup is mandatory to avoid steatohepatitis. Liver
NAFLD, especially early stages (mild NAFLD).
biopsy is the gold standard test to diagnose NAFLD.

However, its invasive nature and missed interpretation
PATIENTS AND METHODS
made biopsy alternative measures are introduced to
This study was conducted at the Internal
avoid its drawbacks [3].
Medicine Department, Zagazig University Hospitals in
Ultrasonography is a noninvasive tool to examine
collaboration with Medical Biochemistry and
the liver parenchyma. Ultrasonography divided the liver
Molecular Biology, and Radiology Departments,
into bright echo liver, increased hepato-renal
Faculty of Medicine, Zagazig University. The
echogenicity, vascular blurring of the hepatic artery or
participants attended the outpatient clinics in the period
portal vein and subcutaneous tissue thickness. However,
between July 2019 and July 2022.
these results are not enough to diagnose mild NAFLD
The included patients' criteria were the age group
[4]. NAFLD patients have subcutaneous thickness of
from 20 to 75 years old with no sex predilection,
more than 25.6 ± 56 mm. while non NAFLD has
overweight and obese subjects who are defined by body
subcutaneous tissue thickness less than 19 ± 52 mm [5].
mass index (BMI) 25 kg/m2 or waist circumference
NAFLD can be defined by clinicians with the
(WC) 85 cm in males or 80 cm in females.
following criteria: diffuse echogenicity, uniformly
All participants were exposed to the
heterogeneous liver, subcutaneous thickness > 2 cm,
anthropometric
measurements,
blood
pressure
liver filling the entire field with no edges, attenuation of
measurement, fasting blood glucose (FBG), two-hour
image quickly within 4­5 cm of depth. With these
post prandial blood glucose (PP2), insulin, glycated
measurements, the accuracy of ultrasonography in the
hemoglobin (HbA1C), total lipid profile, liver function
diagnosis of NAFLD increased by 80% sensitivity and
tests and HOMA IR. Plasma FGF21 was determined
99% specificity [6].
using enzyme-linked immune sorbent assay (ELISA).
2108
Received: 22/10/2022
Accepted: 21/12/2022

Full Paper (vol.902 paper# 17)


INTRODUCTION The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2114-2121

Knowledge and Treatment Adherence towards Pregnancy Induced Hypertension
among Pregnant Women in Ismailia City: An Intervention Study
Hanan Mohamed El-Toukhy, Howaida Henry Fahmy, Salah Abd El-Rahman Ibrahim, Amira Fawzy Hussien
Community Medicine department, Faculty of Medicine, Zagazig University
*Corresponding author: Amira Fawzy Hussien
E mail: Amirayousef42@gmail.com, Mobile phone: +20 120 222 5494, Orchid number: 0000-0003-1069

ABSTRACT
Background and aim:
One of the most frequent pregnancy problems and a leading global cause of maternal and fetal
death and morbidity is pregnancy-induced hypertension. In order to provide effective educational interventions, this
research was conducted to assess and enhance the level of awareness and adherence about pregnancy-induced
hypertension (PIH) among pregnant women in Ismailia city. Method: An interventional study (pre-test/post-test)
conducted at family centers and antenatal out- patient clinic of Ismailia public hospital. It was carried out on 80
hypertensive pregnant women on treatment for at least one month. Interview closed-ended questionnaire were used to
collect data which included; socio-demographic data, pregnant women's knowledge about PIH, Morisky eight-item
Medication Adherence Scale for measuring adherence to PIH drugs, tool for measuring adherence to PIH health related
behaviors and health system factors which may affect adherence to PIH. Results: Significant improvement was reported
after the education to be; 35%, 30% and 35% high, medium and low adherence to PIH drugs respectively. The level of
adherence to PIH health related behaviors before health education was; 18.8% high, 36.2% medium and 45% low
adherence, improved significantly after the education to; 57.5% high, 38.7% medium and 3.5% low adherence.
Conclusion The results clearly demonstrated the effectiveness of educational intervention program in promoting
knowledge and adherence towards PIH.
Keywords: Pregnancy induced hypertension; PIH; knowledge; educational intervention.

INTRODUCTION

Inclusion criteria: Hypertensive pregnant women (BP
The most frequent medical issue that arises during
140/90 mm Hg) above (20) weeks gestation and
pregnancy is pregnancy-induced hypertension (PIH),
hypertensive pregnant women on treatment for at least
which may complicate up to 10% of pregnancies (1).
one month.
All end-organ problems are considered maternal
Exclusion criteria: Normotensive pregnant mothers,
morbidities because of the hypertensive disorders of
hypertensive pregnant mothers with gestational age less
pregnancy. The most terrifying complications are those
than (20) weeks and hypertensive pregnant mothers
that affect the central nervous system, such as stroke,
with gestational age at or more than 20 weeks on
retinal detachment and blindness, or hepatic
treatment for a period less than one month.
haematoma/rupture. The most common complications
are pulmonary oedema, HELLP syndrome (haemolysis,
Techniques for the study: The data was acquired by
elevated liver enzymes, low platelets), and placental
speaking with expectant mothers who were given a PIH
abruption (2).
diagnosis at medical institutions. The examiner went to
Pregnancy-related hypertension diseases have been
the family centers each Monday and Wednesday by
linked to risky perinatal outcomes such as neonatal
each week (these are days of antenatal care in the family
mortality, stillbirth, and fetal growth restriction (3).
centers at Ismailia city) and to the out-patient antenatal
Antihypertensive treatment is used to avoid severe
clinic of the general hospital the rest of the week.
gestational hypertension and maternal hemorrhagic
Finishing the check list took about 20 minutes, while
strokes, despite the fact that there is no agreement on
health education took about 30 minutes. Health
how to manage non-severe hypertension (1). The non-
education was done in separate groups, depending on
pharmacological therapy of pregnant women with
the number of cases by the end of the day and
hypertension problems takes into account nutritional
sometimes it was done case by case according to the
therapies, lifestyle modifications (such as bed rest and
patient preference.
stress reduction), and the setting of care (2).
Tools of the study: Interview closed- format

questionnaire was presented using values such as yes
PATIENTS AND METHODS
/and no as well as choosing from options.
This was an intervention study (pre-post study) was
carried out from June 2018 to August 2019. The study
The instrument is divided into 4 sections:
was carried out at family centers in Ismailia city and
The first section: consisted of: Socio demographic data
antenatal out- patient clinic of Ismailia general hospital.
of the participant and her husband such as age,
Ismailia city incorporates 4 family wellbeing centers; all
education level, occupation, and marital status.
of them were included in the study.
Obstetric and past history including parity, gestational
Target group: The hypertensive pregnant women at
age, past history of having PIH, duration of being on
Ismailia city.
treatment.
2114
Received: 22/10/2022
Accepted: 21/12/2022

Full Paper (vol.902 paper# 18)


c:\work\Jor\vol902_19 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2122-2126

Rehospitalization Incidence in COVID-19 Reinfection:
A Retrospective Cohort Study
Mahmoud Abdelgawad Elattar*1, Samah Ahmed Gad2, Asmaa Nabil Elgamal3, Esraa Morshedy Beltagy3,
Taghreed Salah Elsheikh1, Khaled Ebied Elfeky2, Amany Mohamed Abd el-azziz1, Hassan Yousef Elmsri2
1Clinical Research Department, Kafr El-Sheikh Fever Hospital,
Kafr El-Sheikh Health Affairs, Egyptian Ministry of Health (MOH), Egypt
2Therapeutic Medicine Department,
3Clinical Research Department, Kafr El-Sheikh Health Affairs, Egyptian Ministry of Health (MOH), Egypt
*Corresponding author: Mahmoud Abdelgawad Elattar, Mobile: (+20) 01005750779,
E-Mail: attarmahmoud83@gmail.com, ORCID: 0000-0002-3565-0965
ABSTRACT
Background:
The effect of COVID­19 re-infection is not fully clear. Patients may have a benefit or no change in the
degree of illness if re-infected with the COVID-19 virus. Objective: This study aimed to estimate the incidence of re-
hospitalization due to COVID­19 re-infection and to characterize the features of those re-hospitalized patients.
Patients and Methods: A retrospective cohort study from the COVID-19 patients' registration data in Kafr El-Sheikh
governorate, Egypt in the period from September 2020 to July 2021. The study population was 1000 patients who had
re-infection with the covid-19 disease, at least four months after hospital discharge. The patient presentations included
fever, cough, dyspnea, diarrhea, or fatigue plus: polymerase chain reaction confirming infection with SARS-COV2
and/or computed tomography (CT) chest suggesting covid-19 infection. Results: Among the study population, there
were two (0.2 %), re-hospitalized, due to COVID-19 re-infection. Symptoms with re-hospitalization were fever 100%,
cough 100%, tachypnea 100%, and fatigue 50%. Conclusion: Once hospitalized; COVID-19 patients significantly
have a very low risk of re-admission if re-infected. Clinical approach to COVID-19 patients should consider the
history of previous hospitalization due to COVID-19. This history will help in the management including treatment,
need for hospital admission, and initial prognosis. All study populations didn't receive the COVID-19 vaccine as the
study period was before or just after authorization and availability of the vaccine.
Keywords: COVID-19, Re-infection, Admission, Re-hospitalization, Natural immunity.

INTRODUCTION
COVID-19 reinfection and the need for re-
The worldwide burden of COVID-19 disease is
hospitalization.
growing with more than 600 million cases and a
Our hypothesis; COVID-19 patients who had
mortality of about 1%. By spring 2021, almost a
previous COVID -19 infection will have a mild to
quarter of the world's population had been infected.
moderate form of the disease with a good prognosis if
After the spread of the Delta variant mutation in mid-
re-infected. In recurrent exposure, Specific immunity
2021, there was a significant spike in infection rates (1).
will be responsible for fighting the pathogen with the
The new pandemic of COVID-19 had been
formation of specific antibodies in a short time.
proven to cause re-infection of the same person (2,3).

Risk factors for re-infection were not fully clear.
PATIENTS AND METHODS
Immune-compromised patients, patients with chronic
A retrospective cohort study from the COVID-19
diseases, and personnel with repeated exposure (e.g.
patients' registration data in Kafr El-Sheikh
healthcare workers) resemble the riskiest groups for re-
governorate, Egypt, in the period from September
infection with the COVID-19 virus. Re-infection
2020 to July 2021. The study population was 1000
should be differentiated from prolonged primary
patients who were recorded with hospitalization due to
infection.
COVID-19 infection and then had COVID-19 re-
A suspected COVID-19 re-infection case was
infection, at least four months after discharge. Data of
defined as positive polymerase chain reaction (PCR) or
the study population during hospital admission due to
rapid antigen test (RAT) within 60 days following a
their first COVID-19 infection were collected from
previously confirmed covid-19 infection(4). According
recorded data of COVID -19 patients from isolation
to research, people who have recovered from an
hospitals in Kafr El-Sheikh governorate (Egypt); Kafr
infection can obtain naturally acquired immunity that
El-Sheikh fever hospital, Kafr El-Sheikh chest
appears to be at least as protective as protection
hospital, Qilin hospital, Desouq hospital, and Kafr El-
brought on by vaccinations (5).
Sheikh general hospital. Data of re-infection were
Reinfection had a less infectious course if the
collected from home isolation records then history and
previous infection was symptomatic. Previous studies
data collection by contacting participants about
showed risk factors for re-admission (6), and clinical
COVID-19 re-infection. COVID-19 re-infection was
characteristics of re-hospitalized COVID-19 patients
classified as mild, moderate, or severe according to
(7). The impact of the previous infection with COVID -
clinical, radiological, and laboratory evaluation (8).
19 on patients' hospitalization was not fully known,
Inclusion criteria: Adult patients who was admitted
they may have a benefit or no change. We estimated
due to COVID-19 infection and had re-infection at
the association between natural immunity due to
least four months after discharge.
2122
Received: 18/09/2022
Accepted: 21/11/2022

Full Paper (vol.902 paper# 19)


c:\work\Jor\vol902_20 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2127-2131

Assessing The Efficacy of Single Inferomedial Peribulbar Injection in Lacrimal
Intubation Surgery in Adult Patients: A Randomized Clinical Trial
Abeer S. Salem, Dina Moustafa Mohamed, Sara R. Mahmoud
Anesthesia Department, Research Institute of Ophthalmology, Giza, Egypt
Corresponding author: Abeer S. Salem; email: a.salem@rio.edu.eg,
Mobile no.: +201125666006, ORCID: 0000-0003-1458-0547

ABSTRACT
Background:
Inferomedial injection has been suggested as a more comfortable alternative to medial peribulbar block.
Aim: We aimed to explore inferomedial injection technique efficacy in minimizing pain during injection as well as
intubation compared to the classic medial canthal injection technique during peribulbar block.
Methods: This randomized, controlled trial included adult (18 to 70 year-old) patients scheduled for lacrimal intubation
surgery. Eligible patients were divided in a random way into two groups. Group 1 (n=24) received inferomedial peribulbar
injection using a 25G/ 1" length needle to inject 3 ml of lidocaine: bupivacaine (1: 1) with 30 IU hyaluronidase enzyme to
improve the infiltration of the small volume of the local anesthetic drugs. The classic medial canthus injection was applied
in Group 2 (n=24) using the same types and amounts of local anesthesia (LA) and the same needle length. The pain was
assessed during local anesthetics injection and intubation using the verbal rating scale.
Results: In group 1 a low pain score was more frequent than in group 2 (83.3% vs. 16.7%). The median pain score at the
LA injection was significantly lower in group 1 (1.0: IQR=1.0-1.0) than in group 2 (2.0: IQR=2.0-2.5). Alternatively, a
comparison of the Verbal Rating Scale at intubation revealed comparable results between groups 1 and 2, with no significant
differences (p>0.05).
Conclusions:
Inferomedial LA injection technique is feasible and less painful than the medial canthal injection. Otherwise,
both techniques provided adequate intraoperative analgesia during lacrimal intubation and comparable surgeon satisfaction.
Keywords: lacrimal intubation surgery, peribulbar anesthesia, inferomedial injection, medial canthus injection, pain score.

INTRODUCTION


Obstruction of lacrimal drainage is one of the
analgesia. The efficacy of this technique has been
common lacrimal disorders. Intubation using a silicone
previously reported. B-scan ultrasonography has been
tube has been adopted for the successful treatment of both
used to ascertain the distribution pattern of the injectate in
canalicular and nasolacrimal duct stenosis in adults.
peribulbar anesthesia (8-10). We named it inferomedial
Nasolacrimal stents maintain the patency of the passages
injection in our study after its anatomical site to facilitate
where it is present and thereby improve the drainage of
the description throughout this manuscript.
tears from the lacrimal gland (1, 2).
Inferomedial injection has been suggested as an
Lacrimal intubation surgeries in adults are typically
alternative, more comfortable technique both for the
performed under general anesthesia, which increases their
patient and the surgeon. The aim of this study was to
cost and significantly decreases the practice of these
evaluate the efficacy of the inferomedial injection
procedures. Alternatively, lacrimal tubes can be
technique in minimizing pain during injection as well as
successfully placed as a simple day-case surgery under
intubation compared to the classic medial canthal
local anesthesia (LA) (3).
injection technique during performing the peribulbar
The peribulbar block technique is useful for patients
block.
willing to stay for a short time in the hospital. It has many

advantages including a low incidence of cough and
PATIENTS AND METHODS
emesis during the immediate postoperative period (4).
Ethical considerations
The peribulbar block involves the injection of LA into
This work has been carried out in accordance
the peribulbar space, and it produces globe akinesia and
with The Code of Ethics of the World Medical
anesthesia (5). Medial peribulbar block through the classic
Association (Declaration of Helsinki) for studies
medial canthal injection site has some disadvantages,
involving humans. The current study obtained
such as pain during the LA injection as well as puffiness
approval from the IRB of the Research Institute of
and false tracking which may occur at the injection site (6,
Ophthalmology, Egypt, and informed consents were
7).
obtained from all patients. The authors preserved the
In cataract surgeries, the percutaneous ocular
confidentiality of the participants' data. This trial was
peribulbar anesthesia with the single injection technique
registered at ClinicalTrials.gov (ID: NCT04859049,
using a short needle can provide adequate akinesia and
Date: April 26, 2021).


2127
Received: 18/09/2022
Accepted: 20/11/2022

Full Paper (vol.902 paper# 20)


c:\work\Jor\vol902_21 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2132-2136

Urodynamic Predictors for Voiding Recovery after Transurethral Resection of
Prostate in Benign Prostatic Hyperplasia Patients with Significant
Post-voiding Residual Urine
Mohamed Mostafa Idrees Mohamed, Aref Mohamed Maarouf,
Mohamed Mahmoud Sleem, Ibrahem Ismail Elsayed
Department of Urology, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Mohamed Mostafa Idrees Mohamed
Email: Mohamed.edris915@gmail.com, Mobile: 01015673919
ABSTRACT
Background:
Detrusor underactivity (DU) is a frequent clinical issue that is poorly understood. Both the diagnosis and
the course of treatment are challenging and unpredictable. In men, DU and bladder outlet obstruction (BOO) frequently
coexist. Prostatic surgery may enhance voiding efficiency (VE).
Aim:
To improve the outcome of transurethral resection of the prostate (TURP) by selecting Benign Prostatic Hyperplasia
(BPH) patient with significant post-voiding residual urine who could benefit from surgery and could void normally after
TURP. Patients and methods: This is a clinical trial ­ single arm study included 24 male patients above 50 years old
with BPH and significant postvoiding residual urine who underwent TURP. Urodynamic predictors were assessed.
Results: There was significant difference between patients with good and poor outcomes regarding IPSS pre-operatively,
Qmax, postvoid residual (PVR), Voiding Efficiency and BCI
Conclusion: The success rate of prostatectomy was 83.3% and about 16.7% had poor outcomes. Patients with higher BCI
had good prognosis.
Keywords: Urodynamic, BPH, TURP, Voiding recovery.

INTRODUCTION

The existence of BPO before to surgery is linked to
For people with problematic prostates, the gold
better surgical outcomes as indicated by reductions in
standard of care is still transurethral resection of the
postvoiding residual urine and improvements in
prostate (TURP). Lower urinary tract symptoms (LUTS)
symptoms, quality of life, maximum flow rate, and flow
that are resistant to treatment or have side effects such
rate(6).
persistent acute urine retention (AUR) (1). The
This study aimed to improve the outcome of TURP
urodynamic term for the restriction of the outflow during
by selecting BPH patient with significant post-voiding
voiding is bladder outlet obstruction (BOO), which is
residual urine who could benefit from surgery and could
characterised by decreased urine flow rate and increased
void normally after TURP.
detrusor pressure (2). The two most common causes of

voiding UTS in males are detrusor underactivity (DU)
PATIENTS AND METHODS
and benign prostatic obstruction (BPO). Both diseases
Our single-arm clinical trial, involved 24 male patients
frequently result in a weak urinary stream, excessive
with BPH over 50 years old and significant postvoiding
postvoid residual (PVR) urine, or AUR. According to
residual urine who underwent TURP in Urology
urodynamic studies (UDS), "A contraction of
Department, Zagazig University Hospitals.
diminished power and/or duration, leading in prolonged
Inclusion criteria: Male patient with severe LUTS
bladder emptying and/or failure to attain complete
(IPSS score >20) and significant PVR 300 cc, patients
bladder emptying within a suitable time range" is how
with prostatic specific antigen (PSA) 4 ng/dl, age
the International Continence Society defines DU (3).
between 50-70 years old and decreased Q max < 10
The symptoms of DU and BPO differ, and the two
ml/sec.
disorders interact. Above all, BOO is regarded as one of
the primary causes of DU. They may follow the same
Exclusion criteria: Patient with neurological disorder,
treatment criteria in addition to having the same
patients with documented prostate cancer and patients
symptoms. Improved voiding and reduced risk of urinary
unfit for surgery.
tract infection or upper urinary tract degeneration are the
Preoperative evaluation:
main targets of treatment (4).
All participants in the study underwent the
As there is yet no adequate therapy to make the
following procedures: Medical History including age,
bladder more contractile, several therapies for DU and
main compliant, medical and surgical history, IPSS
urine retention efforts have been concentrated on
(International Prostate Symptom Score) and duration of
lowering resistance at the bladder outflow while
urethral catheter fixation.
awaiting spontaneous bladder recovery (5).
2131
Received:18/08/2022
Accepted:21/10/2022

Full Paper (vol.902 paper# 21)


c:\work\Jor\vol902_22 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2137-2144
Role of Ultrasound Elastography and Diffusion Weighted Magnetic
Resonance Imaging in Evaluation of Soft Tissue Masses
Ahmed Okasha Mohamed1, Mahmoud A. Hifny2, Saeda Mohamed Abdelwahab1 and Mera Asaad Adeeb1*
1Radio-diagnosis, 2Plastic Surgery, Faculty of Medicine, South Valley University, Qena, Egypt
*Corresponding author: Mera Asaad Adeeb,E mail: mera.assad22@gmail.com,mobile:00201284182280

ABSTRACT
Background:
Ultrasound is the main evaluation modality for superficial soft tissue masses to evaluate their size, position,
and relationship between the masses and the surrounding structures.
Objectives:
This study's major goals were to reliably predict if a soft tissue mass was benign or malignant, to describe the
mass's nature utilizing MR DWI and ultrasound elastography, and to minimize needless biopsies.
Patients and methods
: South Valley University's Qena University Hospital served as the site of this cross-sectional
investigation. This research comprised 30 patients who were eligible for MRI testing and ultrasound elastography between
January 2021 and January 2022 and who had identified superficial soft tissue masses or clinical suspicion of having them.
Results
: The majority of findings on MRI were non-enhancing masses (40%). As regard DWI findings among the studied
patient, 56.7% of them were non-restricted diffusion and 43.3% were restricted diffusion. 17 benign and 13 malignant
lesions recognized by DWI were correctly identified with histopathology. The DWI sensitivity was 94.4%, specificity was
100%, with accuracy of 96.7% for evaluating soft tissue masses. Strain ratio yield sensitivity of 87.1% and specificity of
89.7% with cut off level of 2.5 and AUC 0.813.
Conclusion
: In terms of identifying soft tissue masses, DWI has greater sensitivity, specificity, and accuracy than US
elastography.
Keywords: Non-enhancing mass, Soft tissue mass, Ultrasound elastography.


INTRODUCTION
malignant and benign soft tissue masses. USE then
Differentiating between benign and malignant
acquired reaction information arising from the
tumors is crucial to avoiding delays in the treating of
pressure and calculated the tissue stiffness. Because
the latter and avoiding the needless surgical removal
malignant tumors are often more difficult to
of the former (1).
distinguish from benign tumors, USE may be utilized
Pathological diagnosis is often made using a
to do so (9).
needle biopsy, which is the most reliable technique.
In addition, making the proper therapy decisions
However, since it involves intrusive procedures,
and planning requires differentiating between benign
patients may find it upsetting, and it is not practicable
and malignant soft tissue cancers. Due to its superior
for all soft tissue tumors (2). The main form of
ability to differentiate between soft and hard tissues,
assessment for superficial soft tissue masses is
MRI is superior in the assessment of these
ultrasound, which can determine their size, location,
malignancies (10). The approach known as diffusion
and connection with neighboring structures.
weighted imaging (DWI), which takes into account the
Ultrasound may offer a preliminary diagnosis by
structure of the tissue, the stability of the cell
inspections of the edges of the tissue masses, internal
membranes, and the tortuosity of the extracellular
echo features, and internal color flow (3).
space, permits assessment of the brownian motion of
With the use of ultrasonic strain elastography
water in the tissue micro-environment (11). Depending
(USE), the stiffness of the tissue structures may be
on the motion of the water protons inside the tissue,
determined (4). It is a useful tool for distinguishing
DWI may provide a variety of contrasts between health
between cancerous and benign tumors (5).
and sickness (12). In this study ultrasound elastography
A malignant tumor often has more stiffness than
in combination with diffusion weighted image results
a benign tumor. The differential diagnosis used to be
were compared to histopathology.
mostly relied on the doctors' indirect palpations, which
The objective was to describe a soft tissue mass'
might be restricted in cases of obese people, mass sizes
kind using ultrasonic elastography and MRI DWI,
and depths, and doctors' abilities (6).
properly determine if it was benign or malignant, and
Since its first use at the turn of the 20th century,
minimize needless biopsies.
USE has gained widespread acceptance as a useful

technique for differentiating between malignant and
PATIENTS AND METHODS
benign tumors (7). Furthermore, USE has only
At South Valley University at Egypt's Qena University
sometimes been used to study the distinction between
Hospital, this cross-sectional research was conducted.
benign and malignant soft tissue tumors (8).
30 patients were included in the sample between
By exerting pressure to the inspection regions, the
January 2021 and January 2022.
present research intended to evaluate the value of
Inclusion criteria: Patients who were suitable for an
strain elastography (SE) for differentiating between
MRI scan and an ultrasound elastography and who
2137
Received: 17/04/2022
Accepted: 14/06/2022

Full Paper (vol.902 paper# 22)


c:\work\Jor\vol902_23 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2145-2148

Pharyngoplasty and Other Options for Treatment of
Obstructive Sleep Apnea: Review Article
Salimah Mousay Alabd*1, Tarek Abdel Zaher Emara1, Nahla Hassan Gad2, Mohamed Mohamed Rabea1
Departments of 1 Otorhinolaryngology and
2Audio-Vestibular Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Salimah Mousay Alabd, Mobile: (+20) 01092370798, E-Mail: somamusa654@gmail.com

ABSTRACT
Background:
Obstructive sleep apnea (OSA) is a persistent respiratory problem that affects an increasing number of
people. The pharyngeal airway becomes obstructed and narrowed at regular intervals during sleep in people with OSA.
Heart disease, metabolic diseases, cognitive impairment, and depression are only some of the long-term effects of untreated
OSA. Optimal nasal continuous airway pressure usage and restoration of normal breathing are the goals of nasal
reconstructive surgery for patients with nasal airway obstruction due to bony or cartilaginous growths or hypertrophied
tissues.
Objective: Review of the literature on Pharyngoplasty and other options for Treatment of obstructive sleep apnea.
Methods:
We searched PubMed, Google Scholar, and Science Direct for information on Pharyngoplasty, and Treatment
of obstructive sleep apnea. However, only the most current or comprehensive study from March 2004 to January 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.
Conclusion: The idea of Anterolateral Advancement Pharyngoplasty to avoid transecting the palatopharyngeal muscle
(PPM)' lower end and severing any of the muscle fibers in the superior pharyngeal constrictor (SPC), a pharyngoplasty
is performed to partially segregate the PPM's anterior and posterior sections. Tension on the lateral pharyngeal wall
(LPW) was achieved by first hooking the posterior PPM to the lingual velum psoas muscle, and the remaining PPM and
SPC are advanced superolaterally and sutured to the pterygomandibular raphes in a figure-of-eight method.
Keywords: Pharyngoplasty, Treatment, Obstructive sleep apnea.

INTRODUCTION
exhaling due to the persistent positive pressure. Dry
Reduced or missing airflow during sleep is a
mouth, nose, and sinuses are common complaints of
hallmark of obstructive sleep apnea (OSA), a
CPAP users because the therapy dehydrates the mucosal
respiratory disease. Sleep apnea occurs when the
membranes (3).
muscles in the upper airway become too relaxed and
Mandibular advancement splints (MAS):
collapse, causing brief pauses in breathing (hypopneas)
The mandible is held in a forward posture by an oral
or full cessation of breathing (apneas) that last at least
appliance while the patient sleeps. As a result, these
10 seconds. The average length of a pause is between
devices have the potential to effectively treat OSA in
10 and 30 seconds, while some can extend for up to a
mild to severe cases. About 40% of patients reported a
minute. Due to this, blood oxygen levels drop
complete remission of OSA (AHI lowered 5/hr) when
dangerously low, sometimes by as much as 40 percent
using a MAS. About two-thirds of patients saw clinical
in extreme situations (1).
improvement (a 50% reduction in AHI or more),
The disorder is characterized by extreme sleepiness
whereas others may show improvement in symptoms
during the day, which has been related to negative
but fail to objectively respond to this treatment. Patients
health outcomes such as a decreased quality of life,
with mild to moderate OSA, and even those with severe
reduced cognitive function, and an increased chance of
OSA who refuse or cannot utilize CPAP, are
getting in a car accident. In order to properly diagnose
administered MAS nowadays (3).
OSAs, a thorough clinical evaluation is required. Yet,
Positional therapy:
most data indicate that clinical symptoms alone have
This is because the pharyngeal dimension alterations
limited usefulness in the prediction of the illness (2).
and the abdominal compression that occurs when a
Treatment with continuous positive airway pressure
person is lying in a supine position make it more likely
(CPAP), in which air is pumped into a mask to keep the
that the airway would collapse. Thus, techniques to
airway open, is considered the standard of care for
promote lateral sleep have been tried, with mixed
obstructive sleep apnea. Only CPAP, if tolerated, can
success. Patients with OSA often become accustomed
effectively eradicate apneas in all patients. It also has
to and switch to supine sleeping positions as a result of
been found to alleviate metabolic and cardiovascular
positional therapy because of the discomfort, frequent
effects of OSA and may increase survival.
awakenings, and perceived lack of effectiveness of
Unfortunately, CPAP is not always well tolerated by
lateral sleeping positions (3).
patients. Patients frequently report difficulty passively
2145
Received: 08/08/2022
Accepted: 10/10/2022

Full Paper (vol.902 paper# 23)


c:\work\Jor\vol902_24 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2149-2153

High Sensitivity Cardiac Troponin T in Patients with Type 2 Diabetes Mellitus,
Relation to Cardiac Metabolic Risk Factors: Hypertension and Truncal Obesity
Ahmed S. Abo Asy*1, Mohamed Elsaid Ahmed2, Samir Mohamed Attia3, Mahmoud Youssef4
Department of 1Emergency Medicine, Mansoura University Hospitals, and Departments of 2Surgery, Critical Care
Medicine, 3Vascular Surgery and 4Cardiology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed S. Abo Asy, Mobile: (+20) 01007999204, E-mail: dr.ahmedaboasy@gmail.com

ABSTRACT
Background: Diabetes mellitus type 2 (T2DM) is a prevalent metabolic disease that predisposes to diabetic
cardiomyopathy and cardiovascular diseases (CVD). High sensitivity cardiac troponin T (hs-cTnT) can determine who
is most at risk for developing cardiovascular issues and diabetes.
Objective: To evaluate the relation between high-sensitive cardiac troponin T and cardiac metabolic risks (hypertension
and truncal obesity) in patient with T2DM.
Patients and Methods: A prospective cohort study included 50 diabetic patients reached at the emergency units of
Mansoura University Hospital and Al-Azhar University Hospital in Egypt, for one year-duration from May 2021 to May
2022. All of the patients had been subjected to physical examination, medical and family diabetes history. Laboratory
tests, included hs-cTnT, and truncal obesity measurement also were reported.
Results: The biomarker hs-cTnT was found in 32 (64%) of the patients. A strong significant correlation was detected
between hs-cTnT and systolic blood pressure (SBP), diastolic blood pressure (DBP), hypertension, and truncal fat by
dual-emission X-ray absorptiometry (DXA); with p-value (0.007, 0.006, 0.006, 0.001) respectively. Besides, no
significant correlation was detected between hs-cTnT and the duration of diabetes, RBG, HBA1c, and BMI.
Furthermore, the mean truncal fat of study population that detected by DXA scan was ranged from 8 Kg to 24 Kg with
mean + SD = 14.5 + 4.51 Kg. Conclusion: The biomarker hs-cTnT and truncal fat might be associated with cardiac
metabolic risks in patient with T2DM.
Keywords: hs-cTnT, Truncal fat, Troponin T, T2DM, CVD.

INTRODUCTION

(AF), in the general population, vascular risk factors
Type 2 diabetes mellitus (T2DM) is spreading more
and structural heart disease (9-11).
widely around the world, and it is strongly linked to
Measuring hs-cTnT may reveal an underlying
atherosclerotic cardiovascular disease (CVD) (1). A
pathophysiologic overlap between CVD and diabetes
greater resting heart rate has recently been linked to an
that other common risk variables could miss.
increased risk of mortality and cardiovascular issues in
Participants with higher baseline hs-cTnT levels had a
those with type 2 diabetes (2). According to international
higher incidence of diabetes (12-13).
diabetes federation (IDF), almost 537 million people
In this study we aimed to evaluate the relation between
ranged from (20-79 years) worldwide were living with
high-sensitive cardiac troponin T and cardiac metabolic
diabetes in 2022 (3).
risks (hypertension and truncal obesity) in patient with
Furthermore, a higher risk of CVD was also
T2DM.
associated with the duration of diabetes, hypertension,

smoking, being underweight, overweight, or obese, and
PATIENTS AND METHODS
hypoglycemia (4). Therefore, recent research suggests
The study involved 50 patients with T2DM who
that in addition to glucose management, broad,
were receiving antidiabetic treatment and arrived at the
adaptable intervention strategies, such as lifestyle
Emergency Departments of both Mansoura and Al-
modifications, hypertension control, and cholesterol
Azhar University Hospitals over a twelve months period
lowering, are required for reducing morbidity and
(May 2021-May 2021).
mortality associated with macrovascular disease (5).
The inclusion criteria of our study included
A frequent biomarker for myocardial infarction is
patients with T2DM who were receiving antidiabetic
cardiac troponin T (cTnT) (6). Because cTnI is only
treatment and presenting with acute coronary syndrome
found in cardiac muscles, serum cTnI is employed as a
from both sexes. On the other hand, the exclusion
specific cardiac damage diagnostic for acute myocardial
criteria specified patients with chronic kidney, type 1
infarction (AMI) (7). However, it is raised not only in
diabetes mellitus, cardiovascular system diseases
acute pathogenic situations, but also in chronic
history, and patients who were refusing enrollments in
pathogenic conditions. Increasing cTnI levels have
the study. All participants in the current study had a
recently been spotted in patients with cardiomyopathy
medical and family history of diabetes taking, physical
or chronic HF in the general population (8).
examination, including general conditions (appearance,
Furthermore, several studies have demonstrated a
consciousness and decubitus), vital signs, regional
correlation between high-sensitivity cardiac troponin T
examination, radiological tests, and laboratory
(hs-cTnT) levels and the prevalence of atrial fibrillation
investigation such as determination of hs-cTnT and
measurement of truncal obesity.
2149
Received: 14/09/2022
Accepted: 17/11/2022

Full Paper (vol.902 paper# 24)


c:\work\Jor\vol902_25 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2154-2160

Association between COX-2 Gene Polymorphism and Susceptibility to
Colon and Rectal Cancer
Ahmed Ahmed El-Shaarawy1, Tary Salman1, Amira Hegazy2, Merhan Osama1, Karema Diab1
1Department of Lab medicine, National Liver Institute, Menoufia University, Egypt
2Department of Hepatology and Gastroentrology, National Liver Institute, Menoufia University, Egypt
3Department of Oncology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Merhan Osama, Mobile: (+20) 01068948654, E-mail: osamamerhan1990@yahoo.com

ABSTRACT

Background: Intestinal cancer the third most prevalent malignancy and leading cause of cancer mortality worldwide,
is colorectal cancer (CRC). More than one-third of colorectal cancer cases in Egypt include people under the age of 40
who are found to have the disease at an advanced stage. Due to its function in human tumours, cyclooxygenase
(COX), a crucial enzyme in the prostanoid biosynthesis pathway, has drawn a lot of interest. COX-2 regulates cell
proliferation, cell transformation, tumour growth, metastasis, and invasion, and so plays an important role in the origin
and development of metaplastic and dysplastic tissues, as well as the beginning and progression of cancer. Increased
COX-2 expression has been linked to a variety of epithelial-based premalignant and malignant lesions in the
gastrointestinal system, including the colorectal area.
Objectives: To investigate the probable link between COX-2 gene polymorphism and colorectal cancer risk.
Methods: This is a case-control study with 100 participants. Were selected 50 with colorectal cancer (case group)
from Inpatient and Outpatient Oncology Clinic, Faculty of Medicine, Menoufia University and 50 participants without
colorectal neoplasia (control group) matched in age and gender with case group. With the use of the usual literature
approach, the polymorphism -765G/C COX2 gene was being identified using molecular genetic analysis. Clinical and
pathological data from the patient were also examined. The findings demonstrated a link between the existence of the
COX2 gene polymorphism and susceptibility to colorectal cancer in this pattern, with a significant incidence of GC
and CC genotype in those with colorectal cancer. Additionally, there were variations in allele frequencies between the
groups. There was a greater incidence of polymorphism in the left colon when cancer patients were divided based on
the location of their tumours.
Results: The comparison between the two studied groups indicated the genotype distribution of COX 2 gene
polymorphisms in CRC patients that was 42%, 50%, and 8% with GG, GC, and CC respectively whereas in control
group, it was 76% with GG, 22% with GC, and 2% with CC .The genotypic distribution revealed statistical difference
(p=0.003). The allelic frequencies were 67% who had the wild allele G and the remaining 33% had the variant allele C
in CRC group while in control group there were 87% with G and 13% with C allele. The difference was statistically
significant (p=0.001). The GC genotype revealed a significant risk of CRC as compared to GG genotype. Subjects
carrying the C allele had a significant risk of CRC compared to those carrying the allele G
Conclusion: The COX2 gene polymorphism is linked to an increased risk of colorectal cancer, particularly
rectosigmoid tumours.
Keywords: Gene polymorphism, Colorectal cancer, Cyclooxygenase enzyme, Restriction fragment length
polymorphism.

INTRODUCTION
decreased in nations that have embraced preventative
A kind of gastrointestinal cancer that can start
initiatives. Therefore, early detection by screening is
in the colon or the rectum is called colorectal cancer
essential for lowering patient death from CRC, and
(CRC). The majority of instances of colorectal cancer
awareness initiatives also encourage screening (5).
(up to 95%) are adenocarcinomas (1). CRC is the third
A crucial enzyme in the biosynthesis of
most prevalent malignant illness in the globe, only
proteinoid molecules is cyclooxygenase (COX). The
lung and breast cancers occurring more frequently. In
development of metaplastic and dysplastic tissues, the
addition, it is the second most prevalent disease in
onset and course of cancer, and the regulation of cell
women after breast cancer and the third most frequent
division, cell transformation, tumour growth, tumour
cancer in men after lung and prostate cancer (2).
metastasis, and invasion are all impacted by COX-2 (6).
Unfortunately, CRC may be unnoticed for a
In several parts of the gastrointestinal system,
very long time in a lot of people, at least until it
epithelial-based premalignant and malignant lesions
significantly develops and spreads, which negatively
have been linked to increased COX-2 expression (7). It
affects the prognosis (3). CRC risk rises with age and is
is hypothesised that COX-2 polymorphisms may
more prevalent in those over the age of 50. More than
change the enzyme's activity by regulating COX-2
one-third of CRC cases in Egypt involve people under
production differently (8). Differential COX-2
the age of 40, and they are typically discovered at an
expression
may
affect
the
likelihood
that
advanced stage (4). The incidence of CRC has
gastrointestinal adenocarcinomas, such as CRC, may
2154
Received: 29/08/2022
Accepted: 02/11/2022

Full Paper (vol.902 paper# 25)


c:\work\Jor\vol902_26 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2161-2169

Ischemia-Modified Albumin in Cord Blood of Preterm Infants:
A Novel Indicator for Intrauterine Growth Restriction-
A Prospective Case Control Study.
Nehal Elraggal1, Amani Abdelghani 2, Maii Nawara3, Mary Erian4, Basma Mohamed Shehata 1
Department of Pediatrics1, Clinical Pathology2 and Obstetrics and Gynecology; Faculty of Medicine,
Ain Shams University. Ministry of Health Hospitals, 4 Cairo, Egypt
Corresponding author:Basma Mohamed Shehata, ORCID account: 0000-0002-3171-4589,Email:
basma_mshehata@med.asu.edu.eg , Phone number: 002-01222636278

ABSTRACT
Background:
Ischemia modified albumin (IMA) rises promptly after an ischemic event and stays elevated for several
hours. However, a knowledge gap still exists in terms of the association between intrauterine growth restriction (IUGR)
and IMA levels.
Objective: The purpose of this study is to ascertain any potential relationships between cord blood IMA levels and
IUGR in preterm newborns with or without complex gestations,
Methods: A prospective case-control study included 80 mothers of preterm neonates (<37 gestational weeks). Based
on antenatal ultrasound findings, eligible women were divided into two groups: case group including the women
diagnosed antenatally with IUGR, and control group including women with normal fetal development. The analysis and
quantification of the IMA levels was done using a double-antibody sandwich ELISA kit
Results: The albumin level was significantly lower in the case group compared to the control group (3.18 ± 0.28 versus
3.88 ± 0.49; p <0.001), while the IMA level was significantly higher in the case group compared to the other group (145
(97.5 - 210) versus 40 (25- 90); p <0.001). At a cut-off point of 3.4, the albumin had an AUC of 0.993, a sensitivity
of 95%, and a specificity of 87.5% for differentiating IUGR. While the cut-off point of IMA of >50 had an AUC of
0.850, a sensitivity of 92.5%, and a specificity of 67.5% for prediction of IUGR.
Conclusion: The levels of IMA and albumin in the cord blood have a strong correlation with the IUGR.
Keywords: Intrauterine growth restriction; Ischemia modified albumin; Albumin; Ultrasound.

INTRODUCTION

Uncertain oxidative damage at the molecular level is
Intrauterine growth restriction (IUGR) , one of the
what causes ischemic modified albumin (IMA), but
leading causes of perinatal morbidity and mortality, was
reperfusion after an ischemia event may harm serum
defined by the American College of Obstetricians and
albumin (9). In the absence of aggravating clinical
Gynecologists as a foetal weight estimate (EFW) that is
factors like myocardial necrosis, IMA has shown a good
below the 10th percentile (1). The prevalence of IUGR is
predictive value as a relatively novel biomarker in
estimated to be 7­15% of pregnancies worldwide (2).
identifying myocardial ischemia (10). IMA was reported
IUGR has a variety of causes, which can be classified
to have a high sensitivity (>80%) compared to troponin
based on whether the cause is maternal or fetal (3).
and ECG; therefore, it played a key role in detecting
Preeclampsia (PE) is the most common maternal cause
myocardial ischemia in patients associated with
since it causes a generalized oxidative and
retrosternal discomfort. A literature suggested that
hypoxic environment that
contributes
to
the
following an ischemic episode, IMA rised immediately
occurrence of IUGR (4). Reduced umbilical artery blood
and remains increased for several hours (11). However, a
flow, which appears as changes in pulsatility and
knowledge gap still exists in terms of the association
resistance index on Doppler ultrasonography, is the first
between IUGR and IMA levels. Therefore, in preterm
symptom of IUGR (5).
newborns with or without complex gestations, the
Hypertension, smoking, anemia, and placental
purpose of this study was to ascertain any potential
insufficiency are all linked to IUGR because they
relationships between cord blood IMA levels and
generate an ischemic microenvironment and increase
IUGR.
oxidative stress (6). In IUGR fetuses, the risk of perinatal

death was ten times higher than in normal pregnancies
PATIENTS AND METHODS
(7). When examining these fetuses, follow-up and
Written consent was taken from the women after
management are critical. Doppler examination is the
describing the research and its aim. Every woman had
key technique for fetuses' follow-up after diagnosis. The
the option to leave the study at any moment, without
amniotic fluid level, scalp pH, fetal well-being
having to give a reason.
monitoring, base excess, and Apgar score were among

the biochemical and clinical indicators used to indicate
Study Design:
perinatal asphyxia (8).
We conducted a prospective case-control study that
However, no one sign has high predictive
recruited mothers of preterm neonates (<37 gestational
effectiveness in detecting fetal hypoxia or ischemia.
weeks). All women were recruited from the Maternity
Hospital, Ain Shams University hospital, through the
2161
Received: 18/09/2022
Accepted: 20/11/2022

Full Paper (vol.902 paper# 26)


c:\work\Jor\vol902_27 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2170-2177
A New Predictor for Growth Restriction in Preeclampsia. A Case Control Study
Tayseer M.M. Gad1, Mohamed N. El-Barbary1, Rania I. Ismail1,
Dina A. El-Sayed1, Noha Bassiouny2, Basma M. Shehata1
Department of Pediatrics1 and Clinical Pathology2, Faculty of Medicine, Ain Shams University.
Corresponding author:Basma Mohamed Shehata,ORCID account: 0000-0002-3171-4589,
E-mail: basma_mshehata@med.asu.edu.eg , Phone number: 002-01222636278

ABSTRACT
Background:
Preeclampsia(PE) is culpable of the placental hypoxia that persists during pregnancy. The number of
nucleated red blood cells in the cord blood (cNRBCs) is a sign of a hypoxic fetal environment. It might be a potential
indication of intra-uterine growth restriction (IUGR).
Objective: The goal is to ascertain whether pre-eclampsia is related to an increase in the number of cNRBCs in cord blood,
especially those with restricted growth.
Methods: This case control study was conducted on 150 neonates who were divided into three equal groups; group I
included newborns of PE women, without IUGR, group II included newborns of PE women, with IUGR and group III
included apparently healthy newborns of healthy non-PE pregnant women as a control group. As soon as the cord was
clamped, samples for complete blood count and blood gases were taken from the umbilical vein.
Results: cNRBCs count was significantly higher in group with PE and IUGR compared to PE without IUGR and the
control groups. The cutoff value of cNRBC to discriminate newborns of healthy mothers and those with PE was 8
cNRBCs/100 WBCs. Yet the value to discriminate newborns of PE mothers with IUGR and without IUGR was 22
NRBCs/100 WBCs.
Conclusion: When PE was compared to controls, it was discovered that cNRBCs were considerably greater. Moreover,
higher cNRBCs was found in PE with IUGR compared to PE without IUGR. Thus, cNRBCs count has predictive value for
IUGR. It may be used to tell growth-restricted babies from small-for-their-age children.
Keywords: preeclampsia, umbilical cord, nucleated red blood cell count, intrauterine growth restriction.

INTRODUCTION
neonatal circulation. Erythropoietin is primarily
Pre-eclampsia (PE), a condition that impacts 5-8%
responsible for their creation (8).
of pregnancies, significantly increases mother and infant
Increased erythropoietic activity or a rapid release
morbidity and mortality worldwide (1).
from the marrow storage pools were two of the many
Abnormal shallow trophoblast invasion of the
acute and chronic factors that caused an increase in the
mother's uterine spiral arteries has been linked to the
amount of circulating NRBCs. It seems to be one of the
development of PE (2). Due to the decreased blood
most dependable indicators of a hypoxic perinatal
supply to the utero-placental bed as a result, placental
environment (9).
hypoxia persists throughout pregnancy (3).

A large number of anti-angiogenic chemicals are
PATIENTS AND METHODS
secreted by the placenta in response to this hypoxic
Study design:
situation, which results in significant endothelial
Our case control study was carried out in a period of
dysfunction and the pre-eclampsia clinical symptoms (4).
10 months in the Obstetrics and Gynaecology Hospital,
Pre-eclampsia (PE) is a condition that only occurs
Ain Shams University.
during pregnancy and is characterized by proteinuria and
The studied participants were split into three groups;
hypertension. It commonly appears after 20 weeks of
group I included 50 newborns of pre-eclamptic women,
pregnancy (5).
without IUGR, group II included 50 newborns of pre-
When a newborn weighs less than the 10th
eclamptic women, with IUGR and group III included 50
percentile for gestational age, it is diagnosed as IUGR
apparently healthy newborns of healthy normotensive
(intra uterine growth restriction) (6). Particularly in those
pregnant women as control.
who are born very preterm, newborns with IUGR are
After 20 weeks of gestation, pre-eclampsia was
more likely to experience higher morbidity and
clinically defined as the de novo start of hypertension
mortality, particularly if they were preterms. Numerous
(systolic blood pressure 140 mmHg or diastolic blood
long-term impacts have been identified by studies,
pressure 90 mmHg) and proteinuria (300 mg/24 h) (5).
ranging from normal to minor IQ reductions to a
Neonates born to women with autoimmune
noticeably increased risk of cerebral palsy (7).
disorders,
diabetes,
chronic
hypertension,
Nucleated red blood cells (NRBCs), are present in
cardiovascular, renal, or hepatic diseases were excluded.
fetal bone marrow, and they can be released in the
Additionally, those neonates with RH iso-immunization,
2170
Received: 18/09/2022
Accepted: 20/11/2022

Full Paper (vol.902 paper# 27)


c:\work\Jor\vol902_28 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2178-2186

Formulation and Evaluation of Prednisolone -Loaded Alginate
Beads for Taste Masking
*Hiba M. Suza Ali, Eman B. H. Al-Khedairy
Department of Pharmaceutics, College of Pharmacy, University of Baghdad, Baghdad, Iraq.
*Corresponding Author Hiba M. Suza Ali, Email: hibam3449@gmail.com

ABSTRACT
Background:
prednisolone (PRD) is a very bitter, corticosteroid drug, acts as immunosuppressant and anti-inflammatory
used for treatment of many diseases like asthma and arthritis.
Objective: This study aimed to formulate and evaluate taste masked PRD-alginate beads to increase patient compliance.
Method: PRD taste masked beads were prepared by external ionic gelation technique using sodium alginate (S. Alg) as
polymer and 1% calcium chloride as cross linker. The beads were evaluated for their physical properties including general
appearance, percentage yield, drug loading, drug content and in vitro taste masking. The effect of S. Alg concentration,
addition of tween, addition of hydrophilic polymers (Carbopol 940, PEG 4000, HPMC E5 and PVA) on the physical
properties of beads was studied
Result: This method was successful in decreasing the release of PRD from beads in phosphate buffer pH 6.8 within 60
seconds. The optimum formula (F6) was obtained by using S. Alg (0.5% W/W) in combination with carbopol 940 in a ratio
of 1:1:1 ratio (PRD: S. Alg: Carbopol 940) with percentage yield 88%, drug loading 77%, drug content 98.3 ± 2.1 and
0.77 % ± 0.19 release of PRD in phosphate buffer pH 6.8 within 60 seconds, supposing good taste masking.
Conclusion: It can be concluded that oral preparation of PRD with an acceptable taste is possible by using external ionic
gelation technique.
Keywords: Prednisolone, Taste masking, External ionic gelation, Sodium alginate, Calcium chloride and Carbopol 940.

INTRODUCTION
cross-linked with 1% CaCl2 to form calcium-alginate
Pediatric, geriatric and other patients who are suffering
beads loaded with PRD by using external ionic gelation
from difficulty in the swallowing, need a specific oral
method to mask the bitter taste of PRD and improve
dosage form like chewable tablets, fast dissolve oral
patient compliance.
tablet/ film or liquid dosage form. Since some drugs have

undesirable taste, taste masking becomes an important
MATERIAL AND METHOD
way to improve patient compliance. Different techniques
Prednisolone powder (gift from Samarra Drug
are available for taste masking like addition of sweetener
Industry), sodium alginate (viscosity 5- 40 cps, sigma-
and/or flavoring agents, coating with polymer,
Aldrich), un-hydrous calcium chloride (Gainland
complexation with resin or cyclodextrin adsorption,
chemical Co. UK), carbopol 940 (Gainland chemical Co.
chemical reaction like pro-drug and ionic gelation (1).
UK), HPMC E5 (sigma- Aldrich), PEG 4000 (china),
Prednisolone (PRD) is a glucocorticoid acts as
PVA (china).
immunosuppressant and anti- inflammatory drug which

has been widely used for the treatment of allergic
Preparation of PRD- Alginate beads
reactions like asthma and articria, peritumoral edema (2,
By using external ionic gelation method; sodium
3). It has a bitter taste which decreased the patient's
alginate (0.5 or 1 % w/w) and PRD dispersion was
compliance especially children (4).
prepared in distilled water with different ratios as shown
Ionic gelation is a chemical reaction that used to
in table (1), with continuous stirring (500 rpm) for about
encapsulate the active ingredient by formation of
1 hour at 40 oC with or without tween 80 or polymers.
insoluble gel. This method is used for masking of
Later the prepared dispersion was added drop wise to 100
undesirable taste. In this method; alginate salts such as
ml of 1% CaCl2 solution using a needle (23-G). The
sodium alginate reacts with bivalent metal ion like
calcium-alginate beads were then separated, rinsed with
calcium or barium chloride and form beads (insoluble
distilled water, and kept for 24 h in oven for drying at 40
gel) which contain the bitter active ingredient. Taste
oC, after that they were stored in a sealed container (7, 8) .
masking is obtained by decreasing the drug release in the
Physical mixture (PM) for optimum formula was
mouth cavity (5, 6) . Thus this study, aimed to mask the
prepared by mixing 1:1:1 (PRD: S. Alg: polymer) ratio by
bitter taste of PRD by using sodium alginate as polymer
mortar and pestle for 15 minutes for FTIR test.



2178
Received: 15/09/2022
Accepted: 22/11/2022

Full Paper (vol.902 paper# 28)


c:\work\Jor\vol902_29 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2187-2194

Frequency of ABCB1 C3435T Polymorphism in Rheumatoid Arthritis Patients;
Relation to Methotrexate Responsiveness and Methotrexate Adverse Effects
Dina Ragab*1, Sara Eissa1, Rania Ahmed1, Abeer Ali1, Samah Abd Alrahman2, Shahira Al-Fedawy1
Departments 1Clinical Pathology and 2Internal Medicine and Rheumatology, Faculty of Medicine, Ain Shams
University, Egypt
*Corresponding author: Dina Ragab, Mobile: (+20) 01005414292, E-Mail: dinaragab@med.asu.edu.eg

ABSTRACT
Background:
Rheumatoid arthritis (RA) is an inflammatory disease requiring treatment by disease-modifying agents
like methotrexate. C3435T is a single nucleotide polymorphism in the ABCB1 gene that affects the expression of the P-
glycoprotein responsible for the efflux of several drugs from cells increasing both its action and toxicity.
Objective:
Examine the frequency of C3435T in RA patients and assess its influence on responsiveness to methotrexate
treatment and occurrence of methotrexate adverse effects.
Patients and Methods:
Genotyping C3435T polymorphism was done by real-time polymerase chain reaction and the
frequency of the polymorphism was assessed in a sample of 90 RA patients who have received methotrexate treatment
and 90 healthy controls. The prevalence of the polymorphism was also assessed in responders to methotrexate compared
to non-responders, and also in patients who suffered from methotrexate side effects compared to those who did not.
Results: The CC was the most frequent genotype in patients (47.8%) while the CT was the most frequent in controls
(43.3%), however, no association was found between the ABCB1 C3435T genotype and susceptibility to RA under the
different genetic models (p>0.05). Even though the patients who responded to methotrexate had a higher frequency of
the T allele (38.9%) compared to non-responders (27.8%), the genotype and allele frequency were not associated with
response to methotrexate (p>0.05). Also, no association was observed between the frequency of the C3435T
polymorphism and experiencing methotrexate-associated adverse effects (p>0.05).
Conclusion: The C3435T polymorphism of the ABCB1 gene may not be a genetic risk factor for RA and does not affect
responsiveness to methotrexate or affect the occurrence of adverse effects from the drug.
Keywords: Rheumatoid arthritis, Methotrexate, ABCB1, C3435T.

INTRODUCTION

cellular accumulation hindering its pharmacological
Rheumatoid arthritis (RA) is an activity-
action [4, 5].
hindering disease that affects females more than males.
Methotrexate enters the cell mainly via the solute
The hallmark of the disease is the inflammation of joints
carrier transporter and exits the cell via several channels
that leads to local destruction of both the cartilage and
among which are the ATP binding cassette (ABC)
bone in the affected joints [1]. In 2021, the worldwide
transporters [6].
prevalence of RA was around 0.46% [2].
ABC transporter family includes seven subfamilies;
Treatment of RA involves medications in
A ­ G. The ATP binding cassette subfamily B member
addition to patient education, and physiotherapy.
1 (ABCB1) gene [also called multidrug resistance
Medical treatment of RA generally involves non-
protein 1 (MDR1 gene)] is found on chromosome
steroidal anti-inflammatory drugs, glucocorticoids and
7q21.12 and contains 29 exons. The gene encodes the
disease-modifying antirheumatic drugs (DMARDs). transporter P-glycoprotein which transports various
The latter are immunomodulatory therapeutic agents
compounds to the outside of cells including several
that aim to target the immune-inflammatory process
drugs. The gene is highly polymorphic with over 50
occurring in the joints. There exists 3 types of
reported polymorphisms. The C3435T single nucleotide
DMARDs: 1- conventional e.g. methotrexate,
polymorphism in exon 26 is a synonymous
hydroxychloroquine, leflunomide, sulfasalazine and
polymorphism that results in exchange of the cytosine
gold compounds; 2- biologic e.g. CTLA4-Ig, TNF
nucleotide by thymine.
antagonists, IL-1 receptor antagonist, anti-human IL-6
The mutation causes no alteration in the amino
receptor antibody and anti-CD20 agents; and 3- targeted
acid constitution but has a significant effect on the P-
synthetic e.g. inhibitors of Janus kinase [3].
glycoprotein expression and function by altering mRNA
The most widely prescribed drug among
splicing and stability or affecting the efficiency of
DMARDs is methotrexate and it remains the gold
translation with an end result of decrease surface p-
standard for the treatment of RA. Current treatment
glycoprotein level and a decrease in its efflux function
guidelines for RA is that patients are empirically
[7].
initiated on treatment with methotrexate. Unfortunately,
The C3435T polymorphism has been linked to
around 30% of RA patients do not respond to treatment
susceptibility to several diseases including Parkinson's
with methotrexate. Genetic mutations have been
disease [8], inflammatory bowel disease [9], ischemic
implicated in resistance to methotrexate through the
heart disease [10], breast cancer [11], colorectal cancer [12],
effect on either methotrexate metabolism pathway or
and leukemia [13]. The CC genotype of C3435T was also
methotrexate transport carriers resulting in its decreased
reported to be linked to higher risk of
2187
Received: 26/08/2022
Accepted: 19/11/2022

Full Paper (vol.902 paper# 29)


c:\work\Jor\vol902_30 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2195-2198

RIPASA Score in Diagnosis of Acute Appendicitis: To What Extent Is It Accurate?
Haitham S. Afifi 1, Emad M Abdelrahman 1*, Mohamed F Abdelfattah 2, Attia M Elhady 3, Ahmed E Sakr 2
1 General Surgery Department, Faculty of Medicine, Benha University, Egypt
2 Department of General Surgery, Benha Teaching Hospital, Egypt
3 Senior Registrar of Emergency Medicine, King Abdulaziz Airbase Hospital, KSA.
Corresponding author: Emad M. Abdelrahman, Mobile: 01226763986,
ORCID: 0000-0001-6066-2215, Email: emad.sarhan@fmed.bu.edu.eg
ABSTRACT
Background:
The accuracy of different scores of acute appendicitis (AA) is extremely variable and sometimes
unsatisfactory in different ethnic communities. The validity of the RIPSA score among the Eastern Mediterranean
population is still questionable.
Objective: This study aims at evaluating The RIPASA diagnostic accuracy for AA among Egyptians.
Patients and methods:
The current prospective study included 123 patients suffering from AA attending the Emergency
Surgery Department. All items of the RIPASA score were fulfilled. The diagnostic cut-off score for AA by RIPASA was
7.5. Histopathological assessment for the appendix was done for all included patients and correlated to the RIPASA score.
Results: The mean age of the included patients was 31.85 (SD 8.7) years, and 76 (61.8%) of patients were <39.9 years old,
while 47 (38.2%) were >40 years old. RIPASA score sensitivity for AA was 96.4% while the specificity was 75%. The
positive predictive value was 97.27 %, while the negative predictive value was 69.23 %. The diagnostic accuracy was 94.3
%. Conclusion: RIPASA is a reliable and feasible score for AA with high sensitivity, positive predictive value, and
diagnostic accuracy.
Keywords:
Acute appendicitis, Accuracy, RIPASA score, Prospective study, Diagnostic score, Benha University.

INTRODUCTION

population [10]. The validity of the RIPASA score among
Acute appendicitis (AA) is a common abdominal
the Eastern Mediterranean population is still questionable
emergency requiring urgent intervention with a high
and this has motivated us to conduct this study to establish
incidence of negative appendectomy [1]. The diagnosis
the clinical prediction rules for predicting AA among
depends mainly on the clinical presentation with
Eastern Mediterranean ethnic communities and avoid
additional confirmation using radiological investigations
needless procedures and improve the patient outcome.
that are costly and may be not available in developing

countries [2]. However, a great spectrum of diseases
PATIENTS AND METHODS
present with symptoms matching the clinical presentation
Study design
of AA making the diagnosis of AA in some cases
A prospective study was conducted throughout the period
challenging [3]. Surgery carries a wide scale of
from May 2022 to December 2022, and included 123
morbidities. Negative appendectomy (NA), appendicular
patients suffering from AA attending the Emergency
abscess and perforation, wound infection and dehiscence,
Surgery Department at Benha University Hospital and
or even recurrent attacks of adhesive intestinal
Benha Teaching Hospital.
obstructions are examples of such comorbidities. The cost
Inclusion criteria included all patients presented to the
burden on the patient and health system is a crucial issue
Emergency Department with pain in the right lower
to be considered [4].
abdominal quadrant suspicious for AA.
Many scoring systems had been developed to
correlate the clinical presentation and investigations with
Exclusion criteria included patients who received
the pathological confirmation of AA that depends mainly
appendectomies for other causes or in the middle of
on the presence of neutrophils in the wall of the appendix
another surgery, patients with perforated viscus and
with a global aim to lower the negative appendectomy
peritonitis, and patients with a history of renal or ureteric
rates [5,6]. The above-mentioned facts raised a red flag for
stones, or pelvic inflammatory disease. Patients with
the crucial need for assisting need for an accurate scoring
untraceable or incomplete medical records were also
system for acute. Since 1980, many Scores such as
excluded.
Alvarado, RIPASA, Eskelinen, Fenyo, Tzakis, and
The sample size of 1- =0.80 (80%) for the
Ohmann were developed for diagnosis of AA [7]. Many
spearman's correlation at level =0.05 (5%), under these
studies had described the accuracy, sensitivity and
assumptions, amounts to 50 (G*power, version 3.1).
specificity of different scoring systems to be highly
Procedure and assessment
variable and sometimes unsatisfactory results in different
After history taking, clinical examination and
ethnic communities [5,8,9]. RIPASA (Raja Isteri Pengiran
investigations, all items of RIPASA score were fulfilled.
Anak Saleha Appendicitis), is accurate in the Asian
2195
Received: 03/09/2022
Accepted: 06/11/2022

Full Paper (vol.902 paper# 30)


c:\work\Jor\vol902_31 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2199-2207

Serum Level of Anti- -Enolase Antibody in Systemic Lupus Erythematosus Patients
Raheeq Mostafa Al-Werdani1, Dena Mahmoud1, Mostafa Mohamed Mansour2, Basma Ahmed Al-Qadi1
Departments of 1Rheumatology& Rehabilitation and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Raheeq Mostafa Al-werdani, Mobile: (+20)01003035525, Email: raheqt@gmail.com

ABSTRACT

Background: Systemic lupus erythematous (SLE) is a chronic autoimmune disease characterized by the deposition of
immune complexes in various tissues and thus multisystem affection. The autoantibody profile can be utilized as a
significant prognostic indicator for clinicians. Alpha-enolase is a multifunctional protein, which after inflammation, is
expressed in cell membranes of eukaryotic cells, such as monocytes, T lymphocytes, B lymphocytes, neuronal cells,
and endothelial cells.
Objective: The aim of the current study was to evaluate serum level of Anti--enolase Ab in adult systemic lupus
erythematous patient and its association with lupus activity.
Patients and Methods: This was a case control study which included 105 SLE patients who recruited from the
outpatient Rheumatology and Rehabilitation Clinic at Mansoura University Hospital. Participants were divided into
three groups; group 1 (35 participants) which includes adult patients diagnosed as SLE, group 2 (35 participant) which
includes adult patient diagnosed as lupus nephritis and group 3 (35 participants) which includes age- and sex-matched
healthy volunteers (control group).
Results: The current study demonstrated that SLE with LN showed the highest levels, followed by SLE without LN and
lastly the healthy individuals. The anti--enolase antibody level showed significant positive correlations with renal
biopsy grade, SLICC RENAL, SLEDAI-2K, R-SLEDAI. The serum level of anti--enolase antibody could discriminate
between SLE cases and control subjects with high accuracy AUC (AUC=0.997). At best cut off value (=0.894),
sensitivity was 98.6%, specificity was 97.1%, PPV was 98.6%, NPV was 97.2% and accuracy was 98.1%.
Conclusion: The current study demonstrated that, serum Anti--enolase Ab seemed to be significantly correlated with
SLE as well as with diseases activity particularly LN. Additionally, it could be used as a reliable predictor in the
differentiation between SLE and healthy persons, also in differentiating SLE cases with LN from those without LN.
Keywords: Systemic lupus erythematosus, -enolase, Autoantibody.

INTRODUCTION
where it acts as plasminogen receptor and activator (5).
SLE is a chronic inflammatory autoimmune
The upregulation of -enolase expression in cell
disorder with diverse clinical symptoms and serological
membranes might act as an auto-antigen in the
abnormalities. The hallmarks of SLE include the
autoimmune disorders (6).
formation of autoantibodies by a hyper-reactive B
Furthermore, -enolase is a component of the
lymphocytes, deposition of immune complexes in
complex extra-cellular trappings (NETs) released by
organs, significant complement activation and reduced
neutrophils by an active process coined NETosis.
clearance of apoptotic cells. These hallmarks are
Because the latter acts as a key inducer of autoimmune
assumed to be associated with immune dysregulation (1).
response in SLE, -enolase externalization during
SLE has a progressive and a relapsing remitting pattern
disease exacerbations might be result in the formation of
in several cases. To appropriate follow up and manage
-enolase antibodies (Abs) in the serum (7).
SLE cases, it is important to identify the variables
Alpha-enolase antibodies have been detected in
predicating
organ
involvement
including
the
several infectious and autoimmune disorders. These Abs
autoantibody profile which is a crucial prognostic
are increased as a result of bacterial infection or
indicator in the therapeutic plan (2).
uncontrolled growth or proliferation of cells in particular
Renal involvement is common of SLE which
organs in pathophysiologic conditions (8).
can result in significant disease and even mortality (3).
In patient with LN, -enolase was found to be
Early diagnosis of renal disease helps un the cases SLE
highly expressed in the glomeruli and inflammatory
flares or in the case of patients who do not respond to
lesions. On the other hand, in the healthy kidney -
therapy. Thus, development of an optimum clinical
enolase was almost undetectable in glomeruli and only
diagnostic indicator for LN is of high value (4).
expressed in tubules (9). In a recent study, Bruschi and
Alpha- enolase is a multifunctional protein
co-workers (10) identified -enolase as a target antigen in
which was initially recognized as an important
renal biopsies from LN cases.
component of the glycolytic pathway which catalyze the
The non-invasive laboratory and clinical
dehydration
of
2-phosphoglycerate
to
measures of lupus nephritis activity are not sensitive or
phosphenolpyruvate. This protein is often cytoplasmic
specific enough to be reliable for measurement of its
however is also expressed in cell membranes of
course, supporting the necessity for new markers. Anti-
eukaryotic cells, such as monocytes, T lymphocytes, B
alpha enolase Abs have the potential to fill this unmet
lymphocytes, neuronal cells, as well as endothelial cells,
need (11).
2199
Received: 16/09/2022
Accepted: 19/11/2022

Full Paper (vol.902 paper# 31)


c:\work\Jor\vol902_32 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2208-2210

Destructive, Physical, and Surgical Treatment Lines of Warts: Review Article
Aya Gamal Nasr Hassan*, Ahmad Nofal, Ahmed Said Abdelshafy
Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Aya Gamal Nasr Hassan, Mobile: (+20) 01008643227, E-Mail: ayahjamal470@gmail.com

ABSTRACT
Background:
Despite the fact that warts, the microscopic skin protuberances caused by the human papillomavirus, do not
pose any serious health risks, they can be unattractive, unpleasant, uncomfortable, and even contagious. It's possible they'll
regress on their own, but it could take a long time. As a result, many who have them look for treatments both professionally
and commercially. As of yet, there is no one-and-done solution for curing warts with minimal adverse effects. Pain,
burning, blisters, local irritation, bleeding, infection, ulcers, and scarring are only some of the potential side effects of
destructive therapy. Objective: Review of the literature on therapy lines for treatment of warts.
Methods:
We looked for data on therapy and warts treatment in medical journals and databases like PubMed, Google
Scholar, and Science Direct. However, only the most recent or extensive study was taken into account between January
2000 and May 2021. References from related works were also evaluated by the writers. There are not enough resources
to translate documents into languages other than English, hence those documents have been ignored. It was generally
agreed that documents such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations did
not qualify as legitimate scientific study.
Conclusion: Warts can be treated in a number of ways, the most common being chemical cautery laser ablation,
cryotherapy, surgical excision, electrocautery, surgical excision, immunotherapy, which involves stimulating the
immune system to attack the virus and suppress its activity.
Keywords: Warts, Human papillomavirus, Surgical Treatment.

INTRODUCTION

Despite the fact that warts, the microscopic skin
A common skin symptom of human papillomavirus
protuberances caused by the human papillomavirus, do
(HPV) infection is the development of warts.
not pose any serious health risks, they can be
Depending on the epithelial surface they infect and the
unattractive, unpleasant, uncomfortable, and even
individual HPV strain that creates them, many types of
contagious. It's possible they'll regress on their own, but
warts may occur. Common warts, plantar warts, flat
it could take a long time. This is why some who have
warts, and genital warts are all types of warts caused by
warts look for treatments that may be bought without a
human
papillomavirus
infection
(Condyloma
doctor's visit (1).
acuminatum) (2).

Figure (1): Different wart types (1).
2208
Received: 18/09/2022
Accepted: 20/11/2022

Full Paper (vol.902 paper# 32)


c:\work\Jor\vol902_33 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2211-2215

Early Results of Bouquet Technique in Treatment of Metacarpal Fractures
Ashraf M Abdelaziz, Ahmed Sayed Ahmed Elshamy, Ahmed Elsayed Ali Agwa *
Department of Orthopedic Surgery, Faculty of Medicine, Al-Azhar University (for girls), Egypt
*Corresponding author: Ahmed Elsayed Ali Agwa, Mobile: (+20) 1020885510,
ORCID: 0000-0001-5197-5252, Email: ahmedagwa2025@gmail.com,
ABSTRACT
Introduction
: Metacarpal fractures are frequent, and many of them can be managed non-surgically with the proper
reduction and immobilisation. As with any hand fracture, the major goals are to achieve anatomic and stable reduction,
bone union, and early mobilisation. Objective: The aim of the present study was to evaluate the outcome of bouquet
technique in management of unstable metacarpals fractures as isolated or multiple shaft metacarpal fractures, irreducible
or unstable fracture, greater than 30 degree fracture angulation, greater than 10 degree rotational deformity, and
extensive (more than 5 mm) metacarpal shortening.
Patients and methods: A prospective follow up study was carried out on 20 patients with metacarpal factures, managed
at El Qureen Hospital, Dar Elhekmah Hospital and Abo Khalifa Emergency Hospital, A total of 17 males and 3 females
with unstable 2nd to 5th metacarpal fractures fixed by intramedullary k-wires (Bouquet osteosynthesis) were recruited.
Results: The average Quick DASH score was 1.45 (SD 1.23), ranging from zero to four points, and the mean grip
strength of the damaged hand was 96%, which was significantly lower than the non-injured side's range of 85% to 100%.
The functional outcome was satisfactory. Up to 18 patients (90%) patients reported being extremely satisfied, while 2
(10%) patients reported being satisfied.
Conclusion: Bouquet pinning and transverse wiring techniques in metacarpal fractures showed good range of motion
(total active motion >245), grip strength, early radiographic bone union and less post-operative infection.
Keywords: Metacarpal Fractures, Bouquet Technique, Fixation, Immobilization, Follow up study, Al-Azhar University.

INTRODUCTION

fracture, greater than 30 degree fracture angulation,
One of the most frequent orthopaedic injuries is a
greater than 10 degree rotational deformity, and
metacarpal fracture, which is regularly seen in
extensive (more than 5 mm) metacarpal shortening.
emergency rooms and in patients seeking advice

outside. To get the best results, Most of these
PATIENTS AND METHODS
metacarpal fractures can be treated well without
A prospective follow up study was carried out on 20
surgery. Unintentional falls, polytrauma injuries
patients with metacarpal factures, managed at El
received in motor vehicle accidents, direct hits to a hard
Qureen Hospital, Dar Elhekmah Hospital and Abo
object, or physical assaults account for the majority of
Khalifa Emergency Hospital, A total of 17 males and 3
fractures. The most frequent types of metacarpal
females with unstable 2nd to 5th metacarpal fractures
fractures are fourth and fifth metacarpal shaft fractures.
fixed
by
intramedullary
k-wires
(Bouquet
A common injury in the United States, metacarpal
osteosynthesis) were recruited.
fractures account for 30% of all hand fractures and 18%
The minimum and maximum follow-up periods for each
of all fractures below the elbow (1). 70% of them happen
patient ranged from 8 to 16 weeks.
between the second and third decades of life (2).
Inclusion criteria: Solitary or multiple shaft
Metacarpal fractures are common, and with the
metacarpal fracture, greater than 30 degree fracture
right reduction and immobilisation, many of them can
angulation, greater than 10 degree rotational deformity,
be treated without surgery. The main objectives are to
and severe (>5mm) metacarpal shortening were all
achieve anatomic and stable reduction, bone union, and
indications of an unstable or irreducible fracture.
early mobilisation, as with any hand fracture. Positive
Exclusion criteria: Patients with old fractures, non-
functional outcomes require effective therapy and,
united metacarpal fractures and intra-articular
whenever possible, early range of motion. A less
metacarpal fractures were excluded.
intrusive treatment option for metacarpal shaft fractures

below the c-arm is percutaneous Enders type
Methods of diagnosis
intramedullary k wire fixation. As a result, rewarding
History taking: Name, age, sex, occupation, special
performance is advantageous.
habits of medical importance and hand dominance.
In the current study, pre-contoured K wires were
Mode of trauma: Punch trauma was the main
implanted intramedullary to fix metacarpal shaft
mechanism, direct trauma as fall of a heavy object on
fractures using percutaneous blooming (Bouquet
the hand, road traffic accident and falling on the ground
Technique), with the aim of assessing the procedure and
also caused the injuries
functional outcome.
Physical Examination: A thorough evaluation of the
The aim of the present study was to evaluate the
damaged extremity was done before surgery, taking
outcome of bouquet technique in management of
note of the dominant hand, the location of the pain, and
unstable metacarpals fractures as isolated or multiple
any oedema. The patient was instructed to create a fist
shaft metacarpal fractures, irreducible or unstable
or the examiner should passively flex the fingers at the
2211
Received: 18/09/2022
Accepted: 21/11/2022

Full Paper (vol.902 paper# 33)


c:\work\Jor\vol902_34 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2216-2226

Impact of Clinicopathological Factors of Extremities, Visceral, Retroperitoneal
Sarcoma on Treatment Outcome, Experience from Two Egyptian Institutes
Mohammed Fathy Bayomy1, Seham Mohammed El Hagrasy1, Lobna Abdelaziz Abdelaziz1,
Aya Mohamed Saleh1, Hany William Zaky2
1Department of Clinical Oncology, Faculty of Medicine, Zagazig University, Sharkia, Egypt
2Department of Oncology Ahmed Maher Teaching Hospital, Cairo, Egypt
*Corresponding author: Aya Mohamed Saleh, Mobile: (+20)01123622462, Email: ayasaleh082@gmail.com

ABSTRACT
Background
: Less than 1% of all adult malignancies and 12% of pediatric cancers are sarcomas, an uncommon and
diverse category of mesenchymal malignant tumors. The histologic subtype of soft tissue sarcoma (STS), in addition
to the tumors, location, and grade, is a key prognostic factor currently, among the most popular therapies for STSs
include surgery, radiation, and chemotherapy.
Objective: The goal of this paper is to determine soft tissue sarcoma's epidemiology and prognostic markers
retrospectively. It also shows the outcomes for overall survival (OS) and event-free survival (EFS) among Egyptian
patients treated at the clinical oncology and nuclear medicine department of Zagazig University and Ahmad Maher
Teaching hospitals.
Patient and Methods:
We reviewed retrospectively clinical features and tumor characteristics of the medical record
of 121 patients with soft tissue sarcoma presented to Ahmed Maher teaching hospital and clinical oncology and
Nuclear Medicine Department of Zagazig University in the period from January 2010 to December 2021 received
chemotherapy or chemoradiotherapy, the study group's demographic information included sex, age, follow-up time,
and gender, the main tumor site, size, histological subtype, grade, clinical group, and risk stratification were reviewed
as tumor features, to assess the degree of tumor resection or elimination, surgical reports, pathology reports, and tumor
response to treatment.
Conclusion:
Overall survival (OS) is better in extremities than retroperitoneal sarcoma, local recurrence-free survival
(LRFS) was better in extremities and visceral sarcoma, disease-free survival (DFS) was better in extremities than
retroperitoneal which was better than visceral sarcoma and progression-free survival (PFS) was better in extremities
than visceral sarcoma.
Keywords: STS, EFS, PFS, OS, DMFS.

INTRODUCTION

All ages are affected by sarcomas, which are
mass or with signs and sympathies related to the main
mesenchymal malignancies that arise in embryonic
tumor location, the mass effect, or tumor-related
mesenchyme tissues during the process of
consequences [7].
differentiation. Soft tissue sarcomas (STS) account for
Obtaining sufficient tissue for histology and
one percent of all malignant tumors [1].
immunohistochemistry is crucial for a correct
In the US, there were 13,190 new cases of soft
diagnosis [8]. The recommended course of treatment
tissue sarcoma and 5,130 fatalities recorded in 2022
for localized high-grade extremity soft tissue sarcoma
[2]. Each year, there were 3.5 new instances of soft
(ESTS) is large-in-bloc resection combined with
tissue cancer for every 100,000 men and women
radiation therapy (RT).
globally, according to the published incidence rates,
Adjuvant RT may not always be required in
which vary from 1.8 to 5 per 100,000 persons [3].
situations of superficial, low-grade, and small-size
The yearly death rate for both men and women
STS [9], Contrary to surgery and radiation, which
was 1.3 per 100,000. These figures are age-adjusted
focus on local tumor control, the purpose of
and based on incidents from 2014 to 2018 and
chemotherapy is systemic control, which may be
fatalities from 2015 to 2019 [4].
therapeutic,
adjuvant,
or
palliative
[10].
The majority of soft tissue sarcomas (STs)
Cyclophosphamide,
ifosfamide,
vincristine,
develop in the extremities, and their local treatment
doxorubicin, dactinomycin, and etoposide are among
requires a multidisciplinary approach that may require
the medications used to treat patients with these
either large surgical excision alone or in conjunction
malignancies [11].
with radiation [6]. Sarcomas are traditionally divided
The goal of this paper is to determine soft tissue
by histology and primary site into bone versus soft
sarcoma's epidemiology and prognostic markers
tissue sarcoma (STs)[5].
retrospectively.
A computed tomography (CT) scan or magnetic
It also shows the outcomes for overall survival
resonance imaging (MRI) of the main tumor should be
(OS) and event-free survival (EFS) among Egyptian
performed to assess its size and assess any potential
patients treated at the clinical oncology and nuclear
involvement of crucial organ structures. Patients with
medicine department of Zagazig University and
sarcoma may initially present with an asymptomatic
Ahmad Maher Teaching hospitals.
2216
Received: 15/09/2022
Accepted: 18/11/2022

Full Paper (vol.902 paper# 34)


c:\work\Jor\vol902_35 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2227-2230

General View about Plantar fasciitis Treatment Lines: Review Article
Zeinab Hamed Sawan, Sanaa Ahmed El-Tohamy, Amr Shaaban Hafez, Osama Hussein Abdelhalim Basha
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine - Zagazig University, Egypt
Corresponding author: Osama Hussein Abdelhalim Basha, Mobile: (+20) 01110434697, E-Mail: osamabasha20@gmail.com

ABSTRACT
Background
: One of the most frequent reasons of heel discomfort is plantar fasciitis. A thick band of tissue from the
heel bone to the toes on the bottom of each foot experiences degeneration and, to a lesser extent, inflammation. Though
it can also be brought on by prolonged standing or rising from a chair, the discomfort is typically at its greatest when
taking the first few steps after waking up. It tends to occur more often in women, middle-aged, athletes, and the obese.
Objective:
To have overview about treatment lines of Plantar fasciitis.
Methods:
We looked for data on Plantar fasciitis and treatment in medical journals and databases like PubMed, Google
Scholar, and Science Direct. However, only the most recent or extensive study was taken into account between 2000
and 2013. References from related works were also evaluated by the writers. There are not enough resources to translate
documents into languages other than English, hence those documents have been ignored. It was generally agreed that
documents such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations did not qualify
as legitimate scientific study
Conclusion
: It can be treated either by conservative treatment such as rest, analgesics and stretching exercises that are
successful in majority of cases. However, cases not responding to conservative treatments for more than 3 months, they
can be treated with minimal invasive treatment such as corticosteroids, botulinum toxin or platelet-rich plasma (PRP)
injections. Surgical intervention is often considered after failure of conservative treatments for more than 6 months. The
most popular surgical procedures for refractory fasciitis are gastrocnemius recession and plantar fasciotomy.
Keywords: Plantar fasciitis, Platelet-rich plasma, Treatment lines.

