Clistin Versus Colistin Meropenem in Extensively Resistant The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5451-5458

Colistin Versus Colistin & Meropenem in Extensively Resistant
Enterobacterales Organisms Therapy in Critically Ill Patients
Mohammed Abdel Monem Saeed*1, Samah Ahmed Bastawy2,
Marwa Abdel Rady3, Deyaa Mohamed Ibrahim4, Alaa Mohamed Hussein5
Departments of 1Critical Care Medicine, 2Clinical Pathology,
3Microbiology and Immunology, Faculty of Medicine, Helwan University, Egypt
Department of 4Critical Care Nursing, Faculty of Nursing, Helwan University, Egypt
Department of 5Clinical Pharmacist, Faculty of Pharmacy, Helwan University, Egypt
*Corresponding author: Mohammed Abdel Monem Saeed, Mobile: (+20) 01099292999, E-Mail:

Extensively drug resistant (XDR) organisms like Acinetobacter baumannii, pseudomonas aeruginosa
XDR, Klebsiella pneumoniae XDR and Carbapenem-resistant Enterobacterales (CRE) leading to pneumonia and blood
stream infections (BSI) are associated with high mortality rates and therapeutic modalities became restricted.
Objective: Our clinical trial assessed whether combination therapy with Colistin and meropenem was superior to
colistin alone for treatment of the extensively drug resistant Enterobacterals.
Patients and methods: Our study was a randomized, prospective trial, we randomly selected the participants to receive
Colistin loading dose of 5 mg/kg once followed by a maintenance dose of 1.67 mg/kg every 8 hours in Combination
with either meropenem at a dose of 2 gm every 8 hours or Colistin alone, for treatment of pneumonia and/or Blood
stream infection (BSI) caused by extensively resistant (XDR) Acientobacter baumannii, pseudomonas aeruginosa XDR,
Klebsiella pneumoniae XDR and Carbapenem resistant Enterobacterals.
Results: Two hundred participants were randomly assigned to treatment by either Colistin as monotherapy or by
combination of Colistin and meropenem. Acinetobacter baumannii and Klebsiella pneumoniae were the predominant
organisms in our study (67%) and (16%) respectively followed by carbapenem-resistant Enterobacterals (15%) and
pneumonia the most common infection (80%). All patients were in the intensive care unit at the time of enrollment
(100%). There was a statistical difference in mortality between both groups (79% in colistin group and in combination
therapy group was 48%; p < 0.001), clinical improvement (vasopressor requirement, mechanical ventilation settings,
inflammatory markers, leucocytic count and radiology) were all in favor of the Combination therapy of Colistin and
Conclusion: Colistin and meropenem Combination therapy was more beneficial than monotherapy only for the
treatment of pneumonia and/or blood stream infection caused by the XDR Entrobacterals including mortality.
Keywords: Colistin, meropenem, XDR organisms.

colistin when combined with carbapenems, many
Extensively drug-resistant XDR Acientobacter,
experts recommend that colistin be combined with a
XDR Klebsiella pneumoniae, XDR pseudomonas
carbapenem for the treatment of infections caused by
acruginosa and carbapenem resistant Enterobacterales
Carbapenem, resistant gram-negative bacilli, despite
(CRE) causing pneumonia and blood stream infections
the presence of carbapenem resistance and a lack of
are associated with a ruined outcomes(1-4).
solid clinical evidence supporting this strategy.
The World Health organization together with the
Importantly, there are significant risks associated with
U.S. Centers for Disease Control and prevention
wide spread carbapenem use, including further
recognizes these pathogens as serious or urgent threats
resistance development and increase in adverse events
to human health(5), and they highlighted that they are of
including clostridium difficile-associated disease(10, 11).
the highest priority for research and development of
Our study is a randomized prospective trial
new therapeutic agents given the rarity of treatment
assessing outcomes in carbapenem­resistant gram-
options(6). Despite the revival of novel agents in the past
negative bacilli was designed to evaluate whether
decade for the treatment of Carbapenem resistant gram
combination therapy with colistin and a carbapenem is
negative pathogens, unmet needs remain. Novel agents
superior to colistin monotherapy.
are not universally available and not active against all

Carbapenem-resistant pathogens and following their
adoption in clinical practice, resistance to these agents
Our study was a randomized prospective trial conducted
has proliferated(7).
in Helwan University Hospitals in Critical Care
Colistin therefore remains an essential and
Medicine Department Faculty of Medicine Helwan
frequently used agent for the management of infections
University in the period from August 2020 to October
due to XDR gram-negative bacilli in the united states
and worldwide(8).
Eligible patients were more than 18 years old and
Concerns exist regarding Colistin's safety and
had pneumonia and/or bloodstream infection (BSI)
efficacy as monotherapy(9). In Vitro potency synergy of
caused by XDR A. baumannii, XDR pseudomonas
Received: 08/11/2022
Accepted: 08/01/2023

Full Paper (vol.921 paper# 1)

c:\work\Jor\vol921_2 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5459-5464

Obstructive Sleep Apnea in Patients with Central
Obesity, in Benha University Hospital
Mysara Mohamad Mogahed*1, Abeer Mohamed Rawy2,
Nashwa Ahmed Amin2, Yomna Mohamed Marei1, Amira Hussein Allam2
Departments of 1Internal Medicine and 2Chest Disease, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Mysara Mohamad Mogahed, Mobile: (+20) 01205716590,
E-Mail:, ORCID Number: 0000-0002-0688-765

Central obesity is the most prevalent dietary illness in people. It predisposes a person to a complicated
health issues, including stroke, type 2 diabetes, hypertension, non-alcoholic fatty liver disease, and obstructive sleep
apnea syndrome (OSAS). OSA is a chronic, progressive condition that adversely affects quality of life. Due to lower
lung capacity and tension on the pharynx, the degree of upper airway obstruction and hypoxemia owing to OSA seems
to correlate more strongly with the amount of visceral fat (abdominal adiposity) than other clinical indicators of obesity.
Studying the relationship between central obesity and OSA incidence and severity, as well as the
underlying risk factors between their association. Subjects and Methods: This cross-sectional study included 364 adult
subjects with central obesity who visited the Endocrinology Clinic of Benha University Hospital, Egypt, from February
2023 to May 2023. All participants were subjected to measurement of weight, height and waist circumference (WC),
recording of blood pressure, laboratory investigations including: HBA1c, lipid profile, liver and kidney function tests
and overnight polysomnography to assess OSA.
OSA was present in 308 (84.6%). OSA severity was closely related to male sex. Moderate and sever OSA was
significantly associated with male sex, old age, higher WC, higher BMI, diabetes, hypertension, high cholesterol,
triglycerides & LDL. Logistic regression analyses between different variables and OSA showed that age was the most
significant predictor for OSA (p<0.001).
Prevalence and severity of OSA among candidates with central obesity was very high. Age, waist
circumference, hypertension, disturbed lipid profile and T2DM were significantly associated with increased prevalence
and severity of OSA among centrally obese individuals. So, early in the course of their follow-up, healthcare
professionals should examine centrally obese patients for OSA.
Keywords: Central obesity, Obstructive sleep apnea (OSA).

risk factors, central obesity remained the only

Despite the fact that obesity was formerly believed
significant risk factor. This suggests that the major
to be an exclusive problem of high-income countries,
focus for the primary prevention of CVD is central
recent reports have shown a rapid rise in overweight and
adiposity. Moreover, central obesity has been connected
obesity in many low- and middle-income countries
to a number of health conditions, such as malignancies,
(LMICs), particularly in several African nations [1].
stroke [6], type 2 diabetes mellitus, hypertension,
Even if obesity poses a serious threat to one's health,
nonalcoholic fatty liver disease, and all-cause mortality
how much body fat plays a significant role in assessing
[7]. The incidence of obstructive sleep apnea (OSA),
that hazard. Hence, using the body mass index (BMI)
which affects 9% to 38% of the population generally
alone as a health indicator would not be acceptable
and is more prevalent in males, is one of the most
because people with normal weight might occasionally
prevalent and dangerous sleep-related breathing
have central obesity [2].
diseases. The incidence of OSA rises with age, and in
The term "central obesity" refers to a condition in
some senior populations, it has been estimated to be as
which there is a significant buildup of visceral fat in the
high as 90% in men and 78% in women [8]. The
abdomen [3]. According to the World Health
syndrome is characterized by recurrent upper airway
Organization (WHO), central obesity (also known as
collapse during sleep, which can result in sleep
abdominal obesity) is defined as having a waist
fragmentation, oxygen desaturation, and autonomic
circumference (WC) of more than 94 cm for men and
dysfunction [9]. Specific symptoms of OSA in sufferers
80 cm for women, respectively [4]. The biggest predictor
include excessive daily sleepiness, low moods,
of a cluster of risk factors for chronic non-
diminished memory and learning abilities, poor focus
communicable diseases (NCD), independent of BMI, is
and attention span, and cardiovascular diseases, all of
WC as an indicator of central obesity, which is the most
which can cause abrupt death. OSA is a chronic,
prevalent nutritional issue in humans and predisposes
progressive condition that has a severe impact on
the individual to a complicated health problem [5].
quality of life since sleep is a brain function that is
Triglycerides (TGS), high-density lipoprotein
essential to life and promotes relaxation [10].
cholesterol (HDL-C), hypertension, and diabetes all
Based on the findings of the polysomnography,
raise the risk of CVD. However, after adjusting for these
OSA is determined. With the aim of non-invasively

examining sleep disorders, the technique involves
Received: 07/05/2023
Accepted: 05/07/2023

Full Paper (vol.921 paper# 2)

c:\work\Jor\vol921_3 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5465-5473

Role of Multidetector Computed Tomography Coronary Angiography in
Evaluation of Coronary Bifurcation Angles as a Predictor of Coronary Artery Disease
Rabab Mohamed Abdelhay*, Samar Mohamed Shehata,
Sara Emad eldin Abdellatif, Mohamad Gamal Nada, Hanan A. Bahaaeldin
Department of Radiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Rabab Mohamed Abdelhay, Mobile: (+20) 01204592842, E-Mail :

The common and potentially fatal disorder known as coronary artery disease (CAD) is characterised by
turbulent and sluggish blood flow at the coronary artery bifurcation site, particularly at broader angles. Curved
multiplanar reformat (CMPR) and 3D volume rendering (3D VR) techniques could help in prediction of CAD.
Objective: The aim of the current study was to evaluate of the capability of Multi-detector CT (MDCT) coronary
angiography to quantify coronary bifurcation angles for early preventative treatment or preprocedural planning for
coronary intervention. Patients and methods: Using a 128-detectors scanner, 60 patients with typical or atypical chest
discomfort or failed catheterization received MDCT coronary angiography to characterise coronary anatomy. Coronary
bifurcation angles were calculated using specialised software and post-processing methods for correlation with CAD
severity. Results: Compared to the 3D VR approach, the CMPR technique revealed wider values of coronary bifurcation
angles. However, Bland-Altman plots showed that both methods may be alternatively used. Because a wider angle was
linked to a greater degree of stenosis, LAD-LCX angle differed significantly between individuals with significant and
nonsignificant CAD. Conclusion: Measurements of various coronary bifurcation angles, particularly the LAD-LCX
angle, which is thought to be a predictor for CAD, can be made using MDCT coronary angiographic examination with
CMPR and 3D VR methods. More plaques are likely to form when the angle is wider.
Keywords: Coronary artery disease, Bifurcation angle, CMPR, 3D VR, Coronary computed tomography angiography.


there is growing clinical concern for angles between the
In order to replace traditional coronary artery
LAD and the left circumflex coronary artery (LCX) as
angiography (CCA), since the early 1990s, a number of
well as the angles between the left main coronary artery
non-invasive imaging techniques have been developed
(LM) and the left anterior descending coronary artery
for visualizing the coronary arteries [1]. These methods
(LAD) [6].
were initially seemed insufficient for widespread clinical
Interventional cardiologists have emphasized the
use, despite the fact that they have produced encouraging
importance of the coronary bifurcation angle in coronary
outcomes. Electron-beam computed tomography
artery disease (CAD) diagnosis and treatment. Accurate
(EBCT), as well as Magnetic resonance (MR), are two
measurement of the bifurcation angle is essential for the
examples of modern imaging technologies that are still
successful placement of coronary stents and the
frequently employed [2]. The improved performance of
prevention of restenosis and stent thrombosis [5].
128-slice CT equipment and the advent of multi-slice
The aim of the current study was to evaluate of the
computed tomography coronary angiography (MSCT-
capability of Multi-detector CT (MDCT) coronary
CA) have provided a viable alternative to conventional
angiography to quantify coronary bifurcation angles for
CCA for the diagnosis of coronary artery disease [3].
early preventative treatment or preprocedural planning
Utilization of coronary computed tomography
for coronary intervention.
angiography (CCTA) imaging non-invasive technique

showed good sensitivity and negative predictive value
that is frequently used to diagnose coronary stenosis.
In the current study, we sticked to validate our
Additionally, utilizing various post-processing methods
findings according to Strengthening the Reporting of
such maximum intensity projection (MIP), multiplanar
Observational Studies in Epidemiology (STROBE).
reformatted images (MPR), curved multiplanar reformat
A total of 60 adult patients took part in this
(CMPR), and 3D VR make CCTA precisely estimate
retrospective single-center study between July 2022 and
coronary bifurcation angles [4].
December 2022. Patients were evaluated by the
The distribution and make-up of plaques may be
Cardiology Department and then referred to the
greatly influenced by the hemodynamic flow patterns
Radiology Department for CCTA.
that are affected by the three-dimensional (3D) geometry
Participants were considered eligible for the present
of coronary artery bifurcations) [4]. Furthermore,
study if they had either typical or atypical chest
Coronary bifurcation angle has been linked to the
discomfort or if they were scheduled for coronary
formation of plaques in the side branches of coronary
revascularization treatments that needed a precise
arteries due to the turbulent and sluggish flow there [5].
assessment of the coronary artery tree. Patients included
Plaque start in the arterial system may be affected
whither they had previously undergone CCA or not.
by hemodynamic changes brought on by variations in
Patients of any age or gender who arrived with typical
wall shear stress according to coronary bifurcation angle,
or atypical chest discomfort, preprocedural planning, or
Received: 28/1/2023
Accepted: 28/3/2023

Full Paper (vol.921 paper# 3)

c:\work\Jor\vol921_4 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5474-5477

Predictive Value of Follicular Stimulating Hormone on
Luteinizing Hormone Ratio for Ovarian Response to
Simple Ovulation Induction in Patients with Polycystic Ovarian Syndrome
Amany Abdelghany1, Mohamed Fathy Abohashim1, Wisal Ammar Emran Aemmaar2,
Reham A. Elsayed1, Shahenda A. Saleh1*
1 Department of Obstetrics and Gynaecology, Faculty of Medicine, Zagazig University, Egypt
2 Visitor at the Department of Obstetrics and Gynaecology, Zagazig University, Egypt
Corresponding author: Shahenda Ahmed Saleh, Phone number: +201001109730,
ORCID: 0000-0001-6810-0831, E-mail:
Polycystic ovary syndrome (PCOS) is considered the most frequent ovulatory disorder. PCOS often has a
problem in (GnRH) release, with increase in the pituitary secretion of (LH) hormone and high LH/FSH ratio.
Objective: The current study aimed at detecting the predictive level of LH/FSH ratio for the ovarian response, pregnancy
and miscarriage rates in PCOS patients underwent mild ovarian stimulation.
Patients and methods: A prospective cohort study was conducted in Gynaecology and Obstetrics Department, Zagazig
University Hospitals. The study included PCOS women aged from 20 to 37 years, with at least 1 year of infertility, and
normal semen analysis. The exclusion criteria were pelvic surgery and/or pathology. Cycle day 2-5 Serum LH and FSH
were measured. Transvaginal ultrasound was done on cycle day 2-3 to prove quiescent ovaries, letrozole (2.5-5mg) was
started from day 2-3 for successive 5 days with/without HMG (75-150IU/d) then follicular tracking was done till 1-3 follicles
reached 18 mm upon which ovulation trigger was given.
Results: A total 63 infertile women were included in the study. The mean age was 24.81 (SD 2.83) years, the mean BMI
30.65 (SD 6.58) Kg /m2. Basal FSH, LH level, and LH/FSH ratio ranged from 1.9-11.9 mIu/ml, 2.34-21 mIu/ml and 0.37-
4.63, respectively. ROC curve analysis showed LH/FSH ratio to be non-useful predictor of ovarian response, occurrence of
pregnancy or miscarriage in PCOS patients underwent simple ovarian induction, AUC (0.51, 0.64 and 0.69 respectively).
LH/FSH ratio seems to have no role in prediction of stimulated cycle outcome.
LH, FSH, LH/FSH ratio, PCOS, Diagnostic study, Zagazig University.

2023. The study included PCOS women aged from 20 to
Polycystic ovary syndrome (PCOS) is believed to be
37 years.
the most common ovulatory disorder. PCOS has a large
Inclusion criteria were female aged from 20 to 37
prevalence, may reach up to 5%-15% depending on
years, women with at least 1 year of infertility, PCOS
different phenotype, ethnicity, & different criteria used
women diagnosed according to Rotterdam criteria (6), and
for diagnosis (1). Female with PCOS mostly has an
normal partner semen analysis according to WHO (2010).
abnormality in the GnRH release, with increase in the
Exclusion criteria were pelvic surgery,
secretion of LH hormone and high LH/FSH level (2).
endometriosis, pelvic inflammatory disease, abnormal
In healthy ovulatory female, the ratio between both
hysterosalpingography, male factors of infertility, uterine
LH and FSH hormonal level appears to be from 1 to 2.
pathologies such as leiomyoma, adenomyosis, or polyp,
However, in polycystic ovary women, the ratio level
and those with a previous history of ovarian drilling.
becomes reversed, and it might increase 2 (3).
The sample size was calculated to be 60 infertile
The response to ovulation induction therapy has
patients with PCOS; the sample was calculated using the
rarely been explored concerning LH/FSH ratio.
Epi Info version 6 Program, at a confidence interval of
Furthermore, the algorithms available for predicting
95% and power test of 80%.
response to ovulation induction do not consider LH/FSH
History taking with complete general and local
ratio (4). The reverse ratio of LH/FSH may have a
examinations was done. Blood sampling was withdrawn
concealed negative influence on human reproduction but
in the early follicular phase, between cycle day 2-5 Serum
it is still a debatable issue (5). The current study aimed to
LH, FSH was measured and LH/FSH ratio was calculated.
examine the predictive value of LH/FSH ratio for ovarian
Transvaginal sonography was done by the same
response, pregnancy, and miscarriage rates in PCOS
observer on cycle day 2-3 to prove quiescent ovaries then
patients underwent simple ovarian induction.
ovarian stimulation using letrozole (2.5-5mg) (Femara®-
NOVARTIS) starting from cycle day 2-3 for successive 5
A prospective cohort study was conducted in
days with/without HMG (75-150IU/d) then follicular
Gynaecology and Obstetrics Department, Zagazig
tracking was done from day 10 of the cycle, until 1-3
University Hospitals, from August 2022 to February
maximumly dominant follicles reached 18 mm upon
Received: 01/03/2022
Accepted: 01/05/2023

Full Paper (vol.921 paper# 4)

c:\work\Jor\vol921_5 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5478-5486
Outcomes of Primary Percutaneous Coronary Intervention in Post COVID-19
Patients presenting with ST Segment Elevation Myocardial Infarction
Hany M. Fakhry*, Nadeem M. Elmasry, Ali A. El-Abd, Haitham G. Helmy
Department of Cardiology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Hany Mohammed Fakhry Mahmoud, Mobile: (+20) 01002554916, E-mail:

COVID-19 can cause a wide range of thrombotic diseases, including acute coronary syndromes (ACS).
While these thrombotic diseases occur during acute infection, evidence on the long-term thrombotic consequences of
COVID-19 remain unknown.
Objective: The aim of the current study was to establish the particular coronary angiographic findings, as well as the
procedural and clinical effectiveness of revascularization in post COVID-19 patients presenting with STEMI.
Patients and methods: A total 100 patients presented to Ain Shams University Hospitals with ST Segment Elevation
Myocardial Infarction (STEMI) managed by primary percutaneous coronary intervention (PCI). Participants were
divided into two groups: Group (A) included 50 patients who developed COVID-19 infection in the previous 6 months,
and Group (B) included 50 patients who deny COVID-19 infection in the previous 6 months. Group (A) was divided
into two subgroups: the Early Post-COVID subgroup, which included 16 patients who developed STEMI within 8 weeks
of infection, and the Late Post-COVID subgroup, which included 34 patients who developed STEMI >8-24 weeks after
infection. Results: The Early Post-COVID subgroup had a statistically significant high thrombus load on angiography,
with 81.3% versus 48% in the control group. This resulted in a statistically significant increase in the utilization of pre-
dilatation (56.2% versus 24%) and thrombus aspiration (43.8% versus 4%) in the Early Post- COVID grouping (P-
values 0.015 and 0.001, respectively). Coronary no-reflow was a substantially more common in the Early post-COVID
subgroup (62.5%) than in the control group (22%). This translated into a higher Major Adverse Cardiovascular Events
(MACE) among Early Post-COVID patients, at 31.3% versus 6% in the control group.
Conclusion: The thrombogenic impact of COVID-19 on STEMI outcomes continues even after infection clearance
being greatest during the first 8 weeks following infection and thereafter diminishes. It has an impact on the
angiographic, procedural, and overall clinical success of in-hospital revascularization.
Keywords: COVID-19, STEMI, Primary PCI, Thrombosis.


future research into the prevention and treatment of
While COVID-19 infection can be catastrophic,
STEMI in this group of patients.
even fatal, in its acute form, the virus's long-term
The aim of the current study was to look at the
implications remain a hazy and uncharted topic of
particular coronary angiographic findings, as well as
study. The majority of what is known regarding post-
the procedural and clinical effectiveness of
COVID manifestations consists mostly of respiratory
revascularization in post COVID-19 patients who
symptoms such as increasing shortness of breath and
presented with STEMI.
anosmia, referred to as the Post COVID Syndrome (1).

Extensive study has been conducted on the
cardiovascular implications of COVID-19 infection.
A case-control study was conducted on 100
Two recent investigations indicate the presence of
STEMI patients admitted to Ain Shams University
myocardial harm in COVID-19 deaths and survivors 2
Hospital from January 2022 to June 2022. Participants
to 3 months after infection resolution (2,3).
were divided into two groups: Group (A) included
Several studies have linked active COVID-19
patients who had recently developed COVID-19
infection to a higher thrombus burden, more
infection in the previous 6 months as determined by
complications, and lower angiographic success in
RT-PCR or CT chest (CORADS-4 or more), and
patients presenting with STEMI while the infection is
Group (B) "control group" included patients who had
active, necessitating the use of higher doses of
not recently demonstrated such infection as confirmed
Unfractionated Heparin, Glycoprotein IIb/IIIa
by negative COVID-19 antibody test.
inhibitors, and thrombus aspiration (4,5). However,
This pilot randomized controlled trial goal was to
evidence on the long-term effects of COVID-19 is
assess the outcomes of PCI in these patients. The post-
limited in this area. Patients are apparently sensitive to
COVID group was split into two groups: Early post-
venous thromboembolic events during COVID-19
COVID group (within 8 weeks of infection) and Late
infection and, to a lesser extent, 4 to 6 months after
post-COVID group (>8-24 weeks after infection), in
infection (6); our investigation investigates if the same
order to further question the idea that the
holds true for acute coronary syndromes.
thrombogenic impact of COVID-19 diminishes with
Proving the presence of an elevated thrombus
passage of time.
load in post COVID patients can pave the path for
The exclusion criteria were that patients who did
not for any reason perform primary PCI for any reason.
Received: 04/03/2023
Accepted: 06/05/2023

Full Paper (vol.921 paper# 5)

Discussion The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5487-5495

Value of Serum Kidney Injury Molecule-1 in Early Prediction of Kidney
Injury in Patient with Ascites and Spontaneous Bacterial Peritonitis
Ahmed Saleh1*, Nahla Gamal Shaban1, Hassan Mohammad Al-Asklany1,
Mostafa Mansour2, Islam A El-Zayyadi1
Departments of 1Internal Medicine, Hepatology & Gastroenterology Unit and
2Clinical Pathology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ahmed Abdel Ghafar Saleh, Mobile: (+20) 01003958489, E-Mail:

Ascites is a main complication of cirrhosis that can be complicated by spontaneous bacterial peritonitis
(SBP). A major predictor for mortality in this condition includes renal failure.
Objective: The current study aimed to evaluate the value of serum kidney injury molecule-1 (KIM-1) in the early
prediction of kidney injury in cases with SBP.
Patients and Methods:
A prospective cohort study was conducted on admitted patients with decompensated liver
disease in Hepatology and Gastroenterology Unit, Specialized Medical Hospital, Mansoura University, Egypt. A total
160 patients were recruited; 120 patients with SBP (cases) and 40 patients without SBP (controls). Serum KIM-1 was
measured for all patients. Additionally, serum creatinine ( was done every 48 hours during admission and every
week after discharge.
Results: A statistically significant lower AST, direct bilirubin, and Child-Pugh score was noticed in cases versus
controls. Additionally, a significantly higher (on admission and at follow up), and KIM-1 in AKI vs. non-AKI was
noted in cases vs. controls. Moreover, KIM-1, at a cutoff value of >88.6, had a high sensitivity and specificity (95.8%
and 93.7%, respectively) in discriminating AKI from non-AKI patients.
KIM-1 as a biomarker may allow evaluation of the functional condition, hepatorenal syndrome and acute
tubular necrosis as a result potentially allowing early treatment decisions. In addition, this biomarker plays an essential
role in early AKI diagnosis and overall prognostic assessment. This combination of biomarkers may be utilized to plan
upcoming interventional researches in order to improve the outcomes of such cases.
Keywords: Kidney Injury Molecule-1, Spontaneous Bacterial Peritonitis, Kidney Injury, Ascites, Cohort study,
Mansoura University.


cases, as it appears to predict hospital mortality either in
Cirrhosis is the histological development
presence or absence of ascites (5).
of regenerative nodules surrounded by fibrous
Even though serum creatinine ( is the most
bands owing to chronic hepatic injury which has been
commonly utilized marker for renal function (RF), its
demonstrated to be accompanied by portal hypertension
value could be influenced by non-renal factors which
(PHT) and end stage liver disease (ESLD). Progress in
include gender, ethnicity, age, body mass index (BMI),
proper identification of the course and pathophysiology
and medications. As regards cirrhotic, the diagnostic
of cirrhosis, and management of its adverse events, have
value could be decreased owing to a reduction hepatic
been demonstrated to be associated with improvement
synthesis, reduction in skeletal muscle bulk, low protein
of therapeutic modalities and quality of life (QoL) (1).
intake, increased distribution volume and increased
The main adverse events of cirrhosis involve
tubular secretion. In brief, the delay between RF
varices, ascites, hepatic encephalopathy (HE),
reduction and elevation in has been considered as a
main limitation for to be used as an early marker.
carcinoma (HCC), hepatorenal syndrome (HRS),
Novel biomarkers comprising cystatin C, neutrophil
Spontaneous bacterial peritonitis (SBP), and
gelatinase-associated lipocalin (NGAL) and Kidney
coagulations disorders. SBP has been considered as a
Injury Molecule-1 (KIM-1) are suggested to overcome
frequent and critical adverse event of decompensated
such restriction, and have demonstrated advantages
cirrhosis with an incidence of about 20% in hospitalized
with regard to diagnosis and outcomes in various
cases (2). Its association with high frequencies of adverse
populations (6).
KIM-1, a transmembrane glycoprotein situated in
cardiovascular derangement which ultimately ends in
proximal tubules, is elevated throughout ischaemia,
liver failure and renal failure (3).
whereas soluble KIM-1 is secreted in urine. In the
Renal failure has been considered as one of the
context of cirrhotic cases, a multi-centric research
main predictors of mortality in SBP. Acute kidney
demonstrated elevated urinary values among cases with
injury (AKI) occurs commonly in cases with advanced
acute tubular necrosis (ATN) and its correlation with
cirrhosis with ascites (4). Expert committees have
AKI advancement and death (7).
suggested the utilization of the AKI Network (AKIN)
classification to be utilized in the context of cirrhotic
Received: 05/04/2023
Accepted: 07/06/2023

Full Paper (vol.921 paper# 6)

Full Paper (vol.921 paper# 7)

c:\work\Jor\vol921_8 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5503-5507

Insulin Resistance and Related Glycemic Parameters in Type 2
Diabetes Mellitus after Successful Treatment of HCV
Amira M. Elsayed, Medhat M. Elamawy, Walaa M. Ibrahim
Internal Medicine Department, Benha Faculty of Medicine, Benha University, Egypt
Corresponding author: Medhat M. Elamawy,Email:,
Mobile Phone: 01024443810, Orcid ID: 0000-0003-4072-0697

Background: Chronic hepatitis C virus infection is a worldwide health problem that could cause complications such as
cirrhosis or even hepatocellular carcinoma. Hepatitis C virus (HCV) infection has increased preponderance of diabetes
mellitus (DM) type 2 and insulin resistance.
Objectives: Our goal is to determine whether the most recent direct acting antiviral (DAA) medications for the HCV
treatment are linked to improvements in insulin resistance and other related glycemic parameters in type 2 DM patients.
Patients and Methods: This prospective, observational study was conducted on 40 diabetic patients aged >18 years treated
from HCV by DAA. Baselines HCV PCR and liver function tests were obtained before DAA. Pre-and post-treatment change
of the glycemic profile including calculated homeostatic model assessment of insulin resistance (HOMA-IR) lab results
were taken.
Results: Impact of DDA drugs on our subjects' glycemic profile showed improvements of all glycemic indices (Fasting
plasma glucose (FPG), fasting insulin, HBA1c and HOMA-IR with p-value < 0.001. HCV PCR changes after treatment
was positivity correlated significantly especially with FPG and HOMA-IR (r value 0.501 and 0.478 respectively) with p-
value < 0.05.
Conclusion: We concluded that DAAs improved insulin resistance and related glycemic control parameters after eradication
of HCV. Our results suggest that HCV take a part in glucose homeostasis. Liver function before treatment could be a
predictor of improvement of insulin resistance.
Keywords: HCV, HOMA I
- R, Diabetes Mellites, Direct Acting Antiviral DAA


Around 170 million people worldwide had hepatitis
Our goal is to determine whether the most recent DAA
C virus (HCV) infection, and its other later consequences
medications for the treatment of HCV infection improve
such as cirrhosis and liver malignancy, which are linked
insulin resistance and other related glycemic parameters
to increased mortality, are significantly increased by
in type 2 DM patients.
chronic hepatitis C (CHC) infection (1).

According to epidemiological studies, hepatitis C virus
(HCV) infection may be related to increased
This prospective, observational study was
preponderance of diabetes mellitus (DM) type 2 (2).
conducted on patients treated from HCV by DAA who
Moreover, having persistent HCV infection raises the
were attending medical clinics at Benha University
likelihood of developing type 2 DM in patients with
Hospital for follow up. Data were recruited from patient
metabolic syndrome risk factors by an additional 11 times
with HCV that had positive serum real time HCV PCR
and type 2 DM. Diagnosis of DM was according to
Molecular mechanisms explain how HCV infection
American Diabetes Association (ADA) 2022 (7).
might raise the chance of developing type 2 DM or
40 patients, aged >18 years old, received
decrease glycemic control in people who already have
sofosbuvir, simeprevir, peg-interferon, and daclatasvir
condition (4).
with or without ribavirin as a dual or triple therapy for 3
One study demonstrated that insulin resistance (IR)
months according to the recommendations of The
was linked to decreased sustained virological response
Egyptian National Committee for Control of Viral
(SVR) rates in patients undergoing interferon (IFN)-based
therapy, independent of viral genotype (5). IFN-based
The following are our exclusion criteria; age < 18,
therapy is being replaced by direct-acting antivirals
HBV and/or HIV co-infection; pregnancy; liver
(DAAs), which have SVR rates above 90% (1).
malignancy; chronic kidney disease stage 4-5 (GFR less
Hum et al. and Wong et al. discovered that
than 30 ml / minute); and liver or kidney transplanted
individuals with type 2 DM had better glycemic control
when HCV was eradicated with direct acting antiviral
Age, sex, duration of diabetes, anti-diabetic
(DAA) medications (3,6).
treatments, thorough clinical examination, and body mass

index (BMI) were registered.
Received: 15/03/2023
Accepted: 16/05/2023

Full Paper (vol.921 paper# 8)

c:\work\Jor\vol921_9 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5508-5518

Doppler Ultrasound versus Pelvic Magnetic Resonance Imaging in
diagnosis of ovarian mass in teenagers: A Prospective study
Eman Othman Abd Elrahman*, Reda Hemida, Ashraf Ahmed Ghanem,
Nermeen Shams-Eldin, Alhussein Ahmed Mohamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Eman Othman Abd Elrahman, Mobile: (+20) 01022640592, Email: eothman1992
Ultrasound (US) is the first radiological modality to examine females with higher suspicion of adnexal
lesions owing to its widespread accessibility, affordable cost, and higher sensitivity in mass detection. Magnetic
resonance imaging (MRI) offers essential data for the classification of a lot of ovarian masses as neoplastic or non-
neoplastic, and benign or malignant. MRI can identify an adnexal mass and plays an essential role as regard to the
differentiation between benign and malignant tumours. Objective: The current study aimed to compare the diagnostic
accuracy of Doppler US and MRI in diagnosis of nature of ovarian mass in teenagers. Methods: This was a descriptive
prospective study that included 32 patients with 20 years or less and with adnexal mass attending OB/GYN clinic,
admitted and prepared for surgery at Mansoura University Hospitals. All patients were examined after explaining of the
procedure of transabdominal US or transvaginal US (for married) according to scanning condition and 23 patients had
MRI. Results: MRI had 100% sensitivity, 90% specificity, 92.8% accuracy and US achieved 87.5% sensitivity, 96.2%
specificity and 91.2% accuracy. Conclusion: There were no significant differences in sensitivity, specificity, and
accuracy of Doppler US and pelvic MRI in characterization of ovarian masses in teenagers. MRI should be used for
cases when US results are indeterminate or equivocal, in particular when tumour markers are normal.
Keywords: Neoplasia in the adnexa, Color Doppler ultrasound, International ovarian tumour analysis.

characterization of ADNEX. Such approach considers 3
Ovarian masses have been considered as the
clinical and 6 US features for prediction of the risk of
commonest tumours of the female genital tract in
benign ovarian tumour, borderline ovarian tumour,
pediatrics and adolescents. Ovarian masses affect about
Stage I ovarian cancer (OC), Stage II­IV OC and
2.6 cases per 100,000 girls annually in which the
metastasis [7]. In cases when US results are not
malignant ones represent about 1% of whole childhood
conclusive or equivocal, MRI could be considered as a
malignant tumours. About 64% of Childhood ovarian
helpful tool with regard to evaluation of adnexal
masses are recorded to be neoplastic. About 20% of
masses. In addition, it play an essential role in proper
these tumours are derived from the ovarian surface
selection of surgical planning data without radiation
epithelium, while most of such tumours emerge from
exposure [8]. Magnetic resonance imaging could offer
germ cells [1]. Ultrasonography is the initial radiological
precise data in terms of haemorrhage, fat, and collagen.
modality to examine females with a higher suspicious
In addition, it has the ability to recognize various forms
of adnexal masses owing to its widespread and low
of tissue comprised in pelvic lesions, differentiating
charge, as well as its higher sensitivity in mass
benign from malignant ovarian tumours, with an
identification [2]. A lot of morphologic scores on USG
accuracy ranging from 88% to 93% [9]. This study aimed
are suggested, according to the wall thickness, septal
to compare diagnostic accuracy of Doppler US and MRI
characteristic, and lesion echogenicity. Color Doppler
in diagnosis of nature of ovarian mass in teenagers.
ultrasound (CDUS) of ovarian masses play an essential
role with regard to the differentiation between benign
This was a descriptive prospective study from May
and malignant tumour [3]. In addition, it is utilized in
2021 to November 2022 and included patients attending
association with pulsed CDUS to recognize the
to Obstetrics and Gynecology Clinic, Mansoura
waveform analysis of the vessels. Two indices are
University Hospitals.
utilized in analyzing Doppler waveforms; the PI and the
Inclusion criteria: Patients with 20 years or less and
RI. RI below 0.6 and PI below 1.0 are in general
with adnexal mass attending OB/GYN clinic, admitted
considered to be suspicious for malignant tumour [4].
and prepared for surgery at Mansoura University
The international ovarian tumour analysis (IOTA)
group defined the simple rules according to a set of five
Exclusion criteria: Patient older than 20 years old, with
US features suggestive of a benign tumour and 5 US
recurrent ovarian mass or with associated pelvic
features suggestive of a malignant tumour. By utilizing
the simple rules, tumours are categorized as benign if
only B-features are noticed and as malignant if only M
Participants were subjected to detailed history that
features are noticed. In cases with absence of features
included personal history (age, marital status, residence
or in cases with vague features, the simple rules have no
& occupation), menstrual history (regular versus
ability to categorize the tumour as cancerous or non-
irregular cycles), analysis of complains, past surgical
cancerous [5, 6]. In recent years, the IOTA group has
procedures or medical diseases. The physical
designed an approach for more comprehensive
examination included abdominal examination to all
Received: 05/03/2023
Accepted: 06/05/2023

Full Paper (vol.921 paper# 9)

c:\work\Jor\vol921_10 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5519-5527

Implications of a Novel Modified Strategy for Combined Coronary Artery Bypass
Grafting and Mitral Valve Replacement for Ischaemic Heart Disease Patients
Ahmed Saber*1, Ahmed T. Elgengehe2, Eman Salah Eldin Elsakaan3, Hisham M. Elbatanony4
Departments of 1Cardiothoracic Surgery and 2Cardiology, Faculty of Medicine, Cairo University, Egypt
Department of 3Cardiothoracic Surgery, Mansoura University Hospital, Mansoura University, Egypt
Department of 4Cardiothoracic Surgery, Faculty of Medicine, Beni-Suef University, Egypt
*Corresponding author: Ahmed Saber Ibrahim Elsayed, Mobile: (+2)01225386221,
Email:, ORCID ID:

Conventional coronary artery bypass grafting (CABG) and mitral valve replacement (MVR) is the best
definitive treatment for patients with ischemic heart disease (IHD) complicated with severe ischemic mitral regurgitation
(IMR). Yet the procedure itself entails high intraoperative and early postoperative risks added to the higher preoperative
risk profile of its candidates. The higher risk values are largely attributed to the longer duration taken for the combined
procedures with mandatory prolonged aortic cross clamping time with the risk of longer cardiac arrest state and
prolonged cardiopulmonary bypass (CPB) time. Objective: This study primarily aimed at tracing the impact of a
modified strategy adopting CABG on beating on-pumped non-aortic cross clamped heart conserving cardiac ischemia
only for the MVR step of the surgery. Patients and Methods: This retrospective observational non-randomized study
included 56 patients presented with IHD complicated with severe IMR. They had been operated upon by CABG and
MVR. They had anginal pain grade III according to Canadian Cardiovascular Society (CCS) grading of angina pectoris.
Intraoperative aortic cross clamping time, CPB time and mortality, postoperative mortality, morbidity outcomes, overall
hospital complications rate, left ventricular ejection fraction per cent (LVEF%), CCS grading and overall one-year
survival rate were evaluated. Results: No intraoperative mortality happened. The in-hospital mortality was 5.35%.
Multivariable analysis showed that old age (OR: 1.15 (95% CI: 1.090-1.210); p= 0.001), females (OR: 3.25 (95% CI:
1.030-10.801); p= 0.041) and critical preoperative condition (OR: 3.78 (95% CI: 1.179-12.798); p= 0.027) were the
foreshows of operative mortality and showed that old age (OR: 1.16 (95% CI: 1.100-1.122); p= 0.001) and critical
preoperative condition (OR: 4.68 (95% CI: 1.378-15.395); p= 0.008) were those of in-hospital morbidity. The overall
hospital complication rate was 23.21%. The overall one-year survival rate was 94.64% with statistically significant
improvement of LVEF% with a mean 51.53±3.41 (p<0.001) and CCS grade whereas 92.45% were in CCS grade I and
7.54% in CCS grade II (p<0.001). Conclusion: The adopted stepwise approach showed markedly better operative and
postoperative outcomes than reported with statistically significant improvement in both functional clinical statuses,
LVEF% and survival at one-year follow-up.
Keywords: Combined CABG and MVR, Severe IMR, Complicated IHD.

Thoracic Surgeons (STS), in-hospital mortality for the
IHD is a common serious cardiac problem. The
combined procedure is 8.6% compared to 1.8% for
gold standard procedure done to alleviate it is CABG
isolated CABG and 3.9% for isolated MVR (7).
surgery (1). Due to the occurrence of myocardial
The higher risk values are largely related to the
infarction (MI), IMR results representing a seriously
longer duration taken for the combined procedures with
highly impacting complication. It's attributed to left
mandatory prolonged aortic cross clamping (ischemic)
ventricular (LV) remodeling eventually leading to
time with the risk of longer cardiac arrest state and
mitral leaflet tethering with resultant variable degrees of
prolonged cardiopulmonary bypass (CPB) time.
mitral regurgitation (2). It represents 20-50% of the
Consequently, higher incidence of adverse events and
overall complications of IHD (3).
complications would arise. These include myocardial
According to the recent recommendations, severe
infarction (MI), coagulopathy, micro-embolization and
IMR must be corrected surgically, yet no definite
procedure strategy for the combined operation was
settled upon (4). However, Mitral valve replacement
thromboembolism, low cardiac output syndrome,
(MVR) represents a more favorable and durable option
rhythmic complications, hemorrhagic complications
than mitral valve repair in terms of long-term survival
and prolonged postoperative outcomes (5).
immunosuppression, respiratory complications, acute
Conventional combined CABG and MVR
renal failure and deep and superficial wound
operation had been always accused of higher rates of
postoperative morbid adverse events besides
In a trial to decrease these higher risks ratios due
immediate, early and late mortality. These results
to the prolonged combined procedures, we
exceed those resulting from each procedure done alone
hypothesized a modified strategy adopting CABG on
(6). Based on the reports delivered by the Society of
beating bypassed non-aortic cross clamped heart
Received: 18/04/2023
Accepted: 20/06/2023

Full Paper (vol.921 paper# 10)

Introduction The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5528-5539

Role of Magnetic Resonance Imaging in Evaluation of Non-Traumatic
Spinal Lesions in Children
Hayam Abdelmonsif Abdellatif, Ahmed Yassen El-Refaey*, Hazem Hassan Eid
Radio Diagnosis, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Ahmed Yassen El-Refaey, Mobile: (+20) 01000853271, Email:

A wide range of disorders, including those with inflammatory, viral, neoplastic, vascular, metabolic, and
traumatic origins, can affect the spinal cord. Spinal cord lesions may often be distinguished between neoplastic and non-
neoplastic using MRI.
Objective: This study aimed to evaluate the relevance of MRI in the diagnosis of children non-traumatic spinal lesions.
Patient and Method:
A cross-sectional analytic study was conducted on 50 of either child presented with non-traumatic
spinal lesions to be evaluated at our Radiology Department, Faculty of Medicine, Menoufia University by Magnetic
Resonance Imaging during a period time from January to December 2022. All patients included in the current study
were diagnosed based on clinical examination, and other main imaging modalities.
Results: The most common MR diagnosis was myelomeningocele (18%) then meningitis (12%) followed by focal
kyphus deformity, Guillain Barre syndrome, intramedullary abscess, and astrocytoma (10%), osteoblastoma, lipoma
and diastematomyelia (8%) and Tethered cord (6%).
Conclusion: MRI is the best way in evaluation of non-traumatic spinal lesions in children.
Magnetic resonance imaging, Metastatic lesions, Neoplasm, Spinal lesions.


Metastatic lesions from an intracranial tumour
Paediatric populations seldom get spinal
may manifest as spinal lesions. Multiple planes should
tumours. In contrast to adult spinal disorders, paediatric
be used in MRI procedures to benefit from various
versions exhibit a variety of unique characteristics. For
imaging contrasts, such as T1- and T2-weighted
instance, up to 85% of individuals with chronic pain
images. Images with more contrast will have higher
lasting more than two months in children have a
diagnostic sensitivity. Finally, functional sequences
particular diagnosable lesion. Clinical signs of spinal
like 1H magnetic resonance spectroscopy (MRS) and
tumours may also include fever, weakness, weight loss,
diffusion tensor imaging (DTI) may be useful [5]. There
neurological impairments, bowel, and bladder
are increasingly more MRI sequences available that are
dysfunction, and more [1].
less susceptible to susceptibility artefacts. A tiny needle
Anatomic position with regard to the vertebral
biopsy is advised after radiological assessment to
end plate (vertebral corner versus noncore) and
confirm the tumor's histology and direct therapy, as
presence in either central (containing the spinal canal)
well as laboratory evaluation to check for systemic
or lateral (excluding the spinal canal) sagittal slices are
illness [6]. This study aimed to evaluate the relevance of
used to characterise inflammatory lesions, respectively
MRI in the diagnosis of children non-traumatic spinal
[1]. Ankylosing spondylitis (AS) individuals who have
spinal inflammation have significant morbidity, which

might potentially result in disability due to the axial
skeleton's gradual ossification. By anatomic location
A cross-sectional analytic study was conducted
(facet joint, spinous process), inflammatory lesions are
on 50 of either child presented with non-traumatic
also noted in the posterior parts of the spine [2].
spinal lesions to be evaluated at our Radiology
Occult spinal dysraphism is a category that
Department, Faculty of Medicine, Menoufia University
includes lesions when the deformed neural tissue is
by Magnetic Resonance Imaging during the period from
located deep within an intact skin cover. Dorsal dermal
January to December 2022. All patients included in the
sinus, spinal lipoma, tight filum terminale syndrome,
current study were diagnosed based on clinical
neuroenteric cyst (NEC), and diastematomyelia are
examination, and other main imaging modalities.
among the diverse collection of lesions that make up

this condition. These lesions are characterised by a split
Inclusion criteria: Patients with spinal lesion based on
in the spinal cord and/or a caudal mass, a bone spur, or
clinical and laboratory evaluation to detect MRI criteria
a fibrous band tying the spinal cord in an unusually low
and extent of lesion, both sexes, ages up to 18 years old,
position [3].
patients known to have tumor refereed for initial staging
The ability to distinguish between neoplastic
(TNM) staging and planning for treatment and
and non-neoplastic spinal cord lesions is often enabled
underwent preoperative MR imaging and known spinal
by MRI, however its ability to define tumour histology
lesions for follow-up by MRI.
is constrained. The complete spine should always be
Exclusion criteria: Patients who have allergy to MRI
included in an MRI, and the brain should also be
contrast media, Contraindication of MRI e.g., metal,
included if a localized spinal cord neoplasm is found in
prosthesis and ages >18 years.
order to rule out secondary or metastatic lesions [4].

Received: 23/03/2022
Accepted: 24/05/2023

Full Paper (vol.921 paper# 11)

Lidocaine versus midazolam for prevention of post-extubation laryngospam in children undergoing tonsillectomy with or without adenoidectomy: A randomized controlled clinical trial The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5540-5545

Prevalence and Characterization of Carbapenem-Resistant Klebsiella pneumoniae
isolated from the intensive care units of Zagazig University Hospitals
Tahia Mohamed Ahmed Mohamed1, Samir A. Afifi2, Rehab Mohamed Ateya1
Departments of 1Clinical Pathology and 2Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Tahia Mohamed Ahmed Mohamed, Mobile: (+20) 01205249812, E-mail:

: All b-lactamase enzymes, or carbapenemases, are able to hydrolyzing the beta-lactam antibiotics. The
ability of Klebsiella pneumoniae to produce carbapenemases is the primary cause of carbapenem resistance in this
To define the prevalence as well as characterization of carbapenem resistance with genes coding for the
carbapenemase in carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates that was taken from patients in the
intensive care units (ICUs) of Zagazig University Hospitals.
Patients and Methods:
In a cross-sectional study we included patients who were diagnosed with K. pneumoniae
infections from different ICUs of Zagazig University Hospitals, which are referral hospitals serving many patients in
eastern Egypt.
In this study 120 out of the 190 participants who had a confirmed K. pneumoniae infection were found to have
CRKP infections. The XpertCarba-R assay was used to test the isolates for the presence of blaNDM, blaIMP, blaVIM,
blaKPC, and blaOXA-48.
The blaNDM (60%), blaOXA-48 (47.6%), and blaKPC (8.4%) genes were the most common.
None of the isolates had either blaVIM or blaIMP present.
These current data indicate spread of CRKP isolates in our institution poses a serious health threat. Limiting
transmission depends on early detection of isolates that are resistant to carbapenem. In order to prevent the spread of
the CRKP, it is necessary to pay more attention to rationalizing the use of antibiotics and strengthening the application
of infection control precautions, such as hand hygiene, patient isolation, environmental cleaning and antibiotics
stewardship programs.
CRKP, blaNDM, blaKPC, blaOXA-48, Egypt.

the prevalence of carbapenem resistance is increasing in
Egypt. According to one study, 44.3% of K.
pneumoniae isolates from hospitals along the Suez
pathogen that is facultative anaerobic and non-motile, is
Canal exhibited this resistance [10].
strongly related with higher morbidity and mortality
among patients, mainly in immune compromised ones
Correct antibiotic prescribing and infection
[1]. K. pneumoniae is also one of common sources of
control measures are needed and are based on
antibiotic resistance [2].Transposons and plasmids aid in
carbapenem resistance diagnosis to prevent the spread
the spread of antibiotic-resistant bacteria [3].
of resistant strains in various healthcare settings. As a
result, we conducted this study to define the prevalence
A class of enzymes known as b-lactamases, which
as well as characterization of carbapenem resistance and
hydrolyze the beta -lactam ring and render the antibiotic
genes coding for the carbapenemase in CRKP isolates
ineffective against bacterial transpeptidases, are
that were taken from patients at Zagazig University
produced by bacteria when they are able to acquire these
Hospitals (ZUHs) intensive care units (ICUs),
genes. Majority of beta-lactamases are extended-
considering that carbapenems are routinely used as
spectrum beta-lactamases (ESBLs)[4].Because ESBLs
empirical therapy in the intensive care units (ICUs) of
can hydrolyse cephalosporins, monobactams, and
Zagazig University Hospitals (ZUHs).
extended-spectrum penicillins, carbapenems are the
only obtainable therapeutic options [5]. Infectious
illnesses caused by carbapenem-resistant bacteria are
Between October 2022 and March 2023, we
therefore typically treated with these medications as a
conducted this cross-sectional study, All patients
last option [6]. However, due to selection pressure from
admitted to any ZUH Intensive Care Unit who had K.
their erroneous or excessive use, carbapenem-resistant
pneumoniae infection confirmed from any clinical
Enterobacteriaceae (CRE) have appeared. The most
sample were included; The East Delta, Sinai, and Suez
dominant isolate of CRE is CRKP [7].
Canal governorates are all served by Zagazig University
There are phenotypic techniques for detecting
Hospitals, which are tertiary care teaching hospitals.
carbapenemase activity while the genes that encode for
1) Case definition:
this enzyme can be found using molecular tests [8].
In a patient with symptoms and evidence of infection,
According to the CDC's review of hospital surveillance
K. pneumoniae was isolated from various sterile sites
data, 8% of Klebsiella isolates are carbapenem-resistant
such as blood, cerebral spinal fluid, peritoneal fluid, or
[8]. While in other research [9], 5-24% of Klebsiella
pleural fluid. When a patient's symptoms included
isolates were from hospitalised patients. Concerningly,
Received: 01/04/2022
Accepted: 02/06/2023

Full Paper (vol.921 paper# 12)

c:\work\Jor\vol921_13 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5546-5550

Correlation Between Body Mass Index, Manual Dexterity and
Handgrip Strength in School Aged Children
Wessam Osama Sayed*, Naness E. Mohammed, Hebatallah Mohamed Kamal
Department of Pediatrics Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt
*Corresponding author: Wessam Osama Sayed, Mobile: (+20) 01014258675, E-mail:

Childhood obesity and overweight have been related to a number of ailments and health issues. The
human hand performs the challenging everyday chores and is the most engaging and energetic portion of the upper limb.
An essential factor in assessing hand function is dexterity.
Objectives: To investigate the relation between body mass index (BMI), manual dexterity and handgrip strength in
school aged children having normal weight, overweight or obesity.
Subjects and Methods:
One hundred and five primary school children divided into thirty-five students having normal
weight, thirty-five overweight students and thirty-five obese students, from both sex and ranging in age from 9 to 11
years, participated in the study. They were selected from governmental primary school in Shibin Alaqanater, Qalyubia
Governorate. For assessment of BMI, the height and weight were measured. The assessment of manual dexterity was
carried out by using Bruinink-Oseretsky test for motor proficiency 2nd edition (BOT-2) and handgrip strength (HGS)
was assessed by handheld dynamometer.
Results: BMI and HGS showed a mild positive link, while BMI and manual dexterity showed a weak positive non-
significant correlation.
It is concluded that no correlation was found between BMI and manual dexterity but due to the correlation
between BMI and HGS it's recommended that HGS regularly measured in school aged children.
Keywords: BMI, Handgrip strength, Manual dexterity and school aged children.


Young people make up the core of any country
One of the nations with an obesity and
since they often exhibit higher levels of exercise and
overweight health issue is Egypt. With a percentage of
healthier lifestyles. The dominant hand makes up the
over 35% of the total population, it has the highest rate
majority of hand usage in daily life. The hands and
of overweight and obesity in the whole globe (6). Salem
forearms must be very active in order to undertake many
et al. (7) reported that among Egyptian youngsters, the
daily activities and athletic feats. Some tasks requiring
prevalence of obesity was 14.7% for boys and 15.08%
physical exertion and endurance necessitate the use of
for girls.
these muscles (1). Children's physical strength is
The human hand is an essential and
negatively correlated with metabolic and cardiovascular
unavoidable organ. Its activities range from fine to gross
disease biomarkers, and positively correlated with
motor ones. High levels of hand activity are required for
general health, bone health, and self-esteem (2).
several daily tasks and sporting events. Grip strength
The simplest and most widely accepted method
depends on the strength of the hand and forearm
for determining relative body fatness is the BMI. Body
muscles (8). The term "handgrip strength" (HGS) refers
fatness is often defined as a measure of weight in
to the maximum force produced by the contraction of
relation to height and is typically accepted as a reliable
both intrinsic and extrinsic hand muscles, which causes
indicator of adiposity (3).
the hand joints to flex (9). The handgrip is an essential
An imbalance between daily energy intake and
part of human function and a distinctive characteristic
expenditure that causes excessive weight growth is what
that sets humans apart from monkeys (10).
causes obesity. Numerous variables, including genetic,
Dexterity is typically described as the ability to
cultural, socioeconomic, low physical activity,
synchronise minor muscle movements with the eyes,
sleeplessness, eating patterns, endocrine diseases,
hands, and fingers (11). The capacity of a person's hands
medicines, food ads, and energy metabolism, contribute
to quickly move items and coordinate their fingers is
to its occurrence (4).
known as manual dexterity (12). An essential factor in
According to some epidemiologists, 20% of the
assessing hand function is dexterity. These abilities are
world's population will be obese by 2030, defined as
crucial for adults, but much more so for kids, whose
having a BMI above 30 kg/m2 for adults or a BMI below
physical and functional development is greatly
the 95th percentile for their age and sex for children
influenced by their dexterity development (13).
between the ages of 2 and 18. Checking waist size and
Children who attend school need to have strong
body composition is also crucial. Increased risk of
handgrips and good hand dexterity because the majority
cancer, stroke, metabolic illness, heart failure, and other
of their skilled tasks throughout the school day use their
cardiovascular disorders are all associated with obesity
hands. When compared to kids with normal BMI,
having a high BMI may have an impact on a child's hand

strength and dexterity. Children's physical activity will
Received: 15/04/2023
Accepted: 15/06/2023

Full Paper (vol.921 paper# 13)

c:\work\Jor\vol921_14 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5551-5557

The Effect of Combination between Cryolipolysis and Aerobic Exercise in
Reducing Abdominal Adiposity Inobese Subject
Heba I. El Sayed*1, Ragia M. Kamel2, Abir Zakaria3, Ibtesam A. Ali2
1 Physiotherapist practitioner at Quesna Central Hospital, Ministry of health, Egypt, 2Physical Therapy for
Basic Science Department, 3Internal Medicine, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding Author: Heba I. Elsayed, Email:, Mobile: +201004042163

Cryolipolysis is a treatment option for subjects looking for noninvasive body contouring. Combination
between cryolipolysis and aerobic exercise has a significance effect on the reduction of localized fat.
To examine the impact of combining cryolipolysis with aerobic activity and a calorie-restricted diet on the
waist-to-hip ratio and the skin fold of subcutaneous abdominal fat in obese people.
Subjects and Method
s: This was a pretest-posttest randomized controlled clinical study. Forty overweight patients
were split evenly into two groups. Patients in group A (control) were instructed to follow a low-calorie diet and engage
in aerobic exercise, while participants in group B of the trial were given cryolipolysis sessions in combination to the
control group's diet. Assessment of patients was done before and after treatment to measure waisttohip ratio (W/H) as
well as abdominal skin fold.
Results: Mixed MANOVA was performed to examine the effect of treatment on skin fold and (W/H) ratio. The skin
fold and waist to hip (W/H) ratio data collected from both groups before and after treatment were compared statistically.
There was a substantial effect of reduction in skin fold and waist-hip ratio of group B as compared to group A post
treatment (P < 0.01).
Conclusion: Patients who underwent cryolipolysis and aerobic exercise with low caloric diet program exhibited
considerable improvement in skin fold of abdominal subcutaneous fat also waist-hip ratio improved the systemic effects
of cryolipolysis contrasted to those who were kept on a diet as well as aerobic exercise.
Aerobic exercise, Cryolipolysis, Low caloric diet.


Obesity is a serious disease marked by a weight

gain of at least 20% beyond one's optimal weight due to
behaviors (5). Energy-restricted diets (deficit of 2100-
fat accumulation (1).
4200 kJ/d: minimum of 4200-5040 kJ/d for
Obesity has reached pandemic proportions during
female as well as 5040-5880 kJ/d for male) are often
the previous few decades, and numerous obesity-related
low in fat (30 % of overall daily energy consumption),
disorders, such as heart issues, specific types of cancer,
rich in carbs (55-60% of total daily energy
as well as diabetes, have increased at the same time. The
consumption), but also low in protein (10% of total
foundation of therapeutic intervention for treating or
daily energy consumption) (6).
preventing chronic disorders as weight loss through
Due to the acutely high energy cost and ability to
lifestyle adjustment, like a low-calorie diet and working
increase fat utilization, aerobic exercise is frequently
out more, and behavioural strategies to promote these
recommended in conjunction with calorie restriction (7).
changes. Lifestyle changes typically result in a
Numerous studies studied the impact of modest caloric
reduction in body weight. Therefore these approaches
restriction either separately or in addition to aerobic
are unlikely to help an obese person achieve a healthy
activity. According to studies, a walk/jog programme
weight (2). According to the World Health Organization,
enhanced body fat reduction compared to a group that
several devices, including as cavitation, radiofrequency,
only followed a diet (8).
cryolipolysis, as well as others, have been utilised in
There is a gap in the literature regarding combining
recent studies to address this problem (3).
cryolipolysis and aerobic exercise for losing weight,
The cryolipolysis device has been cleared by the
particularly abdominal adiposity, in spite of the fact that
FDA for cutaneous cooling and other applications.
several studies have supported the efficacy of each on
Cryolipolysis is an innovative, minimally invasive
weight loss. Consequently, this study aimed to ascertain
approach. Cryolipolysis is a novel, non-invasive
whether losing abdominal adiposity would be more
method of selective adipocytes reduction with the use
successful when cryolipolysis and aerobic exercise
of controlled, localised chilling (4).
were combined.
The waist hip ratio as well as the waist

circumference are used by clinicians to determine
abdominal obesity. Atherosclerosis and the chance of
The current research was a pretest-posttest randomized
developing acute coronary syndromes are just two of
controlled trial, which was conducted in a non-public
the many vascular disorders that are linked to these
Received: 02/04/2023
Accepted: 04/06/2023

Full Paper (vol.921 paper# 14)

c:\work\Jor\vol921_15 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5558-5569

Neuroprotective And Therapeutic Effects of Exercise in
Restraint Stress Induced Depression Like Behavior Albino Rat Model
Ebtesam M. Ibrahim, Azza Abd Elrahman Megahed,
Amal Ibrahim Khalil Metwally*, Eman Mahmoud Farag Allah
Department of Physiology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Amal Ibrahim Khalil Metwally, Mobile: (+20) 01091517938, E-mail:

Major depressive disorder (MDD) is considered to be a chronic high-risk, recurring mental illness
affecting individual's feelings, cognition, and behaviors. Exercise may be a promising target for the treatment of
depression but the processes underlying this association between mood and exercise intervention are still poorly
Objective: The current work is designed for assessment of beneficial effects of moderate swimming exercise on
behavior and neurochemical parameters in a restraint-stress rat model of depression.
Materials and Methods: Depression was induced via placing rats in individually into a cylindrical, transparent restraint
tube for 2 h/day for 3 weeks. Swimming exercise training was analyzed for its potential health benefits both before and
after a period of chronic restraint stress.
Results: restraint stress induced depression like behavior, increased corticosterone (p<0.001), MDA (p=0.001) as well
as inflammatory markers and decreased hippocampal BDNF (p=0.001) and SOD (p<0.05). swimming exercise was able
to prevent and improve these behavioral and biochemical abnormalities.
Conclusions: exposure to chronic stress induced depression. Swimming exercise training, on the other hand, has a
moderate benefit in reducing these damages if it is undertaken after the stress period. This impact, however, is amplified
when swimming exercise is conducted prior to then in combination with restraint stress.
Keywords: CRS, Depression, Swimming, BDNF, Corticosterone, Oxidative stress.


Numerous studies have established a link between
Major depressive disorder (MDD) is a high-risk
neurotrophic factors, particularly BDNF, and emotional
chronic, recurring mental illness that endangers both
distress. Depression's pathophysiology may be
physical and mental health [1]. Nearly 800,000 people
facilitated by changes in functional neurotrophic
take their own lives each year in the twenty-first
factors, which dampen neuronal plasticity [7].
century, and this trend appears to be a major
In the present study, we examined the effect of
contributing factor [2].
swimming exercise as a potential non-pharmacological
The effect that exercise may have on one's mental
method for prevention and treatment of depression
health is attracting more attention. Exercise is
using the chronic restraint stress (CRS) rat model of
increasingly being used as a non-pharmacological
therapy for depression as studies show that reduces

depressive symptoms and improves physical function[3].
Although there is substantial evidence linking
Thirty-five adults male wistar albino rats weighing
exercise to improved mood, our understanding of the
between 180 ­ 200 g. were procured from the Zagazig
mechanisms behind this association is still limited[4].
University Faculty of Veterinary Medicine. The animal
The World Health Organization has declared stress
section of the physiology department in the medical
to be a "health epidemic" in the modern era. There is
school at Zagazig University provided clean, sanitary
mounting evidence that prolonged emotional stress is a
environments for these animals. The rodents could eat
major contributor to the onset of depression; yet, the
and drink whenever they wanted.
complex and heterogeneous molecular and cellular

pathways implicated in stress-induced brain damage
The rats were acclimated for two weeks before being
remain poorly understood[4].
randomly split into five groups of seven:
Both depression and anxiety have been linked to
Group 1: Sedentary control (Sed-C) intact controls
oxidative stress, according to a number of studies. Also,
(non-stressed & non-exercised). It will serve to establish
the hypothalamic-pituitary-adrenal axis (HPA) has been
basal levels of studied parameters (Behavioral,
linked to both depression and chronic stress [5].
Pathological, and Biochemical) ; control group. Group
While the precise cause of depression remains
2: Trained control (Train-C) (non-Stressed &
unknown, there is growing evidence to suggest that
exercised); swimming exercise only, Group 3:
inflammation and immunological dysregulation play a
Sedentary + restraint stress (Sed-RS) restraint stress
significant role in the condition[6].
only for 3 weeks, Group 4: Restraint stress + training
restraint stress for three weeks followed by
Received: 04/03/202

Accepted: 05/05/2023

Full Paper (vol.921 paper# 15)

c:\work\Jor\vol921_16 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5570-5676

Association between Vitamin D Deficiency and Electrolyte Level and
Myocardial Infarction in Patients Presenting with Acute Coronary Syndrome
Nadia A. Abdalla1, Aleya A. Mohamed1, Fatma A. Ibrahim2,
Muhammad M. Hassan3, Ramdan Ghaleb4, Naggeh M.Mahmoud*4
1Department of Inorganic Chemistry, Faculty of Science, Aswan University, Egypt
2Department of Biochemistry, Biotechnology Research Institute, National Research Centre, Egypt
3Department of Chemist, Aswan Heart Centre, Magdy Yacoub Heart Foundation, Egypt
4Department of Cardiology, Faculty of Medicine, Aswan University, Egypt
*Corresponding author: Naggeh M. Mahmoud, Mobile: (+20) 01127161616, E-mail:

Acute myocardial infarction had been related to greater rates of morbidity and mortality in hospitalized
studied cases around the globe. It has been established that male-studied cases have AMI more frequently than female
ones do.
Objectives: The present research sought to examine serum electrolytes, myocardial infarction, and levels of 25-
hydroxyvitamin D in studied cases with acute coronary syndrome.
Subjects and techniques: This research had been a case-control study, where 150 participants (sixty STEMI cases,
sixty NSTEMI cases and thirty controls) had been recruited from the Cardiology Department, Faculty of Medicine,
Aswan University. Results: All Vit-D level was significantly lower among STEMI and NSTEMI cases linked to a
healthy control population (p <0.001). Serum Ca, K, and Na were significantly lower among STEMI and NSTEMI cases
compared to healthy control population, while Mg was significantly higher among STEMI and NSTEMI cases compared
to healthy control population (p <0.05).
Conclusion: vitamin D and serum electrolytes were deficient in all studied cases with ACS compared to controls.
Additionally, we determined that low vitamin D, high LDL, total cholesterol, impaired renal function and low HDL-C
were significant ACS predictors.
Keywords: 25-Hydroxyvitamin D, Acute coronary syndrome, Myocardial infarction, Electrolyte.


Additionally, it had been understood that vitamin-
Cardiovascular disease is regarded as a serious
D receptors in the nucleus of these cells would
issue in public health. Around the world, CVD had
facilitate the essential mechanistic role of vitamin D
been responsible for ten percent of morbidity and
in the onset and progression of ischemia disorders (6-9).
around 3rd of mortality. Based on WHO, seventeen
Previous studies have consistently found evidence of a
million of fifty-eight million fatalities that occurred
between vitamin
in the world in 2005 could be directly linked to CVD.
and cardiovascular disease (10-14). Previous research on
Total of 7.5 million of them had been victims of
humans and animals revealed that vitamin D might be
coronary heart disease. 1 of 5 primary indicators of
hazardous to the arteries. Additionally, there is evidence
coronary heart disease, along with stable and unstable
to support the hypothesis that there is a link
angina pectoris, myocardial infarction, heart failure, and
among higher incidence of IHD and excessive vitamin-
sudden death (1). Acute myocardial infarction had
D intake (10).
been associated with higher rates of morbidity
The present research wanted to explore levels of
and mortality in hospitalized studied cases around the
25- hydroxyvitamin-D and serum electrolytes and
globe. It has been established that male-studied
myocardial infarction in studied cases presenting with
cases have AMI more frequently than female ones do.
acute coronary syndrome.
Myocardial necrosis in MI is described as occurring

when there is insufficient coronary blood flow. As a
result, its myocardial sustains damage, raising
This research had been case-control study where 150
metabolic demand while reducing oxygen and nutrient
participants (sixty STEMI cases, sixty NSTEMI cases
supply via coronary flow. This came after the sudden
and thirty control) had been recruited from Cardiology
Department, Faculty of Medicine, Aswan University.
atherosclerosis (2).

Inflammatory cells, smooth muscle, and vascular
Sample size calculation
endothelial cells are all implicated in the creation and
Minimum sample size of eighteen studied cases had
stabilization of atherosclerotic lesions as well as
been determined to be necessary for research based on
vascular homeostasis (3-5).
1st type error of = 0.05, statistical power of ninety-five

percent clinical study power of eighty percent,
Received: 05/01/2023
Accepted: 08/03/2023

Full Paper (vol.921 paper# 16)

c:\work\Jor\vol921_17 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5577-5586

Prognostics of Feasibility of Mitral Valve Ring Annuloplasty for Moderate
Functional Mitral Regurgitation Associated with Severe Aortic Valve Disease
Ahmed Saber*1, Moataz Salah Khalil2, Eman Salah Eldin Elsakaan3, Hisham M. Elbatanony4
1Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
2Department of Anesthesia and Intensive Care, Faculty of Medicine, Helwan University, Cairo, Egypt
3Department of Cardiothoracic Surgery, Mansoura University Hospital, Mansoura University, Mansoura, Egypt
4Department of Cardiothoracic Surgery, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
*Corresponding author: Ahmed Saber Ibrahim Elsayed, Mobile: (+20)1225386221,
Email:, ORCID ID:

Management of moderate functional mitral regurgitation (FMR) commonly accompanying severe aortic
valve (AV) disease is still debatable without specific guidelines. Prognostics accused of postoperative residual mitral
regurgitation (MR) in either severe aortic stenosis (AS) or regurgitation (AR) patients are unclear and still questionable.
Objective: This study was aimed to identify the preoperative predictors of residual MR in patients with severe AS or
AR and moderate FMR subjected to aortic valve replacement (AVR) with or without mitral valve (MV) ring
annuloplasty repair.
Patients and Methods:
This retrospective comparative study involved 87 patients presented with severe AS or AR
associated with moderate FMR. Patients were divided into two groups Group (I) that included 40 patients who were
subjected to AVR only and Group (II) that included 47 patients who were subjected to AVR and MV ring annuloplasty
Results: Significant predictors of overall mortality were atrial fibrillation (AF) (p=0.011) and residual MR (p=0.001),
of early residual MR were unattempting MV repair (p=0.007) and prolonged inotropic support (p=0.015), of late residual
MR were postoperative FMR grade 2 or more (p=0.008), persistent AF (p=0.046) and left atrial diameter (LAD) >5 cm
(p=0.054), and of development of residual MR among AS populations were AF (p=0.01), LAD >5 cm (p=0.002), peak
AV gradient <60 mmHg (p=0.01) and mean AV gradient <40 mmHg (p=0.02) while left ventricular end-systolic
diameter (LVESD) <4.5 cm (p=0.001) for AR patients.
Conclusion: It could be concluded that the preoperative grade 2 FMR per se is not associated with poor overall survival
rate and is not an independent risk factor for postoperative mortality for either AS or AR patients. The postoperative
residual MR with its congestive heart failure lethal sequelae is strongly associated with postoperative complications and
higher overall mortality. We strongly recommend combined MV ring annuloplasty during AVR when there are any of
the forementioned preoperative risk factors.
Keywords: FMR, Secondary Mitral Regurgitation, AV disease, MV ring annuloplasty, AVR.


operator's preference based on some reports that
Functional or secondary mitral regurgitation
claimed improvement of almost 50% of the FMR cases
(FMR) is a common surgical entity that is frequently
without surgical intervention. However, most of these
met with severe aortic valve (AV) disease whether
reports involved patients with ischemic mitral or other
aortic stenosis (AS) or regurgitation (AR). Its incidence
organic MV diseases (4).
with such pathologies that eventually need aortic valve
Prognostics (risk factors) accused of residual
replacement (AVR) to be cured reaches as high as 75%
mitral regurgitation (MR) after the setting of AVR are
not clearly demonstrated in the literature and still
FMR is clearly demonstrated when the mitral
questionable. Yet, they're different in either of severe
valve (MV) leaflets are incompetent allowing backward
AS or AR (5). Moreover, fewer reports have assessed the
flow of blood from the left ventricle (LV) to the left
clinical effect of moderate FMR in those patients
atrium (LA) during systole although the MV apparatus
subjected to AVR and further fewer have particularly
doesn't show significant structural nor intrinsic valvular
traced the concomitant preoperative prognostics that
pathology (2). Its common association with severe AV
would affect survival and might predict heart failure
disease is assumed to the LV geometric changes. LV
outcome (4).
hypertrophy, LV dilatation or MV annular dilatation
This study primarily was aimed at investigating,
would result in variable degrees of FMR (3).
analyzing and identifying the preoperative predictors
Management of the moderate degree of FMR
(risk factors) that may predict residual MR and its
commonly associated with severe AV disease is still
adverse changes in patients with severe AV disease (AS
debatable and no specific guidelines are illustrated
or AR) and moderate FMR subjected to AVR with or
despite its high frequency (3). Moreover, dealing with it
without MV ring annuloplasty repair. This is in a trial
in the surgical setting whether to repair the MV annulus
to help wise decision-making for proper management of
or not is generally and largely dependent on the
the moderate FMR (whether to repair surgically or treat
Received: 24/04/2023
Accepted: 25/06/2023

Full Paper (vol.921 paper# 17)

c:\work\Jor\vol921_18 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5587- 5594

The Effectiveness of Ipsilateral Stenting VS Kissing Stenting in the
Treatment of Unilateral Common Iliac Artery Ostial Lesion
Ahmed H. El-naggar1, Ehab M. Abdo2, Nehal Farouk2
1Vascular Surgery Department, Shark El Madina Hospital, Alexandria, Egypt.
2Vascular Surgery Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, Egypt.
Corresponding author: Ahmed H. El-naggar, Email:,mobile:+201271953808

Iliac arteries are commonly affected by occlusive atherosclerotic disease, leading to arterial insufficiency and
lower extremity symptoms. Atherosclerosis in the iliac region often coexists with pathologies below the inguinal ligament.
This study aimed to compare the effectiveness of unilateral common iliac artery stenting versus bilateral kissing
stents in terms of clinical and technical success for treating unilateral common iliac artery ostial lesions.
Method: A prospective study (October 2022-April 2023) that included 40 patients randomly assigned to two groups. Group
A received bilateral kissing stents, while group B underwent unilateral common iliac artery stenting. Clinical evaluation,
technical success, and complications were assessed over six months.
Results: Technical success rate was 100 % in groups A and B, six months primary patency rate in group A was 95% had
patent stent with good inflow while 5% had claudication at 100 M, treated by a balloon expandable stent. While in group
B, 85% had patent stent with good inflow while 5% had claudication at 100 M, treated by balloon expandable stent, 5% had
renal failure, congested heart failure and died, and 5% neglected medication. DFI occurred, sepsis and AKA was done as a
Conclusion: Unilateral common iliac artery stenting demonstrated comparable clinical outcomes, technical success, and
complication rates to bilateral kissing stents. It provides a safe and effective alternative for treating unilateral common iliac
artery ostial lesions.
Keywords: Kissing stent, Unilateral stenting, Common iliac artery, Ostial lesion, Angioplasty.

particularly for short lesions (TASC A and B), providing
The iliac arteries are frequently affected by
acceptable long-term patency rates of 60-90% over 3-5
obstructive atherosclerosis, making them a common site
years. However, its use is limited by initial residual
for symptomatic peripheral artery disease, accounting for
stenosis, late restenosis, and a high rate of distal
approximately one-third of cases (1). Aortic bifurcation
embolization (7, 8). Stents are frequently utilized,
poses a significant challenge, accounting for
especially in lesions involving the distal aorta or the origin
approximately 10% of all iliac lesions. It predominantly
of the CIA (9).The concept of the kissing technique arose
involves the ostia of both common iliac arteries (CIA)
due to concerns about the risks of plaque shift and distal
and, in some cases, includes unilateral ostial disease,
embolization to the contralateral iliac artery (10). Unilateral
which leads to arterial insufficiency in the lower
ostial CIA disease has been treated using a single stent
extremities with ischemic symptoms (2). Atherosclerosis
deployed only on the affected side, and it has been
of the iliac artery can often be asymptomatic. It may be
concluded that the technique is safe and demonstrated
incidentally detected or present with acute ischemia,
comparable mid-term outcomes to those achieved with
intermittent claudication, or critical limb ischemia (CLI)
kissing stents (3) , that need additional devices, bilateral
(3).Surgical intervention has been considered the gold
femoral artery access, and the potential loss of future
standard treatment for aortoiliac lesions due to its
contralateral access options in the endovascular treatment
effectiveness, with acceptable long-term patency rates of
of distant lesions.
approximately 90-95% at 5 years and 82-87% at 10 years
This study aimed to assess the effectiveness of
(4). However, it carries significant complications and
unilateral common iliac artery stenting compared to the
mortality risks, especially among high-risk patients, in
use of kissing stents in terms of both clinical and technical
addition to laparotomy-related complications such as
success in the treatment of ostial lesions of the unilateral
incisional hernia and adhesions (5).
common iliac artery.
Endovascular intervention is now regarded as the

preferred choice with the latest guidelines of the European
Society for Vascular and Endovascular Surgery and
This prospective study, conducted between
demonstrated excellent 5-year patency rates ranging from
October 2022 and April 2023 at Al Zahraa University
80-90%, with low rates of mortality and morbidity, as
Hospital, Cairo, Egypt, and Shark El Madina Hospital in
well as shorter hospitalization periods (6). Various
Alexandria, Egypt. The study involved 40 patients with
endovascular techniques are employed, with balloon
unilateral ostial occlusive disease of the common iliac
angioplasty being the standard therapy for iliac arteries,
artery (CIA). They were randomly assigned to two
Received: 01/05/2023
Accepted: 30/06/2023

Full Paper (vol.921 paper# 18)

c:\work\Jor\vol921_19 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5595- 5603

Can Upregulation of CXCR3 By Phototherapy Improve Vitiligo?
It's Role in Chronicity
Fatma Al-Zahraa1, Nesma Hussein Abdel Hay*1, Seham Adel1, Heba Mahmoud Diab2, Amal Mansour1
1 Medical Biochemistry and Molecular Biology Department, Faculty of Medicine,
Ain Shams University, Abbassia, P.O. box 11381, Cairo, Egypt
2 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Nesma Hussein Abdel Hay, , Tel.: + 201006447007, E-mail:

Vitiligo is melanocyte death that is affected by oxidative stress which elevated levels of reactive oxygen
species can elicit an immune response, and ultimately cause melanocytic death.
The current study aimed to investigate the impact of Narrowband Ultraviolet B (NBUVB) and excimer laser
phototherapy on C-X-C motif chemokine receptor 3B expression in vitiligo patients and its impact on vitiligo
Patients and methods: CXCR3B mRNA expression was measured in skin of 25 patients suffering from non-segmental
vitiligo before and after generalized `NBUVB' and targeted phototherapy `Excimer laser'. All biopsies were kept in -
80C till RNA extraction that was performed utilizing QIAGEN RNeasy Little Pack, QuantiTect Switch Record Unit
and QuantiNova SYBR Green PCR Unit.
Results: After phototherapy patients with vitiligo had higher CXCR3B mRNA levels, in addition, this was higher in
excimer bunch treatment than NBUVB.
Conclusion: Such findings draw attention to CXCR3B as an inherited abnormality in vitiligo patients' skin and raise
concerns about its potential contributions in maintaining vitiligo or triggering relapses & chronicity.
Vitiligo, CXCR3, phototherapy, mRNA, PCR, Intervention study, Ain Shams University.


Vitiligo is acquired skin condition described by
(TRM). In addition, as demonstrated for the chemokine
the selective loss of melanocytes and typical chalky-
receptors CXCR3 in vitiligo, signaling by chemokine
white, non-scaly macules that appear. It is common,
receptors appears to be necessary for moving TRM into
with a prevalence of about 0.5-2% worldwide (1). A
appropriate tissue environment for their formation and
recent meta-analysis revealed that 23% of vitiligo
maintenance (5).
patients have an anxiety disorder, with a significantly
The gene encoding the chemokine receptor
higher prevalence among females than males (2).
CXCR3is highly expressed on effector T cells and is
Clinically, vitiligo has been separated into
crucial to T cell trafficking and function. The CXCR3
segmental vitiligo and non-segmental vitiligo. There are
gene can be found in the region q13 of the long arm of
acrofacial, mucosal, universal, mixed, and rare forms of
chromosome X. CXCR3 can be alternatively spliced
non-segmental vitiligo (3). Vitiligo's exact etiology is
into 3 different isoforms: CXCR3-A, CXCR3-B, and
unknown. T cell-mediated autoimmune destruction,
chemokine receptor 3-alternative. CXCR3-A signals
which may be triggered by oxidative stress, and an
promote cell migration and proliferation, while
underlying genetic predisposition are theories regarding
CXCR3-B signals inhibit angiogenesis and migration
its pathogenesis (4).
but can promote apoptosis in tumor cells (6).
After stopping treatment, vitiligo relapses occur
The 415-amino acid CXCR3B is produced
at the same location, indicating an autoimmune memory
through alternative splicing at 5 end of exon 2 of
of the skin cells that permits disease exacerbation.
CXCR3. CXCR3A is encoded by the gene; a 368-amino
Vitiligo has been now referred to as memory skin
acid multi-pass membrane molecule with molecular
disease, clearly demonstrates the presence of
mass of nearly 41 kDa, whereas CXCR3B has 415
melanocyte-specific Tissue Resident Memory cell
amino acids (Figure 1) (7).

Received: 16/01/2023
Accepted: 19/03/2023

Full Paper (vol.921 paper# 19)

c:\work\Jor\vol921_20 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5604- 5607

Elevated Serum Leptin In Non-Obese Females With Acne Vulgaris.
A Case Control Study
Bakr Mohamed Elzawahry1, Nermeen Ibrahim Bedair2, Yasmine Mohamed Amrousy3, Mahmoud Adel Attia*4
1Department of Dermatology, Faculty of Medicine, Cairo University, Egypt
2Departments of Dermatology, Andrology, Sexual Medicine and STDs and 3Clinical Pathology,
Faculty of Medicine, Helwan University, Egypt
4Cairo Hospital of Dermatology, Egyptian Ministry of Health, Cairo, Egypt
*Corresponding author: Mahmoud Adel Attia, Mobile: (+20) 01064598309, E-mail:

The majority of those who suffer from acne vulgaris are adolescents. In the preteen years, acne commonly
occurs before a girl's menstrual period. About 85% of teens have acne, but it may also afflict people of all ages and last
far into adulthood. Strong evidence supports the participation of follicular hyperkeratinization, hyperactivity of the
sebaceous glands, colonisation of Propionibacterium acnes and yeast, and inflammation in the complicated etiology of
Objective: To evaluate leptin level in non-obese females with acne vulgaris.
Patients and Methods:
This was a cross sectional study that was conducted in Helwan University (Badr) Hospital-
Dermatology Clinic on 42 non-obese females with variable degrees of acne vulgaris, and 21 age compatible controls
from people without any systemic disease, acne lesions, or medication. This study was conducted from August 2020 to
July 2021.
The current study demonstrated that the mean value of serum (S.) leptin was statistically higher among acne
cases than control group (0.295; 0.233) P= 0.002. There was a non-statistically significant difference between severity
in acne groups regarding S. leptin.
We found that acne vulgaris in non-obese females was associated with elevated serum leptin level
compared to healthy controls. Our result supports the hypothesis that leptin may have a significant role in the
pathogenesis of acne, especially in females. According to our findings, this association was not severity related.
Keywords: Serum Leptin Level - Non-Obese Females - Acne Vulgaris.

According to studies, up to half of women in their 20s,
A typical chronic inflammatory condition of the
26% in their 30s, and 14% in their 40s still experience
pilosebaceous unit is acne vulgaris. About 80% of
symptoms. Adult acne has been claimed to affect 54­
young adults and adolescents are affected, and older
82.1 % of women and 17.9­40 % of males (8). More
persons are being diagnosed with it more often (1).
adult women suffer from acne, particularly active
It has been proposed that acne vulgaris is a
professional women in their 20s to 40s. In comparison
cutaneous manifestation of the mTORC1-driven
to teenage acne, adult-induced acne is often mild to
metabolic disorders, which also include type 2 diabetes,
moderate in intensity and manifests as more
obesity, and cancer. The Western diet, particularly its
inflammatory lesions and fewer comedones (9).
high hyperglycemic load and milk consumption, may
Acne's root causes are not entirely understood.
activate the mTORC1 signalling pathway, which is
Endogenous and exogenous variables, such as genetic
mediated by insulin-like growth factor 1 (IGF-1) (2).
predisposition, hormone concentrations, food, smoking,
stress, and UV light exposure, can cause acne or make
insulin/insulin-like growth factor 1 receptors, insulin
it worse (10).
elevation may increase basal keratinocyte proliferation
Leptin, a 167 amino acid protein with a molecular
in the follicular sebaceous unit duct, impairing the
weight of 16 kDa, is released by adipose tissue and
terminal differentiation of follicular corneocytes and
controls the energy balance, neuroendocrine function,
contributing to acne pathogenesis (3). Visceral obesity
metabolism, immune system, and other systems in the
and acne both have adipocytes that have up-regulated
central nervous system (CNS) and peripheral tissues.
mTORC1 signalling, which is directly linked to
The placenta, ovaries, skeletal muscles, the stomach,
enhanced lipogenesis and inflammation. The over
and bone marrow make very little of it, with white
activation of mTORC1 caused by nutritional excess is a
adipose tissue producing the bulk of it (11,12).
key factor in acne (4).
The leptin receptors enhance the pleiotropic effects
The severity of acne in boys was shown to be
of leptin because of its widespread distribution. Leptin's
connected with pubertal maturity. Fifty percent of boys
attachment to its receptor begins several signal
aged 10 and 11 had more than 10 comedones (5). Acne
transduction pathways, which in turn governs a variety
was seen in 78% of females between the ages of 8 and
of cell processes inside the body, such as metabolism
12 in another research (6). There are only 1% of men and
and immune response. Leptin might alter skin diseases
5% of women that have acne by the time they are 40
pathophysiology and, as a result, skin illnesses and
years old (7). Adult women are more likely to have
systemic autoimmune diseases (13).
symptoms, and they are more severe, than adult men.
Received: 15/01/2023
Accepted: 16/03/2023

Full Paper (vol.921 paper# 20)

c:\work\Jor\vol921_21 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5608- 5614

Effect of Flaxseed or Turmeric Oils on Reproductive Parameters and Serum Oxidative
Stress Markers of Male Albino Rats (Rattus Rattus)
Eman G.E. Helal 1,*, Hala A.H. Khattab 2, Waheeb S. Aggad3 , Hager S. Okasha 1
1 Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Cairo, Egypt.
2 Department of Nutrition & Food Science, Faculty of Home Economics, Helwan University, Cairo, Egypt.
3 Department of Anatomy, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia.3
*Corresponding Author: Eman G.E. Helal, E-mail:,
Mobile: 00201001025364,
: Phytoestrogens are estrogen analogues of plant origin, allowing them to act as agonists at estrogen
Objectives: This study was done to discover the effects of flaxseed and turmeric oils on male rats' fertility.
Methodology: Eighteen male albino rats are divided into three groups (6 rats each). Group 1 ( Control group) rats
received distilled water 1 mL/kg orally); group 2 (Flaxseed oil group) rats received 1 mL/kg flaxseed oil orally;group 3
(Turmeric oil) rats received 1 mL/kg turmeric oil orally. After 30 days, blood samples, epididymis, and testis were
collected for biochemical analysis, sperm characteristics and histological examinations.
Results: Flaxseed oil induced a significant decline (p<0.05) in % of body weight change relative to the control group.
Flaxseed and turmeric oils groups showed significant declines (p<0.05) in gonadosomatic index and sperm motility,
concentration, and viability, with a significant increase in sperm abnormalities. Besides, Flaxseed and turmeric oils
groups showed significant decreases (p<0.05) in the serum testosterone levels with significant increases (p<0.05) in
serum prolactin, FSH, and LH levels. Flaxseed and turmeric oils consumption significantly decreased (p<0.05) plasma
CAT and SOD while they significantly increased (p<0.05) plasma MDA relative to the control group. The testis of rats
ingested flaxseed and turmeric oils showed degenerated seminiferous tubules, with a diminished number of mature
spermatozoa in the tubular lumen, reduced diameter of seminiferous tubules and intact basement membrane.
Feeding flaxseed and turmeric oils consumption to adult male rats induced hormonal disturbances with
non-uniformities in sperm characteristics.
Keywords: Flaxseed oil, Turmeric oil, Phytoestrogen, Rats, Sex hormones, Sperm characteristics

Despite all the benefits that have been mentioned,
Presently, many men have erectile dysfunction
the question arises here dose flaxseed or turmeric oils
and infertility. This is for many reasons, including some
have a negative effect on male fertility?
foods which contain Phytoestrogens.