INTRODUCTION
injury. Women, those in their middle years, athletes, and
The majority of adults who experienced heel pain
the overweight are at increased risk(5). Plantar fasciitis
attributed it to plantar fasciitis. More than a million
affects around 10% of the population at some point (6).
people a year reportedly seek treatment for this disease,
The peak age for occurrence is between 40 and 60 (7).
with the majority (66% in one study) visiting a primary
About one and two million annual doctor's visits were
care physician. In the past, it was thought that prolonged
attributed to pain from plantar fasciitis (5).
periods of standing or running caused plantar fasciitis by

causing microtears in the fascia at the calcaneal enthesis.
Anatomy & Function of the Plantar Fascia:
Some doctors have given this disorder the label "plantar
You have a thick band of connective tissue called plantar
fasciosis," implying that it is caused by a degenerative
fascia that wraps around the soles of your feet (8). It's
process rather than acute inflammation (1,2).
triangular, with the medial process of the calcaneal
Plantar fasciitis can be diagnosed using the patient's
tuberosity serving as the starting point for the growth of
history, potential risk factors, and findings from a
the central band, the lateral band, and the medial band (9).
physical examination. Getting out of bed in the morning
It originates on the plantar surface of the foot, the
or getting comfortable for a long period of time causes
proximal phalangeal bases, and the metatarsophalangeal
heel pain and tightness for most individuals. Heel pain
(MTP) joints, and then divides distally into five distinct
typically improves with walking but can worsen later in
strands at the mid-metatarsal level (10)..
the day if the patient stays on walking or stands for long

periods of time(1,2).
Patients with painful impact points may walk with
the affected foot in an equestrian stance during a physical
examination. The plantar calcaneal region is typically
quite sensitive to touch and can cause a severe piercing
pain in most people. Lower leg/first toe dorsiflexion
inactivity is associated with proximal plantar fascia
discomfort and Achilles tendon entrapment. If the
patient's history and physical exam findings don't fit the
conventional profile for plantar fasciitis, then it's best to
check elsewhere for the source of the discomfort in their
heels (1).
Epidemiology:

Heel pain is a common complaint at the podiatry office.
The most common cause of heel pain was plantar fasciitis

(3,4), as well as being the most prevalent plantar fascia
Figure (1): Anatomy of plantar fascia (10).
2227
Received: 16/09/2022
Accepted: 17/11/2022

Full Paper (vol.902 paper# 35)


c:\work\Jor\vol902_36 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2231-2241

Comparison between Plasma gel (Filler) and Polydiaxone (PDO)
Threads in Treating Fine and Medium Sized Infra-Orbital Wrinkles
Using 3D Antera Camera
Samah Ibrahim Hassen1, Heba Mahmoud El-Sayed Diab1,
Wassan Mohammed Jwad Zayed1, Ahmed F. Elhawatky2
1Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain-Shams University, Egypt
2Department of Dermatology, Venereology and Andrology, National Research Center, Egypt
*Corresponding author: Samah Ibrahim Hassen, Mobile: (+20) 01065226609, E-Mail: drsamah81@yahoo.com

ABSTRACT
Background:
Plasma gel is a new procedure in the aesthetic field. It has been used for various dermatological conditions
including wound healing, anti-inflammatory, and cosmetic uses. Infra-orbital dark circles possess no medical harm but
signifies cosmetic and psychological burden.
Objective: Evaluation the efficacy and safety of plasma gel (Filler) injection and comparing its result with polydiaxone
(PDO) mono threads in peri-orbital rejuvenation by subjective measure using a 3D computerized camera which gives a
report with very fine details.
Patients and methods: 40 patients with infra-orbital fine wrinkles were included and by the Antera 3D camera, these
fine wrinkles were divided to small sized and medium sized wrinkles and evaluated for the changes in the size and depth,
indentation index and texture roughness of the wrinkles. Patients underwent plasma gel injections into the infra-orbital
area of the left eye and PDO mono threads insertion in the right side. All patients were evaluated using the Antera
camera at day (0m), after one month (1m) and after 6 months (6m) of the therapy.
Results: Antera reports of the side injected with the plasma gel showed very good response. Also PDO mono threads
insertion revealed marked cosmetic results, yet the efficacy of the plasma filler was superior as regards wrinkle's size,
indentation index and texture roughness. .
Keywords: Infra-orbital fine wrinkles, 3D Antera camera, Plasma gel, PDO thread.


INTRODUCTION
A- Antera 3D camera:
Antera 3D allows you to
analyse a number of parameters related to the skin.
Thanks to sophisticated algorithms, the software allows
users to analyse and measure topographic features of the
skin (such as texture, wrinkles, fine lines, etc.) (1).

B- Wrinkles: This mode allows you to measure a set of
parameters relating to fine lines, wrinkles and folds.
The first thing you need to do when measuring a
wrinkle is to select the appropriate filter. You can
choose between four options: Small (1mm filter):
suitable for the analysis of fine lines. Medium (2mm
filter): this is the default selection suitable for most
wrinkles, e.g. crow's feet, forehead wrinkles,
marionette lines. Large (3mm filter): suitable for large
deep wrinkles, furrows and folds, and custom: this
option allows you to define your own filter and it spans
from 0.5mm to 40mm (1-2).
In our study, we chose the small and medium sized
wrinkles. The color image will change to a false color
map, where the violet indicates the deepest features and

the white corresponds to the top of the surface. You can

now select the particular wrinkle then the software will
Figure (1): Measuring a wrinkle's depth, width and
display the following parameters in the Data Display
overall size.
bar (Figure 1).





2231
Received: 16/09/2022
Accepted: 19/11/2022

Full Paper (vol.902 paper# 36)


c:\work\Jor\vol902_37 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2242-2244

Estimation And Measurement of Correlation Coefficient Values for
The Level of Erythroferrone and Liver Enzymes in Beta-Thalassemia Patients
Hajer H. A. AL-Rawi1 , Firas Sh. A. Algburi2
Department of Biology, college of science, University of Tikrit, Tikrit, Iraq.1, 2
Corresponding author: Hajer H. A. AL-Rawi, hajar.h.abdulmutaleb4440@st.tu. edu.iq,
Orcid ID: 0000-0002-6829-9120, Mobile: 009647717346770

ABSTRACT
Background:
Thalassemia is an inherited blood disorder of the blood cells It is described as a low level of hemoglobin
and a decrease in the number of red blood cells from the normal range.
Objective: This study amied to evaluate the levels and find the correlation coefficient between erythroferrone and liver
enzymes in the beta thalassemia patients.
Patients and methods:
In this study, samples were taken from patients with beta-thalassemia (60 samples) and 30 samples
from healthy people.
Results: The current study's findings demonstrated that both erythroferon and liver enzymes were highly elevated in
patients with thalassemia (P>0.05), and they were also strongly associated.
Conclusions: This study found association between increased levels of erythroferon and severe anemia also association
between increased levels of liver enzymes and severe accumulation of iron.
Keywords: Thalassemia, Erythroferrone, Liver enzymes.


INTRODUCTION

Thalassemia It is a hereditary blood disorder that
The aspartate aminotransferase is also called
results from a genetic mutation that deletes one or more
glutamate oxaloacetate transaminase. The enzyme is
of the globin genes responsible for producing globin
found in the liver, as well as in red blood cells, kidneys,
chains, which leads to a deficiency or complete absence
and brain tissue. The concentration of the enzyme
in the production of hemoglobin chains (1).
increases in case of damage to any of these organs (13).
And that adult hemoglobin has four protein parts

called polypeptide chains, and these chains are classified
PATINENTS AND METHODS
into two chains and two chains (2), so people with
This study was conducted at Al-Karama Teaching
thalassemia have a deficiency or absence in the
Hospital in Baghdad Governorate from December 2021
manufacture of both or one of the beta chains or alpha (3).
to March 2022, and the study included 60 samples of
Thalassemia suffers from the accumulation of iron in
patients with major beta-thalassemia and 30 samples of
various organs of the body, including the liver and spleen,
healthy people whose ages ranged from 5 - 35 years, and
as a result of their continuous receipt of blood. Therefore,
the information about each person was recorded
the accumulation of iron leads to pallor, jaundice, and a
according to the research form.
high level of iron in the blood (4, 5, 6).

Erythroferrone is a protein hormone encoded in
Ethical consent:
humans by the ERFE gene. Erythroferon is produced by
Written informed consent was obtained from each
red blood cells and works by inhibiting hepcidin in the
patient to participate in the current study. The
liver, thus increasing the amount of iron available for the
Central Scientific Research Ethics Committee at
manufacture of hemoglobin (7,8). The most important role
Tikrit University approved this research. This work
of the hormone erythroferon is to regulate iron
was carried out in accordance with the World Medical
metabolism by affecting the substance hepcidin (7) in
Association (Declaration of Helsinki) Code of Ethics
humans and mice, where it is produced in erythrocyte
for studies involving humans.
precursors that multiply when new red blood cells are

made, as is the case after bleeding when there is a need
Inclusion criteria: Patients with thalassemia from both
for more iron (9). Alkaline phosphatase is an enzyme that
genders are involved, and patients who agreed to
removes phosphate groups from nucleotides, alkaloids,
participate in this study.
and proteins by a process called Dephosphorylation (10).
Exclusion criteria: persons less than 5 year or older than
The enzyme is found in all tissues of the body but is
35 year, and other chronic hemolytic anemia.
concentrated mainly in the liver, kidney, placenta, and

Bones (11). Alanine transaminase is one of the
Sampling: Five milliliters of blood were collected from
transaminase enzymes, also called glutamate pyruvate
the patients included in the study, placed in gel tubes and
transaminase, that catalyzes the transfer of the amine
left to clot for 20 minutes, then centrifuged for fifteen
group from alpha-keto-glutaric alanine and in reverse to
minutes at a speed of three thousand revolutions per
give glutamate and pyruvate. This enzyme is used to
minute to collect serum. The serum was then placed in
detect liver damage due to its presence mainly in the liver
three Eppendorf tubes and stored in a deep freezer at -20
and at lower levels in the pancreas, heart, and muscles (12).
2242
Received: 26/08/2022
Accepted: 29/10/2022

Full Paper (vol.902 paper# 37)


c:\work\Jor\vol902_38 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2245-2248

Case-Control Study of Intestinal Parasitic Infection in
Hemodialysis Patients in Sohag Governorate
Manal Reyad GabAllah1, Meray Medhat Shokry Zaghary*2
Departments of 1Medical Parasitology and
2Forensic and Clinical Toxicology, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Manal Reyad GabAllah, Mobile: (+20) 01207159348, E-Mail: manalreyad@yahoo.com

ABSTRACT
Background:
Patients on hemodialysis have drastically lowered immune systems. Particularly in people with
compromised immune systems, intestinal parasites can cause severe morbidity and death.
Objective: In Sohag Governorate, this case-control study examined the probabilities and prevalence rates of intestinal
parasite infections in hemodialysis patients.
Material and methods: This case-control study was carried out on 100 hemodialysis cases and 100 healthy control,
the median was 55 years IQ (45:55), and control the median age was 39 IQ(30-45). Formol ether sedimentation
concentration method, Modified Kinyoun's Acid-Fast Stain (cold), and direct wet mount and iodine stained smear were
used to analyze the three fecal samples taken from each patient.
Results: The present study observed a very highly significant statistical difference between cases and controls as
regards single or mixed or no intestinal parasitic infection, the mixed intestinal parasitic infection was the main type in
the cases group, while, most of the controls were non_infected or single type of infection, parasitic infection in
hemodialysis patients was significantly higher about 4.7 more times than controls.
Conclusions
: Patients on hemodialysis with weakened immune systems brought on by chronic renal disease are more
vulnerable to parasite infections. The findings of the current study demonstrated that intestinal parasites were much
more common in hemodialysis patients.
Keywords: Case-control, Dialysis, Intestinal parasites.

Among the most prevalent intestinal parasite
INTRODUCTION
illnesses in the globe are helminthic disorders caused by
Chronic kidney disease (CKD), a condition that is
Ascaris lumbricoides, Enterobius vermicularis,
becoming more widespread, nearly always necessitates
Trichuris
trichiura,
Hymenolepis
nana,
and
renal replacement therapy, such as (dialysis treatment).
Strongyloides
stercoralis.
Children
who
are
For both preventing and treating parasite infections,
immunocompromised, such as those who are HIV-
immunity is essential (1). Additionally, CKD impairs
positive or receiving hemodialysis, are particularly in
immunity, increasing a person's susceptibility to
danger from the serious health problems caused by
infections (2). The modification of the microbial flora of
these organisms (7).
the gut and the breakdown of the intestinal barrier
In Sohag Governorate, this study examined the
structure caused by CKD are significant contributors to
probabilities and prevalence rates of intestinal parasite
the pathophysiology of inflammation and uremic
infections in hemodialysis patients.
toxicity (3).

CKD negatively impacts neutrophil chemotaxis,
MATERIAL AND METHODS
phagocytosis, bactericidal actions, and T-cell activity.
In the current study, 100 stool samples were taken
Due to their weakened immune systems, patients with
from hemodialysis patients at Sohag Governorate
CKD might get parasite infections (4). Due to their
Hospitals and 100 stool samples were taken from a
compromised immune systems, kids with chronic
healthy control group at outpatient clinics who did not
kidney disease (CKD) are more prone to parasite
have chronic kidney disease.
infections (5).
Using the case-control study equation developed
Intestinal parasite infections are among the most
by Kelsey et al. (8), the OpenEpi software, version 3
common chronic diseases affecting people. Infectious
open source calculator, calculates the sample size.
microorganisms that seldom cause illness in healthy
Using a 2-tailed test with an error probability of 0.05
persons instead appear in patients with weak host
and 80% power, we estimated that the odds ratio was
defenses and cause opportunistic infections.
around 3 and that the proportion of controls to cases was
In individuals with impaired immune systems,
equal (type 1 error). We estimated that each group
certain parasites, such as the Cryptosporidium species,
would require roughly 100 samples.
Isospora, Microsporidia, Giardia lamblia, Entamoeba
The inclusion criteria of age distribution in that
histolytica, and Strongyloides stercoralis, cause
study were cases the median was 55 years IQ (45:55)
gastrointestinal illnesses (6).
and control the median age was 39 IQ(30-45) as in

Figure (1).

2245
Received: 15/09/2022
Accepted: 18/11/2022

Full Paper (vol.902 paper# 38)


c:\work\Jor\vol902_39 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2249-2252

Echocardiographic Assessment of Right Ventricular Function in
Patients with Acute Anterior wall Myocardial Infarction
Rana Salah Eldein Ahmed1, Hanan Mohamed Kamal2,
Zaynab Mohammed Elsayed1, Mohamed Fawzy Abd El All1, Ahmed Fareed*2
Departments of 1Emergency Medicine and 2Cardiology, Faculty of Medicine, Suez Canal University, Egypt
*Corresponding author: Ahmed Fareed, Mobile: (+20) 01282637291, E-Mail: ahmed_ali1@med.suez.edu.eg

ABSTRACT

Background: The main cause of death globally is acute myocardial infarction (AMI), specifically acute coronary
syndrome (ACS). In the setting of acute myocardial infarction, right ventricular (RV) infarction has a greater risk of
adverse outcomes.
Objective: The goal of this study was to evaluate the right ventricular function in patients with an acute anterior
myocardial infarction.
Patients and methods: This case control study included 60 participants who were divided into two groups; group 1
included 30 patients with acute anterior myocardial infarction (first attack and within 1-12 hours of symptoms onset),
and group 2 (control group) included 30 age and gender matched group with no MI. All patients with acute anterior MI
were managed by primary percutaneous coronary intervention (PCI).
Results: Compared to control group, we found that the mean RIMP was significantly higher in the MI group (0.50 ±
0.081 vs 0.28 ± 0.043, p < 0.001), mean TAPSE was significantly lower in the MI group (1.76 ± 0.391 cm vs
2.38 ± 0.420 cm, p 0.001), mean fractional area change was significantly lower in the MI group (32.34 ± 3.625 % vs
48.00 ± 5.350 %, p 0.001), mean DTI-derived tricuspid lateral annular systolic velocity was significantly lower in the
MI group (11.091 ± 2.0334 cm/s vs 13.077 ± 3.0285 cm/s, p= 0.014), and mean right ventricle strain was significantly
lower in the MI group (-16.47 ± 3.246 vs -26.83 ± 2.276, p 0.001).
Conclusion: Echocardiographic RV function parameters are significantly lower in the setting of acute anterior MI
compared to controls denoting more RV dysfunction among this group of patients.
Keywords: MI, RVD, TAPSE, RIMP.

INTRODUCTION
attack and within 1-12 hours of symptoms onset), and
The greatest cause of mortality globally is
group 2 (control group) included 30 age and gender
myocardial infarction (MI) (1). RV dysfunction was
matched group with no MI. All patients with acute
revealed to be a significant determinant in the
anterior MI were managed by primary PCI.
prognosis, mortality, and incidence of cardiogenic
Patients who experienced a left bundle branch
shock in individuals with acute myocardial infarction
block or another type of intraventricular conduction
(2).
delay, patients with previous history of MI, significant
Numerous studies have shown the value of several
valvular disease, pulmonary hypertension with RV
echocardiographic parameters, including tricuspid
systolic pressure by echocardiography >50 mmHg were
annular plane systolic excursion (TAPSE), fractional
excluded from the study.
area change (FAC), tissue Doppler imaging of the
According to the American Society of
lateral tricuspid annulus (S), right ventricular
Cardiology's recommendations, an echocardiographic
myocardial performance index (RIMP), and more
evaluation of RV function was carried out within 24
recently RV free wall global longitudinal strain (RV-
hours after the beginning of symptoms (6).
GLS) for the evaluation of RV systolic function (3-5).
Echocardiographic assessment of RV function:
Up to 50% of patients with acute
1. TAPSE (Trans annular plane systolic excursion):
inferior/posterior MI and up to 10% of individuals with
By using M-mode in the apical four-chamber image, the
anterior STEMI had RV dysfunction. The mechanism
total displacement of the lateral mitral annulus
of left ventricular (LV) dysfunction with anterior wall
(measured in millimetres) was determined (6).
infarctions and right ventricular (RV) dysfunction with
2. RV 2D FAC (Fractional area change): Tracing the
inferior wall infarction are similar (4-5).
RV area (including the trabeculae in the RV cavity) was
Nonetheless, there is no study assessing the
done in systole and diastole in the RV-focused apical
right ventricular function in anterior myocardial
four-chamber view. RV FAC (%) = 100 x (EDA-
infarction patients. The goal of this study was to
ESA)/EDA (6).
evaluate the right ventricular function in patients with
3. DTI-Derived Tricuspid Lateral Annular Systolic
an acute anterior myocardial infarction.PATIENTS
Velocity (S'): Peak systolic speed of the lateral
AND METHODS
tricuspid annulus measured by pulsed wave TDI in the
This case control study included 60 participants
apical four chamber view (cm/sec) (6).
who were divided into two groups; group 1 included 30
4. RIMP (Right ventricular myocardial performance
patients with acute anterior myocardial infarction (first
index): Tricuspid valve closure opening time (TCO),
2249
Received: 19/09/2022
Accepted: 22/11/2022

Full Paper (vol.902 paper# 39)


c:\work\Jor\vol902_40 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2253-2258

Short Term Result of Anatomic Single Bundle ACL Reconstruction with
Peroneus Longus Autograft
Mohammad Othman Mohammed, Fahmy Samir Fahmy, Tareq Bozeed Alsadeq*, Hossam Fathi Mahmoud
Department of Orthopedic, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Tareq Bozeed Alsadeq, Mobile: (+20) 01062195171, E-mail: bozatareq@gmail.com

ABSTRACT
Background:
Common knee injuries pertaining to the anterior cruciate ligament (ACL) have traditionally been treated with
a variety of graft repair techniques involving groups of grafts for bone, patellar tendon, and hamstrings.
Objective: The aim of the current study was to assess the donor site and functional outcome morbidity of single bundle
ACL Peroneus tendon grafting for reconstruction.
Patients and methods:
At the Orthopedic Department of Zagazig University Hospitals, a prospective cohort study was
carried out, on 18 patients with ACL tear during the period from January 2022 to July 2022. Arthroscopic Peroneus longus
tendon autograft was used for anatomic single bundle ACL repair on all patients.
Results: IKDC score considerably increased from 45.83 (SD 7.46) to 78.12 (SD 6.04); 15 (83.3%) patients had excellent
score and 3 (16.7%) patients had good score in AOFAS. complications 13 (72.2%) cases were non-complicated and 27.8%
were complicated (hemarthrosis 5.6%, loss of terminal flexion 5.6%, pain 5.6%, superficial infection 5.6% and Transient
apraxia sural nerve 5.6%).
Conclusion:
Peroneus longus tendon is effective and secure autograft for arthroscopic anterior cruciate ligament
reconstruction; restoration of knee function is adequate, with few donor site morbidities.
Keywords:
Anterior cruciate ligament, Peroneus longus tendon, Knee, Cohort study, Zagazig University.

INTRODUCTION

replacement relating to ACL 2 of the more typical
One of the most frequent knee injuries is an anterior
autografts for ACL restoration are four-strand bone-
cruciate ligament (ACL) tear, with an incidence rate about
patellar tendon-bone (BPTB) and hamstring autografts,
85 per 100,000 in patients aged between 16 and 39 years.
each of which has benefits and drawbacks (5).
Anterior and rotatory instability results from a deficit in
The strength of a hamstring autograft is comparable
the ACL, This serves as the knee's primary stabilizer and
to that of the original ACL, and it is simple to harvest with
limits internal rotation and anterior tibial translation.
little donor site morbidity. However, it has uncertain graft
Noncontact injury occurs most frequently when the knee
size and may result in a loss of hamstring strength. This is
is slightly flexed and in the valgus position and you pivot,
vital for some sportsmen who need powerful hamstring
cut, and jump (1).
power (6).
Typically, physical examination, mechanical tests,
As a result, the peroneus longus tendon is being
imaging, and arthroscopy are used to make the diagnosis
considered for usage by some orthopedic surgeons as an
of ACL rupture. Numerous physical exam measures have
ACL autograft. The ideal autograft donor must be strong
been suggested to evaluate ACL stability, used both as a
enough to be used, an appropriate size, and be simple and
diagnostic tool and for clinical follow-up after ACL
safe to harvest. Peroneus longs tendon (PLT) has been
reconstruction. The three most common tests are the
suggested in some literature as an alternative autograft for
Lachman test, anterior drawer test, and pivot shift test
ACL restoration. PLT is strong and large enough to
often utilized physical examinations (2).
function in an ACL reconstruction as an autograft. With
The anteromedial (AM) and posterolateral (PL)
reference to strength, safety, and donor site morbidity,
bundles make up the two components of the functional
PLT is recognized as an efficient autograft option for
ACL bundles. Similar forces act on the graft of the
ACL repair because complete removal of the PLT has no
reconstructed ACL and the natural ACL in the same
impact on gait or ankle stability. According to certain
anatomical locations. The various ACL reconstruction
studies, Ankle erector power is even greater because to
methods strive to provide a result that is as close to a
the peroneus brevis (7).
natural anatomic reconstruction as is practicable (3).
The aim of the current study was to assess the donor
For people who are active, surgical reconstruction
site and functional outcome morbidity of single bundle
of torn ACLs is typically favored over non-operative care
ACL Peroneus tendon grafting for reconstruction.
since it allows for a quick return to function. Since the

advent of ACL surgery in the late 1960s, the techniques
PATIENTS AND METHODS
for reconstruction have rapidly advanced (4).
A total of 18 patients who received a single bundle
Numerous graft forms, including well-researched
of surgery for ACL repair at Zagazig University
autograft, increase knee stability and function. After
2253
Received: 18/09/2022
Accepted: 21/11/2022

Full Paper (vol.902 paper# 40)


c:\work\Jor\vol902_41 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2259-2264

Safety and Efficacy of Mirabegron in Treatment of Nocturnal Enuresis in Children
Ahmed Sakr, Faraj Farkash*, Hamdy Desouki , Ehab Elsayed
Department of Urology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Faraj Massoud Mohammed Farkash, Mobile: (+20) 01142232867, E-mail: Farajfrkashuro@gmail.com

ABSTRACT
Background:
Nocturnal enuresis affects 5% to 10% of in the United States; an estimated to be 5 to 7 million kids. It affects
all 7-year-olds, and it is more prevalent in boys. About 15% of cases are spontaneously cured each year, although 2% to 3%
of children continue to experience symptoms as adults.
Objective: The aim of the current study was to evaluate the safety and effectiveness of Mirabegron for treatment of NE.
Patients and methods: A one-arm clinical trial was carried out at the Pediatric Unit, Urology Department, Zagazig
University Hospital. A total 36 patients with monosymptomatic nocturnal enuresis (MNE) were enrolled in the study. All
patients received mirabegron 25mg for 3 months at bedtime, together with some strategies for parents to help children who
are wetting the bed.
Results: The age of participants ranged from 7 to 15 with a mean of 9.8 (SD 2.5) years. Sex distribution was 20 (55.2%)
males and 16 (44.4%) females. The duration of the study ranged from 6-12 months. There was a significant decrease in the
mean bed wet after six months from treatment compared with the mean before treatment (P<0.05). After six months of
treatment with Mirabegron, 10 (31.3%) parents reported complete response, 13 (40.6%) had partial response, and 9 (28.1%)
had no response to treatment. Adverse effects were reported in 5 (13.9%) patients; constipation in 3 (8.3%) patients and dry
mouth in 2 (5.5%) patients.
Conclusion:
Mirabegron, a brand-new, first-in-class medication, surfaced as a secure and reliable substitute for children
with NE. More research including more patients and a longer period of follow-up is needed.
Keywords: Nocturnal enuresis, Bedwetting, Mirabegron, Children, Cohort study, Zagazig University.

INTRODUCTION

The urothelial lining and bladder detrusor muscle both
Younger children may experience nocturnal enuresis
contain 3 different types of adrenoceptors (types 1, 2, and
(NE), sometimes known as "bedwetting," which is a type
3), with type 3 being the most prevalent. Detrusor smooth
of nighttime urine incontinence.
muscle relaxation results from stimulation of the 3
In order to be more precise, primary nocturnal
receptors. The therapy of overactive bladder (OAB) has
enuresis (PNE) is the involuntary flow of urine at night in
been extensively used and researched with mirabegron, an
children and adolescents 5 years of age and older who do
agonist of the 3 receptor. It has been established that
not have a congenital or acquired defect of the central
mirabegron is safe, efficient, and well-tolerated. In almost
nervous system or urinary tract and who have not gone
all trials, it produced outcomes that were comparable to
more than 6 months without passing urine. Enuresis is
placebo in terms of the prevalence of dry mouth (3).
categorized as monosymptomatic enuresis, which means
The bladder's detrusor smooth muscle relaxes as a
it has neither non-monosymptomatic enuresis, which
result of the beta-3 adrenergic receptor agonist
indicates the presence of other lower urinary tract
mirabegron, which also improves bladder capacity. It is
symptoms, nor any other lower urinary tract symptoms,
recommended for people with overactive bladder who
mostly daytime symptoms (1).
experience urge incontinence, urgency, and frequent
An altered antidiuretic hormone profile with
urination (4). For the treatment of OAB and neurogenic
nocturnal polyuria, arousal failure, delayed bladder
detrusor overactivity (NDO) in adults, mirabegron has
maturation, and nocturnal detrusor overactivity are
received approval. However, using them on kids (3
examples of multifactorial pathophysiological factors,
years) has just just been authorised for NDO patients (5).
have been implicated in the pathophysiology of NE.
Mirabegron has a high efficacy and tolerability
Common co-morbidities linked to NE include
profile, which may support its incorporation as a primary
constipation, diabetes mellitus, developmental attention
management technique in a formula programme for
or learning difficulties, a history of recurrent urinary tract
children who have just been diagnosed with OAB. It still
infection (UTI) in males, and pinworm infestation.
requires longer-term testing to evaluate its enduring
NE has been linked to risk factors such as age, male
safety,
effectiveness,
discontinuation
rate,
and
gender, daytime incontinence, encopresis, social anxiety,
tachyphylaxis (6).
delayed walking age, positive parental history of enuresis,
The aim of the current study was to evaluate the safety
and sibling history of enuresis (2).
and effectiveness of Mirabegron for treatment of NE.



2259
Received: 20/09/2022
Accepted: 23/11/2022

Full Paper (vol.902 paper# 41)


c:\work\Jor\vol902_42 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2265-2269

Effect of Gender on Clinical Presentation of SLE in Assiut University Hospitals
Ahmed Safwat Abd Elhamid, Salwa El-Gendi, Eman Ibrahem
Department of Internal Medicine, Faculty of Medicine, Assiut University, Egypt
Corresponding author: Ahmed Safwat Abd Elhamid, Mobile: (+20)01159486891, E-mail: safwata47@yahoo.com

ABSTRACT
Background:
Systemic lupus erythematosus (SLE) is a chronic autoimmune illness with an unknown cause.
Autoantibody generation and probable involvement of practically every organ are hallmarks of SLE. There have been
reports of significant regional variations in SLE prevalence. This difference is probably brought on by a number of
sociodemographic factors, including ethnicity, geography, social support, medication compliance, environmental and
occupational factors, as well as race and ethnicity. SLE generally affects women more frequently than it does men. But
the severity of a disease is significantly impacted by gender difference.
Objective: The study's goals were to look at the impact of age at onset and gender on illness features.
Patients and methods: This was a prospective cross-sectional study carried out in Assiut University Hospital, Internal
Medicine Department, registered in Clinical trial.gov: NCT04234633. SLE diagnosed based on criteria were recruited.
Results:
Our study included 185 patients, 75 were males and 110 were females. It revealed that there was statistically
significant increase in alopecia and arthritis in the female group while increased incidence of nephritis and
thrombocytopenia in the male group. Also, male patients have higher Systemic Lupus International Collaborating
Clinics/American College of Rheumatology Damage Index (SLICC DI) compared to females. On the other hand, there
was no difference between the two groups regarding other manifestations of SLE, serological markers or severity
indices. Conclusion: We concluded that gender could influence the clinical picture of SLE and the outcome.
Keywords: Systemic lupus erythematosus, Gender influence, Nephritis, Male lupus.

INTRODUCTION
according to the SLICC/American College of
Systemic
lupus
erythematosus
(SLE)
Rheumatology-Damage Index (SLICC/ACR-DI) [6].
commonly occurs in females at reproductive age which
Inclusion Criteria: We included male and female
implicates that sex hormones play an essential role in
patients with SLE 18 years old diagnosed with SLE
disease pathogenesis. The risk of SLE flare is 1.34 times
more with hormone-replacement therapy, it illustrates
Exclusion Criteria:
how sex hormones affect disease activity. Moreover,
We excluded SLE patients with drug-induced lupus,
low levels of dehydroepiandrosterone (DHEA) and
discoid lupus without systemic manifestations and
estrogen formation, have been linked to a propensity for
pregnant women. In addition to patients with major
SLE [1]. In comparison to those during childbearing
comorbidities or concomitant malignancies.
years, the female to male SLE ratios in prepubertal and
Ethical approval: The Academic and Ethical
postmenopausal women range from 2 to 6:1 and 3 to
Committee of Assiut University approved the study. All
8:1, respectively. At the clinical level, when women and
participants gave signed informed permission after
men exhibit different characteristics, the sex disparities
being told of the study's goal. The worldwide medical
in illness vulnerability are evident. Numerous research
association's code of ethics, the Declaration of Helsinki
on progressive systemic sclerosis (PSS), multiple
for Humans, was adhered to throughout the course of
sclerosis, systemic sclerosis, and rheumatoid arthritis
this study. The study was registered on
have emphasised sex variations in disease presentation
ClinicalTrials.gov Identifier: NCT04234633
with relation to disease severity, symptoms, or
comorbidities [2]. When compared to controls of the
Statistical analysis: Version 24 of the Statistical
same age, SLE patients were shown to have a lower
Package for the Social Sciences (SPSS) was used to
relative mortality risk when they had low female sex
analyse the data. The mean ± standard deviation (SD),
hormone levels at the time of the disease's beginning [3].
median and range were used to convey quantitative
In terms of clinical symptoms and prognosis, male sex
data. Frequency and percentage were used to convey
has been linked to a more severe type of SLE [4].
qualitative data. When comparing two means, the
The goal of this study was to elucidate the
independent-samples t-test of significance was used.
impact and the prognostic effect of age at onset and
Chi-square test was performed to compare qualitative
gender on SLE severity and manifestations.
data. P-values under 0.05 were regarded as significant.
PATIENTS AND METHODS
RESULTS
The current study was conducted at Internal
Demographic data of studied participants
Medicine Department of Assiut University Hospital,
according to gender (Table 1): We found statistically
Assiut, Egypt. It enrolled patients with SLE. Disease
significant increased BMI in female group when
activity for each patient was determined using Systemic
compared to male group. The smoking status was
Lupus Erythematosus Disease Activity Index
significantly higher among the male group as compared
(SLEDAI) [5]. Organ involvement was also defined
to the female group.
2265
Received: 19/09/2022
Accepted: 22/11/202

Full Paper (vol.902 paper# 42)


c:\work\Jor\vol902_43 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2270-2274

Evaluation of C-Arm Drapes Contamination in Orthopedics Theatre
Ahmed A Makl ad1,2, Amel G Elsheredy 1, Eglal A El Sherbeny 1, Abdullah S Hammad2,3
Microbiology Department, Medical Research Institute, Alexandria University, Alexandria City, Egypt.1
El Hadra University Hospital, Alexandria University, Alexandria City, Egypt.2
Orthopedic Surgery and Traumatology Department, Faculty of Medicine,
Alexandria University, Alexandria City, Egypt.3
Corresponding author: Ahmed Ali Maklad, Email:Mri.Ahmed.Microbiology18@alexu.edu.eg,
Cellular phone: +201220200930, ORCID no.: 0000-0003-2834-8677
ABSTRACT
Background
The difficulty encountered during the imaging manoeuvring is to keep both ends of the C-arm well
covered with sterile drapes without disturbing the integrity of the surgical field and de-sterilizing the surgeon or the
instruments. The C- arm drape contamination may carry additional source of surgical site contamination and infection.
Patients and Methods: Forty-six orthopedic operations were carried out at Orthopedic referral major hospital with the
use of C-arm, swabs were collected from C-arm draping preoperatively and postoperatively to evaluate C-arm draping
contamination. This was correlated with operations time, traffic in the operating room, door opening frequency during
surgery and C-arm Lateral position frequency. The level of contamination was determined according to type of species
isolated. Result: Both C- arm tube and intensifier were sterile before almost all operations, but C- arm tube became
contaminated postoperatively in 87 % of operations performed. The most isolated species were Coagulase Negative
Staphylococcus (CONS) . The mean time of the operation, lateral frequency of C- arm, person number within operation
room, and door opening frequency were higher in one species and two species groups than no growth group (>100
minutes, p=0.002), (>7 times, p <0.001), (> 5 persons/hr, p <0.001), and (>10 door openings, p <0.001) respectively.
Conclusion: From the present study, we concluded that C-arm drapes carries an inherent contamination risk that can
spread to an operational area; in particular, with long duration of the operation, frequently lateral positioning of c-arm,
presence of a greater number of personnel in the operating room and high door opening frequency during the surgery.
Keywords: C-arm, Orthopedic Surgeries, Draping, Surgery time, Lateral frequency.

INTRODUCTION

MATERIAL AND METHODS
Despite use of the most current techniques to
This study was carried out at Orthopedic referral
minimize contamination during surgery (e.g., laminar
major hospital. Facility Review Board Approval was
flow operative rooms, ultraviolet lighting, sophisticated
obtained prior to samples collection. Among 46
implant sterilization, peri-operative antibiotics, and
orthopedic operations performed on 35 patients -multiple
modern surgical preparation and draping procedures),
procedures for one patient- with the use of C-arm. Swabs
postoperative infection still occur and it is a morbid
were collected from C-arm draping preoperatively and
complication, frequently leading to multiple operations,
postoperatively to evaluate C-arm draping contamination
long-term use of antibiotics with their associated side
in relation to operation time, traffic of operating room,
effects, pain, and potential prolonged disability (1-3).
door opening frequency during surgery and C-arm
Since the introduction of intra-operative
Lateral position frequency.
fluoroscopy in the 1950s, no standard draping method or
drape has been devised to protect the integrity of the
Study Duration: Study was conducted within time
sterile field while the lower portion of the C-arm (x-ray
period of September 2019 to March 2020.
tube) repeatedly rotates from the unsterile zone into the
Sampling Exclusion Criteria: Exclusion criteria were
sterile field (4).Operative fracture care frequently involves
non-use of a C-arm, using C-arm without skin incision or
the use of intraoperative imaging, with fluoroscopy being
draping, Secondary draping (re-draping during surgery
most common in imaging to a controlled reduction of
due to surgical field breach).
long bone fractures and accurate placement of internal or
C-arm model: General Electric Model (OEC 9800) Plus
external fixation devices, requires numerous changes and
mobile fluoroscopic imaging systems were used (General
re-adjustments of the C-arm position are necessary to
Electric Company TM, Fairfield, CT).
obtain the desired views. The difficulty encountered
Surgical Drapes type: Non-woven disposable drapes.
during the manoeuvring is to keep both ends of the C-
arm well covered with sterile drapes without disturbing
Sample Collection: Two swabs locations (tube and
the integrity of the surgical field and de-sterilising the
intensifier) were chosen because they were most likely to
surgeon or the instruments (5-7).
get in touch with the surgeon and have a higher degree of

contamination reported. The centers of C-arm tube and
Aim of this study: was to evaluate the level of C-arm
intensifier drapes were determined and area of 3 cm X 3
draping contamination in correlation with operation time,
cm was swabbed with cotton swab. Swabs were
frequency of lateral positioning of C- arm, traffic in the
transported to a local laboratory immediately (Medical
operating room and door opening frequency.
Research Institute). The swabs were cultured on blood,
MacConkey's and Sabaraud's agar plates. The plates

2270
Received: 22/09/2022
Accepted: 25/11/2022

Full Paper (vol.902 paper# 43)


c:\work\Jor\vol902_44 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2275-2282

Antibacterial and Antibiofilm Activity of Calcite (CaCO3)
Nanoparticles Synthesized from Chicken Eggshell
Mundher H. Al-Azzawi* and Esam J. Al-Kalifawi
Department of Biology, Collage of Education for Pure Science (IBN Al- Haitham), University of Baghdad, Baghdad, Iraq
Corresponding author: Mundher H. Al-Azzawi, Tel: +964771866751, Email: monzer.hussein1202a@ihcoedu.uobaghdad.edu.iq

ABSTRACT
Background: The Calcite Calicium Carbonate Nanoparticles (CaCO3NPs) synthesized from the chicken eggshell (CES),
this was done by crushing the shell and sieving.
Objective: The aim of the current study is to find a way to benefit from CES residues and the possibility of exploiting them
in the production of CaCO3NPs, which is used in many medical applications.
Material and methods: A hundred burn wounds samples were collected from several clinical sources. A total of 60
bacterial isolates were obtained from the burn wounds. CaCO3NPs has effective antibacterial activity; the inhibition zone
was 12 mm for Acinetobacter baumannii, Proteus mirabilis and Staphylococcus aureus, 13 mm for Escherichia coli, 11
mm for Klebsiella pneumoniae, 14 mm for Burkholderia cepacia, and Pseudomonas aeruginosa.
Results: The results showed that the MIC for A. baumannii was 25 µg/ml. The same MIC values were for K. pneumoniae
and S. aureus, while B. cepacia, E. coli, P. mirabilis, and P. aeruginosa have the MIC was 6.25 µg/ml. The present study
shows the efficiency of CaCO3NPs to prevent the biofilms of Gram negative and Gram-positive isolates.
Conclusion: Synthesized CaCO3NPs from the chicken eggshell have biological effectiveness and it can be used in dental
fillings and bone repair.
Keywords: Burn wound, Pathogenic bacteria, Chicken eggshells, CaCO3NPs, Antibacterial activity, Antibiofilm activity,
University of Baghdad.


INTRODUCTION

Chicken eggs are a vital portion of the daily human
The current study aimed to find a way to benefit
food worldwide and serve as an economical and high-
from ES residues and the possibility of exploiting them in
grade nutritious food (1). An eggshell is the external shell
the production of Calcium carbonate nanoparticles
of a rigid-covered chicken egg, which contains generally
(CaCO3NPs), which is used in many medical applications.
of CaCO3 with certain proteins, additional minerals and

organic membranes (2). The total egg producing has grown
MATERIALS AND METHODS
from 61.7 million tonnes in 2008 to 76.7 million tonnes
Sample Collection: A hundred burn wounds samples
in 2018, as maintained by data from the FAO (3).
were collected from several clinical sources, including the
The producing eggs in Iraq increases yearly; the
Burn Center / Yarmouk Teaching Hospital, educational
amount of eggs was 55,920 tonnes in 2020. The ES waste
laboratories / Burns Specialized Hospital in Medical City,
is only used at the level of scientific research, and the
Al-Kadhimiya Teaching Hospital, Imam Ali Hospital
remaining quantities of ES waste are thrown into landfills
(peace be upon him) and Al-Sadr Hospital at different
sites without any pretreatment (4).
ages and for the period between October 17th, 2021 to
Managing the large amounts of ES rubbish per year
January 10th, 2022. The burn wounds samples were
produced in the world is a trouble as generally this
cultured on different media for the purpose of isolation
material is only thrown at landflls with smell output and
and initial diagnosis of pathogens bacteria.
microbial propagation. Environmental pollution resulting

from throwing ES in the landfill, such as the release of
Isolation and identification of pathogens bacteria:
nushadir (NH3) and kibritid alhaydrujin (H2S) and
Burn wounds samples were inoculated on different media
unpleasant odors, which attract rodents and insects (5).
and incubated at 37ŗC for 24 hours. For further phenotypic
CaCO3 as an intact natural mineral has been used in
characteristics, isolates were sub cultured on (Eosin
a broad scale of applications including medicine,
methylene blue, CHROMagar Orientation). Then, isolates
manufacturing, and nanotechnology (6). CaCO3 of
were subjected to Gram stain and biochemical tests
eggshell is fundamentally used as a diluent in rigid potion
including IMViC (indole, VP, MR, citrate), oxidase,
forms in a medicinal excipient (7). CaCO3 it's also used as
catalase, urease and Kligler iron agar tests. Identification
consumption as a ground for pharmaceutical and dental
of isolates was confirmed by Vitek2 compact system
productions, buffering and disintegration aid in
according to manufacturer's instruction (9).
dissolvable tablets, as well as a food additional and

calcium enhancer (8).
Preparation of chicken eggshells powder: The chicken

eggs powder prepared according to (10).
2275
Received: 22/09/2022
Accepted: 25/11/2022

Full Paper (vol.902 paper# 44)


c:\work\Jor\vol902_45 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2283-2289

Evaluation of Foveal Avascular Zone and Macular Vessel Density in Patients with
Systemic Hypertension Using Optical Coherence Tomography Angiography
Maha Mohamed Abd El Fatah Ebraheim, Elham Abd El Azeem Mohamed,
Osama Mohamed Kamal, Hamdy Ahmed El Gazar, Taher Kamel Eleiwa
Department of Ophthalmology, Faculty of Medicine ­ Benha University, Egypt
*Corresponding author: Maha Mohamed Abd El Fatah, Mobile: (+20) 01026827241, E-Mail: maha.abdelfatah5519@yahoo.com

ABSTRACT
Background:
Hypertension (HTN) affects cardiovascular, renal and neurological systems. The poorly controlled blood
pressure may also cause structural and functional retinal damage. Objective: To assess changes in foveal avascular zone
(FAZ) and macular vessel density using Optical Coherence Tomography Angiography (OCTA) in hypertensive patients.
Patients and Methods: This case control observational study was performed on 120 eyes, divided into 3 groups. Group
A: 40 eyes of 26 patients with HTN for more than 10 years, group B: 40 eyes of 22 patients with HTN less than 10
years, and group C: 40 eyes of 20 normal subjects with completely normal ophthalmological examination. All
participants underwent OCTA.
Results: There was no significant variation in age, gender or FAZ between the three studied groups. Superficial capillary
plexuses in parafovea, parafovea superior hemi, parafovea inferior hemi, perifovea, perifovea superior hemi, and
perifovea inferior hemi were considerably higher in group C than in group A (p =0.002, 0.001, 0.011, 0.014, 0.041, and
0.002, respectively) and group B (p <0.001). Deep capillary plexuses in parafovea, parafovea superior hemi, parafovea
inferior hemi, perifovea, perifovea superior hemi, and perifovea inferior hemi were considerably higher in group C than
in group A (p <0.001), and group B (p =0.004, 0.004, 0.003, 0.002, 0.001, and 0.003, respectively). No significant
difference were observed in the studied parameters between group A and B.
Conclusion: Eyes of HTN patients have lower macular vessel densities (superficial and deep ) compared to those of
healthy controls. The duration and control of hypertension didn't account any substantial differences between the two
groups of hypertensive patients.
Keywords: FAZ; OCTA; HTN; Macular Vessel Density.

INTRODUCTION

examined OCTA-derived data like region, vessel
Systemic hypertension increases risk of ischemic heart
density (VD) and foveal avascular zone (FAZ) (11,12).
diseases, ischemic brain disorders and renal failure (1).
The FAZ is a capillary-free zone in the center of the
The prevalence of hypertension was estimated up to
macula , and its measurement has an important role for
59% in Egypt (2). It is characterized by structural and
the diagnosis and treatment of a lot of retinal diseases
functional abnormalities in the microcirculation,
(13,14).
including microvascular rarefaction and diminished
Tan et al. (15) recent meta-analysis had been done to
circulatory efficiency, which eventually result in organ
analyze macular vessel densities (SVD, DVD) and
failure (3).
foveal avascular area in hypertensive patients. It
In HTN patients, elevated systemic arterial pressure is
revealed lower SVD and DVD and larger FAZ than
related to anatomical and functional retinal
control group.
abnormalities. Arteriolar narrowing, arteriovenous
This study investigated FAZ and macular VD changes
nicking, retinal hemorrhage and optic disc swelling are
using OCTA in systemic HTN patients, and test whether
examples of retinal injury (4).
the duration and control of hypertension could affect the
Forty four percent of those evaluated for hypertension-
studied parameters or not.
related issues developed retinopathy (5). Retinal

hypoperfusion was also seen in hypertensive individuals
PATIENTS AND METHODS
with inadequate blood pressure (BP) management (6).
This case control study was carried out on 120 eyes of
Before permanent organ damage develops, imaging and
68 patients recruited from Ophthalmology and Internal
clinical tests can identify these changes in hypertensive
medicine Outpatient clinics at Benha University
individuals (7). Consequently, retinal microvascular
Hospitals.
changes may be an effective predictor of HTN-related
Cases were divided into three groups: Group A consists
organ damage and a sign that hypertensive individuals
of 40 eyes of 26 patients with HTN for over a decade.
require adequate hypertension control (8).
Group B: 40 eyes of 22 patients with HTN for less than
One of the techniques that analyses retinal
10 years. Group C: (control group):40 eyes of 20 normal
microvasculature with high resolution is optical
people having an ophthalmological examination that
coherence tomography angiography (OCTA) with no
was fully normal.
need for dye injection (9).

The OCTA is being used to assess several retinal
Inclusion criteria:
vascular diseases, including diabetic retinopathy and
Patients with HTN (Groups A & B).
choroid neovascularization (10). Numerous studies have
2283
Received: 20/09/2022
Accepted: 23/11/2022

Full Paper (vol.902 paper# 45)


c:\work\Jor\vol902_46 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2290-2295

Predictive Value of Vital Signs at Presentation in Individuals with
Severe Traumatic Brain Injuries
Mai Hussein Abd El-Azzeim1*, Hanaa Fahmy Abd El-Aziz2, Mohamed Amin Ali 1,
Mohamed Fawzy Abd El-Aal1, Alaa Dessoky Mohamed1
1 Department of Emergency Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
2 Department of Clinical Pathology, Faculty of medicine, Suez Canal University, Ismailia, Egypt
Corresponding author: Mai Hussein Abd El-Azzeim, Mobile: 01028698418, Email: mai.hussein@med.suez.edu.eg

ABSTRACT
Background: Throughout the world, traumatic brain injury (TBI) is a leading cause of mortality and morbidity. It can be
brought on by a variety of factors, including falls from great heights, gunfire, and traffic accidents. The number of injuries
being treated in the emergency room is rising, and in severe trauma cases, the fatality rate might be as high as 50%.
Objective: To improve the outcome of TBI patients by analyzing the vital signs at presentation and their role as a predictor
to the outcome in patients with isolated TBI.
Methods:
Prospective analytical study that included 110 adult traumatic patients presented to Emergency Department in
Suez Canal University Hospital with severe TBI.
Results:
Studying of the demographic data of both groups showed that most of cases 75 (68%) are males, while females
were only 35 (32%). The average heart rate was higher (100 beat/min) in cases with bad outcome compared to (89 beat/min)
in cases with good outcome. The mean respiratory rate was higher (22 breath/min) in cases with bad outcome compared to
(20 breath/min) in cases with good outcome. Both mean systolic and diastolic blood pressure were lower in cases with bad
outcome than in cases with good outcome. Measured oxygen saturation was much lower (mean 91.6 %) in cases with bad
outcome at presentation compared to 95.9 % in cases with good outcome.
Conclusion:
Tachycardia, tachypnea, hypotension and lower levels of oxygen saturation were evident in cases with bad
outcome in sever TBI patients.
Keywords:
Vital signs, Outcome, TBI.

INTRODUCTION

PATIENTS AND METHODS
Traumatic brain injury (TBI) is a form of acquired
The current prospective analytical trial included 110
brain injury caused by rapid trauma to the head. TBI
adult trauma patients who had severe traumatic brain
happens when the head strikes something suddenly and
injuries and had gone to the Emergency Department, Suez
violently or when something pierces the skull and enters
Canal University Hospital. All patients included in the
the brain tissue (1). It is one of the primary causes of
study were subjected to the following:
mortality and morbidity worldwide (2). Secondary brain
Personal data: Name, age, sex, residence, phone
damage caused by malfunctioning neurons as a result of
number & mechanism of trauma.
trauma-induced oxidative stress, ischemia, edoema, and
Vital signs at presentation: HR, RR, BP,
inflammatory response is curable even though basic brain
temperature, oxygen saturation and random blood
damage is irreversible (3).
sugar
The medical personnel are unable to handle all
Outcome: At 7 and 28 days, the 8-point Extended
cases of injury during war conditions because of the rising
Glasgow Outcome Score was used. The 6-month
number and variety of injuries that are being brought to
outcome analysis did not include participants who
the emergency room. The initial step in such a case is
withdrew their consent to the trial. Patients with
typically classifying and addressing the injuries according
GOSE 2-4 or death were considered to have a
to their risk. We need a simple, quick, and reliable
poor result (Table 1).
prognostic scale in order to complete this phase (4).

Predicting the prognosis of critically sick trauma
Ethical approval:
patients using widely accessible, easily obtainable,
Both the Institutional Review Board [IRB] and The
uncomplicated, and reproducible clinical data points is a
Local Committee of Ethics approved the protocol of this
key research target that has not yet been satisfactorily
research in the Department of Emergency Medicine,
addressed. Vital signs can be used as markers of trauma
Faculty of Medicine, Suez Canal University.
severity and to identify individuals who need additional
Informed written consent was taken from all patients.
treatment and are at risk for bad outcomes because they

are regularly measured in all cases at presentation and are

simple to obtain quickly (5).



2290
Received: 24/08/2022
Accepted: 27/10/2022

Full Paper (vol.902 paper# 46)


c:\work\Jor\vol902_47 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2296-2302

SNP in Tumor Necrosis Factor-Alpha (-308 A/G) Gene
Association with HCV Infected Thalassemia Patients
Hiba A. Malallah1*, Athraa J. Al-Shemmary2, Marwa H. AlMmuhammady1,
Adhwaa H. Jaber1, Abbas R. Al-Mashhadi3
1Department of Medical Laboratory Techniques, Imam Ja'afar Al-Sadiq University, Al-Najaf, Iraq,
2 College of Medicine, Jabir Ibn Hayyan Medical University ,Al-Najaf, Iraq,
3College of Medicine, Kufa University, Al-Najaf, Iraq
*Corresponding author: Hiba A. Malallah, Mobile: (+964) 7829661644, Email: hiba.amar@sadiq.edu.iq,

ABSTRACT
Background:
Hemoglobin can develop abnormally as a result of hereditary blood illnesses called thalassemia that
are inherited from a person's parents. Objective: The goal of this study was to identify the tumor necrosis factor alpha
(TNF-) A/G polymorphism and correlate TNF- serum levels with illness progression.
Patients and methods: Eighty cases with beta-thalassemia who had been diagnosed at the thalassemia center at Al-
Zahra Hospital in Al-Najaf province, Iraq participated in a case-control study with 40 healthy individuals serving as
the control group. The 80 individuals were divided based on HCV status. From 50 seropositive hepatitis C virus
(HCV) patients, 19 had IgG positivity, 15 had IgM positivity, and 16 had both IgG and IgM positivity. All patients
and the control group had blood samples taken. DNA from blood was taken to be utilized in PCR to find the TNF-
A/G polymorphism. TNF- levels were assessed using an ELISA test.
Results: The findings explained why HCV-infected individuals had high significant rates of thalassemia than non-
infected ones. The findings showed that in thalassemia patients, AA genotype and A allele are risk factors for severity,
whereas GG genotype and G allele are protective factors for severity.
Conclusions: The findings showed that having an AA genotype increases your chance of contracting HCV. This
study also demonstrated a considerably higher level of TNF- in thalassemia patients compared to controls, as well
as a significantly higher level of TNF- in thalassemia patients who also had HCV infection compared to controls
and patients without HCV infection.
Keywords: Thalassemia, TNF-, SNP, HCV, PCR.

INTRODUCTION
responses such as proliferation, differentiation,
Genetic blood disorders known as thalassemia
lymphocyte activation, survival, and death. They are
can cause faulty hemoglobin formation and are
regulatory proteins produced by many different cell
inherited from a person's parents (1,2). Alpha and beta
types, including monocytes, lymphocytes, antigen-
Thalassemia are the two primary kinds (1). The Middle
presenting cells, fibroblasts, and endothelial cells (9).
East region, Africa, the Indian subcontinent, and South-
Different cytokines' pro- and anti-inflammatory
East Asia all have high rates of thalassemia (3).
activities, which are encoded by single nucleotide
Thalassemia affected 208 million individuals globally
polymorphisms (SNPs), may alter the outcome of HCV
in 2013, with 4.7 million suffering from a severe
infection (10,11).
version of the ailment (4). Diagnosis is typically reached
The host immune response to HCV infection is
through the use of blood tests, a complete blood count,
mainly reliant on tumor necrosis factor alpha (TNF-),
specific hemoglobin tests, and genetic investigations (2).
a strong antiviral cytokine located on chromosome 6
Hepatitis C virus (HCV) infection is one of the
(12,13). Hepatocytes infected with the virus stimulated its
primary causes of chronic liver disease worldwide. This
production (5). Patients with chronic HCV infection
dangerous illness infects around 180 million
exhibited increased liver TNF- levels, demonstrating
individuals, with 20-40% of infected persons clearing
that viral hepatitis infection stimulates human
the virus naturally and the remaining sustaining chronic
hepatocytes to generate TNF- (12).Interferon-gamma
Hepatitis C infection (6). Transmission can occur by
(IFN-) levels may influence antiviral medication
contaminated blood or blood products, infected
outcomes in HCV patients. Furthermore, it was shown
syringes, or organ transplants (6,7). HCV seroprevalence
that IFN- modulates IFN-gamma treatment by
varies from 1 to 3% worldwide, but can reach 85% in
interfering with Janus Kinase-Signal Transduction and
high-risk populations such thalassemia, hemodialysis,
Activator of Transcription (JAK-STAT) signaling
and hemophilia (8).
pathways (11). Immunogenetics has attributed a
One of the most prevalent transfusion-related
considerable influence on heredity in the host immune
infections
among
multi-transfused
thalassemic
system's response to infections (10).
(inherited hematological condition) patients who
The TNF- promoter single nucleotide
require multiple blood transfusions to survive is HCV
polymorphisms (SNPs) located at locations -863, -308,
infection. The pathophysiology of liver infection, as
and -238 are of particular interest among the many
well as the intricate connection between HCV and its
promoter SNPs examined in connection to HCV
host, are now well recognized.Cytokines are low-
infection. The TNF- 308 SNP was discovered to be
molecular-weight proteins that regulate immunological
intricately connected to HCV infection and its effects
2296
Received: 04/08/2022
Accepted: 06/10/2022

Full Paper (vol.902 paper# 47)


c:\work\Jor\vol902_48 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2303-2307

Immunological Assessment of Human Adenosine Deaminase Activity in
Iraqi Female With Thyroid Autoimmune Disease
Afrah Hammoodi Abed*, Maha Fakhry Altaee
Biotechnology Deartment, College of Science, University of Baghdad, Iraq
Corresponding author: Afrah Hammoodi Abed, Phone: 9647519357673, Email: ghamoodi2018@gmail.com

ABSTRACT
Background:
Human Adenosine deaminase is an essential enzyme for modulating the bioactivity of thyroid hormones, and
It is important for the maturation and differentiation of lymphocytes, although its clinical importance in thyroid diseases
have yet to be identified. Objective: The aim of the current study is to determine the Adenosine deaminase concentration
in healthy controls, and in autoimmune thyroid diseases such as Graves' Disease, and Hashimoto's Thyroiditis.
Patients and methods: A total of 183 serum specimens of 103 female patients with autoimmune thyroid diseases and 80
healthy control groups were included in this study and collected from the Baghdad Medical City, Iraq. Quantitative Human
Adenosine Deaminase ELISA kits were used to estimate concentration of serum Adenosine deaminase.
Results: There were a highly significant differences between thyroid patients and controls regarding TSH, T4 and adenosine
deamainase serum levels (P-value 0.000), while no significant differences were seen with T3. On the other hands, There
was a significant difference in adenosine deaminase protein level of autoimmune thyroid diseases patients in compared with
controls (8.39±4.74 vs. 6.99±2.411, P<0.05). The results also indicate that both of age and BMI shows significant
differences in patients compared with controls (42.63±12.97 vs. 38.94±12.82, P<0.05).
Conclusion: There were a highly significant differences between thyroid patients and controls in TSH, T4, Anti-TPO and
anti-TG, except T3.
Keywords
: Adenosine deaminase, Thyroid, Autoimmune Diseases, Graves' Disease, Hashimoto's Thyroiditis, ELISA, Case
control study, Baghdad Medical City.

INTRODUCTION

According to Bonnema and Hegedüs (4), a history of
Autoimmune thyroid diseases (AITDs) are the
goiter in one's family, particularly throughout childhood,
most frequent organ-specific autoimmune disorders
can lead to the development of a benign goiter.
(ADs), affecting around 2-5% of the population. There is
The enzyme adenosine deaminase, also known as
a large gender disparity between those affected, with 5­
ADA, is found in every human tissue despite its
15% of women affected compared to 1% of men.
polymorphic nature. In addition to regulating the levels of
Autoimmune thyroid disease is also referred to as AITD,
adenosine and serving as a general indicator of the
according to Leemans et al. (1). AITD manifests itself in
immune system in cells, ADA is necessary for the
a variety of ways, two of which being Hashimoto
differentiation and maturation of T lymphocytes. This is
Thyroiditis (HT) and Graves' Disease (GD). They both
the case even though ADA also plays a role in managing
represent a loss of immunological tolerance and share the
these levels. In addition to this, it acts as a broad
existance of cellular and humoral immune responses
indication of cellular immunity. In addition, ADA
against thyroid gland Ags, includes the reactive
accelerates the irreversible transformation of adenosine
infiltration of B and T cells, the generation of
into inosine, which is a critical step toward maintaining
autoantibodies, and then the manifestation of clinical
adequate amounts of adenosine. This mechanism is
symptoms. These are the most common factors that
necessary because levels of adenosine could potentially
contribute to hypothyroidism and hyperthyroidism,
go out of control (5). Kaya et al. (6) Several autoimmune
respectively, are HT and GD (2).
diseases, including psoriasis (7), autoimmune hepatitis (8),
The use of particular drugs, having a low birth
inflammatory bowel disease (9), and rheumatic disease
weight, and being exposed to an excessive amount of
(7,8,9), have been found to be associated with high serum
iodine are all environmental risk factors that might lead to
concentrations (10). In the meantime, a higher level of
the development of AITD. There is a correlation between
ADA enzymatic activity was found in the peripheral
the use of tobacco products, high levels of stress, and
white blood cells of GD patients and in the monocytes of
exposure to radiation and the development of this illness
HT patients (11). Insurgents led by Karbownik et al. (12).
(3). The presence of A history of thyroid disease in the
As a consequence of this, the levels of ADA in the serum
family is considered to be one of the most significant risk
have the potential to act as an indicator for the monitoring
factors. that contribute to an increased chance of getting
and evaluation of GD conditions. In addition, the
thyroid disease. If you have a female family within the
antithyroid drug propylthiouracil (PTU), which is
first degree who has thyroid disease, your risk is
administered orally, was found to significantly reduce
somewhat increased (mother, sister, or daughter).
epidermal ADA activity and alleviate psoriatic plaques in
2303
Received: 04/08/2022
Accepted: 06/10/2022

Full Paper (vol.902 paper# 48)


c:\work\Jor\vol902_49 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2308-2310
Reduction of IL-10 Serum Level after 4 Months of Pfizer-BioNTech Vaccine
Administration of 2nd Dose in Students at Al-Iraqia University
Ayaat A. Kadhim 1, Ahmed R. Abdullah 1, Arwa M. Alshuaikh 2
1 Medical Microbiology Department, Medical College, AL-Iraqia University, Baghdad, Iraq
2 Medical Microbiology Department, Medical College, AL-Nahrain University, Baghdad, Iraq
Corresponding author: Ayaat A. Kadhim,Email: Ayaat.a.kadhum@students.alairaqia.edu.iq,Tel: +9647705897280

ABSTRACT
Background:
Vaccination is considered to be the most significant kind of control over the pandemic. Currently, the in-
use Pfizer vaccine is considered to be the most effective prevention method to control this pandemic.
Aim: Our study aims to estimate serum levels of interleukin-10 in fully vaccinated students with the Pfizer/ BioNTech
vaccine after one month and four months.
Methodology: 90 Samples were randomly taken from two different groups of students from Al-Iraqia University, who
were Pfizer-BioNTech completely vaccinated. A 5 ml was drawn from 45 volunteered students after 1 month of
vaccination and the other 45 after 4 months of complete vaccination. Serological analysis was carried out for measuring
interleukin-10 of human serum by using the Human Interleukin-10 ELISA Kit. Demographic data were also collected
from participants including age and gender.
Results: The serum levels of Human Interleukin-10 after 2nd dose of the Pfizer/BioNTech vaccine have significantly
dropped in four months (P<0.05) compared with one month of administration.
Conclusion: Human Interleukin-10 serum levels significantly decreased in the 4th month of the 2nd dose of the Pfizer-
BioNTech vaccine.
Keywords: Interleukin-10, SARS-COVID-19, Pfizer-BioNTech vaccine, Medical students, Al-Iraqia University.

INTRODUCTION
inflammatory and autoimmune pathologies. IL-10
According to the WHO, until 2022 there were
inhibits antigen presentation and reduces the production
about six hundred thousand confirmed cases of COVID-
of inflammatory mediators (5).
19 reported globally, with approximately six million and
Further studies suggest that it might have a
a half deaths while Iraq recorded two million and four
potential role as a pro-inflammatory cytokine. It
hundred thousand COVID-19 infected cases besides
performs numerous activities, promotes or inhibits
twenty-five thousand deaths which placed Iraq third
inflammatory processes, and promotes immune response
among Eastern Mediterranean Sea countries that suffer
(6).
from COVID-19 (1).
This study aims to assess immune response in the
As vaccines have a dynamic role in providing
COVID-19 Pfizer BioNTech fully vaccinated students
adequate protection against infectious diseases by
from Al-Iraqia University after 1 and 4 months of the
provoking antigen-specific antibodies of long-term
vaccination by achieving the objective of estimating the
responding for plasma cells along with developing of
serum level of IL-10.
existed B- and cell and T-cells (2), the Pfizer-BioNTech

vaccine has been used to limit the worldwide spread of
MATERIALS AND METHODS
COVID-19.
Sampling
It's well-known that vaccines will change the
Two groups of ninety randomly selected
cytokines responses, which are small proteins important
volunteers were involved in our study; the First group
in cell signaling and have particular effects on cell
included forty-five volunteered students who accepted to
interaction or communication. Many cell populations
contribute 5 ml of their blood 30 days (one month) after
produce cytokines, but the chief producers are helper T
the administration of (Pfizer-BioNTech) 2nd dose of the
cells (Th) and macrophages. Proinflammatory cytokine
vaccine while the Second group which included also
is liberated mainly by stimulated macrophages to play a
forty-five volunteered students who accepted to give 5
significant role in inflammatory response regulation (3).
ml of their blood after 120 days (four months) of
Interleukin-10 is considered to be an anti-
administration of Pfizer-BioNTech vaccine.
inflammatory cytokine (4), it is generated by activated

immune cells, specifically monocyte/macrophage as well
The drawn blood was put inside a gel tube and
as T-cells, which acts vital roles in preventing
centrifuged for serum, after that, the serum was moved

2308
Received: 19/07/2022
Accepted: 21/09/2022

Full Paper (vol.902 paper# 49)


c:\work\Jor\vol902_50 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2311-2314

Intubation and Ventilation Challenges in COVID-19 Patients: Review Article
Omima Emad Eldin Mohammed*, Alshymaa Mahmoud Ahmed, Osama Salah El-Din Mahmoud, Asmaa
Saadeldeen Farghaly Gadallah, Doaa Mohamed Gad, Nehal Samir Esmaeel Elkadaby
Anaesthesia and Intensive Care Department faculty of medicine Sohag University, Sohag, Egypt
*Corresponding author: Omima Emad Eldin Mohammed, Mobile: (+20) 01093181802, Email: omimaemad2008@yahoo.com

ABSTRACT
Background:
COVID-19 infection, which appeared for the first time in December 2019 in China as a combination of
severe respiratory symptoms among which is pneumonia. A very common and severe complication of COVID-19 severe
illness is the respiratory failure or acute hypoxemic respiratory insufficiency. This complication requires ventilation
therapies to supply adequate oxygen for the patient. The World health organization (WHO) recommends the performing
of endotracheal intubation in hypoxemic respiratory failure patients with acute respiratory distress syndrome who
continue to have breathing problems however they received standard therapy of oxygen.
Objective: This study aimed to assess the challenges related to intubation and ventilation, when to start intubation and
how to deal with different outcomes and problems related to them.
Methods: These databases were searched for studies published between December 2015 and April 2022 that had been
peer-reviewed and had been published in English in the two databases: PubMed and Google Scholar. More synonymous
key words had been used for searching such as intubation and ventilation challenges, ICU, ARDS and COVID-19
patients. Documents written in a language other than English have been disregarded since no sources for interpretation
were discovered. Dissertations, conversations, conference abstract papers, and anything other than the primary scientific
investigations had been disqualified.
Conclusion: Early intubation is recommended over late intubation. The intensivist, ICU nurse, and respiratory therapist
(RT) are crucial team members to manage intubation and ventilation. Prone positioning is an important aspect to be
applied. Lung injury occurs often in serious COVID-19 patients due to the severe and protracted respiratory failure that
occurs in these patients. Majority of PE patients experience some degree of hypoxia as a result of ventilation-perfusion
mismatch and intrapulmonary shunting.
Keywords: Intubation and ventilation challenges, ICU, ARDS, COVID-19 patients.

INTRODUCTION
ventilation using an endotracheal tube is very common
COVID-19 infection, which appeared for the first
during COVID-19 outbreak (8).
time in December 2019 in China as a combination of

severe respiratory symptoms among which is
COVID-19 patients eligible for intubation and
pneumonia(1, 2).
ventilation
It has greatly spread with a high speed and marked
Taking the decision to intubate a patient with
by the World Health Organization (WHO) as a
COVID-19 is a complex one and depends on many
pandemic. As of 2nd January 2023, there have been
various
factors.
The
Chinese
Society
of
665,339,248 cases worldwide, with 6,698,470 deaths (3).
Anaesthesiology Task Force on Airway Management
The healthcare system is still facing a very dangerous
put the recommendations to intubate patients who don't
challenge to deal with this highly infectious virus (4).
show improvement in respiratory distress and oxygen
Many symptoms are associated with COVID-19
insufficiency or with a respiratory rate of greater than
infection ranging from mild symptoms to severe
30 per minute. Patients with poor oxygenation whose
symptoms and illness leading to mortality. Symptoms
partial oxygen pressure to fraction of inspired oxygen
of severe COVID-19 infection can occur very rapidly
ratio is less than 150 mmHg despite 2 hours of oxygen
leading to acute respiratory distress syndrome
flow therapy (9).
(commonly known as ARDS) and can lead to other
These suggestions are similar to those made in the
serious complication that end up with multi organ
surviving sepsis organization's guidelines, which state
failure and death. Therefore, it is critical to manage the
that intubation should be carried out if acute hypoxemic
severe cases of COVID-19 by ICU admission, follow
failure worsens despite receiving high flow nasal
up, diagnosis at the correct time and starting the
cannula (HFNC), conventional oxygen therapy, and a
treatment immediately (5­7).
trial of nasal intermittent positive pressure ventilation
A very common and severe complication of
(10). The World health organization recommends the
COVID-19 severe illness is the respiratory failure or
performing of endotracheal intubation is hypoxemic
acute hypoxemic respiratory insufficiency. This
respiratory failure patients with acute respiratory
complication requires ventilation therapies to supply
distress syndrome who continue to have breathing
adequate oxygen for the patient. Anesthetists and
problems however they received standard therapy of
intensive care health care team are at high risk of
oxygen.
acquiring infection as a result of aerosol producing
The consensus is to intubate patients whose acute
procedures such as intubation and extubation. Invasive
hypoxemic respiratory failure in ARDS caused by
2311
Received: 23/08/2022
Accepted: 26/10/2022

Full Paper (vol.902 paper# 50)


c:\work\Jor\vol902_51 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2315-2320

Helicobacter Pylori Associated Depression among Patients
Presenting with Epigastric Pain
Dina M. Mohamed*1, Hanan Elrassas2
Departments of1Internal Medicine and Gastroenterology and Hepatology and 2Psychiatry,
Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Dina Morsy Mohamed, Mobile: (+20) 01225872779, E-mail: drdinam@yahoo.com

ABSTRACT
Background
: Helicobacter pylori (H. pylori) infection is an extremely prevalent infection that has been connected to a
number of illnesses, including stomach cancer and peptic ulcer disease. Additionally, depression has been listed as a
widespread, expensive, and 13% prevalent public health concern. Despite the substantial link between depression and
H. pylori gastritis, few studies have looked at the connection between H. pylori infection and depression.
Objective:
In this study we aimed to assess the relation between depression and H. pylori infection.
Patients and methods: This was a case control study that included 150 patients with and without H. pylori infection,
patients were diagnosed by detection of H. pylori antigen in the stool, with assessment of presence and severity of
depression in all patients using depression score using PHQ-9 SCORE (Preliminary Psychiatric Assessment Using
Patient Health Questionnaire).
Results: Comparing both groups revealed highly significant increase in PHQ-9 score in group 1 patients with positive
H. pylori infection compared to group 2 patients with negative H. pylori infection with significant increase in the severity
of depression among H. pylori positive group
Conclusion:
H. pylori infection was significantly associated with depression and it is presence is related to the severity
of depression making assessment of the presence of gastrointestinal symptoms or dyspepsia is very important in patient
with depression.
Keywords: H. pylori infection, PHQ-9 score, Depression.

INTRODUCTION
thrombocytopenic purpura (1). According to various
H. pylori is gram-negative bacteria with spiral
socioeconomic categories and populations, H. pylori
shape that is 3.5 microns long and 0.5 microns broad,
infections are more common than others (10).
Its two to seven unipolar sheathed flagella allow it to
The emotional disorders in somatic diseases are
move through sluggish waters. With positive catalase,
frequent problems in internal medicine practice,
oxidase, and urease enzymes (1-2)which needed to live
numerous literature data suggest that there is strong
and colonise, it has to produce the plentiful urease
relation of anxiety disorders, stress or depression to the
enzyme, which makes up more than 5% of the bacteria's
somatic symptoms, the relation can undergo
total protein weight (3­4). Clinically, bacterial urease
potentalisation in case of appearance of other
activity is essential because it serves as the foundation
pathogenic factors like H. pylori infection (12-15), this
for conduct a number of invasive and non-invasive tests
relation confirmed with many scientific reports, with
used to identify H.pylori infection , which is known to
common use of antidepressants and anxiety-relieving
colonise in the antral area of the stomach mucosa (5).
drugs in duodenal ulcers diseases therapy(13-15).
H. pylori is a human gastrointestinal infection
Depression is the second most prevalent cause of
which is believed to be blamed for a number of gastric
disability-adjusted life years lost. It is a very common,
illnesses, from chronic gastritis to more catastrophic
crippling, and expensive public health problem. It
diseases such as stomach cancer. One of the most
results in a persistent low mood and a sense of
prevalent chronic bacterial illnesses affecting people is
hopelessness and has a number of risk factors. The
helicobacter pylori (6). According to estimates of the
connection between digestive tract diseases and
most common illness, H. pylori infection, affects at least
depression has been postulated for a very long time. In
50% of people worldwide (7).
fact, depression was discovered to be a risk factor for
H. pylori infection causes 75% of non-cardia
digestive tract diseases (16).
stomach cancers globally (3). Atrophic gastritis can
It is also likely that the effect of numerous stress
result from gastritis brought on by H. pylori. Atrophic
factors which injure the mucosa of the stomach,
gastritis can then proceed to gastric adenocarcinoma
including also psychological stress, depression
and mucosa-associated lymphoid tissue lymphoma,
disorders and anxiety, modify the immunity of patients
intestinal metaplasia, dysplasia, and neoplasia (5,8,9).
so that these patients become more sensitive to be
Additionally, H. pylori may be responsible for
infected with H. pylori. The infection becomes more
unexplained ulcer risk in people with functional
aggressive and leads to the manifestations of gastritis or
dyspepsia taking modest doses of aspirin or beginning
duodenitis and occurance of peptic ulcer disease (11).
treatment with non-steroidal anti-inflammatory drugs,
The literature reports(17, 18) suggests that the
unexplained anaemia from iron shortage, and idiopathic
presence of the chronic manifested H. pylori infection
2315
Received: 19/09/2022
Accepted: 22/11/2022

Full Paper (vol.902 paper# 51)


c:\work\Jor\vol902_52 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2321-2330

Role of High-Resolution Grey Scale and Power Doppler Ultrasonography in
Assessment of Ankle Joints of Symptomatic and
Asymptomatic Rheumatoid Arthritis Patients
Ahmed Farid Yousef1, Ahmed Fathy Abogamal2,
Hamada Mohamed Khater1, Mohamed Ahmed Baranek1*
1Department of Radiodiagnosis, Faculty of Medicine, Benha University, Egypt
2Department of Rheumatology, Faculty of Medicine, Al-Azhar University, Egypt
*Corresponding author: Mohamed Ahmed Baranek, Mobile: (+20) 01222579126, E-Mail: mbaranek@hotmail.com

ABSTRACT
Background:
Rheumatoid arthritis (RA) is a systemic autoimmune chronic inflammatory condition that may impact a
variety of organs and tissues, but mostly targets flexible (synovial) joints. Objective: The aim of the current study was
to assess influence of power Doppler ultrasound (PDUS) and high-resolution ultrasonography (US) in estimation of
ankle joints abnormalities in patients suffering RA with or without ankle joint pain. Patients and methods: A cross
sectional study was conducted on 100 participants presented with clinical diagnosis of RA, from the Rheumatology
and Rehabilitation outpatient clinic of Al-Azhar University Hospitals. Participants were subjected to a comprehensive
history, clinical examination by the referral to rheumatologist, laboratory tests, and high-resolution US and PDUS
examination. Results: Patients with symptoms had a considerably higher Disease Activity Score in 28 joints (DAS 28)
than those without symptoms (P<0.001). Patients without symptoms had a considerably greater prevalence of low
DAS 28 scores (P<0.001), but high score was considerably greater in symptomatic individuals (P=0.007).
Conclusion:
US enables rapid identification and precise detection of joint and/or tendon inflammatory involvement at
ankle level in individuals with RA. Clinicians should be recommended to utilize US more often to identify
pathological ankle problems.
Keywords: Rheumatoid arthritis, Grey Scale, High Resolution, Power Doppler Ultrasonography, Ankle Joints.

INTRODUCTION

[6].US has proven itself to be a useful imaging method
Rheumatoid arthritis (RA) is a systemic
for assessing articular and periarticular inflammation
autoimmune chronic inflammatory disease that may
in small and large joints throughout the last years.
impact a variety of tissues and organs, but mostly
High resolution musculoskeletal ultrasound (MSUS),
damages flexible (synovial) joints. The process results
incorporating power Doppler ultrasound (PDUS), has
in an inflammatory reaction of the joint capsule
demonstrated to be significantly more accurate than
(synovium) due to enlargement (hyperplasia) of
clinical evaluation in visualizing the inflammatory
synovial cells, extra synovial fluid, and the formation
process. Furthermore, relatively few studies have
of fibrous tissue (pannus) in the synovium [1]. In RA,
examined ankle joint involvement in individuals with
imaging modalities have played a significant function
RA who lack symptoms [3]. In RA, hyperemia
in monitoring development of the disease and therapy
generated by vasodilatation is one of the first visible
reaction for many years [2].Disease activity ratings,
pathologic changes at the onset of joint inflammation,
such as the Disease Activity Score in 28 joints (DAS
and angiogenesis, as one of the fundamental
28), involve big joints like knees and elbows but
requirements for pannus development, plays a
exclude ankle joints. Physicians have a tendency to
significant role in the start and maintenance of
neglect these joints, particularly during short clinic
synovitis [7].
appointment hours. Untreated silent inclusion of these
Doppler is crucial because greyscale US cannot
weight-bearing joints might develop to permanent
differentiate between thickened synovium owing to
problems and have a significant influence on gait and
inflammation and thickened synovium due to prior
mobility if left uncured [3]. Regardless of the
assaults [8]. Power Doppler imaging serves a crucial
underlying musculoskeletal disorder, the ankles are
function in assessing therapy response [9]. To avoid
weight-bearing joints that play a crucial role in the
joint injury from subclinical inflammation, power
balance
and
mobility
of
individuals
[4].
Doppler has been promoted for use in defining RA
Ultrasonography (US) is well adapted for
recovery [10].
investigations of the musculoskeletal system as
The aim of the current study was to assess
structures are frequently superficial, the individual
influence of power PDUS and US in estimation of
may be positioned comfortably, and contrasts with the
ankle joints abnormalities in patients suffering RA
contra-lateral side are available [5]. US technology
with or without ankle joint pain.
provides a number of intrinsic benefits. It is popular

PATIENTS AND METHODS

among patients since it is noninvasive, has a quick
A cross sectional study was conducted on 100
scan time, and does not emit radiation. There are
participants presented with clinical diagnosis of RA,
various benefits from the standpoint of the physician.
from the Rheumatology and Rehabilitation outpatient
It is not hampered by metal artefacts, which may be
clinic of Al-Azhar University Hospitals.
troublesome for magnetic resonance imaging (MRI)
2321
Received: 21/09/2022
Accepted: 24/11/2022

Full Paper (vol.902 paper# 52)


Effect of Heart Rate at Admission on Outcome of Patients Undergoing Primary Percutaneous Coronary Intervention The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2331-2338

Utilization of Left Atrial Size as An Independent Predictor of Cerebrovascular
Stroke in Patients with Sinus Rhythm and Preserved
Left Ventricular Systolic Function
Mohammad Gouda Mohammad, Ashraf AlSeed Dwedar,
Ahmed Reda Abdelrahman Marwad*, Islam Ghanem Ahmed
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Ahmed Reda Abdelrahman Marwad, Mobile: (+20)1278165817,
E-mail: ahmedmarwad007@gmail.com

ABSTRACT
Background:
The enlargement of the left atrium (LA) is thought to be a reflection of the long-term influence of
left ventricular (LV) filling pressure against the LA. There is a correlation between increased LA volume and the
risk of stroke and mortality.
Objective: The aim of the current work was to determine the significance of LA size in stroke prognosis in
patients of all ages who first presented with preserved left ventricular systolic function (LVSF) and sinus rhythm
(SR).
Patients and methods: This cross-sectional study included a total of 156 patients with acute ischemic stroke (AIS)
with suspected symptom onset within the preceding 24 - 48 hours. Patients were divided into 2 groups, group I
included 120 patients (76.9%) of cardio-embolic + large artery disease + small vessel disease patients and group II
included 36 patients (23.1%) of cryptogenic and undetermined patients. Echocardiography was performed for all
subjects.
Results: Highly statistically significant (p-value < 0.001) increased LA volume index in group II patients (37.4 ±
3.9) when compared with group I patients (33.3 ± 6.2). Using Roc curve, it was shown that LA volume index can
be used to discriminate between group I and group II at a cutoff value of > 37.5, with 52.8% sensitivity, 80.8%
specificity, 73.3% PPV and 63.1% NPV (AUC = 0.69 & p-value = 0.0005).
Conclusion: As a clinical tool, left atrial enlargement (LAE) may help determine the likelihood of a stroke and
guide decisions about how to treat those who suffer from ischemic stroke.
Keywords:
Left Atrial Size, Cerebrovascular Stroke, Sinus Rhythm, Left Ventricular Systolic Function.

INTRODUCTION


Even if sinus rhythm is present, the elderly are at
size of the patient's left atrium will rise as a result
increased risk for heart failure, atrial fibrillation (AF),
(LA)(5).
and stroke if their left atrium (LA) is enlarged (1).
The purpose of this study was to investigate
There is substantial evidence linking AF to
the impact of LA size as a predictor of stroke in
ischemic stroke; most of these strokes have been
participants f varying ages who initially presented
observed in patients who initially appeared to be in
with preserved left ventricular systolic function
sinus rhythm. Therefore, it has been hypothesized that
(LVSF) and sinus rhythm (SR).
greater LA size is linked to stroke in sinus rhythm

older adults (2).
PATIENTS AND METHODS
Having a larger LA increases the chances of
This cross-sectional study included a total of 156
having a stroke or dying. There is an elevated risk of
patients with acute ischemic stroke (AIS) with
stroke in those with an indexed LA volume of 32
suspected symptom onset within the preceding 24 -
ml/m2, and this higher risk persists after adjusting for
48 hours, attending at Neurology Critical Care Unit
age and other clinical risk factors for cerebrovascular
and Neurology Stroke Unit and studied at
illness. Even in senior people with no prior history of
Department of Cardiology, Faculty of Medicine,
ischemic neurological episodes, atrial fibrillation
Zagazig university hospital and Al-Ahrar teaching
(AF), or valvular heart disease, an enlarged LA is an
hospital, Zagazig.
independent predictor of a first stroke (3).
Patients were divided into 2 groups, group I
Size of the LA is thought to indicate the average
included 120 patients (76.9%) of cardio-embolic +
effect of left ventricular (LV) filling pressure over
large artery disease + small vessel disease patients
time. There is talk of using it as a diastolic pressure
and group II included 36 patients (23.1%) of
indicator as well (4).
cryptogenic
and
undetermined
patients.
Insufficient myocardial contractility or impaired
Echocardiography was performed for all subjects.
myocardial relaxation leads to a rise in left ventricular
Inclusion criteria:
(LV) filling pressure, which is the primary

pathophysiological component of heart failure. The
Patients who met the diagnostic criteria for

acute ischemic stroke (AIS) established by
the World Health Organization (6).
2331
Received: 16/09/2022
Accepted: 17/11/2022

Full Paper (vol.902 paper# 53)


Effect of Heart Rate at Admission on Outcome of Patients Undergoing Primary Percutaneous Coronary Intervention The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2339-2344

Use of Misoprostol versus Combined Misoprostol and Isosorbide Mononitrate for
Cervical Ripening before Surgical Evacuation of Early Missed Abortion
Hussein Mohammed Abdel Dayem, Taha Abdelfattah Ahmed,
Ahmed Hamdy Mohammed*, Ahmed Hassan Elmasrawy
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Hamdy Mohammed, Mobile: (+20)1025030506,
E-mail: ahmedh.mohammed89@gmail.com

ABSTRACT
Background:
Prior to a first-trimester abortion, a vaginal misoprostol administration has been shown to have less
adverse effects than either an oral or sublingual dose.
Objective: The aim of the current work was to determine whether a combined therapy with isosorbide mononitrate
and misoprostol for preoperative cervical ripening in the first trimester would result in improved clinical
effectiveness and fewer side effects compared with misoprostol used alone.
Patients and methods: This randomized clinical trial study included a total of 54 women with first trimester missed
abortion between 7-12 weeks, attending at Gynecologic Oncology Unit, Department of Obstetrics and Gynecology,
Faculty of Medicine, Zagazig University Hospitals. They were divided into two equal groups: Group I: included
27 cases received 400 µg misoprostol inserted in the posterior fornix 4 hours prior to the surgical evacuation. Group
II: included 27 cases received 20 mg isosorbide mononitrate and 200 µg misoprostol inserted in the posterior fornix
4 hours prior to the surgical evacuation.
Results: Both groups were effective in achieving cervical ripening in terms of effacement, dilatation and softening
but combination group was more effective than misoprostol group. The operative duration was statistically
significantly shorter in combination group than in misoprostol group. Colicky lower abdominal pain was statistically
significant and more prominent in group I (Misoprostol group) while headache was more significant in group II.
Conclusion: It could be concluded that combination of both misoprostol and NO donors makes a synergism in
action with fewer side effects. It softens the cervix and decreases its length with less operative time. It has less
abdominal pain than misoprostol alone
Keywords: Misoprostol, Isosorbide Mononitrate, Missed Abortion.

INTRODUCTION

misoprostol include nausea, vomiting, diarrhea,
A missed abortion occurs when the demise of the
abdominal cramps, chills, fever, and vaginal bleeding;
embryo occurs inside the uterus but is not noticed by
however, these effects are less severe than those
the mother and her medical provider. About 15% of
associated with oral or sublingual treatment (6).
all pregnancies with a clinical diagnosis fall into this
Nitric oxide donor isosorbide mononitrate may
category. The absence of a fetal heartbeat during a
be helpful for cervical ripening due to its effect on
prenatal ultrasound is the most common cause of this
prostaglandin E2 release and vasodilation in the cervix.
diagnosis before 20 weeks of pregnancy (1).
If used cautiously, it is safe, does not stimulate the
As a simple surgical technique with a high
myometrium, and causes few non-life-threatening
success rate (about 99 percent), uterine evacuation is
side effects (7).
an option for treating early missed abortions between
We aimed at this work to determine whether a
the ages of five and thirteen weeks. However, if
combined therapy with isosorbide mononitrate and
cervical ripening has not occurred beforehand, there is
misoprostol for preoperative cervical ripening in the
a higher risk of problems such cervical rupture, uterine
first trimester would result in improved clinical
perforation, and endometritis (2).
effectiveness and fewer side effects compared with
The clinical signs of cervical ripening are the
misoprostol used alone.
cervix becoming softer, effaced, and dilated (3).

Disintegration and dissolution of collagen in the
PATIENTS AND METHODS
cervical stroma is a hallmark of cervical ripening, and
This randomized clinical trial study included a
prostaglandins are a popular treatment option (4).
total of 54 women with first trimester missed
Misoprostol, a homologue of prostaglandin E1, is a
abortion between 7-12 weeks, attending at
particularly effective medication in the cervical
Gynecologic Oncology Unit, Department of
priming process (5).
Obstetrics and Gynecology, Faculty of Medicine,
In order to achieve the best possible balance
Zagazig University Hospitals.
between efficacy and adverse effects, research has

indicated that administering 400 µg g of misoprostol
The included subjects were randomly divided
vaginally 3-4 hours prior to a surgical abortion in the
into two groups; Group I (Misoprostol Group):
first trimester is the optimal dose and regimen. The
included 27 cases received misoprostol 400 g (2
most common unwanted effects of vaginal
2339
Received: 16/09/2022
Accepted: 17/11/2022

Full Paper (vol.902 paper# 54)


c:\work\Jor\vol902_55 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2345-2352

Study of Use of Shear Wave Elastography in Placental Dysfunction by
Comparison of Elasticity Values in Normal and Pre-eclamptic Pregnancies
Ahmed Mohammed Wafdy El Gebally, Ahmed AbdElaziz Elsammak,
Mona Mohammed Refaat, Omnia Emad Eldin Abd Ellatif*
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Omnia Emad Eldin Abd Ellatif, Mobile: (+20) 01277520204, E-Mail: omniaemad55@gmail.com

ABSTRACT
Background:
It has been believed that placental stiffness varies between normal and pre-eclamptic pregnancies.
In order to appreciate this difference, Share Wave Elastography (SWE) of the placenta was done to assess the degree of
placental stiffness. Objective: The aim of the current study was to evaluate the utility of SWE in detection of pre-
eclampsia and correlate the degree of placental stiffness with severity of pre-eclampsia and with perinatal outcome.
Patients and methods: A total of 76 pregnant females in second or third trimester were enrolled in the present study.
Half of them (38 females) had normal pregnancy with no history of medical disease and the second half (38 females)
had pregnancy complicated by pre-eclampsia. SWE was used for all cases.
Results: In pre-eclamptic placentas, the mean stiffness values were significantly higher across all regions and layers
compared to healthy controls. The central placental region showed the greatest disparity. A moderate correlation was
also found between the severity of pre-eclampsia and SWE data. Maximum diagnostic accuracy was achieved with a
cutoff of 18.47 kPa for the central placenta (area under the curve: 0.97; confidence interval: 0.88-1; sensitivity: 94.7%;
specificity: 94.7%; PPV 92.3; and accuracy: 94.7%). Regarding other obstetric and Doppler findings there was a
significant decrease in measured abdominal circumference AC and femur length FL among preeclamptic pregnancies
compared with the control group, together with abnormal Doppler indices with highly statistical significant increase of
resistive index of umbilical artery and significant decrease of resistive index of middle cerebral artery among pre-
eclampsia patients compared to the control group. Conclusion: Difference in placental stiffness between healthy and
pre-eclamptic pregnancies can be assessed using SWE, and it can be used for mentoring early perinatal outcome together
with routine obstetric and Doppler ultrasound study.
Keywords: Shear Wave Elastography, Placental Dysfunction, Pre-eclampsia.

INTRODUCTION

are just some of the many applications of SWE. In our
Preeclampsia is a prominent cause of maternal as
study we aimed to translate the placental shear-wave
well as perinatal mortality and morbidity, contributing
velocity into equivalent unit of stiffness (kPa) (3).
to premature birth in 5-8% of pregnancies and perinatal
The diagnostic utility of this method is now being
mortality in 1-3% of births globally (1).
investigated by comparing the elastic characteristics of
Pre-eclampsia is characterized by abnormal
healthy and diseased tissues (9).
development of uterine placental perfusion, an elevated
The aim of the current study was to evaluate the
inflammatory response, and endothelial dysfunction, all
utility of SWE in detection of pre-eclampsia and
of which can have negative effects on the developing
correlate the degree of placental stiffness with severity
fetus (2). The condition occurs after 20 weeks of
of pre-eclampsia and with perinatal outcome.
pregnancy while fetal impairment is primarily

correlated with gestational age at beginning of
PATIENTS AND METHODS
preeclampsia (3-5). The uterine artery Is abnormal
A total of 76 pregnant females in second or third
women who develop pre-eclampsia before 34 weeks of
trimester aged between 19 and 43 years old were
pregnancy often have abnormal Doppler readings, have
enrolled in the present study. Half of them (38 females)
babies with growth restrictions, and have a difficult
had normal pregnancy with no history of medical
pregnancy
and
delivery
(6).
Disseminated
disease and the second half (38 females) had pregnancy
coagulopathy/hemolysis elevated liver enzymes, and
complicated by pre-eclampsia that are diagnosed
low platelets (HELLP) syndrome, pulmonary edema,
clinically and by urine analysis then classified
acute renal failure, placenta abruption, and long-term
according to clinical severity of the disease into mild,
cardiovascular problems are all common complications
moderate and severe degree. All cases were referred
of severe pre-eclampsia in mothers (7). Elasticity is the
from the Obstetrics and Gynecology Department at
degree to which the rigidity of soft tissue fluctuates in
Zagazig University Hospitals, to Radio diagnosis
response to the physiologic and pathologic processes (8).
Department, Digital Ultrasonography Unit.
Shear waves are generated through a focused
Inclusion criteria:
ultrasonic push beam and then rapidly imaged,
1. Group I: 38 females who are at least halfway
measured by Young's modulus values, expressed in
through their pregnancies (not just the first
kilopascals. Breast, thyroid, prostate, kidney, spleen,
trimester) and who have a healthy baby and no
lymph node characterization, and liver fibrosis imaging
2345
Received: 21/09/2022
Accepted: 24/11/2022

Full Paper (vol.902 paper# 55)


c:\work\Jor\vol902_56 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2353-2358

Evaluation of Myocardial Tissue Doppler Echocardiography as a Predictor for
Recovery of Left Ventricular Function after Percutaneous Coronary
Revascularization for Patients with Coronary Artery Disease
Ahmed M. Fareed*, Ahmed S. Youssef, Mohamed A. Oraby, Ahmed S. Salem
Department of Cardiology, Faculty of Medicine, Suez Canal University, Egypt
*Corresponding author: Ahmed M. Fareed, Mobile: (+20)1282637291, E-mail: ahmed_ali1@med.suez.edu.eg

ABSTRACT

Background: The experiments show that pre-ejection velocity analysis is particularly sensitive to blood flow. After
reduced regional perfusion, tissue velocities drop, but they rise with reperfusion. Thus, following revascularization,
cardiac function recovery may be predicted using tissue doppler imaging (TDI).
Objective: The aim of the current work was to determine the effectiveness of tissue Doppler imaging
echocardiography in predicting the restoration of myocardial function in patients with coronary artery disease (CAD)
following percutaneous coronary revascularization.
Patients and Methods: Our study prospectively enrolled 27 patients. Only 24 patients completed the study protocol
while, unfortunately, three died during follow up. Included patients were diagnosed with CAD based on previous
diagnostic coronary angiography (CA) done before. They have impaired systolic function and regional wall motion
abnormality (RWMA) on transthoracic echocardiography (TTE) and were eligible for percutaneous coronary
intervention (PCI).
Results: From all Tissue Doppler Imaging-Pulsed wave (TDI-PW) derived parameters, only mean IVCPv and mean S
wave velocity of dysfunctional segments at baseline correlate significantly with changes in LVEF (global functional
recovery) with revascularization. The mean of both IVCPv and the S wave of defective segments varied significantly
at baseline among patients who showed significant improvement in LVEF 6 months after revascularization versus those
patients who didn't exhibit significant improvement (2.8±0.4 vs. 3.5±0.8 for IVCPv, and 4.5±0.9 vs 5.8±1.1 for S wave,
p value <0.05 and <0.01 respectively). There was significant moderate positive correlation between mean IVCPv and
mean S wave velocity at baseline and changes in LVEF (global functional recovery) with revascularization (p
value<0.05 and <0.01 respectively).
Conclusions: It could be concluded that in patients with CAD, the resting IVCPv & S wave by TDI pattern accurately
predicts the recovery of global systolic function with high pulse pressure variation (PPV) but not the regional function.
Keywords: Global systolic function, Tissue doppler imaging, Coronary artery disease.

INTRODUCTION

Myocardial viability could be assessed by
The primary cause of death globally now is
multiple modalities in patients with CAD. Nuclear
coronary artery disease (CAD) (45% of all
imaging and more recently cardiac magnetic resonance
Cardiovascular deaths) accounting for 12% of all deaths
imaging are expensive, and frequently inaccessible.
globally (1).
Low dose dobutamine echocardiography relies more on
Despite the debate aroused by ISCHEMIA trial
operator experience. 2-D echocardiography is the most
regarding revascularization of people with ischemic
prevalent imaging modality for the evaluation of global
heart disease who are stable (2), there is upward interest
and segmental ventricular function. However,
in percutaneous treatment of patients with recent or
conventional evaluation of wall motion by visual
recurrent acute coronary syndromes (ACS) due to
assessment of myocardial thickening is relatively
enhancements in observational evidence that effective
subjective, qualitative method, and is operator
treatment of CAD is connected to important changes in
dependent (8). Therefore, most of the currently used
heart function and outcome (3). The rationale for the
modalities for myocardial viability assessment are time
recanalization is the expected increase of recovery of
consuming, expensive or operator-dependent (9).
hibernating myocardium allows for the restoration of
Tissue Doppler imaging (TDI) makes it
left ventricular (LV) function (4).
possible to measure the velocities of myocardial tissue.
Since it was discovered that chronic left ventricular
To begin with, high temporal resolution measurements
dysfunction can be reversed and that the presence of
of the highest tissue velocities during systole and
viable myocardium is a predictor of LV dysfunction
diastole a chosen myocardial section were made using
improvement in CAD patients, the concept of
TDI to quantify myocardial motion (10-11).
hibernating myocardium, It is characterized as an
The pre-ejection phase myocardial velocity
ischemic myocardial fed by a constricted coronary
display by TDI typically consists of an initial A brief
artery, in which the ischemic cells are still alive but the
inward and outward wall movement is indicated by a
contraction is chronically compromised (5, 6), has made
positive wave that is followed by a little negative wave.
a significant contribution to clinical cardiology (7).
Pre-ejection velocity analysis is dependent on the blood
flow to the studied segment (12). Persistence of the initial
2353
Received: 17/09/2022
Accepted: 17/11/2022

Full Paper (vol.902 paper# 56)


c:\work\Jor\vol902_57 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2359-2362

Assessment of Plasma Jet Therapy of Tooth Root Canal Infected with
Escherichia Coli and Enterococcus Faecalis Biofilm In Vitro
Tamara A. Hameed1, Hammad R. Humud1, Layla F. Ali2
1Department of Physics and 2Department of Biology, College of Science, University of Baghdad, Iraq
Corresponding author: Tamara A. Hameed
Email: tamara.aboud1104a@sc.uobaghdad.edu.iq Mobile: +964772671768
ABSTRACT
Background:
Common and persistent isolate ina the teeth following failed therapy of the root canal is the gram-positive
facultative bacterium Enterococcus faecalis and Escherichia coli, which develop biofilm through a complicated process
that results in the formation of a biofilm. Enterococcus faecalis and Escherichia coli are significant factors that cause
chronic periradicular lesions after root canal therapy.
Aim: This study aimed to treat the root canal tooth infected with Escherichia coli and Enterococcus faecalis
Methods: In this study biofilm formation was done for Escherichia coli in growth phase cultured in a brain heart broth
Enterococcus faecalis and Escherichia coli cultured in Luria-Bertani (LB) infusion medium for 18 hrs. Then we studied
the effect of plasma jet that works with argon gas, and it is generated by a power supply that operates at alternating high
voltages in the form of a sinusoidal wave with peak-to-peak value of about 12 kV at a frequency of 30 KHz and its power
is about 200 watts.
Results: Enterococcus faecalis biofilms were treated for 0.5, 1, 1.5, 2, 2.5 minute with a constant gas flow rate 2.5 L/min.
The killing rate decreased from (0.979 to 0.361). In the Enterococcus faecalis biofilms was treated for a longer period of
time (5, 10, 15, 20, 25, 30) min, as the killing rates decreased from (0.739 to 0.179).
Conclusions: The result of this study indicates that plasma jet is useful in disinfecting root canal tooth and reducing the
formation of biofilm.
Keywords: Plasma jet, Enterococcus faecalis, Escherichia coli, Root canal tooth, Biofilm.

1. INTRODUCTION
Bacteria form a sessile microbial community known as a
Endodontic therapy's ultimate objective is to clear the
biofilm when they are encased in an extracellular
root canal system of the microorganisms and promote
polymeric matrix that they self-create. Because of the
apical periodontitis healing (1,2). Routine intracanal
changed bacterial phenotype and biofilm matrix, the
procedures, such as using mechanical instruments,
biofilm has a lower vulnerability to drugs and human
intracanal irrigants, and medications with antibacterial
immune responses. Bacterial biofilms are therefore
properties may be used to remove the majority of
thought to be frequent cause of many oral illnesses, which
pathogenic bacteria and their primary necrotic pulp debris
include the pulpitis, dental caries, damage of the root canal
substrate. However, both single- and multiple-visit root
tooth, and periradicular lesions (7). The latest
canal procedures have commonly been followed by
advancements in the non-thermal, atmospheric-pressure
persistent periradicular infection (3,4). The primary factor
plasmas have made it possible to employ the plasma to
contributing to failure has been identified as the
eliminate the bacteria linked to diseased root canals after
persistence of the bacteria in apical area of root-filled
drilling and cleaning teeth (8).
tooth (5).
The 4th state of the matter, plasma, represents a quasi-
A common and consistent isolate in the teeth
neutral mixture of neutral and charged species. Whereas
following failed therapy of the root canal is the gram-
bulk gas remains close to the temperature of the room, a
positive facultative bacterium Enterococcus faecalis (6).
non-thermal, atmospheric pressure plasma facilitates
Escherichia coli develops its biofilm through a
production of the reactive chemical species and their
complicated process that results in the formation of a
interactions with items being treated. These characteristics
biofilm, which is crucial in the development of a number
made those plasmas very desirable in wide range of
of diseases caused by bacterial attachment and resistance
environmental and bio-medical applications, such as low-
to a broad range of antibiotics. E. faecalis and E. coli are
heat surface modification of polymers, food processing
significant factors in causing chronic periradicular lesions
and medical instruments' sterilization (9).
after the therapy of the root canal. Its incidence in the teeth
Plasma plume for root canal disinfection was created
that had filled roots with periradicular lesions ranged from
using a temperature of the room plasma dentistry probe.
24 to 77 percent, according to reports (2).
The plasma plume can introduce reactive plasma species
According
to
certain
theories,
microbial
(such as charged species and reactive oxygen species
development as biofilm could help microorganisms
(ROS)) that are able to penetrate anywhere in root canal,
survive challenging growth environments, including those
which includes via dentinal tubules, and clean surfaces by
seen in post-endodontic environment of the root canal.
the bactericidal processes(3).
2359
Received: 19/07/2022
Accepted: 24/09/2022

Full Paper (vol.902 paper# 57)


c:\work\Jor\vol902_58 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2363-2369

Serum Level of Survivin in Patients with Psoriasis Vulgaris and
Its Relation to Disease Severity
Hind Ibrahim AbdElwahab Hassan*1, Ahmed Fathy State1, Sherief R. Esmail1, Ahmad S. Hasan2
Departments of 1Dermatology, Andrology and STDs and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Hind Ibrahim AbdElwahab, Mobile: (+20) 01010903906, E-Mail: Hindamer248@gmail.com

ABSTRACT
Background:
The World Health Organization has identified psoriasis as a serious global health issue. Psoriasis is a
persistent, autoimmune skin condition. Survivin is a member of the inhibitor of apoptosis family (IAP) family of
molecules that has significant effects on cell survival and proliferation. Survivin, unlike other IAP members, is seldom
expressed in healthy adult tissues but is abundantly expressed in the majority of neoplasms. Fetal tissues also have a
high level of expression.
Objective: The aim of the current study is to estimate serum level of survivin in psoriatic patients and searching for
correlation between its level and disease severity.
Subjects and Methods: This is a case control study was carried out on 45 patients with psoriasis & 45 matched
healthy controls. All participants were recruited from those attending the outpatient clinic of Dermatology, Andrology
& STDs Department, Mansoura University Hospitals, Mansoura, Egypt.
Results: Non statistically significant difference was found between studied groups as regard occupation, marital status
and smoking history. Among all studied cases, 75.6% have gradual disease onset, 40% progressive, median disease
duration is 8 years ranging from 1 to 40 years and 13.3% positive family history, 15.6% positive systemic diseases,
15.6% surgical operation, 71.1% have psychological stress, 4.4% positive drug history, 100% topical therapy, 4.4%
previous systemic therapy and 26.7% positive previous phototherapy, 100% Skin affection, Presence of trauma,
positive Grattage test, 62.2% hair affection and 46.7% nail affection.
Conclusion: Patients with psoriasis have higher levels of survivin. Survivin did not correlate with severity of psoriasis
(PASI). Higher survivin could predict psoriasis susceptibility, but not severity of psoriasis.
Keywords: Psoriasis, Serum level of survivin, Inhibitor of apoptosis family.

INTRODUCTION
Additionally, it has been proposed that some
The World Health Organization has identified
pathogenesis may possibly result from deficiencies in
the persistent, autoimmune skin condition psoriasis as
apoptosis
inhibition
brought
on
by
the
a significant global health issue (1). An estimated 2-4%
hyperproliferative state found in psoriasis. Studies
of people worldwide are affected (2). Males are twice as
have revealed that keratinocytes in psoriatic tissue
likely to be afflicted as females (3).
exhibit high levels of proliferation and are resistant to
The immune system, psoriasis-associated
apoptosis (9). Thus, keratinocyte survival, tissue
susceptibility
loci,
autoantigens,
and
several
inflammation, and blood vessel maintenance are
environmental variables interact in a complicated way
associated with activation of cell survival pathways
to induce psoriasis (4). Psoriasis has evolved from a
and repression of apoptosis. Survivin promotes the
purely cutaneous condition to one of the systemic
growth of inflammatory cells and is connected to
immune-mediated inflammatory disorders, including
tissue inflammation (10).
type 2 diabetes, rheumatoid arthritis, and inflammatory
Survivin is a member of the IAP family of
bowel disease (5).
molecules that has significant effects on cell survival
Psoriasis causes severe physical and
and proliferation (11).
psychological suffering and impairment that often has
Survivin is more often expressed in neoplasms
a negative effect on the quality of life of the patient (6).
than in healthy adult tissues, in contrast to other IAP
Psoriasis with abnormalities in the dermal
members (12). Fetal tissues also have a high level of
capillary vasculature, a considerable increase in
expression (13).Increased levels of survivin have been
keratinocyte proliferation, and the presence of dermal
shown in studies to successfully prevent apoptosis(14).
and
epidermal
T
lymphocytes,
monocytes,
Additionally, excessive survivin expression blocks
macrophages, and neutrophils with an uncertain cause
both intrinsic and extrinsic apoptotic pathways(15).
is known as psoriasis (7).
It also has an impact on immune system cells,
Numerous immune mediators have been
such as T-cell activation, maturation, and dendritic cell
characterised as being increased in the sick skin of
activation, in addition to controlling cell division and
these individuals because cytokines play a significant
inhibiting apoptosis (16). With all of its well-known side
role in the formation and maintenance of psoriatic
effects, survival may contribute to the alterations in
lesions (8).
psoriasis.
2363
Received: 15/09/2022
Accepted: 16/11/2022

Full Paper (vol.902 paper# 58)


c:\work\Jor\vol902_59 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2370-2378

Correlations of Corneal Epithelial Thickness with Dry Eye
Symptoms among Egyptian Sample Patients
Sara Abd El meged Nage*, Ahmed Esmail
Ophthalmology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Sara Abd El meged Nage, Mobile: (+20) 01009476856,
Email: Sara.attia.12@med.menofia.edu.eg, ORCID: 0000-0003-3421-5037

ABSTRACT
Background:
The multifactorial condition known as dry eye disease (DED) has the ability to harm the conjunctival and
corneal epithelium through its effects on tears and the ocular surface. Instability of the tear film, increased tear
osmolarity, abnormalities of the lacrimal gland and meibomian glands, and a multitude of inflammatory processes in
the epithelial surface cells are all causes of dry eye disease.
Objective: The aim of the current study was to assess correlations between corneal epithelial thickness and dry eye
symptoms among Egyptian sample patients.
Patients and methods: A cross-sectional study was conducted on 80 dry eye patients and 30 healthy people at the
Ophthalmology Department, Menoufia University Hospital, from April 2021 to October 2022.
Results: The dry eye group's superior corneal epithelial thickness (50.85 ± 8.35) was considerably lower than that of
the normal eye group (52.26 ± 2.98), with a P-value of 0.001. The mean of inferior and central corneal epithelial
thicknesses, however, did not differ significantly between dry eyes and normal eyes (P>0.05), measuring 37.08 (SD
12.88) mm, 57.90 (SD 13.85) mm, and 52.67 (SD 2.59) mm, 55.32 (SD 6.84) mm, respectively.
Conclusion: Corneal epithelium of dry eyes has a thinner upper part than that of normal eyes. In individuals with more
severe dry eye disease, the superior and minimum epithelium was significantly thinner and had a broader range of map
standard deviation.
Keywords: Corneal epithelial thickness, Dry eye, Egyptian patients, Symptoms, Superior region.

INTRODUCTION
thickness, an anatomical parameter, in patients with dry
The multifactorial ocular disease known as "dry
eye [6]. A variety of studies were carried out to map the
eye disease" (DED) affects people all over the world
thickness of corneal epithelium in order to determine
and is regularly seen in routine ophthalmology practise.
epithelium injury's morphological signs [7]. Traditional
Ophthalmologists have discovered that DED is quite
methods for measuring epithelial thickness include
prevalent and has a considerable influence on patients'
ultrasonography [8]. However, these techniques demand
quality of life, making it a prominent topic of research
that the instruments make direct or indirect touch with
[1]. However, the multifaceted etiology of the disease
the patient's ocular surface [9].
makes it difficult to accurately and statistically diagnose
Furthermore, because the majority of them only
DED and track therapy response in DED patients, which
pay attention to the central epithelial thickness, none of
poses a significant barrier to raising the standard of care
them can accurately assess the epithelial thickness of
for these patients [2].
the entire cornea (CET) [10].
Depending on which study is cited, how the illness
However, both studies do, concur that the corneas
is diagnosed, and which group is questioned, according
of DED patients have more thickness variation overall
to research done during the last 20 years, the prevalence
than controls do. Regarding the impact of DED on
of DED ranges from 5% to more than 30% at different
epithelial thickness, two earlier investigations produced
ages [3].
contradictory findings, either indicating a thinning in
According to epidemiological studies on DED, its
the superior cornea or a thickening in the middle cornea
frequency varies from 5 to 50% depending on the
[10]. Francoz et al. [9] used in vivo spectral-domain
diagnosis of symptoms with or without signs, and it
Optical coherence tomography (OCT) to measure the
reaches 75% when only signs are taken into account [3].
thickness of the corneal, limbal, and bulbar conjunctival
The damaged corneal epithelium may be what caused
epithelial layers in healthy eyes.
the clinical signs of DED in the eyes, such as pain in the
Li et al. [11] employed Fourier-domain OCT to
eyes, photosensitivity, and shifting vision [4].
measure the corneal epithelial thickness in keratoconus
Ocular surface staining, tear breakup time
eyes. Keratoconus is characterized by apical epithelial
(TBUT), the Schirmer's test, and symptom
thinning. The Fourier-domain OCT was shown to be
questionnaires are among the diagnostic methods
useful in determining the epithelial thickness in post-
currently used in routine clinical practice. Other
LASIK eyes by Ma et al. [12]. Few studies, meanwhile,
methods, such as tear osmolarity measurement, tear film
have discussed about the features of people with dry
interferometry and examination of tear biomarkers are
eyes' corneal epithelial thickness [9].
rapidly being included into patient treatment [5].
The aim of the current study was to assess
Recent studies have used epithelial maps produced
correlations between corneal epithelial thickness and
by optical coherence tomography to evaluate epithelial
dry eye symptoms among Egyptian sample patients.
2370
Received: 27/09/2022
Accepted: 30/11/2022

Full Paper (vol.902 paper# 59)


c:\work\Jor\vol902_60 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2379-2384

Relation between Net Atrioventricular Compliance and In-Hospital
Outcome in Patients with Acute Coronary Syndrome
Mohammad Hossam El-Deen Al-Shaer, Mohammad Mustafa Al-Daydamony,
Mohammed Alabed Mohammed*, Ahmed Shaker Mousa Attia
Cardiology Department, Faculty of Medicine, Zagazig University, Egypt
*Correspondence author: Mohammed Alabed Mohammed, Tel.: 01148570208, E-mail: alabedm927@gmail.com

ABSTRACT
Background:
The leading cause of death in the world is coronary heart disease. Acute coronary syndrome (ACS) patients
can have their in-hospital outcomes evaluated using the tissue Doppler imaging metric known as net atrioventricular
compliance. Objective: The aim of the current study is to assess relation between net atrioventricular compliance and in
hospital outcome in ACS patients. Patients and methods: A cross sectional study was conducted in Zagazig University
Hospital, Cardiology Department on patients with ACS. Patients with atrial fibrillation, a history of moderate or severe
valve stenosis or regurgitation, and myocardial infarction, poor echocardiographic picture quality, and refusal to participate
to the study, significant congenital heart disease or left ventricular hypertrophy were excluded from the study. Detection of
outcome of patients (arrhythmia, death, improvement) was assessed through their hospital stay.
Results:
Multivariate logistic regression predictors, in hospital complications among patients with ACS, showed that Cn
level 11.65 and decrease EF% were significantly independent predictors in hospital complications among ACS patients.
Conclusion: Net atrioventricular compliance can be used as independent predictors in hospital complications among
patients with ACS.
Keywords:
Net Atrioventricular Compliance, Coronary artery disease, In-Hospital, Acute coronary syndrome, Cross
sectional study, Zagazig University.

INTRODUCTION

moderate or severe valve stenosis or regurgitation, and
Despite significant advancements in management,
myocardial infarction, poor echocardiographic picture
coronary artery disease (CAD) remains the most
quality, and refusal to participate to the study, significant
prevalent kind the primary cause of cardiac disease of
congenital heart disease or left ventricular hypertrophy
mortality globally (1). The identification and risk
were excluded from the study.
classification of acute coronary syndrome (ACS) patients
All study participants underwent a thorough history
are greatly aided by non-invasive imaging procedures like
and physical examination, as well as routine laboratory
echocardiographic evaluation of the systolic and diastolic
investigations such as cardiac biomarkers, lipid profiles,
activities of the left ventricle, which are frequently used
and routine lab investigations required for preoperative
in clinical practice for the detection and evaluation of
assessment such as CBC, ECG, serum electrolytes, and
CAD (2). By using hydrodynamic analysis, it is possible to
evaluations of liver and kidney functions.
quantitatively estimate a measurement of the left atrium
Echocardiographic
examination:
Transthoracic
and left ventricle's net compliance is called net
echocardiography was conducted on all patients by the
atrioventricular compliance (Cn). Doppler mitral flow can
same operator who will be blind to the patient groups.
be used to compute a measure of the potential value of the
During end diastole, the internal diameter of the left
net atrioventricular compliance an accurate representation
ventricle (LV), from the parasternal short-axis view, the
of the left atrial and ventricle's net compliance (3).
septal thickness and posterior wall thickness of the LV
According to earlier research, Cn was very useful for
were
measured.
The
American
Society
of
risk stratifying individuals with mitral stenosis. It was
Echocardiography formula was used to calculate LV
discovered to be a reliable predictor of cardiovascular
mass, which was then indexed for body surface area. In
death in patients with mitral stenosis and to be a predictor
both the parasternal long-axis and apical four-chamber
of successful mitral valvuloplasty (4), improvement or
perspectives, the LA volume was computed using the
persistence of pulmonary after successful mitral
prolate ellipse method, and it was indexed for body
valvuloplasty (5), considerable impact on outcome (6,7).
surface area. Using two-dimensional planimetry, the
The aim of the current study is to assess relation
mitral valve area was determined (MVA).
between net atrioventricular compliance and in hospital
The estimated SPAP was defined as 4 × (maximum
outcome in acute coronary syndrome patients.
tricuspid regurgitant jet velocity) 2 + right atrial pressure.
The diameter of the inferior vena cava and its response to
PATIENTS AND METHODS
A cross sectional study was conducted in Zagazig
inspiration were utilized to compute right atrial pressure.
University Hospital, Cardiology Department on ACS
On echocardiography, PHT was classified as an SPAP of
patients. Patients with atrial fibrillation, a history of
35 mmHg. The mean trans-mitral pressure gradient was
2379
Received:30/08/2022
Accepted:3/11/2022

Full Paper (vol.902 paper# 60)


c:\work\Jor\vol902_61 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2385-2390

Association between Breastfeeding Patterns and
Type 1 Diabetes among Children
Enas S Abbas1, Safaa Tawfik1, Marwa R Salem2, G. Wahby Elhady2
1 Clinical Nutrition Department, National Nutrition Institute, Egypt,
2 Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Egypt.
Corresponding Author: G. Wahby Elhady, ORCID: 0000-0002-4141-6008.
Email: gwelhady@gmail.com, or gwelhady@kasralainy.edu.eg

ABSTRACT
Background:
Though factors such as breastfeeding (BF), cow's milk formula, and cereals are among the dietary factors
linked to T1D development, their role is still debatable.
Objective: This study aimed to assess the relationship between BF patterns and the development of T1D.
Subjects and Methods: The study is an epidemiologic hospital-based case-control study in Ismalia city, Egypt. 140
children 15 months- to 13-year-old, from both sexes were included in two groups; the T1D cases (n=70) and the
nondiabetic; age-and-sex-matched, control group (n=70).
Results: The proportion of children who received exclusive breastfeeding (EBF) was low in both cases and controls but
significantly lower among cases (11% vs 53% respectively, P<0.05) with almost nine times rise in the odds of T1D.
More T1D children depended on formula feeding (FF) during their infancy than controls (40% vs 14% respectively,
P<0.05) with four folds rise in the odds of T1D. T1D patients who had FF (n= 28) started it at an earlier age compared
to controls who had FF (n=10) (mean age 3.2 vs 12.3 months respectively, P<0.05). Likewise, the onset of weaning took
place at the age of four months among T1D cases vs five months among controls (P<0.05). No association was detected
between T1D and the sociodemographic or maternal obstetric factors.
Conclusion: Short-term BF or no BF at all may be a substantial risk factor for T1D. FF and the early age at its start
increase the odds of T1D.
Keywords: Type 1 diabetes, Children, Exclusive breastfeeding, Formula feeding, Egypt.

INTRODUCTION


Type 1 diabetes (T1D) is defined as high
T1D compared to a cereal-based diet. Thus, the
blood sugar levels brought on by a deficit in the
pathogenesis of T1D is assumed to be influenced by
production, function, or both, of insulin leading to a
food. Additionally, two significant, human prospective
variety of metabolic disorders [1] and in the long run,
cohort studies have found a relationship between an
damage to tissues and organs [2] in addition to the
early gluten-containing infant diet and the development
emotional and physical burden on patients and families
of autoantibodies against pancreatic islets. As well,
[3]. T1D could develop at any age but most commonly
there is evidence that the intestinal immune system
in childhood and young adulthood [4].
plays a major role in the pathogenesis of T1D.
It is the third most common noncommunicable
According to certain research, the development of T1D
disease (NCD) in children and its annual incidence has
is correlated with short-term BF and early introduction
been increasing by about 2%-5% worldwide [1]. Genetic
of complex proteins like cow's milk protein. The
susceptibility plays a role in the development of T1D,
immune system's maturation is thought to be aided by
yet, the increased incidence during the past five decades
substances found in human milk, which help prevent the
strongly suggests an important role for nongenetic
onset of T1D [9, 10].
factors such as environmental or nutritional factors [1, 4].
Other research, however, did not discover such a
About 129,000 children in the Middle East have T1D of
connection, and other research had even contradictory
whom nearly 50% exist in Egypt and Saudi Arabia [5]. In
or insufficient findings to establish a causal relationship
Egypt, the estimated T1D age-adjusted incidence was
[11]. Thus, though factors such as BF, cow's milk
3.1 % and the age-adjusted prevalence was 26.8 % [6].
formula, and cereals are among the dietary factors
Recent researches indicate that the increasing rates
linked to T1D development, their role is still debatable.
of NCDs, including T1D, in Egypt are probably linked
This study aimed to assess the relationship between BF
with the decline in BF practice with subsequent use of
patterns and the development of T1D.
complementary and/or FF. This suggests that early life

exposures to some environmental or dietary factors may
PATIENTS AND METHODS
have a significant role in the development of T1D [2, 7].
This was an epidemiologic case-control study
Also, large ecological and case-control studies
conducted in the health insurance hospital in Ismailia
supported the hypothesis that BF features a protective
city, Egypt, between 12 September 2019 to 12 March
effect against T1D [4, 8].
2020. 140 children 15 months- to 13-year-old, from
According to research on animal models, a gluten-
both sexes were included in two groups: The case group
free diet greatly lowered the likelihood of developing
(T1D children) (n=70) and the control group

(nondiabetic children) (n=70). Both groups were age-
2385
Received: 19/09/2022
Accepted: 22/11/2022

Full Paper (vol.902 paper# 61)


c:\work\Jor\vol902_62 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2391-2397


Methotrexate versus Methotrexate Combined with Letrazole for
Management of Undisturbed Ectopic Pregnancy
Gamal Abbas El Sayed, Ahmed ELSayed Mansor, Heba Ahmed ELhouseny*, Safaa Abd El Salam Ibrahim
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Heba Ahmed ELhouseny, Mobile: (+20) 01093544525, E-mail: helhouseny7@gmail.com

ABSTRACT
Background
: Extra uterine pregnancy is frequently detected early on, changing into a more benign disease before the
patient's condition worsens. Objective: The current study aimed to evaluate the effectiveness of methotrexate (MTX)
with letrozole in treating women who had tubal ectopic pregnancies.
Patients and methods
: A controlled clinical trial was carried out at the Zagazig University Hospitals' Obstetric and
Gynecological Department and Maternity Hospitals, and Menia ElQamh Central Hospital in the period from February
2022 to September 2022. A total of 30 women were equally divided into two groups; First group (control group) received
MTX to treat medically assisted tubal ectopic pregnancy, while the second group (study group) received both Letrozole
and MTX to treat medically necessary tubal ectopic pregnancy.
Result: In control group, median hCG at Day 0 was 1331, at Day 4 had a value of 645, at Day 7 had a value of 315.5,
and at Day 14 had a value of 39. In study group median hCG at Day 0 was 856, at Day 4 recorded 412, at Day 7 recorded
114, and at Day 14 recorded 29. Success in control group reached 75%, while in study group it reached 86.7%. B-ideal
hCG's cutoff value at day 4 was >1188 and on day 7 was >605. The tests' sensitivity, specificity, PPV, NPV, and
accuracy were all successful (100%).
Conclusion:
Letrozole has a higher resolution rate and a better safety profile when compared to chemotherapy in treating
women who had tubal ectopic pregnancies. More study should be conducted on drugs such as MTX.
Keywords: Ectopic pregnancy, letrozole, -hCG, Methotrexate, Clinical trial, Zagazig University.

INTRODUCTION

Over the past 30 years, the frequency of ectopic
ectopic pregnancy failure. Over several decades of
pregnancies has grown annually (1). Although earlier
clinical usage, they have proven to be safe, well-
diagnosis has been made possible by advancements in
tolerated, affordable, and have little adverse effects (6).
diagnostic techniques, the illness is still life threatening.
The current study aimed to evaluate the
EP is thought to be responsible for over 75% of
effectiveness of methotrexate (MTX) with letrozole in
Mortality in the first trimester and 9% of all fatalities
treating women who had tubal ectopic pregnancies.
due to pregnancy (2).

In comparison to surgical surgery, methotrexate
PATIENT AND METHODS
therapy has proven to be more cost-effective, yet
A controlled clinical trial was carried out at the Zagazig
preserving comparable treatment efficacy and long-
University Hospitals' Obstetric and Gynecological
term fertility. However, it is known that the
Department and Maternity Hospitals, and Menia
chemotherapy drug methotrexate is linked to major side
ElQamh Central Hospital in the period from February
effects, contraindications, and higher failure rates with
2022 to September 2022.
high concentrations of progesterone and beta-hCG

(human chorionic gonadotropin) (3). Additionally, the
Inclusion criteria: Hemodynamic stability. Presence of
ectopic pregnancy takes a long time to resolve after
a heterogenous adnexal mass with a poor increase may
starting methotrexate treatment, and it is necessary to
indicate tubal ectopic pregnancy of hCG i.e. <= 63%
wait many weeks before trying to get pregnant again.
rise over 48 hours. Ages eligible for the study 18 to 40
Additionally, it is not unexpected for there to be adverse
(Adult). Quantitative serum -HCG < 5000 IU/L. Size
effects on ovarian reserve and prospective future
of ectopic mass <3.5cm and no cardiac action of
fertility (4).
embryos. Patient cooperation for routine follow-up.
A third-generation non-steroidal reversible
Normal kidney function test, liver function test,
aromatase inhibitor is letrozole. Pharmacodynamic and
complete blood count (CBC), and electrolyte levels.
pharmacokinetic studies show that following ingestion,
Absence of substantial stomach ache.
it can reduce estradiol levels by up to 95% to 99%. In

addition to progesterone, which is recognized to have a
Exclusion criteria:
crucial role in maintaining early pregnancy, estrogen
Stomach pain that is clinically unpredictable, severe,
also plays a significant role in the support of early
or persistent, or significant hemoperitoneum as detected
pregnancy (5).
by an ultrasound (>300mL). Presence of free fluid in the
Letrozole's potential role in ectopic pregnancies
pelvis or in the abdomen and pelvis. HCG quantitative
has never been studied. It is thought that Letrozole can
5000 IU/L in serum. More than 3.5 cm of ectopic bulk
lower serum estradiol levels, which could lead to
heart activity is present in a pregnancy that is ectopic.
2391
Received: 03/09/2022
Accepted: 06/11/2022

Full Paper (vol.902 paper# 62)


auth3in.doc The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2398-2403

The Effect of Assisted Training Using Supplementation (BCAA) in Developing the
Special Strength and Accuracy of Offensive Skills in Volleyball for Youth
Darya Sardar Faiq (1) * , Samah Nooraldeen Essa (1), Swar Salah Muhialdeen (2)
(1) College of Physical Education and Sports Sciences / University of Baghdad, Iraq.
(2) College of Physical Education and Sports Sciences / University of Garmian, Iraq.
*Corresponding author: Darya Sardar Faiq , Email: darya.sardar.ds@gmail.com , Mobile: 009647765985431

ABSTRACT
Background:
The purpose of this paper is to identify the effect of assisted training using branched-chain amino acids
supplementation (BCAA) in developing the special strength and accuracy of offensive skills in volleyball for youth.
Methods: The researchers used the experimental method in the style of the two groups (control and the experimental)
due to its suitability to the research problem. The players of Al-Muqdadiya Sports Club represented the research
sample, ages (18-19) years, who numbered (15) players and they were divided into two cases and control groups and
for each group (6) players and (3) players, the reconnaissance experiment was conducted on them. The curriculum was
applied to them for a period of two months, at the rate of (3) training units per week, where pre and post-tests were
conducted, then data were collected and processed statistically with the (SPSS) program, and the results obtained
Results: There are significant differences in favor of the experimental group and for all special strength tests at the
expense of the control group.
Conclusion: The supplement (BCAA) had a positive effect on improving the level of physical performance in
volleyball, and the physical exercises had a positive role in the development of the accuracy of the performance of the
players by using them as an aid in the training units.
Keywords: Assisting exercises, BCAA supplementation, and offensive skills.

INTRODUCTION


Training and sports physiology is a tool to
important elements of physical and physiological
achieve the goals needed by the coach so that the team
preparation are the special forces for the effectiveness
he supervises reaches the highest technical and
of volleyball.
physical readiness that enables him to develop all his
By informing the researchers and inquiring
capabilities during times of competition, and to achieve
with some coaches and athletes in volleyball, it was
these goals, he is no longer left to random place due to
seen that there is some lack of strength training for
good preparation using a scientific methodology aimed
volleyball. In addition to the suffering of young athletes
at developing the capabilities of the players. At all
from strength training based on iron halls and jumping
levels, and this was confirmed by Al-Shamaa, 2002
exercises in circulation, which has a lot of negative
"Good preparation requires regulated training and
damage to the joints and bones of young players.
physiological programs based on scientific foundations
Therefore, the researcher sought to find
that take into account the principles of training science,
exercises that help in developing the special strength by
physiology, and the nature of the practice game" (1).
using simple tools and devices while remaining on the

same performance and kinetic path during the match or
And the game of volleyball, which is one of the
exercise, with the use of a nutritional supplement based
games that require capabilities, a high level of physical
on developing this strength in a short period while
fitness that qualifies the athlete to continue in the
giving positive results and the (BCAA) component.
competition, and from what we are witnessing today of
It is one of the components that have proven
great scientific and technological development in
its ability to develop special strength and increase the
various training sciences and volleyball in particular,
activity of nerve capacity, which gives the possibility
the researchers directed to training based on
of increasing the ability of players.
complementary exercises (BCAA) that work to

develop the special strength of the working muscles
Research objective:
during kinetic performance through Work, or
- Identifying the effect of assisted training using
performance similar to movement that has an effective
supplementation (BCAA) in developing the
effect in the direction of muscular work and that serves
special strength and accuracy of offensive
the physical side.
skills in volleyball for youth.


Research problem:
Research hypotheses:
Aggressive skills in volleyball are one of the
- There are statistically significant differences
keys to victory and the real measure of the level of the
between the pre and post-tests in the strength
players and the team. Working on training and
of the volleyball players and in favor of the
developing them requires a high level of training and
post-tests.
physical and skillful preparation, and among the most
2398
Received: 23/09/2022
Accepted: 26/11/2022

Full Paper (vol.902 paper# 63)


c:\work\Jor\vol902_64 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2406-2412

Risk Stratification in Cirrhotic Patients with Emergent Surgery
Mohamed Meligy Ahmed1, Marwa Elfauomy1, Hassan Ahmed ElZohry1,
Khaled Ammar2, Mohmamed Elfauomy3 and Abdelaleem Helal1*

1 Hepatology and Gastroenterology D
H

2
epartment,
epato panc
-
reatobiliary Surgery epa
D
rtment, National Liver lnstitute,

I

3
Menoufia University, Egypt, nternal Medicine epa
D
rtment, Faculty of Medicine, Al A
- zhar U
niversity, Egypt
*Corresponding author: Abdelaleem Helal. E mail: dr.abdelaleemhelal@gmail.com, Telephone number: +20 100 495 9895

ABSTRACT
Background
: Patients with liver disease have a unique pathophysiology that results in the need for a specialized evaluation
before undergoing any surgical procedure. The objective of the present study was to assess different risk scores for high-
risk cirrhotic patients. Patients and methods: We evaluated 115 cirrhotic patients in an Emergency Department, of the
National Liver Institute, Menoufia University, using MELD, PALBI, ALBI, MELD Na scores. The studied cases had
different presentations; 79 patients with strangulated umbilical hernia with bowel loops, 29 patients with intestinal ischemia
from acute mesenteric vascular occlusion managed by surgical explorations, and 7 patients with secondary peritonitis from
neglected spontaneous bacterial peritonitis. All participants signed an informed written consent.
Results: MELD had a best cut off point 9.5, PALBI best cut off point -2.5, ALBI best cut off point -1.5, and MELD Na best
cut off point 287.5. Sensitivities of MELD, PALBI, ALBI and MELD Na were 81.2%, 67%, 50%, and 44%, respectively.
While specificities of MELD, PALBI, ALBI and MELD Na were 70%, 44.1%, 85.3%, and 77%, respectively.
Conclusion:
MELD, PALBI, and ALBI could be used in risk stratification in cirrhotic patients with emergent surgery.
Keywords: Risk stratification; cirrhotic; emergent surgery; MELD, MELD Na, ALBI, PALBI.

INTRODUCTION

PATIENTS AND METHODS:
Studied cases with liver disease present for variety
We evaluated 115 cirrhotic patients in an Emergency
of surgical procedures. In significant proportion of these
Department, of the National Liver Institute, Menoufia
studied cases, surgery may result in problems. These
University.
problems may cause significant morbidity & mortality. In
Cirrhosis was affirmed by clinical signs and
studied cases with liver disease undergoing surgical
imaging, in all situations of intra-operatively diagnosed
procedures, evaluation can expect survival to some extent
cirrhosis. Pre-treatment laboratory data were to calculate
(1). Number of studied cases with liver disease seeking
MELD, PALBI, ALBI and MELD Na scores by their
surgical intervention is rising. However, there are
equations:
significant risk factors present perioperatively when these
1. MELD= 3.78 × ln (bilirubin [mg/dL]) + 9.57 × ln
studied cases undergo surgery under anaesthesia. Nature
(creatinine [mg/dL]) + 11.20 × ln (international
and type of surgery have impact on perioperative
normalized ratio) + 6.43 (Xu et al., 2007).
morbidity and mortality (2).
2. PALBI = (2.02 x log10 bilirubin.37 x (log10 bilirubin
Surgical techniques in studied cases with liver
in pmol/L) 2 0.04 x albumin in g/L+3.48 x
cirrhosis are fraught with problems and have high
log10platelets in p/L + 1.01 x (log10 platelets)
mortality rate. Precise preoperative risk stratification can
(Roayaie et al., 2017).
be difficult, and in some cases, cirrhosis is
3. ALBI= (log10 bilirubin ×.66) + (albumin × -.085)
discovered during surgery (3).
(Johnson et al., 2015).
When cirrhosis has been diagnosed, further risk
4. MELD-Na= MELD + (140 - Na [mmol/L]) - 0.025
stratification is largely determined by degree of
× MELD × (140 ­ Na [mmol/L]) (Jiang et al., 2008).
hepatocellular dysfunction. Child Turcotte Pugh

and model for end stage liver disease are 2 most
Ethical considerations:
commonly used scores to stratify intensity of liver
An approval of the study was obtained from
disease. Both scores have been used to stratify
National Liver Institute's Ethics Committee approved
preoperative risk, with greater MELD and CTP scores
research, Menoufia University.
correlated with greater thirty-day mortality (4).
All patients were informed about the surgery and
Studied cases with liver cirrhosis because of
the auto-transplantation technique, value and possible
different etiologies are at higher rate of mortality when
complications and informed written consent was taken
admitted with emergent surgical complaints especially
from all studied cases. This work has been carried out
when patients with Child-Pugh score B or C. patients at
in accordance with The Code of Ethics of the World
risk when admitted need ICU or a higher rate of mortality.
Medical Association (Declaration of Helsinki) for
The objective of the present study was to assess different
studies involving humans.
risk scores for high-risk cirrhotic patients.

2406
Received: 01/06/2022
Accepted: 08/08/2022

Full Paper (vol.902 paper# 64)


auth3in.doc The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2413-2421

The Effect of Using a Device That Changes the Starting Angle in Swimming
on Some Kinematic Variables of The Starting Stage of Swimming and The
Completion of the 50-Meter Freestyle Swim for
The National Team Swimmers (13-15) Years Old
Ali Hashim Mohammed (1) *, Ahmed Thamer Mohsin (1)
(1) College of Physical Education and Sports Sciences / University of Baghdad, Iraq.
*Corresponding author: Darya Sardar Faiq , Email: alialasmarswim994@gmail.com , Mobile: 009647712653495

ABSTRACT
Background:
The purpose of this paper is to identify the values of some biomechanical variables for the starting phase,
swimming, and completion of the 50-meter freestyle swimming, and identify the effect of using a device (the launch angle
changer for the starting stage of swimming) on some of the biomechanical variables affecting the starting stage of 50m
freestyle swimming.
Methods: The researcher used the experimental approach using the experimental design method (pre and post-test for one
group) due to its suitability to the nature of the research problem. The selection of the research sample came within the basic
and important points in the research procedures, which the researcher adopts to reach results with high credibility. Therefore,
the researcher chose six swimmers representing (100%) of the origin community, and they are the players of the Iraqi
national team, category (13 - 15) years old in the 50-meter freestyle swimming event.
Results: The change in the kinematic variables of the starting phase showed significant differences, which contributed to
the development and increase of the swimmer, is starting speed, and the change in the kinematic variables of the starting
stage showed significant differences, which contributed to the development and increase of the horizontal distance achieved.
One of the most important recommendations is that: increasing focus on the starting stage of swimming during training and
including it within the training units for its effective role in improving the level of achievement, and the use of auxiliary
tools and devices that help detect weaknesses and enhance strengths, which facilitate the coach's task in developing
swimmers
Keywords:
50-meter freestyle swim, starting angle in swimming.

INTRODUCTION
completion time, due to the increased importance of the

The sport of swimming relies heavily on
starting stage in short distances, since the time required to
the kinetic performance of all parts of the body with high-
complete it constitutes a greater percentage of the
level compatibility, and that biomechanical variables are
completion time. So this necessitated the focus of
among the factors that affect kinetic performance directly,
specialists, the coaches and swimmers on this stage to
as we can through technical and biomechanical analysis
determine the ideal performance for it, because it helps
identify the strengths and weaknesses of the swimmers.
the swimmer to achieve a greater horizontal distance and
Thus provide sufficient information for the coach to have
in an ideal time after pushing off from the platform.
a base Sober and accurate information in order to work to
Thus increasing the horizontal distance that the
strengthen the strengths and work to develop them and
swimmer travels during his flight and the next stage
avoid the weaknesses and thus the development of the
during his entry into the water and the movements of the
digital achievement of the swimmers(1).
dolphin that help him to cover the distance after entering
As the performance of the movement in harmony
until he gets out of the water and starts swimming as
between the parts of the body needs to determine the
quickly as possible (1).
movement of the body according to certain paths of the
Likewise, with regard to the swimming stage
parts of the body and certain angles of the joints of the
after the flow, the appropriate strategy that the swimmer
body and specific times in addition to several other
follows to regulate his speed in the race is his ability to
variables, as many methods have appeared, including
invest his energy in the maximum way and benefit from
measuring devices and programs that help in changing
the physical characteristics that the swimmer possesses,
and modifying the biomechanical variables to deliver
especially (the length of the swimmer), so that he employs
them to the ideal image in a way that suits With the
his capabilities in a way that suits the ideal performance
swimmer and his specifications in order to raise the level
to cover the required distance in the least possible time(4).
of technical performance and thus raise the level of
The importance and idea of the research were
achievement(2).
summarized by studying the technical stages of the 50-
As for the 50-meter freestyle swimming event,
meter freestyle race (starting, flowing, swimming and
the starting stage is the main key to the start of this event,
finishing) and determining the best methods and the most
which gives it great importance in reducing the
appropriate auxiliary tools that would help swimmers in
2413
Received: 23/09/2022
Accepted: 26/11/2022

Full Paper (vol.902 paper# 65)


c:\work\Jor\vol902_66 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2422-2428
Knowledge of Al-Kindy College Students about COVID-19 Disease in Children
Ali Kadhim Alqurishi *
Pediatric Department, Al-Kindy College of Medicine, University of Baghdad, Iraq
*Corresponding author: Ali Kadhim Alqurishi ORCID: 0000-0003-2014-0062, Email: aliqurishi@kmc.uobaghdad.edu.iq

ABSTRACT
Background
: Since the beginning of the pandemic, there have only been a few of reports of juvenile cases of coronavirus
illness 2019 (COVID-19). Children with COVID-19 have yet to have their clinical features fully recognized by medical
students. Objective: The aim of the current study was to summarize what medical students know about COVID-19 in
children symptoms, severity, and transmission and prevention.
Subjects and methods: A cross sectional study was conducted on a sample of students from Al-Kindy College of Medicine,
University of Baghdad. The data were collected from 200 students via the distribution of "Google Form" questionnaires
using convenience sampling during the period from January 15, 2021 to May 20, 2021. The answers were analyzed using
descriptive statistics. Ethical approval was obtained from Scientific Committee of Al-Kindy College of Medicine,
University of Baghdad.
Results: The 6th stage students have much thorough knowledge that is more coinciding with scientific data as compared
with other stages. This knowledge could be summarized that children have less risk of getting infection or transmission
to/from adults. Moreover, participants express less severe presentation of infection in children, vaccine is helpful in
preventing infection, and isolating patients and referring them to hospitals are required as well.
Conclusion: Medical students near gradation (6th stage) are enriched with wide and thorough knowledge of COVID-19,
which is an essential fundamental key in management of COVID-19. Moreover, it reflects the success of teaching system
of Al-Kindy College of Medicine, University of Baghdad.
Keywords: COVID-19, Knowledge, Viral transmission, Review, Cross sectional study, University of Baghdad.

INTRODUCTION

The Wuhan Municipal Health Commission in
There is a significant percentage of the available
China announced, in the month of December 2019, that
literature that is based on data from research conducted in
there had been an outbreak of pneumonia in the Chinese
China; yet, there has been documented to be a
city of Wuhan, and that the reason of the outbreak was
geographical variance in the pathology of the illness
unclear )1(. On January, 2020, World Health Organization
across various groups (6). The aim of the present study was
(WHO) attributed the condition to a novel type of
to measure knowledge level among medical students
coronavirus and named it the 2019 novel coronavirus
towards possible sources of COVID-19 transmission in
(COVID-19). The World Health Organization (WHO)
children, transmission through placenta or birth canal and
announced on January 7, 2020 that the ailment was caused
breast feeding, and possible risk factors for COVID-19 in
by a new form of coronavirus and designated it as the
children.
2019 novel coronavirus (COVID-19). COVID-19 is a

highly contagious illness that may be passed from person
SUBJECTS AND METHODS
to person by the exchange of respiratory droplets, hands,
A cross sectional study was conducted on a sample
saliva, and other bodily fluids, as well as through skin
of students from Al-Kindy College of Medicine,
contact (2). Most of the COVID-19 instances that have
University of Baghdad. The data were collected from 200
been described in the scientific literature have been in
students via the distribution of "Google Form"
adults, and there have only been a few of studies
questionnaires using convenience sampling during the
conducted on the condition in children (3).
period from January 15, 2021 to May 20, 2021.
It has been found that most children infected with
The questionnaire consists of 13 questions; include
COVID-19 show no symptoms or have symptoms that are
questions on the students' demographic information (age
far less severe than those seen in adults. On the other
and stage). The second part of the questionnaire used
hand, according to some reports, newborns and younger
Likert scale which included questions about their source
children, particularly those whose immune systems are
of information, likelihood of symptoms and mode of
impaired or who have disorders affecting their lungs, are
transmissions among children.
more prone to have a severe illness course (4).

A child's age, in addition to any other medical
The questionnaire included the following items:
issues, is regarded to be the single most crucial
1. Gender.
determinant in establishing the probable severity of their
2. Age.
sickness (5).
3. Stage.
2422
Received: 19/09/2022
Accepted: 22/11/2022

Full Paper (vol.902 paper# 66)


c:\work\Jor\vol902_67 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2429-2434

Predictors of Pancreatic Leak Post Pancreaticoduodenectomy. Retrospective Study
Anthony Nozhy Abd ElMesseh1, Rasha Mahmoud Allam2, Mohamed Atef ElKordy1*
1-Department of Surgical Oncology, 2-Department of Statistics, National Cancer Institute, Cairo University, Egypt
Correspondence author: Mohamed Atef ElKordy,
Tel: 01554090340, E-mail: malkordy2001@gmail.com

ABSTRACT
Background:
Pancreaticoduodenectomy (PD), a complex operation with a high morbidity rate, especially pancreatic
fistula, is still the standard treatment for resectable pancreatic head, ampullary, distal bile duct, and duodenal tumours.
Despite improvements in pancreatic fistula detection and treatment, it still has a significant death rate. As a result, it is
critical to address the causes of pancreatic fistula for which this study was created.
Objective:
This study aimed to address the different risk factors affecting the incidence of pancreatic leakage post
pancreaticoduodenectomy.
Subjects and Methods:
This is a retrospective case-control study that included all cases that experienced
pancreaticoduodenectomy during the period from January 2014 to December 2021 at the National Cancer Institute
(NCI), Cairo University. The cases have been categorized into two groups (cases who developed pancreatic leakage and
those who did not develop it). Both groups were compared for the possible risk factors: age, gender, tumour size, LNs
positivity, laboratory findings (HB, Albumin), neoadjuvants received, surgical techniques (anastomosis technique, vein
resection, texture of pancreatic remnant), and postoperative nutrition plan used.
Results:
Ninety-five cases of pancreaticoduodenectomy were done during the study period. Among them, 35 cases had
developed postoperative pancreatic fistula (POPF). A significantly higher pancreatic fistula incidence was associated
with the female gender, preoperative haemoglobin levels of < 12 gm/dl and albumin levels of < 3.6 gm/dl, along with
soft pancreatic texture.
Conclusion:
Pancreaticoduodenectomy is an operation with a high morbidity rate. Female gender, low HB and albumin
levels, and soft pancreatic texture are risk factors for developing pancreatic fistula.
Keywords:
Pancreatic fistula, Pancreatic leak, Pancreaticoduodenectomy, Whipple.

INTRODUCTION
categorized into two groups (cases who developed
Pancreatic cancer remains one of the most lethal
pancreatic leakage and those who did not develop it).
cancers. In the USA, it was predicted that 62210 patients
Both groups were compared for the possible risk
would have pancreatic cancer, and about 49,830 persons
factors, including age, gender, tumour size, LNs
would die from it in 2022, making it one of the highest
positivity, laboratory findings (HB, Albumin),
mortality cancers (1).
neoadjuvants
received,
surgical
techniques
The pancreaticoduodenectomy remains the
(anastomosis technique, vein resection, pancreatic
standard procedure for surgical treatment of resectable
remnant texture), and the adopted postoperative
and marginally resectable pancreatic head cancer, and
nutrition plan.
ampullary carcinoma (2).
Postoperative pancreatic fistula (POPF) is defined
Although pancreaticoduodenectomy is a common
as elevation of amylase level in drains after
procedure in cancer centres worldwide (3), a high rate of
pancreaticoduodenectomy at or after day 3
complications is still encountered, including pancreatic
postoperatively more than 3 times the upper limit of
fistula, problems in gastric emptying, intestinal leakage,
normal serum amylase level. The archived medical
haemorrhage and infection (4). Among these
records were obtained from the Cancer Epidemiology &
complications, pancreatic fistula remains the most
Biostatistics Department to retrieve patients' data: Age,
common, with an incidence range of 5-41% (5).
gender, tumour size, LNs positivity, laboratory findings
Pancreatic fistula mortality is still around 6-9%, despite
in the form of HB and albumin, neoadjuvants received,
advancements in diagnosis and management (6).
and surgical techniques in the form of anastomosis
Therefore, it is crucial to address the risk factors of
technique, vein resection, pancreatic remnant texture,
pancreatic fistula for which this study was
and finally postoperative nutrition plan used.
accomplished. This study aimed to address the different

risk factors affecting the incidence of pancreatic leakage
Ethical considerations: This study has been
after pancreaticoduodenectomy.
approved via the Institutional Review Board (IRB)

of the National Cancer Institute, Cairo University
PATIENTS AND METHODS
(Number: 2211-510-019). and the patients were
This was a retrospective case-control study that
given all the information they need about the trial.
included
all
cases
who
underwent
An informed written consent was taken from each
pancreaticoduodenectomy at the National Cancer
participant in the study. This work has been carried
Institute, Cairo University in the period between
out in accordance with The Code of Ethics of the
January 2014 and December 2021. The cases were
2429
Received: 25/11/2022
Accepted: 27/01/2022

Full Paper (vol.902 paper# 67)


c:\work\Jor\vol902_68 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2435-2439

Value of Red Blood Cell derived Extracellular Vesicles as
Novel Biomarker for Thalassemia: Review article
Mostafa Taha Hifny*, Zeinab Ahmed Abd Elhameed, Tarek T. ElMelegy, Hanan Omar, Madeeha Y. Bakheet
Clinical Pathology Department, Assiut University Hospital, Assiut, Egypt
Corresponding author: Mostafa Taha Hifny, Email: mostafa.hifny@aun.edu.eg, Mobile: 01098595276

ABSTRACT
Background:
Hereditary hemolytic anaemia is a broad range of anemias characterised by a reduced ability of red blood
cells to survive as a result of genetic haemoglobin, enzyme, or membrane abnormalities. Red blood cells that have been
affected are more fragile, less deformable, exhibit greater vesiculation, and are more vulnerable to oxidative stress and shear
stress. Extracellular vesicles contain a variety of bioactive substances that have been associated with cellular activation,
intercellular communication, and a number of biological and pathological processes.
Objective: The aim of the study was to evaluate value of red blood cell derived extracellular vesicles as novel biomarker
for thalassemia.
Methods: The study was conducted in Assiut University Hospital, Assiut, Egypt.
Conclusion: Bioactive chemicals are selectively sorted into microvesicles during the carefully regulated process of red
blood cell microvesiculation. Hereditary hemolytic anaemia has a variety of molecular abnormalities that may have an
impact on red blood cell vesiculation. Regarding hereditary hemoglobinopathies such as thalassemias, unstable
haemoglobin causes membrane proteins and lipids to oxidise, haemoglobin to deposit on the membrane, and alterations to
the intracellular viscosity, all of which lead to RBCs that are difficult to deform.
Keywords: Bioactive chemicals, Thalassemia and Haemolytic anaemia.


INTRODUCTION

Hereditary hemolytic anaemia is a broad range of
pathogenesis of thalassemia and other hereditary
anemias characterised by a reduced ability of red blood
hemolytic anemias would need integrating bio-analytical
cells to survive as a result of genetic haemoglobin,
results on abnormalities of red blood cells and their
enzyme, or membrane abnormalities. Red blood cells that
microvesicles.
have been affected are more fragile, less deformable,

exhibit greater vesiculation, and are more vulnerable to
EXTRACELLULAR VESICLES AND THEIR
oxidative stress and shear stress.
PATHOPHYSIOLOGICAL SIGNIFICANCE
Similar to other cells, red blood cells vesiculate, or
A heterogeneous class of cell-determined
form phospholipid extracellular vesicles, both in vivo and
structures having a lipid bilayer film is known as
in vitro. This class of extracellular vesicles includes a
extracellular vesicles. They originate from endosomes or
wide range of vesicles with internal sources and various
are expelled from the plasma film in physiological and
sizes. If they come from multi-vesicular bodies, they are
neurotic conditions (1).
referred to as exosomes. When they emerge from the
Exosomes, ectosomes, shedding microvesicles,
plasma membrane during the budding process in a single
apoptotic blebs, and diverse extracellular vesicle subsets
step, they are known as microvesicles.
are just a few examples of the many and varied vesicles
Apoptotic bodies when they develop as blebs from
that are classified under the name extracellular vesicles
the plasma membrane of cells going through programmed
based on their biogenesis and delivery method (2).
cell death. Extracellular vesicles contain a variety of
Extracellular vesicles should be arranged into three
bioactive substances that have been associated with
distinct main groups, according to the International
cellular activation, intercellular communication, and a
Society for Extracellular Vesicles (ISEV): exosomes,
number of biological and pathological processes.
microvesicles, and apoptotic bodies or apoptotic blebs (3).
Theoretically, only microvesicles are released by adult
Extracellular vesicles (Exo) are described in
red blood cells. With an emphasis on red blood cell
contemporary logical writing as having endocytic origins
vesiculation, we address recent developments in our
that escape from multivesicular endosomes (MVEs),
understanding of extracellular vesicles biology in this
whereas microvesicles are created by blebbing the plasma
review.
layer and subsequent membrane bleb separation (4).
The molecular abnormalities of hereditary
Microvesicles, which are bigger vesicles with a
hemolytic anemias, particularly thalassemia, and their
diameter of 100 to 500 nm, are created during the growth
relationship to red blood cell deformability and
or exocytosis cycle of the plasma layer. Endosomal
vesiculation are also reviewed, along with recent
multivesicular bodies, which have a diameter of 50 to 150
scientific findings on these topics. Understanding the
nm, release exosomes (5).
2435
Received: 25/11/2022
Accepted: 27/01/2022

Full Paper (vol.902 paper# 68)


c:\work\Jor\vol902_69 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2440-2445

Sodium Glucose Transporter 2 Inhibitor as a Novel Therapy for
Patients with Chronic Hyponatremia
Mohamed E. Ibrahim, EL Metwally Lotfy EL Shahawy, Ayman M. Elbadawy, Tayseer Shawky Rashaad,
Zeinab Adel Elsayed Ahmed Srour*, Ahmed Ezzat Mansour
Department of Internal Medicine and Nephrology, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Zeinab Adel Elsayed Srour, Mobile: (+20) 01020894082, E-Mail: asemary902@gmail.com

ABSTRACT
Background:
The most prevalent electrolyte anomaly seen in both hospitalised patients and the general population,
hyponatremia is often defined as serum sodium concentration 135 mEq/L and is linked to higher morbidity and death.
Objective: To study sodium glucose transporter2 (SGLT2) Inhibitors influence in individuals suffering euvolemic and
hypervolemic chronic hyponatremia and it may be a potential new alternative for persistent hyponatremia therapy in
non-diabetic and diabetic patients.
Patients and Methods: That prospective research was carried out on 75 chronic euvolemic or hypervolemic
hyponatremia individuals admitted to internal medicine department in hospitals of Benha university. 2 groups were
formed from participating individuals: 25 hypervolemic hyponatremia or chronic euvolemic individuals in group (1)
who received placebo with additional conventional treatment of chronic hyponatremia (fluid restriction). Group (2)
included 50 hypervolemic hyponatremia or chronic euvolemic individuals who received SGLT2 inhibitor
(empagliflozin). Results: No critical change was seen in serum sodium among day 0 and day 4 or between day 0 and
day 30 in SGLT2 inhibitor untreated patients. Serum sodium was critically lower in day 0 than day 4 (p <0.001) and
was also substantially lower in day 0 than 30 (p <0.001) in SGLT2 inhibitor treated patients.
Conclusions: The use of SGLT2 inhibitor empagliflozin lead to serum sodium critical elevation in day 4 and 30 after
the start of treatment compared to baseline serum sodium level with a higher level at day 4 and 30 than SGLT2
inhibitor untreated patients.
Keywords: Novel Therapy, SGLT2 and Chronic Hyponatremia.

INTRODUCTION

by this family of drugs. In addition, SGLT2 inhibitors
The most common electrolyte problem observed
diminish GFR of a single nephron by causing afferent
in clinical management is hyponatremia, which is
arteriolar restriction, that results in decreased
described as a blood sodium content below 135
intraglomerular pressure [6]. SGLT2 inhibitors
mEq/L. It may be divided into three types based on
eliminate fluid preferentially from the interstitium as
extracellular fluid volume: euvolemic, hypervolemic
opposed to the intravascular space, resulting in
and hypovolemic [1]. Hyponatremia is associated with
increased electrolyte-free water removal and enhanced
elevated morbidity, extending between bone problems
tissue perfusion with no blood volume changing [7].
and elevated risk of fracture to the most severe result
SGLT-2 inhibitors are strong cardioprotective and
of acute hyponatremic encephalopathy, which might
nephroprotective medicines, reducing cardiovascular
need immediate treatment with hypertonic saline [2].
mortality by up to 38%, heart failure hospitalisation by
Limiting fluid intake and boosting renal water
35%, renal disease progression by 45%, and all-cause
output are the major aims in managing hyponatremia.
mortality by 30% [8].
This may be achieved by raising urine solute loading,
The aim of the work was to study influence of
lowering the medullary osmotic gradient regards to
SGLT-2 Inhibitors in euvolemic and hypervolemic
water reabsorption, or suppressing ADH activity [3].
chronic hyponatremia patients and if it could be a
Oral hypoglycemic medicines suppress SGLT-2
potential new alternative for persistent hyponatremia
protein; this is a high-capacity/low-affinity glucose
therapy in non-diabetic and diabetic patients.
transporter situated in the S1 section of renal proximal

PATIENTS AND METHODS
tubules and accountable for 90 percent of glucose
That prospective research was carried out on 75
reabsorption. In diabetic individuals, the production of
chronic euvolemic or hypervolemic hyponatremia
SGLT-2 increases up to thrice, resulting in a 20
individuals admitted to internal medicine department
percent rise in glucose reabsorption at a time when the
in Benha university hospitals.
body is actually struggling from blood glucose
Chronic hyponatremia is hyponatremia which was
elevation. SGLT-2 suppression resulted in elimination
developed over > 48 h. Hyponatremia is described
of 50­60% of filtered glucose, or around 60­100 g per
serum sodium <135 mEq/L and it is classified into 130
day [4].
­ 134 mEq/L for mild hyponatremia, 125 ­ 129 mEq/L
On proximal convoluted tubule brush border
for moderate hyponatremia and <125 mEq/L for severe
epithelium are SGLT2 receptors, that are accountable
hyponatremia.
for roughly 90 percent of renal glucose reabsorption
Patients were split into two groups: Group (1):
in renal tubules [5].
involved 25 with hypervolemic hyponatremia or
Changes in systolic BP may result from
chronic euvolemic patients who received placebo with
natriuresis, osmotic diuresis, and loss of weight caused
additional conventional treatment of chronic
2440
Received: 26/09/2022
Accepted: 29/11/2022

Full Paper (vol.902 paper# 69)


c:\work\Jor\vol902_70 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2446-2450

Can Extended Curettage Alone Be Sufficient for Treating An
Aneurysmal Bone Cyst in The Upper Extremity?
Mohamed Abd El Aziz M. Ali*, Mohammad Hassan Abd Ellatif, Ahmed El Nagar
Orthopaedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Mohamed Abd El Aziz M. Ali, Mobile: (+20) 01026706518, Email: mohamedghith77@gmail.com

ABSTRACT
Background:
Different treatment options for aneurysmal bone cysts (ABCs), which have a high risk of recurrence,
are discussed. The choice of the treatment approach for patients with ABCs is based on the likelihood of recurrence
and any potential side effects. Objective: This study aims to evaluate the outcome of extended curettage alone as a
method of treatment for patients with ABCs of the upper extremity.
Patients and Methods:
From April 2013 to June 2021, 15 primary ABCs in the upper extremity (15 patients) were
diagnosed and managed at the Orthopedic Oncology Unit, Zagazig University Hospital. The patients were 9 males and
6 females. The mean age was 13.2 ± 1.6 years (range, 7 years 5 months to 18 years 2 months). ABCs were present in
the proximal humerus in 7 cases, distal humerus in 3 cases, radius in 3 cases, glenoid in one case, and distal phalanx of
the thumb in one case. All patients were managed by extended curettage and followed up for at least one year.
Results:
All lesions healed after a mean period of 16 weeks (range 10­21 weeks). The time to healing was related to
the age of patients, size, and behavior of the lesion. Superficial infection was seen in one patient and was managed
conservatively. Recurrence developed in one patient at 9 months postoperatively and was managed by repeated
extended curettage. There was only one patient who developed a shortening of the humerus of about 1.5 cm due to
premature fusion of the proximal humeral epiphysis but without angular deformity.
Conclusion: Extended curettage with high-speed burr is considered an effective technique in the management of
ABCs in the upper extremity.
Keywords: Aneurysmal Bone Cyst; Extended Curettage; Upper Extremity.