Flaxseed is the flax plant's seed (Linum
usitatissimum L., family Linaceae) widely used
Flaxseed oil was bought from Harraz Herbal
worldwide due to its biologically active constituents
Drugstore, Cairo, Egypt. Turmeric oil was purchased
exhibiting several health benefits. Flaxseed oil is a rich
from El-Captain Company, Cairo, Egypt.
source of polyunsaturated fatty acids; it contains 54-
Experimental protocol
59% linolenic acid (18:3n-3, ALA) and lignans
This study was performed on eighteen male albino
Additionally, it is a rich source of phytoestrogens (4).
rats (Rattus rattus) weighing (120-150g). Rats were
purchased from the animal farm of El-Nile Com. for
characteristics include anticancer, antioxidant, antiviral,
Pharmaceutical Product, Cairo, Egypt. Rats were kept
bactericidal, anti-inflammatory, and antiatherosclerotic
in cages (three rats per cage) under control and standard
properties (1). It also possesses hypoglycemic and
conditions of normal light/dark cycle, humidity, and
cholesterol lowering effects (5) allowing it to reduce the
temperature throughout the experimental duration.
risk of insulin resistance, obesity, and dyslipidemia (6).
Water ad libitum and food were accessible during the
investigation period. The experiment was done at the
Zingiberaceae) is widely cultivated for its rhizomes. It
Faculty of Science, Al-Azhar University, Cairo, Egypt.
is a widely distributed perennial herb mainly in sub-
The rats were divided into three groups (n=6) after
tropical and tropical regions. It is used as coloring agent
acclimatizing for one week as follows:
in food, confectionery, and pharmacy industry.
Turmeric powder, extracted from plant rhizomes, is
Group I: Control group, rats in this group eceived
mainly constituted of curcumin.
distilled water orally (1 ml/kg).
It possesses various pharmacological actions,
Group 2: Flaxseed oil group, rats in this group
including anti-inflammatory (7), antioxidant (8),
received flaxseed oil orally (1 ml/kg) (12).
hypolipidemic (9), and anti-cancerous (10). Curcuma
Group 3:Turmeric oil group, rats in this group
extract possesses substantial anti-spermatic and
received turmeric oil orally (1 ml/kg) (13).
antifertility activity in male albino rats (11).

Received: 15/01/2023
Accepted: 16/03/2023

Full Paper (vol.921 paper# 21)

c:\work\Jor\vol921_22 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5615- 5619

Role of Maresin-1 in Inflammatory Resolution of Psoriasis
(Maresin-1, Novel Therapeutic Alternative in Psoriasis Patients)
Shaalan T 1*, Ahmed SH 1, Mohammed SA 2, Elhabak DM 1,
1Department of Dermatology, Venereology, and Andrology,
2Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine Benha University
*Corresponding Author: Tebarek Yahya Shaalan, Email:, Phone: +201203356213

Psoriasis is a chronic, recurrent, immune-mediated inflammatory disease that affects 2%­3% of the
world's population. It is related to genetic vulnerability, autoimmunity, mental health, and environmental factors.
Pathogenesis is highly linked to abnormal interactions between innate immunity, T lymphocytes, and keratinocytes.
Maresin 1 (Mar1) is one of the EPA-derived metabolites with substantial anti-inflammatory actions in inflammatory
diseases. Objective: To investigate the possible association between serum level of Mer1 and psoriasis with variable
degrees of severity and compare it with healthy subjects.
Patients and Methods: We conducted a case-control study involving 60 psoriasis patients and 30 apparently healthy
individuals of the same age and gender as controls. All participants were recruited from the Outpatient Clinic of the
Department of Dermatology and Andrology at Benha University Hospitals. Comprehensive assessments, including
history taking, general examination, and skin evaluation, were performed on all participants. Disease severity was
determined using the Psoriatic Area and Severity Index (PASI). Serum samples were collected, and Mar1 levels were
measured using an ELISA technique.
Results: Mar1 level was considerably lower (p = 0.007) in cases compared to controls. At cut-off point of 26.9 pg/ml
achieved 96% sensitivity and 93.5% specificity. Mar1 showed a significant negative correlation with disease duration
and PASI score. Serum Mar1 significantly predicted the degree of disease severity.
Conclusions: Serum Mar1 significantly decreased in psoriatic patients than controls. It could be valuable for possible
diagnostic role and predicting disease pathogenesis, activity and severity of cases with psoriasis.
Keywords: Psoriasis, Disease severity, Maresin-1, ELISA.

IL-22, tumor necrosis factor (TNF), and granulocyte-
Psoriasis is a prevalent, persistent, and
macrophage colony-stimulating factor (GM-CSF) [7].
inflammatory skin condition characterized by clearly
Maresin 1 (Mar1) is an important regulator of the
defined, scaly, and reddened patches. It is a widespread
resolution phase in acute inflammation, which is
global disease, and its occurrence is quite common. In
regulated by endogenous specialized pro-resolving
Egypt, the prevalence of psoriasis ranges from 0.19 to
mediators (SPMs) [8]. In psoriasis, Mar1 has exhibited
3.0 percent [1]. Psoriasis can manifest at any age, with
anti-inflammatory properties. In an imiquimod-induced
higher rates observed between 20 and 30 years old and
animal model of psoriasis, topical Mar1 treatment
again between 50 and 60 years old. A family history of
demonstrated anti-inflammatory benefits. Mar1
the illness is often found among those affected [2]. The
accomplished this by suppressing cutaneous IL-17A
plaques associated with psoriasis can cause
production by decreasing IL-23 receptor expression [9].
disfigurement, significant discomfort, and may be
Therefore, topical Mar1 has the potential to be a therapy
severe. Itching is typically the most troublesome
for inflammatory disorders mediated by IL-17 [10].
symptom experienced by individuals with psoriasis [3].
This study aimed to investigate the possible
Pathogenesis of psoriasis is marked by aberrant
association between serum level of Mer1 and psoriasis
epidermal growth and keratinocyte differentiation. The
with variable degrees of severity and compare it with
complex and multifactorial etiology includes genetic,
healthy subjects.
immunologic, and environmental components [4]. In

psoriasis, keratinocytes are not only characterized by
robust proliferation, but also by altered expression of
Study Design and Participants:
certain keratins, particularly keratin 16 [5]. Genetic
A case-control study was done on 60 psoriasis
evidence on human leukocyte antigen (HLA)
patients and 30 seemingly healthy persons of the same
correlations, in addition to data on the existence of
age and gender who served as the control group. Cases
oligoclonal T cells in lesional skin and their sensitivity
had a mean age of 34±10.4 years and were composed of
to cutaneous antigens, demonstrate the significance of
36.7% males and 63.3% females. All patients were
immune cells in the pathogenesis of psoriasis [6].
recruited from the Outpatient Clinic of the Department
Psoriasis has been tied to polymorphisms in the
of Dermatology and Andrology at Benha University
IL23A, STAT3, IL23R, TYK2, and RUNX3 genes.
Hospitals between January 2022 and September 2022.
These genes are linked to the Th17 immune response,
Inclusion criteria: Both sexes of adult patients with
which plays a role in psoriasis development. Th17 cells
psoriasis were included.
may produce several cytokines, such as IL-21, IL-17F,
Received: 15/01/2023
Accepted: 16/03/2023

Full Paper (vol.921 paper# 22)

c:\work\Jor\vol921_23 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5620- 5624

Assessment of Human Immunodeficiency Virus Infection
Associated Nephropathy: Review Article
Rabab Ahmed Elsayed Ahmed*1, Mohamed Fouad Ahmed Ayoub1,
Ayman Riyadh Abdel Hameed Elsayed1, Fatima AlTaher Taha Morsi1, Mahmoud Ali Khalil Ali2
1Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
2Fellow of Hepato-gastroenterology and Infectious Diseases National Institute of Hepato-Gastroenterology and
Infectious Diseases, GOTHI
*Corresponding author: Rabab Ahmed Elsayed Ahmed, Mobile: (+20) 01210922825, E-Mail:

One of the leading causes of kidney failure in people living with HIV is HIV-associated nephropathy
(HIVAN), the first form of renal involvement in HIV patients to be described.
Objective: Review of literature about Human Immunodeficiency Virus Infection Associated Nephropathy.
We searched PubMed, Google Scholar, and Science Direct for relevant articles on Human Immunodeficiency
Virus, and Nephropathy. Only the most recent or thorough studies were taken into account between December 1981 and
January 2020. The authors also evaluated the value of resources culled from other works in the same genre. Therefore,
documents written in languages other than English have been ignored due to a lack of translation funds. Unpublished
works, oral presentations, conference abstracts, and dissertations were generally agreed upon not to be qualified as
scientific research.
Conclusion: According to reports, roughly 20% of HIV-infected people have end-stage renal disease, making it the
third leading cause of such disease among African-Americans aged 20 to 64 years old. Some parts of Africa, for
example, where the reduction is not as pronounced possibly due to a lack of antiretroviral treatment availability, are
typical of such communities. The classic manifestation of HIVAN is known as collapsing glomerulopathy, and it is
accompanied by proteinuric nephrotic syndrome, tubulointerstitial involvement, characterized by the enlargement and
production of tubular microcysts as well as interstitial inflammation and tubular damage, Its symptoms could include
blood in the urine (hematuria), quickly progressing kidney failure, and high blood pressure in the arteries.
Keywords: Human immunodeficiency virus, Nephropathy.

the development of autoantibodies are all hallmarks of
The acquired immunodeficiency syndrome
this condition, three lines of data that point in the
(AIDS) is a group of symptoms that includes dangerous
direction of an overreaction of the humoral immune
infections, cancers, and weight loss. When AIDS was
response (4). Anti-glomerular basement membrane
initially recognized in the spring of 1981, it was mostly
antibodies, antinuclear antibodies, anti-erythropoietin
manifested by Kaposi's sarcoma and pneumocystis
pneumonia among communities of homosexual males
neutrophil cytoplasmic antibodies, anti-myosin, anti-
in New York City and California. When the illness was
thyroglobulin, and anti-cardiolipin as well as anti-
originally identified, it was primarily found in
thyroid peroxidase, are some of the autoantibodies (5).
communities of homosexual men (1).
As a consequence of this, people living with AIDS are

more likely to suffer from a variety of autoimmune
Autoimmunity in AIDS patients
conditions due to the elevated levels of humoral
It is common practice to underestimate the risk of
immune responses like systemic lupus erythematosus
autoimmunity in AIDS patients, and in certain cases,
(SLE), that are associated with AIDS (6). It has not yet
this risk is even overlooked. On the other hand, the cell-
been determined whether or whether not HIV-infected
mediated immunodeficiency of AIDS patients has
patients with B lymphocyte expansion and an increased
received far too much focus and research. Without
generation of autoantibodies have a higher risk of
realising the crucial role autoimmunity plays in the
developing clinical autoimmune illness or AIDS-
development of HIV infection and AIDS, we have
defining clinical symptoms.
wasted untold billions of dollars on HIV immunizations.

Rather than being caused by a lack of immune system
Clinical trials of HIV vaccines
function, AIDS is a syndrome of autoimmune illnesses
Since it was first reported in 1984 that HIV was the
(2). It has been known for a long time that an
causative agent of AIDS, enormous amounts of time
autoimmune mechanism is involved in the progression
and money have been invested in research with the goal
of AIDS and HIV infection (3).
of producing a vaccine that is both effective and safe

enough to prevent HIV infection. Vaccines against HIV
Abnormally high levels of humoral immunity
genes and proteins have undergone extensive testing
Hyperactivation of B lymphocytes, high levels of
over the course of more than 30 years, including the
immunoglobulins and immunological complexes, and
gp160 subunit vaccine (7). DNA, viral peptides, live viral
Received: 17/01/2023
Accepted: 20/03/2023

Full Paper (vol.921 paper# 23)

c:\work\Jor\vol921_24 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5625- 5629

Assessment of Glycemic State and Intracerebral Hemorrhage: Review Article
Ahmed Essam Mohamed Harby*, Sawsan Abdel aziz Yousef, Wafaa Samir Mohamed, Emad Latif Agban
Department of Neurology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Essam Mohamed Harby, Mobile: (+20) 01143614994, E-Mail:

Intracerebral hemorrhage (ICH) remains the second leading cause of stroke accompanied with great
mortality rate and severe neurological deficits. For ICH patients, available treatment options are still limited, therefore
early recognition and improving results requires careful management of potential sources of harm.
Objective: Review of literature about glycemic state and intracerebral hemorrhage.
We searched PubMed, Google Scholar, and Science Direct for relevant articles on glycemic state and
intracerebral hemorrhage. However, only the most recent or thorough studies were taken into account between October
2000 and April 2023. The authors also evaluated the value of resources culled from other works in the same genre.
Documents written in languages other than English have been ignored due to a lack of translation funds. Unpublished
works, oral presentations, conference abstracts, and dissertations were generally agreed upon not to be qualified as
scientific research.
Conclusion: Patients with diabetes mellitus (DM) appear to develop a self-protective mechanism in response to chronic
hyperglycemia by preferentially down-regulating glucose transporters (GLUT-3 as well as GLUT-1), which allows
glucose to enter cells independently of insulin and thus reduces the acute fluctuation of glucose concentration and
endothelial cell apoptosis. Hyperglycemia due to stress is a temporary condition characterized by higher-than-normal
blood sugar levels. Myocardial infarction, ischemic stroke, and intracerebral haemorrhage are all serious illnesses in
which this phenomenon is frequently observed.
Keywords: Glycemic state, Intracerebral hemorrhage.

Primary Injury:
After ischemic stroke, intracerebral haemorrhage
ICH's first pathological harm is mechanical
(ICH) is the most prevalent cause of severe disability
compression from a hematoma, which raises
and death due to stroke. Half of all deaths from ICH
intracranial pressure and raises the chance of brain
happen within the first 2 days, and the first week, with
herniation. Poor prognosis and high mortality rates are
a 30-day mortality rate of 35-52% (1).
linked to secondary injuries such cerebral edema and
Bleeding into the parenchyma of the brain is the
brain hernia in ICH cases (5).
primary cause of intracerebral haemorrhage (ICH).
Hyperventilation, steroid administration, mannitol, and
Pathologies that lead to ICH can be broken down into
glycerol are some of the treatments for cerebral edema,
the following categories: arterial (small and big artery
however they do not reduce intracranial pressure or
disease), venous, vascular malformation, hemostatic,
prevent further brain injury (6).
and other (2).

ICH (intracranial haemorrhage) occurs due to two
Secondary Brain Injury:
major sporadic cerebral small vessel diseases:
hypertensive arteriopathy, which triggers ICH in the
More and more research points to inflammatory
small perforating artery area of the deep grey nucleus,
processes being involved in ICH-induced brain damage.
brainstem, and white matter. Also, vasculitis
It is believed that activation and polarization of
microangiopathy that includes lobar regions; and
cerebral amyloid angiopathy (CAA), which leads to
pathophysiological functions as well (7).
lobar ICH because of rupture of tiny arteries in the
To keep neurons, the extracellular matrix, and the
superficial cortical and leptomeningeal layers of the
blood-brain barrier (BBB) stable under normal
brain. Rarely, it can even affect very deep nuclei.
Although hypertensive arteriopathy can produce both
environmental monitoring. Pathological alterations
deep and lobar ICH, research classifies ICH as "non-
such as BBB injury, edema, cell death, and so on result
lobar (deep and infra-tentorial)" or "lobar" based on the
from cerebral bleeding because of the excessive
suspected prevalent underlying causative small artery
microglia/macrophages that release a huge number of
disease (3).
inflammatory factors and generate inflammatory
The second most common type of stroke,
waterfall reaction (8).
intracerebral haemorrhage has a high fatality rate and
Microglia and macrophage activation results in two
causes significant neurological impairments. As there
are currently few treatment options for ICH patients, it
is crucial that risk factors for negative outcomes be
alternatively activated microglia/macrophages (M2
identified and managed as soon as possible (4).
phenotype) (M2 phenotype) (9).

Received: 17/01/2023
Accepted: 20/03/2023

Full Paper (vol.921 paper# 24)

c:\work\Jor\vol921_25 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 2630- 2633

Assessment of Depression and Anxiety in Colorectal Cancer Patients: Review Article
Esraa Moustafa Abd El Aleem*, Nagy Fawzy Mohamed Selim,
Ahmed Mohamed Abdallah, Shimaa Ibrahim Amin
Department of Psychiatry, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Esraa Moustafa Abd El Aleem, Mobile: (+20) 01154402324, E-Mail:

"A multifactorial unpleasant emotional experience of a psychological (cognitive, behavioral, and
emotional), social, and/or spiritual nature that may impede with effective coping with cancer," is how the National
Comprehensive Cancer Network (NCCN) describes cancer-related distress.
Objective: Review of literature about Depression and anxiety in colorectal cancer patients.
We searched PubMed, Google Scholar, and Science Direct for relevant articles on Depression, Anxiety and
Colorectal cancer patients. Only the most recent or thorough studies were taken into account between October 2000 and
May 2021. The authors also evaluated the value of resources culled from other works in the same genre. Documents
written in languages other than English have been ignored due to a lack of translation funds. Unpublished works, oral
presentations, conference abstracts, and dissertations were generally agreed upon not to be qualified as scientific
Conclusion: A cancer diagnosis or recurrence, the start of a new treatment, or the course of an illness are all examples
of times when anxiety is frequent. Resilience breakdown after trauma causes post-traumatic stress disorder. The disorder
is characterised by an overwhelming anxiety of reliving the traumatic incident and is frequently accompanied by
intrusive memories of the event, such as nightmares or flashbacks. Traumatized individuals frequently report feeling as
though the terrible incident were occurring all over again during episodes of involuntary sensory flashbacks and
Keywords: Depression, Anxiety, Colorectal Cancer.

occurrences among females. Quality of life measures
According to the NCCN, cancer-related distress is
including physical performance, emotional well-being,
"a multifactorial unpleasant emotional experience of a
and cognitive acuity were shown to be lower in males
psychological (cognitive, behavioral, and emotional),
with colorectal cancer than in controls in a Spanish
social, and/or spiritual origin that may interfere with the
study of people with gastrointestinal cancer (4).
ability to cope well with cancer." Adjustment disorders,
major depressive disorder, and anxiety disorders are all
The SelfRegulatory Model of Illness
part of this spectrum. Patients with cancer commonly go
According to this theory, negative emotions like
undiagnosed, unrecognized, and untreated due to their
anxiety and despair can build up when people aren't able
cancer-related misery. Negative emotions, if left
to control their own emotions. The effects of depression
unchecked, can have serious consequences for a
and anxiety on health and wellbeing in the context of
person's health and well-being, including a decline in
cancer have been the subject of extensive study.
recovery, dissatisfaction, and HrQOL. Anxiety is
Anxiety symptoms have been reported in anywhere
frequent during stressful times like a cancer diagnosis
from 1.0% to 47.2% of patients across studies, and
or recurrence, the start of a new therapy, or the
depression symptoms in anywhere from 1.6% to 57.0%
advancement of an existing condition. However,
of people (5).
depression in cancer patients can be a typical response,
Depression and anxiety are experienced by people
a psychological condition, or a physical side effect of
with colorectal cancer at rates roughly 10% greater than
the disease or treatment (1).
those of their physically healthy colleagues (6). Despite
Evidence suggests that a sense of helplessness, fear
ongoing suffering, psychological symptoms tend to be
of death, and a lack of social support all contribute to
at their worst just after a diagnosis is made.
the onset of these mental health issues (2).
Anxiety, sadness, and post-traumatic stress disorder
(PTSD) are all possible outcomes of the stress of this
Among stoma-using survivors of colorectal cancer
procedure. Patients with stomas, for whatever reason,
therapy. These patients have lower social functioning,
may experience anxiety and melancholy as they adjust
inferior body image, and dysfunctional sexuality. Many
to changes in their body image, sexuality, and the
survivors also deal with chronic bowel trouble, which
societal and religious stigmas that surround faeces (3, 4).
has been linked to emotional distress (7).
Chemotherapy and radiotherapy
Peng et al. (5) published a review of 15 papers showing
The wide variety of toxicities of chemotherapy and
that the percentage of people with CRC who suffer from
radiation therapy that are experienced by patients may
anxiety and/or depression varies from 1% to 47% and
contribute to the prevalence of mental illness, or these
1.6% to 57% respectively. With more frequent
treatment modalities may serve as surrogates for more
Received: 17/01/2023
Accepted: 20/03/2023

Full Paper (vol.921 paper# 25)

Effect of Heart Rate at Admission on Outcome of Patients Undergoing Primary Percutaneous Coronary Intervention The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 2634- 2639

Study of The Effect of Subcutaneous Negative Pressure Drain on
Midline Surgical Wound in Major Gynecological Operation
Mohamed A. Wasfy, Fatma Ramadan Emohamed Omar*, Khalid Fathy Helal, Tarek Mohamed El-Behiedy
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Fatma Ramadan Emohamed Omar, Mobile: (+20)01102903860, E-mail:

Subcutaneous wound drains have demonstrated a high degree of efficacy in a number of surgical
procedures. However, wound drains' usefulness in gynecological surgery, such as caesarean section, remains debatable.
Objective: The aim of the current study was to assess the role of subcutaneous negative pressure drain in wound healing
following major gynecological surgery.
Patients and methods: A randomized controlled clinical trial was carried out at Obstetrics and Gynecology Department,
Zagazig University Hospital. This study included 60 cases, divided in 2 groups, 30 cases in each group; Group 1
included subcutaneous negative pressure drain patients who have undergone subcutaneous tissue re-approximations and
Group 2 included cases who have subcutaneous tissue re-approximation only.
Results: Statistical significant differences were found of body mass index and age between studied groups. There is a
significant difference between the two groups regarding low hematocrit and preoperative elevated serum blood glucose
level. Regarding post-operative complications, there were significant higher frequencies of hematoma, dehiscence
infection, and seroma in Group 1 compared with Group 2. Also there is significant difference between them as regard
duration of postoperative hospital stay that was more in drain group.
Conclusion: In gynecologic surgery, a subcutaneous negative pressure drain is a useful tool for managing wounds.
Keywords: Subcutaneous negative pressure Drain, Gynecological operation, Post-operative complications.


Wound problems occur in 5-35 percent of patients
The use of subcutaneous wound drains has shown
receiving surgery for gynecologic cancer (1).
great promise in a number of surgical specialties.
Complications from wounds result in longer hospital
However, the use of wound drains in gynecological
admissions, lower quality of life, and higher healthcare
procedures, including as caesarean sections, is still
expenses (2).
debated. Most studies only contain a handful of patients,
Increased rates of readmission and postoperative
so we don't know much about the effectiveness of
death as well as delays in chemotherapeutic treatment
wound drains in gynecological malignancy operations
following abdominal surgery have been linked to
on their own, some of whom also have gynecological
wound problems in gynecological cancer (3).
benign disorders (7).
Many methods have been explored to lessen the
There would be a considerable decrease in
potential for wound complications. Postoperative
postoperative wound problems if major gynecological
wound problems can be prevented, in part, by
operations used subcutaneous suture closure with a
shortening the duration of the operation, the use of
drain after the midline surgical incision (6).
prophylactic antibiotics during surgery, proper
The current clinical trial aimed for assessment of
irrigation of the surgical site, establishment of adequate
assessment of the role of subcutaneous negative
hemostasis, avoidance of dead space, and execution of
pressure drain in wound healing following major
precise operations (4).
gynecological surgery.
These methods are predicated on the idea that less

dead space in the subcutaneous tissue means less
opportunity for germs to thrive. The serous fluid or
A randomized controlled clinical trial was carried
blood that collects in this area has the potential to
out at Obstetrics and Gynecology Department, Zagazig
become infected, leading to further wound disruption (5).
University Hospital. This study included 60 cases,
Since wound complications are a major source of
divided in 2 groups, 30 cases in each group; Group 1
surgical morbidity, it is crucial that we learn how to
included subcutaneous negative pressure drain patients
minimize them following a midline surgical wound
who have undergone subcutaneous tissue re-
during a large gynecological operation. Subcutaneous
approximations and Group 2 included cases who have
drainage's efficacy has been mixed between research,
subcutaneous tissue re-approximation only.
which may be due to methodological, demographic, and

statistical discrepancies between the studies (6).
Inclusion criteria:
About 20 years ago, subcutaneous wound drains
All women undergo midline surgical wound for
were developed to remove exudate from wounds. These
major gynecological surgeries, including: Midline
drains limit the buildup of transudate from surgical
incision, Elective surgery, Normal laboratory
wounds, hence decreasing the risk for dead space in the
investigation, and Hemoglobin 10gm/dl.
subcutaneous tissue (5).

Received: 20/01/2023
Accepted: 21/03/2023

Full Paper (vol.921 paper# 26)

c:\work\Jor\vol921_27 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 2640- 2646

Administration of Misoprostol versus Hyoscine Butylbromide Prior to
Hysteroscopy as a Cervical Priming Agent
Marwa Ahmed Elsayed*, Ashraf Talat Abd Elfatah, Ahmed Ismail Mohamed, Hala Sherif Elsayed
Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Marwa Ahmed Elsayed, Mobile: (+20) 01289932500, E-mail:

A treatment called hysteroscopy is used to examine and treat a number of gynecological issues.
Objective: To compare misoprostol versus hyoscine butylbromide as a cervical priming agent in patients underlying
Patients and methods: This randomized controlled clinical trial was carried out on 82 participants who were scheduled
for operative hysteroscopy at Obstetrics and Gynecology Department, Zagazig University Hospitals. All participants in
our study were divided randomly for cervical ripening prior to hysteroscopy into two groups; Group (A): Misoprostol
was administrated (n=41), Group (B): Hyoscine butylbromide was administrated (n= 41). All patients were subjected to
full history taking, routine clinical examination and laboratory investigations. The cervical priming agent was
administrated 2 hours before the scheduled hysteroscopy.
Results: There was no statistically significant difference between the two studied groups regarding age, height, weight,
BMI, the mean parity, previous history of CS, history of abortion, the diagnosis, the procedure time, and anesthesia.
Cervical dilatation width was significantly higher among group A while cervical dilatation time was significantly lower
among group A than group B. The self-reported pain was significantly higher among group A than group B. Nearly 44%
of the participants of group A needed postoperative analgesia administration, while only 12.2% of group B needed
postoperative analgesia administration.
Conclusion: Hyoscine butylbromide is as effective as misoprostol as a cervical priming agent in patients undergoing
operative hysteroscopy with less need for postoperative pain medication and postoperative complications.
Keywords: Hysteroscopy, Misoprostol, Hyoscine Butylbromide, Cervical Priming Agent.

priming agent in patients underlying operative
A treatment called hysteroscopy is used to
diagnose and treat a variety of gynecological issues,
most notably irregular menstruation, endometrial
This randomized controlled clinical trial (RCT)
biopsy, polyp removal, fibroid removal, and infertility
was carried out on 82 participants who were scheduled
(1). Hysteroscopy has a number of advantages over other
for operative hysteroscopy at Obstetrics and
procedures since it is minimally invasive, cheap, easy to
Gynecology Department, Zagazig University Hospitals
perform, and well-liked by patients. As a result, it is
during of period from February 2022 to February 2023.
regarded as the absolute benchmark for both diagnosis

and therapy. A slender telescope-like instrument with a
Inclusion criteria: Females of reproductive age
tiny camera called a hysteroscope is inserted through the
between 18-50 years who were scheduled for operative
cervix to examine the uterus' inside (2).
Cervical dilatation is necessary for bigger tools

used in surgery but is not necessary for diagnostic mini-
Exclusion criteria: Post-menopausal patients,
hysteroscopes with tiny instrument diameters less than
incompetent cervix, stenotic cervix, previous history of
5 mm (3).
cervical surgery, patients suffering from asthma,
Misoprostol (PG E1) usage prior to surgical
hypertension, myasthenia gravis and glaucoma were
hysteroscopy allowed for simple cervical dilatation and
excluded from the study.
fewer difficulties, but it also comes with a long list of

adverse effects, including fever, diarrhoea, nausea, and
Selected patients were divided into two groups:
stomach cramps, in addition to being costly (4).
Group (1): included 41 patients who took misoprostol
Hyoscine butylbromide has a peripheral
400 mcg oral 2 hours before the hysteroscopy. Group
anticholinergic effect that causes a spasmolytic effect
(2): included 41 patients who took hyoscine
on the smooth muscles of the female genital tract. It has
butylbromide 20 mg/ml 1 cm intramuscular 2 hours
demonstrated its effectiveness by shortening the first
before the hysteroscopy.
stage of labour by facilitating cervical dilatation. It also
A thorough history was gathered, which included
has another benefit in that it lessens pain and muscle
a full examination of the patient's complaint and any
cramping with fewer complications, is readily available,
symptoms that needed treatment at the time. It also
and is inexpensive (5).
included information about any known sexually
Therefore, this study aimed to compare
transmitted diseases and prior gynecological illnesses,
misoprostol versus hyoscine butylbromide as a cervical
and determining the risk of contracting HIV and
hepatitis B. The obstetric history, included parity, the
Received: 18/01/2023
Accepted: 21/03/2023

Full Paper (vol.921 paper# 27)

c:\work\Jor\vol921_28 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 2647- 2652

Can Sentinel Node Biopsy Continue to Be a Diagnostic Tool for
Radiologically Negative Axilla in Early Breast Cancer?
Anwar Mohamed Mostafa*, Nawel Hussein Matar, Ramadan Mahmoud Ali, Hassan Ashour
Department of Surgical Oncology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Anwar Mohamed Mostafa, Mobile: (+20) 01014658188, E-mail:

For staging of the axilla, axillary ultrasound (AUS) has been researched as a non-invasive substitute for
sentinel lymph node biopsy (SLNB). Objective: The aim of the present study was to compare between accuracy of AUS
and SLNB in assessment of the axillary nodal status in early breast cancer.
Patients and methods: A cross sectional study was conducted and included 60 female' patients with early breast cancer
and carried out in General Surgery Department, Zagazig University Hospitals. All cases were arranged for accurate
axillary ultrasound examination. Patients were postoperatively followed up for 6 months. Results: The most common
quadrant to be affected is the upper outer quadrant (UOQ) seen in 32 patients of the studied group (53.3%). A total of
28 (46.7%) patients presented with T1 tumors and 32 patients presented with T2 tumors; with an overall incidence
53.3%. Only 4 patients underwent modified radical mastectomy with an overall incidence of 6.7%, and 44 patients
underwent conservative breast surgery with overall incidence 73.3%. The number of excised lymph nodes (LNs) in
study group ranged from 2 to 4. The level of excised LNs in study group ranged from level I and/or level II. Concerning
the Validity of AUS finding; 73.3% of the studied women were negative SLN with Negative AUS LNs. Conclusion:
The surgical procedure as sentinel LNs biopsy SLNB (by methylene blue MB) still has the upper hand as a diagnostic
tool for axillary nodal status with more accuracy and sensitivity than radiological methods as axillary ultrasound AUS.
Keywords: Early Breast Cancer, Sentinel Node Biopsy, Axillary Ultrasound.


be worsened by seroma development, sensory nerve
One of the top 3 most prevalent cancers in the
damage, lymphedema, and a restriction in shoulder
world, breast cancer is a serious health issue. It accounts
range of motion. To prevent a second treatment, many
for 25% of all cancer cases in women, making it the
centers depend on the availability of axillary imaging on
most prevalent. It is the leading cause of cancer death in
sentinel lymph nodes (4).
less developed nations, ranking fifth among the most
We believe that alternatives to SLNB should be
prevalent causes of cancer-related mortality globally (1).
taken into account in a time when axillary surgery is no
One of the most significant prognostic indicators in
longer regarded as therapeutic in clinical T1-T2, N0
breast cancer is the presence of axillary nodes. The
breast cancer and tumor biology as determined by
therapy of breast cancer has undergone significant
biomarker profile and molecular profiling is more
modifications over the past century, going from an era
frequently used as the basis for adjuvant therapy
in which mastectomy or axillary lymph node dissection
decisions (5).
(ALND) was seldom performed to one in which
One-stage axillary clearance and a reduction in the
modified radical mastectomy (MRM) was the standard
necessity for SLNB from 70% to 21% are both possible
of care. Less invasive surgical procedures also improve
with preoperative ultrasound imaging of the axilla in
quality of life (1). Identification and subsequent removal
individuals with clinically negative nodes (4).
of the first node(s) to which the tumor drains its
For axilla staging, axillary ultrasound (AUS) has
lymphatic fluid is known as a sentinel lymph node
been researched as a noninvasive alternative to SLNB.
biopsy (SLNB). As a reliable substitute for ALND for
Based on the morphological characteristics and size of
staging patients with early breast cancer, SLNB has
the lymph nodes, AUS can detect illness in the axillary
gained widespread acceptance (2).
lymph nodes (ALN). Studies that have looked at the
The introduction of SLNB has led to a significant
accuracy of AUS have found that it has good levels of
departure from ALND in the surgical management of
sensitivity and specificity (6).
the axilla for patients with early breast cancer,
Axillary assessment is most frequently performed
improving quality of life and lowering complication
with ultrasound due to its accessibility and safety. High
rates. SLNB also aims to spare the majority of patients
resolution transducers used in advanced ultrasound
the morbidities associated with dissecting all the
technology enable the detection of abnormal-appearing
axillary lymph nodes. The surgical technique of choice
lymph nodes as well as detailed representations of nodal
today for predicting the axillary status in clinically-
shape. It can be challenging and operator-specific to see
negative breast cancer and preventing needless
how metastasis affects lymph node shape. The doctor
morbidity is SNLB (3).
can advise the patient to start with preoperative
SLNB became the norm of therapy for patients with
chemotherapy or to go straight to ALND and skip
clinically node-negative breast cancer because to the
SLND if metastases are found using AUS prior to
significant morbidity of ALND. However, SLNB is
surgery (7). Therefore, the current study aimed to
pricy, time-consuming, may result in morbidity, and can
compare between accuracy of AUS and SLNB in
Received: 20/01/2023
Accepted: 21/03/2023s

Full Paper (vol.921 paper# 28)

c:\work\Jor\vol921_29 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 2653- 2661

Post Massive Weight Loss Brachioplasty Aesthetic Outcome and Complications
Dalia Mohamed Mofreh Elsaka, Ahmed Tharwat Nassar,
Mohamed Mayhoub Abdel-Wahab*, Medhat Samy
Department of Plastic Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Mohamed Mayhoub Abdel-Wahab, Mobile: (+20) 01009475225,

Some people have a "bat wing" deformity and an extension of skin redundancy from the axilla along the
lateral chest wall that overlaps in the breast region, which has an effect on surgical choices. Forearm redundancy can
also occur in certain people.
Objectives: To evaluate the aesthetic outcome and complications of brachioplasty in post massive weight loss patients.
Patients and methods: This is a prospective comparative study conducted on 24 patients with brachioplasty; to evaluate
the aesthetic outcome and complications of brachioplasty in postoperative weight loss patients, in the Plastic Surgery
Department of Menoufia University and Maadi Military Hospital, during a period time from April 2019 to October
Results: According to Spearman's correlation analysis, there was a highly significant positive association between
preoperative average arm circumference and postoperative arm circumference (p <0.01). All three procedures displayed
non-significant predictive results when separating patients with reduced arm circumference from those without (p >
0.05) using ROC-curve analysis. By using ROC-curve analysis, mini brachioplasty technique predicted complications-
free patients with good (82.5%) accuracy, sensitivity= 100% and specificity= 65% (p = 0.0002).
Conclusion: In certain patients with generalised inferior arm skin and fat redundancy, a brachioplasty surgery is an
effective and repeatable therapy. The markers and resection are made simpler. By protecting lymphatics and nerves and
reducing blood loss, it offers a safe process. It generates consistent, foreseeable consequences with reliable performance.
Keywords: Aesthetic, Bariatric, Brachioplasty, Complications, Obesity, Massive Weight.


Excess bodily fat is a definition of obesity. This
Although the canopy-like draping between the
fat may be evenly distributed throughout the body or
axilla and the elbow is the most striking feature, the
may be concentrated in one area [1]. A new group of
unsettling deformity always encompasses the axilla and
persons known as post bariatric patients emerged with
spans across the chest and lateral breast [7]. It can also
the development of bariatric surgery. Massive weight
occasionally extend distally into the forearm. Despite
reduction brought on by bariatric surgery typically
the numerous treatments proposed for its enhancement,
leaves the belly, breasts, arms, and thighs with
surgical rejuvenation of the upper arm continues to be a
superfluous and amorphous skin. Intertrigo, difficulties
challenge for both the patient and the physician [8].
walking, peeing, or engaging in sexual activity are just
Correa-Iturraspe and Fernandez originally
a few of the issues loose skin can lead to [2].
described brachioplasty in 1954. Since then, a number
Formerly obese individuals have adipose and
of adjustments have been made to the surgery to
cutaneous excess after significant weight reduction, and
enhance the look of the scar and the arm's subsequent
their skin has lost the majority of its flexibility [3]. Body
shape. This includes techniques such as S-incisions, W-
contouring following bariatric surgery considerably
plasty, re-epithelialization rolled-up flaps, T-incision,
enhances one's physical and mental state, according to
fascial system suspensions and using molds [9].
studies. Cosmetic surgery may also motivate the patient
Flaws and complications may affect patient
to pay more attention to weight management, increasing
satisfaction. They include incorrectly placed incisions,
the likelihood of long-term weight reduction success [4].
asymmetric widened hypertrophic scar, and pale scars
Dissatisfaction with upper arm excess is
similar to striae which may need revision [10]. Edema,
common in patients who have had significant weight
seroma, wound dehiscence, subcutaneous abscess, and
reduction. They often describe their arms as "bat wings"
a short period of lymphorrhea may occur. Median
because of hanging tissue that can get caught in clothing
antebrachial cutaneous nerve (MACN) injury
and can cause rashes [5].
(paresthesia) and chronic regional pain syndrome were
Embarrassed about the appearance of their
recorded [11].
arms, these individuals avoid short sleeved clothing.
Postoperative contour deformities, transverse
Finding apparel that has sufficient material to conceal
cutaneous folds and postoperative skin laxity and ptosis
their arms, however, is often difficult, if not impossible.
in the axillary region have been noticed. Fat over
They will often have learned to cope with excess in
resection may cause impairment of venous and
other parts of their body but feel that their arms are
lymphatic circulation [12]. So, the aim of this study was
difficult to conceal, especially in hot weather [6].
to evaluate the aesthetic outcome and complications of

brachioplasty in post-massive weight loss patients.
Received: 18/01/2023
Accepted: 21/03/2023

Full Paper (vol.921 paper# 29)

c:\work\Jor\vol921_30 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5672- 5676

Prevalence and Outcomes of Rheumatoid Arthritis with Pregnancy:
A Systematic Review Article
Mohammed Ahmed Ali Asiri 1*, Safiah Ahmad A Assiri 2
1- Registrar Internal Medicine, Armed Forces Hospital Southern Region, Khamis Mushyte, Saudi Arabia
2- Family medicine Resident, Asser central hospital, Abha, Saudi Arabia
Corresponding author: Mohammed Ahmed Ali Asiri, Email:,
Phone Number: +966 53 362 8604

The medical practitioner looking after women with rheumatoid arthritis (RA) may find pregnancy
challenging. The challenges that females with RA have when trying to get pregnant are less well understood, both in terms
of fertility, pregnancy outcomes, and medication safety.
Objectives: This study aimed to assess current evidence regarding pregnancy outcomes in pregnant women with rheumatoid
Information services from the PubMed database were used to choose the articles on rheumatoid arthritis,
pregnancy, inflammatory disease. In our review, all pertinent articles related to both our topic and other articles were used.
Other articles that have nothing to do with this subject were not included. The group members looked through a certain
format in which the data had been extracted.
According to the findings of the included studies, pregnancies in women with RA are linked to higher relative
risks for a range of negative effects on both the mother and the unborn child. Remission of the disease is recommended
prior to conception. RA patients who are expecting should receive the same information and encouragement to schedule
pregnancies with their doctors as other individuals with morbid diseases.
Rheumatoid arthritis, Pregnancy, Inflammatory disease.


Study Methods:
Pregnancy could be difficult for the medical
Between July 1 and October 30, 2022, a qualitative
professional caring for women with rheumatoid arthritis
systematic evaluation was carried out. Rheumatoid
(RA). There are some RA patients who experience a
arthritis, pregnancy, inflammatory disease, and other key
recurrence and require ongoing medication, even though
words were used in diverse combinations during an
many find that their joint pain and inflammation naturally
electronic systematic search on PubMed. The research
reduce during pregnancy (1).
used to create the report comprised clinical studies, cohort
Since RA disease activity affects TTP and
pregnancy outcomes in RA patients, it is essential to
accurately monitor severity of RA disease through
The inclusion criteria were all pertinent studies with
pregnancy. However, this is difficult since pregnancy
goals comparable to those of our investigation. Due to a
impacts a number of metrics used to assess the severity of
lack of translation resources, the time and language
an illness or its components (2).
constraints were set at 10 years and English only. All
In order to strike a compromise between the need
studies unrelated to our subject and articles published ten
to quit using teratogenic drugs like MTX and LEF with
years ago or more were excluded from consideration.
maintaining disease management, rheumatologists must
Following the extraction of qualitative data, the
modify the treatment regimen for RA patients who desire
authors provided the names of the authors, the year, the
to become pregnant. There is a little knowledge in the
type of study, the methodology, and the findings. The data
rheumatological community about the use of anti-TNF
analysis process used no software. On a Microsoft Excel
medications in RA women prior to conception or
Worksheet, the data were retrieved based on a specific
throughout pregnancy (3).
form. The group members looked over these data to
It's essential to tailor the treatment such that the
ascertain the preliminary conclusions and the approaches
sickness is stabilised before conception and to select
for using the surgical method. To verify validity and
medications that can be used without causing harm to the
reduce errors, each member's results underwent a second
unborn child or nursing mother. Less is known regarding
round of revision.
the difficulties that men with RA have when trying to get

pregnant, in fertility, pregnancy outcomes, and
medication safety (4). The latest research on the
The selection and identification of research are
progression of severity of RA disease through pregnancy
shown in figure (1). A total of 314 studies were found after
is summarized in this article.
searching the aforementioned databases, which were then
Received: 16/01/2023
Accepted: 19/03/2023

Full Paper (vol.921 paper# 30)

c:\work\Jor\vol921_31 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5667- 5671

The Early Effects of Coronary Artery Bypass Grafting on Heart Failure
Patients with Borderline versus Reduced Ejection Fraction
Ahmed M. Deebis, Nader A. E. El-Boraey, Ali M. Soliman, Amr Ahmed Adel Soliman*
Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Sharqya, Egypt
*Corresponding author: Amr Ahmed Adel Soliman*, Mobile: (+20) 01154900078, E-mail:

The standard of treatment for treating individuals with severe left main stem and three-vessel coronary
artery disease (CAD) is coronary artery bypass graft (CABG) surgery. Compared to medical care, it is linked to better
Objective: To compare the early effects of coronary artery bypass grafting on individuals with borderline vs decreased
ejection fraction (EF).
Patients and methods: This is a prospective study that included 61 patients with CAD who were subjected for CABG.
The included patients were divided into 2 groups; HF with border line EF (HFbEF) group included 29 patients with
borderline ejection fraction and HF with reduced EF (HFrEF) group included 32 patients in reduced ejection fraction.
All patients were operated upon in Zagazig University Hospitals, Egypt and followed up during the period from
September 2018 till September 2021. Each patient underwent: full history taking, thorough clinical examination,
laboratory investigations and echocardiographic assessment.
Results: There was great improvement of EF in HFrEF group exceeding HFbEF group. The EF at 6 months post-
operative EF was 40.5±9.5% versus 43.2±7.85% in the HFbEF group versus in the HFrEF group respectively (p=0.151).
Among borderline EF group there was no significant difference regarding EF before and after coronary artery
revascularization (P-value= 0.34). There was a statistically significant improvement post-CABG regarding New York
Heart Association (NYHA) classification among HFbEF group and HFrEF (P-value = 0.00004 and <0.0001,
Conclusion: There was great improvement of systolic left ventricular EF in reduced ejection fraction group exceeding
borderline EF group.
Keywords: NYHA, CAD, CABG, EF.

The purpose of this study was to compare the early
Based on decreased rates of major cardiovascular
effects of coronary artery bypass grafting on individuals
and cerebrovascular events at 1-year, coronary artery
with borderline vs decreased ejection fraction (EF).
bypass graft (CABG) surgery is the gold standard of

treatment for the management of patients with severe
three-vessel and left main stem coronary artery disease
The present study was conducted as a prospective
(CAD) [1,2].
study included 61 patients with CAD who were
In contrast to medical therapy alone, the goal of the
subjected for CABG.
randomised trial Surgical Treatment for Ischemic Heart
The included patients were divided into 2 groups;
Failure (STICH) was to determine whether patients with
HFbEF group included 29 patients with borderline
heart failure (HF) and coronary artery disease (CAD)
ejection fraction and HFrEF group included 32 patients
who underwent coronary artery bypass grafting
with reduced ejection fraction. All patients were
(CABG) and guideline-directed medical therapy would
operated upon in Zagazig University Hospitals, Egypt
likely live longer. The CABG group had decreased
and followed up during the period from September 2018
mortality from cardiovascular reasons (or any cause),
till September 2021.
according to the results of this early trial [3,4].

The 10-year extended follow-up study was
Inclusion criteria included; heart failure patients with
subsequently performed to examine the long-term
ischemic heart disease need elective CABG according
effects of CABG in ischemic cardiomyopathy patients.
Findings from this study showed that patients receiving
Foundation/American Heart Association Guidelines [10]
CABG as well as medical therapy had a significantly
for coronary artery bypass graft surgery 2012, which
lower rate of all-cause mortality or hospitalization than
were reviewed in 2017 and patients with ejection
those patients who received only medical therapy [5,6].
fraction less than 50% with viable myocardium, which
Patients with CAD with left ventricular failure
was based on echocardiography, doputamine stress
(ejection fraction 35%) provide a clinical challenge.
echocardiography or nuclear studies.
Both CABG and percutaneous coronary intervention

(PCI) in patients with CAD are linked with better
Exclusion criteria were: patients who were candidates
survival compared to medical therapy, according to
for CABG without left anterior descending coronary
several randomised trials and observational studies [7-9].
artery (LAD) grafting, the patients who were candidates
for urgent or emergency CABG, patients with severe
comorbidity (end stage renal or liver diseases,
intractable malignancies, and intractable hematological
Received: 19/01/2023
Accepted: 22/03/2023

Full Paper (vol.921 paper# 31)

c:\work\Jor\vol921_32 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5672- 5681

Study of Role of Multi Slice Computed Tomography in Evaluation of
Blunt Renal Trauma
Mennat-Allah Osama Khalil*, Ibrahim Abdel-Aziz Lebda, Dalia Nabil Khalifa, Heba Fathy Tantawy
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mennat-Allah Osama Khalil, Mobile: (+20) 01002776810, E-Mail:

Clinicians had difficulties in making correct diagnoses of renal damage caused by various traumas. After blunt
trauma, computed tomography (CT) is the preferred method of visualizing the internal organs.
This study aimed to determine the relationship between multi detector computed tomography (MDCT)
findings and clinical outcomes
Patients and Methods:
A cross section study was performed in Emergency Department, Zagazig University on 24
patients presented with blunt thoraco-abdominal trauma and hematuria. Focused assessment with sonography in trauma
(FAST) and Contrast-enhanced multiphasic renal CT study were done to all cases.
Results: There were statistically significant difference between CT & FAST specificity & PPV in diagnosing grade I renal
injury. Moreover, the accuracy of CT in diagnosing grade I renal injury was statistically significant higher than that of
FAST. There was statistically significant difference between CT & FAST specificity & PPV in diagnosing grade II renal
injury. Moreover, the accuracy of CT in diagnosing grade II renal injury was statistically significantly higher than that of
FAST. Sensitivity of CT was significantly higher than that of FAST in diagnosing grade III renal injury. The sensitivity,
NPV & accuracy of CT in diagnosing grade V renal injury was significantly higher than that of FAST.
Conclusion: The anatomic and functional information provided by contrast-enhanced multi-slice computed tomography
(MSCT) is crucial for precise grading according to the American Association for the Surgery of Trauma (AAST)
classification system, making it the gold standard in evaluation and therapy of renal trauma.
Keywords: Computed tomography, Blunt renal trauma, FAST.

We aimed at this study to determine the
The most common cause of renal damage is blunt
abdominal trauma, affecting 1-5% of all trauma patients
tomography (MDCT) findings and clinical outcomes.
(80% to 90%). Despite its rarity, deep renal trauma can

account for up to 20% (1). Bleeding, damage to the
collecting system, and urine leakage are all possible
Between May 2020 and February 2021, a cross-
outcomes of renal trauma to the parenchyma or renal
sectional study was conducted at The Emergency Room
vasculature. Injuries to the kidney are the norm in the
at Zagazig University. Twenty-four people participated in
genitourinary system (10% of all traumas) (2).
the study (14 males, 10 females) with ages ranging from
After a severe blow to the abdomen, the most
5-55 with a mean age of 21.63 ± 15.265.
reliable method of visualising the internal organs is

computed tomography (CT). Delayed phase images
Inclusion criteria: Any age group and sex with blunt
evaluate the renal collecting system and ureteric
thoraco-abdominal trauma and hematuria.
continuity, while arterial and portal venous phase
Exclusion criteria: Other (non-traumatic) causes of
imaging detect active extravasation (3). Renal injuries,
hematuria, penetrating trauma, pregnant females,
along with injuries to other abdominal or retroperitoneal
haemodynamic or respiratory instability, poor renal
organs, can be swiftly and correctly shown by contrast-
function with high creatinine level (> 2 mg/dL), and
enhanced CT, which is routinely available in emergency
allergy to contrast media.
rooms (4). The most consistent manifestation of renal
injury is gross hematuria; nevertheless, it may not occur

in about 5% of patients, and the severity of the symptom
The patients were subjected to complete history taking, as
does not correlate with the severity of the injury (5).
well as clinical examination and Radiological
All stable patients with massive hematuria and
those who present with microscopic hematuria and
I. FAST (focused assessment with sonography in
hypotension should undergo contrast-enhanced computed
tomography (CT) for the definitive diagnosis of renal
The GE Logiq P7A sector probe (3-5 MHz) machine
trauma. A CT scan should be performed if the mechanism
can serve a variety of purposes. It was used for
of injury or the findings of a physical examination suggest
detecting the existence of free fluid in the abdomen or
renal injury (6). Surgery has become more cautious as a
pelvis and analyzing its volume.
result of MDCT's accurate grading, with the exception of
II. Contrast-enhanced multiphasic renal CT study:
cases involving full lacerations, extensive extravasation,
Philips Ingenuity 128 CT Scanner machine using a
as well as abdominal injuries (7).
powerful automatic injector was used with the patient

Received: 19/01/2023
Accepted: 22/03/2023

Full Paper (vol.921 paper# 32)


Multi-Detector Computed Tomography Evaluation of
Post Pelvi-Abdominal Surgical Complications
Hager Mohsen Saleh Mohamed 1, Mohamed Refaat Habba, Ahmed Tohamy Ahmed 2
1Radiology Department, Ismailia general hospital
2Radiology Department, Faculty of Medicine, Suez Canal University
*Corresponding Author: Hager Mohsen Saleh Mohamed, Phone No.: (+201009330947), E-mail:

Due to the common problems after pelvic-abdominal procedures, the post-operative abdomen is tough.
Hence, every radiologist must be extremely accurate in identifying these problems in order to rapidly identify
potentially life-threatening situations and initiate necessary care immediately.
To the early diagnosis and for adequate treatment planning through using the Multi-Detector Computed
Tomography (MDCT) in the diagnosis of post-operative pelvi-abdominal surgical complications.
Patients and Methods:
This was a descriptive cross-sectional study carried out on 50 adult patients who were
referred to the surgery clinic of Ismailia Suez Canal University and Ismailia General Hospitals suspected to have post
pelvi-abdominal surgical complications. MDCT was done to all patients and the findings were interpreted by two
specialty-certified radiologists.
Our results showed that the most common pre-surgical diagnosis was malignancy and recurrence in 38
patients (76%). Our study showed that recurrent malignancy was the most frequent findings, and 60% of the patients
were managed conservatively.
Computed tomography (CT) was used as gold standard tool in the evaluation of all patients included in
this study as it is presently the workhorse to assess post-operative problems, with the exception of MRI for probable
recurrence of rectal cancer or inflammatory bowel disease.
Keywords: Multi detector, Tomography, Evaluation.


Knowing the most common problems following
have a significant risk of fatal consequences when
pelvic-abdominal surgery is crucial for every radiologist
connected to systemic sepsis (5). According to reports, the
because it allows them to quickly identify potentially life-
morbidity and mortality rate is 10%­40%. More sensitive
threatening circumstances and arrange for appropriate
and specific than pouchography or fluoroscopy, multi-
treatment. The post-operative abdomen can be difficult
detector CT has been said to have a 90% accuracy rate in
(1). Many pelvic-abdominal procedures, including
determining the size and location of abscesses (6).
cholecystectomy, appendectomy, large bowel resection

or colostomy, abdominal wall hernia repair, and
The ability to obtain high-resolution pictures using
exploratory laparotomy, are carried out for various
Multi-Detector CT allows the radiologist to be a key
disorders. Here, a variety of lesions affecting the
player in the postoperative evaluation of patients after
abdominal wall and intraperitoneal tissues are presented
colon surgery. When possible, the radiologist should be
even now, in this age of modern medicine to highlight the
briefed on the study's specific rationale, the specific type
need of CT in their diagnosis and treatment (2).
of surgery performed (ranging from a simple segmental
The first steps in reducing misinterpretation of
bowel excision to a more comprehensive radical
potentially life-threatening problems following pelvic-
resection) & the specific types of anastomoses used (7).
abdominal surgeries are to get familiar with the different
In order to distinguish between expected benign
surgical procedures, particularly the most common
findings and those linked to more concerning disease
anastomosis, and their most prevalent consequences (3).
entities, the idea behind using CT is that axial Multi-
The radiologist frequently encounters altered
Detector CT combined with multiplanar reformation
anatomic findings that make it difficult to distinguish
provides excellent visualization of both normal
between a postoperative result that is expected and a true
postoperative anatomy and typical postoperative
problem. Hence, prior to conducting a diagnostic
examination in such circumstances, consultation with the

referring surgeon is strongly encouraged (3).
In this situation, abdominal Ultrasound (US) is
This descriptive cross-sectional study was carried
frequently the first imaging method used. However,
out on patients who were referred to the surgery clinic
additional imaging methods are almost always required
of Ismailia Suez Canal University and Ismailia General
to supplement ultrasound findings. A reliable imaging
Hospitals suspected to have post pelvi-abdominal
technique for evaluating suspected biliary and vascular
surgical complications. The study was performed on
damage is CT (4).
50 cases who underwent pelvi-abdominal surgeries
As the most frequent cause of morbidity following
and were operated on at Suez Canal University
gastrointestinal procedures, intraabdominal abscesses
Hospital and Ismailia General Hospitals, and were
Received: 08/01/2023
Accepted: 10/03/2023

Full Paper (vol.921 paper# 33)

c:\work\Jor\vol921_34 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5687- 5691

Updates in the Management of Triple Negative BC: Review article
Eman Ibrahim Abdelshakour, Emad Eldin Nabil Hassan, Elsayed Mostafa Ali
Clinical Oncology Department, Sohag University Hospital, Sohag, Egypt
Corresponding author: Eman Ibrahim Abdelshakour,
Email: ,mobile: +201050366830


Breast cancer (BC), which is predicted to impact 1.67 million individuals a year, is the disease with the second highest
mortality rate worldwide, the most common cancer in women, and ranks fifth among causes of cancer-related death. BC
is the most prevalent form of cancer among Egyptian women.
Objective: This review article aimed to investigate for the updates in the management of triple negative BC (TNBC).
Methods: We searched PubMed, Google Scholar, and Science Direct for relevant articles on: Trible negative breast
cancer, updates and management. Only the most recent or thorough studies were taken into account between 2005 and
January 2023. The authors also evaluated the value of resources culled from other works in the same genre. Documents
written in languages other than English have been ignored due to a lack of translation funds. Unpublished works, oral
presentations, conference abstracts, and dissertations were generally agreed upon not to be qualified as scientific
Egypt National Cancer Institute (NCI) reported that at the end of 2001, among 10, 556 patients BC
represented 18.9% of all cancer cases (35.1% in females and 2.2% in men). Approximately 60%­70% of BC patients
are hormone-receptor positive and 20%­25% have amplified HER2. Clinically, ER, PR, and HER2 expression in
primary BC tissue is utilised to identify biological subtypes, forecast outcomes, and to determine the optimal course of
treatment, particularly for endocrine and HER2-targeted regimens. Targeted treatments targeting one of the
aforementioned targets (ER, PR, or HER2) are available for the majority of patients, when patients are identified with
tumours that lack ER, PR, or HER2, these therapy options are not available. These BCs are known as triple negative
breast cancers. TNBC is a subtype of BC that makes up 15% of all cases. It can be recognised by the loss of ER and PR
expression, as well as the absence of HER2/neu oncogene amplification or overexpression.
Keywords: BC, Triple negative, Chemotherapy, Targeted therapy.


linked to worse DMFS and CSS when compared to non-
Breast cancer (BC), which is predicted to impact
TNBC. Despite having a worse prognosis overall, some
1.67 million individuals a year, is the disease with the
TNBC patients in this study were still clear of the
second highest mortality rate worldwide, the most
disease after 5 years, which is noteworthy. Surgery and
common cancer in women, and ranks fifth among
radiation therapy alone resulted in DMFS and CSS for
causes of cancer-related death. BC is the most prevalent
40 TNBC patients of 82% and 86%, respectively. Even
form of cancer among Egyptian women (1).
though the majority of these patients had modest (T1)
Targeted treatments targeting one of the
node negative illness, they had positive outcomes (3).
aforementioned targets (ER, PR, or HER2) are available
According to research studies, some individuals
for the majority of patients, when patients are identified
with early TNBC have extraordinarily chemotherapy-
with tumours that lack ER, PR, or HER2, these therapy
sensitive diseases and have great permanent prognoses.
options are not available. These BCs are known as triple
This is valid, particularly in the perioperative situation.
negative breast cancers. TNBC is a subtype of BC that
Patients with TNBC experienced higher pathological
makes up 15% of all cases. It can be recognised by the
complete response (pCR) rates following chemotherapy
loss of ER and PR expression, and absence of
with neoadjuvant therapy than patients without TNBC
HER2/neu oncogene amplification or overexpression
Different chemosensibilities within and among BC
The idea of a standard approach is incorrect due to
subtypes in the neoadjuvant setting were identified by
the underlying biological variability in TNBC. Without
prospective gene expression investigations. The HER2-
adjuvant therapy, some individuals have favourable
positive subgroup and molecularly identified BL
outcomes; those who receive adjuvant cytotoxic therapy
disease were related to elevated pCR. A group of genes
are cured and those who receive currently available
with differential expression that are correlated with pCR
systemic therapy still have poor prognoses. When
in BL disease can be utilised to predict pCR within the
systemic adjuvant treatment is not used, a fraction of
subgroup (5).
TNBC patients had long-term DFS (3).
Superior OS and DFS over the long run are related
There were no statistically significant variations in
to pCR. Due to chemo-resistant micro-metastatic
local control between the IHC identified BC subtypes
disease, leading to an early, significant resurgence in 3
when researchers examined 5-year local regional
years of being first diagnosed and with a little window
recurrence, distant metastases free survival (DMFS),
between the remote recurrence and the patient's death
and cause specific survival (CSS). However, TNBC was
(median 13 months), the vast majority of early TNBC
Received: 19/01/2023
Accepted: 22/03/2023

Full Paper (vol.921 paper# 34)

c:\work\Jor\vol921_35 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5692- 5700

Evaluation of the Antibiofilm Activity of Laurus nobilis Leaves Extract and
Assessment of Its Effect on fimA and papC genes in Escherichia coli isolates
Ibtihal Essam Mohamed 1*, Ahmed H. Al-Azawi 2
1*Ministry of health, Medical city, National Center Teaching Laboratories, Baghdad, Iraq
2 Biotechnology Dept., Genetic Engineering and Biotechnology Institute for Post Graduate Studies,
University of Baghdad, Baghdad, Iraq.
* Corresponding Author: Ibtihal Essam Mohamed, Email:, Mobile: +964 771 457 0528

The beneficial gut bacterium E. coli can cause blood poisoning, diarrhoea, and other gastrointestinal and
systemic disorders.
Objective: This study amid to examines the antibiofilm activity of Laurus nobilis leaves extract on E. coli isolates and
compares pre- and post-treatment gene expression of fimA and papC genes.
Subjects and Methods: Ten isolates of E. coli were obtained from the Genetic Engineering and Biotechnology
Institute, University of Baghdad, which was previously collected from Baghdad city hospitals and diagnosed by
chemical tests, the diagnosis was confirmed using VITEK-2 System. The preparation of the aqueous and methanolic
Laurus nobilis leaves extracts was done by using the maceration method and Soxhlet apparatus respectively. HPLC
were conducted to determine the active compounds in the extracts. Moreover, molecular detection of fimA and papC
genes and analysis of the gene expression by comparing the isolates treated with sub MIC of methanolic L. nobilis leaves
extract with the untreated isolates.
Results: Methanolic and aqueous extracts contained alkaloids, tannins, phenols, saponins, flavonoids, and glycosides.
Seven polyphenolic compounds, four flavonoids derivatives (Apigenin, Luteolin, Rutin, and kaempferol) and three
phenolic acids (Caffeic acid, Gallic acid, and Syringic acid), were identified by matching retention time with the
standards. Laurus nobilis methanolic leaf extract inhibited 90% and 100% of E. coli biofilm development at 32 and 64
Conclusion: The result of the gene expression revealed that there is a decrease in the expression of the fimA and papC
genes. The present study concluded that the Laurus nobilis leaves extract have rich phytochemical contents, so the
methanolic extract had an excellent reduction effect on biofilm formation and showed remarkable down-regulation on
the papC and fimA genes, which are responsible for the biofilm formation in E. coli.
Keywords: L. nobilis, E. coli, Antibiofilm activity, Gene expression of fimA and papC genes.


as well as being grown as an ornamental plant
Although most strains of E. coli are innocuous and
throughout Europe and America is laurel (Laurus
the bacteria are a regular resident of the large intestine
nobilis L.), an aromatic plant and evergreen tree that
of humans, it is nevertheless important to pinpoint the
belongs to the Lauraceae family (4).
source of E. coli and other gram-negative bacteria
Plants' therapeutic properties have been well-
pathogens that cause newborn illnesses. These
documented for thousands of years, and traditional
dangerous strains are the cause of diarrheal diseases all
medicines continue to play a significant role in the
around the world, in addition to newborn meningitis,
routine treatment of many illnesses in various regions of
septicemia, and urinary tract infections (UTIs). Those in
the world.
the hospital's nursery or other nearby locations may be
Alternative therapies and the therapeutic use of
a source of the gram-negative bacteria that can spread
natural goods, particularly those produced from plants,
throughout the facility (1).
have gained popularity in recent years. One of the
Biofilms are communities of bacteria that have
primary sources of biologically active materials is
banded together on a surface and been coated in a
thought to be plants (5).
polysaccharide and protein matrix in response to
The leaves and berries of the plant are frequently
stressful situations such as irradiation or treatment.
used to flavor and improve meals, particularly meats,
Most biofilms on water surfaces are produced by
sauces, and soups. In addition to its distinctive perfume,
polysaccharide/polymeric matrices, and these matrices
it is used to treat illnesses all over the world. Beyond
are resistant to antimicrobial treatments (2).
rotting bacteria, various components from this plant,
In order to ensure the safety of medicinal plant
including its essential oils and organic acids, have
material used in alternative and complementary
demonstrated potent antibacterial activity against a
medicine, it is routinely subjected to microbial and
variety of foodborne disease microorganisms (6, 7).
bacterial testing. Humans have been using plants to treat

their ailments for as long as we've been around, based

on instinct, taste, and experience (3).
Among these healing plants is one of the most
Chemical reagents: The chemical. reagent absolute
popular culinary spices in all Western and Asian nations
methanol was purchased from BDH (England), while
Received: 22/11/2022
Accepted: 28/12/2022

Full Paper (vol.921 paper# 35)

c:\work\Jor\vol921_36 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5701- 5705

Association between TNF- Serum level and TNF- 308 Gene
Polymorphisms in Sample of Diabetes Iraqi Patients
Alaa N. Lateef, Bushra J. Mohammed
Institute for Genetic Engineering and Biotechnologies for Post-graduate Study, Baghdad University, Baghdad, Iraq
* Corresponding Author: Alaa Nizar Lateef, Email: , Mobile: 07714516730

Diabetes mellitus (DM) is one of the most prevalent, chronic diseases affecting majority of world population.
Objective: The aim of this study was to explore the correlation between TNF- serum levels and TNF-308 gene
polymorphisms in a group of diabetic Iraqi patients.
Subjects and Methods: A blood sample was taken from fifty patients suffered from type2 diabetes (T2DM), and fifty
healthy volunteers as a control. TNF- serum level was detected by ELISA and TNF-308G/A (rs1800629) gene
polymorphism was assessed by high resolution melting real time PCR technique.
Results: The results of estimation TNF- level showed high elevation in patients' group (52.69±4.48 pg/ml) with high
significant difference (P0.01) as compared with control group (23.35±1.67 pg/ml). While detection of TNF--308
polymorphism in patients revealed that the wild genotype GG was 1 (2%), heterogeneous genotype GA was 19 (38%), and
homogeneous genotype AA was 30 (60%) with significant difference (P0.001) and even as in control GG genotype was
35(70%), GA genotype was 10 (20%), AA genotype was 5 (10%) with considerable difference (P0.01). The findings of
correlation between TNF level and TNF-308 genotype in T2DM patients, revealed that a substantial increase at AA
genotype patients (P0.01) in TNF serum level (46.17±4.64 pg/ml) followed by GA patients genotype (29.21±2.74 pg/ml)
and finally GG genotype (5.11±9.15 pg/ml). Conclusion: The result revealed that patients with (A) allele had a higher risk
for T2DM; also the genotype of TNF-308 and the serum level of TNF- in people with T2DM and healthy control were
significantly different.
Keywords: Type 2 diabetes mellitus; TNF-; HRM; ELISA; Iraq.


Tumor necrosis factor alpha has an impact on glucose
Due to its high and rising occurrence and the
metabolism and affects insulin transduction (12,13).
varied and widespread morbidity it causes, which has an
Impairment of -cell function and reduced insulin
impact on people, health systems, and national
secretion induced by glucose may both be mediated by the
economies, diabetes mellitus is one of the most difficult
TNF- . It has been demonstrated in vitro that TNF- may
public health issues in the world (1). T2DM is a metabolic
reduce the glucose-induced insulin release from
disease largely manifested by an inflammatory systemic
pancreatic -cells (14,15). Because of the considerable
condition along with insulin resistance (IR) or a
differences between the various studies that are now
diminished metabolic response to insulin in a variety of
accessible, the relationship between the TNF-promoter
tissues, such as adipose tissue, the liver, and skeletal
genotypes and the chance of developing T2DM is still
muscle, additionally, by inadequate pancreatic beta cell
debatable. The TNF- promoter region comprises a
production of insulin (2,3). It is a heterogeneous disease
number of polymorphisms that are positioned adjacent to
characterized by prolonged periods of elevated blood
the transcriptional start point. One polymorphism at
glucose levels, which result in long-term health problems
nucleotide position -308 has a direct impact on TNF-
(4-6). Diabetes is directly responsible for about 1.6 million
expression; which guanine substituted by adenosine.
deaths annually (7). In Iraq, T2DM affects almost 1.4
Given the importance of the topic, this research sought to
million Iraqis, varying in prevalence from 8.5 percent to
investigate the relationship between TNF- serum levels
13.9 % (8). The genetic susceptibility is essential for the
and TNF- -308 gene single nucleotide polymorphisms in
development of T1DM, but inheritance does not follow
sample of diabetes Iraqi patients.
simple Mendelian rules. The pathogenesis of type 2

diabetes is influenced by both environmental and genetic
elements (7,9). Tumor necrosis factor (TNF-) is a cytokine
Four ml of venous blood was taken from 50 patients
that promotes inflammation. Numerous human disorders,
suffered from T2DM (22 female and 28 male) with age
like type 2 diabetes mellitus (T2DM), have been linked to
ranged between (35-65years) who attended Ashnuna
its dysregulation. TNF- is the first pro-inflammatory
Laboratory for Pathological and Hormonal Analyzes in
cytokine whose role in the establishment of insulin
Diyala, Baquba, and from 50 apparently healthy
resistance and T2DM has been recognized (10). The
volunteers as a control group. Each blood sample was
regulation of this cytokine's expression is linked to insulin
divided up into two halves; first 2 ml of blood was put in
resistance and highly influenced by genetic factors (11).
gel tube, left for 10-30 min to allow clotting, afterwards
Received: 22/11/2022
Accepted: 28/12/2022

Full Paper (vol.921 paper# 36)

c:\work\Jor\vol921_37 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5706- 5715

Red Cell Distribution Width and Neutrophil-Lymphocyte Ratio Predict
Thrombus Burden in Acute Myocardial Infarction
Islam Bastawy*1, Sherif Samir Elzahwy1, Kerolos Youssef2, Tamer Mohamed Abu Arab1
1Departments of Cardiology, Ain Shams University, Cairo, Egypt
2Departments of Cardiology, National Heart Institute, Giza, Egypt
*Corresponding author: Islam Bastawy, Mobile: (+20) 01288700196, E-mail:

In patients with ST-segment elevation myocardial infarction (STEMI), primary percutaneous coronary
intervention (PCI) tries to reestablish coronary flow and ensure effective cardiac reperfusion. An independent
predictor of no-reflow is a large thrombus load.
Objective: This investigation sought to determine if the red cell distribution width (RDW) and neutrophil-lymphocyte
ratio (NLR) were reliable indicators of excessive thrombus load on coronary angiography.
Patients and methods: Two-hundred patients, with STEMI managed by primary PCI within 12 hours from chest pain
onset, were divided into group A with high thrombus burden (Thrombolysis in myocardial infarction (TIMI) thrombus
grade 4-5) and group B with low thrombus burden (TIMI thrombus grade 1-3).
One-hundred and seventeen patients (58.5%) had a high thrombus burden (group A). They had more mean
number of cardiovascular disease (CVD) risk factors (2.4 ±0.99 versus 2.06 ±1.06, p=0.02), longer pain to balloon
time (PTB) (151.28 ±42.05 versus116.99 ±43.16 minutes, p<0.001), higher mean Killip class (1.49±0.73 versus
1.28±0.6, p=0.03), higher RDW (18.99±1.55 versus 14.03±1.52, p<0.001), and higher NLR (5.93±1.39 versus
4.08±0.93 p<0.001) compared to group B. Independent predictors of high thrombus burden were RDW (OR: 4.06,
p<0.001), NLR (OR: 1.35, p= 0.04), number of CVD risk factors (OR: 1.62, p= 0.01), and PTB time (OR: 1.02,
p<0.001). Cut-off values to predict high thrombus burden were 16% for RDW and 4.55 for NLR.
Conclusions: Rapid identification of RDW more than 16% or NLR more than 4.55, could predict a high thrombus
Keywords: Neutrophil-lymphocyte ratio, No-reflow, Pain to balloon time, PCI, RDW, TIMI thrombus grade.


Till now, acute myocardial infarction (MI) has
lymphocyte ratio (NLR) were reliable indicators of
been contributing significantly to morbidity and
excessive thrombus load on coronary angiography.
mortality worldwide despite improving management

outcomes (1).
Acute thrombotic blockage of an epicardial
This cross-sectional observational study was
coronary artery brought on by the rupture or surface
carried out in two centers ( University Hospitals and
erosion of an atherosclerotic plaque results in ST-
National Heart Institute) between October 2019 and
segment elevation myocardial infarction (STEMI) (2).
May 2021. Two hundred patients were included, who
Coronary thrombus consists of platelets, red-
presented with STEMI within 12 hours from the onset
blood corpuscles (RBC), and fibrin, which increases
of chest pain and were managed by primary PCI. The
with increased ischemic time (3).
fourth universal definition of MI defined criteria of
Primary percutaneous coronary intervention
STEMI diagnosis (8). The study excluded patients
(PCI) is the most effective reperfusion modality if
younger than 18 years, patients who refused to sign
available. It aims to restore coronary flow and achieve
consent, and patients without coronary angiographic
successful myocardial reperfusion (myocardial blush
grade (MBG) 2/3) (4), as no-reflow (Thrombolysis in
All patients were subjected to a detailed
myocardial infarction (TIMI) < 3 or MBG < 2) is
history taking and clinical examination, aiming to
related to worse in-hospital, short-term, and long-term
identify age, gender, known risk factors of
outcomes (5).
cardiovascular diseases (CVD) (hypertension, diabetes
It is of value to identify the predictors of no-
mellitus (DM), dyslipidemia, current smoking, family
reflow to apply preventive measures that can be more
history of premature CAD) (9), previous history of
beneficial than its treatment, or to intervene promptly
CVD (MI, PCI, coronary artery bypass graft (CABG),
and rapidly if it happens, as its optimal management is
transient ischemic attack, cerebrovascular disease,
still unclear (6). A large thrombus load is an
peripheral arterial disease, chronic kidney disease),
independent predictor of no-reflow, and it should be
previous use of antithrombotics (antiplatelets or
addressed as soon as possible to limit the incidence of
anticoagulants), pain to balloon (PTB) time, body mass
no-reflow (7).
index (BMI), admission heart rate (HR), systolic blood
This investigation sought to determine if the red
pressure (SBP), diastolic blood pressure (DBP), and
cell distribution width (RDW) and neutrophil-
Killip class (10).

Received: 20/03/2023
Accepted: 30/05/2023

Full Paper (vol.921 paper# 37)

c:\work\Jor\vol921_38 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5716- 5719

Safety of Ultrasound-Guided Trigeminal Nerve Block in
Maxillofacial Surgery under General Anesthesia
Maha Ali Misk, Fatma Mohammed El-Sayed Khames,
Mohammed Abd El-Gawad, Hamdy Ali Hendawy, Medhat Lamey
Anesthesiology and Intensive care, Faculty of Medicine, Suez Canal University
Corresponding author: Maha Ali Misk, Email:, Mobile: 01050366830

Peripheral nerve blocks are being utilized more often, either as a part of multimodal analgesia or even as
a substitute for drugs that treat systemic pain. Primary headache problems and secondary headaches have both been
successfully treated with peripheral nerve blocks.
Objectives: This study aimed to assess safety of ultrasound-guided trigeminal nerve block (USGTNB) in individuals
who are receiving general anesthesia and are undergoing unilateral maxillofacial surgery.
Methods: This cross-sectional study enrolled 25 adult patients aged more than 18 years, who had American Society of
Anesthesiologists physical status I or II and were scheduled for elective unilateral maxillofacial surgery under general
anesthesia. Patients received USGTNB using 5 ml of bupivacaine 0.25%. The intraoperative hemodynamic parameters
were assessed.
Results: More than half of patients were males (64%) with a mean age of 37.28 ± 11.54 years old. Patients had mean
duration of surgery of 2.96 ± 0.69 hours, most of them had ASA grade I. Patients had significantly lower HR compared
to their baseline values. Patients had significantly lower MAP relative to their initial levels. The total fentanyl
consumption was 0.36 ± 0.55 µ/kg. Regarding complications, 12% of patients had headache, 8% had paraesthesia and
4% had nausea\vomiting.
Conclusion: ultrasound-guided nerve block is a safe and reliable method for controlling pain in adult patients
undergoing maxillofacial surgery with fewer side effects.
Keywords: Maxillofacial surgery, Trigeminal nerve block, Ultrasonography, Safety.


purpose of perioperative pain control has seen a
reconstructive and free flap surgeries are all included in
significant rise in recent years. Real-time needle
the broad category of maxillofacial surgery. The
placement and excellent soft tissue and vascular
intricate anatomy and constrained operating room make
imaging are both provided by ultrasound (5).
these procedures difficult. Additionally, during
Trigeminal neuralgia can now be treated using
maxillofacial surgery, discomfort and bleeding are
ultrasound-guided trigeminal nerve blocks (USGTNB).
frequent occurrences (1).
Injection within the pterygopalatine fossa, which houses
The cost of hospitalization and length of stay
the sphenopalatine ganglion, might indirectly block the
both rise due to postoperative discomfort. It also
trigeminal nerve. The superficial and deep petrosal
interferes with sleep and degrades life quality. The
nerves, respectively, influence the parasympathetic and
discomfort felt after surgery can be alleviated in a
sympathetic activity of this ganglion. The sensory
number of ways such as: with oral, intravenous, and
duties of the sphenopalatine ganglion are carried
regional anesthetics, opioid and non-opioid medicines,
through the orbit, nose, buccal mucosa, and palate (6).
and other methods (2).
Nerve blockades are advantageous for
In particular in craniofacial procedures requiring
maxillofacial surgeries because they have fewer
mouth closure by intermaxillary fixation, patients who
negative effects. Additionally, USGTNB protects blood
have taken opioids may experience postoperative
vessels, especially the maxillary artery, from harm. The
nausea and vomiting as well as respiratory depression
potential use of USGTNB for postoperative analgesia in
that makes it challenging to extubate them. Major
craniofacial surgery has recently come up in a few
bleeding is another issue in maxillofacial surgery.
papers (7, 8). In this study, patients having unilateral
Head-up posture, local anesthetic injections including
maxillofacial surgery under general anesthesia had their
adrenaline, and avoiding hypertension are often
perioperative use of USGTNB for pain management
effective ways to control blood loss (3, 4).
evaluated for safety.
A multimodal approach has recently been

proposed to minimize the harmful effects of opioids. In
head and neck surgery, blocks that are guided by
This study was carried out in Suez Canal
fluoroscopy are thought to be the standard of care for
University Hospital, and it was a cross-sectional
pain management. Operations that are guided by
investigation. Participants in the study ranged in age
computed tomography as an alternative are
from 21 to 60 years old and were of both sexes. They
advantageous yet expensive and radiation-risky.
had an American Society of Anesthesiologists (ASA)
Recently, the utilization of ultrasonography for the
physical status of I or II and were scheduled to undergo
Received: 09/01/2023
Accepted: 12/03/2022

Full Paper (vol.921 paper# 38)

c:\work\Jor\vol921_39 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5720- 5727

Study of Role of Shear- Wave Elastography and Musculoskeletal Ultrasound in
Assessment of Hand and Wrist in Rheumatoid Arthritis Patients
Rania Mostafa Almolla, Hossam Eldin Mansour Abdelrahman,
Rahma Hossam Abdelsalam*, Nesma Adel Hamed
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Rahma Hossam Abdelsalam, Mobile: (+20) 01069420782, E-mail:
Joint damage, disease activity, and prognosis in rheumatoid arthritis can now be evaluated by shear-wave
elastographic ultrasonography (SW-EUS). Objective: Evaluate of the role of musculoskeletal ultrasound in early
diagnosis of rheumatoid arthritis and monitoring treatment, as well as evaluating the added value of using Elastography.
Patients and methods: A case-control study that included 30 rheumatoid arthritis patients and 30 controls have same
age and sex of chronic cases; we did shear wave elastography ultrasound (SW-EUS) image obtained for all subjects.
Results: Statistically significant differences were found in SWE parameters, as well as between recently diagnosed RA
patients and after 2 months follow up between RA patients and healthy control where the mean of Elastic Modulus
(KPa) that was statistically lower among RA patient than among healthy control. Also, the mean of Elastic Modulus
(KPa) increased from 15.67 ± 10.56 to 42.07 ± 17.8. Additionally, mean of Mean Velocity (m/sec) increased from 2.19
± 0.63 to 3.47 ± 0.91 that was statistically higher after 2 months. An Elastic Modulus (KPa) Cut-off level of Elastic
Modulus (KPa) < 44.35 had sensitivity of 100 %, and specificity of 94 % in detecting RA changes. Also, Cutoff level
of Mean Velocity (m/sec) < 3.76 had sensitivity of 100 %, and specificity of 93.3 % in detecting RA changes of high
statistical significance.
Conclusion: Diagnosing and assessment of disease activity in RA can be evaluated with SW-EUS.
Keyword: Shear-wave elastography, Musculoskeletal ultrasound, Rheumatoid arthritis.


Hospitals on a sample of 30 rheumatoid arthritis
In rheumatoid arthritis (RA), musculoskeletal
patients who complained of wrist and hand pain,
ultrasonography (MSKUS) is routinely used for
swollen or limited movement. 30 chronic cases of same
diagnosis, illness monitoring, and joint damage
age and sex were involved as control group.
assessment. Both grey scale ultrasonography (GSUS)

and power Doppler ultrasound (PDUS) are commonly
Inclusion criteria: Symptomatizing patients with
used to evaluate tissue shape and blood flow,
positive Rh antibodies, however no clinical signs for
respectively (1).
RH arthritis. Patients recently diagnosed as RA willing
Significant limitations exist despite the fact that
treatment and evaluated over two consecutive study
GSUS and PDUS can detect synovitis and joint
visits. Chronic cases suffering from rheumatoid
degeneration and may aid in predicting future erosions
arthritis. Control cases of the same numbers of chronic
in rheumatoid arthritis (RA) (2). Up to 8.5% of patients
cases: asymptomatic chronic cases individuals with
with osteoarthritis (OA) may exhibit synovial thickness
matched age and sex.
and power Doppler flow, both of which add to

diagnostic ambiguity. Furthermore, the Pearson's
Exclusion criteria: Missed patients during follow up.
correlation between PDUS and erosions is only 0.6, and
Patient with known other causes of arthritis (negative
the sensitivity for erosions is as low as 45% (3).
Rh factor). Patients (suffering from disease/taking
Currently employed in liver, thyroid, and breast
drugs) can change bone density as hyperparathyroidism,
imaging, shear-wave elastographic ultrasonography
thyroxin or steroid therapy. Other autoimmune
(SW-EUS) shows promise in evaluating the synovium
inflammatory diseases and patients with chronic renal
(4). Patients with RA may have softer synovium
failure or chronic liver diseases. Bone disease, fracture,
compared to age- and sex-matched individuals without
or previous surgery on the hand or wrist.
inflammatory arthritis, according to recent research. In

addition, a number of disease activity markers were
found to have a negative Pearson association with
All patients were subjected to: Taking complete
SWV, suggesting that a softer synovium may be
history and complete clinical examination.
indicative of increased disease activity (5).