INTRODUCTION


The medulla of the metaphysis of long bones is
Therefore, a biopsy and histological analysis are
frequently affected by benign lesions called
required for a firm diagnosis of ABCs (4).
aneurysmal bone cysts (ABCs). Rarely do these
Treatment attempts to limit the likelihood of
lesions develop in the cortex or in the outer layers of
recurrence, relieve pain, heal the lesion, and prevent
the diaphysis. Patients with ABCs typically have a
pathological bone fracture (5).
shorter lifespan than 20 years (1).
A variety of treatment options are discussed,
ABCs are single lesions that can develop as
including bone marrow injection, cryoablation,
original lesions or secondary lesions next to other
radiotherapy, radionuclide ablation, intralesional
lesions such giant cell tumours, chondroblastomas, or
curettage with or without adjuvants, en bloc resection,
osteoblastomas (2). 1.4% of all primary bone tumours
embolization, percutaneous injection of polidocanol or
are ABCs, which typically afflict the lower limbs.
doxycycline inside the lesion, and use of denosumab or
Only 5% of the lesions, or approximately 22.5% of
bisphosphonates (6).
ABCs, are seen in the hands (3).
The choice of treatment for patients with ABCs
Patients with ABCs frequently have a slow
depends on the likelihood of recurrence and potential
development of discomfort and edoema, albeit they
side effects of the chosen therapy (5).
can also exhibit pathological fractures. An eccentric
This study aims to evaluate the outcome and
lytic expansile lesion with bone septae across the
effectiveness of extended intralesional curettage alone
cortex, giving the lesion a multi-locular look that is
as a method of treatment for patients with ABCs of the
referred to as a "soap bubble appearance," is the
upper extremity.
characteristic radiographic feature. However, other

imaging methods are necessary in addition to X-rays in
PATIENTS AND METHODS
order to properly diagnose the lesion. The osseous
This a retrospective study included 15 patients
margins of the lesion can be seen on CT images. As
with 15 primary ABCs in the upper extremity. The
ABCs has numerous layers of blood on top of one
diagnosis based on a review of clinical, radiologic, and
another, the MRI scans show multiple fluid lines.
pathologic records of patients
Additionally, MRI can detect edoema, perilesional
. From April 2013 to June 2021. The patients
extension, and bone septae. Though, the previously
were treated by intralesional curettage with a minimum
mentioned characteristics, such as the "soap bubble
follow-up of 2 years. Patients with secondary
look" and "many fluid lines," are not pathognomonic
aneurysmal bone cysts or cysts in the lower extremity
for ABCs because other lesions, such giant cell
were excluded from the study.
tumours,
osteoblastomas,
and
telangiectatic

osteosarcomas, can also exhibit similar characteristics.

2446
Received: 25/09/2022
Accepted: 28/11/2022

Full Paper (vol.902 paper# 70)


c:\work\Jor\vol902_71 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2451-2459

Illness Perception and Glycemic Control Among Type 2 Diabetes Patients
Hosnia Mohamed Ragab, Ahmed Farouk Elsaid, Samah Ahmed Elayman Abdelaal*,
Nesma Abd Allah Mahmoud
Department of Public Health and Community Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Samah Ahmed Elayman Abdelaal, Mobile: (+20)011106689129,
Email: samah011301@medicine.zu.edu.eg


ABSTRACT
Background:
Type 2 Diabetes Mellitus (T2DM) is a serious issue in Egypt, with severe consequences for individuals,
families, and governments. Illness perception in diabetes patients is critical in determining their health outcomes,
particularly in glycemic management, and hence must be assessed and understood in order to optimize their health and
quality of life. Objective: The current study aimed to improve the quality of life of T2DM patients through assessing
their illness perception and identifying its associated factors.
Patients and methods: A cross-sectional was conducted on 157 T2DM Egyptian patients, between August 2021 and
June 2022, at the outpatient clinic of Zagazig University Hospitals. Data on demographic and clinical history were
collected using a structured Arabic questionnaire. Socioeconomic status and illness perception, using the brief illness
perception questionnaire (BIPQ), were assessed.
Results: Most participants had negative illness perceptions (52.2%). There was a statistically significant difference
between participants with good and poor glycemic control in perceptions of consequences (P<0.001), personal control
(P= 0.013), and identity (P= 0.012), as well as overall score of illness perception (P=0.006). There was a statistically
significant difference between participants with negative and positive illness perceptions in sex (P=0.001),
socioeconomic status (P=0.012), type of medications (P<0.001), HbA1c (P=0.008), having a glucometer at home
(P<0.001), and previous hospitalization due to diabetes-related complications (P<0.001).
Conclusion:
T2DM patients suffer negative illness perceptions, especially those with poor glycemic control. Physicians
need to take these perceptions into account, and interventions should be implemented to modify these perceptions with
the purpose of positively affecting glycemic control.
Keywords: Type 2 Diabetes, Illness Perception, Glycemic Control.

INTRODUCTION

and self-management, we must assess sickness
Diabetes Mellitus (DM) is a serious public health
perception in the Egyptian diabetic community and its
issue globally. According to the International Diabetes

Federation (IDF), Egypt ranks ninth in terms of diabetes
possible relationship with glycemic control. So yet, only
prevalence [1].
few researches have looked into this link in the Egyptian
Diabetes causes a slew of long-term consequences,
setting. The current study aimed to improve the quality
including cardiovascular disease and peripheral
of life of type 2 Diabetes Mellitus (T2DM) patients
neuropathy, both of which can lead to disability.
through assessing their illness perception and
Diabetes frequently necessitates that patients modify
identifying its associated factors.
their daily routine in order to better cope with treatment

demands. Illness perception is important in determining
PATIENTS AND METHODS
the effects of this adjustment, and it has been shown to
A cross-sectional was conducted on 157 T2DM
have a significant impact on adherence and self-
Egyptian patients, between August 2021 and June 2022,
management [2].
at the outpatient clinic of Zagazig University Hospitals,
Sickness perception is the set of representations or
Sharkia Governorate. A systematic sampling technique
ideas that individuals have about their illness, including
was used to choose T2DM patients from those who visit
views about the etiology of the illness, its potential
the diabetic outpatient clinic each week.
effects, and whether or not it is treatable or self-

manageable [3].
Inclusion criteria included T2DM patients, aged 18 or
Understanding patients' disease beliefs and their
older, both sexes, and those excluded were those with
relationship to glycemic management is critical for
critical illness, mental incompetence or gestational DM.
maintaining health and minimizing complications.

Diabetes consequences are a significant financial
Tools for Data Collection: A structured Arabic
burden for individuals, their families, and the Egyptian
questionnaire that included three sections:
government [4].
I. Sociodemographic data, assessed according to
Improved adherence and self-management can
Fahmy et al. [5]. Questions included parents' education,
avert a large number of diabetes-related problems.
computer use, income, family size, crowding index,
Given the importance of disease perception in coping
sewage, and refuse disposal.
2451
Received: 26/09/2022
Accepted: 29/11/2022

Full Paper (vol.902 paper# 71)


c:\work\Jor\vol902_72 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2460-2466

High Versus Low Concentration of Aluminium Chloride Hexahydrate
Iontophoresis on Primary Palmar Hyperhidrosis
Eman M. Othman1, Noha A. Nagui2, Marina S. Helmi Fahim1, Marwa M. Abd El-Hameed1
Departments of 1Physical Therapy for Surgery and 2Dermatology, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Marina Sami Helmi Fahim, Mobile: (+20)01222557886,
E-mail: maro_gymnastics@yahoo.com

ABSTRACT
Background:
Primary palmar hyperhidrosis (PH) often develops throughout infancy or adolescence and lasts the
entirety of one's life. Although its cause is uncertain, it is believed to be caused by localised sympathetic hyperactivity
on otherwise healthy eccrine sweat glands, which is typically brought on by emotional or temperature stimulus.
Objective: To evaluate the therapeutic efficacy, tolerability and side effects of the low concentration (1%) versus high
concentration of aluminium chloride hexahydrate (20%) iontophoresis for primary palmar hyperhidrosis.
Patients and Methods: Thirty patients of both genders who established diagnosis of primary palmar hyperhidrosis with
age ranged 10-30 years were selected randomly from dermatology outpatient clinic of Ain Shams General Hospital,
Cairo, Egypt. The included subjects were randomly distributed into two equal groups; Group (A) consisted of 15 patients
(9 females and 6 males) with palmar hyperhidrosis were treated with iontophoresis of low concentration 1% aluminum
chloride for 3 days per week for 4 weeks. Group (B) consisted of 15 patients (8 females and 7 males) were treated with
iontophoresis of high concentration 20% of aluminium chloride hexahydrate at the same time.
Results: Both groups of the study showed a significant decrease in hyperhidrosis from the 3rd day until the 4th week
post-treatment (p < 0.05) throughout the follow-up period. However, comparing between both groups revealed that
improvement in group B was slightly better than group A (P < 0.04), but with more side effects like dermatitis and low
endurance, some patients might stop the treatment sessions.
Conclusion: application of low concentration iontophoresis; 1% of aluminium chloride hexahydrate compared to a high
concentration approach (20%) results in a significant reduction in the rate of palmar sweating with extended endurance
and no skin irritation.
Keywords: Iontophoresis, Low concentration 1% Aluminum Chloride Hexahydrate, High concentration 20%
Aluminum Chloride Hexahydrate, Primary palmar hyperhidrosis.

INTRODUCTION

Primary focal hyperhidrosis is an idiopathic
persons are unable to endure the dermatitis that the high
illness that often affects the axillae, palms, soles, and
concentration solution might induce despite the fact that
cheeks and is characterised by excessive perspiration
it can be extremely effective (4).
that exceeds thermoregulatory demands. Most of the
Since the sweat glands serve as the primary entry
time, there is no underlying illness, and typically,
point for medications, iontophoresis can successfully
emotional stress worsens it rather than heat or exercise
drive the aluminium salt to enter the sweat glands. The
(1).Up to 1% of the general population may be afflicted,
shared mechanism for the effect of topically applied
and there are serious medical, psychological, and
aluminium salt and direct electrical current
occupational consequences. Currently used treatments
administration is sweat gland blockage; this would
include
topical
aluminium
salts,
tap-water
support the application of aluminium salt via
iontophoresis, anticholinergic medications including
iontophoresis (5).
botulinum toxin, local surgical procedures, and
Applying direct current alone can reduce
sympathectomies. However, the relatively high
perspiration, but since the effects are frequently
prevalence of side effects and problems has restricted
transient (lasting only a few days), continual treatment
these therapies. Primary hyperhidrosis (PHH) is
is necessary. Topical aluminium chloride application to
typically treated with aluminium chloride applied
the control hand likewise caused a considerable
topically (2).
reduction in hyperhidrosis, though still with limited
Regardless of the severity, aluminium chloride-
endurance. Particularly for patients with sensitive skin
based antiperspirants are a well-established first-line
and palmar hyperhidrosis who cannot tolerate extended
treatment for all forms of primary focal HH. The mode
contact with topical treatments, iontophoretic
of action involves blocking the eccrine sweat gland
application of aluminium salt might be thought of as a
ducts with aluminium salts, which causes functional and
non-invasive and secure alternative therapy option (6).
structural deterioration of the glandular secretory cells
The aim of this study was to evaluate the
and the ductal epithelial cells, finally halting sweat
therapeutic efficacy, tolerability and side effects of the
output (3).
low concentration (1%) versus high concentration of
For the treatment of aluminium chloride solution
aluminium chloride hexahydrate (20%) iontophoresis
to be successful, large concentrations of up to 30% may
for primary palmar hyperhidrosis.
need to be applied for 6­8 hours. However, some

2460
Received: 03/10/2022
Accepted: 04/12/2022

Full Paper (vol.902 paper# 72)


c:\work\Jor\vol902_73 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2467-2473

Hospital Based Study in Assessment of Risk Factors of Stroke in Young Adults
Enas M. Hassan1, Al-shaimaa M. Aboulfotooh2, Yahia G. Yahia1, Rasha N. Saleh1
1Department of Neurology, Faculty of Medicine, Minia University, Egypt
2Department of Neurology, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Rasha Nady Saleh, Mobile: (+20)01069366601, Email: rashelshwekh82@gmail.com

ABSTRACT
Background:
Stroke is frequently thought of as an old age disease, yet 10% of stroke victims are thought to be under
the age of 45. Although the causes of this increase are unknown, there is evidence that the incidence of ischemic stroke
in young adults is growing. A different strategy to inquiry and care is needed for stroke in the young compared to stroke
in the old. Patients undergoing carotid revascularization operations benefit from the diagnostic and post-interventional
evaluation of carotid artery disease provided by neurosonology.
Objective:
This study aimed at studying the risk factors and most common etiologies of stroke in young adults.
Patients and Methods:
We recruited patients with acute ischemic stroke or transient ischemic attack with age older
than 18 and younger than 40 years old, who were admitted in the Stroke Unit ­Neurology department, Kasr-Alainy
Hospital within the first week of acute event.
Results: Analysis was done for 70 ischemic stroke patients from urban and rural areas. In Males, cardio-embolic, drug-
induced and undetermined causes were the most common etiologies for stroke representing together 63.3% (21 patients).
While among females, about half of the cases (48.6%) were due to cardio-embolic etiology. Age was significantly lower
in stroke of other determined etiology (p<0.01) and significantly higher in stroke of undetermined etiology (p=0.01).
Conclusion: Vascular risk factors, stroke type and presentation tend to differ in Egypt. Stroke in young adult patients
still has more specific causes, which are less common in the older age group. So, diagnosis needs a more oriented
approach to reach the proper stroke etiology for further secondary prevention in those patients.
Keywords: Stroke, Young adults, Carotid duplex, Transcranial Doppler.

INTRODUCTION
patients who undergo carotid revascularization
Stroke is the second leading cause of mortality and
procedures. It is safe, low cost, bed side, noninvasive
the third leading cause of disability worldwide. Stroke
but operator dependent (6). Trans cranial Doppler or
occurs in neonates, babies, children, and young adults
transcranial colour coded duplex sonography helps in
as well as more often in older individuals with severe
detection of occlusion or stenosis, confirmation of
morbidity and death (1).
vascular origin of the presenting symptoms, mapping of
Ischemic strokes make up around 80% of all
the collateral circulation, detection of microemboli and
strokes, and 10% of these so-called "young strokes"
right to left shunt (7).
affect people under the age of 45 (2). Cerebral infarction

continues to be the most prevalent kind of stroke, with
PATIENTS AND METHODS
subarachnoid
haemorrhage
and
intracranial
Patients who were admitted at the Stroke Unit -
haemorrhage accounting for 40­55% and 15­20%,
Neurology Department, Kasr Alainy hospital within the
respectively, of young adult strokes (3).
first week of the acute event were included in the study,
The prevalence of cardioembolic stroke is higher
with age older than 18 and younger than 40 years old of
in younger patients. Vasculopathy (such as arterial
both sexes. Diagnosis of acute arterial cerebral ischemic
dissection), heart abnormalities, recent pregnancy, other
event or transient ischemic attack was based on both
hypercoagulable states, smoking, illegal drug use, early
clinical assessment and cerebral imaging (a brain CT
atherosclerosis, hypertension, and probably migraine
scan or MRI). According to the most recent definition
are other disorders linked to ischemic stroke. Patients
of stroke for clinical trials. It had required either focal
report of having numerous neurological impairments
neurological deficit lasting > 24 hours or imaging of an
that impact their sphincteric, sensory, motor, or
acute clinically relevant brain lesion in patients with
coordination systems. Additionally, patients with a life
rapidly vanishing symptoms.
expectancy of decades have a different post-stroke
Exclusion criteria: Patients presented with cerebral
prognosis than older patients (4).
hemorrhage, subarachnoid & venous sinus thrombosis,
Investigating the causes of young-onset ischemic
and focal brain lesion or demyelinating lesion were
stroke frequently present difficulties. Contrary to stroke
excluded.
in older patients, stroke in young patients has a wide

variety of, frequently uncommon causes and risk
METHODS
factors, such as use of illegal drugs, pregnancy, arterial
A- Clinical Assessment:
dissections, and patent foramen ovale (PFO), which

calls for particular extra research and treatment (5).
Full history had been obtained focusing on risk
Neurosonology helps in diagnosis and peri-
factors,
neurological
examination
and
interventional assessment of Carotid Artery disease in
assessment of stroke severity using National
Institute of Health system score (NIHSS).
2467
Received: 30/08/2022
Accepted: 03/11/2022

Full Paper (vol.902 paper# 73)


c:\work\Jor\vol902_74 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2474-2481

Role of Cardiac MRI in Diagnosis, Follow Up and Post Management
Evaluation of Hypertrophic Cardiomyopathy
Waleed Abdelfattah Mousa1, Mohammed Abd El Aziz Maaly1,
Ola Taher Ismail Allam*1, Hayam Abdelmonsif Abdellatif1
Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Ola Taher Ismail Allam, Mobile: (+20) 01093524109, Email: olaallam2020@gmail.com

ABSTRACT


Background: Cardiac magnetic resonance imaging (CMR) is a valuable assessment tool for assessment of hypertrophic
cardiomyopathy (HCM). Many advanced sequences is rapidly developing.
Objective:
To assess the value of Cardiac MRI In diagnosis, Follow Up and Post-management evaluation of
hypertrophic cardiomyopathy.
Patients and Methods: A diagnostic test accuracy study with prospective evaluation was performed in Cardiology
Department of Kobry Elkobba Military Medical Complex and Radiology and Medical Imaging Department of Magdy
Yacoup Heart Foundation. Cardiac MRI was done for 50 patients who were screened for HCM, were suspected to have
HCM by clinical and echocardiographic examination and some come for follow up.
Results: 74% of the cases had asymmetrical septal hypertrophy. 40% of the cases had systolic anterior motion of the
mitral valve leaflet (SAM). 28% of the patients had left ventricular outflow obstruction (LVOTO), 85.7% of them had
asymmetric septal phenotype and all had SAM. 18% of the cases had systolic midventricular obliteration (MVO), and
all of them had mid ventricular phenotype. 62.1% of the cardiac segments exhibited extracellular volume (ECV)
expansion with no evident LGE with significant P-value (0.009). Follow up of the 6 patients underwent septal
myomectomy revealed that left ventricular thickness range decreased from 22 to 26 mm to 18 to 24 after the operation.
The SAM, mitral regurge and LVOTO resoluted in most of cases.
Conclusions: MRI is a crucial technique for diagnosis, follow up and risk stratification for patients with suspected or
diagnosed to have HCM.
Keywords: Cardiomyopathy, Hypertrophic, Magnetic resonance, Phenotype, Risk assessment.

INTRODUCTION
from 17 to 69 years with a mean age of 40.5 ± 12.8
Hypertrophic cardiomyopathy (HCM) is the most
years.
prevalent genetic form of cardiomyopathy, cardiac

magnetic resonance imaging (CMR) is advantageous
Inclusion criteria: The patients included in this study
over other imaging modalities in the assessment of
were asymptomatic patients with positive family history
individuals with suspected or confirmed HCM [1-2].
of HCM, suspected cases by clinical history,
CMR capacity to describe cardiac tissue is an
echocardiography examination, known cases of HCM
additional benefit. The relationship between gadolinium
under medical treatment and known cases of HCM
retention by the myocardium in fibrotic regions and
underwent surgical myomectomy, alcohol ablation or
clinical consequences has been intensively studied.
had MRI safe or conditional implantable cardioverter
Recently new T1 mapping methods, which may offer
defibrillators (ICDs).
information on diffuse fibrosis, have enhanced this [3].

CMR is also a valuable method for the differential
Exclusion criteria: Patients with MRI non-compatible
diagnosis of HCM, as it can distinguish this disease
cardiac devices. Patients with metallic implants (Ex.
from others that present with an increase in ventricular
Mechanical
Prosthetic
valves),
patients
with
width, such as the physiologic changes associated with
gadolinium hypersensitivity, patients with renal
high-performance athletes, cardiac deposit diseases,
impairment of GFR below 30 ml/min and patient with
aortic
valvular
disease
and
hypertensive
severe claustrophobia. Patients with left ventricular
cardiomyopathy [2].
hypertrophy due to infiltrative cardiomyopathy and
Our study aimed to assess the value of cardiac MRI
hypertension or athletics.
in diagnosis, risk stratification and Follow Up of

patients with hypertrophic cardiomyopathy.
All patients included in this study were subjected

to complete history taking, clinical examination by the
PATIENTS AND METHODS
cardiologist, cardiac MRI examination with the
This study was recruited in Cardiology Department
studying of myocardial function and viability.
of Kobry Elkobba Military Medical Complexes and
Prior to the examination, each patient was given
Radiology and Medical Imaging Department of Magdy
a thorough explanation of the procedure. Patients were
Yacoup Heart Foundation over the period from October
informed that they would have to be stable during the
2020 to December 2021. 50 patients were enrolled in
exam and that they will hear loud noise from the system.
this study, 33 males and 17 females, their ages ranged
Training patients to hold their breath for relatively
2474
Received: 29/08/2022
Accepted: 02/11/2022

Full Paper (vol.902 paper# 74)


c:\work\Jor\vol902_75 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2482-2487

Comparing Outcomes of Lateral Internal Sphincterotomy, Botulinum Toxin
Injection and Laser Therapy in the Management of Chronic Anal Fissure
Peter Nagy Maurice*, Abel Rahman Mohamed Amin, Tamer. A. A. M. Habeeb, Yasser Ali Orban
Department of General Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Peter Nagy Maurice, Mobile: (+20) 01034287659, Email: p.nagy84@yahoo.com

ABSTRACT
Background:
Chronic anal fissure (CAF), which affects both sexes equally, typically develops in early adulthood. For
the therapy of CAF, laser sphincterolysis and botulinum toxin (BTX) have been used. Objective: The aim of the present
study was to evaluate the effectiveness of BTX injection and laser in the treatment of CAF.
Patients and methods: Our clinical trial included 150 patients with CAF and assigned into one of the 3 modalities of
treatment: lateral internal sphincterotomy (50 patients, BTX (50 patients) and laser sphincterolysis (50 patients). In BTX
group, 20 U was diluted in 1ml isotonic saline and half of this dose was injected on each side of the fissure in all cases.
Regarding laser sphincterolysis, all procedures were carried out using the Lasotronix Smart M 1470 nm diode laser
(Poland); for Anal fissure 70-100 W energy given. Patients were followed up after 1 week then every 2 weeks for 8
weeks after intervention.
Results: All cases in all groups stayed for one day at hospital. Healing period was significantly shorter among Botox
group then laser group and significantly longer among open group. In BTX group, 7.5% of the patients were reinjected
with the same dose of botulinum toxin and had healed fissure 2 months after reinjection. Incontinence was significantly
associated with open group and was lower in laser and Botox groups with no significant difference between them.
Conclusion: BTX injection is more suitable first-line treatment of choice for chronic idiopathic anal fissure, which is
not associated with other anal conditions. It is a simple procedure, easy to learn and can be done in outpatient clinic
without need for sedation or local anesthesia. Regarding laser, it has less operation time, discharge may be given within
a few hours, within a day patients can go back to normal routine work, with greater surgical precision and fastest
recovery, fewer blood loss during surgery and no or minimal post-operative pain.
Keywords: Anal Fissure, Sphincterotomy, Botulinum Toxin Injection, Laser Therapy.

INTRODUCTION

The autonomic nervous system is a mediator of
A longitudinal ulcer that extends from below the
BTX activity. The internal sphincter spasm is intended
dentate line to above the anocutaneous line is called a
to be stopped by BTX therapy. It is true that sphincter
chronic anal fissure (CAF); 90% of the time, it is the
manometry following BTX injection has shown a
posterior. The anterior commissure is the second place.
reduction in resting internal pressure (5). BTX causes
In women, 80% of birth defects occur anteriorly and
transient muscular paralysis by preventing the release of
20% are posterior (1). In contrast to botulinum toxin
acetylcholine from presynaptic nerve terminals. It has
(BTX) injection, which has a 70% healing rate with a
also been proposed that BTX injections can cure
20% incidence of recurrence, surgery lateral internal
persistent fissures instead of surgery (6).
sphincterotomy (LIS) has a 90% healing rate after 2
Since the skin of the perianal region is delicate
months and no recurrence rate has been seen (2).
and thin, laser therapy is a cutting-edge method of
When medical therapy for a persistent fissure is
treating these lesions. Laser therapy for perianal lesions
ineffective, surgical procedures are advised. The
is a non-contact procedure that often causes the patient
preferred course of therapy in these circumstances is
to have reduced bleeding, pain, and discomfort.
LIS. By severing a piece of the muscle, this treatment
Therefore, it is regarded as a good alternative for the
reduces internal sphincter spasm. With either open or
treatment of perianal and rectal tumors, anal fistula,
closed techniques, around 30% of the internal sphincter
hemorrhoids, and anal fissure (7). Numerous researches
fibers are severed laterally (3).
on the use of laser therapy for the treatment of tumors,
Because it is rapid, simple, and has few risks, LIS
anal fistulas, and hemorrhoids have been conducted in
is an effective therapy for CAF. Rarely do recurrences
the last ten years. However, there are few researches on
occur. There is no chance of anesthesia or surgical
the use of laser therapy for acute anal fissures (8).
complications with BTX, which is safe and simple and
It was discovered that treating an anal fissure with
provides quick pain relief. Although it is far less
this novel surgical technique was effective, simple, and
intrusive than surgery and has fewer side effects, its
rapid. Additionally, the procedure improved blood flow
recurrence rate is greater. Therefore, BTX injection is
and lessened discomfort. Reduced recovery time,
preferable in middle-aged and older patients, risk
efficient eradication of all clinical problems, and a
factors for anal incontinence, or those who have
minimum of dangers and side effects are all advantages
recently complained of anal fissure. The risk of anal
of laser treatment (9).
incontinence is higher in the surgical group, especially
Although the method is painless and patients are
in senior patients, than BTX injection (4).
more likely to accept and be happy with therapy, it has

certain drawbacks. Surgeons should be taught surgical
2482
Received: 26/09/2022
Accepted: 26/11/2022

Full Paper (vol.902 paper# 75)


c:\work\Jor\vol902_76 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2488-2491

Dermatological Uses of Pulsed Dye Laser with Special Emphasis on
Port Wine Stain: Review Article
Aiah Atiah Mansour El-Feky*, Abdallah Hassan Kandil, Ahmed Said Abdelshafy
Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aiah Atiah Mansour El-Feky, Mobile: (+20) 01025951066, E-Mail: aiahatiah67@gmail.com

ABSTRACT
Background:
For its lasing medium, a dye laser uses a solution of organic dye in a solvent. Among the laser dyes are
rhodamine, fluorescein, coumarin as well as malachite green. In addition to water and glycol, other solvents include
ethanol, methanol, hexane, cyclohexane, and cyclodextrin. The time it takes for the target structure to drop to half its peak
temperature after being irradiated by a laser is shorter than the pulse duration of the laser energy.
Objective: Review of the literature on Dermatological Uses of Pulsed Dye Laser.
Methods:
We looked for data on laser therapy and pulsed dye laser, treatment in medical journals and databases like
PubMed, Google Scholar, and Science Direct. However, only the most recent or extensive study was taken into account
between December 2001 and February 2022. References from related works were also evaluated by the writers. There
are not enough resources to translate documents into languages other than English, hence those documents have been
ignored. It was generally agreed that documents such as unpublished manuscripts, oral presentations, conference
abstracts, and dissertations did not qualify as legitimate scientific study.
Conclusion: Pulsed dye laser (PDL) therapy has shown promise in the treatment of a variety of skin conditions. Port
wine stains can be removed using PDL (vascular malformation), cherry angiomas, telangiectasias, and poikiloderma of
Civatte are examples of acquired cutaneous vascular lesions.
Keywords: Pulsed Dye Laser, Port Wine Stain.

INTRODUCTION
(PWSs), also known as nevus flammeus, are cutaneous
An umbrella term for a diverse range of vascular
vascular abnormalities associated with the postcapillary
abnormalities that continue to provide diagnostic and
venules that can cause severe physical and
therapeutic problems. Correct diagnosis and treatment
psychological difficulties. PWSs don't involute like
of vascular abnormalities depend on the vocabulary
hemangiomas do. PWSs are distinct, smooth, and
used to define and classify these conditions.
expand along with the child in size (2).
Hemangiomas and other vasoproliferative or vascular
In the clinic, it manifests as areas of pinkish red
neoplasms are placed in category 1, while vascular
to violet skin. Despite the higher prevalence of
malformations are placed in category 2 (1). Congenital
congenital PWSs, the incidence of PWSs in babies is
and acquired forms of postcapillary venous shunts
low (0.3%-1.4%) and shows no sex predilection
(3).



Figure (1): Port wine nodules, which range in
Figure (2): Stains from red port wine; blotchy
size from a mung bean to a pea, are a telltale sign
pink areas.
of a spilled drink (black arrows). on the angular,
dark purple-red plaques with distinct margins.
2488
Received: 23/09/2022
Accepted: 26/11/2022

Full Paper (vol.902 paper# 76)


c:\work\Jor\vol902_77 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2492-2499

Subclinical Myopathy in Some Systemic Diseases
Shimaa Mosaad Abdo Fouda*1, Tamer Mohamed Ibrahim Belal1,
Saleh Saleh Al-Esawy2, Mohamed Abd-elsalam Mohamed Ali1
Departments of 1Neurology and 2Radiology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Shimaa Mosaad Abdo Fouda, Mobile: (+20) 01097041605, E-Mail: shimaaafouda@gmail.com

ABSTRACT
Background:
Subclinical myopathy is an earlier stage that can be easily managed to prevent or delay the associated
complications and progression to evident myopathy.
Objective: To evaluate subclinical manifestations and distribution of muscle affection in diabetes mellitus (DM),
chronic liver disease (CLD) and chronic kidney disease (CKD).
Patients and methods: The study includes 60 patients who were classified into 3 equal groups: Group 1 included
diabetes mellitus cases, group 2 included chronic liver disease cases, group 3 included chronic kidney disease cases and
another 20 normal individuals as control who were age- and sex-matched (Group 4). The study was conducted at
Outpatient Clinic and Inpatient Neurology Department at Mansoura University Hospitals. Four groups were subjected
to Electromyography, Magnetic resonance imaging and laboratory investigations.
Results: There was statistically significant difference between the studied groups regarding the CK (creatine kinase)
and LDH (lactate dehydrogenase) levels. The CK level was higher in CLD and CKD groups than in DM and control
groups but within upper normal level. The pattern of myopathy in DM cases was more in proximal than distal muscles
at upper and lower limbs. In CLD cases, the myopathic pattern at upper and lower limbs were close in proportions. The
pattern of myopathy in CKD cases was more in proximal than distal muscles at upper and lower limbs. The distribution
of myopathic pattern in control group was 5%.
Conclusion: Subclinical myopathy isn't uncommon in DM, CLD and CKD. CK level is high in CLD and CKD patients
but within normal upper limit that need further follow up for diagnosis of myopathy.
Keywords: Subclinical myopathy, DM, CLD, CKD, Electromyography, Magnetic resonance imaging.

INTRODUCTION
development of a myopathy in chronic kidney disease.
Myopathy is a muscular disease in which the
With glomerular filtration rates of less than 25 ml/min,
muscle fibers do not function for any one of many
uremic myopathy typically develops and has been
reasons, resulting in muscular weakness. On a structural
linked to increased fatigability and decreased exercise
and functional level, underlying diseases can influence
tolerance (5). Since electromyography and creatine
muscles. These effects can include metabolic changes
kinase levels are typically normal, the diagnosis is made
and changes in muscle ion channels (1).
primarily based on clinical factors (6).
In 2011, Chawla (2) classified Myopathies in
Patients with liver cirrhosis frequently report
systemic disorders to: (1) Endocrine myopathies:
losing muscle mass, which is a classic clinical
Conns syndrome, thyroid disorders, and DM. (2)
observation. The wasting most likely causes disability
Inflammatory myopathies: collagen diseases as SLE
and motor dysfunction. Although there is little
and RA. (3) Myopathy associated with paraneoplastic
information on the functional repercussions, lower
disease. (4) Infectious myopathy: myositis caused by
muscle mass can lead to impaired skeletal muscle
the influenza virus. (5) Myopathies brought on by toxins
metabolism or contractile functions, which can
and drugs (Critical illness myopathy). (6) Chronic renal
contribute to the unfavourable outcomes in cirrhosis.
failure, hepatic failure, and COPD are myopathies that
Although it is likely that inadequate protein intake and
are related to metabolic diseases.
malnutrition play a role in the wasting, patients with
Muscle fatigue rather than actual weakness is
normal dietary intake can still lose muscle mass (7).
more typical in endocrine myopathies. It is unclear what
Electromyography (EMG) may be a crucial
causes the disorder's weakness. There is also the
component of the myopathy diagnosis, alongside blood
question of whether a disease of the muscles affects the
tests, muscle biopsies, and genetic analysis. The EMG
muscles themselves, or whether it affects some other
is rarely used to distinguish between different
part of the motor system. In most cases, the level of CK
myopathies (8).
in the serum is within normal limits (except in

hypothyroidism or hyperthyroidism). The treatment is
MRI is a key tool for defining muscle anatomy
successful for most endocrine myopathies (3).
and morphology as well as characterizing changes to
Numerous factors, including hyperglycemia,
muscle composition. MRI helps to significantly narrow
hypoinsulinemia, and changes in important hormones
the broad differential diagnosis, influencing the
like glucocorticoids, can be blamed for the significant
treatment and predicting prognosis in patients with
loss of muscle mass in Type 2 diabetes (4).
muscle complaints, even though eventually biopsy may
Specifically in the muscles of the lower limbs,
be required to establish diagnosis (9).
proximal weakness and wasting are brought on by the

2492
Received: 30/08/2022
Accepted: 03/11/2022

Full Paper (vol.902 paper# 77)


c:\work\Jor\vol902_78 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2500-2508

What about The Role of miRNA125a-5p in Iraqi Patients with
Autoimmune Hashimoto's Thyroiditis?
Satae Y. Mohammed*, Haidar J. Muhammed
Department of Biology, College of Science, Mustansiriyah University, Baghdad, Iraq
Corresponding author: Satae Y. Mohammed, E-mail: sthg@uomustansiriyah.edu.iq

ABSTRACT

Background: Hashimoto's Thyroiditis a common disease that affects the thyroid gland. Recent studies on Hashimoto's
Thyroiditis indicated the ability of miRNA to silence messenger RNA and regulate post-transcriptional processes.
Objective: The aim of the current study was to find the relationship between microRNA 125a-5p and the production of
antibodies thyroid peroxidase (Anti-TPO). Patients and methods: The present study enrolled 125 patients, whom 25 were
males and 100 females; the ratio of males to females was 1:4. Blood samples were collected from the participants from the
Specialized Center for Endocrinology and Diabetes, Rusafa, Baghdad (Iraqi Ministry of Health). Hashimoto's patients were
diagnosed using clinical methods, ultrasound, and serological testing. Also, anti-TPO were detected using the ELASI
technique. Quantitative reverse transcription-polymerase chain reaction (RT-qPCR) was used to detect microRNA125a-5p
levels in 40 samples from patients with Hashimoto's disease and compare them with 10 healthy individuals.
Results: There were high levels of Anti-TPO in patients with Hashimoto's disease compared with the healthy individuals,
with a statistically significant difference (P 0.01). The study also showed a decrease in the levels of miRNA 125a-5p in
patients with Hashimoto's disease compared with the healthy individuals, with a statistically significant difference (P 0.01).
Conclusion: The study showed a decreased miRNA-125a-5p expression that was found to be inversely associated with the
low level for gene expect. This could be related to many factors as patients might be taking medication, population
differentiation, races, miRNA, and drug interaction.
Keywords: Thyroid hormones, autoimmune Hashimoto's disease, thyroid peroxidase antibody (Anti-TPO), miR125a-5p,
Comparative study, Mustansiriyah University.

INTRODUCTION
many genes and pathways involved in the pathogenesis of
Hashimoto's thyroiditis is caused by a complex
inflammatory and autoimmune diseases (6). Non-coding
multistep process including genetic, environmental, and
RNAs are well-known to play crucial roles in the
immunological variables accompanied by a decrease of
pathogenesis of HT. Which binds to the 3'-untranslated
thyroid hormones T3 and T4. In a nutshell, the loss of
regions (3'-UTRs) of messenger RNAs (mRNAs) in a
immunological tolerance to normal thyroid cells drives
sequence-dependent manner and ultimately either
the generation of antibodies against thyroid tissue,
represses translation or causes degradation of target
resulting in thyroid gland death. When genetically
mRNAs (7,8). Molecular RNA has been linked to various
predisposed
individuals
are
exposed
to
the
human diseases and is pursued as a therapeutic target and
aforementioned environmental variables, the illness
as a clinical diagnosis (9).
process begins with inflammatory changes (1). As in
Their mean length is about 20 bp and used in
autoimmune thyroid illness, the epitope recognition
clinical research and medicine in a slew of recent studies
pattern of antibodies is changed, initiating immunological
(10,11). The apparent high stability of cell-free miRNA
and inflammatory processes (2). As well as important
afforded by small size and packing in supramolecular
thyroid peroxidase, an enzyme that catalyzes the
complexes is one of the explanations for this trend (12).
oxidation of iodine also plays a significant role as an
According to recent research, evidence is
autoantigen in the disease pathogenesis (3).
mounting that microparticles are implicated in the
The production of auto-reactive cells directed
etiology of autoimmune disorders and are instrumental in
against the thyroid gland in which immunological
directing immune responses. Recent research has
tolerance loss has been linked to genetically determined
discovered that miRNAs play a role in T and B cell
immune abnormalities or a lack of regulatory T-cells,
proliferation, maturation, and differentiation, and thus
which serve as suppressors (4).
may influence the outcome of the immune response (13).
Antibodies thyroid peroxidase (Anti-TPO)
The aim of the current study was to find the relationship
autoantibody detection is the most sensitive of the three
between microRNA 125a-5p and the production of Anti-
anti-thyroid autoantibodies for diagnosing chronic
TPO.
thyroiditis (5). miRNA is a small single-stranded non-

coding RNA molecule that functions in silencing and
PATIENTS AND METHODS
post-transcriptional gene expression regulation. miRNAs
The study enrolled 125 patients, whom 25 were males
have recently been identified as powerful regulators of
and 100 females; The ratio of males to females was 1:4.
2500
Received: 02/09/2022
Accepted: 05/11/2022

Full Paper (vol.902 paper# 78)


c:\work\Jor\vol902_79 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2509-2515

Extremities Fractures and Fixation and their Effects on Patients, Quality of Life
Eman M Emara*, Nagwa R Attia, Zeinab F Bahgat
Medical & Surgical Nursing, Faculty of Nursing, Tanta University, Egypt
Corresponding author: Eman Mohammed Emara
Email: eman.emara@nuring.tanta.edu.eg, Tel.: +201016925551

ABSTRACT
Background:
Worldwide extremities fractures is one of the most frequent causes of physical disability and changes in
patients' quality of life.
Aim: This study aimed to assess extremities fractures and fixation and their effects on patients' quality of life.
Subjects and methods:
A descriptive study that was conducted at the Orthopedic Departments in Tanta University
Hospital and Casualty Hospital affiliated to Ministry of Higher Education, Egypt. A convenience sample of 100 adult
patients (18-60years) of both sexes, conscious and able to communicate verbally without any neurological problems.
The assessment was done four times throughout the period of the study before fixation surgery and one week, one month
and three months after fixation surgery.
Three tools were used: Tool (1) Structured interview questionnaire that included 2 parts, part (1) Sociodemographic
questionnaire and Part (2): Clinical assessment. Tool (II) The short musculoskeletal function assessment questionnaires.
Tool (III): Short form 36 (SF-36) health survey questionnaire.
Results: There was a negative impact of extremities fracture on patients' total quality of life. oth extremities and specific
lower extremity fracture had the poorest quality of life scores than upper extremity fracture.
Conclusion:
Extremities fractures and their surgical management including internal and external fixation have a
considerable effect on all dimensions of patients' quality of life.
Keywords: Upper extremity fracture, Lower extremity fracture, Internal fixation, External fixation, Quality of life.

INTRODUCTION
Significance of the study: Musculoskeletal injury
Musculoskeletal fractures are common and are
is one of the leading causes of physical disability on a
considered the main injuries seen in the emergency
worldwide scale, but nursing appears to lack data on the
department in which the extremity fractures are the most
severity and effect of this hardship on QOL. The mostly
prevalent injuries and are a significant source of illness
affected dimension, and the need for a care plan
burden and lost productivity in society (1). A bone
centered on the provision of complete care for this
fracture is a breach in the continuity and integrity of the
aspect. This is due, in part, to a lack of consensus over
bone caused by the inability of the bone to tolerate
the criteria of impairment and decreased function
external pressures. The management of extremity
coupled with bone fracture (7). The aim of the study was
fracture depends on reduction and immobilization of the
to determine the effects of extremity fractures and
fractured site, which include medical, surgical and
fixation on patient's quality of life.
nursing management. The medical treatment includes

examination and inspection for deformity, bruising,
Research Questions: What is the relation between
effusion, open wounds and then urgent reduction and
extremities fractures and quality of life? What is the
splinting are performed (2).
relation between fracture fixation types and quality of
Surgical management of fracture include internal
life? and What is the mostly affected dimension of
and external fixation. Internal fixation refers to the
quality of life in need for comprehensive nursing care
process of joining the bones physically. This technique
strategies?
employs specific screws, plates, wires, or nails to

properly align the bones, followed by reduction (3).
SUBJECT AND METHOD
External fixation is a procedure for fracture stabilisation
This descriptive research was conducted at the
in which pins or wires are percutaneously inserted into
Orthopedic Departments in Tanta University Hospital
bone and kept in place by an external scaffold (4).
and Emergency Hospital affiliated to Ministry of Higher
Quality of life (QOL) is largely an individual's
Education, Egypt. A convenience sample of one
subjective perception of physical, psychological, social,
hundred adults patients (18-60years) of both sexes,
and spiritual well-being. Physical and mental health,
conscious and able to communicate verbally without
degree of independence, and social engagement with the
any neurological problems, pathological fracture and
environment will affect an individual's QOL as also rely
without any chronic diseases.
on external factors (5). The orthopaedic nurses have a

distinct role as they provide patient centred care
Methodology: Three tools were utilized in this study:
depends on evidence-based researches and practice as
Tool (1) Structured Interview Questionnaire: This
well as focused on individualized care using various
tool has been developed after reviewing of recent
strategies (6).
relevant literature (8-9). It comprises two components:
2509
Received: 02/08/2022
Accepted: 03/10/2022

Full Paper (vol.902 paper# 79)


c:\work\Jor\vol902_80 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2516-2519

Preparing Special Exercises for Stress Training to Develop Performance
Endurance and Some Compound Offensive Skills in Youth Football
Montdhar Atwan Mohmmad1* , Saeed Ahmed Saeed2
College of Physical Education and Sports Sciences / University of Baghdad, Iraq.
*Corresponding author: Montdhar Atwan Mohmmad,email: mundather.Atwan1204a@cope.uobaghdad.edu.iq ,
Mobile: +9647808752743
ABSTRACT
Background
: The purpose of this paper is to prepare special exercises for stress training to develop performance
endurance and some compound offensive skills in football for young people, and to identify the effect of stress training
on endurance performance and some offensive skills in football for young people.
Methods: The research community was identified, which were the (25) players of the Oil Sports Club for Youth. The
sample of the research was selected from the same research community, and the goalkeepers were excluded, so that the
number was (23) players, selected from them (3) players for the pilot experiment and (20) players on whom the main
experiment was applied.
Results: After the compound offensive skills were determined, and after the researcher reviewed the sources, research,
previous studies and personal interviews he conducted with the specialists, the appropriate tests were nominated: the
first composite skill test (passing measurement, receiving in a specific area with fast rotation, fast running with the
ball Then passing and receiving, shooting accuracy), the second composite skill test (measurement of running and ball
control, speed of change of direction, shooting accuracy), and the third composite skill test (measurement of passing
and receiving, rapid rotation in a specified space, shooting accuracy towards a divided target).
Conclusion: The researchers concluded that the stress training exercises used on the sample were effective and positive
in developing the performance endurance in football for youth.
Keywords: (stress training, performance endurance, compound skills, and offensive skills).

Research problem:

Football is one of the first popular and popular

games in the world, and it is one of the most abundant
In addition, the more successful the coach is in
games for the player and spectator's enjoyment,
choosing the optimal training method, the more
especially if it is played by skilled players, because they
successful the training process will be and lead to
play it aesthetically and smoothly.
positive results. For the tournament because of its
Functional, tactical and psychological, and
importance, as well as the preparations for quick
football is one of the games that has developed a great
tournaments, or as a result of players' failure to train for
deal, and that this development did not come from a
a certain period or exposure to a period of exams or
vacuum and was not the result of chance, but was
injuries, and the mismatch of the training environment
achieved thanks to sound scientific planning using
with the environment of the matches faced by the
scientific means and methods, and that the game of
attackers, which leads to impeding the physical and
football is one of the games that is directly affected
functional characteristics and thus impeding the
in Kinetic and skill abilities)1(.
performance of compound skills in achieving

distinguished results.
The importance of compound offensive skills
Therefore, the researcher decided to address this
in football has increased in recent times, because
training gap in a scientific and accurate manner by
modern play has become more difficult and compound
developing a training curriculum that relied in its
compared to previous methods of playing, and the
preparation on the pressure method and knowing the
compound offensive skills have the basis for building
extent of its impact on the development of performance
and progressing the football player and working to
endurance and some compound skills in football to put
improve the player's skill and planning level, and
it in the service of the football coaches (3,4,5).
understanding this relationship is the basis for

developing appropriate training curricula. Which helps
Research objective:
us to reach the higher levels of sports, and it is not
- Prepare exercises with stress training to develop
possible to determine the level of sports training that the
performance endurance and some compound
players have reached without benefiting from the tests
offensive skills in football for young people
used in the game.
- Identify the effect of stress training on developing
Based on the foregoing, the importance of the
performance endurance and some compound
research is reflected in the need to know the impact of
offensive skills in football for young people.
stress training and its role in developing performance

endurance and offensive vehicle skills in the training
Research hypotheses:
process )2(.
That there is a significant effect in favor of the

post-tests in the use of stress training to develop
2516
Received: 01/10/2022
Accepted: 04/12/2022

Full Paper (vol.902 paper# 80)


c:\work\Jor\vol902_81 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2520-2525

Laparoscopic Pediatric Inguinal Hernia Repair with and without
Excision of the Hernial Sac
Sari Mustafa Bin Nour*, Ahmed Ezzat Rozeik, Mohammad Alekrashy, Ahmed K. El-Taher
General Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Sari Mustafa Amhimmid Ben Nour, Mobile : (+20) 0114496 3269, E-mail : sary.bin@gmail.com

ABSTRACT
Background:
In skilled hands, laparoscopic repair of inguinal hernias has become an integral part of pediatric inguinal
hernia management. Objective: The aim of the current study is to compare the outcome of laparoscopic inguinal
herniotomy with excision of the hernial sac with laparoscopic inguinal herniotomy with just disconnection of the sac.
Patients and methods: A randomized controlled clinical trial was conducted at Pediatric Surgery Department at Zagazig
University Hospital, on 24 patients who had inguinal hernia. All cases were divided into two groups: Group A (n=13):
Laparoscopic inguinal herniotomy by closure of the hernial defect by intracorporeal purse-string suture ligation of the
peritoneum with excision of the hernial sac. Group B (n=11): Laparoscopic inguinal herniotomy by closure of the hernial
defect by intracorporeal purse-string suture ligation of the peritoneum with just disconnection of the sac.
Results: Testes size in Group (A) pre-operative was mean 238.58 (SD 133.507) mm2 and it was increased to be
postoperative with a mean value of 256.33 (SD 127.278) mm2, while in Group (B) pre-operative mean 117.07 (SD
33.878) mm2 and it was increased to be postoperative with a mean value of 214.31 (SD 229.928) mm2. Preoperative
data showed statistically significant variations between groups. Patients outcome in Group (A) show that 1 (7.7%) had
scrotal hematoma, 1 (7.7%) had scrotal edema and 1 (7.7%) had wound infection, while in Group (B) 1 (9.1%) had
scrotal edema, 1 (9.1%) had wound infection and 1 (9.1%) had recurrence.
Conclusion: Laparoscopic closure of the internal inguinal ring in pediatric inguinal hernia with excision of the sac and
closure after just disconnection of the sac have similar effect on pediatric laparoscopic inguinal herniotomy.
Keywords: Laparoscopic Pediatric Inguinal Hernia, Excision, Hernial sac.

INTRODUCTION

and partially excised. The hernial sac is divided and the
One of the most common children diseases, the
upper part is sutured. An intra-corporeal laparoscopic
incidence of pediatric inguinal hernia (PIH) is between
approach with the IIR is a simulation of an open
0.8% and 4.4%. Having the processus vaginalis not
herniotomy (4).
properly close is the most common cause of this
An alternative to open herniotomy is the
inguinoscrotal malformation. All children diagnosed
laparoscopic transection and intracorporeal closure of
with an inguinal hernia should undergo surgical repair to
the hernia sac has been shown to be both safe and
avoid confinement and significant complications such
successful (5). The aim of the current study is to compare
intestinal necrosis and testicular/ovarian dysfunction or
the outcome of laparoscopic inguinal herniotomy with
mortification (1).
excision of the hernial sac with laparoscopic inguinal
Any case of inguinal hernia requires surgical
herniotomy with just disconnection of the sac.
repair. Traditional treatment involves an open incision

called a herniotomy (OH). Although Laparoscopic
PATIENTS AND METHODS
herniotomy (LH) has been around for over two decades,
A randomized controlled clinical trial was conducted at
there is still some disagreement over whether or not it is
Pediatric Surgery Department at Zagazig University
the preferred method of inguinal hernia repair. An
Hospital, on 24 patients who had inguinal hernia.
intraperitoneal (IP) technique was initially described,

together with partial sac incision and a periorificial
Inclusion criteria: Congenital inguinal hernia patients,
purse-string suture at the internal inguinal ring (IIR).
age group between 2 years old and 14 years old, and
Subsequently, effective extraperitoneal (EP) methods
recurrent inguinal hernia.
were developed to eliminate the requirement for

intracorporeal knot tying (2).
Exclusion criteria: Patients with major cardiac
One of the main benefits of laparoscopy is that it
anomalies, ascites, hernia with undescended testicles,
provides unparalleled visibility, allowing for bilateral
previous major lower abdominal surgery, parental
exploration of the inguinal canal using the same small
refusal, and contraindications for laparoscopy.
trocar incisions and without making any additional

incisions. Parents of kids with inguinal hernias were
All cases were divided into two groups:
persuaded in large part by the lowered chance of cord
Group A: Laparoscopic inguinal herniotomy by closure
injury, decreased postoperative pain, faster recovery, and
of the hernial defect by intra-corporeal purse-string
improved cosmesis offered by this method (3). When
suture ligation of the peritoneum with excision of the
compared to the standard herniotomy, laparoscopic
hernial sac.
methods still differ in that the Sac must be transectioned
2520
Received: 26/09/2022
Accepted: 29/11/2022

Full Paper (vol.902 paper# 81)


c:\work\Jor\vol902_82 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2526-2533

Evaluation of Psychosocial Morbidity among Children and
Adolescents with Beta-Thalassemia Major
1 Ghada Abdelaziz Mohamed Abdelaziz, 1 Osama Roshdy Elsafi,
2 Nelly R. Abdel Fattah, 1 Mahmoud Abdelazeem
1Pediatrics and 2Psychiatry Departments, Faculty of Medicine, Zagazig University, Sharkia, Egypt
Corresponding Author: Ghada Abdelaziz Mohamed, Email:ghadaabdalzizo@gmail.com, Mobile: +01005871744

ABSTRACT
Background:
Thalassemia major (TM) is a long-term illness that affects the child and family emotionally and
psychologically.
Aim: To assess the existence of psychiatric symptoms in thalassemia-affected children and teenagers, such as hysteria,
somatic symptoms, obsessive symptoms, depressive symptoms, anxiety, and phobic anxiety.
Subjects and methods: This is a case-control study that included 42 children and adolescents who have transfusion-
dependent beta-thalassemia major and 42 healthy controls. All patients underwent Psychological assessment using a
questionnaire by The Arabic version of the Child Behavior Check List (CBCL/6-18).
Results: There was a significant difference between the two groups regarding total problems grades that were clinical and
borderline in cases more than in the control group.
Conclusion: The Arabic version of the Child Behavior Check List identifies behavioral and psychological issues in patients
with beta-thalassemia major.
Keywords:
psychosocial, thalassemia major, children, adolescents.


INTRODUCTION


-Thalassemia major is the most common
Additionally, children's and adolescents' capacity to
hemoglobinopathy with a carrier rate of 9-10.2%, it is
independently manage their illness is hampered by
prevalent in the Mediterranean region, particularly in
developmental issues (4). During the academic years and
Egypt (1).
the adolescent years, when kids are looking for
Because of the high costs of treatment, Beta
independence, the disease's drawbacks in many areas of
thalassemia major is a significant health issue for the
life become apparent. It has been connected to a
public health system of any nation, necessitating frequent
psychosocial aspect and a significant detrimental effect
hospitalizations, iron chelation, and general medical
on areas of school functioning because of the potential for
follow-up. This places a strain on the healthcare system
physical deformity, growth retardation, and delayed
as well as the affected families' children, who are made
puberty, as well as the difficulty of management (such as
more susceptible to behavioral, emotional, social, and
regular transfusion and time-consuming iron chelation
psychological problems(2).
treatment) (5).
Depending on the severity of their condition,
It is necessary to evaluate the psychosocial effects
children with transfusion-dependent thalassemia should
of thalassemia to create informational guidelines for
get blood transfusions once or twice monthly. They might
support and counseling programs to optimize coping with
have to remain in the hospital for the duration of the
the disorder. Thalassemic patients and their families have
transfusion day, which would interfere with their social
experienced improved survival due to a high level of
and academic life. Their self-esteem may suffer as a result
social integration, acceptance, and self-esteem, along
of iron overload and the undesirable bronzed color. In
with appropriate medical care and psychosocial support
addition, the risks associated with iron overload may
(6).
become evident in the absence of chelation or as a result

of patient noncompliance(3).
PATIENT AND METHODS
Chronic illness frequently interferes with growth
This is a case-control study that was conducted on
and development. The chronic condition, and the expense
42 children, and adolescents with transfusion-dependent
of treatment, which includes frequent hospital stays, iron
beta-thalassemia major and 42 healthy controls. They
chelation, regular blood transfusions, general medical
were recruited from Hematology Unit, Children's
checkups, and surgery as needed, all contribute to
Hospital, Zagazig University, during the period from
concerns
about
physical,
emotional,
social,
January 2022 to June 2022.
psychological, and behavioral appearance, interfering
The patients were divided into two groups: 42
with the process of becoming independent and
children and adolescents with beta-thalassemia major and
maintaining positive bonds with family and friends.
2526
Received: 22/09/2022
Accepted: 25/11/2022

Full Paper (vol.902 paper# 82)


c:\work\Jor\vol902_83 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2534-2541

Acute Dermatological Toxicity of Hypofractionated Radiotherapy after
Breast Conservative Surgery in Early Breast Cancer Patients
Omnia Yousef Thabet*, Eman Ismail Ibrahim, Alaa Abd El Hamid Fayed, Mona Salah Fattahalla
Department of Clinical Oncology& Nuclear Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Omnia Yousef Thabet, Mobile: (+20) 01020866805, E-Mail: oncoomnia2019@gmail.com

ABSTRACT
Background:
Breast cancer patients treated with chemotherapy and whole breast hypofractionated radiation may
experience acute and delayed cutaneous damage depending on a number of factors.
Objective: Evaluation of acute skin toxicity of hypofractionated radiotherapy (HF Rth) in early breast cancer patients.
Subjects and methods: We included 300 patients in a retrospective study at Clinical Oncology & Nuclear Medicine
Department, Zagazig University Hospitals. Our patients received radiotherapy 40 Gray /15 fractions (40Gy/15Fr) in
3weeks, 5 days a week by use of opposed tangential fields to the whole Breast +/- regional lymph nodes followed by
Boost of 10Gy/5Fr given to the tumor bed. Tumor bed was delineated using preoperative clinical data, cavity seroma or
scar. Acute skin toxicity was assessed in all patients.
Results: About 27% of patients (81 patients) had G0 acute skin toxicity 48.7% had G1 (146 patients), 13.3% (40
patients) had G2 and only 11% had G3. The results demonstrate a strong association between breast and boost volume,
body mass index, bolus use, and acute skin toxicity. No significant correlation was found in patients between age,
diabetes mellitus, hypertension and acute toxicity. Moreover, adjuvant chemotherapy is not linked to acute skin toxicity.
Conclusion: Hypofractionated whole breast irradiation (HF-WBI) is feasible as well as safe, because of the low rate of
moderate-high scores toxicity. Obesity and increase breast size makes acute skin toxicity more pronounced.
Keywords: Hypofractionated Radiotherapy, Breast Conservative Surgery, Breast cancer.


INTRODUCTION

Cancer of the breast is the most frequent
and non-radical tumor excision (focally--otherwise
malignancy in women, accounts for 29% of all
further surgery should be advocated), will benefit from
malignancies in women. After lung cancer, breast
a radiation boost that provides an additional 50% ( RR)?
cancer is the leading cause of cancer death among
reduction (6).
women (1).
Conventional radiotherapy given in 6-7 weeks
According to the statistics of Egypt's National
consisting of 45­50Gy in 25 fractions of 1.8 or
Population-Based Registry Program from 2008-2011,
2Gy/day, 5 days a week then boost 10-16Gy over 5-8
breast cancer is the most common malignancy among
days. Many randomized trials have confirmed that
Egyptian women. Adjuvant systemic chemotherapy and
hypo-fractioned whole breast irradiation 3-4 weeks 40
radiation therapy have drastically reduced the death rate
GY in 15 fractions of 2.67 GY/ day is equivalent to
from breast cancer because of their documented benefit
more conventional whole-breast irradiation with respect
in local management of cancer (radiotherapy) and
to local recurrence, toxicity and cosmetic outcome (7).
prevention of distant metastases (chemotherapy) (2).
The majority of patients undergoing radiation
Standard loco-regional treatment for early-
therapy for early-stage breast cancer will develop acute
stage breast cancer nowadays typically consists of
skin damage. Within 1­4 weeks of starting treatment,
breast-conserving surgery (BCS) and radiation therapy.
they may experience erythema, dry or wet
Several prospective and randomised investigations and
desquamation, and in rare situations, ulceration.
a large number of clinical trials have concluded that it
Women may experience skin toxicity along after
is a safe and preferred therapeutic option in early breast
treatment has ended. The majority of breast cancer
cancers, with similar overall survival and survival rates
patients receiving adjuvant radiotherapy (RT) have RT-
to those seen in patients treated with mastectomy (3). In
induced skin toxicity, which can result in temporary or
addition, the cosmetic results from BCS are superior to
permanent treatment interruption. Swelling, redness,
those of more invasive procedures (4). For effective local
itching, and discomfort are all symptoms of a severe
disease control, radiation must be administered after
skin reaction, as it is the risk of localized or even
breast-conserving surgery (5).
systemic infection and lasting scarring. Improvements
Whole-brain radion therapy (WBRT) alone
in radiation procedures, such as boosting dose
decreases the risk of death from breast cancer by 4%
conformity and dosage uniformity within the irradiated
over 15 years and the risk of any recurrence (both local
area, may help lower the rate of RT-related toxicity (7).
and distant) by 15% over 10 years.
This study aim was evaluation of acute skin
Most patients with unfavorable risk factors for
toxicity of adjuvant hypofractionated radiotherapy in
local control, such as age less than 50 years, grade 3
management of early breast cancer.
tumors, presence of lymphovascular invasion, hormone
receptor negativity, or extensive intraductal component
2534
Received: 26/09/2022
Accepted: 29/11/2022

Full Paper (vol.902 paper# 83)


c:\work\Jor\vol902_84 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2542-2548

Comparison between Lung Ultrasound and Chest Computed Tomography for
Assessment of The Severity of Proven Coronavirus COVID-19 Pneumonia
Suzan Bahig Ali Elhefnawy1, Mohamed Mohsen Tolba Fawzi2,
Fayrouz Abdel Nour Adeab Gawargios1, Nourhan Mohammed Hossam El-Din*1
1Radiodiagnosis Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
2Fellow of Radiodiagnosis at National Hepatology and Tropical Medicine Research Institute (NHTMRI), Egypt
*Corresponding author: Nourhan Mohammed Hossam El-Din, Mobile: (+20)01152045672, Email: nor_hossam23@yahoo.com

ABSTRACT
Background:
Although chest CT is the most popular scan, the ultimate safety for repetition is not established.
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-
2) which results in viral pneumonia and may be diagnosed by a chest computed tomography (CT) scan. In addition,
Lung Ultrasound (LUS) has good diagnostic precision for Alveolar Consolidation and Interstitial Lung Diseases. Aim
of the Work
: We looked into the classification of lung abnormalities by lung ultrasonography, the correlation between
CT results and lung abnormalities in SARS-CoV-2 infection, and the viability of employing this technology to offer a
quantifiable estimation of pulmonary involvement in COVID-19 patients. Patients and Methods: This was a cross-
sectional study that included 30 patients who had symptoms of variable degrees of fever, cough, and dyspnoea with RT-PCR-
confirmed COVID-19 infection by nasopharyngeal swab at admittance or during hospitalization either at the ward or intensive
care unit (ICU) at Ain Shams University Hospitals and National Hepatology and Tropical Medicine Research Institute from
May 2021 to March 2022, for whom CT chest was ordered before admission. Results: This study showed that patients who
suffer from respiratory symptoms or associated lung conditions have the propensity to have greater alterations on LUS
and more severe illness on CT in a sample of patients with PCR-validated COVID-19. The anomalies identified by the
two distinct imaging modalities were related, and the LUS score is related to the clinical characteristics and the severity
determined by the chest CT scan. Conclusion: Contrarily, the benefits of ultrasonography over CT include mobility, no
radiation exposure (for pregnant women and patients at an increased risk for radiation usage), cheap cost, no requirement
for support staff, and repeatability. In extreme circumstances, it might be utilized instead of a CT chest scan (especially
in ICU cases).
Keywords: Lung Ultrasound, Chest Computed Tomography, Severity, Coronavirus, Pneumonia.

INTRODUCTION
Ultrasound. Even while a chest CT is the gold standard
The 2019 coronavirus illness (COVID-19),
for diagnosing lung involvement and has a sensitivity
which was originally identified in the Chinese region of
that surpasses even that of a nasopharyngeal swab, an
Wuhan, spread quickly over the world before being
LUS examination can be a viable substitute for a CT
deemed a pandemic on March 11, 2020 (1).
scan for pregnant women in particular and has certain
SARS-CoV-2 is the culprit, and it has a genome
benefits. One operator may do ultrasounds right at the
that is comparable to the RNA virus families
patient's bedside, minimizing the possibility of medical
responsible for SARS and other Middle East
staff contracting the illness. Additionally, it provides a
respiratory syndromes (2).
reproducible, radiation-free test (5).
In especially patients with comorbidities, this
We looked into the classification of lung
common virus can result in severe acute respiratory
abnormalities by lung ultrasonography, the correlation
distress syndrome (ARDS), secondary infections, and
between CT results and lung abnormalities in SARS-
septic shock, all of which necessitate rapid medical
CoV-2 infection, and the viability of employing this
attention (3).
technology to offer a quantifiable estimation of
Since the start of the COVID-19 epidemic, a
pulmonary involvement in COVID-19 patients.
variety of diagnostic techniques have been used to

PATIENTS AND METHODS
quickly and accurately identify individuals who may
The current study was a cross-sectional study that
have COVID infection and to categorize them
included 30 patients who had symptoms of variable
according to the severity of their illness. Chest CT
degrees of fever, cough, and dyspnoea with RT-PCR-
portrayed a significant role in this situation because of
confirmed COVID-19 infection by nasopharyngeal swab
its high sensitivity (91­96%), but it also has drawbacks
at admittance or during hospitalization either at the ward
relating to scanner accessibility, cleaning processes, and
or intensive care unit (ICU) at Ain Shams University
X-ray exposure (1).
Hospitals and National Hepatology and Tropical Medicine
With its low cost and wide availability, lung
Research Institute from May 2021 to March 2022, for
ultrasonography (LUS) has become a promising
whom CT chest was ordered before admission. An
imaging method for COVID-19 screening (4).
acceptance from the ethical committee of the Radiology
Additionally, it has recently been proposed as a
Department and the ethical committee of the Faculty of
reliable technique for detecting lung affection in
Medicine - Ain Shams University and NHTMRI was
COVID-19 by the Chinese Critical Care Ultrasound
obtained to use the data stored on PACS with the patient's
Study Group and the Italian Academy of Thoracic
consent to perform lung ultrasound.
2542
Received: 25/09/2022
Accepted: 28/11/2022

Full Paper (vol.902 paper# 84)


c:\work\Jor\vol902_85 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2549-2555

Quality of Life in Premenopausal Women Suffering from Urinary Incontinence
Heba Saber Mohammed 1*, Almass Fathi Hassan 2, Asmaa Abobakr Ibrahim 3,
Ahmed Mohamed Farag 4, and Mohamed Fawzy Ibrahim 1
1 Department of Obstetrics and Gynecology faculty of medicine , 2 Department of Family Medicine Faculty of
Medicine, 3 Department of Obstetrics and Gynecology faculty of nursing, 4 Department of Urology, Faculty of
Medicine, Suez Canal University, Ismailia, Egypt
Corresponding Author: Heba Saber mohammed, Telephone: +20 1118602920, Email: dr_hebasaber83@hotmail.com

ABSTRACT
Background:
Women of all ages and races are affected by the widespread clinical disorder known as urinary
incontinence (UI). In premenopausal women, urinary incontinence whatever its type, had a negative effect on the quality
of life (QoL). Objective: The aim of the current study was to assess various forms of urine incontinence in
premenopausal women and alterations in QoL for these women. Patients and methods: A cross-sectional study was
carried out at Suez Canal University Hospital's Gynecological Outpatient Clinic. A total of 345 premenopausal women
complaining of urinary incontinence were recruited from June 2020 to July 2022. QoL was evaluated by an Arabic
validated form of the Urogenital Distress Inventory and adapted incontinence impact questionnaires short forms IIQ-7
and UDI-6. Results: In the UDI-6, the irritative QoL domain was severely affected (44.32%) more than the stress
domain (5.51%) (P<0.001) and with the obstructive domain (19.72%) (P<0.001). In IIQ-7, the travel domain was
severely affected (27.53%) more than other four domains (P<0.001). No statistically significant association was present
between UI type and the grade of QoL domain affected (P>0.05) except in the social domain (P<0.001) and in the travel
domain (P=0.003). Conclusion: Although no statistically significant association between different subtypes of UI in
premenopausal women, UI whatever its type, had a bad impact on QOL.
Keywords:
Urinary incontinence, Premenopausal women, Urogenital distress inventory, Cross sectional study, Suez
Canal University.

INTRODUCTION

incontinence type might play a vital role in determining
Urinary incontinence (UI) is the complaint of
the QoL effects (6). In the majority of research, urge UI
unintentional urine loss, and there are three main
(UUI) served as a predictor of the poorest QoL decline
subtypes of UI recognized by the International
(7). Even when mixed urine incontinence (MUI) was
Continence Society (ICS): urgency a sudden, intense
taken into consideration, it was shown that the urge
urge to urinate is known as UI (UUI), which is defined
component significantly impacted quality of life (QoL)
as the involuntary loss of urine from the bladder when a
(8). The second worldwide consultation on incontinence
sudden strong need to urinate is felt., stress UI (SUI)
created and recommended both the urogenital distress
which is defined as involuntary loss of urine in
inventory (UDI) and the incontinence impact
response to conditions associated with increased
questionnaire (IIQ) (These instruments are composed of
intraabdominal pressure such as laughing or coughing,
30 and 19 questions, respectively) to determine how
and mixed UI (MUI) defined as the complaint of
urine incontinence affects quality of life (9). Due to the
involuntary leakage of urine associated with urgency
lengthy amount of time needed to complete the long
and also with exertion, coughing, sneezing, or effort (1).
form, 7 and 6 question versions of the IIQ and UDI were
Stress urinary incontinence and urge urinary
created. As lengthy forms, it has been demonstrated to
incontinence are the most prevalent kinds of urine
correctly predict the UDI and IIQ (10). Physical exercise,
incontinence in women (2). The prevalence of urinary
interpersonal relationships, travel, and emotional health
incontinence varies between 26-61%, Additionally, age
are the four areas covered by the seven items of the
and obesity cause it to rise; these two conditions may be
initial IIQ-7. The original IIQ-7 had to have several
linked to the climacteric stage, when ovarian function
components added, changed, and removed in order to
declines and plasma levels of sex hormones decline (2,3).
by the seven items of the initial IIQ-7. The original IIQ-
Estrogen receptors in the pelvic floor muscles,
7 had to have several components added, changed, and
urogenital ligaments, fascia, and connective tissues
removed in order to adapt it to the Arab culture through
support the genitourinary tract, highlighting the
one-on-one patient interviews and focus groups.
significance of estrogen action on these structures (4).
The original questionnaire was updated by El-
Recent data suggest that up to 45% of middle-aged
Azab et al. (10) by removing the question about
women had UI bouts a few times every month, while
entertainment activities that were inappropriate for
15% mentioned this issue nearly every day (4).
Egyptian culture. Additionally, it was crucial to include
Women's urinary incontinence (UI) is a serious
a question concerning prayer in order to determine the
health issue that significantly lowers their quality of life
QoL in Arabic Muslim women and numerous Egyptian
(QoL) (5). UI is linked to higher rates of morbidity and
Christians ladies, who stated that their UI was
mortality and can have a negative impact on one's
significantly influencing their church services. The
physical, emotional, and social wellbeing; however, the
social activity-questioning item was adjusted to fit
2549
Received: 03/09/2022
Accepted: 06/11/2022

Full Paper (vol.902 paper# 85)


c:\work\Jor\vol902_86 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2556-2562

The Role of Magnetic Resonance Imaging in Surgical Decision
Making of Suspicious Breast Lesions in Dense Breast
Ahmed Mansour Ahmed1*, Mona Mohamed Zaky1, Mohamed Abdelfatah Hegazy2, Samia Mounir Zaky1
Departments of 1Diagnostic, Interventional Radiology & Medical Imaging, and
2Surgical Oncology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Mansour Ahmed, Mobile: (+20) 01069023619, Email: ahmedmans94@yahoo.com

ABSTRACT

Background: Presurgical Magnetic Resonance Imaging (MRI) is increasingly used for staging patients with breast
cancer. If breast-conserving surgery (BCS) is required, MRI evaluation has to be carried out to cases with suspected
breast cancer, in particular those with dense breast parenchyma, in which the sensitivity of ultrasonography and
mammography is low. Objective: The aim of the current study is to evaluate the validity of MRI in surgical decision
making in women with dense breast who are provisionally diagnosed to have breast cancer by sono-mammography and
are considered suitable for BCS with pathological correlation of MRI findings.
Patients and methods: A prospective case series was conducted on females with dense breast admitted at Mansoura
Oncology Center, during the period of 2 years. The study included patients with dense breast (mammography ACR C
& D) who are provisionally diagnosed to have breast cancer by sono-mammography and are considered suitable for
BCS. All cases underwent breast sonography and MRI. Results: The study was carried out on a total of 30 female cases,
with mean age 43 years old. All cases show abnormal sono-mammographic findings. MRI displayed additional
suspicious findings in the form of non-mass enhancement in 50%, multifocal lesions in 10%, multicentric lesions with
non-mass enhancement and deep fascia infiltration in 3.33%. Concordance and discordancy between MRI additional
findings and pathology displayed true positive in 95.2%. Only 1 (4.8%) non-mass enhancement was false positive
(4.8%). Conclusion: Regarding BCS for cases with dense breast, preoperative breast MRI provides more information
in detecting multifocal, multicentric, and extension of lesions which is necessary for determining the management plan.
Keywords: Breast cancer, Invasive ductal carcinoma, Ductal carcinoma in situ.

INTRODUCTION

(DCIS), evaluating the response to neoadjuvant
Breast cancer is the most frequent cancer
chemotherapy (NAC) and detection of an occult
diagnosed in females, representing more than one out of
primary breast cancer in cases with manifestations of
ten new cancer diagnoses annually. It is the second most
metastasis in axillary lymph nodes (LNs) as well as
common etiology of death from cancer among females
identification of cancer in dense breast tissue [3].
globally [1]. Age, familial history of breast disease,
Surgeries for breast cancer are composed of 2
genetic and environmental factors have been
primary methods: breast-conserving surgery (BCS),
accompanied by a higher possibility for the
only the tumour and an area of normal tissue adjacent to
development of breast cancer [2]. Early diagnosis is
it are excised. Mastectomy, entire breast tissue is
required for proper choice of therapeutic strategy.
excised [5,6]. In recent years, BCS with radiation therapy
Although mammography and ultrasound (US) are the
has been considered as the traditional therapy in the
most frequently radiological approached utilized for the
context of cases with low grade breast cancer. It is safe
diagnosis of breast alterations, the comparatively low
and favored therapeutic approach in all early detected
sensitivity and specificity of such approaches
breast cancers, as it offers comparable efficiency of
(especially among cases with dense breast tissue)
overall survival as mastectomy by a lot of researches. In
resulted in a demand for recent imaging approaches [3].
addition, BCS offers a better esthetic appearance, in
Breast density has implications for breast
comparison with radical management, a considerable
screening and risk. Dense breast tissue obscures tumors
gain for cases [7]. The aim of the current study is to
on a mammogram and has been considered as an
evaluate the validity of MRI in surgical decision making
independent predisposing factor for breast cancer
in women with dense breast who are provisionally
development. Since dense breasts are frequently
diagnosed to have breast cancer by sono-mammography
detected and not abnormal, it is identified that
and are considered suitable for BCS with pathological
mammograms are of minimal efficiency as regards
correlation of MRI findings.
dense breasts and additional screening could help the

recognition of the early stages of breast cancer among
PATIENTS AND METHODS
cases with dense breasts [4].
A prospective case series was conducted on
The primary diagnostic value of Magnetic
females with dense breast admitted at Mansoura
Resonance Imaging (MRI) depends on detection of foci
Oncology Center, during the period of 2 years. The
of multifocal, multicentric or contralateral disease
study
included
patients
with
dense
breast
unrecognized on traditional evaluation (clinical
(mammography ACR C & D) who are provisionally
examination, mammography and US), identification of
diagnosed to have breast cancer by sono-mammography
invasive components in ductal carcinoma in situ
and are considered suitable for BCS. Cases with sono-
2556
Received: 29/09/2022
Accepted: 02/12/2022

Full Paper (vol.902 paper# 86)


c:\work\Jor\vol902_87 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2563-2566

Evaluation of Vitamin D Receptor Gene Polymorphism in
Vitiligo in Sharkia Governorate
Mahmoud Y Abdelmawla1, Somia H Abdullah2, Mohamed M Nasr1, Yasmine E Abd-Elghany1
Dermatology, Venereology and Andrology Department1,
Medical Biochemistry Department2, Faculty of Medicine, Zagazig University, Egypt.
Corresponding Author Name: Yasmine Elsayed Abd-Elghany
Phone Number: +2 0103555489, Email: Yasminsayed829@gmail.com, ORCID: 0000-0002-9630-2147

ABSTRACT
Background:
Vitiligo is a depigmentation disorder with macular depigmentation and white patches as the main clinical
feature. Etiology of vitiligo remains unclear, but multiple factors have been implicated in the development of the disease,
including impaired melanocyte migration, genetic susceptibility and autoimmunity. Objective: The aim of the study
was to identify if there is any relation between vitamin D gene affection and having vitiligo.
Patients and Methods: This was an analytical case control study; in which patients were selected from the outpatient
clinic of Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University Hospitals.
The study was carried out on 60 subjects, divided into 2 groups (30 vitiligo patients, and 30 healthy controls), using
socio-medical questionnaire, Detailed dermatological examination, CBC, liver and kidney function tests and DNA
extract from blood and detection of gene polymorphism.
Results: There was no significant difference between the vitiligo and control groups regarding age, sex, residence, and
family history of vitiligo. The most found genotype in vitiligo patients was GA (80% of cases) with high statistical
significant difference found between the two groups. while the most found genotype in controls was GG (70% of them),
with high statistical significant difference found between the two groups. Vitiligo score was higher in GA genotype
patients compared to GG and AA genotype patients, but with no significant difference.
Conclusion: This study suggests an association between vitamin D receptor (VDR) gene polymorphisms in vitiligo in
Egyptian population.
Keywords: Vitamin D receptor gene polymorphism, Vitiligo, Association.

INTRODUCTION

Department, Faculty of Medicine, Zagazig University
Vitiligo is a depigmentation disorder with
Hospitals, from the first of February 2019 to the end of
macular depigmentation and white patches as the most
February 2020.
common clinical feature, cause of vitiligo remains

unclear, but multiple factors have been implicated in the
Inclusion criteria:
development of the disease, including impaired
All patients enrolled in the study had:
melanocyte migration, genetic susceptibility and
- Adult vitiligo of both sexes.
autoimmunity (1). Vitamin D receptor (VDR) is a

member of the steroid/thyroid hormone receptor
Exclusion criteria:
superfamily. It has been detected that the expression and
Other dermatological diseases (such as systemic
function of the VDR may be influenced by
lupus erythematosus, atopic dermatitis).
polymorphisms of the VDR gene. Vitamin D analogues
Pregnant and lactating females.
have been used in vitiligo intervention alone or in
History of tuberculosis or any active infectious
combination with other treatment (2).
disease.
Vitamin D receptor gene polymorphism is
Systemic illness (e.g., diabetes, hypertension, liver
considered main cause in several autoimmune diseases
diseases, renal disorders, rheumatoid disease or
including vitiligo (3). It has effective role in the
other arthropathy disorder).
regulation of T cell function and the biological function

of melanocytes (4). Also it has master regulator of
Study tools:
epidermal barrier function, inflammation, keratinocytes
All patients were subjected to:
proliferation, and microbial defense (5).
1- Complete history taking:

a- Personal history including age, residence,
The aim of the study: to identify if there is any relation
socioeconomic status, marital status and any
between vitamin D gene affection and having a vitiligo.
marital consanguinity plus nutritional conditions.

b- Family history of similar conditions and other
PATIENTS AND METHODS
diseases.
An analytical case control study was carried out on 60
c- Past
history
of
previous
medication,
subjects divided into 2 groups (30 vitiligo patients, and
psychological stress and surgery.
30 healthy controls), were selected from the outpatient
2- Complete general examination with blood
clinic of Dermatology, Venereology and Andrology
pressure measurement.

2563
Received: 27/06/2022
Accepted: 03/09/2022

Full Paper (vol.902 paper# 87)


c:\work\Jor\vol902_88 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2567-2573

A Comparison between Reversed Cross Finger Flap and Reversed Island
Homo-digital Flap in Reconstruction of Distal Dorsal Digital Defects
Elhossieny Abdelaal Sleem*, Samia Mohamed Saied, Karam Ahmed Mohamed, Gamal Youssef Elsayed
Plastic Surgery Department, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding Authors: Elhossieny Abdelaal Sleem Emails: elhossienysleem92@gmail.com Tel: +20 109 129 3763

ABSTRACT
Background:
The reversed cross-finger flap is a modification for cross-finger flap with the strategies of the hetero-digital
island flap. In the reversed cross-finger flap, the digital artery opposing the distal communicating arch and the pedicle are
included. Objective: This work aimed to assess reversed cross finger flap with reversed island homo-digital flap in
reconstructing distal dorsal finger defect regarding functional, reliability and esthetic results.
Methods:
This prospective study was performed on 30 cases with distal dorsal digital defects and deformities, size of the
defect ranged from 1-3 cm in length and 1-2 cm in width and availability of a healthy donor site. All patients were subjected
to laboratory investigations [Prothrombin time (PT) and complete blood count (CBC)], radiological examination and
photographs.
Results:
In reversed cross-finger flap, the size of the flap ranged from 2 to 4 cm in length and 1 to 3 cm in width and in
Reversed Island homo-digital flap, it ranged from 1 to 3 cm in width and 4 to 6 cm in length. Reversed island homo-digital
flap was done in 15 patients with distal flap necrosis only in one case.
Conclusions:
Both reversed cross finger flap and reversed island homo-digital flap are dependable alternatives for treatment
of minor to moderate size deformities and defects on the fingers' dorsum up to fingertip.
Keywords: Homo-digital flap, Reversed cross finger flap, Reconstruction, Hand reconstruction, Distal dorsal digital
defects.