This study objective was evaluation of role of
Laboratory investigations: ESR, CBC and rheumatoid
musculoskeletal ultrasound in early diagnosis of
rheumatoid arthritis and monitoring treatment, as well

as evaluating the added value of using Elastography.
Imaging including: Plain radiography: AP & lateral
views to exclude any osseous lesions. Synovial
Our case-control study that was conducted at
thickening, effusion, erosion, and tenosynovitis were
Radiodiagnosis Department, Zagazig University
evaluated using grey scale ultrasonography and power
Doppler ultrasound of the wrist and hand joints in all
Received: 09/01/2023
Accepted: 12/03/2022

Full Paper (vol.921 paper# 39)

c:\work\Jor\vol921_40 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5728- 5736

Electrophysiological-Cortical Encoding of Central Auditory
Processing in Adults with Temporal Lobe Epilepsy
Ola Abdallah Ibraheem1, Takwa HM Elkhatib2, Nadia Mohamed Elnabtity1, Rawan HM Salem1*
Departments of 1Audio-Vestibular Medicine, ENT and 2Neurology, Faculty of Medicine - Zagazig University, Egypt
*Corresponding Author: Rawan H. M. Salem, Mobile: (+20) 01557850005, E-Mail:

Temporal lobe epilepsy (TLE) is the most common focal type of epilepsy that originates near the auditory
cortex and hence may impair auditory cortical processing. The functional integrity of the auditory cortex could be assessed
electrophysiologically using slow cortical response (SCR).
Objective: The current study was designed to predict the validity of SCR in evaluating central auditory processing (CAP)
in TLE.
Subjects and Methods: This observational, case-control study involved 38 right-handed participants; the TLE group
included 19 right-handed patients (International League Against Epilepsy criteria was used for diagnosis), and the control
group included 19 right-handed adults matching the TLE group in both gender and age.
Results: TLE group exhibited a significant delay of the left ear's N1 and P2 latency and a significant reduction of the
N1P2 complex amplitude (in both ears). The effect of different variables revealed negative correlations between SCR
latencies and each of the age, age of onset of TLE, and time of last seizure; positive correlations between SCR amplitudes
and each of the age, age of onset of TLE, and time of last seizure; a significant effect of gender on P2 and N2 latencies;
and a significant effect of seizure frequency on P1 latency. Validity measures and the ROC curve revealed a better
accuracy for the left ear's N1 (82%) and then P2 (73%) latencies and for the N1P2 amplitude (right=81% and left=76%).
The current results indicate altered neural activities within the temporal lobes of patients with TLE, which
can be documented electrophysiologically by SCR. N1 and P2 waves' measures showed the highest accuracy, hence
providing useful information about possible functional deterioration and impaired CAP in this population.
Keywords: Central auditory processing, Temporal lobe epilepsy, Slow cortical response.

electrophysiological testing. Cortical auditory evoked
Epilepsy is a widespread neurological disorder that
potentials, such as the slow cortical response (SCR; P1-
affects people of different ages, races, and socioeconomic
N1-P2-N2), are useful tools for assessing CAP(5). Little is
statuses. The International League Against Epilepsy
known about CAPD in TLE. Therefore, the current
(ILAE) has defined epilepsy as having one or more of
research was conducted to predict the validity of SCR in
following symptoms: 1) at least 2 unprovoked (or reflex)
the diagnosis of CAPD in patients with TLE.
seizures, at least twenty-four hours apart; 2) a single

unprovoked (or reflex) seizure with a 10-year recurrence
risk of at least 60% after two unprovoked seizures; and 3)
verification of a specific epilepsy syndrome (1).
This observational, case-control study was
Focal seizures are the commonest seizure type.
performed at the Audio-Vestibular Medicine Unit, ENT
Temporal lobe epilepsy (TLE) is the most common type of
Department, Zagazig University Hospitals. The sample
localization-related epilepsies (2). TLE patients who suffer
size for this study was estimated to be 38 participants,
from epileptic seizures may have their auditory cortex
using Open-Epi at 80% test power and 95% confidence
processing and neuronal functional coordination disrupted.
limits (CL). This sample was divided into control and
Central auditory processing (CAP) and neuro-cognitive
patient groups:
abilities, all of which are crucial for speech intelligibility

and effective communication, may thereafter become
The patient group:
impaired (3).
Included 19 right-handed patients with TLE. Their ages
When talking about how different sounds are
ranged between 18-45 years, of both genders. These
perceived and processed, it is the CAP. Central auditory
participants were referred from the Epilepsy Unit,
processing disorder (CAPD) occurs when sounds are not
Neurology Department, Faculty of Medicine, Zagazig
adequately processed due to a deficit in CAP, leading to
University. The diagnosis and lateralization of the seizure
erroneous data perception. CAPD could be presented by
focus in the TLE patients were established following the
difficulty in one or more of the sound localization and
ILAE criteria by a comprehensive evaluation, including
lateralization, auditory discrimination, auditory pattern
detailed seizure history and seizure semiology. All patients
identification, auditory performance in challenging
exhibited normal hearing sensitivity (pure tone average
situations, and temporal processing(4).
(PTA) 25 dB HL).
Early assessment of CAPD would help for early

intervention and hence improve speech perception and
They were excluded from the study if they had:
communication. The integrity of the central auditory
Medical and/or mental disability or symptomatic
pathway can be evaluated with the help of
epilepsy (Symptomatic epilepsy is defined as
Received: 23/01/2023
Accepted: 26/03/2023

Full Paper (vol.921 paper# 40)

c:\work\Jor\vol921_41 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5737- 5742

Beyond the Lung: Exploring Musculoskeletal and Rheumatological
Complications in Post-COVID-19 Survivors
Ahmed E. Hafez*1, Salma Ahmed Taha1, Ahmed H. Kasem2,
Amel Mahmoud Kamal Eldin3, Tasneem Mohammed Ali4, Faten Ismail1
Departments of 1Rheumatology and Rehabilitation, 2Chest Diseases and
3Clinical Pathology, Faculty of Medicine, Minia University, Egypt
Department of 4Public Health and Community Medicine, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Ahmed E. Hafez, Mobile: (+20) 01101013625, E-mail:,
ORCID: 0000-0002-6065-4693

Post-COVID-19 infection patients often present to rheumatology clinics with a variety of musculoskeletal
complaints; some objective findings in particular merit special attention.
Objective: The goal of this study was to assess post-COPIVID-19 survivors who have recently developed
musculoskeletal problems and to ascertain whether there is a relationship between the current presentation and the course
of the prior infection.
Methods: In this cross-sectional research, 102 post-COVID-19 patients with musculoskeletal complaints were recruited
from the Outpatient Rheumatology Clinic. A detailed medical history of the current complaint as well as prior to
COVID-19 infection was analysed. Joints, mucocutanous, proximal and distal muscles, and peripheral nerves were
evaluated and neurophysiological studies were also conducted.
Results: 64 males and 38 females with mean age of 41.6 ± 12.7 years and duration of COVID-19 infection was 13.6 ±
7.3 days. Duration of the current musculoskeletal complaints was 3.6 ± 1.8 weeks. Arthralgia and myalgias were reported
by 58.8 % and 36.3% respectively, while arthritis was observed in 17.6%. Paresthesia, and motor waekness were
reported by 19.6% and 22.5% respectively. 39.2% of the involved group exhibited objective findings and 31.4 % of
patients had neurophysiological abnormalities.
Conclusions: Arthralgia, myalgias, arthritis and mononeuritis are the most prevelant manifestations in post-COVID-
19 survivors with new onset musculoskeletal complaints. Increasing age, smoking history, increased duration and
severity of prior infection are predisposing factors for neuritis.
Keywords: Post COVID-19, Musculoskeletal pain, Nerve conduction studies, Neuritis.

In December 2019, Wuhan, Hubei Province, China,
wide variety of skin abnormalities, including urticarial
reported a pneumonia outbreak of unknown cause.
rash, confluent erythematous/maculopapular/morbilliform
Epidemiological data linked most of these illnesses to the
rash, papulovesicular exanthem, an acral pattern
Huanan seafood wholesale market. Human airway
resembling chilblains, livedo reticularis/racemosa pattern,
epithelial cells and the Vero E6 and Huh7 cell lines were
and purpuric "vasculitic" pattern [8].
exposed to broncho-alveolar lavage material from
Little data suggest that COVID-19 involves the
individuals with pneumonia of unknown origin. This
central nervous system (CNS). COVID-19 may exhibit
exposure led to the discovery of SARS-CoV-2, formally
neurological symptoms such as headaches, ataxia,
known as Covid-19 [1]. On March 2020, the fictitious
confusion, and a loss of taste and smell. A few patients
SARS-CoV-2 outbreak went global [2].
displayed cerebrovascular illness or seizure activity.
Patients with COVID-19 infections may develop
Whereas additional routes, such as via the cribriform
various clinical symptoms, ranging from mild to severe.
plate of the ethmoid bone close to the olfactory bulb,
The most typical symptoms include fever, coughing, and
should be considered in patients who manifest loss of
shortness of breath. In both lung fields, computerized
taste and smell, the hematogenous route appears to be the
tomography (CT) revealed several features, including
most likely conduit for SARS-CoV2 to reach the brain [9].
ground-glass opacities, interstitial infiltration, crazy-
It's possible that COVID-19 does not directly harm
paving pattern, and numerous patchy consolidations, in
nerves, roots, or anterior horn cells in the same way that
addition to vascular enlargement, thick interlobar septa,
West Nile or polioviruses do. In numerous cases of
and air bronchograms. Patients with severe pneumonia
COVID-19-related Guillain-Barre syndrome (GBS) that
had a respiratory rate of at least 30 breaths per minute, an
have been documented, even the cerebrospinal fluid
oxygen saturation of 93%, or a PaO2/FiO2 of 300 mmHg
(CSF) and the polymerase chain reaction (PCR) for
coronavirus have come back negative [10]. Due to
Although most coronavirus infections occur in the
molecular mimicry between the peripheral nerve's
lungs, the heart, gastrointestinal tract, kidney, liver, and
ganglioside components and the infectious pathogen's
eyes are other organs that require careful management [4-
surface antigens, it is likely to be a Para-infectious or
7]. In recent systematic reviews, cutaneous manifestations
post-infectious complication resulting from an abnormal
have been discussed. COVID-19 patients have reported a
immune response, which can be considered a second
Received: 11/10/2022
Accepted: 10/12/2022

Full Paper (vol.921 paper# 41)

c:\work\Jor\vol921_42 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5743- 5750

Accuracy of Different Scoring Systems for Predicting Successful Induction of
Labor: A Cross-Sectional Study
Mohamed M. Abdullah1, Alaa Eldin A. Youssef1, Mohamed Khalaf1,
Ahmed M.A. Sobh1, Mansour A. Khalifa1, Reham Taha Tawfik1
1Department of Obstetrics and Gynecology Faculty of Medicine, Assiut University
Corresponding Author: Reham Taha Tawfik, Email: , Mobile No.,: 01098018331

: Nowadays, inducing of labor (IOL) is a routine treatment in obstetric practice. For different maternal and
fetal reasons, IOL is currently performed for 20 percent of pregnancies. Limited to non-pregnant women, prediction score
methods for IOL success have indicated that a good preoperative cervical exam is the most important factor.
To evaluate the accuracy of Different Scoring Systems for Predicting Successful Induction of Labor.
Patients and methods:
the study was conducted on department obstructs and gynecology faculty of medicine Assiut
University on 410 patients and they divided into CS (n= 104) and Vaginal delivery (n= 306) .
there was a statistical significant difference between groups regarding Kaplan Meier analysis of time to delivery
based Bishop score and Manipal U/S scoring system, Protocol of induction and Pregestational DM. There was no statistical
significant difference between groups regarding to Accuracy of different scoring system in prediction of successful
induction. Conclusion: Predicting whether or not a woman will have a successful vaginal birth following induction of labor
is becoming increasingly important as a result of the possible impact on healthcare spending, as evidenced by the rapid
increase in the development of prediction models. But because most published models lack external validation and there
are limitations in scope, methodology, and/or measurement of effectiveness in clinical settings, it is difficult to endorse any
one model for widespread clinical usage.
Scoring Systems, Induction of Labor.

method to predict CS following IOL that was simple,
effective, and had external validation. Maternal factors
Nowadays, inducing labor (IOL) is a routine
such as height, parity, body BMI, gestational age,
treatment in obstetric practice. For different maternal and
cervical dilation, fetal head presentation, cervical
fetal reasons, IOL is currently performed for 20 percent
effacement, and the primary rationale for IOL were all
of pregnancies (1), and approximately 20 percent of labor
factored into the final score (7).
inductions result in caesarean delivery (2).

The cervix's favorability, which is often
determined by the physical inspection and Bishop Score,
Woman's Health Hospital-Assiut University was the
is the primary determinant of IOL success (3). Despite
site of the current cross-sectional investigation. Between
being used on all patients prior to IOL, this approach is
December 2020 and May 2022, the research was
constrained by subjectivity and consistency, and
conducted. The Assiut University Medical School's IRB
numerous readings have shown a weak relationship
(IRB No. 17101126/2020) gave its stamp of approval to
between Bishop Score and IOL result (4).
the study's methodology. All subjects provided written
Tolcher et al. (2015) developed a nomogram for
informed permission in accordance with the principles of
discovering independent risk variables that can be
the Declaration of Helsinki. The study protocol is
utilized to predict CS among term-delivering nulliparous
registered at ID: NCT04325256.
females having IOL. A score was assigned based only on
Eligible participants
these factors: maternal age, height, BMI, weight change,
It was hoped that all pregnant women who came to the
gestational age, hypertension/diabetes status, and early
labor unit for IOL for any reason throughout the research
cervical dilatation. The anticipated likelihood of CS
period would participate. Women who were willing to
following IOL at term is equal to the sum of the
take part in the research were required to be carrying a
individual scores (5).
single baby, have a gestational age o 37 weeks, and
When counselling women on the possibility of a
show no signs of vaginal bleeding. Both breech and
caesarean section (CS) following intraocular lens (IOL)
vertex presented fetuses are included. Women who had a
surgery with an unfavorable cervix, Levine et al. (2018)
prior caesarean, uterine surgery, or antepartum
suggested using a new online calculator. Probability of
hemorrhage, or who presented with cephalo-pelvic
CS was determined using the Levine scoring method,
disproportion, were not eligible to participate. Fetuses
which took into account maternal height, parity, BMI at
with significant congenital abnormalities, intrauterine
delivery, and the outcomes of the modified Bishop's score
fetal death (IUFD), fetal growth restriction (FGR), and a
(6). In 2019, Jochum et al. reported a second scoring
presentation other than cephalic are not included.
Received: 29/09/2022
Accepted: 02/12/2022

Full Paper (vol.921 paper# 42)

c:\work\Jor\vol921_43 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5751- 5755

Simple Predictors of Gastro Esophageal Varices Bleeding in Cirrhotic Patients
Mohamed Omar3*, Zakaria Abdellatif Salama1, Yasmin Saad1, Mohammed Mostafa Abdelghaffar2
1 Endemic and Hepatology Medicine, Faculty of Medicine, Cairo University, Egypt
2 Hepatology and Gastroenterology, Ahmed Maher Teaching Hospital, Egypt
3 M.B.B.CH, Master of Tropical Medicine, Cairo University, Egypt
Corresponding author: Mohamed Omar Idris, Email:, Mobile: +201013815363

: Liver stiffness (LS), measured by transient elastography (TE), was correlated with portal hypertension as
well as the presence of esophageal varices (EV).
Objective: The aim of the current study was to examine non-invasive markers that serve as "predictors" of esophageal
varices (EV) and variceal hemorrhage in individuals with liver cirrhosis.
Patients and methods: A total of 250 Egyptian HCV associated cirrhotic persons, age more than 18, body mass index
(BMI) under 35 with no history of ascites, GIT bleeding, HCC, abdominal collaterals, Portal, or splenic vein thrombosis
by ultrasonography were recruited in our study. They were divided into Group I (no varices), Group II (small varices)
and Group III (large varices).
Results: All groups were age and BMI matched, in group III platelet count was lower and MELD score was higher
significantly than groups I and II (115.4±41.6 vs 149.6±60.6 and 132.1±44.9) and (12.1±2.9 vs 9.1+2.5 and 10.1+2.2)
respectively. Hemoglobin, platelet count and serum albumin were significantly decreased in group III in comparison
with groups I and II (P-value <0.001), while serum bilirubin and INR levels were significantly more in group III than
in groups I and II (P-value <0.001). AFP was significantly increased in group II than groups I and III (P-value 0.008).
Our findings demonstrate the potential for using predictors to stratify cirrhotic individuals for the
likelihood of developing extensive EV, hence enhancing the cost-effectiveness of screening endoscopy.
Keywords: Fibroscan, liver stiffness, esophageal varices, splenic stiffness, Comparative study, Cairo University.

exercises remains unclear. The findings of these
Liver cirrhosis, characterized by severe fibrosis as
research differ according to the investigation's
well as regenerating nodules, represents the terminal
population and the cause of liver cirrhosis (8).
stage of the hepatic fibrosis process (1). Poor prognostic
Therefore, the aim of our prospective research was
indications include the major consequences of cirrhosis,
to evaluate the non-invasive markers, based on routine
such as portal hypertension (PHT), liver failure,
laboratory variables, that could expect the possibility of
hepatorenal syndrome in addition to esophageal varices
EVs in liver cirrhosis cases in Albania, a hepatitis B
(EV) (2).
virus infection hotspot in Southeastern Europe also a
Over ninety percent of those with cirrhotic
Mediterranean country with an increased utilization of
conditions have EV, which can lead to bleeding.
domestic alcoholic drinks (9).
Individuals with small EV (SEV) have a five percent
The purpose of this trial was to evaluate non-
probability of bleeding EV, whereas those with large
invasive indicators as "predictors" of EV along with
EV (LEV) have a 15% chance (3).
variceal hemorrhage among people with liver cirrhosis.
About 10 to 20% individuals will die from their

bleeding episodes (4). As a result, EV screening is
strongly recommended in guidelines and consensus
A total of 250 individuals with hepatitis C virus -
statements to those with cirrhosis (5).
caused liver cirrhosis were recruited in our study. There
Therefore, it is commonly advised that individuals
were 3 distinct categories of participants: 50 individuals
with cirrhotic conditions undertake active surveillance,
who had hepatic cirrhosis but no EVs made up Group I,
which is a bothersome process for both the persons and
100 individuals with hepatic cirrhosis and minor EVs
their doctors. Around 50% of cirrhotic cases will not
made up Group II, and other 100 individuals with
acquire EV within the first decade following diagnosis
hepatic cirrhosis and significant EVs made up Group
(6). Currently, several non-invasive markers, for instance
III. Participants attended the Hepatology and
model for end-stage liver disease, platelet count to
Gastroenterology outpatient clinic at Ahmed Maher
spleen diameter (PC/SD), aspartate aminotransferase
Teaching Hospital from March 2013 to September
(AST) to alanine aminotransferase (ALT) ratio
2015. Liver cirrhosis was first diagnosed through
(AST/ALT), fibrosis-4-index (FIB-4), aspartate
medical records. All participants fulfilled the following
aminotransferase to platelet ratio index (APRI), fibrosis
index (FI) and King's score, have been established as a

simple, non-invasive and simpler practical different to
Inclusion criteria: Mature patient's 18 years old.
forecast the existence of EVs in cirrhotic persons (7).
Infection with the hepatitis C virus. Mild pelvic ascites,
Nevertheless, the outcomes of these prior investigations
but not severe or massive ascites, may be acceptable for
have been debated also their practical value in clinical
individuals with liver cirrhosis. There was no previous

Full Paper (vol.921 paper# 43)

c:\work\Jor\vol921_44 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5756- 5762

Prevalence and Possible Risk Factors of Metabolic Associated Fatty Liver Disease
(MAFLD) in Non-Obese Individuals in El-Minia Governorate ­Egypt
Magdy F. Shalaby1, Yasser M. Fouad1, Omar A. AbdelAzeem1, Mahmoud M. Moneer2, Mahmoud M. Higazi2,
Elham Ahmed4, Ahmed AbdEl-Fadel Saedi3, Shereen R. Mahmoud4, Eman S. Mahmoud1, Nady M. Semeda*1
Departments of 1Tropical Medicine, 2Radiology, 3Clinical Pathology and
4Internal Medicine, Faculty of Medicine, Minia University, Egypt
*Corresponding author: Nady M. Semeda, Mobile: (+20) 01142741126, E-mail:

Obesity is a significant risk factor for metabolic associated fatty liver disease (MAFLD). It influences
around 20%-30% of population worldwide and enhances the risk for hepatic and extra-hepatic complications.
However, MAFLD occurs in lean subjects.
Objective: This study aimed to detect the prevalence of non-obese NAFLD in our community, to compare the socio-
demographics, clinical and metabolic characteristics of non-obese versus obese MAFLD individuals, and to determine
risk factors for MAFLD in non-obese subjects.
Materials and methods:
100 adults aged 18 years with BMI 25 were studied. In this study, clinical assessment,
anthropometric measurements, laboratory tests, ultrasonography (US) and shear wave elastography were done.
Among 100 subjects, 26 were MAFLD lean, while 74 healthy controls, the lean MAFLD females were 19
(73.1%), while 7 (26.9%) were males. Lean MAFLD was more common in females, housewives with possible risk
factors like insulin resistance and hyperlipidemia.
MAFLD is present in non-obese individuals with possible risk factors like insulin resistance and
Keywords: Dyslipidemia, Insulin resistance, Lean metabolic associated fatty liver disease.


MAFLD (also known as non-alcoholic fatty liver
This study is an observational cross-sectional
disease) is a multisystem condition that has significant
study, which was performed in the period from May to
consequences, because it enhances the risk of hepatic
December, 2021. This study included 100 patients
cirrhosis, hepatic failure as well as hepatocellular
enrolled from the outpatient clinic of tropical medicine
carcinoma (1, 2). It also can be associated with several
department at Minia University Hospital. The
extra-hepatic complications including cardiovascular
diagnosis of MAFLD was established based on the
diseases, chronic kidney diseases, diabetes (3),
ultrasound characteristics, existence of insulin
osteoporosis, and some types of malignancies (4).
resistance (IR), or metabolic syndrome features, and
There is a complex pathogenetic mechanism for
histological confirmation whenever possible. MAFLD
MAFLD, which includes an interaction between
with BMI < 23 kg/m2 were defined as lean MAFLD.
environmental and genetic factors, with evidence of

shared genetic factors between it and other metabolic
Exclusion criteria
disorders (5). Though, usually, associated with obesity,
Patients aged <18 years and evidence of other
a significant percentage of cases are non-obese, hence
hepatic illnesses, e.g. alcoholic, viral hepatitis,
termed "lean MAFLD" (6). The "lean NAFLD" was
autoimmune hepatitis, hereditary liver diseases,
first recognized among Asian populations. However it
decompensated cirrhosis, malignancy, and alternative
also occurs in other ethnic groups, and might indicate
causes of fatty liver (e.g., on amiodarone) and
visceral obesity without the presence of systemic
congestive hepatopathy.
obesity. Lean MAFLD develops in those with a normal
For comparing characteristics of lean MAFLD
BMI with cutoffs of 25 kg/m2 and 23 kg/m2 in
patients, all patients were 18 years and both sexes
Caucasian and Asian cases, respectively (4).
were included.
Recently, an international consensus advocated

new diagnostic criteria for MAFLD, which are based
Patient's assessment and procedure:
on evidence of fatty liver, along with one of the
Each patient was subjected to detailed history
taking and examination (including anthropometric
dysregulated metabolism (2).
measurements) at the first visit. Anthropometric
Our study aimed at detecting the prevalence of
measurements included weight, height, BMI, waist
non-obese MAFLD in our community, comparing the
circumference (WC), hip circumference (HC) and
waist-hip ratio (WHR).
characteristics between non-obese and obese MAFLD
Following an overnight fasting, blood samples were
subjects, and determining the risk factors for MAFLD
obtained for laboratory tests including liver function
in non-obese subjects.
tests, lipid panel as well as fasting serum insulin and
Received: 23/10/2022
Accepted: 15/12/2022

Full Paper (vol.921 paper# 44)

c:\work\Jor\vol921_45 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5763- 5770

Assessment of Effect of Subcutaneous Immunotherapy on the
Quality of Life of Allergic Rhinitis Children
Mohammed Sanad Nagiub, Amira Abd Elbadea Hefny, Mohammed Mahmoud Romih
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Amira Abd Elbadea Hefny, Mobile: (+20) 01097486744, Email:

When it comes to treating children with respiratory allergies and allergic rhinitis, allergen-specific
immunotherapy is a crucial choice.
Objective: This study aimed to assess the impact of immunotherapy (AIT) on quality of life in children with allergic
Subjects and methods: In a randomized-controlled trial we conducted this study at Pediatric Outpatient Clinic at
Zagazig University Hospitals on 40 pediatrics with allergic rhinitis, randomly allocated into 2 equal groups: the
Immunotherapy group received (AIT + pharmacotherapy) and pharmacotherapy group received pharmacotherapy
Results: The quality of life score started to show significant improvement after five weeks of start of immunotherapy
for immunotherapy group and this improvement continued till the end of six months therapy, Total Nasal Symptoms
(TNS) score started to show significant improvement after six weeks of start of immunotherapy for immunotherapy
group and this improvement continued till the end of six months therapy. Significant improvement occurred in quality
of life questionnaire score and in Total Nasal symptoms score among the immunotherapy group with a percentage of
77.97% and 81.67% respectively. There was statistically significant relation between percentage of improvement in
quality of life questionnaire score and seasonality (Perennial Allergic Rhinitis is associated with better improvement).
Conclusion: Subcutaneous Immunotherapy was safe and effective in the treatment of the Allergic Rhinitis in children.
It resulted in significant improvement in QoL and symptoms through the study period, and this improvement was
higher than in the pharmacotherapy only group. Subcutaneous immunotherapy was associated with minor adverse
Keywords: Subcutaneous immunotherapy, Allergic rhinitis, Quality of Life.


regulatory T-cell (Treg) lymphocytes (6).
About 20% of the population suffers from
We aimed to assess the impact of
allergic rhinitis (AR) with or without conjunctivitis,
immunotherapy (AIT) on quality of life in children
making it one of the most common allergic disorders
with allergic rhinitis.
(1). Asthma-related AR has negative effects on patients'

emotional and physical health, as well as their
academic and social functioning as well as quality of
We conducted randomized-controlled study at
life (QoL) (2).
Pediatric Outpatient Clinic at Zagazig University
Rising rates of childhood AR call for more
Hospitals on 40 pediatrics with allergic rhinitis
research on the effect of disease-modifying treatments
according to Allergic Rhinitis and its Impact on
have on quality of life (2). Both educational measures
Asthma (ARIA) Guidelines update (7) based on
and pharmaceutical therapy are advocated for the
recurrent attacks of typical nasal symptoms (blockage,
treatment of respiratory allergies. These typically
nasal itching, rhinorrhea and sneezing). That were
result in good symptom control, but they do nothing to
reversible spontaneously or with medical treatment.
address the underlying immunological issue or alter

the disease's inevitable progression (3).
Patients enrolled in the study were classified into 2
Allergen avoidance, medication, allergen
groups: Immunotherapy group consisted of 20
immunotherapy (AIT), and patient education are
allergic rhinitis children. They received subcutaneous
recommended as part of the ideal treatment plan for
allergen immunotherapy (SCIT) in addition to
allergic rhinitis in a World Health Organization
traditional pharmacotherapy.
position paper (4). When it comes to treating respiratory

allergies, allergen-specific immunotherapy is a viable
Pharmacotherapy Group: consists of 20 patients,
alternative, and it also has a disease-modifying effect
age and sex matched group of Allergic Rhinitis
that is not shared by pharmaceutical treatments (5).
children, they received pharmacotherapy only.
Purified extracts of specific allergens are given

to patients on a regular basis as part of AIT. This
Inclusion criteria: Age: 5 ­ 17 years. Sex: both sexes
were included.
immunological profile by inducing the release of

immunosuppressive cytokines and directing the
Allergic Rhinitis children diagnosed clinically with
immune response toward the generation of Th1 and
all of the following criteria: (1) Nasal Symptoms
Received: 31/01/2023
Accepted: 26/03/2023

Full Paper (vol.921 paper# 45)

c:\work\Jor\vol921_46 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5771- 5777

Comparison between Presepsin and Procalcitonin in
Early Diagnosis and Prognosis of Sepsis
Noura Ahmed Eriba*1, Soha E Khorshid1, Hoda Abdeen Ebrahim2, Kamal Amer1
Departments of 1Tropical Medicine and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Noura Ahmed Eriba, Mobile: (+20) 01116729592, E-mail:

The introduction of pathogens or conditionally pathogenic microorganisms into the bloodstream triggers
a systemic inflammatory response syndrome known as sepsis.
Objective: Comparison between Presepsin as well as procalcitonin in early diagnosis and prognosis of sepsis.
Subjects and Methods: In a prospective cohort study that was done on 90 cases with early sepsis, who admitted to ICU
at Tropical Medicine Department, Zagazig University Hospitals. On admission, levels of procalcitonin and presepsin
were assessed as well as after twenty-four and seventy-two hours.
Results: Regard cause of admission majority had confusion then drowsiness, regard sepsis causes majority had Urinary
tract infection (UTI) then pneumonia. BCs, Cr, INR and CRP were significantly higher among +VE culture at all reading
group but albumin at all reading, PLT in 2nd and 3rd reading and pH at all reading were significantly lower among -VE
culture. Positive significant correlation was found between SIRS score and CRP at T0 and T2 and high significance at
T1. CRP was highly significantly correlated with Modified SOFA score from T0 to T2. The correlation between SIRS
score and procalcitonin was significant at T1 and T2. Procalcitonin was significantly correlated with Modified SOFA
score at T1 and T2. Presepsin was significantly correlated with SIRS score from T0 to T2. The correlation between
presepsin and Modified SOFA score was significant and highly significant at T1, T0 and T2 respectively.
Conclusion: Similar to procalcitonin, presepsin shows promise as a marker to detect sepsis. Compared to procalcitonin,
presepsin is a more reliable biomarker for early sepsis diagnosis.
Presepsin, Sepsis, Procalcitonin.


An ineffective immunological response to
infection causes sepsis, a potentially fatal organ failure.
acknowledged as a good biochemical diagnostic tool for
With an annual growth rate of 1.5%, sepsis is becoming
separating sepsis from other non-infectious causes of
an increasingly urgent problem in healthcare systems
systemic inflammation response syndrome (SIRS).
around the world. Sepsis is expensive to healthcare
Procalcitonin is widely used as a biomarker for sepsis;
systems and has a human toll as well. More than $24
however, its specificity is low because it is also elevated
billion is spent annually on sepsis-related care, which
in many conditions that are not infections (4).
may involve extended hospital stays, intensive care unit
Presepsin, or soluble CD14 subtype (sCD14-ST),
admissions, hospital readmissions, and intensive testing
is a biomarker that has showed promise as a unique,
and patient monitoring (1).
developing, early signal for the diagnosis of a wide
Clinical indicators and presentation of sepsis can
range of disorders(5). Although presepsin was able to
be deceptive and highly diverse due to the presence of
distinguish sepsis from non-sepsis with moderate
accuracy, its results should be regarded cautiously
characteristics of the patient population, making timely
because of its lack of high diagnostic accuracy (6,7).
diagnosis challenging, consequently, there is a pressing
Monitoring the prognosis and survival rate of patients
requirement for a trustworthy diagnostic approach,
with severe sepsis or septic shock by changes in
enabling early differentiation between bacterial and
presepsin levels may be useful. Patients who had
non-bacterial illnesses(2).
positive blood cultures and responded well to antibiotic
High analytical costs stem from the complexity
treatment had reduced presepsin levels on day 7.
and expertise required for traditional methods of
However, it was shown to be higher in people
infection detection, like methodologies involving
who had positive blood cultures and were given the
culture, biochemistry, antibodies, and molecular
wrong antibiotics. Infections caused by MDR bacteria
biology. As a result, there is always a call for cost-
accounted for the vast majority of cases of unnecessary
effective, accessible, user-friendly, rapid, sensitive, and
antibiotic treatment(8). Acute kidney injury and renal
time-efficient point-of-care analysis (3).
impairment, prolonged mechanical ventilation, and
Along with the diagnostic criteria, the
delayed weaning from vasopressors or inotropic agents
incorporation of biomarkers like C-reactive protein
have all been linked to elevated presepsin levels on day
(CRP) and procalcitonin (PCT) may aid in the early
1. Additionally, prolonged duration of the primary
diagnosis of patients with sepsis, severe sepsis, and
infection, incomplete resolution of the infection, and
septic shock who could benefit from prompt and
death have all been linked to prolonged ICU stays(9).
appropriate medication (2).

Received: 24/01/2023
Accepted: 27/03/2023

Full Paper (vol.921 paper# 46)

c:\work\Jor\vol921_47 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5778- 5783

Assessment of Thyroid Disorders and Chronic Kidney Disease: Review Article
Hamed Abdel Aziz Deraz, Nagwa Mohamed Shawky,
Ahmed Salah Amin Alallam, Mohamed Saber Mohamed Ateya*
Department of Internal Medicine, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed Saber Mohamed Ateya, Mobile: (+20) 01118335056, E-Mail:
The thyroid gland plays a crucial role in human health because it controls several essential physiological
processes. Thyroid hormones (T3 and T4) are responsible for a wide range of physiological processes, from metabolism
to development to protein synthesis to the regulation of numerous other hormones.
Objective: Review of literature about thyroid disorders as well as chronic kidney disease
We searched PubMed, Google Scholar, and Science Direct for relevant articles on Thyroid Disorders as well
as Chronic Kidney Disease. However, only the most recent or thorough study was taken into account between April
2014 and March 2021. The authors also evaluated the value of resources culled from other works in the same genre.
Therefore, documents written in languages other than English have been ignored due to a lack of translation funds.
Unpublished works, oral presentations, conference abstracts, and dissertations were generally agreed upon not to qualify
as scientific research. Conclusion: The impact of thyroid hormone levels on CKD progression is one of the most critical
but least well-studied situations. It has been observed that certain amounts of thyroid hormone coexist with disorders in
renal function. Fasting, chronic metabolic acidosis, and chronic protein deficiency all contribute to low T3 levels, which
may be a marker of chronic kidney disease.
Keywords: Thyroid disorders, chronic kidney disease.

Thyroid disease epidemiology
The thyroid gland plays a crucial role in human
Thyroid disease affects roughly 7.35% of the population
health because it controls several essential physiological
in the United States, or about 1 in 13, or 20 million
processes. Thyroid hormones (T3 and T4) regulate a
individuals. The three main types of thyroid disease are
wide variety of endocrine systems and play critical roles
underactive, overactive, and subclinical. Overt
in metabolic processes, cell growth and differentiation,
hypothyroidism affects 0.3% of the US population and
protein synthesis, and more (Figure 1). Thyroid
subclinical hypothyroidism affects 4.3%, according to
dysfunction is associated with an array of illnesses
the National Health and Nutrition Examination Survey
because of the hormones it produces (T3 and T4). The
III (NHANES III), the biggest survey of its kind in the
impact of thyroid hormone levels on CKD progression
US (0.5% have overt hyperthyroidism and 0.75% have
is one of the most critical but least well-studied
subclinical hyperthyroidism). Both hypothyroidism and
situations. Certain amounts of thyroid hormone have
hyperthyroidism are major causes of morbidity in the
been linked to abnormalities in renal function (1).
United States (2).
Thyroid Physiology:

Figure (1): Both T3 and T4 are essential for normal development and adult metabolic homeostasis due to their roles
in cell differentiation (3).
Received: 24/01/2023
Accepted: 27/03/2023

Full Paper (vol.921 paper# 47)

Introduction The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5784- 5791

Combination of Minoxidil 5% with Carboxytherapy versus
Minoxidil 5% Alone in Treatment of Female Pattern Hair Loss
Fatma Alzahraa Rabea Mohammed Khedr*, Mohamed Khaled Galal Selim, Hanan Fathy Mohamed
Department of Dermatology, Andrology and STDS, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Fatma Alzahraa Khedr, Mobile: (+20) 01117390050, E-mail:

Androgenic alopecia (AGA) is a genetically programmed condition brought on by a woman's
disproportionate sensitivity to androgens. The frontal hairline is often spared whereas the crown and top of the head
experience diffuse hair loss, which is frequently identified by a broader centre part. For women with AGA, topical
minoxidil is a popular and successful therapy for hair loss. By reducing the telogen (resting) phase of hair follicles and
activating the anagen (growth) phase, minoxidil encourages hair growth. Carboxytherapy is a noninvasive method that
has been shown to affect hair development in a number of ways.
Objective: To study the efficacy of combination of both minoxidil 5 % with carboxytherapy versus minoxidil 5 %
alone in treatment of female pattern hair loss.
Patients and methods: This study included 40 female patients with AGA, who were randomized into two groups
(group A and B); Group A included patients who used minoxidil 5% once daily with carboxytherapy session every 3
weeks for 6 months and Group B who used topical minoxidil 5% only once daily for 6 months.
Results: There was a statistically significant increase in hair diameter during treatment in group A compared to group
B (at 3 months and 6 months) (p=0,012, 0.001 respectively). There was a statistically significant increase in hair
density during treatment in group A compared to group B (at 3 months and 6 months) (p = 0.004, < 0.001
respectively). There was a statistically significant increase in hair count during treatment in group A compared to
group B (at 3 months and 6 months) (P=0.048, 0.002 respectively). Higher satisfaction was recorded in group A
compared to group B with a statistically significant difference (P=0.049).
Conclusion: In the context of female pattern hair loss, carboxytherapy seems to be a promising therapeutic modality
and it could be used as a helpful adjuvant therapy of AGA in association with minoxidil. In addition, it is
recommended for maintenance of the results with minimal side effects.
Female androgenetic alopecia, Carboxytherapy, Minoxidil 5%, Hair loss.


Dihydrotestosterone (DHT), an androgen,
The term "carboxytherapy" describes the
causes androgenetic alopecia genetically. It is also
therapeutic injection of sterile, medical-grade CO2 gas
known as pattern baldness, and it primarily affects
intradermally and/or subcutaneously. It causes a local
males, however it can also affect women(1).
pH drop and relative hypercapnia, both of which cause
By that point, new discoveries on the genetics,
a significant vasodilator reaction that eventually boosts
molecular underpinnings, and pathophysiology of
blood flow to the injection site (6). It is regarded as a
androgenetic alopecia (AGA) have led to viable
secure, minimally invasive, and therapeutically
treatment options. Notably, there are several other
effective technique for skin rejuvenation, restoration,
factors that can contribute to AGA outside a person's
and reconditioning(7).
genetic make-up, such as food, stress, immunological
In AGA, hair loss has a complicated etiology
reaction, allergies, inflammation, poor nutrition,
that is brought on by a number of reasons, including a
chemotherapy, hormone imbalance, or direct physical
reduction in the blood supply to the scalp tissue that is
tension on the hair follicles (2).
impacted. It appeared fascinating to assess
For many years, minoxidil has been used to
carboxytherapy's effectiveness and safety in the
treat AGA. By promoting hair development and
treatment of AGA since it enhances circulation at the
halting hair loss, the drug has an impact on follicular
injection site (8).
cells(3). Clinical studies in AGA patients treated with
The Bohr effect, caused by carboxylic gas,
2% or 5% minoxidil shown a striking increase in hair
causes a change in the oxygen dissociation curve,
growth and decrease in hair loss, with the 5%
which eventually improves oxygenation. Additionally,
formulation producing superior results(4).
it interacts with the tissue perfusion regulators to
Application of 1 mL of 2% minoxidil twice
increase lymphatic drainage and perfusion rates in
day and of a half-capful of 5% minoxidil foam once
capillary beds, release regional growth factors, and
daily are the recommended treatments for female
promote angiogenesis(9).
pattern hair loss (FPHL). In FPHL, it has been
The primary pathophysiology of AGA, which
demonstrated that once daily topical administration of
is an androgen-dependent condition, is not directly
5% minoxidil foam is just as effective as twice daily
impacted by carboxytherapy. With improved
treatment of 2% minoxidil with noticeably less side
vascularization of alopecic HFs and consequent
activation of hair regrowth, carboxytherapy can be
Received: 24/01/2023
Accepted: 27/03/2023

Full Paper (vol.921 paper# 48)

c:\work\Jor\vol921_49 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5792- 5797

Updates in Cancer Immunotherapy: Review Article
Aya Mohamed Atya*, Ahmed Elsayed Mohamed, Ahmed Ezzeldin Abugharib
Clinical Oncology Department, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Aya Mohamed Atya, Email:, Mobile: 01050366830

An adaptable group of cells called the immune system in human's works together to defend the body from
external threats like malignant cells. The main types of immunity are natural immunity and immunity that is adaptive.
The naturally occurring immune system, which is made up of phagocytes white blood cells, dendritic cells (DC), natural
killer cells (NK cells), and circulatory plasma proteins, serves as the body's initial line of defence against pathogens.
Utilising the cytotoxicity and antigen-specificity of the human immune system, cancer immunotherapy aims to build an
effective anti-tumor immune response that can eradicate all cancer cells without causing damage to healthy tissue.
Objective: This review article aimed to throw light on updates in cancer immunotherapy.
We searched PubMed, Google Scholar, and Science Direct for relevant articles on Immunity, Cancer
immunotherapy and updates. However, only the most recent or thorough study was taken into account between January
2004 and January 2023. The authors also evaluated the value of resources culled from other works in the same genre.
Therefore, documents written in languages other than English have been ignored due to a lack of translation funds.
Unpublished works, oral presentations, conference abstracts, and dissertations were generally agreed upon not to qualify
as scientific research.
Immunotherapy, a precise form of cancer treatment, is becoming more popular. Cancer immunotherapy is
probably safer than conventional treatments like surgery, chemotherapy, and radiation because it depends on particular
genetic makeup of each patient. The majority of cancer patients have either primary or acquired resistance to
immunotherapy medications currently on the market, underlining the demand for novel strategies.
Update, Immunity, Cancer immunotherapy.


Immune system in action
Immunotherapy aids body to fight cancer, infections,
Immune system of human body is a complex and
and other disorders by using drugs to either activate or
active network of cells that cooperate to protect body
suppress the immune system. Only specific immune
from invasion by foreign substances, such as cancerous
system cells are emphasized in some immunotherapies.
cells (4). Paul Ehrlich, a physicist who developed side-
Some have a more widespread impact on the immune
chain theory of antibody formation, is credited with the
system. Researchers and medical professionals are
discovery that B cells and T lymphocytes provide the
striving to control immune system to discover and
highly adaptable adaptive immune system (5).
remove tumour cells. These procedures can result in

cancer therapy that is efficient (1).
Cancer immunotherapy-precision medicine
The immune system of the human body and
After cardiovascular disorders like ischemic heart
cancerous cells normally live in a state of constant
disease and stroke, cancer is the second most common
balance, and complicated interactions between
reason for mortality worldwide. For many cancer
emerging cancers and the immune system may have an
patients, the invention and application of localized and
effect on how a disease develops, according to
systemic therapeutic techniques, such as chemotherapy
considerable research. Tumours must learn how to
and radiation therapy, have greatly increased quality of
avoid detection by immune system to proliferate and
life and survival rates (6). Although systemic
metastasize (2).
chemotherapy and radiation therapy can successfully
According to the hypothesis of immunological
cure early disease, they may not entirely destroy all
monitoring, immune system has capacity to actively
malignant cells and may also have unwanted adverse
eliminate abnormal cells from body and halt growth of
effects due to off-target harm to healthy tissue (7).
tumour. Elimination, balance, and escape are the three
Utilizing the cytotoxicity and antigen-specificity of
processes that make up the cancer immune editing
human immune system, immunotherapy aims to mount
process. During the process of elimination phase, the
a powerful anti-tumour immune response that is
body's immune system identifies and eliminates
adequate to destroy all tumour cells without
cancerous cells. The human immune system has no
endangering healthy tissue. Today's immunotherapies
ability to completely eradicate all cancer cells during
are being created and researched on the basis of
the state of balance stage; some still persist but are not
advances in knowledge of interactions between human
expanding or multiplying. As a result, the mental
immune system and malignant cells throughout the past
swinging functions properly are at the state of
century (Figure 1) (8).
equilibrium stage (3).
Received: 26/01/2023
Accepted: 29/03/2023

Full Paper (vol.921 paper# 49)

c:\work\Jor\vol921_50 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5798- 5801

Modified Expansion Sphincter Pharyngoplasty (MESP) vs Modified Barbed Reposition
Pharyngoplasty (MBRP): A Comparative Study for Single Level Palatal Surgeries
Mohamed Fouad Attia*, Reda Mahmoud Daoud
Otolaryngology Department, Faculty of Medicine, Al Azhar University
Corresponding author: Mohamed F Attia, Mobile: (+20)1061032996, E-Mail:
Uvulopalatopharyngoplasty is the most common surgical procedure used for management of obstructive
sleep apnea syndrome (OSAS). Recently, more conservative surgical techniques were used with promising results,and
less morbidity. Objective: This study compares the results and outcomes of two surgical modalities for the retropalatal
collapse in OSAS studied cases. We Compared modified expansion sphincter pharyngoplasty (MESP) with modified
barbed reposition pharyngoplasty (MBRP). Methods: Forty studied cases with OSAS had been contained in this
research, separated into 2 groups, with 20 studied cases for each group: MESP and MBRP. All enrolled patients had an
apnea hypopnea index >fifteen. Only patients with oropharyngeal obstruction were comprised in our study. All studied
cases underwent full clinical otolaryngology examination. Drug induce sleep endoscopy (DISE) and Epworth Sleepiness
Scale (ESS) were evaluated preoperatively and 1 year postoperatively. Results: According to Sher's criteria, we found a
significant decrease in AHI and oropharyngeal blockage in both groups (p = 0.01), with a success rate of eighty-eight
percent for MESP and eighty percent for MBRP. Conclusion: BRP and ESP appear to be effective for oropharyngeal
obstruction as a single-level surgery. MESP patients showed a greater decrease at the hypopharyngeal level.
Obstructive sleep apnea syndrome, Drug-induced sleep endoscopy, Modified expansion sphincter
pharyngoplasty, Modified barbed reposition pharyngoplasty.

outcomes, several individuals experienced dysphagia
Chronic OSAS is characterized by recurrent bouts of
afterward17. Another often employed procedure has
upper airway collapse throughout sleeping (1). Disease
been called sphincter pharyngoplasty, which entails
partial uvulectomy, closure of anterior and posterior
three and seven percent, and there have been a variety
of palatopharyngeus
of factors that increase a person's risk of developing this
muscle, and its attachment to pterygoid hamulus18.
ailment, including years old, male sex, obesity, family
New palatal surgery was proposed by
history, menopause, deformities of the face and
Mantovani et al., where oropharyngeal inlet
cranium, and vices including cigarette and alcohol use(2-
and retropalatal space are increased by barbed
4). The collapse of the upper airway has been the main
pathophysiological event that occurs in OSAS.
and anteriorly displaces the posterior pillar19.
However, it occurs at the same time at different levels,
Our research's goal is to share our surgical expertise
like nasal, retropalatal and retro-lingual and laryngeal
with a group of OSAS-studied cases. We compared
collapse(4). Nevertheless, the soft palate collapses is the
MESP and barbed MBRP in a single stage of treatment
most frequent, then pharyngeal walls, the base of the
in studied cases with retropalatal collapse.
tongue, and palatine tonsil5.

Variety of instruments are used to evaluate
upper airway blockage. Currently, drug-induced sleep
Forty studied cases with obstructive sleep apnea
endoscopy has been thought to be the most efficient
syndrome had been involved in this research. This study
method for precisely localizing collapse sites6.
was performed from May 2014 to December 2017. It
Improvements in sleep hygiene, weight
was separated into 2 groups, with 20 studied cases for
loss, use of dental splints, and continuous positive
every group: MESP and MBRP. Years old between
airway pressure therapy are typically the mainstays of
twenty-five and sixty years, BMI >fifteen and thirty-
OSAS treatment(7-11). CPAP is considered the gold
five kg/m2, the tonsillar volume of any degree, apnea-
standard for the management of OSAS. Nevertheless,
hypopnea index >fifteen, and DISE showing solely
about forty percent of studied cases are unable to use
retropalatal blockage had been inclusion criteria.
CPAP machines and need alternative therapies, such as
However, exclusion criteria were patients with previous
surgery12,13. To treat OSA, uvulopalatopharyngoplasty
airway surgery such as UPPP tonsillectomy, severe
has been the most often used surgical surgery. Difficult
medical conditions, DISE indicating nasal obstruction,
part of this treatment is figuring out how much soft
hypopharyngeal, and laryngeal obstruction, and cases
tissue can be removed while still being effective14.
with craniofacial anomalies that had affected airways.
Imaging investigations have shown that lateral
Each studied case's complete medical history
pharyngeal muscle wall collapse plays a significant role
had been gathered, together with their preoperative
in the aetiology of OSA15,16. Lateral pharyngoplasty
and postoperative
method published by Cahali had been intended to treat
Preoperative otolaryngology clinical examination had
individuals with OSA who had lateral pharyngeal wall
been completed on all recruited studied cases, and drug-
collapse. Although surgery produced encouraging
induced sleep endoscopy had been carried out
Received: 25/1/2023
Accepted: 28/3/2023

Full Paper (vol.921 paper# 50)

c:\work\Jor\vol921_51 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5802- 5806

Practical Approach for Treatment lines of Alopecia Areata: Review Article
Samia Ali Ibrahim, Mohamed Ibrahim El-Ghareeb, Aya Mohamed Abd Elhamed
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aya Mohamed Abd Elhamed, Mobile: (+20) 01007209534, E-Mail:

Those with the autoimmune disease alopecia areata (AA) may experience temporary hair loss on the scalp
or in other regions where hair typically grows. Hair loss can occur in discrete areas on the scalp or all over the body, but
AA can also express itself in more diffuse forms. Most people with AA go through unpredictable cycles of relapse and
remission. Some individuals, especially those with significant hair loss, may experience chronicity.
Objective: Review of literature about practical approach for treatment lines of alopecia areata.
We searched Science Direct, Google Scholar as well as PubMed for relevant articles on Alopecia Areata and
its Treatment. However, only the most recent or thorough study was taken into account between September 2001 and
April 2021. The authors also evaluated the value of resources culled from other works in the same genre. Documents
written in languages other than English have been ignored due to a lack of translation funds. Unpublished works, oral
presentations, conference abstracts, and dissertations were generally agreed upon not to qualify as scientific research.
Conclusion: Care for patients with alopecia areata include providing emotional support and making treatment options
available to those who want them. Response to treatment for alopecia areata varies greatly, and few well-designed
clinical trials have examined the methods that have been used. Methods such as topical, intralesional, and systemic
medications and devices are used in these treatments. Due to the limited but promising evidence supporting the
effectiveness of other treatments, individuals with patchy alopecia areata typically begin treatment with intralesional or
topical corticosteroids.
Keywords: Alopecia areata, Approach, Treatment.

more frequently throughout certain times of the year. A
retrospective study of about 450 children with alopecia
Alopecia areata (AA) is an autoimmune disorder
areata found that outbreaks of the condition tend to
that causes temporary hair loss on the scalp and other
occur in the winter. This finding has to be confirmed in
hair-bearing regions. Loss of hair might affect only
a separate investigation (3). Alopecia areata is an
certain sections of the scalp or spread throughout the
autoimmune illness that causes the premature transition
entire body, but AA can also express itself in more
of hair follicles in the growth phase (anagen) into the
diffuse forms. Most people with AA go through
non-proliferative involution (catagen) and resting
unpredictable cycles of relapse and remission. Some
(telogen) phases, resulting in the loss of existing hair
individuals, especially those with significant hair loss,
and the suppression of new hair growth. In alopecia
may experience chronicity. The effects of AA on
areata, unlike cicatricial alopecia, the hair follicle is not
patients' lives are substantial, and the disease itself may
irreversibly destroyed by the inflammatory process (4).
lead to the development of mental health problems (e.g.,
It is still unclear what causes alopecia areata.
anxiety as well as depression) (1).
Breakdown of follicular immune privilege and the
There is an estimated 1-2% prevalence of alopecia
subsequent formation of a T cell-mediated
areata in the general population, with a 1.7% lifetime
immunological onslaught on cells within the hair bulb
risk. However, depending on the community under
are both potential critical events. Some people are just
study, the true prevalence can range from 0.1% to 6.9%
more likely to experience alopecia areata than others (5).
(2). It is unknown if alopecia areata outbreaks occur

Figure (1): Alopecia areata is characterized by a breakdown of immunological privilege in the anagen hair follicle (6).
Received: 25/01/2023
Accepted: 28/03/2023

Full Paper (vol.921 paper# 51)

c:\work\Jor\vol921_52 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5807- 5812

Correlation of Hypothyroidism with Polycystic Ovary Syndrome (PCOS):
A Hospital-Based Cross-Sectional Study, Benha City, Egypt

Amira M. El Sayed1, Mohammed Shawky El-Sayed1, Ahmed Y. Rezk2,
Aya Nabil El-Zanaty1*, Ayman M. El Badawy1
Departments of 1Internal Medicine, Endocrinology Unit and 2Obstetrics & Gynecology,
Faculty of Medicine, Benha University, Egypt
*Corresponding author: Aya Nabil El-Zanaty, Mobile: (+20) 01022856816, Email:

The precise relationship between polycystic ovarian syndrome (PCOS) and thyroid gland function is
still unknown. However, both conditions share a variety of symptoms, including obesity, menstrual irregularities,
hirsutism, infertility, and insulin resistance.
To find out the prevalence and the possible link between hypothyroidism and PCOS.
Patients and methods: Our study was conducted on 200 women for the presence or absence of PCO and
hypothyroidism. Hormonal assay: (FSH, LH, TSH, FT3, FT4, testosterone) as well as fasting plasma glucose, HbA1c,
TPO ab and thyroglobulin ab, HOMA ­ IR, Neck US, Pelvic-abdominal US were performed to all patients.
Results: Overt hypothyroid patients in PCOS group demonstrated significantly higher PCOS criteria, infertility than
those with no hypothyroidism. PCOS patients in hypothyroid group had significantly higher testosterone (0.63 ±0.14 vs
0.39 ±0.05 ng/dl), TPO antibody (median = 489 vs 203 IU/ML), and TG antibody (362.5 vs. 98 IU/ML) than patients
without PCOS. Our results revealed that insulin resistance is a common finding in both condition that is inferred from
the following: Patients with hypothyroidism in PCOS group demonstrated significantly higher weight (94.6 ±22.8 vs.
80.3 ±20.5 kg), BMI (34.7 ±8 vs. 30.5 ±7.5), and waist circumference (101 ±15 vs. 94 ±15 cm). Meanwhile, in
hypothyroidism group, PCOS patients had higher fasting plasma glucose (127 ±30 vs 88 ±17), HBA1C (6.32% ±0.95
vs 5.07% ±0.59), HOMA-IR (median = 3.05 vs 0.9).
Conclusion: There is an association between PCOS and hypothyroidism per se, neither related to the underlying etiology
nor to clinical presentation.
Keywords: Hypothyroidism, PCOS, TSH, TPO ab. and TG ab, testosterone.

insulin resistance, and reproductive diseases. Our aim
About 5-10% of reproductive women are affected
was to assess the prevalence of hypothyroidism in
by PCOS, the most prevalent kind of persistent
women with polycystic ovary disease and to determine
anovulation linked to an excess of androgen [1]. The
the prevalence of polycystic ovary in women with
2003 Rotterdam ESHRE/ASRM updated consensus is
hypothyroidism. We also aimed to explore the possible
currently used as the diagnostic standard for PCOS [2].
link and associated pathogenic mechanism between
After ruling out alternative causes of anovulation and
hypothyroidism and polycystic ovary.
hyperandrogenism, at least two of the following

criteria--chronic oligo/anovulation, clinical and/or
biochemical evidence of hyperandrogenism, and the
This cross-sectional study was conducted at Benha
presence of polycystic ovaries on ultrasound--are
University Hospital. It comprised 200 female subjects
necessary to make the diagnosis. The link between
of 18-40 years old. Participants were divided into two
PCOS and hypothyroidism is receiving more attention.
groups; one group constituted 100 women with PCOS
The most prevalent pathogenic hormone shortage is
(participants were assessed for the presence or absence
primary hypothyroidism, with overt and subclinical
of true hypothyroidism) and another group containing
illness prevalences of 0.3% and 4.3%, respectively [3].
100 with true hypothyroidism (participants were
Anovulation and/or luteal phase defects lead to
assessed for the presence or absence of PCOS).
clinical symptoms such as irregular menstruation and
Diagnosed PCOS subjects were recognized in the
decreased fertility [4]. Although the precise relationship
outpatient clinic of gynecology and obstetrics, while
between PCOS and thyroid function is still unknown,
hypothyroid patients were recognized in the outpatient
both conditions are difficult to diagnose because they
clinic of endocrinology. Females were categorized as
share a number of symptoms, such as obesity, menstrual
PCOS as per Rotterdam criteria 2003 [2].
irregularities brought on by anovulation, acne,
Age < 18 years and > 40 years, known cases of
hirsutism, infertility, miscarriages, and carbohydrate
congenital adrenal hyperplasia, pregnant and lactating
intolerance in the form of insulin resistance. It has been
patients, and any patient receiving hormonal therapy
shown that PCOS and hypothyroidism are related. The
were excluded. Data recruited from each participant
majority of the time, while examining PCOS for the first
included; Age, marital status, a history of infertility
time, subclinical hypothyroidism is found [5].
(either primary or secondary), menstrual history,
It is plausible that a potential imbalance in thyroid
including any history of oligomenorrhea, irregular
function may cause, maintain, or exacerbate the PCOS
periods, or amenorrhea, and any prior sonographic
symptoms based on the link between hypothyroidism,
Received: 25/01/2023
Accepted: 28/03/2023

Full Paper (vol.921 paper# 52)

c:\work\Jor\vol921_53 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5813- 5818

Clinical Outcomes of Coronary Artery Bypass Graft in
Chronic Obstructive Pulmonary Disease: Review Article
Ahmed Mahmoud Ahmed Shafeek, Essam Saad Abd ElWahed,
Mostafa Abdelsattar Kotb, Mohamed sabry Abbas Hassan*
Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mohamed Sabry Abbas Hassan, Mobile: (+20) 01063859586, E-Mail:

A coronary artery bypass graft (CABG) is a significant operation in which healthy blood vessel tissue is
used to bypass a patient's blocked coronary arteries.
Objective: Review of literature about clinical outcomes of coronary artery bypass graft in chronic obstructive
pulmonary disease.
We searched PubMed, Google Scholar, and Science Direct for relevant articles on Coronary Artery Bypass
Graft and Chronic Obstructive Pulmonary Disease. However, only the most recent or thorough study was taken into
account between January 2008 and January 2023. The authors also evaluated the value of resources culled from other
works in the same genre. Therefore, documents written in languages other than English have been ignored due to a lack
of translation funds. Unpublished works, oral presentations, conference abstracts, and dissertations were generally
agreed upon not to qualify as scientific research.
Conclusion: Bypass surgery improves cardiac function, viability, and anginal symptoms by re-establishing blood supply
to the ischemic myocardium. Although coronary artery bypass grafting (CABG) surgery remains the most common
major surgical procedure, its popularity has been declining in recent years due to the rise in the use of non-invasive
procedures including medicinal therapy and percutaneous coronary intervention (PCI). Remodeled airways, fueled by
inflammation and angiogenesis, can have unfavourable consequences for organs outside of the lungs in people with
chronic obstructive pulmonary disease.
Keywords: Coronary artery bypass graft, Chronic obstructive pulmonary disease.


In both the industrialised and the developing world,
400,000 performed annually. However, surgical trends
coronary artery disease (CAD) is the leading cause of
have dropped as medical treatment and percutaneous
death among cardiovascular diseases. Stable angina,
coronary intervention (PCI) have gained in popularity (2,
unstable angina, myocardial infarction (MI), and sudden
cardiac death are all symptoms of coronary artery

disease (CAD), an atherosclerotic illness with an
inflammatory component. High blood pressure, high
When percutaneous coronary intervention (PCI) has
cholesterol, smoking, diabetes, and a family history of
failed to unblock blockages in any of the major coronary
heart disease are all risk factors for CAD. A
arteries, bypass surgery is sometimes indicated as a next
combination of a physical examination, blood tests, and
step. The following are ACCF/AHA Guidelines for
imaging procedures like an electrocardiogram (ECG) or
Class 1 (4):
coronary angiography is typically used to diagnose
The prevalence of left main illness is greater than
CAD. Alterations to one's way of life, medicine, and
surgical treatments like angioplasty and coronary artery
Greater than 70% blockage of all three coronary
bypass grafting are all viable choices for treating CAD
arteries, with or without involvement of the
proximal LAD.
Major surgery known as coronary artery bypass
Two-vessel disease, or blockage of the LAD and
grafting (CABG) involves bypassing atheromatous
another major artery
obstructions in coronary arteries using harvested venous
Patients with severe anginal symptoms despite
or arterial conduits. Bypass surgery improves cardiac
aggressive medical treatment who have one or
function, viability, and anginal symptoms by re-
more major stenosis greater than 70%.
establishing blood supply to the ischemic myocardium.
Sudden cardiac arrest survivor with ischemia-
Coronary artery bypass graft (CABG) operation is the
related ventricular tachycardia and single-vessel
most common major surgical surgery, with almost
damage more than 70% (4).

Received: 25/01/2023
Accepted: 28/03/2023

Full Paper (vol.921 paper# 53)

c:\work\Jor\vol921_54 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5819- 5824

Evaluation of Intra-Cesarean Insertion of Cu-T380 IUCD
(Safety, Efficacy, Expulsion and Continuation Rates)
Ahmed Abd Elhameed Saleh1, Mohamed Abd Elsamie Mohamed1, Esraa Helmy Mohamed1*
1Department of Obstetrics and Gynecology Faculty of medicine- AL-Azhar University (Assiut)
*Corresponding author: Esraa Helmy Mohamed
Mobile: +20 112 376 0601, E-mail:

Interval contraception with Copper T 380A has been shown to be highly effective and reversible, providing
ten years of reliable protection. Multiple studies have demonstrated that intra-caesarean implantation of an intrauterine
contraceptive device (IUCD) is effective and poses no increased risk of infectious morbidity.
Aim and Objectives: We aimed to study the clinical outcomes (safety, effectiveness, expulsion, and continuation rates) of
post placental Copper T 380A insertion in women after cesarean section.
Patients and methods: This case-control study was conducted in the Department of Obstetrics and Gynecology, AL-Azhar
University Hospitals (Assiut), a Tertiary Care Hospital. The study included 67 pregnant women who were scheduled for
elective Cesarean section.
Results: The statistical significance (p-value< 0.001)) was extremely high increased percentage of lost follow at 6 months
(19 patients, 39.6%) and 3 months (12 patients, 21.8%) when compared to 3 weeks (0 patients, 0%). Concerning the
problems that were evaluated, there was no discernible difference (p value > 0.05) between the two time periods of follow-
Conclusion: Intra caesarean IUCD insertion is a promising approach. It is safe and effective with remarkable low failure
rate and minimal side effects over the users.
Keywords: Intra-cesarean insertion, Cu-T380 IUCD, Pregnancy.


Some women are at risk for rapid, recurring, and
Women undergoing Cesarean sections will
unwanted pregnancy if they wait until their postpartum
participate in this trial to assess the clinical results (safety,
visit to start using effective contraception (1).
effectiveness, expulsion, and continuation rates) of post
Approximately 50% of women who do not breastfeed
placental Copper T 380A insertion.
will have ovulated by 6 weeks postpartum (2).

Furthermore, greater than half of women resume sexual
activity within 6 weeks postpartum (3). Many women who
Sixty-seven pregnant women who were scheduled for
want to use an IUCD for postpartum contraception never
elective Cesarean section were included in this case-
get one because they avoid the doctor after giving birth
control study. The study was conducted at Tertiary Care
out of fear of the potential pain and discomfort of the
Hospital, AL-Azhar University Hospital (Assiut).
experiment (4). Because of their lower socioeconomic
The sample size was calculated by using the following
status (5), these women are more likely to have trouble
getting to and from medical appointments and
N = (Z / )² X P (100 ­ P).
communication with their doctors (6).

With a verified success rate, Copper T 380A (IUCD)
Inclusion Criteria: Those interested in using the CuT-
is a long-acting, reversible spacing treatment that can
380 IUCD for contraception must be between the ages of
prevent pregnancy for up to ten years (7). Several studies
18 and 40, have no uterine malformations and genital or
have shown that IUCDs can be successfully implanted
pelvic lesions, or genital cancer.
through an incision made during Caesarean section with

no increase in the risk of infectious morbidity (8, 9). This
Exclusion criteria: Refusal of the patient, age less or
method allows the obstetrician to put the IUCD into the
more than 18-40, Patients with intra-partum fever,
uterus under direct visualization, removing any potential
congenital uterine abnormality, amniotic sac rupture
risk of perforating the uterus. Nonetheless, obstetricians
lasting more than 18 hours, history of postpartum
are reticent to offer the benefits of Copper T 380A IUCD
haemorrhage and Allergy from any component of the
to women undergoing surgical delivery, despite reports
CuT-380A IUCD.
of its safety and effectiveness. The benefits of starting

IUCD use during Caesarean section include skipping the
postpartum waiting period of six weeks and the
Every patient was subjected to: Detailed history taking
subsequent hospital visit (8).
(age, obstetric history, menstrual history, residence,
Received: 15/01/2023
Accepted: 16/03/2023

Full Paper (vol.921 paper# 54)

c:\work\Jor\vol921_55 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5825- 5829

Lifestyle Modification for Management and Prevention of
Type 2 Diabetes: Review Article
Amlak Hadi Alshammari
Family Medicine resident at Hail Family Medicine Academy, Hail
Email: , Phone: +966 55 103 6705

A serious non-communicable illness with emerging incidence international is type-2 diabetes. Type-2
diabetes arises when human body cannot utilize the insulin it generates and produces insufficient amounts. The main factor
contributing to early mortality is type-2 diabetes. If not treated appropriately, it can cause a variety of morbidities, such as
neural disorders, stroke, heart disease, blindness, kidney illness, amputations of extremities, and even death.
Objective: This review article aimed to throw the light on the effect of lifestyle modification for management and prevention
of type 2 diabetes mellitus.
Methods: We searched PubMed, Google Scholar, and Science Direct for relevant articles on Lifestyle modification, type 2
diabetes mellitus, management and prevention. However, only the most recent or thorough study was taken into account
between January 2004 and January 2023. The authors also evaluated the value of resources culled from other works in the
same genre. Therefore, documents written in languages other than English have been ignored due to a lack of translation
funds. Unpublished works, oral presentations, conference abstracts, and dissertations were generally agreed upon not to
qualify as scientific research.
successful lifestyle variations, involving weight loss counselling and physical exercise, are the cornerstones
of type 2 diabetes prevention. We discovered that dietary changes, regular exercise, and weight loss are effective long-term
methods for reducing the risk of heart disease, renal issues, visual abnormalities, nerve damage, and other issues. All
diabetics should get recommendations and prescriptions for physical activity and exercise as a component of managing their
glucose control and general health. Depending on the type of diabetes, age, the activity being done, and the existence of
diabetes-related health issues, different advice and precautions will be made. Each person's unique demands should be
considered when formulating recommendations.
Keywords: Type 2 diabetes mellitus, Lifestyle, Modifications, Prevention, Diet, Exercise.

incidence of the condition. Modifying one's way of life by
Diabetes mellitus (DM) is defined as a group of
losing weight, getting more exercise, and changing one's
metabolic disorders characterized by hyperglycemia
diet are just a few strategies that have been shown to be
caused by defects in insulin secretion, action, or both.
effective in preventing type 2 diabetes mellitus 4. The
Type 1 diabetes mellitus (T1D) and type 2 diabetes
most essential elements for the development of this illness
mellitus (T2D) are the two kinds of diabetes mellitus.
appear to be genetic vulnerability and environmental
Diabetes is a complicated, chronic condition that needs
effects. However, a significant increase in physically
ongoing medical attention and risk-reduction measures
inactive patients, obesity, and type 2 diabetes were
that go beyond glucose control. For the purpose of
documented 5.
avoiding acute problems and lowering the likelihood of
The cornerstone of care in the prevention of diabetes
complications is good glycemic control. However,
management education and assistance are essential 1.
patients may find it challenging to maintain a
95% of instances of diabetes are type 2 diabetes
conventional healthy lifestyle, which can have a negative
mellitus. It is a serious health issue that causes significant
impact on the effectiveness of diabetes treatment by
morbidity and death and affects 5% of adults globally 2. It
increasing insulin resistance, lowering glucose control,
is a costly and challenging condition to manage. The
and causing diabetic complications 6.
estimated 190 million individuals who currently suffer
Preventing or delaying the progression of diabetes in
from diabetes are expected to treble to 325 million people
high-risk people, including individuals with reduced
in the next 25 years 3.
tolerance for glucose, may be possible with lifestyle
intervention programs that emphasise nutritious diets,
cardiovascular events, nephropathy, vascular disorders,
exercise, and small weight reductions 7. Intent to prevent
alterations to the retina, and blindness may trigger
the disease through modifications to lifestyle became
disability and immediate mortality in people with type-2
noticeable in the 1980s, and the 2004 suggestions of the
diabetes. Prevention and management of type 2 diabetes
European Association for the Study of Diabetes (EASD).
mellitus has become more crucial due to these
Diabetes and Nutrition Study Group (DNSG) emphasised
consequences as well as the rising prevalence and
the prospect of T2D prevention throughout lifestyle
Received: 26/01/2023
Accepted: 29/03/2023

Full Paper (vol.921 paper# 55)

c:\work\Jor\vol921_56 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5830- 5835

Assessment of The Foot Arch and Quality of Life in Children with Down Syndrome
Yasmine F. Abo Al Ghait*, Hebatallah Mohamed Kamal, Hamada E. Ayoub, Marwa M. Mohamed Onsy
Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Egypt
*Corresponding author: Yasmine F. Abo Al Ghait, Mobile: (+20)1018234933,

Down syndrome is a genetic condition that has an impact on a person's health and development on many
levels, including their feet. Children with Down syndrome frequently have flat feet and other foot deformities, which
can make walking painful, uncomfortable, and challenging. Objective: The aim of the current study was to evaluate the
foot alignment and its impact on quality of life in children with Down syndrome. Subjects and methods: This
retrospective study included a total of 40children with Down syndrome from both genders with ages ranged from 8 to12
years old recruited from Alfolk Charity Institution, Outpatient Clinic, Intellectual Educational Schools, in Al Gharbia
and Cairo Governorates. Foot arch angels were assessed by X-ray radiological assessment whereas; health status for
children with foot and ankle problem, Quality of life of children with Down syndrome were assessed by the Oxford
ankle foot questionnaire. Results: There was a significant increase in Talo-calcneal angle of the right foot of study group
compared to the reference value (p = 0.001).There was a significant increase in Talo-calcneal angle of the left foot of
study group compared to the reference value (p = 0.001).There was a significant increase in Bohler's angle of the right
foot of study group compared to the reference value (p = 0.001).There was a significant increase in Bohler's angle of
the left foot of study group compared to the reference value (p = 0.02).There was a significant decrease in school & play
score of study group compared to the reference value (p = 0.001). Conclusion: This study concluded that children with
Down syndrome haveproblems in their feet that affect directly their quality of life.
Keywords: Down syndrome, foot arch, X-ray, Quality of life.

Sometimes flatfeet can be uncomfortable, with more
specific symptoms occurring after strenuous activity or
People with chromosomal abnormalities, such as
lengthy walks. In the lower legs and feet, there is
Down syndrome (DS), have 47 instead of 46
widespread discomfort (7).
chromosomes. Trisomy 21 is the most common
autosomal trisomy and the primary genetic cause of
Foot X-ray evaluation can offer a more complete
severe learning impairments (1). The 21st pair of
picture of the foot anatomy and assist uncover any
chromosomes are affected by the defective cell that
abnormalities that may not be obvious during a physical
causes Down syndrome, either by nondisjunction (95%),
examination (8). X-ray scans give accurate and
translocation (3%­4%), or, less commonly, mosaicism
trustworthy data in a variety of foot diseases. For
(1%) caused by division(2). Hypotonia, a small
diagnosis, weight-bearing AP lateral radiographs of the
brachycephalic head, epicanthal folds, a flat nasal bridge,
feet are frequently adequate(9). These radiographs
upward-slanting palpebral fissures, Brushfield spots, a
measure the foot arch angles. The disease can be staged
small mouth, small ears, excessive skin at the nape of the
and treatment choices can be made with the use of
neck, a single transverse palmar crease, and a short fifth
clinical and X-ray examination (10). Additionally, based
finger with clinodactyly and wide spacing are common
on the evaluation of weight-bearing radiographs of the
physical findings. Ligamentous laxity, which can result
foot and ankle, foot X-ray assessment can be utilised to
in acquired hip dislocation, chronic patellar dislocation,
assist clinical decision-making treatment programs for
pes planus, and ankle pronation, are the most frequent
the management of foot abnormalities in children (11).
orthopaedic issues with DS. Degenerative joint disease,
An instrument that is reliable for measuring foot
osteoarthritis, and scoliosis are additional prevalent
pain, function, and appearance is the Oxford Ankle Foot
orthopaedic issues (3). For appropriate gait to occur,
Questionnaire. It can be used to evaluate how the child's
correct foot morphology is necessary, and various foot
quality of life is affected by their foot issues (12). 16 items
abnormalities may be connected to more proximal lower
make up the questionnaire, which is divided into four
limb defects that might considerably impede everyday
categories: general foot health, footwear, foot function,
and foot pain (12). Healthcare professionals can assess the
The most common foot variations in DS are flat
success of treatment initiatives and make necessary
feet, including pronated flat feet, calcaneal valgus,
modifications to treatment strategies by monitoring
hallux valgus, and metatarsus primus varus(5),but if
improvements in quality of life over time (13).The Oxford
these foot variations are not detected early, major
Ankle-Foot Questionnaire was created to evaluate the
disability associated with foot and ankle problems in
develop(6).Children with DS frequently have flat feet,
kids between the ages of 5 and 16. The questionnaire's
which can lead to pain, discomfort, and walking
results can be used to determine how foot or ankle issues
challenges. Severe flat feet can also distort the shoe.
Received: 29/01/2023
Accepted: 30/03/2023

Full Paper (vol.921 paper# 56)

c:\work\Jor\vol921_57 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5836- 5842

Prognostic Factors of Testicular Cancer: A Single Institution Retrospective Study
*Eman Ahmed Abd El-Aziz Mesha, Rasha Hamdy Hamed,
Ibrahim Ali Mohamed Awad, Shimaa El-Metwaly Attia
Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Eman Ahmed Abd El-Aziz Mesha, Mobile: (+20) 01141884884,
ORCID NO: 0009-0009-9322-1366, E-Mail:

Testicular cancer (TC) is the most common cancer in young males, representing about ~1% of new cases
of cancer in male patients around the world.
Objective: The study aims to assess prognostic factors of testicular cancer, overall survival and progression free
Patients and Methods: Sixty patients with testicular cancer who had been attended to the Clinical Oncology and
Nuclear Department at Mansoura University Hospitals between January 2006 and Desember2020 were included in this
retrospective analysis.
Results: The median age of the patients was 43 years. The most common presentation was testicular mass (71.7%).
Cryptorchidism was presented in 7 cases (11.7%). Most of our patients were germ cell tumors 51cases (85%) divided
into seminoma 34 patients (56.7%), nonseminoma17 patients (28.3%), 7 patient (11.7 %) were nongerm cell tumors and
2 patients (3.3%) were miscellaneous tumors. Regarding tumor, node and metastasis (TNM) staging, 43 patients (71.7%)
were stage I, and 14 patients (23.3%) were stage III. Regarding lymph node metastasis, 57 patients (95%) were N0. All
patients underwent high inguinal orchiectomy, (80%) of patients received chemotherapy, and 7 patients (11.7%)
received radiotherapy. The 5 years overall survival was (91.7%) while 5 years progression free survival was (88.3%).
Conclusion: Absence of cryptorchidism, germ cell tumors, node negative and stage I all are good prognostic factors.
Keywords: Prognostic factors of testicular cancer; Orchiectomy; Seminoma; Non-seminoma; Testicular cancer.


Testicular cancer represents about ~1% of new
cases of cancer in male patients around the world. In
retroperitoneal lymph node dissection (RPLND). Even
Western nations, it is the most prevalent cancer among
in the presence of metastatic disease, patients diagnosed
people between the ages of 14 and 44. Globally, the
with testicular cancer have a good prognosis)5(.
incidence of testicular cancer differs from <1 affected

individual per 100,000 males in large parts of Africa and
Asia to 9.2 in Switzerland, 9.4 in Denmark and 9.9 in
This retrospective study aimed to determine the
Norway. India has the lowest age-standardized
clinico-epidemiological characteristics and treatment
incidence of 0.5/100,000 men )1(. Testicular cancer is the
outcome of patients with testicular cancer treated at
most prevalent solid tumor in young males. The
Clinical Oncology and Nuclear Medicine Department at
incidence rate for testicular cancer is about
Mansoura University Hospital from January 2006 to
1.86/100,000 in Egypt)2(.
December 2020, and also, to assess progression-free
Traditionally, testicular cancer appears as a
survival (PFS), and overall survival (OAS) for all the
solid, ache-free mass. Less frequently, patients with
patients with different methods of treatment and
seminoma may exhibit mild testicular discomfort and
evaluation of prognostic factors.
swelling that could be epididymo-orchitis. Others may

exhibit retroperitoneal lump, enlarged breast, thrombus
formation, or emboli in pulmonary vessels in addition
This retrospective analytical study based on the
to supraclavicular or mediastinal lymph node)3( .
hospital records of the testicular cancer patients who
Ninety-five percent of testicular cancer cases
were admitted to Clinical Oncology and Nuclear
are germ cell tumors (GCT), which are classified into
Medicine Department, Mansoura University Hospital
seminoma (classic, anaplastic and spermatocytic
from January 2006 to December 2020 inclusive. A
variants) and non-seminomatous germ cell tumors
rough anticipated number of reliable patient records was
(NSGCT), which include (embryonal carcinoma,
60. The information was obtained using a standard
teratocarcinoma, teratoma, choriocarcinoma and yolk
form: age, medical history (risk factors like
sac tumors). Five percentage of testicular tumors are
cryptorchidism, smoking, history of testicular trauma,
(sex cord stromal tumors, lymphoma). They may arise
clinical data (side, clinical symptoms as testicular mass,
in other extragonadal locations including the
scrotal swelling, scrotal pain or asymptomatic),
retroperitoneum and the mediastinum)4(.
laboratory tests include tumor markers as (b-HCG,
The way testicular cancer is treated has
LDH, alpha-fetoprotein) and complete lab as (CBC,
LFTs, KFTs), radiological assessment as testicular
revolutionized by the addition of cisplatin-based
ultrasound, CT chest, abdomen and pelvis, MRI, PET
Received: 26/01/2023
Accepted: 29/03/2023

Full Paper (vol.921 paper# 57)

c:\work\Jor\vol921_58 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5843- 5847
Knowledge and Performance of Breast Self-Examination among the Iraqi Women
Attending the Breast Clinic at Oncology Teaching Hospital in Baghdad
Yusra Noaman Mohammed Ali, Shaimaa kadhim, Afraa Mahjoob Al-Naddawi
University of Baghdad / College of Medicine, Baghdad Teaching Hospital
Corresponding author: Yusra Noaman Mohammed Ali, Email:,
Phone number: 009647700010032, ORCID: https//


Background: Breast self-examination is considered one of the simple noninvasive methods with very low cost, without
need for special material or tool. In addition, it is very fast effective method for diagnosis of breast cancer.
Objective: To assess the level of knowledge and practice of breast Self-examination (BSE) among the Iraqi women
who attend to the Oncology Teaching Hospital in Baghdad.
Material and methods: A descriptive cross-sectional study. We select any Iraqi women who attended to the Breast
Clinic at the Oncology Teaching Hospital randomly regardless of the age. We collect about 150 Iraqi women with varied
age, and they came from different region in Baghdad and from other governorates in Iraq.
Results: In this study we found that 64.7% of the ladies had a knowledge towards breast self-examination, but only
34% of the respondents perform it. The major reasons behind the nonperformance of the BSE were either those
respondents (34.7%) have never heard about it or about 13.3% don't know how to do it. The major source of information
about BSE were the health workers (14.7%) and from TV (7.3%). A significant difference was found in this study
between overall knowledge and practice of breast self-examination (P<0.05), and a significant difference between the
overall knowledge and the educational level of the participants (P<0.05).
Conclusions: We concluded that poor knowledge among right procedure and practice of breast self-examination in
Iraqi women
Keywords: Breast self-examination, Oncology, Knowledge, Practice.

Signs and symptoms that indicates having breast
Cancer of the breast is a disease that occurs when
1- A change in the size or shape of the breast.
the breast cells initiate to mature out of control leading
2- A new lump or lumpiness, especially in one breast.
to formation of a mass that can be detected
3- Some changes in the nipple like crusting and
radiologically or felt on examination as a lump. This
mass called a malignant tumor when the cells spread
4- When there is some discharge from the nipple that
into surrounding tissues or even to other areas of the
occurs without squeezing.
body. Adding to this, breast cancer does not afflict
5- Inverted nipple.
women only, but also men, as it has been proved by
6- An unusual pain that continue for long time.
recent cases (1).
7- A change in the skin, such as puckering or dimpling
Nowadays, Breast cancer appears to be the most
(like orange peel) (4).
invasive type of cancer that affect the women globally,

and form the commonest cause of death in the women.
Factors with adequate evidence of decreased risk of
The incidence rate of breast cancer varies by region.
breast cancer (3) (5):
Some research found that the breast cancer viewed as
The main risk factors for emerging breast cancer
"cancer of affluence". The incidence and mortality rate
aren't easily adaptable because they consequence from
of breast cancer is positively related to more developed
long time endogenous exposures. But there are some
countries and high socioeconomic position. Spic-and-
main strategies that may decrease the risk of emerging
span studies denote a fuzzy relationship among breast
breast cancer
cancer mortality and high/low socioeconomic position
1- Breast feeding: breast feeding for long duration will
irrespective of the nature of this relationship whether
decrease risk of breast cancer by the effect of
negative or positive (2).
tamoxifen that decrease the incidence of disease in

between 30-40% in high-risk females.
Risk factors of breast cancer:
2- Exercise: physical activity more than seven hours
There are many factors that have been exposed to
per week may decrease risk of developing breast
surge the women's risk of developing breast cancer:
Age of menarche (early), delayed menopause, short
3- Women that become pregnant before 20 years and
period of breast feeding and exogenous hormones such
the women whose first full pregnancy at 35 years or
as oral contraceptives, and hormone replacement
older both of them have risk to develop breast
therapy. In addition to high dietary fat intake and
reduced physical activity, risk of obesity and weight
Although, these factors are helpful in preventing
gain in age 18 years old (3).
or reducing the risk of breast cancer, but it's not enough

for removing the great numbers of breast cancer that
Received: 26/01/2023
Accepted: 29/03/2023

Full Paper (vol.921 paper# 58)

c:\work\Jor\vol921_59 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5848- 5853

Study of Prevalence and Risk Factors of Nocturnal Enuresis in
Children with Thalassemia Major
Ahmed Badr Edin Mohammed1, Mohammed Ahmed Badr1,
Adel Sherif Ahmed1, Ahmed Mohammed Gab Allah2
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Badr Edin Mohammed, Mobile: (+20) 01286441789, E-Mail:

Patients with thalassemia major face an extra challenge in the form of nocturnal enuresis.
To evaluate and assess the prevalence and risk factors of nocturnal enuresis in thalassemia major patients.
Patients and Methods: Data of this cross-sectional study was gathered from the clinical records in the out-persistent
facility of Pediatric Hematology and Oncology Unit, Zagazig clinics. The study recruited 132 children aging 6-18 years.
They were submitted to careful history taking including (age, sex, place, protocol of therapy, duration of follow up),
thorough clinical examination and laboratory tests included: CBC and reticulocyte count, bilirubin (direct ­ indirect),
hemoglobin electrophoresis test, liver function tests, kidney function tests, random blood sugar, urine analysis, bacterial
count in urine and paired serum and urine osmolality.
Results: There was statistically significant relation between the age, family history, splenectomy and nocturnal enuresis.
There was statistically significant relation between decreasing nocturnal enuresis and regularity of blood transfusion.
The ferritin levels were statistically lower in patients with nocturnal enuresis than those without nocturnal enuresis. A
statistically significant negative correlation was found between urine osmolality and ferritin levels in patients with
nocturnal enuresis.
Family background of enuresis and family and social issues have a significant job in the predominance of
bedwetting among thalassemia major patients. The predominance of nighttime enuresis in patients with thalassemia
significantly declines with expanding age and customary blood transfusion. The rate of bedwetting increments in
thalassemia major patients with iron and hemoglobin inadequacy.
Nocturnal Enuresis, Thalassemia Major, Children.


Beta-thalassemia is widely spread in the
found that if both parents had urination when they were
Mediterranean, Middle-East, Transcaucasus, Central
young, their children will suffer from involuntary
Asia, Indian subcontinent, and Far East (1).
urination by 77%, and this percentage drops to 43% if
Beta thalassemia is collection of inherited blood
one of the parents only has involuntary urination, and
disturbances distinguished by abnormality in the
decreases to 15% if the parents were not affected by
hemoglobin beta chains synthesis, which leads to
urination when they were young (3).
mutable phenotypes extended from intense anemia to
We aimed at this work to evaluate and assess the
clinically asymptomatic persons. The average number
prevalence and risk factors of nocturnal enuresis in
of people experiencing symptoms in a year is about 1 in
thalassemia major patients.
100,000 in the world (2).

There are three main forms of thalassemia:
thalassemia major, thalassemia intermedia and
Data of this cross-sectional study were gathered from
thalassemia minor. Persons with thalassemia major
the clinical records in the out-persistent facility of
suffers from intense anemia within the first two years of
Pediatric Hematology and Oncology Unit, Zagazig
life, and they need to regular blood transfusions (2).
clinics. The study recruited 132 children in aging 6-18
People who do not receive treatment or do not have
regular blood transfusions suffer from growth

retardation and skeletal deformities, jaundice,
Incorporation measures:
hepatosplenomegaly, leg ulcers, and masses of
Children with thalassemia major between 6 to 18
extramedullary hematopoiesis (3).
years of age.
Nocturnal enuresis is involuntary urination that
Both genders were included
happens at night while sleeping, after the age when a

person should be able to control his or her bladder. A
Avoidance measures:
child under 5 years old is not considered enuretic. In
Thalassemic patients with renal illness.
order to consider a child at the age of 5-6 years suffering
Thalassemic patients with diuretic drug ingestion.
from involuntary urination, he must have two or more
Thalassemic patients with diabetes mellitus.
episodes of bedwetting per month. While from the age
Thalassemic patients with diabetes insipidus.
of 6 or more, he has one or more per month (4).

Genetic predisposition has a major role in the

occurrence of urination in children. There is a study

Received: 01/02/2023
Accepted: 03/04/2023

Full Paper (vol.921 paper# 59)

c:\work\Jor\vol921_60 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5854- 5862

Prediction of Preterm Mortality with Late Onset Sepsis using the Neonatal
Sequential Organ Failure Assessment Score in Suez Canal University Hospitals
Heba Mahmoud Mahmoud Awad1*, Suzan Samir Gad1,
Amani Waheed El-Den Abdel-Halim2, Abdelmoneim Kassem Khashana1
Departments of 1Pediatrics and Neonatology and
2Industrial Medicine and Occupational Health, Faculty of Medicine, Suez Canal University, Egypt
*Corresponding author: Heba Mahmoud Mahmoud Awad, Mobile: (+20) 01068456876, E-Mail:

The fatal condition known as neonatal sepsis is characterized by life-threatening organ dysfunction
brought on by a dysregulated immune response to infection, but there is no operational definition of organ dysfunction
that is relevant to newborns and may foretell infection-related death.
Objective: The aim of the current study was the prediction of mortality risk factors in low birth weight (LBW) preterm
infants with Late Onset Sepsis (LOS) in Neonatal Intensive Care Unit (NICU).
Patients and methods: A cross sectional analytical study conducted on LBW preterm newborns admitted at Neonatal
Intensive Care Unit in Suez Canal University Hospitals, between June 2020 to May 2021 and diagnosed to have LOS;
nSOFA scores were derived for those patients at multiple time points first at the time os sepsis evaluation then at 48
hours interval till death or discharge then comparing the peak score with the outcome. The score assesses respiratory,
cardiovascular and hematological systems, with scores ranging from (0-8) (0-4) and (0-3) respectively.
Results: The study included 102 neonates; 30 (29%) non-survivors and 72 (71%) survivors. Males were affected more
than females (58.82% vs 41.18%). At a cut-off point of more than 7, which was selected as the optimum criterion; the
sensitivity obtained was 86.67%, the specificity was 98.61% and accuracy 94%. The area-under-ROC-curve was equal
to 0.981 (95% CI: 0.933 - 0.998) with positive statistical significance (P<0.001).
Conclusion: NSOFA score can be used to predict death in LBW babies who have LOS. One of the most important steps
towards better newborn sepsis outcomes is the prediction of LOS mortality.
Keywords: SOFA score, LOS, Sepsis, LBW, Cross sectional study, Suez Canal University.


Even in high-income nations, neonatal sepsis is a
caused by a small sample size, the mother's use of
serious issue that has an influence on morbidity and
antibiotics, the dose of antibiotics taken prior to
death. Prematurely born babies are those in whom
sampling, low blood bacterial counts, or short-term
neonatal sepsis occurs and has the highest effects (1).
bacteremia (9).
Infectious illness frequency was high in low- and
Difficulties in early diagnosis and the unexpected
middle-income nations, which may be a result of limited
course of LOS that can lead to septic shock and death
access to well stocked and staffed medical facilities (2).
need assessment of LOS depending on presence and
An estimated 5.3-8.7 million neonates died in sub-
progression of organ dysfunction and this can be done
Saharan Africa alone in 2014 as a result of neonatal
using the nSOFA which also can predict mortality in
sepsis and subsequent long-term morbidity (3). In Egypt,
these patients (10).
neonatal sepsis affected 33% of neonates admitted to
During the progression to death with LOS, there
Neonatal Intensive Care Unit (NICU) (4,5).
was a considerable rise in the demand for mechanical
Neonatal sepsis is characterized by neurological,
breathing, oxygen use, cardiovascular support (in the
form of vasoactive medications), and the incidence of
symptoms as a result of dysregulated host response to
thrombocytopenia. These data served as the basis for the
infection (6).
development of the nSOFA score system, which was
Neonatal sepsis can manifest as either an early
created to forecast death from LOS in preterm, very low
(EOS) or a late LOS start of symptoms. EOS appears
birth weight (VLBW) children (11, 12).
within the first three days of life (about 72 hours),
The current study was aiming at using the nSOFA
whereas LOS appears between days four and thirty, or
score as a predictor of mortality in premature LBW
after the first seven days (7).
neonates with clinical or proven LOS to define
The incidence of EOS ranges from 1 to 5 per 1000
mortality risk factors; for early detection of high risk
births while the incidence of LOS varies between 0.61%
neonates and trial of modifying management plan for
and 14.2%. There is inverse relation between LOS and
better outcome.
birth weight; 51.2% in infants between 501-750 grams,

newborns under 1500 grammes, 15­25%, and infants
above 2500 grammes, 1.6% (8).
A cross sectional analytical study was
Clinically diagnosing LOS can be difficult due to
conducted at NICU in Suez Canal University
the nonspecific signs and symptoms and negative blood
Hospitals. The study included 102 preterm infants (less
cultures, the diagnostic gold standard, which can be
Received: 05/02/2023
Accepted: 05/04/2023

Full Paper (vol.921 paper# 60)

c:\work\Jor\vol921_61 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5863- 5869

Assessment of Nosocomial Pneumonia Antibiotic Susceptibility
Patterns among Patients in Intensive Care Units
Abdalla M. Nawara1, Hassan Mahmoud Hassanein1, Safaa M. Elalawi2,
Aya Esmail Ahmed Esmail*1, Heba Shafeak Abd El Khalik1
Departments of 1Internal Medicine and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aya Esmail Ahmed Esmail, Mobile: (+20) 01019490837, Email :

In intensive care units (ICUs), nosocomial pneumonia is by far the most frequent nosocomial disease
seen. Severe infections, complications, prolonged hospital admissions, and higher mortality rates are all brought on by
the rise in antibiotic resistance.
Objective: To identify the microbial causes of hospital-acquired pneumonia (HAP) and their antibiotic resistance
pattern among ICU patients in Internal Medicine Department of Zagazig University Hospitals.
Subjects and methods: In a cross-sectional study the sample size assigned was 72 patients. All of those who were
adults had signs and symptoms of pneumonia started at least 48 hours after admission to the ICU and that occurs more
than 48 to 72 hours after tracheal intubation.
Results: The Most frequent organisms isolated were K. pneumonia, Acinetobacter baumannii complex and E. coli
(42.9%, 18.6% and 14.3%, respectively). The most frequent sensitive drugs were colistin (48.6%) followed by
imipenem, amikacin (both 18.6%). Most frequent intermediate drug was gentamycin (5.7%). Finally, most frequent
resistant drugs were cefepime, ciprofloxacin and piperacillin (65.7%, 62.9% and 57.1%, respectively). There was a
highly statistically significant increase in APACHE II score and mortality among dead compared to survived cases.
Conclusion: HAP and ventilator-associated pneumonia (VAP) ICUs patients were mostly affected by K. pneumonia,
Acinetobacter baumannii complex and E. coli, K. pneumonia was the most frequent organism. Most of the cases were
resistant to cefepime, ciprofloxacin and piperacillin, most probably due to its cheap cost and easy availability.
Keywords: Nosocomial Pneumonia, Antibiotic Susceptibility, Intensive Care Units.


The geographical pattern of antimicrobial
An infection of the pulmonary parenchyma
susceptibility, the number of underlying diseases, their
that develops in a patient at least 48 h after hospital
severity, and the severity of the current illness are the
admission or within 14 days of hospital discharge is
four characteristics that should guide the choice and
considered nosocomial pneumonia or hospital-acquired
timing of antimicrobial medicines utilized (7-9).
pneumonia (HAP) (1).
We aimed at this work to identify the
Ten percent to twenty percent of patients who
microbial causes of HAP and their antibiotic resistance
require mechanical ventilation for more than 48 hours
pattern among ICU patients in Internal Medicine
are thought to develop ventilator-associated pneumonia
Department of Zagazig University Hospitals, and
(VAP). VAP is defined as pneumonia that develops
therefore antibiotic susceptibility.
more than forty-eight to seventy-two hours after

tracheal intubation. HAP is less dangerous than VAP (2).
About half of HAP patients, especially those
We carried out a cross-sectional study in the
admitted to the intensive care unit, develop serious
Internal Medicine ICUs of Zagazig University
consequences like empyema, septic shock, and
Hospitals and the Clinical Pathology Department of
multiorgan failure (3).
Zagazig University.
Aerobic Gram-negative bacilli are frequent

causes of HAP and VAP (like Enterobacter spp,
Inclusion criteria:
Klebsiella pneumoniae, Acinetobacter spp, Escherichia
1. Adult patients of both sexes.
coli, as well as Pseudomonas aeruginosa) as well as
2. Patients stay in ICU for at least 48 hrs.
gram-positive cocci (like Staphylococcus aureus, which
Exclusion criteria:
includes strains of S. aureus and Streptococcus that are
1. Patients treated with antibiotics within the preceding
resistant to methicillin) (4). Patients who required
2 weeks.
mechanical ventilation had an estimated 9-27% VAP
2. Age below 18 years.
incidence rate (5).
3. pregnant women
The abuse of antibiotics has contributed to a
4. Immunocompromised and cancer patient.
widespread public health problem: antimicrobial
The designated sample size was 72 individuals.
resistance. Severe infections, complications, prolonged
Each adult patient developed pneumonia symptoms
hospitalizations, and higher mortality rates are all
more than 48-72 hours after tracheal intubation and was
brought on by the rise in antibiotic resistance. The
admitted to the intensive care unit. We excluded
danger of antibiotic side effects increases when they are
individuals with a history of antibiotic treatment of
overused (6).
equal to or less than 2 weeks, pregnant females, and
Received: 01/02/2023
Accepted: 03/04/2023

Full Paper (vol.921 paper# 61)

c:\work\Jor\vol921_62 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5870- 5877

An Overview about Alopecia Areata Etiopathogenesis, Diagnosis, and
Management: Review Article
Ahmed Mohamed Metwally Ahmed*1, Sahar Mohamed Abd El Fattah Al Mokadem1,
Abdullah Mohamed Essawy1, Amal Ahmed Zidan2
Departments of 1Dermatology, Venereology and Andrology and
2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Ahmed Mohamed Metwally Ahmed, Mobile: (+20) 01152866841, E-Mail:

Rapid hair loss is caused by the chronic inflammatory disorder alopecia areata, which destroys the hair
follicle. It often affects the scalp, though it can also affect other hairy areas like the beard or eyebrow. There are numerous
clinical types, including patchy, alopecia totalis, alopecia universalis, and ophiasis. It may be caused by genetic,
immunological, endocrine, or psychological factors.
Objective: Review of literature about Alopecia Areata etiopathogenesis, diagnosis and management
We searched Science Direct, Google Scholar as well as PubMed for relevant articles on Alopecia Areata as
well as etiopathogenesis. However, only the most recent or thorough study was taken into account between October
2003 and January 2023. The authors also evaluated the value of resources culled from other works in the same genre.
Documents written in languages other than English have been ignored due to a lack of translation funds. Unpublished
works, oral presentations, conference abstracts, and dissertations were generally agreed upon not to qualify as scientific
Conclusion: The primary effectors in the pathophysiology of alopecia areata condition are CD8 cytotoxic T cells.
Additionally, Janus kinase (JAK) signaling pathways are upregulated. JAK inhibitors are utilized to block the signaling
pathway downstream and novel therapeutic strategies that have been developed. The most prevalent place for sudden
onset hair loss in alopecia areata is the scalp, and it most commonly affects adults. The absence of scales, erythema, or
the exclamation marks that are pathognomonic for alopecia areata indicate that the skin is entirely healthy. Hair pull
tests are often negative, with the exception of early active lesions near the periphery, which indicate disease activity and
Keywords: Alopecia areata, Etiopathogenesis, Management.


the person's age, developmental stage, food, and
Non-scarring hair loss is a characteristic of the
environmental variations like day length. Cytokines
autoimmune illness alopecia areata (AA). However,
and hormones play essential roles in this cycle,
there may also be complete hair loss on the scalp or the
instructing the follicle to alter its structure and function
entire body. The typical AA look is one or more coin-
so that neighbouring hairs can be in different stages of
shaped or ovoid alopecia patches. It is the third most
the growth cycle (2, 3, 4).
common kind of alopecia overall (after male and female
The life cycle of a hair follicle consists of phases
pattern alopecia), yet it leaves no scars (1).
of active growth and hair shaft synthesis followed by

periods of apoptosis-driven hair follicle regression and
Hair Physiology: hair growth cycle
relative hair follicle quiescence. Anagen (the growing
In the hair follicle, many keratinocyte layers work
phase), Catagen (the transition phase), Telogen (the
together to form a hair. The length of growth cycles in
resting phase), and Exogen (the shedding phase) are the
the dynamic, cyclical process of hair development is
four phases of hair growth and development (shedding)
controlled by a variety of hormones and cytokines and
(5) (Figure 1).
is influenced by a number of variables. Factors include
Received: 30/01/2023
Accepted: 02/04/2023

Full Paper (vol.921 paper# 62)

c:\work\Jor\vol921_63 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5878- 5883

Febrile Neutropenia in Pediatrics with Cancer: Review Article
Asmaa Abdelsalam Abdullha*1, Nehad Ahmed Karam1, Marwa Zakaria Mohamed1, Nahla Ibrahim Zidan2
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Asmaa Abdelsalam Abdullha, Mobile: (+20) 01091030627, E-Mail:

It is known as febrile neutropenia (FN) if a patient suffering from neutropenia also exhibits fever. This is
the most common life-threatening complication of cancer treatment and is considered an emergency by oncologists. The
condition of neutropenia is caused by damage to the bone marrow caused by cancer, chemotherapy, or radiotherapy.
Infections caused by bacteria, fungi, and viruses result from the damage caused by chemotherapy and radiation to the host's
Objective: Review of literature about febrile neutropenia in pediatrics with cancer
We searched PubMed, Google Scholar, and Science Direct for relevant articles on Febrile neutropenia and
Cancer. Only the most recent or thorough study was taken into account between June 2010 and July 2022. Documents
written in languages other than English have been ignored due to a lack of translation funds. Unpublished works, oral
presentations, conference abstracts, and dissertations were generally agreed upon not to qualify as scientific research.
Conclusion: When planning treatment, it is important to take into account the patient's past medical history, including
any illnesses, chemotherapy, medications, infections (particularly those caused by antibiotic-resistant bacteria), and
allergic reactions. It may be necessary to evaluate any pain or discomfort as possible symptoms of infection. Age, co-
morbidities, cancer type, and the use of myelosuppressive chemotherapeutic drugs are all major contributors to the
emergence of febrile neutropenia.
Keywords: Febrile neutropenia, Pediatrics with cancer.

infections (BSIs) in 84% of AL patients, compared to
No one, universally accepted definition of febrile
47% of solid tumor patients and 55% of bone marrow
neutropenia exists at this time. A person is considered
transplant recipients, according to a major national
to have febrile neutropenia if they have a temperature of
survey (4). Other disorders, such as viral or fungal
38.3 degrees Celsius or higher, or if they have two
infections, medication or transfusion responses, or
separate readings of 38 degrees Celsius or higher that
mucositis, may also cause fever as a symptom (5).
are at least an hour apart, and their absolute neutrophil

count (ANC) is below 500 cells/mm3 or is expected to
drop below 500 cells/mm3 within the next 48 hours (1).
Although cytotoxic medication is the most
The susceptibility to the illnesses increases as the
prevalent cause of neutropenia, a cancer's direct
neutrophil count falls below 1000/l, and patients with
involvement with hematopoiesis (as in leukaemia) or
a neutrophil level of 500/C are regarded to be at an
the bone marrow's metastatic replacement of healthy
increased risk for bacterial and fungal infections. The
tissue can also cause a considerable decrease in ANC.
risk of life-threatening infection is proportional to the
A pathological infection, caused by pathogenic
length and severity of neutropenia. Risk increases from
microorganisms in 33% of instances, is generally
about 15% for neutrophil levels between 1000 and
present when neutropenia is accompanied by a rise in
500/l to 20-35% for numbers between 100 and 500/l
body temperature. The severity and duration of FN both
to as high as 50% for counts below 100/l (2).
increase the likelihood of complications. Increases in

aminotransferase levels, a low glomerular filtration rate,
When it comes to paediatric oncology, FN is one
cardiovascular comorbidities, and the rate at which the
of the most lethal infection complications that can arise
ANC is declining are all risk factors (6).
from cytotoxic chemotherapy. During their neutropenic

phase, around a third of children who were treated for
Risk factors of infection in hematological
cancer or who received hematopoietic stem cell
malignancies patients:
transplantation (HSCT) developed FN. Fever problems
Patients with haematological malignancies have a high
occur at a different rate and occur less frequently at
risk of infection due to a number of factors. There is a
higher intensities of care. Primary febrile episodes
complicated interplay between the pathogen and its
during neutropenic periods were more common after
virulence and the degree of impairment of the host's
autologous HSCT (58%), intensive treatment for acute
defensive mechanisms that determines the risk of
leukaemia (AL) or non-Hodgkin lymphoma (NHL), and
development and the severity of infections (7).
allogeneic HSCT (44%), but they were less common

during maintenance chemotherapy for AL (9%) (3).
A) Disease-associated Factors: As a result of aberrant
Infections in the bloodstream are the leading cause
maturation and dysregulated proliferative immature
of FN (BSIs). Neutropenia is related with bloodstream
Received: 30/01/2023
Accepted: 02/04/2023

Full Paper (vol.921 paper# 63)

c:\work\Jor\vol921_64 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5884- 5891

A Comparative study between New Ultrasound Gynecological Reporting
Data System (GIRADS) and Ovarian Reporting Data System (ORADS) in
Evaluating Ovarian Lesions
Rania Mostafa Al-Molla, Gehad Reda Abdelfattah*,
Ebrahim Abdelaziz Libda, Ahmed Mostafa El Maghraby
Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Gehad Reda Abdelfattah, Mobile: (+20) 01013407769, E-mail:

Adnexal masses are a frequent cause of patient complications that necessitate diagnostic imaging, surgical
intervention, and postoperative pathology. No large-scale clinical investigation had previously explored the wide
variation in GI-diagnostic RADS's performance among trials.
Objective: The aim of the current study was to highlight the role of Gynecological Reporting Data System (GIRADS)
and Ovarian Reporting Data System (ORADS) in differentiating ovarian lesions and determine which of them a higher
accuracy has based on biopsy result and short interval follow up.
Patients and methods: A cross-sectional study was conducted on 100 female patients with ovarian mass, attending at
Radiodiagnosis Department of Zagazig University Hospitals from March 2020 to March 2021.
Results: With an AUC of 0.983, 100% sensitivity, 96% specificity, 82% positive predictive value (PPV), 100% negative
predictive value (NPV), and 97% accuracy, GIRAD can distinguish between benign and malignant lesions. ORAD has
a high area under the curve (AUC) for distinguishing between benign and malignant lesions; its sensitivity is 92.9%,
specificity is 91.9%, PPV is 65%, and NPV is 98.8%. Kappa () = 0.834 indicates moderate agreement between GIRAD
and ORAD in determining whether lesions are benign or malignant.
Conclusion: Clinical decision-making appears to be aided by the GI-RADS categorization of adnexal masses, in
comparison to the GIRADS, the ORADS classification system for ovarian masses is a useful non-invasive diagnostic
tool with excellent sensitivity in differentiating between benign and malignant neoplastic lesions. When compared to
the ORADS simple rules, the GIRADS was more sensitive while maintaining equivalent specificity as well as reliability.
Keyword: Gynecological Reporting Data System (GIRADS), Ovarian Reporting Data System (ORADS), Ovarian


Adnexal masses can have gynecologic or non-
always clear (7). Recently many reporting systems are
gynecologic origins and can range from benign luteal
developed to increase the accuracy in diagnosing
cysts to malignant ovarian tumors (1). Ovarian cancer is
ovarian masses as GIRADS, ORADs and IOTA
the second most frequent form of gynecologic cancer,
(International ovarian tumor analysis group) (8).
with an estimated 22,000 new cases identified annually
The aim of the current study was to highlight the
in the United States in 2010 alone (2).
role of Gynecological Reporting Data System
Age, a family history of breast or gynecologic
(GIRADS) and Ovarian Reporting Data System
cancer, the existence of the breast cancer gene "BRCA"
(ORADS) in differentiating ovarian lesions and
or other genetic cancer syndromes, infertility
determine which of them a higher accuracy has based
treatments, obesity, and a lack of children are all risk
on biopsy result and short interval follow up.
factors for ovarian cancer. The patient's contraceptive

method and reproductive state also play an influence
A cross-sectional study was conducted on 100
When performed by an experienced clinician,
female patients with ovarian mass, attending at
transvaginal sonography (TVS) achieves great
Radiodiagnosis Department of Zagazig University
affectability for identifying ovarian disease and has
Hospitals from March 2020 to March 2021.
been shown to be useful for selecting the most cautious
Sample size: A Comprehensive sample was taken
treatment option for ovarian masses (5). TVS has come
including all female patients with ovarian mass,
a long way in terms of its diagnostic accuracy, however
attending at Radiodiagnosis Department Zagazig
a recent large multicenter study found that it has a
University Hospitals for 6 months. The sample was 100
potentially alarmingly high false positive rate of about
twenty-four percent (6).
Randomized research has shown that administrator

experience may be to blame for the high proportion of
Inclusion criteria:
false positives. Another possibility is that the
Any female patient with ovarian cyst or mass
during routine trans-abdominal or pelvic US.
communicated to the practitioner. It's true that
Available pathologic report or regular follow-
descriptions of sonographic findings in reports aren't
Received: 02/02/2023
Accepted: 02/04/2023

Full Paper (vol.921 paper# 64)

c:\work\Jor\vol921_65 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5892- 5899

Diagnostic performance of ACR-TIRADS ultrasound lexicon in risk
stratification of thyroid nodules
Sarah A. Nasser*, Nihal M. Batouty, Adel El-Badrawy
Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Sarah Abdelrahman Nasser, Mobile: (+20) 01010264624, E-Mail:


Background: Thyroid nodules (TNs) are commonly encountered in clinical settings. Many professional organizations
have adopted and published ultrasound-based risk stratification systems (RSSs) as a tool for standardized reporting
and evaluation. The American College of Radiology-Thyroid Imaging Reporting and Data System (ACR-TIRADS)
Committee in 2017 proposed a white paper with a novel risk stratification system that classifies TNs into 5
morphologic categories on the basis of their ultrasonographic features (echogenicity, composition, margin, shape, and
echogenic foci). These features are described and assigned points to obtain a total score that determines the thyroid
nodule's TR risk levels (from TR1 to TR5).
Objective: The aim of the current study was to assess the value of the ACR Thyroid Imaging Reporting and Data
System (ACR-TIRADS) Lexicon in predicting the nature of different thyroid nodules.
Patients and methods: A total of 102 subjects (90 female and 12 males; age between 18 and 77 years) with 130
thyroid nodules with a definitive cytopathologic diagnosis on the basis of US-guided FNAB and/or surgery results
were enrolled. The mean age was 41.03 (SD 13.09) years, with ages ranging between 18 and 77 years. Our study was
carried out between November 2020 and October 2022.
Result: The ACR-TIRADS US lexicon's predictive ability in thyroid nodules' risk stratification was assessed. The
overall accuracy, sensitivity, specificity, NPV, and PPV were 83.08%, 94.34%, 75.32%, 95.08% and 72.46%,
Conclusions: In everyday practice, ACR-TIRADS classification is a non-invasive, safe, reliable, and applicable tool
for evaluating thyroid nodules, standardizing report structure, and reducing inconsistencies with thyroid nodules'
Keywords: ACR TIRADS lexicon, Thyroid nodules, Cytopathology, Malignancy risk, Diagnostic accuracy.


Every nodule is described and allocated points
encountered in clinical settings, with a prevalence of
based on 5 US characteristics (echogenicity,
19% to 70% on ultrasound (US) assessment, a higher
composition, margin, shape, and echogenic foci), and
female incidence, and only ~ 5% of all thyroid nodules
these points are added up to obtain a total numeric
harboring malignancy. Thyroid cancer incidence is
score, resulting in a final risk level from TR1 to TR5.
expanding annually, and it is anticipated to end up as
Depending on the nodule's ACR-TIRADS risk
the 4th leading type of cancer worldwide. Thyroid
category and maximum dimension, FNA or ultrasound
cancer in Egypt is considered to be the 6th most
follow-up is advised (7-9).
common malignancy among Egyptian ladies and the
ACR TIRADS was found to be superior to other
7th among Egyptian men (1-3).
RSSs in terms of reducing the number of unnecessary
Given that ultrasound is the 1st line imaging
FNAs and raising diagnostic accuracy (10).
modality for the assessment of thyroid nodules,
The aim of the current study was to assess the
numerous professional organizations have adopted
value of the ACR Thyroid Imaging Reporting and Data
ultrasound-based RSSs to evaluate thyroid nodules'
System (ACR-TIRADS) Lexicon in predicting the
malignancy risk on the basis of US characteristics
nature of different TNs.
(either point-based or pattern-based approaches) (4).

The TIRADS lexicon was originally proposed in
2009 by Horvath et al., followed by several
Patient's demographic data:
modifications on the basis of clinical practice. In 2017,
A total of 102 subjects (90 female and 12 male;
the American College of Radiology (ACR) published a
age between 18 and 77 years) with 130 TNs with a
score-based, easily applicable approach called the
definitive cytopathologic diagnosis on the basis of US-
ACR Thyroid Imaging Reporting and Data System
guided FNAB and/or surgery results were enrolled
(TIRADS), on the basis of the Breast Imaging
(Figure 1). Our study was carried out between
Reporting and Data System (BIRADS) model (5,6).
November 2020 and October 2022.

Received: 02/02/2023
Accepted: 04/04/2023

Full Paper (vol.921 paper# 65)

c:\work\Jor\vol921_66 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5900- 5906

Extracorporeal Shock Wave Therapy versus Local Corticosteroid Injection and
Platelet-Rich Plasma in The Treatment of Supraspinatus Tendinopathy
Sarah El-Bably*, Sahar Ganeb, Ahmed El-Shambaky, Waleed Hassan
Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Sarah El-Bably, Mobile: (+20) 01000331143, E-mail:


Background: A chronic degenerative musculoskeletal condition known as tendinopathy is widespread in both the
general public and sportsmen. The most typical therapies used to facilitate tendon repair and regeneration are
extracorporeal shockwave therapy (ESWT), platelet-rich plasma (PRP), and local corticosteroid injection.
Objective: The aim of the current study was to evaluate the efficacy of ESWT to corticosteroid and PRP injections in
the treatment of supraspinatus tendonitis.
Patients and methods: A total of 60 subjects suffering from supraspinatus tendinopathy were recruited and divided
into 3 groups: 20 patients who received platelet-rich plasma (PRP) injections, 20 patients who received local
corticosteroid injection, and 20 patients who received ESWT using radial ESWT.
Results: In the PRP group results showed a statistically significant improvement in visual analogue scale (VAS),
tendon thickness, tear size, and American Shoulder and Elbow Surgeons patient self-report section (ASES-p). The
VAS, US examination, and ASES-p all indicated statistically significant improvements after corticosteroid injection.
The VAS, US test, and ASES-p all revealed statistically significant improvements in the ESWT group.
Conclusion: In comparison to steroid injection and ESWT, PRP therapy offers an extra favorable short-term benefit
for the treatment of supraspinatus tendinopathy. ESWT is also a simple, effective, and noninvasive alternative for the
treatment of supraspinatus tendinopathy. Two months following therapy, local corticosteroid injections reduced
discomfort and increased functional abilities.
Keywords: Supraspinatus tendinopathy, Shockwave therapy, Steroid injection, Platelet-rich plasma.


number of levels by acting directly on nuclear steroid
Supraspinatus tendinopathy is a common source
receptors. By doing this, they decrease vascular
of shoulder discomfort, and is a debilitating disorder
permeability, inhibit inflammatory cell accumulation,
that is particularly prevalent after middle age (1,2).
phagocytosis, neutrophil production, metalloprotease,
Resistive overuse is a predisposing factor (3).
and metalloprotease activator, as well as prevent the
Most frequently as a result of recurrent stressors
synthesis and release of several inflammatory
and overloading during sports or occupational
mediators like prostaglandin and leukotrienes, which
activities, the supraspinatus tendon is implicated,
reduces erythema, swelling, heat, and joint tenderness
damaged, and degenerates (4).
and increases relative viscosity (13).
Sometimes wear and tear results in supraspinatus
PRP, which is used to treat supraspinatus
tendinitis, which is commonly associated with
tendinopathy, is an autologous concentration of
subacromial bursitis. There may be partial tears or
platelets derived by whole blood centrifugation under
complete tears (5). Numerous conservative therapies
particular conditions. The activation of growth factors
exist, however there is little data to support their
such as PDGFs alpha, beta, TGFs beta 1 and beta 2,
effectiveness (6).
VEGF, and EGF, which can play a role in tendon
One-impulse acoustic waves known as shock
healing (15), is the result of the anti-inflammatory that is
related to the chemotactic activity towards the cells of
Extracorporeal shock wave treatment (ESWT) has
The aim of the current study was to evaluate the
been successfully utilized to treat enthesopathies over
efficacy of ESWT to corticosteroid and PRP injections
the past 20 years (7).
in the treatment of supraspinatus tendonitis.

epicondylitis, jumper's knee, and supraspinatus
tendinopathy has all been studied in clinical trials (8-11).
A randomized controlled clinical trial was
When subacromial corticosteroid injections are
conducted at Benha University Hospitals. A total of 60
utilized in the treatment of rotator cuff tendinopathies,
patients suffering from supraspinatus tendinopathy
corticosteroid injection in supraspinatus tendinopathy
were recruited and divided into 3 groups: 20 patients
revealed clinical benefits in pain reduction and range
who received platelet-rich plasma (PRP) injections, 20
of motion (12). This is because of their ability to reduce
patients who received local corticosteroid injection,
inflammation and the immune system. They disrupt
and 20 patients who received ESWT using radial
the inflammatory and immunological cascade on a
Received: 02/02/2023
Accepted: 04/04/2023

Full Paper (vol.921 paper# 66)

c:\work\Jor\vol921_67 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5907- 5913

Treatment of Unstable Displaced Distal Radius Fractures Using Kapandji Technique
Ahmed Mohammed Abdelwahab, Riad Mansour Megahed,
Farag A. Khalefa Mohamed*, Yamen Safwet Abdeldayem
Department of Orthopedic, Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Farag A. Khalefa Mohamed, Mobile: (+20)01061793498, E-mail:

One of the most frequent injuries seen in orthopedic practice is distal radius fractures. X-ray is the most
common test used to determine the presence of a fracture. In some cases, a CT scan is needed to confirm a fracture or
exclude intraarticular extension. Intrafocal Kapandji wiring is a safe and effective technique for treating stable fractures of
the lower end of the radius.
Objective: The current study aimed to evaluate the results of treatment of unstable displaced distal radius fractures in adults
with the kapandji procedure.
Patients and methods:
A total of 18 patients were included in this clinical trial, with a mean age of 46.61 years; 61.1% of
them were female. The extra articular unstable displaced distal radius fractures they had were treated by the Kapandji
procedure at the Orthopedic Department, Zagazig University Hospital (Egypt) and Central Ajdabia Hospital (Libya), during
the period from March 2022 to September 2022, with 6 months follow up.
Results: Concerning overall outcome, only 1 (5.6%) patient had fair outcome, 8 (44.4%) patients had good outcome while
9 (50%) patients had excellent outcome. Concerning complications, no patient had tendon injury, no neurovascular injury
or sundeck's atrophy. Meanwhile, 7 (38.9%) patients had superficial infection.
Conclusion: An efficient surgical approach for treating distal radius fractures is closed reduction and percutaneous k-wire
fixation using kapandji technique.
Distal radius, Fracture, Kapandji, Clinical trial, Zagazig University.


One of the most frequent fractures is a fracture of the
volar locking plate (VLP), while another is external
distal radius injuries encountered in orthopedic practice.
fixation (EF) (5).
They make up 7%-14% of all bony injuries in adults. Risk
Due to the extensive dissection of soft tissue around
factors for these fractures include reduced bone mineral
the fracture site and the requirement for removal surgery
density, female sex, early menopause, and family history
in cases of intra-articular fractures, internal fixation with
in the elderly (1).
VLP is a typical treatment for unstable distal radius
Different kinds of stresses can cause a distal radius
fractures (5).
fracture depending on position of the wrist joint at time of
External fixation has a multiple disadvantages, some
fall. These are primarily eccentric avulsion, axial
of which include pin track infection, pin loosening
compression, and bending moments, followed by
neuropathies of the superficial or median radial nerve,
different types of fracture (2).
radial shortening, and loss of radial tilt (6). The double
During distal radius fracture, the multiple
intrafocal pinning method was initially explained by
ligamentous attachments to the bone frequently remain
Aldalbert Kapandji in 1976 (7). Intrafocal Kapandji wiring
intact, enabling reduction through "ligamentotaxis" (3).
is a safe and effective technique for treating unstable
The first step in diagnosis is a person's own
fractures of the lower end of the radius. It is simple to
observation of symptoms. A fracture is diagnosed during
learn. The used technology is inexpensive (8).
a physical examination and serial radiography. The most
The current study aimed to evaluate the results of
frequent test to identify a bone fracture is an X-ray
treatment of unstable displaced distal radius fractures in
affected side, Because not all fractures are visible on a
adults with the kapandji procedure.
single x-ray, a series of X-rays was taken with at least two

views of the area to confirm the presence of the fracture
(4). It may take numerous examinations from various
A total of 18 patients (7 males and 11 females) with
angles to clearly identify the fracture lines in some
extra articular unstable displaced distal radius fractures
fractures, which are frequently difficult to discern. In
were included in this clinical trial, with a mean age of
some circumstances, a CT scan is necessary to show a
46.61 years (range 24 - 77 years) and 61.1% of them were
fracture (4).
One of the fixation methods utilized in clinical
The extra articular unstable displaced distal radius
practice for the treatment of distal radial fractures is the
fractures they had were treated by the Kapandji procedure

at the Orthopedic Department, Zagazig University
Received: 30/01/2023
Accepted: 02/04/2023

Full Paper (vol.921 paper# 67)

c:\work\Jor\vol921_68 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5914- 5918

Supraclavicular Approach vs Retroclavicular Approach as
A Brachial Plexus Block: Review article
Mahmoud Adel Mahmoud Hussein*, Hamza Abo Alam Mahmoud,
Khaled Mohamed Hassan, Abdelrahman Hassan Abdelrahman
Department of Anesthesia and Intensive Care Department, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Mahmoud Adel Mahmoud Hussein, Mobile: (+20) 01110437575, E-mail:

Five roots, three trunks, six divisions (three anterior and three posterior), three cords, and five
branches make up the brachial plexus. Supraclavicular, infraclavicular (ICB), or axillary brachial plexus blocks are
often used in regional anaesthesia for distal upper limb operations. The well-known and straightforward
retroclavicular route for brachial plexus anaesthesia is used. One of the methods for numbing the brachial plexus is
the retroclavicular block. In this method, the needle was placed above the clavicle's midpoint. It is a great option for
hand and elbow surgery.
Objective: This review article compared the needle visualisation, success rate, and timing of the beginning of the
sensory and motor block in supraclavicular and retroclavicular brachial plexus blocks.
Methods: Supraclavicular approach, Retroclavicular approach and Brachial plexus block were searched for in
PubMed, Google and Google Scholar. Only the most current or comprehensive study was included after the authors
thoroughly filtered references from the pertinent literature, which comprised all the recognised studies and reviews.
Conclusion: Supraclavicular approach has better needle visualization than retroclavicular approach and better
success rate but has shorter duration of both sensory and motor block.
Supraclavicular approach, Retroclavicular approach, Brachial plexus block.


For upper limb surgery, regional anaesthesia
The steep angle that the needle creates with the
(RA) has significant benefits over general anaesthesia
ultrasonic probe, which makes needle visibility
(GA). It lessens postoperative pain, which reduces the
difficult, is a natural drawback of this procedure. The
demand for opioids and makes it appropriate for
RCB technique delivers a nearly perpendicular needle
patients with co-morbid conditions that exclude the
ultrasonic (US) beam angle due to its variable needle
use of general anaesthesia (1).
entrance point (4), but nevertheless pursues the same
Supraclavicular, infraclavicular (ICB), or axillary
objective as the ICB. Theoretically, the block
brachial plexus blocks are often used in regional
performance criterion can be improved by this little
anaesthesia for distal upper limb operations. The
but crucial difference (5).
retroclavicular (RCB) brachial plexus block is a

brand-new, ultrasound-guided method of brachial
Brachial plexus block anatomy variations (Figure
plexus surgery (2).
Shorter treatment times, improved needle
Five roots, three trunks, six divisions (three
visualisation, less patient discomfort, and higher
anterior and three posterior), three cords, and five
patient satisfaction are said to be advantages of the
branches make up the brachial plexus. There are
retro-clavicular block over the conventional approach
multiple "pre-terminals" or "collateral" branches,
to the infraclavicular region.
including the subscapular nerve, the thoracodorsal
The brachial plexus anaesthesia technique known
nerve, and the long thoracic nerve, in addition to five
as the ICB method is straightforward to carry out (3).
"terminal" branches (6).

Received: 01/02/2023
Accepted: 03/04/2023

Full Paper (vol.921 paper# 68)

c:\work\Jor\vol921_69 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5919- 5921

Postoperative Pain Control in Patients Undergoing Open
Inguinal Hernia: Review Article
Ahmed Mamdouh Ahmed*, Wael Alham Mahmoud,
Ahmed Mohamed Abdelmaboud, Mohamed Ahmed Elheniedy
Department of Anaesthesia, Intensive Care and Pain Management, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Ahmed Mamdouh Ahmed, Mobile: (+20) 01204452026, E-mail:

Nociceptive and neuropathic post-operative discomfort of moderate severity is related to inguinal
hernia operations. The Wong-Baker FACES pain rating scale, the McGill Pain Questionnaire (MPQ), the Visual
Analogue Scale (VAS), and the Numeric Rating Scale (NRS) for pain are all used to measure pain.
Objective: To control the postoperative pain in patients undergoing open inguinal hernia.
Methods: Pain Control, Undergoing Open Inguinal Hernia and Visual Analogue Scale were searched for in PubMed,
Google Scholar, and The Egyptian Knowledge Bank. Systemic analgesic methods (such as opioids and nonsteroidal
anti-inflammatory drugs), localised analgesic methods (such as quadratus lumborum block (QLB)), and a multimodal
approach to perioperative recovery were used to control postoperative pain. High postoperative pain scores were seen
in patients with high pain levels in the first week following surgery, patients who had recurrent hernia repairs,
patients who had high levels of pain prior to surgery, and patients who had outpatient surgery were all risk factors for
inguinal hernia postoperative pain. Only the most current or comprehensive studies were included after the authors
thoroughly filtered references from the pertinent literature, which comprised all the recognised studies and reviews.
Conclusion: After open inguinal hernia surgery, a multimodal analgesic strategy (a mix of localised and systemic
analgesia) is particularly successful at reducing postoperative discomfort and promoting early mobilisation.
Keywords: Pain control, Undergoing open inguinal hernia, Visual analogue scale.

of any illness. Pain's alerting effect elicits defensive
Moderate intensity nociceptive and neuropathic
reactions and works to minimise tissue damage. The
post-operative discomfort is linked to inguinal hernia
ability to feel pain serves a protective purpose. If
operations (1). The genitofemoral, ilioinguinal, and
tissue damage cannot be prevented, a series of
iliohypogastric nerves are interdigitated and
modifications in the peripheral and CNS that control
overlapped in the inguinal region (2). Inadequate post-
pain perception takes place (9).
operative pain treatment increases patient stress leads
A complicated experience, pain includes elements
to cardiovascular problems, patient discomfort, and
that are physiological, sensory, emotional, cognitive,
slows recovery (3). In the standard of care for
and behavioral. The interplay of physical,
abdominal procedures, opioids are frequently used to
psychological, cultural, and spiritual variables affects
treat moderate to severe post-operative pain. Strong
how strongly pain is felt by an individual (10).
opioids, on the other hand, might result in

constipation, reduced bowel movement, nausea,
Classification of pain: neuropathic, nociceptive,
vomiting, pruritus, urine retention, and even
acute, chronic, pathologic, and physiological pain.
respiratory depression (4).

Regional nerve blocks and intravenous (IV)
patient-controlled analgesia are being used to
postoperative pain is a typical reaction to surgical
alleviate post-operative pain (5). Excellent site-specific
intervention and a factor in delayed healing and
pain alleviation and a decrease in negative side
postoperative discharge. Chronic postsurgical pain
effects are provided by regional nerve blocks (6, 7).
(CPSP) can significantly affect a patient's daily
In addition to being helpful in the proper
activities and quality of life (11).
management of acute pain, newer methods of
Risk factors for chronic postsurgical pain:
regional analgesia, longer acting (LA) and adjuvants,
Recurrent surgery, imagining the worst-case scenario,
and safety with ultrasonography (US) are also helpful
anxiety, female gender, younger age (adults),
in avoiding the development of chronic pain (6). As
workers' compensation, genetic predisposition,
opposed to transversus abdominis plane (TAP) block,
surgical technique with risk of nerve injury, moderate
which only relieves somatic pain, US-guided
to severe postoperative pain, radiation therapy to the
quadratus lumborum (QL) block has recently been
region, neurotoxic chemotherapy, depression, and
proven to produce both somatic and visceral
neuroticism (11).
analgesia (8).
Pain pathway (Figure 1): It can be thought of as a
The International Association for the Study of
three-neuron chain, with the first-order neuron
Pain (IASP) defines pain as "An unpleasant sensory
coming from the periphery and projecting to the
and emotional experience associated with, or
spinal cord, the second-order neuron climbing the
resembling that associated with, actual or potential
spinal cord, and the third-order neuron coming from
tissue damage". Pain is the most prevalent symptom
the cerebral cortex (12).
Received: 01/02/2023
Accepted: 03/04/2023

Full Paper (vol.921 paper# 69)

c:\work\Jor\vol921_70 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5922- 5927

Prevalence of Hypertension in Primary School Children in
Some Rural Areas at Sharqia Governorate
Tarek Abd El Rahman Atiyyah, Mohamed Mahmoud Romih, Mahmoud ELsaeed Gomaa Yousef*
Department of Pediatrics, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Mahmoud ELsaeed Gomaa Yousef, Mobile: (+20) 01066679248, Email:

Increased carotid intima-media thickness and ventricular hypertrophy are two examples of the target
organ damage that can occur in children with hypertension, which also raises the chance of developing cardiovascular
disease later in life.
Objective: To determine prevalence of high blood pressure (HTN) among primary school children in the City of Dyarb
Negm, Sharqia Governorate and determining the causes of high blood pressure in kids.
Subjects and methods: This is a cross-sectional study that we carried out from September 2018 to March 2019. The
sample was calculated to be (817) students. All children were subjected to questionnaire filled by parents asking about:
Personal data and family medical history. Measurements taken for each student were weight, height, and blood pressure.
Results: HTN were (37 cases) 4.5% (3.2% stage 1 and 1.3% stage 2) and pre HTN (76 cases) 9.2%, and normal were
86.4%. Pre hypertension and HTN cases were significantly associated with high social class and HTN was significantly
associated with low social class. HTN and Pre HTN cases were significantly associated with obesity and overweight.
Diabetes mellitus (DM), HTN and obesity positive family history were significantly associated with HTN then Pre HTN.
Conclusion: HTN among studied group was found in 37 cases (4.5%; 3.2% 1st grade and 1.3% 2nd grade). This study
provides important evidence of the association between obesity, based on BMI and high blood pressure. HTN was
significantly associated with high salt intake, higher number of meal and high caloric diet. Family history of HTN and
obesity were significantly associated with HTN then Pre HTN.
Keywords: Hypertension, Children, Primary School Children, Prevalence.


Target organ damage, such as increased carotid
This is a cross-sectional study that we carried out
intima-media thickness or ventricular hypertrophy, can
from September 2018 to March 2019. The sample was
occur in children with hypertension, and this raises the
calculated to be (817) students. Written consents were
chance of developing cardio vascular disorders later in
obtained from all parents of enrolled subjects in the
adulthood. According to one study, kids whose systolic
blood pressure (SBP) is over the 90th percentile tend to
Students aged 6 to 12 years from three different
stay there [1]. Thus, identifying and altering risk factors
elementary schools in three different districts in a rural
can reduce the occurrence of the condition, while early
area near the Dyarb Negm Center in the Sharqia
identification and care in children can limit the disease,
Governorate were recruited using a multi-stage sample
minimize complications, and reduce morbidity and
technique, from 17 centers in Sharqia we chose Dyrab
mortality from cardiovascular diseases in adulthood [2].
Negm Center as a cluster which is mainly a rural center
The rate of childhood hypertension is rising[3]. The
and between 7 main villages in Dyarb we chose Gemiza
previously reported prevalence of hypertension in
village which is the biggest also as a cluster, all the three
children was between 1% and 2%; recent estimates
public primary schools were chosen, then children from
place it between 4% and 5% worldwide[4].
1st to 6th grade were chosen randomly.
In children, there is a complex interaction between
The sample was calculated to be (817) students (317
genetics and environment that contributes to the
boys and 500 girls) as the total number of students at the
development of hypertension (primary). Studies have
three primary schools is about (1920), prevalence of
shown a strong positive family history among siblings
hypertension among primary school children was
with primary hypertension, suggesting a role for
6.48%, power of study was80%, and with CI 95% (Epi
genetics in the development of the disease[5].
info version 6).
Furthermore, obesity is connected to the start of
Inclusion Criteria: Children in three primary school
hypertension in children, and the increased prevalence
children (6 to 12) years old from both sexes; male and
of juvenile obesity is largely to blame for this alarming
increase. Primary hypertension in children has also been
Exclusion Criteria: Children families who were
linked to socioeconomic disadvantage and low birth
unwilling to participate in the study.
weight in firstborns[6].
We aimed at this work to determine prevalence of
All children were subjected to questionnaire filled by
high blood pressure (BP) among primary school
parents asking about:
children in the City of Dyarb Negm, Sharqia
Personal data (name- age- sex-parental occupation
Governorate and determining the causes of high blood
and education), medical history of student such as
pressure in kids.
hypertension, diabetes mellitus and drug intake).

Received: 02/02/2023
Accepted: 04/04/2023

Full Paper (vol.921 paper# 70)

c:\work\Jor\vol921_71 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5928- 5932

Zinc Possible Correlation with Pneumonia: Review Article
Esraa Rizk Elsayed Nasr*1, Samir Mohammed Zamzam1,
Mohammed Mahmoud Romih1, Doaa Metwaly Abd El Monem2
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Esraa Rizk El-sayed Nasr, Mobile: (+20) 0 100 327 5747, E-Mail:

One of the most important trace elements is zinc. Proliferating cells throughout the body, and the immune
system in particular, rely heavily on zinc. Humans have between 2 to 4 micro grammes of zinc in their bodies, with about
95% of that amount being located within their cells. Although zinc is found in all bodily tissues and fluids, about 57% of
the body pool is kept in skeletal muscles, 29% in bone, and 6% in skin.
Objective: Review of literature about zinc possible correlation with pneumonia.
We searched Science Direct, Google Scholar as well as PubMed for relevant articles on Zinc as well as
Pneumonia. Only the most recent or thorough study was taken into account between May 2001 and April 2023. The
authors also evaluated the value of resources culled from other works in the same genre. Therefore, documents written
in languages other than English have been ignored due to a lack of translation funds. Unpublished works, oral
presentations, conference abstracts, and dissertations were generally agreed upon not to qualify as scientific research.
Conclusion: Zinc transporters control the levels of zinc in lung tissue, where it binds mostly to metallothionein (MT).
Cigarette smoke contains significant concentrations of cadmium (Cd), a hazardous heavy metal and carcinogen, and
ZIP8, a zinc transporter, is the primary entry site for Cd. Zinc lowers the cytotoxicity of Cd to alveolar epithelial cells
after inhalation of Cd-containing gas by competing with Cd for binding to ZIP8 protein. Preventative zinc
supplementation can lessen the likelihood of contracting pneumonia. Zinc supplementation has been shown to reduce
the severity and duration of pneumonia.
Keywords: Zinc, Pneumonia, Interleukin, B cells.

is another consequence of zinc deficiency's effect on the
Serum zinc concentrations in healthy adults are
adaptive immune response, which includes thymic
kept within a small range (about 10-15 mol; 70-98
atrophy, lymphopenia of activated T cells, and a
g/dL) by homeostatic processes. When zinc
decrease in both immature and premature B cells (4).
consumption is kept constant (between 5 and 20 mg per
Lymphocyte proliferation slows down in people
day), blood levels of zinc is kept stable (1). To maintain
who don't get enough zinc. Both CD4+ and CD8+
a sufficient zinc level, the mineral must be taken in on a
thymocyte numbers drop dramatically when zinc intake
daily basis through diet. Zinc is mostly absorbed by the
is low. In reaction to higher glucocorticoids caused by
cells of the jejunum and stored in the liver, bones, and
zinc deficiency, naive cells sustain high levels of
muscles. Increased intercellular signaling and zinc
apoptosis. In addition to being able to withstand zinc
homeostasis occur despite plasma zinc making up only
deprivation and thymic atrophy, mature CD4+ and
0.1% of total zinc storage (2).
CD8+ T lymphocytes also have larger quantities of the

anti-apoptotic protein Bcl2. Zinc deficiency,
Zinc and immunity:
interestingly, maintains some parts of innate immunity
Both innate and adaptive immunity play a role in
via maintaining myelopoiesis (5-8).
protecting the body. Innate immune cells are the first to

detect and destroy foreign invaders. Some of the first
Zinc and inflammation:
cells to respond to an infection are called
The inflammatory response resolves and equilibrium is
polymorphonuclear cells (PMNs), macrophages (M),
restored because inflammation is a necessary, protective
and natural killer cells (NK). Zinc deficiency impairs
response to tissue damage and infection. However, in
PMN chemotaxis and phagocytosis, whereas zinc
other cases, the inflammation does not go away and
supplementation restores these functions. Both zinc
becomes chronic, resulting in the dysfunction of the
deficiency and excess have been demonstrated to
affected tissues (3).
impede the action of nicotinamide adenine dinucleotide

phosphate (NADPH) oxidases, which are responsible
NF-B and other signaling pathways:
for the destruction of pathogens following phagocytosis
The NF-kappa B (NF-kappa light chain enhancer
on activated B cells) signaling pathway is an important
The levels of proinflammatory cytokines including
mediator of inflammation. This transcription factor
interleukin (IL)-1beta, IL-6, and tumour necrosis factor
(TNF)-alpha are elevated in the body when zinc is
proliferation, adhesion, tissue remodeling, immune
lacking. Zinc depletion affects NK cell lytic activity and
responses (both innate and adaptive), inflammation, and
NK cell recognition of major histocompatibility
stress responses. Then, it alters the production of
complex (MHC) class I. Reduced antibody production
inflammatory cytokines such TNF-alpha, IL-1 beta, IL-
Received: 02/02/2023
Accepted: 04/04/2023

Full Paper (vol.921 paper# 71)

c:\work\Jor\vol921_72 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5933- 5936

Difficult Airway: Assessment, Prediction and Management: Review Article
Aya Mohammed sayed El-otafey*, Ahmed Elhalwagy,
Wesam Abd-ElgeliL Abu-Alwafa, Ahmed Mohamed Abd-Elmaboud
Anesthesia, Intensive Care and Pain Management Department, Faculty of Medicine, Sohag University, Egypt
*Corresponding author: Aya Mohammed sayed El-otafey, Mobile: (+20) 01065696656, E-mail:

When an anesthesiologist with traditional training has trouble completing tracheal intubation, face mask
ventilation of the upper airway, or both, this is referred to as a "difficult airway" (DA). The greatest danger is when
treating the airways of patients who have been diagnosed with difficult mask ventilation (DMV) or who are anticipated
to be problematic.
Objective: To highlight for using particular techniques makes it easier to intubate a problematic airway.
Methods: We searched PubMed, Google Scholar, and Science Direct for relevant articles on Difficult airway,
assessment, Prediction and Management. Only the most recent or thorough study was taken into account between June
2003 and July 2020. Documents written in languages other than English have been ignored due to a lack of translation
funds. Unpublished works, oral presentations, conference abstracts, and dissertations were generally agreed upon not to
qualify as scientific research.
Conclusion: Difficulty in intubation is a main problem encountered during general anesthesia that arise from anatomical
and physiological barriers. Algorithm for airway management in DA is important to overcome possible complications.
Keywords: Difficult airway, Difficult airway, difficult mask ventilation.


2. Physiologically difficult intubation
Pre-intubation assessments frequently disregard
Patients with significant underlying lung illness,
anatomical and physiological constraints. Because of
acute hypoxemic respiratory failure, or a SpO2 < 100%
this, the following procedures were carried out at each
despite preoxygenation are more prone to experience
intubation, just in case: In event of an emergency,
intubation-related hypoxemia. Positive pressure
phenylephrine and rescue equipment (such as but not
breathing must be used during pre-oxygenation and
limited to oropharyngeal, nasopharyngeal, bougie,
between induction and laryngoscopy in high-risk
laryngeal mask airway (LMA), and cricothyrotomy
patients to prevent hypoxemia [6].
equipment) should be readily accessible [1].

Two procedure specialists are working as a team to
Difficult airway assessment
do the intubation. The patient's left ear is where the
A "difficult airway" (DA) occurs when a classically
primary proceduralist is positioned at the head of the
trained anesthesiologist has difficulty performing
bed, and the secondary proceduralist is standing nearby
tracheal intubation and face mask ventilation of the
but helping [2].
upper airway, or both. A more full explanation would
In two-person bag-mask ventilation, the secondary
include direct tracheal access, airway instrumentation
proceduralist's responsibilities include monitoring vital
(such as with supraglottic airway devices), and airway
signs, providing supplies to the primary proceduralist,
consideration during extubation [7].
and making sure the larynx stays in the proper position

following external laryngeal manipulation. The most
Clinical history
skilled proceduralist will give each airway management
Any past chronic illnesses, such as diabetes mellitus,
method (tracheal intubation, LMA, bag-mask
ankylosing spondylitis, and rheumatoid arthritis, that
ventilation) one "best effort" before going on to the next
have reduced joint mobility should be mentioned. The
one, with a fast progression to cricothyrotomy in the
unusual DA-related disorders Pierre-Robin, Klippel-
exceedingly rare instances of "can't intubate, can't
Feil, and Treacher-Collins are a few examples. Acute
oxygenate" [3].
respiratory tract infections that have recently occurred

increase the risk of bronchospasm and laryngospasm [7].
Difficulty in intubation

1. Anatomically difficult intubation
Clinical examination
Prior to the procedure, risk factors for
Obesity, prominent chest/breasts, beards, and other
anatomically difficult intubations were evaluated. These
external signs of head and neck disease are
factors included previous difficult intubations that were
straightforward to spot during patient examination.
documented, immobility of the jaw [4, 5].
Additional airway-specific tests that are designed to

foretell difficulties have been extensively studied and

published in the literature. Individual airway tests are
Received: 06/02/2023
Accepted: 06/04/2023

Full Paper (vol.921 paper# 72)

c:\work\Jor\vol921_73 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5937- 5941

Association of Helicobacter Pylori Infection with Metabolic Syndrome in Egyptians
Mahmoud Rizk*, Mohamed AbdElatif Afifi, Fawzy Megahed Khalil,
Mohamed Ahmed AlAssal, Alaa Abdelfatah Mohamed, Yomna Mohamed Marei
Internal Medicine Department, Faculty of Medicine, Benha University, Benha Egypt
*Corresponding Author: Mahmoud Rizk, Mobile: (+20) +01117544801, Email:

Helicobacter (H.) pylori infection and metabolic syndrome (MetS) are both significant health concerns
with potential interconnections. However, H. pylori infection and MetS association in the Egyptian society remains
uncertain due to inconsistent findings in previous studies.
Objective: To evaluate correlations between MetS and H. pylori infection.
Patients and Methods: Totally 50 adult participants diagnosed with metabolic syndrome as MetS group and 52 healthy
controls as control group were involved in our study. MetS was diagnosed regarding NECP ATP III criteria, while H.
pylori stool antigen test (SAT) was utilized to determine H. pylori infection presence. Participants underwent medical
history assessment, general examination, laboratory tests, including H. pylori SAT, and abdominal ultrasound.
Results: H pylori was more positive in MetS group in comparison to control group (67.3% vs. 30%, respectively,
P<0.01). Logistic regression model showed that univariate analysis showed that positive H. pylori infection was a risk
factor for MetS development with p value <0.001 and odds ratio 4.8 (95% CI 2.08-11.1). Multivariate logistic regression
found that positive H. pylori infection is a MetS independent predictive factor with 5 folds increase in a developing
MetS risk following age, gender, and body mass index (BMI) adjustment with p value 0.002.
Conclusions: H. pylori infection was significantly related to MetS incidence with 5-fold rise in MetS incidence among
individuals with positive H. pylori antigen in stool test after adjusting for other risk factors.
Keywords: Helicobacter Pylori, Infection, Metabolic Syndrome, Egyptians.


been proposed. Infection with H. pylori has also been
MetS is a significant public health concern
associated to oxidative stress, insulin resistance, and
worldwide, characterized by metabolic abnormalities
low-grade systemic inflammation, which are crucial
clustering involving hypertension, insulin resistance,
MetS components [6,7]. In Egypt, H. pylori infection and
dyslipidaemia and central obesity [1]. MetS prevalence
MetS are prevalent, so it provides an ideal setting to
has progressively risen over the past few decades, and it
explore this potential association. Several researches
is related to an elevated cardiovascular diseases and
have examined H. pylori infection and MetS prevalence
type T2DM risk. MetS has a complicated aetiology
independently in Egyptian populations. However,
involving interactions between genetic, environmental,
limited research has focused on examining H. pylori
and behavioural variables [2, 3]. The Gram-negative
infection and MetS association in this particular
bacteria H. pylori are known to cause chronic gastritis,
community [8,9]. Therefore, this study purposed to assess
peptic ulcer disease, and stomach cancer. It colonises
H. pylori infection and MetS association in Egyptians.
the gastric mucosa. Recent data indicates, however, that
H. pylori may also has a role in extra-gastrointestinal
Study Design and Participants: A cross sectional
diseases, like metabolic disorders. Multiple researches
study was performed to detect H. Pylori infection and
have studied the potential relationship among MetS and
MetS association in Egyptians. Our sample included 50
H. pylori infection, but the outcomes have been variable
adult patients who seek GIT outpatient clinic at faculty
[4, 5]. Based on the observation that H. pylori-induced
of medicine in Benha University that were diagnosed
chronic gastritis changes stomach acid secretion and
with metabolic syndrome (MetS group) along with 52
ghrelin levels, which may impact appetite and satiety, a
healthy controls (control group).
connection between H. pylori infection and MetS has
Metabolic syndrome was diagnosed according to NECP ATP III criteria:

Figure (1): Diagnostic criteria for metabolic syndrome [10].
Received: 02/02/2023
Accepted: 04/04/2023

Full Paper (vol.921 paper# 73)

c:\work\Jor\vol921_74 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5942- 5949

The Role of Radiological Vascular Assessment and Computer-Aided Planning in
The Outcome of Free Vascularized Fibula Flap for Bone Defects Reconstruction
Ahmed Samir Farag*, Mohamed Ahmed Megahed,
Yasser Mohamed Elsheikh, Mohamed Hamdallah Zedan, Mohamed Abdallah Elnahas
Plastic & Reconstructive Surgery Department, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Ahmed S. Farag, Mobile: (+2):01009427749, Email:


Background: Computer aided planning of free vascularized fibula flap is introduced for treating cases with bone defects.
Objective: The aim of the current study was to evaluate the effectiveness and benefits of planning and simulation in the
outcome of free fibula flap (FFF).
Patients and methods: A total of 30 cases were managed in Menoufia University Hospital, Plastic and Reconstructive
Surgery Department, between March 2020 and May 2023. The participants in our study were 15 consecutive patients
(Group 1) who had free fibula flap mandibular reconstruction utilizing CAD-CAM technology and 15 more patients
(Group 2) had free fibular mandibular repair using standard methods.
Results: In contrast to the conventional group (812 minutes), the CAD-CAM group's overall intraoperative duration
was much less (662 minutes). In the CAD-CAM group, only 1 patient had postoperative malocclusion, compared to 6
individuals in the conventional group.
Conclusion: The computer aided planning is effectively allowing the procedure to be performed with less time, effort,
complications and hospitalization time, moreover increased accuracy, better functional and aesthetic outcome.
Keywords: Computer aided planning, Free fibula flap, Bone defects.

accordance with the simulation of the mandibular shape.
A highly difficult technique for the reconstructive
In order to ease osteotomy and improve accuracy, VSP
surgeon is the restoration of discontinuity defects in the
is increasingly used in the context of complicated defect
bone, especially the mandible, caused by benign or
reconstruction, particularly in situations of at least two
malignant tumors. To attempt to rebuild these flaws,
segmental mandible restorations (6).
several alternative strategies have been employed (1).
The perforator vessels that emerge from the fibula's
Alloplastic material, non-vascularized bone
posterior edge supply the skin paddle with nutrients via
grafting, and vascularized bone transfers are some of
the peroneal artery. Regrettably, the anatomical route of
the methods employed. The transfer of osteocutaneous
these perforator arteries frequently exhibits substantial
free tissue with the use of microsurgical methods has
variability, which can make planning challenging (7).
been considered nowadays as the most common
Although Doppler ultrasonography, CTA, and
procedure in the context of mandibular reconstruction
MRA are frequently utilized in the context of
presurgical assessment, the results are frequently not
Owing to the emerging of novel procedures and the
connected to CAD/CAM planning methods. Of note, the
range of flap donor locations, there are many
fibula's bony portion has a sturdy nature. Its
reconstructive choices available. However, the fibula
incorporation into CAD/CAM logarithms with regard to
continues to be the most popular donor location (3).
surgical plan is a commonly utilized and largely
In the context of reconstructive head and neck
appreciated tool as a result (8).
surgeries, the bone restoration of the mandible using
The aim of the current study was to evaluate the
effectiveness and benefits of computer aided planning
mandibulectomy is a recognized conventional
as tool in improving free fibula flap (FFF) results in
treatment. Owing to a lengthy vascular pedicle, a broad
bone defects reconstruction.
artery diameter, and the ability to create a skin island as

well as a muscle cuff, it was found to be an excellent
candidate for mandible restoration (4).
A total of 30 cases were managed in Menoufia
The bone transplant that enables restoration of the
University Hospital, Plastic and Reconstructive Surgery
entire mandible by using a single flap is the fibula. To
Department, between March 2020 and May 2023. The
establish a harmonious and functioning neomandibular
participants in our study were 15 consecutive patients
arch, however, surgeons must restore complicated
(Group 1) who had free fibula flap mandibular
abnormalities with one or multiple osteotomies (5).
reconstruction utilizing CAD-CAM technology and 15
To handle the critical functions of the mandible
more patients (Group 2) had free fibular mandibular
related facial harmony, speaking, mastication, and
repair using standard methods.
airway management and to duplicate it as closely as

possible, the fibula must be precisely adapted,
Inclusion criteria: Patients of both genders (14 males
segmented, and formed. As a result, the actual
and 16 females); their age ranged from 26 to 66 years
osteotomy angles and bent plates are assumed in
old. All participants were patients with extensive bone
Received: 06/02/2023
Accepted: 06/04/2023

Full Paper (vol.921 paper# 74)

c:\work\Jor\vol921_75 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5950- 5953

"Triple Rule Out" CT scan in Emergency Department Patients
Amr Mostafa Kadry Mostafa Elsherif1*, Mohamed Tharwat Mahmoud Solyman1,
Ahmed Samir Ibrahim2, Mohammad Zaki Ali Mourad1
1 Radiology Department, Faculty of Medicine, Sohag University, Egypt
2 Radiology Department, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Amr Mostafa Elsherif, Mobile: (+20) 01005356935, E-mail:

Although conventional coronary angiography is the gold standard tool of diagnosing coronary artery
disease (CAD), it is an invasive procedure, and it can miss non-coronary causes of acute chest pain. Triple role out CT
has emerged as a promising tool for assessment of such cases. Herein, we present our experience in comparing "triple
out CT" as a diagnostic tool for acute chest pain patients. Objective: The aim of the current study was to assess the
validity and efficacy of triple rule-out CT in diagnosis of different vascular causes of chest pain in the Emergency
Department. Patients and methods: The data of 50 patients with an intermediate risk for CAD were retrospectively
reviewed. All of them underwent the triple out protocol, and when coronary cause was established, conventional
angiography was done. Results: CT angiography (CTA) revealed CAD in 29 (58%) subjects, while non-coronary
disease was detected in 12 (24%) patients. The remaining nine subjects had negative CTA study. In the patients
diagnosed with CAD, most of them had severe disease (82.8%), whereas the remaining five patients had moderate one.
Findings rather than CAD included pulmonary embolism, mediastinal mass, acute aortic disease, pulmonary disease,
hernia, and pulmonary artery aneurysm. There was a significant relation agreement between CTA and cardiac
catheterization regarding the severity of CAD (P<0.001). Conclusion: Triple out CT could be a surrogate diagnostic
modality for patients with acute chest pain, even when CAD is suspected. It can yield comparable results compared to
the conventional coronary angiography. Therefore, its application is widely recommended in low-source emergency
Keywords: Acute chest pain, Triple out CT, Coronary angiography.

rule-out CT in diagnosis of different vascular causes of
Acute chest pain is one of the most common causes
chest pain in the Emergency Department.
of emergency department visits (1). It ranks the second

following abdominal pain (2). As acute chest pain has a
wide differential diagnosis, it represents a major
We retrospectively reviewed the data of
diagnostic challenge for emergency care physicians (3).
consecutive 50 patients who presented with acute chest
Although it has benign and simple etiologies, it could
pain to our Emergency Department at Sohag University
be the manifestation of life-threatening conditions
Hospitals, during the period between January and
including myocardial ischemia, thoracic aortic
December 2021.
dissection, or pulmonary embolism (4,5).
We included patients classified to have an
Coronary artery disease (CAD) is one of the most
intermediate risk for acute coronary syndrome (ACS),
common and serious causes of chest pain (6). Although
according to the TIMI score (scores between 3 and 5)
conventional coronary angiography is the gold standard
(14). Contrarily, we excluded patients with high risk
investigation in assessment of such pathology, it is an
(TIMI score >5), pregnancy, high creatinine level (>1.2
invasive technique that carries some risk of
mg/dl), and who reported previous allergy to the
complications (1). Besides, it does not assess other
contrast media. Patients with traumatic chest pain were
causes of chest pain that might be serious as well (7).
also excluded.
Multiple reports have confirmed the efficacy of
All patients were subjected to detailed history
coronary CT angiography in excluding significant
taking, physical examination and routine laboratory
coronary stenosis (8-10). In addition, the "triple rule-out
investigations. The triple out CT protocol in the current
protocol" can assess other causes of life-threatening
study was performed via a 128-multislice CT device
chest pain beside coronary ischemia, using the 64-slice
using a 0.5 mm Detector-row dimension, 0.35 s gantry
MDCT device, with a single breath hold (2,11,12). This
rotation, 160 mm beam width, and 175 s temporal
protocol has been widely used as it is not invasive
resolution for each cross-section image.
compared to the conventional cardiac catheterization,
Five minutes prior to the CT examination, 5 mg
and it could also assess other intrathoracic structures in
of sublingual nitroglycerin was commenced for all cases
a single scan (13).
to obtain sufficient coronary vasodilation, and if the
Herein, we present our experience in comparing
patient had a heart rate more than 65 bpm, intravenous
"triple out CT" as an alternative diagnostic tool to the
metoprolol (5-15 mg) was administered. This was done
conventional coronary angiography in assessment of
to decrease the heart rate in order to enhance the
patients with acute chest pain. The aim of the current
imaging quality. Continuous hemodynamic monitoring
study was to assess the validity and efficacy of triple
Received: 06/02/2023
Accepted: 06/04/2023

Full Paper (vol.921 paper# 75)

c:\work\Jor\vol921_76 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5954- 5960

Flow, Film thickness and Setting Time Properties of Three Mineral
Trioxide Aggregate Based Bio-ceramic Sealers: An in Vitro Study
El Shimaa Abdelkrim Elshazly1*, Dalia Ali Ahmed Moukarab2, Reem Gamal3
Departments of 1Dental Biomaterial, 2Endodontic and
3Dental Materials, Biomaterials, Faculty of Dentistry, Minia University, Egypt
*Corresponding Author: Shimaa Elshazly, Mobile: (+20) 01020020868, E-mail


The mineral trioxide aggregate (MTA) based bio-ceramic (MTA-BCS) has become quite well known for
its top-notch amenities. The quality of the obturation procedure is influenced by the composition and handling
characteristics of the root canal sealers. Flow, film thickness and setting time are the most important handling properties
as they affected the ability of the sealers to enter narrow and irregular spaces.
Objective: The aim of the current study was to evaluate 3 commercially available MTA-BCS sealers regarding flow,
film thickness and setting time.
Materials and methods: Three commercially available MTA based sealers were used in this study. Samples were
divided into three groups; Group I (MTA fillapex), Group II (Ceramoseal HBC) and Group III (Endoseal MTA).
Flow, film thickness, initial and final setting time were tested according to ISO 6876 standards.
Results: For the flow, test Group I showed the highest mean value (26.50±0.50 mm) and the lowest statistically
significant mean value was Group II (22.59±1.94 mm). For the film thickness, the highest statistically significant mean
value was recorded in Group II (29.4±4.72 m) while the lowest mean value was recorded in Group III (15±3.53m).
For initial setting time, the highest statistically significant mean value was recorded in Group I (858.51±11.82 min). The
lowest statistically significant mean value was recorded in Group III (35.2±2.86 min). For final setting time, group I
was unable to set up to one month. Group III was the shortest statistically significant mean value (150.4±3.44 min)
compared to Group II (832±6.78 min).
Conclusion: Within the limitation of this study, it can be concluded that all the tested sealers fulfilled the requirements
of ISO specifications no 6876 for flow and film thickness. Regarding setting time, only Group II fulfilled their
manufacturer declaration for initial setting as stated by ISO.
Keywords: Bio-ceramic sealer, Calcium silicate sealer, Ceramoseal HBC, Endoseal MTA, MTA fillapex sealer.


To create a fluid-proof seal throughout the root
In the 1990s, retrograde fillings made of bio-
canal system, endodontic sealers are utilised. Sealants
ceramic materials were first used in dentistry. Later,
stop leaks, lessen the chance that lingering germs from
root healing cements and root canal sealers also used
the canal may infiltrate the periapical tissues, and heal
these materials (5). Calcium silicate based sealers have
the periapical lesion (1). Grossman claims that the
successful results of root canal treatment. They are
optimum root canal sealers should produce a good seal,
categorized into two groups, MTA based and non MTA-
offer good adhesion, be radio opaque, and not discolour
BCS (6).
the tooth structure. They should also be insoluble in
Tricalcium oxide, tricalcium silicate, bismuth
tissue fluids, easily mixed and injected into the canals,
oxide, tricalcium aluminate, tricalcium oxide,
and dimensionally stable. Sealants should give adequate
tetracalcium aluminoferrite, and silicate oxide make up
working and setting times, be bactericidal or
the majority of the MTA-BCS formula. The chemical
bacteriostatic, and not irritate periradicular tissues (2).
and physical characteristics of MTA are also caused by
Until now, none of commercially available endodontic
a few other mineral oxides (7). They are dimensional
sealers fulfil all these ideal requirements (3).
stable, have excellent sealing ability and are not
Zinc oxide eugenol, calcium hydroxide-containing,
technique sensitive (8).
resin-based, glass-ionomer-based and bio-ceramic-
The MTA-BCS have received scientific interest due
based sealers (BCS) are the different chemical
to their superior properties in comparison to other
categories used to classify sealants. Calcium silicate-
sealers. Previous studies showed variations in properties
based, calcium phosphate-based, and calcium silicate
of different commercially available MTA-BCS which
and phosphate-based combinations are the three
might affect quality and durability (9-11).
categories of bio-ceramic-based sealants (1).
The aim of the current study was to evaluate 3
The main advantages of BCS are excellent
commercially available MTA-BCS sealers regarding
biocompatibility, seal, antibacterial activity and
flow, film thickness and setting time.
radiopacity. Excellent biocompatibility properties are

due to their analogous composition with hard tissues
which lead to a regenerative effect. Furthermore, the
The 3 commercially available MTA-BCS used in
creation of a chemical bond with the tooth structure is
this study are summarized in Table 1.
what allows for an effective seal (4).

Received: 07/02/2023
Accepted: 09/04/2023

Full Paper (vol.921 paper# 76)

c:\work\Jor\vol921_77 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5961- 5967

Prevalence of Obesity in the Under-Fives and Its Association with
Marketed Foods and Beverages for Children and Anxiety in Mothers
Noura A. Awaad*1, Azza M. Abul-Fadl1, Ehsan M. Fahmy2, Eman S. Ahmed1
Departments of 1Pediatrics, and 2Neuro-Psychiatry, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Noura A. Awaad, Mobile: (+20) 01024677939, E-mail:

Childhood obesity is a significant public health issue across the world. Inappropriate marketing of
commercial milk formula (CMF) and unhealthy foods and beverages to young children has been found to be
associated with the emergence of obesity in young children. Additionally, maternal anxiety and the stress they place
on children has been suggested to influence eating habits of children. Objective: To investigate obesity prevalence in
children aged 2-5 years and its association with early feeding practices and inappropriate marketing of unhealthy
foods and beverages, as well as the anxiety levels of their mothers. Patients and Methods: This study employed a
combination of cross-sectional and case-control study designs to investigate the prevalence of overweight and obesity
in children aged 2-5 years in Qalyubia Governorate, as well as the associations between overweight/obesity and the
marketing of breast-milk substitutes and unhealthy foods. The research was divided into two distinct phases. In the
first phase, a survey was conducted among 1000 mother-child pairs from nurseries in the nine districts of Qalyubia.
The second phase involved a case-control study, with 100 obese children and 100 non-obese children being included
for analysis. Results: Overweight (W/A and BMI >+2 Z-scores) and obesity (W/A and BMI > +3 Z-scores) was
identified in 15.4% and 4.2% respectively; and stunting (L-HL/A >-2 Z-scores) in 47%. Children who were not
breastfed or breastfed for shorter durations had higher obesity and overweight rates. 78% of the obese children and
69.5% of the overweight were not breastfed or breastfed for less than one year and stunting in the non-breastfed
was15%. Food preference for fast foods was 95.2% among obese compared to 57.8% in normal weight. One third
consumed fruits and vegetables, while one half consumed fast foods (51%). Exposure to advertisements for fast foods
was highest by T.V. (53.3%) and display in the shops 28.5% compared to 17.5% for fruits. Conclusions: The findings
highlight the prevalence of overweight and obesity among children aged 2-5 years and its association with the
marketing of unhealthy foods and beverages. Maternal anxiety also appears to play a role in children's weight status.
Keywords: Childhood Obesity, Maternal Anxiety, Prevalence, Anthropometric Measurements, Breastfeeding,
Unhealthy food preferences.

dummies are widely offered to infants, and research
Globally, obesity in children under the age of five
has shown connections between infant dummy usage
years is on the rise. Obesity has grown by 2-3 times
and later results in terms of hunger, temperament,
during the last 30 years [1]. Obesity is an underlying
eating, and weight [7]. Moreover, maternal anxiety and
cause for many non-communicable diseases as
distress was also shown to be connected to increased
hypertension and diabetes mellitus later in life [2].
body mass index (BMI) in their offspring [8].
Egypt has the highest rates of obesity with over two
Marketing strategies have a role in the spread of
thirds of its adult population, especially women
CMF, high-carb diets, junk food, fast food, and other
suffering from obesity [3].
unhealthy meals by aggressively promoting these
Breastfeeding has a major effect on a child's
items to the public, in particular children and their
survival, health, nutrition, and development, and it
mothers, in the different channels of media and the
protects against obesity, hypertension, diabetes,
public places. The growth of social media and internet
childhood asthma, and childhood leukaemia [4]. The
technology could be underlying causes. According to a
World Health Organisation (WHO) recommends that
Tongji "China" assessment, media exposure raises the
all newborn breastfeed exclusively for the first six
quantity of CMF children consume, which increases
months of their lives and continue to do so for at least
their chance of developing obese. [9]. Studies by
two years beyond that, supplementing their diets with
Rummo et al. [10] and Maddock [11] showed that
the right foods when they are seven months old [5].
aggressive marketing of unhealthy foods was closely
Early infant feeding practices play an important
linked to obesity in children. The WHO has responded
role in the prevention of obesity. It seems likely that
to such practices by releasing the World Health
some modifiable habits, such as the quality of foods,
Assembly (WHA) resolution in 2017 [12] for
the frequency and amounts a baby is fed, may raise the
prohibiting the promotion of unhealthy foods and
chance of childhood obesity or overweight [4]. Early
drinks for babies and young children, as well as
commercial milk formula (CMF) feeding has been
increasing the six-month window covered by the
shown to be linked to the high rates of childhood
international code of marketing for breast-milk
obesity in a disadvantaged region in Australia [6]. High
replacements to three years [12,13]. Despite this, a multi-
rates of childhood obesity were shown to be related to
country study by WHO and UNICEF showed that
early introduction of bottle feeding with CMF and
marketing influences mother and professional infant
early feeding of solids [6]. Additionally, pacifiers and
feeding decisions [14]. In countries with policies that
Received: 17/03/2023
Accepted: 17/05/2023

Full Paper (vol.921 paper# 77)

c:\work\Jor\vol921_78 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5968- 5976

Role of Immunohistochemistry in Pleural Effusion Cytology: Review Article
*Fatma Ayman Elbadry, Taiseer Refaat Ebrahim, Aziza E. Abdelrahman, Mohamed Ali Alabiad
Pathology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Fatma Ayman Elbadry
Email:, Mobile: 01286584010

Immunohistochemistry is crucial for the proper diagnosis of malignant mesothelioma, especially in cases
with complex morphology and in biopsy and cytology specimens where it is difficult or impossible to determine the
tumor architecture. In the vast majority of instances, the correct identification of tumor lineage is made possible by the
application of a tailored panel of mesothelial- and epithelial-specific markers.
Methods: The authors review the most commonly used cytologic preparations, fixatives, and antibodies used in effusion
Results: Through the utilization of cell block preparations and a panel of antibodies appropriate for the differential
diagnosis in question, ICC conditions utilized in surgical pathology can be most closely replicated.
Conclusions: Accurate differentiation between malignant mesothelioma and lung adenocarcinoma in pleural effusion
cytology is still a big challenge. Therefore, it is mandatory to search for new diagnostic immunohistochemical markers.
Keywords: Immunohistochemistry, Pleural effusion, Cytology.

cytology that is reported in over 50% of cases in routine
A diagnostic problem in and of itself can be
cytology. Such diagnosis errors are usually caused by
cytomorphologic distinction of pleural cytology. When
mistaking reactive mesothelial cells for cancer cells.
the initial locations of tumor cells are unknown or
False-positive diagnoses are less prevalent and
neoplastic cells show only mild atypia, the challenge is
frequently result from misinterpreting reactive
made more difficult. It is frequently used to improve
mesothelial cells as cancerous cells (6).
accurate cytological diagnosis of bodily fluids. Many
A morphologic examination's sensitivity for
antibodies have been utilized to distinguish reactive
detecting metastatic cancer in depending on the
mesothelial cells from metastatic cancer. However, the
cytopathologist's skill and the quality of the
focus of clinical research continues to be finding a
preparations, effusions can range from 40% to 80%. It
biomarker with high sensitivity and specificity (1).
was shown that the specificity increases and the
sensitivity increases from 84 to 94% and from 92 to
immunocytochemical and molecular methods on cell
blocks or smears significantly increases diagnostic
immunocytochemistry are coupled (7).
accuracy (2, 3). It's interesting to note that not all
Calretinin, D2-40, and CK5/6 are three
mesotheliomas readily discharge cancerous cells, for
immunohistochemical markers that have been shown to
example, sarcomatous mesotheliomas are rarely found
distinguish malignant mesothelioma from other types of
using effusion cytology (4). Although epithelioid
cancer. Ber-EP4, CEA, and TTF1 were markers for
mesothelioma has been distinguished from secondary
adenocarcinomas, and Ber-EP4, CK5/6, and CEA were
carcinoma and other malignant tumors that have spread
indicators for lung squamous carcinoma (8), the usage of
to serosal membranes using "positive" and "negative"
a panel of antibodies ensures the accuracy and increases
immune-histochemical markers, none of these markers
the sensitivity and specificity of the diagnostic tool (9).
requires panels of "positive" antibodies and indicators
The indicators that can currently be used to
with negative predictive value for the diagnosis of
distinguish between tables (1) and (2) cover epithelioid
mesothelioma due to its 100% sensitivity and specificity
pleural mesotheliomas from lung adenocarcinomas as
well as epithelioid mesotheliomas and squamous cell
carcinomas. At least two mesothelial and two
adenocarcinoma, reactive mesothelial cells, and
carcinoma markers should be used, according to the
malignant mesothelioma have long been a diagnostic
International Mesothelioma Interest Group in each
challenge to cytopathologists. Immunocytochemistry
panel because none of these markers is 100% specific
assists in reducing false-negative results of effusion


Full Paper (vol.921 paper# 78)

c:\work\Jor\vol921_79 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5977- 5980

Measuring Cervical Length and Uterocervical Angle as a
Tool to Predict Preterm Labor in Pregnant Women
Youssef Abo Elwan Elsayed, Ali Elshabrawy Ali, Hala Mohamed Hesham Abdallah, Basem Mohamed Hamed
Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Hala Mohamed Hesham Abdallah ,
Mobile: (+20) 01127448667 , E-mail:

Preterm birth is one of the most important obstetric problems. According to the American College of
Obstetricians and Gynecologists (ACOG), preterm delivery accounts for 70% of early neonatal deaths and 25­50% of
infant deaths aged less than one year. Data from several studies suggest that preterm labor can be predicted by assessing
cervical conditions such as cervical length (CL), and fetal fibronectin.
Objectives: The goal of the current study was to evaluate and contrast the uterocervical angle and cervical length as
early preterm delivery predictors for delivery in patients with uterine contractions.
Patients and methods: An upcoming observational cohort study performed on 70 pregnant women who were between
28 and 37 (31.5 ± 2.7) weeks of gestation at risk of preterm labor. The mean cervical length was 36.8 ± 10.8 mm and
the mean uterocervical angle was 100.7 ± 26.1 degree. While, the study excluded patients accompanied by placenta
previa or any diseases involving contact bleeding, such as endocervical polyp, infection, or bleeding disorders.
Result: The most common risk factor in the studied group was polyhydramnios and previous history of preterm labor
respectively. We found that the cut-off points of cervical length and uterocervical angle were < 35.5 mm and 105
degree respectively. The study showed that cervical length was superior to utero-cervical angle in the impending preterm
birth prediction labor.
Conclusion: When preterm labor is imminent, both the utero-cervical angle and the cervical length can be measured as
helpful tools for forecasting preterm birth.
Cervical length, Uterocervical angle, Possible preterm labor.

reported as a high-performance screening method for
One of the most significant obstetric issues is
pregnancy, is another innovative cervical assessment
preterm birth. Preterm birth is responsible for between
that measures the uterocervical angle (UCA) (9, 10).
25 and 50% of newborn deaths under one year old and
Additionally, it has been demonstrated that the UCA
70% of early neonatal deaths as The American College
gets worse after a vaginal pessary is inserted in patients
of Obstetricians and Gynecologists (ACOG) says. The
who are susceptible to spontaneous preterm birth (11). It
prevalence of preterm birth in the US is 12%, which is
is a low-cost, simple method that is safe for both mother
similar to the incidence at our center. The World Health
and fetus. However, there is currently no evidence to
Organization claims that spontaneous preterm labor
support the use of UCA measurement in the
causes nearly half of all premature births (1). Preterm
management of upcoming preterm labor (9, 12).
labor that is imminent is defined as labor pains that start
Our study's objective was to assess and contrast the
before 37 weeks, however there are no cervical
sensitivity of cervical length and uterocervical angle as
alterations. Around 25­30% of premature labor
a technique to precisely predict preterm birth in people
situations result in preterm birth (2).
who were experiencing uterine contractions.
According to data from multiple research,

cervical parameters like cervical length can be used to
predict premature labor (CL) and fetal fibronectin (3, 4, 5).
Seventy pregnant women who visited the
As part of managing preterm labor, ACOG advises
Obstetrics and Gynecology Department, Faculty of
sonoelastography as one recent tool for determining the
Medicine, Zagazig University, and Al-Sahel Teaching
threat of premature labor (6), shear wave velocity or the
Hospital in Egypt between April 2022 to October 2022
force impulse of the acoustic radiation (7), and the
participated in this prospective-observational cohort
biometry of the fetal adrenal gland, all have been
study. After obtaining the consent of participants,
documented (8). These methods, meanwhile, necessitate
demographic data were collected. Images were taken by
cutting-edge technology and are inappropriate for
2 ultrasound machines [Siemense Acuson NX2 Elite
widespread application.
(7.5 ­ 10 MHz transvaginal probe) and Mindray DC 70
In the second trimester of pregnancy,
expert (7.5 ­ 10 MHz transvaginal probe)] (Figure 1).
transvaginal ultrasonography (TVS), which has been

Received: 17/03/2023
Accepted: 17/05/2023

Full Paper (vol.921 paper# 79)

c:\work\Jor\vol921_80 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5984- 5990

Effect of Prophylactic Intravenous Ondansetron on Hemodynamic
Parameters in Elective Cesarean Section under Spinal Anesthesia
Mohamed Shehta Tawfek, Essam Fathy Abdelgalel,
Tiseer Hassan Mokhtar Mohmad*, Asmaa Mohammed Galal
Department of Anesthesiology, Intensive care and Pain management, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Tiseer Hassan Mokhtar Mohmad, Mobile: (+20) 01012845307,

Maternal Spinal anesthesia frequently has side effects like hypotension and bradycardia during caesarean
delivery. Maternal Spinal anesthesia frequently has side effects like hypotension and bradycardia during caesarean
delivery. Objective: The current study aimed to evaluate effect of prophylactic intravenous ondansetron on
hemodynamic parameters in elective cesarean section (CS) under spinal anesthesia.
Patients and methods: A total of 80 patients with physical condition as defined by the ASA class II and ages ranging
from 21 to 45 years old scheduled for surgery at Zagazig University's Department of Anesthesia and Surgical Intensive
Care Hospitals; elective CS and Surgery were lasting no longer than 60 minutes. Patients in the control group (group C)
got 10 ml of saline. Individuals in the ondansetron group (group O) received intravenously 4 mg of ondansetron diluted
in 10 ml of saline five minutes before subarachnoid block. The following variables were measured throughout the course
of the trial in both groups: systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MAO),
heart rate, oxygen saturation percentage, and intraoperative need for ephedrine. Moreover, any issues that arise
throughout or following operation were recorded. Results: The frequency of hypotension in expectant women
undergoing spinal anesthesia for elective caesarean delivery was significantly reduced, when prophylactic 4 mg
ondansetron was administered. The use of vasopressors Ondansetron significantly decreased the incidence of
hypertension. Systolic blood pressure was consistently higher and fewer vasopressor medications were used in the
ondansetron group. Conclusion: Intravenous premedication with 4mg ondansetron can effectively reduce the drop in
SBP, DBP, and MAP in expectant mothers scheduled for CS.
Ondansetron, Spinal Anesthesia, Hemodynamic, Clinical trial, Cesarean section, Zagazig University.


prevent it. Lower-leg compression, intravenous fluids,
A straightforward, dependable, and widely used
and vasopressor drugs are a few methods that have been
anesthetic approach is spinal numbness. The drawbacks
recommended to lessen the possibility of spinal
of spinal anesthesia include trembling, hypotension, and
anesthesia-induced hypotension after cesarean delivery;
bradycardia (1).
however, no single strategy has been proven to be
In fact, a sensory block up until T5 is required for
entirely efficient (5). Ondansetron is a medicine that is
spinal anesthesia during caesarean sections (CS), which
becoming more and more popular during subarachnoid
in 55% to 90% of instances always results in a
block patients' treatment for hypotension, which is the
protracted sympathetic block and hypotension (2).
focus of the majority of studies on the prophylactic
Hypotension, which can significantly increase the
management of hypotension. In addition to treating and
most common side effect of spinal anesthesia during CS
preventing nausea and vomiting, ondansetron, a 5-
section is the risk of morbidity and mortality for both
hydroxytryptamine subtype 3 (5-HT3) receptor
the mother and the fetus. Due to peripheral blood
antagonists, may also reduce the hemodynamic changes
pooling and diminished systemic vascular resistance
brought on by spinal anesthesia, according to previous
brought on by sympathetic nervous system blockage,
studies (6).
hypotension develops, which lowers cardiac output (3).
The current study aimed to evaluate effect of
Hypotension and bradycardia may be caused by
prophylactic intravenous ondansetron on hemodynamic
excessive parasympathetic activity, the Bezold-Jarisch
parameters in elective CS under spinal anesthesia.
reflex (BJR), and enhanced baroreceptor activity.

Chemoreceptors and mechanoreceptors, which are
serotonin sensitive, set off the Bezold-Jarisch reflex. In
A total of 80 patients with physical condition as
hypovolemic people, serotonin is an additive BJR
defined by the ASA class II and ages ranging from 21
trigger and animal and human researches have
to 45 years old and body mass index (BMI Kg/m2) >35,
demonstrated that 5HT3 antagonists reduce serotonin-
scheduled for surgery at Zagazig University's
induced BJR. Ondansetron has little side effects but
Department of Anesthesia and Surgical Intensive Care
antagonistic effects on 5HT3 (4).
Hospitals were included in the current randomized,
Despite the ease and safety of spinal anesthesia,
double-blinded, controlled clinical trial. Elective CS
uncommon problems such unresponsive hypotension
and Surgery were lasting no longer than 60 minutes.
and bradycardia pose significant anesthetic difficulties.
A total of 40 patients in the control group (group C)
Instead than treating hypotension, it is preferable to
got 10 ml of saline. Meanwhile, 40 individuals in the

Full Paper (vol.921 paper# 80)

c:\work\Jor\vol921_81 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5991- 5995

Assessment of Pubertal Status in Children and Adolescents with
End-Stage Renal Disease on Hemodialysis
Nermin AbdelMoneim Seleem1, Heba Fouad Pasha2, Eman Sagar Ahmed Sagar 1*,
Mona Mohammed Elsharkawy1
Department of Pediatrics1, Medical Biochemistry 2, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Eman Sagar Ahmed Sagar, Mobile: (+20) 01090947945,

Hormonal dysregulation caused by renal dysfunctions and associated pathophysiological pathways,
particularly hemodialysis, will naturally cause growth anomalies and even postpone puberty in adolescents. Objective: The
aim of the current study was to determine the relationship between serum testosterone and estradiol levels and pubertal
development in children and adolescents with end-stage renal disease (ESRD) who receive regular hemodialysis. Patients
and methods:
A case control study was conducted at the Pediatric Nephrology Department and Out-patient Clinics of
Zagazig University Children Hospital. The study included 54 participants divided into two groups; 27 Children and
adolescents with chronic hemodialysis for ESRD who was identified from the juvenile nephrology unit at the hospital and
27 healthy children and adolescents. All participants underwent a full history taking process, clinical examination, pubertal
assessment using Tanner staging, routine laboratory testing, in addition to throughout the course of the trial, serum levels
of girls' and boys' estradiol and total testosterone were measured. Results: Delayed puberty according to age development
was found among ESRD patients by Tanner staging. Patients' weight and height were significant lower in ESRD when
compared to control group. Total testosterone in ESRD males and serum estradiol in ESRD females were significant low in
comparison to controls and were associated with tanner staging. Conclusion: When compared to the general population,
children with ESRD receiving regular hemodialysis experience significant impairments in pubertal growth and sexual
maturation. Pubertal development is typically postponed, as demonstrated by lower serum levels of the hormones male
testosterone and female estradiol.
Testosterone, Estradiol, Children, Hemodialysis, Case control study, Zagazig University.