INTRODUCTION

vascular pedicle already has protection by its connection
The hand is a vital organ required for social
to the flap skin (6). Therefore, the digital artery is not
interaction, expression, production, and synergy with the
visible as it is concealed beneath the pedicle skin. As a
surroundings. The hand soft tissue is a complicated
result, it is supported by a firm soft tissue. The skin
structure that conceals the deeper structures with specific
attachment contributes to the flap's distal feasibility by
components ( motor and sensory) (1). The palm's thick
limiting pedicle motion and avoiding congestion of the
glabrous skin sustains shearing forces associated with
veins (7).
daily activities and functions as a pain and temperature
The use of reversed homo-digital artery island
sensory organ and communicating touch, but the dorsal
flaps for fingertip reconstruction was first introduced.
skin is malleable and movable, allowing the hand to move
This flap was lifted from the lateral phalanx and centred
in a wide range of motions such as pinching and gripping
on an artery pedicle. Retrograde origin of the blood supply
(2). Hand soft tissue abnormalities are frequently observed
comes from the connecting divisions of the radial and
as a consequence of infection, burns, trauma, and tumour
ulnar digital arteries in the distal phalanx areas and nail
removal (3).
bed (8). This single-phase surgery, which does not need
The finger's dorsum is covered by a thin skin, with
immobilisation or harm to neighbouring fingers, can
a minor amount of subcutaneous tissue beneath, bone
result in a bigger flap size and a wider rotational arc,
structures and the extensor tendons. As a result, it is
making it an attractive choice for distal digital finger
critical to obtain covering following dorsal digital injury
defects. The drawbacks involve the loss of one of two
in order to maintain these tissues. Proper treatment must
proper digital arteries, increased morbidity for a wounded
maximise the utilization of local tissue, protect the
finger, and technically difficult fine dissection, all of
aesthetic look, offer consistent skin cover, reduce donor-
which contribute to the lengthier operational duration (9).
site abnormalities, and maintain the finger's motor
The purpose of this research was to assess the
function (4). Surgeons use repair algorithms like the
reliability, functionality, and aesthetic results of the
reconstructive ladder to determine the most suitable soft-
reversed cross finger flap versus the reversed island
tissue repair technique (5).
homo-digital flap in reconstructing the distal dorsal finger
The reversed cross-finger flap is a modification
defects.
cross-finger flap with the principles of the hetero-digital

island flap. The reversed cross-finger flap is performed on
PATIENTS AND METHODS:
the digital artery directly in front of the pedicle and on the
The study was prospective, done on 30 subjects with distal
distal connecting arch. This is advantageous since the
dorsal digital defects and deformities. Size of defect
2567
Received:16/07/2022
Accepted: 18/09/2022

Full Paper (vol.902 paper# 88)


c:\work\Jor\vol902_89 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2574-2580

Inhibition, Characterization and Purification of -AMY from
Sera of Iraqi Breast Cancer Patients
Namariq A. Lafta*, Alaa Hussein J. Al-Qaisi
Department of Chemistry, College of Science, Al-Nahrain University, Jadriya, Baghdad, Iraq.
*Corresponding author: Namariq A. Lafta, Tel.: +9647805725833, Email: namariqamer93@gmail.com

ABSTRACT
Background: -Amylase enzyme is digestive enzyme that breaks down complex carbohydrates like starch into
simpler sugars; it is being studied as a potential target for anti-cancer therapies.
Objective: The current study aimed to evaluate the general characterization, and inhibition of -Amylase enzyme,
which had been purified from the sera of patients diagnosed with Breast Carcinoma.
Materials and methods: A total of 100 blood serum samples were collected from patients with Breast cancer from
Baghdad National Hope Hospital in Baghdad. -Amylase enzyme was purified from serum clinical isolate in three
stages; precipitation with 65% saturated ammonium sulphate, ion exchange chromatography utilizing a DEAE-
cellulose column, and gel filtration chromatography with a sephadex G-200 column. Changing conditions in pH,
temperature, inhibitor concentration, and kinetics all affect the activity of the -Amylase enzyme.
Results: -Amylase inhibition assay showed that Vitis vinifera L. was the most potent inhibitor (71.8%). During
the kinetic investigation of the enzyme, it was discovered that the inhibitory mechanism that the extracts use is non-
competitive. Vmax was 0.023, and 0.012 mmol min -l at 75 g/ml of Vitis vinifera L. , Verbena Officinalis L
.
extracts, respectively.
Conclusions: High specific activity for -Amylase purified from sera of Iraqi breast cancer patients was obtained
after three purification steps. Ethanolic plant extracts showed inhibitory effect on -Amylase while Vitis vinifera L.
was the most potent inhibitor.
Keywords: -Amylase, Breast Cancer, Characterization, Inhibition, Purification, Al-Nahrain University, Iraq.

INTRODUCTION

-Amylase (-AMY) (E.C.3.2.1.1) is a
gland (9), breast milk (10), and various other tissues (11).
hydrolase enzyme that catalyses the hydrolysis of
In addition to that, -AMY has been identified
starch's internal -1, 4-glycosidic bonds to produce
in cases of lung cancer (12), breast cancer, and ovarian
glucose and maltose. It is a calcium metalloenzyme,
cancer (13). -AMY inhibitors, commonly known as
which means that its activity is dependent on the
starch blockers, may offer possible mitigation by
presence of a metal cofactor (1).
inactivating Amylase in saliva or pancreatic digesting
In addition to being found in significant
juice, lowering blood glucose. Therapies, and they
concentrations in the saliva and pancreatic juice, -
appeared to be a viable replacement for synthetic -
AMY may be isolated from other tissues such the
AMY inhibitors as well as for antioxidant effects (14).
gonads, fallopian tubes, skeletal muscle, and adipose
Several in vivo and in vitro research on the
tissue. The impact of temperature, the circumstances
plants have demonstrated that Vitis vinifera L.
of hydrolysis, and the origin of the enzyme greatly
,Verbena officinalis L., and Ammi visnaga L. have
influence the hydrolysate composition obtained
several pharmacological and biological activities,
following starch hydrolysis (2).
such as anti-tumor, anti-diabetic (15,16,17). As a result,
In human, there are mainly two distinct genes,
in this investigation, -AMY was isolated and
AMY1 and AMY2, which encode salivary (type 1)
characterized from the serum of breast cancer
and pancreatic (type 2) -AMY, respectively (3).
patients. This article also focuses on purification
-AMY may be isolated from humans, plants,
techniques and characterization of -AMY in terms
animals, and microbes. Several purification
of temperature and pH stability, substrate selectivity,
procedures
for
isolating
-AMY
from
and plants as natural sources of inhibitors to -AMY
microbiological sources have also been developed (4).
effects.
Ultrafiltration, salt precipitation, dialysis, and

column chromatography are the methods used. These
MATERIALS AND METHODS
methods produce varying yields and folds of enzyme
Samples:
purification (5).
A total of 100 samples of blood serum were
In women, breast carcinoma (BC) is the most
collected from patients with Breast cancer from
common form of cancer and the primary cause of
Baghdad National Hope Hospital in Baghdad. during
cancer-related death. a-Amylase is utilized as a
the periods from 15/3/2021 to 20/6/2021. Control
biomarker in the clinical diagnosis of diseases such
group 50 samples were collected from healthy people
as cancers and inflammation (6,7) has antibacterial
from a local hospital in Baghdad Iraq. Using a
properties (8), and has been found in the mammary
disposable syringe, 2-4ml of blood was collected by
2574
Received: 19/07/2022
Accepted: 21/09/2022

Full Paper (vol.902 paper# 89)


c:\work\Jor\vol902_90 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2581-2585

Parotidectomy with Autologous Free Dermal Fat Graft:
Functional and cosmetic Improvement
Wael Mohamed Abdelgawad Hamed*, Hassan Mohamed khalaf, Waleed Mohamed Allam,
Khalil Taha Abo Rokba, Eslam Atef Abdelmoneim Sharara, Mohamed Elsaid Aboelnadar AbdelAty
Damanhur Medical National Institute, Elbehiera, Egypt
Corresponding author: Wael Mohamed Abdelgawad Hamed, Tel: 01223004249, Email: waeldoc80@gmail.com

ABSTRACT
Background:
Significant morbidity is caused by facial asymmetry and Frey's syndrome, which are long-term
consequences of parotid surgery resulting from the removal of parotid tissue. The free dermal-fat-facial graft (DFFG)
is one of these techniques, though its use is seldom recorded in medical literature.
Objective: The aim of the current study is to investigate the effectiveness of free DFFG in rebuilding parotidectomy
deficits at the Damanhur Medical National Institute (DMNI) in Elbehiera, Egypt.
Patients and methods: A total of 15 patients at DMNI in Elbehiera, Egypt, had primary parotidectomy and rapid repair
with autologous belly DFFG by the same surgeon. Between 2020 and 2021, prospective data collection was done.
Patients completed two postoperative outcomes surveys.
Results: Of the studied patients, 14 had benign lesions and 1 malignant lesion. Up to 13 (86.6 %) patients reported
perfect facial symmetry, 1 (6.7%) shows slight hollowness, and 1 (6.7%) had mild fullness; none reported notable
hollowness or fullness. Only 2 (13.3%) had minor symptoms, 1 (6.7%) had devastating symptoms, and 12 (80%) did
not have Frey's syndrome, All patients answered a second questionnaire on the transplant donor site. Up to 12 (80%)
were happy or extremely satisfied with the donor site's aesthetic appearance, and 14 (93.3%) reported no pain at the
donor site. Donor site symptoms were not reported.
Conclusion: For most patients, autologous DFFG restored face cosmoses and avoided Frey's syndrome.
Keywords: Parotidectomy, Facial contour, Frey's syndrome, Free dermal fat graft, Case series, Damanhur Medical
National Institute.

INTRODUCTION
alopecia, and zygomatic fullness (6).
Popular long-term consequences of parotidectomy
Additionally, it does not offer sufficient bulk for
include facial asymmetry and Frey's syndrome due to
deep abnormalities. Allogenic human dermis does not
parotid tissue loss (1).
need extra surgical place; nonetheless, it is costly and is
Interposition of graft among skin flap and time bed
linked to rise in length of suction drainage, incidence of
can stop these complications because the graft acts as
sialocele, and salivary fistula development (7).
barrier stopping abnormal innervation of skin sweat
Similarly, synthetic implantable materials like
glands by auriculotemporal nerve cells though adding
vicryl and expanded polytetrafluoroethylene mesh are
bulk to time bed, thereby compensating for void left by
linked with an improved incidence of sialocele and
parotidectomy (2).
implant extrusion (1). Fat grafts, which were first
It is difficult to assess incidence of Frey's
described in 1893, were shown to be efficient in
syndrome since numerous studied cases are unaware of
retaining face aesthetic (8).
their symptoms or do not report them. Objective minor's
Utilizing fat as a reconstruction material offers
exam is exceedingly difficult to administer and quantify
several benefits, including resistance to infection,
(3). In lack of interposition grafting, incidence of Frey's
pliability, absence of a foreign body response, and the
syndrome ranges from 43% to 100% clinically, and
ability to adapt face development and growth in
from 2% to 62% subjectively, based on symptoms like
children (9).
unilateral hyperhidrosis, and flushing in response to
Abdominal free fat grafting, which is found to be
stimuli (4). It has been shown that interposition grafting
successful in filling head and neck faults, containing
significantly reduces both objective and subjective
parotidectomy flaws, across a variety of surgical
incidence of Frey's syndrome (5).
approaches, is one of the fat autograft reconstruction
Interposition grafting techniques include the
strategies with the strongest documentation (10).
sternomastoid muscle (SM) flap, the platysmal flap, and
However, the resorption rate of free fat grafts is
the sub-superficial musculoaponeurotic system flap (3).
uncertain and considerable. The addition of dermis to
Each treatment has its own advantages and
free fat graft can facilitate the revascularization of
disadvantages. SM flap is adequately vascularized and
transplanted fat, hence reducing resorption (11).
does not need an extra skin incision; nonetheless, it is
In this study we are recording on parotidectomy
linked with risk of facial nerve (FN) and spinal
flaws reconstructed mainly with autologous abdominal
accessory nerve (SAN) injury, as well as SM atrophy.
free DFFG and their outcomes in our institute
Temporoparietal fascial flap demands longer incision
(Damanhur Medical National Institute), Elbehiera,
and is related with an increased risk of FN damage,
Egypt.


2581
Received: 02/08/2022
Accepted: 03/10/2022

Full Paper (vol.902 paper# 90)


c:\work\Jor\vol902_91 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2586-2592

Comparison between Blood Serum of Liver Cancer Patients and
Healthy Controls Using UV­Visible Technology
Allawi Hamead Harjan1*, Shihab Ahmed Jasim2, Shaymaa A. Kadhim1,
Hussien Abid Ali Mraity1, Azhar S. Alaboodi1, Ali Abid Abojassim
1Department of Physics, Faculty of Science, University of Kufa, Iraq
2faculty of Agriculture, University of Kufa, Iraq
*Corresponding author: Allawi Hamead Harjan, Mobile: 009647831089442, E-mail: allawi.alasadi@uokufa.edu.iq

ABSTRACT
Background:
It is fundamental to investigate the physical and chemical changes occurring in tissues and cells due to certain
diseases. Objective: Early diagnosis of liver cancer through spectral analysis of serum samples of patients and healthy
subjects. Patients and methods: Fifty-two samples from liver cancer patient, and 45 from healthy, using UV-visible
spectroscopy technology. By using the statistical program (version 20) and independent samples t-test, the averages of the
blood serum for males with new case liver cancer were the highest compared to that of control group.
Results: Concerning the male patients with liver cancer who took chemotherapy and for all wavelengths except 225 nm,
their blood serum average was higher compared to healthy subjects, and it was not statistically significant. Regarding the
women who took chemotherapy, the situation of the absorption is seen to opposite to that the males who took chemotherapy
too. Conclusion: The results showed that there are statistically significant differences between the spectrum of liver cancer
patients and healthy people.
Keyword: Liver cancer, Statistical analysis, Spectra of serum, Uv-visible spectra of serum.

INTRODUCTION

Spectroscopy is concerned with the study of the
source. In the interaction of ultraviolet radiation with
interference between matter and electromagnetic
matter, emission, fusion, or absorption spectra may occur
radiation, which extends from high-energy gamma rays to
(6). During the electronic transitions induced by ultraviolet
very low-energy radio waves through X-rays,
radiation, the substance moves from a lower energy to a
microwaves, ultraviolet, visible and infrared rays, where
higher energy state. These transitions occur only within
the interference diagram between matter and radiation is
conjugated systems (7).
referred to as a spectrogram or spectrum (1). Spectroscopy
As high energies will cause rotational and vibrational
is also concerned with the study of the absorbed or
changes in electronic spectra, this will blur the observed
emitted rays, which is an important technique for studying
spectrum in liquids, rendering it essentially useless (8).
the arrangement of electrons in atoms.
With the application of quantum optical spectroscopy to
UV radiation is a type of electromagnetic energy
investigate breast tissues, a number of studies have
that can be used for many different purposes. It can treat
examined the relationship between the spectra of different
skin conditions, disinfect water, and even cure some types
cancerous tumors. As seen by the UV-Visible spectral
of paint and diagnosis of liver cancer (2). UV-Vis
range, malignant breast tissues absorb and scatter more
spectroscopy is a technique that uses the ultraviolet and
than normal breast tissues (9). The aim of this study was to
visible portions of the electromagnetic spectrum to
early diagnose liver cancer through spectral analysis of
examine substances, the wavelength of a visible light is
serum samples of patients and healthy subjects.
around 400-700 nanometers, while ultraviolet (UV)

radiation spans from roughly 10-400 nanometers. UV
MATERIALS AND METHODS
radiation can cause sunburn, skin cancer, and other health
Samples collections and preparation:
problems. UV spectroscopy measures the intensity and
Ninety-seven blood samples were collected from
wavelength of UV radiation. It can be used to detect
volunteers, of them 45 for healthy and 52 for liver cancer
harmful UV radiation and to identify unknown substances
patients (male and female). Directly after the collection,
(3). The easily accessible part of the region is extended
each blood sample was centrifuged at 3000 rpm for 10
from 200 nm to 800 nm. This shows the absorption only
minutes in order to separate blood cells and suspended
if conjugated -electron systems are presented (4). The
particles from blood serum. Sera were transferred into
ultraviolet region, extending from 190 nanometers to 300
neutral glass vials and stored in a freezer at -20 °C until
nanometers, contains energies sufficient to excite a
dried and were collected in screw capped test tubes.
molecular electron to a higher energy orbital (5).
Shimadzu (Uv-Visible spectrophotometer) was used,
Research on ultra-violet light typically seeks to
double-beam 190-1100 nm (UV 1800). Featuring the
find out what spectrum is obtained from passing it through
highest resolution, the UV-1800 easily satisfies the
the medium rather than what spectrum is generated by the
standards of wavelength resolution. The UV-1800
2586
Received: 01/09/2022
Accepted: 01/11/2022

Full Paper (vol.902 paper# 91)


c:\work\Jor\vol902_92 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2593-2598

Gluten sensitivity and Epilepsy in Children
Hatem Hussein1, Safaa H Saleh1, Hanan S Ahmed2, Hossam Abdelaty Abdellatif Abdelaty1, Eman Mohammed Abdel
Hady El Sayed1
1 Pediatrics Department, Faculty of Medicine, Zagazig University, Egypt
2 Clinical Pathology Department, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Hossam Abdelaty Abdellatif Abdelaty, ORCID: 0000-0001-7561-7847,
Email: hossam.aa@medicine.zu.edu.eg

ABSTRACT
Background:
Gluten sensitivity leads to the inflammatory entropy known as celiac disease (CD), which develops in
those who are susceptible to it. Some research has suggested a connection between childhood epilepsy and CD.
Objective: The aim of the current study is to compare epileptic children and control as regard the development of
gastrointestinal manifestations and gluten sensitivity.
Patients and methods: A case cont
-
rol study was conducted at Children's Hospital, Zagazig University. Children
diagnosed with idiopathic epilepsy based on International League against Epilepsy 2017 classification had been
included. The control group consists of 42 children, age and gender-matched with the case group. Medical history and
complete physical examination were done for all children in both groups.
Results: There is statistically a non-relationship between serum anti-tissue transglutaminase II (TTG) antibody and
either number of drugs, control, presence of GI manifestations or duration of illness of the studied patients.
Conclusion: It is important to pay more attention to the possibility of CD in children who are epileptic. To avoid
irreversible problems, children with different idiopathic forms of epilepsy, and in particular children with frequent
seizures, must be checked for silent CD.
Keywords: Epilepsy, Celiac disease, Prevalence, Children, Case control study, Zagazig University.

INTRODUCTION
sensitive
(93.1%)
and
specific
(96.3%).
Gluten and related prolamines can cause Celiac
Nevertheless, mucosal
biopsy
and
histological
Disease (CD), an immune-mediated systemic illness, in
examination ought to be used to confirm the diagnosis
people who are genetically predisposed to it. It is
(4). To avoid long-term CD consequences, epilepsy-
identified by the existence of various combinations of
studied cases should be screened for CD. However, for
enteropathy, HLA-DQ2 and HLA-DQ8 haplotypes, CD-
people with epilepsy brought on by CD, the gluten-free
specific antibodies, and gluten-dependent clinical
diet is an efficient method of managing conditions (5).
symptoms (1). The terms "classical," "atypical,"
The aim of the current study is to compare
"asymptomatic," "latent," and "potential CD" have all
between epileptic children and control as regard
been used to describe different types of CD. The
development of gastrointestinal manifestations and
European Society for Pediatric Gastroenterology,
gluten sensitivity.
Hepatology, and Nutrition working group decided to

use the following terminology because atypical
PATIENTS AND METHODS
symptoms could be significantly more frequent than
A case control study was conducted at Children's
traditional symptoms: gastrointestinal symptoms and
Hospital, Zagazig University.
warning indications, such as persistent diarrhoea,

persistent constipation, stomach discomfort, nausea,
Inclusion criteria: Children diagnosed with idiopathic
and vomiting. Extraintestinal symptoms and indicators
epilepsy based on International League against Epilepsy
include anaemia from iron insufficiency, low stature,
2017 classification (6) had been included.
delayed puberty, dermatitis herpetiformis, epilepsy,
Exclusion criteria: Children who also had cerebral
neuropathy, reduced bone density, and higher risk of
abnormalities, metabolic conditions, infections, head
fractures (2).
injuries, tumours, and cerebral palsy had been not
Comprehensive review and meta-analysis found
included.
that CD had been present everywhere. According to

serologic test outcomes, the prevalence of CD had been
Sample size: Assuming that the attendance rate of
1.4%, and depending on biopsy data, it was 0.7%. Age,
idiopathic epilepsy is 7 cases per month, the
geography, and gender all affect how often CD is. In
comprehensive sample was 42 cases per 6 months of the
several nations, population-based prevalence research is
study and the same number in the control group.
required (3).

Studied cases with CD were noted to have
Sampling technique: The approach of systematic
neurological problems including cerebellar ataxia,
random sampling had been employed.
polyneuropathy, headaches, and epilepsy. Ability to
The control group consists of 42 children, age and
diagnose CD using immunoglobulin A anti-tissue
gender-matched with the case group. They have no
transglutaminase had been found to be extremely
neurologic disorders and admitted to Zagazig
2593
Received: 01/09/2022
Accepted: 01/11/2022

Full Paper (vol.902 paper# 92)


c:\work\Jor\vol902_93 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2599-2603

A Comparative Study of One Glyceryl Trinitarte Spray versus Two Sprays in
Attenuation of Pressor Response Following Laryngoscopy and Endotracheal Tube
Noor Abbas Jabbar1,*, Basim Herez Ali2

A

1
lhussain Teaching Hospital, F.I.C.M.S. (Anesthesia & I )
C , Iraq
2College of Medicine /Al Mut
-
hanna University, F.I.C.M.S, D.A. (Anesthesia & IC) I
, raq
*Corresponding author: Noor Abbas Jabbar,email: noorabbasa@gmail.com, Mobile:+9647806785743

ABSTRACT
Background: Laryngoscopy and tracheal intubation is invariably associated with certain pressor response like hypertension,
tachycardia as well as a variation in cardiac arrhythmias. Many pharmaceutical therapies had been applied to attenuate this
response with different degree of success. Aims of the Study: To compare the efficacy of one glyceryl trinitarte (GTN)
spray versus two sprays in attenuation of pressor response following laryngoscopy and endotracheal tube.
Patients and Methods: This is a prospective single observational study including 150 consecutive patients scheduled for
elective general surgery under general anesthesia. Control group, group treated with one GTN sublingual spray as (0.4 mg)
and group treated with two metered sprays (0.8mg). Heart rate, blood pressure and oxygen saturation values were recorded
at baseline (before induction), after induction, 2, 4, 6, 8 and 10 after intubation.
Results: SBP, DBP and MAP were significantly reduced in GTN groups (either in one or two sprays) compared to the
control group in post induction and at 2 minutes post-intubation (for SBP and DBP) and till 4 minutes post-intubation (for
MAP). Furthermore, in post induction and 2 min post intubation. Patients treated with 2 sprays had significantly lower SBP,
DBP than those treated with one spray and patients treated with two spray had significantly lower MAP in 2 minutes post
intubation than patients treated with one spray. In contrast, HR Post induction and at 2, 4 and 6 min post intubation two
sprays group had higher mean HR than control group with significant differences.one spray group had higher mean HR than
control group post induction with significant difference. Patients treated with two sprays had higher mean HR than patients
treated with one spray at 2 minutes and 4 minutes post intubation with significant difference.
Conclusions: The sublingual administration of GTN spray in a dose of 0.4 mg or 0.8 mg prior to intubation in normotensive
can attenuate the pressor response to laryngoscopy and intubation. However, one spray GTN is better than two spray
considering the attenuation of blood pressure.
Keywords: glyceryl trinitarte, hemodynamic response, sublingual spray

INTRODUCTION
intracranial compliance reserve and elevated intracranial
The process of laryngoscopy and intubation (LI)
pressure are susceptible to brainstem herniation and
can cause an obvious changes in presser response and
abrupt mortality during L&I. (4).
therefore, minimizing this response is a topic of many
Now infants and small children, there is an increase
studies. The hemodynamic response to LI is regulated by
in parasympathetic tone and hence, bradycardia. In
the
hypothalamo-pituitary-adrenocortical
and
geriatric patients, there is a decrease response to LI with
sympathetic adreno-medullary responses (1).
the advance of the age (5). The period of laryngoscopy, the
The results of these responses are attributed mainly
services and stretching practical near the tissues have a
to the release of catecholamines. The consequence of this
deleterious effect on the hemodynamic changes (6).
system can range from minor issues to major fatal one (2).
Different tactics have been devised to counteract
This is at its peak about 30-45 seconds after L&I. In
these reactions, focusing on various sympathetic reflex
response to LI, the hemodynamic parameters have a slight
pathway levels. The afferent route can be blocked with
increase in their values; all returning within 5 minutes to
topical applications of local anesthetics or superior
baseline. However, after 10 minutes of L&I, plasma
laryngeal nerve blocks.
catecholamine levels in hypertensive patients have a triple
A vasodilator called glyceryl trinitarte (GTN) is
increment and return to the original measurement.
generally used to treat hypertension in emergency
Furthermore, 1 minute after a laryngoscopy,
situations, coronary artery spasm, congestive heart failure
hypertensives' catecholamine levels rise (3). These
(CHF), and chronic anal fissures (7). Plasma
responses may result in ischemic changes in patients with
concentrations of the metabolites are many orders of
coronary artery disease or may increase ICP, push
magnitude higher than those of the parent drug (8).
vitreous gel forward during open-eye surgery, rupture an
Increased vasodilatory response is the main cause of
]aortic or cerebral aneurysm, or increase intraocular
Glyceryl trinitrate overdose toxicity resulted in
pressure in an intact eye. The usual autoregulation process
hypotension, venous pooling and decreased cardiac
may be impaired by disease. Patients who have low
2599
Received: 01/10/2022
Accepted: 04/12/2022

Full Paper (vol.902 paper# 93)


c:\work\Jor\vol902_94 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2604-2609

Brief Overview about Correlation between CD8 and
Multiple Sclerosis: Review Article
Adel Saeed Abd El Ghaffar1, Hanan Salah Mohamed1,
Amal Ahmed Zidan2, Waseem Yousuf Alhadi*1, Engy M. Emad1
Departments of 1Neurology and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding author: Waseem Yousuf Alhadi, Mobile: (+20)012 92-5463545, E-Mail: waseemyousufalhadi@gmail.com

ABSTRACT
Background
: There is now conclusive evidence that multiple sclerosis (MS) belongs to the group of primary
neurodegenerative illnesses. Myelin is the protective layer around nerve fibres in the brain and spinal cord, and it is
the target of an autoimmune attack in multiple sclerosis, a debilitating neurological illness. Immune protection
against intracellular pathogens like viruses and bacteria, as well as tumour surveillance, rely heavily on CD8+ T
cells. There are three main mechanisms that CD8+ T lymphocytes use to eliminate contaminated or cancerous cells
after they have become activated by recognizing their antigen.
Objective:
To have overview about Correlation between CD8 and multiple sclerosis.
Methods:
We looked for data on CD8, T cell and multiple sclerosis in medical journals and databases like PubMed,
Google Scholar, and Science Direct. However, only the most recent or extensive study was taken into account
between January 2000 and May 2021. References from related works were also evaluated by the writers. There are
not enough resources to translate documents into languages other than English, hence those documents have been
ignored. It was generally agreed that documents such as unpublished manuscripts, oral presentations, conference
abstracts, and dissertations did not qualify as legitimate scientific study.
Conclusion
: Autoreactive CD8+ cytotoxic T cells significance in the pathogenesis of multiple sclerosis is becoming
increasingly apparent. It is of great interest to learn whether or not these CD8+ Tregs play a function in regulating
the progression of multiple sclerosis.
Keywords: CD8, T cell, Multiple sclerosis.

INTRODUCTION
In recent years, multiple sclerosis (MS) has
been recognized as a primary neurodegenerative
condition. Myelin is the protective covering enclosing
nerve fibres in the brain and spinal cord, and MS is
defined pathologically by an autoimmune attack on
this substance. Inflammation, neuronal degeneration,
and demyelinating lesions in both white and grey
matter are hallmarks of this disorder (1).
Regardless of how the disease progresses in a
given patient, untreated multiple sclerosis always leads
to a significant impairment and a decline in quality of
life. New treatments have improved the outlook for
those with MS, but the disease remains incurable (2).
By 2020, experts predict that the global MS
population will grow to 2.8 million. By the same
measures used eight years ago, the new rate is 30%
higher. In 2020, we predict a global incidence rate of
35.9 cases per 100,000 people. When comparing the
two time periods, only 14% of countries saw a steady
or declining prevalence. The annual rate of new cases
of multiple sclerosis was determined to be 2.1 per
100,000 people across 75 nations.
By Walton et al. (3), it is estimated that one
person will be diagnosed with multiple sclerosis
every five minutes.


Figure (1): Main Symptoms of Multiple sclerosis (3).


2604
Received: 22/09/2022
Accepted: 23/11/2022

Full Paper (vol.902 paper# 94)


c:\work\Jor\vol902_95 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2610-2615

Treatment Outcome and Survival of Meningioma:
A Retrospective Single Institutional Study
Noha Mohamed Mohamed Wafa, Abbas Mahmoud Sarhan, Abdelmoteleb Mohamed Ebrahim, Rawda Balata
Department of Clinical Oncology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Noha M. Wafa, Mobile: (+20) 01055367609, Email: nohamohmdwafa@gmail.com

ABSTRACT
Background:
Meningiomas are extra-axial primary neoplasms that frequently arise from arachnoid cap cells.
Meningiomas account for around 33% of all primary brain tumours.
Objective: The aim of the present study was to compare relationship between different grades of meningiomas and
clinicopathological character, treatment and its outcome.
Patients and methods: This is a retrospective study included 52 adult meningioma patients treated at Clinical Oncology
Department of Zagazig University Hospitals. The study included data of clinicopathological characters, grades of
meningioma treatment and its outcome.
Results: Among the studied patients, grade I meningioma was more common than grade II and III. The most common
site of meningioma was convexity and sphenoid ring. Spinal meningioma accounted for 1.9%. The most common
pathological type of meningioma was meningothelial meningioma, transitional and anaplastic. Size of tumor at initial
diagnosis was less than 5 cm in 59.5%. Surgical resection was done in all grades of meningioma in 47 patients (90.4%).
33 patients received postoperative radiotherapy (63.5%) and 13 patients were on follow up after surgery (25%). Dose
of radiotherapy differed according to grade of meningioma whereas in grade I radiotherapy dose used was (54-55Gy)
in 40.5% of patients and dose of 60 Gy was used in patients of grade II and III (42.9% and 75% respectively).
Conclusion: Tumor grade was the most important prognostic factor in meningioma patients who received radiation
therapy. In patients with grade II and III tumors the extent of surgical resection was significantly associated with over
all survive.
Keywords: Meningiomas, Treatment, Outcome, Overall Survival.

INTRODUCTION
The
data
collected
were
that
of
Arachnoid cap cells give rise to the extra-axial
clinicopathological characters, grades of meningioma
primary neoplasia known as meningiomas (1). 33% of all
treatment and its outcome. During the determined time
initial brain tumours are meningiomas (2). In the United
period, 46 patients were treated for meningioma at our
States, there are 97.5 incidences of meningiomas for
hospital. The final analysis included 52 (13.6%)
every 100,000 people, with females seeing a two-fold
patients, six of them were missed after initial diagnosis
increase in incidence compared to males (8.36 vs. 3.61
and did not receive treatment.
per 100.000 person-year) (3,4).

The benchmark for classifying meningiomas is
Ethical Consideration:
the WHO tumour grading system. Grade I meningiomas
The Academic and Ethical Committee of
comprise 80% of all meningiomas and are characterised
Zagazig University approved the project. All of the
by benign nature and passive behaviour, whereas grade
subjects' written informed permission was acquired.
II and grade III meningiomas account for 17.7% and
The Zagazig University Institutional Review Board
1.7%, respectively (5,6).
(IRB) Committee gave its approval to the current
Less than 70% of meningiomas survive for at
study (ZU-IRB # 6761/12-7-2021). The Declaration
least 5 years, and for fully benign meningiomas, the 5-
of Helsinki, the World Medical Association's code of
year tumour recurrence rate is under 20% (7-8). Spinal
ethics for studies involving humans, guided the
meningiomas make for 25­45% of intradural spinal
conduct of this work.
tumours and 1.2­12% of all meningiomas (9).

Therefore, this study aimed to compare
Statistical analysis
relationship between different grades of meningiomas
The mean, standard deviation, and median
and clinicopathological character, treatment and its
(range) were used to convey continuous data, while
outcome.
numbers were used to indicate categorical variables
(percentage). The Kruskal Wallis H test was used to
PATIENTS AND METHODS
The current study is a retrospective analysis of
compare quantitative data. The Pearson Chi-square test
adult meningioma patients treated at Clinical Oncology
was used to compare percentages of category variables.
Department of Zagazig University in the period
The period from the date of surgery to the date of
between January 2013 and December 2021. The
recurrence or the most recent follow-up contact at
inclusion criteria included age >18 years old and
which the patient was known to be recurrence free was
complete medical records for adult meningioma patients
used to determine disease free survival (DFS). Using
Microsoft Office Excel 2010 for Windows (Microsoft
2610
Received: 24/09/2022
Accepted: 27/11/2022

Full Paper (vol.902 paper# 95)


c:\work\Jor\vol902_96 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2616-2619

Role of Platelet Rich Plasma in Treatment of Androgenetic
Alopecia: Review Article
Amin Amer, Thanaa Ahmed*, Mohamed El-Ghareeb
Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Thanaa Abdelhakeem Ahmed, Mobile: (+20) 01012858542 E-Mail: thanaagobran@gmail.com

ABSTRACT
Background:
Androgens cause a progressive shortening of the anagen phase of hair growth, leading to the pattern of
thinning hair known as androgenetic alopecia (AGA) in genetically predisposed men and women. Multiple biochemical
processes allow activated platelet rich plasma (PRP) to promote stem cell proliferation and differentiation in the hair
follicle bulge.
Objective: Review of the literature on role of platelet rich plasma in treatment of androgenetic alopecia.
Methods:
These databases were searched for articles published in English in 3 data bases [PubMed ­ Google scholar-
Egyptian Knowledge Bank] and Boolean operators (AND, OR, NOT) had been used such as [Platelet Rich Plasma
AND Androgenetic alopecia OR AGA] and in peer-reviewed articles between October 2001 and October 2022; a 21-
year date range was selected, and no language limitations. Documents in a language apart from English have been
excluded as sources for interpretation was not found. Papers apart from main scientific studies had been excluded:
documents unavailable as total written text, conversation, conference abstract papers and dissertations.
Conclusion: Blood flow to hair follicles is improved thanks to the platelet-rich plasma's ability to regulate
angiogenesis. It has antiapoptotic and mitogenic actions that keep dermal papillae alive for longer, making it a
promising treatment for alopecia. Evidence from the included clinical studies suggests that PRP therapy can be an
effective treatment for AGA. Downtime, adverse effects, and potential safety concerns appear to be low.
Keywords: Platelet Rich Plasma, Androgenetic alopecia.

INTRODUCTION
Patients of white race are most afflicted, next
Androgens cause a progressive shortening of
those of Asian and African descent, and last those of
the anagen phase of hair growth, leading to the pattern
Native American and Eskimo descent. In Caucasian
of thinning hair known as androgenetic alopecia
males, the prevalence roughly parallels age, with 50%
(AGA) in genetically predisposed men and women.
afflicted by age 50 and up to 80% impacted by age 70.
Male- or common-pattern baldness describes this
The prevalence of this condition is very high in
disorder. Norwood-Hamilton pattern baldness in males
women after they hit menopause (4).
and Ludwig pattern alopecia in women fall under this
Patient's own blood is used to create platelet-
category (1).
rich plasma, also known as platelet-enriched plasma or
Male and female hair thinning typically occurs
platelet-rich concentrate. This plasma fraction has a
between the ages of 12 and 40, and around half of the
platelet concentration that is higher than the baseline
population shows some degree of this feature by the
(5).
age of 50. Typical male pattern baldness manifests
Although the optimal platelet count for PRP has
initially as a widening of the fronto-temporal receding
not been determined, the concentrate should have a
area, followed by a narrowing of the mid-frontal area.
platelet count that is at least four to five times higher
As the vertex hair is lifted, the thickness of the hair
than the patient's baseline if it is to have any
often decreases, giving way to a spherical area (1).
therapeutic impact. There are several various phases of
Androgens cause a progressive loss of terminal
tissue healing facilitated by activating autologous
hairs and a gradual increase in vellus hairs in afflicted
growth factors and proteins, such as collagen
areas by stimulating the shrinkage of genetically
synthesis, granulation, and angiogenesis, all of which
predisposed hair follicles (2). Common baldness is also
are included in this treatment technique (6).
known by the titles male pattern hair loss (MPHL),
Evidence suggests that the high concentration
male pattern alopecia, androgen-dependent alopecia,
of bioactive chemicals in PRP and its ability to
and female pattern hair loss (FPHL). (3).
stimulate cell proliferation contribute to its ability to

speed the recovery of damaged tissues (Figure 1) (7).

2616
Received: 29/09/2022
Accepted: 02/12/2022

Full Paper (vol.902 paper# 96)


c:\work\Jor\vol902_97 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2620-2627

Bioremediation of Polluted Soil with Hydrocarbons by Some of
Trichoderma Spp in Al-Najaf-Iraq
Nihad Habeeb Mutlag1*, Sara A. Hamoudi1, Wafaa N. Radhi2
1Department of Ecology-Faculty of Science -University of Kufa
2Jaber Iben Hayyan Medical University, College of Pharmacy
Corresponding author: Nihad Habeeb Mutlag, email: nuhadh.alazerjawi@uokufa.edu.iq , Mobile: +9647706578230
ABSTRACT
Background
: There are many types of microorganisms such as bacteria and fungi, which have the potential for
biochemical analysis of hydrocarbons each organism has a specific role in the analysis process.
Material and methods: This study was conducted by addition some of biocontrol fungi Trichoderma harzianum
(isolate1), Trichoderma harzianum (isolate2), Trichoderma longibrachiatum (isolate 3) in the treatment of contaminated
soil with oil derivatives including the addition of 40 ml of white oil (WO) into the experimental pot containers containing
400 gm of soils and mixed well to achieve artificial pollution. Then, three studied isolates of Trichoderma spp. were
added and mixed with all soil samples that artificially prepared in addition to controlling pots (without the addition of
WO) three replicates for each treatment. The biodegradation of Total Petroleum Hydrocarbons (TPH) % and
Biostimulation Efficiency (B.E) % were calculated for 30,60,90 days after the treatment with bioagent fungi.
Spectrophotometer technique was used to estimate the total petroleum hydrocarbons) that showed T. longibrachiatum
isolate gave the highest Total Petroleum Hydrocarbons (TPH) % reduction in site 1 reaching (93.2%) after 90 days.
Result: Trichoderma (isolate 2) has high rate of biostimulation efficiency% that reach (94.2%). Scanning Electronic
Microscope (SEM) was used to compare the vegetative growth of fungi before and after the addition hydrocarbon with
PDA media, which showed the clear and normal growth with short period to the growth in petri dish after addition 1ml
of oil in comparison with the control petri dish in the three magnification forces values (1000x, 2000x, 5000x, 6000x,
10000x, 14000x) for all three studied bioagent fungi before and after the addition of oil.
Conclusion: Trichoderma has high rate of biostimulation efficiency, before and after the addition hydrocarbon with
PDA media by using of SEM showed the clear and normal growth with short period to the growth in petri dish after
addition 1ml of oil in comparison with the control petri dish in the three magnification forces values.
Keywords: Bioremediation, Trichoderma,Total Hydrocarbons ,SEM, Biocontrol Fungi.

INTRODUCTION
The problem of soil pollution with hydrocarbons is a
There are many types of microorganisms such as
common problem around the world. These compounds
bacteria and fungi, which have the potential for
affect the texture of the soil and its apparent density and
biochemical analysis of hydrocarbons each organism
permeability )1(. This was noticed in the soils near
has a specific role in the analysis process (7). Bacteria are
industrial facilities and centers dealing with petroleum
activated in aquatic environments either fungi and their
products from refineries, factories, storage centers,
role is proved in terrestrial environments most often the
distribution centers and public and private fuel stations
series of decomposition and degrading processes of
)2(. Environmental pollution is the most serious human
these materials have been called into simpler materials
disaster. Polycyclic aromatic hydrocarbon (PAHs) are
by biodegradation, mineralization, biotransformation,
organics components whose basic structure is H, C and
bioremediation and bioaccumulation (8). The definition
O. They are found in nature on two types, aliphatic
of biodegradation is biological treatment by cracking
hydrocarbons and aromatic hydrocarbons. These
chemicals which are generally a series of biochemical
substances are resistant to degradation and have more
reactions that occur to hydrocarbons when the cracking
than 75 compounds classified as hydrocarbons )3(.
process is completed the mineralization process is
These materials are found in the environment from
called such as the products water, CO2 gas and other
the extraction of oil, industrial waste and other sources,
inorganic materials the life transition refers to the path
soil treatment of sewage waste as fertilizer )4(, which
of chemical reactions that induce the molecule to turn
showed clear concentrations of PAHs. The residues
into different materials. Microbes use chemical
contained concentrations of these compounds ranging
pollutants in the soil as a source of energy during
from 1-10 mg / kg). In Iraq, petroleum fields distributed
oxidation and reduction reactions, to metabolize the
widely in many regions and linked together by a big net
target contaminants into an energy that can be used for
of transferring pipes to carry petroleum to all refineries
microbes the (metabolic) outputs are again released into
and exporting ports in north and south of Iraq, but the
the environment typically in a less toxic form than the
accidents usually destroy these pipelines so, a huge
original
pollutants
for
example,
petroleum
quantities of oil may leakage through the soil and cause
hydrocarbons can be destroyed by microorganisms in
pollution of soil (5). In addition to the flow of
the presence of oxygen during respiration (7).
hydrocarbons into groundwater and which is considered
MATERIAL AND METHOD
a dangerous contaminant of the environment, this is
The Study area: Al-Najaf oil refinery was chosen as a
done by the reduction of the microbial diversity that
study area it is located between Al-Najaf governorate
affected the elective phenomenon of these organisms (6).
and Karbala governorate at the left side of the road.
2620
Received: 30/09/2022
Accepted: 03/12/2022

Full Paper (vol.902 paper# 97)


c:\work\Jor\vol902_98 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2628-2633

Ultrasound Guided Bilateral Superficial Cervical Plexus Block Plus Tolerable
Endotracheal Tube Versus Conventional Systemic Analgesia for Thyroid Surgeries
Heba Mohammed Fathi, Hala Ibrahim Zanfaly, Mohammed Ezzat Abdel Galil
Department of Anesthesia, Surgical Intensive Care and Pain Management,
Faculty of Medicine Zagazig University, Egypt
Corresponding author: Mohammed Ezzat Abdel Galil, Email: ezzat201024@gmail.com, Telephone: 01067014335

ABSTRACT
Background:
There is still debate over the use of regional anesthesia during thyroid surgeries.
Objective: This investigation looked at the effectiveness of an ultrasound-guided bilateral superficial cervical plexus
block (BSCPB) combined with a tolerable endotracheal tube (TET) for reducing hemodynamic stress response and
respiratory issues as well as controlling pain during and after surgery.
Methods: This prospective randomized controlled comparative clinical research was performed at the Department of
Anesthesia, Surgical Critical Care and Pain Control in Zagazig University Hospitals. Patients were split into two groups:
Group I (Control group, "C") where patients received general anesthesia with classic endotracheal tube (ETT) and
systemic analgesia. Group II ("BSCPB+TET" "B") patients got ultrasound guided BSCPB then general anesthesia with
TET. Results: Postoperative cough, bronchospasm, and sore throat were substantially distinct between the tested groups
statistically. Group B had significantly less cough than group C. None of patients in group B had postoperative
bronchospasm compared to 22.22% of patients in group C. Group B had significantly lower sore throat than group C
Conclusions:
The use of BSCPB with TET in thyroid surgeries can achieve intraoperative hemodynamic stability,
increase time for 1st analgesic request, decrease total dose of intraoperative and postoperative analgesic requirements
and reduce the frequency of postoperative difficulties in patients undergoing elective thyroid surgeries.
Keywords: Thyroid Surgeries, BSCPB, TET.

INTRODUCTION

its tip. It is then punctured with a small needle, such as
Mild to severe incisional discomfort might be a
a 23G, and tightened by a thread, such as surgical silk,
side effect of thyroid surgery. Additionally, difficulties
along the tube's lesser curvature with its closed end at
in swallowing, throat burning, nausea, and vomiting
the tracheal tip of the endotracheal tube (6).
that might be brought on by the surgical procedure or
The aim of the present research was to investigate
by general anesthetic. Most people experience them,
the effectiveness of ultrasound-guided BSCPB plus
particularly on the first day after surgery (1).
TET for intraoperative and postoperative pain control
With a variety of methods, including opioids and
and minimizing hemodynamic stress response and
non-steroidal anti-inflammatory medicines (NSAIDs),
respiratory problems like coughing, bronchospasm and
or with additional loco-regional anesthetic approaches,
sore throat, which were associated with extubation
surgeons and anesthesiologists have sought to avoid or
process in thyroid surgeries.
cure these issues. Patients who underwent thyroid

procedures may benefit from the use of loco-regional
PATIENTS AND METHODS
anesthetic techniques including bilateral superficial
This
prospective
randomized
controlled
cervical plexus blocks (BSCPB) and local anesthetic
comparative clinical research was performed at the
wound infiltration (LWI) in order to lessen both
Department of Anesthesia, Surgical Critical Care and
intraoperative and postoperative discomfort (2).
Pain Control in Zagazig University Hospitals.
The area of the anterior triangle of the neck has

been anesthetized using a regional block of the
Patient groups were split into two: Group I (Control
superficial cervical plexus, which covers the dermatome
group) "C" patients receive general anesthesia with
grade of the second to fourth cervical nerves on the
ETT
and
systemic
analgesia.
Group
II
anterolateral section of the neck (3).
"BSCPB+TET" "B" patients got ultrasound guided
It is intended that a bilateral superficial cervical
BSCPB then general anesthesia with TET.
plexus nerve block (BSCPB) may lower postoperative

pain's intensity and analgesic usage (4).
Inclusion criteria: Patients with ASA I and ASA II,
The transverse cervical, larger auricular, lesser
mallampati score I, II, age > 21 years old, body mass
occipital and supraclavicular nerves may be made
index < 35, accepted mental state and undergoing
surface-numb by using this popular regional anesthesia
thyroid surgery whose pathology and surgical
ultrasound-guided procedure, which involves bilateral
intervention suppose at least a 24 hours hospital
injections of local anesthetic medications near the
admission.
lateral border of the sternomastoid muscle (5).

TET is an ETT plus a nelaton catheter of 6- or 8-
Exclusion criteria: Patients with opioids treatment
gauge size that has been burned and clamped closed at
before surgery, history of pathology or surgery
2628

Received: 21/08/2022
Accepted: 24/10/2022

Full Paper (vol.902 paper# 98)


c:\work\Jor\vol902_99 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2634-2642

Cognitive Function Assessment in Paediatric Patients with Beta-Thalassemia Major
Samar M. Elbahy, Sanaa H. Ayad, Rashad A. Elsayed, Elham Nawar
Paediatric Department, Faculty of Medicine, Benha University.
Corresponding author: Samar M. Elbahy, ORCID: 0000-0001-8465-3794,
Email: samar.elbahy@fmed.bu.edu.eg, Mobile: 00201501546677

ABSTRACT
Background:
Multiple risk factors in Beta-thalassemia major (TM) children contribute to the impairment of their
neurocognitive function. Multiple studies used different intelligence quotient (IQ) scores to assess the neurocognitive
function in thalassaemic children, however, results were variable.
Objective: This study aimed to assess the cognitive functions of thalassemic children and to compare them to a well-
matched group of healthy controls using the Fourth Edition of the Wechsler Intelligence Scale for Children (WISC- IV).
Subjects and Methods: A cross-sectional study recruited two groups; Group I included 50 children diagnosed with TM
on regular blood transfusions. Group II included 50 healthy control children with no underlying chronic illness, matching
the patients' age, sex, education, parent's education, school performance, and socioeconomic level. A detailed history was
taken, and clinical examination was performed; also, laboratory investigations including full blood picture and serum ferritin
were done. Neurocognitive functions were assessed using WISC- IV.
Results: TM children had significantly lower IQ scores on cognitive function assessment than healthy children, including
the mean of the Full-Scale Intelligence Quotient, as well as the mean scores of the Verbal Comprehension Index, the
Processing Speed Index, the Perceptual Reasoning Index, and the Working Memory Index (P<0.01). There was no
correlation between IQ scores and the age at the onset of disease, transfusion frequency per year, serum ferritin, onset and
duration of chelation, type of chelation, parents' education, and socioeconomic status. However, IQ scores were positively
correlated with pretransfusion Hb, school performance, education, and anthropometric measurements.
Conclusion: We concluded that TM children have significantly lower IQ scores than healthy children, and this requires
attention for neuropsychological assessment of thalassemic children early in life to provide adequate support.
Keywords: -Thalassemia; Cognitive function; Intelligence Quotient; Fourth Edition of the Wechsler Intelligence Scale
for Children; WISC- IV.

INTRODUCTION
regular neurophysiological assessment by using the
Beta-thalassemia major (TM) is a genetic
Third Edition of the Wechsler Intelligence Scale for
disorder, that is known to cause chronic hemolysis
Children (WISC-III) for early recognition of intellectual
exaggerated by ineffective erythropoiesis causing severe
dysfunction in thalassemic children [6].
anemia [1]. It is the most prevalent chronic hemolytic
Multiple studies have been performed to assess
anemia in Egypt (85.1%), a previous epidemiological
cognitive functions in thalassemic children using WISC-
study estimated the carrier rate of thalassemia in 1000
III. These studies showed significantly different results
normal subjects was found to be 9-10.2%[2].
between patients and controls regarding the subsets of
Patients usually present with severe anemia,
intelligence quotient (IQ) [7­12].
jaundice, organomegaly, growth retardation, and skeletal
We aimed to assess cognitive functions in
abnormalities. Therefore, they require chronic blood
thalassemic children using the Fourth Edition of the
transfusion, which comes with the cost of iron overload
Wechsler Intelligence Scale for Children (WISC-IV) and
and chronic iron deposition in different body organs [3].
to compare them to healthy children, and to correlate the
Neurological complications and cognitive dysfunction
results with different clinical variables.
have been previously described in TM patients, either

due to the disease or its treatment. Many risk factors were
SUBJECTS AND METHODS
reported, including chronic hypoxia, iron deposition in
Subjects
the nervous system due to frequent blood transfusions,
This cross-sectional study was conducted at the
silent thromboembolism, and the neurotoxicity of
outpatient Paediatric Haematology Clinic at Benha
Deferoxamine [4]. Furthermore, frequent school absences,
University Hospitals from February 2022 to August 2022.
frequent hospitalizations, and physical and social
One hundred children were enrolled; at an age range 6 to
restrictions also lead to cognitive dysfunction [5].
16 years, with no sex predilection, divided into two
This neurological involvement in TM patients is
groups; Group I included 50 children diagnosed with
primarily silent, with subclinical manifestations that can
TM receiving regular blood transfusions every 2-8
only be detected by cognitive assessment tests, as
weeks. Group II included 50 healthy control children with
demonstrated by Economou et al., who recommended
no underlying chronic illness.
2634
Received: 21/09/2022
Accepted: 24/11/2022

Full Paper (vol.902 paper# 99)


c:\work\Jor\vol902_100 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2643-2650

Effect of Educational Program about Resonant Leadership on
Nurse Managers' Knowledge and Practices
Moshera Mohamed El-Sayed*, Reda Abd El-Fatah Abo Gad, Karima Ahmed El Sayed, Walaa Mostafa Eid
Nursing Administration Department, Faculty of Nursing, Tanta University, Egypt
*Corresponding author: Moshera Mohamed El-sayed, Mobile: 01021486692, Email: drmoshiramohammed90@yahoo.com

ABSTRACT
Background
: Resonant leadership provides the nurse managers with the opportunity to design and manage the
environment. Objective: The current study aimed to evaluate the influence of program regarding resonant leadership
on knowledge and practices of nurse managers.
Subjects and methods: Setting: The study was conducted at Emergency Hospital and Tanta University Main hospital.
Subjects: Nurse Managers and charge nurses (n = 66) at Tanta Main University and Emergency Hospitals, also 322 of
staff nurses. Tool: Three tools were used; (1) Nurse Managers' resonant leadership knowledge structured questionnaire;
(2) Nurse Managers' resonant leadership practice self-report; and (3) Nurses' perception about nurse managers' resonant
leadership structured questionnaire.
Results: The majority (87.9%) of nurse managers had low level of knowledge regarding resonant leadership and none
of them had satisfactory level of resonant leadership practice pre-program. While all of them had high level of
knowledge and practice at immediate, which slightly decreased to the majority (86.4% and 83.3%) of them after 3
months of program respectively. None of nurses described that their nurse managers practiced high resonant leadership.
While all (100%) of them reported that their nurse managers had high level at immediate, which slightly decreased to
84.5% of them after 3 months of program.
Conclusion: Nurse Managers at Main Tanta University Hospital and Emergency Hospital showed low level of
knowledge and practice regarding resonant leadership. While they develop their resonant leadership skills after
implementation of needed programs. It is recommended to organize frequent periodic advancement program for nurse
managers about resonant leadership.
Keywords: Nurse Manager, Knowledge and practice, Resonant leadership.

INTRODUCTION

enables nurse managers to organize resources for giving
For nurses at all levels, leadership is a critical
the nurses what they need to do in their job (8).
ability, even though it might seem obvious to those in
The empowering means the ability of nurse
positions with direct administrative responsibilities (1).
managers to provide professional support of nurses by
Every health care organization needs effective
providing the necessary information, power, and
leadership to be successful (2).
resources (9).
A leader is someone who exerts influence over a
Managing change is the ability of nurse managers
group of people to accomplish shared objective.
to organize, start, carry out, manage, and stabilize
Resonant leaders are capable of inspiring their
change processes at the corporate and individual levels.
subordinates to act in a way that produces the best
Resonant nurse managers have the abilities to
results (3,4).
coordinate the process of change (10). Finally, coaching
Effective resonant leadership at each level of the
is a process that enables nurses' learning and
health care organization encourages nurses to think
development to occur and thus performance to improve.
outside the box through practicing eight specific
Nurse Managers are frequently in the best position
dimensions which include; vision, compassion, overall
in healthcare institution for improving work lives of
positive
mood,
communication,
commitment,
nurses since they are familiar with unit problems and
empowering, managing change, and coaching. Vision
frequently contact with nurses. Therefore, the need for
explains the ability of nurse managers to articulate
implementing educational program will help nurse
expectations for the future of the organization;
managers to be knowledgeable about resonant
compassion refers to the sensitivity of nurse manager to
leadership, as well as, use their knowledge and practice
understand nurses' suffering and find a solution to their
to increase staff nurses' involvement and motivation to
situation through strive to understand nurses' emotional
success (11,12).
needs; overall positive mood is the ability of nurse
The aim of the current study was to assess the
managers to display a positive spirit in work
impact of educational program regarding resonant
environment through create atmosphere of cooperation
leadership on nurse managers' knowledge and practices.
and enthusiasm within organization (5,6).

Furthermore, communication involves mutual
SUBJECTS AND METHODS
exchange of information, idea, and feeling between
Design: A quasi-experimental research design was
nurse managers and nurses (7). Commitment to quality
conducted. Such a design is appropriate for the nature
of the topic being studied.
2643
Received: 01/10/2022
Accepted: 04/12/2022

Full Paper (vol.902 paper# 100)


c:\work\Jor\vol902_101 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2651-2655

Study of Plasminogen activator inhibitor-1 (PAI-1) in
hospitalized COVID-19 patients
Aya Mohamed Boshta1*, Mohamed HossnyFouda1,Mohamed Sayed Hantera2, Enass Arafa El-Zamrany1
1 Clinical Pathology Department, 2 Chest Diseases Department, Faculty of Medicine,TantaUniversity, Tanta,Egypt
*Corresponding Author: Aya Mohamed Boshta, E-mail:ayaboshta@gmail.com, Tel.:+20 106 811 9727

ABSTRACT
Background:
There is an evidence that COVID-19 individuals have impaired fibrinolysis, which may increase their
thrombotic risk further. Hepatocytes and endothelial cells are responsible for the synthesis of plasminogen activator
inhibitor-1 (PAI-1). It is the primary inhibitor of tissue-type plasminogen activator (t-PA) and has a crucial role in
fibrinolysis control. The purpose of our research was to measure the plasma levels of PAI-1 in Patients with COVID-19
who were hospitalized.
Methods:In the current research, 40 Patients with COVID-19 and 40 healthy participants served as controls. Enzyme-
linked immune-sorbent assay (ELISA) was used to measure plasma PAI-1 levels.
Results: There was a considerable elevation in WBCs count and segmented WBCs in cases compared to control with
significant decrease in lymphocytes in cases compared to control group. PAI-1, CRP, LDH, Ferritin and D-Dimer were
remarkably raised in patients compared to control group.There was positive significant correlation between PAI-1 levels
and urea, creatinine, AST, LDH, ferritin, D-Dimer and CRP. PAI-1 showed 93% sensitivity and 87% specificity at cut
off 5.5 ng/ml in discriminating patients from control group.
Conclusions:
Plasma concentrations of PAI-1, a measure of fibrinolytic homeostasis, were higher in ICU patients with
COVID-19. This research also showed that PAI-1 may be added to the list of biomarkers used to define Patients with
COVID-19.
Keywords:COVID-19,Biomarkers,PAI-1, Fibrinolytic, Homeostasis.

INTRODUCTION

Several acute uncommon respiratory disorders
fibroblasts are the types that make PAI-1.[4].PAI-1, as a
emerged in December 2019 in Wuhan, China, and
possible biomarker, a key regulator of fibrinolysis was
quickly spread to neighbouring cities. The culprit was
discovered. PAI-1 reduces plasminogen activator, a
swiftly identified as a new coronavirus. This new
necessary enzyme in the conversion of plasminogen to
coronavirus was discovered given the name respiratory
plasmin. This causes intravascular coagulation,
distress syndromecoronavirus-2 (SARS-CoV-2) due to
hypoperfusion, and organ failure by inhibiting
its 70% similarity to SARS, which is a single-stranded
fibrinolysis[5].
RNA coronavirus with a positive sense that
COVID-19 infected patients may have poor
predominantly infects human cells[1].
fibrinolysis, which may increase their thrombotic risk.
ACE2 is overexpressed in lung alveolar cells,
This has been shown by dramatically diminished clot
vascular endothelial cells and cardiac myocytes among
lysis at 30 minutes using thromboelastography (TEG) in
others. SARS-CoV-2 is mostly spread by respiratory
individuals with severe COVID-19 infection.
tract invasion and inhalation. This virus may live for
Moreover, Patients with COVID-19 had significantly
24­72 hours on transmission-friendly surfaces[2].
increased PAI-1 levels that are associated with
Infection with SARS-CoV-2 may cause mild to severe
diminished fibrinolytic ability [6]. This study aimed to
failure in respiration and multiple organ failure.
evaluate the plasma levels of PAI-1 in COVID-19
Asymptomatic people may have pulmonary ground
hospitalized patients.
glass opacification seen on computed tomography

(CT) scan [1].
PATIENTS AND METHODS
Hypercoagulability is associated with COVID-19,
The current research was done on 80 patients who were
which manifests as an enhanced risk of venous
divided into two groups: group1 included 40 Patients
thromboembolic events and microvascular target-organ
with COVID-19 ranging in age from 21 to 63 years, and
damage. The relationship between significant
group2 contained 40 healthy persons ranging in age
inflammation and coagulation is crucial for estimation
from 20 to 60 years who acted as the control group.
the prognosis of severe Patients with COVID-19[3].
Patients were recruited from COVID-19 ICU Hospitals
Plasminogen activator inhibitor-1 (PAI-1) is a serine
at Tanta University.
protease inhibitor with a single chain glycoprotein (or

serpins). It contains 379 amino acids and a 50 kDa
Inclusion criteria:
molecular mass. PAI-1 is the major suppressor of tissue-
Established diagnosis of COVID-19 as indicated by a
type plasminogen activators (t-PA) and urinary-type
positive nasopharyngeal viral PCR for SARS-CoV2,
plasminogen activators (u-PA). Megakaryocytes,
and all control subjects were healthy, non-medicated,
endothelial cells, monocytes, macrophages, smooth
and exhibited no signs of pathological conditions.
muscle cells, adipocytes, cardiac myocytes and

2651
Received: 01/10/2022
Accepted: 04/12/2022

Full Paper (vol.902 paper# 101)


c:\work\Jor\vol902_102 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2656-2661

Short-Term Outcomes of Conventional versus VATS Lobectomy in
Surgical Treatment of NSCLC
Abdelhamid Fathi Sherif1, Rakan Khalifa2, Anhar Elsayed Abd-Ellatif1
1Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Egypt
2Department of Surgery, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
*Corresponding author: Abdelhamid Fathi Sherif, Mobile: +966509499912, E-Mail: abdelhamidfathi6@gmail.com

ABSTRACT
Background:
A major cause of cancer-related death is non-small-cell lung cancer (NSCLC). As only 20 % of NSCLC
cases are typically discovered while the illness is potentially curable & resectable, resulting in poor 5-year survival rate.
Objective:
To compare between conventional versus VATS lobectomy in surgical treatment of NSCLC.
Patients and Methods:
This prospective randomized open label clinical trial involved 100 patients aged >18 years old
sex diagnosed with NSCLS at Benha university. Randomly, cases were classified into 2 equal groups by computer
generator into group A (n=50): underwent open thoracotomy, and group B (n=50): underwent VATS. All patients were
subjected to full history taking, general examination such as vital signs and laboratory investigations were recorded.
Results:
Group A had significant increased duration of operation, prolonged air leak, & atelectasis than group B (P
value <0.001, 027, 0.030 respectively). Pneumonia, hemothorax, AF, cerebrovascular accident and wound infection
were insignificantly different between both groups. Group B had significant lower ICU stay & hospital stay than group
A. Bleeding, readmission, recurrence, and mortality were insignificantly different between both groups. Group B had
significant higher mean survival rate than group A.
Conclusion:
Open lobectomy was accompanied with a reduced survival rate and more comorbidities than VATS
lobectomy. These findings imply showed that for treating NSCLC at an early stage, VATS is a safe & efficient method.
Keywords: Conventional, VATS, Open thoracotomy, Surgical treatment, NSCLC.

INTRODUCTION
appropriate in terms of long-term survival & acceptable
A major cause of cancer-related death is non-
outcomes, open surgery and large pulmonary resection
small-cell lung cancer (NSCLC). As only 20 % of
were favoured for lung cancer treatment for a long time
NSCLC cases are typically discovered while the illness
(6). Nevertheless, VATS-L is still regarded as a difficult
is potentially curable & resectable, resulting in poor 5-
treatment with intraoperative complications risk so
year survival rate (1). The spread of screening
severe that they necessitate emergency or urgent
programmes of lung cancer in the past 2 decades which
thoracotomy for care (7).
have lowered mortality in high-risk persons through
Regarding 5-year overall survival & systemic
early diagnosis, has increased the number of small
recurrence for selected patients with early-stage
nodules and, consequently, the number of small
NSCLC, VATS was revealed to be superior to open
incisions that surgeons must deal with & perform (2).
thoracotomy according to a recent meta-analysis. The
Video technology utilization & rib spreading avoidance
thoracic community's adoption of VATS has been
are characteristics of minimally invasive thoracoscopic
gradual, despite numerous retrospective observational
surgery. In comparison with open thoracotomy, this
studies reporting superior short- & long-term outcomes.
minimally invasive surgical method has demonstrated
Globally, only a small percentage of pulmonary
positive perioperative outcomes, including decreased
resections are conducted utilizing VATS at now (8). To
occurrences of pain, cardiac arrhythmias, & pneumonia
compare VATS to open thoracotomy, there is a shortage
(3).
of strong clinical evidence in the form of large
For NSCLC treatment, it has been demonstrated
randomized controlled studies & publication bias
that Video-assisted thoracic surgery lobectomy (VATS-
cannot be ruled out in the great majority of published
L) is a safe & effective substitute to conventional
retrospective research studies. This study aimed to
thoracotomy. With more experience and improved
compare between conventional versus VATS
technology, the applicability of VATS has substantially
lobectomy in surgical treatment of NSCLC.
grown (4). Since VATS is safe & successful, it has been

established and is approved for the excision of a clinical
PATIENTS AND METHODS
stage I NSCLC (early-stage). In earlier studies, VATS
This retrospective randomized open label clinical trial
lung resection was associated with superior short-term
involved 100 patients aged >18 years old of both sex
results, including shorter hospital stays, fewer adverse
diagnosed with NSCLS.
events, and lower morbidity & mortality rates compared

to thoracotomy (5). In spite of its generally
Exclusion
criteria:
Broncho-angioplasty
or
acknowledged benefits, thoracic surgeons had not
bronchoplasty,
sleeve
lobectomy,
substantial
accepted VATS as a successful technique until recently.
anatomical resection with pneumonectomy or small
As these minimally invasive treatments were perceived
lung resections, as well as patients who received
to be more technically difficult and less ontologically
lobectomy for a condition other than NSCLC. Also,
2656
Received: 03/09/2022
Accepted: 06/11/2022

Full Paper (vol.902 paper# 102)


c:\work\Jor\vol902_103 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2662-2669

Circumcision in Neonates and Infants Using Different Techniques:
A Comparative Study
Doaa Omar Refaat1, Ismeal Mohamed Tantawy2, Mohamed Mahmoud Mokhtar1, Khaled Mosad Mosad*1
Departments of 1General Surgery and 2Pediatric Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Khaled M. Mosad, Mobile: (+20)1280120240, Email: khalidmosad61@yahoo.com

ABSTRACT
Background:
The most frequent operation done throughout history is circumcision. Surgeons were worried about
improved circumcision equipment that can reduce problems and are simple to use while also considering how cost-
effective they are.
Objective: The aim of the current work was to compare the postoperative outcomes between four groups of patients
treated with conventional, bone cutter with thermal cautery, plastibell and gomco techniques of circumcision.
Patients and methods: This randomized clinical trial study included a total of 220 infants who have undergone
circumcision at the Department of Pediatric Surgery, Zagazig University Hospitals. According to the method of
circumcision used; infants were divided into 4 groups, (55 infants each) Group A: Bone cutter with thermal cautery
technique; Group B: Conventional technique; Group C: Plastibell device technique and Group D: Gomco clamp
technique. The outcomes were assessed intra-operatively and post-operatively.
Results:
There were significant differences between the studied groups as regards the need for stitches and the number
of stitches. There were significant differences between studied groups regard length of targe mucosal cut off. There was
a significant higher percent of infants suffering from bleeding at recovery in Gomco clamp technique group compared
to other groups. There were significant differences between studied groups regard Parents' satisfaction (p<0.001). There
were significant differences between studied groups regard cosmetic score. There were significant differences between
studied groups regard beer assessment score (p<0.001).
Conclusion
: It could be concluded that circumcision using thermal assisted device is found to be significantly superior
to the other methods in terms of operative time and post- circumcision hemostasis. Generally, complications are minor
among all groups.
Keywords: Circumcision, Bone Cutter with Thermal Cautery, Plastibell and Gomco, Neonates.

INTRODUCTION


In addition to being a medical operation with
frequently involve the use of bone-cutting forceps, and
clear risks and advantages, circumcision is a religious
many pediatric surgeons prefer to use thermal cautery
tradition. Most often, circumcision is done for religious
rather than a knife to remove superfluous skin since it
rather than medical reasons (1). Neonatal and infant
reduces the likelihood of bleeding (6). Circumcision is
circumcision can be performed using a variety of
frequently performed using the Gomco technique. The
methods, such as the standard method, the Plastibell
Gomco procedure is still a popular circumcision
device, the Gomco clamp, and the Mogen clamp (2).
technique in Saudi Arabia. In Saudi Arabia, there are
It is simple to circumcise both newborns and
not much research on the effectiveness and safety of
young children. Most of the time, healing is finished
this method (7).
within the first two weeks following surgery. There is a
The aim of this work was to compare the
1 to 15% chance of surgical problems with it (3). In the
postoperative outcomes of four groups of patients
present day, using a Plastibell gadget has become the
treated with conventional, bone cutter with thermal
technique of choice for babies younger than a year old.
cautery, plastibell and gomco techniques of
Hollister released the Plastibell circumcision tool in the
circumcision.
1950s. According to various research, the Plastibell

device (PD) has a 2.0­3.0% reported complication rate.
PATIENTS AND METHODS
Plastibell circumcision is mostly performed under
This randomized clinical trial study included a
vision, is practically bloodless, is the least painful and
total of 220 infants who have undergone circumcision
easiest to complete, and has no terrible side effects like
at the Department of Pediatric Surgery, Zagazig
urethro-cutaneous fistula or traumatic amputation of
University Hospitals.
the glans (4).

General practitioners frequently perform
According to the method of circumcision used; infants
circumcisions using the bone cutter procedure. In
were divided into 4 groups, (55 infants each) Group A:
Pakistan, the most popular procedure for circumcision
Bone cutter with thermal cautery technique; Group B:
is still the bone cutter method. General practitioners are
Conventional technique; Group C: Plastibell device
hesitant to use the plastibell circumcision device over
technique and Group D: Gomco clamp technique.
the bone cutter approach since there are so few

randomized research available on its effectiveness and
Inclusion Criteria:
safety (5). Egyptian male circumcision practices still
Male infants aged 2 years, presented at the
2662
Received: 24/09/2022
Accepted: 27/11/2022

Full Paper (vol.902 paper# 103)


c:\work\Jor\vol902_104 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2670-2676

Effect of Circulating Angiotensin Converting Enzyme Level in
Portal Hypertension
Ahmed Ahmed El-Shaarawy1, Eman Ahmed Gawish1,
Ahmed Kamal Khamis2, Hager Said Hamed Meselhy*1, Mary Albert Naguib1
Departments of 1Clinical Pathology,
2Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Egypt
*Corresponding author: Hager Said Hamed Meselhy, Mobile: (+20)1069774115, E-Mail: hagersaid542@gmail.com

ABSTRACT
Background:
A common clinical condition, portal hypertension (PHT) is brought on by mesenchymal dysfunction in
cirrhotic livers. Esophageal varices (EV), a dangerous complication, demand that patients be watched closely at all times.
The zinc metallopeptidase angiotensin-converting enzyme (ACE) is located on the surface of endothelial and epithelial
cells. It is an essential part of the renin-angiotensin system (RAS), which controls plasma volume and blood pressure.
Objectives: The present study was designed to assess angiotensin-converting enzyme (ACE) levels in portal hypertension
patients and study its association with presence of esophageal varices.
Patients and methods: A total of 105 subjects, including 35 portal hypertension patients with esophageal varices, 35 portal
hypertension patients without esophageal varices and 35 healthy controls were selected. ACE level was measured using
enzyme-linked immunosorbent assay (ELISA)
Results Serum ACE was significantly increased in PHTN with EV group versus PHTN without EV and healthy groups. A
significant association was detected between ACE levels and the size of varices, as higher levels of ACE were found in
patients with large varices (p=0.010). In addition, a significant association was found between ACE and blood transfusion
(p=0.012) and lower hemoglobin levels (P value < 0.001) in PHTN with EV group. A cutoff values of 44.15 ng/mL and
48.75 ng/mL could significantly discriminate PHT patients with EV from healthy controls and PHTN patients without
esophageal varices respectively.
Conclusion: It could be concluded that angiotensin-converting enzyme (ACE) could be a potential diagnostic marker for
the presence of esophageal varices in portal hypertensive patients and a non- invasive marker for recognizing patients at
risk of variceal rupture.
Keywords: Portal hypertension, Esophageal Varices, angiotensin-converting enzyme.


INTRODUCTION

Portal hypertension is a dangerous complication of
regulation of vasoconstriction, sodium homoeostasis,
liver disease caused by increased resistance to portal
fibrosis, cell proliferation, and the inflammation
blood flow into the liver. (1). Due to significant
associated with various diseases, including liver cirrhosis
consequences such ascites, bleeding from gastro-
(6). According to earlier studies, the RAS is crucial to the
esophageal varices, and encephalopathy, cirrhosis has a
cirrhosis-related development of portal hypertension (7).
devastating sequela that increases morbidity and mortality
Furthermore, many experimental and clinical studies have
(2). Esophageal varices (EV) are portosystemic collaterals
shown that modulating the RAS improves portal pressure
that form in the lower esophageal submucosa
in cirrhotic animal models and human patients, implying
preferentially. It is responsible for 10% to 30% of all cases
that this system could be a target in the development of
of upper gastrointestinal bleeding. (3).
future therapies for cirrhosis-related portal hypertension.
For detecting varices, upper gastrointestinal
(8). So, we aimed to measure angiotensin-converting
endoscopy is regarded as the gold standard (4). This
enzyme (ACE) levels in portal hypertension patients and
procedure, however, is invasive, restrictive, and relatively
study its association with presence of esophageal Varices.
expensive. As a result, there is an urgent need to identify

noninvasive tests that can be repeated during the follow-
SUBJECTS AND METHODS
up of cirrhotic patients at risk of bleeding. (5).
This case-control study was conducted at the National
The angiotensin-converting enzyme (ACE), a zinc
Liver Institute, Menoufia University in Egypt. It included
metallopeptidase found on the surface of endothelial and
70 portal hypertensive (PHT) patients; 35 with
epithelial cells, is an important component of the renin-
esophageal varices and 35 without esophageal varices.
angiotensin system (RAS). By catalyzing the conversion
They were recruited from Departments of Hepatology and
of angiotensin I to angiotensin II, ACE regulates blood
Gastroenterology, National Liver Institute. In addition, 35
pressure and plasma volume. As a result, ACE raises
healthy unrelated individuals who were age- and gender-
blood pressure indirectly (by causing blood vessels
matched were recruited from Blood Donation Unit of
constriction). Ang II is the primary effector in the
National Liver Institute as a control group.
2670
Received: 24/09/2022
Accepted: 27/11/2022

Full Paper (vol.902 paper# 104)


c:\work\Jor\vol902_105 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2677-2687

Improvement of Human Dental Enamel Using Laser-Prepared Indium Oxide
Nanoparticles Suspension Solution (In Vitro Study)
Dhuha M Hasan 1,2 *, Maha Jamal Abbas 3, Batool Hassan Al-Ghurabi 4
1 Pedodontic and Preventive dentistry department, College of Dentistry, University of Baghdad/ Baghdad, Iraq.2
Department of Dentistry, Al-Mustaqbal College University, Babylon, Iraq.
3 Preventive Dentistry, College of Dentistry, Mustansiriyah University/ Baghdad, Iraq
4 Microbiology/Immunology, Department of Basic science College of Dentistry, University of Baghdad/ Baghdad, Iraq
* Correspondence: Dhuha M Hasan , E-mail: dhuah.malek@uomus.edu.iq, Mobile:009647826616639

ABSTRACT
Background:
Despite the fact that fluoride-based remineralization technologies have dominated preventive dentistry for
the past century, but new and innovative nanomaterials approaches are transforming the industry. A variety of unique
nanomaterials are now easily available to assist remineralization of dental enamel surface.
Objective: investigate the effect of indium oxide nanoparticles application in comparison to de-ionized water and sodium
fluoride on human tooth enamel by assessing the morphological changes in enamel ultra-structure. Using a field emission
scanning electron microscope, x-ray diffraction, and ultraviolet visible absorption to evaluate the physical characteristics of
indium oxide nanoparticles created by laser ablation in liquid.
Method: Teeth samples were seventy-two divided randomly into two phases; each phase consists of study and treated
groups with indium oxide nanoparticles, control positive treated with sodium fluoride, and control negative with deionized
water. Each group was consisted of twelve teeth, from each group two teeth for scanning electron microscopy and the rests
were for energy dispersion spectroscopy. Result: result showed change in chemical composition of dental enamel was
recorded for both preventive and treatment groups after nanoparticles application and this was supported by energy
dispersive spectroscopy and scanning electron microscope.
Conclusion: Laser prepared indium oxide nanoparticles colloidal suspensions were found to be effective remineralizing
agent to dental enamel and thus can be considered as an alternative to sodium fluoride mouth wash.
Keywords: Indium oxide nanoparticles, human normal dental enamel, scanning electron microscopy, energy dispersion
spectroscopy.

INTRODUCTION

Dental caries is a complex disease process brought on
numerous investigations on the production of various
by a microbial imbalance in the oral biofilm in which
structured In2O3 materials, including nanotubes,
early detection and attempts are made to reverse or stop
nanowires, nanobelts, and nanofibers, for a variety of uses
dental caries for maintaining tooth structure. Fluoride
(6). Since the demand for consumer electronics has
offers tooth enamel hardness and durability and prevents
increased, so has occupational exposure to particles
cavities, can be used to increase a tooth's resistance to acid
containing indium (7,8). Pulsed laser ablation in liquid is
attack. Despite efforts and improvements in caries
one of the most popular dominant technologies to produce
management, many patients continue to have caries (1).
pure and stable NPs suspensions due to its low cost, high
Nanotechnology can help with dental caries
efficiency, and precision (9,10).
prevention and management by reducing plaque and
Indium oxide nanoparticles have been created using a
assisting with initial caries remineralization. This
variety
of
methods,
including
chemical,
engineering specialty used molecular machines with
solvo/hydrothermal, pulsed laser deposition, and others
precise structures that are equivalent to nano means 10-9,
(11,12,13). The Gram negative bacterium Escherichia coli (E.
because of their distinctive properties, such as their better
coli) were killed by the metal oxide indium oxide
surface-to-volume ratio and enhanced bioavailability
nanoparticles, which has been shown to have antibacterial
toward cells and tissues (2,3). Due to metal nanomaterial's
action. This metal oxide also had therapeutic potential for
ability to disrupt bacterial metabolism and inhibit biofilm
the treatment of infectious disorders (14).
development, significant antibacterial action was
With a wet chemical process, novel indium and
displayed by metal and metal oxide nanoparticles (NPs)
titanium oxide nanoparticles with antibacterial action
through metal ion release, oxidative stress generation, and
against Gram-positive pathogens were created. Gram
non-oxidative processes(4,5).
positive Staphylococcus aureus and Gram negative E. coli
An important and fascinating transparent metal
were both effectively inhibited by indium oxide
nanomaterial is indium oxide (In2O3), which was used in
nanoparticles that were created using the hydrothermal
solar cells, photocatalysts, organic light-emitting diodes,
technique (15). The acquired results showed that the
architectural glasses, and panel displays. There have been
pathogenic Candida albicans might be inhibited in-vitro
2677
Received: 28/10/2022
Accepted: 28/12/2022

Full Paper (vol.902 paper# 105)


c:\work\Jor\vol902_106 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 2688-2694

Study of Clinico-Pathological Characters of Extremity Soft Tissue Sarcoma
Majdi Milad Abdulsalam Hamd, Adel Mahmoud Moursi, Alaa M. I. Khalil, Osama A. Eltih, Hassan Ashour
Department of General Surgery, Faculty of Medicine, Zagazig, University, Sharkia, Egypt
*Corresponding author: Majdi Milad Abdulsalam Hamd, Mobile: (+20)012915087741, E-Mail: majdihamd2@gmail.com
ABSTRACT
Background:
Histological analysis is used to distinguish between benign and malignant tumors, allowing for the
definitive diagnosis of soft tissue sarcoma (STS).
Objective: To evaluate the clinicopathological characteristics of extremity soft tissue sarcoma.
Subjects and Methods: The present cross-sectional study included a total sample of 18 participants with soft tissue
sarcoma planned for surgery according to their tissue biopsy.
Results: Regarding the characteristics of STS in the present results, the mean size was 20.1± 10.6 cm, ten patients
(55.6%) had STS on the right side and 44.4% had STS on the left side. Only five patients (27.8%) had superficial STS
and 13 (72.2%) had deep STS. Regarding the stages of STS, 2 (11.1%) were stage IA, 3 (16.7%) were stage IB, 4
(22.2%) were stage IIA, 6 (33.3%) were stage IIB, 1 (5.6%) was stage IIIA and 2 (11.1%) were stage IIIB. Regarding
the histopathological diagnosis of STS, 2 (11.1%) had undifferentiated pleomorphic sarcoma, 3 (16.7%) had
liposarcoma, 7 (38.9%) had rhabdomyosarcoma, 3 (16.7%) had myxofibrosarcoma, and 3 (16.7%) had
leiomyosarcoma. The comparison between males and females regarding characteristics and histopathological types of
STS showed that there was no statistically significant difference. Conclusion: Males are more likely to be diagnosed
with soft tissue sarcoma, while middle-aged people are disproportionately afflicted. The lower extremities are the most
prevalent site of involvement, and rhabdomyosarcoma is the most common histologic subtype. The clinicopathological
features of soft tissue sarcoma are not influenced by gender distribution.
Keywords: Clinico-pathological characters, Extremity, Soft tissue sarcoma.


INTRODUCTION

Rare connective tissue malignant tumors called
local relapse of the tumors, which can occur at any time
sarcomas are characterized by their heterogeneity and
during the course of treatment (5).
the ability to differentiate into several cell types,
It was the goal of this study, to evaluate the
including those of other connective tissues (lipocytes,
clinicopathological characteristics of extremity soft
fibrous supporting structures, muscle, etc.), visceral
tissue sarcoma.
tissues, and bone. As much as 40% of all STS develop in
SUBJECTS AND METHODS
the extremities. Lower extremities more often than upper
Subjects: Our study is a cross-sectional study done on a
ones (28%) (12 percent). About 44% of all STS
study sample of 18 cases with soft tissue sarcoma
involving an extremity occur in the thigh (1).
planned for surgery at the General Surgery Department
Genetic and environmental variables (such as
of Zagazig University hospitals.
chemical carcinogens), irradiation, viral infections
(especially HHV-8), and immunological weakness have
Inclusion criteria: Patients with STS involving the
all been linked to an increased risk of STS, although its
extremities, all age groups, both sexes, cases during
exact cause remains unknown. Scarred or implanted
study time, and patients who agreed to sign informed
areas can also experience sporadic occurrences.
consent.
Symptom-free and big at diagnosis, soft-tissue sarcomas
Exclusion criteria: Patients presenting with local
spread hematogenously, most commonly to the lungs (2).
recurrence, patients unfit for surgery, patients who
Histology is used to provide the definitive
refused to share in the study, and patients who missed
diagnosis of STS, ruling out the possibility of a benign
the follow-up.
growth and, if cancerous, determining the sarcoma's
histological grade as well as subtypes (3). When a mass
All patients ha ve gone through:
cannot be identified by the use of clinical history,
A. Complete history: Each individual will have a
physical examination, laboratory tests, or imaging, a
thorough clinical history taken, with an emphasis on
biopsy may be required to make a definitive diagnosis.
their current symptoms.
Biopsies are performed to gather diagnostic tissue while
B. Evaluation clinically: Both general and local
minimizing collateral damage, stopping the spread of
examinations were performed to every patient.
cancer, and interfering with future treatment options.
Operative measures:
Some methods that have been developed to achieve these
The incision was made at the appropriate position and
aims are open surgical biopsy, fine-needle aspiration
size relative to the tumor based on the information so
(FNA) as well as core biopsy (4).
obtained to determine the extent of the operation.
Despite the need for drastic or extensive surgical
excision as a standard of treatment, the 5-year survival
Biopsy: To properly diagnose STS, a tissue sample
rate for those with localized STS tumors is just 55% to
should be conducted, ideally by a sarcoma surgeon.
70%. One of the primary difficulties in STS care is the
A core needle or Trucut needle biopsy is the quickest and
2688
Received: 16/09/2022
Accepted: 17/11/2022

Full Paper (vol.902 paper# 106)


c:\work\Jor\vol902_107 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 2695-2700

Role of Umbilical Cord C- Peptide Level in Early Detection of
Hypoglycemia in Infant of Diabetic Mother
Effat Hussein Assar1, Maha M. Taher Rachwan2, Ola Abd Elmonem Khalifa1, Marwa Elsayed Ahmed1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine ­ Benha University, Egypt
*Corresponding author: Ola Abd Elmonem Khalifa, Mobile: (+20) 01032701457, E-Mail: olakhalifa4568@gmail.com

ABSTRACT
Background:
Until date, diabetes during pregnancy has been linked to an increased risk of maternal, fetal, and
neonatal morbidity and mortality. Infants of diabetic mothers (IDM) frequently have difficulties related to fetal
hyperglycemia and hyperinsulinemia caused by maternal hyperglycemia. Because insulin breakdown is accelerated
in the presence of mild hemolysis, cord serum C-peptide levels are utilized as an indicator of fetal beta-cell function
rather than insulin levels. Objective: To study the relationship between umbilical cord C-peptide and risk of
hypoglycemia in infants of diabetic mothers.
Patients and Methods: This Cross-sectional study was conducted on 50 infants of diabetic mothers. Infants who
developed hypoglycemia in first 24-hour age were considered as cases and infants who did not develop
hypoglycemia during the first 24 hours were considered as controls in Neonatal Unit of Benha university hospitals
in cooperation with the Department of Obstetrics and Gynecology, during the period from January 2022 to July
2022. Result: The infants were divided into two groups: Hypoglycemia group (Cases group): included 31 infants
of diabetic mothers who developed hypoglycemia in first 24-hour age. normoglycemic group (Control group):
included 19 infants who did not develop hypoglycemia during the first 24 hours.
Conclusion: In this study, we discovered a substantial rise in UC C-peptide levels in hypoglycemic babies as
compared to the control group, indicating that C-peptide might be utilized as an early predictor of hypoglycemia in
IDMs.
Keywords:
Infant of diabetic mother, Hypoglycemia, Umbilical cord C peptide.


INTRODUCTION

Diabetes during pregnancy has previously been
Human C-peptide is a 31 amino acid chain that
linked to an increased risk of maternal, fetal, and
is released in an equimolar ratio with insulin by
neonatal morbidity and mortality (1). Infants of
pancreatic beta cells. Because insulin breakdown is
diabetic mothers (IDM) frequently have difficulties
accelerated in the presence of mild hemolysis, cord
related to fetal hyperglycemia and hyperinsulinemia
serum C-peptide levels are utilized as an indicator of
caused by maternal hyperglycemia (2).
fetal beta-cell function rather than insulin levels. The
Maternal hyperglycemia during the first
purpose of this study was to investigate the link
trimester might result in spontaneous miscarriages or
between umbilical cord C-peptide and the risk of
significant birth abnormalities such as truncus
hypoglycemia in diabetes mothers' newborns (4-8).
arteriosus
or
aortic
coarctation.
Maternal
Therefore, this research aimed to study the
hyperglycemia can produce fetal hyperglycemia and
relationship between umbilical cord C-peptide and
hyperinsulinemia in the second and third trimesters,
risk of hypoglycemia in infants of diabetic mothers.
resulting in post-natal neonatal hypoglycemia,
PATIENTS AND METHODS
hypocalcemia, polycythemia, hyperbilirubinemia,
This Cross-sectional study was conducted on
septal cardiac hypertrophy, delayed lung maturation,
50 infants of diabetic mothers who developed
and macrosomia. As a result, hyperinsulinemia is a
hypoglycemia in first 24-hour age were considered as
key factor in the development of numerous problems
cases and infants who did not develop hypoglycemia
in IDM (3).
during the first 24 hours whether admitted or not were
Maternal hyperglycemia during the first
considered as controls in Neonatal Unit of Benha
trimester might result in spontaneous miscarriages or
university hospitals in cooperation with the
significant birth abnormalities such as truncus
Department of Obstetrics and Gynecology, during the
arteriosus
or
aortic
coarctation.
Maternal
period from January 2022 to July 2022.
hyperglycemia can produce fetal hyperglycemia and
hyperinsulinemia in the second and third trimesters,
Inclusion criteria:
resulting in post-natal neonatal hypoglycemia,
Infants of diabetic mothers.
hypocalcemia, polycythemia, hyperbilirubinemia,
Both sexes were included.
septal cardiac hypertrophy, delayed lung maturation
Full term and preterm.
and macrosomia. As a result, hyperinsulinemia is a

key factor in the development of numerous problems
in IDM (3).
2695
Received: 30/09/2022
Accepted: 03/12/2022

Full Paper (vol.902 paper# 107)


c:\work\Jor\vol902_108 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 2701-2708

Bronchial Artery Embolization Procedure for Treatment of
Hemoptysis Caused by Cavitary Lung Lesions
Ahmed Mostafa Mohamed, Ahmed El Shimy, Norhan Abozeid Ahmed Abdelaziz,
Nourhan Mohammed Hossam El Din*
Department of Radiodiagnosis, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Nourhan Mohammed Hossam El Din, Mobile: (+20) 01152045672,
E-mail: nor_hossam23@yahoo.com

ABSTRACT

Background: Embolization of the bronchial artery is one of the non-surgical successful measures to treat hemoptysis
without surgery.
Aim of the Work: To evaluate the technique, efficacy, and safety of Bronchial Artery Embolization (BAE) in patients
with hemoptysis due to cavitary lung lesions.
Patients and Methods: This study was a reconstructive (retrospective and prospective) cohort study and included 20
candidates who presented with hemoptysis due to cavitary lung lesions and were refractory to the supportive treatment
measures during the period between March 2021 and September 2021. The study population was referred from the Chest
Department to Interventional Radiology Unit, at Ain Shams University Hospitals.
Results: Massive hemoptysis was seen in 15 patients and recurrent mild-moderate in 5 patients. On imaging, cavitary
lesions were seen on the left side in 8 patients, the right side in 8 patients, and bilateral involvement in 4 patients.
Bronchiectatic changes were the predominant pathology seen in 6 patients. Immediate success was achieved in 20
patients, while recurrence within one month was noted in 4 patients. 13 patients reported experiencing minor problems
like chest pain, but no serious ones like spinal cord ischemia.
Conclusion: When a patient has hemoptysis, BAE is a standard technique that is both safe and effective with a very
low complication rate.
Keywords: Computed Tomography; Hemoptysis; Bronchial artery embolization; Trans-arterial Embolization.

INTRODUCTION

Bleeding from the lower respiratory tract is
Urinary and genital bleeding as well as Hemoptysis.
known as hemoptysis. It can range in severity from a
TAE in general and BAE specifically are minimally
little spotting to a hemorrhage that poses a serious threat
invasive procedures that can be done under local
to life. Mild (50 mL/24 hr), moderate (50-300 mL/24
anesthesia in emergency outpatient. These procedures
hr), and severe (> 300 mL/24 hr) hemoptysis are the
are gaining wide acceptance in all guidelines being safe
three categories (1).
and effective treatment with highly successful both
The most significant causes of hemoptysis
technically and clinically with markedly fewer
related to bleeding from bronchial arteries are
complications compared with surgical treatment
bronchiectasis,
tuberculosis,
arteriovenous
options (1).
malformations, chronic bronchitis, malignancy,
Given its excellent early success rate and
cavitary lung lesions, and fungus infection. If the
relatively low risk to the often used alternative
etiology is unknown, cryptogenic hemoptysis is the
medicinal and surgical therapies, bronchial artery
diagnosis (2). Although bronchoscopy and computed
embolization has become a common treatment for
tomography (CT) is crucial for determining the source
severe hemoptysis (6).
and location of bleeding, the angiography approach is
The work aimed to evaluate the technique,
very crucial since it is both diagnostic and therapeutic
efficacy, and safety of bronchial artery embolization in
(3). Cavitary lung lesions, which can include lung
patients with hemoptysis due to cavitary lung lesions
abscesses, aspergillosis, and post-TB sequelae,
and referred to the Interventional Radiology Unit, Ain
accounted for 25% of instances of hemoptysis (4).
Shams University Hospitals.
Massive hemoptysis has been successfully

treated using bronchial artery embolization (BAE),
PATIENTS AND METHODS
which has been proven to be both safe and efficient. At
The current study was a reconstructive
the one-year follow-up, the recurrence rate after BAE
(retrospective and prospective) cohort study that
can reach 57.5%, particularly in some instances of
included 20 subjects suffering from hemoptysis as a
cavitary lesions. Cavitary lesions and aspergilloma are
complication of cavitary lung lesion and not responding
thought to have the highest recurrence rates (5).
to the routine medical supportive measures from March
Since the last decade of the twentieth century;
2021 to September 2021. The candidates were referred
Trans-arterial Embolization (TAE) has emerged as a
by the chest department to Interventional Radiology
very important treatment modality and a gold standard
Unit, at Ain Shams University Hospitals.
in the management of various kinds of bleeding all over

the body for example, Cerebral, Upper, and Lower GIT,

2701
Received: 25/09/2022
Accepted: 28/11/2022

Full Paper (vol.902 paper# 108)


c:\work\Jor\vol902_109 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 2709-2715

Estimation of Leptin and Estrogen Hormones in Obese Women with Arthritis
Maryam Abdul Hussein Jabbar, Zainab Khudair Hussein
Department of Biology, College of Science, Baghdad University, Iraq
*Corresponding author: Maryam Abdul Hussein Jabbar, Mobile: (+964) 783 011 9004,
Email: mariam.abdulhussain1202a@sc.uobaghdad.edu.iq

ABSTRACT

Background: Obesity is abnormal accumulation of fat in the body, which led to many health problems that will reduce the
life expectancy. Arthritis is joints inflammation that cause many of symptoms such as swelling, tenderness, pain and
stiffness of most joints. The arthritis is divided into many types, but the most common types are osteoarthritis and
rheumatoid arthritis the last type is the focus of our topic. Rheumatoid arthritis (RA) is an auto-immune, chronic
inflammation that can cause damage for joints and other body organs like skin, eyes, lungs, heart and blood vessels.
Objective: The study aimed to investigate the levels of leptin and estrogen hormones in obese women with arthritis. We
focused on rheumatoid arthritis especially.
Patients and Methods: The research included ninety women They were distributed into three groups, 30 obese women
with body mass index (BMI) more than 25 Kg/m2 for overweight and more than 30 Kg/m2 for obese, 30 obese women with
rheumatoid arthritis which have positive rheumatoid factor (RF) and 30 control women with normal weight and BMI <
25Kg/m2 and healthy from RA. BMI, WHR was calculated for all participants.
Result: The result of estrogen hormone showed highly significant difference (P0.01) in G1 (55.74 ± 9.23), G2 (55.35 ±
11.77) compared to G3 (129.85 ±16.69). While leptin hormone revealed no significant difference among G1 (2102.13
±78.03), G2 (2005.80 ±23.81) and G3 (1931.27 ±22.91).
Conclusion: We concluded that leptin levels did not differ among the three groups. Conversely estrogen levels showed
highly difference between the three groups.
Keywords: Obesity, Body mass index, Waist-hips ratio, Rheumatoid arthritis, Leptin, Estrogen hormones.


INTRODUCTION

Obesity is increase in body weight and amount of fat
between women and men by 15% and 11%, respectively)
body because of increasing in food and calories intake
(5).
with corresponding decrease in expenditure. This
There are many measurements used to identify and
accumulates calorie that lead to build up more adipose
classify obesity of these measurement is BMI, which are
tissue. In addition, less movement also increases body
called previously Quetelet index (6). The BMI equation
weight (1).
used to calculate the value of BMI, which is dividing the
Obesity is associated with many diseases including
weight in kilogram (Kg) on square of high in meter (m) (7).
cardiovascular disease (CVD), insulin resistance, type 2
Based on BMI values, obesity was classified to BMI<20
diabetes mellitus (DM), hypertension, dyslipidemia,
Kg/2underweight, BMI 20-24.9 Kg/2 normal weight,
coronary heart disease (CHD), gallbladder disease,
BMI (25-29.9) Kg/2 overweight, BMI (30-39.9 Kg/2)
obstructive sleep apnea, nonalcoholic fatty liver disease
obese and BMI40 severely obese (8). The other indicator
and some malignancies including endometrial, breast, and
or measurement of obesity is waist-hip ratio (WHR),
colon cancer according to guidelines of The American
which is calculated by dividing the narrowest point of
Heart Association and the American College of
waist on widest points around hips (9). WHR can predict
Cardiology (2).
the central obesity in adult and adolescent, which are
Obesity also have influence on fertility and It
related to metabolic disorders (insulin resistance and
interferes with the pregnancy process in women by
dyslipidemia) and increase the risk of cardiovascular
affecting spontaneous ovulation, interfering with the
disease. The values of WHR differ among gender, WHR
efficiency and outcomes of assisted reproductive
> 0.90 in men and > 0.85 in women (10).
technology (ART), and by worsening the physiological
Leptin is one of hormones that regulate the body
process and delivery in pregnancy (3). Obesity is one of the
weight and control of appetite and energy homeostasis so
causes that lead to polycystic ovary syndrome (PCOS) (4).
it has a significant role in obesity, it is secreted from
Obesity is a worldwide epidemic. In 2016, obesity
adipose tissue (11). The adipose tissue is considered as
rates increased 4 times what they were since 1975. In
endocrine organ and not fat storage only as was thought
2016, obesity rates reached about 1.9 billion in adults over
previously (12).
the age of 18, who were overweight, while the number of
Leptin sends the signal that is related to size and
people suffering from obesity is among these 650, and in
energy store in organism to brain (13), so it works on "brain
general, the obesity rate in 2016 was only 13% (distributed
gut axis" and thus it is transmitting the satiety signal to the
2709
Received: 03/09/2022
Accepted: 06/11/2022

Full Paper (vol.902 paper# 109)


c:\work\Jor\vol902_110 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90, Page 2716-2727

Clinical Characteristics, Risk Factors and Short-Term Outcomes of Severe Cases of
COVID-19: A Retrospective Analytic Single Center Study
Nawar Hilal Alwash 1, Jawad Ibrahim Rasheed2, Manal Khudder Abdulrazaq 3*
1 Department of Medicine, Baghdad Teaching Hospital, Arab Board Student,
Medical City Campus/ Bab-Al Muadham/ Baghdad, Iraq,
2 Consultant physician, University of Warith Al-Anbiyaa. Iraq,
3 Department of Medicine, College of Medicine, University of Baghdad, Medical City Campus/ Bab-Al Muadham/ Baghdad, Iraq
*Corresponding author: Manal Khudder Abdulrazaq, Email: manalkhudhur@comed.uobaghdad.edu.iq, Mobile number: 009647810742816

ABSTRACT
Background & objectives:
About 26% of hospitalised patients with COVID-19 have high mortality rates and up to
17% will require ventilatory support and critical care. We aimed to evaluate the clinical characteristics of patients with
severe COVID-19, short- term outcomes (discharge, ventilator free, mechanical ventilation, dead) & their predictive
values.
Methods: This retrospective analytic single center study included 80 hospitalized patients with severe COVID-19.
Clinical data, complications and outcomes including admission to an ICU, use of non-invasive ventilation, and death,
were analysed. The in-hospital complications were ARDS, pneumonia, hyperglycemia, shock, acute kidney injury.
Levels of D-dimer, ferritin and lactate were measured. ROC analysis was used & p- value 0.05 was considered
statistically significant.
Results:
The mean age was 53.45± 13.17years (range 18-77 years) and 46 (51%) were males. ARDS was the most
common complication followed by hyperglycemia. Out of 80 patients; 52(65%) patients used CPAP and 25(31.25%)
used non-invasive ventilator; 59 patients died with mortality rate (73.75%). There was a statistically significant
association between lymphocyte count, neutrophil count and neutrophil- lymphocyte ratio (NLR), D- dimer, S. Ferritin
and lactate with the development of ARDS. As predictors for mortality; the AUC for lactate, ferritin& D-dimer was
[(0.902, 95%CI= 0.830-0.973, p<0.001), (0.800, 95%CI= 0.678-0.923, p<0.001), (0.757, 95%CI= 0.637-0.877,
p=0.001)] respectively.
Conclusions: High levels of (S. Ferritin, D-dimer and NLR) are correlated with increased mortality in cases of severe
Covid-19, and that the development of ARDS was associated with neutrophil& lymphocyte count, S. Ferritin, D-dimer
and NLR.
Keywords: COVID-19; Complications; Outcomes; Severe.

INTRODUCTION

severe concomitant acute or chronic diseases.
About 26% of widely used biomarker for
Demographic, epidemiologic, clinical, laboratory
evaluating the prognosis of many health-related
findings, complications, imaging studies, treatment,
problems. Recently, a study showed that NLR is
complications, and outcomes, including admissions to
elevated in patients with severe COVID-19, and its
an intensive care unit (ICU), the use of non-invasive
performance in the prognosis of severe disease should
ventilation, and death, were analysed. The study was
be further evaluated (13). We aimed to evaluate the
retrospective in nature and therefore patient consent was
demographic, clinical, laboratory findings, treatment,
deemed not necessary.
the distribution of short-term outcomes (discharge,

ventilator free, mechanical ventilation, dead), the
Inclusion criteria
distribution of complications (ARDS, AKI, acute liver
Based on the Diagnosis and Treatment Scheme for
injury, and septic shock) and to study the predictive
SARS- CoV-2 of Chinese (The Seven Edition), severe
value of different variables in prediction of different
patients were diagnosed if one or more of following
complications and outcome.
criteria were met: Dyspnea with respiratory rate (RR)

30 times/min, resting finger oxygen saturation 93%,
PATIENTS & METHODS
and artery PaO2/FiO2 300 mm Hg (1 mm Hg = 0.133
Study design& sample
kPa). Regarding management, all patients received the
From October 1, 2020, to December 31, 2020;
same
treatment
according
to
the
[The
this retrospective analytic single center study included
WHO Therapeutics and COVID-19: living guidelinese
80 patients with confirmed COVID-19 pneumonia
First version, published in 2nd of September 2020] (14).
hospitalized at Al- Kindy hospital in Baghdad, Iraq.

Diagnosis was based on interim guidance provided by
Complications
the WHO (defined as a positive result on realtime
The primary outcome of this study was the
reversetranscriptase polymerasechainreaction assay
incidence of in-hospital complications, defined as
of nasal or pharyngeal swab specimens). Reasons for
organ-specific diagnoses occurring alone or in addition
admission were severe COVID19 patients with other
to any hallmarks of COVID-19 illness. All
2716
Received: 03/09/2022
Accepted: 06/11/2022

Full Paper (vol.902 paper# 110)


Effect of Heart Rate at Admission on Outcome of Patients Undergoing Primary Percutaneous Coronary Intervention The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2728-2733

Effects of Thioctic Acid on the Hyperinsulinemia and
Ovarian Volume in Female Patients with Polycystic Ovary Syndrome
Bassem Mohamed Hamed, Yousef Abo Elwan El-Sayed, Samar Said El-Ghazawy*, Ahmed Ismail Mohamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Samar Said El-Ghazawy, Mobile: (+20)1024441242, E-mail: ahmedseleim87@gmail.com

ABSTRACT
Background:
Many scientists believe that elevated insulin levels are the primary cause of polycystic ovarian syndrome
(PCOS). The hyperinsulinemia of obese women can be lowered by taking thioctic acid (Thioctacid-HR).
Objective: The aim of the current work was to evaluate the effect of thioctic acid (Thioctacid-HR) on hyperinsulinemia,
insulin resistance, menstrual function, and the volume of the ovaries in patients with PCOS.
Patients and methods: This comparative, interventional, prospective randomized clinical study included a total of 38
women with PCOS, attending at Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of
Medicine, Zagazig University Hospitals. Patients were randomly assigned into two equal sized groups of 19 subjects
each by closed envelop technique as follow: group I (Case group) received Thioctic acid for 3 months and group II
(Control Group) with no interventional treatment.
Results: Regarding fasting and post prandial insulin, there were no significant differences between 2 groups. Taking of
thioctic acid (Thioctacid-HR) for 6 months resulted in a significant decrease in the fasting and post prandial insulin after
treatment. Also, there was a significant decrease in HOMA-IR after treatment.
Conclusion: It could be concluded that thioctic acid has significant effect on PCOs clinically but no effect on
ultrasound findings. Also, it decreases insulin level after 6 months. Therefore, Thioctic acid could help in treatment of
PCOS.
Keywords: Thioctic acid, Polycystic ovary syndrome, Hyperinsulinemia.

INTRODUCTION

Many scientists believe that elevated insulin levels
When two or more of the following symptoms are
are the primary cause of polycystic ovarian syndrome
present, a clinical diagnosis of polycystic ovarian
(PCOS). Hyperinsulinemia in PCOS patients can be
syndrome can be made: persistent oligo-ovulation or
effectively treated with the insulin sensitizers
anovulation; excess androgen production; and
(biguanides, glitazones), which has led to menstrual
polycystic ovaries. Ovulatory infertility is the leading
cycle and fertility normalization in over half of patients
cause of infertility in developed countries, affecting
(4). Patients with polycystic ovarian syndrome and
between 5 and 10 percent of reproductive-age women.
hyperinsulinemia in addition to liver illness may benefit
Menstrual dysfunction and the androgen-related
from thioctic acid because of its long-standing
symptoms of hirsutism, acne, and hair loss are common
reputation as an efficient hepatoprotector (nonalcoholic
clinical presentations (1).
steatosis, cirrhosis, or cirrhosis). Patients with PCOS
Hyperandrogenism and chronic anovulation in
who were overweight and hyperinsulinemic on an oral
women without particular adrenal and pituitary gland
glucose tolerance test responded favorably to a
disorders characterize polycystic ovary syndrome, a
combination of alpha lipoic acid and MYO. Positive
diverse clinical condition. Some people may have a
effects were also seen in a subset of those who were
history of polycystic ovary syndrome in their families,
overweight and had a first-degree relative with diabetes
but the underlying cause of this condition is still
(5).
unknown. Menstrual irregularities, hirsutism, acne, and,
Reducing hyperinsulinemia using thioctic acid
less frequently, a male pattern of alopecia typically
helps obese men and women lose weight, enhance
emerge around the time of perimenarche. Metabolic
insulin sensitivity, and normalize their lipid and
disorders, such as obesity and insulin resistance with
carbohydrate metabolism (6).
hyperinsulinemia, have been linked to polycystic
Therefore, in this trial, we aimed to evaluate the
ovarian syndrome as well (2).
effect of thioctic acid (Thioctacid-HR) on
In addition to being the leading source of androgen
hyperinsulinemia, insulin resistance, menstrual function,
excess in females of reproductive age, polycystic ovary
and the volume of the ovaries in patients with PCOS.
syndrome (PCOS) is a prevalent endocrine condition

affecting this population. PCOS is characterized by a
PATIENTS & METHODS
wide range of symptoms, which makes diagnosis
This comparative, interventional, prospective
challenging and has led to definitional debates.
randomized clinical study included a total of 38 women
Polycystic ovary syndrome (PCOS) is a syndrome
with PCOS, attending at Gynecologic Oncology Unit,
characterized by amenorrhea, hirsutism, and polycystic
Department of Obstetrics and Gynecology, Faculty of
ovaries, and it was first described in a 1935 paper by
Medicine, Zagazig University Hospitals.
Stein and Leventhal (3).

2728
Received: 03/10/2022
Accepted: 06/12/2022

Full Paper (vol.902 paper# 111)


auth3in.doc The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90(2), Page 2734-2741

The Effect of a Program Using Auxiliary Tools to Improve
The Long Passing Skill of Football Juniors
Hayder Talib Faisal 1, * , Nawres Ahmed Abd Zaid1
1AL-Esraa University College / Department of Physical Education and Sport Science, Iraq
*Corresponding author: Hayder Talib Faisal , Email: haider.t@esraa.edu.iq mobile: +9647804657396

ABSTRACT
Background:
Football was one of the first games to become widely played around the world, and as it developed
quickly, the need to enhance skillful performance arose Aim: The study was conducted to designing auxiliary training
tools that develop the long passing skill of football juniors, designing a training program using the proposed training
tools to develop the long-passing skills of football juniors, and identifying the effect of a training program using the
suggested training tools in developing the emerging long passing skills in football.
Methods: two groups the control and experimental groups using the pre and post measurement system. The research
community consists of football players under (17) years old in Iraq, numbering (100) players and the research sample
includes the players of the National Center for the Nurturing of Athletic Talent in football under (17) years in the
Republic of Iraq / Baghdad Governorate, whose number is (20) players representing the National Center for the
Nurturing of Athletic Talent in football in (Al-Shaab Stadium), and they were chosen in a random method, and they
were divided Players by lottery.
Results
: The experimental program using the auxiliary tools applied to the sample had a positive effect on the research
sample in improving the long scrolling skill.
Conclusion: Need to use auxiliary tools in training programs for juniors because of their positive improving impact.
Keywords:
long passing, football, program using auxiliary tools

INTRODUCTION


The goal of sports training is to increase
process and focus on other aspects of training such as
performance levels in all sports-related games and
the tactical aspects and adaptations for the practiced
activities, whether they be competitive or recreational.
activity, building and developing the elements of
Improvements in levels across different sports have
physical fitness and others to reach the higher levels (2).
been made possible by the use of organized,

The stage of preparing young people is one
standardized training programs built on scientific
of the important stages in the career of the athlete and
principles. These programs have helped individual
preparing him properly by providing him with the
athletes compete at the highest levels possible in
skills, experience and knowledge related to the
sporting competitions. Unlocking athletes' potential to
practiced activity as well as developing the elements of
perform at the greatest levels and achieve sporting
general and specific physical fitness and the necessary
success through sports training is one of the branches
psychological preparation.
of training that is concerned with enhancing and
So, the person in charge of the training process
developing performance(1).
must be sufficiently aware of the characteristics of this

Football was one of the first games to
age stage. That is, the process of developing the athlete
become widely played around the world, and as it
is greatly affected by biological development as well as
developed quickly, the need to enhance skillful
his ability to adapt as a result of the training process,
performance arose. As a result, conducting applied
since the athlete at this age stage is in the stage of
scientific research in the area has become absolutely
growth of the functional systems and the kinetic system
necessary for football players to perform automatically
(skeletal-muscular). So any mistake or negligence in
and expertly under any match circumstances. Football,
training can lead to problems or injuries that may have
with the intention of furthering this field, and the
undesirable consequences in the future.
younger age groups serve as the firm framework upon
Therefore, it must be taken into account that the
which to construct a more advanced level of football in
size of the training load is commensurate with the
the future.
athlete to ensure progress at the level at the ideal speed
"The training of young people aims to prepare and
and rationing the training load in the early stages of
prepare the young person to reach the higher levels
training with an increase in the training volume and
appropriate to the characteristics of his age stage, his
with moderate intensity, in order to suit the age stage
individual characteristics, the possibility of his
that they are going through. Taking into account not
biological development, his ability to adapt to the
spacing the units training during one week to avoid
requirements of the higher levels, and to build a solid
losing the adaptations that occurred during the previous
base for those levels." And the development of kinetic
training units Between (3-6) training units per week.
capabilities and capabilities so that the player has a

The use of auxiliary training tools is one of
large kinetic and skill base that will be a kinetic balance
the crucial and essential steps in developing and
through which the youth can continue the training
preparing players because they speed up the process of
2734
Received: 01/10/2022
Accepted: 04/12/2022

Full Paper (vol.902 paper# 112)


c:\work\Jor\vol902_113 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90(2), Page 2742-2747


Training of Skilled Force with The Different Medical Ball and Their Effect on
Developing Some Special Physical Abilities and the Accuracy of
Long Shooting Performance in Handball
Nawras Ahmed Abdel Zaid * , Nahla Sobeih Obeid ,Yasser Ahmed Mohammed
Faculty of Al-Esraa University - Department of Physical Education and Sports Sciences
*Corresponding author: Nawras Ahmed Abdel Zaid, Email: nawras-sport@esraa.edu.iq mobile: +9647805667354

ABSTRACT
Background: The basic skills of handball are the cornerstone of the application and success of offensive and defensive
plans as well as upgrading the world's capabilities and this requires emphasizing the development of strength in the
muscle groups operating during the performance of skills.
Methods
: The researchers applied MAHA training by using rubber balls for weights and various sizes to eliminate the
use of the legal ball during the skill test to entertain the resistances on all the muscles working and within the duty of
each muscle.
Result: on a group of players of the Center for Sports Talent for Handball under the Ministry of Youth and Sports in
Baghdad, and the researchers conducted a precision test for the skill of shooting Remote jumping and special physical
tests, and carried out (24) special training units for eight weeks by three training units per week.
Conclusion: the researchers reached several conclusions the most important of which was the development of the
capabilities of instant and rapid force, speed of performance and arm speed, which is a special physical capability for
shooting skill and improve the accuracy of the performance of the remote shooting of the search sample.
Keywords: Accuracy. Muscle strength. Special physical abilities. Rubber balls.

INTRODUCTION

of the defender, who is back in a state of jumping with

The basic skills of handball are the cornerstone
him. However, the strength and height of the player's
of the application and success of offensive and
jump depends on the defender in terms of his height,
defensive plans besides upgrading physical abilities,
height of jump and how he reacts towards him and after
which are the basis for success and winning the game.
the goal as well as his privilege with the strength of good
And the need requires the development of strength in
muscles of the cast arm in order to achieve its highest
the muscle groups working during the performance of
speed during the performance of the shot and at the
skills in order to increase their efficiency and level of
highest accuracy (3). Accuracy is an important element
mobilization to develop skilled performance. So the
of the success of the performance of basic skills in
importance of research using rubber special size of
handball and requires high efficiency, as it has an
handball with different weights when applying skilled
effective role in successful shooting, and accuracy
performance in order to increase the build-up of motor
means "the possibility of directing the will full
units (muscle fibers) and increase their effectiveness,
movement towards a target that is determined, and
strength and impact on skilled performance. As well as
requires high efficiency of the muscular and nervous
the use of training with a regular handball, to show the
organs. Nerve signals to muscles from the nervous
impact of these exercises in mastering performance and
system are also required to be well-directed, whether
accuracy of one of the basic skills, which is remote
directed at working muscles or corresponding muscles,
shooting by handball (1).
so that the movement in the desired direction leads to
The development of the work of these muscles
the accuracy necessary to injure the target" (4).
must be in accordance with their motor duty and with
In addition, the study of special physical
the resistances of the semi-instrument (handball) used
abilities and the identification of their levels when
during the skill performance to increase their self-
applying performance contributes to the identification
cutting for difficult the movement for the purpose of
and improvement of the reality of the application of
increasing the strengthening of the muscle fiber and
performance by accessing specific information" (5).
increasing the mobility of the performance and
This requires harnessing appropriate training methods
increasing its effectiveness and strength in influencing
related to the development of muscular work such as
the mastery of performance and accuracy, especially for
training using multiple resistances, to achieve the best
the skill of long-range shooting. It is important during
level of performance while improving the physical
training to focus on basic skills passing, receiving,
abilities of especially as "the great development in
scoring, etc., and in different directions and according
sports achievements cannot be attributed to the
to each player's physical abilities, position in play and
development of speed and strength used in this or that
duties (2).
event, but the result of the study of the movement is a

This skill depends mainly on the strength of the
thorough scientific study according to its time and place
muscles of the arms in particular as well as the muscles
as well as the forces causing the occurrence of this
of the legs to perform a vertical jump for the player who
movement" (6).
is injured and how focused and capable he is in the face
2742
Received: 01/10/2022
Accepted: 04/12/2022

Full Paper (vol.902 paper# 113)


c:\work\Jor\vol902_114 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90(2), Page 2748-2752

The Essential Role of Alpha Lipoic Acid on the Cardiovasculer System in
Rabbits Subjected to Methandienone Adimnstration
Mohammed H. Asker
Medical Laboratory Technique Department, Al-Rasheed University College, Iraq
Corresponding author: Mohammed H. Asker, Mobile: 096407706297549,
Email: Dr.mohammed_haider@aleasheedcol.edu.iq

ABSTRACT
Introduction:
Chemically, lipoic acid (LA) is (R)-5-(1,2-dithiolan-3-yl)pentanoic acid, and it is a naturally occurring
substance (1-3). Lipoic acid has an amphipathic feature and is primarily a lipophilic molecule.
Objective: The aim of the current study was to examine the preventive effects of ALA on certain biological cardiac
markers and histology of heart and aorta in rabbits.
Subjects and methods: A total of 20 rabbits were divided into four groups: Rabbits in Group 1 (G1) were given distilled
water. The rabbits in Group 2 (G2) were given alpha lipoic acid orally. Group 3 (G3) rabbits received Methandienone.
Group 4 (G4) rabbits received Methandienone (0.35mg/kg.B.wt) and alpha lipoic acid (10Mg/kg B.wt) orally. Results:
The results reveal that supplemented groups (G2 and G4) show a significant decrease in CPK, CRP and troponin serum
level. Moreover, there is an increase in heart index (0.45% and 0.41%) as compared with none supplemented groups
(0.43% and 0.35%) respectively. The histological sections of the heart from the supplemented groups show no clear
lesions with normal spindle shape cardiac muscle and intercalated disc with normal aorta and epithelial cells. On the
other hand, there was clear necrosis of cardiac muscle fibers with fatty dispassion, irregular myocardial endothelial
degeneration and congested blood vessels. The aorta of these groups has enlargement and thickening of endothelial cells
with infiltration of fatty cells in tunica intima.
Conclusions: ALA has a protection on cardiovascular system.
Keywords: Methandienone, Alpha lipoic acid, cardiovascular system, Experimental study, Al-Rasheed University
College.

INTRODUCTION

Chemically, lipoic acid (LA) is (R)-5-(1,2-
known as dianabol on the marketplace, is distinguished
dithiolan-3-yl)pentanoic acid, and it is a naturally
by the addition of an alkyl group to its 17 carbon atoms
occurring substance (1,2).
(7). AASs are more commonly used to grow muscle bulk
Due to the carboxylic acid group connected to the
and maintain a state of intense exercise than for the
ring structure, lipoic acid has an amphipathic feature
euphoria they cause.
and is primarily a lipophilic molecule. Human organs
Additionally, androgenic steroids alter the release
with substantial metabolic activity, such as the liver,
of stress hormone and endorphins, as well as the
heart, and kidney, which have high quantities of this
hypothalamic-pituitary-adrenal (HPA) axis, which may
acid, produce LA. Both the cytosol and cellular
enhance the reinforcing effects of exercise (2).
membranes contain a lot of LA. LA may pass the blood-
After being exposed to stressful situations, the
brain barrier, is quickly absorbed from the digestive
adrenal axis becomes activated, triggering a cascade (3)
tract, and has no negative side effects (3).
of hormonal secretions that alter bodily functions and
Due to the asymmetric carbon atom in LA, there
behavior in order to preserve homeostasis (4After
are two potential optical isomers (R and S). Only the R-
experiencing
stress,
the
pituitary
gland's
isomer is produced endogenously. LA has two thiol
proopiomelanocortin (POMC) gene is expressed more,
groups that can be reduced or oxidized (DHLA)
which stimulates the release of corticotropin releasing
included LA and DHLA (4).
hormone (CRH), which in turn boosts the production of
The purpose of the current study was to determine
peptides such beta endorphin and adrenocorticotropic
how oral supplementation with ALA affected certain
hormone (ACTH) (8).
cardiovascular system-related parameters. Because LA
The stress response is then triggered by ACTH
stimulates the nuclear factor and peroxisome
activating the adrenal gland, which is followed, at least
proliferator-activated receptors (PPAR) activation
in part, by beta endorphin blocking CRH release (9). A
cascade and has implications for the regulation of
chemical with morphine-like effects called beta
carbohydrate and lipid metabolism (5,6), it was chosen as
endorphin is released by the pituitary and
a potential target for future research.
hypothalamus. In response to pain, intense activity, and
Synthetic testosterone derivatives, or AASs, are
despair, it is released in large amounts (4).
anabolic androgenic steroids. It has been used for years
The aim of the current study was to examine the
to treat osteoporosis, severe anemia, burns, short
preventive effects of ALA on certain biological cardiac
stature, and other conditions (1). The third class of AAS
markers and histology of heart and aorta in rabbits.
employed in the recent work, methandienone, also



2748
Received:10/10/2022
Accepted:15/12/2022

Full Paper (vol.902 paper# 114)


Effect of Heart Rate at Admission on Outcome of Patients Undergoing Primary Percutaneous Coronary Intervention The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90(2), Page 2753-2757

Role of Oral Antibiotic for Bowel Preparation before
Gynecologic Oncology Surgery
Mahmoud Abubakr Negm, Ashraf Mohamed Nasr,
Nada Saad Abdelgelel Salem*, Mohammed Ahmed Wasfy
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Nada Saad Abdelgelel Salem, Mobile: (+20) 01024558634, E-mail: nada90.saad@gmail.com

ABSTRACT
Background:
When used prior to a bowel injury, oral antibiotic bowel preparation (OABP) reduces intraluminal
bacteria l load and, thus, the risk of surgical site infection (SSI). Objective: The aim of the current study was to
investigate the role of preoperative oral antibiotic in gynecological oncology surgery in field visualization, reducing
postoperative ileus and surgical site infection.
Patients and methods: A cohort study was conducted on a total of 130 women who underwent tumor debulking surgery
for gynecological cancer (ovarian, uterine, cervical or endometrial). On the day before surgery, patients received peri-
operative prophylactic oral antibiotics, and on the day of surgery, all patients were subjected to intravenous
cephalosporin. Results: Preoperative oral antibiotic was associated with SSI incidence of 15.4%; 20 cases with surgical
site infection (SSI) and 110 cases without SSI. Also favorable surgical field (reported as good or sufficient) was reported
in 92.4% of cases. Return of intestinal function was early with mean duration of 19 hours.
Conclusion:
Preoperative oral antibiotic was associated with low incidence of SSI. Favorable operating field and early
return of Bowel function.
Keywords:
Oral Antibiotic, Bowel Preparation, Gynecologic Oncology Surgery, Cohort study, Zagazig University.

INTRODUCTION

oncology surgery in field visualization, reducing
In the fields of gastrointestinal and gynaecological
postoperative ileus and surgical site infection.
oncology, mechanical bowel preparation (MBP) has

traditionally been recommended prior to surgery for
PATIENTS AND METHODS
patients at risk of colon or rectal perforation due to
A cohort study was conducted at Gynecologic
significant adhesion over the pelvis or for patients with
Oncology
Unit,
Obstetrics
and
Gynecology
advanced stages of ovarian, uterine, or cervical
Department, Faculty of Medicine, Zagazig University.
carcinoma (1).
The study included of 130 women who underwent
The term "bowel preparation" (BP) is commonly
tumor debulking surgery for gynecological cancer
used to describe the process of removing stool and other
(ovarian, uterine, cervical or endometrial) were
bowel contents using a series of oral or rectal
enrolled.
mechanical methods prior to surgery. Preoperative

bowel preparation has been used routinely for over 70
Inclusion criteria: Any women who underwent tumor
years, although its usage is still largely guided by
debulking surgery for gynecological cancer (ovarian,
opinion rather than evidence (3).
uterine, cervical or endometrial): (1) Age: any age
The goals of the bowel preparation are better
group. (2) BMI: 18.5 to 40 kg/m2. (3) Healthy non
vision of the surgical field, simpler bowel packing, and
anemic women.
less pollution of the peritoneal cavity and surgical site
Exclusion criteria: Women with allergic sensitivity for
in the event of bowel entrance (4).
antibiotics used in the study.
Liu et al. (5) argued that anastomotic leakage and

infection risks would be the same with or without
Study interventions and procedures:
preoperative Mechanical bowel preparation (MBP), and
1. According to inclusion and exclusion criteria;
indicated that MBP might be skipped. Very few studies
patients were subjected to:
have looked at whether or not MBP is necessary for
a) Complete history taking of clinical importance
individuals following gynecological cancer surgery
including:
with concurrent colon or rectal resection.
Personal history: age, residence, occupation, marital
In recent decades, a new subset of BP known as
status and special habits as smoking, alcohol, etc.
oral antibiotic bowel preparation (OABP) has arisen to
Present history: of current complain (onset, coarse,
meet the demand for further minimizing postoperative
duration, previous workups).
morbidities and mortality among patients; This is
Menstrual history: day of last menstrual period and
because the incidence of SSI following intestinal
regularity.
damage have gone down as the intraluminal bacterial
Obstetric history: gravidity, parity, previous
burden has decreased (6).
miscarriages or obstetric complications.
The aim of the current study was to investigate the role
Contraceptive history: type, duration of use before
of preoperative oral antibiotic in gynecological
pregnancy.
2753
Received: 22/09/2022
Accepted: 23/11/2022

Full Paper (vol.902 paper# 115)


c:\work\Jor\vol902_116 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2758-2762

Acute Kidney Injury at ICU: Review Article
Abdelrahman Hassan Abdelrahman, Khalid Mohamed Hassan,
Islam Mokhtar Ahmed, Samar Thabet Abu Bakre, Al Shaymaa Mahmoud Ahmed,
Omima Emad Eldin Mohammed, Waleed Adel Ahmed*
Department of Anaesthesia, ICU and Pain Management, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Waleed Adel Ahmed, Mobile: (+20) 01006392210, E-Mail: Waleed.salama@med.sohag.edu.eg

ABSTRACT
Background:
Acute kidney injury is a frequent consequence among intensive care unit cases with severe illness (ICU).
It is currently considered that the incidence of acute kidney injury is substantially higher than previously anticipated,
with over fifty percent of ICU cases having acute kidney injury at some stage during critical illness. More than fifty
percent of ICU cases with acute kidney injury and multiorgan failure are reported to die. Those requiring renal
replacement treatment (RRT) have a mortality rate of up to 80 percent. Acute kidney injury is defined by an abrupt,
hours-to-days-long decline in kidney function, leading in the buildup of waste products.
Objective: This review article aimed to assess and examine Cases in ICU with acute kidney injury.
Methods: A comprehensive search was conducted in PubMed, Google Scholar, and Science Direct for information on
acute kidney injury, ICU, Kidney, Liver function and RRT. 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.
Conclusion: Acute kidney injury is responsible for poor outcome in hospitalised cases. In critical cases, the underlying
cause of acute kidney injury is renal hypoperfusion during shock episodes. Therefore, prevention is the most effective
therapy.
Keywords: Acute kidney injury, ICU, Kidney, Liver function, RRT.

INTRODUCTION
or total blockage to UOP, resulting in glomerular,
Acute kidney injury is now recognized as a serious
interstitial,
tubule,
or
vascular
malfunction.
health issue affecting many people from all over the
Hemodynamically induced pre-renal dysfunction and
world and resulting in lower survival and can progress
acute tubule necrosis (ATN) owing to ischemia-
to CKD. It is frequently encountered alongside other
reperfusion damage, toxic exposure, or infection are the
acute diseases and is prevalent among severely unwell
most prevalent causes of acute kidney injury in
individuals. Acute kidney injury also plays a significant
critically sick cases (3).
role, since it is substantially related with increased

expenditures of care, worse outcomes, and reduced
Epidemiology
QOL following release from hospital. Impact and
Acute renal damage varies by population type and
prognosis of acute kidney injury varies substantially
characteristics. Utilizing the existing 0.3 mg/ml change
based on severity, clinical context, concomitant
in SCr cutoff, available data indicates that the incidence
variables, and geographic location (1).
of acute renal damage in hospitalised patients varies
Acute kidney injury is prevalent in the ICU, and its
from three to fifty percent and from 10 to 70 percent in
frequency is rising. The reported mortality of Cases in
the ICU. A 2013 meta-analysis of the incidence of acute
ICU with acute kidney injury differs between research
renal injury according to the kidney enhancing global
based on the criteria of diagnosis and the patient
outcomes stage system with a total of 3,585,911 persons
population investigated. In the majority of studies, death
indicated occurrence in 23 percent of all hospitalised
rises proportionally with the severity of renal damage.
cases (1).
Cases that require renal replacement therapy (RRT)
Numerous cohort studies have been conducted on
have a fifty to seventy percent death rate. Although
critically sick cases to determine the prevalence of acute
acute kidney injury necessitating RRT in the ICU is a
kidney injury in the ICU. According to conclusive
well-known independent risk factor for in-hospital
statistics, the prevalence is as high as 70% in some
mortality, even minor increases in serum creatinine
groups. Cases with ICU-related acute kidney injury are
(SCr) are linked with an increased risk of death (2).
younger, mostly males, and more likely than those with
Acute kidney injury is characterised by quick
isolated acute kidney injury to have acute kidney injury
reduction in glomerular filtration rate (GFR), which
coupled with multisystem organ failure. Sepsis is the
results in accumulation of metabolites from metabolism
most significant acknowledged risk factor for acute
and fluid, electrolytes, and acid-base disturbance. A
kidney injury in the ICU. Other significant risk factors
diverse syndrome characterised by hemodynamic
include a history of DM, HTN, or CKD, concurrent use
abnormalities that disrupt normal renal perfusion and
of vasopressors, and mechanical ventilation. The rates
reduce GFR without injury to the parenchyma, partial
of RRT and mortality due to acute kidney injury are
2758
Received: 05/09/2022
Accepted: 08/11/2022

Full Paper (vol.902 paper# 116)


c:\work\Jor\vol902_117 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2762-2766

Predictive Value of New Sequential Organ Failure Assessment (SOFA)
Score of Mortality in Critically Ill Patients in Emergency Department in
Suez Canal University Hospital
Bassant Sayed Moussa*, Yasmin El Sayed Mohamed El Beltagy, Safaa Tharwat Taha
Emergency Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
*Corresponding author: Bassant S. Moussa, Mobile: (+20)01227062927,
E-mail: bassant_sayed@med.suez.edu.eg, ORCID: 0000-0002-4413-0355
ABSTRACT
Background:
One of the scoring methods used to assess organ failure is the Sequential Organ Failure Assessment
(SOFA) score, which can forecast the severity and course of the illness. It is currently utilised as a crucial indicator for
determining if a patient has sepsis syndrome. Objective: This study aimed to assess the prognostic predictive
performance of a new indicator, SOFAComb calculated by SOFA + absolute SOFA score in critically ill patients in
the Emergency Department at Suez Canal University Hospital. Patients and Methods: This was a descriptive cross-
sectional study conducted on 124 patients aged 18 years and above who attended the Emergency Department (ED) at
Suez Canal University Hospital, Ismailia, Egypt diagnosed with sepsis. Results: The patients' ages varied from 86 to
104 years, with a mean age of 62.6 years. Male participants made up 46% of the study and female participants made up
54%. In terms of predicting mortality in sepsis patients, the SOFAComb outperformed SOFA in terms of sensitivity,
specificity, and positive predictive value (PPV). While SOFA outperformed both in terms of PPV and specificity.
Conclusion: The SOFAComb presented a good predictive tool for patient outcome.
Keywords: Sepsis, SOFA, SOFA, SOFAComb.

INTRODUCTION
analysis; the objective of this study is to conduct a
One of the grading methods used to evaluate
prospective study to corroborate the findings.
organ failure is the Sequential Organ Failure
The study's objectives are to demonstrate the
Assessment (SOFA) score, which can forecast the
clinical picture and demographic data of critically ill
course and severity of the illness (1,2). The recognition of
patients and to assess prognostic factors (like
sepsis syndrome on a distinct patient level now uses it
comorbidities) that affected morbidity and mortality
as a crucial premise (3). Organ dysfunction scores are
rate of critically ill patients. Hypothesis: SOFAComb
being used more frequently to evaluate the efficacy of
is a high predictive value than SOFA and absolute
novel therapy medications in phase II trials after being
SOFA score for predicting mortality in critically ill
adopted as an endpoint in exploratory studies for sepsis
patients in the emergency departments.
by the European Medicines Agency (EMA) and others
(4)
PATIENTS AND METHODS
. Despite certain jargon differences, the SOFA score
This was a descriptive cross-sectional study
has proved useful in a variety of applications. Several
conducted on 124 patients aged 18 years and above who
words are often used and connected to the meanings
attended the Emergency Department (ED) at Suez
given below (5):
Canal University Hospital, Ismailia, Egypt including
Admission SOFA: Based on the highest value for
patients that were critically ill and had severe
each subscore in the 24 hours before to entrance to the
respiratory,
cardiovascular,
or
neurological
ICU, the admission SOFA score is determined.
derangement, or combination: Respiratory failure type
Daily Extreme SOFA Score: Calculated for each
1 or type 2, hypotension or heart failure, disturbed level
24-hour assessment, the daily extreme SOFA score is
of consciousness, of both sexes. The SOFA score was
similar to the daily SOFA score; the SOFA score should
determined on Day 1 (baseline), Day 2, Day 4, Day 7,
be assessed using the maximum value of each subscore
and consisted of six components: respiratory,
for that time period. Maximum SOFA score: During the
coagulation, hepatic, circulatory, nervous system, and
course of the research, the maximum SOFA score is the
renal scores. On day 28, the results for the patients were
greatest daily SOFA score.
also noted.
Delta SOFA score: The delta SOFA is the
difference between the beginning point value and the
Ethical approval:
total SOFA score (or that of a different subscore). The
All data of the patients included in this study
SOFA for admission or a certain study day might serve
had been collected after having informed written
as the beginning point value. Mean SOFA: Based on the
consent from the patients or patients' first-degree
sum of the SOFA scores for each research day, the mean
relatives. After receiving approval from the Ethics
SOFA score is computed for a single patient throughout
Council of the Faculty of Medicine at Suez Canal
the course of a specified study period (4).
University, the researcher collected data on a pre-
A new indication, SOFAComb derived by
organized data sheet. The conduct of this study
SOFA + absolute SOFA score, was seen in a recent
adhered to the Declaration of Helsinki for Humans,
research based on this idea (6). However, there were
the international medical association's rule of ethics.
restrictions because the data was a retrospective
2762
Received: 03/10/2022
Accepted: 06/12/2022

Full Paper (vol.902 paper# 117)


c:\work\Jor\vol902_118 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2767-2774
Long-term Follow-up of Chronic Hepatitis C Patients Treated by
Direct- Acting Antivirals
Ahmed Tawheed1, Mohamed El-Kassas1, Amr El-Fouly1, Gamal Esmat2
1 Endemic Medicine Department, Helwan University, 2 Endemic Medicine Department, Cairo University
Corresponding author: Ahmed Tawheed Mowafy, Mobile no.: +201140009080
Helwan University, Ain Helwan, Cairo, Egypt, Email: Ahmed.tawhid@med.helwan.edu.eg

ABSTRACT
Background:
Hepatitis C virus HCV infection is one of the main causes of chronic liver disease worldwide, Egypt has the
highest national-level HCV prevalence in the world, and direct Acting Antivirals are widely used to treat HCV infection in
Egypt. Aim: To perform a long-term follow-up of patients with chronic hepatitis C who received IFN free regimen of direct-
acting antivirals (DAAs). The follow-up aimed to study the incidence of hepatocellular carcinoma, viral recurrence in this
cohort of patients and improvement of liver biochemicals or liver decompensation.
Methodology: We recruited 1041 Egyptian HCV patients, who finished treatment more than 1 year before recruitment and
then we assessed the improvement of the biochemical profile and the liver condition, incidence of occurrence or recurrence
hepatocellular carcinoma after treatment.
Results: The follow-up values of ALT, AST, INR, Bilirubin, Platelets and fibrosis-4 (Fib-4) showed a statistically
significant improvement more than 1 year after treatment, while the improvement in albumin and AFP was noted without
statistical significancy. By comparing the different groups of the study, patients with advanced liver disease showed a greater
improvement in those parameters. However, they carried an increased risk of developing hepatocellular carcinoma.
Conclusion: Achieving SVR using DAAs can improve liver functions tests, AFP, platelet count and FIB-4 value and
persons with severe liver disease should be advised to undergo HCC surveillance after achieving sustained virological
response (SVR).
Keywords: HCV, DAAs, Long-term, Hepatitis C virus.

INTRODUCTION

Infection with the hepatitis C virus (HCV) is a
There is still disagreement on how to handle
major contributor to chronic liver disease worldwide.
people with decompensated cirrhosis.
Hepatocellular carcinoma (HCC) and minor histologic
Cheung and colleagues (7) discovered advantages
alterations to cirrhosis are possible long-term effects of
of utilizing DAAs to treat individuals with Child-Pugh C
HCV infection. The proportion of persons aged 15 to 59
cirrhosis. They asserted that viral eradication may
who tested positive for HCV RNA represent 7% of the
enhance liver function. The risk of a late relapse is
Egyptian population, making Egypt the country with the
extremely rare, according to Simmons and colleagues (8)'
greatest national incidence of HCV in the whole globe (1).
systematic review and meta-analysis. Additionally, DAAs
An important health problem and financial
have demonstrated real and substantial impacts on all
burden is the morbidity of HCV in untreated individuals
health risks associated with HCV, with proof coming
with cirrhosis of the liver, liver cell failure, and
from the regression of liver fibrosis, which is thought to
hepatocellular cancer (2).
be the endpoint of chronic liver disease and its aftereffects
Recent developments in pharmacological
(9). It was anticipated that as time went on, more
research have led to the emergence of several direct
significant fibrosis-related changes would manifest. On
antiviral medicines (DAAs) with high levels of SVR and
the other hand, DAAs have proven to be quite accurate in
dramatically better side-effect patterns (3).
the early diagnosis of dynamic fibrosis regression changes
Beginning in November 2015, a new SOF and
(10).
daclatasvir (DAC) combination, with or without RBV,
Cardoso and colleagues (11) reported a
was added to the treatment regimens. This new
significant post-DAA incidence of HCC among SVR
formulation became the primary form of therapy in the the
patients in a letter to the editor in 2016 with a proportion
national program, due to a cost saving of more than 80%
of 7.41%. Additional studies showed that the
of the reduced cost of the brand medications that were
reappearance of HCC following DAA therapy was more
being used in the program (4,5,6).
aggressive than it was before to the treatment (12).







2767
Received: 04/09/2022
Accepted: 07/11/2022


Full Paper (vol.902 paper# 118)


c:\work\Jor\vol902_119 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90(2), Page 2775-2783

Cost-Effectiveness Analysis of Ceftazidime/Avibactam Versus Polymyxin E in The
Treatment of Carbapenem-Resistant Enterobacteriaceae Infections: Literature Review
Ahmad Fasseeh1, Amany A. Salem*1, 2, Ahmed M. Rasmy3, Hanaa El Gendy4,
Laszlo Szilberhorn5, Tarek Barakat6, Mahmoud Radwan6. and Balaz Nagy5
1Syreon Middle East (SME), Alexandria, Egypt, 2Cairo University, Cairo, Egypt,
3Alexandria University, Alexandria, Egypt, 4Ain Shams University, Cairo, Egypt,
5Syreon Research institute (SRI), Budapest, Hungary, 6Pfizer Egypt, Cairo, Egypt
*Corresponding author: Amany A. Salem, email: amany.ahmed@kasralainy.edu.eg,mobile:+201001606449

ABSTRACT
Background:
Antibiotic resistance is a global issue that is rapidly spreading. The emergence of multi-drug resistant
strains has been attributed to the overuse or misuse of antibiotics. Despite the lack of national data, the prevalence of
multidrug resistant (MDR) bacteria in Egypt is comparable to or even higher than the global average. The US CDC
defines carbapenem-resistant Enterobacteriaceae (CRE) as enterobacteria non-susceptible to any carbapenem
or documented to produce a carbapenemase. Ceftazidime/Avibactam (CAZ/AVI) is a novel -lactam and non--
lactamase inhibitor with a distinct mechanism of action. The use of CAZ/AVI, compared with other sequential antibiotics
including Colistin results in reduced mortality and less hospitalization time.
Objective: The study aimed to compare the cost-effectiveness of Ceftazidime/Avibactam (CAZ/AVI) to Polymyxin E
in treating carbapenem-resistant Enterobacteriaceae (CRE) infections in hospitalized adult patients in Egypt from the
public payer perspective.
Method: We used PubMed database for the search and only English-language papers were considered, with no
restriction on publication date. Two independent reviewers performed the title and abstract screening, and a third
principal reviewer resolved conflicts. All article titles and abstracts were initially screened using predefined exclusion
criteria, such as no English abstract, no economic evaluation of an antibacterial agent, prevention strategies and non-
transparent reporting of methodology. Based on the findings of the literature review, a decision tree model linked to a
survival Markov model was developed to compare CAZ/AVI and Polymyxin E in hospitalized adult patients. The
effectiveness measures were quality-adjusted life years (QALYs) and life years (Lys). From the public payer's
perspective, costs in Egyptian health care settings were estimated. Deterministic and probabilistic sensitivity analyses
were used to evaluate the model's robustness.
Results: The discounted incremental QALYs associated with CAZ/AVI versus Colistin were 0.30, the life-years gained
were 0.42 years, and the discounted incremental costs were EGP 51,528 over a five-year time horizon. These resulted
in EGP 170,832 per QALY and EGP 121,473 per life-year gained.
Conclusion: CAZ/AVI provides a breakthrough in the health benefit for CRE intensive care unit patients; however, it
is not cost-effective against Colistin in the Egyptian health care settings at the current price level. Using a managed entry
agreement could improve CAZ/AVI's cost-effectiveness and accessibility.
Keywords: Ceftazidime/Avibactam, Polymyxin E, carbapenem-resistant Enterobacteriaceae, Multidrug resistance.

INTRODUCTION
or imipenem or 2 mg/L for ertapenem) or documented
Antibiotic resistance is a global issue that is
to produce a carbapenemase 5. The three main
rapidly spreading. Antibiotic use in recent decades has
mechanisms in carbapenem resistance are (1)
been linked to a worldwide increase in antibiotic-
carbapenemase
production,
which
inactivates
resistant strains of bacteria known as superbugs or
carbapenems by hydrolysis, (2) increase in the
multi-drug resistant (MDR) bacteria 1. The emergence
production of efflux pumps, which can actively extrude
of multi-drug resistant strains has been attributed to the
carbapenems from the bacterial cell and (3) porin
overuse or misuse of antibiotics. Multiple drug
mutation or loss, which leads to decreased carbapenem
resistance mechanisms have been discovered, but the
entry through the bacterial cell wall 5. CRE is a serious
development of novel antibiotics to overcome these
threat because it has a high mortality rate even when
mechanisms has lagged behind the emergence rate of
treated early 6.
those new multi-drug resistant strains 2. Despite the lack
CAZ/AVI is a novel -lactam and non--
of national data, the prevalence of MDR bacteria in
lactamase inhibitor with a distinct mechanism of action.
Egypt is comparable to or even higher than the global
It is a predetermined drug combination: (a) Avibactam
average 3, 4.
is a novel non--lactam -lactamase inhibitor. Its
Carbapenem resistance is defined as the ability
spectrum includes -lactamases from classes A and C,
of bacteria to survive in the presence of adequate
as well as ESBLs and serine-based carbapenems
carbapenem concentrations. The US CDC defines
(KPCs). It also works on class D -lactamases (e.g.
carbapenem-resistant Enterobacteriaceae (CRE) as
OXA-48 type carbapenems). (b) Ceftazidime is a
enterobacteria non-susceptible to any carbapenem (i.e.
cephalosporin approved for the treatment of
showing a MIC of 4 mg/L for doripenem, meropenem
complicated
intra-abdominal
infection
(cIAI),
2775
Received: 03/09/2022
Accepted: 06/11/2022

Full Paper (vol.902 paper# 119)


c:\work\Jor\vol902_120 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90(2), Page 2784-2788

Evaluation of Cardiac Complications Using Conventional
Echocardiography among Children with End Stage Renal Disease
Ahmed Hassan Mahmoud Hassan1, Shaimaa Ibrahim Ahmed Mohamed1,
Abd Elhamid Abd Allah Abd Allah1, Mohamed Ahmed Salem2, Raafat Salama1
1Department of Pediatrics, Al Ahrar Teaching Hospital, Zagazig, Egypt
2Department of Pediatrics, El Mounira General Hospital, Cairo, Egypt
*Corresponding author: Ahmed Hassan Mahmoud Hassan, Mobile: (+20) 01022128882, E-Mail: drahmhassan@gmail.com

ABSTRACT
Background:
Children with chronic renal failure have an increased risk of mortality due to cardiovascular problems.
Objective: To evaluation of cardiac complications using conventional echocardiography among children with end stage
renal disease.
Subject and Methods: This study was conducted on 40 children with chronic renal failure (17 males and 23 females),
their age ranged from 8 years to 17 years, attending the Nephrology Unit of the Pediatric Hospital Zagazig University.
All children were subjected to thorough history taking, complete detailed clinical examination and laboratory
investigations. All cases and control were assessed by conventional echocardiography.
Results:
using mitral and tricuspid inflow velocities peak early velocity (E), peak late velocity (A), E/A ratio, we found
significant decreased E/A ratio in our cases predialysis than control group of both mitral and tricuspid inflow velocities;
the E/A ratio of the mitral and tricuspid valves dropped considerably following dialysis, which has been linked to
diminished compliance of the ventricle due to hypertrophy. Myocardial performance index (MPI) assessing global
systolic and diastolic functions of both RV and LV showed statistically significant increased values in cases more than
control but did not show significant difference after dialysis.
Conclusion: Major cardiac abnormalities are present in children with chronic renal failure (CRF), and they likely
contribute to the high cardiovascular death rate seen in this population.
Keywords: End Stage Renal Disease, Conventional Echocardiography.


INTRODUCTION
PATIENTS AND METHODS
End-stage renal failure (ESRF) is the last,
This study was conducted on 40 children with
catastrophic stage of chronic renal failure (CRF).
chronic renal failure (17 male and 23 female), their age
Chronic kidney disease (CKD) encompasses the whole
ranged
range and severity of renal disease and is a leading cause
from 8 years to 17 years, attending the Nephrology Unit
of morbidity and death in children globally (1). Forty
of the Pediatric Hospital Zagazig University. their data
percent of all deaths in people with end-stage renal
were collected pre and postdialysis, the proportion of
disease can be attributed to cardiovascular problems (2).
boys to girls were nearly equal.
The onset of cardiovascular disease in CRF is

influenced by a number of variables. The development
Inclusion Criteria: Diagnosed children with chronic
of crucial and significant variables that contribute to the
renal failure and ongoing dialysis.
avoidable worsening of CVD in this patient population

appears to begin early in the course of CKD (2).
Exclusion Criteria: Refusal of the parents, and age
Cardiovascular complications may occur in patients
more than 18.
with ESRD who don't have any cardiac abnormalities

before starting dialysis (3).
Methodology:
Ejection phase indices are the most used
All individuals enrolled in the trial underwent a
echocardiographic markers of left ventricular systolic
thorough clinical evaluation (history, physical
performance. These indices are used to evaluate the
examination, etc.).
efficiency with which the left ventricle pumps blood and

are affected by the heart's preload, after load, and
Full History
contractility. As it contracts and relaxes, the left
· Name, age, sex, date of admission.
ventricle pumps blood through the body, carrying
· Chronology of symptoms.
oxygen-rich blood to the cells that need it. The
· Co-existing medical Condition.
ventricle's pumping efficiency may thus be measured in
· Social and family history.
part by its stroke volume (4).

The purpose of this research was evaluation of
Clinical examination
cardiac
complications
using
conventional
· General: Wt, Ht, BMI.
echocardiography among children with end stage renal
· Neurological: level of consciousness, headache.
disease.
· Respiratory: tachypnea, rapid shallow breathing.

· Cardiovascular.
2784
Received: 02/10/2022
Accepted: 05/12/2022

Full Paper (vol.902 paper# 120)


c:\work\Jor\vol902_121 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90(2), Page 2789-2795

Effect of High Progesterone Level on Day of Human Chrionic Gonadotropin
Triggering on Pregnancy Rate in Frozen Embryo Transfer
Mohamed Lotfy Mohamed Elsayed, Eman Mahfoz Hafez, Fatma Toba Abdelmoaty*, Amr Mostafa Abo-Elfth
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Fatma Toba Abdelmoaty, Mobile: (+20) 01015624547,
E-mail: Fatma.T.Mangood@Gmail.com

ABSTRACT
Background:
The endometrial morphology and receptivity, the embryo implantation procedure and the success rate of
In vitro fertilization (IVF) are all significantly influenced by progesterone. The increased progesterone adversely
affected the endometrial environment of fresh cycles, reducing the chance of pregnancy. However, the embryo quality
is equally as crucial to the embryo-endometrial cross-dialog as endometrial receptivity, based on the rate of pregnancy
in frozen cycles. Objective: The aim of the current study was to determine how Day of human chorionic gonadotropin
(HCG) was impacted by early progesterone rise.
Patients and methods: A retrospective cohort research was conducted in the Obstetrics and Gynaecology Department
of the Zagazig University Hospital. The study included records of all cases fulfilling the next inclusion criteria: Women
with any type of subfertility who underwent frozen embryo transfer, Age less than 40 years old, gonadotropin-releasing
hormone (GnRH) antagonist stimulation protocol in fresh Intracytoplasmic Sperm Injection (ICSI) cycle, Basal
serum follicle stimulating hormone (FSH) concentration less than 15 mIU/mL. Over 5 years, 200 records were included
as a comprehensive sample undergoing ICSI and subsequent frozen embryo.
Results: Using a threshold value for serum progesterone previously described of 1.5 ng/ml, 142 from 200 (71%) frozen
embryo transfers that involved the transfer of embryos from low progesterone level ICSI cycles, and 58 from 200 (29%)
frozen embryo transfers in which embryos from elevated progesterone level. The evolution of pregnancy outcomes
following ICSI cycles demonstrated that there was no discernible difference between the groups with higher blood
levels. Conclusion: Elevated progesterone levels on the day of HCG do not negatively affect pregnancy outcomes in
frozen cycles triggering.
Keywords: Intracytoplasmic Sperm Injection, Transfer of frozen embryos, Progesterone, Embryo quality, Retrospective
Cohort, Zagazig University.

INTRODUCTION

specifically, the increase in progesterone likely
Because Infertility is a growing medical and
accelerates the endometrium, slowing the development
psychological concern issue for an increasing
of the embryo and the responsiveness of the
percentage of the population, governments all across the
endometrium (4).
world are investing extensively in Assisted
The quality of the embryo is equally crucial to
Reproductive Technology (ART).
endometrial receptivity. Another explanation is that the
Results of ART have improved because of better
quality of the resulting oocyte or embryo is negatively
knowledge of male reproductive mechanisms,
impacted by the high amounts of progesterone.
improvements made to gamete manipulation, gamete
Uncertainty exists over how higher progesterone levels
preservation, and solid knowledge about female
may impact the viability of embryos (5).
reproductive systems (1).
Santos et al. (6) showed that individuals with both
Progesterone
strongly
affects
endometrial
low and high live birth rates (LBRs) had considerably
morphology, receptivity, the embryo implantation
lower (0.05 ng/mL) and high (1.5 ng/mL) levels of
process
and
In
vitro
fertilization (IVF)/
progesterone the day before the HCG trigger.
Intracytoplasmic Sperm Injection (ICSI) operation
Because patients with high progesterone had
success rates (2).
reduced pregnancy chances with fresh embryo transfer
Previously, it has been noted that blood
IVF, doctors now keep an eye on progesterone levels
progesterone levels rise on the day of the release of
throughout the late follicular phase or on the day of the
human chorionic gonadotropin (HCG) as a result of
HCG trigger IVF/ ICSI cycles than patients without
gonadotropin-releasing hormone (GnRH) agonists'
elevated progesterone. It has been argued that a policy
inhibition
of
endogenous
gonadotropins
and
of keeping all embryos from a new IVF/ICSI cycle and
antagonists, together with controlled ovarian
replacing them in a subsequent round will help to
stimulation (COS) cycles trigger.
mitigate the possible dangers of high progesterone on
Progesterone increase was discovered in 13-46% of
pregnancy (7).
IVF or ICSI cycles (3). The receptivity of the
The aim of the current study was to determine
endometrium is assumed to be affected by
whether an early progesterone surge on the day of HCG
progesterone's activity on the tissue, which is regarded
triggering would have any bearing on the likelihood of
to have a detrimental effect on pregnancy rates. More
conception in frozen cycles.


2789
Received:5/10/2022
Accepted:8/12/2022

Full Paper (vol.902 paper# 121)


c:\work\Jor\vol902_122 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90(2), Page 2796-2801

The Deficiency of PROTAMINE 1 Gene Expression and Its Effects on
Sperm DNA Fragmentation in A Sample of Iraqi Infertile Male
Haider Kudher Abbas1*, Abdulameer M. Ghareeb2 , Farah Thamer Samawi3
1Kamal Al- Samaraie IVF Hospital / Ministry of Health /Baghdad, Iraq
2Institute of Genetic Engineering and Biotechnology for Postgraduate Studies/
University of Baghdad/ Baghdad, Iraq
3Biotechnology Research Center/Al-Nahrain University/ Baghdad, Iraq
*Corresponding author: Haider Kudher Abbas, Mobile: (+964)07735199483,
Email: haiderkudher93@gmail.com,ORCID ID /0000-0002-9026-7504

ABSTRACT
Background:
Protamines are the nuclear proteins essential for chromatin compaction during spermatogenesis. Spermatozoa
may develop the SDF if the spermatogenesis is dysregulated, which affects male infertility
Objective: This study was conducted to quantify the PROTAMINE 1 gene expression in the semen specimen of infertile
Iraqi male and estimate sperm DNA fragmentation.
Patients and Material: 50 semen specimens were gathered from infertile males and 50 samples from healthy fertile
individual as control group and subjected for semen analysis, determinations the expression of PROTAMINE 1 gene and
estimation sperm DNA fragmentation.
Results: There were no appreciable differences in the ejaculation volume between the studied groups.the fertile group's
mean sperm concentration (m/ml)(49.58 ±2.93)was statistically significantly (p <0.05) higher than the infertile male
group(27.08±15.7).The progressive motility of fertile male(57.20 ± 2.27) was significantly(P < 0.001) higher as compared
to other infertile male groups(22.29 ± 1.95).The morphologically normal sperm of control males(52.20 ± 1.91) was a highly
significant (P < 0.001) as compared to infertile male groups (36.30± 2.20).The fold protamine 1 gene expression of patients
group(0.26) had a lower significantly than the healthy group (1).The mean SDF of infertile male group(43.05 ± 2.93) was
statistically significant (P < 0.001)than the fertile male group( 17.97 ± 9.90).
Conclusion: The current study found that increased sperm with breaks DNA was linked to reduced protamine 1 gene
expression and negative impacts on sperm parameters.
Keywords: protamine 1 gene, Spermatozoa, sperm DNA fragmentation, infertile Iraqi patients, gene expression.

INTRODUCTION
fertilization and full embryo development(9).The

One of the most significant gynecological
replacement of most histones with smaller proteins, called
issues, fail to conceive clinically after a 12 months of
protamines, during spermatogenesis was what causes the
routine, sexual activity that is not protected is known as
spermatozoa cell to have a distinct chromatin structure
infertility(1). The reasons behind infertility are multiple,
(10).Protamine is manufactured in the last stage of sperm
including diseases of ovulation process and the uterus in
of many animals and plants and includes PRM1, PRM2,
women, in addition to the disorder of sperm production
and PRM3. Protamines bind to DNA resulting in sperm
and poor semen quality in men(2).
chromatin condensation and a genetically inactive
Infertility became in recent years a serious
state(11). The genome-wide histone hyperacetylation was
social, mental and physical health problem worldwide
usually what starts the binding process. Next, the
(3,4). Millions of couples all over the world suffer from the
spermatid histone variant was loaded on the
problem of infertility (5). Factors known to cause male
chromosomes. Finally, Protamines work with transition
infertility were: decrease the production of sperm cells,
proteins to bind to DNAs to create a compacted sperm
progressive motility of sperm, normal sperm morphology
head in the final(12).
(6). Men and women of reproductive age who were
The follow meiotic differentiation of spermatids
infertile estimated at about 15%, and the reason was due
completely reorganizes the whole male germ cell genome.
to the male in 50% of them (7). There were many factors
A large proportion of Protamines gradually take the place
that affect the fertility of males, the most significant of
of somatic histones as the spermatid core expands and
which were hormonal deficiencies, physical conditions,
contracts. Protamines are basic nuclear and small proteins
issues with sexually transmitted diseases, environmental
that are unique to sperm and are necessary for the
and lifestyle factors, and genetic factors (8). The sperm
condensation of the haploid genome. During fertilization,
cell's primary function during fertilization was to transfer
this vital step of tight packing shields the sperm genome
the paternal genome to an egg. According to Kumaresan
from the negative effects of physical and chemical factors
et al. who indicated that the integrity of the sperm's
(13). Protamination is that protamine replaces histones
genetic material was critical to the complete success of
linked to DNA, which leads to a decrease in the
2796
Received:04/10/2022
Accepted:07/12/2022

Full Paper (vol.902 paper# 122)


c:\work\Jor\vol902_123 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2802-2807

Assessment of Urine Albumin Creatinine Ratio in Renal Injury in
Septic Children and Its Relation to Outcome
Nehad Ahmed Karam1, Shimaa Saad Abdelhamid1, Weam Ibrahim Ismail2, Amina Abdelazim Semary*1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine ­ Zagazig University, Egypt
*Corresponding author: Amina Abdelazim Semary, Mobile: (+20) 01288189794, E-Mail: aminasemary@gmail.com

ABSTRACT
Background:
The paediatric intensive care unit (PICU) is critical in providing demanding and necessary treatment to
very unwell children. PICU children have a much greater risk of morbidity and mortality in both underdeveloped and
developed nations.
Objective: The aim of this study was to assess the urine albumin creatinine ratio (ACR) in renal injury in septic children
and it's role in predicting outcome.
Patients and Methods: This study was carried out in Pediatric Intensive Care Unit and clinical pathology department
at Zagazig University Hospitals in the period from April 2022 to October 2022. It was approved by Institutional Review
Board- Zagazig University (IRB 9482). Written informed consent was taken from all parents.
Results: This study included 68 patients with median age 1 year, females represented 47.1% of them and males were
(52.9%). Our study revealed that, blood culture was positive in 80.9% of patients and 44.1% had sepsis degree 3 .In the
current study, median albumin/creatinine ratio on admission was 319 mg/g which significantly decreased to 253 mg/g
after 24 hours. Our study showed that, there is statistically significant relation between mortality and ACR on admission
and after 24 hours (significantly higher in those with non-survivors). In non-survivors, there was significant increase in
ACR while there was significant decrease in ACR in survivors after 24 hours. Concerning trend for ACR, 97.1% of
non-survivors had increasing ACR after 24 hours versus one patient of survivors.
Conclusion: Elevated urinary ACR is associated with the severity of sepsis, morbidity, and mortality.
Keywords: Urine Albumin Creatinine Ratio - Assessment ­ Renal Injury - Septic Children.

INTRODUCTION

Even in developed nations, sepsis remains one of
severity and organ dysfunction, as well as be a predictor
the main causes of mortality in children. Many children
of death and morbidity (5).
who are said to die from various underlying diseases
The aim of this study was to assess the urine
really pass away from sepsis, despite the fact that
albumin creatinine ratio in renal injury in septic children
demographic data does not clearly demonstrate this (1).
and it's role in predicting outcome.
It might be difficult and extremely important to

predict morbidity and death in paediatric critical care
PATIENTS AND METHODS
units. Making the proper judgements and resulting
This study was carried out in Pediatric Intensive
improvements in outcomes are made possible through
Care Unit and clinical pathology department at Zagazig
accurate prediction. To forecast PICU outcomes, a
University Hospitals in the period from April 2022 to
variety of clinical metrics are utilised, including the
October 2022.
paediatric risk of mortality (PRISM) score, paediatric

logistic organ dysfunction (PELOD) score, and
A) Patients:
paediatric index of mortality 2 (PIM 2). In developed
From 200 patients admitted to Pediatric
country ICU settings, these scores have been verified.
Intensive Care Unit, Children's Hospital Zagazig
These scores must be calculated using a variety of
University. Sixty eight patients were included aged
characteristics and online resources (2).
between 1month and 14 years, critically ill patients,
Inflammatory reaction damages the endothelium
diagnosed as sepsis by Systemic inflammatory
membrane in critically sick patients, which is followed
response syndrome (SIRS) criteria and documented
by an increase in capillary permeability and temporary
infection. SIRS is an exaggerated defense response of
albuminuria. Albuminuria can vary in severity, and the
the body to a noxious stressor (infection, trauma,
majority of cases are not detected by urine dipstick
surgery, acute inflammation, ischemia or reperfusion,
protein
quantification,
thus
the
term
or malignancy, to name a few) to localize and then
"microalbuminuria". Spot urine albumin creatinine ratio
eliminate the endogenous or exogenous source of the
(ACR) tests can detect microalbuminuria (3). The ACR
insult (6).
is a straightforward, uncomplicated, and non-invasive

measurement that can accurately predict PICU
Pediatric SIRS criteria(7) :
outcomes (4).
The presence of at least two of the following four
In children with sepsis, severe sepsis, septic
criteria, one of which must be abnormal temperature
shock, and MODS, it was expected that a greater urine
or leukocyte count:
albumin:creatinine ratio (ACR) would increase disease
-. Core temperature o f >38.5°C or <36°C.

-.Leukocyte count elevated or depressed for age or >
2802
Received: 09/10/2022
Accepted: 12/12/2022

Full Paper (vol.902 paper# 123)


auth3in.doc The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90(2), Page 2808-2813

The Effect of Balance Exercises on Some Strength Abilities of
The Legs for High-Spiking Players in Volleyball
Haitham Sadek Kadhim1, *, Ahmed Sabea Atea1
1College of Physical Education and Sports Sciences, University of Baghdad, Iraq.
*Corresponding author: Haitham Sadek Kadhim, Email: haitham.sadek1104a@cope.uobaghdad.edu.iq
Mobile: +9647708476298

ABSTRACT
Background
: The purpose of this paper is to identify the effect of balance exercises with different tools on some of
the strength capabilities of the two men of volleyball players specialized in high spiking, and it was assumed that there
were statistically significant differences in the mentioned abilities between the (pre-post) tests of the mentioned sample.
Method: The researchers used the semi-arbitrary experimental method with a pre-test and a post-test with a group
design, and the sample was selected from the Army Club season (2021-2022) and numbered (6) players specialized in
high spiking representing 100% of the hitters, and the statistical program (SPSS) was used to extract the mean (Mean),
standard deviation (SD), Skewness, (T test) for the correlated samples.
Results and conclusions: They concluded that the applied exercises affected the speed-distinguishing strength of the
two men at a better level than their impact on the explosive force.
Keywords: static balance, dynamic balance, explosive power.