ESRD, as these endocrine diseases cause the difficulties
The clinical condition known as chronic kidney
of the transition from childhood to adulthood are made
disease (CKD) is characterized by a long-term, gradual
more difficult by growth failure. These kids' delayed
deterioration in kidney function. For example, the Kidney
puberty was attributed to a number of reasons, including
Disease Improving Global Outcomes (KDIGO)
neuroendocrine dysfunction in the pituitary-gonadal,
guidelines describe CKD as abnormalities in the structure
peripheral changes brought on by uremia, gonadal injury,
or function of the kidneys that have existed for >3 months
and poor control of gonadotropin secretion (3).
and have a negative impact on health. End-stage renal
CKD is linked to a change in sex hormones.
disease (ESRD), which affects 5­10 children per million
Teenagers and adults with chronic uremia have been
annually, is a serious health issue for kids. Hemodialysis
found to have total and free blood levels of testosterone
is the most widely used type of medications to replace the
and dihydrotestosterone that are low or low to normal as
kidneys in this sickness. ESRD patients typically die from
a result of decreased production and/or increased
cardiovascular problems rather than renal illness (1).
metabolic clearance. Reduced testosterone conversion to
While adolescence is the period from puberty until
dihydrotestosterone as a result of decreased 5- reductase
full maturity, puberty is the time when the reproductive
activity may be the reason of the delayed pubertal
organs begin to function. Puberty begins when
development observed in some dialysis patients. Similar
to how glomerular filtration rate (GFR) declines in
secretion rise in the hypothalamus and it is transported to
tandem with serum estradiol levels in females, some
teenage girls exhibit serum estradiol levels that are low to
gonadotropin-releasing hormone, which in turn regulates
normal or dropping in proportion to pubertal age (4).
ovarian and testicular activities, causes the gonadotrophs
The aim of the current study was to measure the
to secrete luteinizing hormone and follicle-stimulating
levels of blood testosterone and serum estradiol in
hormone (2).
children and adolescents with ESRD who get regular
Chronic renal failure can cause pathophysiological
hemodialysis and the relation between serum
changes in the sex hormones that might delay or block
testosterone and estradiol levels and pubertal
pubertal maturation. Over 50% of the girls had evidence
of pubertal axis delay and one-third of the boys with

Received: 05/12/2022
Accepted: 07/02/2023

Full Paper (vol.921 paper# 81)

c:\work\Jor\vol921_82 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 5996- 6000

Meta Analysis of the Results of Internal Fixation of Femoral Neck
Fractures in Young Adults by Cannulated Screws
Mohamed Abdelfattah Sebaei, Khaled Edris Abdelrahman,
*Mohamed Samir Abdallah, and Yehia Tarek El-Bromboly

Orthopedic Department, Faculty of Medicine, Zagazig University, Egypt.
*Corresponding Author: Mohamed Samir Abdallah, Mobile: (+20) 01125104000, E-mail:

Even while femoral neck fractures are more common in the elderly, high-energy induction's nature leads
to worse clinical consequences in the young. This study aimed to do a meta-analysis to assess the clinical results of
internal fixation with cannulated screws in the treatment of fracture neck femur in young adults, including the rate of
union, rates of revision surgery, surgical complications, and general medical issues.
Subjects and methods: Utilizing research databases from 2000 to 2021, pertinent publications were found. The
following keywords were used in the search: young adults, cannulated screws, internal fixation, and femoral neck
fractures. To ascertain the impact of internal fixation of femoral neck fractures in young adults by cannulated screws
and rates of postoperative complications, revision, function, operating time, Harris hip score, and follow-up time in
young adult patients with a femoral neck fracture, six published randomized controlled trials involving a total of 231
patients were suitable for inclusion in the review. With the Revman 5.1 program, studies' demographic data were
extracted, including the number of patients, their ages, and their gender.
Result: 231 patients were treated with cannulated screws for internal fixation. A follow-up period of 21.6 6.0 months
was typical for all patients. In contrast, 171 patients (74.3%) had a satisfactory union without any problems. Nonunion
occurred in 27 patients (11.6%), fixation failure in 8, and AVN in 22, respectively.
Conclusion: Young patients with femoral neck fractures who are relatively healthy and independent can benefit from
internal fixation with cannulated screws.
Keyword; Young adults, Cannulated screws, Internal fixation, Fractures of the femoral neck.

Giving the young age and increased levels of
Young individuals rarely experience femoral
activity, arthroplasty surgeries are not recommended,
neck fractures, which frequently result from high-
and reoperation and salvage procedures like
intensity trauma. They have a higher chance of
osteotomies have high failure rates(14). Understanding
developing femoral head osteonecrosis and nonunion (1).
and treating young adult femoral neck fractures benefits
A positive outcome can be influenced by a variety of
from knowledge of various treatment options and
factors, many of which can play a key part in preventing
potential consequences (1).
these disastrous complications. While establishing an
The objectives of treatment differ for young
anatomic reduction and a secure internal fixation are
adults versus the elderly. The objectives are maximizing
essential, other therapeutic factors like the timing of
movement and weight bearing in the older patient while
surgery, the function of the capsulotomy, and the types
avoiding problems related to extended bed rest. The
of fixation remain in question. Three cannulated
possibilities for surgery include hemiarthroplasty,
cancellous screws can be used for permanent fixation
complete hip arthroplasty, reduction and internal
fixation. The patient's physiological age, amount of
In the older population, intracapsular femoral
exercise, medical comorbidities, and level of bone
neck fractures following a minor fall are rather
density are all taken into account (1).
prevalent(3) nonetheless, they only represent 2 to 3
The internal fixation of the femoral neck
percent of all femoral neck fractures in young people(4-7).
fracture by cannulated screws and an open or closed
Understanding and contrasting the characteristics
reduction are two highly successful therapeutic options
between elderly and young adult patients is crucial for the
for young adults. Preserving the femoral head,
evaluation and treatment of femoral neck fractures in
preventing osteonecrosis, and preventing nonunion are
young adults. There are distinctive distinctions in the
the primary objectives (1,2).
osseous and vascular structure, the mechanism of
There have been several clinical investigations
damage, accompanying injuries, fracture pattern, and
into cannulated screws used for internal fixation. They
therapeutic objectives (1-4).
consist of systematic reviews, randomized controlled
Femoral head osteonecrosis and nonunion are
trials, and observational research. By doing an up-to-
more common in young individuals with femoral neck
date meta-analysis of RCTs, we solve these problems.
fractures(6,8-12). In young patients with femoral neck
Our goal in this study is to conduct a meta-analysis to
fractures, osteonecrosis rates range from 12 to 86% in
assess the clinical outcomes of internal fixation by
the literature (5,6,10­13). This terrible consequence may
cannulated screws in the treatment of fracture neck
cause the femoral head to collapse, which would then
femur in young adults, including the percentage of
result in osteoarthritis (1).
union, the prevalence of revision surgery, the incidence
Received: 23/01/2023
Accepted: 260/3/2023

Full Paper (vol.921 paper# 82)

c:\work\Jor\vol921_83 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6001- 6008

Quality of Medical Records Documentation Practices at
Menoufia Clinical Oncology Department
Sara Saied Abdelghaffar 1*, Omaima Abo El_Fateh Mohamed 1, Hala Marawan Gabr 1,
Zeinab Abdelaziz Kasemy 1, Ashraf Abdel Ghany 2, Shaimaa Yaihya Abdel Raouf 1
1 Public Health and Community Medicine Department
2 Clinical Oncology Department, Faculty of Medicine, Menoufia University, Egypt.
*Corresponding Author: Sara Saied Abdelghaffar, Email:, Phone: +201065374482

Cancer registries rely on extracting data from a patient's medical records, so without proper
documentation we will have incomplete abstracted data items and missed data values within cancer registries.
Objectives: To assess the quality of the oncology patients' records, compare patients with complete versus
incomplete records according to survival time, and analysis of cancer statistics during 2019 at the Clinical Oncology
Department at Menoufia University Hospitals.
Methods: A retrospective study was conducted at the Clinical Oncology Department at Menoufia University
Hospitals. All the available oncology patient records formed during 2019 (1844) are revised according to the checklist
to detect absence and presence of the items of the checklist.
The percentage of oncology patient records exceed 80 % level of completeness was 78.3%- 75.5% of the
records had no clear outcomes, the mean survival time was significantly higher among complete (33.35 ± 0.21
months) than incomplete records (31.34 ± 0.79 months) (P <0.05). The most common tumor among the whole
population was Breast Cancer followed by GIT Tumors, the most common tumor among male participant patients
was GIT Tumors followed by Blood Cancer. While the most common tumor among female participant patients was
Breast Cancer followed by Female Genital Tumors.
Conclusion: The survival time was higher among the patient with records exceed the 80 % level of completeness
than the patient with lower completeness level, so hospital documentation needs more care.
Keywords: Completeness- Hospital documentation- Oncology- Medical records- Survival.


Medical records are systematic documentations of
have incomplete abstracted data items and missed data
the patients' socio-demographic data, present history
values within cancer registries [3].
of illness, clinical findings, investigations, diagnosis,
Egypt did not have cancer incidence rates at the
treatment, follow-up and prognosis [1].
national level until the report of the national cancer
Accurate health care data taken from the medical
registry program in Egypt appeared. Until that time,
records are needed for the current and future service
the published rates were the rates from the cancer
provided to a patient at all levels of health care,
registry in Gharbia governorate, but none of these
medico-legal purposes, accurate information about
published rates can be considered expressive of Egypt,
diseases, clinical research, outcomes of health care
as they relied on results of one registry in a single delta
intervention and statistical information [2]. Also for
governorate and therefore could not be relied upon to
specific medical specialties such as oncology, the data
understand the current situation of cancer in Egypt [7].
are de facto evidence which hold promise for rapid
So, this study is conducted as an evaluation of the
advances in oncology because it may represent a more
quality of Oncology Patient Records Documentation
accessible and cost-effective way to validate the
and analysis of cancer statistics in 2019 at Menoufia
efficacy of clinical interventions and can support
University Hospitals aiming at the quality
clinical trials [3].
improvement of patient records, preparing for the
All over the world, there are many problems
application of the electronic records and atrial of
related to registry systems such as data loss, incorrect
cancer registry in Menoufia University Hospital to
data, duplicate records, and illegible data [4]. The lack
provide information for the National Cancer Registry
of proper data leads to incorrect decisions in clinical
Program of Egypt database of cancer incidence.
practice, treatment errors, unnecessary repeating of

investigation, inappropriate referrals and the loss of
time and other resources [5].
Study setting: The study is conducted at the Clinical
Cancer registry is the process of continuous,
Oncology Department at Menoufia University
systematic collection of data on the rates and
characteristics of reported cancers to help to evaluate

and control the effect of cancer on the community [6].
Sample size: The study includes all patient records
These cancer registries rely on extracting data from a
formed during 2019 at the department. The number of
patient's medical records, so without proper
the formed records is 2128, but the available records at
documentation within the medical records, we will
Received: 05/02/2023
Accepted: 05/04/2023

Full Paper (vol.921 paper# 83)

c:\work\Jor\vol921_84 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6009- 6014

Effect of Different Levels of Sorghum Powder on Rats Inflected with Hepatotoxicity
Ibrahim Said Salim, Nehal Mohamed Abd-El Mageed, Aya Alhusein Salim*
Nutrition and Food Science Department, Faculty of Home Economics, Helwan University
Corresponding author: Aya Alhusein Salim,Email:,
Mobile: 01050366830

Liver is an important organ in the body as it secrets bile, stores fat-soluble vitamins and handles
cholesterol hemostasis. Cereal crops such as sorghum seeds serve as a rich source of dietary fiber and nutrients. These
seeds may protect against hepatotoxicity.
Aim: The purpose of this research was to identify the phytochemical components of sorghum powder and evaluate its
protective effects against carbon tetrachloride (CCl4)-induced hepatotoxicity in rats.
Materials and methods: Forty-eight adult male albino rats were distributed into six groups (n=8). Group (1) was control
(non-treated) and group (2) was injected subcutaneously by carbon tetrachloride CCl4 (2 ml/kg) twice a week for 2
consecutive weeks to induce hepatic toxicity Groups (3), (4), (5) and (6) were administered CCl4 plus 2.5%, 5%, 7.5%
& 10% of sorghum powder, respectively. After 12 hours of fasting, blood samples were taken for biochemical
examination from the rats in the experiment. Antioxidant activity, ALT and AST levels, lipid profile (HDL-c, LDL-c &
VLDL-c), uric acid, and urea nitrogen were all measured with serum samples from sacrificed rats.
Results: Sorghum seeds powder contains a lot of minerals, fatty acids and many bioactive compounds. It has a high
antioxidant activity, hepatoprotective, nephroprotective and hypochlosterolemic effects. Sorghum seeds powder
ameliorated the histopathological lesion seen in the liver of hepatotoxic male albino rats.
Conclusion: The findings indicated that sorghum powder contains carbohydrates, and many bioactive constituents such
as phenolic compounds, carotenoids, chlorophyll, tannins, phytates and dilatory fibers. Sorghum powder decreased body
weight gain, increased antioxidant activity but decreased liver enzyme ALT and AST, TC, LDL-c & VLDL-c, while
increased HDL-c. Sorghum seeds powder is considered a promising ameliorative agent against CCL4-induced
hepatotoxicity in rats. Therefore, sorghum powder may be beneficial for patients suffering from liver toxicity.
Keywords: Sorghum powder- Hepatotoxicity- Phytochemical analysis- Biochemical parameters- Histopathology.


Liver disease is the leading cause of mortality
There are a variety of liver function tests available to
annually. About 29 million individuals suffer from
assess the liver's health (1).
chronic liver disease and liver disease affects over 30
The liver is the 2nd largest organ in the human
million people in the USA (1).
body and is responsible for over 5,000 distinct bodily
In England, liver disease ranks fifth in terms of
functions. Some of these functions include clotting
mortality rates, behind cancer, stroke, and respiratory
blood, removing toxins from the blood, converting food
illnesses. Chronic hepatitis B and C, alcohol, and non-
into nutrients, controlling hormone levels, warding off
alcoholic steatohepatitis related to obesity and
infections and illnesses, regenerating after injury, and
metabolic syndrome are among the most prevalent
metabolizing cholesterol, glucose, and iron while also
causes of liver disease globally (2).
regulating their levels. Most people rarely think about
As the country with the highest hepatitis C
their livers until something goes wrong with them,
prevalence worldwide, Egypt will soon see the
despite the fact that liver diseases are on the rise and
epidemic's apex. More than half a million people are
currently affect one out of every ten individuals. Liver
anticipated to become infected with the virus every
illnesses can be hereditary, or they can be caused by a
year, according to research conducted in 2010. The
range of conditions that are harmful to the liver.
Egyptian Ministry of Health and Population reports that
Sorghum is a cereal that belongs to the Poaceae
each year 100,000 Egyptians contract HIV. According
or Gramineae grass family and was first domesticated
to research, Egypt has the highest rate of hepatitis C
among 3,700 & 4,000 years ago (3).
virus infection in the world, with a prevalence that is ten
It is endemic to northern Africa. After maize,
times higher than in Europe and the USA (1).
wheat, rice, and barley in terms of cereal crop
In India, approximately 10 people are diagnosed
production in 2017, sorghum ranked fifth with 57.6
with liver cirrhosis each year. The World Health
million tons produced each year (4).
Organization indicates that liver disease is the 10th
Sorghum is one of the most important cereal crops
leading reason for death in India. Every fifth Indian
grown all over the world.
suffers from some form of liver illness. More people die
In both the tropics and subtropics, sorghum has
from liver illness than from either diabetes or
become a popular crop. Sorghum is one of the key crops
automobile accidents. Until the disease has progressed
used to manufacture meals like bread and porridge in
and caused significant damage to the liver, there are
several under-developed and semiarid parts of Asia and
typically no outward manifestations of liver disease.
Received: 09/01/2023
Accepted: 12/03/2023

Full Paper (vol.921 paper# 84)

c:\work\Jor\vol921_85 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6015- 6027

HRCT Chest For Prediction of COVID-19 and Non COVID-19 Disease
Hayam Abdelmonsif Abdellatif, Mona Ahmed Abd Elgawad, Hazem Hassan Eid
Radio Diagnosis Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
Corresponding author: Mona Ahmed Abd Elgawad, Mobile: +201093660610, Email:

High resolution chest computed tomography (HRCT) plays vital role in finding of COVID-19 and
differentiation between COVID-19 with other types of chest infection.
The aim of the present study was to assess HRCT chest's usefulness in identifying COVID-19 pneumonia
and distinguishing it from other chest infections.
Patients and methods:
Our comparative study included 50 patients and HRCT was performed for all cases. A total of
38 patients were confirmed to have COVID-19 by typical HRCT findings and PCR, and 12 patients were confirmed
non COVID-19 by history, lab investigations and atypical CT finding. All cases were graded using CORADS scoring
Results: Common CT findings included ground-glass concentrations in the periphery and subpleura. Prominent
interlobular septations; also, vascular dilatation, consolidation, fibrotic streaks, atelectatic bands are also CT findings.
Consolodations, cavitations, calcifications pleural effusion are more common in other types of chest infections.
Conclusion: CORADS system helps radiologists grading typical CT finding and making decision of presence of
COVID-19 or other types of chest infection.
COVID-19, HRCT, Chest infection, Comparative study, Menoufia University.


First identified in Wuhan, Hubei Province, China,
bilateral numerous lobular with subsegmental regions
the severe acute respiratory syndrome coronavirus 2
of consolidation. Researchers discovered that the
(SARS-CoV-2) causing coronavirus disease 2019
severity of an illness was proportional to the number of
(COVID-19) is rapidly spreading to other domestic
lung segments affected (8).
cities and countries outside of China (1).
Pleural effusion (seen in only almost 5% of chest
COVID-19 has a diverse range of clinical
CT scans), masses, cavitations and lymphadenopathies
presentations. The most common symptoms of COVID-
were also atypical CT findings (9).
19 include fever, coughing, exhaustion, and
Lesions of different types of pneumonia are
expectoration. Anorexia, chest pain, dyspnea (shortness
shown at distinct scales, shapes, and locations on chest
of breath) and muscle aches are also frequent. In
CT scan, allowing for easy visual separation. For
addition to problems with smell and taste, it seems that
instance, in contrast to the diffuse distribution of the
this is a common symptom. However, headaches,
other non-COVID-19 VP, aberrant results from ground-
vomiting and
glass opacities in individuals with COVID-19 are
abdominal discomfort are also possible, albeit less
typically multifocal, bilateral, and peripheral. Opacities
common, side effects. The list of possible COVID-19
in the lungs can be segmental (in the case of
symptoms is so broad that literally anything could be a
bronchopneumonia) or lobar (in the case of lobar
symptom. As more is learned about COVID-19, the list
pneumonia) when bilateral pneumonia is present (10).
of possible symptoms may also grow (2).
People with moderate to severe symptoms can
Uncertain variables, such as cytotoxicity and
benefit greatly from the Coronavirus Disease 2019
lymphopenia (3) as well the ensuing inflammatory
(COVID-19) Reporting and Data System (CO-RADS),
response, contribute to the development of the disease
a categorical evaluation scheme for pulmonary
into overt lung damage and acute respiratory distress
manifestations of COVID-19 at unenhanced chest CT
syndrome (ARDS). Inflammatory markers such as D-
with substantial interobserver agreement, particularly in
Dimer, ferritin and interleukin-6 (IL-6) that are
categories 1and 5 (11).
overexpressed are associated with a bad prognosis (4).
The simplicity of this classification is its greatest
Today, chest computed tomography images are a
strength, leading to fair to good agreement between
crucial non-invasive tool for accurately detecting
observers, even among radiologists of varying levels of
various pneumonia subtypes (5). The gold standard for
experience. When compared to a clinical diagnosis and
confirming COVID-19 is a virus-specific reverse-
positive results for RT-PCR assays, the classification
transcriptase polymerase chain reaction (RT-PCR) (6).
also shows strength in being able to distinguish among
Pneumonias can be a result of a wide variety of
radiological abnormalities associated with a high or low
species, although they often present radiographically
risk of COVID-19 (12).
similarly (7).
The aim of the present study was to assess high
Individuals with COVID-19 often had ground-
resolution chest computed tomography (HRCT) chest's
glass opacities on chest computed tomography scans,
usefulness in identifying COVID-19 pneumonia and
most often in the lower and peripheral lobes, as well as
distinguishing it from other chest infections.
Received: 02/01/2023
Accepted: 05/03/2023

Full Paper (vol.921 paper# 85)

c:\work\Jor\vol921_86 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6028- 6032

Gastroprotective Effect of Bidens pilosa L. Leaves against
Indomethacin-Induced Gastric Ulceration in Rats
Ibrahim S. Salem; Inas Z. Abudo Abdallah; Hala A. E. Ciam*
Nutrition and Food Sciences Department, Faculty of Home Economics, Helwan University
Corresponding author: Hala A. E. Ciam, Email:, Mobile: 01050366830

Using an indomethacin (IND)-induced gastric ulcer model in rats, we sought to identify the phytochemical components
of Bidens pilosa (B. pilosa) leaves and examine their gastroprotective effects. There was a total of 56 male albino adult
rats used, split into 7 groups (n=8 rats per group). Group (1) was control -ve normal (non- treated) and group (2) was
+ve control given orally 30 mg/ kg indomethacin (IND). GROUP (3) B. pilosa extract I + IND and will receive B. pilosa
extract (75 mg/kg b.wt /day) orally. Groups (4), (5) and (6) were administered IND plus 75, 150 and 300 mg/kg of B.
pilosa extract, respectively. Group (7) was given 30 mg/ kg IND and received Ranitidine as a reference drug (50 mg/kg
b.wt /day) orally for 2 2 consecutive weeks before IND administration. The experiment concluded with the sacrifice of
the rats, the opening of their stomachs, and the collection of blood samples for biochemical examination. Gastric
mucosal homogenates were examined for antioxidant enzyme activities. The results showed that dried powder of B.
pilosa leaves contains carbohydrates, glycosides, sterols, triterpenoids, flavonoids, tannins, saponins and alkaloids,
while Anthraquinones were absent. B. pilosa extract increase body weight gain, increased levels of antioxidant enzymes
glutathione peroxidase (GPx), Superoxide dismutase (SOD) & Catalase (CAT) in gastric homogenate and decreased
serum liver enzymes. B. pilosa extract alleviated gastric ulceration in rats. Therefore B. pilosa may be beneficial for
patients suffering from gastric ulcer.
Keywords: Bidens Pilosa- Gastric ulcer- Indomethacin ­ Phytochemical analysis, Biochemical parametrs ­


The risk of death and disability caused by gastric
immunosuppressive (8), hepatoprotective (9), and
ulcers is high. Upper gastrointestinal bleeding can be
antioxidant (10, 11).
caused by a stomach ulcer if it is left untreated (1).

Gastroduodenal ulcers are thought to have their origins
in a number of factors, including the secretion of acid-
Field-fresh B. pilosa L. leaves, from the village of El-
pepsin, the presence of parietal cells, the integrity of the
Blakos in the city of Kom Hamada in the governorate of
mucosal barrier, the creation of mucus, the delivery of
El-Beheira. Leaves cataloged by the Agricultural
blood and nutrients, the regeneration of damaged cells,
Research Service's Flora and Phytotaxonomy
and the presence of endogenous (2).
Department, part of the Horticultural Research Institute.
Peptic ulcers can be caused by a number of

different things, including poor eating habits, smoking
Drugs and Chemicals: The 100mg capsules of
cigarettes, taking too many nonsteroidal anti-
indomethacin were purchased from Miss Scientific Co.
inflammatory drugs, being under a lot of stress, having
in Dokki, Giza. GlaxoSmithKline, Egypt, was the
a family history of the disease, or being infected with
source for our ranitidine. Nitric oxide (NO), catalase
Helicobacter pylori, as reported by Kim et al. (3). While
the use of various pharmaceutical medicines has helped
malondialdehyde (MDA). Morgan Co., Cairo, Egypt,
reduce mortality and morbidity rates associated with
cellulose, and D-L methionine. El-Gomhoriya Pharm.
gastroduodenal ulcer and peptic disorders, the risks
& Chem. Ind. Co. in Cairo, Egypt, supplied the mineral
associated with these treatments make them far from
and vitamin components and the sucrose. Corn oil
purchased at a neighborhood store. Starch and Glucose
Bidens pilosa L. (B. pilosa, Family Asteraceae) is a
Co. in Helwan, Cairo, Egypt, is where we'll be buying
member of the daisy family also known as black-jack,
our corn starch.
hairy beggar-ticks, and Spanish needle. Originally from

South America, this therapeutic herb is now found in
Experimental Animals: Animals from the Sprague
nearly every country (4). B. pilosa is an annual herb that
Dawley strain, adult male albino rats (56 totals) were
can reach a height of 1.5 m and has stems that are finely
bought from the Animal House at the National Research
hairy. Bright green, toothed & oblong or ovate
Center in Dokki, Egypt.
lanceolate in shape, the leaves are compound with 3­7

imparipinnate leaflets. Flower clusters can be either
white or yellow, and the seeds are a long, thin black with
Preparation of Plant Extract: B. pilosa leaves were
prominent ribs (5). Several studies have shown that B.
cleaned with running water and then dried in the air. The
pilosa plant extracts have therapeutic effects, including
air-dried leaves were processed into a powder and
those of being antiulcerogenic (6), antitumor (7),
stored in an airtight container until needed. 500 grams
Received: 09/01/2023
Accepted: 12/03/2023

Full Paper (vol.921 paper# 86)

c:\work\Jor\vol921_87 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6033- 6038

Sonographic Sliding Sign as a Predictor of Intra- Abdominal Adhesions in
Pregnant Woman with Previous Pelvi-Abdominal Surgery
Heba Farag Salama1, Mohamed Kandil1, Ahmed Helmy Mohamed Dawoud2*, Haitham Aboali Hamza1
1Obstetrics and Gynecology ­ Faculty of Medicine ­ Menoufia University, Egypt
2Resident at Shebin Elkom Teaching Hospital, Egypt
Corresponding author: Ahmed Helmy Mohamed Dawoud, Email:, Mobile: +201064325966

Intra-abdominal adhesions are frequently linked to higher likelihood of complications such as hemorrhage
and visceral injury during cesarean section in a woman with previous pelvi-abdominal surgery. This is why prediction
of intraoperative adhesions is important.
Objective: To check the sonographic sliding sign of the uterus as a predictor of intra-abdominal adhesions prediction
in females who are undergoing CS and who had a history of pelvic and abdominal surgery, involving a previous CS.
A prospective observational study carried out on 69 females with history of previous pelvi-abdominal surgery
including CS and planned to have CS to predict intra-abdominal adhesions. During deep breathing, transabdominal
ultrasound (TAS) is utilized to demonstrate the sonographic sliding sign of the uterus beneath the inner fascia of
abdominal muscles. Females were believed to be at a high hazard for severe adhesions when sliding was absent but at a
low hazard when sliding was obvious. Intraoperative assessment of adhesions was done in correlation to the sonographic
5 out of 8 cases with -ve sliding sign were confirmed intraoperatively to have marked adhesions and 59 out of
61 cases with +ve sliding sign had no or mild adhesions. The sensitivity, specificity, ppv, npv of the sliding sign were
71.4%, 95.2%, 62.5%, and 96.7% respectively.
Conclusion: The uterine sliding sign has a good specificity, negative predictive value, and moderate sensitivity for
predicting intraoperative adhesions. This technique might help surgeons to undertake anticipated complex operations.
Keywords: Sliding sign, Intra-abdominal adhesions, Abdominal ultrasound.


In the last three decades, Cesarean section (CS)
allowing the patient to be informed about the potential
rates have increased to levels well above the
for heightened complications, if necessary (4).
recommended between ten and fifteen (1). The frequency

of repeat Caesarean sections is increasing worldwide.
Hypothesis: To analyze the connections among the
Approximately ninety percent of women with a history
uterine sliding sign and other operational and neonatal
of Cesarean deliveries have an intended repeat Cesarean
outcomes, as well as to determine the predictive
delivery in their subsequent gestation. Those who have
usefulness of the uterine sliding sign for the presence of
undergone pelvic-abdominal surgery or who had many
intra-abdominal adhesions in women who had a history
CS may develop intra-abdominal adhesions. Prolonged
of pelvi-abdominal surgery or who had undergone a
damage to nearby viscera, and blood loss are all
prior CS.
possible complications of adhesiolysis (2). Injuries to the

bladder and colon (0.1­0.3%), blood loss (0.1­1.4%),
infection (0.4­1.6%), and even hysterectomy (0.1­
This was a prospective observational study
1.4%) are all significantly increased in subsequent
conducted at Obstetrics and Gynecology Department,
procedures due to post-CS adhesions. Damage to
Menoufia Faculty of Medicine Hospitals and Shebin
neighboring viscera, hemorrhage, and, in the event of
Elkom Teaching Hospital during time interval from
emergency CS, the perinatal poor consequence coupled
January 2022 till January 2023. The study included 69
as a result of the delayed birth of the newborn are all
pregnant women recruited from Outpatient Clinic of
possible complications of adhesiolysis (3).
Obstetrics and Gynecology Department and were
When a woman is suspected of having extensive
candidates for elective cesarean section.
intra-abdominal adhesions, it is advisable to perform

surgery by making a midline skin incision to gain access
Inclusion Criteria: History of previous pelvi-
to the peritoneal cavity. Additionally, preparations for
abdominal surgery including previous CS, gestational
blood products should be made, surgeons should be
age at or beyond 37 weeks, planned to undergo elective
assigned, and preoperative surgical assistance from
CS and BMI < 30 on admission).
other medical specialties should be requested to ensure

a successful operation. It is crucial for surgeons to
Exclusion Criteria: Overweight women, abnormal
possess the ability to identify patients at risk of
placental invasion, emergency Cesarean delivery.
developing adhesions. This valuable information can
The following maternal features and obstetrical
then be utilized by multidisciplinary surgical teams to
history were obtained through interviews and medical
adequately prepare for the procedure, while also
record reviews: Demographic data (patient age, parity,
Received: 23/12/2022
Accepted: 25/02/2023

Full Paper (vol.921 paper# 87)

c:\work\Jor\vol921_88 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6039- 6044

Different Echocardiographic Modalities for Assessment of RV Function in
Acute Right Ventricular Myocardial Infarction.
A Comparative Study between Thrombolytic Therapy and
Primary Percutaneous Coronary Intervention
Ghada A. Kazamel1, El-Sayed Abd EL-Khalek Aldarky2, Tarek Helmy Abu Al-Azm2,
Amro El-Sayed Mohamed El-Nagar2, Amro Mohamed Shaker2, Mahmoud Tantawy3
1Cardiology Department, National Heart Institute, Egypt
2Cardiology Department, Faculty of Medicine, Benha University, Benha, Egypt
3Cardiology Department, Faculty of Medicine, Misr University for Science and Technology, Egypt
*Corresponding author: Mahmoud Tantawy, Mobile: (+20) 01221865587, E-mail:

When compared to cases who had isolated inferior infarctions, those with right ventricular infarctions that
occur alongside inferior infarctions had greater odds of bradycardia or severe hypotension, needing pacing support, with
higher in-hospital rate of death.
Objective: The aim of the current study to evaluate pulsed wave TDI role together with other Conventional Echo-
Doppler modalities in the right ventricular (RV) function assesement among acute inferior ST elevation myocardial
infarction (STEMI) associated with RV infarction.
Patients and methods: A two arm, single blinded randomized controlled clinical trial was performed on 100 cases,
presenting with acute inferior myocardial infarction (MI) associated with RV infarction, during the period from
January 2020 to July 2022. Patients were divided into two groups; Group A involved 50 cases who underwent
coronary angiography and primary percutaneous coronary intervention (PCI), while Group B involved 50 cases who
received thrombolytic therapy.
Results: Patients who had undergone primary PCI showed highly significant improvement of RV systolic function, in
comparison with patients who received thrombolytic therapy. In comparison to Group B (TT), Group A (PPCI)
showed a significant higher S' (14.19±1.77cm/s vs. 10.01±2.66cm/s, P<0.001) and longer ET (285.41±38.83ms vs.
233.82±51.47ms, P<0.001), while isovolumetric times (IVCT and IVRT) were significant lower in Group A versus
Group B (62.80±13.68ms vs. 79.53±16.26ms, P<0.001; 64.43±19.07ms vs. 80.73±19.20ms, P<0.001, respectively).
Primary PCI is superior to thrombolytic therapy in terms of improvement of RV function where pulsed
wave TDI is a more sensitive diagnostic tool of RV infarction.
Right Ventricle. Myocardial Infarction, Tissue Doppler Imaging, Thrombolytic Therapy, Primary
Percutaneous Coronary Intervention.

The current study objective was to evaluate the
Ischemic damage and necrosis of the cardiac
role of pulsed wave TDI together with conventional
muscle characterise acute myocardial infarction (MI),
Echo-Doppler modalities in assessing right ventricular
more generally termed as a heart attack. When oxygen
function in the setting of acute inferior STEMI
and nutrients aren't delivered to cells fast enough, they
associated with RV infarction.
suffer ischemic damage. We began our publication by

discussing the prevalence as well as diagnosing RV
infarction, with an emphasis on non-invasive
A two-arm, single blinded randomized controlled
techniques like TDI and other Echo techniques. Later,
clinical trial was performed on 100 cases, presenting
we attempted to summarise its outlook in light of
with acute inferior myocardial infarction (MI)
developments between the eras of fibrinolytic therapy
associated with RV infarction, during the period from
and mechanical reperfusion [1].
January 2020 to July 2022. Patients were recruited
Right ventricular functions as well as size can
from the Cardiology Department of National Heart
be thoroughly assessed with relative ease and low cost
Institute, Cairo, Egypt.
using echocardiography. The RV has a complicated

and unusual crescent form, making accurate
Inclusion criteria:
measurements of its size and function difficult using
Acute de novo inferior ST EMI as documented by:
echocardiographic imaging [1]. As a result, the RV
Evidence of inferior ST elevation myocardial
cannot be seen in its whole in a standard 2D
infarction (STEMI) evidenced by typical chest pain,
typical rise of biochemical markers of myocardial
comprehensive evaluation of the RV, data from all
necrosis and In the inferior leads of II, III, as well
acoustic windows and echo modalities are required.
as the AVF, there must be an ST-segment elevation
Furthermore, the clinical report should provide an
equal to or greater than 1mm.
evaluation using both qualitative and quantitative
Patients with acute myocardial infarction or chest
criteria [2].
pain showed ST segment elevation in leads V1,
Received: 09/02/2023
Accepted: 11/04/2023

Full Paper (vol.921 paper# 88)

c:\work\Jor\vol921_89 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6045- 6053

Association of TGFB1 Gene Polymorphism with Congenital Heart Disease
*1 Alaa Refaat Mohamed Ibrahim, 1 Bashir Abd Allah Hassan, 2 Amal Fawzy, 1 Ahmed AbdElSamad ElHewala
1 Pediatrics Department, 2 Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Alaa Refaat Mohamed Ibrahim, Email:, Mobile: 01006259587

: One of the most prevalent congenital deformities in infants is congenital heart disease (CHD) that has high
rates of morbidity and mortality. To enhance patient clinical outcomes, it is vital to investigate CHD pathophysiology.
Cardiovascular illness has been linked to TGF-1 signaling disruptions.
Aim of the Study: The forecasting of CHD susceptibility in the Egyptian population is our aim.
Patients and methods: This case-control study was conducted at the Pediatric Cardiology Unit at the Zagazig Children
Hospital, Faculty of Medicine, Zagazig University, with 60 CHD patients and 60 healthy controls of similar age and sex.
Single nucleotide polymorphisms (SNPs) that are genotyped include: The TGFB1 rs1800471 and rs1982073 analysis were
carried out using restriction fragment length polymorphism (RFLP PCR).
Results: The CT and TT genotypes of rs1982073 were significantly more prevalent in the CHD group compared to controls.
The C allele was only identified in 65 (54%) of the CHD cases and the T allele in 55 (46%) of them, whereas the C allele
was present in 94 (78%) of the control participants and the T allele in 26 (22%) of them. There was a significant difference
between CHD cases and controls in terms of the T allele of rs1982073, which was higher in CHD cases compared to
Conclusion: The current study shows a link between the TGFB1 gene variant rs1982073 and the incidence of congenital
cardiac disease in Egyptian communities.
Keywords: TGFB1, Polymorphism, CHD.


A set of structural heart defects or intrathoracic great
population. Family clustering of CHD with varying
vessels anomalies that are the result of improper cardiac
morphologies is not unusual. Second, a number of
development are referred to as congenital heart disease
genetic variations have been linked to a higher risk of
(CHD). Although surgical procedures and interventional
CHD. Overall, our results show that CHD development
therapies have advanced quickly over the past few
and occurrence are strongly influenced by genetic
decades, congenital heart disease (CHD) is still the
predisposition to CHD (5).
leading non-infectious cause of infant mortality globally.
Transforming growth factor- (TGF), a family of
Its incidence in newborns is estimated to be around 1% (1).
pluripotent cytokines that are ubiquitously produced, is
Furthermore, even after the efficient repair of cardiac
connected to a wide range of physiological and
irregularities, its related consequences such as heart
pathological processes (6).
failure, arrhythmia, and sudden cardiac death may still
According to a previous study, TGF encouraged
manifest. (2).
valve remodeling and differentiation throughout the
In recent years, CHD prevalence has increased
development of the heart by promoting matrix
among both infants and the general population. Before the
organization and reducing cushion mesenchyme
age of five, only a tiny percentage of kids may recover on
differentiation into cartilage cell lineage. (7).
their own; the majority require surgery to address
TGF-1, one of TGF's isoforms, has been shown to
deformities. In general, late diagnosis of CHD leads to
participate in the vascular system's physiology,
increased prenatal morbidity and mortality. Therefore,
pathophysiology, and development, as well as the cell
investigating CHD pathophysiology is essential to
enhancing patient clinical outcomes. Heart defects may
maturation, and death. Numerous autoimmune, fibrotic,
result from a variety of risk factors, including medication
and cardiovascular disorders, as well as cancer, have all
use, heavy alcohol consumption during pregnancy with
been linked to disruptions in TGF-1 signaling (8).
measles (German) or rubella virus infection in the mother
Additionally, it might cause organ fibrosis and
during the first trimester of pregnancy (3,4).
malfunction when expressed too much. Chromosome
Despite substantial research, the precise cause of
19q13.1-q13.3 contains the TGF-1 gene, which has six
CHD is still mostly unknown. However, there is
big introns and seven exons (9). TGF1 gene
growing proof that genetic factors are a significant
polymorphisms may alter the expression and function of
component in its development. First off, there is a larger
TGF1 protein, resulting in a variety of cardiovascular
risk of cardiac abnormalities emerging in the
disorders (10).
descendants of CHD patients than there is in the general
Received: 09/02/2023
Accepted: 11/04/2023

Full Paper (vol.921 paper# 89)

c:\work\Jor\vol921_90 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6054- 6061

Serum Growth Differentiation Factor 15 as a Biomarker for
Chronic Heart Failure in Coronary Artery Disease Patients
Sally Salah Eldin Abdullah Mohammed Sarhan1, Islam Ghanem Ahmed Ghanem*2,
Marwa Mohamed Abd Elzaher Mohamed1, Nahla Mohammed Ibrahim1, Mona Ibrahim Abdelhamid1
1Department of Clinical Pathology, El Ahrar Teaching Hospital, Zagazig, Egypt
2Department of Cardiology, Faculty of Medicine, Zagazig Univeristy, Zagazig, Egypt
*Corresponding author: Islam Ghanem Ahmed Ghanem, Mobile: (+20) 01062829880,
E-mail:, ORCID ID: 0000-0001-5512-2978

: GDF-15, a member of the superfamily of transforming GF beta, regulates pathways of inflammation
and apoptosis in both short-term and long-term tissue injury. Among novel biomarkers is GDF-15, which is used to
diagnose chronic heart failure conditions. LVEF is associated with increased end diastolic diameter, increase in LV
mass index, and increased GDF-15. Objective: For assessing the validity of the GDF-15 test to predict CHF onset in
people with coronary atherosclerosis. Subjects and methods: Our research was done on sixty-nine subjects, who
were categorized as the following: 23 patients with CAD, 23 patients who developed CHF on top of CAD according
to the revised Framingham criteria, and 23 subjects who represented the control group. CAD was evidenced by history
of MI or PCI or CABG or positive treadmill or imaging stress test or coronary angiography (CA) revealing 50%
stenosis in 1 coronary vessels. Results: Although there was no age difference between the CAD and CHF groups,
there were high statistical significance difference regarding age among studied groups. However, no statistical
significance difference was found regarding gender in the study groups. Smoking-related differences between the two
groups and the control group were statistically significant, but not those between the CAD and CHF groups. Although
there was a very statistically significant discrepancy between both the CAD and CHF groups and the control group,
there was no a statistically significant in comparing hypertension between the CAD and CHF groups. There was not a
significant difference in terms of DM between the CAD and CHF groups, however there was a statistically
significant difference between the two groups and the control group. Conclusion: Our findings suggest that GDF-15
might be a valuable biomarker for predicting HF onset in CAD patients. GDF-15 levels were highly significantly
different among CAD patients when compared to persons in good condition.
Keywords: CAD, CHF, GDF-15.

growth factors, is linked to pathways of inflammation
Stable coronary artery disease (CAD), a major
and apoptosis [8].
public health concern with significant morbidity and
Measuring blood levels of GDF-15, a
mortality worldwide [1], is caused by ACS and chronic
consequence of functioning macrophages, may aid in
inflammatory atherosclerosis. According to studies,
the early detection of atherosclerosis. Numerous
inflammatory reactions may have a major impact on
investigations have demonstrated that macrophages are
the development of CAD 2] .[
crucial in the onset of arterial thrombosis, a life-
CHF, which is caused by coronary artery
threatening consequence of atherosclerosis [9].
atherosclerosis, is the most common kind of HF. CHF
Increased expression levels of GDF-15 have been
has become a pandemic in recent years [3]. Circulating
linked to worsened conditions for persons with heart
biomarkers are increasingly being used to improve
disease, particularly ACS patients, independent of
patient management and understand the pathogenesis
troponin or BNP levels. Reports indicating GDF-15
of HF [4]. Given that HF affects several organ systems,
has a protective impact against heart disease have been
biomarkers for cardiac and extracardiac disorders may
attributed to the antiapoptotic, anti-inflammatory, or
offer additional insight above cardiac indicators such
anti-hypertrophic activities reported in animal models
cardiac troponins or natriuretic peptides [5].
[10]. Interest in GDF-15 as possible heart failure
Hs-CTnT increases among CHF diseased people
indicators is now rising[11].
have been connected to the gradually increasing
The purpose of this study is to evaluate the
frequency of cardiovascular events, despite the fact
reliability of the GDF-15 test to forecast the
that conventional cardiac troponin T tests are routinely
development of CHF in CAD patients.
utilised as a positive or negative categorical variable.

Hs-CTnT at baseline and during follow-up is a
powerful predictor of cardiac events in people with
Forty-six individuals with CAD who were
heart failure [6].
hospitalized in Cardiology Departments were included,
A possible cardiovascular biomarker, GDF-15,
at Zagazig University Hospitals, as well as 23 control
which integrates information from cardiac and
individuals, and they were divided into three groups:
extracardiac disease pathways linked to the incidence,

progression, and prognosis of HF [7], is developing.

GDF-15, a member of the superfamily of transforming
Received: 09/02/2023
Accepted: 11/04/2023

Full Paper (vol.921 paper# 90)

c:\work\Jor\vol921_91 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6062- 6069

Left Ventricular Mass after Growth Hormone Replacement Therapy
Ihab A Ahmed1, *Ahmed AlAmir1, Hanan S Ahmed2, Heba Abouzeid1
Pediatrics Department 1, Clinical Pathology Department 2, Zagazig University, Egypt
*Corresponding author: Ahmed AlAmir, Email:, Mobile: 01014662848

Adults with growth hormone deficiency (GHD) have a number of cardiovascular risk factors that may
enhance their risk of cardiovascular morbidity and mortality. The impact of growth hormone (GH) therapy on heart function
and metabolic abnormalities that may increase children's risk of cardiovascular disease (CVD) at an early age has been the
subject of very few research in children.
Aim: To evaluate the effect of growth hormone therapy on left ventricular mass. Patients and methods: This prospective
cohort study was carried out at Pediatric Cardiology and Endocrinology Units of Children's Hospital and Clinical Pathology
Laboratory, Faculty of Medicine, Zagazig University. In total, 41 people took part while studying. Two groups were created
out of them: those with idiopathic short stature, which included 16 children, and those with growth hormone insufficiency,
which included 25 children. To determine LV mass, Echocardiography was used.
The left ventricular mass increased in a statistically meaningful way (from 83.4 g to 89.57 g) after GH therapy.
LV mass increased remarkably in our patients after GH therapy .LV mass correlated positively with duration
of GH therapy and negatively with the percentage of final height to lowest target height.
Keywords: Left ventricular mass; Growth hormone.


Growth hormone (GH) is crucial for somatic
development and metabolic control. As it enhances

To asses left ventricular mass (LVM) and left
glucose uptake, utilization, and inhibits gluconeogenesis,
ventricular mass index (LVMi) in children
insulin lowers postprandial blood sugar and
receiving growth hormone.
glycogenolysis (1).
To asses LV systolic function in children receiving
GH is considered as a determinant of heart
growth hormone therapy using Echocardiography.
growth. Left ventricular (LV) hypertrophy and cardiac

dysfunction are linked to GH overproduction (2).
Impaired cardiac functioning have been linked to
From March 2022 to May 2023, this prospective cohort
growth hormone insufficiency as one of the main causes.
study was conducted at the Children's Hospital Pediatric
Cardiovascular dysfunction is characterized by a decline
Cardiology and Endocrinology Units and Clinical
in LV mass, a reduced ejection fraction, and abnormalities
Pathology Department. In this study, 41 children were
in LV diastolic filling. Recombinant human growth
enrolled. They were split into two categories: Group 1;
hormone therapy may improve contractility, increase
that included growth hormone deficiency group:
exercise capacity, and raise LVEF in some GHD patients.
comprised 25 children and Group 2 that included
mass, and increase cardiac output. Additionally, excessive
Idiopathic short stature group which comprised 16
growth hormone is linked to heart dysfunction and LV
enlargement (3).
Patients with age 4-10 years, receiving growth
A beneficial non-invasive imaging technique
hormone therapy for two years or more with normal
frequently utilized in a variety of pediatric heart
thyroid function tests were included in the study.
conditions is Echocardiography. It has been suggested
Children with dysmorphic traits such as Turner syndrome
that tissue doppler imaging (TDI) is useful for assessing
or skeletal dysplasia with evidence of present
early alterations in systolic and diastolic cardiac
cardiovascular disease, respiratory, renal, hepatic, or
dysfunction. Age, heart rate, and preload have less of an
endocrine disease, multiple pituitary hormone deficiency,
impact on the TDI results than they do on traditional
history of prematurity or intrauterine growth retardation,
Echocardiography. These variables have been linked to
cardiovascular disease-related mortality and morbidity in
atherosclerosis, patients that are not welling to complete
the past. Therefore, it may be concluded that TDI is a
the study and patients receiving drugs that may affect
valuable method for identifying subclinical myocardial
blood glucose level were excluded from the study.
disease (4).
Body mass index (BMI), which is calculated as weight

(kg) divided by square of height (m), and mid parent
Aim: Evaluating growth hormone treatment's effects on
height (taki) that was calculated by taking the average of
the bulk and systolic function of the left ventricle.
mother's and father's height after addition of 13 cm in
Received: 08/02/2023
Accepted: 10/04/2023

Full Paper (vol.921 paper# 91)

c:\work\Jor\vol921_92 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6070- 6074

Efficacy of Intravaginal Administration of Isosorbide Mononitrate Together with
Misoprostol versus Misoprostol Alone in The Induction of Labor in Postdate Women
Noha A. Sakna*, Abdelrahman A. Mohamed, Khaled S. Moussa, Ahmed M. Atek
Department of Obstetrics and Gynecology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Noha A. Sakna, Mobile: (+20) 01114812170, E-mail:

Many studies proved that the administration of isosorbide mononitrate in combination with misoprostol
might increase the success rates of abortion and delivery and help in the reduction of side effects of misoprostol.
Objective: To ascertain if misoprostol and intravaginal isosorbide mononitrate (IMN) intravaginally administered
together can reduce the time needed to induce labor in postdate women.
Patients and Methods: One hundred postdate pregnant women with unfavourable cervixes who were due for labor
induction, in Labor Ward, Ain Shams Maternity Hospital, were selected and randomly allocated to receive IMN 40 mg
with misoprostol 25 µg or misoprostol 25 µg alone by vaginal administration. The duration of induction to the active
phase is the primary result. To match the two groups, Bishop's score, gestational age, parity, and mother's age were
taken into consideration.
Results: Women who took IMN with misoprostol had substantially shorter induction to active phase lengths (10.6±1.5
against 8.8±1.3 p 0.001) and from the beginning of induction to the time of delivery (17.2±2.3 versus 12.2±2.7 p 0.001)
than those who got misoprostol alone. There was no statistically significant difference between the two groups regarding
uterine contractile anomalies including tachysystole, hypertonus, and hyperstimulation. The risk of maternal side effects
such flushing, hypotension, tachycardia, diarrhea, or postpartum hemorrhage was not significantly different between the
two groups, despite the presence of a substantial variation in the rate of headache. 2 patients (4%) had headache in group
A (misoprostol alone), compared to 15 (or 30%) in group B (IMN with misoprostol).
Conclusion: The use of IMN in combination with misoprostol in the induction of labor is effective in the reduction of
the duration of induction and safe on the mother and fetus.
Keywords: Misoprostol, Induction, IMN.

given vaginally has no discernible negative effects on either
Even if the perfect method for starting labor is yet
hemodynamics of mother or fetus (8). Furthermore, there
aways ahead, it is now a crucial part of contemporary
aren't many research that have looked into how well NO
obstetrics. The outcome of labor induction is determined
donors work for cervix priming and labor induction.
by a number of factors. A ripening cervix is one of the

essential components to a successful induction. The
inflammatory cascade and the active cervical ripening
To determine if IMN and misoprostol are effective at
process are similar. A number of degradative enzymes
cutting the time it takes for post-date women to induce
breakdown and disorganize the collagen framework,
increase the amount of extracellular and intracellular

water, reorganise the extracellular matrix proteins, and
raise the water content of the cells (1).
The study's participants were 100 post-term
Typically, cervical ripening medicines are used to
pregnant women who were hospitalized for labor
treat women with an unripened cervix, which is
induction at Ain Shams Maternity Hospital between
commonly defined as having a Bishops score of less than
January and July 2019. This study employed a
six. Prostaglandins (PGs) have been the primary cervical
prospective, randomised, double-blind, controlled trial.
ripening agents since the late 1960s, and they have been
Age (twenty, thirty-five years), a single fetus,
administered to induce labor in a variety of methods with
gestation age > 40 weeks based on LMP or first-trimester
comparable outcomes. Even if there are a number of
ultrasonography, not in labor (six contractions in 1 hour),
Bishop's score seven, and no medical condition were
pharmacological (mechanical) techniques have been
included as inclusion criteria.
utilised to speed up cervical ripening and induce labor (2).
Gestational age 40 weeks, ripe cervix (Bishop's
Nevertheless, in recent years misoprostol (3,4), and
score > 6), membranes rupture, suspicious with
donors of nitric oxide (NO) have both been used to soften
chorioamnionitis, placenta previa, or unexplained vaginal
the cervix and start labor(5,6). Contrary to prostaglandins,
bleeding, hx of major uterine operation, hypertonic
NO donors boost rather than reduce uterine blood flow
uterine pattern, severe preeclampsia, renal or hepatic
and promote rather than inhibit uterine myometrial
dysfunction, contraindications to receiving PG, and
contractions. Because of this, NO donors like IMN appear
general medical disorder diseased women (e.g., diabetes,
to be the best cervical ripening agent before labor
hypertension), were considered as exclusive criteria.
induction (7). Numerous studies have also shown that IMN
Received: 09/02/2023
Accepted: 11/04/2023

Full Paper (vol.921 paper# 92)

c:\work\Jor\vol921_93 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6075- 6081

Female Sexual Function and Distress before and after Treatment of
Moderate and Severe Psoriasis
Aya El-Harby Mohammad Abd-Elaal*, Sherif R. Ismail, Moheiddin F. Alghobary
Dermatology, Andrology and STDs Department, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Aya El-Harby Mohammad, Mobile: (+20) 01098828216, E-mail:

As a systemic immune-mediated illness, psoriasis must be detected and diagnosed in vulnerable
individuals early in order to reduce disease burden and enable early treatment of the disease's symptoms. Due to the
rising frequency of despair, anxiety, and suicidal thoughts among psoriasis patients, the effect of psoriasis on
psychological and mental health is presently a crucial issue.
Objective: The aim of the current study was to evaluate impact of psoriasis on female sexual function and to study
changes that might occur in response to treatment in moderate and severe psoriasis.
Patients and methods: In this case-control study, there were 90 female psoriatic patients and 90 matched controls. The
patients underwent thorough history-taking as well as thorough dermatological examination. Using the PASI score, the
illness severity was evaluated. The female sexual function index (FSFI) and female sexual distress scale (FSDS) were
used to assess sexual function. The assessment was performed before treatment and at 1 month, 2 months and 3 months
after treatment.
Results: There was a statistically significant decrease in the disease severity starting from 1 month after treatment. At
baseline, there was no statistically significant difference between the 2 groups regarding the components of FSFI (except
the total score) that was higher in the cases group (P<0.001). However, after treatment all the components of the FSFI
were statistically significantly higher in the cases group (P<0.001). The FSDS was statistically significantly higher in
the cases group before treatment, after 1 month and after 2 months of treatment (P<0.001), but after 3 months, there was
no statistically significant difference (P=0.650).
Conclusion: Psoriasis is associated with impairment of the sexual functions in the affected females. The treatment was
associated with improvement in the sexual functions, but the modality of treatment didn't affect the sexual function.
Keywords: Psoriasis, PASI, FSFI, FSDS.


experience some sort of sexual difficulty that lowers
Psoriasis is a widespread autoimmune condition
their quality of life (QOL) (7).
that affects the skin, nails, and joints and is chronic,
Other variables include physical manifestations
inflammatory, and T-cell mediated. 2-3% of the
like stinging, pruritus, desquamation, bleeding,
population is impacted by it (1). Its primary
psychological conditions like sadness and anxiety, and
distinguishing feature is the symmetrical distribution
joint pain. These conditions may all contribute to the
across the body of the red plaques with sharp borders
high prevalence of sexual dysfunction in psoriasis
and adhering silvery white scales (2).
patients. Additionally, a variety of psoriasis-related
Psoriasis has a very complicated etiology that is
comorbidities, including atherosclerosis disease,
influenced by both hereditary and environmental
diabetes mellitus, and metabolic syndrome, might have
factors. Due to area and ethnicity, psoriasis incidence
an impact on sexual activity (8).
and prevalence vary greatly as well (3,4).
There are several therapy possibilities. In general,
Psoriasis sufferers frequently experience shame,
minor disease is treated with topical medications,
low self-esteem, and stigmatisation, which can lead
moderate disease is treated with phototherapy, and
them to put off forming a family or having children
severe disease is treated with systemic drugs (9).
owing to the risk of passing on the illness. Additionally,
NBUVB (Narrowband UVB light) and PUVA
it has been said that depression significantly contributes
therapy, which combine psoralen and UVA radiation,
to patients' increased morbidity (5).
are examples of phototherapy (10). In severe instances,
A difficulty that a person or a couple encounters
including those involving the nails and psoriatic
during any phase of a normal sexual activity, including
arthritis, systemic medications are employed. Options
physical pleasure, desire, preference, arousal, or
include methotrexate, retinoids, cyclosporine, and
orgasm, is known as sexual dysfunction (or sexual
fumarates (4).
malfunction or sexual illness). The DSM-5 states that
Although the impact of psoriasis on patients'
(with the exception of drug or medication-induced
sexual and mental health has been extensively
sexual dysfunction) a person must experience
researched, no studies have attempted to assess the
significant discomfort and interpersonal strain for at
impact of various treatment techniques on these
least six months in order to be diagnosed with sexual
dysfunction (6).
The aim of the current study was to evaluate
Psoriasis is a noticeable skin condition that makes
impact of psoriasis on female sexual function and to
the sufferer feel stigmatised. Many women claim to
Received: 12/02/2023
Accepted: 12/04/2023

Full Paper (vol.921 paper# 93)

c:\work\Jor\vol921_94 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6082- 6086

Relationships between Serum Interleukin-6, Radiographic Severity a
WOMAC Index in Patients with Primary Knee Osteoarthritis
Riham Ahmed 1, Nema Soliman 2, Shereen Elwan 1
1 Department of Physical Medicine, Rheumatology and Rehabilitation,
2 Biochemistry Department, Faculty of Medicine & University Hospitals, Tanta University, Tanta , Egypt
Corresponding author: Riham Ahmed, E-mail:,
ORCID number: 0000-0002-3687-7555, Mobile number: +201224201494

Osteoarthritis (OA) is the highest prevalent degenerative joint condition, leading to joint discomfort and
impaired function.
This study aimed to examin the relationship among serum interleukin-6 (IL-6) and knee osteoarthritis
(KOA) signs as well as the relationship among serum IL-6 and radiographic severity in cases with primary KOA.
Methods: This case-control research involved 50 primary KOA cases and 50 controls. Signs were measured through
the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Results: Serum IL-6 was significantly elevated in OA cases than controls. WOMAC in OA cases ranged from 0 to 95
and Kellegren-Lawrence (KL) score mean was 2.7 ± 0.76. Serum IL-6 was significantly correlated with pain, physical
function score, and radiographic score. Regression analysis revealed that IL-6 had a higher influence on WOMAC and
KL score.
Conclusion: Serum IL-6 is elevated in KOA cases. In addition, serum IL-6 is associated with OA signs and radiographic
Primary knee osteoarthritis, Interleukin-6, WOMAC, Kellegren-Lawrence score, Visual analogue scale.


Several research document the IL-6 catabolic impacts
Osteoarthritis (OA) is a gradual degenerative
on cartilage and synovium with concomitant muscular
joint condition whose influence is growing as life
degeneration, after traumatic events. High IL-6 serum
expectancy increases [1].
level was identified as an independent prognostic
OA impacts all joint tissues, leading to articular
factor of incident radiographic KOA [11].
cartilage mass loss, subchondral bone remodeling, new
The above-mentioned degenerative changes are
bone production, and synovium inflammation [2]. Knee
related to pain and other OA signs that may result in
osteoarthritis (KOA) is considered the highest prevalent
limits in everyday activities, poor quality of life and
type of arthritis leading to pain and dysfunction,
functional impairment [12]. Therefore, more research
especially in elderly population [3].
into the commonest pathogenic factors can help to the
Multiple causes are included in the OA
development of novel treatment targets for OA [13]. This
development involving genetic predisposition, obesity,
research objected to examine the possible relationship
aging, and trauma [2]. Inflammation has a key role in OA
between serum IL-6 and KOA signs such as pain,
pathogenesis, as inflammatory cytokines are released
stiffness and physical function as measured by
and this has an immediate consequence on degeneration
WOMAC and to examine the connection among serum
of cartilage mass [4]. Other factors, such as damage-
IL-6 and radiographic severity in primary KOA cases.
associated molecular mechanisms along with

inflammation [5]. Multiple publications are focusing on
This case-control research involved fifty patients who
the rising role of the cytokine network in OA
met the
pathogenesis [6].
classification criteria for primary KOA [14] and a control
Proinflammatory cytokines are considered
group of fifty randomly chosen healthy individuals.
essential players in OA, and in many other

inflammatory processes [7]. In tissues subjected to high
Exclusion criteria: (1) presence of any concomitant
mechanical load, cytokines disturb the catabolic and
autoimmune, metabolic, infectious, or inflammatory
anabolic processes. Among the multiple cytokines, a
disease; (2) secondary OA.
great importance is attributed to Interlukin-1, tumor

necrosis factor , interleukin-6 (IL-6), IL-15, IL-17, and
Ethical approval: This research was approved by the
IL-18 [8].
Local Research Ethical Committee of Tanta
IL-6 is considered a pleiotropic cytokine which
University (approval code 35105/12/21). Prior to
has 184 amino acid residues [9]. In OA, the synovium
inclusion, the participants gave an informed
produces IL-6 via plasma cells or activated synovial
consents. The study meets the provisions of the
fibroblasts in the synovial lining, while the infrapatellar
Helsinki 1995 Declaration.
fat pad (IFP) acts as a significant supplier of IL-6 [10].


Full Paper (vol.921 paper# 94)

c:\work\Jor\vol921_95 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6087- 6090

Insight about Lines of Treatment of Onychomycosis: Review Article
Heba Salah Aldeen Abu Shagour*1, Amany Abdel-Rahman Nassar1,
Fathia Mohamed Khattab1, Nahla Abd Elhamid Mohamed2
Departments of 1Dermatology, Venereology and Andrology and
2Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Heba Salah Aldeen Abu Shagour, Mobile: (+20) 01159348465, E-mail:

Fungal infections of the nail bed are known as onychomycosis. Nail plate hypertrophy, onycholysis, and
nail discolouration are all symptoms. Nail plate, nail matrix, and nail bed are all parts of the nail unit that might be impacted.
Objective: Review of literature about lines of treatment of onychomycosis.
We searched Science Direct, Google Scholar as well as PubMed for relevant articles on Onychomycosis and
Lines of treatment. Only the most recent or thorough study was taken into account between December 2015 and April
2023. The authors also evaluated the value of resources culled from other works in the same genre. Documents written
in languages other than English have been ignored due to lack of translation funds. Unpublished works, oral
presentations, conference abstracts, and dissertations were generally agreed upon not to qualify as scientific research.
Conclusion: Because the fungus lives so deeply within the nail plate, treatment for onychomycosis can take a long time,
patients often don't stick with it, and the condition often returns. Possible treatments include surgical avulsion, laser
therapy, photodynamic therapy, and both topical and oral antifungal medications (e.g., very thick and chronic fungal
Keywords: Onychomycosis, Treatment.

Different clinical subgroups of onychomycosis are
Onychomycosis is a fungal infection of the nail
generated due to the place and pattern of fungal
unit that causes nail discoloration, onycholysis, and nail
invasion. Fungi can avoid standard antifungal
plate thickness (dermatophytes, non-dermatophyte
treatments by forming biofilms, which also contributes
moulds, and yeasts). All of the three components of the
to antifungal resistance. Onychomycosis causes a
nail, the plate, the matrix, and the nail bed, are
staining of the nail, usually white or yellowish-brown.
interconnected and vulnerable to damage. Nail fungus
Color changes, including violet, green, and even black,
derives from the Greek (onyx) for nail and (mykes) for
have been observed on the nail plate. Other clinical
fungus (onychomycosis). At least half of all nail
symptoms include thickening of the nail plate,
illnesses can be traced back to onychomycosis, the most
subungual hyperkeratosis, and onycholysis (nail
common nail ailment (1).
separation from the nail bed) (onychauxis) (5).
It is advised and cost-effective to confirm a clinical

diagnosis of onychomycosis in the lab before beginning
treatment. Over the past few years, fresh diagnostic
To avoid a misdiagnosis, it may be prudent to have
tools and therapeutic approaches have evolved, making
a lab confirm onychomycosis prior to starting treatment.
onychomycosis easier to spot and cure than ever before.
Potentially harmful drug interactions between systemic
The target audience for this message is anyone
antifungal drugs, therapeutic failure, and patient
interested in staying abreast of the latest developments
discomfort from excessive treatment are all possible
in diagnosing and managing onychomycosis (2).
outcomes of an incorrect diagnosis. The patient may
According to recent published epidemiological
also have to pay for it out of their own pocket. Many
studies, onychomycosis has a global frequency of about
doctors still treat onychomycosis by trial-and-error
5.5% in the general population. The disorder is seen far
methods (4).
more frequently in older people than in younger ones,
Because the fungus lives so deeply within the nail
and its incidence rises with age. In North America, it is
plate, treatment for onychomycosis can take a long time,
estimated that 0.4% of children have it, while the
patients often don't stick with it, and the condition often
number rises to as high as 35% of those over the age of
returns. Surgical avulsion, laser therapy, as well as
65 (3).
photodynamic therapy (6).
Onychomycosis is caused by dermatophytes, non-

dermatophytic moulds, or yeasts coming into touch with
Oral antifungal agents
the nail. Due to defective cell-mediated immunity, the
When it comes for treating onychomycosis, oral
nail unit is easily infected by fungi. Fungi produce
antifungal therapy is preferred over topical antifungal
proteolytic, keratinolytic, and lipolytic enzymes, which
therapy for both children and adults due to its shorter
break down the keratin in the nail plate and make room
treatment courses and greater cure rates. Oral antifungal
for the fungus to invade (4).
medications have a lesser risk of causing side effects in
Fungal infections may be more common in people
youngsters (7).
whose immune systems are weakened in some way.
Received: 13/02/2023
Accepted: 13/04/2023

Full Paper (vol.921 paper# 95)

c:\work\Jor\vol921_96 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6091- 6094

Serum Vitamin D Levels in Children with Immune
Thrombocytopenia: Review Article
Mervat Abdallah Hesham1, Laila Metwally Sherief, Amal Fawzy Abd-Elmeged2, Maha Ibrahim Said*1
Departments of 1Pediatrics and 2Biochemistry Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
*Corresponding author: Maha Ibrahim Said, Mobile: (+20) 01060593446, E-Mail:

Platelet disorders include immune thrombocytopenia (ITP). In ITP, the child's platelet count is too low,
therefore blood does not clot normally. Small blood cells called platelets are produced in the bone marrow. Platelet
degradation by antibodies and/or cells may have a role in ITP's pathophysiology, albeit this is not fully understood. Children
who are newly diagnosed or chronic ITP type often have vitamin D (VD) deficiency. Since of this, immune cells that
express VD nuclear receptor (VDR) are helpful because they can break down VD.
Objective: Assessment of correlations of vitamin D Level among children who have immune thrombocytopenia.
We scoured scholarly journals and information repositories including PubMed, Google Scholar, and Science
Direct for studies on serum vitamin D levels and immune thrombocytopenia. Only the most recent or comprehensive
study conducted between November 2001 and July 2020 was considered. The authors also analysed references from
comparable works. As a result, non-English documents have been overlooked due to a lack of resources to translate
them. Unpublished articles, oral presentations, conference abstracts, and dissertations were all generally agreed upon
not to constitute legitimate scientific investigations.
Conclusion: Among newly diagnosed ITP cases, especially in children, cytokine abnormalities have been identified.
Literature on VD and ITP, pathogenesis and medical diagnosis is poorly reviewed. The use of VD can also be helpful
for new diagnosed as well as chronic ITP patients.
Keywords: Immune thrombocytopenia, Children, Vitamin D.

certain patients' bone marrow, there are several
The highest frequency of ITP is between the ages
symptoms of morphological defects, including
of 2 and 5, although the age varies from early childhood
apoptotic ultrastructure and Caspase-3 activation, as
to older people. The disorder is self-limited in most
well as platelet destruction. In addition to these cellular
children with resolution in 80% of patients within 6-12
deficits, ITP patients also have an unbalanced cytokine
months of diagnosis. A platelet-facing autoantibody
profile, with decreased levels of cytokines like
develops in a tiny number of youngsters, about 1 in
interleukin (IL)-2, interferon (IFN), and IL-17 in their
20,000, 1­4 weeks following exposure to a specific viral
blood (4).
infection (1).
Within the first three months following diagnosis,
Platelet degradation by antibodies and/or by cells
clinical classification of ITP is possible into three
may have a role in the pathophysiology of ITP, however
stages, with the first stage being the time of initial
this is still poorly understood. Recent research,
diagnosis. Symptoms of intermittent thrombocytopenic
however, has revealed the importance of the bone
purpura (ITP) typically last between three and twelve
marrow niche, cytokine imbalances, and T-cell
months, but those of chronic ITP persist for longer.
impairments. The most common cause of ITP is the
Recently diagnosed acute ITP was once a term used
binding of IgG autoantibodies to platelets and MKs.
only to describe adolescents. If immediate treatment is
These antibodies target highly expressed surface
needed for bleeding symptoms, a diagnosis of ITP is
antigens including glycoprotein (GP) IIb 3 (GPIIbIIIA)
considered life-threatening. The vast majority of adult
and GPIb- IX-V (2).
patients will experience persistent symptoms over time
When platelets containing bound autoantibodies
are recognised by phagocytes expressing Fc-receptors,
Secosteroids, short for "separated steroids," are the
this leads to increased antibody-mediated platelet
many forms of vitamin D. As a result of differences in
phagocytosis and, in particular, spleen injury.
their side chains, vitamin D2 and vitamin D3 function
Furthermore, MK development and survival could be
differently. D2 has a methyl group at carbon 24 and a
hampered or even prevented by autoantibody binding.
double bond between carbons 22 and 23 on its side
Furthermore, the glycoprotein hormone thrombopoietin
chain. One of the numerous analogues of vitamin D is
(TPO) produced in the liver cannot be used to treat
secosteroids, commonly referred to as split steroids. The
decrease in platelet counts (3).
structural and physiological characteristics of vitamins
A novel functional defect of TPO has been added
D2 and D3 differ from one another. As part of its side
to the pathogenesis of the disease, as nearly two-thirds
chain, the D2 molecule has a double bond between
of people with ITP have either normal or reduced levels
carbons 22 and 23 and a methyl group on carbon 24 (6).
of plasma TPO. Despite an increased quantity of MK in


Full Paper (vol.921 paper# 96)

c:\work\Jor\vol921_97 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6095- 6099

Assessment of Age Changes in Corneal Endothelial Cell Count among
Emmetropes Using Non-Contact Specular Microscope in Suez Canal
University, Ophthalmology Outpatient Clinic
Hussein SE El Nahass, Mohamed E Shahin, Basma G. Mahmoud
Ophthalmology Department, Faculty of Medicine, Suez University
Corresponding Author: Basma G. Mahmoud, Email:, Mobile: +201001558203

The human corneal endothelial cells are non-regenerating cells that are primarily hexagonal in shape.
Corneal endothelium is metabolically active and serves an essential function in the maintenance of corneal transparency.
It is able to accomplish this by pumping water out of the stroma and into the aqueous humor.
Objective: This study aimed to evaluate corneal endothelial cell density and morphology among different age groups
of emmetropic individuals.
Patients and Methods: This study involved eighty eyes of forty subjects classified into 5 age groups. Evaluation of
corneal endothelium in emmetropic participants was performed by specular microscopy.
Results: When comparing endothelial cell density (ECD), there was a highly significant age disparity. There was a
statistically significant distinction in HEX% among the age ranges surveyed, while we found an increasing coefficient
of variation (CV) percentage with increasing age.
Conclusion: We discovered a statistically significant difference in ECD and morphology across the various age groups,
which led us to conclude that age has a substantial impact on corneal endothelial cell density and morphology.
Keywords: Cornea, Age Changes, Endothelial cell.

The human corneal endothelial cells are non-
This prospective observational study included
regenerating cells that are primarily hexagonal in shape.
eighty (80) eyes of forty (40) emmetropic participants.
These cells line the back of Descemet's membrane and
They were recruited from the Ophthalmology
are aligned such that their pointed ends face the front of
Department, Faculty of Medicine, Suez Canal
the eye (1).
University. We studied endothelial corneal cell changes
Corneal endothelium is metabolically active and
by ageing.
serves an essential function in the maintenance of

corneal transparency. It is able to accomplish this by
Inclusion criteria: Emmetropes of both sexes aged
pumping water out of the stroma and into the aqueous
more than 5 years.
humor, so ensuring that the stroma continues to be

dehydrated at a level of water content of 70% or less (2).
Exclusion criteria: Eyes with previous ocular surgeries
Utilizing a specular microscope, one is able to
or trauma, previous contact lens wear, corneal diseases,
determine the density and shape of corneal endothelial
ocular pathology, glaucoma as well as systemic diseases
cells. It has been shown that the specular microscope is
that could affect the eye (e.g. collagen disease and DM)
highly reliable and reproducible when subjected to the
were excluded.
necessary calibration steps (3).

Non-contact the corneal endothelial cell layer can
The eighty eyes were classified into 5 age groups: (1)
be analyzed for its morphology using a spherical
aged 5-14 years, (2) aged 15-29 years, (3) 30-44, (4) 45-
microscope, which is a method that does not involve
60, (5) more than 60 years.
any invasive procedures. It measures both the mean cell
A thorough ophthalmic examination was
density (MCD) and the coefficient of variation (CV) in
conducted, including a review of the patient's medical
the cell size, and it also determines whether or not the
history, measurement of visual acuity, refraction,
cells have a hexagonal look. An index of the corneal
external eye, intraocular pressure, and slit-lamp
endothelium's functioning properly can be derived from
biomicroscopy with direct and indirect inspection.
these characteristics (4).

Preoperative evaluation of the corneal
Non-contact specular microscope: (NIDEK CEM-
endothelium is crucial for predicting the likelihood of
530): To count ocular endothelial cells and examine
corneal problems following intra-ocular or refractive
their shape, a noncontact specular microscope was
surgery, as these procedures might result in substantial
utilized. The device illuminates the cornea and then
morphological change to the corneal endothelium.
records the reflection of light from the optical contact
Examining the quantity and shape of corneal endothelial
between the corneal endothelium and the aqueous
cells across multiple age groups in emmetropic patients
humor. The device examines the reflected picture and
is the focus of this research.
renders a specular photomicrograph of it. The number

of endothelial cells, cell density, size variation

(polymegathism), and form variation (pleomorphism)
Received: 08/02/2023
Accepted: 10/04/2023

Full Paper (vol.921 paper# 97)

c:\work\Jor\vol921_98 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6100- 6108

Production, Extraction, and Purification of An Extracellular Melanin
Pigment from Clinically Isolated Pseudomonas aeruginosa
Mohammed R. Gheni*, Nisreen H. Odaa
Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq
Correspondence Author: Mohammed Redha Ghani, Phone: +96 47714377682, E-mail:

Melanin is a high-molecular weight pigment produced through the oxidative polymerization of phenolic or
indolic compounds and plays a perfect role in UV-light shielding, as well as in photoprotection. Among biopolymers,
melanin is unique in many aspects. This study is designed to screen Production, extraction and characterizes of an
extracellular melanin pigment from clinically isolated P. aeruginosa.
Objective: The aim of the current study is isolation and diagnosis of P. aeruginosa using vitek-2 compact system and
screening the ability to produce melanin and characterization of extracted melanin by UV-vis, FTIR, XRD and SEM.
Materials and methods:
the samples swab inoculated on cetrimide agar as selective media and incubated aerobically for
24 hours at 37°C and used nutrient agar with nutrient broth supplement with 1% tyrosine for Screening for melanin
production by P. aeruginosa isolates.
Results: Four isolates P. aeruginosa were identified out of 109 specimens have ability to produce melanin pigment under
specific medium and culture conditions. According to morphological, cultural, biochemical, and VITEK-2 characteristics,
isolates were identified as P. aeruginosa. The results showed that the isolate of burn was greatest in production of melanin.
Based on its solubility in organic solvents, the black pigment was identified as melanin and structurally and functionally
characterized by UV-Vis absorbance and presence of various characteristic peaks that determined by FTIR analysis, and
the morphology of the pigment surface was examined using SEM and XRD spectra analysis.
Conclusion: Depending on the type of bacteria and the conditions of their culture, different melanin-producing bacteria
produce different amounts of melanin. The primary factors for bacterial melanin production are L-tyrosine, energy source,
pH, temperature and surface area for shaker agitation. In this study, results found that the optimum condition for melanin
production by P. aeruginosa in pH=7.3 and the effect of L-tyrosine concentration on melanin production found that use
1g/L is the best concentration for production.
P. aeruginosa, Detection, Melanin pigment, Physico-Chemical Characterization, Experimental study,
University of Baghdad.


Melanin is a biopolymer synthesized from phenolic
Melanin was first used by Berzelius to refer to dark
or indolic compounds (1). It has the capacity to absorb a
animal pigments in 1840 (9). The source and mechanism
variety of electromagnetic radiation, from visible light to
of melanin synthesis depend on many factors like
the X-ray region(2). It serves as a shield against chemicals,
enzymes, polymerization pathways and building blocks
heat, desiccation and hyperosmotic shock (heavy metals
(10). It can be classified depending on chemical
and oxidizing agents) (3).
composition like monomer subunit structure (11).
The most important ones are free radical scavenging
The aim of the current study is isolation and
and drug delivery capability (4). Although melanin is
diagnosis of P. aeruginosa using vitek-2 compact system
required to improve microbes' capability of competing
and screening the ability to produce melanin and
and surviving in different unfavorable conditions, such as
characterization of extracted melanin by UV-vis, FTIR,
those caused by ultraviolet rays, it is thought to be not
XRD and SEM.
necessary for their growth and development (5).

P. aeruginosa is a motile, heterotrophic, gram-
negative rod shape that measures 0.5-1.0 µm in width and
Collection and Identification of P. aeruginosa isolate:
1-5 µm in length. It is facultative non-spore forming and
From November 2021 to February 2022, 109 samples
grows using aerobic respiration, P. aeruginosa can
were collected. All the samples were clinically isolated
survive in varying temperatures ranging from 4 to 42°C
from Iraqi patient's hospitals (burns patients, UTI,
and produces flat, large, serrated, green or blue pigmented
tracheostomy patients in ICU, endotracheal tube patients
colonies giving characteristic sweetish fruity odour (6,7). P.
in ICU, mastoiditis, and wound infection). These samples
aeruginosa is a commercially valuable organism because
were collected from Medical City/Burning Hospital, ICU
it produces many soluble pigments like pyocyanin (blue-
Ghazy AL-Hariri Hospital for surgical specialties, Arabi
green), pyorubin (red), pyoveridin (yellow-green) and
Private Hospital, and Al Alawia Hospital. All samples
pyomelanin (brown-black) (8).
swab inoculated on cetrimide agar as selective media and
Received: 18/08/2022
Accepted: 21/10/2022

Full Paper (vol.921 paper# 98)

c:\work\Jor\vol921_99 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6109- 6116

The Association between Fetal Head Station at the First Diagnosis of the
Second Stage of Labor and Delivery Outcomes
Mohamed Kandil, Nehad M. Hosny, Marwa Ahmed Thabet*, Essam. A. Amin
Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt
*Corresponding author: Marwa Ahmed Thabet, Mobile: (+20) 01094711279, E-mail:

The impact of foetal head station at the onset of 2nd stage of labor on the duration of 2nd stage duration
is still controversial in spite of multiple studies conducted on evaluation of foetal head station early in labor, but still
much less data on the impact of foetal head descend in the 2nd stage. Objective: The study aimed to evaluate the
correlation between foetal head station diagnosed at the start of second stage of labour and fetomaternal delivery
outcomes. Subjects and methods: This study was carried out on 100 female participants were in spontaneous labor at
37-42 weeks in emergency room (ER) at Obstetrics and Gynecology Department at Menoufia University Hospitals
after obtaining their consent from January 2022 till December 2022. Upon the diagnosis of the second stage of labour,
women were divided into three groups according to the foetal head station: above (S<0), at the level of (S=0), and
below (S>0). The length of the second stage and the risk of operational delivery were examined and stratified by
parity between the groups. All subjects had routine testing (CBC, Coagulation profile, Kidney function tests, Liver
function tests), and all females underwent obstetric ultrasounds. Results: 46% of the 100 individuals who matched the
inclusion criteria were nulliparous, whereas 54% were multiparous. 10.9%, 34.8%, and 54.3% of the nulliparous
women had foetal head S<0, S=0, and S>0 following second stage diagnosis. 20.4%, 37%, and 42.6% of the
multiparous women were identified as having foetal head S<0, S=0, and S>0, respectively. The length of the second
stage was independently and strongly correlated with foetal head station at the time of second stage diagnosis
(P<0.001). Conclusion: The length of the second stage is strongly and independently correlated with the foetal head
station at the first diagnosis of the second stage. Between three groups of multiparous, there was a statistically
significant difference in the necessity for the Kristeller manoeuvre, with multiparous females with S0 needing fundal
pressure more often.
Keywords: Fetal head station, Head descend, labor, 2nd stage, Nulliparous, Multiparous.


Commonly, the duration of this second stage is
One of the most significant experiences a person
used to manage it [7, 12]. Foetal descent describes the
can have is giving birth. Despite the intricacy and
presenting part's downward journey via the birth canal.
complexity of contemporary obstetrics, it's critical to
The midway (0 station) is designated as the plane of
keep in mind that every pregnancy has one
the maternal ischial spines. There are generally
straightforward goal: to deliver a healthy baby to a
recognised categorization systems of foetal station (-5
healthy mother [1]. Power, passenger, and "passage" are
to +5) and (3 to +3) that are based on a quantitative
three interconnected and interacting components that
measure in centimeters of the distance of the leading
influence the mechanics of labour. The second stage
bony edge from the ischial spines [8].
begins shortly after the cervix has fully dilated and

concludes with the delivery of the foetus [2]. A
subjective instrument, digital evaluation of foetal head
Study design and grouping
station during labour is prone to significant
This analytical prospective cross-sectional study
disagreement among examiners, particularly during
included female participants in spontaneous labor at
lengthy labour when caput succedaneum and moulding
37-42 weeks in ER at Obstetrics and Gynecology
make foetal head position interpretation more
Department at Menoufia University Hospitals through
challenging [3].
the period from January 2022 to December 2022.
Foetal station is clinically evaluated during the
Participants were divided into nulliparous and
second stage of labour to determine dystocia, measure
multiparous women who further divided according to
descent, and decide how to hasten delivery when
foetal head station into 3 groups: Group I: S>0, foetal
necessary. A 45° angle between the foetal head's
head below the spinal process level (also known as
anteroposterior diameter and the maternal pelvis
S+1, S+2, or S+3; used as a reference group). Group
indicates that the skull's base is at or below the level of
II: S=0, foetal head at the level of the spinal process.
the ischial spines, which corresponds to the pelvis's
Group III: Foetal head, level above the spinal process
minimum diameter, making foetal head rotation
(i.e., S- 1, S- 2, or S- 3).
evaluation valuable as well [4].
Sample size estimation
Numerous research have looked at the use of
Estimated in the faculty of medicine at Menoufia
University's public health and community medicine
characteristics to predict the method of delivery during
department and academic research department. Based
the second stage of labour [5,6].
on a review of the prior literature, Ashwal et al. (8) who

discovered that both nulliparous and multiparous

women are at an increased risk for operative delivery
Received: 11/03/2023
Accepted: 13/05/2023

Full Paper (vol.921 paper# 99)

c:\work\Jor\vol921_100 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6117- 6125

E-Cadherin and Hydrogen Peroxide in Vitiliginous Skin
Marwa M. A. Abdallah1, Alaa A. Abdel-Magid1, Manal L. Louka2, Mona H. Raafat3, Christine K. Gobrial1
Departments of 1Dermatology and Venereology, 2Medical Biochemistry and
Molecular Biology and 3Histology and Cell Biology, Faculty of Medicine, Ain Shams University, Egypt
Corresponding author: Christine Kamal Thabet Gobrial, Mobile: (+20)01226312561, E-mail:

Vitiligo is a chronic acquired skin disorder that causes loss of its colour. The definite cause is unknown
but may be due to genetic factors, immune system changes or stress exposure. Oxidative stress may cause melanocytic
destruction through its damaging effects on the cell components.
Objective: Measurement of E-cadherin and hydrogen peroxide (H2O2) level in vitiligo patients versus controls.
Patients and Methods: This case-control study involved 20 sex and age matched participants, 10 active non segmental
vitiligo (NSV) patients, and 10 non vitiliginous controls, all recruited from the Dermatology Department, Ain Shams
University and New Cairo Police Academy Hospital from March 2018 till March 2021. Skin biopsies were taken from
four different anatomical sites in cases and controls for immune-histochemical evaluation of E-cadherin and biochemical
measurement of H2O2.
Results: H2O2 showed statistically significant higher values, while E-cadherin had significantly lower staining in
patients than controls.
Conclusion: Higher H2O2 level, in vitiligo patients, is suggestive of oxidative stress. Current study may indicate that
vitiligo is not just a disease of melanocytes, but keratinocytes may also play a role, as well. Keratinocytes in depigmented
epidermis may have a changed microenvironment, as evidenced by a lack of cell-to-cell adhesion between keratinocytes
and melanocytes, as well as between keratinocytes, disrupting the skin pigmentary system.
Keywords: E-Cadherin, Hydrogen Peroxide, Vitiligo and Oxidative Stress.