INTRODUCTION


Most of the exercises for developing muscle
The fact that the player performs the main part of
strength have a known direction, and this leads to the
the skill while he is in the air, and the player is governed
regularity of the instructions towards the specified
by the nature of the numbers represented by the
direction. But in balance exercises and because of the
location of the ball in the air and its proximity or
anxiety of the base of support, the instructions were not
distance from the net and the blocking wall. In addition
known in the direction, and the instructions were
to that it was considered the basic offensive technical
mobilized at the highest speed after the kinetic action,
skill to score points and thus achieve victory in the
and the body works to respond accordingly to adjust its
match. Therefore, the importance of the research lies in
direction. And this was similar to the difference
what the researchers want to develop, which is the
between the known reaction and the kinetic response
strength of the two legs and the skillful performance of
whose direction is unknown except after the issuance
spiking. It was found that adding balance exercises to
of the instruction. This might be one of the most
the training units resulted in improvements in vertical
prominent features of balance exercises from other
jumping, agility, and some other abilities (5,6).
exercises, especially in the development of strength.
And through the experience of the two
This lead to a positive outcome in improving the
researchers in the field of volleyball as well as their
player's movements, as it is not limited to strength, but
practice of training it, they noticed that balance
includes performance as well. Balance is of great
exercises in all their forms were not used within the
importance because it was an integral part of all leg
training units in an organized and follow-up linger by
movements (1).
the coaches even at the level of the national teams of
Possession of the player's balance reflects the
the game and clubs. Not to mention the auxiliary tools
appearance of his superiority over his peers, and it is
for it, and if used, it was purely coincidental and did not
one of the qualities of superior players. It has been
take its importance and full training time to know its
shown that elite athletes possess a superior balance of
impact.
power over their less efficient counterparts (2,3).
And when reviewing most international studies
In addition, having the ability to balance in a
and sources, we found its multiple uses and its role in
distinctive way gives preference to developing other
developing the physical and skillful abilities of
capabilities. Balance affects kinetic responses and the
volleyball and various other games. Balance exercises
athlete's ability to perceive, pay attention and focus (4).
work directly in improving the resulting strength of the
The game of volleyball, is witnessing a remarkable and
player by reducing the proportions of muscles allocated
continuous development at the level of skillful and
to achieve stability and allowing them to contribute
physical performance. And we mentioned in particular
more driving force. performance in decentralized
the skill of spiking, as this skill exceeded its
contractions such as a counter or repetitive jumps (7).
outstanding performance in terms of jump height,
It represents the problem of the players in the
strength, control, fluidity, and coordinated movement
critical stages of performance of the skill, and on the
of body parts by some international players to levels far
basis of this, the researchers aimed to identify the effect
from the players of our teams, which is considered one
of balance exercises with different tools on some of the
of the difficult skills in the game.
strength capabilities of the two men of the volleyball

players who specialize in high spiking, and they
2808
Received:1/10/2022
Accepted:4/12/2022

Full Paper (vol.902 paper# 124)


c:\work\Jor\vol902_125 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2814-2822

The Injury in Pulmonary Tissue Following Fipronil Exposure in Male Albino Rats and
The Protective Role of Vitamin E (Histological and Immune-Histochemical Study)
Asmaa S. Baset
Department of Human Anatomy and Embryology, Faculty of Medicine, Sohag University, Egypt.
Corresponding author: Asmaa Sabry, Mobile: (+20) 01060426278,
Email: sandylady78@gmail.com, ORCID number: 0000-0003-3401-7284

ABSTRACT
Background:
The extensive use of fipronil exposes mammals to this hazardous environmental toxin. It is transformed
into many components, which affects GABA-gated chloride channels in mammals. Vitamin E (Vit E) is one of the fat-
soluble vitamins and is abundant in vegetable oils, margarine, nuts, and cereal and has an antioxidant effect.
Aim of the work:
Evaluate the effects of fipronil on the lung tissue of rats and the possible protective effects of Vit E.
Material and methods: Thirty adult male albino rats, 200 - 250 gm, were partitioned into:- group I (control): formed
of 10 rats taking regular diet and water, group II (fipronil treated): 10 rats took fipronil at a dose of 20 mg/kg, orally
once daily for 5 days only, and group III (fipronil and Vit E treated ): 10 rats got Vit E at a portion of 1000 mg/kg orally
once daily for 2 weeks then fipronil given as the previous dose orally once daily during the last 5 days.
Results: In the group treated with fipronil there was destruction in the bronchi and alveoli present in alveolar septa,
excessive collagen deposition presented around a bronchiole and the alveolar wall using Masson trichome stain, and
positive expression of (TNF- and caspas-3). Vit E had a moderate effect in a damaged cell but a sign of inflammation
was still present in the cell. Conclusion: Fipronil causes damage to the tissue of the lung and vitamin E has a weak
effect on the protection of the lung against fipronil.
Keywords: Fipronil, Lung, Vitamin E, Caspas-3.

INTRODUCTION
lipid chain directly or indirectly, so it is considered an
Around 4.6 million pesticides are used in recent
antioxidant [12]. Several research revealed that use of
year to avoid or damage pest in agricultural settings.
vitamins with other antioxidants strengthen their
The danger of insecticides is present in their persistence
effects[13].
for long time in the environment [1].

Fipronil (FPN)= is member in the phenyl pyrazole
AIM OF THE WORK
family, which is used in different areas as anti-flea and
Evaluate effects of fipronil on the lung tissue of
tick sprays and for agriculture [2]. It affects GABA-gated
rats and possible protective effects of VIT. E.
chloride channels, so it is more effective in insects

compared to other, while in mammals its effect through
MATERIAL AND METHODS
production of substance (sulfone, sulfide, and
Drugs:
disulfonyl), which affect these channels[3-4].
Fipronil, FPN: introduced as (cockroach killing bait
It focuses on gamma amino butyric acid receptor
powder) applied from local market of pesticides.
(GABAR) receptors as an antagonist; these receptors
Vit E :1000 mg brought from Pharco, Pharmaceuticals
are expressed in the lungs of both humans and animals
Industries.
making them vulnerable to damage [5]. It can enter the

body either through inhalation where the farmers spray
Animals:
insecticide without taking precautions, or oral pathway
Thirty adult male albino rats, 200 - 250 gm each. The
through contamination of food obtained from animals
animals were obtained from the Animal House, Faculty
and plants [6].
of Medicine, Assiut University, and were housed in the
The extensive use of FPN in the environment
Animal Facility at Faculty of Medicine, Sohag
leads to its precipitation in the soil and water, which
University, Egypt.
exposes mammals to this dangerous environmental
Rats were divided into 3 groups:
toxin [7-8]. It has been reported that fipronil applies
1-Group I (control): formed of 10 adult albino rats fed
dangerous impacts on vital organs through suppress of
normal diet and water.
mitochondrial respiratory chain and calcium
2-Group II (fipronil treated): 10 adult albino rats
homeostasis, and its harm towards nucleic acids and
received fipronil at a dose of 20 mg/kg, 1/5 the LD50
proteins [9].
(where LD 50=97mg /kg), orally once daily for 5 days
Vitamin E (Vit E) is one of the fat-soluble vitamins
only[14].
and is abundant in vegetable oils, margarine, nuts, and
3- Group III (fipronil and Vit E treated): 10 adult albino
cereal [10]. It is antioxidant organically present in
rats received Vit E at a portion of 1000 mg/kg orally
biologic systems by the overproduction of ROS and
once daily for 2 weeks then during the last 5 days
nitrogen species. It produces protection to the outer
fipronil was given as the previous dose; orally once
layer of the cell against lipid peroxidation [11]. Also, it
daily [15].
can attack free radicals, which begin the oxidation of the
2814
Received: 18/09/2022
Accepted: 21/11/2022

Full Paper (vol.902 paper# 125)


c:\work\Jor\vol902_126 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2823-2830

Outcomes of Endovascular Treatment in Patients with
Superficial Femoral Artery In-Stent Restenosis
Bahgat Abdelhamid Thabet1, Mahmoud Ismael Ahmed1, Mohamed Ibrahim Ahmed1, Mark Malak Mahrous2*
1Vascular and Endovascular Surgery department, Faculty of Medicine - Assiut University
2Resident doctor of Vascular Surgery Department, Faculty of Medicine - Assiut University Hospital
*Corresponding author: Mark Malak Mahrous, Email: zekomessi16@gmail.com
Mobile: +201275414196
ABSTRACT
Background:
The femoropopliteal artery lesions classed as trans-Atlantic inter-society consensus (TASC) A-C lesions
and some TASC D cases should be treated with endovascular therapy, according to current recommendations (Level C,
Class I, recommendations based on expert opinion and retrospective studies)
Aim: This study aimed to evaluate the effectiveness and safety of endovascular balloon angioplasty in cases of
superficial femoral artery stenosis.
Patients and Methods: This study was presented to the faculty of medicine's department of vascular surgery at Assiut
University Hospital between October 2019 and October 2021. It is a prospective hospital-based study for patients with
superficial femoral artery in-stent restenosis.
Results: The primary patency rate at 12 months was 82.6%, demonstrating that none of the 23 patients who received
effective endovascular therapy experienced any loss of function or passed away during the observation period.
Conclusion:
Endovascular treatment is a safe and effective way for treating chronic lower limb ischemia caused by
SFA-ISR. Both DCB and traditional balloon angioplasty are associated with low post-procedural morbidity and death.
It is an excellent surgical replacement with a high rate of technical success. Drug-coated balloon angioplasty is a helpful
operation with a significant decrease in recurring stenosis and repeat angioplasty for up to a year because of the anti-
proliferative effects of paclitaxel.
Keywords: Outcomes, Endovascular treatment, Patients, Superficial femoral artery, In-stent restenosis.

INTRODUCTION

Current recommendations (Level C, Class I,
gradually started using drug-coated balloons (DCBs) to
recommendations based on expert opinion and
treat femoro-popliteal blockages (5).
retrospective studies) advise endovascular therapy of
Drug-coated balloons (DCBs) have been a viable
the femoropopliteal artery as the first line of treatment,
therapeutic alternative in the field of interventional
especially in trans-Atlantic inter-society consensus
therapy in recent years. By allowing antiproliferative
(TASC) A-C lesions and in some TASC D instances (1).
medications to be temporarily given to the artery wall
The femoropopliteal segment is one of the most difficult
without the need for an implanted drug delivery system,
arterial regions to treat endovascularly because of its
this method may minimise the negative effects of
anatomical location and mechanical characteristics, as
polymer-based stent technology. Paclitaxel-coated
it has a significant risk of restenosis and vessel recoil.
balloons are safe and effective in decreasing restenosis
Actually, the two primary downsides of stenting in the
in individuals with coronary ISR and de novo
femoropopliteal region are stent fracture and in-stent
femoropopliteal lesions, according to small clinical
restenosis (ISR) (2).
randomised studies (6). The purpose of the study was to
Restenosis in stents refers to the decrease in
evaluate the effectiveness and safety of endovascular
luminal volume brought on by the encroachment of
balloon angioplasty in cases of superficial femoral
cells, extracellular matrix, and thrombi inside the
artery stenosis.
cylinder of the stented artery and/or at the 5-mm

margins proximal and distal to the stent (ISR) (3). For an
PATIENTS AND METHODS
endovascular specialist, femoro-popliteal in-stent
This study is a prospective hospital-based study for
restenosis (ISR) continues to rank among the most
patients with superficial femoral artery in-stent
bothersome issues. Within the first year following
restenosis that was presented to The Faculty of
femoro-popliteal artery stenting, it happens in 18% to
Medicine's Department of Vascular Surgery at Assiut
40% of patients, making it a rather prevalent
University Hospital between October 2019 and October
occurrence. After stenting of longer lesions, SFA-ISR is
2021.
more frequent and may be related to stent breakage (4).
Inclusion criteria: All patients with SFA-ISR-caused
Initial procedural success rates for ISR treatment are
chronic lower limb ischemia who met one or more of
high, but long-term, permanent patency is relatively
the following criteria: Rutherford categories 4 to 6
uncommon. Recent studies have demonstrated that anti-
patients, patients with a peak systolic velocity ratio
proliferative
drug-coated
balloon
angioplasty
(PSVR) of more than 2.4 by duplex at any point inside
treatments had higher patency rates than those utilising
the stent, which indicates more than 50% stenosis, and
plain balloons. A number of interventional centres
patients with patent popliteal artery with at least one

patent tibial vessel as backup.
2823
Received: 04/09/2022
Accepted: 07/11/2022

Full Paper (vol.902 paper# 126)


c:\work\Jor\vol902_127 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2831-2838

Detection of flaA, fliC , mrpA and rsbA Gene in proteus mirabilis Multidrug
Resistance Isolated from Different Clinical Sources in Baquba City
Ibraheem M. AL-Dulaimy, Ali Jaffar Saleem, Hadi R. Rasheed Al-Taai
Department of Biology, College of Education Pure Science, University of Diyala, Iraq.
Corresponding author name: Ibraheem M. AL-Dulaimy, E-mail abrahimph1994@gmail.com

ABSTRACT
Background
: P. mirabilis possesses multiple virulence factors that enable them to cause infection in various anatomical
sites of the human body, including endotoxin, and some of them are secreted into a medium such as the enzyme that
analyzes urea, hemolytic enzyme, protease, biofilm, DNase, and others. Excessive use of antibiotics has led to the
emergence of multidrug resistance and multidrug resistance bacteria that cause serious infections that are difficult to
treat.
Objectives: The study aims to molecular investigation of the virulence genes in Proteus mirabilis multidrug resistant.
Methods: A total of 100 samples collected from different clinical sources (urinary tract infections, wounds, stool) in
sterile containers in different hospitals in Baquba city (Baquba Teaching Hospital and Al-Batool Hospital) were
subjected to antibiotic susceptibility study using disc-diffusion method. Molecular detection of virulence genes using
polymerase chain reaction (PCR) analysis and amplicons sequenced.
Results
: The results showed that all isolates had multiple resistance against antibiotic, and the highest resistance was
against antibiotic Trimethoprim and lowest resistance towards two antibiotic Imipenem and Amikacin . PCR analysis
revealed the presence of flaA ,fliC, mrpA and rsbA were present in all isolates in a ratio 100% .
Conclusion: Isolates of Proteus mirabilis bacteria, which have virulence factors, it causes many diseases and susceptible
to infection through their ability to move, transfer, adhere, and form a biofilm.
Keywords: Proteus mirabilis; urinary tract infection; virulence factor, rsbA gene.

INTRODUCTION

poorly monitored (3). The Enterobacteriaceae with the
In both hospitals and the general populace, urinary
lowest rates of extended-spectrum beta-lactamases
tract infections (UTIs) are the most common bacterial
(ESBL) and carbapenemase synthesis along with UTIs
diseases effecting, ranging in intensity from an infection
is Proteus spp. Due to the limited antibiotic penetration
without symptom to acute prostatitis, pyelonephritis,
and development of resistant genes that result in
cystitis, and urethritis. This is among the most common
antibiotic resistance, indwelling medical devices
disorders, impacting individuals of all ages. There's
(IMDs) are the most resistant to biofilm-producing
many Proteus species, with Proteus mirabilis being one
microbial invaders (5). Due to the pathogen's capacity to
of the most important. This pathogen is classified as an
mediate urea hydrolysis via the urease it generates,
opportunistic
pathogen
that
affect
immune-
which generates tissue necrosis and inflammation at the
compromised patients with a variety of diseases and
infection site and prevents antibiotics from contacting
causes nosocomial infections and urinary tract
the pathogen, P. mirabilis infections are hard to treat,
infections (1).
last an a while, and commonly result in death (6).
Dependent on the patient's location and type, it is
The frequent use of antibiotics leads to antibiotic
also known as Proteus UTI. All patients with catheters
resistance and the emergence of antibiotic resistance
are at risk for lethal infections, including UTI,
genes, especially in Gram-negative bacteria (7). This is
urolithiasis formation, congestion of the urinary tract,
considered as one of the most serious chronic illnesses.
bladder stones, kidney stones, and bacteriuria (2).
A sensory protein that governs swarming behavior is
Protease, an enzyme which helps in the breakdown of
represented by the rsbA gene. RsbA was shown to
protein, and urease, an enzyme which catalyses the
promote
gene
expression
for
extracellular
hydrolysis of urea, among characteristics of the
polysaccharide production and biofilm formation,
virulence factors and enzymes which P. mirabilis
showing it might function as a protein sensor of
possesses. Toxins such as hemolysin, a hemolytic toxin,
environmental conditions. A histidine-containing
and proteus toxin agglutinin are found (3).
phosphor transmitter is expressed by rsbA gene .
Additionally, P. mirabilis has a secondary
Nanoparticles of metal oxides having a size range of 1­
virulence factor that participates in adhesions, flagella,
100 nm represent a new orientation that is increasingly
and colonization (4). Urinary pathogens' virulence
being progressed for use in research and medically care
factors increase subsequent infections and adherence to
related implementation (8). Due to their low production
mucosal surfaces. The multiresistant enterobacteria that
costs, safety, and simplicity of preparation, ZnO NPs
cause UTI are a significant public health issue.
are of the greatest interest (9).
Antibiotic resistance is still a big issue, particularly in
It has several medicinal uses, including the
underdeveloped nations wherever sanitation is still a
delivery of medications, anti-cancer, anti-diabetic,
concern and antibiotic usage is often indiscriminate and
antibacterial, antifungal, and agronomic qualities (10).
2831
Received: 01/10/2022
Accepted: 04/12/2022

Full Paper (vol.902 paper# 127)


c:\work\Jor\vol902_128 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2839-2846
Serum microRNA-499-5p Expression and Its Correlation with Chemokine
(C-C motif) Ligand 18 in Acute Myocardial Infarction
Asmaa R. Abdel-Hamed a, Elen Nasser a, Dina M. Abo-Elmatty a, Gamila M. Nasr b, Ahmed Salah Salem b*
a Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
b Department of Cardiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
*Corresponding author: Ahmed Salah Salem, Tel.: +2 01069966565, Email: ahmedsalah@med.suez.edu.eg

ABSTRACT

Background: The major cause of illness and death is acute myocardial infarction (AMI). Therefore, to reduce death rates,
effective and precise diagnostic biomarkers are needed.
Objective: The aim of the current study was to evaluate the association between the expression of miRNA-499-5p and the
chemokine (C-C motif) ligand 18 (CCL18) in AMI and its related characteristics in Egyptian populations.
Patients and methods: A total of 150 participants were separated into 2 groups for a cross-sectional analytical study; AMI
group was composed of 75 patients with AMI, whereas the control subjects' group was made up of 75 people who seemed
to be healthy. Over a six-month period from March to September 2018, patients were chosen from the Cardiac Care Units
at Suez Canal University Hospital and General Hospital. Using 6-Quantitative Real-Time Polymerase Chain Reaction, the
expression of miRNA-499-5p in serum was measured. Using an enzyme-linked immunosorbent test, plasma CCL18 is
determined.
Results: Patients with AMI had considerably higher plasma levels of CCL18 than the control group (236.6 vs. 56.05 ng/mL;
P<0.001). Significant P-value indicates a positive correlation between plasma CCL18 and male sex, smoking, heart rate,
fasting blood sugar, and cardiac markers. In 89.3% of AMI patients, serum miRNA-499-5p expression was significantly
increased by 6.36-fold (P<0.001). Creatine kinase MB and cardiac troponin I both exhibited a positive connection with
serum miRNA-499-5p expression (P=0.003 and P=0.002, respectively). Additionally, serum miRNA-499-5p expression
and plasma CCL18 showed a positive connection (P=0.004).
Conclusion: CCL18 and miRNA 499-5p are potential biomarkers for AMI and possible predictors for the risk of myocardial
damage in Egyptians.
Keywords: CCL18, miRNA-499-5p, Acute myocardial infarction, Cross sectional study, Suez Canal University.

INTRODUCTION

Chemokines are small signaling proteins that attract
Coronary heart disease represents one of the main
circulating leukocytes to inflamed regions and activate
causes of death rates globally1. Atherosclerosis represents
them. Chemokine activate G protein-coupled receptors
one the important risk factors for cardiovascular events.
and stimulate chemotaxis6,7. CC chemokines are found at
Atherosclerosis is believed to be inflammatory process
the chronic inflammation sites and tend to attract
from onset to progression to plaque rupture2.
mononuclear cells6.
Acute myocardial infarction (AMI), angina
Chemokines has important role in atherosclerosis
pectoris, or ischemia can result from a plaque rupture.
and subsequent myocardial injury, and remodeling after
Myocyte necrosis that results from AMI triggers a range
acute coronary syndrome8. In acute cardiovascular
of biochemical intracellular signaling cascades, including
diseases, chemokines are involved in inflammation,
the release of inflammatory cytokines3.
necrosis, neovascularization, and leukocyte recruitment.
The extent of myocardial injury, subsequent left
At all stages of atherosclerosis, leukocyte recruitment and
ventricular remodeling and clinical prognosis are all
infiltration are critical. Atherosclerotic lesions express a
determined by inflammatory processes following an acute
number of chemokine, such as CCL3/MIP1a,
myocardial infarction and reperfusion4. Inflammatory
CCL5/RANTES,
and
CC
Chemokine
Ligand-
biomarkers have the potential to be good predictors of
18/pulmonary (CCL18/ PARC)9. The majority of CCL18/
cardiovascular outcome. Furthermore, they can help in
PARC is released in the lungs, where it attracts T
new treatment strategies, such as neutralizing certain
lymphocytes. In reaction to ischemia, this chemokine
leukocyte migration and inflammatory substances,
stimulates fibroblasts, causing lung fibrosis and perhaps
thereby affecting the progression of the illness, and
cardiac fibrosis10.
improving heart output after AMI,4 because
MicroRNAs (miRNAs) have recently attracted
atherosclerosis is caused by inflammation and immune
increased interest due to the fact that they are commonly
cells; it's not surprising that chemokines and chemokine
deregulated in a variety of clinical disorders, including
receptors have been related to AMI5.
cardiac illnesses11. Endogenous short non-coding RNAs
called miRNAs couple with specific places in the 3'
2839
Received: 05/10/2022
Accepted: 08/12/2022

Full Paper (vol.902 paper# 128)


c:\work\Jor\vol902_129 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2847-2851

Myopathic Changes in Patients with Long-term Fatigue after COVID-19
Elsayed Fathi Ali Hamed*
Department of Neurology, Faculty of Medicine, Alazhar University, New Damitta, Egypt
Department of Neurology, Alazhar University Hospital, New Damitta, Egpyt
Corresponding Author: Elsayed Fathi Ali Hamed, Mobile: 01224000280, E mail: drsayedfathy@gmil.com

ABSTRACT
Background:
Neurological symptoms during the acute infection include headache, disorientation, critical disease
myopathy, stroke, abnormal cerebral perfusion, and leptomeningeal augmentation, as well as Guillain-Barre syndrome.
Objective: The aim of the current study was to look at the electrical activity of peripheral nerve and muscle in patients
who had COVID-19-related continuing neuromuscular symptoms.
Patients and methods: This study was conducted in the period from Jan 2022 to June 2022. A total of 50 patients
participated in the study. All patients were monitored at the Neurology Department of Alazhar University Hospital, New
Damitta. In addition, 50 healthy controls matched for age and sex were recruited. All patients and healthy controls
completed a thorough clinical assessment and neurological examination, which included force measurement, deep
tendon reflex testing, and sensory evaluation, on the day of the neurophysiological assessment. The three average
neuropathy ratings for each patient were also recorded; The Utah Early Neuropathy Score (UENS), the Michigan
Neuropathy Screening Instrument (MNSI), and the Neuropathy Impairment Score (NIS).
Results: No statistical significant difference was found between the 2 studied groups regarding sex, age or BMI. The
results of the studied groups' quantitative electromyography (qEMG), nerve conduction studies (NCS), Peroneal MCV
(m/sec), Tibial MCV (m/sec), and Tibial minimum F-wave delay revealed extremely substantial difference between
case and control groups. Sural SCV (m/sec), or Sural SNAP amplitude (mV), with the exception of Ulnar MCV (m/sec),
Ulnar Palpitations, physical weariness, and myalgia all were significantly higher in the case group.
Conclusion:
A typical finding in long-term COVID-19 is myopathic qEMG. We suggest that myopathy may play a
significant role in these individuals' physical exhaustion.
Keywords: Myopathic changes, Long-term, Fatigue, COVID-19, Case control study, Alazhar University Hospital.

INTRODUCTION

PATIENTS AND METHODS
The novel coronavirus illness COVID-19 is mostly
A case-control study was conducted at Alazhar
caused by the severe acute respiratory syndrome 2
University Hospital, New Damitta. The study was
(SARS-CoV-2) virus, which has spread globally and is
conducted on 50 patients with COVID-19 diseases from
a serious health problem. Within the first year of the
January 2022 to June 2022. All patients had evidence of
outbreak, millions more became sick, and more than 2.5
prior SARS-CoV-2 infection through a polymerase
million people perished worldwide. In addition to
chain reaction (PCR) test or antibodies. The Department
having an impact on the nervous, cardiovascular, and
of Infectious Diseases' Long-Term COVID-19 Clinic
renal systems, COVID-19 also affects the pulmonary
forwarded each patient with the suspicion that they had
system (1).
neuropathy. All patients were followed at the Neurology
Among the neurological symptoms seen
Department, Faculty of Medicine, Alazhar University,
during the acute infection are headache, disorientation,
New Damitta. In addition, 50 healthy controls matched
Guillain-Barre syndrome, critical illness myopathy,
for age and sex were recruited. When COVID-19
stroke, aberrant cerebral perfusion, and leptomeningeal
patients with ongoing symptoms were sent for a
enhancement. There have been documented cases of
neurophysiological test, the Long-Term COVID-19
COVID-19 with varying degrees of severity, from those
Clinic assessed them. The patient's medical records
with no symptoms to those requiring intensive care units
were reviewed for persistent complaints.
(ICU) (2). Numerous studies have demonstrated that

COVID-19 can harm one's health in the long run, even
Clinical Examination: All patients and controls got a
in people who weren't admitted to the hospital.
thorough clinical examination as well as a neurological
However, with those who are healing from severe
examination that included force estimation, profound
COVID-19, especially those whom needed ICU care,
ligament reflexes, and tactile testing when they arrived
we expect persistent issues (3).
for the neurophysiological investigation. The three
It is currently unknown what causes COVID-
average neuropathy ratings for each patient were also
19's persistent symptoms, what causes their underlying
recorded: the Utah Early Neuropathy Score (UENS), the
mechanisms, and how long they last. As a result,
Michigan Neuropathy Screening Instrument (MNSI),
COVID-19's long-term neurological effects are still
and the Neuropathy Impedance Score (NIS).
unknown (4). The aim of the current study was to look at
UENS is a solid predictor of early neuropathy due to its
the electrical activity of peripheral nerve and muscle in
emphasis on tactile inclusion and division into
patients who had COVID-19-related continuing
subgroups that act on engine capability, little fibre
neuromuscular symptoms.
2847
Received: 01/09/2022
Accepted: 04/11/2022

Full Paper (vol.902 paper# 129)


c:\work\Jor\vol902_130 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2852-2857

Detection of Cytomegalovirus among Women with Abortion by Real Time PCR
Saja Hussain Kalaf1, Zahraa J. Jameel 2
1Department of Biology, Collage of science, University of Diyala, Iraq
2Department of Environment, Collage of Energy and Environmental Science, University of Al-karkh, Iraq

Corresponding Author: Zahraa J. Jameel, E-mail: dr.zahraa.j@kus.edu.iq.mobile:0096407729650289

ABSTRACT
Background:
The cytomegalovirus (CMV), which has a widespread distribution and can infect people at any stage of life,
is one of the opportunistic viruses. It is a major cause of prenatal and perinatal infections and may lead to important
complications in pregnancy.
Objective: This study was suggested to molecular screening for cytomegalovirus among sample women who suffered
miscarriage by using Real time PCR and identification of the UL97 gene by conventional PCR technique
Methodology:
The study includes 100 samples, 80 women who suffered from abortion and were referred to Al-Batool
Teaching Hospital and 20 healthy control women in a period between November 2021 and January 2022. Real-Time (PCR
qPCR) was used in the study's initial phase to detect HCMV DNA in blood samples.
Result: The result showed the HCMV DNA was detected in 8 (10.0%) out of 80 patients were found to be CMV positive.
Due to the necessity of early and accurate infection diagnosis before the development of their effects, even with low levels
of pathogenicity, the molecular strategy can be useful for achieving this objective. The polymerase chain reaction (PCR)
method was used in the study's second section to amplify the UL97 gene, which showed detection of the HCMV in 5
(62.5%) of specimens out of 8 (100 %) of a total specimens infected with HCMV that were collected from aborted women
and then detected by real time PCR technique.
Conclusions: There was no statistically significant difference between the study groups in terms of HCMV positive as
assessed by real-time PCR and the UL97 gene (p >0.05).

Keywords: Cytomegalovirus, Abortion, qPCR, UL97 gene.

INTRODUCTION


The cytomegalovirus is the most prevalent member
One of the many causes of prenatal harm that
of the herpes virus family (CMV). Human
results in abortion is the cytomegalovirus, also known as
cytomegalovirus (HCMV) is the largest common cause of
human herpes virus type 5 (7). When a fetus or embryo
congenital malformation resulting from viral intrauterine
naturally dies before it can survive on its own, it is known
infection in wealthy countries (1). HCMV is endemic in
as a spontaneous abortion or pregnancy loss. The first
the majority of the world's populations. In various
trimester accounts for around 80% of spontaneous
geographic regions, the prevalence rate of HCMV ranges
pregnancies loss, and the rate drops with each additional
from 30 to 100% (2). Viral infection can spread
week of gestation (8).
horizontally (via sexual contact or contact with fluids like
The viral phosphotransferase is encoded by the
saliva, breast milk, maternal vaginal secretions, or blood)
UL97 gene. It is in charge of phosphorylating Ganciclovir
as well as vertically (transplacentally from mother to
(GCV). Several conserved subdomains of the UL97
fetus) (3).
protein have distinct roles. Subdomains II, III, VIB, and
HCMV infections can be contracted during
VII are engaged in the phosphate transfer, subdomain IX
pregnancy, infancy, or maturity through sexual contact,
is necessary for substrate binding, and subdomain I is in
organ transplantation, or blood transfusions (4). The four
charge of ATP binding. Resistance to GCV may result
probable HCMV infection states are latent (non-
from mutations in the UL97 gene (9).
productive), lytic (productive), asymptomatic, or
Treatment for HCMV infection involves taking
symptomatic (5).
antiviral drugs such ganciclovir (GCV), cidofovir, and
The human herpes virus with the highest genetic
foscarnet. The nucleoside analogue GCV is a prodrug that
content is cytomegalovirus. Compared to HSV, it has a
requires phosphorylation to become functional (10).
DNA genome that is 240 kbp bigger. Over 200 different
The best approach for detecting CMV was
proteins that make up the virus have only been partially
determined to be Real Time PCR, followed by ELISA and
identified. Once, a cell surface glycoprotein, acts as an Fc
fast testing. All of these methods were shown to be helpful
receptor by non-specifically attaching to the Fc portion of
for both diagnosis and therapy. Nucleic acid tests take less
immunoglobulins. Infected cells may be able to thwart
time to complete because real-time PCR eliminates the
immune clearance by secreting a coating of ineffective
need for post-PCR processing procedures (11).
host immunoglobulins (6).
The goals of this study was to know the problem of

abortion and its relationship to cytomegalovirus and to
2852
Received: 05/10/2022
Accepted: 08/12/2022

Full Paper (vol.902 paper# 130)


c:\work\Jor\vol902_131 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2858-2862

The Role of Procalcitonin and Serum Amyloid a As a Laboratory
Biomarker in COVID-19
Sura A. Nayef*, Muntaha M. Hassan, Hazim I. Ghazzay
University of Anbar, College of Medicine, Iraq
Corresponding Author: Sura A. Nayef, Phone: +96 407903806005, E-Mail: Suranayf@gmail.com

ABSTRACT
Background:
Recent research demonstrates the critical impact that cytokine storm and intensive immune response
against the virus play in worsening the severity and death of illness. Biomarkers such as Procalcitonin (PCT), Serum
Amyloid A (SAA) play a part in the etiology of severe COVID-19 and may serve as an early indicator for severity.
Objective: The current study aimed to determine the serum concentrations of these laboratory biomarkers (PCT and
SAA) in asymptomatic, moderate, severe and critical COVID-19 patients and to compare them to healthy controls.
Patients and methods: A total of 100 patients by positive RT-PCR COVID-19 results besides a control group of 46
healthy participants with negative RT-PCR results. Patients were classified as 4 groups; critical, severe, moderate, or
asymptomatic, according to WHO standards. Enzyme-Linked Immune Sorbent Assay (ELISA) was used by (CV Human
Reader HS REF 16670) to measure PCT and SAA.
Results: Mean level of PCT is 404.59 pg/ml and SAA 19.1 pg/ml among patients more than controls (127.65 and 10.64,
respectively). Mean levels were higher among both PCT and SAA in critical (680.84 and 28.46, respectively) and severe
(565.86 and 23.27, respectively) of COVID-19 patients, other than moderate (226.98 and 13.71, respectively) and
asymptomatic (144.67 and 10.75, respectively). Conclusion: There was a major alteration in the level of PCT and SAA
among patients groups (critical, severe, moderate, and asymptomatic) and control group. A strong correlation was found
between biomarkers high concentrations, old age, and chronic diseases with the disease severity.
Keywords: Serum Amyloid A, Procalcitonin, COVID-19, Prognosis, Case control study, University of Anbar.

INTRODUCTION


This respiratory infection has spread globally
offer more evidence for clinical finding and
after the coronavirus disease 19 (COVID-19) outbreak
management, this task will examine selected indices of
in China in December 2019, becoming a pandemic that
peripheral blood analysis and biochemical analysis with
has infected millions of people and spread to numerous
[Procalcitonin (PCT), Serum amyloid A (SAA) and
countries (1).
lymphocyte count] in COVID-19 patients, PCT has
Furthermost patients infected by SARS-CoV-2
used as a diagnostic marker in clinical practice (7). PCT
have mild illness and existing common symptoms for
is released by all parenchymal tissue under the influence
example fever, cough, besides fatigue (2).
of endotoxins and pro-inflammatory cytokines.
A minor number of infected patients would
Increased levels of PCT, the 116-amino acid precursor
development to severe cases with acute respiratory
of the hormone calcitonin, are positively correlated with
distress syndrome. Some patients with severe and
COVID-19 severity, a marker of secondary bacterial
critical illness would degenerate in a short period of
infection (8).
time and die rapidly due to multiple organ failure,
Various viral and bacterial infections have been
especially in elderly patients (3).
proven to cause a rise in SAA, an acute-phase reactant
In severe and critical COVID-19, the number of
that release by the liver (9). The level of SAA has newly
inflammatory and non-inflammatory markers increased.
been measured in biological fluids from patients with
Some of these indicators were utilized to assess the
different lung diseases (10).
severity and prognosis of pneumonia. It is well
In this study, we sought to determine whether, in
recognized that the generation of pro-inflammatory
addition to the primary parameters, it is possible to use
cytokines typically characterizes dysregulated innate
these inflammatory markers to assess the severity of the
and adaptive immune responses (4).
disease in COVID-19 patients and to support the
Pro-inflammatory cytokines, such as COVID-19,
diagnosis of COVID-19 patients. We also sought to
IL-6, and IL-10, which have been used to support
determine whether these indices from routine laboratory
diagnosis, monitor treatment, and assess illness
testing are useful in predicting prognosis in COVID-19
severity, can be utilized as predictors for quick detection
patients.
of individuals at higher risk of disease and assist doctors

(5).
PATIENTS AND METHODS
Except for these strictures, many other parameters
Study was carried out on 146 persons, divided into
too can be easy to get after routine blood and
two groups; 100 patients with positive RT-PCR
biochemical investigation (6). In order to identify
COVID-19 test, and a control group of 46 healthy
whether other indices from common laboratory testing
persons with negative RT-PCR test.
have prophetic value in patients with COVID-19, and
2858
Received: 05/10/2022
Accepted: 08/12/2022

Full Paper (vol.902 paper# 131)


c:\work\Jor\vol902_132 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2863-2866

Impact of COVID-19 on Chronic Stable Coronary Artery Disease
Mahmoud Tantawy1*, Ahmed Elbarbary1
Departments of 1Cardiology and 2Internal Medicine, Faculty of Medicine,
Misr University for Science and Technology, Egypt
*Corresponding Author: Mahmoud Tantawy, Mobile: (+20) 01221865587, Email: drmtantawy@yahoo.com

ABSTRACT
Background:
Cardiac risk factors and diseases have been linked to worse outcomes related to COVID-19 infection.
The goal of treatment in such patients is targeting disease stabilization or regression. However, at any time this chronic
disease can change to acute coronary syndrome (ACS) due to plaque rupture with either a precipitating factor or
without. Objective: The aim of the current study was to detect the impact of COVID-19 infection on patients with
chronic coronary artery disease.
Patients and methods: A total of 102 patients with chronic coronary syndrome treated from May 2020 to September
2021 at Misr University of Science and Technology Hospitals were enrolled in our study. This cohort of patients was
divided into two groups: Group 1 (COVID-19 Group) included patients with chronic coronary syndrome and being
infected by COVID-19, while Group 2 (Control Group) included patients with chronic coronary syndrome without
COVID-19 infection. Participants were followed up period of 6 months. Study outcomes were mortality and major
adverse cardiovascular events (MACE) within 6 months follow up from COVID-19 diagnosis.
Results: There were statistically significant increase in number of patients with unstable angina and non-ST-elevation
myocardial infarction (NSTEMI) in the COVID-19 Group versus Control Group (54.8% versus 35%, respectively).
As regard left ventricular (LV) dysfunction, congestive heart failure, percutaneous coronary intervention (PCI),
coronary artery bypass graft surgery (CABG), ST-elevation myocardial infarction (STEMI), and death, these were
more prominent in COVID-19 (Group 1) than in control group with chronic stable angina but without COVID-19
(Group 2) but without statistically significant difference.
Conclusion: COVID-19 infection could have a direct worsening effect on coronary artery disease.
Keywords: COVID-19, Chronic coronary syndrome, Acute coronary syndrome, Major adverse cardiovascular events.


INTRODUCTION

Although COVID-19 is a primary lung disease
The aim of the current study was to detect the
with known lung infiltrates, it has shown other hepatic,
impact of COVID-19 infection on patients with chronic
renal and cardiac affection (1,2). There is a bidirectional
coronary artery disease.
relationship between COVID-19 and cardiac illness.

Cardiac risk factors and diseases have been linked to
PATIENTS AND METHODS
high suspicion for COVID-19 infection and more severe
A total of 102 patients with chronic coronary
cases with worse outcomes (2).
syndrome treated from May 2020 to September 2021 at
Patients with chronic coronary syndrome (CCS)
Misr University of Science and Technology Hospitals
have been demonstrated to have a higher risk of having
were enrolled in our study. This cohort of patients was
severe COVID-19, and to have a higher mortality rate
divided into two groups: Group 1 (COVID-19 Group)
due to the disease. CCS patients may also be at a higher
included patients with chronic coronary syndrome and
risk for long-term COVID-19 problems as lung fibrosis
being infected by COVID-19, while Group 2 (Control
and cardiac injury, according to some studies (3).
Group) included patients with chronic coronary
syndrome without COVID-19 infection.
On the other side, COVID-19 infection induced

cardiac diseases like myocarditis, thromboembolism,
Inclusion criteria: All patients with previous
and arrhythmias. Some clinical studies have reported
confirmed stable coronary artery disease, and mild and
interaction between some cardiac diseases and
moderate cases of COVID-19 infection.
commonly used medications for COVID-19 (1,2).
Exclusion criteria: Patients <18 years old and above
Patients diagnosed with chronic stable angina are
80 years old, severe cases of COVID-19 that need
usually chronic long-standing patients with angina that
ventilation, and patients without previous history of
is being controlled by lifestyle modifications, medical
coronary artery disease.
treatment with or without coronary intervention. The

goal of treatment in such patients is targeting disease
Follow up for 6 months duration:
stabilization or regression. However, at any time this
Follow up for 6 months by thorough history taking,
chronic disease can change to acute coronary syndrome
clinical examination, ECG, and echocardiography.
(ACS) due to plaque rupture with either a precipitating
Special attention was given for any deterioration of
factor or without (3).
anginal symptoms, ECG, or echocardiography.
2863
Received: 07/10/2022
Accepted: 10/12/2022

Full Paper (vol.902 paper# 132)


c:\work\Jor\vol902_133 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2867-2873

Psychosocial Factors in Relation to Disability in Patients with
Chronic Low Back Pain
Heba Abdel Fattah Atya Hassan1, Miada Nagy Almohamady Abdallah2
1 Resident of Rheumatology and Rehabilitation, El GAlaa Teaching Hospital, Cairo, Egypt
2 Rheumatology and Rehabilitation Specialist, Ahmed Maher Teaching Hospital, Egypt
*Corresponding author: Heba Abd-El Fatah Attia, Mobile: (+20) 01028317209, E-Mail: hebaatya@hotmail.com

ABSTRACT
Background
: One of the most common complaints is low back pain (LBP). It adds a lot of extra effort for general
practitioners. Objective: The aim of the current study was to assess the impact of various risk factors, in particular
psychosocial factors on pain intensity and disability in patients with chronic LBP.
Patients and methods: The present case control study comprised 30 adult patients suffering from low back pain, persisting
for more than 6 months in duration, as well as, 30 adult healthy (pain-free) individuals of matching age, sex and BMI.
Results:
Pain intensity by VAS was positively correlated with Total Oswestry Disability Questionnaire had moderate to
severe disability (P<0.001). As for disability, it was positively correlated with age but not with disease duration (P<0.05).
Beliefs and attitudes by SOPA showed that patients had statistically significant higher scoring than controls regarding
disability, harm and emotions sub-items. Pain and disability were statistically significantly correlated with disability, harm,
emotion and solicitude sub-items.
Conclusion:
Psychological factors interactions are of utmost importance in chronic LBP patients. Hence, their assessment
is crucial for any comprehensive evaluation and management of a chronic pain patient. Anxiety and depression were
associated with chronic LBP patients. Negative attitudes and beliefs are increasingly accepted as having an important role
in disability related to back problems.
Keywords
: Psychosocial Factors, Disability, Low Back Pain.

INTRODUCTION
The aim of the current study was to assess the
One of the most common complaints is low back
impact of various risk factors, in particular psychosocial
pain (LBP). It makes a significant impact on the
factors on pain intensity and disability in patients with
workload of family medicine. In any given year, 7% of
chronic LBP.
the adult population will seek help for this issue. It is

widely accepted, however, that the majority of these
PATIENTS AND METHODS
episodes will be brief, and that "80-90 percent" of
The present case control study included 60 participants
episodes of LBP recover in roughly six weeks (1).
recruited from El GAlaa Teaching Hospital and Ahmed
About 35% will eventually experience chronic,
Maher Teaching Hospital.
persistent pain, incapacity in everyday living, and work
Patient Group: A total of 30 adult patients,
loss. Most occurrences of pain cannot have a specific
complaining of LBP of mechanical origin, which lasts
origin pinpointed. However, there is only a modest
more than 6 months were enrolled in our study. Patients
relationship between the etiology and the occurrence of
with LBP less than 6 months, having LBP as a result of,
back discomfort. It's possible that the causes of the first
inflammatory,
infective,
neoplastic,
traumatic,
pain are distinct from those of the chronic pain (2).
metabolic, or congenital abnormalities or having
Disabilities are common, and LBP is a major
referred LBP were excluded from the study.
contributor. It has been said that back pain disability is a
phenomenon of the 20th century. Patients with similar
Control Group: A total of 30 healthy individuals of
physical findings in the back may have widely varying
matching age, sex and BMI, served as a control group.
degrees of impairment (3).
All subjects were assessed for history, general
A growing body of evidence suggests that patients'
examination with pulse, blood pressure, temperature
attitudes and beliefs especially fear avoidance beliefs and
and respiratory rate measuring and BMI. Lower limbs
passive coping techniques play a significant role in the
were examined for motor, sensory and reflexes.
development of disability due to back disorders (3).
Spinal Movements:
The likelihood that pain, disability, and time away
Anterior spinal flexion: The patient was advised
from work will persist over time can be predicted in large
to stand with his feet together and bend forward
part by psychological factors. However, depression
until his fingers touched the floor (the patient
symptoms may take precedence over pain characteristics
flexes to within 10 cm from the floor).
when determining whether or not someone with chronic

low back pain should seek medical attention. Low back
Lateral spinal flexion: The patient was instructed
pain consultations should take into account patients'
to run his hands down each of his legs, one at a
psychological and social circumstances (4).
time, and mark the distance, in cm, that his hands
travelled before touching the floor. The patient was
instructed to run his hands down each of his legs,
2867
Received: 25/09/2022
Accepted: 28/11/2022

Full Paper (vol.902 paper# 133)


c:\work\Jor\vol902_134 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2874-2888

Standardization of Reference Values for Fetal Gastric Size in Normal Gestation
Waleed Abd Elfattah Mousa1, Reham Sayed Ahmed Mohamed ElGendy2*, Tarek Fawzy Abd Ella1
1 Radiodiagnosis Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Menoufia, Egypt
2 Shebin ElKom Teaching Hospital, Shebin Elkom, Menoufia, Egypt
*Corresponding author: Reham Elgendy, Mobile: (+20) 0100 651 9563, Email: rehamelgendy648@gmail.com

ABSTRACT
Background:
On ultrasound, the stomach may be seen in the fetal abdomen's left upper quadrant as an echolucent
organ. At around 14 weeks of gestation, the larger and lesser curvatures, the fundus, the body, and the pylorus can all
be seen as part of the stomach's distinctive structure. Numerous malformations and a poor fetal outcome can be linked
to a fetal stomach that is non-visualized, dilated, or even tiny.
Objectives: The aim of the current study was to establish standardized reference values for fetal stomach size throughout
normal pregnancy as demonstrated during routine antenatal ultrasonography.
Patients and methods: This was a longitudinal multicentric study of 260 normal singleton Pregnancies, sonographic
evaluation was carried out between the 14th and 40th weeks of gestation. The pregnant women entered the study during
the period from January 2020 to October 2022 and were evaluated in the unit of ultrasonography of Menoufia University
Hospitals.
Results: Fetal gastric area was found more significant correlated with gastric circumference (r=0.991, P-value <0.001)
and gastric volume (r=0.988, P-value <0.001), however fetal gastric area was found less significant correlated with
gestational age (r=0.962, P-value <0.001) and gastric longitudinal diameter (r=0.968, P-value <0.001). Fetal gastric area
was more significant correlated with abdominal volume (r=0.928, P-value <0.001) and abdominal area (r=0.914, P-value
<0.001), however fetal gastric area was less significant correlated with Abdominal longitudinal (r=0.863, P-value
<0.001) and abdominal anterior posterior diameter (r=0.866, P-value <0.001).
Conclusions: In a healthy pregnancy, fetal stomach dimensions are correlated with gestational age, and a nomogram of
fetal gastric development may be helpful in determining if the fetus is developing normally and whether any digestive
system abnormalities exist.
Keywords: Fetal abdomen, Fetal gastric size, Fetal stomach\abdomen ratio, Gastric area, Normal gestation.

INTRODUCTION


On ultrasound, the stomach may be seen in the

fetal abdomen's left upper quadrant as an echolucent
Fetal gastric volume measures, obtained using
organ. After 10 weeks of gestation, measurements of the
sonography, seem to be helpful in evaluating digestive
stomach region and sonographic vision of the fetal
system abnormalities (4).
stomach are both feasible. At around 14 weeks of
An appropriate selection of transabdominal
gestation, the fundus, body, and pylorus, as well as the
ultrasound pictures is necessary for fetal AC
larger and lesser curvatures, may be seen as the
measurement. The stomach bubble (SB) and the portal
stomach's unique anatomy (1).
segment from the umbilical vein (UV), which has the
For the determination and measurement of gastric
recognizable "hockey-stick" look, must be present in the
longitudinal dimensions, the ultrasonic plane that
typical AC plane (5).
supplied the biggest stomach area, including the
The interplay of at least four processes--
pylorus, on a transverse and oblique slice, was utilized.
swallowing, stomach secretion, stomach absorption,
Transverse and anterior-posterior dimensions were
and stomach emptying--determines the size of the fetal
measured using the transverse slice at the gastric
stomach. Because stomach filling and emptying are
corpus's
center.
Also
measured
were
the
dynamic processes, regular pregnancies can result in
circumferences
of
the
abdomen.
Abdominal
changes in gastric size over time (6).
circumference and stomach size are significantly
The aim of the current study was to establish
correlated (2).
standardized reference values for fetal stomach size
Numerous malformations and a poor fetal
throughout normal pregnancy as demonstrated during
outcome can be linked to a fetal stomach that is non-
routine antenatal ultrasonography.
visualized, dilated, or even tiny. In order to determine

the normal limits of fetal stomach growth, efforts were
PATIENTS AND METHODS
made to measure the stomach circumference
This was a longitudinal multicentric study of 260
(SC)/abdominal circumference (AC) ratio.
normal singleton Pregnancies, sonographic evaluation
Despite being an organ that is always evolving,
was carried out between the 14th and 40th weeks of
the fetal stomach can be estimated by using the SC/AC
gestation.
ratio as a possible measure (3).



2874
Received:7/10/2022
Accepted:10/12/2022

Full Paper (vol.902 paper# 134)


c:\work\Jor\vol902_135 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2889-2895

Survey on Pattern and Determinants of Blood Transfusion in
Benha Neonatal Intensive Unit
Aliaa Mohamed ElHady Diab, Omima Mohammed Abdel Haie,
Hager Ahmed Basuney*, Marwa Elsayed Ahmed
Department of Pediatrics, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Hager Ahmed Basuney, Mobile: (+20) 01021216976, E-Mail: drhager661@gmail.com

ABSTRACT

Background: Blood transfusion is used to replenish lost blood components in a number of medical situations.
Objective: To identify blood transfusion indications, complications and frequency in Benha neonatal intensive care
(NICU). Patients and Methods: This research was carried out on all neonates attended to NICU in Benha University
Hospital between January 2022 and July 2022. A number of 173 neonates were admitted to NICU during the study
period, 51 (29.5%) of them needed blood transfusion.
Results: Neonates who had blood transfusion consisted of 27 males (52.9%) and 24 females (47.1%); their mean
gestational age was 32.7±3.1 weeks. The most common causes of blood transfusion in the studied group were anemia
of prematurity (29.4%), followed by neonatal sepsis (16.9%). Most cases (49%) received blood transfusion at 7 to 14
days. Neonates who had blood transfusion had statistically higher frequency of mortality and longer duration of hospital
stay compared to neonates who didn't have blood transfusion. Multiple linear regression analysis revealed that
gestational age, weight, and need of oxygen support are potential predictors for blood transfusion.
Conclusion: Rate of transfusion in the newborn unit was 29.5%. The most common causes of blood transfusion in the
studied group are anemia of prematurity (29.4%), followed by neonatal sepsis (16.9%). Efforts are required to prevent
preterm labour and sepsis, in order to decrease the need for transfusions in neonatal units.
Keywords: Blood transfusion, NICU, Preterm, Neonatal.

INTRODUCTION

infrastructure, despite the high demand. Furthermore,
Blood transfusion is a vital method of medical
facilities for rigorous blood screening before transfusion
therapy, especially in pediatrics, where prevalent
are very restricted; thus, danger of transmitting illnesses
diseases are often associated with blood loss or
such as hepatitis, CMV, syphilis, and HIV is elevated
destruction. The treatment restores the blood's volume
(5). Despite the inadequate blood storage system,
and particular components, that have distinct
neonatologists in this region of the globe are faced with
functions in oxygen transport, immunity, and
the clinical necessity of transfusing a high number of
coagulation. By improving cardiac output and oxygen
critically sick infants with blood. This renders precise
supply to tissues, and by eliminating toxins such as
compliance with international criteria for the use of
bilirubin from the body, blood transfusions are
blood and its derivatives challenging in underdeveloped
necessary to sustain life (1).
nations (2).
Neonatal transfusions may be necessary for
Many NICUs have adopted packed red blood
physiological or pathological reasons. Anemia of
cells (RBCs) transfusion protocols to reduce
prematurity is a physiological condition associated with
transfusions number given to severely unwell neonates.
insufficient maternofetal iron transfer and inadequate
Neonatal patients maintained without reference for
postnatal synthesis of endogenous erythropoietin in
transfusion guidelines are twice as likely to require a
newborns. In sections of developing world, where
blood transfusion as neonates handled according to
recombinant erythropoietin is accessible, blood
recommendations (2). It has been determined that strict
donation is a widespread procedure, but replacement
adherence to rules reduces exposure of extremely low
treatment using manufactured erythropoietin is
birth-weight neonates to donor products of blood; as a
prevalent in the developed world(2).
result, our institution and others have adopted
In the developing world, the primary causes of
guidelines. In addition to recommendations, the choice
newborn morbidity and death are mechanical and
to transfuse often depends on the clinical situation of the
chemical birth traumas, jaundice and infections. These
patient (i.e. increasing apnea and desaturations). These
problems may be related to hemolysis, coagulation
symptoms may also be caused by infection,
abnormalities, or the buildup of potential poisons (3).
gastroesophageal
reflux,
respiratory
distress,
Frequently, neonatal bleeding issues need blood
prematurity apnea, or necrotizing enterocolitis (6).
transfusions. In such cases, blood transfusion is
The aim of this research was to identify blood
necessary to avoid mortality due to sudden circulatory
transfusion indications, complications and frequency in
collapse or serious hypoxemia (4).
Benha NICU.
In most regions of the poor world, the practice of

using blood and its derivatives in newborn care is
PATIENTS AND METHODS
riddled with the issue of an ineffective blood banking
2889
Received: 06/10/2022
Accepted: 09/12/2022

Full Paper (vol.902 paper# 135)


c:\work\Jor\vol902_136 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2896-2899

Prognostic Value of Echocardiography in Recovered COVID-19 Patients: Review Article
Montaser Mostafa Alcekelly, Hisham Samir Roshdy, Mohamed Abdelrahim Mohamed*, Alaa ElSayed Salama
Department of Cardiology, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding author: Mohamed Abdelrahim Mohamed, E-Mail: Mohamedrahim877@gmail.com

ABSTRACT
Global health is under danger due to COVID-19's overwhelming global spread. Despite the fact that the respiratory
system is the primary organ affected by SARS-CoV-2, there is mounting evidence that it can also impact the cardiovascular
system. A useful tool for assessing cardiovascular disease is echocardiography. It is affordable, broadly accessible, and
offers data that can affect management. Leading international societies advice using only echocardiography when a potential
clinical benefit exists, favoring focused assessments, and employing smaller portable equipment due to the danger of staff
infection and equipment contamination during the procedure. Several investigations over the past few several different types
of echocardiographic anomalies have been described for months in COVID-19 individuals. These findings are summarized
in this review, which also discusses potential contributing mechanisms.
Keywords: COVID19, Cardiovascular disease, Echocardiography, Review, Zagazig University.

INTRODUCTION


Impaired ventricular performance is linked to
responses, inflammatory and immunological reactions,
myocarditis, myocardial injury, arrhythmia, HF, venous
deconditioning, and post-traumatic stress disorder. These
thromboembolism, myocardial ischemia, and necrosis, all
conditions may increase the likelihood of myocardial
of which increase the risk of patient mortality. Numerous
damage and inflammation, which may lead to left
more direct or indirect cardiovascular problems are
ventricular dysfunction (4).
connected to COVID-19 infection (1).
It has long been known that COVID-19 causes

multiorgan involvement, and that cardiac dysfunction is
Echocardiographic manifestations in COVID-19:
linked to worse outcomes (6). Due to the potential for
The 2DE is a crucial, noninvasive test that aids in
disease transmission, although it is rarely used, 2DE is
determining hemodynamic and cardiac condition.
incredibly beneficial in this patient population (7). It
Patients with COVID-19 who have multiple organ
enables noninvasive assessment of the patient's
involvement, two-dimensional echocardiography (2DE)
hemodynamic and heart health, providing information on
has become increasingly important, particularly in
the severity of the illness (6). Additionally, in these people,
situations with Instability of hemodynamics Routine 2DE
2DE can be utilized to rule out obstructive diseases (such
is not recommended for all patients due to the risk of
cardiac tamponade and pulmonary embolism) as well as
infection, and there are presently no thorough 2DE studies
hypovolemic shock (decreased cardiac output and
in COVID-19 patients (2).
collapsed IVC) (8).
More COVID- 19 patients continue to report
Patients with COVID-19 have been proven to have
persistent symptoms, even weeks after the acute stage of
worse prognoses when they have myocardial damage (9).
a viral infection, such as lassitude, palpitations, impaired
According to a recent report, the left heart of these
exercise tolerance, shortness of breath, chest pain,
patients may show myocardial involvement, segmental
neurocognitive challenges, muscle pains and weakness,
contraction abnormalities, or global hypokinesia as a
gloominess, anxiety, and other mental health problems (3).
result of hypoxia damage, respiratory strain, and
In their investigation, Greenhalgh et al. classified this
inflammation (10) has demonstrated that a decrease in
condition as post-acute. If symptoms persist for more than
RVGLS (less than 23%) may have a predictive
three months after the illness's beginning and extended if
significance in COVID-19 patients, even though LVEF
symptoms last for three to twelve weeks, COVID-19 (4).
was not lowered. Then again, Szekely et al. (11) According
Between 10% and 50% of instances are recorded in
to research, patients with myocardial damage and worse
various studies, which is a significant variation in its
clinical circumstances had poorer RV function compared
reported occurrence (5). Contrary to post-acute syndromes
to those with normal troponin levels or moderate clinical
acquired after other serious illnesses, patients with the
symptoms. These patients' LV systolic performance did
post-acute COVID-19 condition have been described with
not differ considerably.
mild or severe manifestations of the disease, who did not
Another study revealed that patients with dilated
require intensive care unit admission. Unknown are the
and impaired RV function on echocardiography that was
causes of the post-acute COVID-19 syndrome. Some
done had LV systolic function that was normal or
papers relate chronic viremia to relapse and/or reinfection
hyperdynamic within 5 days of hospital admission (12).
with SARS-CoV-2, inadequate or nonexistent antibody
2896
Received: 06/10/2022
Accepted: 09/12/2022

Full Paper (vol.902 paper# 136)


c:\work\Jor\vol902_137 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2900-2908

Amino Acid as Co-Crystal Coformer for Ebastine Solubility Enhancement
Zainab M.Salih, Eman B. H. Al-Khedairy
1Department of Pharmaceutics College of Pharmacy, University of Baghdad, Baghdad, Iraq.
*Corresponding author: Zainab M.Salih. E-Mail: zainab.mahdi1200m@copharm.uobaghdad.edu.iq , Phone:+9640750 560
1381

ABSTRACT
Background
: Ebastine (EB) is a selective, nonsedating H1 antihistamine belonging to Class II(BCS); its insufficient
water solubility limits its oral bioavailability. Cocrystal is one of the most modern techniques used to increase the
solubility and dissolving rate of a medicine, among other physicochemical properties.
Aim: The primary purpose of this study was to construct and assess EB cocrystal as an experiment to improve its
solubility.
Methods: Various processes, such as solvent evaporation and liquid asset grinding with varying molar ratios of amino
acid as a co-former, have been used to produce cocrystals. The produced formulations were evaluated by yield %, drug
content, saturation solubility, in vitro dissolution tests, Powder X-ray Diffraction (PXRD), and scanning electron
microscopy.
Results: Increased solubility by 364 times in distilled water with an improved dissolving profile.
Conclusion
: Due to its ability to enhance physicochemical and mechanical qualities, co-crystallization is a promising
method for solid formation. Using unique hydrogen bond synthon motifs, co-crystals have been successfully produced
from several medications and co-former
Keyword: Ebastine,l-prolin ,l-histidin ,asparagine ,solvent evaporation ,liquid assist grinding.

INTRODUCTION
Pharmaceutical co-crystals
Recent researches in pharmaceutical formulations
A "pharmaceutical co-crystal" is created via hydrogen
aimed to improve material, dissolution, and storage
bonding or other non-covalent bond, such - interaction
stability of active pharmaceutical ingredients (1).
and van- der-Waals bond, between an active
The Food and Drug Administration (FDA) defines
pharmaceutical ingredient (API) and a coformer in a
typical co-crystal as "multi-component solid crystal
specific stoichiometry ratio. Coformer is either ionic or a
supermolecular complexes comprised of two or more
neutrally nontoxic inactive chemical selected from the
constituents inside a crystals lattice where the constituents
(FDA) and (GRAS) list, or it is another active
are in the neutral state and interact through non-ionic bond
pharmaceutical
ingredient.
Co-crystal
formation
(2,3,4)
necessitates knowledge of the drug's target, selection of a
Co-crystals are often classified into two types, which
suitable coformer, and many tests (8).
are both molecular and ionic co-crystals. Molecular co-
Co-crystal formation permits the modification of key
crystals consist of two or more different neutral
physicochemical properties of pharmaceuticals, such as
components and are kept together by hydrogen or halogen
solubility, dissolution rate, temperature and humidity
bonds .On the other hand, ionic co-crystals have at least
stability, and compressibility. The co-crystal synthesis of
one ionic component and were maintained by
medicinal compounds a substantial occasion for the
coordination bonds or charge-aided hydrogen bonds in
progress of pharmaceutical products with improved
the case of the presence of metal cations (5).
physicochemical qualities that do not alter their
Cocrystallization was defined as the modification of
pharmacological effects. Due to this, there has been a
a compound molecular structure and altering its physical
significant push to generate cocrystals for a variety of
properties. This modification can be used industrially to
applications, making cocrystallization the preferred
minimize the need for additional additives and allowing
approach in pharmaceutical sciences. (9).
the physicochemical properties of drugs to be improved(6).
Advantages of co-crystals
Amino acids are natural zwitterionic molecules with
Improving the solubility
relatively low toxicity compared to other coformers
Solubility and dissolution rate played a significant
In addition, research indicated that it was
influence in determining the pace and degree of
straightforward for amino acids to build charge-aided
absorption.
hydrogen bonding chains in crystalline stages and co-
Co-crystals were believed to feature a mechanism that
crystals. Amino and carboxyl groups of amino acids were
promotes solubility by changing the lattice and solvation
good hydrogen bond donors and acceptors, making amino
energies, and increasing the solvent affinity due to
acids excellent candidates for zwitterionic coformers co-
presence of coformer(8).
crystals (7).
2900
Received: 06/10/2022
Accepted: 09/12/2022

Full Paper (vol.902 paper# 137)


c:\work\Jor\vol902_138 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2909-2914

The Efficacy of Repetitive Transcranial Magnetic Stimulation in
Treating Patients with Chronic Daily Headache
Elsayed Fathi Ali Hamed*
Department of Neurology, Faculty of Medicine, Al-Azhar University, New Damietta, Egypt
Department of Neurology, Alazhar University Hospital, New Damietta, Egpyt
Corresponding Author: Elsayed Fathi Ali Hamed, Mobile: 01224000280, E mail: drsayedfathy@gmil.com

ABSTRACT
Background:
Chronic daily headache (CDH) is a headache that lasts at least 15 days, 3 months, and 4 hours a day
without treatment. Transcranial Magnetic Stimulation (TMS) uses short magnetic pulses over the head to temporarily
alter brain cortical excitability. Prefrontal cortex rTMS has shown analgesic benefits.
Objective:
The purpose of the current study was to assess the effectiveness of repetitive transcranial magnetic
stimulation in the management of chronic daily headache patients.
Patients and methods: A clinical trial was conducted in the period from July 2022 to December 2022 A total of 40
patients participated in the study. All patients were monitored at the Neurology Department of Al-Azhar University
Hospital, New Damitta. A total of 25 patients made up the experimental group, which received genuine (5 Hz) rTMS,
while 15 patients made up the control group received phoney (5 Hz) rTMS.
Results: There were no statistically significant differences between the intervention and control groups in terms of age,
sex, BMI, headache frequency, or duration. Prior to treatment, the intervention and control groups had comparable
incidence and indices of headache. Following therapy, compared to the control group, the intervention group's headache
frequency and index considerably decreased. The severity of the headaches before treatment was similar between the
intervention and control groups. Following therapy, the intervention group's headache severity dramatically decreased
as compared to the control group.
Conclusion: Patients whom suffer from chronic migraines and tension headaches may be effectively treated and
prevented using high-frequency rTMS. In light of this, it is advised that patients with chronic daily headaches, especially
those who are not responding to therapy, consider high-frequency rTMS as a potential treatment.
Keywords: Chronic tension-type headache, Transcranial Magnetic Stimulation, Treatment, Chronic Daily Headache,
Clinical trial, Alazhar University.

INTRODUCTION
aura is visual, and it might manifest as zigzag lines or a
A chronic daily headache is a headache that goes
large scintillating scotoma (5).
untreated for at least 15 days out of every month, for at
Transcranial magnetic stimulation (TMS) is a non-
least three months, and for at least four hours each day
invasive and safe method of altering the cortical
(CDH). Chronic tension-type headache and chronic
excitability of the brain by delivering brief magnetic
migraine are examples of primary CDH, as are new-
pulses over the head. In animal models, TMS was
onset everyday pain and hemicrania continuous (1).
observed to reduce cortical spreading depression,
Chronic tension type headache (CTTH) is the most
suggesting potential therapeutic use, particularly in
common type of headache. This is the basis for 80% of
migraine attacks accompanied by an aura. The
headache diagnoses (2). CTTH is distinguished clinically
repetition frequency of transcranial magnetic
by the lack of differentiating signs and symptoms, a
stimulation (rTMS), measured in hertz (Hz) or pulses
mild headache that is never severe, and the absence of
per second (6).
migraine features. Patients frequently exhibit minor
Low-frequency (slow) and high-frequency (fast)
phonophobia, photophobia, or none of these symptoms
rTMS are classified into frequency categories using
(3). Aching, pressure, and the sense that a tight band is
frequencies of 1 Hz or less and bigger (ranging between
tightening around the head are all symptoms of pain.
5 and 25 Hz). Another aspect connected with
Migraine is a frequent neurological condition. Statistics
stimulation is the strength of stimulation, which is
show that 18% of men and 43% of women will suffer
described as a percentage of each person's resting motor
from a migraine at some point in their lives. The most
threshold. The underlying brain may be permanently
common description of migraine is recurrent, pulsating
altered as a result of recurrent TMS. The prefrontal
or throbbing, moderate to severe, unilateral pain lasting
cortex may be especially helpful in reducing the
4­72 hours with complete relief in between attacks
emotional, attentional, and affective components of pain
(episodic).In addition to the headache, nausea, and
(7).
vomiting; there may be abnormalities in the senses of
Prior studies have indicated that prefrontal cortex
sight, sound, and smell (4).
rTMS has analgesic advantages. Although it is unknown
Auras can cause unilateral sensory anomalies
how the left prefrontal cortex impacts pain, numerous
and/or deglutition difficulties. The most common sort of
theories maintain that left prefrontal activation actively
2909
Received: 01/09/2022
Accepted: 04/11/2022

Full Paper (vol.902 paper# 138)


c:\work\Jor\vol902_139 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2915-2919

Outcomes of Hyaluronic Acid and HOS Test on Sperm Selection for
Intracytoplasmic Sperm Injection: A Comparative Study
Hanan Khaled Osman*1, Ahmed Emam Dakrory1, Ahmed Mohamed Abbas 2, Amel Ramadan Omar1
1Department of Zoology, Faculty of Science, Cairo University, Egypt
2Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Hanan Khaled Osman, Mobile: (+20)01285473568, Email: hanan.ivf@gmail.com

ABSTRACT
Background:
The outcome of intracytoplasmic sperm injection (ICSI) and embryo development are significantly
influenced by sperm quality.
Objective: The aim of the present study is to find the different outcomes of ICSI by using hyaluronic acid (HA) and
hypo-osmotic swelling (HOS) test in sperm selection so as to obtain the best results of ICSI outcomes and the best
embryos with high quality to increase pregnancy rate in cases of infertility.
Patients and Methods:
This study was carried out on 100 patients in ICSI cycles with confirmed diagnosis with
unexplained infertility or repeated failure of ICSI cycles, and patients with HOS test positive semen profile. Statistics
have been made for the study results.
Results: There was significant difference between the HOS and HA groups regarding the fertilization rates, cleavage
stage, and blastulation quality (63.7% VS 85.9%; 54.3% VS 80.7% and 50.8% VS 66.6% respectively). However, no
statistically significant difference was found between the HOS and HA groups regarding oocytes injected (6.46 % VS
6.56%; P =0.870). They were almost equal in number in ICSI, to avoid any factors which may affect the results.
Conclusion: HA could be thought of as the best routine on a regular basis for sperm selection before ICSI. Finally, we
have achieved our main goal from the study, which is getting the best protocol for sperm selection in ICSI, which gives
the best embryos quality for embryo transfer and increase pregnancy rate in cases of infertility.
Keywords: Hyaluronic acid, HOS test, Sperm selection, ICSI.

INTRODUCTION
other cell types, leukocytes, bacteria, and toxic
A single sperm cell is injected directly into the
substances, preventing the production of ROS (6).
cytoplasm of an egg during an in vitro fertilisation (IVF)
Additionally, growing research indicates that sperm
process known as intracytoplasmic sperm injection
DNA integrity issues lead to worse ART results (7).
(ICSI). The gametes are prepared using this method in
Some new methods are far superior than the old ones
order to obtain embryos that may be transplanted to a
and highly helpful (8).
mother uterus. ICSI and conventional IVF differ from
According to Casper et al. (9), who
one another in a number of ways. The procedures that
recommended using the traditional hypo-osmotic
must be carried out both before and after insemination
swelling (HOS) test in these circumstances, fertilisation
are the same. ICSI requires just one sperm cell per
and cleavage rates were 43 and 39%, respectively, when
oocyte for insemination (1).
the spermatozoa were selected using the HOS test as
The effectiveness of ICSI has been compared to that
opposed to 26 and 23% when the spermatozoa were
of in vitro fertilisation (IVF), a less complex procedure
selected randomly. Smikle and Turek (10) discovered in
in which the oocytes are picked up and overnight left
an in vitro investigation that the traditional HOS test
with the prepared sperm sample, where fertilisation
could precisely determine the viability of functioning
takes place after a kind of spontaneous sperm selection
spermatozoa, and occasional pregnancies have been
(2). Today, ICSI has supplanted IVF as the method of
documented (11). Liu et al. (12), who chose viable
choice for treating infertility in wealthy nations (3).
spermatozoa using a NaCl hypo-osmotic solution,
For ICSI, there are many sperm selection methods.
obtained similar outcomes.
Sperm in vitro selection and capacitation must be
Based on the functional sperms' propensity to enlarge
completed prior to ICSI. In addition to the most popular
when exposed to hypoosmotic fluid, the HOS test
in vitro sperm capacitation methods (swim-up, density
measures this propensity. The tips of the tails of
gradients, filtering, and simple wash) (4), the traditional
spermatozoa with defective cell membrane function do
techniques, such as swim up (SU) and density gradient
not enlarge or invaginate (13).
centrifugation (DGC), which rely on separation
To assess the structural and functional integrity of
processes reliant on morphology and motility, have
spermatozoa, a low-cost hypo-osmotic swelling test is
produced disappointing results (5). For sperm cell
helpful. It is predicated on the idea that, in hypoosmotic
preparation techniques to be used in assisted
situations, fluids move across cell membranes to reach
reproductive technology (ART) ART routine
equilibrium on both sides of the membrane (14). This
procedures, they must be easy, inexpensive, and quick,
behavior is frequently referred to as "tail curling". The
enabling a highly effective selection that separates
ballooning of the plasma membrane is what causes the
motile and morphologically normal spermatozoa from
curl (15).
2915
Received: 06/10/2022
Accepted: 09/12/2022

Full Paper (vol.902 paper# 139)


c:\work\Jor\vol902_140 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2920-2922

Variations in Treatment Options of Fractures of the
Distal Radius: Review Article
Ahmed Mustafa Elfeky, Riad Mansour Megahed,
*Ahmed Sheikh El ­ Arab, Ahmed Mohamed Abdelwahab
Department of Orthopedic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Sheikh El ­ Arab
Mobile: (+20) 01003571464, E-mail: dr.ahmedsheikhelarab@gmail.com

ABSTRACT
Background:
Proximal radius of the forearm (DR) frequently sustains fractures. As life expectancy rises, more individuals
are at risk for radial fractures because of the rising occurrence of these injuries. The majority of distal radial fractures occur
in youngsters, teenagers, and the elderly. Between various age categories, fracture patterns, care, and consequences vary.
Reviewing these distinctions, identifying which fracture patterns are emergent, and promptly referring patients for additional
therapy are essential for physicians.
Objective: To assess the care of distal radial fractures will be discussed in this activity.
Methods: We searched PubMed, Google Scholar, and Science Direct for information on distal, radial fractures, youngsters,
teenagers and the elderly. However, only the most current or comprehensive study from January 1986 to May 2020 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:
Early Closed reduction and percutaneous pinning of distal radius fracture gives a better result. The results of
meta-analysis are based on observational studies and, thus, further attention should be directed to studies of good
methodological quality. Therefore, multicenter prospective cohort studies are required and will be able to answer these
questions with more certainty and a higher level of evidence.
Keywords: Distal radius, Fractures, Youngsters, Teenagers, Elderly Surgical, Non-surgical, Management.


INTRODUCTION
A. Non-operative management of fractures of the
Splint immobilisation, cast immobilisation, open
distal radius:
reduction, broken distal radius can be treated with a
The majority of radius distal fractures don't need to be
closed reduction and cast or a closed reduction and
operated on. The list of conditions that warrant surgical
percutaneous pinning immobilisation.
treatment and the list of contraindications to non-operative
The following is a discussion of the benefits and
management can be found in table (1) (1).
drawbacks of non-surgical and surgical management, as

well as the steps, results, and effects of each (1).
---------------------------------------------------------------------------------------------------------------------------------------------------

Table (1
): Non operative management (1).

2920
Received: 9/10/2022
Accepted: 12/12/2022

Full Paper (vol.902 paper# 140)


c:\work\Jor\vol902_141 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2923-2928

Assessment of Serum Uric Acid and Electrolytes Levels in
Subclinical and Overt Hypothyroidism Patients
1 Reyad Emhmed Ali Elhomrani, 1 Hoda Gouda Bakr,
1 Amira Ahmed Mahmoud Mounier, 2 Ahmad Sallam Soliman
1 Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Reyad Emhmed Ali Elhomrani, Email: Riyadelhomrani@gmail.com, Mobile: 01210219895

ABSTRACT
Background:
A common endocrine condition known as hypothyroidism is characterised by insufficient thyroid hormone
production by the thyroid gland. Nearly all tissues need thyroid hormones for optimal growth, development, and operation,
and the kidneys especially depend on them for healthy growth and operation. Thyroid dysfunction and uric acid (UA)
metabolism may be related, according to some studies. A rise in serum uric acid (UA) levels may result from thyroid
disease's impact on the purine metabolism.
Objective: To examine the connection between thyroid hormones and blood uric acid in people with primary
hypothyroidism.
Patients and methods: This case-control comparative study was carried out at the Internal Medicine Department, Faculty
of Medicine, Zagazig University. 126 subjects with similar age and sex distribution participated in the study. They were
divided into three groups: 42 people with subclinical hypothyroidism, 42 people with overt hypothyroidism, and 42 healthy
people (control individuals).
Results: A statistically significant difference existed between the groups that were being researched in uric acid level. Post
hoc test showed that there was a highly statistical significance increase in uric acid in hypothyroidism group compared to
the subclinical hypothyroidism and control. In addition, there was a statistically significant rise in uric acid levels in the
subclinical hypothyroidism group compared to the control group.
Conclusion:
Compared to euthyroid controls, blood uric acid levels are higher in overt hypothyroid and subclinical
hypothyroid individuals.
Keywords:
Uric acid, Subclinical, Overt, Hypothyroidism.

INTRODUCTION

The most prevalent endocrine condition is thyroid
electrolyte homeostasis. Both kidney diseases and thyroid
illness conditions in the globe. According to reports,
problems can have an impact on the physiology and
almost 42 million of people struggle with thyroid issues
development of the kidneys (6).
(1). The most frequent underlying cause of hypothyroidism
Humans produce uric acid (UA) as endogenous
is iodine deficiency (2, 3).
and as dietary purine metabolism byproduct. Blood uric
The term "hypothyroidism" refers to a condition
acid levels are a good indicator of how efficiently purines
in which the hypothalamic-pituitary-thyroid axis is
are broken down and how quickly UA is excreted (7).
compromised, resulting in a decrease in the synthesis of
The liver primarily produces uric acid (UA), an
thyroid hormones. High TSH, low T4 and T3, and low T3
antioxidant that is water soluble. It prevents the harm
are discovered in the laboratory. Common endocrine
causes free radical while also protecting DNA and cell
disorders such as subclinical hypothyroidism are
membranes (8, 9). Uric acid serves as an antioxidant and is
characterised by normal T3, T4 levels, elevated TSH
influenced by thyroid function. Additionally, thyroid
levels, and typically no clinical symptoms. The incidence
failure affects the purine metabolism, which can lead to
of primary hypothyroidism, which affects 0.5-2.0% of
an increase in uric acid content (10).
women and 0.2% of males, is a common syndrome.
According to some evidence, thyroid dysfunction
According to numerous publications, there has lately been
and UA metabolism are related.
a 2.1% increase in the number of people with autoimmune
Kuzell et al. (11) were the first to link
illnesses and hypothyroidism (4, 5).
hypothyroidism with hyperuricemia. In a cross-sectional
Constipation, cold intolerance, and weight gain
investigation by Ashizawa et al. (12) it was discovered in
are all symptoms of hypothyroidism. Important biological
women's serum where UA levels were related to
effects of thyroid hormones include the modulation of
subclinical hypothyroidism. However, previous research
body hemodynamics, thermoregulation and many
demonstrated that hypothyroidism and hyperthyroidism
metabolic processes. It affects practically all bodily
are frequently related with higher UA values. This
metabolisms, including those for carbohydrates, proteins,
Possibly due to the fact that primary hyperthyroid
lipids, and the well-known regulation of water and
patients' purine metabolism is raised and that primary
2923
Received: 2/9/2022
Accepted: 5/11/2022

Full Paper (vol.902 paper# 141)


c:\work\Jor\vol902_142 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2929-2931

Toxic Effects of Acrylamide on Human Health: A Review Article
Rania A. Radwan*1, Soheir Ali Mohamed1, Saher M. Gebril2, Abeer F. EL_Naeem3, Maha A. Hilal1
Departments of 1Forensic and Clinical Toxicology, 2Histology and
3Anatomy and Embryology, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Rania A. Radwan, Mobile: (+20) 01005327561, E-Mail: rania_ahmaed@med.sohag.edu.eg

ABSTRACT
Background:
Acrylamide (ACR) is produced in the chemical industry with high volumes such as water-soluble
polymers and synthetic organic chemicals. The presence of acrylamide in food was initially assumed to be a result of
exogenous contamination. Alarming levels of ACR were first to be discovered in a variety of cooked foods by a
Swedish group. The highest levels have been detected in potatoes [fried potato chips and french fries] and grain-based
cooked foods using very high temperatures. ACR has major toxic effects on various body systems through multiple
mechanisms. ACR was classified as a probable carcinogen to humans.
Objective: The present work aimed to discuss these possible toxic effects on humans, mechanisms, and safety of
exposure.
Methods:
We researched for data on [Acrylamide, Neurotoxin, Fried potato chips, and French fries] at PubMed,
Google Scholar, and Science Direct. However, only the most recent or extensive study was taken into account
between August 1999 and September 2022. References from related works were also evaluated by the writers. There
are not enough resources to translate documents into languages other than English, hence those documents have been
ignored. It was generally agreed that documents such as unpublished manuscripts, oral presentations, conference
abstracts, and dissertations did not qualify as a legitimate scientific studies.
Conclusion: Daily consumption of food processed at high temperature make humans at great risk of chronic ACR
toxicity which affects greatly human health. Screening for ACR and its active biomarkers in blood and urine is
essential in highly susceptible populations as in occupational exposure.
Keywords: Acrylamide, Neurotoxin, Fried potato chips, French fries.