University Hospitals and New Cairo Police Academy
Vitiligo is an acquired skin depigmentation
Hospital from March 2018 till March 2021.
affecting about 1% of people, [1,2] due to destruction of
This study included twenty subjects who were
melanocytes [3]. It may be segmental, non-segmental or
divided into two groups:
mixed [4]. Pathogenesis hypotheses of vitiligo include:
Group I: Ten active NSV patients recruited from the
autoimmune [5], neural [6], and defective free radical
outpatient clinic and Group II: Ten non vitiliginous
defense interfering with melanogenesis [7,8]. The main
controls (attended the dermatology clinic for cosmetic
epidermal faulty cellular adhesion function may be
involved, according to the melanocytotoxicity idea [9,10].
We included patients with active NSV whose
Catenins and cadherins mediate interactions between
vitiligo disease activity (VIDA) score was 3 and 4 [19],
keratinocytes and melanocytes [11]. Environmental
Fitzpatrick skin types II, III and IV, who did not receive
redox state affects cell-cell adhesion that is dependent
any systemic treatment or phototherapy for vitiligo at
on E-cadherin [12,13].
least for 3 months or topical treatment for 2 months
Auto-cytotoxic hypothesis assumes oxidative
before the current study.
stress, as initiative to melanocyte degeneration [14],
We excluded; segmental and stable vitiligo
having hydrogen peroxide (H2O2) buildup in the
patients i.e., there has been no advancement of current
patients' epidermis who are actively experiencing
disease or the emergence of new lesions in the previous
vitiligo [15,16], which is more observed in perilesional
six months, those on systemic or topical vitiligo
skin, suggesting its role in initiating depigmentation
treatment, patients suffering any concomitant
process [17]. Reactive oxygen species (ROS) cause lipid
dermatological diseases or receiving antioxidants.
peroxidation, deoxyribonucleic acid modification, and
Complete dermatological examination was
inflammatory cytokines secretion [18].
done to exclude other diseases and VIDA score
We aimed at evaluating the immuno-
assessment based on a six-point scale according to Njoo
histochemical staining of tissue E-cadherin in skin
et al. [19], was done for evaluating vitiligo activity; [+4:
samples from active non segmental vitiligo (NSV)
activity of 6 weeks or less period, +3: activity of 6
patients, in different anatomical areas, in comparison to
weeks to 3 months, +2: activity of 3 to 6 months, +1:
controls, and measuring H2O2 levels in the same
activity of 6 to 12 months, 0: stable at least for 1 year
samples in an attempt to find a possible causal
and -1: stable at least for 1 year with spontaneous re-
relationship between E-cadherin and H2O2 in the
pathogenesis of vitiligo.
Four punch biopsies (5 mm) were taken from

each patient and control: non-lesional skin without any

sign of inflammation, [face (post auricular), distal acral
This case control study was issued in the Department of
sites, trunk and lower limb (around the knee)].
Dermatology, Venereology and Andrology, Ain Shams
Received: 14/02/2023
Accepted: 16/04/2023

Full Paper (vol.921 paper# 100)

c:\work\Jor\vol921_101 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6126- 6132

Laboratory Predictors of High Thrombus Burden in Acute ST-Elevation
Myocardial Infarction Undergoing Primary Percutaneous Intervention
Eman H Seddik1*, Kamel Ghazal1, Ahmed El-Sayed Mohammed2, Marwa M Gad1, Shaimaa Wageeh1
1 Cardiovascular Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
2 Cardiovascular Department, Hehia General Hospital, Zagazig, Egypt
*Corresponding author: Eman H Seddik,Mobile:(+20)01276179809,
E-mail:,ORCID ID:0000-0003-1148-3805

Background and Aim
: A risk factor for stent thrombosis, no-reflow, and unfavorable outcomes is still intracoronary
thrombus. Hematological markers' diagnostic utility in cardiovascular diseases (CVDs) is an important field for research.
So our aim is to ascertain the association between various hematological markers and the high thrombus burden.
: This cross-sectional study included 124 cases of acute ST-elevation myocardial infarction (STEMI) and was
classified into two groups ; 54 cases in the group (I) had a low thrombus burden, whereas 70 cases in group (II) had a high
thrombus burden. Electrocardiography (ECG), echocardiography, complete blood count (CBC) sample, lipid profile, and
troponin were gathered.
Results : Group II had lower high-density lipoprotein (HDL-C) with a significant difference of p<0.001. Significant higher
white cell counts (WBC) count, monocytes, relative distribution width (RDW), neutrophile to lymphocytes ratio (NLR),
monocytes to high-density lipoprotein ratio (MHR), and troponin were also in favor of group II. MHR at odds ratio 0.35
with 95% confidence interval (CI) and troponin at odds ratio 0.659 were significant predictors of high thrombus burden.
MHR sensitivity was 78% , specificity was 65%, and p<0.001, while troponin sensitivity was 74%,specificity was 56% ,
and p<0.001. The cutoff values were 0.026 and 3.2 for MHR and troponin respectively.
Conclusion: Troponin and MHR were simple, sensitive, and low-cost markers, might be helpful in predicting the high
thrombus burden.
Keywords: Predictors; Monocytes to high-density lipoprotein (MHR); High thrombus burden


ST-segment elevation myocardial infarction
monocyte to high-density lipoprotein cholesterol ratio
(STEMI) has been associated with a high rate of
(MHR) are associated with unfavourable outcomes and
morbidity and mortality (1). The pathophysiology behind
severe coronary artery disease (9). So, we aimed to
acute coronary syndrome is made up of intracoronary
ascertain the relationship between the different
thrombus formation on top of atherosclerotic plaque
hematological indices and the high thrombus burden in
rupture and a decrease in coronary blood flow (2).
acute STEMI managed by primary percutaneous coronary
Intracoronary thrombus burden remains a risk factor for
intervention (PPCI).
long-term adverse cardiovascular events, stent

thrombosis, no-reflow, and distal embolization (3).
Hematological markers, predictive and even diagnostic
This cross-sectional study was conducted at Zagazig
value in cardiovascular diseases (CVDs) is a major field
University Hospital from (July 2020 to December 2022) on
of research (4).
acute STEMI patients presented within the first twelve
Decreased relative distribution width (RDW) is
hours after the chest pain beginning and then managed
related to a lower likelihood of adverse events in patients
with PPCI. STEMI was defined as typical cardiac chest
with acute myocardial infarction (5). Leukocytes are
pain and new ST-elevation in 2 contiguous leads with
considered essential for thrombus formation as well as
more than 1 mm in all leads except leads V2­V3 or the
plaque activation in acute coronary syndrome (ACS). The
presence of new-onset left bundle branch block with a rise
most reliable indicator of unfavorable outcomes has been
of (CK-MB or troponin) (10). Participants who had blood
proven to be the neutrophil-lymphocyte ratio (NLR)
transfusions in the last three months, who had any type of
among the markers of inflammation in ACS (6).
inflammatory disease or any type of blood disorder such
Monocytes play a critical role in atherosclerosis by
as anemia or patients who had received thrombolytic
releasing cytokines that are pro-inflammatory and pro-
therapy within the previous 24 hours were all excluded
oxidant (7).
from the study.

cholesterol (HDL-C) has a cardioprotective role by
Electrocardiogram parameters (ECG):
preventing the oxidation of low-density lipoprotein
A twelve-lead ECG was done before the procedure and
(LDL) and monocyte activation (8). High values of the
sixty minutes after the PPCI to assess the infarct site
Received: 11/03/2023
Accepted: 13/05/2023

Full Paper (vol.921 paper# 101)

c:\work\Jor\vol921_102 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6133- 6143

Comparison between Bacterial Cellulose Graft and Temporalis
Fascia Graft in Myringoplasty
Mohsen Mahmoud Abd El Raziq1, Mohamed Osman Abdel-Monem2,
Aya Elsayed Abd El Raziq*1 and Mostafa Gomaa Sobhy1
1 Otorhinolaryngology Department, Faculty of Medicine and 2 Botany and Microbiology Department,
Faculty of Science, Benha University, Benha, Egypt
*Corresponding author: Aya E. Abd El Raziq, Mobile: (+20) 01099995712,
E-Mail:, ORCID Number: 0009-0005-2745-1041

Perforation of the tympanic membrane is a common clinical concern for
ENT specialists. They're mostly small to medium. Mini myringoplasty is a less invasive way to repair perforations of
this size. Objective: The current study's purpose is to compare two grafts in myringoplasty, temporalis fascia and
bacterial cellulose according to their results.
Patients and Methods: A non-randomized clinical trial. This study continued from May to November 2022 and included
all patients who fulfilled the inclusion and exclusion criteria.
Results: Our study comprised 40 patients, ranging in age from 20 to 50, including 14 men and 26 females. The surgical
success rates for the temporalis fascia group were 75%, while those for the bacterial cellulose group were 90%. In the
temporalis fascia group, the mean Air Bone (A-B) gap was 21.50 ± 3.28 preoperatively and 13.35 ± 5.93 postoperatively.
The surgery took 70.75 ± 5.68 minutes. In the bacterial cellulose group, the mean A-B gap was 22.00 ± 3.40
preoperatively and 10.25 ± 4.41 postoperatively. The surgery took 15.80 ± 2.40 minutes.
Conclusions: Myringoplasty with bacterial cellulose graft is a safe, minimally invasive, effective procedure. There is no
need for any harvesting incision. It is a low-cost option, a simple procedure that can be done in an outpatient clinic with
just local anesthesia and no hospital stay required. In this study, we have achieved in the bacterial cellulose group a high
success rate in healing and hearing results and also significantly less operating time than temporalis fascia graft
Keywords: Temporalis Fascia, Bacterial cellulose (BC), Myringoplasty.


Various graft materials, such as a vein, concha or
dissolved. Despite its potential permeability to liquids
tragal cartilage, temporalis fascia and xenograft, are
and gases, it would be very resistant to tension and
employed for tympanic membrane repair in
stretching. The substance in issue must be safe and
tympanoplasty. One of these graft materials is
sterile [4].
temporalis fascia, its most popular because of its
Bacterial cellulose is favored as a graft material
accessibility, closeness to the donor site on the surgical
because of its excellent qualities, which include strong
field and its high success rate. When it is used as graft
tensile strength, thermal stability, mechanical strength,
in traditional myringoplasty, patients often experience
and water retention [5]. Recent research has shown that
significant improvement in hearing and healing of
wounds may heal quickly with the help of bacterial
perforation. However, this approach leaves a visible
cellulose because of its potential to stimulate cellular
scar and causes permanent numbness around the ear
proliferation and differentiation [6].
following surgery [1].
Since BC's purification processes are simpler, more
Reperforation of temporalis fascia grafts is common
cheaper, and environmentally friendly than other plant-
in patients with eustachian dysfunction, disease of the
based cellulose, it is being evaluated for a wide variety
middle ear as adhesive otitis media, and disease in
of applications [7]. Preclinical and clinical investigations
tympanic membrane as atrophic, sclerotic membrane
demonstrated the efficacy of this biomaterial as a
and bilateral or completely perforation in it [2].
mechanical barrier and also as an adjuvant in the
Bacterial cellulose is a type of extracellular
management of wounds [8] and ulcerative lesions [9].
polymer. It biosynthesized from glucose by bacteria. It
The current study purpose is to compare between
has several desirable characteristics due to its physio-
two grafts, temporalis fascia and bacterial cellulose
chemical nature and crystalline nano-fibrillar structure.
according to results of them in myringoplasty of small
These characteristics include high chemical purity (i.e.,
or moderate perforations.
no lignin or hemicellulose), degree of polymerization is

8000, excellent water uptake, high thermal stability [3].
The fermentation of the Acetobacter xylinum
This is a non-randomized clinical trial. This study was
bacterium would result in the formation of a bacterial
conducted from May 2022 to November 2022 and all
cellulose film. They are inert, resistant, and unable to be
patients who fulfilled the specified inclusion and
Received: 14/02/2023
Accepted: 16/04/2023

Full Paper (vol.921 paper# 102)

c:\work\Jor\vol921_103 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6144- 6149

Fallopian Tube Recanalization for the Management of Infertility: Review article
Mohammed Mouselhy Farrag, Khaled Ahmed Atwa, Waleed Fouad Gharib,
Mohammed El-prince Adel, Mohammed Ahmed Sayed Abd El-Sattar*
Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University
Corresponding author: Mohammed Ahmed Sayed Abd El-Sattar, Email:, Mobile: +201013736393


Infertility is an issue that affects people all over the world. It is defined as the inability to conceive a child following
a period of a year of consistent, unprotected sexual activity. Infertility can have a variety of causes, some of which are
linked to male issues while others are related to female factors. One of the most prevalent causes of infertility in women
is a blockage of the fallopian tubes. Infertility was initially treated with fluoroscopic fallopian tube recanalization in
1985. Over a hundred studies have been published since then detailing different techniques for recanalizing blocked
fallopian tubes. Methods of fallopian tube recanalization for the treatment of infertility were the focus of this research.
In conclusion, recanalization of the fallopian tubes is an outpatient operation characterized by a low risk of complications
and a short recovery time. For women with a blocked fallopian tube at its proximal end, this treatment option should be
their first choice.
Keywords: Selective salpingography, Fallopian tube occlusion, Recanalization, Infertility

Inability to become pregnant in women can have
chromopertubation reveals tubal blockage (5).
several reasons, but the most common is a problem with
The purpose of this research was to assess the
the ovaries and fallopian tubes, which accounts for 25 to
efficacy of fallopian tube recanalization procedures for
35 percent of all cases of ovulatory infertility in women
treating infertility.
around the world. Approximately 10 to 20 percent of all

cases of tubal factor infertility are attributable to
Structure and Function
proximal tubal blockage (1).
The fallopian tubes are two tubes in a woman's
Previous pelvic inflammatory disease, pelvic
pelvis that connect her ovaries to her uterus on both
surgery, or endometriosis, can lead to proximal
sides. They play a key role in the transfer of oocytes as
obstruction or injury of the fallopian tubes, both of
well as the subsequent fertilization process. As a result
which are considered forms of fallopian tube disease.
of their importance, the fallopian tubes are frequently
Surgical tubal repair, watchful waiting and in vitro
the target of surgical sterilization procedures and are
fertilization-embryo transfer (IVF-ET) are all viable
also a prevalent cause of infertility. They may also serve
treatment options. However, it is vital to determine the
as origins for tumors or ascending infections. The
origin of the tubal illness because in vitro fertilization-
fallopian tubes are hollow seromuscular organs that
embryo transfer may not be required in all cases of
originate at the uterine horns, extend laterally within the
infertility (2).
superior edge of the mesosalpinx of the wide ligament,
Tubal reconstructive operation is an option for
and terminate near the ipsilateral ovary. Other names for
couples hoping to lessen their reliance on IVF-ET since
fallopian tubes are oviducts along with uterine tubes.
it allows women with normal tubal mucosa to conceive
They range in length from eleven to twelve centimeters
without the assistance of artificial reproductive
and have a lumen diameter of fewer than one millimeter
technologies (3).

hysterosalpingography (HSG), a test used to determine
Fallopian Tube Obstruction: Diagnosis and
whether or not the fallopian tubes are patent, has a
specificity of eighty-three percent but a sensitivity of
The fallopian tubes are an essential part of the
just sixty-five percent, hence laparoscopy is now the
process by which sperm and eggs become attached to
preferred method for diagnosing tubal blockage (4).
one another, yet it is impossible to conceive naturally
Catheters, flexible atraumatic guide wires, or balloon
without them functioning normally. One of the most
systems may be employed to re-open blocked fallopian
significant factors contributing to a woman's inability to
conceive a child is a condition known as obstruction of
the fallopian tubes. Patients in this situation have a
fluoroscopic, sonographic, or tactile guiding. The
strong desire to have their clogged fallopian tubes
ability to objectively define the source of proximal tubal
unblocked and their reproductive capabilities fully
obstruction and provide a correct visual assessment of
restored (7). Inflammation is the leading cause of
endotubal illness is made possible through
fallopian tube obstruction. Fallopian tube obstruction is
falloposcopy. Accurate diagnosis of tubal blockage,
a growing problem, as are cases of reproductive system
peritubal adhesion, and endometriosis requires
infection and the "items" that spread them.
laparoscopy. Hysteroscopic tubal catheterization (HTC)
Hydrosalpinx along with blocked fallopian tubes are
Received: 05/01/2023
Accepted: 08/03/2023

Full Paper (vol.921 paper# 103)

c:\work\Jor\vol921_104 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6150- 6157

Assessment of Blood Lead and Its Determinants among Cables
Industry Workers at 10th of Ramadan City in Egypt
Dina G. Zaki*, Safaa A. El-Naggar, Amani S. Ahmed, Mryhan A. Adel
Department of Community, Environmental and Occupational Medicine,
Faculty of Medicine, Zagazig University, Egypt
Corresponding author: Dina G. Zaki, Email:, Tel.: 002/01067603331

Lead poisoning remains a major occupational health problem, especially in developing countries which
lack strict legislations for protection of health of workers. Objective: This study was conducted among cable industry
workers aiming to assess blood lead level (BLL) of lead exposed workers and to determine the associated occupational
risk factors of elevated blood lead. Subjects and methods: A cross sectional study was conducted among 170 cable
industry workers at 10th of Ramadan City in Egypt during the period from July 2022 to June 2023, using a semi structured
questionnaire assessing present history of lead toxicity symptoms and by investigating BLL.
Results: The current study showed that (80 %) of cable workers had elevated BLL, and reported lead toxicity symptoms
as (10%) suffered irritability and nervousness, (9.4%) memory problems, (9.4 %) tingling or numbness in extremities,
(5.3 %) difficult concentration, (6.5 %) abdominal pain, (3.5%) constipation and (8.8 %) muscle pain. By regression
analysis, the study indicated that, current occupation, previous occupational exposure and gown nonuse were the
significant predictors of occurrence of current high BLL. Conclusion: Implementation of engineering control measures,
ensuring continuous availability of properly designed personal protective equipment (PPE) with applying health
education programs for workers about occupational health hazards and preventive measures are recommended.
Keywords: Blood lead, Cable industry, Lead toxicity, Symptoms, 10th of Ramadan, Cable workers.

exposed for an extended period of time may score lower
The element lead is essential to life on Earth. Lead,
on assessments of cognitive functioning and
which can be found in both the ground and the air, has
neuropsychological testing. Young children and infants
a long history of being one of humanity's most
are more vulnerable to the effects of lead exposure,
important metals. Lead was originally a waste product
which can include behavioral issues, learning
from the silver industry, but due to its many useful
difficulties, and a reduced IQ. Anemia and hypertension
properties (including low melting point, malleability,
have both been linked to prolonged lead exposure,
and resistance to corrosion), it quickly gained
especially in the elderly and the middle-aged. Exposure
widespread popularity. The Egyptians fashioned
to high amounts of lead was associated with fatal brain
sculptures out of lead and used sinkers made of lead to
and kidney damage in both adults and children. An
catch fish. The Romans employed substantial quantities
increased risk of miscarriage has been linked to lead
of lead for a variety of purposes, including the lining of
exposure during pregnancy. Male fertility is decreased
water supply pipes and cisterns, roofing, shipbuilding,
by prolonged lead exposure. Lead intoxication
weights, cooking pots, and wine sweeteners. Lead
frequently results in blood problems and nervous
poisoning was therefore widespread in Roman society.
system damage (3(
Despite the fact that much has been learned about lead
Lead exposure is linked to an increased risk of
and its negative consequences, exposure to lead
developing idiopathic intellectual disability (30%),
continues to be a major problem in the modern world.
cardiovascular disease (4.6%), and chronic renal disease
Once lead has been extracted from its ore, it cannot be
(3%), according to the World Health Organization.
destroyed or returned to its natural state (although it can
Everyone with a blood lead level higher than 5 ug/dl
be recycled and reused). The vast majority of lead dust
should take steps to identify the source of lead exposure
on the soil's surface will still be there 70 to 200 years
and take measures to decrease and terminate exposure,
from now (1).
as recommended by the World Health Organization.
About one million people worldwide succumb to
Lead exposure of any kind is harmful (2).
lead poisoning every year. In addition, millions more,
Leaded gasoline, industrial operations like
including many youngsters, are exposed to low amounts
smelting of lead and its combustion, pottery, boat
of lead, which can have lasting effects (2). Long-term
building, lead based painting, lead containing pipelines,
effects of lead exposure are expected to cause 21.7
printing books are only a few of the many sources of
million DALYs (disability-adjusted life years) of
lead and its compounds to which humans are exposed
disability and death worldwide (2). Every single human
through their work. In addition, lead is currently
organ can be negatively impacted by lead exposure.
employed in a variety of applications, including
Lead intoxication can have an adverse effect on nearly
construction, cable sheathing, radiation shielding, and
every bodily process (3).
alloys. It is utilized as a powder in a wide variety of
Lead toxicity primarily affects the neurological
applications, including pigments, paste, glass, glazes,
system rather than other organs. Adults who are
and functional ceramics (3).
Received: 19/01/2023
Accepted: 22/03/2023

Full Paper (vol.921 paper# 104)

c:\work\Jor\vol921_105 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6158- 6162

Role of Vitamin B12 and Folic Acid in Obsessive-Compulsive
Disorder: Review Article
Nouran Hassan Hussein Hussein*, Osama Mohammed Ibraheem Gado,
Amira Ahmed Fouad, Youmna Ahmed Abdelmeneim Khalil
Psychiatry department, Faculty of Medicine, Zagazig University
*Corresponding Author: Nouran Hassan Hussein Hussein, Tel: 01018119951, Email:

When a person suffers from obsessive-compulsive disorder (OCD), they experience intrusive and
disturbing thoughts about specific topics (known as "obsessions") or feelings of compulsion to perform specific
behaviors (known as "compulsions"). There is mounting evidence that dietary folate and vitamin B12 are crucial to the
normal and abnormal functioning of the neuropsychiatric system. Studies on the incidence of neuropsychiatric
symptoms in patients deficient in vitamin B12 have been conducted all over the world. Folate and vitamin B12 have
lately been described in a substantial amount of literature as therapy or supplements for the management of psychiatric
Aim of work: Shedding the light on the role of vitamin b12 and folic acid in OCD cases hoping to improve lately the
assessment of symptoms severity and thus reducing the morbidity and mortality rates.
Methods: Our research was a review article, interpreted in Al-Azazy Mental Health and Addiction Treatment Hospital
during the period from august 2022 till January 2023. The Zagazig University IRB (ZU-IRB #9456/10-4-2022) was
contacted for approval. We compiled and evaluated data from a wide range of relevant studies before writing a narrative
review of our findings.
Conclusion: We came to the conclusion that certain neuropsychiatric illnesses, such as OCD, can be correlated with
vitamin B12 and folic acid levels. We suggest keeping a close eye on this phenomenon, which has to be investigated
further. Our results can be used as a jumping off point for related studies.
Keywords: Obsessive, Compulsive, Vitamin B12, Folic acid.


Vitamins B12 and folic acid are examples of
From August 2022 to January 2023, researchers
water-soluble vitamins. Both are critical for making
at Al-Azazy Hospital looked at the effectiveness of a
new RBCs, but vitamin B12 is especially important for
review article on the hospital's addiction and mental
keeping the brain and nervous system healthy. Mood
health therapy. We filed for and received approval from
disorders, dementia, paranoid psychoses, violent
the university's IRB (ZU-IRB #9456/10-4-2022). We
behavior, and demyelinating myelopathy are only some
collected and analyzed many studies that were relevant
of the psychiatric and neurological problems that have
to our topic and wrote a narrative review of our findings.
been associated to vitamin B12 and folic acid

The article:
hematological or neurological disorders may emerge
Problems with obsessive compulsive disorder:
with mental symptoms (1).
Obsessive-compulsive disorder (OCD) is
Folate and vitamin B12 are essential for the
characterized by repetitive, ritualized activities
carbon transfer metabolism required for serotonin
(compulsions) or persistent, distressing thoughts
synthesis, and this has been underlined by previous
(obsessions) about a set of predetermined themes. For
research between folic acid deficiencies with depressive
an extended amount of time, the person has no say over
disorders. Vitamin B12 and folic acid levels may be
their thoughts or actions. Counting objects, checking
associated to neuropsychiatric disorders like OCD,
locks multiple times, and repeatedly washing hands are
according to some research. The severity of obsessive-
all examples of common compulsions. Persistently
compulsive disorder is inversely related to vitamin B12
engaging in these behaviors creates difficulties in one's
deficiency, according to the available research.
day-to-day (3).
This suggests that patients with OCD who are
The root causes have yet to be identified.
showing signs of resistance would benefit from taking
Identical twins are more likely to be affected than
vitamin B12 supplements. In addition, keeping an eye
fraternal or fraternity-like twins, suggesting a familial
on your vitamin B12 levels is useful in OCD treatment
link. Exposure to or experience with trauma as a child
is one of the risk factors. Subsequent infections have
The purpose of this study was to increase our
been connected to several of the individuals. Using the
understanding of how vitamin B12 and folic acid affect
patient's reported symptoms, a diagnosis is made, and
individuals with OCD so that we can better assess the
then all other possible medical and drug-related reasons
severity of their symptoms and reduce their risk of
are ruled out. It is projected that 2.3% of the population
will develop OCD throughout their lifetimes, and that

1.2% of the population will have the illness at any one
Received: 07/02/2023
Accepted: 09/04/2023

Full Paper (vol.921 paper# 105)

c:\work\Jor\vol921_106 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6163- 6170

Assessment of the Need for Cardiac Support Using Custodiol HTK
Cardioplegia versus Traditional Crystalloid Cardioplegia
Fatma Ibrahim Amin Ibrahim*1, Ezzat Mohamed EL-Taher1,
Mohamed Emad EL-Din Abdel-Ghaffar 1, Nihal Adel Nasr 1, Hassan Salah Hassan2
1Anesthesiology and Intensive Care Department,
2Cardiothoracic Surgery Department, Faculty of Medicine, Suez Canal University, Egypt
Corresponding author: Fatma Ibrahim Amin Ibrahim, Tel. +201093414161, E-mail:

Cardioplegia is responsible to prevent damage to the heart muscle during open heart operation, also to
create a sterile, bloodless operating environment. The perfect cardioplegic solution for protection of the myocardium
during operations on the heart is still controversial. Aim: To compare the intraoperative and postoperative requirement
for an intra-aortic balloon pump between custodiol histidine-tryptophan-ketoglutarate (HTK) cardioplegia versus
traditional crystalloid cardioplegia.
Methods: A prospective clinical trial investigation, conducted on 48 individuals underwent pump coronary artery
bypass graft surgery. done in the routine cardiothoracic surgeries, Suez Canal University Hospital from 2020 to 2023.
Results: The mean lactate one minute and 15 minutes after CC removal was statistically significantly larger in
Antegrade traditional cold crystalloid cardioplegia (ICCC) group than in HTK group. The mean CK-MB 15 minutes
after reperfusion, 6, 12 and 1 day postoperatively was statistically significantly greater in ICCC group than in HTK
group. The mean CTnI 15 minutes after reperfusion, and 6 hours postoperatively was statistically significantly more in
ICCC group than in HTK group, group A was statistically significantly advanced in heart rate than group B regarding
half an hour after weaning (p= 0.001), one hour after weaning (p= 0.001), sternal closure (p= 0.001) and skin closure
(p= 0.002).. Conclusion: According to the biomarkers of myocardial injury, a single dose of custodiol HTK is more
effective at preserving the myocardium during coronary artery bypass surgery than intermittent ante grade cold
crystalloid cardioplegia. This was determined by comparing the two treatments.
Keywords: Lactate, Cardiac Troponin, Creatine Kinase.


decreased as a result of the rise in extracellular
One of the most common contributing factors is
potassium content. The heart eventually stops beating in
injury to the myocardium that occurs after operation
the diastole. Due to the myocardium's slow washout and
that lead to mortality and morbidity among individuals
rewarming, cold cardioplegia must typically be repeated
who have undergone heart operation. Significant
at intervals of roughly 30 minutes (3). This is the method
advancements in cardiac surgery have been made
used in Suez Canal University Hospitals during
possible in large part by the development of myocardial
cardiothoracic surgeries.
preservation technology. Utilization of warm vs cold
In the 1970s, Bretschneider er al. were the only
cardioplegia, intermittent versus continuous perfusion,
researchers who initially proposed using histidine-
antegrade versus retrograde administration, versus
tryptophan-ketoglutarate (HTK), a treatment that was
based on the intracellular level of electrolytes (4).
Tryptophan-Ketoglutarate and their contrasts all remain
The addition of mannitol reduces cellular edema,
controversial (1).
tryptophan stabilises the cell membrane, and the
A key tactic for facilitating cardiac surgery and
buffering effect of histidine may contribute to a rise in
the effectiveness of anaerobic glycolysis. Nicotinamide
cardioplegia. Cardioplegia was initially developed as a
adenine dinucleotide is produced from ketoglutarate (5).
tool to facilitate hypothermic hyperkalemic arrest. In
Numerous investigations using experimental
order to optimise the myocardium during this period of
models or biochemical markers have demonstrated the
ischemia, several additives were investigated. Further
effectiveness of the HTK solution. In various nations,
research was done on the ideal cardioplegic
HTK has recently been employed in cardiac surgery as
temperature, timing, and delivery routes. While
a cardioplegia and multi-organ preservation solution (6).
cardioplegia is widely acknowledged to be an essential
Regarding the best procedures for myocardial
instrument for myocardial protection during open-heart
protection during heart operation, there is still a lot of
operations performed with the pump, there is still debate
debate. Numerous investigations have contrasted
concerning a number of its components, temperatures,
standard crystalloid cardioplegia with custodial HTK
and methods of administration (2).
cardioplegia for the preservation of the myocardium,
The solution used in conventional crystalloid
however the results have been ambiguous (1).
cardioplegia is high in potassium. This cardioplegia is
Due to its well-integrated components that help
used to occasionally perfuse the coronary circulation
the heart's myocardium stay healthy and regain its
after the start of cardiopulmonary bypass and aortic
function, custodiol HTK rather than crystalloid
cross-clamping. The transmembrane potential is
cardioplegia may enhance postoperative cardiac

Received: 10/01/2023
Accepted: 13/03/2023

Full Paper (vol.921 paper# 106)

c:\work\Jor\vol921_107 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6171- 6176

Pan -Immune- Inflammation Value to Predict Early Mortality in Adults with
Severe Covid 19: An Observational Retrospective Study
Mohamed Ahmed Abdel Hafez, Sabry Abdullah Shoeib, Ali Mohamed El Khouly,
Aya Mokhtar Basiony Nada*, Rana Kamal Eldin Wahb
Internal Medicine Department, Faculty of Medicine, Menoufia University
*Corresponding author: Aya Mokhtar Basiony Nada, Email:, Mobile: (+20)1097973866


Background: The SARS-CoV-2 infection has triggered a worldwide outbreak of COVID-19. Infection with SARS-
CoV-2 can cause a wide spectrum of symptoms, from no obvious illness at all to a life-threatening form of the virus
called COVID-19 that necessitates hospitalization. Hospitalized patients frequently develop life-threatening cases of
pneumonia and acute respiratory distress syndrome (ARDS).
The study's overall objective was to establish the predictive significance of pan-immune-inflammatory status
for death in persons suffering from severe Covid-19.
Patients and methods: A retrospective study that was conducted on 200 cases of sever Covid 19 collected from ICU,
Department of Internal Medicine, Menoufia University Hospital, Full analysis of medical history and laboratory
investigations were taken during the period study from September 2021 to October 2022.
Results: Results showed that PIV (pan immune inflammation value) was increased in studied cases by mean of
(343.28±127.9), and there was highly statistically significant +ve relationship among PIV and mortality in studied
patients (higher in died group) P value <0.001 by mean of 526.01±72.81. PIV was the most important predictor of
mortality in severe COVID-19 cases in univariate analysis of highly statistically significant.
It could be concluded that PIV is increased in severe COVID-19 cases and is an important predictor of
mortality of these patients.
Keywords: COVID-19, Inflammation, Pan immune inflammation value, Prognosis


status for death in persons suffering from severe Covid-
The severe acute respiratory syndrome (SARS-CoV-
2) may be caused by a coronavirus pandemic (1).

The global cost of treating this viral infection has
overwhelmed healthcare and public health institutions.
This retrospective study included a total of 200 cases
Researchers have been hard at work looking into
with severe covid 19 collected from ICU, Department
biological factors as possible markers of COVID-19 risk
of internal medicine, Menoufia University Hospital.
and severity. Risk factor epidemiology aims to predict
during the period from September 2021 to October
or discover persons who may become ill, be
hospitalized, or pass away to provide more targeted

public health interventions and relieve strain on already-
Inclusion criteria: Individuals who tested positive for
stretched health care infrastructures (2). T-cell adaptive
immune responses are crucial in SARS-CoV-2 infection,
nasopharyngeal and/or oropharyngeal swabs.
as they are in other respiratory viral infections. Whether
Exclusion criteria: Chronic inflammatory disease as
or not T cell responses are beneficial in COVID-19 is
(FMF, malignancy), patients on immunosuppressive
still up for debate; data has been shown for both
therapy, and patients with viral infection other than
suboptimal and dysfunctional and excessive T cell
responses (3).

The pathophysiology of COVID-19 is a topic of
The following were applied to all study participants:
ongoing research. Increased neutrophils and platelets,
Thorough Full medical history taking:
as well as decreased lymphocytes, have been linked by
Paying particular attention to: age, gender, BMI,
several studies (4). Based on these results, it seems likely
occupation, and any unusual or potentially harmful
that immuno-inflammatory responses contribute
behavior (such as smoking). Duration and timing of
significantly to the pathophysiology of COVID-19 and
symptoms such as (but not limited to) fever, cough,
to the development of the disease (as well as its many
consequences) (5). Neutrophil, platelet, monocyte, and
disorientation, headache, sore throat, rhinorrhea, chest
lymphocyte counts as well as their relative variations in
pain, diarrhea, nausea, and vomiting. Background
PIV's value may be indicative of the equilibrium
comorbidities (such as a history of high blood pressure
between the host's immunological and inflammatory
or diabetes), Drug history.
status. Viral illnesses developed and progressed with

the help of inflammatory cells (1).
Laboratory investigations: Complete blood count
The aim of the current work was to establish the
(CBC), ALT & AST, PT & INR, Bilirubin (total
predictive significance of pan-immune-inflammatory
&direct), albumin, virology, serum urea& creatinine,
Received: 10/01/2023
Accepted: 13/03/2023

Full Paper (vol.921 paper# 107)

c:\work\Jor\vol921_108 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6177- 6184

Atrophic Acne Scar Fractional CO2 Laser Treatment; Comparative Whole versus
Focal Area Study
Mahmoud Abdelrahim AbdAllah, Salwa Gamal Hussain Gomah, Christine Kamal Thabet Gobrial*
Department of Dermatology and Venereology, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Christine Kamal Thabet Gobrial, Mobile: (+20) 01226312561, E-mail:

Acne patients are always concerned with scars and may suffer from depression and suicidal thoughts
and even attempts. The commonest type is atrophic scars that could be ice pick and rolling or boxcar scars. Many
therapeutic modalities are used for amelioration of the post acne scars.
Objectives: This study aimed to compare between whole facial-area versus Focal Acne Scar Treatment (FAST)
treatment techniques of atrophic post-acne scars using fractional carbon dioxide light amplification by stimulated
emission of radiation (CO2 LASER)
Patients and Methods: This split face comparative study was held in Dermatology and Venereology Department, Ain
Shams University. It included twenty atrophic, post-acne vulgaris adult scar patients. Each patient received one
fractional CO2 LASER resurfacing session; the right side of the face was treated by the whole area, while the left by
the FAST technique. Before and after results evaluation was done by 16 mega pixel Samsung UK S6 edge and Antera
3D digital cameras' photographs, patients' satisfaction and physician blinded scoring.
Results: Antera texture (roughness) mode showed statistically highly significant improvement in acne scars using
both whole and focal fractional CO2 laser treatment, but no statistically significant difference could be detected
between both modalities. Patients' and researchers' assessments of post-treatment results showed statistically non-
significant differences in both modalities.
Treatment of post-acne atrophic scars with fractional CO2 laser showed statistically highly significant
improvement by both techniques and both were equally preferable.
Keywords: Focal acne scar treatment, Atrophic post-acne scars, Fractional CO2 laser.

replaced other methods of treating acne scars as the
Scarring is a major concern of acne patient. It may
gold standard. Resurfacing often involves treating the
exacerbate depression and even leads to suicidal
entire face, including both skin with and without scars
thoughts. Facial appearance interferes with human
(11). FAST is a useful technique for enhancing the look
relationships and employment (1). Acne scars are
of atrophic acne scars. Less negative effects and
classed as atrophic, hypertrophic, or keloidal. Atrophic
quicker recovery might be achieved even with higher
acne is the commonest type (ice pick and rolling or
energy and density levels (11).
boxcar scars (2, 3).
We aimed at comparing the results of atrophic
There are several treatment options for scars, such
acne scar treatment, using, whole facial (scarred and
as chemical peeling and dermabrasion, which are
non-scarred areas) versus FAST by factional CO2 laser
facial resurfacing techniques of damaged layers to
in a split face study.

epithelialization process (4, 5), punch techniques,
transforming larger, deeper scars into smaller, linear
This study was issued in the Department of
closure (6), fat transplantation and tissue augmentation
technique using soft tissue fillers in order to treat
Hospital, Ain Shams University, from January 2018
atrophic acne scars (5, 7).
till December 2019. We included atrophic scarring
For the treatment of acne scars, laser therapy is a
acne vulgaris patients; rolling, boxcar and ice pick
reliable and simple option (8). It may be ablative or
scars, if not dominant, according to scar morphological
non-ablative as well as fractionated or non-
classification (3), with various severities: mild,
fractionated. Non fractionated lasers act on the whole
moderate and severe according to qualitative global
treated skin surface area, whereas fractionated lasers
scarring grading system (12). Males and females in the
produce microscopic thermal skin wounds, split by
age group from 18 to 44 years, Fitzpatrick skin types
non-involved tissue islands from which tissue healing
III and IV.
begins (9).

A randomized blinded, split face comparison of
Excluded criteria:
non-ablative fractionated laser (NAFL) (1550 nm
Patients with active acne, dominant ice pick scars,
erbium) to ablative fractionated laser (AFL) (10600
having a history of using isotretinoin, deep chemical
nm carbon dioxide demonstrated equal or greater
peel, filler injection or any invasive ablative
improvement in scarring, with AFL than NAFL (10).
procedures in the previous 6 months and those
Due to their effectiveness, safety, and short recovery
suffering from active herpes simplex (HSV), herpes
periods, AFL carbon dioxide (CO2) lasers have
zoster or any other infection in the treated area or
Received: 13/02/2023
Accepted: 13/04/2023

Full Paper (vol.921 paper# 108)

c:\work\Jor\vol921_109 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6185- 6190

Evaluation of CCN3 as an Inflammatory Marker of Disease Activity in
Rheumatoid Arthritis Patients
Sarah Mahmoud Hassan Kamel1*, Mohammad Ibrahim Zaghloul 1,
Radwa Mahmoud Elsharaby 2, Mervat Ismail Hussein 1
1 Physical Medicine, Rheumatology and Rehabilitation Department,
2 Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
*Corresponding Author: Sarah Mahmoud Hassan Kamel, Email:, Mobile: +201050366830

Rheumatoid arthritis (RA) is an inflammatory form of arthritis that affects around 1% of adults
worldwide. Symmetric polyarticular synovial inflammation is its defining feature. Nephroblastoma overexpressed
protein (CCN3) proteins are important mediators of organogenesis and inflammation; CCN3 was found in synovial
tissues of patients with RA and Osteoarthritis.
Objective: Consequently, goal of this research was to establish significance of serum CCN3 levels in RA patients and
their relationship to disorder activity and severity. Methods: This case control investigation was performed on 50
subjects who were allocated into two groups; patient group: thirty patients with RA and control group: twenty healthy
volunteers with ages and sexes that are matched. All patients were exposed to rheumatological and systemic
examinations, and assessment of RA activity and X-ray on both hands and feet.
RA patients had significantly greater levels of serum CCN3. Serum CCN3 levels and disorder activity in RA
patients showed a positive, statistically significant connection. There were significant positive correlations between
CCN3 concentration and length of morning stiffness, number of tender and swollen joints, Visual Analog Scale,
Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein(CRP), Disease Activity Score (DAS28), Rheumatoid Factor
(RF), Anti cyclic Citrullinated peptid(Anti CCp), erosion score and joint space narrowing.
Serum concentration of CCN3 was substantially higher in RA patients contrasted to controls. This level
in these patients was positively connected with the severity and length of the disorder. With bone degradation, joint
degeneration, and diminished functional status in RA patients, the serum CCN3 level was strongly associated.
Keywords: CCN3, Rheumatoid arthritis, DAS28, Inflammatory marker


By controlling inflammatory chemicals in astrocytes
The prevalence of rheumatoid arthritis (RA), a
and encouraging CNS regeneration, fibrotic disorders
chronic inflammatory systemic autoimmune disorder
and cancer can be prevented [8]. These functions are
that mostly impacts elderly people, ranges from 0.4% to
mediated via own putative receptors, altering the impact
1%. It is two times as prevalent in women as in men,
of different cytokines and growth factors, interaction
with a ratio of 2:1. RA primarily affects the synovial
with integrin's and by the Notch pathway, which
joints causing early death, deteriorating health, and
controls cell destiny during development and keeps
socioeconomic burdens [1, 2].
adult tissue in a homeostatic state [9].
Although the pathophysiology of RA is not yet
understood, immunological dysregulation is caused by
(NOV/CCN3) could be found in synovial tissues of RA
the interaction of genetic, infections, sex hormone, and
and OA [10]. Its role in RA remains unknown, may be a
environment-related factors. The pathophysiology of
possible sign of disorder activity for RA [11].
the disorder involves a variety of immune cells and
The goal of this research was to establish the
components, and RA patients' synovium and serum
function of CCN3 serum concentrations in RA patients
have been found to have an up-regulation of a variety of
and their relationship to disease activity and severity.
cytokines and chemokines [3].

Clinical manifestations of RA are arthritis, stiffness,
swelling, tenderness, deformity of tiny hand joints,
This case control research involved 30 patients who
wrist, elbows, shoulder and metatarsophalangeal (MTP)
met 2010 American College of Rheumatology
joints, ankle, knee and hip joints with decreased range
of motion on examination [4, 5]. Laboratory
(EULAR) classification criteria for rheumatoid arthritis
investigations of RA includes acute-phase reactants as
[12]. They were chosen from outpatient clinic of Tanta
erythrocyte sedimentation rate, C-reactive protein,
University Hospitals' Rheumatology, Rehabilitation
rheumatoid factor (RF) and anti-CCP [6]. CCN family of
and Physical Medicine Department from March 2021.
proteins includes the nephroblastoma overexpressed

protein (NOV/CCN3), which controls a number of
Ethical considerations:
cellular processes including migration, proliferation,
The Ethical Committee, Tanta University
differentiation, survival, apoptosis, and extracellular
Hospitals endorsed our research in 3/2021 with
matrix remodelling in a cell-specific way [7].
approval code 34486/2/21. The patient or their
CCN proteins are important regulators of
family members signed a consent form. This work
organogenesis and inflammation in living organisms.
has been carried out in accordance with The Code of

Full Paper (vol.921 paper# 109)

c:\work\Jor\vol921_110 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6191- 6197

The Role of Point of Care Lung Ultrasound in Diagnosis of Different
Neonatal Lung Diseases in NICU: A Prospective Study
Shaimaa Reda Abdelmaksoud, Ahmed Abdulfattah Azab, Omima Mohammed Abdel Haie,
Rehab Elsaied Elsawy, Ghada Khattab Mohammed*, Enas M. Nor Eldeen
Department of Pediatrics and Pulmonology, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Ghada Khattab Mohammed, Mobile: (+20)01066844867, E-Mail:


Background: Due to its radiation-free feature, comfort, high accuracy, and cheap cost, lung ultrasonography (LUS)
has been used in clinical practice to diagnose and discriminate infant lung disorders; nevertheless, its usage in
neonatal care is still restricted.
Objective: To assess the role of point of care LUS in diagnosis of different neonatal lung diseases compared to chest
X-ray (CXR).
Patients and Methods:
This is a prospective study on 115 neonates (preterm and full-term) with newborn lung
disorders of various etiologies; those with substantial congenital abnormalities, such as chest deformities, complicated
congenital heart diseases, and central respiratory failure were excluded. On admission, CXR and LUS were performed
for diagnosis. They were then repeated after 3 days and after 7 days, or sooner or later, if necessary, based on the
clinical status.
: LUS diagnosis sensitivity (Sn) and specificity (Sp) for respiratory distress syndrome (RDS), transient
tachypnea of the newborn (TTN), pneumonia, meconium aspiration syndrome (MAS), pneumothorax (PTX),
pulmonary atelectasis and pulmonary edema were 95.7/98.5%, 100/100% 97.1/98.8, 100/100%, 94.1%/98.9%,
100/100%, 100/100%, respectively. With a 95% CI of 0.91 to 1, the overall agreement between LUS and CXR was
98.3%. The diagnosis of NLDS was mostly in accord with LUS and CXR.
: LUS may be used as a substitute for other methods of diagnosing newborn lung illnesses since it is an
imaging modality that is accurate, dependable, rapid, simple to use, real-time, and radiation-free.
Keywords: Lung ultrasound, Neonatal lung diseases, Chest X-ray.


Both preterm and term babies who have lung
diagnosis of neonatal lung diseases of different
illness are frequently in danger of dying. Therefore, a
timely and precise identification of lung problems in

neonates is essential since diverse etiologies require
distinct therapeutic approaches (1).
From June 2021 to January 2023, prospective
In the past, computed tomography (CT) and/or
research including 115 newborns hospitalised to the
chest X-rays were the major tools used to diagnose
Neonatal Critical Care Unit of the Pediatrics
lung illness in children. CXR, however, exposes the
Department at Benha University Hospital and
patient to ionising radiation, necessitates transfer to
suffering from various lung illnesses was conducted.
specialised radiographic contexts with all the
Inclusion criteria: Neonatal patients with various
associated infection concerns for cases and operators,
lung disorders, whether preterm or full-term. Neonates
and may not be effective at the bedside (2).
with several significant congenital abnormalities, chest
Due to the anatomical components' gas-filled
deformities, complicated congenital heart disorders,
nature, the lung was traditionally not regarded to be a
and central respiratory failure were admitted exclusion
target for ultrasonic waves. The damaged lung creates
criteria. According to the NICU procedure, qualified
neonatologists took care of the enrolled infants.
tissues/gases/tissue contact when US waves penetrate
Neonatal respiratory distress (NRD) severity was
lung tissue, according to recent advances in ultrasound
assessed using the Downs and Silverman-Andersen
research. Lung ultrasonography (LUS) use in the clinic
clinical ratings.
is based on these artifacts (3).
To diagnose and distinguish between the various
Due to its radiation-free simplicity, high accuracy,
etiologies of NRD, including transient TTN, RDS,
and cheap cost, LUS is implemented in clinical
neonatal pneumonia, meconium aspiration syndrome
practice to diagnose and classify infant lung disorders.
(MAS), PTX, pulmonary edema, and pulmonary
It has been demonstrated in recent years that LUS
atelectasis (PA), CXR findings were analysed and
demonstrates good specificity (Sp) and sensitivity (Sn)
utilized as the best approach. Plain CXR and LUS
for diagnosing different infant lung disorders (1).
were performed on admission for diagnosis, and they
The ESPNIC guidelines on POCUS usage in
were repeated seven days later or sooner, if necessary,
pediatrics evidently highlight the importance of LUS
based on the clinical condition of the enrollee neonates
in the evaluation of the critically ill patient. The goal
and by the treatment of neonatologists in conjunction
of the present study was to evaluate the role of LUS in
with the clinical evaluation and laboratory findings to
Received: 13/03/2023
Accepted: 14/05/2023

Full Paper (vol.921 paper# 110)

c:\work\Jor\vol921_111 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6198- 6202

Evaluation of Cystatin C Role as a Predictor of Acute Kidney Injury in
Patients with Chronic Obstructive Pulmonary Disease
Enas Abdellah Esmail*1, Ibrahim Mahmoud Shalan1, Haitham Abdel-Azeem Abdel-Rahman2, Ali Sobhy
Mohammed3, Yasin Abd-ElKareem Galal1, Waleed Saber Abd elnaser2, Wageeh Hassan Sayed1
Departments of 1Chest Diseases, 2Internal Medicine and
3Clinical Pathology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: Enas Abdellah Esmail, Mobile: (+20) 01020429098, E-mail:

Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) had a prevalence
of acute kidney injury (AKI) between 1.9% and 21.3%. It has been suggested that serum protein cystatin C (Cys C) can
be used as a marker for the early detection of AKI.
Objective: This study aimed to assess the role of cystatin C in prediction of acute kidney injury in patients with chronic
obstructive pulmonary disease (COPD).
Patients and methods: The study was conducted on 150 subjects divided into three groups: Group (1) included fifty
patients with an AECOPD, group (2) included fifty patients with stable COPD without exacerbation and group (3)
included fifty subjects as control subjects who were recruited from the general population and matched for age and sex.
All participants were subjected to full history taking, clinical assessment and laboratory investigations. Serum creatinine
at admission and after 48 hours was estimated. Pulmonary function test (PFT) was performed using a spirometry. Serum
Cys C levels was measured for all subjects.
Results: There was a high statistically significant (p-value < 0.001) increase of Cys C level in AECOPD group (median
= 0.95, IQR = 0.86 ­ 1) when compared to stable COPD group (median = 0.7, IQR = 0.64 ­ 0.79) and control group
(median = 0.6, IQR = 0.58­ 0.61). Serum Cys C can be used to discriminate between AECOPD group and stable COPD
group at a cutoff level of > 0.79, with 96% sensitivity, 88% specificity, 88.9% PPV and 95.7% NPV (AUC = 0.97 & p-
value < 0.001).
Conclusion: Patients with AECOPD who had serum cystatin C level more than 0.79 are thought to have a higher risk
of developing HA-AKI. Serum Cystatin C level is negatively correlated with FEV1 and FEV1/FVC. We recommend
using of serum Cystatin C for prediction of AKI in COPD patients.
Keywords: Cystatin C, AKI, Chronic obstructive pulmonary disease.

C) levels at admission who were more likely to have
Airflow limitation brought on by anomalies in the
AKI. We aimed to determine the correlation between
airways and/or lungs is what defines COPD, a
Cys C levels and pulmonary function test (PFT). The
widespread, preventable, and curable illness caused by
study was performed on 150 subjects 96 males and 54
prolonged contact with harmful particles or gases and
females above age of 40 who were divided into three
affected by host variables including immature lungs [1].
The prevalence of AKI is rising globally, and it
Group (1): included fifty patients with an acute
frequently leads to the progression of chronic kidney
exacerbation of COPD (AECOPD).
disease (CKD) and, eventually, end-stage renal failure
Group (2): included fifty patients with stable
[2]. AKI affects between 1.9 and 21.3% of patients
COPD without exacerbation.
diagnosed with AECOPD [3].
Group (3): included fifty age- and sex-matched
Cystatin C (Cys C) is the most significant endogenous
healthy individuals worked as a control group.
cysteine protease inhibitor. Cys C regulates the
COPD exacerbation is diagnosed by an acute worsening
production or leakage of proteases from lysosomes by
of respiratory symptoms that need further medication [1].
forming complexes with cathepsins in dying or ill
AKI was recognised by a rise in SCr: increase in SCr
cells [4]. Patients with emphysema, inflammatory lung
0.3 mg/dL within 48 hours, according to Kidney
disease, and chronic renal disease all had elevated Cys
Disease Improving Global Outcomes (KDIGO)
C levels [5]. For the early detection of AKI, serum
recommendations [7].
cystatin C shows great promise as a marker [6]. Our

study's primary objective was to evaluate cystatin C's
Exclusion criteria: Patients with cystic fibrosis-
utility for predicting acute kidney damage in COPD
associated acute renal injury, history of CKD and
dialysis treatment prior to admission, or urinary tract

infection were not included.
This research was performed at Chest Diseases
examination, and laboratory investigation were
Department, Al-Azhar Assiut University Hospital in the
performed for all individuals (including CBC, serum
period from January 2021 to October 2021 to assess if
albumin, serum sodium, serum creatinine, estimated
COPD patients who had elevated serum cystatin C (Cys
GFR, serum total bilirubin and international normalized
Received: 14/02/2023
Accepted: 16/04/2023

Full Paper (vol.921 paper# 111)

c:\work\Jor\vol921_112 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 203


Post Intragastric Balloon Removal Complications in Patients with Morbid Obesity
Mohamed Abdalla El-Sayed Abdalla1, Mohamed Ibrahim Shoer1,
Mohamed Mahmoud Abdo1, Ayman Amer Salm1, Hanan Hassen Omar2
1Department of Internal Medicine, 2Department of clinical Pathology,
Faculty of Medicine, Suez Canal University, Egypt
Corresponding author: Mohamed Abdalla El-Sayed Abdalla, Email:,Mobile: 01050366830

If the obese patient is willing to take part in a weight loss program that is medically supervised,
intragastric balloon implantation has been found to be a safe, well-tolerated, and moderately cost minimally invasive
surgery for weight loss. The present research is a retrospective investigation that looks at previously reported cases to
determine if the patient, the technology, or the practitioner is to blame for major visceral complications. Aim: The goal
of this research was to document the difficulties experienced by morbidly obese patients following the removal of a bio-
enteric intragastric balloon.
Patients and methods:
Fifty morbidly obese patients (both sexes, ages 22-53 years) from the Suez Canal University
Hospitals' Internal Medicine. Results: The patients' ages ranged from 22 to 53 years old, with a mean ±SD of 35.79
years. The average weight at the outset was 126.69±9.79 kilograms, or approximately 116.8±89.22 pounds. It was
discovered that belching was the most often reported side effect, with 30 people (71.4% of the sample) reporting it. 18
patients (42.9%) reported feeling nauseous, 8 patients (19%) reported having bad breath, and 15 patients (35.7%)
reported having reflux. Conclusion: Despite these concerns, hollow viscera complications are uncommon after a BIB
or Orbera balloon implantation. By mandating training and accreditation programmes for bariatric endoscopic doctors
and maintaining close supervision of obese patients undergoing balloon procedures, these complications can be avoided.
Intragastric Balloon, Complications, Morbid Obesity.


The use of intragastric balloons (IGBs) as a less
A cross-sectional approach was used for this
intrusive treatment option for morbid obesity has a
research. Between May 2017 and April 2018,
mixed track record of success and failure. Its use is
researchers from the Internal Medicine and
restricted to a small set of strictly outlined scenarios (1).
Gastrointestinal Endoscopy departments at Suez Canal
The BIB (Bioenterics Intragastric Balloon) was
University Hospitals in Ismailia, Egypt, conducted this
introduced to Europe in 1991 and has since become the
study. Fifty patients with body mass indexes (BMIs) of
most popular and commonly used IGB. The identical
40 or more were included in the analysis. Patients' ages
balloon, marketed under the trade name ORBERA
ranged from 22 to 53, with 12 (28.6%) men and 30
(Apollo Endosurgery Inc, Austin, Texas, USA), has
(71.4% women) making up the sample size. Participants
been available for sale for several years after receiving
met the following requirements to be included in the
FDA permission for usage in the US in the summer of
study: Participants were adults (over the age of 18) with
2015 (2). When the FDA posted reports of adverse
BMI of 40 or higher, regardless of gender. Patients who
events, including four cases of "patient death not
have many medical issues or who refused to participate
definitively attributed to the device or the insertion
were not included.
procedure" and one case of "potential complications
An informed written consent was taken from all
associated with the balloon treatment," two
the participants before taking any data or doing any
psychiatrists surprisingly recommended that the device
be discontinued. These argue that the ORBERA balloon
All patients had thorough medical histories
and Re-Shape are not completely risk-free (3).
reviewed. The patients were told to adhere to a certain
Since several published studies have shown with
food plan before the research. Patients were instructed
average reduction of among 55.6 & 32.1 % of extra
to keep a food journal, which was examined once a
body weight at six months following therapy or around
month. The participants underwent the BIB after a
25 % at 1 year it looks to be potentially helpful. The
month of therapy that included a low-calorie diet (1500
bulk of the time, this loss was kept off for a short or
kcal/d) and physical activity (a 45-minute walk five
medium amount of time, but in 23% of patients, along
times a week). Endoscopically implanted in the
with diet, exercise, and lifestyle changes, the loss was
stomach, the balloon (Inamed Health; Santa Barbara,
kept off for up to 5 years. Hundreds of thousands of
CA) contained 500­600 cc of physiological saline
obese people who are at high risk of surgical problems
containing methylene blue. The following appointments
or are just terrified of it choose to pursue this treatment
have been made during patient recruiting, 1 month after
option due to the ease of the process, the positive
balloon insertion, 6 months after BIB removal, and 1
outcomes, and the relatively inexpensive cost of the
month after balloon removal.
device (4).The goal of this research was to describe
The balloon was withdrawn from the patients six
complication after bio-enteric intragastric balloon
months after the BIB was implanted, along with an
removal patients with morbid obesity.
endoscopic examination of their esophagus, stomach,
Received: 09 0
/ 1 202
Accepted: 12 0
/ 3 2
/ 023

Full Paper (vol.921 paper# 112)

c:\work\Jor\vol921_113 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6207- 6212

Targeted Therapy in Non-Small Cell Lung Cancer: Review Article
Alyaa Alaa Abd Alrhman Ahmed*, Asmaa Abd Alghany Abd Allatef, Rafaat Abd Alaal Bakheet
Clinical Oncology and Nuclear Medicine Department, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Alyaa Alaa Abd Alrhman Ahmed, Mobile: +(20)1050366830, Email:

Lung cancer is responsible for the majority of cancer-related deaths in this nation. Based on histological type, the two
primary forms of lung cancer are small cell lung cancer (SCLC) (15%) and non-small cell lung cancer (NSCLC) (85%).
The genesis of lung cancer is impacted by an assortment of variables, involving cigarette smoking, pollutants in the air,
factors related to the environment, workplace cancer-causing agents, nutrition, infections caused by viruses, previous
lung disorders, inherited, and immunologic factors. Oftentimes, non-small cell lung cancer does not become apparent
until it has advanced. In between 50 and 75% of patients, coughing prevails, subsequent to hemoptysis, chest discomfort,
and breathlessness. Laboratory abnormalities or paraneoplastic syndromes are less frequent signs. The most prevalent
type of cancer that leads to mortality is lung cancer. Lung cancer occurrence worldwide was estimated at around 1.8
million new cases in 2012, according to the International Agency for Cancer Research (IARC) of the WHO. It is
presently being established which therapy is best for persons with lung cancer. Specifically, for those with pulmonary
adenocarcinoma, large-cell histology, and non-small-cell lung cancer, it is critical to look for PD-L1 expression levels,
EGFR alterations, ALK, and ROS1 translocations. These tests can also be carried out on squamous cell histology patients
who have never smoked or smoke seldom. A thorough genomic scan for HER2 insertions, BRAF mutations, MET, TRK,
and RET variants could potentially uncover experimental targeted medicines currently undergoing evaluation in human
clinical studies in alongside contributing to various other molecular discrepancies.
Keywords: Lung cancer, Mortality, SCLC, Non SCLC, EGFR, Review, Sohag University.


patient's general well-being and breathing capacity are
Globally, lungs cancers rank as one of the biggest
also crucial. The origin, diagnosis, course of therapy,
contributors of cancer-related death. Non-small cell
and new medications employed in it are all going to be
lung cancer (NSCLC) (85%) and lung cancer with small
examined in this research (2).
cells (SCLC) (15%) are the two primary forms of lung

malignancy according to histopathological type (1).
Incidence and etiology:
Biopsy needs to be done for the histological verification
The biggest cause of fatalities from cancer globally
of the diagnosis. The stage of NSCLC impacts both the
is lung cancer. 2012 recorded 1.8 million new instances
future prospects and available therapies, which is
of lung cancer around the world, according to the
crucial. TNM staging is based on the existence of
International Organization for Research on Cancer
metastases (M), how much lymph nodes are influenced
(IARC) of the World Health Organisation (WHO).
(N), and the features of the underlying tumor (T). The
Reality that the United States' 5-year survival rate is
options for therapy for the stages of NSCLC determine
still just 18% highlights the high overall ratio of
treatment options, but other variables such as the
fatalities to prevalence (3).

Figure 1: Adult tobacco consumption by nation in 2015, as a percentage; developed based on data from the
Worldwide Health Observatory of the World Health Organisation (WHO)(4).

Received: 08/02/2023
Accepted: 10/04/2023

Full Paper (vol.921 paper# 113)

c:\work\Jor\vol921_114 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6213- 6216

An Overview about Specific Language Impairment: Review Article
Amany Abdelbaset Sabry Mohammed*, Amal Saeed Quriba, Elham Magdy Hassan, Nasser Labeb Alnakeb
Department of Phoniatrics, E.N.T, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Amany Abdelbaset Sabry Mohammed, Mobile: (+20) 01119290707, E-Mail:

Children without other causes of language delay, such as deafness, intellectual disability, neurological
impairment and major emotional problem, or socioeconomic disadvantage, may be affected by specific language impairment
(SLI), a communication disorder. A child's language skills (including those of speaking, listening, reading, and writing) might
be negatively affected by SLI.
Objective: Review of the literature on Specific language impairment.
We scoured scholarly papers and databases like PubMed, Google Scholar, and Science Direct for information
on specific language disability. Only the latest or most comprehensive study between March 2000 and September 2022
was considered. The authors also analysed references from similar literature. Documents written in languages other than
English have been overlooked because of a lack of funding to translate them. Unpublished articles, oral presentations,
conference abstracts, and dissertations were all generally agreed upon not to constitute legitimate scientific investigation.
Conclusion: About 8% of kindergarteners have specific language impairment, making it one of the most prevalent
developmental disorders. Numerous global studies show that anywhere between seven and fifteen percent of preschool
and school-aged children are developing language and literacy skills at a slower rate than their classmates. Children with
SLI may have auditory processing or processing difficulties due to interactions between spoken and non-verbal brain
Keywords: Specific language impairment, Children.

with SLI, motor difficulties are a common symptom.
Children without other causes of language delay,
However, quantitative studies have identified changes in
such as deafness, intellectual disability, neurological
brain size or relative proportions of white or grey matter
impairment and major emotional problem, or
in certain regions in children with SLI, even though brain
socioeconomic disadvantage, may be affected by specific
scans rarely indicate any evident abnormalities in these
language impairment (SLI), a communication disorder. A
kids (4).
child's language skills (including those of speaking,
Motherhood stress and elevated testosterone levels
listening, reading, and writing) might be negatively
have been linked to this occurrence. There is an elevated
affected by SLI (1).
chance of impairments in children who have a family
Without any obvious physical disability, recognised
history of speech disorders. The percentage of children
syndrome, or other mitigating medical factors, children
with Specific Language Impairments (SLI) is estimated
with what is known as a developmental language disorder
to be between 3 and 6% of the population, and 7.4% of
(DLD) and language delay, or developmental dysphasia
children aged five and under (5).
struggle to express themselves and understand others
Causes of SLI:
through spoken and written language (2).

About 8% of kindergarteners have this disease,
making it one of the most prevalent in the population.
Multiple studies point to a strong genetic relationship
Multiple international studies have found that between
as a possible explanation for SLI, although its exact
seven and fifteen percent of preschool and school-aged
causation remains unknown. Children with SLI are more
children have language acquisition and development rates
likely to have family members who themselves have
that are different from the norm. Children with SLI are
experienced speech impairments or delays. Between half
those who have trouble learning and using language, but
and two-thirds of SLI cases in children can be traced back
for whom the cause is unknown. These kids have average
to a first-degree relative. There is no link between
social-emotional skills, hearing, and IQ even if they can't
learning many languages and SLI. However, the disease
talk. However, these kids have a lot of problems with
is not limited to monolingual youngsters; it can also affect
language, from delayed onset and slower learning of
those who speak multiple languages (6).
lexical and grammatical forms to smaller vocabularies to
According to Starling et al. (7), the genetic basis of
trouble with inflectional morphology and sophisticated
this impairment is demonstrated by the higher prevalence
syntax. At first, it was thought that these language
of SLI in monozygotic than in dizygotic twins. They
difficulties were caused by a lack of grammatical skills
proved the role that genetics plays in shaping linguistic
aptitude. The influence of these elements was greatest
There is overwhelming evidence from the scientific
with respect to expressive abilities, and it was least with
literature that guys are more likely to experience SLI than
respect to passive vocabulary, which was mostly
girls. No connection has been established to genes on sex
influenced by one's surroundings. They were unable to
chromosomes, hence the cause is unknown. In children
definitively identify the genetic marker as the sole cause
of SLI. They supported the theory that the different
Received: 15/02/2023
Accepted: 17/04/2023

Full Paper (vol.921 paper# 114)

c:\work\Jor\vol921_115 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6217- 6222

Effect of Pulsed High Intensity Laser Therapy on Cervical Myofascial
Pain Syndrome after Neck Dissection Surgeries
Naglaa Mohmed Ramadan Amin Gawaan1, Khadra Mohmmed Ali1,
Eid Rizk El Gammal2, Nancy Hassan Aboelyazied Aboelnour1
1Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt
2Department of Oncosurgery, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Naglaa Mohmed Ramadan, Mobile: (+20) 01111045652,


Surgery, radiation therapy and chemotherapy are used to treat head and neck cancer (HNC) patients,
with the goal of maximizing survival while maintaining physical form and function. Objectives: The study's primary
goal was to determine if pulsed high-intensity laser therapy (HILT) was effective in treating cervical myofascial pain
and restoring cervical range of motion (ROM) following neck dissection procedures. Subjects and methods: This
study was a randomized controlled trial and applied to a total number of forty patients from both genders who have
cervical Myofascial Pain Syndrome (MPS) history at upper trapezius muscle (UTM) at least one month following a
unilateral MRND and were randomly assigned into two groups equal in number (20 patients for each group); (HLIT
group): received pulsed high intensity laser therapy in addition to traditional physical therapy program and (Control
group): received traditional physical therapy program all treatment 3 times per week for one month . Pain was
evaluated by Visual analogue scale and pressure algometer, while neck ROM was evaluated by universal goniometer
before and after 4 weeks of intervention. Results: a comparison between the groups showed a significantly lower
VAS, significantly higher PPT and a statistically significant difference between the study group's right and left
bending and rotation and that of the control group (p< 0.001). Conclusion: Patients with cervical myofascial trigger
points were found to benefit greatly from high intensity laser treatment as a kind of physical therapy.
Keywords: HILT, MPS, Neck dissection surgeries, VAS.

In addition to muscular tightness, sensitive spots,
Surgery, radiation treatment (XRT), and/or
restricted range of motion, tiredness, weakness, and
chemotherapy are used to treat patients who have been
possibly autonomic dysfunction, MPS is a common
diagnosed with head and neck cancer (HNC), with the
musculoskeletal condition that causes pain that is both
goal of maximising survival while maintaining
intense and deep in one or more muscles and fasciae
physical form and function (1). In order to treat cervical
(5). Myofascial trigger points are now treated manually
lymphatic metastases, a surgical operation known as a
utilising acupressure massage techniques as well as
neck dissection involves the removal of the lymphatic
physical therapy technologies like ultrasound and laser
and fatty tissue of the neck. Because cervical lymph
(6). Musculoskeletal disorders are treated using laser
nodes are the primary site of metastasis for upper aero-
treatment, which includes shining red and near-
digestive tract cancers, neck dissection operations are
infrared light on superficial wounds or wounded
often combined with surgical excision of these cancers
tissues to speed up soft tissue recovery and reduce both
(2). The neck dissection procedures can be carried out
acute and long-term pain. HILT is regarded as one of
in a number of ways. One of these strategies is the
the phototherapeutic devices that have become popular
radical neck dissection surgery, which entails the
for treating both acute and chronic inflammatory pain,
complete excision of lymph nodes from one side of the
as well as the impairments that go along with it.
neck, the sternocleidomastoid muscle, an important
However, recent research has shown that HILT has
vein (the internal jugular vein), and the spinal
deeper effects on inflammation and edema, analgesic
accessory nerve, which is crucial for the full range of
effects, and deeper joint stimulation. Therefore, the use
motion of the arm and shoulder. The key structures
of HILT for MPS may reduce pain and enhance
listed above are all preserved in the modified radical
function (7).
neck dissection (3).
Because there is little information on the
Neck morbidity, such as discomfort, numbness,
effectiveness of HILT in treating MPS after surgery,
and reduced range of motion, was a severe and
this research was created to look into the effects of
noticeable side effect of cancer treatment. Two forms
pulsed HILT on patients who had a history of cervical
of neck pain--neuropathic and myofascial pains--
MPS at the upper trapezius muscle (UTM) after
were documented in a study of 25 individuals who had
receiving a unilateral MRND.
neck dissection-related lifelong neck discomfort.

Additionally, 33% and 37% of 220 patients who had
neck dissection surgery had neck and shoulder
This study included 40 cervical MPS post-neck
discomfort, while 32% and 46% of patients reported
dissection surgery patients, aged 20 to 60, who were
neuropathic and myofascial pains (4).
recruited from the Damanhur Oncology Centre.
Received: 15/02/2023
Accepted: 17/04/2023

Full Paper (vol.921 paper# 115)

c:\work\Jor\vol921_116 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6223- 6227

Medication Adherence in Patients with Rheumatoid Arthritis and
Juvenile Idiopathic Arthritis: A Comparative study
Yasser A Abdelhameed, Sahar S. Ganeb, Waleed A. Salah Eldin, Faten M. Abdeltawab*
Department Rheumatology, Rehabilitation, and Physical Medicine, Faculty of Medicine, Benha University, Egypt
*Corresponding author: Faten M. Abdeltawab, Mobile: (+20) 1122254083, E-Mail:

In chronic illnesses requiring long-term therapy, such as Rheumatoid Arthritis (RA) and Juvenile
Idiopathic Arthritis (JIA), medication non-adherence is a major issue that drives up expenses globally. Adherence is
crucial to achieving desired results but is frequently poor during treatments.
Our study aimed to evaluate compliance to DMARDS between Rheumatoid Arthritis patients and Juvenile
Idiopathic Arthritis patients by Compliance Questionnaire of Rheumatology (CQR) and factors potentially affecting it.
Subjects and methods: This comparative study included two groups: Group (1): 120 rheumatoid arthritis and group
(2): 60 juvenile idiopathic arthritis patients. All patients were subjected to: Complete history taking, clinical
examination, disease activity assessment, quality of life, anxiety and depression, socioeconomic status and adherence to
treatment by Standardized questionnaires.Results: Our study revealed that medication non-adherence was higher in RA
group than JIA group with highly significant difference between both groups. Fear of drug side effect was the first cause
of disease-modifying antirheumatic drugs (DMARDs) non-adherence in both groups. Also our study found that there
was significant difference as regards steroid administration in JIA group and DMARD non adherence. There was
significant value regarding depression and DMARD non-adherence in RA group. As regards socioeconomic status and
DMARD non-adherence, there was significant difference among RA group.
Conclusion: RA group had a greater rate of DMARDS non-adherence than JIA group. Non-adherence is a complex
issue that is impacted by a number of variables. These variables may be separated into five categories: Social and
economic variables, treatment-related factors, disease-related factors, patient-related factors, and factors associated to
the health care system.
RA, JIA, KMARD, Quality of life.


The chronic inflammatory illness rheumatoid
Rheumatism (ACR/EULAR) 2010 classification
arthritis (RA) is characterised by ongoing synovitis in
criteria for diagnosis of RA (8).
the joints and systemic inflammatory reactions that may

Group (II): 60 JIA patients diagnosed according
result in permanent impairment (1, 2). RA is seen as a
to ILAR classification criteria of JIA (9).
multistep illness. The immune system becomes
All patients were recruited from those attending
activated outside the joint compartment, primarily in the
the Outpatient's Clinic and Inpatient's Unit of
mucosal surfaces, during the preclinical stage of the
Rheumatology, Rehabilitation and Physical Medicine
illness as a result of genetic predisposition and
Department of Benha University Hospitals.
environmental stimuli (3). In children, JIA is the most

prevalent chronic rheumatic condition. Currently, all
Exclusion criteria:
types of chronic arthritis with an uncertain aetiology
a. Additional autoimmune disorders: Vasculitis,
that begin before the age of 16 are included under the
SLE, rheumatic fever, dermatomyositis,
general label "JIA" (4). There are seven distinct subtypes
polymyositis, enteropathic arthritis, Behcet
of JIA according to the International League of
illness, Sjogren's syndrome, and mixed
Associations for Rheumatology (ILAR) (5). Notably,
connective disorders that are some examples of
oligoarticular JIA (oJIA) is more prevalent in European
connective diseases.
nations, whereas polyarticular JIA (pJIA), enthesitis-
b. Acute illness or septic arthritis.
related arthritis (ErA), and systemic JIA (sJIA), are
c. Metabolic disorders.
most prevalent in Asia, India, Australia, New Zealand,
d. Endocrine conditions.
Costa Rica, and South Africa (6).
e. Neuropathic illnesses.
There are two types of medical non-adherence:
f. A hereditary bone condition.
purposeful and inadvertent. It may be divided into
g. Neoplastic illnesses, such as leukaemia.
purposeful sources for non-adherence, such as cases
h. Psychogenic rheumatic disease.
when a patient decided to stop taking medicine or skip
i. Sarcoidosis.
a dose on their own initiative without contacting a
j. Familial Mediterranean fever.
doctor (7).
k. Soft tissue rheumatic disease.

Every Rheumatoid Arthritis participant in this
This study involved two groups:
research underwent:

Group (I): 120 RA patients diagnosed according
A) Complete history taking, which included
information on age, sex, smoking, drinking, the duration
Received: 16/02/2023
Accepted: 18/04/2023

Full Paper (vol.921 paper# 116)

c:\work\Jor\vol921_117 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6228- 6231

Accuracy of Biometric Formulae (Hoffer Q and SRK/T) in
Hypermetropic Patients undergoing Cataract Surgery by Phacoemulsification
AbdAllah Ahmed Mustafa Hamad1, Ahmed Anwar Abd Elghany2,
Khalad Abd Elsalam Zaky3, Mahmoud Ahmed Ghoneim4
Department of Ophthalmology, Faculty of Medicine, Suez Canal University. Egypt.
Corresponding Author: AbdAllah Ahmed Mustafa Hamad1, Tel: 01005176175

In eyes with significant hyperopia, where attaining precise surgical refractive outcomes may be
particularly problematic, the predictive efficiency of the formulas falls.
Aim of work: The goals of this research were: (1) To determine how well the individual can see after having cataract
operation in hyperopic persons utilizing the IOL master (Carl Zeiss Meditec, Inc., Dublin, CA, USA) & the Topcon
RM-8000B, and (2) To contrast the prediction error of two biometric equations (Hoffer Q and SRK/T).
Methods: Our study was an observational clinical study (analytical cross-sectional). 180 eyes from 180 patients of both
sexes with axial length below 22 mm were recognized from individuals performing cataract surgery by
phacoemulsification at Ophthalmology Department, Faculty of Medicine, Suez Canal University. A sample of cases
was chosen & divided into two groups, each including 90 eyes. One group used Hoffer Q formula (n= 90) and the other
group used SRK/T formula (n= 90). Biometry was performed on all participants utilizing the intraocular lens (IOL)
master. Each participant had one of their eyes chosen at random. Errors in prediction were computed by comparing
preoperative refraction with the refraction measured after surgery utilizing the improved formulae (Hoffer and SRK/T).
Results: Our findings also revealed that the Hoffer Q formula is not with greater precision than SRK/T formula in
refractive outcome in hypermetropic patients undergoing cataract surgery as there was no significant variation among
them in refractive outcome.
Conclusion: Hoffer Q formula is not superior in terms of accuracy to SRK/T formula in refractive outcome in
hypermetropic patients undergoing cataract surgery as there was no significant distinction among them in refractive
Keywords: Hypermetropia, Hoffer, SRK/T, Cataract.

of both sexes with axial length under 22 mm for cases
There is a decrease in the formulas' predictive
that need phacoemulsification for cataract removal at
effectiveness in eyes with substantial hyperopia, when

correct operative refractive outcomes can be hard to
the Ophthalmology Department, Faculty of Medicine,
achieve (1).
Suez Canal University.
The Holladay & SRK/T equations indicate a linear

connection among axial length (AL) as well as anterior
Exclusion criteria:
chamber depth, which could not be true in tiny eyes,
Patients with corneal abnormalities, history of
which is one of the numerous reasons that lead to
inferior performance in hyperopia (2).
operation or trauma, preoperative pupil dilatation less
The Hoffer Q, which suggests a correlation among
than 4 mm, axial length above 22 mm or complications
axial length & anterior chamber depth, is thought to be
were excluded.
more reliable in very hyperopic individuals. The
Selected cases were split into two separate groups
National Institute for Health and Care Excellence
of 90 eyes in each. One group used Hoffer Q formula
(NICE) has superseded the advice of organizations such
(n= 90) and the other group used SRK/T formula (n=
the Royal College of Ophthalmologists (RCOphth), it
90). All subjects did biometry using IOL master & IOL
found that people whose AL was less than 22 mm
implantation. Each participant had one of their eyes
benefited more from the Hoffer Q (3, 4).
chosen at random. Errors in prediction were determined
The purpose of this research was to contrast the
by comparing preoperative refraction with the
prediction inaccuracy of the Hoffer Q along with the
refraction measured after surgery utilizing the improved
SRK/T biometric formulas utilizing the IOL master &
formulae (Hoffer and SRK/T).
the auto refractometer Topcon (RM-8000B) to assess

the visual acuity of hyperopic persons following
Ethical Approval:
cataract removal.
The trial was given approval by the Ethics

Board of the Ophthalmology Department of Faculty
of Medicine, Suez Canal University (IRB# 6476/17-
The research was an observational clinical study
5-2022). The participants were given all of the
(analytical cross-sectional). 180 eyes from 180 patients
relevant details about the examination. A reported
consent form was signed by each participant in the

Received: 15/02/2023
Accepted: 17/04/2023

Full Paper (vol.921 paper# 117)

c:\work\Jor\vol921_118 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6232- 6238

Therapeutic Effect of Ipsilesional High-Frequency Repetitive
Transcranial Magnetic Stimulation Following Local Botulinum Toxin
Injection in Post-Stroke Upper Limb Spasticity
Mohamed M. Abdelkader*, Abd El-Raoof O. Abd El-Baky, Wael T. Soliman, Enas M. Hassan, Rehab G. Taha
Department of Neurology, Faculty of Medicine, Minia University, Minia, Egypt
*Corresponding author: Mohamed Mahmoud Abdelkader, Mobil: (+20)01003164380, E-mail:
Background: One of the most prominently apparent stroke consequences is spasticity. By preventing acetylcholine
release at the neuromuscular junction, intramuscular injection of botulinum toxin can reduce post-stroke stiffness.
Additionally, repetitive transcranial magnetic stimulation (rTMS), a type of noninvasive brain stimulation (NIBS), is
well recognised to impact neuroplastic changes and control the healing of injured brain areas. Objective: The aim of
the current study was to evaluate the combined effect of local botulinum toxin injection and ipsilesional high-
frequency rTMS (HF-rTMS) on spastic UL in post-stroke patients, and if this effect could add together to the other
treatment modalities available to these patients. Patients and Methods: 45 patients with post-stroke spastic upper
limb (UL) were injected with botulinum toxin type-A (BoNT-A), then randomly designated to treatment with 20 Hz
rTMS (Real rTMS group), N= 22 and SHAM rTMS group, N=23, applied over the ipsilesional cortex over 4 weeks.
Spasticity was assessed with Modified Ashworth scale (MAS), the motor function of the affected upper limb was
evaluated serially by Wolf Motor Function Tests (WMFT) and motor power was assessed by Medical Research
Council (MRC) just before administration, 1.5 months and 3 months after administration of BoNT-A. Results: The
real rTMS group showed significant improvement of spastic muscles as evident by reduction of their MAS score with
significant improvement of motor function and motor power as shown by WMFT and MRC. Conclusion: These
findings suggested that, the application of HF-rTMS over the ipsilesional cortex following local BoNT-A injection
contributes in reduction of spasticity and improves motor power and function in post-stroke patients.
Keywords: Spasticity, Botulinum toxin, Repetitive Transcranial Magnetic Stimulation, Post-Stroke.

be impacted by the degree of the afflicted upper limb's
One of the most significant impairments linked to
motor functional impairment, which is mostly
upper motor neuron injuries is frequently thought to be
dependent on the presence or absence of spasticity (16).
spasticity. In the chronic period following a stroke, 20%
The aim of our current study was to evaluate the
of individuals experience limb spasticity (1).
combined effect of local botulinum toxin injection and
Contractures may occur as a result of other issues such
ipsilesional HF-rTMS on spastic UL in post-stroke
as motor weakness, sluggish movement of the afflicted
patients, and if this effect could add together to the other
limb, discomfort, and deformity brought on by
treatment modalities available to these patients.
spasticity. As a result, post-stroke spasticity
significantly lowers quality of life (2, 3). Treatment
Our study participants were 45 post-stroke patients
options for post-stroke spastic disorders include
of both sexes. All patients were enlisted from
intramuscular injections of botulinum toxin, selective
Neurology Outpatients Clinic of Minia University
peripheral nerve block with phenol, and oral anti-spastic
Hospital with age ranged 18-90.
medicines (4, 5). The neuromuscular junction is inhibited
by the local injection of botulinum toxin type A (BoNT-
Inclusion criteria: Time after onset of stroke of 12
A), which also lessens the spasticity of the injected
months or more, past history of a sole manifested stroke
muscle. However, not all spasticity patients or with all
only, no cognitive disability with a pre-treatment Mini
grades may show improvement in active motor function
Mental State Examination score 26, Modified
on the spastic limb after botulinum toxin injection (6­10).
Ashworth scale (MAS) 1 for finger flexor and/or wrist
In contrast, several studies demonstrated the therapeutic
flexor muscles and Medical Research Council (MRC)
efficacy of repetitive transcranial magnetic stimulation
(rTMS) administered to the ipsilesional or non-lesional
Botulinum Toxin Injection:
hemisphere for post-stroke patients with upper limb
All patients were injected by botulinum toxin type-A
spastic weakness (11-13). In stroke patients with spasticity,
(BoNT-A) in the spastic UL muscles guided by
rTMS significantly reduced it, according to Wang et al.
Ultrasonography (US) by using EUROMUSCULUS
(14). This practical outcome of rTMS may be accounted
for by increased neuronal activity in the lesional
GlaxoSmithKline, Tokyo, Japan) is sold in vials that
hemisphere brought on by decreased interhemispheric
include 100 units of the BoNT-A formulation that is
inhibition towards the lesional hemisphere (11­14). As a
vacuum-dried powder, 0.5 mg of human serum albumin,
result, numerous institutions safely employ the use of
and 0.9 mg of sodium chloride that must be
rTMS and occupational therapy (OT) as a therapeutic
reconstituted with sterile normal saline (0.9%) to a total
technique for the treatment of spastic upper limb (UL)
volume of 2 ml. The US equipment used was
weakness (15). The effectiveness of rTMS/OT appears to
assess the accurate site for spastic muscles injection.
Received: 16/02/2023
Accepted: 18/04/2023

Full Paper (vol.921 paper# 118)

c:\work\Jor\vol921_119 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6239- 6245

Assessment of Right Liver Lobe Size/Serum Albumin Ratio as
A New Non-Invasive Predictor for The Presence of Oesophageal Varices in
Egyptian Patients with HCV Related Liver Cirrhosis
Amr Gamal Sabet Mohammed*, Ahmed Qasem Mohammed, Abd El Wahab Fathi Ali
Department of Hepatology, Gastroenterology, and Infectious Diseases,
Faculty of Medicine, Al-Azhar University, Assiut, Egypt
*Corresponding author: Amr Gamal Sabet Mohammed, Mobile: (+20) 01156482702, E-mail:

Oesophageal varices (OV) are discovered in 24% and up to 80% of cirrhotic liver cirrhotic patient and
the severity of varices differs from patient to another, oesophageal endoscopy is the best method for evaluating OV.
Objective: As a non-invasive indicator of OV in cirrhotic patients, we hypothesize that we can use the right liver lobe
diameter/serum albumin ratio. This will allow us to limit the usage of screening endoscopy.
Patients and Methods: Sixty individuals with cirrhotic liver were included in this cross-sectional analysis. Two equal
groups of patients (N=30) were formed: Group (1), which included patients with cirrhosis due to HCV infection with
or without LCF and Group (2), which included patients with matching ages and sexes who were visiting an
endoscopic unit for problems other than cirrhosis.
Results: Oesophageal varices was statistically correlated with Rt liver lobe diameter/serum albumin ratio
(RLLD/Alb). The sensitivity and specificity were 95.7 % and 93.3% respectively and the cutoff point value was
>3.98. Plt count/spleen diameter ratio (P/S) demonstrated a statistical correlation with incidence of esophageal varices.
The sensitivity was 90.4% and specificity was 98.2% with best cutoff point value16.3.
Conclusions: Physicians can benefit from using RLLD/Alb (with or without P/S) as a non-invasive OV predictor.
Keywords: RLLD/Alb, Non-Invasive Predictor, OV, HCV.


Oesophageal varices (OV) are hepatic-systemic
Two equally sized groups of patients were formed
shunts in the lower oesophagus that occur as a
(N=30): Patients in groups 1 and 2 were matched for
consequence of liver cirrhosis with consequence of
age and sex and as for the second group, patients were
rupture and bleeding, this is why OV puts patients in a
undergoing endoscopies for conditions other than
critical situation [1]. OV transforms liver cirrhosis
cirrhosis. Group 1 included patients who were cirrhotic
patients from asymptomatic mild case to another
due to HCV infection with or without LCF.
clinical stage with associated mortality up to 57% [2, 3].

The American College of Gastroenterology and
Inclusion Criteria: HCV-related liver cirrhotic
the American Association for the Study of Liver
Disease have also agreed that all patients with liver

cirrhosis should have upper GIT endoscopy for varices
Exclusion criteria:
assessment, which should be repeated annually
1- Patients did not have cirrhotic liver.
depending on clinical status. [4-6].
2- Subjects with portal vein thrombosis.
Due to variability of occurrence of (OV) among
3- Subjects with hepatic focal lesions or
liver cirrhotic patients with wide range from 24% to
hepatocellular carcinoma.
80% we thought that screening all patients in
4- Those decline sharing in the research.
developing countries will be costly and puts large

burdens on the health care [7-8]. Much research was
Investigations done to all cases:
done to test non-invasive maneuvers for screening for
1. History taking.
(OV) including CT scanning and video capsule
2. Full physical examination.
endoscopy [8, 9].
3. Laboratory investigations which included:
Our study aims at evaluating the accuracy of the
CBC, ALT, AST, direct, total, and indirect
RLLD/Ab as a non-invasive predictor of (OV) in
serum bilirubin, serum albumin, and (PT), as
patients with liver cirrhosis in order to limit the use of
well as alfa fetoprotein, which are tests for
screening endoscopy.
liver function.

Viral indicators for hepatitis, such as HBsAg
and HCV Ab.
Our analytic study included 60 cirrhotic cases
Renal function tests, including urea, urethane,
selected from Hepatology outpatient clinics and
and serum cr measurements.
inpatient wards at Al-Azhar Assiut University
Unexpected blood sugar.

Received: 16/02/2023
Accepted: 18/04/2023

Full Paper (vol.921 paper# 119)

c:\work\Jor\vol921_120 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6246- 6255

Antimicrobial Activity of Some Honeybee Products on Multidrug-Resistant
Secondary Microbial Infection from COVID-19 Patients
Asmaa K. Helmy1*; Ahmed G. Hegazi 2; Nagwa M. Sidkey1
1 Botany and Microbiology Department, Faculty of Science for Girls, Al-Azhar University.

2 Zoonotic Diseases Department, National Research Centre, Dokki, Giza, Egypt

* Corresponding Author:, 0009-0005-2709-9981

COVID-19 patients are vulnerable to develop secondary microbial infections that are frequently multidrug-
resistant (MDR) and increase the severity of the disease and mortality risk, which has created an urgent need for the use of
natural products as antimicrobial agents.
Objective: This study aimed to evaluate and compare the polyphenol content of some honeybee products from different
origins as well as their antimicrobial activity against some MDR secondary microbial infections in COVID-19 patients.
Methods: During the winter of 2021, sixteen clinical microbial isolates were collected from sputum and chest swabs of
COVID-19 patients from some hospitals in Cairo, Egypt, and their antimicrobial susceptibility testing was performed. The
total phenolic content (TPC) and total flavonoid content (TFC) of eight honeybee products from different origins were
evaluated, and their antimicrobial activity was determined by recording the inhibition zone diameter (IZD) and minimum
inhibitory concentration (MIC).
Results: According to results, Turkish propolis, Egyptian royal jelly sample1, and Egyptian honey contained the highest
polyphenol content and consequently showed significant antimicrobial activity compared to other bee products under study.
Turkish propolis contained elevated polyphenol contents (TPC= 322.33 mg Gallic acid (GAE)/100 g and TFC= 88.974 mg
Quercetin (QUE)/100 g) and expressed its antimicrobial activity with IZD ranging 15.33­28.33 mm and MIC value of
0.105­7.5 mg/ml. Also, Egyptian royal jelly1 and Egyptian honey contained high polyphenol contents (TPC= 134.737 mg
GAE/100 g and TFC= 78.162 mg QUE/100 g) and (TPC= 98.571 mg GAE/100 g and TFC= 44.487 mg QUE/100 g),
respectively, and showed antimicrobial activity with IZD of 0.00­21.66 mm and 0.00­22.00 mm, respectively, as well as
MIC values of 1.150­4.69% and 6.25­37.50%, respectively. Indeed, all honey and royal jelly samples showed no activity
against Candida spp., while propolis exhibited good action against it.
Conclusion: Honeybee products are promising natural products that possess unique antimicrobial activities that help to
fight MDR secondary microbial infections in COVID-19 patients, in which their antimicrobial activity is largely affected
by polyphenol contents and geographical origins.
Keywords: Honey, MDR, MIC, Polyphenols, Propolis, and Royal Jelly.

royal jelly are important honeybee products that have
Coronavirus disease 2019 (COVID-19) is a serious
been used since ancient times owing to their health
viral infectious disease caused by the recently identified
benefits and pharmacological activities (4). These products
severe acute respiratory syndrome­coronavirus 2 (SARS-
possess pharmacological and biological properties in
CoV-2). It was declared in March 2020 by the World
varying degrees owing to their content of antioxidant
Health Organization (WHO) as a worldwide pandemic
compounds, such as phenolic acids, flavonoids, and/or
causing millions of morbidities and death (1). Several
terpenoids. Variations in the active contents of each bee
studies on COVID-19 patients have reported the
product were strongly influenced by their floral sources,
prevalence of secondary microbial (bacterial and fungal)
geographical location, weather, season, and extraction
infections, with an increasing predominance of
methods (5).
multidrug-resistant (MDR) Gram-negative bacteria and
Honey is one of the oldest bee products and has been
Candida species (2, 3). The increased prevalence of MDR
produced by bees from the nectar of many flowers. It is
microbial infections may be due to the empiric
an aqueous supersaturated mixture of sugars with trace
prescription of antibiotics for the majority of patients
amounts of organic acids, proteins, minerals, vitamins,
suspected or diagnosed with COVID-19 (2). Therefore,
and polyphenols (flavonoids and phenolic compounds)
there is an increasing demand for the development of
that are important for the biological properties of honey
different choices other than communal antibiotics, such as
(6). Nearly all types of honey, including monofloral and
apitherapy, to correct immunological deficiencies in
multi-floral honey, have antimicrobial activity in different
COVID-19 patients as well as to prevent antimicrobial
ranges (7).
resistance (4).
Propolis (bee glue) is a natural sticky resinous
Apitherapy or bee therapy involves the use of bee
substance collected by bees from the resinous secretion of
products for therapeutic purposes. Honey, propolis, and
buds of different plant species and, which then combines
Received: 19/02/2023

Accepted: 19/04/2023

Full Paper (vol.921 paper# 120)

c:\work\Jor\vol921_121 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6256- 6260

Could Reticulocyte Haemoglobin Content (CHr) Help in
Determination of Iron Status? Review article
Mohamed Ahmed Badr1, Shaimaa Saad Abdelhamid Elashkar1,
Weaam lbrahim lsmail2, Asmaa Ahmed Alshafie Abozid1
Departments of 1Pediatrics and 2Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Asmaa Ahmed Alshafie Abozid, Mobile: (+20) 01015426561, E-Mail:

Hemoglobin (Hb) carries oxygen throughout the body and is essential to survival, so maintaining healthy
levels of Hb production is crucial. Due to their short lifespan (about 120 days), mature erythrocyte Hb is not a reliable
indicator of Hb production. Objective: Review of the literature if Reticulocyte haemoglobin content (CHr) help in
determination of iron status. Methods: We looked for data on Reticulocyte Haemoglobin Content in scholarly journals
and databases including PubMed, Google Scholar, and Science Direct. The most recent or extensive studies published
between October 2012 and August 2022 was taken into account. The writers also analysed similar works cited in their
work. Lack of resources to translate documents written in languages other than English has led to their neglection. It was
generally recognized that scientific research did not include research that was not published in a peer-reviewed journal,
presented orally, or presented as a conference abstract or dissertation. Conclusion: CHr is unaffected by influences
outside of iron metabolism and reflects the current state of Hb synthesis. In cases when it is challenging to estimate the
ideal iron requirement, such as when providing an erythropoiesis-stimulating drug. CHr testing can help with the early
detection of iron deficiency (ESA). Several investigations have shown that CHr detection in peripheral blood samples is
a reliable method for identifying individuals with an iron shortage. It has been demonstrated to be a reliable indicator of
iron status and a practical method for gauging the success of iron therapy.
Keywords: Reticulocyte haemoglobin content, Iron deficiency anemia.

variables outside iron levels. CHr, which may be
Children displaying any of the iron deficiency
measured immediately as Hb ret level by H*3 or
anemia (IDA) symptoms warrant additional evaluation.
ADVIA blood analyzers, is therefore anticipated to aid
However, who should be evaluated for IDA given that
in the evaluation of iron deficiency or excess, leading to
most kids with the disease don't show any symptoms and
the correct prescription of iron deficiency medication (6).
pale skin isn't a good indicator? Although the American
Iron storage, transport, and metabolism:
Academy of Pediatrics suggests starting screenings at
In a normal human being, the amount of iron is
the age of one year old, many wealthy countries lack
around 4.5 g to 5 g. Roughly 70% of this is found in the
even basic guidelines (1). In the meantime, reticulocytes
reticuloendothelial system (Hb, bone marrow, and
are released from the bone marrow into the peripheral
reticuloendothelial macrophages), 30% in the liver and
circulation, where they undergo maturation into
spleen as ferritin (the storage iron), and 10% in the
erythrocytes over the course of the next two days.
muscles as myoglobin (7). Iron metabolism is
Therefore, the reticulocyte Hb content (Hb-ret) may be
distinguished by the fact that iron is excreted exclusively
an indicator of the most up-to-date Hb production
through the regular shedding of skin and gastrointestinal
mucosal cells. It lacks an active excretion route and has
Furthermore, iron, a crucial component of Hb, is a
a mostly closed metabolic architecture. Iron absorption
necessary element for virtually all human cells, with
occurs predominantly in the duodenum and jejunal
roughly 70% of the body's iron located in the
epithelial cells, and daily loss of iron is just 1-2 mg (8).
reticuloendothelial system. Hb-ret is regarded a helpful
Divalent metal transporter 1 (DMT1) transports
method for evaluating acute iron metabolism in the
nonheme iron to the intestinal epithelial cells, while
body, provided that hematopoiesis is normal. Hb
heme iron is carried in its native form. Ferroportin,
synthesis is affected by iron intake (3). An iron deficit
which is expressed in the vascular lumen, is responsible
can induce anaemia and metabolic issues, while an iron
for the absorption of both forms of iron into the blood.
overload can reduce the body's ability to effectively use
Ferrous iron, a very toxic type of iron, enters cells
the iron it already has. Furthermore, iron overload is
through the bloodstream through binding to the
linked to arteriosclerosis, carcinogenesis, hepatopathy,
membrane protein transferrin receptor (TfR) (4).
and diabetes because it causes the production of
Hematopoiesis necessitates an iron content of 0.8-1.0
hydroxyl radicals via the Fenton and Haber-Weiss
mg/h, but serum iron level is only 3-4 mg, thus the
reactions (4).
organism can rapidly enter a state of iron insufficiency if
Because iron metabolism lacks a functional
iron is not given constantly into the blood (6). It is the
excretion system, maintaining normal blood iron levels
reticuloendothelial system that primarily facilitates the
and avoiding excessive iron supplementation are of
recirculation of iron into the blood, while the intestinal
paramount importance (5). Traditional iron indices can
absorption rate is just 1-2 mg/day. In addition, the liver
provide a rough estimate of the body's iron status, but
secretes a peptide called hepcidin, which controls iron
they are not always reliable because they are affected by
Received: 19/02/2023
Accepted: 19/04/2023

Full Paper (vol.921 paper# 121)

c:\work\Jor\vol921_122 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6261- 6268

The Outcome of Early Laparoscopic Cholecystectomy after
Acute Biliary Pancreatitis "on Same Admission"
Mohammed A. El Balshy, Mohammed Saeed Abo Ghanima, Ahmed Sabry El Gamal, Adel Saad Zeidan
Department of General Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
*Corresponding author: Mohammed Saeed Abo Ghanima, Mobile: (+20) 01095396660,
An acute pancreatic inflammatory process that may or may not include nearby tissues or distant organ
systems is known as acute pancreatitis.
Objectives: This study aimed to evaluate the possibility of early laparoscopic cholecystectomy at the same time of
admission in patients with non-necrotizing biliary acute pancreatitis.
Patients and methods: This study was carried out on twenty patients to detect the outcome of early laparoscopic
cholecystectomy in acute biliary pancreatitis on same admission, which will be performed in General Surgery
Department of Faculty of Medicine Menoufia University and General Surgery Department of Damanhur Medical
National Institute.
Results: MRCP was done in 4 cases only (20%), and revealed multiple small gallstones in these 4 cases, only minimal
intra-hepatic biliary dilatation (IHBRD) in 2 cases (10%). IOC was done for the four cases revealed that two cases (10%)
had no common bile duct (CBD) stones, the other two cases (10%) had a small stone in CBD, so CBD stone extraction
was done through transcystic CBD exploration with IOC, the CBD diameter was within normal in these 4 cases, ranged
from 7-9.5 mm, mean diameter was 8.25 ± 1.44 mm. The early laparoscopic cholecystectomy group experienced a
considerably shorter overall hospital stay than the delayed laparoscopic cholecystectomy group.
Conclusion: In moderate acute biliary pancreatitis, laparoscopic cholecystectomy is safe and doable during index
hospitalisation without any further risks.
Keywords: Acute biliary pancreatitis, Cholecystectomy, Laparoscopic.

avoid these. A patient may be at risk for a deadly
Acute pancreatitis (AP) is described as a sudden
episode of acute pancreatitis if decisive therapy is not
onset of pancreatic inflammation with varied
given [5, 6]. The aim of this study was to evaluate the
involvement of nearby tissues or distant organ systems
possibility of early laparoscopic cholecystectomy at the
[1]. It is one of the most prevalent gastrointestinal
same time of admission in patients with non-necrotizing
disorders, which typically has a mild and self-limiting
acute biliary pancreatitis.
course. However, 10% to 20% of patients experience a

rapidly progressing inflammatory response that is
linked to a lengthy hospital stay as well as significant
This study was carried out on twenty patients to
morbidity and mortality. Less than 1% of patients with
mild pancreatitis die, whereas between 10% and 30% of
cholecystectomy in acute biliary pancreatitis on same
patients with severe pancreatitis do. Resulting in a
admission to be performed in General Surgery
financial, physical, and emotional strain on people [2]. It
Department, Faculty of Medicine, Menoufia University
can range from a minor, self-limiting pancreatic
and General Surgery Department of Damanhur Medical
inflammation to a serious condition with infected
National Institute.
pancreatic necrosis, multiple organ failure, and a
Inclusion criteria: All patients of gall bladder stones as
significant mortality risk. Even in the lack of particular
primary cause of acute pancreatitis with clinical and
therapies that target the pathophysiology that
radiological evidence (Elevated serum levels of
determines clinical result, the clinical outcome has
amylase and lipase associated with pancreatitis in
improved in recent decades. This is likely due to a more
ultrasonography and /or CT scan).
uniform approach to diagnosis, monitoring, and care [3].
Small gallstones and sludge are the most
Exclusion criteria: Patients with severe pancreatitis
frequent causes of acute pancreatitis. These obstructions
with organ failure (severe pancreatitis is defined as the
temporarily block the same channel that empties both
presence of more than three Ranson criteria at the time
the biliary and pancreatic ducts, which causes
of admission). Patients unwillingness to cooperate, high
inflammation of the pancreas [4]. In some older research,
suspicion of retained CBD stone (Elevated Bilirubin
surgeons favoured delaying the procedure until all
Level with Ultrasound demonstration of CBD stone),
clinical indications and test results had disappeared.
Patients may experience recurrent biliary events such as
cholecystectomy (such as uncontrolled diabetes or
biliary pancreatitis, acute cholecystitis, cholangitis, or
cardiac patients), pregnancy, prior to a gastric bypass,
biliary colic following an episode of biliary pancreatitis.
complications (such as pancreatic pseudo cyst,
Following an incident of acute biliary pancreatitis,
pancreatic abscess, and pancreatic fistula) and a history
cholecystectomy is advised by worldwide standards to
of prior upper abdominal surgery that should rule out
Received: 20/02/2023
Accepted: 20/04/2023

Full Paper (vol.921 paper# 122)

c:\work\Jor\vol921_123 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6269- 6275

Assessment of Serum Interleukin-23 in Acne Vulgaris Patients and
Its Correlation with Disease Severity
Mohammed S. Sultan1, Magdy A. Elsohafy1, Manal M. El-Dsouky2, Osama G. Mansour*1
Departments of 1Dermatology, Andrology & STDs and
2Medical Biochemistry, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Osama G. Mansour, Mobile: (+20)01060597017, Email:

Background: Acne vulgaris (AV) is a chronic inflammatory disease of the pilosebaceous unit, which affects adolescents
and young adults. Interleukin (IL)-23 and IL-17 have been found to significantly influence the chronic inflammatory
response. Furthermore, the discovery of their pathways had contributed to a better understanding of the pathomechanism of
inflammatory disorders.
Objective: This study aimed at measuring serum IL-23 concentrations among AV cases with different severities and to
compare them with normal controls.
Patients and Methods: This case-control study included 80 subjects who were allocated into 2 groups: Group (A) included
40 cases with acne vulgaris, and group (B) included 40 healthy controls. In the patient group, the Global Acne Grading
System Severity (GAGS) was utilized in evaluating the AV severity.
Results: The mean serum IL-23 level was statistically significantly greater in the AV group (48.57 ± 17.63 pg/mL) compared
to the control group (11.81 ± 4.28 pg/mL). No significant differences were found regarding serum IL-23 concentrations
between child versus adult, males versus females, as well as different nutritional status among AV group. There was
significant increase in serum IL-23 concentrations with increased severity of AV group (p < 0.001).
Conclusion: Serum IL-23 is not only a marker of the pathogenetic process of AV but also it can serve as a prognostic
predictor for AV severity.
Keywords: Serum interleukin-23, Acne Vulgaris, Global acne grading system, Pilosebaceous, Propionibacterium acnes.

response in AV itself is related to Propionibacterium acnes
AV is a chronic inflammatory skin disorder. It causes
that induce keratinocytes to release pro-inflammatory
significant limitations in social and psychological
cytokines, mainly IL-1 [4]. Other cytokines associated
functions. Also, it usually causes cosmetic complaints.
with pathomechanism of AV include IL-6, IL-8, IL-10,
Although, AV commonly develops at puberty, it may also
and IL-12 [5].
begin in the post-pubertal period [1].
Propionibacterium acnes induces the release of IL-17
AV presents as comedones (whiteheads and
cytokine by Th17 cells [6]. IL-17 has a key role in the
blackheads), papules, pustules, nodules, or cysts.
pathomechanism of many skin conditions including AV. It
Symptoms such as irritation, itching, and local pain can
is also increased with AV severity indicating that AV can
be associated with decreased quality of life (QOL).
be mediated by Th17 cells [7, 8].
Scaring or facial deformities influence about 20% of teens
Interleukin-23 has a role in the differentiation and
with AV [2]. Acne affects up to 80% of the population and
expansion of Th17 lymphocytes from naive CD4+ T
it is mostly found in those aged 15-25 years. Prevalence
lymphocytes. It is also released from dendritic cells and
of acne on age 15-44 years is 34% of males and 27%of
macrophages. IL-23 can facilitate the development of
females, respectively. Acne lesions often resolve quicker
Th17 lymphocytes, which release IL-17 and other
in males in comparison with females. However, males
cytokines that stimulate epidermal cells to secrete
often have a worse presentation [1].
cytokines and chemokines with the subsequent activation
of innate immune responses leading to a vicious cycle of
Propionibacterium acnes (P. acnes) is a central factor
inflammatory process involving IL-23/1L-17 axis causing
contributing to AV by taking part in the skin inflammation
a recurrent inflammation [9].
as well as in cutaneous microbiota and innate immune
This study aimed at measuring the serum IL-23
response. Two other factors include an enhanced
concentrations in AV cases with different severities and
production and modified composition of the sebum, and
comparing them with normal control individuals. It also
hyper cornification of the pilosebaceous duct due to
aimed at further understanding the role of IL-23 in
hyperproliferation and abnormal differentiation of
pathomechanism of AV and correlating it with its severity.
keratinocytes in its upper part [3].

It has been recently shown that inflammatory
response has a key role in inflammatory and
This case-control study included 80 cases that were
noninflammatory lesions in AV. The inflammatory
recruited from the Outpatient Clinic of Dermatology,
Received: 20/02/2023
Accepted: 20/04/2023

Full Paper (vol.921 paper# 123)

c:\work\Jor\vol921_124 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6276- 6286

Effect of Shockwave Therapy and Home Exercises for
Treatment of Chronic Supraspinatus Tendinitis
Reem Mohamed Elsayed*, Atif Ebrahim Elghaweet, Abeer Abdelhamid Fikry Eldawoody
Department of Rheumatology, Rehabilitation and Physical Medicine,
Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Reem Mohamed Elsayed, Mobile: (+20)01066258805, Email:

: About sixty percent of all shoulder discomfort cases are caused by supraspinatus tendonitis.
Extracorporeal shock wave therapy (ESWT), which has been shown to be effective in treating a number of
musculoskeletal conditions, including enthesopathies, seems to be a potential alternative. Supraspinatus tendinopathy is
treated with a variety of progressive exercises.
Objective: In order to effectively treat chronic supraspinatus tendonitis, this study evaluated the therapeutic effects of
SWT, at-home exercises, and their combination.
Patients and Methods: This study was a clinical trial study and was carried out on patients with chronic supraspinatus
tendinitis and were randomly divided into three groups according to the line of treatment. Shockwave therapy group
included 26 patients. Home exercises program group included 26 patients. Combined shockwave therapy and home
exercises program group included 26 patients. Diagnosis of supraspinatus tendinitis was confirmed by diagnostic
musculoskeletal ultrasonography.
Results: There were improvement in all groups but combined therapy group was superior to other groups. Shockwave
therapy group showed improvement in shoulder pain, tenderness, active abduction and disability but home exercises
group had better effects while combined therapy group showed more improvements in all shoulder parameters relative
to the baseline and between groups.
Conclusion: Shockwave therapy and home exercises have been proved to be effective for the treatment of chronic
supraspinatus tendinitis, improving shoulder pain, tenderness, active abduction and disability. They also reduced the
treatment cost. Adding home exercises to shock wave therapy interventions increases the gained improvements in all
shoulder parameters relative to the baseline and between groups.
Keywords: Extracorporeal shock wave therapy, Supraspinatus tendinopathy, Home exercises.

precise mechanism of action of ESWT for chronic
Only the back and the knees are more common
tendinosis has not been identified [8].
locations for musculoskeletal pain than the shoulder
Prior to surgery, ESWT has been suggested as a second-
joint. According to estimates, 11.2 per one thousand
line therapy [9]. Supraspinatus tendinopathy treatment
patients in primary care experience shoulder pain
involves a variety of progressive exercises. Exercise
annually [1]. Around sixty percent of all shoulder pain
programmes are broken down into three stages: self-
presentations are clinically caused by supraspinatus
stretching, strengthening, and joint mobility [10]. Its
tendonitis. The muscle most frequently used in the
usefulness is still unknown, though.
overall shoulder complex is the supraspinatus [2].

Although supraspinatus tendonitis frequently resolves
on its own, symptoms may linger. Non-steroidal anti-
In order to effectively treat chronic supraspinatus
inflammatory medicines, physical therapy such as
tendonitis, this study evaluated the therapeutic effects of
shortwave and therapeutic ultrasonography, steroid
SWT, at-home exercises, and their combination.
injections, needling, and lavage are some of the

available therapeutic alternatives. However, there is not
much proof that these treatments are effective. The
Patients with persistent supraspinatus tendonitis for
efficiency of surgical procedures such as arthroscopic
at least six months were the subjects of this clinical trial
or open acromioplasty with the option of curettage of
investigation. From June 2021 to February 2023,
calcific deposits is still debatable [3].
candidates were chosen from the Physical Medicine,
Extracorporeal shock wave therapy (ESWT) has
Rheumatology and Rehabilitation Department's
been shown to be effective in treating a number of
outpatient clinics at Mansoura University Hospital.
In this study, patients with a single shoulder's
enthesopathies, such as plantar fasciitis, elbow
chronic supraspinatus tendinitis were included. These
epicondylitis, patellar tendinitis, and Achilles tendinitis
patients' symptoms included anterior shoulder joint
[4­7]. It has been hypothesized that early release of
pain, painful shoulder abduction in the scapular plane,
angiogenic and proliferating growth factors was
and positive results for the empty/full can test,
induced by ESWT, with a positive effect on
Hawkins-Kennedy test, and Neer Impingement test.
neovascularization of the tendon, which may lead to
MSK US supported the diagnosis of supraspinatus
regeneration potential reactivation, even though the
tendonitis. We also included patients who did not
Received: 20/02/2023
Accepted: 20/04/2023

Full Paper (vol.921 paper# 124)

c:\work\Jor\vol921_125 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6287- 6290

Patterns of Acute Kidney Injury in Banha Teaching Hospital
Mohamed Elbasha Ibrahim Ismael
Benha Teaching Hospital, National Institute of Urology and Nephrology,Egypt
Corresponding Author: Mohamed Elbasha Ibrahim Ismael, E mail:, Mobile phone: +20 101 381 5363

: Acute kidney injury (AKI) is a common and preventable condition that affects 21% of adults and 33% of
children globally, with higher mortality rates among the elderly and those with multiple comorbidities in developed
countries. The lack of data on AKI in Africa may be due to limited access to renal replacement medication, and
identifying high-risk individuals is crucial to avoiding the development of chronic kidney disease. Aim: The study aimed
to evaluate patterns of AKI in Banha Teaching Hospital. Patients and Methods: The study collected data on patients
aged 18 and older with AKI, including epidemiological, anamnestic, clinical, biological, imaging, treatment, and
outcome data. AKI was defined according to the KDIGO classification and classified according to the mechanism of
occurrence. Total and partial recovery was defined based on the evolution of renal function. Results: The study found
that diabetes, coma, high creatinine levels, and sepsis were positively correlated with death occurrence. Gender, blood
pressure, heart disease, and certain types of AKI did not show significant correlation with death occurrence.
: AKI is frequent among the population and often fatal, but can potentially be prevented by expanding
extracellular volume to improve renal blood flow and decrease exposure to nephrotoxic agents.
Acute Kidney Injury, Patterns, Epidemiology, Mortality


A medical condition known as acute kidney injury
This was a study done in in Benha University
(AKI) might have been brought on by one of a number
Hospital between the years August 2022 ­ February
of different factors. Acute kidney injury (AKI) is
2023 The study was conducted on 320 subjects. All
characterized by a sudden and reversible decline in renal
patients were monitored in the Internal Medicine and
function. One of the telltale signs of AKI is an elevation
Dialysis units of the Benha Medical Schools.
in plasma creatinine levels. This condition, which may
Any adult patient who was diagnosed with AKI
be avoided simply and is quickly treated, is quite
was qualified for participation into the study. Those
common in hospitals and other in-patient institutions.
who had chronic renal illness, regardless of whether or
According to Hoste et al. (1), AKI affects 21% of adults
not they were receiving hemodialysis, as well as those
and 33% of children all over the globe. The mortality
who did not have acute kidney injury, were excluded
rate for adults is 23%, while the mortality rate for
from the study. For each patient who participated in the
children is just 13%.AKI may occur in one of two ways:
study, the following information was collected:
either before hospitalization in the community or as a
Information on the patient's age, gender, and residency
complication when the patient is already in the hospital.
that was used for epidemiological purposes. Data on the
The majority of those who suffer from community-
acquired acute kidney damage are younger individuals,
information on the patient's medical history such as
and the condition is more prevalent in nations that have
hypertension, diabetes, and heart disease, as well as the
less medical resources (2). According to Yang, (3),
patient's medications and the cause for hospitalization.
however, hospital-acquired AKI is more common in
Data from clinical examinations, including the patient's
developed countries, especially among the elderly and
blood pressure and temperature at the time of
those who have a number of comorbidities.
admission, as well as their state of awareness, hydration
Epidemiologically speaking, it is difficult to
status, and rate of diuresis. Information pertaining to the
determine the prevalence of AKI in Africa. Nigeria,
patient's biology, such as the blood count, serum
which is located in Sub-Saharan Africa, is the only
creatinine level, and plasma urea level. Imaging data,
nation having data on the prevalence of AKI, according
such as renal ultrasounds, which may offer further
to a 2015 global meta-analysis of 154 nations (4). The
information about the kidneys are examples of this kind
lack of knowledge regarding AKI is likely due to the
of data. The treatment that was received, which may
lack of drugs available to treat renal replacement
have an effect on how the patient ultimately fared. Data
therapy. AKI is more common in hospitals than in the
about the patient's outcomes, such as whether or not
general population, according to several studies (5).
they were released, died, were discharged against the
Identifying individuals at risk of developing AKI,
recommendation of their medical providers, or were
whether acquired in the community or in a hospital, is
moved to another hospital.
crucial. Following an episode of AKI, inflammatory
The operational definitions adopted were as
lesions may progress to renal fibrosis, leading to the
follows: The KDIGO categorization method was used
development of chronic kidney disease. Therefore, it is
throughout the study investigation to appropriately
essential to identify high-risk individuals (2).
characterize cases of acute kidney injury (AKI). The
The present study aimed to evaluate patterns of
severity of AKI was determined using baseline
acute kidney injury in Banha Teaching Hospital
creatinine levels, which served as the foundation for
Received: 01/01/2023
Accepted: 04/03/2023

Full Paper (vol.921 paper# 125)

c:\work\Jor\vol921_126 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6291- 6296

Klebsiella pneumoniae Carbapenemase Detection Methods: Review article
Ghada El-Sayed Amr1, Manal Mohamad Elamin1,
Ghada Mohammed Abdelrazek2, Nanis Abdallah Salah Mahmoud1
Departments of 1Clinical Pathology and 2Anesthesia & Surgical Intensive Care,
Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Nanis Abdallah Salah Mahmoud, Mobile: (+20) 01063602553, E-Mail:

The Klebsiella tribe is a subfamily of the Enterobacteriaceae family, which includes the Klebsiella genus.
The organisms are named after the German microbiologist Edwin Klebs, who worked in the 19th century. Klebsiella are
Gram-negative bacteria that are nonmotile and rod-shaped. Their polysaccharide capsule is easily recognizable.
Carbapenems are a type of -lactam antibiotic that are effective against a wide range of microorganisms, including both
Gram-positive and Gram-negative bacteria, as well as aerobic and anaerobic strains.
Objective: Review of the literature on Klebsiella pneumoniae carbapenemase detection methods.
Methods: We looked for data on Klebsiella pneumoniae, detection methods in scholarly journals and databases
including PubMed, Google Scholar, and Science Direct. Only, the most recent or extensive study published between
May 2017 and May 2022 was taken into account. The writers also analyzed similar works cited in their work. Lack of
resources to translate documents written in languages other than English has led to their neglect. It was generally
recognized that scientific research did not include research that was not published in a peer-reviewed journal, presented
orally, or presented as a conference abstract or dissertation.
Conclusion: Implementing effective antibiotic therapy depends on the prompt and accurate laboratory detection of
carbapenemase-producing bacteria. Disk-diffusion testing or increased minimum inhibitory concentrations (MICs) for
carbapenems are typically used for screening for carbapenemase synthesis. A rapid turnaround time for carbapenemase
detection technologies is desirable for prompt regulation. As discussed in Enterobacteriaceae and Acinetobacter
baumannii, this could be complicated by the fact that MICs to carbapenems may be raised yet still within the susceptible
range or even low.
Keywords: Klebsiella pneumoniae, Detection methods.

in poor health. These species' ability to acquire
The Klebsiella tribe is a subfamily of the
resistance to several antibiotics and to potentially
Enterobacteriaceae family, which includes the
transmit plasmids to other organisms has made their
Klebsiella genus. The organisms are named after the
acquisition a major problem in hospitals worldwide (2).
German microbiologist Edwin Klebs who worked in the
K. pneumoniae is able to outwit the host's cellular
19th century. Klebsiella are Gram-negative bacteria that
and humoral defenses in addition to the physical and
are nonmotile and rod-shaped. Their polysaccharide
chemical barriers present during an infection. The
capsule is easily recognizable. This capsule protects the
vulnerable cell is then attacked by the host organism
entire cell, explains the organism's bloated gram stain
once it has entered the host, a process that is related to
appearance, and several host defenses (1).
pattern recognition. The monocyte/macrophage system
Klebsiella can be found almost anywhere on Earth.
is involved in the innate vulnerable response after
It's possible for them to set up shop on human skin, in
identification by the receptor activates the product of
the throat, or in the gut. Colonization of sterile wounds
central vulnerable intercessors. In addition to its
and urine is also possible. The cost of transportation
phagocytic abilities, this system controls the sensitive
varies widely between studies. Many Klebsiella species
response to cytokines and chemokine products. When
are thought to be commensal in the biliary tract, and
the body detects an illness, neutrophils rush in to begin
they have also been found in the colon and intestines.
fighting it. Important cytokine proteins at this stage
Endotracheal intubation, compromised host defenses,
include IL-8 and IL-23, both of which contribute to the
and antibiotic usage have all been linked to
transformation of a granulopoiesis response (4).
oropharyngeal carriage (2).
Preclinical research has shown that neutrophil
Most human infections are caused by two species
within this genus: K pneumoniae and K oxytoca. These
protein may play a part in the host's resistance against
microbes are opportunistic pathogens that can be found
K pneumoniae infection. Elastase, an enzyme involved
in the wild and in the mucosal surfaces of mammals.
in the pathophysiology of several tissue-destructive
Both patients' digestive systems and healthcare workers'
disorders, is hypothesized to be oxidatively inactivated
hands are major sources of harmful reservoirs of
by neutrophil myeloperoxidase. A protein that binds
infection. Nosocomial outbreaks occur when an
lipopolysaccharides increases the movement of
organism spreads fast within a healthcare facility (3). In
components of bacterial cell walls into inflammatory
addition to a history of antibiotic usage, other factors
cells (5).
that increase the probability of infection include being
Received: 20/02/2023
Accepted: 20/04/2023

Full Paper (vol.921 paper# 126)

c:\work\Jor\vol921_127 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6297- 6302

Epidemiology of Open Tibial Fractures among Trauma Patients
Presented to Mansoura Emergency Hospital
Barakat Sayed El-Alfy1, Hesham Khairy Ismael2,
Ahmed Salah El-Din Zaghloul1, Mohamed Elsayed Taha Elmenyawy3*
1Department of orthopedic and Joints Surgery, Faculty of Medicine ­ Mansoura University, Egypt
2Department of Emergency Medicine and Critical Care Medicine, Emergency Hospital ­ Mansoura University
3 Resident of Emergency Medicine, Sheikh Zayed Specialized Hospital.
*Corresponding author: Mohamed Elsayed Taha Elmenyawy
Mobile: +20 106 052 3301, E-mail:
Open tibia fractures are notoriously challenging to treat, and the repercussions of these fractures can be
seen in a wide variety of aspects of a patient's life. The majorities of fractures to long bones happen in men who are of
working age and are typically the consequence of multiple traumas.
Aim and objectives: This study aimed to calculate the prevalence of open tibial fractures among cases.
Subjects and methods:
The current inquiry was a prospective observational study that tracked 350 cases at the
Emergency Department of Mansoura University Hospital in Egypt for an entire year, beginning in January 2022 and
ending in December 2022. The cases were observed over the course of the study.
Tibial shaft was impacted in 49 cases (41.2%), whereas the distal tibia was affected in 43 cases (36.1%). In 27
out of 100 instances (22.7%), the problem was located in the proximal tibia. There were only 18 cases who were
admitted to the critical care unit, which is just 15% of the total number of patients who were hospitalized. The majority
of cases (85%) were admitted to the ward. Those who suffered from hypertension had the highest prevalence of co-
occurring conditions. Conclusion: In the cases that were examined, the most common source of trauma was a road
traffic accident. Open fractures of the tibia are commonly the result of polytrauma. In the event that a patient with an
open tibial fracture does not receive the appropriate medical care, it can result in serious complications or even death.
Keywords: Epidemiology, Open Tibial Fractures, Trauma.


skeletal fixation, and the related risk for late sequelae
Damage to the bone and soft tissue around an
(such as non-union and infection) are all affected by the
open tibial diaphyseal fracture is almost always severe.
type of fracture and the extent of the open soft tissue
Infection, nonunion, and wound complications
injury in these patients. Thus, treatment plans for
skyrocket when the fracture site is contaminated and the
patients who have sustained severe injuries must
soft-tissue envelope is devitalized. Both of these factors
consider not just the severity of the injuries but also the
contribute to rising the potential for problems, thus
individual's general state of health. Individuals with
accounting for them is important. The tibia is a leg bone
many injuries will benefit greatly from this (4).
that is well-known for its considerable size. The tibia is
The initial evaluation of an individual with an
a particularly vulnerable bone to fracture because of its
open tibial shaft fracture should adhere to the
exposed shape (1).
requirements of the protocol for advanced trauma life
Even if there are no additional symptoms of
support because more than half of these individuals also
trauma, an open fracture should always be treated as an
present with additional injuries. This is because people
orthopedic emergency. This is because more of the
in this category typically have sustained more than one
bone is visible with an open fracture. Open soft tissue
injury. There is considerable opportunity for error when
injuries accompany many of these fractures because the
estimating the long-term prognosis of patients with
sheath covering the soft tissues is so thin. The thin
open tibial shaft fractures (5, 6).
sheath plays a role in this. Accidents involving motor
The first stage in treating an injury is a thorough
vehicles account for more than half of all open tibial
examination of the patient and the affected limb. In this
shaft fractures. Most of the rest of the injuries are the
process, all the actions take place at once. A precise
result of other causes, such as falling, getting hurt while
assessment of the injury's severity is crucial, as is
playing sports, or taking a direct blow to the leg (2).
minimizing the risk of infection through prompt
During surgical debridement, Gustilo and
administration of antibiotics, prompt debridement, and
Anderson's damage categorization is used to direct
thorough irrigation. The purpose of this research was to
treatment and predict outcomes. Because the
determine how common and how severe open tibial
classification considers the total amount of damage, this
fractures are among patients admitted to Mansoura
is the case. Gustilo type III injuries, also known as high-
Emergency Hospital. Individuals whose fractures were
energy open injuries, are prevalent because the vast
gathered had been brought in by ambulance.
majority of these fractures occur during high-impact
occurrences. According to the extensive epidemiologic
At Mansoura University Emergency Hospital in
study conducted by Gustilo and colleagues, type III
Mansoura, Egypt, about three hundred and fifty patients
fractures account for more than 60% of all open tibial
were screened for potential participation in a
shaft fractures (3). Acute blood loss, the time and type of
Received: 16/02/2023
Accepted: 18/04/2023

Full Paper (vol.921 paper# 127)

c:\work\Jor\vol921_128 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6303- 6308

An Overview about Mitral Valve Replacement Surgery Options: Review Article
Amany G. Abdallah, Amr Tawfek, Wisam Ashour Alsadiq*,
Mamdouh Elsharawy, Nabil Alsadik, Dina Said Shemais
Department of Cardiothoracic Surgery, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Wisam Ashour Alsadiq, Mobile: (+20) 01151942408, E-mail:

For many years, median sternotomy has been the gold standard for doing any kind of open-heart surgery.
The standard full sternotomy method to mitral valve surgery has been shown to be unnecessary, and minimally invasive
surgery has been shown to be a viable option with reduced perioperative morbidity as well as short-term mortality.
Objective: Review of literature about Mitral Valve Replacement Surgery Options.
We searched PubMed, Google Scholar, and Science Direct for relevant articles on Mitral Valve Replacement
Surgery Options. Only the most recent or thorough study was taken into account between October 2011 and February
2023. Documents written in languages other than English have been ignored due to lack of translation funds.
Unpublished works, oral presentations, conference abstracts, and dissertations were generally agreed upon not to qualify
as scientific research.
Conclusion: By minimizing the need for large incisions and the associated risks of blood loss, pain, and infection,
minimally invasive surgery has gained popularity and has been shown to be effective in a large number of patients
undergoing mitral valve surgery. This method provides superior cosmetic outcomes, lowers the risk of sternal infection,
minimises pain, necessitates fewer blood transfusions, speeds healing, and shortens the length of hospital staying.
Keywords: Mitral valve replacement, Mitral regurgitation, Open-heart surgery.


The median sternotomy, the most common method
on the valve surface work together to keep the valves in
of open-heart surgery, has been criticised for being too
proper mechanical and metabolic shape (5).
lengthy, painful, and dangerous. Mitral valve surgery is

decided based on the patient's condition, comorbidities,
Mitral annulus: During systole, the fibrous mitral
illness severity, surgeon's experience, and treatment
annulus contracts like a sphincter, restricting the size of
facility. Capabilities beyond those required for
the mitral valve. An inability to completely close the
cardiopulmonary bypass or sternotomy are necessary
mitral valve due to dilation, especially at the point of
for less invasive cardiac treatments. Minimally invasive
posterior leaflet insertion (6).
heart valve surgery was first criticised due to the

expectation of poor results from tiny incisions (1).
Leaflets: The mitral valve has two leaflets, one in front
Minimally invasive techniques like mitral valve
and one in back. The anterior leaflet occupies two-thirds
surgery are gaining popularity because of the burden
of the valve opening and one-third of the annular ring.
they put on patients. Safe, low-morbidity, and
It's the thicker, zonal posterior leaflet that wraps around
reoperation rates are all associated with minimally
the annulus. Histologically, leaflets are composed of the
invasive mitral valve surgery. It has the potential to
fibrosa, atrial, and spongiosa tissues (6).
replace a full sternotomy because it is less invasive,

hastens healing, boosts patient satisfaction, and reduces
Chordae Tendinae: Main and secondary chordae
costs without compromising efficiency. Thoracic
tendinae make up the subvalvular apparatus. Primary
endoscopy-assisted minimally invasive mitral valve
chordae that are thinner avoid edge prolapse, while
repair, many mitral valve procedures benefit from this
secondary chordae that are thicker reduce leaflet tension
technique's improved aesthetics and decreased sternal
infection, pain, blood transfusion, and hospital stay
Papillary muscles: During systole, the papillary
rates (2).
muscles contract and the chordae tendineae shorten to

shut the mitral valve and prevent regurgitation. The
Mitral valve surgery anatomy
anterior and posterior papillary muscles help hold the
The components of a healthy mitral valve (MV) are
mitral valve in place (6, 7).
the annulus, leaflets, chordae tendinae, papillary

muscles, and chambers. During diastole, its complicated
The left atrium: The left atrium sits above the left
shape allows blood to flow into the left ventricle (LV),
ventricle and is situated behind the right atrium. The
whereas during systole, it prevents blood from flowing
pulmonary veins supply it with oxygenated blood (8).
backwards from the LA into the LV. The proper

operation of MV depends on the consistency and
The left ventricle: The left ventricle, located in the left
coordination of these parts (3, 4). Interstitial cells that
lower quadrant of the heart, has thick walls and a
respond to mechanotransduction and endothelial cells
rounded tip. The aortic valve is reached via the mitral

valve mechanism (9).
Received: 21/02/2023
Accepted: 24/04/2023

Full Paper (vol.921 paper# 128)

ABSTRACT The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6309- 6313

The Use of Minimal Transverse Diameter of Subglottic Airway in Determining the
Endotracheal Tube Size in Infants: A Prospective Observational Study
Alaa Abd El-Aziz Mahmoud Niazi1, Mohamed Hani Kamal Zaki1,2,
Salah Galal Mostafa Ali Amer1, Sherif Abdullah Mohamed2*
1 Department of Anesthesiology, ICU and Pain Management,
Faculty of Medicine, Misr University for Science and Technology, Egypt
2 Department of Anesthesiology, ICU and pain management, Faculty of Medicine, Cairo University
*Corresponding author: Salah Galal Mostafa Ali Amer, Mobile: (+20) 01550010140,

For infants receiving general anesthesia (GA), it is crucial to select the proper endotracheal tube (ETT)
size since an unsuitable tube might damage the airway and cause subglottic stenosis. On the other hand, a smaller
tracheal tube increases the resistance to gas flow, the danger of aspiration, the requirement for inadequate ventilation,
and the necessity of reintubation with a different size tracheal tube.
Objective: The aim of the present study was to investigate the efficacy of the minimum transverse diameter of the
subglottic airway (MTDSA) as a reliable method for selection of the tubal size in infants.
Patients and methods: A randomized controlled clinical trial was conducted on infants aged >1 year underwent
surgery at Souad Kafafi University Hospital-Misr University of science and Technology. Infants were divided in two
equal groups; Group A underwent measurement of MTDSA (21 infant), and Group B used the conventional method
(internal diameter (ID) of the most frequently used ETT were 3.0 mm for infants less than 1 month old, 3.5 mm for
those 1 to 4 months old, 4.0 mm for those 5 to 17 months old) (21 infants).
Results: The use of MTDSA as a method for selection of the tubal size could predict up to 86.7% of correct tube size
in contrast to only 47.6% in group B; there was a highly significant difference between the 2 studied groups regarding
the internal and external diameters of the selected tubes.
Conclusion: Compared to other approaches, MTDSA using ultrasonography has a higher sensitivity for predicting the
size of an ETT. Younger infants have more ultrasonographic sensitivity than older ones.
Keywords: Endotracheal tube, MTDSA, Ultrasonography, Infant.


rapidly changing size every month, to determine their
It can be challenging to determine the ideal
ETT size (6,7).
endotracheal tube (ETT) size in children and infants (1).
The aim of the present study was to investigate the
A number of formulas and anthropological measures
efficacy of MTDSA as a reliable method for selection
have been made utilizing age, crown-heel length,
of the tubal size in infants.
height, and fifth fingernail width (2).

Age-based formulas have a varied effectiveness
rate ranging from 47% to 77% and are most frequently
A randomized controlled clinical trial was conducted
employed in pediatric age groups (3,4).
on infants aged >1 year underwent surgery at Souad
A smaller-than-needed ETT causes inadequate
Kafafi University Hospital-Misr University of science
ventilation, inaccurate end-tidal gas monitoring,
and Technology, during the period from June 2022 to
operating room pollution, higher medical gas costs,
December 2022.
and a possible aspiration risk. In contrast, a bigger tube
Infants were divided in two equal groups; Group A
may result in subglottic granulomas and stenosis, as
underwent measurement of MTDSA (21 infant), and
well as trauma and postoperative stridor. The patient's
Group B used the conventional method (internal
hemodynamic condition may be compromised by
diameter (ID) of the most frequently used ETT were
repeated laryngoscopic efforts to switch to an
3.0 mm for infants less than 1 month old, 3.5 mm for
appropriate-sized tube, which can also lead to airway
those 1 to 4 months old, 4.0 mm for those 5 to 17
edema and damage.
months old) (21 infants).
The minimum transverse diameter of the subglottic

airway (MTDSA) measured by ultrasound (USG) is a
Inclusion criteria: Infants >1 year of age scheduled
relatively new method for estimating the size of the
for surgery underwent general anesthesia (GA) and
ETT (5). Although having a 90% success record,
informed written consent was obtained from parents.
MTDSA hasn't been the main factor in choosing ETTs

Exclusion criteria: Infant parents refuse. Infants with
Previous studies were done on young children
anticipated difficult airway or congenital malformation
showed a very high success rate to choose the
of airway (subglottic stenosis, laryngomalacia, choanal
appropriate ETT size when using MTDSA. However,
atresia, etc.). Bleeding tendency (as hemophilia A).
they included, but, did not focus on infants, with their
Preterm babies.
Received: 13/10/2023
Accepted: 16/12/2023

Full Paper (vol.921 paper# 129)

c:\work\Jor\vol921_130 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6314- 6317

Influence of Repressed Lithium Silicate Ceramics on
Translucency: Comparative Study
Ahmed lbrahim Eltantawy Ahmed*, Walid Abd El-Ghafar Al-Zordk, Amal Abdelsamad Sakrana
Department of Fixed Prosthodontics, Faculty of Dentistry, Mansoura University, Egypt
*Corresponding author: Ahmed lbrahim Eltantawy Ahmed, Mobile: (+20) 01002327771, Email:
It is more cost-effective to press many restorations from a single ingot of lithium dislilicate glass-
ceramics during the heat-pressing process. However, in many cases this is impossible and can lead to a substantial
amount of waste (The sprues and button). Some dental labs reportedly recycle (repress) the remaining materials after
heat pressing. Objective: The aim of the current study was to evaluate the effect of repressed lithium silicate ceramics
on translucency (TP). Materials and methods: A total 60 discs were divided in 2 groups. The first group was pressed,
and the second group was repressed ceramics. Each group included 30 discs (10 IPS e.max Press, 10 Celtra, 10
Ambria). The changes in translucency difference between the compared groups were evaluated. Results:
Translucency parameter in IPS e.max Press translucency parameter in press (19.5±1.4) decreased in repress (17.3±1.4)
with TP (2.2±0.08), while Celtra translucency parameter in press (16.2±1.4) decreased in repress (14.2±1.4) with
TP (1.9±0.07), and Ambria translucency parameter in press (11.4±1.4) decreased in repress (10.11±1.4) with TP
(1.3±0.09). Contrast ratio of both press and repress were equal (0.7± 0.13). Conclusions: The translucency of
repressed ceramics decreased after repress. We advise pressing glass ceramics for a single injection.
Keywords: Color change, Lithium disilicate, Repress, translucency.


a more natural look than traditional ceramics.
Physicians and patients paid attention to use all-
Additionally, Ambria offers excellent bonding with
ceramic systems to produce esthetic dental
dental substrates and can be used for a variety of
restorations. Because of the unique properties of these
procedures including veneers, inlays, onlays, and
materials such as esthetics, low thermal conductivity,
crowns (3).
strength and biocompatibility. All-ceramic restorations
Celtra, on the other hand, is a high-performance
can be made from a variety of materials and techniques
zirconia-reinforced lithium silicate ceramic. Its
today; some of these, however, call for hot pressing in
strength allows for a reduction in the thickness of
a specialized furnace in order to get the desired form
restorations without sacrificing esthetics, which is
(pressable materials).(1).
particularly important in anterior restorations. Celtra is
The dental industry has adopted hot pressing as a
also highly resistant to chipping and fractures, making
regular method for making all-ceramic prostheses.
it an ideal solution for patients with bruxism or
This method, in contrast to others like sintering, offers
grinding habits. These two new ceramic materials offer
better crystalline dispersion within a glass matrix,
better esthetics, strength, and durability than traditional
reduced porosity, and the best flexibility. A pneumatic
ceramics, making them valuable assets to dental
pressing furnace uses a pressurised alumina piston to
practitioners (4).
press the ingots into the mould. The risers and any
To the best authors' knowledge, no on the effect
leftover material are discarded following the pressing
of reprocessing pressable ceramics on bond strength
and cooling processes (button). It's best to start over
has been done. As a result, re-pressing (or repeated
with a fresh ingot and press the buttons from scratch.
pressing) can modify the lithium silicate ceramic
There have been reports, however, that some dental
microstructure, and impact the ceramic ability to bond
clinics recycle these materials. The risks and benefits
to resins. The following question arises: Does ceramic
of this treatment are unclear due to a lack of data. It's
re-pressing affect color and resin bond durability? (5).
not obvious if these buttons may be disabled and
The aim of the current study was to evaluate the effect
reused (2).
of repressed lithium silicate ceramics on translucency
Dental ceramic technology has been rapidly
advancing and two of the new trends in the market are

Ambria and Celtra. Ambria is a new type of hybrid
ceramic that is known for its translucency and strength.
I. Materials:
It is made using a process that combines a lithium
The materials used in the current study are
disilicate material and a zirconia material, resulting in
summarized in Table 1.

Table (1):
Materials used in the current study.
Product Name
SiO2/ Li2O/ P2O5/ K2O/ ZrO2/ other oxides and ceramic
IPS e.max Press ingot
IvoclarVivadent, Germany
SiO2/Li2O /P2O5/ ZrO2/ Al2O3/K2O/CeO2 and other oxides
Celtra press ingot
Dentsply Sirona, U.S.A
and pigments.
Ambria press ingot
SiO2, Li2O, ZrO2, Pigment
VITAZahnfabrik, Germany
Received: 21/02/2023
Accepted: 24/04/2023

Full Paper (vol.921 paper# 130)

c:\work\Jor\vol921_131 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6318- 6322

Platelet Rich Plasma: A New Biological Modality in
Treatment of Atrophic Rhinitis: Review Article
Marwa Saad Badry1, Usama Mohamed Rashad1,
Mostafa Adel Ahmed2, Ahmed Roshdi Hamed3, Ramadan Hashem Sayed1
1 -Department of Otolaryngology-Head and Neck Surgery, Sohag university hospital, Sohag, Egypt.
2 -Department of clinical pathology, Sohag university hospital, Sohag, Egypt.
3- Department of pathology, Sohag university hospital, Sohag, Egypt.
* Corresponding author: Marwa Saad Badry,Email:, Mobile: +201004042163

Atrophic rhinitis is a chronic debilitating nasal disease which may be primary, or secondary to various
underlying etiologies. Several methods of treatment have been previously adopted with minimal success rate. In order
to achieve effective and long-standing method of treatment for this challenging pathology, this method should work
mainly on reversal of the pathologic changes in nasal microanatomy.
Objective: Review article investigating the use of platelet- rich plasma in treatment of atrophic rhinitis.
Methods: We scoured scholarly journals and databases including PubMed, Google Scholar, and Science Direct for
reports on Treatment of atrophic rhinitis, Platelet-rich plasma and new biological modality between November 1990
and April 2023. However, only the latest or most comprehensive study was considered. The authors also assessed the
usefulness of references drawn from similar books. As a result, non-English documents have been overlooked due to a
lack of resources to translate them. It was commonly recognized that scientific research did not include things like
unpublished publications, oral presentations, conference abstracts, or dissertations.
Conclusion: Platelet Rich Plasma (PRP) is a plasma fraction with a very high platelet content that also contains
phagocytic cells, a significant amount of fibrinogen, a number of chemotactic factors and cytokines that may be used to
control tissue inflammatory response, as well as growth factors that can help with tissue healing and regeneration. It is
now considered the best treatment for treating atrophic rhinitis as a result.
Keywords: Atrophic rhinitis, Platelet rich plasma (PRP).

if atrophic rhinitis is purely an infectious disease or a
The chronic, crippling condition known as
combination of infectious, hereditary, dietary, and
atrophic rhinitis damages the nasal mucosa (AR).
vascular disorders of the paranasal sinuses (1).
Beginning in the middle of the 20th century, some

authors distinguished between two conditions when
Clinical features: The clinical manifestations of PAR
describing atrophic rhinitis (primary and secondary).
include a persistent feeling of nasal obstruction,
The aetiology determines how the two disease entities
formation of nasal crusts, epistaxis, fetor (the most
are distinguished from one another.
distressing symptom), olfactory disturbances like

hyposmia and anosmia in certain cases. Other
A-Primary atrophic rhinitis (PAR):
symptoms, which may be involved include facial pain,
Primary atrophic rhinitis, or ozena, is a progressive
dryness of nasal mucosa, dyspnea, sleep disturbance,
chronic nasal disease characterized by mucosal atrophy
headache and occasionally mucopurulent nasal
with resorption of the underlying bone, formation of
discharge (4, 5).
thick crusts, and a distinct fetid odor (1). It has unique
During examinations, nasal endoscopy is utilised to
epidemiological features and clinical characteristics.
diagnose AR. This method exposes the nasopharynx
For decades, clinicians and researchers have tried to
and choanae, as well as atrophic, occasionally crusty, or
suggest theories for the etiology of primary atrophic
ulcerated nasal cavity mucosa. It also denotes the
rhinitis (2).
inferior and/or middle turbinates being absent,

hypoplastic, or atrophying, and varying degrees of
Incidence: In tropical and subtropical nations like
sinonasal wall destruction. It is often secondary atrophic
India, Pakistan, Egypt, and Bangladesh, PAR is a
rhinitis when these symptoms are present, but this must
frequent ailment. Young and middle-aged adults are
be validated by a clinicopathological work-up. These
often affected, with a female predominance (F: M =
signs may include synechiae, septal perforation,
5.6:1) (3).
osteochondral erosions, the aftereffects of past

sinonasal surgery and Wegener's granulomatosis, or
Etiology: As the cause of PAR is still a matter of
sinonasal sarcoidosis (6).
A rhinomanometric analysis will reveal noticeably
microbiologists, and epidemiologists have been
reduced resistance and very high nasal airflow rates.
interested in this problem for more than a century. The
Acoustic rhinomanometry will show that the nasal
exact etiology of the disease is still unknown, but
cavities are bigger in cross-section than usual (7).
multiple suggestions have been proposed. It is unknown
Received: 04/11/2022
Accepted: 06/01/2023

Full Paper (vol.921 paper# 131)

c:\work\Jor\vol921_132 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6323- 6327

Assessment of Serum Interleukin-36 Level in Patients with Warts
Hadeer I. M. Al Sadik 1*, Amal H. A. Gomaa2, Fadia M.Attia 3 , Radwa El-Sayed Mahmoud Marie
1Dermatology, Venereology and Andrology, 3Clinical Pathology, Faculty of Medicine, Suez Canal University,
Ismailia, Egypt
2Dermatology, Ministry of Health and Population, Kafr Sakr Hospital, Al-Sharkia, Egypt
Corresponding author: Hadeer I. Mohamed, E-mail:

Mobile: +201065677662

The human papillomavirus (HPV) is the causative agent of harmless verrucous overgrowths called warts.
Their eradication depends on effective T helper 1/cytotoxic T cells cellular immunity. Interleukin (IL)-36 agonist
cytokines are secreted mainly by epithelial cells, such as keratinocytes, in response to infections or inflammatory
condition. These cytokines enhance innate immune response and promote the activation of Th1 and Th17 cells.
The study aimed to evaluate IL-36 serum level in persons with warts in comparison with healthy controls in order
to investigate the potential function of Interleukin-36 in the immune response against this common skin viral infection.
Subjects and Methods: In this case-control study, participants were forty people with warts who were recruited from
the Dermatology Outpatient Clinics at Suez Canal University Hospitals in Ismailia city, Egypt, as well as forty people
who served as healthy control group.
Results: Serum Interleukin-36 level was significantly greater in patients with warts than in healthy controls (p < 0.001).
However, there was no significant relation amongst IL-36 level & clinical data gathered from individuals affected by
warts (age, gender, site, number, clinical type, and recurrence).
Serum level of IL-36 was significantly increased in patients with warts compared to controls. This high
serum level of Interleukin-36 might highlight the possible role of IL-36 in promoting the cell-mediated immune
response against human papillomavirus.
Keywords: IL-36, Warts


Human papillomavirus (HPV) infection results in
release of IL-36 (, & ). IL-36 cytokines are then
the benign verrucous growths known as warts, which
activated by proteases released by neutrophil (5, 6).
are exceedingly prevalent. Contact directly with
someone who is infected or environmental exposure is
proinflammatory mediators that promote innate
the two main ways that people contract human
immune responses. They induce the synthesis of
papillomavirus infection. The different types of warts
chemokines, IL-1, TNF-, and antimicrobial peptides
are categorized as follows: appearance or location into
by keratinocytes, as well as interferon (INF)- by
common warts, palmoplantar, plane, and genital warts
plasmacytoid dendritic cells & IL-1, IL-6, besides IL-
23 by myeloid cells. These mediators trigger the
In the early phases of infection, keratinocytes,
activation of T helper (Th) 1 and Th17 cells causing the
dendritic cells, natural killer (NK) cells, Langerhans
release of IL-17, IL-1, and IL-6, in addition to TNF-.
cells and T cells are important cells for generating an
These cytokines in turn enhance more production of IL-
efficient adaptive immune response against HPV
36 agonists in a synergistic manner. In addition to this,
infection. These cells take up the antigen and carry it to
they work in concert with one another as well as inspire
lymph nodes, where T cells are exposed to it.
epithelial cells to create a wide range of growth factors
Additionally, NK cells have the ability to totally
& inflammatory mediators, which both contribute along
with to increase the vicious cycle of skin pathology (5, 7).
keratinocytes can be constitutively stimulated to release
This study proposed to measure serum level of IL-36
a number of different cytokines, including IL-1, IL-6,
in persons with warts in contrast to the standard healthy
IL-10 and IL-18 in addition to tumor necrosis factor
controls to explore the possible role of IL-36 in the
(TNF)- that are implicated in the immune response
against HPV (3).
Interleukin-36 family of cytokines includes 3

agonist cytokines: IL-36, IL-36, and IL-36 (4). IL-36
cytokines are mostly released by epithelial cells
This descriptive analytical case-control study
including keratinocytes, especially during infections
included forty patients who attended the Dermatology
and inflammatory conditions. The activation of toll like
Outpatient Clinic, Suez Canal University Hospitals,
receptors on dendritic cells, macrophages, and epithelial
presenting with warts. They were evaluated by
cells by pathogen-associated molecular patterns and
experienced dermatologist. Control subjects with age,
drugs, or other environmental factors triggers the
and gender-matched and who didn't have warts and

Received: 21/2/2023
Accepted: 23/4/2023

Full Paper (vol.921 paper# 132)

c:\work\Jor\vol921_133 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6328- 6332

Hospital Information Society to Enhance the Patient Care Applied on
Ahmed Maher Teaching Hospital
Tamer Abdu Mohammed Megahed, Hany Mohamed Abd-Allah Embaby
Pediatric Surgery Department, Ahmed Maher Teaching Hospital, Egypt
Corresponding Author: Tamer Abdu Mohammed Megahed, Phone number: 01000 862 100, ORCID 0000-0001-7352-4196,

Information provides knowledge, awareness, and power. Virtual organizations are developing and grow-
ing in every facet of our communities. Geographic boundaries are no longer a barrier for organizations. As virtual
societies develop, it will be feasible to find answers to any questions at anytime, anywhere. Objective: The aim of the
current study was to evaluate the impact of transition from paper forms to electronic forms and activation of Hospital
Information System on increasing the speed and accuracy of workflow.
Patients and methods: A cross sectional study included 50 staff members by evaluating the quality of service and staff
learning obstacles before implementing Hospital Information System programs package during July and August 2022
and after implementing Hospital Information System programs package during February and March 2023 using formu-
lated Key Performance Indicator to measure Internal Processes KPIs and Capacity KPIs and Customer Satisfaction
KPIs. Results: A hospital information system seeks to improve workflow, clinical judgment, and data security as hos-
pitals look to automate and optimize their activities. To increase overall profitability, a compliant cloud-based hospital
management software system may contain a health billing platform with strong encryption, denial management capa-
bilities, and multiple user components. Every hospital has different demands, therefore it's important to carefully analyze
each one to lay a solid foundation for future success. Conclusion: Those results show that Hospital Management Infor-
mation System represents a safe and effective tool to achieve significant improvement in work cycle time and decrease
workload. Hospital Management Information System appears to have a real and significant impact on both workers and
patient satisfaction in the form of decrease stuff absentee rate and increase patients' applause rate.
Keywords: Hospital Management Information System, Information Society, Society 5, Ahmed Maher Teaching Hos-
pital, Egypt.

was to evaluate the impact of transition from paper
Virtual organizations are expanding in all different
forms to electronic forms and activation of Hospital In-
aspects of our societies. Without geographic borders,
formation System on increasing the speed and accuracy
enabling companies operate globally on limited physi-
of workflow.
cal resources. In other words, we are indeed living in

information age (1).
Public authorities begin to automat clerical and ad-
Patients' Selection:
ministrative tasks, through the use of decision-support
A cross sectional study included 50 staff members
systems and through the development of electronic pay-
and 50 patients by evaluating the quality of service and
ment systems (2).
staff learning obstacles before implementing Hospital
Information is now seen as a valuable resource
Information System programs package during July and
within organizations, If properly managed and used can
August 2022 and after implementing Hospital Infor-
stimulate innovation, speed product development, raise
mation System programs package during February and
levels of productivity, ensure consistent standards of
March 2023 using formulated Key Performance Indica-
quality and, through all these means, raise the relative
tor to measure Internal Processes KPIs and Capacity
level of competitiveness (3). The aim of the current study
KPIs and Customer Satisfaction KPIs.

Table (1):
KPIs used in the current study.
Customer Satisfaction
Internal Processes
Customer Satisfaction Index by answering Cycle Time by measuring the total
Employee Satisfaction
a survey to the customers after they have amount of time needed to complete a
Index by measuring net
completed on-patient admission process.
process from start to finish.
promoter scores (which
Number of Support Tickets & Complaints Cycles measured:
by assessing the number of new issues/sup- Patient admission from Emergency
likely they'd be to refer
port tickets/complaints being generated
others to your company),
Patient admission from Out-patient employee survey and ab-
sentee rates.
Laboratory order to result arrival

Received: 21/02/2023
Accepted: 24/04/2023

Full Paper (vol.921 paper# 133)

c:\work\Jor\vol921_134 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6333- 6342

Risk Assessment of COVID-19 on Pregnant Women and Pregnancy Outcomes
Asmaa Y Sharfeldin1*, Omaima A Mohamed1, Dalia E Desouky1,
Reda A Ibrahem1, Mohamed A Rezk2, Sally Abdelwanees1
1 Public Health and Community Medicine Department and
2 Obstetric and Gynecology Department, Faculty of Medicine, Menoufia University, Egypt.
* Address for Correspondence: Asmaa Yahia Sharfeldin, Email:,, Phone: +201004820099, ORCID: 0000-0002-5858-7620

Pregnant females represent a large category that deserves a meticulous consideration during any pandemics
especially COVID-19.
Objectives: To assess maternal and fetal outcomes for 3rd trimester pregnant women during COVID-19 pandemic.
Patients and Methods: This cohort study was conducted on 85 COVID-19 pregnant women and 85 non-infected pregnant
women (control) collected over 1.5 years period, they were followed up till delivery and hospital discharge.
Result: Maternal outcome of COVID-19 cases showed that 80% required blood transfusion vs 14.1% in control group
(relative risk (RR)=5.7, 95% confidence interval (CI): 3.3-9.7), 40% needed intensive care unit admission vs 7.1% (RR=5.7,
95% CI: 2.5-12.8), 29.4% needed mechanical ventilation vs 1.2% (RR=25.0, 95% CI: 3.5-180.4), 47.1% had complications
vs 7.1% (RR=6.7, 95% CI: 2.9-14.9), maternal mortality was 15.3% vs 1.2% (RR= 13, 95% CI: 1.7-97.2). Neonatal
complications represented 41.2% vs 21.2% (RR=1.9, 95% CI: 1.2-3.2) and neonatal mortality was 14.1% vs 5.9% (RR=
2.4, 95% CI: 0.9-6.5). Gestational age, Oxygen saturation (SpO2) on admission and SpO2 during hospital stay were
significantly lower among complicated cases (33.9±3.0 weeks, 78.5±13.5 % and 93.5±4.7 %, respectively). Multivariate
logistic regression showed that gestational age (P=0.002, odds ratio (OR)=0.725, 95% CI=0.551-0.956) and SpO2 on
admission (%) (P=0.001, OR=0.851, 95% CI=0.773-0.936) were independent predictors for COVID-19 complications
among pregnant females.
Conclusion: COVID-19 infection is associated with unfavorable maternal and neonatal consequences in 3rd trimester
pregnant females, so comprehensive follow up of both infected mothers and their neonates is highly recommended.
Keywords: Pregnancy with COVID-19, Mortality, Maternal outcomes, Fetal outcomes.


In late December 2019, an outbreak of novel
infections specially influenza than other general
coronavirus disease 2019 (COVID-19) caused by a novel
population. This is due to immunologic alterations and
coronavirus named severe acute respiratory syndrome
physiological (cardiopulmonary) adaptive changes (e.g.,
coronavirus 2 (SARS-CoV-2) was reported in Wuhan,
increased heart rate, reduced pulmonary residual capacity,
Hubei Province, China, and soon spread all over China
etc.) that contribute to increased risk of hypoxemia and
and overseas [1].
disease severity [6,7].
On the 11th of March 2020, the World Health
In addition to the impact of COVID19 infection
Organization (WHO) announced COVID-19 as a
during pregnancy on maternal outcome, there are
pandemic infectious disease. Egypt announced the
concerns related to the vertical transmission route and
detection of the first COVID-19 case on the 14th of
potential effect on fetal and neonatal outcome. So that
February 2020 [2].
pregnant women constitute a vulnerable group that
The outbreak of COVID-19 spread quickly and
requires special attention regarding prevention and
extensively all through the world within the early 2020s,
management [8].
disproportionately impacting the elderly, Black and
On the 26th of June 2020, Egyptian Ministry of
Brown communities, and pregnant women [3].
Health advised women to postpone pregnancy as the virus
Coronavirus family members responsible for
could cause blood clotting and consequently could affect
severe acute respiratory syndrome (SARS-CoV-1) and
the placenta, which feeds the baby. In addition to that; the
Middle East respiratory syndrome (MERS-CoV) have
virus could cause other symptoms to the pregnant woman
been accompanied with severe complications during
pregnancy and unfavorable pregnancy outcomes. On the
Yu et al. [10] reported that maternal and neonatal
other hand, SARS-CoV-2 belongs to the human
outcomes of late infected pregnant females appeared very
coronavirus family, so it shows a pandemic trend to
good, while WAPM [7] and Li et al. [11] showed that
involve many pregnant women [4,5]. Pregnant women are
maternal outcomes included maternal mortality,
more susceptible for severe illness from all respiratory
admission to ICU, requiring mechanical ventilation, etc.
Received: 13/10/2023
Accepted: 16/12/2023

Full Paper (vol.921 paper# 134)

Outcome of Internal Fixation of Pott's Fractures of the The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6343- 6349

Study of Functional Outcomes and Complications of Internal Fixation of
Pott's Ankle Fractures in Diabetic Patients
Waleed Mohammed Nafea, Omar Abdelwahab Kelany,
Eslam Mohammed Elnaggar*, Mohamed Hussien Elsayed
Orthopedic Surgery Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Eslam Mohammed Elnaggar, Mobile: (+20) 01027443022, Email:

Both diabetes mellitus (DM) and ankle fractures are becoming more common. Patients who have both
diabetes and an ankle fracture have a higher risk of complications, some of which can be fatal.
Objective: The aim of the current study was to evaluate functional outcomes and complications of internal fixation of
Pott's ankle fractures in diabetic patients.
Patients and methods: During this prospective study, 30 patients with ankle Pott's fractures were recruited from
Orthopedic Out-patient Clinic in Zagazig University Hospital, from January 2022 to January 2023. Operative fixation was
done through Open Reduction Internal Fixation (ORIF) by plate and screws or tension band according to AO principles of
periarticular fracture fixation.
Results: The mean age of participants was 40.09 (SD 13.2) years and 60% were males. The high union rate occurs mainly
at week 10 at higher percent (74%) in controlled diabetic patients, while union rate in uncontrolled diabetic patients was
delayed till 6 months with higher complication rates.
Both open and closed therapy of ankle fractures are associated with greater complication rates in patients
with DM. Patients with poorly controlled diabetes who have high HBA1C levels experience more complications than
patients with well-controlled diabetes. The best method of treating unstable ankle fractures in diabetes patients under
control is open reduction and internal fixation.
Keywords: Pott's fractures, Diabetes mellitus, Internal fixation, Prospective study, Zagazig University.


by plate and screws or tension band according to AO
Even though ankle fractures are a typical occurrence
principles of periarticular fracture fixation.
for orthopedic surgeons, they can be complicated in
Inclusion criteria: Recent isolated Pott's fracture,
diabetic patients and have challenging treatment options
adults patients (patients aged 20 years or older), diabetic
while having an easy diagnosis and excellent results with
patients, Bimalleolar or Trimalleolar Pott's fractures.
either conservative or surgical therapy (1).
Diabetics make up about 1 in 8 patients who have
Exclusion criteria: Poly-trauma patient, patients that
rotational ankle fractures need surgical treatment.
are older than 70 years old or younger than 20 Old
Diabetes patients have been found to have between 26%
to 47% more problems following ankle fracture surgery
arthroneuropathy, patients with peripheral vascular
than non-diabetic patients in comparable control groups
disease, pathological fractures.
(2). After treating ankle fractures, a recent large-scale
Pre-operative: Anteroposterior, lateral, mortise were
analysis found that diabetes mellitus had the highest risk
used, other optional views or CT scans were used if
of amputation. Diabetics are more likely to need
needed to evaluate ankle fractures. HbA1C and blood
additional procedures and have worse outcomes
glucose levels were measured randomly and after fasting
following surgery due to the increased risk of infection
in the lab. In addition, blood count, liver and kidney
and other serious surgical consequences results in terms
function evaluations, HIV, HBV, and HCV screening
of the activity limitation score (3).
were done before surgery.
The aim of the current study was to assess the
functional results and complications of internal fixation
Operative technique: All procedures were performed
of Pott's ankle fractures in diabetic patients.
on supine patients while the patients were under spinal

anesthetic (except patients with trimaleolar fractures
surgery was done prone (on a regular table), pneumatic,
During this prospective study, 30 patients with ankle
and tourniquet used around the midthigh without
Pott's fractures were recruited from Orthopedic Out-
exsanguination in diabetic cases and tourniquet deflation
patient Clinic in Zagazig University Hospital, from
before wound closure and start hemostasis.
January 2022 to January 2023. Operative fixation was
1. In Open Reduction Internal Fixation (ORIF) straight
done through Open Reduction Internal Fixation (ORIF)
lateral route to the distal fibula from the lateral
malleolus (30 patients) was used and posterolateral

Full Paper (vol.921 paper# 135)

c:\work\Jor\vol921_136 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6350- 6357

Validity of Immunohistochemical Expression of Cell Adhesion Molecule 1
(CADM1) in Differentiating Early-Stage Mycosis Fungoides from Its Benign Mimickers
*Aya M. Elshabrawy, Mai Ahmed Gobran, Noha F. Elaidy , Naglaa A Mostafa
Pathology Department, Faculty of Medicine, Zagazig University, Egypt
*Corresponding author: Aya Mohamed Elshabrawy Seliem, Email:, Mobile: 01221239945

Mycosis fungoides (MF) is the commonest cutaneous T-cell lymphoma. Early-stage MF is difficult to be
differentiated from benign inflammatory dermatoses (BIDs). CADM1 immunohistochemical staining may be valuable in
differentiating early-stage MF from BIDs. Few studies are available regarding its role in this differentiation.
Aim: To evaluate validity of CADM1 versus TOX & CD4 IHC in differentiating Early-Stage Mycosis Fungoides from Its
Benign Mimickers.
Materials and methods: This retrospective cross-sectional analysis was conducted of a total 75 paraffin blocks of skin
tissue that were taken from seventy five individual from the pathology department's archives at faculty of medicine in
Zagazig. thirty five blocks with MF and forty blocks with other benign dermatoses (15 cases of psoriasis, 15 lichen planus,
10 chronic dermatitis). CADM1, TOX and CD4 expressions were assessed.
Regarding the diagnostic performance of CADM1, TOX &CD4 in diagnosis of early stage MF and differentiating
it from BIDs , we detected that CADM1 had the highest sensitivity (94.3%) followed by TOX (88.57%). While TOX had
highest specificity (95%) followed by CADM1 (92.5%). Additionally, our study revealed that positive TOX expression was
higher in plaque stage than in patch stage.
Conclusion: CADM1 and TOX are considered beneficial in diagnosis of early MF, as CADM1 has highest sensitivity &
TOX has highest specificity. TOX can also be used as prognostic marker being significantly higher in plaque than patch
stage MF.
Immunohistochemical, CADM1, Mycosis Fungoides, Benign Mimickers.

to find epidermotropism of single lymphocytes. Useful
The most prevalent variety of cutaneous T-cell
hints can be found in the arrangement of lymphocytes
lymphomas is mycosis fungoides (MF). (CTCLs),
with somewhat larger nuclei and a tiny halo along the
representing almost 50% of all new cases. It affects males
epidermis's basal layer (3).
nearly twice as often as females in their late fifties.

Early-stage MF (patch & plaque) remains a
Patients that are Caucasian are the majority. Although the
significant diagnostic challenge because it frequently
cause is unknown, it could be brought on by long-term
resembles BIDs such eczema, lichenoid dermatoses,
antigenic stimulation that causes T cell clonal growth and
psoriasis, and psoriasiform dermatoses. Progressive
infiltration of the skin (1).
diseases typically have a high death rate, even though the
The three clinical stages of mycosis fungoides are
majority of patients survive for decades following diagnosis
patch, plaque, and tumor, and the clinical course is
in the early stages. Therefore, making a distinction between
generally protracted across decades. The patch stage is
early MF and BIDs is crucial. Although molecular
characterized by reddish patches that are flat, varying in
diagnostics and immunohistochemistry having false-
size, and may even appear wrinkled. Plaque stage of
positive, false-negative and inconclusive diagnoses are still
mycosis fungoides occurs after patch stage. reddish-
brown, raised lesions are its defining feature; in those with
immunophenotypic correlation must be considered
darker skin tones, plaques might appear grey or silver.
carefully to diagnose or exclude MF by differentiating it
Patch and plaque stages of mycosis fungoides are both
from other inflammatory and reactive processes (4).
regarded as early stages. Large, irregular lumps are

A glycoprotein known as CD4 is found on the
frequently present at the tumor stage. Any area of the
surface of immune cells including T helper cells,
body, such as the head and face, might develop tumors
monocytes, macrophages, and dendritic cells. The human
from plaques or normal skin (2).
immune system relies heavily on white blood cells,
Histopathologically, MF is distinguished by
sometimes referred to as CD4 cells, T-helper cells, or T4
proliferation of small to medium-sized pleomorphic
cells. Helper cells are what they are called because one of
lymphocytes in the epidermis creating intraepidermal
their primary functions is to communicate with other
aggregates known as "Pautrier's microabscesses". These
immune cell types, such as CD8 killer cells, in order to
microabscesses, early lesions and cancers may not have
instruct them to attack the infectious particle (5).
it. an infiltration that resembles a band in a fibrotic

In the majority of T helper cell-related neoplasms,
papillary dermis is visible in early MF lesions. It is typical
CD4 is still expressed. On tissue biopsy samples, CD4
Received: 19/02/2023
Accepted: 19/04/2023

Full Paper (vol.921 paper# 136)

c:\work\Jor\vol921_137 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6358- 6362

Insulin Doses for Dietary Fat and Protein in Children and Adolescents with
Type 1 Diabetes Mellitus; Strategies and Challenges: Review Article
Ahmed M. Hegab, Susana E. Hasaballah*, Montaser M. Mohamed
Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
*Corresponding author: Susana E. Hasaballah, Mobile: (+20) 01283109511, E-mail:

The present approach for treating type 1 diabetes mellitus (T1DM) in children and adolescents relies
heavily on carbohydrate restriction and rigorous insulin treatment. The amount of carbohydrates in each meal or snack
is the main factor used to determine the insulin dosages given during meals. Consuming fat and protein along with
carbs, however, might postpone stomach emptying and result in late postprandial hyperglycemia. Recent research has
emphasised the need of modifying insulin dosages for dietary protein and fat to reduce postprandial glucose
excursions. To predict insulin needs for meals' protein and fat compositions, many insulin dosage techniques have
been devised. Nevertheless, the contemporary clinical practice still faces difficulties in regulating insulin dosages for
dietary fat and protein.
Objective: This review presents different studies that assessed the effects of dietary fat and protein on postprandial
glycemic responses.
The following search terms were used in PubMed, Google Scholar, and Science Direct searches: Insulin
treatment, Dietary fat and protein, and T1DM. The authors carefully analysed all relevant references from the relevant
literature, including all respectable research and reviews, and only the most recent or comprehensive study was
Conclusion: To achieve postprandial euglycemia, insulin dosage adjustments for dietary fat and protein are necessary.
The best insulin dosage methods to account for the protein and fat composition of the meals are yet unclear.
Combination boluses offer better postprandial glycaemic control for T1DM patients using insulin pumps than
conventional and prolonged boluses. It is yet unknown if dividing insulin dosages among patients on the MDI regimen
would improve postprandial glycaemic control.
Insulin therapy, Dietary fat and protein, T1DM.


Blood sugar effects of dietary fat and protein
Intensive insulin treatment and carbohydrate
Increased dietary fat reduces peripheral tissues'
counting are essential for the management of T1DM in
sensitivity to insulin and boosts hepatic glucose
children and teenagers [1]. One of two insulin regimens,
production through promoting gluconeogenesis. When
the multiple daily injection (MDI) regimen or insulin
taken with carbs, dietary fat can cause delayed
pump treatment, can be used to administer intensive
stomach emptying, which can first reduce the
insulin therapy. Bolus insulin is delivered before each
postprandial glycemic response before increasing and
meal and snack, and basal insulin is given once or
extending it for several hours after the meal [5]. By
twice day as part of the MDI protocol. Insulin pumps
increasing plasma levels of glucagon, and ghrelin,
make it possible to employ several boluses each day
dietary protein has an impact on glucose homeostasis.
without the need for individual injections [2].
The main macronutrient that influences
gluconeogenesis by increasing hepatic blood glucose
postprandial blood glucose levels is carbohydrate. By
synthesis [6].
counting carbs, one may estimate the amount of

Protein intake's impact on postprandial blood
carbohydrates in each meal and modify bolus insulin
sugar levels
dosages in accordance with the carbohydrate content
The amount of protein and other macronutrients
of each meal or snack. Calculating the pre-meal dosage
in a meal can have an influence on postprandial
involves dividing the grams of carbohydrates in a meal
glycemia in different ways [7, 8]. According to Paterson
or snack by the ICR [3].
et al. [9] eating a meal with 75 grams or more of protein
However, dietary protein and fat have been
on its own caused a considerable rise in postprandial
shown in numerous studies to have an effect on
blood sugar levels 3 to 5 hours after the meal.
postprandial blood glucose levels [4]. Consuming fat
Additionally, it was shown that increasing the protein
and protein together with carbs might cause late
in a low-fat meal while maintaining the amount of
postprandial hyperglycemia and prolong stomach
carbs reduced the blood glucose excursion in the first
emptying. To enhance postprandial glucose control
hours following the meal, with a later dose-dependent
following high-fat and protein meals, the prandial
rise in blood glucose levels [10].
insulin dosages must be changed [5].
Klupa et al. [11] on the other hand found that in

individuals utilising insulin pumps, the eating of a

meal high in pure protein had no effect on postprandial

blood glucose levels. Furthermore, in 28 patients with
Received: 26/02/2023
Accepted: 26/04/2023

Full Paper (vol.921 paper# 137)

Discussion The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6363- 6370

Vitronectin (VTN): A Novel Diagnostic and Prognostic Marker for Hepatocellular
Carcinoma (HCC) on Top of Chronic Hepatitis C Virus Related Diseases
Amal S. Bakir, Hesham H. Al-Kilany, Ramy S. Ghait, Hamed S. Badawy*
Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Hamed Saad Badawy, Mobile: (+20) 01063458901, E-mail:


Background: Hepatocellular carcinoma is the most common liver tumor, which is the fifth most prevalent cancer
The comparison of alpha-fetoprotein (AFP) and serum vitronectin (VTN) in the diagnosis and prognosis of
hepatocellular carcinoma in addition to hepatitis CV-related liver disorders.
Patients and Methods:
There were 60 participants in this prospective observational study, and they were split into 4
groups as follows: Group 1 had ten average people. Ten individuals in group 2 with hepatitis C virus infection were
included. Twenty individuals with cirrhosis were in group 3. Twenty patients in Group 4 with HCC (in addition to
cirrhosis caused by the hepatitis C virus) had tests for vitronectin and AFP before and three months after intervention.
We discovered a statistically significant difference in low platelet count, high serum Cr, high INR, low serum
Alb high bilirubin, and greater aspartate aminotransferase between the cirrhotic group and the non-cirrhotic groups. The
median level of alfa-fetoprotein in group 4 (Hepatocellular carcinoma patients) was 110 IU/millilitre, which was
substantially higher than the median value in the other research groups. The median vitronectin level was unable to
differentiate among the different research groups. There was no statistically significant difference in the serum level of
vitronectin between the 3 categories in group 3 (cirrhotic patients), according to the Child's classification.
Chronic HCV infection and hepatocellular carcinoma are both health issues in Egypt. As blood AFP levels
may be normal in as much as forty percent of patients with hepatocellular carcinoma, particularly in the early stages, it
has low specificity for recognising cirrhosis, chronic hepatitis, or cholangiocarcinoma and limited sensitivity for
detecting hepatocellular carcinoma.
Keywords: Vitronectin, Hepatocellular carcinoma, HCV, AFP.


In Egypt, HCC is 2.3 percent more common than
and cirrhosis of the liver all have increased blood AFP
other malignancies overall. During a ten-year period in
levels. Newer markers are needed to address these
Egypt, the prevalence of HCC in those with chronic
problems and enable an earlier diagnosis of HCC (5,6).
liver disease nearly doubled, with 48% of cases being
AFP levels can be elevated in a variety of disease
associated with liver cirrhosis brought on by the
presentations, which include metastatic colon tumor and
hepatitis C virus (HCV). In fact, after cirrhosis has been
intrahepatic cholangiocarcinoma, for instance (7).
diagnosed, it is now widely known that HCC almost
Despite the fact that as many as thirty to forty percent of
usually develops in chronic HCV patients (1).
HCC patients have normal AFP levels, AFP has a low
Patients who have chronic HBV or HCV infection
level of specificity and sensitivity (8).
should be examined with ultrasound and serum alpha-
Vitronectin (VTN or VN), a glycoprotein of the
fetoprotein (AFP) since they are more prone to develop
hemopexin family, is widely present in serum, the ECM,
HCC (2). Using imaging or lab methods, HCC can be
and bone (9). VTN is a glycoprotein produced and
diagnosed. The three primary radiological diagnostic
released by the liver (10). Vitronectin has been shown to
methods are ultrasound, triphasic CT and dynamic MRI.
effectively attach to and integrate into the extracellular
Ultrasonography sensitivity for the detection of HCC is
matrix (ECM) of a variety of human tissues, promoting
directly impacted by size of tumor. Other serious
cell adhesion and differentiation while also controlling
problem is how operator-dependent the US is (3,4). HCC
ECM stability and composition (11). Malignancy may be
can be diagnosed in a laboratory by measuring
influenced by vitronectin, according to certain theories
circulating biomarkers or by invasive fine-needle
cytology with intra- or inter-observer variability (5).
The study's aim was to compare the roles of
The American Association for the Study of Liver
AFP and serum VTN to diagnose and prognose
Diseases recommended that blood levels of AFP >200
hepatocellular carcinoma as well as liver diseases linked
ng per millilitre as a substitute for FNC for diagnosis,
to HCV.
particularly in people with liver cirrhosis. A third of

patients with early-stage HCC and small tumors (less-
than 3 centimeters) go undiagnosed despite AFP's
This was a prospective observational study,
modest diagnostic performance (sensitivity: 39-65
conducted over a period of six-months in EL-Mahalla
percent; specificity: 76-94 percent). But it's vital to
Hepatology Teaching Hospital. The study included 60
consider that certain kinds of tumors, chronic hepatitis,

Received: 26/02/2023
Accepted: 26/04/2023

Full Paper (vol.921 paper# 138)

PROTOCOL OF A THESIS FOR PARTIAL FULFILMENT OF The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6371- 6378
Combination Vs Single Antibiotics for Prevention of Surgical Site
Infection during Caesarean Section in Obese Women: Randomized Controlled Trial
Hassan T. Khairy, Mohammed S. El Safty, Abeer M. El Sayed, Waleed M. Khalaf
Department of Obstetrics & Gynaecology, Ain-Shams University Faculty of Medicine
Corresponding author: Waleed Mohamed Khalaf Mobile: 01226274935 Email:

Obesity rate among ladies have been growing, and it is one of the risk factors of surgical site
infection (SSI) ensuing Caesarean delivery. Medical comorbidities, structural variables (such as increased tissue
pressure and skin folds), and bioactive adipose tissue that are linked to an increase in the risk of SSI are all
connected with obesity. In order to avoid SSI in obese women having caesarean deliveries, the work compares the
effectiveness of cephalexin + metronidazole versus cephalexin alone.
Objective: This study aimed to compare the effectiveness of cephalexin combined with metronidazole and
cephalexin alone for SSI prevention in obese women having Caesarean deliveries.
Subjects and methods: 280 patients participated in this interventional prospective randomised controlled-clinical
trial in accordance with the inclusion and exclusion criteria. They were divided randomly in 2 groups (A & B),
from them 270 patients completed follow up. In group A, patients received 2 gm cephalexin IV before skin incision
then postoperatively they received 1 gm cephalexin IV after 8 hrs. In group B, patients received 2 gm cephalexin
IV before skin incision plus 1 gm metronidazole rectally at time of urinary catheter insertion then postoperatively
they received 1 gm cephalexin IV plus 1 gm metronidazole rectally after 8 hrs. Both groups were followed for the
occurrence of SSI, endometritis, UTI, febrile morbidities, hospital stay and readmission and studied drugs side
Results: This study found a statistically significant difference in post-operative SSI rates (P>0.05). The most
frequent postpartum complication in both groups was wound infection, which occurred more frequently in group A
(the control group) than group B (the study group), with a statistically significant difference between the two.
Between the two groups, there was no discernible difference in any other aspect of the postpartum experience for
mothers. The women in both groups did not significantly differ from one another concerning hospital readmission,
receiving therapeutic antibiotic. Concerning hospital readmission: in group A, 2 patients was readmitted to manage
wound infection (wound dehiscence) and in group B no one was readmitted at hospital. As regards etiology of
therapeutic antibiotic, it was mainly to manage wound complications according to C & S.
Conclusion: Administration of prophylactic combined antibiotics to obese women prior to caesarean delivery was
more effective than single antibiotic administration (cephalexin alone) in reducing post-CS SSI in class I obesity.
Keywords: Single antibiotics, Surgical site infection, Caesarean delivery, Obese women.