INTRODUCTION

byproduct 8-hydroxydeoxyguanosine (8-OHdG) and
Acrylamide (CH2=CHCONH2) is a water-
the acrylamide metabolite N-acetyl-S-(propionamide)-
soluble compound used to produce different chemical
cysteine (AAMA). Nitric oxide synthase (NOS)
and industrial applications at low cost including
signaling
was
implicated,
according
to
cosmetics, food processing, agriculture, and water
immunohistochemical investigations (8).
purification. It is also formed by heating food from
Haridevamuthu et al. (9) Acrylamide could have
carbohydrates and amino acid present in the food such
a negative impact on the antioxidant defense
as in fried potato products, bread, and coffee. Because
mechanism. Another aspect to take into account is the
of its high water solubility, ACR is easily released to
adduct that acrylamide creates in presynaptic neurons,
human water supplies(1,2,3). Acrylamide is generated in
which causes neuroinflammation.
food via the Maillard reaction between asparagine and
Acrylamide's neurotoxicity is caused by
reducing sugars by heat(4).
interference with nerve energy metabolism, disruption
Previous studies have shown that acrylamide can
of ion balance, inhibition of axonal transport by
have a variety of harmful impacts on living things,
binding to microtubules, interference with neuro
including the ability to cause cancer, neurotoxicity, or
conduction (causing visible neurotoxicity), and
endocrine disruption (5).
induction of oxidative stress (free radicals cause
I- Mechanism of toxicity of ACR:
interference with acetylcholine esterase activity and
Song et al. (6) treated U2OS cells with ACR for 6
disruptions of synaptic vesicle fusion, which results in
and 24 hours before collecting them for further
damage to ultrastructure and functional errors) (10).
investigation, providing useful proof of the
Acrylamide and/or glycidamide binding to
cytotoxicity produced by ACR. A total of 73 important
spermatid protamines leads to dominant mortality and
differential metabolites were discovered, and it was
impacts sperm morphology, which might be used to
shown that ACR reduced autophagic flow, raised
explain the mechanisms of reproductive toxicity.
reactive oxygen species (ROS) content, elevated
Because acrylamide may bind to the motor proteins
apoptosis rates, and secreted inflammatory factors. By
kinesin and dynein, it can cause distal axonopathy,
lowering the quantities of glycolytic intermediates,
which leads to paralysis in the back legs. It may also
reducing the pace of the tricarboxylic acid (TCA)
cause anesthesia in the penis, which has implications
cycle, and increasing the levels of numerous amino
on mounting, intromission, and sperm motility. ACR-
acid metabolites and lipid metabolites, exposure to
induced reproductive and neurological damage does
ACR attenuated glycolysis/gluconeogenesis.
not appear to be directly related to the mutations that
According to Lin et al. (7), there is a substantial
are anticipated to result from glycidamide binding
correlation between urine levels of the oxidative stress
directly to DNA (11).
2929
Received: 02/10/2022
Accepted: 05/12/2022

Full Paper (vol.902 paper# 142)


c:\work\Jor\vol902_143 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2932-2938

Association of NF-B1/IKK Gene Expression with Disease Activity Indices in
Patients with Early Rheumatoid Arthritis
Ibrahim Mohammed Rageh1, Rasha Mohammed Fawzy2, Rania Mohamed Elateek*1, Seham Gouda Ameen1
Departments of 1Clinical and Chemical Pathology,
2Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Rania Mohamed Elateek, Mobile: (+20)1005297903, Email: shimaa01023@gmail.com

ABSTRACT

Background: Pain, swelling, soreness from touching, stiffness in the joints, particularly in the morning, and
symmetrical polyarthritis are all symptoms of rheumatoid arthritis (RA), a prevalent form of autoimmune inflammatory
arthritis.
Objective: This work was aimed to investigate whether there is a correlation between the expression of the nuclear
factor kappa beta1/IKK epsilon (NF-B1/IKK) gene and disease activity indices in individuals who have early
rheumatoid arthritis.
Patients and Methods: This study involved 50 patients with newly diagnosed RA and 30 subjects serving as controls.
Patients were subjected to detailed medical history, clinical examination, and underwent evaluation of illness severity
using disease severity scores (DAS-28). Laboratory investigations, and real time PCR was done for NF-B1/IKK.
Examination using power Doppler ultrasonography (PDUS) was carried out on 22 of the joints that were affected by
RA.
Results: NF-B1 and IKK gene expression levels were significantly increased in cases with positive RF and Anti-CCP
compared to patients without (p < 0.001 for both). Also, according to disease activity; the higher the activity the more
NF-B1 and IKK gene expression levels with significant differences (p <0.001). Higher erythrocyte sedimentation rate
(ESR), PDUS, NF-B1 and IKK gene expression levels were associated with risk of higher DAS grades in univariable
analysis (p=0.007, 0.023, 0.011, 0.002 respectively). However, in multivariable analysis, only higher NF-B1 and IKK
gene expression levels were considered independent predictors of higher DAS grades (p=0.019, 0.044 respectively).
Conclusion: Our findings suggest that NF-B1 and IKK play an important role in RA pathogenesis and could be
considered as an activity indicator.
Keywords: Rheumatoid Arthritis, NF-B1, IKK, Disease Activity.

INTRODUCTION


Pain, swelling, soreness from touching,
because
it
affects
DNA
transcription,
the
stiffness in the joints, particularly in the morning,
synthesis of cytokines, cell survival, and other
and symmetrical polyarthritis are all symptoms
activities that occur inside cells (6).
of rheumatoid arthritis (RA), a prevalent form of
RelA/p65, c-Rel, RelB, NF-B1 (p50), and
autoimmune
inflammatory
arthritis
(1).
In
NF-B2 (p52) are the five members of the NF-B
rheumatoid
arthritis
(RA),
the
synovial
transcription factor family that may form homo-
membrane of the joints is affected by the immune
and heterodimers. These transcription factors are
system, leading to inflammation and damage to
involved in the regulation of gene expression. In
the joints. It affects smaller joints, such as finger
the absence of certain triggers, these dimers
joints, more than bigger joints (2).
remain linked to IB (inhibitors of NF-B) and are
The human leukocyte antigen (HLA) and
thus prevented from engaging in transcriptional
major histocompatibility (MHC) genes are the
activity (7).
ones that are considered to be the most
The NF-kB signaling system reacts to a
significant contributors to an elevated risk of
variety of stimuli, including cytokine and growth
deteriorated rheumatoid arthritis (RA). Minor
factor signaling to identify pathogen products, as
genes, such as cytokine promoters and T cell
well as DNA damage and carcinogenic stress.
signaling genes, among others, have been linked
The activation of the NF-kappa B "canonical
to susceptibility and severity (3). Increased
pathway" stimulates the formation of the IKK (IB
expression of genes involved in inflammation
kinase) protein complex, which contains the IKK
may be caused by epigenetic alterations such as
and IKK kinases as well as the regulatory subunit
faulty DNA, dysregulated histone marks, or the
IKK/O. This protein complex phosphorylates IB
production of microRNAs (4).
(Inhibitor of nuclear factor kappa-B), which in
There is a small family of inducible
turn induces its detachment from NF-kappa B
transcription factors known as Nuclear Factor
and its (8).
kappa-light-chain-enhancer of activated B cells.
Inhibitor of nuclear factor kappa-B kinase
These factors play an essential part in the
subunit epsilon, also known as I-kappa-B kinase
function of all mammalian cells (5). It is able to
epsilon or IKK-epsilon (IKK), is an enzyme that
govern the immunological response to infection
in humans is encoded by the I-kappa-B kinase
2932
Received: 03/10/2022
Accepted: 06/12/2022

Full Paper (vol.902 paper# 143)


c:\work\Jor\vol902_144 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2939-2944

Endoscopic Assessment of Gastroesophageal Reflux Disease Severity in
Type 2 Diabetic Patients
Marwan Nabil Elgohary, Hoda Abdel-Aziz El-Hady, Mohamed Omar Ben Elmukhtar, Ahmed Esmail Hassan
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed Omar Ben Elmukhtar, Mobile: (+20)1150860615, E-Mail: dr.mktr96@gmail.com

ABSTRACT

Background: Gastroesophageal Reflux Disease (GERD) and type 2 diabetes have impacted countries' economies,
healthcare systems, and patients' social life. Much modern literature discusses the prevalence of GERD in type 2 diabetes
mellitus, and few studies assess the severity of GERD in type 2 diabetes mellitus.
Objective: The aim of the current work was to assess the severity of GERD in type 2 diabetic patients compared to
non-diabetic patients.
Patients and Methods: This cross-sectional study included a total of 194 patients aged 18 to 65 years with GERD
attending at the Gastrointestinal Endoscopy Unit, Internal Medicine Department, Zagazig University Hospitals. All
patients were diagnosed with GERD by endoscopy and were presented with esophageal and non-esophageal
manifestations. Patients were divided into two groups; Diabetic Group included 87 patients with type 2 diabetes, and
Group 2 (control) included 107 nondiabetic patients served as control.
Results: Typical GERD symptoms were 37.6% of cases with highly statistically significant differences between the two
groups (P-value = 0.000). Heartburn was a common symptom in diabetic patients (47%), with a highly statistically
significant difference between the two groups. Epigastric pain (30%) was most common in non-diabetic patients. The
most common extra-esophageal manifestations in type 2 diabetic patients were hoarseness (15%) and chest pain (13%).
In contrast, dysphagia (13%) was common in non-diabetics. The GERD severity was mild grade (grade A, 80%), with
a statistically significant difference between the two groups. However, comparing other grades between the two groups
showed significantly more severe in the type 2 diabetic group.
Conclusion: It could be concluded that type 2 diabetes mellitus patients tend to have more gastroesophageal reflux
disease severity than non-diabetics. However, most patients of the two groups presented with mild endoscopic severity
of gastroesophageal reflux disease.
Keywords:
Gastroesophageal Reflux Disease, Type 2 Diabetes Mellitus, Endoscopy.

INTRODUCTION

patients aged 18 to 65 years diagnosed with
Gastroesophageal reflux disease (GERD) is a
gastroesophageal reflux disease attending at the
chronic disease with high prevalence in Middle East
Gastrointestinal Endoscopy Unit, Internal Medicine
and the North Africa (1). Heartburn and regurgitation
Department, Zagazig University Hospitals.
are common GERD symptoms (2). Also, GERD has
The included 194 GERD patients were divided into two
extra-esophageal manifestations (2). Endoscopy is a
groups; Group 1 (Diabetic) included 87 patients with
tool for diagnosing GERD, and the Los Angeles
type 2 diabetes, and Group 2 (control) included 107
classification is used to determine the severity of
non-diabetic patients served as control.
GERD (3).

There are numerous complications associated
Inclusion criteria: All patients who were diagnosed
with GERD. The most well-known consequence is
with GERD by endoscopy and were presented with
Barrett's esophagus, a precancerous lesion that
esophageal and extra-esophageal manifestations.
develops into esophageal adenocarcinoma (4).
Exclusion criteria:
Diabetes mellitus type 2 (T2DM) is a
Acute metabolic complications of DM (diabetic
progressive metabolic condition. Diabetes has the
ketoacidosis
(DKA)
or
hyperglycemic
highest relative prevalence across the Middle East and
hyperosmolar non-ketonic state (HONKS).
North Africa. It has various gastrointestinal problems,
GIT condition: Barrett's esophagus. Esophageal
and GERD is the most prevalent (5).
adenocarcinoma and other malignant or benign
GERD and type 2 diabetes significantly
gastrointestinal tumors. Achalasia and esophageal
negatively impact national economies, healthcare
strictures. Active peptic ulcers of the
systems, and patients' social lives (6). The prevalence of
gastroduodenal zone, and Zollinger-Ellison
GERD in type 2 diabetes mellitus is well discussed in
syndrome.
modern literature. However, little research assesses
Absolute and relative contraindications to
GERD's severity in T2DM.
endoscopy. Absolute contraindication to elective
This study was aimed to assess the severity of GERD
upper GI endoscopy is a lack of informed consent
in patients with T2DM.
from a mentally competent patient. Relative

contraindications are organ perforations and states
PATIENTS AND METHODS
of cardiac or respiratory decompensation.
This cross-sectional study included a total of 194
Alcohol abuse.
2939
Received: 03/10/2022
Accepted: 06/12/2022

Full Paper (vol.902 paper# 144)


c:\work\Jor\vol902_145 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2945-2951

Role of MR Fistulography Combined with Diffusion-Weighted Magnetic
Resonance Imaging in Evaluation of Perianal Fistula
Saeda Mohamed Abd-Elwahab 1, Ahmed Okasha Mohamed 1,
Nourhan Abobakr Abdelhamid 1*, Mohamed Ahmed Negm 2
1 Diagnostic and Interventional Radiology Department, 2 Pediatric Surgery Department,
Faculty of Medicine, South Valley University, Qena, Egypt
*Corresponding author: Nourhan Abobakr Abdelhamid, Email: medonido445@gmail.com , Mobile no:+201091646874
ABSTRACT
Background:
Magnetic resonance imaging (MRI) is the imaging method of choice for assessing perianal fistulae
because of its ability to highlight the connection between perianal fistulae and anal sphincters, fistula extensions,
secondary ramifications, and related disorders.
Objectives:
This study aimed to evaluate the role of MRI compared to DWI in perianal fistula, to provide a roadmap
to surgeons to prevent recurrences or sphincter incontinence, and to evaluate recurrent perianal fistula after surgery.
Patients and methods
: This prospective cohort study was conducted in Qena University Hospital, South Valley
University, Qena, Egypt in the duration from January 2021 to January 2022. The study included 30 patients with perianal
fistula. Results: In the present study more than half of the studied patients had grade 1 when it was classified by St.
James's University Hospital classification by MRI (56.7%) or by Combined T2W and DWI (60.05). highly significant
agreement between St. James's University Hospital classification by MRI and Grading by Combined T2W and DWI
with agreement equal to 89.0%. When compared to T2-weighted imaging on its own, our findings indicated that DWI
provided a considerable benefit to the diagnostic process when attempting to identify a perianal fistula. This seem to
imply that DWI should be routinely incorporated as an additional step to the more standard strategy for the investigation
of perianal fistula using MRI. Conclusion: According to our findings, DWI significantly improved upon T2-weighted
imaging alone in the identification of perianal fistula. As a result, it is suggested that DWI be routinely incorporated to
the MRI examination of perianal fistula protocol.
Keywords:
Intersphincteric, Magnetic resonance imaging, Perianal fistulae, Transsphincteric, DWI, St. James's
University Hospital classification.

INTRODUCTION

sequences are frequently used in MRI to diagnose
Fistula in ano (FIA) is a morbid disorder that is
perianal fistulas (5). The MRI fistula tract protocol now
becoming more prevalent, with a prevalence of 1 per
includes gadolinium chelate-enhanced imaging because
10,000 people. It has its own underlying causes as anal
it makes it easier to see abscesses and distinguish
glandular infection, Crohn's disease, radiation, and
between active illness and fibrous tracts. However,
secondary malignancy (1). Even though anorectal fistulas
there are several drawbacks to using gadolinium chelate
are easily repaired surgically, the risk of secondary
(6). As a direct consequence of this fact, DWI has
recurrence is significant because the treatment
become increasingly significant in the identification of
neglected infection foci. Surgery is performed with the
perianal fistula. On diffusion-weighted imaging (DWI),
primary objective of preserving the functionality of the
the acute inflammatory process can be distinguished
anal sphincter while at the same time eliminating all foci
from the normal-appearing tissues that are located in
of infection associated to the fistula and the fistula tract
close proximity to it thanks to the stark contrast that can
(2). It is essential for successful surgical outcomes to
be detected between the two. Recent studies in a variety
have a clear visualisation of the extent of the fistula tract
of medical journals have demonstrated that DWI has a
as well as its connections to the anal sphincter. At the
high degree of sensitivity and specificity for the
present time, magnetic resonance imaging (MRI)
diagnosis of perianal fistula, as well as for the
continues to be the imaging modality of choice for
evaluation of fistula activity and any accompanying
evaluating patients prior to surgery and investigating
abscesses (5, 7, 8).
post-surgical recurrence of perianal fistula (3).
If the b-value of the DWI is increased, the image
The fistula tract, abscess formation, and secondary
will have a higher contrast, greater tissue diffusibility,
tracts may all be evaluated using MRI, and the fistula
and less T2 shine-through effect. In DWI, a higher b-
tract's connections to the levator plate and the
value is linked to a lower apparent diffusion coefficient
ischiorectal fossa can be clearly seen. When it comes to
(ADC) value, in addition to a reduction in the T2 shine-
visualising diseased tracts and abscesses, MRI is well
through effect being seen in patients with perianal
known to be more effective than the other modalities.
fistula and/or accompanying abscess. When the b-
Preoperative MRI is recognised to be especially
values are increased, the DWI images show a greater
significant in recurrent and complex disease, since it
contrast between the perianal fistula or related abscess
significantly lowers the postoperative recurrence rate (4).
and the structures that are located around it. This is the
T1-weighted sequences are typically used when
case whether the fistula is linked with an abscess or not
performing an MRI exam to make a diagnosis of
(9). The gold standard of our study was to have
perianal fistula, T2-weighted sequences and STAIR
successful surgical outcomes as it is important
2945
Received: 04/05/2022
Accepted: 05/07/2022

Full Paper (vol.902 paper# 145)


c:\work\Jor\vol902_146 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2952-2958

Topical versus Intravenous Tranexamic Acid in Reducing Blood Loss during
Transurethral Resection of Prostate
Abdallatif M. Aboushawareb, Hany A. Abdullah, Iman Y. Ismail, Esam Abdelgawad*
Urology Department, Faculty of Medicine, Suez Canal University, Egypt
Corresponding author: Esam Abdelgawad, Telephone: +201501599744,
ORCID: 0000-0003-2055-4791, E-mail: esam76u@gmail.com

ABSTRACT

Background: Transurethral Resection of Prostate (TURP) is still the first option in treatment for these patients. The
main adverse effects of TURP are bleeding and absorption of irrigation fluid.
Objective:
The main aim of the current study is to compare the efficacy of topical versus intravenous Tranexamic Acid
(TXA) acid in decreasing blood loss in TURP.
Patients and methods: This study was carried out over a period of 9 months on 56 patients presenting with Lower
Urinary Tract Symptoms (LUTS) secondary to senile enlarged prostate refractory to medical therapy and to TURP at
Urology Department in Damietta Specialized and Suez Canal University Hospitals. Patients were divided into 2 groups;
Group A received one gram of TXA intravenously at the beginning of the surgery, while the patients in the Group B
received the drug in the irrigation fluid 500 mg/liter. Intraoperative blood loss was measured from the collecting bucket.
Vital signs were observed for both groups preoperatively, during and after the surgery. Hemoglobin was determined
preoperatively and postoperatively.
Results:
Our results found higher reduction in operative blood loss in Group A in comparison to Group B which was
147 and 215 ml, respectively. Moreover, we found that the mean operative time was highly significant different between
both groups, longer in Group B (40 minutes) than in Group A (33 minutes). Our study results showed no difference
regarding the hospital stay, capsular perforation, bleeding and clot retention.
Conclusion: The use of TXA intravenously is better than its topical administration in decreasing the surgical blood loss
during TURP. There is no evidence of reducing rate of post-operative complications between using TXA intravenously
and topically TXA.
Keywords:
Tranexamic acid, TURP, Blood loss, Clinical trial, Suez Canal University.

INTRODUCTION

Therefore, administration of antifibrinolytic
Benign prostatic hyperplasia (BPH) is a process
elements might reduce the amount of postoperative
in which the pathology results in increased number of
blood loss caused by TURP (10,11).
both stromal and epithelial cells in the area of the
Tranexamic acid (TXA) is derived from the
prostate around the urethra which is pathologically
amino acid lysine and, in humans, exerts an activity
known as hyperplasia, and not hypertrophy (1). The
against fibrinolysis by reversibly binding to
accurate cause is not well known; however,
plasminogen (12). Recently, many evidence based studies
"reactivation" of embryonic processes is one of the
has concluded that TXA is an effective treatment for
hypotheses that may cause BPH (2).
minimizing blood loss in cardiac, liver and orthopedic
BPH is a common condition that affects elderly
surgery (13, 14). Since TXA enter the extra vascular space
men. Recently, many noninvasive and mini-invasive
and stored in tissues, it act by inhibition of tissue
modalities have become popular for the management of
fibrinolysis and stabilize blood clots (15).
men with voiding symptoms; however, TURP is still the
Bleeding during TURP is a dangerous adverse
first option in treatment for these patients. The main
effect. To minimize postoperative blood loss many
adverse effects of TURP are bleeding and absorption of
variable approaches have been tried. One of the
irrigation fluid. Factors that influence perioperative
approaches was the use of TXA topical or intravenous;
blood loss include prostate size, weight of tissue
however, role of tranexamic acid in decreasing
resected, operative time, preoperative urine culture,
hematuria after TURP wasn't well studied. Thus, the
finasteride treatment, use of acetylsalicylic acid, blood
aim of the current study is to compare the safety and
pressure, type of anesthesia, and the age of patient (3-8).
efficacy of intravenous versus topical TXA during
To minimize the perioperative bleeding, multiple
TURP.
variable approaches have been tried including (5-7):

Intravenous estrogens, traction of the catheter, Intra-
PATIENTS AND METHODS
prostatic vasopressin, Phenol solution and Finasteride
This clinical trial was conducted among 56 male
use.
patients with BPH suffering from Lower Urinary Tract
The urothelium and urine contain high percentage
Symptoms (LUTS) refractory to medical treatment and
of plasminogen activators that cause the dissolution of
requiring TURP at the Urology Department in Damietta
clots. Thus with increasing fibrinolytic activity,
Specialized and Suez Canal University Hospitals.
postoperative blood loss increases in urine (9).
Inclusion criteria were patients with prostate size

range from 30-80 gm., age more than 18 years old,
2952
Received: 03/10/2022
Accepted: 06/12/2022

Full Paper (vol.902 paper# 146)


c:\work\Jor\vol902_147 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2959-2966

Electrodiagnosis and Imaging Studies in Neonatal Brachial Plexus Palsy:
Comparative study
1 Yassir Abdelhay, 2 Mohammad Reda Ahmad, 1 Amina Mohamed Hosseny
1 Rheumatology, Rehabilitation and Physical Medicine Department and
2 Plastic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Yassir Abdelhay, Email: yassir126@gmail.com, Phone: 01144372252

ABSTRACT
Background:
Neonatal brachial plexus palsy (NBPP) is a prevalent type of newborn morbidity with a potentially
devastating persistence. Neurosurgical management is indicated in NBPP patients. The selection of those infants for
surgery would be made easier by early prognostic assessment.
Aim: To compare electrodiagnostics and imaging in the same patients because they have not previously been
compared for precision in identifying infant brachial plexus avulsions.
Patients and methods:
This study looked back at 40 infants who had surgical NBPP and were treated between
2020 and 2022 in Faculty of Medicine, Zagazig University Hospitals in Plastic Surgery, Radiology, Neuro and
Rheumatology Departments. To assess the performance accuracy of ancillary tests, in comparison to surgical
findings, we reported electrodiagnostic testing (EDX) and imaging sensitivity, specificity and accuracy.
Results: The mean age at surgery was 9.93±7.42 months. 45% were Narakas grade I­II, and 55% were Narakas grade
III­IV. For all nerve roots, the overall accuracy of detecting avulsion was 55% for imaging and 65% for EDX. The
overall accuracy of detecting rupture was 45% for imaging and 65% for EDX.
Conclusion: Imaging and EDX are not as precise as was previously asserted. Given that each test's strengths
frequently compensate for its weaknesses of the others, the ideal workup for patients with NBPP is likely to include a
variety of modalities.
Keywords:
Neonate, Brachial plexus, Electrodiagnostic, Nerve conduction studies, Electromyography.

INTRODUCTION

because they have not previously been compared for
Management of neonatal brachial plexus palsy
precision in identifying infant brachial plexus avulsions.
(NBPP) has rapidly evolved in the last 30 years, with

many contentious opinions (1). Making decisions is still
METHODS
a hot topic, particularly when it comes to the scheduling
Study Design
of surgery, the selection of the procedure, and the
This study looked back at 40 infants who had
inclusion of aiding testing (2). Electrodiagnostic testing
surgical NBPP and were treated between 2020 and
(EDX) and other modalities of imaging are two
2022 in Faculty of Medicine, Zagazig University
examples of preoperative contributing testing. The main
Hospitals in Plastic Surgery, Radiology, Neuro and
aim of preoperative testing is localization of the injury
Rheumatology Departments. We took into account
and preoperative planning for nerve reconstruction.
consecutive newborns. The current protocol called
Some facilities use EDX and imaging simultaneously,
for if no signs of improvement were present after
whereas others never do either (3).
three months. Diagnostic imaging (first-line MRI)
Avulsion to the lower trunk is the only surgical
was performed after electrodiagnostics at one month
recommendation for early intervention that is not
or when the referral was made. The current protocol
debatable (4). According to different outcome studies,
involves diagnostic imaging (first-line MRI) at 3
children who experienced early repair, gain more
months if no signs of recovery exist, and
positive benefits. So, identifying avulsion injures
electrodiagnostics at 1 month or at the time of
accurately preoperational is mandatory (5).
referral. Age and gender of the patient and NBPP-
Avulsion injuries can be identified with 60% to
specific reports factors such the affected side and the
80% accuracy with imaging, including CT and MRI
Narakas grade were evaluated. One surgeon
myelography (6). EDX has a 19% and 93%, respectively,
determined the Narakas grade based on the
low sensitivity and excellent specificity for avulsion
description of the infant's hand/arm motions by the
injury detection (7). It becomes problematic when there
mother or obstetrician at delivery, either at the first
are both preganglionic and postganglionic injuries since
clinical appointment, around one month of age, or
this causes the injury to be incorrectly classified as a
both, the physical examination and neurological
single postganglionic lesion. There are three categories
evaluation. The surgical results (gold standard) at the
of brachial plexus injuries; preganglionic lesion,
root and trunk levels confirmed the preoperative
postganglionic lesion, and a combination of both.
imaging and EDX accuracy of NBPP lesion detection
Accurate and precise localization is a critical factor in
(preganglionic and postganglionic). To assess the
determining the proper treatment strategy (8).
performance accuracy of ancillary tests, in
The purpose of this study was to compare
comparison to surgical findings, we reported EDX
electrodiagnostics and imaging in the same patients
and imaging sensitivity, specificity, and accuracy.
2959
Received: 08/08/2022
Accepted: 11/10/2022

Full Paper (vol.902 paper# 147)


c:\work\Jor\vol902_148 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2967-2969

Decorin Effect on Hemostasis: What Is New?
Abeer Albiomy Khalifa, Reham Hassan ELazony, Malak Musa AL-Klbash, Shaimaa El-Ssayed Hadhoud
Department of Physiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Malak Musa AL-klbash, Mobile: (+20) 01156516015, E-mail: mokaaklbash@gmail.com

ABSTRACT
There is growing evidence that many environmental factors control how fibrin clots. Fibrinogen's D regions are
bound by decorin and regulates the action of transforming growth factor and collagen fibrillogenesis. The construction,
structure, and clearance of fibrin fibres are modified by the interaction between decorin and fibrinogen. Compared to
fibrinogen, decorin core protein-controlled clotting in substoichiometric levels, however, for a comparable impact, the
active decorin peptide needed to be in excess. These concentration-dependent outcomes suggest that decorin binds to
the D regions to sterically influence fibrin synthesis. Images of fibrin that has clot in the presence of increasing amounts
of the decorin core protein taken using scanning electron microscopy indicated successively decreased fibre diameter.
The budget cuts of Zn2+ ions from the fibrinogen-binding domain at the N-terminus prevented decorin from integrating
into the fibrin network. The decorin-formed curving thin fibres underwent quicker plasminogen activator-dependent
fibrinolysis of the tissue-type as opposed to the linear bulkier fibrin fibres. Together, our findings show that decorin can
control fibrin organisation and provide new insight into how extracellular matrix elements might affect hemostasis,
thrombosis, and wound healing.

INTRODUCTION

disorders, and cancer. DCN has also been applied in a
Hemostasis is the process of creating a blood clot
number of anticancer treatment procedures(10).
to cover a broken vessel, followed by its removal once

it is no longer necessary. The clot starts tissue healing
Inactivation of DCN:
while stopping further blood loss. Successful
Many proteases and growth factors, including
hemostasis can be separated into several phases, which
matrix metalloproteinase, also known as membrane
include the formation of a platelet plug (primary
type 1-matrix metalloproteinase (MT1-MMP) -2
hemostasis) and stabilization of the platelet plug with
(MMP-2), MMP-3, and MMP-7, have been shown to
cross-linked fibrin (secondary hemostasis) followed by
break down DCN into smaller pieces and biologically
destruction of the clot by fibrinolysis (1).
inactivate it in experiments (10).

Additionally,
proteases
produced
by
DECORIN
inflammatory cells can also inactivate DCN (39),
The small leucine-rich proteoglycan (SLRP)
through processes known as damage-associated
family's prototype and best-characterized member is the
molecular patterns (DAMPs), which can be discerned
decorin proteoglycan. The tight bond it has with
by pattern recognition receptors (PRRs), such as Toll-
collagen fibres is hinted at in its name, which manifests
like receptors (TLR) 2/4, sparking an inflammatory
as fibril "decoration" (2-4).
response (12).
A 42-kDa decorin (DCN) contains a protein core that is

conserved and participates in protein-protein
DCN'S MAIN BIOLOGICAL FUNCTIONS:
interactions (5,6).
Anti-fibrosis growth factor interaction:

The harmful process of fibrosis can affect many
In a zinc-dependent manner, A powerful muscle
different organs, including the skin, kidneys, lungs,
development inhibitor called myostatin is bound to by
heart, and chronic metabolic illnesses including
decorin and rendered inactive, and reduces its anti-
diabetes and hypertension that is characterized by
myogenic effects. During muscle contraction, skeletal
excessive deposition of Extracellular matrix (ECM)
muscles secrete it (7).
resulting from an imbalance between synthesis and
Moreover, in 1986, the DCN gene was cloned,
degradation, which occurs in multiple organs, including
and it was found that macrophages, smooth muscle
the lungs, heart, kidneys and skin (13-16).
cells, and fibroblasts primarily produce and secrete
The most effective pro-fibrotic cytokine in the
DCN in their rough endoplasmic reticula and Golgi
process of fibrogenesis is without a doubt transforming
apparatuses (5,6).
growth factor (TGF), which can stimulate fibroblasts,
Decorin was discovered to have an impact on
stop them from dying, and cause them to create
several cellular processes, including as migration and
excessive amounts of matrix substances such as
proliferation, and spreading as well as inflammatory
collagen types I, III, and IV and fibronectin (17-19).
responses and fibrillogenesis (8,9).
Together, DCN inhibits collagen I maturation,
DCN has drawn interest for its essential roles in
promotes collagenase, and controls the extracellular
managing as well as its possible involvement in the
matrix components, such as thrombospondin-1 and
biological processes of inflammatory diseases, fibrotic
fibronectin, which are produced (20).

2967
Received: 08/10/2022
Accepted: 11/12/2022

Full Paper (vol.902 paper# 148)


c:\work\Jor\vol902_149 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2970-2978

Peripheral Blood mRNA and Protein Levels of CCN1 and CCN3 in
Psoriatic Arthritis: A Case-Control Study
Marwa M. Esawy 1, Lobna I Kotb2, Shereen A. Baioumy3, Alshimaa M. Ibrahim4, Marwa A. Shabana1*
1Clinical Pathology Department, 2 Rheumatology and Physical Medicine and Rehabilitation Department,
3Microbiology and Immunology Department, 4Dermatology, Venereology and Sexually Transmitted Diseases
Department, Faculty of Human Medicine, Zagazig University, Egypt.
*Corresponding author: Marwa A. Shabana, Telephone Number: 00201015114400, Email: marwa_shabana@yahoo.com
ABSTRACT
Background:
Patients with psoriasis may develop psoriatic arthritis (PsA), an inflammatory joint disorder. Measuring
cellular communication network (CCN) expression levels can help in disease diagnosis and prognosis. The purpose of
this study was to assess the diagnostic value of CCN1 and CCN3 expressions for PsA.
Patients and methods: Thirty-seven PsA patients, 37 psoriasis patients, and 37 matched healthy controls participated
in a case-control study. ELISA was used to detect protein levels while qRT-PCR was used to evaluate gene expression.
Results: Patients with PsA and psoriasis had greater serum and expression levels of CCN1 compared to controls (p<
0.0001). Patients with PsA and psoriasis had greater serum and expression levels of CCN1 compared to controls (p=
0.003, p< 0.0001). Both CCN3 levels in PsA patients were greater than in controls (p< 0.0001), but patients with
psoriasis did not significantly differ from controls (p=0.13, p=0.38). When compared to psoriasis patients, PsA patients
had greater serum and expression levels of CCN3 (p< 0.0001). In terms of psoriasis duration and severity, CCN1
exhibited a positive relation. It was shown that CCN3 and both the duration and severity of arthritis correlated positively.
All markers were positively correlated with inflammatory markers.
Conclusions: The most accurate marker for PsA detection was CCN3 expression, followed by the serum level of CCN1.
However, CCN1 expression was the most accurate marker for the differentiation between psoriasis and PsA, followed
by CCN3 expression. CCN3 could be a marker for PsA severity. These preliminary data need further studies to confirm
their findings.
Keywords: CCN; Psoriasis; Psoriatic Arthritis; Severity.

INTRODUCTION
linked to osteoarthritis and inflammatory diseases (14).
Psoriatic arthritis (PsA) is an inflammatory
Increased serum CCN3 levels are linked to disease
condition that damages psoriatic patients' joints and has
severity in RA (15). However, the role of CCN1 and
an immunological basis (1). About 3% of people
CCN3 in PsA is uncertain. Psoriasis and PsA are
worldwide are affected by PsA. PsA is found in 30% of
evidently complex genetic illnesses (16), with improperly
psoriatic patients (2, 3). Psoriatic arthritis can strike at any
expressed genes. Biological processes are determined
age, but most people get it between the ages of 30 and
by proteins, which are the end products of gene
50, and both men and women are affected equally (4).
expression. Therefore, measuring gene and protein
PsA causes a variety of joint symptoms and is
expression levels can help with disease diagnosis,
frequently linked to signs of nail involvement (5). Joint
prognosis, and therapy planning (17). This study
damage caused by PsA not only reduces articular
hypothesizes that CCN1 and CCN3 gene expressions
function and increases mortality, but also affects
increased in PsA patients. So, this work aimed to
patients' capacity to work and social connections (6).
evaluate the potential diagnostic roles of CCN1 and
Six matricellular proteins make up the cellular
CCN3 genes expressions and proteins levels in PsA
communication network (CCN) family that are all
patients, as well as the relation between these markers
involved in angiogenesis and wound healing (7). CCN
and disease severity.
genes have been linked to the pathophysiology of

chronic inflammatory disorders like rheumatoid
SUBJECTS AND METHODS
arthritis (RA), neuroinflammatory diseases, and
Study Design:
inflammatory kidney disease (8). CCN1 is a crucial
This study, conducted in 2022, used a case-control
proinflammatory mediator in RA based on increased
design. The patients were found from the Departments
levels of CCN1 in synovial fluid from RA patients (9).
of Rheumatology and Dermatology. At the Clinical
By stimulating the generation of monocyte
Pathology and Microbiology Departments, the samples
chemoattractant protein-1 in osteoblasts, CCN1
were examined.
promotes monocyte movement (10).

In addition, knocking down CCN1 in an animal
Ethical approval:
model reduced joint swelling and cartilage degradation
The study protocol was approved by the Faculty of
(11). CCN3 is a matrix molecule that may be released
Medicine's Institutional Review Board (Zagazig
from the cytoplasm and participates in angiogenesis and
University) [IRB#9887]. All participants signed
fibrosis, among other functions (12). CCN3 was found in
written informed consent forms. The study has been
arthritis patients' synovial tissues (13). CCN3 has been
carried out in accordance with The Code of Ethics of
2970
Received: 13/08/2022
Accepted: 16/10/2022

Full Paper (vol.902 paper# 149)


c:\work\Jor\vol902_150 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2979-2982

Evaluation of Mediastinal Lymphadenopathy with Diffusion Weighted MRI
Noha M. Attia1, Mostafa Thabet Hussein1, Gehad Mohammed Safwat Ali2*
Diagnostic and Interventional Radiology Department, Faculty of Medicine, Assuit University, Egypt.2- M.B.B.CH
Corresponding author: Gehad Mohammed Safwat Ali, Mobile: +201011743273, Email: dr_gahad@yahoo.com

ABSTRACT
Background
: Staging and prognosis of malignant lymph nodes, as well as treatment planning, depend on the
identification of mediastinal lymphadenopathy. MR images are used to distinguish between benign and malignant lymph
nodes, including those of the mediastinum. Since many solid malignant and benign lesions on computed tomography
(CT) appear remarkably similar, MRI provides a noninvasive way to further characterize mediastinal lesions. MRI has
a greater contrast for soft tissues than CT.
Objective: The present study aimed to evaluate MRI diffusion's sensitivity and specificity for differentiating between
benign and malignant lesions. Determine the mean ADC for malignant mediastinal lesions especially those with
mediastinal lymphadenopathy.
Patients and methods: A descriptive study included 36 patients with mediastinal lymph nodes. Patients were referred
from Chest, Oncology and Cardiothoracic departments in Assiut University Hospitals for MRI assessment after being
initially diagnosed by CT. The study was conducted at the Radiology Department at Assiut University Hospitals, in the
period between August 2019 and April 2020.
Results: ADC had 94% sensitivity and 88% specificity for diagnosing malignant mediastinal lymph nodes with
overall accuracy of 92%, and area under receiver operating characteristic (ROC) curve was 0.92.
Conclusion
: Non-invasive diffusion-weighted MRI is highly sensitive and specific in distinction between malignant
and benign mediastinal enlargement of lymph nodes. This also offers important data for grading mediastinal cancer.
Keywords: Mediastinal lymphadenopathy, Diffusion Weighted MR, mediastinal malignancy.

INTRODUCTION

make up 50% of anterior mediastinal tumours.
Mediastinal lymph nodes have a wide range of
Congenital cysts are often found in the middle
histological and radiological characteristics (1). Despite
mediastinum while neurogenic tumours are frequently
the fact that some tumours, including thyroid masses
found in the posterior mediastinum (8).
and cysts, together with many solid malignant and
Malignant lymphoma accounts for nearly 20% of
benign lesions have highly accurate imaging clues on
all mediastinum neoplasms in adults and 50% in
computed tomography (CT) (2).
children. Notably, mediastinal involvement is seen in
Accurate mass identification is required to deliver
80% HL and up to 45% NHLs (9).
the right care. The mediastinum's most used imaging
Lymphadenopathy is an important discovery in
method is CT; it cannot accurately distinguish between
inflammatory, infectious, and malignant illnesses (10).
benign and malignant tumours in this area. On the other
Common causes of mediastinal lymphadenopathy
hand, as MRI can capture superb soft tissue detail, it
include fungus infections, lymphoma, sarcoidosis,
offers useful diagnostic information when evaluating
tuberculosis, and a number of other diseases (11).
the mediastinum (3). Standard MR imaging can also

offer precise anatomic details regarding the position,
PATIENTS AND METHODS
margin, and contour of mediastinal masses (4). In
A descriptive study included 36 patients with
addition, specialised applications that reveal subtle
mediastinal lymph nodes. Patients were referred from
metabolic and biophysical variations between tissues
Chest, Oncology and Cardiothoracic departments in
have been created in recent years. One of these
Assiut University Hospitals for MRI assessment after
techniques, diffusion-weighted magnetic resonance
being initially diagnosed by CT.
imaging (DWI), focuses on the translational mobility of
The study was conducted at the Radiology Department
water molecules to provide insight on the target tissue's
at Assiut University Hospitals, in the period between
microstructural features and show whether they
August 2019 and April 2020.
promote or restrict such flexibility in proton transit (5).

DWI establishes the inner cellular density and water
Inclusion criteria: Patients who underwent CT
flow. Higher cellular density tissues have more intact
imaging and had mediastinal lymphadenopathy.
cell membranes, which limits how much water can

diffuse through them (6).
Exclusion criteria:
Quick imaging methods like echo-planar imaging
If there are any general MRI restrictions for the
(EPI) make it simpler to use DWI in thoracic imaging
patient (pacemakers, cochlear implants, cerebral
by minimising the negative effects of motion (7).
aneurysm clips, ocular metallic foreign bodies,
There aren't many studies that use DWI for
claustrophobia, bullets or shrapnel near great vessels or
mediastinal pathology. Mediastinal masses, including
vital organs). The mass is purely cystic in type. Previous
thymoma, teratoma, thyroid disease, and lymphoma,
tthoracic surgery. Severely ill patients.
2979
Received: 23/09/2022
Accepted: 26/11/2022

Full Paper (vol.902 paper# 150)


c:\work\Jor\vol902_151 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2983-2989

Using Doppler Tissue Imaging among Children with End-Stage Renal
Disease for Assessment of Cardiac Complications
Ahmed Hassan Mahmoud Hassan*, Shaimaa Ibrahim Ahmed Mohamed,
Abd Elhamid Abd Allah Abd Allah, Raafat Salama
Department of Pediatrics, Al Ahrar Teaching Hospital, Zagazig, Sharkia, Egypt
*Corresponding author: Ahmed Hassan Mahmoud Hassan, Mobile: (+20) 01022128882, E-Mail: drahmhassan@gmail.com

ABSTRACT
Background:
Children with chronic renal disease can experience heart difficulties as a result of their condition.
Objective: To evaluation of cardiac complications using Doppler tissue imaging among Children with end-stage renal
disease.
Subject and Methods: This study was conducted on 40 children with chronic renal failure (17 male and 23 female) their
ages ranged from 8 years to 17 years attending the Nephrology Unit of the Pediatric Hospital Zagazig University. All
children were subjected to thorough history taking, complete detailed clinical examination, and laboratory investigations.
All cases and control were assessed by tissue Doppler velocity and strain imaging before and after dialysis.
Results:
Tissue Doppler Imaging (TDI) assessment of systolic functions using lateral and septal mitral velocity (S) in
cases is decreased significantly in predialysis cases more than control but did not show significant change after dialysis,
also septal S of tricuspid is reduced significantly in cases predialysis than control but did not show significant change
after dialysis. TDI assessment of septal mitral & tricuspid E &E/A showed a significant reduction in predialysis cases
more than control but did not show any change after dialysis, also lateral mitral &tricuspid E&E/A is decreased
significantly in cases more than control but showed a significant decrease after dialysis.
Conclusion: children with chronic renal failure (CRF) have significant cardiac abnormalities, TDI is a superior
diagnostic method than conventional echocardiography in the diagnosis of systolic dysfunction as in our cases that
appeared normal by conventional echocardiography. Also, TDI is less load-dependent in septal mitral & tricuspid
E&E/A
Keywords: End Stage Renal Disease, Doppler tissue imaging.

INTRODUCTION

The purpose of this research was the evaluation of
Renal dysfunction is classified into chronic renal
cardiac complications using Doppler tissue imaging
failure (CRF) phases, with moderate impairment
among Children with end-stage renal disease.
(glomerular filtration rate [GFR] 75 ml/min/1.73 m2)

progressing to severe impairment (GFR 10 ml/min/1.73
PATIENTS AND METHODS
m2). This is the stage during which medications and
Data were gathered pre- and post-dialysis from 40
biologicals are used to treat the effects of renal
children (8-17 years old) with chronic renal failure
dysfunction, end-stage renal disease (ESRD) is a
visiting the Nephrology Unit of the Pediatric Hospital at
condition in which a patient's renal failure is so severe
Zagazig University. The ratio of males to females was
that they require dialysis or a kidney transplant to
approximately equal.
maintain their homeostasis and eventually their lives (1).

Multiple factors contribute to the complexity of
Inclusion Criteria: Diagnosed children with chronic
CVD development in CRF. Important and potentially
renal failure and ongoing dialysis.
modifiable risk factors for the development of CVD in

this patient population appear to be present early in the
Exclusion Criteria: Refusal of the parents, and age
course of CKD (2). Several factors contribute to the
more than 18.
complexity of cardiovascular disease development in

CRF. Furthermore, it appears that significant risk factors
Methodology:
for developing CVD in this patient population emerge
All participants in the research underwent a thorough
early in the course of CKD and are amenable to
clinical evaluation (history and physical) before
intervention (2).
inclusion.
Ejection phase indices are the most used

echocardiographic markers of left ventricular systolic
Full History: Name, age, sex, date of admission, the
performance. These indices are used to evaluate the
chronology of symptoms, and social and family history.
efficiency with which the left ventricle pumps blood and
Clinical examination: General: Wt, Ht, BMI.
are affected by the heart's preload, after load, and
Neurological: level of consciousness, headache.
contractility. The left ventricle's ability to pump
Respiratory: tachypnea, rapid shallow breathing, and
oxygenated blood to the body's tissues is essential. For
cardiovascular.
this reason, the ventricle's pump efficiency may be

measured in part by its stroke volume (3).
Tissue doppler imaging: The four-chamber view was
used for tissue Doppler imaging, and the mitral annular
2983
Received: 02/10/2022
Accepted: 05/12/2022

Full Paper (vol.902 paper# 151)


c:\work\Jor\vol902_152 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2990-2997

Evaluation of Non-Surgical Management of Intracranial Meningioma
Tarek Hassan Abd El-Bary, Mohamed Ahmed Samir,
Ali Alaraby Ishteewi Elgaddar*, Magdy Omar El-Sheikh
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ali Alaraby Ishteewi Elgaddar, Mobile: (+20) 01557484404, E-Mail: alialaraby90@gmail.com

ABSTRACT
Background:
Meningiomas are common extra-axial primary brain tumors, which originate from the arachnoid cap
cells. It's possible that intracranial meningiomas can be managed non-surgically.
Objective: The aim of the current study was to evaluate non-surgical management of intracranial meningiomas to better
guide the management decision-making.
Patients and methods: A retrospective analytical study was conducted at the Department of Neurosurgery in the Faculty
of Medicine at Zagazig University. A total of 53 patients, with 57 meningiomas were enrolled in the current study.
Patients were divided into 2 groups based on symptomatic and radiological progression; Group A included 42 patients
who continued non-surgical management, and Group B included 11 patients who required surgical intervention. Results:
During the follow-up period, 19.3% of patients needed surgical intervention. The mean age of cases was of 54.1 (SD
9.7) years. Group A patients had significantly older ages at diagnosis than Group B patients (P<0.05). The tumor size in
Group A was <25mm (64.4%), ranged from 25-40mm (35.6%), and >40 mm (0%) versus 25%, 66.7%, and 8.3%,
respectively in Group B (P=0.014). Increased size at diagnosis was a significant predictor for surgical intervention
(P<0.05). In Group A, the rate of growth/year was 1.94 (SD 0.74) mm with the range 0.22-3.94 mm/year versus 4.92
(SD 1.3) mm with the range 3.1-6.75 mm/year in Group B (P=0.0001).
Conclusion: Our results contribute to predicting the growth pattern of intracranial meningioma and thus select the
optimal management.
Keywords: Meningioma, Conservative, Growth rate, Non-surgical management.

INTRODUCTION


About a third of all 1ry brain tumors are
long history, those who are elderly and whose
meningiomas.
The
incidence
of
intracranial
symptoms are progressing slowly, those whose life
meningiomas is 2.3 per 100,000. The peak age is
expectancy is short and/or whose clinical condition is
between the ages of 60 and 69, and the majority of them
poor due to their age, and those for whom surgery
are women (1). Based on histologic criteria, the World
carries a significant hazard (1).
Health Organization divided meningiomas into 15
The aim of the current study was to evaluate
subgroups across 3 grades. About 80.5% of
non-surgical management of intracranial meningiomas
meningiomas are WHO grade 1, which have benign
to better guide the management decision-making.
histology and indolent behavior. In contrast, grade 2

(17.7%) and grade 3 (1.7%) meningiomas have atypical
PATIENTS AND METHODS
to malignant histology and are more aggressive. Only
A retrospective analytical study was conducted at
ionized radiation exposure stands out as a potential
the Department of Neurosurgery in the Faculty of
environmental risk factor for meningioma, which has
Medicine at Zagazig University. A total of 53 patients,
been linked to increases in the risk of 6-10 times (2).
with 57 meningiomas were enrolled in the current study.
Understanding the individual's goals for therapy

and weighing those against the potential short- and
Inclusion criteria: Patients with non-surgically treated
long-term benefits and dangers is crucial (1).
brain meningiomas who presented to the Department of
About 2% of cranial MRIs will reveal an
Neurosurgery at Zagazig University Hospitals from
asymptomatic meningioma. More people are getting
January 2015 to November 2022.
cranial imaging and with that come a rise in the number
Exclusion criteria: Patients lost during the follow-up
of patients diagnosed with meningioma by chance.
period.
Waiting to observe if the lesion progresses is a common

treatment option, because of its' benign nature, modest
Patient evaluation: All patients involved were
size, and lack of compression on surrounding structures
subjected to clinical assessment by general and
(3). Increasing neurologic deficit and radiographic
neurological examination, in addition to laboratory and
evidence of a surgically curable tumor make surgery an
radiological assessment.
obvious indication in many individuals. In other cases,
it may be best to simply observe the patient and assess
a) Clinical assessment:
them clinically and with MRI scans regularly. Patients
History taking: Personal history, onset, and
who have no symptoms and minimal or no edema in the
course of any complaint.
surrounding brain areas are good candidates for
General examination: Paying particular
observation, as are those with minimal symptoms or a
attention to the symptoms of systemic illness.
2990
Received: 09/10/2022
Accepted: 12/12/2022

Full Paper (vol.902 paper# 152)


c:\work\Jor\vol902_153 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 2998-3003
Comparison between Oxytocin and Dinoprostone in Labor Induction in
Pregnancies with Premature Rupture of Membranes
Tamer E. Elghazaly*1, Ihab F. Allam1, Hassan A. Bayoumy1
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
*Corresponding author: Tamer Elsayed Mohammed Elghazaly, Mobile: (+20) 01032060647, E-Mail: ayazizo93@gmail.com

ABSTRACT
Background:
Premature membrane rupture (PROM) remains one of the most difficult issues in obstetrics because of the
increased morbidity and mortality of both mothers and fetuses. Several studies have looked at the best management
techniques for these circumstances. Objective: This study aimed to compare between two protocols (oxytocin versus
sustained release dinoprostone followed six hours later by oxytocin) for induction of labor in pregnancies with premature
rupture of membranes at term. Patients and Methods: This prospective comparative study was conducted at Ain Shams
Maternity Hospital and Obstetrics and Gynecology Department at El-Sahel Teaching Hospital during the period between
May 2013 and August 2014. This study included 90 pregnant women with premature rapture of membranes at term (37-
42 weeks of gestation, as determined by first day of LMP or by 1st or 3nd trimester ultrasound scan).
Results: Vaginal delivery within 24 hours of labor induction was significantly increased in dinoprostone-oxytocin group
than oxytocin. (66.7% for oxytocin group vs. 80% for dinoprostone followed by oxytocin). Also, more cesarean sections
were performed in the oxytocin group (33.3% for oxytocin group vs. 20% for dinoprostone-oxytocin group). Mean
induction active phase and induction delivery intervals were significantly shorter in oxytocin group than dinoprostone-
oxytocin group. Conclusion: With a significant increase in the rate of vaginal delivery within 24 hours in comparison
with oxytocin alone and shorter induction active phase and induction delivery intervals in the oxytocin group than in the
dinoprostone-oxytocin group. Sustained release dinoprostone followed by oxytocin six hours later is an alternative safe
method for inducing labour in women with term PROM. There is no distinction between the two groups in terms of
maternal and newborn outcomes.
Keywords: Oxytocin, Dinoprostone, Labor induction, PROM.

INTRODUCTION

and poor Bishop scores. Nevertheless, there is a dearth of
The term "premature rupture of the membranes"
information about the efficiency and safety of PGE2 in
(PROM) is defined as burst of foetal membranes before
term pregnancies complicated by PROM. Just a small
the start of typical uterine contractions (1). Due to the
number of studies have examined pre-induction cervical
increased morbidity and mortality of both mothers and
softening in women with PROM and an unfavourable
foetuses, one of the most difficult issues in obstetrics is
cervix (3, 4, 6).
still PROM. Several studies have examined the best
PATIENTS AND METHODS
management practices for these circumstances. The main
This prospective comparative study was conducted at
concern in treating patients with PROM is whether to
Ain Shams Maternity Hospital and Obstetrics and
induce labour or let them go into labour naturally. A
Gynecology Department at El-Sahel Teaching Hospital
systematic analysis in 2017 comparing the pregnancy
during the period between May 2013 and August 2014.
outcomes of planned early intervention and expectant
This study included 90 pregnant women with premature
treatment in 23 randomised trials of women with PROM
rapture of membranes at term (37-42 weeks of gestation,
at or before 37 weeks of gestation indicated that
as determined by first day of LMP or by 1st or 3rd
induction of labour was more beneficial for patients than
trimester ultrasound scan).
expectant management (2).
Two groups of patients were formed; group A
There is no agreement on the process of labour
(conventional group) contained 45 patients who received
induction for women who are not prohibited from giving
an intravenous oxytocin infusion. There were 45
birth vaginally. The initial administration of any
individuals in group B (the experimental treatment
prostaglandin other than oxytocin has not shown clearly
group) who received a dinoprostone pessary. There was a
to be beneficial for women with PROM, even those with
pool of fluid in the posterior fornix as amniotic fluid
unfavourable cervixes, according to meta-analyses of
started to drain from the cervical OS during sterile
randomised studies, however data for the latter subgroup
speculum examination, confirming the existence of
are scarce (3, 4). The use of oxytocin as the primary labour
PROM at term.
induction technique in PROM is supported by recent

advice (5).Prostaglandin E2 (PGE2) vaginal inserts have
Inclusion criteria: Women who have a live, single-term
been shown to be both safe and effective in promoting
foetus, exhibiting a vertex, undergoing a reactive non-
cervical softening in women with post-term pregnancies
stress test, or experiencing an early membrane rupture
2998
Received: 10/10/2022
Accepted: 13/12/2022

Full Paper (vol.902 paper# 153)


c:\work\Jor\vol902_154 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 3004-3008

Prevalence and Prognostic Significance of Deep Venous Thrombosis in
Pulmonary Embolism
Ali O. Abdelaziz1*, Ysora M. Ali1, Bahaa I. Mohamed1, Nada A. Abdelaziz1,
Shaimaa F. Kamel2, Maha Trafawy3, Rasha M. Emam1
Departments of 1Chest, 2Hematology Unit Internal Medicine, and
3Endocrine Unit Internal Medicine, Faculty of Medicine, Minia University, Egypt
*Corresponding author: Ali Omar Abdelaziz, Mobile: (+20) 01142741126, E-Mail: omran282@yahoo.com

ABSTRACT
Background:
Deep venous thrombosis (DVT) and pulmonary embolism (PE) are regarded as 2 distinct clinical
presentations of the same illness. Up to 90% of symptomatic PEs are caused by thrombi in the venous system of the
lower extremities. There is a great deal of uncertainty regarding the precise frequency of DVT in individuals with PE
and the clinical importance of concurrent DVT. Objective: The aim of the current study was to evaluate the prevalence
and prognostic significance of DVT in patients with PE.
Patients and methods: A retrospective study included 100 patients with confirmed PE. CT pulmonary angiography
(CTPA) was used to diagnose all PEs. Using duplex ultrasonography, all patients were evaluated for the existence of
DVT in the lower or upper extremities. Patients were classified into concomitant DVT and non-DVT groups.
Results: DVT was detected in 44% of PE cases (16 of them had subclinical DVT without evident symptoms "36.4% of
DVT cases"). Proximal lower limb DVT was found in 36 patients and 6 cases suffered distal lower limb DVT. Upper
limb DVT was shown in only 2 cases. Bilateral DVT was found in only 4 cases. Wells and modified Wells scores were
significantly different among the 2 groups, where DVT confirmed cases presented more with likely or high-risk cases
than DVT negative group. Mortality was proved to be insignificantly different between both groups with 22.3%
mortality in DVT positive cases and 25% mortality in DVT negative cases, with overall mortality of 24%.
Conclusions: Nearly half of PE cases had concomitant DVT and that associated DVT had no effect on mortality. Post-
operative period and cancer are two comorbidities that could be risk factors for PE without DVT.
Keywords: Pulmonary embolism, DVT, Prevalence, Prognostic significance.


INTRODUCTION

Pulmonary embolism (PE) and deep venous
probability for PE was done using wells and simplified
thrombosis (DVT) are viewed as two distinct clinical
wells scores.
symptoms of the same illness. Because of sharing
CT pulmonary angiography was used to diagnose all
similar
etiology,
the
concept
of
venous
PEs (CTPA). The localization of the thrombus in the
thromboembolism (VTE) was introduced several years
major pulmonary arteries, lobar pulmonary arteries, and
ago (1).Almost 90% of individuals with symptomatic
segmental or sub segmental branches was further
PEs had the source of the emboli in the venous system
assessed for each confirmed PE on CTPA.
of the lower limbs (2). Despite of the advances in the
Duplex ultrasonography was used to determine if DVT
diagnostic and therapeutic modalities, there is still
was present in the lower or upper extremities. Duplex
considerable mortality rate of VTE during the first 3
ultrasonography results led to the classification of DVT
months with reported range of 1.4% to 17.4% (3).
into proximal and distal DVT. Proximal DVT is defined
Many studies demonstrated that some patients
as thrombosis that affects the common and external iliac
with symptomatic DVT had asymptomatic PE.
veins, common femoral vein, femoral vein, and
Meanwhile many patients with PE had clinically silent
popliteal vein without respect to calf vein thrombosis.
DVT (4). Nonetheless, little is known about the actual
The thrombosis exclusively affects the calf veins in
frequency of DVT in individuals with PE and its clinical
distal DVT (7).
importance (5,6). Also, there is a lack of information
Patients were classified into concomitant DVT and non-
about the prognostic value of concurrent DVT in PE
DVT groups. Chest plain radiography, and some
patients (7).The aim of the current study was to evaluate
laboratory tests (PaO2, A-a oxygen gradient,
the prevalence and prognostic significance of DVT in
lymphocytic count) were done and compared between
patients with PE.
both groups, as well as comparison regarding the

location of the embolus in the multidetector CTPA.
PATIENTS AND METHODS
Mortality was also compared between both groups.
A retrospective study included 100 patients with

confirmed PE. Data were collected from records of
Ethical Approval:
inpatients admitted in the Chest Department and
This study was ethically approved by the
Respiratory Intensive Care Unit of Minia University
Institutional Review Board of the Faculty of
Hospital.
Medicine, El-Minia University. Written informed
For all patients detailed history regarding risk factors
consent was obtained from all participants. This
for VTE was recorded. Also, assessment of clinical
study was executed according to the code of ethics of
3004
Received: 09/10/2022
Accepted: 12/12/2022

Full Paper (vol.902 paper# 154)


c:\work\Jor\vol902_155 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 3009-3014

Ultrasonographic Measurement of Distal Femoral and Proximal Tibial Epiphyseal
Ossification Centers in the Third Trimester and their Correlation to Gestational Age
Nadia M. Madkour, Badeea S. Soliman, Dalia Zakareya Hussein, Ahmed Hassan El-Massarawy
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Dalia Zakareya Hussein, Mobile: (+20) 01117858338, E-mail: daliazakareya9@gmail.com

ABSTRACT
Background:
Sonographic estimations are derived from calculations based on fetal measurements and thus, serves as an
indirect indicator of maturity and GA. Objective: This study aimed to measure the distal femoral (DFOC) and proximal
Tibia (PTOS) epiphyseal ossification centers in the 3rd trimester and correlate them to BPD, HC, AC, FL and GA to
increase the ultrasound accuracy of gestational age (GA) estimation and thus avoiding iatrogenic prematurity.
MethodS:
A prospective observational cohort study. A total of 150 low risk pregnant women. The Distal Femoral and
the Proximal Tibia epiphyseal ossification centers were measured and correlate them to BPD, HC, AC, FL and GA.
Results: The best cut-off of DFOC in prediction of maturity (GA 37th weeks' gestation) was 4.4 mm with area
under curve 0.88 (CI: 0.83 to 0.94) with sensitivity 82.8%, specificity 79.3%, positive predictive value (PPV) 95%,
negative predictive value (NPV) 49% and overall accuracy 80% (p<0.001), the best cut-off of PTOC in prediction of
maturity (GA 37th weeks' gestation) was 2.5 mm with area under curve 0.887 (CI: 0.83 to 0.95) with sensitivity
82.8%, specificity 74.4%, positive predictive value (PPV) 95%, negative predictive value (NPV) 44% and overall
accuracy 76% (p<0.001). Conclusion: There was a strong positive correlation between DFOC, PTOC and GA.
Keywords: Ultrasound, Gestational age, Distal femoral, Proximal tibia, Ossification centers.


INTRODUCTION
determination of gestational age becomes a real
Accurate gestational age estimation is one of the
challenge even with ultrasonography (5).
most important factors needed for optimum obstetrical
Non-traditional ultrasound measurements as
management. Neonatal respiratory distress syndrome is
secondary epiphyseal ossification centers in late
the most leading one for neonatal mortality and
gestation may assist in determining accurate gestational
morbidity. Lack of accurate gestational age estimation,
age and appropriate fetal lung maturity (1). Adding of
particularly in some geographical regions at greatest
new ultrasound measurements as distal femoral and
risk of these conditions, means that preterm delivery
proximal tibia ossification centers in 3rd trimester to the
and small for gestational age rates are mere
traditional measurements, may increase the ultrasound
approximations in many parts of the world (1).
accuracy in gestational age estimation, diagnosis of
Respiratory distress syndrome is a major cause of
intrauterine growth restriction, prediction of fetal lung
neonatal morbidity and mortality that is most
maturity and avoiding iatrogenic prematurity (1).
commonly caused by a deficiency in lung surfactant in

premature infants. Therefore, laboratory tests were
METHODS
developed to measure the presence and concentration of
A prospective observational cohort study was
lung surfactant in amniotic fluid in order to estimate
conducted in Department of Obstetrics & Gynecology,
maturity of the fetal lung. Although these tests were
Faculty of Medicine, Zagazig University in the period
once widely employed, their utilization by physician
from August 2021 to January 2022. A total of 150
has decreased in last years. Several studies have shown
pregnant women; singleton pregnancy, completed 28th
that demonstration of a mature fetal index by antenatal
weeks' gestation based on last regular sure menstrual
testing does not improve neonatal outcomes. Reduced
period and /or 1st trimester ultrasound dating. Low risk
respiratory and non-respiratory morbidities are highly
and uncomplicated pregnancies.
correlated with gestational age of the fetus. Fetal lung
Exclusion criteria: Pregnancies with medical
maturity testing may have passed the point of being
complication as diabetes mellitus and hypertension,
clinically
useful (2).
Unusual
methods
like
obstetric
complication
as
oligohydramnios,
amniocentesis, radiography and ultrasound are required
polyhydramnios and intrauterine growth restriction,
to assess the fetal maturity. Amniocentesis is an
and/or fetal congenital anomalies.
invasive technique and use of X-rays is hazardous to
All women in this study were subjected to full
fetus (3).
history, clinical examination. investigations [ CBC, Rh
Evidence suggested that gestational age estimation
factor, FBS, PPBS, kidney and liver function tests and
using ultrasound measurements is clinically superior to
clotting and bleeding time]. Trans-abdominal
using menstrual dating with or without ultrasound,
ultrasound. The distal femoral and the proximal tibia
providing ultrasound is performed with quality and
epiphyseal ossification centers were measured using
accuracy (4). Pregnant women are frequently unsure of
Mindary DC-70EXP ultrasound.
the date of their last menstrual period and when this is
Trans-abdominal ultrasound using a 5 MHZ
combined with late booking for antenatal care,
convex array transducer probe. GA was calculated by

measuring BPD, HC, AC, and FL. Fetal condition,
3009
Received: 08/10/2022
Accepted: 11/12/2022

Full Paper (vol.902 paper# 155)


c:\work\Jor\vol902_156 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 3015-3021

Clinical Significance of Circulating Cell-Free Mitochondrial DNA in
Breast Cancer Patients
Salma M. Hassanin*, Menat Allah A. Shaaban, Sayeda A. Saleh
Department of Clinical and Chemical Pathology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Salma Mostafa Hassanin, Mobile: (+20) 01112076007,
Email: salmanashaat@gmail.com, ORCHID No.: 0000-0002-8386-8176

ABSTRACT
Background
: Breast cancer is one of the most frequent cancers and the leading cause of death globally. In Egypt, it
accounts for 18% of all cancer cases.
Objective:
In order to assess its clinical value as an early diagnostic marker, the current study examined circulating
cell-free mitochondrial DNA (Mt.DNA) detected by RT-PCR in breast cancer patient samples.
Subjects and Methods: 25 breast cancer patients and 15 patients with benign masses participated in this study. Patients
were selected from Ain-Shams University Hospitals' outpatient clinics and surgery department. The results of these
patients were compared with a control group of 10 age-matched healthy persons. For the purposes of determining CEA,
CA 15.3, and Mt.DNA, blood samples were obtained.
Results: The combined use of Mt.DNA and CA15.3 or CEA, raised the diagnostic sensitivity in discriminating patients with
breast cancer from non-cancer patients to 100%, with 96% specificity, 96% PPV, 100% NPV and 98% efficacy.
Conclusion: Our research showed that, as compared to women with benign breast illnesses and healthy controls, breast cancer
patients have considerably reduced Mt. DNA levels. Mt. DNA levels were also much lower in stage I breast cancer than in
benign conditions and healthy individuals, suggesting its potential for use as an early marker.
Keywords: Cancer breast, Mitochondrial DNA, Tumor marker.

INTRODUCTION
were contrasted with a control group of ten (10) age-
With more than 2 million cases in 2020, breast
matched, seemingly healthy persons. After receiving
cancer will be the most frequently diagnosed
oral consent, everyone agreed to participate voluntarily.
malignancy in females around the world. 18% of cancer
A) Group I (Breast Cancer Cases):
cases are in Egypt (1). However, early diagnosis allows
Group I consisted of twenty-five (25) female patients
for better treatment options, more successful follow-up,
with breast cancer. They were diagnosed by
and ultimately a better prognosis for the patients (2).
histopathology. They ranged between 39 and 67 years
Serum biomarkers are used to diagnose breast
(median age 53 years, Interquartile range (IQR) 43.5-
cancer. However, they are unreliable for the detection
58.5 years). According to TNM staging, they were
of breast cancer in terms of sensitivity and negative
subdivided into:
predictive values (3). Numerous studies have shown that
1. Stage I: (n=7). This group included 7 cancer cases.
tumor cells reduce mitochondrial activity to change
They ranged between 39 and 53 years (median age
their metabolism in response to their environment (4).
43 years, IQR 40-51 years).
There have been reports of point mutations, substantial
2. Stage II: (n=12). This group included 12 cancer
deletions, and changes in copy number in a number of
cases. They ranged between 45 and 67 years
cancer forms, among other Mt.DNA modifications (5).
(median age 50 years, IQR 47-60 years).
Reduced Mt.DNA has been correlated to malignancies
3. Stage III: (n=6). This group included 6 cancer
of the kidney, breast, ovary, and liver (6).
cases. They ranged between 48 and 52 years
Scientists are interested in Mt.DNA because the
(median age 50 years, IQR 48-51 years).
alterations in the Mt.DNA could be used as a sensitive
B) Group II (Pathological Control Patients): This
early biomarker for the non-invasive detection of a
group included fifteen 15 age-matched female
variety of solid cancers, including breast cancer (7).
patients serving as a pathological control group.
This work was to study circulating cell-free
They ranged between 35 and 51 years (median age
mitochondrial DNA (Mt.DNA) analyzed by q rt-PCR in a
43 years, IQR 37-48 years). These patients had
group of breast cancer patients to evaluate its clinical
benign diseases as fibroadenoma, ductal epithelial
importance as an early diagnostic marker. This might
hyperplasia and fibrocystic disease of the breast.
make early intervention possible and affect the therapy
C) Group III (Healthy Controls): This group
regimens.
included ten 10 healthy females serving as a healthy

control group. They ranged between 40 and 65
SUBJECTS AND METHODS
years (median age of 52.5 years, IQR 47-56 years).
Twenty-five (25) female patients with breast cancer

and fifteen (15) female patients with benign breast
Ethical Consideration:
masses participated in this study. Patients were gathered
Each participant provided written informed
from Ain-Shams University Hospitals' outpatient clinics
consent, which is collected after the project was
and surgery department. The outcomes of these patients
given ethical board approval at Ain Shams
3015
Received: 09/10/2022
Accepted: 12/12/2022

Full Paper (vol.902 paper# 156)


c:\work\Jor\vol902_157 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 3022-3026

Diagnostic Utility of Serum Copeptin Level in Children with Febrile Seizures
Ammar Ali Ammar Abdulhafith1*, Ahmed Galal Siam1, Ahmed Abdel Sabour Mohammed2, AMR I. Risha1
Department of Pediatrics1, Clinical Pathology2, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ammar Ali Ammar Abdulhafith, Mobile: (+20)01141696913,
E-mail: ammaralnoga817@gmail.com
ABSTRACT
Introduction:
Febrile seizures are the most frequent convulsive episode in children, involving 2-5% of those between the
ages of six months and five years. Arginine-vasopressin (AVP), a pituitary hormone, has been shown to play a role in
response to fever and convulsions, affecting the thermoregulatory system. Copeptin's C-terminal region has been identified
as a reliable predictor of AVP production. Objective: The aim of the current study was to assess serum copeptin's diagnostic
utility in febrile seizures.
Patients and methods:
A case-control study was conducted at Zagazig University's Emergency Room and Neurology Unit
of Children's Hospital. A total of 46 patients were recruited and were divided into two groups; Febrile seizure group included
23 patients and febrile without seizures group included 23 patients.
Results: There is significant higher copeptin value in febrile seizures group compared to febrile control without seizures
group (P<0.05). Copeptin in diagnose seizure patients in febrile patients revealed a sensitivity of 82.6%, a specificity of
78.3% and 80.4% accuracy at a cutoff value >75 pg/ml.
Conclusion: Serum copeptin can tell the difference between a febrile seizure and a febrile without a seizure. Serum copeptin
at cut off value >75pg/ml was a good marker for detecting seizures in febrile patients. Serum copeptin performed adequately
as a diagnostic tool, highlighting its potential role in the febrile seizure diagnostic algorithm.
Keywords:
Serum Copeptin, Febrile Seizures, Children, Case control study, Zagazig University.

INTRODUCTION

Children's Hospital. A total of 46 patients were
Febrile seizures (FS) are seizures that occur during
recruited and were divided into two groups: A) Febrile
childhood and are not caused by a central nervous system
seizure
group
included
23
patients
whose
infection. They are the most common convulsive episode
parents/guardians or reported a convulsive episode
in childhood and affect 2-5% of kids between the ages of
accompanied by a high body temperature (>38°C),
six months and five (1,2). Although the precise etiology of
without prior afebrile seizure history. B) Febrile without
febrile convulsions is unknown, it is generally accepted
seizures group included 23 patients who were age and
that a complex interaction of hereditary and
Gender matched to case group, without a prior history of
environmental variables is to exist. The extracranial
febrile or afebrile seizures.
origin of fever in febrile convulsions and the elevated

temperature that goes along with it are both typical
Inclusion criteria: Age ranged from six months to six
physiological reactions to infection. Some potential
years. Both genders.
mechanisms for these convulsions include the release of
Exclusion criteria: Patients aged less than 6 months or
cytokines during fever, which results in momentary
more than 6 years. Children with infections of the central
aberrant brain electrical activity (3-5). It has been
nervous system. Seizures associated with hypoxic
demonstrated that the pituitary hormone arginine-
ischemic
encephalopathy.
Disorders
of
the
vasopressin (AVP) contributes to the thermoregulatory
neurocutaneous system. Metabolic inborn error.
response to fever and convulsions. The C-terminal region
Every patient was subjected to comprehensive history
of copeptin has been found to be a reliable indication of
taking and clinical examination. Neurological
AVP synthesis despite the fact that AVP is unstable in
examination included pupil, level of consciousness,
peripheral blood and therefore inappropriate for
motor, sensory, cranial nerves, gait, as well as Glasgow
diagnostic usage (1). Copeptin can be used as a substitute
coma scale (GCS), a measurement tool for assessing
for arginine vasopressin to indicate an overactive arginine
consciousness in critically unwell or traumatized patients.
vasopressin system because it is a more durable molecule
The subsequent ratings are added and categorized: A
in plasma, and the kidneys help to partially eliminate it
minor brain injury is worth 13 to 15 points, a moderate
(6,7). The aim of the current study was to assess serum
brain injury is worth 9 to 12 points, and a severe brain
copeptin's diagnostic utility in febrile seizures.
injury is worth 3 to 8 points (7).

Laboratory investigations included:
PATIENTS AND METHODS
CBC (complete blood count): CBC sample was drawn
A case-control study was conducted at Zagazig
from venous blood that had been thoroughly mixed and
University's Emergency Room and Neurology Unit of
anticoagulated with ethylene diamine tetraacetic acid

(EDTA). The test was carried out within 6 hours of
receiving the blood specimen. The experiment was
3022
Received: 18/09/2022
Accepted: 21/11/2022

Full Paper (vol.902 paper# 157)


c:\work\Jor\vol902_158 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 3027-3029

Liposarcoma of Spermatic Cord: A Case Report
Wael Mohamed Abdelgawad Hamed*, Hassan Mohamed Khalaf, Waleed Mohamed Allam,
Khalil Taha Abo Rokba, Eslam Atef Abdelmoneim Sharara, Mohamed Elsaid Aboelnadar AbdelAty
Damanhur Medical National Institute, Elbehiera, Egypt
Corresponding author: Wael Mohamed Abdelgawad Hamed, Tel.: 01223004249, Email: waeldoc80@gmail.com

ABSTRACT
A painless inguinal or scrotal tumor is a characteristic of the uncommon illness known as liposarcoma of the spermatic
cord (LSC). We introduce a 40-year-old man who was hospitalized to the Surgery Department with indications of a
right inguinal unilateral, painless, hard, firm mass that was slow-growing. Histopathology evaluation revealed a
lipomatous neoplasm formed of lobules of fat cells of variable size having large nuclei with few showing nuclear
indentation by vacules. The fat cells are separated by either loose myxoid stroma or fibrous stroma that shows atypical
cells with large hyperchromatic nuclei. The mass is surrounded by an intact facia. The submitted membranes and
fibrofatty tissues are free from tumor invasion.
Keywords: Spermatic cord, Liposarcoma, Radical orchiectomy, Case report, Damanhur Medical National Institute.

BACKGROUND

at Damanhour Teaching Hospital in Elbehiera, Egypt.
The most prevalent primary cancerous tumor of the
When the patient performed the Valsalva maneuver, it
spermatic cord is a malignant tumor called liposarcoma,
was discovered during a clinical examination that the
which develops from mesenchymal cells (1).
swelling had descended from the inguinal canal into the
Patients of all ages may develop primary spermatic
scrotum. This led to the clinical and radiological
cord tumors, which make up 7-10% of all intrascrotal
diagnosis of an indirect inguinal hernia. A multi-
tumors but are very uncommon. In most cases, they
loculated, encapsulated yellow mass was discovered
manifest as hard, palpable, slow-growing paratesticular
intra-operatively after the spermatic cord was severed;
lumps. Even though lipomas make up the majority of
there were no hernias seen, and the mass was totally
them, which are mostly benign, 25% of them are
dissectable from the surrounding tissues with the intact
potentially fatal malignant tumors (2).
capsule and preservation of the spermatic cord and
Lipomyosarcomas,
leiomyosarcomas,
testis. The final pathological evaluation of the specimen
rhabdomyosarcomas, malignant fibrous histiocytomas,
was well differentiated liposarcoma with intact capsule
and fibrosarcomas are the most often reported
and free surgical resection margin, metastatic work up
malignant histological forms. Due to the rarity of these
was done and was free. Consultation was done with a
malignant tumors, treatment has been challenging, and
consultant medical oncologist for if the patient in need
there is no agreement on the best surgical and non-
for radical orchiectomy, the final decision is no need for
surgical treatment approaches. (3).
further surgical interventions.
Less than 200 instances of paratesticular

liposarcomas have been documented in the literature as
HISTOPATHOLOGY
of this writing. Most of these tumors are present as
Gross pathology reveals a well-defined mass with intact
scrotal or inguinal lumps that are painless and slowly
facia measuring 11x9x8cm, the mass has a lobulated
developing. Spermatic cord liposarcomas are
yellow myxoid cut section admixed with whitish areas.
uncommon, and because of this, they are frequently
Also submitted is a membranous structure 10x4cm and
misdiagnosed as inguinoscrotal hernias, hydrocele,
small fibfofatty specimen's collectively measuring
lipomas, funicular cysts, or testicular cancers (4).
4x4cm. Histopathology report reveals a lipomatous
There is limited information about liposarcomas
neoplasm formed of lobules of fat cells of variable size
and no formal guidelines or standards for diagnosis,
having large nuclei with few showing nuclear
therapy, or patient follow-up due to the rarity of these
indentation by vacules. The fat cells are separated by
tumors. Due to these restrictions, there is no universal
either loose myxoid stroma or fibrous stroma that shows
agreement on the best surgical and adjuvant therapies
atypical cells with large hyperchromatic nuclei. The
(5).
mass is surrounded by an intact fascia. The submitted

membranes and fibrofatty tissues are free from tumor
CASE PRESENTATION
invasion.
A 40-year-old male patient with a painless movable
The patient gave informed permission for the sharing of
mass in the right inguinal area was seen in April 2022
the information displayed here.

3027
Received: 03/08/2022
Accepted: 04/10/2022

Full Paper (vol.902 paper# 158)


c:\work\Jor\vol902_159 The Egyptian Journal of Hospital Medicine (January 2023) Vol. 90 (2), Page 3030-3034

Neuromonitoring of Spinal Intradural Extramedullary Lesions
Samy Hasanin Mohamed, Wael Abd Elrahman Elmesallamy,
Hesham Ahmed Yakout, Magdy Omar Elsheikh
Department of Neurosurgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hesham Ahmed Yakout, Mobile: (+20) 01024137521, Email: heshamyakout@gmail.com

ABSTRACT
Background:
Intraoperative neuromonitoring for intramedullary tumours is now a common procedure in
neurosurgery, however it remains controversial whether it is appropriate for intradural extramedullary tumours.
Objective: The aim of this study is to evaluate the role of intraoperative neuromonitoring during surgery for intradural
extramedullary tumors.
Patients and methods: This study included 15 patients with intradural extramedullary tumors who underwent
microsurgical resection guided by intraoperative neuromonitoring at Neurosurgery Department, Zagazig University
Hospitals. Neurological status on admission and at follow-up was assessed using the Modified McCormick Scale.
Results: Cases mainly presented with motor symptoms (66.6%). Twenty percent of cases had sphincter abnormality
and 13.3% had only sensory symptoms. Complete gross total excision of the lesion was accomplished in 73.3% of
cases, 13.3% of cases had near total removal, 1 case (6.6%) had subtotal resection and in 1 case (6.6%) only biopsy
was taken. Modified McCormick grading at follow-up (minimum 6 months) after surgery, showed improved grade in
80% of the studied cases.
Conclusion: The use of intraoperative neuromonitoring during surgery for intradural extramedullary tumors was
useful. It enabled a safer tumor manipulation in challenging case such as lesions at the cranio-vertebral junction or in
antero/antero-lateral positions (where the rotation of the spinal cord may be observed), as well as tumors adherent to
the spinal cord without a visible cleavage plane.
Keywords: Extramedullary lesions, Neuromonitoring, Modified McCormick Scale.

INTRODUCTION
PATIENTS AND METHODS
The intradural extramedullary tumours include
This prospective study included 15 patients with
meningiomas, nerve sheath tumours (schwannomas and
intradural extramedullary tumors who underwent
neurofibromas), metastases, dermoids, teratomas,
microsurgical resection guided by intraoperative
paragangliomas,
ependymomas,
and
neuromonitoring at Neurosurgery Department, Zagazig
hemangioblastomas (1,2). Complete excision is the
University Hospitals. Neurological status on admission
surgical objective for intradural extramedullary tumours
and at follow-up was assessed using the Modified
(IDEMs) whenever it is possible (3).
McCormick Scale.
In
two
techniques,
intraoperative
The inclusion criteria included patients of both
neurophysiological monitoring (IOM) can help
genders in the ag