The goal of a Caesarean delivery, a crucial
treat SSI. Evidence-based surgical approaches,
obstetrical surgical procedure, is to rescue both the
appropriate antibiotic prophylaxis, and optimisation of
mother and the foetus. Over the past few decades,
maternal comorbidities are crucial procedures that
there has been a sharp increase in the frequency of
effectively reduce the risk of SSI. Globally, the SSI rate
caesarean deliveries, both primary and recurrent, with
varies from 3% to 15%. The vast variation in incidence
an estimated 22.9 million Caesarean deliveries
may be brought about by variations in population
worldwide in 2012 (1).
characteristics and vulnerability factors, perioperative
SSI is one of the most frequent obstacle
procedures, and the time between the operation and the
following Caesarean delivery. Its incidence is about
diagnosis. In the past thirty years, there has been a
3% to 15%. It causes significant financial load on the
notable decrease in the chance of getting SSI, largely as
health care system, as well as physical and
a result of advances in medical technology, sterile
psychological burdens on the mother. Additionally,
practices, antibiotic prophylaxis, and other procedures
SSI is linked to a potential 3% maternal death rate. It
(3). However, the increase in Caesarean delivery rate is
is projected that the SSI will rise as well, explaining
expected to result in increase of SSI. Moreover, SSI
its clinical significance, as the Caesarean delivery rate
can be annoying for the mother who is caring for her
increases globally. Body mass index (BMI) of 30
newborn while recovering from the treatment. It
kg/m2 for mothers was linked to a significant rise in
might lengthen maternal hospital stays, expand health
the probability of SSI (2).
care fees, and have other negative socioeconomic
In order to reduce post Caesarean delivery
consequences (4).
morbidity and mortality, it is essential to recognize the
The misuse of antibiotics is the main cause of
considerable implications, and the consequences of SSI
the development of antibiotic resistance. For instance,
and to develop master plans to diagnose, prevent, and
using broader spectrum medications than necessary or
Received: 23/2/2023
Accepted: 25/4/2023

Full Paper (vol.921 paper# 139)

c:\work\Jor\vol921_140 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6379- 6386

Association of Work Stress & Total Income with Sick Leave during COVID-19
Pandemic applied on Ahmed Maher and El-Gomhoria Teaching Hospital/
Hany Mohamed Abd-Allah Embaby, Tamer Abdu Mohammed Megahed
Pediatric Surgery Department Ahmed Maher Teaching Hospital, Egypt
Corresponding Author: Tamer Abdu Mohammed Megahed
Phone numbers: 01000 862 100 E-mail address:, ORCID ID: 0000-0001-7352-4196

Although COVID-19 pandemic drew an intense global attention to sick leave incidence, policies, and
effect on different public and national levels, still there hasn't been enough scientific research well done to address and
manage this subject.
Objective: To Study the correlation between workload and sick absenteeism of the employees and the impact on total
Patients and Methods: A cross-sectional research involved 50 staff members by evaluating the correlation between
workload and sick absenteeism were assessed by formulating Key Performance Indicator to asses customers (internal)
satisfaction, work obstacles and distribution of employee leave in contrast to sick leave distribution.
Results: As hospitals look to increase the benefit from the human element as one of the most important elements of
capital, providing an ideal work environment in order to reach the optimal benefit of human element. Careful analysis
of specific staff needs will build a strong foundation toward developmental success.
Conclusion: An elevating level on sick leave of stress related reasons during COVID-19 pandemic needs a valid tool
for early identification of individuals at risk of leaving work because of such factors. Findings of this study refers that
the workplace stress scale questionnaire is a reliable and valid questionnaire.
Keywords: Sick leave, Workplace stress, Absence.

Self-reported questions about total sickness
Sickness absence is an indicator to staff morbidity
absenteeism days during the last year and total monthly
and wellbeing, it also have an economical burden to
income was added to the questionnaire. Also, after
companies and society (1).
obtaining participants' consents, review the center's
Association of income of the employee and the
personnel records was done to confirm the days of sick
frequency of the sick leave is often controversial (2).
leave and net salary and compare them to the
Job stress can be a reason for increasing health
participant's answers.
care costs in many countries, it also seems to be related

to less productivity and performance, and higher inci-
Inclusion Criteria:
dents of absenteeism and turnover (3).
o All full-time working staff that has been working
Many previous studies have concluded that job
in the specified study centers for at least 1 year
stress is linked to poor health and absenteeism leave (4).
and still.
The workplace stress scale (WSS) is the most common
o Sickness leave (not due to covid-19 confirmed
and well-studied models evaluating job stress (5).
illness) only was considered.
This study aimed to correlate between workload and

sick absenteeism of the employees and the impact on
Exclusion Criteria:
total income.
o Employees unwilling to participate.

o All the employees who were on sick leave
and/or maternity leave for more than 3 months
A. Selection of participants:
in the last year.
This cross-sectional study enrolled 50 staff
o Sickness leaves due to COVID-19 illness
members to evaluate the correlation between
confirmed by PCR test or chest CT scan.
workload and sick absenteeism that was assessed
o Incomplete questionnaire answers may result in
by formulating Key Performance Indicator to
questionnaire exclusion.
assess customers (internal) satisfaction, work
o Regular vacation and holidays leaves will be
obstacles and distribution of employee leave in
contrast to sick leave distribution.
o Ongoing sick leave (full- or part-time), leave of

absence, pregnancy.
B. Methods:
o Employees who have serious mental disease
This cross-sectional study evaluated the
(e.g. psychosis), post-traumatic stress illness, or
association of workload, income and sickness
any other severe co-morbidity that is severe
absenteeism. The workload was assessed using a
enough to remarkably impact their ability to
translated version of the workplace stress scale
work and/or quality of life.
questionnaire (WSQ).

Received: 21/02/2023
Accepted: 24/04/2023

Full Paper (vol.921 paper# 140)

c:\work\Jor\vol921_141 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6387- 6394

Vitamin D-Binding Protein as a Diagnostic Biomarker for Acute Meningitis
Badawy A. AbdulAziz1, Magdy Abdul Mawgoud Gad1, Mahmoud Ali Khalil2,
Lamyaa Mohmed Kamal3, Mohamed Ahmed AbdelMonem1
1Department of Hepatology, Gastroenterology and Infectious Diseases, Faculty of Medicine Benha University, Egypt
2Department of Hepatology and Tropical Medicine, National Liver and
Tropical Medicine Research Institute (Imbaba Fever Hospital), Egypt
3Department of Clinical and Chemical Pathology, General Organization for
Teaching Hospitals and Institutes (GOTHI), Egypt
*Corresponding author: Mohamed Ahmed AbdelMonem, Mobile: (+20) 01002426082, E-mail:

Meningitis is an acute inflammation of the pia, arachnoids, and the fluid in the subarachnoid space of the
brain. Because there is no diagnostic biomarker, it is difficult to diagnose. Objective: The aim of the current study
was to evaluate the validity of using cerebrospinal fluid (CSF) Vitamin-D Binding Protein (VDBP) as a new potential
marker for diagnosing meningitis. Patients and methods: A cross-section study was conducted on 48 patients with
manifestations suggesting an acute meningitis, 28 patients with an acute meningitis who were divided into bacterial
group containing 10 patients and viral group containing 18 patients confirmed by laboratory investigations and 20
patients who were clinically suspected as an acute meningitis, but excluded by laboratory investigations, the study was
conducted within the period from May 2022 to December 2022. CSF and blood samples were obtained in pairs. CSF
and serum VDBP were measured in the 3 groups. CSF VDBP concentrations were compared versus serum VDBP
concentrations according to disease (viral meningitis vs. bacterial meningitis vs non-meningitis). Receiver operating
characteristic (ROC) analysis for diagnosing meningitis using CSF VDBP concentration was performed. Results:
There was a statistical significant difference as regard the CSF VDBP (P<0.01) was found between viral, bacterial and
control groups (2.49±.65, 2.43±.55 and 1.74±.25g/mL, respectively). There was a statistical significant difference
(P<0.05) in serum VDBP between the viral, bacterial and control groups (214.5±36.5, 197.4±54.8 and 174.3±40.4
g/mL, respectively). ROC curve analysis showed that the optimum cut-off level of CSF VDBP for diagnosing
meningitis was 1.94 g/mL with a sensitivity of 82.1% and specificity of 85%. AUC of CSF VDBP was 0.865 (95%
CI: 0.761­0.969). Conclusion: The cerebrospinal fluid (CSF) Vitamin-D Binding Protein (VDBP) level demonstrated
an excellent diagnostic performance. It could serve as a potential marker for diagnosing acute meningitis.
Keywords: Cerebrospinal fluid, Vitamin D-binding protein, Meningitis Biomarker.

predominantly lymphocytic pleocytosis, normal
Meningitis is an acute inflammation of the pia,
glucose levels and normal to slight increase in protein
arachnoids, and the fluid in the subarachnoid space of
levels [7].
the brain [1]. There are two main types of meningitis:
ABM is characterized by a high and
septic and aseptic [2], with aseptic meningitis being the
predominantly neutrophilic pleocytosis, decreased
commonest type. Most cases of meningitis are because
glucose levels, and an elevated protein level [8].
of viral, bacterial, fungal, and parasitic infections,
However, this is not the case in every patient. It varies
Meningitis can also be related to various noninfectious
in elderly subjects and those with partially treated
causes [3].
meningitis or immunosuppression. The examiner's
The global incidence of meningitis is 20 cases
skill level can also affect the differential cell count of
per 100,000 people; that is, about 1.2 million; the
CSF. As a result, more novel markers are required for
incidence and etiology vary across geographic regions.
more reliable detection of meningitis [9].
Aseptic meningitis differs from bacterial meningitis if
Vitamin-D Binding Protein (VDBP) is a 58-kDa
there is meningeal inflammation with no bacterial
multifunctional protein synthesized in the liver and
growth signs by CSF culture [4].
circulates in the bloodstream. It is an acute phase
Acute bacterial meningitis (ABM) is a medical
reactant. As a result, VDBP level can fluctuate
emergency with an estimated incidence of 1.38 cases
according to the condition [10-13]. VDBP was originally
per 100,000 populations and a mortality rate of 14.3%
known as group-specific component globulin, it is
in western countries [5]. In ABM, 10% of patients die if
recognized to have an important role in vitamin D
there is a delay in diagnosis or treatment [6].
metabolic transport, in recent years, other functions of
Furthermore, survivors of ABM are at an
VDBP have been discovered, such as actin
increased risk of cognitive dysfunction or other
sequestration and immune response regulation [14].
neurological deficits. Due to the poor utility of clinical
Polymorphism is common in the gene that
indicators in diagnosing meningitis, any patient who
encodes VDBP (GC). The frequency of its genotype
presents with meningitis's symptoms must have a
varies according to ethnic population. Furthermore,
lumbar puncture (LP) performed as soon as possible to
variations in VDBP affinity for 25(OH)D have been
evaluate the CSF to confirm the diagnosis. Aseptic
found based on genotype. Two single-nucleotide
polymorphisms (SNPs), rs7041 and rs4588, cause 3
Received: 26/02/2023
Accepted: 26/04/2023

Full Paper (vol.921 paper# 141)

c:\work\Jor\vol921_142 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6395- 6402

Measuring Adverse Events in the Neonatal Intensive Care Units in
Mit-Ghamr Central Hospital
Mohamed Ibrahim EL-Kalioby1, Shaimaa Ismail Sahmoud1, Enas El-Said Metwally Helal2
1Pediatrics Department, Faculty of Medicine - Suez Canal University, Egypt
2Pediatrics and Neonatology Department, Mit-Ghamr Central Hospital, Egypt
Corresponding author: Enas El-Said Metwally Helal, E-mail:,
Mobile: +201032644043

Children in neonatal intensive care units (ICU) are more susceptible to medical errors. Measuring adverse
events is a very important issue for patient safety and using trigger tool methodology as a different strategy is beneficial
to both more focused as well as rapid chart review to establish whether or not an adverse event occurred.
For evaluation the prevalence of adverse events (AEs) in Mit-Ghamr Neonatal ICU using the trigger tool and to
evaluate the prevalence of adverse events in Mit-Ghamr neonatal Intensive Care Unit with other hospitals in Egypt and
Subjects and Methods:
A cross sectional analytic study using medical record review and charts study was done
including 511 medical records, it consisted of all neonates admitted to Mit-Ghamr neonatal ICU between 1st January to
31 December 2017.
Results: a total of 465 adverse events with incidence rate of 0.91 adverse event/patient and 1.16 trigger/patient. The
most common adverse event was nosocomial infections with more than half of the overall adverse events (n=282;
55.2%), followed by catheter infiltration (n=64; 12.5%), hypotension was 5.5%, respiratory arrest 4.7%, accidental
extubation 4.1%, death 3.5%, renal insufficiency 2%, and seizures was 0.6%. Category (F) was the most prevalent harm
category among the occurred adverse events (45.7%) followed by category (E) (28.8%). Only a minority (3.1%) had a
permanent harm (category G) and category H was 22.4%.
Nosocomial infections constitute the majority of all adverse events, followed by catheter infiltration and
Patient Safety, Trigger Tool

Measuring adverse events is a very important issue
for patient safety and using trigger tool methodology as
Patient safety is a priority for health care providers.
a different strategy in order to facilitate a more targeted
However, some undesirable incidents can occur even
and time-saving chart review, it is beneficial to
with the goal of providing a good care to the patient.
determine whether or not an adverse event occurred (5).
These undesirable incidents can lead to injury to the
The Institute for Healthcare Improvement Global
patient. In this case it is defined as an adverse event like
Trigger Tool has been proposed a retrospective chart
(nosocomial infection, catheter infiltration, burn,
review as a good method to detect adverse events (6).
medication error or respiratory arrest) (1).
It was discovered that the glucose tolerance test
Childrens in neonatal intensive care units are more
(GTT) may be utilized in the neonatal ICU to assess
at risk for medical errors due to their low weight,
adverse events, as well as to detect a two to three times
physiological immaturity, their limited compensating
larger harm rate than was previously discovered with
abilities, and the chance that they may be admitted for
the use of alternative methodologies (7). It is proved to
long lengths of time as well as exposed to multiple
be a flexible tool that can be used in different
therapies that may lead to injury. Additionally, because
environments and it can accurately identify different
of the likelihood that they may be admitted for long
types of adverse events at low cost (8).
periods of time, they are subjected to several
As patient safety is of particular concern to health
interventions that may lead to harm (2).
authorities, the health care sector in Egypt should
When a patient experiences a medical error, there
identify and collect information on adverse events to
should be an investigation conducted to uncover the
know their incidence and prevent their recurrence, in
variables that contributed to the incident, regardless of
addition there is lack of studies and information about
whether or not the patient was harmed by the error
adverse events in NICUs, such information is essential
(referred to as an adverse event or a near miss) (3).
for improving the quality and accuracy of the care
Adverse events can be identified by triggers that
provided in NICUs in Egypt.
may occur in NICU. For example, nosocomial infection
This study used The Global Trigger Tool to
could be identified by the trigger antibiotic use, the
retrospectively identify the neonatal adverse events in
interventricular hemorrhage could be identified by
Mit-Ghamr neonatal ICU.
abnormal cranial imaging; acute renal failure could be

identified by the trigger increased creatinine (4).
This was a cross sectional analytic study using
medical record review and charts of Mit-Ghamr Central
Received: 21/02/2023
Accepted: 23/04/2023

Full Paper (vol.921 paper# 142)

c:\work\Jor\vol921_143 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6403- 6412

Bone Mineral Density in Female Patients with Rheumatoid Arthritis in
Relation to Anti-Cyclic Citrullinated Peptide Antibody and Rheumatoid Factor
Ghada Mohamed Bakr Elalfy1*, Ibrahim Abdallah Elboghdady1,
Ziyad Mohamed Tawhid2, Nanees Abdelbadie Salem3, Ola Mohamad Mostafa Gharbia1
Departments of 1Department of Rheumatology & Rehabilitation, 2Clinical Pathology and
3Pediatrics, Faculty of Medicine, Mansoura University, Egypt
*Corresponding author: Ghada Mohamed Bakr, Mobile: (+20) 01000229190, E-mail:

Rheumatoid arthritis (RA) is an autoimmune disorder associated with a chronic inflammation, which can
cause joint damage and extra-articular complications. Anti-citrullinated protein antibody (ACPA) positivity is
accompanied by poor prognosis in RA, and testing for ACPA has become traditional practice in the context of RA
Objective: The aim of the study was to estimate the prevalence of low bone mineral density (BMD) among female
patients with RA using dual energy x-ray absorptiometry (DEXA), and to study the correlation between BMD & levels
of anti-cyclic citrullinated peptide (anti-CCP) and RF in the studied cases.
Patients and methods: The present study was a cross-section descriptive study that was conducted on eighty female
patients with RA. All patients were subjected to assessment to the levels of anti-CCP and RF using ELISA. BMD was
measured by DEXA.
Results: Osteopenia and Osteoporosis at lumbar spine, femoral neck and distal end of radius showed statistically
significant increase in +ve anti-CCP patients when compared to ­ve anti-CCP patients. BMD at the lumbar spine,
femoral neck and lower end of radius showed statistically significant decrease in +ve anti-CCP patients when compared
to ­ve anti-CCP patients. History of fragility fracture showed statistically significant increase in RA patients with +ve
RF when compared to -ve RF patients.
Conclusion: Bone loss and fragility fracture are common in RA and increased in seropositive RA, post-menopausal
state and corticosteroids use. The presence of ACPA and RF are strongly predictive for the development of osteoporosis
and erosions in RA patients. It would be a more appropriate approach to carefully monitor osteoporosis in seropositive
Keywords: Anti-CCP, Rheumatoid factor, Rheumatoid arthritis, Dual energy X-ray absorptiometry.

and RF were accompanied by bone loss in cases with
RA is a chronic immune-inflammatory disease
early, untreated RA [7].
accompanied by bone loss, erosions, and osteoporosis.
This work was done to estimate the prevalence of
Erosive RA and osteoporosis have a comparable
low BMD among female patients with RA using DEXA
cellular pathway, that comprises inflammatory
and to study the correlation between BMD & levels of
stimulation of osteoclasts and reduced osteoblast
anti-CCP and RF in the studied cases.
stimulation [1]. Minimal BMD in cases with RA has

been demonstrated to be associated with a higher
possibility of fractures and mortality, particularly
This was a cross-section descriptive study
among postmenopausal females [2].
performed on eighty (80) female cases with RA who
The best approach for measurement of systemic
were diagnosed based on ACR/EULAR [8] classification
BMD is DEXA. ACPA positivity is accompanied by
criteria for RA. The patients were selected from
poor prognosis in RA, and evaluating ACPA has
Outpatient Clinics of Rheumatology & Rehabilitation
become traditional practice in the context of RA
Department, Mansoura University Hospitals through
diagnosis [3]. Novel study recommended that ACPA
the period from January 2021 to October 2021.
could trigger bone loss and serum receptor activator of

nuclear factor kappa beta (RANKL) is recorded to be
Exclusion criteria: Patients with other immune­
elevated in ACPA-positive cases regardless of acute
mediated diseases as systemic lupus, scleroderma,
phase reactants and proinflammatory cytokines [4].
Behcet disease and ankylosing spondylitis. Patients
Cases with positive anti-cyclic citrullinated
with medical conditions as celiac disease, inflammatory
peptide-II antibodies were recorded to be accompanied
bowel disease, renal or hepatic diseases, malignant
by bone damage, which initiates before the onset of RA
tumours and multiple myeloma. Patients with hormonal
[5]. Increase in anti-CCP2 antibody values revealed to be
disorders as thyroid problems, hyperparathyroidism,
a predictor of localized hand digital X-ray
hypogonadism and patients on medications that can
radiogrammetry (DXR) BMD loss in cases with early
cause bone loss as anti-depressants, anti-epileptics, loop
RA [6]. Data analysis showed that anti-CCP2 antibodies
diuretics, heparin and warfarin.
Received: 01/03/2023
Accepted: 30/04/2023

Full Paper (vol.921 paper# 143)

INTRODUCTION The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6413- 6419

Noninvasive Ventilation After Extubation Improves Weaning
Outcome After Respiratory Failure
Hoda Ali Abou Youssef, Amany Atef Elkarim Abou Zeid,
Raef Hosny Emam, Hebatallah Hany Assal, Yasser Mehrez Elsarem
Department of Chest Diseases, Faculty of Medicine, Cairo University
Corresponding author: Yasser Mehrez Elsarem, Email:, Tel.,: 01024364514

The total prevalence of respiratory failure is unknown since it is a syndrome instead of a single disease
happening. It's possible, but not certain, that race has an influence in the emergence of acute respiratory failure (ARF).
Aim: The purpose of the research was to contrast the efficiency of Noninvasive ventilation (NIV) with oxygen mask
(OM) in individuals with ARF shortly following scheduled extubation.
Methods: The research was done between December 2012 and October 2014 at three different respiratory ICUs at the
hospitals of Kasr Al-Ainy, El-Mehalla Chest, and El-Abbassia Chest. 56 cases with type II respiratory failure, who
needed ventilator and intubation assistance for longer than two days, were included in the research; while 4 patients who
had successfully extubated themselves were not. NIV group (26 patients): Cases were ventilated utilizing either a NIV
ventilator or an ICU ventilator set to a pressure support ventilation mode with a PEEPext added. PEEPext was started
at 5 cm H2O and raised until oxygen saturation was maintained at >92% while Pinsp was titrated to patient tolerance.
Attaining these parameters (oxygen saturation 92 percent, respiratory rate 25 breaths/min, and pH > 7.35) was the goal.
We increased the FiO2 until we had a SaO2 of 92%. Each patient wore a full-face mask while receiving treatment.
Results: NIV group had significantly lesser heart rate (HR) 1 hour after trial. HR non-significantly increased from MV
to SBT in both groups. HR increased from SBT to 1 hour after trial in both groups, but the changes were significant
only in SMT group.
: Patients with chronic respiratory illness may benefit from utilization of non-invasive ventilation
immediately following planned extubation as it decreases the rates of reintubation, VAP, and mortality in the ICU.
Keywords: Non-invasive ventilation; Extubation; Chronic respiratory disorders

In instances of decompensated acute on chronic
COPD is a kind of obstructive lung disease
ventilatory failure, NIPPV is an effective first-line
characterized by persistently reduced airflow; other
therapy for patients with conditions such as motor
names for this condition include chronic obstructive
neuron disease, obesity-hypoventilation syndrome,
lung disease (COLD) and chronic obstructive airway
muscular dystrophy, myopathies and chest wall
disease (COAD). As time passes, it tends to get worse.
problems such as kyphosis and thoracoplasty (5).
Difficulty breathing, coughing, and mucous production
Unfortunately, the prevalence of NIV use in ARF
are the primary indicators (1). The prevalence of COPD
among the severely sick has only been the subject of a
among those who suffer from chronic bronchitis is high
small number of epidemiological researches. To be
more specific, there has been no population-based
Approximately one-quarter of all deaths in the UK
investigation of NIV's usefulness in a specific area (6).
can be attributed to respiratory disorders. It is estimated
Our primary objective was to contrast the efficiency
that 20 percent or more of those with COPD admitted to
of NIV with OM in cases with ARF.
the hospital for an exacerbation have respiratory

acidosis. Rapid identification and treatment of acute
ventilatory failure (AVF) can minimize morbidity and
The research was done between December 2012 and
death , but this difficult-yet-common medical
October 2014 at three different respiratory ICUs at the
emergency is often misdiagnosed and hence left
hospitals of Kasr Al-Ainy, El-Mehalla Chest, and El-
untreated (3).
Abbassia Chest.
However, the true incidence of respiratory failure is

unknown since it is a condition rather than a specific
Inclusion criteria: Type respiratory failure
illness. The association among racial background and
individuals who had been on a ventilator for greater than
ARF is still up for discussion. Following controlling for
48 hours (hrs) were evaluated.
variations in case mix, research by Khan et al., (4) stated

no statistically significant variance in mortality amongst
Exclusion criteria: Patients in a coma, those with a
cases of Native Indian and Asian heritage who were
cervical spine injury, those with neuromuscular
hospitalized with acute critical illness.
illnesses, those who are aggressive or uncooperative,
Exacerbations of COPD by acidotic hypercapnic
those whose anatomy prevents them from wearing a
ventilatory failure are related to a significantly lesser
mask, those with uncontrolled cardiac ischemia or
risk of endotracheal intubation, hospital stay, and short-
arrhythmias, those who have just undergone face
and long-term mortality if NIPPV is used (3).
Received: 21/02/2023
Accepted: 23/04/2023

Full Paper (vol.921 paper# 144)

c:\work\Jor\vol921_145 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6420- 6427

Opening-Wedge vs. Closing-Wedge High Tibial Osteotomy for
Medial Compartmental Knee Osteoarthritis: A Systematic Review and
Meta-Analysis of Randomized Controlled Trials
Waleed Abdelsalam Ali Abdelsalam Omara1, Alameldin Sobhe Abdel Samea Abdel Hamed2,
Mostafa Kamal Kotb Ali2, Youssef Shams Youssef Beheiry2
1Orthopedic Surgery, Kafer el Skeik General Hospital, Egypt

2Orthopedic Surgery, Ain shams University, Egypt
3Orthopedic Surgery, Benha University, Egypt
Corresponding author: Waleed Abdelsalam Ali Abdelsalam Omara, Tel.: 01050366830, Email:

The main purpose of HTO is to put off the start of sickness and the requirement for a knee replacement
for as long as possible. The opening wedge high tibial osteotomy (OWHTO) and the closing wedge high tibial osteotomy
(CWHTO) are the two surgical techniques that are performed the most frequently.
Objective: The aim of this meta-analysis of randomized controlled trials (RCTs) is to compare OWHTO with CWHTO
with regard to clinical and radiological results as well as adverse events.
Materials and methods: PubMed, Embase, Web of Science, and Scopus were searched for RCTs comparing OWHTO
and CWHTO for the outcomes of interest. We collected information on the rate of complications, as well as the clinical
and radiological results. Results: There were a total of 648 participants across 11 trials that met our inclusion criteria;
324 patients received OWHTO and 326 individuals had CWHTO. Our study showed that OWHTO is linked to a more
sloping tibia, a lower patellar height, a longer leg length, and a higher rate of metal removal. Overall effectiveness,
degrees of angular rectification, and incidences of complications were comparable between the two methods.
Although OWHTO and CWHTO demonstrated different effects on PTS, patellar height, and leg length,
no technique was found to be superior in terms of functional outcomes, and postoperative complications. We need more
RCTs with similar populations, big sample numbers, and extended follow-up periods.
Opening-wedge, closing-wedge, tibial osteotomy, osteoarthritis, meta-analysis, Egypt.


Progressive cartilage breakdown and physical
deterioration characterize osteoarthritis (OA), the most
The Preferred Reporting Items for Systematic
prevalent condition of the knee joint (1). When knee OA
Reviews & Meta-Analyses (PRISMA) checklist was
has progressed, the best surgical choice for therapy is a
used to guide our systematic review. (Open) AND
total knee arthroplasty (TKA) (2). However, high tibial
(Closed OR Closing) AND (Tibial Osteotomy) was
osteotomy (HTO) and other surgical treatments have
used to search PubMed, Embase and Web of Science
shown promise in treating medial compartment OA in
from their creation to June 2023. Endnote X9 (Thomson
young, active individuals (3). The major aim of HTO is
Reuters, New York, NY, USA) was utilizes for
to delay the advancement of the illness and avoid the
importing the retrieved results and perform a duplicate-
need for knee replacement (4).
content search.
Jackson and Waugh (5) initially described HTO in
After that, the titles and abstracts of the remaining
1961. The most common procedures are (OWHTO) and
publications were reviewed using the following
(CWHTO). There are benefits and drawbacks to every
criteria to determine which ones should be excluded:
approach. OWHTO's theoretical benefits include bone
Content originally published in languages outside
stock preservation, the lack of fibular osteotomy, and
the avoidance of peroneal palsy (3, 6). OWHTO is
categorizations. Case reports, brief case series, and
becoming increasingly popular as a result of the
conference articles. Research using cultured cells and
animals, studies that don't matter.
biomaterials in conjunction with the introduction of new
After identifying papers that could be relevant, we
implants that have a firm locking mechanism. In earlier
collected their full texts and evaluated them for
research, comparing the two approaches did not reveal
a statistically significant difference in either the

functional outcomes or the rates of complications (7).
Studies were included in our analysis if they fulfilled
In order to find a solution to the problem, we carried
one of the following inclusion criteria: Comparing
out a meta-analysis of randomized controlled trials
OWHTO to CWHTO for medial compartment knee OA
(RCTs), in which we compared the outcomes of
in randomized controlled trials, a minimum of 6 months
OWHTO and CWHTO in terms of clinical and
of follow-up, obtaining information necessary for
radiological findings, as well as adverse events.
making comparisons.

Received: 23/02/2023
Accepted: 25/04/2023

Full Paper (vol.921 paper# 145)

c:\work\Jor\vol921_146 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6428- 6431

Efficacy of Erector Spinae Plane Block in Modified Radical Mastectomy Regarding
Postoperative Analgesia and Stress Response: Randomized-Controlled Trial
Ahmed A. Bedewy1, Maged M. Salah2, Hesham M. Sultan1, Moataz S. Khalil1
1Anesthesia, Surgical Intensive Care and Pain Management Department,
Faculty of Medicine, Helwan University, Egypt
2Anesthesia, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Cairo University, Egypt
*Corresponding author: Hesham M. Sultan, Mobile: (+20) 01553895516, E-mail:

Erector spinae plane block (ESPB) is one modality technique, which had great outcomes among many
surgeries. However, its efficacy in modified radical mastectomy remains to be fully explored.
Objective: To compare between using ESPB vs traditional intravenous analgesia for control pain after breast surgeries.
Patients and methods: 40 cases were included splitted into two groups. Group A included 20 cases who received ultra-
sonography guided erector spinae plane block. Group B included 20 cases who had only postoperative morphine. We
compared between the two groups regarding pain scores by numerical rating scale, stress response, overall fentanyl
consumption, morphine consumption, intraoperative changes among mean arterial blood pressure, heart rate as well as
presence of postoperative complications.
Results: A statistically significant decrease in pain scores among group A was found compared to group B at all intervals
(P<0.05). Also, we found statistically significant decrease among postoperative morphine consumption (P=0.001),
decrease in intraoperative fentanyl needs (P<0.001), decrease in serum cortisol level 1 hour after operation (P<0.001),
decrease in postoperative nausea and vomiting among group A compared to group B. While, we found non-significant
change in intraoperative fentanyl consumption and in pain scores at other time intervals.
Conclusion: Our study showed that erector spine plane block had a more impressive analgesic effect than intravenous
analgesia in modified radical mastectomy with lower morphine consumption and lower postoperative cortisol level.
Keywords: ESPB, Intravenous analgesia, modified radical mastectomy, Stress response.


Surgery is the cornerstone of breast cancer
treatment, which is often supplemented by other
This Randomized controlled clinical trial (single
methods like chemotherapy, radiation therapy, and
blinded) was done on 40 female patients aged between
hormonal management. However, after having breast
35 to 60 years old who were undergoing modified
cancer surgery, many people experience chronic pain.
radical mastectomy under general anesthesia in Helwan
There is a negative impact on quality of life and
and Cairo University Hospitals for 24 months. Subjects
functionality for women who have persistent pain after
were randomly organized into two groups using block
breast cancer surgery. Other research has also linked
randomization method. Patients were randomly
preoperative breast pain and immediate postoperative
classified into ten blocks of 4 patients. Each block is
pain to the onset of Chronic pain after breast cancer
formed of 2 patients for group A and 2 patients for group
surgery (CPBCS) (1).
B then the 10 blocks were randomly sequenced.
The sympathetic nervous system as well as the
Group A: consisted of 20 cases who received ultra-
hypothalamic-pituitary-adrenal axis undergo neuronal
sonography guided erector spinae plane block.
activation in response to surgical pain and trauma,
Group B: consisted of 20 cases who received
resulting in a variety of hormonal alterations.
intravenous morphine only.
Traditionally, glucocorticoid production and release are

stimulated by hypothalamic activation leading to the
Study procedure:
release of adrenocorticotropic hormone (ACTH) from
Pre-operative patient assessment:
the pituitary (2). Thus came the need for better ways of
History, physical exam, laboratory (CBC, INR, AST,
control of postoperative pain one of them is erector
ALT, urea. serum creatinine and random blood sugar),
spinae plane block, cases who had severe chronic
electrocardiograph for patients older than 45 years or
thoracic neuropathic pain as well as cases undergoing
patients with history of cardiac disorders and chest x-
video-assisted thoracoscopic surgery were the first to
ray were done at preoperative assessment clinic.
benefit from the ESP block, which is a unique
Pre-surgery evaluation in the evening before the
interfascial paraspinal plane approach developed by
operation. The patients were taught to use the Numeric
Forero et al. (3).
Pain Rating scale, which ranges from zero (no agony)
We aimed at this work to compare between using
to ten (the greatest pain imaginable). This was done with
ESPB vs traditional intravenous analgesia for control
the participant's knowledge and agreement. Fasting is
pain after breast surgeries.
required prior to surgery, with a minimum of 6 hours
Received: 01/03/2023
Accepted: 30/04/2023

Full Paper (vol.921 paper# 146)

c:\work\Jor\vol921_147 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6432- 6439

Urinary Neutrophil Gelatinase Associated lipocalin (NGAL) as
A Biomarker of Acute Kidney Injury in Patients with Liver Cirrhosis
Mohamed Abd Ellatif Afifi*, Abd Elhakim Hasan,
Ahmed Refaat Mohammed, Raof Mostafa Rashed, Mahmoud Rizk
Department of Internal Medicine, Faculty of Medicine, Benha University, Egypt
*Corresponding Author: Mohamed Abd Ellatif Afifi, Mobile: (+20) 01001588752, E-mail:

: The severity of acute kidney injury (AKI) syndrome varies. The blood urea nitrogen (BUN) and
creatinine (Cr) retention, as well as a rapid drop in the glomerular filtration rate (GFR), are its defining features. The
discovery of a superior gold standard to serum Cr concentration or urine output, as well as proof that a marker-
directed therapy strategy may enhance clinical outcomes, would be significant step forward for AKI biomarker
Objective: To determine if urine neutrophil gelatinase associated lipocalin (uNGAL) is a reliable indicator of AKI in
patients with liver cirrhosis.
Patients and methods: This study included 80 cirrhotic patients. Patients were allocated into two groups as follows:
group I: 30 cirrhotic cases with normal kidney functions (without AKI) and group II: 50 cirrhotic cases with AKI who
were divided into 3 subgroups according to type of AKI: group IIa included 20 cases with prerenal AKI, group IIb
included 20 cases with hepatorenal syndrome (HRS-AKI) and group IIc included 10 cases with acute tubular necrosis
Results: In terms of uNGAL, there were statistically significant variations across the groups that were examined (P
value <0.001) with mean uNGAL value is highest in group IIc (ATN) (259.80±44.364 ng/ml) followed by group IIb
(HRS-AKI) (192.85±40.782 ng/ml) than group IIa (Pre-renal AKI) (61.00±8.706 ng/ml) and group I (29.00±5.420
ng/ml). uNGAL at a cut-off value 239 ng/ml could differentiate ATN from HRS with sensitivity of 80%, 90%
specificity, 80% PPV, 90% NPV, with an area under curve (AUC) = 0.880, and P value of 0.001. uNGAL at cut-
off value >190 ng/ml had 100% sensitivity, 88.24% specificity, 60% PPV, and 100% NPV for predicting inhospital
mortality in cirrhotic patients with AKI (AUC = 0.96; P 0.001).
Conclusion: To diagnose and differentiate between various causes of AKI in cases with liver cirrhosis, uNGAL may
be employed as an accurate biomarker. Additionally, it has prognostic value in such patients.
Keywords: uNGAL, AKI, Liver Cirrhosis.

ATN entails structural injury to the kidney, prerenal
Together with liver cancer, cirrhosis ranks third
azotemia reflects the functional renal component (7).
among the causes of mortality for adults between the
Actual alterations in renal function are frequently
ages of 45 and 64 and is responsible for 3-5% of
detected after the diagnosis of AKI based on plasma
fatalities globally (1).
creatinine (8).
Chronic liver inflammation results in cirrhosis,
Cirrhosis dramatically alters the kinetics of
which is followed by widespread hepatic fibrosis, in
creatinine. Because of decreased muscle and liver
which regenerating hepatic nodules replace the normal
generation of Cr, reduced the conversion of creatine to
hepatic architecture and finally cause liver failure (2). It
Cr in the liver, high volume of distribution, enhanced
may result from a variety of factors, which include
tubular secretion of Cr, and altered creatinine excretion
obesity, non-alcoholic fatty liver disease, excess
owing to medications, the levels stay low. It takes
alcohol use, infection with hepatitis B or C,
between 24 to 48 hours for blood creatinine to increase
autoimmune disorders, cholestatic diseases, and an
after a renal tubule injury. Serum creatinine does not
excess of iron or copper (3).
accurately represent the functioning condition of the
Decompensated cirrhosis frequently leads to the
kidney in circumstances with abrupt declines in GFR
extremely deadly condition known as AKI. Relative
until a steady state equilibrium is attained. Jaffe's
variations in serum creatinine are used to categorise
technique for estimating Cr can be interfered with by
and characterise AKI in cirrhosis. A higher AKI stage,
high serum bilirubin. Additionally, serum creatinine
or a more serious damage, is linked to a higher 90-day
does not distinguish between various AKI etiology (9).
death rate (4). It is connected to a worse prognosis (5).
A 25-kD member of the lipocalin family of
In cirrhotic patients, the prevalence of kidney
proteins, NGAL serves as a growth and differentiation
impairment ranges between 14% and 50%. According
factor in a variety of cell types and participates in iron
to estimates, 50% of those with cirrhosis and ascites
transport in the renal epithelium (10). NGAL levels
and 20% admitted to the hospital with severe cirrhosis
increase three hours after cellular damage, and
(6). Prerenal azotemia, HRS, ATN, and postrenal
depending on the degree of the injury, its concentration
causes are all possible causes of renal failure. While
peak can be seen between 6 and 12 hours later. This
Received: 01/03/2023
Accepted: 30/04/2023

Full Paper (vol.921 paper# 147)

c:\work\Jor\vol921_148 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6440- 6448

Comparison between Effect of Dexmedetomidine and Dexamethasone as an
Additive to Subtenon Block with General Anesthesia on Perioperative
Outcomes for Pediatric Strabismus Surgeries
Mohamed Eslam Elshehawi, Salma Farhat Ali Ahmed, Aboelnour Elmorsy Badran, Medhat Mikhail Messeha
Anesthesia and Surgical Intensive Care Department, Mansoura Faculty of Medicine, Egypt.
Corresponding Author: Medhat Mikhail Messeha, E-mail:,
Mobile: (+20)1207788199. ORCID ID:
Dexamethasone is given to the patient during surgery to decrease the possibility of post-operative nausea
and vomiting (PONV), alleviate pain, and make the patient feel better. Dexmedetomidine is a strong and highly selective
alpha 2-adrenoreceptor agonist utilized nowadays in the ICU as a continuous infusion for sedation and analgesia.
Aim of the work: This study aimed to compare the effectiveness of pre-operative injection of dexmedetomidine or
dexamethasone in sub-tenon block (STB) in conjunction to bupivacaine anesthesia under general anesthesia on reducing
pain in the immediate postsurgical period (VAS) emergence agitation, hemodynamic stability and attenuating airway reflex
to extubation in cases who were undergone strabismus operations.
Patients and Methods: This study was conducted on a total of 80 cases who were divided into two groups (n=40). Group
I received sub-tenon mixture of, bupivacaine 0.5% (2 ml) and dexmedetomidine 0.5 g/kg (1 ml). Group II received sub-
tenon bupivacaine 0.5% (2 ml) and dexamethasone 0.1 mg/kg (1 ml). Postoperative pain (POP) was evaluated by using a
verbal pain scale (VPS). Emergence agitation (EA) was assessed with the PAED scale.
Results: Dexmedetomidine was associated with a lower analgesic requirement, minimal VAS score and lower emergence
agitation and lower complications compared to dexamethasone.
Conclusion: Dexmedetomidine as an adjuvant to STB in conjunction to general anaesthesia had promising outcomes in
pain reduction, lower analgesic requirement and emergence agitation and low possibility of complications compared to
Keywords: Dexmedetomidine, Dexamethasone, Sub-tenon block, Strabismus.

stability and attenuating airway reflex to extubation in
Strabismus surgery is a frequent ocular surgery in
patients undergoing strabismus surgeries.
pediatric population. Squint operation in children has
Outcomes: Primary outcome involved the effect on
been demonstrated to be often associated with discomfort
postoperative visual analogue score (VAS). While
or pain, based on the number of muscles that need to be
corrected and the technique of surgery. Intravenous
requirements in the 24 h postoperative emergence
opioid agents and NSAIDs are the mainstays of analgesia
agitation, Ramsay sedation score, intraoperative
in the intraoperative and postoperative periods. A high
hemodynamic stability, the occurrence of OCR and the
possibility of intraoperative oculo-cardiac reflex (OCR)
incidence PONV.
and PONV are frequently seen in squint surgeries [1, 2].

Regional analgesia approach has been suggested
in combination with general anaesthesia in recent years
This was a prospective randomized controlled
[3]. One of the local anesthetic approaches utilized in
study conducted at Ophthalmology Centre Mansoura
ocular surgeries is the STB. In such approach, local
University following approval from the IRB
anesthesia is injected posterior to Tenon's capsule [4].
(MS.20.01.1016). This study involved 80 ASA I and II
Dexmedetomidine is a highly selective centrally acting -
participants, aged 6- 12 years of both sexes, who were
2 agonist with analgesic and sedative actions with no
arranged for elective squint operations with general
respiratory depressing effects [5]. It has been used in
anesthesia. Patients were interviewed and enrolled in this
regional anesthesia in addition to local anesthesia to
study after obtaining written informed consents from
increase the analgesic duration [6]. Dexamethasone is a
potent steroid that can be effective as an adjunct to local

anesthesia in several researches [7, 8].
Exclusion criteria: Patients having redo surgery,
The current study aimed to compare the
hypersensitivity to any of the study medications
(including postoperative analgesia), having heart, liver,
dexmedetomidine and dexamethasone in sub-tenon block
kidney or respiratory disease and patients whose parents
in conjunction to general anesthesia under sevoflurane
anesthesia on reducing pain in the immediate postsurgical
By utilizing a software-derived random number sequence,
period (VAS) emergence agitation, hemodynamic
80 patients were randomly assigned by sealed opaque
Received: 24/02/2022
Accepted: 25/04/2022

Full Paper (vol.921 paper# 148)

c:\work\Jor\vol921_149 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6449- 6454

Effect of Electro-Stimulation in Management of Fecal Incontinence
Post Colorectal Surgery
Ahmed Khalaf Gaber Ali1, Mohamed Mahmoud Abd Elkhalek Khalaf1,
Osama Abdullah Abdul Raheem2, Mohamed Bayoumi Ibrahim1, Aya Gamal Fawzy El-Sayed1
1Department of Physical Therapy for Surgery and Burn, Faculty of Physical Therapy, Cairo,University, Giza, Egypt
2Department of General Surgery, Faculty of Medicine, Sohag University, Sohag, Egypt
Corresponding author: Ahmed Khalaf Gaber Ali,,Mobile:+201145488862

Fecal incontinence (FI) is a serious health, financial, as well as social problem. FI can be treated with
several different approaches. FI is characterized by the uncontrollable passing of feces and includes (1) solid feces; (2)
liquid feces; (3) soiling without any sort of sensation, warning, or trouble wiping it off is a passive FI;as well as (4)
coital FI. Furthermore, fecal urgency is the sudden, compelling, and difficult-to-defer need to defecate, while flatal
incontinence is the spontaneous loss of flatus. Objective: to detect the effect of electro-stimulation in the managing of
fecal incontinence in post colorectal surgery patients.
Patients and Methods: A total of 30 male patients experiencing fecal incontinence following colorectal surgery were
split up into two groups of 15, completely at random from the physical therapy out-patient clinic at Tahta General
Hospital in Egypt. The patients' ages ranged from 45 to 60. Group (A) (Control group): Composed of 15 patients with
fecal incontinence post colorectal surgery who received pelvic floor exercise and medical treatment for 3 months. Group
(B) (Experimental group): Composed of 15 patients with fecal incontinence post colorectal surgery who received pelvic
floor exercise and medical treatment in addition to electrical stimulation for 3 months.
Results: Group B had much substantial improvements in spontaneous as well as maximum contraction amplitude
compared to group A, and a significantly lower Vaizey Incontinence Score (p > 0.01). Conclusion: It could be
concluded that electrical stimulation has a significant improvement in management of fecal incontinence.
Keywords: Fecal incontinence, Electro-stimulation, Pelvic floor exercise, EMG, Vaizey Incontinence Score.

role as well lactose, fructose, and sorbitol. It's also worth
Fecal incontinence (FI) is a serious health,
noting that patients may be experiencing a combination
financial, and social problem because of the impairment
of symptoms due to the multi-factorial nature of FI(2).
it causes over time. FI can be treated with several
Pharmacotherapy, dietary and behavioral changes,
and conservative management options for FI include
Involuntary feces loss (FI) is characterized by a variety
dietary fiber supplements and behavioral changes like
of symptoms, such as (1) solid feces; (2) liquid feces;
scheduled toileting. Few studies have explored
(3) soiling without any sort of sensation, warning, or
prompted voiding as a FI treatment, and they have found
trouble wiping it off is a passive FI; as well as (4) coital
little benefit (3).
FI. A person with fecal urgency has an immediate and
Electrical stimulation, which causes the stimulated
strong need to defecate and cannot hold it in. Flatus
muscles to contract passively, is used to treat numerous
leakage involuntarily occurs in people with flatal
pelvic floor dysfunctions ( Pelvic floor muscles (PFM)
incontinence (1). Enteric material, which is sufficiently
or anal sphincters)(4). Pelvic floor muscle training
hard as well as bulky, a passively distensible reservoir
(PFMT) outlines a wide range of techniques aimed to
capable of being evacuated, as well as an efficient
improving pelvic floor as well as strength of the anal
barrier to outflow is the major components required for
sphincter, endurance, but also synchronization (5).
fecal continence. Therefore, FI can be caused by
The aim of current study was to assess the
alterations in the composition or volume of stool
effectiveness of electro-stimulation for treating fecal
delivered to the sphincter, a rectum that is too small to
incontinence following colorectal surgery.
hold stool, damaged function of the ano-sphincter or

diminished sensitivity (2). Therefore, diarrhea, reduction
in rectal compliance (e.g., ulcerative proctitis as well as
Thirty male patients havingFI post colorectal
radiation proctitis), damage to the anal sphincter (e.g.,
surgery;their ages ranged from 45 to 60 years,
trauma, obstetrical injury, as well as surgery), a
participated in this study for 3 months.Subjects were
diminished ability to experience rectal sensation (e.g.,
recruited from Tahta General Hospital in Egypt.
spinal cord injury, multiple sclerosis, as well as diabetes
Patients were randomly divided into two equal groups.
mellitus) are all common etiologies of FI(2).
Patients with FI following colorectal surgery who met
In addition to overflow incontinence, as a subset of
the inclusion and exclusion criteria (lack of cardiac or
fecal retention, as well as impaction are common causes
pulmonary disease, diabetes mellitus, other orthopedic
of FI. Medications (such as laxatives, anticholinergics,
constraints, psychological or neurological problems)
antidepressants, as well as caffeine), food intolerances,
participated in the study.
and psychosis with purposeful soiling may all play a
Management: Vaizey incontinence score:The higher
Received: 23/02/2023
Accepted: 25/04/2023

Full Paper (vol.921 paper# 149)

c:\work\Jor\vol921_150 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6455-6458

Hematological Effects of Antiviral Drugs for Hepatitis C Virus
Hesham Hamdy, Amal Shawky, Rasha Samir, Esraa Elsayed Ahmed Harhor
Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Egypt
*Corresponding author: Hamed Saad Badawy, Mobile: (+20) 01063458901, E-mail:

Direct-acting antivirals (DAAs) have replaced interferon-based therapies in the treatment of HCV
infection. Despite general success, treating some patient populations with antiviral medication is still difficult. Even
though serious adverse effects are uncommon, they can nonetheless occur, particularly in individuals with advanced
liver disease.
Objective: Our goal was to assess the haematological effects of antiviral medications in chronic HCV patients.
Patients and methods: The total number of patients included, were 50. Males represented 27 (54.0%) of total patients
and females represented 23 (46.0%). The mean age of the studied patients was 46.24 ± 9.67 years. All patients were
thoroughly examined, and full labs were obtained before start and 3 & 6 months after treatment.
Results: SVR was 100% in our research (P-value 0.001). Three- and six-months following therapy, there was a
statistically significant increase in mean corpuscular volume (MCV) and hematocrit (HCT) (P-values = 0.035 and 0.048,
respectively). Three months after starting therapy, haemoglobin levels rose, although the increases weren't statistically
significant (P-value = 0.719). Six months after starting therapy, haemoglobin showed a statistically significant
improvement (P-value = 0.019). Six months following the start of therapy, the platelet count increased statistically
significantly (P-value = 0.038). Six months following therapy, our study found statistically significant reductions in total
bilirubin (P-value = 0.001), ALT (P-value = 0.012), AST (P-value = 0.001), and AFP (P-value = 0.002).
Conclusions: Results indicated that the sofosbuvir-daclatasvir medication combination is safe for Egyptians and that it
plays a key role in the treatment of HCV with fewest side effects.
Keywords: Hematological, Antiviral drugs, DAAs, HCV.

patients were thoroughly examined and full labs were
The treatment choices for people with chronic
obtained before start and 3 & 6 months after treatment.
HCV infection have changed as a result of the

emergence of very effective all-oral, interferon-free
Exclusion criteria: Hepatitis B patients. Patients with
medicines, and the majority of patients may now
impaired kidney function (estimated GFR< 60%).
achieve viral clearance. With more than 95% efficacy,
Patients on Ribavirin. The patients do not have any
little side effects, and a brief 8­12 week treatment
hematological disease either acute or chronic,
hereditary or acquired.
Elbasvir/Grazoprevir, and Ledipasvir/Sofosbuvir have

All studied patients were subjected to:
recently gained popularity. This has improved cure rates
1. Complete history taking.
and treatment safety (1-3).
2. Comprehensive clinical assessment (general and
Despite general success, treating some patient
populations with antiviral medication is still difficult.
3. Abdominal U/S.
Even while serious adverse effects are uncommon, they
4. Routine laboratory investigations: (was done at the
are not entirely unheard of, particularly in individuals
start of the study and after 3 and 6 months):
with advanced liver disease, in whom ribavirin (RBV)
Complete blood picture.
use is nevertheless advised (4-5).
Peripheral blood film, Reticulocytic count
In controlled research, low rates of DAA-related
side effects have been documented; nonetheless,
LDH, and serum ferritin (when indicated).
investigations conducted in the real world have revealed
Liver function tests (AST, ALT, alkaline
new toxicities and drug-drug interactions in specific
phosphatase, total bilirubin, direct bilirubin,
groups (6-7). Our goal was to assess the haematological
prothrombin time, and S. albumin).
effects of antiviral medications in chronic HCV
Kidney function test (blood urea and serum

Ethical approval: Ain Shams Medical Ethics
This was a cross-sectional study that was conducted
Committee, Faculty of Medicine, Ain Shams
at HCV-treatment Unit of Ain Shams University
University gave its approval to this study. All
Hospital. The study was done through the period from
participants gave written consents after receiving all
February to August 2018.
information. The Helsinki Declaration was followed
The total number of patients included, were 50. Males
throughout the study's conduct.
represented 27 (54.0%) of total patients and females
Statistical Analysis
represented 23 (46.0%). The mean age of the studied
SPSS version 20.0 was used to tabulate and
patients was 46.24 ± 9.67 years (P-value = 0.443). All
statistically analyse the collected data. The mean ± SD
Received: 01/03/2023
Accepted: 30/04/2023

Full Paper (vol.921 paper# 150)

c:\work\Jor\vol921_151 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6459- 6463

Efficacy of Extracorporeal Shock Wave Therapy on
Shoulder Dysfunction Post Mastectomy
Maha Helmy Ammar Ahmed Elseody1*, Amal Mohamed Abd El Baky2 ,
Mahmoud Abdel Fattah Faried Nasef3, Khadra Mohamed Ali2
1* BSc., Faculty of Physical Therapy, Cairo University, Egypt.
2 Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Egypt.
3 Plastic and Burn Surgery, Faculty of Medicine, Al Azhar University, Egypt.
*Corresponding author: Maha Helmy Ammar Ahmed Elseody, Mobile: 01020537621, Email:

Post mastectomy shoulder pain can be severe enough to result in long-term difficulties, disrupt sleep, impair
the ability to carry out daily tasks, including using the affected arm, and result in frozen shoulder.
Objective: The aim of the current study is to assess the effectiveness of extracorporeal shock wave on shoulder dysfunction
post mastectomy.
Patients and methods: The study was conducted on 40 patients undergoing mastectomy between the ages of 40 and 65
who experienced shoulder pain and limited range of motion and were randomly split into two equal groups, each with 20
patients. Group A (Study group): For eight weeks, extracorporeal shockwave therapy (ESWT) was administered once a
week to 20 patients of females receiving traditional physical therapy three times per week. Group B (Control group): 20
female patients who got only traditional physical therapy three times a week with sham- shock wave once a week for eight
weeks were included in this group.
There was a significant increase in the measurement of passive range of motion for shoulder abduction, flexion,
external rotation and internal rotation in the post-treatment assessments compared to the baseline measurement (P<0.001)
and by comparing both groups, there were a statistically significant higher ROM in Group A than Group B (P< 0.001).
Also, a significant increase in the measurement of active ROMs for shoulder abduction, flexion, external rotation and
internal rotation in the post-treatment assessments compared to baseline measurement (P<0.001). Conclusion:
Extracorporeal shock wave therapy is more effective than conventional physical therapy in the treatment of patients with
shoulder dysfunction following mastectomy.
Extracorporeal shockwave therapy, Shoulder Dysfunction, Postmastectomy, Comparative study, Cairo


The complex shoulder girdle movements
Modified radical mastectomy involves complete
necessary for arm raising may potentially be impacted by
removal of the breast, the majority or all of the ipsilateral
the aftereffects of surgery or radiotherapy. Normally, the
axillary lymph nodes, and the lining over the chest
humerus and scapula move together smoothly and in
muscles are all completely removed during a mastectomy.
synchronicity (6).
In a radical mastectomy, every lymph node beneath the
The head of the humerus is kept in the glenoid
arm, along with the entire breast and the supporting chest
fossa throughout the movement by precise muscle firing
wall muscles (including the pectoralis major and minor
of the scapulothoracic and scapulohumeral muscles in
muscles), are removed (1).
response to sophisticated proprioceptive input (7).
There are many non-surgical treatment options
Joint synovial membranes thicken and stick to
for shoulder dysfunction, including thermotherapy,
articular surfaces as a result of shoulder adhesion, which
psychotherapy, electric percutaneous nerve therapy,
causes discomfort to progressively worsen and joint range
ultrasound therapy, manual therapy, and taping therapy.
of motion to gradually deteriorate. Even though frozen
Extracorporeal shockwave therapy (ESWT) has recently
shoulder does not itself result in neurogenic muscle
gained attention (2).
weakness like cervical radiculopathy, it does cause pain,
Many women who had breast cancer mastectomy
reduce external rotation of the shoulder joint, decrease
endure shoulder movement limitation thereafter, which
flexibility and elasticity, and make daily activities
can seriously impact their daily lives and quality of life (3).
challenging due to the associated joint fibrosis and
Shoulder limitation and disability are about six
chronic inflammation (8).
times more prevalent in women who have undergone
ESWT is a technique of treatment that involves
mastectomy (4). Despite more advanced surgical methods
the application of extracorporeal shock waves to lesions
and after care, discomfort and functional limitations
in order to promote revascularization and stimulate or
continue to be issues for individuals who have breast-
reactivate the repair of bones and connective tissues,
conserving surgery (5).
Received: 23/02/2023
Accepted: 25/04/2023

Full Paper (vol.921 paper# 151)

c:\work\Jor\vol921_152 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6464- 6471

Comparison of Interleukin 15 gene Expression in Vaccinated Individuals (Pfizer ­
AstraZeneca- Sinopharm) Vaccines and Critical COVID-19 Iraqi patients
Ali J. Mankhi* and Lubna M. Rasoul
Department of Biology, College of Science, University of Baghdad, Baghdad, Iraq
Corresponding author: Ali J. Mankhi, email:, Mobile: +9647737951495

The cytokine interleukin-15 is widely known for helping natural killer cells and CD8 T cells development and
maintain homeostasis, but recent research reveals that IL-15 also mediates the antiviral responses of both cell types during
an active immune response.
Aim of the study: study Interleukin-15 gene expression in vaccinated individuals (Pfizer Sinopharm and AstraZeneca
vaccines) and critical cases infected with COVID-19 in Iraqi individuals, for the purpose of investigating the role of IL -
15 gene in determining the immune response in vaccinated individuals (Pfizer ­ AstraZeneca- Sinopharm vaccines) and
COVID-19 patients.
Study design: This study was conducted between the period from January and March 2022. A total number of 179 (male
and female) blood samples were collected from Ibn AI-Khatib Hospital and health centers (AL-Sindibad health center,
AL Rasheed health center and other places). Immunological assay for evaluation of anti-COVID-19 IgG and IgM was
accomplished by ELISA technique. Molecular analysis was achieved by real time PCR to confirm our results by detecting
of IL-15 gene levels.
Results: Showed that the Sinopharm, BioNTech and AstraZeneca vaccines groups exhibited the highest neutralization
potential compared to the unvaccinated controls. The results indicated that Sinopharm vaccines generally induced the
highest amounts of SARS-CoV-2 reactive IgM and IgG compared to other vaccines (7.31 ± 1.52) IgM and (38.84 ± 26.35)
IgG P -value (0.001). The critical patient showed a highly significant difference between males and females of IgM P- value
(0.002). The patients had the highest IgM production in males. The Sinopharm vaccine had the highest productivity of IgG
in the two groups compared to Pfizer and AstraZeneca vaccine. The critical patient, Sinopharm vaccine and AstraZeneca
vaccine showed significant difference between (41-70) (21-40) groups of IgM. The critical patient showed a highly
significant difference between males and females of IgG P- value (0.006). The patients had the highest IgG production in
males. The critical patient and Pfizer vaccine showed significant difference between (41-70) (21-40) groups of IgG. The IL-
15 gene showed no effect with COVID-19.
Conclusion: The study showed that Pfizer, Sinopharm and AstraZeneca vaccines produced IgM and IgG against COVID-
19 in terms of age and gender compared to the unvaccinated individuals, with no effect of the booster dose compared to the
second dose.
Keyword: SARS-CoV-2, IgG, IgM, Real-Time PCR, IL-15 gene.

membrane (M), and envelope (E). When a virus enters the
The pandemic has swiftly expanded after the first
body and forms envelopes, protein M is essential (3).
COVID-19 cases were found in China in December 2019.
The virus reproduces, germination, forms an
By February 22, 2022, there had been more than 426
envelope, and disseminates due to protein E (4). Increased
million cases of COVID-19, which was brought on by the
viral transcription and assembly are caused by the
SARS-CoV-2 virus, and more than 5.8 million fatalities
multifunctional N protein (5). The virus attaches to host
(1). Virion-like organisms with viral envelopes are
cells thanks to the spike (S) protein as well. It thus
coronaviruses (CoVs). These virion particles have a 120
occupies a unique place in the study of medications and
nm diameter. The virus's surface is covered in
vaccinations. It is important to note that because proteins
glycoproteins and proteins that form cloverleaf structures,
N, M, and E do not respond to neutralizing or
which give the virus a crown-like appearance. Because of
immunological antibodies, they are not considered to be
their crown-like form, these viruses are also referred to as
therapeutic targets (6).
coronaviruses. These viruses contain genetic material
The BNT162b2 vaccine from Pfizer-BioNTech is an
inside a region known as the nucleocapsid, which is
mRNA vaccine included in a lipid nanoparticle
formed of capsid-coated proteins (2). RNA genomics
formulation. The prefusion S glycoprotein of SARS-
belongs to the genus coronavirus. In the virus's
CoV-2, the virus that causes COVID-19, can be encoded
nucleocapsid, this genetic material appears as a spiral or
by the Pfizer vaccine (7). The ideal temperature for this
circular structure (3). The four structural proteins of the
vaccine to be kept at with a high level of efficiency is -70
SARS-CoV-2 virus are nucleocapsid (N), spike (S),
°C, although creating such an environment is difficult (8).
A collaboration between the German Biotechnology
Received: 16/7/2022
Accepted: 18/9/2022

Full Paper (vol.921 paper# 152)

c:\work\Jor\vol921_153 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6472- 6479

Impact of Betanin on Diabetes Induced Experimentally by Streptozotocin and
Associated Histopathological Changes in Albino Adult Rats
Mohamed Ali Mahmoud Abbas (1), Fayez Mohammed Abd Elfattah Elbayoumy (2),
Fawzy Mahmoud Abou Galala(3)
(1) Department of Medical Physiology, Damietta Faculty of Medicine, Al-Azhar University, Egypt.
(2) Department of Anatomy and Embryology, Faculty of Medicine (Boys), Al-Azhar University, Cairo, Egypt.
(3) Department of Anatomy and Embryology, Damietta Faculty of Medicine, Al-Azhar University, Egypt
Corresponding author: Mohamed Ali Mahmoud Abbas, Mobile: (+20) 01002561051, E-Mail:
The endocrine problem diabetes mellitus is the most prevalent condition. Over time, the heart and blood
arteries become among the tissues and organs that are negatively impacted by this medical disease. Beets' anti-
inflammatory, antioxidant, anti-tumor, high pressure-lowering, neuroprotective, and immune-modulating advantages
are equivalent to those of pharmaceuticals.
Aim of the work: Analyzing the effects of betanin on experimentally generated diabetes and related Histopathological
Alteration in Adult Albino Rats.
Material and Methods: Rattus norvegicus albino adult males were separated into four equal groups, as follows:
Group I functioned as the control group, Group II was the diabetic group, Group III was the normal plus betanin, and
Group IV was the diabetic group that had been given betanin therapy. The samples of blood have been collected at the
completion of the study's period to be investigated blood glucose levels, glycated haemoglobin, serum insulin, alanine
amino transferase (ALT), aspartate amino transferase (AST), lipid profiles, malondialdehyde (MDA), tumour necrosis
factor alpha (TNF), catalase, nuclear factor Kapp, lactate dehydrogenase, interleukin 1 and interleukin 6.
Additionally, liver and pancreas samples were taken for a histopathology investigation.
Results: The drug streptozotocin (STZ) substantially increased levels of blood sugar, glycated haemoglobin,
cholesterol, alanine amino transferase, aspartate amino transferase, malondialdehyde, TNF, lactate dehydrogenase,
nuclear factor kappa, IL-1, and IL-6 while substantially reducing levels of serum insulin and catalase. All levels
substantially improved after receiving betanin treatment.
Conclusion: Due to its antioxidant properties, betanin has a preventive impact on diabetic rats.
Keywords: Betanin; Streptozotocin; Histopathological; Albino; Diabetes.

which comes in a variety of grown forms and is the
Diabetes mellitus (DM), an extremely
most well-known, is one of its distinguishing
complicated long-term disorder, is distinguished by an
characteristics. Raw, baked, boiling, or juice extraction
illness of persistently elevated glucose levels spurred on
are all acceptable ways to consume beets. Red beets
by irregularities in the function of insulin, production,
were fantastic when grilled pickled, in dishes such as
or both, and it also causes a variety of deterioration in
salads or made into soup, making them a popular meal
the absorption and utilization of carbohydrates, lipids,
in many countries in Eastern and Central Europe (4).
and proteins (1).
Beta vulgaris, also known as betanin, represents
Diabetes mellitus (DM), which is among the
one of the greatest cultivated vegetables in the world.
most essential medical conditions, has adverse effects
Running efficiency and training endurance can both be
that degrade the patient's quality of life. Nowadays, a
improved by beetroot (5).
lot of people are struggling with DM. The increased
Additionally, it is employed to manage
prevalence and seriousness of complications related to
hypertension (6) and possesses antibacterial, antiradical,
diabetes brought on by insufficient care and high blood
or cytotoxic effects (7). As a result, it might have
sugar levels that persist are the key contributors to the
hepatoprotective and anti-diabetic effects (8).
rising rates of illness and death seen among people with
The conclusion of Abedimanesh et al. (2) is
this disease., which results in disturbances in metabolic
reinforced by findings of the current research, which
functions like sugar, lipid, and protein utilization. The
suggested that betanin that is had a protective impact
primary pathogenic risk factors for diabetes mellitus
contrary to diabetes outcomes in the diabetic rats
have all been identified as inflammation, oxidative
induced by STZ. The mechanisms explaining this
stress, inflammatory factors, and immunological
finding involve diminished high blood sugar levels,
reactions, although the actual etiopathogenesis of the
hyperlipidemia, and tests for liver function, as well as
condition is still not entirely known (2).
enhanced liver and tissue from the pancreas
Diabetic microangiopathy develops because of
functionality. It has been discovered that the
the degenerative alterations that DM led to thickening
mechanisms through which betanin produces these
the vascular basement membrane, produces in the
encouraging effects are the nuclear factor kappa B,
microvasculature (3). In the family Chenopodiaceae,
sirtuin-1, and 5 adenosine monophosphate activated
Beta vulgaris is a plant. Beetroot (betanin), often known
as table garden beetroot, is a purple root vegetable.,
investigation's goal was to assess how beetroot affected
Received: 02/05/2022
Accepted: 22/07/2022

Full Paper (vol.921 paper# 153)

c:\work\Jor\vol921_154 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6480- 6487

Plasma Osteopontin Level and Nonalcoholic Fatty Liver Disease in
Patients with Type 2 Diabetes Mellitus
Mahmoud Rizk*, Mohamed Ahmed El Assal, Mohammed Awad Sakr,
Ahmed Refaat Mohammed, Mohamed Abd Ellatif Afifi
Department of Internal Medicine, Faculty of Medicine, Benha University, Benha, Egypt
*Corresponding author: Mahmoud Rizk, Mobile: (+20) 01117454801, E-mail:

Type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) are frequently linked.
NAFLD has grown to be a major health problem. A glycoprotein called osteopontin (OPN) has been linked to the
aetiology of NAFLD.
This study aimed to determine if there is a connection between the level of plasma OPN and the
occurrence of NAFLD in people with T2DM.
Patients and Methods:
This case-control study was conducted in the outpatient clinic of Internal Medicine
Department at Benha University Hospital through the period between November 2022 and April 2023. It included 138
participants divided into three groups: Group 1 included 46 patients with NAFLD and T2DM, group 2 included 46
patients with NAFLD without T2DM, and group 3 that contained 46 healthy individuals as control group.
There were significantly higher plasma OPN concentrations in both groups 1 and 2 than in group 3. OPN
levels were higher in group 1 compared to group 2. A positive correlation was found between OPN and body mass
index (BMI) in both NAFLD groups. In group 2, plasma OPN correlated positively with uric acid and high-density
lipoproteins (HDL) levels, while a negative correlation was observed with systolic blood pressure (SBP).
Patient's with NAFLD and T2DM had higher plasma OPN levels more than those without diabetes who
have NAFLD. Additionally, our study showed a favorable association between plasma OPN level and BMI, uric acid
(UA), and HDL, suggesting that plasma OPN may have a role in the adjustment of the metabolic state.
Keywords: Osteopontin, NAFLD, Type 2 diabetes mellitus.

NAFLD and T2DM, and their interaction may lead to
One of the most common causes of chronic liver
22 an increase in both hepatic and diabetic mortalities
disease (CLD) in the globe is NAFLD. In the absence
in cases with concurrent NAFLD and T2D (5).
of alcohol misuse, drug adverse effects, or viral
The crucial role of OPN in cell signaling,
hepatitis, NAFLD is characterised by an increased
including the control of cell proliferation, migration,
intrahepatic triglyceride (TG) concentration, with or
inflammation, fibrosis, and tumour growth, has been
without inflammation and fibrosis (1).
well studied. OPN may have a role in the development
Steatosis alone, which is often benign, can
of NAFLD and NASH, according to earlier
advance to steatohepatitis, which has inflammation and
investigations. In morbidly obese people, elevated
fibrosis, followed by cirrhosis, liver failure, and in rare
OPN expression in the liver substantially linked with
circumstances, hepatocellular cancer. Obesity, DM,
steatosis and insulin resistance (6). Our study aimed at
and metabolic syndrome are frequently linked to
determination if there is a connection between the
NAFLD. It is regarded as a component of the
level of plasma OPN and the occurrence of NAFLD in
metabolic syndrome as well (2).
people with T2DM.
T2DM is characterised by hyperglycemia brought

on by a variety of pathophysiological elements, most
notably insulin resistance and insufficient insulin
This study was conducted in the outpatient clinic
production. Diabetes patients are more likely to
of Internal Medicine Department at Benha University
experience accelerated atherosclerosis, which can lead
Hospital through the period between November 2022
to coronary artery disease, peripheral artery disease,
and April 2023. It included 138 participants divided
and cerebrovascular diseases, all of which have a
into three groups. Group 1 included 46 cases with
significant negative impact on morbidity and
NAFLD and T2DM, group 2 included 46 cases with
NAFLD without T2DM, and group 3 contained 46
Diabetes is expected to be substantially more
healthy subjects as control group.
common in NAFL and nonalcoholic steatohepatitis

(NASH) patients than in the general population
Inclusion criteria: Patients aged 18 years,
(8.5%), with prevalence rates of 22.51% and 43.63%,
diagnosed patients with NAFLD by abdominal
respectively (4).
ultrasonography based on World Gastroenterology
Organisation Global Guidelines (7).
fibrogenesis, and carcinogenesis in different tissues are

all strongly hypothesised to play a role in the complex
Exclusion criteria: Patients with secondary causes of
bidirectional association between the progression of
liver steatosis (7). Patients who have gestational
Received: 01/03/2023
Accepted: 30/04/2023

Full Paper (vol.921 paper# 154)

c:\work\Jor\vol921_155 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6488- 6491

Central venous Catheters Indications and Complications: Review Article
Maha Hamed Mohamed Abdelrahim, Waleed Adel Ahmed Salama, Mahmoud Ahmed Mosa Mohamed
Department of Anesthesia, Intensive Care and Pain Management, Faculty of Medicine, Sohag University, Egypt
Corresponding author: Maha Hamed Mohamed, Mobile: (+20) 01029012925, E-mail:

Background: Dr. Werner Forssmann used a ureteric catheter to enter the right side of the heart through his cubital
vein to create the central line, also known as central venous catheterization, in 1929. Since then, the central line
technology has improved steadily and is now required for many critical patient indications, including parenteral
nutrition, drug administration, hemodialysis, and rapid fluid resuscitation for the shocked. Central lines come in a
wide variety of sizes, locations, and types. Additionally, we should remember that there are a lot of potential issues
with the central line.
Objective: Study of the indications and possible complications of central venous catheter.
Methods: CVC, Cannula insertion, Pneumothorax, infection, Bleeding, and Complications were the search phrases
utilised in PubMed and Science Direct searches. After meticulous reviewing, references from the applicable literature,
including all renowned research and reviews were included as well as the most current or complete study conducted
between August 2003 and March 2023.
Conclusion: There are many sites possible for central line insertion, several indications, and the benefit of ultrasound
guidance to avoid many possible complications.
Keywords: CVC, Cannula insertion, Pneumothorax, Infection, Bleeding, Complications.


Until its terminal lumen is located within the

superior vena cava, inferior vena cava, or right atrium,
3- Implanted ports
a central venous catheter (CVC) is placed into a major,
They are favoured for long-term usage because
central vein (internal jugular, femoral, or subclavian).
they produce superior aesthetic outcomes and are less
In 1929, a CVC was positioned for the first time.
prone to infection than both tunneled and non-tunneled
Central venous access evolved over the ensuing

decades into a vital tool for understanding cardiac
catheters. The issue with implanted ports is that they
physiology as well as a vital line for parenteral
need to be installed surgically, which involves more
feeding, haemodialysis, and numerous drugs. The site
time and expertise (2).
of catheter insertion should be chosen to have a low

risk of thrombosis, infection, and mechanical issues.
4- Dialysis catheters
Since the femoral vein has a higher likelihood of
Hemodialysis and continuous renal replacement
thrombosis and infection compared to other sites, it
procedures both use dialysis catheters (3). Both are
should be avoided (1).
utilised for blood filtration, often in cases of acute

renal damage, fluid overload, or sepsis. Metabolic
Catheter types:
acidosis, hyperkalemia, the use of certain medications
The kind and length of the proposed therapy determine
(salicylates, lithium, isopropanol, and ethylene glycol),
the catheter's choice and selection.
uremia, and when the serum creatinine is more than 10

mg/dL are some other reasons for dialysis (4).
1- Non-tunneled catheters
Heparin is needed to prevent clots from forming in the
The majority of the time, untunneled catheters are
big bore central lines used for hemodialysis, which can
utilised and observed in emergency and urgent
also be tunneled for long-term usage (2).
circumstances. As it's straightforward and simple to

insert. Non-tunneled catheters are only effective for a
5- Peripherally inserted central catheters (PIC)
brief period of time. They need to be removed as soon
An upper arm vein is used to enter a peripherally
as possible to avoid issues like thrombosis or
inserted central catheter, which is subsequently
infections (2).
directed into the superior vena cava on the right side of

the heart. It can stay in place for several weeks to
2- Tunneled catheters
months (2). They are recommended when a patient
When intravenous access is required more than
requires intravenous administration of antibiotics or
once over the course of a month, tunneled catheters are
chemotherapy medications while maintaining the
utilised. Compared to non-tunneled catheters, they had
integrity of the peripheral vascular system (4).
a decreased infection rate (2).

Received: 01/03/2023
Accepted: 02/05/2023

Full Paper (vol.921 paper# 155)

c:\work\Jor\vol921_156 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6492- 6500

Association of Serum Level of Bisphenol A with Polycystic Ovary
Syndrome and Its Impact on Its Hormonal Profile
Essam A. Amin1, Ahmed Nabil Abdelhamid1, Tarek Mohammad Sayyed1,
Ahmed Kamal Mohammed*2, Thoria Ahmed Omar3
Departments of 1Obstetrics and Gynecology and 3Clinical Pathology, Faculty of Medicine, Menoufia University, Egypt
Department of 2Obstetrics and Gynecology, Damanhour National Medical Institute, Egypt
*Corresponding author: Ahmed Kamal Mohammed, Mobile: (+20) 01012203352, E-mail:

Bisphenol-A (BPA) may have a part in the aetiology of polycystic ovary syndrome (PCOS), or
polycystic ovarian syndrome. BPA concentrations in biological fluids have been reported to be greater in PCOS
women, and blood BPA levels in premenopausal women were associated with hepatic steatosis and indicators of
low-grade inflammation.
Objective: This research aimed to determine the relationship between blood levels of Bisphenol-A, an endocrine
disrupting substance (EDC), and PCOS as well as its effects on the hormonal profiles of the PCOS group in
comparison to the healthy control group.
Subjects and methods: This cross-sectional study was carried out on 60 female participants who were selected from
Outpatient Clinic of Obstetrics and Gynecology at Menoufia University Hospital and Damanhour National Medical
Institute The General Organization of Teaching Hospitals and Institutes through the period from August 2021 to
January 2023. Results: The cutoff value of BPA sera levels in PCOS group was 12.50, with Sensitivity of 95% and
Specificity of 85% at AUC of 0.590.
Conclusion: BPA sera levels was correlated with different gynecological complications like infertility, abnormal
uterine bleeding (AUB), hirsutism and different metabolic complications like DM and chronic HTN as a secondary
outcome in PCOS group.
Keywords: BPA, Hormonal profile, Infertility, PCOS.

water pipes [8]. BPA is a substance known as an
The most prevalent endocrinopathy in
endocrine disruptor chemical (EDC) because of its
premenopausal women is PCOS. Despite the fact that
estrogenic qualities, which indicates that it alters
the aetiology of PCOS already encompasses a
functions of the endocrine system and consequently
complex combination of genetic and epigenetic
causes adverse effects in an intact organism, or its
variables, medical and scientific understanding of the
progeny, or (sub)populations [9]. It has been shown and
issue is still insufficient [1, 2].
extensively discussed that BPA affects a wide range of
The presence of any or all of the following
cells both through conventional signaling (oestrogen
symptoms, including irregular menstrual cycles
receptors: ER and ER) and through unconventional
(amenorrhea or oligomenorrhea), an excess of
pathways [10].
androgen, anovulation that result in infertility, and
Furthermore, current research has emphasised
polycystic ovaries as seen on ultrasound, is required to
its possible contribution to the aetiology of PCOS [11].
diagnose this heterogeneous disease [3]. Additionally,
The gonadotropin-releasing hormone (GnRH) pulse
PCOS sufferers experience higher rates of weight gain
generator may be activated by hypothalamic BPA
and obesity prevalence, which makes the problem
exposure, which may then enhance luteinizing
more severe, causes great concern for people who are
hormone (LH) and reduce follicle-stimulating
affected, and necessitates attention to a healthy
hormone (FSH) production by the pituitary and induce
lifestyle [4]. PCOS has the potential to have
ovarian hyperandrogenism [12].
detrimental effects, such as an increased risk of
Additionally, androgen synthesis in ovarian
endometrial hyperplasia and neoplasia [5].
theca cells may be directly stimulated by BPA,
It has been demonstrated that environmental
resulting in hyperandrogenemia and consequent
endocrine disruptors (EEDs) can alter how the
hyper- estrogenemia. BPA concentrations in
biological fluids have been discovered to be greater in
hormones. EEDs are therefore intended to function as
PCOS women, and blood BPA levels in
steroid-agonists and/or antagonists. Previous research
premenopausal women have been linked to hepatic
also suggested a link between PCOS and prior EED
steatosis and indicators of low-grade inflammation [13].
exposure, as well as with alterations in environment
Therefore, the goal of our investigation was to
and way of life [6].
determine whether there was a relationship between
One of the most prevalent plasticizers is BPA,
serum BPA concentrations as an EDC and PCOS as
which may be found in a number of everyday items
well as how it affected the hormonal profile of the
such as food packaging, cans, electronics, dental
PCOS group in comparison with the healthy control
sealant materials, carbonless receipts, eyeglasses, and
Received: 01/03/2023
Accepted: 02/05/2023

Full Paper (vol.921 paper# 156)

c:\work\Jor\vol921_157 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6501- 6507

Comparison between Fetal Fibronectin Versus Ultrasonographic
Assessment of The Cervical Length in Patients with Unfavourable Cervix in
Prediction of Successful Induction of Labor
Waleed M. Khalaf, Ayman A Abulnour*, Mohamed E. Mohamed,
Hytham M Elhamy , Abdelrhman Mohamed Saleh
Obstetrics and Gynaecology Department, Faculty of Medicine, Ain Shams University
Corresponding Author: Waleed M. Khalaf, Email:,
Mobile: +201226274935/ +966552165630

When the advantages of delivery for the mother or the foetus outweigh the hazards of continuing the
pregnancy, labour should be induced.
Objective: The purpose of the study was to examine the effectiveness of foetal fibronectin (fFN) and transvaginal cervix
ultrasonography in predicting successful labour induction for unfavourable cervixes (Bishop score 5 or below).
Subjects and Methods: In the Maternity Centre, Faculty of Medicine, Ain Shams University, a prospective study was
carried out. Patients in this study were selected from those attending in Obstetrics Outpatient Department who were
nullipara pregnant women. 40 women were assessed for study eligibility and fulfilled all inclusion criteria.
Results: Mode of delivery had a significant correlation with Bishop score, while there was no discernible correlation
between delivery method and transvaginal ultrasound. The bishop score was significantly correlated with fFN, all the
cases with bishop 3 were negative fFN. The OSS showed insignificant relation with fFN. Also, there was no significant
difference between negative and positive fFN regarding cervix (CX) length. The sensitivity of CX in prediction of
successful labor induction occurring within 24 hours at cut off value of 3.11 was 50.0% and the specificity was 53.2%,
and the accuracy was 51.1%. The Bishop score at cut off value of 4.0, the sensitivity was 60%, specificity was 64.5%
and the accuracy was 62%. The sensitivity of fetal fibronectin in prediction of successful labor induction occurring
within 24 hours at cutoff value 1.56 was 85%, the specificity was 80% and the accuracy was 82.6%.
Conclusion: Although transvaginal cervical length measurement provides an objective way to evaluate the cervix when
the Bishop score is equivocal, it may not be able to predict failed inductions with enough accuracy but it can help identify
women who are at risk for caesarean delivery. fFN showed a highly significant sensitivity, specificity and accuracy to
predict the successful induction of labor .
Fetal fibronectin, Ultrasonography, Unfavourable cervix, Induction, Labor, Cervical length, Nulliparous.


When the advantages of delivery for the mother and
The possibility that nulliparous women undergoing
foetus outweigh the hazards of continuing the
labour induction will make progress is independently
pregnancy, we induce labour. Many recognised
predicted by transvaginal sonographic assessments of
cervical length. These findings firmly establish that
chorioamnionitis and oligohydramnios, as well as
preinduction cervical length in nulliparous women
maternal medical conditions, such as hypertensive
undergoing labour induction significantly influences
labour progression only during the latent period of
hypertension, diabetes mellitus, renal disease, chronic
labour, not the active phase (7).
pulmonary disease, etc., all are indications for labour
It is not recommended to use the Bishop score to
induction (1) .
determine whether to induce labour because it is a poor
When labour is induced yet the cervix is
predictor of the results of doing so at term (8).
unfavourable, there are between 22% and 24% more
Large glycoprotein known as fibronectin, with a
caesarean sections performed (2, 3). Preinduction Bishop
molecular weight of roughly 420 kDa, is often found in
score is the only technique now used to anticipate if a
virtually all tissues and bodily fluids. Its main functions
successful vaginal birth will result from an induced
are in phagocytosis and cell adhesion (9).
labour (4).
Foetal fibronectin (fFN) is a glycoprotein that is
Within seven days, sonographically measured
infrequently present in cervicovaginal secretions in the
cervical length and fetal fibronectin (fFN) in
late second and early third trimesters and serves as an
cervicovaginal secretions show potential in predicting
adherent at the maternal-fetal interface. Despite the fact
premature birth according to growing data (5).
that foetal fibronectin has only been studied as a
Numerous researches assessed the accuracy of
qualitative test, with a result of 50 ng/dL or higher being
using sonographic cervical length evaluation to gauge
considered positive, the risk for preterm birth grows as
how well a labour induction will go. It is still unknown
the level of foetal fibronectin rises . A positive test
how ultrasound examination would be used to choose
typically indicates that the maternal-fetal decidual bond
women who will have effective inductions (6).
has been broken. A positive foetal fibronectin test was

observed to increase the chance of preterm birth before
Received: 07/03/2023
Accepted: 04/05/2023

Full Paper (vol.921 paper# 157)

c:\work\Jor\vol921_158 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6508- 6513

Comparison between Therapeutic Ultrasound and Laser Therapy in
Treatment of Plantar Fasciitis Diagnosed by Ultrasonography
Maha Arafa Ali*, Abeer Fikry A. Eldawoody, Abdelmoaty Ali Afifi
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Mansoura University, Egypt
*Corresponding Author: Maha Arafa Ali, Mobile: (+20)01069134357, Email:

Background: The majority of people who experience pain in the plantar surface of their heel have plantar fasciitis
(PF). Patients who suffer from chronic plantar fasciitis have access to a variety of additional treatment options, such as
extracorporeal shockwave therapy, ultrasound (US) therapy, low-level laser therapy, and surgical plantar fasciotomy.
Objective: This study aimed to evaluate the efficacy of therapeutic US in comparison with laser therapy in plantar
fasciitis treatment.
Methods: This prospective randomized clinical study included 56 patients diagnosed as plantar fasciitis. The patients
were divided into two groups according to the treatment they received. Group (1) had 28 patients who were treated by
laser therapy (scanning method), with 808 nm wavelength. The area is irradiated in 3 points over 3 cm2 three times
weekly for 2 weeks and group (2) had 28 patients who were treated by ultrasound therapy at a frequency of 3 MHZ in
a pulsed mode (1;4) for eight minutes (min) at an intensity of 0.5W/cm2 three times weekly for 4 weeks. Hamstrings
and calf muscles were stretched.
Results: The Mayo score, the foot and ankle ability and the foot function index pain subscale (FFI-P) thad
significantly improved in both groups four and eight weeks after treatment in comparison with the baseline and at 8
weeks compared to 4 weeks. The improvement was significantly higher in the laser therapy at 8 weeks after treatment.
The plantar fascia thickness (PFT) decreased significantly in both groups 4 and 8 weeks after treatment compared to
the baseline and at 8 weeks compared to 4 weeks.
Conclusion: When it comes to the treatment of PF, it has been demonstrated that laser therapy, specifically the
scanning method, when combined with stretching exercises, is more effective than traditional ultrasound.
Keywords: Therapeutic ultrasound, Laser therapy, Plantar fasciitis.

plantar fasciitis (5). Ultrasonography (US) is an
accurate, easy, and quick method for identifying
The human foot is a terminal portion of the limb
plantar fascia thickness (PFT). It is of great importance
that supports the body's weight and enables movement.
to detect the normal thickness of the planter fascia, as
It is a strong and complicated mechanical structure (1).
increased PFT and hypoechogenicity are sonographic
It is a dense, fibrous, connective tissue structure that
features of plantar fasciitis (6).
originates from the medial tuberosity of the calcaneus,
Ultrasound (US), is a mechanical form of energy,
and it is known as the plantar fascia. It is divided into
which has been used to hasten the rate at which the
three parts: the medial, lateral, and central parts (2).
injured tissue heal and improve the overall quality of
Plantar fasciitis (PF) is a degenerative state, which
that healing. The most common form of conventional
happens when the plantar fascia is subjected to
therapeutic ultrasound is characterized by low energy,
compressive forces as a result of repeated trauma. This
pulses of long duration, and diffuse form. This type of
causes the foot's longitudinal arch to become flattened.
ultrasound warms the soft tissue that is located under
The gait on support phase is characterized by traction
the ultrasonic beam (7). Plantar fasciitis can also be
forces, which, when combined with inflammation, can
treated with laser therapy, which is a non-invasive
lead to fibrosis and degeneration. Plantar fasciitis is the
treatment that does not cause any discomfort. Low
most frequent cause of heel pain, representing eighty
level laser therapy is assumed to hasten the healing
percent of all instances. People between the ages of 40
process of wounds, along with reducing pain and
and 60 are the ones who are most likely to be affected
alleviating inflammation (8).
by it (3).
The aim of the current study was to evaluate the
Overuse of the plantar fascia, activities such as
efficacy of therapeutic US in comparison with laser
ballet jumping, long distance running, long periods of
therapy in PF treatment that has been clinically
standing, overweight, pregnancy, and athletes are all
diagnosed as well as confirmed by ultrasonography.
predisposing factors for plantar fasciitis, but the exact

cause of plantar fasciitis is still unknown. On the other
hand, the predisposing factors that lead to plantar
This prospective randomized clinical study
fasciitis include those things. The patient typically
comprised 56 cases with plantar fasciitis recruited
suffers from pain on the medial side of the plantar
from Rheumatology and Rehabilitation Outpatient
heel, and this pain is typically worse during the
Clinic at Mansoura University Hospitals, Egypt.
patient's initial few steps after waking up (4). Near the
Patients were clinically diagnosed as plantar fasciitis
origin of the central band of plantar aponeurosis at the
according to Clinical Practice Guidelines for Heel Pain
medial plantar tubercle is the typical location of pain in
and Plantar Fasciitis (9) .
Received: 08/03/2023
Accepted: 07/05/2023

Full Paper (vol.921 paper# 158)

c:\work\Jor\vol921_159 The Egyptian Journal of Hospital Medicine (July 2023) Vol. 92, Page 6514- 6518

Health Status Using (SF)-36 Questionnaire in Postpartum Women with
Placenta Accreta Spectrum: A Prospective Study
Sherif Badran*, Ezzat Hamed, Bishoy Atef, Mostafa Elsonbaty, Mohammed Farouk
Department of Obste